OB ATI 1: Pregnancy & Labor Concepts

A nurse is reviewing contraception options for four clients. The nurse should identify which of the following clients has a contraindication for receiving oral contraceptives?

A. A 26-year-old client who has migraine headaches at the start of each menstrual cycle

B. A 28-year-old client who has a history of pelvic inflammatory disease

C. A 32-year-old client who has benign breast disease

D. A 38-year-old client who reports smoking one pack of cigarettes every day

D. A 38-year-old client who reports smoking one pack of cigarettes every day

Rationale:A client who is over the age of 35 and smokes is at increased risk of thromboembolism

A nurse is reviewing the health history of a client who has a new prescription for a combined oral contraceptive (COC). The nurse recognizes that which of the following client medications can interfere with the effectiveness of the COC?

A. Antihypertensives

B. Anticonvulsants

C. Antioxidants

D. Antiemetics

B. Rationale:

Anticonvulsants when taken simultaneously with COCs can decrease their effectiveness. The anticonvulsants included are: phenytoin, phenobarbital, carbamazepine, oxcarbazepine, topiramate, and primidone.

A nurse is reinforcing teaching about contraceptive methods with a client. Which of the following should the nurse recognize as a contraindication for diaphragm use?

A. The client is 42 years old.

B. The client smokes cigarettes.

C. The client has pelvic relaxation.

D. The client has a 3-month-old infant.

C. The client has pelvic relaxation. Rationale:Pelvic relaxation and large cystocele are contraindications for diaphragm use

A nurse is caring for a client who is considering several methods of contraception. Which of the following methods of contraception should the nurse identify as being most reliable?

A. A male condom

B. An intrauterine device (IUD)

C. An oral contraceptive

D. A diaphragm with spermicide.

B. An intrauterine device (IUD) Rationale:An IUD is found to have a failure rat

A nurse is leading a discussion about contraception with a group of 14-year-old clients. After the presentation, a client asks the nurse which method would be best for her to use. Which of the following responses should the nurse make?

A. "You are so young. Are you ready for the responsibilities of a sexual relationship?"

B. "Because of your age, I think that a barrier method would be the best choice."

C. "Before I can help you, I need to know more about your sexual activity."

D. "A provider can help you with that after a physical examination."

C. "Before I can help you, I need to know more about your sexual activity."

A nurse is planning a teaching session about hysterosalpingography for a client who has a diagnosis of infertility. The nurse should include which of the following information in the teaching plan?

A. The client might experience shoulder pain following the procedure.

B. The client should anticipate scheduling the procedure 5 days prior to menstruation.

C. The client might experience diarrhea as a result of the procedure.

D. The client should be on a liquid diet for 1 day following the procedure.

A. The client might experience shoulder pain following the procedure. Rationale:Shoulder pain can occur due to phrenic nerve irritation cause by the contrast media.

A nurse at a family practice clinic receives a call from a client who is prescribed oral contraceptives but forgot to take one dose. The client reports she is in the first week of a 28-day cycle pack. Which of the following instructions should the nurse provide?

A. "Do not have vaginal intercourse until after your next period."

B. "Stop taking the pills and switch to a different contraceptive method."

C. "Take the missed dose now, then continue the medication as ordered."

D. "Take a home pregnancy test."

C. "Take the missed dose now, then continue the medication as ordered." Rationale: The nurse should tell the client to take the missed dose immediately, then continue with the pack as order

A nurse is caring for a client whose Papanicolaou (Pap) test cytology results are abnormal. Which of the following procedures should the nurse anticipate for this client?

A. Rectovaginal palpation by the provider

B. Dilation and curettage

C. Human chorionic gonadotropin (hCG) test

D. Colposcopy

D. Colposcopy Rationale: The nurse should anticipate follow-up visit for a client who has an abnormal Pap test to include a colposcopy and direc

A 39-year old woman presents seeking contraception. She smokes 20 cigarettes a day and denies a personal or family history of venous thromboembolism, migraines with aura, hypertension, or cancer. Her surgical history is notable for a left-sided salpingectomy for ectopic pregnancy 7 years ago. Which methods of contraception would be contraindicated in this patient? Select all that apply.

A. Copper intrauterine device

B. Levonogesterol intrauterine system

C. Combined oral contraceptive

D. Progesterone only pill

B. Levonogesterol intrauterine system C. Combined oral contraceptive D. Progesterone only pill

A healthy 35-year-old nulligravid woman presents with 2 years of infertility. She reports regular menstrual cycles that occur "like clockwork" every 30 days without abnormal bleeding and frequent unprotected intercourse with her husband. She denies a history of sexually transmitted infection, galactorrhea, or male pattern hair growth, and the review of systems is negative. Her partner has never fathered a child and is healthy.Which of the following is considered a routine test as part of this patient's assessment?

A. Hysterosalpingogram

B. 17-hydroxyprogesterone level

C. Prolactin level

D. Karyotyping

A. Hysterosalpingogram Rationale: The infertility evaluation should consider an assessment of ovulation, ovarian reserve, the uterus, and fallopian tube patency.Appropriate routine tests of tubal patency include a hyste

A 31-year-old woman presents for a screening Pap smear. Which of the following is considered the most suitable position for an internal gynecologic exam?

A. Prone position

B. Trendelenburg position

C. Lateral position

D. Lithotomy position

D. Lithotomy position Rationale: The most suitable position for an internal gynecologic exam is the lithotomy position. The lithotomy position allows greater visualization of the vulva, vagina, and uterine cervix.Typically the gynecologic exam includes inspecting the external genitalia, a bimanual examination, and a speculum exam

A nurse is teaching a group of teenage clients about the use of condoms for the prevention of sexually transmitted infections (STIs). Which of the following statements should the nurse include in the teaching?

A. "Use a natural membrane condom rather than a polyurethane condom."

B. "You may use a condom more than once."

C. "Use an oil-based lubricant when you use a condom." D. "Female condoms can help prevent transmission of sexually transmitted viruses."

D. "Female condoms can help prevent transmission of sexually transmitted viruses." Rationale: The client who uses a female condom can prevent sexually transmitted viruses when the polyurethane or nitrile sheath is placed in the vagina.

A nurse is teaching a group of newly licensed nurses on effective techniques for counseling clients about sexually transmitted infections (STIs). Which of the following statements should the nurse include in the teaching?

A. "Use closed-ended questions when obtaining the health history."

B. "A client's reproductive health history is not needed for counseling purposes."

C. "Ask about the client's exposure to any past or present STIs."

D. "Refer the client to genetic counseling if he has had a STI."

C. "Ask about the client's exposure to any past or present STIs." Rationale: The nurse should assess the client exposure to any past or present STIs and any treatment taken.

A nurse is caring for a client who asks to be screened for cervical cancer because a relative has been diagnosed with it. Which of the following tests should the nurse expect the provider to use?

A. A serum prolactin level

B. A Papanicolaou test

C. A vaginal ultrasound

D. An endometrial biopsy

B. A Papanicolaou test Rationale:A Papanicolaou test involves sampling cells from the cervix to detect abnormal cells and growth. The nurse should recommend the cl

A. Painless red vaginal bleeding Rationale:Placenta previa is a condition of pregnancy when the placenta implants in the lower part of the uterus, partly or completely obstructing the cervical os (outlet to the vagina). Bright red, painless vaginal bleeding occurs in the second and third trimester

D. "It occurs during the first trimester and near the end of the pregnancy." Rationale: Urinary frequency is due to increased bladder sensitivity during the first trimester and recurs near the end of the pregnancy as the enlarging uterus places pressure on the bladder.

A. Shortly after giving birth Rationale: The rubella immunization should be offered to the client following birth, preferably prior to discharge from the hospital. This prevents the client from contracting rubella during the current or subsequent pregnancies, which would put her fetus at risk for rubella syndrome.

D. The client requires a rubella immunization following delivery. Rationale:A negative rubella titer indicates that the client is susceptible to the rubella virus and needs vaccination following delivery. Immunization during pregnancy is contraindicated because of possible injury to the developing fetus. Following rubella immunization, the client should be cautioned not to conceive for 1 month.

B. Initiate IV access. Rationale:Insertion of a large-bore IV catheter is the priority nursing action. The client is losing blood rapidly, has hypotension, and tachycardia. IV access will allow IV fluids and blood to be administered quickly if hypovolemia develops

D. Excessive uterine enlargement Rationale:A hydatidiform mole is a rare tumor that forms inside the uterus at the beginning of a pregnancy and results in the over-production of tissue that would normally develop into the placenta. This tissue consists of fluid-filled vesicles. A rapidly enlarging uterus is a classic finding in clients who have a molar pregnancy. It is often accompanied by severe nausea and vomiting, elevated human chorionic gonadotropin levels, signs of hyperthyroidism, and early onset of preeclampsia.

C. Offer the client a snack of orange juice and crackers. Rationale:A nonstress test depends upon fetal movement, and this fetus is most likely asleep. Most fetuses are more active after meals due to the increase in the mother's blood sugar. Giving the mother a snack will promote fetal movement.

B. Position the client with one hip elevated. Rationale:Based on Maslow's hierarchy of needs, the client's need for an adequate blood pressure to perfuse herself and her fetus is a physiological need that requires immediate intervention. Supine hypotension is a frequent cause of low blood pressure in clients who are pregnant. By turning the client on her side and retaking her blood pressure, the nurse is attempting to correct the low blood pressure and reassess.

B. Changes in the cervix Rationale:Assessment of progressive changes in the effacement and dilation of the cervix is the most accurate indication of true labor.

D. Respiratory rate Rationale: Magnesium sulfate is typically administered to a client in preterm labor to achieve the tocolytic (uterine relaxation) effect. Magnesium sulfate depresses the function of the central nervous system, causing respiratory depression. Baseline assessment of respiratory status, checking the respiratory rate frequently, and reassessment of respiratory status with each change in dosage of magnesium sulfate is the primary focus when assessing the client. There is a narrow margin between what is considered a therapeutic dose and a toxic dose of magnesium sulfate.

C. Consume foods fortified with folic acid. Rationale:Increased consumption of folic acid in the 3 months prior to conception, as well as throughout the pregnancy, reduces the incidence of neural tube defects in the developing fetus.

D. Insert a gloved hand into the vagina to relieve pressure on the cord. Rationale: This is the first nursing action because it is essential to prevent any pressure on the umbilical cord to promote oxygenation of the fetus.

D. Dyspnea Rationale: The presence of dyspnea is a manifestation of pulmonary edema, which is a potentially life-threatening complication of terbutaline. This finding should be reported to the provider immediately.

B. A client who is experiencing preterm labor at 26 weeks of gestation Rationale: Tocolytic medications, such as terbutaline, indomethacin, and nifedipine are used to relax the uterus in preterm labor. A client who is in preterm labor at 26 weeks of gestation is a candidate for tocolytic therapy

B. Location of the placenta Rationale:Painless, spontaneous vaginal bleeding might indicate that the client has placenta previa. Placenta previa is a condition in which the placenta is implanted low in the uterus, sometimes to the point of covering the cervical os. As the cervix effaces, the client begins to bleed. The ultrasound will show the location of the placenta and help to determine what sort of delivery the client requires and how emergent it is.

A. "The primary consideration is what type of incision was performed this time." Rationale: The most common type of incision during a cesarean birth is transverse, which is made across the lower, thinner part of the uterus. It is the primary criteria that permits a vaginal birth after a cesarean (VBAC). Other types of incisions increase the risk of uterine rupture. Additional criteria for VBAC include an adequate maternal pelvis, no uterine scars or history of rupture, the availability of a provider to monitor labor, and personnel to perform a cesarean birth if needed.

C. "This will occur between the fourth and fifth months of pregnancy." Rationale: Quickening is defined as the first time the client is able to feel her fetus move. In a primigravida client, this usually occurs at 18 weeks of gestation or later. In a multigravida client, this can occur as early as 14 to 16 weeks.

A. Uteroplacental insufficiency Rationale: The pattern of the fetal heart rate during labor is an indicator of fetal well-being. Late decelerations are the result of uteroplacental insufficiency and the fetus becomes hypoxemic. They are an ominous sign if they cannot be corrected and place the fetus at risk for a low Apgar score.

D. Facial edema Rationale: Facial edema is a warning sign of a hypertensive condition or preeclampsia and should be reported immediately to the provider.

C. Unilateral, cramp-like abdominal pain Rationale:An ectopic pregnancy is one in which the fertilized egg implants in tissue outside of the uterus and the placenta and fetus begin to develop in this area. The most common site is within a fallopian tube; however, ectopic pregnancies can occur in the ovary, the abdomen, and in the cervix.

0504 Correct Rationale: Using Nägele's rule, the nurse subtracts three months from the date of the last menstrual period, then adds 7 days. July minus 3 months equals April. There are 30 days in April, so 27 + 7 = May 4. The client's EDB is May 4, which would be written as 0504 in the MMDD format

A. "This infection is treated with one dose of azithromycin." Rationale:A single dose of azithromycin is an appropriate treatment for a chlamydial infection. An acceptable alternative is doxycycline twice a day for 7 days.

D. Folic acid Rationale:Adequate amounts of folic acid before conception and during the first trimester of pregnancy are necessary for fetal neural tube development. This vitamin helps prevent spina bifida and other neurological disorders.

C. Linea nigra D. Chloasma E. Striae gravidarum

A. History of migraines B. Nulliparous C. Twin gestations

D. The lowermost portion of the fetus is at the level of the ischial spines. Rationale: The presenting part is at 0 station when its lowermost portion is at the level of an imaginary line drawn between the client's ischial spines. Levels above the ischial spines are negative values: -1, -2, -3. Levels below the ischial spines are positive values: +1, +2, +3.

D. "You will need to double your intake of iron during pregnancy." Rationale: During pregnancy, the need for iron increases to allow transfer of the appropriate amounts to the fetus and to support expansion of the client's red blood cell volume.

B. "The recommendation for you is about 15 to 25 pounds."

Rationale:Clients who are overweight, having a BMI of 25 to 29.9, should be advised that the recommended weight gain is 7 to 11.5 kg (15 to 25 lb). The pattern of weight gain is also important, with minimal gain in the first trimester.

A. Variable decelerations are due to umbilical cord compression. Rationale:Variable decelerations are decreases in the fetal heart rate with an abrupt onset, followed by a gradual return to baseline. Variable decelerations coincide with umbilical cord compression, which decreases the oxygen supply to the fetus.

D. Frank breech Rationale: With a frank breech presentation, the fetal heart is generally above the level of the client's umbilicus.

A. Fetal breathing B. Fetal motion D. Amniotic fluid volume

D. Assist the client to turn onto her side. Rationale: Maternal hypotension results from the pressure of the enlarged uterus on the inferior vena cava. Turning the client to her right side relieves this pressure and restores blood pressure to the expected reference range.

B. Hypertension Rationale: Maternal hypertension, either chronic or related to pregnancy, is the most common risk factor for placental abruption.

A. 4-0-1-2-2 Rationale: This response correctly describes the client's current status: pregnant currently and had 3 prior pregnancies (G); no term births (T); one pregnancy resulted in the preterm birth (P) of twins; two pregnancies ended in abortion (A); and she has two living children (L).

A. February 11, 2016 Rationale:Subtracting 3 calendar months and adding 7 days plus one year will result in this estimated date of delivery

B. Assist the client to breathe into a paper bag. Rationale: This client is experiencing respiratory alkalosis due to hyperventilation. The client should be assisted to breathe into a paper bag or to cup her hands over her mouth to increase the carbon dioxide level, which replaces the bicarbonate ion.

A. Place the client in the lateral position. Rationale: This is a late deceleration and is associated with fetal hypoxemia due to insufficient placental perfusion. Placing the client in the lateral position is the first action the nurse should take.

A. The presenting part is 1 cm above the ischial spines. Rationale:Station is the relation of the presenting part to the ischial spines of the maternal pelvis and is measured in centimeters above, below, or at the level of the spines. If the station is minus (-) 1, then the presenting part is 1 cm above the ischial spines.

B. Assess the fetal heart rate pattern. Rationale:Variable fetal heart rate decelerations and bradycardia can occur with an amniotomy as a result of umbilical cord prolapse or compression. Cord prolapse necessitates an emergent delivery.

B. Placenta previa Rationale:Painless, bright red vaginal bleeding in the second or third trimester is a manifestation of placenta previa.

B. A nonreactive test Rationale:An NST that does not produce two or more qualifying accelerations within a 20-min period is interpreted as nonreactive. Qualifying accelerations peak at least 15 /min above the FHR baseline and last at least 15 seconds.

C. "It assists in identifying the location of the placenta and fetus."

Rationale:Identifying the positions of the fetus, placenta, and amniotic fluid pockets immediately prior to

the amniocentesis increases the safety of this test by assisting with correct placement of the

needle.

B. Disseminated intravascular coagulation Rationale: Clinical manifestations of disseminated intravascular coagulation (DIC) include oozing from intravenous access and venipuncture sites; petechiae, especially under the site of the blood pressure cuff; spontaneous bleeding from the gums and nose; other signs of bruising; and hematuria.

C. Have the client pant during the next contractions. Rationale:Panting is rapid, continuous, shallow breathing. It helps a client in labor refrain from pushing before her cervix reaches full dilation. Observe for hyperventilation and have the client exhale slowly through pursed lips.

A. Cervical dilation

B. "Moderate exercise improves circulation." Rationale:Improving circulation is just one of the many benefits of moderate exercise during pregnancy. It enhances well-being, promotes rest and relaxation, and improves muscle tone.

B. A surge of energy Rationale:Prior to the onset of labor, the pregnant client experiences a surge of energy.

A. Respiratory depression Rationale: Magnesium sulfate toxicity can cause life-threatening adverse effects, including respiratory and CNS depression. The nurse should report a respiratory rate slower than 12/min immediately to the provider and stop the infusion.

D. Hypotension

Rationale:Maternal hypotension is an adverse effect of epidural anesthesia. The nurse should administer an IV fluid bolus prior to the placement of the epidural catheter to decrease the likelihood of this complication.

B. Discontinue the infusion of the IV oxytocin. Rationale: Discontinue the oxytocin infusion immediately if a client is experiencing late decelerations due to uterine hyperstimulation.

B. Indomethacin C. Magnesium sulfate

C. Observe for crowning. Rationale:In the descent phase of the second stage of labor, crowning occurs when the fetal head is at +2 to +4 station. Because this is the client's third childbirth experience, it is reasonable to assume that delivery is imminent.

D. Apply an external fetal monitor. Rationale:Based on Maslow's hierarchy of needs, the nurse should immediately apply the fetal monitor to determine if the fetus is in distress.

D. Place the client in a lateral position Rationale:Based on Maslow's hierarchy of needs, the client should be moved to a lateral position or a pillow placed under one of the client's hips to relieve pressure on the inferior vena cava and improve the blood pressure.

A. Hydrops fetalis Rationale: Hydrops fetalis is the most severe form of Rh incompatibility and can be prevented by the administration of Rho (D) immunoglobulin.

C. Empty her bladder immediately prior to the procedure. Rationale:Emptying the bladder before amniocentesis prevents possible puncture of the bladder and displacement of the uterus and fetus.

B. Assess the fetal heart rate. Rationale: The fetal heart rate should be assessed before and immediately after the amniotomy to detect any changes.

D. Variable decelerations Rationale:Variable decelerations occur when the umbilical cord becomes compressed and disrupts the flow of oxygen to the fetus.

C. Assess the odor of the amniotic fluid. Rationale: Chorioamnionitis is an infection of the amniotic cavity that presents with maternal fever, tachycardia, increased uterine tenderness, and foul-smelling amniotic fluid.

D. Preparation for cesarean birth Rationale:A cesarean birth is indicated for all clients who have a confirmed placenta previa.

C. An excessive amount of amniotic fluid is present. Rationale:An excess of amniotic fluid is defined as amniotic fluid pockets of >8 cm or an amniotic fluid index of greater than 25. Polyhydramnios or hydramnios is associated with neural tube defects, obstructions of the fetal gastrointestinal tract, multiple fetuses, and fetal hydrops.

A. Contractions lasting longer than 90 seconds Rationale:A pattern of prolonged uterine contractions lasting more than 90 seconds is an indication that there is inadequate uterine relaxation and should be reported to the provider.

C. "It promotes fetal lung maturity." Rationale:Betamethasone is a glucocorticoid that enhances fetal lung maturity by promoting the release of certain enzymes that help produce surfactant.

D. Encourage the client to empty her bladder every 2 hr. Rationale:A client in labor should be encouraged to empty her bladder every 2 hr. Bladder distention can impede the descent of the fetus and slow the progression of labor. It can also contribute to uterine atony after delivery, increasing the client's risk of postpartum hemorrhage.

D. Turn the client onto her side. Rationale: When using the urgent vs non-urgent approach to client care, the nurse determines that the priority action is to turn the client onto her left side. Late decelerations indicate that the client might have uteroplacental insufficiency, maternal hypotension, uterine tachysystole form oxytocin administration, or several other complicating factors. The client might be exerting pressure on the inferior vena cava, which decreases the oxygen to the placenta and thus to the fetus. Turning the client onto her side will relieve the pressure and facilitate better blood flow to the placenta, thereby increasing the fetal oxygen supply.

D. Obtain a 30 min electronic fetal monitoring (EFM) strip prior to induction. Rationale: The nurse should obtain a 20 to 30 min EFM strip before induction of the spinal anesthesia. The strip should be evaluated as baseline information. After induction, fetal heart rate and pattern is assessed and documented every 5 to 10 min and emergency care is provided for fetal distress, such as bradycardia or late decelerations.

B. Weakened uterine contractions Rationale: Terbutaline is a beta2-adrenergic agonist that acts to relax uterine smooth muscles. Terbutaline is used to stop contractions in a client who is experiencing preterm labor.

B. Blood pressure 80/56 mm Hg Rationale: When using the airway, breathing, circulation approach to client care, the nurse's priority finding is a blood pressure of 80/56, which indicates hypotension. The client's blood pressure is not adequate to sustain uteroplacental perfusion and oxygen to the fetus, which can lead to respiratory distress and possibly death.

A nurse is providing teaching to a client who is at 30 weeks of gestation and is to have a nonstress test (NST). Which of the following statements by the client indicates a need for further teaching?

A. "I will have to lie on my back during the test."

B. "My baby's heart rate will be monitored during the test." C. "I should schedule the test when the baby is usually active."

D. "It will take 20 to 30 minutes to complete the test."

A. "I will have to lie on my back during the test." Rationale: The client is placed in a Semi-Fowler's position with one hip slightly elevated to promote uterine perfusion and prevent supine hypotension as a result of the uterus compressing the maternal vena cava.

70.A nurse in an antepartum unit is triaging clients. Which of the following clients should the nurse see first?

A. A client who is at 38 weeks of gestation and reports a cough and fever

B. A client who has missed a period and reports vaginal spotting

C. A client who is at 14 weeks of gestation and reports nausea and vomiting

D. A client who is at 28 weeks of gestation and reports of painless vaginal bleeding

D. A client who is at 28 weeks of gestation and reports of painless vaginal bleeding

Rationale: Using the urgent vs. nonurgent approach to client care, the nurse should assess this client first. The nurse should suspect placenta previa when vaginal bleeding occurs after 24 weeks of gestation. A pregnant woman can lose up to 40% of blood before showing signs of shock.