OB QUIZ #3

Question 1

A primigravida at 38 weeks presents with loss of her mucous plug. What is the nurse’s best response?
A. “This means labor will begin within 24 hours.”
B. “This is normal and does not mean labor is imminent.”
C. “You should come to the hospital immediately.”
D. “This is a sign of infection and needs evaluation.”

Answer 1

Answer: B
Rationale: Loss of the mucous plug is normal and acts as a protective barrier. It does not necessarily indicate the onset of labor and can regenerate.

Question 2

Which Bishop score indicates the most favorable cervix for induction?
A. 3
B. 5
C. 8
D. 10

Answer 2

Answer: D
Rationale: A Bishop score of 8 or higher suggests a cervix that is favorable for induction, indicating readiness for labor.

Question 3

A nurse is assessing a postpartum patient and notes bright red bleeding similar to a menstrual period. What should the nurse do next?
A. Reassure the patient this is normal.
B. Monitor the bleeding for one hour.
C. Notify the healthcare provider immediately.
D. Perform fundal massage.

Answer 3

Answer: C
Rationale: Bright red bleeding resembling a menstrual period postpartum is abnormal and may indicate postpartum hemorrhage (PPH). Immediate intervention is required.

Question 4

When assessing a postpartum patient’s lochia, the nurse notes a foul odor. What is the nurse’s priority intervention?
A. Increase fluid intake.
B. Notify the healthcare provider.
C. Encourage breastfeeding.
D. Perform perineal care.

Answer 4

Answer: B
Rationale: Foul-smelling lochia may indicate an infection, which requires prompt evaluation by a healthcare provider.

Question 5

A patient reports severe headaches and swelling in her hands postpartum. What is the nurse’s best action?
A. Document the findings as normal.
B. Assess blood pressure and notify the provider.
C. Provide pain medication for the headache.
D. Reassess symptoms in one hour.

Answer 5

Answer: B
Rationale: Severe headaches and swelling can indicate preeclampsia. Blood pressure assessment and timely intervention are crucial.

Question 6

Which uterotonic medication is contraindicated in a patient with hypertension?
A. Pitocin
B. Methergine
C. Cytotec
D. Hemabate

Answer 6

Answer: B
Rationale: Methergine is contraindicated in patients with hypertension as it can raise blood pressure.

Question 7

A postpartum patient asks how to suppress lactation. What is the best teaching by the nurse?
A. Apply warm compresses to the breasts.
B. Express milk regularly to relieve discomfort.
C. Use a supportive bra and avoid nipple stimulation.
D. Take over-the-counter decongestants.

Answer 7

Answer: C
Rationale: Suppressing lactation involves wearing a supportive bra and avoiding nipple stimulation. Warm compresses and milk expression can stimulate lactation.

Question 8

A patient presents with suspected uterine atony. What is the priority nursing intervention?
A. Assess vital signs.
B. Perform fundal massage.
C. Administer oxygen.
D. Notify the healthcare provider.

Answer 8

Answer: B
Rationale: Uterine atony is the leading cause of postpartum hemorrhage. Fundal massage is the first-line intervention to promote uterine contraction.

Question 9

A patient is receiving Pitocin for labor induction. What is the most critical assessment?
A. Maternal heart rate
B. Maternal blood pressure
C. Fetal heart rate
D. Maternal temperature

Answer 9

Answer: C
Rationale: Continuous fetal heart rate monitoring is essential during Pitocin administration to detect fetal distress due to uterine hyperstimulation.

Question 10

A postpartum patient is experiencing afterpains. What should the nurse suggest?
A. Use a heating pad on the abdomen.
B. Increase ambulation.
C. Take ibuprofen as prescribed.
D. Perform Kegel exercises.

Answer 10

Answer: C
Rationale: Ibuprofen is effective in managing afterpains due to its anti-inflammatory properties.

Question 11

What is the most common risk associated with TOLAC?
A. Uterine rupture
B. Infection
C. Postpartum hemorrhage
D. Prolonged labor

Answer 11

Answer: A
Rationale: Uterine rupture is the most significant risk during a trial of labor after cesarean (TOLAC).

Question 12

A patient presents with decreased fetal movement. What should the nurse recommend?
A. Monitor for an additional hour.
B. Perform a kick count test.
C. Reassess the next day.
D. Notify the healthcare provider.

Answer 12

Answer: D
Rationale: Decreased fetal movement can indicate fetal distress. Immediate evaluation is necessary.

Question 13

The nurse identifies a boggy uterus in a postpartum patient. What is the priority intervention?
A. Increase fluid intake.
B. Perform fundal massage.
C. Assess lochia.
D. Notify the healthcare provider.

Answer 13

Answer: B
Rationale: A boggy uterus indicates poor contraction. Fundal massage stimulates contraction to reduce the risk of hemorrhage.

Question 14

What is the nurse’s first action when managing a patient with suspected mastitis?
A. Administer antibiotics.
B. Encourage breastfeeding.
C. Apply warm compresses.
D. Notify the provider.

Answer 14

Answer: D
Rationale: Mastitis requires prompt evaluation and treatment, including antibiotics prescribed by a healthcare provider.

Question 14

A patient undergoing a cesarean section asks about risks. Which is a key risk to discuss?
A. Uterine rupture
B. Increased risk of future placental complications
C. Fetal distress
D. Shortened labor

Answer 14

Answer: B
Rationale: Cesarean sections increase the risk of placental complications, such as placenta previa and accreta, in future pregnancies.

Question 15

Which of the following postpartum findings requires immediate intervention?
A. Lochia rubra 2 days postpartum
B. A firm uterine fundus at the umbilicus
C. Sudden onset of chills and a temperature of 101°F
D. Perineal swelling and discomfort

Answer 15

Answer: C
Rationale: A sudden fever postpartum may indicate infection and requires immediate intervention.

Question 16

A patient reports severe pain after a vacuum-assisted delivery. The nurse suspects a vaginal hematoma. What is the priority action?
A. Apply ice to the perineum.
B. Notify the healthcare provider immediately.
C. Administer prescribed analgesics.
D. Reassess in 30 minutes.

Answer 16

Answer: B
Rationale: Vaginal hematomas can lead to significant blood loss. Immediate evaluation and intervention by the healthcare provider are essential.

Question 17

A nurse is teaching a postpartum patient about perineal care after an episiotomy. Which statement indicates the patient needs further teaching?
A. “I will use a peri-bottle to rinse after using the bathroom.”
B. “I will apply ice packs to reduce swelling.”
C. “I should avoid sitting directly on my stitches.”
D. “I should use hot water for sitz baths immediately after delivery.”

Answer 17

Answer: D
Rationale: Sitz baths with warm, not hot, water are recommended after the first 24 hours to promote healing and comfort.

Question 18

A nurse is administering Hemabate to a postpartum patient with uterine atony. What condition in the patient’s history requires caution?
A. Hypertension
B. Asthma
C. Diabetes
D. Hypothyroidism

Answer 18

Answer: B
Rationale: Hemabate (Carboprost) can cause bronchospasm and is contraindicated in patients with asthma.

Question 19

A patient at 36 weeks gestation presents with severe headaches and blurred vision. What is the nurse’s priority intervention?
A. Assess for proteinuria.
B. Encourage fluid intake.
C. Administer antihypertensive medication.
D. Notify the healthcare provider immediately.

Answer 19

Answer: D
Rationale: Severe headaches and blurred vision are symptoms of preeclampsia. Immediate provider notification is essential to manage this condition.

Question 20

A nurse is teaching a patient with mastitis about breastfeeding. Which statement indicates the need for further teaching?
A. “I will empty both breasts completely with each feeding.”
B. “I should stop breastfeeding on the affected side.”
C. “I will apply warm compresses before feeding.”
D. “I will wear a supportive bra.”

Answer 20

Answer: B
Rationale: Breastfeeding should continue on the affected side to prevent milk stasis, which can worsen mastitis.

Question 21

A postpartum patient reports frequent urination and excessive sweating. What is the nurse’s best response?
A. “This is normal as your body eliminates excess fluids.”
B. “You should drink less water to prevent overhydration.”
C. “This is a sign of a urinary tract infection.”
D. “You need blood work to check your hydration status.”

Answer 21

Answer: A
Rationale: Diuresis and diaphoresis are normal postpartum processes to eliminate excess fluid accumulated during pregnancy.

Question 22

A nurse is assessing a patient in labor who is receiving Pitocin. The patient has contractions every 1 minute lasting 90 seconds, with a fetal heart rate of 100 bpm. What is the nurse’s priority intervention?
A. Stop the Pitocin infusion.
B. Increase the infusion rate.
C. Continue monitoring the patient.
D. Administer oxygen via nasal cannula.

Answer 22

Answer: A
Rationale: Contractions every minute with prolonged durations indicate uterine hyperstimulation, which can compromise fetal oxygenation. The Pitocin infusion should be stopped immediately.

Question 23

Which patient is most at risk for uterine rupture during labor?
A. A primigravida at 40 weeks receiving Pitocin.
B. A patient attempting a vaginal birth after two prior cesarean sections.
C. A patient with twins at 38 weeks in spontaneous labor.
D. A patient at 41 weeks with macrosomia and intact membranes.

Answer 23

Answer: B
Rationale: A history of multiple cesarean sections increases the risk of uterine rupture, especially during a trial of labor.

Question 24

Scenario:
A 29-year-old G3P2 delivers a 9 lb infant using a vacuum-assisted delivery. Postpartum, the nurse notes perineal swelling and a drop in hemoglobin levels.

Questions:

What is the nurse’s priority assessment in this situation?
A. Check for uterine atony.
B. Assess for a vaginal hematoma.
C. Monitor for signs of infection.
D. Evaluate for retained placenta.
Answer: B
Rationale: Perineal swelling and a hemoglobin drop after a vacuum-assisted delivery suggest a vaginal hematoma.

Answer 24

What intervention should the nurse prepare for if a vaginal hematoma is confirmed?
A. Fundal massage to control bleeding.
B. Surgical evacuation by the provider.
C. Administration of uterotonics.
D. Application of ice packs to reduce swelling.
Answer: B
Rationale: Large hematomas often require surgical evacuation to prevent further complications.

Question 25

A postpartum patient has a firm fundus and moderate lochia rubra but complains of severe rectal pain. The nurse suspects which condition?
A. Uterine atony
B. Vaginal hematoma
C. Retained placenta
D. Normal postpartum changes

Answer 25

Answer: B
Rationale: Severe rectal pain with a firm uterus and moderate lochia is consistent with a vaginal hematoma.

Question 26

Scenario:
A 34-year-old G1P1 woman is 2 days postoperative from a cesarean section. She reports incisional pain and difficulty moving around but denies fever or discharge from the incision.

Questions:

What is the nurse’s first action to address the patient’s pain?
A. Encourage ambulation to relieve discomfort.
B. Administer prescribed analgesics.
C. Apply a warm compress to the incision.
D. Assess the patient’s pain level using a pain scale.
Answer: D
Rationale: Pain assessment is the first step in managing the patient’s discomfort.

Answer 26

Which finding in the patient’s incision would require immediate intervention?
A. Redness at the edges
B. A small amount of serous drainage
C. Separation of the incision with purulent drainage
D. Bruising around the incision site
Answer: C
Rationale: Wound dehiscence with purulent drainage indicates infection and requires prompt intervention.

Question 27

Scenario:
A 25-year-old G2P2 woman presents 3 weeks postpartum with a fever of 101°F, breast tenderness, and a hard, reddened area on her left breast. She is breastfeeding but reports difficulty latching the baby on the affected side.

Questions:

What should the nurse do first?
A. Encourage the patient to stop breastfeeding temporarily.
B. Teach the patient to apply cold compresses after feeding.
C. Refer the patient to a lactation consultant.
D. Notify the provider for antibiotic initiation.
Answer: D
Rationale: Mastitis requires prompt treatment with antibiotics to prevent complications such as abscess formation.

Answer 27

Which nursing intervention supports continued breastfeeding?
A. Recommend alternating warm and cold compresses.
B. Suggest pumping the unaffected breast only.
C. Advise weaning to reduce milk production.
D. Teach complete emptying of both breasts.
Answer: D
Rationale: Emptying both breasts prevents milk stasis, which exacerbates mastitis and encourages healing.

Question 28

Scenario:
A 35-year-old G3P3 woman presents to the clinic 5 days postpartum with complaints of fatigue, a headache, and swelling in her feet. She denies fever or excessive bleeding.

Questions:

What should the nurse prioritize in this assessment?
A. Assess her lochia for clots.
B. Check her blood pressure.
C. Evaluate her perineum for infection.
D. Ask about breastfeeding practices.
Answer: B
Rationale: A headache and swelling can indicate postpartum preeclampsia, and blood pressure assessment is a priority.

Answer 28

What symptom would further confirm the suspicion of postpartum preeclampsia?
A. Bright red bleeding
B. Blurred vision
C. Increased milk production
D. Decreased urinary output
Answer: B
Rationale: Blurred vision is a hallmark sign of preeclampsia due to vasospasm and hypertension.

Question 29

Scenario:
A 32-year-old G1P1 woman is 2 days postpartum after a vaginal delivery with a second-degree laceration. She reports perineal discomfort and hemorrhoids.

Questions:

What teaching should the nurse provide for perineal care?
A. Use a peri-bottle to cleanse after voiding and pat dry.
B. Apply ice packs for 48 hours and avoid sitting.
C. Use hot compresses for pain relief.
D. Avoid any cleansing agents near the laceration.
Answer: A
Rationale: A peri-bottle promotes hygiene and prevents infection by gently cleansing the area. Ice is recommended only in the first 24 hours.

Answer 29

Which intervention can the nurse suggest to manage hemorrhoids?
A. Avoid stool softeners.
B. Apply witch hazel pads and use a sitz bath.
C. Increase dairy intake.
D. Limit fiber to prevent irritation.
Answer: B
Rationale: Witch hazel pads and sitz baths reduce inflammation and discomfort associated with hemorrhoids.

Question 30

Scenario:
A 28-year-old G2P2 woman is 24 hours postpartum following a vaginal delivery. On assessment, the nurse notes the uterus is firm and located 2 cm below the umbilicus. The patient reports passing small clots and moderate lochia rubra.

Questions:

What does the nurse understand about the location of the uterus at this time postpartum?
A. It is abnormal and suggests uterine atony.
B. It is normal and indicates uterine involution.
C. It is abnormal and requires immediate intervention.
D. It indicates retained placental fragments.
Answer: B
Rationale: A firm uterus located 2 cm below the umbilicus at 24 hours postpartum is consistent with normal uterine involution.

Answer 30

Which characteristic of lochia rubra requires further investigation?
A. Small clots
B. Moderate flow
C. Foul odor
D. Dark red color
Answer: C
Rationale: Foul-smelling lochia indicates a possible infection and requires prompt evaluation.