Maternity Exam 3 Practice Questions
What is a normal hemoglobin?
11-16
What is a normal hematocrit?
35-45%
what is a normal HbA1C?
< 7%
what is the loading dose of magnesium sulfate? A) 2-3 g/hr B) 4-6 g over 30-60 min C) 2-3 g over 30-60 min D) 4-6g/hr
B) 4-6 g over 30-60 min
a nurse is assessing a pregnant woman with gestational hypertension. Which of the following would lead the nurse to suspect that the client has developed severe preeclampsia? A) urine protein 300 mg/24 hrs B) BP 150/96 C) mild facial edema D) Hyperreflexia
D) Hyperreflexia the rest are all s/s of mild preeclampsia
what are the cutoffs for GTT testing?
fasting: < 92 1 hr postprandial: < 180 2 hr postprandial: < 153 3 hr postprandial: < 140
A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate? A) cord compression B) fetal distress related to hypoxia C) infection D) CNS involvement
B) fetal distress related to hypoxia
When are most pregnant patients tested for gestational diabetes? A. 6-12 weeks gestation B. 12-20 weeks gestation C. 24-28 weeks gestation D. 34-36 week gestation
C. 24-28 weeks gestation
what is an elevated bilirubin level?
> 1.2
what is an elevated value for ALT?
> 50
A patient has a 3 hour glucose tolerance test performed. The results are the following: Fasting 94 mg/dL, 1 hour 210 mg/dL, 2 hour 180 mg/dL, 3 hour 130 mg/dL. Identify which results are abnormal: Select all that apply: A. Fasting result B. 1 hour result C. 2 hour result D. 3 hour result
A. Fasting B. 1 hour result C. 2 hour result fasting: < 92 1 hr: < 180 2 hr: < 153 3 hr: < 140
Your patient with preeclampsia is started on Magnesium Sulfate. The nurse knows to have what medication on standby? A. Acetylcysteine B. Calcium carbonate C. Oxytocin D. Calcium gluconate
D. Calcium gluconate
A woman is in the 2nd trimester of pregnancy. Her blood pressure is 148/92, she has edema of the hands and feet, and her urine protein is 1+ dipstick. These data are indicative of: a) mild preeclampsia b) severe preeclampsia c) HELLP syndrome d) eclampsia
a) mild preeclampsia
what level of proteinuria is seen with MILD preeclampsia?
> 300 mg /24 hr or +1 dipstick
Identify the hallmark of placenta previa that differentiates it from abruptio placenta A) sudden onset of painless vaginal bleeding B) board like abdomen with severe pain C) sudden onset of bright red vaginal bleeding D) severe vaginal pain with bright red bleeding
A) sudden onset of painless vaginal bleeding when the placenta attaches to the lower uterine segment near or over the cervical os, bleeding may occur without the onset of contractions of pain
In a patient with preeclampsia, what signs and symptoms indicate that the patient has a high risk of experiencing a seizure due to central nervous system irritability? Select all that apply: A. You note bouncing of the foot when it is quickly dorsiflexed. B. Patellar and bicep deep tendon reflexes are graded 4+. C. Platelet count 200,000 D. Patient reports a decrease in headache pain.
A. You note bouncing of the foot when it is quickly dorsiflexed. B. Patellar and bicep deep tendon reflexes are graded 4+. The answers are A and B. Option A indicates positive clonus and Option B is indicative of hyperreflexia. If these findings are present it demonstrates that the central nervous system is irritated and there is a high risk of potential seizure activity. Seizure precautions should be initiated and the physician notified.
what is the therapeutic level for magnesium sulfate? A) 1-6 B) 4-7 C) 5-10 D) 2-8
B) 4-7
What medication should not be combined with Digitalis Glycoside? A) betamethasone B) Magnesium Sulfate C) Antibiotics D) Nifedipine
B) Magnesium Sulfate - can cause arrhythmias
A patient who is 25 weeks pregnant has partial placenta previa. As the nurse you're educating the patient about the condition and self-care. Which statement by the patient requires you to re-educate the patient? A. "I will avoid sexual intercourse and douching throughout the rest of the pregnancy." B. "I may start to experience dark red bleeding with pain." C. "I will have another ultrasound at 32 weeks to re-assess the placenta's location." D. "My uterus should be soft and non-tender."
B. "I may start to experience dark red bleeding with pain." The answer is B. All the other options are CORRECT about partial placenta previa. Option B is WRONG because this condition will present with PAINLESS, bright red bleeding NOT with pain and dark red bleeding, which happens in abruptio placentae.
Your patient is 36 weeks pregnant and has gestational diabetes. Which lab result below is euglycemic? A. Blood glucose 55 mg/dL B. Blood glucose 82 mg/dL C. Blood glucose 148 mg/dL D. Blood glucose 325 mg/dL
B. Blood glucose 82 mg/dL Euglycemic means "normal" blood glucose level. Typically a normal blood glucose level is about 70-140 mg/dL. The only option that reflects a normal blood glucose level is option B: 82 mg/dL...Option A is HYPOglycemic, Option C is slightly HYPERglycemic, Option D is HYPERglycemic.
Select all the risk factors below that increases a woman's risk for developing preeclampsia: A. Nulligravida B. Primigravida C. BMI 34 D. Pregnant with twins E. Maternal history of preeclampsia F. Age: 25-years-old G. History of Lupus and Diabetes
B. Primigravida C. BMI 34 D. Pregnant with twins E. Maternal history of preeclampsia G. History of Lupus and Diabetes The answers are: B, C, D, E, and G. Risk factors for preeclampsia include: History of preeclampsia or family history, first pregnancy (primigravida), significant health history prior to pregnancy: diabetes, lupus, high blood pressure, kidney disease, Obese: BMI >30, having more than one baby (twins, triplets etc.), age (young <18 or advanced >35).
Which of these are NOT side effects of magnesium sulfate? A) flushing B) headache C) absent DTRs D) respiratory depression E) blurred vision F) n/v G) headache
C) absent DTRs this is a s/s of mag toxicity
What is the biggest side effect with Labetalol? A) bradycardia B) decreased respiratory rate C) hypotension D) blurred vision
C) hypotension
Which statement is TRUE regarding abruptio placenta? A. This condition occurs due to an abnormal attachment of the placenta in the uterus near or over the cervical opening. B. A marginal abruptio placenta occurs when the placenta is located near the edge of the cervical opening. C. Nursing interventions for this condition includes measuring the fundal height. D. Fetal distress is not common in this condition as it is in placenta previa.
C. Nursing interventions for this condition includes measuring the fundal height.
The nurse knows that preeclampsia tends to occur during what time in a pregnancy?* A. before 20 weeks B. in the third trimester and postpartum C. after 20 weeks D. in the first and second trimester
C. after 20 weeks
Fill-in-the-blank: The signs and symptoms of preeclampsia are mainly occurring because substances released by the ischemic placenta cause damage to the _________________ in mom's body, which injures organs. A. spiral arteries B. epithelial cells C. endothelial cells D. juxtaglomerular cells
C. endothelial cells The answer is C: The signs and symptoms of preeclampsia are mainly occurring because substances released by the ischemic placenta cause damage to the ENDOTHELIAL CELLS in mom's body, which injures organs.
the nurse admits into the labor area a patient who is in preterm labor. The assessment findings that would constitute a diagnosis of preterm labor is: A) cervical effacement of 30% or more B) 2 contractions in 30 minutes C) cervical change < 1 cm D) 8 contractions in 1 hour
D) 8 contractions in 1 hour Diagnosis includes: - presence of contractions AND cervical change - OR cervix > 1-2 cm dilated - OR > 80% effaced at least 4 contractions in 20 minutes or 8 in 1 hour
Which of the following statements is the most appropriate for the nurse to say to a patient with a complete placenta previa? A) During the second stage of labor you will need to bear down B) you should ambulate in the halls at least twice each day C) the doctor will likely induce your labor with oxytocin D) please promptly report if you experience any bleeding or feel any back discomfort
D) please promptly report if you experience any bleeding or feel any back discomfort labor often begins with back pain. Labor is contraindicated for a patient with complete placenta previa. Will likely have C section
When do most patients tend to develop gestational diabetes during pregnancy? A. usually during the 1-3 month of pregnancy B. usually during the 2-3 month of pregnancy C. usually during the 1-2 trimester of pregnancy D. usually during the 2-3 trimester of pregnancy
D. usually during the 2-3 trimester of pregnancy
what level of proteinuria is seen with SEVERE preeclampsia?
> 500 mg/24 hr or + 3/4 dipstick
What is an elevated value for AST?
> 70
what is a HbA1C level that indicates need for intervention?
> 8%
Select all the signs and symptoms associated with placenta previa: A. Painless bright red bleeding B. Concealed bleeding C. Hard, tender uterus D. Normal fetal heart rate E. Abnormal fetal position F. Rigid abdomen
A. Painless bright red bleeding D. Normal fetal heart rate E. Abnormal fetal position The answer is A, D, and E. These are all sign and symptoms of placenta previa. The other options are associated abruptio placentae.
A 28 year old female, who is 33 weeks pregnant with her second child, has uncontrolled hypertension. What risk factor below found in the patient's health history places her at risk for abruptio placentae?* A. childhood polio B. preeclampisa C. c-section D. her age
B. preeclampisa The answer is B. Preeclampisa is a risk factor for experiencing abruptio placentae. The patient is at risk for developing this condition again since she is currently experiencing uncontrolled hypertension with this pregnancy.
Fill-in the blank: When a woman develops gestational diabetes it is during a time in the pregnancy when insulin sensitivity is _____________. This is majorly influenced by hormones such as estrogen, progesterone, _______________ and _______________. A. high; prolactin and human chorionic gonadotropin (hCG) B. low; estriol and human placental lactogen (hPL) C. high; human chorionic gonadotropin (hCG) and cortisol D. low; human placental lactogen (hPL) and cortisol
D. low; human placental lactogen (hPL) and cortisol
a 30 year old primigravida patient presents for a routine prenatal appointment. She verbalizes great concern regarding the possibility of preterm labor and delivering a preterm newborn with complications. As her nurse, you explain the risk factors of delivery preterm include all of the following EXCEPT: A) maternal age greater than 30 B) maternal infection C) multiple gestation D) problems with uterus or cervix
A) maternal age greater than 30 would be > 35
A woman in labor is at risk for abruptio placentae. Which of the following assessments would most likely lead you to suspect that this has happened? A) sharp fundal pain and discomfort between contractions B) Painless vaginal bleeding and fall in blood pressure C) pain in a lower quadrant and increased HR D) an increased BP and oliguria
A) sharp fundal pain and discomfort between contractions
Jennie's sister rings the call bell and yells, "Come quickly, Mary is shaking all over." The nurse determines that Jenny is experincing an eclamptic seizure. Which nursing intervention takes priority? A) turn mary onto her side and place a pillow behind her to stabilize position B) gently insert a tongue blade or bite block into Mary's mouth C) suction the mouth, or oropharynx, and then apply oxygen at 10 L per minute by facemask D) go to the medication room and draw up a bolus of magnesium sulfate to administer
A) turn mary onto her side and place a pillow behind her to stabilize position
A patient is 35 weeks pregnant. She has gestational diabetes and uncontrolled hyperglycemia. Her current blood glucose is 290 mg/dL. You administer insulin per physician's order and recheck the blood glucose level per protocol. It is now 135 mg/dL. Which statement by the patient requires you to notify the physician? A. "It burns when I urinate." B. "My back is hurting." C. "I feel tired." D. "I feel the baby kick about 10 times an hour."
A. "It burns when I urinate." The answer is A. Gestational diabetes places a patient at risk for urinary tract infections because the glucose can leak into the urine leading to infection (remember bacteria thrive on glucose). This scenario tells us the patient has uncontrolled hyperglycemia, which definitely puts her at risk for glycosuria (glucose in the urine). The physician should be notified if the patient reports burning on urination so a urine analysis can be performed. All the other options are normal findings in a pregnancy at this stage.
A 34-year-old female is currently 16 weeks pregnant. You're collecting the patient's health history. She has the following health history: gravida 5, para 4, BMI 28, hypertension, depression, and family history of Type 2 diabetes. Select below all the risk factors in this scenario that increases this patient's risk for developing gestational diabetes? A. 34-years-old B. 16 weeks pregnant C. Gravida 5, para 4 D. BMI 28 E. Hypertension F. Depression G. Family history of Type 2 diabetes
A. 34-years-old C. Gravida 5, para 4 D. BMI 28 G. Family history of Type 2 diabetes To help you remember the risk factors think of the word "MOMMA". Maternal age > 25, Obese or overweight (BMI >25), Macrosomia (fetal) previous babies greater than 9 lbs, Multiple pregnancies, A history (previous diagnoses of gestational diabetes or family history of diabetes).
A 37 week pregnant patient is admitted with severe preeclampsia. The patient begins to experiences a tonic-clonic seizure. Which of the following would the nurse AVOID during the seizure? A. Placing the patient in a supine position B. Holding down the patient's head to prevent injury C. Staying with the patient and activating the emergency response team D. Timing the seizure E. Providing 8 to 10 L of oxygen
A. Placing the patient in a supine position B. Holding down the patient's head to prevent injury The answers are A and B. The nurse would want to place the patient on their side (preferably the left-side...not supine) to help prevent the tongue from obstructing the airway, preventing aspiration, and improving blood flow to the placenta. In addition, the nurse would NOT want to restrain the patient, which can cause injury. Option C, D, and E are steps the nurse would want to take.
A client with severe preeclampsia who has a BP of 170/110 mm Hg, a pulse of 108 bpm, and respirations of 24 per minute is placed on IV magnesium sulfate therapy. 8 hours later her BP is 150/110, the pulse is 98, and respirations are 10, and there is absence of knee-jerk reflex. The nurse should: A) wait 1 hour, monitor vitals and reflexes again, and then, if necessary discontinue the infusion B) stop the infusion of mag sulfate and notify the physician C) administer calcium gluconate as antidote for magnesium sulfate D) continue the mag sulfate infusion because the BP is still high
B) stop the infusion of mag sulfate and notify the physician
a 28 year old G2P0 preterm patient presents for observation admission at 30 weeks gestation, with a change to her cervix 1 cm/40%/-1 since her last prenatal visit. Her care provider has ordered Terbutaline 0.24 mg sq. What side effects from Terbutaline should you educate the patient about? A) increased contractions B) tremors or nervousness C) hypoglycemia D) Drowsiness
B) tremors or nervousness
You're providing an educational class for pregnant women about gestational diabetes. You discuss the role of insulin in the body. Select all the CORRECT statements about the role and function of insulin: A. "Insulin is a type of cell that provides glucose to the body from the blood." B. "Insulin is a hormone secreted by the beta cells of the pancreas." C. "Insulin influences cells by causing them to uptake glucose from the blood." D. "Insulin is a protein that helps carry glucose into the cell for energy."
B. "Insulin is a hormone secreted by the beta cells of the pancreas." C. "Insulin influences cells by causing them to uptake glucose from the blood. The answers are B and C. Insulin is a HORMONE secreted by the beta cells found in the pancreas. It influences or causes cells to take in glucose from the blood. Option A and D are incorrect statements about insulin.
A 36-year-old pregnant female is diagnosed with gestational diabetes at 28 weeks gestation. You're educating the patient about this condition. Which statement by the patient demonstrates they understood your teaching about gestational diabetes? A. "Once I deliver the baby, it will go away, and I will not need any further testing." B. "It is important I try to get my fasting blood glucose around 70-95 mg/dL and <140 mg/dL 1 hour after meals." C. "There are no risks or complications related to gestational diabetes other than hyperglycemia." D. "I'm at risk for delivering a baby that is too small for its gestational age due to this condition."
B. "It is important I try to get my fasting blood glucose around 70-95 mg/dL and <140 mg/dL 1 hour after meals." The answer is B. This is the only correct statement in the scenario. It is important the mother monitors her blood glucose level regularly and tries to maintain an euglycemic level (normal blood glucose level): 70-95 mg/dL fasting and <140 mg/dL 1 hour after meals. In most cases, once the baby is delivered, the gestational diabetes will disappear, BUT at 6-12 weeks postpartum the mother will need to be reassessed for diabetes. Remember in the lecture, according to the CDC.gov 50% of women who are diagnosed with gestational diabetes will develop Type 2 diabetes later on. There are risks and complications associated with gestational diabetes such as pre-term labor, preeclampsia, hyper/hypoglycemia, macrosomia (large baby), hypoglycemia in baby at birth etc.
You're providing an in-service to a group of new labor and delivery nurse graduates about the pathophysiology of preeclampsia. Which statement by one of the group participants demonstrates they understood how this condition develops? A. "The basal arteries of the myometrium fail to widen to support blood flow to the placenta." B. "The placenta experiences ischemia because the spiral arteries of the uterus fail to reshape and increase in diameter." C. "The cardiovascular system of the mother fails to compensate for the increased blood flow from the fetus and placental ischemia occurs." D. "If the mother experience uncontrolled hypertension and proteinuria, it compromises blood flow to the placenta and leads to preeclampsia."
B. "The placenta experiences ischemia because the spiral arteries of the uterus fail to reshape and increase in diameter." The answer is B. This is the only correct statement. When preeclampsia occurs it is because the spiral arteries of the uterus failed to widen in diameter due to poor trophoblast invasion during the beginning of the pregnancy. Overtime, this causes problems (usually after 20 weeks gestation) and the placenta experiences ischemia. When the placenta becomes ischemic is releases substances into mom's circulation that are very toxic to her endothelial cells, which causes all the signs and symptoms seen in preeclampsia. Severity varies in patients.
A patient is currently 34 weeks pregnant with her first baby. Which findings below could indicate the development of preeclampsia in this patient that would need to be reported to the physician? Select all that apply: A. 1600: blood pressure 144/100, 1700: blood pressure 120/80 B. 3+ dipstick urine protein C. 1 hour glucose tolerance test 90 mg/dL D. 0800: blood pressure 142/92, 1230: blood pressure: 144/98 E. <300 mg/dL 24-hour urine protein
B. 3+ dipstick urine protein D. 0800: blood pressure 142/92, 1230: blood pressure: 144/98
You're discharging a patient who just gave birth to a baby at 39 weeks gestation. The patient had gestational diabetes throughout her pregnancy. Her blood glucose levels have now returned to normal. When should the patient first follow-up with her physician for blood glucose testing? A. 1-3 years B. 6-12 weeks postpartum C. 1 year postpartum D. Not applicable since this condition has resolved and only occurs during pregnancy
B. 6-12 weeks postpartum Patients who've had gestational diabetes are at high risk for developing Type 2 diabetes. She should first follow-up with her physician at 6-12 weeks postpartum for initial blood glucose testing. After this, she should follow-up 1-3 years for blood glucose testing since there is a high risk of her developing Type 2 diabetes.
A patient has gestational diabetes and is currently 34 weeks pregnant. Which assessment findings below should you immediately report to the physician? Select all that apply: A. Blood glucose 129 mg/dL B. Blood pressure 190/102 C. Proteinuria D. Linea nigra E. Negative glycosuria
B. Blood pressure 190/102 C. Proteinuria The answers are B and C. Preeclampsia is a potential complication of gestational diabetes. It can cause hypertension (option B) and protein in the urine (option C). Option A is a normal blood glucose reading, option D is a normal finding during pregnancy, and option E is a normal finding (an abnormal finding would be positive glycosuria...meaning there is glucose leaking in the urine).
A 36 year old woman, who is 38 weeks pregnant, reports having dark red bleeding. The patient experienced abruptio placentae with her last pregnancy at 29 weeks. What other signs and symptoms can present with abruptio placentae? Select all that apply: A. Decrease in fundal height B. Hard abdomen C. Fetal distress D. Abnormal fetal position E. Tender uterus
B. Hard abdomen C. Fetal distress E. Tender uterus The answers are: B, C, and E. Option A is wrong because there may be an INCREASE in fundal height (not decrease) due to concealed bleeding. Option D is wrong because this tends to occur in placenta previa because the placenta attaches too low in the uterus at the cervical opening.
A baby is born at 37 weeks gestation to a mother with gestational diabetes. As the nurse you know at birth that the newborn is at risk for? Select all that apply: A. Hyperglycemia B. Hypoglycemia C. Respiratory distress D. Jaundice E. Hyperthermia
B. Hypoglycemia C. Respiratory distress The newborn is at risk for hypoglycemia and respiratory distress. When a baby of a mom, who has gestational diabetes, is still in utero there is a constant high supply of glucose. This causes the baby to increase its fat stores (producing a large baby) and create a lot of insulin to deal with the high glucose it is receiving from mom. BUT once the baby leaves utero, the glucose supply decreases but the baby still has a lot of insulin on board. This can lead to a drop in blood glucose (hypoglycemia) at birth. In addition, uncontrolled gestational diabetes can affect lung maturity in babies and this increases the newborn's risk of respiratory distress at birth.
A 37-year-old female patient who is 36 weeks pregnant is diagnosed with mild preeclampsia. The nurse will include what information in the patient's education? Select all that apply: A. Report weight gain of >4 lbs in one week to physician B. Incorporate foods like eggs, nuts, fish, meat in your diet C. Follow a no salt diet D. Headache and vision changes are expected side effects of this condition and cause no reason for concern. E. Importance of monitoring urine protein at home F. Lying on left-side is recommended along with rest G. Report a decrease in fetal activity immediately
B. Incorporate foods like eggs, nuts, fish, meat in your diet E. Importance of monitoring urine protein at home F. Lying on left-side is recommended along with rest G. Report a decrease in fetal activity immediately The answers are: B, E, F, and G. These options are topics the nurse wants to include in the patient's teaching with preeclampsia. Option A is wrong because the patient should report a weight gain of >2 lbs (NOT 4 lbs) in one week. Option C is wrong become it is no longer recommended the patient restrict salt in diet but limit it. Option D is wrong because a headache and vision changes are serious complications that may indicate the development of eclampsia, and the patient should report it immediately.
Your patient who is 34 weeks pregnant is diagnosed with total placenta previa. The patient is A positive. What nursing interventions below will you include in the patient's care? Select all that apply: A. Routine vaginal examinations B. Monitoring vital signs C. Administer RhoGAM per MD order D. Assess internal fetal monitoring E. Placing patient on side-lying position F. Monitoring pad count G. Monitoring CBC and clotting levels
B. Monitoring vital signs E. Placing patient on side-lying position F. Monitoring pad count G. Monitoring CBC and clotting levels The answers are: B, E, F, and G. Option A is WRONG because vaginal exams are avoided to prevent causing damage to the placenta presenting at the cervical opening. Option C is WRONG because the patient is A positive and does NOT need RhoGAM, which is for patients who are RH negative. Option D is WRONG because external monitoring should be used NOT internal, which can damage the placenta at the cervical opening.
What insulin do these values match? - Onset: 5-15 min - Peak: 30-75 min - Duration: 2-3 hr A) NPH / Lente B) Regular C) Lispro D) Ultralente
C) Lispro
the nurse is teaching a pregnant woman with preterm premature rupture of membranes (PPROM) who is about to be discharged home about caring for herself. Which statement by the woman indicates a need for additional teaching? A) i need to keep a close eye on how active my baby is each day B) i need to call my doctor if my temp increases C) it's okay for my husband and me to have sex D) i can shower but i shouldn't take a tub bath
C) it's okay for my husband and me to have sex PELVIC REST
a 32 year old gravida 3 para 2 at 36 weeks' gestation comes to the obstetric department reporting abdominal pain. Her BP is 164/90, her HR is 100 bpm, and her RR is 24 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What assessment should the nurse make next? A) check DTRs B) measure fundal height C) palpate the fundus and check FHR D) obtain a voided urine specimen, and determine blood type
C) palpate the fundus and check FHR
A woman, who is 22 weeks pregnant, has a routine ultrasound performed. The ultrasound shows that he placenta is located at the edge of the cervical opening. As the nurse you know that which statement is FALSE about this finding? A) this is known as marginal placenta Previa B) the placenta may move upward as pregnancy progresses and need to be reevaluated with another ultrasound at 32 weeks gestation C) the patient will need to have a C section and cannot delivery vaginally D) the woman should report any bleeding to the doctor
C) the patient will need to have a C section and cannot delivery vaginally The answer is C. All the other options are CORRECT. Option C is FALSE. This is a type of placenta previa called marginal (or low-lying). There is a chance the woman can delivery vaginally, but if the placenta was completely over the cervix or partially covering it a c-section would be required. At the 20 week ultrasound the location of the placenta is detected. The location will be re-evaluated at about 32 weeks. If a placenta is found to be low lying there is a chance the placenta will move upward (away from the cervix) as the uterus grows to accommodate the baby.
How would the nurse check for clonus in a patient with preeclampsia? A. Assess the patellar and bicep tendon with a reflex hammer and grade the reaction. B. Assess for muscular rigidity by having the patient extend the arms and place resistance against the arms. C. Assess for beating of the foot when the foot is quickly dorsiflexed. D. Assess for dorsiflexion of the foot by quickly plantar flexing the foot.
C. Assess for beating of the foot when the foot is quickly dorsiflexed The answer is C: To check for clonus the nurse will have the patient dangle the leg and support the patient's lower leg. Then the nurse will quickly dorsiflex the foot. The nurse is assessing for bouncing or beating of the foot (hence the foot attempts to plantarflex). If the foot attempts to bounce or beat 3 or more times, it is positive for clonus.
You're teaching a pregnant mother with gestational diabetes about the signs and symptoms of hyperglycemia. What are the signs and symptoms you will include in your education to the patient? Select all that apply: A. Sweating B. Confusion C. Frequent hunger D. Polydipsia E. Anxiety F. Frequent urination
C. Frequent hunger D. Polydipsia F. Frequent urination Remember the 3 Ps for hyperglycemia: Polyphagia (frequent hunger), polydipsia (frequent thirst), polyuria (frequent urination). Sweating, confusion, and anxiety are signs and symptoms of HYPOglycemia (low blood glucose)
A patient completes a one hour glucose tolerance test. The patient's result is 190 mg/dL. As the nurse you know that the next step in the patient's care is to? A. Continue monitoring pregnancy, the test is normal B. Reassess blood glucose in 2 weeks C. Notify the physician who will order the patient to take a 3 hour glucose tolerance test D. Provide education to the patient about how to manage gestational diabetes during pregnancy
C. Notify the physician who will order the patient to take a 3 hour glucose tolerance test A test result >140 mg/dL for 1 hour glucose tolerance test requires that the patient take a 3 hour glucose tolerance test. This test will be used to diagnose if the patient has gestational diabetes.
A client is admitted with preeclampsia to the labor and birthing suite. Her BP is 140/90, she has 2+ protein in the urine, and edema of the hands and face. As part of the admissions history, the nurse should ask the client about: A) headache, visual disturbances, edema, abdominal pain B) visual disturbances, headache, constipation, bleeding C) constipation, edema, visual problems, headache D) leakage of fluid, edema, bleeding, and abdominal pain
A) headache, visual disturbances, edema, abdominal pain
what is the maintenance of magnesium sulfate? A) 2-3 g/hr B) 4-6 g over 30-60 min C) 2-3 g over 30-60 min D) 4-6g/hr
A) 2-3 g/hr
which of these are symptoms of hydralazine? Select all that apply A) Headache B) chest pain C) tachycardia D) flushing E) oliguria
A) Headache B) chest pain D) flushing
What insulin do these values match? - Onset: 2-4 hr - Peak: 5-10 hr - Duration: 12-24 hr A) NPH / Lente B) Regular C) Lispro D) Ultralente
A) NPH / Lente
Which of these are symptoms of magnesium toxicity? SATA A) RR < 12 B) Proteinuria C) Absent DTRs D) oliguria E) cardiac arrhythmias F) Tachycardia G) Coma, death H) Cardiac arrest
A) RR < 12 C) Absent DTRs D) oliguria E) cardiac arrhythmias G) Coma, death H) Cardiac arrest
A primigravida presents to labor and delivery at 36 weeks gestation complaining of severe uterine tenderness and decreased fetal movement. What other clinical indicators would lead the nurse to suspect abruptio placentae? A) dark red vaginal bleeding and board like rigid abdomen B) dark red vaginal bleeding and soft uterine resting tone C) bright red vaginal bleeding and board like rigid abd D) bright red vaginal bleeding and soft uterine resting tone
A) dark red vaginal bleeding and board like rigid abdomen
Your patient is 36 weeks pregnant with severe preeclampsia. The physician has ordered lab work to assess for HELLP Syndrome. Which findings on the patient's lab results correlate with HELLP Syndrome? A. Hemoglobin 12 g/dL B. Platelets 90,000 μL C. ALT 100 IU/L D. AST 90 IU/L E. Glucose 350 mg/dL F. Abnormal RBC peripheral smear
B. Platelets 90,000 μL C. ALT 100 IU/L D. AST 90 IU/L F. Abnormal RBC peripheral smear The answers are: B, C, D, and F. HELLP Syndrome causes of Hemolysis of RBCs (abnormal RBC peripheral smear), Elevated Liver enzymes (>70 IU/L for AST or > 50 for ALT), Low Platelets (<100,000 μL ).
a client with a history of cervical insufficiency is seen for reports of pink-tinged discharge and pelvic pressure. The primary care provider decides to perform a cervical cerclage. The nurse teaches the client about the procedure. Which client response indicates that the teaching has been effective? A) "staples are put in the cervix to prevent it from dilating" B) "the cervix is glued shut so no amniotic fluid can escape" C) "purse string sutures are placed in the cervix to prevent it from dilating" D) "a cervical cap is placed so no amniotic fluid can escape"
C) "purse string sutures are placed in the cervix to prevent it from dilating"
Which of these is NOT a side effect of Nifedipine or Terbutaline? A) flushing B) Hypotension C) Bradycardia D) Vasodilation E) Chest pain F) Headache
C) Bradycardia the side effect is TACHYcardia not bradycardia
A woman is experiencing preterm labor. The client asks why she is on betamethasone (Celestone). The best response by the nurse would be: A) this medication will hault the labor process, until the baby is more mature B) this medication will relax and smooth muscles in the infant's lungs so that, if born early, the baby can breathe C) this medication has been found to be effective in stimulating lung development in the preterm infant D) this medication is an antibiotic that will help resolve UTIs, which has led to your preterm labor
C) this medication has been found to be effective in stimulating lung development in the preterm infant
Which of these meds is a tocolytic? A) magnesium sulfate B) Labetalol C) Hydralazine D) Nifedipine E) Betamethasone
D) Nifedipine
What insulin do these values match? - Onset: 3-4 hr - Peak: 14-24 hr - Duration: 24-36 hr A) NPH / Lente B) Regular C) Lispro D) Ultralente
D) Ultralente
A pregnant patient is admitted to the emergency department with bleeding. The nurse realizes that the patient might have placenta previa. Which sign would be suggestive of placenta previa? A) sudden onset of vaginal bleeding B) firm and stony hard uterus C) increase in size of abdomen D) bright red vaginal bleeding
D) bright red vaginal bleeding
What is the pathophysiology responsible for a client who complains of a pounding headache and elevated DTRs? A) severe anxiety B) increased perfusion to the brain C) retinal arteriolar spasms D) cerebral edema
D) cerebral edema
The nurse is reviewing the lab test results of a pregnant client. Which one of the following findings would alert the nurse to the development of HELLP? A) hyperglycemia B) elevated platelet count C) leukocytosis D) elevated liver enzymes
D) elevated liver enzymes
You educate a pregnant patient with gestational diabetes that she should try to have a blood glucose level of ______________ 1 hour after a meal. A. <70 mg/dL B. <250 mg/dL C. >160 mg/dL D. <140 mg/dL
D. <140 mg/dL
A 39 week pregnant patient is in labor. The patient has preeclampsia. The patient is receiving IV Magnesium Sulfate. Which finding below indicates Magnesium Sulfate toxicity and requires you to notify the physician? A. Deep tendon reflex 4+ B. Respiratory rate of 13 breaths per minute C. Urinary output of 600 mL over 12 hours D. Clonus presenting in the lower extremities E. Patient reports flushing or feeling hot
E. Patient reports flushing or feeling hot The answer is E. The nurse should monitor for Magnesium Sulfate toxicity. Signs of this include: EARLY: flushing or feeling hot/warm, later on: decreased or absent reflexes (finding of 4+ Deep tendon reflex is considered HYPERreflexia), Respiratory rate less than 12 breaths per minute, Urinary output of less than 30 mL/hr, EKG changes.
A 32-year-old female is diagnosed with gestational diabetes. As the nurse you know that what test below is used to diagnose a patient with this condition? A. 1 hour glucose tolerance test B. 24 hour urine collection C. Hemoglobin A1C D. 3 hour glucose tolerance test
D. 3 hour glucose tolerance test If a patient has a positive 1 hour glucose tolerance test (which is administered at about 24-28 weeks), a 3 hour glucose tolerance test is ordered. If this test is abnormal, it is used to diagnose gestational diabetes.
Disseminated intravascular coagulation (DIC) can occur in __________________. This happens because when the placenta becomes damaged and detaches from the uterine wall, large amounts of _____________ are released into mom's circulation, leading to clot formation and then clotting factor depletion. A. Placenta previa, fibrinogen B. Placenta previa, platelets C. Abruptio placentae, fibrinogen D. Abruptio placentae, thromboplastin
D. Abruptio placentae, thromboplastin
A preterm labor patient is receiving betamethasone. When the patient asks what this is for, the best response by the nurse would be: A) it will help reduce the severity of respiratory distress in your newborn B) it is commonly used to prevent seizures C) it will help reduce uterine irritability D) it will help to reduce softening of your cervix
A) it will help reduce the severity of respiratory distress in your newborn
What is the cause of the epigastric pain that sometimes occurs with severe preeclampsia? A) liver distension B) renal damage C) internal bleeding D) increased gastric acidity
A) liver distension
When is there a possibility for the use of prophylactic Antibiotics? Select all that apply A) preterm labor B) Placenta Previa C) Diabetes D) cardiac diseases
A) preterm labor D) cardiac diseases (to prevent endocarditis)
Select all the patients below who are at risk for developing placenta previa: A. A 37 year old woman who is pregnant with her 7th child. B. A 28 year old pregnant female with chronic hypertension. C. A 25 year old female who is 36 weeks pregnant that has experienced trauma to abdomen. D. A 20 year old pregnant female who is a cocaine user.
A. A 37 year old woman who is pregnant with her 7th child. D. A 20 year old pregnant female who is a cocaine user. The answer is A and D. Risk factors for developing placenta previa include: Maternal age >35 years old, multiples (twins etc.), already had a baby, drug use: cocaine or smoking, surgery to the uterus that will leave scarring: fibroid removal, c-section etc.
You're performing a head-to-toe assessment on a patient admitted with abruptio placentae. Which of the following assessment findings would you immediately report to the physician? A. Oozing around the IV site B. Tender uterus C. Hard abdomen D. Vaginal bleeding
A. Oozing around the IV site The answer is A. Oozing around the IV site can indicate the patient is entering into DIC (disseminated intravascular coagulation) because clotting levels have been depleted. Therefore, the MD should be notified. Option B, C, and D are findings found in this condition, but Option A is a SEVERE complication that can develop from it.
What insulin do these values match? - Onset: 0.5 - 1 hr - Peak: 2-4 hr - Duration: 5-8 hr A) NPH / Lente B) Regular C) Lispro D) Ultralente
B) Regular
Which of the following findings is indicative of HELLP syndrome, which sometimes complicates severe preeclampsia? A) elevated BP B) Thrombocytopenia C) Edema of face, hands, and feet D) Seizures
B) Thrombocytopenia Hemolysis (low Hgb/Hct) Elevated Liver Enzymes (AST/ALT) Low platelets (< 100,000 = thrombocytopenia)
If the patient had HELLP syndrome, which lab results would the nurse expect her to exhibit? A) elevated hemoglobin and hematocrit (H&H), decreased liver enzymes, platelet count < 100,000 mm3 B) decreased H&H, elevated liver enzymes, platelet count < 100,000 mm3 C) decreased H&H, decreased liver enzymes, platelet count > 150,000 D) elevated H&H, elevated liver enzymes, platelet count > 150,000
B) decreased H&H, elevated liver enzymes, platelet count < 100,000 mm3
The nurse educator is describing the different kinds of abruptio placentae to a group of students, explaining that in a complete abruptio placentae: A) there is massive vaginal bleeding in the presence of almost total separation B) Blood passes between the fetal membranes and uterine wall, and escapes vaginally C) the placenta separates marginal, and there can be concealed bleeding D) separation begins at the periphery of the placenta
there is massive vaginal bleeding in the presence of almost total separation
