OB 34 questions with rationale abrezy Flashcards
A couple has been trying to conceive for nine months without success. Which information obtained from the clients is most likely to have an impact on the couple’s ability to conceive a child?
A) Exercise regimen of both partners includes running four miles each morning
B) History of having sexual intercourse 2 to 3 times per week.
C) The woman’s menstrual period occurs every 35 days.
D) They use lubricants with each sexual encounter to decrease friction.
D) They use lubricants with each sexual encounter to decrease friction.
Rationale: The use of lubricants (D) has the potential to affect fertility because some lubricants interfere with sperm motility.
While excessive heat can affect sperm production, bicycling, rather than running (A) is more likely to concentrate heat in the groin area. While having intercourse too frequently has been implicated as a cause for decreased numbers of sperm, 2 to 3 times per week (B) is not considered excessive. (C) should not affect fertility.
A client in active labor complains of cramps in her leg. What intervention should the nurse implement?
A) Ask the client if she takes a daily calcium tablet.
B) Extend the leg and dorsiflex the foot.
C) Lower the leg off the side of the bed.
D) Elevate the leg above the heart.
B) Extend the leg and dorsiflex the foot.
Rationale:
Dorsiflexing the foot by pushing the sole of the foot forward or by standing (if the client is capable) (B), and putting the heel of the foot on the floor is the best means of relieving leg cramps. (A) is not related to leg cramps caused by reduced circulation to the foot. (C) is not likely to be helpful. (D) is used to promote venous return, but is not indicated for leg cramps.
A primigravida at 40-weeks gestation is receiving oxytocin (Pitocin) to augment labor. Which adverse effect should the nurse monitor for during the infusion of Pitocin?
A) Dehydration.
B) Hyperstimulation.
C) Galactorrhea.
D) Fetal tachycardia.
B) Hyperstimulation.
Rationale:
Pitocin causes the uterine myofibril to contract, so unless the infusion is closely monitored, the client is at risk for hyperstimulation (B) which can lead to tetanic contractions, uterine rupture, and fetal distress or demise. Dehydration (A) and galactorrhea (C) are not adverse effects associated with the administration of Pitocin. Fetal tachycardia (D) is an initial response to any stressor, including an increase in maternal temperature or intrauterine infection, but fetal decelerations indicate distress following tetanic contractions.
A client is admitted with the diagnosis of total placenta previa. Which finding is most important for the nurse to report to the healthcare provider immediately?
A) Heart rate of 100 beats/minute.
B) Variable fetal heart rate.
C) Onset of uterine contractions.
D) Burning on urination.
C) Onset of uterine contractions.
Rationale:
Total (complete) placenta previa involves the placenta covering the entire cervical os (opening). The onset of uterine contractions (C) places the client at risk for dilation and placental separation, which causes painless hemorrhaging. Although (A, B, and D) should be reported, the risk of hemorrhage is the priority.
A multigravida client at 41-weeks gestation presents in the labor and delivery unit after a non-stress test indicated that the fetus is experiencing some difficulties in utero. Which diagnostic test should the nurse prepare the client for additional information about fetal status?
A) Biophysical profile (BPP).
B) Ultrasound for fetal anomalies.
C) Maternal serum alpha-fetoprotein (AF) screening.
D) Percutaneous umbilical blood sampling (PUBS).
A) Biophysical profile (BPP).
Rationale:
BPP (A) provides data regarding fetal risk surveillance by examining 5 areas: fetal breathing movements, fetal movements, amniotic fluid volume, and fetal tone and heart rate. The client’s gestation has progressed past the estimated date of confinement, so the major concern is fetal well-being related to an aging placenta, not screening for fetal anomalies (B). Maternal serum AF screening is generally checked between 15 and 22 weeks to detect neural tube defects (C). Although PUBS is performed to determine a number of at-risk fetal conditions, the BPP determines current fetal risk (D).
Which action should the nurse implement when preparing to measure the fundal height of a pregnant client?
A) Have the client empty her bladder.
B) Request the client lie on her left side.
C) Perform Leopold’s maneuvers first.
D) Give the client some cold juice to drink.
A) Have the client empty her bladder.
Rationale:
To accurately measure the fundal height, the bladder must be empty
(A) to avoid elevation of the uterus. Fundal height is not measured with the client lying on her side (B). Leopold’s maneuvers are performed to assess fetal position and the expected location of the point of maximal impulse (PMI) for fetal heart rate (C). Cold juice (D) does not affect the fundal height measurement, but may be given to arouse the fetus if the fetus appears to be sleeping during a non-stress test.
In developing a teaching plan for expectant parents, the nurse plans to include information about when the parents can expect the infant’s fontanels to close. The nurse bases the explanation on knowledge that for the normal newborn, the
A) anterior fontanel closes at 2 to 4 months and the posterior by the end of the first week.
B) anterior fontanel closes at 5 to 7 months and the posterior by the end of the second week.
C) anterior fontanel closes at 8 to 11 months and the posterior by the end of the first month.
D) anterior fontanel closes at 12 to 18 months and the posterior by the end of the second month.
D) anterior fontanel closes at 12 to 18 months and the posterior by the end of the second month.
Rationale:
In the normal infant the anterior fontanel closes at 12 to 18 months of age and the posterior fontanel by the end of the second month (D). These growth and development milestones should be memorized to prepare for the NCLEX.
A primigravida client who is 5 cm dilated, 90% effaced, and at 0 station is requesting an epidural for pain relief. Which assessment finding is most important for the nurse to report to the healthcare provider?
A) Cervical dilation of 5 cm with 90% effacement.
B) White blood cell count of 12,000/mm3.
C) Hemoglobin of 12 mg/dl and hematocrit of 38%.
D) A platelet count of 67,000/mm3.
D) A platelet count of 67,000/mm3.
Rationale:
Thrombocytopenia (low platelet count) (D) should be reported to the healthcare provider because it places the client at risk for bleeding when an epidural is administred.
(A, B, and C) are within the normal parameters for a client in active labor and is not contraindicated for the placement of an epidural.
The nurse assesses a client admitted to the labor and delivery unit and obtains the following data: dark red vaginal bleeding, uterus slightly tense between contractions, BP 110/68, FHR 110 beats/minute, cervix 1 cm dilated and uneffaced. Based on these assessment findings, what intervention should the nurse implement?
A) Insert an internal fetal monitor.
B) Assess for cervical changes q1h.
C) Monitor bleeding from IV sites.
D) Perform Leopold’s maneuvers.
C) Monitor bleeding from IV sites.
Rationale:
Monitoring bleeding from peripheral sites (C) is the priority intervention. This client is presenting with signs of placental abruption. Disseminated intravascular coagulation (DIC) is a complication of placental abruptio, characterized by abnormal bleeding.
Invasive vaginal procedures (A and B) or (D) can increase the abruption and bleeding, so these interventions are contraindicated.
Just after delivery, a new mother tells the nurse, “I was unsuccessful breastfeeding my first child, but I would like to try with this baby.” Which intervention is best for the nurse to implement first?
A) Assess the husband’s feelings about his wife’s decision to breastfeed their baby.
B) Ask the client to describe why she was unsuccessful with breastfeeding her last child.
C) Encourage the client to develop a positive attitude about breastfeeding to help ensure success.
D) Provide assistance to the mother to begin breastfeeding as soon as possible after delivery.
D) Provide assistance to the mother to begin breastfeeding as soon as possible after delivery.
Rationale:
Infants respond to breastfeeding best when feeding is initiated in the active phase soon after delivery (D).
(A and B) might provide interesting data, but gathering this information is not as important as providing support and instructions to the new mother. While (C) is also true, this response by the nurse might seem judgmental to a new mother.
The nurse caring for a laboring client encourages her to void at least q2h, and records each time the client empties her bladder. What is the primary reason for implementing this nursing intervention?
A) Emptying the bladder during delivery is difficult because of the position of the presenting fetal part.
B) An over-distended bladder could be traumatized during labor as well as prolong the progress of labor.
C) Urine specimens for glucose and protein must be obtained at certain intervals throughout labor.
D) Frequent voiding minimizes the need for catheterization which increases the chance of bladder infection.
B) An over-distended bladder could be traumatized during labor as well as prolong the progress of labor.
Rationale:
A full bladder can impair the efficiency of the uterine contractions and impede descent of the fetus during labor (B). Also, because of the close proximity of the bladder to the uterus, the bladder can be traumatized by the descent of the fetus.
It is not difficult to empty the bladder during delivery (A). Urine specimens are obtained only by special order (C). There is danger of infection due to catheterization (D), but this is not the primary reason for encouraging the client to void during labor.
A 23-year-old client who is receiving Medicaid benefits is pregnant with her first child. Based on knowledge of the statistics related to infant mortality, which plan should the nurse implement with this client?
A) Refer the client to a social worker to arrange for home care.
B) Recommend perinatal care from an obstetrician, not a nurse-midwife.
C) Teach the client why keeping prenatal care appointments is important.
D) Advise the client that neonatal intensive care may be needed.
C) Teach the client why keeping prenatal care appointments is important.
Rationale:
Regular prenatal visits should begin early in pregnancy to monitor health of the mother and development of the fetus (C). Based on the client’s information, (A, B, and D) are not indicated.
On admission to the prenatal clinic, a 23-year-old woman tells the nurse that her last menstrual period began on February 15, and that previously her periods were regular. Her pregnancy test is positive. This client’s expected date of delivery (EDD) is
A) November 22.
B) November 8.
C) December 22.
D) October 22.
A) November 22.
Rationale:
(A) correctly applies Nägele’s rule for estimating the due date by counting back 3 months from the first day of the last menstrual period (January, December, November) and adding 7 days (15+7=22).
The nurse is assessing a client who is having a non-stress test (NST) at 41-weeks gestation. The nurse determines that the client is not having contractions, the fetal heart rate (FHR) baseline is 144 bpm, and no FHR accelerations are occurring. What action should the nurse take?
A) Check the client for urinary bladder distention.
B) Notify the healthcare provider of the nonreactive results.
C) Have the mother stimulate the fetus to move.
D) Ask the client if she has felt any fetal movement.
D) Ask the client if she has felt any fetal movement.
Rationale: The client should be asked if she has felt the fetus move (D). An NST is used to determine fetal well-being, and is often implemented when postmaturity is suspected. A “reactive” NST occurs if the FHR accelerates 15 bpm for 15 seconds in response to the fetus’ own movement, and is “nonreactive” if no FHR acceleration occurs in response to fetal movement. The client should empty her bladder before starting the test, but bladder distention does not impede fetal movement (A). The client should be quizzed about fetal movement before determining that the NST is nonreactive (B). If no movement has occurred in the last 20 to 30 minutes, it is likely that the fetus is sleeping–providing the mother with orange juice often wakes the infant, and then the NST should be conducted again.
The total bilirubin level of a 36-hour, breastfeeding newborn is 14 mg/dl. Based on this finding, which intervention should the nurse implement?
A) Provide phototherapy for 30 minutes q8h.
B) Feed the newborn sterile water hourly.
C) Encourage the mother to breastfeed frequently.
D) Assess the newborn’s blood glucose level.
C) Encourage the mother to breastfeed frequently.
Rationale:
The normal total bilirubin level is 6 to 12 mg/dl after Day 1 of life. This infant’s bilirubin is beginning to climb and the infant should be monitored to prevent further complications. Breast milk provides calories and enhances GI motility, which will assist the bowel in eliminating bilirubin (C).
(A) is not indicated at this level. (B) would limit caloric intake, which is essential in preventing jaundice. (D) is not related to bilirubin levels.
