OB Exam 4

The health care provider (HCP) has informed the labor nurse that he believes the uterus has inverted in a primiparous client who has just given birth. Which findings would help to confirm this diagnosis? Select all that apply. A. hypotension B. gush of blood from the vagina C. inability to palpate the uterus D. intense, severe, tearing type of abdominal pain E. diaphoresis

ABCE

A nurse completes postpartum assessments on every shift. Which parameters should the nurse include in the assessment? Select all that apply. A. lochia B. bowel sounds C. appetite D. CBC E. bladder

ABE

Uterine _____________ involves retrogressive changes that return the uterus to its nonpregnant size and condition

involution

A postpartum client is experiencing thoughts and behaviors common to the taking-hold phase. Which items are characteristic of this phase? Select all that apply A. gives up fantasized image of her child and accepts the real one B. holds new child and breastfeeds without prompting C. expresses a strong interest in taking care of her child D. incorporates the neonate into the family unit

BC (taking-hold phase = when the mother is ready to take responsibility for her care, as well as her neonate's care)

Select the S/S of endometritis: A. edema B. foul-smelling lochia C. nausea D. lower abdominal tenderness E. urinary urgency

BCD

An enterocoele occurs when.... A. the small intestine bulges into the vagina B. the rectum sags and bulges into the vagina C. the bladder drops into the vagina

A

During what timeframe is it normal to have bright red lochia? A. Postpartum day 0-4 B. Postpartum day 0-7 C. Postpartum day 5-8 D. Postpartum day 0-14

A

REEDA is an assessment of the.... A. perineum B. entire female GU tract C. uterus D. cervix

A

Which instruction should the nurse offer a client as primary preventive measures to prevent mastitis? A. Perform handwashing before breastfeeding B. Avoid frequent breastfeeding C. Apply cold compresses to the breast D. Avoid massaging the breast area

A

A client was given an injection of Carboprost for uterine atony. In preparing to care for this client postpartum, the nurse should assess the client for which common adverse effect of the medication? A. nausea and diarrhea B. fever C. vertigo and confusion D. restlessness

AB

The accidental leakage of urine that occurs with increased pressure on the bladder from coughing, sneezing, laughing, or physical exertion A. Functional incontinence B. Mixed incontinence C. Urge incontinence D. Stress incontinence

D

Which measurement best describes postpartum hemorrhage? A. blood loss of 400 ml, occurring at least 24 hours after birth B. blood loss of 600 ml, occurring at least 24 hours after birth C. blood loss of 800 ml, occurring at least 24 hours after birth D. blood loss of 1,000 ml, occurring at least 24 hours after birth

D

Which med(s) are contraindicated in those w/ active cardiovascular disease, pulmonary, or hepatic disease? A. Misoprostol (Cytotec) B. Prostaglandin (PGF2a), Carboprost (Hemabate) C. Methylergonovine maleate (Methergine) D. Oxytocin (Pitocin) E. Dinoprostone (Prostin E2)

AB

A mother with a history of varicose veins has just delivered her first baby. The nurse suspects that the mother has developed a PE. Which data below would lead to this nursing judgment? Select all that apply. A. chest pain B. diaphoresis C. fever D. confusion E. cough

ABDE (left out the obvious one - SOB)

A nurse is explaining the risk factors associated with a client's postpartum depression. Which statements from the nurse are accurate about postpartum depression? Select all that apply. A. "PPD is a rare, only occurring in about 5% of women." B. "A risk factor is an unplanned pregnancy." C. Symptoms present for two weeks or more." D. "Symptoms often begin around 4 weeks postpartum." E. "It is much less common in multiparas."

BCD (often worse w/ multiparas)

When assessing the episiotomy site of a postpartum client who delivered 3 hours ago, the nurse would document which findings as expected? Select all that apply A. Redness B. Edema C. Bleeding D. Slight bruising E. Clear-yellow discharge

BD

The MOST common cause is of postpartum hemorrhage is.... A. hematomas B. uterine atony C. uterine prolapse D. placenta accreta

B (aka failure of the uterus to contract/retract after birth)

Lochia _______ occurs from postpartum days 10 to 14 A. serosa B. alba C. rubra

B (last of the stages, think of alba like albino because it's a whiteish/yellow color)

Select the following factors that place a patient a risk of an amniotic fluid embolism (AFE): A. Prolonged periods of sitting B. placental abruption C. Anemia D. MVC

BD (AFE = when amniotic fluid enters the mother's bloodstream)

The nurse is developing a care plan for a client with an episiotomy. Which interventions would be included for the nursing diagnosis acute pain related to perineal sutures? Select all that apply. A. Avoid the application of topical pain gels B. Apply an ice pack intermittently to the perineal area for 3 days C. Administer sitz baths three to four times per day D. Encourage the client to do Kegel exercises

CD (ice is applied during the first 24 hours, then heat is used)

True or false: afterpains improve with breastfeeding

False (they are worse due to the release of oxytocin)

True or false: afterpains are worse for first time mothers

False (they are worse for multiparous mothers because the uterus has been extended more times)

_____________ is an infectious condition involving the endometrium, decidua, and adjacent myometrium.

Metritis

While instructing the client about breast-feeding, which instructions should the nurse include to help the mother prevent mastitis? Select all that apply. A. Change the breast pads frequently. B. Expose your nipples to air part of the day. C. Wash your hands before handling your breast and breast-feeding. D. Release the baby's grasp on the nipple before removing the baby from the breast.

ABCD

The nurse plans to instruct the postpartum client who is breastfeeding about methods to prevent breast engorgement. Which measures should the nurse include in the teaching plan? Select all that apply. A. Breastfeed the neonate at frequent intervals B. Keep mom and baby together as much as possible C. Wear a supportive brassiere with nipple shields D. Use breast pump between feedings E. Feed the neonate 5 minutes per side on the first day

AB

A postmenopausal woman's pelvic organ prolapse is being treated with a pessary. Which action would be most important for the nurse to do? A. Advise the woman to use a lubricant when inserting it B. Ensure that she has a prescription for an estrogen cream preparation C. Have the woman make a follow-up appointment in about 6-12 months D. Teach the woman to remove the pessary twice a week for cleaning

B (postmenopausal women typically experience thinning of the vaginal mucosa, making them susceptible to vaginal ulceration with the use of a pessary. It's important that women use an estrogen cream to make the vaginal mucosa more resistant to erosion and to strengthen the vaginal walls)

The nurse finds that a client who gave birth 3 hours ago has completely saturated a perineal pad within 15 minutes. Which of the following actions should the nurse take? Select all that apply. A. Begin an intravenous infusion of lactated Ringer's solution B. Palpate the client's fundus C. Place the client in high Fowler's position D. Assess the client's vital signs

BD

A cystocele occurs when.... A. the small intestine bulges into the vagina B. the rectum sags and bulges into the vagina C. the bladder drops into the vagina

C

A nurse is caring for a client who has just received an episiotomy. The nurse observes that the laceration extends through the anal sphincter muscle but not through the anterior rectal wall. How does the nurse classify the laceration? A. First degree B. Second degree C. Third degree D. Fourth degree

C

A nurse is caring for a postpartum client diagnosed with von Willebrand disease. What should be the nurse's priority for this client? A. Check the lochia B. Monitor the pain level C. Assess the fundal height D. Assess the temperature

A (note, Von Willebrand disease is a congenital bleeding disorder)

The nurse palpates a client's fundus, and notes it is 1 in (3 cm) above the umbilicus and displaced to the right. What would be priority nursing actions? Select all that apply A. Have the client void and reassess the fundus B. Ask the client how many pads she is soaking per hour C. Massage the fundus and express clots D. Place the patient in semi-Fowler's position

AB

Select the following S/S of postpartum hemorrhage: A. agitation B. decreased urinary output C. decreased BP D. change in O2 sat E. bradycardia

ABCD

Which findings should lead the nurse to suspect that a client who had a cesarean birth 8 hours earlier is developing disseminated intravascular coagulation (DIC) and report to the health care provider (HCP)? Select all that apply. A. petechiae on the arm where the blood pressure was taken B. heart rate of 126 bpm C. abdominal incision dressing with bright red drainage D. platelet count of 80,000/mm3 (80 X 109/L)

ABCD

A client who is 3 days postpartum and breastfeeding her baby. The following assessment is made by the nurse: episiotomy area: red and edematous; breasts: firm and tender on palpation; fundus: firm 2 finger breaths below umbilicus. What nursing actions are indicated? Select all that apply. A. Suggest that the client apply cool compress to breasts B. Suggest the client take cool sitz baths twice a day C. Ask the client how often the baby feeds. D. Encourage the client to sit on a supportive device E. Obtain a swab for a culture and sensitivity

AC

Carboprost is prescribed for a woman experiencing postpartum hemorrhage. The nurse monitors the woman closely for which adverse effects? A. flushing B. uterine hyperstimulation C. HA D. seizures

AC

After discussing how to care for hemorrhoids, the nurse understands that which statement(s) by the class would require no further teaching? A. "I already have some pads with witch hazel at home." B. "I only eat a low-fiber diet." C. "My mom always used dibucaine." D. "Sitz baths worked the last time."

ACD

Select the following risk factors for endometritis: A. C-section delivery B. IV analgesics during labor C. Episiotomy D. Improper pericare E. Hx of endometriosis

ACD

The client is one day postpartum with an episiotomy. Teaching includes medications commonly used for the local relief of perineal pain due to episiotomy and/or laceration. Which medications does the nurse include in the client's teaching concerning pain? Select all that apply. A. witch hazel B. NSAIDs C. ASA D. benzocaine E. oxycodone/acetaminophen

AD (note these are both LOCAL anesthetics)

Methylergonovine is prescribed for a woman experiencing postpartum hemorrhage. The nurse monitors the woman closely for which adverse effects? A. N/V B. uterine hyperstimulation C. HA D. seizures E. HTN

ADE (Uterine hyperstimulation is an adverse effect of oxytocin)

The healthcare provider has prescribed methylergonovine maleate for postpartum hemorrhage. What would be a contraindication for a client who has been prescribed this medication? Select all that apply. A. history of asthma or acute inflammatory disease B. cardiac disease C. known drug sensitivity to methylergonovine maleate D. history of high blood pressure

BCD

What information should the nurse include in a teaching plan for first-time parents of a bottle-feeding term newborn? Select all that apply. A. All-term babies have well developed sucking skills. B. Fill the entire nipple of the bottle with formula. C. Do not prop the bottle. D. The husband can feed the baby the bottle whenever possible.

BCD (note, some term neonates are sleepy and do not suck well)

A nurse on a postpartum unit is teaching a new mother about babies using cues to communicate needs. What action suggests that the mother understands a newborn's cues? Select all that apply. A. The mother states she will seek cues only around feeding times B. The mother looks for nonverbal and behavioral cues C. The mother states she will seek cues when the infant is in an awake state D. The mother states that cues could be communicating, "I need something different"

BD

Which med(s) for postpartum hemorrhage are contraindicated in those w/ HTN? A. Misoprostol (Cytotec) B. Prostaglandin (PGF2a), Carboprost (Hemabate) C. Methylergonovine maleate (Methergine) D. Oxytocin (Pitocin) E. Dinoprostone (Prostin E2)

C

A client is in the first hour of her recovery after a vaginal birth. During an assessment, the lochia is moderate, bright red, and is trickling from the vagina. The nurse locates the fundus at the umbilicus; it is firm and midline with no palpable bladder. The client's vital signs remain at their baseline. What is the nurse's next action? A. Recheck hematocrit and hemoglobin B. Document the findings as normal C. Increase patient's IV rate D. Report the findings to the health care provider (HCP)

D (At any point in the postpartum period, the lochia should be dark in color, rather than bright red, and the volume should not be great enough to trickle/run from the vagina)

The nurse is caring for four postpartum client, monitoring them for postpartum infection. Which client is the priority due to current vital signs suggesting a postpartum infection? A. Client 35 hours postpartum with a temperature of 99.6°F (37.5°C) B. Client 20 hours postpartum with a temperature of 102.4°F (39.1°C) C. Client 25 hours postpartum with a temperature of 99.2°F (37.3°C) D. Client 30 hours postpartum with a temperature of 100.4°F (38°C)

D (Postpartum infection: a fever of 100.4°F (38°C) after the first 24 hours after childbirth, occurring on at least 2 of the first 10 days after birth, exclusive of the first 24 hours)

True or false: a high REEDA score of 13 indicates increased tissue trauma

True

True or false: the postpartum woman commonly exhibits bradycardia

True