OB Final Exam
Methylergonovine is prescribed for a woman to treat postpartum hemorrhage. Before the administration of methylergonovine, what is the PRIORITY assessment?
Blood pressure.
The nurse is monitoring a postpartum client who received epidural anesthesia for delivery for the presence of a vulvar hematoma. Which assessment finding would BEST indicate the presence of a hematoma?
Changes in vital signs.
An ultrasound is performed on a client at term gestation that is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that an abruptio placenta is present. Based on these findings, the nurse would prepare the client for:
Delivery of the fetus.
The nurse in a health care clinic is instructing a pregnant client on how to perform "kick counts." Which statement by the client indicates a NEED FOR FURTHER TEACHING?
"I need to lie flat on my back to perform the procedure." *If fewer than 10 kicks are felt in a 2-hour period, the client should recount the kicks over the next 2 hours *Hands should be placed on the largest part of the abdomen
The nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes mellitus. Which statement made by the client INDICATES A NEED FOR FURTHER TEACHING?
"I should avoid exercise because of the negative effects of insulin."
The nurse is providing instructions to a pregnant client with a history of cardiac disease regarding appropriate dietary measures. Which statement, if made my the client, indicates AN UNDERSTANDING of the information provided by the nurse?
"I should drink adequate fluids and increase my intake of high-fiber foods."
The nurse is providing instructions about measures to prevent postpartum mastitis to a client who is breastfeeding her newborn. Which statement would indicate a need for further instruction?
"I should wash my nipples daily with soap and water."
The nurse asks a nursing student to describe the procedure for administering erythromycin ointment to the eyes of a newborn. Which student statement indicated that FURTHER TEACHING IS NEEDED about the administration of the eye medication?
"I will flush the eyes after instilling the ointment."
A client in the first trimester of pregnancy arrives at the health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding the management of care. Which statement made by the client indicates a NEED FOR FURTHER TEACHING?
"I will maintain strict bed rest throughout the remainder of the pregnancy."
The nurse is assessing a pregnant client with type 1 diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. The nurse determines that FURTHER TEACHING IS NEEDED if the client makes which statement?
"I will need to increase my insulin dosage during the first 3 months of pregnancy."
The nurse is reviewing true and false labor signs with a multiparous client. the nurse determines that the client UNDERSTANDS the signs of true labor if she makes which statement?
"My contractions will increase in duration and intensity."
The nurse in a maternity unity is providing emotional support to a client and her significant other who are preparing to be discharged from the hospital after the birth of a dead fetus. Which statement made by the client indicates a component of the NORMAL GRIEVING PROCESS?
"We want to attend a support group."
The nurse is providing instructions to a pregnant client with HIV regarding care to the newborn after delivery. The client asks the nurse about the feeding options that are available. Which response should the nurse make to the client?
"You will need to bottle-fed your newborn."
The maternity nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the primary health care provider's prescriptions and SHOULD QUESTION which prescription?
Obtain equipment for a manual pelvic examination.
The nurse is providing instructions to a pregnant client who is scheduled for amniocentesis. What instruction should the nurse provide?
An informed consent needs to be signed before the procedure.
The nurse is admitting a pregnant client to the labor room and attaches an external electronic fetal monitor to the client's abdomen. After attachment of the monitor, what is the next nursing action?
Assess the baseline fetal heart rate.
The nurse in a maternity unit is reviewing the clients' records. Which clients should the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)?
1. A primigravida with abruptio placenta 3. A gravida 2 who has just been diagnosed with dead fetus syndrome 5. A primigravida at 29 weeks of gestation who was recently diagnosed with gestational hypertension
The nurse in the labor room is caring for a client in the active stage of the first phase of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. What is the most appropriate nursing action?
1. Administer oxygen via face mask
The nurse is monitoring a client who is in the active stage of labor. The nurse documents that the client is experiencing labor dystocia. The nurse determines which risk factors in the client's history placed her at risk for this complication?
1. Agee 54 years 2. Body mass index of 28 3. Previous difficulty with fertility
The nurse is performing an assessment on a client who suspects that she is pregnant and is checked the client for PROBABLE signs of pregnancy. The nurse should assess for:
1. Ballotment 2. Chadwick's sign 3. Uterine enlargement 4. Positive pregnancy test
The nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate (MgSO4). The nurse should monitor for which adverse effects of this medication?
1. Flushing 4. Depressed respirations 5. Extreme muscle weakness
The clinic nurse is performing a psychosocial assessment of a client who has been told that she is pregnant. Which assessment findings indicate to the nurse that the client is at risk for contracting HIV? Select all that apply.
1. The client has a history of intravenous drug use 3. The client has a history of sexually transmitted infections
The nurse is preparing a list of self-care instructions for a postpartum client who was diagnosed with mastitis. Which instructions should be included on the list? Select all that apply.
1. Wear a supportive bra 2. Rest during the acute phase 3. Maintain a fluid intake of at least 3,000 mL/day 4. Continue to breastfeed if the breasts are not too sore
The nurse is planning to admit aa pregnant client who is obese. In planning care for this client, which potential client needs should the nurse anticipate? Select all that apply.
2. Administration of subcutaneous heparin postdelivery as prescribed 3. An overbed lift may be necessary if the client requires a cesarean section 5. Thromboembolism stocking or sequential compression devices may be prescribed
A rubella titer result of a 1-day postpartum client is less than 1:8, ad a rubella virus vaccine is prescribed to be administered before discharge. The nurse provides which information to the client about the vaccine?
2. Pregnancy needs to be avoided for 1-3 months 3. The vaccine is administered by the subcutaneous route 4. Exposure to immunosuppressed individuals needs to be avoided 5. A hypersensitivity reaction can occur is the client has an allergy to eggs
A pregnant client is receiving magnesium sulfate (MgSO4) for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which findings are noted on assessment? Select all that apply.
2. Respirations of 10 breaths/min 4. Urine output of 20 mL in one hour
The nurse is reviewing the record of a client in the labor room and notes that the PHCP has documented that the fetal presenting part is at the -1 station. This documented finding indicated that the fetal presenting part is located at which area? Refer to the figure.
3 (1 cm above the ischial spines or 1 cm above station 0)
A client arrives at a birthing center in active labor. After examination, it is determined that her membranes are still intact and she is at a -2 station. The PHCP prepares to perform an amniotomy. What will the nurse relay to the client as the MOST LIKELY outcomes of the amniotomy? Select all that apply.
3. Increased efficiency of contractions 5. The need for frequent fetal heart rate monitoring to detect the presence of a prolapsed cord
The nurse is caring for a client in labor. Which assessment findings indicate to the nurse that the client is beginning the second stage of labor? Select all that apply/
3. The cervix is dilated completely 5. The Ferguson reflex is initiated from perineal pressure
The nurse is monitoring a client who is receiving oxytocin to induce labor. Which assessment findings should cause the nurse to IMMEDIATELY DISCONTINUE the oxytocin infusion? Select all that apply.
3. Uterine hyperstimulation 4. Late decelerations of the fetal heart rate
A client in preterm labor (31 weeks) who is dilated to 4 cm has been started on magnesium sulfate and contractions have stopped. If the client's labor can be inhibited for the next 48 hours, the nurse anticipates a prescription for which medication?
Betamethasone *Betamethasone is a glucocorticoid given to increase the production of surfactant to stimulate fetal lung maturation *Administered to clients in preterm labor (28-32 weeks) if the labor can be inhibited for 48 hours
The nurse is performing an assessment on a client diagnosed with placenta previa. Which assessment findings should the nurse expect to note? Select all that apply.
4. Bright red vaginal bleeding 5. Soft, relaxed, non-tender uterus 6. Fundal height may be greater than expected for gestational age
The nurse is preparing to care for four assigned clients. Which client is at MOST risk for hemorrhage?
A multiparous client who delivered a large baby after oxytocin induction.
A non-stress test (NST) is performed on a client who is pregnant, and the results of the test indicate non-reactive findings. The primary health care provider prescribes a contraction stress test, and the results are documented as negative. How should the nurse document this finding?
A normal test result.
The nurse suspects a pulmonary embolism (postpartum). Which is the initial nursing action?
Administer 8-10L oxygen by face mask
Fetal distress is occurring with a laboring client. As the nurse prepares the client for a cesarean birth, what is the MOST IMPORTANT nursing action?
Administer oxygen, 8-10L/min, via face mask
The nurse is monitoring a client in the immediate postpartum period for signs of hemorrhage. Which sign, if noted, would be an early sign of excessive blood loss?
An increase in the pulse rate from 88 to 102 beats per minute.
The nurse is assisting a client undergoing induction of labor (IOL) at 41 weeks gestation. The client's contractions are moderate and occurring every 2-3 minutes, with a duration of 60 seconds. An internal fetal heart rate monitor is in place. The baseline FHR has been 120-122 beats per minute for the past hour. What is the PRIORITY nursing action?
Discontinue the infusion of oxytocin. *Oxytocin can cause forceful uterine contractions and decrease oxygenation to the placenta, resulting in decreased variability (< 5 bpm)
The nurse is caring for a client in labor and is monitoring the fetal heart rate patterns. The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. Which action is most appropriate?
Document the findings and tell the mother that the pattern on the monitor indicates fetal wellbeing.
A postpartum client is diagnosed with cystitis. The nurse should plan for which priority action in the care of the client?
Encouraging fluid intake (3,000 mL/day)
The postpartum nurse is assessing a client who delivered a healthy infant by cesarean section for signs and symptoms of superficial venous thrombosis. Which sign should the nurse note if superficial venous thrombosis were present?
Enlarged, hardened veins
The nurse is performing an assessment on a pregnant client in the last trimester with aa diagnosis of preeclampsia. The nurse reviews the assessment findings and determines which finding is the MOST closely associated with a complication of this diagnosis?
Evidence of bleeding, such as in the gums, petechiae, and purpura. *Severe preeclampsia can trigger DIC
The nurse is performing an assessment of a client who is scheduled for a cesarean delivery at 39 weeks of gestation. Which assessment finding indicates the NEED TO CONTACT THE PHCP?
Fetal heart rate of 180 beats per minute
Which assessment finding after an amniotomy should be conducted first?
Fetal heart rate patterns
The nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5 y/o child who was delivered at term and tells the nurse that she does not have any history of abortion or fetal demise. Using GTPAL, what should the nurse document in the client's chart?
G = 2, T = 1, P = 0, A = 0, L = 1
A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks associated with placenta previa?
Hemorrhage
The home care nurse is monitoring a pregnant client who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which sign of preeclampsia?
Hypertension.
A pregnant client is seen for a regular prenatal visit and tells the nurse that she is experiencing irregular contractions. The nurse determines that she is experiencing Braxton Hick's contractions. On the basis of this finding, which nursing action is appropriate?
Inform the client that these contractions are considered common and may occur throughout the pregnancy.
The nurse is preparing to administer exogenous surfactant to a premature infant who has respiratory distress syndrome. The nurse prepares to administer the medication by which route?
Intrathecal.
A pregnant client reports to a health care clinic complaining of loss of appetite, weight loss, and fatigue. After an assessment of the client, tuberculosis (TB) is suspected. A sputum culture is obtained and identifies Mycobacterium tuberculosis. Which instruction should the nurse include in the client's teaching plan?
Isoniazid plus rifampin will be required for 9 months.
A client arrives at the clinic for the first prenatal assessment. She tells the nurse that the first day of her last normal menstrual period was October 19, 2020. Using Naegele's Rule, which expected date of delivery should he nurse document in the client's chart?
July 26, 2021 *10-3 = 7, 19 + 7 = 26, 2020 + 1 = 2021
The nurse is planning care for a newborn of a mother with diabetes Mellitus. What is the PRIORITY nursing consideration for this newborn?
Maintaining safety because of low blood glucose levels.
The nurse creates a plan of care for a woman with HIV and her newborn. the nurse should include which intervention in the plan of care?
Maintaining standard precautions at all times while caring for the infant.
On assessment of a postpartum client, the nurse notes that the uterus feels soft and boggy. The nurse should take which initial actino?
Massage the fundus until it is firm.
The nurse has created a plan of care for a client experiencing dystocia and includes several nursing actions in the plan of care. What is the PRIORITY NURSING ACTION?
Monitoring the fetal heart rate.
An opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures that which medication is readily accessible should respiratory depression occur?
Naloxone (Narcan)
The nurse is assessing a client in the fourth stage of labor and notes that the fundus is firm, but that bleeding is excessive. Which should be the INITIAL nursing action?
Notify the obstetrician (OB).
The nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes that last 45 seconds. The nurse notes that the fetal heart rate between contractions is 100 beats per minute. Which nursing action is most appropriate?
Notify the primary health care provider (PHCP)
The nurse is reviewing the primary health care provider's (PHCP's) prescriptions for a client admitted for premature rupture of the membranes (PROM). Gestational age of the fetus is determined to be 37 weeks. Which prescription should the nurse question?
Perform a vaginal examination every shift *Continuous FHR monitoring, frequent assessment of maternal VS, and antibiotics per protocol are not questionable prescriptions
Methylergonovine is prescribed for a client with postpartum hemorrhage. Before administering the medication, the nurse should contact the OB who prescribed it if which condition is documented in the client's medical history?
Peripheral vascular disease *This medication is contraindicated in clients with significant CVD, PVD, HTN, preeclampsia, or eclampsia -- they are worsened by the vasoconstricting effect of this ergot alkaloid
A nurse in a birthing room is monitoring a client with dysfunctional labor for signs of fetal or maternal compromise. Which assessment finding should alert the nurse to a compromise?
Persistent non-reassuring fetal heart rate
The nurse in a labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence fo the umbilical cord protruding from the vagina. What is the FIRST nursing action with this finding
Place the client in Trendelenburg's position. *Prompt actions must be taken to improve fetal oxygenation in the event of cord prolapse
The nurse is creating a plan of care for a postpartum client with a small vulvar hematoma. The nurse should include which specific action during the first 12 hours after delivery?
Prepare an ice pack for application to the area.
The nurse in a labor room is preparing to care for a client with hypertonic uterine coontractions. The unrse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. What is the PRIORITY nursing action?
Provide pain relief measures.
The nurse has been working with a laboring client and notes that she has been pushing effectively for 1 hour. What is the client's PRIMARY physiological need at this time?
Rest between contractions.
A client in labor is transported t the delivery room and prepared for cesarean delivery. After the client is transferred to the delivery room table, the nurse should place the client in which position?
Supine position with a wedge under the right hiip
The home care nurse visits a pregnant client who has a diagnosis of preeclampsia. Which assessment finding indicates a worsening of the preeclampsia and the need to notify the primary health care provider (PHCP)?
The client complains of a headache and blurred vision.
The nurse is performing an assessment on a client who has just been told that a pregnancy test is positive. Which assessment finding indicates that the client is at risk for preterm labor?
The client has a history of cardiac disease.
The nurse is performing an assessment of a pregnant client who is at 28 weeks of gestation. The nurse measures the fundal height in centimeters and notes that the fundal height is 30cm. How should the nurse interpret this finding?
The client is measuring normal for gestational age. *Fetal age +/- 2 cm = appropriate fundal height measurement after 18 weeks
The nurse evaluates the ability to fo a hepatitis B-positive mother t provide safe bottle-feeding to her newborn during postpartum hospitalization. Which maternal action BEST exemplifies the mother's knowledge of potential disease transmission to the newborn?
The mother washes and dries her hands before and after self-care of the perineum and asks for a pair of gloves before feeding.
A pregnant client in the first trimester calls the nurse at a health care clinic and reports that she has noticed a thing, colorless vaginal drainage. The nurse should make which statement ti the client?
The vaginal discharge may be bothersome, but is a normal occurrence.
The nurse is assessing a pregnant client in the second trimester fo pregnancy who was admitted t the maternity unit with a suspected diagnosis of abruptio placentae. Which assessment finding should the nurse expect to note if this condition is present?
Uterine tenderness.
The nurse is monitoring a client in labor. The nurse suspects umbilical cord compressiono if which is noted on thhe external monitor tracing during a contraction?
Variable decelerations.
