OB Final Review

A woman, at 15 weeks' gestation is admitted to the maternity unit for a McDonald's cerclage procedure. What statement would indicate that the patient teaching has been successful?

"I'll need to come back at 37 weeks' gestation to have my sutures cut."

A nurse prepares to administer a vitamin K injection to a newborn infant. The mother asks the nurse why her newborn infant needs the injection. The best response by the nurse would be

"Newborn infants are deficient in Vit K, and this injection prevents your infant from abdominal bleeding"

Pregnant woman at 38 weeks' gestation is diagnosed with abruptio placentae. Which of the following would the nurse expect to find on assessment?

"Rigid, painful abdomen, increased resting tone on EFM."

A client at 36 weeks' gestation has tested positive for Group B streptococci. Which of the following comments by the nurse is appropriate at this time?

"The bacteria is living in your vagina. It will not hurt you but we will give you IV antibiotics while you are in labor to protect your baby from getting sick."

A pregnant client, 36 weeks' gestation, calls the clinic and tells the nurse that she thinks she is in labor. What is the nurse's best response?

"What makes you think you are in labor?"

When the fetal head is at the level of the ischial spine, it is said that the station of the fetal head is:

0 station

The nurse is assessing the APGAR score on a newborn infant at 1-minute of age. The infant is limp, grimaces in response to stimulation, gasping respirations, an HR of 106 beats per minute and is cyanotic. The nurse would reports the APGAR to the physician as

4

What assessments should the nurse perform prior to giving the scheduled dose of terbutaline to a client, with a history of preterm labor?

Assess the client's apical pulse

While performing an admission assessment on a term newborn, the nurse notes poor muscle tone and slight jitterness. The appropriate nursing action is to

Assess the infant's blood glucose level

A 36-week-gestation client is having an amniocentesis. For which of the following reasons is the test likely being conducted?

Assessment of fetal lung maturity

Palpation of the fundus 18 hours after birth reveals that it is firm, 2 fingerbreaths above the umbilicus, and delivered to the right. The nurse initially:

Assists the woman to empty her bladder

A couple had their third baby by cesarean birth. The woman's incision has become infected and she has been placed in isolation. Since she cannot breastfeed her baby while she is in isolation, the nurse instructs her to pump her breasts. The most important reason for pumping her breasts is to

Assure continued milk production

A 2-day old, full-term newborn has had an uneventful neonatal course. What is the proper way to assess a newborn's pulse?

Auscultates the apical rate for 1 minute

When you are designing a pamphlet for morning sickness for new prenatal patients. Which of the following teaching would you make sure to include?

Avoid eating greasy foods

A newborn was admitted to the NICU after being delivered at 29 weeks of gestation to a 28-year-old multiparous, married, Caucasian female whose pregnancy was uncomplicated until premature rupture of membranes and preterm birth. The newborn's parents arrive for their first visit after the birth. The parents walk toward the bedside but remain approximately 5 feet away from the bed. The nurse's most appropriate action would be to:

Go to the parents, introduce himself or herself, and gently encourage them to come meet their infant; explain the equipment first and the focus on the newborn

The nurse is caring for a 15 minute old newborn. Which of the following assessment findings would require further interventions by the nurse?

Grunting

Which of the following tests would be performed to determine if a client is having an ectopic pregnancy?

HCG level and ultrasound

A viral sexually transmitted infection that affects most people in the United States today is:

Human papillomavirus (HPV)

When caring for a newborn, the nurse must be alert for signs of cold stress such as

Hypoglycemia

When doing a postpartum assessment, the nurse observes swelling in the right calf. The client is complaining of calf pain and unilateral leg pain. What is the initial treatment for this?

IV heparin

An important nursing intervention the nurse performs during the third stage of labor is to

Promote parent-newborn interaction

A client is complaining of severe back labor. Which of the following nursing interventions would be most effective?

Provide direct sacral pressure

A newborn undergoing phototherapy experiences increased uterine output and loose stools. What is the priority nursing action?

Provides extra fluids to prevent dehydration

What is the highest priority assessment the nurse makes for a third trimester gravid client that is bleeding?

Pulse

Which of the following physiological responses is considered normal in the early postpartum period?

Rapid diuresis

A full-term newborn was just born. Which nursing intervention is important for the nurse to perform first?

Remove wet blankets

A pregnant client is receiving magnesium sulfate for the management of preeclampsia. A nurse determines the client is experiencing toxicity from the medication if which of the following is noted on assessment?

Respirations of 10 per minute

A pregnant woman, 13 weeks gestation, is admitted to the hospital with a diagnosis of hyperemesis gravidarum. What is the highest priority for this client?

Reverse fluid, electrolyte, & acid-base imbalances that are present using IV therapy

Pathologic hyperbilirubinemia, as indicated by the appearance of jaundice in the first 24 hours, is most likely to occur in:

Rh+ newborns who have been exposed to Rh+ antibodies from their RH-mothers

Fetal well-being during labor is assessed by:

The response of the FHR to uterine contractions (UCs)

What is the priority instruction to help prevent acute mastitis?

Using proper breastfeeding techniques

A fetal fibronectin assessment of the cervicovaginal fluids of a 28-week gravida is positive. Based on the results, which of the following complaints should the nurse advise the client to report immediately to the health provider?

Uterine cramping

When monitoring a fetal heart rate with moderate variability, the nurse notes the V-shaped decelerations to 80 from a baseline of 120. One occurred during a contraction, another occured 10 seconds after the contraction, and a third occurred 40 seconds after yet another contraction. The nurse interprets these findings as resulting from which of the following?

Cord compression

A client with Type 1 diabetes comes to the clinic for her first prenatal visit. What testing would be performed at this time?

Glucose Tolerance Test, Vital Signs, Type and Screen

A woman has just had her first baby by cesarean birth. This is her first postoperative day. She asks the nurse why she has to turn, cough, and deep breath when it causes her incision to hurt so much. The nurse should tell her that:

Decreased mobility and lowered resistance put her at risk for lung infection, and the exercises will help prevent that

A woman who is 4 hours postpartum ambulates for the first time to the bathroom and suddenly has a large gush of lochia rubra. The nurse's first action is to

Determine if the bleeding slows to normal or remains large

A 32 week gestation pregnant client is hospitalized for a blood pressure of 162/112, 3+ proteinuria, blurred vision and decreased urine output. Which of the following would the nurse anticipate to implement initially in the plan of care?

Draw liver enzymes, Betamethasone, Magnesium Sulfate

When would the nurse expect to see the monitor tracing shown above? Image*

During the second stage of labor

A woman has given birth prior to the arrival of the physician. The most appropriate nursing action to decrease postpartal bleeding is to

Encourage breast feeding

After a prolapse of the fetal umbilical cord, a woman has an emergency cesarean section under general anesthesia, and the baby died. In order to facilitate the grief process for the woman and her partner, the nurse

Encourages the parents to express their feelings, and explain that they may experience different feelings

A 26 week-gestation woman is diagnosed with severe preclampsia. Which of the following would require further assessment by the nurse?

Epigastric pain

When assessing a post partum client the nurse finds that the client has rapid and shallow respirations, weak irregular pulse with cool pale skin. What is the priority nursing action?

Establish IV access

A baby is born precipitously in the ER. The nurse's initial action should be to:

Establish an airway of the baby

A pregnant diabetic has been diagnosed with hydramnios. Which of the following would explain this finding?

Excessive fetal urination

The nurse teaches a pregnant client about danger signs of pregnancy. Which of the following should the nurse report to the provider immediately?

Facial edema

A laboring primigravida complains of increasing rectal pressure. A vaginal exam reveals 8cm, 100%, 2+, LOA. What would the nurse conclude?

Fetus has descended down into the birth canal

A nurse teaching the new parent about cord care tells them

Fold the diaper below the cord to speed drying

A client with asthma is scheduled for an induction. On exam, the nurse documents a Bishop's score of 4. What cervical ripening agent would the nurse anticipate will be ordered?

Foley Catheter

A woman's labor is being induced with oxytocin. The nurse assesses the woman's status and that of her fetus just before an infusion increment of 2 milliunits/min. The nurse discontinues the infusion and notifies the woman's physician when assessments reveal

Frequency of uterine contractions: every 1.5 to 2 minutes with a duration of 90 seconds

The nurse is assessing the fetal station during a vaginal examination. Which of the following structures should the nurse palpate?

Ischial spines

A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for this client

Keep calcium gluconate on hand in case of a magnesium sulfate overdose, Monitor I and O's hourly, Monitor deep tendon reflexes hourly, Monitor renal function and cardiac function closely, Notify the physician if urinary output is less than 30 mL per hour

To prevent preterm labor from progressing, drugs are usually prescribed to stop contractions. The nurse may anticipate administering which medication?

Magnesium sulfate and terbutaline

To reduce the risk of hypoglycemia in a full-term newborn weighing 2,900 grams, what should the nurse do?

Maintain the infants temp above 97.7F

The external monitor shows a fetal heart rate of 140 with decreased variability for the previous 2 hours. What is the priority nursing action?

Obtain a medical order for an internal monitor

In addition to breathing with contractions, which of the following actions can help a woman in labor to work with the pain of the first stage of labor?

Performing effleurage

A woman, para 1, gravida 1, gave birth vaginally to a baby about 24 hours ago. Which of the following assessment findings should be reported to the health care provider immediately?

Perineum is red and edematous; painful with red hemorrhoids

Which of the following physical findings would lead the nurse to suspect that a client with severe preeclampsia has developed HELLP syndrome? SATA

Petechiae, jaundice, platelets 75,000

After suctioning to clear the airway of a term neonate who appears in good condition after a spontaneous vaginal deliver, the nurse

Places the infant under a radiant warmer

The labor nurse has just received a shift report on four gravid patients. Which of the patients should the nurse assess first?

g1p0 32wks, placental abruption, FHR 120 (5minutes ago)

You are monitoring four clients in labor and delivery on the central monitor. Which client would you report as having a "Category ll" reading?

A 34 week gestation with baseline of 130 bpm, moderate variability with recurrent variable decelerations

A client had a last menstrual period of July 5th, 2020. Her estimated date of delivery (EDD) should be which of the following?

April 12, 2021

A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. How does the nurse, using the GTPAL format, document the client's obstetric history?

G5T2P1

The most common neonatal sepsis and meningitis infections seen within 24 hours after birth are caused by which organism?

GBS-hemolytic streptococci

A client is in active labor. The nurse has applied the external fetal and uterine monitor to the client's abdomen. How would the nurse properly assess the uterine activity?

Palpating the client's abdomen and noting the onset, duration, and intensity of the contraction

A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to:

Perform fundal massage

When caring for a client who is at risk for a post partum infection the nurse understands that the most effective treatment for infection is

Prevention

The nurse notes variable decelerations on the fetal heart monitor. The nurse's first actions is to

Turn the woman on her side

A pregnant client is diagnosed with severe PIH is admitted for treatment. The clinician orders Magnesium sulfate intravenously. Ordered: Magnesium sulfate: 4 gram loading dose administered over 30 minutes. Maintenance dose 1 gram per hour. The nurse adds 60 grams of magnesium sulfate to 1000 mL of 0.9% NaCl. How many mL/hr would the nurse set the pump initially?

133

The physician orders: magnesium sulfate 4 gram loading dose to infuse over 20 minutes; then a maintenance dose of 1 gram per hour via continuous infusion. The pharmacy has sent 1000 mL 0.9% sodium chloride with 80 grams of magnesium sulfate. How many mL/hr will the nurse set the pump to infuse the loading dose?

150 mL/hr

During a clinical visit, a client states that she has begin to feel fetal movement. When is fetal movement is first felt by a primigravida woman?

20 weeks' gestation

The physician orders Pitocin at 2 milliunits per minute. The pharmacy sends a bag labeled 30 units in 500 mL. How many mL/hr will the nurse set the pump for the initial dose?

2 mL/hr

The provider orders pitocin 2 milliunits per minute every 15 minutes until contractions are every two-three minutes with duration of 50-60 seconds. The pharmacy sends a bag label Pitocin 30 units in 500 mL of Lactated Ringers. The nurse sets the pump to deliver the initial rate at

2 mL/hr

A client is admitted for labor induction at 0500. The physician orders oxytocin to be infused at 2 milliunits per minute, and increased by 2 milliunits per minute every 30 minutes. The nurse adds 40 units of oxytocin to 1000 mL of normal saline. How many mL per hour will the nurse increase the pump at 0530?

3 mL

On which postpartum days can the client expect lochia serosa?

3-10days postpartum

A client presents to the emergency room in preterm labor. What should the nurse do first?

Ask her to lie down in a side-lying position and assess her contractions

The nurse is assessing the APGAR score on a newborn infant at a 1-minute of age. The infant has a pink trunk and head, blue hands and feet, and flexed extremities. He has a weak cry, heart rate of 130 bpm, and cries in response to suctioning. What is his APGAP score

8

A primigravid client at 37 weeks' gestation who has been diagnosed with preeclampsia is to be admitted to high risk antenatal unit. Which of the following rooms is most appropriate for this client?

A darkened room as close to the nurse's station as possible

A 21-year-old primigravida, 36 weeks' gestation, has cardiac disease, class III, as a result of having had childhood rheumatic fever. During a prenatal visit, the nurse reviews the signs of cardiac decompression with her. The nurse recognizes that the client understands these signs and symptoms if she states: "I would notify my doctor if I have

A frequent cough

A 21-year-old primigravida, 36 weeks' gestation, has cardiac disease, class lll, as a result of having had childhood rheumatic fever. During a prenatal visit the nurse reviews the signs of cardiac decompensation with her. The nurse recognizes that the client understands these signs and symptoms if she states: "I would notify my doctor if I have:

A frequent cough

The nurse is caring for the women listed below. The client who is at the highest risk for post arum complications is

A woman with severe preeclampsia on magnesium sulfate whose labor is being induced

A multigravid client in active labor at term suddenly sits up and says, "I can't breathe! My chest hurts really bad!" The client's skin begins to turn a dusky gray color. After calling for assistance, the nurse next

Administers oxygen by face mask

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The sings of NEC are nonspecific. What would the nurse assess for?

Abdominal distention, temperature instability, and grossly bloody stools

During a prenatal examination, the nurse draws blood from a client who is Rh negative. The nurse explains that an indirect Coombs test will be performed to predict whether the fetus is at risk for which condition?

Acute hemolytic disease

The nurse is assessing the apical rate of a newborn. The nurse recognizes as an expected assessment finding is

Apical heart rate of 150 BPM and was irregular for a period of time following an episode of crying

When assessing with the delivery of an infant experiencing shoulder dystocia, the nurse

Applies suprapubic pressure as the nurse midwife delivers the baby

A client received an episiotomy that was sutured after the delivery of her baby. What is the most appropriate nursing measure to help prevent vulva or vaginal hematoma?

Applying an ice pack to the client's perineum during the first hour after birth and immediately after that

You have several babies that were admitted into the neonatal nursery. Which baby should you assess first?

Baby with APGAR 9/9, weight 4660 grams

What is the appropriate management for a 8 weeks gestation client who has slight bleeding, mild uterine cramping with a closed cervix?

Bedrest, pad counts and pelvic rest

You receive an obese 37-year-old-client from the labor and delivery recovery room. Your patient has had a lengthy labor (30 hours) and she had to be delivered by forceps. She delivered a 9lb 7oz baby boy vaginally 2 hours ago. You are assessing your postpartum patient and know that which characteristics is not one of the criteria that would place a client at risk for postpartum hemorrhage?

Client's weight

A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. Which of the following assessment findings would warrant further investigation?

Bleeding in the gums, petechiae, and purpura

Which of the following groups of newborn reflexes below are present at birth and remain unchanged through adulthood?

Blink, cough, sneeze, and gag

The nurse is caring for a client who has been diagnosed with placenta accreta. The nurse anticipates the initial management for the client will be

Blood component replacement therapy

When designing a teaching plan at the clinic, what would be the priority teaching for clients with STI?

Ceftriaxone sodium(Rocephin) may be used to treat Neisseria gonorrhoeae infections

During the initial assessment of a client in early labor, the nurse performs a vaginal exam to obtain information about the

Cervical dilation and effacement

A nurse is monitoring the labor of a client who is receiving IV Pitocin at 6 mL/hr. Which of the following clinical signs would lead to the nurse to stop the infusion?

Change in FHR from 128-102bpm

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate after the peak of the contraction and does not recover to baseline until after the contraction is complete. What is the nurse's priority intervention?

Change the woman's position

The nurse is caring for a woman admitted for preterm labor at 35 weeks gestation. The woman's husband tells the nurse, "Something happened, my wife's bed is wet." What is the nurse's priority action?

Check the fetal heart tones

A 19 year old G1P0 patient at 40 weeks' gestation who is in labor is being treated with magnesium sulfate for preeclampsia. What are the priority assessments with this medication? Select all that apply.

Checking deep tendon reflexes, Checking respiratory rate, Noting urine output

A hospitalized gravida's blood work is hematocrit 30% and hemoglobin 10 gm/dL. In light of the laboratory data, which of the following meal choices should the nurse recommend to this patient?

Chicken livers, sliced tomatoes, and dried apricots

A 20-week gestation client is at the prenatal clinic for a check up. Click the area on the abdomen where the nurse would expect to find the fundal height

Click on umbilicus

Signs of a missed abortion are noted in a woman at 8 weeks' gestation. The nurse anticipates that an appropriate management approach for this type of abortion is

Initially allow a natural evacuation of the products of conception

The nursing action with the highest priority after admitting a multigravid client at 36 weeks' gestation admitted to the labor unit, with a probable diagnosis of abruptio placenta, is (assume action is ordered)

Inserting a large-gauge intravenous catheter

The nurse recalls the measurement that requires the use of an intrauterine pressure catheter in order to be accurate is the:

Intensity of uterine contractions

A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A non stress test in the obstetrician's office revealed a nonreactive tracing. Upon artificial rupture of membranes, thick, meconium-stained fluid was noted. The nurse caring for the infant after birth should anticipate which of the following?

Meconium aspiration, hypoglycemia, and dry, cracked skin

A woman in active labor receives an analgesic, an opioid agonist. Which medication relieves severe, persistent, or recurrent pain, but should be used cautiously in women with cardiac disease?

Meperidine (Demerol)

A woman in labor has just received an epidural block. What is the most important nursing intervention to perform?

Monitor the maternal blood pressure

A prenatal client is informing the nurse of her presumed signs of why she may be pregnant. Which of the following findings would the nurse determine are presumptive signs of pregnancy?

Nausea and vomiting, Amenorrhea, Urinary frequency

A client with severe preeclampsia is admitted to the hospital with a blood pressure of 162/111, 3+ proteinuria, and severe pitting edema on the lower extremities. Which of the following would be most important to include in the plan of care for the client?

Seizure precautions

You are teaching a training class for new labor and delivery nurses. Which condition would you include as a vaginal delivery emergency?

Shoulder dystocia

The nurse decides on a teaching plan for a new mother and her infant. The plan should be

Showing by example and an explanation of how to care for the infant

A fetus is in the LOA position in utero. Which of the following findings would the nurse observe when doing Leopold's maneuvers?

Small objects on the right side of the uterus

A baby was born prematurely at 35 weeks' gestation. Realizing that he may have a surfactant deficiency that may lead to respiratory distress, the nurse observes specifically for:

Sternal retractions

You are caring for a 28 week gestation client with pregestational diabetes. Which risk factors would this nurse know to look for due to this condition?

Stillbirth, Macrosomic fetus, Cesarean birth

The nurse has administered diphenhydramine (Benadryl) to a post-cesarean client who is experiencing side effects from the parenteral morphine sulfate that was administered 30 minutes earlier. Which of the following actions should the nurse perform following the administration of the medication?

Supervise while the woman holds her newborn

Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should

Take the baby back to the nursery, reassuring the woman that her rest is a priority at this time

As the nurse helps a new mother change the diaper of her 16-hour-old newborn, the mother expresses concern that the bowel movement is almost black in color. She asks the nurse if something is wrong. The nurse responds to this mother's concern by

Telling the mother that the stool is normal

One of the first symptoms of puerperal infection to assess for in the postpartum woman is:

Temperature of 38*C (100.4*F) or higher on 2 successive days starting 24 hours after birth

The following are signs that the placenta has been detached except?

The client feels like bearing down

At 28 weeks' gestation, an Rh-negative woman receives RhoGAM. Which of the following would indicate that the medication is effective?

The mother produces no Rh antibodies

The pediatrician writes an order for a term newborn for Vitamin K 1 mg IM. Which of the following responses provides a rationale for this order?

The neonatal gut is sterile

What is the priority teaching when teaching the postpartum woman about periods?

The pads should be applied and removed in a front-to-back direction

Why would a nurse provide non nutrive sucking when providing gavage feeding to an infant?

To promote nipple attachment

You receive an order to administer Vitamin K injection to a newborn. The nurse knows that this is the most appropriate site for the injection?

Vastus lateralis muscle

When weighing a baby, the nurse:

Weighs the baby at the same time each day for accuracy

The nurse prepares to administer, the rubella vaccine to a postpartum client

Whose rubella titer is less than 1:8

After delivery, the nurse is preparing an ice pack to place on a client's episiotomy. The nurse should:

Work from front to back when placing the ice pack