OB Exam 3
A nurse is caring for a client who is in labor. The nurse should identify that which of the following infections can be treated during labor or immediately following birth? (Select all that apply.) a. Gonorrhea b. Chlamydia c. HIV d. Group B streptococcus beta-hemolytic e. TORCH infection
A, B, C, D A: Erythromycin is administered to the infant immediately following delivery to prevent Neisseria gonorrhea. B: Erythromycin is administered to the infant immediately following delivery to prevent Chlamydia trachomatis. C: Retrovir is prescribed to a client in labor who is HIV-positive. D: Penicillin G or ampicillin may be prescribed to treat positive GBS
A nurse in an antepartum clinic is assessing a client who has a TORCH infection. Which of the following findings should the nurse expect? (Select all that apply.) a. Joint pain b. Malaise c. Rash d. Urinary frequency e. Tender lymph nodes
A, B, C, E A: TORCH infections are flu-like in presentation, such as joint pain. B: TORCH infections are flu-like in presentation, such as malaise. C: TORCH infections can include findings such as rash. E: TORCH infections are flu-like in presentation, such as tender lymph nodes.
A nurse is administering magnesium sulfate IV to a client who has severe preeclampsia for seizure prophylaxis. Which of the following indicates magnesium sulfate toxicity? (Select all that apply.) a. Respirations less than 12/min b. Urinary output less than 30 mL/hr c. Hyperreflexia deep-tendon reflexes d. Decreased level of consciousness e. Flushing and sweating
A, B, D A: A respiratory rate less than 12/min is a sign of magnesium sulfate toxicity. B: Urinary output less than 30 mL/hr is a sign of magnesium sulfate toxicity. C: The absence of patellar deep-tendon reflexes is a sign of magnesium sulfate toxicity. D: Decreased level of consciousness is a sign of magnesium sulfate toxicity. E: Flushing and sweating are adverse effects of magnesium sulfate but are not signs of toxicity.
1. A nurse is caring for a client who is at 14 weeks gestation and has hyperemesis gravidarum. The nurse should identify that which of the following are risk factors for the client? (Select all that apply.) a. Obesity b. Multifetal pregnancy c. Maternal age greater than 40 d. Migraine headaches e. Oligohydramnios
A, B, D A: Obesity is a risk factor for hyperemesis gravidarum. B: Multifetal pregnancy is a risk factor for hyperemesis gravidarum. C: Maternal age less than 30 is a risk factor for hyperemesis gravidarum. D: Migraine headache is a risk factor for hyperemesis gravidarum. E: Oligohydramnios is not a risk factor for hyperemesis gravidarum.
A nurse is caring for a client who reports indications of preterm labor. Which for the following findings are risk factors of this condition? (Select all that apply.) a. Urinary tract infection b. Multifetal pregnancy c. Oligohydramnios d. Diabetes mellitus e. Uterine abnormalities
A, B, D, E A: A urinary tract infection is a risk of preterm labor. B: Multifetal pregnancy is a risk factor of preterm labor. D: Diabetes mellitus is a risk factor of preterm labor. E: Uterine abnormalities are a risk factor of preterm labor.
A nurse is caring for a client who has a prescription for magnesium sulfate. The nurse should recognize that which of the following contraindications for use of this medication? (Select all that apply.) a. Fetal distress b. Preterm labor c. Vaginal bleeding d. Cervical dilation greater than 6 cm e. Severe gestational hypertension
A, C, D A: Acute fetal distress is a complication that is a contraindication for use of magnesium sulfate therapy. C: Vaginal bleeding is a complication that is a contraindication for magnesium sulfate therapy. D: Cervical dilation greater than 6 cm is a complication that is a contraindication for magnesium sulfate therapy.
Pain control is an important outcome for a woman after a cesarean delivery because it impacts attaining every other outcome except A.Adequate production of breast milk B. Prevention of pneumonia and thrombophlebitis C. Maintenance of bowel function D. Continuation of maternal-infant bonding process
A. Adequate production of breast milk Rationale: Pain can prevent postoperative women from turning in bed and in early ambulation, which assists in prevention of pneumonia and thrombophlebitis and in maintaining bowel function. Pain can also interrupt the maternal-infant bonding process. There is little evidence that pain affects production of breast milk.
The nurse notices that a colleague who was helping to prepare Moja has left the room to liaise with the OR in anticipation of the cesarean birth. The nurse also notices that the colleague left Moja's electronic health record open and in view of her support people. Which course of action would be best? a. Immediately close the record even though all care may not yet be recorded. b. Locate the nurse and ask her to come back so she can close the record. c. Minimize the record and wait for the nurse to come back and close it. d. Report the nurse to the nurse manager for violating confidentiality.
A. The nurse's priority in this situation is to protect confidential health information. Leaving or minimizing the record until the nurse who left it open returns may expose Moja's health information. Reporting this error to the nurse-manager is not the immediate priority.
The nurse gives a report to an OR nurse prior to a cesarean birth and describes actions she took to reduce the size of the patient's bladder and to keep it away from the surgical field during the procedure. Which action should the nurse describe to her colleague? a. Inserting a Foley catheter to drain the bladder and decrease its size b. Administering an oxytocic drug to cause the bladder to forcefully contract c. Restricting the woman's fluids for at least 16 hours before surgery d. Administering the woman a diuretic to reduce bladder volume
A. The urinary catheter inserted by the nurse will keep the bladder empty. Oxytocin contracts the uterus, not the bladder. Restricting fluid and administering a diuretic could lead to fluid volume deficit.
A nurse is providing care for a client who is diagnosed with a marginal abruptio placentae. The nurse is aware that which of the following findings are risk factors for developing the condition? (Select all that apply.) a. Fetal position b. Blunt abdominal trauma c. Cocaine use d. Maternal age e. Cigarette smoking
B, C, E B: Blunt abdominal trauma is a risk factor associated with abruptio placentae. C: Cocaine use is a risk factor associated with abruptio placentae. E: Cigarette smoking is a risk factor associated with abruptio placentae.
Which statement by a woman who is 8 weeks pregnant and has cardiac disease would you most likely follow up closely? A. "I have been really constipated for the last few weeks." B. "I have gained 4 lb during the last week, but I'm not eating more than before." C. "I have not felt any fetal movement as yet." D. "I have had episodes in the morning when I have almost thrown up."
B. "I have gained 4 lb during the last week, but I'm not eating more than before. "Rationale: Constipation and nausea are common during the first trimester. Fetal movement (quickening) is not usually felt until the second trimester. Weight gain of 4 lb within a week during the first 8 weeks of pregnancy without additional intake could signal increased circulatory fluid and impending heart failure.
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 A. Will have a shorter second stage of labor B. May experience more pronounced back pain C. May need to have an external cephalic version performed D. Probably will need to have the delivery assisted by forceps or vacuum extraction
B. May experience more pronounced back pain Rationale: An occiput posterior presentation means that labor will be longer because the occiput needs to rotate to an anterior position. Women often complain of intense back pain during labor. External cephalic versions are not used to correct posterior cephalic positions. Most woman are able to deliver without instrument assistance.
A pregnant woman who is carrying triplets is concerned when her obstetrician suggested that she give birth by cesarean delivery. What is the most accurate statement that the nurse can make to the woman regarding this? A.Traditional labor room suites cannot accommodate the personnel needed during the birth of three infants like the operating room can. B. It is safer to know exactly when the delivery will occur so that the healthcare team will be available. C. A cesarean delivery helps to prevent complications due to cord prolapse or premature placental separation. D. Labor contractions are so powerful in a multiple gestation that a cesarean delivery is safer for the infants and mother.
C. A cesarean delivery helps to prevent complications due to cord prolapse or premature placental separation. Rationale: Multiple gestations are more likely to have labor complications such as prolapsed cords and premature placental separation. Cesarean delivery should not be suggested as a matter of convenience or availability of healthcare providers. Because the uterus is "overstretched" during a multiple pregnancy, it is more likely that hypotonic contractions might occur, which would prolong labor.
Suppose Moja had an amniotomy during her labor. Immediately after this procedure, which nursing assessment would be most important for the nurse to make? a. Ask her to rate her pain level after the procedure. b. Assess maternal heart rate to detect possible bleeding. c. Assess FHR to detect possible cord prolapse. d. Document the amount of amniotic fluid that has been lost.
C. A danger of amniotomy is that the fetal cord can prolapse which will interfere with fetal circulation. This makes the nurse's immediate assessment of the fetal heart rate important.
After reporting to the unit, you are assigned to the following patients. Which of the patients should be evaluated first? A.A 7-week pregnant woman who had a cervical cerclage performed 4 hours ago B. A patient diagnosed with pregnancy-induced hypertension experiencing urine output of 75 ml/hr, blood pressure of 135/90 mmHg, and slight proteinuria C. A woman at 5 weeks' gestation with suspected ectopic pregnancy complaining of shoulder and abdominal pain D. A patient in her 20th week of pregnancy suspected of having a trophoblastic pregnancy
C. A woman at 5 weeks' gestation with suspected ectopic pregnancy complaining of shoulder and abdominal pain Rationale: Although all of these women need to be monitored, the women with a suspected ectopic pregnancy is at the highest risk to develop sudden complications with a very rapid decline.
Angelina develops a DVT while in the hospital on bed rest and is prescribed low-molecular-weight heparin. The nurse identifies which action as important when planning care for her? a. Showing her how to self-administer the drug as a rectal suppository b. Cautioning her that her hemoglobin level will be closely monitored during therapy c. Allowing her to choose a subcutaneous site for the injection d. Monitoring her white blood cell count daily for decreased coagulation
C. An appropriate nursing action for Angelina is allowing her to choose a subcutaneous site for the injection. Heparin is administered subcutaneously. Hemoglobin levels and WBC do not need to be monitored during therapy.
The nurse notices Rosann's contractions are 70 seconds long and occur every 90 seconds when assessing the frequency of her contractions after she receives oxytocin. What would be the nurse's first action? a. Ask Rosann to turn onto her left side and breathe deeply. b. Increase the rate of Rosann's IV fluid infusion. c. Discontinue the administration of the oxytocin infusion. d. Give an emergency bolus of oxytocin to relax the uterus.
C. Discontinuing the oxytocin infusion would be the nurse's first step in the management of Rosann's change in labor progress. Turning to the left side and increasing fluid are second and third steps
The nurse routinely assesses all pregnant women for signs of hypertension while interviewing them at the prenatal clinic and then documents the findings in the electronic health record. Which statement by Beverly would the nurse document as possible evidence that she might be developing gestational hypertension? a. "My feet are so swollen at night I can't put on my bedroom slippers." b. "I never guessed I would feel as tired as I do just from being pregnant." c. "My abdomen feels firm, as if I had a blown-up balloon inside me." d. "I can live with my puffy feet, but now it's also my hands and wrists."
D. The nurse recognizes that edema is often a first symptom of gestational hypertension a woman notes. The edema associated with gestational hypertension can be separated from the typical ankle edema of pregnancy because it begins to accumulate in the upper part of the body as well. Beverly's other statements are not necessarily indicative of gestational hypertension.
To determine which risk factors were associated with shoulder dystocia, researchers studied a cohort of births from 1967 to 2009 in Norway, a sample of 2,014,956 vaginal births. The results of the study found an increased incidence of shoulder dystocia associated with increased fetal weight, maternal diabetes, prolonged labor, instrumental delivery and parity (Øverland, Vatten, & Eskild, 2014). Based on this study and the fact that a sonogram has shown Rosann's fetus to be extremely large, what assessment would the nurse want to prioritize for Rosann's baby after birth? a. If his abdominal wall appears to be ruptured b. If his arms feel warm and are the same length c. If his buttocks or back have extensive bruising d. If his eyes can focus steadily on a nearby object
C. The research results revealed an increase in shoulder dystocia, which can result in diaphragmatic paralysis. Because this affects breathing, it is the nurse's primary assessment taken after the birth.
Internal uterine and fetal monitoring are needed in an obese laboring woman. What assessment immediately after an amniotomy would be your primary concern? A.Checking for meconium-stained amniotic fluid B. Checking maternal blood pressure C. Recording the amount of amniotic fluid released D. Immediate monitoring of fetal heart rate
D. Immediate monitoring of fetal heart rate Rationale: Although meconium staining is a possible sign of past fetal distress, amniotomy always places the fetus at immediate risk for a prolapsed cord, and a decreased FHR is a sign that this may have occurred.
Rosann Bigalow states that her contractions are irregular in frequency and short in duration. She screams in pain, however, every time she has a contraction. What action by the nurse would be best? a. Recognize that this is a usual response to labor and offer her a back rub. b. Notify the anesthesiologist that Rosann needs to have epidural anesthesia. c. Obtain a prescription from her primary care provider for an analgesic. d. Document/report frequency and duration of contractions plus facilitate pain relief.
D. It would be important for the nurse to document the characteristics of Rosann's contractions to see if they are irregular; even though ineffective, they are still painful so she needs pain relief.
Moja tells the nurse she does not intend to continue breastfeeding after she returns home, stating, "My stomach's too painful." What action would the nurse add to the plan of care that is most apt to be helpful to Moja? a. Insist Moja speak with one of the hospital's lactation consultants. b. Instruct her to take over-the-counter analgesics just before breastfeeding. c. Design a study to identify factors that affect breastfeeding success. d. Explain that her uterine pain will not last more than a few more days.
D. Moja needs reassurance from the nurse that incisional pain only lasts about 7 days following surgery. Although women need to be comfortable while breastfeeding, many medications are contraindicated. Referral to a lactation consultant may or may not be necessary, and the nurse should not insist on this action.
A pregnant woman at 37 weeks' gestation comes into the emergency room with heavy bleeding and begins to show signs of hypovolemic shock. As an intervention, you would: A. Place the woman flat in bed on her back B. Perform a vaginal exam to determine the extent of the bleeding C. Gain intravenous access using a 27-gauge needle D. Withhold oral fluid
D. Withhold oral fluid Rationale: Oral fluids are withheld because emergency surgery may be needed. Pregnant women in hypovolemia should be placed on their left side to allow blood flow to the placenta. Vaginal exam should not be performed—if placenta previa is present, the placenta may be perforated. Because intravenous fluids and blood may need to be administered rapidly, 16- to 18-gauge intravenous access is recommended
A nurse is caring for a client who has a diagnosis of ruptured ectopic pregnancy. Which of the following findings is seen with this condition? a. No alteration in menses b. Transvaginal ultrasound indicating a fetus in the uterus c. Serum progesterone greater than expected reference range d. Report of severe shoulder pain
D: A client's report of severe shoulder pain is a finding associated with a ruptured ectopic pregnancy due to the presence of blood in the abdominal cavity, which irritates the diaphragm and phrenic nerves.
A nurse in labor and delivery is providing care for a client who is in preterm labor at 32 weeks of gestation. Which of the following medications should the nurse anticipate the provider will prescribe to hasten fetal lung maturity? a. Calcium gluconate b. Indomethacin c. Nifedipine d. Betamethasone
D: Betamethasone is a glucocorticoid given to clients in preterm labor to hasten surfactant production.
A nurse is caring for a client who is receiving IV magnesium sulfate. Which of the following medications should the nurse anticipate administering if magnesium sulfate toxicity is suspected? a. Nifedipine b. Pyridoxine c. Ferrous sulfate d. Calcium gluconate
D: Calcium gluconate is the antidote for magnesium sulfate.
A nurse is reviewing discharge teaching with a client who has premature rupture of membranes at 26 weeks gestation. Which of the following instructions should the nurse include in the teaching? a. Use a condom with sexual intercourse. b. Avoid bubble bath solution when taking a tub bath. c. Wipe from back to front when performing perineal hygiene. d. Keep a daily record of fetal kick counts.
D: The client should record daily fetal kick counts.
A nurse manager is reviewing ways to prevent a TORCH infection during pregnancy with a group of newly licensed nurses. Which of the following statements by a nurse indicates understanding of the teaching? a. "Obtain an immunization against rubella early in pregnancy." b. "Seek prophylactic treatment if cytomegalovirus is detected during pregnancy." c. "A woman should avoid crowded places during pregnancy." d. "A woman should avoid consuming undercooked meat while pregnant."
D: Toxoplasmosis, a TORCH infection, contracted by consuming undercooked meats.
A nurse is admitting a client who is in labor and has HIV. Which of the following interventions should the nurse identify as contraindicated for this client? (Select all that apply.) a. Episiotomy b. Oxytocin infusion c. Forceps d. Cesarean birth e. Internal fetal monitoring
A, C, E A: An episiotomy should be avoided for a client who is HIV-positive due to the risk of maternal blood exposure. C: The use of forceps during delivery should be avoided due to the risk of fetal bleeding. E: Internal fetal monitoring should be avoided due to the risk of fetal bleeding.
Which is the most accurate and reliable Outcome measure for evaluating an intervention? A. A fasting glucose level of 85 mg/dl B. An oral intake measurement of 720 ml of fluids within 8 hours C. An exercise diary indicating the pregnant woman walked 30 minutes every day for a week D. The statement by a pregnant woman, "I understand why folic acid is important for red blood cell formation."
A. A fasting glucose level of 85 mg/dl Rationale: Fasting glucose level is the only measure of an outcome. The other three choices are evaluation of activities (processes), which may or may not result in a desired outcome.
A woman whose membranes ruptured is discharged to home care. Which of the following points would you most likely include in her teaching plan? A. Having her monitor her temperature twice a day B. Anticipating having a vaginal examination within 24 hours after discharge C. Remaining on bed rest for the first 24 hours and then resume normal activity D. Hourly assessment of Homans sign
A. Having her monitor her temperature twice a day Rationale: Rupture of the membranes without the onset of labor places the woman at risk for infection. Vaginal examination increases the risk of infection and would not be performed unless labor begins. Bed rest is usually prescribed until it is determined that labor is inevitable or induced. Hourly assessment of Homans sign is unnecessary
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.
A. Prepare oxytocin as prescribed using a piggyback intravenous setup. Rationale: As a safety measure, oxytocin should always be administered through a secondary line. A side-lying position (especially the left side) is preferable because it is the optimum position for fetal oxygenation and avoids vena cava syndrome. It is anticipated that continuous uterine and fetal monitoring will be performed rather than episodic monitoring with a fetoscope because this does not monitor uterine contractions. Induction of labor does not assure that the period of labor will be any shorter.
Angelina had tuberculosis as a teenager, and her primary care provider orders a chest X-ray during pregnancy. The nurse would want care team members to know that this is necessary because of which danger of tuberculosis during pregnancy? a. Calcium deposits that wall off old tuberculosis lesions can break down. b. Latent tuberculosis can turn to pneumonia if a woman has a folic acid deficit. c. PPD tests are always negative during pregnancy so tuberculosis often goes undetected. d. The disease can result in neural tube defects in the fetus.
A. The nurse should alert care team members that because the fetus requires calcium to build bones, calcium-surrounded tuberculosis lesions can be activated if a woman doesn't ingest adequate calcium.
Women who have had a complication of pregnancy have the potential to develop depression in the postpartal period because their pregnancy did not go the way they wanted or imagined. To see what factors tend to be associated with depression in women who develop gestational diabetes, researchers administered a questionnaire to 71 women at 4 to 15 weeks postpartum. Results of the study showed that 34% of the women who developed gestational diabetes showed depressive symptoms; factors most associated with depression were cesarean birth and more weight gain than expected during pregnancy (Nicklas, Miller, Zera, et al., 2013). Based on the previous study, which statement by Angelina would worry the nurse most that she might develop postpartum depression? a. "I want to shed some pounds so I'll fit into the new dress I bought for New Year's Eve." b. "I hated giving insulin to myself; I'm relieved to not be doing that anymore." c. "My baby is bigger than I expected, but his eyes are beautiful and he's cute." d. "I think my husband adjusted better to my having diabetes than I did."
A. The nurse should be concerned about Angelina wanting to "shed some pounds." Concerns about gaining weight and having to have a cesarean birth were the two factors most associated with depression following pregnancy with gestational diabetes. Wanting to "shed some pounds" is suggestive of earlier weight gain that is perceived as being excessive.
A nurse is providing care for a client who is at 32 weeks gestation and who has a placenta previa. The nurse notes that the client is actively bleeding. Which of the following types of medications should the nurse anticipate the provider will prescribe? a. Betamethasone b. Indomethacin c. Nifedipine d. Methylergonovine
A: Betamethasone is given to promote lung maturity if delivery is anticipated.
A nurse is caring for a client who has gonorrhea. Which of the following medications should the nurse anticipate the provider will prescribe? a. Ceftriaxone b. Fluconazole c. Metronidazole d. Zidovudine
A: Ceftriaxone IM or doxycycline orally for 7 days is prescribed for the treatment of gonorrhea.
Beverly's husband drove her to the emergency room because she was having symptoms of preterm labor. The admitting nurse in the emergency department identifies which action as the priority? a. Encourage her to carefully walk so the fetal head maintains pressure on her cervix. b. Position her in a side-lying position and assess fetal heart rate and contractions. c. Obtain blood for an hCG hormone assessment. d. Ensure no one initiates intravenous fluid infusion because hypervolemia exacerbates preterm labor.
B. The nurse identifies assessing FHR and whether she is having contractions as the best first actions. Walking stimulates contractions. Hydration, not dehydration, may reduce contractions.
Because so many women of childbearing age work at physically demanding occupations, researchers assessed the work lifting requirements of 66,693 pregnant woman when they were at 16 weeks gestational age by phone interview and then analyzed if there was an association between their work lifting characteristics and the development of small-for-gestational-age babies. Results of the study showed no consistent association between the work-related lifting and the incidence of small-for-gestational-age babies (Juhl, Larsen, Anderson, et al., 2014). Based on the previous study, which statement by Beverly about her job as a secretary at a construction site would give the nurse the most concern regarding fetal health? a. "I think I likely walk at least a mile every work day." b. "I rarely have time to eat when I'm at work because I get so busy." c. "Sometimes, I have to move boxes of files around the office." d. "I usually help my colleague bring boxes of paper up to the office for the photocopier."
B. The nurse is aware that activities at work were not associated with development of hypertension of pregnancy. Not taking time to eat regularly could lead to fetal hypoglycemia and would be a significant concern that the nurse should address.
Beverly Muzuki has an Rh-negative blood type. Her electronic record shows she had a previous miscarriage at 16 weeks into her last pregnancy. What medication should the nurse check she received following the miscarriage to minimize isoimmunization? a. Misoprostol (Cytotec) b. RhIG (RhoGAM) c. Ferrous sulfate d. Packed red blood cell transfusion
B. The nurse should check if Beverly received Rh immune globulin (RhIG or RhoGAM) because it is the medication used to minimize the risk of isoimmunization.
Angelina is prescribed an insulin pump to administer insulin for her gestational diabetes. What patient education would the nurse want to provide to explain why nighttime is a particularly hazardous time for her fetus during pump therapy? a. The fetus can develop hyperglycemia from excessive insulin administration. b. Continuous insulin administration with no food intake can lead to hypoglycemia. c. Her lack of exercise at night tends to lead to hypercalcemia from muscle disuse. d. Her lack of fluid intake during the night causes a relative increase in serum insulin levels.
B. The nurse should explain that continuous insulin administration with no food intake can lead to hypoglycemia. Women should typically eat a high-protein/complex carbohydrate snack such as peanut butter and celery before bedtime to prevent fetal hypoglycemia from ingesting little food during the night.
A nurse is caring for a client who is receiving nifedipine for prevention of preterm labor. The nurse should monitor the client for which of the following manifestations? a. Blood-tinged sputum b. Dizziness c. Pallor d. Somnolence
B: Dizziness and lightheadedness are associated with orthostatic hypotension, which occurs with nifedipine.
A nurse in the emergency department is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states she missed one menstrual cycle and cannot be pregnancy because she has an intrauterine device. The nurse should suspect which of the following? a. Missed abortion b. Ectopic pregnancy c. Severe preeclampsia d. Hydatidiform mole
B: Manifestations of an ectopic pregnancy include unilateral lower quadrant pain with or without bleeding. Use of an IUD is a risk factor associated with this condition.
1. A nurse is caring for a client who has suspected hyperemesis gravidarum and is reviewing the client's laboratory reports. Which of the following findings is a manifestation of this condition? a. Hgb 12.2 g/dL b. Urine ketones present c. Alanine aminotransferase 20 IU/L d. Serum glucose 114 mg/dL
B: the presence of ketones in the urine is associated with the breakdown of proteins and fats that occurs in a client who has hyperemesis gravidarum.
Which of the following is the primary reason that the cesarean birth rate is so high in the United States? A.Premature labor B. Fetal malpresentation C. History of previous cesarean delivery D. Labor dystocia
C. History of previous cesarean delivery Rationale: Neither labor dystocia nor fetal malpresentation is the most prevalent reason for performing a cesarean delivery. History of a prior cesarean birth is the most common reason for performing a subsequent cesarean delivery.
Suppose a sonogram shows Beverly, who is beginning preterm labor, has a placenta previa. The nurse identifies which measure as the priority to ensure her safety? a. Keep her physically active to avoid a deep vein thrombosis. b. Perform a daily vaginal exam to assess the extent of the previa. c. Assess for vaginal bleeding and clear fluid leakage every shift. d. Keep her nothing by mouth (NPO) as she will need an emergency cesarean birth.
C. It is important for the nurse to assess for vaginal bleeding and clear fluid leakage every shift. Vaginal examinations are contraindicated as this procedure may cause bleeding. If the previa is not total, a cesarean birth may not be necessary.
Moja Hamma needs to have an IV infusion started prior to her cesarean procedure. Which course of action would be best? a. Introduce the cannula into the back of either hand. b. Begin the IV infusion in the hand nearest to you. c. Ask Moja which hand she would prefer you to use. d. Explain that IVs are typically started in the right hand.
C. Moja will want her dominant hand free to hold her baby after birth, so the nurse needs to identify this. The nurse giving Moja this choice exemplifies patient-centered care
While reviewing antenatal electronic records, the charge nurse of a prenatal clinic notes that a high number of pregnant women seen in the clinic, including Angelina Gomez, have developed UTIs during their pregnancies. The nurse should emphasize the need for staff nurses to do which of the following? a. Ensure that the housekeeping department is adequately cleaning the toilets. b. Suggest all women be prescribed a prophylactic antibiotic during their first trimester. c. Educate women on the need for sound perineal care during pregnancy. d. Urge women to restrict fluid to keep their urine acidic and concentrated.
C. Nurses should emphasize that good perineal care, a generous fluid intake, wearing cotton underwear, and avoiding bath salts are common ways to avoid urinary tract infections so should be followed during pregnancy.
Angelina is friends with a woman in the clinic who has sickle-cell anemia, and they often talk together about their care. Which statement would alert the nurse that her friend may need further instruction on prenatal care? a. "I understand why folic acid is important for red cell formation." b. "I'm careful to drink at least eight glasses of fluid every day." c. "I take an iron pill every day to help grow new red blood cells." d. "I've temporarily stopped jogging so I don't risk becoming dehydrated."
C. The nurse is alerted to the fact that the woman is taking an iron pill every day. Women with sickle-cell anemia are not prescribed iron pills during pregnancy because sickle cells are unable to incorporate as much iron in their structure as normal red cells. The woman's other statements reflect a sound understanding of sickle cell disease.
Beverly Muzuki had a miscarriage when she was younger. After addressing her immediate psychosocial needs, the nurse identifies which advice as best for a woman who says she is miscarrying? a. Lie down and remain on bed rest for 24 hours to stop the bleeding. b. Continue light activity as usual because most spotting during pregnancy is harmless. c. Save any clots or material passed for your healthcare provider to examine. d. Use a tampon to put pressure on your cervix and stop the bleeding.
C. The nurse should advise saving any clots or material passed to help the healthcare provider assess the amount of bleeding and whether the miscarriage process is incomplete or complete and allows them to be assessed for the possibility of gestational trophoblastic disease. A woman should not use a tampon, so the amount of bleeding she is having can be evaluated. Vaginal bleeding always needs to be investigated during pregnancy
Rosann's primary care provider is considering whether to augment her labor with oxytocin. What would make the nurse question the care provider's use of oxytocin for her? a. Her blood pressure is slightly elevated above normal. b. Her membranes ruptured after only 1 hour of labor. c. Her fetus is large for gestational age by a sonogram. d. She had an amniocentesis performed during pregnancy.
C. The nurse would question her labor augmentation with oxytocin because with a large fetus cephalopelvic disproportion may be present. Amniocentesis, elevated blood pressure, and ruptured membranes do not contraindicate the use of oxytocin.
5. The majority of women who have a cesarean birth are physically eligible to future births vaginally. Researchers examined what influences a woman's choice in birth mode. They looked at 20 papers reporting views of 507 women who had a previous cesarean section. Women choosing a vaginal birth after cesarean were strongly influenced by a preconceived anticipation of vaginal birth. Women seeking repeat cesarean were often influenced by a prior traumatic birth experience. Women who were open to hearing suggestions had fewer preconceptions about the birth method and were able to hear a range of options (Black, Entwistle, Bhattacharya, et al., 2016). Moja tells the nurse, although she knows she will be eligible, she isn't certain if she wants to have a vaginal birth for her next child. Based on the previous study findings, what would be the nurse's best assurance for her? a. "It doesn't matter. Once a cesarean, always a cesarean is the rule." b. "Birth is such a personal experience it's impossible to say." c. "Let's talk about the risks and benefits of both types of deliveries to help you make your decision." d. "My coworker had a vaginal birth after a cesarean birth and she was satisfied with her choice."
C. Women rated spontaneous vaginal birth as the most satisfying type. Nurses should be knowledgeable about best evidence and use this knowledge to guide their practice. A coworker's personal experience might not be a reliable opinion. Instrumental vaginal births were rated lower than cesarean sections, so it would be inaccurate to describe all vaginal births as being more satisfying than all cesarean births.
A nurse at an antepartum clinic is caring for a client who is at 4 months of gestation. The client reports continued nausea and vomiting and scant, prune-colored discharge. She ahs experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse suspect? a. Hyperemesis gravidarum b. Threatened abortion c. Hydatidiform mole d. Preterm labor
C: A client who has a hydatidiform mole exhibits increased fundal height that is inconsistent with the week of gestation, and excessive nausea and vomiting due to elevated hCG level. Scant, dark discharge occurs in the second trimester.
A nurse is reviewing a new prescription of a ferrous sulfate with a client who is at 12 weeks of gestation. Which of the following statements by the client indicates understanding of the teaching? a. "I will take this pill with my breakfast." b. "I will take this medication with a glass of milk." c. "I plan to drink more orange juice while taking this pill." d. "I plan to add more calcium-rich foods to my diet while taking this medication."
C: A diet with increased vitamin C improves the absorption of ferrous sulfate.
Rosann's baby is not only large but also in an occipitoposterior position. The nurse would want the team members to know which position is best for a woman whose baby is in the occipitoposterior position during labor? a. On her right side to stretch the pelvic inlet b. Walking about to encourage fetal descent c. Sitting in a rocking chair to aid presentation d. On her hands and knees to help fetal rotation
D. Although not evidence based, the nurse would want team members to know a hands-and-knees position appears to aid fetal occipital rotation more than the other listed positions.
