purple book OB questions

78. A client has just been transferred to the postpartum unit from labor and delivery. Which of the following nursing care goals is of highest priority?

3. The client will have a moderate lochial flow.--> the is most important goal during the immediate post-delivery period

41. A client, G1 P1001, 1 hour postpartum from a spontaneous vaginal delivery with local anesthesia, states that she needs to urinate. Which of the following actions by the nurse is appropriate at this time?

4. Assist the woman to the bathroom.

15. A breastfeeding woman, 1 1/2 months postdelivery, calls the nurse in the obstetrician's office and states, "I am very embarrassed but I need help. Last night I had an orgasm when my husband and I were making love. You should have seen the milk. We were both soaking wet. What is wrong with me?" The nurse should base the response to the client on which of the following?

2. The same hormone stimulates orgasms and the milk ejection reflex.--> oxytocin stimulates sexual organism and is also the hormone that stimulates the milk ejection reflex

13. A breastfeeding mother states that she has sore nipples. In response to the complaint, the nurse assists with "latch on" and recommends that the mother do which of the following?

3. Rotate the baby's positions at each feed.--> rotating positions at feedings is one action that can help to minimize the severity of sore nipples

79. A client has just been transferred to the postpartum unit from labor and delivery. Which of the following tasks should the registered nurse delegate to the nursing care assistant?

3. Take the client's vital signs.--> this action can be delegated to a nursing assistant. once the vital signs are checked , the nursing assistant can report the results to the nurse for his or her interpretation

40. The nurse is developing a standard care plan for postpartum clients who have had midline episiotomies. Which of the following interventions should be included in the plan?

3. Teach client to contract her buttocks before sitting.--> when clients contract their buttocks before sitting, they usually fell less pain that when they sit directly on the suture line

72. The nurse should warn a client who is about to receive Methergine (ergonovine) of which of the following side effects?

3. Cramping.--> cramping is an expected outcome of administration of Methergine

32. A postoperative cesarean section woman is to receive morphine 4 mg q 3-4 h subcutaneously for pain. The morphine is available on the unit in premeasured syringes 10 mg/1 mL. Each time the nurse administers the medication, how many milliliters (mL) of morphine will be wasted? Calculate to the nearest tenth.

0.6 mL

82.The nurse must initiate discharge teaching with the couple regarding the need for an infant car seat for the day of discharge. Which of the following responses indicates that the nurse acted appropriately? The nurse discussed the need with the couple:

1. On admission to the labor room.--> discharge teaching should be initiated at the time admission. this nurse is correct in initiation the process in the labor room .

87. During a postpartum assessment, the nurse assesses the calves of a client's legs. The nurse is checking for which of the following signs/symptoms? Select all that apply.

1. Pain.---> the nurse would assess for pain 2. Warmth.--> the nurse would assess for warmth 5. Redness.---> the nurse would assess for redness

76. A client who delivered a 3,900-gram baby vaginally over a right mediolateral episiotomy states, "How am I supposed to have a bowel movement? The stitches are right there!" Which of the following is the best response by the nurse?

1. "I will call the doctor to order a stool softener for you." 2. "Your stitches are actually far away from your rectal area."--> a right mediolateral episiotomy is angles away form the perineum and rectum

68. The nurse is caring for a Seventh Day Adventist woman who delivered a baby boy by cesarean section. Which of the following questions should be asked regarding this woman's care?

1. "Would you like me to order a vegetarian clear liquid diet for you?"--> seventh day Adventist usually follow vegetarian diets

28. The nurse is caring for a postpartum client who experienced a second-degree perineal laceration at delivery 2 hours ago. Which of the following interventions should the nurse perform at this time?

1. Apply an ice pack to the perineum.--> it is appropriate to apply an ice pack to the area

26. A breastfeeding client, G10 P6408, delivered 10 minutes ago. Which of the following assessments is most important for the nurse to perform at this time?

2. Fundus--> an assessment of the woman's fundus is the most important assessment to perform on this client

59. Which of the following nursing interventions would be appropriate for the nurse to perform to achieve the client care goal: The client will not develop postpartum thrombophlebitis?

1. Encourage early ambulation.--> early ambulation does help to prevent thrombophlebitis

5. A 3-day-postpartum breastfeeding woman is being assessed. Her breasts are firm and warm to the touch. When asked when she last fed the baby her reply is, "I fed the baby last evening. I let the nurses feed him in the nursery last night. I needed to rest." Which of the following actions should the nurse take at this time?

1. Encourage the woman exclusively to breastfeed her baby.--> client should be strongly encouraged exclusively to breastfeed their babies to prevent engorgement

10. The nurse in the obstetric clinic received a telephone call from a bottle-feeding mother of a 3-day-old. The client states that her breasts are firm, red, and warm to the touch. Which of the following is the best action for the nurse to advise the client to perform?

1. Intermittently apply ice packs to her axillae and breasts.--> the client should apply ice packs to her axillae and breast

85. The surgeon has removed the surgical cesarean section dressing from a post-op day 1 client. Which of the following actions by the nurse is appropriate?

1. Irrigate the incision twice daily. 2. Monitor the incision for drainage.--> the nurse should assess for all signs on the REEDA scale

56. Which of the following is the priority nursing action during the immediate postpartum period?

1. Palpate fundus.--> fundal assessment is the priority nursing action

86. A nurse is performing a postpartum assessment on a newly delivered client. Which of the following actions will the nurse perform? Select all that apply.

1. Palpate the breasts.--> the nurse should palpate the breast to assess for fullness and/or engorgement 3. Check vaginal discharge.--> the nurse should check the clients vaginal discharge 4. Assess the extremities.--> the nurse should assess the client extremities 5. Inspect the perineum.--> the nurse should inspect the clients perineum

57. Immediately after delivery, a woman is shaking uncontrollably. Which of the following nursing actions is most appropriate?.

1. Provide the woman with warm blankets.--> appropriate action is to provide the client with warm blankets

69. An Asian client's temperature 10 hours after delivery is 100.2°F, but when encouraged she refuses to drink her ice water. Which of the following nursing actions is most appropriate?

1. Replace the ice water with hot water.--> Asians many of whom believe in the hot-cold theory of disease, will often not drink cold fluids or eat cold foods during the postpartum period

34. A client is receiving an epidural infusion of a narcotic for pain relief after a cesarean section. The nurse would report to the anesthesiologist if which of the following were assessed?

1. Respiratory rate 8 rpm --> this client respiratory rate is below normal

16. A client who is 3 days postpartum asks the nurse, "When may my husband and I begin having sexual relations again?" The nurse should encourage the couple to wait until after which of the following has occurred?

1. The client has had her six-week postpartum checkup.--> the couple is encouraged to wait until after involution is complete

55. During a postpartum assessment, it is noted that a G1 P1001 woman, who delivered vaginally over an intact perineum, has a cluster of hemorrhoids. Which of the following would be appropriate for the nurse to include in the woman's health teaching? Select all that apply.

1. The client should use a sitz bath daily as a relief measure.--> sitz bath do have a soothing affect for clients with hemorrhoids 2. The client should digitally replace external hemorrhoids into her rectum.--> clients often feel some relief when external hemorrhoids and reinserted into the rectum quantity with subsequent pregnancies. 5. The client should apply topical anesthetic as a relief measure.--> topical anesthetics can provide relief form the discomfort of hemorrhoids

2. A 3-day-postpartum client questions why she is to receive the rubella vaccine before leaving the hospital. Which of the following rationales should guide the nurse's response?

1. The client's obstetric status is optimal for receiving the vaccine.--> because the vaccine is teratogenic, the best time to administer it is when the client is not pregnant

1.A 3-day-breastfeeding client who is not immune to rubella is to receive the rubella vaccine at discharge. Which of the following must the nurse include in her discharge teaching regarding the vaccine?

1. The woman should not become pregnant for at least 4 weeks.--> the rubella vaccine is live attenuate vaccine. Severe birth defects can develop if the woman becomes pregnant within 4 weeks of receiving the injection

74. The nurse has provided teaching to a post-op cesarean client who is being discharged on Colace (docusate sodium) 100 mg po tid. Which of the following would indicate that the teaching was successful?

1. The woman swallows the tablets whole.--> colace capsules should not be crushed broken or chewed

48. The nurse palpates a distended bladder on a woman who delivered vaginally 2 hours earlier. The woman refuses to go to the bathroom, "I really don't need to go." Which of the following responses by the nurse is appropriate?

2. "I understand but I still would like you to try to urinate."--> mothers often do not feel bladder pressure after delivery

31. The nurse is caring for a client who had an emergency cesarean section, with her husband in attendance, the day before. The baby's Apgar was 9/9. The woman and her partner had attended childbirth education classes and had anticipated having a water birth with family present. Which of the following comments by the nurse is appropriate?

2. "With all of your preparations, it must have been disappointing for you to have had a cesarean."--> this comment convey sensitivity and understanding to the client

14. Which of the following statements is true about breastfeeding mothers as compared to bottle-feeding mothers?

2. Breastfeeding mothers have decreased incidence of diabetes mellitus later in life.--> there is evidence to show that women who breastfeed their babies are less likely to develop type 2 diabetes later in life

4. To prevent infection, the nurse teaches the postpartum client to perform which of the following tasks?

2. Change the peripad at each voiding.--> it is likely that this client is dehydrated. shoe should be advised to drink fluids --> client should be advised to change their pads at each voiding

60. The nurse is developing a plan of care for the postpartum client during the "taking in" phase. Which of the following should the nurse include in the plan?

2. Discuss the labor and birth with the mother.--> during the taking in phase, clients need to internalize their labor experiences. discussing the labor process is appropriate for this postpartum phase

81. A maternity nurse knows that obstetric clients are most at high risk for cardiovascular compromise during the one hour immediately following a delivery because of which of the following? 1. Weight of the uterine body is significantly reduced. 2. Excess blood volume from pregnancy is circulating in the woman's periphery. 3. Cervix is fully dilated and the lochia flows freely. 4. Maternal blood pressure drops precipitously once the baby's head emerges

2. Excess blood volume from pregnancy is circulating in the woman's periphery.-->once the placenta is birthed, the reservoir for the mother's large blood volumes is gone

24. During a home visit, the nurse assesses a client 2 weeks after delivery. Which of the following signs/symptoms should the nurse expect to see?

2. Lochia alba.--> the nurse would expect that the client would have lochia alba

49. A client, G1 P0101, postpartum 1 day, is assessed. The nurse notes that the client's lochia rubra is moderate and her fundus is boggy 2 cm above the umbilicus and deviated to the right. Which of the following actions should the nurse take first?

2. Massage the woman's fundus. --> the action is the first that the nurse should take

62. The nurse takes a newborn to a primipara for a feeding. The mother holds the baby en face, strokes his cheek, and states that this is the first newborn she has ever held. Which of the following nursing assessments is most appropriate?

2. Positive bonding but teaching related to newborn care is needed.--> the client is showing signs of positive bonding---en face position and stroking of the baby's cheeks-- and is in need of information on child care

64. A nurse is counseling a woman about postpartum blues. Which of the following should be included in the discussion?

2. Postpartum blues last about a week or two.--> the blues usually resolve within 2 weeks of delivery

30. A woman is receiving patient-controlled analgesia (PCA) post-cesarean section. Which of the following must be included in the patient teaching?

2. The client should report any feelings of nausea or itching to the nurse.--> the information is correct. clients often experience nausea and/or itching when PCA narcotics are administered

58. One nursing diagnosis that a nurse has identified for a postpartum client is: Risk for intrauterine infection r/t vaginal delivery. During the postpartum period, which of the following goals should the nurse include in the care plan in relation to this diagnosis? Select all that apply.

2. The client will have a stable white blood cell count.--> an important goal is that the woman's WBC will remain stable 3. The client will have a normal temperature.--> an important goal is that is that the woman's temperature will remain normal 4. The client will have normal-smelling vaginal discharge.--> an important goal is that the woman's lochia will smell normal

36. A post-cesarean section, breastfeeding client, whose subjective pain level is 2/5, requests her as needed (prn) narcotic analgesics every 3 hours. She states, "I have decided to make sure that I feel as little pain from this experience as possible." Which of the following should the nurse conclude in relation to this woman's behavior?

2. The woman is high risk for severe constipation.--> one of the common side effects of narcotics is constipation

50. The nurse has taught a new admission to the postpartum unit about pericare. Which of the following indicates that the client understands the procedure? Select all that apply.

2. The woman washes her hands before and after the procedure.--> the woman should wash her hands before and after performing pericare care. 4. The woman sprays her perineum from front to back.--> this statement is just accurate

38. The nurse is assessing the midline episiotomy on a postpartum client. Which of the following findings should the nurse expect to see?

2. Well-approximated edges.--> the nurse would expect to see well-approximated edges

20. Which of the following laboratory values would the nurse expect to see in a normal postpartum woman?

2. White blood cell count, 16,000 cells/mm3.--> the nurse would expect to see an elevated white cell count.

17. A breastfeeding client, 7 weeks postpartum, complains to an obstetrician's triage nurse that when she and her husband had intercourse for the first time after the delivery, "I couldn't stand it. It was so painful. The doctor must have done something terrible to my vagina." Which of the following responses by the nurse is appropriate?

3. "Women who breastfeed often have vaginal dryness. A vaginal lubricant may remedy your discomfort."-->the woman should be encouraged to use a lubricating jelly or oil

65. A 2-day postpartum mother, G2 P2002, states that her 2-year-old daughter at home is very excited about taking "my baby sister" home. Which of the following is an appropriate response by the nurse?

3. "Your daughter is likely to become very jealous of the new baby."--> the nurse should forewarn the mother about the likelihood of the 2 year old's jealousy

18. The nurse monitors his or her postpartum clients carefully because which of the following physiological changes occurs during the early postpartum period?

3. Decreased blood volume.--> the blood volume does drop precipitously during the early postpartum period

27. The nurse is caring for a client who had a cesarean section under spinal anesthesia less than 2 hours ago. Which of the following nursing actions is appropriate at this time?

3. Have her turn and deep breathe every 2 hours.--> the woman should turn, cough, and deep breathe every 2 hours

44. The nurse is assessing the laboratory report on a 2-day postpartum G1 P1001. The woman had a normal postpartum assessment this morning. Which of the following results should the nurse report to the primary health care provider?

3. Hematocrit, 26%.--> the client's hematocrit is well below normal. this value should be reported to the client's health care providers

54. On admission to the labor and delivery unit, a client's hemoglobin (Hgb) was assessed at 11.0 g/dL, and her hematocrit (Hct) at 33%. Which of the following values would the nurse expect to see 2 days after a normal spontaneous vaginal delivery?

3. Hgb 10.5 g/dL; Hct 31%.-> the nurse would expected these values a light decrease in both hemoglobin and hematocrit values

66. The home health nurse visits a client who is 6 days postdelivery. The client appears sad, weeps frequently, and states, "I don't know what is wrong with me. I feel terrible. I should be happy, but I'm not." Which of the following nursing diagnoses is appropriate for this client?

3. Ineffective individual coping related to hormonal shifts.--> this client is showing signs of postpartum blues; one of the main reasons for this problem is related to the hormonal changes that occur after delivery

25. The day after delivery, a woman, whose fundus is firm at 1 cm below the umbilicus and who has moderate lochia, tells the nurse that something must be wrong: "All I do is go to the bathroom." Which of the following is an appropriate nursing response?

3. Inform the client that polyuria is normal.--> Polyuria is normal

47. The nurse is examining a 2-day-postpartum client whose fundus is 2 cm below the umbilicus and whose bright red lochia saturates about 4 inches of a pad in 1 hour. What should the nurse document in the nursing record?

3. Normal involution, lochia rubra moderate.--> the involution is normal and lochia is rubra

63. A primipara, 2 hours postpartum, requests that the nurse diaper her baby after a feeding because "I am so tired right now. I just want to have something to eat and take a nap." Based on this information, the nurse concludes that the woman is exhibiting signs of which of the following?

3. Normal postpartum behavior.--> the client is exhibiting normal postpartum behavior

53. A physician has ordered an iron supplement for a postpartum woman. The nurse strongly suggests that the woman take the medicine with which of the following drinks?

3. Orange juice.--> the nurse would recommend that iron be taken with orange juice because ascorbic acid, which is in orange juice, promotes that absorption of iron into the body

29. A woman had a cesarean section yesterday. She states that she needs to cough but that she is afraid to. Which of the following is the nurse's best response?

4. "If you support your incision with a pillow, coughing should hurt less."--> the is the appropriate response. the nurse is providing the client with a means of reducing the discomfort of post-surgical coughing

45. A bottle-feeding woman, 1 1/2 weeks postpartum from a vaginal delivery, calls the obstetric office to state that she has saturated 2 pads in the past 1 hour. Which of the following responses by the nurse is appropriate?

4. "It is important for you to be examined by the doctor today. Let me check to see when you can come in."-> the client should be examined to assess her involution

7. A 2-day-postpartum breastfeeding woman states, "I am sick of being fat. When can I go on a diet?" Which of the following responses is appropriate?

4. "Many mothers lose weight when they breastfeed because the baby consumes about 600 calories a day."--> many mothers who consume approximately the same number of calories while breastfeeding as they did when they were pregnant do lose weight while breastfeeding

39. A client, G1 P1, who had an epidural, has just delivered a daughter, Apgar 9/9, over a mediolateral episiotomy. The physician used low forceps. While recovering, the client states, "I'm a failure. I couldn't stand the pain and couldn't even push my baby out by myself!" Which of the following is the best response for the nurse to make?

4. "To have things work out differently than you had planned is disappointing."--> this response shows that the nurse has an understanding of the client's feelings

23. The nurse is evaluating the involution of a woman who is 3 days postpartum. Which of the following findings would the nurse evaluate as normal?

4. Fundus 3 cm below the umbilicus, lochia serosa.--> the fundus is usually 3 cm below the umbilicus on day 3 and the lochia usually has turned to serosa by day 3

75. The nurse hears the following information on a newly delivered client during shift report: 21 years old, married, G1 P1001, 8 hours post-spontaneous vaginal delivery over an intact perineum; vitals 110/70, 98.6˚F, 82, 18; fundus firm at umbilicus; moderate lochia rubra; ambulated to bathroom to void 4 times; breastfeeding every 2 hours. Which of the following nursing diagnoses should the nurse include in this client's nursing care plan?

4. Knowledge deficit r/t lack of parenting experience.--> the nurse would anticipate that she is in need of teaching regarding newborn care as well as self-care

8. A G2 P2002, who is postpartum 6 hours from a spontaneous vaginal delivery, is assessed. The nurse notes that the fundus is firm at the umbilicus, there is heavy lochia rubra, and perineal sutures are intact. Which of the following actions should the nurse take at this time?

4. Notify the woman's primary health care provider. --> because the heavy lochia, the nurse should notify the woman's health care provider--> because of the heavy lochia, the nurse should notify the woman's health care provider

37. A nurse is assessing a 1-day-postpartum woman who had her baby by cesarean section. Which of the following should the nurse report to the surgeon?

4. Pad saturation every 30 minutes. --> this blood loss is excessive, especially for a postoperative cesarean section client. the surgeon should be notified

83. The nurse is preparing to place a peripad on the perineum of a client who delivered her baby 10 minutes earlier. The client states, "I don't use those. I always use tampons." Which of the following actions by the nurse is appropriate at this time?

4. State that it is unsafe to place anything into the vagina until involution is complete.--> it is unsafe to place anything in the vagina before involution is complete

9. A client informs the nurse that she intends to bottle feed her baby. Which of the following actions should the nurse encourage the client to perform? Select all that apply.

4. Wear a supportive bra 24 hours a day.--> mothers should be advised to wear a supportive bra 24 hours a day for a week or so. --> 5. Stand with her back toward the shower water.--> the mother should be advised to stand with her back toward the warm shower water.

77. After a client's placenta is birthed, the obstetrician states, "Please add 20 units of oxytocin to the intravenous and increase the drip rate to 250 mL/hr." The client has 750 mL in her IV and the IV tubing delivers fluid at the rate of 10 gtt/mL. To what drip rate should the nurse set the intravenous?

42 gtt/min

51. The nurse informs a postpartum woman that which of the following is the reason ibuprofen (Advil) is especially effective for afterbirth pains?

2. Ibuprofen has an antiprostaglandin effect.--> ibuprofen has an antiprostaglandin effect

70. A medication order reads: Methergine (ergonovine) 0.2 mg po q 6 h × 4 doses. Which of the following assessments should be made before administering each dose of this medication?.

3. Blood pressure.--> the BP should be assessed before administering Methergine

80. A client, G2 P1102, is 30 minutes postpartum from a low forceps vaginal delivery over a right mediolateral episiotomy. Her physician has just finished repairing the incision. The client's legs are in the stirrups and she is breastfeeding her baby. Which of the following actions should the nurse perform?

3. Lower both of her legs at the same time.--> if the legs are removed from the stirrups one at a time then the woman is at high risk for back and abdominal injuries

35. A client, 2 days postoperative from a cesarean section, complains to the nurse that she has yet to have a bowel movement since the surgery. Which of the following responses by the nurse would be appropriate at this time?

4. "Fluids and exercise often help to combat constipation. Take a stroll around the unit and drink lots of fluid."--> consuming fluids and fiber and exercising all help clients to reestablish normal bowel function

61. The nurse is developing a plan of care for the postpartum client during the "taking hold" phase. Which of the following should the nurse include in the plan?

4. Assure the client that she is an excellent mother.--> client in the taking hold phase need assurance that they are learning the skills they will need to care for their new baby

46. A client, 2 days postpartum from a spontaneous vaginal delivery, asks the nurse about postpartum exercises. Which of the following responses by the nurse is appropriate?

4. "You can do some Kegel exercises today and then slowly increase your toning exercises over the next few weeks."--> the client should begin with Kegel exercises shortly after delivery, move to abdominal tightening exercises in the next couple of days, and then slowly progress to stomach crunches and so on.

12. The nurse is caring for a breastfeeding mother who asks advice on foods that will provide both vitamin A and iron. Which of the following should the nurse recommend?

4. 1 1/2 cup raw broccoli.--> broccoli is very high in vitamin A

67. A Muslim woman requests something to eat after the delivery of her baby. Which of the following meals would be most appropriate for the nurse to give her?

4. Chicken and dumplings.

11. A multigravid, postpartum woman reports severe abdominal cramping whenever she nurses her baby. Which of the following responses by the nurse is appropriate?

4. Discuss the action of breastfeeding hormones.--> the nurse should discuss the action of Oxycontin

3. A patient, G2 P1102, who delivered her baby 8 hours ago, now has a temperature of 100.2°F. Which of the following is the appropriate nursing intervention at this time?

4. Encourage intake of water and other fluids.

73. The third stage of labor has just ended for a client who has decided to bottle feed her baby. Which of the following maternal hormones will increase sharply at this time?

2. Prolactin.--> prolactin will elevate sharply in the clients bloodstream

84. A client has been transferred to the post-anesthesia care unit from a cesarean delivery. The client had spinal anesthesia for the surgery. Which of the following interventions should the nurse perform at this time?

1. Assess the level of the anesthesia.--> the nurse should assess the level of anesthesia every 15 minutes while in the postanesthsesia care unit

43. A 1-day postpartum woman states, "I think I have a urinary tract infection. I have to go to the bathroom all the time." Which of the following actions should the nurse take?

1. Assure the woman that frequent urination is normal after delivery.--> reassuring the client is appropriate

33. The obstetrician has ordered that a post-op cesarean section client's patient-controlled analgesia (PCA) be discontinued. Which of the following actions by the nurse is appropriate?

1. Discard the remaining medication in the presence of another nurse--> because the medication in a PCA pump is controlled by law. the medication must be wasted in the presence of another nurse

71. Which of the following complementary therapies can a nurse suggest to a multiparous woman who is complaining of severe afterbirth pains?

1. Lie prone with a small pillow cushioning her abdomen.--> lying prone on a pillow helps to relieve some women's after birth pains

6. A breastfeeding woman has been counseled on how to prevent engorgement. Which of the following actions by the mother shows that the teaching was effective?

2. She feeds her baby every 2 to 3 hours.--> the best way to prevent engorgement is to feed the baby every 2 to 3 hrs

22. The nurse is discussing the importance of doing Kegel exercises during the postpartum period. Which of the following should be included in the teaching plan?

2. She should practice by stopping the urine flow midstream every time she voids.

42. A nurse is assessing the fundus of a client during the immediate postpartum period. Which of the following actions indicates that the nurse is performing the skill correctly?

2. The nurse stabilizes the base of the uterus with his or her dependent hand.--> the nurse should stabilize the base of the uterus with his or her dependent hand

19. A woman, 24 hours postpartum, is complaining of profuse diaphoresis. She has no other complaints. Which of the following actions by the nurse is appropriate?

3. Reassure the woman that this is normal.--> diaphoresis is normal during the postpartum period