OB Final Exam

A woman contacts her doctor and states that she felt a gush of fluid as she was walking across the room. Which suggestion by the nurse would be most appropriate?

"Come to the clinic or emergency department for an evaluation."

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 makes which statement?

"I can take ibuprofen if I have any pain.

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

Cesarean

The nursing staff in a labor and delivery unit has noticed an increase in the number of patients experiencing placental abruption. The nurses begin to review demographics for the patients involved. Which risk factors will the nurses expect?

Cocaine use Abdominal trauma Hypertensive disorders

The nurse receives orders to administer RhoGAM to her patient. The nurse understands that this drug will prevent the patient from:

Developing Rh sensitivity

The patient asks the nurse why kegal exercises are important to perform after a vaginal delivery. The nurse states that these exercises:

Improve pelvic floor tone

The nurse is discussing changes in the external cervical os with a patient who is being seen for a postpartum checkup 7 weeks after a vaginal delivery. The nurse appropriately describes the appearance of the cervix as:

Slit-like

A nurse is assessing a newborn. Which finding would alert the nurse to the possibility of respiratory distress in a newborn?

Sternal retractions

The nurse provides education to her patient on breastfeeding. Which of the following responses by the mother indicates that teaching was successful?

"I should wash my hands before starting to breast-feed."

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'm feeling so guilty and worthless lately."

The nurse is providing education to a client who will have a scheduled cesarean birth. Which of the following statements would indicate a need for further teaching?

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

The nurse is assisting the breastfeeding patient with latch and positioning. The nurse observes a nutritive suck and can hear the baby swallow. The mother voices concerns that she feels like she is having contractions like she experienced while in labor. Which response by the nurse is most appropriate?

"The baby's sucking releases a hormone that causes the uterus to contract."

A nurse suspects that a client may be developing disseminated intravascular coagulation. The woman has a history of abruptio placenta during delivery. Which finding would help to support the nurses's suspicion?

Appearance of petechiae

It is determined that a client's blood Rh is negative and her partner's is positive. To help prevent Rh isoimmunization, the nurse would expect to administer Rho(D) immune globulin at which time?

At 28 weeks gestation and again within 72 hours after delivery.

The Labor and Delivery nurse goes into her patient's room and assesses signs and symptoms of an amniotic fluid embolism. Which signs and symptoms did the nurse likely assess? Select all that apply.

Bleeding with bruising Pulmonary edema Significant difficulty breathing Tachycardia

A patient arrives for her fourth month prenatal visit and expresses concern because of a leakage of yellow fluid from her breasts. Which topic does the nurse discuss during this visit?

Breast changes

The nurse in a prenatal unit is providing care for a patient who experiences PPROM (pre-term premature rupture of membranes) at 32 weeks gestation. Which assessment does the nurse consider unnecessary?

Check for cervical dilation

The nurse places a warmed blanket on the scale when weighing a newborn to minimize heat loss via which mechanism?

Conduction

The nurse is caring for a patient diagnosed with preeclampsia. The patient is on seizure precautions and receiving magnesium sulfate intravenously. Which assessment finding would require immediate intervention?

Diminished deep tendon reflexes

The nurse is caring for a patient who had a 3rd degree laceration during delivery. Which medication would the nurse expect to administer?

Docusate

After the birth of a newborn, which action would the nurse do first to assist in thermoregulation?

Dry the newborn thoroughly

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

Early ambulation

The nurse is providing education to the postpartum patient on diuresis during the postpartum period. The patient asks the nurse what is causing her to sweat so much. The nurse informs the patient that the decrease in which hormone is the reason for this occurrence?

Estrogen

A client who is 4 months pregnant is at the prenatal clinic for her initial visit. Her history reveals she has 7-year old twins who were born at 34 weeks gestation, a 2-year old son born at 39 weeks gestation, and a spontaneous abortion 1 year ago at 6 weeks gestation. Using the GTPAL method, the nurse would document her obstetric history as:

G4 T1 P1 A1 L3

The nurse is assessing a patient who is in labor. The nurse understands that the patient is at higher risk for placental abruption based on which finding?

Gestational hypertension

The nurse on a mother-baby floor receives report on a patient who delivered 6 hours ago. The nurse understands that which of the following would require further assessment?

Heart rate of 120 beats per minute

A nurse is massaging a postpartum client's fundus and places the non dominant hand on the area above the symphysis pubis based on the understanding that this action?

Helps support the lower segment of the uterus.

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 condition?

Hematoma

A pregnant woman needs an update in her immunizations. Which vaccination would the nurse ensure that the woman receives ?

Hepatitis B

A pregnant patient is at the prenatal clinic for a routine visit at 30 weeks gestation. The nurse monitors the patient for indications of physiological demands by the fetus on the patient. Which findings causes the nurse concern?

Hgb of 9.5 g/dL and Hct of 30%

When assessing a newborn 1 hour after birth, the nurse measures an axillary temperature of 95.8 degrees F, an apical pulse of 114 beats/minute, and a respiratory rate of 60 breaths/minute. The nurse would identify which area as the highest priority?

Hypothermia

A mother-baby nurse is teaching a nursing student about risk factors that cause the postpartum patient to be at increased risk for thromboembolism. Which of the following would the nurse be least likely to identify as a risk factor?

Increased red blood cell production

A woman who is bottle feeding her infant asks the nurse how she should care for her breasts since she is not breastfeeding. The best response by the nurse would be:

Instructing her to apply ice pack to both breasts every other hour.

A patient who is pregnant asks the nurse when her baby is due to be born. The patient reports her last menstrual period (LMP) date as April 14. Using Naegele's rule, the nurse will set the estimated due date (EDD) as what date?

January 21

A woman comes into the Labor and Delivery unit and is being seen in the triage room. Upon assessment, it is determined that she is 50% effaced, 3cm dilated, and having contractions every 5 minutes lasting 35 seconds. It is determined by the nurse that the patient is in:

Latent phase of the first stage

The nurse is providing education to a nursing student about a cesarean delivery. The nurse informs the student that the lochial flow of the patient is expected to be:

Less than after a vaginal delivery

The nurse is assessing a patient who is 39 weeks pregnant. The patient states that she feels different than she did last week. When asked to expand on this feeling, the patient states that she has been urinating more, and she can now breath much easier. The patient also states that she has increased cramping and lower back pain. The nurse interprets these findings as:

Lightening

A patient in the third trimester of pregnancy expresses concern to the nurse about changes to her muscles, joints, and bones. Which conditions does the nurse reassure the patient are normal changes of pregnancy? Select all that apply.

Low back pain Increased risk for falls Waddling gait

The nurse is providing care to a patient diagnosed with pre-eclampsia. The patient is receiving magnesium sulfate 2g/hr in 100ml of IV fluid. Which assessment finding will cause the nurse to administer calcium gluconate to the patient via IV push?

Lower extremity reflexes at a zero.

A postpartum client comes to the clinic for her routine 6-week visit. The nurse assesses the client and suspects that she is experiencing sub-involution based on which finding?

Moderate lochia serosa

Assessment of a newborn reveals rhythmic spontaneous movements. The nurse interprets this as indicating:

Motor maturity

A nurse is assessing a client who gave birth vaginally about 4 hours ago. The client tells the nurse that she changed her perineal pad about an hour ago. On inspection, the nurse notes that the pad is now saturated. The uterus is firm and approximately at the level of the umbilicus. Further inspection of the perineum reveals an area, bluish in color and bulging just under the skin surface. Which action would the nurse do next?

Notify the health care provider

When assessing several women for a possible trial of labor after cesarean (TOLAC), which woman would the nurse identify as being the best candidate?

One who had a previous cesarean birth via a low transverse incision.

A nurse assesses a patient in labor. Upon assessment, the nurse notes hypotonic uterine dysfunction. The provider verifies that cephalopelvic disproportion is unlikely. Which medication group would the nurse prepare to administer?

Oxytocins

The nurse educator is preparing a presentation on preterm labor (PTL) and birth (PTB). Which information does the nurse recognize as being inaccurate?

PTL is defined as regular uterine contractions resulting in cervical changes before 40 weeks gestation.

Upon pelvic examination, it is determined that the fetus is in the LOP position. The Labor and Delivery nurse understands that which intervention would be a priority for her laboring patient?

Pain relief measures

The nurse educator is preparing a class on how to best assess the intensity of contractions prior to placing the patient on electronic fetal monitor. Which statement made by the nurse educator would be most appropriate?

Palpate the maternal abdomen during a contraction.

The mother-baby nurse admits a patient who delivered 4 hours ago. The patient has yet to void and the nurse must provide an intervention. Which of the following would be least effective in stimulating the patient to void?

Placing her hand in a basin of cool water.

The nurse helps her patient to the bathroom to use a sitz bath. Which is a priory action made by the nurse?

Placing the call light within her reach.

Prior to discharging a 24-hour old newborn, the nurse assesses her respiratory status. What would the nurse expect to assess?

Respiratory rate 45, irregular

The nurse is collecting health information from a patient who is early in the first trimester of pregnancy. Which topic is most important for the nurse to discuss with the patient after learning that the patient works for a commercial cleaning company?

Risk related to exposure to environmental toxins.

The nurse in a prenatal clinic is assessing a patient who is at 37 weeks gestation for twins. The patient reports increased discomfort and increased lower pelvic pressure. Which action does the nurse take with this patient?

Sends the patient to the hospital to be checked for possible signs of labor.

The nurse is speaking with a patient who is 38 weeks pregnant. The patient asks the nurse "what factors start labor?" Which response by the nurse would be accurate? Select all that apply.

The placenta begins to age and deteriorate and this triggers the start of contractions. There is more pressure on the cervix, which causes the start of contractions by releasing oxytocin. The fetus releases a stress hormone, cortisol, and this starts contractions. Oxytocin stimulates uterine muscles to contract.

The nurse is conducting a staff education session about pre-eclampsia and eclampsia complications. Which statements by the nurse are accurate about HELLP syndrome?

This syndrome increases liver enzymes. This syndrome destroys red blood cells. This syndrome impacts the amount of platelets.

The nurse encourages the mother of a healthy newborn to put the newborn to breast immediately after birth for which reason?

To facilitate maternal-infant bonding.

The nurse is assessing a newborn's eyes. Which finding would the nurse identify as normal? Select all that apply.

Transient deviation of the eyes Able to track object to midline Involuntary repetitive eye movement

The nurse is assessing a patient in labor. On assessment she finds that contractions are 2-3 minutes apart, her cervix is 9cm dilated, and she is 90% affected. The nurse interprets these findings as indicating:

Transition phase of the first stage of labor.

The nurse is checking the fundus of a woman who delivered 2 days ago. Upon assessment, the nurse would expect the fundus to be at which location?

Two finger breadths below the umbilicus

The nurse is planning an assessment on a patient in the second trimester of pregnancy. For which assessments will the nurse plan? Select all that apply

Urine testing with a dipstick. Presence of depended edema. Antibody screening for RH factor.

The nurse is assessing a postpartum patient who is breastfeeding her infant. The patient informs the nurse that she is experiencing nipple pain during feeding. Which of the following actions would be the least appropriate suggestion by the nurse?

Use of a mild analgesic about 1 hour before breast-feeding.

The nurse is caring for a postpartum patient. The nurse understands that her patient is at increased risk for postpartum hemorrhage because of her history of:

Uterine atony, placenta previa, operative procedures

A Labor and Delivery nurse conducts an assessment on her patient who was admitted to the labor and birth area. The nurse notes a sudden onset of fetal bradycardia. Upon abdominal inspection, the nurse finds an irregular wall contour and the client complains of acute abdominal pain that is continuous. The nurse notes that the client admitted to using street drugs earlier that night. Which condition would the nurse suspect?

Uterine rupture

The nurse is assisting the obstetrician with a patient who is in the placental stage of labor. Which finding would indicate that the placenta is separating from the wall of the uterus?

Uterus becomes globular

After teaching a woman who has had an evacuation for gestational trophoblastic disease about her condition, which statement indicates that the nurse's teaching was successful?

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

The nurse is assessing the vital signs and lab values of a woman who is one day postpartum from a vaginal delivery. The nurse notes that the following would warrant an intervention?

Acute decrease in hematocrit

Which information on a client's health history would the nurse identify as contributing to the client's risk for ectopic pregnancy?

Recurrent pelvic infections

When teaching new parents about the sensory capabilities of their newborn, which sense would the nurse identify as being the least mature?

Vision

The nurse is assessing a postpartum patient's lochia and finds that there is a 2-inch stain on the perineal pad. The nurse documents this finding as which of the following?

Scant

A nurse is speaking with a patient who is 35 weeks pregnant. The patient is worried that she is going into labor. Which statement by the patient would indicate that she is experiencing false labor?

"The contractions slow down when I walk around."

A nurse measures a pregnant woman's fundal height and finds it to be 28cm. The nurse interprets this to indicate that the client is at how many weeks gestation?

28 weeks gestation

The Labor and Delivery nurse is caring for a patient who had an episiotomy during delivery 1 hour ago. The patient is complaining of pain and discomfort at the incision site. Which action by the nurse would be most appropriate?

Apply an ice pack to the site

While performing a physical assessment of a newborn boy, the nurse notes diffuse edema of the soft tissues of his scalp that crosses suture lines. The nurse documents this finding as:

Caput succedaneum

The nurse is completing a postpartum assessment. Which finding would alert the nurse to a potential problem?

A pulse rate of 110

The nurse is providing care for a patient at 30 weeks gestation. Which topic related to patient concern or discomfort is most important for the nurse to address?

Dizziness when lying supine.

The newborn nurse is assessing the newborn after a vacuum assisted vaginal delivery. The nurse would be alert for which possible effect on the newborn?

Cephalohematoma

On a follow-up visit to the clinic, a nurse suspects that a postpartum client is experiencing postpartum psychosis. Which finding would most likely lead the nurse to suspect this condition?

Delusional beliefs

The nurse is reviewing the assessment findings made by the obstetrician of a client scheduled to undergo a labor induction. Which documented assessment finding would indicate to the nurse that the patient's cervix is ripe in preparation for labor induction?

Shortened

The nurse in a prenatal clinic is reviewing the files of four patients scheduled for visits. Which patient does the nurse identify as having the highest risk-pregnancy?

The patient who is 40 years old, obese, and experiencing pregnancy-induced hypertension.

The nurse is developing a discharge teaching plan for a postpartum woman who has developed a postpartum infection. Which measures would the nurse most likely include in this teaching plan? Select all that apply.

Washing hands before and after perineal care. Handling perineal pads by the edges. Taking the prescribed antibiotic until it is finished

The nurse is reading the patient's chart, which indicates the patient has a "gynecoid pelvis." What finding is expected in this patient?

Wider outlet