OB Exam 1

What is an example of proximity?

-Rooming in with the infant

The nurse is working with a young couple who are expecting their first child but do not have family living in the area. After explaining the concept of family-centered care to the people, the nurse determines that additional explanation is needed when the couple identifies which type of support as being involved with this type of care?

Appraisal

When communicating with a client who speaks a different language, the best practice for the nurse is to do what?

Arrange for an interpreter when communicating with the client.

As a nurse is explaining the difference between true versus false labor to her childbirth class, she states that the major difference between them is what?

Progressive cervical changes occur in true labor.

The family has decided to have a home birth with a midwife. What statement indicates to the nurse that the family has considered all options?

"Our midwife works with a local primary care provider and the hospital in case there are any complications or concerns."

A woman who is breastfeeding for her newborn says, "he doesn't seem to want to nurse. I must be doing something wrong." What response by the nurse would be least helpful?

"Some woman just can't breast-feed. Maybe you're one of those women."

If the woman is a diabetic, what is critical to alert the newborn nursery of in the newborn?

Hypoglycemia

A nurse in a woman's shelter is counseling a client who has been a victim of abuse. What type of prevention is this treatment?

Tertiary

A patient is Rh-negative and has given birth to a newborn who is Rh-positive. Within how many hours should the Rh immunoglobulin be injected in the mother?

Within 72 hours

A preterm newborn is to be discharged home on oxygen therapy and tube feedings. Which statement by the parents would indicate that they need additional teaching and preparation for this transition?

"Our insurance company will pay for all the equipment that we need for the treatments." Insurance companies do not always cover all items necessary for care.

The nurse is providing care to a client in labor. On examination, the nurse determines the fetus is at -1 station. The nurse interprets this as indicating that the fetus is where?

-1cm above the ischial spines

What are the levels of the fetal station?

-3 -2 -1 0=ischial spine/0=biparietal diameter +1 +2 +3

When teaching a group of soon-to-be parents about the structures of the fetal skull, the nurse describes the anterior fontanelle. What descriptions would the nurse include?

-Approximately 2 to 3 cm in size -Closes about 12-18 months

The local community health nurses are working with the surrounding clinics to initiate programs that will help develop policies to reflect the goals of Healthy People 2020 (HP 2020). What would be included in those policies?

-Decrease the health disparities among the different populations -Increase the quality of life and life expectancy -Identify potential at-risk clients for pregnancy complications

What can be some causes for postpartum headaches?

-Gestational hypertension -Stress -Leakage of cerebrospinal fluid due to spinal anesthesia

During the delivery, the physician performed an episiotomy. The client is now complaining of discomfort. To reduce this discomfort and increase hygiene to the perineum, the client should encourage to use what?

-Ice packs -Peri bottle and warm water -Witch hazel pads -Anesthetic sprays -Sitz baths

The nurse is caring for a client who had been administered an anesthetic block during labor. Which of the following are risks that the nurse should watch in the client?

-Incomplete emptying of bladder -Bladder distention -Urinary retention

What are some examples of parental attachment?

-Look/gaze -Identify infant as unique individual

A 25-year-old gravida 2, para 2-0-0-2, gave birth 4 hours ago to a 9lbs 7oz boy after augmentation of labor with oxytocin (Pitocin). She puts on her call light and asks for her nurse right away stating, "I am bleeding a lot". The most likely cause of what?

uterine atony

What are examples of interaction between parent and infant?

-mutual or reciprocal -acquaintance -claiming process (name, part of family member)

Which uncommon fetal attitude results in a brow presentation?

A partial extension

While discussing labor with a client and her partner, the nurse is asked what the best position is for delivering the baby. The nurse provides them with information that indicates research has shown which position as the best?

A position of comfort for the mother

A pregnant woman is at 38 weeks of gestation and wants to know if any signs indicate that labor is getting closer to starting. The nurse informs the woman that this is a sign that labor will being soon:

A surge of energy

A laboring woman is admitted to the labor and delivery. She is 6cm dilation. She would be in which phase of the first stage of labor?

Active phase

A nurse caring for a laboring woman is cognizant that early decelerations are caused by what?

Altered fetal cerebral blood flow, fetus's response to fetal head compression.

When reviewing the history of a woman in labor, the nurse notes that the client has a funnel-shaped pelvis. How would the nurse identify this pelvic shape?

Android

Although most blood specimens are drawn by laboratory technicians, nurses may be required to perform heel sticks to obtain for glucose monitoring or newborn screening. The most serious complication of an infant heel stick is necrotizing osteochondritis resulting from the lancet penetration of the bone. To prevent this problem the stick should be done where?

At the outer aspect of the heel

A nurse administers vitamin K to the newborn for what reason?

Bacteria that synthesize Vitamin K are not present in the newborn's intestinal tract.

What is involved in the third stage of labor?

Birth of baby to when placenta is delivered

Client advocacy, utilization management, and coordination of care describe what?

Case Management

A nurse is caring for a woman in labor and understands that as the fetus travels through the birth canal, the fetus makes positional changes. What is the correct order of cardinal movements of labor?

Engagement, decent, flexion, internal rotation, extension, external rotation, and expulsion. The cardinal movements of labor describe the positional changes the fetus goes through as it travels through the passageway.

After birth, the cervix returns to its pre-pregnant shape. T or F

False: after delivery, the cervix closes but never regains its pre-pregnant appearance. It is no longer circular, but appears as a jagged slit-like opening.

As a nurse at the local public health office, you recognize that what is a major but often overlooked problem?

Fetal mortality. It refers to the spontaneous intrauterine death at any time during pregnancy, commonly referred to as a miscarriage. The U.S. mortality rate is 6.2 per 1,000 live births.

Which stage of labor is the longest stage?

First stage

What is single footling breech?

Flexion, except for one leg extended at hip and knee

The nurse is participating in a poisoning prevention program. This activity is an example of which type of community-based nursing intervention?

Health education program.

A nurse is providing care to a client who has undergone a mastectomy. The nurse provides the woman with information about where to obtain a breast prosthesis. This is an example of which type of community-based nursing intervention?

Health system referral

When preparing a presentation for a local woman's group on women's health problems, what would the nurse include as the number one cause of mortality for women in the United States?

Heart disease

As the client gets closer to her due date, it is important to stress that the woman seeks assessment after spontaneous rupture of the membranes (SROM) due to what?

Increased risk of infection

Nurses should be aware that accelerations in the fetal heart rate is what?

Indications of fetal well-being when they are periodic.

How long is it before the mother may pass her first bowel movement?

It may take 2-3 days after childbirth

What is the most common cause of fetal tachycardia?

Maternal fever

During labor, a fetus with an average heart rate of 135 beats/min over a 10 minute period is considered to have what type of range of hear beats?

Normal range (110-160)

A nurse is caring for a patient who delivered 15 hours ago. The client informs the nurse that she experiences painful uterine contractions when breastfeeding the baby. The nurse would be accurate in identifying which hormone as the cause of these afterpains?

Oxytocin released due to the sucking reflex, which strengthens uterine contractions.

A 19-year-old female presents in advanced labor. Examination reveals the fetus is in frank breech position. You explain to the client this means what?

The buttocks are presenting first with both legs extended up toward the face.

What is the risk of a boggy uterus?

Uterine atony allows hemorrhage to flow into the uterus.

A nurse assisting a pregnant client during pregnancy is to monitor uterine contractions. Which of the following factors should the nurse assess to monitor uterine contractions?

Uterine resting tone, frequency, and intensity

What is shoulder presentation?

When the presenting part is the scapula and the whole body is in flexion.

What is the most important nursing intervention after an epidural anesthesia injection has been given?

Monitor maternal blood pressure

A nurse working in an ambulatory health care clinic located in a poor neighborhood. Which nursing intervention would most likely provide the greatest benefit for the women and their children seen at this clinic?

Providing them with drug samples for therapy.

A nurse is examining a client who underwent a vaginal birth 24 hours ago. The client asks the nurse why her discharge is such a deep red color. What explanation is the most accurate for the nurse to give the client?

"The discharge consists of mucus, tissue debris, and blood; this gives it the deep red color".

Which immunizations are safe for the pregnant client to receive?

-Influenza vaccine -Tdap -Hep B

What are the signs preceding labor?

-Lightening: baby descends into the pelvis -Bloody show: "mucus plug" obstructs the cervical canal since conception is passed

A new mom is alarmed at the elongated shape of her newborn's head. Assessment reveals swelling at the area of the presenting part. The swelling crosses the suture lines. The nurse suspects which conditions?

-Molding (or overlapping of the cranial bones) -Caput succedaneum (fluid collecting in the scalp -Cephalohematoma (blood beneath the scalp)

Interventions that are underutilized in promoting a normal birth. What are they?

-Oral nutrition and fluids in labor (provides hydration and comfort) -Skin to skin contact after birth for infant bonding. (promotes bonding and warmth) -Open glottis pushing in the second stage of labor. (allows the woman's body to sense the urge to push naturally.)

You are a nurse working in a home health agency and your supervisor has asked you to develop some teaching aids that stress secondary prevention care. Which of the following topics might be included?

-PAP smears -Blood pressure evaluations -Self-breast examinations

What are the senses between the parent and infant?

-Touch -Eye contact (en face) -Voice -Infant response to high pitched voices -Odor

A nurse caring for a pregnant client in labor observes that the FHR is below 110. Which interventions should the nurse perform?

-Turn the client on her side -Increase the IV fluid rate -Administer O2 -Assess for underlying causes

What are the three types of presentation of the baby's head at birth?

-Vertex: chin to chest -Sinciput: level head -Brow: chin is up

What are the seven cardinal movements of mechanism of labor?

1. Engagement: head engages the pelvis 2. Descent: latent to active 3. Flexion: chin gets closer to chest in smaller diameters 4. Internal rotation: fetal head is guided into correct position 5. Extension: fetal head under the symphysis pubis 6. External rotation: delivery of anterior shoulder 7. Expulsion: delivery of the body of the baby.

What is an example of bonding?

Eye-to-eye contact

What is the fourth stage of labor?

2 hours after delivery of the placenta

The nurse is teaching a postpartum woman and her spouse about postpartum blues. The nurse would instruct the couple to seek further care if the client's symptoms persist beyond how long?

2 weeks

How long does it take on average, for an episiotomy to heal?

2-3 weeks (4-6 weeks fully).

An infant boy was born just a few minutes ago. The nurse is conducting the initial assessment. How often should the APGAR assessment be performed at?

At least twice, 1 minute and 5 minutes after birth

The nurse is assessing a client who has given birth within the past hour. The nurse would expect to find the woman's fundus at which location?

At the level of the umbilicus

A patient who gave birth 2 days ago is complaining to the nurse of profuse sweating during the night. What should the nurse recommend to the client in this regard?

Be sure to change your pajamas to prevent you from chilling. Postpartal diaphoresis is normal and drinking cold fluids will help to replenish the loss of fluid, but it will not prevent it.

Which assessment would indicate that a woman is in true labor?

Cervix is 4cm dilated, 90% effaced. True labor is characterized by contractions occurring at regular intervals that increase in frequency, duration, and intensity.

What is the leading cause of infant mortality in the United States?

Congenital abnormalities

A woman gave birth vaginally approximately 12 hours ago, and her temperature is now 100 degrees F. What action would be the most appropriate?

Continue to monitor the woman's temperature every 4 hours; this finding is normal

Perinatal nurses are legally responsible for what?

Correctly interpreting FHR patters, inititating appropriate nursing interventions, and documenting the outcomes.

As a nurse in the emergency department, you have witnessed women arriving in labor with complications. You recognize a major factor that contributes to a poor outcome for many of these clients is:

Lack of care

A new mother who is nervous about her baby developing sudden infant death syndrome (SIDS) asks the nurse how to prevent it. Which suggestion would be the most appropriate for the nurse to make?

Lay the newborn on its back, not the stomach to sleep

Prenatal education provided at a local clinic should include emphasizing to the mother to keep all routine prenatal visits. What is the rationale for this point?

Most pregnancy-related complications are preventable

A nurse is reviewing a postpartum woman's history and labor and birth record. The nurse determines the need to closely monitor this client for infection based on which factor?

Placenta removed via manual extraction

Lactation is stimulated by which hormone?

Prolactin

On a routine prenatal visit, the nurse is concerned that the client may have a substance abuse problem. To ensure proper care of her client, the nurse should do what?

Refer the client to available community services

To provide optimum care for the postpartum patient, the nurse understands that what is the most common cause of sub involution?

Retained placental fragments and infection.

The nurse is providing care to a pregnant Arab American woman. Based on the nurse's understanding of the client's culture, the nurse would expect the woman to consult with which individual before making any decisions?

The client's husband. In Arab culture, women are subordinate to men; young individuals are subordinate to older persons. In Hispanic cultures, the women are the decision makers for health. In Native American culture, the elders are looked to for assistance.

Which patient would receive the Rubella vaccine postpartum?

The woman who is borderline to immune to Rubella. Borderline immunity is also called inadequate immunity.

The client who has just been walking around her room, sits down and reports leg tightness and ashiness. After resting, she states she is feeling much better. The nurse recognizes that this discomfort could be due to what?

Thromboembolic disorder of the lower extremities

What is involution of the uterus?

When the uterus returns shape and the placental site heals. -Fundus descends 1-2cm q24h -2 weeks after childbirth the uterus is no longer palpable -Returns to a non-pregnant state by 6 weeks

It's the nurses first meeting with a pregnant client. What is the first point that the nurse needs to ascertain as part of admission assessment to check whether the client needs to be admitted to the hospital?

Whether she is in true or false labor

What is involved in the second phase of labor?

*From full dilation to birth of infant -Latent phases: baby moving down and cervix is 10 cm fully effaced and dilated -Active: to the birth of the fetus (pushing)

What is involved in the first stage of labor?

*The longest stage of labor *From the time dilation begins to the time the cervix is fully dilated -Latent: effacement of the cervix -Active: rapid dilation of the cervix and increase in descent of presenting part. -Transition: shortest, hardest phase

A nurse is conducting a class on breast cancer for a group of young women. What statements by the class indicate to the nurse that the teaching was successful?

-A diet high in fat can be a risk factor for developing breast cancer -If someone in the family has breast cancer, my risk would be increased -My risk is increased if I had an irregular menstrual cycle starting at an early age

What are the 5 factors affecting process of labor and birth?

-Passenger (fetus) -Passageway (birth canal) -Powers (contractions) -Position of mother -Psychologic response

What are the types of lochia?

-Rubra (Bright red): first 3 days -Serosa (red, maroon/yellow tinged): 4-10 days, old blood, serum and leukocytes -Alba (yellow): after day 10, dead cells, mucus, serum, and bacteria.

What are the different levels of a soaked pad?

-Scant: less than 2.5cm of stain -Light: 2.5-10cm -Moderate: 10-15cm -Heavy: full pad saturated within one hour

The postpartum process can be broken down into various phases. The nurse recognizes that the mother who is caring for herself and her newborn is considered to be in which of these phases?

-Taking-hold phase

What are the stages of pain through labor and birth?

1. First stage: visceral pain (from cervical changes, distention of lower uterine segment, and uterine ischemia-lower abdomen) 2. Second stage: somatic pain (intense, sharp, burning, localized pain-stretching and distention of perineal tissues) 3. Third stage: similar to first

What are the stages of labor regarding size in diameter?

1st stage: Onset of True Labor -Latent phase: 0-3cm -Active phase: 4-7cm -Transition: 8-10cm 2nd stage: Delivery of Baby -10cm 3rd stage: Delivery of Placenta 4th stage: 1-4 hours post delivery

What is lochia?

Bloody discharge from the uterus that contains sloughed off necrotic tissue, undergoes changes that reflect the healing stages of the uterine placental site

A new dad is alarmed at the shape of his newborn's head. When responding to the dad, the nurse reminds him this is due to what?

Cranial bones overlapping at the suture lines. It is a temporary situation that will correct itself

The nurse notes that the fetal head is at the vaginal opening and does not regress between contractions. The nurse interprets this finding which process?

Crowning

A concerned client tells the nurse that her husband, who was very excited about the baby before its birth, is apparently happy but seems to be afraid of the baby. What suggestions should the nurse give the client's husband to resolve the issue?

Suggest that her husband begin holding the baby frequently

Which factor would most likely be responsible for a pregnant woman's failure to receive adequate prenatal care in the United States?

Lack of health insurance to cover expenses

Physiologic preparation for labor would be demonstrated by what?

Lightening, whereby the fetus drops into the true pelvis

Which fetal lie is the most conductive to a spontaneous vaginal birth?

Longitudinal

A client with high cholesterol levels tells the nurse that she is planning to use an herbal remedy to supplement the prescribed medication therapy. The nurse should instruct the client to perform which action?

Speak to the primary healthcare provider about using the herbal remedy.

A nurse is assessing the uterine fundus in a patient who is two days post-op delivery. Where should she expect to find it?

The rate the uterus descends is about 1cm/day, so the fundus should be 2cm below the umbilicus

The shortest but most intense phase of labor is what phase?

The transition phase. The transition phase is in the first stage of labor and occurs when the contractions are 1-2 minutes apart and the dilation is taking place.It is the most difficult but shortest phase.

Cephalic presentation refers to a fetus whose head enters the pelvis inlet first. T or F

True.