Study for OB Final Exam
Which is the best position for the baby to be born in?
ROA OR LOA
The maternal health nurse is caring for a laboring woman who is in the second stage of labor. Which statement will the nurse use when encouraging the client to breathe during this stage? A. Breathe however you feel comfortable B. Hold your breath then exhale deeply C. Take a large, deep breath then exhale deeply D. Hold your breath only when you push
Breathe however you feel comfortable
Which pelvic measurement is most important for the acceptance and passage of the fetal head during labor? A. False pelvis B. Pelvic outlet C. Ischial spines D. Pelvic inlet
Pelvic inlet
When does the first stage of labor begin?
the start of uterine contractions
WHAT ARE LATE DECELERATIONS INDICATIVE OF?
uteroplacental insufficiency or decreased blood flow through the intervillous spaces of the uterus during uterine contractions
A woman at 15 weeks' gestation who works at a daycare center thinks she may have just been exposed to rubella at work. The client asks how this may affect her fetus. What is the best response the nurse can give? A. "By the end of the eighth week all of the organ systems and major structures are present, so exposure to any teratogen can lead to birth defects. More assessments are needed." B. "Your health care provider will let you know if there are any problems with your baby." C. "We will have to see what gestational age your baby was at exposure." D. "We will need to perform some additional tests."
"By the end of the eighth week all of the organ systems and major structures are present, so exposure to any teratogen can lead to birth defects. More assessments are needed."
Upon waiting for the placenta to be delivered, up to how many minutes is normal to wait?
30 minutes is considered normal
The nurse is working with and teaching a young couple at the infertility clinic who have been trying to get pregnant for the past year. What percentage of couples are noted to get pregnant after trying during the proper time within the year?
80 to 85 %
An Rh-negative woman at 6 weeks' gestation is scheduled for a medically induced termination. Which outcomes should the nurse identify as appropriate for this patient? Select all that apply A. Attend contraceptive counseling B. Received Rho (D) immune globulin C. Scheduled post-procedure sonogram D. Avoided strenuous activity for 3 weeks ? E. Experienced menstrual cycle in 2 months ?
A - Attend contraceptive counseling B - Received Rho (D) immune globulin C - Scheduled post-procdedure sonogram
What is going on here?
A fetal heart rate (FHR) showing variable and prolonged decelerations. Note the abrupt drop in FHR in both types of decelerations. The variable decelerations return to baseline more quickly than the prolonged deceleration at 26 to 31 minutes, however.
A woman in her 16th week of pregnancy comes to the health center for a follow up visit. Which physiologic change would the nurse expect to assess? Select all that apply. A. A uterus that is palpable B. Colostrum that can be expelled from the nipples C. Increased blood pressure D. Linea nigra and melasma (Chloasma) E. Varicosities of the vulva, rectum and/or legs
A uterus that is palpable Colostrum that can be expelled from the nipples
The nurse is caring for several clients at the prenatal clinic. Which client would the nurse prepare for a routine fetal ultrasound? ****THIS IS A TRICK QUESTION. THE TRUE ANSWER LIES IN THE NUMBER OF WEEKS SHE IS PREGNANT***** A. A woman at 10 weeks' gestation who reports increased urination and fatigue B. A woman at 38 weeks' gestation having increased insomnia due to breathing discomfort C. A woman being seen to confirm pregnancy since her last menstrual period was 6 weeks prior D. A woman at 20 weeks' gestation reporting increased nasal stuffiness
A woman at 20 weeks' gestation reporting increased nasal stuffiness
During a postpartum hemorrhage, the nurse anticipated administering which medication to cause vasoconstriction of the uterine vessels?
A. Oxytocin, methylergonovine and misoprostol all stimulate the uterine muscle to contract. Methylergonovine is the only medication that also stimulates vasoconstriction of the uterine vessels, thereby decreasing bleeding.
What administration considerations apply to oxytocin?
Administer IV via infusion pump, gradually increase the flow rate by 1 to 2 milliunits/min every 30 to 50 min until contractions last 1 min or less every 2 to 3 min, Monitor blood pressure and pulse rate, Monitor for uterine hyperstimulation (hypertonic contractions) lasting longer than 60 seconds, occurring more frequently than every 2 to 3 min, resting uterine pressure greater than 15 to 20. ****STOP the infusion and report hyperstimulation immediately, Monitor FHR and rhythm and report s/s of fetal distress. ***STOP the infusion for serious alterations in FHR or rhythm......
An Rh-negative patient is having an amniocentesis. What is the highest priority nursing intervention to perform immediately after the procedure?
Administer Rh immune globulin
Which of the following statements regarding weight and pregnancy is correct? A. An underweight woman should increase her caloric intake by 500 to 1000 calories a day. B. Obesity usually occurs from hypothyroidism C. Dieting during pregnancy to reduce weight is recommended only for morbidly obese women D. Women who are underweight coming into pregnancy should gain the same amount of weight as women with a normal BMI.
An underweight woman should increase her caloric intake by 500 to 1000 calories a day.
This image could be used for a "hot spot" which is placing an x on the anterior or posterior fontanelle. Could be stated: Which of the fontanelles closes at 12 to 18 months
Anterior fontanelle
When teaching a group of soon-to-be parents about the structures of the fetal skull, the nurse describes the anterior fontanel (fontanelle). Which description would the nurse include? A. Triangular shape B. Located at the back of the fetal head C. Closes 8 to 12 weeks after birth D. Approximately 2 to 3 cm in size
Approximately 2 to 3 cm in size The anterior fontanel (fontanelle) measures about 2 to 3 cm in size, is diamond-shaped, and closes 12 to 18 months after birth. The posterior fontanelle is triangular and located at the back of the fetal head. The posterior fontanelle closes about 8 to 12 weeks after birth. IMAGE for fontanelles.
The nursing instructor is presenting a session on the cellular division involved in the reproduction of human life. Which statement indicates the group's need for further education? A. The ovum and sperm are the female and male gametes. Each gamete has 23 chromosomes, half of the 46 needed for human development. B. At ovulation, the gametes unite to form the cell that becomes the developing fetus. C. Each soma cell contains 46 chromosomes arranged in 23 pairs D. Of the 23 pairs of chromosomes, 22 are autosomes which determine genetic traits.
At ovulation, the gametes unite to form the cell that becomes the developing fetus
A nurse is reviewing the medical record of a client who has come to the clinic for an evaluation and reproductive life planning with oral contraceptives. Which information if found on the client's medical record would alert the nurse to a possible contraindication for oral contraceptives? Select all that apply. A. 31 years of age B. History of migraine headaches with aura C. Smoking 3 to 5 cigarettes a day D. History of deep vein thrombosis E. Diabetic retinopathy
B - History of migraine headaches with aura D - History of deep vein thrombosis E - Diabetic retinopathy
After learning that her fetus is in the LST position, the client asks the nurse what this means. Which structure will the nurse point out is presenting first? A. Head B. Chin C. Buttocks D. Shoulder
Buttocks The second letter indicates the presenting part. The letter "S" indicates the sacrum or buttocks as the presenting part. The fetal head would be noted by the letter "O," indicating occiput. The fetal chin would be noted by the letter "M," indicating mentum. The fetal shoulder would be noted by the letter "A," indicating the acromion process. The first letter indicates the side of the maternal pelvis toward which the presenting part is facing ("R" for right and "L" for left). The last letter specifies whether the presenting part is facing the anterior (A) or posterior (P) portion of the maternal pelvis or whether it is in a transverse (T) position. Application Chapter 15
A primagravida has an office appointment in her 39th week of pregnancy. Which assessment data is most definitive of the onset of labor? A. The mother reports frequent urination B. The fetal head is engaged in the pelvis C. Cervical ripening is noted on examination D. Expulsion of the mucous plug
Cervical ripening is noted on examination
All of the following are premonitory signs of labor EXCEPT A. Lightening B. Effacement C. Bloody show D. Nesting E. Chadwick's sign
Chadwick's sign
The nurse is assessing a 37-year-old woman, pregnant with twins in her second trimester, and notes the following over the past 3 visits: blood pressure 128/88, 134/90, and 130/86. Which nutritional supplement should the nurse suggest the client take?
Calcium The elevated blood pressures indicate the client is possibly developing gestational hypertension. This increases the risk of developing pre-eclampsia. Current research has demonstrated that calcium supplementation during pregnancy may reduce the risk of pre-eclampsia. Excessive levels of vitamin A may cause birth defects. Iron supplementation is used to fortify blood cell formation and decrease anemia. Lactase supplementation aids in the digestion of dairy. Application Chapter 10
What is this?
Early fetal heart rate deceleration (the time between 2 and 4 seconds) follows the pattern of the contraction starting when the contraction begins and ending when the contraction subsides. This is a normal pattern of a healthy fetus.
1. The nurse is reviewing health records to collect information regarding infant mortality. Which data, when noted, would alert the nurse to further assess the client's chart for evidence of the child dying during infancy? Select all that apply. A. Male infant born at home, during a pre-planned home birth B. Female infant born at 31 weeks' gestation in a hospital setting C. Male infant diagnosed with low birth weight of 2400 grams D. Female infant who died at age 9 months from sudden infant death syndrome (SIDS) E. Male infant diagnosed with a congenital abnormality soon after birth
Female infant born at 31 weeks gestation in a hospital setting Male infant diagnosed with a low birth weight of 2400 grams Male infant diagnosed with a congenital abnormality soon after birth
A nurse is explaining to a client about conception. Which area would the nurse identify as the location where fertilization of the egg occurs?
Fertilization most often occurs in the ampulla, the distal portion of the tube, located between the isthmus and the infundibulum.
A client who is in her third trimester is to undergo an amniocentesis. The nurse understands that the rationale for testing at this point is to determine:
Fetal lung maturity
A pregnant client tells the nurse that she has a 2-year-old child at home who was born at 38 weeks; she had a miscarriage at 9 weeks; and she gave birth to a set of twins at 34 weeks. Which documentation would be appropriate for the nurse?
Gravida 3, Para 2
What physical changes take place when a woman becomes pregnant? Select all that apply. A. The uterus becomes pear-shaped B. Heart rate increases 10 to 15 beats per minute C. Respiratory rate increases 20% D. The areola becomes more prominent E. Nasal congestion increases due to edema
Heart rate increases 10 to 15 beats per minute The areola becomes more prominent Nasal congestion increases due to edema
What is this?
Late deceleration (the time between 20 and 22 seconds) occurs after the peak of a contraction and continues beyond the end of the contraction. This is an ominous pattern in labor because it suggests the fetus is growing short of oxygen. The prolonged deceleration (between 26 and 31 seconds) is also ominous.
You assess that the fetus of a woman is in an occiput posterior position. You know that her labor most likely will be different from a woman whose fetus is in an anterior position in that the woman
May experience more pronounced back pain
The nurse is reviewing the graph below. Which fetal heart rate pattern would be expected after the administration of Nubain 10 mg for pain during labor? A. Undetected variability B. Minimal variability C. Moderate variability D. Marked variability
Minimal variability will occur after administration of Pain medication during labor (Nubain). The FHR will decrease, but return to baseline, usually within 10 minutes. If the FHR doesn't then further assessment would be warranted. Undetected and minimal variability is indicative of fetal compromise. (possibility asleep, metabolic acidosis, CNS depression-(medication), Moderate variability is what nurses expect to see, Marked variability can be from acute hypoxia (hypertonic contractions), cord compression, drugs (oxytocin, cocaine, meth). Nurses want to see Moderate variability with accelerations. Analyze Chapter 15
What administrations considerations apply to Methergine?
Must know what Methergine (Methylergometrine) is used for (analgesic/uterotonic drug that treats severe bleeding from the uterus AFTER childbirth), increases rate and strength of the contractions and stiffness of the uterus muscles, then decreases bleeding Check blood pressure before administration, Do NOT give if b/p exceeds parameters set by provider, Give orally for 2 to 7 days or IM every 2 hr as needed, Give the drug IV ONLY if emergency control of severe hemorrhage, Administer IV doses slowly (over 1 min to minimize adverse effects, Administer after the delivery of the placenta, Monitor vital signs and uterine response, TELL the client to expect some cramping
What administration considerations apply to dinoprostone vaginal insert or gel? Short answer
Must know what dinoprostone is (prostaglandin hormone that helps dilate the cervix in pregnant women) Gel-administer intracervically using a syringe prefilled with the drug in gel form and an endocervical catheter, have client lie supine during instillation and remain supine for 30 min, repeat dosing every 6 hr, twice, if the desired therapeutic effect has not occurred, monitor uterine activity, FHR, uterine hyperstimulation, ***report immediately, Begin oxytocin 6 to 12 hours after the last dose ******when lying supine, be sure they are not totally flat, elevate with a towel (hips or one hip) Vaginal insert-insert pouch containing drug into the posterior fornix of the vagina, client lie supine for 2 hr while the pouch gradually releases the drug, remove pouch using the attached tape when active labor begins or 12 hours later ***Follow the monitoring precautions listed above
A client has been showing a gradual increase in FHR baseline with variables; however, after 5 hours of labor and several position changes by the client, the fetus no longer shows signs of hypoxia. The client's cervix is almost completely effaced and dilated to 8 cm. Which action should the nurse prioritize if it appears the fetus has stopped descending? A. Alert the team that internal fetal monitoring may be needed B. Palpate the area just above the symphysis pubis C. Institute effleurage and apply pressure to the client's lower back during contractions D. Encourage the client to push
Palpate the area just above the symphysis pubis
A 17-year-old woman has become pregnant as her boyfriend refused to wear condoms. The boyfriend calls her names, often becomes jealous and, although rare, sometimes hits her. Which condition is this pregnant client most at risk of developing in this pregnancy? Select all that apply A. Placental abruption B. Small for gestational age (SGA) infant C. Preterm birth D. Sexually transmitted infection E. Postterm pregnancy
Placental abruption Small for gestational age (SGA) infant Preterm birth Sexually transmitted infection
You are preparing for an induction of labor. Which of these would the nurse expect to do in preparation? A. Prepare oxytocin as prescribed using a piggyback intravenous setup. B. Teach the pregnant woman to lie on her back as much as possible during labor. C. Make sure that a fetoscope is available in the room for monitoring. D. Assure the pregnant woman that the induction process will assure a shorter than usual labor.
Prepare oxytocin as prescribed using a piggyback intravenous setup.
This position noted in the diagram is helpful for relieving what symptom during pregnancy and labor? A. Contraction intensity B. Relief of back pain C. Discomfort during the day D. Stretching of pelvic floor muscles
Relief of back pain
A multigravida woman arrives in the emergency department panting and screaming, "The baby's coming!" Which action should the nurse prioritize? A. Assess maternal and fetal vital signs B. Ask medical and obstetrical history C. Escort to labor and delivery D. Quickly evaluate the perineum
Quickly evaluate the perineum
A laboring woman chooses to deliver her infant in the supine recumbent position. Which advantage(s) does the nurse recognize this position has over the lithotomy position for birth? Select all that apply A. Reduction of perineal tears B. Increased strength of contractions due to gravity C. Improved fetal descent into the birth canal D. Reduction of tension on the perineum E. Increased comfort
Reduction of perineal tears Reduction of tension on the perineum Increased comfort
A black couple presents for a genetic counseling appointment. They are pregnant and are concerned about their child. This couple would have genetic testing for what condition?
Sickle cell anemia
In assessing the dietary intake over the last 24 hours of a pregnant client, which food would be most concerning to the nurse? A. Medium-well steak and a fresh salad B. Smoked salmon and bagels C. 6 oz of white tuna with crackers D. Cooked hot dog on a bun with mustard
Smoked salmon and bagels Pregnant women should not eat refrigerated meats or smoked seafood unless it is part of a cooked dish. 6 ounces of white tuna, a well-cooked hot dog and a steak that is cooked thoroughly are all safe foods.
A nurse working as a member of a genetic counseling team understands that her careful assessment of which body areas in a newborn may provide important indications for structural genetic disorders?
Space between the eyes, the shape of the ears, and the numbers of fingers and toes
A pregnant woman is planning on taking a vacation that involves extensive travel by automobile. Which of the following guidelines should you give her?
Stop and walk every hour. The danger of long periods of travel occurs when the woman sits for long periods with her knees sharply bent. Walking increases venous return and reduces the possibility of thrombophlebitis.
What kind of position is this?
Taylor sitting
A male client is being evaluated for infertility. What additional data should a nurse obtain?
Testosterone Rh factor Blood type UA
What is the fourth stage of labor?
The first hour or two after the delivery of the placenta
The best way to assure fetal status or well-being is by EFM for accelerations and deceleration patterns? True or False A. True B. False
True The EFM monitoring for accelerations and deceleration patterns indicate an intact nervous system (hypoxia/acidosis). Sympathetic (increases with movement-accelerations) and parasympathetic (reduces rate-vagal) there will be STV and LTV causes: spontaneous movement, vag exam, scalp stimulation, contractions. Early, Late and Variable decelerations.
What administration considerations apply to magnesium sulfate?
Why do we give Mag? To prevent seizures due to pre-eclampsia that is not resolving, or to lower blood pressure, Mag affects the CNS so monitor for DTR and Blood pressure changes Loading dose 4 to 6 mg IV bolus as secondary infusion over 15 to 30 min, use a volumetric pump to ensure accuracy of dose, administer maintenance dose by continuous infusion at 2 g/hr, Monitor blood levels to maintain therapeutic level at 4 to 7 mEq/L.*****Monitor DTR and urine output---excreted in the urine
What administration considerations apply to betamethasone?
Why do we give betamethasone (to speed up lung development in preterm fetuses, it stimulates the release of surfactant, which lubricates the lungs, allowing the air sacs to slide against one another without sticking when the infant breathes) Administer 12 mg IM for 2-e doses 24 hr apart, Dexamethasone 6 mg IM for 4 doses 12 hr apart, give dep IM in ventral gluteal or vastus lateralis muscle
What administration considerations apply to terbutaline?
Why do we use Terbutaline to laboring mothers? (it's a bronchodilator and Tocolytic used to treat preterm labor-assist in decreasing contractions) remember the side effects of Terbutaline Confirm preterm labor and gestation between 20 and 36 weeks, usually administered subcutaneously (lateral deltoid area0 every 20 min, up to 3 hr and no longer than 48 hr, less often administered IV, Monitor FHR and report signs of maternal or fetal distress ***STOP the infusion for serious alterations in FHR above 180 or a nonreassuring rhythm
If excessive bleeding with poor uterine contraction remains after massing the fundus and giving oxytocin, then
an injection of carboprost tromethamine (Hemabate) or methylergonovine maleate (Methergine) is yet another solution to increase uterine contraction and to guard against hemorrhage. It is important to know prior to the second stage whether a woman has a contraindication to either of these drugs such as asthma or hypertension.
What are prolonged decelerations?
are a decrease from the FHR baseline of 15 beats/min or more and last longer than 2 to 3 minutes but less than 10 minutes. They generally reflect an isolated occurrence, but they may signify a significant event, such as cord compression or maternal hypotension.
Early decelerations normally occur late in labor, when the head has descended fairly low; they are viewed as innocent. If they occur early in labor, before the head has fully descended, the head compression causing the waveform change could be the result of
cephalopelvic disproportion and is a cause to investigate
When does the second stage of labor begin?
is the time from full cervical dilatation to birth of the newborn
What is the third stage of labor?
is the time from the birth of the baby until the placenta is delivered
After the placenta inspection, if the mother's uterus has not contracted firmly on its own, the primary care provider will
massage the fundus to urge it to contract. Oxytocin (Pitocin 10 units) may be prescribed to be administered intramuscularly (IM) or per 1,000 ml fluid intravenously (IV) to also help contraction
If a prolapsed cord is diagnosed as the cause of the variable decelerations,
oxygen will be prescribed as well as changing her position to a knee-to-chest one to help relieve pressure on the cord
A nurse is assessing a pregnant women in her second trimester and obtains a urine sample for analysis. When reviewing the results, which finding would cause the nurse to be concerned? A. serum creatinine: 1.2 mg/100 mL (106 µmol/L) B. BUN: 10 mg/100 mL (3.57 mmol/L) C. reduced glomerular filtration rate D. creatinine clearance: 100 mL/minute (1.67 mL/s/m2)
serum creatinine: 1.2 mg/100 mL (106 µmol/L)
