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OB Escape Room

Terms in this set (25)

A couple arrives at their appointment with the OB/GYN provider to discuss their difficulties trying to conceive. The first task for the nurse is to

1. draw bloodwork
2. perform an ultrasound
3. obtain a medical history
4. calculate her LMP
obtain a medical history

Investigation for infertility is done from least invasive to most invasive. A medical history is the starting point for both the patient and their partner.
The nurse notes that the couple has been trying to conceive for nine months. Infertility can be diagnosed

1. at three months for clients who are AMA
2. at one year for clients who are below 35 years of age
3. after labwork confirms abnormal FSH
4. after ultrasound confirms uterine abnormalities
at one year for clients who are below 35 years of age

Infertility is diagnosed at six months for patient's over 35 years of age (AMA) or one year for under 35.
The nurse notes that the patient has a history of endometriosis and is taking NSAIDs. What is the purpose of the NSAID?

1. to stimulate ovulation
2. to stimulate shedding of endometrial tissue
3. reduce pain associated with intercourse
4. reduce inflammation
reduce inflammation

NSAIDs are the first line of treatment for endometriosis, which is the inflammation of endometrial tissue outside of the uterus, which is painful. NSAIDs reduce inflammation, which will reduce pain.
During the thorough history, the nurse identifies that the couple has a relevant genetic history. The father is a carrier for phenylketonuria (PKU), an inherited disorder that lacks the enzyme to break down phenylalanine in the body. PKU disease is a

1. sex-linked genetic disorder
2. autosomal dominant genetic disorder
3. trisomy genetic disorder
4. autosomal recessive genetic disorder
autosomal recessive genetic disorder

The patient's partner is a carrier for PKU. Carriers are associated with autosomal recessive genetic disorders, as it takes two affected genes for the person to express the disorder.
If the mother is not a carrier for PKU, the risk of their baby having the PKU disease is

1. 0%
2. 25%
3. 50%
4. 100%
0%

If the partner is a carrier for PKU (Pp) and the patient is not (PP), when you cross those (Punnet Square) you end up with the following: PP, PP, Pp, Pp. 0% will have the disease, 50% carriers.
P = dominant trait (no PKU)
p = PKU trait
The nurse explains to the parents that routine testing is done on all newborns to test for common genetic disorders, called the newborn screen. This is an example of

1. single-gene testing
2. pharmacogenetics
3. population-based testing
4. genomics
population-based testing

Population-based screenings are done for asymptomatic individuals regardless of their risk. Newborn screenings are done on all babies at birth for early identification and treatment before onset of symptoms.
The father expresses concern that his sister's baby is diagnosed with Down syndrome (Ds) and asks what symptoms the baby would show at birth. How would the nurse respond to his question? Select all that apply.

1. poor muscle tone
2. cognitive impairment
3. poor feeding
4. abnormal facial features
poor muscle tone
poor feeding
abnormal facial features

Down syndrome is a trisomy genetic disorder. The phenotype is characterized by low-set ears, epicanthal folds, fissured and protruded tongue, and intellectual disability (among others). At birth, cognitive disability will not be able to be assessed, therefore other indications such as poor/uncoordinated feeding, poor muscle tone, and these facial features are indications of the disorder.
The couple is able to conceive after two rounds of Clomid. At the initial prenatal visit, the nurse is explaining testing options. Which of the following are available in the first trimester? Select all that apply.

1. cell-free DNA
2. MSAFP
3. Amniocentesis
4. nuchal translucency
cell-free DNA
nuchal translucency

Cell-free DNA is offered between 10-12 weeks and nuchal translucency is offered between 10-14 weeks. Amniocentesis and MSAFP are not done until the second trimester.
After reviewing the patient's history, the nurse is concerned about the high level of stress the patient is experiencing through work and family dynamics. This is an example of what type of risk factor?

1. Biophysical
2. Psychosocial
3. Sociodemographic
4. Environmental
Psychosocial

Personal relationships and stress are considered psychosocial risk factors
At 28 weeks, the nurse explains how to perform fetal kick counts. Which of the following indicates that the patient understands the procedure?

1. "I will count each movement for one hour."
2. "Only sharp jabs count as a kick."
3. "If there's less than 10 kicks every hour, I need to call the doctor."
4. "I won't eat or drink anything because that could alter the results."
"I will count each movement for one hour."

Fetal kick counts should be done at least once a day, feeling for any movement (kicks, jabs, rolls) and counting each as one kick. The patient should eat and drink prior and be in a comfortable resting position. If the patient feels less than 3 kicks in one hour, the provider should be notified for further investigation.
The patient is diagnosed with preeclampsia at 34 weeks. The provider instructs the patient to come in for a routine non-stress test. What will the nurse look for?

1. a score of 8/8
2. one acceleration in 20 minutes
3. two accelerations that are 10x10
4. two accelerations that are 15x15
two accelerations that are 15x15

A reactive non-stress test for a fetus greater than 32 weeks includes two accelerations at least 15 seconds long and 15 beats above baseline in 20 minutes.
At 35 weeks, the provider wants to induce labor due worsening preeclampsia. Which assessment can be used to ensure adequate fetal lung maturity?

1. chorionic villus sampling (CVS)
2. amniocentesis
3. MSAFP
4. ultrasound
amniocentesis

The only assessment than can be performed to test for lung maturity is the amniocentesis. This is done in the third trimester. The amniotic fluid contains lecithin and sphingomyelin, surfactants that increase fetal lung compliance. This assessment is identifying the ratio between the two to ensure adequacy for the fetus at birth to support their own breathing.
Which of the following is NOT a common risk factor for both CVS and amniocentesis?

1. infection
2. Rh sensitization
3. leaking of amniotic fluid
4. Miscarriage
leaking of amniotic fluid

CVS and amniocentesis share many of the same associated risks/complications from the procedure. However, the amniocentesis is the only one that interferes with the amniotic fluid and membranes.
The provider is deciding which method to use to induce labor. Which of the following will provide the best information?

1. ultrasound
2. gestational age
3. Bishop score
4. fetal heart rate
Bishop score

Method of induction is largely based upon the Bishop score, which rates the cervical exam for readiness and success for vaginal delivery. Scores below 8 require pre-induction, or cervical ripening.
The patient's cervical exam is 1cm, 25% effaced, -3 station, medium consistency, and midposition. Calculate the Bishop score.

1. 2
2. 3
3. 5
4. 6
3

The Bishop's score is 3. 1cm = 1 point, 25% effaced = 0 points, -3 station = 0 points, medium consistency = 1 point, and midposition = 1 point.
Based on the patient's Bishop score, which of the following would be the best option for induction?

1. misoprostil (Cytotec)
2. AROM
3. oxytocin (Pitocin)
4. C/section
misoprostil (Cytotec)

Since the Bishop's score is 3, cervical ripening is required prior to oxytocin (Pitocin). Misoprostil (Cytotec) is a prostaglandin that is used for cervical ripening.
The provider chooses to use the cervical ripening balloon (CRB) for induction. How does this method work?

1. prostaglandin softens the cervix
2. increases uterine contractions
3. mechanically dilates the cervix
4. breaks the amniotic sac
mechanically dilates the cervix

The cervical ripening balloon (CRB) is a mechanical method of inducing labor. The catheter is inserted into the vaginal canal, through the cervix. Balloons are inflated with sterile water, which puts pressure on the cervix from above and below.
The nurse is preparing to begin the oxytocin (Pitocin) infusion. The nurse knows best practice includes which of the following?

1. titrating per gtt/gravity
2. intermittent fetal monitoring
3. IV piggyback into distal port
4. two RN verification
two RN verification

Oxytocin (Pitocin) is a high-alert medication that requires two-RN verification, due to the potential for harm. This medication should only be used via an IV pump, piggybacked into the most proximal port to the patient, and continuous fetal monitoring.
As the induction progresses, the patient begins to experience lower abdominal cramping. Which of the following is an example of gate-control theory?

1. massage
2. imagery
3. focal point
4. breathing techniques
massage

Gate-control theory is the idea that there are limited sensory pathways for impulses to travel. Pain can be limited by replacing some of those pathways with positive sensations, such as massage. The others are distraction techniques.
Despite the patient being induced with oxytocin (Pitocin), the nurse wishes to promote comfort through non-pharmacological measures. Which of the following is most appropriate?

1. ambulation with intermittent monitoring
2. hydrotherapy with doppler auscultation
3. birthing ball at the bedside with continuous monitoring
4. epidural block with continuous monitoring
birthing ball at the bedside with continuous monitoring

Using the birthing ball at bedside with continuous monitoring is the best option due to the Pitocin infusion. The birthing ball allows for movement during the contraction and widens the pelvis, allowing the fetus to descend. It also helps to relieve pressure as opposed to sitting in a hard chair or bed. An epidural is a pharmacological method.
The patient requests IV pain medication. Which of the following would NOT be a consideration prior to administration?

1. FHR characteristics
2. history of opioid use
3. frequency of contractions
4. cervical exam
frequency of contractions

Before administering IV pain medication, it is important to consider the patient's history, cervical exam, and FHR characteristics. Nubain should not be administered if the patient has a history of opioid-use disorder, advanced cervical dilation (delivery within 4 hours), or abnormal FHR tracing.
After nalbuphine (Nubain) administration, the nurse reviews the FHR tracing. Which of the following would the nurse most likely observe?

1. decreased variability
2. increased variability
3. variables
4. Tachycardia
decreased variability

Opioids cross the placenta and affect the CNS system of the fetus. This will appear as decreased, or minimal, variability.
Two hours after administration of Nubain, the patient requests an epidural. The nurse understands that the epidural

1. will cause immediate numbness.
2. is performed by injecting medication into the CSF.
3. allows the patient to ambulate as desired.
4. requires an IV fluid bolus prior to administration.
requires an IV fluid bolus prior to administration.

An epidural requires 500-1000mL IV fluid bolus prior to administration. This is due to the widespread vasodilation of the blood vessels and is done as a preventative measure. Medication is administered into the epidural space, which is just outside the dura surrounding the CSF fluid. A spinal block punctures the dura and injects medication into the CSF fluid.
After the epidural, the nurse takes frequent blood pressure readings and notes the patient's BP has dropped to 90/60. Why has this happened?

1. vasodilation of blood vessels
2. decreased pain
3. increased fluid volume
4. increased pulse rate
vasodilation of blood vessels

The vasodilation of blood vessels reduces blood return to the heart, thereby causing hypotension.
The patient progresses quickly and delivers a healthy baby vaginally. Unfortunately, the epidural did not help the perineal pain during delivery and the patient is in need of a repair for a second degree laceration. Which is the best option for pain control at this time?

1. pudendal block
2. lidocaine
3. nitrous oxide
4. general anesthesia
lidocaine

Lidocaine is the best option for a perineal repair, as it is a local anesthetic and does not affect the patient systemically.
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