OB MODULE 2 TEST EXAM

OB MODULE 2 TEST EXAM 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 - CORRECT 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 - CORRECT 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 - CORRECT 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. - CORRECT 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? - CORRECT 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? - CORRECT ANSWER-The corpus luteum secretes estrogen and progesterone during the remaining 14 days of the cycle. What is the normal intrauterine fetal attitude? - CORRECT 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? - CORRECT ANSWER-Secondary amenorrhea What is the postpartum period? - CORRECT ANSWER-The postpartum period starts immediately after delivery and is usually completed by week 6 after delivery. What is the rooting reflex? - CORRECT ANSWER-Touching the newborn's lip, cheek, or corner of the mouth with a nipple causes the newborn to turn the head toward the nipple and open mouth. The newborn takes hold of the nipple and sucks. The rooting reflex usually disappears 3 to 4 months. What are the interventions for the contraction stress test? - CORRECT ANSWER-The external fetal monitor is applied to the client and a 20-minute baseline strip is recorded. The uterus is stimulated with (Pitocin) or by having the client nipple stimulate until 3 contractions with a duration of 40 seconds or more in a 10-minute period have been achieved. What are the assessment for premature rupture of membranes? - CORRECT ANSWER-Fluid pooling into a vaginal vault; Nitrazine test is positive. Assess the amount, color, consistency, and odor of fluid. Elevated temperature may indicate the presence of infection. Fetal tachycardia is a sign of infection. What are the assessments for meconium aspiration syndrome? - CORRECT ANSWERRespiratory distress at birth; tachypnea, cyanosis, retractions, nasal flaring, grunting, crackles, and rhonchi. Nails, skin, and umbilical cord may be stained yellow-green. What assessments should be made for heavy third trimester vaginal bleeding? - CORRECT ANSWER-Assess maternal vital signs and fetal heart rate. What is the significance of blood in the amniotic fluid? - CORRECT ANSWER-Bloody amniotic fluid may indicate abruptio placentae or fetal trauma. An unpleasant odor to amniotic fluid is associated with infection. When during pregnancy does ankle edema occur? - CORRECT ANSWER-Usually occurs in the second and third trimesters. Results from venous stasis and increased venous pressure caused by uterine enlargement. What is the fetal presentation? - CORRECT ANSWER-Part of the fetus that enters the pelvic inlet first. The cephalic presentation is the normal presentation. What is the normal postpartum temperature? - CORRECT ANSWER-Temperature may increase to 100.4 because of inflammation associated with delivery. Higher temperature elevations may be caused by infection. What position should the client be placed in for an epidural? - CORRECT ANSWERLateral left with legs flexed and back curved. Average expected weight gain during pregnancy? - CORRECT ANSWER-25-35 lbs How many chromosomes present in the ovum and sperm? - CORRECT ANSWER-23 each How do contractions change during the transition phase of labor? - CORRECT ANSWER-They increase in frequency, intensity, and duration. How does true labor differ from false labor? - CORRECT ANSWER-True labor produces regular contractions, pelvic pain, progressive fetal dissent, blood show, and progressive cervical effacement and dilation