OB HESI 2 TEST BANK
Which nursing intervention is most helpful in relieving postpartum uterine contractions or
"afterpains?"
a. Lying prone with a pillow on the abdomen
b. Using a breast pump
c. Massaging the abdomen
d. Giving oxytocic medications
a. Lying prone with a pillow on the abdomen
Lying prone (A) keeps the fundus contracted and is especially useful with multiparas,
who commonly experience afterpains due to lack of uterine tone.
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. Ccmplete a sterile vaginal exam
b. Take maternal temperature every 2 hours
c. Prepare for an immediate cesarean birth
d. Obtain sterile suction equipment
a. Complete a sterile vaginal exam
A vaginal exam (A) should be performed after the rupture of membranes to determine
the presence of a prolapsed cord.
When explaining "postpartum blues" to a client who is 1 day postpartum, which
symptoms should the nurse include in the teaching plan? (Select all that apply.)
a. Mood swings
b. Panic attacks
c. Tearfulness
d. Decreased need for sleep
e. Disinterest in the infant
a. Mood swings
c. Tearfulness
"Postpartum blues" is a common emotional response related to the rapid decrease in
placental hormones after delivery and include mood swings (A), tearfulness (C), feeling
low, emotional, and fatigued.
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 complete blood count (CBC) drawn
c. Obtain a specimen for urine analysis
d. Place the client on strict bedrest
, c. Obtain a specimen for urine analysis
Obtaining a urine analysis (C) should be done first because preterm clients with uterine
irritability and contractions are often suffering from a urinary tract infection, and this
should be ruled out first.
A client in active labor complains of cramps in her leg. What intervention should the
nurse implement?
a. Ask the 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 the leg above the heart
b. Extend the leg and dorsiflex the foot
Dorsiflexing the foot by puching the sole of the foot forward or by stnading (if the client
is capable) (B), and putting the heel of the foot on the floor is the best means of
relieving leg cramps.
The nurse is caring for a woman with a previously diagnosed heart disease who is in the
second stage of labor. Which assessment findings are of greatest concern?
a. edema, basilar rales, and an irregular pulse
b. Increased urinary output, and tachycardia
c. Shortness of breath, bradycardia, and hypertension
d. Regular heart rate, and hypertension
a. Edema, basilar rales, and an irregular pulse
Edema, basilar rales, and an irregular pulse (A) indicate cardiac decompensation and
require immediate intervention.
The nurse is teaching a woman how to use her basal body temperature (BBT) pattern
as a tool to assist her in conceiving a child. Which temperature pattern indicates the
occurrence of ovulation, and therefor, the best time for intercourse to ensure
conception?
a. Between the time the temperature falls and rises
b. Between 36 and 48 hours after the temperature rises
c. When the temperature falls and remains low for 36 hours
d. Within 72 hours before the temperature falls
a. Between the time the temperature falls and rises
In most women, the BBT drops slightly 24 to 36 hours before ovulation and rises 24 to
72 hours after ovulation, when the corpus luteum of the ruptured ovary produces
progesterone. Therefore, intercourse between the time of the temperature fall and rise
(A) is the best time for conception.
A client who is in the second trimester of pregnancy tells the nurse that she wants to
use herbal therapy. Which response is best for the nurse to provide?
a. Herbs are a corner stone of good health to include in your treatment
b. Touch is also therapeutic in relieving discomfort and anxiety
c. Your healthcare provider should direct treatment options for herbal therapy
d. It is important that you want to take part in your care
Which nursing intervention is most helpful in relieving postpartum uterine contractions or
"afterpains?"
a. Lying prone with a pillow on the abdomen
b. Using a breast pump
c. Massaging the abdomen
d. Giving oxytocic medications
a. Lying prone with a pillow on the abdomen
Lying prone (A) keeps the fundus contracted and is especially useful with multiparas,
who commonly experience afterpains due to lack of uterine tone.
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. Ccmplete a sterile vaginal exam
b. Take maternal temperature every 2 hours
c. Prepare for an immediate cesarean birth
d. Obtain sterile suction equipment
a. Complete a sterile vaginal exam
A vaginal exam (A) should be performed after the rupture of membranes to determine
the presence of a prolapsed cord.
When explaining "postpartum blues" to a client who is 1 day postpartum, which
symptoms should the nurse include in the teaching plan? (Select all that apply.)
a. Mood swings
b. Panic attacks
c. Tearfulness
d. Decreased need for sleep
e. Disinterest in the infant
a. Mood swings
c. Tearfulness
"Postpartum blues" is a common emotional response related to the rapid decrease in
placental hormones after delivery and include mood swings (A), tearfulness (C), feeling
low, emotional, and fatigued.
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 complete blood count (CBC) drawn
c. Obtain a specimen for urine analysis
d. Place the client on strict bedrest
, c. Obtain a specimen for urine analysis
Obtaining a urine analysis (C) should be done first because preterm clients with uterine
irritability and contractions are often suffering from a urinary tract infection, and this
should be ruled out first.
A client in active labor complains of cramps in her leg. What intervention should the
nurse implement?
a. Ask the 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 the leg above the heart
b. Extend the leg and dorsiflex the foot
Dorsiflexing the foot by puching the sole of the foot forward or by stnading (if the client
is capable) (B), and putting the heel of the foot on the floor is the best means of
relieving leg cramps.
The nurse is caring for a woman with a previously diagnosed heart disease who is in the
second stage of labor. Which assessment findings are of greatest concern?
a. edema, basilar rales, and an irregular pulse
b. Increased urinary output, and tachycardia
c. Shortness of breath, bradycardia, and hypertension
d. Regular heart rate, and hypertension
a. Edema, basilar rales, and an irregular pulse
Edema, basilar rales, and an irregular pulse (A) indicate cardiac decompensation and
require immediate intervention.
The nurse is teaching a woman how to use her basal body temperature (BBT) pattern
as a tool to assist her in conceiving a child. Which temperature pattern indicates the
occurrence of ovulation, and therefor, the best time for intercourse to ensure
conception?
a. Between the time the temperature falls and rises
b. Between 36 and 48 hours after the temperature rises
c. When the temperature falls and remains low for 36 hours
d. Within 72 hours before the temperature falls
a. Between the time the temperature falls and rises
In most women, the BBT drops slightly 24 to 36 hours before ovulation and rises 24 to
72 hours after ovulation, when the corpus luteum of the ruptured ovary produces
progesterone. Therefore, intercourse between the time of the temperature fall and rise
(A) is the best time for conception.
A client who is in the second trimester of pregnancy tells the nurse that she wants to
use herbal therapy. Which response is best for the nurse to provide?
a. Herbs are a corner stone of good health to include in your treatment
b. Touch is also therapeutic in relieving discomfort and anxiety
c. Your healthcare provider should direct treatment options for herbal therapy
d. It is important that you want to take part in your care
