Obstetrics Review Questions

1. Obstetrics Review Questions Ana H. Corona, MSN, FNP-C Nursing Instructor November 2007 Study Guide Zone 2007; Examcram2 NCLEX RN-PN 2007

2. Q1 • Gerry C. and her roommate, Anne B., each delivered a child two days ago. Gerry is breast-feeding; Anne is using formula. Which of the following instructions can the nurse give to both mothers? • A) Apply warm compresses to breast if too full. • B) Do not apply any soap to your nipples. • C) Wear a good, well-supporting bra. • D) Apply cold compresses to breast if too full.

3. A1 • The correct answer is C. A well-fitting, supportive bra with wide straps can be recommended for both the nursing and the nonnursing mother, for the support of the breasts and for comfort. The nursing mother's bra should have front flaps over each breast for easy access during nursing periods.

4. Q2 • Which of the following is NOT one of the four stages of labor and delivery?A: onset of labor through complete dilation of the cervixB: cervical dilation through the delivery of the placentaC: placenta delivery through complete stabilization of the motherD: birth through the delivery of the placenta

5. Answer 2 • B. The correct answer combines two of the four stages of labor and delivery.

6. Q3 • Which of the following is not scored with the APGAR? • 02 Stats • Heart Rate • Color • Tone

7. Answer 3 • A. The right answer was 02 Stats.

8. Q4 • Ms. S. delivers a 6 lb 4 oz (2835 g) baby boy. Which of the following statements would indicate to the nurse that the mother has begun to integrate her new baby into the family structure? • A) My parents wanted a granddaughter. • B) When he yawns, he looks just like his brother. • C) I wish he had curly hair like my husband. • D) All this baby does is cry. He's not like my other child.

9. A4 • The correct answer is B. Family identification of the newborn is an important part of attachment. The first step in identification is defined in terms of likeness to family members. By saying "All this baby does is cry. He's not like my other child," the mother is emphasizing a negative characteristic of the baby and comparing him unfavorably to her other child. By saying "I wish he had curly hair like my husband," the mother is wishing that he had curly hair like her husband; she is not looking at a positive characteristic of the baby that will fit in with the family. By saying "My parents wanted a granddaughter," the mother is thinking that the baby should have been a girl instead of a boy.

10. Q5 • If a newborn exhibits a heart rate of 80 bpm the APGAR score should be? • 0 • 1 • 2 • 3

11. Answer 5 • B. The right answer was 1.

12. Q6 • If a newborn exhibits blue extremities and the body is pink the APGAR score should be? • 0 • 1 • 2 • 3

13. Answer 6 • B. The right answer was 1.

14. Q7 • The licensed vocational nurse may not assume the primary care for a client: • In the fourth stage of labor • Two days post-appendectomy • With a venous access device • With bipolar disorder

15. A7 • Answer C is correct. The licensed vocational nurse may not assume primary care of the client with a central venous access device. The licensed vocational nurse may care for the client in labor, the client post-operative client, and the client with bipolar disorder; therefore, answers A, B, and D are incorrect.

16. Q8 • The 5-minute Apgar of a baby delivered by C-section is recorded as 9. The most likely reason for this score is: • The mottled appearance of the trunk • The presence of conjunctival hemorrhages • Cyanosis of the hands and feet • Respiratory rate of 20–28 per minute

17. A8 • Answer C is correct. Although cyanosis of the hands and feet is common in the newborn, it accounts for an Apgar score of less than 10. Answer B suggests cooling, which is not scored by the Apgar. Answer B is incorrect because conjunctival hemorrhages are not associated with the Apgar. Answer D is incorrect because it is within normal range as measured by the Apgar.

18. Q9 • The LPN is preparing to administer an injection of vitamin K to the newborn. The nurse should administer the injection in the: • Rectus femoris muscle • Vastus lateralis muscle • Deltoid muscle • Dorsogluteal muscle

19. A9 • Answer B is correct. The nurse should administer the injection in the vastus lateralis muscle. Answers A and C are not as well developed in the newborn; therefore, they are incorrect. Answer D is incorrect because the dorsogluteal muscle is not used for IM injections until the child is 3 years of age.

20. Q10 • A newborn weighed 7 pounds at birth. At 6 months of age, the infant could be expected to weigh: • 14 pounds • 18 pounds • 25 pounds • 30 pounds

21. A10 • Answer A is correct. The infant’s birth weight should double by 6 months of age. Answers B, C, and D are incorrect because they are greater than the expected weight gain by 6 months of age.

22. Q11 • Assessment of a newborn male reveals that the infant has hypospadias. The nurse knows that: • The infant should not be circumcised. • Surgical correction will be done by 6 months of age. • Surgical correction is delayed until 6 years of age. • The infant should be circumcised to facilitate voiding.

23. A11 • Answer A is correct. The infant with hypospadias should not be circumcised because the foreskin is used in reconstruction. Answer B and C are incorrect because reconstruction is done between 16 and 18 months of age, before toilet training. Answer D is incorrect because the infant with hypospadias should not be circumcised.

24. Q12 • When performing a newborn assessment, the nurse measures the circumference of the neonate's head and chest. Which assessment finding is expected in the normal newborn? • The head and chest circumference are the same. • The head is 2cm larger than the chest. • The head is 3cm smaller than the chest. • The head is 4cm larger than the chest.

25. A12 • Answer B is correct. The head circumference of the normal newborn is approximately 33cm, while the chest circumference is 31cm. Answer A is incorrect because the head and chest are not the same circumference. Answer C is incorrect because the head is larger in circumference than the chest. Answer D is incorrect because the difference in head circumference and chest circumference is too great.

26. Q13 • A newborn male has been diagnosed with hypospadias with chordee. The nurse understands that the infant will have altered patterns of urination because: • The urinary meatus is on the dorsum of the penis. • The ureters will reflux urine into the kidneys. • The urinary meatus is on the top of the penis. • The bladder lies outside the abdominal cavity

27. A13 • Answer A is correct. The infant with hypospadias has altered patterns of urinary elimination caused by the location of the urinary meatus on the dorsum, or underside, of the penis. Answer B is incorrect because it refers to ureteral reflux. Answer C is incorrect because it refers to epispadias. Answer D is incorrect because it refers to exstrophy of the bladder.

28. Q14 • The physician has ordered an external monitor for a laboring client. If the fetus is in the left occipital posterior (LOP) position, the nurse knows that the ultrasound transducer will be located: • Near the symphysis pubis • Near the umbilicus • Over the fetal back • Over the fetal abdomen

29. A14 • Answer C is correct. In the left occipital posterior position, the heart sounds will be heard loudest through the fetal back. Answers A, B, and D are incorrect locations.

30. 15 • The nurse is caring for a 7 lb 9 oz infant born 24-hours ago by cesarean section due to maternal herpes simplex virus. It would be MOST important for the nurse to take which of the following actions? • Wear gloves when caring for the infant. • Administer immune globulin. • Place the infant in isolation. • Encourage the mother to bottle feed the infant.

31. 15 • A. • Explanation of Answer:The nurse should also inspect the eyes, mouth, and skin for lesions.

32. 16 • Which of the following observations of a 8 lb 4 oz newborn boy, if made by the nurse, would require an intervention? • The infant’s respirations are 36, shallow and irregular in rate, rhythm, and depth. • The infant’s axillary temperature is 96.2° F (35.6° C). • Rapid pulsations are visible in the fifth intercostal space, left midclavicular line. • There is asynchronous spontaneous movement of the infant’s extremities.

33. 16 • B. • Explanation of Answer:This subnormal temperature indicates prematurity, infection, low environment temperature, inadequate clothing, and/or dehydration

34. 17 • The nurse on postpartum is preparing four patients for discharge. It would be MOST important for the nurse to refer which of the following patients for home care? • A 15-year-old primapara who delivered a7 lb male 2 days ago. • An 18-year-old multipara who delivered a 9 lb female by cesarean section 2 days ago. • A 20-year-old multipara who delivered 1 day and is complaining of cramping. • A 22-year-old who delivered by cesarean section and is complaining of burning on urination.

35. 17 • D. • Explanation of Answer:This indicates urinary tract infection and requires a follow-up.

36. 18 • A new mother has some questions about (PKU). Which of the following statements made by a nurse is not correct regarding PKU? A: A Guthrie test can check the necessary lab values. B: The urine has a high concentration of phenylpyruvic acid C: Mental deficits are often present with PKU. D: The effects of PKU are reversible.

37. 18 • (D) The effects of PKU stay with the infant throughout their life.

38. 19 • A nurse is caring for an infant that has recently been diagnosed with a congenital heart defect. Which of the following clinical signs would most likely be present? A: Slow pulse rate B: Weight gain C: Decreased systolic pressure D: Irregular WBC lab values

39. 19 • (B) Weight gain is associated with CHF and congenital heart deficits

40. 20 • A mother has recently been informed that her child has Down’s syndrome.  You will be assigned to care for the child at shift change.  Which of the following characteristics is not associated with Down’s syndrome? A:  Simian crease B:  Brachycephaly C:  Oily skin D:  Hypotonicity

41. 20 • (C) The skin would be dry and not oily.

42. 21 • THE NURSE IS TEACHING BASIC INFANT CARE TO A GROUP OF FIRST-TIME PARENTS. THE NURSE SHOULD EXPLAIN THAT A SPONGE BATH IS RECOMMENDED FOR THE FIRST 2 WEEKS OF LIFE BECAUSE: • NEW PARENTS NEED TIME TO LEARN HOW TO HOLD THE BABY. • THE UMBILICAL CORD NEEDS TIME TO SEPARATE. • NEWBORN SKIN IS EASILY TRAUMATIZED BY WASHING. • THE CHANCE OF CHILLING THE BABY OUTWEIGHS THE BENEFITS OF BATHING.

43. 21 • Answer B is correct. The umbilical cord needs time to dry and fall off before putting the infant in the tub. Although answers A, C, and D might be important, they are not the primary answer to the question.

44. 22 • WHEN THE NURSE CHECKS THE FUNDUS OF A CLIENT ON THE FIRST POSTPARTUM DAY, SHE NOTES THAT THE FUNDUS IS FIRM, IS AT THE LEVEL OF THE UMBILICUS, AND IS DISPLACED TO THE RIGHT. THE NEXT ACTION THE NURSE SHOULD TAKE IS TO: • CHECK THE CLIENT FOR BLADDER DISTENTION • ASSESS THE BLOOD PRESSURE FOR HYPOTENSION • DETERMINE WHETHER AN OXYTOCIC DRUG WAS GIVEN • CHECK FOR THE EXPULSION OF SMALL CLOTS

45. 22 • Answer A is correct. If the fundus of the client is displaced to the side, this might indicate a full bladder. The next action by the nurse should be to check for bladder distention and catheterize, if necessary. The answers in B, C, and D are actions that relate to postpartal hemorrhage.

46. 23 • A CLIENT IS ADMITTED TO THE LABOR AND DELIVERY UNIT IN ACTIVE LABOR. DURING EXAMINATION, THE NURSE NOTES A PAPULAR LESION ON THE PERINEUM. WHICH INITIAL ACTION IS MOST APPROPRIATE? • DOCUMENT THE FINDING • REPORT THE FINDING TO THE DOCTOR • PREPARE THE CLIENT FOR A C-SECTION • CONTINUE PRIMARY CARE AS PRESCRIBED

47. 23 • Answer B is correct. Any lesion should be reported to the doctor. This can indicate a herpes lesion. Clients with open lesions related to herpes are delivered by Cesarean section because there is a possibility of transmission of the infection to the fetus with direct contact to lesions. It is not enough to document the finding, so answer A is incorrect. The physician must make the decision to perform a C-section, making answer C incorrect. It is not enough to continue primary care, so answer D is incorrect.

48. Q24 • On the second day postpartum, the nurse asks the new mother to describe her vaginal bleeding. The nurse should expect her to say that it is • A) red with clots. • B) thin and white. • C) red and moderate. • D) scant and brown.

49. A24 • The correct answer is C. Lochia rubra is moderate red discharge, present for the first 2-3 days postpartum. Multiple clots are a sign of lack of tone in the uterine musculature. Scant, brown discharge (lochia serosa) would be present 7-10 days after delivery. Thin, white discharge (lochia alba) begins around the tenth day and ends about three weeks following delivery.

50. Q25 • During delivery, a mediolateral episiotomy is performed and Ms. L. delivers a 7 lb 8 oz girl. To detect postpartum complications in Ms. L. as soon as possible, the nurse should be particularly alert for all of the following except • A) ecchymosis and edema of the perineum. • B) a foul lochial odor. • C) separation of the episiotomy wound edges. • D) discomfort while sitting.