some ob nclex questions i like

A patient asks her nurse, "My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?" The best response by the nurse is: *A.*"Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby." *B.* "Your placenta isn't working properly, and your baby is in danger." *C.* "This means that we will need to perform an amniocentesis to detect if you have any placental damage." *D.* "Don't worry about it. Everything is fine."

*A.*"Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby." b/c it's the longest answer :P ~ check chapter 10 for more info if you please

A woman arrives at the clinic for a pregnancy test. The first day of her last menstrual period (LMP) was September 10, 2019. Her expected date of birth (EDB) would be?

*June 17, 2020* Using Nägele's rule, June 17, 2020, is the correct EDB. The EDB is calculated by subtracting 3 months from the first day of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of September 10, 2019:September 10, 2019 − 3 months = June 10, 2019 + 7 days = June 17, 2019 + 1 year = June 17, 2020

A pregnant woman's biophysical profile score is 8. She asks the nurse to explain the results. The nurse's best response is: *a.* "The test results are within normal limits." *b.* "Immediate delivery by cesarean birth is being considered." *c.* "Further testing will be performed to determine the meaning of this score." *d.* "An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding delivery."

*a.* "The test results are within normal limits." The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high risk patients. Delivery can be delayed if fetal well-being is indicated. Scores less than 4 should be investigated, and delivery could be initiated sooner than planned. This score is within normal range, and no further testing is required at this time. The results of the biophysical profile are usually available immediately after the procedure is performed.

What laboratory marker is indicative of disseminated intravascular coagulation (DIC)? *a.* Bleeding time of 10 minutes *b.* Presence of fibrin split products *c.* Thrombocytopenia *d.* Hyperfibrinogenemia

*b.* Presence of fibrin split products Degradation of fibrin leads to the accumulation of fibrin split products in the blood. Bleeding time in DIC is normal. Low platelets may occur with but are not indicative of DIC because they may result from other coagulopathies. Hypofibrinogenemia would occur with DIC.

With regard to follow-up visits for women receiving prenatal care, nurses should be aware that: *a.* the interview portions become more intensive as the visits become more frequent over the course of the pregnancy. *b.* monthly visits are scheduled for the first trimester, every 2 weeks for the second trimester, and weekly for the third trimester. *c.* during the abdominal examination, the nurse should be alert for supine hypotension. *d.* for pregnant women, a systolic blood pressure (BP) of 130 and a diastolic BP of 80 is sufficient to be considered hypertensive.

*c.* during the abdominal examination, the nurse should be alert for supine hypotension. The woman lies on her back during the abdominal examination, possibly compressing the vena cava and aorta, which can cause a decrease in blood pressure and a feeling of faintness. The interview portion of follow-up examinations is less extensive than in the initial prenatal visits, during which so much new information must be gathered. Monthly visits are routinely scheduled for the first and second trimesters; visits increase to every 2 weeks at week 28 and to once a week at week 36. For pregnant women hypertension is defined as a systolic BP of 140 or greater and a diastolic BP of 90 or greater.

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

1. A normal test result Contraction stress test results may be interpreted as negative (normal), positive (abnormal), or equivocal. A negative test result indicates that no late decelerations occurred in the fetal heart rate, although the fetus was stressed by 3 contractions of at least 40 seconds' duration in a 10-minute period. Options 2, 3, and 4 are incorrect interpretations.

The diagnosis of pregnancy is based on which positive signs of pregnancy? *Select all that apply.* *a.* Identification of fetal heartbeat *b.* Palpation of fetal outline *c.* Visualization of the fetus *d.* Verification of fetal movement *e.* Positive hCG test

*a.* Identification of fetal heartbeat *c.* Visualization of the fetus *d.* Verification of fetal movement Identification of fetal heartbeat, visualization of the fetus, and verification of fetal movement are all positive, objective signs of pregnancy. Palpation of fetal outline and a positive hCG test are probable signs of pregnancy. A tumor also can be palpated. Medication and tumors may lead to false-positive results on pregnancy tests.

The multiple marker test is used to assess the fetus for which condition? *a.* Down syndrome *b.* Diaphragmatic hernia *c.* Congenital cardiac abnormality *d.* Anencephaly

*a.* Down syndrome The maternal serum level of alpha-fetoprotein is used to screen for Down syndrome, neural tube defects, and other chromosome anomalies. The multiple marker test would not detect diaphragmatic hernia, congenital cardiac abnormality, or anencephaly. Additional testing, such as ultrasonography and amniocentesis, would be required to diagnose these conditions.

During a patient's physical examination the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as: *a.* Hegar's sign. *b.* McDonald's sign. *c.* Chadwick's sign. *d.* Goodell's sign.

*a.* Hegar's sign. At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occurs; this is called Hegar's sign. McDonald's sign indicates a fast food restaurant. Chadwick's sign is the blue-violet coloring of the cervix caused by increased vascularity; this occurs around the fourth week of gestation. Softening of the cervical tip is called Goodell's sign, which may be observed around the sixth week of pregnancy.

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature of 37.1° C, pulse rate of 96 beats/min, respiratory rate of 24 breaths/min, blood pressure (BP) of 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for: *a.* hydralazine. *b.* magnesium sulfate bolus. *c.* diazepam. *d.* calcium gluconate.

*a.* hydralazine. Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically, it is administered for a systolic BP greater than 160 mm Hg or a diastolic BP greater than 110 mm Hg. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The patient is not currently displaying any signs or symptoms of magnesium toxicity.

A patient who has undergone a dilation and curettage for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that vital signs are stable, bleeding has been controlled, and the woman has adequately recovered from the administration of anesthesia. To promote an optimal recovery, discharge teaching should include: *SATA* *a.* iron supplementation. *b.* resumption of intercourse at 6 weeks following the procedure. *c.* referral to a support group if necessary. *d.* expectation of heavy bleeding for at least 2 weeks. *e.* emphasizing the need for rest.

*a.* iron supplementation. *c.* referral to a support group if necessary. *e.* emphasizing the need for rest. The woman should be advised to consume a diet high in iron and protein. For many women iron supplementation is also necessary. Acknowledge that the patient has experienced a loss, albeit early. She can be taught to expect mood swings and possibly depression. Referral to a support group, clergy, or professional counseling may be necessary. Discharge teaching should emphasize the need for rest. Nothing should be placed in the vagina for 2 weeks after the procedure. This includes tampons and vaginal intercourse. The purpose of this recommendation is to prevent infection. Should infection occur, antibiotics may be prescribed. The patient should expect a scant, dark discharge for 1 to 2 weeks. Should heavy, profuse, or bright bleeding occur, she should be instructed to contact her provider.

Nurses should be aware that the biophysical profile (BPP): *a.* is an accurate indicator of impending fetal death. *b.* is a compilation of health risk factors of the mother during the later stages of pregnancy. *c.* consists of a Doppler blood flow analysis and an amniotic fluid index. *d.* involves an invasive form of ultrasound examination.

*a.* is an accurate indicator of impending fetal death. An abnormal BPP score is an indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure.

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

*a.* negative. Adequate uterine activity necessary for a CST consists of the presence of three contractions in a 10-minute time frame. If no decelerations are observed in the FHR pattern with the contractions, the findings are considered to be negative. A positive CST indicates the presence of repetitive later FHR decelerations. Satisfactory and unsatisfactory are not applicable terms.

During the first trimester, a woman can expect which of the following changes in her sexual desire? *a.* An increase, because of enlarging breasts *b.* A decrease, because of nausea and fatigue *c.* No change *d.* An increase, because of increased levels of female hormones

*b.* A decrease, because of nausea and fatigue Maternal physiologic changes such as breast enlargement, nausea, fatigue, abdominal changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses may affect sexuality and sexual expression. Libido may be depressed in the first trimester but often increases during the second and third trimesters. During pregnancy, the breasts may become enlarged and tender; this tends to interfere with coitus, decreasing the desire to engage in sexual activity.

A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus? *a.* Ultrasound for fetal anomalies *b.* Biophysical profile (BPP) *c.* Maternal serum alpha-fetoprotein (MSAFP) screening *d.* Percutaneous umbilical blood sampling (PUBS)

*b.* Biophysical profile (BPP) Real-time ultrasound permits detailed assessment of the physical and physiologic characteristics of the developing fetus and cataloging of normal and abnormal biophysical responses to stimuli. *BPP is a noninvasive, dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease.* An ultrasound for fetal anomalies would most likely have been performed earlier in the pregnancy. It is too late in the pregnancy to perform MSAFP screening. Also, MSAFP screening does not provide information related to fetal well-being. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of a fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.

Which finding in the urine analysis of a pregnant woman is considered a variation of normal? *a.* Proteinuria *b.* Glycosuria *c.* Bacteria in the urine *d.* Ketones in the urine

*b.* Glycosuria Small amounts of glucose may indicate "physiologic spilling." The presence of protein could indicate kidney disease or preeclampsia. Urinary tract infections are associated with bacteria in the urine. An increase in ketones indicates that the patient is exercising too strenuously or has an inadequate fluid and food intake.

A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level? *a.* Not palpable above the symphysis at this time *b.* Slightly above the symphysis pubis *c.* At the level of the umbilicus *d.* Slightly above the umbilicus

*b.* Slightly above the symphysis pubis In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. As the uterus grows, it may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. The uterus rises gradually to the level of the umbilicus at 22 to 24 weeks of gestation.

Which maternal condition always necessitates delivery by cesarean section? *a.* Partial abruptio placentae *b.* Total placenta previa *c.* Ectopic pregnancy *d.* Eclampsia

*b.* Total placenta previa In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal delivery occurred. If the mother has stable vital signs and the fetus is alive, a vaginal delivery can be attempted in cases of partial abruptio placentae. If the fetus has died, a vaginal delivery is preferred. The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. Labor can be safely induced if the eclampsia is under control.

To prevent gastrointestinal upset, patients should be instructed to take iron supplements: *a.* on a full stomach. *b.* at bedtime. *c.* after eating a meal. *d.* with milk.

*b.* at bedtime. Patients should be instructed to take iron supplements at bedtime. Iron supplements are best absorbed if they are taken when the stomach is empty. Bran, tea, coffee, milk, and eggs may reduce absorption. Iron can be taken at bedtime if abdominal discomfort occurs when it is taken between meals.

A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse? *a.* Blood pressure (BP) increase to 138/86 mm Hg. *b.* Weight gain of 0.5 kg during the past 2 weeks. *c.* A dipstick value of 3+ for protein in her urine. *d.* Pitting pedal edema at the end of the day.

*c.* A dipstick value of 3+ for protein in her urine. Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ should alert the nurse that additional testing or assessment should be made. Generally, hypertension is defined as a BP of 140/90 or an increase in systolic pressure of 30 mm Hg or in diastolic pressure of 15 mm Hg. Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week. Edema occurs in many normal pregnancies and in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia.

Which meal would provide the most absorbable iron? *a.* Toasted cheese sandwich, celery sticks, tomato slices, and a grape drink *b.* Oatmeal, whole wheat toast, jelly, and low-fat milk *c.* Black bean soup, wheat crackers, orange sections, and prunes *d.* Red beans and rice, cornbread, mixed greens, and decaffeinated tea

*c.* Black bean soup, wheat crackers, orange sections, and prunes Food sources that are rich in iron include liver, meats, whole grain or enriched breads and cereals, deep green leafy vegetables, legumes, and dried fruits. In addition, the vitamin C in orange sections aids absorption. Dairy products and tea are not sources of iron.

During pregnancy, many changes occur as a direct result of the presence of the fetus. Which of these adaptations meet this criterion? *Select all that apply.* *a.* Leukorrhea *b.* Development of the operculum *c.* Quickening *d.* Ballottement *e.* Lightening

*c.* Quickening *d.* Ballottement *e.* Lightening Leukorrhea is a white or slightly gray vaginal discharge that develops in response to cervical stimulation by estrogen and progesterone. Quickening is the first recognition of fetal movements or "feeling life." Quickening is often described as a flutter and is felt earlier in multiparous women than in primiparas. Lightening occurs when the fetus begins to descend into the pelvis. This occurs 2 weeks before labor in the nullipara and at the start of labor in the multipara. Mucus fills the cervical canal creating a plug otherwise known as the operculum. The operculum acts as a barrier against bacterial invasion during the pregnancy. Passive movement of the unengaged fetus is referred to as ballottement.

Methotrexate is recommended as part of the treatment plan for which obstetric complication? *a.* Complete hydatidiform mole *b.* Missed abortion *c.* Unruptured ectopic pregnancy *d.* Abruptio placentae

*c.* Unruptured ectopic pregnancy Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 4 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for complete hydatidiform mole, missed abortion, and abruptio placentae.

A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature of 37.3° C, pulse rate of 88 beats/min, respiratory rate of 10 breaths/min, blood pressure (BP) of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The patient complains, "I'm so thirsty and warm." The nurse: *a.* calls for a stat magnesium sulfate level. *b.* administers oxygen. *c.* discontinues the magnesium sulfate infusion. *d.* prepares to administer hydralazine.

*c.* discontinues the magnesium sulfate infusion. The patient is displaying clinical signs and symptoms of magnesium toxicity. Magnesium should be discontinued immediately. In addition, calcium gluconate, the antidote for magnesium, may be administered. Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically it is administered for a systolic BP greater than 160 mm Hg or a diastolic BP greater than 110 mm Hg.

Magnesium sulfate is given to women with preeclampsia and eclampsia to: *a.* improve patellar reflexes and increase respiratory efficiency. *b.* shorten the duration of labor. *c.* prevent and treat convulsions. *d.* prevent a boggy uterus and lessen lochial flow.

*c.* prevent and treat convulsions. Magnesium sulfate is the drug of choice to prevent convulsions, although it can generate other problems. Loss of patellar reflexes and respiratory depression are signs of magnesium toxicity. Magnesium sulfate can increase the duration of labor. Women are at risk for a boggy uterus and heavy lochial flow as a result of magnesium sulfate therapy.

A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine "several times" during the past year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics place the woman in a high risk category? *a.* Blood pressure, age, and BMI *b.* Drug/alcohol use, age, and family history *c.* Family history, blood pressure, and BMI *d.* Family history, BMI, and drug/alcohol abuse

*d.* Family history, BMI, and drug/alcohol abuse i'm not putting the rationale b/c you should know why!

When caring for a pregnant woman with cardiac problems, the nurse must be alert for signs and symptoms of cardiac decompensation, which include: *a.* a regular heart rate and hypertension. *b.* an increased urinary output, tachycardia, and dry cough. *c.* shortness of breath, bradycardia, and hypertension. *d.* dyspnea; crackles; and an irregular, weak pulse.

*d.* dyspnea; crackles; and an irregular, weak pulse. Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, rapid pulse; rapid respirations; a moist, frequent cough; generalized edema; increasing fatigue; and cyanosisofthelipsandnailbeds.NAURreSgINulGaTrBh.eCaOrtMrateandhypertensionarenotgenerally associated with cardiac decompensation. Tachycardia would indicate cardiac decompensation, but increased urinary output and a dry cough would not. Shortness of breath would indicate cardiac decompensation, but bradycardia and hypertension would not.

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. The nurse suspects the onset of: *a.* eclamptic seizure. *b.* rupture of the uterus. *c.* placenta previa. *d.* placental abruption.

*d.* placental abruption. Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture manifests as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. *Placenta previa manifests with bright red, painless vaginal bleeding.*

The nurse caring for the pregnant patient must understand that the hormone essential for maintaining pregnancy is: *a.* estrogen. *b.* human chorionic gonadotropin (hCG). *c.* oxytocin. *d.* progesterone.

*d.* progesterone. Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles. This reduces uterine activity and prevents miscarriage. Estrogen plays a vital role in pregnancy, but it is not the primary hormone for maintaining pregnancy. hCG levels increase at implantation but decline after 60 to 70 days. Oxytocin stimulates uterine contractions.

The nurse recognizes that a nonstress test (NST) in which two or more fetal heart rate (FHR) accelerations of 15 beats/min or more occur with fetal movement in a 20-minute period is: *a.* nonreactive. *b.* positive. *c.* negative. *d.* reactive.

*d.* reactive. The NST is reactive (normal) when two or more FHR accelerations of at least 15 beats/min (each with a duration of at least 15 seconds) occur in a 20-minute period. A nonreactive result means that the heart rate did not accelerate during fetal movement. A positive result is not used with NST. Contraction stress test (CST) uses positive as a result term. A negative result is not used with NST. CST uses negative as a result term.