HESI OB Questions

When does a nurse caring for a client with eclampsia determine that the risk for another seizure has decreased? 1. After birth occurs 2. After labor begins 3. 48 hours postpartum 4. 24 hours postpartum

3. 48 hours postpartum The danger of a seizure in a woman with eclampsia subsides when postpartum diuresis has occurred, usually 48 hours after birth; however, the risk for seizures may remain for as long as 2 weeks after delivery. After birth occurs, after labor starts, and 24 hours after delivery are all too soon.

A pregnant client is admitted to the high-risk unit with abdominal pain and heavy vaginal bleeding. What action should the nurse take first? Start Oxygen

The client is hemorrhaging and has decreased cardiac output. Oxygen is needed to prevent further maternal and fetal compromise. Administering an opioid will sedate an already compromised fetus. Elevating the head of the bed will decrease blood flow to vital centers in the brain. Although blood should eventually be drawn for laboratory tests, it is not the priority.

A client's membranes rupture during labor. The nurse immediately assesses the electronic fetal heart rate. Variable decelerations lasting more than 90 seconds, followed by bradycardia, are observed on the monitoring strip. What does the nurse suspect as the cause of this change? 1. Fetal acidosis 2. Prolapsed cord 3. Head compression 4. Uteroplacental insufficiency

2. Prolapsed cord This variable pattern with bradycardia is an ominous sign; it is indicative of cord compression, which can result in fetal hypoxia. Immediate intervention is required. Fetal acidosis occurs with uteroplacental insufficiency, not in response to a prolapsed cord. Early decelerations are associated with head compression and are benign. Late decelerations and tachycardia are associated with uteroplacental insufficiency, not a prolapsed cord.

A pregnant client asks the clinic nurse how smoking will affect her baby. What information about cigarette smoking will influence the nurse's response? 1. It relieves maternal tension, and the fetus responds accordingly to the reduction in stress. 2. The resulting vasoconstriction affects both fetal and maternal blood vessels. 3. Substances contained in smoke diffuse through the placenta and compromise the fetus's well-being. 4. Effects are limited because fetal circulation and maternal circulation are separated by the placental barrier.

2. The resulting vasoconstriction affects both fetal and maternal blood vessels. Cigarette smoking or continued exposure to secondary smoke causes both maternal and fetal vasoconstriction, resulting in fetal growth retardation and increased fetal and infant mortality. There is no clinical evidence that smoking relieves tension or that the fetus is more relaxed. Smoking causes vasoconstriction; permeability of the placenta to smoke is irrelevant. Although the fetal and maternal circulations are separate, vasoconstriction occurs in both mother and fetus.

A client is admitted to the birthing unit in active labor. Amniotomy is performed by the health care provider. What physiologic change does the nurse expect to occur after the procedure? 1. Diminished vaginal bleeding 2. Less discomfort with contractions 3. Progressive dilation and effacement 4. Increased maternal and fetal heart rates

3. Progressive dilation and effacement Amniotomy permits more effective pressure of the fetal head on the cervix, enhancing dilation and effacement. Vaginal bleeding may increase because of the progression of labor. Discomfort may increase because contractions usually become more intense after amniotomy. Amniotomy should not affect maternal or fetal heart rates.

While a client at 30 weeks' gestation is being examined in the prenatal clinic, the nurse identifies a respiratory rate of 26/min, blood pressure of 100/60, and diaphragmatic tenderness, and the client reports increased urinary output. Which finding indicates that the client may be experiencing a complication? 1. Urinary output 2. Blood pressure 3. Respiratory rate 4. Diaphragmatic tenderness

3. Respiratory rate The increased respiratory rate is one sign of cardiac decompensation; cardiac output and blood volume peak during the second trimester, and signs and symptoms of cardiac disease become prominent at this time. Oliguria (not increased urine output), accompanied by edema of the face, legs, and fingers, is a sign of cardiac complications. The client's blood pressure is within the expected range for a pregnant woman. Diaphragmatic tenderness is a vague symptom that is not related to heart disease.

A pregnant client in the third trimester tells the nurse in the prenatal clinic that she has heartburn after every meal. What explanation should the nurse give about the cause of the heartburn? 1. "The esophageal sphincter relaxes and allows acid to be regurgitated." 2. "In pregnancy, gastric motility increases, causing a burning sensation." 3. "In pregnancy, gastric pH increases, causing acid to enter the esophagus." 4. "In pregnancy, the pyloric sphincter relaxes, allowing acid to enter the intestine."

1. "The esophageal sphincter relaxes and allows acid to be regurgitated." Relaxation of the esophageal sphincter, resulting in regurgitation of acid, causes heartburn (pyrosis) during the second half of pregnancy. Delayed emptying of stomach contents because of decreased gastric motility and displacement of the stomach because of uterine enlargement contribute to the problem. Gastric motility is decreased during pregnancy. When gastric pH increases, gastric juices become more alkaline, leaving little or no acid to be regurgitated into the esophagus. The pyloric sphincter does not relax, and acid does not pass into the small intestine.

A pregnant client's last menstrual period was on February 11. A physical assessment on July 18 should reveal the top of the fundus: 1. Even with the umbilicus 2. Just above the symphysis pubis 3. Two fingerbreadths above the umbilicus 4. Halfway between the symphysis and umbilicus

1. Even with the umbilicus Around the 22nd week of gestation the top of the fundus is at the level of the umbilicus. Just above the symphysis pubis is too low for a pregnancy between the fifth and sixth months of gestation. Two fingerbreadths above the umbilicus is too high for 20 to 22 weeks' gestation. Halfway between the symphysis pubis and umbilicus is too low for a pregnancy between the fifth and sixth months of gestation.

A nurse determines that a postpartum client is gravida 1, para 1. Her blood type is B negative, and her baby's blood type is O positive. What should the nurse include in the plan of care? 1. Obtaining an order for RhoGAM 2. Determining the father's blood type 3. Checking for signs of ABO incompatibility 4. Obtaining blood for type and crossmatching

1. Obtaining an order for RhoGAM RhoGAM will prevent sensitization from Rh incompatibility that may arise between an Rh-negative mother and an Rh-positive infant. Because the newborn has type O blood with no ABO incompatibility, neither mother nor infant will require a transfusion; this is the mother's first pregnancy, so the risk for RH incompatibility is minimal. Only the mother's and the newborn's Rh factors are relevant at this time. ABO incompatibility does not exist; it may if the mother has O-positive and the newborn has type B blood.

A pregnant woman at 6 weeks' gestation tells the nurse at her first prenatal visit that she uses an over-the-counter herbal product as a health supplement that has been approved by the Food and Drug Administration. What should the nurse recommend to the client? Select all that apply. 1. Stop taking the supplement immediately. 2. Discuss the use of the supplement with the practitioner. 3. Increase the dosage of the supplement as pregnancy progresses. 4. Ask the pharmacist whether the supplement is safe for use during pregnancy. 5. Discuss the use of any over-the-counter products with the practitioner.

1. Stop taking the supplement immediately. 2. Discuss the use of the supplement with the practitioner. 5. Discuss the use of any over-the-counter products with the practitioner. Stopping the supplement is appropriate until more instructions are received from the practitioner. It is the practitioner's responsibility to counsel the client regarding all prescriptions, over-the-counter medications, and supplements. Continuing or increasing the dose of the supplement is unsafe; it may be detrimental to both the client and the fetus. The nurse may not prescribe medications of any kind, and to do so is functioning outside of the legal definition of nursing practice. It is the practitioner's responsibility, not the pharmacist's, to counsel the client regarding all prescriptions, over-the-counter medications, and supplements.

A client in active labor is rushed from the emergency department to the labor and birth suite screaming, "Knock me out!" Examination reveals that her cervix is dilated 9 cm. What should the nurse say while trying to calm the client? 1. "I'll rub your back—that will help ease your pain." 2. "You'll get a shot when you reach the birthing room." 3. "I'm sure you're in pain, but try to bear with it for the baby's sake." 4. "Medication may interfere with the baby's first breaths; keep breathing."

4. "Medication may interfere with the baby's first breaths; keep breathing." Analgesia crosses the placental barrier; when birth is imminent, it can cause respiratory depression in the newborn. The client is exhibiting fear and panic; a backrub at this time will not be effective and will probably be rejected. Stating that the client will get a shot when she reaches the birthing room is incorrect and provides false reassurance. Although acknowledging that the client is in pain is an empathic response, an explanation of why medication cannot be given is more appropriate in this situation.

A client who is at 33 weeks' gestation has contracted gonorrhea and is prescribed probenecid (Benemid) and penicillin. What instructions will the nurse give to the client regarding the reason for dual therapy? 1. "Your allergy to penicillin is minimized." 2. "The side effects of the disease are reduced." 3. "Your immune defense mechanisms are more active." 4. "The amount of penicillin in your blood is increased."

4. "The amount of penicillin in your blood is increased." Probenecid (Benemid) reduces renal tubular excretion of penicillin. The other options are unrelated to the concomitant administration of penicillin and probenecid.

A woman at 39 weeks' gestation whose membranes have ruptured at home arrives at the clinic to be evaluated. Assessment reveals mild irregular contractions 10 to 15 minutes apart and a fetal heart rate (FHR) of 186 beats/min is auscultated between contractions. In light of this assessment, what does the nurse conclude? 1. The fetus is not at risk. 2. A precipitous birth is imminent. 3. This is a response to an infection. 4. A further assessment is necessary.

4. A further assessment is necessary. The fetal heart rate should be 110 to 160 beats/min; an FHR of 186 is tachycardic and further evaluation is necessary because the fetus may be at risk. The data indicate that the client is in early labor. Although fetal tachycardia is associated with infection, there are other causes.

A nurse is caring for a group of postpartum clients. Which client is at the highest risk for disseminated intravascular coagulation (DIC)? 1. Gravida III with twins 2. Gravida V with endometriosis 3. Gravida II who had a 9-lb baby 4. Gravida I who has had an intrauterine fetal death

4. Gravida I who has had an intrauterine fetal death Intrauterine fetal death is one of the risk factors for DIC; other risk factors include abruptio placentae, amniotic fluid embolism, sepsis, and liver disease. Multiple pregnancy, endometriosis, and high birthweight are not risk factors for DIC.