OB Exam 3 Flashcards
A patient just delivered vaginally and had an EBL of 650mL. Should you be concerned?
Yes. This indicates hemorrhage.
A post partum patient with hx of cardiovascular disease might have more challenges r/t to what change during birth?
Fluid loss
What are the main ways that women lose fluid post partum?
Blood loss, urine output, sweat.
A patient that is 1 day postpartum has recorded output of 130mL in the last hour, how should the nurse address this finding?
Keep monitoring. This is a normal finding for the first 2-3 days.
In a postpartum patient, when should BP and HR return to normal levels?
Within a few hours
What might elevated HR indicate in a postpartum patient?
Impending shock
What is difference between increased temperature in the mother during first 24 hours after giving birth vs after the first 24 hours.
Maternal fever after the first 24 hours is abnormal and should be addressed. Maternal fever in first 24 hours is usually related to the stress of giving birth.
Rubra. What and why?
Bright red discharge. Just blood
Serosa. What and why?
Pinkish/ brownish discharge. WBCs, blood, and debris
Alba. What and why?
Whiteish/yellow color. WBCs and bacteria.
The nurse knows the client understand the correct process for completing Kegel exercises when she says ….
A. I contract my thighs, buttocks, and abdomen.
B. I do 10 of these exercises everyday
C. I stand while doing these exercises
D. I pretend that I am trying to stop the flow of urine mid stream.
D
Is involution a normal finding?
Yes. Involution is the return of the uterus to non-pregnant state.
Location of fundus over time.
- At birth = at umbilicus
- Moves down 1cm every 24 hours
- Cannot be palpated by 2 weeks
- Returns to prepregnant state by 6 weeks.
A mother is breastfeeding her baby and says, “I already had this baby, why am I still cramping?”, how should the nurse respond?
Educate the mother by telling her that breastfeeding releases oxytocin, which causes contraction of uterus (cramping)
The nurse feels swelling on the newborn’s scalp that crosses suture lines. What is this called?
Caput succadaneum
What is the reason the nurse administers Vitamin K to the newborn?
Bacteria that synthesize vitamin K are not present in the newborn’s intestinal tract.
A patient who is 1 month postpartum states that she has been feeling fatigued, very irritated/angry, and says she wants to just be alone and let her husband take care of her child. What condition does the nurse suspect?
Postpartum depression.
A patient is 2 weeks postpartum and states that she’s been very sad and that she’s been seeing military patrolling outside her house because they want to get her and her baby. While reviewing the chart, the nurse finds that she has significant history of bipolar disorder, what condition does the nurse suspect?
Postpartum psychosis.
A patient that is 2 days postpartum states that she is feeling upset/ emotional. She denies having feelings of wanting to harm herself or the baby. What condition does the nurse suspect?
Postpartum blues.
The nurse recognizes that these 4 meds are used to treat PPH:
- Carboprost tromethamine (Hemabate)
- Oxytocin
- Misoprostol (Cytotec)
- Methylergonovine (Methergine)
A nurse is an assessing a patient who just recently gave birth. The nurse knows the patient changed their pad 20 minutes ago, but when the nurse checks now, the pad is fully saturated. What does the nurse suspect is happening? What should the nurse do first?
-The nurse should suspect PPH.
- The nurse should check for boggy fundus, then massage fungus until it’s firm.
The nurse is caring for a patient that is suffering a PPH. The nurse has been massaging the fundus for several minutes and all medications have been administered but there is still bleeding, the fundus is still boggy, and the patient’s LOC is decreasing along w/ BP. What would be the next actions?
Bimanual fundal massage, bakri balloon.
The provider performs bimanual massage and places a bakri balloon but there are still signs of bleeding, what would the next action be?
Transfer to IR to plug uterine arteries.
All options for PPH treatment have been exhausted and the patient is still declining. What is the last resort procedure that can be done as a life-saving measure?
Hysterectomy.
A nurse is educating a new mother about how to prevent or minimize physiologic jaundice. What teaching should she include?
Adequate/ frequent feeding can help to prevent or minimize physiologic jaundice.
How can the nurse tell if a newborn is getting enough breastmilk?
Measure output. The number of wet diapers should be at least the same as the babies age in days for the first few days. Baby should be content between feedings. 6-8 diapers a day after first few days.
A nurse is caring for a newborn that is 8 hours old. On assessment the nurse notes yellowing of the skin and sclera. What is this finding called?
Pathologic jaundice
A nurse is caring for a newborn with pathologic jaundice. The nurse knows that this is usually a result of what?
Hemolysis r/t Rh or ABO incompatibility.
The nurse is talking to a new mother that is 2 days postpartum. She is concerned because she notices yellowing of her child’s skin. How does the nurse explain this finding?
This is physiologic jaundice and it is a common finding in newborns.
A mother gives birth to her baby at 35 weeks. How should this baby be classified?
Late pre-term.
What are concerns the nurse may have r/t pre-term babies?
Immaturity of organ systems, respiratory issues, LBW, hypotonia, difficulty with thermoregulation, hypoglycemia, hyperbilirubinemia, sepsis.
A mother that has been resting on the unit begins to complain of pain in her right calf. Upon assessment, the calf is swollen and red. What does the nurse suspect?
TED
A nurse recognizes that hydration, ambulation, SCDs, and enoxaparin all have what purpose in common?
Prevention of TED.
What would be a reason to hold a methylergonovine dose?
HTN
What 2 newborn complications are r/t shoulder dystocia?
Clavicle fracture and Erb’s palsy
If a mother has type O blood, which blood types could the baby have that would be incompatible?
Types A, B, AB
Carboprost tromethamine side effects
Increase BP, N/V/D
What does the acronym LATCH stand for?
Latch
Audible swallowing
Type of nipple
Comfortability (breastfeeding shouldn’t hurt)
Help (how much help does mother need)
A mother has just given birth and plans to breastfeed. When should she begin breastfeeding her newborn?
Within an hour if possible.
A breastfeeding mother complains of nipple soreness. What usually causes this?
Baby not having good latch.
What can be done to help or prevent nipple soreness?
Assess latch and reposition.
A woman is about to give birth any second. What information do you want to know to provide the best care for the newborn?
Gestational age, what meds have been given recently, and color of fluid when water broke (MAS).
What can be done to ensure a safe sleeping environment for a newborn?
Have the baby sleep alone, on their back, in the crib.
What are the main newborn reflexes we expect to see during assessment?
-Sucking/ rooting
- Swallow
- Grasp
- Moro (startle)
- Stepping
- Babinski
A nurse is caring for a mother and her baby when the mother states that her newborn son must be cold because he’s been “shivering” lately and hasn’t eaten in a few hours. What should the nurse suspect? What should the nurse do first?
The nurse should suspect hypoglycemia. Assess the newborns blood glucose level, instruct mother to feed.
When administering an IM medication to a newborn, which site would be the most appropriate?
Vastus lateralis.
A mother just gave birth and has been experiencing a temperature of around 100.6. The next day, the nurse obtains a temperature reading of 101.8, what might this be a sign of?
Infection
A mother is 8 hours post-partum and on the most recent VS check her HR was 120 bpm. The nurse looks in the chart and sees that the last HR recorded just 4 hours ago was 88. What might the nurse suspect?
Impending shock
A 3 hour old newborn appears jittery. What is the priority nursing action for this newborn?
Obtain glucose level via heel stick
After the birth of a healthy crying newborn, what is the first intervention the nurse should do?
Dry the infant and remove wet linens.
Which of the following would be scored as two points in the Apgar score? SATA
A. Pink body, blue hands and feet
B. HR > 100bpm
C. Well flexed
D. Grimace
E. Cry
B, C, E
Erythromycin ophthalmic ointment is administered to prevent which STIs? SATA
A. Chlamydia
B. Gonorrhea
C. Genital herpes
D. HPV
E. Hepatitis B
A and B
A newborn’s temperature at 20 hours from birth is 97.2 degrees axillary. What is the priority nursing action?
Place the infant skin to skin on the mothers chest.
A neonate at highest risk for hyperbilirubinemia is one who has which of the following?:
A. Caput succedaneum
B. Erythema toxicum
C. Molding
D. Cephalohematoma
D. Cephalohematoma
Which of the following would be a concern if assessed in a newborn at four hours of age?
A. Jaundice
B. Irregular respiratory rate
C. Acrocyanosis
D. Cardiac murmur
A. Jaundice
Jaundice within the first 24 hours of life is pathologic.
A nurse is discussing benefits of breastfeeding to the mother with a prenatal education class for parents. Which is NOT a maternal benefit of breastfeeding?
A. Protection against certain cancers
B. Reduces mother’s risk of developing migraines
C. Reduce’s mother’s risk of PPH
D. Protection against osteoporosis
B. Reduces mother’s risk of developing migraines.
A nurse is teaching a postpartum day one client who has never breastfed before about breastfeeding. Which statement(s) shows a need for further teaching? SATA
A. “If the baby still looks hungry between feedings I can give some pumped breastmilk in a bottle.”
B. “I should make sure only my nipple is in the baby’s mouth when latching.”
C. “Watching for the baby to start crying is the best way to figure out when to start feeding.”
D. If the baby has 6-8 wet diapers a day when we get home I will know she is getting enough milk.
E. “Until I get used to feeding the baby I am better off to use the cradle hold for all feedings.”
F. “I expect the baby should feed about every 4 hours.”
A, B, C, E, F
A nurse is monitoring a newborn for signs of neonatal abstinence syndrome (NAS). Which symptoms would alert the nurse the the possibility of NAS? SATA
A. Jitteriness/ tremors
B. Excoriations on the face
C. High-pitched, shrill cry
D. Poor feeding
E. Decreased or relaxed muscle tone
A, B, C, D
A nurse caring for a preterm newborn is monitoring for signs of necrotizing enterocolitis (NEC). Which are signs of NEC? SATA
A. increased abdominal circumference
B. bloody stools
C. spitting up small amounts of milk
D. bulging anterior fontanel
E. elevated alpha fetoprotein levels
A, B
The diabetic mother of a newborn at one hour of age asks why the nurse is sticking her baby’s heel for blood glucose testing. Which is the correct response by the nurse?
A. Your baby may have a high blood glucose due to your high blood glucose during pregnancy.
B. Your baby may have a low blood glucose because of making too much insulin before birth due to your diabetes.
C. Your baby is more likely to be diabetic like you because of heredity.
D. Your baby was used to relying on your insulin before birth, and may not have enough insulin right now.
B
Which finding is an early sign of neonatal sepsis?
A. Seizures
B. Persistent temp of 96.8 degrees
C. WBC count of 14,000
D. Blood glucose 140
B
A nurse caring for a postpartum client two weeks after giving birth notes lochia rubra that saturates a perineal pad in half an hour. Which condition is the most likely cause of this finding?
Retained placental fragments
A 32 year old client delivered a 9 pound 4 ounce newborn by repeat Cesarean section one hour ago under spinal anesthesia after attempting a vaginal birth and dystocia. Medical history: asthma treated with daily inhaler, iron deficiency anemia. Baseline findings prior to delivery: VS 110/64, 78, 14, 98.6, 99%, Hgb – 9.5, 1+ pedal edema, Blood type A positive. EBL was 1520 ml. Your client is recovering with the newborn. Your assessment: fundus boggy, non-tender, 3 fb above umbilicus midline, lochia heavy rubra with small clots, saturated 3 pads since birth. Which additional findings would you anticipate at this time? SATA
A. Moving lower extremities but unable to lift legs
B. Voided 250 ml clear urine since delivery
C. Pulse 124
D. BP 130/80
E. Negative pedal edema
F. Hemoglobin 7.5 gm/dL
A, C, F
A woman who gave birth 24 hours ago tells the nurse, “Since I had the baby I have to urinate
every couple of hours.” Which response by the nurse is most appropriate?
A. You may have an infection, so let me get a urine specimen.
B. Your uterus is not contracting as quickly as it should, and it is pressing on your bladder.
C. The anesthesia that you received is wearing off and your bladder is working again.
D. Your body is getting rid of extra fluids from the pregnancy that causes your bladder to fill quickly.
D
The nurse is caring for a client who had a cesarean section 12 hours ago. Which is the priority goal for care?
A. Provide food and drink as quickly as possible
B. Provide education about incision care
C. Prevent puerperal infection
D. Prevent postpartum hemorrhage
D
When assessing a patient during the postpartum period a nurse observes bright red vaginal discharge with a few 0.5 cm clots saturating half of a perineal pad in 3 hours. Which is the correct documentation of this finding?
A. Late postpartum hemorrhage
B. Lochia serosa
C. Lochia alba
D. Lochia rubra
D. Lochia rubra
A primipara client gave birth vaginally to a healthy newborn girl 36 hours ago. The nurse
palpates the client’s fundus. Which location does the nurse expect to find the fundus at?
A. At the level of the umbilicus
B. Three to four fingerbreadths below the umbilicus
C. One to two fingerbreadths below the umbilicus
D. Two to three fingerbreadths above the umbilicus
C. One to two fingerbreadths below the umbilicus.
A nurse completing an assessment on a 2 day postpartum client prior to discharge to home notes the uterine fundus at 2 cm above the umbilicus, left of midline, firm and non-tender. Which is the next nursing action?
A. Notify the provider about possible subinvolution.
B. Ask the client to empty her bladder and repeat the abdominal exam.
C. Ask the client to empty her bladder then complete the discharge.
D. Massage the uterus and repeat the abdominal exam
B. Ask client to empty bladder then repeat exam.
The postpartum period (puerperium) begins after the delivery of the placenta
and last until:
The woman’s body returns to the prepregnant state (6 weeks)
A 20 year client, G3 P0111 at 33 weeks gestation comes to the ED complaining of intermittent thigh and low backache for the last hour and increased clear mucus vaginal discharge. Abdomen is gravid, soft, non-tender, fundal height 32 cm, cephalic presentation. EFM shows contractions q 3 minutes x 40 seconds, FHT 130s, moderate variability, no decelerations. Vaginal exam – neg nitrazine, neg ferning, cervix 2 cm, 50%, -3, ceph. Indicate whether each finding shows the client’s condition is improving, unchanged, or declining after treatment. Each may be used more than once.
fern- declining
contractions q10- improving
Denies pain- Improving
FHR 140, moderate variability - unchanged
cervix 5cm - declining
Clear mucous discharge - Unchanged
A 32 year old client delivered a 9 pound 4 ounce newborn by repeat Cesarean section one hour ago under spinal anesthesia after attempting a vaginal birth and dystocia. Medical history: asthma treated with daily inhaler, iron deficiency anemia. Baseline findings prior to delivery: VS 110/64, 78, 14, 98.6, 99%, Hgb – 9.5, 1+ pedal edema, Blood type A positive. EBL was 1520 ml. Your client is recovering with the newborn. Your assessment: fundus boggy, non-tender, 3 fb above umbilicus midline, lochia heavy rubra with small clots, saturated 3 pads since birth. For each action match with indicated, non-essential, or contraindicated. You may use each selection more than once.
- Monitor urinary output –> Indicated
- Massage uterus until firm –> indicated
- Administer carboprost as ordered –> Indicated
- Initiate regular diet –> Contraindicated
- Discontinue IV fluids –> Contraindicated
- Turn client on left side –> Non-essential
A 20 year client, G3 P0111 at 33 weeks gestation comes to the ED
complaining of intermittent thigh and low backache for the last hour
and increased clear mucus vaginal discharge. Abdomen is gravid, soft,
non-tender, fundal height 32 cm, cephalic presentation. EFM shows
contractions q 3 minutes x 40 seconds, FHT 130s, moderate variability,
no decelerations. Vaginal exam – neg nitrazine, neg ferning, cervix 2
cm, 50%, -3, ceph. Which cues require immediate action? Select all that apply
- G3 P0111
- 33 weeks gestation
- Contractions q 3 minutes
- Cervix 2cm, 50%, -3 cephalic
A 20 year client, G3 P0111 at 33 weeks gestation comes to the ED
complaining of intermittent thigh and low backache for the last hour
and increased clear mucus vaginal discharge. Abdomen is gravid, soft,
non-tender, fundal height 32 cm, cephalic presentation. EFM shows
contractions q 3 minutes x 40 seconds, FHT 130s, moderate variability,
no decelerations. Vaginal exam – neg nitrazine, neg ferning, cervix-2
cm, 50%, -3, ceph. What actions should the nurse take immediately? Select all that apply
- IV hydration
- Administer betamethasone as ordered
- Notify NICU of preterm labor
- Administer terbutaline as ordered
- Obtain group B strep test.
If you could choose one item to have at the birth of a newborn with known fetal distress, which would you choose and why?
A. 100 % oxygen by mask
B. Positive pressure ventilation bag and mask
C. Naloxone (Narcan)
D. Laryngoscope and endotracheal tube
B. Positive pressure ventilation bag and mask
Narcan not useful unless opioid related. 100% O2 doesn’t help if they’re not breathing. Intubation is rare.
When using bulb suction, is it best to suction mouth or nose first?
Mouth first, then nose (M then N)
Which of the following skin signs indicate there may be a problem?
A. Vernix caseosa
B. Acrocyanosis
C. Jaundice
D. Nevi
E. Petechiae
F. Erythema toxicum
G. Mongolian spots
H. Milia
I. Central cyanosis
C, E, I
What is the most concerning complication r/t IUGR babies?
Stillbirth
The nurse is caring for a newborn who has been circumcised. What nursing care should be done?
Vaseline/ petroleum jelly dressing. Change dressing with every diaper change until site heals completely. Administer PO Tylenol via syringe for pain.
What assessment/ monitoring should be done with new circumcision?
Observe for any excessive bleeding (priority), observe for voiding.
What are the most important things to know regarding car seat safety?
- Know how to adjust straps correctly
- Nothing between straps, just a onesie on baby.
Regarding nonnutritive sucking, what is suggested for mothers that are breastfeeding?
Nonnutritive sucking is discouraged until mothers milk supply is established.
What might be expected regarding WBCs in a 3 day postpartum patient?
Elevated (up to 30,000)
Why are postpartum patients at higher risk for DVT/ PE in the first 2-3 weeks after birth?
Coagulation factors remain elevated during this time.
Because so much is fluid is lost during the birthing process, what BP related complication might be expected during the first day postpartum?
Orthostatic hypotension
The nurse is caring for a patient with hydrocephalus. What are the nursing priorities?
Reposition, decrease and monitor ICP
