Term
The nurse is assessing the laboring client who is morbidly obese. The nurse is unable to determine the fetal position. Which action should be performed by the nurse to obtain the most accurate method of determining fetal position in this client?
a. Inspect the client’s abdomen.
b. Palpate the client’s abdomen.
c. Perform a vaginal examination.
d. Perform transabdominal ultrasound. |
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Definition
| d. Real-time transabdominal ultrasound (US) is the most accurate assessment measure to determine the fetal position and is frequently available in the birthing setting. US images may be used to assess fetal lie, presentation, and position in the morbidly obese client. |
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Term
Interventions have been prescribed by the HCP for the client with decreased fetal movement at 35 weeks’ gestation. Place the prescribed interventions in the sequence that they should be performed by the nurse.
1. Prepare for a nonstress test
2. Prepare for a biophysical profile
3. Palpate for fetal movement
4. Apply and explain the external FHM
a. 3, 2, 4, 1
b. 2, 3, 4, 1
c. 4, 1, 2, 3
d. 3, 4, 1, 2 |
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Definition
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Term
Which of these is a cause of macrosomia?
a. sickle cell anemia
b. gestational diabetes
c. thalassemia
d. folic acid |
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Definition
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Term
During which cycle day of a typical 28 day menstrual cycle does the follicular phase occur?
a. Cycle days 7-14
b. Cycle days 14-28
c. Cycle days 1-6
d. Cycle days 1-13 |
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Definition
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Term
A primigravida at 12 weeks gestation appears in your OBGYN clinic having begun a spontaneous abortion with dilation and effacement. She has type 1 diabetes and is Rh negative. Which is the most appropriate first intervention to provide to the mother?
a. check glucose and treat with insulin
b. administer Rh immunoglobin
c. provide oxygen
d. contact neonatal physician |
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Definition
| b. administer Rh immunoglobin |
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Term
You are treating a geriatric multigravida with hypothyroidism and mitral valve prolapse. What is the correct intervention for mitral valve prolapse for this patient?
a. Furosemide 20 mg PO BID
b. Cardisem 350 mg PO daily
c. bedrest
d. monitor for new onset murmur |
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Definition
| d. monitor for new onset murmur |
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Term
A 27-year-old primigravid client with insulin-dependent diabetes at 34 weeks’ gestation undergoes a nonstress test, the results of which are documented as reactive. What should the nurse tell the client that the test results indicate?
a. A contraction stress test is necessary.
b. The nonstress test should be repeated.
c. Chorionic villus sampling is necessary.
d. There is evidence of fetal well-being. |
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Definition
| d. There is evidence of fetal well-being |
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Term
What is not a use for oxytocin?
a. prevent preeclampsia
b. induce labor
c. promote lactation
d. stimulate postnatal contractions |
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Definition
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Term
The client admitted in preterm labor is told that an amniocentesis needs to be performed. The client asks the nurse why this is necessary when the HCP has been performing ultrasounds throughout the pregnancy. Which is the most appropriate response by the nurse?
a. “Your baby is older now, and an amniocentesis provides us with more information on how your baby is doing.”
b. “An amniocentesis could not be performed before 32 weeks, so you will be having this test from now until delivery.”
c. “Your doctor wants to make sure that there are no problems with the baby that an ultrasound might not be able to identify.”
d. “With your preterm labor your doctor needs to know your baby’s lung maturity; this is best identified by amniocentesis.” |
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Definition
c. “Your doctor wants to make sure that there are no problems with the baby that an ultrasound might not be able to identify.”
d. “With your preterm labor your doctor needs to know your baby’s lung maturity; this is best identified by amniocentesis.” |
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Term
The nurse is caring for the client who is being evaluated for a suspected malpresentation. The fetus’s long axis is lying across the maternal abdomen, and the contour of the abdomen is elongated. Which should be the nurse’s documentation of the lie of the fetus?
a. Vertex
b. Breech
c. Transverse
d. Brow |
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Definition
| c. A transverse lie occurs in 1 in 300 births and is marked by the fetus’s lying in a side-lying position across the abdomen. |
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Term
A 24 week primigravida presents with dizziness to the emergency room. Her manual blood pressure is 102/28. A LR bolus of 500 ml is ordered for a MAP less than 60 mmHg. What should the nurse do next?
a. document the vital signs since the MAP is above 60 mmHg.
b. contact the physician since the MAP is less than 60 mmHg.
c. start an IV to bolus as ordered.
d. do a vaginal examination. |
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Definition
| c. start an IV to bolus as ordered. |
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Term
What is not a complication of gestational hypertension?
a. macrosomia
b. Intrauterine fetal death
c. Placental insufficiency
d. HELLP syndrome |
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Definition
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Term
What is one of the diagnostic symptoms of preeclampsia?
a. headache
b. proteinuria
c. hyperglycemia
d. fluid retention |
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Definition
| b. proteinuria. The diagnostic symptoms of preeclampsia is |
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Term
Which of the following is not an appropriate treatment for mild preeclampsia?
a. provide bedrest
b. monitor BP
c. monitor deep tendon reflexes
d. decrease dietary protein |
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Definition
| d. decrease dietary protein. One should increase protein intake because of the loss of protein by the renal system. |
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Term
Why is avoiding seizure so important when treating a prenatal patient with preeclampsia?
a. risk of the mother choking from swallowing her tongue
b. seizures may result in permanent brain damage
c. seizure of abdominal muscles may result in cord constriction
d. the mother may harm herself during seizure activity |
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Definition
| c. seizure of abdominal muscles may result in cord constriction |
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Term
You are providing information to a primigravid patient with hyperemesis gravidarium. Which of the following indicates a need for further teaching?
a. “I should eat bland foods.”
b. “I should eat small, frequent meals.”
c. “I may take vitamin B6 as ordered by my doctor.”
d. “If I see red or blood in my vomit, I should call the doctor right away.” |
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Definition
| a. “I should eat bland foods.” One should eat non-greasy tasty foods |
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Term
A primigravid client at 38 weeks’ gestation comes to the labor room because “my water broke.” The healthcare provider (HCP) asks the nurse to verify spontaneous rupture of membranes using nitrazine paper. The nurse observes that the nitrazine paper turns bright blue. The nurse’s next action should be to:
a. notify the HCP that the membranes are ruptured.
b. perform a sterile vaginal examination to assess the cervix.
c. document the findings of the nitrazine test.
d. offer the client a sterile sanitary pad after performing perineal care. |
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Definition
| a. notify the HCP that the membranes are ruptured. |
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Term
What is an antidote for magnesium toxicity?
a. Calcium gluconate
b. Epinephrine
c. Atropine
d. Glucose |
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Definition
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Term
Once the cervix begins to dilate, the appropriate nursing intervention is:
a. place the patient on bedrest on their left side
b. provide oxygen
c. cervical cerclage
d. prepare for pregnancy termination |
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Definition
| d. prepare for pregnancy termination |
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Term
Rho (D) immune globulin (RhoGAM) is prescribed for a client before she is discharged after a spontaneous abortion. The nurse instructs the client that this drug is used to prevent which condition?
a. development of a future Rh-positive fetus
b. an antibody response to Rh-negative blood
c. a future pregnancy resulting in abortion
d. development of Rh-positive antibodies |
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Definition
| d. Rh sensitization can be prevented by Rho(D) immune globulin, which clears the maternal circulation of Rh-positive cells before sensitization can occur, thereby blocking maternal antibody production to Rh-positive cells. Administration of this drug will not prevent future Rh-positive fetuses, nor will it prevent future abortions. An antibody response will not occur to Rh-negative cells. Rh-negative mothers do not develop sensitivities if the fetus is also Rh negative. |
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Term
The nurse caring for a laboring client receiving an oxytocin infusion assesses that the fetal heart rate has slowed to 90 BPM. Heart rate does not recover after 90 seconds. Which should be the nurse’s first action?
a. Notify the health care provider
b. Reassess the fetal heart tones
c. Stop the oxytocin infusion
d. Prepare to administer terbutaline sulfate |
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Definition
| c. Because oxytocin (Pitocin) stimulates contractions, the nurse should first stop the infusion. A contraction that occurs more frequently than every 2 minutes and has a prolonged duration suggests hyperstimulation and approaching tetany. This could lead to uterine rupture. |
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Term
When teaching your patient how to decrease the discomfort of restless leg syndrome, you confirm they understand the teaching when they say:
a. “A cool shower or bath will help the burning sensation.”
b. “Elevating my legs at night will decrease discomfort.”
c. “When symptoms appear, I can walk or take a warm bath to relieve the discomfort.”
d. “It occurs after strenuous exertion in the day.” |
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Definition
| c. “When symptoms appear, I can walk or take a warm bath to relieve the discomfort.” |
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Term
Which of these is patients is not at increased risk of developing preeclampsia?
a. A multigravida with three previous full term births
b. An 18 year old primigravida
c. A multigravida with a history of severe preeclampsia
d. A multigravida in her first pregnancy with a new partner |
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Definition
| a. A multigravida with three previous full term births |
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Term
A client with a past medical history of ventricular septal defect repaired in infancy is seen at the prenatal clinic. She has dyspnea with exertion and is very tired. Her vital signs are oxygen saturation 98, pulse 80, respirations 20, blood pressure 116/ 72 mm Hg. She has + 2 pedal edema and clear breath sounds. The nurse determines the client’s symptoms indicate which cardiac functional classification?
a. class I
b. class II
c. class III
d. class IV |
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Definition
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Term
What is a quadruple-marker screening indication for?
a. thalassemia
b. rheumatic heart disease
c. sickle cell hemoglobinopathy
d. Down’s syndrome |
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Definition
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Term
When caring for a multigravid client admitted to the hospital with vaginal bleeding at 38 weeks’ gestation, which therapeutic agent would the nurse anticipate administering intravenously if the client develops disseminated intravascular coagulation (DIC)?
a. Ringer’s lactate solution
b. fresh frozen platelets
c. 5% dextrose solution
d. warfarin |
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Definition
| b. fresh frozen platelets |
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Term
The client at 32 weeks’ gestation presents to a hospital with a severe headache. Her admission BP is 184/104 mm Hg. Based on the assessment and findings of the serum laboratory report, which most severe complication warrants the nurse’s further assessment?
Bilirubin 2.1 mg/dL
LDH 782 units/L
AST (SGOT) 84 units/L
ALT (SGPT) 51 units/L
Plt 99,000/mm3
Hgb 12.1 g/dL
Hct 36.3%
a. Renal failure
b. Liver failure
c. Preeclampsia
d. HELLP syndrome |
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Definition
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Term
The client who is actively bleeding due to a spontaneous abortion asks the nurse why this is happening. The nurse advises the client that the majority of first-trimester losses are related to which problem?
a. Cervical incompetence
b. Chronic maternal disease
c. Poor implantation
d. Chromosomal abnormalities |
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Definition
| d. Chromosomal abnormalities account for the majority of first-trimester spontaneous abortions. |
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Term
The nurse assesses the client in her third trimester with suspected placenta previa. Which finding should the nurse associate with placenta previa?
a. Cervix is 100% effaced
b. Painless vaginal bleeding
c. The fetal lie is transverse
d. Absence of fetal movement |
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Definition
| b. In placenta previa, the abnormal location of the placenta causes painless, bright red vaginal bleeding as the lower uterine segment stretches and thins. |
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Term
The 28-year-old pregnant client (G3P2) has just been diagnosed with gestational diabetes at 30 weeks. The client asks what types of complications may occur with this diagnosis. Which complications should the nurse identify as being associated with gestational diabetes?
a. Seizures
b. Large-for-gestational-age infant
c. Low-birth-weight infant
d. Preterm labor |
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Definition
| b. Infants of diabetic mothers can be large as a result of excess glucose to the fetus. |
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Term
The nurse is screening prenatal clients who may be carriers for potential genetic abnormalities. Which ethnic group should the nurse identify as having the lowest risk for hemoglobinopathies, such as sickle cell disease and thalassemia?
a. African descent
b. Southeast Asian descent
c. Scandinavian descent
d. Mediterranean descent |
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Definition
| c. Individuals of Scandinavian descent are not an identified risk group for hemoglobinopathies. |
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Term
The nurse is calculating the pregnant client’s obstetrical history. The client reports having one miscarriage at 10 weeks and one child born at 39 weeks. What number should the nurse document on the client’s medical record for gravida?
a. 2
b. 3
c. 1
d. 4 |
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Definition
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Term
While assessing a 2-hour old neonate, the nurse observes the neonate to have acrocyanosis. Which of the following nursing actions should be performed initially?
a. Activate the code blue or emergency system.
b. Do nothing because acrocyanosis is normal in the neonate
c. Immediately take the newborn's temperature according to hospital policy
d. Notify the physician of the need for a cardiac consult |
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Definition
| b. Do nothing because acrocyanosis is normal in the neonate. |
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Term
The client has been in labor for 21 hours. Induction was started 16 hours ago, and she is now dilated 5 cm. She has made little progress, and there has been no fetal descent. The HCP identifies cephalopelvic disproportion (CPD). The nurse should prepare the client for which mode of delivery?
a. Traditional vaginal delivery
b. Forceps-assisted delivery
c. Vacuum-assisted delivery
d. Cesarean section delivery |
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Definition
| d. A fetus diagnosed with CPD is unable to be delivered vaginally and requires a cesarean section birth. |
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Term
The laboring client suddenly experiences a dramatic drop in the FHR from the 150s to the 110s. A vaginal exam reveals the presence of the fetal cord protruding through the cervix. What should be the nurse’s first intervention?
a. Put continuous pressure on the presenting part to keep it off the cord
b. Place the bed in Trendelenburg position
c. Insert a urinary catheter and instill saline
d. Continue to monitor the FHR |
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Definition
| a. The nurse should first exert continuous pressure on the presenting part to prevent further cord compression. This is continued until birth, which is usually by cesarean section. |
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Term
The laboring client tells the nurse that she wants to avoid an episiotomy if possible. Which response by the nurse is best?
a. “Usually making an episiotomy incision is avoided whenever possible.”
b. “Having an episiotomy reduces prolonged pushing and perineal trauma.”
c. “An episiotomy is routine because it can prevent pelvic floor damage.”
d. “Tell me more about your concerns about having an episiotomy.” |
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Definition
| a. “Usually making an episiotomy incision is avoided whenever possible.” |
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Term
The nurse’s laboring client presents with ruptured membranes, frequent contractions, and bloody show. She reports a greenish discharge for 2 days. What is the actions that should be completed first.
a. Perform a sterile vaginal exam
b. Assess the client thoroughly
c. Obtain fetal heart tones
d. Notify the health care provider |
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Definition
| c. Obtain FHT should be first. The client has ruptured membranes with greenish fluid, and the fetus could be experiencing nonreassuring fetal status. |
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Term
The nurse is caring for the client in preterm labor who has gestational diabetes. The nurse determines that the client has a reactive NST when which findings are noted?
a. Two fetal heart rate (FHR) accelerations of 15 beats per minute (bpm) above baseline for at least 15 seconds in a 20-minute period
b. An FHR acceleration of 15 bpm above baseline for at least 10 seconds in the 40-minute time period for the NST
c. Two FHR accelerations of 20 bpm above baseline when the mother changes position during the 20-minute NST
d. The occurrence of at least three mild repetitive variable decelerations in the 20-minute time period for the NST |
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Definition
| a. The criterion for a reactive (normal) NST is the presence of two FHR accelerations of 15 bpm above baseline lasting 15 seconds or longer in a 20-minute period. |
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Term
The nurse is about to auscultate FHR on the client in triage. What information should the nurse determine first in order to find the correct placement for auscultation?
a. Position of the fetus
b. Position of the placenta
c. Presence of contractions
d. Where to apply the ultrasonic gel |
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Definition
| a. The nurse should first perform Leopold’s maneuvers to determine the fetal position. This will enable proper placement of the Doppler device over the location of the FHR. |
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Term
The client had a D&C for treating an incomplete spontaneous abortion. Which statements should the nurse include when preparing the client for discharge the same day?
a. “Return for a blood transfusion if bleeding continues to be dark red.”
b. “Intravenous antibiotics will be prescribed every 8 hours for two days.”
c. “I can make a referral to a pregnancy loss support group if you like.”
d. “You need to use contraceptives to avoid getting pregnant for one year.” |
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Definition
| c. The client who had an incomplete spontaneous abortion may experience grief and loss. The nurse should offer to do a referral to a pregnancy loss support group to provide ongoing support after hospital discharge. |
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Term
What is not appropriate patient teaching after a spontaneous abortion?
a. Clean the perineum after each voiding or bowel movement
b. Avoid tampon use, douching, and vaginal intercourse for two weeks.
c. When able you should try again to have a baby as soon as possible
d. Eat foods high in iron and protein to promote tissue repair |
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Definition
| c. When able you should try again to have a baby as soon as possible |
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Term
What has had the greatest impact on reducing infant mortality in the United States?
a. Access to high-quality prenatal care
b. Decreased incidence of congenital abnormalities
c. Better maternal nutrition
d. Improved funding for health care |
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Definition
| a. Access to high-quality prenatal care |
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Term
The nurse is caring for the 30-weeks-pregnant client who is having contractions every 11 /2 to 2 minutes with spontaneous rupture of membranes 2 hours ago. Her cervix is 8 cm dilated and 100% effaced. The nurse determines that delivery is imminent. What intervention is the most important at this time?
a. Administering a tocolytic agent
b. Providing teaching information on premature infant care
c. Notifying neonatology of the impending birth
d. Preparing for a cesarean section birth |
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Definition
| c. The most important intervention is to notify the neonatal team of the delivery because the team members will be needed for respiratory support and possible resuscitation. |
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Term
After instructing a primigravid client at 38 weeks’ gestation about how preeclampsia can affect the client and the growing fetus, the nurse realizes that the client needs additional instruction when she says that preeclampsia can lead to which problem?
a. hydrocephalic infant
b. abruptio placentae
c. intrauterine growth restriction
d. poor placental perfusion |
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Definition
| a. Congenital anomalies such as hydrocephalus are not associated with preeclampsia. Conditions such as stillbirth, prematurity, abruptio placentae, intrauterine growth restriction, and poor placental perfusion are associated with preeclampsia. Abruptio placentae occurs because of severe vasoconstriction. Intrauterine growth restriction is possible owing to poor placental perfusion. Poor placental perfusion results from increased vasoconstriction. |
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Term
The nurse is instructing a preeclamptic client about monitoring the movements of her fetus to determine fetal well-being. Which statement by the client indicates that she needs further instruction about when to call the healthcare provider (HCP) concerning fetal movement?
a. “if the fetus is becoming less active than before”
b. “if it takes longer each day for the fetus to move 10 times”
c. “if the fetus stops moving for 12 hours”
d. “if the fetus moves more often than three times an hour” |
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Definition
| d. The HCP should be notified if there is a gradual slowing over time of fetal activity, if each day it takes longer for the fetus to move a minimum of 10 times, or if the fetus stops moving for 12 hours or longer. |
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Term
The nurse is planning care for a group of pregnant clients. Which client should be referred to a healthcare provider (HCP) immediately?
a. a woman who is at 10 weeks’ gestation, is having nausea and vomiting, and has + 1 ketones in her urine
b. a woman who is at 37 weeks’ gestation and has insulin-dependent diabetes experiencing two to three hyperglycemic episodes weekly
c. a woman at 32 weeks’ gestation who is preeclamptic with + 3 proteinuria
d. a woman at 15 weeks’ gestation who reports she has not felt fetal movement |
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Definition
| c. a woman at 32 weeks’ gestation who is preeclamptic with + 3 proteinuria |
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Term
A patient who is 28 weeks’ gestation undergoes a non-stress test when she noticed that the baby hasn’t moved recently. The results are considered reactive. What does this mean?
a. The baby has normal heart rate accelerations
b. The baby does not have any noted birth defects
c. The baby is most likely neurologically impaired
d. The baby is going to be born pre-term |
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Definition
| a. The baby has normal heart rate accelerations |
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