NU472 HESI Obstetrics/Maternity Practice Quiz - 43 Questions

A pregnant client with mitral stenosis Class III is prescribed complete bedrest. The client asks the nurse, "Why must I stay in bed all the time?" Which response is best for the nurse to provide this client? o "Complete bedrest decreases oxygen needs and demands on the heart muscle tissue." o "We want your baby to be healthy, and this is the only way we can make sure that will happen." o "I know you're upset. Would you like to talk about some things you could do while in bed?" o "Labor is difficult and you need to use this time to rest before you have to assume all child-caring duties."

o "Complete bedrest decreases oxygen needs and demands on the heart muscle tissue." · The healthcare provider prescribed activity restriction and complete bedrest to this client in order to help preserve cardiac reserves.

A client at 32-weeks gestation comes to the prenatal clinic with complaints of pedal edema, dyspnea, fatigue, and a moist cough. Which question is most important for the nurse to ask this client? o "Which symptom did you experience first?" o "Are you eating large amounts of salty foods?" o "Have you visited a foreign country recently?" o "Do you have a history of rheumatic fever?"

o "Do you have a history of rheumatic fever?" · Obtaining a client's health history is a priority because clients with a history of rheumatic fever may develop mitral valve prolapse, which increases the risk for cardiac decompensation due to the increased blood volume that occurs during pregnancy.

A client who is in the second trimester of pregnancy tells the nurse that she wants to use herbal therapy. Which response is best for the nurse to provide? o "Herbs are a cornerstone of good health to include in your treatment." o "Touch is also therapeutic in relieving discomfort and anxiety." o "Your healthcare provider should direct treatment options for herbal therapy." o "It is important that you want to take part in your care."

o "It is important that you want to take part in your care." · Clients need to be viewed holistically. By acknowledging the emphasis the client made to alternative and complementary therapies, such as herbal therapy, the client is empowered as an integral member of the healthcare team.

A female client with insulin-dependent diabetes arrives at the clinic seeking a plan to get pregnant in approximately 6 months. She tells the nurse that she wants to have an uncomplicated pregnancy and a healthy baby. What information should the nurse share with the client? o "Your current dose of Insulin should be maintained throughout your pregnancy." o "Maintain blood sugar levels in a constant range within normal limits during pregnancy." o "The course and outcome of your pregnancy is not an achievable goal with diabetes." o "Expect an increase in insulin dosages by 5 units/week during the first trimester."

o "Maintain blood sugar levels in a constant range within normal limits during pregnancy." · Maintaining blood sugar within a normal range during pregnancy has a strong correlation with a good outcome.

A new mother asks the nurse, "How do I know that my daughter is getting enough breast milk?" Which response is best for the nurse provide? o "Weigh the baby daily, and if she is gaining weight, she is eating enough." o "Your milk is sufficient if the baby is voiding pale straw-colored urine 6 to 10 times a day." o "Offer the baby extra bottle milk after her feeding, and see if she is still hungry." o "If you're concerned, you might consider bottle feeding so that you can monitor her intake."

o "Your milk is sufficient if the baby is voiding pale straw-colored urine 6 to 10 times a day." An infant is hydrated when the urine is dilute (straw-colored) and frequency of voiding is >6 to 10 times/day. Infants feed 8-12 times in a 24 hour period.

A client at 32-weeks gestation is diagnosed with preeclampsia. Which assessment finding is most indicative of an impending convulsion? o 3+ deep tendon reflexes and hyperclonus. o Periorbital edema, flashing lights, and aura. o Epigastric pain in the third trimester. o Recent decreased urinary output.

o 3+ deep tendon reflexes and hyperclonus. · Three plus deep tendon reflexes and hyperclonus are indicative of an impending convulsion and require immediate attention.

A client at 32-weeks gestation is hospitalized with severe pregnancy-induced hypertension (PIH). The healthcare provide prescribed magnesium sulfate is to control the symptoms. Which assessment finding would indicate that therapeutic drug level has been achieved? o 4+ reflexes. o Urinary output of 50 ml per hour. o A decrease in respiratory rate from 24 to 16. o A decreased body temperature.

o A decrease in respiratory rate from 24 to 16. · Magnesium sulfate is a CNS depressant that helps prevent seizures. A decreased respiratory rate indicates that the drug is effective. (Respiratory rate below 12 indicates toxic effects.) The therapeutic level of magnesium sulfate for a PIH client is 4.8 to 9.6 mg/dl.

The nurse is preparing a client with a term pregnancy who is in active labor for an amniotomy. What equipment should the nurse have available at the client's bedside? Select all that apply. o Litmus paper. o Fetal scalp electrode. o A sterile glove. o An amnihook. o Sterile vaginal speculum. o Lubricant.

o A sterile glove. o An amnihook. o Lubricant. · A single sterile glove, an amnihook, and lubricant are the necessary equipment for performing an amniotomy.

The nurse is preparing a client with a term pregnancy who is in active labor for an amniotomy. What equipment should the nurse have available at the client's bedside? Select all that apply. o Litmus paper. o Fetal scalp electrode. o A sterile glove. o An amniotic hook. o Sterile vaginal speculum. o A Doppler.

o A sterile glove. o An amniotic hook. o A Doppler. · A single sterile glove, an amniotic hook , and Doppler are needed to check fetal heart tones are the necessary equipment for performing an amniotomy.

A woman who gave birth 48 hours ago is bottle-feeding her infant. During assessment, the nurse determines that both breasts are swollen, warm, and tender upon palpation. What action should the nurse take? o Apply cold compresses to both breasts for comfort. o Instruct the client run warm water on her breasts. o Wear a loose-fitting bra to prevent nipple irritation. o Express small amounts of milk to relieve pressure.

o Apply cold compresses to both breasts for comfort. The client is experiencing engorgement even though she is bottle-feeding her infant, and applying cold compresses may help reduce discomfort.

A vaginally delivered infant of an HIV positive mother is admitted to the newborn nursery. What intervention should the nurse perform first? o Bathe the infant with an antimicrobial soap. o Measure the head and chest circumference. o Obtain the infant's footprints. o Administer vitamin K (AquaMEPHYTON).

o Bathe the infant with an antimicrobial soap. · To reduce direct contact with the human immuno-virus in blood and body fluids on the newborn's skin, a bath with an antimicrobial soap should be administered first.

The nurse is teaching a woman how to use her basal body temperature (BBT) pattern as a tool to assist her in conceiving a child. Which temperature pattern indicates the occurrence of ovulation, and therefore, the best time for intercourse to ensure conception? o Between the time the temperature falls and rises. o Between 36 and 48 hours after the temperature rises. o When the temperature falls and remains low for 36 hours. o Within 72 hours before the temperature falls.

o Between the time the temperature falls and rises. · In most women, the BBT drops slightly 24 to 36 hours before ovulation and rises 24 to 72 hours after ovulation, when the corpus luteum of the ruptured ovary produces progesterone making between the time of the temperature fall and rise is the best time to try to conceive.

A client with gestational hypertension is in active labor and receiving an infusion of magnesium sulfate. Which is the most important drug the nurse should have available for signs of potential toxicity? o Oxytocin (PItocin). o Calcium gluconate. o Terbutaline (Brethine). o Naloxone (Narcan).

o Calcium gluconate. The antidote for magnesium sulfate is calcium gluconate, which should be readily available if the client manifest signs of toxicity.

One hour after giving birth to an 8-pound infant, a client's lochia rubra has increased from small to large and her fundus is boggy despite massage. The client's pulse is 84 beats/minute and blood pressure is 156/96. The healthcare provider prescribes Methergine 0.2 mg IM X 1. What action should the nurse take immediately? o Give the medication as prescribed and monitor for efficacy. o Encourage the client to breastfeed rather than bottle feed. o Have the client empty her bladder and massage the fundus. o Call the healthcare provider to question the prescription.

o Call the healthcare provider to question the prescription. · Methergine is used to treat postpartum hemorrhage, but is contraindicated for clients with elevated blood pressure, so the nurse should contact the healthcare provider and question the prescription because the client's elevated blood pressure.

Which assessment finding should the nursery nurse report to the pediatric healthcare provider? o Blood glucose level of 45 mg/dl. o Blood pressure of 82/45 mmHg. o Non-bulging anterior fontanel. o Central cyanosis when crying.

o Central cyanosis when crying. · An infant who demonstrates central cyanosis when crying is manifesting poor adaptation to extrauterine life which should be reported to the healthcare provider for determination of a possible underlying cardiovascular problem. The other options are expected findings in newborn.

A 4-week-old premature infant has been receiving epoetin alfa (Epogen) for the last three weeks. Which assessment finding indicates to the nurse that the drug is effective? o Slowly increasing urinary output over the last week. o Respiratory rate changes from the 40s to the 60s. o Changes in apical heart rate from the 180s to the 140s. o Change in indirect bilirubin from 12 mg/dl to 8 mg/dl.

o Changes in apical heart rate from the 180s to the 140s. · Epogen, given to prevent or treat anemia, stimulates erythropoietin production, resulting in an increase in RBCs. Since the body has not had to compensate for anemia with an increased heart rate, changes in heart rate from high to normal is one indicator that Epogen is effective.

A newborn infant is brought to the nursery from the birthing suite. The nurse notices that the infant is breathing satisfactorily but appears dusky. What action should the nurse take first? o Notify the pediatrician immediately. o Suction the infant's nares, then the oral cavity. o Check the infant's oxygen saturation rate. o Position the infant on the right side.

o Check the infant's oxygen saturation rate. · When possible, the nurse should first obtain measurable objective data; an oxygen saturation rate provides such information.

A client who has an autosomal dominant inherited disorder is exploring family planning options and the risk of transmission of the disorder to an infant. The nurse's response should be based on what information? o Males inherit the disorder with a greater frequency than females. o Each pregnancy carries a 50% chance of inheriting the disorder. o The disorders can occur in 25% of pregnancies. o All children will be carriers of the disorder.

o Each pregnancy carries a 50% chance of inheriting the disorder. · According to the laws of inheritance, an autosomal dominant disorder has a 50% chance of being transmitted with each pregnancy, and if transmitted, the disorder will appear in the child.

The nurse is caring for a woman with a previously diagnosed heart disease who is in the second stage of labor. Which assessment findings are of greatest concern? o Edema, basilar rales, and an irregular pulse. o Increased urinary output and tachycardia. o Shortness of breath, bradycardia, and hypertension. o Regular heart rate and hypertension.

o Edema, basilar rales, and an irregular pulse. Edema, basilar rales, and an irregular pulse indicate cardiac decompensation and require immediate intervention.

The healthcare provider prescribes terbutaline (Brethine) for a client in preterm labor. Before initiating this prescription, it is most important for the nurse to assess the client for which condition? o Gestational diabetes. o Elevated blood pressure. o Urinary tract infection. o Swelling in lower extremities.

o Gestational diabetes. · The nurse should evaluate the client for gestational diabetes because terbutaline (Brethine) increases blood glucose levels.

The nurse attempts to help an unmarried teenager deal with her feelings following a spontaneous abortion at 8-weeks gestation. What type of emotional response should the nurse anticipate? o Grief related to her perceptions about the loss of this child. o Relief of ambivalent feelings experienced with this pregnancy. o Shock because she may not have realized that she was pregnant. o Guilt because she had not followed her healthcare provider's instructions.

o Grief related to her perceptions about the loss of this child. · Clients can experience Grief/loss response at all stages of pregnancy loss.

Which action should the nurse implement when preparing to measure the fundal height of a pregnant client? o Have the client empty her bladder. o Request the client lie on her left side. o Perform Leopold's maneuvers first. o Give the client some cold juice to drink.

o Have the client empty her bladder. · To avoid an elevation of the uterus, the client must empty the bladder prior to obtaining an accurate fundal height measurement.

When evaluating maternal bonding, which of the following maternal behaviors exhibited by the client would the nurse most likely expect to see when a new mother receives her infant for the first time? o She eagerly reaches for the infant, undresses the infant, and examines the infant completely. o Her arms and hands receive the infant and she then traces the infant's profile with her fingertips. o Her arms and hands receive the infant and she then cuddles the infant to her own body. o She eagerly reaches for the infant and then holds the infant close to her own body.

o Her arms and hands receive the infant and she then traces the infant's profile with her fingertips. · Attachment/bonding theory indicates that most mothers will demonstrate behaviors such as tracing the infant's profile with her fingertips during the initial visit with the newborn, which may be at delivery or later.

A client who is attending antepartum classes asks the nurse why her healthcare provider has prescribed iron tablets. The nurse's response is based on what knowledge? o Supplementary iron is more efficiently utilized during pregnancy. o It is difficult to consume 18 mg of additional iron by diet alone. o Iron absorption is decreased in the GI tract during pregnancy. o Iron is needed to prevent megaloblastic anemia in the last trimester.

o It is difficult to consume 18 mg of additional iron by diet alone. Consuming enough iron-containing foods to facilitate adequate fetal storage of iron and to meet the demands of pregnancy is difficult so iron supplements are often recommended.

An expectant father tells the nurse he fears that his wife "is losing her mind." He states she is constantly rubbing her abdomen and talking to the baby, and that she actually reprimands the baby when it moves too much. What recommendation should the nurse make to this expectant father? o Reassure him that these are normal reactions to pregnancy and suggest that he discuss his concerns with the childbirth education nurse. o Help him to understand that his wife is experiencing normal symptoms of ambivalence about the pregnancy and no action is needed. o Ask him to observe his wife's behavior carefully for the next few weeks and report any similar behavior to the nurse at the next prenatal visit. o Let him know that these behaviors are part of normal maternal/fetal bonding which occur once the mother feels fetal movement.

o Let him know that these behaviors are part of normal maternal/fetal bonding which occur once the mother feels fetal movement. · These behaviors are positive signs of maternal/fetal bonding and do not reflect ambivalence. No intervention is needed. Quickening, the first perception of fetal movement, occurs at 17 to 20 weeks gestation and begins a new phase of prenatal bonding during the second trimester.

When assisting a client to relieve postpartum uterine contractions, which nursing intervention would be most helpful for the nurse to take?" o Lying client prone with a pillow on the abdomen. o Asking the client to express milk via breast pump. o Massaging the client's abdomen. o Giving oxytocic medications.

o Lying client prone with a pillow on the abdomen. Lying prone keeps the fundus contracted and is especially useful with multiparas, who commonly experience afterpains due to lack of uterine tone.

A 30-year-old gravida 2, para 1 client is admitted to the hospital at 26-weeks gestation in preterm labor. She is given a dose of terbutaline sulfate (Brethine) 0.25 mg subcutaneous. Which assessment is the highest priority for the nurse to monitor during the administration of this drug? o Maternal blood pressure and respirations. o Maternal and fetal heart rates. o Hourly urinary output. o Deep tendon reflexes

o Maternal and fetal heart rates. · Monitoring maternal and fetal heart rates is most important when terbutaline is being administered because Terbutaline acts as a sympathomimetic agent that stimulates both beta 1 receptors (causing tachycardia, a side effect of the drug) and beta 2 receptors (causing uterine relaxation, a desired effect of the drug).

The nurse assesses a client admitted to the labor and delivery unit and obtains the following data: dark red vaginal bleeding, uterus slightly tense between contractions, BP 110/68, FHR 110 beats/minute, cervix 1 cm dilated and uneffaced. Based on these assessment findings, what intervention should the nurse implement? o Insert an internal fetal monitor. o Assess for cervical changes q1h. o Monitor bleeding from IV sites. o Perform Leopold's maneuvers.

o Monitor bleeding from IV sites. · Monitoring bleeding from peripheral sites is the priority intervention. This client is presenting with signs of placental abruption. Disseminated intravascular coagulation (DIC) is a complication of placental abruptio, characterized by abnormal bleeding.

On admission to the prenatal clinic, a 23-year-old woman tells the nurse that her last menstrual period began on February 15, and that previously her periods were regular. Her pregnancy test is positive. This client's expected date of delivery (EDD) would be o November 22. o November 8. o December 22. o October 22.

o November 22. November 22 is the answer. The RN correctly applied N gele's rule for estimating the due date by counting back 3 months from the first day of the last menstrual period (January, December, November) and adding 7 days (15+7=22).

Twenty minutes after a continuous epidural anesthetic is administered, a laboring client's blood pressure drops from 120/80 to 90/60. What action will the nurse take? o Notify the healthcare provider or anesthesiologist immediately. o Continue to assess the blood pressure q5 minutes. o Place the woman in a lateral position. o Turn off the continuous epidural.

o Place the woman in a lateral position. The nurse should immediately turn the woman to a lateral position, place a pillow or wedge under the right hip to deflect the uterus, increase the rate of the main line IV infusion, and administer oxygen by face mask at 10-12 L/min. If the blood pressure remains low, especially if it further decreases, the anesthesiologist/healthcare provider should be notified immediately.

An off-duty nurse finds a woman in a supermarket parking lot delivering an infant while her husband is screaming for someone to help his wife. Which intervention has the highest priority? o Use a thread to tie off the umbilical cord. o Provide as much privacy as possible for the woman. o Reassure the husband and try to keep him calm. o Put the newborn to breast.

o Put the newborn to breast. · The most important intervention is placing the newborn to the mother's breast. This action serves two purposes as it will help contract the uterus thus preventing a postpartum hemorrhage and avoid infant "cold-stress" because skin to skin will maintain the infant's thermoregulation.

A client receiving epidural anesthesia begins to experience nausea and becomes pale and clammy. What intervention should the nurse implement first? o Raise the foot of the bed. o Assess for vaginal bleeding. o Evaluate the fetal heart rate. o Take the client's blood pressure.

o Raise the foot of the bed. · These symptoms are suggestive of hypotension which is a side effect of epidural anesthesia. Raising the foot of the bed will increase venous return and provide blood to the vital areas.

The nurse is providing discharge teaching for a client who is 24 hours postpartum. The nurse explains to the client that her vaginal discharge will change from red to pink and then to white. The client asks, "What if I start having red bleeding after it changes?" What should the nurse instruct the client to do? o Reduce activity level and notify the healthcare provider. o Go to bed and assume a knee-chest position. o Massage the uterus and go to the emergency room. o Do not worry as this is a normal occurrence.

o Reduce activity level and notify the healthcare provider. · Lochia should progress in stages from rubra (red) to serosa (pinkish) to alba (whitish), and not return to red. The return to rubra usually indicates subinvolution or infection. If such a sign occurs, the mother should notify the clinic/healthcare provider and reduce her activity to conserve energy.

During labor, the nurse determines that a full-term client is demonstrating late decelerations. In which sequence should the nurse implement these nursing actions? (Place the first action on top and last action on the bottom.) o Reposition the client. o Call the healthcare provider. o Increase IV fluid. o Provide oxygen via face mask.

o Reposition the client. o Increase IV fluid. o Provide oxygen via face mask. o Call the healthcare provider. · To stabilize the fetus, intrauterine resuscitation becomes the first priority. In order to enhance the fetal blood supply, the laboring client should be repositioned to displace the gravid uterus and improve fetal perfusion. Secondly, the IV fluids should be increased to expand the maternal circulating blood volume. The next step to optimize oxygenation of the circulatory blood volume is to apply oxygen via face to the mother. Finally, the last step is to notify the primary healthcare provider for additional interventions to resolve the fetal stress.

The nurse is calculating the estimated date of confinement (EDC) using Ngele's rule for a client whose last menstrual period started on December 1. Which date is most accurate? o August 1. o August 10. o September 3. o September 8.

o September 8. · Calculation of a client's EDC provides baseline data to monitor fetal gestation. Ngele's rule uses the formula: subtract 3 months and add 7 days to the first day of the last normal menstrual period, so December 1 minus 3 months + 7 days is September 8.

A couple, concerned because the woman has not been able to conceive, is referred to a healthcare provider for a fertility workup and a hysterosalpingography is scheduled. Which complaint would indicate to the nurse that the woman's fallopian tubes are patent? o Back pain. o Abdominal pain. o Shoulder pain. o Leg cramps.

o Shoulder pain. · If the tubes are patent (open), pain is referred to the shoulder from a subdiaphragmatic collection of peritoneal dye/gas.

A 26-year-old, gravida 2, para 1 client is admitted to the hospital at 28-weeks gestation in preterm labor. She is given 3 doses of terbutaline sulfate (Brethine) 0.25 mg subcutaneously to stop her labor contractions. Which assessment finding would provide the nurse the earliest indication that the client is experiencing primary side effects of terbutaline sulfate? o Drowsiness and bradycardia. o Depressed reflexes and increased respirations. o Tachycardia and a feeling of nervousness. o A flushed, warm feeling and a dry mouth.

o Tachycardia and a feeling of nervousness. · Terbutaline sulfate (Brethine), a beta-sympathomimetic drug which stimulates beta-adrenergic receptors in the uterine muscle to stop contractions. The beta-adrenergic agonist properties of the drug may cause tachycardia, increased cardiac output, restlessness, headache, and a feeling of "nervousness".

A client who had a miscarriage 6 months ago becomes pregnant. Which instruction is most important for the nurse to provide this client? o Elevate lower legs while resting. o Increase caloric intake by 200 to 300 calories per day. o Increase water intake to 8 full glasses per day. o Take prescribed multivitamin and mineral supplements.

o Take prescribed multivitamin and mineral supplements. A client who has had a spontaneous abortion or still birth in the last 1 years should take multivitamin and mineral supplements and maintain a balanced diet because the previous pregnancy may have left her nutritionally depleted.

A full-term infant is transferred to the nursery from labor and delivery. Which information is most important for the nurse to receive when planning immediate care for the newborn? o The length of labor and method of delivery. o The infant's condition at birth and treatment received. o The feeding method chosen by the parents. o The history of drugs given to the mother during labor.

o The infant's condition at birth and treatment received. · Immediate care is most dependent on the infant's current status (i.e., Apgar scores at 1 and 5 minutes) and any treatment or resuscitation that was indicated.

After each feeding, a 3-day-old newborn is spitting up large amounts of a non-dairy based Newborn formula. The pediatric healthcare provider changes the neonate's formula to a soy protein isolate based infant formula. What information should the nurse provide to the mother about the newly prescribed formula? o The new formula is a coconut milk formula used with babies with impaired fat absorption. o The new formula is prescribed for infants with malabsorption syndromes. o The new formula is a casein protein source that is low in phenylalanine. o The prescribed formula is well tolerated by lactose intolerant infants.

o The prescribed formula is well tolerated by lactose intolerant infants. · The nurse should explain that the newborn's feeding intolerance may be related to the lactose found in cow's milk formula and is being replaced with the soy-based formula that contains sucrose, which is well-tolerated in infants with milk allergies and lactose intolerance.

While breastfeeding, a new mother strokes the top of her baby's head and asks the nurse about the baby's swollen scalp. The nurse responds that the swelling is caput succedaneum. Which additional information should the nurse provide this new mother? o The infant should be positioned to reduce the swelling. o The swelling is a subperiosteal collection of blood. o The pediatrician will aspirate the blood if it gets larger. o The scalp edema will subside in a few days after birth.

o The scalp edema will subside in a few days after birth. · Caput succedaneum is edema of the fetal scalp that crosses over the suture lines and is caused by pressure on the fetal head against the cervix during labor; it subside in a few days after birth without treatment.

During a prenatal visit, the client is concerned about the effects smoking can have on the fetus. Which response by the nurse is most accurate regarding infants of mothers who smoke during pregnancy? o These infants have lower Apgar scores when born. o These infants have lower birth weights. o Respiratory distress is seen initially. o A higher rate of congenital anomalies.

o These infants have lower birth weights. Smoking is associated with low-birth-weight infants, therefore mothers are encouraged not to smoke during pregnancy.

When preparing a class on newborn care for expectant parents, what content should the nurse teach concerning the newborn infant born at term gestation? o Milia are red marks made by forceps and will disappear within 7 to 10 days. o Meconium is the first stool and is usually yellow gold in color. o Vernix is a white, cheesy substance, predominantly located in the skin folds. o Pseudostrabismus found in newborns is treated by minor surgery.

o Vernix is a white, cheesy substance, predominantly located in the skin folds. The vernix is found in the folds of the skin, is a characteristic of term infants.