OB Final

A nurse is providing care to several pregnant women at the clinic. The nurse would screen for group B streptococcus infection in a client at:

36 weeks gestation

A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. Which level would the nurse identify as therapeutic?

6.1 mEq/L

A pregnant woman is admitted with premature rupture of the membranes. The nurse is assessing the woman closely for possible infection. Which of the following would lead the nurse to suspect that the woman is developing an infection? (select all that apply)

Abdominal tenderness, elevated maternal pulse, cloudy malodorous fluid

The nurse is assessing a newborn who is large for gestational age. The newborn was born breech. The nurse suspects that the newborn may have experienced trauma to the upper brachial plexus based on which assessment findings?

Absent Moro reflex

Which of the following would lead the nurse to suspect that a postpartum woman is experiencing a problem?

Acute decrease in hematocrit

An LGA newborn has a blood glucose level of 30 mg/dL and is exhibiting symptoms of hypoglycemia. Which of the following would the nurse do next?

Administer intravenous glucose immediately

A client with trichomoniasis is to receive metronidazole (flagyl). The nurse instructs the client to avoid which of the following while taking this drug?

Alcohol

A primipara client who is bottle feeding her baby begins to experience breast engorgement on her third postpartum day. Which instruction would be most appropriate to aid in relieving her discomfort?

Apply ice packs to your breasts to reduce the amount of milk being produced

A woman who is 42 weeks pregnant comes to the clinic. Which of the following would be most important?

Determining an accurate gestational age

A nurse is preparing an inservice education program for a group of nurses about dystocia involving problems with the passenger. Which of the following would the nurse most likely include as the most common problem?

Persistent occiput posterior position

The nurse reviews the CD4 cell count of a client who is HIV-positive. A result less than which of the following would indicate to the nurse that the client has AIDS?

200 cells

It is determined that a clients blood Rh is negative and her partners is positive. To help prevent Rh isoimmunization, the nurse anticipates that the client will receive RhoGAM at which time?

At 28 weeks gestation and again within 72 hours after delivery

After teaching parents about their newborn, the nurse determines that the teaching was successful when they identify the development of a close emotional attraction to a newborn by parents during the first 30 to 60 minutes after birth as which of the following?

Bonding

Which of the following would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia?

Calcium gluconate

Assessment of a female client reveals a thick, white vaginal discharge. She also reports intense itching and dyspareunia. Based on these findings, the nurse would suspect that the client has:

Candidiasis

A woman gave birth to a newborn via vaginal delivery with the use of a vacuum extractor. The nurse would be alert for which of the following in the newborn?

Caput succedaneum

After discussing various methods of contraception with a client and her partner, the nurse determines that the teaching was successful when they identify which contraceptive method as providing protection against sexually transmitted infections?

Condoms

Which of the following would the nurse include in the plan of care for a newborn receiving phototherapy?

Covering the newborns eyes while under the bililight

Risk associated with gentamicin use with a newborn. Key assessments

Damage to hearing (ototoxicity), hearing screenings

A nurse suspects that a pregnant client may be experiencing abruption placenta based on assessment of which of the following? (Select all that apply.)

Dark red vaginal bleeding, rigid uterus, absent fetal heart tones

A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. Which finding would the nurse interpret as indicating a therapeutic level of medication?

Deep tendon reflexed 2+

The nurse frequently assesses the respiratory status of a preterm newborn based on the understanding that the newborn is at increased risk for respiratory distress syndrome because of which of the following?

Deficiency of surfactant, or c section, or mom had gestational diabetes

A nurse is developing a program for pregnant women with diabetes about reducing complications. Which factor would the nurse identify as being most important in helping to reduce the maternal/fetal/neonatal complications associated with pregnancy and diabetes?

Degree of glycemic control achieved during the pregnancy

Abnormal findings in the newborn

Delivered 12 hour ago and cyanosis of hands and feet is this concerning? Its normal If they have small amount of spitting up after, normal but mucous and bubbling at lips need to be looked at further

The nurse administers RhoGAM to Rh-negative client after delivery of an Rh-positive newborn based on the understanding that thus drug will prevent her from:

Developing Rh sensitivity

Assessment of a postpartum woman experiencing postpartum hemorrhage reveals mild shock. Which of the following would the nurse expect to assess? (select all that apply)

Diaphoresis, cool extremities

A woman with hyperemesis gravidarum asks the nurse about suggestions to minimize nausea and vomiting. Which suggestion would be most appropriate for the nurse to make?

Drink fluids in between meals rather than with meals

A client is diagnosed with pelvic inflammatory disease (PID). When reviewing the client's medical record, which of the following would the nurse expect to find? (select all that apply)

Dysmenorrhea, dysuria, lower abdominal tenderness, discomfort with cervical motion

a multipara client develops thrombophlebitis after delivery. Which of the following would alert the nurse to the need for immediate intervention?

Dyspnea, diaphoresis, hypotension, and chest pain

A nurse is developing a plan of care for a woman who is at risk for thromboembolism. Which of the following would the nurse include as the most cost-effective method for prevention?

Early ambulation

When developing the plan of care for the parents of a newborn, the nurse identifies interventions to promote bonding and attachment based on the rationale that bonding and attachment are most supported by which measure?

Early parent infant contact following birth

After teaching a class on preventing pelvic inflammatory disease, the instructor determines that the teaching was successful when the class identifies which of the following as an effective method?

Emphasizing the need for infected sexual partners to receive treatment

The parents of a preterm newborn being cared for in the neonatal intensive care unit (NICU. are coming to visit for the first time. The newborn is receiving mechanical ventilation and intravenous fluids and medications and is being monitored electronically by various devices. Which action by the nurse would be most appropriate?

Encourage the parents to touch the newborn

A postpartum woman is diagnosed with metritis. The nurse interprets this as an infection involving which of the following? (select all that apply)

Endometrium, decidua, myometrium

A nurse is preparing a presentation for a group of woman at the clinic who have been diagnosed with genital herpes. Which of the following would the nurse expect to include as a possible precipitating factor for a recurrent outbreak? (select all that apply)

Exposure to ultraviolet light, use of corticosteroids, emotional stress, intercourse

A newborn with severe meconium aspiration syndrome (MAS. is not responding to conventional treatment. Which of the following would the nurse anticipate as possibly necessary for this newborn?

Extracorporeal membrane oxygenation (ECMO) or check the vocal cords

After teaching a group of nursing students about the possible causes of spontaneous abortion, the instructor determines that the teaching was successful when the students identify which of the following as the most common cause of first trimester abortions?

Fetal genetic abnormalities

A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition?

Fetopelvic disproportion

The nurse would be alert for possible placental abruption during labor when assessment reveals which of the following?

Gestational hypertension

Which of the following findings would the nurse interpret as suggesting a diagnosis of gestational trophoblastic disease?

Gestational hypertension, hyperemesis gravidarum, absence of FHR

A group of students are reviewing information about sexually transmitted infections and their effect on pregnancy. The students demonstrate understanding of the information when they identify which infection as being responsible for opthalmia neonatorum?

Gonorrhea

A group of nursing students are reviewing information about vaccines used to prevent STIs. The students would expect to find information about which of the following?

HPV, HAV, HBV

A woman who is 2 weeks postpartum calls the clinic and says, my left breast hurts. After further assessment on the phone, the nurse suspects the woman has mastitis. In addition to pain, the nurse would assess for which of the following?

Hardening of an area in the affected breast

Which statement would alert the nurse to the potential for impaired bonding between mother and newborn?

He looks like a frog to me

When the nurse is assessing a postpartum client approximately 6 hours after delivery, which finding would warrant further investigation?

Heart rate of 120 beats/minute

Assessment of a postpartum client reveals a firm uterus with bright-red bleeding and a localized bluish bulging area just under the skin at the perineum. The woman also is complaining of significant pelvic pain and is experiencing problems with voiding. The nurse suspects which of the following?

Hematoma

A postpartum woman who developed deep vein thrombosis is being discharged on anticoagulant therapy. After teaching the woman about this treatment, the nurse determines that additional teaching is needed when the woman states which of the following?

I can take ibuprofen if I have any pain

A nurse is assessing a postpartum client who is at home. Which statement by the client would lead the nurse to suspect that the client may be developing postpartum depression?

I feel so guilty and worthless lately

A nurse is teaching a woman with genital ulcers how to care for them. Which statement by the client indicates a need for additional teaching?

I need to abstain from intercourse primarily when the lesions are present

After teaching a pregnant woman with iron deficiency anemia about her prescribed iron supplement, which statement indicates successful teaching?

I need to eat foods high in fiber

After teaching a woman who has had an evacuation for a hydatidiform mole (molar pregnancy. about her condition, which of the following statements indicates that the nurses teaching was successful?

I will be sure to avoid getting pregnant for at least 1 year

A nurse is teaching a pregnant woman at risk for preterm labor about what to do if she experiences signs and symptoms. The nurse determines that the teaching was successful when the woman states that if she experiences any symptoms, she will do which of the following?

I'll drink several glasses of water

After teaching a couple about what to expect with their planned cesarean birth, which statement indicates the need for additional teaching?

I'm going to have to wait a few days before I can start breast-feeding

Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which of the following responses by the nurse would be most appropriate?

I'm sorry you lost your baby

Patient teaching with candidiasis

If left untreated during pregnancy this can transmit to baby and cause thrush which is an infection on the tongue that can spread to the esophagus and impact feeding

Risk factors for the preterm newborn

If moms membranes were ruptured for more than 24 hours, if mom had fever at delivery (101 or 102), if baby had floppy muscle tone

Findings with hypothermia

Immature mechanism for thermoregulation, less brown fat or adipose tissue than full term baby

The nurse is developing a plan of care for a client who is receiving highly active antiretroviral therapy (HAART) for treatment of HIV. The goal of this therapy is to:

Improve survival rates

A nurse is describing the risks associated with prolonged pregnancies as part of an inservice presentation. Which of the following would the nurse be least likely to incorporate in the discussion as an underlying reason for problems in the fetus?

Increase amniotic fluid volume

A nurse teaches a postpartum woman about her risk for thromboembolism. Which of the following would the nurse be least likely to include as a factor increasing her risk?

Increased red blood cell production

A nurse is teaching a pregnant woman with preterm premature rupture of membranes who is about to be discharged home about caring for herself. Which statement by the woman indicates a need for additional teaching?

It's okay for my husband and me to have intercourse or need to be on pelvic rest

Signs of hypoglycemia with the newborn

Jittery baby with a high pitched cry (do heel stick for blood sugar)

After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position?

Kneechest

the nurse is assessing a postpartum client's loch and finds that there is about a 4-inch stain on the perineal pad. The nurse documents thus finding as which of the following?

Light

Assessment of the macrosomic newborn

Looks for signs of fractured clavicle, nerve damage, when morro reflex it is asymmetrical?? Could be nerve damage from fractured clavicle. Watch for hypoglycemia

A home health nurse is assessing a postpartum woman who was discharged 2 days ago. The woman tells the nurse that she has a low-grade fever and feels lousy. Which of the following findings would lead the nurse to suspect metritis? (select all that apply)

Lower abdominal tenderness, anorexia

Because a pregnant clients diabetes has been poorly controlled throughout her pregnancy, the nurse would be alert for which of the following in the neonate at birth?

Macrosomia

Facilitation of bonding

Make sure it's safe, secure, comfortable environment

After reviewing a clients history, which factor would the nurse identify as placing her at risk for gestational hypertension?

Mother has gestational hypertension during pregnancy

Nursing actions with lochia

Notify MD if loch has a foul odor or heavy bleeding or clots after loch serosa has started

A nurse is working as part of a committee to establish policies to promote bonding and attachment. Which practice would be least effective in achieving this goal?

Offering round-the-clock nursery care for all infants

The nurse prepares to administer a gavage feeding for a newborn with transient tachypnea based on the understanding that this type of feeding is necessary for which reason?

Oxygen demands need to be reduced

The fetus of a woman in labor is determined to be in persistent occiput posterior position. Which of the following would the nurse identify as the priority intervention?

Pain relief measures

Which of the following would the nurse include when teaching a new mother about the difference between pathologic and physiologic jaundice?

Pathologic jaundice appears within 24 hours after birth.

After teaching a group of students about risk factors with postpartum hemorrhage, the instructor determines that the teaching was successful when the students identify which of the following as a risk factor? (select all that apply)

Placenta previa, hydramnios, labor augmentation

Signs of infection of the newborn

Poor feeding, hypothermic, lethargy

Reciprocal attachment

Positive feedback from the baby while the parents are holding it

A nurse is developing a teaching plan for a postpartum woman who is breast-feeding about sexuality and contraception. Which of the following would the nurse most likely include? (select all that apply)

Possible experience if fluctuations in sexual interest, use of a water based lubricant to ease vaginal discomfort, possibility of increased breast sensitivity during sexual activity

The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurses teaching was successful?

Pregnancy affects insulin production, so I'll need to make adjustments in my diet

When planning the care for an SGA newborn, which action would the nurse determine as a priority?

Preventing hypoglycemia with early feedings

A group of students are reviewing risk factors associated with postpartum hemorrhage. The students demonstrate understanding of the information when they identify which the following as associated with uterine tone? (select all that apply)

Rapid labor, hydramnios

A newborn is experiencing cold stress. Which of the following would the nurse expect to assess? (Select all that apply.)

Respiratory distress, hypoglycemia, metabolic alkalosis

After teaching a class on sexually transmitted infections, the instructor determines that the teaching was successful when the class identifies which statement as true?

STIs can affect anyone if exposed to the infectious organism

After teaching a group of nursing students about risk factors associated with dystocia, the instructor determines that the teaching was successful when the students identify which of the following as increasing the risk? (select all that apply)

Short maternal stature, maternal age over 35, breech fetal presentation

Which finding would indicate to the nurse that a woman's cervix is ripe in preparation for labor induction?

Shortened

Post partum assessing uterus

Should be firm or firm with massage, should not be boggy

The nurse notifies the obstetrical team immediately because the nurse suspects that the pregnant woman may be exhibiting signs and symptoms of amniotic fluid embolism. Which findings would the nurse most likely assess? (Select all that apply.)

Significant difficulty breathing, tachycardia, pulmonary edema, bleeding with bruising

After reviewing information about postpartum blues, a group of students demonstrate understanding when they state which of the following about this condition?

Sleep usually helps to resolve the blues

Which of the following would alert the nurse to the possibility of respiratory distress in a newborn?

Sternal retractions or nasal flaring

A woman is experiencing postpartum hemorrhage is ordered to receive a uterotonic agent. Which of the following would the nurse least expect to administer?

Terbutaline

A client with genital herpes simplex infection asks the nurse, Will I ever be cured of this infection? Which response by the nurse would be most appropriate>

There is no cure, but drug therapy helps to reduce symptoms and recurrence

When assessing the postpartum woman, the nurse uses indicators other than pulse rate and blood pressure for postpartum hemorrhage based on the knowledge that:

These measures may not change until after the blood loss is large

The nurse is assessing a newborn of a woman who is suspected of abusing alcohol. Which newborn finding would provide additional evidence to support this suspicion?

Thin upper lip

The nurse is assessing a newborn and suspects that the newborn was exposed to drugs in utero because the newborn is exhibiting signs of neonatal abstinence syndrome. Which of the following would the nurse expect to assess? (Select all that apply.)

Tremors, regurgitation, shrill high-pitched cry, frequent sneezing

A woman comes to the clinic complaining of a vaginal discharge. The nurse suspects trichomoniasis based on which of the following? (select all that apply)

Urinary frequency, yellow/green discharge

A postpartum woman who is breast feeding tells the nurse that she is experiencing nipple pain. Which of the following would be least appropriate for the nurse to suggest?

Use of a mild analgesic about 1 hour before breast feeding

A group of students are reviewing the causes of postpartum hemorrhage. The students demonstrate understanding of the information when they identify which of the following as the most common cause?

Uterine atony

Which of the following factors in a client's history would alert the nurse to an increased risk for postpartum hemorrhage?

Uterine atony, placenta previa, operative procedures

A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which of the following findings would require immediate intervention?

Uterine output of 20 mL/hr

A woman with a history of crack cocaine abuse is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also complains of acute abdominal pain that is continuous. Which of the following would the nurse suspect?

Uterine rupture

postpartum vital signs

Vital signs q 15 for 1 hr, then q 30 min for 1 hr, q4 hr for 24hr, temp may be elevated but if it remains over 100.4 after 24 hrs may indicate infection, BP may initially decrease and back to normal by one week, expect orthostatic hypotension, pulse may decrease (40-60) due to the decrease in blood volume and decrease strain on the heart but WNL within 6-10 days, if pulse is elevated look for a cause, pain is 5th vital sign

Which of the following would be most appropriate when massaging a woman's fundus?

Wait until the uterus is firm to express clots

When planning the care of a newborn addicted to cocaine who is experiencing withdrawal, which of the following would be least appropriate to include?

Waking the newborn every hour

A woman is to undergo an amnioinfusion. Which statement would be most appropriate to include when teaching the woman about this procedure?

You'll need to stay in bed while you're having this procedure

A nurse is developing a plan of care for a preterm infant experiencing respiratory distress. Which of the following would the nurse be least likely to include in this plan?

administer oxygen using an oxygen hood

Coombs test

antibody titer and blood type rh factor

methergine nursing assessment

blood pressure before administration

As part of an inservice program, a nurse is describing a transient, self limiting mood disorder that affects mothers after childbirth. The nurse correctly identifies this as postpartum:

blues

Signs of infection with parametritis

broad ligament, ovaries, Fallopian tubes, or septic pelvic thrombophlebitis

The nurse is assessing the newborn of a mother who had gestational diabetes. Which of the following would the nurse expect to find? (Select all that apply.)

buffalo hump, distended upper abdomen, excessive subcutaneous fat

The nurse is assessing a preterm newborns fluid and hydration status. Which of the following would alert the nurse to possible overhydration?

bulging fontanelle

Hep B

can survive outside the body for 7 days

The nurse is making a follow-up home visit to a woman who is 12 days postpartum. Which. of the following would the nurse expect to find when assessing the client's fundus?

cannot be palpated

The nurse encourages a female client with human papillomavirus (HPV) to receive continued follow-up care because she is at risk for:

cervical cancer

The fetus of a nulliparous woman is in a shoulder presentation. The nurse would most likely prepare the client for which type of birth?

cesarean

A group of nursing students are preparing a presentation for their class about measures to prevent toxoplasmosis. Which of the following would the students be least likely to include? Select all that apply.

cooking all meat to an internal temperature of 140 F

Which of the following, if noted in the maternal history, would the nurse identify as possibly contributing to the birth of an LGA newborn?

diabetes

A woman with preterm labor is receiving magnesium sulfate. Which finding would require the nurse to intervene immediately?

diminished deep tendon reflexes

The nurse is reviewing the laboratory test results of a pregnant client. Which one of the following findings would alert the nurse to the development of HELLP syndrome?

elevated liver enzymes

Which findings would the nurse expect to find in a client with bacterial vaginosis

fish-like odor of discharge

A newborn is suspected of having fetal alcohol syndrome. Which of the following would the nurse expect to assess?

flattened maxilla

nursing intervention to prevent dehydration, reduce/prevent DVT's

fluids

Which assessment finding would lead the nurse to suspect infection as the cause of a clients PROM?

foul odor

signs of infection in the reproductive tract

foul smelling loch, low back ache, dysuria, uterine tenderness, pelvic pain

When caring for a mother who has had a cesarean birth, the nurse would expect the clients lochia to be:

less than after a vaginal birth

Nursing management of chlamydia and gonorrhea

listen and show interest and respect in a nonjudgmental manner

When teaching a class of pregnant women about the effects of substance abuse during pregnancy, which of the following would the nurse most likely include?

low birth weight infants

After teaching a group of nursing students about tocolytic therapy, the instructor determines that the teaching was successful when they identify which drug as being used for tocolysis? (select all that apply)

nifedipine, terbutaline, indomethacin

rubella vaccine

not given during pregnancy because it is a live attenuated virus. Cannot become pregnant for three months after vaccine due to risk for fetal abnormalities. Vaccine should be offered after birth.

Bacterial vaginosis

only the woman has to be treated

A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer?

oxytocin

risk factors for respiratory distress syndrome

premature, c section baby, mom has had gestational diabetes

management of parental concerns over newborn bruising after delivery

reassure it is temporary, it will go away, if baby seems to be in pain we will treat with acetaminophen (NIP score will tell if they're in pain)

Which of the following data on a clients health history would the nurse identify as contributing to the clients risk for an ectopic pregnancy?

recurrent pelvic infections

PID treatment to avoid during pregnancy

tetracyclines and quinlones

A primipara client gave birth vaginally to a healthy newborn girl 48 hours ago. The nurse palates the clients fundus, expecting it to be at which location

two finger breadths below the unbilicus

PID is usually caused by

untreated chlamydia or gonorrhea

A pregnant woman is receiving misoprostol to ripen her cervix and induce labor. The nurse assesses the woman closely for which of the following?

uterine hyperstimulation