OB exam 1
What structure provides cushioning and warmth to the fetus?
- amniotic fluid
A 24 year old patient is asking about available birth control methods that she could use. She is unsure if she wants anymore children in the future. She smokes ½ pack per day. Which of the following would you expect the provider to prescribe?
- copper IUD
The nurse is caring for a patient who is in labor with her first child. The patient's mother is present for support and notes that things have changed in the delivery room since she last gave birth in the early 1980s. Which current trend or intervention may the patient's mother find most different?
- hospital support for breastfeeding
A patient presents to the clinic with the complaints of a severe vaginal infection. She denies being pregnant but the nurse thinks she probably is. Which of the following are probable signs of pregnancy? SATA
-Chadwick's sign
Ms. Hall presents to the clinic for an OB appointment at 16 weeks. She asks about available screenings to detect neural tube defects in the fetus. Which screening is appropriate to perform first?
-MSAFP
A patient underwent a D & C after an incomplete abortion. What client education is needed before she discharges home?
-Nothing in the vagina for 2 weeks
The nurse is counseling a patient regarding pregnancy. The patient lost her first 2 pregnancies in the second trimester of gestation for undetermined reasons. Which initial advice does the nurse provide for this patient?
-Seek genetic studies
A patient is diagnosed with preeclampsia and started on magnesium sulfate. She is experiencing signs of magnesium sulfate toxicity. What is the appropriate first step to take?
-Stop the magnesium sulfate infusion
The nurse is discussing genetically linked disease with a couple planning a pregnancy. The female states, "I am concerned because there is a history of sickle-cell disease in my family." Which information from the nurse is correct?
-The male partner needs genetic testing
The nurse is caring for a patient at 7 weeks gestation. The nurse suspects that the patient may have been using marijuana. With consent, the nurse confirms via urine drug screen. Which statement by the nurse is most appropriate?
-Using marijuana while pregnant can have a negative effect on the neurological development of your baby."
A couple has been unable to conceive. The mom has 1 previous child from a previous relationship and the father has a history of 2 children with a previous relationship. He then had a vasectomy and had it reversed. A semen analysis was completed and WNL. What tests would the nurse expect the provider to order next? Select all that apply
-an u/s on the dad to look at scrotum and ureters - hormonal levels of mom - post coital analysis of cervical mucous
A patient presents to the clinic to undergo an amniocentesis after the MSAFP detected possible neural tube defects in her fetus. The mother appears scared and anxious. What can you do to help comfort her? SATA
-discuss the procedure and different steps -keep the patient warm and as comfortable as possible during the procedure -Provide pamphlets on the procedure for her to review before it begins
•Kinsley is a G5P0 at 30 years old. She has a history of 5 miscarriages, all before 20 weeks gestation. Which tests are appropriate to conduct? Select all that apply
-hormone analysis (look at progesterone) -•ultrasonography (look at uterine for shape and fibroids) - Genetic testing
A nurse is providing discharge education to a patient after a chorionic villus sampling procedure. What would warrant further teaching to be needed?
It is ok to take ibuprofen to help with the cramping It is normal to leak clear fluid after this procedure A temperature of 100.5 F is expected for 1-2 days
A patient presents to labor and delivery at 37 weeks with complaints of a severe headache, occasional contractions, and normal fetal movement. What assessment should be performed next?
Vital signs
A patient presents at 7 weeks to the emergency room with intense abdominal pain. An ultrasound is performed to confirm the pregnancy and the fetus is noted to be implanted in one of the fallopian tubes. During SBAR to the provider, the nurse recommends which mediation to help with this condition?
methotrexate
A patient presents with bright red vaginal bleeding at 34 weeks gestation. She has no history of prenatal care or ultrasounds during this pregnancy. She denies feeling any contractions and states that the fetus is active. What action should the charge nurse stop the primary nurse from performing?
performing a sterile vaginal exam
A patient had a BPP performed. The score was 6/10. What is an appropriate next intervention?
retest in 12-24 hours
A patient is 28 weeks pregnant and in preterm labor. The provider orders nifedipine to be given. The nurse knows the medication is a successful tocolytic when what occurs?
- contractions decrease and space out
A patient has decided to undergo chorionic villus sampling to detect a genetic chromosomal abnormality in her fetus. What complication should she be made aware of prior to the procedure?
-risk for miscarriage
Which of the following patients are at risk for developing preeclampsia? SATA
-A 16 year old first time mom - A 40 year old pregnant with twins for her 1st pregnancy -A 30 year old with diabetes - a 21 year old with history of chronic hypertension
A patient presents to the clinic for her 16 week appointment. She states she has been vomiting for days and is unable to keep anything down. Her weight is down 10 pounds since her last appointment 4 weeks ago. What pharmacological interventions are expected? SATA
-administer Vitamin B6 -antiemetic
The provider informs the patient of her abnormal MSAFP results at her 16 week appointment. What would be an appropriate next step?
-an amniocentesis should be performed to confirm the results by 18 weeks gestation
A nurse is talking to a local prenatal mom's group about different birth control methods. One mom asks about diaphragms. What education will the nurse provide? SATA
-you must keep it in for at least 6 hours after intercourse
A pt is 36 weeks pregnant and is undergoing an amniocentesis. Which of the following would indicate fetal lung maturity?
A lecithin/sphingomyelin ratio of 2:1
A patient had a BPP performed at 37 weeks due to chronic hypertension and scored a 4/10. The provider recommends delivery and orders a contraction stress test to be done at this time. The nurse is providing education to the patient about a CST. What education is correct?
A negative CST means that the fetus will most likely not be able to tolerate labor
The nurse is providing discharge teaching to a patient who is being discharged home after being in preterm labor. The patient is a primigravida at 33 weeks gestation. She received betamethasone x 2 and nifedipine 3 times. What education will the nurse provide? SATA
A: "nothing in the vagina" B: "Try to rest on you left side" C: "Increase your fluid intake"
A patient presents to the hospital at 28 weeks in labor. The nurse knows that the provider might order which of the following medications? SATA
A: magnesium sulfate B: nifedipine C: terbutaline D: indomethacin E: betamethasone
A nurse hears a student nurse is teach another student nurse about preeclampsia. Which of the following things that the nurse overhears should she clarify with the student nurses? SATA
A: preeclampsia can develop at anytime during pregnancy B: preeclampsia is preventable C: preeclampsia can be cured with medication D: preeclampsia is defined as a blood pressure >140/90
You hear a nurse providing education to a pt who reports smoking a pack a day during her pregnancy. You make sure to correct her when she states which of the following:
it is ok to smoke during the pregnancy as long as you stop after 36 weeks as this is when it affects the fetus the most
A G3T2P0A0L2 patient at 35 weeks gestation is sent to the labor unit after a clinic appointment. She has a history of chronic hypertension and type 1 diabetes. She had a nonstress test performed in the clinic and it was nonreactive. She was sent to the hospital for further monitoring. What additional test will be needed to assess fetal wellbeing in-utero?
- biophysical profile
The nurse is caring for a 14-year-old patient who is 32 weeks pregnant. After complaining of genital sores and discomfort, the patient tests positive for syphilis. The fetus is at an increased risk of which condition?
- blindness
What is the name of the ethical duty to do no harm?
- •Nonmaleficence
The pt presents to the clinic at 36 weeks for a routine prenatal appointment. The provider collects a GBS swab. The mom asks what GBS is and why she is being tested for it. How should the nurse respond? SATA
it can cause fetal death your baby will be monitored for signs of infection after delivery
A G4T0P3A0L3 at 16 weeks was prescribed vaginal progesterone. She has a history of delivering at 28, 26, and 25 weeks. She is asking why she needs to use this medication because she does not like inserting it. What education does the nurse provide?
it can decrease your chances of delivering early
During a 16 week prenatal appointment, the patient asks about why she feels lightheaded when she lays on her back. The nurse explains to her that this is caused by what?
laying flat on her back can cause pressure on the vena cava
The nurse has made it a goal to increase the rate at which women begin prenatal care in the first trimester. The nurse relates this decision to national goals for better maternal and infant outcomes. What guidelines will the nurse use to guide her maternal health goals?
- Healthy people 2020
The 3 top causes of maternal morbidity/mortality
- Hemorahage - Infection - Preeclampsia
The nurse is providing teaching at a 28 week appointment to a patient about fetal kick counts. The nurse asks the patient to teach back the information. The nurse knows that the patient understands when she says what?
- I should feel 10 kicks in 2 hours
The nurse is experiencing an ethical dilemma when confronted with a situation in which either the mother or fetus is predicted to die. The nurse feels bound by the ANA Code of Ethics to protect both patients. Which aspect of care during an ethical dilemma will guide her the most?
- Maternity nurses are bound to advocate first and foremost for the well-being of the mother
The nurse on a maternity unit is an Orthodox Jew whose rabbi teaches that pregnancy terminations are permitted only to save the life of the mother. Which situation becomes possible if the nurse puts aside personal values and assists with elective terminations?
- Moral Distress
The nurse is providing care for a patient in active labor. The patient continuously asks the nurse for medication to "stop the pain." Which ethical principle does the nurse use when replying, "We need to protect the baby from being overmedicated. Let me help you with some breathing and relaxation techniques."?
- Nonmaleficence
What maternal health conditions are associated with maternal obesity? Select all that apply
- Gestational Diabetes - Pre-eclampsia -Thromboembolism -Gestational HTN
A nursing student is asked to set goals that will decrease the fetal death outcomes during delivery. What guidelines will the nursing student use to assist in setting her goals?
- Healthy people 2020
What are the leading causes of infant mortality in the United States?
- Congenital Malformations & Chromosomal abnormalities
Which of the following patients would the nurse want to assess first for preterm labor
C: A G3T2P0A0L2 at 36 weeks gestation who presents with complaints of persistent low backache for the past 2 hours.
A patient presents in preterm labor at 32 weeks. The nurse administers betamethasone and nifedipine. The contractions space out. The patient asks why she needs the shot of betamethasone. How should the nurse respond?
C: The betamethasone will help your babies' lungs develop
The nurse is reviewing recent lab results of a patient. What medications will the nurse plan to administer throughout the course of the pregnancy? SATA
Penicillin, zidovudine, ceftriaxone, flu, TDAP
A patient presents with a headache, RUQ pain, petechia, and VS 162/116-122-20-94%-98.5F. You are worried that she might be experiencing HELLP. What labs would you expect to see for this patient?
Platelets 90,000 AST 800 ALT 400
A patient with a history of hypertension is giving birth. During delivery, the staff was not able to stabilize the patient's blood pressure. As a result, the patient died shortly after delivery. This is an example of what type of death?
- indirect obstetric death
A nurse is providing education to high school students about different barrier methods of birth control. Which of the following will she be talking about? SATA
- male condoms - cervical caps - diaphragms
A patient presents for an initial prenatal appointment. She is unsure of how far along she is or when her LMP was. How can her EDC be determined? SATA
-fundal height -ultrasound
A nurse is presenting at a local high school about risks associated with teen pregnancies. Which of the following would she mention as risks the mom might experience during her pregnancy? SATA
-increased risk of STI's -increased risk of hypertension
A patient at 33 weeks gestation with a first pregnancy arrives at the labor and delivery unit with contractions. After monitoring the patient, the nurse determines the woman is in active labor and calls the doctor. The doctor prescribes a sleeping medication and sends the patient home. Which action does the nurse take?
- questions the doctors prescribed treatment
•June and husband have been attempting to get pregnant for 2 years. She has a history of never being pregnant. Her husband has 3 kids from a previous relationship and has had his vasectomy reversed. What is the appropriate next step?
- semen analysis (easiest and cheapest)
A patient at 37 weeks gestation arrives at the labor and delivery unit with spontaneous rupture of membranes. Which factor causes the nurse to anticipate the doctor will prescribe a medical method of labor induction?
- •he fetus is viable and the barrier for a sterile uterine environment is breached placing mom and fetus at risk for infection
A provider orders a BPP on a patient with gestational diabetes. Which of the following findings would score 2 points on the BPP scale? SATA
-3 fetal movements -at least 2 breathing motions during 30 minutes -reactive NST
The nurse is teaching a class about embryonic and fetal development to couples in the early stage of pregnancy. For which reason does the nurse emphasize the first 8 weeks of gestation?
-All organ systems are developing during this period
A patient and spouse present to the clinic after their 3rd failed IVF transfer. They sit as far apart as possible in the exam room. The wife is tearful, and the husband appears upset and mad. He makes a comment about how expensive this has been. They have a small fight about this comment in front of the nurse. What is an appropriate response from the nurse?
-it is very common for couples experiencing infertility to need therapy
A nurse is providing education to a patient who is a type 1 diabetic with uncontrolled blood sugars. The patient states she hates giving herself injections. What education should the nurse provide about complications the newborn can experience related to uncontrolled blood sugars?
-neonatal hypoglycemia -macrosomia - respiratory distress syndrome
A nurse is providing teaching to a student nurse about the different hormones involved in implantation. The nurse tells the student that which of the following hormones are important to help the endometrium prepare for implantation of the fertilized egg?
-progesterone
A patient presents to the hospital at 25 weeks gestation with complaints of her water breaking 12 hours ago. She states she only came into the hospital because her mom made her and she doesn't feel like she needs to be there. She denies feeling any contractions and states that baby is active. The nurse educates the patient about ways to decrease her risk of complications from premature rupture of membranes including: SATA
-refraining from intercourse - no tub baths - encourage increased hydration
During a routine prenatal appointment, the patient is tested for STI's and is positive for gonorrhea. She is asking questions about why it is important to get treated for this. The nurse responds by saying:
untreated gonorrhea can have complications for you and for the fetus
•Ms. Volz is a G5P0. She is able to conceive but unable to stay pregnant. Which of the following do you think could be contributing to her infertility?
•Uterine fibroids/tumors
