Obstetrics Case Studies

Instructions All questions apply to this case study. Your responses should be brief and to the point.
When asked to provide several answers, list them in order of priority or significance. Do not assume
information that is not provided.
Scenario 1 P.M. comes to the obstetric (OB) clinic because she has missed two menstrual periods and
thinks she might be pregnant. She states she is nauseated, especially in the morning, so she completed a
home pregnancy test and it was positive. As the intake nurse in the clinic, you are responsible for
gathering information before she sees the physician.
1. What are the two most important questions to ask to determine possible pregnancy?
2. You ask whether she has ever been pregnant, and she tells you she has never been pregnant.
How would you record this information?
3. What additional information would be needed to complete the TPAL record?
4. It is important to complete the intake interview. What categories will you address with P.M.?
Chart Review
Vital signs
Blood pressure 116/74 mm Hg
Heart rate 88 beats/min
Respiratory rate 16 breaths/min
Temperature 98.9° F (37.2° C)
5. Do any of these vital signs cause concern? What should you do?
6. P.M. tells you that the date of her last menstrual period (LMP) was February 2. How would you
calculate her due date? What is her due date?
7. What is the significance of a gynecoid pelvis?
8. What specimens are important to obtain when the pelvic examination is done?
9. A psychological assessment is done to determine P.M.’s feelings and attitudes regarding her
pregnancy. How do attitudes, beliefs, and feelings affect pregnancy?
10. P.M. asks you whether there are any foods she should avoid while pregnant. She lists some of
her favorite foods. Which foods, if any, should she avoid eating while she is pregnant? (Select all
that apply.)
a. Hot dogs
b. Sushi
c. Yogurt
d. Deli meat
e. Cheddar cheese
11. As the nurse, you know what assessment and teaching are vital in the prenatal period to ensure
a positive outcome. What information is important to include at every visit and at specific times
during the pregnancy?
12. After her examination, P.M. states that she is worried because her sister had an ectopic
pregnancy and had to have surgery. She asks you, “What are the signs of an ectopic pregnancy?”
Which of these are correct? (Select all that apply.)
a. Fullness and tenderness in her abdomen, near ovaries
b. Pain, either unilateral, bilateral, or diffuse over the abdomen
c. Nausea
d. Dark red or brown vaginal bleeding
e. Increased fatigue
13. P.M. asks the nurse about what should be reported to her doctor. List at least six of the “danger
signs of pregnancy.”
14. Changes in the body caused by pregnancy include relaxation of joints, alteration to center of
gravity, faintness, and discomforts. These changes can lead to problems with coordination and
balance. In teaching P.M. about safety during pregnancy, what will you include in your teaching?
15. P.M. asks, “Is a vaginal exam done every visit?” What is your response? Explain your answer.
Scenario 2 You are the charge nurse working in labor and delivery at a local hospital. D.H. comes to the
unit having contractions and feeling somewhat uncomfortable. You take her to the intake room to
provide privacy, have her change into a gown, and ask her three initial questions to determine your next
course of action, this, whether to do a vaginal exam or to continue asking her more question.
1. What three initial questions will you ask, and why?

2. D.H. has contractions 2 to 3 minutes apart and lasting 45 seconds. It is her third pregnancy
(gravida 3, para 2002). Her bag of waters is intact at this time. She states that her due date is 2
days away. You determine that it is appropriate to ask for further questions before a vaginal
exam is done. What information do you need?
3. What assessment should you make to gain further information from D.H.?
4. Upon examination, D.H. is 80% effaced and 4 cm dilated. The fetal heart rate (FHR) is 150
beats/min and regular. She is admitted to a labor and delivery room on the unit. What nursing
measures should be done at this time?
5. List the stages of labor. D.H. is in what stage of labor?
6. D.H. states that she is feeling discomfort and asks you whether there is alternative therapy
available before taking medication. List at least four alternative methods to assist D.H. with
controlling her discomfort.
7. As you assess both the mother and the fetus during the active stage of labor, you will look for
abnormalities. Which of these are potential abnormalities during labor? (Select all that apply.)
a. Unusual bleeding
b. Brown or greenish amniotic fluid
c. Contractions that last 40 to 70 seconds
d. Sudden, severe pain
e. Increased maternal fatigue
8. Put these actions in order of priority:
___a. Discontinue the oxytocin infusion.
___b. Turn D.H. onto her left side and elevate her legs.
___c. Increase the rate of the maintenance IV fluids.
___d. Administer oxygen at 8-10 L/min by facemask.
9. Decelerations occur in an early, variable, or late pattern. What is the significance of these
patterns? State what the nurse should do for each type.
10. As you monitor D.H., you observe for prolapse of the umbilical cord. Describe what this is and
what can happen to the fetus if this occurs.
11. What would be done if you noted that D.H. had a prolapsed cord?
12. What is involved in the immediate care of the newborn?
Scenario 3 T.N. delivered a health male infant 2 hours ago. She had a midline episiotomy. This is her
sixth pregnancy. Before this delivery, she was para 4014. She had an epidural block for her labor and
delivery. She is now admitted to the postpartum unit.
1. What is important to note in the initial assessment?
2. You find a boggy fundus during your assessment. What corrective measures can be instituted?
3. The patient complains of pain and discomfort in her perineal area. How will you respond?
4. The nurse reviews the hospital security guidelines with T.N. The nurse points out that her baby
has a special identification bracelet that matches a bracelet worn by T.N. and reviews other
security procedures. Which statement by T.N. indicates a need for more teaching?
a. “If I have a question about someone’s identity, I can ask about it.”
b. “If someone comes to take my baby for an exam, that person will usually carry my baby to
the exam room.”
c. “Nurses on this unit all wear the same purple uniforms.”
d. “Each staff member who takes my baby somewhere should have a picture identification
badge.”
5. An hour after admission, you recheck T.N.’s perineal pad and find that there is a very small
amount of drainage on the pad. What will you do next?
a. Ask T.N. to change her perineal pad.
b. Check her perineal pad again in 1 hour.
c. Check the pad underneath T.N.’s buttocks.
d. Document the findings in T.N.’s medical record.
6. That evening, the NAP assesses T.N.’s vital signs. Which vital signs would be of concern at this
time?
Chart Review
Vital signs
Temperature 99.9° F (37.7° C) oral
Pulse rate 120 beats/min
Blood pressure 100/50 mm Hg
Respiratory rate 16 breaths/min

7. What will you do next?
8. T.N.’s condition is stable and you prepare to provide patient teaching. What patient teaching is
vital after delivery?
9. T.N. tells you she must go back to work in 6 weeks and is not sure she can continue
breastfeeding. What options are available to her?

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Instructions All questions apply to this case study. Your responses should be brief and to the point.

1. What three initial questions will you ask, and why?

1. What is important to note in the initial assessment?

c. “Nurses on this unit all wear the same purple uniforms.”

a. Ask T.N. to change her perineal pad.

b. Check her perineal pad again in 1 hour.

c. Check the pad underneath T.N.’s buttocks.

d. Document the findings in T.N.’s medical record.

Temperature 99.9° F (37.7° C) oral

Pulse rate 120 beats/min

Blood pressure 100/50 mm Hg

Respiratory rate 16 breaths/min

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