OB Missed Questions

A client in active labor asks the nurse why her blood pressure is being monitored so frequently. What is the most appropriate response by the nurse? "It is part of our standard policy." "Changes in your blood pressure can affect the fetus." "Low blood pressure may cause dizziness and fainting." "Increased blood pressure is a sign of preeclampsia."

"Changes in your blood pressure can affect the fetus." During contractions, blood pressure increases and blood flow to the intervillous spaces decreases, compromising the fetal blood supply. Therefore, the nurse should frequently assess the client's blood pressure to determine whether it returns to precontraction levels and allows adequate fetal blood flow. Preeclampsia causes the blood pressure to increase, and low blood pressure may cause dizziness; however, neither fact explains the primary reason for frequent monitoring. Telling the client that it is policy is not a patient-centered response.

The nurse is caring for a primagravida in active labor. The provider performs an amniotomy to augment labor. What is the nurse's priority action after the procedure is completed? Perform a nonstress test. Perform a sterile vaginal exam. Check the fetal heart rate for bradycardia. Prepare for an imminent birth.

Check the fetal heart rate for bradycardia. After a client has an amniotomy, the nurse should ensure that the cord is not prolapsed and that the fetus tolerated the procedure well. The most effective way to do this is to check the fetal heart rate. Fetal well-being is assessed via a nonstress test. Fetal position is determined by vaginal examination. Artificial rupture of membranes does not indicate an imminent birth.

Identify the following perineal changes The nurse assesses the perineal changes of a woman in the second stage of labor. The figure below represents which perineal change? anterior-posterior slit oval opening circular shape crowning

Crowning occurs when the fetal head is visible. Anterior-posterior slit occurs as the perineum flattens and is followed by an oval opening. As labor progresses, the perineum takes on a circular shape, followed by crowning.

The nurse observes a darkish blue pigment on the buttocks and back of a neonate of African descent. Which action is most appropriate? Ask the obstetrician to assess the child. Assess the child for other areas of cyanosis. Document this observation in the child's medical record. Advise the mother that the bruising will fade in a few days.

Document this observation in the child's medical record. The bluish pigment on the buttocks and back of an infant of African descent is a common finding and should be documented as Mongolian spots in the child's medical record. These spots typically fade by the time the child is 5 or 6 years. Additional assessment by the care provider is not indicated. The marks are not bruises.

The nurse assesses a 15-hour-old infant and finds jaundice. What is the priority action the nurse needs to take? Continue with normal newborn care. Notify the health care provider of the finding. Provide an extra feeding for the infant. Wait and assess the skin color when the infant is over 24 hours old.

Notify the health care provider of the finding. Jaundice that appears before 24 hours of age is considered pathologic. Jaundice appears when bilirubin levels reach 5 to 7 mg/dL (85.5 to 120 μmol). The health care provider should be notified for intervention to prevent kernicterus. This disease process can cause lifelong central nervous system damage. Disregarding the finding or waiting to report the finding will delay treatment and potentially cause permeant harm to the infant. Providing an extra feeding will have no effect on the hyperbilirubinemia that is causing the jaundice.

A client comes to the office for her first prenatal visit. She reports that January 3 was the first day of her last menstrual period. According to Naegele's rule, what date should the nurse record as the estimated date of delivery (EDD)? November 10 October 10 September 10 December 10

October 10 The nurse can calculate EDD using Naegele's rule (add 7 days to the first day of the last menstrual period, then subtract 3 months, and finally add 1 year). In this example, January 3 + 7 days = January 10. Three months prior to that date is October 10 of the previous year. Adding 1 year, her EDD is October 10 of the current year.

During a home visit to a breastfeeding primiparous client at 1 week postpartum, the client tells the nurse that her nipples have become sore and cracked from the feedings. Which instructions should the nurse give the client? Wipe off any lanolin creams from the nipple before each feeding. Position the baby with the entire areola in the baby's mouth. Feed the baby less often for the next several days. Use a mild soap while in the shower to prevent an infection.

Position the baby with the entire areola in the baby's mouth. Even if the nipples are sore and cracked, the mother should position the baby with the entire areola in the baby's mouth so that the nipple is not compressed between the baby's gums during feeding. The best method is to prevent cracked nipples before they occur. This can be done by feeding frequently and using proper positioning. Warm, moist tea bags can soothe cracked nipples because of tannic acid in the tea. Creams on the nipples should be avoided; wiping off any lanolin creams from the nipple before each feeding can cause further soreness. Feeding the baby less often for the next few days will cause engorgement (and possible neonatal weight loss), leading to additional problems. Soap use while in the shower should be avoided to prevent drying and removal of protective oils.

A nurse is eliciting reflexes in a neonate during a physical examination. Identify the area that the nurse would touch to elicit a plantar grasp reflex.

To elicit a plantar grasp reflex, the nurse would touch the sole of the foot near the base of the digits, causing flexion or grasping. This reflex disappears around age 9 months.

While performing a physical assessment on a term neonate shortly after birth, which finding would cause the nurse to notify the health care provider (HCP)? deep creases across the soles of the feet frequent sneezing during the assessment single crease on each of the palms absence of lanugo on the skin

single crease on each of the palms A single crease across the palm (simian crease) is most commonly associated with chromosomal abnormalities, notably Down syndrome. Deep creases across the soles of the feet is a normal finding in a term neonate. Frequent sneezing in a term neonate is normal. This occurs because the neonate is a nose breather and sneezing helps to clear the nares. An absence of lanugo on the skin of a term neonate is a normal finding.

The nurse hears a pregnant client yell, "Oh my! The baby is coming!" After placing the client in a supine position and trying to maintain some privacy, the nurse sees that the neonate's head is being born. What should the nurse do first? Suction the mouth with two fingertips. Check for presence of a cord around the neck. Tell the client to bear down with force. Advise the mother that help is on the way.

Check for presence of a cord around the neck. In an emergency in which the neonate's head is already being born, the first action by the nurse should be to check for the presence of a cord around the neonate's neck. If the cord is present, the nurse should gently remove it from around the neck. The mother should be told to breathe gently and avoid forceful bearing-down efforts, which could lead to lacerations. Although blood and bodily fluid precautions are always present in client care, this is an emergency. If possible, the nurse should put on gloves. Suctioning the mouth can be done after the nurse has checked that the cord is not around the neonate's neck. Telling the mother that help is on the way is not reassuring because emergency medical technicians may take some time to arrive. Birth is imminent because the neonate's head is emerging.

A nurse and an LPN are working in the labor and birth unit. Of the activities that must be done immediately, which should the nurse assign to the LPN? Complete an initial assessment on a client. Increase the oxytocin rate on a laboring client. Perform a straight catheterization for protein analysis. Assess a laboring client for a change in labor pattern.

Perform a straight catheterization for protein analysis. The straight catheterization is within the scope of practice of a licensed practical nurse. An initial or continuing assessment is the responsibility of the registered nurse. Assessment must be complete before increasing the IV rate of oxytocin. The assessment and the increase in oxytocin rate are responsibilities for the nurse.

When preparing a multigravid client at 34 weeks' gestation experiencing preterm labor for the shake test performed on amniotic fluid, the nurse would instruct the client that this test is done to evaluate the maturity of which fetal system? urinary gastrointestinal cardiovascular pulmonary

pulmonary The shake test helps determine the maturity of the fetal pulmonary system. The test is based on the fact that surfactant foams when mixed with ethanol. The more stable the foam, the more mature the fetal pulmonary system. Although the shake test is inexpensive and provides rapid results, problems have been noted with its reliability. Therefore, the lecithin-sphingomyelin ratio is usually determined in conjunction with the shake test.

While assessing a multigravid client at 10 weeks' gestation, the nurse notes a purplish color to the vagina and cervix. The nurse documents this as what finding? Goodell's sign Chadwick's sign Hegar's sign melasma

Chadwick's sign A purplish blue discoloration of the vagina and cervix is termed Chadwick's sign; it is caused by increased vascularity of the vagina during pregnancy and is considered a probable sign of pregnancy. Goodell's sign, also considered a probable sign of pregnancy, refers to a softening of the cervix during pregnancy. Hegar's sign, also a probable sign of pregnancy, refers to a softening of the lower uterine segment. Melasma, the mask of pregnancy, refers to the pigmentation of the skin on the face during pregnancy. Melasma is considered a presumptive sign of pregnancy.

The nurse caring for a multigravida in active labor observes a variable fetal heart rate deceleration pattern. What should the nurse do first? Administer oxygen by mask at 4 L. Change the client's position. Contact the client's primary care provider. Document the tracing in the client's record.

Change the client's position. A variable deceleration pattern of the fetal heart rate is usually due to cord compression. This may be a result of the cord around the presenting part, a short cord, or the maternal position. Treatment involves changing the maternal position. If this does not resolve the variable heart rate pattern, the primary care provider or nurse midwife should be notified. Oxygen may be needed at a rate of 8 to 10 L. If changing the position does not resolve the problem, the primary care provider should be notified. Documenting the problem does not resolve the problem of cord compression.

A diabetic postpartum client plans to breastfeed. The nurse determines that the client's understanding of breastfeeding instructions is sufficient when the client makes which statement? "Insulin will be transferred to the baby through breast milk." "Breastfeeding is not recommended for diabetic mothers." "Breast milk from diabetic mothers contains few antibodies." "Breastfeeding will assist in lowering maternal blood glucose."

"Breastfeeding will assist in lowering maternal blood glucose." Breastfeeding consumes maternal calories and requires energy which increases the maternal basal metabolic rate and assists in lowering the maternal blood glucose level. Insulin is not transferred to the infant through breast milk. Breastfeeding is recommended for diabetic mothers because it does lower blood glucose levels. The number of antibodies in breast milk is not altered by maternal diabetes.

A multigravid client admitted to the labor area is scheduled for a cesarean birth under spinal anesthesia. Which client statement indicates that teaching about spinal anesthesia has been understood? "The medication will be administered while I am in prone position." "The anesthetic may cause a severe headache, which is treatable." "My blood pressure may increase if I lie down too soon after the injection." "I can expect immediate anesthesia that can be reversed very easily."

"The anesthetic may cause a severe headache, which is treatable." Spinal anesthesia is used less commonly today because of preference for epidural block anesthesia. One of the adverse effects of spinal anesthesia is a "spinal headache" caused by leakage of spinal fluid from the needle insertion. This can be treated by applying a cool cloth to the forehead, keeping the client in a flat position, or using a blood patch that can clot and seal off any further leakage of fluid. Spinal anesthesia is administered with the client in a sitting position or side lying. Another adverse effect of spinal anesthesia is hypotension caused by vasodilation. General anesthesia provides immediate anesthesia, whereas the full effects of spinal anesthesia may not be felt for 20 to 30 minutes. General anesthesia can be discontinued quickly when the anesthesiologist administers oxygen instead of nitrous oxide. Epidural anesthesia may take 1 to 2 hours to wear off.

After teaching the client about bottle-feeding, which client statement indicates the need for additional teaching? "Bottle-fed babies up to 6 months of age may gain as much as 1 ounce (30 g)/day." "Iron-fortified formulas are usually recommended for newborns." "Bottle-fed babies will usually regain their birth weight by 10 to 14 days of age." "Whole milk is an acceptable alternative to formula once the baby is 4 months old."

"Whole milk is an acceptable alternative to formula once the baby is 4 months old." Neither unmodified cow's milk nor whole milk is an acceptable alternative for newborn nutrition. The American Academy of Pediatrics and Canadian Pediatric Society recommend that infants be given breast milk or formula until 1 year of age. However, the American Academy of Pediatrics Committee on Nutrition has decreed that cow's milk could be substituted in the second 6 months of life, but only if the amount of milk calories does not exceed 65% of total calories and iron is replaced through solid foods. The protein content in cow's milk is too high, is poorly digested, and may cause gastrointestinal tract bleeding. Bottle-fed infants may gain as much as 1 oz (30 g)/day up to age 6 months. Iron-fortified formulas are recommended. Bottle-fed neonates may regain their birth weight by 10 to 14 days of age.

A nurse encourages a postpartum client to discuss the childbirth experience. Which client outcome is most appropriate for this client? The client demonstrates the ability to care for the neonate completely by time of discharge. The client demonstrates the ability to integrate the childbirth experience and progress to the task of maternal role attainment. The client demonstrates an understanding of her physical needs related to labor and birth. The client demonstrates an understanding of the neonate's physical needs related to labor and birth.

The client demonstrates the ability to integrate the childbirth experience and progress to the task of maternal role attainment. Discussing the childbirth experience helps the client acknowledge and understand what happened during this event. The nurse should give the client a chance to ask questions about the event and seek clarification, if needed. After the client discusses the event, she may be able to shift the focus away from herself and begin the tasks that will help her assume the maternal role. The nurse must determine the client's understanding of her physical needs and those of her neonate after teaching and demonstrating care techniques; discussing the childbirth experience won't help her to meet these needs.

A client, 30 weeks pregnant, is scheduled for a biophysical profile (BPP) to evaluate the health of the fetus. The client's BPP score is 8. What does this score indicate? The fetus should be delivered within 24 hours. The client should repeat the test in 24 hours. The fetus isn't in distress at this time. The client should repeat the test in 1 week.

The fetus isn't in distress at this time. The BPP evaluates fetal health by assessing five variables: fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate, and qualitative amniotic fluid volume. A normal response for each variable receives 2 points; an abnormal response receives 0 points. A score between 8 and 10 is considered normal, indicating that the fetus has a low risk of oxygen deprivation and isn't in distress. A fetus with a score of 6 or lower is at risk for asphyxia and premature birth; this score warrants detailed investigation. The BPP may be repeated if the score isn't within normal limits.

A nurse cares for a woman who gave birth to a term neonate at 0600. At 1600, the woman has a distended bladder and is reporting pain of 5 on a scale of 1 to 10. The nurse reviews the client's output record. What should the nurse do first? output: 0800: 30 mL, 1000: 50 mL, 1100: 30 mL, 1600: 60 mL Apply a warm, moist towel over the bladder. Ask the woman to sit on the toilet while the nurse runs water from the faucet. Administer acetaminophen with codeine. Use an in-and-out catheter to empty the bladder.

Use an in-and-out catheter to empty the bladder. The client is not emptying her bladder after repeated attempts. The nurse should now use an in-and-out catheter to empty the bladder. While the other comfort measures may be helpful, this client has not completely emptied her bladder since birth and will be at risk for a urinary tract infection and postpartum hemorrhage.

The nurse is admitting a primigravid client at 37 weeks' gestation who has been diagnosed with preeclampsia to the labor and birth area. Which client care rooms is most appropriate for this client? a brightly lit private room at the end of the hall from the nurses' station a semiprivate room midway down the hall from the nurses' station a private room with many windows that is near the operating room a darkened private room as close to the nurses' station as possible

a darkened private room as close to the nurses' station as possible A primigravid client diagnosed with preeclampsia has the potential for developing seizures (eclampsia). This client should be in a room with the least amount of stimulation possible to reduce the risk of seizures and as close to the nurses' station as possible in case the client requires immediate assistance. Bright lighting and sunshine can be a stimulant, possibly increasing the risk of seizures, as can being in a semiprivate room with roommate, visitors, conversation, and noise.

What data indicates to the nurse that placental detachment is occurring? an abrupt lengthening of the cord a decrease in the number of contractions relaxation of the uterus decreased vaginal bleeding

an abrupt lengthening of the cord An abrupt lengthening of the cord, an increase (not a decrease) in the number of contractions, and an increase (not a decrease) in vaginal bleeding are all indications that the placenta has detached from the wall of the uterus. Relaxation of the uterus is not an indication for detachment of the placenta.

Assessment of a client in active labor reveals meconium-stained amniotic fluid and fetal heart sounds in the upper right quadrant. What is the most likely cause of this situation? breech position transverse lie occiput posterior position compound presentation

breech position Fetal heart sounds in the upper right quadrant and meconium-stained amniotic fluid indicate a breech presentation. The staining is usually caused by the squeezing actions of the uterus on a fetus in the breech position, although late decelerations, entrance into the second stage of labor, and multiple gestation may contribute to meconium-stained amniotic fluid.

The nurse is working with four clients on the obstetrical unit. Which client will be the highest priority for a cesarean section? client at 40 weeks' gestation whose fetus weighs 8 lb (3,630 g) by ultrasound estimate client at 37 weeks' gestation with fetus in the right occiput posterior (ROP) position client at 32 weeks' gestation with fetus in breech position client at 38 weeks' gestation with active herpes lesions

client at 38 weeks' gestation with active herpes lesions Explanation: Herpes simplex virus can be transmitted to the infant during a vaginal birth. The neonatal effects of herpes are severe enough that a cesarean birth is warranted if active lesions—primary or secondary—are present. A client with a primary infection during pregnancy sheds the virus for up to 3 months after the lesion has healed. The client carrying an infant weighing 8 lb (3,629 g) will be given a trial of labor before a cesarean. The client with a fetus in the ROP position will have a slow labor with increased back pain but can give birth vaginally. The fetus in a breech position still has many weeks to change positions before being at term. At 7 months' gestation, the breech position is not a concern.

A breastfeeding primiparous client with a midline episiotomy is prescribed ibuprofen orally. When does the nurse instruct the client to take the medication? before going to bed midway between feedings immediately after a feeding when providing supplemental formula

immediately after a feeding Taking ibuprofen 200 mg orally immediately after breastfeeding helps minimize the neonate's exposure to the drug because drugs are most highly concentrated in the body soon after they are taken. Most mothers breastfeed on demand or every 2 to 3 hours, so the effects of the ibuprofen should be decreased by the next breastfeeding session. Taking the medication before going to bed is inappropriate because, although the mother may go to bed at a certain time, the neonate may wish to breastfeed soon after the mother goes to bed. If the mother takes the medication midway between feedings, then its peak action may occur midway between feedings. Breast milk is sufficient for the neonate's nutritional needs. Most breastfeeding mothers should not be encouraged to provide supplemental feedings to the infant because this may result in nipple confusion.

A nurse completes the initial assessment of a newborn. According to the due date on the antenatal record, the baby is 12 days postmature. Which of the following physical findings contradicts the estimated gestational age of the newborn? meconium aspiration absence of lanugo hypoglycemia increased amounts of vernix

increased amounts of vernix Vernix caseosa is a whitish substance that serves as a protective covering over the fetal body throughout the pregnancy. Vernix usually disappears by term gestation. It is highly unusual for a 12-day postmature baby to have increased amounts of vernix. A discrepancy between the estimated date of conception and gestational age by physical examination must have occurred. Meconium aspiration is a sign of fetal distress but does not coincide with gestation. The presence of lanugo is greatest at 28-30 weeks and begins to disappear as term gestation approaches. Therefore, an absence of lanugo on assessment would be expected with a postmature infant. Hypoglycemia can occur at any gestation, although it is associated with other conditions, including prematurity and small size for gestational age.

A preterm infant born 2 hours ago at 34 weeks' gestation is experiencing rapid respirations, grunting, no breath sounds on one side, and a shift in location of heart sounds. The nurse should prepare to assist with which procedure? placement of the neonate on a ventilator administration of bronchodilators through the nares suctioning of the neonate's nares with wall suction insertion of a chest tube into the neonate

insertion of a chest tube into the neonate The client data support the diagnosis of pneumothorax, which would be confirmed with a chest x-ray. Pneumothorax is an accumulation of air in the thoracic cavity between the parietal and visceral pleurae and requires immediate removal of the accumulated air. Resolution is initiated with insertion of a chest tube connected to continuous negative pressure. The neonate does not need to be placed on a ventilator unless there is evidence of severe respiratory distress. The goal of treatment is to reinflate the collapsed lung. Administering bronchodilators through the nares or suctioning the neonate's nares would do nothing to aid in lung reinflation.

A newly pregnant client tells the nurse that she hasn't been taking her prenatal vitamins because they make her nauseated. In addition to telling the client how important taking the vitamins are, the nurse should advise her to: switch brands. take the vitamin on a full stomach. take the vitamin with orange juice for better absorption. take the vitamin first thing in the morning.

take the vitamin on a full stomach. Prenatal vitamins commonly cause nausea and taking them on a full stomach may curb this adverse effect. Switching brands may not be helpful and may be more costly. Orange juice tends to make pregnant women nauseated. The vitamins may be taken at night, rather than in the morning, to reduce nausea.

The nurse and the health care provider are planning care for a multigravida hospitalized at 36 weeks' gestation with confirmed rupture of membranes (ROM) and no evidence of labor. What should the nurse initiate first? vaginal culture for Neisseria gonorrhea sonogram for amniotic fluid volume index determine meaningful diversional activities frequent assessments for cervical dilation

vaginal culture for Neisseria gonorrhea The exact etiology of preterm premature rupture of membranes is unknown. Infection is considered an etiology and a problem associated with the ROM and can be life threatening for both the mother and her fetus. Sources of infection that cause rupture of membranes are often vaginal infections or urinary tract infections, and this assessment should be initiated first. The sonogram will be helpful if there is a need to determine the amount of amniotic fluid present or the need to find a pocket of fluid to determine fetal lung maturity. Repeated cervical examinations set the client up for infection; one exam would be needed to determine current status, but repetition is not indicated unless there is a need. Diversional activities will be an intervention that will be very helpful after stabilization of the client and if birth is not indicated at this time.