OB NCLEX Style Practice Questions

A client, 34 weeks pregnant, arrives at the ER with SEVERE abdominal pain, uterine tenderness and an increased uterine tone. The client denies vaginal bleeding. The external fetal monitor shows fetal distress with severe, variable decels. The client most likely has which of the following?

1. Abruptio placentae a client w/ severe abruptio placentae will often have SEVERE abdominal pain. The uterus will have increased tone w/ little to no return to resting tone btw/ contractions. The fetus will start to show signs of distress, with decels in the HR or even fetal death w/ large placental separation. Placenta previa usually involves PAINLESS vaginal bleeding w/out UCs. A molar preg. generally would be detected before 34 weeks gestation. An ecoptic preg. which usually occurs in the FALLOPIAN TUBES, would rupture well before 34 weeks gestation

a client is being admitted to the antepartum unit for hypovolemia secondary to hyperemesis gravidarum. WHich of the following factors predisposes a client to the development of this? 1. trophoblastic disease 2. maternal age > 35 y.o. 3. malnourished or underweight clients 4. low levels of HCG

1. Trophoblastic disease is associated w/ hyperemesis grav obesity and maternal age younger than 20 y.o. are risk factors too. High levels of estrogen HCG have also been associated with the development.

A client is 33 weeks pregnant and has had diabetes since she was 21. When checking her fasting blood sugar level, which values indicate the clients disease was controlled. 1. 45 mg/dl 2. 85 mg/dl 3. 120 mg/dl 4. 136 mg/dl

2. 85 mg/dl recommended fasting blood sugar levels in pregnant clients w/ dm are 60-90 mg/dl a fasting blood sugar level of 45mg/dl is low and may result in hypoglyecemia a bs level below 120mg/dl is recommeded for 1hour postprandial values a bs level above 136 mg/dl in a pregnant client indicates hyperglycemia

a 21 y.o. client, 6 weeks pregnant, is diagnosed with hyperemesis gravidum. This excessive vomiting during pregnancy will often result in which of the following? 1. bowel perforation 2. electrolyte imbalance 3. miscarriage 4. PIH

2. ELECTROLYTE IMBALANCE Excessive vomiting in clients with hyperemesis grav often causes weight loss / fluid and electrolyte, acid base imbalance. PIH and bowel perforation arent r/t hyper grav the effects of hyper grav on the fetus depend on the severity of the disorder. clients w/ severe hyper grav may have low birth weight infant, but the disorder isnt life threatening to the fetus.

A 21 y.o. has arrives to the ER with c/o cramping abdominal pain and mild vaginal bleeding. Pelvic exam shows a left adnexal mass that's tender when palpated. Culdocentesis shows blood in the culdesac. This client probably has which of the following conditions? 1. Abruptio placentae 2. Ecoptic pregnancy 3. Hydatidiform mole 4. Pelvic Inflammatory Disease

2. Ecoptic pregnancy most ecoptic pregnancies dont appear as obvious life threatening med emergencies. THey must be considered in any sexually active woman of childbearing age who c/o menstrual irregularity, cramping abdominal pain, and mild vaginal bleeding. PID, abruptio placentae and hydatidiform moles wont show blood in the cul de sac

A 17 y.o. primpigravida with severe PIH has been receiving mag sulfate IV for 3 hours. The latest assessment reveals DTR of +1, BP 150/100 mmgHg, pulse 92 bpm, respiratory rate 10bpm and urine output 20ml/hr. Which of the following actions would be most approp? 1. Continue monitoring per standards of care 2. Stop the mag sulfate infusion 3. Increase infusion by 5gtt/min 4. Decrease infusion by 5gtt/min

2. Stop the mag sulfate infusion Mag sulfate should be withheld if the clients resp rate or urine output falls or if reflexes are diminished / absent. The client also shows other signs of impending toxicity such as flushing / feeling warm. Inaction wont resolve the clients suppressed DTRs and low RR / urine output. The client is already showing CNS depression bc of excessive magsulfte so increasing the infusion is wrong. Impending toxicity indicates that the infusion should be stopped rather than just slowed down.

A woman who's 36 week preg comes into L&D with mild contractions. Which of the following complications should the nurse watch for when the client informs her that she has placenta previa? 1. sudden ROM 2. Vaginal bleeding 3. emesis 4. fever

2. Vaginal bleeding contractions may disrupt the microvascular network in the placenta of the client with placenta previa and result in bleeding. if the separation of the placenta occurs at the margin of the placenta, the blood will escape vaginally. sudden ROM isnt r/t placenta previa fever would indicate an infections process, and emesis isnt r/t placenta previa

Which drug would the nurse choose to utilize as an antagonist for magnesium sulfate? 1. Oxytocin 2. Terbutaline 3. Calcium gluconate 4. Narcan

3. Calcium gluconate should be kept at the bedside while a client is recieivng mag sulfate infusion. If magnesium toxicity occurs, calcium gluconate is admined as an antidote oxytocin is the synthetic form of the naturally occurring pituitary hormone used to initiate or augment UCs Terbutaline is a beta2 adrenergic agonist that may be used to relax smooth muscle of the uterus, esp for PTL and uterine hyperstimulation Naloxone is an opiate antagonist admin to reverse resp distress

A client has just given birth at 42 weeks gestation. When assessing the neontate, which phsycial finding is expected? 1. a sleepy, lethargic baby 2. lanugo covering body 3. desquamation of the epidermis 4. vernix caseosa covering the body

3. desquamation of the epidermis postdate fetuses lose the vernix caseosa and the epidermis may become desquamated these neonates are usually VERY alert lanugo is missing in the postdate neonate

Which nursing ntervention helps prevent evaporative heat loss in the neonate immed after birth? 1. admin warm oxygen 2. controlling drafts in the room 3. immed drying the neonate 4. placing neonate on a warm, dry towel

3. immed drying the neonate decreases evaoporative heat loss from moist body from birth placing the neonate on a warm, dry towel decreases CONDUCTIVE losses. controlling draft in the room and admin warm oxygen helps reduce CONVECTIVE LOSS

Which of the following complications can be potentially life threatening and can occur in a client receiving a tocolytic agent? 1. diabetic ketoacidosis 2. hyperemesis gravidarum 3. pulmonary edema 4. sickle cell anemia

3. pulmonary edema Tocolytics are used to stop labor contractions. The most common adverse effect associated with the use of these drugs is pulmonary edema. Clients who dont have diabetes dont need to be observed for diabetic ketoacidosis. Hyperemesis gravidium doesnt result from tocolytic use. Sickle cell anemia is an inherited genetic condition and doesnt develop spontaneously

After reviewing the client's maternal history of magnesium sulfate during labor, which condition would the nurse anticipate as a potential problem in the neonate? 1. hypoglycemia 2. jitteriness 3. resp depression 4. tachycardia

3. resp depression mag sulfate crosses the placenta and adverse neonatal effects are: resp depression hypotonia bradycardia the serum blood sugar isnt affected by mag sulfate the neonate wold be floppy, not jittery

Which of the following rationales best explains why a pregnant client should lie on her left side when resting or sleeping in the later stages of pregnancy? 1. to facilitate digestion 2. to facilitate bladder emptying 3. to prevent compression of vena cava 4. to avoid fetal anomalies

3. to prevent compression of vena cava the weight of the preg uterus is sufficiently heavy to compress the vena cava, which could impair blood flow to the uterus, possibily decreasing oxygen to the fetus. The side lying position hasnt been shown to prevent fetal anolmaies nor bladder emptying and or digestion

A 21y.o. client has been diagnosed with hydatidiform mole. Which of the following factors is considered a risk factor for developing hydatidiform mole? 1. age in 20s or 30s 2. high in SES 3. Primigravida 4. prior molar gestation

4. previous molar gestation increases risk for developing subsequent molar gestation by 4-5 times. Adolescents and women ages 40+ are at increased risk for molar pregs. MULTIGRAVIDAS, esp women with prior preg loss, and women with LOWER SES are at increased risk for this problem.

Which assessment finding would be the most unlikely risk factor for RDS 1. second born of twins 2. neonate born at 34 weeks 3. neonate of diabetic mom 4. chronic maternal HTN

4. CHRONIC MATERNAL HTN unlikely factor bc chronic fetal stress tends to INCREASE LUNG MATURITY premature neonates < 35 weeks are associated with RDS Even with a mature lecithin to sphingomyelin ration, neonates of moms with diabetes still develop RDS 2nd born of twins may be prone to greater risk of asphyxia

Which of the following answers best describes the stage of pregnancy in which maternal and fetal blood are exchanged? 1. conception 2. 9 weeks gestation when the fetal heart is well developed 3. 32-34 weeks gestation 3rd Trimester 4. maternal and fetal blood are never exchanged

4. maternal and fetal blood are never exchanged only nutrients and waste products are transferred across the placenta. blood exchange never occurs complications and some medical procedures can cause an exchange to occur accidentally

Because uteroplacental circulation is compromised in clients with preeclampsia, a NST is performed to detect which conditions? 1. Anemia 2. Fetal well being 3. IUGR 4. oligohydarminos

An NST is based on the theory that a healthy fetus will have transient fetal heart rate accelerations with fetal movement. A fetus with compromised uteroplacental circulation usually wont have these accelerations, which indicate a nonreactive NST. Serial US wil detect IUGR and oligohydramnios in a fetus. An NST cant detect anemia in a fetus

The doctor suspects that the client has an ectopic pregnancy. Which symptom is consistent with a diagnosis of ectopic pregnancy? a. Painless vaginal bleeding b. Abdominal cramping c. Throbbing pain in the upper quadrant d. Sudden, stabbing pain in the lower quadrant

Answer D is correct. The signs of an ectopic pregnancy are vague until the fallopian tube ruptures. The client will complain of sudden, stabbing pain in the lower quadrant that radiates down the leg or up into the chest. Painless vaginal bleeding is a sign of placenta previa, abdominal cramping is a sign of labor, and throbbing pain in the upper quadrant is not a sign of an ectopic pregnancy, making answers A, B, and C incorrect.

Which of the following hormones would be administered for the stimulation of uterine contractions? 1. Estrogen 2. Fetal cortisol 3. Oxytocin 4. Progesterone

Oxytocin is the hormone responsible for stimulating UCs. Pitocin, the synthetic form, may be given to clients who are past their due date. Progesterone has a relaxation effect on the uterus Fetal cortisol is believed to slow the production of progesterone by the placenta although estrogen has a role in UC, it isnt given in a synthetic form to help UC

Main role of surfactant in the neonate

helps the lungs remain expanded after the initiation of breathing works by reducing surface tension in the lung allows the lung to remain slightly expanded decreases amount of work required for inspiration

Conduction heat loss

is the loss of heat from the BODY SURFACE to COOLER SURFACES in direct contact

RADIATION HEAT LOSS

is the loss of heat from the body surface to COOLER SOLID SURFACES NOT in direct contact but in relative proximity

Breastfeeding preterm neonates

studies have proven that breast milk provides preterm neonates w/ better protection from infection such as NEC bc of the antibodies contained in breast milk Commercial formula doesn't provide any better nutrition than breast milk breast milk feedings can be started as soon as the neonate is stable and the neonate is more likely to develop infections when fed formula rather than breast milk

Convection heat loss

the flow of heat from the body surface to COOLER AIR

Evaporation Heat Loss

the loss of heat that occurs when a liquid is converted to a vapor