OB Exam #3 Practice Questions from Book and class

Question 1

1. A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time?

A. Biophysical profile

B. Amniocentesis

C. Maternal serum alpha-fetoprotein (MSAFP)

D. Transvaginal ultrasound

Answer 1

D. Transvaginal ultrasound

An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age. Transvaginal ultrasound is especially useful for obese women whose thick abdominal layers cannot be penetrated adequately with the abdominal approach.

Question 2

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits:

A. A sleepy, sedated affect
B. A respiratory rate of 10 breaths/min
C. Deep tendon reflexes of 2+
D. Absent ankle clonus

Answer 2

B. A respiratory rate of 10 breaths/min

A respiratory rate of 10 breaths/min indicates that the client is experiencing respiratory depression (bradypnea) from magnesium toxicity.

Question 3

A nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is:

A. Hypertension
B. Hyperemesis gravidarum
C. Hemorrhagic complications
D. Infections

Answer 3

A. Hypertension

Preeclampsia and eclampsia are two noted, deadly forms of hypertension. Hypertension is the most common medical complication of pregnancy.

Question 4

With regard to preeclampsia and eclampsia, nurses should be aware that:

A. Preeclampsia is a condition of the first trimester; eclampsia is a condition of the second and third trimesters

B. Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain

C. The causes of preeclampsia and eclampsia are well documented

D. The causes of preeclampsia and eclampsia are unknown, although several have been suggested.

Answer 4

B. Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain

Vasospasms diminish the diameter of blood vessels, which impedes blood flow to all organs.

Question 5

A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if:

A. Blood pressure is reduced to prepregnant baseline

B. Seizures do not occur

C. Deep tendon reflexes become hypotonic

D. Diuresis reduces fluid retention

Answer 5

B. Seizures do not occur

Magnesium sulfate is a central nervous system (CNS) depressant given primarily to prevent seizures.

Hypotonia is a sign of an excessive serum level of magnesium. It is critical that calcium gluconate be on hand to counteract the depressant effects of magnesium toxicity.

Question 6

A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for:

A. Hydralazine
B. Magnesium sulfate bolus
C. Diazepam
D. Calcium gluconate

Answer 6

A. Hydralazine

Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia.

Question 7

Nurses should be aware that HELLP syndrome:

A. Is a mild form of preeclampsia

B. Can be diagnosed by a nurse alert to its symptoms

C. Is characterized by hemolysis, elevated liver enzymes, and low platelets

D. Is associated with preterm labor but not perinatal mortality

Answer 7

C. Is characterized by hemolysis, elevated liver enzymes, and low platelets

The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and low platelets (LP).

Question 8

A nurse providing care for the antepartum woman should understand that the contraction stress test (CST):

A. Sometimes uses vibroacoustic stimulation

B. Is an invasive test; however, contractions are stimulated

C. Is considered negative if no late decelerations are observed with the contractions

D. Is more effective than nonstress test (NST) if the membranes have already been ruptured

Answer 8

C. Is considered negative if no late decelerations are observed with the contractions

No late decelerations indicate a positive CST.

Question 9

In the past, factors to determine whether a woman was likely to develop a high risk pregnancy were evaluated primarily from a medical point of view. A broader more comprehensive approach to high risk pregnancy has been adopted. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. These categories include all of these except:

A. Biophysical
B. Psychosocial
C. Geographic
D. Environmental

Answer 9

C. Geographic

This category is correctly referred to as sociodemographic risk. These factors stem from the mother and her family. Ethnicity may be one of the risks to pregnancy; however, it is not the only factor in this category. Low income, lack of prenatal care, age, parity, and marital status are included.

Question 10

A woman who is at 36 weeks of gestation is having a nonstress test. Which statement indicates her correct understanding of the test?

A. “I will need to have a full bladder for the test to be done accurately.”

B. “I should have my husband drive me home after the test because I may be nauseated.”

C. “This test will help to determine if the baby has Down syndrome or a neural tube defect.”

D. “This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby.”

Answer 10

D. “This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby.”

The nonstress test is one of the most widely used techniques to determine fetal well-being and is accomplished by monitoring fetal heart rate in conjunction with fetal activity and movements.

Question 11

What is an appropriate indicator for performing a contraction stress test?

A.Increased fetal movement and small for gestational age

B. Maternal diabetes mellitus and postmaturity

C. Adolescent pregnancy and poor prenatal care

D. History of preterm labor and intrauterine growth restriction

Answer 11

B. Maternal diabetes mellitus and postmaturity

Maternal diabetes mellitus and postmaturity are two indications for performing a contraction stress test.

Question 12

The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis?

A. Doppler blood flow analysis
B. Contraction stress test (CST)
C. Amniocentesis
D. Daily fetal movement counts

Answer 12

A. Doppler blood flow analysis

Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high risk pregnancies because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor.

Question 13

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that:

A.Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis

B. Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects

C. Percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome

D.MSAFP is a screening tool only; it identifies candidates for more definitive procedures

Answer 13

D.MSAFP is a screening tool only; it identifies candidates for more definitive procedures

This is correct. MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP.

Question 14

A woman presents to the emergency department complaining of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary health care provider finds that the cervix is closed. The anticipated plan of care for this woman is based on a probable diagnosis of which type of spontaneous abortion?

A. Incomplete
B. Inevitable
C. Threatened
D. Septic

Answer 14

C. Threatened

A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation.

Question 15

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is:

A. Bleeding
B. Intense abdominal pain
C. Uterine activity
D. Cramping

Answer 15

B. Intense abdominal pain

Pain is absent with placenta previa and may be agonizing with abruptio placentae.

Question 16

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. The nurse suspects the onset of:

A. Eclamptic seizure
B. Rupture of the uterus
C. Placenta previa
D. Placental abruption

Answer 16

D. Placental abruption

Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption.

Question 17

In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate?

A. Administration of blood

B. Preparation of the woman for invasive hemodynamic monitoring

C.Restriction of intravascular fluids

D. Administration of steroids

Answer 17

A. Administration of blood

Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters.

Question 18

Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion?

A. Prepare the woman for a dilation and curettage (D&C).

B. Place the woman on bed rest for at least 1 week and reevaluate.

C. Prepare the woman for an ultrasound and bloodwork.

D. Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month

Answer 18

C. Prepare the woman for an ultrasound and bloodwork.

Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin (hCG) and progesterone levels may be performed to determine if the fetus is alive and within the uterus. If the pregnancy is lost, the woman should be guided through the grieving process.

Question 19

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time she is at the greatest risk for:

A. Hemorrhage
B. Infection
C. Urinary retention
D. Thrombophlebitis

Answer 19

A. Hemorrhage

Hemorrhage is the most immediate risk because the lower uterine segment has limited ability to contract to reduce blood loss.

Question 20

Appendicitis is more difficult to diagnose during pregnancy because the appendix is:

A. Covered by the uterus
B. Displaced to the left
C. Low and to the right
D. High and to the right

Answer 20

D. High and to the right

High and to the right is the correct position of the appendix as pregnancy develops, which makes diagnosis of appendicitis difficult.

Question 21

A nurse is caring for a woman with mitral stenosis who is in the active stage. Which action should the nurse take to promote cardiac function?

A. Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics.

B. Prepare the woman for delivery by cesarean section because this is the recommended delivery method to sustain hemodynamics.

C.Encourage the woman to avoid the use of narcotics or epidural regional analgesia because this alters cardiac function.

D. Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling.

Answer 21

A. Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics.

The side-lying position with the head and shoulders elevated helps facilitate hemodynamics during labor.

Question 22

During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of:

A. Euglycemia
B. Rheumatic fever
C. Pneumonia
D. Cardiac decompensation

Answer 22

D. Cardiac decompensation

Symptoms of cardiac decompensation may appear abruptly or gradually.

Question 23

Thalassemia is a relatively common anemia in which:

A. An insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs)

B. RBCs have a normal life span but are sickled in shape

C. Folate deficiency occurs

D. There are inadequate levels of vitamin B12

Answer 23

A. An insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs)

Thalassemia is a hereditary disorder that involves the abnormal synthesis of the alpha or beta chains of hemoglobin. An insufficient amount of hemoglobin is produced to fill the RBCs.

Question 24

From 4% to 8% of pregnant women have asthma, making it one of the most common preexisting conditions of pregnancy. Severity of symptoms usually peaks:

A. In the first trimester

B. Between 24 to 36 weeks of gestation

C. During the last 4 weeks of pregnancy

D. Immediately postpartum

Answer 24

B. Between 24 to 36 weeks of gestation

The severity of symptoms peaks between 24 and 36 weeks of gestation. Asthma appears to be associated with intrauterine growth restriction and preterm birth.

Question 25

A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the earliest sign of decompensation is most often:

A. Orthopnea

B. Decreasing energy levels

C. Moist frequent cough and frothy sputum

D. Crackles (rales) at the bases of the lungs on auscultation

Answer 25

B. Decreasing energy levels

Decreasing energy level (fatigue) is an early finding of heart failure. Care must be taken to recognize it as a warning rather than a typical change of the third trimester. Cardiac decompensation is most likely to occur early in the third trimester, during childbirth, and during the first 48 hours following birth.

Question 26

After the administration of methotrexate for the medical management of an ectopic pregnancy what follow up is required?

A. an ultrasound in a month to assess healing

B. regular quantitative HCG levels to assess for failure of treatment

C. surgical laparoscopy

Answer 26

B. regular quantitative HCG levels to assess for failure of treatment

Question 27

Bleeding disorders in late pregnancy include all of these except:

A. Spontaneous abortion
B. Placenta previa
C. Abruptio placentae
D. Cord insertion

Answer 27

A. Spontaneous abortion

Question 28

Signs and symptoms of a pulmonary embolus in pregnancy are: (choose all that apply)

A.  dyspnea 
B.  tachypnea 
C.  chest pain 
D.  apprehension 
E.  low temperature

Answer 28

A. dyspnea
B. tachypnea
C. chest pain
D. apprehension

Question 29

Your client at 39 weeks gestation with a previous history of a C/section comes to labor and delivery with complaints of regular contractions and a moderate amount of bright red vaginal bleeding. You are concerned that she might have which of the following? (choose all that apply)

A.  placenta previa 
B.  placental abruption 
C.  succenturiate lobe of  
      placenta 
D.  uterine rupture 
E.  chorioamnionitis

Answer 29

A. placenta previa
B. placental abruption
D. uterine rupture

Question 30

The lowest risk diagnostic test for your pregnant client suspected of having a DVT is:

A. contrast venography
B. impedance plethysmography
C. doppler ultrasonography

Answer 30

C. doppler ultrasonography

Question 31

Your client, a G-1 at 39 weeks gestation comes to labor and delivery with complaints of regular contractions every 4 minutes and a moderate amount of bright red vaginal bleeding. She has a Category 1 FHR strip (reassuring). On the phone, the healthcare provider asks you how her labor progress is. You reply:

A. “I haven’t yet examined her cervix. I’ll check her when I next go in the room and will notify you of the results.”

B. “I’m uncomfortable performing a vaginal exam due to the amount of vaginal bleeding seen. Would you please come see the client?”

C. “She is dilated to 4 cm/ 80 % effaced/ -3 station. She is contracting regularly and coping with it well.”

D. “She is very uncomfortable with her contractions. Could she get her epidural now prior to any exams?”

Answer 31

B. “I’m uncomfortable performing a vaginal exam due to the amount of vaginal bleeding seen. Would you please come see the client?”

Question 32

A prophylactic cerclage for an incompetent cervix is usually placed at:

A. 11 to 15 weeks of gestation
B. 6 to 8 weeks of gestation
C. 23 to 24 weeks of gestation
D. After 24 weeks of gestation

Answer 32

A. 11 to 15 weeks of gestation

Question 33

Which assessment is not included in the fetal biophysical profile (BPP)

A.  fetal movement 
B.  fetal tone 
C.  fetal heart rate 
D.  amniotic fluid index 
E.  placental grade

Answer 33

E. placental grade

Question 34

A cerclage generally needs to be removed prior to the onset of labor.

A. True
B. False

Answer 34

A. True

Question 35

A laboring woman with no known risk factors suddenly experiences spontaneous rupture of membranes (ROM). The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. There is no change in uterine resting tone. The fetal heart rate begins to decline rapidly after the ROM. The nurse should suspect the possibility of:

A. Placenta previa
B. Abruptio placentae
C. Vasa previa
D. Disseminated intravascular coagulation (DIC)

Answer 35

C. Vasa previa

Question 36

Maternal causes of intrauterine growth restriction include anything that affects the blood supply to the fetus.

True
False

Answer 36

True

Question 37

Your client at 20 weeks gestation becomes upset after receiving the abnormally elevated results of her second maternal serum alpha fetoprotein testing.  In counseling her about future options, you tell her that the next test likely to be done will be:
A.  daily fetal movement counts 
B.  an ultrasound 
C.  an amniocentesis 
D.  a nonstress test

Answer 37

B. an ultrasound

Question 38

Methotrexate is recommended as part of the treatment plan for which obstetric complication?

A. Complete hydatidiform mole
B. Missed abortion
C. Unruptured ectopic pregnancy
D. Abruptio placentae

Answer 38

C. Unruptured ectopic pregnancy

Question 39

Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. Possible causes of early miscarriage include all except:

A. Chromosomal abnormalities
B. Infections
C. Endocrine imbalance
D. Systemic disorders

Answer 39

B. Infections

Question 40

A 41-week pregnant multigravida is sent to labor and delivery unit after a non reactive nonstress test. Which test would most likely be done first?

A. chorionic villi sampling

B. an ultrasound for fetal
anomalies

C. a fetal biophysical profile (BPP)

D. an amniocentesis for fetal lung maturity

Answer 40

C. a fetal biophysical profile (BPP)

Question 41

A perinatal nurse is giving discharge instructions to a woman, status post suction and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse is:

A. “If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available.”

B. “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, it would make the diagnosis of this cancer more difficult.”

C. “If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at this time.”

D. “Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy.”

Answer 41

B. “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, it would make the diagnosis of this cancer more difficult.”

Question 42

Your 37 week client calls saying “my baby isn’t moving as much as before”. Your best response would be:

A. “Call 911 to get to the hospital for an emergency C/section.”

B. “That’s normal for this far along in pregnancy. Don’t worry.”

C. “Keep watching the movements and come to your next scheduled appointment next week.”

D. “Please come in to the office now for a nonstress test or biophysical profile so we can check things out.”

Answer 42

D. “Please come in to the office now for a nonstress test or biophysical profile so we can check things out.”

Question 43

A 39-year-old primigravida thinks that she is about 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day, but she tells you that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique could be used with this pregnant woman at this time?

A. Ultrasound examination

B. Maternal serum alpha-fetoprotein (MSAFP) screening

C. Amniocentesis

D. Nonstress test (NST)

Answer 43

A. Ultrasound examination

Question 44

The most common site for an ectopic pregnancy is:

A. abdominal
B. cervical
C. ampullar
D. ovarian

Answer 44

C. ampullar

Question 45

When is the maternal serum alpha fetoprotein testing done?

A. 10 weeks
B. 13 weeks
C. 18 weeks
D. 22 weeks

Answer 45

C. 18 weeks

Question 46

With regard to hemorrhagic complications that may present during pregnancy, nurses should know that:

A. The incidence of ectopic pregnancy is declining as a result of improved diagnostic techniques

B. An incompetent cervix usually is not diagnosed until the woman has lost one or two pregnancies

C. One ectopic pregnancy does not affect a woman’s fertility or her likelihood of having a normal pregnancy the next time

D. Gestational trophoblastic neoplasia (GTN) is one of the persistently incurable gynecologic malignancies

Answer 46

B. An incompetent cervix usually is not diagnosed until the woman has lost one or two pregnancies

Question 47

Types of miscarriage (spontaneous abortion) include which of the following (choose all that apply)?

A.  threatened 
B.  inevitable 
C.  inadequate 
D.  complete 
E.  missed

Answer 47

B. inevitable
C. inadequate
E. missed

Question 48

Which of these are leading causes of maternal mortality in pregnancy (choose all that apply)

A.  Hemorrhage 
B.  Hypertension 
C.  Pulmonary embolism 
D.  Diabetes 
E.  Congenital anomalies

Answer 48

A. Hemorrhage
B. Hypertension
C. Pulmonary embolism

Question 49

f your client has been receiving magnesium sulfate for many hours prior to delivery, what complications would she and her infant be at risk for? (choose all that apply)

A. Increased duration of labor

B. Postpartum hemorrhage

C. Nneonatal respiratory depression and drowsiness

D. Scant lochia flow postpartum

E. A boggy uterus with heavy lochia flow postpartum

Answer 49

A. Increased duration of labor

B. Postpartum hemorrhage

C. Nneonatal respiratory depression and drowsiness

E. A boggy uterus with heavy lochia flow postpartum

Because magnesium sulfate is also a tocolytic agent, its use may increase the duration of labor. The amount of oxytocin needed to stimulate labor may be more than that needed for the woman who is not receiving magnesium sulfate. High serum levels of magnesium can cause relaxation of smooth muscle such as the uterus. Because of this tocolytic effect, the client most likely will have a boggy uterus with increased amounts of bleeding and risk for hemorrhage. Since magnesium sulfate also crosses through to the fetus it can cause respiration depression in the neonate after delivery

Question 50

Nurses should be aware that chronic hypertension:
A. Is defined as hypertension that begins during pregnancy and lasts for the duration of pregnancy

B. Is considered severe when the systolic blood pressure (BP) is greater than 140 mm Hg or the diastolic BP is greater than 90 mm Hg

C. Is general hypertension plus proteinuria

D. Can occur independently of or simultaneously with preeclampsia

Answer 50

D. Can occur independently of or simultaneously with preeclampsia

Women with chronic hypertension may develop superimposed preeclampsia, which increases the morbidity for both the mother and fetus. Chronic hypertension is present before pregnancy or diagnosed before the twentieth week of gestation and persists longer than 6 weeks postpartum. Chronic hypertension becomes severe with a diastolic BP of 110 mm Hg or higher. Proteinuria is an excessive concentration of protein in the urine. It is a complication of hypertension, not a defining characteristic.

Question 51

On your client’s initial prenatal visit at 16 weeks gestation, her blood pressure reads 148/94. Repeat readings done appropriately are 142/92 and 145/95. You anticipate a diagnosis of:

A. Chronic hypertension

B. Pre eclampsia

C. Gestational hypertension

D. Chronic hypertension with superimposed pre eclampsia

E. Eclampsia

Answer 51

A. Chronic hypertension

If 20 weeks with hypertension the diagnosis would be chronic hypertension. If 20 weeks with new onset hypertension, the diagnosis would be either pre eclampsia (depending on proteinuria) or gestational hypertension. These can only be diagnosed after 20 weeks.

Question 52

The antidote administered to reverse heparin is _______________?

Answer 52

Protamine sulfate

Protamine sulfate is the typical antidote given in case of a heparin overdose. Protamine sulfate counteracts the anti-clotting effects of heparin by binding to the molecules. The usual dosage is one mg administered very slowly for every 100 IU of heparin a patient has taken. Although many hospitals are becoming more vigilant and attempting to install safeguards against accidental overdoses, there is still a margin for human error and heparin overdose remains a serious concern. Heparin is one of the high risk medications that some hospitals require 2 RNs to witness and determine the dose.

Question 53

Your client on Magnesium sulfate therapy is experiencing the following symptoms, drowsiness, respiratory rate of 8, unable to respond to LOC check, and DTR’s absent. Your initial nursing action is to:

A. obtain magnesium blood level.

B. turn off the magnesium infusion.

C. administer calcium gluconate to reverse the magnesium infusion.

D. notify the healthcare provider.

Answer 53

B. turn off the magnesium infusion.

must first turn off the medication, then possibly do all the other options. Calcium gluconate only if ordered by the healthcare provider

Question 54

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 is not a complication of bed rest?

A. Thrombophlebitis
B. Psychologic stress
C. Fluid retention
D. Cardiovascular deconditioning

Answer 54

C. Fluid retention

No evidence has been found that the practice of bed rest improves pregnancy outcome. Fluid retention is not an adverse outcome of prolonged bed rest. The woman is more likely to experience diuresis with accompanying fluid and electrolyte imbalance and weight loss. Prolonged bed rest is known to increase the risk for thrombophlebitis. Psychologic stress is known to begin on the first day of bed rest and continue for the duration of the therapy. Therefore, restricted activity, rather than complete bed rest is recommended. Cardiovascular deconditioning is a known complication of bed rest.

Question 55

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/min, respiratory rate 10 breaths/min, blood pressure (BP) 152/98 mm Hg, absent deep tendon reflexes, and no ankle clonus with a urine output of 25 ml/hr for the past 2 hours . The client complains, “I’m so thirsty and warm.” The nurse initially would:

A. Call for a stat magnesium sulfate level

B. Administer oxygen

C. Discontinue the magnesium sulfate infusion

D. Prepare to administer hydralazine

Answer 55

C. Discontinue the magnesium sulfate infusion

The client is displaying clinical signs and symptoms of magnesium toxicity. Magnesium should be discontinued immediately. Additionally, calcium gluconate, the antidote for magnesium, might be administered if ordered by the healthcare provider. Regardless of the magnesium level, the client is displaying clinical signs and symptoms of magnesium toxicity. The first action by the nurse should be to discontinue the infusion of magnesium sulfate. Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically it is administered for a systolic BP greater than 160 mm Hg or a diastolic BP greater than 110 mm Hg.

Question 56

Which instruction would be important for the nurse to include in discharge teaching of a pregnant chronic hypertensive client?

A. “If you begin to have a headache, double your medication for the next dose.”

B. “Do not decrease or discontinue your medications, even if your blood pressure feels normal.”

C. “If you begin to feel fatigued, decrease your medication for 2 days and call the physician.”

D. “Increase your intake of dairy products to replace the calcium you will be losing.”

Answer 56

B. “Do not decrease or discontinue your medications, even if your blood pressure feels normal.”

Compliance with medication administration is a serious problem with hypertensive clients. A C are incorrect because clients must continue their medication and notify the healthcare provider of excessive fatigue or consistent headaches. They should not alter their medication without notifying the healthcare provider. D is incorrect because calcium is not a problem with this client.

Question 57

Preeclampsia is a unique disease process related only to human pregnancy. The exact cause of this condition continues to elude researchers. The American College of Obstetricians and Gynecologists has developed a comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors?

A. A 30-year-old obese Caucasian with her third pregnancy

B. A 41-year-old Caucasian primigravida
Correct Answer

C. An African-American client who is 19 years old and pregnant with twins

D. A 25-year-old Asian-American whose pregnancy is the result of donor insemination

Answer 57

C. An African-American client who is 19 years old and pregnant with twins

There are three risk factors present for the 19-year-old African-American client. She is of African-American ethnicity, is at the young end of the age distribution, and has a multiple pregnancy. In planning care for this client the nurse must monitor blood pressure frequently and teach the woman regarding early warning signs. The 30-year-old obese Caucasian client has only has one known risk factor: obesity. Age distribution appears to be U-shaped, with women less than 20 years and more than 40 years being at greatest risk. Preeclampsia continues to be seen more frequently in primigravidas; this client is a multigravida woman.

Question 58

The antidote administered to reverse magnesium toxicity is ______________________.

Answer 58

Calcium Gluconate

Calcium gluconate may be given by slow IV push (usually by the physician) over at least 3 minutes to prevent undesirable reactions such as arrhythmias, bradycardia, respiratory arrest, and ventricular fibrillation.

Question 59

A woman at 39 weeks of gestation with a diagnosis 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, hard, painful abdomen. The nurse suspects the onset of:

A. Eclamptic seizure
B. Rupture of the uterus
C. Placenta previa
D. Abruptio placentae

Answer 59

D. Abruptio placentae

Uterine tenderness in the presence of increasing tone may be the earliest finding of abruptio placentae. Women with preeclampsia are at increased risk for an abruption due to decreased placental perfusion. Also, increased frequency of contractions to every minute may be an indication of abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture presents as hypotonic uterine activity, signs of hypovolemia and, in many cases, the absence of pain. Placenta previa presents with bright red, painless vaginal bleeding.

Question 60

Which of the following is required for the diagnosis of HELLP syndrome?

A.  pulmonary edema 
B.  elevated liver enzymes 
C.  elevated blood pressure 
D.  overall peripheral edema 
 E. decreased platelet count

Answer 60

B. elevated liver enzymes
C. elevated blood pressure
E. decreased platelet count

Prior to administering antihypertensive medication, it is important to assess client for a decreased blood pressure. A is expected in med that has vasodilating effects like apresoline. B is consistent with diagnosis of hypertension. D would indicate a decrease in oxygenation to the brain.

Question 61

One of the most important components of the physical assessment of the pregnant client is the determination of blood pressure. Consistency in measurement techniques must be maintained to ensure that the nuances in variation of blood pressure (BP) readings are not the result of provider error. The nurse must be aware of which techniques are important in obtaining an accurate BP reading. (Choose all that apply).

A. The client should be seated.

B. The client’s arm should be placed at the level of the heart.

C. An electronic BP device should be used.

D. The cuff should cover a minimum of 60% of the upper arm.

E. The same arm should be used for every reading.

Answer 61

A. The client should be seated.
B. The client’s arm should be placed at the level of the heart.
E. The same arm should be used for every reading.

BP readings are easily affected by maternal position. Ideally the client should be seated. An alternative position is left lateral recumbent with the arm at the level of the heart. The arm should always be held in a horizontal position at approximately the level of the heart. The same arm should be used at every visit. The manual sphygmomanometer is the most accurate device. If manual as well as electronic devices are used in the care setting, the nurse must use caution when interpreting the readings. A proper size cuff should cover at least 80% of the upper arm or be approximately 1.5 times the length of the upper arm.

Question 62

In planning care for women with severe gestational hypertension, nurses should be aware that:

A. Induction of labor is likely, as near term as is safely possible

B. If at home, the woman should be confined to her bed, even with mild gestational hypertension

C. A special diet low in protein and salt should be initiated

D. Vaginal birth is not an option

Answer 62

A. Induction of labor is likely, as near term as is safely possible

By 34 weeks of gestation the risk of continuing the pregnancy may be considered greater than the risks of preterm birth. Strict bed rest is controversial for mild cases; some women in the hospital are even allowed to move around. For severe cases, bedrest is most likely. Diet and fluid recommendations are much the same as for healthy pregnant women, although some authorities have suggested a diet high in protein. Women with severe gestational hypertension might be able to attempt vaginal birth, but are at increased risk for a cesarean delivery.