OB inpatient certification practice questions with answers 2024, Exams of Nursing

Download OB inpatient certification practice questions with answers 2024 and more Exams Nursing in PDF only on Docsity! OB inpatient certification practice questions with answers 2024 After delivery, progesterone levels fall causing what acid/base change? ✔ Increase pco2 With what disorder would AFP be elevated? ✔ Esophageal atresia, neural tube defects Women with a history of GDM have increased risk of diabetes at what rate? ✔ Onset within 20 years in 35-60% Glucose screen is done when? ✔ 24-28 weeks If a mother has Insulin dependent diabetes during pregnancy, what electrolyte imbalance is the neonate at risk for? ✔ Magnesium deficiency In which trimester is new onset of GHTN most common? ✔ 3rd trimester In a pregnancy complicated by hypertension, what is a sign of deteriorating status? ✔ Increased serum creatinine What difference can be expected between manual and electronic diastolic BP? ✔ Manual are 5-7 mm HG higher On admission to L&D , a woman has 2+ reflexes. After IV mag, DTRs are absent. What is your immediate nursing intervention? ✔ Stop mag and notify provider With no apparent HSV lesions what is the recommendation? ✔ Oral acyclovir 4 weeks prior to delivery +IgG antibodies in PP period? ✔ The recurrence is unlikely, no further action is required. (IgG chronic, IgM is active) The most common rheumatic valvular lesion in pregnancy is? ✔ Mitral stenosis Cardiac defect with most complications in labor? ✔ Mitral stenosis Methamphetamines are expected to last? ✔ 7-24 hrs What is recommended L/S ratio? ✔ 2:1 - lungs are probably mature 3:1 - indicative of maturity What causes a sinusoidal FHR tracing? ✔ Fetal anemia What is the parenteral analgesic with most rapid peak effect? ✔ Fentanyl What neonatal complication is increased with cesarean delivery? ✔ Respiratory morbidity A woman who has a c/s is more likely to be re-hospitalized with what pp complication? ✔ Wound infection During the postpartum period, low levels of placental lactogen, estrogen, cortisol, growth hormone and insulinase result in? ✔ Lower glucose levels Due to the catabolic process of involution postpartum, which lab value is expected to be elevated postpartum? ✔ BUN Avg weight loss with delivery? ✔ 12 lbs Where would you expect to palpate fundus 24h pp? ✔ 1cm below umbilicus What is the term for lochia appearing 3-10 days pp and pink or brown in colora ✔ Lochia serosa The process of involution that allows for healing of the placental site preventing scarring is? ✔ Exfoliation True or false 2500cc urine 2 days pp is a normal physiologic response to delivery ✔ True If pp woman's fundus is deviated from midline first RN intervention is? ✔ Empty bladder ✔ A cascade of hormones Compared to term breast milk, preterm breast milk is composed of? ✔ Higher protein content In comparison to mature breast milk, the relative content of transitional breast milk has? ✔ Increased protein content Immunoglobulin secreted in breast milk is ✔ IgA Not getting recommended 2500-2700 kcal per day while breastfeeding can lead to? ✔ Decreased milk production Minimum number of kcal for breastfeeding woman is? ✔ 1800 kcal A 36 hr old BF infant has nursed 8 times in the last 24hrs on one breast per feeding. The infant has had 2 wet diapers and 2 moderate sized green BM. The baby has rhythmic suck with audible swallow during feeds. This baby is? ✔ Eating well and as expected for this age It is important to breastfeed at night in the early weeks when lactation is being established because? ✔ Prolactin levels are highest at night Most common reason fore sore nipples when breastfeeding? ✔ Improper latch A pt reports sore nipples. The nurse knows that the characteristics of the pain will help to? ✔ Identify the cause A pp woman who is breastfeeding delivered 48 hours ago and is reporting breast engorgement. The cause of this engorgement is? ✔ Vascular changes Pp breastfeeding mom states baby is not satisfied after feeding. States the baby nurses 15 min on each breast then screams. Appropriate intervention? ✔ Observe the baby at the breast during feeding A nursing mom needs an antihypertensive. A good choice is? ✔ Nifedipine A woman on methadone wants to breastfeed. She should be advised that? ✔ Supervised methadone is considered safe The type of neonatal jaundice caused by inadequate breast milk intake is? ✔ Breastfeeding jaundice Extracellular fluid as % of body weight for a term neonate is? ✔ A approx 40% Soy based formula is recommended for infants who have? ✔ Galactosemia Which of the following may indicate a delay in bonding? ✔ When baby is fussy, mom sends to nursery The phase of maternal adjustment that typically starts on the 2nd or 3rd day pp where the mother focuses on care of the baby and resumes control of her body is? ✔ Taking hold Lasts about ten days Mothering tasks take priority Emphasis on present Impatient and drive. To organize self Teach baby care The phase of maternal adjustment for the first day or two after birth. Mothers need rest and "mothering". ✔ Taking in Primary concern is own needs, sleep and food. Talkative about birth experience. Perceptive, passive, teach self care The phase of maternal adjustment in which couples try to return to pre baby relationship and siblings get to know baby ✔ Letting go Must accept baby as separate person Establish new norms for family A nurse makes a home visit to pt who is overwhelmed from nursing baby all the time. Physical assessment of mom and baby are normal. The nurse knows this a manifestation of? ✔ Postpartum blues Maternal role attainment? ✔ Occurs within 3-10 months following birth A fathers reaction to stress ✔ Is just as important as the mothers reaction Resources for adoptive vs biological parents are? ✔ Less available Which of the following is true for a mother following the loss of one infant of a multiple birth? ✔ There is usually less support for grieving parents because the frequent response is they should be thankful for the survival of the living child A supportive intervention for the parents of a dying infant is? ✔ Offer to stay with family until asked to leave The grief response associated with permanent, progressive, recurring and cyclic loss is? ✔ Chronic sorrow When speaking to parents about impending neonatal death, the most appropriate term to use is? ✔ Natural death A pp pt is diagnosed with sheehans syndrome. This is caused by? ✔ Pituitary necrosis. Damage is from lack of oxygenation caused by massive blood loss and severe low BP during or after birth. Causes permanent hypopituitarism, sometimes called "postpartum hypopituitarism". Rare in industrialized nations Clinical signs of hemorrhage such as BP 90/70, pulse 118, and tachypnea can be seen when blood loss reaches ✔ 1500ml 1 hour after delivery of fetal demise, pt becomes tachypnecic, cold, and begins to lose consciousness. Labs are crit 28, fibrinogen 350, plt 75,000. What is the most likely issue? ✔ Hemorrhage Obstetric hemorrhage is defined by what parameter? ✔ Hemodynamic status of the patient G5 with large newborn for GA is likely to have what complication ✔ Hemorrhage 48 hrs post c/s, RN notes pt left calf and foot are cool and pale. Left pedal pulse is diminished and there is a decrease in capillary refill. Homans sign is neg bilaterally. Pt reports l leg tenderness. Most important initial intervention is? ✔ Place pt on bed rest and elevate left leg Pt diagnosed with pp infection denies pain but seems confused, agitated. VS T 99.9, BP 98/50, p 125. Urine output is decreased. Most likely diagnosis? ✔ Septic shock In assessing reflexes of a term infant, the nurse lifts the newborn slightly from the bed and slow.y lowers the baby back to the surface. What is the expected response? ✔ Fingers for a C and arms returning to chest as if in embrace - Moro reflex The most distinct characteristic of active sleep state in the neonate is? ✔ Rapid eye movement The finding of a 3rd fontanelle along the sagittal suture suggests? ✔ Congenital anomaly (downs) In the assessment of the BP of the newborn which of the following is true regarding upper and lower extremities? ✔ A slight difference is normal If a neonate has CHF, the nurse should recognize that this is a manifestation of? ✔ Underlying disease Infants with hr <90 or > 200 should be first evaluated with? ✔ Electrocardiogram Gases ph 7.29, p02 22mmhg, pCO2 47, base excess -4 ✔ Normal values Decrease in 02 concentration that is responsible for the initiation of newborn respirations occurs in the? ✔ Brain A normal breathing pattern in a 2 hour old neonate may include? ✔ Episodic breathing Which of the following diagnoses is a result of delayed reabsorption of fetal lung fluid production? ✔ Transient tachypnea of the newborn A newborn is noted to have cyanosis when quiet but is pink when crying. The most likely diagnosis is? ✔ Choanal atresia On physical exam of the newborn abdomen a normal finding is? ✔ Lower edge is palpated up to 2.5 cm below the right costal margin in the midclavicular line A preterm pts at 30 weeks received indocin. Her baby should be observed for? ✔ Necrotizing enterocolitis If a newborn is born with a port wine stain the RN should watch for problems involving what system? ✔ Neurologic A new mother asks about a mark that looks like a bruise. Physical exam reveals large gray non blanching macules over buttocks. This is most likely? ✔ Mongolian spot In a 32 week neonate expected muscle development would include? ✔ A good grasp reflex To assess the fontanelles a newborn should be in what position? ✔ Sitting What is craniotabes? ✔ Finding of softening or thinning of the skull. Can be normal esp preterm but may be first sign of rickets/ vit d deficiency Craniotabes is typically found in what region of the skull? ✔ Parietal and occipital The primary mechanism of action of glucagon when given for tx of hypoglycemia is? ✔ Stimulation of glycogen release from the liver A neonate has scrotal swelling which is soft, nontender and transilluminates and there are no palpable masses. The the most likely diagnosis? ✔ Hydrocele After delivery, a newborn exhibits flaccidity of both the lower arm and hand. The birth was complicated by shoulder dystocia and subsequent forceps. The expected diagnosis? ✔ Klumpkes paralysis Breastfeeding mom asks when iron supplements should be given to her baby? ✔ Adequate in breastfeeding until about 6 months of age Hygiene care of the uncircumcised neonate? ✔ Avoid retraction of the foreskin until separation naturally occurs AAP recommends supplementation of 400IU of vitamin D/day for breastfed and partially breastfed infants. ✔ Within a few days of birth PP d/c instructions given to mother whose newborn received Hep B at birth include flu vaccines to be given at what age? ✔ 2&4 months Neonate born to a mom with HBsAg+ should have? ✔ Hep B immunoglobulin and Heb B vaccine within 12 hours of birth A few hours after administering eye prophylaxis to the newborn, The nurse notes edema and a greenish yellow discharge. This reaction is due to? ✔ Silver nitrate 1 day old neonate demonstrates temp. Instability, lethargy, and poor muscle tone. Sepsis is suspected. The nurse anticipates that prophylactic antibiotics prescribed is? ✔ Ampicillin and gentamicin Natal teeth are often seen in? ✔ Native population A newborn is diagnosed with cyanotic heart disease. This would indicate which of the following? ✔ Epsteins anomaly The most appropriate diagnostic procedure to confirm a pneumothorax is? ✔ X-ray A mother calls the mother baby unit 2 weeks following delivery and reports that her baby is crying inconsolably for periods of 1-2 hours. Otherwise the baby is healthy and eating well. The nurse should explain that if the baby has colic, it is? ✔ Generally resolved with continued behavior After delivery, a term neonate begins gagging on secretions and has episodes of vomitting. An orogastric tube is passed and 30ml of gastric aspirated is obtained. The maternal hx is likely to include? ✔ Polyhydramnios At birth the newborn is noted have absent breath sounds on the left with heart sounds shifted to the right, the abdomen is noted to be scaphoid and ventilation is difficult. The most likely diagnosis? ✔ Diaphragmatic hernia The delivery record of a newborn pt reports hydramnios in the 3rd trimester. The newborn should be closely assessed for anomalies of the? ✔ Intestinine When the nurse examines the umbilical cord of a newborn, she notes an umbilical cord hernia. This is more commonly seen in ethnic populations? ✔ African Americans Cerebral blood flow interruption causes ✔ Early decal think head compression Vagal response As fetus matures which branch of the nervous system has more influence over FHR variability ✔ Parasympathetic takes over after 32 weeks Max 24 hour IV dose labetelol ✔ 220 Hyperventilation is caused by what hormone? ✔ Progesterone Fetal attitude ✔ Relation of fetal parts to each other - I.e. Flexed or not flexed Leopolds 1 st manueveur ✔ Presentation FLM using lamellalar body count ✔ 30,000-50,000 = mature Nitrazine ✔ Blue 7.1 rupture 7.5 blood or mucus Burr cells ✔ Hemolysis on smear = HELLP Gaskin manueveur ✔ All 4's for shoulder Normally during pregnancy, maternal sitting and standing blood pressure readings ✔ Decrease, then increase What happens to maternal PaO2 and PaCO2 during pregnancy? ✔ PaO2 increases and PaCO2 decreases The slight increase in pH that occurs during pregnancy is due to ✔ An increase in ventilatory rate During pregnancy, serum urea and creatinine levels ✔ Decrease During pregnancy cardiac out put increases approx ✔ 30-50% By term blood flow to the uterus is approximately ✔ 500ml/min Metabolic changes in pregnancy are ✔ Anabolic -1st half, catabolic 2nd half The primary determinant of volume hemostasis ✔ Renal sodium Increased absorption of calcium is due to increased ✔ Vitamin D (or calciferol) Placental production of this hormone requires interaction of the mother, fetus and placenta ✔ Estriol The 5 diabetogenic hormones of pregnancy ✔ Prolactin, estrogen, progesterone, human placental lactogen, cortisol Congenital cardiac disease occurs in what approximate percentage of live births? ✔ 0.8% Mitral and aortic stenosis are examples of cardiac diseases caused by ✔ Rheumatic fever During pregnancy, predicted values of peak expiratory flow rates are ✔ Unchanged During a asthma exacerbation there is ✔ Increased peripheral vascular resistance A complication seen in up to 26% of women with varicella pneumonia in the first 20weeks of gestation is ✔ Intrauterine infection The prenatal diagnostic screening test most accurate in multiple gestations is ✔ Nuchal translucency Multiple congenital anomalies have been associated with maternal obesity such as ✔ Cleft lip and palate Fetal programming refers to ✔ Process in which an in utero stimulus establishes a permanent fetal response that can lead to increased susceptibility to disease throughout life Uterine crontactility may be what in overweight and obese women ✔ Decreased Extremely obese women have a what % higher risk of stillbirth than a woman of normal weight ✔ 40% The normal length of the pre gravid cervix is ✔ 3.5 to 4 cm Bishop score evaluates ✔ Dilation Effacement Station Consistency Position Oxygen is transferred from mother to fetus by ✔ Passive diffusion Most fetal dysthymias are benign. The exception is which dysthymia that may lead to fetal congestive heart failure? ✔ Supraventricular tachycardia The greatest complication of tocolytic therapy for women with multiple gestations is ✔ Pulmonary edema Pain in 1st stage of labor is caused by ✔ Cervical and lower uterine segment stretching and traction on ovaries, Fallopian tubes and uterine ligaments The release of maternal catecholamines during labor results in ✔ Uterine hypoperfusion and decreased blood flow to the placenta Baroreceptors mediate what kind of decel ✔ Variable Normal metabolic changes during the postpartum period include increased levels of ✔ Plasma renin and angiotensin II Peak cardiac output at birth occurs at ✔ 10 to 15 minutes Intrauterine infection should be suspected when newborn has elevated ✔ IgM ✔ Sleep deprivation Long term inhaled corticosteroid therapy to treat asthma has been implicated in increased incidence of ✔ Preeclampsia A 24 yr old Caucasian woman at 28 weeks gestation presents for regular prenatal visit. According to the American diabetes association, what is the appropriate screening for gestational diabetes? ✔ No need for testing What is the most common maternal congenital cardiac lesion with a left-to-right shunt that is detected during pregnancy? ✔ Mitral stenosis During pregnancy which of the following cardiovascular parameters decreases by at least 20% ✔ Systemic vascular resistance A pt has been moved to the surgery suite for a cesarean birth. There is an internal fetal scalp electrode in place. This should be removed when the ✔ Abdominal prep is initiated Ultrasound for antepartum testing uses high frequency sound waves to produce an image that varies based on ✔ Density of the structure under the transducer A fetus at 36 weeks receives a BPP score of 6. The amniotic fluid was scored as normal. The expected management is ✔ Repeat the test in 24 hours A woman at 37 weeks with no risk factors and no complications to date. She calls because she thinks the baby is not moving as much as previously. She should be instructed to ✔ Come in for evaluation Which FHR pattern characteristic determines fetal oxygen reserve? ✔ Presence of variability With an fse with artifact, what nursing intervention is appropriate? ✔ Auscultate to r/o arrhythmia Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially when seen at the onset of labor? ✔ Early decel Vagal stimulation would be manifested as what type of FHR pattern? ✔ Early A risk of aminofusion is ✔ Uterine overdistension A fetal hr pattern that can occur with a prolapsed cord is? ✔ Prolonged Palpating the uterus is best performed by using the ✔ Fingertips At a prenatal visit, a woman's uterus is palpated at the xiphoid process. This would normally be found at how many weeks gestation? ✔ 36 In evaluating a cord blood gas, if the ph is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? ✔ HCO3 For what gestational ages would you test FFN? ✔ 22-35 In post term preg, the most important u/s parameter is ✔ AFI One theory of labor initiation is an increase in? ✔ Progesterone A pt had an unsuccessful external cephalic version. How soon can this be repeated? ✔ 7 days if <37 weeks, reactive tracing, adequate fluid During the bearing down phase of 2nd stage labor , the nurse should help facilitate the woman's perineum to stretch by? ✔ No action An episiotomy is selectively used for? ✔ Abnormal FHR pattern Compared to a mediolateral episiotomy, a midline episiotomy results in? ✔ Less blood loss A newborn is at higher risk of jaundice when? ✔ Delivery is assisted by vacuum extraction When a vacuum procedure is unsuccessful the max number of attempts or pop offs recommended before declaring the procedure unsuccessful is? ✔ 3 in 20 minutes The risk of water intoxication is decreased during induction of labor if oxytocin is given in a ✔ Balanced electrolyte solution The mechanism of action of sterile water injections for labor pain ✔ Gate control theory Discontinuing an epidural when a woman has the urge to push may ✔ Lead to dysfunctional uterine activity A characteristic of velementous cord insertion is ✔ Lack of whartons jelly What type of breech has the highest risk of cord prolapse ✔ Footling A 36 weeks woman needs cpr for cardiac arrest. Recommended action to facilitate cardiac output during resuscitation is ✔ Uterine displacement A placental condition that occurs when the fetal vessels course through the amniotic membranes and are present at the cervical os is ✔ Vasa previa When 2nd stage labor lasts longer than 2 hours with normal FHR current recommendations are to ✔ Continue to watch if there is evidence of descent One absolute contraindication to epidural anesthesia is ✔ Coagulapathy A woman with hydramnios is experiencing abdominal pain and dyspnea. Treatment with indomethacin will ✔ Decrease fetal urine production Research has shown that administration of IV fluids during preterm labor ✔ Increases risks when combined with tocolytics A clinical sign of plancental abruption is ✔ Pain with ctx not congruent with ctx intensity A pt with previa is scheduled for c/s. The RN can anticipate what kind of incision ✔ Terbutaline (beta-MIMETICS) A woman received mag sulfate during labor GHTN. What effect can this have on the newborn? ✔ Muscle weakness Prenatal hx shows a quad screen with a maternal serum alpha protein (MSAFP) lower than normal and higher than normal HCG and inhibin A. The nurse can expect what diagnosis of the newborn? ✔ Trisomy 21 What is associated with elevated maternal serum alpha protein? ✔ Neural tube defects Subsequent to a massive hemorrhage after delivery of a macerated fetus, a woman appears to stabilize. Suddenly a 1hr postpartum, her respirations become shallow and rapid. She states she feels cold and begins to lose consciousness. Lab tests are: Hct 34, fibrinogen 350, plt 125,000. The most appropriate management includes ✔ Blood products Pt diagnosed with a pp infection states she has no pain. She seems confused and agitated. 98/50, pulse 125, and output is decreased ✔ Septic shock A postpartum pt is diagnosed with sheehans syndrome which is caused by ✔ Postpartum necrosis A woman 4 hours postpartum reports sudden, excruciating vulvar pain and severe rectal pressure. This pt is likely exhibiting symptoms of ✔ Vulvar hematoma Functional closure of the ductus arteriosis occurs as a result of ✔ Increased arterial oxygen tension A woman with hydramnios is experiencing abdominal pain and dyspnea. Treatment with indomethacin will ✔ Decrease fetal urine production A pregnant woman on a continuous mag sulfate infusion for preeclampsia exhibits the following: rr 14, decreased deep tendon reflexes clonus absent ✔ Maintain the infusion rate A woman with a BMI of 18 gains 25 pounds during her pregnancy. The pregnancy is at increased risk for ✔ Low birthweight infant Within the first two days after birth, progesterone levels fall causing what acid base change ✔ Increased PaCO2 and low ph What acid base change is normal in pregnancy? ✔ Slight alkalosis, elevated ph due to decrease PaCO2 Compared to the value seen in the 3rd trimester, the catabolic process of involution causes an increase in which of the following values postpartum? ✔ BUN The cause of sudden late onset postpartum hemorrhage secondary to retained placental fragments is due to ✔ Necrotic tissue separation from the uterus The insulin requirement for most breastfeeding women is ✔ Decreased You are caring for a new mother in the recovery room who delivered by c/s at 35weeks. She has a personal history of Tetraology of Fallot. Your nursing care ✔ Vital signs including lung sounds and assessment of pedal edema What % of women with gestation Htn will develop proteinuria ✔ 25% In the absence of proteinuria, preeclampsia can be diagnosed with new onset of any of the following: ✔ Plt < 100,00, serum creatinine > 1.1 or doubling of serum creating conc. In absence of other renal disease, elevated liver enzymes to 2x normal Severe pre-e = any ONE of the following > 20 weeks ✔ BP 160 or 110 at least 4 hrs apart while on bed rest, plt < 100,000, 2x normal liver functions or severe ft upper quad or epigastric pain unresponsive to meds and not accountable to alt diagnoses or both, creatinine greater than 1.1 or double normal, pulmonary edema, new onset cerebral or visual disturbances Superimposed pre-e ✔ Must have prior diagnoses of CHTN or before 20 weeks Superimposed pre-e diagnosed when ✔ New onset proteinuria after 20wks, sudden change in proteinuria, sudden change in BP requiring dose inc, change in symptoms, inc ALT, AST, plt <100,000, rt upper quad pain, severe ha, pulmonary congestion or edema, renal insuff (creatinine 1.1 or double) Eclampsia ✔ New onset grand mal sx in pt with pre-e HELLP ✔ Hemolysis - abnormal peripheral smear (shistocytes, burr cells), LDH > 600, total bilirubin >= 1.2, elevated liver enzymes, serum asparate amniotransferase>70, low pots< 150,000 Secondary causes of hypertension ✔ Cortisol, pituitary tumor, glucocorticoid meds, sleep apnea, meth/cocaine, renal artery stenosis Path physiology of Htn ✔ Starts early in placental development with incomplete trophoblastic invasion into maternal spiral arteries that perfume the placenta. Results in tortuous vessels, high resistance, I paired p,acetal functioning and decreased placental perfusion Pathophysiology of tachysystole ✔ Constriction of spiral arterioles and decreased blood flow in the intervillous space, risk for fetal hypoxemia and metabolic acidemia Acidosis ✔ Increase in hydrogen ions in tissue Metabolic acidosis ✔ Low bicarb (base excess) in the presence of normal (PCO2) Respiratory acidosis ✔ High pco2 with normal bicarb Asphyxia ✔ Hypoxia with metabolic acidosis Cord ph - arteries ✔ From fetus - deoxygenated Cord ph - vein ✔ To fetus oxygenated FHR tones of baby in ROP position best assessed over ✔ Right lower quad Crettas ✔ Think alphabet in order of badness Doppler flow - rising s/d ratios ✔ Reflect blood flow resistance to placenta, demonstrates dismissed vessel flow volume