OB EXAM1 Latest review

OB EXAM1 Latest review OB EXAM1 Latest review OB EXAM1 review The nurse is preparing to teach a prenatal class about fetal circulation. Which statements should be included in the teaching plan? Select all that apply. ...

OB EXAM1 Latest review OB EXAM1 Latest review OB EXAM1 review The 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, specifcally 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 fnd 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 Rationale: By the end of the twelfth week, the external genitalia of the fetus have developed to 1OB EXAM1 review 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 fnding, 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 frst 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 fndings, based on the information in the question, the HCP needs to be notifed. 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 follicle-stimulating 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 2OB EXAM1 review 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. 3OB EXAM1 review 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 ofce or in a special prenatal testing unit. Hospitalization is not necessary after the procedure. A pregnant client in the frst 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 frst trimester. Many clients notice a thin, colorless or 4OB EXAM1 review 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 fndings. The health care provider prescribes a contraction stress test, and the results are documented as negative. How should the nurse document this fnding? 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 specifed 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 fnding? 1. The client is measuring large for gestational age. 2. The client is measuring small for gestational age. 5OB EXAM1 review 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 fngers 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 fnding, 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 6OB EXAM1 review in a preterm labor condition. Rationale: Braxton Hicks contractions are irregular, painless contractions that may occur intermittently throughout pregnancy. Because Braxton Hicks contractions may occur and are normal in some pregnant women during pregnancy, there is no reason to notify the health care provider. This client is not in preterm labor and, therefore, does not need to be placed on bed rest or be admitted to the hospital to be monitored. A client arrives at the clinic for the frst prenatal assessment. She tells the nurse that the frst day of her last normal menstrual period was October 19, 2018. Using Nägele's rule, which expected date of delivery should the nurse document in the client's chart? 1. July 12, 2019 2. July 26, 2019 3. August 12, 2019 4. August 26, 2019 Rationale: Accurate use of Nägele's rule requires that the woman have a regular 28-day menstrual cycle. Subtract 3 months and add 7 days to the frst day of the last menstrual period, and then add 1 year to that date: frst day of the last menstrual period, October 19, 2018; subtract 3 months, July 19, 2018; add 7 days, July 26, 2018; add 1 year, July 26, 2019. The nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year-old child who was delivered at 38 weeks and tells the nurse that she does not have a history of any type of abortion or fetal demise. Using GTPAL, what should the nurse document in the client's chart? 1. G = 3, T = 2, P = 0, A = 0, L = 1 2. G = 2, T = 1, P = 0, A = 0, L = 1 3. G = 1, T = 1, P = 1, A = 0, L = 1 4. G = 2, T = 0, P = 0, A = 0, L = 1 Rationale: Pregnancy outcomes can be described with the acronym GTPAL. G is gravidity, the number of pregnancies; T is term births, the number born at term (longer than 37 weeks); P is preterm births, the number born before 37 weeks of gestation; A is abortions or miscarriages, the number of abortions or miscarriages (included in gravida if before 20 weeks of gestation; included in parity if past 20 weeks of gestation); and L is the number of current living children. A woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 38 weeks, the number of term births is 1, and the number of preterm births is 0. The number of abortions is 0, and the number of living children is 1. The home care nurse visits a pregnant client who has a diagnosis of mild preeclampsia. Which assessment fnding indicates a worsening of the preeclampsia and the need to notify the health care provider (HCP)? 7OB EXAM1 review 1. Urinary output has increased. 2. Dependent edema has resolved. 3. Blood pressure reading is at the prenatal baseline. 4. The client complains of a headache and blurred vision. Rationale: If the client complains of a headache and blurred vision, the HCP should be notifed, because these are signs of worsening preeclampsia. Options 1, 2, and 3 are normal fndings. The nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes mellitus. Which statement made by the client indicates a need for further teaching? 1. "I should stay on the diabetic diet." 2. "I should perform glucose monitoring at home." 3. "I should avoid exercise because of the negative effects on insulin production." 4. "I should be aware of any infections and report signs of infection immediately to my health care provider (HCP)." Rationale: Exercise is safe for a client with gestational diabetes mellitus and is helpful in lowering the blood glucose level. Dietary modifcations are the mainstay of treatment, and the client is placed on a standard diabetic diet. Many clients are taught to perform blood glucose monitoring. If the client is not performing the blood glucose monitoring at home, it is performed at the clinic or HCP's ofce. Signs of infection need to be reported to the HCP. The nurse is performing an assessment on a pregnant client in the last trimester with a diagnosis of severe preeclampsia. The nurse reviews the assessment fndings and determines that which fnding is most closely associated with a complication of this diagnosis? 1. Enlargement of the breasts 2. Complaints of feeling hot when the room is cool 3. Periods of fetal movement followed by quiet periods 4. Evidence of bleeding, such as in the gums, petechiae, and purpura Rationale: Severe preeclampsia can trigger disseminated intravascular coagulation (DIC) because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the health care provider if noted on assessment. Options 1, 2, and 3 are normal occurrences in the last trimester of pregnancy. The nurse in a maternity unit is reviewing the clients' records. Which clients should the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)? Select all that apply. 8OB EXAM1 review 1. A primigravida with mild preeclampsia 2. A primigravida who delivered a 10-lb infant 3 hours ago 3. A gravida II who has just been diagnosed with dead fetus syndrome 4. A gravida IV who delivered 8 hours ago and has lost 500 mL of blood 5. A primigravida at 29 weeks of gestation who was recently diagnosed with severe preeclampsia Rationale: In a pregnant client, DIC is a condition in which the clotting cascade is activated, resulting in the formation of clots in the microcirculation. Dead fetus syndrome is considered a risk factor for DIC. Severe preeclampsia is considered a risk factor for DIC; a mild case is not. Delivering a large newborn is not considered a risk factor for DIC. Hemorrhage is a risk factor for DIC; however, a loss of 500 mL is not considered hemorrhage. The home care nurse is monitoring a pregnant client with gestational hypertension who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which classic signs of preeclampsia? Select all that apply. 1. Proteinuria 2. Hypertension 3. Low-grade fever 4. Generalized edema 5. Increased pulse rate 6. Increased respiratory rate Rationale: The two classic signs of preeclampsia are hypertension and proteinuria. A low-grade fever, increased pulse rate, or increased respiratory rate is not associated with preeclampsia. Generalized edema may occur, but is no longer included as a classic sign of preeclampsia because it can occur in many conditions. The nurse is assessing a pregnant client with type 1 diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. The nurse determines that further teaching is needed if the client makes which statement? 1. "I will need to increase my insulin dosage during the first 3 months of pregnancy." 2. "My insulin dose will likely need to be increased during the second and third trimesters." 3. "Episodes of hypoglycemia are more likely to occur during the first 3 months of pregnancy." 4. "My insulin needs should return to prepregnant levels within 7 to 10 days after birth if I am bottle-feeding." 9OB EXAM1 review Rationale: Insulin needs decrease in the frst trimester of pregnancy because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. The statements in options 2, 3, and 4 are accurate and signify that the client understands control of her diabetes during pregnancy. A pregnant client reports to a health care clinic, complaining of loss of appetite, weight loss, and fatigue. After assessment of the client, tuberculosis is suspected. A sputum culture is obtained and identifes Mycobacterium tuberculosis. Which instruction should the nurse include in the client's teaching plan? 1. Therapeutic abortion is required. 2. Isoniazid plus rifampin will be required for 9 months. 3. She will have to stay at home until treatment is completed. 4. Medication will not be started until after delivery of the fetus. Rationale: More than 1 medication may be used to prevent the growth of resistant organisms in a pregnant client with tuberculosis. Treatment must continue for a prolonged period. The preferred treatment for the pregnant client is isoniazid plus rifampin daily for 9 months. Ethambutol is added initially if medication resistance is suspected. Pyridoxine (vitamin B6) often is administered with isoniazid to prevent fetal neurotoxicity. The client does not need to stay at home during treatment, and therapeutic abortion is not required. The nurse is providing instructions to a pregnant client with a history of cardiac disease regarding appropriate dietary measures. Which statement, if made by the client, indicates an understanding of the information provided by the nurse? 1. "I should increase my sodium intake during pregnancy." 2. "I should lower my blood volume by limiting my fluids." 3. "I should maintain a low-calorie diet to prevent any weight gain." 4. "I should drink adequate fluids and increase my intake of high-fiber foods." Rationale: Constipation can cause the client to use the Valsalva maneuver. The Valsalva maneuver should be avoided in clients with cardiac disease because it can cause blood to rush to the heart and overload the cardiac system. Constipation can be prevented by the addition of fluids and a high-fber diet. A low-calorie diet is not recommended during pregnancy and could be harmful to the fetus. Sodium should be restricted as prescribed by the health care provider because excess sodium would cause an overload to the circulating blood volume and contribute to cardiac complications. Diets low in fluid can cause a decrease in blood volume, which could deprive the fetus of nutrients. The clinic nurse is performing a psychosocial assessment of a client who has been told that she is pregnant. Which assessment fndings indicate to the nurse that the client is at risk for contracting human immunodefciency virus (HIV)? Select all that apply. 10OB EXAM1 review 1. The client has a history of intravenous drug use. 2. The client has a significant other who is heterosexual. 3. The client has a history of sexually transmitted infections. 4. The client has had one sexual partner for the past 10 years. 5. The client has a previous history of gestational diabetes mellitus. Rationale: HIV is transmitted by intimate sexual contact and the exchange of body fluids, exposure to infected blood, and passage from an infected woman to her fetus. Clients who fall into the high-risk category for HIV infection include individuals who have used intravenous drugs, individuals who experience persistent and recurrent sexually transmitted infections, and individuals who have a history of multiple sexual partners. Gestational diabetes mellitus does not predispose the client to HIV. A client with a heterosexual partner, particularly a client who has had only one sexual partner in 10 years, does not have a high risk for contracting HIV. A client in the frst 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? 1. "I will watch for the evidence of the passage of tissue." 2. "I will maintain strict bed rest throughout the remainder of the pregnancy." 3. "I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad." 4. "I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding." Rationale: Strict bed rest throughout the remainder of the pregnancy is not required for a threatened abortion. The client should watch for the evidence of the passage of tissue. The client is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The client is advised to curtail sexual activities until bleeding has ceased and for 2 weeks after the last evidence of bleeding or as recommended by the health care provider. The nurse is planning to admit a pregnant client who is obese. In planning care for this client, which potential client needs should the nurse anticipate? Select all that apply. 1. Bed rest as a necessary preventive measure may be prescribed. 2. Routine administration of subcutaneous heparin may be prescribed. 3. An overbed lift may be necessary if the client requires a cesarean section. 4. Less frequent cleansing of a cesarean incision, if present, may be 11OB EXAM1 review prescribed. 5. Thromboembolism stockings or sequential compression devices may be prescribed. Rationale: The obese pregnant client is at risk for complications such as venous thromboembolism and increased need for cesarean section. Additionally, the obese client requires special considerations pertaining to nursing care. To prevent venous thromboembolism, particularly in the client who required cesarean section, frequent and early ambulation (not bed rest), prior to and after surgery, is recommended. Routine administration of prophylactic pharmacological venous thromboembolism medications such as heparin is also commonly prescribed. An overbed lift may be needed to transfer a client from a bed to an operating table if cesarean section is necessary. Increased monitoring and cleansing of a cesarean incision, if present, will likely be prescribed due to the increased risk for infection secondary to increased abdominal fat. Thromboembolism stockings or sequential compression devices will likely be prescribed because of the client's increased risk of blood clots. The nurse is caring for a client in labor. Which assessment fndings indicate to the nurse that the client is beginning the second stage of labor? Select all that apply. 1. The contractions are regular. 2. The membranes have ruptured. 3. The cervix is dilated completely. 4. The client begins to expel clear vaginal fluid. 5. The spontaneous urge to push is initiated from perineal pressure. Rationale: The second stage of labor begins when the cervix is dilated completely and ends with birth of the neonate. The woman has a strong urge to push in stage 2 from perineal pressure. Options 1, 2, and 4 are not specifc assessment fndings of the second stage of labor and occur in stage 1. The nurse in the labor room is caring for a client in the active stage of the frst phase of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. What is the most appropriate nursing action? 1. Administer oxygen via face mask. 2. Place the mother in a supine position. 3. Increase the rate of the oxytocin intravenous infusion. 4. Document the findings and continue to monitor the fetal patterns. Rationale: Late decelerations are due to uteroplacental insufciency and occur because of decreased blood flow and oxygen to the fetus during the uterine contractions. Hypoxemia results; oxygen at 8 to 10 L/minute via face mask is necessary. The supine position is avoided because it decreases uterine blood flow to the fetus. The client should be turned onto her side to displace pressure of the gravid uterus on the inferior 12OB EXAM1 review vena cava. An intravenous oxytocin infusion is discontinued when a late deceleration is noted. The oxytocin would cause further hypoxemia because of increased uteroplacental insufciency resulting from stimulation of contractions by this medication. Although the nurse would document the occurrence, option 4 would delay necessary treatment. The nurse is performing an assessment of a client who is scheduled for a cesarean delivery at 39 weeks of gestation. Which assessment fnding indicates the need to contact the health care provider (HCP)? 1. Hemoglobin of 11 g/dL (110 mmol/L) 2. Fetal heart rate of 180 beats/minute 3. Maternal pulse rate of 85 beats/minute 4. White blood cell count of 12,000 mm3 (12.0 × 109/L) Rationale: A normal fetal heart rate is 110 to 160 beats/minute. A fetal heart rate of 180 beats/minute could indicate fetal distress and would warrant immediate notifcation of the HCP. By full term, a normal maternal hemoglobin range is 11–13 g/dL (110–130 mmol/L) because of the hemodilution caused by an increase in plasma volume during pregnancy. The maternal pulse rate during pregnancy increases 10 to 15 beats/minute over pre-pregnancy readings to facilitate increased cardiac output, oxygen transport, and kidney fltration. White blood cell counts in a normal pregnancy begin to increase in the second trimester and peak in the third trimester, with a normal range of 11,000 to 15,000 mm3 (11 to 15 x 10 9/L), up to 18,000 mm3 (18 x 109/L). During the immediate postpartum period, the white blood cell count may be 25,000 to 30,000 mm3 (25 to 30 x 109/L) because of increased leukocytosis that occurs during delivery. The nurse is reviewing the record of a client in the labor room and notes that the health care provider has documented that the fetal presenting part is at the –1 station. This documented fnding indicates that the fetal presenting part is located at which area? Click on the image to indicate your answer. Rationale: Station is the measurement of the progress of descent in centimeters above or below the midplane from the presenting part to the ischial spine. It is measured in centimeters, and noted as a negative number above the line and as a positive number below the line. At the negative 1 (–1) station, the fetal presenting part is 1 cm above the ischial spine. Option 1 is at the negative 5 (–5) station and the fetal presenting part is 5 cm above the ischial spine. Option 2 is at the negative 2 (–2) station and the fetal presenting part is 2 cm above the ischial spine. Option 4 is at the positive 3 (+3) and the fetal presenting part is 3 cm below the ischial spine. A client arrives at a birthing center in active labor. Following examination, it is determined that her membranes are still intact and she is at a –2 station. The health care provider prepares to perform an amniotomy. What will the nurse relay to the client as the most likely outcomes of the amniotomy? Select all that apply. 1. Less pressure on her cervix 2. Decreased number of contractions 13OB EXAM1 review 3. Increased efficiency of contractions 4. The need for increased maternal blood pressure monitoring 5. The need for frequent fetal heart rate monitoring to detect the presence of a prolapsed cord Rationale: Amniotomy (artifcial rupture of the membranes) can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if the progress begins to slow. Rupturing of the membranes allows the fetal head to contact the cervix more directly and may increase the efciency of contractions. Increased monitoring of maternal blood pressure is unnecessary following this procedure. The fetal heart rate needs to be monitored frequently, as there is an increased likelihood of a prolapsed cord with ruptured membranes and a high presenting part. The nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which is noted on the external monitor tracing during a contraction? 1. Variability 2. Accelerations 3. Early decelerations 4. Variable decelerations Rationale: Variable decelerations occur if the umbilical cord becomes compressed, reducing blood flow between the placenta and the fetus. Variability refers to fluctuations in the baseline fetal heart rate. Accelerations are a reassuring sign and usually occur with fetal movement. Early decelerations result from pressure on the fetal head during a contraction. A client in labor is transported to the delivery room and prepared for a cesarean delivery. After the client is transferred to the delivery room table, the nurse should place the client in which position? 1. Supine position with a wedge under the right hip 2. Trendelenburg's position with the legs in stirrups 3. Prone position with the legs separated and elevated 4. Semi Fowler's position with a pillow under the knees Rationale: Vena cava and descending aorta compression by the pregnant uterus impedes blood return from the lower trunk and extremities. This leads to decreasing cardiac return, cardiac output, and blood flow to the uterus and subsequently the fetus. The best position to prevent this would be side-lying, with the uterus displaced off the abdominal vessels. Positioning for abdominal surgery necessitates a supine position, however; a wedge placed under the right hip provides displacement of the uterus. Trendelenburg's position places pressure from the pregnant uterus on the diaphragm and lungs, 14OB EXAM1 review decreasing respiratory capacity and oxygenation. A prone or semi Fowler's position is not practical for this type of abdominal surgery. The nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes that last 45 seconds. The nurse notes that the fetal heart rate between contractions is 100 beats/minute. Which nursing action is most appropriate? 1. Notify the health care provider (HCP). 2. Continue monitoring the fetal heart rate. 3. Encourage the client to continue pushing with each contraction. 4. Instruct the client's coach to continue to encourage breathing techniques. Rationale: A normal fetal heart rate is 110 to 160 beats/minute, and the fetal heart rate should be within this range between contractions. Fetal bradycardia between contractions may indicate the need for immediate medical management, and the HCP or nurse-midwife needs to be notifed. Options 2, 3, and 4 are inappropriate nursing actions in this situation and delay necessary intervention . The nurse is caring for a client in labor and is monitoring the fetal heart rate patterns. The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. Which action is most appropriate? 1. Notify the health care provider of the findings. 2. Reposition the mother and check the monitor for changes in the fetal tracing. 3. Take the mother's vital signs and tell the mother that bed rest is required to conserve oxygen. 4. Document the findings and tell the mother that the pattern on the monitor indicates fetal well-being. Rationale: Accelerations are transient increases in the fetal heart rate that often accompany contractions or are caused by fetal movement. Episodic accelerations are thought to be a sign of fetal well-being and adequate oxygen reserve. Options 1, 2, and 3 are inaccurate nursing actions and are unnecessary. The nurse is admitting a pregnant client to the labor room and attaches an external electronic fetal monitor to the client's abdomen. After attachment of the electronic fetal monitor, what is the next nursing action? 1. Identify the types of accelerations. 2. Assess the baseline fetal heart rate. 3. Determine the intensity of the contractions. 4. Determine the frequency of the contractions. 15OB EXAM1 review Rationale: Assessing the baseline fetal heart rate is important so that abnormal variations of the baseline rate can be identifed if they occur. The intensity of contractions is assessed by an internal fetal monitor, not an external fetal monitor. Options 1 and 4 are important to assess, but not as the frst priority. Fetal heart rate is evaluated by assessing baseline and periodic changes. Periodic changes occur in response to the intermittent stress of uterine contractions and the baseline beat-to-beat variability of the fetal heart rate. The nurse is reviewing true and false labor signs with a multiparous client. The nurse determines that the client understands the signs of true labor if she makes which statement? 1. "I won't be in labor until my baby drops." 2. "My contractions will be felt in my abdominal area." 3. "My contractions will not be as painful if I walk around." 4. "My contractions will increase in duration and intensity." Rationale: True labor is present when contractions increase in duration and intensity. Lightening or dropping leads to engagement (presenting part reaches the level of the ischial spine) and occurs when the fetus descends into the pelvis about 2 weeks before delivery. Contractions felt in the abdominal area and contractions that ease with walking are signs of false labor. Which assessment following an amniotomy should be conducted frst? 1. Cervical dilation 2. Bladder distention 3. Fetal heart rate pattern 4. Maternal blood pressure Rationale: Fetal heart rate is assessed immediately after amniotomy to detect any changes that may indicate cord compression or prolapse. When the membranes are ruptured, minimal vaginal examinations would be done because of the risk of infection. Bladder distention or maternal blood pressure would not be the frst thing to check after an amniotomy. The nurse has been working with a laboring client and notes that she has been pushing effectively for 1 hour. What is the client's primary physiological need at this time? 1. Ambulation 2. Rest between contractions 3. Change positions frequently 4. Consume oral food and fluids Rationale: The birth process expends a great deal of energy, particularly during the transition 16OB EXAM1 review stage. Encouraging rest between contractions conserves maternal energy, facilitating voluntary pushing efforts with contractions. Uteroplacental perfusion also is enhanced, which promotes fetal tolerance of the stress of labor. Ambulation is encouraged during early labor. Ice chips should be provided. Changing positions frequently is not the primary physiological need. Food and fluids are likely to be withheld at this time. The nurse is assisting a client undergoing induction of labor at 41 weeks of gestation. The client's contractions are moderate and occurring every 2 to 3 minutes, with a duration of 60 seconds. An internal fetal heart rate monitor is in place. The baseline fetal heart rate has been 120 to 122 beats/minute for the past hour. What is the priority nursing action? 1. Notify the health care provider. 2. Discontinue the infusion of oxytocin. 3. Place oxygen on at 8 to 10 L/minute via face mask. 4. Contact the client's primary support person(s) if not currently present. Rationale: The priority nursing action is to stop the infusion of oxytocin. Oxytocin can cause forceful uterine contractions and decrease oxygenation to the placenta, resulting in decreased variability. After stopping the oxytocin, the nurse should reposition the laboring mother. Notifying the health care provider, applying oxygen, and increasing the rate of the intravenous (IV) fluid (the solution without the oxytocin) are also actions that are indicated in this situation, but not the priority action. Contacting the client's primary support person(s) is not the priority action at this time. The nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which assessment fnding should the nurse expect to note if this condition is present? 1. Soft abdomen 2. Uterine tenderness 3. Absence of abdominal pain 4. Painless, bright red vaginal bleeding Rationale: Abruptio placentae is the premature separation of the placenta from the uterine wall after the twentieth week of gestation and before the fetus is delivered. In abruptio placentae, acute abdominal pain is present. Uterine tenderness accompanies placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen feels hard and boardlike on palpation as the blood penetrates the myometrium and causes uterine irritability. A soft abdomen and painless, bright red vaginal bleeding in the second or third trimester of pregnancy are signs of placenta previa. The maternity nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the health care provider's prescriptions and should question which prescription? 17OB EXAM1 review 1. Prepare the client for an ultrasound. 2. Obtain equipment for a manual pelvic examination. 3. Prepare to draw a hemoglobin and hematocrit blood sample. 4. Obtain equipment for external electronic fetal heart rate monitoring. Rationale: Placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os. Manual pelvic examinations are contraindicated when vaginal bleeding is apparent until a diagnosis is made and placenta previa is ruled out. Digital examination of the cervix can lead to hemorrhage. A diagnosis of placenta previa is made by ultrasound. The hemoglobin and hematocrit levels are monitored, and external electronic fetal heart rate monitoring is initiated. Electronic fetal monitoring (external) is crucial in evaluating the status of the fetus, who is at risk for severe hypoxia. The nurse is performing an assessment on a client who has just been told that a pregnancy test is positive. Which assessment fnding indicates that the client is at risk for preterm labor? 1. The client is a 35-year-old primigravida. 2. The client has a history of cardiac disease. 3. The client's hemoglobin level is 13.5 g/dL (135 mmol/L). 4. The client is a 20-year-old primigravida of average weight and height. Rationale: Preterm labor occurs after the twentieth week but before the thirty-seventh week of gestation. Several factors are associated with preterm labor, including a history of medical conditions, present and past obstetric problems, social and environmental factors, and substance abuse. Other risk factors include a multifetal pregnancy, which contributes to overdistention of the uterus; anemia, which decreases oxygen supply to the uterus; and age younger than 18 years or frst pregnancy at age older than 40 years. The nurse is monitoring a client who is in the active stage of labor. The nurse documents that the client is experiencing labor dystocia. The nurse determines that which risk factors in the client's history placed her at risk for this complication? Select all that apply. 1. Age 54 2. Body mass index of 28 3. Previous difficulty with fertility 4. Administration of oxytocin for induction 5. Potassium level of 3.6 mEq/L (3.6 mmol/L) Rationale: Risk factors that increase a woman's risk for dysfunctional labor include the following: advanced maternal age, being overweight, electrolyte imbalances, previous difculty 18OB EXAM1 review with fertility, uterine overstimulation with oxytocin, short stature, prior version, masculine characteristics, uterine abnormalities, malpresentations and position of the fetus, cephalopelvic disproportion, maternal fatigue, dehydration, fear, administration of an analgesic early in labor, and use of epidural analgesia. Age 54 is considered advanced maternal age, and a body mass index of 28 is considered overweight. Previous difculty with infertility is another risk factor for labor dystocia. A potassium level of 3.6 mEq/L (3.6 mmol/L) is normal and administration of oxytocin alone is not a risk factor; risk exists only if uterine hyperstimulation occurs. The nurse in a birthing room is monitoring a client with dysfunctional labor for signs of fetal or maternal compromise. Which assessment fnding should alert the nurse to a compromise? 1. Maternal fatigue 2. Coordinated uterine contractions 3. Progressive changes in the cervix 4. Persistent nonreassuring fetal heart rate Rationale: Signs of fetal or maternal compromise include a persistent, nonreassuring fetal heart rate, fetal acidosis, and the passage of meconium. Maternal fatigue and infection can occur if the labor is prolonged++, but do not indicate fetal or maternal compromise. Coordinated uterine contractions and progressive changes in the cervix are a reassuring pattern in labor. The nurse in a labor room is preparing to care for a client with hypertonic uterine contractions. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. What is the priority nursing action? 1. Provide pain relief measures. 2. Prepare the client for an amniotomy. 3. Promote ambulation every 30 minutes. 4. Monitor the oxytocin infusion closely. Rationale: Hypertonic uterine contractions are painful, occur frequently, and are uncoordinated. Management of hypertonic labor depends on the cause. Relief of pain is the primary intervention to promote a normal labor pattern. An amniotomy and oxytocin infusion are not treatment measures for hypertonic contractions; however, these treatments may be used in clients with hypotonic dysfunction. A client with hypertonic uterine contractions would not be encouraged to ambulate every 30 minutes, but would be encouraged to rest. The nurse is reviewing the health care provider's (HCP's) prescriptions for a client admitted for premature rupture of the membranes. Gestational age of the fetus is determined to be 37 weeks. Which prescription should the nurse question? 1. Monitor fetal heart rate continuously. 19OB EXAM1 review 2. Monitor maternal vital signs frequently. 3. Perform a vaginal examination every shift. 4. Administer an antibiotic per HCP prescription and per agency protocol. Rationale: Vaginal examinations should not be done routinely on a client with premature rupture of the membranes because of the risk of infection. The nurse would expect to monitor fetal heart rate, monitor maternal vital signs, and administer an antibiotic. The nurse has created a plan of care for a client experiencing dystocia and includes several nursing actions in the plan of care. What is the priority nursing action? 1. Providing comfort measures 2. Monitoring the fetal heart rate 3. Changing the client's position frequently 4. Keeping the significant other informed of the progress of the labor Rationale: Dystocia is difcult labor that is prolonged or more painful than expected. The priority is to monitor the fetal heart rate. Although providing comfort measures, changing the client's position frequently, and keeping the signifcant other informed of the progress of the labor are components of the plan of care, the fetal status would be the priority. The nurse is performing an assessment on a client diagnosed with placenta previa. Which assessment fndings should the nurse expect to note? Select all that apply. 1. Uterine rigidity 2. Uterine tenderness 3. Severe abdominal pain 4. Bright red vaginal bleeding 5. Soft, relaxed, nontender uterus 6. Fundal height may be greater than expected for gestational age Rationale: Placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os. Painless, bright red vaginal bleeding in the second or third trimester of pregnancy is a sign of placenta previa. The client has a soft, relaxed, nontender uterus, and fundal height may be more than expected for gestational age. In abruptio placentae, severe abdominal pain is present. Uterine tenderness accompanies placental abruption. In addition, in abruptio placentae, the abdomen feels hard and boardlike on palpation as the blood penetrates the myometrium and causes uterine irritability. The nurse provides instructions to a malnourished pregnant client regarding iron supplementation. Which client statement indicates an understanding of the instructions? 1. "Iron supplements will give me diarrhea." 20OB EXAM1 review 2. "Meat does not provide iron and should be avoided." 3. "The iron is best absorbed if taken on an empty stomach." 4. "On the days that I eat green leafy vegetables or calf liver I can omit taking the iron supplement." Rationale: Iron is needed to allow for transfer of adequate iron to the fetus and to permit expansion of the maternal red blood cell mass. During pregnancy, the relative excess of plasma causes a decrease in the hemoglobin concentration and hematocrit, known as physiological anemia of pregnancy. This is a normal adaptation during pregnancy. Iron is best absorbed if taken on an empty stomach. Taking it with a fluid high in ascorbic acid such as tomato juice enhances absorption. Iron supplements usually cause constipation. Meats are an excellent source of iron. The client needs to take the iron supplements regardless of food intake. A pregnant client at 10 weeks' gestation calls the prenatal clinic to report a recent exposure to a child with rubella. The nurse reviews the client's chart. What is the nurse's best response to the client? Refer to the chart below. History and Physical Laboratory and Diagnostic Results Medications Gravida, Term Births, Preterm Births, Abortions, Living Children (GTPAL) 1,0,0,0,0 Venereal Disease Research Laboratory (VDRL) nonreactive Prenatal vitamins Weight 135 lb (61 kg) Rubella immune Positive Goodell and Chadwick Rh positive, Type O 1. "You should avoid all school-age children during pregnancy." 2. "There is no need to be concerned if you don't have a fever or rash within the next 2 days." 3 "You were wise to call. Your rubella titer indicates that you are immune and your baby is not at risk." 4. "Be sure to tell the health care provider in 2 weeks, as additional screening will be prescribed during your second trimester." 21OB EXAM1 review Rationale: Rubella virus is spread by aerosol droplet transmission through the upper respiratory tract and has an incubation period of 14 to 21 days. The risks of maternal and subsequent fetal infection during the second trimester include hearing loss and congenital anomalies; these risks decrease after the frst 12 weeks of pregnancy. Rubella titer determination is a standard prenatal test for pregnant women during their initial screening and entry into the health care delivery system. As noted in this client's chart, she is immune to rubella. The correct option is the only option that helps to clarify maternal concerns with accurate information. During a routine prenatal visit, a client complains of gums that bleed easily with brushing. The nurse performs an assessment and teaches the client about proper nutrition to minimize this problem. Which client statement indicates an understanding of the proper nutrition to minimize this problem? 1. "I will drink 8 oz (235 ml) of water with each meal." 2. "I will eat 3 servings of cracked wheat bread each day." 3. "I will eat 2 saltine crackers before I get up each morning." 4. "I will eat fresh fruits and vegetables for snacks and for dessert each day." Rationale: Fresh fruits and vegetables provide vitamins and minerals needed for healthy gums. Drinking water with meals has no direct effect on gums. Cracked wheat bread may abrade the tender gums. Eating saltine crackers can also abrade the tender gums. The nurse has performed a nonstress test on a pregnant client and is reviewing the fetal monitor strip. How should the nurse document this fnding in the client's medical record? Refer to Figure. (Figure from McKinney et al. [2013], p. 310.) View Figure 1. Normal 22OB EXAM1 review 2. Abnormal 3. Need for further evaluation 4. Findings difficult to interpret The nursing instructor asks the nursing student about the physiology related to the cessation of ovulation that occurs during pregnancy. Which response, if made by the student, indicates an understanding of this physiological process? Select all that apply. 1 . "Ovulation ceases during pregnancy because the circulating levels of estrogen and progesterone are high." 2 . "Ovulation ceases during pregnancy because the circulating levels of estrogen and progesterone are low." 3 . "The low levels of estrogen and progesterone increase the release of the follicle-stimulating hormone and luteinizing hormone." 4 . "The high levels of estrogen and progesterone promote the release of the follicle-stimulating hormone and luteinizing hormone." 5 . "The release of the follicle-stimulating hormone and luteinizing hormone is inhibited by adaptations related to pregnancy." Rationale: Ovulation ceases during pregnancy because the circulating levels of estrogen and progesterone are high, inhibiting the release of follicle-stimulating and luteinizing hormones, which are necessary for ovulation. All other options are incorrect. The nurse encourages a pregnant client who is human immunodefciency virus (HIV) positive to immediately report any early signs of vaginal discharge or perineal tenderness to the health care provider. The client asks the nurse about the importance of this action, and the nurse responds by making which statement to the client? 1. "This is necessary to relieve your anxiety." 2. "This is necessary to eliminate the need for further uncomfortable screenings." 3. "This is necessary to minimize the financial cost of caring for an HIVpositive client." 4. "This is necessary to assist in identifying potential infections that may need to be treated." Rationale: The HIV-compromised client may be at high risk for superimposed infections during pregnancy. These include, for example, Candida infections, genital herpes, and anogenital condyloma. Early reporting of signs and symptoms may alert the members of the health care team that further assessment and testing are needed to diagnose and manage additional maternal and fetal physiological risks. All other options do represent possible outcomes of this nursing intervention, but they are not the priority of care when promoting maternal-fetal well-being. 23OB EXAM1 review A pregnant client who is anemic tells the nurse that she is concerned about her infant's condition after delivery. Which nursing response would best support the client? 1. "You should not worry about your baby's condition after the delivery because complications are rare." 2. "Your baby will probably need to spend a few days in the neonatal intensive care unit after delivery." 3. "You will not have any problems if you follow all the advice the health care provider has given you." 4. "The effects of anemia on your baby are difficult to predict, but let's review your plan of care to ensure you are providing the best nutrition and growth potential." Rationale: The effects of maternal iron defciency anemia on the developing fetus and neonate are unclear. In general, it is believed that the fetus will receive adequate maternal stores of iron even if a defciency is present. Neonates of severely anemic mothers have been reported to experience reduced red blood cell volume, hemoglobin level, and iron stores. Telling a client that she will not have any problems if she follows the health care provider's advice and telling her that she should not worry because complications are rare provide false reassurance to the client. Telling the client that the baby will probably spend time in the neonatal intensive care unit will cause further concern. The correct option provides the most realistic support for the client and allows the nurse an opportunity to review the client's plan of care to clarify information and reassure the client. The client is being seen at 24 weeks' gestation at the prenatal clinic. At her last routine visit, the fundus was located at the umbilicus. Today, the fundus is measured and found to be 23 cm. How should the nurse interpret this fnding? 1. Fundus is at the appropriate level. 2. Fundus is larger than expected height. 3. Fundus is smaller than expected height. 4. Growth pattern indicates intrauterine growth restriction (IUGR). Rationale: At the previous routine visit at 20 weeks' gestation, the fundus was located at the umbilicus. For each subsequent week after 20 weeks, fundal height should increase by approximately 1 cm/week. At 24 weeks' gestation, the appropriate fundal height would be 24 cm plus or minus 2 cm. By 36 weeks' gestation, the fundus reaches its highest level at the xiphoid process. The nurse is performing a prenatal assessment on a pregnant client. The nurse should plan to implement teaching related to risk for abruptio placentae if which information is obtained on assessment? 1. The client is 28 years of age. 2. This is the second pregnancy. 24OB EXAM1 review 3. The client has a history of hypertension. 4. The client performs moderate exercise on a regular daily schedule. Rationale: Abruptio placentae is the premature separation of the placenta from the uterine wall after the 20th week of gestation and before the fetus is delivered. Abruptio placentae is associated with conditions characterized by poor uteroplacental circulation, such as hypertension, smoking, and alcohol or cocaine abuse. The condition also is associated with physical and mechanical factors, such as overdistention of the uterus, which occurs with multiple gestation or polyhydramnios. In addition, a short umbilical cord, physical trauma, and increased maternal age and parity are risk factors. During a prenatal visit, the nurse is explaining dietary management to a client with preexisting diabetes mellitus. The nurse determines that teaching has been effective if the client makes which statement? 1. "Diet and insulin needs change during pregnancy." 2. "I will plan my diet based on the results of urine glucose testing." 3. "I will need to eat 600 more calories every day because I am pregnant." 4. "I can continue with the same diet as before pregnancy, as long as it is well balanced." Rationale: The diet for a pregnant client with diabetes mellitus is individualized to allow for increased fetal and metabolic requirements, with consideration of such factors as prepregnancy weight and dietary habits, overall health, ethnic background, lifestyle, stage of pregnancy, knowledge of nutrition, and insulin therapy. Dietary management during diabetic pregnancy must be based on blood, not urine, glucose changes. An increase of 600 calories a day is not required. Diet and insulin needs change during the pregnancy in direct correlation to hormonal changes and energy needs. In the second and third trimesters, insulin needs increase. The nurse has provided home care instructions to a client with a history of cardiac disease who has just been told that she is pregnant. Which statement, if made by the client, indicates a need for further instruction? 1. "It is best that I rest lying on my side to promote blood return to the heart." 2. "I need to avoid excessive weight gain to prevent increased demands on my heart." 3. "I need to try to avoid stressful situations because stress increases the workload on the heart." 4. "During the pregnancy, I need to avoid contact with other individuals as much as possible to prevent infection." Rationale: To avoid infections, visitors with active infections should not be allowed to visit the client; otherwise, restrictions are not required. Resting should be done by lying on the 25OB EXAM1 review side to promote blood return. Too much weight gain can place further demands on the heart. Stress causes increased heart workload, and the client should be instructed to avoid stress. The nurse assists a pregnant client with cardiac disease to identify resources to help her care for her 18-month-old child during the last trimester of pregnancy. The nurse encourages the pregnant client to use these resources primarily for which reason? 1. Reduce excessive maternal stress and fatigue. 2. Help the mother prepare for labor and delivery. 3. Avoid exposure to potential pathogens and resulting infections. 4. Prepare the 18-month-old child for maternal separation during hospitalization. Rationale: A variety of factors can cause increased emotional stress during pregnancy, resulting in further cardiac complications. The client with known cardiac disease is at greater risk for such complications. The use of resources will assist the client to avoid emotional stress, thus reducing additional cardiac compromise during the last trimester. These resources are not intended to minimize potential risk of maternal infection or prepare the client and family for the subsequent labor, delivery, and hospitalization. The nurse is instructing a pregnant client on measures to increase iron in the diet. The nurse should tell the client to consume which food that contains the highest source of dietary iron? 1. Milk 2. Potatoes 3. Cantaloupe 4. Whole-grain cereal Rationale: Dietary sources of iron include lean meats; liver; shellfsh; dark green, leafy vegetables; legumes; whole grains and enriched grains; cereals; and molasses. Milk is high in calcium and also contains phosphorus. Potatoes and cantaloupe are high in vitamin C. The nurse is reviewing a nutritional plan of care with a pregnant client and is identifying the food items highest in folic acid. The nurse determines that the client understands the foods that supply the highest amounts of folic acid if the client states that she will include which item in the daily diet? 1. Milk 2. Yogurt 3. Bananas 4. Leafy green vegetables Rationale: Leafy green vegetables are rich in folate (folic acid). Milk and yogurt supply calcium; bananas provide potassium. 26OB EXAM1 review A pregnant client who is at 30 weeks' gestation comes to the clinic for a routine visit, and the nurse performs an assessment on her. Which observations made by the nurse during the assessment indicates a need for further teaching? Select all that apply. 1. The client is wearing sneakers. 2. The client is wearing knee-high nylon stockings. 3. The client is wearing flat shoes with rubber soles. 4. The client is wearing pants with an elastic waistband. 5. The client is wearing sweatpants with snug elastic ankle bands. Rationale: Varicose veins often develop in the lower extremities during pregnancy. Any constricting clothing such as knee-high stockings or snug elastic ankle bands impedes venous return from the lower legs and thus places the client at higher risk for developing varicosities. Clients should be encouraged to wear pantyhose or support hose. Flat nonslip shoes with proper support are important to assist the pregnant woman to maintain proper posture and balance and to minimize the risk for falls. Pants with an elastic waistband are comfortable and are not constricting. A pregnant client tells the nurse that she frequently has a backache, and the nurse provides instructions regarding measures that will assist in relieving the backache. Which statement by the client indicates a need for further instruction? 1. "I should wear flat-heeled shoes." 2. "I should sleep on a firm mattress." 3. "I should try to maintain good posture." 4. "I should do more exercises to strengthen my back muscles." Rationale: Some measures that will assist in relieving a backache include maintaining good posture and body mechanics, resting and avoiding fatigue, wearing flat-heeled shoes, and sleeping on a frm mattress. The back discomfort that occurs in a pregnant client is often caused by the exaggerated lumbar and cervicothoracic curves resulting from a change in the center of gravity because of the enlarged uterus. Performing more exercises to strengthen the back muscles could be harmful to a pregnant client. A nonstress test is prescribed for a pregnant client, and she asks the nurse about the procedure. How should the nurse respond? 1. "The test is a procedure that will require an informed consent to be signed." 2. "The test will take about 2 hours and will require close monitoring for 2 hours after the procedure is completed." 3. "The test is done to see if the baby can handle the stress of labor, and medicine is given to make the uterus contract." 4. "A round, hard plastic disk called an ultrasound transducer picks up and marks the fetal heart activity on the recording paper and is secured over 27OB EXAM1 review the abdomen." Rationale: The nonstress test takes about 20 to 30 minutes. The test is termed nonstress because it consists of monitoring only; the fetus is not challenged or stressed by uterine contractions (medication is not given) to obtain the necessary data. The test is noninvasive (an informed consent is not required), and an ultrasound transducer that records fetal heart activity is secured over the maternal abdomen, where the fetal heart is heard most clearly. A tocotransducer that detects uterine activity and fetal movement also is secured to the maternal abdomen. Fetal heart activity and movements are recorded. The nurse is developing a plan of care for a pregnant client who is complaining of intermittent episodes of constipation. To help alleviate this problem, the nurse should instruct the client to take which measure? 1. Consume a low-fiber diet. 2. Drink 8 glasses of water per day. 3. Use a Fleet enema when the episodes occur. 4. Take a mild stool softener daily in the evening. Rationale: The nurse should instruct the client to drink at least 8 to 10 (8-oz) glasses of fluid each day, of which 4 to 6 glasses are water, and to consume a diet that includes fber to prevent constipation. The client should not use enemas or take stool softeners, laxatives, mineral oil, or other medications without frst consulting with the health care provider or nurse-midwife. A pregnant client in the prenatal clinic is scheduled for a biophysical profle (BPP). The client asks the nurse what this test involves. The nurse should make which appropriate response? 1. "This test measures your ability to tolerate the pregnancy." 2. "This test measures amniotic fluid volume and fetal activity." 3. "This test measures your cardiac status and ability to tolerate labor." 4. "This test measures only the amount of amniotic fluid present in the uterus." Rationale: The BPP assesses 5 parameters of fetal activity: fetal heart rate, fetal breathing movements, gross fetal movements, fetal tone, and amniotic fluid volume. In a BPP, each of the 5 parameters contributes 0 to 2 points, with a score of 8 considered normal and a score of 10 perfect. Results are available immediately. A BPP test deals with fetal, not maternal, well-being. Options 1 and 3 relate to maternal well-being. Amniotic fluid measurement is only 1 component of the BPP test. The nurse is taking a nutritional history from a 16-year-old pregnant adolescent. Which statement, if made by the adolescent, should alert the nurse to a potential psychosocial problem? 28OB EXAM1 review 1. "I don't like dairy products." 2. "I will continue drinking my afternoon milkshake." 3. "I'm not used to eating so much food, but I will try." 4. "I want to gain only 10 pounds because I want to have a small, petite baby." Rationale: Pregnant adolescents are at higher risk for complications. Peer pressure is an important influence on nutritional status. Adolescents often are concerned about their body image. If weight is a major focus for the adolescent, the adolescent is more likely to restrict calories to avoid weight gain. The correct option is the only one that suggests a possible psychosocial problem. The remaining options relate to physiological issues. he nurse is conducting a session about nutrition with a group of adolescents who are pregnant. Which measure is most appropriate to teach these adolescents? 1. Eat only when hungry. 2. Eliminate snacks during the day. 3. Avoid meals in fast-food restaurants. 4. Monitor for appropriate weight gain patterns. Rationale: The nurse should teach the adolescents about appropriate weight patterns and how to monitor these patterns. The adolescent is more likely to follow suggestions and adhere to the appropriate dietary patterns if the nurse explains why the weight gain is important for the fetus and the mother. Advising an adolescent to eat only when hungry could lead to a defcit in nutrients. Telling an adolescent to avoid fast-food restaurants and eliminate snacks may cause the adolescent to rebel. The nurse is discussing nutrition with a pregnant client who has lactose intolerance. The nurse should instruct the client to supplement the dietary source of calcium by eating which food? 1. Soft cheese 2. Dried fruits 3. Creamed spinach 4. Fresh-squeezed orange juice Rationale: The best source of calcium is dairy products. Women with lactose intolerance need other sources of calcium. Calcium is present in dark green leafy vegetables, broccoli, legumes, nuts, and dried fruits. Soft cheese is a dairy product and is not tolerated well by the client with lactose intolerance. Some hard cheeses are well aged and may be permissible on a lactose-free diet. Spinach contains calcium, but it also contains oxalates that decrease calcium availability. In addition, creamed spinach may not be tolerated by a client with lactose intolerance. Orange juice does not contain signifcant amounts of calcium unless fortifed with calcium. The nurse has provided instructions to a pregnant client who is preparing to take iron 29OB EXAM1 review supplements. The nurse determines that the client understands the instructions if she states that she will take the supplements with which item? 1. Tea 2. Milk 3. Coffee 4. Orange juice Rationale: Foods containing ascorbic acid will increase the absorption of iron. Orange juice is the only item that contains ascorbic acid and will increase the absorption of iron supplements. Tannin and caffeine in tea decrease iron absorption. Calcium and phosphorus in milk also decrease iron absorption. Coffee binds iron, prevents it from being fully absorbed, and contains caffeine. A client arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago. The client tells the nurse that a home pregnancy test was positive but that she began to have mild cramps and is now having moderate vaginal bleeding. On physical examination of the client, it is noted that she has a dilated cervix. Which statement, if made by the client, indicates that the client is interpreting the situation correctly? 1. "I will need to remain on bed rest for 2 weeks." 2. "I will need to take a full course of antibiotic treatment." 3. "I will need to take tocolytic medication to halt the labor process." 4. "I will need to prepare myself and my family for the loss of this pregnancy." Rationale: The client is experiencing a spontaneous abortion (miscarriage), which cannot be prevented and will terminate her pregnancy. Bed rest will not reverse this process. The nurse is reviewing the record of a pregnant client seen in the health care clinic for the frst prenatal visit. Which data, if noted on the client's record, should alert the nurse that the client is at risk for a spontaneous abortion? 1. Age 35 years 2. History of syphilis 3. History of genital herpes 4. History of diabetes mellitus Rationale: Maternal infections such as syphilis, toxoplasmosis, and rubella are causes of spontaneous abortion. There is no evidence that genital herpes is a causative agent in abortion, although the presence of active lesions at the time of birth presents concerns. Maternal age greater than 40 years and diabetes mellitus are considered high-risk factors in a pregnancy but are related to an increased risk of congenital malformations, not abortions. 30OB EXAM1 review he nurse is preparing to care for a client who is being admitted to the hospital with a possible diagnosis of ectopic pregnancy. The nurse develops a plan of care for the client and determines that which nursing action is the priority? 1. Checking for edema 2. Monitoring daily weight 3. Monitoring the apical pulse 4. Monitoring the temperature Rationale: Nursing care for the client with a possible ectopic pregnancy is focused on preventing or identifying hypovolemic shock and controlling pain. An elevated pulse rate is an indicator of shock. Edema and weight gain are more of a concern for the client with preeclampsia or gestational hypertension, and an elevated temperature is an indicator of infection. The nurse reviews the assessment history for a client with a suspected ectopic pregnancy. Which assessment fndings predispose the client to an ectopic pregnancy? Select all that apply. 1. Use of diaphragm 2. Use of fertility medications 3. History of Chlamydia 4. Use of an intrauterine device 5. History of pelvic inflammatory disease (PID) Rationale: An ectopic pregnancy is one that establishes itself somewhere other than inside the uterus. Multiple factors may predispose a woman to an ectopic pregnancy. Fertility medications, history of sexually transmitted infections, intrauterine devices, and PID have all been associated with ectopic pregnancy. There are no data to support any additional risk for ectopic pregnancy with the use of the diaphragm. The nurse is reviewing the record of a pregnant client seen in the health care clinic for the frst prenatal visit. Which data if noted on the client's record would alert the nurse that the client is at risk for developing gestational diabetes during this pregnancy? 1. The client's last baby weighed 10 pounds at birth. 2. The client's previous deliveries were by cesarean section. 3. The client has a family history of cardiovascular disease. 4. The client is 5 feet, 3 inches tall and weighs 165 pounds. Rationale: Known risk factors that increase the risk of developing gestational diabetes include obesity (more than approximately 198 pounds, depending on height), chronic hypertension, family history of diabetes mellitus, previous birth of a large infant (greater than 4000 g), and gestational diabetes in a previous pregnancy. Options 2, 3, and 4 are not risk factors associated with the development of gestational diabetes. 31OB EXAM1 review The nurse is teaching a pregnant client with diabetes about nutrition and insulin needs during pregnancy. The nurse determines that the client understands dietary and insulin needs if the client states that the second half of pregnancy may require which treatment? 1. Increased insulin 2. Decreased insulin 3. Increased caloric intake 4. Decreased protein intake Rationale: Glucose crosses the placenta, but insulin does not. High fetal demands for glucose, combined with the insulin resistance caused by hormonal changes in the last half of pregnancy, can result in elevation of maternal blood glucose levels. This increases the mother's demand for insulin. This is referred to as the diabetogenic effect of pregnancy. Caloric and protein intake is not affected by diabetes. he nurse is assessing a client with a diagnosis of gestational trophoblastic disease (hydatidiform mole). The nurse understands that which fndings are associated with this condition? Select all that apply. 1. Vaginal bleeding 2. Excessive fetal activity 3. Excessive nausea and vomiting 4. Larger-than-normal uterus for gestational age 5. Elevated levels of human chorionic gonadotropin (hCG) Rationale: The most common fndings of gestational trophoblastic disease (hydatidiform mole) include vaginal bleeding, excessive nausea and vomiting, larger-than-normal uterus for gestational age, elevated levels of hCG, failure to detect fetal heart activity even with sensitive instruments, and early development of gestational hypertension. Fetal activity would not be noted. The nurse in the prenatal clinic is providing nutritional counseling to a pregnant client. The nurse instructs the client to increase the intake of folic acid and tells the client that which food item is highest in folic acid? 1. Pork 2. Cheese 3. Chicken 4. Dried peas Rationale: Sources of folic acid include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Pork, cheese, and chicken are not high in folic acid. Pork is a good source of thiamine. Cheese is a dairy product and is high in calcium. Chicken is a good source of protein 32OB EXAM1 review A pregnant client at 16 weeks' gestation reports to the health care clinic for a triple screen test. The nurse determines that the client understands the purpose of this test when the client makes which statements? Select all that apply. 1. "Prematurity risk increases with a positive result." 2. "This test can be used as a screening for spina bifida." 3. "One of the purposes of this test is to determine the sex of my baby." 4. "This test is a screening test, and I will need other testing if I have abnormal results." 5. "This test can indicate if I may be at an increased risk for having a child with Down syndrome Rationale: A triple screen test is a screening tool. Maternal blood is drawn and alpha-fetoprotein, human chorionic gonadotropin, and estriol values are assessed to determine if the mother is at an increased risk for neural tube defects or chromosomal trisomies. Spina bifda and Down syndrome are the two most common risks that fall into these categories, respectively. These results must be followed by additional diagnostic testing, as the triple screen is only a screening result. This test does not have any relationship to prematurity or sex determination of the fetus. A client in the prenatal clinic asks the nurse about the delivery date. The nurse notes that the client's record indicates that the client began her last menses on March 7, 2018, and ended the menses on March 14, 2018. Using Nägele's rule, the nurse should tell the client that the estimated date of delivery is what date? Fill in the blank. Record your answer using 6 digits (mmddyy). Correct Answer: 121418 Rationale: Nägele's rule is a noninvasive method for estimating the date of birth and is based on the assumption that the menstrual cycle is 28 days. The rule states the following: Subtract 3 months from the frst day of the last menstrual period, add 7 days, then adjust the year. March 7, 2018, minus 3 months is December 7, 2017. December 7, 2017, plus 7 days is December 14, 2017. Adding 1 year brings the date of delivery to December 14, 2018. The prenatal clinic nurse asks a nursing student to identify the physiological adaptations of the cardiovascular system that occur during pregnancy. The nurse determines that the student understands these physiological changes if the student makes which statement? 1. "An increase in pulse rate occurs." 2. "A decrease in blood volume occurs." 3. "A decrease in cardiac output occurs." 4. "The blood pressure increases by 20 mm Hg." Rationale: Between 14 and 20 weeks' gestation, the maternal pulse rate increases slowly by 10 to 15 beats/minute, which lasts until term. Cardiac output and blood volume increase. 33OB EXAM1 review Blood pressure decreases in the frst half of pregnancy and returns to baseline in the second half of pregnancy. The prenatal client asks the nurse about substances that can cross the placental barrier and potentially affect the fetus. The nurse most appropriately explains that which substances can cross this barrier? Select all that apply. 1. Viruses 2. Bacteria 3. Nutrients 4. Antibodies 5. Medications Rationale: Large particles such as bacteria cannot pass through the placenta, but viruses, nutrients, medications, antibodies, and recreational drugs can pass through the placenta and potentially affect the fetus. Metabolic waste products of the fetus cross the placental membrane from the fetal blood into the maternal blood. The maternal kidneys then excrete them. A client who is 8 weeks' pregnant calls the prenatal clinic and tells the nurse that she is experiencing nausea and vomiting every morning. The nurse should suggest which measure that will best promote relief of the signs and symptoms? 1. Eating a high-fat diet 2. Increasing fluids with meals 3. Eating a high-carbohydrate diet 4. Eating dry crackers before arising Rationale: Some strategies for decreasing morning nausea are keeping crackers, Melba toast, or dry cereal at the bedside to eat before getting up in the morning; eating smaller, more frequent meals; decreasing fats; and consuming adequate fluid between meals but not with meals. A high-carbohydrate diet could increase the episodes of nausea. The home care nurse is visiting a prenatal client who has a history of heart disease. The nurse provides instructions to the client regarding home care measures to promote a healthy pregnancy and includes which measure in that instruction? 1. Increase daily calories to ensure weight gain. 2. Maintain a supine position during rest periods. 3. Restrict visitors who may have an active infection. 4. Avoid becoming concerned about placing stress on the heart. Rationale: The client should avoid exposure to infection and not allow persons with active infections to visit. Too much weight gain causes an increase in body requirements and increases stress on the heart. The client should rest on the left side to promote blood 34OB EXAM1 review return. Stress causes increased heart workload, with the potential for adverse consequences. A home care nurse is visiting a pregnant client with a diagnosis of mild preeclampsia. What is the priority nursing intervention during the home visit? 1. Monitor for fetal movement. 2. Monitor the maternal blood glucose. 3. Instruct the client to maintain complete bed rest. 4. Instruct the client to restrict dietary sodium and any food items that contain sodium. Rationale: A client with mild preeclampsia can be managed at home. The priority intervention of the home care nurse is to monitor for fetal movement. The expectant mother also is asked to keep a record of fetal movements. A maternal blood glucose would not provide specifc data related to preeclampsia. Bed rest with bathroom privileges is prescribed; complete bed rest is not necessary. Urine should be checked for protein. Sodium restriction is not necessary. A maternity unit nurse is creating a plan of care for a client with severe preeclampsia who will be admitted to the nursing unit. The nurse should include which nursing intervention in the plan? 1. Restrict food and fluids. 2. Reduce external stimuli. 3. Monitor blood glucose levels. 4. Maintain the client in a supine position Rationale: The client with severe preeclampsia is kept on bed rest in a quiet environment. External stimuli such as lights, noise, and visitors that may precipitate a seizure should be kept to a minimum. Food and fluid are not restricted unless specifcally prescribed by the health care provider. The client is instructed to rest in a left lateral position to decrease pressure on the vena cava, thereby increasing cardiac perfusion of vital organs. A client with severe preeclampsia is admitted to the maternity department. Which room assignment is most appropriate for this client? 1. A private room across from the elevator 2. A semiprivate room across from the nurses' station 3. A private room 2 doors away from the nurses' station 4. A semiprivate room with another client who enjoys watching television Rationale: A quiet room in which stimuli can be minimized is most important for the client with severe preeclampsia. A private room 2 doors away from the nurses' station is the best room assignment for this client. A private room across from the elevator and a semiprivate room across from the nurses' station may be noisy. A semiprivate room with 35OB EXAM1 review a client who enjoys watching television would provide external stimuli, which must be kept minimal for the client with severe preeclampsia. A couple is seen in the fertility clinic. After several tests it has been determined that the husband is not sterile and that the wife has nonpatent fallopian tubes. The nurse is preparing the woman and her husband for an in vitro fertilization. Which statement by the woman or her spouse indicates a need for further information about the procedure? 1. "Ova and sperm are collected and allowed to incubate." 2. "A fertilized ovum is transferred into the woman's uterus." 3. "The procedure is a method of medically assisted reproduction." 4. "The procedure is performed using artificial insemination of sperm instilled through the vagina." Rationale: In vitro fertilization is a method of medically assisted reproduction for women with nonpatent, diseased, or missing fallopian tubes or with infertility of unknown cause. Ova and sperm are obtained from the potential parent or donor, placed in a nutrient medium, and allowed to incubate; then the fertilized ovum is transferred into the woman's uterus. The woman houses the pregnancy throughout gestation and gives birth. Option 4 describes the procedure for artifcial insemination. Options 1, 2, and 3 are correct statements regarding in vitro fertilization. The nurse in the gynecology clinic is reviewing the record of a pregnant client after the frst prenatal visit. The nurse notes that the health care provider has documented that the woman has a platypelloid pelvis. On the basis of this documentation, the nurse anticipates which possible outcomes? Select all that apply. 1. Places the client at risk for dystocia 2. Has an increased probability of cesarean section 3. Is roomy and most conducive to a vaginal birth 4. Places the client at high risk for precipitous labor 5. Has a flat shape that may impede fetal descent 6. Has an oval shape that will require cesarean section Rationale: A platypelloid pelvis has a flat shape that may impede fetal descent, making vaginal delivery more difcult. Because of the constricted shape of this pelvis, rapid delivery will not occur and a cesarean section may be necessary. A gynecoid pelvis is roomy and ideal for vaginal birth. An anthropoid pelvis has an oval shape, and an android pelvis is heart shaped. The nurse is counseling a pregnant woman diagnosed with gestational diabetes at 29 weeks' gestation. Which information should the nurse discuss with the client? Select all that apply. 1. Plan induction at 35 weeks. 36OB EXAM1 review 2. Plan amniocentesis at this time. 3. Schedule a biophysical profile immediately. 4. Plan for weekly nonstress tests at 32 weeks. 5. Obtain nutritional counseling with a dietitian. Rationale: Gestational diabetes can result in delayed lung maturity and complications, and carrying the baby until full term is the goal. The nurse should discuss nonstress testing procedures, the plan for nutritional counseling, and the plan for delivery. Amniocentesis is not indicated at this time. Biophysical profle is done at 32 to 36 weeks' gestation. The nurse provides dietary instructions to a pregnant woman regarding food items that contain folic acid. Which food item should the nurse recommend as a good source of folic acid? 1. Cheese 2. Spinach 3. Potatoes 4. Bananas Rationale: Folic acid is needed during pregnancy for healthy cell growth and repair. A pregnant woman should have at least 4 servings of folic acid–rich foods per day. Food items high in folic acid include glandular meats, yeast, legumes, whole grains, and dark green leafy vegetables. Milk products and cheese supply calcium, potatoes provide vitamin B6, and bananas provide potassium. The nurse is caring for a client with preeclampsia who is receiving an intravenous (IV) infusion of magnesium sulfate. When gathering items to be available for the client, which highest priority item should the nurse obtain? 1. Tongue blade 2. Percussion hammer 3. Potassium chloride injection 4. Calcium gluconate injection Rationale: Toxic effects of magnesium sulfate may cause loss of deep tendon reflexes, heart block, respiratory paralysis, and cardiac arrest. The antidote for magnesium sulfate is calcium gluconate. An airway rather than a tongue blade is an appropriate item. A percussion hammer may be important to assess reflexes but is not the highest priority item. Potassium chloride is not related to the administration of magnesium sulfate. A pregnant client has been diagnosed with a vaginal infection from the organism Candida albicans. Which fnding should the nurse expect to note when assessing this client? 1. Costovertebral angle pain 37OB EXAM1 review 2. Pain, itching, and vaginal discharge 3. Absence of any signs and symptoms 4. Proteinuria, hematuria, edema, and hypertension Rationale: Clinical manifestations of a vaginal Candida infection include pain; itching; and a thick, white vaginal discharge. Costovertebral angle pain, proteinuria, hematuria, edema, and hypertension are clinical manifestations that may be associated with a urinary tract infection. The nurse is performing an assessment on a client seen in the health care clinic for a frst prenatal visit. The client reports February 9 as the frst day of the last menstrual period (LMP). Using Nägele's rule, what date later that same year will the nurse relay as the client's due date? Fill in the blank. Record your answer using 4 digits (mmdd). Correct Answer: 1116 The nurse is performing a measurement of fundal height in a client whose pregnancy has reached 36 weeks of gestation. During the measurement the client begins to feel lightheaded. On the basis of knowledge of the physiological changes of pregnancy, the nurse understands that which is the cause of the lightheadedness? 1. A full bladder 2. Emotional instability 3. Insufficient iron intake 4. Compression of the vena cava Rationale: Compression of the inferior vena cava and aorta by the uterus may cause supine hypotension syndrome late in pregnancy. Having the woman turn onto her left side or elevating the left buttock during fundal height measurement will prevent or correct the problem. The remaining options are unrelated to this syndrome. A pregnant client has been instructed on the prevention of genital tract infections. Which client statement indicates an understanding of these preventive measures? 1. "I can douche anytime I want." 2. "I can wear my tight-fitting jeans." 3. "I should avoid the use of condoms." 4. "I should wear underwear with a cotton panel liner." Rationale: Wearing items with a cotton panel liner allows for air movement in and around the genital area. Douching is to be avoided. Wearing tight clothing can irritate the genital area and does not allow for air circulation. Condoms should be used to minimize the spread of genital tract infections. The nurse is reviewing the results of the rubella screening (titer) with a pregnant client. The test results are positive, and the mother asks if it is safe for her toddler to receive the vaccine. What is the nurse's best response? 38OB EXAM1 review 1. "Most children do not receive the vaccine until they are 5 years of age." 2. "You are still susceptible to rubella, so your toddler should receive the vaccine." 3. "It is not advised for children of pregnant women to be vaccinated during their mother's pregnancy." 4. "Your titer supports your immunity to rubella, and it is safe for your toddler to receive the vaccine at this time." Rationale: All pregnant women should be screened for prior rubella exposure during pregnancy. A positive maternal titer further indicates that a signifcant antibody titer has developed in response to a prior exposure to rubella. All children of pregnant women should receive their immunizations according to schedule. In addition, no defnitive evidence suggests that the rubella vaccine virus is transmitted from client to client. A clinic nurse is explaining to a client the changes in the integumentary system that occur during pregnancy and should tell the client that which change may persist after she gives birth? 1. Epulis 2. Chloasma 3. Telangiectasia 4. Striae gravidarum Rationale: Striae gravidarum, or stretch marks, reflect separation within the underlying connective tissue of the skin. After birth they usually fade, although they never disappear completely. Options 1, 2, and 3 are incorrect. An epulis is a red, raised nodule on the gums that bleeds easily. Chloasma, or mask of pregnancy, is a blotchy, browning hyperpigmentation of the skin over the cheeks, nose, and forehead and is especially noticed in dark-complexioned pregnant women. Chloasma usually fades after the birth. Telangiectasias, or vascular "spiders," are tiny star-shaped or branch-shaped, slightly raised, and pulsating end arterioles usually found on the neck, thorax, face, and arms. They occur as a result of elevated levels of circulating estrogen. The spiders usually disappear after delivery. A clinic nurse is instructing a pregnant client regarding dietary measures to promote a healthy pregnancy. The nurse tells the client about the importance of an adequate daily fluid intake. Which client statement best indicates an understanding of the daily fluid requirement? 1. "I should drink 12 glasses of fruit juices and milk every day." 2. "I should drink 8 to 10 glasses of fluid a day, and I can drink as many diet soft drinks as I want." 3. "I should drink 12 glasses of fluid a day, and I can include the coffee or tea that I drink in the count." 39OB EXAM1 review 4. "I should drink at least 8 to 10 glasses of fluid each day, of which at least 6 glasses should be water." Rationale: The nurse should instruct the client to have an adequate fluid intake daily to assist in digestion and in the management of constipation. The pregnant client should consume at least 8 to 10 (8-oz) glasses of fluid each day, of which at least 6 glasses should be water. It is not necessary for the client to drink 12 glasses of fruit juices and milk every day. Because of their sodium content, diet soft drinks should be consumed in moderation. Caffeinated beverages have a diuretic effect, which may be counterproductive to increasing fluid intake. A prenatal clinic nurse is providing instructions to a group of pregnant women regarding measures to prevent toxoplasmosis. Which client statement indicates a need for further instruction? 1. "I should cook meat thoroughly." 2. "I should drink unpasteurized milk only." 3. "I should avoid contact with materials that are possibly contaminated with cat feces." 4. "I should avoid touching mucous membranes of the mouth or eyes while handling raw meat." Rationale: All pregnant women should be advised to follow certain procedures to prevent the development of toxoplasmosis. All meats should be cooked thoroughly. Pregnant clients should avoid uncooked eggs and unpasteurized milk. All fruits and vegetables should be washed before consumption. Contact with materials that possibly are contaminated with cat feces, such as cat litter boxes, sand boxes, or garden soil should be avoided. Last, the pregnant client should avoid touching mucous membranes of the mouth or eyes while handling raw meat, thoroughly wash all kitchen surfaces that come in contact with uncooked meat, and wash the hands thoroughly after handling raw meat. A home care nurse is monitoring a 16-year-old primigravida who is at 36 weeks' gestation and has gestational hypertension. Her blood pressure during the past 3 weeks has been averaging 130/90 mm Hg. She has had some swelling in the lower extremities and has had mild proteinuria. Which statement by the woman should alert the nurse to the worsening of gestational hypertension? 1. "My vision for the past 2 days has been really fuzzy." 2. "The swelling in my hands and ankles has gone down." 3. "I had heartburn yesterday after I ate some spicy foods." 4. "I had a headache yesterday, but I took some acetaminophen and it went away." Rationale: Visual disturbances such as blurred vision, double vision, or spots before the eyes indicate arterial spasms and edema in the retina and may be a warning sign of worsening gestational hypertension. Resolution of swelling is not an indicator of 40OB EXAM1 review preeclampsia. Heartburn is a common discomfort of pregnancy, especially with intake of spicy foods. A continuous headache indicates poor cerebral perfusion; having just 1 headache that is relieved with medication is not an indicator of preeclampsia. A primigravida is receiving magnesium sulfate for the treatment of gestational hypertension. The nurse who is caring for the client is performing assessments every 30 minutes. Which fnding would be of most concern to the nurse? 1. Urinary output of 20 mL 2. Deep tendon reflexes of 2+ 3. Fetal heart rate of 120 beats/minute 4. Respiratory rate of 10 breaths/minute Rationale: Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less than 12 breaths per minute, the health care provider needs to be notifed and continuation of the medication needs to be reassessed. A urinary output of 20 mL in a 30-minute period is adequate; less than 30 mL in 1 hour needs to be reported. Deep tendon reflexes of 2+ are normal. The fetal heart rate is within normal limits for a resting fetus. The nurse is reviewing fetal development with a client who is at 36 weeks' gestation. Which statements describe the characteristics that are present in a fetus at this time? Select all that apply. 1. Eyelids begin to fuse. 2. Fetal heart begins to beat. 3. The fetal skin is transparent. 4. The fetus weighs approximately 1200 g. 5. The fetus is approximately 42 to 48 cm long. 6. The lecithin-sphingomyelin (L/S) ratio is greater than 2:1. Rationale: At gestational week 36, the fetus weighs 2500 g and is approximately 42 to 48 cm long. The fetal skin is transparent at week 16, but at 36 weeks the skin is pink and the body is rounded. Lanugo is disappearing, and the L/S ratio is greater than 2:1. At gestational week 8, the eyelids begin to fuse. The fetal heart begins to beat at week 5. At 28 weeks' gestation, the fetus weighs approximately 1200 g. A client who has just been told that she is pregnant wants to know when the baby's heart will be completely developed and beating. The nurse reads in the client's chart that the health care provider has determined the client to be at 6 weeks' gestation. What is the nurse's best response? 1. "Your baby's heart right now consists of 2 parallel tubes, so we can't hear it today." 2. "Your baby's heart right now is beginning to partition into 4 chambers and has begun to beat, so we should be able to hear it with a Doppler." 41OB EXAM1 review 3. "Your baby's heart right now is beginning to partition into 4 chambers and has begun to beat, so we should be able to hear it with a fetoscope." 4. "Your baby's heart right now has double heart chambers and has begun to beat, so we should be able to see it beat using an ultrasound machine." Rationale: By gestational week 5, double heart chambers are visible by ultrasound, and the heart begins to beat. The fetal heart is only 2 parallel tubes at week 3. At week 5, the heart can be visualized only by ultrasound. To be heard by Doppler, the gestation must be 10 to 12 weeks; to be heard by fetoscope, the gestation must be at least 20 weeks. During a woman's 38-week prenatal visit, the nurse assesses the fetal heart rate to be 180 beats/minute. What might the nurse suspect as the most likely cause of this tachycardia? 1. Maternal infection 2. Gestational hypertension 3. Gestational diabetes mellitus 4. Consumption of recent high-sugar snack Rationale: The fetal heart rate depends on gestational age and ranges from 160 to 170 beats/minute in the frst trimester but slows with fetal growth to approximately 110 to 160 beats/minute near or at term. Near or at term, if the fetal heart rate is less than 110 beats/minute or more than 160 beats/minute with the uterus at rest, the fetus may be in distress. A fetal heart rate of 180 beats/minute indicates tachycardia and could indicate intrauterine infection and fetal distress. Gestational hypertension, gestational diabetes, and consuming a high-sugar diet may affect the fetal heart rate but are not the most likely causes. The nurse is reviewing the medical record of a woman scheduled for her weekly prenatal appointment. The nurse notes that the woman has been diagnosed with mild preeclampsia. Which interventions should the nurse include in planning nursing care for this client? Select all that apply. 1. Assess blood pressure. 2. Check the urine for protein. 3. Assess deep tendon reflexes. 4. Discuss the need for hospitalization. 5. Teach the importance of keeping track of a daily weight. Rationale: With mild cases of preeclampsia, the condition is monitored with self-care and bed rest at home. Before the need for hospitalization is discussed, the woman would need to be assessed for progression of the disease process. The nurse must assess blood pressure, weight, and the presence of protein in the urine because an increase in these areas would 42OB EXAM1 review During a woman's 20-week prenatal visit, the nurse is measuring fundal height. The nurse locates the fundus at the level of the umbilicus. What should be the nurse's next intervention? 1. Notify the health care provider (HCP). 2. Plan to refer the client for ultrasound testing. 3. Document findings in the electronic health record. 4. Schedule the client for a return appointment in 1 week for reassessment. Rationale: At 20 weeks' gestation, the fundus can be palpated at the umbilicus, the expected location. Because the assessment fnding is normal, documentation of the fnding should be the next step. Information will be shared with the HCP, but since the fnding is normal there is no urgency to do this. A normal assessment fnding does not need to be followed by an ultrasound or an extra prenatal visit. The nurse is teaching a woman in her frst trimester measures to alleviate nausea and vomiting. Which statement by the woman indicates that further teaching is required? 1. "I will avoid fried foods." 2. "I will eat 5 or 6 small meals a day." 3. "I will eat dry crackers for breakfast after I get up." 4. "I will contact the clinic if the vomiting does not subside." Rationale: Nausea and vomiting during the frst trimester constitute a common complaint. A possible cause is the increasing levels of human chorionic gonadotropin or altered carbohydrate metabolism. Dry crackers should be eaten before getting out of bed rather than after arising. The client should avoid fried foods and eat 5 or 6 small meals throughout the day rather than fewer larger meals. The nausea and vomiting should lessen throughout the day, but if they continue, the health care provider should be notifed for further intervention. The nursing instructor asks a nursing student who is preparing to assist with the assessment of an 18 weeks' gestation gravida 2, para 1 (G2P1) pregnant woman to describe expectations related to the process of quickening. Which statements, if made by the student, indicate an understanding of this process? Select all that apply. 1. "It is the thinning of the lower uterine segment." 2. "It is the fetal movement that is felt by the mother." 3. "It is the irregular, painless contractions that occur throughout pregnancy." 4. "It is the soft blowing sound that can be heard when the uterus is auscultated." 5. "It is typically experienced by the multigravida client between 16 and 18 weeks' gestation." 43OB EXAM1 review 6. "It is an experience of feeling fetal movement that is present only in the primigravida client." Rationale: Quickening is fetal movement and may occur as early as 16 weeks' gestation in the multigravida client. The primigravida client typically experiences quickening between weeks 18 and 20. The expectant mother frst notices subtle fetal movements that gradually increase in intensity. Thinning of the lower uterine segment occurs at about the sixth week of pregnancy and is called Hegar's sign. Braxton Hicks contractions are irregular, painless contractions that may occur throughout pregnancy, beginning as early as 16 weeks. A soft blowing sound that corresponds to the maternal pulse may be auscultated over the uterus, and this is known as uterine soufe. This sound is caused by the blood circulation to the placenta and corresponds to the maternal pulse. A multigravida experiences quickening sooner than the primigravida due to prior experience and more rapid physical changes. The nurse is interviewing a 16-year-old client during her initial prenatal clinic visit. The client is beginning week 18 of her frst pregnancy. Which statement, if made by the client, indicates an immediate need for further investigation? 1. "I don't like my figure anymore. My clothes are all too tight." 2. "I don't like my breasts anymore. These silver lines are ugly." 3. "I don't like my stomach anymore. That brown line is disgusting." 4. "I don't like my face anymore. I always look like I have been crying." Rationale: In the correct option, there is an implication of periorbital and facial edema, which could be indicative of gestational hypertension. The question identifes an adolescent who has not sought early prenatal care. Such clients are at higher risk for the development of gestational hypertension. Although the remaining options also deal with body image, and these comments should not be ignored, the need for follow-up is not urgent. he nurse reviews the plan of care for a woman at 37 weeks' gestation who has sickle cell anemia. The nurse determines that which problem listed on the nursing care plan will receive the highest priority? 1. Pain 2. Disturbed body image 3. Insufficient fluid volume 4. Inability to tolerate activity Rationale: In a client with sickle cell anemia, dehydration will precipitate sickling of the red blood cells. Sickling can lead to life-threatening consequences for the pregnant woman and for the fetus, such as an interruption of blood flow to the placenta. Although the remaining options may also be appropriate problems for the client with sickle cell anemia, they are not the priority. The nurse provides instructions to a malnourished client regarding iron supplementation during pregnancy. Which statement, if made by the client, indicates an understanding of the instructions? 44OB EXAM1 review 1. "Iron supplements will give me diarrhea." 2. "Meat does not provide iron and should be avoided." 3. "The iron is best absorbed if taken on an empty stomach." 4. "My body has all of the iron it needs, and I don't need to take supplements." Rationale: Iron is best absorbed if taken on an empty stomach. Iron supplements usually cause constipation. Meats are an excellent source of iron. Iron is needed both to allow for transfer of adequate iron to the fetus and to permit expansion of the maternal red blood cell mass. During pregnancy the relative excess of plasma causes a decrease in the hemoglobin concentration and the hematocrit level. This is a normal adaptation and is known as physiological anemia of pregnancy. A pregnant woman in her second trimester calls the prenatal clinic nurse to report a recent exposure to a child with rubella. Which response by the nurse is most appropriate and supportive to the woman? 1. "You should avoid all school-age children during pregnancy." 2. "There is no need to be concerned if you don't have a fever or rash within the next 2 days." 3. "Be sure to tell the health care provider on your next prenatal visit, but there is little risk in the second trimester." 4. "You were wise to call. I will check your rubella titer screening results, and we can immediately identify whether future interventions are needed." Rationale: Rubella virus is spread by aerosol droplet transmission through the upper respiratory tract and has an incubation period of 14 to 21 days. The risks associated with maternal and subsequent fetal infection during the second trimester include hearing loss and congenital anomalies. Rubella titer determination is a standard antenatal test for childbearing women during their initial screening and entry into the health care delivery system. The correct option helps to clarify maternal concerns with accurate information based on the acquisition of rubella infection and potential fetal side effects. A pregnant woman has a positive history of genital herpes but has not had lesions during this pregnancy. What should the nurse plan to tell the client? 1. "You will be isolated from your newborn infant after delivery." 2. "Vaginal deliveries can reduce neonatal infection risks, even if you have an active lesion at the time." 3. "There is little risk to your newborn infant during this pregnancy, during the birth, and after delivery." 4. "You will be evaluated at the time of delivery for genital lesions, and if any are present, a cesarean delivery will be needed." 45OB EXAM1 review Rationale: With active herpetic genital lesions, cesarean delivery can reduce neonatal infection risks. In the absence of active genital lesions, vaginal delivery is indicated unless there are other indications for cesarean delivery. Maternal isolation is not necessary, but cultures should be obtained from potentially exposed newborn infants on the day of delivery. A pregnant primigravida is seen in the health care clinic and asks the nurse what causes the breasts to change in size and appearance during pregnancy. The nurse plans to base the response on which facts? Select all that apply. 1. The breasts become stretched because of the weight gain. 2. The increased metabolic rate causes the breasts to become larger. 3. The breast changes occur because of the secretion of estrogen and progesterone. 4. Cortisol secreted by the adrenal glands plays a role in increasing the size and appearance of the breasts. 5. Blood vessels beneath the skin often appear as a blue, intertwining network, especially in a primigravida. Rationale: During pregnancy, the breasts change in size and appearance. The increase in size occurs because of the effects of estrogen and progesterone. Estrogen stimulates the growth of mammary ductal tissue, and progesterone promotes the growth of lobes, lobules, and alveoli. A delicate network of veins is often visible just beneath the surface of the skin. The remaining options are unrelated to breast changes during pregnancy. The nurse is conducting a prepared childbirth class and is instructing pregnant women about the method of efeurage. The nurse instructs the women to perform the procedure by doing which action? 1. Contracting and then consciously relaxing different muscle groups 2. Massaging the abdomen during contractions, using both hands in a circular motion 3. Instructing her partner to stroke or massage a tightened muscle by the use of touch 4. Contracting an area of the body, such as an arm or leg, and then concentrating on letting tension go from the rest of the body Rationale: Efeurage is massage of the abdomen during contractions. Women learn to do efeurage using both hands in a circular motion. Progressive relaxation involves contracting and then consciously releasing different muscle groups. Touch relaxation helps the woman to learn to loosen taut muscles when she is touched by her partner. Neuromuscular disassociation helps the woman to relax her body even when 1 group of muscles is strongly contracted. In this procedure, the woman contracts an area such as an arm or leg and then concentrates on letting tension go from the rest of the body. 46OB EXAM1 review During a routine prenatal visit, a client complains of gums that bleed easily with brushing. The nurse performs an assessment and then teaches the client about proper nutrition to minimize this problem. Which statement, if made by the client, indicates an understanding of the proper nutritional measures to minimize this problem? 1. "I will drink 8 ounces of water with each meal." 2. "I will eat 3 servings of cracked wheat bread each day." 3. "I will eat 2 saltine crackers before I get up each morning." 4. "I will eat fresh fruits and vegetables for snacks and for dessert each day." Rationale: Fresh fruits and vegetables will provide vitamins and minerals needed for healthy gums. Drinking water with meals has no direct effect on gums; cracked wheat bread may abrade the tender gums. Eating saltine crackers before arising helps to decrease nausea. A prenatal woman with a history of heart disease has been instructed on care at home. Which statement, if made by the woman, indicates that she understands her needs? 1. "My weight gain is not important." 2. "I should avoid stressful situations." 3. "I should rest by lying on my back." 4. "There is no restriction on people who visit me." Rationale: Stress causes increased heart workload, and the client should be instructed to avoid stress. Too much weight gain can place further demands on the heart. Resting should be on the left side to promote blood return and avoid supine hypotension. To avoid infections, individuals with active infections should not be allowed to visit the client. Otherwise, restrictions are not required. The nurse is reviewing the record of a pregnant woman and notes that the health care provider has documented the presence of Chadwick's sign. Which assessment fnding supports the presence of Chadwick's sign? 1. Darkening of the areola 2. Softening of the uterine isthmus 3. Bluish discoloration of cervix and vagina 4. Palpation of the uterus above the level of the symphysis pubis Rationale: The cervix undergoes signifcant changes after conception. The most obvious changes occur in color and consistency. In response to the increasing levels of estrogen, the cervix becomes congested with blood, resulting in the characteristic bluish color that extends to include the vagina and labia. This discoloration, referred to as Chadwick's sign, is one of the earliest signs of pregnancy. Darkening of the areola occurs during pregnancy but is not related to Chadwick's sign. Softening of the uterine isthmus is 47OB EXAM1 review known as Hegar's sign. The presence of the uterus (fundal height) just above the symphysis pubis dates the pregnancy to be about 13 weeks' gestation. A contraction stress test is scheduled for a pregnant woman, and she asks the nurse to describe the test. What should the nurse include in the teaching? Select all that apply. 1. Uterine contractions are stimulated by Leopold's maneuvers. 2. An external fetal monitor is attached, and the woman ambulates on a treadmill until contractions begin. 3. An external monitor is attached in order to view fetal heart rate response to an established contraction pattern. 4. The uterus is stimulated to contract by the administration of small amounts of oxytocin or by nipple stimulation. 5. Small amounts of oxytocin are administered during internal fetal monitoring to stimulate uterine contractions. Rationale: A contraction stress test assesses placental oxygenation and function, determines fetal ability to tolerate labor, determines fetal well-being, and is performed if the nonstress test is abnormal. The fetus is exposed to the stressor of contractions to assess the adequacy of placental perfusion under simulated labor conditions. An external fetal monitor is applied to the mother, and a 20- to 30-minute baseline strip is recorded. The uterus is then stimulated to contract by the administration of a dilute dose of oxytocin or by having the mother use nipple stimulation until 3 palpable contractions of 40 seconds or longer in a 10-minute period have occurred. Frequent maternal blood pressure readings are taken, and the client is monitored closely while increasing doses of oxytocin are given. Leopold's maneuvers help to determine fetal position and presentation. A treadmill is not used for a contraction stress test. Internal fetal monitoring is not possible until membranes have been ruptured. A nonstress test is performed on a client who is pregnant, and the results of the test indicate nonreactive fndings. The health care provider (HCP) prescribes a contraction stress test. The test is performed, and the nurse notes that the HCP has documented the results as negative. How should the nurse interpret this fnding? 1. A normal test result 2. An abnormal test result 3. A high risk for fetal demise 4. The need for a cesarean delivery 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. Repetitive late decelerations render the test results positive. 48OB EXAM1 review A pregnant woman seen in the health care clinic has tested positive for human immunodefciency virus (HIV). What can the nurse determine based on this information? 1. The woman has the herpes simplex virus (HSV). 2. The woman has contracted an airborne viral disease. 3. The neonate will definitely develop this disease after birth. 4. HIV antibodies are detected by the enzyme-linked immunosorbent assay (ELISA) test. Rationale: Diagnosis of HIV infection depends on serological studies to detect HIV antibodies. The most commonly used test is the ELISA. HIV and herpes simplex virus are different types of infections. HIV infection occurs primarily through the exchange of body fluids, not via airborne disease. A neonate born to an HIV-positive mother is at risk for developing the virus, but it is not an absolute. In the prenatal clinic, the nurse is interviewing a new client and obtaining health history information. Which action should the nurse plan to elicit the most accurate responses to the questions that refer to sexually transmitted infections? 1. Establish a therapeutic relationship. 2. Use specific closed-ended questions. 3. Omit these types of questions because they are highly personal. 4. Apologize for the embarrassment that these questions will cause the client. Rationale: The initial assessment interview establishes the therapeutic relationship between the nurse and the pregnant woman. It is planned, purposeful communication that focuses on specifc content. The remaining options are incorrect and would not lend themselves to eliciting accurate information from the client. The clinic nurse is teaching a pregnant woman about the warning signs in pregnancy. Which, if identifed as a warning sign by the woman, should indicate a need for further education? 1. Rapid weight gain 2. Visual disturbances 3. Generalized or facial edema 4. Presence of irregular, painless contractions Rationale: Braxton Hicks contractions are the normal, irregular, painless contractions of the uterus that may occur throughout pregnancy. Rapid weight gain, visual disturbances, and generalized or facial edema are warning signs in pregnancy. Additional warning signs in pregnancy include vaginal bleeding, premature rupture of the membranes, preterm uterine contractions that are normal and regular, change in or absence of fetal activity, 49OB EXAM1 review severe headache, epigastric pain, persistent vomiting, abdominal pain, and signs of infection. The nurse is performing a physical assessment on a client during her frst prenatal visit to the clinic. The nurse takes the client's temperature and notes that it is 99.2°F. Based on this fnding, which nursing action is most appropriate? 1. Document the temperature. 2. Notify the health care provider. 3. Retake the temperature by the rectal route. 4. Inform the client that the temperature is elevated and antibiotics may be required. Rationale: The normal temperature during pregnancy is 36.2°C to 37.6°C (98°F to 99.6°F). This slight elevation occurs because of the increased metabolic effect that occurs as a result of pregnancy. A temperature greater than this may suggest an infection that could require medical management. The remaining options are unnecessary. A 39-week-gestation pregnant client calls the maternity unit, stating, "My baby has not moved very much in the past few days. Should I be concerned?" Which is the best response made by the nurse? 1. "Six to eight fetal movements in a 24-hour period are adequate to determine that the fetus is healthy." 2. "Fetal movement is a sign of fetal health. Even if the amount has decreased, the fetus is still healthy." 3. "Continue to count fetal movements for the next 24 hours and call your health care provider if the number of movements continues to decrease." 4. "Fetal movements do not decrease as a woman nears term; therefore, you should be seen by your health care provider for further evaluation." Rationale: Fetal movements may decrease during fetal sleep cycles and while a woman is taking depressant medication, drinking alcohol, or smoking cigarettes. A decrease in fetal movement over a period of 1 or more days or as a woman approaches term is abnormal and requires further evaluation for fetal well-being. In most protocols for fetal movement, 10 movements in any designated amount of time (usually 2 or 3 hours) is the minimal number required to determine fetal health, so option 1 can be eliminated because it does not meet the minimal fetal movement requirement. Although fetal movement is a reassuring sign of fetal health, fetal movement that is perceived as being less than on the previous day could indicate a decrease in fetal oxygenation and a need for further evaluation, so therefore eliminate option 2. Option 3 can be eliminated because this recommendation would delay time that could be used to diagnose a possible at-risk fetus. A 25-year-old woman arrives on the maternity unit on February 2. She states that her estimated date of delivery (EDD) is March 22. She is verbalizing complaints of dull lower back pain, pelvic heaviness, and diarrhea for the past few days. On admission for 50OB EXAM1 review observation, the client's blood pressure is 128/80 mm Hg, pulse is 100 beats/minute, respirations are 16 breaths/minute, and temperature is 99°F. The nurse plans care based on which interpretation? 1. The woman requires further evaluation for preterm labor. 2. The woman is suffering from an intestinal bacterial infection. 3. The woman is exhibiting signs and symptoms of gestational hypertension. 4. The woman needs instruction on pelvic tilts to decrease her lower back pain. Rationale: Classic signs and symptoms of preterm labor include lower abdominal cramping, possibly accompanied by diarrhea; dull and intermittent low back pain; painful menstrual-like cramps; suprapubic pain or pressure; pelvic pressure or heaviness; urinary frequency; change in character and amount of vaginal discharge; and rupture of amniotic membranes. Early recognition of preterm labor is essential, so interventions such as tocolytic therapy and administration of antenatal glucocorticoids can be initiated; therefore, further evaluation of the cervix, membrane status, uterine activity, and fetal heart rate is necessary to determine if the client is in preterm labor (the correct option). The client's temperature is only slightly elevated and her diarrhea presents in addition to the signs and symptoms of preterm labor, so option 2 can be eliminated. The client is not exhibiting signs of gestational hypertension, so therefore eliminate option 3. Because the client has additional complaints that may possibly relate to preterm labor, instruction on pelvic tilts to decrease back pain is irrelevant at this time, so therefore eliminate option 4. The nurse in an obstetrical clinic is reviewing current prenatal laboratory results of a pregnant client who is being seen for a routine prenatal visit. The nurse discovers that the client's 1-hour oral glucose tolerance test (OGTT) result was 163 mg/dL (9.3 mmol/L). Which is the nurse's best response to the client? 1. "Your OGTT results indicate that your baby is at high risk for macrosomia and special considerations may be necessary at delivery." 2. "Your OGTT results are within normal limits, but continuing your prenatal visits remains essential to monitor fetal growth and development." 3. "The OGTT is a screening tool for gestational diabetes, and you will need further testing to confirm a diagnosis owing to your results being elevated." 4. "Your OGTT results indicate that you are positive for gestational diabetes. You will be scheduled for a dietitian consultation to plan your daily dietary intake." Rationale: Recommendations for gestational diabetes mellitus (GDM) screening during pregnancy indicate that women should be screened using the 1-hour OGTT at 24 to 28 weeks' gestation. The OGTT is a screening tool, and when results are greater than 140 mg/dL (8 51OB EXAM1 review mmol/L) the recommendation is further assessment via the 3-hour OGTT. Although fetal macrosomia is associated with maternal glucose intolerance, this diagnosis cannot be made with a 1-hour OGTT, thus eliminating option 1. Option 2 indicates that the OGTT results are within normal limits and therefore can be eliminated because the client's 1- hour OGTT results exceed the normal level. Only when 2 or more of the 4 measured glucose levels are exceeded can a woman be diagnosed with GDM. This fact eliminates option 4. The result of a biophysical profle (BPP) of a 28-year-old client at 36 weeks' gestation after the ultrasound components is 8. Based on this result, the nurse should take which action? 1. Notify the health care provider (HCP). 2. Prepare the client for labor induction. 3. Place the fetal heart monitor on the client in order to do a nonstress test (NST). 4. Provide the client with information regarding warning signs and symptoms of pregnancy and discharge her to home. Rationale: The BPP includes 5 components, one of which is an NST. Each of these components allows the practitioners to assess if the central nervous system is fully functional and that the fetus is not hypoxemic. Four components are included in the ultrasound portion of the profle in addition to an NST: fetal breathing movements, fetal movements, fetal tone, and amniotic fluid index. Each of the 5 components is given a score of either 2 or 0. Zero indicates an abnormal result, and a 2 indicates a normal result. After the ultrasound components, the client's BPP is 8 out of 8 possible points. This indicates fetal well-being, but there is a need to complete the BPP by obtaining an NST. Notifying the HCP can be eliminated because the BPP result thus far is normal. Labor induction can be eliminated because the client's gestational age is not term and the BPP reveals no abnormalities or the need for induction. To complete a BPP, an NST must be done; therefore, it is inappropriate to send the client home at this point in her care, so eliminate option 4. A client in week 35 of her pregnancy is placed on the fetal heart monitor for a nonstress test (NST) as a result of her complaints of decreased fetal movement. Twenty minutes after placing the client on the monitor, the nurse sees the following monitor strip and makes which conclusion regarding the NST? Refer to Figure. (From McKinney et al. [2013], p. 319.) View Figure 1. The fetal heart rate (FHR) is negative, with a baseline of 130 beats/minute, moderate variability, and no decelerations. 2. The FHR is reactive, with a baseline of 130 beats/minute, moderate variability, and no decelerations. 3. The FHR is nonreactive, with a baseline of 130 beats/minute, moderate variability, and small episodic decelerations. 52OB EXAM1 review 4. The FHR is positive, with a baseline of 130 beats/minute, moderate variability, and no decelerations. Rationale: The monitor strip clearly reveals that the FHR evidences at least 2 accelerations at 15 beats/minute above baseline and lasting for 15 seconds or more within a 20-minute period or less. These accelerations also are associated with fetal movements that are evidenced by the green blocks on the lower portion of the strip. This interpretation meets the criteria for a reactive NST. Terms used to assess or describe an NST are reactive or nonreactive. The terms positive and negative are used to describe a contraction stress test (CST). Because of the use of these terms, options 1 and 4 are incorrect. The criteria for a reactive NST are 2 or more accelerations of 15 beats/minute, lasting for 15 seconds over a 20-minute period; normal baseline rate (110 to 160 beats/minute); and variability amplitude of 10 or more beats/minute. No decelerations are noted on the fetal monitor strip. The fetal monitor strip identifes tThe charge nurse on a labor and delivery unit has numerous admissions of laboring clients and must transfer 1 of the clients to the postpartum/gynecological unit, where the nurse-to-client ratio will be 1:4. Which antepartum client is the most appropriate one to transfer? 1. The 36-year-old, gravida I, para 0 client who is at 24 weeks' gestation and is being monitored for preterm labor 2. The 26-year-old, gravida I, para 0 client who is at 10 weeks' gestation and is experiencing vaginal bleeding 3. The 40-year-old, gravida III, para 0 client who is at 38 weeks' gestation and is complaining of decreased fetal movement 4. The 29-year-old, gravida I, para 0 client who is at 42 weeks' gestation and had a biophysical profile score of 5 earlier today Rationale: The fetus of the client at 10 weeks' gestation is in a previability stage, whereas those of the other clients are at a stage of viability. There is limited monitoring that can be done with a 10-week fetus; Doppler monitoring is not feasible during the frst trimester. Bed rest and continued monitoring are most likely the primary treatments for this client at this point in her pregnancy. Bed rest could be maintained, and bleeding could be monitored by a postpartum nurse. The clients with preterm and postterm gestations (24 and 42 weeks, respectively) are those most at risk, so these clients require more fetal monitoring. The woman who is at 38 weeks' gestation is also in need of fetal monitoring because of a possibility of decreased fetal movement. Until the fetal well-being can be confrmed with fetal monitoring, this client should remain on the labor and delivery unit where she can be continuously monitored. In addition, the 2 older clients (36 and 40 years) are considered to be of advanced maternal age, indicating a need for closer monitoring. Which medication, if present in the client's history, indicates a need for teaching related to the woman's potential risk for carrying a fetus with a congenital cleft lip or cleft palate? 1. Folic acid 2. Phenytoin 53OB EXAM1 review 3. Bupropion 4. Methyldopa Rationale: An antiseizure medication (specifcally phenytoin) taken during pregnancy is a known risk factor in the development of cleft lip and cleft palate. Folic acid use is recommended during pregnancy to reduce the risk of cleft lip and palate. The use of an antidepressant (bupropion) has not been found to increase a woman's risk of developing a fetus with cleft lip or palate. Although bupropion can be used for smoking cessation, and maternal smoking can contribute to the development of cleft lip, taking bupropion does not increase a woman's risk of having a fetus affected by cleft lip or palate. Methyldopa may be used during pregnancy for maintenance in women with chronic hypertension. The nurse is caring for a client with a diagnosis of placenta previa. The nurse collects data knowing that which are characteristic of placenta previa? Select all that apply. 1. A tender and rigid uterus 2. Painless, bright red vaginal bleeding 3. Location in the lower uterine segment 4. Greenish discoloration of the amniotic fluid 5. Vaginal bleeding accompanied by abdominal pain Rationale: Placenta previa is a condition in which the placenta is located in the lower uterine segment. It does not cause pain but does cause bright red vaginal bleeding. This occurs because the placenta is overriding the cervical os, and as the cervix dilates the placental vessels bleed. Abruptio placenta is painful and results in a rigid and tender uterus. Greenish discoloration of the amniotic fluid occurs as a result of meconium staining. A nulliparous woman asks the nurse when she will begin to feel fetal movements. The nurse responds by telling the woman that the frst recognition of fetal movement will occur at approximately how many weeks of gestation? 1. 5 weeks 2. 9 weeks 3. 13 weeks 4. 18 weeks Rationale: The frst recognition of fetal movements, or feeling life, by the multiparous woman may occur as early as 14 to 16 weeks' gestation. The nulliparous woman may not notice these sensations until 18 weeks' gestation or later, as she has no prior experience and the uterus has not been previously stretched during pregnancy adaptation. The frst recognition of fetal movement is called quickening. 54OB EXAM1 review The nurse is assessing a woman in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which fndings should the nurse expect to note if abruptio placentae is present? Select all that apply. 1. Soft uterus 2. Abdominal pain 3. Nontender uterus 4. Firm uterus by palpation 5. Painless vaginal bleeding Rationale: Classic signs and symptoms of abruptio placentae include vaginal bleeding, abdominal pain, and uterine tenderness and contractions. Mild to severe uterine hypertonicity is present. Pain is mild to severe and either localized or diffuse over 1 region of the uterus, with a boardlike abdomen. Painless vaginal bleeding and a soft, nontender uterus in the second or third trimester of pregnancy are signs of placenta previa. A woman in the third trimester of pregnancy with a diagnosis of mild preeclampsia is being monitored at home. The home care nurse teaches the woman about the signs that need to be reported to the health care provider (HCP). The nurse should tell the woman to call the HCP if which occurs? 1. Urine test is negative for protein. 2. Fetal movements are more than 4 per hour. 3. Weight increases by more than 1 pound in a week. 4. The blood pressure reading ranges between 122/80 mm Hg and 130/82 mm Hg. Rationale: The nurse should instruct the client to report any increase in blood pressure, protein in the urine, weight gain greater than 1 pound per week, or edema. The client also is taught how to count fetal movements and is instructed that decreased fetal activity (3 or fewer movements per hour) may indicate fetal compromise and should be reported. A woman in the third trimester of pregnancy visits the clinic for a scheduled prenatal appointment. The woman tells the nurse that she frequently has leg cramps, primarily when she is reclining. Once thrombophlebitis has been ruled out, the nurse should tell the woman to implement which measure to alleviate the leg cramps? 1. Apply heat to the affected area. 2. Take acetaminophen every 4 hours. 3. Self-administer calcium carbonate tablets 3 times daily. 4. Purchase a chewable antacid that contains calcium and take a tablet with each meal. Rationale: Leg cramps may be a result of compression of the nerves supplying the legs by the 55OB EXAM1 review enlarging uterus, a reduced level of diffusible serum calcium, or an increase in serum phosphorus. For the pregnant woman who complains of leg cramps, the nurse should perform further assessments to ensure that the client is not experiencing thrombophlebitis. Once this has been ruled out, the nurse should instruct the woman to place heat on the affected area, dorsiflex the foot until the spasm relaxes, or stand and walk. The health care provider may prescribe oral supplementation with calcium carbonate tablets or calcium hydroxide gel with each meal to increase the calcium level and lower the phosphorus level, but the nurse should not prescribe these or any other medications. The nurse is preparing a pregnant woman for a transvaginal ultrasound examination. The nurse should tell the woman that which will occur? 1. She will feel some pain during the procedure. 2. She will be placed in a supine left side-lying position. 3. She will feel some pressure when the vaginal probe is moved. 4. She will need to drink 2 quarts of water to attain a full bladder. Rationale: Transvaginal ultrasonography, in which a lubricated probe is inserted into the vagina, allows evaluation of the pelvic anatomy. A transvaginal ultrasound examination is well tolerated by most women because it alleviates the need for a full bladder to perform the test. The woman is placed in a lithotomy position or with her pelvis elevated by towels, cushions, or a folded blanket. The procedure is not physically painful, although the woman may feel pressure as the probe is moved. The nurse is assisting in conducting a prenatal session with a group of expectant parents. One of the expectant parents asks, "How does the milk get secreted from the breast?" What should be the nurse's response? 1. "Prolactin stimulates the secretion of milk, which is called lactogenesis." 2. "Oxytocin stimulates the secretion of milk, which is called lactogenesis." 3. "Progesterone stimulates the secretion of milk, which is called lactogenesis." 4. "Testosterone stimulates the secretion of milk, which is called lactogenesis." Rationale: Prolactin stimulates the secretion of milk, which is called lactogenesis. Oxytocin stimulates contractions during birth and stimulates postpartum contractions to compress uterine vessels and control bleeding. Progesterone stimulates the secretions of the endometrial glands, causing endometrial vessels to become highly dilated and tortuous in preparation for possible embryo implantation. Testosterone is produced by the adrenal glands in the female and induces the growth of pubic and axillary hair at puberty. The nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes mellitus. Which statement by the client indicates a need for further teaching? 56OB EXAM1 review 1. "I need to stay on the diabetic diet." 2. "I will perform glucose monitoring at home." 3. "I cannot exercise because of the negative effects on insulin production." 4. "I will report signs of infection immediately to my health care provider. Rationale: Exercise is safe for the client with gestational diabetes mellitus and is helpful in lowering the blood glucose level. Dietary modifcations are the mainstay of treatment, and the client is placed on a standard diabetic diet. Many women are taught to perform blood glucose monitoring. If the woman is not performing the blood glucose monitoring at home, it will be performed at the clinic or health care provider's ofce. Signs of infection need to be reported to the health care provider. A client calls the health care provider's ofce to schedule an appointment because she has missed 2 menstrual cycles and has always been very regular. The client receives an appointment for the next day. The nurse should expect which fndings to be present at this prenatal visit if the client is pregnant? Select all that apply. 1. Chadwick's sign 2. Vertex presentation 3. Positive pregnancy test 4. Fetal heart rate audible by fetoscope 5. Fetal movement detectable by the mother Rationale: Having missed 2 menstrual cycles with a normal history, the client is at approximately 8 weeks' gestation. Hormonal changes lead to vascular congestion in the cervix and vagina. The tissues have an appearance of looking "blue," and this change is identifed by the term Chadwick's sign. In early pregnancy, human chorionic gonadotropin (hCG) is produced by trophoblastic cells that surround the developing embryo. This hormone is responsible for a positive pregnancy test. The pregnancy is not advanced signifcantly enough to be able to determine a presentation. Fetal heart rate is not audible by fetoscope until approximately 20 weeks. The earliest a mother experiences fetal movement is approximately 14 weeks. The nurse is teaching a pregnant client about the physiological effects and hormonal changes that occur during pregnancy. The client asks the nurse about the role of estrogen in pregnancy. Which responses should the nurse give the client about the role of estrogen? Select all that apply. 1. It maintains and relaxes the uterine lining for implantation. 2. It stimulates metabolism of glucose and converts the glucose to fat. 3. It increases the blood flow to mucous membranes and causes them to swell and soften. 4. It prevents the involution of the corpus luteum and maintains the production of progesterone until the placenta is formed. 57OB EXAM1 review 5. It stimulates uterine development to provide an environment for the fetus and stimulates the breasts to prepare for lactation. Rationale: Estrogen is a very important hormone of pregnancy. It is responsible for vasocongestion of the mucous membranes. Estrogen stimulates uterine development to provide an environment for the fetus and stimulates the breasts to prepare for lactation. Progesterone maintains the uterine lining for implantation and relaxes all smooth muscle. Human placental lactogen stimulates the metabolism of glucose and converts the glucose to fat; it is antagonistic to insulin. Human chorionic gonadotropin prevents involution of the corpus luteum and maintains the production of progesterone until the placenta is formed. The nurse is collecting data from a client during the frst prenatal visit. The client is anxious to know the sex of the fetus and asks the nurse when she will be able to know. The nurse should respond to the client knowing that the sex of the fetus is determined by which weeks? 1. 6 to 8 2. 8 to 10 3. 12 to 16 4. 20 to 22 Rationale: By the end of the twelfth week of gestation, the fetal sex can be determined by the appearance of the external genitalia on ultrasound; therefore, the other options are incorrect The nurse is collecting data from a client seen in the health care clinic for a frst prenatal visit. The nurse asks the client when the frst day of her last menstrual period was and the client reports February 9, 2018. Using Nägele's rule, the nurse determines that what is the estimated date of delivery? Fill in the blank. Record your answer using 6 digits (mmddyy). Correct Answer: 111618 Rationale: Nägele's rule determines the estimated date of birth and works on the premise that the woman has a 28-day menstrual cycle. To calculate the estimated date of delivery, subtract 3 months from the frst day of the last menstrual period, add 7 days, and then add 1 year if needed. Therefore, the frst day of the last menstrual period, February 9, 2018; subtract 3 months, November 9, 2017; add 7 days, November 16, 2017; and add 1 year, November 16, 2018. A pregnant client is seen in the health care clinic. During the prenatal visit, the client informs the nurse that she is experiencing pain in her calf when she walks. Which is the most appropriate nursing action? 1. Instruct the client to avoid walking. 2. Assess for signs of venous thrombosis. 3. Instruct the client to elevate the legs throughout the day. 58OB EXAM1 review 4. Tell the client that this is normal during pregnancy. Rationale: If a woman complains of calf pain during walking, it could be an indication of venous thrombosis of the lower extremities. The most appropriate nursing action is to check for the presence of additional signs of venous thrombosis. Ambulation is a necessary exercise, and the woman should be encouraged to ambulate during pregnancy. Although it is important to elevate the legs during pregnancy, elevating the legs consistently is not the most appropriate nursing action. It is not appropriate to tell the client that this is normal during pregnancy. A client in her second trimester of pregnancy is seen at the health care clinic. The nurse collects data from the client and notes that the fetal heart rate is 90 beats/minute. Which nursing action is appropriate? 1. Document the findings. 2. Notify the health care provider (HCP). 3. Inform the client that everything is normal and fine. 4. Instruct the client to return to the clinic in 1 week for reevaluation of the fetal heart rate. Rationale: The fetal heart rate should be 110 to 160 beats/minute during pregnancy. A fetal heart rate of 90 beats/minute (bradycardia) requires that the HCP be notifed and the client be evaluated further. The other options are inappropriate and delay necessary intervention. The nurse is caring for a pregnant woman who has herpes genitalis. The nurse provides instructions to the woman about treatment modalities that may be necessary for this condition. Which statement made by the woman indicates an understanding of these treatment measures? 1. "I do not need to abstain from sexual intercourse." 2. "I need to use vaginal creams after I douche every day." 3. "I need to douche and perform a sitz bath 3 times a day." 4. "It may be necessary to have a cesarean section for delivery." Rationale: If a woman has an active lesion, either recurrent or primary at the time of labor, delivery should be by cesarean section. Women are advised to abstain from sexual contact while the lesions are present. If it is an initial infection, the woman should continue to abstain from sexual intercourse until the cultures are negative because prolonged viral shedding may occur. Douches are contraindicated, and the genital area should be kept clean and dry to promote healing. A pregnant woman tests positive for the hepatitis B virus (HBV). The woman asks the nurse if she will be able to breast-feed the baby as planned after delivery. Which response by the nurse is most appropriate? 1. "Breast-feeding can start 6 months after delivery." 2. "Breast-feeding is allowed after the baby has been vaccinated with 59OB EXAM1 review immune globulin." 3. "Breast-feeding is not advised, and you should seriously consider bottlefeeding the baby." 4. "Breast-feeding is not a problem, and you will be able to breast-feed immediately after delivery." Rationale: Although HBV is transmitted in breast milk, after scheduled newborn vaccines and immune globulin have been administered to the newborn, the woman may breast-feed without risk to the newborn. The remaining options are incorrect responses. The nurse is collecting data from a client who is at 32 weeks' gestation. The nurse measures the fundal height in centimeters and expects the fndings to be how many centimeters (cm)? 1. 22 cm 2. 28 cm 3. 32 cm 4. 40 cm Rationale: From 22 weeks until term, the fundal height measured in centimeters is roughly plus or minus 2 cm of the gestational age of the fetus in weeks. If the fundal height exceeds weeks of gestation, additional assessment is necessary to investigate the cause for the unexpected uterine size. If an unexpected increase in uterine size is present, it may be that the estimated date of delivery is incorrect and the pregnancy is more advanced than previously thought. If the estimated date of delivery is correct, it may be possible that more than 1 fetus is present. A pregnant client is seen in the health care clinic for a regular prenatal visit. The client tells the nurse that she is experiencing irregular contractions. The nurse determines that the client is experiencing Braxton Hicks contractions. Which nursing action should the nurse implement? 1. Contact the health care provider. 2. Instruct the client to maintain bed rest for the remainder of the pregnancy. 3. Instruct the client that these are common and may occur throughout the pregnancy. 4. Call the maternity unit and inform them that the client will be admitted in a prelabor condition Rationale: Braxton Hicks contractions are irregular, painless contractions that occur throughout pregnancy, although many expectant mothers do not notice them until the third trimester. Because Braxton Hicks contractions may occur and are normal in some pregnant women during pregnancy, the other options are unnecessary and inaccurate. 60OB EXAM1 review The nurse is reviewing the record of a client who has just been told that her pregnancy test is positive. The health care provider has documented the presence of frst trimester pregnancy signs. Which signs should the nurse anticipate as being present during this time frame? Select all that apply. 1. Hegar's sign 2. Babinski's sign 3. Ortolani's sign 4. Goodell's sign 5. Chadwick's sign Rationale: In the early weeks of pregnancy, the uterus and cervix undergo physical changes. The uterine isthmus softens (Hegar's sign); the cervix becomes softer as a result of pelvic vasoconstriction, causing Goodell's sign; and the cervix and vagina become vasocongested, which gives a blue appearance and is known as Chadwick's sign. Babinski's sign is related to neurological integrity. Ortolani's sign is related to the presence of hip dysplasia. A nursing instructor asks a nursing student to describe the process of quickening. Which statements by the student indicate an understanding of this term? Select all that apply. 1. "It is the thinning of the lower uterine segment." 2. "It is the fetal movement that is felt by the mother." 3. "It is irregular, painless contractions that occur throughout pregnancy." 4. "It is the soft blowing sound that can be heard when the uterus is auscultated." 5. "It is a process that occurs in the pregnant woman as early as 16 weeks but definitely by week 20." Rationale: Quickening is fetal movement and is not perceived until the second trimester. Between 16 and 20 weeks' gestation, the expectant client frst notices subtle fetal movements that gradually increase in intensity. A thinning of the lower uterine segment occurs at about 6 weeks' gestation and is called Hegar's sign. Braxton Hicks contractions are irregular, painless contractions that occur throughout pregnancy, although many expectant mothers do not notice them until the third trimester. A soft blowing sound that corresponds to the maternal pulse may be auscultated over the uterus, known as uterine soufe. This sound is caused by the blood circulation to the placenta and corresponds to the maternal pulse. A pregnant client asks the nurse in the clinic, "When will I begin to feel fetal movement?" Which response should the nurse make? 1. Between 6 and 8 weeks 2. Between 8 and 10 weeks 61OB EXAM1 review 3. Between 12 and 14 weeks 4. Between 16 and 20 weeks Rationale: Fetal movement, called quickening, is not perceived until the second trimester. Between 16 and 20 weeks' gestation, the expectant client frst notices subtle fetal movements that gradually increase in intensity. Therefore, the remaining options are incorrect. A rubella titer is performed on a client who has just been told that she is pregnant. The results of the titer indicate that the client is not immune to rubella. Which should the nurse anticipate to be prescribed for this client? 1. Immunization with rubella 2. Retesting rubella titer during pregnancy 3. Antibiotics to be taken throughout the pregnancy 4. Counseling the mother regarding therapeutic abortion Rationale: A rubella titer is performed to determine immunity to rubella. If the client's titer is less than 1:8, the mother is not immune. A retest during pregnancy is prescribed, and the mother is immunized postpartum if she is not immune. Antibiotics are not prescribed. Counseling the client regarding therapeutic abortion is an inaccurate option A nursing student is preparing to instruct a pregnant client in performing Kegel exercises. The nursing instructor asks the student the purpose of Kegel exercises. Which response made by the student indicates an understanding of the purpose? Select all that apply. 1. "The exercises will help reduce backaches." 2. "The exercises will help prevent ankle edema." 3. "The exercises will help prevent urinary tract infections." 4. "The exercises will help strengthen the pelvic floor in preparation for delivery." 5. "The exercises will help strengthen the muscles that support the bladder and urethra." Rationale: Kegel exercises will assist in strengthening the pelvic floor as well as the muscles that support the bladder and urethra. Pelvic tilt exercises will help to reduce backaches. Leg elevation will assist in preventing ankle edema. Instructing a client to drink 8 oz of fluids 6 times a day will help to prevent urinary tract infections. The nurse in a health care clinic is instructing a client on how to perform kick counts. Which statement made by the client indicates a need for further teaching? 1. "I should lie on my back to perform the procedure." 2. "I will use a clock or a timer and record the number of movements or kicks." 62OB EXAM1 review 3. "I should count the fetal movements for 30 to 60 minutes 3 times a day." 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 lie on her side, not her back, when performing kick counts. Lying on the back increases the risk for vena cava syndrome. The client should use a timer or a clock and should record the number of movements felt during that time. The client is advised to count the fetal movements for 30 to 60 minutes 3 times a day. The client is instructed to place her hands on the largest part of her abdomen and concentrate on the fetal movements. A pregnant client asks the nurse, "What should I expect during a nonstress test?" Which information should the nurse provide to the client? 1. "The test is an invasive procedure and requires that you sign an informed consent." 2. "The fetus is challenged by uterine contractions to obtain the necessary information." 3. "The test will take about 2 hours and will require close monitoring for 2 hours after the procedure is completed." 4. "An ultrasound transducer that records fetal heart activity is secured over the abdomen where the fetal heart is heard most clearly." Rationale: A nonstress test is performed to assess fetal well-being. It is a noninvasive test, and an ultrasound transducer that records fetal heart activity is secured over the maternal abdomen where the fetal heart is heard most clearly. A tocotransducer that detects uterine activity and fetal movement is then secured to the maternal abdomen. Fetal heart activity and movements are recorded. The test is termed nonstress because it consists of monitoring only; the test does not include any invasive components. The fetus is not challenged or stressed by uterine contractions to obtain the necessary data. The nonstress test takes about 30 to 40 minutes. The nurse provides teaching on how to relieve discomfort to a client in her second trimester of pregnancy who is having frequent low back pain and ankle edema at the end of the day. Which statement made by the client indicates an understanding of the teaching? 1. "When I get home I should lie on my left side, with my feet in a dorsiflexed position." 2. "I should soak in a tub bath of hot water when I get home and then perform pelvic tilt exercises." 3. "When I get home I should lie on my right side, with my feet elevated on a pillow, and put a heating pad on my back." 4. "When I get home I should lie on the floor, with my legs elevated on a couch, and turn my hips and knees at right angles." 63OB EXAM1 review Rationale: Lying on the floor with the legs elevated on a couch with the hips and knees at right angles will produce a posture of pelvic tilt while countering gravity, which is the force that leads to edema of the lower extremities. Lying on the left side with the feet dorsiflexed may help with the reduction of hemorrhoids. Remember that heat needs to be prescribed by a health care provider (HCP). A pregnant client calls the nurse at the health care provider's ofce and reports that she has noticed a thin, colorless vaginal drainage. Which information is most appropriate for the nurse to provide 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: Many pregnant clients notice an increased thin, colorless or yellow vaginal discharge throughout pregnancy. The increase in the amount of discharge may be bothersome, but it is usually a normal occurrence. This occurrence does not require that the client report to the health care clinic or emergency department immediately. If vaginal discharge is profuse, panty liners may be desirable. The client should not use tampons, because they may increase the likelihood for development of an infection or toxic shock syndrome. If panty liners are used, they should be changed frequently. The nurse has assisted in performing a nonstress test on a pregnant client and is reviewing the documentation related to the results of the test. The nurse notes that the health care provider has documented the test results as reactive. How should the nurse interpret this result? 1. Normal findings 2. Abnormal findings 3. Need for further evaluation 4. That the findings on the monitor were difficult to interpret Rationale: A reactive nonstress test is a normal result. To be considered reactive, the baseline must be within normal range (110 to 160 beats/minute with good variability), and there must be 2 or more fetal heart rate accelerations of at least 15 beats/minute, each with a duration of at least 15 seconds, in a 20-minute interval. Therefore, the other options are incorrect. A pregnant client calls the clinic and tells the nurse that she is experiencing leg cramps and is awakened by the cramps at night. Which activity should the nurse tell the client to perform when the cramps occur? 1. Dorsiflex the foot while flexing the knee. 2. Dorsiflex the foot while extending the knee. 64OB EXAM1 review 3. Plantar flex the foot while flexing the knee. 4. Plantar flex the foot while extending the knee. Rationale: Leg cramps occur when the pregnant client stretches the leg and plantar flexes the foot. Dorsiflexing the foot while extending the knee stretches the affected muscle, prevents the muscle from contracting, and stops the cramping. Therefore, the other activities are incorrect. he nurse is providing instructions about treatment for hemorrhoids to a client in the second trimester of pregnancy. Which statement made by the client indicates a need for further teaching? 1. "Cool sitz baths will help in relieving the discomfort." 2. "I should perform Kegel exercises as you have instructed." 3. "I should apply heat packs to the hemorrhoids to help them shrink." 4. "I can apply ice packs to the hemorrhoids to assist in relieving discomfort." Rationale: Hot packs will increase the blood flow to the area and worsen the discomfort from hemorrhoids. Remedies for the symptoms of hemorrhoids include ice packs, warm or cold sitz baths, gentle cleansing, and topical ointments and anesthetic agents. Kegel exercises help to strengthen the perineum. The clinic nurse is discussing nutrition with a pregnant client who has lactose intolerance. Which food should the nurse instruct the client to eat to supplement the dietary source of calcium? 1. Parmesan cheese 2. Broccoli 3. Creamed spinach 4. Freshly squeezed orange juice Rationale: The best source of calcium is dairy products. Cheese is a dairy product and cannot be eaten when the client has lactose intolerance; therefore, women with lactose intolerance need other sources of calcium. Calcium is present in dark green leafy vegetables, broccoli, legumes, nuts, and dried fruits. Spinach contains calcium, but it also contains oxalates that decrease calcium availability. In addition, creamed spinach may not be tolerated by a client with lactose intolerance. Orange juice does not contain signifcant amounts of calcium unless it has been fortifed with calcium. The nurse is providing instructions to a pregnant client visiting the antenatal clinic about foods that are rich in folic acid. Which food should the nurse encourage the client to consume because it is highest in folic acid? 65OB EXAM1 review 1. Rice 2. Cheese 3. Chicken 4. Green leafy vegetables Rationale: Of the choices available, green leafy vegetables are highest in folic acid. Other sources of folic acid include whole grains, fruits, liver, dried peas, and beans. Chicken, rice, and cheese are not high in folic acid. Cheese is high in calcium, and rice and chicken are good sources of iron A pregnant client asks the nurse about the types of exercises that are allowed during pregnancy. Which exercise should the nurse instruct the client to engage in? 1. Swimming 2. Water skiing 3. Downhill skiing 4. Aerobic exercising Rationale: Non–weight-bearing exercises are preferable to weight-bearing exercises. Non–weightbearing exercise, such as swimming, is allowed during pregnancy. Competitive or highrisk sports, such as scuba diving, water skiing, downhill skiing, horseback riding, basketball, volleyball, aerobic exercise, and gymnastics, should be avoided. Other exercises to avoid are shoulder standing and bicycling with the legs in the air because the use of the knee-chest position should be avoided. A pregnant client reports to the health care clinic complaining of loss of appetite, weight loss, and fatigue. A sputum culture is obtained, and Mycobacterium tuberculosis is identifed in the sputum. Which instruction should the nurse provide to the client regarding therapeutic management of tuberculosis? 1. The need for therapeutic abortion is required. 2. Medication will not be started until after delivery of the fetus. 3. Isoniazid plus rifampin will be required for a total of 9 months. 4. The newborn must receive medication therapy immediately following birth. Rationale: More than 1 medication may be used to prevent the growth of resistant organisms in the pregnant client with tuberculosis. Treatment must continue for a prolonged period. The preferred treatment for the pregnant client is isoniazid plus rifampin daily for a total of 9 months. Ethambutol is added initially if medication resistance is suspected. Pyridoxine (vitamin B6) is often administered with isoniazid to prevent fetal neurotoxicity. The infant will be tested at birth and may be started on preventive isoniazid therapy. Skin testing on the infant should be repeated at 3 months, and 66OB EXAM1 review isoniazid may be stopped if the skin test result remains negative. If the skin test result converts to positive, a full course of isoniazid should be given. The nurse provides home care instructions to a pregnant client with a history of cardiac disease. Which statement made by the client indicates a need for further teaching? 1. "It is best that I rest on my left side to promote blood return to the heart." 2. "I need to avoid excessive weight gain to prevent increased demands on my heart." 3. "I need to try to avoid stressful situations because stress increases the workload on the heart." 4. "During the pregnancy, I need to avoid contact with other individuals as much as possible to prevent infection." Rationale: To avoid infections, visitors with active infections should not be allowed to visit the client; otherwise restrictions are not required. Resting should be done while lying on the left side to promote blood return. Too much weight gain can place further demands on the heart. Stress causes increased workload on the heart, and the client should be instructed to avoid stress. The nurse is collecting data on a pregnant client in the frst trimester of pregnancy diagnosed with iron defciency anemia. The nurse should monitor the client to detect which manifestation indicating that this problem has not yet resolved? 1. Pink mucous membranes 2. Increased vaginal secretions 3. Complaints of daily headaches and fatigue 4. Complaints of increased frequency of voiding Rationale: Anemia is one of the most common problems in pregnancy, and iron defciency anemia and folic acid defciency anemia are 2 of the most common types. It is estimated that between 20% and 60% of all women are anemic at some point during pregnancy, with hemoglobin concentration lower than 10.0 to 11.0 g/dL (100 to 110 mmol/L). Complaints of daily headaches and fatigue are abnormal fndings and may reflect complications caused by decreased oxygen supply to vital organs, thus supporting laboratory fndings. The incorrect options are expected fndings in the frst trimester of pregnancy. The nurse is conducting a routine screening to detect a client's risk for toxoplasmosis parasite infection during pregnancy. Which factor should the nurse ask the client about to determine this risk? 1. Presence of cats in the home 2. Number of sexual partners during pregnancy 3. Exposure to children with rashes or gastrointestinal symptoms 4. History of high fevers or unusual rashes during the first 6 weeks of pregnancy 67OB EXAM1 review Rationale: Toxoplasmosis is a systemic (and usually asymptomatic) illness caused by a protozoan parasite. Approximately one third of all women in the United States have positive antibody titers for toxoplasmosis, thus confrming prior exposure. Humans acquire the infection by consuming inadequately cooked meat, eggs, or milk; by ingesting or inhaling the oocyst stage excreted in feline feces or contaminated soil; or by receiving contaminated blood products. Other than transplacental infection, this disease is rarely transmitted from human to human. During pregnancy, the parasite may be transmitted across the placenta and cause severe infection in the developing embryo or fetus. The other options are questions unrelated to toxoplasmosis. Which is the priority nursing action for the client with an ectopic pregnancy? 1. Assessing urine for proteinuria 2. Checking the electrolyte values 3. Monitoring for signs of infection 4. Monitoring the pulse and blood pressure Rationale: Nursing care for a client with a possible ectopic pregnancy is focused on preventing or identifying hypovolemic shock and controlling pain. An elevated pulse rate and a drop in blood pressure are indicators of shock. Proteinuria may be associated with preeclampsia, and an elevation in temperature is an indicator of infection. Electrolyte values are unrelated to ectopic pregnancy. The nurse is reviewing the record of a pregnant client seen in the health care clinic for the frst prenatal visit. Which data should alert the nurse that the client is at risk for developing gestational diabetes during this pregnancy? Select all that apply. 1. The client's last baby weighed 10 lb at birth. 2. The client has a family history of type 1 diabetes. 3. The client is 5 feet, 3 inches tall and weighs 165 lb. 4. The client's previous deliveries were by cesarean section. 5. The client has a history of gestational diabetes with her previous pregnancy. Rationale: Known risk factors that increase the risk of developing gestational diabetes include obesity (more than 198 lb), chronic hypertension, family history of type 2 diabetes, previous birth of a large infant (more than 4000 g), and gestational diabetes in a previous pregnancy. The other options are not risk factors associated with the development of gestational diabetes. The nurse is teaching a pregnant client with diabetes about nutrition and insulin needs during pregnancy. The nurse determines that the client understands dietary and insulin needs if the client states that which may be required during the second half of pregnancy? 1. Increased insulin 68OB EXAM1 review 2. Decreased insulin 3. Increased caloric intake 4. Decreased caloric intake Rationale: Glucose crosses the placenta, but insulin does not. High fetal demands for glucose, combined with the insulin resistance caused by hormonal changes in the last half of pregnancy can result in elevation of maternal blood glucose levels. This increases the mother's demand for insulin and is referred to as the diabetogenic effect of pregnancy. Caloric requirements are not affected by diabetes. The nurse is providing instructions about taking iron supplements to a pregnant client. The nurse determines that the client understands the instructions if the client states that she will take the supplements with which drink? 1. Tea 2. Milk 3. Coffee 4. Orange juice Rationale: Foods containing ascorbic acid will increase the absorption of iron. Calcium and phosphorus in milk and tannin in tea decrease iron absorption. Caffeine in coffee binds iron and prevents it from being fully absorbed. Orange juice is the only item that contains ascorbic acid and will increase the absorption of iron supplements. The nurse is assisting the health care provider to perform Leopold's maneuvers on a pregnant client. Which action should the nurse perform before the procedure? 1. Ask the client to urinate. 2. Ask the client to drink 8 oz of water. 3. Locate the fetal heart tones with a fetoscope. 4. Warm the sonogram gel before placing it on the client's abdomen. Rationale: An empty bladder contributes to a woman's comfort during this examination. Drinking water to fll the bladder and warming sonogram gel may be performed before a sonography (ultrasound). Often Leopold's maneuvers are performed to aid the examiner in locating the fetal heart tones. The nurse is collecting data on clients who are in their frst trimester of pregnancy. The nurse is concerned with identifying clients who may be at risk for the development of postpartum complications. Which client is least likely to be at risk for the development of thrombophlebitis in the postpartum period? 1. A 35-year-old client who reports that she smokes 2. A 26-year-old client with a family history of thrombophlebitis 3. A 37-year-old client in her fourth pregnancy who is overweight 69OB EXAM1 review 4. A 22-year-old client in her first pregnancy who states that oral contraceptives taken in the past have caused thrombophlebitis Rationale: Certain factors create a risk for the development of thrombophlebitis. These factors include smoking, varicose veins, obesity, a history of thrombophlebitis, women who are older than 35 years or have had more than 3 pregnancies, and women who have had a cesarean birth. The client described in the correct option is least likely to be at risk for the development of a thromboembolic disorder because this client has a family history rather than a personal history of thrombophlebitis. The clinic nurse is instructing a pregnant client in her frst trimester about nutrition. The nurse should determine that the client needs further teaching if the client believes that which is true about nutrition during pregnancy? 1. Iron supplements should be taken throughout the pregnancy. 2. Calcium intake should be increased for the duration of the pregnancy. 3. Pregnancy greatly increases the risk of malnourishment for the mother. 4. The maternal diet significantly influences fetal growth and development. Rationale: Although pregnancy poses some nutritional risk for the mother, the client is not at risk of becoming malnourished. Intake of dietary iron is usually insufcient for most pregnant women, and iron supplements are routinely encouraged. Calcium is critical during the third trimester but must be increased from the onset of pregnancy. Good nutrition during pregnancy signifcantly and positively influences fetal growth and development. The nurse is providing emergency measures to a client in labor who has been diagnosed with a prolapsed cord. The mother becomes anxious and frightened and says to the nurse, "Why are all of these people in here? Is my baby going to be all right?" Which client problem is most appropriate to address at this time? 1. The client's fear 2. The client's fatigue 3. The client's inability to control the situation 4. The client's inability to cope with the situation Rationale: The mother is anxious and frightened, and the most appropriate problem to address for the client at this time is fear. There are no data in the question to support a client problem with fatigue, inability to control the situation, or inability to cope with the situation. These problems may be considered for this client at some point during the hospitalization experience. The maternity nurse is caring for a client with abruptio placentae and is monitoring her for disseminated intravascular coagulation (DIC). Which assessment fndings are most likely associated with disseminated intravascular coagulation? Select all that apply. 1. Petechiae 70OB EXAM1 review 2. Hematuria 3. Increased platelet count 4. Prolonged clotting times 5. Oozing from injection sites 6. Swelling of the calf of 1 leg Rationale: DIC is a state of diffuse clotting in which clotting factors are consumed, leading to widespread bleeding. Platelets are decreased because they are consumed by the process. Coagulation studies show no clot formation (and are thus normal to prolonged), and fbrin plugs may clog the microvasculature diffusely rather than in an isolated area. The presence of petechiae, hematuria, and oozing from injection sites are signs associated with DIC. Swelling and pain in the calf of 1 leg are more likely to be associated with thrombophlebitis. The nurse in a labor room is assisting with the vaginal delivery of a newborn infant. The nurse should monitor the client closely for the risk of uterine rupture if which occurred? 1. Forceps delivery 2. Schultz presentation 3. Hypotonic contractions 4. Weak bearing-down efforts Rationale: Excessive fundal pressure, forceps delivery, violent bearing-down efforts, tumultuous labor, and shoulder dystocia can place a client at risk for traumatic uterine rupture. Schultz presentation is the expulsion of the placenta with the fetal side presenting frst and is not associated with uterine rupture. Hypotonic contractions and weak bearingdown efforts do not add to the risk of rupture because they do not add to the stress on the uterine wall. The nurse is caring for a client who is experiencing a precipitous labor and is waiting for the health care provider to arrive. When the infant's head crowns, what instruction should the nurse give the client? 1. Bear down. 2. Breathe rapidly. 3. Hold your breath. 4. Push with each contraction. Rationale: During a precipitous labor, when the infant's head crowns the nurse instructs the client to breathe rapidly to decrease the urge to push. The client is not instructed to push or bear down. Holding the breath decreases the amount of oxygen to the mother and the fetus. 71OB EXAM1 review The nurse explains the purpose of efeurage to a client in early labor. Which statement should the nurse include in the explanation? 1. "It is the application of pressure to the sacrum to relieve a backache." 2. "It is a form of biofeedback to enhance bearing-down efforts during delivery." 3. "It is light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus." 4. "It is performed to stimulate uterine activity by contracting a specific muscle group while other parts of the body rest." Rationale: Efeurage is a specifc type of cutaneous stimulation involving light stroking of the abdomen and is used before transition to promote relaxation and relieve mild to moderate pain. Efeurage also provides tactile stimulation to the fetus. Options 1, 2, and 4 are inaccurate descriptions of efeurage. A client in labor is dilated 10 cm. At this point in the labor process, at least how often should the nurse assess and document the fetal heart rate? 1. Hourly 2. Every 15 minutes 3. Every 30 minutes 4. Before each contraction Rationale: The second stage of labor begins when the cervix is dilated completely (10 cm). Maternal pulse, blood pressure, and fetal heart rate are assessed every 5 to 15 minutes, depending on agency protocol; some agency protocols recommend assessment after each contraction. Hourly and every 30 minutes represent lengthy time intervals for assessment in this stage of labor. The nurse is caring for a client in labor and prepares to auscultate the fetal heart rate (FHR) by using a Doppler ultrasound device. Which action should the nurse take to determine fetal heart sounds accurately? 1. Noting whether the heart rate is greater than 140 beats/minute 2. Placing the diaphragm of the Doppler on the mother's abdomen 3. Palpating the maternal radial pulse while listening to the FHR 4. Performing Leopold's maneuvers first to determine the location of the fetal heart Rationale: The nurse should simultaneously palpate the maternal radial or carotid pulse and auscultate the FHR to differentiate between the two. If the fetal and maternal heart rates are similar, the nurse may mistake the maternal heart rate for the FHR. Noting whether the heart rate is more than 140 beats/minute or placing the diaphragm of the Doppler on the mother's abdomen will not ensure accuracy in obtaining the FHR. 72OB EXAM1 review Leopold's maneuvers may help the examiner to locate the position of the fetus but will not ensure a distinction between the 2 heart rates. The nurse is caring for a client in labor who is receiving oxytocin by intravenous infusion to stimulate uterine contractions. Which assessment fnding should indicate to the nurse that the infusion needs to be discontinued? 1. Increased urinary output 2. A fetal heart rate of 90 beats/minute 3. 3 contractions occurring within a 10-minute period 4. Adequate resting tone of the uterus palpated between contractions Rationale: A normal fetal heart rate is 110 to 160 beats/minute. Bradycardia or late or variable decelerations indicate fetal distress and the need to discontinue the oxytocin. Increased urinary output is unrelated to the use of oxytocin. The goal of labor augmentation is to achieve 3 good-quality contractions (appropriate intensity and duration) in a 10-minute period. The uterus should return to resting tone between contractions, and there should be no evidence of fetal distress. The nurse is preparing to care for a client in labor. The health care provider has prescribed an intravenous (IV) infusion of oxytocin. The nurse ensures that which intervention is implemented before initiating the infusion? 1. An IV infusion of antibiotics 2. Placing the client on complete bed rest 3. Continuous electronic fetal monitoring 4. Placing a code cart at the client's bedside Rationale: Oxytocin is a uterine stimulant used to induce labor. Continuous electronic fetal monitoring should be implemented during an IV infusion of oxytocin. There are no data in the question to indicate the need for complete bed rest or the need for antibiotics. Placing a code cart at the bedside of a client receiving an oxytocin infusion is not necessary. The nurse assists in the vaginal delivery of a newborn infant. After the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse documents these observations as signs of which condition? 1. Hematoma 2. Uterine atony 3. Placenta previa 4. Placental separation Rationale: As the placenta separates, it settles downward into the lower uterine segment. The umbilical cord lengthens, and a sudden trickle or spurt of blood appears. Options 1, 2, and 3 are incorrect interpretations. 73OB EXAM1 review During the intrapartum period, the nurse is caring for a client with sickle cell disease. The nurse ensures that the client receives adequate intravenous fluid intake and oxygen consumption to achieve which outcome? 1. Stimulate the labor process. 2. Prevent dehydration and hypoxemia. 3. Avoid the necessity of a cesarean section. 4. Eliminate the need for analgesic administration. Rationale: A variety of conditions, including dehydration, hypoxemia, infection, and exertion, can stimulate the sickling process during the intrapartum period. Maintaining adequate intravenous fluid intake and the administration of oxygen via face mask will help to ensure a safe environment for maternal and fetal health during labor. These measures will not stimulate the labor process, avoid the necessity of a cesarean section, or eliminate the need for analgesic administration. A client with a 38-week twin gestation is admitted to a birthing center in early labor. One of the fetuses is a breech presentation. Which intervention is least appropriate in planning the nursing care of this client? 1. Measure fundal height. 2. Attach electronic fetal monitoring. 3. Prepare the client for a possible cesarean section. 4. Visually examine the perineum and vaginal opening. Rationale: Measuring fundal height is least appropriate because it should be measured at each antepartum clinic visit, not in the intrapartum period. All other options are priorities. Intrapartum management and assessment require careful attention to maternal and fetal status. The fetuses should be monitored by dual electronic fetal monitoring, and any signs of distress must be reported to the health care provider. A cesarean section may be necessary if a fetus is breech. The nurse should examine the perineum and vaginal opening visually for signs of the cord, which sometimes prolapses through the cervix. The nurse prepares a plan of care for the client with preeclampsia and documents that if the client progresses from preeclampsia to eclampsia, the nurse should take which frst action? 1. Administer oxygen by face mask. 2. Clear and maintain an open airway. 3. Administer magnesium sulfate intravenously. 4. Assess the blood pressure and fetal heart rate. Rationale: The frst action during a seizure (eclampsia) is to ensure a patent airway. All other options are actions that follow. 74OB EXAM1 review A prenatal client with vaginal bleeding is being admitted to the labor unit. The labor room nurse is performing the admission assessment and should suspect a diagnosis of placenta previa if which fnding is noted? 1. Back pain 2. Abdominal pain 3. Painful vaginal bleeding 4. Painless vaginal bleeding Rationale: The classic sign of placenta previa is the sudden onset of painless vaginal bleeding. Painful vaginal bleeding, abdominal pain, and back pain identify signs and symptoms of abruptio placentae. A prenatal client with severe abdominal pain is admitted to the maternity unit. The nurse is monitoring the client closely because concealed bleeding is suspected. Which assessment fndings indicate the presence of concealed bleeding? Select all that apply. 1. Back pain 2. Heavy vaginal bleeding 3. Increase in fundal height 4. Hard, boardlike abdomen 5. Persistent abdominal pain 6. Early deceleration on the fetal heart monitor Rationale: The signs of concealed abdominal bleeding in a pregnant client include an increase in fundal height; hard, boardlike abdomen; persistent abdominal pain; late decelerations in fetal heart rate; and decreasing baseline variability. Back pain, heavy vaginal bleeding, and early deceleration on the fetal heart monitor are not specifc signs of concealed bleeding. The nurse is caring for a client during the second stage of labor. On assessment, the nurse notes a slowing of the fetal heart rate and a loss of variability. Which is the initial nursing action? 1. Turn the client onto her side and give oxygen by face mask at 8 to 10 L/min. 2. Turn the client onto her back and give oxygen by face mask at 8 to 10 L/min. 3. Turn the client onto her side and give oxygen by nasal cannula at 2 to 4 L/min. 4. Turn the client onto her back and give oxygen by nasal cannula at 2 to 4 L/min. 75OB EXAM1 review Rationale: If a fetal heart rate begins to slow or a loss of variability is observed, this could indicate fetal distress. To promote adequate oxygenation for the mother and her fetus, the mother is turned onto her side, which reduces the pressure of the uterus on the ascending vena cava and descending aorta. Oxygen by face mask at 8 to 10 L/min is then applied to the mother. An amniotomy is performed on a client in labor. On the amniotic fluid examination, the delivery room nurse should identify which fndings as normal? 1. Light green, with no odor 2. Clear and dark amber in color 3. Thick and white, with no odor 4. Pale straw in color, with flecks of vernix Rationale: Amniotic fluid normally is pale straw in color and may contain flecks of vernix caseosa. Greenish fluid may indicate the presence of meconium and suggests fetal distress. Amber-colored fluid suggests the presence of bilirubin. The fluid should not be thick and white; this could be an indication of infection. A labor room nurse is performing an assessment on a client in labor and notes that the fetal heart rate (FHR) is 158 beats/minute and regular. The client's contractions are every 5 minutes, with a duration of 40 seconds and of moderate intensity. On the basis of these assessment fndings, what is the appropriate nursing action? 1. Contact the obstetrician. 2. Continue to monitor the client. 3. Report the FHR to the anesthesiologist. 4. Prepare for imminent delivery of the fetus. Rationale: The FHR normally is 110 to 160 beats/minute. Signs of potential complications of labor are contractions consistently lasting 90 seconds or longer or consistently occurring 2 minutes or less apart; fetal bradycardia, tachycardia, or persistently decreased variability; and irregular FHR. The assessment fndings identifed in the question are not signs of potential complications. The nurse is creating a plan of care for a pregnant client with a diagnosis of severe preeclampsia. Which nursing actions should be included in the care plan for this client? Select all that apply. 1. Keep the room semi-dark. 2. Initiate seizure precautions. 3. Pad the side rails of the bed. 4. Avoid environmental stimulation. 5. Allow out-of-bed activity as tolerated. 76OB EXAM1 review Rationale: Clients with severe preeclampsia are maintained on bed rest in the lateral position. Only bathroom privileges may be allowed. Keeping the room semi-dark, initiating seizure precautions, and padding the side rails of the bed are accurate interventions. In addition, environmental stimuli such as interactions with visitors are kept at a minimum to avoid stimulating the client's central nervous system and causing a seizure. The labor room nurse assists with the administration of a lumbar epidural block. How should the nurse check for the major side effect associated with this type of regional anesthesia? 1. Assessing the mother's reflexes 2. Taking the mother's temperature 3. Taking the mother's apical pulse 4. Monitoring the mother's blood pressure Rationale: A major side effect of regional anesthesia is hypotension, which results from vasodilation in the lower body and a reduction in venous return. After regional anesthesia, the blood pressure is taken every 1 to 2 minutes for 15 minutes and then every 10 to 15 minutes. Reflexes, temperature, and apical pulse are not specifcally related to this type of anesthesia. The nurse assists the health care provider to perform an amniotomy on a client in labor. Which is the priority nursing action after this procedure? 1. Assess the fetal heart rate. 2. Check the client's temperature. 3. Change the pads under the client. 4. Check the client's respiratory rate. Rationale: After amniotomy or rupture of the membranes in the birth setting, the nurse immediately assesses the fetal heart rate for at least 1 minute to detect changes associated with prolapse or compression of the umbilical cord. The quantity, color, and odor of the amniotic fluid also are noted. The client's temperature should be assessed every 2 to 4 hours, and the nurse also should check the client's vital signs. The pads under the client should be changed regularly to promote comfort and reduce the moist environment that favors bacterial growth, but this is not the priority. The goal for a woman with partial premature separation of the placenta is: "The woman will not exhibit signs of fetal distress." Which outcome, documented by the nurse, indicates that this goal has been achieved? 1. No accelerations of fetal heart rate (FHR) 2. Moderate variability present 3. Variable decelerations present 4. FHR of 170 to 180 beats/minute 77OB EXAM1 review Rationale: Reassuring signs in the fetal heart tracing include an FHR of 110 to 160 beats/minute, accelerations of the FHR, no variable decelerations, and the presence of moderate variability. The moderate variability indicates that the fetus is able to make the necessary adjustments to the stresses of the labor. Variable decelerations indicate cord compression. The nurse is caring for a client in active labor. Which nursing intervention would be the best method to prevent fetal heart rate (FHR) decelerations? 1. Prepare the client for a cesarean delivery. 2. Monitor the FHR every 30 minutes. 3. Encourage an upright or side-lying maternal position. 4. Increase the rate of the oxytocin infusion every 10 minutes. Rationale: Side-lying and upright positions such as walking, standing, and squatting can improve venous return and encourage effective uterine activity. Many nursing actions are available to prevent FHR decelerations, without necessitating surgical intervention. Monitoring the FHR every 30 minutes will not prevent FHR decelerations. The nurse should discontinue an oxytocin infusion in the presence of FHR decelerations, thereby reducing uterine activity and increasing uteroplacental perfusion. The nurse is administering magnesium sulfate to a client for preeclampsia at 34 weeks' gestation. What is the priority nursing action for this client? 1. Assess for signs and symptoms of labor. 2. Assess the client's temperature every 2 hours. 3. Schedule a daily ultrasound to assess fetal movement. 4. Schedule a nonstress test every 4 hours to assess fetal well-being. Rationale: As a result of the sedative effect of the magnesium sulfate, the client may not perceive labor. This client is not at high risk for infection. Daily ultrasound exams are not necessary for this client. A nonstress test may be done, but not every 4 hours. The nurse is preparing to administer an analgesic to a client in labor. Which analgesic is contraindicated for a client who has a history of opioid dependency? 1. Fentanyl 2. Morphine sulfate 3. Butorphanol tartrate 4. Meperidine hydrochloride Rationale: Butorphanol tartrate is an opioid analgesic that can precipitate withdrawal symptoms in an opioid-dependent client. Therefore, it is contraindicated if the client has a history of opioid dependency. Fentanyl, morphine sulfate, and meperidine are opioid analgesics but do not tend to precipitate withdrawal symptoms in opioid-dependent clients. 78OB EXAM1 review The nurse in a delivery room is assessing a client immediately after delivery of the placenta. Which maternal observation could indicate uterine inversion and require immediate intervention? 1. Chest pain 2. A rigid abdomen 3. A soft and boggy uterus 4. Complaints of severe abdominal pain Rationale: Signs of uterine inversion include a depression in the fundal area, visualization of the interior of the uterus through the cervix or vagina, severe abdominal pain, hemorrhage, and shock. Chest pain and a rigid abdomen are signs of a ruptured uterus. A soft and boggy uterus indicates that the muscle is not contracting. The nurse is caring for a client in the transition phase of the frst stage of labor. The client is experiencing uterine contractions every 2 minutes and she cries out in pain with each contraction. What is the nurse's best interpretation of this client's behavior? 1. Exhaustion 2. Valsalva maneuver 3. Involuntary grunting 4. Fear of losing control Rationale: Pain, helplessness, panicking, and fear of losing control are possible behaviors in the transition phase of the frst stage of labor. Options 1, 2, and 3 are not indicative of the description provided in the question. Fetal distress is occurring with a woman in labor. As the nurse prepares her for a cesarean birth, what other intervention should the nurse implement? 1. Continue the oxytocin drip. 2. Slow the intravenous (IV) rate. 3. Place the client in a high Fowler's position. 4. Administer oxygen at 8 to 10 L/min via face mask. Rationale: Oxygen is administered at 8 to 10 L/min via face mask to optimize oxygenation of the circulating blood volume. Oxytocin stimulates the uterus and is discontinued if fetal heart rate patterns change for any reason. The IV infusion should be increased, not decreased, so as to increase the maternal blood volume. The woman's position should be lateral with legs raised to increase maternal blood volume and improve the maternal vascular system. A pregnant 39-week-gestation gravida 1, para 0 client arrives on the labor and delivery unit with signs and symptoms of active labor. The nurse reviews the client's prenatal record and discovers that she has had a positive group B streptococcus (GBS) laboratory report during her prenatal course. After performing a cervical exam, the nurse confrms 79OB EXAM1 review that the cervix is dilated 6 cm and 90% effaced. Which should be the nurse's frst action? 1. Provide the client with instructions on how to push. 2. Prepare the labor room and the client for an imminent delivery. 3. Call the health care provider (HCP) to obtain a prescription for intravenous antibiotic prophylaxis (IAP). 4. Call the HCP to the labor and delivery unit to perform a delivery. Rationale: The client evidences progression toward delivery because the cervix is dilated 6 cm and the signs and symptoms of active labor are present. Because the client has had a positive GBS result during pregnancy, her neonate is at risk for becoming infected with GBS via vertical transmission during birth. GBS poses a signifcant risk for infant morbidity and mortality. To decrease this risk, it is recommended that IAP be administered during labor. Providing the client with instructions on pushing is not appropriate at a time when she does not need to use this information; thus, this is not a priority. The client is not close to complete dilation; therefore, the HCP is not required for delivery at this time. A pregnant 39-week-gestation client arrives at the labor and delivery unit in active labor. On confrmation of labor, the client reports a history of herpes simplex virus (HSV) to the nurse, who notes the presence of lesions on inspection of the client's perineum. Which should be the nurse's initial action? 1. Perform an abdominal scrub on the client. 2. Prepare the delivery room for a vaginal delivery. 3. Explain to the client why a cesarean delivery is necessary. 4. Call the health care provider to obtain a prescription for an antiviral medication. Rationale: Because neonatal infection of HSV is life-threatening, prevention of neonatal infection is critical. Current recommendations state that a cesarean delivery within 4 hours after labor begins or membranes rupture is necessary if visible lesions are present on the woman's perineum. An abdominal scrub will be necessary eventually for the cesarean delivery but should not be the nurse's initial action. Antiviral medications are used to control symptoms, not to eradicate the infection. At this phase in the client's pregnancy, the focus is on preventing transmission to the fetus rather than controlling the symptoms of HSV. The nurse is caring for a client in labor and notes that minimal variability is present on a fetal heart rate (FHR) monitor strip. Which conditions are most likely associated with minimal variability? Select all that apply. 1. Early labor 2. Amniotomy 3. Tachycardia 80OB EXAM1 review 4. Fetal hypoxia 5. Metabolic acidemia 6. Congenital anomalies Rationale: The fluctuations in the baseline FHR are the defnition of variability. Variability can be classifed into 4 different categories: absent, minimal, moderate, and marked. Minimal variability is defned as fluctuations that are fewer than 6 beats/minute. Tachycardia, fetal hypoxia, metabolic acidemia, and congenital anomalies are all associated with possible minimal variability. Rupturing membranes and early labor are not correlated to this condition. After the spontaneous rupture of a laboring woman's membranes, the fetal heart rate drops to 85 beats/minute. Which should be the nurse's priority action? 1. Reposition the laboring woman to knee-chest. 2. Assess the vagina and cervix with a gloved hand. 3. Notify the health care provider of the need for an amnioinfusion. 4. Document the description of the fetal bradycardia in the nursing notes. Rationale: It is most common to see an umbilical cord prolapsed directly after the rupture of membranes, when gravity washes the cord in front of the presenting part. A cord prolapse can be evidenced by fetal bradycardia with variable decelerations occurring with uterine contractions. Because the fetal heart rate became bradycardic immediately following the spontaneous rupture of the client's membranes, the nurse's initial action should be to glove the examining hand and insert 2 fngers into the vagina to assess for the presence of a prolapsed cord and then to relieve compression of the cord by exerting upward pressure on the presenting part. Repositioning the woman to a kneechest position is a correct intervention for prolapsed cord, but confrmation of the prolapsed cord and relieving compression is the frst intervention that should be implemented; therefore, option 1 can be eliminated. An amnioinfusion may be used to minimize the effects of cord compression in utero, not a prolapsed cord, so option 3 can be eliminated. Although documentation of this occurrence is important, it is not the priority in this situation, so option 4 can also be eliminated. On assessment of the fetal heart rate (FHR) of a laboring woman, the nurse discovers decelerations that have a gradual onset, last longer than 30 seconds, and return to the baseline rate with the completion of each contraction. The nurse plans care, knowing that this identifes which category of decelerations? 1. Episodic, late decelerations that indicate uteroplacental insufficiency 2. Periodic, early decelerations that indicate fetal head compression 3. Periodic, variable decelerations that indicate cord compression 4. Episodic, early decelerations that may be a result of maternal hypotension 81OB EXAM1 review Rationale: An early deceleration is described as a visually apparent gradual decrease of the FHR with a gradual return to the FHR baseline. Late decelerations do not return to the FHR baseline until after the uterine contraction is over, thus eliminating option 1. Variable decelerations are defned as having a rapid onset of less than 30 seconds with a rapid return to FHR baseline, which does not match the description of the FHR described; therefore, eliminate option 3. Early decelerations are caused by fetal head compression, resulting from uterine contractions, vaginal examination, or fundal pressure, which would eliminate option 4. Shortly after receiving epidural anesthesia, a laboring woman's blood pressure drops to 95/43 mm Hg. Which immediate actions should the nurse take? Select all that apply. 1. Prepare for delivery. 2. Administer a tocolytic. 3. Administer an opioid antagonist. 4. Turn the woman to a lateral position. 5. Increase the rate of the intravenous infusion. 6. Administer oxygen by face mask at 10 L/minute. Rationale: Maternal hypotension results in decreased placental perfusion, so the focus of nursing care should be to initiate interventions that increase oxygen perfusion to the fetus. Turning the woman to left lateral position assists in deflecting the uterus off of the vena cava, thus improving maternal circulation. Increasing the rate of the intravenous infusion will increase blood volume, which will increase the maternal blood pressure. An increase in blood pressure would increase placental perfusion. Administering a high flow rate of oxygen will increase the oxygen levels in the maternal circulation and increase oxygen delivery to the fetus. The woman is not revealing any signs or symptoms of imminent delivery, as she just received an epidural which is typically administered at 6 cm or earlier dilation, so option 1 can be eliminated. Administering a tocolytic can be eliminated because the decrease in placental perfusion is the result of maternal hypotension, not uterine hyperstimulation. Administering an opioid antagonist can be eliminated because the client is not experiencing an ineffective breathing pattern caused by opioid administration. The nurse is administering an intravenous analgesic to a laboring woman. The woman inquires as to why the nurse is waiting for a contraction to begin before she infuses the medication into the intravenous line. Which is the nurse's most appropriate response? 1. "The medication will affect you and your pain level only when given during a contraction." 2. "The medication will provide optimal relief when it is given while your pain level is highest." 3. "Because the uterine blood vessels constrict during a contraction, the fetus will be less affected by the medication." 82OB EXAM1 review 4. "You will experience a lower incidence of adverse effects from the medication when administered during a contraction." Rationale: Intravenous medication should be administered slowly in small doses starting at the beginning of a contraction and carrying over for 3 to 5 contractions. This intervention minimizes the amount of the medication that crosses the placenta and enters the fetal circulation, thus minimizing its effects on the fetus. Although this method of administration may decrease the amount of medication reaching the fetus, it does not totally eliminate effects of the medication on the fetus. The statements in the remaining options are incorrect information about the medication effects. On March 10, the nurse performed an initial assessment on a client admitted to the labor and delivery unit for "rule out labor." The client has not received prenatal care but is certain that the frst day of her last menstrual period (LMP) was July 7 the previous year. The nurse plans care based on which interpretation? 1. The client is possibly in preterm labor. 2. The fetus may not be viable at delivery. 3. The client may require labor augmentation. 4. The fetus is at high risk for shoulder dystocia. Rationale: According to Nägele's rule, by subtracting 3 months and adding 7 days and 1 year to this client's LMP the nurse can determine that her estimated date of delivery (EDD) is April 14. This client is in the labor and delivery unit to be evaluated for the presence of labor more than 1 month before her EDD; therefore, she is possibly in preterm labor. Viability is said to occur between the 22nd and 25th weeks of gestation. This fetus is approximately 4 weeks before term. If this client truly is in labor, the health care provider's plan would be to try to stop the labor in order to prevent delivery at this early stage in the pregnancy. This would eliminate option 3, labor augmentation. Because of the typical 36-week gestational size of a fetus, 2200 to 2900 g, there would be no risk for a difcult shoulder delivery. The nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of a slowing labor. The nurse is reviewing the health care provider's prescriptions and should expect to note which prescribed treatment for this condition? 1. Oxytocin infusion 2. Increased hydration 3. Administration of a tocolytic medication 4. Administration of a medication that will provide sedation Rationale: Therapeutic management for hypotonic uterine dysfunction includes oxytocin augmentation and amniotomy to stimulate a labor that slows. A cesarean birth will be performed if no progress in labor occurs. The remaining options identify therapeutic measures for a client with hypertonic dysfunction. 83OB EXAM1 review A woman in active labor has requested a regional anesthetic. She is currently 5 cm dilated. The health care provider has prescribed an epidural block. Which nursing intervention should be implemented after the epidural block has been placed? 1. Palpate the bladder at frequent intervals. 2. Encourage the woman to walk to progress the labor. 3. Assess the blood pressure frequently for hypertension. 4. Encourage the woman to assume a supine position after the epidural has been placed. Rationale: The effect of the epidural is that anesthesia is felt from the ffth lumbar space to the sacral region of the vertebral column. The woman loses the sensation that she needs to urinate. The nurse must palpate the bladder frequently because a full bladder will impede progression of the fetus during the laboring process. Ambulation is not allowed because of the anesthesia. The woman is encouraged to lie on her side to increase placental perfusion to the fetus. Hypotension, not hypertension, is a concern. The nurse in the labor room is caring for a client who is in the frst stage of labor. On assessing the fetal patterns, the nurse notes an early deceleration of the fetal heart rate (FHR) on the monitor strip. Based on this fnding, which is the appropriate nursing action? 1. Contact the health care provider (HCP). 2. Place the client in Trendelenburg's position. 3. Administer oxygen to the client by face mask. 4. Document the findings and continue to monitor fetal patterns. Rationale: Early deceleration of the FHR refers to a gradual decrease in the heart rate, followed by a return to baseline, in response to compression of the fetal head. It is a normal and benign fnding. Because early decelerations are considered benign, interventions are not necessary. Therefore, contacting the HCP, changing the client' position, or administering oxygen is not necessary. The nurse is caring for a client who is receiving oxytocin for induction of labor and notes a nonreassuring fetal heart rate (FHR) pattern on the fetal monitor. On the basis of this fnding, the nurse should take which action frst? 1. Stop the oxytocin infusion. 2. Check the client's blood pressure. 3. Check the client for bladder distention. 4. Place the client in a side-lying position Rationale: Oxytocin stimulates uterine contractions and is used to induce labor. If uterine hypertonicity or a non reassuring FHR pattern occurs, the nurse needs to intervene to reduce uterine activity and increase fetal oxygenation. The oxytocin infusion is stopped, the client is placed in a side-lying position, and oxygen by face mask at 8 to 10 L/min is 84OB EXAM1 review administered. The health care provider is notifed. The nurse should monitor the client's blood pressure and intake and output; however, the nurse should frst stop the infusion. Which statement, if made by the laboring client, most likely indicates that the client is in the second stage of labor? 1. "I feel like I need to push." 2. "My contractions seem to be getting stronger." 3. "I am glad that I have several minutes to rest between contractions." 4. "Warm fluid is running down my legs each time I have a contraction." Rationale: The second stage of labor begins when the cervix is completely dilated and ends with birth of the infant. At this time, the laboring woman typically experiences the desire to push. Contractions becoming stronger are experienced throughout labor and do not indicate that she has reached stage 2. Having several minutes to rest between contractions does not describe the end of transition.Leaking of amniotic fluid does not mean that she is completely dilated. The nurse is caring for a client in the active stage of labor. The nurse notes that the fetal pattern shows a late deceleration on the monitor strip. Based on this fnding, the nurse should prepare for which appropriate nursing action? 1. Administering oxygen via face mask 2. Placing the mother in a supine position 3. Increasing the rate of the intravenous (IV) oxytocin infusion 4. Documenting the findings and continuing to monitor the fetal patterns Rationale: Late decelerations are caused by uteroplacental insufciency as a result of decreased blood flow and oxygen to the fetus during the uterine contractions. This causes hypoxemia; therefore, oxygen is necessary. The supine position is avoided because it decreases uterine blood flow to the fetus. The client should be turned on her side to displace pressure of the gravid uterus on the inferior vena cava. An IV oxytocin infusion is discontinued when a late deceleration is noted; otherwise, the oxytocin would cause further hypoxemia because of increased uteroplacental insufciency caused by stimulation of contractions caused by the oxytocin. Documenting and monitoring would delay necessary treatment. A client in labor is receiving oxytocin by intravenous infusion to stimulate uterine contractions. Which fnding indicates that the rate of infusion needs to be decreased? 1. Increased urinary output 2. A fetal heart rate of 180 beats/min 3. Three contractions occurring in a 10-minute period 4. Adequate resting tone of the uterus palpated between contractions Rationale: A normal fetal heart rate is 110 to 160 beats/min. Acute hypoxia is a common cause of 85OB EXAM1 review fetal tachycardia. The dosage of oxytocin should be decreased in the presence of fetal tachycardia, which can occur from excessive uterine activity. The goal of labor augmentation is to achieve 3 good-quality contractions (appropriate intensity and duration) in a 10-minute period. The uterus should return to resting tone between contractions, and there should be no evidence of fetal distress. Increased urinary output is unrelated to the use of oxytocin. The nurse is monitoring a client in labor whose membranes ruptured spontaneously. What is the initial nursing action? 1. Determine the fetal heart rate. 2. Provide peripads for the client. 3. Take the client's blood pressure. 4. Note the amount, color, and odor of the amniotic fluid. Rationale: When the membranes rupture in the birth setting, the nurse immediately assesses the fetal heart rate to detect changes associated with prolapse or compression of the umbilical cord. Taking the blood pressure and noting the characteristics of the amniotic fluid are also appropriate actions, but are not the initial actions in this situation. The nurse may assist the client in cleaning, changing clothing, and providing peripads, but determining the fetal heart rate is the initial action. The nurse assists in the vaginal delivery of a newborn. Following the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse should document these observations as signs of which condition? 1. Hematoma 2. Uterine atony 3. Placenta previa 4. Placental separation Rationale: As the placenta separates, it settles downward into the lower uterine segment. The umbilical cord lengthens, and a sudden trickle or spurt of blood appears. The other options are not characterized by these fndings. The nurse is preparing to care for a client in labor. The health care provider (HCP) has prescribed an intravenous (IV) infusion of oxytocin. The nurse should ensure that which is implemented before the beginning of the infusion? 1. An IV infusion of antibiotics 2. Placing the client on complete bed rest 3. Continuous electronic fetal monitoring 4. Placing a code cart at the client's bedside Rationale: Continuous electronic fetal monitoring should be implemented during an IV infusion of oxytocin. There are no data in the question that indicate the need for antibiotics or 86OB EXAM1 review complete bed rest. It is not necessary to place a code cart at the bedside of a client receiving an oxytocin infusion. The nurse is assisting in the care of a client in labor who is having an amniotomy performed. The nurse should report which abnormal fndings to the health care provider (HCP)? Select all that apply. 1. Clear, dark amber amniotic fluid 2. Amniotic fluid volume of 800 mL 3. Light green amniotic fluid with no odor 4. Thick white amniotic fluid with no odor 5. Straw-colored amniotic fluid with flecks of vernix Rationale: Amniotic fluid is normally a pale straw color and may contain flecks of vernix caseosa. It should have a thin, watery consistency and may have a mild odor. The normal amount of amniotic fluid ranges from 500 to 1000 mL. Dark amber color, light green color, and thick white color are not descriptions of normal amniotic fluid and should be brought to the HCP's attention. The nurse is creating a plan of care for a client experiencing dystocia and includes several nursing interventions in the plan. The nurse prioritizes the plan and selects which nursing intervention as the highest priority? 1. Monitoring fetal status 2. Providing comfort measures 3. Changing the client's position frequently 4. Keeping the significant other informed of the progress of the labor Rationale: The priority in the plan of care should include the intervention that addresses the physiological integrity of the fetus. Although providing comfort measures, changing the client's position frequently, and keeping the signifcant other informed of the progress of the labor are components of the plan of care, fetal status is the priority. The nurse is monitoring a client with dysfunctional labor for signs of fetal or maternal compromise. Which fnding should alert the nurse to a compromise? 1. Maternal fatigue 2. The passage of meconium 3. Coordinated uterine contractions 4. Progressive changes in the cervix Rationale: Signs of fetal or maternal compromise include a persistent, nonreassuring fetal heart rate; fetal acidosis; and the passage of meconium. Maternal fatigue and infection can occur if the labor is prolonged but does not indicate fetal or maternal compromise. 87OB EXAM1 review Progressive changes in the cervix and coordinated uterine contractions are a reassuring pattern in labor. The nurse is preparing to care for a client with hypertonic labor. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. Which is the priority nursing intervention? 1. Provide pain relief measures. 2. Prepare the client for an amniotomy. 3. Monitor the oxytocin infusion closely. 4. Promote ambulation every 30 minutes. Rationale: Management of hypertonic labor depends on the cause. Relief of pain is the primary intervention to promote a normal labor pattern. Therapeutic management for hypotonic uterine dysfunction includes amniotomy and oxytocin augmentation to stimulate a labor that slows. The client with hypertonic uterine dysfunction should not be encouraged to ambulate every 30 minutes but should be encouraged to rest. The nurse performs a vaginal assessment on a pregnant client in labor. On assessment, the nurse notes the presence of the umbilical cord protruding from the vagina. Which is the initial nursing action? 1. Gently push the cord into the vagina. 2. Place the client in Trendelenburg's position. 3. Find the closest telephone and page the health care provider (HCP) stat. 4. Call the delivery room to notify the staff that the client will be transported immediately. Rationale: When cord prolapse occurs, prompt actions are taken to relieve cord compression and increase fetal oxygenation. The mother should be positioned with her hips higher than her head to shift the fetal presenting part toward the diaphragm. The nurse should push the call light to summon help, and other staff members should call the HCP and notify the delivery room. If the cord is protruding from the vagina, no attempt should be made to replace it because that could traumatize it and further reduce blood flow. Oxygen at 8 to 10 L/min by face mask is administered to the mother to increase fetal oxygenation. The nurse is caring for a client during the second stage of labor. On assessment, the nurse notes a slowing of the fetal heart rate and a loss of variability. What is the initial nursing action? 1. Turn the client on her side and administer oxygen by face mask at 8 to 10 L/min. 2. Turn the client on her back and administer oxygen by face mask at 8 to 10 L/min. 3. Turn the client on her side and administer oxygen by nasal cannula at 2 to 4 L/min. 88OB EXAM1 review 4. Turn the client on her back and administer oxygen by nasal cannula at 2 to 4 L/min. Rationale: If a fetal heart rate begins to slow or a loss of variability is observed, this could indicate fetal distress. To facilitate oxygen to the mother and her fetus, the client is turned to her side, which reduces the pressure of the uterus on the ascending vena cava and descending aorta. Oxygen at 8 to 10 L/min is applied to the mother by face mask. An ultrasound is performed on a client with suspected abruptio placentae, and the results indicate that a placental abruption is present. Which intervention should the nurse prepare the client for? 1. Delivery of the fetus 2. Strict monitoring of intake and output 3. Complete bed rest for the remainder of the pregnancy 4. The need for weekly monitoring of coagulation studies until the time of delivery Rationale: The goal of management in abruptio placentae is to control the hemorrhage and deliver the fetus as soon as possible. Because delivery of the fetus is necessary, the remaining options are incorrect regarding management of the client with abruptio placentae. The nurse is monitoring a client who is in the active phase of labor. The client has been experiencing contractions that are short, irregular, and weak. Which type of labor dystocia should the nurse document that the client is experiencing? 1. Hypotonic 2. Precipitate 3. Hypertonic 4. Preterm labor Rationale: Hypotonic labor contractions are short, irregular, and weak and usually occur during the active phase of labor. Precipitate labor is that which lasts in its entirety for 3 hours or less. Hypertonic dysfunction usually occurs during the latent phase of labor. Preterm labor is the onset of labor after 20 weeks of gestation and before the beginning of the 38th week of gestation. The nurse has collected the following data on a client in labor. The fetal heart rate (FHR) is 154 beats/min and is regular, and contractions have moderate intensity, occur every 5 minutes, and have a duration of 35 seconds. Using this information, what is the appropriate action for the nurse to take? 1. Prepare for imminent delivery. 2. Continue to monitor the client. 3. Report the FHR to the anesthesiologist on call. 89OB EXAM1 review 4. Report the findings to the health care provider (HCP). Rationale: The data collected by the nurse are within normal limits and require no further action on the part of the nurse other than continued monitoring. The FHR is normally 110 to 160 beats/min. Signs of potential complications of labor include contractions consistently lasting 90 seconds or longer; contractions consistently occurring 2 minutes or less apart; fetal bradycardia, tachycardia, or persistently decreased variability; and irregular FHR. There are no data to indicate that delivery is imminent and no data to support contacting the anesthesiologist or HCP. A pregnant client admitted to the labor room arrived with a fetal heart rate (FHR) of 94 beats/minute and the umbilical cord protruding from the vagina. The client tells the nurse that her "water broke" before coming to the hospital. What is the appropriate nursing action? 1. Sit the client in a high Fowler's position. 2. Call the pharmacy for a tocolytic medication. 3. Get intravenous (IV) therapy equipment and solution from the storage area. 4. Wrap the cord loosely in a sterile towel soaked with warm, sterile normal saline. Rationale: When an umbilical cord is protruding, the cord must be protected from drying out and becoming compressed. Wrapping the cord with a sterile, saline-soaked towel will help accomplish this. The nurse must also help reduce compression of the cord by placing the client in an extreme Trendelenburg's or modifed Sims' position. The health care provider is also notifed immediately. A tocolytic would be used if the client had inadequate uterine relaxation. IV solutions may be administered but are not the priority item with the information given. The purpose of a vaginal examination for a client in labor is to specifcally assess the status of which fndings? Select all that apply. 1. Station 2. Dilation 3. Effacement 4. Bloody show 5. Contraction effort Rationale: The vaginal examination for a client in labor specifcally determines effacement 0% to 100%, dilation 0 to 10 cm, and station –5 cm (above the maternal ischial spine) to +5 cm (below the maternal ischial spine). Bloody show is the brownish or blood-tinged cervical mucus that may be passed preceding labor and is not a specifc part of the assessment when performing a vaginal examination. Contraction effort is not determined by vaginal examination. 90OB EXAM1 review The nurse is collecting data from a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which fndings are associated with abruptio placentae? Select all that apply. 1. Uterine tenderness 2. Acute abdominal pain 3. A hard, "boardlike" abdomen 4. Painless, bright red vaginal bleeding 5. Increased uterine resting tone on fetal monitoring Rationale: In abruptio placentae, acute abdominal pain is present. Uterine tenderness accompanies placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen will feel hard and board like on palpation as the blood penetrates the myometrium and causes uterine irritability. Observation of the fetal monitoring often reveals increased uterine resting tone, caused by placental abruption. Painless, bright red vaginal bleeding in the second or third trimester of pregnancy is a sign of placenta previa. A pregnant client tells the nurse that she has been craving "unusual foods." The nurse gathers additional assessment data and discovers that the client has been ingesting daily amounts of white clay dirt from her backyard. Laboratory studies are performed and the nurse determines that which fnding indicates a physiological consequence of the client's practice? 1. Hematocrit 38% (0.38) 2. Glucose 86 mg/dL (4.8 mmol/L) 3. Hemoglobin 9 g/dL (90 mmol/L) 4. White blood cell count 12,400 mm3 (12.4 × 109/L) Rationale: Pica practices often lead to iron defciency anemia, resulting in a decreased hemoglobin level. The laboratory values in options 1, 2, and 4 are normal for the pregnant client. A pregnant client asks the nurse about the types of exercises that are allowed during pregnancy. The nurse should tell that client that which exercise is safest? 1. Swimming 2. Scuba diving 3. Low-impact gymnastics 4. Bicycling with the legs in the air Rationale: Non–weight-bearing exercises are preferable to weight-bearing exercises during pregnancy. Exercises to avoid are shoulder standing and bicycling with the legs in the 91OB EXAM1 review air because the knee-chest position should be avoided. Competitive or high-risk sports such as scuba diving, water skiing, downhill skiing, horseback riding, basketball, volleyball, and gymnastics should be avoided. Non–weight-bearing exercises such as swimming are allowed. A health care provider has prescribed transvaginal ultrasonography for a client in the frst trimester of pregnancy, and the client asks the nurse about the procedure. How should the nurse respond to the client? 1. "The procedure takes about 2 hours." 2. "It will be necessary to drink 1 to 2 quarts (1 to 2 liters) of water before the examination." 3. "The probe that will be inserted into the vagina will be covered with a disposable cover and coated with a gel." 4. "Gel is spread over the abdomen, and a round disk transducer will be moved over the abdomen to obtain the picture." Rationale: Transvaginal ultrasonography allows clear visibility of the uterus, gestational sac, embryo, and deep pelvic structures, such as the ovaries and fallopian tubes. The client is placed in a lithotomy position and a transvaginal probe, encased in a disposable cover and coated with a gel that provides lubrication and promotes conductivity, is inserted into the vagina. The client may feel more comfortable if she is allowed to insert the probe. The procedure takes about 10 to 15 minutes. Options 2 and 4 identify components of abdominal ultrasound. The nurse has instructed a pregnant client in measures to prevent varicose veins during pregnancy. Which statement by the client indicates a need for further instruction? 1. "I should wear panty hose." 2. "I should wear support hose." 3. "I should wear flat nonslip shoes that have good support." 4. "I should wear knee-high hose, but I should not leave them on longer than 8 hours." Rationale: Varicose veins often develop in the lower extremities during pregnancy. Any constrictive clothing, such as knee-high hose, impedes venous return from the lower legs and places the client at risk for developing varicosities. The client should be encouraged to wear support hose or panty hose. Flat nonslip shoes with proper support are important to assist the pregnant woman to maintain proper posture and balance and to minimize falls A pregnant client calls a clinic and tells the nurse that she is experiencing leg cramps that awaken her at night. What should the nurse tell the client to provide relief from the leg cramps? 1. "Bend your foot toward your body while flexing the knee when the cramps occur." 92OB EXAM1 review 2. "Bend your foot toward your body while extending the knee when the cramps occur." 3. "Point your foot away from your body while flexing the knee when the cramps occur." 4. "Point your foot away from your body while extending the knee when the cramps occur." Rationale: Leg cramps occur when the pregnant client stretches her leg and plantar flexes her foot. Dorsiflexion of the foot while extending the knee stretches the affected muscle, prevents the muscle from contracting, and stops the cramping. Options 1, 3, and 4 are not measures that provide relief from leg cramps. The nurse is providing instructions regarding the treatment of hemorrhoids to a client who is in the second trimester of pregnancy. Which statement by the client indicates a need for further instruction? 1. "I should avoid straining during bowel movements." 2. "I can gently replace the hemorrhoids into the rectum." 3. "I can apply ice packs to the hemorrhoids to reduce the swelling." 4. "I should apply heat packs to the hemorrhoids to help the hemorrhoids shrink. Rationale: Measures that provide relief from hemorrhoids include avoiding constipation and straining during bowel movements; applying ice packs to reduce the hemorrhoidal swelling; gently replacing the hemorrhoids into the rectum; using stool softeners, ointments, or sprays as prescribed; and assuming certain positions to relieve pressure on the hemorrhoids. Heat packs increase the blood flow to the area and worsen the discomfort from hemorrhoids. The nurse is providing instructions to a client in the frst trimester of pregnancy regarding measures to assist in reducing breast tenderness. Which instruction should the nurse provide? 1. Avoid wearing a bra. 2. Wash the breasts with warm water and keep them dry. 3. Wear tight-fitting blouses or dresses to provide support. 4. Wash the nipples and areolar area daily with soap, and massage the breasts with lotion. Rationale: The pregnant client should be instructed to wash the breasts with warm water and keep them dry. The client should be instructed to avoid using soap on the nipples and areolar area to prevent the drying of tissues. Wearing a supportive bra with wide adjustable 93OB EXAM1 review straps can decrease breast tenderness. Tight-ftting blouses or dresses cause discomfort. The client is instructed to wear soft-textured clothing to decrease nipple tenderness and to use breast pads inside the bra to prevent leakage through the clothing if colostrum is a problem. The nurse is describing cardiovascular system changes that occur during pregnancy to a client. Which fndings are normal for a client in the second trimester? Select all that apply. 1. Increase in pulse rate 2. Increase in blood pressure 3. Frequent bowel elimination 4. Increase in red blood cell production 5. Decrease in white blood cell production Rationale: Numerous cardiovascular adaptations occur during pregnancy. Between 14 and 20 weeks' gestation, the pulse rate increases about 10 to 15 beats/minute, which then persists to term. During pregnancy, there is an accelerated production of red blood cells. During the second trimester, systolic and diastolic pressures decrease by about 5 to 10 mm Hg until 24 to 32 weeks. The blood pressure by term usually is no higher than the prepregnancy level. Constipation may occur as a result of decreased gastrointestinal motility or pressure of the uterus. The clinic nurse is providing instructions to a pregnant client regarding measures that assist in alleviating heartburn. Which statement by the client indicates an understanding of the instructions? 1. "I should avoid between-meal snacks." 2. "I should lie down for an hour after eating." 3. "I should use spices for cooking rather than using salt." 4. "I should avoid eating foods that produce gas and fatty foods." Rationale: Lying down is likely to lead to reflux of stomach contents, especially immediately after a meal. The client should be instructed to avoid spices, along with salt, because spices trigger heartburn. Salt produces edema. The client should be encouraged to eat between-meal snacks and should be instructed that to control heartburn, eating smaller, more frequent portions is preferred over eating 3 large meals. The client also should limit or avoid gas-producing and fatty foods. The nurse is providing instructions to a pregnant client with genital herpes about the measures that are needed to protect the fetus. Which instruction should the nurse provide to the client? 1. Daily administration of acyclovir is necessary during the entire pregnancy. 2. Total abstinence from sexual intercourse is necessary during the entire 94OB EXAM1 review pregnancy. 3. Sitz baths need to be taken every 4 hours while awake if vaginal lesions are present. 4. A cesarean section will be necessary if vaginal lesions are present at the time of labor. Rationale: For women with active lesions, either recurrent or primary at the time of labor, delivery should be by cesarean section to prevent the fetus from being in contact with the genital herpes. The safety of acyclovir has not been established during pregnancy, and it should be used only when a life-threatening infection is present. Clients should be advised to abstain from sexual contact while the lesions are present. If this is an initial infection, clients should continue to abstain until they become culture-negative because prolonged viral shedding may occur in such cases. Keeping the genital area clean and dry promotes healing. The nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. Based on her last normal menstrual period, she is 8 weeks' gestation. Appropriate physical assessments are completed. Which fndings are anticipated to be present at this time? Select all that apply. 1. A softening of the cervix 2. The presence of fetal movement 3. Bluish discoloration of the vaginal tissue 4. The presence of human chorionic gonadotropin in the urine 5. A soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus Rationale: At the beginning of the second month of gestation, the cervix becomes softer as a result of increased vascularity and hyperplasia, which cause Goodell's sign. Cervical softening is noted by the examiner during pelvic examination. Bluish discoloration of the vaginal tissue occurs due to hyperemia and is known as Chadwick's sign. Human chorionic gonadotropin is the basis for the positive pregnancy test and would be present in the urine. Eight weeks' gestation is too early for the presence of fetal movement. A soft blowing sound that corresponds to the maternal pulse may be auscultated over the uterus and is caused by blood circulating through the placenta. This occurs later in the pregnancy. The health care provider (HCP) is assessing the client for the presence of ballottement. To make this determination, the HCP should take which action? 1. Auscultate for fetal heart sounds. 2. Assess the cervix for compressibility. 3. Palpate the abdomen for fetal movement. 4. Initiate a gentle upward tap on the cervix. 95OB EXAM1 review Rationale: Ballottement is a technique of palpating a floating structure by bouncing it gently and feeling it rebound. In the technique used to palpate the fetus, the examiner places a fnger in the vagina and taps gently upward, causing the fetus to rise. The fetus then sinks, and the examiner feels a gentle tap on the fnger. Auscultating for fetal heart sounds and palpating the abdomen for fetal movement are a part of fetal assessment. Assessing the cervix for compressibility is determining the presence of Hegar's sign. A primigravida asks the nurse in the clinic when she will be able to begin to feel the fetus move. The nurse responds by telling the mother that fetal movements will be