In class questions OB ALL EXAMS
Which infants will need to have the circumcision delayed? Select all that apply. An infant delivered at 28 weeks An infant delivered at 39 weeks to a heroin addicted mother A 38 week infant with descended testes and swelling due to breech presentation An infant whose parents have refused the vitamin k injection An infant diagnosed with an epispadis
A, D, E
Erythromycin eye ointment is administered to newborns within 30 minutes of delivery to? Prevent staph infections Treat conjunctivitis Prevent complications associated with sexually transmitted infections Prevent group b strep infections vertically transmitted from the mother
C
What is the safest injection site for newborn infants? Deltoid Ventrogluteal Vastus Lateralis Rectis Femoris
C
Which client is experiencing magnesium toxicity? A client at 29 weeks with a FHR tracing exhibiting decreased variability over the last 20 minutes A client who experiences flushing and vomiting while receiving a mag bolus A client with no clonus and 1+ deep tendon reflexes A client who is oriented to person and is confused about where she is
D
Which of the following would the nurse expect to see with a client diagnosed with sever pre-eclampsia and abnormal Doppler cord blood studies at 38 weeks gestation? Maternal blood pressure 140/80 Late decelerations Urine protein 100mg in a 24 hour collection Fundal height measurement 32 cm
D
Is blue hands and feet/cyanotic feet and hands. "acrocynaosis" Are you concerned? Yes No
no
Is it possible for a mother to experience mixing of maternal and fetal blood during a woman's first pregnancy? Yes No
yes
What are some alternatives to pain medication and an epidural during labor?
Hypnosis Sterile saline injections Peanut Ball Guided imagery Frequent position changes
Lip/mouth/tongue is blue, are you concerned? Yes No
Yes
A 2 day old infant's blood values are: Blood: O- direct coomb's titer, glucose 45, bilirubin 8.5mg/dL/ The mother's blood type is A+. What is the nursing priority? Continue to monitor Start an IV line and contact the physician Observe the baby for kernicterus Administer Rhogam per physician's order
A
A laboring client requests IV pain medication. Assessment findings include: VE (8/40%/-1); FHR baseline is 120s with minimal variability; and strong contractions every 2-4 minutes. Prior to narcotic administration, the nurse is concerned with: Vaginal exam Contraction pattern FHR pattern Plans for epidural placement
C
A nurse performs a contraction stress test and determines that the test is positive. What is the priority nursing assessment or intervention? Take the client off of the EFM and educate her on how to perform kick counts. Perform acoustic stimulation three times and monitor the fetal response Educate the client on the need for a cesarean section Perform al UNCOIL techniques and notify the HCP
D
A client at 14 weeks gestation presents to the emergency room complaining of abdominal pain. Fetal heart tones are ordered. The best method to assess heart tones in the scenario is Listen and count the fetal heart tones using a Doppler Place the client on the external fetal monitor Listen and count the rate using a stethoscope Request that the practitioner obtain fetal heart tones via an ultrasound
A
A client complaining of secondary amenorrhea is seeking care. What finding from her history is significant? Athletic activities Vaccination history Pet ownership History of asthma
A
A client is admitted at 32 weeks with severe pre-eclampsia and HELLP syndrome. Select all the appropriate nursing interventions and provider orders Blood pressure monitoring every 30 minutes Intermittenent FHR monitoring (NEEDS CONTINUOUS WITH MAG) Deep tendon reflexes and clonus every hour Mag sulfate 6g bolus over 30 minutes then 2 grams/hr Celestone/betamethasone12mg IM now and repeat in 24 hours Tongue blade
A, C, D, E
At the end of the THIRD stage of labor, there are many necessary nursing interventions. SATA. Vigorously massage the fundus Prepare for delivery of the placenta Assist the mother with breastfeeding Place the mother on her left side to optimize perfusion Administer intravenous oxytocin/Pitocin per institution protocol
A, C, E
Pitocin administration is not acceptable in certain situations? SATA Before delivery with a schedule C-section Latent phase of stage 1 Significant variable decelerations Early decelerations Late decelerations End of stage 3
A, C, E
A 23 year old primiparous client is admitted to the hospital's materinity unit for delivery. The client is HIV positive. The nurse understands that the risk of perinatal transmission to the baby during and after delivery can be significantly reduced by a number of prophylactic interventions. Which interventions should be included in the plan of care? SATA Delivery by Cesarean Section Pneumococcal, HBV, and Haemophillus influenza vaccine Continuation of antiviral medications in the postpartum period Intrapartum treatment with antiviral medications Avoidance of breastfeeding Intravenous penicillin administration during labor
A, D, E
The nurse is caring for four women who are being evaluated for labor. Which women will likely require a cesarean delivery? A fetus in the left sacral position A mother who treated for syphilis in the first trimester who is not currently symptomatic A mother whose infant has been diagnosed with down's syndrome A mother who is HIV positive with a viral load of more than 1,000 copies/mL A mother who is positive for GBS with membranes ruptured >18 hours A mother with a history of genital herpes who is complaining of perineal burning and itching
A, D, F
Which postpartum client requires Rhogam, SATA. Mother O+, infant AB+ Mother A-, infant A+ Mother is B-, infant B- Mother AB-, infant is unknown, father B- Mother B-, status post miscarriage at 8 weeks Mother O+, infant O-
B D E
A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is what? Positive urine pregnancy test Positive serum pregnancy test Maternal report of fetal movement Fetal movement noted by the HCP
D
Before administering Rhogam to the postpartum woman, the most important lab value to assess is: The results of the Percutaneous Umbilical Blood Sample The father's blood type A Coomb's titer on the infant The infant's blood type
D
A nurse is performing an antenatal assessment on a patient at 26 weeks gestation. The most concerning finding is? A firm round object is noted low in the patient's pelvic area A fundal height of 30cm Category 1 FHR tracing Fetal heart rate with 125 baseline and two acclerations to 140 for 25 seconds in the last 20 minutes
B
A nurse notes that an infant has cyanotic hands and feet 8 hours after birth. Which of the following actions is the most appropriate? Administer oxygen Place the infant in the crib Assess the oxygen saturation Notify the physician
B
A client is 1 hour status post dilation and curettage. Which finding would warrant further assessment and intervention? The client reports her uterine pain as a 4 on a numeric 0-10 scale Half of the peri pad is saturated with bright red blood Blood pressure is 98/50 and pulse is 88 The client reports extreme sadness over the situation and is crying silently
B
A labor and delivery nurse is reviewing the physical exam on a client that has just been admitted in the latent phase of labor. Which of the following findings would be most at risk for a C-Section? Platypelloid pelvis/RMP Anthropoid pelvis/LSA Anthropoid-shaped pelvis/LOA Gynecoid-pelvis/ROP
B
When caring for a laboring client the nurse notes FHR at 170s with moderate variability. Based on this finding the nurse would first: Notify the HCP Prepare the client for a cesarean section Perform acoustic stimulation Assess the maternal temperature
D
When evaluating a fetal tracing, the nurse notes some fetal heart rate decelerations. What is the priority? Perform a vaginal exam UNCOIL Place an internal fetal scalp electrode Examine the relationship of the FHR to the contraction
D
A laboring primigravida complains of increasing rectal pressure and an urge to push. A vaginal exam reveals: 9cm, 80% effacement and +1 station. The nurse concludes: The client should begin pushing with every other contraction The client should not push with contractions The baby is high in the pelvis and the woman will need to push for 1-2 hours The baby has descended well into the birth canal and she should begin pushing
B
A nurse evaluates the FHR tracing and notes the baseline at 115 with moderate variability, contractions are every 2 minutes with decelerations that drop to the 90s after the acme of the contraction and return to baseline 40 seconds after the end of the contractions. What is the nursing priority? Decrease the oxytocin Discontinue the oxytocin Administer oxygen via NC Perform acoustic stimulation
B
A couple is concerned that their four year old infant will have problems once their baby delivers in 6 weeks. What is the best recommendation for this couple? Encourage the parents to take their 4 year old to sibling classes Encourage the parents to set aside time for both children. Inform the parents to purchase a big brother/sister t-shirt for the 4 year old for the hospital Suggest that the clients could send their 4 year old to spend time with another family who has a newborn.
A
When examining the difference between true and false labor, which statement is most accurate: "In true labor, my contractions will progressively increase in intensity." "In true labor, I will lose my mucous plug." "In false labor, I will only dilate to 1cm." "In false labor, I will feel contractions in my back."
A
Which drug requires pre-medication with an antiemtic, antidiarrheal, and antipyretic? Hemabate (Carboprost) Trexall (Methotrexate) Magnesium Sulfate Methergine (Methylergonovine)
A
Which of the following findings indicates respiratory distress in the newborn? Tachypnea Apnea for 10 seconds Acrocyanosis Coarse rocnchi noted in the upper lobes *(normal, worried with complete ronchi)
A
A patient at 18 weeks gestation has been diagnosed with gestation, trophoblastic disease. In addition to vaginal bleeding, what symptom would the nurse expect to see? Severe unilateral pain Hyperemesis gravidarum Fetal heart tones via Doppler Chronic hypertension
B
The nurse notes the fetal heart rate baseline at 115 with moderate variability and decelerations that drop abruptly 30 beats below the baseline for 40 seconds during and between contractions. The return to baseline is rapid, what is the priority? Discontinue the Oxytocin/Pitocin Continue to monitor Prepare the client for a cesarean Notify the HCP
A
The nursing priority when a patient is experiencing magnesium toxicity is? Discontinue the magnesium Decrease the magnesium Administer calcium gluconate Send a serum magnesium level
A
The treatment of a positive Group B strep pregnant woman is Penicillin G during labor Delivery via Cesarean section Penicillin G before, during, and after labor Induction of labor between 36-37 weeks
A
What causes early decelerations? Head compression Cord Compression Uteroplacental insufficiency Polyhydramnios
A
What is considered the number one safest injection site in the adult? Ventrogluteal Vastus lateralis Rectis femoris Dorsal gluteal
A
Which of the following assessments would alert the nurse to complications associated with hyperbillrubinemia? Yellow sclera at 18 hours of birth Elevated bilirubin level on day 3 Yellow skin on day 4 Increased sleepiness 12 hours after birth
A
Which statement regarding diabetes during pregnancy is correct? In the first trimester, estrogen and progesterone stimulate the beta cells in the pancreases to increase insulin production In the second and third trimester, maternal insulin levels are directly proportional to infant level. Insulin crosses the placenta, but glucose does not. Directly after birth to the placenta, the serum glucose is likely to remain elevated for up to 6 weeks.
A
What is the best and safest type of birth control for the bottle feeding mother in the early postpartum period (1st 6 weeks)? SATA Condoms Depo Provera injection Oral contraceptives Abstinence Copper IUD Rhythm method
A D E
In order to be eligible to be discharged home with a diagnosis of placenta previa at 28 weeks gestation, the client must meet all of the following criteria? SATA Biophysical profile score 8/8 NST appropriate for gestational age There is a 3cm area of bright red blood on the peri pad The hemoglobin and hematocrit have increased since the last bleeding episode a week ago The client reports mild pain with her 10 contraction this last hour The client has access to reliable transportation and a telephone
A, B, D, F
A client diagnosed with pre-eclampsia is prescribed bed rest. What improvement in the client's status indicates the bed is having a positive impact? SATA the urine output increases from 50 to 100mL/hr the fetal variablitly increases the pre-eclampsia will resolve in 24-48 hours the client will exhibit 2 beats of clonus bilaterally the client notes a decrease in her headache pain and scotoma the client reports the presence of epigastric pain
A, B, E
A nurse is educating a client at 28 weeks on the proper procedure for counting daily fetal movement. What is the correct way to educate the client? SATA Make sure that you are adequately hydrated and nourished before starting your assessment Use a pen and paper to track all the movements for an hour Once you feel movement, you can discontinue the assessment You may begin performing daily kick counts next month as your gestation is too early When you assess for movement, a quiet environment is best Your baby's movement will decrease the closer you are to a term or post term gestation.
A, B, E
An MBU nurse is caring for a couplet. The day old infant's blood values are: Blood type=O+, negative direct Coomb's titer, glucose level 38, bilirubin 8.5 mg/dL. The mother's blood type is A-. What are the nursing priorities? SATA Have the mother breast feed the baby Contact the HCP Place the infant under bill lights Feed the infant glucose water When available, administer Rhogam to the mother Transfer the infant to the NICU
A, B, E
What information should a nurse include when teaching post-circumcision care to parents of a neonate before discharge from the hospital? SATA The neonate must void before being discharged home. Petroleum jelly should be applied to the glans of the penis with each diaper change. The neonate can take tub baths while the circumcision heals. Small amounts of blood noted on the front of the diaper should be reported. The circumcision will require care for 2 to 4 days after discharge.
A, B, E
A woman has been diagnosed with a ruptured ectopic pregnancy. What is the nursing priority? Administer methotrexate IM Bolus the IV line with 500-1000 mL of crystalloid fluid Assess the abdomen for cullen's sign Perform orthostatic vital signs
B
A woman has been diagnosed with syphilis. Which of the following nursing interventions is appropriate? Council the woman on how to live with a chronic infection Assess the woman regarding symptoms of other STI's Assist the HCP with cryotherapy procedures Educate the woman regarding safe use and disposal of menstrual pads
B
Which of the following signs/symptoms would the nurse expects to see in the woman with placental abruption? Pain free vaginal bleeding Increasing fundal height FHR accelerations BP 98/40, pulse 90
B
Which of the following would alert the nurse that an infant was experiencing respiratory distress? Acrocyanosis Intercostal retractions Apnea lasting 15 seconds Fine ronchi in the upper lobes
B
A nurse is reviewing the FHR tracing and contraction pattern on the client being triaged for spontaneous labor. The TOCO monitor is not registering any contractions. The client is tearful and thrashing from side to side. The SVE is 2/50/-2. What is the priority in this scenario? Reassure the client that she is doing well with breathing through her contractions. Readjust the TOCO monitor Palpate the fundus Notify the HCP
C
A nurse is reviewing the fidings of a three our oral glucose test (OGTT). Which of the following is positive for gestational diabetes mellitus? A result where the 3 hour result is elevated A one hour oral glucose screen is 135 The one hour and two results are elevated The one hour oral glucose screen is elevated and the fasting level on the GTT is elevated
C
a client has experienced an intrauterine fetal demise (IUFD) for the third time in 2 years. She desires genetics testing. The nurse understands that the best and freshest sample can be obtained: after the infant delivers and when the autopsy is performed prior to deliver, using the chorionic villus sampling procedure prior to delivery, via an amniocentesis procedure after delivery and when the bath has been completed, but no lotion is applied
B
A client at 19 weeks gestation with a history of hypertension and asthma is diagnosed with a missed abortion. The client says that she would like to resolve the loss as soon as possible, but would also like to bond with the baby. The client is admitted for delivery. What are the best options for this client. SATA. Dilations and curettage Cytotec/misoprostil administration Low dose oxytocin protocol Hemabate/carboprost administration Dilation and evacuation Laparotomy
B C
The nurse is assisting a client who is prepared to use the paced breathing method. What information is accurate? Take a deep relaxing breath with the beginning of the contraction. Exhale all the air that she is holding as the contraction builds. Have her pant at the beginning of the contraction and take cleansing breaths with the acme of the contraction. Encourage her to take 3 long breaths with the beginning of the contraction, 2 short breaths in the middles, and one long exhalation with descent of the contraction.
A
A client has received methotrexate IM for resolution of ectopic pregnancy. What is the most important follow up information to impart to this client? If you experience sharp unilateral abdominal pain, seek medical care immediately Be certain to avoid pregnancy for a year with oral contraceptives Be sure to consume a balanced diet with no restrictions Take your prenatal vitamins and iron for 6 weeks
A
A laboring primigravida complains of increasing rectal pressure and an urge to push. A vaginal exam reveals 10cm/100%/+1. The priority in this scenario is: Educate the client on effective pushing techniques The client should not push with contractions The baby is high in the pelvis, and the woman will need to push for 1-2 hours The baby has descended well into the birth and the client will need to wait until she is a +3 station to push
A
A nurse is assessing a client at 36 weeks gestation who is diagnosed with pregnancy associated hypertension. The nurse would be most concerned when: The contraction stress test is positive The fundal height is 36.5cm The non-stress test is non-reactive The cord Doppler studies are less than 3
A
A nurse is performing a contraction stress test (CST) on a high risk antepartum client who is 35 week gestation, diagnosed with pre-eclampsia. The nurse interprets the CST as positive. What is the priority in this scenario? Perform UNCOIL techniques and notify the HCP Notify the HCP and recommend an amniocentesis Discontinue the external fetal monitoring and educate the client on how to perform fetal movement counts Perform acoustic stimulation and continue to monitor the fetal state
A
A nurse is visiting a breastfeeding client at home 2 weeks post-delivery of a 7 pound infant boy via C/S. The lochia is serosa with the... a midline fundus palpated as firm in the symphysis pubis area. Her nipples are cracked. The client is crying and reports her uterine cramping and nipple pain as a 6 out of 10. The client yells a... the baby for crying. What is the nursing priority in this scenario? Performs a head to toe assessment on the newborn Encourage the client to join a postpartum support group Educate the client to take motrin around the clock Evaluate the client's latching on and off procedures
A
A patient is admitted to the L&D unit with vaginal bleeding. To differentiate between placenta previa and placental abrutption, the nurse will assess? Abdominal pain FHR pattern Pad counts Hgb & Hct counts
A
A pregnant patient is notified that her triple screen is positive for neural tube defects. The nurse will anticipate that the next appropriate test is: Ultrasound Amniocentesis Percutaneous blood sampling (PUBS) Alpha-feto protein
A
After stabilizing the newborn infant of a mother diagnosed with gestational diabetes, the priority is Assess the infant's glucose level and observe closely for signs and symptoms of hypoglycemia Assess the infant for macrosmonia and perform the gestational age assessment Dubowitz Assess the infant's glucose level and observe closely for signs and symptoms of hyperglycemia Assess the infant for Ortoloni's click and the integrity of the clavicles
A
Based on the following pelvic and fetal assessment, which should best indicate probable success for a vaginal delivery? Anthropoid, ROA Gynecoid, RSA Platypelloid, LSA Android, ROA
A
Four pregnant women indicate to the nurse that they wish to breastfeed their babies. Which mother should be advised to bottle feed her child? A mother with a current and active history of heroin use A mother who received the Rubella vaccination A mother who received the Rhogam injection. A mother who plans to smoke outside of the house
A
Labor epidurals are placed with the mother in: The sitting position The prone position The left lateral position The supine position
A
On Examination the nurse notes the cervix is 8/90/+2, what is the interpretation of the client's labor? Fetal descent is going well Vaginal delivery will occur in 1 hour Fetal head is not engaged External rotation is complete
A
The best way to prevent hypothermia in the newborn is to: Place the baby on the mother's chest and dry with warm blankets Bathe the infant while under the radiant warmer Wrap the baby in 2 warm blankets with a hat on the head Place the infant under the radiant warmer for 30 minutes
A
The most likely reason for increased bleeding during the immediate postpartum period is: Uterine Atony Retained placental fragments Delivery of a macrocosmic infant Lacerations
A
The nurse caring for a laboring client knows that increased cardiac output during labor has many systemic effects on the mother and the fetus. Which nursing intervention BEST demonstrates the nurse's knowledge of this concept. Positioning the patient on her side promotes optimal circulation and prevents vena cava syndrome Placing the mother in high fowlers increases stroke volume Placing the client in supine position with the head of bead elevated 30 degrees promotes FHR accelerations Elevated blood pressure (>160/90) improves uteroplacental circulation
A
in the outpatient obstetric setting, consistency in measurement of blood pressure techniques must be maintained to ensure that the nuances in the variation of the VP readings are not the result of provider error. Which techniques are important in obtaining accurate BP readings in the outpatient setting? SATA the client should be seated the client's arm should be placed at the level of the heart an electric bp device should be used the cuff should cover a minimum of 60% of the upper arm the same arm should be used for every reading
A, B, E
Select all infants who are considered appropriate for gestational age: A preterm infant whose height and weight are at the 80th percentile and the head circumference is at the 90th percentile A posterm infant whose head circumference and length are at the 85th percentile and the weight is at the 90th percentile An infant whose height and weight are at the 95th percentile and the head circumference at the 90th percentile A term infant whose height, weight, and head circumference are all at the 5th percentile A term infant whose height, weight, and head circumference all fall between the 50th and 75th percentile A term infant whose weight and length are at the 60th percentile and the head circumference is at the 35th percentile
A, B, E, F
What specific information should the nurse provide the client undergoing amniocentesis? SATA The test is done during U/S guidance Numbing medicine is used if desired or necessary There are no significant risks to the mother or fetus that need to be discussed You will need to be NPO prior to the test A tight abdominal bandage will need to remain in place for 12 hours You will need to empty your bladder prior to the procedure
A, B, F
The BP of a pregnant client at 24 weeks becomes low when the client lies on the back. What would the best nursing intervention to maintain a normal BP? Start an IV and administer a bolus of 500mLs Turn the patient to her left side Encourage the client to sit on the side of the bed for at least 5 minutes Have the client stand and take deep cleansing breaths
Answer: B
A client just delivered a baby at 39 weeks. She delivered her first child at 38 weeks, second child at 39 weeks, and her third pregnancy was twins delivered at 35 weeks. What is her obstetric history? SATA G5 P3105 G4 P3105 G4 P3205 G5P5 G4P4 G4P3
Answer: B & E
A 24 year old HIV negative male has decided that he is ready to experiment with his sexuality. He is currently dating a male and a female who both report being sexually active with 1-2 other partners. Pre-exposure prophylaxis (PrEP) therapy is prescribed. What is the most important information to impart to this client about PrEP therapy? Educate the client on the benefits of higly active antiviral therapy in conjuction with PrEP therapy Eduated the client on safe sex practices and strategies for increasing the use of condoms. PrEP is not effective against pregnancy; therefore the female client should use some form of birth control He should take PrEP the night before or day after engaging in high risk sexual behaviors
B
A G44004 is 15 minutes post spontaneous vaginal delivery. Her baby weighted 4,300 grams. Initially, which complication should the nurse monitor, considering the patient scenario? Elevated blood pressure Hemorrhage from uterine atony Increased risk of thrombosis Maternal hyperglycemia
B
A breastfeeding woman has been educated on how to avoid engorgement. Which of the following actions by the mother shows that teaching was effective? She pumps her breasts after each feeding She feeds her baby every 2-3 hours She feeds her baby 10 minutes on each side She wears cabbage leaves for 24 hours a day
B
A client diagnosed with severe pre-ecalmpsia is prescribed hydralazine/apresoline 5mg IV push now for an escalating blood pressure. Her last BP was 180/118. The nurse administeres the medication. What is an expected finding after administering the medication? The BP will stabilize at 110/60 The BP will stabilize at 150/80 The client will experience a decrease in her HA, scotoma, reflexes, and epigastric pain The client's urine output will increase from 20mL/hr to 60 mL/hr
B
A patient at 35 weeks gestation has been in the hospital for 3 weeks with premature onset of labor. The fetal heart rate is 130s and reactive. The physician is considering delivery of the infant. Which diagnostic tool/test would be appropriate to suggest for the patient at this time? Cord Doppler studies Amniocentesis Biophysical profile Transvaginal ultrasound
B
A patient diagnosed with Type 1 diabetes presents to prenatal visits at 20 weeks gestation. The glycosylated HgA1c level at 10% at this visit. The nurse knows that many complications can arise with pre-existing diabetes. The most important prenatal testing relevant at this time is Maternal serum glucose Fetal echocardiogram NST Glucose tolerance test
B
An 18 year old female client is scheduled to receive her first dose of Gardasil. What information is important to impact to the client? Once you complete all of the doses, then you will no longer be at risk for contracting cervical cancer related to HPB. If you experience any swelling or hives, then you need to seek medical treatment. This vaccine increases the risk of developing cervical cancer; pap smears are recommended yearly. Since you are abstinent and only plan on having sex once you're married, then you are not a candidate for this vaccination.
B
An adolescent client admits to the nurse that she is unsure of her ability to be a good mother. She further states that she is having trouble making a connection with the baby. The nurse notes that the infant spends a lot of time in the crib except for when the mother is bottle feeding or changing the baby. What is the best way to assist and address the client's concern? Educate the mother on the advantages of breast feeding Demonstrate the en face position to the client and other methods to facilitate bonding Encourage the mother to attend parting classes with other adolescents Contact the social worker and report the client's conerns
B
At birth, an infant is placed under a radiant warmer, dried off, and stimulated. The infant exhibits central cyanosis and is breathing 14 breaths/minute with no crying, tone is flaccid, HR is 90 and decreasing. What is the priority? Begin bath and mask and chest compressions Position the infant's head in the sniff position Chart the Apgar score as a 2 Administer blow by oxygen
B
Brisk reflexes, scotoma, and headaches are pre-curses to which harmful complication associated with pre-eclampsia? Decreased tissue perfusion to liver Seizures HELLP syndrome Intrauterine growth restriction
B
Erythromycin ointment is administerd to newbors to: Prevent staph infections in the eye Prevent neonatal blindness Prevent hemorrhagic disorder Prophylactically treat group B strep
B
In evaluating the intensity of a contraction, the nurse palpates the fundus and describes a mid to moderate contraction as the surface of a: Nose Chin Cheek forehead
B
In order to be eligible to discharge home with a diagnosis of pre-eclampsia, the client must meet all of the following criteria except? Live within 30 minutes of the nearest hospital The last seizure was 12 hours ago Be able to perform and monitor kick counts Be able to monitor weight and blood pressure and return if symptoms worsen
B
On admission to the maternity unit, a mother reports smoking 2 packs of cigarettes per day and plans to continue smoking after delivery. The mother reports that she would like to breastfeed her baby. The nurse's response is based on Breastfeeding is contraindicated in this scenario Breastfeeding is protective and should be encouraged A 2-pack-a-day smoker should be reported to child protective services for child abuse A mother who admits to smoking is likely to be abusing other illicit substances
B
The female athlete triad includes which common menstrual disorder? Dysmenorrhea Amenorrhea Menorrhagia Menorrhagia
B
The nurse palpates a distended bladder on a woman who delivered vaginally 5 hours earlier. The woman refuses to go to the bathroom, "I really don't need to go." Which of the following responses is the most appropriate? Okay I must be palpating your uterus That feeling is most likely due to the effects of the anesthesia, but you still need to try in order to empty your bladder. You still must be numb from the local anesthesia That is a problem, I will need to catheterize you
B
The nurse should be aware that the most common side effect/complication of an epidural are all of the following except: Hypotension Hypertension Increased maternal temperature Bladder distension
B
To reduce the risk for complications associated with an infant with ABO incompatibilities, it is most important for the nurse to monitor: Serum WBC count Serum bilirubin level Blood type with Rh factor Temperature
B
What causes variable decelerations? Head compression Cord compression Uteroplacental insufficiency Hypotension associated with the epidural
B
What is the most important aspect of education for the patient receiving a single dose of intramuscular methotrexate/trexall for resolution of ectopic pregnancy? Avoid pregnancy for one year Follow up in 3-7 days with an obstetrician Continue to take prenatal vitamins Follow up with an oncologist
B
When considering the pathophysiology related to preexisting diabetes; which of the following statements is most accurate An increase in maternal hormones during the 1st trimester decreases maternal insulin production The placenta is the major source of insulin resistance in the 2nd and 3rd trimesters A decrease in maternal hormones during the 2nd trimester triggers an increased production of insulin Maternal insulin levels are directly proportional to infant levels in the 1st trimester
B
Which client is the best candidate for PrEP therapy? A 22 year old HIV negative nurse who is currently not sexually active but works in an HIV unit in the prison A 28 year old client who is HIV negative and is in a monogamous relationship with her HIV positive husband who started antiviral therapy during the past month A 42 year old male who is HIV positive and refuses to use condoms during intercourse A 14 year old HIV negative male who is questioning his sexuality but reports that he plans to remain a virgin until he is emotionally prepared to engage in intercourse
B
Which infant best fit the criteria for having a Dubowitz/Gestational Age Assessment/Ballard exam? A 39 week baby at one hour of birth whose mother received consistent prenatal care A two hour old 38 week baby whose mother received inconsistent prenatal care A 2 day old 32 week infant whose mother received no prenatal care A 6 hour old infant born at 37 weeks to a heroin addicted mother whose prenatal care started 4 weeks ago
B
Which intervention would help prevent development of postpartum thrombophlebitis? Promote adequate oral fluid intake Promote early ambulation Place sequential compression devices on all patients Administer subcutaneous low molecular weight heparin
B
Which of the following findings would support a nurse WITHOLDING IV Narcotic administration for management of labor pain? Client request for an epidural Minimal variability of the FHR for an hour Sterile vaginal exam 8/100/+1 FHR accelerations for 60 seconds twice in 20 minutes
B
The postpartum nurse is educating a new nurse on important aspects of assessment and treatment with venous thromboembolism in the postpartum population. Select all that apply. Assess the Homan's sign once a shift and as needed Bed ridden or Cesarean section clients will wear the compression stockings/devices until ambulation is achieved Assess the color, presence of edema, pain, and pulses in the legs and feet once a shift and as needed Educate the clients to report tenderness and pain in their calves Promote early ambulation with postpartum clients
B, C, D, E
Which clients are at greatest risk for developing or may have not been diagnosed with pre-eclampsia? SATA A 27 year old client who is pregnant for the second time. She experienced a miscarriage with her first pregnancy A 17 year old client who is pregnant for the first time A 39 year old client who is pregnant for the 5th time. She has a different partner. Her last delivery was 12 years ago A 29 year old client who was recently diagnosed with intrauterine growth restriction A 32 year old client who is pregnant with her third child and has been diagnosed with gestational diabetes mellitus A 25 year old client pregnant at 37 weeks with her second baby. There are no problems noted in her record except her GBS is positive
B, C, D, E
The nurse is teaching a group of women about home pregnancy tests. Which instructions does the nurse include in the lesson? SATA The test may be performed anytime during the day Make sure to follow the manufacturer's instructions If the test is positive, then contact your HCP for a follow-up If the test is negative, then contact your HCP for a follow-up If the test is negative and you continue to experience amenorrhea, then repeat the test in a week
B, C, E
A woman diagnosed with pre-eclampsia is admitted to the ob unit. She begins to experience a seizure. The nurse's primary duty during the seizure is to : Place the fetus on the fetal monitor Stay with the patient and call for help Insert an oral airway Turn the client on her side and support her head Suction the patient's mouth to prevent aspiration Start magnesium sulfate with a 6 gram bolus over 30 minutes
B, D, F
The nurse understands that HELLP syndrome can lead to many deleterious effects for the mother and the fetus. SATA. Cirrhosis Placental abruption Placenta previa Disseminated intravascular coagulation Macrosomia Seizures
B, D, F
A nurse is explaining probable signs of pregnancy to a client. Which signs are under this category? SATA Heart tones noted on an ultrasound Positive urine pregnancy test Quickening noted by the mother Amenorrhea Positive Chadwick's sign Ballottement
B, E, F
There are many associated risk factors in the development of placenta previa. SATA Jogger with low body mass index First time mother who smokes 2 PPD RN who works 3 busy 12 hour shifts a week on a med-surf floor A client who delivered at 32 weeks SVD with her last pregnancy due to pre-eclampsia Infertility client pregnant with triplets A client who has a history of two previous C/S
B, E, F
A 25 year old client is admitted at 12 weeks gestation for vaginal bleeding, no fetal heartbeat seen on ultrasound. The client is experiencing what type of loss and what is an appropriate treatment? Incompetent cervix, cerclage placement Missed abortion, amniocentesis Inevitable abortion, dilation and curettage Incomplete abortion, cytotec (misoprostil) induction
C
A G3P2 at 40 weeks gestation is lying on her back when the nurse is placing the external fetal heart monitors. The client suddenly states, "I am dizzy. I feel as if I'm going to faint." Which of the following actions should the nurse take FIRST: Request internal fetal monitor placement Ask the patient to breathe into her cupped hands Help the patient to turn onto her left side Take the patient's blood pressure
C
A client at 20 weeks gestation is notified that the results of her maternal serum alpha-fetoprotein (MSAFP) are low. What anticipatory guidance and/or follow up should the nurse impart to the client? Education regarding the outcomes of infants born with Down's Syndrome. Further testing is indicated via chorionic villus sampling Further testing is indicated via an ultrasound and amniocentesis Education regarding outcomes of infants born with open neural tube defects.
C
A client at 24 weeks gestation is admitted to the ED after sustating severe internal injuries during an MVA. The nurse suspects internal bleeding and placental abruption. The suspicion is verified by which of the following findings: Early decelerations on the EFM Kleiaure Betke is positive Late decels are noted on the EFM The BP was 110/58 an hour ago and is 108/56 now
C
A client at 34 weeks is status post cerclage placement in the recovery room. Which finding is most concerning? Temperature of 97.6 and the client reports feeling cold The fetal heart rate is 125 and the client denies feeling any movement The client reports some mild lower abdominal cramping There is a 1cm size spot of her pinkish red discharge on her pad
C
A client is at 16 weeks gestation. Approximately what level would the nurse expect the fundal height to reside. At the level of the umbilicus At the level of the symphysis pubis Slightly below the umbilicus Slightly above the umbilicus
C
A laboring client has progressed from 5 cm to 7 cm in 3 hours. When evaluating the contraction pattern of women in the active phase of labor with internal fetal monitors (IUPC), the nurse is MOST concerned by which of the following assessments: Intensity 50-75 mmHg, resting tone 5 mmHg Contractions irregular with consistent duration of 80-90 seconds Contractions every 2-3 minutes, with resting tone 35mmHg Contractions every 2-4 minutes, duration 60-80 seconds
C
A nurse assesses a breast feeding client's breast on day 4 post cesarean section. The breasts are firm and warm to touch. What is the priority in this scenario? Notify the HCP and recommend a lactation suppressant Educate the client to express milk from her breasts every 3 hours Intermittently apply cool/lukewarm compresses to the breast axillae areas Apply lanolin/lansinoh to her nipples every 2-3 hours
C
A nurse is caring for a client at 34 weeks gestation. The cervical exam is 3cm dilated, 50% effaced, and -3 station. The fetal heart rate is 130's and reactive, contractions are every 5 minutes. What intervention/assessment is most important at this time? A contraction stress test Administration of medications that inhibit uterine contractions Antibiotic administration A biophysical profile
C
A nurse is reviewing the pre-eclamptic client's assessment findings and lab values. The client is 32 weeks and is receiving mag. Which finding would warrant a call to the HCP? The client reports there is no change in her headaches and rates it at a 4. The 24 hour urine has 200mg of protein The AST, ALT and LDH are all elevated from the labs performed 4 hours ago The platelet level has dropped to 120,000
C
A woman G4P0210 is admitted at 12 weeks gestation for cerclage placement. Which of the following long-term outcomes is appropriate for this patient? The patient will gain less than 25 pounds during the pregnancy The baby will be classified as appropriate for gestational age at birth The patient will deliver as close as term as possible The patient will now have a normal pregnancy
C
A woman enters triage who state she "thinks" shes is in labor. Which assessment best demonstrates true labor? Leopold's Maneuvers Contraction strength Vaginal examination FHR
C
A woman is 8 months pregnant. She tells the nurse that she knows her baby listens to her, but her husband thinks she is imagining things. Which response by the nurse is most appropriate? Many pregnant women imagine what their baby is doing in utero You need to direct your questions to your HCP At this gestation, the baby is able to hear and respond to voices Thinking that your baby can hear will help you bond
C
A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and note that it is 20% lower than the baseline level. Which action should the nurse take? Encourage the patient to empty her bladder Stop the IV infusion and notify the anesthesiologist Turn the client to her left side and increase the IV rate No action is necessary as the drop in BP is an expected finding.
C
After completeing the Ballard Assessment, the nurse determines that the infant's weight is at the 95%; height at the 85%; and head circumference at the 50%. Based on this the nurse would classify the infant as: SGA LGA AGA Not enough info
C
After completing the Ballard Assessment, the nurse determines that infant's weight is at the 95%; height at the 95%; and head circumference at the 95%. What is the classification and what problems should the nurse anticipate? AGA, no apparent problem SGA, hyperglycemia LGA, hypoglycemia Symmetrical IUGR, neurological deficits
C
An HIV positive mother is admitted for a scheduled cesarean section at 39 weeks. The client wants to participate in kangaroo care. The nurse honors the request. Which action or finding is most concerning? The infant is on the mother's chest with only a diaper and blankets on the back side The axillary temperature is 97.9 degrees F The mother is using a nipple shield to help the baby latch on The father of the baby places the baby skin to skin when the mother becomes tired
C
An essential component of counseling women regarding safe sex practices includes a discussion regarding avoiding the exchange of body fluids. The most effective physical barrier promoted for the prevention of STIs and HIV is the condom. To educate the client about the use of condoms, which information related to condom use is the most important? Safe places to store condoms Leaving the decision up to the partner Strategies to enhance condom use Choice of condom colors and special features
C
An hour old infant has the following vital signs: Temperature = 97.9, Pulse = 142, respiratory rate = 44. Over the last 15 minutes, the infant has been jittery. What is the nursing priority? Assess the infant for sneezing and high pitched shrill cry Turn the radiant warmer up by one degree Celsius and reassess the temperature in 15 minutes Assess the infant's glucose level via heel stick Send the umbilical cord segment for drugs of alcohol abuse
C
An insulin dependent diabetic G3P0200 at 12 weeks gestation is being seen for her prenatal visit. Which finding is most concerning? Blood sugar level 140 mg/Dl 2 hours after lunch HgA1c 6% HgA1c 9% Fasting blood sugar is 80
C
At 36 weeks of pregnancy, a woman experiences preterm labor. She started her prenatal care at 25 weeks gestation and her due date is not certain. The fetal heart rate tracing is interpreted as a Category I tracing. The client continues to experience regular contractions. The cervical exam is unchanged at 2 cm/75%/-1. The health care provider is considering delivery of the infant. What is an important assessment at this time? Contraction stress test Biophysical profile Amniocentesis Chronic villus sampling
C
During the latent phase, the client asks the nurse if she can walk for 30 minutes. The nurse assesses the mother and her fetus prior to allowing her to ambulate. Assessment includes: vaginal exam (1cm, 40%, 0 station); FHR baseline is 160 and reactive; and contractions every 4-6 minutes and strong in intensity. What is the most appropriate nursing action Deny the request to ambulate Leave on the monitor and reassess the fetal heart pattern in 30 minutes Allow the client to walk for 30 minutes Assess the maternal temperature
C
In the first trimester, which practice by the mother is most concerning? Smoking ½ pack of cigarettes every 2-3 days Vegan diet and lifestyle Occasional consumption of beer and wine on the weekends Sedentary lifestyle
C
The due date is june 9th. What is the gestational age on February 20th? 23 4/7th weeks 24 weeks 24 3/7th weeks 6 months
C
The nurse is performing the initial assessment on a multigravida client at 16 weeks gestation. The client is a 36 year old Hispanic female, BMI 28, and she reports being in good health. The client asks when the screen for gestational diabetes will be done. The nurse responds. You do not need to be screened unless you have a family history of diabetes You will need a hemoglobin A1C drawn today We will schedule a screening test next visit in 4 weeks The screening test will be done between 24-28 weeks gestation
C
Upon examining a patient on day 2 after spontaneous vaginal delivery, a nurse finds the perineal pad to be completely saturated with bright red blood over the last 15 minutes. The priority in this scenario is: Start a second IV line of NS Notify the HCP Massage the fundus Assess vital signs
C
What causes late decelerations? Head compressions Cord compressions Uteroplacental insufficiency Eating veal chops
C
What is the most important information to impart to a postpartum client who is scheduled to receive a Rubella injection? We will need to retest your blood at your postpartum visit in 6 weeks. This vaccination will help you not to spread rubella to your infant. Use some sort of birth control or abstinence for a month If you plan to breastfeed, then we will need to delay the vaccination for 6 weeks
C
When assessing fetal station during a vaginal examination, the nurse should assess which pelvic structure? Cervical OS Cervical effacement Ischial spines Ischial Tuberosity
C
When assisting a laboring mother into a comfortable position, she requests ambulation/walking. The fetus is vertex and contractions are irregular. Based on this request, the nurse will need to evaluate all of the following except: FHR assessment Vaginal exam Fetal position Amniotic membrane status
C
Which of the following characteristics and characteristics with preterm infants? Many creases in hands and feet Decreased amount of vernix and a copious amount of lanugo Large labia minora; small majora Well flexed extremities
C
What is the best description of the attached placenta? SATA Succinturiate Vasa previa Battledore Velamentous Placenta abruption
C, D
Many side effects are likely to occur due to epidurals during the postpartum period. SATA Difficulty breathing Retained placenta fragments Urinary retention Return of sensation is gradual and varies but usually returns in 4-6 hours The infant may experience difficulty latching on
C, D, E
Normal vaginal childbirth, cardinal movements
Cervix dilation and effacement, engage and descent, internal rotation, external rotation
A G2P1 at 40 weeks gestation presents to triage and reports, I think I'm in labor. My contractions are 4-5 minutes apart, I had a gust of clear vaginal fluid about 15 minutes ago. In prioritizing care for this client, the nurse should FIRST: Assess a sterile cervical exam Assist the HCP in the collection of the amnisure test Assess the client's vital signs Place the client on the external fetal monitor
D
A breastfeeding mother experienced retained placental fragments and postpartum hemorrhage. Which of the following breastfeeding complications would the nurse expect to see? Engorgement Blocked milk duct Mastitis Low breast milk supply
D
A client at 32 weeks gestation is being monitored for intrauterine growth restriction (IUGR). The fundal height measures 29cm. in addition to the ultrasound assessment, which test is helping in assessing IUGR more precisely? Daily fetal heart movement counts Non-stress test (PUBS) Doppler blood flow studies
D
A client diagnosed with HELLP syndrome at 28 weeks is being induced with oxytocin. Mag is also infusing at 2g an hour. The SVE is 1cm/20%/-1. The contractions are regular. The last platelet count was 95,000 down from 105,000 four hours previous. The client desires an epidural. The anesthesiologist has agreed to place the epidural. What is the nursing priority? Advise the client to refuse the epidural as this is an unsafe situation Follow the chain of command in the institution and notify the nurse manager Continue with the plan of care and begin a 1,000mL fluid bolus to combat hypotension Confer with the anesthesiologist and recommend that coagulation labs be performed
D
A nurse is assessing a patient on magnesium sulfate due to pre-eclampsia. The nurse knows that magnesium is effective when? The uterine contractions are spacing out The patient's blood pressure is down from 140/90 to 110/58 The fetal heart rate variability goes from moderate to minimal The patient's reflexes down from 3+ and 2 beats of clonus bilaterally to 2+ and no clonus
D
A nurse is caring for a laboring client at 40 weeks gestation who is a type 1 diabetic. The client is placed on an insulin drip. The client's last glucose level was 125, what is the most appropriate nursing action? Leave the insulin drip at the current rate Decrease the insulin drip per protocol Discontinue the insulin drip Increase the insulin drip per protocol
D
A nurse is reviewing the pre-eclamptic patient's assessment findings and lab values. Which finding would warrant a call to the physician? Deep tendon reflex of 3+, 0 clonus 24 hour urine with a protein level of 200mg negative contraction stress test urine output of 100mL over the last 4 hours
D
A nurse palpates a round object in the fundal region of the uterus. The smooth contour of the back is noted on the mother's left side. What is the most likely presentation? RSA ROA LScT LSA
D
A nurse receives report on four mother and baby couplets. Which clients should the nurse assess first? A mother post C/S 8 hours ago requesting pain medication. The baby is in the NBN. A mother who slept uninterrupted for 8 hours who reports a saturated perineal pad. Infant is at the breast. A mother who calls out to report that her infant's hands and feet are cyanotic. A mother who calls out stating that an employee without the MBU ID badge is going to take her NB for an X-ray.
D
A patient at 33 weeks gestation has been on the external fetal monitor for 40 minutes and the strip is determined to be non reactive. The nurse suspects that the infant is in a sleep cycle, the priority in this scenario is? Notify the HCP immediately Ask the father to sing to the mother's pregnant abdomen in order to wake the fetus Instruct the patient to walk for 30 minutes Perform acoustic stimulation
D
A pregnant client with a positive triple screen for down's syndrome asks the nurse what the advantage of chorionic villus sampling over an amniocentesis? The nurse's best response is: There is a decreased risk of hemorrhage with the CVS The CVS involves a blood test The risk of miscarriage is lower with the CVS With the CVS, you are able to get the results back at an earlier time in pregnancy
D
A pregnant woman is being discharged from the hospital after placement of cerclage due to a history of recurrent pregnancy loss secondary to an incomplete cervix. Discharge teaching should emphasize that: She will need to make arrangements so that she can be on strict bed rest at home She will need to deliver via cesarean section The patient will be place on antibiotics throughout the remainder of her pregnancy The presence of any uterine cramping or low back pain should be reported to her HCP
D
A primagravid women requests IV pain medication. The nurse assesses the mother and fetal monitor prior to administering Stadol. Assessment includes: vaginal exam (8 cm, 100%, +1 station); FHR baseline is 120's with occasional late decelerations; and strong contractions every 2-3 minutes. Prior to narcotic administration, the nurse is CONCERNED with: Contraction strength and pattern Plans for epidural placement Vaginal exam Fetal heart rate findings
D
A type 1 diabetic client at 8 weeks gestation is being counseled on her diet during pregnancy. What information is critical in managing the client's blood sugar levels? The client should target her pre-meal blood sugar between 100-120 The optimal diet includes 40% carbs, 30% fats, and 30% protein The total caloric intake should be around 1500-1800 calories due to hyperglycemia problems in the first trimester The client will need to schedule her meals and snacks without missing any meals throughout the day
D
After completeing all of the assessments on a postpartum client (BUBBLE LE), all of which were WDL, the nurse performs orthostatic vital signs. The BP decreased and pulse increased by 20%, and the client becomes dizzy. Temperature is 99.3 and respirations are 18. The nurse then reviews the laboratory values below. What is the priority in the scenario? Massage the fundus and administer oxytocin. Notify the physician and recommend a blood transfusion. Assess the client's temperature and recommend blood cultures be ordered and drawn Start an IVF bolus with LR's and notify the HCP
D
Fetal circulation is different from newborn circulation. The most accurate statement related to the function of fetal circulation is: Premature shunts allow mixing of oxygenated and deoxygenated blood to enter the lungs for oxygenation and then to be circulated to the peripheral tissues There is a direct mixing of maternal and fetal blood, which allows the fetus to receive adequate oxygenation and perfusion Most blood bypasses the lungs via the ductus venosus. By diffusion, the placenta allows for perfusion and adequate nutrients to be supplied to the developing fetus.
D
Following a negative contraction stress test on a client at 32 weeks gestation, the nurse is assured that teaching was effective when the client states: I'll call my husband to let him know that I'm going to be admitted to the hospital for further testing. I'll come into the hospital when I lose my mucous plug I'll need to come back next week to have the quad screen performed I'll monitor my baby's movement three times a day and contact my practitioner if I notice a decrease in movement
D
The nurse is discharging a paitent status post delivery of a molar pregnancy. The most significant aspect of teaching to the is patient emphasizes the importance of Avoiding pregnancy for 22 months Wearing sunscreen while on doxy Having an ultrasound performed once a year Having serial lab work completed
D
What condition would the semi-fowler's position be recommended? Dysmenorrhea Endometriosis Human papilloma virus Pelvic inflammatory disease
D
What is the most appropriate nursing action when late decelrations are noted on the external fetal monitor? Prepare the client for a cesarean section Perform acoustic stimulation Perform a sterile vaginal/cervical exam Change the clients position
D
What is the most appropriate nursing intervention for early decelerations? Administer oxygen at 10L via facemask Discontinue oxytocin/Pitocin Increase IVF Preform a sterile vaginal/cervical exam
D
