Ob Exam 3

Assessment of a woman in labor reveals cervical dilation of 3 cm, cervical effacement of 30%, and contractions occurring every 7-8 minutes, lasting about 40 seconds. The nurse determines that this client is in:

A: latent phase of the first stage

12. Some women experience a rupture of their membranes before going into true labor. A nurse recognizes that a woman who presents with PPROM has complete how many weeks of gestation?

A: less than 37 weeks

14. A nurse is providing care to a multiparous client. The client has a history of cesarean births. The nurse anticipates the need to closely monitor the client for which condition?

A: placenta accreta

11. A pregnant client is brought to the health care facility with signs of premature rupture of the membranes (PROM). Which conditions and complications are associated with PROM? SATA

A: prolapsed cord B: abruptio placenta E: preterm labor

A woman in labor received an opioid close to the time of birth. The nurse would assess the newborn for which effect?

A: respiratory depression

11. A nurse is describing a technique developed in the 1940s by Dr. Arnold Kegel to assist postpartum women with a common issue. The nurse explains that the purpose of this technique to is:

A: strengthen the pelvic floor muscles to reduce urinary incontinence

13. A pregnant 36-year-old woman has presented to the emergency department with vaginal bleeding. While reviewing the client's history, the nurse suspects placenta previa when which risk factors are found in her record? SATA

A: infertility treatment B: smoking C: advancing maternal age D: previous induced surgical abortion

9. A nurse is caring for a client who has had a vaginal birth. Which should the nurse recommend to the client to improve pelvic floor tone?

A: kegel exercises

16. The nurse is educating a group of pregnant women about risk factors associated with preterm labor. Which factor would the nurse include in the teaching? SATA

A: alcohol use during pregnancy B: lack of prenatal care C: victim of intimate partner violence

12. A nurse is caring for a client who is experiencing acute onset of dyspnea and hypotension. The HCP suspects the client has amniotic fluid embolism. What other S&S would alert the nurse to the presence of this condition in the client? SATA

A: cyanosis E: pulmonary edema

A nurse notes a pregnant woman has just entered the second stage of labor. Which interaction should the nurse prioritize at this time to assist the client?

A: encouraging the woman to push when she has a strong desire to do so

10. The nursing student correctly identifies which risk factors for developing dystocia?

A: epidurals B: excessive analgesia C: multiple gestation D: maternal exhaustion F: high fetal station at complete cervical dilation G: shoulder dystocia

15. A client has arrived to the birthing center in labor, requesting a VBAC. The nurse knows that she would be a good candidate after reading the client's previous history based on which finding?

A: has previous lower abdominal incision

A client is in the third stage of labor. Which finding would alert the nurse that the placenta is separating?

uterus is becoming globular

A nurse is providing care to a woman in labor. The nurse determines that the client is in the active phase based on which assessment findings? Select all that apply

A & B: Cervical dilation of 6 cm contractions every 2 to 3 minutes

10. When caring for a client with premature rupture of membranes (PROM), the nurse observes an increase in the client's pulse. What should the nurse do next?

A. Assess the client's temp

5. When caring for a client requiring a forceps-assisted birth, the nurse would be alert for:

B: potential lacerations and bleeding

13. A nurse is caring for an antenatal mother diagnosed with umbilical prolapse. For which should the nurse monitor the fetus?

A: fetal hypoxia

the nurse is assessing the external fetal monitor and notes the following: FHR of 175 bpm, decrease in variability, and late decelerations. Which action should the nurse prioritize at this time?

A: Have the woman change her position

17. During the early postpartum period, a new mother is displaying dependent behaviors. What behaviors would the nurse recognize as normal for this period? SATA

A: Needing assistance with changing her peripad C. Telling the nurse about her delivery experience D. Asking the nurse to take the newborn away so she can rest

17. A 24-year-old client is brought to the emergency department complaining of severe abdominal pain, vaginal bleeding, and fatigue. The nurse notes on assessment cool, clammy skin, confusion, and vital signs: HR 130, RR 28, and BP 98/60 mmHg. Which action should the nurse prioritize?

A: Rule out shock

The nurse is performing Leopold's maneuvers as part of the initial assessment. which action would the nurse do first?

A: Feel for the fetal buttocks or head while palpating the abdomen

Which action is a priority when caring for a woman during the fourth stage of labor?

A: assessing the uterine fundus

6. What finding would the nurse describe as "light" or "small" lochia?

B: 4-inch stain or 10-25 mL loss

A nursing student correctly identifies the most desirable position to promote an easy birth as which position?

B: occiput anterior

15. The nurse is performing an assessment for a client in the immediate postpartum period. Which assessment finding should the nurse prioritize?

C: Hemorrhage

the fetus of a woman in labor is determining to be in a persistent occiput posterior position. Which intervention would the nurse prioritize?

B: Pain relief measures

11. The nurse is caring for a client experiencing a prolonged second stage of labor. The nurse would placed priority on preparing the client for which intervention?

A: a forceps and vacuum-assisted birth

18. The nurse is conducting a breast exam on a postpartum mother on the second day following delivery. What findings would the nurse determine to be normal? SATA

A. Breasts feel slightly firm D. Flattened nipple on the right breast E. Breasts are non-painful

19. The nurse is inspecting a new mother's perineum. What actions would the nurse take for this client? SATA

A. Inspect the episiotomy for sutures and to ensure that the edges are approximated C. Note any hemorrhoids E. Gently palpate for any hematomas

19. A woman at 37 weeks gestation presents to the L&D area with symptoms of abruptio placentae. Which action should the nurse prioritize?

A. ensure large bore IV access is obtained

13. A nurse visiting a postpartum client at home is reviewing the need for the woman to meet her own nutritional needs. The woman is breastfeeding her newborn. The nurse determines that the client understands her nutritional needs based on which statements?

A: "I need to drink about 2-4 quarts of fluid each day B: "I should have about 4 servings of fruits each day" D: "I will have at least 4-5 servings of milk each day"

A nurse is describing the different types of regional analgesia and anesthesia for labor to a group of pregnant women. Which statement by the group indicated that the teaching was successful?

A: "We can get up and walk around after receiving combined spinal-epidural analgesia"

9. The nurse is requested to assist the physician with an external version. What intervention should the nurse perform prior to and immediately after the external version?

A: A non stress test

9. A nurse is caring for a client at 38 weeks gestation who is diagnosed with chorioamnionitis. On which intervention should the nurse place priority?

A: Administer oxytocin

4. A client at 34 weeks gestation has reported to the hospital in labor. The following is documented on history and physical assessment: -no rupture of membranes, mild cramping, no bleeding -reassuring pattern on fetal heart monitor -cervix is dilated 3 cm, effacement 30% The nurse anticipates which treatment plan?

A: Admission to the hospital, bed rest, and a tocolytic agent

3. A nurse is providing care to a couple who have experienced intrauterine fetal demise. Which action would be least effective in assisting couple at this time?

A: Avoid any discussion of the situation with the couple

8. The nurse is preparing discharge instructions for a pregnant patient experiencing preterm rupture of membranes. What should the nurse include in this teaching? SATA

A: Avoid douching E: Measure oral temp twice a day

1. A woman at 32 weeks' gestation is admitted in preterm labor. On the nurse's admission assessment, which of the following findings would cause the nurse to question the administration of a tocolytic agent?

A: Cervical dilation of 5 cm

The nurse notes persistent early decelerations on the fetal monitoring strip. Which action should the nurse prioritize in this situation?

A: Continue to monitor the FHR because this pattern is benign

7. A pregnant patient is diagnose with preterm labor. What should the nurse teach the patient to help prevent the reoccurrence of preterm labor? SATA

A: Drink 8-10 glasses of fluid each day B: Report any sings of ruptured membranes C: Reminders on bed rest except to use the bathroom

14. When assessing the episiotomy site of a postpartum client that delivered 3-hours ago, the nurse would document which findings as expected? SATA

A: Edema C: Slight bruising

5. A client is 2 weeks past her due date, and her health provider is considering whether to induce labor. Which conditions must be present before induction can take place? SATA

A: The fetus is in a longitudinal lie B: The cervix is ripe C: A presenting part is engaged

1. During pregnancy a woman's cardiovascular system expands to care for the growing fetus. After birth, during the early postpartum period, the woman eliminates additional fluid volume she has been carrying. What is one way she does this?

A: Urinary elimination

10. The nurse is assisting a young mother who has decided not to breastfeed her infant. The nurse should make which suggestions to the client to ease discomfort and prevent breast engorgement? SATA

A: Wear tight supportive bra 24 hours each day B: Apply ice to the breast for approx 15-20 minutes every other hour C: Avoid sexual stimulation

19. The nurse is receiving shift handoff for a client with dystocia. Which nursing interventions are most appropriate in the plan of care? SATA

B: Nipple stimulation C: Admin of enema E: Emotional support

6. After an hour of oxytocin therapy, a patient in labor experiences headache and vomiting. What should the nurse do?

B: Notify the physician and stop the infusion

3. A pregnant client is admitted to a health care unit with disseminated intravascular coagulation (DIC). Which prescription is the nurse most likely to receive regarding the therapy for such a client?

B. Administer cryoprecipitate and platelets

18. At 31 weeks' gestation, a 37yo woman w/ a hx of preterm birth reports cramps, vaginal pain, and low, dull backache accompanied by vaginal discharge and bleeding. Assessment reveals cervix 2.1 cm long; fetal fibronectin in cervical secretions, and cervix dilated 3-4 cm. Which interactions should the nurse prepare to assist with?

B. Hospitalization, tocolytic, and corticosteroids

20. After the abdominal dressing is removed 24 hours following a cesarean delivery, the nurse inspects the incision and observes drainage from the incision, redness along the suture line and moderate edema. Staples are intact. What action would the nurse take?

B. Let the RN know of your findings

4. After teaching a couple about what to expect with their planned cesarean birth, which statement indicates the need for additional teaching?

B: "I'm going to have to wait a few days before I can start breastfeeding"

After describing continuous internal electronic fetal monitoring to a laboring woman and her partner, which statement by the woman would indicate the need for additional teaching?

B: "Unfortunately, I'm going to have to stay quite still in bed while it is in place"

17. A woman arrives in the L&D unit in the beginning early phase with her contractions 5-8 minutes apart and dilated 1 cm. Thirty minutes later the nurse finds the woman in hard, active labor and 8 cm dilated. The nurse calls for assistance, prepares for a precipitate birth, and monitors the woman for which priority assessment caused by a rapid birth?

B: Check perineal area frequently for bleeding

15. During labor, a woman undergoing induction with oxytocin should be monitored frequently. Which assessment findings should result in the oxytocin being discontinued immediately and the health care provider notified? SATA

B: Contractions strong at 80 mmHg pressure with each contraction E: Contractions lasting between 90-120 seconds occurring every 2-3 minutes

20. A client reports bright red, painless vaginal bleeding during her 32nd week of pregnancy. A sonogram reveals that the placenta has implanted low in the uterus and is partially covering the cervical os. Which immediate care measure are initiated? SATA

B: Determine the time bleeding began and about how much blood has been lost C: Obtain baseline vital signs and compare to those vitals signs previously obtained E: Attach external monitoring equipment to record fetal heart sounds and kick counts

6. a nursing student has learned that precipitous labor is when the uterus contracts so frequently and with such intensity that a very rapid birth will take place. This means the labor will be completed in which span of time?

B: Less than 3 hours

8. A client who has given birth a week ago reports discomfit when defecting and ambulating. The birth involved an episiotomy. Which suggestions should the nurse provide to the client to provide local comfort? SATA

B: Use of warm sitz baths C: use of anesthetic spray D: Use of witch hazel pads

14. A graduate nurse (GN) is caring for a woman being inducted via oxytocin infusion. The client is currently reporting a headache and is vomiting. The graduate nurse thinks that the client is getting near the end of labor. However, the GN preceptor intervenes by performing which interventions immediately after hearing this report?

B: discontinuing the oxytocin infusion D: notifying the HCP immediately

2. A nurse is assessing a woman during the first 24 h after birth. Which assessment finding would the nurse determine as acceptable during this time? SATA

B: fundus one fingerbreadth below the umbilicus E: Moderate saturation of peripad every 3 hours

A client is admitted to the labor ad birthing suite in early labor. On review of her prenatal history, the nurse determines that the client's pelvic shape as identified in the antepartal progress notes is the most favorable one for a vaginal birth. Which pelvic shape would the nurse have noted?

B: gynecoid

A woman calls the health care facility stating that she is in labor. The nurse would urge the client to come to the facility if the client reports which symptom?

B: moderately strong contractions every 4 minutes, lasting about 1 minute

7. When giving a postpartum client self-care instructions in preparation for discharge, the nurse instructs her to report heavy or excessive bleeding. How should the nurse describe "heavy bleeding"?

B: saturating 1 pad in 1 hour

2. A pregnant client in her 34th week of gestation is diagnosed with amnionitis due to group B streptococcus. The nurse monitors the client closely based on the understanding that the client is at risk for which of the following?

C. Preterm birth

Assessment of a woman in labor reveals that the fetus is in a cephalic presentation and engagement has occurred. The nurse interprets this finding to indicate that the presenting part is at which station?

C: 0

2. A woman develops a pathologic retraction ring during labor. On assessment, you would expect to find its appearance as which?

C: A line of indentation over the lower abdomen

1. Mrs. Carter is admitted to the L&D unit. The lab results of her cervical culture for group B streptococcal were positive. What priority intervention will be initiated?

C: Ampicillin or cefazolin intravenous is given before delivery

16. A nurse is reading a journal article about cesarean births and the indications for them. Place the indications for cesarean birth below in the proper sequence from most frequent to least frequent. All options must be used.

C: Labor dystocia D: Abnormal fetal heart rate tracing A: Fetal malpresentation B: Multiple gestation E: Suspected macrosomia

12. Which client should the postpartum nurse assess first after receiving shift report?

C: The 2-day postpartum client who has a blood pressure of 138/90 mmHg

A client has not received any medication during her labor. She is having frequent contractions every 1 to 2 minutes and has become irritable with her coach and no longer will allow the nurse to palpate her fundus during contractions. Her cervix is 8 cm dilated and 90% effaced. The nurse interprets these findings as indicating:

C: Transition phase of the first stage of labor

The nursing instructor is preparing a group of nursing students for their clinical phase and is questioning them on the various assessment skills they will need. The instructor determines the session is successful when the students correctly choose which time interval to assess the fetal heart rate of clients who are in the active phase of labor?

C: every 15 to 30 minutes

When palpating the fundus during a contraction, the nurse notes that it feels like a chin. The nurse interprets this finding as indicating which type of contraction?

C: moderate

5. A woman who had a cesarean birth of twins 6 hours ago reports shortness of breath and pain in her right calf. What complication should the nurse expect?

C: pulmonary emboli

4. Based on the nurse's knowledge about the postpartum period and an increase in blood coagulability during the first 48 hours, the nurse closely assesses the client for which condition?

C: thromboembolism

7. A patient who comes to the ER states she has not felt any fetal movement for several days. The physician cannot hear a heartbeat suspects fetal death. Once fetal death is confirmed by ultrasound, the physician immediately induces labor. Why is it important in this case to induce labor as soon as possible?

C: to prevent coagulopathy

18. A woman in active labor with a hx of 2 previous c-sections is being monitored frequently as she tries to have a vaginal birth. Suddenly, the woman grabs the nurse's hand and states, "something inside me is tearing". The nurse notes her BP is 80/50 mm Hg,m pulse rate is 130 bpm and weak, the skin is cool and clammy, and the fetal monitor shows bradycardia. the nurse activates the code team because the nurse suspects the client may be experiencing which complication?

D. Uterine

A nurse is explaining the use of effleurage as a pain relief measure during labor. Which statement would the nurse most likely use when explaining this measure?

D: "the technique involves light stroking of the abdomen with breathing"

8. The nurse is monitoring a client in labor who has had a previous cesarean section and is trying a vaginal birth with an epidural. The nurse observes a sudden drop in blood pressure, increased heart rate, and deep variable deceleration on the fetal monitor. The client reports severe pain in her abdomen and shoulder. What should the nurse prepare to do?

D: Prepare the client for a c-section

20. The nurse is assessing a multipara woman who presents to the hospital after approx. 2 hours of labor and notes the fetus is in a transverse lie. After notifying the RN and PCP, which action should the LPN prioritize?

D: Prepare to assist with external version

3. A G1 P0101 woman delivered by C section is now in the recovery room. She received Duramorph via intrathecal catheter. On review of orders before transfer to the postpartum unit the nurse notes one entry that needs clarification by the physician. Which order is the source of the nurse's concern?

D: monitor respirations every 4 hours for 24 hours

16. A client who gave birth 18 hours ago is experiencing a change in lochia flow from scant to moderate. Prioritize the actions the nurse would take to assess the client's fundus. All options must be used

b, d, c, e, a, f