OB Exam 1

During a morning assessment, Melanie, who delivered a healthy baby girl two days ago, tells the nurse that the devil told her the baby will never be healthy unless Melanie leaves her in a bathtub of water. What should the nurse do at that time?

Press the call button for the charge nurse and provider to come immediately

The failure of the uterus to return to its prepregnancy state is called _________________.

Subinvolution

Syrah received an epidural an hour ago. Upon re-entering the room, the nurse notes that Syrah is sleeping soundly. Assessing her vitals, the nurse realizes Syrah is not sleeping soundly and may need Naloxone. What in her assessment findings would indicate this to the nurse?

Syrah's oxygen saturation is 88%, and respirations are 8

The nurse is performing an assessment on a patient 44 hours after an uneventful delivery. Which of the following would cause the nurse to suspect the patient is developing endometritis? Select all that apply.

Temperature of 101.2 F Suprapubic pain Foul smelling lochia Scant, odorless lochia

The nurse is educating a new mother on signs and symptoms to report once she and her infant are discharged home. Which statement by the mother indicates a need for further teaching?

"If my baby's soft spot is raised, I know it will go away in a few days"

A new nurse on the floor is describing the need for internal fetal monitoring to the nurse educator during a simulation drill. Which of the following statements made by the new nurse indicates a need for further education?

"Internal monitors can be placed in my patient any time there is a concern for fetal well-being"

The nurse is quantifying the blood loss for a patient experiencing a PPH. She has the following blood saturated items: 2 disposable chux pads - dry weight 22 gm 4 large peripads - dry weight 27 gm 1 ice pack peripad - dry weight 175 gm 1 plastic basin - dry weight 120 gm Total weight of all items including numerous large clots in the basin is 1,783 gm. What is the quantified blood loss in mL for this patient? Enter the numeral only. Do not enter the unit.

1336

A common way to prevent maternal hypotension in a patient receiving an epidural is which of the following?

Administer a bolus of IV fluids before epidural placement

Marcella is a G3P2002 who has arrived at the hospital in active labor at 38 weeks 2 days. FHTs are 145, she's contracting every 3 to 5 minutes, and she is rating her contraction pain at a 6 on a scale of 1 to 10. On sterile vaginal exam, her cervix is dilated to 6 cm, effaced 80%, the infant is at +1 station, and the position is RSA. With this information, what orders should you anticipate next?

Admit to labor and delivery, place an IV, collect type and screen, and a CBC. Notify the OR team of the need for a caesarean section.

When would be the most optimal time for the nurse to perform a newborn assessment?

After the infant has just finished nursing and is interacting with her parents

Once the infant reaches +4 station, it is at what maternal landmark?

At the pelvic outlet

Which one of these term infants would require gloves to be worn during handling by the nurse?

Baby girl Hunter, 2 hours old. Erythema toxicum, vernix in groin and axilla, born at home and placed skin to skin with mom where she has been since delivery

zQuiz One of the differences between postpartum blues and postpartum depression is which of the following?

Blues happen in the immediate postpartum, depression starts after a few weeks

Rooming-in, using cluster care to minimize interruptions, and limiting visitors are all examples of what type of nursing care?

Bonding-oriented

The nurse is performing an assessment on an infant who is 25 hours old. The nurse knows that which of the following findings could be a medical emergency and needs to be reported to the provider immediately?

CCHD results of 95% in the hand, 99% in the foot

The nurse assists the patient to the bathroom for the first time after delivery, and the patient asks her partner to get her supplies for her. The partner brings a clear squirt bottle with something floating in it, a container containing folded disposable clothes, and reusable peripads to the patient. On inquiry, the patient states the squirt bottle contains mineral water with rose petals and rose water for peri care. The disposable towels are soaked in witch hazel for additional cleansing and comfort, and the reusable pads are clean cotton pads that she will take home and wash. As her nurse, what is your best response?

Can I help you with your pericare and use of your personal supplies?

While assessing the tracing of a term laboring patient on continuous fetal monitoring, the nurse notes the fetal heart rate is 115 bpm with moderate variability. There are several early decelerations, along with a few accelerations that last 30 seconds and increase the heart rate by 20 bpm. What category of fetal heart tracing is this?

Category I

Julia, a G3P1011 at term, was admitted in active labor 6 hours ago. On admittance, she was dilated 5 cm, 70% effaced, and at 0 station. The nurse just checked her cervix and she was 7 cm, 80% effaced, and at 0 station. What is the suspected complication at this time?

Cephalopelvic disproportion

The nurse is palpating the uterus of a patient who has been in active labor for several hours. The nurse knows the contractions are of moderate intensity when they feel like a ___________.

Chin

While assessing a newborn's head, the nurse notes the anterior fontanelle is depressed. What could this indicate?

Dehydration

During an infant assessment at 20 hours of life on a newborn male, the nurse notes the following; periodic breathing, 38 respirations a minute, heart rate 143, temperature 37 C/98.6 F. Acrocyanosis, Mongolian spots bilaterally on buttocks, and brick red discoloration in the diaper. What are the nurse's next steps after documenting these findings?

Discuss these normal findings with the parents

During an infant assessment at 20 hours of life on a newborn male, the nurse notes the following: Periodic breathing, 38 respirations a minute, heart rate 143, temperature 37°C/98.6°F. Acrocyanosis, Mongolian spots bilaterally on the buttocks, and brick red discoloration in the diaper. What are the nurse's next steps after documenting these findings?

Discuss these normal findings with the parents of the infant

Place the maternal structures based on the cardinal movements of labor in the order in which they are reached.

Entering the maternal inlet Pelvic floor and cervix Levator ani muscles Under the pubic symphonysis

During discharge teaching with a patient who has experienced a DVT during labor and delivery and has been prescribed warfarin, the nurse is sure to emphasis avoiding which of the following? Select all that apply.

Excessive alcohol consumption MMR vaccine Ibuprofen Large amounts of green leafy vegetables

Heather, a term G2P1001, has been actively laboring and progressing through an unmedicated labor for the past 7 hours. She has remained calm and is using breathing techniques with her partner. After a particularly strong contraction, Heather begins to cry and states, "I just want it done, I can't do much more, how much longer will it take?" What stage and phase of labor is Heather in?

First stage, transition phase

Heather, a term G2P1001, has been actively laboring and progressing through an unmedicated labor for the past 7 hours. She has remained calm and is using breathing techniques with her partner. After a particularly strong contraction, Heather begins to cry and states, "I just wants it done, I can't do much more, how much longer will it take?" What stage and phase of labor is Heather in?

First stage, transition phase

The first line of treatment for uterine atony is ____________.

Fundal massage

A nurse is calling report to the provider of a patient who just came into OB triage actively laboring with delivery imminent. On the phone, the nurse states "Erika Jones, a 26-year-old G5P3104, is in triage contracting every 2-3 minutes with a reactive NST. Her cervix is 9 cm dilated, 100% effaced and the baby is ROA, +2 ration. Her membranes are intact, and vital signs are all within normal limits. She has had a normal healthy pregnancy and is stating she needs to push." What priority information is missing from this report?

Gestational age and EDD

Melody is a term 16-year-old G1P0 who was admitted several hours ago at 4 cm dilated, 40% effaced, and ballotable. She has been having moderate to strong contractions every 3-6 minutes. She hid her pregnancy until she went into labor and has had no prenatal care or prenatal preparation. She has been screaming through every contraction and asking for a caesarean section because "it just hurts too bad." On assessment 10 minutes ago, the provider states Melody is 4 cm dilated, 60% effaced, at -2 station, and not progressing well through the second stage of labor. What is Melody experiencing, and what would be the best actions to take at this time?

Hypertonic labor. Expect order for hydromorphone, warm shower and rest

Which of the following statements are true about intermittent auscultation (IA)?

IA results in fewer caesarean sections IA allows for increased freedom of movement IA should be started right after a uterine contraction has ended IA requires 1:1 care

Benefits of delayed cord clamping include all of the following except what?

Increased chance of maternal hemorrhage

Serena, a G4P2103, is 42 weeks 3 days pregnant and is being induced with oxytocin for being postdates. Her medical history shows she takes levothyroxine for hypothyroidism, she had an ectopic pregnancy 5 years ago, and her BMI is 23%. Which part of this information would indicate to the nurse that Serena is at risk for a PPH?

Induction

Which of the following statements are true about hyperbilirubinemia (jaundice)? Select all that apply.

It is classified as two separate forms of jaundice depending on when it appears Phototherapy can cause dehydration when used for jaundice Jaundice can occur due to birth trauma and inadequate elimination

The nurse knows if, while doing a vaginal exam, the fetus' occiput is located to the maternal anterior left, she will chart the position as which of the following?

LOA

Quinesha delivered an infant boy with an epidural in place 2 hours ago. The nurse is attempting to assist her to the bathroom when Quinesha states she has a "sudden really bad headache" and wants to lay down. On laying down, she states her head feels better. What should the nurse suspect is causing Quinesha's headache?

Leaking CSF

When suspecting a DVT, the nurse knows the provider will use ______________ as one of the most reliable diagnostic tools.

MRI

A patient has come to the emergency department complaining of aches, fatigue, breast pain, fever, and chills. What diagnosis would the nurse expect the provider to give to this patient?

Mastitis

The baseline FHR on a patient on admittance was 130 to 140 with moderate variability. Over the course of the last 5 hours, the FHR has risen to a baseline of 155 to 170. What does this most likely indicate?

Maternal infection

The nurse is caring for a G3P1102 patient while she labors. She is 38 weeks 4 days, her medical record shows a BMI of 36%, history of chronic hypertension, gallbladder removal 2 years ago, and her past pregnancies were uneventful. She had a reactive NST in OB triage when she arrived in active labor about 14 hours ago. She delivered approximately 15 mins ago and is showing signs of postpartum hemorrhage (PPH) with a QBL of 1,600 mL. Which of the following orders from the provider should you question?

Methylergonovine 0.2 mg IV every 2 hours for 3 doses

The mother of an 8-hour-old infant has requested the nurse to assess her infant's face. The grandmother of the infant is at the bedside stating, "Those pimples need popped". What skin condition is this?

Milia

The fundus is firm, midline, and at +1, but there is still a steady stream of bleeding. What should the nurse do?

Notify provider of the findings

Andrea had GDM during her pregnancy. She just delivered an infant girl who weighs 5,381 gm. What should the nurse do?

Perform a glucose check on the infant

Neada delivered an infant boy an hour ago. The delivery was routine except for meconium in the amniotic fluid. Apgars were 8/9, and the infant has transitioned well while skin-to-skin and just finished nursing. The nurse is at the bedside performing a head-to-toe assessment. Findings include caput, peeling skin around the hands and feet, an accessory nipple, and long fingernails. With this information, what gestational age would this infant most likely be?

Postdates

Jodi, a G3P2002, arrived in OB triage 18 minutes ago saying her contractions just started within the hour, but she's feeling pressure. On exam, the nurse finds Jodi completely dilated and effaced, and the infant crowning. The nurse is delivering the infant as the midwife walks into the room. What type of delivery is this, and what complication is Jodi at risk for?

Precipitous, PPH

A postpartum cesarean patient calls to the nurse's station and states it's painful to breathe and she feels like her heart is racing. The nurse enters the room to find the patient holding her chest and coughing. The patient says she's scared and can't catch her breath. What complication should the nurse anticipate the patient being diagnosed with?

Pulmonary embolism

During a morning assessment, Melanie, who delivered a healthy baby girl 2 days ago, tells the nurse that the devil told her the baby will never be healthy unless Melanie leaves her in a bathtub of water. What should the nurse do at that time?

Push the call bell for the charge nurse and provider to come in the room immediately

During and after every delivery, the nurse weighs the pads, linens, and any bloody items. This is called _____________________ .

Quantifying blood loss

Mariah is in active labor and being continuously monitored. FHR is 120 with moderate variability and contractions every 3-5 minutes. The nurse also notes decelerations that begin and end with the contractions. What is the appropriate nursing action to address these decelerations?

Reassure patient and support person that she and baby are doing well

Stacey is a new nurse on this unit but an experience labor and delivery nurse. She just received a reprimand for placing internal fetal monitors on a patient, a task she performed routinely at her previous unit in another state but is only done by the provider on this unit. What should Stacey have done to prevent this reprimand?

Review institution policies for differences in practice between facilities

Monique delivered 2 hours ago, and on routine fundal and perineal assessment, the nurse notes a firm fundus that is midline at the umbilicus and moderate bright red bleeding. Where is this bleeding likely coming from?

The cervix

To differentiate caput succedaneum from cephalhematoma, the nurse knows to palpate which structure?

The suture lines

Infant delivered 52 hours ago and is now having tremors, excessive sneezing, tachypnea, and has not slept for several hours.

This is a sign of heroin withdrawal

Which of the following statements about labor and delivery are true?

True labor can be defined as cervical change If the fetus isnt in a favorable position, the MD may turn them externally Every labor and delivery is different

Valerie is a 28-year-old G3P1011 at 37 weeks and 3 days who was just brought to OB triage by ambulance and is exhibiting signs of hypovolemia. On abdominal palpation, bony protrusions are felt. Vital signs are BP 95/55 mm Hg, HR 129, respirations 24 min, oxygen saturation 94%, temperature 36.7 C, and pain is a 4 on a scale of 1-10. Valerie states she began having contractions, but then had a sharp pain that wasn't a contraction and hasn't had any since. What obstetric emergency is Valerie experiencing?

Uterine rupture