OB 2

A nurse is providing discharge teaching to a client who has a c-section 3 days ago. What instructions should the nurse include in the teaching?

You can still become pregnant if you are breastfeeding. The nurse should instruct the client that breastfeeding does not prevent ovulation. Therefore, the client can become pregnant. The nurse should discuss contraception that is safe to use while breastfeeding.

A nurse is teaching a client about nonpharmalogical pain management to a breastfeeding mother who is experiencing breast engorgement. The nurse should recommend application of what?

Cold cabbage leaves The application of fresh, raw cabbage leaves that have been chilled is an effective nonpharmacological method to relieve the pain associated with engorgement. The nurse should instruct the client to place the cabbage leaves on the breasts for 15 to 20 min, repeating the application for two to three sessions as needed. More frequent applications could decrease the client's milk supply.

A nurse is providing teaching to a client who has a new prescription for combined oral contraceptives. What finding should the nurse include as an adverse effect of this medication?

Depression The nurse should instruct the client that depression is a common adverse effect of combined oral contraceptives. Other common adverse effects of the medication include amenorrhea, weight gain, headache, nausea, breakthrough bleeding, and breast tenderness.

A nurse is creating a plan of care for a client who adheres to traditional Hispanic cultural beliefs. What cultural practices should the nurse include in the plan of care?

Protect the clients head and feet from cold air. Protecting the client's head and feet from cold air should be included in the plan of care because this is a traditional Hispanic practice during the postpartum period.

A nurse in an antepartum clinic is assessing a client who is at 32 weeks gestation. What finding should the nurse report to the provider?

Report of decreased fetal movement. The nurse should identify that a client who reports decreased fetal movement could be experiencing a complication related to fetal well-being. A decrease in fetal movement can indicate fetal distress.

A nurse is teaching a newly licensed nurse about collecting a specimen for the universal newborn screening. What statement should the nurse include in the teaching?

The nurse should ensure that the newborn has been receiving regular feedings for at least 24 hr prior to testing.

A nurse is caring for a client who is at 36 weeks gestation and has a prescription for an amniocentesis. For what reason would the nurse prepare the client for an ultrasound?

To locate a pocket of fluid An ultrasound is done to locate a pocket of amniotic fluid and the placenta prior to an amniocentesis. This decreases the risk of injury to the fetus.

What is the first step of leopold maneuvers?

During this step, the nurse palpates the client's abdomen with the palms to determine which fetal part is in the uterine fundus. This step also identifies the lie (transverse or longitudinal) and presentation (cephalic or breech) of the fetus.

A nurse is assessing a newborn who was born at 26 weeks gestation using the new ballard score. What finding should the nurse expect?

Minimal arm recoil The nurse should expect a newborn who was born at 26 weeks of gestation to have decreased muscular tone, or minimal arm recoil.

Antidote for morphine?

Naloxone (Narcan)

A nurse is performing a physical assessment of a newborn upon admission to the nursery. What manifestations should the nurse expect?

1. Acrocyanosis 2. Anterior fontanel larger than posterior 3. Two umbilical arteries visible 4. Positive Babinski reflex

Physical assessment of a newborn. What findings should the nurse expect?

1. HR: 154/min (110-160) 2. Axillary temp within 97.7-99.5 3. Respiratory rate between 30-60 4. Length between 45-55 cm 5. Weight between 5.5-8.8

A nurse is teaching a client about the physiological changes that occur during pregnancy. The client is at 10 weeks gestation and has a normal BMI. What should the nurse include in the teaching.

1. Weight gain of about 25-35 lbs during your pregnancy is normal. 2. I will likely need to use alternative positions during sex. The weight gain of pregnancy will likely require alternative positions for sexual intercourse. This client statement indicates that she understands the nurse's teaching about the physiological changes that occur during pregnancy.

Proper steps in order of how to bathe a newborn.

1. Wipe the eyes from inner canthus outwards. 2. Wash the neck by lifting the chin 3. Clean around umbilical cord stump 4. Wash legs and feet 5. Clean diaper area The nurse should demonstrate how to bathe a newborn by using a head to toe, clean to dirty, approach.

A nurse is caring for a client who is at 32 weeks gestation and is in preterm labor. The provider prescribed betamethasone 12 mg IM. What outcome should the nurse expect?

A reduction in respiratory distress in the newborn. Betamethasone is a glucocorticoid that is given to stimulate fetal lung maturity and prevent respiratory distress.

A nurse is assessing a group of newborns. What newborn finding would the nurse report to the provider?

A newborn who is 18 hours old and has an axillary temperature of 99.9 An axillary temperature greater than 37.5° C (99.5° F) is above the expected reference range for a newborn and can be an indication of sepsis. Therefore, the nurse should report this finding to the provider.

A nurse is a prenatal clinic is assessing a group of clients. What client should the nurse see first?

A client who is at 11 weeks gestation and reports abdominal cramping. When using the urgent vs nonurgent approach to client care, the nurse should determine that the priority finding is a client who is at 11 weeks of gestation and reports abdominal cramping. Abdominal cramping can indicate an ectopic pregnancy or manifestations of spontaneous abortion. The nurse should request that the provider see this client first.

A nurse is reviewing a clients prenatal lab results who is at 12 weeks gestation. What lab finding should the nurse report to the provider?

Hemoglobin 10g/dL A hemoglobin of 10 g/dL is below the expected reference range of greater than 11 g/dL for a client who is pregnant. The nurse should report this finding to the provider to obtain a prescription for ferrous iron supplementation because of anemia.

A nurse is caring for a client who is at 35 weeks gestation and is undergoing a nonstress test that reveals a variable deceleration on the FHR. What action should the nurse take?

Have the client change position Having the client change position is an appropriate intervention for a variable deceleration to relieve umbilical cord compression.

A nurse is performing an assessment on a client who is at 18 weeks gestation. What finding should the nurse expect?

FHR 152/min The expected range for the FHR is 110/min to 160/min. The FHR is higher earlier in gestation with an average of approximately 160/min at 20 weeks of gestation. Therefore, this is an expected finding by the nurse.

A nurse is assessing a client who received carboprost for postpartum hemorrhage. What finding is an adverse effect of this medication?

Hypertension The nurse should recognize that carboprost is a vasoconstrictor that can cause hypertension.

A nurse is providing teaching to a client who is at 40 weeks gestation and has a new prescription for misoprostol. What instructions should the nurse include?

I can administer oxytocin 4 hours after the insertion of the medication The nurse can administer oxytocin no sooner than 4 hr after the last dose of misoprostol. Oxytocin can be administered following misoprostol for clients who have cervical ripening and have not begun labor.

A nurse is teaching a client who is at 12 weeks gestation about nutrition during pregnancy. What statement by the client indicates understanding of the teaching?

I should take 600 micrograms of folic acid each day. A client who is pregnant should increase folic acid intake to 600 mcg daily. Folic acid assists with preventing neural tube birth defects.

A nurse is assessing a newborn 12 hours after birth. What manifestation should the nurse report to the provider?

Jaundice. A small amount of jaundice is normal in newborns but AFTER 24 hours of life. Before 24 hours and jaundice is indicative of a problem.

What is a contraindication of initiating an oxytocin infusion?

Late decelerations Late decelerations are indicative of uteroplacental insufficiency. Therefore, this is a contraindication for the administration of oxytocin and should be reported to the provider.

A nurse is caring for a client who has uterine atony and is experiencing postpartum hemorrhage. What action is the nurses priority?

Massage the clients fundus. Uterine atony and postpartum hemorrhage indicate that this client is at the greatest risk for hypovolemic shock. This can compromise the perfusion to the client's vital organs, which can lead to death. Therefore, the nurse's priority is to massage the client's fundus to minimize blood loss.

A nurse is caring for a client with preeclampsia who is receiving mag sulfate IV. What is the nurses priority intervention?

Monitor FHR continuously. Magnesium sulfate, which is used to prevent seizures in clients who have preeclampsia, is a high-alert medication that requires close monitoring. The FHR and uterine contractions should be monitored continuously while the client is receiving magnesium sulfate.

What is the nurses priority intervention after a patient undergoes an amniocentesis?

Monitor the FHR The greatest risk to this client and her fetus is fetal death. Therefore, the priority nursing intervention is to monitor the FHR following an amniocentesis.

A nurse is caring for a client who is at 38 weeks gestation. what action should the nurse take prior to applying an external transducer for fetal monitoring?

Perform Leopold maneuvers The nurse should perform Leopold maneuvers to assess the position of the fetus to best determine the optimal placement for the external fetal monitoring transducer.

A nurse is assessing a newborn who was delivered vaginally and experienced a tight nuchal cord. What finding should the nurse expect?

Petechiae over the head Nuchal cord, or the umbilical cord being wrapped tightly around the neck, can cause bruising and petechiae over the face, head, and neck.

A nurse is assessing a late preterm newborn. What manifestation is indicative of hypoglycemia?

Respiratory distress Late preterm newborns are at an increased risk for hypoglycemia due to decreased glycogen stores and immature insulin secretion. Respiratory distress is a manifestation of hypoglycemia. Other manifestations of hypoglycemia include an abnormal cry, jitteriness, lethargy, poor feeding, apnea, and seizures.

A nurse is caring for a prenatal client who has parvovirus B19. What action should the nurse take?

Schedule an ultrasound. The nurse should schedule serial ultrasound examinations to monitor the fetus during the pregnancy to detect the possible development of fetal hydrops. Also, the virus can cause miscarriage, intrauterine growth restriction, fetal anemia, or stillbirth.

A nurse is assessing a newborn who is 16 hours old. What finding should the nurse report to the provider?

Substernal retractions The nurse should identify that substernal retractions, apnea, grunting, nasal flaring, and tachypnea are manifestations of neonatal infection or respiratory distress in the newborn. The nurse should report these findings to the provider for immediate intervention.

A nurse is admitting a client who is in labor. The client admits to recent cocaine use. For what complication should the nurse assess?

Abruptio placenta Cocaine use increases the risk for vasoconstriction and possible abruptio placenta.

A nurse is caring for a client who is at 26 weeks gestation with epilepsy. The nurse enters the room and observes the client having a seizure. After turning the clients head to one side, what should the nurse do after the seizure?

Administer oxygen via a nonrebreather mask When using the airway, breathing, and circulation approach to client care, the nurse should place the priority on administering oxygen to the client via a nonrebreather mask at 10 L/min to ensure adequate oxygenation to the fetus.

A nurse is caring for a client who has hyperemesis gravidarum and is receiving IV fluid replacement. What finding should the nurse report to the provider?

BUN 25 mg/dL The nurse should report an elevated BUN to the provider since it can indicate dehydration. Pregnant BUN: 3-13 Nonpregnant: 7-20

A nurse is caring for a client who is at 36 weeks gestation and has a positive contraction stress test. The nurse should plan to prepare the client for what diagnostic test?

Biophysical Profile A positive contraction stress test indicates that further evaluation of the fetus is necessary. A biophysical profile will provide further evaluation with a real-time ultrasound.

A nurse is assessing a client who has severe preeclampsia. What manifestation should the nurse expect?

Blurred vision with this condition- can have arteriolar vasospasms and decreased blood flow to the retina which can lead to visual disturbances, such as blurred vision, double vision, or dark spots in the visual field.

What medication should the nurse prepare to give if the client is experiencing magnesium toxicity?

Calcium gluconate

A nurse is caring for a postpartum client who is receiving heparin continuously IV for thrombophlebitis in her left calf. What action should the nurse take?

Maintain the client on bed rest. The client should remain on bed rest to decrease the risk of dislodging the clot, which could cause a pulmonary embolism. Elevation of the affected leg is recommended.

A nurse is preparing to collect a blood specimen from a newborn via a heel stick. What technique should the nurse use to minimize pain?

Place the newborn skin to skin on the mothers chest. Placing the newborn skin to skin on the mother's chest is an effective technique to significantly decrease the newborn's pain level and anxiety. The nurse should implement this technique before, during, and after the procedure.

A nurse is reviewing a medical record of a women in her first trimester. what finding should the nurse identify as a risk factor for preeclampsia?

Pregestational DM Pregestational diabetes mellitus increases a client's risk for the development of preeclampsia. Other risk factors include preexisting hypertension, renal disease, systemic lupus erythematosus, and rheumatoid arthritis.

A nurse is caring for a client who is at 32 weeks gestation and has gonorrhea. The nurse should identify that the client is at increased risk for?

Premature rupture of membranes The nurse should identify that a client who is pregnant and has gonorrhea is at an increased risk for premature rupture of membranes, chorioamnionitis, preterm birth, neonatal sepsis, and intrauterine growth restriction.

A nurse is assessing a client who is at 36 weeks gestation. What finding should the nurse report to the provider?

Report of visual disturbances Visual disturbances such as blurred vision are a potential prenatal complication associated with hypertension. The nurse should report this finding to the provider so that additional fetal and maternal evaluation can be performed.

A nurse is caring for a client who is at 22 weeks gestation and is HIV positive. What action should the nurse take?

Report the clients condition to the local health department. The nurse should report the condition to the local health department. HIV is one of the conditions on the list of Nationally Notifiable Infectious Conditions that is required to be reported.

A nurse is assessing a client who has gestational DM and is experiencing hyperglycemia. What finding should the nurse expect?

Reports increased urinary output Increased urinary output, nausea and vomiting, reports of thirst, abdominal pain, constipation, drowsiness, and headaches are manifestations of hyperglycemia. Other manifestations include weak rapid pulse, fruity breath odor, urine positive for sugar and acetone, and a blood glucose level greater than 200 mg/dL.

A nurse is caring for a client who is at 24 weeks gestation and has suspected placental abruption. What lab test should the nurse expect the provider will order?

The nurse should expect the provider to prescribe a Kleihauer-Betke test for a client who has suspected placental abruption to determine if fetal blood is in maternal circulation. This test is useful to determine if Rho-(D) immune globulin therapy should be administered to a client who is Rh-negative.

A nurse performing a vaginal exam observes the umbilical cord protruding from the vagina. After calling for assistance, what action should the nurse take next?

The nurse should quickly apply gloves and insert two fingers into the vagina toward the cervix, exerting upward pressure onto the presenting part to relieve umbilical cord compression and increase oxygenation to the fetus.

A nurse is assessing a client who is 1 day postpartum and has a vaginal hematoma. What manifestation should the nurse expect?

Vaginal pressure The nurse should expect a client who has a vaginal hematoma to report pressure in the vagina due to the blood that leaked into the tissues.

A nurse is teaching a client about her new prescription for a nonstress test. What information should the nurse include?

You should press the handheld button when you feel your baby move. The nurse should instruct the client to press the handheld button when the fetus moves. This action will mark the fetal monitor tracing with the client's reports of fetal movement. This will assist in the interpretation of the nonstress test to determine if it is reactive or nonreactive.

A nurse is assessing a client who is at 38 weeks gestation during a weekly prenatal visit. What finding should the nurse report to the provider?

weight gain of 2.2 lbs in a week. This is above the expected weight gain and could be indicative of a complication.