OB EXAM 4 STUDY GUIDE QUESTIONS WITH VERIFIED ANSWERS 100% CORRECT 2024, Exams of Nursing

Download OB EXAM 4 STUDY GUIDE QUESTIONS WITH VERIFIED ANSWERS 100% CORRECT 2024 and more Exams Nursing in PDF only on Docsity! OB EXAM 4 STUDY GUIDE QUESTIONS WITH VERIFIED ANSWERS 100% CORRECT 2024 1. What are the primary signs, symptoms, and concerns about a patient with Postpartum depression with psychotic features? - Affects 1-2 per 100 births - Requires inpatient psychiatric care - Commonly associated with bipolar disorder -S/S: Mania, depression, or both. Postpartum psychosis is defined by the presence of abnormally elevated energy levels, cognition, and mood; and one or more depressive episodes. Rapid onset of bizarre behavior, auditory or visual hallucinations, paranoid or grandiose delusions, elements of delirium or disorientation, and extreme deficits in judgement accompanied by high levels of impulsivity that can contribute to increased risk of suicide or infanticide When a woman is diagnosed with postpartum depression (PPD) with psychotic features, what is the nurses primary concern in planning the clients care? a. Displaying outbursts of anger b. Neglecting her hygiene c. Harming her infant d. Losing interest in her husband ANS: C 2. What should the nurse caring for a pregnant woman with Methamphetamines know about methamphetamines and pregnancy? - Associated with pre-term birth and low birth weight The use of methamphetamine (meth) has been described as a significant drug problem in the United States. The nurse who provides care to this client population should be cognizant of what regarding methamphetamine use? a. Methamphetamines are similar to opiates. b. Methamphetamines are stimulants with vasoconstrictive characteristics. c. Methamphetamines should not be discontinued during pregnancy. d. Methamphetamines are associated with a low rate of relapse. ANS: B 3. What type of treatment is best for women who are addicted to opioids when pregnant? - Medical withdrawal from opioids during pregnancy is not currently recommended With one exception, the safest pregnancy is one during which the woman is drug and alcohol free. What is the optimal treatment for women addicted to opioids? a. Methadone maintenance treatment (MMT) b. Detoxification c. Smoking cessation d. 4 Ps Plus ANS: A 4. Pregnant women in preterm labor are given Betamethasone for what reason? - To mature the baby’s lungs and prepare for delivery A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM) doses of betamethasone. What is the purpose of this pharmacologic intervention? a. To stimulate fetal surfactant production b. To reduce maternal and fetal tachycardia associated with ritodrine administration c. To suppress uterine contractions d. To maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy ANS: A 5. What type of Uterine dysfunction occurs when a woman’s labor is unchanged for several hours? - Hypotonic labor - Can cause Protraction Disorders: where progress in labor is slower than normal - Can cause Arrest Disorders: where there is no progress in labor. Initially make normal progress into the active phase of first- stage labor, but then the contractions become weak and inefficient or stop altogether A primigravida at 40 weeks of gestation is having uterine contractions every to 2 minutes and states that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this womans labor? a. She is exhibiting hypotonic uterine dysfunction. b. She is experiencing a normal latent stage. c. She is exhibiting hypertonic uterine dysfunction. d. She is experiencing precipitous labor. ANS: C 6. Explain the reason that Cytotec is given to pregnant women. - For induction of labor and cervical ripening, can also give for PPH A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her labor is being controlled with tocolytic medications. She asks when she might be able to go home. Which response by the nurse is mostaccurate? a. After the baby is born. b. When we can stabilize your preterm labor and arrange home health visits. c. Whenever your physician says that it is okay. d. It depends on what kind of insurance coverage you have. ANS: B a. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress b. Woman with severe preeclampsia on magnesium sulfate whose labor is being induced c. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor d. Primigravida in spontaneous labor with preterm twins ANS: B In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, which finding alerts the nurse to possible side effects? a. Urine output of 160 ml in 4 hours b. DTRs 2+ and no clonus c. Respiratory rate (RR) of 16 breaths per minute d. Serum magnesium level of 10 mg/dl ANS: D 10. What is the difference between Placental accrete, increta, percreta, and placental abruption concerning the wall of the uterus? -Accreta= slight penetration of myometrium -Increta = deep penetration of myometrium -Percreta = perforation of myometrium and uterine serosa, possibly involving adjacent organs -Abruption: the detachment of all of part of a normally implanted placenta from the uterus. Separation occurs in the area of the decidua basalis after 20 weeks of gestation and before the birth of the infant. Which classification of placental separation is not recognized as an abnormal adherence pattern? a. Placenta accreta b. Placenta increta c. Placenta percreta d. Placenta abruptio ANS: D 11. After delivery, a nurse notices a small trickle of blood bleeding from the vagina. What is likely to have occurred? -Laceration -Lacerations typically present with a firm, contracted uterus and a steady stream of unclotted bright red blood. (Hematoma is a localized bluish bulging area) What would a steady trickle of bright red blood from the vagina in the presence of a firm fundus suggest to the nurse? a. Uterine atony b. Lacerations of the genital tract c. Perineal hematoma d. Infection of the uterus ANS: B 12. How does surfactant help the baby’s lung in a premature birth? Surfactant helps with lung expansion. Surfactant lowers surface tension, therefore reducing the pressure required to keep the alveoli open with inspiration, and prevents total alveolar collapse on exhalation, thereby maintaining alveolar stability A premature infant with respiratory distress syndrome (RDS) receives artificial surfactant. How does the nurse explain surfactant therapy to the parents? a. Surfactant improves the ability of your babys lungs to exchange oxygen and carbon dioxide. b. The drug keeps your baby from requiring too much sedation. c. Surfactant is used to reduce episodes of periodic apnea. d. Your baby needs this medication to fight a possible respiratory tract infection. ANS: A 13. Developmental miles stones for a premature baby are different from a normal newborn. What would the nurse explain the differences to the mother at discharge? -Preterm infants experience catch-up body growth during the first 2 years of life. Milestones are corrected until 2 ½ years old. An infant is being discharged from the NICU after 70 days of hospitalization. The infant was born at 30 weeks of gestation with several conditions associated with prematurity, including RDS, mild bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP), requiring surgical treatment. During discharge teaching, the infants mother asks the nurse if her baby will meet developmental milestones on time, as did her son who was born at term. What is the nurses most appropriate response? a. Your baby will develop exactly like your first child. b. Your baby does not appear to have any problems at this time. c. Your baby will need to be corrected for prematurity. d. Your baby will need to be followed very closely. ANS: C 14. What are the general signs and symptoms of necrotizing enterocolitis in a premature newborn? - Generalized signs: decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, and cyanosis. -GI symptoms: abdominal distention, increasing or bile-stained residual gastric aspirates, grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. What are generalized signs and symptoms of this condition? a. Hypertonia, tachycardia, and metabolic alkalosis b. Abdominal distention, temperature instability, and grossly bloody stools c. Hypertension, absence of apnea, and ruddy skin color d. Scaphoid abdomen, no residual with feedings, and increased urinary output ANS: B 15. What is the first priority of the nurse caring for a newborn when the mother has diabetes? -Feeding newborn to keep from becoming hypoglycemic. To manage her diabetes appropriately and to ensure a good fetal outcome, how would the pregnant woman with diabetes alter her diet? a. Eat six small equal meals per day. b. Reduce the carbohydrates in her diet. c. Eat her meals and snacks on a fixed schedule. d. Increase her consumption of protein. ANS: C 16. How is HIV transferred to the infant prenatally and postpartum? -Postpartum: breastfeeding -Prenatally: body secretions (vaginal secretions) during delivery Human immunodeficiency virus (HIV) may be transmitted perinatally or during the postpartum period. Which statement regarding the method of transmission is most accurate? a. Only in the third trimester from the maternal circulation b. From the use of unsterile instruments c. Only through the ingestion of amniotic fluid d. Through the ingestion of breast milk from an infected mother ANS: D 17. A pregnant woman needs induction of labor. Prior to starting the induction, a vaginal exam is done, 3/50/-4, soft, mid position. What is the bishop score number, and what would be the best medical intervention for this Bishop score and starting the induction? -Bishop score is 6; having a Bishop score of 6 or less the chances of having a vaginal delivery are low and the cervix is said to be unfavorable or unripe for induction, so you need to use ripening agents! Which statement related to the induction of labor is most accurate? a. Can be achieved by external and internal version techniques b. Is also known as a trial of labor (TOL) c. Is almost always performed for medical reasons d. Is rated for viability by a Bishop score ANS: D 18. Once a Pitocin induction is started, what reasons are given for turning off the Pitocin for the mom and the baby? -Tachysystole or fetal intolerance - A1c levels are normally lower in pregnant women than in nonpregnant individuals. Therefore, the estimation of glycemic control provided by the test applies to a shorter period of time, only the previous 2 to 6 weeks. 26. What are the signs and symptoms of a pregnant woman with cardiac decompensation? -Subjective: Increasing fatigue and/or difficulty breathing with her usual activities (early finding), feeling of smothering, frequent cough, palpitations (feels like heart is racing), generalized edema (i.e., rings no longer fit) -Objective: irregular/weak/rapid pulse (>100bpm), progressive generalized edema, crackles @ base of lungs that does not clear after coughing, orthopnea, increased dyspnea, rapid respirations (> 25/min), moist/frequent cough, cyanosis of the lips and nail beds -Can be abrupt or gradual When caring for a pregnant woman with cardiac problems, the nurse must be alert for the signs and symptoms of cardiac decompensation. Which critical findings would the nurse find on assessment of the client experiencing this condition? a. Regular heart rate and hypertension b. Increased urinary output, tachycardia, and dry cough c. Shortness of breath, bradycardia, and hypertension d. Dyspnea, crackles, and an irregular, weak pulse ANS: D 27. Which postpartum medication used to stop postpartum hemorrhage is not used in women with asthma? -Hemabate (Carboprost) A woman with asthma is experiencing a postpartum hemorrhage. Which drug should be avoided when treating postpartum bleeding to avoid exacerbating asthma? a. Oxytocin (Pitocin) b. Nonsteroidal antiinflammatory drugs (NSAIDs) c. Hemabate d. Fentanyl ANS: C 28. A woman has Cholecystitis while pregnant. What diet would you, as the nurse, recommend? -Low fat diet. Which important component of nutritional counseling should the nurse include in health teaching for a pregnant woman who is experiencing cholecystitis? a. Assess the womans dietary history for adequate calories and proteins. b. Teach the woman that the bulk of calories should come from proteins. c. Instruct the woman to eat a low-fat diet and to avoid fried foods. d. Instruct the woman to eat a low-cholesterol, low-salt diet. ANS: C 29. What is a primary priority of a trauma team when a pregnant mom is in a car accident? -Careful assessment of signs and symptoms of placental abruption. A pregnant woman at 33 weeks of gestation is brought to the birthing unit after a minor automobile accident. The client is experiencing no pain and no vaginal bleeding, her vital signs are stable, and the FHR is 132 beats per minute with variability. What is the nurses highest priority? a. Monitoring the woman for a ruptured spleen b. Obtaining a physicians order to discharge her home c. Monitoring her for 24 hours d. Using continuous EFM for a minimum of 4 hours ANS: D A pregnant woman at term is transported to the emergency department (ED) after a severe vehicular accident. The obstetric nurse responds and rushes to the ED with a fetal monitor. Cardiopulmonary arrest occurs as the obstetric nurse arrives. What is the highest priority for the trauma team? a. Obtaining IV access, and starting aggressive fluid resuscitation b. Quickly applying the fetal monitor to determine whether the fetus viability c. Starting cardiopulmonary resuscitation (CPR) d. Transferring the woman to the surgical unit for an emergency cesarean delivery in case the fetus is still alive ANS: C It is extremely rare for a woman to die in childbirth; however, it can happen. In the United States, the annual occurrence of maternal death is 12 per 100,000 cases of live birth. What are the leading causes of maternal death? a. Embolism and preeclampsia b. Trauma and motor vehicle accidents (MVAs) c. Hemorrhage and infection d. Underlying chronic conditions ANS: B 30. What is PUPPP of pregnancy, and why do some pregnant get PUPPP and not others? -It is a rash causing itching during pregnancy, it is not harmful to the mother or fetus. PUPPP is pruritic urticarial papules and plaques of pregnancy. Classically appears in primigravida's during the mid to late third trimester and occurs slightly more often in woman carrying males. Goal of therapy is to alleviate discomfort. Another common pregnancy-specific condition is pruritic urticarial papules and plaques of pregnancy (PUPPP). A client asks the nurse why she has developed this condition and what can be done. What is the nurses bestresponse? a. PUPPP is associated with decreased maternal weight gain. b. The rate of hypertension decreases with PUPPP. c. This common pregnancy-specific condition is associated with a poor fetal outcome. d. The goal of therapy is to relieve discomfort. ANS: D 31. What is the first medication used with a postpartum hemorrhage when the mom has a boggy uterus? -Oxytocin Which is the initial treatment for the client with vWD who experiences a PPH? a. Cryoprecipitate b. Factor VIII and von Willebrand factor (vWf) c. Desmopressin d. Hemabate ANS: C 32. What are the signs and symptoms of a cold and stressed newborn? By understanding the four mechanisms of heat transfer (convection, conduction, radiation, and evaporation), the nurse can create an environment for the infant that prevents temperature instability. Which significant symptoms will the infant display when experiencing cold stress? a. Decreased respiratory rate b. Bradycardia, followed by an increased heart rate c. Mottled skin with acrocyanosis d. Increased physical activity ANS: C 33. Name all the medications that are used to help stop a postpartum hemorrhage. -Pitocin: 10-40 units (up to 80) added to 1000 mL of LR, administered aker the placenta is delivered -Cytotec (Misoprostol): 800-1000 mcg rectally -Methergine (Methylergonovine): Do not give with hypertension -Hemabate (Carboprost): IM, max = 8 doses; pretreat with Imodium or Lomotil; do not give to patients with a history of Asthma lithium-free pregnancy or, if indicated, reinstitute the lithium after the first trimester 38. What viruses cause Bell’s palsy in a pregnant woman? -Herpes Simplex Virus, Herpes Zoster virus - Women who develop Bell palsy during pregnancy have an increased risk for gestational hypertension or preeclampsia Bell palsy is an acute idiopathic facial paralysis, the cause for which remains unknown. Which statement regarding this condition is correct? a. Bell palsy is the sudden development of bilateral facial weakness. b. Women with Bell palsy have an increased risk for hypertension. c. Pregnant women are affected twice as often as nonpregnant women. d. Bell palsy occurs most frequently in the first trimester. ANS: B 39. What is the “diabetogenic effect of pregnancy,” and who and when are pregnant women screened? -In the 2nd and 3rd trimesters this occurs; decreased tolerance to glucose, increased insulin resistance, decreased hepatic glycogen stores, increased hepatic production of glucose -Women with risk factors for gestational diabetes should be screened earlier in pregnancy, before 24-28 weeks, women without risk factors should be screened between 24-28 weeks A number of metabolic changes occur throughout pregnancy. Which physiologic adaptation of pregnancy will influence the nurses plan of care? a. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own. b. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar. c. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. d. Maternal insulin requirements steadily decline during pregnancy. ANS: C 40. What risk factors increase the chances of a pregnant mom getting gestational diabetes? -Family history of diabetes, previous pregnancy that resulted in an unexplained still birth or the birth of a malformed or macrosomia fetus, obesity, HTN, glycosuria, maternal age >25 Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the client mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. This fetus is at the greatest risk for which condition? a. Macrosomia b. Congenital anomalies of the central nervous system c. Preterm birth d. Low birth weight ANS: A 41. What are the signs and symptoms of Hypothyroidism in pregnancy? -weight gain, lethargy, decrease in exercise capacity, and cold intolerance. Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Because severe hypothyroidism is associated with infertility and miscarriage, it is not often seen in pregnancy. Regardless of this fact, the nurse should be aware of the characteristic symptoms of hypothyroidism. Which do they include? (Select all that apply.) a. Hot flashes b. Weight loss c. Lethargy d. Decrease in exercise capacity e. Cold intolerance ANS: C, D, E 42. What is neonatal abstinence syndrome, and which drug is the most common cause that the mother takes during pregnancy? -Withdrawal after intrauterine exposure to certain drugs, occurs with the abrupt cessation of the drug exposure at birth -Most commonly caused by opioids Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. What is the first step in the provision of care for the infant? a. Pharmacologic treatment b. Reduction of environmental stimuli c. Neonatal abstinence syndrome (NAS) scoring d. Adequate nutrition and maintenance of fluid and electrolyte balance ANS: C 43. What are the signs and symptoms of fetal alcohol syndrome? -Prenatal and postnatal growth restriction, CNS malfunctions including cognitive impairment, craniofacial features -> thin upper lip, short palpebral fissures, flat midface, indistinct philtrum (normally a crease between the upper lip and nostrils) Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. Which condition is rarely associated with fetal alcohol syndrome (FAS)? a. Respiratory conditions b. Intellectual impairment c. Neural development disorder d. Alcohol-related birth defects (ARBDs) ANS: A 44. What are the signs and symptoms of postpartum depression without psychotic features? -Irritability, feelings of detachment toward the newborn. Which is the most accurate description of PPD without psychotic features? a. Postpartum baby blues requiring the woman to visit with a counselor or psychologist b. Condition that is more common among older Caucasian women because they have higher expectations c. Distinguishable by pervasive sadness along with mood swings d. Condition that disappears without outside help ANS: C 45. Most pregnant women with cardiac problems are on medication to prevent blood clots and not cross the placenta during pregnancy.