Ob Exam 2

Exam 2 1. A primigravida presents to labor and delivery stating she is 39 weeks pregnant and her water broke 12 hours ago. Her contractions are irregular and she is dilated 4 cm. Which medication order does the nurse anticipate? a. Oxytocin (Pitocin) 2. At a third trimester clinic visit, the nurse teaches a primigravida client to watch for signs of impending labor, such as: a. Bloody show and increased pelvic pressure b. Diarrhea, indigestion or nausea 3. A G2P1 is in active labor, upon review of the fetal heart monitor tracing, repetitive late decelerations are noted. The nurses first action would be to: a. Turn the pt on her left side, increase IV fluids and give oxygen by face mask 4. A laboring client had received an order for epidural anesthesia. In order to prevent the most common complication with this procedure, which intervention would the nurse expect to use prior to placement of the epidural catheter? a. Rapidly infuse a 500-1000 ml bolus of intravenous fluid 5. A G1P0 has been in active labor for 8 hours and is making slow, steady progress. She complains of intense back pain with the contractions and rates her pain as 8. She requests an epidural for pain relief. Which fetal position/presentation would the nurse suspect? a. Occiput posterior 6. A 38-week pregnant woman has an ultrasound for amniotic fluid index (AFI). The exam results are AFI=5: a reduced amniotic fluid volume. Reduced levels of amniotic fluid indicate a. Chronic fetal hypoxemia 7. Which strategies would be effective to prevent preterm birth? SATA a. Promoting adequate nutrition b. Use of progesterone injections for women with a history of preterm births c. Routine assessment and intervention for infection d. Assessment and intervention for illicit drug use 8. After performing Leopold’s maneuver, the nurse determines the fetus is in a vertex presentation with the fetal back on the maternal right side. Auscultation of the heart rate should begin where on the maternal abdomen? a. Right lower quadrant of the maternal abdomen 9. A multipara has just delivered her baby and the cord has been cut. A small gush of bright red blood (<100 cc) and lengthening of the cord is observed. The nurse should do what to assist? a. Advise the pt the placenta is delivering 10. A nulliparous woman is in the active phase of labor, and her cervix has progressed to 6 cm dilation. The nurse evaluates the external fetal monitor tracing and notes the following: gradual decrease in FHR at the onset of several uterine contractions, returning to baseline rate by the end of the contraction; shape is uniform and smooth, inversely mirroring the contraction. Based on these findings, the nurse should document: a. Early decelerations 11. During the hospital shift, the L&D triage nurse has 4 pts arrive simultaneously. Which pt should the nurse evaluate first? a. Grand multip feeling pressure with contractions 12. A pregnant woman is in an MVA. She is placed on a backboard, an IV is started and her BP is 80/50. What is the priority important intervention? a. Tilt the back board 13. A history of fetal loss at 14-18 weeks gestation with painless cervical insufficiency cervical dilation is associated with: a. Cervical insufficiency b. Cervical incompetence 14. The antidote for magnesium sulfate is: a. Calcium gluconate 15. Respiratory depression of the neonate is a concern if birth is imminent 16. A pt is receiving magnesium sulfate for preterm labor. What is true regarding this medication? a. The loading dose often causes maternal flushing, headache and lethargy 17. A multigravida presents in active labor. Which of the following notations in her prenatal history would prompt the nurse to prepare for a cesarean section: a. Prior c/section with a high vertical (classical) uterine incision 18. The laboring multipara, who is 9 cm dilated and wanting to have natural childbirth, cries out, “I can’t take it anymore”. He best response by the nurse is: a. “You are doing a great job, you’re almost there. Let’s take some breaths together” 19. A 40-year-old primigravida asks about prenatal tests. Which of the tests below are used as screening tests for the increased likelihood of Trisomy 21 (down syndrome)? SATA a. Cell free DNA b. MSAFP/quad screen c. Nuchal folds on 3D ultrasound 20. A pt presents with oligohydramnios at 42 weeks gestation and is admitted for induction of labor. Several hours later the membranes rupture and the nurse note a large amount of thick, green (meconium) stained fluid. There are frequent, abrupt decelerations of the fetal heart rate on the monitor. Prior to a cesarean section, the nurse anticipates what intervention? a. Amnioinfusion 21. A pt arrives with orders for a NST. The nurse knows what regarding the nonstress test (NST)? a. A reactive test requires a minimum of two accelerations within 20 min 22. A woman’s labor is being induced with oxytocin. The nurse assesses the woman’s status, that of her fetus, and the labor progress itself just before and infusion increase of 2 mU/min. The nurse would discontinue the infusion if what is notes during the assessment? a. Frequency of uterine contractions: every 1 ½ minutes with poor relaxation in between 23. A pt has uncontrolled diabetes and the estimated fetal weight is over 4000 grams. Anticipating potential shoulder dystocia at delivery, the nurse should be prepared to a. Apply suprapubic pressure and use McRoberts maneuver 24. A pt at 32 weeks gestation is admitted with intermittent painless vaginal bleeding and a complete placenta previa is diagnosed. She is admitted to the high-risk antepartum unit. Her bleeding is now resolved. Expectant management would include: a. Activity limitation, monitor bleeding and plan for a cesarean birth 25. The condition where the vessels of the umbilical cord divide some distress from the placental membranes is called a. Velamentous insertion 26. A pt presents for prenatal care with a history of irregular menstrual cycles and an “unsure” LMP. What is the most reliable basis for establishing her due date? a. First trimester ultrasound 27. A pt is diagnosed with oligohydramnios at 38 weeks gestation. The nurse knows that oligohydramnios is a. A risk factor for cord compression in labor 28. Immediately after delivery, the cord is clamped and cut and the wet, crying, vigorous newborn is placed skin to skin with mom and covered with a blanket, with a length of cord still attached to the mental clamp. What is the FIRST priority action? a. Dry and stimulate the infant while assessing cry/respirations 29. A pt comes in from home and states that when the membranes ruptured “something fell out”. As soon as the patient lies down the nurse does an exam and feels a slowly pulsating cord (rate less than 100) in front of the presenting part. The nurses next action is to: a. Elevate the presenting part just enough to relieve the cord compression 30. A G1P0 has ruptured membranes. The physician orders Pitocin augmentation, beginning at 2 mu/min. the pharmacy sends a 1000 mL bag of LR with 20 units Pitocin added. The nurse will set the infusion pump at a. 6 mL/hour 31. During a prenatal visit, a primigravida asks about fetal movement. Which is true regarding fetal movement as an indicator of fetal well-being? a. Fetal movements can usually be felt by the mother by 20 weeks gestation 32. What foods would the client be advised to eat with a hemoglobin of 8.6 mg/dl and a hematocrit of 25.1% a. Chicken and eggs 33. During a prepared childbirth class, a father asks how to measure contraction frequency. The nurse explains that frequency is measured from the a. Beginning of one contraction to the beginning of the next contraction 34. A life-threatening condition where the placenta is abnormally attached to the uterine myometrium is called a. Placenta accrete 35. A multiparous mother has just delivered a 9-pound baby with a 750 ml EBL. She complains of feeling chilled and dizzy and the nurse notes that her uterine fundus is soft, midline and 3 fingers above the umbilicus. Which of the following is the nurses FIRST priority? a. Vigorously massage uterine fundus until firm 36. A pt is being admitted for a schedules labor induction with oxytocin for postdates. Which of the following assessment findings would be a contraindication to labor induction? SATA a. Fetal lie is transverse b. Active genital herpes infection c. Presenting part ballotable with unknown presentation d. Complete placenta previa e. Previous classical (vertical) c/s 37. A vaginal examination reveals that a woman is in active labor with a double footling breech. This presentation in labor and birth has an increased risk for? SATA a. Prolapsed cord b. Dystocia 38. Methods for augmenting labor include: SATA a. Amniotomy b. Stripping the membranes c. Oxytocin infusion 39. A laboring woman is receiving IV magnesium sulfate at 2 gm/hour for preeclampsia after a 4 gm loading dose. The change of shift assessment reveals urine output 20 mL in the last hour, BP 156/90, pulse 78, respirations 8/min, patellar reflexes absent, clear lung sounds bilaterally. The priority intervention for the nurse is to a. Discontinue the infusion and notify the physician 40. A woman phones the labor unit at 10:00 PM and says she has been having intermittent “back pain” all day. She is 12 weeks gestation. The nurse should tell the woman she a. Should come to the hospital now for further evaluation 41. Which statement is true regarding placenta previa and placental abruption? a. With placental abruption the drop in maternal hemoglobin is greater than apparent maternal blood loss 42. After several hours of labor, the nurse reviews the fetal heart monitor tracing. The nurse notes abrupt decelerations of the fetal heart rate during uterine contractions with quick return to baseline and correctly interprets this pattern to be consistent with? a. Umbilical cord compression 43. A pt presents at 34 weeks gestation (by LMP). She had heavy vaginal bleeding with clots, FHTs of 140 with repetitive late decelerations and absent variability, a pulse of 110, and severe abdominal pain. The uterus is firm to palpation and there is no rest between contractions. The physician is en route to the to the hospital to evaluate the patient and has already provided phone orders. Which of the following would be the nurses first priority? a. Start an IV and draw lab work ordered 44. Which of the following is the most common risk of episiotomy for vaginal delivery? a. Extension to serious tears (3rd and 4th degrees) 45. An obviously pregnant woman walks into the hospital ER shouting “Help me! Help me! My baby is coming, I’m so afraid.” The RN determines delivery is imminent. What action is most important for the RN to take? a. Provide clear, concise instructions in a calm, deliberate manner 46. A multiparous woman is in labor. Leopold’s maneuver indicates the fetal back on the left side of the maternal abdomen and FHTs are auscultated on the lower quadrant. The results of the vaginal examination are: 6cm/90%/+2/LOT. According to these findings the: a. Fetal attitude is flexed 47. A pt at term reports that her membranes have ruptured. The nurse assesses the fluid to confirm ROM and determines its characteristics. Normal assessment findings with ruptured membranes include: SATA a. Positive ferning via microscope b. Blue nitrazine paper c. Clear, straw color with no odor 48. An obstetrical emergency where a bolus of amniotic fluid, fetal cells or hair enters the maternal circulation and the maternal lungs is called a. Amniotic fluid embolism b. Anaphylactoid syndrome of pregnancy 49. A laboring woman requests something for pain relief. She is 1 cm dilated and her contractions are mild, occurring every 8-20 minutes and lasting 20-30 seconds. In discussing her options, the nurse explains that an epidural at this point in her labor could possibly increase her risk for what problem? a. Prolonged labor 50. A diabetic pt needs to be delivered prior to term due to non-reassuring fetal test results. Which of the following tests might be used to help determine if the fetal lungs are mature? a. L/S ratio and PG presence 51. Which medication would the nurse expect to administer to accelerate fetal lung maturity? a. Celestone soluspan 52. Effects of betamimetics used for tocolysis include? a. Tachycardia and cardiac dysrhythmias 53. A multigravida with a frank breech presentation is admitted for an external version. The nurse knows a. A reactive nonstress test is obtained immediately before the version 54. During Pitocin augmentation of labor for a pt with a prior c/s, a multiparous woman (G6, P5) suddenly becomes pale, diaphoretic and complains of severe lower abdominal pain with a tearing sensation. On vaginal exam, the nurse notes the presenting part is floating. Her uterus is tender. A prolonged deceleration is observed on the monitor. The nurse should suspect: a. Rupture of the uterus 55. A laboring woman’s temperature is elevated. The FHR pattern that can be expected with maternal fever would be: a. FHR baseline 170-180 56. A primigravida arrives to the L&D unit in obvious labor. Her spouse described her contractions as occurring every 1-2 minutes, lasting 60 seconds. She is irritable, restless, and vocal during contractions and complains of intense pressure. On exam, her cervix is dilated 8 cm, 100% effaced and the fetus is at 0 station. With the next contraction, she yells, “I can’t take it anymore.” Which best described her labor at this point? a. Stage 1, transition phase