OB exam 1 review -sauders
jojjjThe nurse is preparing to teach a prenatal class about fetal circulation. Which
statements should be included in the teaching plan? Select all that apply.
1. "The ductus arteriosus allow
...
OB exam 1 review -sauders
jojjjThe nurse is preparing to teach a prenatal class about fetal circulation. Which
statements should be included in the teaching plan? Select all that apply.
1. "The ductus arteriosus allows blood to bypass the fetal lungs."
2. "One vein carries oxygenated blood from the placenta to the fetus."
3. "The normal fetal heart tone range is 140 to 160 beats per minute in early
pregnancy."
4. "Two arteries carry deoxygenated blood and waste products away from
the fetus to the placenta."
5. "Two veins carry blood that is high in carbon dioxide and other waste
products away from the fetus to the placenta."
Rationale:
The ductus arteriosus is a unique fetal circulation structure that allows the
nonfunctioning lungs to receive only a minimal amount of oxygenated blood for tissue
maintenance. Oxygenated blood is transported to the fetus by one umbilical vein. The
normal fetal heart tone range is considered to be 110 to 160 beats per minute. Arteries
carry deoxygenated blood and waste products from the fetus, and the umbilical vein
carries oxygenated blood and provides oxygen and nutrients to the fetus. Blood pumped
by the embryo's heart leaves the embryo through two umbilical arteries.
The nursing instructor asks the student to describe fetal circulation, specifically the
ductus venosus. Which statement by the student indicates an understanding of the
ductus venosus?
1. "It connects the pulmonary artery to the aorta."
2. "It is an opening between the right and left atria."
3. "It connects the umbilical vein to the inferior vena cava."
4. "It connects the umbilical artery to the inferior vena cava."
Rationale:
The ductus venosus connects the umbilical vein to the inferior vena cava. The foramen
ovale is a temporary opening between the right and left atria. The ductus arteriosus
joins the aorta and the pulmonary artery.
A pregnant client tells the clinic nurse that she wants to know the sex of her baby as
soon as it can be determined. The nurse informs the client that she should be able to
find out the sex at 12 weeks' gestation because of which factor?
1. The appearance of the fetal external genitalia
2. The beginning of differentiation in the fetal groin
3. The fetal testes are descended into the scrotal sac
4. The internal differences in males and females become apparent
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Rationale:
By the end of the twelfth week, the external genitalia of the fetus have developed to
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such a degree that the sex of the fetus can be determined visually. Differentiation of the
external genitalia occurs at the end of the ninth week. Testes descend into the scrotal
sac at the end of the thirty-eighth week. Internal differences in the male and female
occur at the end of the seventh week.
The nurse is performing an assessment on a client who is at 38 weeks' gestation and
notes that the fetal heart rate (FHR) is 174 beats/minute. On the basis of this finding,
what is the priority nursing action?
1. Document the finding.
2. Check the mother's heart rate.
3. Notify the health care provider (HCP).
4. Tell the client that the fetal heart rate is normal.
Rationale:
The FHR depends on gestational age and ranges from 160 to 170 beats/minute in the
first trimester, but slows with fetal growth to 110 to 160 beats/minute near or at term. At
or near term, if the FHR is less than 110 beats/minute or more than 160 beats/minute
with the uterus at rest, the fetus may be in distress. Because the FHR is increased from
the reference range, the nurse should notify the HCP. Options 2 and 4 are inappropriate
actions based on the information in the question. Although the nurse documents the
findings, based on the information in the question, the HCP needs to be notified.
The nurse is conducting a prenatal class on the female reproductive system. When a
client in the class asks why the fertilized ovum stays in the fallopian tube for 3 days,
what is the nurse's best response?
1. "It promotes the fertilized ovum's chances of survival."
2. "It promotes the fertilized ovum's exposure to estrogen and
progesterone."
3. "It promotes the fertilized ovum's normal implantation in the top portion
of the uterus."
4. "It promotes the fertilized ovum's exposure to luteinizing hormone and
follicle-stimulating hormone."
Rationale:
The tubal isthmus remains contracted until 3 days after conception to allow the
fertilized ovum to develop within the tube. This initial growth of the fertilized ovum
promotes its normal implantation in the fundal portion of the uterine corpus. Estrogen is
a hormone produced by the ovarian follicles, corpus luteum, adrenal cortex, and
placenta during pregnancy. Progesterone is a hormone secreted by the corpus luteum of
the ovary, adrenal glands, and placenta during pregnancy. Luteinizing hormone and folliclestimulating hormone are excreted by the anterior pituitary gland. The survival of the
fertilized ovum does not depend on it staying in the fallopian tube for 3 days.
The nursing instructor asks a nursing student to explain the characteristics of the
amniotic fluid. The student responds correctly by explaining which as characteristics of
amniotic fluid? Select all that apply.
1. Allows for fetal movement
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2. Surrounds, cushions, and protects the fetus
3. Maintains the body temperature of the fetus
4. Can be used to measure fetal kidney function
5. Prevents large particles such as bacteria from passing to the fetus
6. Provides an exchange of nutrients and waste products between the
mother and the fetus
Rationale:
The amniotic fluid surrounds, cushions, and protects the fetus. It allows the fetus to
move freely and maintains the body temperature of the fetus. In addition, the amniotic
fluid contains urine from the fetus and can be used to assess fetal kidney function. The
placenta prevents large particles such as bacteria from passing to the fetus and
provides an exchange of nutrients and waste products between the mother and the
fetus.
A couple comes to the family planning clinic and asks about sterilization procedures.
Which question by the nurse should determine whether this method of family planning
would be most appropriate?
1. "Did you ever had surgery?"
2. "Do you plan to have any other children?"
3. "Do either of you have diabetes mellitus?"
4. "Do either of you have problems with high blood pressure?"
Rationale:
Sterilization is a method of contraception for couples who have completed their families.
It should be considered a permanent end to fertility because reversal surgery is not
always successful. The nurse would ask the couple about their plans for having children
in the future. Options 1, 3, and 4 are unrelated to this procedure.
The nurse should make which statement to a pregnant client found to have a gynecoid
pelvis?
1. "Your type of pelvis has a narrow pubic arch."
2. "Your type of pelvis is the most favorable for labor and birth."
3. "Your type of pelvis is a wide pelvis, but it has a short diameter."
4. "You will need a cesarean section because this type of pelvis is not
favorable for a vaginal delivery."
Rationale:
A gynecoid pelvis is a normal female pelvis and is the most favorable for successful
labor and birth. An android pelvis (resembling a male pelvis) would be unfavorable for
labor because of the narrow pelvic planes. An anthropoid pelvis has an outlet that is
adequate, with a normal or moderately narrow pubic arch. A platypelloid pelvis (flat
pelvis) has a wide transverse diameter, but the anteroposterior diameter is short,
making the outlet inadequate.
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Which purposes of placental functioning should the nurse include in a prenatal
class? Select all that apply.
1. It cushions and protects the baby.
2. It maintains the temperature of the baby.
3. It is the way the baby gets food and oxygen.
4. It prevents all antibodies and viruses from passing to the baby.
5. It provides an exchange of nutrients and waste products between the
mother and developing fetus.
Rationale:
The placenta provides an exchange of oxygen, nutrients, and waste products between
the mother and the fetus. The amniotic fluid surrounds, cushions, and protects the fetus
and maintains the body temperature of the fetus. Nutrients, medications, antibodies,
and viruses can pass through the placenta
The nurse is providing instructions to a pregnant client who is scheduled for an
amniocentesis. What instruction should the nurse provide?
1. Strict bed rest is required after the procedure.
2. Hospitalization is necessary for 24 hours after the procedure.
3. An informed consent needs to be signed before the procedure.
4. A fever is expected after the procedure because of the trauma to the
abdomen.
Rationale:
Because amniocentesis is an invasive procedure, informed consent needs to be
obtained before the procedure. After the procedure, the client is instructed to rest, but
may resume light activity after the cramping subsides. The client is instructed to keep
the puncture site clean and to report any complications, such as chills, fever, bleeding,
leakage of fluid at the needle insertion site, decreased fetal movement, uterine
contractions, or cramping. Amniocentesis is an outpatient procedure and may be done
in the health care provider's office or in a special prenatal testing unit. Hospitalization is
not necessary after the procedure.
A pregnant client in the first trimester calls the nurse at a health care clinic and reports
that she has noticed a thin, colorless vaginal drainage. The nurse should make which
statement to the client?
1. "Come to the clinic immediately."
2. "The vaginal discharge may be bothersome, but is a normal occurrence."
3. "Report to the emergency department at the maternity center
immediately."
4. "Use tampons if the discharge is bothersome, but be sure to change the
tampons every 2 hours."
Rationale:
Leukorrhea begins during the first trimester. Many clients notice a thin, colorless or
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yellow vaginal discharge throughout pregnancy. Some clients become distressed about
this condition, but it does not require that the client report to the health care clinic or
emergency department immediately. If vaginal discharge is profuse, the client may use
panty liners, but she should not wear tampons because of the risk of infection. If the
client uses panty liners, she should change them frequently.
A nonstress test is performed on a client who is pregnant, and the results of the test
indicate nonreactive findings. The health care provider prescribes a contraction stress
test, and the results are documented as negative. How should the nurse document this
finding?
1. A normal test result
2. An abnormal test result
3. A high risk for fetal demise
4. The need for a cesarean section
Rationale:
Contraction stress test results may be interpreted as negative (normal), positive
(abnormal), or equivocal. A negative test result indicates that no late decelerations
occurred in the fetal heart rate, although the fetus was stressed by 3 contractions of at
least 40 seconds' duration in a 10-minute period. Options 2, 3, and 4 are incorrect
interpretations.
The nurse in a health care clinic is instructing a pregnant client how to perform "kick
counts." Which statement by the client indicates a need for further instruction?
1. "I will record the number of movements or kicks."
2. "I need to lie flat on my back to perform the procedure."
3. "If I count fewer than 10 kicks in a 2-hour period, I should count the
kicks again over the next 2 hours."
4. "I should place my hands on the largest part of my abdomen and
concentrate on the fetal movements to count the kicks."
Rationale:
The client should sit or lie quietly on her side to perform kick counts. Lying flat on the
back is not necessary to perform this procedure, can cause discomfort, and presents a
risk of vena cava (supine hypotensive) syndrome. The client is instructed to place her
hands on the largest part of the abdomen and concentrate on the fetal movements. The
client records the number of movements felt during a specified time period. The client
needs to notify the health care provider (HCP) if she feels fewer than 10 kicks over two
consecutive 2-hour intervals or as instructed by the HCP.
The nurse is performing an assessment of a pregnant client who is at 28 weeks of
gestation. The nurse measures the fundal height in centimeters and notes that the
fundal height is 30 cm. How should the nurse interpret this finding?
1. The client is measuring large for gestational age.
2. The client is measuring small for gestational age.
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3. The client is measuring normal for gestational age.
4. More evidence is needed to determine size for gestational age.
Rationale:
During the second and third trimesters (weeks 18 to 30), fundal height in centimeters
approximately equals the fetus's age in weeks ± 2 cm. Therefore, if the client is at 28
weeks gestation, a fundal height of 30 cm would indicate that the client is measuring
normal for gestational age. At 16 weeks, the fundus can be located halfway between the
symphysis pubis and the umbilicus. At 20 to 22 weeks, the fundus is at the umbilicus. At
36 weeks, the fundus is at the xiphoid process.
The nurse is performing an assessment on a client who suspects that she is pregnant
and is checking the client for probable signs of pregnancy. The nurse should assess for
which probable signs of pregnancy? Select all that apply.
1. Ballottement
2. Chadwick's sign
3. Uterine enlargement
4. Positive pregnancy test
5. Fetal heart rate detected by a nonelectronic device
6. Outline of fetus via radiography or ultrasonography
Rationale:
The probable signs of pregnancy include uterine enlargement, Hegar's sign
(compressibility and softening of the lower uterine segment that occurs at about week
6), Goodell's sign (softening of the cervix that occurs at the beginning of the second
month), Chadwick's sign (violet coloration of the mucous membranes of the cervix,
vagina, and vulva that occurs at about week 4), ballottement (rebounding of the fetus
against the examiner's fingers on palpation), Braxton Hicks contractions, and a positive
pregnancy test for the presence of human chorionic gonadotropin. Positive signs of
pregnancy include fetal heart rate detected by electronic device (Doppler transducer) at
10 to 12 weeks and by nonelectronic device (fetoscope) at 20 weeks of gestation, active
fetal movements palpable by the examiner, and an outline of the fetus by radiography
or ultrasonography.
A pregnant client is seen for a regular prenatal visit and tells the nurse that she is
experiencing irregular contractions. The nurse determines that she is experiencing
Braxton Hicks contractions. On the basis of this finding, which nursing action is
appropriate?
1. Contact the health care provider.
2. Instruct the client to maintain bed rest for the remainder of the
pregnancy.
3. Inform the client that these contractions are common and may occur
throughout the pregnancy.
4. Call the maternity unit and inform them that the client will be admitted
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