extra OB practice

When preparing a teaching plan about self-care during the postpartum period, the nurse understands that on the fourth postpartum day the lochia is known as: 1. Alba 2. Rubra 3. Serosa 4. Purpura

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On the third postpartum day, a client who had an unexpected cesarean birth is found crying during morning rounds. She says, "I know my baby is fine, but I can't help crying. I wanted natural childbirth so much. Why did this have to happen to me?" The nurse responds knowing that: 1. The client's feelings will pass after she has bonded with her baby 2. The client is probably suffering from postpartum depression and needs special care 3. A woman's self-concept is severely affected by cesarean birth, and the client's statement reflects this 4. A cesarean birth may be a traumatic psychologic experience in addition to an acute obstetric emergency

4. A cesarean birth may be a traumatic psychologic experience in addition to an acute obstetric emergency rationale: the client's response is appropriate to the situation + this is the time "postpartum blues" occur

The fetus of a client in labor is in the LOP position. To alleviate some of the discomfort caused by this type of labor, the nurse should advise the client's partner to: 1. Encourage the client to sleep between contractions 2. Elevate the head of the client's bed to a 45-degree angle 3. Instruct the client to take deeper breaths during contractions 4. Apply pressure to the client's sacral area during a contraction

4. Apply pressure to the client's sacral area during a contraction rationale: pressure on the sacral area during a contraction provides counterpressure to the gravitational force of the fetal head in the occiput posterior position

A client in active labor is admitted to the birthing room. A vaginal examination reveals a 6- to 7-cm dilation. Based on this finding the nurse should expect that this client would: 1. Have a profuse bloody show 2. Appear unable to control her shaking legs 3. Be uncomfortable because of nausea and vomiting 4. Have contractions of 60-seconds duration every three to five minutes

4. Have contractions of 60-seconds duration every three to five minutes rationale: this is a description of the contractions during the active portion of the first stage of labor

A client is admitted to the birthing room in active labor. The nurse determines that the fetus is in the left occipital posterior (LOP) position. The nurse is aware that in this position the fetal heart can best be heard at point: 1. RUQ 2. LUQ 3. RLQ 4. LLQ

4. LLQ rationale: FHR sounds are heard through the fetus's back; when the position of the fetus is in the LOP or LOA the fetal heart sounds are located in the left lower quadrant of the mother

A multipara is admitted to the birthing room in active labor. Her vital signs are temperature 98° F; pulse 70 beats per minute; respirations 18; and blood pressure 126/76. A vaginal examination reveals a cervix 50% effaced and 6 cm dilated with the vertex presenting at +2 station. The client is complaining of pain and asks for medication. The nurse should be concerned about respiratory depression of the infant at birth if the client were given: 1. Naloxone (Narcan) 2. Lorazepam (Ativan) 3. Midazolam (Versed) 4. Meperidine HC1 (Demerol)

4. Meperidine HC1 (Demerol) rationale: meperidine is an opioid that can cause respiratory depression in the neonate if administered less than four hours before birth

A vaginal examination reveals that a client's cervix is 50% effaced and 6 cm dilated. The head is at 0 station, and the fetus is in an ROA position. The contractions are occurring every three to four minutes, lasting 60 seconds and are of moderate intensity. From this data the nurse would assess that the client is: 1. Early in the first stage of labor 2. In the transitional phase of labor 3. Beginning the second stage of labor 4. Midway through the first stage of labor

4. Midway through the first stage of labor rationale: the cervix is 50% effaced and 6 cm dilated during the active phase of the first stage of labor

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 position of the baby is: 1. Breech 2. Transverse 3. Occiput anterior 4. Occiput posterior

4. Occiput posterior rationale: a persistent occiput posterior position causes intense back pain because of fetal compression of the sacral nerves

During labor, the nurse encourages the client to void. The nurse recognizes that an over-distended urinary bladder during labor can: 1. Interfere with the delivery of the placenta 2. Interfere with the assessment of cervical dilation 3. Prevent the diagnosis of cephalopelvic disproportion 4. Predispose to uterine hemorrhage immediately after birth

4. Predispose to uterine hemorrhage immediately after birth rationale: an over-distended urinary bladder prevents the uterus from contracting after birth and contraction of the uterus constricts blood vessels, preventing hemorrhage

The parents do not want their newborn's eyes treated with a prophylactic agent. The nurse's best response would be: 1. this is really for the baby's good 2. this is a legal requirement and must be done 3. have you discussed this with your pediatrician? 4. you'll have to sign an informed consent to refuse the treatment

4. you'll have to sign an informed consent to refuse the treatment rationale: this is the required intervention when legally required eye treatment is refused

During the assessment of a client in labor, the cervix is determined to be 4 cm dilated. The nurse understands that this client is in the stage of labor known as: 1. First 2. Second 3. Prodromal 4. Transitional

1. First rationale: the first stage of labor is from 0 cervical dilation til full dilation

The nurse performs Leopold's maneuvers on a newly admitted client in labor. Palpation reveals a soft, firm mass in the fundus, a firm, smooth mass on the mother's left side, several knobs and protrusions on the mother's right side, and a hard, round moveable mass in the pubic area with the brow on the right. Based on these findings, the nurse recognizes that the fetal position is: 1. LOA 2. ROA 3. LMP 4. RMP

1. LOA rationale: the fetus is in the left occiput anterior position because the butt is in the fundus, the back is on the left, and the head is flexed indicating an anterior occiput

During labor, a client has an internal fetal monitor applied. The nurse should take action in response to a fetal heart rate that: 1. Does not drop during contractions 2. Fluctuates from 130 to 140 beats per minute 3. Uniformly drops to 120 beats per minute with each contraction 4. Repeatedly drops abruptly to 90 beats per minute unrelated to contractions

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The nurse is observing the electronic fetal monitor as a client in labor enters the second stage. The nurse identifies early decelerations of the fetal heart rate with return to baseline at the end of each contraction. This usually indicates: 1. Fetal acidosis 2. Fetal cord prolapse 3. Maternal hypotension 4. Fetal head compression

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The cervix of a client in labor is fully dilated and 100% effaced. The fetal head is at +3 station, the fetal heart rate ranges from 140-150 BPM, and the contractions are two minutes apart lasting 60 seconds. When inspecting the perineum the nurse would expect to find: 1. Small tears in the perineum 2. Greenish-yellow amniotic fluid 3. Increasing amounts of amniotic fluid 4. A small amount of caput with each contraction

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Five minutes after the birth of a neonate, the nurse midwife assesses that the client's placenta is separating when: 1. The fundus becomes completely relaxed 2. There is a lengthening of the umbilical cord 3. The client complains of unbearable abdominal pain 4. Bright red blood continually seeps out of the vaginal opening

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One hour after delivery, the nurse palpates a client's funds to determine if involution is taking place. The fundus is firm, in the midline, and two finger-breadths below the umbilicus. Based on these findings the nurse should: 1. Encourage the client to void 2. Notify the physician immediately 3. Massage the uterus vigorously and attempt to express clots 4. Identify this as expected and continue periodic assessments

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The nurse is evaluating uterine tone eight hours after a woman has delivered a healthy infant. The nurse would be able to determine that the uterus is involuting appropriately when: 1. Numerous clots are passed vaginally 2. Bleeding from the episiotomy has stopped 3. There is a moderate amount of lochia rubra 4. No uterine cramps occur during breastfeeding

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A client is to receive an epidural anesthetic during labor. After the client is anesthetized, the nurse should monitor the client for: 1. Lightheadedness 2. Urinary retention 3. Decreased temperature 4. Decreased level of consciousness

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After a cesarean birth, the nurse performs fundal checks every 15 minutes. During one check the nurse notes that the fundus is soft and boggy. The priority nursing action at this time is to: 1. Elevate the client's legs 2. Massage the client's fundus 3. Increase the oxytocin drip rate 4. Examine the client's perineum for bleeding

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In the second hour after birth of a neonate a client's uterus is found to be firm, above the level of the umbilicus, and to the right of mid- line. The appropriate intervention would be to: 1. Observe for signs of retained secundines 2. Assist the client to the bathroom to empty her bladder 3. Massage her uterus vigorously to prevent hemorrhage 4. Tell the client that this is a sign of uterine stabilization

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During the fourth stage of labor, about one hour after giving birth, a client begins to shiver uncontrollably. The best nursing action would be to: 1. Check the vital signs since the client may be going into hypovolemic shock 2. Monitor the client's blood pressure because shivering may cause it to elevate 3. Obtain an order to increase the amount of IV fluids as the client is probably dehydrated 4. Cover the client with additional blankets to alleviate this typical postpartum sensation of feeling cold

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A client is admitted in active labor. During the assessment between contractions the nurse palpates her abdomen to determine the fetal presentation, which is the: 1. Position of the fetal body parts 2. Portion of the fetus that enters the pelvis first 3. Relationship of the fetal presenting part to the mother's pelvis 4. Relationship of the long axis of the fetus to the long axis of the mother

2. Portion of the fetus that enters the pelvis first rationale: this is the definition of presentation; can be cephalic, breech, or shoulder

At one minute after birth the nurse notes that an infant is crying, has a heart rate of 140, has blue hands and feet, resists the suction catheter, and keeps the arms extended. What Apgar score should the nurse assign for this infant?

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Immediately after the birth of a neonate, the nurse's first action should be to: 1. Dry and place the infant in a warm environment 2. Perform an abbreviated systematic physical assessment 3. Cut the umbilical cord and attach a clamp to the cord 4. Administer oxygen by face mask until cyanosis clears

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An assessment of a newborn includes the differentiation between cephalhematoma and caput succedaneum. When making this assessment, the nurse understands that with caput succedaneum the: 1. Edema crosses the suture line 2. Swelling increases within 24 hours 3. Scalp over the swelling becomes ecchymotic 4. Area surrounding the swelling will be tender

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When assessing a newborn's grasp reflex, the nurse should elicit it by: 1. Putting direct pressure along the sole of the newborn's foot 2. Jarring the crib and watching the movement of the newborn's hands 3. Pressing the examining fingers against the palms of the newborn's hands 4. Holding the body upright and allowing the newborn's feet to touch a surface

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A client in labor is admitted to the birthing room. The nurse's assessment reveals that the fetus is at -1 station, which means the presenting part is: 1. Visible at the vaginal opening 2. One cm below the ischial spines 3. One cm above the ischial spines 4. At the level of the ischial spines

3. One cm above the ischial spines rationale: station -1 that the fetal head is 1 cm above the ischial spines (negative above, positive below)

A woman who is having contractions is concerned whether she is in true labor. She states, "How will you know if I am really in labor?" The nurse's response is based on the knowledge that: 1. A bloody show is rare with false labor 2. Fetal movement is decreased in true labor 3. The cervix dilates and effaces in true labor 4. The membranes rupture when true labor begins

3. The cervix dilates and effaces in true labor rationale: the major difference between true and false labor is that true labor can be confirmed by verifying dilation and effacement of the cervix

When assessing a newborn's Moro reflex the nurse should elicit it by: 1. Turning the infant's head quickly to one side 2. Tapping briskly on the bridge of the infant's nose 3. Stroking the infant's back alongside the spine 4. Suddenly but gently jarring the infant's bassinet

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A baby weighing 5 pounds, 6 ounces is born via cesarean birth. The nurse expects the newborn's respiratory rate to range between: 1. 20 to 40 per minute 2. 30 to 60 per minute 3. 60 to 80 per minute 4. 70 to 90 per minute

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After the birth of her daughter, a mother states to the nurse, "I was told that my baby has to have an injection of vitamin K. She's so small to be getting a shot. Why does she have to have it?" The nurse's most appropriate response would be: 1. "Your baby needs the injection to help her develop red blood cells." 2. "An injection of vitamin K will help to prevent your baby from becoming jaundiced." 3. "Newborns are deficient in vitamin K. This treatment protects your baby from bleeding." 4. "A newborn's blood clots faster than it should. This injection helps decrease the clotting time."

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When assessing for developmental dysplasia of the hip (DDH) during the newborn assessment, the nurse should determine if the infant has extra skin folds in the: 1. Thigh 2. Abdomen 3. Calf muscles 4. Popliteal area

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At one minute after birth a newborn's body is pink with blue extremities, the heart rate is 122, there is withdrawal when the soles are flicked, the respirations are easy with no evidence of distress and the arms and legs are flexed and vigorously moving. The nurse assesses the Apgar score to be: 1. 7 2. 8 3. 9 4. 10

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When assessing a newborn, the nurse notes several areas of raised white spots on the chin and nose. The nurse is aware that these are known as: 1. Milia 2. Lanugo 3. Vascular nevi 4. Erythema toxicum

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A client delivers a full-term male infant with an 8/9 Apgar score. The immediate nursing care of this newborn should include: 1. Assessing respirations, identifying the infant, and keeping him warm 2. Applying a prophylactic agent to the eyes, giving AquaMEPHYTON, and bathing him 3. Rushing him to the nursery while aspirating the oropharynx, and stimulating him often 4. Weighing him, placing him in a crib, and keeping him near until the mother is ready to hold him

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