OB & HESI FINAL EXAM QUESTIONS
AND ANSWERS
Anticipate what intervention for abruptio placentae - answer-delivery
Preterm labor - answer-before 37 weeks
Risks: multifetal pregnancy, overdistended uterus, anemia, age extremities, substance
abuse, hx of obsteric or other issues (cardiac issues)
Hypotonic labor - answer-short, irregular, weak usually during the active phase of labor
Hypertonic labor - answer-usually during the latent phase of labor causing painful,
frequent, uncoordinated contractions
Priority nurse action: pain relief measures
Placenta previa has an increased risk for what pp - answer-hemorrhage because the
implantation is in the lower uterine segment which has different musculature than the
fundus
Prompt nursing action for umbilical cord protruding from the vagina - answer-- place in
trendelenburg/ hips higher than the head
- call light, other nurse should get delivery room ready
- if protruding from the vagina no attempt to replace cord because it could traumatize
blood flow
- the examiner may place gloved hand into vagina to hold the presenting part off the
umbilical cord
- oxygen by mask
Involution - answer-rapid decrease in size of the uterus as it returns to the nonpregnant
state
Bf women may experience a more rapid involution due to oxytocin release during bf
Assess: the weight of the uterus decreases from 2 lb to 2 oz in 6 weeks
Fundal height decreases about 1 cm/day
By day 10 cannot be palpated
Flaccid--> atony --> massage
Tender --> infection --> assess further
,Lochia - answer-scant: less than 2.5 cm per hour
Light: less than 10 cm per hour
Moderate: less than 15 cm per hour
Heavy: saturated in 1 hour
Excessive: saturated in 15 minutes
Breast care for the non-breastfeeder - answer-avoid stimulation
Breast binder
Ice
Engorgement usually resolves 24-36 hours
Lochia characteristics - answer-rubra: delivery to day 3
Serosa: days 4-10
Alba: white 11-14
When should the cervix regenerate - answer-after 1 week
Menstrual flow postpartum - answer-resumes within 1-2 months in nonbreastfeeders
Resumes within 3-6 months in breastfeeders
Women may ovulate without menstruation
Milk production - answer-caused by decrease in estrogen and progesterone that cause
increased prolactin
Colostrum first 48-72 hours
Distended by 3rd day
Engorgement day 4
Latch - answer-latch
Audible swallow
Type of nipple
Comfort of mother
Hold of baby
Birth control pills during bf - answer-progestin only!! Estrogen is not good for bf cause of
its interference with milk supply
,Nursing action for a pp woman with a temp of 100.2 - answer-increase hydration via oral
fluids (might be transient temp elevation r/t dehydration)
What is the priority concern for a pp woman with midline episiotomy and hemorrhoirds -
answer-pain level
Clots larger than ___cm are considered abnormal
Usually caused by uterine atony, retained placental fragments, etc.
Notify hcp - answer-1
Heavy bleeding - answer-saturated pad in one hour
Light bleeding - answer-less than 10 cm per hour
Most common location of hematoma - answer-vulvar caused by rapid bleeding into the
soft tissue r/t operative delivery
Assessment of hematoma - answer-signs of shock
Abnormal, severe pain
Pressure in perineal area
Inability to void
Bulging mass with discolored skin
Hemorrhage - answer-blood loss of 500 ml or more after delivery (1000 after c/s)
*primary cause of maternal mortality
Early: first 24 hours
Late: following 24 hours - up to 6 weeks
Intervene: uterine massage, vitals q5-15, hcp for shock, ebl (1 gram= 1 ml blood)
Early pp hemorrhage causes - answer-uterine atony
Lacerations of gi tract
Retained placenta
Inversion of the uterus
Interventions for uterine atony - answer-iv access, blood workup, uterine tonics/oxytocin
available, keep bladder empty
Call for help
Uterine massage
, Uterine stimulant medications - answer-methergine (can cause hypertension, do not use
before placenta delivery) *hold drug if 140/90 or higher!!
Hemabata (prostaglandin f2): contraindicated in patients with asthma, check temp q2
hours, do not give prior to placenta delivery
Oxytocin is the only uterine stimulant that can be given prior to placenta
Temp up to 100.4 pp - answer-dehydration usually in the first 24 hours
Infection: mastitis - answer-occurs mainly in bf moms 2-3 weeks post delivery
Encourage expression of milk @4 hours, supportive bra, rest during acute pain phase,
maintain 3000 cc fluid intake
Pulmonary embolism - answer-sudden feeling of impending doom
Initial action: 02
Subinvolution - answer-incomplete involution or failure for uterus to return to prior
condition
Assess: pain on palpation, larger than expected, more vaginal bleeding
Intervene: elevate legs to promote venous return, frequent voiding, monitor h/h, prepare
to administer methergine as a uterine stimulant
Types of thrombophelbitis - answer-superficial: palpable, warm, pink
Tenderness/pain in affected lower extremity
Femoral: malaise, chills, fever, diminished peripheral pulses, shiny white
Pain, stiff, swelling of affected leg
Pelvic: severe chills, dramatic body temp changes, pe may be the first sign
Early sign of blood loss - answer-increasing pulse
Decreasing bp is late sign
Enlarged, hardened vein: _______________ thrombosis - answer-superficial
Apgar score - answer-hr........ Absent...........less than 100.........over 100
Rr........absent.............slow, irreg.............good, cry
Tone.. Flaccid..............minimal..................good flex
Reflex..n/a...................minimal................cry, active move
Skin.....pallor..............blue extremities....pink, warm
AND ANSWERS
Anticipate what intervention for abruptio placentae - answer-delivery
Preterm labor - answer-before 37 weeks
Risks: multifetal pregnancy, overdistended uterus, anemia, age extremities, substance
abuse, hx of obsteric or other issues (cardiac issues)
Hypotonic labor - answer-short, irregular, weak usually during the active phase of labor
Hypertonic labor - answer-usually during the latent phase of labor causing painful,
frequent, uncoordinated contractions
Priority nurse action: pain relief measures
Placenta previa has an increased risk for what pp - answer-hemorrhage because the
implantation is in the lower uterine segment which has different musculature than the
fundus
Prompt nursing action for umbilical cord protruding from the vagina - answer-- place in
trendelenburg/ hips higher than the head
- call light, other nurse should get delivery room ready
- if protruding from the vagina no attempt to replace cord because it could traumatize
blood flow
- the examiner may place gloved hand into vagina to hold the presenting part off the
umbilical cord
- oxygen by mask
Involution - answer-rapid decrease in size of the uterus as it returns to the nonpregnant
state
Bf women may experience a more rapid involution due to oxytocin release during bf
Assess: the weight of the uterus decreases from 2 lb to 2 oz in 6 weeks
Fundal height decreases about 1 cm/day
By day 10 cannot be palpated
Flaccid--> atony --> massage
Tender --> infection --> assess further
,Lochia - answer-scant: less than 2.5 cm per hour
Light: less than 10 cm per hour
Moderate: less than 15 cm per hour
Heavy: saturated in 1 hour
Excessive: saturated in 15 minutes
Breast care for the non-breastfeeder - answer-avoid stimulation
Breast binder
Ice
Engorgement usually resolves 24-36 hours
Lochia characteristics - answer-rubra: delivery to day 3
Serosa: days 4-10
Alba: white 11-14
When should the cervix regenerate - answer-after 1 week
Menstrual flow postpartum - answer-resumes within 1-2 months in nonbreastfeeders
Resumes within 3-6 months in breastfeeders
Women may ovulate without menstruation
Milk production - answer-caused by decrease in estrogen and progesterone that cause
increased prolactin
Colostrum first 48-72 hours
Distended by 3rd day
Engorgement day 4
Latch - answer-latch
Audible swallow
Type of nipple
Comfort of mother
Hold of baby
Birth control pills during bf - answer-progestin only!! Estrogen is not good for bf cause of
its interference with milk supply
,Nursing action for a pp woman with a temp of 100.2 - answer-increase hydration via oral
fluids (might be transient temp elevation r/t dehydration)
What is the priority concern for a pp woman with midline episiotomy and hemorrhoirds -
answer-pain level
Clots larger than ___cm are considered abnormal
Usually caused by uterine atony, retained placental fragments, etc.
Notify hcp - answer-1
Heavy bleeding - answer-saturated pad in one hour
Light bleeding - answer-less than 10 cm per hour
Most common location of hematoma - answer-vulvar caused by rapid bleeding into the
soft tissue r/t operative delivery
Assessment of hematoma - answer-signs of shock
Abnormal, severe pain
Pressure in perineal area
Inability to void
Bulging mass with discolored skin
Hemorrhage - answer-blood loss of 500 ml or more after delivery (1000 after c/s)
*primary cause of maternal mortality
Early: first 24 hours
Late: following 24 hours - up to 6 weeks
Intervene: uterine massage, vitals q5-15, hcp for shock, ebl (1 gram= 1 ml blood)
Early pp hemorrhage causes - answer-uterine atony
Lacerations of gi tract
Retained placenta
Inversion of the uterus
Interventions for uterine atony - answer-iv access, blood workup, uterine tonics/oxytocin
available, keep bladder empty
Call for help
Uterine massage
, Uterine stimulant medications - answer-methergine (can cause hypertension, do not use
before placenta delivery) *hold drug if 140/90 or higher!!
Hemabata (prostaglandin f2): contraindicated in patients with asthma, check temp q2
hours, do not give prior to placenta delivery
Oxytocin is the only uterine stimulant that can be given prior to placenta
Temp up to 100.4 pp - answer-dehydration usually in the first 24 hours
Infection: mastitis - answer-occurs mainly in bf moms 2-3 weeks post delivery
Encourage expression of milk @4 hours, supportive bra, rest during acute pain phase,
maintain 3000 cc fluid intake
Pulmonary embolism - answer-sudden feeling of impending doom
Initial action: 02
Subinvolution - answer-incomplete involution or failure for uterus to return to prior
condition
Assess: pain on palpation, larger than expected, more vaginal bleeding
Intervene: elevate legs to promote venous return, frequent voiding, monitor h/h, prepare
to administer methergine as a uterine stimulant
Types of thrombophelbitis - answer-superficial: palpable, warm, pink
Tenderness/pain in affected lower extremity
Femoral: malaise, chills, fever, diminished peripheral pulses, shiny white
Pain, stiff, swelling of affected leg
Pelvic: severe chills, dramatic body temp changes, pe may be the first sign
Early sign of blood loss - answer-increasing pulse
Decreasing bp is late sign
Enlarged, hardened vein: _______________ thrombosis - answer-superficial
Apgar score - answer-hr........ Absent...........less than 100.........over 100
Rr........absent.............slow, irreg.............good, cry
Tone.. Flaccid..............minimal..................good flex
Reflex..n/a...................minimal................cry, active move
Skin.....pallor..............blue extremities....pink, warm
