OB HESI HINTS EXAM QUESTIONS
WITH COMPLETE SOLUTIONS
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
Antagoinst drugs (Stadol, Nubain) - Answer-Have less respiratory depression but must
be used w/ caution in a mother w/ preexisiting narcotic dependency b/c withdrawal
symptoms occur immediately
Pudendal + subarachnoid (saddle) blocks - Answer-Are only used in the 2nd stage of
labor
- Peridural + epidural blocks may be used during all stages of labor
Effectiveness of blocks - Answer-1st sign of a block's effectiveness is usually warmth +
tingling in the ball of the foot or the big toe
When to stop continuous infusion - Answer-Stop continuous infusion at the end of stage
1 or during transition to increase effectiveness of pushing
Regional Block Anesthesia + Fetal Presentation - Answer-- Internal rotation is harder to
achieve when the pelvic floor is relaxed by anesthesia; this results in a persistent
occiput-posterior position of the fetus.
- Monitor fetal position. Remember the mother cannot tell you she back pain, which is
the cardinal sign of persistent posterior fetal position
- Regional blocks, especially epidural + caudal blocks, commonly result in assisted
(forceps or vacuum) delivery because of the inability to push effectively during the 2nd
stage
Normal Leukocystosis of pregnancy - Answer-Averages 12,000 -15,000 mm3. During
the first 10-12 days postdelivery, values of 25,000 mm3 are common
- Elevated WBC + the normal elevated Erythrocyte Sedimentation Rate (ESR) may
confuse interpretation of acute postpartal infections
If the nurse assess a client's temp to be 101 F on the client's 2nd postpartum day, what
assessments should be made before notifying the physician? - Answer-- Assess fundal
height + firmness
- Assess perineal integrity
, - Check for S+S of thromboembolism
- Assess pulse, BP, + respirations
- Client's subjective description of symptoms (i.e. burning on urination, pain in leg,
excessive tenderness of uterus)
Uterine Atony Postpartum - Answer-After the 1st postpartum day, the most common
cause of uterine atony is retained placental fragments
- nurse must check for the presence of fragments in lochial tissue
Blood loss in postpartal period - Answer-Women can tolerate blood loss, even slightly
excessive blood loss, in the postpartal period b/c of the 40% increase in plasma volume
during pregnancy
In postpartal period a woman can void up to 3000 mL/day to reduce the volume
increase that occurred during pregnancy
Voiding Postpartum - Answer-Client should void w/in 4 hrs of delivery. Monitor client
closely for urine retention
- Suspect retention if voiding is frequent + <100 mL per voiding
Ambulation after delivery - Answer-Women often have a syncopal (fainting) spell on the
1st ambulation after delivery (usually r/t vasomotor changes, orthostatic hypotension)
- Nurse should check client's Hgb + Hct for anemia + BP, sitting + lying down, to
ascertain orthostatic hypotension
Kegel Exercises - Answer-Kegels increase the integrity of the introitus + improve urine
retention
- Teach client to alternate contraction + relaxation of the pubococcygeal muscles
Assessing for Thromboembolism - Answer-Examine legs of postpartum client daily for
pain, warmth, + tenderness or a swollen vein that is tender to the touch
Rhogam - Answer-Given to an Rh- mother who delivers an Rh+ fetus + has a negative
direct Coombs test
- if mother has a positive Coombs test, there is no need to give RhoGAM b/c mother is
already sensitized
Rhogam + Rubella - Answer-B/c Rh immune globulins suppress the immune system,
the client who receives both RhoGAM + the rubella vaccine should be tested for rubella
immunity at 3 months
Postpartum Blues - Answer-Usually normal especially 5-7 days after delivery
(unexplained tearfulness, feeling down, + having a decreased appetite)
- Encourage use of support persons to help w/ housework for 1st 2 postpartum weeks
(refer to community resources)
WITH COMPLETE SOLUTIONS
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
Antagoinst drugs (Stadol, Nubain) - Answer-Have less respiratory depression but must
be used w/ caution in a mother w/ preexisiting narcotic dependency b/c withdrawal
symptoms occur immediately
Pudendal + subarachnoid (saddle) blocks - Answer-Are only used in the 2nd stage of
labor
- Peridural + epidural blocks may be used during all stages of labor
Effectiveness of blocks - Answer-1st sign of a block's effectiveness is usually warmth +
tingling in the ball of the foot or the big toe
When to stop continuous infusion - Answer-Stop continuous infusion at the end of stage
1 or during transition to increase effectiveness of pushing
Regional Block Anesthesia + Fetal Presentation - Answer-- Internal rotation is harder to
achieve when the pelvic floor is relaxed by anesthesia; this results in a persistent
occiput-posterior position of the fetus.
- Monitor fetal position. Remember the mother cannot tell you she back pain, which is
the cardinal sign of persistent posterior fetal position
- Regional blocks, especially epidural + caudal blocks, commonly result in assisted
(forceps or vacuum) delivery because of the inability to push effectively during the 2nd
stage
Normal Leukocystosis of pregnancy - Answer-Averages 12,000 -15,000 mm3. During
the first 10-12 days postdelivery, values of 25,000 mm3 are common
- Elevated WBC + the normal elevated Erythrocyte Sedimentation Rate (ESR) may
confuse interpretation of acute postpartal infections
If the nurse assess a client's temp to be 101 F on the client's 2nd postpartum day, what
assessments should be made before notifying the physician? - Answer-- Assess fundal
height + firmness
- Assess perineal integrity
, - Check for S+S of thromboembolism
- Assess pulse, BP, + respirations
- Client's subjective description of symptoms (i.e. burning on urination, pain in leg,
excessive tenderness of uterus)
Uterine Atony Postpartum - Answer-After the 1st postpartum day, the most common
cause of uterine atony is retained placental fragments
- nurse must check for the presence of fragments in lochial tissue
Blood loss in postpartal period - Answer-Women can tolerate blood loss, even slightly
excessive blood loss, in the postpartal period b/c of the 40% increase in plasma volume
during pregnancy
In postpartal period a woman can void up to 3000 mL/day to reduce the volume
increase that occurred during pregnancy
Voiding Postpartum - Answer-Client should void w/in 4 hrs of delivery. Monitor client
closely for urine retention
- Suspect retention if voiding is frequent + <100 mL per voiding
Ambulation after delivery - Answer-Women often have a syncopal (fainting) spell on the
1st ambulation after delivery (usually r/t vasomotor changes, orthostatic hypotension)
- Nurse should check client's Hgb + Hct for anemia + BP, sitting + lying down, to
ascertain orthostatic hypotension
Kegel Exercises - Answer-Kegels increase the integrity of the introitus + improve urine
retention
- Teach client to alternate contraction + relaxation of the pubococcygeal muscles
Assessing for Thromboembolism - Answer-Examine legs of postpartum client daily for
pain, warmth, + tenderness or a swollen vein that is tender to the touch
Rhogam - Answer-Given to an Rh- mother who delivers an Rh+ fetus + has a negative
direct Coombs test
- if mother has a positive Coombs test, there is no need to give RhoGAM b/c mother is
already sensitized
Rhogam + Rubella - Answer-B/c Rh immune globulins suppress the immune system,
the client who receives both RhoGAM + the rubella vaccine should be tested for rubella
immunity at 3 months
Postpartum Blues - Answer-Usually normal especially 5-7 days after delivery
(unexplained tearfulness, feeling down, + having a decreased appetite)
- Encourage use of support persons to help w/ housework for 1st 2 postpartum weeks
(refer to community resources)
