Elsevier Exam 3 OB EAQs

What assessments should be done before administering uterine stimulants to induce labor? Select all that apply.

The cervix must be ready for labor induction. The fetal heart rate and contractions should be documented. The mother's blood pressure, pulse rate, and respirations should be assessed.

A client is found to have gestational hypertension in the twenty-second week of gestation. Which major complication of hypertensive disease associated with pregnancy should the nurse anticipate?

Abruptio placentae

Which clinical finding does the nurse expect when assessing a client with abruptio placentae?

Boardlike abdomen

A nurse assesses a client in the labor room and finds that the client's Bishop score for her cervical status is 6. Which medication may be administered to this client?

Dinoprostone

What step should a nurse take when preparing to administer Rho(D) immune globulin to a postpartum client?

Ensure that the client is Rh negative and the neonate is Rh positive

The nurse is reviewing the obstetric history of a client who has had an abruptio placentae. Which prenatal condition does the nurse expect to find in this client's history?

Gestational hypertension

A client with preeclampsia is admitted to the labor and birthing suite. Her blood pressure is 130/90 mm Hg, and she has 2+ protein in her urine along with edema of the hands and face. Which signs or symptoms would the client display if she were developing hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome)? Select all that apply.

Headache Abdominal Pain Flulike symptoms

During a home visit the nurse obtains information regarding a postpartum client's behavior and suspects that she is experiencing postpartum depression. Which assessments support this conclusion? Select all that apply.

Lethargy Ambivalence Emotional lability

The primary healthcare provider diagnoses placenta previa in a primiparous client. What does this indicate to the nurse regarding the condition of the placenta?

Low-lying

The nurse determines that a postpartum client is gravida 1, para 1. Her blood type is B negative, and her baby's blood type is O positive. What should the nurse include in the plan of care?

Obtaining a prescription for Rho (D) immune globulin

A young pregnant adolescent is diagnosed as having bacterial vaginosis. What further complications related to bacterial vaginosis may occur during pregnancy? Select all that apply.

Preterm labor and birth Intraamniotic infection Postpartum endometritis

A pregnant woman with a history of heart disease visits the prenatal clinic toward the end of her second trimester. Which intervention does the nurse anticipate will be part of this client's care plan?

Prophylactic antibiotics at the time of birth

The nurse is developing a care plan for a client with postpartum psychosis. Which priority intervention should the nurse implement?

Referring the client to a psychiatric healthcare provider as prescribed

Rho(D) immune globulin (RhoGAM) is prescribed for an Rh-negative client who has just given birth. Before giving the medication, the nurse verifies the newborn's Rh factor and reaction to the Coombs test. Which combination of newborn Rh factor and Coombs test result confirms the need to give Rho(D) immune globulin?

Rh positive with a negative Coombs result

In which clinical situation would cervical ripening drugs be prescribed to pregnant women?

The cervical status indicates a Bishop score of 6.

What medication teaching does the nurse provide to a newly pregnant client with cardiac disease?

Maintenance dosages of cardiac medications will probably be increased.

When entering the room of a client in active labor to answer the call light, the nurse sees that she is ashen gray, dyspneic, and clutching her chest. What should the nurse do immediately after pressing the emergency light in the client's room?

Administer oxygen by facemask

Despite medication, a client's preterm labor continues, her cervix dilates, and birth appears inevitable. Which medication does the nurse anticipate will be prescribed to increase the chance of the newborn's survival?

Betamethasone

A client who is in labor is admitted 30 hours after her membranes ruptured. Which condition is this client at increased risk for?

Chorioamnionitis

After the removal of a hydatidiform mole, the nurse assesses the client's laboratory data during a follow-up visit. The nurse notes that a prolonged increase of the serum human chorionic gonadotropin (hCG) level is a danger sign. Which condition is this client at increased risk of developing?

Choriocarcinoma

A woman's pregnancy has been uneventful, and she has gained 25 lb (11.3 kg). At term her hemoglobin level is 10.6 g/dL (106 mmol/L) and her hematocrit is 31%. What is the physiologic reason for these hemoglobin and hematocrit levels?

Hemodilution

Which drug is administered to women after delivery to prevent postpartum uterine atony and hemorrhage but is not given to augment labor?

Methylergonovine

The nurse is assessing a new mother at a healthcare facility. Which symptom does the nurse identify as a risk factor for postpartum blues?

Mild irritability

A client at 39 weeks' gestation is admitted for induction of labor. Knowing that several medications are used to induce labor, a nurse identifies those that may be prescribed. Select all that apply.

Oxytocin Misoprostol Dinoprostone

A pregnant client has class II cardiac disease. To best plan the client's care, what does the nurse anticipate for the client?

Should be hospitalized if there is evidence of cardiac decompensation

Which statements relate to preterm labor? Select all that apply.

The treatment for preterm labor includes bed rest and hydration. Preterm labor before the 20th week is indicative of a nonviable fetus.

What complication should a nurse be alert for in a client receiving an oxytocin infusion to induce labor?

Uterine tetany

A client has been receiving oxytocin to augment labor. For what adverse reaction caused by a prolonged oxytocin infusion should the nurse monitor the client?

Water intoxication

A client with poorly controlled type 1 diabetes is now in her thirty-fourth week of pregnancy. The primary healthcare provider tells her that she should have an amniocentesis at 37 weeks to assess fetal lung maturity and that induction of labor will be initiated if the fetus's lungs are mature. The client asks the nurse why an early birth may be necessary. How should the nurse reply?

"Your glucose level will be hard to control as you reach term."

A client comes to the clinic for a 6-week postpartum check-up. She confides that she is experiencing exhaustion that is not relieved by sleep and feelings of failure as a mother because the infant "cries all of the time." When asked whether she has a support system, she replies that she lives alone. Which response would provide the most accurate information?

Asking the client questions, using a postpartum depression scale

Within minutes of giving birth to a healthy infant, the client displays symptoms of respiratory distress. An amniotic fluid embolism is suspected. In addition to respiratory distress, for what other complication should the nurse assess the client?

Uncontrolled bleeding

Why is it important for the nurse to encourage a client with preeclampsia to lie in the left-lateral recumbent position?

Uterine and kidney perfusion are maximized, and compression of the major vessels is relieved.

A client is admitted to the labor and delivery unit for labor augmentation with oxytocin. She is postterm at 40 weeks, 3 days, and has gestational diabetes. The cervix is dilated to 2 cm and 90% effaced. The primary healthcare provider performed an amniotomy to permit internal electronic fetal monitoring. The amniotic fluid is pale yellow and moderate in amount. Immediately after the amniotomy the nurse will assess the fetal heart rate for at least 1 full minute for signs of what?

Uterine cord prolapse

A client in labor is admitted to the birthing unit 20 hours after her membranes have ruptured. Which complication should the nurse anticipate when assessing the character of the client's amniotic fluid?

Maternal sepsis

The nurse in the birthing unit is caring for several postpartum clients. Which factor will increase the risk for hypotonic uterine dystocia?

Twin gestation

What does the nurse expect the size of a newborn to be if the mother had inadequately controlled type 1 diabetes during her pregnancy?

Large for gestational age, near term

A nurse suspects that a newborn has toxoplasmosis, one of the TORCH infections. How and when may it have been transmitted to the newborn?

In utero through the placenta

A woman is admitted to the high-risk unit in preterm labor at 30 weeks' gestation. Which factor does the nurse suspect precipitated this preterm labor?

Incompetent cervix

A client's membranes ruptured 20 hours before admission. The client was in labor for 24 hours before giving birth. For which postpartum complication is this client at risk?

Infection

A nurse is caring for a group of postpartum clients. Which client is at the highest risk for disseminated intravascular coagulation (DIC)?

Gravida I who has had an intrauterine fetal death

The nurse is reviewing a client's history. Which two predisposing causes of puerperal (postpartum) infection should prompt the nurse to monitor this client closely?

Hemorrhage and trauma during labor

A client measuring at 18 weeks' gestation visits the prenatal clinic stating that she is still very nauseated and vomits frequently. Physical examination reveals a brown vaginal discharge and a blood pressure of 148/90 mm Hg. What condition does the nurse suspect the client is experiencing?

Hydatidiform mole

The nurse is explaining insulin needs to a client with gestational diabetes who is in her second trimester of pregnancy. Which information should the nurse give to this client?

Insulin needs will increase during the second trimester.

On the third postpartum day, the nurse enters the room of a client who had an unexpected cesarean birth and finds her crying. The client says, "I know my baby is fine, but I can't help crying. I wanted natural childbirth so much. Why did this have to happen to me?" What should the nurse consider when responding?

A woman's self-concept may be negatively affected by a cesarean birth, and the client's statement may reflect this.

Which interventions should be included in the plan of care for a client with class I cardiac disease during the last weeks of pregnancy?

Advising the client to limit stress, promoting rest after meals, and educating the client about the analgesia and anesthesia used during labor

In the second hour after a client gives birth, her uterus is found to be firm, above the level of the umbilicus, and to the right of midline. What is the appropriate nursing intervention at this time?

Assisting the client to the bathroom to empty her bladder

A grand multipara at 34 weeks' gestation is brought to the emergency department because of vaginal bleeding. The nurse suspects that the client has a placenta previa. Which characteristic typical of placenta previa supports the nurse's conclusion?

Painless vaginal bleeding in the third trimester

A newborn is admitted to the nursery. The newborn weighs 10 lb, 2 oz (4592 g), which is 2 lb (907 g) more than the birthweight of any of the neonate's siblings. Which intervention should the nurse implement in relation to this baby's birth weight?

Perform serial glucose readings

A client at 42 weeks' gestation is admitted for a nonstress test. The nurse concludes that this test is being done because of what possible complication related to a prolonged pregnancy?

Placental insufficiency

A client who is at risk for seizures as a result of severe preeclampsia is receiving an intravenous infusion of magnesium sulfate. What findings cause the nurse to determine that the client is showing signs of magnesium sulfate toxicity? Select all that apply.

Respirations of 10 breaths/min Loss of patellar reflexes

A nurse is monitoring a client with severe preeclampsia for the onset of eclampsia. What objective clinical finding indicates an impending seizure?

Rolling of the eyes to one side with a fixed stare

A woman who gave birth to a second child 3 weeks ago is depressed and having difficulty caring for her children. At the end of the day both of the children are dirty, wet, and crying. The woman tells her husband that she "just can't take this anymore." The husband calls the women's health clinic and asks what he should do. What is the best response by the nurse?

Telling him that his wife may be suffering from depression and needs emergency care

A client who is visiting the prenatal clinic for the first time has a serology test for toxoplasmosis. What information about the client's activities in the history indicates to the nurse that there is a need for this test?

The client cares for a neighbor's cat

After receiving a diagnosis of placenta previa, the client asks the nurse what this means. What is the nurse's best response?

"The placenta is implanted in the lower uterine segment, and it's covering part or all of the cervical opening."

A client who has six living children has just given birth. After expulsion of the placenta, an infusion of lactated Ringer solution with 10 units of oxytocin is prescribed. What should the nurse explain to the client when she asks why this infusion is needed?

"The medication helps your uterus contract."

During her first prenatal visit a client tells the nurse that she needed an exchange transfusion when she was born because of Rh incompatibility. She asks the nurse whether her baby will need one also. How should the nurse respond?

"You should have no problem because you're Rh positive."

During her sixth month of pregnancy, a woman visits the prenatal clinic for the first time. As part of the initial assessment a complete blood count and urinalysis are performed. Which laboratory finding should alert the nurse to the need for further assessment?

Hemoglobin of 10 g/dL (100 mmol/L)

A nurse who is caring for a postpartum client expresses concern because the woman is at increased risk for hemorrhage. Which factor in the client's history alerted the nurse to this concern?

Multifetal pregnancy