OB exam 3|26 Questions with Verified Answers
Spontaneous Abortion (Early Pregnancy Lost) - CORRECT ANSWER Vaginal bleeding from conception to 20 weeks
... [Show More] gestation (fetal viability)
A nurse is prepared to assess a postpartum woman's fundus. To facilitate the accuracy of the examination, the nurse should tell the woman to:
A. Elevate the head of her bed
B. Place her hands under her head
C. Flex her knees
D. Lie flat with legs extended and toes pointed - CORRECT ANSWER C.
follow principles for effective and accurate assessment of the abdomen; the woman should be assisted into supine position with head and shoulders on a pillow, arms at sides, and knees flexed; this facilitates relaxation of abdominal muscles and allows deep palpation
A primigravida at 10 weeks of gestation reports mild uterine cramping and slight vaginal spotting without passage of tissue. When she is examined, no cervical dilation is noted. The nurse caring for this woman should:
A. Anticipate that the woman will be sent home with instructions to limit her activity and to avoid stress or orgasm
B.Prepare the woman for a dilation and curettage
C. Notify a grief counselor to assist the woman with the imminent loss of her fetus
D. Tell the woman that the doctor will most likely perform a clercage to help maintain her pregnancy. - CORRECT ANSWER A.
The woman is experiencing a threatened miscarriage; therefore expectant management is attempted first, although there are no research-proven therapies.
B and C reflect management of an inevitable and complete or incomplete abortion; cerclage or suturing of the cervix is done for recurrent spontaneous miscarriage associated with premature dilation of the cervix (reduced cervical competence)
A woman is admitted through the emergency department with a medical diagnosis of ruptured ectopic pregnancy. The primary nursing diagnosis at this time is:
A. Acute pain related to irritation of the peritonuem with blood
B. Risk for infection related to tissue trauma
C. Deficient fluid volume related to blood loss associated with rupture of the uterine tube
D. Anticipatory grieving related to unexpected pregnancy outcome - CORRECT ANSWER C.
A, B, D are appropriate nursing diagnoses but deficient fluid volume is the most immediate concern since it places the woman's well-being at greatest risk
A woman diagnosed with an ectopic pregnancy is to receive methotrexate. The nurse should explain to the woman that: (SATA)
A. Methotrexate is an analgesic that will relieve the dull abdominal pain she is experiencing
B. She should double-flus the toilet with the lid down for 72 hours after receiving methotrexate.
C. She will receive the medication IM.
D. She must stop taking folic acid supplements as long she is on methotrexate
E. Her partner should use a condom during intercourse
F. She must return weekly for measurement of her progesterone level to determine if the methotrexate therapy has been effective - CORRECT ANSWER B, C, D
methotrexate destroys rapidly dividing cells, in this case the fetus and placenta, to avoid rupture of tube and need for surgery; folic acid increases the risk for side effects with this medication; the woman should not put anything into her vagina; she needs to return to check hCG level.
A pregnant woman at 32 weeks of gestation comes to the ED because she has begun to experience bright red vaginal bleeding. She reports that she has no pain. The admission nurse suspects that the woman is experiencing:
A. Abruptio placentae
B. Disseminated intravascular coagulation
C. Placenta previa
D. Preterm labor - CORRECT ANSWER C.
the clinical manifestations of placenta previa are described; bleeding and clots with abdominal pain and uterine tenderness are characteristics of abruptio placenta; massive bleeding for many sites is associated with DIC; bleeding is not an expected sign of preterm labor.
A pregnant woman at 38 weeks gestation and diagnosed with marginal placenta previa has just given birth to a healthy newborn male. The nurse recognizes that the immediate focus for the care of this woman is:
A. Prevent hemorrhage
B. Relieving pain
C. Preventing infection
D. Fostering attachment of the woman with her new son - CORRECT ANSWER A.
hemorrhage is a major potential postpartum complication because the implantation site of the placenta is in the lower uterine segment, which has a limited capacity to contract after birth; infection is another major complication but is not the immediate focus of care
B and D are also important but not to the same degree as hemorrhage which is life threatening
A nurse is preparing to administer RhoGAM to a postpartum woman. Before implementing this care measure the nurse should:
A. Ensure that medication is given within 12 hours after birth
B. Verify that the indirect and direct Coombs test results are negative
C. Make sure that the newborn is Rh negative
D. Cancel the administration of the RhoGAM if it was given to the woman during her pregnancy - CORRECT ANSWER B.
direct and indirect Coombs test must be negative, indicating that antibodies have not been formed, before RhoGAM can be given; it must be given within 72 hours of birth; the newborn need to be Rh +, it is often given in the third trimester and then again after birth
When teaching a postpartum woman with an episiotomy about using a sitz bath, the nurse should emphasize:
A. Using sterile equipment
B. Filling the sitz bath basin with hot water
C. Taking a sitz bath once a day for 10 minutes
D. Squeeze her buttocks together before sitting down, then relaxing them - CORRECT ANSWER D.
see box 21-1; squeezing the buttocks together before sitting down will reduce pulling on any perineal repairs; this is a medical aseptic procedure; therefore clean, not sterile, equipment is used; the water should be warm at 38 to 40, sitz bath is used at least twice a day for 20 minutes each time.
Before discharge at 2 days postpartum, the nurse evaluates a woman's level of knowledge regarding the care of her second-degree perineal laceration. Which statements made by the woman indicate the need for further instruction before she goes home? (SATA)
A. "I will wash my stitches at least once a day with mild soap and warm water"
B. "I will change my pad every time I go to the bathroom-at least four time each day"
C. "I will position my squeeze bottle upward so that the warm water can remove lochia from my vagina"
D. "I will use my squeeze bottle filled with warm water to cleanse my stitches after I urinate"
E. "I will wear a pair of clean, disposable gloves when I wash my stitches and change my pad just like the nurses did"
F. "I will apply the anesthetic cream to my stitches at least six times per day" - CORRECT ANSWER C, E, and F
squeeze bottle is always pointed backward and not upward into the vagina, which could carry debris through the cervix and into the uterus; topical medications should be used sparingly only three to four times per day; gloves are not needed but she should wash her hands before and after perineal care.
When assessing postpartum women during the first 24 hours after birth, the nurse must be alert for signs that could indicate the development of postpartum physiologic complications. Which signs are of concern to the nurse? (SATA)
A. Temp-38
B. Fundus-midline, boggy
C. Lochia-three quarters of pad saturated in 3 hours
D. Voids approximately 20 to 30 mL of urine in each of the first three voidings after birth - CORRECT ANSWER B and D
temp of 38 during the first 24 hours may be related to deficient fluid and is therefore not a concern; fundus should be midline but firm, not boggy; saturation of the pad in 15 minutes or less would be a concern; each voiding should be at least 100 to 150 mL
Postpartum Blues - CORRECT ANSWER Common 50-85%
-Functioning is not impaired
-Duration peak-day 5, resolves within 10 days
-Treatment=none
Symptoms
-sadness/tearfulness
-restlessness/insomnia
-fatigue
-anxiety
-mood swings
-depressed affect
Postpartum depression - CORRECT ANSWER 10-15%
-can lead to functional impairment
-duration: 2 weeks to 12 months
-treatment: antidepressants and psychotherapy
Symptoms:
-intense fear, anxiety, anger
-irritability
-feelings of guilt
-jealousy/rejection of infant
-no interest in the baby
-thought of harming self or baby
Postpartum Psychosis - CORRECT ANSWER 0.1 to 0.2% not very common
-a psychiatric emergency
-duration: variable, typical onset within 2 weeks
-treatment: antipsychotics, mood stabilizers, inpatient psychiatric care
Symptoms:
-auditory and/or visual hallucination (25%)
-delusions
-delirium/confusion
-bizarre behavior
-deficits in judgement
-impulsiveness
A nurse has assessed a woman who gave birth vaginally 12 hours ago. Which findings would require further assessment?
A. Bright to dark red uterine discharge
B. Midline episiotomy-approximated, moderate edema, slight erythema, absence of ecchymosis
C. Protrusion of abdomen with slight separation of abdominal wall muscles
D. Fundus firm at 2 cm above the umbilicus and to the right midline. - CORRECT ANSWER Choice D.
Fundus should be at or 1 cm above the umbilicus and at midline; deviation from midline (in this case to the right) could indicate a full bladder; bright to dark red uterine discharge refers to lochia rubra; edema and erythema are common shortly after repair of a wound ; decreased abdominal muscle tone and enlarged uterus result in abdominal protrusion; separation of the abdominal muscle walls, diastasis recti abdominis, is common during pregnancy and the postpartum period.
A woman, 24 hours after giving birth, complains to the nurse that her sleep was interrupted the night before because of sweating and the need to have her gown and bed linens changed. The nurse's first action is to:
A. Assess this woman for signs of infection
B. Explain to the woman that the sweating represents her body's attempt to eliminate the fluid that was accumulated during pregnancy.
C. Notify her physician of the finding
D. Document the finding as postpartum diaphoresis - CORRECT ANSWER Choice B.
The woman is describing the normal finding of postpartum diaphoresis, which is the body's attempt to excrete fluid retained during pregnancy;
Which woman at 24 hours following birth is least likely to experience afterpains?
A. Primipara who is breastfeeding her twins, who were born at 38 weeks of gestation
B. Multipara who is breastfeeding her 10-pound full-term baby girl
C. Multipara who is bottle-feeding her 8-pound baby boy
D. Primipara who is bottle-feeding her 7-pound baby girl - CORRECT ANSWER Choice D.
Afterpains are most likely to occur in the following circumstance: multiparity, overdistention of the uterus (marcosomia, multifetal pregnancy), breastfeeding (enfogenous oxytocin secretion), and administration of an oxytocic
Habitual or recurrent abortion - CORRECT ANSWER Three or more consecutive losses before 20 weeks of gestation. Cervix is open
Management and Treatment
Identification and treatment of underlying cause if possible. Prophylactic cerclage if r/t cervical insufficiency
Assessment:
Less than 20 weeks gestation fetus is nonviable
Greater than 20 weeks or 500 g, funeral arrangements are needed - CORRECT ANSWER Nursing Interventions:
ID type of abortion and management
Monitor UC if necessary
Monitor VS, LOC until stable
Abortion symptoms include - CORRECT ANSWER uterine cramping, backache, and pelvic pressure.
If bleeding is noted count of perineal pads/hr
Be aware of S/S of shock
-HR elevated; weak thready pulse
-Skin; pallor. cool, clammy
-Hypotension
Nursing Interventions:
-Start IV with large bore (over 18)
-Administer RhoGAM to Rh neg clients with Rh+ baby
Teach client to notify if:
-Temp >100.4
-foul odor to vaginal discharge
-Bright red bleeding
-bleeding with any tissue fragments
Threatened Abortion - CORRECT ANSWER -Vaginal spotting early in gestation
-No passage of embryonic or fetal tissue
-Abdominal cramping
-Cervix is closed
Management and Treatment
-Possible mild activity restriction with bedrest 24-48 hours, sedation. Instead to avoid stimulation of sexual intercourse and orgasm for 2 weeks
Inevitable Abortion - CORRECT ANSWER Pregnancy loss that cannot be prevented. Bleeding may be moderate/heavy. Cervix is dilated with tissue in cervix
Management and treatment:
-If products of conception are not passed spontaneously, vacuum curettage or administration of prostaglandin analog to evacuate the uterus. A D&C may be performed
Incomplete Abortion - CORRECT ANSWER -Passage of some of the product of conception
-Ultrasound reveals retained material in the uterus
-Cervix is open
Management and Treatment
-Cervix is open but may require additional dilation before curettage
Complete Abortion - CORRECT ANSWER All fetal tissue and products of conception passed in bleeding. Ultrasound reveals an empty uterus
Management and Treatment
No further intervention may be needed if uterine contractions adequate to prevent hemorrhage and there is no infection. No need for treatment but follow up care to discuss related issues.
Septic Abortion - CORRECT ANSWER -Fever
-abdominal pain and tenderness
-Bleeding from scant to heavy, usually malodorous
-Cervix is usually dilated
Management and Treatment
-Care includes termination of pregnancy; culture and sensitivity studies to initiate appropriate antibiotic therapy
Missed Abortion - CORRECT ANSWER Retained nonviable embryo or fetus for 6 weeks or more. Fetus has died and placenta atrophied but products of conception retained. Cervix is closed.
Management and treatment
-If spontaneous evacuation of the uterus does not occur within one month, uterus is evacuated by method appropriate to duration of the pregnancy. Blood clotting factors are monitored. DIC with uncontrolled hemorrhage may develop in cases of fetal death after week 12 [Show Less]