Exam 4 (Complications During Pregnancy, Labor, Birth/Preterm Labor/Newborn at Risk)

Question 1

A patient at 6 weeks gestation arrives to the ED with mild cramping and spotting on a sanitary pad. A speculum exam reveals that the cervix is closed. The nurse anticipates what order from the ED physician?

A) Draw hCG level now and if applicable, again in 48 hours.
B) Admit the patient and prepare her for a D&C.
C) Administer IV fluids and prepare family for possibility of delivery.
D) Discharge patient to home; follow-up in one week.
E) None of the above

Answer 1

A

Question 2

The doctor suspects that the patient has an ectopic pregnancy. Which symptom is consistent with a diagnosis of ectopic pregnancy?

A) Painless vaginal bleeding
B) Intermittent abdominal cramping
C) Throbbing pain in the upper quadrant
D) Sudden, stabbing pain in the lower quadrant
E) None of the above

Answer 2

D

Question 3

Clients with Gestational Diabetes are usually managed by which of the following therapies?

A) Long acting insulin
B) Diet
C) Oral Anti-diabetic drugs
D) Oral hypoglycemic drugs/insulin
E) None of the above

Answer 3

B

Question 4

A 15-year-old primigravida is admitted with a tentative diagnosis of HELLP syndrome. Which laboratory finding is associated with HELLP syndrome?

A) Decreased blood glucose
B) Elevated platelet count
C) Decreased proteinuria
D) Elevated hepatic enzymes
E) All of the above

Answer 4

D

Question 5

A pregnant woman is HIV-positive. She is asking about ways to decrease the risk of vertical transmission to her baby. Which option given by the nurse would confer the least risk to the baby?

A) Antiretroviral medications and induction of labor
B) Cesarean delivery
C) Cesarean delivery plus antiretroviral medications for the newborn
D) Vaginal delivery plus antiretroviral medications for the newborn
E) None of the above

Answer 5

C

Question 6

Which statement by a pregnant patient with a placenta previa indicates accurate understanding?

A) “I can still have an epidural when I deliver vaginally.”
B) “I should rest and remain at home if I notice bleeding.”
C) “If I am bleeding, I will experience a great deal of pain.”
D) “My baby’s heart rate may not necessarily be affected.”
E) None of the Above.

Answer 6

D

Question 7

An ultrasound is performed on a pregnant patient at 38 weeks gestation that is experiencing heavy vaginal bleeding. The results of the ultrasound indicate that placental abruption is present. Based on these findings, the nurse would prepare the patient for:

A) Continuous fetal monitoring and admit for induction.
B) Prep the patient for a Stat C/S.
C) Admit to the antepartum unit and re-evaluate in the am.
D) Turn patient left lateral and plan for transvaginal ultrasound for confirmation.
E) None of the Above.

Answer 7

B

Question 8

A G3P2002 pregnant patient at 39 weeks gestation is having uterine contractions every 1 to 2 minutes and says that they are very painful. Her cervix is dilated 3 cm and has not changed in 4 hours. The woman is crying, moving side to side in bed and requests an epidural. What is the most likely status of this woman’s labor?

A) She is exhibiting hypotonic uterine dysfunction.
B) She is experiencing a normal latent phase of labor.
C) She is exhibiting hypertonic uterine dysfunction.
D) She is experiencing a dystocia due to position.
E) None of the Above.

Answer 8

C

Question 9

A pregnant patient at 40 weeks gestation has been recently diagnosed with hypotonic uterine dysfunction. Cervical exam: 5/90/0. Which of the following would not be the proper intervention to correct the diagnosis?

A) Administer Morphine 4mg IV push as ordered.
B) Assist the patient to ambulate in the hallway.
C) Administer Pitocin 2mu/min IV and titrate per order.
D) Call Certified Nurse Midwife to evaluate patient for AROM.
E) None of the Above.

Answer 9

A

Question 10

A nurse is developing a plan of care for a client experiencing dystocia and includes several nursing interventions in the plan of care. The nurse prioritizes the plan of care and selects which of the following nursing interventions as the highest priority?

A) Keeping the significant other informed of the progress of the labor.
B) Providing comfort measures.
C) Monitoring the fetal heart rate.
D) Changing the client’s position frequently.
E) Checking the cervix for progress.
F) None of the Above.

Answer 10

C

Question 11

The nurse is caring for a client whose labor is being augmented with Pitocin. He or she recognizes that the Pitocin should be discontinued immediately if there is evidence of:

A) Fetal heart rate of 165 and absent variability.
B) Spontaneous rupture of the amniotic membranes.
C) The patient has an uncontrollable urge to push.
D) Uterine contractions occurring every 3-5 minutes.
E) Fetal heart rate of 150 and early decelerations.
F) None of the Above.

Answer 11

A

Question 12

A full term patient arrives at a birthing center in active labor. Her membranes are still intact and she has a Cat I tracing. The nurse-midwife prepares to perform an amniotomy. A nurse who is assisting the nurse-midwife explains to the client that after this procedure, she will most likely have:

A) Minimal pressure on her cervix
B) Increased efficiency of contractions
C) The need for a foley catheter
D) An IUPC (intrauterine pressure catheter) placed to monitor contractions
E) None of the Above

Answer 12

B

Question 13

Which of the following patients’ would be the best candidate for Cervidil:

A) SVE: 2-3/90/-1, vtx presentation.
B) SROM during latent phase of labor.
C) SVE: 3/60/-2, vtx presentation.
D) SVE: 1/50/-3, breech presentation.
E) Contractions occurring every 1-2 minutes.
F) None of the Above.

Answer 13

C

Question 14

A 42 week pregnant patient is admitted to labor and delivery for induction of labor. Which intervention(s) are most likely needed for this patient during the course of labor?

(Select all that apply)

A) IV Bolus of LR
B) Frequent position changes
C) Oxygen Administration
D) Insertion of Cervidil
E) Continuous fetal monitoring
F) None of the Above

Answer 14

A,B,C,D,E

Question 15

When would a Postterm pregnant patient, not be a candidate for labor induction:

A) Macrosomia confirmed
B) Oligohydramnios
C) Patient is in extreme pain
D) Baby is confirmed ROP position
E) CPD is diagnosed
F) None of the Above

Answer 15

E

Question 16

The patient has been pushing for two hours and is exhausted. The fetal head is visible between contractions. The physician informs the patient that forceps could be used to facilitate the delivery. Which statement indicates that the patient needs more teaching about forceps extraction assistance?

A) “The forceps are placed on the baby’s head, and the physician will pull.”
B) “I can stop pushing and just rest if the forceps are being used.”
C) “The baby’s head might have a bruise or scrape from the metal edge.”
D) “The forceps will be applied for a total of ten minutes or less.”
E) None of the Above

Answer 16

B

Question 17

A patient is 38 weeks and pregnant with her second child. Her first child was born via emergent cesarean delivery. She asks the nurse if a vaginal birth is possible. What response by the nurse is most appropriate?

A) “No, after cesarean birth you cannot delivery vaginally.”
B) “Not if your cesarean delivery was the classic-style operation.”
C) “Yes, you can always at least have a trial of labor.”
D) “Yes, vaginal birth is usually successful after cesarean deliveries.”
E) None of the above

Answer 17

B

Question 18

A postpartum nurse is caring for a patient who gave birth to a term infant two hours ago. The chart notes that the baby was born after demonstrating a positive turtle sign. What assessment finding by the nurse warrants immediate action?

A) Lochia rubra is noted on the pad, 50ml.
B) Maternal blood pressure is 90/42 mm Hg.
C) Maternal heart rate is 68 beats/minute.
D) Patient is complaining of a lower back ache.
E) None of the Above

Answer 18

B

Question 19

A G3P0111 pregnant patient at 10 weeks gestation, has a history of preterm birth, and has been prescribed Hydroxyprogesterone Caproate 250mg IM weekly starting today. How many ml’s would you draw up in your syringe based upon the supplied label?

Label –> 1.25g/5mL

Answer 19

1mL

Question 20

A G1P0 pregnant patient at 26 weeks gestation, arrives to triage complaining of painful contractions that are occurring every few minutes. The fetal monitor shows a Category I tracing, and contractions every 2-3 minutes. The nurse midwife completes a sterile speculum exam, and the patient’s cervix is closed. The nurse midwife orders Terbutaline 0.25mg SQ X1 STAT. How many ml’s would you draw up in your syringe based upon the supplied label?

Label –> 1mg/mL

Answer 20

0.25 mL

Question 21

A nurse is completing an initial assessment for a preterm patient that has been receiving Magnesium Sulfate (MgSO4) IV as a tocolytic, day 1. The order in her chart reads: MgSO4 (maintenance) IV infusion 2g/hr. The nurse notes that the pump is set at 150ml/hr. She takes a set of VS: B/P - 130/62, P - 92, RR - 18, T - 98.7.

The bag is labeled as below. What is the nurse’s best action?
500mL Magnesium Sulfate
in 5% Dextrose Injection
(0.162mEq Mg++/mL) 20 mg/mL 10g TOTAL
Each 100mL contains Magnesium Sulfate Heptahydrate 2g (equivalent to 16.2 mEq Magnesium)

A) Verify her calculations with a 2nd nurse and decrease the rate to 100 ml/hr.
B) Verify her calculations with a 2nd nurse and continue the flow rate as it is set.
C) Verify calculation and call provider for dose clarification.
D) Discontinue the MgSO4 infusion because the patient’s vitals are abnormal.
E) None of the Above

Answer 21

A

Question 22

A G1P0 pregnant patient at 30 weeks gestation has been prescribed Betamethasone 12 mg IM x 2 doses, 24 hours apart starting now. What are the total ml’s of Betamethasone that the patient will receive in a 24-hour period, upon completion of the 2nd dose?

Label –> 30mg per 5 mL
(6mg* per mL)

Answer 22

4mL

Question 23

You are in the newborn nursery assisting with newborn assessments. You are assessing a 8 pound 6 ounce male neonate born 12 hours ago. You note he has dry cracked skin, long nails that are slightly green tinged, and has loose skin with non-existent fat layers. This neonate most likely has which of the following conditions?

A) Physiologic Jaundice
B) Birth after 42 weeks
C) SGA
D) Early Onset Sepsis
E) None of the Above

Answer 23

B

Question 24

A 20 year-old woman delivered a female infant at 28 weeks gestation by c-section 12 hours ago. You observe a student nurse bring the mother to the NICU to see her baby for the first time. Which of the following statement(s) by the student nurse to the mother would be appropriate at this time?

(Select all that apply)

A) “If all is well, your baby should be able to go home tomorrow.”
B) “Your baby may be here for awhile but we will start planning for when your baby goes home.”
C) “Be prepared for your baby to have many monitors, IVs, and equipment to help her breathe.”
D) “Your baby’s nurse will be give you continuous updates on how your baby is doing.”
E) “You will only be able to see your baby. You will not get to touch her during your first visit.”

Answer 24

B,C,D

Question 25

A 35 year-old G1P0 just gave birth to a full term baby at 40 weeks gestation. Her baby boy is SGA, weighing 4 pounds 5 ounces. The baby was taken to the NICU for observation. Which condition would not be a likely cause?

A) Cold Stress
B) Polycythemia
C) Hypoglycemia
D) Intracranial Hemorrhage
E) None of the Above

Answer 25

D