OB HESI HINTS EXAM QUESTIONS
WITH COMPLETE SOLUTIONS
Fetal Well being - Answer-Determined by assessing fundal height, FHTs + rate, fetal
movement, + uterine activity (contractions)
- Changes in FHR are the 1st + most important indicators of compromised blood flow to
the fetus, + these changes require action!
(normal FHR = 110-160 bpm)
Early Danger Signs for Preeclampsia + Eclampsia: - Answer-- Visual disturbances
- Swelling of face, fingers, or sacrum
- Severe, continuous HA
- Persistent vomiting
- Epigastric pain
- Infection (chills, temp > 100.4, Dysuria, Pain in abdomen)
- Fluid discharge or bleeding from vagina (anything other than normal leukorrhea)
- Change in fetal movement or increased FHR
Teach pts. to report there immediately so early tx can optimize maternal + fetal outcome
Prenatal vitamins - Answer-Most providers prescribe prenatal vitamins to ensure the
client receives adequate intake of vitamins
- Only HCP can prescribe prenatal vitamins
- Nurses' responsibility to teach about proper diet + about taking prescribed vitamins
Calcium for Pregnant Women - Answer-It is recommended that pregnant women
consume the equivalent of 3 cups of milk or yogurt per day
- This will ensure that the daily calcium needs are met + will alleviate occurrence of leg
cramps
Neural Tube Defect Screening - Answer-In some state, screening for neural tube
defects by testing either maternal serum alpha fetoprotein (AFP) levels or amniotic fluid
AFP levels is mandated by state law
- This screening test is highly associated w/ both false positives + false negatives
Gestational Age Determination - Answer-Gestational age is best determined by an early
sonogram rather than a later one
Amniocentesis - Answer-When an amniocentesis is done in early pregnancy bladder
must be full to help support the uterus + to help push the uterus up in the abdomen for
easy access
When an amniocentesis is done in late pregnancy, the bladder must be empty so it will
not be punctured
,Early Decels - Answer-Causes: Head compression + fetal descent
- Usually occur b/n 4-7cm + in the 2nd stage of labor
Nursing intervention: check for labor progress if these are noted
Cord Prolapse - Answer-If cord prolapse is detected, the examiner should position the
mother to relive pressure on the cord (i.e. knee-chest position) or push the presenting
part off the cord until immediate c-section can be accomplished
Late Decels - Answer-Indicate uteroplacental insufficiency
- associated w/ conditions such as postmaturity, preeclampsia, DM, cardiac disease +
abriptio placenta
Decel patterns + decreased variability - Answer-When deceleration patterns (late or
variable) are associated w/ decreased or absent variability + tachycardia, the situation is
ominous (potentially disastrous) + requires immediate intervention + fetal assessment
Nursing interventions for late + variable decels - Answer-- A decrease in uteroplacental
perfusion results in late decals
- Cord compression results in variable decels
Nursing interventions should include:
- Changing maternal position
- Discontinuing oxytocin (Pitocin) infusion
- Administering oxygen
- Notifying the HCP
Dangers of Nipple Stimulation - Answer-Danger of nipple stimulation lie in controlling
the "dose" of oxytocin delivered by the posterior pituitary
- The chance of hyperstimulation or tetany (contractions over 90 sec or contractions w/
< 30 sec between them) is increased
Percutaneous Umbilical Blood Sampling (PUBS) - Answer-PUBS can be done during
pregnancy under US for prenatal diagnosis + therapy
- Hemoglobinpathies, clotting disorders, sepsis, + some genetic testing can be done
using this method
Determining Fetal Lung Maturity - Answer-Most important determinant of fetal maturity
for extrauterine survival is the lung maturity: lung surfactant (L/S) ratio (2:1 or higher)
True vs. False Labor - Answer-True Labor:
- Pain in lower back that radiates to abdomen
- Pain accompanied by regular rhythmic contractions
- Contractions that intensify w/ ambulation
- Progressive cervical dilation + effacement
, False Labor:
- Discomfort localized in abdomen
- No lower back pain
- Contractions decrease in intensity or frequency w/ ambulation
Normal Findings of a Client in Labor - Answer-- Normal FHR in labor: 110-160 bpm
- Normal maternal BP: <140/90
- Normal maternal pulse: <100 bpm
- Normal maternal temp: <100.4
*Slight elevation in temp may occur b/c of dehydration + the work of labor. Anything
higher indicated infection + must be reported immediately
Unengaged Infant Head - Answer-If infant's head is floating, watch for cord prolapse
Meconium Stained Fluid - Answer-Meconium-stained fluid is yellow-green or gold-yellow
+ may indicate fetal stress
Breathing Techniques During Labor - Answer-Breathing techniques, such as deep
chest, accelerated, + cued, are not prescribed by the stage of labor but by the
discomfort level of the laboring woman.
- If coping is decreased switch to a new technique
Hyperventilation in labor - Answer-Hyperventilation results in respiratory alkalosis that is
caused by blowing off too much CO2. Symptoms include:
- Dizziness
- Tingling of fingers
- Stiff mouth
Have woman breathe into her cupped hands or a paper bag in order to rebreathe CO2
Cervical Dilation - Answer-Determine cervical dilation before allowing client to push.
Cervix should be completely dilated (10 cm) before the client begins pushing.
If pushing starts too early the cervix can become edematous + never fully dilated
Pitocin After Placental Delivery - Answer-Give the oxytocin (Pitocin) after the placenta is
delivered b/c the drug will cause the uterus to contract. If the oxytocic drug is
administered before the placenta is delivered, it may result in a retained placenta, which
predisposes the client to hemorrhage + infection
Application of Perineal Pads after delivery - Answer-- Place 2 on perineum
- Do not touch inside of pad
- Do apply from front to back, being careful not to drag pad across the anus
Merthergine - Answer-NOT given to clients w/ HTN b/c of its vasoconstrictive action.
WITH COMPLETE SOLUTIONS
Fetal Well being - Answer-Determined by assessing fundal height, FHTs + rate, fetal
movement, + uterine activity (contractions)
- Changes in FHR are the 1st + most important indicators of compromised blood flow to
the fetus, + these changes require action!
(normal FHR = 110-160 bpm)
Early Danger Signs for Preeclampsia + Eclampsia: - Answer-- Visual disturbances
- Swelling of face, fingers, or sacrum
- Severe, continuous HA
- Persistent vomiting
- Epigastric pain
- Infection (chills, temp > 100.4, Dysuria, Pain in abdomen)
- Fluid discharge or bleeding from vagina (anything other than normal leukorrhea)
- Change in fetal movement or increased FHR
Teach pts. to report there immediately so early tx can optimize maternal + fetal outcome
Prenatal vitamins - Answer-Most providers prescribe prenatal vitamins to ensure the
client receives adequate intake of vitamins
- Only HCP can prescribe prenatal vitamins
- Nurses' responsibility to teach about proper diet + about taking prescribed vitamins
Calcium for Pregnant Women - Answer-It is recommended that pregnant women
consume the equivalent of 3 cups of milk or yogurt per day
- This will ensure that the daily calcium needs are met + will alleviate occurrence of leg
cramps
Neural Tube Defect Screening - Answer-In some state, screening for neural tube
defects by testing either maternal serum alpha fetoprotein (AFP) levels or amniotic fluid
AFP levels is mandated by state law
- This screening test is highly associated w/ both false positives + false negatives
Gestational Age Determination - Answer-Gestational age is best determined by an early
sonogram rather than a later one
Amniocentesis - Answer-When an amniocentesis is done in early pregnancy bladder
must be full to help support the uterus + to help push the uterus up in the abdomen for
easy access
When an amniocentesis is done in late pregnancy, the bladder must be empty so it will
not be punctured
,Early Decels - Answer-Causes: Head compression + fetal descent
- Usually occur b/n 4-7cm + in the 2nd stage of labor
Nursing intervention: check for labor progress if these are noted
Cord Prolapse - Answer-If cord prolapse is detected, the examiner should position the
mother to relive pressure on the cord (i.e. knee-chest position) or push the presenting
part off the cord until immediate c-section can be accomplished
Late Decels - Answer-Indicate uteroplacental insufficiency
- associated w/ conditions such as postmaturity, preeclampsia, DM, cardiac disease +
abriptio placenta
Decel patterns + decreased variability - Answer-When deceleration patterns (late or
variable) are associated w/ decreased or absent variability + tachycardia, the situation is
ominous (potentially disastrous) + requires immediate intervention + fetal assessment
Nursing interventions for late + variable decels - Answer-- A decrease in uteroplacental
perfusion results in late decals
- Cord compression results in variable decels
Nursing interventions should include:
- Changing maternal position
- Discontinuing oxytocin (Pitocin) infusion
- Administering oxygen
- Notifying the HCP
Dangers of Nipple Stimulation - Answer-Danger of nipple stimulation lie in controlling
the "dose" of oxytocin delivered by the posterior pituitary
- The chance of hyperstimulation or tetany (contractions over 90 sec or contractions w/
< 30 sec between them) is increased
Percutaneous Umbilical Blood Sampling (PUBS) - Answer-PUBS can be done during
pregnancy under US for prenatal diagnosis + therapy
- Hemoglobinpathies, clotting disorders, sepsis, + some genetic testing can be done
using this method
Determining Fetal Lung Maturity - Answer-Most important determinant of fetal maturity
for extrauterine survival is the lung maturity: lung surfactant (L/S) ratio (2:1 or higher)
True vs. False Labor - Answer-True Labor:
- Pain in lower back that radiates to abdomen
- Pain accompanied by regular rhythmic contractions
- Contractions that intensify w/ ambulation
- Progressive cervical dilation + effacement
, False Labor:
- Discomfort localized in abdomen
- No lower back pain
- Contractions decrease in intensity or frequency w/ ambulation
Normal Findings of a Client in Labor - Answer-- Normal FHR in labor: 110-160 bpm
- Normal maternal BP: <140/90
- Normal maternal pulse: <100 bpm
- Normal maternal temp: <100.4
*Slight elevation in temp may occur b/c of dehydration + the work of labor. Anything
higher indicated infection + must be reported immediately
Unengaged Infant Head - Answer-If infant's head is floating, watch for cord prolapse
Meconium Stained Fluid - Answer-Meconium-stained fluid is yellow-green or gold-yellow
+ may indicate fetal stress
Breathing Techniques During Labor - Answer-Breathing techniques, such as deep
chest, accelerated, + cued, are not prescribed by the stage of labor but by the
discomfort level of the laboring woman.
- If coping is decreased switch to a new technique
Hyperventilation in labor - Answer-Hyperventilation results in respiratory alkalosis that is
caused by blowing off too much CO2. Symptoms include:
- Dizziness
- Tingling of fingers
- Stiff mouth
Have woman breathe into her cupped hands or a paper bag in order to rebreathe CO2
Cervical Dilation - Answer-Determine cervical dilation before allowing client to push.
Cervix should be completely dilated (10 cm) before the client begins pushing.
If pushing starts too early the cervix can become edematous + never fully dilated
Pitocin After Placental Delivery - Answer-Give the oxytocin (Pitocin) after the placenta is
delivered b/c the drug will cause the uterus to contract. If the oxytocic drug is
administered before the placenta is delivered, it may result in a retained placenta, which
predisposes the client to hemorrhage + infection
Application of Perineal Pads after delivery - Answer-- Place 2 on perineum
- Do not touch inside of pad
- Do apply from front to back, being careful not to drag pad across the anus
Merthergine - Answer-NOT given to clients w/ HTN b/c of its vasoconstrictive action.
