OB HESI HINTS EXAM QUESTIONS
WITH COMPLETE SOLUTIONS
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.
- Pitcoin is given w/ caution to those w/ HTN
- NEVER give Methergine or Hemabate to a client while she is labor or before delivery
of placenta
, If nurse finds the fundus soft, boggy, + displaced to the right of the umbilicus, what
action should be taken first? - Answer-1. Perform fundal massage
2. Have client empty bladder - full bladder is one of the most common reasons for
uterine atony or hemorrhage in the 1st 24 hrs after delivery.
*Recheck fundus every 15 mins for 1 hr then every 30 mins for 2 hrs
Narcotic analgesics - Answer-If narcotic analgesics are given, raise side rails + place
call light w/in reach. Instruct client not to get out of bed or ambulate w/o assistance +
caution them about drowsiness of a side effect
Tearing of perineal area - Answer-- 1st degree tear = involved only the epidermis
- 2nd degree tear = involved dermis, muscle, + fascia
- 3rd degree tear = extends into the anal sphincter
- 4th degree tear = extends up the rectal mucosa
Tears cause pain + swelling. Avoid rectal manipulation
APGARS - Answer-- Do not wait until a 1 min APGAR is assigned to begin in
resuscitation of the compromised neonate
- APGAR scores of 6 or lower at 5 mins require an additional APGAR assessment at 10
mins
IV vs. IM administration of analgesics - Answer-IV administration of analgesics is
preferred to IM administration for a client in labor b/c the onset + peak occur more
quickly + the duration of the drug is shorter.
IV administration times - Answer-Onset: 5 mins
Peak: 30 mins
Duration: 1 hr
IM administration times - Answer-Onset: w/in 30 mins
Peak: 1-3 hrs after injection
Duration: 4-6 hrs
Tranquilizers - Answer-Tranquilizers (ataractics + phenothiazines), such as Phenergan
+ Vistaril, are used in labor as analgesic-potentiating drugs to decrease the amt. of
narcotic needed to decrease maternal anxiety
Agonist narcotic drugs (Morphine) - Answer-Produce narcosis + have a higher risk for
causing maternal + fetal respiratory depression
WITH COMPLETE SOLUTIONS
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.
- Pitcoin is given w/ caution to those w/ HTN
- NEVER give Methergine or Hemabate to a client while she is labor or before delivery
of placenta
, If nurse finds the fundus soft, boggy, + displaced to the right of the umbilicus, what
action should be taken first? - Answer-1. Perform fundal massage
2. Have client empty bladder - full bladder is one of the most common reasons for
uterine atony or hemorrhage in the 1st 24 hrs after delivery.
*Recheck fundus every 15 mins for 1 hr then every 30 mins for 2 hrs
Narcotic analgesics - Answer-If narcotic analgesics are given, raise side rails + place
call light w/in reach. Instruct client not to get out of bed or ambulate w/o assistance +
caution them about drowsiness of a side effect
Tearing of perineal area - Answer-- 1st degree tear = involved only the epidermis
- 2nd degree tear = involved dermis, muscle, + fascia
- 3rd degree tear = extends into the anal sphincter
- 4th degree tear = extends up the rectal mucosa
Tears cause pain + swelling. Avoid rectal manipulation
APGARS - Answer-- Do not wait until a 1 min APGAR is assigned to begin in
resuscitation of the compromised neonate
- APGAR scores of 6 or lower at 5 mins require an additional APGAR assessment at 10
mins
IV vs. IM administration of analgesics - Answer-IV administration of analgesics is
preferred to IM administration for a client in labor b/c the onset + peak occur more
quickly + the duration of the drug is shorter.
IV administration times - Answer-Onset: 5 mins
Peak: 30 mins
Duration: 1 hr
IM administration times - Answer-Onset: w/in 30 mins
Peak: 1-3 hrs after injection
Duration: 4-6 hrs
Tranquilizers - Answer-Tranquilizers (ataractics + phenothiazines), such as Phenergan
+ Vistaril, are used in labor as analgesic-potentiating drugs to decrease the amt. of
narcotic needed to decrease maternal anxiety
Agonist narcotic drugs (Morphine) - Answer-Produce narcosis + have a higher risk for
causing maternal + fetal respiratory depression
