OB HESI: ULTIMATE QUESTION PACK
3 day old baby. Feeds every 2 hours. Nurse notes white curd patches on oral mucus membranes. Action to implement?
... [Show More] ans: needs medicine
3 day postpartum patient. Husband calls states wife is crying, irritable. Inform the husband? ans: contact the clinic in 2 weeks if symptoms become worse
Baby blues are normal, he needs to bring her in if it gets severe or persists for two weeks
Review this bc the answer choices are tricky!!Not just be there with her.. WATCH her and symptoms
3 months pregnant, thin watery secretions ans: normal lochia
4 postpartum clients. Who is a priority for psychosocial distress? ans: Immigrant that just moved with her husband, first baby, new country**
24 hours after admission to the newborn nursery, a full-term male infant develops localized edema on the right side of his head. The nurse knows that an accumulation of blood between the periosteum and skull that does not cross suture lines is known as ans: Cephalohematoma
(Caused by forceps trauma, may last up to 8 weeks)
28 weeks gestation with twins. Fundal height 27 cm. fundal height measured 28 cm 3 weeks ago. What does the nurse conclude from this? ans: may indicate IUGR
30 minutes postpartum, continuing to bleed. Boggy uterus. Intervention? ans: Uterine massage
30 year old primigravida delivers 9 pound vaginally after 30 hour labor. Priority nursing action? ans: observe for signs of hemorrhage
32 weeks gestations with possible UTI. Action to implement? ans: Collect urine for culture**
35 weeks gestation. Breech baby. Contractions 3-5 minutes apart and mom states "I think my water just broke". Inspection reveals umbilical cord protruding. Intervention to implement? ans: Place patient in the knee-chest position
38 weeks gestation with a history of PIH. Pitocin started. 1 hour after Pitocin, patients gets a headache. Contractions are 1-2 minutes apart lasting 60-75 seconds. Intervention most important? ans: discontinue the Pitocin
38 weeks gestation, tachycardia, tremulous, hypertensive. Assessment action most important? ans: obtain a drug screen
40 weeks gestation and spontaneous rupture of membranes that is meconium stained. What additional finding should the nurse report? ans: - FHR 100-110
A 3-day postpartum client, who is not immune to rubella, is to receive the vaccine at discharge. Which of the following must the nurse include in her discharge teaching regarding the vaccine?
A) The woman should not become pregnant for at least 4 weeks.
B) The woman should pump and dump her breast milk for 1 week.
C) The mother must wear a surgical mask when she cares for the baby.
D) Passive antibodies transported across the placenta will protect the baby. ans: A) The woman should not become pregnant for at least 4 weeks.
A 3-day-postpartum client questions why she is to receive the rubella vaccine before leaving the hospital. Which of the following rationales should guide the nurse's response?
A) The client's obstetric status is optimal for receiving the vaccine.
B)The client's immune system is highly responsive during the postpartum period.
C) The client's baby will be high risk for acquiring rubella if the woman does not receive the vaccine.
D) The client's insurance company will pay for the shot if it is given during the immediate postpartum period. ans: A) The client's obstetric status is optimal for receiving the vaccine.
A 4-day postpartum client calls the clinic and reports that her nipples are so sore that she does not know if she can continue to breastfeed her infant. What instruction is best for the nurse to provide? ans: ---
A 16-year-old gravida 1, para 0 client has just been admitted to the hospital with a diagnosis of eclampsia. She is not presently convulsing. Which intervention should the nurse plan to include in this client's nursing care plan? ans: Monitor Blood pressure, pulse, and respirations q4h.
A 26-year old, G2 P1 client is admitted to the hospital at 28-weeks gestation in preterm labor. She is given 3 doses of terbutaline sulfate (Brethine) 0.25 mg SQ to stop her labor contractions. The nurse plans to monitor which primary side effect of terbutaline sulfate? ans: Tachycardia & feeling of nervousness
A 30-year-old gravida 2, para 1 client is admitted to the hospital at 26 weeks gestation in preterm labor. Given dose of terbutaline sulfate (Berthine) 0.25 mg SQ. Which assessment is the highest priority for the nurse to monitor during administration of this drug? ans: Monitoring fetal & maternal heart rates!!!
A 34-week primigravida with pregnancy induced hypertension (PIH) is receiving Ringer's Lactate 500 ml with magnesium sulfate 20 grams at the rate of 3 grams/hour. How many ml/hour should the nurse program the infusion pump? (Enter numeric value only) ans: 75
A 36-week primigravida is admitted to labor and delivery with severe abdominal pain and bright red vaginal bleeding. Her abdomen is rigid and tender to touch. The fetal heart rate (FHR) is 90 beats/minute, and the maternal heart rate is 120 beats/minute. What action should the nurse implement first? ans: obtain written consent for an emergency cesarean section.
A 36-year-old woman comes to the emergency department complaining of severe abdominal cramping and heavy bleeding. She informs the nurse that she is 10 weeks pregnant. Cervical examination reveals heavy bleeding; the cervical os is open and tissue is present. Which type of miscarriage is the client experiencing?
A) Missed
B) Complete
C) Inevitable
D) Threatened ans: C) Inevitable
Miscarriage is inevitable because the cervical os has opened, heavy bleeding is occurring, and tissue is present with the bleeding. In a missed miscarriage, the fetus has died but the products of conception are retained in utero for as long as several weeks. There may be no bleeding or cramping, and the os is closed. In a complete miscarriage all fetal tissue has already passed and the cervix is closed; there may be slight bleeding. Symptoms of a threatened miscarriage include spotting and a closed cervical os. There may be mild cramping.
A 38 week primigravida is admitted to L&D after a non-reactive result on a non-stress test (NST). The nurse begins contraction stress test (CST) with oxytocin (Pitocin) infusion, Which finding is most important to report to the HCP?
A) Spontaneous rupture of membranes
B) FHR accelerations with fetal movement
C) Absence of uterine contractions within 20 minutes
D) A pattern of late fetal decelerations ans: D) A pattern of late fetal decelerations
A 38-week primigravida who works as a secretary & sits at a computer for 8 hours each day tells the nurse that her feet have begun to swell. Which instruction would be most effective in preventing pooling of blood in lower extremities? ans: Move about every hour
A breastfeeding infant, screened for congenital hypothyroidism, is found to have low levels of thyroxine (T4) and high levels of thyroid stimulating hormone (TSH). What is the best explanation for this finding? ans: The TSH is high because of the low production of T4 by the thyroid.
A client arrives at the clinic in preterm labor, and terbutaline (Brethine) is prescribed. For what therapeutic effect should the nurse monitor the client?
A) increased blood pressure and pulse
B) Reduction of pain in the perineal area
C) Gradual cervical dilation as labor progresses
D) Decreased frequency and duration of contractions ans: D) Decreased frequency and duration of contractions
Terbutaline sulfate (Brethine) is a β-mimetic that acts on the smooth muscles of the uterus to reduce contractility, which in turn inhibits dilation and the frequency and duration of contractions. Although terbutaline may increase blood pressure and pulse, this is a side, not a therapeutic, effect requiring frequent assessments. Terbutaline is not an analgesic. It should stop cervical dilation rather than increase it.
A client at 28 weeks gestation admitted to unit following involvement in a motor vehicle collision. While stabilizing the patient, the nurse obtains fetal monitor reading. Which action should the nurse take if the fetus is tachycardic on the monitor? ans: Contact the healthcare provider after initiating oxygen per face mask
A client at 28-weeks gestation calls the antepartum clinic and states that she is experiencing a small amount of vaginal bleeding which she describes as bright red. She further states that she is not experiencing any contractions or abdominal pain. Which instruction should the nurse provide? ans: Come to the clinic today for an ultrasound
(Concerned about placenta previa)
A client at 30 weeks gestation is being treated in the emergency department for a broken finger. The nurse assesses the FHR while the client is in a sitting position and has a heart rate of 92 beats per minute. What intervention is most important for the nurse to perform?
a. encourage the client to empty her bladder
b. determine the maternal pulse rate
c. instruct the client to drink a glass a juice
d. place the client in a supine position ans: Encourage the client to empty her bladder
A client at 30-weeks gestation, complaining of pressure over the pubic area, is admitted for observation. She is contracting irregularly and demonstrates underlying uterine irritability. Vaginal examination reveals that her cervix is closed, thick, and high. Based on these data, which intervention should the nurse implement first?
A) Provide oral hydration
B) Have a CBC drawn
C) Obtain specimens for urinalysis
D) Place the client on strict bedrest ans: C) Obtain specimens for urinalysis
Obtained first because preterm clients with uterine irritability & contractions are often suffering from UTI and this should be ruled out first.
A client at 32-weeks gestation is hospitalized with severe pregnancy-induced hypertension (PIH), and magnesium sulfate is prescribed to control the symptoms. Which assessment finding indicates the therapeutic drug level has been achieved? ans: A decrease in respiratory rate from 24 to 16
(Respiratory rate BELOW 12 indiates toxicity)
A client at 33-weeks gestation is admitted with a moderate amount of vaginal bleeding & no contractions are noted on the external monitor. Which intervention?
A) Weigh pads
B) Weight daily
C) Measure I&O
D) Ambulate 15 mins QID ans: A) Weigh pads
A client at 34 weeks gestation comes to the birthing center complaining of vaginal bleeding that began one hour ago. The nurse's assessment reveals approximately 30 ml of bright red vaginal bleeding, FHR of 130 to 140 beats/min, no contraction, and no complaints of pain. What is the most likely case of this client's bleeding? ans: placenta previa
A client at 35 weeks gestation complains of a "pain whenever the baby moves". On assessment, nurse notes client's temperature to be 101.2 , with severe abdominal or uterine tenderness on palpation. The nurse knows these findings are indicative of what condition? ans: Chorioamnionitis**
A client in active labor complains of cramps in her leg. What intervention should the nurse implement?
A) Ask client if she takes a daily calcium tablet
B) Extend the leg and dorsiflex the foot
C) Lower the leg off the side of the bed
D) Elevate leg above the heart ans: B) Extend the leg and dorsiflex the foot
A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement made by the client indicates a need for further instruction?
A) "I will watch for the evidence of the passage of tissue."
B) "I will maintain strict bed rest throughout the remainder of the pregnancy."
C) "I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad."
D) "I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding." ans: B) "I will maintain strict bed rest throughout the remainder of the pregnancy."
A client in the first trimester of pregnancy calls the prenatal clinic to report she is nauseated and her stools are black and thick since she started taking iron supplements last week. How should the nurse respond? Select all that apply ans: Changes in color and consistency of stool are normal
A client in the last trimester of pregnancy is prescribed sulfonamide for a urinary tract infection. What risk will this medication be to the developing fetus? ans: Jaundice
A client is attending antepartum classes, asks nurse why her healthcare provider prescribed iron tablets,. The nurse's response is based on what knowledge? ans: It is difficult to consume 18 mg of additional iron by diet alone
A client is receiving oxytocin (Pitocin) to augment early labor. Which assessment is most important for the nurse to obtain each time the infusion rate is increased? ans: Contraction pattern
A client receiving epidural anesthesia begins to experience nausea and becomes pale and clammy. What intervention should the nurse implement first? ans: Raise the foot of the bed
A client whose labor is being augmented with an oxytocin (Pitocin) infusion requests an epidural for pain control. Findings of the last vaginal exam, performed 1 hour ago, were 3 cm cervical dilatation, 60% effacement, and a -2 station. What action should the nurse implement first? ans: Determine current cervical dilation.
A client with gestational diabetes is undergoing a non-stress test (NST) at 34-weeks gestation. The baseline fetal heart rate (FHR) is 144 beats/minute. The client is instructed to mark the fetal monitor paper by pressing a button attached to the fetal monitor each time the baby moves. After 20 minutes, the nurse evaluates the fetal monitor strip. Which outcome indicates a reactive NST? ans: Two FHR accelerations of 15 beats/minute x 15 seconds are recorded.
A client's membranes rupture during labor. The nurse immediately assesses the electronic fetal heart rate. Variable decelerations lasting more than 90 seconds, followed by bradycardia, are observed on the monitoring strip. What does the nurse suspect is the cause of this change?
A) Fetal acidosis
B) Prolapsed cord
C) Head compression
D) Uteroplacental insufficiency ans: B) Prolapsed cord
This variable pattern with bradycardia is an ominous sign; it is indicative of cord compression, which can result in fetal hypoxia. Immediate intervention is required. Fetal acidosis occurs with uteroplacental insufficiency, not in response to a prolapsed cord. Early decelerations are associated with head compression and are benign. Late decelerations and tachycardia are associated with uteroplacental insufficiency, not a prolapsed cord.
A couple, concerned because the woman has not been able to conceive, is referred to a healthcare provider for a fertility workup and a hysterosalpingography is scheduled. Which postprocedure complaint indicates that the fallopian tubes are patent? ans: Shoulder pain
(If fallopian tubes are OPEN, pain is referred to shoulder)
A full-term infant is admitted to the newborn nursery and, after careful assessment, the nurse suspects that the infant may have esophageal atresia. Which symptoms is the newborn likely exhibiting? ans: Choking, coughing, cyanosis (3 Cs)
A full-term, 24-hour-old infant in the nursery regurgitates and suddenly turns cyanotic. What should the nurse do first? ans: Stimulate the infant to cry.
A laboring client's membranes rupture spontaneously. The nurse notices that the amniotic fluid is greenish-brown. What intervention should the nurse implement first? ans: Contact the healthcare provider.
A loading dose of terbutaline (Bretine) 250 mcg IV is prescribed for a client in preterm labor. Brethine 20 mg is added to 1000 ml D5W. How many ml of the solution should the nurse administer? (Enter numeric value only) ans: 13
A multigravida client arrives at the labor and delivery unit and tells the nurse that her bag of water has broken. The nurse identifies the presence of meconium fluid on the perineum and determines the fetal heart rate is between 140 to 150 beats/minute. What action should the nurse implement next?
A) Complete a sterile vaginal exam
B) Take maternal temperature every 2 hours
C) Prepare for immediate C-Section
D) Obtain sterile suction equipment ans: A) Complete a sterile vaginal exam
Should be done to assess for presence of prolapsed cord
A neonate who has congenital adrenal hyperplasia (CAH) presents with ambiguous genitalia. What is the primary nursing consideration when supporting the parents of a child with this anomaly? ans: Offer information about ultrasonography and genotyping to determine sex assignment.
A new mother is afraid to touch her baby's head for fear of hurting the "large soft spot." Which explanation should the nurse give to this anxious client? ans: There's a strong, tough membrane there to protect the baby so you need not be afraid to wash or comb hair
A new mother is having trouble breastfeeding her newborn son. He is making frantic rooting motions and will not grasp the nipple. What intervention would be most helpful to this mother? ans: Ask the mother to stop feeding, comfort the infant, and then assist the mother to help the baby lactch on.
A newborn who was a breech presentation is admitted to the nursery. Which assessment procedure is a priority for the nurse to perform? ans: Babinski's reflex.
A newborn with a respiratory rate of 40 bpm at one minute after birth is demonstrating cyanosis of the hands and feet. What action should the nurse take? ans: Continue to monitor
A newborn with myelomeningocele is admitted to the neonatal intensive care unit. Which preoperative nursing intervention should the nurse implement first? ans: Place the infant on the abdomen to protect the sac.
A newborn's head circumference is 12 inches (30.5cm), and his chest measurement is 13 inches (33cm). The nurse notes that this infant has no molding, and was at breech presentation delivery by c section. What action should the nurse take based on these data? ans: Record the finding on the chart. They are within normal limits.
A nurse administers two serial intramuscular injections of betamethasone (Celestone) to a woman at 32 weeks gestation who has been admitted to preterm labor. The nurse knows that this medication is given in order to: ans: Stimulate surfactant production.
Corticosteroids stimulate surfactant production; they also have been shown to reduce the incidence of intraventricular hemorrhage. Betamethasone (Celestone) does not affect the labor process, increase placental perfusion, or affect the intensity of contractions.
A nurse is preparing to assess the uterine fundus of a client in the immediate postpartum period. After locating the fundus, the nurse notes that the uterus feels soft and boggy. Which nursing intervention would be most appropriate?
A) Elevate the client's legs.
B) Massage the fundus until it is firm.
C) Ask the client to turn on her left side.
D) Push on the uterus to assist in expressing clots. ans: B) Massage the fundus until it is firm.
A patient, G2P102, who delivered her baby 8 hours ago, now has a temperature of 100.2ºF.
Which of the following is the appropriate nursing intervention at this time?
A) Notify the doctor to get an order for acetaminophen.
B) Request an infectious disease consult from the doctor.
C) Provide the woman with cool compresses.
D) Encourage intake of water and other fluids. ans: D) Encourage intake of water and other fluids.
A postpartum who is breastfeeding arrives for her 6-week postpartum visit and reports that she is still having vaginal discharge. How should the nurse respond? ans: Please describe the discharge
A pregnant client with severe preeclampsia is receiving IV magnesium sulfate. What should the nurse keep at the bedside to prepare for the possibility of magnesium sulfate toxicity?
A) Oxygen
B) Naloxone
C) Calcium gluconate
D) Suction equipment ans: C) Calcium gluconate
The antagonist of magnesium sulfate is calcium gluconate. Oxygen is ineffective if the action of magnesium is not reversed. Naloxone is unnecessary; it is an opioid antagonist. Suction equipment may be necessary if the client has excessive secretions after a seizure. The priority intervention is trying to prevent a seizure.
A pregnant woman in the first trimester of pregnancy has a hemoglobin of 8.6 mg/dl and a hematocrit of 25.1%. What food should the nurse encourage this client to include in her diet? ans: Chicken.
A pregnant woman with mitral stenosis Class III is prescribed complete bedrest. The client asks the nurse "Why must I stay in bed all the time?" Which response is the best? ans: Complete bedrest decreases oxygen needs and demands on heart muscles
A primigravida arrives at the observation unit of the maternity unit because thinks is in labor. The nurse applies the external fetal heart monitor and determines that the fetal heart rate is 140 beats/minute and the contractions are occurring irregularly every 10 to 15 minutes. What assessment finding confirms to the nurse that the client is not labor at this time? ans: Contractions decrease with walking.
A primigravida in labor has complete cervical dilatation. Contractions are occurring every 1.5 to 2 minutes lasting 60 to 90 seconds. Upon examination, the nurse determines that birth is imminent because what has occurred?
A) An increase in bloody show
B) Perineum is bulging.
C) Perineum is flattened.
D) Crowning ans: ANS: D) CROWNING
A primipara at 38-weeks gestation is admitted to labor and delivery for a biophysical profile (BPP). The nurse should prepare the client for what procedures? ans: Ultrasonography and nonstress test. [Show Less]