OBSTETRIC GYNECOLOGY REVIEW SERIES 1. A woman in active labor has requested a regional anesthetic. She is currently 5 cm dilated.

The physician has prescribed an epidural block. Which of the following nursing interventions would be implemented after the epidural block has been placed? a. Palpate the bladder at frequent intervals b. Assess the blood pressure frequently for hypertension c. Encourage the woman to walk to progress the labor. d. Encourage the woman to assume a supine position after the epidural has been placed.

A: the effect of the epidural is that anesthesia is felt from the fifth lumbar space to the sacral region of the vertebral column. The woman loses 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 labor progress. Hypotension, not hypertension, is a concern. Ambulation is not allowed because of the anesthesia. The woman is encouraged to lie on her side to increase placental perfusion to the fetus.

2. Which of the following would be considered an abnormal finding in a newborn less than 12 hours old? Select all that apply: a. Grunting respirations b. Presence of vernix caseosa c. Heart rate of 190 beats/min d. Anterior fontanelle measuring 5.2 cm e. Bluish discoloration of hands and feet f. A yellow discoloration of the sclera and body

ACF: The normal newborn heart rate is 120 to 140 beats/min. grunting respirations is a sign of possible respiratory distress. The presence of yellow discoloration could indicate newborn jaundice. Options B, D, and E are normal findings. Anterior fontanelle should measure between 3.6 and 6 cm.

3. A nurse is caring for a client with a diagnosis of placenta previa. The nurse collects data knowing that which of the following is a characteristic of placenta previa. a. b. c. d. A tender and rigid uterus Painless, bright red vaginal bleeding Greenish discoloration of the amniotic fluid Vaginal bleeding accompanied by abdominal pain

B: 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. Abruption placenta is painful and results in rigid and tender uterus. Greenish discoloration of the amniotic fluid occurs as a result of meconium staining.

4. A nurse working in an infertility clinic reviews the medical history of a 35year-old woman who is currently taking fertility medications and is planning a pregnancy. Which of the following medications, if present in the clients history, would indicate a need for teaching related to the womans potential risk for carrying a fetus with a congenital cleft lip or cleft palate? a. b. c. d. Methyldopa (Aldomet) Bupropion (Wellbutrin SR) Phenytoin (Dilantin) Folic Acid (Folvite)

C: An antiepileptic (specifically phenytoin) taken during pregnancy is a known risk factor for the development of cleft lip and cleft palate. The use of an antidepressant (bupropion) has not been found to increase a womans risk of developing a fetus with cleft lip or palate. Although bupropion can be used for smoking cessation, and smoking can contribute to the development of cleft lip, taking bupropion does not increase a womans risk of having a fetus affected by cleft lip or palate. Methyldopa is used during pregnancy for maintenance in women with chronic hypertension. Folic acid use is recommended during pregnancy to reduce the risk of cleft lip and palate.

5. The charge nurse on a labor and delivery unit has become overwhelmed with admission of labouring clients and must transfer one of the clients to the postpartum/gynaecological unit, where the nurse-to-client ratio will be 1:4. Which of the following antepartum clients would be the most appropriate one to transfer? a. The 36-year-old, gravida 1, para 0 client who is at 24 weeks gestation and is being monitored for preterm labor b. The 26-year-old, gravida 1, para 0 client who is at 10 weeks gestation and is experiencing vaginal bleeding

c. The 40-year-old, gravida 3, para 0 client who is at 38 weeks gestation and is complaining of decreased fetal movement d. The 29-year-old, gravida 1, para 0 client who is at 42 weeks gestation and had a biophysical profile score of 5 earlier today.

B: the fetus of the client at 10 weeks gestation is in a pre-viability stage, where 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 first trimester. Bedrest would be the primary treatment for this client at this point in her pregnancy. Bedrest could be maintained, and bleeding could be monitored by a postpartum nurse. The clients with preterm and postterm gestation (24 and 42 weeks, respectively) are those most at risk, so clients would require fetal monitoring. The client who is at 38 weeks gestation is also in need of fetal monitoring because of a possibility of a decreased fetal movement. Until the fetal well-being can be confirmed with fetal monitoring, this client should remain on the labor and delivery unit where she can be continuously monitored. Additionally, the two older clients (36 and 40 years) are considered to be of advanced maternal age, indicating a need for closer monitoring.

6. On assessment of a client who is 30 minutes into the fourth stage of labor, the nurse finds the clients perineal pad saturated in blood and blood soaked into the bed linen under the clients buttocks. The nurses initial action is which of the following? a. b. c. d. Call the physician Assess the clients vital signs Gently massage the uterine fundus Administer a 300-mL bolus of a 20 units/L oxytocin (Pitocin) solution.

C: The most frequent cause of excessive bleeding after childbirth is uterine atony. A major intervention to restore adequate tone is stimulation of the uterine muscle via gently massage the uterine fundus. Options A, B, and D may be necessary but they are not initial actions. The initial action is to alleviate the problem. Additionally a physicians prescription is needed to administer a medication

7. Which of the following newborn is most at risk for a brachial plexus injury? a. A 36-week preterm infant delivered vaginally after premature rupture of membranes b. c. d. A term infant malpresentation delivered via primary cesarean section for

A term infant with a history of a forceps-assisted delivery A large for gestational age infant with a history of shoulder dystocia at delivery

D: Brachial plexus injuries, a fractured clavicle, or a fractured humerus are all possible risks during a delivery of an infant with should dystocia and must be considered during the immediate newborn assessment. Stretching or pulling away of the shoulder from the head may occur during a difficult delivery such as one involving should dystocia. This positioning may cause damage to the upper plexus. Larger infants are more likely to be involved in a delivery in which adequate space is a concern. In most cases, option A would result in an infant of smaller size, so shoulder dystocia would not be a priority risk. Should dystocia does not occur during cesarean section, which eliminates option B. Option C can be eliminated because with a forceps delivery, priority concern is for facial or head injuries more than shoulder, arm, or clavicle injuries.

8.

The result of a biophysical profile (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? a. b. c. Notify the physician Prepare the client for labor induction Place the fetal heart monitor on the client in order to do a nonstress test (NST)

d.

Provide the client with information regarding warning signs and symptoms of pregnancy and discharge her home.

C: 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 profile in addition to an NST: fetal breathing movements, fetal movements, fetal tone, and amniotic fluid index. Each of the five 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 clients BPP was an 8 out of 8 possible points. This indicates fetal well-being, but there is a need to complete the BPP by obtaining an NST.

9.

The nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of a slowing labor. The nurse is reviewing the physicians prescriptions and would expect to note which of the following prescribed treatments for this condition? a. Increased hydration b. Oxytocin (Pitocin) infusion c. Administration of a medication that will provide sedation d. Administration of a tocolytic medication

B: 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

10.A nursing student is asked about the procedure used to elicit Homans sign. Which of the following responses by the nursing student would indicate an understanding of this assessment technique? a. I will ask the client to raise her legs up to her waist and then to lower her legs slowly b. I will ask the client to raise her legs and to try to lower them against pressure from my hand c. I will ask the client to extend legs flat on the bed, and I will gently dorsiflex her foot forward

d.

I will ask the client to extend her legs flat on the bed, and I will grasp her foot and sharply extend it backward.

C: To elicit Homans sign, the nurse asks the client to extend her legs flat on the bed. The nurse then grasps the foot and dorsiflexes it forward. If this causes any discomfort or resistance, the nurse should notify the physician that Homans sign may be present.

11. A nurse is instruction a postpartum client with endometritis about preventing the spread of infection to the newborn infant. The nurse would tell the client that: a. b. c. d. Hands should be washed thoroughly before holding the infant The infant will not be allowed in the mothers room at all There is no danger of the newborn contracting the disease Visitors are not allowed to hold the baby

A: Transmission of infectious diseases can occur through contaminated items such as hands and bed linens of client with endometritis. An important method of preventing infection is to break the chain of infection. Handwashing is one of the most effective methods of preventing the transmission of infectious diseases. The newborn infant is allowed in the mothers room and visitors are allowed to hold the newborn infant as long as handwashing and other protective measures are instituted.

12.A nursing student is asked to describe the corpus of the uterus. Which of the following responses, if made by the student, indicates an understanding of the anatomy of the uterus? a. b. c. d. It is the lower portion of the uterus It is the uppermost part of the uterus It is the area where the cervix meets the external os It is the area where the vagina meets the uterus.

B: the uterus has three divisions, the corpus, isthmus, and cervix. The upper division is the corpus or body of the uterus. The uppermost part of the uterine corpus is the fundus of the uterus.

13. A discharge nurse is discussing mastitis with a postpartum client. Which of the following statements by the clients would indicate a need for further instructions? a. If I develop a hot, reddened, triangle-shaped area on my breast, I should contact my health care provider b. I may develop mastitis if I wear underwire bras, experience excessive fatigue, or suddenly decrease the number of feedings c. If I develop a fever, chills, or body aches at any time after discharge, I should stop breast-feeding immediately d. Antibiotics, rest, ward compresses, and adequate fluid intake are all important for the treatment of mastitis

C: Mastitis, a breast infection, is best characterized by a sudden onset on flu-like symptoms, localized breast pain and tenderness, and a hot, reddened area on the breast that often resembles the shape of a pie wedge. Treatment usually includes antibiotics, but the mother should be instructed to feed the baby or pump frequently to adequately empty the affected breast. The mother should not discontinue breast-feeding.

14. On March 10, 2013, a nurse performed an initial assessment on a client admitted to the labor and delivery united for rule out labor. The client has not received prenatal care but is certain of her last menstrual period (LMP) was July 7, 2012. The nurse plans care based on which of the following? a. b. c. d. The client is possibly in preterm labor The fetus may not be viable at delivery The fetus is at high risk for shoulder dystocia The client may require labor augmentation

A: according to Nigeles rule, subtracting 3 months, and adding 7 days and 1 year to this clients LMP, her estimated date of delivery (EDD) would be April 14, 2013. This client is on the labor and delivery unit to be

evaluated for the presence of labor more than 1 month before her EDD, therefore possibly being in preterm before labor.

15. A nurse is assessing a client in the fourth stage of labor and notes that the fundus is firm but that bleeding is excessive. The initial nursing action would be which of the following? a. Record the findings b. Notify the physician c. Massage the fundus d. Place the client in Trendelenburgs position

B: if bleeding is excessive, the cause may be laceration of the cervix or birth canal. Massaging the fundus if it is firm will not assist in controlling the bleeding. Trendelenburgs position is to be avoided because it may interfere with cardiac function. Although the nurse would record the findings, the initial nursing action would be to notify the physician

16. A postpartum client is being treated for deep venous thrombophlebitis. A nurse understands that the clients response to treatment will be evaluated by regularly assessing the client for: a. Dysuria, ecchymosis, and vertigo b. Epistaxis, hematuria, and dysuria c. Hematuria, ecchymosis, and vertigo d. Hematuria, ecchymosis, and epistaxis

D: The treatment for deep venous thrombophlebitis is anticoagulant therapy. The nurse assesses for bleeding, which is an adverse effect of anticoagulants.

17.A nurse is developing a plan of care for a client recovering from a cesarean delivery. To prevent thrombophlebitis, the nurse plans to encourage the woman to: a. Elevate her legs b. Remain on bed rest

c. Ambulate frequently d. Apply warm moist packs to the legs

C: Statis is believed to be a predisposing factor in the development of thrombophlebitis. Because cesarean delivery is also a risk factor for thrombophlebitis, new mothers should ambulate early and frequently to promote circulation and prevent statis.

18.A nurse is monitoring a postpartum client in the fourth stage of labor, which of the following findings, if noted by the nurse, would indicate a complication related to a laceration of the birth canal. a. Presence of dark red lochia b. Palpation of the uterus as a firm contracted ball c. The saturation of more than one peripad per hour d. Palpation of the fundus at the level of the umbilicus

C: in the first 24 hours after birth, the uterus will feel like a firmly contracted ball, roughly the size of a large grapefruit. One easily can locate the uterus at the level of the umbilicus. Lochia should be dark red and moderate in amount. Saturation of more than one peripad per hour is considered excessive even in the early postpartum period.

19.A client in a postpartum unit complains of sudden sharp chest pain. The nurse notes that the client is tachycardic and the respiratory rate is elevated. The nurse suspects a pulmonary embolism. The initial nursing action is which of the following? a. Initiate an intravenous line b. Assess the clients blood pressure c. Prepare to administer morphine sulphate d. Administer oxygen at 8 to 10 L/min by face mask

D: if pulmonary embolism is suspected, oxygen should be administered at 8 to 10 L/min by face mask. Oxygen is used to decrease hypoxia. The woman also is kept on bed rest with the head of the bed slightly

elevated to reduce dyspnea. Morphine sulphate may be prescribed for the client, but this action would not be the initial nursing action. An intravenous line also will be required and vital signs need to be monitored, but these actions would follow the administration of the oxygen.

20. A nurse is developing a plan of care for a postpartum client who was diagnosed with superficial venous thrombosis. Which of the following interventions would be a component of the plan of care? a. Ambulation four to six times daily b. Administration of anticoagulants c. Elevation of the affected extremity d. Application of ice packs to the affected area

C: Thrombosis that is limited to the superficial veins of the saphenous system is treated with analgesics, rest, and elastic support stockings. Elevation of the affected lower extremity to improve venous return may be recommended. Warm packs may be applied to the affected area to promote healing. There is no need for anticoagulants or antiinflammatory agents unless the condition persists. After 5 to 7 days of bed rest, and when symptoms disappear, the woman may ambulate gradually.

21.A postpartum nurse is assessing a client who delivered a healthy newborn infant by cesarean section for signs and symptoms of superficial venous thrombosis. Which of the following signs and symptoms would the nurse note if superficial venous thrombosis were present? a. Paleness of the calf area b. Coolness of the calf area c. Enlarged, hardened veins d. Palpable dorsalis pedis pulses.

C: Thrombosis is of superficial veins usually is accompanied by signs and symptoms of inflammation. These include swelling of the involved extremity and redness, tenderness, and warmth. It may also be possible

to palpate the enlarged, hard vein. Clients sometimes experience pain when they walk.

22. A nurse is preparing to assess the uterine fundus of a client in the immediate fundus of a client in the immediate postpartum period. When the nurse locates the fundus, she notes that the uterus feels soft and boggy. Which nursing intervention would be appropriate initially? a. Elevate the mothers legs b. Encourage the mother to void c. Massage the fundus until it is firm d. Push on the uterus to assist in expressing clots.

C: If the uterus is not contracted firmly, the initial intervention is to massage the fundus until it is firm and to express clots that may have accumulated in the uterus. Pushing on an uncontracted uterus can invert the uterus and cause massive hemorrhage. Elevating the clients legs and encouraging the client to void will not assist in managing uterine atony. If the uterus does not remain contracted as a result of the uterine massage, the problem may be a distended bladder and the nurse should assist the mother to urinate, but this would not be the initial action.

23.After surgical evacuation and repair of a paravaginal hematoma, a client is discharged 3 days postpartum. The nurse determines that the client needs further discharge instructs when she states: a. I will probably need my mother to help me with housekeeping b. Because I am so sore, I will nurse the baby while lying on my side c. My husband and I will not have intercourse until the stitches are healed d. The only medications I will take are prenatal vitamins and stool softeners. D: The postoperative client will need an antibiotic because she is at increased risk for infection as a result of the break in skin integrity and collection of blood at the hematoma site. Options A, B, and C indicate that the mother understands the home care measures following surgical evacuation and repair of a paravaginal hematoma.

24.A nurse has provided instructions to a new mother with a urinary tract infection regarding foods and fluids to consume that will acidify the urine. Identification of which of the following as an effective urine acidifying fluid by the mother indicates a need for further instruction? a. Apricot juice b. Carbonated drinks c. Prune juice d. Cranberry juice

B: Acidification of the urine inhibits multiplication of bacteria. Fluids that acidify the urine include apricot, plum and prune, and cranberry juice. Carbonated drinks should be avoided because they increase urine alkalinity.

25.A nurse is providing instruction about measures to prevent postpartum mastitis to a client who is breast-feeding her newborn. Which of the following, if stated by the client, would indicate a need for further instructions? a. I should breast-feed every 2-3 hours b. I should change the breast pad frequently c. I should wash my hands well before breast-feeding d. I should wash my nipples daily with soap and water

D: Mastitis generally is caused by an organism that enters through an injured area of the nipples, such as a crack or blister. Measures to prevent the development of mastitis include changing nursing pads when they are wet and avoiding continuous pressure on the breasts. Soap is drying and could lead to cracking of the nipples, and the mother should be instructed to avoid the use of soap on the nipples during breast-feeding. The mother is taught about the importance of hand washing and that she should breast-feed every 2 to 3 hours