OB Exam 2
Which statement made by the nursing student about the management of reduced cervical competence (premature dilation of the cervix) in a pregnant patient indicates effective learning?
"A prophylactic cerclage is used to constrict the internal os of the cervix."
The nurse has taught a postpartum patient about postpartum blues. Which statement given by the patient indicates effective teaching?
"I might feel like laughing one minute and crying the next."
After delivery, the primary health care provider (PHP) prescribes Rh immune globulin to a postpartum patient. The nurse asks the PHP, "What is the purpose of this medication?" Which is the best response by the PHP?
"It protects the patient's next baby from being affected by Rh incompatibility."
Which statement made by the nursing student about the management of molar pregnancy indicates effective learning?
"Suction curettage is the safest way of terminating molar pregnancy."
The nurse provides care to a non-breastfeeding mother after birth who reports tenderness in the breasts. Upon assessment, the nurse confirms the breasts are distended and teaches the patient about the physiology of the breasts for non-breastfeeding women. Which statement made by the patient indicates teaching was effective?
"The swelling is caused by a congestion of veins."
The nurse is preparing to administer rubella vaccine to a postpartum patient. What should the nurse tell the patient?
"You should use proper contraception for 1-3 months after the vaccination."
A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits what?
A RR of 10 breaths/min
A pregnant patient with chronic hypertension is at risk for placental abruption. Which symptoms of abruption does the nurse instruct the patient to be alert for?
Abdominal pain Vaginal bleeding Uterine tenderness
A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of what?
Abruptio placentae
Which is a priority nursing action when a pregnant patient with severe gestational hypertension is admitted to the health care facility?
Administer the prescribed magnesium sulfate.
An examiner who discovers unequal movement or uneven gluteal skinfolds during the Ortolani maneuver does what?
Alerts the health care provider that the infant has a dislocated hip
The nurse is caring for a postpartum patient. One day after delivery, the nurse assesses the lochia of the patient and finds that it is red and has a foul-smelling odor. What does the nurse conclude from this assessment?
An infection is present
While assessing a postpartum patient, the nurse finds that the patient has a fourth-degree laceration. What immediate interventions should the nurse perform while caring for the patient?
Apply an ice pack to limit edema during the first 12 to 24 hours.
While assessing a postpartum patient early in the morning, the nurse finds that the patient's perineal pad is completely saturated. What is the first step the nurse should take in this situation?
Ask the patient when she last changed her pad
A patient with severe gestational hypertension is prescribed hydralazine (Apresoline). What is a priority nursing intervention in this case?
Assess BP frequently
A postpartum patient is being prepared for discharge and is instructed to visit the clinic after 6 weeks for follow-up. When should the nurse discuss contraceptive options with the patient?
At the time of discharge
The nurse observes that intravenous (IV) administration of magnesium sulfate has resulted in magnesium toxicity in a pregnant patient with preeclampsia. The nurse immediately discontinues the infusion and reports to the primary health care provider (PHP). For which drug does the nurse obtain a prescription from the PHP?
Calcium gluconate
What are the possible causes of miscarriage during early pregnancy? Select all that apply.
Chromosomal abnormalities Endocrine imbalance Hypothyroidism Antiphospholipid antibodies
Which hypertensive disorders can occur during pregnancy?
Chronic hypertension Gestational hypertension Preeclampsia-eclampsia
The nurse observes that eclampsia has developed in a pregnant patient after starting magnesium sulfate therapy. What action does the nurse take?
Continue to administer magnesium sulfate per protocol.
The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms should the nurse expect to observe?
Decreased urinary output and irritability Ankle clonus and epigastric pain Platelet count of less than 100,000/mm 3 and visual problems
The nurse assesses a postpartum patient and finds that the patient has lochia rubra with a firm fundus at the level of the umbilicus. Which is the most important nursing intervention in this situation?
Document the findings and continue to monitor
While caring for an infant, which method should the nurse adopt to prevent heat loss due to evaporation?
Dry the infant immediately after a bath
An 8-month-pregnant patient presents with preeclampsia. Which clinical findings in the patient indicate that the disease has progressed to HELLP syndrome?
Elevated liver enzymes Low platelet count Hemolysis Hepatic dysfunction
The nurse is caring for a pregnant patient who just delivered a baby. The woman has continuous, heavy vaginal bleeding after the delivery. What should be the immediate medication intervention?
Exogenous oxytocin
The nurse helps a breastfeeding mother change the diaper of her 16-hour-old newborn after the first bowel movement. The mother expresses concern because the large amount of thick, sticky stool is very dark green, almost black in color. She asks the nurse if something is wrong. How should the nurse respond to this mother's concern?
Explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements
What instruction does the nurse provide to a pregnant patient with mild preeclampsia?
Fetal movement counts daily
What is the priority teaching tip the nurse should provide about bottle-feeding?
Hold the infant semi-upright
A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the health care provider, anticipating an order for what?
Hydralazine
A woman complains of excess vaginal bleeding after childbirth. The patient reports that the presence of excess blood is not continuous and denies any headaches or dizziness. What does the nurse suspect to be the cause of this excess bleeding?
Increased activity
What is the most prevalent clinical manifestation of abruptio placentae?
Intense abdominal pain
What is true of postbirth uterine/vaginal discharge (called lochia) ?
It should smell like normal menstrual flow unless an infection is present.
The postpartum patient reports to the nurse, "I am having intolerable pain after the delivery." Which conditions would cause the patient's afterpains?
Lactating, multiparous, multiple gestation
What parameter does the nurse check in the amniocentesis report of a pregnant patient to assess fetal lung growth?
Lecithin-to-sphingomyelin (L/S) ratio
As part of postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding patient who is 1-day postpartum. What do expected findings include?
Little if any change Small amount of clear, yellow fluid expressed
The nurse is caring for a patient who is in her immediate puerperium and reports profuse sweating, increased urinary output, and weight loss. What reason does the nurse identify for these manifestations?
Loss of excess tissue fluid
The nurse examines a patient 1 hour after birth. The patient's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. What is the nurse's initial action?
Massage the fundus
What is the basic mechanism for heat generation in newborns?
Metabolism of brown fat
The nurse notes that, when placed on the scale, the newborn immediately abducts and extends the arms, and the fingers fan out with the thumb and forefinger forming a "C." What is this response known as?
Moro reflex
A pregnant patient after 20 weeks of gestation reports painless, bright red vaginal bleeding. Upon assessment, the nurse finds that the patient's vital signs are normal. Which condition does the nurse suspect in the patient?
Placenta previa
After the delivery of a baby, the nurse instructs the patient to immediately start breastfeeding. Which complication is the nurse trying to prevent by giving this instruction?
Postpartum hemorrhage
Which is an important nursing intervention when a patient has an incomplete miscarriage with heavy bleeding?
Prepare the patient for dilation and curettage.
Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion?
Prepare the woman for an ultrasound and bloodwork.
What does the nurse include in the plan of care of a pregnant patient with mild preeclampsia?
Provide diversionary activities. Encourage the intake of more fluids. Recommend a support group
The nurse is caring for a family who has a newborn. The father appears to be very anxious and nervous when the newborn's mother asks him to bring the baby. Which nursing intervention is most beneficial in promoting father-infant bonding?
Provide education about the newborn while the father is present
A woman at 37 weeks of gestation is admitted with a placental abruption after a motor vehicle accident. Which assessment data are most indicative of her condition worsening?
Pulse (P) 112, respiration (R) 32, blood pressure (BP) 108/60; fetal heart rate (FHR) 166--178
Which intervention will help prevent the risk of pulmonary edema in a pregnant patient with severe preeclampsia?
Restrict total intravenous (IV) and oral fluids to 125 mL/hr.
Which maternal risk is associated with placenta previa?
Surgery related trauma
A postpartum patient who has an episiotomy is being discharged to home. Which instruction about medications is most important for the patient?
Take stool softeners regularly.
The nurse advises a postpartum patient not to give any water to her 1-month-old infant after breastfeeding. What is the reason for this advice?
The breast milk contains enough water to hydrate the child.
The nurse notes the infant's body temperature to be 38.5° C (101.3° F). Upon further assessment, the nurse finds that the infant has extension posture, dilated blood vessels of the skin, warm hands and feet, and an appearance of flushed skin. What does the nurse conclude from these findings?
The infant might have been swaddled in too many blankets
What could be the probable reason for scanty lochia in a postpartum patient?
The patient had a C-section
What does the nurse infer about the patient's condition from the finding of slightly bluish-colored milk expressed from the breasts of a postnatal patient?
The patient may be expressing mature milk.
The parent of a newborn reports to the nurse, "My baby has small, red papules on the face and hands." What response should the nurse give to the parent?
The skin reaction is normal
The nurse observes a student nurse providing care to a newborn immediately following birth. Which action made by the student nurse causes the nurse to intervene?
The student nurse leaves the newborn slightly damp after birth to avoid skin friction.
Why is vitamin K given to the newborn?
To help the baby's blood clot
The nurse is educating a lactating patient about feeding an infant. Why does the nurse ask the patient to breastfeed the child from either breast for longer durations?
To increase the caloric intake from fats
The nurse performs nasal and oral suctioning of a newborn immediately after birth. What is the reason for this nursing intervention?
To stimulate respiration
Perineal care is an important infection control measure. When evaluating a postpartum patient's perineal care technique, the nurse recognizes the need for additional instruction if the patient does what?
Uses the peribottle to rinse upward into her vagina
On reviewing the medical reports of a postpartum patient, the nurse finds that the patient has Homans' sign. What does the nurse interpret from this finding?
Venous thromboembolism (VTE)
The nurse taught new parents the guidelines to follow regarding the bottle-feeding of their newborn. They will be using formula from a can of concentrate. The parents would demonstrate an understanding of the nurse's instructions if they do what?
Wash the top of the can and can opener with soap and water before opening the can.
A postpartum patient has chosen not to breastfeed. What instructions should the nurse provide to the patient to prevent discomfort caused by breast engorgement?
Wear a well-fitted support bra. Use a breast binder. Apply ice packs on the breasts
The birth weight of a breastfed newborn was 8 lbs, 4 oz. On the third day the newborn's weight was 7 lbs, 12 oz. On the basis of this finding, what should the nurse do?
encourage the mother to continue breastfeeding since it is effective in meeting the newborn's nutrient and fluid needs.
The nurse is caring for a postpartum patient who reports dizziness upon standing. What does the nurse believe to be the most likely cause for this occurrence?
orthostatic hypotension
In helping the breastfeeding mother position the baby, what should nurses keep in mind?
whatever the position used, the infant is "belly to belly" with the mother.
