OB Exam #4 Flashcards
The perinatal nurse assisting with establishing lactation is aware that acute mastitis can be minimized by:
A. Wearing a supportive bra 24 hours a day
B. Using proper breastfeeding techniques
C. Washing the nipples and breasts with mild soap and water once a day
D. Wearing a nipple shield for the first few days of breastfeeding
B. Using proper breastfeeding techniques
Which client is at greatest risk for early postpartum hemorrhage (PPH)?
A. A primigravida in spontaneous labor with preterm twins
B. A multiparous woman (G3, P2-0-0-2) with an 8-hour labor
C. A primiparous woman (G2, P1-0-0-1) being prepared for an emergency cesarean birth for fetal distress
D. A woman with severe preeclampsia on magnesium sulfate whose labor is being induced
D. A woman with severe preeclampsia on magnesium sulfate whose labor is being induced
Nurses need to know the basic definitions and incidence data about postpartum hemorrhage (PPH). For instance:
A. Traditionally, it takes more than 1000 ml of blood after vaginal birth and 2500 ml after cesarean birth to define the condition as PPH.
B. Traditionally, PPH has been classified as early or late with respect to birth.
C. If anything, nurses and doctors tend to overestimate the amount of blood loss.
D. PPH is easy to recognize early; after all, the woman is bleeding.
B. Traditionally, PPH has been classified as early or late with respect to birth.
A perinatal nurse caring for a postpartum woman understands that late postpartum hemorrhage (PPH) is most likely caused by:
A. Cervical lacerations
B. Defective vascularity of the decidua
C. Subinvolution of the uterus
D. Coagulation disorders
C. Subinvolution of the uterus
A perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is:
A. Uterine inversion
B. Vaginal laceration
C. Vaginal hematoma
D. Uterine atony
D. Uterine atony
As a powerful central nervous system (CNS) stimulant, which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth?
A. PCP
B. Alcohol
C. Cocaine
D. Heroin
C. Cocaine
When caring for a postpartum woman experiencing hemorrhagic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is:
A. Absence of cyanosis in the buccal mucosa
B. Urinary output of at least 30 ml/hr
C. Diminished restlessness
D. Cool, dry skin
B. Urinary output of at least 30 ml/hr
Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. A diagnosis of fetal alcohol syndrome (FAS) is made when there are visible markers in each of three categories. Which is not a recognized category for diagnosis of FAS?
A. Craniofacial dysmorphologies
B. Impaired growth
C. Central nervous system (CNS) abnormality
D. Respiratory conditions
D. Respiratory conditions
A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to:
A. Catheterize the bladder
B. Establish venous access
C. Perform fundal massage
D. Prepare the woman for surgical intervention
C. Perform fundal massage
During inpatient psychiatric hospitalization, it is important for the new mother to have:
A. Contact with her significant other
B. No contact with anyone who annoys her
C. The infant with her at all times
D. Supervised and guided visits with her infant
D. Supervised and guided visits with her infant
Lacerations of the cervix, vagina, or perineum are also causes of PPH. Factors that influence the causes and incidence of obstetric lacerations of the lower genital tract include all except:
A. Adherent retained placenta
B. Abnormal presentation of the fetus
C. Operative or precipitate birth
D. Congenital abnormalities of the maternal soft parts
A. Adherent retained placenta
According to Beck’s studies, what risk factor for postpartum depression (PPD) is likely to have the greatest effect on the woman’s condition?
A. Single-mother status
B. Unplanned or unwanted pregnancy
C. Low socioeconomic status
D. Prenatal depression
D. Prenatal depression
Anxiety disorders are the most common mental disorders that affect women. While providing care to the maternity client, a nurse should be aware that one of these disorders is likely to be triggered by the process of labor and delivery. This disorder is:
A. Phobias
B. Panic disorder
C. Obsessive-compulsive disorder (OCD)
D. Posttraumatic stress disorder (PTSD)
D. Post-traumatic stress disorder (PTSD)
It is important for the perinatal nurse to be knowledgeable regarding conditions of abnormal adherence of the placenta. This occurs when the zygote implants in an area of defective endometrium and results in little to no zone separation between the placenta an decidua. Which classification of separation is not recognized as an abnormal adherence pattern?
A. Placenta accreta
B. Placenta percreta
C. Placenta abruption
D. Placenta increta
C. Placenta abruption
A woman who has recently given birth complaints of pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness over an enlarged, hardened area. The nurse should suspect ________ and should confirm the diagnosis by ________________.
A. Thrombophlebitis; using real-time and color Doppler ultrasound
B. Thrombocytopenic purpura; drawing blood for laboratory analysis
C. von Willebrand disease (vWD); noting whether bleeding times have been extended
D. Disseminated intravascular coagulation (DIC); asking for laboratory tests
A. Thrombophlebitis; using real-time and color Doppler ultrasound
Obese women are at risk for several complications during pregnancy and birth. These include all except:
Thromboembolism
Wound infection
Cesarean birth
Breech presentatioin
Breech presentatioin
An unmarried young woman describes her sex life as “active” and involving “many” partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). The nurse’s most appropriate response is:
A. “The IUD does not interfere with sex.”
B. “Pregnancy rates are high with the IUDs”.
C. “The risk of pelvic inflammatory disease will be higher for you.”
D. “The IUD will protect you from sexually transmitted infections.”
C. “The risk of pelvic inflammatory disease will be higher for you.”
In planning for home care of a woman with preterm labor, the nurse needs to address which concern?
A. Home health care providers are necessary.
B. Restricted activity and medications are necessary to prevent recurrence of preterm labor.
C. Prolonged bed rest may cause negative physiologic effects.
D. Nursing assessments are different from those done in the hospital setting.
C. Prolonged bed rest may cause negative physiologic effects.
A nurse providing care for a woman with preterm labor on terbutaline includes which intervention to identify side effects of the drug?
A. Assess for bradycardia
B. Assess for hypoglycemia
C. Assess for dyspnea and crackles
D. Assess deep tendon reflexes (DTRs)
C. Assess for dyspnea and crackles
In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, which finding alerts the nurse to possible side effects?
A. Serum magnesium level of 10 mg/dl
B. Respiratory rate (RR) of 16 breaths/min
C. Deep tendon reflexes 2+ and no clonus
D. Urine output of 160 ml in 4 hours
A. Serum magnesium level of 10 mg/dl
A woman has chosen the calendar method of conception control. During the assessment process, it is most important that the nurse:
A. Obtain a history of menstrual cycle lengths for the past 6 to 12 months
B. Determine the client’s weight gain and loss pattern for the previous year
C. Examine skin pigmentation and hair texture for hormonal changes
D. Explore the client’s previous experiences with conception control
A. Obtain a history of menstrual cycle lengths for the past 6 to 12 months
The primary theme of the feminist perspective on violence against women recognizes the:
A. Dominance and coercive control over women by men
B. Cultural norm of violence in Western society
C. Basic human instinctual drive toward aggression
D. Role of testosterone as teh underlying cause of men’s violent behavior
A. Dominance and coercive control over women by men
Women who’s cervical length is greater than 30 mm are unlikely to give birth prematurely even if they have symptoms of preterm later
greater than 30 they are good
Fetalfibronectin is present during preterm labor
but may not have it if positive.
Which contraceptive method has a failure rate of less than 25%?
Standard days
Postovulation
Periodic abstinence
Coitus interruptus
Standard days
Intimate partner violence (IPV) is seen in all races, ethnicities, religions, and socioeconomic backgrounds. Which statement is most accurate regarding the reporting of IPV in the Unites States?
A. Caucasian women report less IPV than do non-Caucasians.
B. Native-American women report IPV at a rate similar to other gorups.
C. African-American women are less likely to report IPV than Caucasian women.
D. Asian women report more IPV than do other minority groups.
A. Caucasian women report less IPV than do non-Caucasians.
Which statement is the most complete and accurate description of medical abortions?
A. They can be either elective or therapeutic.
B. They are performed only for maternal health.
C. They can be achieved through surgical procedures or with drugs.
D. They are mostly performed in the second trimester.
A. They can be either elective or therapeutic.
You (the nurse) are reviewing the educational packet provided to a client about a tubal ligation. What is an important fact you should point out? Choose all that apply.
A. “This is an effective form of 100% permanent sterilization. You won’t be able to get pregnant.”
B. “Your menstrual cycle will greatly increase after your sterilization.”
C “Sterilizationi offers some form of protection against sexually transmitted infections.”
D “Sterilization offers no protection against sexually transmitted infections.”
E “It is highly unlikely that you will become pregnant after the procedure.”
D “Sterilization offers no protection against sexually transmitted infections.”
E “It is highly unlikely that you will become pregnant after the procedure.”
Before 20 weeks is called
abortion
The nurse who is evaluating the client for potential abuse should be aware that intimate partner violence includes (choose all that apply):
Economic abuse Sexual abuse Emotional abuse Physical abuse Psychologic abuse
All of them
Common characteristics of a potential batterer include (choose all that apply):
Substance abuse problems Excellent verbal skills Personality disorders High frustration tolerance High level of self-esteem
Substance abuse problems Personality disorders
The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions. What clinical cues alert the n ruse that the woman is experiencing uterine hyperstimulation? Choose all that apply:
A Uterine contractions lasting >90 seconds and occurring 20 mm Hg
A Uterine contractions lasting >90 seconds and occurring 20 mm Hg
B Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR) and pattern
Complications and risks associated with cesarean births include (choose all that apply):
Fetal risks Hemorrhage Wound dehiscence Urinary tract infections Pulmonary edema
All of them
Less than 36 weeks then can be given a tocalytic is the less than 6 cm
Side effects
Increased Heart rate
dyspnea crackles
Sign and symptoms of late postpartum hemorrhage include: (choose all that apply)
a. Fever, pelvic pain
b Excessive lochial flow
c Excessive maternal activity
d Foul smelling lochia
e Lochia alba
f Uterine and fundal tenderness
a. Fever, pelvic pain
b Excessive lochial flow
d Foul smelling lochia
f Uterine and fundal tenderness
Prevention of future gynecological problems for the obstetrical client would be best helped by: (choose all that apply)
A, Pelvic stretching exercises
b Performing an episiotomy for vaginal births
c Avoiding straining and constipation
d Kegel exercises
e Avoiding heavy lifting
c Avoiding straining and constipation
d Kegel exercises
e Avoiding heavy lifting
You have the following orders for your postpartum client: Methergine (methylergonovine) 0.2 mg po every 6 hours for 2 days and Oxytocin (pitocin) 20 units to first 2 liters of Lactated Ringers to infuse at 125 ml/hr. What would be important to assess for this client? (choose all that apply)
a Skin integrity
b Vaginal bleeding
c Pain scale
d History of hypertension
e History of asthma
f Frequent vital signs
b Vaginal bleeding
c Pain scale
d History of hypertension
f Frequent vital signs
Maternal Tocalytic contraindications
HTN
Significant vaginal Bleeding
Cardiac Disease
Which of the following increase a client’s risk for thrombophlebitis? (choose all that apply)
a Obesity
b Blood type AB negative
c Cesarean birth
d Early ambulation
e Dehydration
a Obesity
b Blood type AB negative
c Cesarean birth
e Dehydration
What is the most common tocalytic?
Magnesium
Complications Mag level of 10 Low resp low HR LOC Changes
Antidote is calcium gluconate
It is important for the perinatal nurse to be knowledgeable regarding conditions of abnormal adherence of the placenta. This occurs when the zygote implants in an area of defective endometrium and results in little to no zone separation between the placenta and decidua. Which classification of separation is not recognized as an abnormal adherence pattern?
a Placenta accreta
b Placenta increta
c Placenta percreta
d Placenta abruptio
d Placenta abruptio
Less than 10% of women who are substance abusers receive treatment for their addiction during pregnancy. Is this statement true or false?
True
False
True
When a client admits to drug use in pregnancy it is important to: (choose all that apply)
a Screen for sexually transmitted infections
b Request a social work referral
c Obtain meconium from the infant and test for the presence of drugs
d Assess the clients readiness to withdraw from drugs
e Place the client in a drug treatment program to begin withdrawal as soon as possible
f Obtain a urine drug screen even if she does not give permission
a Screen for sexually transmitted infections
b Request a social work referral
d Assess the clients readiness to withdraw from drugs
Causes of postpartum hemorrhage include which of the following: (choose all that apply)
a Uterine atony
b Lacerations of the cervix and genital tract
c Subinvolution
d Adherent retained placenta
e Nonadherent retained placenta
f Endometritis
a Uterine atony
b Lacerations of the cervix and genital tract
c Subinvolution
d Adherent retained placenta
e Nonadherent retained placenta
