OB Exam 3 Questions With Correct Detailed Answers Guaranteed Success.

A postpartum client overhears the nurse tell the health care provider that she has a positive Homans sign and asks what it means. Which is the nurses best response? a.You have pitting edema in your ankles. b.You have deep tendon reflexes rated 2+. c.You have calf pain when the nurse flexes your foot. d.You have a fleshy odor to your vaginal drainage. - correct answersC Discomfort in the calf with sharp dorsiflexion of the foot may indicate a deep vein thrombosis. Edema is within normal limits for the first few days until the excess interstitial fluid is remobilized and excreted. Deep tendon reflexes should be 1+ to 2+. A fleshy odor, not a foul odor, is within normal limits. Which client would be most likely to have severe afterbirth pains and request a narcotic analgesic? a.Gravida 5, para 5 b.Primipara who delivered a 7-lb boy c.Client who is bottle feeding her first child d.Client who wishes to breastfeed as soon as her baby is out of the neonatal intensive care unit - correct answersA The discomfort of afterpains is more acute for multiparas because repeated stretching of muscle fibers leads to loss of uterine muscle tone. The uterus of a primipara tends to remain contracted. Afterpains are particularly severe during breastfeeding, not bottle feeding. The non-nursing mother may have engorgement problems. She should empty her breasts regularly to stimulate milk production so she will have the milk when the baby is strong enough to nurse. Which maternal event is abnormal in the early postpartal period? a.Diuresis and diaphoresis b.Flatulence and constipation c.Extreme hunger and thirst d.Lochial color changes from rubra to alba - correct answersD For the first 3 days after childbirth, lochia is termed rubra. Lochia serosa follows, and then at about 11 days, the discharge becomes clear, colorless, or white. The body rids itself of increased plasma volume. Urine output of 3000 mL/day is common for the first few days after birth and is facilitated by hormonal changes in the mother. Bowel tone remains sluggish for days. Many women anticipate pain during defecation and are unwilling to exert pressure on the perineum. The new mother is hungry because of energy used in labor and thirsty because of fluid restrictions during labor. Which fundal assessment finding at 12 hours after birth requires further assessment? a.The fundus is palpable at the level of the umbilicus. b.The fundus is palpable two fingerbreadths above the umbilicus. c.The fundus is palpable one fingerbreadth below the umbilicus. d.The fundus is palpable two fingerbreadths below the umbilicus. - correct answersB The fundus rises to the umbilicus after birth and remains there for about 24 hours. A fundus that is above the umbilicus may indicate uterine atony or urinary retention. The fundus palpable at the umbilicus is an appropriate assessment finding for 12 hours postpartum. The fundus palpable one fingerbreadth below the umbilicus is an appropriate assessment finding for 12 hours postpartum. The fundus palpable two fingerbreadths below the umbilicus is an unusual finding for 12 hours postpartum, but is still appropriate If the clients white blood cell (WBC) count is 25,000/mm3 on her second postpartum day, which action should the nurse take? a.Document the finding. b.Tell the health care provider. c.Begin antibiotic therapy immediately. d.Have the laboratory draw blood for reanalysis. - correct answersA An increase in WBC count to 25,000/mm3 during the postpartum period is considered normal and not a sign of infection. The nurse should document the finding. Because this is a normal finding, there is no reason to alert the health care provider. Antibiotics are not needed because the elevated WBCs are caused by the stress of labor and not an infectious process. There is no need for reassessment as it is expected for the WBCs to be elevated Postpartal overdistention of the bladder and urinary retention can lead to which complication? a.Fever and increased blood pressure b.Postpartum hemorrhage and eclampsia c.Urinary tract infection and uterine rupture d.Postpartum hemorrhage and urinary tract infection - correct answersD Incomplete emptying and overdistention of the bladder can lead to urinary tract infection. Overdistention of the bladder displaces the uterus and prevents contraction of the uterine muscle. There is no correlation between bladder distention and blood pressure or fever. There is no correlation between bladder distention and eclampsia. The risk of uterine rupture decreases after the birth. A postpartum client asks, Will these stretch marks go away? Which is the nurses best response? a.No, never. b.Yes, eventually. c.They will fade to silvery lines but wont disappear completely. d.They will continue to fade and should be gone by your 6-week checkup. - correct answersC Stretch marks never disappear altogether, but they do gradually fade to silvery lines. Stating never is true, but more information can be added, such as the changes that will occur with the stretch marks. Stretch marks do not disappear. A pregnant client asks when the dark line on her abdomen (linea nigra) will go away. The nurse knows the pigmentation will decrease after birth because of: ased estrogen. ased progesterone. ased human placental lactogen. ased melanocyte-stimulating hormone. - correct answersD Melanocyte-stimulating hormone increases during pregnancy and is responsible for changes in skin pigmentation; the amount decreases after birth. Estrogen levels decrease after birth. Progesterone levels decrease after birth. Human placental lactogen production continues to aid in lactation. However, it does not affect pigmentation If the fundus is palpated on the right side of the abdomen above the expected level, the nurse should suspect that the client has which? a.Distended bladder b.Normal involution c.Been lying on her right side too long d.Stretched ligaments that are unable to support the uterus - correct answersA The presence of a full bladder will displace the uterus. A palpated fundus on the right side of the abdomen above the expected level is not an expected finding. Position of the client should not alter uterine position. The problem is a full bladder displacing the uterus. The Centers for Disease Control and Prevention (CDC) recommends the use of which personal protective equipment with which the nurse is likely to come into contact? a.Any body fluids b.Any client at any time c.Blood and blood products d.Any client suspected of being HIV-positive - correct answersC Possible contamination of medical personnel can result from contact with blood, blood products, and only certain body fluids. Only certain body fluids can cause contamination. It is not necessary to wear protective equipment continually with all clients. Protective equipment is important with a client if the nurse is at risk for contamination with blood or certain body fluids. The equipment does not have to be worn with casual contact. Rho(D) immune globulin will be ordered postpartum if which situation occurs? a.Mother Rh-negative, baby Rh-positive b.Mother Rh-negative, baby Rh-negative c.Mother Rh-positive, baby Rh-positive d.Mother Rh-positive, baby Rh-negative - correct answersA An Rh-negative mother delivering an Rh-positive baby may develop antibodies to fetal cells that entered her bloodstream when the placenta separated. The Rho(D) immune globulin works to destroy the fetal cells in the maternal circulation before sensitization occurs. When the blood types are alike as with mother Rh-negative, baby Rh-negative, no antibody formation would be anticipated. If the Rh-positive blood of the mother comes in contact with the Rh-negative blood of the infant, no antibodies would develop because the antigens are in the mothers blood, not the infants. If rubella vaccine is indicated for a postpartum client, which instructions to the client should be included? a.No specific instructions b.Drinking plenty of fluids to prevent fever c.Recommendation to stop breastfeeding for 24 hours after the injection d.Explanation of the risks of becoming pregnant within 28 days following injection - correct answersD Potential risks to the fetus can occur if pregnancy results within 3 months after rubella vaccine administration. The mother does need to understand potential side effects and that pregnancy is discouraged for 3 months. The mother should be afebrile before the vaccine. Small amounts of the vaccine do cross the breast milk, but it is believed that there is no need to discontinue breastfeeding. Which is the best measure to prevent abdominal distention following a cesarean birth? a.Rectal suppositories b.Carbonated beverages c.Early and frequent ambulation d.Tightening and relaxing abdominal muscles - correct answersC Activity can aid the movement of accumulated gas in the gastrointestinal tract. Rectal suppositories can be helpful after distention occurs, but do not prevent it. Carbonated beverages may increase distention. Ambulation is the best prevention. Which documentation in the clients chart on the 14th postpartum day indicates a normal involution process? a.Breasts firm and tender b.Episiotomy slightly red and puffy c.Moderate bright red lochial flow d.Fundus below the symphysis and not palpable - correct answersD The fundus descends 1 cm/day, so by postpartum day 14 it is no longer palpable. Breasts are not part of the involution process. The episiotomy should not be red or puffy at this stage. The lochia should be changed by this day to serosa. To assess fundal contraction 6 hours after cesarean birth, which action should the nurse perform? a.Assess lochial flow rather than palpating the fundus. b.Palpate forcefully through the abdominal dressing. c.Place hands on both sides of the abdomen and press downward. d.Gently palpate, applying the same technique used for vaginal deliveries. - correct answersD Assessment of the fundus is the same for vaginal and cesarean deliveries. Forceful palpation should never be used. The top of the fundus, not the sides, should be palpated and massaged. Assessing lochial flow is not adequate; the fundus also needs to be checked. The nurse has completed a postpartum assessment on a client who delivered an hour ago. Which amount of lochia consists of a moderate amount? a.Saturated peripad b.4- to 6-inch stain on the peripad c.1- to 4-inch stain on the peripad d.Less than a 1-inch stain on the peripad - correct answersB Because estimating the amount of lochia is difficult, nurses frequently record flow by estimating the amount of lochia in 1 hour using the following labels: Scantless than a 1-inch stain on the peripad Light1- to 4-inch stain Moderate4- to 6-inch stain Heavysaturated peripad Excessivesaturated peripad in 15 minutes Determining the time interval that the peripad is in place is also important. Lochia is less for women who have had a cesarean birth because some of the endometrial lining is removed during surgery The postpartum nurse has completed discharge teaching for a client being discharged after an uncomplicated vaginal birth. Which statement by the client indicates that further teaching is needed? a.I may not have a bowel movement until the 2nd postpartum day. b.If I breastfeed and supplement with formula, I wont need any birth control. c.I know my normal pattern of bowel elimination wont return until about 8 to 10 days. d.If I am not breastfeeding, I should use birth control when I resume sexual relations with my husband. - correct answersB For some women, ovulation resumes as early as 3 weeks postpartum. Therefore, contraceptive measures are important considerations when sexual relations are resumed for lactating and nonlactating women. Further teaching would be needed if the client does not feel any need for birth control with breastfeeding and supplementing with formula. The first stool usually occurs within 2 to 3 days postpartum. Normal patterns of bowel elimination generally resume by 8 to 14 days after birth. The nurse is caring for a postpartum client who delivered by the vaginal route 12 hours ago. Which assessment finding should the nurse report to the health care provider?