Obstetric Practice Exam - For All Aspiring Nurses

According to the American Diabetes Association, women who are not at high risk for gestational diabetes do not need to be tested for it. Factors that may put a woman at high risk include a family history of diabetes, being overweight or obese, being over the age of 25, having had gestational diabetes in a previous pregnancy, or belonging to certain ethnic groups. In this case, the woman is 24 years old, does not have a family history of diabetes, and her weight and height are within normal range, so she would not be considered high risk and therefore does not need testing.

In the conservative management of placenta previa, the goal is to prolong the pregnancy until fetal lung maturity is achieved. This is because placenta previa is a condition where the placenta partially or completely covers the cervix, which can lead to bleeding and complications during delivery. By prolonging the pregnancy, it allows more time for the baby's lungs to develop and mature, reducing the risk of respiratory problems after birth. This approach aims to balance the need for a safe delivery with the need to give the baby the best chance of a healthy start.

Methyldopa (Aldomet) is the initial antihypertensive drug for a pregnant woman with chronic hypertension because it has been extensively studied and proven to be safe and effective during pregnancy. It is considered the first-line treatment for hypertension in pregnancy due to its ability to lower blood pressure without harming the fetus. Magnesium sulfate is not used as an antihypertensive drug but rather as a treatment for preeclampsia and to prevent seizures. Labetalol is also commonly used in pregnancy, but it is typically reserved for cases where methyldopa is ineffective or not tolerated.

The risk of water intoxication during induction of labor is decreased when oxytocin is given in a balanced electrolyte solution. This is because a balanced electrolyte solution helps maintain the body's fluid and electrolyte balance, preventing excessive water intake and the associated risk of water intoxication. Oxytocin, a hormone used to induce labor, can cause fluid retention and dilution of electrolytes, so administering it in a balanced electrolyte solution helps mitigate these risks.

Misoprostol (Cytotec) is a medication commonly used in obstetrics and gynecology to induce labor or to soften the cervix. However, its primary action is to soften the cervix. This is important because a softened cervix is more favorable for labor induction or for certain gynecological procedures, such as dilatation and curettage or hysteroscopy. By softening the cervix, misoprostol helps to prepare the cervix for these procedures or to facilitate the progression of labor.

Obstetric hemorrhage is defined by the hemodynamic status of the patient. This means that the parameter used to determine if a patient is experiencing obstetric hemorrhage is their circulatory status, specifically their blood pressure, heart rate, and overall blood flow. Monitoring the hemodynamic status is crucial in identifying and managing obstetric hemorrhage because it helps healthcare providers assess the severity of the bleeding and make informed decisions regarding treatment and intervention.

The symptoms described indicate false labor. False labor, also known as Braxton Hicks contractions, are irregular contractions that can occur in the third trimester of pregnancy. These contractions are usually painless and do not lead to cervical dilation or effacement. In this case, the contractions occurring every 15-25 minutes and the relief obtained by walking suggest that they are not true labor contractions.

The first maneuver in Leopold's maneuvers should determine the presentation of the fetus. Leopold's maneuvers are a series of four steps used to assess the position of the fetus in the mother's abdomen. By palpating the abdomen, the healthcare provider can determine the part of the fetus that is closest to the birth canal, known as the presentation. This information is crucial in determining the appropriate management and delivery method for the mother and baby.

A hemoglobin A1c of 10.6 indicates a high risk of congenital anomalies. Hemoglobin A1c is a measure of average blood sugar levels over a period of time, and a value of 10.6 indicates poorly controlled diabetes. Uncontrolled diabetes during pregnancy can increase the risk of congenital anomalies in the fetus. Therefore, a high hemoglobin A1c level suggests an increased risk of congenital anomalies.

The current AWHONN recommendations for umbilical cord cleaning suggest using sterile water initially, followed by plain water. This approach is based on the belief that sterile water helps to prevent infection and promote healing of the umbilical cord stump. Once the cord stump has dried and fallen off, plain water can be used to continue keeping the area clean. This method avoids the use of potentially irritating substances like providone-iodine or alcohol swabs, which may cause skin irritation or delay the healing process.

During pregnancy, there is a natural increase in blood clotting factors to prevent excessive bleeding during childbirth. However, this increase in clotting factors also leads to a decrease in fibrinolytic activity, which is the body's ability to break down blood clots. This depressed fibrinolytic activity can predispose a pregnant patient to venous thrombosis, as the blood clots are not efficiently dissolved. Venous thrombosis refers to the formation of blood clots in the veins, which can be dangerous if they travel to vital organs such as the lungs. Therefore, depressed fibrinolytic activity is the hemotological change in pregnancy that increases the risk of venous thrombosis.

The contraceptive sponge is a barrier method of contraception that is inserted into the vagina before intercourse to prevent pregnancy. It contains spermicide that kills sperm and provides additional protection. The patient should be advised to leave the sponge in place for 6 hours after intercourse to ensure maximum effectiveness. This allows enough time for the spermicide to kill any sperm that may have entered the vagina during intercourse. Leaving the sponge in place for less than 6 hours may decrease its effectiveness in preventing pregnancy.

It is important to explain to the pregnant woman who smokes cigarettes that any decrease in smoking improves fetal outcome. This means that even reducing the number of cigarettes smoked can have a positive impact on the health of the fetus. Quitting smoking completely is ideal, but any effort to decrease smoking is beneficial. This explanation emphasizes the importance of taking steps to reduce smoking and highlights the potential positive effects on the fetus.

Cesarean in a previous pregnancy increases the risk for placenta accreta. Placenta accreta is a condition where the placenta attaches too deeply into the uterine wall. This can lead to complications during delivery, such as severe bleeding and the need for a hysterectomy. Cesarean sections can cause scarring in the uterus, which can make it more difficult for the placenta to properly attach in subsequent pregnancies. Therefore, women who have had a previous cesarean are at a higher risk for placenta accreta.

Zidovudine (ZDV) is an antiretroviral medication used for the treatment of HIV. It is given to pregnant women with HIV to reduce the risk of mother-to-child transmission of the virus. In this case, the nurse should explain that ZDV will be given intravenously (IV) during labor. This is because IV administration allows for a rapid onset of action and ensures that the medication reaches therapeutic levels in the mother's bloodstream during labor, reducing the risk of transmission to the infant. Giving ZDV to the infant following delivery or continuing it until 38 weeks gestation are not appropriate options in this scenario.

Afterbirth pains, also known as postpartum contractions, are the uterine contractions that occur after childbirth. These contractions help the uterus to shrink back to its pre-pregnancy size. Typically, afterbirth pains last for a few days to a couple of weeks. However, they are usually most intense during the first 2-3 days after delivery. Therefore, the correct answer is 2-3 days.

During pregnancy, it is important to manage chronic hypertension to ensure the health of both the mother and the baby. Methyldopa, also known as Aldomet, is considered the initial antihypertensive drug of choice for pregnant women with chronic hypertension. It has been extensively studied and proven to be safe and effective in controlling blood pressure during pregnancy. Methyldopa works by reducing the levels of certain chemicals in the brain that cause blood vessels to constrict, thereby lowering blood pressure. It is considered safe for use during pregnancy and is often recommended as the first-line treatment option.

Mitral stenosis is the most common maternal congenital cardiac lesion with a left to right shunt that is detected during pregnancy. This condition refers to the narrowing of the mitral valve, which separates the left atrium and the left ventricle of the heart. This narrowing restricts blood flow from the left atrium to the left ventricle, causing a buildup of pressure in the left atrium and leading to a left to right shunt. This condition can have implications for both the mother and the developing fetus during pregnancy.

If the woman's condyloma acuminata lesions are large enough to increase the risk of hemorrhage, cesarean delivery would be indicated. This is because during vaginal delivery, there is a higher chance of trauma to the lesions, leading to excessive bleeding. Therefore, a cesarean delivery would be a safer option to prevent complications associated with hemorrhage.

Sleep deprivation can predispose an epileptic woman to seizures during pregnancy. Lack of sufficient sleep can disrupt the normal functioning of the brain and increase the likelihood of seizures in individuals with epilepsy. Sleep deprivation can also lead to increased stress levels, which can further trigger seizures. It is important for epileptic women to prioritize adequate sleep during pregnancy to minimize the risk of seizures and ensure a healthy pregnancy.

Treating preterm labor patients with bed rest can lead to an increase in glucose intolerance. This means that the patient may have difficulty regulating their blood sugar levels, potentially leading to the development of diabetes. It is important to monitor blood sugar levels closely in these patients and take appropriate measures to manage their glucose levels to prevent any complications. However, there is no direct evidence to suggest that bed rest increases the risk of diabetes following pregnancy or excessive birth weight.

A velamentous cord insertion is a condition where the umbilical cord inserts into the fetal membranes rather than directly into the placenta. In this condition, the Wharton jelly, which is a gelatinous substance that surrounds and protects the blood vessels in the umbilical cord, is lacking. This can lead to increased vulnerability of the blood vessels, potentially causing complications such as compression or rupture of the vessels. Therefore, the characteristic of a velamentous cord insertion is a lack of Wharton jelly.

The internal fetal scalp electrode should be removed when the abdominal prep is complete. This is because the abdominal prep involves cleaning and sterilizing the surgical site, including the area where the electrode is inserted. Removing the electrode after the prep ensures that it is not contaminated and reduces the risk of infection during the cesarean birth.

The most important initial nursing action would be to raise and pad the side rails on the bed. This patient is exhibiting signs and symptoms of preeclampsia, a potentially life-threatening condition during pregnancy. The elevated blood pressure, edema, and proteinuria are all indicative of preeclampsia. The presence of clonus and hyperactive deep tendon reflexes further suggest severe preeclampsia. Raising and padding the side rails on the bed is essential to ensure the safety of the patient and prevent falls or injuries due to potential seizures or loss of consciousness associated with preeclampsia. Starting an IV and notifying the provider may be necessary subsequent actions, but the immediate priority is to ensure the patient's safety.

The LS ratio of 2.5 indicates mature fetal lungs, which is associated with a minimal risk for neonatal respiratory distress syndrome (RDS). RDS is a condition that occurs in premature infants due to immature lungs, resulting in difficulty breathing. In this case, the amniocentesis results suggest that the baby's lungs are mature enough to produce surfactant, a substance that helps keep the lungs inflated and functioning properly. Therefore, the risk for neonatal RDS is minimal.

Long-term inhaled corticosteroid therapy for asthma has been associated with an increased incidence of preeclampsia. Preeclampsia is a condition that occurs during pregnancy and is characterized by high blood pressure and damage to organs, such as the liver and kidneys. The exact mechanism by which inhaled corticosteroids contribute to preeclampsia is not fully understood, but it is believed to involve the suppression of the immune system and disruption of the normal balance of hormones during pregnancy. It is important for healthcare providers to consider this potential risk when prescribing corticosteroids to pregnant women with asthma.

During the bearing down phase of the second stage of labor, the nurse should not take any action to facilitate the stretching of the woman's perineum. This is because the perineum naturally stretches during this phase to allow for the baby's head to pass through the birth canal. Any intervention or manipulation by the nurse may increase the risk of perineal tearing or the need for an episiotomy. Therefore, it is best to allow the perineum to stretch on its own without any additional assistance.

The standard of care is based and derived from a legal and regulatory perspective because it is important to ensure that healthcare providers adhere to certain standards and guidelines set by the law and regulatory bodies. These standards are in place to protect patients and ensure that they receive safe and appropriate care. Legal and regulatory perspectives provide a framework for defining what is considered acceptable and appropriate in the healthcare industry, and help to establish accountability and responsibility for healthcare providers.

A midline episiotomy is a surgical incision made in the midline of the perineum during childbirth. Compared to a mediolateral episiotomy, which is made at an angle, a midline episiotomy is associated with less blood loss. This is because the incision is made in the direction of the natural fibers of the perineal muscles, causing less trauma and damage to blood vessels. Additionally, a midline episiotomy is easier to repair as it involves a straight incision that can be sutured more easily. However, it does not result in a more difficult delivery as it does not interfere with the baby's passage through the birth canal.

The brain is responsible for initiating newborn respiration because it sends signals to the respiratory muscles to contract and relax, allowing for the intake of oxygen. As the baby is born and the umbilical cord is clamped, there is a decrease in oxygen supply, which triggers the brain to stimulate the respiratory system. This leads to the first breath being taken by the newborn. The brain's role in initiating respiration is essential for the baby to transition from receiving oxygen through the placenta to breathing on its own.

During the first stage of labor, the pain primarily results from pressure on adjacent structures and nerves. As the baby moves down the birth canal, it puts pressure on the surrounding structures such as the cervix, bladder, and rectum. This pressure causes discomfort and pain. Additionally, the nerves in the pelvis and lower back are also affected, leading to further pain sensations. Fear of labor may contribute to the overall experience of pain, but it is not the primary cause in the first stage of labor. Upper uterine pain from contractions may be experienced in later stages of labor, but it is not the main source of pain in the first stage.

The correct answer is vascular changes. After delivering a baby, there is an increase in blood flow to the breasts, leading to engorgement. This increased blood flow is due to vascular changes in the breast tissue, which causes swelling and discomfort. The let down reflex is the release of milk from the breasts, and while it can contribute to engorgement, it is not the primary cause. Similarly, a reduction in oxytocin, a hormone that helps with milk production and release, may contribute to engorgement, but it is not the underlying cause.

The appropriate screening for gestational diabetes mellitus (GDM) in this case is "No need for testing." According to the American Diabetes Association, women with no risk factors for GDM, such as a family history of diabetes or pre-pregnancy obesity, do not require routine screening for GDM. Since the patient does not have a family history of diabetes and her height and weight are within normal range, there is no indication for testing at this time.

Assessment of the newborn gestational age should be done within 4 hours of birth because it allows healthcare professionals to evaluate the physical and developmental characteristics of the newborn, which can help determine the appropriate care and interventions needed. This timeframe allows for a more comprehensive assessment, including measurements, observations, and screenings, to accurately assess the gestational age and identify any potential health issues or complications that may require immediate attention.

Given that the woman is at 37 weeks gestation and has no risk factors or complications, any decrease in fetal movement should be taken seriously. Decreased fetal movement could indicate potential problems with the baby's well-being. Therefore, the woman should be instructed to come in for evaluation immediately to ensure the health and safety of both her and the baby.

Narcotic agonist-antagonists have a ceiling effect, meaning that once a certain dose is reached, additional doses will not have any additional effect on respiratory depression. This is because these drugs have a maximum effect that cannot be surpassed, even with higher doses. Therefore, increasing the dosage beyond a certain point will not lead to increased respiratory depression.

In a patient with placenta previa, where the placenta is covering the cervix, a cesarean birth is necessary. The nurse can anticipate that a low segment vertical incision will be made. This type of incision is commonly used in cases of placenta previa as it allows for better access to the lower segment of the uterus and minimizes the risk of bleeding from the placenta. It also reduces the risk of complications during the surgery and promotes better healing postoperatively.

The fetal attitude in the mother's pelvis refers to the position of the fetal parts in relation to each other. This includes the flexion or extension of the fetal head, the position of the limbs, and the overall posture of the fetus. It does not specifically refer to the fetal head position or the fetal position in relation to the maternal pelvic outlet.

The correct answer is "first few days". The American Academy of Pediatrics and the Centers for Disease Control recommend a Vitamin D supplement of 200IU for all breastfed infants within the first few days of birth. This is because breast milk may not provide enough Vitamin D, and infants need this nutrient for healthy growth and development.

Engrossment refers to the interactive process of the father with the newborn. It is a term used to describe the intense focus and absorption that a father experiences when bonding with his newborn child. During this period, the father becomes emotionally and mentally engrossed in the baby, developing a strong attachment and connection. This process involves active participation, nurturing, and the development of a deep sense of responsibility towards the child.

The most likely explanation for neurologic injury in a surviving twin after the intrauterine death of the co-twin is significant hypotension at the time of the demise. This is because the death of the co-twin can lead to a decrease in blood flow to the surviving twin, causing a drop in blood pressure. This decrease in blood pressure can result in inadequate oxygen and nutrient supply to the brain, leading to neurologic injury. Sepsis and lack of oxygen in attempt to repair the demised twin are not the most likely causes of neurologic injury in this scenario.

The presence of symptoms such as headache, elevated blood pressure, pitting edema, increased deep tendon reflexes (DTRs), and clonus indicate the possibility of preeclampsia, which is a serious condition during pregnancy. A dipstick protein level of 3+ further supports this diagnosis. Therefore, notifying the healthcare provider immediately is crucial to ensure prompt medical intervention and management of preeclampsia to prevent complications for both the mother and the baby. Starting an IV and raising and padding the side rails of the bed may be necessary actions, but they are not as urgent or important as notifying the provider.