Midterm Flashcards
1
Q
A patient is in active labor and is being continuously monitored with a fetal monitor. The patient’s labor has been normal to this point. The patient’s membranes ruptured 1 hour ago, and the fluid was clear. The FHR baseline is 125 bpm. Contractions are occurring every 3 minutes and lasting 60 seconds, and are of moderate intensity with a soft resting tone. On entering the room, the nurse sees the patient lying supine and notices that there has been abrupt slowing in the FHR to 90 bpm during the last two contractions, each episode lasting 30 seconds or less. The patient complains of breathlessness and becomes pale and diaphoretic. What is the most appropriate nursing response?
A. Initiate oxygen therapy at 8 to 10 L/min by face mask and increase nonadditive IV fluid.
B. Reposition the patient, check blood pressure, and continue to monitor the FHR pattern.
C. Notify the practitioner and document findings in the patient’s record.
D. Notify the practitioner and prepare for cesarean delivery
A
B. Reposition the patient, check blood pressure, and continue to monitor the FHR pattern.
2
Q
Which of the following is the priority intervention for a supine patient whose monitor strip shows decelerations that begin after the peak of the contraction and return to the baseline after the contraction ends?
A. Increase IV infusion.
B. Elevate lower extremities.
C. Reposition to left side-lying position.
D. Administer oxygen per face mask at 4 to 6 L/minute.
A
C. Reposition to left side-lying position.
3
Q
What if the mom can’t turn and is laying supine?
A
place a wedge under hips to tilt the uterus
4
Q
Adequate intake of which of the following nutrients has been shown to reduce the risk of neural tube defects?
A) folic acid
B) mercury
C) vitamin D
D) vitamin C
A
A) folic acid
5
Q
A pregnant patient arrives for her first prenatal visit at the clinic. She informs the nurse that she has been taking an additional 400 mcg of folic acid prior to becoming pregnant. Based on the patient’s history, she has reached 8 weeks’ gestation. Which recommendation would the nurse provide regarding folic acid supplementation?
A. Have the patient continue to take 400 mcg folic acid throughout her pregnancy.
B. Tell the patient that she no longer has to take additional folic acid because it will be included in her prenatal vitamins.
C. Have the patient increase her folic acid intake to 1000 mcg throughout the rest of her pregnancy.
D. Schedule the patient to go for an AFP (alpha-fetoprotein) test.
A
B. Tell the patient that she no longer has to take additional folic acid because it will be included in her prenatal vitamins.
6
Q
The pregnant teen who was prescribed prenatal vitamins at her initial prenatal visit states that she does not like to take them. How should the nurse respond? SATA
A. “Folic acid has been found to be essential for minimizing the risk of neural tube defects.”
B. “You do not have to take these supplements if you think you are healthy enough.”
C. “These medications do the same thing. I will call your doctor to cancel one of your medications.”
D. “You can trust your doctor to know what you need.”
E. “You need the supplements because your dietary intake may not be adequate for fetal development.”
A
A. “Folic acid has been found to be essential for minimizing the risk of neural tube defects.”
E. “You need the supplements because your dietary intake may not be adequate for fetal development.”
7
Q
The nurse is reviewing an electronic fetal monitor tracing from a patient in active labor and notes the fetal heart rate gradually drops to 20 beats per minute (bpm) below the baseline and returns to the baseline well after the completion of the patient’s contractions. How will the nurse document these findings?
A. Late decelerations
B. Early decelerations
C. Variable decelerations
D. Proximal decelerations
A
A. Late decelerations
8
Q
What are examples of late deceleration causes and complications?
A
- Uteroplacental insufficiency causing inadequate fetal oxygenation
- Maternal hypotension, placenta previa, abruptio placentae, uterine tachysystole with oxytocin
- Preeclampsia
- Late- or post-term pregnancy
- Maternal diabetes mellitus
9
Q
What is the best nursing action to implement when late decelerations occur?
a. Reposition the patient to supine
b. Decrease flow of intravenous (IV) fluids
c. Increase oxygen to 10 L/minute
d. Prepare to increase oxytocin drip
A
c. Increase oxygen to 10 L/minute
10
Q
The nurse evaluates a pattern on the fetal monitor that appears similar to early decelerations. The deceleration begins near the acme of the contraction and continues well beyond the end of the contraction. Which nursing action indicates the proper evaluation of this situation?
A. This pattern reflects variable decelerations. No interventions are necessary at this time.
B. Document this Category I fetal heart rate pattern and decrease the rate of the intravenous (IV) fluid.
C. Continue to monitor these early decelerations, which occur as the fetal head is compressed during a contraction.
D. This deceleration pattern is associated with uteroplacental insufficiency. The nurse must act quickly to improve placental blood flow and fetal oxygen supply.
A
D. This deceleration pattern is associated with uteroplacental insufficiency. The nurse must act quickly to improve placental blood flow and fetal oxygen supply.
11
Q
What are late decelerations associated with?
A
fetal hypoxia and uterine rupture
AKA fetal distress
12
Q
What are nursing interventions for late decelerations?
A
- place pt in side-lying position
- insert an IV catheter and increase rate of IV infusion
- Discontinue oxytocin is being infused
- Administer O2 by mask 8-10 L/min via nonrebreather
- elevate pt legs
- notify hcp
13
Q
Which data found on a patient’s health history would place her at risk for an ectopic pregnancy?
A. Ovarian cyst 2 years ago
B. Recurrent pelvic infections
C. Use of oral contraceptives for 5 years
D. Heavy menstrual flow of 4 days’ duration
A
B. Recurrent pelvic infections
14
Q
What is an ectopic pregnancy? What can it lead to?
A
ovum implants in the fallopian tubes or abdominal cavity
lead to:
- fallopian tube can rupture
- extensive bleeding
15
Q
What are s/s of ectopic pregnancy?
A
-unilateral stabbing pain and tenderness in the lower abdominal quadrant
- late period 1-2 weeks, lighter than usual, or irregular
- SCANT, DARK RED, OR BROWN vaginal spotting 6-8 weeks after last normal menses
- red vaginal bleeding if rupture has occurred
-Referred shoulder pain due to blood in the peritoneal cavity
16
Q
What are s/s of a hemorrhage?
A
shock (dizziness, hypotension, pallor)
large amounts of blood
17
Q
A 35-year-old female is in labor. The baby is engaged in the pelvis. As the nurse you know that this means that the fetal station is approximately?
A. +1
B. 0
C. +2
D. -1
A
B. 0
18
Q
When the mother’s membranes rupture during active labor, the fetal heart rate should be observed for the occurrence of which periodic pattern?
A. Early decelerations
B. Variable decelerations
C. Non Periodic accelerations
D. Increase in baseline variability
A
B. Variable decelerations
19
Q
What is the most likely cause for this fetal heart rate pattern?
A. Administration of an epidural for pain relief during labor
B. Cord compression
C. Breech position of fetus
D. Administration of meperidine (Demerol) for pain relief during labor
A
B. Cord compression
20
Q
When a pattern of variable decelerations occur, the nurse should immediately
A. administer O2 at 8 to 10 L/minute.
B. place a wedge under the right hip.
C. increase the IV fluids to 150 mL/hour.
D. position patient in a knee-chest position.
A
D. position patient in a knee-chest position.
21
Q
What are examples of causes and complications of variable decelerations?
A
- umbilical cord compression
- short cord
- prolapsed cord
- nuchal cord (around fetal neck)
22
Q
Use Nägele’s rule to determine the EDD (estimated day of birth) for a patient whose last menstrual period started on April 12.
A. February 19
B. January 19
C. January 21
D. February 7
A
B. January 19
23
Q
Calculate the estimated date of birth (EDD) in October using Nägele’s rule for a patient whose last normal menstrual period (LNMP) began on January 1. Record your answer as a whole number.
A
october 8
24
Q
When a Category II pattern of the fetal heart rate is noted and the patient is lying on her left side, which nursing action is indicated?
A. Lower the head of the bed.
B. Place a wedge under the left hip.
C. Change her position to the right side.
D. Place the mother in Trendelenburg position.
A
C. Change her position to the right side.
25
Which analysis of maternal serum is the best predictor of chromosomal abnormalities in the fetus?
A. Biophysical profile
B. Multiple-marker screening
C. Lecithin-to-sphingomyelin ratio
D. Blood type and crossmatch of maternal and fetal serum
B. Multiple-marker screening
26
WHat does Maternal Serum Alpha-fetoprotein (MSAFP) test for? When is it done?
tests for NTDs (neural tube defects and down syndrome
done weeks 15-22 weeks of gestation
27
What is the term for a nonstress test in which there are two or more fetal heart rate accelerations of 15 or more beats per minute (BPM) with fetal movement in a 20-minute period?
a. Positive
b. Negative
c. Reactive
d. Nonreactive
Reactive
28
Non stress test results interpretation
ONLY REACTIVE VS NONREACTIVE
reactive = normal (if the FHR accelerates at least 15/min for at least 15 seconds and occurs two or more times during a 20 min period)
nonreactive = FHR did not accel. during fetal movement
29
A patient at 36 weeks gestation is undergoing a nonstress (NST) test. The nurse observes the fetal heart rate baseline at 135 beats per minute (bpm) and four non episodic patterns of the fetal heart rate reaching 160 bpm for periods of 20 to 25 seconds each. How will the nurse record these findings?
A. NST positive, nonreassuring
B. NST negative, reassuring
C. NST reactive, reassuring
D. NST nonreactive, nonreassuring
C. NST reactive, reassuring
30
The nurse is assessing a patient in her 37th week of pregnancy for the psychological responses commonly experienced as birth nears. Which psychological responses should the nurse expect to evaluate? (Select all that apply.)
A. The patient is excited to see her baby.
B. The patient has not started to prepare the nursery for the new baby.
C. The patient expresses concern about how to know if labor has started.
D. The patient and her spouse are concerned about getting to the birth center in time.
E. The patient and her spouse have not discussed how they will share household tasks.
A. The patient is excited to see her baby.
C. The patient expresses concern about how to know if labor has started.
D. The patient and her spouse are concerned about getting to the birth center in time.
31
What are physiological changes preceding labor?
- Backache
- Weight loss
- Lightening
- Contractions
- Increased vaginal discharge or bloody show
- Energy burst
- GI changes
- Cervical ripening
- Rupture of membranes
32
The nurse detects hypotension in a laboring patient after an epidural. Which actions should the nurse plan to implement? (Select all that apply.)
A. Encourage the patient to drink fluids.
B. Place the patient in a Trendelenburg position.
C. Administer a normal saline bolus as prescribed.
D. Administer oxygen at 8 to 10 L/minute per face mask.
E. Administer IV ephedrine in 5- to 10-mg increments as prescribed.
C. Administer a normal saline bolus as prescribed.
D. Administer oxygen at 8 to 10 L/minute per face mask.
E. Administer IV ephedrine in 5- to 10-mg increments as prescribed.
33
Which of the following behaviors would be applicable to a nursing diagnosis of “risk for injury” in a patient who is in labor?
A. Length of second-stage labor is 2 hours.
B. Patient has received an epidural for pain control during the labor process.
C. Patient is using breathing techniques during contractions to maximize pain relief.
D. Patient is receiving parenteral fluids during the course of labor to maintain
hydration.
B. Patient has received an epidural for pain control during the labor process.
34
If a mom is hypotensive after an epidural, what will the nurse do?
least invasive - reposition to left side
most invasive - bolus NS
35
To improve placental blood flow immediately after the injection of an epidural anesthetic, the nurse should
A. give the woman oxygen.
B. turn the woman to the right side.
C. decrease the intravenous infusion rate.
D. place a wedge under the woman’s right hip.
D. place a wedge under the woman’s right hip.
36
A patient in active labor requests an epidural for pain management. What is the nurse’s most appropriate intervention at this juncture?
A. Assess the fetal heart rate pattern over the next 30 minutes.
B. Take the patient’s blood pressure every 5 minutes for 15 minutes.
C. Determine the patient’s contraction pattern for the next 30 minutes.
D. Initiate an IV infusion of lactated Ringer’s solution at 2000 mL/hour over 30 minutes.
D. Initiate an IV infusion of lactated Ringer’s solution at 2000 mL/hour over 30 minutes.
37
The nurse detects hypotension in a laboring patient after an epidural. Which actions should the nurse plan to implement? (Select all that apply.)
A. Encourage the patient to drink fluids.
B. Place the patient in a Trendelenburg position.
C. Administer a normal saline bolus as prescribed.
D. Administer oxygen at 8 to 10 L/minute per face mask.
E. Administer IV ephedrine in 5- to 10-mg increments as prescribed.
C. Administer a normal saline bolus as prescribed.
D. Administer oxygen at 8 to 10 L/minute per face mask.
E. Administer IV ephedrine in 5- to 10-mg increments as prescribed.
38
If the pt is experiencing hypotension and has a fever and itching with an epidural, what is your
priority intervention? What do you intervene with first? BP, temp, itching etc.
ABCs
39
The nurse detects hypotension in a laboring patient after an epidural. Which actions should the nurse plan to implement? (Select all that apply.)
a. Encourage the patient to drink fluids.
b. Place the patient in a Trendelenburg position.
c. Administer a normal saline bolus as prescribed.
d. Administer oxygen at 8 to 10 L/minute per face mask.
e. Administer IV ephedrine in 5- to 10-mg increments as prescribed.
c. Administer a normal saline bolus as prescribed.
d. Administer oxygen at 8 to 10 L/minute per face mask.
e. Administer IV ephedrine in 5- to 10-mg increments as prescribed.
40
The nurse is monitoring a patient in the active stage of labor. Which conditions associated with fetal compromise should the nurse monitor? (Select all that apply.)
a. Maternal hypotension
b. Fetal heart rate of 140 to 150 bpm
c. Meconium-stained amniotic fluid
d. Maternal fever—38C (100.4F) or higher
e. Complete uterine relaxation of more than 30 seconds between contractions
a. Maternal hypotension
c. Meconium-stained amniotic fluid
d. Maternal fever—38C (100.4F) or higher
41
Do we give rubella during pregnancy?
Naur give it after
42
A pregnant patient reports that she works in a long-term care setting and is concerned about the impending flu season. She asks about receiving the flu vaccine. As the nurse, you are aware that some immunizations are safe to administer during pregnancy, whereas others are not. Which vaccines could this patient receive? (Select all that apply.)
A. Tetanus
B. Varicella
C. Influenza
D. Hepatitis A and B
E. Measles, mumps, rubella (MMR)
A. Tetanus
C. Influenza
D. Hepatitis A and B
43
Which vaccinations are contraindicated for pregnancy?
live virus vaccines
MMR, varicella (chickenpox), or smallpox
44
Which vaccinations are indicated for the postpartum patient if she does not have immunity? (Select all that apply.)
A. Pertussis
B. Rubella
C. Diphtheria, tetanus (Tdap)
D. RhoGAM
E. Varicella
A. Pertussis
B. Rubella
C. Diphtheria, tetanus (Tdap)
E. Varicella
45
What is a classic sign of placenta previa?
sudden onset
bright red vaginal bleeding 2nd or 3rd tri
46
Which assessment by the nurse would differentiate a placenta previa from an abruptio placentae?
a. Saturated perineal pad in 1 hour
b. Pain level 0 on a scale of 0 to 10
c. Cervical dilation at 2 cm
d. Fetal heart rate at 160 bpm
b. Pain level 0 on a scale of 0 to 10
47
Which assessment in a patient diagnosed with preeclampsia who is taking magnesium sulfate would indicate a therapeutic level of medication?
A. Drowsiness
B. Urinary output of 20 mL/hour
C. Normal deep tendon reflexes
D. Respiratory rate of 10 to 12 breaths per minute
C. Normal deep tendon reflexes
48
A patient taking magnesium sulfate has a respiratory rate of 10 breaths per minute. In addition to discontinuing the medication, which action should the nurse take?
a. Increase the patient’s IV fluids.
b. Administer calcium gluconate.
c. Vigorously stimulate the patient.
d. Instruct the patient to take deep breaths.
b. Administer calcium gluconate.
49
The nurse is monitoring a patient with severe preeclampsia who is on IV magnesium sulfate. Which signs of magnesium toxicity should the nurse monitor for? (Select all that apply.)
A. Cool, clammy skin
B. Altered sensorium
C. Pulse oximeter reading of 95%
D. Respiratory rate of less than 12 breaths per minute
E. Absence of deep tendon reflexes
B. Altered sensorium
D. Respiratory rate of less than 12 breaths per minute
E. Absence of deep tendon reflexes
50
A labor and birth nurse receives a call from the laboratory regarding a preeclamptic patient receiving an IV infusion of magnesium sulfate. The laboratory technician reports that the patient’s magnesium level is 7.6 mg/dL. What is the nurse’s priority action?
a. Stop the infusion of magnesium.
b. Assess the patient’s respiratory rate.
c. Assess the patient’s deep tendon reflexes.
d. Notify the health care provider of the magnesium level.
b. Assess the patient’s respiratory rate.
51
What is the therapeutic level for magnesium?
4-8 mg/dL
52
What are the s/s of magnesium toxicity?
- RR < 12
- Maternal 02 <95%
- Absence of deep tendon reflexes
- Sweating, flushing
- Altered sensorium (confused, lethargic, slurred speech, drowsy, disoriented)
- Hypotension
53
If pt is experiencing mag toxicity what id the first thing you do?
Stop mag infusion
54
The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum is to determine whether the fetus has which condition?
A. Hemophilia
B. Sickle cell anemia
C. A neural tube defect
D. Abnormal lecithin-to-sphingomyelin ratio
C. A neural tube defect
55
A patient who smokes one pack of cigarettes daily has a positive pregnancy test. The nurse will explain that smoking during pregnancy increases the risk of which condition?
A. Congenital anomalies
B. Death before or after birth
C. Neonatal hypoglycemia
D. Neonatal withdrawal syndrome
B. Death before or after birth
56
Which effect is a common response to both smoking and cocaine use in the pregnant patient?
a. Vasoconstriction
b. Increased appetite
c. Increased metabolism
d. Changes in insulin metabolism
a. Vasoconstriction
57
Which is the most dangerous effect on the fetus of a patient who smokes cigarettes while pregnant?
A. Intrauterine growth restriction
B. Genetic changes and anomalies
C. Extensive central nervous system damage
D. Fetal addiction to the substance inhaled
A. Intrauterine growth restriction
58
If a baby is in breech presentation where should fetal heart tones be assessed?
above the umbilicus in either R or L upper quadrant of abd
use Leopold maneuvers
59
What maternal condition puts her at risk for placental abruption?
Preeclampsia
60
A laboring patient has asked the nurse to assist her in utilizing a cutaneous stimulation strategy for pain management. The nurse would
A. assist her into the shower.
B. apply a heat pack to lower back.
C. help her to create a relaxing mental scene.
D. encourage cleansing breaths and slow-paced breathing.
B. apply a heat pack to lower back.
61
A relaxation technique that can be used during the childbirth experience to decrease maternal pain perception is
A. using increased environmental stimulation as a method of distraction.
B. restricting family and friends from visiting during the labor period to keep the
patient focused on breathing techniques.
C. medicating the patient frequently to reduce pain perception.
D. assisting the patient in breathing methods aimed at taking control of pain perception based on the contraction pattern.
D. assisting the patient in breathing methods aimed at taking control of pain perception based on the contraction pattern.
62
Which method of pain management would be safest for a gravida 3, para 2, admitted at 8 cm cervical dilation?
A. Narcotics
B. Spinal block
C. Epidural anesthesia
D. Breathing and relaxation techniques
D. Breathing and relaxation techniques
63
The nurse is teaching a childbirth education class. Which information regarding excessive pain in labor should the nurse include in the session?
a. It usually results in a more rapid labor.
b. It has no effect on the outcome of labor.
c. It is considered to be a normal occurrence.
d. It may result in decreased placental perfusion.
d. It may result in decreased placental perfusion.
64
What are cognitive strategies?
- childbirth education and preparation
- promoting relaxation and breathing exercises
- Hypnosis
- Biofeedback
65
What are sensory stimulation strategies?
- aromatherapy
- breathing techniques
- imagery
- music
- use of focal points
- subdued lighting
66
Which fetal position may cause the laboring patient increased back discomfort?
A. Left occiput anterior
B. Left occiput posterior
C. Right occiput anterior
D. Right occiput transverse
B. Left occiput posterior
67
A 35-year-old patient has an amniocentesis performed to identify whether her baby has a chromosomal defect. Which statement indicates that the patient understands the situation?
A. “The doctor will tell me if I should have an abortion when the test results come back.”
B. “When all the lab results come back, my husband and I will make a decision about the pregnancy.”
C. “My mother must not find out about all this testing. If she does, she will think I’m having an abortion.”
D. “I know there are support groups for parents who have a baby with birth defects, but we have plenty of insurance to cover what we need.”
B. “When all the lab results come back, my husband and I will make a decision about the pregnancy.”
68
What is the purpose of amniocentesis for a patient hospitalized at 34 weeks of gestation with pregnancy- induced hypertension?
A. Determine if a metabolic disorder exists.
B. Identify the sex of the fetus.
C. Identify abnormal fetal cells.
D. Determine fetal lung maturity.
D. Determine fetal lung maturity.
69
The patient presenting at 38 weeks’ gestation, gravida 1, para 0, vaginal exam 4 cm, 100% effaced, +1 station vertex. What is the most likely intervention for this fetal heart rate pattern?
A. Continue oxytocin (Pitocin) infusion.
B. Contact the anesthesia department for epidural administration.
C. Change maternal position.
D. Administer Narcan to patient and prepare for immediate vaginal delivery.
C. Change maternal position.
70
Rh incompatibility can occur if the patient is Rh-negative and the
A. fetus is Rh-negative.
B. fetus is Rh-positive.
C. father is Rh-positive.
D. father and fetus are both Rh-negative.
B. fetus is Rh-positive.
71
Fraternal twins are delivered by your Rh-negative patient. Twin A is Rh-positive and twin B is Rh- negative. Prior to administering Rho(D) immune globulin (RhoGAM), the nurse should determine the results of the
A. direct Coombs test of twin A.
B. direct Coombs test of twin B.
C. indirect Coombs test of the mother.
D. transcutaneous bilirubin level for both twins.
C. indirect Coombs test of the mother.
72
An infant is diagnosed with fetal anemia. Which information would support this clinical diagnosis?
A. Presence of excess maternal hormones
B. Maternal blood type O-negative, Rh-negative, and infant blood type O-negative, Rh-negative
C. Passive immunity
D. Rh-negative mother and Rh-positive baby
C. Passive immunity
73
When is Rhogam administered?
Administer RhO9D immune globulin IM around 28 weeks gestation for clients who are Rh negative
74
An expectant mother, diagnosed with oligohydramnios, asks the nurse what this condition means for the baby. Which statement should the nurse provide for the patient?
A. Oligohydramnios can cause poor fetal lung development.
B. Oligohydramnios means that the fetus is excreting excessive urine.
C. Oligohydramnios could mean that the fetus has a gastrointestinal blockage.
D. Oligohydramnios is associated with fetal central nervous system abnormalities.
A. Oligohydramnios can cause poor fetal lung development.
75
A patient with polyhydramnios is admitted to a labor-birth-recovery-postpartum (LDRP) suite. Her membranes rupture and the fluid is clear and odorless; however, the fetal heart monitor indicates bradycardia and variable decelerations. Which action should be taken next?
A. Perform Leopold maneuvers.
B. Perform a vaginal examination.
C. Apply warm saline soaks to the vagina.
D. Place the patient in a high Fowler position.
B. Perform a vaginal examination.
76
What is oligohydramnios?
SCANT AMOUNT OR ABSENCE OF AMNIOTIC FLUID
77
What is hydramnios?
excessive amniotic fluid
78
What is polyhydramnios?
overdistended the uterus, creating a high risk for induction
79
What can a GDM mom take?
Oral hypoglycemic therapy
limit use of glyburide
80
Which of the following behaviors would be applicable to a nursing diagnosis of “risk for injury” in a patient who is in labor?
A. Length of second-stage labor is 2 hours.
B. Patient has received an epidural for pain control during the labor process.
C. Patient is using breathing techniques during contractions to maximize pain relief. D. Patient is receiving parenteral fluids during the course of labor to maintain
hydration.
B. Patient has received an epidural for pain control during the labor process.
81
What are s/s of preclampsia?
headache unrelieved by meds
proteinuria
edema
maternal hypotension
82
The nurse is teaching a pregnant patient about signs of possible pregnancy complications. Which should the nurse include in the teaching plan? (Select all that apply.)
A. Report watery vaginal discharge.
B. Report puffiness of the face or around the eyes.
C. Report any bloody show when you go into labor.
D. Report visual disturbances, such as spots before the eyes.
E. Report any dependent edema that occurs at the end of the day
A. Report watery vaginal discharge.
B. Report puffiness of the face or around the eyes.
D. Report visual disturbances, such as spots before the eyes.
83
Which complaint made by a patient at 35 weeks of gestation requires additional assessment?
A. Abdominal pain
B. Ankle edema in the afternoon
C. Backache with prolonged standing
D. Shortness of breath when climbing stairs
A. Abdominal pain
84
The clinic nurse is performing a prenatal assessment on a pregnant patient at risk for preeclampsia. Which clinical sign would NOT present as a symptom of preeclampsia?
a. Edema
b. Proteinuria
c. Glucosuria
d. Hypertension
c. Glucosuria
85
A patient with preeclampsia is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate
A. gastrointestinal upset.
B. effects of magnesium sulfate.
C. anxiety caused by hospitalization.
D. worsening disease and impending convulsion.
D. worsening disease and impending convulsion.
86
With spinal anesthesia block, what will the nurse do?
help mom w/ reposition
laterally if possible
87
What is indicated if there is painless bright red bleeding?
placenta previa
88
If a patient has large amounts of bleeding, do we do a vaginal birth?
NO do a C section
89
Which routine nursing assessment is contraindicated for a patient admitted with suspected placenta previa?
A. Determining cervical dilation and effacement
B. Monitoring FHR and maternal vital signs
C. Observing vaginal bleeding or leakage of amniotic fluid
D. Determining frequency, duration, and intensity of contractions
A. Determining cervical dilation and effacement
90
Which maternal condition always necessitates delivery by cesarean birth?
A. Partial abruptio placentae
B. Total placenta previa
C. Ectopic pregnancy
D. Eclampsia
B. Total placenta previa
91
The nurse is preparing a patient for a cesarean birth scheduled to be performed under general anesthesia. Which should the nurse plan to administer, if ordered by the health care provider, to prevent aspiration of gastric contents? (Select all that apply.)
A. Citric acid (Bicitra)
B. Ranitidine (Zantac)
C. Hydroxyzine (Vistaril)
D. Glycopyrrolate (Robinul)
E. Promethazine (Phenergan)
A. Citric acid (Bicitra)
B. Ranitidine (Zantac)
D. Glycopyrrolate (Robinul)
92
If a patient has placenta previa, what is done?
give IV meds and blood products
corticosteroids
93
What is the best explanation that the nurse can provide to a patient who is concerned that she has “pseudoanemia” of pregnancy?
A. Have her write down her concerns and tell her that you will ask the physician to respond once the lab results have been evaluated.
B. Tell her that this is a benign self-limiting condition that can be easily corrected by switching to a high-iron diet.
C. Inform her that because of the pregnancy, her blood volume has increased, leading
to a substantial dilution effect on her serum blood levels, and that most women experience this condition.
D. Contact the physician and get a prescription for iron pills to correct this condition.
C. Inform her that because of the pregnancy, her blood volume has increased, leading
to a substantial dilution effect on her serum blood levels, and that most women experience this condition.
94
In order to increase the absorption of iron by a pregnant patient, which beverage should an iron preparation be given with?
A. Tea
B. Milk
C. Coffee
D. Orange juice
D. Orange juice
95
The traditional diet of Asian women includes little meat and few dairy products and may be low in calcium and iron. The nurse can assist a patient increase her intake of these foods by which action?
A. Suggest that she eat more tofu, bok choy, and broccoli.
B. Suggest that she eat more hot foods during pregnancy.
C. Emphasize the need for increased milk intake during pregnancy.
D. Tell her husband that she must increase her intake of fruits and vegetables for the
baby’s sake.
A. Suggest that she eat more tofu, bok choy, and broccoli.
96
A pregnant patient with significant iron-deficiency anemia is prescribed iron supplements. The patient explains to the nurse that she cannot take iron because it makes her nauseous. What is the best response by the nurse?
A. “Iron will be absorbed more readily if taken with orange juice.”
B. “It is important to take this drug regardless of this side effect.”
C. “Taking the drug with milk may decrease your symptoms.”
D. “Try taking the iron at bedtime on an empty stomach.”
D. “Try taking the iron at bedtime on an empty stomach.”
97
When should iron supplementation during a normal pregnancy begin?
A. Before pregnancy
B. In the first trimester
C. In the third trimester
D. In the second trimester
D. In the second trimester
98
What is an expecting finding of low iron?
fatigue
weakness
pica
99
How much iron is recommended for pregnancy?
27mg/day
100
What is the definition of true labor?
cervical change
101
To determine if the patient is in true labor, the nurse would assess for changes in
A. cervical dilation.
B. amount of bloody show.
C. fetal position and station.
D. pattern of uterine contractions.
A. cervical dilation.
102
The clinic nurse is obtaining a health history on a newly pregnant patient. Which is an indication for fetal diagnostic procedures if present in the health history?
A. Maternal diabetes
B. Weight gain of 25 lb
C. Maternal age older than 30 years
D. Previous infant weighing more than 3000 g at birth
A. Maternal diabetes
103
Which factor is known to increase the risk of gestational diabetes mellitus?
A. Previous birth of large infant
B. Maternal age younger than 25 years
C. Underweight prior to pregnancy
D. Previous diagnosis of type 2 diabetes mellitus
A. Previous birth of large infant
104
What is associated with excess weight gain during pregnancy?
Prolonged labor and gestational diabetes
105
The nurse is providing care to a patient who was just admitted to the labor and birth unit in active labor at term. The patient informed the nurse, “I have not received any prenatal care because I cannot afford to go to the doctor. And, this is my third baby, so I know what to expect.” What is the nurse’s primary concern when developing the patient’s plan of care?
A. Low birth weight
B. Oligohydramnios
C. Gestational diabetes
D. Gestational hypertension
A. Low birth weight
106
A nurse is reviewing evidence-based teaching and learning principles. Which situation is most conducive to learning with patients of other cultures?
A. An auditorium is being used as a classroom for 300 students.
B. A teacher who speaks very little Spanish is teaching a class of Hispanic students.
C. A class is composed of students of various ages and educational backgrounds.
D. An Asian nurse provides nutritional information to a group of pregnant Asian women.
D. An Asian nurse provides nutritional information to a group of pregnant Asian women.
107
The health care provider reports that the primigravida’s fundus can be palpated at the umbilicus. Which priority question will the nurse include in the patient’s assessment?
A. “Have you noticed that it is easier for you to breathe now?”
B. “Would you like to hear the baby’s heartbeat for the first time?”
C. “Have you felt a fluttering sensation in your lower pelvic area yet?”
D. “Have you recently developed any unusual cravings, such as for chalk or dirt?”
C. “Have you felt a fluttering sensation in your lower pelvic area yet?”
108
When planning a healthy diet with a pregnant patient, what should the nurse’s first action be?
A. Teach the patient about MyPlate.
B. Review the patient’s current dietary intake.
C. Instruct the patient to limit the intake of fatty foods.
D. Caution the patient to avoid large doses of vitamins, especially those that are fat-soluble.
B. Review the patient’s current dietary intake.
109
A pregnant woman of normal weight enters her 13th week of pregnancy. If the patient eats and exercises as directed, what will the nurse anticipate as the ongoing weight gain for the remaining trimesters?
A. 0.3 lb every week
B. 1 lb every week
C. 1.8 lb every week
D. 2 lb every week
B. 1 lb every week
110
To facilitate adequate urinary elimination during the postpartum period, the nurse should incorporate which intervention into the plan of care?
A. Have the patient drink carbonated beverages to promote urinary excretion.
B. Tell the patient that because of postpartum diuresis there is less risk to develop
dehydration.
C. Limit fluid intake to prevent polyuria.
D. Teach the patient to perform pelvic floor exercises to combat potential stress incontinence.
D. Teach the patient to perform pelvic floor exercises to combat potential stress incontinence.
111
Changes in the diet of the pregnant patient who has phenylketonuria would include
A. adding foods high in vitamin C.
B. eliminating drinks containing aspartame.
C. restricting protein intake to <20 g a day.
D. increasing caloric intake to at least 1800 cal/day.
B. eliminating drinks containing aspartame.
112
What is seen in abruptio placentae?
dark red bleeding
sudden onset intense localized pain
113
Which finding would indicate concealed hemorrhage in abruptio placentae?
A. Bradycardia
B. Hard boardlike abdomen
C. Decrease in fundal height
D. Decrease in abdominal pain
B. Hard boardlike abdomen
114
What needs to happen in order for internal monitoring to be placed?
a rupture
115
Which maternal condition should be considered a contraindication for the application of internal monitoring devices?
A. Unruptured membranes
B. Cervix dilated to 4 cm
C. Fetus has known heart defect
D. Maternal HIV
A. Unruptured membranes
116
Which kind of decel mirrors uterine contractions?
early decelerations
117
When the deceleration pattern of the fetal heart rate mirrors the uterine contraction, which nursing action is indicated?
A. Reposition the patient.
B. Apply a fetal scalp electrode.
C. Record this normal pattern.
D. Administer oxygen by nasal cannula.
C. Record this normal pattern.
118
Is a early decelerations bad for baby?
no fetal compromise
no intervention
119
What increases 40-60%
blood volume
120
What is the physiologic reason for vascular volume increasing by 40% to 60% during pregnancy?
A. Prevents maternal and fetal dehydration
B. Eliminates metabolic wastes of the mother
C. Provides adequate perfusion of the placenta
D. Compensates for decreased renal plasma flow
C. Provides adequate perfusion of the placenta
121
Physiologic anemia often occurs during pregnancy due to
A. inadequate intake of iron.
B. the fetus establishing iron stores.
C. dilution of hemoglobin concentration.
D. decreased production of erythrocytes.
C. dilution of hemoglobin concentration.
122
You are performing assessments for an obstetric patient who is 5 months pregnant with her third child. Which finding would cause you to suspect that the patient was at risk?
A. Patient states that she doesn’t feel any Braxton Hicks contractions like she had in her prior pregnancies.
B. Fundal height is below the umbilicus.
C. Cervical changes, such as Goodell’s sign and Chadwick’s sign, are present.
D. She has increased vaginal secretions.
B. Fundal height is below the umbilicus.
123
What is the term for a nonstress test in which there are two or more fetal heart rate accelerations of 15 or more beats per minute (BPM) with fetal movement in a 20-minute period?
a. Positive
b. Negative
c. Reactive
d. Nonreactive
c. Reactive
124
A patient at 36 weeks gestation is undergoing a nonstress (NST) test. The nurse observes the fetal heart rate baseline at 135 beats per minute (bpm) and four nonepisodic patterns of the fetal heart rate reaching 160 bpm for periods of 20 to 25 seconds each. How will the nurse record these findings?
A. NST positive, nonreassuring
B. NST negative, reassuring
C. NST reactive, reassuring
D. NST nonreactive, nonreassuring
C. NST reactive, reassuring
125
Which finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole?
A. Blood pressure of 120/80 mm Hg
B. Complaint of frequent mild nausea
C. Fundal height measurement of 18 cm
D. History of bright red spotting for 1 day weeks ago
C. Fundal height measurement of 18 cm
126
The nurse is reviewing the instructions given to a patient at 24 weeks’ gestation for a glucose challenge test (GCT). The nurse determines that the patient understands the teaching when she makes which statement?
A. “I have to fast the night before the test.”
B. “I will drink a sugary solution containing 100 g of glucose.”
C. “I will have blood drawn at 1 hour after I drink the glucose solution.”
D. “I should keep track of my baby’s movements between now and the test.”
C. “I will have blood drawn at 1 hour after I drink the glucose solution.”
127
Describe HELLP syndrome
Hemolysis
Elevated Liver enzyme levels
Low Platelet count
platelet count of 50,000/mcL indicates thrombocytopenia
128
Which intrapartal assessment should be avoided when caring for a patient with HELLP syndrome?
A. Abdominal palpation
B. Venous sample of blood
C. Checking deep tendon reflexes
D. Auscultation of the heart and lungs
A. Abdominal palpation
129
Which finding is a positive sign of pregnancy?
A. Amenorrhea
B. Breast changes
C. Fetal movement felt by the woman
D. Visualization of fetus by ultrasound
D. Visualization of fetus by ultrasound
130
Which findings are presumptive signs of pregnancy? (Select all that apply.)
A. Quickening
B. Amenorrhea
C. Ballottement
D. Goodell’s sign
E. Chadwick’s sign
A. Quickening
B. Amenorrhea
E. Chadwick’s sign
131
Which nursing assessment indicates that a patient who is in the second stage of labor is almost ready to give birth?
A. Bloody mucous discharge increases.
B. The vulva bulges and encircles the fetal head.
C. The membranes rupture during a contraction.
D. The fetal head is felt at 0 station during the vaginal examination.
B. The vulva bulges and encircles the fetal head.
132
What medication softens the cervix?
misoprostol
inserted
133
The nurse is preparing to administer a vaginal prostaglandin preparation to ripen the cervix of her patient. With which patient should the nurse question the use of vaginal prostaglandin as a cervical ripening agent?
A. The patient who has a Bishop’s score of 5
B. The patient who is at 42 weeks of gestation
C. The patient who had a previous low transverse cesarean birth
D. The patient who had previous surgery in the upper uterus
D. The patient who had previous surgery in the upper uterus
134
The nurse is preparing supplies for an amnioinfusion on a patient with intact membranes. Which supplies should the nurse gather? (Select all that apply.)
A. Extra underpads
B. Solution of 3% normal saline
C. Amniotic hook to perform an amniotomy
D. Solid intrauterine pressure catheter with a pressure transducer on its tip
A. Extra underpads
C. Amniotic hook to perform an amniotomy
135
What happens for an amnioinfusion to happen?
membranes ruptures
cord compression
136
What happens for an amniocentesis to happen?
membranes have not ruptured
137
If a mom is bleeding, do you stick your fingers in to do a vaginal exam?
NOOO
138
When the water breaks what are we looking for, what are we assessing?
Drainage, color, odor
139
Which routine nursing assessment is contraindicated for a patient admitted with suspected placenta previa?
A. Determining cervical dilation and effacement
B. Monitoring FHR and maternal vital signs
C. Observing vaginal bleeding or leakage of amniotic fluid
D. Determining frequency, duration, and intensity of contractions
A. Determining cervical dilation and effacement
140
What are impending signs of labor?
Backache
Weight loss
Lightening Contractions
Increased vaginal discharge or bloody show
Energy burst
GI Changes
Cervical ripening Rupture of membranes
Assessment of amniotic fluid
141
A 28-year-old gravida 1, para 0 patient who is at term calls the labor and birth unit stating that she thinks she is in labor. She states that she does have some vaginal discharge and feels wet; however, it is not bloody in nature. She relates a contraction pattern that is irregular, ranging from 5 to 7 minutes and lasting 30 seconds. Which questions should the nurse pose to the patient during this telephone triage? (Select all that apply.)
A. Does she think that her membranes have ruptured?
B. Is there any evidence of bloody show?
C. Instruct the patient to keep monitoring her contraction pattern and call you back if
they become more regular.
D. When is her next scheduled visit with her health care provider?
E. Tell her to come into the hospital for evaluation.
A. Does she think that her membranes have ruptured?
E. Tell her to come into the hospital for evaluation.
142
Which information is covered by early pregnancy classes offered in the first and second trimesters?
A. Methods of pain relief
B. The phases and stages of labor
C. Coping with common discomforts of pregnancy
D. Prebirth and postbirth care of a patient having a cesarean birth
C. Coping with common discomforts of pregnancy
143
A patient asks the nurse how she can tell if labor is real. Which information should the nurse provide to this patient? (Select all that apply.)
A. In true labor, the cervix begins to dilate.
B. In true labor, the contractions are felt in the abdomen and groin.
C. In true labor, contractions often resemble menstrual cramps during early labor.
D. In true labor, contractions are inconsistent in frequency, duration, and intensity in
the early stages.
E. In true labor your contractions tend to increase in frequency, duration, and intensity with walking.
A. In true labor, the cervix begins to dilate.
C. In true labor, contractions often resemble menstrual cramps during early labor.
E. In true labor your contractions tend to increase in frequency, duration, and intensity with walking.
144
The nurse is planning care for a patient during the fourth stage of labor. Which interventions should the nurse plan to implement? (Select all that apply.)
A. Offer the patient a warm blanket.
B. Place an ice pack on the perineum.
C. Massage the uterus if it is boggy.
D. Delay breastfeeding until the patient is rested.
E. Explain to the patient that the lochia will be light pink in color.
A. Offer the patient a warm blanket.
B. Place an ice pack on the perineum.
C. Massage the uterus if it is boggy.
145
VEAL
CHOP
Variable decels
Early decels (mirror contractions)
Acceleration
Late decels
Cord compression
Head compression
Ok
Placenta previa
146
Why is mag sulfate given?
for preeclampsia to reduce risk of seizures
147
A patient with preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is a
a. diuretic.
b. tocolytic.
c. anticonvulsant.
d. antihypertensive.
c. anticonvulsant.
148
Which clinical intervention is the only known cure for preeclampsia?
A. Magnesium sulfate
B. Delivery of the fetus
C. Antihypertensive medications
D. Administration of aspirin (ASA) every day of the pregnancy
B. Delivery of the fetus
149
What is oxytocin (pitocin) used for?
induction of labor
delivery of placenta
mngmt of postpartum hemorrhage
stress testing
150
What should be monitored with oxytocin (pitocin)?
BP
RR
HR every 30-60 min
uterine contractions
