OB Final

The clinic nurse is teaching a pregnant client about the warning signs in pregnancy. Which, if identified as a warning sign by the client, would indicate a need for further education?

Presence of irregular, painless contractions

A client diagnosed with severe preeclampsia is receiving magnesium sulfate by continuous intravenous infusion. Which assessment finding would indicate that the medication should be discontinued?

Absence of deep tendon reflexes

Methylergonovine is prescribed for a client to treat postpartum hemorrhage. Before administration of methylergonovine, what is the priority assessment?

BP

Methylergonovine has been prescribed for a client who is at risk for postpartum bleeding in the immediate postpartum period. The nurse preparing to administer the medication ensures that which priority item is at the bedside?

BP cuff

Newborn with hyperbilirubenemia

Breast feed 2-3 hrs

The nurse is caring for a client with preeclampsia who is receiving an intravenous (IV) infusion of magnesium sulfate. When gathering items to be available for the client, which highest priority item would the nurse obtain?

Calcium gluconate injection

The nurse is monitoring a postpartum client who received epidural anesthesia for delivery for the presence of a vulvar hematoma. Which assessment finding would best indicate the presence of a hematoma?

Changes in vital signs

The nurse suspects the presence of uterine atony and massages the uterus, but this action does not assist in controlling blood loss. Which is the next nursing action?

Contact the primary health care provider (PHCP).

Vitamin K for newborns

Promotes maturation of the bowel

A maternity unit nurse is creating a plan of care for a client with severe preeclampsia who will be admitted to the nursing unit. The nurse would include which nursing intervention in the plan?

Reduce external stimuli.

A pregnant client reports noticing a thin, colorless vaginal drainage. Which information would the nurse provide to the client?

This is a normal occurrence.

A client with preeclampsia is receiving magnesium sulfate. The nurse would assess the client closely for which sign of magnesium toxicity?

Respiratory rate of 10 breaths/minute

A primigravida is receiving magnesium sulfate for the treatment of gestational hypertension. The nurse who is caring for the client is performing assessments every 30 minutes. Which finding would be of most concern to the nurse?

Respiratory rate of 10 breaths/minute

Several late decelerations over 10 mins

Umbilical cord compression

A client in the third trimester of pregnancy with a diagnosis of mild preeclampsia is being monitored at home. The home care nurse teaches the client about the signs that need to be reported to the primary health care provider (PHCP). The nurse would tell the client to call the PHCP if which occurs?

Weight increases by more than 1 pound in a week.

The nurse is assessing the deep tendon reflexes of a client with severe preeclampsia who is receiving intravenous magnesium sulfate. The nurse would perform which procedure to assess the brachioradialis reflex? Click on the image to indicate your answer.

Wrist

Most favorable pelvis

gynecoid

The nursing student is assigned to care for a client in the postpartum unit. The coassigned registered nurse asks the student to identify the most objective method to assess the amount of lochial flow in the client. Which statement, if made by the student, indicates an understanding of this method?

"I should weigh the perineal pad before and after use and note the amount of time between each pad change."

The nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes mellitus. Which statement by the client indicates an understanding of self-care for this diagnosis?

"I will report signs of infection immediately to my primary health care provider."

The nurse provides instructions to a malnourished client regarding iron supplementation during pregnancy. Which statement, if made by the client, indicates an understanding of the instructions?

"Iron supplements may give me constipation."

The senior nursing student is assigned to care for a client with severe preeclampsia who is receiving an intravenous infusion of magnesium sulfate. The co-assigned registered nurse asks the student to describe the actions and effects of this medication. Which statement, if made by the student, indicates the need for further teaching?

"It increases acetylcholine, blocking neuromuscular transmission."

The nurse in an obstetrical clinic is reviewing current prenatal laboratory results of a pregnant client who is being seen for a routine prenatal visit. The nurse discovers that the client's 1-hour oral glucose tolerance test (OGTT) result was 163 mg/dL (9.3 mmol/L). Which is the nurse's best response to the client?

"The OGTT is a screening tool for gestational diabetes, and you will need further testing to confirm a diagnosis, owing to your results being elevated."

After surgical evacuation and repair of a paravaginal hematoma, a client is discharged 3 days postpartum. The nurse determines that the client needs further discharge instructions when the client makes which statement?

"The only medications I will take are prenatal vitamins and stool softeners."

The nurse is caring for a client in the postpartum period immediately after delivery. The nurse performs an assessment on the client and prepares to assess uterine involution by taking which action?

Palpating the uterine fundus

The nurse is reviewing the record of a pregnant client seen in the health care clinic for the first prenatal visit. Which data if noted on the client's record would alert the nurse that the client is at risk for developing gestational diabetes during this pregnancy?

The client's last baby weighed 10 pounds at birth.

The nurse provides teaching on how to relieve discomfort to a client in the second trimester of pregnancy who is having frequent low back pain and ankle edema at the end of the day. Which statement made by the client indicates an understanding of the teaching?

When I get home, I need to lie on the floor with my legs elevated on a couch and turn my hips and knees at right angles."

A pregnant client calls a clinic and tells the nurse about experiencing leg cramps that awaken the client at night. What would the nurse tell the client to provide relief from the leg cramps? Rationale

Bend your foot toward your body while extending the knee when the cramps occur."

The nurse is performing a measurement of fundal height in a client whose pregnancy has reached 36 weeks of gestation. During the measurement, the client begins to feel light-headed. On the basis of knowledge of the physiological changes of pregnancy, the nurse understands that which is the cause of the light-headedness?

Compression of the vena cava

The postpartum client asks the nurse about the occurrence of afterpains. The nurse informs the client that afterpains will be especially noticeable during which activity?

breast feeding

The nurse is reviewing the medical record of a client scheduled for a weekly prenatal appointment. The nurse notes that the client has been diagnosed with mild preeclampsia. Which interventions would the nurse include in planning nursing care for this client? Select all that apply.

Assess blood pressure. Check the urine for protein. Assess deep tendon reflexes. Teach the importance of keeping track of a daily weight.

The nurse is administering magnesium sulfate to a client for preeclampsia at 34 weeks' gestation. What is the priority nursing action for this client?

Assess for signs and symptoms of labor.

Priority nursing action in 4th stage of labor

Assess fundal consistency and amount

A type 1 diabetic birthing client delivered a 4400-gram newborn 3 hours ago. The client has already initiated breast/chest-feeding. What would the nurse plan to do to maintain euglycemia in this client?

Assess the blood glucose before administering any glucose-lowering medications.

The nurse is assessing the fundus in a postpartum client and notes that the uterus is soft and spongy and not firmly contracted. The nurse would prepare to implement which interventions? Select all that apply.

Massaging the uterus Assisting the client to urinate Checking for a distended bladder

A home care nurse is visiting a pregnant client with a diagnosis of mild preeclampsia. What is the priority nursing intervention during the home visit?

Monitor for fetal movement.

The nurse understand signs of true labor when she states

My contractions will increase in duration and intensity

A woman with preeclampsia is receiving magnesium sulfate. Which indicates to the nurse that the magnesium sulfate therapy is effective?

Seizures do not occur.

The nurse is monitoring a client in the immediate postpartum period for signs of hemorrhage. Which sign, if noted, would be an early sign of excessive blood loss?

An increase in the pulse rate from 88 to 102 beats/minute

The nurse is monitoring a postpartum client who is bleeding for signs of shock. Which indicates an early sign of shock?

An increased pulse rate of 80 to 120 beats/min

The nurse is interviewing a 16-year-old client during the initial prenatal clinic visit. The client is beginning week 18 of their first pregnancy. Which statement, if made by the client, indicates an immediate need for further investigation?

"I don't like my face anymore. I always look as if I have been crying."

The nurse is providing instructions regarding the treatment of hemorrhoids to a client who is in the second trimester of pregnancy. Which statement by the client indicates a need for further instruction?

"I need to apply heat packs to the hemorrhoids to help the hemorrhoids shrink."

The nurse is providing instructions about treatment for hemorrhoids to a client in the second trimester of pregnancy. Which statement made by the client indicates a need for further teaching?

"I need to apply heat packs to the hemorrhoids to help them shrink."

The clinic nurse is providing instructions to a pregnant client regarding measures that assist in alleviating heartburn. Which statement by the client indicates an understanding of the instructions?

"I need to avoid eating fatty foods and foods that produce gas."

The nurse has instructed a pregnant client in measures to prevent varicose veins during pregnancy. Which statement by the client indicates a need for further instruction?

"I need to wear knee-high hose, but I would not leave them on longer than 8 hours."

The nurse is teaching a client in the first trimester measures to alleviate nausea and vomiting. Which statement by the client indicates that further teaching is required?

"I will eat dry crackers for breakfast after I get up."

During a routine prenatal visit, a client complains of gums that bleed easily with brushing. The nurse performs an assessment and then teaches the client about proper nutrition to minimize this problem. Which statement, if made by the client, indicates an understanding of the proper nutritional measures to minimize this problem?

"I will eat fresh fruits and vegetables for snacks and for dessert each day."

A home care nurse is monitoring a 16-year-old primigravida who is at 36 weeks' gestation and has gestational hypertension. The client's blood pressure during the past 3 weeks has been averaging 130/90 mm Hg and the client has had some swelling in the lower extremities and has had mild proteinuria. Which statement by the client would alert the nurse to the worsening of gestational hypertension?

"My vision for the past 2 days has been really fuzzy."

Premonitory signs of labor

- Cervical changes - Lightening - Increased energy level - "Bloody show" - Braxton Hicks contractions - Spontaneous rupture of membranes

A client with severe preeclampsia is receiving intravenous magnesium sulfate. The nurse is reviewing the laboratory results and determines that which magnesium level is within the therapeutic range?

5 mEq/L (2.5 mmol/L)

The nurse is preparing to care for four assigned clients. Which client is at most risk for hemorrhage?

A multiparous client who delivered a large baby after oxytocin induction

A client with severe preeclampsia is admitted to the maternity department. Which room assignment is most appropriate for this client?

A private room two doors away from the nurses' station

The postpartum unit nurse has provided information on performing a sitz bath to a postpartum client after a vaginal delivery. The client demonstrates understanding of the purpose of the sitz bath by stating that it will promote which action?

Assist in healing and provide comfort.

The nurse is caring for a client who is experiencing a precipitous labor and is waiting for the primary health care provider to arrive. When the infant's head crowns, what instruction would the nurse give the client?

Breathe rapidly.

The nurse prepares a plan of care for the client with preeclampsia and documents that if the client progresses from preeclampsia to eclampsia, the nurse would take which first action?

Clear and maintain an open airway.

A pregnant client calls the clinic and tells the nurse about experiencing leg cramps and is awakened by the cramps at night. Which activity would the nurse tell the client to perform when the cramps occur?

Dorsiflex the foot while extending the knee.

What is the priority assessment following ROM

FHR

The nurse in a labor room is assisting with the vaginal delivery of a newborn infant. The nurse would monitor the client closely for the risk of uterine rupture if which occurred?

Forceps delivery

On assessment of a client who is 30 minutes into the fourth stage of labor, the nurse finds the client's perineal pad saturated with blood and blood soaked into the bed linen under the client's buttocks. Which is the nurse's initial action?

Gently massage the uterine fundus.

The nurse is teaching a pregnant client with diabetes about nutrition and insulin needs during pregnancy. The nurse would provide the client with which information?

Glucose crosses the placenta.

The nurse reviews the assessment history for a client with a suspected ectopic pregnancy. Which assessment findings predispose the client to an ectopic pregnancy? Select all that apply.

History of Chlamydia Use of fertility medications Use of an intrauterine device History of pelvic inflammatory disease (PID)

The nurse is reviewing the record of a pregnant client seen in the health care clinic for the first prenatal visit. Which data, if noted on the client's record, would alert the nurse that the client is at risk for a spontaneous abortion?

History of syphilis

A prenatal client with severe abdominal pain is admitted to the maternity unit. The nurse is monitoring the client closely because concealed bleeding is suspected. Which assessment findings indicate the presence of concealed bleeding? Select all that apply.

Increase in fundal height Hard, board-like abdomen Persistent abdominal pain

The nurse is teaching a pregnant client with diabetes about nutrition and insulin needs during pregnancy. The nurse determines that the client understands dietary and insulin needs if the client states that the second half of pregnancy may require which treatment?

Increased insulin

The nurse is caring for a client with a diagnosis of subinvolution. The nurse would recognize which conditions as causes of this diagnosis? Select all that apply.

Infection Retained placental fragments from delivery

A pregnant client tells the nurse that she is experiencing irregular contractions. The nurse determines that the client is experiencing Braxton Hicks contractions and provides the client with which information?

Irregular contractions are common and may occur throughout the pregnancy.

The nurse is creating a plan of care for a pregnant client with a diagnosis of severe preeclampsia. Which nursing actions would be included in the care plan for this client? Select all that apply.

Keep the room semi-dark. Initiate seizure precautions. Pad the side rails of the bed. Avoid environmental stimulation.

When performing a postpartum assessment on a client, the nurse notes the presence of clots in the lochia. The nurse examines the clots and notes that they are larger than 1 cm. Which nursing action is most appropriate?

Notify the health care provider.

Sever back pain in active phase of labor, the fetus is in what position

Occiput posterior

Methylergonovine is prescribed for a client with postpartum hemorrhage. Before administering the medication, the nurse would contact the primary health care provider who prescribed the medication if which condition is documented in the client's medical history?

Peripheral vascular disease

The nurse is counseling a pregnant client diagnosed with gestational diabetes at 29 weeks' gestation. Which information would the nurse discuss with the client? Select all that apply.

Plan for weekly nonstress tests at 32 weeks. Obtain nutritional counseling with a dietitian.

The nurse is creating a plan of care for a postpartum client with a small vulvar hematoma. The nurse would include which specific action during the first 12 hours after delivery?

Prepare an ice pack for application to the area.

A pregnant client received epidural anesthesia during labor and had a forceps delivery after pushing for 2 hours. At 6 hours postpartum the client's systolic blood pressure has dropped 20 points, the diastolic blood pressure has dropped 10 points, and the client's pulse is 120 beats/minute. The client is anxious and restless. On further assessment, a vulvar hematoma is verified. After notifying the primary health care provider (PHCP), what is the nurse's next action?

Prepare the client for surgery.

After a precipitous delivery, the nurse notes that the new parent is passive and touches the newborn infant only briefly with their fingertips. What would the nurse do to help the client process the delivery?

Support the parent's reaction to the newborn infant.

Which data places the client at risk for developing gestational diabetes during pregnancy?

The client has a history of gestational diabetes with a previous pregnancy.

The nurse performs an assessment of a pregnant client who is receiving intravenous magnesium sulfate for management of preeclampsia and notes that the client's deep tendon reflexes are absent. On the basis of this finding, the nurse would make which interpretation?

The client is experiencing magnesium excess. Submit

The nurse is monitoring a postpartum client in the fourth stage of labor. Which finding, if noted by the nurse, indicates a complication related to a laceration of the birth canal?

The saturation of more than 1 peripad per hour

The nurse is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in reducing breast/chest tenderness. Which instruction would the nurse provide?

Wash the breasts/chest with warm water and keep them dry.