OB Quiz Wk 5 & 6

Question 1

A primigravida at 32 weeks gestation is being monitored in her prenatal clinic for preeclampsia. Which of the following should concern her nurse?

Answer 1

A dipstick value of 3+ for protein in her urine

Question 2

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman’s latest laboratory test findings, which reveal a platelet count of 90,000, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician because the lab results are indicative of:

Answer 2

HELLP syndrome

Question 3

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 of 37.3° C, pulse rate of 88 beats/min, respiratory rate of 10 breaths/min, blood pressure of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The client complains, “I’m so thirsty and warm.” The nurse:

Answer 3

Discontinues the magnesium sulfate infusion

Know the signs of magnesium sulfate toxicity–note the respiratory rate in particular.

Question 4

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

Answer 4

Hydralazine

Question 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, board-like, painful abdomen. Fetal heart rate is dropping and is now 98 beats per minute. The nurse suspects the onset of:

Answer 5

Abruptio placentae

Question 6

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 care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion?

Answer 6

Threatened

Question 7

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

Answer 7

Unruptured ectopic pregnancy

Question 8

A pregnant woman is being discharged from the hospital after placement of cerclage because of a history of recurrent pregnancy loss secondary to an incompetent cervix. Discharge teaching should emphasize that:

Answer 8

The presence of any uterine cramping or low backache may indicate preterm labor and should be reported.

Cerclage is only for an inadequate cervix– it won’t keep the fetus in if the problem is preterm labor.

Question 9

The perinatal nurse is giving discharge instructions to a woman, status postsuction 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 would be:

Answer 9

“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 10

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. Upon her arrival at the hospital, what would be an expected diagnostic procedure?

Answer 10

Ultrasound for placental location

Question 11

A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. She shows the nurse her readings for the past few days. Which one should the nurse tell her indicates a need for adjustment (insulin or sugar)?

Answer 11

250 mg/dl 2 hours after lunch; this is too high, time for insulin

Question 12

Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with:

Answer 12

Congenital anomalies in the fetus

Question 13

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for:

Answer 13

Macrosomia

Question 14

With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that:

Answer 14

Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.

Question 15

Women with hyperemesis gravidarum:

Answer 15

Have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance

Question 16

The nurse providing care for a woman with preterm labor on terbutaline would include which of the following interventions to identify side effects of the drug?

Answer 16

Assess for dyspnea and crackles

Question 17

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to:

Answer 17

Stimulate fetal surfactant production

Question 18

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. Which of the following findings indicates that preterm labor is occurring?

Answer 18

The cervix is effacing and dilated to 2 cm.

Question 19

In evaluating the effectiveness of oxytocin induction, the nurse would expect:

Answer 19

Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart.

Question 20

A pregnant woman’s amniotic membranes rupture. Prolapsed cord is suspected. Which of the following interventions would be the top priority?

Answer 20

Place the woman in the knee-chest position

Question 21

How much alcohol can a woman safely consume in pregnancy?

Answer 21

none

Question 22

Ultrasound in the first trimester is done using:

Answer 22

Abdominal sonography

Question 23

A procedure to obtain amniotic fluid, using a needle inserted trans-abdominally through the abdominal wall.

Answer 23

Amniocentesis

Question 24

Which of the following is not one of the three leading causes of maternal death in the US?

Answer 24

Diabetic ketoacidosis

Question 25

At which time in pregnancy is the ultrasound better at predicting gestational age?

Answer 25

First 20 weeks

Question 26

A primigravida at 32 weeks gestation is being monitored in her prenatal clinic for preeclampsia. Which of the following should concern her nurse?

Answer 26

A dipstick value of 3+ for protein in her urine

Question 27

A woman with preeclampsia has a seizure (now we can say she has eclampsia). The nurse’s primary duty during the seizure is to:

Answer 27

Stay with the client and call for help

Question 28

Magnesium sulfate is given to women with preeclampsia and eclampsia to:

Answer 28

Prevent and treat convulsions

Question 29

Nurses should be aware that HELLP syndrome:

Answer 29

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

Question 30

The most common medical complication of pregnancy is:

Answer 30

Hypertension

Question 31

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

Answer 31

Unruptured ectopic pregnancy

Question 32

The most prevalent clinical manifestation of abruptio placentae (in which the placenta separates from the uterine wall before labor) is:

Answer 32

Intense abdominal pain

Question 33

With regard to miscarriage, nurses should be aware that:

Answer 33

If it occurs before the twelfth week of pregnancy, it may present only as moderate discomfort and blood loss.

Question 34

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 care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion?

Answer 34

Threatened

Question 35

A client has just has surgery to deliver a nonviable fetus resulting from abruptio placenta. As a result of the abruptio placenta, the client develops DIC (disseminated intravascular coagulation) and is told about the complication. The begins to cry and scream, “God just let me die now!” Which nursing diagnosis should direct care for this client?

Answer 35

Hopelessness related to the loss of baby and personal health.

Question 36

Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Nurses should know that:

Answer 36

During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.

Question 37

During a prenatal visit, the nurse is explaining dietary management to a woman with pregestational diabetes. The nurse evaluates that teaching has been effective when the woman states:

Answer 37

“Diet and insulin needs change during pregnancy.”

Question 38

The nurse caring for a woman hospitalized for hyperemesis gravidarum would expect that initial treatment would involve:

Answer 38

IV therapy to correct fluid and electrolyte imbalances

Question 39

Diabetes in pregnancy puts the fetus at risk in a number of ways. Nurses should be aware that:

Answer 39

The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.

Question 40

A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. She shows the nurse her readings for the past few days. Which one should the nurse tell her indicates a need for adjustment (insulin or sugar)?

Answer 40

60 mg/dl just after waking up from a nap; this is too low, maybe eat a snack before going to sleep

Question 41

In planning for home care of a woman with preterm labor, the nurse needs to address which of the following concerns?

Answer 41

Prolonged bed rest may cause negative physiologic effects.

Question 42

The nurse providing care for a woman with preterm labor on terbutaline would include which of the following interventions to identify side effects of the drug?

Answer 42

Assess for dyspnea and crackles

Question 43

For a woman at 42 weeks of gestation, which of the following findings would require more assessment by the nurse?

Answer 43

One fetal movement noted in 1 hour of assessment by the mother

Question 44

Prepidil (prostaglandin gel) has been ordered for a pregnant woman at 43 weeks of gestation. The nurse recognizes that this medication will be administered to:

Answer 44

Ripen the cervix in preparation for labor induction

Question 45

A client is to have an amniotomy to induce labor. The nurse recognizes that the priority intervention after the amniotomy is to:

Answer 45

Assess the FHR

Question 46

A patient at 36 weeks gestation has been scheduled for a biophysical profile. She asks why the test is needed. The would correctly tell her that the test:

Answer 46

Observes her baby’s activities to ensure that her baby is getting enough oxygen.

Question 47

As a part of preparing a 24-year-old women at 42 weeks of gestation for a Nonstress test, the nurse would:

Answer 47

Show her how to indicate when her baby moves.

Question 48

The MSAFP (maternal serum alpha-fetal protein) test is to predict spina bifida, but the expanded triple screen can predict increased chances for:

Answer 48

Down’s syndrome

Question 49

How much alcohol can a woman safely consume in pregnancy?

Answer 49

none

Question 50

A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a BMI of 17.5. She admits to having used cocaine “several times” during the past year and drinks alcohol occasionally. Her blood pressure is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect. Which characteristics place the woman in a high risk category?

Answer 50

Family history, BMI, drug/alcohol abuse

Question 51

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. Which of the following diagnostic techniques might be performed with this pregnant woman at this time in the pregnancy?

Answer 51

Ultrasound examination

Question 52

A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus?

Answer 52

Biophysical profile

Question 53

A maternal serum alpha-fetoprotein test indicates an elevated level. It is repeated and again is reported as higher than normal. What would be the next step in the assessment sequence to determine the well-being of the fetus?

Answer 53

Ultrasound for fetal anomalies

US, then amniocentesis. Also, the US is used at the beginning of the amnio so it can be determined where the cord and placenta are and the best way to access the fluid.

Question 54

The patient has RH negative blood, while her husband has PH positive blood. She asks the nurse if testing will be done to determine how the baby is responding to the situation. The nurse would correctly reply that the following test will be used to determine if she is manufacturing antibodies against the baby:

Answer 54

Indirect Coombs

Question 55

A patient is 36 weeks pregnant and is scheduled for a nonstress test. The nurse understands that the desired result is a reactive stress test which would include which of the following:

Answer 55

A normal rate with at least two accelerations of 15 seconds each.