OB PROCTORED 1 → 2016 QUESTIONS AND EXPLANATIONScytomegalovirus
21. A nurse manager on the labor and delivery unit is teaching a group of newly
... [Show More] licensed nurses about maternal cytomegalovirus. Which of the following information should the nurse manager include in the teaching?
1. Transmission can occur via the saliva and urine of the newborn (PDF p.48: Cytomegalovirus is part of the TORCH infections that can cross the placenta and have teratogenic effects on the fetus. Latent virus can be reactivated and cause disease to the fetus in utero or during passage through the birth canal. Transmitted by droplet infection from person to person, a virus found in semen, cervical and vaginal secretions, breast milk, placental tissue, urine, feces, and blood)
2. Mothers will receive prophylactic treatment with acyclovir prior to delivery (PDF p.48: Treatment of toxoplasmosis includes sulfonamides or a combination of pyrimethamine and sulfadiazine)
3. Lesions are visible on the mothers genitalia (PDF p.48: Cytomegalovirus: asymptomatic or mononucleosis-like manifestations; Herpes simplex infection: symptoms consisting of painful blisters
4. This infection requires airborne precautions are initiated for the newborn (PDF p.48: Transmitted by droplet infection)
22. A nurse is caring for a client who is in the second stage of labor. Which of the following manifestations should the nurse expect?
1. The client delivers the newborn (PDF p.73: 2nd stage--birth) 2. The client expels the placenta (3rd stage)
3. The client beings having regular contractions (1st stage, active phase)
4. The client experiences gradual dilation of the cervix (1st stage, active phase)
23. A nurse is teaching a client who is breastfeeding and has mastitis. Which of the following statements by the client indicates an understanding of the teaching?
1. I should a nipple shield while breastfeeding (PDF p.129: Use a breast shield between feedings)
2. I should apply lanolin to the infection site daily (PDF p.129: Have the client apply breast creams as prescribed and wear breast shields in her bra to soften her nipples if
they are irritated and cracked. Sore nipples with cracks & fissures are indication of mastitis which is an infection in the milk duct) (WebMD: Lanolin is a medication fused as a moisturizer to treat or prevent dry & irritated skin)
3. I should apply warm compresses after the feeding (PDF p.144: Encourage the client to use ice packs or warm packs on affected breasts for discomfort)
4. I should stop breastfeeding until the infection has healed (PDF p.144: Instruct the client to continue breastfeeding frequently q2-4 hr especially on the affected side completely emptying her breasts with each feeding to prevent milk stasis, which provides a medium for bacterial growth)
24. A nurse in a provider’s office is caring for a 20 y/o client who is at 12 weeks of gestation and requests an amniocentesis to determine the gender of the fetus. Which of the following responses should the nurse make?
1. We can schedule the procedure for later today if you’d like (PDF p.33: performed after 14 weeks of gestation)
2. You can’t have an amniocentesis until you're at least 35 y/o
3. Your provider will schedule a chorionic villus sampling to determine the sex of your baby (first-trimester alternative to amniocentesis to determine any abnormality)
4. This procedure determines if your baby has genetic or congenital disorders (PDF p.33: The aspiration of amniotic fluid for analysis of chromosomal & congenital anomalies, lung maturity, meconium in amniotic fluid, etc)
25. A nurse is assessing a client who is at 37 weeks of gestation. Which of the following statements by the client requires immediate intervention by the nurse?
1. My feet are really swollen today (PDF p.22: lower-extremity edema can occur during the second and third trimesters)
2. I have been seeing spots this morning (PDF p.60: Visual disturbances (blurring of vision, flashes of lights or dots before the eyes) are s/s of severe preeclampsia & can lead to seizure activity aka eclampsia)
3. I didn't have lunch today but I had breakfast this morning
4. It burns when I urinate (s/s of UTI--not as urgent)
26. A nurse is teaching a client who is postpartum about car seat safety. Which of the following statements indicates an understanding of the instructions?
1. I will adjust the angle of the carseat so that my baby is at a 90 degree angle (30-45 degrees)
2. I will position the car seat in the front passenger seat facing the front of the car (PDF p.179: rear-facing in the back seat)
3. I will place the shoulder harness slightly below my baby’s shoulders
4. I will make sure the retainer clip is at the level of my baby’s abdomen (should be chest!)
27. A nurse is performing a physical examination of a term newborn upon admission to the nursery. In which order should the nurse perform the following assessments?
1. Observe the newborns respirations (PDF p.156: Vital signs are checked in the following sequence: respirations, heart rate, blood pressure, and temperature. The nurse observes the respiratory rate first before the newborn becomes active or agitated by use of the stethoscope, thermometer, and/or blood pressure cuff)
2. Auscultate the newborn’s heart rate
3. Auscultate the newborns abdomen
4. Test the newborn’s reflexes
28. A nurse is monitoring a client who has preeclampsia and is receiving magnesium sulfate by continuous IV infusion. Which of the following findings should the nurse report to the provider?
1. Respiratory rate 14/min
2. Urinary output 20 ml/hr (PDF p.60: Magnesium sulfate toxicity = absent tendon reflex, urine output <30ml/hr, RR
<12/min, decreased LOC, cardiac dysrhythmias)
3. BP 148/94 mmHg
4. 2+ deep tendon reflexes
:::: Magnesium sulfate = relaxes the smooth muscle of the uterus and inhibits uterine activity by suppressing contractions.
29. A nurse is assessing a full term newborn 1 hr following a vaginal birth. Which of the following is an expected assessment finding?
1. The newborn’s head circumference is greater than the chest circumference (PDF p.157: Head should be 2 to 3 cm larger than chest circumference)
2. The newborn exhibits apnea episodes of 30 seconds (PDF p.126: Too long; RR varies from 30 to 60 breaths/min with short periods of apnea (less than 15 seconds)
3. The newborn has a heart rate of 70/min while sleeping (PDF p.126: Too low; HR ranges from 110 to 160/min with brief fluctuations above and below this range depending on activity level)
4. The newborn’s anterior fontanelle bulges when he is quiet (PDF p.157: Fontanels can bulge when the newborn cries, coughs or vomits, and are flat when the newborn is quiet)
30. A nurse in a postpartum unit is caring for several clients. Which of the following tasks should the nurse delegate to assistive personnel?
1. Help the client with perineal care (CNA=hygiene, ADLs)
2. Check the saturation of the perineal pad (RN=Assess)
3. Provide the client with a dose of magnesium hydroxide (RN=Medication administration)
4. Demonstrate to a client how to change a diaper (RN=Teach)
31. A nurse if caring for a client who is postpartum following repair of a vaginal laceration. The client has a firm fundus, moderate lochia rubra & reports moderate perineal discomfort & pressure. Which of the following actions should the nurse take?
1. Check the perineal area (PDF p.119: Assess first! Assess episiotomy and lacerations for approximation, drainage, quantity, and quality)
2. Perform deep fundal massage (Unnecessary b/c fundus is firm & no need for assistance for uterine contraction)
3. Administer methylergonovine 0.2 mg IM (PDF p.118: An oxytocic given after the placenta is delivered to promote uterine contractions and to prevent hemorrhage. Unnecessary b/c fundus is firm)
4. Obtain a vaginal culture (PDF p.119: Lacerations can delay the production of estrogen-influenced cervical mucus and are a predisposing factor to infection. But assess area first for s/s of infection)
32. A nurse is assessing a full term newborn upon admission to the nursery. Which of the following clinical findings should the nurse report to the provider?
1. Single palmar creases (PDF p.194: characteristics of Down Syndrome= short broad hands with a fifth finger that has one flexion crease instead of two, a deep crease across the center of the palm aka simian crease)
2. Rust stained urine (PDF p.159: Uric acid crystals will produce a rust color in the urine the first couple of days of life)
3. Subconjunctival hemorrhage (PDF p.158: Subconjunctival hemorrhages can result from pressure during birth)
4. Transient circumoral cyanosis (r/t respiratory distress; ABC circulation priority)
33. A nurse at an antepartum clinic is caring for four clients. Which of the following clients should the nurse assess first?
1. A client who is at 8 weeks of gestation and reports severe vomiting (PDF p.58: Hyperemesis gravidarum is excessive nausea and vomiting that is prolonged past 12 weeks of gestation and results in a 5% weight loss from prepregnancy weight, electrolyte imbalance, acetonuria, and ketosis. There is a risk to the fetus for intrauterine growth restriction or preterm birth if the condition persists)
2. A client who is at 36 weeks of gestation and reports back pain following intercourse
3. A client who is at 24 weeks of gestation and reports periodic tingling of the fingers (PDF p.59 & 80: Decreased O2 circulation r/t hypoglycemia or hyperventilation; ABC priority)
4. A client who is at 10 weeks gestation and reports frequent urination (PDF p.16: Urinary frequency is common during pregnancy. Filtration rate increases secondary to the influence of pregnancy hormones and an increase in blood volume and metabolic demands. The amount of urine produced remains the same)
34. A nurse is conducting a class for a group of clients about birth control. Which of the following information should the nurse
1. You should have an annual exam to assess your diaphragm (PDF p.5: Replaced every 2 years and refitted for a 20% weight fluctuation, after abdominal or pelvic surgery, and after every pregnancy)
2. Your fertility will return 6 months after your provider removes your IUD (PDF p.8: Contraception can be reversed with
3. You should use spermicide 3 hrs prior to sexual intercourse (PDF p.5: Up to 6 hours before intercourse)
4. You will not need to use birth control for 1 month after receiving emergency contraception (PDF p.6: Does not provide
35. A nurse is assessing the results of a nonstress test for an antepartal client at 35 wks of gestation. Which of the following findings should indicate to the nurse the need for further diagnostic testing?
1. Three fetal movements perceived by the client in a 20 min testing period (PDF p.31: occurs two or more times during a 20-min period)
2. No late decelerations in the fetal heart rate noted with three uterine contractions of 60 seconds in duration w/in a 10 min testing period (PDF p.32: Contraction Stress Test (CST) = nipple or oxytocin-stimulated contraction test; Negative CST is a normal finding which is indicated if within a 10-min period, with three uterine contractions, there are no late decelerations of the FHR)
3. Irregular contractions of 10-20 secs in duration that are not felt by the client (possible Braxton Hicks contraction?)
4. An increase in fetal heart rate to 150/min above the baseline of 140/min lasting 10 seconds in response to fetal movement within a 40 min testing period (PDF p.31: NST is interpreted as reactive if the FHR is a normal baseline rate with moderate variability, accelerates at least 15/min for at least 15 seconds and occurs two or more times during a 20- min period; Nonreactive NST is a test that does not demonstrate at least two qualifying accelerations in a 20-min window)
36. A nurse is providing discharge teaching to a client following tubal ligation. Which of the following statements by the client indicates an understanding of the teaching?
1. Premenstrual tension will no longer be present → menstruation still remain the same as before the sterilization.
2. Ovulation will remain the same → you may feel pain at ovulation
3. Hormone replacements will be needed following this procedure → no change in hormones and their influence.
4. My monthly menstrual period will be shorter Lowdermilk pg. 187 PDF
37. A nurse is assessing the fetal heart rate for a client who is at 38 weeks of gestation. When using an ultrasound device, the nurse hears blood rushing through the umbilical vessels in synchronization with the fetal heartbeat. Which of the following terms should the nurse use to document this finding?
1. Goodell’s sign
2. Quickening
3. Funic souffle
4. Hegar’s sign
Lowdermilk PDF PG. 293 (sound made by blood rushing through the umbilical vessels and synchronous with the fetal heart rate).
38. A nurse is admitting a client who is in preterm labor to the labor and delivery unit. The nurse should anticipate which of the following tests to assess for fetal lung maturity?
1. Direct Coombs’ test
2. Biophysical profile
3. Chorionic villus sampling (CVS)
4. Lecithin/sphingomyelin ratio
ATI OB PG. 56 A 2:1 ration indicating fetal lung maturity (2:5:1 or 3:1 for a client who has diabetes mellitus.
39. A nurse is reviewing the laboratory report of a client who is 24 hr postpartum vaginal delivery. The client has a hemoglobin level of
9.0 g/dL & Hct of 25%. Which of the following actions should the nurse take? 1. Prepare the client for a blood transfusion
2. Instruct the client that the provider will check for placental fragments
3. Initiate IV access for isotonic solution with an 18- gauge catheter
4. Administer an iron supplement to the client→ According to Lowdermilk pg. 741 Normal HCT range in nonpregnant women is 37% to 47%. However, normal values for pregnant women with adequate iron stores may be as low as 33%.
40. A nurse in a provider’s office is assessing a client at her first antepartum visit. The client states that the first day of her last menstrual period was March 8. Use Nagele’s rule to calculate the est. date of delivery.
➔ March 8, minus 3 months plus 7 days and 1 year equals an estimated date of delivery of December 15 (1215).
41. A nurse on the labor and delivery unit is caring for a client who is at 33 weeks of gestation and was admitted with placenta previa.
Which of the following interventions should the nurse include in the client’s plan of care?
1. A non stress test twice weekly → possibly if bleeding stops. But patient newly admit and 33 weeks gestation (Braxton hicks contraction)
2. Administration of magnesium sulfate → Tocolysis effect. 33 weeks have Braxton hicks contraction.
3. Routine vaginal exams → avoid in presence of vaginal bleeding until placenta abruption and placenta previa is ruled out; may exacerbate bleeding.
4. Ambulation as tolerated → bed rest; Lowdermilk 682 if the bleeding stops, the woman will most likely be placed on bed rest with bathroom privileges and limited activity.
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