OB Exam 1

A nurse is teaching a childbirth class to a group of pregnant women. One of the women asks the nurse at what point during the pregnancy the embryo becomes a fetus. How should the nurse respond? 1 "During the eighth week of the pregnancy." 2 "At the end of the second week of pregnancy." 3 "When the fertilized egg becomes implanted." 4 "When the products of conception are seen on the sonogram."

"During the eighth week of the pregnancy."

A primigravida at 36 weeks' gestation is admitted to the birthing room with ruptured membranes and a cervix that is dilated 2 cm and 75% effaced. What is the priority question the nurse should ask? 1 "When is your expected date of birth?" 2 "How do you plan to manage your labor?" 3 "When did you eat your last meal?" 4 "How frequent are your contractions?"

"How frequent are your contractions?"

The nurse discusses the recommended weight gain during pregnancy with a newly pregnant client who is 5 feet 3 inches tall and weighs 125 lb. The nurse explains that with the recommended weight gain, at term the client should weigh about: 1 150 lb 2 140 lb 3 135 lb 4 130 lb

150 lb

A pregnant client who is scheduled for a nonstress test (NST) asks a nurse how the test can show that "my baby is all right." The nurse explains that it is a way of evaluating the condition of the fetus by comparing the fetal heart rate (FHR) with: 1 Fetal gestational age 2 Fetal physical activity 3 Maternal blood pressure 4 Maternal uterine contractions

Fetal physical activity

A nurse is assessing clients on the postpartum unit for pain. The client who will have more severe afterbirth pains is one who: 1 Is a grand multipara 2 Is a breastfeeding primipara 3 Had a vaginal birth for a first pregnancy 4 Had a cesarean birth at 43 weeks' gestation

Is a grand multipara

A pregnant client interested in childbirth education asks how the Lamaze method differs from the Read method. What should the nurse explain about the Lamaze method? 1 It is an easier method to teach and learn. 2 It provides relaxation and techniques that can be used during labor. 3 It is a natural approach based on childbirth without pain. 4 It avoids the use of pain-relieving medications during labor.

It provides relaxation and techniques that can be used during labor.

What are the indicators of nutritional risk in pregnancy in a client who is of normal weight? Select all that apply. 1 Smoker 2 Twin gestation 3 Hemoglobin of 12 g/dL 4 Term delivery 2 years ago 5 Caffeine intake of 180 mg/day 6 Fasting blood sugar of 80 mg/dL

Smoker Twin Gestation

Which statements by a client with hyperemesis gravidarum would confirm that the client needs further teaching? Select all that apply. 1 "I'll start drinking protein shakes." 2 "I'll start drinking plenty of fluids." 3 "I'll start limiting my carbohydrates." 4 "I'll lie down for at least 2 hours after I eat." 5 "I'll be sure to schedule rest periods throughout the day so I won't get tired."

"I'll start limiting my carbohydrates." "I'll lie down for at least 2 hours after I eat."

A client in her 10th week of pregnancy exhibits presumptive signs of pregnancy that the nurse may detect, including which of the following? Select all that apply. 1 Amenorrhea 2 Breast changes 3 Urinary frequency 4 Abdominal enlargement 5 Positive urine pregnancy test

Amenorrhea Breast changes Urinary frequency

A 22-year-old primigravida is admitted to the hospital in labor. After performing a vaginal examination, the nurse determines that the client's cervix is dilated 2 cm and 80% effaced and that the presenting part is at 0 station. What is the location of the presenting part? 1 Entering the vagina 2 Floating within the bony pelvis 3 At the level of the ischial spines 4 Above the level of the ischial spines

At the level of the ischial spines

A nurse is teaching a young primigravida about body changes during pregnancy. The nurse explains that most prenatal clients experience urinary frequency in the first trimester because of an increase in: 1 Estrogen level 2 Extracellular fluid volume 3 Kidney glomerular filtration 4 Bladder pressure from the enlarged uterus

Bladder pressure from the enlarged uterus

A client in her 30th week of gestation is in preterm labor, and the practitioner prescribes betamethasone (Celestone). The client asks the nurse why she is being given this drug. As a basis for the response the nurse takes into consideration that it: 1 Prevents chorioamnionitis 2 Increases uteroplacental exchange 3 Promotes neonatal pulmonary maturity 4 Is used to treat fetal respiratory distress syndrome

Promotes neonatal pulmonary maturity

Select the priority intervention for a pregnant client whose monitor strip shows fetal heart rate decelerations characterized by a rapid descent and ascent to and from the lowest point of the deceleration. 1. Elevating the legs 2. Repositioning the client from side to side 3. Increasing the rate of intravenous infusion 4. Administering oxygen by way of facemask

Repositioning the client from side to side

A nurse is teaching a prenatal class about the changes that occur during the second trimester of pregnancy. What cardiovascular changes should the nurse include? Select all that apply. 1 Cardiac output increases. 2 Blood pressure decreases. 3 The heart is displaced upward. 4 The blood plasma volume peaks. 5 The hematocrit level is lowered

Cardiac output increases Blood pressure deceases The heart is displaced upward

A pregnant woman reports nausea and vomiting during the first trimester of pregnancy. The nurse explains that an increase in which hormone is the precipitating cause of the nausea and vomiting? 1 Estrogen 2 Progesterone 3 Luteinizing hormone 4 Chorionic gonadotropin

Chorionic gonadotropin

A client in labor is receiving an oxytocin (Pitocin) infusion. What should the nurse do first when repetitive late decelerations of the fetal heart rate are observed? 1 Administer oxygen. 2 Place the client on the left side. 3 Discontinue the oxytocin infusion. 4 Check the client's blood pressure.

Discontinue oxytocin infusion

A nurse is observing the electronic fetal monitor as a client in labor enters the second stage. The nurse identifies early decelerations of the fetal heart rate with a return to the baseline at the end of each contraction. What does this usually indicate? 1. Maternal diabetes 2. Fetal cord prolapse 3. Maternal hypotension 4. Fetal head compression

Fetal head compression

A primigravida at 8 weeks' gestation is visiting the prenatal clinic for the first time. What should an assessment reveal at this time? 1 Lightening 2 Quickening 3 Goodell's sign 4 Braxton Hicks sign

Goodell's sign

The four essential components of labor are powers, passageway, passenger, and psyche. Passageway refers to the bony pelvis. What type of pelvis is considered the most favorable for a vaginal delivery? 1 Android 2 Anthropoid 3 Gynecoid 4 Platypelloid

Gynecoid

A client at 42 weeks' gestation is admitted for a nonstress test. The nurse concludes that this test is being done because a prolonged pregnancy can: 1 Cause polyhydramnios 2 Lead to placental insufficiency 3 Predispose the client to postpartum infection 4 Indicate the presence of subclinical gestational diabetes

Lead to placental insufficiency

The nurse is teaching parents about the side effects of immunization vaccines. What expected side effect associated with the Haemophilus influenzae (Hib) vaccine should the nurse include in the teaching? 1 Urticaria 2 Lethargy 3 Low-grade fever 4 Generalized rash

Low grade fever

A nurse is assessing the rate of involution of a client's uterus on the second postpartum day. Where does the nurse expect the fundus to be located? 1. At the level of the umbilicus 2. One fingerbreadth above the umbilicus 3. Above and to the right of the umbilicus 4. One or two fingerbreadths below the umbilicus

One or two fingerbreadths under the umbilicus

A client in labor is having an indwelling urinary catheter inserted. What should the nurse plan to do to prevent late decelerations of the fetal heart rate during this procedure? 1 Position both the client's legs simultaneously. 2 Urge the client to take deep breaths frequently. 3 Place a rolled towel under the client's right hip. 4 Loosen the transducer belts around the client's abdomen.

Placed a rolled towl under the client's righr hip

A client at 40 weeks' gestation is admitted to the birthing unit in labor. During the initial examination the nurse uses Leopold maneuvers to palpate the abdomen. The purpose of this intervention is to assess the:

Position of the fetus

A nurse administers two serial intramuscular injections of betamethasone (Celestone) to a woman at 32 weeks' gestation who has been admitted in preterm labor. The nurse knows that this medication is given to: 1 Stop the process of labor. 2 Increase placental perfusion. 3 Stimulate surfactant production. 4 Reduce intensity of contractions.

Stimulate surfactant production

A client at 7 weeks' gestation tells a nurse in the prenatal clinic that she is sick every morning with nausea and vomiting and adds that she does not think she can tolerate it throughout her pregnancy. The nurse assures her that this is a common occurrence in early pregnancy and will probably disappear by the end of the: 1 Fifth month 2 Third month 3 Fourth month 4 Second month

Third month

A couple is concerned about the risks associated with an in vitro fertilization embryo transfer (IVF-ET).Which of the following is a risk factor associated with IVF? 1 Embryonic HIV 2 Tubal pregnancy 3 Congenital anomalies 4 Hyperemesis gravidarum

Tubal pregnancy

All women of childbearing age are advised to include at least 400 micrograms of folic acid in the daily diet to lessen the risk of neural tube defects in pregnancy. What should the nurse recommend to meet the recommendation? Select all that apply. 1 Vitamin A 2 Vitamin B6 3 Vitamin B9 4 Vitamin B12 5 Legumes, dark-green leafy vegetables, and citrus fruits 6 Eggs, meat, and poultry

Vitamin B9 Legumes, dark leafy vegetables, and citrus fruits

A client attending a prenatal class about nutrition tells the nurse that she is a strict vegetarian (vegan). What should the nurse encourage the client to eat that includes all the essential amino acids? 1. Macaroni and cheese 2. Whole-grain cereals and nuts 3. Scrambled eggs and buttermilk 4. Brown rice and whole-wheat bread

Whole grain cereals and nuts

What information in a postpartum client's health history should alert the nurse to monitor the client for signs of infection? 1 Three spontaneous abortions 2 B-negative maternal blood type 3 Blood loss of 850 mL after a vaginal birth 4 Temperature of 99.9º F (37.7° C) during the first postpartum day

Blood loss of 850 mL after a vaginal birth

How does the nurse distinguish true labor from false labor? 1. Cervical dilation is progressive. 2. Contractions stop when the client walks around. 3. The client's contractions progress only when she is in a side-lying position. 4. Contractions occur immediately after the membranes rupture.

Cervical dilation is progressive

A primigravida at 12 weeks' gestation complains of nausea and vomiting during a visit to the prenatal clinic. Which pregnancy hormone should the nurse explain is thought to be responsible for nausea and vomiting during the first trimester?

Human chorionic gonadotropin (hCG

A nurse is planning a childbirth education class about maternal psychological and physiological changes as pregnancy nears term. Which problems and concerns should the nurse include in the presentation? Select all that apply. 1 Food cravings increase. 2 Nesting needs increase. 3 Dependency needs decrease. 4 Anxiety about childbirth increases. 5 Gastrointestinal motility decreases.

Nesting needs increase Anxiety about childbirth increases GI motility decreases

A primigravida tells the nurse that she has morning sickness. What suggestion should the nurse make to help relieve the nausea? 1 Eating three small meals a day 2 Increasing dietary calcium intake 3 Avoiding long periods without food 4 Drinking 2 quarts or more of fluid a day

Avoiding long periods without food

A pregnant woman in her second trimester arrives at the local health department, requesting a flu shot. The client states that she gets the flu vaccine every year and has never had an adverse reaction. What action should the nurse perform? 1 Do not administer the vaccine until checking with the physician. 2 Do not administer the vaccine due to pregnancy contraindication. 3 Administer the usual dose of the vaccine. 4 Administer half the usual dose of the vaccine.

Administer the usual dose of the vaccine.

A multiparous client presents to the labor and delivery area in active labor. The initial vaginal examination reveals that the cervix is dilated 4 cm and 100% effaced. Two hours later the client experiences rectal pressure, followed by delivery 5 minutes later. How is this delivery best documented? 1 Precipitous vaginal delivery 2 Prolonged transitional phase 3 Primigravida primary delivery 4 Normal spontaneous vaginal delivery

Precipitous vaginal delivery

A multipara whose membranes have ruptured is admitted in early labor. Assessment reveals a breech presentation, cervical dilation of 3 cm, and fetal station at −2. For what complication should the nurse assess when caring for this client? 1 Vaginal bleeding 2 Urinary tract infection 3 Prolapse of the umbilical cord 4 Meconium in the amniotic fluid

Prolapse of the umbilical cord

A nurse is counseling a pregnant client who is a vegetarian. What should the nurse plan to do to ensure optimal nutrition during the pregnancy? 1 Refer the client to a dietitian to help plan her daily menu. 2 Encourage the client to join a group that teaches nutrition. 3 Explain that she needs to include meat in her diet at least once a day. 4 Advise the client that it is unhealthy to continue a vegetarian diet during pregnancy.

Refer the client to a dietitian to help plan her daily menu.

A nonstress test (NST) is scheduled for a client with mild preeclampsia. During the test, the client asks the nurse what it means when the fetal heart rate goes up every time the fetus moves. What should the nurse consider before responding? 1 These accelerations are a sign of fetal well-being. 2 These accelerations indicate fetal head compression. 3 Umbilical cord compression is causing these accelerations. 4 Uteroplacental insufficiency is causing these accelerations

These accelerations are a sign of fetal well-being.

A client at 32 weeks' gestation is admitted in active labor. Her cervix is effaced and dilated 4 cm. Intramuscular betamethasone (Celestone) 12 mg is prescribed. What should the nurse tell the client about why the medication is being given? 1 Cervical dilation is increased. 2 Fetal lung maturity is accelerated. 3 The risk of a precipitous birth is reduced. 4 The potential for maternal hypertension is minimized.

Fetal lung maturity is accelerated.

A client is admitted to the birthing unit in active labor. Cervical dilation has progressed from 2 to 3 cm over the previous 8 hours. The health care provider determines that the client has hypotonic dystocia, and an infusion of oxytocin (Pitocin) is prescribed to augment her contractions. What is the most important nursing action at this time? 1 Checking the perineum for bulging 2 Documenting the fetal heart rate and its variations 3 Preparing the client for an emergency cesarean birth 4 Monitoring the duration and intensity of the contractions

Monitoring the duration and intensity of the contractions

A pregnant client in the third trimester tells the nurse in the prenatal clinic that she has heartburn after every meal. What explanation should the nurse give about the cause of the heartburn? 1 "The esophageal sphincter relaxes and allows acid to be regurgitated." 2 "In pregnancy, gastric motility increases, causing a burning sensation." 3 "In pregnancy, gastric pH increases, causing acid to enter the esophagus." 4 "In pregnancy, the pyloric sphincter relaxes, allowing acid to enter the intestine."

"The esophageal sphincter relaxes and allows acid to be regurgitated."

A client who is pregnant for the first time asks the nurse about the changes in her body. While describing the changes in each body system, the nurse mentions that the system that undergoes the most profound change of all during pregnancy is the: 1 Urinary system 2 Endocrine system 3 Cardiovascular system 4 Gastrointestinal system

Cardiovascular system

A client at 11 weeks' gestation reports having to urinate more often. The nurse explains that urinary frequency often occurs because bladder capacity during pregnancy is diminished by: 1. Atony of the detrusor muscle 2. Compression by the enlarging uterus 3. Compromise of the autonomic reflexes 4. Narrowing of the ureteral entrance at the trigone

Compression by the enlarging uterus

A multipara is admitted to the birthing room in active labor. Her temperature is 98° F (36.7° C), pulse 70 beats/min, respirations 18 breaths/min, and blood pressure 126/76 mm Hg. A vaginal examination reveals a cervix that is 90% effaced and 7 cm dilated with the vertex presenting at 2+ station. The client is complaining of pain and asks for medication. Which medication should be avoided because it may cause respiratory depression in the newborn? 1 Naloxone (Narcan) 2 Lorazepam (Ativan) 3 Meperidine (Demerol) 4 Promethazine (Phenergan

Meperidine (Demerol)

Late decelerations are present on the monitor strip of a client who received epidural anesthesia 20 minutes ago. The nurse should immediately: 1 Reposition the client from supine to left lateral. 2 Increase the intravenous flow rate from 125 to 150 mL/hr. 3 Administer oxygen at a rate of 8 to 10 L/min by way of facemask. 4 Assess the maternal blood pressure for a systolic pressure below 100 mm Hg

Reposition the client from supine to left lateral.

After an emergency cesarean birth, the client tells the nurse that she was hoping for a "natural" childbirth but is glad that she and her baby are all right. Which postpartum phase of adjustment does this statement most closely typify? 1 Taking-in 2 Letting-go 3 Taking-hold 4 Working-through

Taking-in

While conducting prenatal teaching, a nurse should explain to clients that there is an increase in vaginal secretions during pregnancy called leukorrhea. What causes this increase? 1. Decreased metabolic rate Increased production of estrogen 3 Secretion from the Bartholin glands 4 Supply of sodium chloride to the vaginal cells

Increased production of estrogen

A nurse determines that a postpartum client's fundus is firm and has shifted to the right and two fingerwidths above the umbilicus 2 hours after giving birth. What should the nurse conclude about this finding? 1 Bladder fullness 2 Early involution 3 Retained secundines 4 Concealed hemorrhage

Bladder fullness

A nurse is teaching a childbirth preparation class. Which exercise should the nurse teach the women for toning the pelvic floor? 1 Pelvic tilt 2 Half sit-ups 3 Pelvic rocking 4 Kegel exercises

Kegel exercises

The nurse is caring for a client in transitioning labor and notes an early deceleration on the fetal heart monitor. Which intervention would be appropriate for the nurse to implement? 1 Administering oxygen at 12 L/min 2 Continuing to monitor fetal heart rate (FHR) tracing 3 Placing the client in a side-lying position 4 Stopping the oxytocin drip

Continuing to monitor the fetal heart rate (FHR) tracing

At 38 weeks' gestation a client is admitted to the birthing unit in active labor, and an external fetal monitor is applied. Late fetal heart rate decelerations begin to appear when her cervix is dilated 6 cm and her contractions are occurring every 4 minutes and lasting 45 seconds. What does the nurse conclude is the cause of these late decelerations? 1 Imminent vaginal birth 2 Uteroplacental insufficiency 3 Pattern of nonprogressive labor 4 Reassuring response to contractions

Uteroplacental insufficiency

What change does a nurse expect in a client's hematologic system during the second trimester of pregnancy? 1 An increase in hematocrit 2 An increase in blood volume 3 A decrease in sedimentation rate 4 A decrease in white blood cells

An increase in blood volume

After performing Leopold maneuvers on a laboring client, a nurse determines that the fetus is in the right occiput posterior (ROP) position. Where should the Doppler ultrasound transducer be placed to best auscultate fetal heart tones? 1 Above the umbilicus in the midline 2 Above the umbilicus on the left side 3 Below the umbilicus on the right side 4 Below the umbilicus near the left groin

Below the umbilicus on the right side

During a childbirth class, several participants have questions about the elective induction of labor. One participant states that it is more convenient for a woman with a busy schedule. What evidenced-based information should the nurse provide to the participant? 1 "Elective induction rates are dropping nationwide." 2 "Elective induction is recommended if the client has a classic uterine incision." 3 "The widespread use of elective induction increases the risk of unfavorable outcomes." 4 "There is no evidence that elective induction makes any difference in the labor experience.

"The widespread use of elective induction increases the risk of unfavorable outcomes."

A pregnant woman tells a nurse in the prenatal clinic that she knows that folic acid is very important during pregnancy and that she is taking a prescribed supplement. She asks the nurse what foods contain folic acid (folate) so she may add them to her diet in its natural form. Which foods should the nurse recommend? Select all that apply.

Black and pinto beans Enriched bread and pasta

A client's membranes rupture while her labor is being augmented with an oxytocin (Pitocin) infusion. The nurse observes variable decelerations in the fetal heart rate on the fetal monitor strip. What action should the nurse take next? 1. Changing the client's position 2. Taking the client's blood pressure 3. Stopping the client's oxytocin infusion 4. Preparing the client for an immediate birth

Changing the clients position

External fetal uterine monitoring is started for a client in active labor. A nurse identifies fetal heart rate decelerations in a uniform wave shape that reflects the shape of the contraction. What is the nurse's next action? 1 Notifying the health care provider of possible head compression 2 Placing the client in a knee-chest position to avoid cord compression 3 Putting the client in a dorsal recumbent position to prevent compression of the vena cava 4 Continuing to monitor the client for the return of the fetal heart rate to baseline when each contraction ends

Continuing to monitor the client for the return of the fetal heart rate to baseline when each contraction ends

A primigravida who is at 38 weeks' gestation is undergoing a nonstress test. The nurse determines that the baseline fetal heart rate is 130 to 140 beats/min. It rises to 160 on two occasions and 157 once during a 20-minute period. Each of the episodes in which the heart rate is increased lasts 20 seconds. What action should the nurse take? 1. Discontinuing the test because the pattern is within the expected range 2. Encouraging the client to drink more fluids to decrease the fetal heart rate 3. Notifying the primary health care provider and preparing for an emergency birth 4. Recording this nonreassuring pattern and continuing the test for further evaluation

Discontinuing the test because the pattern is within the expected range

On reporting to the labor and delivery area a primipara indicates to the nurse that her contractions are occurring every 5 minutes. Upon further inquiry the nurse learns that the client has not attended any childbirth classes, and a cervical assessment reveals that she is in labor. When is the best time for the nurse to include education on simple breathing and relaxation techniques? 1 During the latent phase of the first stage of labor 2 During the active phase of the first stage of labor 3 During the active phase of the second stage of labor 4 During the transition phase of the first stage of labor

During the latent phase of the first stage of labor

A pregnant client who is a strict vegetarian (vegan) asks the nurse if there is anything special she should do in relation to her diet. What should the nurse recommend? 1 Taking a vitamin supplement daily 2 Eating at least 40 g of protein each day 3 Drinking at least 1 quart of milk per day 4 Including specific nonanimal proteins in her daily diet

Including specific non-animal protein in her daily diet

At a client's first prenatal visit, the nurse-midwife performs a pelvic examination. The nurse states that the client's cervix is bluish purple, which is known as the Chadwick sign. The client becomes concerned and asks whether something is wrong. The nurse replies, "This is expected; it: 1. Helps confirm your pregnancy" 2. Is not unusual, even in women who are not pregnant" 3. Occurs because the blood is trapped by the pregnant uterus" 4. Is caused by increased blood flow to the uterus during pregnancy

It is caused by increased blood flow to the uterus

A client is admitted in active labor. The nurse, performing Leopold maneuvers, determines that the fetus is in the left occiput anterior (LOA) position. Where should the nurse place the transducer of the electronic fetal monitor? 1 Right lower midline 2 Left lower quadrant 3 Left upper quadrant 4 Right upper quadran

Left lower quadrant

An external monitor is placed on the abdomen of a client admitted in active labor. The nurse notes that during each contraction the fetal heart rate decelerates as the contraction peaks. What should the nurse do next? 1 Help the client into a knee-chest position to help prevent cord compression. 2 Notify the health care provider of the possibility of head compression. 3 Monitor the fetal heart rate until it returns to baseline when the contraction ends. 4 Place the client in a semi-Fowler position to prevent compression of the vena cava

Monitor the fetal heart rate until it returns to baseline when the contraction ends

Methods of relieving back pain are explained during a childbirth class. What activities identified by the client permit the nurse to conclude that the teaching has been understood? Select all that apply. 1 Tailor sitting 2 Pelvic rocking 3 Forward tilting 4 Sacral pressure 5 Kegel exercises

Pelvic rocking Forward tilting Sacral pressure

A strict vegetarian (vegan) becomes pregnant and asks the nurse whether there is anything special she should do in regard to her diet during pregnancy. What is most the important measure for the nurse to instruct the client to take? 1 Eat at least 40 g/day of protein. 2 Drink at least 1 quart/day of milk. 3 Take a vitamin supplemented with iron every day. 4 Plan to eat from specific groups of vegetable proteins each day.

Plan to eat from specific groups of vegetable proteins each day

A nurse is teaching a class of expectant parents about nutritional needs during pregnancy. What information should the nurse include? 1 Carbohydrate needs decrease during pregnancy. 2 Protein needs increase to at least 70 g/day during pregnancy. 3 Phosphorus and calcium needs decrease gradually throughout pregnancy. 4 Caloric needs increase gradually up to 100 more kcal/day throughout pregnancy.

Protein needs to increase to at least 70 g/day during pregnancy

A pregnant client who has a history of cardiac disease asks how she can relieve her occasional heartburn. The nurse should instruct the client to avoid antacids containing: 1 Sodium 2 Calcium 3 Aluminum 4 Magnesium

Sodium

A nurse places fetal and uterine monitors on the abdomen of a client in labor. While observing the relationship between the fetal heart rate and uterine contractions, the nurse identifies four late decelerations. What condition is most frequently associated with late decelerations? 1 Head compression 2 Maternal hypothyroidism 3 Uteroplacental insufficiency 4 Umbilical cord compression

Uteroplacental insufficiency