Inpatient OB Review Exam 49 Questions with Verified Answers
A client had a nonreactive NST and was sent for a BPP. Which of the following BPP findings
... [Show More] would confirm poor oxygenation to the fetus?
Two pockets of amniotic fluid
Well-flexed extremities
Decreased muscle tone
Presence of fetal breathing movement - CORRECT ANSWER Decreased muscle tone
RATIONALE: decreased muscle tone would be indicative of fetal hypoxia.
A patient's perception of pain may manifest as all of the following EXCEPT: - CORRECT ANSWER Increased rationality and problem-solving
RATIONALE: Perception of pain occurs when stimulus from peripheral or visceral nerve sites reach the CNS pain center. The body then responds physically and emotionally in response to this pain perception.
A 32-week gestation client presents to the unit with complaint of "my water just broke." She denies having any contractions. Her prenatal record reveals she has a vasa previa. The nurse anticipates:
Giving the patient BMZ and waiting 24 hours to deliver
Adm the pt and monitoring fetal status until fetal lung maturity is achieved
A scheduled c/s delivery under spinal anesthesia
An emergency c/s delivery under general anesthesia - CORRECT ANSWER An emergency cesarean section delivery under general anesthesia
RATIONALE: Fetal blood vessels cross over the cervical os and may rupture when the amniotic sac ruptures.
A client in the latent phase of labor calls the nurse into the room stating her "water just broke." The nurse notes the fetal heart rate is 60 BPM. What is the nurse's initial action?
Perform a vaginal exam
Prepare for an emergency cesarean section
Turn the patient supine
Start a second IV site - CORRECT ANSWER Perform a vaginal exam
Which condition may be missed if an infant has the newborn screening test performed before he has tolerated protein feedings for at least 24-48 hours?
Hypothyroidism
Sickle cell anemia
Cystic fibrosis
Phenylketonuria - CORRECT ANSWER Phenylketonuria
RATIONALE: for phenylketonuria to be detected in the newborn screening blood test, certain amino acids found in breast milk or formula must first accumulate. Then the deficiency of the enzyme that should metabolize these proteins can be detected.
Which one of the following sexually transmitted infections (STIs) does NOT cross the placenta?
Neisseria gonorrhea
HIV
Syphilis
Chlamydia - CORRECT ANSWER Neisseria gonorrhea
In the low-risk patient who is in the active stage of labor and being monitored electronically, the fetal heart should be assessed every: - CORRECT ANSWER 30 minutes
A G2 P1 at 30 weeks gestation client is admitted to the antepartum unit with preterm labor. The client has also been diagnosed with gestational diabetes. Which of the following tocolytics should NOT be used with this patient?
Magnesium sulfate
Nifedipine (Procardia)
Terbutaline (Brethine)
Verapamil - CORRECT ANSWER Terbutaline (Brethine)
RATIONALE: Beta 2 receptor agonists have the potential to elevate blood sugars and should not be used as tocolytics in diabetic patients. These drugs include terbutaline and ritodrine.
At 32 weeks, a prenatal patient reported decreased fetal movement. A non-stress test is reported as non-reactive. Which of the following is appropriate for this patient?
Induction of labor
Biophysical profile (BPP)
Contraction stress test (CST)
Amniocentesis - CORRECT ANSWER Biophysical profile (BPP)
BPP measures fetal tone, movement, breathing rate, and amniotic fluid.
A low level of alpha fetoprotein may indicate which of the following conditions?
Down syndrome
Maternal fetal hemorrhage
Multiple gestation pregnancy
Neural tube defects - CORRECT ANSWER Down syndrome
RATIONALE: High levels may suggest a neural tube defect, esophageal defects, or the failure of the abdominal wall to close. Low levels of AFP may indicate Trisomy 21 (Down syndrome), Trisomy 18 (Edwards syndrome), or other chromosomal abnormalities
A client arrives to the Labor & Delivery unit in active labor. She is 40+2 weeks gestation. The nurse knows that a pregnancy is classified as post-term beginning at: - CORRECT ANSWER 42 weeks gestation
Postdates after 40 weeks
Postterm after 42 weeks
The primary goal of intervention in working with women who are in an abusive relationship is to:
- Set up an appt with a counselor for the client
- Convince client to set up a safety plan when she leaves the abusive partner
- Help her develop enough courage and financial support to leave the abusive partner
- Empower her and improve her self-esteem to regain control of her own life - CORRECT ANSWER Empower her and improve her self-esteem to regain control of her own life
RATIONALE: While feeling victimized, she is less likely to make these changes.
When differentiating false labor from true labor, which finding would suggest that a woman who has been ambulating 1-2 hours is in true labor? - CORRECT ANSWER Progressive cervical change
During pregnancy, which of the following foods should the woman avoid? - CORRECT ANSWER Raw meat and uncooked shellfish
RATIONALE:
toxoplasmosis, a parasitic infection which can be transmitted to the fetus and which may lead to miscarriage. Raw shellfish may have high levels of mercury which can affect fetal CNS development.
Listeria is another contaminant that may be found in raw or undercooked foods and can lead to miscarriage, fetal demise, or severe illness in the newborn.
A fetal scalp blood sample reveals a pH 7.21. Based on the finding, the nurse is prepared to:
Assist repeat testing in 30 minutes
Recognize the pH is normal
Transfer the patient to OR for cesarean delivery
Prepare the patient for imminent vaginal delivery - CORRECT ANSWER Recognize the pH is normal
RATIONALE:
Normal fetal pH is 7.25 to 7.35
Borderline pH is 7.20 to 7.25.
Abnormal if it is less than 7.20.
A nurse is counselling a patient with twin gestation. The nurse knows that pregnancies with multiple gestations are at risk for all of the following EXCEPT:
Oligohydramnios
Gestational hypertension
Anemia
Diabetes - CORRECT ANSWER Diabetes
Potential complications of multiple pregnancies include:
PTL
GHTN
anemia
birth defects
miscarriage
twin-to-twin transfusion syndrome
hydramnios and oligohydramnios
C/S
PPH
During labor, a woman in pain complains of dizziness, light-headedness, and numbness and tingling in her lips. The MOST LIKELY cause of these symptoms is: - CORRECT ANSWER Hyperventilation
A 38-week-gestation client presents for a nonstress test (NST) for gestational diabetes. Failure to elicit a reactive pattern with a NST after 40 minutes of fetal monitoring warrants: - CORRECT ANSWER Further evaluation
Requires additional testing, e.g. a biophysical profile (BPP), to determine if the result is truly related to hypoxia or if there is another issue, e.g. fetal sleep pattern or maternal drugs.
A pregnant client states she was diagnosed with GBS during her first pregnancy. She asks the nurse if she will be tested for GBS again during this pregnancy. The nurse knows that Group B streptococcus should be tested in the pregnant woman between:
22-24 weeks
26-28 weeks
35-37 weeks
38-40 weeks - CORRECT ANSWER 35-37 weeks
After the last dose of misoprostol (Cytotec), oxytocin administration should be delayed for at least:
30-60 minutes
2 hours
4 hours
6-12 hours - CORRECT ANSWER 4 hours
A patient with a placenta previa is scheduled for a cesarean birth. The nurse can anticipate what type of incision?
Classic vertical incision
Low segment transverse
Low segment vertical
Classical fundal incision - CORRECT ANSWER Low segment vertical
Following delivery, the mother is found to be in the taking-in phase. Which of the following behaviors would the nurse expect to see in a mother in the taking-in phase of maternal role adaptation:
Gaining self-confidence
Adjusting to her new relationships
Being passive and dependent
Resuming control over her life - CORRECT ANSWER Being passive and dependent
RATIONALE: Reba Rubin (1984) described the taking-in maternal role adaptation phase. She described the mother as being passive and dependent on others the first 24 hours after delivery.
The nurse knows that before the practitioner can use forceps:
- The patient should be fully dilated, membranes ruptured, fetus vertex, and no possibility of cephalopelvic disproportion (CPD)
- The patient's bladder must be full and an episiotomy is not needed
- A consent has been signed and the patient has refused assisted birth
- A vacuum extractor should have been used first - CORRECT ANSWER The patient should be fully dilated, membranes ruptured, fetus vertex, and no possibility of cephalopelvic disproportion (CPD)
A laboring woman requests epidural anesthesia and wants to know how long it will take for the medication to relieve her pain. The nurse knows that the amount of time allotted to verify that the anesthetic is causing a motor/sensory block is: - CORRECT ANSWER 20 minutes
The nurse is assessing a newborn and notes that he is alert, the heart and respiratory rates are stable, and the infant has passed meconium. The nurse knows that these behaviors indicate:
The initial period of reactivity
The second period of reactivity
The decreased responsiveness period
The period of sleep - CORRECT ANSWER The second period of reactivity
RATIONALE: The second period of reactivity is characterized by infant alertness, stabilized heart and respiratory rates, and the passage of meconium.
This procedure may be performed to control pain in labor and delivery. Complications include marked hypotension, impaired placental perfusion, and impaired breathing patterns. It is considered appropriate for vaginal birth, but not for labor. The medication is injected into the subarachnoid space.
General anesthesia
Epidural anesthesia
Spinal anesthesia
Pudendal block - CORRECT ANSWER Spinal anesthesia
A positive contraction stress test (CST) is characterized by: - CORRECT ANSWER Late decelerations >50% of contractions
The administration of butorphanol (Stadol) may cause a fetal heart rate change known as: - CORRECT ANSWER Sinusoidal
A potential fetal complication that occurs with cordocentesis (percutaneous umbilical blood sampling) 3% of the time is:
Cardiac dysrhythmias
Miscarriage
Fetal bradycardia
Fetal tachycardia - CORRECT ANSWER Miscarriage
A woman in active labor and dilated to 6 cm is now experiencing decreased intensity and frequency of contractions. After 2 hours, the vaginal exam reveals that the cervix is still 6 cm dilated. The nurse interprets this as a sign of:
Hypertonic labor
Prolonged labor
Hypotonic labor
Dysfunctional labor - CORRECT ANSWER Hypotonic labor
RATIONALE: Hypotonic labor is most commonly noted in the active phase of Stage 1 labor. It is defined by ineffective contractions which are unable to dilate the cervix and thus lead to secondary inertia.
A G3 P2 with gestational diabetes, poorly controlled, is fully dilated and has been pushing for a little over an hour. The doctor has been called to the room for imminent delivery. The nurse suspects that shoulder dystocia may be involved during the delivery. The nurse would be prepared to do all of the following EXCEPT:
Fundal pressure
Suprapubic pressure
Emptying of bladder
Neonatal resuscitation - CORRECT ANSWER Fundal pressure
Which one of the following cardiac conditions listed below has the highest rate of maternal mortality?
Atrial septal defect
Mitral stenosis, corrected
Pulmonary hypertension
Ventricular septal defect - CORRECT ANSWER Pulmonary hypertension
RATIONALE: Cardiovascular conditions that present a high risk for pregnant women to develop complications include: Eisenmenger's syndrome, severe pulmonary hypertension, complex cyanotic heart disease, Marfan syndrome, uncorrected severe aortic stenosis or mitral stenosis, and a history of prior peripartum cardiomyopathy.
A client gave birth vaginally two days ago. She is now experiencing breast engorgement. What physiologic change leads to breast engorgement?
An inc in blood and lymph supply to the breasts
A dec in estrogen and an increase in progesterone levels
Colostrum production inc suddenly
Fluid retention in breast tissue from IV fluids - CORRECT ANSWER An increase in blood and lymph supply to the breasts
A woman at term is in labor and exhibits significant variable decelerations on an electronic fetal monitor. An amnioinfusion is ordered with the goal of: - CORRECT ANSWER Relieving umbilical cord compression
A laboring woman is found supine with a blood pressure of 88/40. The nurse's initial response is to turn the patient to her left side. The nurse does this because she knows maternal supine hypotension is caused mainly by compression of the:
Inferior vena cava
Superior vena cava
Spinal arteries
Aorta and vena cava - CORRECT ANSWER Aorta and vena cava
RATIONALE: A pregnant woman in her 3rd trimester of pregnancy is at risk for supine hypotension syndrome whenever she is in a supine or sitting position for prolonged periods of time. The uterus compresses the major blood vessels near the spine, including the aorta and superior/inferior vena cavae, reducing in decreased blood flow both to and from the heart. Some sources term this phenomenon the "aortocaval" compression.
The nurse has taught a group of women in a breastfeeding class about nutritional needs while lactating. Which action by the women would indicate adequate understanding of nutritional needs while breastfeeding? - CORRECT ANSWER They increase their intake of protein and calories
RATIONALE: Lactating mothers need approximately 500 additional calories for metabolic maintenance and an additional 20 g of protein to help build and regenerate body cells.
A client has just delivered vaginally. During the 4th stage of labor, she suddenly develops shortness of breath, an extreme drop in blood pressure and increased anxiety. The nurse would suspect which rare, but potentially lethal, condition?
Vaginal hematoma
Placenta previa
Amniotic fluid embolus/Anaphylactoid Syndrome of Pregnancy
Postpartum hemorrhage - CORRECT ANSWER Amniotic fluid embolus/Anaphylactoid Syndrome of Pregnancy
RATIONALE: Amniotic fluid emboli are rare but serious. They have a sudden and rapid onset.
Symptoms in the mother:
SOB
pulmonary edema
HypoTN
cardiovascular collapse
DIC
altered mental status - anxiety, nausea and vomiting, chills, tachycardia
dysrhythmias
seizures
coma.
An umbilical cord blood gas (artery) on a term neonate reveals the following: pH 7.29 pCO2: 47 mmHg HCO3: 23 mEq/L This blood gas indicates:
- The neonate is in a balanced acid-base state
- These values represent metabolic acidosis
- These values indicate respiratory acidosis
- These values indicate respiratory alkalosis - CORRECT ANSWER The neonate is in a balanced acid-base state
What is normal blood gas for term newborn? - CORRECT ANSWER pH 7.27 - 7.28
pCO2 49.2 - 50.3
HCO3 22-23.1
base excess 2.7 - 3.6
The MOST accurate dating of a pregnancy by ultrasound is: - CORRECT ANSWER Crown-rump length during 1st trimester
A pregnant woman is diagnosed with toxoplasmosis. Which of the following is NOT a risk factor for contracting toxoplasmosis? - CORRECT ANSWER Eating well-cooked meats
The nurse would be MOST alert for the development of transient tachypnea in a newborn who:
Was born by cesarean section
Received no sedation
Has a mother with a cardiac condition
Is small for gestational age (SGA) - CORRECT ANSWER Was born by cesarean section
Which factor would most likely be responsible for a pregnant woman's failure to receive adequate prenatal care in the U.S.? - CORRECT ANSWER Lack of health insurance to cover obstetrical care
One theory of labor initiation is an increase in:
Follicular stimulating hormone (FSH)
Progesterone
Prostacyclin
Estrogen - CORRECT ANSWER Estrogen
RATIONALE: The progesterone deprivation theory suggests that in the latter days of pregnancy, there is a marked elevation in estrogen defeating progesterone's ability to maintain the pregnancy.
The nurse is teaching a client about risk factors that may lead to placenta abruptio. Which of the following is NOT a risk factor for placenta abruptio?
Blood clotting disorders
Cigarette smoking
Cocaine use
Hypotension - CORRECT ANSWER Hypotension
An antihypertensive category that is contraindicated during the second and third trimester of pregnancy is:
Ace inhibitors
Beta blockers
Calcium channel blockers
Thiazides - CORRECT ANSWER Ace inhibitors
RATIONALE: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin blocking agents (ARBs) are associated with reduced blood flow to the fetal kidneys, renal agenesis/dysgenesis, oligohydramnios, calvarial and pulmonary hypoplasia, intrauterine growth restriction, neonatal renal failure and fetal death.
A Type I (pregestational) diabetic woman at 32 weeks gestation is admitted with complaints of abdominal pain, nausea and vomiting over the last 48 hours. She states she omitted her insulin last evening and this morning since she could not eat. Her vital signs are 138/86 T-99 P-120 R 32. A serum blood sugar is 187. Her arterial blood gas pH is 7.32. The appropriate treatment is:
Aggressive IV hydration with 0.9% NS and IV insulin
Fluid restriction and IV glucose
Hyperalimentation and subcutaneous insulin
Maintain NPO and hydrate with IV lactated ringers (LR) - CORRECT ANSWER Aggressive IV hydration with 0.9% normal saline (NS) and IV insulin
RATIONALE: Lab results indicate patient is in diabetic ketoacidosis. This is treated with 0.9% NS hydration and IV insulin. Lactate-containing solutions should be avoided as they can worsen the acidotic state.
During the second stage of labor, the cardinal movement of restitution describes: - CORRECT ANSWER Rotation of the fetal head 45 degrees after head delivery
RATIONALE: Restitution is the movement of the baby's head from face-down to facing sideways in order for the shoulders to fit under the maternal pubic arch.
The client has just delivered vaginally and is now in the third stage of labor. Which of the following observations by the nurse would suggest that placental separation is occurring:
The uterus stops contracting
The umbilical cord stops pulsating
The uterine shape becomes globular
The maternal blood pressure drops - CORRECT ANSWER The uterine shape becomes globular [Show Less]