OB Exam 2
The is assisting a patient who just delivered a healthy baby boy weighing 7 pounds. Upon cord
traction of placenta, she notices a sudden gushing of a large amount of blood and the fundus is no
longer palpable in the abdomen. What are useful nursing interventions if uterine inversion is
suspected?
1. Administering oxytocic
2. Assess vital signs
3. Discontinue uterotonic drugs
4. Do not attempt to remove the placenta
5. Establish IV access and fluids - Answer 2. Assess vital signs
3. Discontinue uterotonic drugs
4. Do not attempt to remove the placenta
5. Establish IV access and fluids
Rationale: Never attempt to remove the placenta if it is still attached, because this will only create a
larger surface area for bleeding. When an inversion occurs a large amount of blood suddenly gushes
from the vagina. The fundus is not palpable in the abdomen. If the loss of blood continues
unchecked, the woman will immediately show signs of blood loss. Uterine inversion may occur after
the birth if traction is applied to the umbilical cord too soon or if the pressure is applied to the
uterine fundus when the uterus is not contracted. Administering an oxytocic drug only compounds
the inversion. Uterotonic drugs should be discontinued to allow uterine relaxation for replacement.
IV fluids should be commenced to support blood pressure.
A nurse is reviewing her assignments. Which patient should she assess first?
1. A 12-hour infant who is small for gestational age.
2. Four hour infant with a cardiac defect.
3. 9 hour old infant who has not voided
4. 3 day old infant waiting for discharge - Answer 2. Four hour infant with a cardiac defect
Rationale: The infant with a cardiac defect is at the most risk for complications and should be
assessed first.
At 32 weeks' gestation a 15-year-old primigravid client who is 5'2", has gained 20 lbs, with a 1 lb
weight gain in the last 2 weeks. Urinalysis reveals negative glucose and a trace of protein. The nurse
should advise the client that which of the following factors increases her risk for preeclampsia?
1. Total weight gain
2. Short stature
, 3. Adolescent age group
4. Proteinuria - Answer 3. Adolescent age group
Rationale: Client's with increased risk for preeclampsia include primigravid clients younger than 20
years or older than 40 years, clients with 5 or more pregnancies, women of color, women with
multifetal pregnancies, women with diabetes or heart issues. A total weight gain of 20 lbs in the at
32 weeks gestation with a 1 lb weight gain in the last 2 weeks is within normal limits. Trace amounts
of protein in the urine is common during pregnancy but amounts of +1 or more may be pregnancy
induced hypertension.
A patient has meconium-stained amniotic fluid. Fetal scalp sampling indicates a blood pH of 7.12 and
fetal bradycardia is present. Based on these findings, the nurse should take which action?
1. Administer amnioinfusion.
2. Prepare for cesarean section.
3. Reposition the patient.
4. Start IV as prescribed. - Answer 2. Prepare for cesarean section.
Rationale: Infants with meconium-stained amniotic fluid may have respiratory difficulties and
bradycardia at birth. Based on this assessment, fetal metabolic acidosis is present. These findings
pose a great threat to the newborn's well-being. A cesarean section is required. Amnioinfusion is an
infusion of sterile isotonic solution into the uterine cavity during labor to reduce umbilical cord
compression. This is also done to dilute meconium in the amniotic fluid, reducing the risk that the
infant will aspirate thick meconium at birth. The procedure is not sufficient in this scenario neither is
the IV.
What is premature rupture of membranes? - Answer Premature rupture of the membranes is
spontaneous rupture of the amniotic membrane before the onset of labor. When the rupture of
membranes is before term infection becomes a risk.
What hormones are secreted by the corpus luteum? - Answer The corpus luteum secretes estrogen
and progesterone during the remaining 14 days of the cycle.
What is the normal intrauterine fetal attitude? - Answer It is the relationship of the fetal body parts
to one another. The normal intrauterine attitude is flexion, in which the fetal back is rounded, the
head is forward on the chest, and the arms and legs are folded in against the body.
Absence of menses for 6 months or more in a client with prior normal menses is known as? -
Answer Secondary amenorrhea
The is assisting a patient who just delivered a healthy baby boy weighing 7 pounds. Upon cord
traction of placenta, she notices a sudden gushing of a large amount of blood and the fundus is no
longer palpable in the abdomen. What are useful nursing interventions if uterine inversion is
suspected?
1. Administering oxytocic
2. Assess vital signs
3. Discontinue uterotonic drugs
4. Do not attempt to remove the placenta
5. Establish IV access and fluids - Answer 2. Assess vital signs
3. Discontinue uterotonic drugs
4. Do not attempt to remove the placenta
5. Establish IV access and fluids
Rationale: Never attempt to remove the placenta if it is still attached, because this will only create a
larger surface area for bleeding. When an inversion occurs a large amount of blood suddenly gushes
from the vagina. The fundus is not palpable in the abdomen. If the loss of blood continues
unchecked, the woman will immediately show signs of blood loss. Uterine inversion may occur after
the birth if traction is applied to the umbilical cord too soon or if the pressure is applied to the
uterine fundus when the uterus is not contracted. Administering an oxytocic drug only compounds
the inversion. Uterotonic drugs should be discontinued to allow uterine relaxation for replacement.
IV fluids should be commenced to support blood pressure.
A nurse is reviewing her assignments. Which patient should she assess first?
1. A 12-hour infant who is small for gestational age.
2. Four hour infant with a cardiac defect.
3. 9 hour old infant who has not voided
4. 3 day old infant waiting for discharge - Answer 2. Four hour infant with a cardiac defect
Rationale: The infant with a cardiac defect is at the most risk for complications and should be
assessed first.
At 32 weeks' gestation a 15-year-old primigravid client who is 5'2", has gained 20 lbs, with a 1 lb
weight gain in the last 2 weeks. Urinalysis reveals negative glucose and a trace of protein. The nurse
should advise the client that which of the following factors increases her risk for preeclampsia?
1. Total weight gain
2. Short stature
, 3. Adolescent age group
4. Proteinuria - Answer 3. Adolescent age group
Rationale: Client's with increased risk for preeclampsia include primigravid clients younger than 20
years or older than 40 years, clients with 5 or more pregnancies, women of color, women with
multifetal pregnancies, women with diabetes or heart issues. A total weight gain of 20 lbs in the at
32 weeks gestation with a 1 lb weight gain in the last 2 weeks is within normal limits. Trace amounts
of protein in the urine is common during pregnancy but amounts of +1 or more may be pregnancy
induced hypertension.
A patient has meconium-stained amniotic fluid. Fetal scalp sampling indicates a blood pH of 7.12 and
fetal bradycardia is present. Based on these findings, the nurse should take which action?
1. Administer amnioinfusion.
2. Prepare for cesarean section.
3. Reposition the patient.
4. Start IV as prescribed. - Answer 2. Prepare for cesarean section.
Rationale: Infants with meconium-stained amniotic fluid may have respiratory difficulties and
bradycardia at birth. Based on this assessment, fetal metabolic acidosis is present. These findings
pose a great threat to the newborn's well-being. A cesarean section is required. Amnioinfusion is an
infusion of sterile isotonic solution into the uterine cavity during labor to reduce umbilical cord
compression. This is also done to dilute meconium in the amniotic fluid, reducing the risk that the
infant will aspirate thick meconium at birth. The procedure is not sufficient in this scenario neither is
the IV.
What is premature rupture of membranes? - Answer Premature rupture of the membranes is
spontaneous rupture of the amniotic membrane before the onset of labor. When the rupture of
membranes is before term infection becomes a risk.
What hormones are secreted by the corpus luteum? - Answer The corpus luteum secretes estrogen
and progesterone during the remaining 14 days of the cycle.
What is the normal intrauterine fetal attitude? - Answer It is the relationship of the fetal body parts
to one another. The normal intrauterine attitude is flexion, in which the fetal back is rounded, the
head is forward on the chest, and the arms and legs are folded in against the body.
Absence of menses for 6 months or more in a client with prior normal menses is known as? -
Answer Secondary amenorrhea
