OB Peds EAQ Questions

The nurse is preparing a client for epidural anesthesia. Which client statement would cause the nurse to stop the placement of the epidural catheter? 1 "I'm not exactly sure how an epidural works." 2 "I understand that the epidural might or might not take my pain away." 3 "I signed the consent form for an epidural at my last clinic appointment." 4 "I'm aware that the epidural could cause my contractions to slow down."

1 "I'm not exactly sure how an epidural works." A description of the various anesthetic techniques and what they entail is essential to informed consent, even if the woman received information about analgesia and anesthesia earlier in her pregnancy. Nurses play a significant role in the informed consent process by clarifying and describing procedures or by acting as the woman's advocate and asking the primary healthcare provider for further explanation. There are three essential components of an informed consent. First, the procedure and its advantages and disadvantages must be thoroughly explained. Second, the woman must agree with the plan of labor pain management as explained to her. Third, her consent must be given freely without coercion or manipulation from the healthcare provider.

A client is to undergo amniocentesis at 38 weeks' gestation to determine fetal lung maturity. What lecithin/sphingomyelin ratio (L/S ratio) is adequate for the nurse to conclude that the fetus's lungs are mature enough to sustain extrauterine life? 1 2:1 2 1:1 3 1:4 4 3:4

1 2:1 The lecithin concentration increases abruptly at 35 weeks, reaching a level that is twice the amount of sphingomyelin, which decreases concurrently. At 30 to 32 weeks' gestation, the amounts of lecithin and sphingomyelin are equal, indicating lung immaturity. A ratio of 1:4 does not reflect fetal lung maturity; nor does a ratio of 3:4.

A man and a woman want to use the calendar (rhythm) method of contraception but do not understand how it works. Based on an average 28-day cycle, during what time frame does the nurse explain that they should refrain from intercourse? 1 Days 10 to 17 of the menstrual cycle 2 7 days before the end of the menstrual cycle 3 7 days after completion of the menstrual period 4 14 days after completion of the menstrual period

1 Days 10 to 17 of the menstrual cycle Ovulation is anticipated approximately 14 days before menstruation; however, it is more reliable to avoid using a specific number of days and instead base calculations on the individual's cycle rather than the average 28-day cycle. Before relying on this method, a woman records the number of days in each menstrual cycle for at least 6 months. The first day of monthly bleeding is always counted as day 1. The woman subtracts 18 from the length of her shortest recorded cycle. This tells her the estimated first day of her fertile time. Then she subtracts 11 days from the length of her longest recorded cycle. This tells her the estimated last day of her fertile time. The couple avoids vaginal sex, or uses condoms or a diaphragm, during the fertile time. They can also use withdrawal or spermicides, but these are less effective. She updates these calculations each month, always using the 6 most recent cycles.

Which instruction is most important for the nurse to include when teaching a client about a contraction stress test (CST)? 1 Empty the bladder before the test. 2 Eat nothing for 6 hours after the test. 3 Take the prescribed alprazolam before the test. 4 Be prepared to remain in the hospital for 12 hours after the test

1 Empty the bladder before the test. The CST will take 1 to 2 hours, during which time the client is confined to bed. Movement on and off a bedpan should be avoided. There are no food restrictions before or after this test. Alprazolam may interfere with results of the CST because it will sedate the fetus. If the test is explained in language that the client can comprehend, an anxiolytic should not be necessary. The client may go home 1 hour after the test is completed.

A client asks the nurse about the use of an intrauterine device (IUD) for contraception. Which information should the nurse include in the response? Select all that apply. 1 Expulsion of the device 2 Occasional dyspareunia 3 Delay of return to fertility 4 Risk for perforation of the uterus 5 Increased number of vaginal infections

1 Expulsion of the device 2 Occasional dyspareunia 4 Risk for perforation of the uterus The presence of the IUD thread should be verified before coitus, because the device may be expelled during menses; if the IUD has been expelled, pregnancy can occur. Although dyspareunia is not common, if it does occur, it should be reported. Perforation may occur during insertion of the IUD. The IUD does not affect fertility, as does the oral contraceptive. Immediately after the device is removed the client may try to conceive. The incidence of vaginal infections is not increased with the use of an IUD unless there is unprotected sex with a partner who has a sexually transmitted infection.

Which of the following variables are scored on a biophysical profile? Select all that apply. 1 Fetal tone 2 Fetal position 3 Fetal movement 4 Amniotic fluid index 5 Fetal breathing movements 6 Contraction stress test results

1 Fetal tone 3 Fetal movement 4 Amniotic fluid index 5 Fetal breathing movements Fetal tone, fetal movement, amniotic fluid index, and fetal breathing movements are all scored on a biophysical profile. Fetal position is not one of the variables that are scored. A nonstress test, not a contraction stress test, is also part of the biophysical profile.

A nonstress test is scheduled for a client with preeclampsia. During the nonstress test the nurse concludes that if accelerations of the fetal heart rate occur with fetal movement, this probably indicates what? 1 Fetal well-being 2 Fetal head compression 3 Uteroplacental insufficiency 4 Umbilical cord compression

1 Fetal well-being Accelerations of the fetal heart rate with fetal movement indicate fetal well-being. Early decelerations are associated with fetal head compression. Late decelerations are associated with uteroplacental insufficiency. Variable decelerations are associated with cord compression.

The nurse is caring for a client in her third trimester who is scheduled for an amniocentesis. What should the nurse do to prepare the client for this test? 1 Instruct her to void immediately before the test. 2 Tell her to assume the high Fowler position before the test. 3 Encourage her to drink three glasses of water before the test. 4 Advise her to take nothing by mouth for several hours before the test.

1 Instruct her to void immediately before the test. The client is instructed to void immediately before the test to help prevent injury to the bladder as the needle is introduced into the amniotic sac. The supine position with a hip roll under the right hip is the preferred position for this procedure. Telling the client to assume the high Fowler position before the test will cause the bladder to fill, making it vulnerable to injury as the needle is inserted into the amniotic sac. Encouraging the client to drink three glasses of water before the test is advised if the amniocentesis is being performed early during pregnancy. There is no reason to withhold food or fluid, because the test does not involve the gastrointestinal tract

A woman at 40 weeks' gestation is admitted in active labor. When the client reaches 5 centimeters dilation, the woman asks for and receives epidural analgesia. Once the epidural catheter has been inserted, which assessments and interventions should be performed? Select all that apply. 1 Maintaining intravenous fluid administration 2 Having oxygen available in case of hypotension 3 Checking the bladder for distention every 2 hours 4 Positioning the client supine for ease of monitoring 5 Monitoring fetal heart rate and labor progress per hospital protocol 6 Administering an oxytocin infusion to maintain the labor pattern

1 Maintaining intravenous fluid administration 2 Having oxygen available in case of hypotension 3 Checking the bladder for distention every 2 hours 5 Monitoring fetal heart rate and labor progress per hospital protocol Hypotension is a common problem in the client receiving epidural analgesia. Intravenous fluids can help counter this problem and also provide a vehicle for emergency drug administration. Oxygen should be available in case of hypotension as a result of the epidural block or as emergency care should the anesthetic agent migrate upward. Because sensation below the waist will be compromised, the client may be unaware of bladder distention, a situation that can occur with labor, possibly resulting in trauma to the bladder. Fetal heart tones and the progress of labor should be monitored. The client should be positioned on her side to prevent vena cava syndrome. Labor may be slowed by the epidural, but it is not essential that a woman receiving an epidural have oxytocin to maintain the labor pattern.

Late decelerations are present on the monitor strip of a client who received epidural anesthesia 20 minutes ago. What should the nurse do immediately? 1 Reposition the client from supine to left lateral. 2 Increase the intravenous flow rate from 125 to 150 mL/hr. 3 Administer oxygen at a rate of 8 to 10 L/min by way of face mask. 4 Assess the maternal blood pressure for a systolic pressure below 100 mm Hg.

1 Reposition the client from supine to left lateral. Hypotension is a common side effect of epidural anesthesia that results in decreased placental perfusion and late decelerations on the fetal monitor. The priority intervention is repositioning the client to relieve compression of the vena cava and increase venous return, which in turn increases placental perfusion. Administering oxygen and increasing the flow rate are correct interventions, but neither is the priority because these interventions would not be effective until compression of the vena cava has been relieved and placental perfusion increased. Assessing the maternal blood pressure for a systolic pressure below 100 mm Hg only provides data and does not correct the late deceleration.

The nurse is teaching a sex education course to high school students. What information should the nurse provide regarding the rationale for an increase in gonorrhea prevalence? Select all that apply. 1 Symptoms of the disease are vague. 2 Screening blood tests are expensive. 3 The incubation period is relatively short. 4 Causative organisms have become resistant to treatment. 5 Diagnostic tests for the causative organism are not yet available.

1 Symptoms of the disease are vague. 3 The incubation period is relatively short. 4 Causative organisms have become resistant to treatment. Many clients with gonorrhea are asymptomatic. The incubation period is 3 to 5 days. There is no effective, readily available blood test for gonorrhea. Gonorrhea responds well to treatment, but the Centers for Disease Control and Prevention has received several reports of resistant strains. At times backup secondary medications must be used in order to treat the infection. Urethral/vaginal smears or cultures are specific for the identification of the gonococcal organism.

A young sexually active client at the family planning clinic is advised to have a Papanicolaou (Pap) smear. She has never had a Pap smear before. What information should the nurse include in the explanation of this procedure? 1 The Pap smear can detect cancer of the cervix. 2 Vaginal bleeding is expected after a Pap smear. 3 Colposcopy will be used to visualize the cervix. 4 Scraping the cervix is the most uncomfortable part.

1 The Pap smear can detect cancer of the cervix. The Pap smear can detect cancer of the cervix by revealing atypical as well as cancerous cells. Scraping of the cells can cause a few drops of blood to be expelled; vaginal bleeding does not occur. A colposcopy is not part of a routine Pap smear. Insertion of the speculum is usually the most uncomfortable part of the test.

An internal fetal monitor is applied while a client is in labor. What should the nurse explain to the client regarding positioning while the monitor is in place? 1 The most comfortable position may be assumed. 2 Maintaining a supine position holds the internal electrode in place. 3 Monitoring is more accurate with the client in the side-lying position. 4 The monitor leads may be detached when the client is sitting on the bedpan

1 The most comfortable position may be assumed. Because electrodes are placed internally (on the fetal scalp, not on the mother's abdomen), position does not affect the monitor. Although the supine position does not affect the monitor, it should be discouraged because the pressure of the gravid uterus inhibits venous return, leading to reduced cardiac output. The side-lying position is recommended because it promotes maternal-fetal circulation. It is not the position but the internal placement of electrodes on the fetal scalp that ensures accurate monitoring. Constant monitoring provides continuous ongoing assessment of fetal status; there is no reason to detach the leads.

During their initial visit to the prenatal clinic, a couple asks the nurse whether the woman should have an amniocentesis for genetic studies. Which factor indicates that an amniocentesis should be performed? 1 Recent history of drug abuse 2 Family history of genetic abnormalities 3 Maternal age older than 30 years at the time of the first pregnancy 4 Request by client to determine sex of fetus

2 Family history of genetic abnormalities Amniocentesis is usually reserved for those women considered at higher risk of carrying a fetus with a chromosomal or genetic abnormality. The main reason for performing amniocentesis is the diagnosis of genetic problems. Even though a recent history of drug abuse may increase the risk of the development of the fetus, it is not a genetic issue. A history of more than three prior spontaneous abortions is not a reason to perform this invasive procedure. The risk will outweigh the benefit and will increase the risk of another spontaneous abortion. Amniocentesis is no longer performed routinely if the client is an older primigravida. A sonogram is performed first. Determining the sex with an amniocentesis puts the mother at high risk for complications. Other less invasive procedures can be done to determine sex of fetus

Select the priority intervention for a pregnant client whose monitor strip shows fetal heart rate decelerations characterized by a rapid descent and ascent to and from the lowest point of the deceleration. 1 Elevating the legs 2 Repositioning the client from side to side 3 Increasing the rate of intravenous infusion 4 Administering oxygen by way of face mask

2 Repositioning the client from side to side A deceleration with a rapid descent and ascent to and from the lowest point of the deceleration is a variable deceleration caused by cord compression. Changing the client's position from side to side promotes release of the compression. Elevating the legs and increasing the rate of intravenous fluid administration are interventions for placental perfusion problems and do not affect cord compression. Oxygen given while the cord remains compressed will not provide fetal oxygenation.

A client in active labor has requested epidural anesthesia for pain management. The anesthetist has completed an evaluation, and the nurse has initiated an intravenous fluid bolus. The client's partner asks why this is necessary. What is the best explanation? 1 It is the policy of the institution to provide 2 bags of lactated Ringer solution. 2 There is a risk of hypotension, and the large amount of IV fluid reduces this risk. 3 Giving the large amount of IV fluid is a means of hydrating the client when she is unable to drink. 4 The client must be given 500 mL of fluid to ascertain that the line is patent.

2 There is a risk of hypotension, and the large amount of IV fluid reduces this risk. Once an epidural is initiated there is a risk of hypotension (low blood pressure), which may result in fetal distress. This risk is reduced by the administration of 500 to 2000 mL. Epidural medication is administered through a catheter placed by the anesthetist. Quoting institutional policy does not provide the explanation for administering the solution. Providing 500 mL of fluid is useful in counteracting the risk of hypotension; however, it is not given as a means of determining that the line is patent before the administration of medication.

A contraction stress test (CST) is performed on a client at 40 weeks' gestation. The findings are interpreted as negative. What does the nurse conclude from this interpretation? 1 Testing will be repeated in 24 hours because the results indicate hyperstimulation. 2 There will be weekly retesting because, at this time, the fetus has adequate oxygen reserves. 3 Emergency birth will be considered because the fetal heart rate has early decelerations with uterine contractions. 4 Induction of labor will be performed because fetal heart rate accelerations with movement is indicative of a false result

2 There will be weekly retesting because, at this time, the fetus has adequate oxygen reserves A negative test result implies that placental support is adequate; it is associated with a low fetal death rate within 1 week. A negative test result does not indicate hyperstimulation. This is a negative test result; if there were persistent late decelerations with contractions, the test would be positive and intervention would be required. Fetal heart rate accelerations with movement are reassuring; an expeditious birth is not indicated.

A woman arrives at the prenatal clinic stating that her pregnancy test is positive. She asks the nurse for information regarding an abortion. After verifying that the woman is at 8 weeks' gestation, the nurse counsels her that having an abortion is controversial and that many women have long-lasting feelings of guilt after an abortion. What is the nurse's legal responsibility? 1 To share her own thoughts on abortion with the client 2 To provide the client with correct, unbiased information 3 To ask why the client wants information about abortion 4 To notify the primary healthcare provider because this is beyond the scope of nursing practice

2 To provide the client with correct, unbiased information Nurses who counsel clients regarding abortion should know what services are available and the various methods that are used to induce abortion. Nurses who cannot control their negative feelings regarding abortion should not counsel women who are thinking of undergoing the procedure. Nursing practice necessitates knowledge of research results; statements must be based on fact, not personal feelings or beliefs. The nurse should give the client only the information requested, not state personal feelings. The nurse is responsible for giving information about abortion and need not defer to the primary healthcare provider.

At 38 weeks' gestation a client is admitted to the birthing unit in active labor, and an external fetal monitor is applied. Late fetal heart rate decelerations begin to appear when her cervix is dilated 6 cm, and her contractions are occurring every 4 minutes and lasting 45 seconds. What is the likely cause of these late decelerations? 1 Imminent vaginal birth 2 Uteroplacental insufficiency 3 Pattern of nonprogressive labor 4 Reassuring response to contractions

2 Uteroplacental insufficiency Late decelerations are indicative of uteroplacental insufficiency and, left uncorrected, lead to fetal hypoxia, fetal myocardial depression, or both. The imminence of birth cannot be determined from fetal heart rate decelerations, only from cervical dilation. Birth occurs after the cervix has dilated to 10 cm and the fetus has passed through the birth canal. Nonprogressive labor cannot be determined from fetal heart rate decelerations, only from cervical dilation. Late decelerations are not expected, are not reassuring, and must not be ignored.

A laboring client expresses concern about the effect that an intravenous analgesic may have on her fetus. What is the best response by the nurse to reassure the client? 1 "I'll dilute the medication so it won't have an immediate impact on the baby." 2 "I'll just give a half-dose of the medication while the uterus is in its relaxed phase." 3 "It will be administered during a contraction, when the uterine blood vessels are constricted." 4 "It will be administered in the proximal port of your IV so that you have immediate pain relief."

3 "It will be administered during a contraction, when the uterine blood vessels are constricted." Giving the medication during a contraction, when the uterine vessels are constricted, keeps the medication within the maternal vascular system for several seconds and decreases the impact on the fetus. The other options are incorrect because none of these responses involves administration during a contraction.

A woman visits the clinic because she has dysmenorrhea. Which goal is most realistic for this client to achieve? 1 Reducing the pad saturation rate 2 Making intercourse less uncomfortable 3 Easing the pain of the client's menstruation 4 Eliminating bleeding between menstrual periods

3 Easing the pain of the client's menstruation Dysmenorrhea is painful menstruation; the goal of care is making menstruation less painful. The other options are appropriate for a client who is experiencing excessive menstrual flow (menorrhagia) or dyspareunia (painful intercourse). Bleeding between menstrual periods would require further investigational work-up.

The nurse teaches a client who is about to undergo an amniocentesis that ultrasonography will be performed just before the procedure to determine what? 1 Gestational age of the fetus 2 Amount of fluid in the amniotic sac 3 Position of the fetus and the placenta 4 Location of the umbilical cord and placenta

3 Position of the fetus and the placenta The position of the fetus and placenta is located by means of ultrasonography to assist in preventing trauma from the needle during the amniocentesis. Although ultrasonography can be used to determine gestational age, this is not its purpose before an amniocentesis. Determining the amount of fluid in the amniotic sac is not the purpose of ultrasonography just before an amniocentesis. The position of the placenta and fetus, not just the cord and the placenta, is needed for safe introduction of the needle.

While caring for a client in labor, the nurse notes that during a contraction there is a 15-beat-per-minute acceleration of the fetal heart rate above the baseline. What is the nurse's most appropriate action at his time? 1 Call the practitioner to prepare for an imminent birth. 2 Turn the mother on her left side to increase venous return. 3 Record the fetal response to contractions and continue to monitor the heart rate. 4 Document the fetal heart rate abnormality and monitor the fetal heart rate continuously.

3 Record the fetal response to contractions and continue to monitor the heart rate. Periodic accelerations are the most reassuring of fetal heart rate indicators, regardless of the cause. This increase in the fetal heart rate does not require intervention by the practitioner at this time. Turning the mother on her left side to increase venous return is done when a fetal heart rate deceleration occurs. This is not a fetal heart rate abnormality and does not require a specific amount of time for observation; if the interventions are effective, monitoring should continue as before.

A woman visits the clinic for an annual physical examination, and herpes genitalis is diagnosed. The client asks how the disease can be diagnosed without any tests. What is the nurse's best response? 1 "There's a sore in your vagina." 2 "There's a rash near your vagina." 3 "You have a typical discharge from your vagina." 4 "You have blisters on the skin around your vagina."

4 "You have blisters on the skin around your vagina." Herpes genitalis is characterized by a cluster of vesicles, not one lesion, a rash, or vaginal discharge. The characteristic sign of herpes genitalis is a cluster of vesicles (blisters) on the vulva, perineum, vagina, cervix, and/or perianal area. These rupture spontaneously, leaving painful erosions.

A nurse is observing the electronic fetal monitor as a client in labor enters the second stage. The nurse identifies early decelerations of the fetal heart rate with a return to the baseline at the end of each contraction. What does this fetal heart rate pattern usually indicate? 1 Maternal diabetes 2 Fetal cord prolapse 3 Maternal hypotension 4 Fetal head compression

4 Fetal head compression Early decelerations are expected occurrences as the fetal head passes through the birth canal; the fetal heart rate returns to baseline quickly, indicating fetal well-being. The data do not indicate that the mother has diabetes. Variable decelerations occur with umbilical cord compression, not prolapse. Maternal hypotension will cause late decelerations because of fetal hypoxia.

A nurse at the fertility clinic is counseling a couple about the tests that will be necessary in order to determine the cause of their infertility. Which test will most likely be used to evaluate the woman's organs of reproduction? 1 Biopsy 2 Cystogram 3 Culdoscopy 4 Hysterosalpingogram

4 Hysterosalpingogram A hysterosalpingogram enables the examiner to visualize the uterus and fallopian tubes and the pelvic organs of reproduction. A biopsy is the surgical excision of tissue for diagnostic purposes. A cystogram is used to visualize the urinary bladder. Culdoscopy is the direct examination of female pelvic viscera with the use of an endoscope introduced through a perforation in the vagina.

What is the priority nursing care immediately after an amniocentesis? 1 Giving perineal care after the procedure 2 Encouraging lots of fluids every hour 3 Changing the abdominal dressing 4 Monitoring for signs of uterine contractions

4 Monitoring for signs of uterine contractions It is possible that stimulation of the uterus resulting from the amniocentesis will initiate uterine contractions. Perineal care is not necessary, because an amniocentesis is not done by way of the vagina. Encouraging fluids every hour is irrelevant, because the amount of amniotic fluid is not influenced by fluid ingestion. Changing the abdominal dressing is not necessary, because the needlestick site seals immediately.

A nurse is providing discharge instructions to a client who has had an aspiration abortion by suction curettage. Which postprocedure instruction is most important for the nurse to give the client? 1 Avoid showering for 2 days. 2 Postpone tampon use for 1 or 2 days. 3 Wait 3 weeks until engaging in sexual intercourse. 4 Report any bleeding that requires a pad change every 2 hours.

4 Report any bleeding that requires a pad change every 2 hours. Excessive bleeding should be reported because it is an indication that all of the products of conception have not been evacuated. The client may shower daily. Tampons should be avoided for at least 3 days, although some protocols stress avoidance of tampons for 3 weeks. Depending on the protocol, sexual intercourse should be avoided for at least 1 week and up to 2 weeks.

The nurse is interviewing a 41-year-old woman who is being seen in the infertility clinic for her first visit. She and her husband have been married for 3 years and have not used any form of contraception during this time. Neither the woman nor her husband has children from previous relationships. She asks the nurse what test or treatment will be done first. What should the nurse inform her that she and her husband should expect? 1 A laparoscopy 2 The start of fertility medication 3 A hysteroscopy 4 Semen analysis

4 Semen analysis Semen analysis is painless, is less costly than other interventions, and provides important information regarding the male partner's fertility. Fertility medication would not be initiated until an evaluation of ovulatory function had been completed. Simpler evaluations and therapies are completed before more complex efforts such as surgical procedures like laparoscopy and hysteroscopy are performed.

The nurse is interpreting the results of a nonstress test (NST) on a client at 41 weeks' gestation. Which result after 20 minutes is suggestive of fetal reactivity? 1 Absence of long-term variability 2 Above-average fetal baseline heart rate of 160 beats/min 3 No late decelerations associated with contractions 4 Two accelerations of 15 beats/min lasting 15 seconds

4 Two accelerations of 15 beats/min lasting 15 seconds According to the American Congress of Obstetricians and Gynecologists, fetal reactivity is a fetal tracing 15 beats' acceleration above baseline lasting 15 seconds or more, normal baseline rate, and long-term variability amplitude of 10 or more beats/min. An absence of long-term variability is an ominous sign that must be addressed. An above-average baseline heart rate is acceptable up to 160 beats/min. An increasing baseline heart rate is a sign of maternal infection. Contractions are not expected with a nonstress test; early, late, or variable fetal heart rate decelerations are associated with uterine contractions.