NCLEX OB Q'S
4.) Your patient is suffering from constipation and is 8 months pregnant. Which statement is incorrect when educating the patient about relief measures? A. Taking a cap-ful of Ex-lax a day will help relieve constipation B. Try to eat food rich is fiber such as beans, fruits, and vegetables along with sufficient fluid intake. C. Exercise regularly D. Constipation is experienced in the 2nd and 3rd trimester because of decreased intestinal motility
A A pregnant patient should be discouraged from taking any type of medications (even over-the-counter) unless prescribed by the OB doctor. This option is out of the scope of practice for the nurse.
2.) A patient is wanting to become pregnant and has underwent prenatal counsel and testing. Her rubella titer is lower than 1:8. She consents to receiving the rubella vaccine. What education will you provide to the patient? A.She must use an effective birth control method at the time of immunization and not become pregnant for 1-3 months. B.Once she has a positive pregnancy test she is to call the office to schedule another appointment. C.The patient's rubella titer is normal and therefore the vaccine is not needed. D.It is okay to come into contact with people who are immunocompromised.
A The only correct option is: She must use an effective birth control method at the time of immunization and not become pregnant for 1-3 months. Other options are incorrect statements about education regarding the rubella vaccine.
Which statement by the patient (who is 5'5 127 lbs) would cause you to re-educated the patient about nutrition during her pregnancy? A."I can expect to gain 50-60 lbs during my pregnancy" B."I will need to increase by calorie intake by 300 cal/day" C."I need to be sure to eat a lot foods with folic acid in them" D."I don't have to watch my sodium intake unless the MD specifies"
A. If a woman has a normal pre-pregnancy weight she should expect to gain 25 to 35 lbs during her pregnancy. All other options are correct statements.
7.) A patient who is 8 1/2 months pregnant tells you she has been counting her baby's kicks and is concerned because within a 4 hour period the baby has only kicked 32 times. What nursing intervention is correct? A.Reassure the patient this kick count is normal. B.Notify the MD of this finding. C.Prep the patient for an abdominal ultrasound. D.Assess the patient's urine for protein and glucose.
A. Reassuring the patient this is normal is the correct answer. The mother should feel the baby kick at least 10 times in two consecutive 2 hour periods.
Your patient who is 17 weeks pregnant describes to you she has been feeling the baby move. Which terms describes this movement? A.Quickening B.Ballottement C.Braxton Hick's contractions D.None of the above because fetal movement isn't felt until 20 weeks gestation
A.Quickening
A patient who is 35 weeks pregnant states she thinks her "water broke" but she isn't sure because it is a very little amount. What do you anticipate the MD will order first? A. Ultrasound B.Nitrazine strip test C.Nonstress test D.Amniocentesis
B
1.) Your patient has underwent testing of her blood type and Rh factor. She has A- blood type. Which of the following statement is correct? A.At 36 weeks she will receive Rh immune globulin. B.At 28 weeks she should receive the Rh immune globulin. C.No further testing will be done because the patient is Rh negative, instead of Rh positive. D.The patient will be checked for clotting problems.
B The patient's Rh factor is negative so she will need to receive the Rh immune globulin at 28 weeks. If the patient was A+ (meaning her Rh factor is positive) she would not have to receive the Rh immune globulin.
6.) A patient is having an abdominal ultrasound to assess fetal gestational age and estimated date of delivery. Which statement is incorrect about this type of testing? A.An abdominal ultrasound can outline and identify fetal and maternal structures. B.Before the abdominal ultrasound is performed the patient should empty bladder. C.Generally, at 20 weeks an abdominal ultrasound can be performed to assess fetal gender. D.There are two types of ultrasounds that can be safely performed on a pregnant patient: abdominal and transvaginal
B. A patient should have a full bladder before the procedure so better images of the fetus can be obtained. So instructing the patient to drink water to fill the bladder for the procedure would be ideal.
Which of the following is a probable sign of pregnancy? A.Quickening B.Goodell's Sign C.Amenorrhea D.Fetal heart rate detected by electronic device
B. Pregnancy signs are categorized into 3 categories: Presumptive, Probable, and Positive. Amenorrhea and quickening are presumptive signs of pregnancy, and fetal heart rate detected by an electronic devices is a positive sign of pregnancy. Out of this selection Goodell's sign is the only probable sign.
During an assessment of a pregnant patient (who is 20 weeks pregnant) she tells you the following information regarding her pregnancy outcomes: She currently has 3 children (ages: 3, 8, 19), all of them were born at 39 and 40 weeks gestation, she has been pregnant 5 times (including this pregnancy). How would you document her GTPAL? A.G: 4, T: 3, P: 0, A: 0, L: 4 B.G: 5, T: 3, P: 0, A: 1, L: 3 C.G: 4, T: 4, P: 0, A: 0, L: 3 D.G: 5, T: 3, P: 0, A: 1, L: 4
B. The answer is G: 5, T: 3, P: 0, A: 1, L: 3. G is the number of pregnancies including the present one. T is the number of babies born after 37 weeks gestation. P is the number of babies born before 37 weeks gestation. A is the number of abortions or miscarriages and L is the number of current living children.
5.) A patient in the early stages of pregnancy is suffering from "morning sickness". Which statement by the patient requires you to further educate the patient about this condition? A."I eat frequently through out the day and they are small amounts". B."I have my saltines at my bedside to munch on before I get up". C."I have been addicted to Mexican food and fried pickles lately." D."I know this morning sickness will pass and I should feel better in the 2nd trimester".
C
8.) A patient is undergoing an amniocentesis. Which statement is correct about this procedure? A.The patient will be ordered a blood type and cross before the procedure. B.It is performed at 30-32 weeks pregnancy. C.The patient is to be in the supine position. D.It is normal for the patient to leak fluid at the needle insertion site for 2-4 days.
C
3.) A patient is the third trimester of her pregnancy states she has been getting "terrible" leg cramps at night. Which statement is true about leg cramps during pregnancy? A. Avoiding regular exercise with help prevent tireness in the legs, therefore resting the legs will decrease leg cramps B.Tell the patient to increase her intake of iron fortified foods because low irons levels can cause leg cramps C. Dorsiflexing the foot will help the affected leg D. A prenatal work up needs to be performed for this is not NORMAL
C Legs cramps are normal in the 2nd and 3rd trimester of pregnancy and is usually caused by an altered calcium-phosphorus balance and pressure of the uterus on the nerves. Getting regular exercise, increasing calcium intake (NOT IRON), and dorsiflexing the foot of the affected leg with help this patient.
A patient tells you her last menstrual period was September 10th, 2014. According to the Nagele's rule when is her expected due date? A June 10, 2015 B. May 17, 2015 C. June 17, 2015 D. June 10, 2014
C. Using the Nagele's rule to calculate an expected due date you would add 7 days to the first day of the last menstrual period which would be September 17, 2014. Then subtract 3 months which would be June 17, 2014 and then add 1 year and this would make the expected due date June 17, 2015.
During a vaginal assessment on a patient who is 8 weeks pregnant, you note a bluish coloration of the mucous membrane of the cervix, vagina, and vulva. You would document this finding as what? A.Goodell's Sign B.Hegar's Sign C.Chadwick's Sign D. Ballottement
Chadwick's Sign This description is known as Chadwick's sign and can happen as early as 6 weeks gestation.
After doing Leopold's maneuvers, the nurse determines that the fetus is in the ROP position. To bestauscultate the fetal heart tones, the Doppler is placed: A. Above the umbilicus at the midline B. Above the umbilicus on the left side C. Below the umbilicus on the right side D. Below the umbilicus near the left groin
Correct Answer: C. Below the umbilicus on the right side Fetal heart tones are best auscultated through the fetal back; because the position is ROP (right occiput presentation), the back would be below the umbilicus and on the right side. Option A: The baby's heartbeat is loudest in its upper chest or upper back, depending on which way the baby is facing. Option B: If you hear the heartbeat loudest above the mother's umbilicus, the baby may be in the breech position Option D: If you hear the heartbeat loudest below the mother's umbilicus, the baby is probably head down.
A pregnant patient has a nonstress test performed. The results showed the baby had 4 fetal heart rate accelerations of at least 15 beats/min that lasted 15 seconds from start to finish in association with fetal movement during 20 minutes. The results of this would be documented as: A."Nonreactive" Nonstress Test B.Negative Contraction Stress Test C.Positive Contraction Stress Test D."Reactive" Nonstress Test
D
You are measuring the fundal height on a patient who is 20 weeks pregnant. Where do you expect to locate the fundus of the uterus? A.Symphysis pubis B.Xiphoid process C.None of the above because the fundus can not be located until 30 weeks gestation D.Umbilicus
D. At 20 to 22 weeks gestation the fundus should be located at the umbilicus. At 16 weeks the fundus can be found between the symphysis pubis and umbilicus, and at 36 weeks gestation is the fundus is found at the xiphoid process.
You are doing an assessment on a female patient. She tells you she gave birth to twin girls at 39 weeks. You would chart the following regarding parity? A.Nullipara B.Multipara C.Gravida D.Primipara
D. This describes a primipara woman because she had one birth that occurred after 20 weeks gestation. Note parity is the number of births NOT the number of fetuses as with twins in this situation. Multipara is a woman who has had two or more pregnancies resulting in a successful delivery, and nullipara is a woman who has not had a birth at more than 20 weeks gestation.
After teaching a pregnant woman who is in labor about the purpose of the episiotomy, which of the following purposes stated by the client would indicate to the nurse that the teaching was effective? A. Shortens the second stage of labor. B. Enlarges the pelvic inlet. C. Prevents perineal edema. D. Ensures quick placenta delivery.
a
Because cervical effacement and dilation are not progressing in a patient in labor, the doctor orders I.V. administration of oxytocin (Pitocin). Why must the nurse monitor the patient's fluid intake and output closely during oxytocin administration? A. Oxytocin causes water intoxication. B. Oxytocin causes excessive thirst. C. Oxytocin is toxic to the kidneys. D. Oxytocin has a diuretic effect.
a
For a patient in active labor, the nurse-midwife plans to use an internal electronic fetal monitoring (EFM) device. What must occur before the internal EFM can be applied? A. The membranes must rupture. B. The fetus must be at 0 station. C. The cervix must be dilated fully. D. The patient must receive anesthesia.
a
Immediately after delivery, the nurse-midwife assesses the neonate's head for signs of molding. Which factors determine the type of molding? A. Fetal body flexion or extension B. Maternal age, body frame, and weight C. Maternal and paternal ethnic backgrounds D. Maternal parity and gravidity
a
The multigravida mother with a history of rapid labor who us in active labor calls out to the nurse, "The baby is coming!" which of the following would be the nurse's first action? A. Inspect the perineum. B. Time the contractions. C. Auscultate the fetal heart rate. D. Contact the birth attendant.
a
The nurse is caring for a client in labor. The external fetal monitor shows a pattern of variable decelerations in fetal heart rate. What should the nurse do first? A. Change the client's position. B. Prepare for an emergency cesarean section. C. Check for placenta previa. D. Administer oxygen.
a
When administering magnesium sulfate to a client with preeclampsia, the nurse understands that this drug is given to: A. Prevent seizures. B. Reduce blood pressure. C. Slow the process of labor. D. Increase dieresis.
a
Which change would the nurse identify as a progressive physiological change in the postpartum period? A. Lactation B. Lochia C. Uterine involution D. Diuresis
a
When monitoring the fetal heart rate of a client in labor, the nurse identifies an elevation of 15 beats above the baseline rate of 135 beats per minute lasting for 15 seconds. This should be documented as: A. An acceleration B. An early elevation C. A sonographic motion D. A tachycardic heart rate
a An acceleration is an abrupt elevation above the baseline of 15 beats per minute for 15 seconds; if the acceleration persists for more than 10 minutes it is considered a change in baseline rate. A tachycardic FHR is above 160 beats per minute.
A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the following is noted on the external monitor tracing during a contraction? A. Early decelerations B. Variable decelerations C. Late decelerations D. Short-term variability
b
A patient is in the second stage of labor. During this stage, how frequently should the nurse in charge assess her uterine contractions? A. Every 5 minutes. B. Every 15 minutes. C. Every 30 minutes. D. Every 60 minutes.
b
After 3 days of breastfeeding, a postpartum patient reports nipple soreness. To relieve her discomfort, the nurse should suggest that she: A. Apply warm compresses to her nipples just before feeding. B. Lubricate her nipples with expressed milk before feeding. C. Dry her nipples with a soft towel after feedings. D. Apply soap directly to her nipples, and then rinse.
b
During which of the following stages of labor would the nurse assess "crowning"? A. First stage B. Second stage C. Third stage D. Fourth stage
b
The nurse is developing a teaching plan for a patient who is 8 weeks pregnant. The nurse should tell the patient that she can expect to feel the fetus move at which time? A. Between 10 and 12 weeks' gestation B. Between 16 and 20 weeks' gestation. C. Between 21 and 23 weeks' gestation. D. Between 24 and 26 weeks' gestation.
b
What is the approximate time that the blastocyst spends traveling to the uterus for implantation? A. 2 days B. 7 days C. 10 days D. 14 weeks
b
Which of the following would the nurse identify as a presumptive sign of pregnancy? A. Hegar sign B. Nausea and vomiting C. Skin pigmentation changes D. Positive serum pregnancy test
b
While the client is in active labor with twins and the cervix is 5 cm dilated, the nurse observes contractions occurring at a rate of every 7 to 8 minutes in a 30-minute period. Which of the following would be the nurse's most appropriate action? A. Note the fetal heart rate patterns. B. Notify the physician immediately. C. Administer oxygen at 6 liters by mask. D. Have the client pant-blow during the contractions.
b
A client who delivered by cesarean section 24 hours ago is using a patient-controlled analgesia (PCA) pump for pain control. Her oral intake has been ice chips only since surgery. She is now complaining of nausea and bloating, and states that because she had nothing to eat, she is too weak to breastfeed her infant. Which nursing diagnosis has the highest priority? A. Altered nutrition, less than body requirements for lactation. B. Alteration in comfort related to nausea and abdominal distention. C. Impaired bowel motility related to pain medication and immobility. D. Fatigue related to cesarean delivery and physical care demands of infant.
c
A patient with pregnancy-induced hypertension probably exhibits which of the following symptoms? A. Proteinuria, headaches, vaginal bleeding B. Headaches, double vision, vaginal bleeding C. Proteinuria, headaches, double vision D. Proteinuria, double vision, uterine contractions
c
Accompanied by her husband, a patient seeks admission to the labor and delivery area. The client states that she is in labor and says she attended the hospital clinic for prenatal care. Which question should the nurse ask her first? A. "Do you have any chronic illness?" B. "Do you have any allergies?" C. "What is your expected due date?" D. "Who will be with you during labor?"
c
After completing a second vaginal examination of a client in labor, the nurse-midwife determines that the fetus is in the right occiput anterior position and at (-1) station. Based on these findings, the nurse-midwife knows that the fetal presenting part is: A. 1 cm below the ischial spines. B. Directly in line with the ischial spines. C. 1 cm above the ischial spines. D. In no relationship to the ischial spines.
c
Cervical softening and uterine souffle are classified as which of the following? A. Diagnostic signs B. Presumptive signs C. Probable signs D. Positive signs
c
The nurse is teaching care of the newborn to a childbirth preparation class and describes the need for administering antibiotic ointment into the eyes of the newborn. An expectant father asks, "What type of disease causes infections in babies that can be prevented by using this ointment?" Which response by the nurse is accurate? A. Herpes B. Trichomonas C. Gonorrhea D. Syphilis
c
When talking with a pregnant client who is experiencing aching swollen, leg veins, the nurse would explain that this is most probably the result of which of the following? A. Thrombophlebitis B. Pregnancy-induced hypertension C. Pressure on blood vessels from the enlarging uterus D. The force of gravity pulling down on the uterus
c
Which of the following represents the average amount of weight gained during pregnancy? A. 12 to 22 lb B 15 to 25 lb C. 24 to 30 lb D. 25 to 40 lb
c
abor is a series of events affected by the coordination of the five essential factors. One of these is the passenger (fetus). Which are the other four factors? A. Contractions, passageway, placental position and function, pattern of care. B. Contractions, maternal response, placental position, psychological response. C. Passageway, contractions, placental position, and function, psychological response. D. Passageway, placental position, and function, paternal response, psychological response.
c
A 31-year-old multipara is admitted to the birthing room after initial examination reveals her cervix to be at 8 cm, completely effaced (100 %), and at 0 station. What phase of labor is she in? A. Active phase B. Latent phase C. Expulsive phase D. Transitional phase
d
A female adult patient is taking a progestin-only oral contraceptive or mini pill. Progestin use may increase the patient's risk for: A. Endometriosis B. Female hypogonadism C. Premenstrual syndrome D. Tubal or ectopic pregnancy
d
A nurse in the delivery room is assisting with the delivery of a newborn infant. After the delivery of the newborn, the nurse assists in delivering the placenta. Which observation would indicate that the placenta has separated from the uterine wall and is ready for delivery? A. The umbilical cord shortens in length and changes in color B. A soft and boggy uterus C. Maternal complaints of severe uterine cramping D. Changes in the shape of the uterus
d
A nurse is caring for a client in the second stage of labor. The client is experiencing uterine contractions every 2 minutes and cries out in pain with each contraction. The nurse recognizes this behavior as: A. Exhaustion B. Valsalva's maneuver C. Involuntary grunting D. Fear of losing control
d
A pregnant client is admitted to the labor room. An assessment is performed, and the nurse notes that the client's hemoglobin and hematocrit levels are low, indicating anemia. The nurse determines that the client is at risk for which of the following? A. A loud mouth B. Low self-esteem C. Hemorrhage D. Postpartum infections
d
During a prenatal visit at 4 months gestation, a pregnant client asks whether tests can be done to identify fetal abnormalities. Between 18 and 40 weeks gestation, which procedure is used to detect fetal anomalies? A. Amniocentesis. B. Chorionic villi sampling. C. Fetoscopy. D. Ultrasound.
d
FHR can be auscultated with a fetoscope as early as which of the following? A. 5 weeks gestation B. 10 weeks gestation C. 15 weeks gestation D. 20 weeks gestation
d
Which of the following nursing interventions would the nurse perform during the third stage of labor? A. Obtain a urine specimen and other laboratory tests. B. Assess uterine contractions every 30 minutes. C. Coach for effective client pushing. D. Promote parent-newborn interaction.
d
