exam for OB

A nurse is teaching a client who is pregnant about the amniocentesis procedure. Which of the following statements should the nurse include in the teaching?

empty bladder

• During the admission of a woman with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease? A. Diarrhea B. Hypermenorrhea C. Abnormal bleeding

d

MS does it effect contractions

no, bed rest and steriods

A nurse is caring for a client who is in preterm labor and is scheduled to undergo and amniocentesis. The nurse should evaluate which of the following tests to assess fetal lung maturity?

- Lecithin/sphingomyelin (L/S) ration

A home care nurse is monitoring a 16-year-old primigravida who is at 36 weeks' gestation and has gestational hypertension. Her blood pressure during the past 3 weeks has been averaging in the 130/90 mm Hg range. She has had some swelling in the lower extremities and has had mild proteinuria. Which statement by the woman should alert the nurse to the worsening of gestational hypertension? 1. "My vision the past 2 days has been really fuzzy." 2. "The swelling in my hands and ankles has gone down." 3. "I had heartburn yesterday after I ate some spicy foods." 4. "I had a headache yesterday, but I took some acetaminophen (Tylenol) and it went away."

1

A woman infected with the human immunodeficiency virus (HIV) has given birth to a normal-appearing infant, and the nurse provides instructions about newborn infant care. Which statement by the mother indicates a need for further instruction? 1."I'm going to breast-feed my baby starting right away." 2."I need to wash my hands before and after bathroom use." 3."My baby needs to be on antiviral medications for the next 6 weeks." 4."I am going to contact some support groups listed in my take-home material to help me with everything I'll have to deal with when I get home."

1

nurse is caring for a client who is scheduled for a maternal serum alpha-fetoprotein test at 15 weeks of gestation. The nurse would provide which explanation about this test to the client? 1.It is a screening test for spinal defects in the fetus. 2.It looks for different types of diseases in the fetal cells. 3.This test identifies a Rh incompatibility between the mother and fetus. 4.It assesses fetal lung maturity and lecithin/sphingomyelin (L/S) ratio

1

A nonstress test is performed on a client who is pregnant, and the results of the test indicate nonreactive findings. The primary health care provider prescribes a contraction stress test, and the results are documented as negative. How should the nurse document this finding? 1. A normal test result 2. An abnormal test result 3. A high risk for fetal demise 4. The need for a cesarean section

1. A normal test result

The nurse is reviewing the medical record of a woman scheduled for her weekly prenatal appointment. The nurse notes that the woman has been diagnosed with mild preeclampsia. Which interventions should the nurse include in planning nursing care for this client? Select all that apply. 1.)Assess blood pressure. 2.)Check the urine for protein 3.)Assess deep tendon reflexes. 4.)Discuss the need for hospitalization. 5.)Teach the importance of keeping track of a daily weight.

1235

The nurse in a health care clinic is instructing a pregnant client how to perform "kick counts." Which statement by the client indicates a need for further instruction? 1. "I will record the number of movements or kicks," 2. "I need to lie flat on my back to perform the procedure." 3. "If I count fewer than 10 kicks in a 2 hour period, I should count the kicks again over the next two hours." 4. "I should place my hands on the largest part of my abdomen and concentrate on the fetal movements to count the kicks."

2

The maternal serum alpha-fetoprotein (MSAFP) is a screening tool indicated for all high-risk pregnant clients between 15 -20 weeks gestation. A client who is 18 weeks pregnant had her blood drawn for this test. Her test results showed low levels which is associated with which disorder? 1.Spina bifida 2.Diabetes mellitus 3.Down syndrome (Trisomy 21) 4.Anencephaly

3

Which intervention would reduce the risk of perinatal transmission via vaginal birth in an adolescent who is diagnosed with HIV infection? 1. Using forceps during delivery 2. Using a fetal scalp electrode during delivery 3. Using antiretroviral(prophylaxis) drug during the intrapartum period 4. Administering zidovudine an hour before labor

3

1. When should screening for group B streptococcus be performed?

A woman should be screened for Group B Strep at 35-37 weeks gestation using a rectovaginal culture intravenous antibiotic prophylaxis is offered to all who test positive.

· The client who is 41 weeks gestation has just had a biophysical profile with a score of two. Which of the following nursing interventions would be most appropriate?

A. Contact the provider immediately and prepare the client for imminent delivery

A nurse is caring for a client who is pregnant and is to undergo a contraction stress test (CST). Which of the following findings are indications for this procedure? (SATA) a. Decreased fetal movement b. Intrauterine growth restriction (IUGR) c. Post maturity d. Placenta previa e. Amniotic fluid emboli

Abc

• While performing the fetal acoustic stimulation test (FAST) in a patient, the nurse observes that there is no fetal response even after 3 minutes of testing. Which test does the nurse suggest? A. Amniocentesis B. Biophysical profile (BPP) C. Cordocentesis D. Coombs' test

b

While providing care in an obstetric setting, the nurse should understand that postpartum care of the woman with cardiac disease:

Includes rest, stool softeners, and monitoring of the effect of activity.

8. During her pregnancy a women with pre gestational diabetes has been monitoring her blood glucose level several times a day. Which level requires further assessment? -a) 85 mg/dl - 15 min prior to breakfast b) 90 mg/dl - prior to lunch c) 140 mg/dl - 2 hours after lunch d) 126 mg/dl - 1 hour after supper

c

A client with preeclampsia is receiving magnesium sulfate and oxytocin Ivy to induce labor at 38 weeks. The nurse determines the magnesium sulfate has been effective after noting which effect on the client?

NO SEIZURES

A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which findings are noted on assessment? SATA

RESP OF 10 URINE 20

1. In cases of respiratory depression due to magnesium toxicity, What is the appropriate treatment?

STOP AND ADMIN CALCIUM

12. The pregnant patient with epilepsy that has anti-epileptic medications to control seizures is stating concerns about the effect of AED's on the baby. What teaching would be appropriate for this woman?

There are pregnancy safe anti-epileptic drugs for pregnancy and is more beneficial to continue the medication than to quit due the side of effects of discontinuing the medication

7. A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to: a. Endometriosis. c. Primary dysmenorrhea. b. PMS. d. Secondary dysmenorrhea.

a

A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be: a. Negative B. positive

a

• The nurse is especially interested in the results of which laboratory test that provides the nurse with the best information about ongoing control of type one diabetes mellitus in a pregnant adolescent? A. Fasting blood glucose B. Glycosylated hemoglobin (HbA1c) C. Oral glucose tolerance test (OGTT) D. Post-prandial glucose

b

• The nurse is preparing to administer medication therapy to a woman diagnosed with syphilis. The nurse would expect to administer: QUIZLET A. miconazole. B. penicillin G. C. metronidazole. D. doxycycline.

b

18. A prenatal client at 30 weeks' gestation is scheduled for a nonstress test (NST), and asks the nurse, "What is this test for?" The nurse correctly responds that the test is used to determine which of the following? Select all that apply .a. Accelerations of fetal heart rate .b. Fetal lung maturity .c. Adequate fetal oxygenation. d. Fetal well-being

a, c, d

The nurse is reviewing four prenatal charts. Which client would be an appropriate candidate for a contraction stress test (CST)? a. A client with intrauterine growth retardation. b. A client with an incompetent cervix. c. A client with multiple gestation. d. A client with placenta previa.

a. A client with intrauterine growth retardation.

0. Which statement(s) is/are true about seizures and anticonvulsant use in pregnancy? (Select all that apply) A) Seizures may increase up to 25% in epileptic women B) Many anticonvulsants have teratogenic properties C) Anticonvulsant use increases loss of folic acid D) Anticonvulsants increase the effects of vitamin K E) Valproic acid causes malformation in 40% to 80% of fetuses

abc

The nurse is reviewing maternal serum alpha-fetoprotein (MSAFP) results. Which conditions are associated with elevated levels of MSAFP? (Select all that apply.) a. Fetal demise b. Neural tube defects c. Abdominal wall defects d. Chromosomal trisomies e. Gestational trophoblastic disease

abc

• A nurse in an infertility clinic is providing care to a family who has been unable to conceive for 18 months. which of the following data should the nurse assess select all that apply A. occupation B. menstrual history C. childhood infectious disease D. history of falls E. recent blood transfusions

abc

• The clinic nurse is performing a psychological assessment of a client who has been told that she is pregnant. Which of the following indicate to the nurse that the client is at risk for contracting HIV SATA A. The client has a history of IV drug use B. The client has a significant other who is heterosexual C. The client has a history of sexually transmitted diseases D. The client has had one sexual partner for the past 10 years E. The client has a previous history of gestational diabetes

ac

• A nurse is admitting a client who is in labor and had HIV. Which of the following interventions should the nurse ID as contraindicated for this client? SATA A. Vacuum extractor B. Oxytocin infusion C. Forceps D. Cesarean birth E. Internal fetal monitoring.

ace

A nurse is caring for a client who is pregnant and undergoing a nonstress test. The client asks why the nurse is using an acoustic vibration device. Which of the following responses should the nurse make?

awake the baby

6. The nurse is seeing patients in the antepartum clinic. Be prepared to prioritize patients when given hypothetical information about a group of patients. A. An 18-year old multigravida at 28 weeks gestation with a positive indirect Coombs test. B. A 24-year old multigravida at 32 weeks gestation with moderate facial edema. C. A 30- year old woman at 26 weeks gestation with bilateral yellow breast exudate. D. A 43-year old primigravida at 18 weeks gestation who reports an absence of fetal movement.

b

Maternal serum alpha-fetoprotein (MSAFP) screening indicates an elevated level. MSAFP screening is repeated and again is reported as higher than normal. What would be the next step in the assessment sequence to determine the well-being of the fetus? A. Percutaneous umbilical blood sampling (PUBS) B. Ultrasound for fetal anomalies C. Biophysical profile (BPP) for fetal well-being D. Amniocentesis for genetic anomalies

b

Physiologic anemia often occurs during pregnancy as a result of: a. Inadequate intake of iron. b. Dilution of hemoglobin concentration. c. The fetus establishing iron stores. d. Decreased production of erythrocytes.

b

Which nursing action would take priority when caring for a woman with a suspected ectopic pregnancy? A. Administer oxygen B. Monitor vital signs C. Obtain surgical consent D. Provide emotional support

b

• A client at 28 weeks' gestation is admitted to the labor and birth unit. Which test would most likely be used to assess the client's comprehensive fetal status? A. Amniocentesis. b. Biophysical profile (BPP). c. Nonstress test (NST). d. Ultrasound for physical structure.

b

• the nurse is caring for a woman following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? A. Placing cool compresses on the affected arm B. Elevating the affected arm on a pillow above heart level C. Avoiding arm exercises in the immediate postoperative period D. Maintain an IV site below the antecubital space on the affect arm

b

• A nurse is reviewing findings of a clients biophyisical profile (BPP) The nurse should expect which of the following variables to be included in this test? (SATA) A. Fetal weight B. Fetal breathing movement C. Fetal tone D. Fetal position E. Amniotic fluid volume

bce

• The nurse is caring for a client scheduled for a medical abortion. The client's pregnancy is in the first trimester. The client is asking the nurse some questions related to this procedure. Which of the following comments below would be correct to give this client? (Select all that apply). a. "This procedure will use aspiration of the uterine contents." b. "This procedure will utilize medications to end the pregnancy." c. It is more common for a medical abortion to be utilized in the second trimester." d. "Look for signs of complication, such as fever greater than 100.4 F, chills, heavy bleeding, foul-smelling, vaginal discharge, and severe abdominal pain and tenderness. e. "In addition to Methotrexate orally, you will need to return in 3 days for vaginal placement of Cytotec. You will experience nausea and will continue to take medication as prescribed for that as directed."

bde

The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum is to determine whether the fetus has which? a. Hemophilia b. Sickle cell anemia c. A neural tube defect d. A normal lecithin-to-sphingomyelin ratio

c

When nurses help their expectant mothers assess the daily fetal movement counts, they should be aware that: a. Alcohol or cigarette smoke can irritate the fetus into greater activity .b. "Kick counts" should be taken every half hour and averaged every 6 hours, with every other 6-hour stretch off. c. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours. d. Obese mothers familiar with their bodies can assess fetal movement as well as average-size women.

c

You are the clinic nurse caring for a pregnant woman in her third trimester. The woman is HIV positive and voices concerns about passing the infection on to her baby. What is your best response? a) Perinatal transmission of the virus is a real fear. Would you like to talk to a social worker? b) Do you have other children? Your baby has a one-in-four chance of having HIV at birth, so if you have three other children who are not HIV positive, then this one will be HIV positive. c) If you are taking antiretroviral medications and you don't breastfeed your baby, you greatly reduce the risk of perinatal transmission of the disease. d) There is nothing you can do. You will just have to wait and see if your baby is born HIV positive.

c

3. A nurse practitioner performs a clinical breast examination on a woman diagnosed with fibroadenoma. The nurse knows that fibroadenoma is characterized by: a. Inflammation of the milk ducts and glands behind the nipples. b. Thick, sticky discharge from the nipple of the affected breast. c. Lumpiness in both breasts that develops 1 week before menstruation. d. A single lump in one breast that can be expected to shrink as the woman ages.

d

4. Blood volume expansion during pregnancy leads to: a. Iron-deficiency anemia b. Maternal iron stores being insufficient to meet the demands for iron in fetal development c. Plasma fibrin increase of 40% and fibrinogen increase of 50% d. Physiological anemia of pregnancy

d

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that: A. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. B. Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects. C. Percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome. D. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

d

The major advantage of chorionic villus sampling (CVS) over amniocentesis is that it a. is not an invasive procedure. b. does not require hospitalization .c. has less risk of spontaneous abortion. d. is performed earlier in pregnancy.

d

1. A woman at 24 weeks gestation weighed 138 lbs. and was complaining of swollen ankles. Her BP was 140/92 mm Hg. She is now 28 weeks of gestation. Upon examination, your assessment reveals the following: BP 156/94, P 88, R 20, weight 142 lbs., proteinuria 1+, and ankle edema 2+.

preeclampsia

A nurse is caring for a client who's experiencing a ruptured ectopic pregnancy. Which of the following findings is expected with this condition?

report shoulder pain

17. What is the effect of rheumatic heart disease on cardiac output?

· Patients will have a fixed cardiac output due to stenosis so they cant handle the extra fluid volume of pregnancy