NURS 3550 / NURS3550 OB Exam 1 & 2 QUESTIONS EXAM 1 1. A client is 24 weeks pregnant. The nurse notes on the prenatal record that the patients BP was
... [Show More] 120/70 before pregnancy. Today the patients BP is 110/62. The nurse should take which of the following actions? a. 2. A multigravida who is O negative will have which routine screening tests to determine if Rh sensitization has occurred? a. 3. A pregnant woman is married to an intravenous drug user. She had a negative HIV screening test just after missing her first menstrual period. What would indicate that the patient needs to be retested if occurring later in pregnancy? a. 4. A couple are both known to be carriers of the autosomal recessive disorder cystic fibrosis. They are unaffected, but their 2-year-old daughter has the condition. They are planning a second pregnancy and would like to understand their chances of a second child being affected. Which of the following responses by the nurse is accurate? a. 5. After an early ultrasound, a woman and her spouse learn they are having twins. Which statements by the nurse are correct and could be included in the teaching plan? SATA a. b. Identical twins usually have a common placenta, and may have one chorion and two amnions c. 6. A woman is 34 weeks pregnant. When she comes for an early morning clinic visit, she mentions that she only had time for a doughnut and juice for breakfast this morning. Results of her urine specimen show a small amount of glucose (1+ by dipstick) present. This most likely indicates: a. A decreased renal threshold for glucose due to the normal changes of pregnancy. 7. A woman is being treated for pre-eclampsia with magnesium sulfate. The nurse is concerned that the pt is in early drug toxicity. What assessment finding by the nurse indicates early magnesium sulfate toxicity? a. 8. A new OB pt reports that her last normal menses started August 16th and ended August 21st. which of the following is her EDC, according to Nagele’s Rule? a. rd 9. A new pt is having her first prenatal visit and wants to continue with her vegan diet. The nurse would advise the patient that: a. 10. An HIV client presents to clinic for prenatal care. The nurse knows that the recommended medication for the prevention of HIV perinatal (vertical) transmission is: a. 11. Which is true about human reproduction? a. 12. Which of the following is true regarding fetal circulation? SATA a. b. c. Fetal circulation delivers high oxygen concentrations to the head, neck, brain and heart d. The umbilical vein carries oxygenated blood from the placenta to fetal circulation 13. Folic acid supplements are recommended for women of childbearing age. The addition of folic acid to the diet may have prevented which of the following circumstances? a. 14. An essential part of discharge teaching for a pt who had a molar pregnancy (gestational trophoblastic neoplasm) includes that the pt should: a. 15. Males are more often affected by X-linked recessive disorders because: a. 16. A 22-year-old primigravida is 10 weeks pregnant. She has had nausea periodically throughout the day for the past few weeks. What is the most common primary cause of this complication? a. 17. Noelle O’Malley is a 40-year-old G5P4 who presents to the office for a regular prenatal visit. Her midwife recommends a flu vaccine and Ms. O’Malley agrees and signs a consent form. The order reads “Give 45 mcg influenza vaccine IM times one”. The nurse has on hand a 10 ml multi dose vial with 90mcg per 0.5 mL. how many milliliters will the nurse draw into the syringe? a. 18. A woman is 6 weeks pregnant. She has had cramping, backache, and bleeding for the past three days. Her cervix is now dilating. She is crying and says to the nurse: “Is my baby going to be Ok?”. In consoling the woman, the nurse does understand that the pt is now experiencing: a. 19. The nurse is preparing to give discharge teaching to a pt who just had an spontaneous abortion followed by a D&C (dilation & curettage). The nurse knows the priority teaching includes? a. 20. A pt is concerned that she has been taking medication in the first trimester before she was aware of her pregnancy. The nurse looks up the medication and finds that it is categorized for level of fetal risk as FDA Category A for drug use during pregnancy. She would inform the pt: a. 21. On a prior visit, the nurse has advised a patient to increase her intake of iron-rich foods due to her iron- deficiency anemia. On follow up, the nurse knows the pt has had effective teaching if she reports increased intake of: a. Enriched b. c. Beans 22. A 25year old client pregnant with twins is at an increased risk for which of the following gestational conditions? a. 23. Because of the normal physiologic changes occurring during pregnancy, the nurse can expect to find which lab results on a pregnant pt, compared to pre-pregnant levels? a. A decrease in hematocrit 24. A pt presents to the clinic with a history of preterm labor. Based on knowledge of the action of different hormones in pregnancy, which hormone would the nurse expect to be used clinically to prevent premature labor? a. 25. A woman arrived for her first prenatal visit. The practitioner determines she is 8 weeks pregnant. What lab work would normally be obtained at this visit? SATA a. b. Gonorrhea culture c. HbsAg 26. Of the following infections, the one known to be a powerful, multi-system teratogen is: a. Rubella 27. Which of the following are true regarding fetal development? a. A 25-week fetus can be considered “viable” 28. A woman is 30-week gestation by LMP. Her fundal height measurement at this clinic appointment is 24 cm. based on this finding, the nurse should: a. 29. The nurse is discussing immunizations with a 12-week antepartum pt who is rubella nonimmune. What statement by the nurse would be correct? a. 30. What goal is most important for the nurse to include in the plan of care of a pregnant client with insulin dependent diabetes? a. 31. Which maternal condition or disease would you expect might improve during pregnancy due to the physiologic changes of pregnancy? a. 32. The order reads: administer 1 gm Ampicillin IV q 4 hours. The pharmacy sends the medication diluted in 50 ml with the instructions to administer over 30 minutes. The infusion pump runs in Ml/hour. The nurse will set the pump to how many mL/hr? a. 33. A high risk pt at 28 weeks gestation is asked to keep track of fetal movements. One week later, she calls the clinic and anxiously tells the nurse that although she has been paying close attention, she has not felt the baby move at all for over 8 hours, which is unusual for this baby. The most appropriate response by the nurse would be: a. 34. A woman has come to the clinic because she suspects she is pregnant. Which would be probable signs of pregnancy? a. b. Presence of hCG in the serum or urine c. Positive Hagar’s sign 35. A mother is 35 years old and is asking whether it is “safe” for her to get pregnant at her age? The nurses answer should be based on which of the following? a. 36. A pt is learning to self-assess for signs of ovulation to time intercourse in order to achieve a planned pregnancy. Which is a sign associated with ovulation? a. 37. Which of the following is true regarding the cytomegalovirus (CMV)? a. It can be passed transplacental to the fetus 38. A pt complains during her first months of pregnancy, “It seems like I have to go to the bathroom every 5 minutes.” Which statement would be the best explanation to give the pt? a. 39. A Rh-negative mother and a Rh-positive father are expecting a child. Screening revealed a positive indirect coombs test. Which statement regarding this result is correct? a. 40. A 20-year-old pt at 10 weeks gestation is preparing for her first prenatal visit. She confides, “This pregnancy was unplanned, I’m not sure if I want to be pregnant or not. I haven’t even decided whether I’m going to continue the pregnancy.” Which of the following is the best response? a. 41. A woman is hospitalized with severe pre-eclampsia at 32 weeks. Which would be expected as part of her plan of care? SATA a. b. c. Administration of corticosteroids 42. A woman demonstrates an understanding of the importance of increasing her intake of foods high in iron when she includes which of the following foods in her diet? a. Eggs 43. A currently pregnant woman reports the following pregnancy outcomes: • A vaginal delivery of a stillbirth at 30 weeks • One child born via c/s at 32 weeks (still living) • A spontaneous abortion at 10 weeks gestation • A vaginal delivery at 39 weeks gestation (still living) Which of the following accurately expresses this OB history using the 5-digit system (G_T_P_A_L_)? a. Gravida 5 T1 P2 A1 L2 44. A pt has an ectopic pregnancy and is being treated with methotrexate. What parameter will be monitored to be sure the treatment is working, and what would be the expected findings by one week of therapy? a. 45. a primigravida at 14 weeks gestation states that she hasn’t felt fetal movement yet. The best response by the nurse, based on her knowledge of when quickening occurs, is: a. “Movements is usually felt around 18-20 weeks gestation” 46. A pt with Class III heart disease is being treated for her 1st prenatal visit. Which of the following points would the nurse stress for this pt? a. 47. A pt in her 3rd trimester of pregnancy reports a headache and ankle edema at the end of the day and frequent leg cramps, especially at night. What strategies would be most appropriate for the nurse to suggest? SATA a. b. Perform pelvic tilt exercises c. 48. A pregnant pt at 28 weeks has a hematocrit that is slightly lower than her pre-pregnancy hematocrit. Which statement by the nurse is the best way to explain this to the pt? a. 49. A woman at 36 weeks of gestation assumes a supine position fr a fundal assessment and Leopold’s maneuvers. She begins to complain about feeling dizzy and nauseous. Her skin feels damp and cool. The nurses first action would be to: a. 50. In the 16th week, a pt phones the clinic to report symptoms of frequency and burning on urination. Which statement indicates she understood prior prenatal teaching related to bladder infection? a. 51. A 26 multi para is 24-weeks pregnant. Her previous births include 2 large for gestational age babies and one unexplained stillbirth. With this history what assessment should be made in order to identify her most probable pregestational problems? a. 52. A teenage pregnant client is diagnosed with iron deficiency anemia. Which nutrients should the nurse encourage her to take with her iron supplements to increase iron absorption? a. Vitamin C 53. During her first prenatal visit to the clinic at seven-week gestation, a 24-year-old pregnant client comments, “My blood type is A negative. Will that cause problems?” The nurse’s best response would be: a. 54. A client with pre-eclampsia is prescribed to receive magnesium sulfate 72 grams per 24 hrs. the solution sent by the pharmacy contains 20 mg/mL. how many mL should the client receive per hour? a. 150 mL/hr Exam 2 1. A primigravida presents to labor and delivery stating she is 39 weeks pregnant and her water broke 12 hours ago. Her contractions are irregular and she is dilated 4 cm. Which medication order does the nurse anticipate? a. Oxytocin (Pitocin) 2. At a third trimester clinic visit, the nurse teaches a primigravida client to watch for signs of impending labor, such as: a. b. 3. A G2P1 is in active labor, upon review of the fetal heart monitor tracing, repetitive late decelerations are noted. The nurses first action would be to: a. 4. A laboring client had received an order for epidural anesthesia. In order to prevent the most common complication with this procedure, which intervention would the nurse expect to use prior to placement of the epidural catheter? a. 5. A G1P0 has been in active labor for 8 hours and is making slow, steady progress. She complains of intense back pain with the contractions and rates her pain as 8. She requests an epidural for pain relief. Which fetal position/presentation would the nurse suspect? a. 6. A 38-week pregnant woman has an ultrasound for amniotic fluid index (AFI). The exam results are AFI=5: a reduced amniotic fluid volume. Reduced levels of amniotic fluid indicate a. 7. Which strategies would be effective to prevent preterm birth? SATA a. b. Use of progesterone injections for women with a history of preterm births c. Routine assessment and intervention for infection d. 8. After performing Leopold’s maneuver, the nurse determines the fetus is in a vertex presentation with the fetal back on the maternal right side. Auscultation of the heart rate should begin where on the maternal abdomen? a. 9. A multipara has just delivered her baby and the cord has been cut. A small gush of bright red blood (<100 cc) and lengthening of the cord is observed. The nurse should do what to assist? a. 10. A nulliparous woman is in the active phase of labor, and her cervix has progressed to 6 cm dilation. The nurse evaluates the external fetal monitor tracing and notes the following: gradual decrease in FHR at the onset of several uterine contractions, returning to baseline rate by the end of the contraction; shape is uniform and smooth, inversely mirroring the contraction. Based on these findings, the nurse should document: a. 11. During the hospital shift, the L&D triage nurse has 4 pts arrive simultaneously. Which pt should the nurse evaluate first? a. 12. A pregnant woman is in an MVA. She is placed on a backboard, an IV is started and her BP is 80/50. What is the priority important intervention? a. 13. A history of fetal loss at 14-18 weeks gestation with painless cervical insufficiency cervical dilation is associated with: a. b. 14. The antidote for magnesium sulfate is: a. 15. Respiratory depression of the neonate is a concern if birth is imminent 16. A pt is receiving magnesium sulfate for preterm labor. What is true regarding this medication? a. 17. A multigravida presents in active labor. Which of the following notations in her prenatal history would prompt the nurse to prepare for a cesarean section: a. 18. The laboring multipara, who is 9 cm dilated and wanting to have natural childbirth, cries out, “I can’t take it anymore”. He best response by the nurse is: a. 19. A 40-year-old primigravida asks about prenatal tests. Which of the tests below are used as screening tests for the increased likelihood of Trisomy 21 (down syndrome)? SATA a. b. MSAFP/quad screen c. 20. A pt presents with oligohydramnios at 42 weeks gestation and is admitted for induction of labor. Several hours later the membranes rupture and the nurse note a large amount of thick, green (meconium) stained fluid. There are frequent, abrupt decelerations of the fetal heart rate on the monitor. Prior to a cesarean section, the nurse anticipates what intervention? a. 21. A pt arrives with orders for a NST. The nurse knows what regarding the nonstress test (NST)? a. A reactive test requires a minimum of two accelerations within 20 min 22. A woman’s labor is being induced with oxytocin. The nurse assesses the woman’s status, that of her fetus, and the labor progress itself just before and infusion increase of 2 mU/min. The nurse would discontinue the infusion if what is notes during the assessment? a. 23. A pt has uncontrolled diabetes and the estimated fetal weight is over 4000 grams. Anticipating potential shoulder dystocia at delivery, the nurse should be prepared to a. 24. A pt at 32 weeks gestation is admitted with intermittent painless vaginal bleeding and a complete placenta previa is diagnosed. She is admitted to the high-risk antepartum unit. Her bleeding is now resolved. Expectant management would include: a. 25. The condition where the vessels of the umbilical cord divide some distress from the placental membranes is called a. 26. A pt presents for prenatal care with a history of irregular menstrual cycles and an “unsure” LMP. What is the most reliable basis for establishing her due date? a. 27. A pt is diagnosed with oligohydramnios at 38 weeks gestation. The nurse knows that oligohydramnios is a. A riskfactor for cord 28. Immediately after delivery, the cord is clamped and cut and the wet, crying, vigorous newborn is placed skin to skin with mom and covered with a blanket, with a length of cord still attached to the mental clamp. What is the FIRST priority action? a. 29. A pt comes in from home and states that when the membranes ruptured “something fell out”. As soon as the patient lies down the nurse does an exam and feels a slowly pulsating cord (rate less than 100) in front of the presenting part. The nurses next action is to: a. 30. A G1P0 has ruptured membranes. The physician orders Pitocin augmentation, beginning at 2 mu/min. the pharmacy sends a 1000 mL bag of LR with 20 units Pitocin added. The nurse will set the infusion pump at a. 31. During a prenatal visit, a primigravida asks about fetal movement. Which is true regarding fetal movement as an indicator of fetal well-being? a. 32. What foods would the client be advised to eat with a hemoglobin of 8.6 mg/dl and a hematocrit of 25.1% a. 33. During a prepared childbirth class, a father asks how to measure contraction frequency. The nurse explains that frequency is measured from the a. 34. A life-threatening condition where the placenta is abnormally attached to the uterine myometrium is called a. 35. A multiparous mother has just delivered a 9-pound baby with a 750 ml EBL. She complains of feeling chilled and dizzy and the nurse notes that her uterine fundus is soft, midline and 3 fingers above the umbilicus. Which of the following is the nurses FIRST priority? a. 36. A pt is being admitted for a schedules labor induction with oxytocin for postdates. Which of the following assessment findings would be a contraindication to labor induction? SATA a. b. Active genital herpes infection c. e. Previous classical (vertical) c/s 37. A vaginal examination reveals that a woman is in active labor with a double footling breech. This presentation in labor and birth has an increased risk for? SATA a. Prolapsed b. 38. Methods for augmenting labor include: SATA a. Amniotomy b. c. 39. A laboring woman is receiving IV magnesium sulfate at 2 gm/hour for preeclampsia after a 4 gm loading dose. The change of shift assessment reveals urine output 20 mL in the last hour, BP 156/90, pulse 78, respirations 8/min, patellar reflexes absent, clear lung sounds bilaterally. The priority intervention for the nurse is to a. 40. A woman phones the labor unit at 10:00 PM and says she has been having intermittent “back pain” all day. She is 12 weeks gestation. The nurse should tell the woman she a. 41. Which statement is true regarding placenta previa and placental abruption? a. 42. After several hours of labor, the nurse reviews the fetal heart monitor tracing. The nurse notes abrupt decelerations of the fetal heart rate during uterine contractions with quick return to baseline and correctly interprets this pattern to be consistent with? a. 43. A pt presents at 34 weeks gestation (by LMP). She had heavy vaginal bleeding with clots, FHTs of 140 with repetitive late decelerations and absent variability, a pulse of 110, and severe abdominal pain. The uterus is firm to palpation and there is no rest between contractions. The physician is en route to the to the hospital to evaluate the patient and has already provided phone orders. Which of the following would be the nurses first priority? a. 44. Which of the following is the most common risk of episiotomy for vaginal delivery? a. Extension to serious tears (3rd and 4th degrees) 45. An obviously pregnant woman walks into the hospital ER shouting “Help me! Help me! My baby is coming, I’m so afraid.” The RN determines delivery is imminent. What action is most important for the RN to take? a. 46. A multiparous woman is in labor. Leopold’s maneuver indicates the fetal back on the left side of the maternal abdomen and FHTs are auscultated on the lower quadrant. The results of the vaginal examination are: 6cm/90%/+2/LOT. According to these findings the: a. 47. A pt at term reports that her membranes have ruptured. The nurse assesses the fluid to confirm ROM and determines its characteristics. Normal assessment findings with ruptured membranes include: SATA a. Positive ferning via microscope b. c. Clear, straw color with no odor 48. An obstetrical emergency where a bolus of amniotic fluid, fetal cells or hair enters the maternal circulation and the maternal lungs is called a. b. Anaphylactoid syndrome of pregnancy 49. A laboring woman requests something for pain relief. She is 1 cm dilated and her contractions are mild, occurring every 8-20 minutes and lasting 20-30 seconds. In discussing her options, the nurse explains that an epidural at this point in her labor could possibly increase her risk for what problem? a. 50. A diabetic pt needs to be delivered prior to term due to non-reassuring fetal test results. Which of the following tests might be used to help determine if the fetal lungs are mature? a. 51. Which medication would the nurse expect to administer to accelerate fetal lung maturity? a. Celestone soluspan 52. Effects of betamimetics used for tocolysis include? a. Tachycardia and cardiac dysrhythmias 53. A multigravida with a frank breech presentation is admitted for an external version. The nurse knows a. A reactivenonstress test is obtained immediately 54. During Pitocin augmentation of labor for a pt with a prior c/s, a multiparous woman (G6, P5) suddenly becomes pale, diaphoretic and complains of severe lower abdominal pain with a tearing sensation. On vaginal exam, the nurse notes the presenting part is floating. Her uterus is tender. A prolonged deceleration is observed on the monitor. The nurse should suspect: a. 55. A laboring woman’s temperature is elevated. The FHR pattern that can be expected with maternal fever would be: a. 56. A primigravida arrives to the L&D unit in obvious labor. Her spouse described her contractions as occurring every 1-2 minutes, lasting 60 seconds. She is irritable, restless, and vocal during contractions and complains of intense pressure. On exam, her cervix is dilated 8 cm, 100% effaced and the fetus is at 0 station. With the next contraction, she yells, “I can’t take it anymore.” Which best described her labor at this point? a. [Show Less]