OB (Exam 1)

A 15-year-old client is being seen for her first prenatal visit. Because of this client's special nutritional needs, the nurse evaluates the client's intake of?

Calcium and iron

During a prenatal exam, the nurse notes scarring on and around the woman's genitalia. Which of the following questions is most important for the nurse to ask in relation to this observation?

"Have you ever been forced to have sex?"

Which of the following clients is at the highest risk for developing a hypertensive illness during pregnancy? 1. G1 P0000, AGE 41 HX of DM 2. G2 P0101, AGE 34 HX OF RHEUMATIC FEVER 3. G3 P1102, AGE 27 HX OF SCOLOSIS 4. G3 P1011, AGE 20 HX OF CELIAC DISEASE

1 G1 P0000 AGE 41 HX OF DM (Women who are at the highest risk are primigravida's, multiple gestations, women who are younger than 17 and older than 34)

A nurse who is caring for a pregnant client with type 1 DM should carefully monitor the client for which of the following? SELECT ALL THAT APPLY 1. UTI 2. Multiple gestations 3. Metabolic acidosis 4. Pathological hypotension 5. Hypolipidemia

1 and 3

A woman is to receive methotrexate IM for an ectopic pregnancy. The nurse should teach the woman about which of the following common side effects? SELECT ALL THAT APPLY 1. Nausea and vomiting 2. Abdominal pain 3. Fatigue 4. Light headedness 5. Breast tenderness

1, 2, 3, 4.

A 39 year old client at 18 weeks gestation has had an amniocentesis. Before D/C the nurse teaches the woman to call her doctor if she experiences which of the following conditions? SELECT ALL THAT APPLY 1.Fever or chills 2. Lack of fetal movement 3. Abdominal pain 4. Rash or pruritis 5. Vaginal bleeding or fluid

1, 2, 3, and 5

A client at 12 weeks gestation presents in the ER with abdominal cramps and scant dark red vaginal bleeding. For which of the following signs/symptoms should the nurse assess this client? SELECT ALL THAT APPLY 1. Tachycardia 2. Referred shoulder pain 3. Headache 4. Fetal heart dysrhythmias 5. Hypertension

1, 3, 4, AND 5

Which of the following long-term goals is appropriate for a client at 10 weeks gestation who is diagnosed with gestational trophoblastic disease (hydatidiform mole)

Client will be cancer free 1 year from diagnosis (complication is cancer)

The nurse is evaluating the effectiveness of bed rest for a client with pre-eclampsia without severe features. Which of the following signs/symptoms would the nurse determine is a finding that suggests pre-eclampsia with severe features? SELECT ALL THAT APPLY 1. Platelet count 95,000/mcL 2. 2+ proteinuria 3. Increase in plasma protein 4. Serum creatinine greater than 1.3 mg/dL

1,2,4 (A platelet count less than 100,000 per microliter is a sign of pre-eclampsia with severe features, a reading greater than 1+ indicates worsening kidney insufficiency, and serum creatine greater than 1.1 mg/dL indicates worsening renal insufficiency)

The blood work of a client hospitalized on the antepartum unit of the hospital is as follows: hematocrit 30% and hemoglobin 10 gm/dL. Which of the following meal choices should the nurse recommend to this client? 1. Chicken livers, sliced tomatoes, and dried apricots 2. Cheese sandwich, tossed salad, and rice pudding 3. Veggie burger, cucumber salad, and a wedge of cantaloupe 4. Bagel with cream cheese, pear, and hearts of lettuce

1. Foods high in iron (liver and dried fruits) food high in vitamin C (tomatoes)

A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following lab values would be consistent with this diagnosis?

pH: 7.5, PO2: 90, PC02: 45, HBCO3: 30 mEq/L (Client is in metabolic alkalosis)

32 weeks gestation HX: G8P7007 DX: placenta previa Which of the following interventions would the nurse expect to see on the provider's orders? SELECT ALL THAT APPLY 1. Daily contraction stress test 2. Blood type and cross match 3. Bedrest with passive ROM 4. Daily serum electrolyte assessments 5. Weekly biophysical profiles

2, 3, 5 (Because of the high risk of bleeding from the placental site, activity is limited. Blood must be readily available. )

A pregnant client with DM has been diagnosed with polyhydramnios Which of the following would explain this finding? 1. Excessive fetal urination 2. Recurring hypoglycemic episodes 3. Fetal sacral agenesis 4. Placental vascular damage

1. Excessive fetal urination

A gravid client with 4+ proteinuria and 4+ reflexes is admitted to the hospital. The nurse must closely monitor the woman for which of the following? 1. Grand mal seizures 2. High platelet count 3. Explosive diarrhea. 4. Jaundice

1. Grand mal seizures

Which of the following findings would the nurse expect to see when assessing a first first-trimester client suspected of having a gestational trophoblastic disease that the nurse would not expect to see when assessing a first trimester gravida with a normal pregnancy?

1. Grape-like clusters passed from the vagina 2. Markedly elevated blood pressure

A nurse is caring for four prenatal clients in the clinic. Which of the clients is at high risk for placenta previa? 1. Jogger with low body mass index 2. Primigravida who smokes 1 pack of cigarettes per day 3. Infertility client who is carrying in vitro triplets 3. RN who works 12-hour shifts 4. Police officer on foot patrol

2,3

Which of the following pregnant clients is most high risk for preterm premature rupture of the membranes (PPROM)? SELECT ALL THAT APPLY 1. 31 weeks, with prolapsed mitral valve (PMV) 2. 32 weeks, with UTI 3. 33 weeks, with twins post in vitro fertilization (IVF) 4. 34 weeks with GDM 5. 35 weeks, with DVT (deep vein thrombosis)

2,3

Nurse interviewing a prenatal client. Which of the following factors in the clients history should the nurse highlight for the primary healthcare provider? 1. she is 18 years old 2. she owns a cat/dog 3. she eats peanut butter daily 4. she works as a surgeon

1. She owns a cat/dog Cat feces are a potential source of toxoplasmosis

A client at 27 weeks gestation has been diagnosed with GDM. Which of the following therapies will most likely be ordered for this client? 1. Oral hypoglycemic agents 2. Diet control and exercise 3. Regular insulin injections 4. Inhaled insulin

2. Treatment for clients with GDM is normally begins with carbohydrate counting and exercise

30 year old client with HX of G3P1201 is planning to become pregnant again. She reports that 8 years ago she gave birth to a premature baby boy who died shortly after delivery from an infection secondary to spina bifida. Which of the following interventions is most important for this client? 1. Grief counseling 2. Nutrition counseling 3. Infection control counseling 4. Genetic counseling

2. Low folic acid = possible neural tube defect

A client with type 1 GDM has developed polyhydramnios. She is 34 weeks pregnant. The client should be taught to report which of the following? 1. Uterine contractions 2. Reduced urinary output 3. Marked fatigue 4. Puerperal rash

1. uterine contractions

A client has just done a fetal kick count assessment. She noted 6 movements during the past hour. If taught correctly, what should her next action be? 1. nothing, because further action is not warranted 2. Call the primary healthcare provider to discuss next step 3. Redo a test during the next half hour 4. Drink a glass or orange juice and redo test

2. Call the primary healthcare provider to discuss next step (Woman should notify her healthcare provider, who will likely perform either a NST or in some situations BPP which includes ultrasound)

A client with a history of CHF disease is 36 weeks pregnant. Which of the following findings should the nurse report to the primary healthcare provider? 1. Presence of striae gravidarum 2. Dyspnea on exertion 3. 4-pound weight gain in a month 4. Patellar reflexes +2

2. Dyspnea on exertion (Client complaining of dyspnea on exertion is likely going into left-sided CHF)

A client has been diagnosed with pseudocyesis. Which of the following signs/symptoms would the nurse expect to see? 1. 4+ pedal edema 2. No fetal heartbeat 3. Hematocrit above 40% 4. Denial of quickening

2. No fetal heartbeat (Pseudocyesis is a false pregnancy, rare but some women develop pregnancy symptoms and believe they are pregnant even though they are not. This is a psychiatric illness.)

A woman at 29 weeks gestation with a diagnosis of pre-eclampsia with severe features is noted to have a BP of 170/112, 4+ proteinuria, and a weight gain of 10 lbs. over the past two days. Which of the following signs/symptoms would the nurse also expect to see? 1. Fundal height of 32 cm 2. Oliguria 3. Patellar reflexes of +2 4. Nystagmus

2. Oliguria (decreased urine output)

A client is admitted with a diagnosis of third-trimester bleeding. It is a priority for the nurse to assess for a change in which of the following vital signs? 1. Temp 2. Pulse 3. Respirations 4. BP

2. Pulse Blood volume is doubled by the end of the second trimester, because of this if they bleed they can main BP relatively for a long period of time. The pulse rate will rise. A drop in BP is a very late sign and an ominous sign.

Prenatal teaching for a pregnant woman should include instructions to do which of the following? 1. Refrain from touching her pet bird 2. Wear gloves when gardening 3. Cook pork until medium well done 4. Avoid sleeping with the dog

2. Wear gloves when gardening (Clients should be advised to wear gloves when gardening because cat feces can carry the toxoplasmosis protozoa)

Diabetic client HX of G3P0200, 38 weeks gestation Client states nausea and vomiting for the past 24 hours Which blood value presents the highest risk for her unborn baby? 1. Glucose: 150 mg/dL 2. pH: 7.25 3.PCO2: 34 mm Hg 4. Hemoglobin A1c: 6%

2. pH: 7.25 Client is in acidosis

A gravid woman has just been admitted to the ER subsequent to a head-on automobile accident. Her body appears to be injured. The nurse carefully monitors the woman for which of the following possible complications of pregnancy? SELECT ALL THAT APPLY 1. Placenta previa 2. Transverse fetal lie 3. Placental abruption 4. pre- eclampsia with severe features 5. PTL

3,5

A client who is 24 weeks pregnant has been diagnosed with syphilis. She asks the nurse how the infection will affect the baby. The nurse's response should be based on which of the following? 1. She is at high risk for premature rupture of the membranes 2. The baby will be born with congenital syphilis 3. PCN therapy will reduce the risk to the fetus 4. The fetus will likely be born with a cardiac defect

3. PCN therapy will reduce the risk to the fetus (Usually a single shot of PCN administered to the mother will cure her and protect the baby)

A 14-year-old client is seeking obstetric care. Which of the following vital signs must be monitored very carefully during the woman's pregnancy? 1. Heart rate 2. RR 3. BP 4. Temperature

3. BP (At risk for hypertensive illness of pregnancy)

Which of the following clients is at the highest risk for pseudocyesis? 1. Client with lymphatic CA 2. Client with celiac disease 3. Client with multiple miscarriages 4. Client with grand multiparity

3. Client with multiple miscarriages

Which of the following findings should the nurse expect when assessing a client at 8 weeks gestation with gestational trophoblastic disease (hydatidiform mole) 1. Protracted pain 2. variable fetal heart decelerations 3. Dark brown vaginal bleeding 4. Suicidal ideations

3. Dark brown vaginal bleeding (DX when C/O dark brown vaginal discharge early in pregnancy)

The nurse assessed four primigravid clients in the prenatal clinic. Which of the women would the nurse refer to the nurse midwife for further assessment?

32 weeks gestation complains of epigastric pain and facial edema

A woman T 26 weeks gestation is dx with pre-eclampsia with severe features and HELP syndrome. The nurse will assess for which of the following signs/symptoms? 1. Low serum creatinine 2. High serum protein 3. Bloody stools 4. Epigastric pain

4 (HELP syndrome is one of the manifestations of pre-eclampsia when the liver is involved)

A client has pre-eclampsia with severe features. The nurse would expect the primary healthcare provider to order tests to assess the fetus for which of the following? 1. Severe anemia 2. Hypoprothrombinemia 3. Craniosynostosis 4. IUGR

4 (Perfusion to the placenta drops when clients are pre-eclamptic because of impaired blood flow. When the placenta is poorly perfused, the baby is poorly nourished and fetal growth is affected.)

The nurse is caring for a client who was just admitted to the hospital to rule out ectopic pregnancy. Which of the following orders is the most important for the nurse to perform? 1. Take client's temp 2. Document the time of client's last meal 3. Obtain urine for urinalysis 4. Assess for complaint of dizziness or weakness

4. These symptoms are seen in clients who develop hypovolemia from internal bleeding, internal bleeding will be present if the client's fallopian tubes are ruptured.

Nurses working in obstetrics clinics know that in general, teen pregnancies are high risk because of which of the following? 1. High probability of chromosomal abnormalities 2. High oral intake of manganese and zinc 3. High numbers of post-term deliveries 4. High incidence of late prenatal care

4. High incidence of late prenatal care (Teens are likely to delay entry into the healthcare system)

A client with insulin dependent diabetes will require higher doses of insulin as which of the following hormones increases in her body? 1. Estrogen 2. Progesterone 3. HCG 4. Human placental lactogen

4. Human placental lactogen

A pregnant woman with sickle cell anemia is admitted in vaco occlusive crisis. Which of the following is the priority intervention that the nurse must perform? 1. Administer narcotic analgesics 2. Apply heat to swollen joints 3. Place on strict bedrest 4. Infuse IV solution

4. Infuse IV solution Improves perfusion to the clients organ systems.

A woman 8 weeks pregnant is admitted to the obstetrical unit with a diagnosis of threatened abortion. Which of the following tests would help to determine whether the woman is carrying a viable or a nonviable pregnancy? 1. Luteinizing hormone 2. Endometrial biopsy 3. Hysterosalpingogram 4. Serum progesterone level

4. Serum progesterone level (Progesterone is PRO gestation and supports pregnancy, high levels indicate a viable embryo whereas a low level indicates a pregnancy loss)

It is discovered that a client at 24 weeks is leaking amniotic fluid. Before client is sent home on bedrest, what must the nurse teach her?

Abstain from engaging in intercourse for the rest of the pregnancy

Nonstress test (NST) reactive definition:

At least two fetal heart rate accelerations of 15 bpm lasting 15 or more seconds during a 20 min period

A client is admitted to the hospital with a dx of pre-eclampsia with severe features. The nurse is assessing for clonus. Which of the following actions should the nurse perform?

Dorsiflex the woman's foot (Test is done when the nurse dorsiflexes the foot and then releases the foot, more than 2 beats of clonus is abnormal)

A client with diabetes is to receive 5 units regular and 15 units NPH insulin at 0800, to administer the medication appropriately what is the best approach?

Draw 5 units regular first and 15 units NPH second into the same syringe and inject

A nurse is counseling a pre-eclampsia client about her diet. Which should the nurse encourage the woman to do?

Eat a well-balanced diet. (Clients should eat a well balanced diet with sufficient protein to replace the lost protein)

A client at 32 weeks gestation states she thinks she is leaking amniotic fluid. Which of the following tests could be performed to determine whether the membranes had ruptured?

Fern test

A pregnant woman has sickle cell anemia. Which of the following situations could precipitate a vaso-occlusive crisis in this woman?

Hypoxia

A pregnant client is being seen for diarrhea, fever, stiff neck, and headache. The nurse learns the woman drinks unpasteurized milk and eats soft cheese daily. For which of the following bacterial infections should this woman be assessed?

Listeria monocytogenes

A client is recovering at the GYN office following a late first trimester SA. At this time, it is essential for the nurse to check which of the following?

Maternal blood type (If client is RH- she must receive a dose of RHOgam within 72 hours of the miscarriage even if the fetal blood type is unknown.)

A lecithin/sphingomyelin (L/S) ratio has been ordered by a pregnant woman's obstetrician. Which of the following data will the nurse learn from this test?

Maturation of the fetal lungs (fetal lungs have reached maturation when the ratio of the substance is 2:1 or higher)

Ultrasound has found oligohydramnios. The nurse will expect to see that the baby has what? 1. Multicystic dysplastic kidneys 2. Coaraction of the aorta 3. Hydrocephalus 4. Hepatic cirrhosis

Multicystic dysplastic kidneys

A nurse works in a clinic with a high adolescent pregnancy population. The nurse provides teaching to the young women to prevent which of the following high risk complications of pregnancy?

Preterm birth (It's important the teens learn the telltale sign of PTL such as intermittent backache, cramping, and discomfort low in the pelvic area. Because of their lifestyle choices, pregnant teens are at high risk for low birth weight, and PTL)

A woman has been diagnosed with ruptured ectopic pregnancy. Which of the following signs/symptoms is a characteristic of this diagnosis?

Sharp unilateral pain

What does the lab value of L/S 1:1 ratio from an amniocentesis indicate?

The baby is premature

Caring for a client who HAS T1DM and wishes to become pregnant. Clients Hgb: 7% today fasting blood glucose result was 100 mg/dL (5.5 mmol/L) What can you interpret from the data?

The client has been hyperglycemic for the past 3 months and is within target levels today. (AIC less than 7% and pre-prandial blood sugar of 70-130 mg/dL or postprandial blood sugar of less than 180 mg/dL)

A client is being taught fetal kick counting. Which of the following should be included in the client teaching?

The client should lie on their side (Best position for perfusing the placenta)

A nurse is performing assessments on four clients at 22 weeks gestation. The nurse reports to the obstetrician that which of the clients may be carrying twins?

The client whose fundal height is measuring 26 cm (After 20 weeks gestation the nurse would expect the fundal height to be equal to the number of weeks of the woman's gestation, the fundal height is 4 cm above expected 22 cm)

Long term goal for a client with placenta previa?

The client will be symptom free until at least 37 weeks gestation

A woman is to receive Rho (D) immune globulin at 28 weeks gestation. Which of the following actions must the nurse perform before giving the injection?

Verify the identity of the woman

A client at 32 weeks gestation was last seen in the prenatal clinic 4 weeks ago, at 28 weeks gestation. Which of the following changes should the nurse bring to the attention of the certified nurse midwife?

Weight change from 128 - 138 pounds (10-pound weight gain is worrisome, during the second and third trimesters approx. 1 lb./week)