Elsevier Exam 1 OB EAQs

Using the five-digit system, determine the obstetric history in this situation: The client is 38 weeks into her fourth pregnancy. Her third pregnancy, a twin gestation, ended at 32 weeks with a live birth, her second pregnancy ended at 38 weeks with a live birth, and her first pregnancy ended at 18 weeks.

G4, T1, P1, A1, L3

Which of the following variables are scored on a biophysical profile? Select all that apply.

Fetal tone Fetal movement Amniotic fluid index Fetal breathing movements

At a client's first prenatal visit, the nurse-midwife performs a pelvic examination. The nurse states that the client's cervix is bluish purple, which is known as the Chadwick sign. The client becomes concerned and asks whether something is wrong. What does the nurse respond with about this expected finding?

"It is caused by increased blood flow to the uterus during pregnancy."

A near-term client reports that her fetus is moving less this week than last week. Which responses by the nurse are appropriate at this time? Select all that apply.

"It would be good for you to come to labor and delivery to be evaluated today." "Always call the healthcare provider if you're worried that your baby isn't moving enough." "Let me teach you how to conduct a kick count, and then you can call me when you've done one."

Which statement made by a pregnant client to a nurse indicates that the client does not understand the teaching regarding fetal growth and development?

"The baby gets food from the amniotic fluid."

During her first prenatal visit a client tells the nurse that she needed an exchange transfusion when she was born because of Rh incompatibility. She asks the nurse whether her baby will need one also. How should the nurse respond?

"You should have no problem because you're Rh positive."

A nurse is teaching a family planning class about ovulation and conception. The nurse should instruct the class that the ovum is thought to be viable for what period of time after ovulation?

24 to 36 hours

A client is to undergo amniocentesis at 38 weeks' gestation to determine fetal lung maturity. What lecithin/sphingomyelin ratio (L/S ratio) is adequate for the nurse to conclude that the fetus's lungs are mature enough to sustain extrauterine life?

2:1

The nurse is reviewing the documented results of a lecithin/sphingomyelin (L/S) ratio. Which finding is indicative of fetal lung maturity?

2:1

How long will a client's ovum stay viable after its release to get fertilized?

72 hours

The nurse is teaching a prenatal class regarding the risks of smoking during pregnancy. What neonatal consequence of maternal smoking should the nurse include in the teaching?

Low birthweight

A client in her tenth week of pregnancy exhibits presumptive signs of pregnancy. Which clinical findings may the nurse determine upon assessment? Select all that apply.

Amenorrhea Breast changes Urinary frequency

A nurse is caring for a client in preterm labor who is receiving a course of corticosteroids to promote fetal lung maturity. What test may be used to most accurately determine fetal lung maturity?

Amniocentesis

The nurse is obtaining the health history of a woman who is visiting the prenatal clinic for the first time. She states that she is 5 months pregnant. Which positive sign of pregnancy should the nurse evaluate in this client?

Audible fetal heartbeat

The client who is pregnant for the first time asks the nurse about the changes in her body. While describing the changes in each body system, the nurse mentions that the system that undergoes the most profound change of all during pregnancy is the what?

Cardiovascular system

The nurse at a prenatal clinic determines the fundal height of a healthy multipara at 16 weeks' gestation to be one fingerbreadth above the umbilicus. What might the nurse's next action be?

Check for two distinct fetal heart rates

A nurse is teaching a class of expectant parents about changes that are to be expected during pregnancy. Which changes does the nurse explain result from the melanocyte-stimulating hormone? Select all that apply.

Chloasma Linea nigra

A pregnant woman reports nausea and vomiting during the first trimester of pregnancy. The nurse explains that an increase in which hormone is the precipitating cause of the nausea and vomiting?

Chorionic gonadotropin

During the initial prenatal visit of a woman at 23 weeks' gestation, the nurse discovers that she has a history of pica. What is the most appropriate nursing action?

Determining whether the diet is nutritionally adequate

A client at 35 weeks' gestation calls the prenatal clinic, concerned that she has "not felt the baby move as much as usual." The most appropriate recommendation by the nurse is to have the client call the clinic with the results after she has done what?

Drunk a glass of orange juice and timed 10 fetal movements

While a client is being interviewed on her first prenatal visit she states that she has a 4-year-old son who was born at 41 weeks' gestation and a 3-year-old daughter who was born at 35 weeks' gestation. The client lost one pregnancy at 9 weeks and another at 18 weeks. Using the GTPAL system, how would you record this information?

G5 T1 P1 A2 L2

A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. How does the nurse, using the GTPAL format, document the client's obstetric history?

G5 T2 P1 A1 L4

A nurse is assessing a client at 16 weeks' gestation. Where does the nurse expect the fundal height to be located?

Half the distance to the umbilicus

A client presents to the clinic with complaints of nausea and amenorrhea and reports that she obtained a positive result on a home pregnancy test. Which component of the history is most indicative of pregnancy?

Her urine immunoassay test is positive.

A client who is at 12 weeks' gestation tells the nurse at the prenatal clinic that she is experiencing severe nausea and frequent vomiting. The nurse suspects that the client has hyperemesis gravidarum. Which factor is frequently associated with this disorder?

High level of chorionic gonadotropin

A primigravida at 12 weeks' gestation complains of nausea and vomiting during a visit to the prenatal clinic. Which pregnancy hormone should the nurse explain is thought to be responsible for nausea and vomiting during the first trimester?

Human chorionic gonadotropin (hCG)

The nurse is educating a couple concerning the process of fertilization. The nurse explains to the couple that which component stimulates the release of estrogen and progesterone after fertilization?

Human chorionic gonadotropin (hCG)

The nurse is planning a prenatal class about the changes that occur during pregnancy and the necessity of routine health care throughout pregnancy. Which cardiovascular compensatory mechanisms should the nurse explain to the class? Select all that apply.

Increased blood volume Increased cardiac output Enlargement of the heart

A nurse caring for a pregnant woman determines that she is engaging in the practice of pica. Why should the nurse prepare a teaching plan for this client?

Inedible items are being ingested.

Upon arriving in the birthing room the nurse finds the client lying on her back with her head on a pillow and the bed in a flat position. The nurse explains that it is important to avoid lying in the supine position because of what reason?

It will prevent adequate blood flow to the fetus.

During her first prenatal visit the client reports that her last menstrual period began on April 15. According to Nägele rule, what is the expected date of delivery (EDD)?

January 22

A registered nurse is teaching a nursing student about various developmental theories. What points mentioned by the registered nurse are accurate? Select all that apply.

Moral development theory attempts to define how moral reasoning matures in an individual. Developmental theory provides a basis for nurses to assess and understand a client's responses. Cognitive development focuses on rational thinking processes that include changes in children, adolescents, and adults to perform intellectual operations.

The primary healthcare provider prescribes a contraction stress test (CST) for a client whose nonstress test (NST) was nonreactive. Which maternal complications should prompt the nurse to question the prescription? Select all that apply.

Preterm labor Drug addiction Incompetent cervix Premature rupture of membranes

A primigravida in the first trimester tells a nurse that she has heard that hormones play an important role in pregnancy. Which hormone should the nurse tell the client maintains pregnancy?

Progesterone

Before the administration of Rho(D) immune globulin, the nurse reviews the laboratory data of a pregnant client. Which blood type and Coombs test result must a pregnant woman have to receive Rho(D) immune globulin after giving birth?

Rh negative and Coombs negative

Rho(D) immune globulin (RhoGAM) is prescribed for an Rh-negative client who has just given birth. Before giving the medication, the nurse verifies the newborn's Rh factor and reaction to the Coombs test. Which combination of newborn Rh factor and Coombs test result confirms the need to give Rho(D) immune globulin?

Rh positive with a negative Coombs result

The nurse is caring for a pregnant client during a contraction stress test (CST). In what position should the nurse place the client?

Semi-Fowler position to avoid hypotension

The nurse is assessing a pregnant client during the third trimester. Which clinical finding is expected in the later stages of pregnancy?

Shortness of breath on exertion

A pregnant woman continues consuming alcohol during pregnancy. Which teratogenic effects might be seen in the fetus or neonate? Select all that apply.

Stillbirth Spontaneous abortion Intellectual disabilities

A 37-year-old client with hypertension, type 1 diabetes and good glycemic control is pregnant for the third time. Her first child is 4 years old, and her second pregnancy resulted in a stillbirth. She is seen in the antepartum testing unit for a nonstress test (NST) at 33 weeks' gestation. What are the primary risk factors in the client's history that indicate the need for a nonstress test? Select all that apply.

The risk for placental insufficiency A history of stillbirth from her last pregnancy Maternal history of hypertension

A 40-year-old multigravida's pregnancy is confirmed at 8 weeks' gestation. She says, "I can't wait another 2 months for an amniocentesis to find out whether my baby has a chromosomal anomaly like my first child." The nurse responds that she can have chorionic villus sampling (CVS) between the tenth and twelfth weeks; what is true about this test if it is performed before this time?

The test can cause fetal anomalies.

During a newborn assessment the nurse counts the infant's cord vessels. What does the nurse expect to observe in a healthy newborn?

Three vessels: one vein and two arteries

The nurse is caring for a woman who just had a positive contraction stress test (CST). Which complication of pregnancy is of most concern when there is a positive CST?

Uteroplacental insufficiency