Evolve OB Exam Version B

Twenty-four hours after admission to the newborn nursery, a full-term male infant develops localized edema on the right side of his head. The nurse knows that in the newborn, an accumulation of blood between the periosteum and skull which does not cross the suture line is a newborn variation known as.

A cephalohematoma, caused by forceps trauma and may last up to 8 weeks.

A client at 32-weeks gestation is hospitalized with severe pregnancy-induced hypertension, and magnesium sulfate is prescribed to control the symptoms. Which assessment finding indicates the therapeutic drug level has been achieved?

A decrease in respiratory rate from 24 to 16.

A woman who thinks she could be pregnant calls her neighbor, a nurse, to ask when she could use a home pregnancy test to diagnose pregnancy. Which response is best.

A home pregnancy test can be used right after your first missed period.

A multigravida client at 41-weeks gestation presents in the labor and delivery unit after a non-stress test indicated that the fetus is experiencing some difficulties in utero. Which diagnostic test should the nurse prepare the client for additional information about fetal status?

Biophysical profile (BPP)

One hour after giving birth to an 8- pound infant a client's lochia rubra has increased from small to large and her fundus is boggy despite massage. The client's pulse is 84 beats/minute and blood pressure is 156/96. The healthcare provider prescribes Methergine 0.2 mg IM x 1. What action should the nurse take immediately?

Call the healthcare provider to question the prescription. Methergine is contraindicated for clients with elevate blood pressure, so the nurse should contact the healthcare provider and question the prescription.

Which assessment finding should the nursery nurse report to the pediatric healthcare provider?

Central cyanosis when crying

A 4-week-old premature infant has been receiving epoetin alfa (Epogen) for the last three weeks. Which assessment finding indicates to the nurse that the drug is effective?

Changes in apical hear rate from the 180s to the 140s. Epogen, given to prevent or treat anemia, stimulates erythropoietin production, resulting in an increase in RBCs, Since the body has not had to compensate for anemia with an increased heart rate, changes in heart rate from high to normal is on indicator that Epogen is effective.

What action should the nurse implement to decrease the client's risk for hemorrhage after a cesarean section?

Check the firmness of the uterus every 15 minutes.

A newborn infant is brought to the nursery from the birthing suite. The nurse notices that the infant is breathing satisfactorily but appears dusky. What action should the nurse take first?

Check the infant's oxygen saturation rate.

A full-term infant is admitted to the newborn nursery and, after careful assessment, the nurse suspects that the infant may have an esophageal atresia. Which symptoms is this newborn likely to have exhibited?

Choking, coughing, and cyanosis.

A client at 28- weeks gestation calls the antepartal clinic and states that she is experiencing a small amount of vaginal bleeding which she describes as bright red. She further states that she is not experiencing any uterine contraction or abdominal pain. What instruction should the nurse provide?

Come to the clinic today for an ultrasound.

A multigravida client arrives at the labor and delivery unit and tells the nurse that her bag of water has broken. The nurse identifies the presence of meconium fluid on the peritoneum and determines the fetal heart rate is between 140 to 150 bpm. What action should the nurse implement next?

Complete a sterile vaginal exam.

A pregnant client with mitral stenosis Class III is prescribed complete bedrest. The client asks the nurse, "Why must I stay in bed all the time?" Which response is best for the nurse to provide this client?

Complete bedrest decreases oxygen needs and demands on the heart muscle tissue.

A mother who is breastfeeding her baby receives instructions from the nurse. Which instruction is most effective to prevent nipple soreness?

Correctly place the infant on the breast.

A client with no prenatal care arrives at the labor unit screaming, "The baby is coming!" The nurse preforms a vaginal examination that reveals the cervix is 3 cm dilated and 75% effaced. What additional information is most important for the nurse to obtain?

Date of last normal menstrual period. Evaluating the gestation of the pregnancy takes priority. If the fetus is preterm and the FHR is reassuring, the HCP may attempt to prolong the pregnancy and administer corticosteroids to mature the lungs of the fetus.

A client at 32-weeks gestation comes to the prenatal clinic with complaints of pedal edema, dyspnea, fatigue, and a moist cough. Which question is most important for the nurse to ask this client?

Do you have a history of rheumatic fever? Clients with a history of rheumatic fever may develop mitral valve prolapse, which increases the risk for cardiac decompensation due to the increased blood volume that occurs during pregnancy, so obtaining information about this client's health history is a priority.

A hour old newborn has a pink papular rash with vesicles superimposed on the thorax, back, and abdomen. What action should the nurse implement?

Document the finding in the infant's record.

A client who has an autosomal dominant inherited disorder is exploring family planning options and the risk of transmission of the disorder to an infant. The nurse's response should be based on what information?

Each pregnancy carries a 50% chance of inheriting the disorder.

The nurse is caring for a woman with a previously diagnosed heart disease who is in the second stage of labor. Which assessment findings are of greatest concern?

Edema, basilar rales, and an irregular pulse.

The nurse is planning preconception care for a new female client. Which information should the nurse provide the client?

Encourage healthy lifestyle for families desiring pregnancy.

The total bilirubin level of a 36-hour, breastfeeding newborn is 14 mg/ dl. Based on this finding, which intervention should the nurse implement?

Encourage the mother to breastfeed frequently. Normal is 6-12 mg/dl

A client in active labor complains of cramps in her leg. What intervention should the nurse implement?

Extend the leg and dorsiflex the foot. Dorsiflexing the foot by pushing the sole of the foot forward or by standing, and putting the heel of the foot on the floor is the best means of relieving leg. cramps.

The nurse is teaching breastfeeding to prospective parents in a childbirth educations class. Which instruction should the nurse include as content in the class?

Feed your baby every 2 to 3 hours or on demand, whichever comes first.

The healthcare provider prescribes terbutaline (Brethine) for a client in preterm labor. Before initiating this prescription, it is most important for the nurse to assess the client for which condition?

Gestational diabetes terbutaline increases blood glucose levels.

The nurse is teaching care of the newborn to a group of prospective parents and describes the need for administering antibiotic ointment into the eyes of the newborn. Which infectious organism will this treatment prevent form harming the infant?

Gonorrhea.

The nurse attempts to help an unmarried teenager deal with her feelings following a spontaneous abortion at 8-weeks gestation. What type of emotional response should the nurse anticipate?

Grief related to her perceptions about the loss of this child.

The nurse instructs a laboring client to use accelerated-blowing breathing. The client beings to complain of tingling fingers and dizziness. What action should the nurse take?

Have the client breathe inter her cupped hands. blowing off too much carbon dioxide

A 14-weeks gestation, a client arrives at the Emergency Center complaining of a dull pain the in right lower quadrant of her abdomen. The nurse obtains a blood sample and initiates an IV> Thirty minutes after admission, the client reports feeling sharp abdominal pain and a shoulder pain. Assessment findings include diaphoresis, a heart rate of 120 bpm, and a blood pressure of 86/48. Which action should the nurse implement first?

Increase the rate of IV fluids. demonstrating symptoms of blood loss, probably the result of an ectopic pregnancy.

A full term infant is transferred to the nursery from labor and delivery. Which information is most important for the nurse to receive when planning immediate care for the newborn?

Infant's condition at birth and treatment received.

Immediately after birth a newborn is suctioned, dried, and placed under a radiant warmer. The infant has spontaneous respirations and the nurse assesses an apical heart rate of 80 bpm and respirations of 20 bpm. What action should the nurse perform next?

Initiate positive pressure ventilation. Infant's vital signs are not within the normal range, and oxygen deprivation leads to cardiac depression in infants.

A client who is attending antepartum classes asks the nurse why her healthcare provider has prescribed iron tablets. The nurse's response is based on what knowledge?

It is difficult to consume 18 mg of additional iron by diet alone.

The nurse is counseling a woman who wants to become pregnant. The woman tells the nurse that she has a 36-day menstrual cycle and the first day of the last menstrual period was January 8. The nurse correctly calculates that the woman's snext fertile period is.

January 30-31

An expectant father tells the nurse he fears that his wife "is losing her mind." He states she is constantly rubbing her abdomen and talking to the baby, and that she actually reprimands the baby when it moves too much. What recommendation should the nurse make to this expectant father?

Let him know that these behavior are part of normal maternal/fetal bonding which occur once the mother feels fetal movement.

During a prenatal visit, the nurse discusses with a client the effects of smoking on the fetus. When compared with nonsmokers, mothers who smoke during pregnancy tend to produce infants who have.

Lower birth weights.

Which nursing interventions is most helpful in relieving PP uterine contractions or "afterpains?"

Lying prone with a pillow on the abdomen.

A female client with insulin-dependent diabetes arrives at the clinic seeking a plan to get pregnant in approximately 6 months. She tells the nurse that she want to have an uncomplicated pregnancy and a healthy baby. What information should the nurse share with the client?

Maintain blood sugar levels in constant range within normal limits during pregnancy.

A 30-year-old gravida 2, para 1 client is admitted to the hospital at 26-weeks gestation in preterm labor. She is given a dose of terbutaline sulfate (Brethine) 0.25 mg SQ. Which assessment is the highest priority for the nurse to monitor during the administration of this drug?

Maternal and fetal heart rates. Terbutaline acts as a sympathomimetic agent that stimulates both beta 1 receptors and stimulation of beta 2 receptors.

A pregnant client tells the nurse that the first day of her last menstrual period was August 2, 2006. Based on Naegele's rule, what is the estimated date of delivery?

May 9, 2007 LMC -3 month + 7 days + 1 year

A client who gave birth to a healthy 8 pound infant 3 hours ago is admitted to the PP unit. Which nursing plan is best in assisting this mother to bond with her newborn infant?

Meet the mother's physical needs and demonstrate warmth toward, the infant.

The nurse assesses a client admitted to the labor and delivery unit and obtains the following data: dark red vaginal bleeding, uterus slightly tense between contractions, BP 110/68, FHR 110 bpm, cervix 1 cm dilated and uneffaced. Based on these assessment findings, what intervention should the nurse implement?

Monitor bleeding from IV sites. The client is presenting with signs of placental abruption. Disseminated intravascular coagulation is a complication of placental abruption, characterized by abnormal bleeding. Invasive vaginal procedures can increase the abruption and bleeding.

When explaining "postpartum blues" to a client who is 1 day postpartum, which symptoms should the nurse include in the teaching plan?

Mood Swings Tearfulness.

A 38-week primigravida who works as a secretary and sits at a computer 8 hours each day tells the nurse that her feet have begun to swell. Which instruction would be most effective in preventing pooling of blood in the lower extremities?

Move about every hour.

On admission to the prenatal clinical , a 23-year-old woman tells the nurse that her last menstrual period began on February 15, and that previously her periods were regular. Her pregnancy test is positive. The client's expected date of delivery is

November 22

The nurse identifies crepitus when examining the chest of a newborn who was delivered vaginally. Which further assessment should the nurse perform?

Observe for an asymmetrical Moro reflex.

The nurse observes a new mother avoiding eye contact with her newborn. Which action should the nurse take?

Observe the mother for other attachment behaviors.

Twenty minutes after a continuous epidural anesthetic is administered, a laboring client's blood pressure drops from 120/80 to 902/60. What action should the nurse take?

Place the woman in a lateral position.

The nurse observes a new mother is rooming-in and caring for her newborn infant. Which observation indicates the need for further teaching?

Places the infant prone in the bassinet.

Just after delivery, a new mother tells the nurse. "I was unsuccessful breastfeeding my first child, but I would like to try with this baby." Which intervention is best for the nurse to implement first?

Provide assistance to the mother to begin breastfeeding as soon as possible after delivery.

An off-duty nurse finds a woman in a supermarket parking lot delivering an infant while her husband is screaming for someone to help his wife. Which intervention has the highest priority?

Put the newborn to breast.

A 30-year-old multiparous woman who has a 3-year-old boy and an newborn girl tells the nurse, "My son is so jealous of my daughter, I don't know how I'll ever manage both children when I get home." How should the nurse respond?

REgression in behavior in the older child is a typical reaction so he needs attention at this time.

A client receiving epidural anesthesia begins to experience nausea and becomes pale and clammy. What intervention should the nurse implement first?

Raise the foot of the bed.

The nurse is providing discharge teaching for a client who is 24 hours postpartum. The nurse explains to the client that her vaginal discharge will change from red to pink and then to white. The client asks, "What if I start having red bleeding after it changes?" What should the nurse instruct the client to do?

Reduce activity level and notify the healthcare provider.

During labor, the nurse determines that a full-term client is demonstrating late decelerations. In which sequence should the nurse implement these nursing actions?

Reposition the client. Provide oxygen via face mask Increase IV fluid Call the healthcare provider

The nurse should explain to a 30-year-old gravid client that alpha fetoprotein testing is recommended for which purpose?

Screen for neural tube defects

The nurse is calculating the estimated date of confinement using Naegele's rule for a client whose last menstrual period started on December 1. Which date is most accurate?

September 8

A couple, concerned because the woman has not been able to conceive, is referred to a health care provider for a fertility workup and a hysterosalpingography is scheduled. Which postprocedure complaint indicates that the fallopian tubes are patent?

Shoulder pain. If the tubes are patent, pain is referred to the shoulder from a subdiaphragmatic collection of peritoneal gye. gas.

After each feeding, a 3-day-old newborn is spitting up large amounts of Enfamil Newborn Formula, a nonfat cow's milk formula. The pediatric HCP changes the neonate's formula to Similac Soy Isomil Formula, a soy protein isolate based infant formula. What information should the nurse provide to the mother about the newly prescribed formula?

Similac Soy Isomil Formula is a soy-based formula that contains sucrose.

A 26-year-old, gravida 2, para 1 client is admitted to the hospital at 28-weeks gestation in preterm labor. She is given 3 doses of terbutaline sulfate (Brethine) 0.25 mg SQ to stop her labor contractions. The nurse plans to monitor for which primary side effect of terbutaline sulfate?

Tachycardia and a feeling of nervousness.

A woman who had a miscarriage 6 months ago becomes pregnant. Which instruction is most important for the nurse to provide this client?

Take prescribed multivitamin and mineral supplements. the previous pregnancy may have left her nutritionally depleted

A 23-year-old client who is receiving Medicaid benefits is pregnant with her first child. Based on knowledge of the statistics related to infant mortality, which plan should the nurse implement with this client?

Teach the client why keeping prenatal care appointment is important.

A new mother who has just had her baby says to the nurse, "I saw the baby in the recovery room. She sure has a funny looking head." Which response by the nurse is best?

That is normal; the head will return to a round shape within to days.

Client teaching is an important part of the maternity nurse's role. Which factor has the greatest influence on successful teaching of the gravid client?

The client's readiness to learn.

In developing a teaching plan for expectant parents, the nurse plans to include information about when the parents can expect the infant's fontanels to close. The nurse bases the explanation on knowledge that for the normal newborn,

anterior fontanel closes at 12 to 18 months and the posterior by the end of the second month.

What action should the nurse implement when preparing to measure the fundal height of a pregnant client?

Have the client empty her bladder.

Which maternal behavior is the nurse most likely to see when a new mother receives her infant for the first time?

Her arms and hands receive the infant and she the traces the infant's profile with her fingertips.

A client at 32-weeks gestation is diagnosed with preeclampsia. Which assessment finding is most indicative of an impending convulsion?

3+ DTR and hyperclonus

A pregnant woman comes to the prenatal clinic for an initial visit. In reviewing her childbearing history, the client indicate that she has delivered premature twins, one full-term baby, and has had no abortions. Which GTPAL should the nurse document in this client's record?

3-1-1-0-3

In evaluating the respiratory effort of a one-hour-old infant using the Silverman-anderson Index, the nurse determines the infant has synchronized chest and abdominal movement, just visible lower chest retractions, just visible xiphoid retractions, minimal and transient nasal flaring, and an expiratory grunt heard only on auscultation. What Silverman-Anderson score should the nurse assign to this infant?

4

A primigravida client who is 5 cm dilated, 90% effaced, and at 0 station is requesting a epidural for pain relief. Which assessment finding is most important for the nurse to report to the healthcare provider?

A platelet count of 67,000/mm3 Thrombocytopenia should be reported to the healthcare provider because it places the client at risk for bleeding when an epidural is administered.

The nurse is preparing a client with a term pregnancy who is in active labor for an amniotomy. What equipment should the nurse have available at the client's bedside?

A sterile glove An amniotic hook A Doppler

The nurse is performing a gestational age assessment on a full-term newborn during the first hour of transition using the Ballard scale. Based on this assessment, the nurse determines that the neonate has a maturity rating of 40-weeks. What findings should the nurse identify to determine if the neonate is small for gestational age?

Admission weight of 4 pounds, 15 ounces Head to heel length of 17 inches Frontal occipital circumference of 12.5 inches

The nurse caring for a laboring client encourages her to void at least q2h, and records each time the client empties her bladder. What is the primary reason for implementing this nursing intervention?

An over-distended bladder could be traumatized during labor as well as prolong the progress of labor.

A woman who gave birth 48 hours ago is bottle-feeding her infant. During assessment, the nurse determines that both breast are swollen, warm, and tender upon palpation. What action should the nurse take?

Apply cold compresses to both for comfort.

A 40-week gestation primigravida client is being induced with an oxytocin secondary infusion and complains of pain in her lower back. Which intervention should the nurse implement?

Apply firm pressure to sacral area

The nurse is assessing a client who is having a NEST at 41-weeks gestation. The nurse determines that the client is not having contractions, the FHR baseline is 144 bpm, and no FHR accelerations are occurring. What action should the nurse take?

Ask the client if she has felt any fetal movement.

When assessing a client who is at 12-weeks gestation, the nurse recommends that she and her husband consider attending childbirth preparation classes. When is the best time for the couple to attend these classes?

At 30-weeks gestation.

A vaginally delivered infant of an HIV positive mother is admitted to the newborn nursery. What intervention should the nurse preform first?

Bathe the infant with an antimicrobial soap.

The nurse is teaching a woman how to use her basal body temperature pattern as a tool to assist her in conceiving a child. Which temperature pattern indicated the occurrence of ovulation, and therefore, the best time for intercourse to ensure conception?

Between the time the temperature falls and rises.

A client with gestational hypertension is in active labor and receiving an infusion of magnesium sulfate. Which drug should the nurse have available for signs of potential toxicity?

Calcium gluconate.

The nurse is preparing to give an enema to a laboring client. Which client requires the most caution when carrying out this procedure? A. A gravida 6, para 5 who is 38 years of age and in early labor. B. A 37-week primigravida who presents at 100% effacement, 3 cm cervical dilatation, and a -1 station. C. A gravida 2, para 1 who is at 1 cm cervical dilatation and a 0 station admitted for induction of labor due to post dates. D. A 40-week primigravida who is at 6 cm cervical dilatation and the presenting part is not engaged.

D. When the presenting part is ballottable, it is floating out of the pelvis. In such situation, the cord can descend before the fetus causing a prolapsed cord, which is a emergency situation.

A healthcare provider informs the charge nurse of a labor and delivery unity that a client is coming to the unit with suspected abruptio placentae. What findings should the charge nurse expect the client to demonstrate?

Dark, red vaginal bleeding Increased uterine irritability. A rigid abdomen.

A woman with Type 2 diabetes mellitus becomes pregnant, and her oral hypoglycemic agent are discontinued. Which intervention is most important for the nurse to implement?

Describe diet changes that can improve the management of her diabetes.

A 28-year client in active labor complains of cramps in her leg. What intervention should the nurse implement?

Extend the leg and dorsiflex the foot.

A primigravida at 40-week gestation is receiving oxytocin to augment labor. Which adverse effect should the nurse monitor for during the infusion of Pitocin?

Hyperstimulation. Pitocin causes the uterine myofibril to contract, so unless the infusion is closely monitored, the client is at risk for hyper stimulation which can lead to tetanic contractions, uterine rupture, and fetal distress or demise.

A client who is in the second trimester of pregnancy tells the nurse that she wants to use herbal therapy. Which response is best for the nurse to provide?

It is important that you want to take part in your care.

A client at 30-weeks gestation, complaining of pressure over the pubic area, is admitted for observation. She is contracting irregularly and demonstrates underlying uterine irritability. Vaginal examination reveals that her cervix is closed, thick, and high. Based on these data, which intervention should the nurse implement first?

Obtain a specimen for urine analysis. preterm clients with uterine irritability and contractions are often suffering from a urinary tract infection, and this should be ruled out first.

A client is admitted with the diagnosis of total placenta previa. Which finding is most important for the nurse to report to the health care provider immediately?

Onset of uterine contractions.

A client in active labor is admitted with preeclampsia. Which assessment finding is most significant in planning this client's care?

Patellar reflex 4 + indication of impending seizure

While breastfeeding, a new mother strokes the top of her baby's head and asks the nurse about the baby's swollen scalp. The nurse responds that the swelling is caput succedaneum. Which additional information should the nurse provide this new mother?

The scalp edema will subside in a few day after birth.

A new mother is afraid to touch her baby's head for fear of hurting the 'large soft spot." Which explanation should the nurse give to this anxious client?

There's a strong, tough membrane there to protect the baby so you need not be afraid to wash or comb his/ her hair.

The nurse is assessing the umbilical cord of a newborn. Which finding constitutes a normal finding?

Three vessels: two arteries and one vein.

A 42-week gestational client is receiving an intravenous infusion of oxytocin to augment early labor. The nurse should discontinue the oxytocin infusion for which pattern of contractions?

Transition labor with contractions every 2 minutes, lasting 90 seconds each.

A 35-year-old primigravida client with severe preeclampsia is receiving magnesium sulfate via continuous IV infusion. Which assessment data indicates to the nurse that the client is experiencing magnesium sulfate toxicity?

Urine output 90 ml/4 hours Urine output of less than 100 ml/ 4 hours, absent, DTRs, and a respiratory rate of less than 12 breath/ minute are cardinal signs of magnesium sulfate toxicity.

Which nursing intervention is helpful in relieving "afterpains?"

Using relaxation breathing techniques. Periodic contractions and relaxation of the uterus causes "afterpains."

When preparing a class on newborn care for expectant parents, what content should the nurse teach concerning the newborn infant born at term gestation?

Vernix is a white, cheesy substance, predominantly located in the skin folds.

The nurse is assessing a 3-day old infant with a cephalohematoma in the newborn nursery. Which assessment finding should the nurse report to the healthcare provider?

Yellowish tinge to the skin.

A new mother asks the nurse, " How do I know that my daughter is getting enough breast milk?" Which explanation should the nurse provide?

Your milk is sufficient if the baby is voiding pale straw-colored urine to 6-10 times a day

A newborn, whose mother is HIV positive, is scheduled for follow-up assessments. The nurse knows that the most likely presenting symptom for a pediatric client with AIDs is:

a persistent cold

The nurse should encourage the laboring client to g=begin pushing when

the cervix is completely dilated.

The nurse is counseling a couple who has sought information about conceiving. For teaching purposes, the nurse should know that ovulation usually occurs.

two weeks before menstruation.