OB Final Exam - Quiz 10
Which nursing intervention should be immediately performed after the forceps-assisted birth of an infant? Select one: a. Administering prophylactic antibiotic agents to the infant b. Assessing the infant for signs of trauma c. Applying a cold pack to the infant's scalp d. Measuring the circumference of the infant's head
The correct answer is: Assessing the infant for signs of trauma
Which statement related to cephalopelvic disproportion (CPD) is the least accurate? Select one: a. CPD can be accurately predicted b. The fetus cannot be born vaginally. c. Causes of CPD may have maternal or fetal origins. d. CPD can be related to either fetal size or fetal position.
The correct answer is: CPD can be accurately predicted
If nonsurgical treatment for late PPH is ineffective, which surgical procedure would be appropriate to correct the cause of this condition? Select one: a. Dilation and curettage (D&C) b. Laparoscopy c. Hysterectomy d. Laparotomy
The correct answer is: Dilation and curettage (D&C)
Augmentation of labor: Select one: a. Is part of the active management of labor instituted when the labor process is unsatisfactory and uterine contractions are ineffective b. Relies on more invasive methods when oxytocin and amniotomy have failed c. Is elective induction of labor d. Is an operative vaginal delivery that uses vacuum cups
The correct answer is: Is part of the active management of labor instituted when the labor process is unsatisfactory and uterine contractions are ineffective. Labor augmentation is the stimulation of ineffective UCs after the onset of spontaneous labor to manage labor dystocia. Lower doses of oxytocin are required but all of the principles pertaining to the use of oxytocin apply to augmentation.
What is the primary nursing responsibility when caring for a client who is experiencing an obstetric hemorrhage associated with uterine atony? Select one: a. Catheterizing the bladder b. Establishing venous access c. Performing fundal massage Correct! d. Preparing the woman for surgical intervention
The correct answer is: Performing fundal massage
The nurse is teaching a client with preterm premature rupture of membranes (PPROM) regarding self-care activities. Which activities should the nurse include in her teaching? Select one: a. Tampons are safe to use to absorb the leaking amniotic fluid. b. Do not engage in sexual activity. c. Report a temperature higher than 40° C. d. Taking frequent tub baths is safe.
The correct answer is: Do not engage in sexual activity.
Which classification of placental separation is not recognized as an abnormal adherence pattern? Select one: a. Placenta accreta b. Placenta increta c. Placenta percreta d. Placenta abruptio
The correct answer is: Placenta abruptio
Which medications are used to manage PPH? (Select all that apply.) Select one or more: a. Hemabate b. Methergine c. Oxytocin d. Terbutaline e. Magnesium sulfate
The correct answers are: Oxytocin, Methergine, Hemabate
Which of the following are indications for cesarean birth? (Select all that apply.) Select one or more: a. Previous cesarean birth b. Placental abnormalities c. Previous uterine surgery d. Failure to progress in labor
The correct answers are: Previous cesarean birth, Placental abnormalities, Previous uterine surgery, Failure to progress in labor
The exact cause of preterm labor is unknown but believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Which type of infection has not been linked to preterm birth? Select one: a. Viral b. Periodontal c. Urinary tract d. Cervical
Correct Answer: A
A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness over an enlarged, hardened area. Which condition should the nurse suspect, and how will it be confirmed? Select one: a. Idiopathic or immune thrombocytopenic purpura (ITP); drawing blood for laboratory analysis b. Thrombophlebitis; using real-time and color Doppler ultrasound c. von Willebrand disease (vWD); noting whether bleeding times have been extended d. Disseminated intravascular coagulation (DIC); asking for laboratory tests
Correct Answer: B
A primigravida at 40 weeks of gestation is having uterine contractions every 1½ to 2 minutes and states that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor? Select one: a. She is experiencing precipitous labor. b. She is experiencing a normal latent stage. c. She is exhibiting hypotonic uterine dysfunction. d. She is exhibiting hypertonic uterine dysfunction
Correct Answer: D
Sandy G21001 is 41 weeks pregnant and presents to L&D for induction. The physician orders Pitocin to be infused at 2mU/min. The IV bag is LR 1000mL with 10 units of Pitocin. The infusion pump delivers ___mL/hour. How will the nurse program the infusion pump to deliver the medication as ordered? Select one: a. 6mL/hour b. 18mL/hour c. 12 mL/hour d. 30mL/hour
The correct answer is: 12 mL/hour 10 units:1000mL:: X:1mL 1000X=10 X=0.01unit or 10 mU 2mU/min divided by 10mU/mL = 0.2mL/min x 60 min = 12 mL/hour
Approximately 8 hours ago, Juanita, a 32-year-old G1 P0, gave birth after 2 hours of pushing. She required an episiotomy and an assisted birth (forceps) due to the weight and size of her baby (9 lb. 9 oz.). The perinatal nurse is performing an assessment of Juanita's perineal area. A slight bulge is palpated and the presence of ecchymoses to the right of the episiotomy is noted. The area feels "full" and is approximately 4 cm in diameter. Juanita describes this area as "very tender." The perinatal nurse notifies the physician of the findings related to Juanita's assessment. The first step in care will most likely be to: Select one: a. Prepare Juanita for surgery b. Administer intravenous fluids c. Apply ice to the perineum d. Insert a urinary catheter
The correct answer is: Apply ice to the perineum. If the hematoma is less than 3 to 5 centimeters in diameter, the physician usually orders palliative treatments such as ice to the area for the first 12 hours along with pain medication. After 12 hours, sitz baths are prescribed to replace the application of ice. However, a hematoma larger than 5 centimeters may require incision and drainage with the possible placement of a drain.
The obstetric provider has informed the nurse that she will be performing an amniotomy on the client to induce labor. What is the nurse's highest priority intervention after the amniotomy is performed? Select one: a. Taking the client's vital signs b. Applying clean linens under the woman c. Assessing the fetal heart rate (FHR) d. Performing a vaginal examination
The correct answer is: Assessing the fetal heart rate (FHR)
Which of the following is an indication for the administration of methylergonovine (Methergine)? Select one: a. Boggy uterus that does not respond to massage and oxytocin therapy b. Woman with a large hematoma c. Woman with a deep vein thrombosis d. Woman with severe postpartum depression
The correct answer is: Boggy uterus that does not respond to massage and oxytocin therapy. Methergine is administered IM or IV in the presence of postpartum hemorrhage due to uterine atony or subinvolution when fundal massage and oxytocin therapy are ineffective. Always check BP before administration and notify provider before injection if elevated as Methergine can increase BP.
A postpartum woman has been diagnosed with postpartum psychosis and will shortly be admitted to the psychiatric unit. Which of the following actions should the nurse perform to ensure safety for both mother and infant? Select one: a. Closely monitor all mother-infant interactions b. Maintain client on strict bed rest. c. Restrict visitation to her partner. d. Carefully monitor toileting.
The correct answer is: Closely monitor all mother-infant interactions Postpartum psychosis (PPP) is a variant of bipolar disorder and is the most serious form of postpartum mood disorders. Onset of symptoms can be as early as the 3rd postpartum day. Assessment findings include paranoia, delusions associated with the baby, mood swings, extreme agitation, confused thinking, and strange beliefs.
The nurse is performing an assessment on a client who thinks she may be experiencing preterm labor. Which information is the most important for the nurse to understand and share with the client? Select one: a. Because all women must be considered at risk for preterm labor and prediction is so variable, teaching pregnant women the symptoms of preterm labor probably causes more harm through false alarms. b. Because preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. c. Braxton Hicks contractions often signal the onset of preterm labor. d. Diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.
The correct answer is: Diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.
Which condition is considered a medical emergency that requires immediate treatment? Select one: a. Uterine atony b. Inversion of the uterus c. Hypotonic uterus d. ITP
The correct answer is: Inversion of the uterus
During labor induction with oxytocin, the fetal heart rate baseline is in the 140s with moderate variability. Contraction frequency is assessed to be every 2-3 minutes with duration of 60 seconds, of moderate strength to palpation. Based on this assessment, the nurse should take which action? Select one: a. Increase oxytocin infusion rate per provider's protocol. b. Stop oxytocin infusion immediately. c. Maintain present oxytocin infusion rate and continue to assess. d. Decrease oxytocin infusion rate by 2 mU/min and report to provider.
The correct answer is: Maintain present oxytocin infusion rate and continue to assess. The goal of oxytocin use in labor is to establish uterine contraction patterns that promote cervical dilation of about 1 cm/hr once in active labor. The lowest possible dose should be used to achieve labor progress. Generally, the labor pattern should be 3 UCs in 10 minutes, lasting 40-60 seconds with an intensity of 25-75 mm/HG with IUPC and resting tone <20 mm HG with 1 minute between each UC. The labor pattern described above is appropriate and no increase or decrease in oxytocin infusion rate is indicated.
A patient, G1 P0, is admitted to the labor and delivery unit for induction of labor. The following assessments were made on admission: Bishop score of 4, fetal heart rate 140s with moderate variability and no decelerations, TPR 98.6°F, 88, 20, BP 120/80, negative obstetrical history. A prostaglandin suppository was inserted at that time. Which of the following findings, 6 hours after insertion, would warrant the removal of the Cervidil (dinoprostone)? Select one: a. Bishop score of 5 b. Fetal heart of 152 bpm c. Respiratory rate of 24 rpm d. More than 5 contractions in 10 minutes Correct! This is hyperstimulation.
The correct answer is: More than 5 contractions in 10 minutes
If the umbilical cord prolapses during labor, the nurse should immediately: Select one: a. Type and cross-match blood for an emergency transfusion. b. Await provider order for preparation for an emergency cesarean section. c. Attempt to reposition the cord above the presenting part. d. Perform vaginal exam and lifting the presenting part off of the cord to relieve pressure on the cord.
The correct answer is: Perform vaginal exam and lifting the presenting part off of the cord to relieve pressure on the cord. Prolapse of the umbilical cord is when the cord lies below the presenting part of the fetus. The cord becomes trapped against the presenting part and circulation is occluded; FHR will usually show bradycardia or prolonged decel. An emergency cesarean birth is typically performed. Occlusion of the cord may be partially relieved by lifting the presenting part off the cord with a vaginal exam. The examiner's hand remains in the vagina, lifting the presenting part off the cord until delivery by cesarean. There is no attempt to push the cord above the presenting part. Type and screen of blood is generally done on admission for all laboring women; type and cross-match can readily be accomplished using the blood sample already in the lab.
Tanya, a 30-year-old woman, is being prepared for a planned cesarean birth. The perinatal nurse assists the anesthesiologist with the spinal block and then positions Tanya in a supine position. Tanya's blood pressure drops to 90/52, and there is a decrease in the fetal heart rate to 110 bpm. The perinatal nurse's best response is to: Select one: a. Place Tanya in a left lateral tilt b. Discontinue Tanya's intravenous administration. c. Have naloxone (Narcan) ready for administration. d. Have epinephrine ready for administration.
The correct answer is: Place Tanya in a left lateral tilt. Reposition the woman after epidural or spinal anesthesia in a supine position with a left lateral tilt to decrease the pressure from the uterus on the inferior vena cava and to maintain placental perfusion.
The perinatal nurse is providing care to Carol, a 28-year-old multiparous woman in labor. Upon arrival to the birthing suite, Carol was 7 cm dilated and experiencing contractions every 1 to 2 minutes which she describes as "strong." Carol states she labored for 1 hour at home. As the nurse assists Carol from the assessment area to her labor and birth room, Carol states that she is feeling some rectal pressure. Carol is most likely experiencing: Select one: a. Hypertonic contractions b. Hypotonic contractions c. Precipitous labor d. Uterine hyperstimulation
The correct answer is: Precipitous labor. Precipitous labor that lasts fewer than 3 hours from onset to birth. Precipitous labor is more likely to be seen in woman who have previously given birth or have a previous history of rapid labors. As the fetal head descends, the woman may feel rectal pressure indicating delivery is imminent.
A pregnant woman who has a history of cesarean births is requesting to have a vaginal birth after cesarean (VBAC). In which of the following situations should the nurse advise the patient that her request may be declined? Select one: a. Previous uterine surgery b. Flexed fetal attitude c. Previous low flap uterine incision d. Positive vaginal candidiasis
The correct answer is: Previous uterine surgery. Contraindications for trial of labor after cesarean (TOLAC) leading to VBAC include vertical uterine incision, previous uterine surgery, previous uterine rupture, pelvic abnormalities, complications preventing vaginal delivery, lack of personnel required for operative delivery.
The perinatal nurse notes a rapid decrease in the fetal heart rate that does not recover immediately following an amniotomy. The most likely cause of this obstetrical emergency is: Select one: a. Prolapsed umbilical cord. b. Vasa previa c. Oligohydramnios d. Placental abruption
The correct answer is: Prolapsed umbilical cord. Amniotomy is the artificial rupture of membranes (AROM) to induce or augment labor. This is a common procedure seen in obstetrics. Risks associated with amniotomy include umbilical cord prolapse when the presenting part is not engaged. Vasa previa or rupture of fetal vessels unsupported by the placenta is a very rare situation and usually results in rapid fetal exsanguination in the presence of bloody fluid seen following AROM.
A primigravida woman at 42 weeks' gestation received Prepidil (dinoprostone) for induction 12 hours ago. The Bishop score is now 3. Which of the following actions by the nurse is appropriate? Select one: a. Perform Nitrazine analysis of the amniotic fluid. b. Report the lack of progress to the obstetrician. c. Place the woman on her left side. d. Ask the provider for an order for oxytocin.
The correct answer is: Report the lack of progress to the obstetrician. Prepidil is indicated for cervical ripening, the process of physical softening and opening of the cervix. Cervical status is the most important predictor of successful induction of labor. Cervical status is assessed before induction of labor using the Bishop score. A score of 6 or more is considered favorable for successful induction of labor.
In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, which finding alerts the nurse to possible side effects? Select one: a. Serum magnesium level of 10 mg/dl b. DTRs 2+ and no clonus c. Urine output of 160 ml in 4 hours d. Respiratory rate (RR) of 16 breaths per minute
The correct answer is: Serum magnesium level of 10 mg/dl
What is one of the initial signs and symptoms of puerperal infection in the postpartum client? Select one: a. Pain with voiding b. Fatigue continuing for longer than 1 week c. Temperature of 38° C (100.4° F) or higher on 2 successive days Correct! d. Profuse vaginal lochia with ambulation
The correct answer is: Temperature of 38° C (100.4° F) or higher on 2 successive days
Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. What is the primary purpose of prostaglandin administration? Select one: a. To stimulate the amniotic membranes to rupture b. To ripen the cervix in preparation for labor induction c. To enhance uteroplacental perfusion in an aging placenta d. To increase amniotic fluid volume
The correct answer is: To ripen the cervix in preparation for labor induction
A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM) doses of betamethasone. What is the purpose of this pharmacologic intervention? Select one: a. To maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy b. To reduce maternal and fetal tachycardia associated with ritodrine administration c. To stimulate fetal surfactant production d. To suppress uterine contractions
The correct answer is: To stimulate fetal surfactant production
Nurses need to understand the basic definitions and incidence data regarding PPH. Which statement regarding this condition is most accurate? Select one: a. PPH is easy to recognize early; after all, the woman is bleeding. b. Traditionally, it takes more than 1000 ml of blood after vaginal birth and 2500 ml after cesarean birth to define the condition as PPH. c. Traditionally, PPH has been classified as early PPH or late PPH with respect to birth. d. If anything, nurses and physicians tend to overestimate the amount of blood loss.
The correct answer is: Traditionally, PPH has been classified as early PPH or late PPH with respect to birth.
The nurse suspects that her postpartum client is experiencing hemorrhagic shock. Which observation indicates or would confirm this diagnosis? Select one: a. Calm mental status b. Urinary output of at least 30 ml/hr Correct!- this answer should read urinary output of less than 30ml/hr c. Cool, dry skin d. Absence of cyanosis in the buccal mucosa
The correct answer is: Urinary output of at least 30 ml/hr
During the postpartum assessment, the perinatal nurse notes that a patient who has just experienced a forceps-assisted birth now has a large quantity of bright red bleeding. Her uterine fundus is firm and midline. The nurse's most appropriate action is to notify the physician/certified nurse midwife and anticipate the need for: Select one: a. Vaginal assessment and possible repair of vaginal and/or cervical lacerations b. An oxytocin infusion c. Further information for the woman/family about forceps d. Bladder assessment and catheterization
The correct answer is: Vaginal assessment and possible repair of vaginal and/or cervical lacerations
The perinatal nurse understands that the purpose of the surgical "time-out" is to: Select one: a. Confirm that the surgeon is ready to begin b. Verify that it is the correct patient and planned procedure Surgical "time-out" is performed by the entire surgical team and the patient prior to the administration of anesthesia. The purpose is to validate correct patient and planned procedure. c. Verify that anesthesia is adequate d. Confirm that the neonatal team is in attendance
The correct answer is: Verify that it is the correct patient and planned procedure
Which client is at greatest risk for early PPH? Select one: a. Woman with severe preeclampsia on magnesium sulfate whose labor is being induced b. Primigravida in spontaneous labor with preterm twins c. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor d. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress
The correct answer is: Woman with severe preeclampsia on magnesium sulfate whose labor is being induced. The effects of magnesium sulfate puts this patient at greater risk for PPH than the other scenarios.
Tachysystole, previously referred to as hyperstimulation, is defined as: Select one or more: a. Contractions lasting 2 minutes or longer b. Five or more contractions in 10 minutes over a 30-minute window c. Contractions occurring within 1 minute of each other d. Uterine resting tone below 20 mm/Hg
The correct answers are: Contractions lasting 2 minutes or longer, Five or more contractions in 10 minutes over a 30-minute window, Contractions occurring within 1 minute of each other. Contractions lasting more than 2 minutes, five or more contractions in 10 minutes, and contractions occurring within 1 minute of each other describe the criteria for tachysystole. Uterine resting tone below 20 mm/Hg reflects normal uterine resting tone.
Documentation related to vacuum delivery includes which of the following: Select one or more: a. Fetal heart rate b. Timing and number of applications c. Position and station of fetal head d. Maternal position
The correct answers are: Fetal heart rate, Timing and number of applications, Position and station of fetal head. Assessment of fetal heart rate is part of second-stage management, timing and number of applications are part of standard of care related to safe vacuum deliveries, and position and station of fetal head are noted for safe vacuum extraction. Maternal position is not critical to the documentation related to vacuum deliveries
Which of the following are primary risk factors for subinvolution of the uterus? (Select all that apply.) Select one or more: a. Fibroids b. Retained placental tissue c. Metritis d. Urinary tract infection
The correct answers are: Fibroids, Retained placental tissue, Metritis. Retained placental tissue does not allow the uterus to remain contracted. Infection in the uterus is a risk factor for subinvolution. UTI does not interfere with involution of the uterus.
Jennifer is 3 hours postpartum following the vaginal delivery of a 9lb 15oz baby girl. Estimated blood loss at delivery was 800 ml. The RN is aware that Jennifer experienced an early-postpartum hemorrhage. Select the appropriate nursing actions for the care of this patient. (Select all that apply.) Select one or more: a. Maintain IV site in case fluids/medication for PPH are indicated b. Frequent fundal assessment to prevent uterine atony and further blood loss c. Assess for displaced uterus secondary to overdistended bladder. d. Assess lochia for amount and for clots
The correct answers are: Maintain IV site in case fluids/medication for PPH are indicated, Frequent fundal assessment to prevent uterine atony and further blood loss, Assess for displaced uterus secondary to overdistended bladder., Assess lochia for amount and for clots. PPH is blood loss greater than 500 ml for vaginal deliveries and 1000 ml for cesarean with a 10% drop in hemoglobin and/or hematocrit. Unfortunately, postpartum women may not show signs/symptoms of PPH until about 1/3 of entire blood volume is lost. RNs must frequently assess uterine tone, location, and position as well as blood loss amount and characteristics (slow, steady, sudden, massive, presence of clots, possible distended bladder). Keeping the IV site intact will allow immediate access to fluids and/or medications should PPH worsen.
The induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule clients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. What are appropriate indications for induction? (Select all that apply) Select one or more: a. Fetal death b. Convenience of the woman or her physician c. Rupture of membranes at or near term d. Postterm pregnancy e. Maternal fatigue and frustration at 38 weeks gestation
The correct answers are: Rupture of membranes at or near term, Postterm pregnancy, Fetal death
Women who are obese are at risk for several complications during pregnancy and birth. Which of these would the nurse anticipate with an obese client? (Select all that apply.) Select one or more: a. Thromboembolism b. Breech presentation c. Cesarean birth d. Hypertension e. Wound infection
The correct answers are: Thromboembolism, Cesarean birth, Wound infection, Hypertension
Nursing actions focused at reducing a postpartum woman's risk for cystitis include which of the following? (Select all that apply.) Select one or more: a. Voiding within a few hours post-birth b. Oral intake of a minimum of 3000 mL per day c. Changing peri-pads every 3 to 4 hours or more frequently as indicated d. Reminding the woman to void every 3 to 4 hours while awake
The correct answers are: Voiding within a few hours post-birth, Oral intake of a minimum of 3000 mL per day, Changing peri-pads every 3 to 4 hours or more frequently as indicated, Reminding the woman to void every 3 to 4 hours while awake Early voiding helps flush bacteria from the urethra. Voiding every 3 to 4 hours will decrease the risk of bacterial growth in the bladder. Soiled peri-pads are a media for bacterial growth. It is recommend that a postpartum woman drink a minimum of 3000 mL/day to help dilute urine and promote frequent voiding.
PPH may be sudden and result in rapid blood loss. The nurse must be alert to the symptoms of hemorrhage and hypovolemic shock and be prepared to act quickly to minimize blood loss. Astute assessment of the client's circulatory status can be performed with noninvasive monitoring. Match the type of noninvasive assessment that the nurse would perform with the appropriate clinical manifestation or body system.
Observation → presence or absence of anxiety, Measurement → pulse oximetry, Palpation → arterial pulses, Auscultation → heart pulses, Inspection → skin color, temperature, and turgor
Endometritis is an infection that usually starts at the placental site. Select one: True False
The correct answer is 'True'. Endometritis is an infection of the endometrium that usually starts at the placental site and spreads to encompass the entire endometrium.
Primary prevention of preterm labor and birth include which of the following? (Select all that apply). Select one or more: a. Induce pregnant woman at 37 weeks b. Identify risk factors of preterm birth for individual pregnant woman c. Treat pregnant woman with magnesium sulfate this is secondary prevention- see powerpoint d. Manage risk factors for preterm birth in individual pregnant woman correct!
The correct answers are: Identify risk factors of preterm birth for individual pregnant woman, Manage risk factors for preterm birth in individual pregnant woman
Which nursing intervention is paramount when providing care to a client with preterm labor who has received terbutaline? Select one: a. Assess deep tendon reflexes (DTRs). b. Assess for dyspnea and crackles. c. Assess for bradycardia. d. Assess for hypoglycemia.
The correct answer is: Assess for dyspnea and crackles.
