OB - Exam 2 - More Questions!

Question 1

A primigravida client at 26 weeks’ gestation has been administered a glucose tolerance test. What would the nurse anticipate as a normal finding?

1. Glycosylated hemoglobin A1c of 5.0%
2. Blood glucose of 200 mg/L at 60 minutes
3. 24-hour urine glucose level of 5 mg/dL
4. Blood glucose level of 110 mg/L at 3 hours

Answer 1

4. Blood glucose level of 110 mg/L at 3 hours

Rationale:
In the glucose tolerance test (OGTT), the blood glucose level is evaluated before the test (a fasting blood glucose), 1 hour after a 100-gm glucose load, 2 hours after the glucose load, and 3 hours after the glucose load. The normal value for 1 hour is less than 180 mg/L, the normal value for 2 hours is less than 155 mg/L, and the normal value for 3 hours is less than 140 mg/L. The glycosylated hemoglobin value reflects blood glucose control for the past 120 days, and the urine glucose level is not as reliable an indicator of control as the serum glucose level. (Lowdermilk, Perry, Cashion, et al, 10 ed., p. 701.)

Question 2

The nurse is assessing a primigravida client who is at 26 weeks’ gestation; the client’s blood type is AB negative, her serology is negative, and she has a history of one miscarriage at 20 weeks. Based on this information, what will the nurse anticipate being ordered for this client?

1. An amniocentesis at 30 weeks’ gestation
2. Administration of Rho(D) (RhIG or RhoGAM) at 28 weeks’ gestation
3. A blood test on the father to determine his blood type
4. Fetal blood sampling to determine fetal blood type

Answer 2

2. Administration of Rho(D) (RhIG or RhoGAM) at 28 weeks’ gestation

Rationale:
Rho(D) or RhoGAM is given to all Rh-negative women in the 28th week of gestation. The blood type of the father may be determined, but paternity is not an important issue in this situation. An amniocentesis is not necessary at this time, and obtaining fetal blood to determine blood type is more risky than administering the medication to the mother. (Lowdermilk, Perry, Cashion, et al, 10 ed., p. 500.)

Question 3

What will be important for the nurse to assess in the client immediately after an amniocentesis?

1. Increased fetal activity
2. Elevated temperature
3. Spontaneous rupture of the membranes
4. Abnormal lung sounds

Answer 3

3. Spontaneous rupture of the membranes

Rationale:
Damage to the membranes is a possibility and a high-priority situation. Fever would not be an immediate problem. Fetal heart rate is monitored, not activity; the client’s lungs should not be involved. (Lowdermilk, Perry, Cashion, Alden, 10 ed., p. 645.)

Question 4

A woman in her second trimester of pregnancy is coming in for evaluation and monitoring the growth of her twins. Which test would be appropriate for the nurse to explain to the client?

1. Nonstress test (NST)
2. Ultrasound
3. Lecithin/sphingomyelin (L/S) ratio
4. Amniocentesis

Answer 4

2. Ultrasound

Rationale:
The ultrasound (sonogram) is used to assess and monitor growth of the fetuses, position of the placenta, and position of the fetuses. The nonstress test (NST) is used to observe the response of the fetal heart rates to the stress of activity and would not necessarily be performed during the second trimester. The L/S ratio determines whether sufficient surfactant exists for the lungs to function after birth and would be performed in the third trimester. An amniocentesis is performed to obtain a sample of amniotic fluid for analysis, usually assessing for genetic defects. (Lowdermilk, Perry, Cashion, Alden, 10 ed., p. 640.)

Question 5

What is the appropriate nursing action when preparing a client for transvaginal ultrasonography?

1. Place her in lithotomy position.
2. Prepare her arm for starting an IV.
3. Instruct the client to drink 1 L (1 qt) of fluid.
4. Have the client be NPO for 2 hours before testing.

Answer 5

1. Place her in lithotomy position.

Rationale:
The client is placed in lithotomy position with her pelvis elevated by towels, pillows, or a cushion. The transducer probe is introduced into the vagina and lubricated with a water-soluble gel. The probe can be placed into the vagina by the client or the examiner. The transvaginal ultrasound does not have to be performed with a full bladder. The nurse should ask the client to empty her bladder when the client is having an abdominal ultrasound. An IV is not necessary for this procedure, and the client does not have any diet restrictions. (Lowdermilk, Perry, Cashion, Alden, 10 ed., p. 640.)

Question 6

A pregnant client at 16 weeks’ gestation has a blood sample for rubella antibody screening drawn. The test results reveal a low titer. When discussing the results with the client, what is an appropriate nursing action?

1. Arrange for the client to have a measles-mumps-rubella (MMR) immunization.
2. Explain to the client that the results are expected.
3. Counsel the client regarding potential birth defects.
4. Instruct the client to receive the rubella immunization immediately after delivery.

Answer 6

4. Instruct the client to receive the rubella immunization immediately after delivery.

Rationale:
With a low rubella titer, the client is at risk for developing rubella. Nothing can be done during this pregnancy, but immediately after delivery, within the early postpartum period, she needs to receive an immunization. She should not receive the live virus during pregnancy. (Lowdermilk, Perry, Cashion, Alden, 10 ed., p. 499.)

Question 7

When preparing a client for an amniocentesis procedure, the nurse should:

1. Instruct the client to drink 1 L (1 qt) of fluid
2. Ask the client to void first
3. Prepare her arm for starting an IV
4. Place her on her left side with knees flexed

Answer 7

2. Ask the client to void first

Rationale:
The nurse should ask the client to empty her bladder to reduce the risk of bladder perforation from the puncture. Encouraging intake of fluids (1 L of fluid) is the procedure before a transabdominal ultrasound exam (unless the ultrasound exam is done before amniocentesis to locate the placenta). An IV is not necessarily started before an amniocentesis. The client should be supine during the procedure. When the procedure is over, the client is placed on her left side to avoid supine hypotension, promote venous return, and ensure adequate cardiac output. (Lowdermilk, Perry, Cashion, Alden, 10 ed., p. 645.)

Question 8

An examination reveals that a client is 8 weeks pregnant and is in apparent good health. What would be routine prenatal laboratory studies? Select all that apply.

1. Complete blood count
2. RPR, VDRL, or FTA-ABS
3. Rh and type
4. Urinalysis
5. HIV antibody
6. Rubella titer

Answer 8

1. Complete blood count
2. RPR, VDRL, or FTA-ABS
3. Rh and type
4. Urinalysis
5. Rubella titer

Rationale:
At the initial visit, certain laboratory test data are necessary to determine baseline values. The recommended studies are Pap test, serology (RPR, VDRL, or FTA-ABS), complete blood count, Rh and type, urinalysis, electrolytes, and antibody screening for rubella and hepatitis B surface antigen, tuberculin skin testing or chest film after 20 weeks of gestation for reactive tuberculin skin tests, along with glucose tolerance tests at 24 to 28 weeks to screen for gestational diabetes. HIV antibody screening can be performed only with the client’s permission, although all pregnant women are encouraged to have HIV testing performed. (Lowdermilk, Perry, Cashion, Alden, 10 ed., p. 340.)

Question 9

The nurse is assisting with an aminoinfusion. What is an important nursing intervention during this procedure?

1. Monitor for any type of bloody vaginal secretions.
2. Ask the client to move to a sitting position and lean over the bedside table.
3. Check the cervix to determine the progress of labor.
4. Monitor the intensity and frequency of uterine contractions during the procedure.

Answer 9

4. Monitor the intensity and frequency of uterine contractions during the procedure.

Rationale:
The most important nursing intervention is to monitor the intensity and frequency of uterine contractions during the aminoinfusion procedure. Aminoinfusion is performed during labor to dilute aminotic fluid that is heavily stained with meconium or to supplement the amount of amniotic fluid to reduce problems with variable decelerations caused by cord compression. The mother is supine for the procedure and the status of the cervix is not checked during the procedure. (Lowdermilk, Perry, Cashion, Alden, 10 ed., p. 429.)

Question 10

The nurse is preparing a teaching plan for a client who has just had her pregnancy confirmed. What will be important for the nurse to include in the teaching plan? Select all that apply.

1. Exercise aerobically three times per and ensure frequent position changes.
2. Prevent constipation with a stool softener.
3. Sexual activity is permitted as long as membranes are intact.
4. Showers are preferred to prevent contamination of vaginal area.
5. Tetanus and measles-mumps-rubella vaccinations will be given now.
6. Balanced dietary intake with approximately 300 to 500 additional calories.

Answer 10

1. Exercise aerobically three times per and ensure frequent position changes.
2. Sexual activity is permitted as long as membranes are intact.
3. Balanced dietary intake with approximately 300 to 500 additional calories.

Rationale:
Changing position, moderate exercise, normal sexual activity as long as membranes are intact, and increasing calories 300 cal for pregnancy and 500 cal for lactation are all included in the teaching plan. Constipation should be controlled first by dietary intake. Showers are okay, and tub baths are not contraindicated. However, safety (falling) is a concern during the last trimester. Live virus vaccines should not be administered during pregnancy. (Lowdermilk, Perry, Cashion, Alden, 10 ed., pp. 344-353.)

Question 11

A client is in her first trimester of pregnancy. She complains of nausea, increased fatigue, increased urination, and emotional lability. What is the best nursing action?

1. Discuss with the client that these are normal discomforts of the first trimester.
2. Obtain a urine sample for culture to determine whether the client has a urinary tract infection.
3. Assess the client for cardiac problems and notify the health care provider.
4. Explain to the client that these symptoms are indicative of early complications.

Answer 11

1. Discuss with the client that these are normal discomforts of the first trimester.

Rationale:
It is important to explain to the client that these are normal findings and follow up with suggestions to make her more comfortable. No evidence exists of urinary tract infection or cardiac problems. Complications during the first trimester would be bleeding, spontaneous abortion, and infections. (Lowdermilk, Perry, Cashion, Alden, 10 ed., p. 350.)

Question 12

A pregnant client at 12 weeks of gestation complains of feeling nauseated all day long. The nurse would advise her to:

1. Lie down immediately after meals
2. Drink a small amount of milk with each meal
3. Eat small but frequent meals
4. Take sodium bicarbonate when nauseated

Answer 12

3. Eat small but frequent meals

Rationale:
Eating small but frequent meals will help to relieve the nausea of early pregnancy. Sodium bicarbonate should not be taken, because it can alter acid-base balance. Lying down and drinking milk will not relieve the nausea. (Lowdermilk, Perry, Cashion, Alden, 10 ed., p. 350.)

Question 13

At the beginning of her third trimester, a client reports she is having some discomfort in her lower back. What would the nurse check?

1. Her posture and the type of shoes she usually wears
2. Her bowel habits
3. With the doctor for his advice
4. The amount of milk that she drinks

Answer 13

1. Her posture and the type of shoes she usually wears

Rationale:
Pregnant women should be advised about the importance of good posture and body mechanics to prevent back strain, especially during the last trimester with the increase in size of the growing uterus. Low-heeled shoes help to maintain the body’s center of gravity and prevent backaches. Constipation would not necessarily cause lower back discomfort. (Lowdermilk, Perry, Cashion, Alden, 10 ed., pp. 347-348.)

Question 14

During labor, the nurse determines that a full-term client is experiencing late-term decelerations. In which sequence should the nurse implement these nursing actions?
Provide oxygen via face mask.
Increase IV fluid.
Notify the health care provider.
Reposition the client.

Answer 14

1. Reposition the client
2. Provide oxygen via face mask.
3. Increase IV fluid
4. Call the HCP

To stabilize the fetus, intrauterine resuscitation is the first priority, and to enhance fetal blood supply, the laboring client should be positioned (1) to displace the gravid uterus and improve fetal perfusion, (2) optimize oxygenation of circulatory blood volume, oxygen via face mask (3) expand maternal circulating blood volume (4) primary HCP notified for additional interventions for fetal stress.

Question 15

A new mother who just had her baby says to the nurse, “I saw the baby in the recovery room. She sure has a funny looking head.” Which response by the nurse is best?

a. This is not an unusual shaped head, especially for a first baby.
b. It may look funny to you, but newborn babies are often born with heads like your baby’s.
c. That is normal, the head will return to a round shape within 7 to 10 days.
d. Your pelvis is too small, so the baby’s head had to adjust to the birth canal.

Answer 15

c. That is normal, the head will return to a round shape within 7 to 10 days.\

C reassures the mother, and provides correct information about the return to a “normal” shape. The others are negative or dismissing.

Question 16

The nurse is assessing the umbilical cord of a newborn. Which finding constitutes a normal finding?

a. Two vessels: one artery and one vein.
b. Two vessels: two arteries and no veins.
c. Three vessels: two arteries and one vein.
d. Three vessels: two veins and one artery.

Answer 16

c. Three vessels: two arteries and one vein.

Question 17

A client at 28 weeks gestation calls the antepartal clinic and states that she is experiencing a small amount of vaginal bleeding which she describes as bright red. She is not experiencing any uterine contractions or abdominal pain - what instruction should the nurse provide?

a. Come to the clinic today for an ultrasound.
b. Go immediately to the emergency room.
c. Lie on your left side for one hour to see if the bleeding stops.
d. Bring a urine specimen to the clinic tomorrow to see if you have a urinary tract infeciton.

Answer 17

a. Come to the clinic today for an ultrasound.

3rd semester painless bleeding, characteristic of placenta previa. Bright red bleeding might be intermittent, occur in gushes, or continuous. Diagnosis is confirmed with transabdominal ultrasound.