OB COURSE POINT QUIZ 2/3
A pregnant woman is flying across the country to visit her family. After teaching the woman about traveling during pregnancy, which statement indicates that the teaching was successful? A. "I'll sit in a window seat so I can focus on the sky to help relax me." B. "I won't drink too much fluid so I don't have to urinate so often." C. "I'll get up and walk around the airplane about every 2 hours." D. "I'll do some upper arm stretches while sitting in my seat."
"I'll get up and walk around the airplane about every 2 hours." explanation: When traveling by airplane, the woman should get up and walk about the plane every 2 hours to promote circulation. An aisle seat is recommended so that she can have easy access to the aisle. Drinking water throughout the flight is encouraged to maintain hydration. Calf-tensing exercises are important to improve circulation to the lower extremities.
A client's membranes spontaneously ruptured, as evidenced by a gush of clear fluid with a contraction. What would the nurse do next? A. Check the fetal heart rate. B. Perform a vaginal exam. C. Notify the primary care provider immediately. D. Change the linen saver pad.
A. Check the fetal heart rate. explanation: When membranes rupture, the priority focus is on assessing fetal heart rate first to identify a deceleration, which might indicate cord compression secondary to cord prolapse. A vaginal exam may be done later to evaluate for continued progression of labor. The primary care provider should be notified, but this is not a priority at this time. Changing the linen saver pad would be appropriate once the fetal status is determined and the primary care provider has been notified.
A woman who is 12 hours postpartum had a pulse rate around 80 beats per minute during pregnancy. Now, the nurse finds a pulse of 66 beats per minute. Which of these actions should the nurse take? A. Document the finding, as it is a normal finding at this time. B. Contact the primary care provider, as it indicates early DIC. C. Contact the primary care provider, as it is a first sign of postpartum eclampsia. D. Obtain a prescription for a CBC, as it suggests postpartum anemia.
A. Document the finding, as it is a normal finding at this time. explanation: Pulse rates of 60 to 80 beats per minute at rest are normal during the first week after birth. This pulse rate is called puerperal bradycardia.
In which woman would an IUD be contraindicated? A. a woman over 35 years of age who smokes B. a woman with hypertension C. a woman with multiple sexual partners D. a woman with a history of thromboembolic disease
C. a woman with multiple sexual partners explanation: The use of an IUD may increase the risk of pelvic inflammatory disease; women with multiple sexual partners are at risk for PID and should not compound their risk further.
On the first prenatal visit, examination of the woman's internal genitalia reveals a bluish coloration of the cervix and vaginal mucosa. The nurse documents this finding as: Hagar's sign. Goodall's sign. Chadwick's sign. Homans' sign.
Chadwicks sign Explanation: Chadwick's sign refers to the bluish coloration of the cervix and vaginal mucosa. Hegar's sign refers to softening of the isthmus. Goodell's sign refers to softening of the cervix. Homans' sign indicates pain on dorsiflexion of the foot.
A nurse helps a postpartum woman out of bed for the first time postpartally and notices that she has a very heavy lochia flow. Which assessment finding would best help the nurse decide that the flow is within normal limits? A. The flow contains large clots. B. The flow is over 500 mL. C. Her uterus is soft to your touch. D. The color of the flow is red.
D. The color of the flow is red. explanation: A typical lochia flow on the first day postpartally is red; it contains no large clots; the uterus is firm, indicating that it is well contracted.
A 32-year-old woman presents to the labor and birth suite in active labor. She is multigravida, relaxed, and talking with her husband. When examined by the nurse, the fetus is found to be in a cephalic presentation. His occiput is facing toward the front and slightly to the right of the mother's pelvis, and he is exhibiting a flexed attitude. How does the nurse document the position of the fetus? LOA LOP ROA ROP
ROA explanation: The nurse should document the fetal position in the clinical record using abbreviations. The first letter describes the side of the maternal pelvis toward which the presenting part is facing ("R" for right and "L" for left). The second letter or abbreviation indicates the reference point ("O" for occiput, "Fr" for frontum, etc.). The last part of the designation specifies whether the presenting part is facing the anterior (A) or the posterior (P) portion of the pelvis, or whether it is in a transverse (T) position.
On assessment of a 2-day postpartum client the nurse finds that the fundus is boggy, at the umbilicus, and slightly to the right. What is the most likely cause of this assessment finding? A. Uteruine atony B. full bowel C. bladder distention D. poor bladder tone
bladder distention explanation: The most often cause of a displaced uterus is a distended bladder. Ask the client to void and then reassess the uterus. According to the scenario described, the most likely cause of the uterine findings would not be uterine atony. A full bowel or poor bladder tone would not cause a boggy and displaced fundus.
A woman in labor who received an opioid for pain relief develops respiratory depression. The nurse would expect which agent to be administered? A. butorphanol B. fentanyl C. naloxone D. promethazine
noloxone explanation: Naloxone is an opioid antagonist used to reverse the effects of opioids such as respiratory depression. Butorphanol and fentanyl are opioids and would cause further respiratory depression. Promethazine is an ataractic used as an adjunct to potentiate the effectiveness of the opioid.
A client's maternal serum alpha-fetoprotein (MSAFP) level was unusually elevated at 17 weeks. The nurse suspects which condition? A. fetal hypoxia B. open spinal defects C. Down syndrome D. maternal hypertension
open spinal defects explanation: Elevated MSAFP levels are associated with open neural tube defects. Fetal hypoxia would be noted with fetal heart rate tracings and via nonstress and contraction stress testing. MSAFP in conjunction with marker screening tests would be more reliable for detecting Down syndrome. Maternal hypertension would be noted via serial blood pressure monitoring.
A woman comes to the prenatal clinic suspecting that she is pregnant, and assessment reveals probable signs of pregnancy. Which findings would the nurse most likely assess? Select all that apply. positive pregnancy test ultrasound visualization of the fetus auscultation of a fetal heart beat ballottement absence of menstruation softening of the cervix
positive pregnancy test ballottement softening of the cervix explanation: Probable signs of pregnancy include a positive pregnancy test, ballottement, and softening of the cervix (Goodell's sign). Ultrasound visualization of the fetus, auscultation of a fetal heart beat, and palpation of fetal movements are considered positive signs of pregnancy. Absence of menstruation is a presumptive sign of pregnancy.
During a nonstress test, when monitoring the fetal heart rate, the nurse notes that when the expectant mother reports fetal movement, the heart rate increases 15 beats or more above the baseline. The nurse interprets this as: A. variable decelerations. B. fetal tachycardia. C. a nonreactive pattern. D. reactive pattern
reactive pattern explanation: A reactive nonstress test indicates fetal activity, as evidenced by acceleration of the fetal heart rate by at least 15 bpm for at least 15 seconds within a 20-minute recording period. If this does not occur, the test is considered nonreactive. An increase in the fetal heart rate does not indicate variable decelerations. Fetal tachycardia would be noted as a heart rate greater than 160 bpm.
A nurse is teaching a pregnant client in her first trimester about discomforts that she may experience. The nurse determines that the teaching was successful when the woman identifies which discomforts as common during the first trimester? Select all that apply. urinary frequency breast tenderness cravings backache leg cramps
urinary frequency breast tenderness cravings explanation: Discomforts common in the first trimester include urinary frequency, breast tenderness, and cravings. Backache and leg cramps are common during the second trimester. Legs cramps are also common during the third trimester.
Which positions would be most appropriate for the nurse to suggest as a comfort measure to a woman who is in the first stage of labor? Select all that apply. walking with partner support straddling with forward leaning over a chair closed knee-chest position rocking back and forth with foot on chair supine with legs raised at a 90-degree angle
walking with partner support straddling with forward leaning over a chair rocking back and forth with foot on chair explanation: Positioning during the first stage of labor includes walking with support from the partner, side-lying with pillows between the knees, leaning forward by straddling a chair, table, or bed or kneeling over a birthing ball, lunging by rocking weight back and forth with a foot up on a chair or birthing ball, or an open knee-chest position.
A woman in the last trimester of pregnancy reports sleeping poorly. She becomes light-headed and dizzy whenever she sleeps on her back, but she cannot sleep at all if she lies on her side. How would the nurse suggest she try sleeping? without a pillow with a pillow under her shoulders with a pillow under her right hip with a pillow under both hips
with a pillow under her right hip explanation: Pregnancy places strain on the cardiovascular system with increased fluid in the lungs and heart. When the woman lies flat on her back the uterus and contents can compress the vena cava and aorta and reduce blood flow resulting in the light-headed and dizzy spells. Removal of the pillow would not affect the effects on the vena cava. A pillow under the shoulders would hurt the neck, and a pillow under both hips would exacerbate the light-headedness.
Which action is a priority when caring for a woman during the fourth stage of labor? A. assessing the uterine fundus B. offering fluids as indicated C. encouraging the woman to void D. assisting with perineal care
A. assessing the uterine fundus explanation: During the fourth stage of labor, a priority is to assess the woman's fundus to prevent postpartum hemorrhage. Offering fluids, encouraging voiding, and assisting with perineal care are important but not an immediate priority.
There are advantages and disadvantages to any kind of method used to control pain during labor and birth. What is an advantage of opioid administration? A. It provides total pain control. B. It is generally given p.o. C. It has the ability to be administered by the nurse. D. It can be given frequently without risk to the fetus.
C. It has the ability to be administered by the nurse. explanation: Opioids are most frequently given by the intravenous (IV) route because this route provides fast onset and more consistent drug levels than do the subcutaneous or intramuscular routes.
A postpartum client is experiencing subinvolution. When reviewing the woman's labor and birth history, which contributor would the nurse identify as being a significant to this condition? A. early ambulation B. short duration of labor C. breastfeeding D. use of anesthetics
D. use of anesthetics Explanation: Factors that inhibit involution include prolonged labor and difficult birth, incomplete expulsion of amniotic membranes and placenta, uterine infection, overdistention of uterine muscles (such as by multiple gestation, hydramnios, or large singleton fetus), full bladder (which displaces the uterus and interferes with contractions), anesthesia (which relaxes uterine muscles), and close childbirth spacing. Factors that facilitate uterine involution include complete expulsion of amniotic membranes and placenta at birth, complication-free labor and birth process, breastfeeding, and early ambulation.
In a client's seventh month of pregnancy, she reports feeling "dizzy, like I'm going to pass out, when I lie down flat on my back." The nurse explains that this is due to: A. pressure of the gravid uterus on the vena cava. B. a 50% increase in blood volume. C. physiologic anemia due to hemoglobin decrease. D. pressure of the presenting fetal part on the diaphragm.
A. Pressure of the gravid uterus on the vena cava explanation: The client is describing symptoms of supine hypotension syndrome, which occurs when the heavy gravid uterus falls back against the superior vena cava in the supine position. The vena cava is compressed, reducing venous return, cardiac output, and blood pressure, with increased orthostasis. The increased blood volume and physiologic anemia are unrelated to the client's symptoms. Pressure on the diaphragm would lead to dyspnea.
When a nurse suspects that a client may have been abused, the first action should be to: A. ask the client about the injuries and if they are related to abuse. B. encourage the client to leave the batterer immediately. C. set up an appointment with a domestic violence counselor. D. ask the suspected abuser about the victim's injuries.
A. ask the client about the injuries and if they are related to abuse. Explanation: The first step is to screen for abuse and identify the connection between the woman's injuries and abuse. Once abuse is detected, the nurse should immediately isolate the woman to provide privacy and prevent retaliation by the abuser. Encouraging the woman to leave the batterer immediately is not realistic. Setting up an appointment with a counselor would be appropriate once the abuse is detected and the woman is safe. Questioning the suspected abuser might worsen the situation.
A nurse is teaching a group of nursing students about the role of progesterone in labor. The nurse should explain that which action is the function of progesterone? A. suppresses the uterine irritability throughout pregnancy B. promotes oxytocin production from the posterior C. pituitary sensitizes the uterus to effects of oxytocin on the myometrium D. stimulates smooth muscle contraction in the uterus
A. suppresses the uterine irritability throughout pregnancy explanation: The function of progesterone is to suppress uterine irritability throughout pregnancy. The function of estrogen is to promote oxytocin production and to sensitize the uterus to the effects of oxytocin. Prostaglandin, and not progesterone, stimulates the smooth muscle contractions in the uterus.
A client is in the third stage of labor. Which finding would alert the nurse that the placenta is separating? A. uterus becomes globular B. fetal head at vaginal opening C. umbilical cord shortens D. mucous plug is expelled
A. uterus becomes globular explanation: Placental separation is indicated by the uterus changing shape to globular and upward rising of the uterus. Additional signs include a sudden trickle of blood from the vaginal opening, and lengthening (not shortening) of the umbilical cord. The fetal head at the vaginal opening is termed crowning and occurs before birth of the head. Expulsion of the mucous plug is a premonitory sign of labor.
The first time the nurse sees a woman during pregnancy, her fundal height is palpable at the level of her umbilicus. This measurement is typical of what gestational age? A. 12 weeks B. 20 weeks C. 24 weeks D. 6 weeks
B. 20 weeks explanation: The uterus expands to reach the height of the umbilicus by week 20. Before week 20 it is too low to be palpated, and after week 20 it may be beyond the umbilicus.
A primipara client gave birth vaginally to a healthy newborn girl 12 hours ago. The nurse palpates the client's fundus. Which finding would the nurse identify as expected? A. two fingerbreadths above the umbilicus B. at the level of the umbilicus C. two fingerbreadths below the umbilicus D. four fingerbreadths below the umbilicus
B. at the level of the umbilicus explanation: During the first few days after birth, the uterus typically descends downward from the level of the umbilicus at a rate of 1 cm (1 fingerbreadth) per day so that by 3 days, the fundus lies 2 to 3 fingerbreadths below the umbilicus.
A woman in labor is to receive continuous internal electronic fetal monitoring. The nurse prepares the client for this monitoring based on the understanding that which criterion must be present? A. intact membranes B. cervical dilation of 2 cm or more C. floating presenting fetal part D. a neonatologist to insert the electrode
B. cervical dilation of 2 cm or more explanation: For continuous internal electronic fetal monitoring, four criteria must be met: ruptured membranes, cervical dilation of at least 2 cm, fetal presenting part low enough to allow placement of the electrode, and a skilled practitioner available to insert the electrode.
The nurse administers Rho(D) immune globulin to an Rh-negative client after birth of an Rh-positive newborn based on the understanding that this drug will prevent her from: A. becoming Rh positive. B. developing Rh sensitivity. C. developing AB antigens in her blood. D. becoming pregnant with an Rh-positive fetus.
B. developing Rh sensitivity. explanation: The woman who is Rh-negative and whose infant is Rh-positive should be given Rho(D) immune globulin within 72 hours after birth to prevent sensitization.
A nurse is making a home visit to a postpartum woman who gave birth to a healthy newborn 4 days ago. The woman's breasts are swollen, hard, and tender to the touch. The nurse documents this finding as: A. involution. B. engorgement. C. mastitis. D. engrossment.
B. engorgement. explanation: Engorgement is the process of swelling of the breast tissue as a result of an increase in blood and lymph supply as a precursor to lactation (Figure 15.4). Breast engorgement usually peaks in 3 to 5 days postpartum and usually subsides within the next 24 to 36 hours (Chapman, 2011). Engorgement can occur from infrequent feeding or ineffective emptying of the breasts and typically lasts about 24 hours. Breasts increase in vascularity and swell in response to prolactin 2 to 4 days after birth. If engorged, the breasts will be hard and tender to touch. Involution refers to the process of the uterus returning to its prepregnant state. Mastitis refers to an infection of the breasts. Engrossment refers to the bond that develops between the father and the newborn.
A woman has opted to use the basal body temperature method for contraception. The nurse instructs the client that a rise in basal body temperature indicates which event? A. onset of menses B. ovulation C. pregnancy D. safe period for intercourse
B. ovulation explanation: Basal body temperatures typically rise within a day or two after ovulation and remain elevated for approximately 2 weeks, at which point bleeding usually begins. Basal body temperature is not a means for determining pregnancy. Having intercourse while the temperature is elevated would increase the risk of pregnancy.
A nurse is reviewing the fetal heart rate pattern and observes abrupt decreases in FHR below the baseline, appearing as a U-shape. The nurse interprets these changes as reflecting which type of deceleration? A. early decelerations B. variable decelerations C. prolonged decelerations D. late decelerations
B. variable decelerations explanation: Variable decelerations present as visually apparent abrupt decreases in FHR below baseline and have an unpredictable shape on the FHR baseline, possibly demonstrating no consistent relationship to uterine contractions. The shape of variable decelerations may be U, V, or W, or they may not resemble other patterns. Early decelerations are visually apparent, usually symmetrical and characterized by a gradual decrease in the FHR in which the nadir (lowest point) occurs at the peak of the contraction. They are thought to be a result of fetal head compression that results in a reflex vagal response with a resultant slowing of the FHR during uterine contractions. Late decelerations are visually apparent, usually symmetrical, transitory decreases in FHR that occur after the peak of the contraction. The FHR does not return to baseline levels until well after the contraction has ended. Delayed timing of the deceleration occurs, with the nadir of the uterine contraction. Late decelerations are associated with uteroplacental insufficiency. Prolonged decelerations are abrupt FHR declines of at least 15 bpm that last longer than 2 minutes but less than 10 minutes.
A gravida 2 para 1 client in the 10th week of her pregnancy says to the nurse, "I've never urinated as often as I have for the past three weeks." Which response would be most appropriate for the nurse to make? A. "Having to urinate so often is annoying. I suggest that you watch how much fluid you are drinking and limit it." B. "You shouldn't be urinating this frequently now; it usually stops by the time you're eight weeks pregnant. Is there anything else bothering you?" C. "By the time you are 12 weeks pregnant, this frequent urination should really decrease, but it is likely to return toward the end of your pregnancy." D. "Women having their second child generally don't have frequent urination. Are you experiencing any burning sensations?"
C. "By the time you are 12 weeks pregnant, this frequent urination should really decrease, but it is likely to return toward the end of your pregnancy." explanation: As the uterus grows, it presses on the urinary bladder, causing the increased frequency of urination during the first trimester. This complaint lessens during the second trimester only to reappear in the third trimester as the fetus begins to descend into the pelvis, causing pressure on the bladder.
A woman in her 40th week of pregnancy calls the nurse at the clinic and says she is not sure whether she is in true or false labor. Which statement by the client would lead the nurse to suspect that the woman is experiencing false labor? A. "I'm feeling contractions mostly in my back." B. "My contractions are about 6 minutes apart and regular." C. "The contractions slow down when I walk around." D. "If I try to talk to my partner during a contraction, I can't."
C. "The contractions slow down when I walk around." explanation: False labor is characterized by contractions that are irregular and weak, often slowing down with walking or a position change. True labor contractions begin in the back and radiate around toward the front of the abdomen. They are regular and become stronger over time; the woman may find it extremely difficult if not impossible to have a conversation during a contraction.
A nurse is preparing a presentation for a local community group about intimate partner violence. Which statement would be most appropriate for the nurse to include in the presentation? A. Abuse primarily affects young, unmarried women. B. Until the 1990s, society tended to legitimize a man's control over a woman. C. Abuse in homosexual relationships may go unreported for fear of harassment. D. Children who witness abuse of a parent are less likely to become batterers.
C. Abuse in homosexual relationships may go unreported for fear of harassment. explanation: Abuse occurs in both heterosexual and homosexual relationships, but violence within homosexual relationships may go unreported for fear of harassment or ridicule. Few statistics are available on its incidence in homosexual relationships. Abuse affects women at nearly every stage of their lives and may occur in old or young, beautiful or unattractive, married or single women. Until the 1970s, society tended to legitimize a man's power and control over a woman. Children who witness one parent abusing another are more likely to become delinquents or batterers themselves.
During a postpartum exam on the day of birth, the woman reports that she is still so sore that she cannot sit comfortably. The nurse examines her perineum and find the edges of the episiotomy approximated without signs of a hematoma. Which intervention will be most beneficial at this point? A. Notify a primary care provider. B. Apply a warm washcloth. C. Place an ice pack. D. Put on a witch hazel pad.
C. Place an ice pack. explanation: The labia and perineum may be edematous after birth and bruised; the use of ice would assist in decreasing the pain and swelling. Applying a warm washcloth would bring more blood as well as fluid to the sore area, thereby increasing the edema and the soreness. Applying a witch hazel pad needs the order of the primary care provider. Notifying a care provider is not necessary at this time as this is considered a normal finding.
When screening a client about intimate partner violence, which type of questions should the nurse employ? A. direct questions, like "Does your partner harm you?" B. indirect questions, like "Do you feel safe in your home?" C. direct or indirect questions D. neither direct nor indirect questions
C. direct or indirect questions explanation: When interviewing a client about intimate partner violence, direct questioning and indirect questioning elicit the same answers. Either direct or indirect questions can be used
During a routine antepartal visit, a pregnant woman says, "I've noticed my gums bleeding a bit since I've become pregnant. Is this normal?" The nurse bases the response on the understanding of which effect of pregnancy? A. elevated progesterone levels B. increased venous pressure C. influence of estrogen and blood vessel proliferation D. effects of regurgitation from relaxation of the cardiac sphincter
C. influence of estrogen and blood vessel proliferation explanation: During pregnancy, the gums become hyperemic, swollen, and friable and tend to bleed easily. This change is influenced by estrogen and increased proliferation of blood vessels and circulation to the mouth. Elevated progesterone levels cause smooth muscle relaxation, which results in delayed gastric emptying and decreased peristalsis. Increased venous pressure contributes to the formation of hemorrhoids. Relaxation of the cardiac sphincter, in conjunction with slowed gastric emptying, leads to reflux due to regurgitation of the stomach contents into the upper esophagus.
A 40-year-old woman comes to the clinic reporting having missed her period for two months. A pregnancy test is positive. What is she and her fetus at increased risk for? A. type 2 diabetes mellitus B. type 1 diabetes mellitus C. placental abnormalities D. post term birth
C. placental abnormalities explanation: A woman older than 35 years is more likely to conceive a child with chromosomal abnormalities, such as Down syndrome. She is also at higher risk for spontaneous abortion (miscarriage), preeclampsia-eclampsia, gestational diabetes, preterm birth, bleeding and placental abnormalities, and other intrapartum complications.
When dealing with a pregnant adolescent, the nurse assists the client to integrate the tasks of pregnancy while at the same time fostering development of which trait? A. trust B. autonomy C. self-identity D. dependence
C. self-identity Explanation: The nurse assists the pregnant adolescent to integrate the tasks of pregnancy, bonding, and preparing to care for another with the tasks of developing self-identity and independence. Trust is a developmental task of infancy. Autonomy is a developmental task of toddlerhood. Independence, not dependence, is fostered.
A client who is breastfeeding her newborn tells the nurse, "I notice that when I feed him, I feel fairly strong contraction-like pain. Labor is over. Why am I having contractions now?" Which response by the nurse would be most appropriate? A. "Your uterus is still shrinking in size; that's why you're feeling this pain." B. "Let me check your vaginal discharge just to make sure everything is fine." C."Your body is responding to the events of labor, just like after a tough workout." D. "The baby's sucking releases a hormone that causes the uterus to contract."
D. "The baby's sucking releases a hormone that causes the uterus to contract." explanation: The woman is describing afterpains, which are usually stronger during breastfeeding because oxytocin released by the sucking reflex strengthens uterine contractions. Afterpains are associated with uterine involution, but the woman's description strongly correlates with the hormonal events of breast-feeding. All women experience afterpains, but they are more acute in multiparous women secondary to repeated stretching of the uterine muscles.
A client has just given birth to her second child and will breastfeed. Although she wants "lots of kids," she does not want to become pregnant again until her second child is at least 2 years old. The nurse would counsel her to start using birth control at what point? A. as soon as she stops breastfeeding B. within 18 months C. within 6 weeks D. as soon as she resumes sexual activity
D. as soon as she resumes sexual activity explanation: She can ovulate even though she is not having a normal menstrual cycle. She needs to take precautions. Beginning to use birth control within 6 weeks, or within 18 months, or as soon as she stops breastfeeding is not affording her protection from getting pregnant. She should use mechanical means of birth control as soon as she resumes sexual activity
A nurse is assessing a woman in labor. Which finding would the nurse identify as a cause for concern during a contraction? A. heart rate increase from 76 bpm to 90 bpm B. blood pressure rise from 110/60 mm Hg to 120/74 C. white blood cell count of 12,000 cells/mm3 D. respiratory rate of 10 breaths/minute
D. respiratory rate of 10 breaths/minute explanation: During labor, the mother experiences various physiologic responses including an increase in heart rate by 10 to 20 bpm, a rise in blood pressure by up to 35 mm Hg during a contraction, an increase in white blood cell count to 25,000 to 30,000 cells/mm3, perhaps as a result of tissue trauma, and an increase in respiratory rate with greater oxygen consumption due to the increase in metabolism. A drop in respiratory rate would be a cause for concern.
