OB unit 2 skills questions

3. The nurse teaches the family about using a bulb syringe on their newborn. Which statement indicates that the family requires further instruction?

A. "I need to clean the bulb syringe about once a week."

2. The electronic fetal monitor ultrasound transducer and tocotransducer have been applied to a patient at 37 weeks' gestation. The nurse in charge of the patient's care is instructing a new nurse about the NST. Which is the most accurate characterization of a reactive NST at this gestational age?

A. Presence of two FHR accelerations measuring at least 15 bpm and lasting at least 15 seconds within a 20-minute segment

Organization guidelines state that the nurse should perform the NBS assessment on a newborn during the general assessment. During a general assessment of a term newborn, the nurse notices that he is crying and frequently sucking his fists. What is the appropriate nursing action?

A. The nurse should facilitate a feeding for the newborn and perform the NBS assessment later.

A healthy baby boy is born at 39 weeks' gestation. The nurse notices bleeding from the umbilical cord site. When would the nurse expect to see signs of early VKDB?

A. Within the first 24 hours

10. An infant has been diagnosed with early VKDB. Which medications are associated with this condition?

Anticoagulants

A 17-year-old primigravida is admitted in early labor. Her cervix is 2 to 3 cm dilated and 100% effaced. The fetus is cephalic, and the presenting part is at -1 station. The patient's membranes are intact. The patient is holding her boyfriend's hand tightly and breathing rapidly with each contraction. She tells the nurse in a shaky voice, "I'm so nervous. I've never been in a hospital before. I don't know anything about labor or if I can do this." What is an appropriate nursing diagnosis for this patient?

Anxiety related to unfamiliar environment and lack of birth preparation

1. While caring for a 30-hour-old term newborn, the nurse notices the sclerae are yellow-tinged. What should the nurse do next?

B. Assess for other areas of jaundice and report to the practitioner.

A multiparous patient has been laboring for 2 hours. On her last vaginal examination, the nurse found the patient's cervix to be dilated 6 cm and 90% effaced with the fetal head presenting at +1 station. The patient refused IV pain medication as well as an epidural anesthetic, stating, "I did it without anything with my other baby." Now the patient reports an occasional urge to push and requests pain medication in her IV line. With the next contraction, the patient cries out, "I feel like I need to have a bowel movement." What should the nurse do at this time?

B. Check the perineum and perform a sterile vaginal examination.

1. How should the neonate be positioned for a heel stick?

B. Supine, foot in a dependent position

1. The nurse is called to the delivery room of a neonate born at 25 weeks' gestation. Weighing less than 1 kg (2.2 lb), the neonate is floppy with poor respiratory effort and a heart rate of 50 bpm despite 30 seconds of PPV via bag and mask. What is the nurse's next appropriate action?

Begin chest compressions.

1. While completing the initial cord assessment after a newborn's delivery, the nurse finds two vessels in the cord. What may this finding indicate?

Congenital abnormalities

A breastfeeding infant shows signs of late-onset VKDB. Which bleeding site is at high risk in infants with this condition?

D. Cranium

A nurse is teaching a new mother how to use the bulb syringe properly. During the procedure, the newborn vomits. To avoid complications related to using the bulb syringe, what should the nurse tell the mother?

Insert the bulb syringe tip into the side of the oral cavity toward the secretions

7. When administering vitamin K, the nurse should avoid which action?

Massaging the area

5. The nurse is documenting the newborn's response to bulb suctioning. What should the nurse document?

The newborn's color and respiratory rate before and after suctioning

2. A nurse who is new to the unit is about to administer vitamin K IM to a newborn and is not sure which site to choose for injection. Which site would the senior nurse advise the new nurse to use?

Vastus lateralis muscle

3. A nurse performing cord care notices that the cord is oozing purulent fluid from the reddened base. Which is the most accurate indication for this finding?

infection

3. A mother requests to hold her neonate during a heel stick. How should the nurse respond?

Propose skin-to-skin contact during the procedure.

The nurse is preparing a patient for an NST. The patient states that she prefers to lie flat on her back. The nurse knows that which position is best?

Semi-Fowler with lateral tilt

A patient is being admitted for early labor at 40 weeks' gestation. She is gravida 2, para 1. When asked if she is leaking fluid or having bloody show, the patient mentions having had a gush of fluid about 2 hours ago. What important question does the nurse then ask the patient?

"Did you notice what color the fluid was?"

A 32-year-old pregnant patient is being admitted to the labor and delivery unit. She is gravida 4, para 2, and at 39 weeks' gestation. While auscultating the lung and heart sounds, the nurse notices a thin, yellowish discharge from the patient's right nipple. The patient also notices it and comments, "I don't know what that is, but I have noticed it for the last couple of months." What is the best way for the nurse to respond?

"It is most likely colostrum, indicating your breasts are getting ready for the baby."

1. A laboring gravida 2, para 1 is being cared for on the family birth unit. Her cervix is currently 5 cm dilated and 100% effaced. The fetus is at -2 station and cephalic in a left occiput anterior position. The patient calls the nurse to the room and reports a large gush of fluid with her most recent contraction. The nurse assesses that the patient's membranes are ruptured and that the amniotic fluid is green and watery. What is the most important nursing intervention at this time?

Assess FHR to check for any change in baseline or any abnormal patterns.

4. The nurse is preparing to administer a vitamin K injection IM to a newborn. During the procedure, what is the most appropriate comfort measure for the newborn?

B. Asking the mother to breastfeed the newborn while the nurse administers the injection

5. The nurse is caring for a patient with increasing vaginal bleeding and observes that the fundus is boggy, high, and displaced to the right of the umbilicus. What is the most likely cause of the bleeding?

B. Full bladder

A woman who is a gravida 5 para 4 at 38 weeks' gestation arrives at the labor and delivery unit in active labor. The nurse performs a sterile vaginal examination and determines that the patient's cervix is dilated to 8 cm. The patient has no IV access at the time of delivery. The nurse recognizes that the patient has an increased risk of postpartum hemorrhage because of her multiparity. Which of the following doses of oxytocin is most commonly used to prevent postpartum hemorrhage?

C. 10 units of oxytocin for IM injection

5. The nurse is caring for a 3-day-old term newborn who was born by cesarean delivery after a failed oxytocin induction. The mother, age 40, is of Chinese descent. The nurse notes that the sclera of the newborn's eyes are yellow-tinged. How should the nurse respond?

C. Assess for other areas of jaundice, get a TcB reading, and report the findings to the practitioner.

4. After completely removing the bulb syringe tip from the newborn's mouth and cleaning the bulb syringe, why does the nurse place it in the newborn's crib in a clean, dry area?

C. It allows for emergency access to the bulb syringe and prevents the possibility of cross-contamination from other surfaces or newborns.

3. A woman arrives at the hospital in active labor saying she's approximately 7 months pregnant and has had no prenatal care. She denies drug and alcohol use. The neonate is delivered before laboratory work can be obtained. The neonate appears to be at approximately 30 weeks' gestation and is floppy with poor respiratory effort and a heart rate greater than 90 bpm. What is the best course of action?

C. Provide PPV if the neonate is still unresponsive after drying and stimulation.

4. The orienting nurse asks a new nurse what types of vessels to look for when assessing the umbilical cord. Which of the following statements is most accurate?

C. Two arteries and one vein

5. The nurse caring for a neonate in a double-walled incubator finds that the neonate's temperature is 37.5°C (99.5°F). Two hours earlier, the temperature was 36.5°C (97.7°F). The incubator is in servo control with the skin temperature set to 36.5°C (97.7°F). What should the nurse do immediately?

Check to see whether the skin probe is properly secured to the neonate.

5. The nurse attends the delivery of a neonate born at 32 weeks' gestation. The neonate was dried, stimulated, and positioned. Spontaneous respirations of 44 per minute and a heart rate of 132 bpm are noted at 30 seconds of life. A pulse oximetry probe is placed on the right wrist. The initial saturation is 48%, and the nurse provides blow-by oxygen with 40% FIO2. The saturations do not improve, so what is the nurse's next course of action?

D. Continue to assess respirations and perfusion, and increase FIO2 to 100%.

7. Two hours after delivery, a premature neonate remains on a radiant warmer. During this time, an endotracheal tube and umbilical catheters have been placed. The neonate's vital signs are stable. Why should the nurse prepare to move the neonate to a double-walled incubator?

D. Double-walled incubators decrease insensible water loss and radiant and convection heat loss.

2. A mother asks how to diaper her newborn while the umbilical cord is still attached. Which statement is most accurate?

D. Make sure the diaper is folded below the cord until the cord falls off.

1. A primigravida is concerned that an NST will harm her fetus. She asks the nurse about the advantages of the NST over other methods of evaluating fetal well-being. Which response is the most appropriate?

D. NST is noninvasive, has no adverse effects on the mother or fetus, and has no contraindications.

4. While performing an NBS assessment, the nurse notices that the newborn's skin displays characteristics listed in two boxes on the NBS tool. How should the nurse determine the appropriate score?

D. Use critical thinking to determine the appropriate score based on the nurse's observations.

4. A neonate has reached a corrected gestational age and weight at which he can be weaned from an incubator to an open crib. The incubator is at room temperature, and the neonate is dressed in a hat and sleeper. Before moving the neonate to an open crib, what should the nurse do?

D. Wrap the neonate in a blanket.

A neonate is admitted to the nursery with an axillary temperature of 35.8°C (96.4°F). One of the nurse's first interventions should be to check the neonate for a low blood glucose level. Why is the nurse concerned about hypoglycemia?

Glucose is needed for heat production.

6. After obtaining blood from a neonate, the nurse notes that the puncture site is still bleeding. What must the nurse do?

D. Provide gentle pressure until the bleeding stops

2. After surfactant administration, what is the nurse's appropriate course of action?

C. Continue to monitor respiratory status and anticipate the weaning of ventilator support.

5. A newly hired nurse who is assessing GA for the first time asks the preceptor whether intervention is necessary when the newborn's NBS is low. In which circumstance is the NBS tool not useful in guiding care for the newborn?

C. Determining whether the newborn requires invasive respiratory support such as intubation

4. A patient asks why the nurse performing the NST is using a vibroacoustic stimulator. The nurse explains that using the stimulator while watching the fetal monitor and palpating the patient's abdomen aids assessment. The nurse is trying to elicit which finding?

C. FHR accelerations and an increase in fetal movements

2. When determining the need for suctioning a newborn with a bulb syringe, what is important for the nurse to know?

Suctioning immediately after birth with a bulb syringe should be considered only if the airway appears obstructed.

4. The nurse is requested to assist at the delivery of a 24-weeks' gestation neonate. The neonate has not responded to resuscitation efforts so far and is being given chest compressions when the father arrives on the scene. How should the nurse proceed?

. Allow the father to stay and watch the resuscitation efforts and support him.

2. A 1-week-old neonate needs a bilirubin level assessment. The nurse examines the neonate's feet and notes lancet marks on both the medial and lateral aspects of the left heel. Where should the nurse draw blood from the neonate?

. Right heel

5. A patient is receiving oxytocin for induction of labor with an initial infusion rate of 2 milliunits/min and a titration rate of 2 milliunits/min every 30 minutes. The FHR tracing indicates a Category I FHR tracing with uterine tachysystole. Despite implementation of interventions that include repositioning the patient to a lateral position and administering an IV fluid bolus, the tachysystole continues. A Category II FHR tracing is then observed. The nurse discontinues the oxytocin, which was infusing at 12 milliunits/min. After the infusion has been discontinued for 20 minutes, the tachysystole has resolved and the fetal monitor tracing indicates adequate fetal oxygenation. At which rate should the nurse restart the oxytocin infusion?

6 milliunits/min

4. A 5-day-old neonate is crying during a heel stick procedure performed to check blood glucose. The mother insists that the nurse hurry up and do the heel stick, but the antiseptic is not dry. What should the nurse tell the mother?

A. "The antiseptic doesn't work well unless it dries."

6. Which statement indicates that the parents of a premature neonate need additional education regarding an incubator?

A. "The baby looks so cute in her own little house! How do I get her out?"

3. The nurse has received an order from the practitioner to begin labor augmentation with IV oxytocin on a patient at 39 weeks' gestation. The pharmacy notifies the nurse that no premixed bags are available and it will be approximately 30 minutes for the premixed solution to arrive on the unit. What is the most appropriate nursing action?

A. Alert the practitioner that the oxytocin infusion is being held until the pharmacy delivers the solution to the unit.

6. The nurse is assisting in the intubation of a neonate born at 28 weeks' gestation. Bilateral breath sounds have not yet been adequately assessed. A carbon dioxide detector is used but is not changing color to indicate the presence of carbon dioxide. What should the nurse do next?

A. Assess chest wall movement and administer several breaths.

A primigravida at 40 weeks' gestation is admitted to the labor unit in latent labor. Her prenatal history does not indicate any risk factors. Her initial vital signs are temperature of 37.1°C (98.8°F); pulse, 86 bpm; respirations, 20; and blood pressure, 114/68 mm Hg. She has been connected to external electronic monitoring for 1 hour. FHR baseline is 145 with moderate variability, the presence of accelerations, and absence of decelerations. She is having contractions every 3 to 4 minutes, each lasting 40 to 60 seconds, mild to palpation, and with soft resting tone. What is an appropriate nursing intervention at this point?

A. Encourage the patient to ambulate within the labor unit.

3. The nurse is caring for a full-term newborn who was delivered vaginally and has a cephalohematoma. The newborn, who is breastfed, has O-positive blood and the mother has O-negative blood. Based on this history, what is the newborn's risk of hyperbilirubinemia?

A. High risk because of the presence of multiple risk factors

When teaching the mother to care for the infant's cord, which intervention is key to preventing infection?

A. Keeping it clean and dry

1. Which statement regarding newborns receiving vitamin K immediately after birth is most accurate?

A. Newborns' GI systems are sterile, resulting in a lack of vitamin K production.

8. Before assessing a neonate, why does the nurse warm the hands and any equipment that will be used?

Any object that comes into contact with the neonate's skin could contribute to heat loss through conduction.

After the nurse administers an injection of vitamin K to a newborn, what is the most appropriate nursing action?

Applying pressure to the injection site with a gauze pad

While assessing an antepartum patient, the nurse hears a loud moan coming from the hallway. The nurse steps outside the room and sees a pregnant patient arriving on a stretcher accompanied by a nurse from the emergency department. What is the first priority for the nurse from the labor and delivery department?

Assess if delivery is imminent.

5. A patient at 38 weeks' gestation is excited to hear her fetus' heartbeat. She asks what the patterns on the monitor tracing mean and whether a heart rate of 140 bpm is normal. The best response would include which indicators of adequate fetal oxygenation separate from the reactive NST?

B. FHR baseline between 110 and 160 bpm and moderate variability or fluctuations in the FHR over time

5. A 5-day-old neonate with jaundice needs a bilirubin sample drawn. Even after the nurse applies a warm pack to both feet, the blood from the heel puncture does not flow freely. Why does the nurse decide to obtain the blood from a venipuncture instead of milking the foot for blood?

B. Milking may increase hemolysis, causing falsely elevated bilirubin levels.

1. The nurse is preparing to care for a neonate who has just been born at 28 weeks' gestation. Why does the nurse institute preventive measures to maintain a neutral thermal environment and place the incubator away from drafts and open doors?

B. Premature neonates have less brown fat with which to maintain body temperature.

The nurse is caring for a term newborn, 18 hours old, who presents with a TcB level of 7.4 mg/dl and is lethargic. How should the nurse respond?

B. Recognize that these signs are abnormal and notify the practitioner.

3. The nurse is assessing scarf sign on a premature newborn and notices that she is not breathing. The cardiac monitor indicates 83% oxygen saturation and a heart rate of 62 bpm. How should the nurse respond?

B. Stop the assessment immediately, resuscitate the newborn, and resume the assessment later.

2. The practitioner has ordered phototherapy using two halogen lamps for a term newborn. The bilirubin meter reading is less than the practitioner ordered, even with new bulbs. Which nursing intervention should occur next?

D. Notify the practitioner that the desired irradiance level is not obtainable with the current phototherapy order.

1. The nurse admits a patient to the labor and delivery unit for induction of labor. The patient is at 37 weeks' gestation and has preeclampsia. The last ultrasound showed some fetal growth restriction. The patient's current vital signs are blood pressure 167/101 mm Hg, pulse 96 bpm, respirations 20 breaths/min, and temperature 36.4°C (97.5°F). She denies feeling contractions or having pain. The practitioner has written orders to begin labor induction with oxytocin. What should the nurse do before initiating the oxytocin infusion?

D. Obtain a 30-minute fetal monitor tracing of the FHR and contraction patterns.

5. When monitoring preterm newborns during phototherapy, what should the nurse keep in mind?

D. Preterm newborns are more prone to dehydration during phototherapy than term newborns.

3. The nurse gives discharge instructions about jaundice to a newborn's family. Which statement by the mother indicates that more instruction is necessary?

C. "I'll be sure to give my baby some extra sips of water during the day, so he'll make plenty of wet diapers."

4. A nurse determines that a term newborn who is 36 hours old falls below the 40th percentile on the Bhutani curve with a TcB level of 6 mg/dl. The nurse also finds jaundice on the newborn's forehead and nose. The practitioner has written discharge orders, and the newborn has a follow-up appointment with the pediatric practitioner in 2 days. What is the appropriate nursing intervention for this newborn?

C. Discharge the newborn and instruct the parents to keep the early follow-up appointment with the pediatric practitioner.

A neonate of 26 weeks' gestation is about to be delivered. How should the nurse prepare to limit heat loss for the neonate?

C. Get a polyethylene bag to place over the neonate's body.

5. A 2-day-old newborn begins bleeding profusely from the circumcision site. The nurse applies pressure to the site and notes that the newborn did not receive vitamin K at birth because the mother refused. The nurse reviews the newborn's record. Which risk factor is associated with classic-onset VKDB?

C. Inadequate formula or breast milk intake

2. While assessing the popliteal angle on a newborn delivered in the breech position, the nurse notices that the foot can almost touch the newborn's face. How should the nurse record this finding?

C. Normal: Record the score as depicted by the stick figures on the NBS tool.

2. A nurse is caring for a patient who has been receiving an oxytocin infusion for labor induction. The infusion was initiated approximately 8 hours ago and is currently infusing at 20 milliunits/min. While assessing the patient, the nurse observes a Category I FHR tracing with a contraction pattern of six contractions in the last 10 minutes. Which of these nursing interventions should come first?

C. Place the patient in a lateral position.

2. The nurse is caring for a postpartum patient with severe preeclampsia who received magnesium sulfate during labor. While performing an assessment 60 minutes after the vaginal delivery, the nurse observes that the patient's fundus is firm, but her bleeding has increased and is now a constant bright red flow. The nurse massages the patient's fundus and attempts to express clots but observes that there are none. The patient appears lethargic and diaphoretic, and her heart rate is 135 bpm. The nurse also notices some bleeding around the patient's IV site. Which maternal condition should the nurse suspect?

DIC

3. The nurse is caring for a patient with a suspected postpartum hemorrhage. What is the nurse's next step?

D. Initiate the postpartum hemorrhage protocol and call for help.

2. A 28-week preterm newborn has been under phototherapy for 12 hours for an earlier sternal TcB reading of 8 mg/dl. The present sternal TcB reading is 3 mg/dl. What is the significance of this reading?

D. It is unreliable because the newborn's sternum has been exposed to phototherapy.

4. A normothermic term newborn has been on a radiant warmer under two bank lights for about 3 hours. Now the nurse notices that the newborn's axillary temperature is 37.6°C (99.7°F). Which nursing intervention is most appropriate?

Decrease the skin temperature setting on the radiant warmer by 0.2°C (0.36°F) and recheck the newborn's temperature in an hour.

A patient delivered her first child 3 years ago. A year later she had a spontaneous abortion at 12 weeks' gestation. She presents to the antepartum unit at 38 weeks' gestation reporting rupture of membranes 1 hour ago, but she is not having contractions. What is the nurse's calculation of the patient's gravidity and parity?

Gravida 3, para 1

A patient remains in the labor and delivery unit after a forceps delivery of a 10-lb, 8-oz healthy newborn. Thirty minutes after delivery, the patient is reporting severe perineal pain and pressure despite having an epidural. Her vital signs are normal except for a heart rate of 122 bpm. What is the first thing the nurse should assess for?

Hematoma

The nurse has assisted a laboring patient through delivery and is informing her that a postpartum nurse will now care for her. The patient thanks the nurse for all her help and says, "That was a much better experience than I had hoped." Why is it is important that the patient perceive her birth experience as positive?

Patients who perceive their birth experience as negative are at higher risk for postpartum depression.

A 22-year-old African-American patient is being admitted to the labor unit for induction of labor. She is gravida 1, para 0, and currently at 40 5/7 weeks' gestation. She is 150 cm (4 ft 11 in) tall and weighs 50 kg (110 lb). She admits to smoking two or three cigarettes per day but denies use of alcohol or illegal substances. Her prenatal laboratory tests show a hemoglobin level of 10 gm/dl and a hematocrit level of 30.6%. Her blood type is O negative, and the serologic test for syphilis is nonreactive. Other than coming to the unit for outpatient nonstress tests twice over the past week, she has not been hospitalized during this pregnancy. The FHR today is 100 bpm with an irregular rhythm; there are late decelerations. The patient's blood pressure is 144/86; pulse, 88 bpm; respirations, 16 per minute; and temperature, 36.8°C (98.2°F). The patient denies having pain. Which cluster of factors indicates an increased risk for this patient and her fetus?

Nonwhite race, height, smoking, anemia, category II (indeterminate) FHR characteristics, and elevated blood pressure

6. A 40-year-old gravida 3, para 2 has received an epidural anesthetic for pain management during labor. Her cervix is 8 cm dilated and 100% effaced. She rates her pain as 8 on a scale of 0 to 10. She is able to talk through her contractions without grimacing and is dozing between contractions. She asks the nurse, "Why isn't my epidural working? I didn't feel anything with my other babies." Which of the following explanations would be appropriate for the nurse to relay to the patient?

Previous birth experiences may affect a patient's perception and expectations of the current labor process.

4. The laboring patient has progressed to 5 cm dilation, and the fetal presenting part is at +1 station. The patient is experiencing contractions every 3 minutes, lasting 60 to 90 seconds, and palpating moderate to strong with soft resting tone. The FHR pattern demonstrates normal characteristics indicative of fetal well-being. The patient is having difficulty relaxing between contractions and reports low back pain. She further states that changing her position is not alleviating the discomfort. The patient and nurse have discussed pain management for labor, and the patient verbalized a desire to labor without epidural anesthesia or analgesia. What is the most appropriate nursing intervention for pain management at this time?

Provide, or instruct the support person to provide, counterpressure to the sacral area during contractions.

A patient is admitted to the labor and delivery unit. The fetal monitor is applied, and the patient moves into a supine position for the assessment. During the examination, the nurse notes that the FHR is 124 bpm with moderate variability and that the patient's fundus is soft on palpation. Vital signs reveal blood pressure of 86/40, pulse of 96 bpm, respiratory rate of 20 per minute, and temperature of 36.8°C (98.2°F). After a few minutes of monitoring, the nurse notices that the FHR variability is minimal. What should the nurse do first?

Reposition the patient so that she is not supine.

During the labor admission assessment, the nurse asks the patient if she has used illegal drugs or herbal preparations. The patient glances at her family members and then quickly denies using anything illegal. The patient becomes quiet, responding to the nurse's questions with short answers. She begins to appear tense. What does this behavior tell the nurse?

Sensitive questions should be asked while the patient is alone.

4. A patient is experiencing postpartum hemorrhage 2 hours after a vaginal delivery. The nurse notices blood clots on the patient's perineal pad and a 1200-ml QBL after weighing her perineal pads and underpads. The practitioner has ordered blood products; however, the situation becomes critical very rapidly as the patient becomes hypotensive with a blood pressure of 80/40, diaphoretic, and pale. Which condition should the nurse suspect?

Severe hypovolemia

6. A student nurse is asking about a 3-day-old newborn's ability to produce vitamin K. By what age can healthy newborns produce their own vitamin K?

1 week