Reproductive Health & Pregnancy
Which hormone surge directly triggers ovulation, and which hormone is detected by a pregnancy test?
The LH surge triggers ovulation. Pregnancy tests detect hCG.
A patient reports painful contractions every five minutes, but two cervical examinations show no change. What finding is needed to establish true labor?
Progressive cervical change, including dilation and/or effacement. Pain and contraction frequency alone do not establish true labor.
What is the difference between induction and augmentation of labor?
Induction starts labor that has not begun spontaneously. Augmentation strengthens labor that has already started. Oxytocin may be used for either.
What are the four Ts used to organize the causes of postpartum hemorrhage?
Tone, trauma, tissue, and thrombin.
What does an Apgar score tell us about a newborn, and what five things are we looking at?
It describes the newborn’s condition at the time of assessment. The five components are appearance, pulse, grimace, activity, and respirations—color, heart rate, reflex response, muscle tone, and breathing.
A 37-year-old patient who smokes and has migraines with aura requests combined oral contraceptives. What should the nurse recognize about this request?
Estrogen-containing contraception is contraindicated because of increased cardiovascular and stroke risk. The nurse should communicate the findings and support discussion of appropriate alternatives.
A contraction starts at 10:00 and ends at 10:01. The next contraction starts at 10:04. What are the contraction frequency and duration?
Frequency: every four minutes.
Duration: 60 seconds.
Frequency is measured from the beginning of one contraction to the beginning of the next.
Immediately after an amniotomy, what is the nurse’s priority assessment, and why?
Assess the fetal heart rate immediately. Rupture of membranes can allow cord prolapse or compression, producing an abrupt change in fetal status.
A postpartum patient has heavy bleeding and a boggy fundus displaced to the right. What should the nurse do, and what additional problem does the position suggest?
Initiate fundal massage, call for assistance, assess blood loss and maternal status, and address a likely distended bladder, which can interfere with uterine contraction.
Two newborns both weigh 2,500 grams. One was born at 35 weeks and the other at 40 weeks. Why should the nurse avoid interpreting their growth using birth weight alone?
Birth weight must be interpreted in relation to gestational age. The same weight can reflect different growth classifications and risks. Assess the complete picture, including measurements, maturity, feeding, and clinical findings.
A patient’s quad screen indicates an increased risk for a chromosomal condition. She asks, “Does this mean my baby definitely has it?” What is the nurse’s best response?
“This result shows an increased risk; it does not confirm a diagnosis. Further evaluation and diagnostic testing can provide more information.”
The fetal heart rate baseline is 140 beats/minute with moderate variability and accelerations. What do these findings suggest about current fetal status?
They are reassuring findings. Moderate variability and accelerations support adequate current fetal oxygenation and acid–base status.
A patient at 30 weeks is expected to give birth prematurely. Why might both betamethasone and magnesium sulfate be prescribed?
Betamethasone promotes fetal lung maturation. Magnesium sulfate may be used for fetal neuroprotection when early preterm birth is anticipated.
A patient with postpartum hemorrhage has chronic hypertension and asthma. Which two commonly used uterotonics require the nurse to question their use?
Methylergonovine because of hypertension, and carboprost because of asthma.
What are the purposes of the newborn’s vitamin K injection and erythromycin eye ointment?
Vitamin K helps prevent vitamin K deficiency bleeding. Erythromycin eye ointment helps prevent gonococcal ophthalmia neonatorum.
A patient at 30 weeks has painless, bright red vaginal bleeding. Placenta previa is suspected. Which assessment must the nurse avoid until placental location is established?
A digital vaginal examination, because it could disrupt the placenta and provoke severe hemorrhage. Assess maternal and fetal stability and promptly notify the obstetric team.
A patient receiving oxytocin has seven contractions in ten minutes, averaged over 30 minutes, with recurrent late decelerations. What uterine activity pattern is present, and what is the priority action?
Uterine tachysystole: more than five contractions in ten minutes, averaged over 30 minutes.
Stop the oxytocin infusion to address the excessive uterine stimulation, while initiating other indicated measures and notifying the team.
The fetal head delivers, but the shoulders do not follow. Which pressure is contraindicated, and which two maneuvers should the nurse anticipate assisting with?
Fundal pressure is contraindicated. Anticipate McRoberts maneuver and suprapubic pressure, with immediate assistance from the team. Fundal pressure can worsen the impaction.
Nine days after cesarean birth, a patient has fever, uterine tenderness, foul-smelling lochia, heart rate 116, and respirations 24. What infection is most concerning, and why is prompt escalation needed?
Endometritis is strongly suspected. Fever with tachycardia and tachypnea raises concern for systemic infection and possible sepsis, requiring prompt assessment and escalation even before hypotension develops.
A newborn has a respiratory rate of 68 with grunting, nasal flaring, and blue lips and tongue. Are these expected transitional findings, and what should the nurse prioritize?
No. These findings indicate respiratory distress with central cyanosis. Immediately assess and support breathing and oxygenation, obtain appropriate monitoring, and summon neonatal assistance.
A pregnant patient tests positive for syphilis and reports a documented penicillin allergy. She asks whether treatment can wait until after delivery. What treatment approach should the nurse anticipate?
Penicillin desensitization followed by penicillin treatment through the appropriate clinical team. Treatment should not be delayed; maternal infection threatens the fetus even when the mother feels well.
Ten minutes after an epidural, the patient’s blood pressure falls to 78/40 and recurrent late decelerations appear. What is the likely connection, and what should the nurse do immediately?
Epidural-related maternal hypotension can reduce uteroplacental perfusion. Reposition laterally, increase IV fluids as appropriate, and promptly notify anesthesia and the obstetric team. Anticipate a prescribed vasopressor and reassess maternal and fetal response.
Immediately after membrane rupture, the fetal heart rate drops and the nurse feels an umbilical cord below the presenting part. What immediate action relieves the cause of fetal compromise?
Manually elevate the presenting part off the cord while calling for immediate help. Maintain elevation until relieved by the team or delivery, position to reduce compression, and prepare for urgent birth.
A postpartum patient reports hearing a voice telling her to hurt her baby. What is the nurse’s priority response?
Treat this as a psychiatric emergency. Protect the patient and infant, remain with the patient, ensure the infant is supervised by another responsible caregiver, and activate urgent psychiatric/emergency evaluation.
Before discharge, a parent says, “I’ll let the baby sleep in the car seat, and I’ll add extra water to the formula so it lasts longer.” What should the nurse do before discharge proceeds?
Correct both unsafe practices and use teach-back or return demonstration to verify understanding: