Ob midterm study guide

Question 1

Anatomy of umbilical cord

Answer 1

2 arteries(carries deoxygenated blood), 1 vein (carries oxygenated blood)

Question 2

Pt comes in labor, contracting q2-3 mins, VS taken, fetal hr 122, maternal hr 128, bp 88/46 what is priority?

Answer 2

Reposition (Left side, off back)

Question 3

Primary vit in food that reduces change of neurologic defects?

Answer 3

Folic acid

Question 4

Late Decelerations shows:

Answer 4

uteral deficiency // variable declarations: cord

Question 5

SIgns of ectopic pregnancy?

Answer 5

Sharp abdominal pain on one side (unilateral).

Question 6

Fetal head location and descent to the ?

Answer 6

-3 is up , +3 is out?

Question 7

A nurse in a prenatal clinic is caring for a client who is at 38 weeks gestation and undergoing a contraction stress test. The test results are negative. Which of the following interpretations of this finding should the nurse make?
A. There is no evidence of cervical incompetence.
B. There is no evidence of two or more accelerations in fetal heart rate in 20 min.
C. There is no evidence of uteroplacental insufficiency.
D. There are less than 3 uterine contractions in a 10 min period.

Answer 7

C. There is no evidence of uteroplacental insufficiency.

Question 8

A nurse is assessing a client who is in active labor and notes that the presenting part is at 0 station. Which of the following is the correct interpretation of this clinical finding?
A. The fetal head is in the left occiput posterior position.
B. The largest fetal diameter has passed through the pelvic outlet.
C. The posterior fontanel is palpable.
D. The lowermost portion of the fetus is at the level of the ischial spines.

Answer 8

D. The lowermost portion of the fetus is at the level of the ischial spines.

Question 9

Decelerations- V E Acceleration Late placenta?

Answer 9

V: Variable Decelerations
E: Early Decelerations
A: Acceleration
L: Late Decelerations

Corresponding causes:
C: Cord Compression (for Variable Decelerations)
H: Head Compression (for Early Decelerations)
O: Oxygenation (for Accelerations)
P: Placental Insufficiency (for Late Decelerations)

Question 10

Last menstrual period: June 4. Estimated delivery day?

Answer 10

March 11

Question 11

After the start of contraction, fetal heart rate starts decreasing what is your intervention:

Answer 11

reposition on lateral side if not an option choose oxygen

Question 12

Baby’s head is at -1, this means:

Answer 12

1 cm above ischial spine

Question 13

A nurse on the labor and delivery unit is caring for a client following a vaginal examination by the provider which is documented as: -1. Which of the following interpretations of this finding should the nurse make?
A. The presenting part is 1cm above the ischial spines.
B. The presenting art is 1cm below the ischial spines.
C. The cervix is 1cm dilated.
D. The cervix is effaced 1cm.

Answer 13

A. The presenting part is 1cm above the ischial spines.

Question 14

A nurse in a clinic is reviewing the medical records of a group of clients who are pregnant. The nurse should anticipate the provider will order a maternal serum alpha-fetoprotein (MSAFP) screening for which of the following clients?
A. A client who has mitral valve prolapse
B. A client who has been exposed to AIDS
C. All of the clients
D. A client who has a history of preterm labor.

Answer 14

C. All of the clients

Question 15

Maternal serum fetal alpha protein order on:

Answer 15

every patient!

Question 16

End of NST, 30 mins, baseline 140, minimal variability, no accelerations, 2 decel:

Answer 16

Non
reactive

Question 17

atient comes in 38 weeks preg, what are signs of going into labor:

Answer 17

baby dropping,
nesting (surge of energy), lightning ( baby head drops down)

Question 18

Major complications of epidural block:

Answer 18

hypotension

Question 19

Pt on epidural bp 88/42, fetal hr 130 what do you do?

Answer 19

Reposition

Question 20

s/s of hyperemesis gravidarum:

Answer 20

wt loss (due to n/v), dehydration. Help pt by
meds such as reglan, IV fluids to help with hydration, small amounts of food and fluid, monitor I&O

Question 21

A nurse in a clinic is caring for a client who is at 39 weeks of gestation and who asks about the signs that precede the onset of labor. Which of the following should the nurse identify as a sign that precedes labor?
A. Decreased vaginal discharge
B. A surge of energy
C. Urinary retention
D. Weight gain of 0.5 to 1.5 kg

Answer 21

B. A surge of energy

Question 22

A nurse is assessing a client in labor who has had epidural anesthesia for pain relief. Which of the following findings should the nurse identify as a complication from the epidural block?
A. Vomiting
B. Tachycardia
C. Respiratory depression
D. Hypotension

Answer 22

D. Hypotension

Question 23

A nurse on a labor unit is admitting a client who reports painful contractions. The nurse determines that the contractions have a durtiong of 1min and a frequency of 3min. The nurse obtains the following vitals: fetal heart rate 130/min, maternal heart rate 128/min, and maternal blood pressure 92/54mmHg. Which of the following is the priority action for the nurse to take?
A. Notify the provider of the findings.
B. Position the client with one hip elevated.
C. Ask the client if she needs pain medication.
D. Have the client void.

Answer 23

B. Position the client with one hip elevated.

Question 24

A pregnant patient tells the nurse that she has been nauseated and vomiting. How will the nurse explain that hyperemesis gravidarum is distinguished from morning sickness?

a. Hyperemesis gravidarum usually lasts for the duration of the pregnancy.
b. Hyperemesis gravidarum causes dehydration and electrolyte imbalances.
c. Sensitivity to smells is usually the cause of vomiting in hyperemesis gravidarum.
d. The woman with hyperemesis gravidarum will have persistent vomiting without weight loss.

Answer 24

b. Hyperemesis gravidarum causes dehydration and electrolyte imbalances.

Question 25

Recommend rubella immunizations occur

Answer 25

AFTER delivery

Question 26

Signs of Placenta previa?

Answer 26

Placenta is covering cervix, bright red and painless bleeding

Question 27

Pt w preeclampsia, receiving mag sulfate. RR 10, DTR +1, u will FIRST:

Answer 27

STOP giving the med

Question 28

Reason to do maternal serum alpha fetoprotein:

Answer 28

for spinal, neural, and abdominal wall defects

Question 29

A nurse is caring for a client who is at 36 weeks of gestation and who has suspected placenta previa. Which of the following findings support this diagnosis? a. Painless red vaginal bleeding b. Increasing abdominal pain with a non relaxed uterus c. Abdominal pain with scant red vaginal bleeding d. Intermittent abdominal pain following passage of bloody mucus

Answer 29

a. Painless red vaginal bleeding

Question 30

A nurse is assessing a client who received magnesium sulfate to treat preterm labor. Which of the following clinical findings should the nurse identify as an indication of toxicity to magnesium sulfate therapy and report to the provider? A. Respiratory depression B. Facial flushing C. Nausea D. Drowsiness

Answer 30

A. Respiratory depression

Question 31

A nurse is preparing to administer magnesium sulfate IV to a client who is experiencing preterm labor. Which of the following is the priority nursing assessment for this client? A. Temperature B. Fetal heart rate (FHR) C. Bowel sounds D. Respiratory rate

Answer 31

D. Respiratory rate

Question 32

Taking hx, smokes half a cig a day

Answer 32

educate to stop smoking bc of IUGR (tiny bby)

Question 33

Where do we expect fetal heart tones on pregnant mom?

Answer 33

Lower abdomen

Question 34

Most common RF that leads to placental abruption

Answer 34

HTN

Question 35

Gate control theory of pain?

Answer 35

Redirect pain, so massage shoulders and remove sensitization and distract them from pain

Question 36

Lower back pain with contraction the baby is in

Answer 36

occipital posterior position

Question 37

Pt comes in HA, spots in eyes, BP 150/90 u will

Answer 37

administer an antihypertensive(to lower BP), mag sulfate(to prevent seizures), then check protein in urine

Question 38

Pt comes in and has vaginal spotting, RLQ pain what are we suspecting: Meds to give?

Answer 38

ectopic pregnancy. Methotrexate. Know pt blood type because RH sensitization, Watching Beta HCG blood level (will decrease if med working)

Question 39

Amniocentesis

Answer 39

empty the bladder, we do it on week 14 of gestation bc thats when amnio fluid starts building

Question 40

Late decelerations on fetal monitor:

Answer 40

reposition on side

Question 41

A nurse is completing a health history for a client who is at 6 weeks of gestation. The client informs the nurse that she smokes one pack of cigarettes per day. The nurse should advise the client that smoking places the client's newborn at risk for which of the following complications? A. Hearing loss B. Intrauterine growth restriction C. Type 1 diabetes mellitus D. Congenital heart defects

Answer 41

B. Intrauterine growth restriction

Question 42

Nurse is caring for patient who's pregnant and at end of her 1st trimester. Nurse should place Doppler ultrasound stethoscope in which locations to begin assessing fetal heart tones (FHT)? Just above the umbilicus Just above the symphysis pubis The right lower quadrant The left lower quadrant

Answer 42

Just above the symphysis pubis

Question 43

A nurse in a provider's office is caring for a client who is at 34 weeks of gestation and at risk for placental abruption. The nurse should recognize that which of the following is the most common risk factor for abruption? A. Cocaine use B. Hypertension C. Blunt force trauma D. Cigarette smoking

Answer 43

B. Hypertension

Question 44

A nurse is caring for a client who is in labor. Which of the following nursing actions reflects application of the gate control theory of pain? A. Administer prescribed analgesic medication B. Encourage the client to rest between contractions C. Massage the client's back D. Turn the client onto her left side

Answer 44

C. Massage the client's back

Question 45

A nurse is caring for a client who is in labor and whose fetus is in the right occiput posterior position. The client is dilated to 8 cm and reports back pain. Which of the following actions should the nurse take? A. Apply sacral counterpressure B. Perform transcutaneous electrical nerve stimulation (TENS) C. Initiate slow-paced breathing. D. Assist with biofeedback

Answer 45

A. Apply sacral counterpressure

Question 46

A nurse in a prenatal clinic is instructing a client about an amniocentesis, which is scheduled at 15weeks of gestation. Which of the following should be included in the teaching? A. "The test will be performed if your baby's heart beat is heard." B. "This test will determine if your baby's lungs are mature." C. "This test requires the presence of amniotic fluid." D. "After the test, you will be given Rh0 immune globulin since you are Rh positive."

Answer 46

C. "This test requires the presence of amniotic fluid."

Question 47

A nurse is caring for a client who is in active labor and notes late decelerations in the FHR. Which of the following actions should the nurse take first? A. Apply a fetal scalp electrode. B. Increase the rate of the IV infusion. C. Administer oxygen at 10 L/min via a nonrebreather mask. D. Change the client's position.

Answer 47

D. Change the client's position.

Question 48

Baby delivered, might have hyperbilirubinemia. Why does this occur?

Answer 48

Cause mom has no RH factor, so blood sensitizes.

Question 49

Polyhydramnios:

Answer 49

too much amniotic fluid

Question 50

Gestational diabetic pt, what is anticipated

Answer 50

insulin

Question 51

Severe preeclampsia, S/S?

Answer 51

Protein uremia, high bp, headache, visual disturbances,

Question 52

Immunizations u can get during pregnancy:

Answer 52

flu shot, covid, tdap

Question 53

Pt is receiving mag sulfate, which finding would u report to provider

Answer 53

UA output of 50mL/hr

Question 54

Which following assessment should nurse report to HCP?

Answer 54

DTR below 2+, visual disturbances, HA, edema/wt gain.

Question 55

Pt is term w large amount of painless bright red bleeding, no contractions, fetal HR , HR 120, RR 26, T 97.6. Priority nursing action:

Answer 55

Iv access

Question 56

Prenatal nutrition, T/f: intake calcium prenatal vitamins will meet your needs vit E requirements decrease due to u will need to double your iron intake

Answer 56

calcium = false prenatals = false vit e = false doble iron = true

Question 57

Pt is 41 weeks in labor, take BP 88/50. What do you do?

Answer 57

REPOSITION

Question 58

Confirmatory sign of labor?

Answer 58

Cervical dilation

Question 59

Newly diagnosed gestation diabetes. Which statement needs more education:

Answer 59

I will reduce my exercise to 3 days a week

Question 60

PKU:

Answer 60

monitor protein intake

Question 61

Pt 35 weeks, preeclampsia, continuous abd pain, vaginal bleeding:

Answer 61

Placental abruption, ruptu placente?

Question 62

Contraindication to internal monitors:

Answer 62

unruptured membranes

Question 63

Deceleration on monitor is mirror, intervention:

Answer 63

nothing bc that is normal

Question 64

Why does the body increase vascular volume by 40-60% during pregnancy?

Answer 64

Because it provides adequate perfusion to the placenta.

Question 65

Physiological anemia:

Answer 65

fake/ false anemia bc the blood serum increases n dilutes the hemoglobin concentration

Question 66

At 20 wks gestation, measuring fundus at 17 sonometers, what are we thinking

Answer 66

Lower

Question 67

last menstrual april 2nd:

Answer 67

january 9th

Question 68

NST is nonreactive or reactive.

Answer 68

CST is either positive or negative.

Question 69

What is the primary s/e to analgesic to newborn ?

Answer 69

resp depression

Question 70

Hydanephorm Moles we are seeing in the uterus

Answer 70

larger uterus, mom will be vomiting bc beta hcg is gonna be high

Question 71

igh risk pt went from preeclampsia to eclampsia, what puts them at high risk for developing HELLP syndrome:

Answer 71

elevated liver enzymes OR low platelet

Question 72

Glucose challenge test. When are we drawing blood?

Answer 72

1 hr after drinking. Then 2, then 3.

Question 73

Positive sign of pregnancy:

Answer 73

ultrasound / visualization of fetus, fetal hr

Question 74

Sign of true labor:

Answer 74

cervical dilation

Question 75

Dinoprostone gel is used for

Answer 75

cervical ripening

Question 76

Doctor comes in and wants to do an amminospy

Answer 76

onsent, put monitor on to assess fetal HR

Question 77

Pt comes in, 39 weeks, ruptured, fever 100.2. s/o Infection:

Answer 77

color and odor.

Question 78

Pt w placenta previa we will NOT b doing

Answer 78

placenta exam

Question 79

Who do u see first?

Answer 79

30 weeks gestation painless vaginal bleeding

Question 80

NGN- molar pregnancy, r/t tumor or cancer. What kind of bleeding?

Answer 80

Dark brown or bright red, occurs at 16 weeks gestation, bc of bleeding pt can be anemic

Question 81

Numba 1 sign for concerning for preeclampsia patient that needs further evaluation:

Answer 81

elevated blood pressure, HA, excessive gain weight

Question 82

Pt comes in w possible placental abruption. U will:

Answer 82

place on toco and ultrasound, monitor fetal HR, check I&O’s, start IV, draw blood

Question 83

First time mom, what sign to look for onset of labor:

Answer 83

contractions, cervical changes, bloody show or lose mucus plug

Question 84

Pt just delivered, got some demerol for pain what do u anticipate giving to the baby:

Answer 84

narcan

Question 85

Pt comes in thinking she is in labor, contractions Q5 mins. This is the first stage of labor called:

Answer 85

Latent phase

Question 86

NGN- s/o abruptly placenta- abdomen hard and rigid, lab work low platelet, low hgb, uterine tone is firm rigid board, extreme pain, bleeding bright red or dark depending on abruption**

Question 87

A nurse is caring for a client who has just delivered her first newborn. The nurse anticipates hyperbilirubinemia due to Rh incompatibility. The nurse should understand that hyperbilirubinemia occurs with Rh incompatibility for which reason? A. The client's blood does not contain the Rh factor, so she produces antiRh antibodies that cross the placental barrier and cause hemolysis of red blood cells in newborns B. The client's blood contains the Rh factor and the newborn's does not, antibodies that destroy red blood cells are formed in the fetus C. The client has a history of receiving a transfusion with Rh-negative blood D. The client's blood is Rh-positive and therefore forms antibodies against the fetus' Rh-negative blood which cross the placenta and causes the destruction of the fetal red blood cells

Answer 87

A. The client's blood does not contain the Rh factor, so she produces antiRh antibodies that cross the placental barrier and cause hemolysis of red blood cells in newborns

Question 88

An antepartum client has polyhydramnios. Which of the following findings should the nurse anticipate?

Answer 88

Congenital anomalies in the fetus

Question 89

The nurse is assessing a client with mild preeclampsia to see if she has progressed to severe preeclampsia. Which of the following would be associated with the progression of this disease process? Select all that apply. A. Oliguria B. Visual changes C. Right upper quadrant pain D. Elevated liver function tests E. Creatinine 0.04

Answer 89

A. Oliguria B. Visual changes C. Right upper quadrant pain D. Elevated liver function tests

Question 90

A nurse is assessing a pregnant client for possible preeclampsia. Which symptom would be indicative of this diagnosis? A. Active fetal movement B. Edema in the feet C. Proteinuria D. Seizures

Answer 90

C. Proteinuria

Question 91

A nurse is teaching a client who is at 23 weeks of gestation about immunizations. Which of the following statements should the nurse include in the teaching? A. "You should not receive the rubella vaccine while breastfeeding." B. "You should receive a varicella vaccine before you deliver." C. "You can receive an influenza vaccination during pregnancy." D. "You cannot receive the Tdap vaccine until after you deliver."

Answer 91

C. "You can receive an influenza vaccination during pregnancy."

Question 92

A nurse is assessing a client who is at 35 weeks of gestation and is receiving magnesium sulfate via continuous IV infusion for severe pre-eclampsia. Which of the following findings should the nurse report to the provider? A: Deep Tendon Reflexes 2+ B: BP 150/96 mm Hg C: Urinary output 20 mL/hr D: Respiratory Rate 16/min

Answer 92

C: Urinary output 20 mL/hr

Question 93

A nurse in a hosptial is caring for a client For a client who is 38 weeks gestation and has a large amount of painless, bright red vaginal bleeding. Priority nursing action?

Answer 93

Initiate IV access

Question 94

A nurse midwife is examining a client who is a primigravida at 42 weeks of gestation and states that she believes she in in labor. Which of the following findings confirm to the nurse that the client is in labor? A. Cervical dilation B. Reports of pain above the umbilicus C. Brownish vaginal discharge D. Amniotic fluid in the vaginal vault

Answer 94

A. Cervical dilation

Question 95

A nurse in a prenatal clinic is teaching a patient who is in her second trimester and has a new diagnosis of gestational diabetes. Which of the following statements by the patient indicates a need for further teaching? A. “I will reduce my exercise schedule to 3 days a week.”. B. “I will take my glyburide daily with breakfast.”. C. “I know I am at increased risk to develop type 2 diabetes.”. D. “I should limit my carbohydrates to 50% of caloric intake.”. E. “I should limit my carbohydrates to 50% of caloric intake.”.

Answer 95

A. “I will reduce my exercise schedule to 3 days a week.”.

Question 96

A nurse in the antepartum unit is caring for a client who is at 36 weeks of gestation and has pregnancy-induced hypertension. Suddenly, the client reports continuous abdominal pain and vaginal bleeding. The nurse should suspect which of the following complications? A. Placenta previa B. Prolapsed cord C. Incompetent cervix D. Abruptio placentae

Answer 96

D. Abruptio placentae

Question 97

Which maternal condition is considered a contraindication for the application of internal monitoring devices? a. Unruptured membranes b. Cervix is dilated to 4 cm c. External monitors are currently being used d. Fetus has a known heart defect

Answer 97

a. Unruptured membranes

Question 98

What is the most likely cause for early decelerations in the fetal heart rate (FHR) pattern? What is the most likely cause for early decelerations in the fetal heart rate (FHR) pattern? a.Altered fetal cerebral blood flow b.Umbilical cord compression c.Uteroplacental insufficiency d.Spontaneous rupture of membranes

Answer 98

a.Altered fetal cerebral blood flow

Question 99

**Decelerations that mirror the contractions are present with each contraction on the monitor strip of a multipara who received epidural anesthesia 20 minutes ago. The nurse should: a. maintain the normal assessment routine. b. administer O2 at 8 to 10 L/min by face mask. c. increase the IV flow rate from 125 to 150 mL/hr. d. assess the maternal blood pressure for a systolic pressure below 100

Answer 99

a. maintain the normal assessment routine.

Question 100

The nurse providing newborn stabilization must be aware that the primary side effect of maternal narcotic analgesia in the newborn is: a. Respiratory depression. . b. Bradycardia. c. Acrocyanosis d. Tachypnea.

Answer 100

a. Respiratory depression. .

Question 101

A nurse in a prenatal clinic is assessing a client who is suspected of having a hydatidform mole. Which of the following findings should the nurse expect to observe in this client? A. rapidly dropping human chorionic gonadotropin (hCG) levels B. profuse clear vaginal discharge C. irregular fetal heart rate D. Excessive uterine enlargement

Answer 101

D. Excessive uterine enlargement

Question 102

A nurse at an antepartum clinic is caring for a client who is at 4 months of gestation. The client reports continued nausea and vomiting and scant, prune-colored discharge. She has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse suspect? A. Hyperemesis gravidarum B. Threatened abortion C. Hydatidiform mole D. Preterm labor

Answer 102

C. Hydatidiform mole

Question 103

A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding? A. hyperglycemia B. elevated platelet count C. disseminated intravascular coagulation (DIC) D. elevated liver enzymes

Answer 103

D. elevated liver enzymes

Question 104

A nurse is caring for a client who states I think I am pregnant. Which of the following findings should the nurse identify as a positive sign of pregnancy a. Positive serum pregnancy test b. Amenorrhea c. Fetal heart tones heard on an auscultated Doppler d. Chadwick sign

Answer 104

c. Fetal heart tones heard on an auscultated Doppler

Question 105

A nurse in a prenatal clinic is teaching a client who has a new prescription for dinoprostone gel. Which of the following statements should the nurse include in the teaching? A. "This medication promotes softening of the cervix." B. "This medication is used to treat preeclampsia." C. "It causes relaxation of the uterine muscles." D. "It is used to treat genital herpes simplex virus."

Answer 105

A. "This medication promotes softening of the cervix."

Question 106

A nurse admits a woman who is at 38 weeks of gestation and in early labor with ruptured membranes. The nurse determines that the client's oral temperature is 38.9 degrees celsius (102 degrees fahrenheit). Besides notifying the provider, which of the following is an appropriate nursing action? A. Recheck the client's temperature in 4 hr. B. Administer glucocorticoids intramuscularly. C. Assess the odor of the amniotic fluid. D. Prepare the client for emergency cesarean section.

Answer 106

C. Assess the odor of the amniotic fluid.

Question 107

A nurse is reviewing the medical record of a client who is at 33 weeks gestation and has placenta previa and bleeding. Which of the following prescriptions should the nurse clarify with the provider? A: Perform a vaginal examination. B: Perform continuous external fetal monitoring. C: Insert a large-bore IV catheter D: Obtain a blood sample for laboratory testing.

Answer 107

A: Perform a vaginal examination.

Question 108

A nurse is teaching a client who is at 30 weeks of gestation about warning signs of complications that she should report to her provider. Which of the following findings should the nurse include in the teaching? A: Mild constipation B: Nasal congestion C: Painless vaginal bleeding D: 10 fetal movements per hour

Answer 108

C: Painless vaginal bleeding

Question 109

A nurse is assessing a client who is at 12 weeks of gestation and has a hydatidiform mole. Which of the following findings should the nurse expect? A: Hypothermia B: Dark brown vaginal discharge C: Decreased urinary output D: Fetal heart tones

Answer 109

B: Dark brown vaginal discharge

Question 110

The nurse administers meperidine (Demerol) 25 mg IV push to a laboring client, who delivers the infant 90 minutes later. What medication should the nurse anticipate administering to the infant? A. Naloxone (Narcan). B. Nalbuphine (Nubain). C. Promethazine (Phenergan). D. Fentanyl (Sublimaze).

Answer 110

A. Naloxone (Narcan).