OB Exam 2 EAQ

A nurse is caring for a mother and neonate. What is the priority nursing action to prevent heat loss in the neonate immediately after birth? Bottle feeding immediately after birth Dressing the newborn in a shirt and gown immediately Bathing the newborn in warm water as soon as possible Putting the naked newborn on the mother's skin and covering the infant with a blanket

Putting the naked newborn on the mother's skin and covering the infant with a blanket

The nurse admits a client in active labor to the birthing center. She is 100% effaced, dilated 3 cm, and at +1 station. What stage of labor has this client reached? First Latent Second Transitional

first

The nurse is assessing the newborn in the first hour after birth. Which findings does the nurse identify as normal for the newborn? Select all that apply. The newborn has a flat abdomen. The newborn weighs 6 lbs (2,700 g). The newborn's hands and feet appear cyanosed. The newborn does not blink in the presence of light. The circumference of the head is 33 cm (13 in).

newborn weighs 6 lbs newborns hands and feet cyanosed circumference of head 33cm

An expectant couple asks the nurse about the cause of low back pain in labor. The nurse replies that this pain occurs most often when the fetus is in what position? Breech Transverse Occiput anterior Occiput posterior

occiput posterior

On the second postpartum day a client mentions that her nipples are becoming sore from breastfeeding. What is the nurse's initial action in response to this information? Assess her breastfeeding techniques to identify possible causes. Provide a nipple shield to keep the infant's mouth off the nipples. Instruct her to apply warm compresses 10 minutes before she begins to breastfeed. Explain that she should limit breastfeeding to 5 minutes per side until the soreness subsides.

assess her breastfeeding techniques to identify possible causes

After performing Leopold maneuvers on a laboring client, the 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? Above the umbilicus in the midline Above the umbilicus on the left side Below the umbilicus on the right side Below the umbilicus near the left groin

below the umbilicus on the right side

A nurse teaches a woman who is planning to breastfeed how to relieve breast engorgement. The nurse determines that further teaching is necessary when the woman states that she will do what? Manually express breast milk Breastfeed the infant less frequently Apply warm compresses to both breasts Place cold compresses on the breasts just after breastfeeding

breastfeed the infant less frequently

What is the nurse's primary critical observation when assessing a newborn for an Apgar score? Heart rate Respiratory rate Presence of meconium Evaluation of the Moro reflex

heart rate

A vaginal examination reveals that a client's cervix is 90% effaced and dilated to 6 cm. The fetus's head is at station 0, and the fetus is in a right occiput anterior (ROA) position. The contractions are occurring every 3 to 4 minutes, are lasting 60 seconds, and are of moderate intensity. What should the nurse record about the client's stage of labor? Early first stage of labor Transition stage of labor Beginning second stage of labor Midway through first stage of labor

midway through the first stage of labor

The nurse is assessing several postpartum clients at the very beginning of her shift. Which problem does the nurse identify that might predispose a client to postpartum hemorrhage? Preeclampsia Multifetal pregnancy Prolonged first-stage labor Cephalopelvic disproportion

multifetal pregnancy

A community health nurse visits an infant who was born at home 24 hours ago. While assessing the infant the nurse identifies slight jaundice of the face and trunk. What should the nurse do next? A. Obtain a stat order for bilirubin level B. Plan for immediate admission to the hospital C. Document this expected finding D. Arrange for the infant to have phototherapy in the home

A. Obtain a stat order for a bilirubin level

A client is receiving an epidural anesthetic during labor. Which alteration in client status does the nurse recognize as a likely side effect of the anesthetic? Hypertension Urine retention Subnormal temperature Decreased level of consciousness

urine retention

A primigravida client gave birth by vaginal delivery 24 hours ago. Which findings would be considered normal? Fundus firm at the umbilicus; moderate lochia rubra; voiding quantity sufficient; colostrum present Fundus firm, one fingerbreadth above the umbilicus; scant lochia alba; voided twice, 500 mL, 400 mL; breasts heavy Fundus firm, two fingerbreadths above the umbilicus; moderate lochia serosa; voided once, 200 mL; colostrum present Fundus firm, two fingerbreadths below the umbilicus; moderate serosa alba; voiding quantity sufficient; breasts engorged

Fundus firm at the umbilicus; moderate lochia rubra; voiding quantity sufficient; colostrum present

Which information should the nurse include in the discharge teaching of a postpartum client? The prenatal Kegel tightening exercises should be continued. The episiotomy sutures will be removed at the first postpartum visit. She may not have a bowel movement for up to a week after the birth. She should schedule a postpartum checkup as soon as her menses returns.

The prenatal Kegel tightening exercises should be continued

A client who has had a cesarean birth appears upset. She has been having difficulty breastfeeding for two days and now asks the nurse to bring her a bottle of formula. What is the nurse's initial action? Obtaining the requested formula Administering the prescribed pain medication Assessing the client's breastfeeding technique Notifying the practitioner of the client's request to switch feeding methods

assessing the client's breastfeeding technique

What is the optimal nursing action for a client in active labor whose cervix is dilated 4 cm and 100% effaced with the fetal head at 0 station? Document the fetal heart rate every 5 minutes. Call the anesthesia department to alert the staff there of an imminent birth. Assist the client's coach in helping her with the use of breathing techniques. Suggest that the client accept the as-needed (PRN) medication for pain that has been prescribed.

assist the client's coach in helping her with the use of breathing techniques

A nurse is teaching a postpartum client the characteristics of lochia and any deviations that should be reported immediately. Which client statement indicates that the teaching was effective? "If I pass any clots, I'll notify the clinic." "I'll call the clinic if my lochia changes from red to pink." "I'll notify the clinic if my lochia starts to smell bad." "If my vaginal discharge continues for 3 weeks, I'll call the clinic."

"I'll notify the clinic if my lochia starts to smell bad."

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. How should the nurse respond? "These accelerations are a sign of fetal well-being." "These accelerations indicate fetal head compression." "Umbilical cord compression is causing these accelerations." "Uteroplacental insufficiency is causing these accelerations."

"These accelerations are a sign of fetal well-being."

The nurse is teaching participants in a prenatal class regarding breastfeeding versus formula feeding. A client asks, "What is the primary advantage of breastfeeding?" Which response is most appropriate? "Breastfed infants have fewer infections." "Breastfeeding inhibits ovulation in the mother." "Breastfed infants adhere more easily to a feeding schedule." "Breastfeeding provides more protein than cow's milk formula does."

"breastfed infants have fewer infections"

Twelve hours after a spontaneous birth a client's temperature is 100.4° F (38° C). What should the nurse suspect as the cause of this increase in temperature? Mastitis Dehydration Puerperal infection Urinary tract infection

dehydration

A client in labor is receiving an oxytocin (Pitocin) infusion. Which intervention is a priority for the nurse when repetitive late decelerations of the fetal heart rate are observed? Administer oxygen. Place the client on the left side. Discontinue the oxytocin infusion. Check the client's blood pressure.

discontinue the oxytocin infusion

Fetal heart rate tracing abnormalities are observed on the fetal monitor when a client in active labor turns to the supine position. Which nursing action is most beneficial at this time? Helping the client change her position Informing the client of the problem with the fetus Administering oxygen by mask to the client at 2 L/min Readjusting placement of the fetal monitor on the client's abdomen

helping the client change her position

The nurse is assessing clients on the postpartum unit for pain. The nurse knows which client will most likely complain of and/or experience more severe afterbirth pains? The client who is a grand multipara The client who is a breastfeeding primipara The client who had a vaginal birth for a first pregnancy The client who had a cesarean birth at 43 weeks' gestation

the client who is a grand multipara

The nurse is helping a mother breast-feed her newborn. What is the best indication that the newborn has achieved an effective attachment to the breast? The tongue is securely on top of the nipple. The mouth covers most of the areolar surface. Loud sucking sounds are heard during the 15 minutes spent at each breast. Vigorous suckling occurs for the 5 minutes the infant spends at each breast before falling asleep.

the mouth covers most of the areolar surface

Five minutes after birth, a newborn is pale; has irregular, slow respirations; has a heart rate of 120 beats/min; displays minimal flexion of the extremities; and has minimal reflex responses. What is this newborn's Apgar score? Record your answer using a whole number.

5

A nurse is assessing a newborn for signs of hyperbilirubinemia (pathologic jaundice). Which clinical finding confirms this complication? A. muscle irritability within 1 hr of birth B. neurologic signs during the first 24 hours C. jaundice that develops within 12-24 hrs D. jaundice that develops between 48-72 hrs

C. jaundice that develops in the first 12-24 hrs

The nurse is performing the nursery intake assessment of a 1-hour-old newborn. The assessment reveals that the newborn's hands and feet are cyanotic, and there is circumoral pallor when the infant cries or feeds. What action should the nurse perform based on these findings? Notify the practitioner, because circumoral pallor may indicate cardiac problems Notify the practitioner, because both signs are indicative of increased intracranial pressure Take no specific action, because both signs are expected in a newborn until 2 weeks of age Take no specific action, because circumoral pallor is an expected finding during feedings and periods of crying

Notify the practitioner, because circumoral pallor may indicate cardiac problems

A mother asks the neonatal nurse why her infant must be monitored so closely for hypoglycemia when her type 1 diabetes was in excellent control during the entire pregnancy. How should the nurse best respond? "A newborn's glucose level drops after birth, so we're being especially cautious with your baby because of your diabetes." "A newborn's pancreas produces an increased amount of insulin during the first day of birth, so we're checking to see whether hypoglycemia has occurred." "Babies of mothers with diabetes do not have large stores of glucose at birth, so it's difficult for them to maintain the blood glucose level within an acceptable range." "Babies of mothers with diabetes have a higher-than-average insulin level because of the excess glucose received from the mothers during pregnancy, so the glucose level may drop."

"Babies of mothers with diabetes have a higher-than-average insulin level because of the excess glucose received from the mothers during pregnancy, so the glucose level may drop."

How does the nurse know that a client at 40 weeks' gestation is experiencing true labor? Cervical dilation Membrane rupture Decreased fetal heart rate Intensification of contractions

cervical dilation

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

changing the client's position

What should the nurse include in the teaching plan for parents of an infant with phenylketonuria (PKU)? Testing for PKU is done immediately after birth. Cognitive impairment occurs if PKU is untreated. Treatment for PKU includes lifelong medications. PKU is transmitted by an autosomal dominant gene.

cognitive impairment occurs if PKU is untreated

A newborn's Apgar score at 5 minutes is 5. Which condition correlates with this low Apgar score? a. cerebral palsy b. genetic defects c. mental retardation d. neonatal morbidity

d. neonatal morbidity

A primiparous client reports to the maternity unit stating that her contractions are occurring every 5 minutes. Upon further inquiry the nurse learns that the client has not attended any childbirth classes. A cervical assessment reveals that she is in true labor. When is the best time for the nurse to include education on simple breathing and relaxation techniques? During the latent phase of the first stage of labor During the active phase of the first stage of labor During the active phase of the second stage of labor During the transition phase of the first stage of labor

during the latent phase of the first stage of labor

A newborn is circumcised prior to discharge from the hospital. What should the immediate postoperative care include? Keeping the infant NPO for 4 hours to prevent vomiting Encouraging the intake of alkaline fluids to reduce urine acidity Changing the dressing using dry, sterile gauze to maintain cleanliness Encouraging the mother to cuddle her baby to provide emotional support

encouraging the mother to cuddle her baby to provide emotional support

The nurse concludes that a positive contraction stress test (CST) result may be indicative of potential fetal compromise. A CST result is considered positive when the fetal heart rate shows what during contractions? Late decelerations Early accelerations Variable decelerations Prolonged accelerations

late decelerations

Before discharge, what suggestion should the nurse give to a nonnursing mother to help limit breast engorgement? Place raw cabbage leaves over the breast. Stop drinking milk for 1 week. Take an analgesic every 4 hours. Apply warm compresses to the breasts.

place raw cabbage leaves over the breast

The nurse plans to weigh a newborn. What is the most appropriate way to obtain the newborn's weight most accurately? Placing the naked infant on the scale Removing the infant's clothes except for the diaper before weighing Weighing the infant's clothes and then subtracting that weight from the clothed infant's weight Having the mother hold the infant while on an adult scale and subtracting the mother's weight from the combined weight

placing the naked infant on the scale

A newborn is experiencing cold stress while being admitted to the nursery. Which nursing goal has the highest immediate priority? Minimize shivering Prevent hyperglycemia Limit oxygen consumption Prevent metabolism of fat stores

prevent metabolism of fat stores

While assessing a newborn, the nurse notes that the infant's skin is mottled. What should the nurse's primary intervention be? Administer oxygen Offer an oral feeding Notify the practitioner Warm the environment

warm the environment