NPII OB Exam 1
A patient who is pregnant does not remember the last date of her menstrual period. In which manner does the nurse expect the estimated date of delivery (EDD) to be determined for this patient? A. Having an ultrasound examination B. Using the gestational wheel C. Asking when previous babies were born D. Obtaining a history of gestational length
A. Having an ultrasound examination ^A fetal ultrasound will provide information about fetal development,= an accurate estimated date of delivery (EDD). -The gestational wheel can only be used if date of LMP is known. -The birthdays of the child's siblings are irrelevant. -Whether a mother carries to term is secondary to determining the normal EDD.
The nurse is providing pre-amniocentesis teaching for a patient who is at 18 weeks gestation. Which information does the nurse provide? Select all that apply. A. Positioning on the left side will avoid injury to the fetus. B. A full bladder will assist in ultrasound visualization. C. Discomfort will be minimized with a local anesthetic. D. Avoid lifting heavy objects for a period of 2 weeks. E. Abdominal cramping and bleeding is normal for 24 hours
B, C -Because pt is <20wks' gestation, a full bladder will assist w/ ultrasound visualization. To minimize discomfort as the needle is inserted, the patient will receive local anesthesia. Injury to the fetus and placenta is avoided through the use of ultrasonography during needle insertion. Placing the patient on her left side is not sufficient. The nurse will instruct the patient to avoid heavy lifting for a period of 2 days following the procedure. The nurse teaches the patient to report abdominal pain or cramping, fluid leakage, bleeding, decrease in fetal movement, fever, or chills to the HCP. The listed manifestations are not expected or normal.
A patient arrives for her fourth month prenatal visit and expresses concern because of a leakage of yellow fluid from her breasts. Which topic does the nurse discuss during this visit? A. Signs of infection B. Breast changes C. A change in EDD D. Support bras
B. Breast changes: The leakage of yellow fluid from the patient's breasts is a normal change during pregnancy and is colostrum, which is rich in antibodies for the neonate. Can begin as early as 16 weeks. No infection. Does not affect the EDD. Support bras= 1st trimester due to expected breast enlargement and doesn't address the patient's concern.
4. The nurse is providing care for a patient at 30 weeks' gestation. Which topic related to patient concern or discomfort is most important for the nurse to address? A. Increased breast enlargement B. Dizziness when lying supine C. Dependent edema and varicosities D. Hyperpigmentation on the face
B. Dizziness when lying supine. ^Most important issue for the nurse to address. Provide education about supine and orthostatic hypotension; advise patient to refrain from supine positioning. Patient needs to use side-lying positions. -Nurse needs to instruct the patient about management of dependent edema and varicosities= sit or lie with the feet and legs elevated several times daily. Not the most important issue for the nurse to address. -Many patients will express concern over hyperpigmentation on the face. Nurse needs to review cause and remind patient that the coloration is likely to be temporary. Not the most important issue for the nurse to address. -If patient is experiencing increased breast enlargement, nurse should reiterate importance of well-fitting bra. Not the most important issue for the nurse to address.
A patient is confirmed to be pregnant. Obstetric history includes two sets of twins born at 30 and 32 weeks' gestation, respectively, a singleton birth born at 39 weeks' gestation, and two pregnancies lost in the first trimester. In which way will the nurse define the patient's obstetrical history? A. G4, T3, P2, A2, L3 B. G6, T1, P4, A2, L5 C. G5, T1, P2, A2, L5 D. G6, T4, P0, A4, L3
B. G6, T1, P4, A2, L5 -Nurse will correctly determine that the patient has been pregnant 6 times; delivered 1 term neonate; had 2 set of twins born prematurely for a total of 4 births; had 2 spontaneous abortions before 20 weeks gestation; and currently has 5 living children.
A patient who is at 30 weeks' gestation is involved in a car crash. The nurse recognizes that which initial testing will be used to assess fetal well-being? A. Ultrasonography B. Nonstress testing C. Contraction stress test D. Fetal movement counting
B. Nonstress testing -Initially, NST used to monitor FHR patterns and accelerations as an indication of fetal well-being. HR of a physiologically normal fetus with adequate oxygenation and an intact autonomic nervous system accelerates in response to movement. Most widely accepted method to assess fetal well-being after maternal trauma, among other conditions. -A CST used to ascertain fetal well-being in response to uterine contractions. Primarily used at term pregnancy if the mother has a nonreactive NST. -Fetal movement counting is a procedure used to routinely check for fetal well-being by measuring fetal movement in a specific time frame. Tests for general well-being and doesn't monitor FHR, which may be compromised due to trauma. -Ultrasonography useful for assessing the uterine and fetal structures; but, does not specifically indicate fetal well-being.
A patient is scheduled for a contraction stress test (CST) at 36 weeks' gestation. The nurse is aware that a successful testing is dependent on which factor? A. Whether Braxton-Hicks contractions are occurring B. Whether uterine contractions can be stimulated C. If the mother is not overly tired or anxious D. If the fetus is in an awake cycle and active
B. Whether uterine contractions can be stimulated -Success; IS dependent on ability to stimulate uterine contractions; w/ careful admin of IV oxytocin or by nipple stimulation for 10mins. -Success; NOT affected if the mother is overly tired or anxious, NOT dependent on fetus being awake/active, & NOT dependent on presence of Braxton-Hicks at time of testing.
A patient in the second trimester of pregnancy becomes upset when the health care provider (HCP) schedules several screening tests. The patient voices concern that something is wrong with her baby. Which statement by the nurse will reduce the patient's anxiety? A. "Multiple screening tests are ordered for every pregnancy." B. "It is better to identify problems before birth than afterward." C. "Screening tests are primarily to identify those without disease or abnormality." D. "Diagnostic testing is a reason for worry because they indicate fetal problems."
C. "Screening tests are primarily to identify those without disease or abnormality." -The truthful statement will alleviate the pt's anxiety.
A patient in the third trimester of pregnancy reports having heartburn nearly every day. Which recommendations does the nurse make to alleviate the problem? Select all that apply. A. Consume three moderate-sized meals daily. B. Sip clear, carbonated beverages when eating. C. Assume a low Fowler position after meals. D. Avoid eating 3 hours prior to bedtime. E. Avoid consuming spicy, fatty, or fried food.
D, E- Avoid eating 3hrs prior to bedtime, Avoid consuming spicy, fatty, or fried food. -Heartburn during 3rd trimester is managed by eating small/frequent meals, avoiding fluid intake during meals, remaining upright for 30-45mins after eating, avoiding eating at least 3hrs prior to bedtime, and Avoiding spicy/fatty/fried food.
A patient who is at 20 weeks' gestation is being prepared for an MRI after a nonconclusive ultrasound testing for suspected brain abnormality related to possible zika virus exposure. Which nursing actions are appropriate for this patient? Select all that apply. A. Provide information regarding the test. B. Allow patient to express feelings about her high-risk pregnancy. C. Promote open communication with her primary health care providers. D. Encourage patient to think about resolutions for negative testing. E. Provide psychological support to the patient and her partner.
A, B, C, E -Nursing responsibility r/t antenatal testing is to inform pt expectations during testing, provide pt and partner w/ psychological support (pt likely to be anxious & should be allowed to express feelings.), promote open communication w/ pt's primary HCPs (especially important in event of high-risk pregnancies.) -In this scenario, nurse needs to refrain from encouraging pt from thinking of resolutions if MRI test results indicate manifestations of zika virus. nurse needs to encourage pt to make informed decisions when all factors are available.
A patient arrives at a maternal health client and tells the nurse she has missed a period and thinks she is pregnant. Which information shared with the nurse is a presumptive sign of pregnancy? A. Positive results on a home pregnancy test B. Breast enlargement, tenderness, and tingling C. First awareness of fetal movements D. Increased appetite
If patient experiences breast enlargement, tenderness, and tingling after missing a period, the patient has a presumptive sign of pregnancy. =subjective finding, occurs 2-3wks after conception. -After missing one period, not likely the patient will experience first awareness of fetal movement, which is a presumptive sign but does not occur until 18-20wks after conception. -An increase in appetite not a presumptive sign of pregnancy. More likely sign is n/v, can occur from 2-12wks. -A positive result on a home pregnancy test is a probable sign of pregnancy, not a presumptive sign, which is primarily subjective information provided by the patient.
The nurse explains to a patient who has missed a second menstrual cycle that a combination of presumptive and probable signs is used to make a practical diagnosis of pregnancy. Which signs are expected by the nurse when making a practical diagnosis? Select all that apply. A. Elevated hCG levels in blood and urine B. Brownish pigmentation on the face C. Fetal movement detected by the examiner D. Bluish-purple coloration of vagina and cervix E. Occasional mild contractions
A, B, D- Elevated hCG levels in blood and urine, Brownish pigmentation on the face, Bluish-purple coloration of vagina and cervix. - Elevated hCG levels= probable sign. -Brownish pigmentation on the patient's forehead, temples, cheeks, and/or upper lip is melisma (chloasma)= probable sign. -Bluish-purple coloration (Chadwick's sign) of the vaginal mucosa, cervix, and vulva occurs at 6-8wks gestation= considered probable sign -Fetal movement that can be observed/detected by examiner= a positive sign, but doesn't occur until after or about 20wks' gestation. Unexpected at this time. -Contractions not expected, even Braxton-Hicks contractions, until long after the pregnancy is identified.
The nurse is providing care for a 45-year-old patient who has just learned she is in the second trimester of pregnancy. The patient thought she was experiencing manifestations of menopause until she recognized fetal movement. Which diagnostic test does the nurse expect to be prescribed for this patient? A. Amniocentesis B. Ultrasonography C. Daily fetal movement count D. Chorionic villi sampling
A. Amniocentesis Due to age of pt & period of gestation, Nurse expects amniocentesis to be performed. The test is appropriate between 15-20wks of gestation & for detection of genetic disorders in mothers >35yrs.
An Eastern European Jewish couple had two children who died from Tay-Sachs disease. The couple is currently pregnant and have asked for genetic confirmation about this fetus with the intention of early termination if the fetus tests positively. For which reason does the nurse expect chorionic villa sampling to be prescribed? A. The test is performed as early as 10 weeks' gestation. B. Risks to the fetus and mother are less than other tests. C. A positive result allows termination during the test. D. This is the only testing that is disease specific.
A. The test is performed as early as 10wks' gestation. -Chorionic villa testing- performed as early as 10wks gestation. Given the reproductive history of the couple and their expectations, this is the test the nurse should expect to be prescribed. Risks higher for chorionic villa testing than for amniocentesis; 7% fetal loss related to bleeding, infection, and rupture of membranes. But, amniocentesis isn't performed until <15wks' gestation. Results of chromosomal studies from a chorionic villa testing are available within 1wk. Not possible to perform a termination during the initial testing. Chorionic villa testing not specific to Tay-Sachs disease; The testing is effective in detecting DNA or metabolic disorders.
The nurse is assessing a patient who just received confirmation of pregnancy. While collecting information about the patient's medical history, which information alerts the nurse to biophysical risk factors? Select all that apply. A. The patient is primipara who is 38 years of age. B. The patient smokes two packs of cigarettes weekly. C. The patient has been a strict vegetarian for 25 years. D. The patient works as a nuclear medicine technician. E. The patient is medically treated for rheumatoid arthritis.
C, E -Nutritional practices are a biological factor that can place pt and/or fetus at risk. Special considerations are needed to make sure iron and protein requirements are met. -A patient with a diagnosis of rheumatoid arthritis who is medically treated has biological factors that place pt and/or fetus at risk. -Age and parity are sociodemographic factors that place pt and/or fetus at risk. -Smoking is a psychosocial factor that places pt and/or fetus at risk. -Environmental factors can place pt and/or fetus at risk. -Risk factors= exposure to chemicals, radiation, and pollutants.
A patient is scheduled for transvaginal ultrasound testing. Which preparation by the nurse is appropriate? A. Place the patient supine with a pillow beneath her head. B. Explain that pain at 4 or less on a 0 to10 scale is expected. C. Ascertain whether the patient has a latex or banana allergy. D. Request that the patient's partner leave the testing room.
C. Ascertain whether the pt has a latex or banana allergy. -Because the transvaginal ultrasound probe is covered by a latex sheath, nurse needs to ascertain whether the patient has a latex allergy or has exhibited an allergic response to specific foods such as bananas.
A patient who is pregnant shares details of being in a physically and psychologically abusive relationship with her baby's father. Which statement by the nurse is indicative of AWHONN's standing regarding intimate partner violence (IPV)? A. "If you are all alone, you need to make arrangements for someone to stay with you." B. "Your partner needs to come to the office so that we can confront his behavior." C. "I will call a women's shelter to make arrangement for you to move in immediately." D. "Let's explore ways to protect you and stop the abuse you have been enduring."
D. "Let's explore ways to protect you and stop the abuse you have been enduring." -AWHONN promotes safety, support, education, and confidentiality as part of the interventions to protect the woman who is experiencing partner abuse; this statement covers the patient's needs.
A patient has experienced an uneventful pregnancy but begins to have vaginal spotting at 38 weeks' gestation. The health care provider (HCP) suspects placenta previa initiated by cervical thinning. Which testing does the nurse expect the HCP to schedule? A. Doppler flow studies B. Nonstress testing C. Magnetic resonance imaging D. Ultrasonography studies
D. Ultrasonography studies -Ultrasonography studies are appropriate in determining placental placement & possible abnormalities. -Doppler flow studies= evaluate placental profusion, not placement. -NST= determines fetal wellbeing & measures cardiac function during fetal movement or contractions. -MRI= detailed imaging when screening tests indicate possible abnormalities.
The nurse is planning an assessment on a patient in the second trimester of pregnancy. For which assessments will the nurse plan? Select all that apply. A. Urine testing with a dipstick. B. Presence of dependent edema. C. Determine EDD by Naegele's rule. D. Antibody screening for Rh?2- patient. E. Check for chromosomal abnormalities.
A, B, D- Urine testing w/ dipstick, Presence of dependent edema, Antibody screening for RH2- patient. -During 2nd trimester, common for nurse to perform urine testing w/ dipstick; checks for glucose, albumin, and ketones. Mild proteinuria and glycosuria= expected. -During 2nd trimester, nurse should check the pt. for slight, dependent edema in lower extremities due to decreased venous return. Upper body edema= abnormal and requires additional evaluation. 2nd trimester, nurse will perform screening to determine if the Rh- pt has produced antibodies. If so, the pt will receive 1st dose Rhogam. Pt's Rh factor is determined in 1st trimester. EDD is estimated using Naegele's rule during 1st trimester; EDD determined in 2nd trimester if pt isn't aware of last menstrual cycle. -Chromosomal abnormalities aren't routinely screened; but, during early stage of 2nd trimester, all pts should be offered screening & diagnostic testing regardless of age or other risk factors.
The nurse is providing dietary teaching to a patient in the first trimester of pregnancy who is overweight. Which daily dietary suggestions does the nurse make? Select all that apply. A. One cup of 100% juice and cup of dried fruit. B. Three cups of raw leafy and 1 cup cooked vegetables C. One and a half cups of cooked pasta, rice, or cereal D. Six ounces of lean meat, 2 eggs, and cup of beans E. One cup of milk, 1 cup of yogurt, and oz of cheese
A, E.- 1c of 100% juice & 1c of dried fruit. 1c of milk, 1c of yogurt, & 1oz of cheese. -In 1st trimester, pt. requires 2c fruit; 1c 100% juice & 1c dried fruit daily. 1c milk, 1c yogurt, &1oz cheese is =recommended daily dairy intake. -In 1st trimester, pt. requires cups of vegetables; needs 6 ounces of grains; needs ounces of protein daily; -One ounce of protein= 1 oz lean meat, poultry, or seafood; cup of cooked beans, oz of nuts or 2 tbs peanut butter; or 1 egg. Suggested foods =10oz of protein.
A patient is in her first trimester of her second pregnancy. The patient's first child was born with a trisomy 21 defect. The patient is requesting testing to determine whether the current fetus has the same defect. Which initial testing does the nurse expect the HCP to prescribe? A. Fetal ultrasound B. Magnetic resonance imaging C. Chorionic villa sampling D. Amniocentesis
A. Fetal Ultrasound -Fetal ultrasound in 1st trimester can be performed for nuchal translucency (which measures the midsagittal plane w/ neck of fetus to assess the amount of fluid behind the neck.) Elevated measurement is associated w/ trisomy 21. This is the initial test the nurse can expect; results may require further diagnostic testing.
A pregnant patient is at the prenatal clinic for a routine visit at 30 weeks' gestation. The nurse monitors the patient for indications of physiological demands by the fetus on the patient. Which finding causes the nurse concern? A. Hgb of 9.5 g/dL and Hct. of 30% B. PT of 16.5 seconds C. WBCs of 16,000 mm3 D. Heart rate up 20 bpm
A. Hgb of 9.5 g/dL and Hct of 30% ^These are below normal for the patient. Causes concern because the increased demand of iron for fetal development results in maternal iron deficiency anemia. -Normal PT is in the range of 11 to 13.5 seconds. Doesn't cause concern. -WBC count of 16,000 mm3 is not abnormal in a patient who is at 30 weeks' gestation, especially if there aren't indications of infection. -A 15 to 20 bpm increase in heart rate is expected due to a 40% increase in cardiac output. Doesn't cause concern.
A patient in the third trimester of pregnancy expresses concern to the nurse about changes to her muscles, joints, and bones. Which conditions does the nurse reassure the patient are normal changes of pregnancy? Select all that apply. A. Waddling gait B. Low back pain C. Increased risk of falls D. Fractures E. Severe muscle aches
A, B, C- Waddling gait, Low back pain, Increased risk of falls. - A waddling gait and Low back pain= normal change and r/t increased progesterone and relaxin levels causing softening of joints and increased joint mobility. Widening and increased mobility of the sacroiliac and symphysis pubis result. -Increased risk of falls= expected; due to shift in center of gravity r/t enlarged uterus. The pt. needs to take precautions to avoid falls or activities requiring balance. -Fractures = not expected/normal. -Muscle aches= not normal and may signal an electrolyte imbalance.
