OB EXAM 3--TEST BANK QUESTIONS Flashcards
- A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine “several times” during the past year and occasionally drinks alcohol. Her blood pressure is 108/70 mm Hg. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics places this client in a high-risk category?
Family history, BMI, drug and alcohol abuse
- The nurse sees a woman for the first time when she is 30 weeks pregnant. The client has smoked throughout the pregnancy, and fundal height measurements now are suggestive of intrauterine growth restriction (IUGR) in the fetus. In addition to ultrasound to measure fetal size, what is another tool useful in confirming the diagnosis?
Doppler blood flow analysis
- A 41-week pregnant multigravida arrives at the labor and delivery unit after a NST indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool yields more detailed information about the condition of the fetus?
BPP
- At 35 weeks of pregnancy, a woman experiences preterm labor. Although tocolytic medications are administered and she is placed on bed rest, she continues to experience regular uterine contractions and her cervix is beginning to dilate and efface. What is an important test for fetal well-being at this time?
Amniocentesis for fetal lung maturity
- A 30-year-old gravida 3, para 2-0-0-2 is at 18 weeks of gestation. Which screening test should the nurse recommend be ordered for this client?
MSAFP screening
- A client asks her nurse, “My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?” What is the nurse’s best response?
“Your placenta changes as your pregnancy progresses, and it is given a score that indicates how well it is functioning.”
- A woman is undergoing a nipple-stimulated CST. She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline heart rate of approximately 120 beats per minute without any decelerations. What is the correct interpretation of this test?
negative
- Of these psychosocial factors, which has the least negative effect on the health of the mother and/or fetus?
moderate coffee consumption
- In comparing the abdominal and transvaginal methods of ultrasound examination, which information should the nurse provide to the client?
The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.
- Which clinical finding is a major use of ultrasonography in the first trimester?
Presence of maternal abnormalities
- Which information is the highest priority for the nurse to comprehend regarding the BPP?
BPP is an accurate indicator of impending fetal well-being.
- A client in the third trimester has just undergone an amniocentesis to determine fetal lung maturity. Which statement regarding this testing is important for the nurse in formulating a care plan?
Administration of Rho(D) immunoglobulin may be necessary.
- The nurse is planning the care for a laboring client with diabetes mellitus. This client is at greater risk for which clinical finding?
Polyhydramnios
is a screening tool only; it identifies candidates for more definitive diagnostic procedures
MSAFP
Four categories have now been established, based on the threats to the health of the woman and the outcome of pregnancy. Which category should not be included in this group?
geographic
- A pregnant woman’s BPP score is 8. She asks the nurse to explain the results. How should the nurse respond at this time?
“The test results are within normal limits.”
- Which analysis of maternal serum may predict chromosomal abnormalities in the fetus?
Multiple-marker screening
- While working with the pregnant client in her first trimester, what information does the nurse provide regarding when CVS can be performed (in weeks of gestation)?
10-13
- Which nursing intervention is necessary before a first-trimester transabdominal ultrasound?
Instruct the woman to drink 1 to 2 quarts of water.
- How does the nurse document a NST during which two or more FHR accelerations of 15 beats per minute or more occur with fetal movement in a 20-minute period?
reactive
- IUGR is associated with which pregnancy-related risk factors? (Select all that apply.)
Poor nutrition
Maternal collagen disease
Gestational hypertension
Smoking
IUGR is not associated with?
premature rupture of membranes
- Which assessments are included in the fetal BPP? (Select all that apply.)
Fetal movement
Fetal tone
Fetal heart rate
AFI
Which assessments is not included in the fetal BPP?
placental grade
- Transvaginal ultrasonography is often performed during the first trimester. While preparing a 6-week gestational client for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for which situations? (Select all that apply.)
Multifetal gestation
Obesity
Fetal abnormalities
Ectopic pregnancy
transvaginal ultrasounds don’t check for?
amniotic fluid volume
- A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse?
Dipstick value of 3+ for protein in her urine
- The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the oxytocin (Pitocin) infusion, the nurse reviews the woman’s latest laboratory test findings, which reveal a platelet count of 90,000 mm3, an elevated aspartate aminotransaminase (AST) level, and a falling hematocrit. The laboratory results are indicative of which condition?
Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome
- A woman with preeclampsia has a seizure. What is the nurse’s highest priority during a seizure?
To stay with the client and call for help
- A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment, the nurse finds the following vital signs: temperature 37.3° C, pulse rate 88 beats per minute, respiratory rate 10 breaths per minute, BP 148/90 mm Hg, absent deep tendon reflexes (DTRs), and no ankle clonus. The client complains, “I’m so thirsty and warm.” What is the nurse’s immediate action?
To discontinue the magnesium sulfate infusion
- A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes, dark red vaginal bleeding, and a tense, painful abdomen. Which clinical change does the nurse anticipate?
Abruptio placentae
- A woman with worsening preeclampsia is admitted to the hospital’s labor and birth unit. The physician explains the plan of care for severe preeclampsia, including the induction of labor, to the woman and her husband. Which statement by the husband leads the nurse to believe that the couple needs further information?
“Since we will be here for a while, I will call my mother so she can bring the two boys—2 years and 4 years of age—to visit their mother.”
- The client has been on magnesium sulfate for 20 hours for the treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings does the nurse expect to observe or assess in this client?
Boggy uterus with heavy lochia flow
- The client is being induced in response to worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active, despite several hours of oxytocin administration. She asks the nurse, “Why is this taking so long?” What is the nurse’s most appropriate response?
“The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor.”
- What nursing diagnosis is the most appropriate for a woman experiencing severe preeclampsia?
Risk for injury to mother and fetus, related to central nervous system (CNS) irritability
- Which statement best describes chronic hypertension?
Chronic hypertension can occur independently of or simultaneously with preeclampsia.
- Which intervention is most important when planning care for a client with severe gestational hypertension?
Induction of labor is likely, as near term as possible.
- What is the primary purpose for magnesium sulfate administration for clients with preeclampsia and eclampsia?
To prevent convulsions
- The American College of Obstetricians and Gynecologists (ACOG) has developed a comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors?
19-year-old African American who is pregnant with twins
- Women with mild gestational hypertension and mild preeclampsia can be safely managed at home with frequent maternal and fetal evaluation. Complete or partial bed rest is still frequently ordered by some providers. Which complication is rarely the result of prolonged bed rest?
Fluid retention
- Which neonatal complications are associated with hypertension in the mother?
Intrauterine growth restriction (IUGR) and prematurity
- A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the client and documents the following findings: temperature of 37.1° C, pulse rate of 96 beats per minute, respiratory rate of 24 breaths per minute, BP of 155/112 mm Hg, 3+ DTRs, and no ankle clonus. The nurse calls the provider with an update. The nurse should anticipate an order for which medication?
Hydralazine
- The client being cared for has severe preeclampsia and is receiving a magnesium sulfate infusion. Which new finding would give the nurse cause for concern?
Respiratory rate of 10 breaths per minute
- What is the most common medical complication of pregnancy?
Hypertension
- Which statement most accurately describes the HELLP syndrome?
Characterized by hemolysis, elevated liver enzymes, and low platelets
- Which adverse prenatal outcomes are associated with the HELLP syndrome? (Select all that apply.)
placental abruption
renal failure
maternal & fetal death
- A pregnant woman is being discharged from the hospital after the placement of a cervical cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix. Which information regarding postprocedural care should the nurse emphasize in the discharge teaching?
The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure should be reported.
- A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. What is the bestresponse by the nurse?
“The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, then it would make the diagnosis of this cancer more difficult.”
- The nurse is preparing to administer methotrexate to the client. This hazardous drug is most often used for which obstetric complication?
Unruptured ectopic pregnancy
- A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic procedure will the client most likely have performed?
Transvaginal ultrasound for placental location
ecchymotic blueness around the woman’s umbilicus. What does this finding indicate?
Cullen sign associated with a ruptured ectopic pregnancy
- The nurse who elects to practice in the area of women’s health must have a thorough understanding of miscarriage. Which statement regarding this condition is most accurate?
If a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as moderate discomfort and blood loss.
- A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which differential diagnosis would not be applicable for this client?
spontaneous abortion
- With regard to hemorrhagic complications that may occur during pregnancy, what information is most accurate?
An incompetent cervix is usually not diagnosed until the woman has lost one or two pregnancies.
- The management of the pregnant client who has experienced a pregnancy loss depends on the type of miscarriage and the signs and symptoms. While planning care for a client who desires outpatient management after a first-trimester loss, what would the nurse expect the plan to include?
Misoprostol
- Which laboratory marker is indicative of DIC?
Presence of fibrin split products