OB CA2

49. Pregnant women with cardiovascular disease presents a more challenging role for the nurse as continuous assessment of the woman's health status is warranted, as well as conducting activities for health education and health promotion Pregnancy taxes the circulatory system of every woman because the blood volume and cardiac output increase by approximately 30%. Erin is 7 months pregnant. All of the following are normal cardiovascular adjustment to pregnancy, except A. Cardiomegaly B. Transient murmurs C. Palpitations D. Left lateral displacement of the heart

A

48 Depending on the functional capacity of the heart, the most important principle of management in client with cardiac disease is rest. Early signs of infection should be reported immediately. Proper diet ensures normal weight gain Management would depend on cardiac functional capacity. Which of the following interventions would the nurse include in the care of plan of a client in labour complicated by a heart disease? A. The client may ambulate to hasten labour. B. Instruct the client on correct pushing techniques, C. Prepare the client for a C-section. D. An episiotomy and forceps delivery will likely be performed

D

40. The nurse is aware that in the second half of pregnancy women who are diabetic require a. Increased dosage of insulin b. Administration of estrogenic hormones c. Administration of pancreatic enzymes d. Decreased caloric intake

a

A pregnant woman with cardiac disease is on anti-coagulant therapy. Which of the following is commonly use for pregnant woman? a. Heparin b. Streptokinase c. Coumadin d. aspirin

a

14. Abortion is classified as which of the following? 1. Termination of the products of conception at 20 weeks gestation and above 2. An expelled fetus weighing 500gms and below 3. Termination of products of conception at 20 weeks AOG and below 4. Open cervix, intact BOW a. 182 b. 2&3 c. 3&4 d. 184

b

15. Which of the following are the two common complications of missed abortion? a. Heavy, persistent bleeding b. Fever and hypotension mon c. Brownish secretions and hypertension d. Infection and DIC

b

18. Which of the following are associated with abruptio placenta? 1. Couvelaire uterus 2. Hard, contracting uterus 3. HELLP syndrome 4. DIC a. 1&2 b. 1,283 c. 3&4 d. 1,284

b

20. Urinalysis in PIH reveals would reveal which of the following? a. + iron acid b. + albumin c.+ glucose d. Elevated WBC

b

30. A direct coomb's test is done on the cord blood to detect the presence of a. Fetal red cells in the maternal serum b. Maternal Antibodies coating the baby's red blood cells c. Antigens coating the baby's red blood cells d. Maternal red cells in the fetal circulation.

b

34. Severe pregnancy-induced hypertension (PIH) causes which condition? a. Increased circulating blood volume c. Uteroplacental insufficiency b. Development of heart disease d. Toxins in the blood stream

c

37. The physician orders IV magnesium sulfate for a primigravida client with severe preeclampsia. Which of the following medications would the nurse has readily available at the client's bedside? a. Hydralazine (Apresoline) b. Diazepam (Valium) c. Calcium gluconate d. Phenytoin (Dilantin)

c

45. Gestational diabetes is a mild form of diabetes mellitus. It can be diagnosed in a woman during pregnancy but disappear after delivery. Which of the following procedures would be most accurate in diagnosing this condition? a. intravenous glucose tolerance test at the initial prenatal visit b. intravenous glucose tolerance test during the second trimester c. oral glucose tolerance test during the second trimester d. daily urine testing from the initial prenatal visit

c

What position will the cardiac client need to assume in labor to allow for maximum functioning of her heart? a. Supine b. Dorsal recumbent c. Semi-fowler's d. Sim's position

c

10. On her 38 weeks' gestation, a primigravid client with poorly controlled Diabetes and severe Preeclamsia is admitted for a cesarean delivery. The nurse explains to the client that a cesarian delivery helps to prevent which of the following? a. Neonatal Hyperbilirubineamia b. Congenital Anomalies c. Perinatal Asphyxia d. Stillbirth

d

16. Which of the classic signs of preeclampsia stated below, is not specific? a. Proteinuria b. Hypertension c. Generalized edema d. Physiologic edema

d

21. You would you advise Karmel, which of the following diets? a. Low fats, low salt, low fiber b. Low fats, high salt, high fiber c. Low fats, no salt, high protein d. Low fats, moderate salt, high protein

d

39. A client with gestational diabetes will undergo OGTT, which of the following is true about this test? a. it is the best screening test for GDM b. It requires the administration of a 50-gm glucose solution c. it requires the client to increase CHON intake 2-3 days prior to the test d. none of the above

d

8. A multigravida client at 34 weeks' gestation on preterm labor is prepared for the shake test on her amniotic fluid. The nurse would inform the client that this test is will to evaluate the maturity of which of the following fetal systems? Perry Says of Willi a. Urinary b. Gastrointestinal c. Cardiovascular d. Pulmonary status of villi

d

Karmel, on her 35 weeks pregnancy is admitted for BP 180/100, severe headache and blurred vision. She was placed on bed rest and MgSO4 is prescribed. 19. Which of the following would you anticipate in her maternal history: MOD a. Vaginal spotting, on and of b. Esophageal discomfort is experienced after a full meal c. Fetus moves frequently d. Rapid increase in weight gain, having gained 20 lbs in the 1st and 2md trimester

d

The major threat imposed by pregnancy in patents with heart disease is increased blood volume and potential congestive heart failure. Signs and symptoms includes cough, dyspnea, edema, and arrhythmia A 24-year old primigravida has Rheumatic heart disease lesion. Her pregnancy has just been diagnosed. Her heart disease has caused her moderate to marked limitation of physical activity. With less than ordinary activity she experiences fatigue, palpitations, dyspnea and the like. Her cardiac disease and functional capacity classification is A Class B. Class II C. Class III D. Class IV

C

50. Erin has been diagnosed with heart failure. In assessing Erin's cardiovascular status, this data is of least importance A. Bipedal edema B. Cyanosis of nailbeds C. Cough D. Pyrosis

D

1. Assessment of a multiparous client who delivered a neonate weighing 8 pounds by cesarean delivery an hour earlier, reveals a Soft fundus with excessive lochia rubra. Which of the following would the nurse expect to include in the client's plan of care? a. Administration of Oxytocin IM b. Placement of intravenous oxytocin c. Rigorous fundal massage every 5 minutes d. Preparation for an emergency hysterectomy

a

2. An NSVD multiparous client having persistent lochia rubra of moderate to heavy amount, visits the urgent care center 5 days after. She asks the nurse, "Why am I continuing to bleed like this?" The nurse replies that this type of postpartum bleeding is usually caused by which of the following? a. Uterine atony b. Cervical lacerations c. Vaginal laceration d. Retained placental fragments

a

A gravid-cardiac mother is advised to observe bed rest primarily to a. allow the fetus to achieve normal intrauterine growth b. Minimize oxygen consumption which can aggravate the condition of the compromised heart of the mother c. prevent perinatal infection d. reduce the incidence of premature labor

b

22. The action of MgSO4 is classified as a. Hypotensive drugs b. Sedative c. CNS depressant d. Relaxes the uterus, avoids irritability of uterine muscle

c

in taking care of Erin, you would least prioritize a. Monitor fetal heart rate and contractions b. Educate the client regarding measures to avoid infection c. Remove sodium from the client's diet d. Encourage client to rest in a lateral recumbent position

c

26. The nurse reviews an order to administer Rh (D) immune globulin to an Rh negative woman following the birth of an Rin positive baby. Which assessment is a priority before the nurse gives the injection? A) Newborn's blood type B) Coombs' test results C) Previous RhoGAM history D) Gravida and parity

B

32. When caring for a client with preeclampsia, which of the following actions is a priority? A. Reducing visual and auditory stimulation B. Continually assessing the fetal tracing for signs of fetal distress C. Monitoring the client's labor carefully and preparing for a fast delivery D. Checking vital signs every 15 minutes to watch for increasing blood pressure

D

38. All women experience a number of changes in the glucose insulin regulatory system as pregnancy progresses. Mrs Allen, 28 years old, has recently found out that she is pregnant. She has a sedentary lifestyle and says she has gotten used to eating fast food and junk food. Mrs. Allen has a familial history of diabetes and was recommended by her physician for diabetes. Your teaching plan should include: diabetes screening. You decide to teach her regarding gestational A. During pregnancy, the renal threshold for glucose is decreased B. During pregnancy, an increase in dietary intake may lead to the development of gestational diabetes C. Carbohydrate metabolism changes during pregnancy D. The pregnancy hormone HPL produces insulin resistance

D

27. Mrs. K is an Rh negative mother who has just given birth to an Rh positive infant. She had a negative indirect Coombs test at 38 weeks gestation and her infant had a negative direct Coombs test. What should the nurse know about these tests? a. Although Mrs. K's infant is Rh positive, she has no antibodies to the Rh factor. RhoGAM should be given b. Since Mrs. K's infant is Rh positive, the Coombs' tests are meaningless. c. Mrs. K. has formed antigens against the Rh factor. RhoGAM must be given to the infant. d. Mrs. K. has demonstrated antibodies to the Rh factor. She should not have any more children

a

29. Incidence of Rh incompatibility has been greatly reduced by the administration of RhoGAM to a. All Rh(-) mothers within 72 hours after delivery b. All Rh(-) neonates immediately after birth c. All Rh(-) mothers after 72 hours of delivery d. All Rh(-) mothers every trimester and ff delivery, if the fetus is Rh(+)

a

3. A 38-year-old client on her 14th weeks' gestation is admitted to the hospital with a diagnosis of complete Hydatidiform. Mole. Soon after admission, the nurse would assess the client for signs and symptoms of which of the following? a. Pregnancy-induced Hypertension b. Gestational Diabetes c. Hypothyroidism d. Polycythemia

a

42. If regular insulin is administered at 9 am, the nurse expects the blood glucose level to decrease starting at a. 9:30 am b. 10.00 am c. 1:00 pm d 3.00 pm

a

46. The control of diabetes in affected pregnant women is complicated by the diabetogenic effects of pregnancy itself Which of the following changes most often is made in the insulin requirement of the pregnant women taking insulin for overt diabetes? a. a gradual increase that drops sharply after delivery b. a gradual decrease that rise sharply after delivery c. a sustained increased throughout the pregnancy, returning to higher than pre-gestational levels after delivery d. Irregular variations throughout pregnancy, returning to pre-gestational levels after delivery

a

7. On arrival at the emergency department, a client tells the nurse that she suspects that she may be pregnant but has severe pain in the lower abdomen accompanied with a small amounts of bleeding. Her blood pressure is 70/50 mm Hg and her pulse rate is 120bpm. The nurse notifies the physician immediately because she suspects which of the following? a. Ectopic pregnancy b. Abruptio Placentae c. Gestational Trophoblastic Disease d. Complete Abortion

a

17. Of the following are the recommended protocol for a woman with severe preeclampsia, which one is not included? a. Reduced activity b. Bed rest w/reduced environmental stimuli c. Home care is inappropriate d. The main goal is to prevent generalized seizures

b

31. A woman you care for has an RH-negative blood type. Following the birth of her infant, you administer her RHIG (D immune globulin). The purpose of this is to a. Promote maternal D antibody formation: b. Prevent maternal D antibody formation c. Stimulate maternal D immune antigens d. Prevent fetal RH blood formation

b

35. A teenage primigravida with severe preeclampsia is in active labor. Her mother is at the bedside. Which of the following would alert the nurse that the client may be about to experience a seizure? a. Hyporeflexia b. Epigastric pain c. Decreased temperature d. Decreased contraction intensity

b

4. When assessing a client who had a D & C to expel a molar pregnancy, which of the following would be important to the nurse? a. Urinary tract infection b. Hemorrhage c. Abdominal distention d. Chorioamnionitis 5. After suction and evacuation of a complete Hydatidiform Mole, the 28-year-old multigravida client asks the nurse when she can become pregnant again. The nurse would advise the client not be become pregnant again for at least within which of the following? a. 6 months b. 12 months c. 18 months d. 24 months

b

43. Which of the following is the most likely reason why pregnant diabetic mothers with poorly controlled diabetes enter the hospital earlier than the expected date of confinement? a. These women usually develop pregnancy induced hypertension requiring hospital care b. Fetal acidosis is a potential problem that may lead to cognitive impairment c. Babies of diabetic women are usually large requiring early delivery d. Infection is one complication common in diabetics that usually occurs by early third trimester

b

5. After suction and evacuation of a complete Hydatidiform Mole, the 28-year-old multigravida client asks the nurse when she can become pregnant again. The nurse would advise the client not be become pregnant again for at least within which of the following? a. 6 months b. 12 months c. 18 months d. 24 months

b

A pregnant client with class 3 cardiac disease is seen during an initial prenatal visit. The nurse selects which of the following priority nursing diagnoses? a. Knowledge deficit related to self-care during pregnancy b. Activity intolerance related to compromised cardiac status. c. Alteration in nutrition related to sodium-restricted diet d. Fear, client and family, related to pregnancy outcome.

b

11. Which of the following is the best nursing management of a woman with threatened abortion is: a. Count perineal pads to detect progression of bleeding b. Take vital signs every 30 minutes c. Advise the mother bed rest to relax the uterus and avoid or minimize contractions d. Give Isoxsuprine as ordered to prevent contractions

c

12. Which of the following are the assessment signs observed by the RN in threatened abortion? a. Closed cervix, ruptured BOW b. Closed cervix, spotting c. Uterine cramps, spotting, (+) BOW, Closed cervix d. Closed cervix, intact BOW

c

13. Which of the following are the characteristics of inevitable abortion: a. Open cervix, ruptured BOW, placental parts remain incomplete b. Open cervix, intact BOW, placental parts and fetus remain c. Open cervix, ruptured BOW fetus and placental parts still intact d. Closed cervix, ruptured BOW fetus and placental parts still remain

c

25. The nurse as a clinician knows that Methotrexate, a chemotherapeutic agent is given also in pregnancy. Which of the following obstetrical conditions is this used? a. Ectopic pregnancy and abruptio placenta b. P previa and missed abortion c. Ectopic pregnancy and H-mole d. H-mole and preeclampsia severe

c

41. Identifying gestational diabetes is part of the prenatal care. When would the nurse schedule a patient for a glucose tolerance test: a. 6th week of pregnancy b. 12th week of pregnancy c. 24th week of pregnancy d. 32th week of pregnancy

c

44. Mrs. Castro asks about the method of delivering her baby. Which of these is the best response? a. "it will probably be cesarean section to minimize trauma to the baby b. "you will probably have a CS or labor induction by about 36-37 weeks and that's just about anytime from now" c. "your pregnancy will be carefully monitored. The best time of your delivery will, be chosen based on your health and the fetal well being and maturity d. "you will be monitored frequently and if your blood sugar is controlled, you will most likely be allowed to reach 40 weeks during which labor can start naturally."

c

47. A 24 year old primigravida has Rheumatic heart disease lesion. Her pregnancy has just been diagnosed. Her heart disease has caused her to limit moderate to marked limitation of physical activity. The nurse selects which of the following priority nursing diagnosis? a. Knowledge deficit related to self-care during pregnancy b. Alteration in nutrition related to sodium restricted diet c. Activity intolerance related to compromised cardiac status d. Fear related to pregnancy outcome

c

6. A 36-year-old multigravida client is admitted for possible ruptured ectopic pregnancy. When obtaining the client's history, which of the following would be a significant predisposing factor? a. Urinary tract infection b. Marijuana use during pregnancy c. Episodes of pelvic inflammatory disease d. Use of estrogen-progestin contraceptives

c

9. A multigravida client at 24 weeks' gestation visits the hospital because she suspects that her water has ruptured. The leaking fluid is tested with nitrazine paper. The nurse confirms that the client's membranes have ruptured, the paper turns into which of the following colors? a. Yellow (intact) b. Green c. Blue (raptured) d. Red

c

Intrapartum period: The preferred way of delivering the baby in a gravid-cardiac is vaginal delivery assisted by forceps under epidural anesthesia. The main rationale for this is a. To allow atraumatic delivery of the baby b. To allow a gradual shifting of the blood into the maternal circulation c. To make the delivery effort free and the mother does not need to push with d. To prevent perineal laceration with the expulsion of the fetal head contractions

c

Marina, G7P5 is admitted to the hospital in labor at 1 pm Cx-6-7cm, BOW intact 24. Which of the following is Marina's condition? 1. She is in active labor 2. She will deliver at approximately 4pm 3. She may go into hypotonic contractions probably affect 4. The RN must be alert in testing for the presence of the Bandl's ning a. 1&2 b. 2&4 c. 1,2&3 d. all but 3

c

23. Karmel complained of severe epigastric pain. Which of the following organs would the RN suspect as a. Brain b. Heart c. Lungs d. Liver

d

28. The combination of the parents' blood Rh findings that MOST often leads to Rh factor problem is when the blood a. Both parents are Rh (+) b. Both parents are Rh (-) c. The mother is Rh (+) and the father is Rh (-) d. The mother is Rh (-) and the father is Rh (+)

d

33. A woman has been diagnosed as having pregnancy-induced hypertension, Which of the following is the most typical symptom of this? a. Increased perspiration b. Weight loss c. Susceptibility to infection d. Protein in urine

d

36. A primigravida who has been diagnosed with PiH is to be admitted to the labor and delivery area. Which of the following for this client? client care rooms would the nurse determine to be the MOST appropriate a. A semi-private room with mathers to keep her company b. A private room with many windows that is near the nursery room c. A brightly lit private room at the end of the hall from the nurse's station d. A darkened private room as close to the nurse's station as possible

d