Ob 3

A client at 40 weeks' gestation is admitted to the birthing unit in early active labor. She tells the nurse that her membranes ruptured 26 hours ago. Assessments of the fetal heart rate range between 168 and 174 beats/min. What is the priority nursing action? 1 Obtaining maternal vital signs 2 Planning for an emergency birth 3 Administering oxygen by way of nasal cannula 4 Preparing for fetal scalp blood sampling

1 obtaining maternal vital signs

A pregnant client who has a history of cardiac disease asks how she can relieve her occasional heartburn. The nurse should instruct the client to avoid antacids containing: 1 Sodium 2 Calcium 3 Aluminum 4 Magnesium

1 sodium

A nurse is caring for a client who is receiving IV magnesium sulfate for preeclampsia. At 37 weeks' gestation she gives birth to an infant weighing 4 lb. What clinical finding in the newborn may indicate magnesium sulfate toxicity? 1 Pallor 2 Tremor 3 Hypotonia 4 Tachycardia

3 hypotonia

On her first visit to the prenatal clinic a client with rheumatic heart disease asks the nurse whether she has special nutritional needs. What supplements in addition to the regular pregnancy diet and prenatal vitamin and minerals will she need? (Select all that apply.) 1 Iron 2 Calcium 3 Folic acid 4 Vitamin C 5 Vitamin B12

1 iron, 3 folic acid

A client at 28 weeks' gestation with previously diagnosed mitral valve stenosis is being evaluated in the clinic. Which sign or symptom indicates that the client is experiencing cardiac difficulties? 1 Systolic murmur 2 Heart palpitations 3 Syncope on exertion 4 Displaced apical pulse

3 syncope on exertion

A nurse places fetal and uterine monitors on the abdomen of a client in labor. While observing the relationship between the fetal heart rate and uterine contractions, the nurse identifies four late decelerations. What condition is most frequently associated with late decelerations? 1 Head compression 2 Maternal hypothyroidism 3 Uteroplacental insufficiency 4 Umbilical cord compression

3 uteroplacental insufficiency

A client with severe preeclampsia is receiving an IV infusion of magnesium sulfate. The nurse remembers that magnesium sulfate is a: 1 Hypotensive that relaxes smooth muscles 2 Cholinergic that increases the release of acetylcholine 3 Muscle relaxant that decreases the severity of uterine contractions 4 Central nervous system depressant that blocks neuromuscular transmissions

4 central nervous system depressant that blocks neuromuscular transmissions

During a follow-up appointment, a client at 21 weeks' gestation is found to have hyperemesis gravidarum. The client says, "Why is this happening to me? I don't know whether I can continue like this." What is the best response by the nurse? 1 "Are you saying that you want to schedule an abortion?" 2 "This must be physically and emotionally challenging for you." 3 "We're doing the best we can here, so please be patient with us." 4 "There are dietary changes and medications available that can ease the nausea."

2 "this must be physically and emotionally challenging for you."

At 32 weeks' gestation a client undergoes ultrasound, which reveals a low-lying placenta. What complication should the nurse anticipate as the client's pregnancy approaches term? 1 Sharp abdominal pain 2 Painless vaginal bleeding 3 Increased lower back pain 4 Early rupture of membranes

2 painless vaginal bleeding

Women who become pregnant for the first time at a later reproductive age (35 years or older) are at risk for what complications? (Select all that apply.) 1 Seizures 2 Preterm labor 3 Multiple gestation 4 Chromosomal anomalies 5 Bleeding in the first trimester

2 preterm labor, 3 multiple gestation, 4 chromosomal anomalies, 5 bleeding in the first trimester

A breastfeeding mother experiences redness and pain in the left breast, a temperature of 100.8° F (38.2° C), chills, and malaise. What condition does the nurse suspect? 1 Mastitis 2 Engorgement 3 Blocked milk duct 4 Inadequate milk production

1 Mastitis

Which pregnant client does the nurse suspect is most likely to have placenta previa? 1 19 years old, gravida 1, para 0 2 30 years old, gravida 6, para 5 3 25 years old, gravida 2, para 1 4 40 years old, gravida 3, para 2

2 30 years old, gravida 6, para 5

A client with worsening preeclampsia is admitted to the high-risk unit, and the nurse manager places her in a private room. A nonstimulating environment is important for a client with increased cerebral irritability because it: 1 Limits intracellular fluid reabsorption 2 Reduces the severity of frontal headaches 3 Decreases the probability of generalized seizures 4 Prolongs the duration of action of hypotensive medications

3 decreases the probability of generalized seizures

A client is found to have gestational hypertension in the 22nd week of gestation. What is a major complication of hypertensive disease associated with pregnancy that the nurse should anticipate? 1 Placenta previa 2 Polyhydramnios 3 Isoimmunization 4 Abruptio placentae

4 abruptio placentae

A client who is at risk for seizures as a result of severe preeclampsia is receiving an IV infusion of magnesium sulfate. What findings cause the nurse to determine that the client is showing signs of magnesium sulfate toxicity? (Select all that apply.) 1 Proteinuria 2 Epigastric pain 3 Respirations of 10/min 4 Loss of patellar reflexes 5 Urine output of 40 mL/hr

3 respirations of 10/min, 4 loss of patellar reflexes

A pregnant client with a history of preterm labor is at home on bedrest. What instructions should a teaching plan for this client include? 1 Place blocks under the foot of the bed. 2 Sit upright with several pillows behind the back. 3 Lie on the side with the head raised on a small pillow. 4 Assume the knee-chest position at regular intervals throughout the day.

3 lie on the side with the head raised on a small pillow

What clinical manifestation requires immediate intervention in a woman with a probable ruptured tubal pregnancy? 1 Abdominal distention 2 Intermittent abdominal contractions 3 Dull, continuous upper-quadrant abdominal pain 4 Sudden onset of knifelike pain in one of the lower quadrants

4 sudden onset of knifelike pain in one of the lower quadrants

What is the safest position for a woman in labor when the nurse notes a prolapsed cord? 1 Prone 2 Fowler 3 Lithotomy 4 Trendelenburg

4 trendelenburg

When reviewing the history of a client admitted in preterm labor during her 30th week of gestation, the nurse suspects a risk factor associated with this client's preterm labor. What is this risk factor? 1 Primigravida 2 Android-shaped pelvis 3 Anticonvulsant medication therapy 4 Multiple urinary tract infections

4 multiple urinary tract infections

A nurse is caring for a client with severe preeclampsia who is receiving magnesium sulfate. What side effects indicate that the serum magnesium level may be excessive? (Select all that apply.) 1 Absence of the knee-jerk reflex 2 Urine output of 100 mL/hr 3 Blood pressure of 140/90 mm Hg 4 Apical pulse of 80 beats/min 5 Respiratory rate of 11 breaths/min

1 absence of the knee jerk reflex, 5 respiratory rate of 11 breaths/min

A client with severe preeclampsia in the high-risk unit is receiving an infusion of magnesium sulfate. If eclampsia were to occur, what action would the nurse take first? 1 Prevent injury 2 Assess fetal heart tones 3 Maintain an open airway 4 Increase the infusion rate

1 prevent injury

A client in the birthing suite has spontaneous rupture of the membranes, after which a prolapsed cord is identified. The nurse calls for help and with a sterile gloved hand moves the fetal head off the cord. What should the nurse anticipate? 1 Cesarean birth 2 Prolonged labor 3 Rapidly induced labor 4 Vacuum extraction vaginal birth

1 cesarean birth

A woman is being seen in the prenatal clinic at 36 weeks' gestation. The nurse is reviewing signs and symptoms that should be reported to health care provider with the mother. Which signs and symptoms require further evaluation by the health care provider? (Select all that apply.) 1 Decreased urine output 2 Blurred vision with spots 3 Urinary frequency without dysuria 4 Heartburn after eating a fatty meal 5 Contractions that are regular and 5 minutes apart 6 Shortness of breath after climbing a flight of stairs

1 decreased urine output, 2 blurred vision with spots, 5 contractions that are regular and 5 minutes apart

On reporting to the labor and delivery area a primipara indicates to the nurse that her contractions are occurring every 5 minutes. Upon further inquiry the nurse learns that the client has not attended any childbirth classes, and a cervical assessment reveals that she is in labor. When is the best time for the nurse to include education on simple breathing and relaxation techniques? 1 During the latent phase of the first stage of labor 2 During the active phase of the first stage of labor 3 During the active phase of the second stage of labor 4 During the transition phase of the first stage of labor

1 during the latent phase of the first stage of labor

A client is admitted to the birthing suite with a blood pressure of 150/90 mm Hg, 3+ proteinuria, and edema of the hands and face. A diagnosis of severe preeclampsia is made. What other clinical findings support this diagnosis? (Select all that apply.) 1 Headache 2 Constipation 3 Abdominal pain 4 Vaginal bleeding 5 Visual disturbances

1 headache, 3 abdominal pain, 5 visual disturbances

A client in labor is admitted with a suspected breech presentation. For what occurrence should the nurse be prepared? 1 Uterine inertia 2 Prolapsed cord 3 Imminent birth 4 Precipitate labor

2 prolapsed cord

Laboratory studies reveal that a pregnant client's blood type is O and she is Rh-positive. Problems related to incompatibility may develop in her infant if the infant is: 1 Rh-negative 2 Type A or B 3 Born preterm 4 Type O and Rh-positive

2 type A or B

A nurse is admitting a pregnant client who has mitral valve stenosis to the high-risk unit. What prophylactic medication does the nurse anticipate administering during the intrapartum period? 1 Diuretic 2 Antibiotic 3 Cardiotonic 4 Anticoagulant

2 antibiotic

A client at 9 weeks' gestation asks the nurse in the prenatal clinic whether she may have chorionic villi sampling (CVS) performed during this visit. What should the nurse keep in mind as the optimal time for CVS while formulating a response? 1 At 8 weeks but no later than 10 weeks 2 At 10 weeks but no later than 12 weeks 3 At 12 weeks but no later than 14 weeks 4 At 14 weeks but no later than 16 weeks

2 at 10 weeks but no later than 12 weeks

A client is being prepared for an emergency cesarean birth because of fetal compromise. What is the most important preoperative nursing action? 1 Preparing the abdomen 2 Confirming the signed consent 3 Inserting an indwelling catheter 4 Administering an antiemetic

2 confirming signed consent

A 16-year-old primigravida who appears to be at or close to term arrives at the emergency department stating that she is in labor and complaining of pain continuing between contractions. The nurse palpates the abdomen, which is firm and shows no sign of relaxation. What problem does the nurse conclude that the client is experiencing? 1 Placenta previa 2 Precipitous birth 3 Abruptio placentae 4 Breech presentation

3 abruptio placentae

A client who is in the first trimester is being discharged after a week of hospitalization for hyperemesis gravidarum. She is to be maintained at home with rehydration infusion therapy. What is the priority nursing activity for the home health nurse? 1 Determining fetal well-being 2 Monitoring for signs of infection 3 Monitoring the client for signs of electrolyte imbalances 4 Teaching about changes in nutritional needs during pregnancy

3 monitoring the client for signs of electrolyte imbalances

A nurse is caring for a client with type 1 diabetes on her first postpartum day. When planning care for this client, what changes in the client's insulin requirements does the nurse expect? 1 Slowly decrease 2 Quickly increase 3 Suddenly decrease 4 Usually remain unchanged

3 suddenly decrease

What should the nurse explain to a newly pregnant client with cardiac disease? 1 Palpitations are expected as pregnancy progresses. 2 Other cardiac medications will be substituted for digoxin. 3 It is not safe to administer prophylactic penicillin during pregnancy. 4 Maintenance dosages of cardiac medications will probably be increased.

4 maintenance dosages of cardiac medications will probably be increased.

A practitioner prescribes penicillin G benzathine suspension (Bicillin L-A) 2.45 million units for a client with a sexually transmitted infection (STI). The medication is available in a multidose vial of 10 mL in which 1 mL = 300,000 units. How many milliliters should the nurse administer? Record your answer using one decimal place. ____ mL.

8.2 mL

A nurse concludes that a positive contraction stress test (CST) result may be indicative of potential fetal compromise. A CST result is considered positive when during contractions the fetal heart rate shows: 1 Late decelerations 2 Early accelerations 3 Variable decelerations 4 Prolonged accelerations

1 late decelerations

A primigravida is admitted to the emergency department with a sharp, shooting pain in the lower abdomen and vaginal spotting. A ruptured tubal pregnancy is diagnosed. During what week of gestation does this condition most commonly occur? 1 6th 2 12th 3 16th 4 18th

1 6th

When working with a client who has spontaneously aborted a pregnancy, it is important for the nurse to first deal with his or her own feelings about abortion, death, and loss so that he or she may : 1 Maintain control of the situation 2 Share personal grief with the clients 3 Allow the clients to express their grief 4 Teach the clients how to cope effectively

3 allow the clients to express their grief

What are the primary nursing interventions when a client is receiving an infusion of magnesium sulfate for severe preeclampsia? (Select all that apply.) 1 Restricting visitors 2 Limiting fluid intake 3 Preparing for a precipitate birth 4 Maintaining a quiet environment 5 Keeping magnesium gluconate at the bedside

1 restricting visitors, 4 maintaining a quiet environment

A nurse on the postpartum unit is assessing several clients. Which clinical finding requires immediate investigation? 1 An inflamed episiotomy 2 A slow trickle of blood from the vagina 3 An estimated blood loss of half a liter during a vaginal birth 4 A boggy uterine fundus that becomes firm after prolonged massage

2 a slow trickle of blood from the vagina

Which information is most important for a large-for-gestational-age (LGA) infant of a diabetic mother (IDM)? 1 Temperature less than 98° F (36.6° C) 2 Heart rate of 110 beats/min 3 Blood glucose level less than 40 mg/dL 4 Increasing bilirubin during the first 24 hours

3 blood glucose level less than 40 mg/dL

A client is admitted with a marginal placenta previa. What should the nurse have available? 1 One unit of freeze-dried plasma 2 Vitamin K for intramuscular injection 3 Two units of typed and screened blood 4 Heparin sodium for intravenous injection

3 Two units of typed and screened blood

A client who is in labor is admitted 30 hours after her membranes ruptured. For what condition does the nurse anticipate that the client is most at risk? 1 Cord prolapse 2 Placenta previa 3 Chorioamnionitis 4 Abruptio placentae

3 chorioamnionitis

A primigravida is admitted with a ruptured fallopian tube resulting from a tubal pregnancy and surgery is performed to remove the fallopian tube. What should postoperative nursing care include? 1 Counseling on how to prevent another tubal pregnancy 2 Administering Rho (D) immune globulin to prevent isoimmunization 3 Explaining that the client may still be capable of becoming pregnant 4 Telling the client to avoid douching after intercourse because this may dislodge a fertilized egg

3 explaining that the client may still be capable of becoming pregnant

A neighbor who is a nurse is called on to assist with an emergency home birth. What should the nurse do to help expel the placenta? 1 Put pressure on the fundus 2 Ask the mother to bear down 3 Have the mother breastfeed the newborn 4 Place gentle continuous tension on the cord

3 have the mother breastfeed the newborn

A client at 36 hours' postpartum is being treated with subcutaneous enoxaparin (Lovenox) for deep vein thrombosis of the left calf. Which client adaptation is of most concern to the nurse who is monitoring the client? 1 Dyspnea 2 Pulse rate of 62 breaths/min 3 Blood pressure of 136/88 mm Hg 4 Homan sign in the left leg

1 dyspnea

A client with preeclampsia is admitted to the labor and birthing suite. Her blood pressure is 130/90 and she has 2+ protein in her urine and edema of the hands and face. Which signs or symptoms are suggestive that HELLP syndrome is developing? (Select all that apply.) 1 Headache 2 Constipation 3 Abdominal pain 4 Vaginal bleeding 5 Flulike symptoms

1 headaches, 3 abdominal pain, 5 flulike symptoms

A nurse is caring for a pregnant client with thrombophlebitis. Which anticoagulant medication may be prescribed? (Select all that apply.) 1 Heparin (Hep-Lock) 2 Clopidogrel (Plavix) 3 Warfarin (Coumadin) 4 Enoxaparin (Lovenox) 5 Acetylsalicylic acid (Acuprin)

1 heparin (hep-lock), 4 enoxaparin (lovenox)

Which adaptation does the nurse suspect is the result of early decompensation in a pregnant woman with cardiac problems? 1 Hemoptysis 2 Tachycardia 3 Increasing fatigue 4 Generalized edema

3 increasing fatigue

A health care provider prescribes carboprost (Hemabate) to be administered to a postpartum client with intractable vaginal bleeding. What client factor should alert the nurse to question the prescription? 1 History of asthma 2 Homan sign 3 Increased blood pressure 4 Absence of the Babinski reflex

1 history of asthma

A 26-year-old primigravida experiencing severe abdominal pain is brought to the emergency department by ambulance with a suspected ruptured tubal pregnancy. What should the nurse do first? 1 Insert an intravenous catheter 2 Ask the client to sign a surgical consent form 3 Determine whether a family member is present 4 Ascertain the first day of the client's last menstrual period

1 insert an intravenous catheter

At 37 weeks' gestation a client's membranes spontaneously rupture but she does not have contractions. What action is most important in the nursing plan of care for this client? 1 Monitoring for the presence of fever 2 Monitoring for signs of preeclampsia 3 Monitoring for heavy vaginal bleeding 4 Making preparations for fetal scalp pH sampling

1 monitoring for the presence of fever

A client at 39 weeks' gestation is admitted for induction of labor. Knowing that several medications are used to induce labor, a nurse identifies those that may be prescribed. (Select all that apply.) 1 Oxytocin (Pitocin) 2 Misoprostol (Cytotec) 3 Ergonovine (Ergotrate) 4 Carboprost (Hemabate) 5 Dinoprostone (Prepidil)

1 oxytocin (pitocin), 2 misoprostol (cytotec), 5 dinoprostone (prepidil)

Sonography of a primigravida who is at 15 weeks' gestation reveals a twin pregnancy. The nurse reviews with the client the risks of a multiple pregnancy that were explained by the health care provider. Which condition does the client identify that indicates the need for further instruction about complications associated with a multiple gestation? 1 Preterm birth 2 Down syndrome 3 Twin-to-twin transfusion 4 Gestational hypertension

2 Down syndrome

While reviewing laboratory results of clients seen at a maternity clinic, the nurse notes that one client's maternal serum α-fetoprotein level is lower than is typical. The nurse recognizes that this may be associated with: 1 Fetal demise 2 Down syndrome 3 Neural tube defects 4 Esophageal obstruction

2 Down syndrome

In what disorder is stimulation of labor contraindicated? 1 Diabetes mellitus 2 Mild preeclampsia 3 Total placenta previa 4 Premature rupture of the membranes

3 total placenta previa

A client at 39 weeks' gestation arrives in the birthing suite reporting that she is having regular contractions. A vaginal examination reveals that the presentation is a double-footling breech. The practitioner decides to proceed to a cesarean birth under regional anesthesia. What is an important intervention to help prevent postoperative maternal complications? 1 Providing scrupulous skin care 2 Maintaining adequate hydration 3 Monitoring the vital signs frequently 4 Teaching how to use an incentive spirometer

2 maintaining adequate hydration

A client at 6 weeks' gestation who has type 1 diabetes is attending the prenatal clinic for the first time. The nurse explains that during the first trimester insulin requirements may decrease because: 1 Body metabolism is sluggish in the first trimester. 2 Morning sickness may lead to decreased food intake. 3 Fetal requirements of glucose in this period are minimal. 4 Hormones of pregnancy increase the body's need for insulin.

2 morning sickness may lead to decrease food intake

After an incomplete abortion, a client tells a nurse that although her health care provider explained what an incomplete abortion was, she did not understand. What is the best response by the nurse? 1 "I don't think you should focus on this anymore." 2 "It's when the fetus dies but is retained in the uterus for at least 2 months." 3 "It's when the fetus is expelled but other parts of the pregnancy remain in the uterus." 4 "I think it's best for you to ask your health care provider for the answer to that question."

3 "it's when the fetus is expelled but other parts of the pregnancy remain in the uterus."

The family of a pregnant client with myasthenia gravis asks the nurse whether the client will be an invalid. What is the best response by the nurse? 1 "Medications will mask the signs of the disease." 2 "With continuous treatment, the progression of the disease can usually be controlled." 3 "The progression is slow, so people with myasthenia will spend their younger life with few problems." 4 "There will be periods when bedrest will be necessary and times when regular activity will be possible."

3 "the progression is slow, so people with myasthenia will spend their younger life with few problems."

A primigravida with type 1 diabetes is having her first prenatal visit. While discussing changes in insulin needs during pregnancy and after birth, the nurse explains that in light of the client's blood glucose readings she should expect to increase her insulin dosage. Between which weeks of gestation is this expected to occur? 1 10th and 12th weeks of gestation 2 18th and 22nd weeks of gestation 3 24th and 28th weeks of gestation 4 36th and 40th weeks of gestation

3 24th and 28th weeks of gestation

A nurse is caring for several pregnant clients in the prenatal clinic. Which client causes the most concern because of her predisposition to placenta previa? 1 19 years old, gravida 1, para 0 2 25 years old, gravida 2, para 1 3 30 years old, gravida 6, para 5 4 40 years old, gravida 2, para 1

3 30 years old, gravida 6, para 5

A 24-year-old client who has had type 1 diabetes for 6 years is concerned about how her pregnancy will affect her diet and insulin needs. How should the nurse respond? 1 "Insulin needs will decrease; the excess glucose will be used for fetal growth." 2 "Diet and insulin needs won't change, and maternal and fetal needs will be met." 3 "Protein needs will increase and adjustments to insulin dosage will be necessary." 4 "Insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring."

4 "insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring."

What should be included in the plan of care for a client with class I cardiac disease during the last weeks of pregnancy? 1 Administering penicillin, promoting periods of rest, and daily testing of urine for protein 2 Maintaining bedrest, administering oxygen and penicillin, and monitoring for cardiac decompensation 3 Instituting seizure precautions and instructing the client to report dyspnea, coughing, palpitations, and increased fatigue 4 Advising the client to limit stress, promoting rest after meals, and educating the client about the analgesia and anesthesia used during labor

4 advising the client to limit stress, promoting rest after meals, and educating the client about the analgesia and anesthesia used during labor

A nurse is caring for a postpartum client who had abruptio placentae. Which finding indicates that disseminated intravascular coagulation (DIC) is occurring? 1 Boggy uterus 2 Hypovolemic shock 3 Multiple vaginal clots 4 Bleeding at the venipuncture site

4 bleeding at the venipuncture site

What is a nurse's most important concern when caring for a client with a ruptured tubal pregnancy? 1 Infection 2 Hypervolemia 3 Protein deficiency 4 Diminished cardiac output

4 diminished cardiac output

At 30 weeks' gestation a client with class II cardiac disease expresses concern about her labor and asks the nurse what to expect. What does the nurse tell the client to expect if cardiac decompensation occurs? 1 Elective cesarean birth 2 Artificial rupture of the membranes 3 Induction of labor with an oxytocin infusion 4 Epidural anesthesia with a vacuum extraction birth

4 epidural anesthesia with a vacuum extraction birth

A pregnant client with cardiac disease asks a nurse to clarify what she was told about making the birth easier for her. What should the nurse remind her is an option to facilitate birth? 1 Inducing labor with Pitocin 2 Scheduling a cesarean birth 3 Monitoring an unassisted vaginal birth 4 Facilitating the birth with vacuum extraction

4 facilitating the birth with vacuum extraction

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-pound baby 4 Gravida I who has had an intrauterine fetal death

4 gravida I who has had an intrauterine fetal death

A woman with an active lifestyle is in her 30th week of pregnancy. Which activity will the nurse discourage? 1 Yoga 2 Swimming 3 Bicycling 4 Leg lifts and sit-ups

4 leg lifts and sit ups

A nurse is counseling a pregnant woman with type 1 diabetes. What is the most important nursing consideration in the planning of care for this client? 1 Higher risk for fetal mortality 2 Possible need for cesarean birth 3 Expectation of lowered insulin needs 4 Requirement of intensive prenatal care

4 requirement of intensive prenatal care

A client has a diagnosis of an unruptured tubal pregnancy. Which findings correlate with this diagnosis? (Select all that apply.) 1 Rigid abdomen 2 Referred shoulder pain 3 Unilateral abdominal pain 4 History of a sexually transmitted infection 5 Ecchymotic blueness around the umbilicus

3 unilateral abdominal pain, 4 history of a sexually transmitted infection