OB Exam #1 Practice Questions
A client is admitted at 23 weeks' gestation with a large amount of vaginal bleeding. Upon assessment, the nurse notes petechiae on the arms, face, and legs. The nurse reviews the client's laboratory results. Which results are relevant for the nurse to provide to the health care provider? A:aPTT: 75 seconds B:Hematocrit: 30.2 mg/dL C: Platelets: 65,000 mm3 D:WBC: 11 mm3 E: D-dimer: positive
A:aPTT: 75 seconds B:Hematocrit: 30.2 mg/dL C: Platelets: 65,000 mm3 E: D-dimer: positive Rationale: Disseminated Intravascular Coagulation (DIC) is a complication that can occur after an acute bleeding episode where the clotting cascade has been triggered. With DIC, the client depletes all available clotting factors resulting in continued bleeding. Clients will experience bleeding of gums, bleeding at IV sites, and have generalized petechiae. Lab values which indicate DIC are an aPTT with a value longer than normal (30-40 seconds), and platelets below 75,000 mm3. A positive D-dimer test indicates fibrin activation from widespread thrombus formation and breakdown in the body. This test is often used to support a diagnosis of DIC.
A client who has not received prenatal care reports to the obstetrics unit in active labor. Upon assessment, the nurse notes a rash on the palms of the hands and the soles of the feet as well as lymphadectomy. The nurse reviews the prescriptions entered in the client's electronic health record. Which prescriptions require the nurse to contact the health care provider? A: Notify nursery of suspected maternal infection. B: Administer Kefzol 2 GM IVPB now. C: Initiate IV of D5LR at 125mL/hr. D: Place client on droplet precautions. E: Client may have epidural when desired.
B: Administer Kefzol 2 GM IVPB now. D: Place client on droplet precautions. Rationale: Syphilis is a sexually transmitted infection caused by Treponema pallidum. Infection during pregnancy can result in stillbirth, prematuriy, and congenital syphilis. It can be transmitted through kissing, biting, or oral-genital sex. Transplacental transmission may occur with an infection during pregnancy. Primary syphilis presents with a single sore called a chancre. If it is not treated, secondary syphilis can develop where the client has a rash and lympadenopathy. When detected early, the client can be treated prior to development into secondary or tertiary disease. All women are screened for syphilis at the first prenatal visit. With positive diagnosis, women are treated wth Penicillin G by intravenous route, the preferred drug. Followup testing is required after treatment to determine eradication. If a client presents with secondary syphilis, there is a higher chance it has been transmitted to the fetus and the nursery staff need to be prepared to treat the newborn. The client with syphilis is placed on standard blood and body fluid precautions.
A client who is pregnant for the first time is prescribed additional iron supplementation due to anemia. Which information does the nurse provide to help the client understand why anemia is more common in pregnancy? A:"Your body stops making red blood cells during pregnancy." B:"Your blood volume has increased but red blood cells have not." C: "You are not eating enough to keep your iron levels high." D:"Your body is giving more of your red blood cells to your baby."
B:"Your blood volume has increased but red blood cells have not." Rationale: To provide an adequate exchange of nutrients in the placenta and to compensate for blood loss at birth, the circulatory blood volume of the woman's body increases at least 30% during pregnancy. Although red cell mass also increases, plasma volume increases more, causing hemodilution and a lower hemoglobin and hematocrit. The increase in blood volume occurs gradually near the end of the first trimester. It peaks at about the 28th to the 32nd week and continues at this high level through the third trimester. Iron absorption may be impaired during pregnancy as a result of decreased gastric acidity, and additional iron is often prescribed during pregnancy to prevent true anemia, but physiologic anemia is seen in most women simply due to hemodilution.
A nurse is teaching a group of women about the side effects of different types of contraceptives. What common side effect associated with the use of an intrauterine device (IUD) should the nurse discuss during the teaching session? A: Tubal pregnancy B: Rupture of the uterus C: Expulsion of the device D: Excessive menstrual flow
D: Excessive menstrual Flow Rationale: After IUD insertion there may be excessive menstrual flow for several cycles. Because the IUD is a foreign body, there is an increase in the blood supply, a result of the inflammatory process. There is no documentation of an increased risk for tubal pregnancy. Rupture of the uterus may occur on insertion but is uncommon. Expulsion of the device may occur, but it is not classified as a side effect.
A client in her tenth week of pregnancy exhibits presumptive signs of pregnancy. Which clinical findings may the nurse determine upon assessment? Select all that apply. A: Amenorrhea B: Breast changes C: Urinary frequency D: Abdominal enlargement E: Positive urine pregnancy test
A: Amenorrhea B: Breast changes C: Urinary frequency Rationale: The key to answering this question is understanding the difference between presumptive versus probable signs of pregnancy. Presumptive signs of pregnancy are less specific subjective changes that are reported by the client during an assessment interview. Probable signs of pregnancy are more objective changes that can be measured in the reproductive organs during a physical assessment. The absence of menstruation (amenorrhea) is a presumptive sign of pregnancy that is recognized at 4-weeks' gestation. Breast changes, related to increased levels of estrogen and progesterone, are a presumptive sign of pregnancy that is recognized at 3- to 4-weeks' gestation. Urinary frequency, related to pressure of the enlarging uterus on the urinary bladder, is a presumptive sign of pregnancy that is recognized at 6- to 12-weeks' gestation. Abdominal enlargement related to the enlarging uterus is a probable sign of pregnancy that is recognized when the enlarging uterus rises out of the pelvis at 14- to 16-weeks' gestation. A positive urine pregnancy test result, indicating an increase in human chorionic gonadotropin (hCG), is a probable sign of pregnancy that can be detected 26 days after conception.
A nurse cares for a client diagnosed with preeclampsia. The nurse prepares to administer magnesium sulfate as prescribed. Which assessment data is important prior to initiation of the magnesium sulfate? A: REspiratory Rate B: deep tendon reflexes C: BP D: Bowel Function E: urinary output
A: REspiratory Rate B: deep tendon reflexes C: BP Rationale: Magnesium Sulfate is the gold standard treatment for prevention of seizures with a diagnosis of severe preeclampsia. It results in vasodilation in the peripheral and cerebral circulation, preventing cerebral edema which lead to development of seizures. This vasodilation also generally results in a decreased blood pressure for the client whose blood pressure readings may be > 160/100 mm Hg. Serum magnesium levels should be maintained at 4 to 8 mEq/L to prevent pre-eclamptic seizures. If the blood serum level rises above this, respiratory depression, hyporeflexia, cardiac arrhythmias, and cardiac arrest can occur. Baseline assessments should be conducted in order to monitor for development of these complications. Magnesium is excreted through the urine, so monitoring of urinary output is important to determine potential risk for development of magnesium toxicity.
The nurse is teaching a sex education course to high school students. What information should the nurse provide regarding the rationale for an increase in gonorrhea prevalence? Select all that apply. A: Symptoms of the disease are vague. B: Screening blood tests are expensive. C: The incubation period is relatively short. D: Causative organisms have become resistant to treatment. E: Diagnostic tests for the causative organism are not yet available
A: Symptoms of the disease are vague. C: The incubation period is relatively short. D: Causative organisms have become resistant to treatment. Rationale: Many clients with gonorrhea are asymptomatic. The incubation period is 3 to 5 days. There is no effective, readily available blood test for gonorrhea. Gonorrhea responds well to treatment, but the Centers for Disease Control and Prevention has received several reports of resistant strains. At times backup secondary medications must be used in order to treat the infection. Urethral/vaginal smears or cultures are specific for the identification of the gonococcal organism.
A nurse is teaching a prenatal class regarding the physiologic alterations that occur during the second trimester of pregnancy. What cardiovascular changes should the nurse include? Select all that apply. A: Cardiac output increases. B: Blood pressure decreases. C: The heart is displaced upward. D: The blood plasma volume peaks. E: The hematocrit level is lowered
A: cardiac output increases B: blood pressure decreases C: the heart is displaced upward Rationale: Cardiac output increases during the second trimester due to an increasing plasma volume. The blood pressure decreases because of the enlarged intravascular compartment and hormonal effects on peripheral resistance. As the fetus grows and the enlarging uterus outgrows the pelvic cavity, it displaces the heart upward and to the left. The blood volume starts to increase earlier, but does not peak until the third trimester. The reduction in hematocrit occurs in the first trimester; the erythrocyte increase may not be in direct proportion to the blood volume, lowering hematocrit and hemoglobin levels, which remain lower throughout pregnancy.
A nurse educates a client diagnosed with insulin dependent diabetes regarding insulin needs during pregnancy. Which information does the nurse provide to the client? A:Insulin needs will increase after the first trimester. B:Insulin needs will remain the same throughout the pregnancy. C: Insulin needs will decrease in the third trimester. D: Insulin will not be required for the duration of the pregnancy.
A:Insulin needs will increase after the first trimester. Rationale: Pregnancy complicated by diabetes, whether pre-existing or gestational is considered high risk. The goal for prevention of maternal and fetal complications is to maintain glucose control before and during pregnancy. During pregnancy, the metabolic rate and needs increase throughout the pregnancy and insulin needs will increase after the first trimester. It is not uncommon for insulin needs to double or triple by the end of the pregnancy. As the pregnancy progresses, insulin needs continue to increase with the added risk of hypoglycemia due to increasing fetal glucose demands. Close glucose monitoring is required.
