OB Midterm - purple lizard questions with complete solutions

The nurse is assessing a client with a tentative diagnosis of hydatidiform mole. Which clinical finding should the nurse anticipate? Hypotension Decreased fetal heart rate Unusual uterine enlargement Painless, heavy vaginal bleeding Unusual uterine enlargement A laboring client reports low back pain. Which intervention should the nurse recommend to the client's coach to promote the most comfort for this client? Instruct her to flex her knees. Place her in the supine position. Apply pressure to her back during contractions. Perform neuromuscular control exercises with her. Apply pressure to her back during contractions 00:22 01:16 A pregnant woman is admitted in active labor. What should the nurse instruct her coach to do when the client complains of back pain? Position her with her legs elevated. Apply pressure to the sacrum during contractions. Encourage performance of a panting-breathing pattern. Encourage her to do Kegel exercises between contractions. Apply pressure to the sacrum during contractions. A client at 12 weeks' gestation arrives in the prenatal clinic complaining of cramping and vaginal spotting. A pelvic examination reveals that the cervix is closed. Which probable diagnosis should the nurse expect? Missed abortion Inevitable abortion Incomplete abortion Threatened abortion Threatened abortion 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 as is open and tissue is present. Which type of abortion is the client experiencing? Missed Complete Inevitable Threatened Inevitable The nurse is caring for a client in preterm labor who reports that she fell down the stairs. Bruises are apparent on the left part of the client's lower abdomen, the back of each shoulder, and on both wrists. After instituting electronic fetal monitoring, starting tocolytic therapy, and examining the monitor strips, what action should the nurse take next? Ambulating the client to promote circulation Inserting two small-bore intravenous catheters Determining whether the client feels safe at home Ensuring that the client has her glasses to ambulate Determining whether the client feels safe at home While a multiparous client is in active labor, her membranes rupture spontaneously. The nurse notes a loop of umbilical cord protruding from her vagina. What is the priority nursing action at this time? Monitoring the fetal heart rate Covering the cord with a saline dressing Pushing the cord back into the vaginal vault Holding the presenting part away from the cord Holding the presenting part away from the cord The nurse is reviewing the obstetric history of a client who has had an abruptio placentae. Which prenatal condition does the nurse expect to find in this client's history? Cardiac disease Hyperthyroidism Gestational hypertension Cephalopelvic disproportion Gestational hypertension Physical assessment of a client in active labor reveals that the cervix is dilated 3 to 4 cm and 50% effaced, the fetus is in the right sacrum anterior (RSA) position, and contractions are 5 minutes apart. Where should the nurse place the stethoscope to best locate the fetal heart tones? picture of abdomen a The nurse is caring for a pregnant client with type 1 diabetes. Which complication is the result of type 1 diabetes? Increased risk of hypertensive states Abnormal placental implantation Excessive weight gain because of increased appetite Decreased amount of amniotic fluid as the pregnancy progresses Increased risk of hypertensive states While monitoring the fetal heart rate (FHR) of a client in labor, the nurse identifies an increase of 15 beats more than the baseline rate of 135 beats per minute that lasts 15 seconds. How should the nurse document this event? An acceleration An early increase A sonographic motion A tachycardic heart rate An acceleration A primigravida is admitted to the emergency department with a sharp, shooting pain in the lower abdomen and vaginal spotting. A ruptured tubal pregnancy is diagnosed. During what week of gestation does this condition most commonly occur? Sixth Twelfth Sixteenth Eighteenth Sixth A client at 42 weeks' gestation is scheduled for induction of labor. The nurse begins the induction with a piggyback infusion of 15 units of oxytocin. Which clinical finding requires the nurse to discontinue the oxytocin infusion? Contractions that occur every 3 minutes and lasting 60 seconds Elevation of blood pressure from 110/70 to 135/85 mm Hg during the last 30 minutes Rupture of membranes with amniotic fluid that contains threads of blood and mucus Several late fetal heart rate decelerations that return to baseline after the contraction is over Several late fetal heart rate decelerations that return to baseline after the contraction is over A client on her first prenatal clinic visit is at 6 weeks' gestation. She asks how long she may continue to work and when she should plan to quit. How should the nurse respond? "What activities does your job entail?" "How do you feel about continuing to work?" "Most women work throughout their pregnancies." "Usually women quit work at the start of their third trimester." "What activities does your job entail?" What is the optimal method for the nurse to use to assess blood loss in a client with placenta previa? Count or weigh perineal pads Monitor pulse and blood pressure Check hemoglobin and hematocrit values Measure or estimate the height of the fundus Count or weigh perineal pads The nurse admits a client in active labor to the birthing center. She is 100% effaced, dilated 3 cm, and at +1 station. What stage of labor has this client reached? First Latent Second Transitional First A pregnant client arrives on the birthing unit from the emergency department with frank blood running down both legs and a reported low blood pressure. What is the priority nursing intervention? Assessing fetal heart tones Assessing for a prolapsed cord Starting an intravenous (IV) infusion Inserting a uterine pressure catheter Assessing fetal heart tones A woman is admitted to the high-risk unit in preterm labor at 30 weeks' gestation. Which factor does the nurse suspect precipitated this preterm labor? Android pelvis Incompetent cervix First-time pregnancy Antiseizure medication Incompetent cervix A client in active labor has requested epidural anesthesia for pain management. The anesthetist has completed an evaluation, and the nurse has initiated an intravenous fluid bolus. The client's partner asks why this is necessary. What is the best explanation? It is the policy of the institution to provide 2 bags of lactated Ringer solution. There is a risk of hypotension, and the large amount of IV fluid reduces this risk. Giving the large amount of IV fluid is a means of hydrating the client when she is unable to drink. The client must be given 500 mL of fluid to ascertain that the line is patent. There is a risk of hypotension, and the large amount of IV fluid reduces this risk. A nurse assesses the frequency of a client's contractions by timing them from the beginning of a contraction until when? The uterus starts to relax The end of a second contraction The uterus has relaxed completely The beginning of the next contraction The beginning of the next contraction A client who is at 20-weeks' gestation visits the prenatal clinic for the first time. Assessment reveals temperature of 98.8° F (37.1° C), pulse of 80 beats per minute, blood pressure of 128/80 mm Hg, weight of 142 lb (64.4 kg) (pre-pregnancy weight was 132 lb (59.9 kg), fetal heart rate (FHR) of 140 beats per minute, urine that is negative for protein, and fasting blood glucose level of 92 mg/dL (5.2 mmol/L). What should the nurse do after making these assessments? Report the findings because the client needs immediate intervention. Document the results because they are expected at 20-weeks' gestation. Record the findings in the medical record because they are not within the norm but are not critical. Prepare the client for an emergency admission because these findings may represent jeopardy to the client and fetus. Document the results because they are expected at 20-weeks' gestation. What is the best advice a nurse can provide to a pregnant woman in her first trimester? "Cut down on drugs, alcohol, and cigarettes." "Avoid drugs and don't smoke or drink alcohol." "Avoid smoking, limit alcohol consumption, and don't take aspirin." "Take only prescription drugs, especially in the second and third trimesters." "Avoid drugs and don't smoke or drink alcohol." A 28-year-old woman is recovering from her third consecutive spontaneous abortion in 2 years. What is the most therapeutic nursing intervention for this client at her follow-up appointment? Focusing on the client's physical needs Encouraging the client to verbalize her feelings about the loss Reminding the client that she will be able to become pregnant again Encouraging the client to think of herself, her husband, and their future Encouraging the client to verbalize her feelings about the loss What is the desired outcome for the intrapartum client during the third stage of labor? Absence of discomfort Firmly contracted uterine fundus Efficient fetal heart beat-to-beat variability Maternal respiratory rate within the expected range Firmly contracted uterine fundus The nurse is caring for a client who has had a spontaneous abortion. Which complication should the nurse assess this client for? Hemorrhage Dehydration Hypertension Subinvolution Hemorrhage The nurse instructs a pregnant woman in labor that she must avoid lying on her back. The nurse bases this instruction on the information that the supine position is primarily avoided because it can do what? Prolong the course of labor Cause decreased placental perfusion Lead to transient episodes of hypertension Interfere with free movement of the coccyx Cause decreased placental perfusion An expectant couple asks the nurse about the cause of low back pain in labor. The nurse replies that this pain occurs most often when the fetus is in what position? Breech Transverse Occiput anterior Occiput posterior Occiput posterior A pregnant woman who is in the third trimester arrives in the emergency department with vaginal bleeding. She states that she snorted cocaine approximately 2 hours ago. Which complication does the nurse suspect as the cause of the bleeding? Placenta previa Tubal pregnancy Abruptio placentae Spontaneous abortion Abruptio placentae During the assessment of a client in labor, the cervix is determined to be dilated 4 cm. What stage of labor does the nurse record? First Second Prodromal Transitional First A pregnant client at 37 weeks' gestation is taught the signs and symptoms that should be reported immediately to the primary care provider. The nurse determines that the client understands the information presented when she states that she will immediately report what? Lower back pain White vaginal discharge Irregular strong contractions Leakage of fluid from the vagina Leakage of fluid from the vagina A client at her first visit to the prenatal clinic states that she has missed three menstrual periods and thinks that she is carrying twins because her abdomen is so large. She now has a brownish vaginal discharge. Her blood pressure is increased, indicating that she may have gestational hypertension. What condition does the nurse suspect the client may have? Renal failure Placenta previa Hydatidiform mole Abruptio placentae Hydatidiform mole While mopping the kitchen floor, a client at 37 weeks' gestation experiences a sudden sharp pain in her abdomen with a period of fetal hyperactivity. When the client arrives at the prenatal clinic, the nurse examines her and detects fundal tenderness and a small amount of dark-red bleeding. What does the nurse conclude is the probable cause of these clinical manifestations? True labor Placenta previa Partial abruptio placentae Abdominal muscular injury Partial abruptio placentae The nurse admits a client with preeclampsia to the high-risk prenatal unit. What is the next nursing action after the vital signs have been obtained? Calling the primary healthcare provider Checking the client's reflexes Determining the client's blood type Administering the prescribed intravenous (IV) normal saline Checking the client's reflexes A client who is at 13 weeks' gestation arrives at the emergency department. She states that she began to have spotting and a small amount of vaginal bleeding several hours ago. This is her second pregnancy. Which gravidity should the nurse record? Multipara Primipara Multigravida Primigravida Multigravida The nurse determines that a client's placenta has separated during the third stage of labor. Which clinical finding supports the nurse's conclusion? A gush of blood Bogginess of the uterus Shrinkage of the uterus An abrupt drop in blood pressure A gush of blood A 24-year-old client who has had type 1 diabetes for 6 years is concerned about how her pregnancy will affect both diet and insulin needs. How should the nurse respond? "Insulin needs will decrease; the excess glucose will be used for fetal growth." "Diet and insulin needs won't change, and maternal and fetal needs will be met." "Protein needs will increase, and adjustments to insulin dosage will be necessary." "Insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring." "Insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring." The partner of a woman in labor is having difficulty timing the frequency of contractions and asks the nurse to review the procedure. How should contractions be timed? From the end of one contraction to the end of the next contraction From the end of one contraction to the beginning of the next contraction From the beginning of one contraction to the end of the next contraction From the beginning of one contraction to the beginning of the next contraction From the beginning of one contraction to the beginning of the next contraction The cervix of a client in labor is fully dilated and effaced. The head of the fetus is at +2 station. What should the nurse encourage the client to do during contractions? Relax by closing her eyes Push with her glottis open Blow to slow the birth process Pant to prevent cervical edema Push with her glottis open As the nurse inspects the perineum of a client who is in active labor, the client suddenly turns pale and states that she feels as if she is going to faint even though she is lying flat on her back. What is the nurse's priority intervention? Turn her onto her left side Elevate the head of the bed Place her feet on several pillows Give her oxygen via a face mask Turn her onto her left side A client who is in labor is admitted 30 hours after her membranes ruptured. Which condition is this client at increased risk for? Cord prolapse Placenta previa Chorioamnionitis Abruptio placentae Chorioamnionitis The risk of developing chorioamnionitis (intra-amniotic infection) is increased with prolonged rupture of the membranes; foul-smelling fluid is a sign of infection A client is admitted to the emergency department in active labor. The client is bearing down, the fetal head is crowning, and birth appears imminent. Which breathing pattern should the nurse instruct the patient to adopt? Take slow, deep breaths Hold her breath and push with each contraction Breathe faster than usual with long cleansing breaths Pant and then exhale through the mouth with pursed lips Pant and then exhale through the mouth with pursed lips The nurse concludes that a positive contraction stress test (CST) result may be indicative of potential fetal compromise. A CST result is considered positive when the fetal heart rate shows what during contractions? Late decelerations Early accelerations Variable decelerations Prolonged accelerations Late decelerations A woman at 40 weeks' gestation is having contractions. Wondering whether she is in true labor, she asks, "How will you know if I'm really in labor?" Which information should the nurse provide to the patient at this time? The cervix dilates and becomes effaced in true labor. Bloody show is the first sign of true labor. The membranes rupture at the beginning of true labor. Fetal movements lessen and become weaker in true labor. The cervix dilates and becomes effaced in true labor. Which nursing assessment is most important for a large-for-gestational-age (LGA) infant of a diabetic mother (IDM)? Temperature less than 98° F (36.6° C) Heart rate of 110 beats/min Blood glucose level less than 40 mg/dL (2.2 mmol/L) Increasing bilirubin during the first 24 hours Blood glucose level less than 40 mg/dL (2.2 mmol/L)