OB DOCX

OB DOCX 1. A nurse is assessing a client who is at 33 weeks of gestation. Which of the following findings should the nurse report to the provider? 2. A nurse is assessing a newborn following a circumcision 48 hr ago. The nurse should identify that yellow exudate covering the newborn's glans penis indicates which of the following? 3. A nurse is developing a plan of care for a client who is in the latent phase of labor. Which of the following interventions should the nurse include in the plan to manage the client's pain? 4. A nurse is reviewing the laboratory results for a postpartum client who is receiving warfarin for deep-vein thrombosis. Which of the following laboratory tests should the nurse monitor? 5. A nurse is reviewing the medical record of a client who has preeclampsia prior to administering labetalol. For which of the following findings should the nurse withhold the medication? 6. A nurse is assessing a client who is in labor. Which of the following findings should the nurse expect? 7. A nurse is caring for a newborn immediately following birth who has meconium-stained amniotic fluid and exhibits good muscle tone and respiratory efforts. Which of the following actions should the nurse take first? 8. A nurse is assessing a client who is at 8 weeks of gestation and has hyperemesis gravidarum. Which of the following are findings of this condition? (Select all that apply.) 9. A nurse is caring for a newborn who was delivered by cesarean birth 1 min ago and displays some flexion of the extremities, is not crying, has irregular respiratory effort, and has a heart rate of 92/min. The nurse notes grimacing but no crying when rubbing the soles of the newborn's feet. The newborn's skin color is pink with blue extremities. What is the correct Apgar score? 10. A nurse is planning to obtain a blood specimen from a newborn via a heel stick. Which of the following actions should the nurse take? 11. A nurse is teaching a class to clients who are pregnant. Which of the following topics should the nurse include in the discussion about cesarean birth? (Select all that apply.) 12. A nurse is assessing a 1 HOUR-old newborn. Which of the following findings should the nurse report to the provider? a. Transient circumoral cyanosis: Transient circumoral cyanosis is bluish discoloration around the mouth of the newborn and is an expected finding that does not require reporting to the provider. b. Transient strabismus: Transient strabismus is a disorder in which the two eyes do not look in the same direction. This is an expected finding during the newborn period until 3 to 4 months of age and does not require reporting to the provider. c. Caput succedaneum: Caput succedaneum is swelling of the scalp of the newborn and is an expected finding following a vaginal birth. While it is important to assess and document, it does not require reporting to the provider. d. Generalized petechiae: Generalized petechiae are pinpoint round spots that appear on the skin, which can indicate a clotting factor deficiency or infection. The nurse should report this finding to the provider immediately. 13. A nurse is assessing a newborn. Which of the following findings indicates a need to check the newborn's blood glucose level for hypoglycemia? a. Shrill cry: A shrill cry can be indicative of neonatal abstinence syndrome and hypocalcemia. Additional findings of neonatal abstinence syndrome include tachypnea, irritability, tremors, incessant crying, frequent sneezing, frequent yawning, excessive sweating, exaggerated Moro reflex, mottling of skin, uncoordinated sucking, incessant hunger, vomiting, and diarrhea. b. Weak peripheral pulses: Weak peripheral pulses are not a finding associated with hypoglycemia. c. Yellowish skin: Yellowish skin is a finding associated with hyperbilirubinemia. The nurse should assess for hyperbilirubinemia every 8 to 12 hr by pressing the sternum or forehead with a finger for several seconds and then releasing the pressure. The area will blanch and appear yellow if jaundice is present. Other areas to assess in newborns who have darker skin tones include the conjunctival sacs and the oral mucosa. d. Hypotonia: CNS findings of hypoglycemia include lethargy and hypotonia, as well as jitteriness, twitching, poor feeding, temperature instability, apnea, respiratory distress, and seizures. 14. A nurse is caring for a client who had a vaginal delivery 2 hr ago and is reporting increasing perineal pain and pressure. The nurse examines the client's perineum and sees a 4 cm (1.6 in) area of purplish discoloration with swelling. The nurse should interpret these findings as which of the following? a. A hematoma: A hematoma is a collection of blood in the connective tissue while the overlying skin or mucous membranes remain intact. Hematomas develop from injury to soft tissue in spontaneous deliveries, as well as forceps- and vacuum-assisted deliveries. Small hematomas usually reabsorb on their own, but large ones might require incision and ligation of bleeding vessels. b. Retained placental fragments: Placental retention is trapping of part of or the entire placenta inside the uterus. The placenta is generally retrieved manually if it did not deliver intact during the third stage of labor. c. A laceration: A laceration is a tear in the perineal skin or mucous membranes of the vulva or vagina. Cervical lacerations are also a possibility, but the nurse would not be able to see them on an inspection of the perineum. Lacerations generally bleed bright red blood, rather than the darker red color of lochia, and must be repaired. d. Ecchymosis: Ecchymosis is a bruised area caused by bleeding from small blood vessels under the skin. A bruise will be tender to the touch, but it will not cause the increasing pain and pressure this client is reporting. 15. A nurse is assessing a client who is in active labor. The client reports back labor pains. Which of the following nonpharmacological interventions should the nurse provide to manage the client's pain? a. Encourage the support person to apply sacral counterpressure.: Consistent pressure applied by the support person using the heel of the hand or fist against the client's sacral area will lift the fetal head off the spinal nerves and provide relief of the pain in the lower back. b. Encourage the support person to perform effleurage.: Effleurage is the light, gentle, circular stroking of the client's abdomen with the fingertips in rhythm with breathing during contractions. This can be an effective nonpharmacological pain management intervention for the client in early labor. However, this technique will not relieve the back labor discomfort caused by the fetal head pressing on the spinal nerves. c. Teach the client patterned breathing techniques.: Patterned breathing can provide distraction from the discomfort associated with labor pain and promote abdominal relaxation. However, it will not reduce back pain caused by the fetal head pressing against the spinal nerves. 16. : A nurse is performing an initial assessment during a client's first prenatal visit. The client states that her last menstrual period began April 22. Use Nägele's rule to calculate the expected date of birth (EDB). (Use the MMDD format to enter exactly four numerals, with no spaces or punctuation between the numbers.) MMDD. 0129: The most common method of determining the estimated date of birth is to apply Nägele's rule. Begin with the first day of the client's last menstrual period, subtract 3 months, and add 7 days. For this client, subtracting 3 months from April would be January, and adding 7 days to the 22nd would be the 29th. Using the MMDD format, the EDB is 0129. 17. A nurse is caring for a client who is 3 days postpartum. Which of the following actions should the nurse take? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.) EXHIBIT a. Instruct the client to stop breastfeeding.: Fever for 2 consecutive days, chills, foul-smelling lochia, and abdominal tenderness are manifestations of endometritis, an infection of the lining of the uterus. The nurse should assist the client with bonding, including breastfeeding, during this time as the client might experience fatigue. b. Obtain a vaginal culture.; MY ANSWER: Fever for 2 consecutive days, chills, foul-smelling lochia, and abdominal tenderness are manifestations of endometritis, an infection of the lining of the uterus. The nurse should obtain a vaginal culture using a sterile swab to collect the fluid from the client's vaginal cavity to identify the organism. c. Initiate airborne isolation precautions.: Fever for 2 consecutive days, chills, foul-smelling lochia, and abdominal tenderness are manifestations of endometritis, an infection of the lining of the uterus. Airborne isolation precautions are not indicated. The nurse should use gloves when assisting the client with perineal care. d. Place the client on strict bed rest.: Fever for 2 consecutive days, chills, foul-smelling lochia, and abdominal tenderness are manifestations of endometritis, an infection of the lining of the uterus. The nurse should assist the client to ambulate frequently to promote drainage of the infected lochia and prevent pooling within the uterus. 18. A nurse is teaching a client who has hyperemesis gravidarum about dietary modifications. Which of the following client statements indicates an understanding of the teaching? a. "I will avoid eating high-carbohydrate, sugary snacks.": Clients who have hyperemesis gravidarum might find that eating a high-carbohydrate, sweet snack before consuming protein will decrease nausea and vomiting. b. "I will drink 16 ounces of water during each meal.": The client should consume liquids and solids separately throughout the day to self-manage hyperemesis. c. "I will eat small, frequent meals throughout the day.: The client should focus on eating small, frequent meals throughout the day and consuming foods that are appealing. d. "I will eliminate dairy products from my diet.": The client should not eliminate dairy products from the diet because dairy foods might be easier to tolerate than other foods. 19. A nurse is reviewing the results of a nonstress test for a client who is at 37 weeks of gestation. Which of the following findings indicates a reactive nonstress test? a. Fetal heart rate (FHR) accelerations occur with fetal movement: A nonstress test measures the response of the FHR to fetal movement. Accelerations of the FHR with fetal movement are a reassuring sign of fetal well-being. b. Late decelerations of the FHR occur with contractions: Late decelerations of the FHR with contractions are an indication of fetal compromise due to uteroplacental insufficiency. Late decelerations require further evaluation. c. Variable decelerations of the FHR with uterine contractions: Variable decelerations of the FHR with uterine contractions might indicate fetal compromise due to a disruption in the oxygen supply to the fetus. Variable decelerations require further evaluation. d. FHR pattern with minimal variability: Minimal variability of the FHR can indicate fetal compromise from fetal hypoxemia and metabolic academia, neurologic injury, or CNS depression. Minimal variability of the FHR requires further evaluation. 20. A nurse is assessing a client who has preeclampsia and received a dose of calcium gluconate to treat magnesium sulfate toxicity. Which of the following findings should the nurse identify as an indication that calcium gluconate was effective? a. Respiratory rate 12/min: The nurse should identify that respiratory depression is a manifestation of magnesium sulfate toxicity. A respiratory rate of 12/min is within the expected reference range of 12 to 20/min. Therefore, this finding is an indication that calcium gluconate was effective. b. Absent deep tendon reflexes: The nurse should identify that absent deep tendon reflexes is a manifestation of magnesium sulfate toxicity. Therefore, this finding does not indicate that calcium gluconate was effective. Other manifestations of magnesium sulfate toxicity include respiratory depression, blurred vision, decreased consciousness, and cardiac arrest. c. Slurred speech: The nurse should identify that slurred speech is a manifestation of magnesium sulfate toxicity. Therefore, this finding does not indicate that calcium gluconate was effective. Other manifestations of magnesium sulfate toxicity include respiratory depression, blurred vision, decreased consciousness, and cardiac arrest. d. Urine output 22 mL/hr: The nurse should identify that preeclampsia decreases perfusion to organs and tissues. Decreased renal perfusion reduces the glomerular filtration rate which causes oliguria, or urine output less than 25 mL/hr. Decreased renal perfusion increases the risk for magnesium toxicity. Therefore, the nurse should identify urinary output of 22 mL/hr as a manifestation of preeclampsia that increases the risk of magnesium toxicity.