OB - Maternity Exam 3
Naomi a 41-week G3P2 presents in L&D after a non-reactive nonstress test (NST) indicates that her baby could be experiencing some difficulties in utero. Which diagnostic tool yields the most appropriate detailed information about her baby's well-being in this case?
Biophysical Profile (BPP)
Kate gave birth to a 9 pound, 10oz baby boy two hours ago. Her fundus is now boggy, 2 cm above the umbilicus, and deviated to the right of midline. In the immediate postpartum period, the most serious consequence likely to occur from this is:
Bladder wall atony
What drug is used to reverse the effects of Magnesium Sulfate?
Calcium Gluconate
Olivia is being induced in response to her worsening preeclampsia. She is also receiving magnesium sulfate. It appears that the labor has not become active, despite several hours of Pitocin administration. She asks the nurse, "Why is this taking so long?" What is the nurse's most appropriate response?
The length of labor varies for different women but don't worry I will keep increasing the Pitocin.
Michelle is a 26 year old gravida 2 para 1, at 28 weeks gestation at her doctors appointment when she experience bright red, painless vaginal bleeding. An ambulance transfers her to the hospital, on arrival to the hospital what diagnostic procedure is most likely to be done?
Ultrasound for placental location.
Tessa asks her nurse, "My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?" What is the nurse's best response?
Your placenta changes as your pregnancy progresses, and it is given a score that indicates how well it is functioning.
Which finding could be seen with a first-trimester ultrasound?
a twin pregnancy.
Baby boy Michael is an infant of a diabetic mother. He is more likely to experience hypoglycemia than other infants because:
His metabolism is much higher.
While obtaining a diet history, the nurse might be told that the expectant mother has cravings for ice chips, cornstarch, and baking soda. Which nutritional problem does this behavior indicate?
Pica
Wendy was diagnosed with Preeclampsia during her pregnancy. While in labor she becomes eclamptic, the nurse's primary duty is to:
Stay with the woman and call for help.
Disseminated intravascular coagulation (DIC) is a very serious complication of pregnancy. You suspect your patient is experiencing it, your priority nursing interventions will consist of the following except:
Decrease her IV rate of Lactated Ringers to 50ml/hr to avoid fluid overload.
Metabolic changes during pregnancy that affect glucose and insulin in the mother and fetus are important to understand. Nurses should know that?
During the 2nd and 3rd trimesters, pregnancy exerts a maternal diabetogenic effect (glucose resistance) that ensures an abundant supply of glucose for the baby.
The priority nursing responsibility when caring for a woman experiencing postpartum hemorrhage is to:
Establish venous access if she doesn't already have an IV.
A placenta accreta can result in:
Excess vaginal bleeding.
During a vaginal delivery, the obstetrician declares that a shoulder dystocia has occurred. Which of the following actions by the nurse is appropriate at this time?
Flex the woman's thighs sharply toward her abdomen (McRoberts maneuver).
The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000 mm3, an elevated aspartate aminotransaminase (AST) level, a falling hematocrit. The laboratory results are indicative of which condition?
HELLP Syndrome.
HELLP stands for:
Hemolysis, Elevated Liver Enzymes, Low Platelets.
Obese women are at risk for several complications during pregnancy, birth and postpartum. These include all of the following except:
Hypoglycemia
Rachel, who is 33 weeks pregnant, went out to get the mail and slipped on ice 3 hours ago. She twisted her right ankle landed on her right hip. She is complaining of hip and ankle pain but not abdominal pain. Her certified nurse-midwife (CNM) ordered 4 hours of continuous fetal monitoring to rule out what condition?
Placenta Previa
Emma is pregnant at 39 weeks gestation and is admitted to the L&D unit. She suddenly experiences increased contraction frequency of every 1-2 minutes, dark red vaginal bleeding, and a painful, board-like abdomen. The nurse suspects a/an:
Placental abruption
Preeclampsia is a very serious pregnancy complication that is not well understood. However, the most commonly believed cause relates to?
Poor nutrition and weight gain in pregnancy.
April is a G3P2 and has been in stage 2 of her labor for 3 hours. Her Certified Nurse Midwife (CNM) has decided that she will need to have a cesarean section due to fetal distress and maternal exhaustion. What are some of the risks of the surgery you expect her to discuss with April?
Possible infection, bleeding and an increased postpartum recovery time.
Which physiologic alteration of pregnancy most significantly affects glucose metabolism?
Pregnancy affects the function of the Islets of Langerhans in the Pancreas.
Magnesium Sulfate is given to a woman with preeclampsia to:
Prevent seizures.
There are factors associated with high risk pregnancies that can be separated into the four broad categories which include the following except?
Psychiatric
Jenny is performing a Non-Stress Test after Michelle's amniocentesis. What result is jenny hoping for that shows that Michelle's baby is stable after the procedure?
Reactive
Infants of mothers with diabetes are at higher risk for developing:
Respiratory Distress Syndrome
In evaluating the effectiveness of Magnesium Sulfate for the management of preeclampsia, which finding alerts the nurse to possible dangerous side effects?
Respiratory rate of 10
What nursing diagnosis is the most appropriate for a woman experiencing severe preeclampsia?
Risk for deficient fluid volume, related to increased sodium retention secondary to the administration of magnesium sulfate.
Becky is attempting the TOLAC. During augmentation of labor with IV Pitocin she becomes pale & diaphoretic and reports severe lower abdominal pain. Fetal distress shown as a prolonged deceleration is noted on the monitor. The nurse should suspect a/an:
Rupture of the uterus.
Vivian has Type 1 Diabetes Mellitus that is poorly controlled, she is coming for a preconception consultation with her OB physician, Dr. Matthews, because she wants to have a baby. What possible complications of Type 1 DM would Dr. Matthews discuss with Vivian?
The baby is at risk to be hyperglycemic at birth.
Joanne is a 40-year-old primigravida who delivered a 9 pound, 4 ounce baby after 3 hours of pushing. A vacuum extractor was used and she sustained a 4th degree laceration. A laceration of this type extends:
Through the vagina
When caring for a woman in hemorrhagic shock, the nurse recognizes that the most objective assessment of adequate organ prefusion and oxygenation is:
Urine output of at least 30ml/hr.
Robin is 22 weeks pregnant with her first child. She has had an uncomplicated prenatal course so far with a history of a LEEP procedure done 3 years ago. She presents at the office for her routine ultrasound. The fetal measurements are WNL and the vaginal ultrasound shows her cervix is already funneling down to 2.1cm. With these current findings you expect:
A consult for cervical insufficiency and expect a rescue cerclage to be placed.
After the delivery of a LGA baby, the nurse notes the mother has bright red blood continuously trickling from her vagina. Her fundus is firm and located in the midline. The nurse concludes that which of the following is the most likely cause of the bleeding?
A perineal laceration.
Becky a G3P2 is 28 weeks gestation. She had a cesarean section with her son due to his breech position 3 years ago. She is discussing a possible TOLAC and VBAC with her physician. A TOLAC can be defined as:
A trial of labor after cesarean section.
Which order should the nurse expect for a patient admitted with a threatened abortion?
Bed rest.
Maria, a Labor & Delivery nurse observes a prolonged deceleration on the fetal monitor. In her assessment, she discovers a loop of the umbilical cord protruding into the vagina. The most appropriate first intervention is for Maria to:
Call physician immediately and prep for a cesarean section.
Which infant bone is most often fractured during birth?
Clavicle.
Linda is admitted to Labor and Delivery for the induction of Labor. She is to have an amniotomy (also called AROM, active rupture of membranes) to induce labor. The priority nursing intervention for Linda and her baby immediately after the amniotomy would be:
Continue electric fetal monitoring, paying attention to the baby's heart rate and her uterine contraction pattern.
The Bishop Score is used to:
Determine favorability of the cervix for induction.
Which of the following conditions may occur after a woman and her baby are discharged from her hospital?
Infection
Jessica is being admitted for hyperemesis gravidarium. What initial treatment is expected for her?
Intravenous (IV) therapy to correct fluid and electrolyte imbalances.
Nurses should be aware that chronic hypertension is defined as:
Is present before the pregnancy or develops before 20 weeks gestation.
Anna's hemoglobin & hematocrit have decreased since her prenatal visit that took place 2 months ago. Her midwife started her on iron supplement. What teaching would Anna need regarding the iron supplementation?
Make sure to drink water and eat a high fiber diet to help with constipation that the iron may cause.
A woman has come to the clinic for preconception counselling because she wants to start trying to get pregnant. Which nutritional guidance should she expect to receive?
Make sure you include adequate folic acid in your diet.
A 39-year-old primigravida woman comes in for her first prenatal visit. She believes that she is approximately 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day. Her lab results are within normal limits . What diagnostic technique would be useful at this time?
Nonstress test (NST).
Dr. Matthews also wants to discuss Viviana's possible complications due to her Type 1 DM. What are the possible maternal complications related to type 1 DM?
Oligohydramnios
A pregnant woman's Biophysical Profile (BPP) score is 8. She asks the nurse to explain the results. How should the nurse respond at this time?
The test results are within normal limits.
Two hours after delivery the Labor and Delivery nurse is caring for Linda. The nurse's assessment reveals that there is profuse vaginal bleeding. The most likely etiology for the bleeding is:
Vaginal Laceration
