OB Exam 2 Practice Quiz

Question 1

A nurse is assessing several postpartum clients. Which clients are at risk for developing postpartum hemorrhage? Select all that apply.

Answer 1

Retained Placental Fragments
Twin Birth
Over Distended Bladder

Question 2

A nurse caring for a laboring patient notes the Baseline Fetal Heart Rate (FHR)to be 155 with moderate variability andno accelerations or decelerations.The nurse would inform the primary caregiver that the category of the tracing is:

Answer 2

Category I Tracing

(Rational: The tracing is a Category I because the baseline is within normal limits (110-160), variability is moderate. Category II does not include moderate variability. There are no Category III criteria such as viability, abnormal baseline, or decelerations.)

Question 3

The nurse caring for a patient in the active stage of labor notes the fetal heart tone baseline is fluctuating between 1-5 beats for a 20 minute period.The nurse knows that this could be caused by the: (Select all that apply).

Answer 3

Fetus being in a state of sleep
Administration of 1mg Stadol

(Rational: Factors that can result in decreased variability are drugs-narcotics, tranquilizers, barbiturates, and anesthetics depress CNS mechanisms for cardiac control: Example magnesium sulfate and stadol. & nbsp; Fetal sleep states can decrease variability, which usually returns in 20-30 minutes. & nbsp; Cocaine and the application of an ISE can result in an increase in variability.)

Question 4

A client delivering in a birthing center is in the second stage of labor and is having no complications. Intermittent auscultation of FHR and uterine palpation of contractions is being performed to monitor FHR patterns. How frequently should the nurse assess the FHR?

Answer 4

Every 15 Mins

(Rational: ATI pages 170 and 188- With low-risk women, the FHRshould be assess every 15 minutes in the second stage of labor. In high-risk women, FHR should be assessed every 5 minutes in the second stage of labor. Every 60 minutes, FHR assessment is done during the latent phase for low-risk women. Every 30 minutes, FHRassessment is done in the active phase for low-risk women and in the latent phase for high-risk women.)

Question 5

Pathologic jaundice in the full term neonate is best described as:

Answer 5

jaundice at or near birth with bilirubin levels increasing greater than 5-6mg/dl in 24 hours

(rational: At any serum bilirubin level, the appearance of jaundice within the first 24 hours of life usually indicates a pathological process. Ineffective breastfeeding is not a pathological process but rather breastfeeding mismanagement. Jaundice found after 24 hours is considered physiologic jaundice. )

Question 6

The neurological syndrome resulting from untreated bilirubin at levels higher than 25mg/dL potentially causing cerebral palsy, epilepsy, or mental retardation is:

Answer 6

Kernicterus

(Rational: Erb-Duchenne is caused by birth trauma, Hypoxia as a result of stress, and hyperbilirubinemia from an elevated bilirubin level. )

Question 7

Pathologic jaundice of the neonate is best defined as the:

Answer 7

Clinical disorder appearing within 24 H of age, associated with anemia, RBC enzyme defects, or RBC membrane disorders.

(Rational: Text page 645: Pathologic jaundice appears before 24 hours of age and is associated with anemia, RBC enzyme defects, or RBC membrane disorders.)

Question 8

If the placenta is not detaching within 30 minutes of the delivery, what is a possible cause?

Answer 8

Placenta Acreta or Increta

Question 9

An expectant woman of 28 weeks with no history of hypertension presents with a BP of 145/94 and no proteinuria. You anticipate a diagnosis of:

Answer 9

Gestational HTN

Question 10

The nurse is reviewing the records of several pregnant patients. Which one of the following is the nurse most likely to refer to a preterm labor and birth prevention program?

Answer 10

36 y.o. Hispanic G3 T0 P1 A1 L1 who is a gestational diabetic.

(Rational: Class notes & Discussion: The single most important predictor of preterm labor and birth is a history of preterm labor or birth.)

Question 11

Mothers with gestational diabetes are at a higher risk for:

Answer 11

Macrosomia

(Rational: Precipitous delivery is not related to gestational diabetes. Diabetic mothers are more prone to have polyhydramnios not oligohydramnios. Pica is craving non nutritive items.)

Question 12

A primigravida is in the latent phase of labor. The nurse expects the patient to:

Answer 12

use rhythmic breathing and relaxation

(Rational: During the latent phase the patient should experience mild discomfort as the cervix is softening and thinning. The patient should be able to rest easily with relaxation techniques.)

Question 13

A nurse teaching a childbirth education class is explaining the cardinal movements of labor. In which order would the nurse explain the movements, starting from the onset of labor through delivery?

Answer 13

Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion

(Rational: Class notes and text: During the labor process the fetus must adapt to the maternal pelvis in order for a vaginal birth to occur. These adjustments are the cardinal movements of labor. The order in which these movements occur is as follows: engagement, descent, flexion, internal rotation, extension, external rotation, expulsion.)

Question 14

During the examination of a 16 week gestation client, the nurse observes bruises on the client’s face and abdomen. Further assessment is required to confirm:

Answer 14

Domestic Abuse

Question 15

The nurse caring for a client who is 8 hours postpartum performs her assessment. She finds the client’s fundus is firm and located midline at the umbilicus. She notices moderate lochia rubra on the peri-pad. Which action should the nurse take?

Answer 15

Do nothing these are normal assessment findings

(Rational: These are things the nurse would expect to see at 8 hours post delivery)

Question 16

You have a patient experiencing disseminated intravascular coagulation (DIC) secondary to placental abruption. Which of the following would you expect to find?

Answer 16

decreased platelets, decreased fibrinogen, prolonged prothrombin time, fragmented red blood cells.

Question 17

When evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate at the onset of several contractions and returns to baseline before each contraction ends as if to mirror the contractionpattern. The nurse should:

Answer 17

Document the findings in the client’s record.

(Rational: The FHR indicates early decelerations, which are not an ominous sign and do not require any intervention. The nurse would simply document these findings.)

Question 18

On examination, it is noted that alaboring patient’s fetusis in the right occiput anterior (ROA) position.Where should the nurse place the ultrasound transducer to obtain a fetal heart tone tracing?

Answer 18

Right Lower Quadrant

( Rational: If a fetus is ROA then the PMI of the fetal heart tones would be in the right lower quadrant, which is were the fetal back would be located.)

Question 19

The fetal heart rate pattern in this tracing is caused by:

Answer 19

Uteroplacenal insufficiency

(Rational: The pattern in this strip is a late deceleration. Persistent and repetitive late decelerations indicate the presence of fetal hypoxemia from insufficient placental perfusion – i.e. uteroplacenal insufficiency.)