OB exam 2

Question 1

A client who delivered their infant by cesarean section 1 week ago called their health care provider’s office to report chills, fever of 101.6℉ (38.7℃) and a poor appetite. They also tell the nurse that they are having strong afterbirth pains and their lochia has increased in volume and has an odor. Lab work shows an elevated WBC count. Which of these reported findings is the most significant finding related to the suspected diagnosis of endometritis?

Answer 1

Fever

Question 2

The postpartum client and their spouse are excited about their newborn. However, they are also concerned about getting pregnant again too soon and ask about using birth control. Which instruction should the nurse include in their discharge education to address this issue?

Answer 2

“Ovulation may return as soon as 3 weeks after birth.”

Question 3

The nurse is assessing a client who is 14 hours postpartum and notes very heavy lochia flow with large clots. Which action should the nurse prioritize?

Answer 3

Palpate their fundus.

Question 4

A 31-year-old client at 28 weeks’ gestation reports frequent low back pain and ankle edema by the end of the day. Which suggestion should the nurse prioritize for this client?

Answer 4

Rest when possible with feet elevated at or above the heart.

Question 5

A 19-year-old client presents in advanced labor. Examination reveals the fetus is in frank breech position. The nurse interprets this finding as indicating:

Answer 5

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

Question 6

Which factor puts a multiparous client on their first postpartum day at risk for developing hemorrhage?

Answer 6

uterine atony

Question 7

A nurse is performing a vaginal examination of a client in the early stages of labor. The client has been at 2 cm dilated for the past 2 hours, but effacement has progressed steadily. Which statement by the nurse would best encourage the client regarding their progress?

Answer 7

“You are still 2 cm dilated, but the cervix is thinning out nicely.”

Question 8

A client is concerned because it is 24 hours after giving birth and their breasts have still not become engorged with breast milk. How should the nurse respond to this concern?

Answer 8

“It takes about 3 days after birth for milk to begin forming.”

Question 9

A client is Rh-negative and has given birth to their newborn. What should the nurse do next?

Answer 9

Determine the newborn’s blood type and rhesus.

Question 10

A client who is 4 days postpartum calls the nurse triage from home and reports feeling very fatigued. The client experienced prolonged labor with prolonged premature rupture of membranes. Which statement by the client requires further follow-up by the nurse?

Answer 10

“I am feeling cold and have the chills.”

Question 11

A client who is breastfeeding their newborn tells the nurse, “I notice that when I feed my newborn, I feel fairly strong contraction-like pain. Labor is over. Why am I having contractions now?” Which response by the nurse is best?

Answer 11

“The newborn’s sucking releases a hormone that causes the uterus to contract.”

Question 12

A nurse practitioner is conducting an in-service education program for a group of nurses working in the labor and birth unit. The program is focusing on interpreting FHR patterns. The nurse practitioner determines that the teaching was successful when the group identifies which patterns as indicating abnormal fetal acid-base status? Select all that apply.

Answer 12

fetal bradycardia
sinusoidal pattern
recurrent late decelerations

Question 13

A client reports prolonged nausea, vomiting every morning for the past week, and no appetite. The pregnancy test comes back positive. What recommendation should the nurse give this client? Select all that apply.

Answer 13

Take small amounts of liquids between meals, not with them.
Eat a saltine cracker before getting out of bed in the morning.
Delay eating breakfast until the nausea and vomiting has passed.

Question 13

During the physical examination at the first prenatal visit a speculum examination is performed and a bluish-colored cervix is noted. How will the nurse interpret this finding?

Answer 13

Chadwick sign

Question 14

A client who gave birth to their infant 1 week ago calls the clinic to report pain with urination and increased frequency. What response should the nurse prioritize?

Answer 14

“After giving birth it is easier to develop an infection in the urinary system; we need to see you today.”

Question 14

When reviewing the medical record of a postpartum client, the nurse notes that the client has experienced a third-degree laceration. The nurse understands that the laceration extends to which area?

Answer 14

through the anal sphincter muscle

Question 15

The nurse observes a 2-in (5-cm) lochia stain on the perineal pad of a 1-day postpartum client. Which action should the nurse do next?

Answer 15

Document the lochia as scant.

Question 16

The nurse is assessing clients, all of which have given birth within the past 24 hours. Which assessment leads the nurse to suspect the client is experiencing postpartum blues?

Answer 16

30-year-old client who is teary-eyed when asked how they and the newborn are doing with breastfeeding

Question 17

A primiparous client who is bottle-feeding their infant begins to experience breast engorgement on the third postpartum day. Which instruction by the nurse will aid in relieving the client’s discomfort?

Answer 17

“Apply ice packs to your breasts to reduce the amount of milk being produced.”

Question 18

A postpartum client with an episiotomy asks the nurse about perineal care. Which recommendation would the nurse give?

Answer 18

Wash the perineum with their daily shower.

Question 19

A client is in active labor. Checking the EFM tracing, the nurse notes variables that are abnormal. What would be the nurse’s first nursing intervention?

Answer 19

Help the client change positions.

Question 20

Which assessment would lead the nurse to believe a postpartum client is developing a urinary complication?

Answer 20

At 8 hours postdelivery the client has voided a total of 100 mL in four small voidings.

Question 21

After teaching a pregnant client how to perform fetal movement (kick) counts, the nurse determines that the teaching was successful when the client makes which statement?

Answer 21

“I’ll sit comfortably in a recliner or lie on my side when I do the counts.”

Question 22

A client in the third trimester comes to the clinic for an evaluation. Assessment reveals that the cervix is thinning. The client says, “I know my cervix needs to dilate, but why does it get thinner?” Which response by the nurse would be appropriate?

Answer 22

“You need the cervix to thin so it can stretch more easily.”

Question 23

The nurse is assisting a postpartum client out of bed to the bathroom for a sitz bath. Which action is the nurse's priority?

Answer 23

placing the call light within their reach

Question 24

A nurse is caring for a client who has had an intrauterine fetal death with prolonged retention of the fetus. For which signs and symptoms should the nurse watch to assess for an increased risk of disseminated intravascular coagulation? Select all that apply.

Answer 24

bleeding gums tachycardia acute kidney injury

Question 25

Which information would the nurse emphasize in the teaching plan for a birthing parent who is reluctant to begin taking warm sitz baths?

Answer 25

Sitz baths increase the blood supply to the perineal area.

Question 26

A nurse is caring for a client who is in the first stage of labor. The client is experiencing extreme pain due to the labor. The nurse understands that which factors are causing the extreme pain in the client? Select all that apply.

Answer 26

lower uterine segment distention stretching and tearing of structures dilation (dilatation) of the cervix

Question 27

The nurse is caring for a postpartum client who exhibits a large amount of bleeding. Which areas would the nurse need to assess before the client ambulates?

Answer 27

Blood pressure, pulse, reports of dizziness

Question 28

A postpartum client has decided to bottle feed their newborn. After teaching the client about it, the nurse determines that the teaching was successful based on which client statement(s)? Select all that apply

Answer 28

"I will be sure not to use the microwave to warm the formula." "I will make sure the nipple and neck of the bottle are filled with formula during a feeding." "I will get my newborn to suck by touching the nipple to the lips."

Question 29

The nurse palpates a postpartum client’s fundus 2 hours after birth and finds it located to the right of midline and somewhat soft. What is the correct interpretation of this finding?

Answer 29

The bladder is distended.

Question 30

At the first prenatal visit, the client reports their last menstrual period (LMP) was November 16. The nurse determines the estimated due date to be:

Answer 30

August 23

Question 31

A nurse is taking a history during a client's first prenatal visit. Which assessment finding would alert the nurse to the need for further assessment?

Answer 31

history of diabetes for 4 years

Question 32

The nurse is caring for a pregnant client in the triage department who reports they are in labor. The client is at 39 weeks' gestation. The client rates their pain 9/10 and is guarding their abdomen. The nurse has performed a cervical exam and noted the cervix is 1 cm in length and dilated to 9 cm. What is the nurse's first action?

Answer 32

Move the client to a room and begin admission.

Question 33

A pregnant client is discussing nonpharmacologic pain control measures with the nurse in anticipation of labor. After discussing the various breathing patterns that can be used, the client decides to use slow-paced breathing. Which instruction will the nurse provide to the client about this technique?

Answer 33

"Inhale through your nose and exhale through pursed lips."

Question 34

The client, who has just been walking around the room, sits down and reports leg tightness and achiness. After resting, the client states they are feeling much better. The nurse recognizes that this discomfort could be due to which cause?

Answer 34

thromboembolic disorder of the lower extremities

Question 35

A nurse is developing a teaching plan about sexuality and contraception for a postpartum client who is breastfeeding. Which statement(s) to the client would the nurse include in the teaching? Select all that apply.

Answer 35

"You may experience fluctuations in sexual interest." "Using a water-based lubricant can ease vaginal discomfort." "You may experience increased breast sensitivity during sexual activity."

Question 36

The nurse is assessing a client 48 hours postpartum and notes on assessment: temperature 101.2oF (38.4oC), HR 82, RR 18, BP 125/78 mm Hg. The nurse should suspect the vital signs indicate which potential situation?

Answer 36

Infection

Question 37

The skull is the most important factor in relation to the labor and birth processes. The fetal skull must be small enough to travel through the bony pelvis. What feature of the fetal skull helps to make this passage possible?

Answer 37

Molding

Question 38

In recording a postpartum client’s urinary output, the nurse notes that they are voiding between 150 and 200 ml with each hourly void. How would the nurse interpret this finding?

Answer 38

The urinary output is normal.

Question 39

The nurse is assessing a new client who presents in early labor. The nurse determines the fetus has an acceptable heart rate if found within which range?

Answer 39

110 to 160 bpm

Question 40

A nurse is caring for a client who gave birth 10 hours agp. The nurse observes perineal edema in the client. What intervention should the nurse perform to decrease the swelling?

Answer 40

Apply ice.

Question 41

Which is the most important nursing assessment of the pregnant client during the fourth stage of labor?

Answer 41

Hemorrhage

Question 42

The nurse teaches a sedentary pregnant client with a BMI of 35 about the importance of healthy lifestyle during pregnancy. Which goal would be appropriate for this client?

Answer 42

Walk for 30 minutes 5 days a week.

Question 43

A nurse is providing care to a client who is 6 hours postpartum. The nurse suspects urinary retention based on which finding?

Answer 43

50 to 70 mL urine per void every hour

Question 44

A fundal massage is sometimes performed on a postpartum client. The nurse would perform this procedure to address which condition?

Answer 44

uterine atony

Question 45

The nurse is teaching a client about mastitis. Which statement should the nurse include in their teaching?

Answer 45

Symptoms include fever, chills, malaise, and localized breast tenderness.

Question 46

The nurse is caring for a client who underwent a cesarean birth 24 hours ago. Which assessment finding indicates the need for further action?

Answer 46

The fundus is located 2 fingerbreadths above the umbilicus.

Question 47

A nurse notes a client's prelabor vital signs were: temperature, 98.8°F (37.1°C); blood pressure, 120/70 mm Hg; heart rate, 80 beats/min; and respiratory rate, 20 breaths/min. Which set of assessment findings during the early postpartum period should the nurse prioritize?

Answer 47

blood pressure of 90/50 mm Hg; heart rate of 120 beats/min; respiratory rate of 24 breaths/min

Question 48

A nurse is developing a plan of care for a postpartum client, newborn, and partner to facilitate the attachment process. Which intervention is appropriate for the nurse to include in the plan?

Answer 48

Ensure early and frequent parent–newborn interactions.

Question 49

The nurse recognizes that the postpartum period is a time of rapid changes for each client. What is believed to be the cause of postpartum affective disorders?

Answer 49

drop in estrogen and progesterone levels after birth

Question 50

A client calls the clinic asking to come in to be evaluated. The client states that when they went to bed last night the fetus was high in the abdomen, but this morning the fetus feels like it has dropped down. After asking several questions, the nurse explains this is probably due to:

Answer 50

lightening.

Question 51

The nurse is assessing a pregnant client at 37 weeks' gestation and notes the fetus is at 0 station. When questioned by the client as to what has happened, the nurse should point out which event has occurred?

Answer 51

engagement

Question 52

A new parent is diagnosed with a venous thromboembolism in their left calf. Which risk factor is associated with this problem? Select all that apply.

Answer 52

cesarean birth obesity

Question 52

A client is experiencing postpartum hemorrhage and the nurse begins to massage the fundus. Which action will the nurse take when massaging the client's fundus?

Answer 52

Wait until the uterus is firm to express clots.

Question 53

A client at 39 weeks' gestation presents to the labor and birth unit reporting abdominal pain. What should the nurse do first?

Answer 53

Determine if the client is in true or false labor.

Question 54

The nurse is monitoring a client in the first stage of labor. The nurse determines the client's uterine contractions are effective and progressing well based on which finding?

Answer 54

Dilation (dilatation) of cervix

Question 55

While waiting for the placenta to deliver during the third stage of labor the nurse must assess the birthing parent's vital signs every 15 minutes. What sign would indicate impending shock?

Answer 55

tachycardia and a falling blood pressure

Question 56

A labor nurse is caring for a client who is 7 cm dilated, 100% effaced, at a +1 station, and has a face presentation on examination. The nurse knows that teaching was understood when the birth partner makes which statement?

Answer 56

“Our baby will come out face first.”

Question 57

When teaching the new parent about breastfeeding, the nurse is correct when providing what instructions? Select all that apply.

Answer 57

Help the client initiate breastfeeding within 30 minutes of birth. Encourage breastfeeding of the newborn infant on demand. Place the newborn in uninterrupted skin-to-skin contact (kangaroo care) with the parent.

Question 58

A pregnant client is concerned about gaining weight. The nurse explains that the extra calories are needed for which purpose? Select all that apply.

Answer 58

supplying energy to the fetus sustaining the elevated metabolic rate providing energy for increased workload promoting cellular growth

Question 59

A nurse is conducting an in-service program for a group of nurses working in the prenatal clinic. When discussing the theories about the onset of labor, the nurse points out which factor as a possible cause? Select all that apply.

Answer 59

release of oxytocin by the pituitary prostaglandin production in the myometrium

Question 59

A nurse is providing care to a pregnant client at 9 weeks' gestation. The client reports that their breasts have become quite tender. The client says, "I know my breasts are going to get bigger, but I didn't think that it would be uncomfortable." The nurse offers suggestions to address this discomfort, based on the understanding that this change is the result of which hormones? Select all that apply.

Answer 59

estrogen progesterone

Question 60

The nurse is admitting a primigravida client who has just presented to the unit in early labor. Which response should the nurse prioritize to assist the client in remaining calm and cooperative during birth?

Answer 60

"The infant is coming. I'll explain what's happening and guide you."

Question 61

Which recommendation should be given to a client with mastitis who is concerned about breastfeeding their neonate?

Answer 61

The client should continue to breastfeed; mastitis will not infect the neonate.

Question 62

The nurse determines that the fetal heart rate averages approximately 140 beats per minute over a 10-minute period. The nurse identifies this as:

Answer 62

baseline FHR.

Question 63

Which nursing action is a priority when the fetus is at the +4 station?

Answer 63

Have a blue bulb suction and an infant warmer ready.

Question 64

The nurse is educating a client about the importance of folic acid before conception and during pregnancy, to prevent neural tube defects in the fetus. The client plans to take prenatal vitamins and minerals. What food source would the nurse recommend to add to the client's diet?

Answer 64

Green leafy vegetables

Question 65

The nurse is caring for a client who had been administered regional nerve block anesthesia during labor. For which risk(s) should the nurse watch in the client? Select all that apply.

Answer 65

incomplete emptying of bladder bladder distention ambulation difficulty urinary retention

Question 66

The nurse has received the results of a client's postpartum hemoglobin and hematocrit. Review of the client's history reveals a prepartum hemoglobin of 14 g/dl (140 g/l) and hematocrit of 42% (0.42). Which result should the nurse prioritize?

Answer 66

hemoglobin 9 g/dl (90 g/l) and hematocrit 32% (0.32) in a client who has given birth by cesarean

Question 67

A full-term neonate delivered an hour after the client received IV meperidine is showing signs of respiratory depression. The nurse should be prepared to administer which medication?

Answer 67

naloxone

Question 68

A nurse is providing care to a postpartum client who gave birth about 2 days ago. The client asks the nurse, "I haven't moved my bowels yet. Is this a problem?" Which response by the nurse would be most appropriate?

Answer 68

"It might take up to a week for your bowels to return to their normal pattern."

Question 69

A primigravida is 1 cm dilated, in early latent labor, and interested in avoiding epidural anesthesia. After asking about which nonpharmacologic options for pain relief they can use at this time, which option(s) should the nurse point out to the client? Select all that apply.

Answer 69

Simple breathing exercises Effleurage Walking and then using a birthing ball

Question 70

Assessment of a pregnant client in labor reveals that the fetal attitude is normal. The nurse interprets this as indicating which information? Select all that apply.

Answer 70

chin is on the chest legs are flexed at the knees

Question 71

The nurse is caring for several clients in the postpartum clinic setting. Which statement(s), when made by one of the clients, would alert the nurse to further assess that client for postpartum psychosis? Select all that apply.

Answer 71

"The newborn is not really mine emotionally, since I was never pregnant and do not have children." "When the newborn is sleeping, I can see their thoughts projected on my phone and I do not like the thoughts." "I believe my newborn is losing weight because I will not feed them because my milk was poisoned by the health care provider."

Question 72

A primiparous client gave birth vaginally to a healthy newborn 12 hours ago. The nurse palpates the client's fundus. Which finding does the nurse identify as expected?

Answer 72

at the level of the umbilicus

Question 73

A client in the third trimester reports to the nurse shortness of breath when sleeping. The nurse informs the client that this is normal and occurs because the growing fetus puts pressure on the diaphragm. Which measure should the nurse suggest to help alleviate this problem?

Answer 73

Use extra pillows.

Question 74

A client at 38 weeks' gestation is in labor and oxytocin is prescribed to augment the labor. When preparing to administer this medication, what action by the nurse would be appropriate?

Answer 74

Administer the medication piggybacked into a primary IV line using a pump.

Question 75

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

Answer 75

crowning

Question 76

When caring for a client in the third stage of labor, the nurse notices that the expulsion of the placenta has not occurred within 5 minutes after birth of the infant. What should the nurse do?

Answer 76

Nothing. Normal time for stage three is 5 to 30 minutes.

Question 77

The nurse’s assessment identified signs that the client is depressed. What is the nurse’s greatest concern for a client who is depressed?

Answer 77

harm to self

Question 78

The nurse is discussing options to provide relief of labor pain when the client states, “Why can’t the health care provider provide a sedative during labor?” Which disadvantages are common with providing a sedative as pain management? Select all that apply.

Answer 78

Sedatives will not provide pain relief. The sedation effect can cross to the fetus. Sedatives are only used in early labor

Question 79

A client gave birth 1 week ago and currently is tearful, anxious, and sad, and reports having no appetite. The client is diagnosed with postpartum blues. What factor(s) contribute to this condition? Select all that apply.

Answer 79

hormonal changes fatigue discomfort disrupted sleep patterns

Question 80

A client states, “I think my water broke! I felt this gush of fluid between my legs.” Which finding confirms rupture of membranes has occurred?

Answer 80

nitrazine paper turned blue

Question 81

A client's last menstrual period was April 11. Using the Naegele rule, the estimated date of delivery (EDD) would be:

Answer 81

January 18.

Question 82

The nurse will be assisting a client during an amniocentesis. Which nursing intervention should the nurse prioritize?

Answer 82

Be certain the client is aware of potential complications.

Question 83

A pregnant client, G2P1, comes to the clinic in their third trimester for a prenatal visit. During assessment, the client reports noticing increased pelvic pressure, cramping, and lower back pain. Which response by the nurse is best?

Answer 83

"Do you feel like it has been easier to breathe lately?"

Question 84

In the labor and delivery unit, which is the best way to prevent the spread of infection?

Answer 84

Complete hand hygiene

Question 85

A postpartum client has a fourth-degree perineal laceration. The nurse expects which medication to be prescribed?

Answer 85

docusate

Question 86

During the early postpartum period, a new parent is displaying dependent behaviors typical of the taking-in phase. What behavior(s) will the nurse recognize as normal for this period? Select all that apply.

Answer 86

needing assistance with changing the perineal pad telling the nurse about the birth experience asking the nurse to take the newborn away so the client can rest

Question 87

An adolescent primipara was cautious at first when holding and touching their newborn. The client seemed almost afraid to make contact with the newborn and only touched the newborn lightly and briefly. However, 48 hours after the birth, the nurse notices that the client is pressing the newborn's cheek against their own and kissing the newborn on the forehead. The nurse recognizes these actions as:

Answer 87

attachment.

Question 88

A client in the second trimester of pregnancy is beginning to experience more headaches. In addition to suggesting holding an ice pack to the forehead, the health care provider recommends which medication to provide some relief from the pain?

Answer 88

acetaminophen

Question 89

A gravida client in their second trimester has shared that they still enjoy a glass of wine about once a week with dinner. What response by the nurse is most appropriate?

Answer 89

"There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus."

Question 90

The nurse is teaching a postpartum client and their spouse about postpartum blues. The nurse would instruct the couple to seek further care if the client's symptoms persist beyond which time frame?

Answer 90

2 weeks

Question 91

During a routine prenatal visit, a client at 36 weeks' gestation states they have difficulty breathing and feels like their pulse rate is really fast. The nurse finds the pulse to be 100 beats/min (increased from baseline readings of 70 to 74 beats/min) and irregular. Which is the priority intervention for this client?

Answer 91

Assess anterior and posterior lung sounds.