Flashcards in OB EXAM 3--TEST BANK QUESTIONS Deck (141):
1. 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
3. 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
4. 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?
5. 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
6. 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?
8. 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.”
9. 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?
10. Of these psychosocial factors, which has the least negative effect on the health of the mother and/or fetus?
moderate coffee consumption
12. 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.
13. Which clinical finding is a major use of ultrasonography in the first trimester?
Presence of maternal abnormalities
14. Which information is the highest priority for the nurse to comprehend regarding the BPP?
BPP is an accurate indicator of impending fetal well-being.
15. 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.
17. The nurse is planning the care for a laboring client with diabetes mellitus. This client is at greater risk for which clinical finding?
is a screening tool only; it identifies candidates for more definitive diagnostic procedures
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?
20. 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.”
21. Which analysis of maternal serum may predict chromosomal abnormalities in the fetus?
22. 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)?
23. Which nursing intervention is necessary before a first-trimester transabdominal ultrasound?
Instruct the woman to drink 1 to 2 quarts of water.
24. 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?
1. IUGR is associated with which pregnancy-related risk factors? (Select all that apply.)
Maternal collagen disease
IUGR is not associated with?
premature rupture of membranes
2. Which assessments are included in the fetal BPP? (Select all that apply.)
Fetal heart rate
Which assessments is not included in the fetal BPP?
3. 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.)
transvaginal ultrasounds don't check for?
amniotic fluid volume
1. 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
2. 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
3. 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
4. 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
5. 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?
6. 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.”
7. 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
8. 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.”
9. 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
10. Which statement best describes chronic hypertension?
Chronic hypertension can occur independently of or simultaneously with preeclampsia.
11. 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.
12. What is the primary purpose for magnesium sulfate administration for clients with preeclampsia and eclampsia?
To prevent convulsions
13. 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
14. 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?
15. Which neonatal complications are associated with hypertension in the mother?
Intrauterine growth restriction (IUGR) and prematurity
17. 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?
18. 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
19. What is the most common medical complication of pregnancy?
20. Which statement most accurately describes the HELLP syndrome?
Characterized by hemolysis, elevated liver enzymes, and low platelets
1. Which adverse prenatal outcomes are associated with the HELLP syndrome? (Select all that apply.)
maternal & fetal death
1. 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.
2. 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.”
3. The nurse is preparing to administer methotrexate to the client. This hazardous drug is most often used for which obstetric complication?
Unruptured ectopic pregnancy
4. 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
7. 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.
8. A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which differential diagnosis would not be applicable for this client?
9. 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.
10. 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?
11. Which laboratory marker is indicative of DIC?
Presence of fibrin split products
12. When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of gestation)?
13. In caring for an immediate postpartum client, the nurse notes petechiae and oozing from her intravenous (IV) site. The client would be closely monitored for which clotting disorder?
14. In caring for the woman with DIC, which order should the nurse anticipate?
Administration of blood
16. In contrast to placenta previa, what is the most prevalent clinical manifestation of abruptio placentae?
Intense abdominal pain
17. Which maternal condition always necessitates delivery by cesarean birth?
Complete placenta previa
18. What is the correct definition of a spontaneous termination of a pregnancy (abortion)?
Pregnancy is less than 20 weeks.
19. What is the correct terminology for an abortion in which the fetus dies but is retained within the uterus?
20. What condition indicates concealed hemorrhage when the client experiences abruptio placentae?
Hard, boardlike abdomen
21. What is the highest priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy?
Assessing FHR and maternal vital signs
23. Which finding on a prenatal visit at 10 weeks of gestation might suggest a hydatidiform mole?
Fundal height measurement of 18 cm
24. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Which information assists the nurse in developing the plan of care?
Hemorrhage is the primary concern.
What are possible causes of early miscarriage? (Select all that apply.)
what is not a cause of early miscarriage
The nurse suspects that a client has early signs of ectopic pregnancy. The nurse should be observing the client for which signs or symptoms? (Select all that apply.)
Vaginal spotting or light bleeding
1. Preconception counseling is critical in the safe management of diabetic pregnancies. Which complication is commonly associated with poor glycemic control before and during early pregnancy?
Congenital anomalies in the fetus
2. During a prenatal visit, the nurse is explaining dietary management to a woman with pregestational diabetes. Which statement by the client reassures the nurse that teaching has been effective?
“Diet and insulin needs change during pregnancy.”
3. Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the client mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. This fetus is at the greatest risk for which condition?
6. The nurse who is caring for a woman hospitalized for hyperemesis gravidarum would expect the initial treatment to involve what?
Intravenous (IV) therapy to correct fluid and electrolyte imbalances
7. In terms of the incidence and classification of diabetes, which information should the nurse keep in mind when evaluating clients during their ongoing prenatal appointments?
Type 2 diabetes often goes undiagnosed.
9. Which statement concerning the complication of maternal diabetes is the most accurate?
Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
10. Which statement regarding the laboratory test for glycosylated hemoglobin Alc is correct?
This laboratory test measures the levels of hemoglobin Alc, which should remain at less than 7%.
12. An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends. This young woman appears more concerned about how her pregnancy will affect her social life than her recent diagnosis of diabetes. A number of nursing diagnoses are applicable to assist in planning adequate care. What is the most appropriate diagnosis at this time?
Deficient knowledge, related to diabetic pregnancy management
13. A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. The client shows the nurse her readings for the past few days. Which reading signals the nurse that the client may require an adjustment of insulin or carbohydrates?
50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.
14. Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?
15. Which preexisting factor is known to increase the risk of GDM?
Previous birth of large infant
16. Which physiologic alteration of pregnancy most significantly affects glucose metabolism?
Placental hormones are antagonistic to insulin, thus resulting in insulin resistance.
17. To manage her diabetes appropriately and to ensure a good fetal outcome, how would the pregnant woman with diabetes alter her diet?
Eat her meals and snacks on a fixed schedule.
3. Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Over time, diabetes causes significant changes in the microvascular and macrovascular circulations. What do these complications include? (Select all that apply.)
1. When caring for a pregnant woman with cardiac problems, the nurse must be alert for the signs and symptoms of cardiac decompensation. Which critical findings would the nurse find on assessment of the client experiencing this condition?
Dyspnea, crackles, and an irregular, weak pulse
3. Which information should the nurse take into consideration when planning care for a postpartum client with cardiac disease?
The plan of care includes rest, stool softeners, and monitoring of the effect of activity.
4. A woman has experienced iron deficiency anemia during her pregnancy. She had been taking iron for 3 months before the birth. The client gave birth by cesarean 2 days earlier and has been having problems with constipation. After assisting her back to bed from the bathroom, the nurse notes that the woman’s stools are dark (greenish-black). What should the nurse’s initial action be?
Recognize the finding as a normal result of iron therapy.
5. A woman with asthma is experiencing a postpartum hemorrhage. Which drug should be avoided when treating postpartum bleeding to avoid exacerbating asthma?
9. Which information regarding the care of antepartum women with cardiac conditions is most important for the nurse to understand?
Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms.
10. A woman at 28 weeks of gestation experiences blunt abdominal trauma as the result of a fall. The nurse must closely observe the client for what?
11. Which neurologic condition would require preconception counseling, if at all possible?
13. What form of heart disease in women of childbearing years generally has a benign effect on pregnancy?
Mitral valve prolapse
14. A pregnant woman at 33 weeks of gestation is brought to the birthing unit after a minor automobile accident. The client is experiencing no pain and no vaginal bleeding, her vital signs are stable, and the FHR is 132 beats per minute with variability. What is the nurse’s highest priority?
Using continuous EFM for a minimum of 4 hours
18. It is extremely rare for a woman to die in childbirth; however, it can happen. In the United States, the annual occurrence of maternal death is 12 per 100,000 cases of live birth. What are the leading causes of maternal death?
Trauma and motor vehicle accidents (MVAs)
1. Which congenital anomalies can occur as a result of the use of antiepileptic drugs (AEDs) in pregnancy? (Select all that apply.)
Congenital heart disease
Neural tube defects
3. In caring for a pregnant woman with sickle cell anemia, the nurse must be aware of the signs and symptoms of a sickle cell crisis. What do these include? (Select all that apply.)
1. A client with a history of bipolar disorder is called by the postpartum support nurse for follow-up. Which symptoms would reassure the nurse that the client is not experiencing a manic episode?
Increased appetite and lack of interest in activities
2. When a woman is diagnosed with postpartum depression (PPD) with psychotic features, what is the nurse’s primary concern in planning the client’s care?
Harming her infant
3. During an inpatient psychiatric hospitalization, what is the most important nursing intervention?
Supervising and guiding visits with her infant
4. Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. Which condition is rarely associated with fetal alcohol syndrome (FAS)?
5. As a powerful central nervous system (CNS) stimulant, which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth?
6. According to research, which risk factor for PPD is likely to have the greatest effect on the client postpartum?
7. Which is the most accurate description of PPD without psychotic features?
Distinguishable by pervasive sadness along with mood swings
8. While providing care to the maternity client, the nurse should be aware that one of these anxiety disorders is likely to be triggered by the process of labor and birth. Which disorder fits this criterion?
Posttraumatic stress disorder (PTSD)
9. Which substance used during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications?
10. As part of the discharge teaching, the nurse can prepare the mother for her upcoming adjustment to her new role by instructing her regarding self-care activities to help prevent PPD. Which statement regarding this condition ismost helpful for the client?
Realize that PPD is a common occurrence that affects many women.
11. A woman at 24 weeks of gestation states that she has a glass of wine with dinner every evening. Why would the nurse counsel the client to eliminate all alcohol?
The fetus is placed at risk for altered brain growth.
12. A pregnant woman who abuses cocaine admits to exchanging sex to finance her drug habit. This behavior places the client at the greatest risk for what?
Sexually transmitted infections (STIs)
13. What is the most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant?
Intrauterine growth restriction
14. The use of methamphetamine (meth) has been described as a significant drug problem in the United States. The nurse who provides care to this client population should be cognizant of what regarding methamphetamine use?
Methamphetamines are stimulants with vasoconstrictive characteristics.
15. With one exception, the safest pregnancy is one during which the woman is drug and alcohol free. What is the optimal treatment for women addicted to opioids?
Methadone maintenance treatment (MMT)
The 4 Ps
1. In planning for home care of a woman with preterm labor, which concern should the nurse need to address?
Prolonged bed rest may cause negative physiologic effects.
3. In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, which finding alerts the nurse to possible side effects?
Serum magnesium level of 10 mg/dl
4. A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM) doses of betamethasone. What is the purpose of this pharmacologic intervention?
To stimulate fetal surfactant production
5. A primigravida at 40 weeks of gestation is having uterine contractions every 1 1/2 to 2 minutes and states that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman’s labor?
She is exhibiting hypertonic uterine dysfunction.
6. A woman is having her first child. She has been in labor for 15 hours. A vaginal examination performed 2 hours earlier revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part of the fetus was at station 0; however, another vaginal examination performed 5 minutes ago indicated no changes. What abnormal labor pattern is associated with this description?
7. Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. What is the primary purpose of prostaglandin administration?
To ripen the cervix in preparation for labor induction
8. A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her labor is being controlled with tocolytic medications. She asks when she might be able to go home. Which response by the nurse is mostaccurate?
“When we can stabilize your preterm labor and arrange home health visits.”
9. The obstetric provider has informed the nurse that she will be performing an amniotomy on the client to induce labor. What is the nurse’s highest priority intervention after the amniotomy is performed?
Assessing the fetal heart rate (FHR)
is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of gestation.
11. The nurse is performing an assessment on a client who thinks she may be experiencing preterm labor. Which information is the most important for the nurse to understand and share with the client?
Diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.
12. Which statement related to cephalopelvic disproportion (CPD) is the least accurate?
CPD can be accurately predicted.
13. Which statement related to the induction of labor is most accurate?
Is rated for viability by a Bishop score
14. A number of methods can be used for inducing labor. Which cervical ripening method falls under the category of mechanical or physical?
Labor can sometimes be induced with balloon catheters or laminaria tents.
15. Which description most accurately describes the augmentation of labor?
Is part of the active management of labor that is instituted when the labor process is unsatisfactory
16. The exact cause of preterm labor is unknown but believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Which type of infection has not been linked to preterm birth?
17. The nurse is teaching a client with preterm premature rupture of membranes (PPROM) regarding self-care activities. Which activities should the nurse include in her teaching?
Do not engage in sexual activity.
18. A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. Which finding indicates that preterm labor is occurring?
The cervix is effacing and dilated to 2 cm.
19. Which assessment is least likely to be associated with a breech presentation?
20. A pregnant woman’s amniotic membranes have ruptured. A prolapsed umbilical cord is suspected. What intervention would be the nurse’s highest priority?
Placing the woman in the knee-chest position
21. What is the primary purpose for the use of tocolytic therapy to suppress uterine activity?
The most important function of tocolytic therapy is to provide the opportunity to administer antenatal glucocorticoids.
22. When would an internal version be indicated to manipulate the fetus into a vertex position?
Second twin from a transverse lie to a breech presentation during a vaginal birth
23. A client at 39 weeks of gestation has been admitted for an external version. Which intervention would the nurse anticipate the provider to order?
24. What is a maternal indication for the use of vacuum-assisted birth?
25. Which nursing intervention should be immediately performed after the forceps-assisted birth of an infant?
Assessing the infant for signs of trauma
2. What are the complications and risks associated with cesarean births? (Select all that apply.)
Urinary tract infections
3. Women who are obese are at risk for several complications during pregnancy and birth. Which of these would the nurse anticipate with an obese client? (Select all that apply.)
What are appropriate indications for induction? (Select all that apply?)
Rupture of membranes at or near term
Chorioamnionitis (inflammation of the amniotic sac)
5. Indications for a primary cesarean birth are often nonrecurring. Therefore, a woman who has had a cesarean birth with a low transverse scar may be a candidate for vaginal birth after cesarean (VBAC). Which clients would beless likely to have a successful VBAC? (Select all that apply.)
Delivery at a rural hospital
Maternal obesity (BMI >30)