Inpatient Obstetric Nursing Exam Quiz

The correct answer is vulvar hematoma. This is because the woman is experiencing sudden, excruciating vulvar pain and severe rectal pressure, which are common symptoms of a vulvar hematoma. A vulvar hematoma occurs when there is bleeding into the tissues of the vulva, usually as a result of trauma during childbirth. This can cause significant pain and discomfort for the woman. Bartholin gland cyst and vulvar edema do not typically present with the same symptoms described in the question.

Following the administration of epidural anesthesia, it is important to monitor the patient's blood pressure for possible hypotension. Epidural anesthesia can cause a decrease in blood pressure, and monitoring is necessary to identify and address any hypotensive episodes promptly. This is crucial to prevent complications such as decreased perfusion to vital organs and potential harm to the patient. Administering oxytocin or maintaining the patient in a flat position to avoid post-anesthesia headache are not the most important nursing actions following the administration of epidural anesthesia.

The correct answer suggests that obtaining further obstetrical history details may contribute to understanding the patient's complaint of intermittent lower back pain. This information could provide insights into any previous pregnancies, complications, or conditions that may be relevant to her current symptoms. It could help in assessing the potential causes of the pain and determining the appropriate course of action for the patient's care.

The patient's symptoms of confusion, agitation, low blood pressure, increased heart rate, and decreased urine output suggest a systemic infection that has progressed to septic shock. Septic shock occurs when an infection leads to a severe inflammatory response, causing widespread organ dysfunction. The patient's lack of pain is not consistent with a pulmonary embolism, which typically presents with chest pain and shortness of breath. Thromboembolism is also unlikely as the patient's symptoms are more indicative of an infection rather than a blood clot. Therefore, septic shock is the most likely diagnosis based on the given information.

Minimal or absent fetal heart rate variability is the most predictive parameter of fetal compromise. Fetal heart rate variability refers to the normal fluctuations in the fetal heart rate, which indicate a healthy autonomic nervous system. When there is minimal or no variability, it suggests that the fetus is experiencing stress or compromise, as the autonomic nervous system is not functioning properly. This can be a sign of fetal distress and may require further monitoring or intervention to ensure the well-being of the fetus.

On the second day postpartum, it is normal for a patient to have increased urine output. This is because during pregnancy, the body retains extra fluid, and after delivery, the body starts to eliminate this excess fluid. Therefore, it is important for the nurse to reassure the patient that increased urine output is a normal response to delivery, rather than contacting the care provider for an antibiotic order or obtaining a urine sample.

Magnesium sulfate can cause muscle weakness in the newborn. This is because magnesium acts as a muscle relaxant and can affect the neuromuscular transmission. When given to the mother during labor for gestational hypertension, magnesium sulfate can cross the placenta and affect the baby's muscles, leading to weakness. Elevated cortisol levels and hyperglycemia are not associated with the administration of magnesium sulfate during labor.

A patient at 34 weeks gestation in a low-risk pregnancy who reports decreased fetal movement over the preceding hour should be instructed to have something to eat and drink, lie on her left side, and count fetal movements over the next 1-2 hours. This is because decreased fetal movement can be a sign of potential fetal distress, and these instructions are commonly recommended to stimulate fetal movement. If the fetal movements do not increase or if the patient has any concerns, she should then report to her primary medical provider for further assessment.

Women who experience precipitous labor, which is defined as labor that progresses very quickly, are at an increased risk for perineal lacerations. This is because the rapid descent and birth of the baby can put excessive pressure on the perineum, causing tears or lacerations. Preeclampsia, a condition characterized by high blood pressure and organ damage, and urinary retention are not directly related to precipitous labor, so they are not the correct answer in this case.

The given scenario suggests that the woman is experiencing postpartum hemorrhage, which is evident from her symptoms of rapid and shallow respirations, feeling cold, and losing consciousness. The laboratory tests indicate a low hematocrit level and a normal fibrinogen level, suggesting blood loss. The platelet count is slightly low, which may be due to dilutional effects. Therefore, the most appropriate management would be the administration of blood products, such as packed red blood cells, to replenish the lost blood volume and improve oxygen-carrying capacity. Epinephrine and heparin are not indicated in this situation.

The correct answer is Betamethasone 12 mg IM. PTL stands for preterm labor, which is when a woman goes into labor before 37 weeks of pregnancy. Betamethasone is a corticosteroid that is commonly used to accelerate fetal lung maturation in cases of preterm labor. It helps to reduce the risk of respiratory distress syndrome in premature infants. Therefore, it is expected that the physician will order Betamethasone 12 mg IM for the patient in triage with PTL.

When an Rh-negative mother delivers an Rh-positive infant, there is a risk of alloimmunization, which means the mother's immune system produces Rh antibodies in response to the Rh-positive blood cells of the infant. These antibodies can cross the placenta and attack the red blood cells of subsequent Rh-positive fetuses. This can lead to hemolytic disease of the newborn in subsequent pregnancies, causing destruction of the baby's red blood cells and potentially leading to serious complications. Therefore, the greatest risk of hemolytic disease is in subsequent Rh-positive fetuses.

Terbutaline (Beta-mimetics) is contraindicated in diabetic women as it can cause hyperglycemia, which can worsen their diabetic condition. Beta-mimetics like terbutaline can stimulate the release of glucose from the liver and decrease insulin sensitivity, leading to elevated blood sugar levels. Therefore, it is not recommended for use as a tocolytic in diabetic women. Magnesium sulfate and nifedipine do not have the same contraindications in diabetic women.

An active primary HSV outbreak at the time of delivery poses the greatest risk of transmission to a newborn. This is because during a primary outbreak, the mother has a high viral load and may shed the virus more easily. In addition, the newborn's immune system is not fully developed, making them more susceptible to infection. In contrast, an active recurrent outbreak or a history of a primary outbreak early in pregnancy without active disease at the time of delivery may still pose a risk, but it is lower compared to an active primary outbreak.

The distinguishing factor between early and late decelerations is their timing in relation to the contractions. Early decelerations occur in response to the start of a contraction and mirror the contraction pattern, while late decelerations occur after the peak of the contraction and are associated with uteroplacental insufficiency. Therefore, the timing of the deceleration in relation to the contractions helps differentiate between the two types.

A woman with a BMI of 18 who gains 25 pounds during her pregnancy is not necessarily at increased risk for any of the listed complications (cesarean delivery, low birthweight infant, or preeclampsia) based solely on her weight gain. A BMI of 18 is considered underweight, and a weight gain of 25 pounds during pregnancy may be within the recommended range for a woman with this initial BMI, depending on her individual needs and circumstances. It is essential for pregnant women to have regular prenatal care, including monitoring weight gain and overall health, to ensure the best possible outcomes for both the mother and baby. Potential risks and complications during pregnancy can be influenced by various factors, and healthcare providers will consider the woman's unique situation when providing guidance and care.

Breastfeeding women with diabetes generally have decreased insulin requirements compared to bottle feeding diabetics. This is because breastfeeding helps to naturally lower blood glucose levels in the mother. Breastfeeding stimulates the release of hormones that increase insulin sensitivity and promote glucose uptake by the muscles. As a result, the mother's insulin needs are reduced. It is important for diabetic breastfeeding women to monitor their blood sugar levels closely and adjust their insulin dosage accordingly to maintain stable blood glucose levels.

The nurse knows that specific areas of pain can have a specific cause. This means that the pain in the patient's nipples may be caused by a specific issue or condition, such as an infection, injury, or breastfeeding problem. It suggests that the nurse should assess the patient's nipples and surrounding areas to determine the specific cause of the pain and provide appropriate treatment or interventions.

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that is commonly used to delay preterm labor. However, one of the potential side effects of indomethacin is the increased risk of developing necrotizing enterocolitis (NEC) in the newborn. NEC is a serious condition characterized by inflammation and damage to the intestines, particularly in premature infants. Therefore, it is important to closely observe the newborn for signs and symptoms of NEC after the mother has received indomethacin to ensure early detection and prompt treatment if necessary.

Based on the prenatal history provided, a quad screen with a lower than normal maternal serum alpha-fetoprotein (MSAFP) and higher than normal HCG and Inhibin A suggests the diagnosis of Trisomy 21 (Down syndrome). Trisomy 21 is a genetic disorder caused by the presence of an extra copy of chromosome 21. The abnormal levels of these markers in the quad screen are indicative of the condition.

Sheehan's Syndrome is a condition that occurs when the pituitary gland is damaged due to severe blood loss during childbirth, leading to inadequate hormone production. This damage is caused by postpartum necrosis, which refers to the death of tissues in the pituitary gland. Gestational hypertension and hyperglycemia following delivery are not directly related to the development of Sheehan's Syndrome.

The given symptoms indicate that the pregnant woman's respiratory rate is within the normal range and her deep tendon reflexes are decreased with clonus absent. These findings suggest that the Magnesium Sulfate infusion is effectively managing her preeclampsia without causing any adverse effects. Therefore, it is appropriate to maintain the infusion rate to continue providing the necessary treatment and ensure the well-being of both the mother and the baby.

The correct answer is that the mother's antibodies will be protective, so no action is needed. When a pregnant woman is diagnosed with varicella-zoster, she develops antibodies that can be passed on to the fetus through the placenta. These antibodies provide passive immunity to the newborn, protecting them from varicella-zoster infection. Therefore, there is no need to administer zoster immunoglobulin to the newborn or the patient prior to delivery.

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that can be used to treat hydramnios, a condition characterized by excessive amniotic fluid. The excessive amniotic fluid can put pressure on the abdomen, causing pain, and also on the lungs, leading to difficulty in breathing (dyspnea). Indomethacin works by inhibiting the production of prostaglandins, which are responsible for maintaining fetal kidney function and urine production. Therefore, the use of indomethacin in the treatment of hydramnios would decrease fetal urine production, helping to reduce the excessive amniotic fluid.

The average weight loss at birth is 12 lbs. This is because during childbirth, a woman typically loses the weight of the baby, the placenta, and amniotic fluid, which can amount to around 12 lbs.

The correct answer is vital signs including lung sounds and assessment of pedal edema. This is because the patient has a personal history of tetralogy of Fallot, which is a congenital heart defect. Monitoring vital signs, especially lung sounds and pedal edema, can help assess her cardiac status and detect any signs of complications or worsening of her condition. This is crucial in ensuring the patient's safety and well-being during the recovery period.

The correct answer is necrotic tissue separation from the uterus. This is because retained placental fragments can lead to necrosis, or tissue death, which can cause separation of the tissue from the uterus. This can result in sudden late onset of postpartum hemorrhage. Increased uterine contraction activity and weakness in the uterine musculature may contribute to postpartum hemorrhage, but they are not the primary cause in this scenario.

Increased arterial oxygen tension leads to functional closure of the ductus arteriosus. The ductus arteriosus is a blood vessel that connects the pulmonary artery to the aorta in a fetus. During fetal development, the ductus arteriosus allows blood to bypass the lungs since the fetus receives oxygen from the placenta. However, after birth, when the baby starts breathing on its own, the increased arterial oxygen tension signals the ductus arteriosus to close. This closure is essential for proper circulation and oxygenation of blood in the body.

BUN stands for Blood Urea Nitrogen, which is a measure of the amount of nitrogen in the blood that comes from urea, a waste product of protein metabolism. During pregnancy, the BUN levels tend to decrease due to increased blood volume and increased renal blood flow. However, after giving birth, BUN levels tend to increase due to the decrease in blood volume and the body's adjustment to normal non-pregnant state. Therefore, an increase in BUN happens postpartum.

Within the first 2 days after birth, the fall in progesterone levels causes a decreased PaCO2. This occurs because progesterone stimulates respiratory drive during pregnancy, so its reduction after birth leads to a transient decrease in respiratory drive, resulting in lower levels of carbon dioxide exhalation.