OB Final
An ethical dilemma is: A choice that violates ethical principles a conflict between what is just and good A violation of patient autonomy A conflict between advocacy and respect
A choice that violates ethical principles
The nurse notes that a new father gazes at his baby for prolonged periods of time and comments that his baby is beautiful and he is very happy having a baby. These behaviors are commonly associated with: A) Engrossment B) Attachment C) Couvade syndrome D) Bonding
A) Engrossment
A perinatal nurse assesses the skin condition of a newborn, which is characterized by a yellow coloration of the skin, sclera, and oral mucous membranes. What condition is most likely the cause of this symptom? A) Jaundice B) Hypoglycemia C) Physiologic anemia of infancy D) Low glomerular filtration rate
A) Jaundice
The perinatal nurse notifies the physician of the findings related to Juanita's assessment. The first step in care will most likely be to: A) Insert a urinary catheter B) Apply ice to the perineum C) Administer intravenous fluids D) Prepare Juanita for surgery
B) Apply ice to the perineum
Which of the following neonates is at highest risk for cold stress? A) A 32 gestational week AGA neonate B) A 38 gestational week AGA neonate C) A 33 gestational week SGA neonate D) A 36 gestational week LGA neonate
C) A 33 gestational week SGA neonate
The perinatal nurse contacts the pediatrician about a heart murmur that was auscultated during a routine newborn assessment. This finding would be abnormal at: A) 24 to 48 hours B) 8 to 12 hours C) 12 to 24 hours D) 48 to 72 hours
D) 48 to 72 hours
Mrs. H is telling you she feels the urge to push. This is most likely caused by what? Low fetal station triggering the Ferguson reflex A fetal position of occiput posterior (OP) The second stage of labor Transition phase
Low fetal station triggering the Ferguson reflex
In caring for a primiparous woman in labor, one of the factors to evaluate is uterine activity. This is referred to as the ____ of labor. Powers Passage Passenger Psyche
Powers
The nurse is assessing a baby girl on admission to the newborn nursery. Which of the following findings should the nurse report to the neonatologist? A) Grunting B) Intermittent strabismus C) Startling D) Vaginal bleeding
A) Grunting
On day four following the birth of an average size baby, the nurse would expect the fundus to be at: A) 3 cm below umbilicus B) 4 cm below umbilicus C) 1 cm below umbilicus D) 2 cm below umbilicus
B) 4 cm below umbilicus
The nurse is providing discharge counseling to a woman who is breastfeeding her baby. The nurse advises the woman that if she experiences unilateral breast inflammation, she should do which of the following? A) Bottle feed the baby during the next day. B) Apply warm soaks to the reddened area. C) Consume an herbal galactagogue. D) Take expressed breast milk to the laboratory for analysis
B) Apply warm soaks to the reddened area.
A woman at 10 weeks' gestation is diagnosed with gestational trophoblastic disease (hydatiform mole). Which of the following findings would the nurse expect to see? Dark brown vaginal bleeding Macular papular rash White blood cell count 17,000/ mm3 Platelet count of 550,000/ mm3
Dark brown vaginal bleeding
A newborn who is born with withdrawal syndrome will be removed from the maternal mother immediately. True False
False
Presumptive signs of pregnancy include (select all that apply): Nausea Fatigue Ballottement Amenorrhea
Nausea Fatigue Amenorrhea
The American Nurses Association Code of Ethics for Nurses directs nurses to provide patient care that is: Respectful Negotiable Curative Utilitarian
Respectful
Autonomy is defined as the right to: Self-determination Equal treatment Do good Be valued
Self-determination
The provision of support during labor has demonstrated that women experience a decrease in anxiety and a feeling of being in more control. In clinical situations, this has resulted in: Earlier admission to the hospital Increased epidural rates Improved gestational age A decrease in interventions
A decrease in interventions
Which of the following nursing actions are important in the care of a postpartum woman who is at risk for orthostatic hypotension? (Select all that apply.) A) Have patient remain in bed for the first 4 hours postbirth. B) Open an ammonia ampule and have the patient smell the ammonia prior to getting out of bed. C) Instruct patient to slowly rise to a standing position. D) Explain to the patient the cause and incidence of orthostatic hypotension.
A) Have patient remain in bed for the first 4 hours postbirth. B) Open an ammonia ampule and have the patient smell the ammonia prior to getting out of bed. C) Instruct patient to slowly rise to a standing position. D) Explain to the patient the cause and incidence of orthostatic hypotension.
To accurately measure the neonate's head, the nurse places the measuring tape around the head: A) Just above the ears and eyebrows B) Middle of the ear and over the bridge of the nose C) Middle of the ear and over the eyes D) Just below the ears and over the upper lip
A) Just above the ears and eyebrows
Karen, a G2, P1, experienced a precipitous birth 90 minutes ago. Her infant is 4200 grams and a repair of a second-degree laceration was needed following the birth. As part of the nursing assessment, the nurse discovers that Karen's uterus is boggy. Furthermore, it is noted that Karen's vaginal bleeding has increased. The nurse's most appropriate first action is to: A) Massage the uterine fundus with continual lower segment support. B) Assess vital signs including blood pressure and pulse. C) Measure and document each perineal pad changed in order to assess blood loss. D) Ensure appropriate lighting for a perineal repair if it is needed.
A) Massage the uterine fundus with continual lower segment support.
A 42-week gestation neonate is admitted to the NICU (neonatal intensive care unit). This neonate is at risk for which complication? A) Meconium aspiration syndrome B) Necrotizing enterocolitis C) Intraventricular hemorrhage D) Failure to thrive
A) Meconium aspiration syndrome
Which of these medications is commonly used to control postpartum bleeding related to uterine atony? A) Oxytocin B) Magnesium sulfate C) Phytonadione D) Warfarin
A) Oxytocin
The nurse is massaging a boggy uterus. The uterus does not respond to the massage. Which medication would the nurse expect would be given first: A) Oxytocin or pitocin B) Methergine C) Carboprost D) Ergotrate
A) Oxytocin or pitocin
A neonate is admitted to the nursery. The nurse makes the following assessments: weight 2845 grams, overriding sagittal suture, difficult to palpate posterior fontanel, and point of maximum intensity at the xiphoid process. Which of the assessments should be reported to the health-care practitioner? A) Point of maximum intensity B) Difficult to palpate posterior fontanel C) Birth weight D) Sagittal suture line
A) Point of maximum intensity
Which of the following neonatal signs or symptoms would the nurse expect to see in a neonate with an elevated bilirubin level? A) Poor feeding B) Hyperthermia C) Low glucose D) Hyperactivity
A) Poor feeding
The perinatal nurse teaches the postpartum woman about warning signs regarding development of postpartum infection. Signs and symptoms that merit assessment by the health-care provider include the development of a fever and: A) Uterine tenderness B) Diarrhea C) Breast engorgement D) Emotional lability
A) Uterine tenderness
A G2 P1 woman who experienced a prolonged labor and prolonged rupture of membranes is at risk for metritis. Which of the following nursing actions are directed at decreasing this risk? (Select all that apply.) A) Instruct woman to change her peri-pads after each voiding B) Instruct woman to apply hot packs to the perineum C) Instruct woman to ambulate in the halls eight times a day D) Instruct woman to increase her fluid intake
ALL
The nurse uses the external electronic fetal heart monitor to evaluate fetal status. The fetal heart tracing shows accelerations. Accelerations in the fetal heart are: Never associated with the uterine contraction pattern Associated with fetal well-being and oxygenation A reason to notify the care provider An indication of potential fetal intolerance to labor
Associated with fetal well-being and oxygenation
A postpartum woman, who gave birth 12 hours ago, is breastfeeding her baby. She tells her nurse that she is concerned that her baby is not getting enough food since her milk has not come in. The best response for this patient is: A) "I understand your concern, but your baby will be okay until your milk comes in." B) "Milk normally comes in around the third day. Prior to that, he is getting colostrum which is high in protein and immunoglobulins which are important for your baby's health." C) "You can bottle feed until your milk comes in." D) "Your baby seems content, so you should not worry about him getting enough to eat."
B) "Milk normally comes in around the third day. Prior to that, he is getting colostrum which is high in protein and immunoglobulins which are important for your baby's health."
The nurse completes an initial newborn examination on a baby boy at 90 minutes of age. The baby was born at 40 weeks' gestation with no birth trauma. The nurse's findings include the following parameters: heart rate, 136 beats per minute; respiratory rate, 64 breaths per minute; temperature, 98.2°F (36.8°C); length, 49.5 cm; and weight, 3500 g. The nurse documents the presence of a heart murmur, absence of bowel sounds, symmetry of ears and eyes, no grunting or nasal flaring, and full range of movement of all extremities. Which assessment would warrant further investigation and require immediate consultation with the baby's health-care provider? A) Presence of a heart murmur B) Absent bowel sounds C) Respiratory rate D) Weight
B) Absent bowel sounds
Which of the following clients is most likely to complain of afterbirth pains during her postpartum period? A) G2 P0, group B streptococci in the vagina B) G3 P2, gave birth to a 4100-gram baby C) G4 P1, diagnosed with preterm labor D) G1 P0, diagnosed with preeclampsia
B) G3 P2, gave birth to a 4100-gram baby
Approximately 8 hours ago, Juanita, a 32-year-old G1 P0 (now G1,P1), gave birth after 2 mc009-1.jpg hours of pushing. She required an episiotomy and an assisted birth (forceps) due to the weight and size of her baby (9 lb. 9 oz.). The perinatal nurse is performing an assessment of Juanita's perineal area. A slight bulge is palpated and the presence of ecchymoses to the right of the episiotomy is noted. The area feels "full" and is approximately 4 cm in diameter. Juanita describes this area as "very tender." The most likely cause of these signs and symptoms is: A) Postpartum hemorrhage B) Hematoma formation C) Sepsis in the episiotomy site D) Inadequate repair of the episiotomy
B) Hematoma formation
Heat loss through radiation can be reduced by: A) Warming equipment used on the neonate B) Placing crib near a warm wall C) Drying the neonate D) Closing door to room
B) Placing crib near a warm wall
The nurse is teaching the parents of a healthy newborn about infant safety. Which of the following should be included in the teaching plan? A) Crib slates should be a maximum of 10 inches apart. B) Remove strings from infant sleepwear. C) Water temperature for the infant's bath should be 39°C. D) Cover electrical outlets once the infant is crawling.
B) Remove strings from infant sleepwear.
A nurse is performing a postpartum assessment 30 minutes after a vaginal delivery. Which of the following actions indicates that the nurse is performing the assessment correctly? A) The nurse monitors the client's central venous pressure. B) The nurse assesses the client's perineum for edema and ecchymoses. C) The nurse measures the fundal height in relation to the symphysis pubis. D) The nurse performs a sterile vaginal speculum exam.
B) The nurse assesses the client's perineum for edema and ecchymoses.
The nurse is caring for a woman, G2 P1001, 40 weeks' gestation, in labor. A 12 P.M. assessment revealed: cervix 4 cm, 80% effaced, -3 station, and fetal heart 124 with moderate variability. 5 p.m. assessment: cervix 6 cm, 90% effaced, -3 station, and fetal heart 120 with minimal variability. 10 a.m. assessment: cervix 8 cm, 100% effaced, -3 station, and fetal heart 124 with absent variability. Based on the assessments, which of the following should the nurse conclude? Woman is carrying a small-for-gestational age fetus. Baby is potentially acidotic. Descent is progressing well. Woman should begin to push with the next contraction.
Baby is potentially acidotic.
A woman you are caring for in labor requests an epidural for pain relief in labor. Included in your preparation for epidural placement is a baseline set of vital signs. The most common vital sign to change after epidural placement: Blood pressure, hypotension Pulse, bradycardia Blood pressure, hypertension Pulse, tachycardia
Blood pressure, hypotension
The perinatal nurse is assessing a woman in triage who is 34 + 3 weeks' gestation in her first pregnancy. She is worried about having her baby "too soon," and she is experiencing uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats per minute. A vaginal examination performed by the health-care provider reveals that the cervix is closed, long, and posterior. The most likely diagnosis would be: Preterm labor Braxton-Hicks contractions Term labor Back labo
Braxton-Hicks contractions
A postpartum nurse has received an exchange report on the four following mother-baby couplets. Based on the provided information, which couplet should the nurse first assess? A) A 25-year-old G2P1 woman who is 36 hours postbirth and is having difficulty breastfeeding her baby girl. Her fundus is firm at the umbilicus, and lochia is moderate to scant. B) A 28-year-old G2P1 woman who delivered a 3800 gram baby girl by elective cesarean birth. She had spinal anesthesia and was given intrathecal preservative-free morphine for postoperative pain management. Her vital signs are B/P 115/75, P 80, R 18 T 98. C) A 32-year-old G5P4 woman who delivered a 4500 gram baby boy 2 hours ago after a 20 hour labor that was augmented. It was reported that her fundus is 2 cm above umbilicus with moderate lochia. D) A 16-year-old G1P0 who will be discharged in the afternoon. It was reported that she refers to her baby boy as "it" and that she requested to have her baby stay in the nursery so she could sleep.
C) A 32-year-old G5P4 woman who delivered a 4500 gram baby boy 2 hours ago after a 20 hour labor that was augmented. It was reported that her fundus is 2 cm above umbilicus with moderate lochia.
Maddy, a G3 P1 woman, gave birth 12 hours ago to a 9 lb. 13 oz. daughter. She experiences severe cramps with breastfeeding. The perinatal nurse best describes this condition as: A) Uterine hypertonia B) Rectus abdominis diastasis C) Afterpains D) Bladder hypertonia
C) Afterpains
A woman gave birth to a 3200 g baby girl with an estimated gestational age of 40 weeks. The baby is 1 hour of age. In preparation of giving the baby an injection of vitamin K, the nurse will: A) Replace needle with a 18 gauge 1" needle. B) Completely undress the neonate to identify the injection site. C) Explain to the parents the action of the medication and answer their questions. D) Remove the neonate from the room so the parents will not be distressed by seeing the injection.
C) Explain to the parents the action of the medication and answer their questions.
A neonatal nurse caring for newborns knows that the best time for a mother to first attempt breastfeeding is during which one of the following stages of activity? A) Second period of reactivity B) First period of inactivity and sleep C) First period of reactivity D) Second period of inactivity and sleep
C) First period of reactivity
A nursery nurse observes that a full-term AGA neonate has nasal congestion, hypertonia, and tremors and is extremely irritable. Based on these observations, the nurse suspects which of the following? A) Hypoglycemia B) Hypercalcemia C) Neonatal withdrawal or Abstinence syndrome D) Cold stress
C) Neonatal withdrawal or Abstinence syndrome
The NICU nurse recognizes that respiratory distress syndrome results from a developmental lack of: A) Calcium B) Lecithin C) Surfactant D) Magnesium
C) Surfactant
The perinatal nurse observes the new mother watching her baby daughter closely, touching her face, and asking many questions about infant feeding. This stage of mothering is best described as: A) Taking in B) Taking charge C) Taking hold D) Taking time
C) Taking hold
A postpartum woman has been diagnosed with postpartum psychosis. Which of the following actions should the nurse perform? A) Restrict visitation to her partner. B) Carefully monitor I/O. C) Supervise all infant care. D) Maintain client on strict bed rest.
C) Supervise all infant care.
A woman is considered in active labor when: Cervical dilation progresses from 4 to 7 cm with effacement of 40% to 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds. Cervical dilation progresses to 10 cm with effacement of 90%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds. Cervical dilation progresses to 3 cm with effacement of 30%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds. Cervical dilation progresses to 8 cm with effacement of 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.
Cervical dilation progresses from 4 to 7 cm with effacement of 40% to 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.
Infants whose mothers were obese during pregnancy are at higher risk for which of the following? (Select all that apply.) Childhood diabetes Heart defects Hypospadias Respiratory distress
Childhood diabetes Heart defects Hypospadias
A woman in labor and delivery is being given subcutaneous terbutaline for preterm labor. Which of the following common medication effects would the nurse expect to see in the mother? Serum potassium level increases Diarrhea Complaints of nervousness Urticaria
Complaints of nervousness
A patient, G1 P0, is admitted to the labor and delivery unit for induction of labor. The following assessments were made on admission: Bishop score of 4, fetal heart rate 140s with good variability and no decelerations, TPR 37°C, 88, 20, BP 120/80, negative obstetrical history. A prostaglandin medication was inserted intravaginally at that time. Which of the following findings, 6 hours after insertion, would warrant the removal of the Cervidil (dinoprostone)? Contraction frequency of every 2 minutes Respiratory rate of 24 rpm Fetal heart of 152 bpm Bishop score of 5
Contraction frequency of every 2 minutes
Jane's husband Brian has begun to put on weight. What is this a possible sign of? Culturalism syndrome Couvade syndrome Moratorium phase Attachment
Couvade syndrome
A NICU nurse is caring for a full-term neonate being treated for group B streptococcus. The mother of the neonate is crying and shares that she cannot understand how her baby became infected. The best response by the nurse is: A) "I see that this is very upsetting for you. I will come back later and answer your questions." B) "Premature newborns are more susceptible to infections due to an immature immune system. Would you like additional information on the newborn immune system?" C) "The infection was transmitted to your baby during the birthing process. Do you have a history of sexual transmitted infections?" D) "Approximately 10% to 30% of women are asymptomatic carries of group B streptococcus which is found in the rectal area. Sometimes it migrates to the vaginal canal without reason. Do you have other questions regarding your baby's health?"
D) "Approximately 10% to 30% of women are asymptomatic carries of group B streptococcus which is found in the rectal area. Sometimes it migrates to the vaginal canal without reason. Do you have other questions regarding your baby's health?"
The perinatal nurse accurately defines postpartum hemorrhage by including a decrease in hematocrit levels from pre- to postbirth by: A) 5% B) 15% C) 8% D) 10%
D) 10%
A mother refused to allow her son to receive the vitamin K injection at birth. Which of the following signs or symptoms might the nurse observe in the baby as a result? A) Glucose levels are subnormal. B) Vital signs are labile. C) Skin color is dusky. D) Circumcision site oozes blood.
D) Circumcision site oozes blood.
The nurse is assessing the neonate's skin and notes the presence of small, irregular, red patches on the cheeks that will develop into single, yellow pimples on the chest or abdomen. The name for this common neonatal skin condition is: A) Milia B) Pustular melanosis C) Neonatal acne D) Erythema toxicum
D) Erythema toxicum
A full-term neonate who is 30 hours old has a bilirubin level of 10 mg/dL. The neonate has a yellowish tint to the skin of the face. The mother is breastfeeding her newborn. The nurse caring for this neonate would anticipate which of the following interventions? A) Phototherapy B) Switch from breastfeeding to bottle feeding C) Assess red blood cell count D) Feeding neonate every 2 to 3 hours
D) Feeding neonate every 2 to 3 hours
The nurse is teaching the parents of a 1-day-old baby how to give their baby a bath. Which of the following actions should be included? A) Keep the door of the room open to allow for ventilation. B) Clean the eye from the outer canthus to the inner canthus. C) Check the temperature of the water with your fingertip. D) Gather all supplies before beginning the bath.
D) Gather all supplies before beginning the bath.
During change of shift report, the nurse hears the following information on a newly delivered client: 27 years old, married, G4 P3, 8 hours post spontaneous vaginal delivery over 3° laceration, vitals—110/70, 98.6°F, 82, 18, fundus firm at umbilicus, moderate lochia, ambulated to bathroom to void three times for a total of 900 mL, breastfeeding every 2 hours. Which of the following nursing diagnoses should the nurse include in this client's nursing care plan? A) Fluid volume deficit B) Ineffective breastfeeding C) Impaired urinary elimination D) Impaired skin integrity
D) Impaired skin integrity
The perinatal nurse recognizes that a risk factor for postpartum depression is: A) Age >35 years B) Bad tasting food C) Regular schedule of prenatal care D) Inadequate social support
D) Inadequate social support
A neonate is born at 33 weeks' gestation with a birth weight of 2400 grams. This neonate would be classified as: A) Late preterm B) Very low birth weight C) Extremely low birth weight D) Low birth weight
D) Low birth weight
Painful nipples are a major reason why women stop breastfeeding. A primary intervention to decrease nipple irritation is: A) Applying hot compresses to breast prior to feeding B) Instructing woman to express colostrum or milk at the end of the feeding session and rub it on her nipples C) Air drying nipples for 10 minutes at the end of the feeding session D) Teaching proper techniques for latching-on and releasing of suction
D) Teaching proper techniques for latching-on and releasing of suction
Four babies have just been admitted into the neonatal nursery. Which of the babies should the nurse assess first? A) The baby with glucose 60 mg/dL, heart rate 132 B) The baby with Apgar 9/9, weight 2960 grams C) The baby with respirations 52, oxygen saturation 98% D) The baby with temperature 96.3°F, length 17 inches
D) The baby with temperature 96.3°F, length 17 inches
A pregnant patient at 35 weeks' gestation gives birth to a healthy baby boy. What factors regarding the development of the normal respiratory system should the nurse consider when performing an assessment of the neonate? A) As the fetus approaches term, there is an increase in the secretion of intrapulmonary fluid. B) Lung expansion after birth suppresses the release of surfactant. C) Surfactant causes an increased surface tension within the alveoli, which allows for alveolar reexpansion following each exhalation. D) Under normal circumstances, by the 34th to 36th weeks of gestation, surfactant is produced in sufficient amounts to maintain alveolar stability.
D) Under normal circumstances, by the 34th to 36th weeks of gestation, surfactant is produced in sufficient amounts to maintain alveolar stability.
A pregnant client with a history of multiple sexual partners is at highest risk for which of the following complications: Gestational diabetes Pregnancy-induced hypertension Ectopic pregnancy Premature rupture of membranes
Ectopic pregnancy
A 40 week gestation patient has labored for 14 hours, SROM 12 hours ago, received an epidural and has reached 10/100/+1. She is urged to push and does for five hours straight. The nurse has assisted the patient in different positions to facilitate delivery but the fetus has not moved down. The fetus tolerates the process well though the provider is eager to get the fetus out. It is suggested to the patient that it is time to do a cesarean section. The patient refuses and says she would rather continue pushing. She continues to push effortlessly for another five hours. The fetus is still tolerating the labor well. What is the nurse's next step. Educate the patient on other pushing maneuvers. Call the hospital ethics board to discuss the situation to get order for patient to get a c-section. Educate patient regarding risks associated with pushing for so long. Ask the significant other to encourage patient to sign the consent for C-section. Tell patient that she is required to do cesarean section.
Educate the patient on other pushing maneuvers. Educate patient regarding risks associated with pushing for so long.
A nurse is asked to assist in an induction of a client who is 22 weeks gestation and recently discovered that her fetus is anencephaly. The nurse turns to her charge nurse and states that she refuses to take this patient. This action of the nurse puts them at risk for being written up for insubordination. True False
False
Immediately postpartum, the insulin needs in diabetic women increase dramatically. True False
False
As the nurse explains the purpose of the tocotransducer (Toco), which she places on the abdomen, she states that this monitoring device provides an accurate evaluation of which of the following? Frequency of contractions Uterine hypertonus Intensity of contractions Progress of labor
Frequency of contractions
A nurse is visiting with a client for the first time who is ten weeks gestation. The nurse asks the client if she has ever used alcohol. The client responds shyly, "yes". What further information should the nurse ask? Do you have a cat? How much fish do you consume in a week? Have you used alcohol during this pregnancy? What religion are you?
Have you used alcohol during this pregnancy?
An ethical dilemma unique to perinatal nursing is the: Shortage of health-care resources Innate conflict between maternal and fetal rights Intensive use of technology Risk of violation of the principle of veracity
Innate conflict between maternal and fetal rights
The nurse is providing prenatal teaching to a group of diverse pregnant women. One woman, who indicates she smokes two to three cigarettes a day, asks about its impact on her pregnancy. The nurse explains that the most significant risk to the fetus is: Respiratory distress at birth Severe neonatal anemia Low neonatal birth weight Neonatal hyperbilirubinemia
Low neonatal birth weight
A 16-year-old patient is admitted to the hospital with a diagnosis of severe preeclampsia. The nurse must closely monitor the woman for which of the following? Explosive diarrhea High leukocyte count Low platelet count Fractured pelvis
Low platelet count
During labor induction with oxytocin, the fetal heart rate baseline is in the 140s with moderate variability. Contraction frequency is assessed to be every 2-3 minutes with duration of 60 seconds, of moderate strength to palpation. Based on this assessment, the nurse should take which action? Increase oxytocin infusion rate per physician's protocol. Decrease oxytocin infusion rate by 2 mU/min and report to physician. Maintain present oxytocin infusion rate and continue to assess. Stop oxytocin infusion immediately.
Maintain present oxytocin infusion rate and continue to assess.
Early decelerations are probably caused by: Momentary increase in intracranial pressure due to head compression Umbilical cord occlusion Decreased maternal-fetal exchange Compression of umbilical cord
Momentary increase in intracranial pressure due to head compression
During the postpartum assessment, the perinatal nurse notes that a patient who has just experienced a forceps-assisted birth now has a large quantity of bright red bleeding. Her uterine fundus is firm. The nurse's most appropriate action is to notify the physician/certified nurse midwife and describe a: Requirement for an oxytocin infusion Need for further information for the woman/family about forceps Requirement for bladder assessment and catheterization Need for vaginal assessment and repair
Need for vaginal assessment and repair
Marked hemodynamic changes in pregnancy can impact the pregnant woman with cardiac disease. Signs and symptoms of deteriorating cardiac status include (select all that apply): Irritation Nocturnal dyspnea Orthopnea Palpitations
Nocturnal dyspnea Orthopnea Palpitations
You are in the process of admitting a multiparous woman to labor and delivery from the triage area. One hour ago her vaginal exam was 4/70/0. While completing your review of her prenatal record and completing the admission questionnaire, she tells you she has an urge to have a bowel movement and feels like pushing. Your priority nursing intervention is to: Perform a vaginal exam. Assist your patient to the bathroom to have a bowel movement. Assess the fetal heart rate and uterine contractions. Reassure the patient and rapidly complete the admission.
Perform a vaginal exam.
The perinatal nurse is providing care to Carol, a 28-year-old multiparous woman in labor. Upon arrival to the birthing suite, Carol was 7 cm dilated and experiencing contractions every 1 to 2 minutes which she describes as "strong." Carol states she labored for 1 hour at home. As the nurse assists Carol from the assessment area to her labor and birth room, Carol states that she is feeling some rectal pressure. Carol is most likely experiencing: Uterine hyperstimulation Hypertonic contractions Precipitous labor Hypotonic contractions
Precipitous labor
Ms. M is 38 weeks' gestation and is a G1 P0. At 10 pm Ms. M has just been informed by the nurse that she is 3 to 4 cm dilated, cervix is 100% effaced, -1 station and contractions are every 4 to 5 minutes. When the nurse tells her the findings from the SVE, Ms. M states that she had been contracting since early that morning and she becomes extremely frustrated stating "I should have had this baby by now." What is the best response by the nurse? Discuss various analgesic options Remind her that length of labor for the first child can be 18 to 24 hours Promote relaxation techniques Tell Ms. M that the provider will be contacted immediately about the slow progress of labor
Promote relaxation techniques
A nurse is visiting with a 14 year old female from Minnesota. The 14 year old is interested in getting some form of birth control but does not want her parents to know. The nurse's next action is to.... Provide education on the different forms of birth control. Tell the teenager to come back with a parent. Ask patient if she has started menarche. Determine if the teenager has already had intercourse. Explain to the patient that she is too young to receive birth control.
Provide education on the different forms of birth control. Ask patient if she has started menarche. Determine if the teenager has already had intercourse.
A nurse is visiting with a client who twelve weeks gestation. The nurse asked the client if she has used drugs or alcohol during this pregnancy. The client openly admits to the use of alcohol and occasionally marijuana. What should the nurse do next? (Select all that apply). Provide education on the harm that could come from using drugs and alcohol during pregnancy. Assess the client's learning abilities. Tell the client that she is killing her newborn. Ask the client about their views of alcohol and drug use. Call a social worker in to talk with the client. Use a screen tool to assess the amount of substances used.
Provide education on the harm that could come from using drugs and alcohol during pregnancy. Assess the client's learning abilities. Ask the client about their views of alcohol and drug use. Use a screen tool to assess the amount of substances used.
Evidence-based practice is the integration of the best: Randomized clinical trials, clinical expertise, and patients' requests Quantitative research, clinical expertise, and patients' preferences Research evidence, clinical expertise, and patients' values Research findings, clinical experience, and patients' preferences
Research evidence, clinical expertise, and patients' values
Which of the following nursing diagnoses is of highest priority for a client with an ectopic pregnancy who has developed disseminated intravascular coagulation (DIC)? Risk for deficient fluid volume Risk for disturbed identity Risk for family process interrupted High risk for injury
Risk for deficient fluid volume
The nurse is assisting a physician in the delivery of a baby via vacuum extraction. Which of the following nursing diagnoses for the gravida is appropriate at this time? Colonic constipation Risk for impaired parenting Risk for injury Ineffective individual coping
Risk for injury
Betamethasone is a steroid that is given to a pregnant woman with signs of preterm labor. The purpose of giving steroids is to (select all that apply): Stimulate the production of surfactant in the preterm infant Be given between 24 and 34 weeks' gestation Increase the severity of respiratory distress Accelerate fetal lung maturity
Stimulate the production of surfactant in the preterm infant Be given between 24 and 34 weeks' gestation Accelerate fetal lung maturity
Identify the hallmark of placenta previa that differentiates it from abruptio placenta. Board-like abdomen with severe pain Sudden onset of painless vaginal bleeding Sudden onset of bright red vaginal bleeding Severe vaginal pain with bright red bleeding
Sudden onset of painless vaginal bleeding
Abruptio placenta is a risk factor for amniotic fluid embolism. A) True B) False
TRUE
The nurse is caring for two laboring women. Which of the patients should be monitored most carefully for signs of placental abruption? The patient who is hepatitis B surface antigen positive The patient with placenta previa The patient with eclampsia The patient whose vagina is colonized with group B streptococci
The patient with eclampsia
A gravida, G4 P1203, fetal heart rate 150s, is 14 weeks pregnant, fundal height 1 cm above the symphysis. She denies experiencing quickening. Which of the following nursing conclusions made by the nurse is correct? The woman is experiencing a normal pregnancy. The woman may be having difficulty accepting this pregnancy. The woman must see a nutritionist as soon as possible. The woman will likely miscarry the conceptus.
The woman is experiencing a normal pregnancy.
The perinatal nurse describes risk factors for placenta previa to the student nurse. Placenta previa risk factors include (select all that apply): Cocaine use Tobacco use Previous caesarean birth Previous use of medroxyprogesterone (Depo-Provera)
Tobacco use Previous caesarean birth
Which of the following laboratory values is most concerning in a client with pregnancy-induced hypertension? Blood urea nitrogen 24 mg/dL Uric acid level of 8 mg/dL Total platelet count of 40,000 mm Total urine protein of 200 mg/dL
Total platelet count of 40,000 mm
A pregnant woman who has a history of a cesarean birth is requesting to have a vaginal birth after cesarean (VBAC). In which of the following situations should the nurse advise the patient that her request may be declined? Flexed fetal attitude Transverse fetal lie Previous low flap uterine incision Positive vaginal candidiasis
Transverse fetal lie
When caring for a primiparous woman being evaluated for admission for labor, a key distinction between true versus false labor is: True labor contractions result in rupture of membranes, and with false labor, the membranes remain intact. True labor contractions result in increasing anxiety and discomfort, and false labor does not. True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes. True labor contractions are accompanied by loss of the mucus plug and bloody show, and with false labor there is no vaginal discharge.
True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.
After assessing the FHR tracing shown below, which of the following interventions should the nurse perform? mc007-1.jpg Administer oxygen by nasal cannula. Provide the patient with caring labor support. Encourage the patient to push with each contraction. Turn the woman on her side.
Turn the woman on her side.
A woman presents to a prenatal clinic appointment at 10 weeks' gestation, in the first trimester of pregnancy. Which of the following symptoms would be considered a normal finding at this point in pregnancy? Occipital headache Urinary frequency Diarrhea Leg cramps
Urinary frequency
Jehovah's Witnesses gladly accept medicine and medical treatment. True False
true
The perinatal nurse teaches the postpartum woman that the most critical time to achieve effectiveness from the application of ice packs to the perineum is during the first 24 hours following birth. A) True B) False
true
CDC studies have identified 0.2 to 1.5 infants with FAS for every 1,000 live births in certain areas of the United States. True False
True
Which of the following sites is priority for the nurse to assess when caring for a breastfeeding client, G8 P5, who is 1 hour postdelivery? A) Lungs B) Rectum C) Fundus D) Nipples
(C) Fundus
The nurse knows that a FHR monitor printout indicates a Category III abnormal fetal heart rate pattern when: (A) Baseline variability is 6 to 25 bpm with decelerations (B)Occasional periodic accelerations occur. (C)FHR mirrors the uterine contractions. (D)Baseline variability is minimal or absent with decelerations.
(D)Baseline variability is minimal or absent with decelerations.
Maternity nursing is the most litigious of all the areas of nursing. True False
True
Metritis is an infection that usually starts at the placental site. A) True B) False
True
If the umbilical cord prolapses during labor, the nurse should immediately: Attempt to reposition the cord above the presenting part. Apply manual pressure to the presenting part to relieve pressure on the cord. Await MD order for preparation for an emergency cesarean section. Type and cross-match blood for an emergency transfusion.
Apply manual pressure to the presenting part to relieve pressure on the cord.
A surrogate mother who received a fertilized embryo with no genetic relation decides she would rather raise the child herself and not allow visitation with the intended parents. Within Minnesota law, this is allowed. True False
False
Four women are close to delivery on the labor and delivery unit. The nurse knows to be vigilant to the signs of neonatal respiratory distress in which delivery? 41-week-gestation pregnancy with biophysical profile score of 10/10 that morning 42-week-gestation pregnancy complicated by intrauterine growth restriction 39-week-gestation pregnancy complicated by maternal cholecystitis 40-week-gestation pregnancy with estimated fetal weight of 3200 grams
42-week-gestation pregnancy complicated by intrauterine growth restriction
Metabolic changes during pregnancy ____ glucose tolerance. alter maintain lower increase
lower
A patient at 37 weeks' gestation is being seen in the prenatal clinic. Where would the nurse expect the fundal height to be palpated? right below the xiphoid process At a point between the umbilicus and the xiphoid At the umbilicus At a level directly above the symphysis pubis
right below the xiphoid process
Which of the following is an indication for the administration of methylergonovine? A) Woman with a large hematoma B) Woman with a deep vein thrombosis C) Boggy uterus that does not respond to massage and oxytocin therapy D) Woman with severe postpartum depression
C) Boggy uterus that does not respond to massage and oxytocin therapy
The perinatal nurse providing care to a laboring woman recognizes a category II, fetal heart rate tracing. The most appropriate initial action is to: Document the fetal heart rate and variability Decrease the intravenous solution Request that the physician/certified nurse-midwife come to the hospital STAT Assist the laboring woman to a left lateral position
Assist the laboring woman to a left lateral position
What is the most common expected emotional reaction of a woman to the news that she is pregnant? Jealousy Acceptance Ambivalence Depression
Ambivalence
The clinic nurse talks with Suzy, a pregnant woman at 9 weeks' gestation who has just learned of her pregnancy. Suzy's nausea and vomiting are most likely caused by (select all that apply): Increased levels of estrogen Increased levels of progesterone An altered carbohydrate metabolism Increased levels of human chorionic gonadotropin
An altered carbohydrate metabolism Increased levels of human chorionic gonadotropin
A client on 2 gm/hr of magnesium sulfate has decreased deep tendon reflexes. Identify the priority nursing assessment to ensure client safety. Assess uterine contractions continuously. Assess fetal heart rate continuously. Assess urinary output. Assess respiratory rate.
Assess respiratory rate.
Kerry, a 30-year-old G3 TPAL 0110 woman presents to the labor unit triage with complaints of lower abdominal cramping and urinary frequency at 30 weeks' gestation. An appropriate nursing action would be to (select all that apply): Assess the fetal heart rate Obtain urine for culture and sensitivity Assess Kerry's blood pressure and pulse Palpate Kerry's abdomen for contractions
Assess the fetal heart rate Obtain urine for culture and sensitivity Palpate Kerry's abdomen for contractions
The labor patient you are caring for is ambulating in the hall. Her vaginal exam 1 hour ago indicated she was 4/70/-1 station. She tells you she has fluid running down her leg. Your priority nursing intervention is to: Assist your patient to the bathroom. Call the care provider. Assess the color, odor, and amount of fluid. Assess the fetal heart rate.
Assess the fetal heart rate.
A nurse is preparing to monitor a patient who is to receive an amnioinfusion. Which of the following actions should the nurse make at this time? Attach the patient to an oxygen saturation monitor. Assist in insertion of an internal uterine pressure catheter. Attach the patient to an electronic blood pressure cuff. Perform an amniotic fluid Nitrazine test.
Assist in insertion of an internal uterine pressure catheter.
