OB exam 4 practice questions
During the assessment, the nurse observes a separation of the rectus muscle that is more than two fingerbreadths wide. Which instruction should the nurse offer the client? Avoid sleeping on back Perform regular exercises Sleep on a firm mattress Avoid lifting heavy objects
avoid lifting heavy objects
A nurse is caring for a postpartum client with urinary tract infection. Which instruction would the nurse include in the teaching plan for the client to help prevent future infections? "Avoid foods that are salty" "Apply ice to infected area" "Empty your bladder frequently" "Wear your elastic compression stockings"
"empty your bladder frequently"
In talking to a mother who is 6 hours post-delivery, the mother reports that she has changed her perineal pad twice in the last hour. What question by the nurse would best elicit information needed to determine the mother's status?...
"how much blood was on the two pads?"
When assessing a client's uterine fundus during the fourth stage of labor, the nurse palpates a soft, uncontracted fundus. Which of the following would the nurse do next? Gently massage the boggy fundus Suggest avoiding lifting weight Suggest complete bed rest Instruct the client to exercise
gently massage the boggy fundus
A woman is experiencing a postpartum hemorrhage due to uterine atony. Which risk factor would the nurse recognize as contributory to this specific problem? fetal demise preeclampsia placenta accreta multiparity
mutiparity
Eight days after birth the woman notices a return to red lochia. What condition does the nurse anticipate this patient is experiencing? Genital tract infection Disseminate intravascular coagulopathy Perineal hematoma rupture Retained placental fragments
retained placental fragments
Which body system is most vulnerable to infection during the postpartum period? Breasts Respiratory Urinary Gastrointestinal
urinary
During pregnancy a woman's cardiovascular system expands to care for the growing fetus. After birth, during the early postpartum period, the woman eliminates the additional fluid volume she has been carrying. What is one way she does this? Urinary elimination Being too tired to eat Elimination of solid wastes Breathing off fluid vapor
urinary elimination
Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage? thrombophlebitis hemoglobin level of 12 g/dL moderate amount of lochia rubra uterine atony
uterine atony (atony=loss of tone=increased risk for hemorrhage)
The nursing instructor is leading a discussion exploring the various conditions that can result in postpartum hemorrhage. The instructor determines the session is successful when the students correctly choose which condition is most frequently the cause of postpartum hemorrhage? Perineal lacerations Hematoma Disseminated intravascular coagulation Uterine atony
uterine atony (uterine atony increases risk of hemorrhage)
When assessing a postpartum client who was diagnosed with a cervical laceration that has been repaired, what sign should the nurse report as a possible development of hypovolemic shock? weak and rapid pulse decreased respiratory rate warm and flushed skin elevated blood pressure
weak and rapid pulse
A postpartum client reports urinary frequency and burning. What cause would the nurse suspect? subinvolution uterine atony urinary tract infection stress incontinence
uti
A nurse is assigned to care for a client with lacerations. The nurse knows that which factor would be the most likely cause of lacerations of the genital tract? excessive traction on umbilical cord history of hypertension development of endometritis birth of a large newborn
birth of a large newborn
A nurse helps a postpartum woman out of bed for the first time postpartally and notices that she has a very heavy lochia flow. Which assessment finding would best help the nurse decide that the flow is within normal limits? The flow contains large clots. Her uterus is soft to your touch. The flow is over 500 mL. The color of the flow is red.
color of the flow is red
The nurse is making a home visit to a woman who is 4 days postpartum. Which finding would indicate to the nurse that the woman is experiencing a problem?...
if the uterus is 1 cm below the umbilicus (By the fourth postpartum day, the uterus should be approximately 4 cm below the umbilicus. Being only at 1 cm indicates that the uterus is not contracting as it should.)
The nursing instructor is leading a discussion on the physical changes to a woman's body after delivery of the baby. The instructor determines the session is successful after the students correctly point out which process results in the return of nonpregnant size and function of the female organs? Evolution Involution Decrement Progression
involution
A nurse is caring for a client who has had a cesarean birth and has developed a wound infection. What precautions should be taken by the nurse as a primary prevention measure? Keep the incisions clean and dry Apply ice packs every 12 to 24 hours Use a sitz bath once every 24 hours Apply ice and heat alternatively
keep the incisions clean and dry
After teaching a group of pregnant women about the skin changes that will occur after the birth of their newborn, the nurse understands there is a need for additional teaching when one of the women makes which statement? "This line on my belly will go away over time." "I might lose some hair, but it will grow back." "I can't wait for these stretch marks to disappear after I give birth." "My nipples won't be so dark after I give birth."
"i cant wait for these stretch marks to disappear after i give birth" (Stretch marks gradually fade to silvery lines but do not disappear completely. As estrogen and progesterone levels decrease, the darkened pigmentation on the abdomen, face, and nipples gradually fades.)
The nurse is performing an assessment for a client in the immediate postpartum period. Which assessment finding should the nurse prioritize? Bladder distention Infection Hemorrhage Dehydration
hemorrhage
The nurse is caring for a client who underwent a cesarean birth 24 hours ago. Which assessment finding indicates the need for further action? The client requires assistance to ambulate in the hallway. Bowel sounds are active. The fundus is located 2 fingerbreadths above the umbilicus. The client is having a moderate amount of rubra lochia. The client is afibrile.
the fundus is located 2 fingerbreadths above the umbilicus (The client recovering from a cesarean birth will require frequent assessments. The client will display a moderate amount of lochia. The fundus should be in the midline position and at or just below the level of the umbilicus. The client is encouraged to ambulate. Requiring assisting is not problematic at this stage of the recovery period. The absence of a temperature elevation is also normal.)
An 20-year-old primipara is getting ready to go home. She had a second-degree episiotomy with repair. She confides in the nurse that she is afraid to go to her postpartum checkup because she is afraid to have the stitches removed. Which reply by the nurse is best? "It is very important for you to go to your checkup visit. Besides, the stitches do not have to be removed." "It doesn't hurt when the midwife takes out the stitches. You will only feel a little tugging and pulling sensation." "Many women have that fear after having an episiotomy. The stitches do not need to be removed because the suture will be gradually absorbed." "Oh, you must not miss your follow-up appointment. Don't worry. Your midwife will be very gentle."
"Many women have that fear after having an episiotomy. The stitches do not need to be removed because the suture will be gradually absorbed."
A woman who delivered her infant 2 days ago asks the nurse why she wakes up at night drenched in sweat. She is concerned that this is a problem. The nurse's best reply would be: "Many women sweat after delivery but you seem to be perspiring far more than normal. I'll call the doctor." "Sweating is very normal for the first few days after childbirth because your body needs to get rid of all the excess water from pregnancy." "I need to get your vital signs and check your fundus to be sure you are not going into shock." "Often, when a postpartum woman perspires like you are reporting, it means that they have an infection."
"Sweating is very normal for the first few days after childbirth because your body needs to get rid of all the excess water from pregnancy."
The nurse is caring for a client who underwent a cesarean birth one day ago. After listening to the nurse's discussion about the plan of care, the client indicates that she is in a great deal of pain and does not wish to ambulate until the next day. What response by the nurse is most appropriate? "As long as you walk more tomorrow to make up for the delay in walking today you should be fine." "If you do not get up to walk you will not recover." "Maybe you will feel better after you take pain medication." "Walking is the best way to prevent complications such as blood clots."
"Walking is the best way to prevent complications such as blood clots."
Which instruction would the nurse include in the teaching plan for a postpartum woman with mastitis? "Try applying warm compresses to your breasts to encourage the milk to be released." "Stop breastfeeding until the pain and swelling subside." "You'll need to take this medication to stop the milk from being produced." "Limit the amount of fluid you drink so your breasts don't get much fuller."
"try applying a warm compress to your breasts to encourage milk to be released"
The nurse is preparing to assess a client who is 1 day postpartum. The nurse predicts the client's fundus will be at which location on assessment? 1 cm below the umbilicus 1 cm above the umbilicus At level of umbilicus At the symphysis pubis
1 cm below the umbilicus
A postpartum client's care provider has prescribed a stool softener. When providing health education to the client, the nurse should teach the client to: take the medication on empty stomach. drink plenty of fluids while taking the medication. consider herbal alternatives. limit intake of high-fiber foods.
drink plenty of fluids
A woman who delivered her infant by cesarean section 1 week ago called her physician's office to report chills, fever of 101.6℉ (38.7℃) and a poor appetite. She also tells the nurse that she is having strong afterbirth pains and her lochia has increased in volume and has an odor. Labwork shows an elevated WBC count. Which of these reported findings is the most significant finding related to the suspected diagnosis of endometritis? Lochia odor Elevated WBC count Strong afterpains Fever
fever (Increased temperature is the most significant finding in this time period to support the suspicion of endometritis.)
The LVN/LPN will be assessing a postpartum client for danger signs after a vaginal birth. What assessment finding would the nurse assess as a danger sign for this client? fundus is firm presence of lochia rubra fundus is above the umbilicus fever more than 100.4° F (38° C)
fever over 100.4
On postpartum day 4, a client has a temperature of 101.4°F (38.6°C). Which findings would be consistent with a diagnosis of endometritis?...
foul smelling lochia, tender uterus, strong afterbirth pains
When doing a health assessment, at which location would the nurse expect to palpate the fundus in a woman on the second postpartal day and how should it feel? fundus height 4 cm below umbilicus and midline fundus two fingerbreadths below umbilicus and firm fundus two fingerbreadths above symphysis pubis and hard fundus 4 cm above symphysis pubis and firm
fundus two fingerbreadths below the umbilicus and firm
A nurse is performing an assessment on a female client who gave birth 24 hours ago. On assessment, the nurse finds that the fundus is 2 cm above the umbilicus and boggy. Which intervention is a priority? Have the client void, and then massage the fundus until it is firm. Notify the primary care provider, and document the findings. Check and inspect the lochia, and document all findings. Assess a full set of vital signs.
have the client void and then massage the fundus until it is firm
The nurse is caring for a client is who 24-hours post delivery of an infant. Which assessment does the nurse predict the health care provider will prioritize for the mother at this time? folic acid level blood type hemoglobin and hematocrit iron level
hemoglobin and hematocrit
A nurse is assessing uterine involution of a postpartum woman. When reviewing the woman's labor and birth record, which factor would the nurse identify as potentially delaying involution? Select all that apply. hydramnios limited use of analgesia birth of triplets grand multiparity labor of 4 hours
hydramnios birth of triplets grand multiparity
A nurse is developing a program to help reduce the risk of late postpartum hemorrhage in clients in the labor and birth unit. Which measure would the nurse emphasize as part of this program? inspecting the placenta after delivery for intactness administering broad-spectrum antibiotics manually removing the placenta at birth applying pressure to the umbilical cord to remove the placenta
inspecting the placenta after delivery for intactness
The nurse assesses the client who is 1 hour postpartum and discovers a heavy, steady gush of bright red blood from the vagina in the presence of a firm fundus. Which potential cause should the nurse question and report to the RN or primary care provider? Laceration Uterine atony Perineal hematoma Infection of the uterus
laceration (A gush of blood with a firm uterus is more likely to occur from a laceration rather than from the uterine atony.)
*While assessing a postpartum woman, the nurse palpates a contracted uterus. Perineal inspection reveals a steady stream of bright red blood trickling out of the vagina. The woman reports mild perineal pain. She just voided 200 mL of clear yellow urine. Which condition would the nurse suspect? uterine atony laceration hematoma uterine inversion
laceration (Lacerations typically present with a firm contracted uterus and a steady stream of unclotted bright red blood)
The nurse assesses a postpartum woman's perineum and notices that her lochial discharge is moderate in amount and red. The nurse would record this as what type of lochia? lochia rubra lochia normalia lochia serosa lochia alba
lochia rubra (rubra=red)
During a home visit, a postpartum patient is complaining of a painful area on one breast. The nurse notes a local area on one breast to be red and warm to touch. For which health problem should the nurse plan care for this patient? Engorgement Breast cancer Mastitis Plugged milk duct
mastitis (Mastitis is usually unilateral and the affected breast feels painful, appears swollen, and reddened.)
A postpartum patient is prescribed methylergonovine 0.2 mg for uterine subinvolution. Which action should the nurse take before administering the medication to the patient? Assess ambulation. Measure urine output. Evaluate current hematocrit level. Measure blood pressure.
measure BP (can increase BP)
When assessing a postpartum mother, the nurse asks the client how many peripads she has used over the last 4 hours. The mother responds that she has changed her pad 2 to 3 times per hour when they were saturated. What action should the nurse take? Encourage the mother to start massaging her fundus every hour. Record the number of peripads on the client's chart. Bring the mother more peripads to her bedside. Notify the RN of the finding.
notify RN! (If a mother reports that she is saturating more than one peripad per hour, the RN needs to be notified because this is too much bleeding. Having the mother massage the fundus after demonstrating how to do it is a good idea but her excessive bleeding is a much higher priority at this time.)
A nurse is caring for a client who is nursing her baby boy. The client reports afterpains. Secretion of which substance would the nurse identify as the cause of afterpains? progesterone prolactin estrogen oxytocin
oxytocin
The LPN has reported that uterine massage is ineffective on a client. The nurse anticipates the health care provider will prescribe which medication to address this issue? Penicillin Ibuprofen Oxytocin Digoxin
oxytocin (drug used for uterine atony)
The nurse is assessing a client at a postpartum visit and notes the client is emotionally sensitive, complains about being a failure, and appears extremely sad. The nurse concludes the client is presenting with which potential condition? postpartum depression postpartum blues postpartum psychosis anxiety disorders
postpartum depression
The nurse receives a report on a client with type 1 diabetes mellitus whose delivery was complicated by polyhydramnios and macrosomia. The nurse is aware of these complications and knows to monitor the client closely for which of the following? Increased insulin needs Postpartum mastitis Postpartum hemorrhage Gestational hypertension
postpartum hem (The client is at risk for a postpartum hemorrhage from the overdistention of the uterus because of the extra amniotic fluid and the large neonate.)
A postpartum woman is experiencing subinvolution. When reviewing the client's history for factors that might contribute to this condition, which factors would the nurse identify? Select all that apply. empty bladder prolonged labor hydramnios early ambulation breastfeeding uterine infection
prolonged labor hydramnios uterine infection
The nurse is assessing a postpartum client's vital signs 24 hours after the birth of her infant and notes: respirations 18, pulse 110 bpm, temperature 101.4 and blood pressure 128/88. Which assessment finding should the nurse prioritize for further attention? temperature pulse blood pressure respiration
pulse
The nurse is caring for a postpartum woman who is diagnosed with endometritis. Which position should the nurse encourage the client to maintain? Flat in bed Semi-Fowler On her left side Trendelenburg
semi-fowler (encourages lochia to drain so it will not become stagnant and cause further infection)
Which recommendation should be given to a client with mastitis who is concerned about breast-feeding her neonate? She should stop breast-feeding until completing the antibiotic. She should continue to breast-feed; mastitis will not infect the neonate. She should not use analgesics because they are not compatible with breast-feeding. She should supplement feeding with formula until the infection resolves.
she should continue to breastfeed; mastitis won't infect the neonate (The client with mastitis should be encouraged to continue breast-feeding while taking antibiotics for the infection. No supplemental feedings are necessary because breast-feeding does not need to be altered and actually encourages resolution of the infection. Analgesics are safe and should be administered as needed.)
In recording a postpartum mother's urinary output, the nurse notes that she is voiding between 100 to 200 mL with each void. How would the nurse interpret this finding? The urinary output is inadequate and the mother needs to drinks more fluids. The urinary output is inadequate suggestive of urinary retention. The urinary output is above expected levels. The urinary output is normal.
the urinary output is normal (Expected urinary output for a postpartum woman is at least 100 mL with each void on a regular basis. Therefore 100 to 200 mL are a normal volume for each void.)
Which reason explains why women should be encouraged to perform Kegel exercises after birth? They promote the return of normal bowel function. They promote blood flow, enabling healing and muscle strengthening. They assist with lochia removal. They assist the woman in burning calories for rapid postpartum weight loss.
they promote blood flow, enabling healing and muscle strengthening
A client who gave birth several hours ago is experiencing postpartum hemorrhage. She had a cesarean birth and received deep, general anesthesia. She has a history of postpartum hemorrhage with her previous births. The blood is a dark red. Which cause of the hemorrhage is most likely in this client? retained placental fragment uterine atony disseminated intravascular coagulation cervical laceration
uterine atony
A fundal massage is sometimes performed on a postpartum woman. The nurse would perform this procedure to address which condition? uterine contraction uterine atony uterine prolapse uterine subinvolution
uterine atony (which is failure of the uterus to contract and retract after birth)
Which instruction would the nurse include in the teaching plan for a postpartal client with a history of thromboembolism to reduce the risk of a recurrence? Wear support hose or antiembolic stockings. Avoid pressure on the thigh muscles. Refrain from performing leg exercises. Flex the muscles at the groin.
wear support hose or anti embolic stockings
The nurse is caring for several postpartum clients and notes various warning signs that are concerning. Which client should the nurse suspect is developing endometritis? A woman with a history of infection and smoking, temperature 101° F (38.3° C) on the fourth postpartum day; reports severe perineal pain; edges of the episiotomy have separated. A woman with diabetes, vaginal birth, HR 110, temperature 101.7° F (38.7° C) on the third postpartum day. The next day, appears ill; temperature now 102.9° F (39.3° C); WBC 31,500 cells/mm&$176;3; negative blood cultures. An obese woman with temperature 100.4° F (38° C) at 12 hours after birth; lochia is moderate; negative vaginal cultures. A woman with PROM before birth; reports severe burning with urination, malaise and severe temperature spikes on the 7th postpartum day. WBC is 21,850 cells/mm&$176;3; temperature 101° F (38.3° C); skin pale and clammy.
A woman with diabetes, vaginal birth, HR 110, temperature 101.7° F (38.7° C) on the third postpartum day. The next day, appears ill; temperature now 102.9° F (39.3° C); WBC 31,500 cells/mm&$176;3; negative blood cultures.
The nurse suspects that a postpartum mother is experiencing uterine atony. What physical findings would the nurse note in this client that would validate the suspicion? Select all that apply. Urinary output of 50 mL over the last hour Deep pelvic pain unrelieved by comfort measures Boggy fundus Fundus located above the umbilicus Heavy lochia
Boggy fundus Fundus located above the umbilicus Heavy lochia
A client presents to the clinic with her 3-week-old infant complaining of general flu-like symptoms and a painful right breast. Assessment reveals temperature 101o8F (38.8oC) and the right breast nipple with a hard area that is red and warm. Which instruction should the nurse prioritize for this client? Complete the 10-day antibiotic prescription even if she begins to feel better. Breast-feed or otherwise empty her breasts at least every 3 hours. Use NSAIDs, warm showers, and warm compresses to relieve discomfort. Increase her fluid intake to ensure that she will continue to produce adequate milk.
COMPLETE the 10 day antibiotic prescription even if she begins to feel better
It is discovered that a new mother has developed a puerperal infection. What is the most likely expected outcome that the nurse will identify for this client related to this condition? Client's temperature remains below 100.4° F or 38° C orally. Lochia discharge amount is 6 inches or less on a perineal pad in 1 hour. Fundus remains firm and midline with progressive descent. Client maintains a urinary output greater than 30 mL per hour.
Client's temperature remains below 100.4F or 38C orally
Why are postpartal women prone to urinary retention? Catheterization at the time of delivery reduces bladder tonicity. Decreased bladder sensation results from edema because of pressure of birth. Frequent partial voidings never relieve the bladder pressure. Mild dehydration causes a concentrated urine volume in the bladder.
Decreased bladder sensation results from edema because of pressure of birth.
Which assessment finding 1 hour after birth should be reported to the health care provider? Fundus is displaced to the right, and bladder is hard. Fundus of uterus is palpable at the level of the umbilicus. Large, bruised hemorrhoids are protruding from the anal opening. Lochia rubra is saturating a pad every 45 to 60 minutes.
Lochia rubra is saturating a pad every 45 to 60 minutes.
Which postpartum clients would require the nurse to intervene? Select all that apply. Primipara with vital signs including temperature 100.2, blood pressure 140/ 86, pulse 124, respiratory rate 12. Postpartum client requesting newborn stay in nursery so that she can nap. First day postpartum client with blood pressure 84/48, pulse 128, respiratory rate 16. Multipara with vital signs including temperature 99, blood pressure 136/84, pulse 96, respiratory rate 32. Primipara with vital signs including temperature 100.2, respiratory rate 28, oxygen saturation 94%. Postpartum client with urine output of 30 ml/hour for 2 hours.
Primipara with vital signs including temperature 100.2, blood pressure 140/ 86, pulse 124, respiratory rate 12. Multipara with vital signs including temperature 99, blood pressure 136/84, pulse 96, respiratory rate 32. Postpartum client with urine output of 30 ml/hour for 2 hours. First day postpartum client with blood pressure 84/48, pulse 128, respiratory rate 16. Primipara with vital signs including temperature 100.2, respiratory rate 28, oxygen saturation 94%.
Which postpartum client will the nurse assess first? a 22-year-old who has been up, showered, and packing for discharge later today an 18-year-old who wants to sleep until 10:00 before the nurse brings the infant for a visit a 35-year-old who had estimated blood loss of 700 mL and has a supine BP of 130/80 mm Hg and BP of 100/65 mm Hg when head of the bed is elevated a 30-year-old postpartum client who had a cesarean birth and is sleeping following pain medication administration
a 35-year-old who had estimated blood loss of 700 mL and has a supine BP of 130/80 mm Hg and BP of 100/65 mm Hg when head of the bed is elevated
The nurse is assisting with a birth, and the client has just delivered the placenta. Suddenly, bright red blood gushes from the vagina. The nurse recognizes that which occurrence is the most likely cause of this postpartum hemorrhage? Disseminated intravascular coagulation Uterine atony A cervical laceration Retained placental fragments
a cervical laceration (Lacerations of the cervix are usually found on the sides of the cervix, near the branches of the uterine artery. If the artery is torn, the blood loss may be so great that blood gushes from the vaginal opening. Because this is arterial bleeding, it is brighter red than the venous blood lost with uterine atony.)
The nurse is preparing discharge instructions for a postpartum woman who has developed DVT after a long and difficult birthing process. The nurse will include instruction on which medication for this client?...
anticoags
A nurse is caring for a client who gave birth about 10 hours earlier. The nurse observes perineal edema in the client. What intervention should the nurse perform to decrease the swelling caused by perineal edema? Apply ice. Apply moist heat. Use a warm sitz bath or tub bath. Use ointments locally.
apply ice
In talking to a mother who is 6 hours post-delivery, the mother reports that she has changed her perineal pad twice in the last hour. What question by the nurse would best elicit information needed to determine the mother's status? "When did you last void?" "Are you in any pain with your bleeding?" "How much blood was on the two pads?" "What time did you last change your pad?"
ask the client how much blood was on the pad
A postpartal woman has a history of thrombophlebitis. Which action would help the nurse determine if she is developing this postpartally? Take her temperature every 4 hours. Palpate her feet for tingling or numbness. Assess for calf redness and edema. Ask her if she feels any warmth in her legs.
assess for calf redness and edema
The nurse notes uterine atony in the postpartum client. Which assessment is completed next? Assessment of the lung fields Assessment of bowel function Assessment of the perineal pad Assessment of laboratory data
assessment of perineal pad
A primipara client gave birth vaginally to a healthy newborn girl 12 hours ago. The nurse palpates the client's fundus. Which finding would the nurse identify as expected? at the level of the umbilicus two fingerbreadths below the umbilicus four fingerbreadths below the umbilicus two fingerbreadths above the umbilicus
at the level of the umbilicus (During the first few days after birth, the uterus typically descends downward from the level of the umbilicus at a rate of 1 cm (1 fingerbreadth) per day so that by 3 days, the fundus lies 2 to 3 fingerbreadths below the umbilicus.)
