OB Midterm
A nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The physician has documented the presence of Goodell's sign. The nurse determines that this sign indicates: 1. A softening of the cervix. 2. The presence of fetal movement 3. The presence of HCG in the urine 4. A soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus.
1. A softening of the cervix.
During labor, progressive fetal descent occurs. Place the stations listed in their proper sequence from first to last. All options must be used 1. 2+ station 2. -4 station 3. -2 station 4. 0 station 5. +4 station
2. -4 station 3. -2 station 4. 0 station1. 1. 2+ station 5. +4 station
A clinic nurse is providing instructions to pregnant client regarding measures that assist in alleviating heartburn. Which statement by the client indicates an understanding of the instructions? 1. "I should avoid between-meal snacks." 2. "I should lie down for an hour after meals." 3. "I should use spices for cooking rather than using salt." 4. I should avoid eating foods that produce gas, such as beans and some vegetables, and fatty foods such as deep-fried chicken."
4. I should avoid eating foods that produce gas, such as beans and some vegetables, and fatty foods such as deep-fried chicken."
A nurse is providing discharge teaching to a patient following the removal of a hydatidiform mole. which of the following statements should the nurse include in the teaching? A. "Do not become pregnant for at least 1 year." B. "Seek genetic counseling for yourself and your partner prior to getting pregnant again." C. " You should have the hCG level drawn in 6 weeks." D. " Have your blood pressure checked weekly for the next month."
A. "D not become pregnant for at least 1 year." Hydatidiform moles are uncontrolled growths in the uterus arising from placental or fetal tissue in early pregnancy. There is an increased incidence of choriocarcinoma associated with molar pregnancies. Pregnancy must be avoided for 1 year so the patient can be closely monitored for manifestations of this condition.
A nurse educator in the labor and delivery unit is reviewing the use of chemical agents to promote cervical ripening with a group of newly licensed nurses. which of the following statements by a nurse indicates understanding of the teaching? A. "They are tablets administered vaginally." B. "They act by absorbing fluid from tissues." C. "They promote dilation of the os." D. "They include an amniotomy.
A. "They are tablets administered vaginally."
A nurse is caring for a patient who is scheduled to undergo an amniocentesis to assess fetal lung maturity. The client is G2P1 and at 36 weeks of gestation, and she has an 0-positive blood type. Which of the following interventions should the nurse perform. A. Apply an external fetal monitor to the client B. Instruct the patient to drink fluids and not void prior to the procedure C. Administer Rho(D) immunoglobin after the procedure D. Instruct the client to take a deep breath and hold it during the entry of the needle
A. Apply an external fetal monitor to the client The nurse should assess fetal heart tones and uterine tone prior to and throughout the procedure to establish a baseline and monitor for changes.
A nurse is caring for a patient in the third trimester of pregnancy who is scheduled to undergo a non-stress test. Which of the following actions should the nurse take prior to the test? A. Ask the patient to drink a glass of orange juice B. Prepare the client for a vaginal examination C. Request a serum hemoglobin level D. Obtain a clean-catch urine specimen
A. Ask the patient to drink a glass of orange juice The nurse should give the client orange juice or glucose preparation prior to this test. This should raise the client's blood glucose level and help promote fetal movement.
A nurse is caring for a patient who is 33 weeks pregnant and has a blood pressure of 143/94. The nurse knows the patient is at risk for which of the following? A. B baby that is small for gestational age B. A baby that is large for gestational age C. Premature preterm rupture of membranes D. A baby with heart defect
A. B baby that is small for gestational age Gestational HTN causes the fetus to be growth restricted due to inappropriate blood flow to the placenta and fetus.
A nurse is caring for a patient who is at 14 weeks of gestation and has hyperemesis gravidarum. The nurse should identify that which of the following are risk factors for the patient? SATA A. Diabetes B. Multifetal pregnancy C. Maternal age greater than 40 D. Gestational trophoblastic disease E. Oligohydramnios
A. Diabetes B. Multifetal pregnancy D. Gestational trophoblastic disease
A nurse is caring for a patient who is at 40 weeks of gestation and experiencing contractions every 3 to 5 min and becoming stronger. A vaginal exam reveals that the patients cervix is 3 cm dilated, 80% effaced, and -1 station. The patient asks for pain medication. which of the following actions should the nurse take? SATA A. Encourage use of patterned breathing techniques B. Insert an indwelling urinary catheter C. Administer opioid analgesic medication D. Suggest application of cold E. Provide ice chips
A. Encourage use of patterned breathing techniques C. Administer opioid analgesic medication D. Suggest application of cold
In explaining to a client during her initial prenatal exam the importance of testing pregnant women for gonorrhea, the nurse should tell the client that gonorrhea can cause neonatal A. Eye infections B. Perineal discharge C. Liver damage D. Congenital anomalies
A. Eye infections
A nurse is caring for a patient who has a prescription for magnesium sulfate. The nurse should recognize that which of the following are contraindications for use of this medication? SATA A. Fetal distress B. Preterm labor C. Vaginal bleeding D. Cervical dilation greater than 6 cm E. Severe gestational hypertension
A. Fetal distress C. Vaginal bleeding D. Cervical dilation greater than 6 cm
A nurse is caring for a patient who has been in labor for 12hr with intact membranes. The nurse performs a vaginal examination to ensure which of the following prior to the performance of the amniotomy? A. Fetal engagement B. Fetal lie C. Fetal attitude D. Fetal position
A. Fetal engagement It is imperative that the fetus os engaged at 0 station and at the level of the maternal ischial spines to prevent prolapse of the umbilical cord.
A nurse is caring for a patient having contractions every 8 min that are 30 to 40 sec in duration. The patients cervix is 2cm dilated, 50% effaced, and the fetus is at a -2 station with FHR around 140/min. Which of the following stages and phases of labor is this client experiencing? A. First stage, latent phase B. First stage, active phase C. First stage, transition phase D. Second stage of labor
A. First stage, latent phase In stage 1, latent phase, the cervix dilates from 0 to 3 cm, and contraction duration ranges from 30 to 45 seconds.
A nurse is caring for a term macrosomic newborn whose mother has poorly controlled type 2 diabetes. The newborn has respiratory distress syndrome. The nurse should be aware that the most likely cause of the respiratory distress is which of the following? A. Hyperinsulinemia B. Brachial plexus injury C. Increased deposits of fat in the chest and shoulder area D. Increased blood viscosity
A. Hyperinsulinemia
A nurse is caring for a patient in the third stage of labor. which of the following findings indicate placental separation? SATA A. Lengthening of the umbilical cord B. Swift gush of clear amniotic fluid C. Softening of the lower uterine segment D. Appearance of dark blood from the vagina E. Fundus firm upon palpation
A. Lengthening of the umbilical cord D. Appearance of dark blood from the vagina E. Fundus firm upon palpation
A nurse is caring for a patient 8 hr psotpartum and is experiencing hemorrhage. Which of the following actions should the nurse implement after notifying the provider? SATA A. Massage the fundus B. Give oxygen at 2 L/min nasal cannula C. Administer oxytocin with IV fluids D. Insert an indwelling urinary catheter E. Place the client in a lateral position with her legs elevates 30°
A. Massage the fundus C. Administer oxytocin with IV fluids D. Insert an indwelling urinary catheter E. Place the client in a lateral position with her legs elevates 30° The nurse should massage the fundus to expel clots and help the uterus contract. The nurse should add ocytocin to the inravenous drip and inset an indwelling urinary catheter to monitor urinary output and perfusion to the kidney. Finally, the nurse should place the client in a lateral position with her legs elevated 30°
A 22 year old woman with vaginal bleeding has come to the triage unit for assessment of light spotting. She has missed one period and following a transvaginal ultrasound, her pregnancy is confirmed. However, implantation has occurred in the right fallopian tube the mass is 2 cm and has not ruptured. The most appropriate therapy would be: A. Methotrexate B. IV hydration and mag. Sulfate C. Salpingectomy (removal of tube) by laparotomy D. Reassess the mass in one week
A. Methotrexate
A nurse in a clinic is caring for a client who is at 11 weeks gestation and reports that she has had slight occasional vaginal bleeding over the past 2 weeks. Following an ex amination by the provider, the client is told that the fetus has died and the placenta, fetus, and tissues remain in the uterus. How should the nurse document these findings? A. Missed miscarriage B. Inevitable miscarriage C. Incomplete miscarriage D. Complete miscarriage
A. Missed miscarriage
A nurse is caring for a patient who is in active labor. The cervix is dilated to 5 cm, and the membranes are intact. Based on the use of external electronic fetal monitoring, the nurse notes a FHR of 115 to 124/min with occasional increases up to 150 to 155.min that last for 25 sec and have moderate variability. There is no slowing of the FHR from the baseline. This patient is exhibiting manifestations of which of the following? SATA A. Moderate variability B. FHR accelerations C. FHR decelerations D. Normal baseline FHR E. Fetal tachycardia
A. Moderate variability B. FHR accelerations D. Normal baseline FHR
A nurse is assessing a client who reports that she might be pregnant. Which of the following findings should the nurse identify as a presumptive sign of pregnancy? A. Nausea in the morning B. Positive home pregnancy test C. Increased sensitivity of the cervix upon examination D. Gestational sac observed by transvaginal ultrasound.
A. Nausea in the morning Nausea is a presumptive sign of pregnancy that is, subjective symptom reported by the mother that could have a cause other than pregnancy.
A nurse in a clinic is assessing a client who is at 8 weeks of gestation and has hyperemesis gravidarum. Which of the following findings should the nurse expect? (Select all that apply) A. Nulliparous B. Oligohydramnios C. Hx of Gestational HTN D. Hx of migraines E. Twin gestations
A. Nulliparous D. Hx of migraines E. Twin gestations
A nurse is caring for a patient who is 42 weeks of gestation and is having an ultrasound. For which of the following conditions should the nurse plan for an amnionfusion? SATA A. Oligohydramnios B. Hydramnios C. Fetal cord compression D. Hydration E. Fetal immaturity.
A. Oligohydramnios C. Fetal cord compression
A nurse is planning care for a newborn who is large for gestational age due to maternal gestational diabetes mellitus. The nurse should recognize that the newborn is at risk for which of the following conditions (select all that apply) A. Polycythemia B. Hypermagnesemia C. Hypoglycemia D. Hyperbilirubinemia E. Hypercalcemia - hypo
A. Polycythemia C. Hypoglycemia D. Hyperbilirubinemia
A nurse is admitting a client who has a diagnosis of preterm labor. The nurse anticipates a prescription by the provider for which of the following medications? (Select all that apply.) A. Procardia B. Antibiotic therapy C. Prostaglandin D. Oxytocin E. Mag. Sulfate
A. Procardia E. Mag. Sulfate
A nurse is in the ambulatory surgery center is providing discharge teaching to a client who had a dilation and curettage following a spontaneous miscarriage. Which of the following should be included in the teaching? A. Products of conception will be present in vaginal bleeding B. Increased intake of zinc-rich foods is recommended C. Vaginal intercourse can be resumed after 2 weeks D. Aspirin may be taken for cramps.
A. Products of conception will be present in vaginal bleeding
A nurse is caring for a patient who is in the second stage of labor. The patient's labor has been progressing, and a vaginal delivery is expected in 20 min. The provider is preparing to administer lidocaine for pain relief and perform an episiotomy. The nurse should know that which of the following types of regional anesthetic block is to be administered? A. Pudendal B. Epidural C. Spinal D. Paracervical
A. Pudendal
A nurse is reviewing the medical record of a client who is at 20 weeks of gestation. which of the following findings should the nurse identify as a presumptive indication of pregnancy? A. Report of fetal movement by the client B. Auscultation of the fetal heart rate with Doppler ultrasound C. Presence of Chadwick's on pelvic examination D. Report of Braxton-Hicks contractions by the client
A. Report of fetal movement by the client Quickening (the report of fetal movement felt by the client) begins around 18-20 weeks of gestation and is considered a presumptive indication of pregnancy.
A nurse is administering magnesium sulfate IV for seizure prophylaxis to a patient who has severe preeclampsia. Which of the following indicates magnesium sulfate toxicity? SATA A. Respirations less than 12/min B. Urinary output less than 25mL/hr C. Hyperreflexic deep-tendon reflexes D. Decreased LOC E. Flushing and sweating
A. Respirations less than 12/min B. Urinary output less than 25mL/hr D. Decreased LOC HyPO dtr Flushing and sweating are adverse effects
A nurse is caring for a client who is in the second stage of labor. Which of the following manifestations should the nurse expect? A. The client delivers the newborn B. The client expels the placenta C. The client beings having regular contractions D. The client experiences gradual dilation of the cervix
A. The client delivers the newborn
A nurse manager on the labor and delivery unit is teaching a group of newly licensed nurses about maternal cytomegalovirus. Which of the following information should the nurse manager include in the teaching? A. Transmission can occur via the saliva and urine of the newborn B. Mothers will receive prophylactic treatment with acyclovir prior to delivery - (ganciclovir) C. Lesions are visible on the mother's genitalia D. This infection requires airborne precautions are initiated for the newborn
A. Transmission can occur via the saliva and urine of the newborn
A nurse is caring for a patient in active labor whose membranes have ruptured. The fetal monitor tracing reveals late decelerations. Which of the following actions should the nurse take first? A. Turn the patient onto her side B. Palpate the client's uterus C. Administer oxygen to the client D. Increase the client's IV fluids
A. Turn the patient onto her side
A nurse is caring for a client who has suspected ectopic pregnancy at 8 weeks gestation. Which of the following manifestations should the nurse expect to identify as consistent with the diagnosis? A. Unilateral, cramp-like abd. Pain B. Severe nausea and vomiting C. Large amount of vaginal bleeding D. Uterine enlargement greater than expected for gestational age
A. Unilateral, cramp-like abd. Pain
A nurse is caring for a patient who reports manifestations of preterm labor. Which of the following findings are risk factors of this condition. SATA A. Urinary tract infection B. Multifetal pregnancy C. Oligohydramnios D. DM E. Uterine abnormalities
A. Urinary tract infection B. Multifetal pregnancy D. DM E. Uterine abnormalities
A nurse is caring for a client at 34 weeks gestation who presents with vaginal bleeding. which of the following assessments will indicate whether the bleeding is caused by placenta previa or an abruption placenta? A. Uterine tone B. Fetal heart rate C. Blood pressure D. Amount of bleeding
A. Uterine tone The uterus will be relaxed, soft, and painless if the bleeding is caused by placenta previa. With abruptio placenta, the uterus will be firm and board-like, and client will complain of pain.
A nurse is caring for a client who is at 28 weeks of gestation and received and received terbutaline. Which of the following findings should the nurse expect? A. Weakened uterine contractions B. Maternal blood glucose 63mg/dL C. Enhanced production of fetal lung surfactant D. FHR 100/min
A. Weakened uterine contractions
The nurse is measuring a contraction from the beginning of the increment to the end of the decrement for the same contraction. The nurse would document this as which finding? A: Duration B: Intensity C: Frequency D: Peak
A: Duration
A nurse is caring for a client who is in active labor and reports severe back pain. During assessment, the fetus is noted to be in the occiput posterior position. Which of the following maternal positions should the nurse suggest to the client to facilitate normal labor progress? A: Hands and knees B: Lithotomy C: Trendelenburg D: Supine with a rolled tower under one hip
A: Hands and knees
The nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes for 45 seconds. The nurse notes that the FHR between contractions is 100 bpm. Which nursing action is most appropriate? A: Notify the HCP B: Continuing monitoring FHR C: Encourage the client to continue pushing with each contraction D: Instruct the client's coach to continue to encourage breathing techniques
A: Notify the HCP
A nurse is assessing a patient at 35 weeks gestation is receiving magnesium sulfate via continuous IV infusion for severe pre-eclampsia. Which of the following findings should the nurse report to the provider? A. Deep tendon reflexes 2+ B. Blood pressure 150/96 mmHg C. Urinary output 20 mL/hr D. Respiratory rate 16/min
C. Urinary output 20 mL/hr The nurse should report a urinary output of 20 mL/hr because this can indicate inadequate renal perfusion, increasing the risk of magnesium sulfate toxicity. A decrease in urinary output can also indicate reduced renal perfusion secondary to a worsening of the client's pre-eclampsia.
A nurse is assessing a patient who is in the fourth stage of labor. Which of the following findings should the nurse expect? A. Breast engorgement B. Hypthermia C. Urinary retention D. Rupture of membranes
C. Urinary retention After delivery, many clients have a reduced urge to urinate. This can result from birth trauma, a large bladder capacity after birth, analgesia, pelvic soreness, an episiotomy, and other factors.
A nurse in a prenatal clinic is caring for a client who has hyperemesis gravidarum. Which of the following is the initial laboratory test used to evaluate this condition? A. Liver enzymes B. Complete blood count C. Urine ketones D. Thyroid levels
C. Urine ketones
A nurse is caring for a client who has severe preeclampsia and is receiving mag. Sulfate IV at 2g/hr. Which of the following findings indicates that is sage for the nurse to continue the infusion? A. RR 16/min B. HR 56/min C. Urine output of 50mL in 4hr D. Diminished DTR
C. Urine output of 50mL in 4hr
A nurse is caring for a client who is in labor. A vaginal examination reveals the following findings: 2cm, 50%, +1, right occiput anterior (ROA). Based on this information, which of the following fetal positions should the nurse documents in the medical record? A. Transverse B. Breech C. Vertex D. Mentum
C. Vertex. ROA describes the relationship of the presenting part of the fetus to the client's pelvis. In this case, the occipital bone is the presenting part and is located anteriorly on the client's right side. Based on the presentation of the fetus, the position is vertex.
A nurse is caring for a client who is at 42 weeks of gestation and in active labor. Which of the following findings is the fetus at risk for developing? A: Intrauterine growth restriction B: Hyperglycemia C: Meconium aspiration D: Polyhydraminos
C: Meconium aspiration
The nurse is caring for a client in labor. Which assessment findings indicate to the nurse that the client is beginning the second stage of labor? Select all that apply. A: The contractions are regular B: The membranes have ruptured C: The cervix is dilated completely D: The client begins to expel clear vaginal fluid E: The spontaneous urge to push is initiated from perineal pressure
C: The cervix is dilated completely E: The spontaneous urge to push is initiated from perineal pressure
The nurse is assessing a patient who has given birth within the past hour. The nurse would expect to find the patient's fundus at which location? A: between the umbilicus and the symphysis pubis B: one fingerbreadth below the umbilicus C: at the level of the umbilicus D: 2 cm above the umbilicus
C: at the level of the umbilicus
A woman is in the fourth stage of labor. During the first hour of this stage, the nurse would assess the woman's fundus at which frequency? A: every 5 minutes B: every 10 minutes C: every 15 minutes D: every 20 minutes
C: every 15 minutes
A client calls the clinic asking coming in to be evaluated. She states that when she went to bed last night the fetus was high in the abdomen, but this morning the fetus feels like it has dropped down. After asking several questions, the nurses explains this is due to: A: start of labor B: placenta previa C: lightening D: rupture of the membrane
C: lightening
A 19-year-old presents in advanced labor. Examination reveals the fetus is in frank breech position. The nurse interprets this finding as indicating: A: one arm is presenting B: the fetus is sitting cross-legged above the cervix C: the buttocks are presenting first with both legs extended up towards the face D: one leg is presenting
C: the buttocks are presenting first with both legs extended up towards the face
On examination, the nurse determines the client is at 50% effacement. This means: A: the cervical canal is 1.5 cm long B: the cervical canal is 2 cm long C: the cervical canal is 1 cm long D: the cervical canal is 2.5 cm long
C: the cervical canal is 1 cm long
A nurse is teaching a patient about the benefits of internal fetal heart monitoring. which of the following statements should the nurse include? SATA A. "It is considered a noninvasive procedure." B. "It can detect abnormal fetal heart tones early." C. "It can determine the amount of amniotic fluid you have." D. "It allows for accurate readings with maternal movement." E. "It can measure uterine contraction intensity."
B. "It can detect abnormal fetal heart tones early." D. "It allows for accurate readings with maternal movement." E. "It can measure uterine contraction intensity."
A nurse is assessing a pregnant client at 26 weeks of gestation who reports an episode of dizziness after lying on her back on the couch. Which of the following actions should the nurse take? A. Request a prescription for preeclampsia laboratory studies B. Advise the patient to lie on her side C. Request an ultrasound to evaluate fetal wellbeing D. Advise the client to add a calcium supplement to her diet
B. Advise the patient to lie on her side. Dizziness after a pregnant client lies flat on her back is a sign of supine hypotension, which is caused by compression of the vena cava from the weight of the pregnant uterus. Pregnant women should be advised to avoid lying in a supine position.
A nurse is admitting a client who has severe preeclampsia at 35 weeks of gestation and is reviewing the provider's orders. Which of the following orders requires clarification? A. Continuous fetal monitoring B. Ambulate twice daily C. Obtain a daily weight D. Assess DTR hourly
B. Ambulate twice daily
A nurse is caring for a patient who is 40 weeks of gestation and reports having large gush of fluid from the vagina while walking from the bathroom. which of the following actions should the nurse take first? A. Examine the amniotic fluid for meconium B. Check the FHR C. Dry the patient and make them comfortable D. Apply a tocotransducer
B. Check the FHR
A nurse is assessing a patient who is at 12 weeks gestation and has a hydatidiform mole. Which of the following findings should the nurse expect? A. Hypothermia B. Dark brown vaginal discharge C. Decreased urinary output D. Fetal heart tones
B. Dark brown vaginal discharge A hydatidiform mole (a molar pregnancy) is benign proliferative growth of the chorionic villi that gives rise to multiple cysts. The products of conception transform into a large number of edematous, fluid-filled vesicles. As cells slough off the uterine wall, vaginal discharge is usually dark brown and can contain grape-like clusters
A nurse is caring for a client who has had a pudendal nerve block. The nurse should monitor for which of the following findings as an adverse effect A. Maternal hypertension B. Decreased ability to bear down C. Fetal bradycardia D. Uterine hyperstimulation
B. Decreased ability to bear down
A nurse is caring for a patient who is receiving nifedipine for prevention of preterm labor. The nurse should monitor the client for which of the following manifestations? A. Blood-tinged sputum B. Dizziness C. Pallor D. Somnolence
B. Dizziness Dizziness and lightheadedness are associated with orthostatic hypotension, which occurs when taking nifedipine.
A nurse is caring for a patient who is receiving oxytocin for induction of labor and has an intrauterine pressure catheter (IUPC) placed to monitor uterine contractions. For which of the following contraction patterns should the nurse discontinue the infusion of oxytocin? A. Frequency of every 2 min B. Duration of 90 to 120 sec C. Intensity of 60 to 90 mm Hg D. Resting tone of 15 mm Hg
B. Duration of 90 to 120 sec Should be less than 90 sec
A nurse is admitting a client who is at 37 weeks of gestation and has severe gestational HTN. Which of following actions should the nurse expect to implement? (Select all that apply) A. Evaluate neurologic status q8hr B. Ensure that calcium gluconate is readily available C. Provide a dark, quiet environment D. Admin. Mag. Sulfate IV E. Assess Resp. status q4
B. Ensure that calcium gluconate is readily available C. Provide a dark, quiet environment D. Admin. Mag. Sulfate IV
A nurse is assessing a client who is pregnant and reports increased nasal stuffiness. The nurse should inform the patient that which of the following hormones is responsible for this discomfort? A. Relaxin B. Estrogen C. Progesterone D. Human Chorionic somatomammotropin (HCS)
B. Estrogen. Estrogen increases vascularity and connective tissue growth. Nasal stuffiness, a common discomfort in pregnancy, results from the increased vascularity of the mucus membranes within the nasal passages.
A nurse is caring for a patient who is in labor and has received epidural analgesia. The patient's blood pressure is 88/50 mmHg, and the fetal heart tracing shows late decelerations. Which of the following actions should the nurse take? A. Assist the client to the bathroom to empty her bladder B. Increase the rate of the primary IV infusion C. Position the client in a semi-Fowler's position D. Provide glucose via oral hydration or IV
B. Increase the rate of the primary IV infusion Late decelerations can be caused by uteroplacental insufficiency. The fetal heart tracing shows a gradual decrease in fetal heart rate with a return baseline on uterine contractions. This could be related to maternal hypotension, which can be corrected with increased IV fluids to increase maternal blood volume. This improves uterine and cardiac perfusion as well.
A nurse is completing an admission assessment for a patient who is 39 weeks of gestation and reports fluid leaking from the vagina for 2 days. Which of the following conditions is the patient at risk for developing? A. Cord compression B. Infection C. Postpartum hemorrhage D. Hydramnios
B. Infection Rupture membranes longer than 24 hours prior to delivery increases the risk for infection.
A nurse is caring for a client who is at 39 weeks of gestation and is in active labor. The nurse locates the fetal heart tones above the client's umbilicus at midline. The nurse should suspect that the fetus is in which of the following positions? A) cephalic B) transverse C) posterior D) breech
D) breech
A nurse is caring a patient who a requests an intrauterine device (IUD) for contraception. Which of the following findings is a contraindication for this device? A. Hypertension B.Menorrhagia C. History of multiple gestations D. History of thromboembolic disease
B. Menorrhagia An IUD is a small plastic or copper device placed inside the uterus that changes the uterine environment to prevent pregnancy. An IUD is contraindicated for women who have menorrhagia, severe dysmenorrhea, or a history of ectopic pregnancy.
A nurse is preparing to administer an IV infusion of oxytocin for labor induction to a patient who is at 41 weeks of gestation. Which of the following actions should the nurse plan to take? A. Administer the oxytocin with a manual IV tubing B. Monitor the fetal heart rate every 15 minutes initially C. Begin the infusion at 10 mulliunits/min D. Titrate the dosage until the client has 1 contraction every minute
B. Monitor the fetal heart rate every 15 minutes initially The nurse should plan to monitor the fetal heart rate (FHR) every 15 min through the first stage of labor and then every 5 min during the second stage. Additionally, the nurse should document the FHR with every change of the oxytocin dosage.
A nurse is admitting a patient who is in labor and experiencing moderate bright red vaginal bleeding. Which of the following actions should the nurse take? A. perform a vaginal examination to determine cervical dilation B. Obtain blood samples for baseline laboratory values C. Place a spiral electrode on the fetal presenting part D. Prepare the client for a transvaginal ultrasound
B. Obtain blood samples for baseline laboratory values The nurse should obtain samples of the patients blood for baseline testing of hemoglobin and hematocrit levels.
A nurse is performing Leopold maneuvers on a client who is in labor. which of the following techniques should the nurse use to identify the fetal lie? A. Apply palms of both hands to sides of the uterus B. Palpate the fundus of the uterus C. Grasp lower uterine segment between thumb and fingers D. Stand facing the patient's feet with fingertips outlining cephalic prominence
B. Palpate the fundus of the uterus
The nurse is reviewing the chart of a patient who has a positive RPR what medication would be most effective in treatment? A. Erythromycin B. Penicillin G C. Metroninzole D. Sulfonimide
B. Penicillin G
A nurse in a prenatal clinic is reviewing the laboratory results of a client who is at 33 weeks of gestation. For which of the following results should the nurse notify the provider? A. Hgb 11.3 g/dl B. Platelet count 135,000/mm^3 C. WBC count 10,500/mm^3 D. Hct 38%
B. Platelet count 135,000/mm^3 The nurse should notify the provider of this result because it is an indication of thrombocytopenia. A low platelet count is a manifestation of preeclampsia or HELLP syndrome and requires further evaluation.
A nurse is planning care for a client in active labor whose fetus is in an occipital brow presentation. Which of the following complication should the nurse anticipate as a result of this fetal presentation? A. Precipitous labor B. Prolonged labor C. Hypertonic uterine dysfunction D. Umbilical cord prolapse
B. Prolonged labor An occipital brow presentation increases the diameter of the presenting part, which may prevent the fetal head from descending into the pelvis. This can result in prolonged labor, forceps-or vacuum-assisted birth, or a cesarean delivery.
A nurse is caring for a client who has oligohydraminos. Which of the following fetal anomalies should the nurse expect? A. Atrial septal defect B. Renal agenesis C. Spina Bifida D. Hydrocephalus
B. Renal agenesis Oligohydramnios is a volume of amniotic fluid that is <300 mL during the third trimester pf pregnancy. This occurs when there is a renal system dysfunction of obstructive uropathy. The absence of fetal kidneys will cause oligohydramnios.
A nurse is caring for a patient who is in active labor. The patient reports lower-back pain. The nurse suspects that this pain is related to a persistent occiput posterior fetal position. Which of the following non-pharmacological nursing interventions should the nurse recommend to the client? A. Abdominal effleurage B. Sacral counter-pressure C. Showering if not contraindicated D. Back rub and massage
B. Sacral counter-pressure
A nurse is caring for a client who is in labor and is prescribed an amnioinfusion. Which of the following findings is an indication for this procedure? A. Fetal macrosomia B. Variable decelerations C. Early decelerations D. Increased uterine tone
B. Variable decelerations
A nurse is caring for a newborn who is SGA. Which of the following findings is associated with this condition? A. Gray umbilical cord B. Wide skull sutures C. Moist skin D. Protruded abdomen
B. Wide skull sutures
A nurse is assessing a patient who is 2 days postpartum. In which of the following locations should the nurse expect to locate the patients fundus? A. 3 cm above the umbilicus B. 1 cm above the umbilicus C. 3 cm below the umbilicus D. 1 cm below the umbilicus
C. 3 cm below the umbilicus The patient's fundus should descend about 1 to 2 cm every 24 hours; therfore, at 2 days postpartum, the patient's fundus should be located 3 cm below the umbilicus.
A nurse is caring for several clients. The nurse should recognize that it is safe to administer tocolytic therapy to which of the following clients? A. A client is experiencing Braxton-Hicks contractions at 36 weeks B. A client is experiencing fetal death at 32 weeks C. A client is experiencing preterm labor at 26 weeks D. A client who has post term pregnancy at 42 weeks
C. A client is experiencing preterm labor at 26 weeks
A nurse is caring for a client who is in the latent phase of the first stage of labor and is in pain. Which of the following nursing interventions are appropriate to reduce pain. (Select all that apply) A. Perform Leopold maneuvers B. Have the client sit in a tub of warm water C. Ambulate the client in the hallway D. Administer 70% nitrous oxide mixed with o2 E. Apply counter pressure to the sacral area
C. Ambulate the client in the hallway E. Apply counter pressure to the sacral area
A nurse is caring for a patient in their first stage of labor. Which of the following findings should the nurse identify as a cause of concern? A. Pink, mucoid vaginal discharge B. Brownish vaginal discharge C. Contractions lasting 100 seconds D. Contractions occurring every 4 to 5 min
C. Contractions lasting 100 seconds Contractions during the first stage of labor range from 45 to 80 seconds. They should not exceed 90 seconds.
A nurse is caring for a client in the latent phase of labor who is receiving oxytocin via continuous IV infusion. The client is having contractions every 2 min that last 100 to 110 sec, and the fetal heart rate (FHR) is reassuring. Which of the following actions should the nurse take? A. Decrease the infusion rate of the maintenance IV fluid B. Administer oxygen via nonrebreather mask C. Decrease the dose of oxytocin by half D. Administer terbutaline 0.25 mg subcutaneously
C. Decrease the dose of oxytocin by half The nurse should decrease the dose of oxytocin by half because the client is experiencing uterine tachysystole.
A nurse is planning care for a client who has a prescription for oxytocin. Which of the following is a contraindication to use of this medication? A. Prolonged rupture of membranes at 38 weeks gestation B. Intrauterine growth restriction C. Post-term pregnancy D. Active genital herpes
D. Active genital herpes he use of oxytocin is contraindicated for clients who have an active genital herpes infection. The newborn can acquire the infection while passing through the birth canal. Therefor, a cesarean birth is recommended for clients who have an active genital herpes infection.
Which of the following medications administered to the pregnant client with GDM and experiencing preterm labor requires close monitoring of the patient's blood glucose levels? a. Mag. Sulfate b. Indomethacin c. Nifedipine d. Bethamethasone
D. Bethamethasone
A nurse is caring for a patient who is at 39 weeks gestation and shows manifestations of labor. Which of the following findings will alert the nurse that the patient is in true labor? A. Contractions felt in the upper abdomen B. A small amount of bloody discharge C. Contractions occurring every 2 to 10 min D. Changes in cervical dilation or effacement
D. Changes in cervical dilation or effacement Cervical changes are a sign of true labor.
A nurse is caring for an adolescent client who is gravida 1 and para 0. The client was admitted to the hospital at 38 weeks of gestation with a diagnosis of preeclampsia. Which of the following findings should the nurse identify as inconsistent with preeclampsia? A. +1 pitting sacral edema B. BP 148/98 C. +3 proteinuria in the urine D. DTR of +1
D. DTR of +1
A nurse is planning care for a newly admitted patient who reports, "I am in labor and I have been having vaginal bleeding for two weeks." Which of the following should the nurse include in the plan of care? A. Inspect the introitus for prolapsed cord B. Perform a test to identify the ferning pattern C. Monitor station of the presenting part D. Defer vaginal examinations
D. Defer vaginal examinations Need to rule out placenta previa or abruptio first.
A nurse is providing care to a client who is in labor and experienced a spontaneous rupture of membranes. Which of the following findings requires intervention by the nurse? A. Intense contractions lasting less than 30 seconds B. Rest periods between contractions lasting longer than 90 seconds C. Fetal heart rate decreased by 15/min D. Maternal temperature of 37.8 °C (100°F) after ruptured membranes
C. Fetal heart rate decreased by 15/min A fetal heart rate decreases of 15/min is known as variable decelerations and requires intervention by the nurse due to cord compression. The cord can prolapse after the rupture of membranes, compromising the fetus. The fetal heart rate pattern should be monitored for several minutes after the rupture of membranes to assess the wellbeing of the fetus.
The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000, an elevated liver aspartate transaminase level, and a falling Hct. The nurse n notifies the physician because the lab results are indicative of: A. Preterm Labor B. Normal results C. HELLP syndrome D. Thrombocytpenia
C. HELLP syndrome
A nurse is discussing family planning with a client who has a history of DVT. The nurse should inform the client that this condition is a contraindication for which of the following birth control methods? A. Intrauterine device B. Cervical cap C. Oral contraceptive D. Diaphragm
C. Oral contraceptive
A nurse is assessing a postpartum client who has preeclampsia and notes a boggy uterus and excessive uterine bleeding. The nurse should plan to administer which of the following medications? A. Terbutaline B. Magnesium sulfate C. Oxytocin D. Methylergonovine
C. Oxytocin Is a uterontonic medication that causes the uterus to contract and reduces excessive uterine bleeding.
A nurse is reviewing the provider's admission orders for a client who is at 37 weeks of gestation and is HIV positive. Which of the following orders should the nurse clarify with the provider? A. Intermittent auscultation B. Biophysical profile C. Non-stress test (NST) D. Fetal scalp electrode
D. Fetal scalp electrode The placement of a fetal scalp electrode is an invasive procedure that requires ruptured membranes. The electrode is inserted into the fetal scalp, which will increase the fetus's exposure to HIV and is contraindicated.
The piece of assessment data that would constitute a diagnosis of preterm labor is A. Cervical change of 0.5 cm per hour B. Two contractions in 30 minutes C. Cervical effacement of 30% D. Five contractions in 1 hour
D. Five contractions in 1 hour
A nurse is caring for a newborn who was born to a client with a narcotic use disorder. which of the following nursing actions is contraindicated in the care of this newborn? A. Promoting maternal-newborn bonding B. Tight swaddling of the newborn C. Small frequent feedings D. Frequent stimulation
D. Frequent stimulation This newborn needs a quiet, calm environment with minimal stimulation to promote rest and reduce stress. A stimulating environment can trigger irritability and hyperactive behaviors.
A nurse is assessing a client who is 1 hrs. postpartum. The nurse notes a large amount of vaginal bleeding with several large blood clots on the client's peri pad. The clients BP is 70/42 mmHg and her heart rate is 150/min. Which of the following actions should the nurse take first? A. Apply O2 at 10-12 L/min- (#3 priority-- Provide oxygen at 2 to 3 L/min per nasal cannula) B. Elevate the legs- (#4 priority-- Elevate legs to a 20° to 30° angle to increase venous return) C. Administer an IV bolus of oxytocin- (#2 priority-- To promote uterine contraction, a faster action than massaging the fundus) D. Massage the fundus
D. Massage the fundus
A nurse is caring for a patient who has a soft uterus and increased lochial flow. which of the medications should the nurse plan to administer to promote uterine contractions? A. Terbutaline B. Nifedipine (procardia) C. Magnesium sulfate D. Methylergonovine
D. Methylergonovine The nurse should administer methylergonovine, an ergot alkaloid, which promotes uterine contractions.
A nurse is using Naegele's rule to determine the estimated date of birth (EDB) for a patient whose first day of her last menstrual period was February 2, 2018. the nurse should identify which of the following as the patient's EDB? A. November 16, 2018 B. October 19, 2018 C. October 26, 2018 D. November 9, 2018
D. November 9, 2018
A nurse is caring for a patient who is using patterned breathing during labor. The client reports using patterned breathing during labor. The patient reports numbness and tingling of the fingers. Which of the following actions should the nurse take? A. Administer oxygen via nasal cannula B. Apply a warm blanket C. Assist the patient to a side-lying position D. Place an oxygen mask over the patient's nose and mouth.
D. Place an oxygen mask over the patient's nose and mouth. The patient is experiencing hyperventilation caused by low PCO2
A nurse is admitting a client to the birthing unit who reports her contractions started 1 hrs. ago. The nurse determines the client is 80% effaced & 8 cm dilated. The nurse realizes that the client is at risk for which of the following conditions. A. Incompetent cervix B. Ectopic pregnancy C. Hyperemesis gravidarum D. Postpartum hemorrhage
D. Postpartum hemorrhage
A patient, Barbara, is diagnosed with severe preeclampsia on her routine prenatal visit and sent to the hospital and admitted. Which of the following findings would the nurse expect for this condition? A. Ketonuria B. Headache blurred vision C. BP 180/112 D. Proteinuria +3, oliguria
D. Proteinuria +3, oliguria
A nurse is reviewing the electronic monitor tracing of a patient who is in active labor. A fetus receives more oxygen when which of the following appears on the tracing? A. Peak of the uterine contraction B. Monderate variability C. FHR acceleration D. Relaxation between uterine contractions
D. Relaxation between uterine contractions
The perinatal nurse is teaching the new nurse about fetal fibronectin, and fibronectin is best described as the: A. Glue that attaches the fetal membranes to the underlying uterine decidua B. Cement like lining of chorion and amnion C. Basilar lining of the endometrium basement membrane D. Swab test done at 36-37 weeks in the patient with intact membranes
D. Swab test done at 36-37 weeks in the patient with intact membranes
A nurse is caring for a client who is at 37 weeks of gestation and has placenta previa. The client asks the nurse why the provider does not do an internal examination. Which of the following explanations of the primary reason should the nurse provide? A. There is an increased risk of ROM B. There is an increased risk of introducing infection C. This could initiate preterm labor D. This could cause profound bleeding
D. This could cause profound bleeding
A nurse is caring for a patient in labor whose cervix is dilated to 9cm. She is experiencing strong contractions every 2 min lasting 75 sec. The nurse should recognize that the client is in which of the following phases or stages of labor? A. Latent phase of the first stage B. Active phase of the first stage C. Second stage D. Transition phase of the first stage
D. Transition phase of the first stage. These findings indicate the transition phase of the first stage of labor. The first stage ends with the transition phase in which the cervix dilates to 8 to 10cm. Uterine contractions are strong, occurring every 2 to 3 minutes and lasting 45 to 90 seconds.
A nurse is caring for a client who is in premature labor and is receiving terbutaline. The nurse should monitor the client for which of the following adverse effects that should be reported to the provider? A. Nervousness B. Headaches C. Dyspnea D. Tremors
D. Tremors
A patient calls for a provider's office and reports having contractions for 2 hours that increase with activity and did not decrease with rest and hydration. The patient denies leaking of vaginal fluid but did not notice blood when wiping after voiding. which of the following manifestations is the client experiencing? A. Braxton Hicks contractions B. Rupture of membranes C. Fetal descent D. True contractions
D. True contractions True contractions do not go away with hydration pr walking. They are regular in frequency, duration and intensity and become stronger with walking.
A nurse is providing care for a patient who is in the second stage of labor. The fetal heart tracing indicates multiple variable deceleration. which of the following actions should the nurse take? A. Complete blood count B. Liver enzymes C. Bilirubin level D. Urine ketones
D. Urine ketones The nurse should prepare an amnioinfusion to decrease cord compression.
A nurse is assessing a client who is suspected of having hyperemesis gravidarum. Which if the following laboratory tests should the nurse check first? A. Complete blood count B. Liver enzymes C. Bilirubin level D. Urine ketones
D. Urine ketones When using the urgent vs nonurgent approach to patient care, the nurse should determine that the priority laboratory test to check is urine ketones. Excessive ketones in the urine indicate the body is not using carbohydrates from food as fuel and is inadequately trying to break down fat. The presence of ketones in the urine supports the diagnosis of hyperemesis gravidarum.
A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is: A: 7 B: 9 C: 6 D: 5
D: 5
A nurse is caring for a client in active labor. When last examined 2 hours ago, the client's cervix was 3 cm dilated, 100% effaced, membranes intact, and the fetus was at a -2 station. The client suddenly states "My water broke". The monitor reveals a FHR of 80 to 85/min, and the nurse performs a vaginal examination, noticing clear fluid and a pulsing loop of umbilical cord in the client's vagina. Which of the following actions should the nurse perform first? A: Place the client in the Trendelenburg postion B: Apply pressure o the presenting part with her fingers C: Administer oxygen at 10L/min via a face mask D: Call for assistance
D: Call for assistance
What do the 5 P's of labor help to determine as pertains to labor processes? A) Pain Management B) Labor Progression C) Risk for Bleeding D) Emotional Support
B) Labor Progression
A nurse is caring for a patient who has trichomoniasis and a prescription for metronidazole. Which of the following instructions should the nurse provide to the patient about the treatment plan? A. "Your partner needs to be culture and be treated with metronidazole only if his cultures are positive." B. "You and you partner need to take the medication and use a condom during intercourse until the cultures are negative." C. "If both you and your partner are treated simultaneously, you may continue to engage in sexual intercourse." D. " Only you will need to take the metronidazole, but you should not have intercourse until your culture is negative."
B. "You and your partner need to take the medication and use a condom during intercourse until cultures are negative." Trichomonas vaginalis is the organism that causes the sexually transmitted infection trichomoniasis. Both men and women can be infected with trichomoniasis. Clinical findings include yellowish to greenish, frothy, mucopurulent, copious discharge with an unpleasant odor, as well as itching, burning, or redness of the vulva and vagina. Trichomoniasis can be treated easily with metronidazole. However, for the treatment to work, it is important to make sure both sexual partners receive treatment to prevent reinfection. Instruct the patient to use condoms during sexual intercourse while being treated.
A nurse is teaching a client who is at 10 weeks gestation about an abdominal ultrasound in the first trimester. Which of the following pieces of information should the nurse include in the teaching? A. "You will have a nonstress test prior to the ultrasound." B. "You will need to have a full bladder during the ultrasound." C. "The ultrasound will determine the length of you cervix." D. "You will experience uterine cramping during the ultrasound."
B. "You will need to have a full bladder during the ultrasound." A full bladder helps lift the gravid uterus out of the pelvis during the examination. Therefore, the client should have a full bladder during the ultrasound to obtain the most accurate image of the fetus.
A nurse is caring for a patient who had a vaginal delivery 24 hours ago. Which of the following findings should the nurse report to the provider? A. A 2,000 mL urine since delivery B. 3+ deep tendon reflexes C. Fundus at umbilicus D. Soft breasts
B. 3+ deep tendon reflexes Deep tendon reflexes of 3+ greater can indicate preeclampsia and should be reported to the provider
A nurse in the antepartum unit is caring for a client who is at 36 weeks of gestation and has pregnancy-induced hypertension. Suddenly, the client reports cont. abdominal pain and vaginal bleeding. The nurse should suspect which of the following complications? A. Placenta previa B. Abruptio placentae C. Prolapsed cord D. Incompetent cervix
B. Abruptio placentae
A nurse is discussing the expected changes related to pregnancy with a client who is at 8 weeks gestation. Which of the following findings should the patient report to the provider during the first trimester. A. Breast tenderness B. Urinary frequency C. Persistent vomiting D. No fetal movement
C. Persistent vomiting Intermittent nausea and vomiting during the first trimester are common. However, the nurse should inform the patient that persistent vomiting suggests hyperemesis gravidarum and increases the risk of fluid and electrolyte imbalance. In this situation, maternal and fetal health might be compromised, and symptoms should be reported to the provider. The cause of hyperemesis gravidarum is unknown but might result from human chorionic gonadotropon (hCG) levels. the patient should be encouraged to eat dry crackers upon awakening, eat 5-6 small meals daily, and avoid friend, odorous, or spicy foods.
A nurse is providing teaching for a client about hormonal changes during pregnancy. The nurse identifies that which of the following hormones plays a key role in preventing miscarriage? A. Oxytocin B. Prolactin C. Progesterone D. Estrogen
C. Progesterone Progesterone maintains the endometrium and has a relaxant effect on the uterus so that the fetus is not expelled.
A nurse is preparing to administer mag. Sulfate IV to a client who is experiencing preterm labor. Which of the following is the priority nursing assessment for this client? A. Temp B. Bowel Sounds C. Respiratory Rate D. FHR
C. Respiratory Rate
A nurse is reviewing the Immunization status of a client who is pregnant. The nurse should inform the client that it is safe for her to receive which of the following immunizations during pregnancy? A. Varicella B. Rubella - live vaccine C. Tetanus D. Rubeola
C. Tetanus
A nurse is caring for a patient who is in active labor, irritable, reports the urge to have a bowel movement. The patient vomits and states, "Ive had enough. I can't do this anymore." Which of the following stages of labor is the patient experiencing? A. Second stage B. Fourth stage C. Transition stage D. Latent phase
C. Transition stage
