OB NCLEX Style Questions

4. A client is experiencing dysmenorrhea. Which intervention should the nurse encourage the client to use that may provide some relief? A) Utilize a heating pad on the abdomen B) Iron supplementation C) Decreasing fluid intake D) Measuring intake and output

A) Utilize a heating pad on the abdomen

10. Which of the following interventions should the nurse recommend to a client who is experiencing primary dysmenorrhea? (Select all that apply) A) Increase caffeine intake B) Use a heating pad C) Try relaxation techniques D) Engage in regular exercise E) Avoid vitamin supplements

B) Use a heating pad C) Try relaxation techniques D) Engage in regular exercise

3) On assessment of a postpartum client, the nurse notes that the uterus feels soft and boggy. The nurse should take which initial action? A) Document the findings B) Elevate the client's legs C) Massage the fundus until it is firm D) Push on the uterus to assist in expressing clots

Answer: C

3. The home care nurse is monitoring a pregnant client who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which sign of preeclampsia? a. Hypertension b. Low-grade fever c. Generalized edema d. Increased pulse rate

Answer: A Rationale: A sign of preeclampsia is persistent hypertension. A low-grade fever or increased pulse rate is not associated with preeclampsia. Generalized edema may occur but is not a specific sign of preeclampsia because it can occur in many conditions.

5. The nurse is providing teaching about treatment of dysmenorrhea. Which therapy is known to be helpful in the treatment of this condition? (Select all that apply) A) Fish oil with vitamin B12 B) Combined oral contraceptives (COCs) C) Vitamin E and thiamine D) Paroxetine E) SSRIs

B) Combined oral contraceptives (COCs) C) Vitamin E and thiamine D) Paroxetine E) SSRIs

6. A client diagnosed with dysmenorrhea reports that medications are ineffective to treat the pain. The client is asking about alternative therapies to manage acute pain. Which nonpharmacologic treatment should the nurse recommend? (Select all that apply) A) Core strength training B) Guided imagery C) Biofeedback D) Relaxation E) Increased exercise regimen

B) Guided imagery C) Biofeedback E) Increased exercise regimen

7. The nurse is teaching a client self-care measures to cope with pain related to dysmenorrhea. The inclusion of which pain-relief measure should indicate to the nurse that further teaching is required? A) Use of NSAIDs B) Exercise C) Application of cold packs D) Relaxation techniques

C) Application of cold packs

1. The nurse is assessing a client with a diagnosis of primary dysmenorrhea. Which condition should the nurse recognize as a cause of primary dysmenorrhea? A) Pelvic adhesions B) Endometriosis C) Release of prostaglandins D) Infections

C) Release of prostaglandins

4. A client is diagnosed with placenta previa. The nurse plans care with the understanding that which is associated with placenta previa? 1. The placenta is implanted in the lower uterine segment. 2. The greatest risk associated with this condition is chronic hypertension. 3. There are two placentas attached to the fetus located in the side of the uterine wall. 4. The placenta is half the size that it is expected to be, presenting a risk for deprivation of nutrients to the fetus.

ANS: 1 Rationale: In placenta previa, there is one placenta that is normal size but is implanted in the lower uterine segment. The lower uterine segment does not contain the same intertwining musculature as the fundus of the uterus; therefore, the greatest risk associated with this condition is bleeding.

5. As A pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the nurse tells the client that the usual treatment for partial placenta previa is which of the following? 1. Activity limited to bed rest 2. Platelet infusion 3. Immediate cesarean delivery 4. Labor induction with oxytocin

ANS: 1 Rationale: Treatment of partial placenta previa includes bed rest, hydration, and careful monitoring of the client's bleeding.

8. Select all the patients below who are at risk for developing placenta previa: 1. A 37-year-old woman who is pregnant with her 7th child. 2. A 28-year-old pregnant female with chronic hypertension. 3. A 25-year-old female who is 36 weeks pregnant that has experienced trauma to abdomen. 4. A 20-year-old pregnant female who is a cocaine user.

ANS: 1,4 Rationale: 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.

3. The nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which risk associated with placenta previa? 1. Infection 2. Hemorrhage 3. Chronic hypertension 4. Disseminated intravascular coagulation

ANS: 2 Rationale: In placenta previa, the placenta is implanted in the lower uterine segment. The lower uterine segment does not contain the same intertwining musculature as the fundus of the uterus, and this site is more prone to bleeding. Options 1, 3, and 4 are not risks that are related specifically to placenta previa.

9. 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? 1. "I will avoid sexual intercourse and douching throughout the rest of the pregnancy." 2. "I may start to experience dark red bleeding with pain." 3. "I will have another ultrasound at 32 weeks to re-assess the placenta's location." 4. "My uterus should be soft and non-tender."

ANS: 2 Rationale: All the other options are CORRECT about partial placenta previa. Option 2 is WRONG because this condition will present with PAINLESS, bright red bleeding NOT with pain and dark red bleeding, which happens in abruptio placentae.

1. The maternity nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the primary health care provider's prescriptions and should question which prescription? 1. Prepare the client for an ultrasound. 2. Obtain equipment for a manual pelvic examination. 3. Prepare to draw a hemoglobin and hematocrit blood sample. 4. Obtain equipment for external electronic fetal heart rate monitoring.

ANS: 2 Rationale: Placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os. Manual pelvic examinations are contraindicated when vaginal bleeding is apparent until a diagnosis is made and placenta previa is ruled out. Digital examination of the cervix can lead to hemorrhage. A diagnosis of placenta previa is made by ultrasound. The hemoglobin and hematocrit levels are monitored, and external electronic fetal heart rate monitoring is initiated. Electronic fetal monitoring (external) is crucial in evaluating the status of the fetus, who is at risk for severe hypoxia.

7. 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: 1. Routine vaginal examinations 2. Monitoring vital signs 3. Administer RhoGAM per MD order 4. Assess internal fetal monitoring 5. Placing patient on side-lying position 6. Monitoring pad count 7. Monitoring CBC and clotting levels

ANS: 2, 5, 6, 7 Rationale: Option 1 is WRONG because vaginal exams are avoided to prevent causing damage to the placenta presenting at the cervical opening. Option 3 is WRONG because the patient is A positive and does NOT need RhoGAM, which is for patients who are RH negative. Option 4 is WRONG because external monitoring should be used NOT internal, which can damage the placenta at the cervical opening.

6. A woman, who is 22 weeks pregnant, has a routine ultrasound performed. The ultrasound shows that the placenta is located at the edge of the cervical opening. As the nurse you know that which statement is FALSE about this finding: 1. This is known as marginal placenta previa. 2. The placenta may move upward as the pregnancy progresses and needs to be re-evaluated with another ultrasound at about 32 weeks gestation. 3. The patient will need to have a c-section and cannot deliver vaginally. 4. The woman should report any bleeding immediately to the doctor.

ANS: 3 Rationale: All the other options are CORRECT. Option 3 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.

10. Tyra experienced painless vaginal bleeding and has just been diagnosed as having a placenta previa. Which of the following procedures is usually performed to diagnose placenta previa? 1. Amniocentesis 2. Digital or speculum examination 3. External fetal monitoring 4. Ultrasound

ANS: 4 Rationale: Once the mother and the fetus are stabilized, ultrasound evaluation of the placenta should be done to determine the cause of the bleeding. Amniocentesis is contraindicated in placenta previa. A digital or speculum examination shouldn't be done as this may lead to severe bleeding or hemorrhage. External fetal monitoring won't detect a placenta previa, although it will detect fetal distress, which may result from blood loss or placenta separation.

2. The nurse is performing an assessment on a client diagnosed with placenta previa. Which assessment findings should the nurse expect to note? Select all that apply. 1. Uterine rigidity 2. Uterine tenderness 3. Severe abdominal pain 4. Bright red vaginal bleeding 5. Soft, relaxed, nontender uterus 6. Fundal height may be greater than expected for gestational age

ANS: 4, 5, 6 Rationale: Placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os. Painless, bright red vaginal bleeding in the second or third trimester of pregnancy is a sign of placenta previa. The client has a soft, relaxed, nontender uterus, and fundal height may be more than expected for gestational age. In abruptio placentae, severe abdominal pain is present. Uterine tenderness accompanies placental abruption. In addition, in abruptio placentae, the abdomen feels hard and board-like on palpation, as the blood penetrates the myometrium and causes uterine irritability.

8. Which of the following would the nurse assess in a client experiencing abruptio placenta? a. Bright red, painless vaginal bleeding b. Concealed or external dark red bleeding c. Palpable fetal outline d. Soft and nontender abdomen

ANS: B A client with abruptio placentae may exhibit concealed or dark red bleeding, possibly reporting sudden intense localized uterine pain. The uterus is typically firm to boardlike, and the fetal presenting part may be engaged. Bright red, painless vaginal bleeding, a palpable fetal outline and a soft nontender abdomen are manifestations of placenta previa.

7. 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

ANS: 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.

10. Hanna is a 21-year-old woman who is presenting at the emergency room for severe vaginal bleeding. She is 32 weeks pregnant. Upon further examination, she is found to be suffering from abruptio placentae. Which of the following assessment findings would be of least concern to the nurse? a. Shortness of breath b. Small red dots on the skin c. A tender uterus d. Decreasing blood pressure e. Bleeding from oral mucosa

ANS: C Abruptio placentae is a serious condition where the placenta inappropriately and prematurely detaches from the uterus. Women with obstetric complications such as abruptio placentae can quickly develop disseminated intravascular coagulation (DIC). DIC is a clotting disorder in which the blood inappropriately clots. Severe bleeding can also occur as clotting proteins become scarce. Symptoms of DIC include blood clots, and bleeding into the tissues such as the skin and oral mucosa. A decreasing blood pressure is concerning due to the severe bleeding caused by the combination of DIC and abruptio placentae. Shortness of breath could indicate the presence of a blood clot. Although uterine tenderness is of concern, it is common with abruptio placentae and does not indicate an immediately life-threatening condition.

9. Which of the following increases the risk of placental abruption? a. Age < 35 years b. Gestational diabetes c. Previous placental abruption d. Strenuous exercise

ANS: C Previous placental abruption. The risk of placental abruption is increased 15- to 20-fold if an earlier pregnancy had been complicated by placental abruption.6 Other risk factors include chronic hypertension, cocaine use, preeclampsia, age over 35 years, trauma, thrombophilia, cigarette smoking, preterm premature rupture of membranes, chorioamnionitis, and multiparity.

6. A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes, dark red vaginal bleeding, and a tense, painful abdomen. Which clinical change does the nurse anticipate? a. Eclamptic seizure b. Rupture of the uterus c. Placenta previa d. Abruptio placentae

ANS: D Uterine tenderness in the presence of increasing tone may be the earliest sign of abruptio placentae. Women with preeclampsia are at increased risk for an abruption attributable to decreased placental perfusion. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture exhibits hypotonic uterine activity, signs of hypovolemia, and, in many cases, the absence of pain. Placenta previa exhibits bright red, painless vaginal bleeding.

7. The nurse is conducting a routine screening to detect a client's risk for toxoplasmosis parasite infection during pregnancy. Which factor should the nurse ask the client about to determine this risk? 1. Presence of cats in the home 2. Number of sexual partners during pregnancy 3. Exposure to children with rashes or gastrointestinal symptoms 4. History of high fevers or unusual rashes during the first 6 weeks of pregnancy

ANSWER: 1 Rationale: Toxoplasmosis is a systemic (and usually asymptomatic) illness caused by a protozoan parasite. Approximately one third of all women in the United States have positive antibody titers for toxoplasmosis, thus confirming prior exposure. Humans acquire the infection by consuming inadequately cooked meat, eggs, or milk; by ingesting or inhaling the oocyst stage excreted in feline feces or contaminated soil; or by receiving contaminated blood products. Other than transplacental infection, this disease is rarely transmitted from human to human. During pregnancy, the parasite may be transmitted across the placenta and cause severe infection in the developing embryo or fetus. The other options are questions unrelated to toxoplasmosis.

The clinic nurse is performing a psychosocial assessment of a client who has been told that she is pregnant. Which assessment findings indicate to the nurse that the client is at risk for contracting human immunodeficiency virus (HIV)? Select all that apply. 1. The client has a history of intravenous drug use. 2. The client has a significant other who is heterosexual. 3. The client has a history of sexually transmitted infections. 4. The client has had one sexual partner for the past 10 years. 5. The client has a previous history of gestational diabetes mellitus

ANSWER: 1, 3 Rationale: HIV is transmitted by intimate sexual contact and the exchange of body fluids, exposure to infected blood, and passage from an infected woman to her fetus. Clients who fall into the high-risk category for HIV infection include individuals who have used intravenous drugs, individuals who experience persistent and recurrent sexually transmitted infections, and individuals who have a history of multiple sexual partners. Gestational diabetes mellitus does not predispose the client to HIV. A client with a heterosexual partner, particularly a client who has had only one sexual partner in 10 years, does not have a high risk for contracting HIV.

5. A prenatal clinic nurse is providing instructions to a group of pregnant women regarding measures to prevent toxoplasmosis. Which client statement indicates a need for further instruction? 1. "I should cook meat thoroughly." 2. "I should drink unpasteurized milk only." 3. "I should avoid contact with materials that are possibly contaminated with cat feces." 4. "I should avoid touching mucous membranes of the mouth or eyes while handling raw meat."

ANSWER: 2 Rationale: All pregnant women should be advised to follow certain procedures to prevent the development of toxoplasmosis. All meats should be cooked thoroughly. Pregnant clients should avoid uncooked eggs and unpasteurized milk. All fruits and vegetables should be washed before consumption. Contact with materials that possibly are contaminated with cat feces, such as cat litter boxes, sand boxes, or garden soil should be avoided. Last, the pregnant client should avoid touching mucous membranes of the mouth or eyes while handling raw meat, thoroughly wash all kitchen surfaces that come in contact with uncooked meat, and wash the hands thoroughly after handling raw meat.

10. A pregnant woman tests positive for the hepatitis B virus (HBV). The woman asks the nurse if she will be able to breast-feed the baby as planned after delivery. Which response by the nurse is most appropriate 1. "Breast-feeding can start 6 months after delivery." 2. "Breast-feeding is allowed after the baby has been vaccinated with immune globulin." 3. "Breast-feeding is not advised, and you should seriously consider bottle-feeding the baby." 4. "Breast-feeding is not a problem, and you will be able to breast-feed immediately after delivery."

ANSWER: 2 Rationale: Although HBV is transmitted in breast milk, after scheduled newborn vaccines and immune globulin have been administered to the newborn, the woman may breast-feed without risk to the newborn. The remaining options are incorrect responses.

9. A rubella titer result of a 1-day postpartum client is less than 1:8, and a rubella virus vaccine is prescribed to be administered before discharge. The nurse provides which information to the client about the vaccine? Select all that apply. 1. Breast-feeding needs to be stopped for 3 months. 2. Pregnancy needs to be avoided for 1 to 3 months. 3. The vaccine is administered by the subcutaneous route. 4. Exposure to immunosuppressed individuals needs to be avoided. 5. A hypersensitivity reaction can occur if the client has an allergy to eggs. 6. The area of the injection needs to be covered with a sterile gauze for 1 week.

ANSWER: 2, 3, 4, 5 Rationale: Rubella vaccine is administered to women who have not had rubella or women who are not serologically immune. The vaccine may be administered in the immediate postpartum period to prevent the possibility of contracting rubella in future pregnancies. The live attenuated rubella virus is not communicable in breast milk; breast-feeding does not need to be stopped. The client is counseled not to become pregnant for 1 to 3 months after immunization or as specified by the obstetrician because of a possible risk to a fetus from the live virus vaccine; the client must be using effective birth control at the time of the immunization. The client should avoid contact with immunosuppressed individuals because of their low immunity toward live viruses and because the virus is shed in the urine and other body fluids. The vaccine is administered by the subcutaneous route. A hypersensitivity reaction can occur if the client has an allergy to eggs because the vaccine is made from duck eggs. There is no useful or necessary reason for covering the area of the injection with a sterile gauze.

8. A pregnant 39-week-gestation client arrives at the labor and delivery unit in active labor. On confirmation of labor, the client reports a history of herpes simplex virus (HSV) to the nurse, who notes the presence of lesions on inspection of the client's perineum. Which should be the nurse's initial action? 1. Perform an abdominal scrub on the client. 2. Prepare the delivery room for a vaginal delivery. 3. Explain to the client why a cesarean delivery is necessary. 4. Call the primary health care provider to obtain a prescription for an antiviral medication.

ANSWER: 3 Rationale: Because neonatal infection of HSV is life-threatening, prevention of neonatal infection is critical. Current recommendations state that a cesarean delivery within 4 hours after labor begins or membranes rupture is necessary if visible lesions are present on the woman's perineum. An abdominal scrub will be necessary eventually for the cesarean delivery but should not be the nurse's initial action. Antiviral medications are used to control symptoms, not to eradicate the infection. At this phase in the client's pregnancy, the focus is on preventing transmission to the fetus rather than controlling the symptoms of HSV.

2. A pregnant client at 10 weeks' gestation calls the prenatal clinic to report a recent exposure to a child with rubella. The nurse reviews the client's chart. What is the nurse's best response to the client? Refer to chart. 1. "You should avoid all school-age children during pregnancy." 2. "There is no need to be concerned if you don't have a fever or rash within the next 2 days." 3. "You were wise to call. Your rubella titer indicates that you are immune and your baby is not at risk." 4. "Be sure to tell the primary health care provider in 2 weeks, as additional screening will be prescribed during your second trimester."

ANSWER: 3 Rationale: Rubella virus is spread by aerosol droplet transmission through the upper respiratory tract and has an incubation period of 14 to 21 days. The risks of maternal and subsequent fetal infection during the second trimester include hearing loss and congenital anomalies; these risks decrease after the first 12 weeks of pregnancy. Rubella titer determination is a standard prenatal test for pregnant women during their initial screening and entry into the health care delivery system. As noted in this client's chart, she is immune to rubella. The correct option is the only option that helps clarify maternal concerns with accurate information.

4. The nurse is reviewing the results of the rubella screening (titer) with a pregnant client. The test results are positive, and the mother asks if it is safe for her toddler to receive the vaccine. What is the nurse's best response? 1. "Most children do not receive the vaccine until they are 5 years of age." 2. "You are still susceptible to rubella, so your toddler should receive the vaccine." 3. "It is not advised for children of pregnant women to be vaccinated during their mother's pregnancy." 4. "Your titer supports your immunity to rubella, and it is safe for your toddler to receive the vaccine at this time."

ANSWER: 4 Rationale: All pregnant women should be screened for prior rubella exposure during pregnancy. A positive maternal titer further indicates that a significant antibody titer has developed in response to a prior exposure to rubella. All children of pregnant women should receive their immunizations according to schedule. In addition, no definitive evidence suggests that the rubella vaccine virus is transmitted from client to client.

6. A pregnant woman seen in the health care clinic has tested positive for human immunodeficiency virus (HIV). What can the nurse determine based on this information? 1. The woman has the herpes simplex virus (HSV). 2. The woman has contracted an airborne viral disease. 3. The neonate will definitely develop this disease after birth. 4. HIV antibodies are detected by the enzyme-linked immunosorbent assay (ELISA) test.

ANSWER: 4 Rationale: Diagnosis of HIV infection depends on serological studies to detect HIV antibodies. The most commonly used test is the ELISA. HIV and herpes simplex virus are different types of infections. HIV infection occurs primarily through the exchange of body fluids, not via airborne disease. A neonate born to an HIV-positive mother is at risk for developing the virus, but it is not an absolute.

3. The nurse encourages a pregnant client who is human immunodeficiency virus (HIV) positive to immediately report any early signs of vaginal discharge or perineal tenderness to the primary health care provider. The client asks the nurse about the importance of this action, and the nurse responds by making which statement to the client? 1. "This is necessary to relieve your anxiety." 2. "This is necessary to eliminate the need for further uncomfortable screenings." 3. "This is necessary to minimize the financial cost of caring for an HIV-positive client." 4. "This is necessary to assist in identifying potential infections that may need to be treated."

ANSWER: 4 Rationale: The HIV-compromised client may be at high risk for superimposed infections during pregnancy. These include, for example, Candida infections, genital herpes, and anogenital condyloma. Early reporting of signs and symptoms may alert the members of the health care team that further assessment and testing are needed to diagnose and manage additional maternal and fetal physiological risks. All other options do represent possible outcomes of this nursing intervention, but they are not the priority of care when promoting maternal-fetal well-being.

7. A nurse is evaluating the background of four teenagers. Which statements by the teens should the nurse recognize as psychosocial factors contributing to the risk of pregnancy for these teens? Select all that apply. a. "I just want someone to love me." b. "I'd leave my boyfriend, but I'm afraid of what he might do." c. "I have a hard time feeling good about myself." d. "I want a prescription for oral contraceptives."

Answer: a. "I just want someone to love me." b. "I'd leave my boyfriend, but I'm afraid of what he might do." c. "I have a hard time feeling good about myself." Rationale: Family dysfunction and poor self-esteem are major risk factors for adolescent pregnancy. The adolescent girl might use pregnancy for various conscious or subconscious reasons: to punish her father and/or mother; to escape from an undesirable home situation; to gain attention; or to feel that she has someone to love and to love her. Teens that become pregnant compared to teens who have not been pregnant, have usually been physically, emotionally, or sexually abused. In fact, maltreatment of any kind is a high-risk contributor to early teen pregnancy. Contraceptive use is not a psychosocial risk. Answer 3 indicates low self- esteem. Answer 4 indicates a potentially coercive relationship, which could include maltreatment.

8. The nurse is writing a grant for an adolescent pregnancy prevention program. She needs to include factors that contribute to adolescent pregnancy. Select all that apply. a. Hispanic or African American heritage. b. Poverty. c. Attending community college. d. Lack of adult supervision.

Answer: a. Hispanic or African American heritage. b. Poverty. d. Lack of adult supervision. Rationale: Poverty, increased time spent without adult supervision, being African American or Hispanic, low educational achievement, and a previous adolescent pregnancy are considered factors that contribute to adolescent pregnancy.

7. A home care nurse is visiting a pregnant client with a diagnosis of mild preeclampsia. What is the priority nursing intervention during the home visit? a. Monitor for fetal movement b. Monitor the maternal blood glucose c. Instruct the client to maintain complete bed rest d. Instruct the client to restrict dietary sodium and any food items that contain sodium

Answer: A Rationale: A client with mild preeclampsia can be managed at home. The priority intervention of the home care nurse is to monitor for fetal movement. The expectant mother also is asked to keep a record of fetal movements. A maternal blood glucose would not provide specific data related to preeclampsia. Bed rest with bathroom privileges is prescribed; complete bed rest is not necessary. Urine should be checked for protein. Sodium restriction is not necessary.

2. An ultrasound is performed on a client at term gestation who is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that abruptio placentae is present. On the basis of these findings, the nurse should prepare the client for which anticipated prescription? a. Delivery of the fetus b. Strict monitoring of intake and output c. Complete bed rest for the remainder of the pregnancy d. The need for weekly monitoring of coagulation studies until the time of delivery

Answer: A Rationale: Abruptio placentae is the premature separation of the placenta from the uterine wall after the 20th week of gestation and before the fetus is delivered. The goal of management in abruptio placentae is to control the hemorrhage and deliver the fetus as soon as possible. Delivery is the treatment of choice if the fetus is at term gestation or if the bleeding is moderate to severe and the client or fetus is in jeopardy. Because delivery of the fetus is necessary, options 2, 3, and 4 are incorrect regarding management of a client with abruptio placentae. Test-Taking Strategy: Focus on the subject, management of abruptio placentae. Use knowledge regarding the pathophysiology and management of abruptio placentae to answer the question. Note the words term gestation and moderate vaginal bleeding. Knowing that the goal is to deliver the fetus will direct you easily to the correct option.

6. The home care nurse is monitoring a pregnant client with gestational hypertension who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which classic signs of preeclampsia? Select all that apply. a. Proteinuria b. Hypertension c. Low-grade fever d. Generalized edema e. Increased pulse rate f. Increased respiratory rate

Answer: A, B Rationale: The two classic signs of preeclampsia are hypertension and proteinuria. A low-grade fever, increased pulse rate, or increased respiratory rate is not associated with preeclampsia. Generalized edema may occur but is no longer included as a classic sign of preeclampsia because it can occur in many conditions.

3. The nurse in a maternity unit is reviewing the clients' records. Which clients should the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)? Select all that apply. a. A primigravida with abruptio placenta b. A primigravida who delivered a 10-lb infant 3 hours ago c. A gravida 2 who has just been diagnosed with dead fetus syndrome d. A gravida 4 who delivered 8 hours ago and has lost 500 mL of blood e. A primigravida at 29 weeks of gestation who was recently diagnosed with gestational hypertension

Answer: A, C, E Rationale: In a pregnant client, DIC is a condition in which the clotting cascade is activated, resulting in the formation of clots in the microcirculation. Predisposing conditions include abruptio placentae, amniotic fluid embolism, gestational hypertension, HELLP syndrome, intrauterine fetal death, liver disease, sepsis, severe postpartum hemorrhage, and blood loss. Delivering a large newborn is not considered a risk factor for DIC. Hemorrhage is a risk factor for DIC; however, a loss of 500 mL is not considered hemorrhage. Test-Taking Strategy: Note the strategic word, most. Focus on the subject, the client at most risk for DIC. Think about the pathophysiology associated with DIC and select the options that identify abnormal conditions. This will direct you to the correct options

4) When performing a postpartum assessment on a client, the nurse notes the presence of clots in the lochia. The nurse examines the clots and notes that they are larger than 1 cm. Which nursing action is most appropriate? A) Document the findings B) Notify the obstetrician (OB) C) Reassess the client in 2 hours D) Encourage increased oral intake of fluids

Answer: B

8) The nurse is monitoring a client in the immediate postpartum period for signs of hemorrhage. Which sign, if noted, would be an early sign of excessive blood loss? A) A temperature of 100.4° F (38° C) B) An increase in the pulse rate from 88 to 102 beats per minute C) A blood pressure change from 130/88 to 124/80 mm Hg D) An increase in the respiratory rate from 18 to 22 breaths per minute

Answer: B

8. A maternity unit nurse is creating a plan of care for a client with severe preeclampsia who will be admitted to the nursing unit. The nurse should include which nursing intervention in the plan? a. Restrict food and fluids. b. Reduce external stimuli. c. Monitor blood glucose levels. d. Maintain the client in a supine position.

Answer: B Rationale: The client with severe preeclampsia is kept on bed rest in a quiet environment. External stimuli such as lights, noise, and visitors that may precipitate a seizure should be kept to a minimum. Food and fluid are not restricted unless specifically prescribed by the primary health care provider. The client is instructed to rest in a left lateral position to decrease pressure on the vena cava, thereby increasing cardiac perfusion of vital organs.

1. The nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which assessment finding should the nurse expect to note if this condition is present? a. Soft abdomen b. Uterine tenderness c. Absence of abdominal pain d. Painless, bright red vaginal bleeding

Answer: B Rationale: Abruptio placentae is the premature separation of the placenta from the uterine wall after the twentieth week of gestation and before the fetus is delivered. In abruptio placentae, acute abdominal pain is present. Uterine tenderness accompanies placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen feels hard and board-like on palpation as the blood penetrates the myometrium and causes uterine irritability. A soft abdomen and painless, bright red vaginal bleeding in the second or third trimester of pregnancy are signs of placenta previa. Test-Taking Strategy: Focus on the subject, assessment findings in abruptio placentae. Remember that the difference between placenta previa and abruptio placentae involves the presence of uterine pain and tenderness with abruptio placentae, as opposed to painless bleeding with placenta previa.

7) With which conditions is a risk of postpartum hemorrhage associated? Select all that apply. A) Pregnancy-induced hypertension. B) Retained placental fragments. C) The birth of a macrosomatic neonate. D) Full urinary bladder. E) Advanced maternal age.

Answer: B, C, D

10) Which of the following complications may be indicated by continuous seepage of blood from the vagina of a PP client, when palpation of the uterus reveals a firm uterus 1 cm below the umbilicus? A) Retained placental fragments B) Urinary tract infection C) Cervical laceration D) Uterine atony

Answer: C

2) The nurse is preparing to care for four assigned clients. Which client is at most risk for hemorrhage? A) A primiparous client who delivered 4 hours ago B) A multiparous client who delivered 6 hours ago C) A multiparous client who delivered a large baby after oxytocin induction D) A primiparous client who delivered 6 hours ago and had epidural anesthesia

Answer: C

5. Which action should the nurse take first when admitting a multigravida client at 36 weeks' gestation with a probable diagnosis of abruptio placentae? a. Prepare the client for a vaginal examination b. Obtain a brief history from the client c. Insert a large-gauge intravenous catheter d. Prepare the client for an ultrasound scan

Answer: C Abruptio placentae is a medical emergency because the degree of hypovolemic shock may be out of proportion to visible blood loss. On admission, the nurse should plan to first insert a large-gauge intravenous catheter for fluid replacement and oxygen by mask to decrease fetal anoxia. Vaginal examination usually is not performed on pregnant clients who are experiencing third-trimester bleeding due to abruptio placentae because it can result in damage to the placenta and further fetal anoxia. The client's history can be obtained once the client has been admitted and the intravenous line has been started. The goal is birth of the fetus, usually by emergency cesarean section. The nurse should also plan to monitor the client's vital signs and the fetal heart rate. Ultrasound is of limited use in the diagnosis of abruptio placentae.

9. A client with severe preeclampsia is admitted to the maternity department. Which room assignment is most appropriate for this client? a. A private room across from the elevator b. A semiprivate room across from the nurses' station c. A private room 2 doors away from the nurses' station d. A semiprivate room with another client who enjoys watching television

Answer: C Rationale: A quiet room in which stimuli can be minimized is most important for the client with severe preeclampsia. A private room 2 doors away from the nurses' station is the best room assignment for this client. A private room across from the elevator and a semiprivate room across from the nurses' station may be noisy. A semiprivate room with a client who enjoys watching television would provide external stimuli, which must be kept minimal for the client with severe preeclampsia. The client with severe preeclampsia requires intense nursing observation and care.

4. Following a cesarean birth for abruptio placentae, a multigravid client tells the nurse, "I feel like such a failure. None of my other births were like this." Which factor is most important for the nurse to consider when responding to the client? a. The client will most likely have postpartum blues. b. Maternal-infant bonding is likely to be difficult c. The client's feeling of grief is a normal reaction d. This type of birth was necessary to save the client's life

Answer: C Rationale: Feelings of loss, grief, and guilt are normal after a cesarean birth, particularly if it was not planned. The nurse should support the client, listen with empathy, and allow the client time to grieve. The likelihood of the client experiencing postpartum blues is not known, and no evidence is presented. Although maternal-infant bonding may be delayed owing to neonatal complications or maternal pain and subsequent medications, it should not be difficult. Although the nurse is aware that this type of birth was necessary to save the client's life, using this as the basis for the response does not acknowledge the mother's feelings.

1) The nurse is monitoring the amount of lochia drainage in a client who is 2 hours postpartum and notes that the client has saturated a perineal pad in 15 minutes. How should the nurse respond to this finding initially? A) Document the finding B) Encourage the client to ambulate C) Encourage the client to increase fluid intake D) Contact the obstetrician (OB) and inform him or her of this finding

Answer: D

5) The nurse is providing care to a client who just delivered her sixth term infant. In addition to routine postpartum care, what additional priority nursing action will the nurse include in this client's plan of care? A) Use warm water in the peri bottle to cleanse the peri area after birth B) Perform fundal assessments every 15 minutes for the first hour after delivery C) Bring the siblings in to see the newborn at two hours after delivery D) Weigh the peri pads before and after placement to the peri area

Answer: D

6) On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. What is the nurse's highest priority? A) Beginning an intravenous (IV) infusion of Ringer's lactate solution B) Assessing the woman's vital signs C) Calling the woman's primary health care provider D) Massaging the woman's fundus

Answer: D

9) A nurse in a PP unit is instructing a mother regarding lochia and the amount of expected lochia drainage. The nurse instructs the mother that the normal amount of lochia may vary but should never exceed the need for: A) One peripad per day B) Two peripads per day C) Three peripads per day D) Eight peripads per day

Answer: D

1. The home care nurse visits a pregnant client who has a diagnosis of preeclampsia. Which assessment finding indicates a worsening of the preeclampsia and the need to notify the primary health care provider (PHCP)? a. Urinary output has increased b. Dependent edema has resolved c. Blood pressure reading is at the prenatal baseline d. The client complains of a headache and blurred vision

Answer: D Rationale: If the client complains of a headache and blurred vision, the PHCP should be notified because these are signs of worsening preeclampsia. Options 1, 2, and 3 are normal findings.

2. The nurse is performing an assessment on a pregnant client in the last trimester with a diagnosis of preeclampsia. The nurse reviews the assessment findings and determines that which finding is most closely associated with a complication of this diagnosis? a. Enlargement of the breasts b. Complaints of feeling hot when the room is cool c. Periods of fetal movement followed by quiet periods d. Evidence of bleeding, such as in the gums, petechiae, and purpura

Answer: D Rationale: Severe preeclampsia can trigger disseminated intravascular coagulation (DIC) because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the primary health care provider if noted on assessment. Options 1, 2, and 3 are normal occurrences in the last trimester of pregnancy.

10. The nurse is caring for a client with preeclampsia who is receiving an intravenous (IV) infusion of magnesium sulfate. When gathering items to be available for the client, which highest priority item should the nurse obtain? a. Tongue blade b. Percussion hammer c. Potassium chloride injection d. Calcium gluconate injection

Answer: D Rationale: Toxic effects of magnesium sulfate may cause loss of deep tendon reflexes, heart block, respiratory paralysis, and cardiac arrest. The antidote for magnesium sulfate is calcium gluconate. An airway rather than a tongue blade is an appropriate item. A percussion hammer may be important to assess reflexes but is not the highest priority item. Potassium chloride is not related to the administration of magnesium sulfate.

1. In general, teen pregnancies are high risk because of which of the following? a. high probability of chromosomal anomalies b. high oral intake of manganese and zinc c. high numbers of post-term deliveries d. high incidence of late prenatal care

Answer: D. high incidence of late prenatal care Rationale: Late prenatal care is particularly problematic for teen pregnancies. Because organogenesis occurs during the first trimester, by the time many teens acknowledge that they are pregnant and seek care, they are already past this critical period. They are likely to have consumed damaging substances, or at the very least, consumed inadequate quantities of essential nutrients such as folic acid.

9. A nurse is working with a pregnant teenager in the prenatal clinic. What would be the most important nursing action to help this teen meet the third-trimester developmental tasks of pregnancy? a. Assess the client for discomforts of pregnancy. b. Discuss continued education plans. c. Reassure the client that ambivalence is normal. d. Emphasize the need for good nutrition.

Answer: a. Assess the client for discomforts of pregnancy. Rationale: Assessing the client for discomforts of pregnancy is a third-trimester development task. Ambivalence about the pregnancy, the need for good nutrition, and discussing continued education plans are first-trimester developmental tasks.

10. The nurse assesses for complications of pregnancy in a 19-year-old client. Which of the following data might indicate a complication associated with adolescent pregnancy? a. Hypertension, proteinuria, edema. b. Large-for-gestational-age infant. c. Painless vaginal spotting. d. Bright red, painful vaginal bleeding.

Answer: a. Hypertension, proteinuria, edema. Rationale: Risks for pregnant adolescents include preterm births, low-birth-weight infants, cephalopelvic disproportion, iron-deficiency anemia, and pre-eclampsia. Placenta previa, pregnancy-induced diabetes, and abruptio placentae are not common complications of pregnant adolescents.

6. A nurse is teaching psychosocial development to a group of adolescents. The nurse expects teens in which stage of adolescence to be most able to recognize STDs and pregnancy as risks of unprotected sex? a. Late adolescence. b. Preadolescence. c. Middle adolescence. d. Early adolescence.

Answer: a. Late Adolescence Rationale: In late adolescence (ages 18-19 years), teens are more at ease with their individuality and decision-making ability. They can think abstractly and anticipate consequences. Late adolescents are capable of formal operational thought. They learn to solve problems, to conceptualize, and to make decisions. These abilities help them see themselves as having control, which leads to the ability to understand and accept the consequences of their behavior.

3. The nurse provides education to pregnant teen's to prevent which of the following high-risk complications of pregnancy? a. preterm birth b. gestational diabetes c. macrocosmic births d. polycythemia

Answer: a. preterm birth Rationale: Due to their lifestyles, pregnant teens are at high risk for low-birth-weight, preterm births. It is very important that the nurse educate the pregnant teen for signs of preterm labor, such as intermittent backache, cramping, and discomfort low in the pelvic area

4. Because of a pregnant teen's special nutritional needs, the nurse evaluates the client's intake of: a. protein and magnesium b. calcium and iron c. carbohydrates and Zink d. pyroxidine and thiamine

Answer: b. Calcium and iron Rationale: Adolescents are in need of higher levels of both calcium and iron during their pregnancies than are adult women. These nutrients are needed because many of the teens who become pregnant have not completed their own growth. Calcium is, of course, needed for the teen's own bone growth as well as for the bone growth of the fetus. Iron is needed for the teen's hematological function as well as the baby's blood supply.

5. Pregnant adolescents have increased nutritional needs as compared with pregnant adults. Which of the following foods would meet those needs? a. banana b. cheeseburger c. strawberries d. rice

Answer: b. cheeseburger Rationale: Cheeseburger meets both iron and calcium needs; banana and strawberries do not meet iron or calcium needs; rice is high in protein and contains some calcium but is not a good source of iron. The best way to remember the special nutritional needs of an adolescent is to remember that they are still growing themselves. As a result, they need the minerals, calcium, and iron, as well as protein for their own growth and development and to meet the needs of the growing fetus. Of the choices, only cheeseburgers meet all of these needs.

2. Which of the following vital signs must be monitored very carefully during a teen's pregnancy? a. heart rate b. respiratory rate c. blood pressure d. temperature

Answer: c. blood pressure Rationale: Adolescents who are 16 years old or younger are particularly at high risk for hypertensive illnesses of pregnancy. It is especially important for the nurse and the client's primary healthcare practitioner to determine the client's baseline blood pressure to identify any elevations as soon as possible.

5. The nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate. The nurse should monitor for which adverse effects of this medication? Select all that apply a. Flushing b. Hypertension c. Increased urine output d. Depressed respirations e. Extreme muscle weakness f. Hyperactive deep tendon reflexes

Answers: A, D, E Rationale: Magnesium sulfate is a central nervous system depressant and relaxes smooth muscle, including the uterus. It is used to halt preterm labor contractions and is used for preeclamptic clients to prevent seizures. Adverse effects include flushing, depressed respirations, depressed deep tendon reflexes, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated serum magnesium levels.

4. 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? Select all that apply. a. Proteinuria of 3+ b. Respirations of 10 breaths per minute c. Presence of deep tendon reflexes d. Urine output of 20 mL in an hour e. Serum magnesium level of 4 mEqL (2 mmol/L)/

Answers: B,D Rationale: Magnesium toxicity can occur from magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden decline in fetal heart rate and maternal heart rate and blood pressure. Respiratory rate below 12 breaths per minute is a sign of toxicity. Urine output should be at least 25 to 30 mL per hour. Proteinuria of 3 + is an expected finding in a client with preeclampsia. Presence of deep tendon reflexes is a normal and expected finding. Therapeutic serum levels of magnesium are 4 to 7.5 mEq/L (2 to 3.75 mmol/L).

9. The nurse is caring for a young client who reports that she has painful periods. Which assessment findings suggest that this client is experiencing primary dysmenorrhea? (Select all that apply) A) Bleeding between menstrual periods B) Headache C) Fatigue D) Diarrhea E) Scant menses

B) Headache C) Fatigue D) Diarrhea

2. The nurse is presenting material about secondary dysmenorrhea to a group of young women. Which information should be included in the presentation? (Select all that apply) A) Pain is always on the first day of menses and radiates to the groin B) It can be associated with several disorders including tumors, adhesions, and infections. C) It is considered to be one of the most painful gynecologic disorders D) Dysmenorrhea generally affects women aged 30-50 E) The pain diminishes with time and is often much less after childbirth

B) It can be associated with several disorders including tumors, adhesions, and infections. C) It is considered to be one of the most painful gynecologic disorders D) Dysmenorrhea generally affects women aged 30-50

8. Which of the following statements is true regarding the etiology and pathophysiology of primary dysmenorrhea? A) Primary dysmenorrhea is caused by decreased levels of prostaglandins, which cause uterine contractions to increase in strength. B) Primary dysmenorrhea begins within the first three or four menstrual periods after menarche and will occur with each ovulatory cycle during a woman's teens and twenties C) Secondary dysmenorrhea is more common than primary dysmenorrhea D) Causes of primary dysmenorrhea include endometriosis, tumors, cysts, pelvic adhesions, pelvic inflammatory disease, infections, cervical stenosis, uterine leiomyomas, and adenomyosis

B) Primary dysmenorrhea begins within the first three or four menstrual periods after menarche and will occur with each ovulatory cycle during a woman's teens and twenties