OB practice questions
PPH is defined as blood loss > _____ after vaginal delivery or ____after C-section
500; 1000 mL
Karen has continued bleeding during the fourth stage with a contracted uterus, the cause is most likely to be:
Cervical and perineal Lacerations
What complication may be indicated by continuous seepage of blood from the vagina of a PP patient, when palpation of the uterus reveals a firm fundus, 1 cm below the umbilicus?
Cervical laceration
Method of heat loss from a cold surface
Conduction
Patients with gestational diabetes are usually managed by which of the following therapies? A. Diet B. Long acting insulin C. Oral hypoglycemic drugs D. Oral hypoglycemic drugs/insulin
A.
Placenta does not penetrate the uterine muscle
Accreta
The optimum time to initiate lactation is:
As soon as possible after the infant's birth
A woman in her 8th month of pregnancy is having dinner with her husband at their favorite restaurant. The women suddenly chokes on a piece of chicken and appears to lose consciousness. What would be the best action by a nurse sitting at the next table?
Begin CPR
nonshivering thermogenesis
brown fat
The primary source of heat production in the term neonate is:
brown fat metabolism
Connects the pulmonary artery with descending aorta
ductus arteriosus
Dry the neonate immediately after birth to decrease heat loss due to:
evaporation
During your initial assessment you notice a bluish marking across the newborn's lower back. You recognize that this finding is:
frequently seen in dark-skinned newborns
upper portion of the uterus
fundus
Collection of blood in the vagina or perineal area
hematoma
fine downy hair of newborn infant
lanugo
Decreased tone of the uterine muscle
uterine atony
Covers the fetus in pregnancy, protects the skin
vernix
A pregnant patient in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with diagnosis and assess the patient for:
Evidence of bleeding, such as in the gums, petechiae, and purpura.
The nurse is planning care for a 16 yo in the prenatal clinic. Adolescents are prone to which complication during pregnancy?
Iron deficiency anemia
Assessment tool for evaluating breastfeeding
LATCH
Greater than 4,000 grams
LGA
Which of the following medications administered to the patient with gestational diabetes mellitus and experiencing preterm labor requires close monitoring of the patient's blood glucose levels?
Magnesium Sulfate
What is the best method to monitor a fetus of a patient with diabetes starting at 36 weeks?
NST weekly
What hormone is responsible for the afterpains experienced during postpartum:
Oxytocin
Must be given within 72 hours if Rh Negative
Rhogam
T/F Atonic bleeding is due to a lack of tone in the uterus
True
Blood loss from a normal vaginal delivery should NOT exceed:
500 mL
Which of the following nursing actions are directed at promoting bonding (SELECT ALL THAT APPLY) A. providing opportunity for parents to hold their newborn as soon as possible following birth B. providing opportunity for the couple to talk about their birth experience and about becoming parents C. promoting rest and comfort by keeping the newborn in the nursery at night D. providing positive comments to parents regarding their interactions with their newborn.
A, B, D
Which of the following physiological responses is considered normal in the early postpartum period? A. urinary urgency and dysuria B. rapid diuresis C. increase in BP D. increase motility of the GI system
B. Rapid diuresis
A patient who is 32 weeks pregnant is being monitored in the antepartum unit for chronic hypertension with superimposed pre-eclampsia. She suddenly complains of continuous abdominal pain and vaginal bleeding. Which of the following nursing interventions should be included in the care of this patient? Select all that apply A. Evaluate VS B. Prepare for vaginal delivery C. Reassure client that she'll be able to continue pregnancy D. Evaluate FHT E. Monitor amount of vaginal bleeding F. Monitor Intake & Output
A. Evaluate VS D. Evaluate FHT E. Monitor amount of vaginal bleeding F. Monitor Intake & Output
Which of the following behaviors characterizes the PP mother in the taking-in phase? A. Passive and dependent B. Striving for independence and autonomy C. Curious and interested in care of the baby D. Exhibiting maximum readiness for new learning
A. Passive and dependent
A pregnant woman states that she frequently ingests laundry starch. When assessing the client, for what should the nurse be alert?
Anemia
white papules on the face of a neonate
Milia
Placental function begins to decrease towards the end of pregnancy which may result in decreased oxygen delivery to the fetal kidneys. This may cause:
Oligohydramnios
Which of the following factors would contribute to a high risk pregnancy? A. Blood type O positive B. First pregnancy at age 33 yo C. Hx of allergy to honey bees and shrimp D. Hx of Gestational Diabetes with second pregnancy
D.
At 17 yo primigravida with severe PIH has been receiving magnesium sulfate IV for 3 hrs. The latests assessment reveals DTR of +1, BP 150/100 mmgHg, 92 bpm, respiratory rate 10 bpm, and urine output 20 mL/hr. What following action would be most appropriate? A. continue monitoring per standards of care B. Discontinue the magnesium sulfate infusion C. Decrease infusion by 0.5 g/hr D. Increase infusion by 1 g/hr
Discontinue the magnesium sulfate infusion
T/F Methergine is contraindicated in asthma
False
A maternity nurse is caring for a client with abruptio placentae and is monitoring the client for disseminated intravascular coagulopathy. What assessment finding is LEAST likely to be associated with disseminated intravascular coagulation?
Swelling of the calf of one leg.
Which of the four T's is the LEAST common cause of PPH?
Thrombin
The four Ts of PPH are:
Tone, Trauma, Tissue and Thrombin
T/F Milk production is influenced by hormones and suckling?
True
A nurse is assessing a pregnant patient in the second trimester of pregnancy who is admitted to the maternity unit with a suspected diagnosis of abruptio placentae. What assessment finding would the nurse expect to note if this condition is present?
Uterine tenderness
A stillborn infant was delivered in the birthing suite a few hours ago. After the delivery, the family remained together, holding and touching the baby. Which statement by the nurse would further assist the family in their initial period of grief?
What have you named your baby?
As part of the cardiovascular adaptation of the newborn, construction of the ductus arteriosus provides for:
a sufficient blood supply to the lungs.
Localized soft tissue edema of the scalp
caput succedaneum
Unilateral swelling between periosteum and skull
cephalhematoma
Opening between the right and left atrium
foramen ovale
Do not administer if elevated blood pressure
methergine
Increased amniotic fluid
polyhyrdamnios
Raises temperature and facilitates breastfeeding
skin to skin
Uterus does NOT decrease in size
sub involution
The nurse receives an order to start an infusion for a client whos hemorrhaging due to a placenta previa. What supplies will be needed? 1. Y tubing, normal saline solution, and 22G cathether 2. Ytubing, lactated Ringers solution and 18G cath 3. Y tubing, normal saline, 18G cath 4. Y tubing, lactated RIngers, 20G cath
3. Y tubing, normal saline, 18G cath
Which of the following signs if noted in a new mother in the PP period, would be a sign of excessive blood loss? A. Temp of 100.4 F B. An increase in pulse from 88 to 120 BPM C. An increase in the respiratory rate from 18 to 22 breaths per min D. A blood pressure change from 130/88 to 124/80 mm Hg.
B. An increase in pulse from 88 to 120 BPM
The healthcare provider is caring for a woman during the birth of her baby. As the fetal head is delivered, the healthcare provider notes that the head retracts against the mother's perineum (turtle sign). What actions by the nurse will be anticipated that the healthcare provider will implement? Select all that apply A. Attempt delivery with forceps B. Empty the women's bladder C. Ask the women to begin pushing D. Flex the woman's thighs against her abdomen E. Apply fundal pressure F. Call for assistance
B. Empty the women's bladder C. Ask the women to begin pushing D. Flex the woman's thighs against her abdomen F. Call for assistance
During your assessment in the 4th stage of labor you note that the funds is firm but that bleeding is excessive. The initial nursing action would be which of the following: A. Massage the fundus. B. Place the mother in the transdelenburg position C. Notify the physician D. Record the finding
C. Notify the physician.
Which of the following drugs would the nurse expect to administer to the patient receiving intravenous magnesium sulfate for pre-eclampsia. If the client develops magnesium toxicity?
Calcium gluconate
A maternity nurse is preparing for the admission of a patient in the third trimester of pregnancy that is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the physician's orders and would question which order?
Obtain equipment for a manual pelvic examination
Which two hormones most affect milk synthesis and milk ejection?
Oxytocin and prolactin
A nurse is reviewing the physician's orders for a patient admitted for premature rupture of the membranes. Gestational age of the fetus is determined to be 37 weeks. Which physician's order should the nurse question?
Perform a vaginal examination every shift
A women is admitted to the obstetric unit at 30 wks gestation with a sudden onset of vaginal bleeding that is bright red in color. Her uterus is soft and her pain report is 0 on a 0 -10 scale. The fetal heart rate is 140 beats/min. What is most likely her diagnosis?
Placenta previa
What is an appropriate statement for the nurse to say to a patient with a complete placenta previa?
Please report to a nurse if you feel any back discomfort. --- Labor often begins with back pain. Labor is contraindicated for a client with complete placenta previa.
The nurse is developing a care plan for a patient in her 34th week of gestation who is experiencing premature labor. What nonpharmocological intervention should the plan include to halt premature labor?
Promoting adequate hydration
Which of the following complications can be potentially life threatening and can occur in a patient receiving a tocolytic agent? A. diabetic ketoacidosis B. Hyperemesis gravidarum C. Pulmonary edema D. Sickle cell anemia
Pulmonary edema
Heather is diagnosed with preterm labor at 28 weeks gestation. Later she comes to the ER saying "I think I'm in labor" The nurse would expect her physical exam to show:
Regular uterine contractions with cervical dilation.
During the IMMEDIATE postpartum (recovery) period, the woman focuses on:
Reviewing the birth experience
Rho isoimmunization in a pregnant patient develops during which condition?
Rh positive fetal blood crosses into maternal blood, stimulating maternal antibodies.
What would the nurse most likely expect to find when assessing a pregnant patient with abruptio placenta?
Rigid, bordlike abdomen
The nurse anticipates that the assessment of a NORMAL episiotomy immediately post-delivery is most likely to reveal:
Slight bruising
What factor might result in a decrease supply of breastmilk in a PP mother?
Supplemental feedings with formula
Movement between dependent and independent behaviors
Taking hold phase
T/F PPH (postpartum hemorrhage) is the leading cause of maternal death worldwide.
True
T/F The normal blood flow through the placental site each minute is 500-800 mls per minute
True
T/F The postpartum nurse is caring for a couple who experienced an unplanned emergency cesarean birth The nurse observes the following behaviors: -parents are gently touching their newborn -mother is softly singing to her baby -father is gazing into his baby's eyes the parents are displaying positive signs of bonding?
True
Oxygen is delivered from the placenta to the fetus by way of the:
Umbilical vein
Which of the following circumstances is most likely to cause uterine atony and lead to PP hemorrhage?
Urinary retention
A nurse is caring for a pregnant patient with preeclampsia. The nurse prepares a plan of care for the patient and documents in the plan that if the client progresses from preeclampsia to eclampsia, the nurses's first action should be to:
clear and maintain an open airway.
Your patient has just delivered at 42 weeks gestation. When assessing the newborn, which physical finding is expected?
desquamation of the epidermis
The nurse notes that a new father gazes at his baby for prolonged periods of time and comments that his baby is beautiful and he is very happy having a baby. This behaviors are commonly associated with:
engrossment
Loss of body heat directly after birth
evaporation
what is a risk factor for PPH?
fetal macrosomia prolonged labor chorioamnionitis
Because utter-placental circulation is compromised in patient with preeclampsia, a NST is performed to detect:
fetal well being
Jitteriness, hypotonia, temp instability
hypoglycemia
The initial assessment for a neonate admitted to the nursery begins by:
inspecting the posture, color and respiratory effort.
Second most common cause of primary post partum hemorrhage
lacerations
New role of mother
letting go phase
A nurse is caring for a patient whose membranes ruptured prematurely 12 hours ago. When assessing the client, the nurse's highest priority is to evaluate:
maternal vital signs and fetal heart rate
Hormone for Let-Down
oxytocin
Placenta extends fully through the uterine wall
percreta
Maria, 34 wks pregnant arrives at the ER with SEVERE abdominal pain, uterine tenderness and an increased uterine tone. The client also has vaginal bleeding. There external fetal monitor shows minimal variability with late decelerations. The patient most likely has:
placental abruptio
The 6 week period after childbirth
postpartum
A baby has just been delivered by low forceps. Her term infant had a cord around the neck one time. As the nurse in the delivery your PRIMARY focus is on assessment of the baby's:
respiratory effect
An expected finding on your one day postpartum who is primipara and breastfeeding would be:
soft, non-tender; colostrum is present
Period of dependent behaviors
taking in phase
Baby Charles was born 35 4/7 weeks gestation and weighted 8lb 4 oz placing him in greater than the 90th percentile. After completing a gestational age assessment on this newborn, the correct identification for him would be:
a preterm, large for gestational age
The nursery nurse notes the presence of diffuse edema on a baby girl's head. Review of the birth record indicates that her mother experienced a prolonged labor and difficult childbirth. By the second day of life, the edema has disappeared. The nurse documents the following condition in the infant's chart. a. Caput succedaneum b. Cephalhematoma c. Subperiosteal hemorrhage d. Epstein pearls
a. Caput succedaneum
What types of trauma during labor and birth would lead to Post Part Hemorrhage (PPH) risk?
Instrumental assisted birth (vacuum or forceps) C-section Lacerations of the cervix or vaginal wall.
The neonate of a mother with gestational diabetes is at risk for what complication?
Hypoglycemia
Present in breast milk, provides passive immunity
IGA
Kim who has had no prenatal care was diagnosed with polyhydramnios and delivered a baby weighing 4500 grams. What complications of pregnancy likely contributed to these findings?
Gestational Diabetes
