OB Exam 1 Practice Questions

Liz Calhorn is scheduled to have an amniocentesis to test for fetal maturity. To help make sure the procedure is successful, what instruction would be best to give her before this procedure?

A. If the client is having the amniocentesis after week 20 of pregnancy, the nurse should ensure the client voids prior to the amniocentesis to prevent puncturing the bladder.

Blood volume normally increases during pregnancy. The extent of this increase is what percentage of prepregnancy volume?

C. 30% to 50% Rationale: To supply adequate blood for fetal circulation, blood volume increases 30% to 50%.

A woman during her first trimester questions how much longer she will have urinary frequency. Which should the nurse advise her regarding urinary frequency?

A. It is a common complaint during the first trimester and again later in the third trimester. Rationale: The weight of the growing uterus causes urinary frequency during the first trimester. After lightning occurs in the last trimester, urinary frequency reoccurs.

which statement by Lauren would make the nurse believe she's having a typical reaction to her second pregnancy?

A. The nurse is aware that women in the study reacted both positively and negatively at the thought of a second pregnancy. Lauren's paradoxical response represents this.

Mrs. Smith asks the nurse to compute her expected due date. Based on the fact that her last menstrual flow began on July 20, which due date would the nurse estimate?

A April 27 Rationale: Naegele's rule is to count backward 3 months and add 7 days from the first day of the last menstrual period to determine an expected due date.

Multigravida

A woman who has been pregnant previously

Grand multipara

A woman who has carried five or more pregnancies to viability

Multipara

A woman who has carried two or more pregnancies to viability

Primipara

A woman who has given birth to one child past age of viability

Nulligravida

A woman who has never been and is not currently pregnant

Gravida

A woman who is or has been pregnant

Primigravida

A woman who is pregnant for the first time

Which of the following nursing interventions is appropriate when preparing a woman for an amniocentesis?

B. Be certain she knows that there is a slight risk of complication, such as premature labor, from amniocentesis. Rationale: Amniocentesis carries a slight risk of beginning labor. The woman should not hold her breath because that depresses the diaphragm, shifts the contour of the uterus, and may shift the location of the placenta to the chosen needle insertion site. The bladder should be emptied to avoid accidental puncture.

As a pregnant woman lies on the examining table, she grows very short of breath and dizzy. The nurse recognizes which as the probable cause?

C. Blood is trapped in the vena cava in a supine position. Rationale: Supine hypotension syndrome, or an interference with blood return to the heart, occurs when the weight of the fetus rests on the vena cava.

if Sandra asks the nurse if she should choose a nurse-midwife as her primary care provider, how would the nurse best answer her question?

C. The nurse should explain that the odds of experiencing a medication-free birth are far higher when a nurse-midwife leads care. It is inaccurate to characterize nurse-midwives as always being more "patient-friendly," and it is not appropriate to wholly defer teaching or advice when the patient initiates.

The nurse is reviewing danger signs of pregnancy with Sandra. In the interests of safety, which of the following would the nurse tell her to report if it should occur?

C. The nurse should have Sandra report a weight gain more than 3 lb a week during the second trimester as this would be a potential sign of gestational hypertension. The other listed changes do not constitute safety risks.

Liz Calhorn is scheduled to have an ultrasound examination and the nurse wants to ensure that she understands and is prepared for this procedure to mitigate her anxiety. What instruction would the nurse give her before her examination?

C. The nurse should teach that a full bladder improves the accuracy of the scan. There is no pain involved.

The term "reproductive life planning" best refers to the counseling of?

Couples with concerns related to conceiving, genetic abnormalities, and child-spacing needs. Rationale: Reproductive life planning is pertinent to any woman and man of childbearing age who is in, or is planning to be in, a sexual relationship. It refers to planning for both having and not having children. Although reproductive life planning can encompass preventing pregnancies for genetic reasons, it is not limited to this purpose.

Lauren Maxwell's doctor told her she had a positive Chadwick's sign. When she asks the nurse what this means, the best answer would be which of the following?

D. The nurse should explain that Chadwick's sign is a color change in the vagina from pink to purple because of increased formation of blood vessels and blood flow.

Dana is a typical 17-year-old adolescent, her likelihood of giving birth in 2012 is mostly related to which of the following factors?

Having access to multiple methods, reliable methods, and highly effective methods of birth control caused a 36% decrease in the pregnancy rate among adolescents from 2007 to 2012. Teens were not likely to decrease sexual activity or more likely to use abortion. Although community influence may play a role in the rates of adolescent pregnancy, that was not measured in this study.

A male patient is interested in learning more about having vasectomy. Which of the following would you include in your teaching?

He will need to continue to use contraception until at least 10 weeks after the procedure. Rationale: Vasectomy does not stop sperm production nor does it affect ejaculation. Usually, there is no swelling of the scrotum, even immediately after the procedure, although occasionally a hematoma may form. Because residual sperm may be present in the vas deferens, birth control should be used until the sperm count is negative.

When a woman uses a vaginal spermicide, which of the following actions should she be performing?

Insert the product by applicator no more than 1 hour prior to coitus. Rationale: Vaginal spermicides are most effective when placed far back in the vagina where seminal fluid and sperm tend to collect; because spermicides have a short half-life at body temperature, they should not be placed more than 1 hour before sexual relations. Feminine hygiene products are not effective substitutes for spermicides.

Suppose Dana, 17 years old, chooses intramuscular injections of DMPA as her method of reproductive life planning. What instructions would the nurse want members of the care team to give her with regard to this method?

Intramuscular injections (DMPA) are associated with osteoporosis, so recommending a high calcium intake is important.

During a prephysical interview, a patient reports that she and her husband are using the "rhythm method" of contraception. This method of family planning requires?

Requires abstinence from sexual intercourse 3 to 4 days before ovulation and 3 to 4 days after ovulation Rationale: Abstinence during that time period provides some degree of protection during the most fertile days of the cycle. Adding additional ways of determining when ovulation occurs, such as monitoring cervical mucus or basal temperature, would increase the accuracy of predicting ovulation.

Para

The number of pregnancies that have reached viability, regardless of whether the infants were born alive

Suppose Dana, 17 years old, chooses to use a COC as her family planning method. What is a danger sign of COCs the nurse would ask her to report?

The nurse should have Dana report severe migraine headaches because they are a contraindication to COCs.

Suppose Dana, 17 years old, tells the nurse she wants to use a fertility awareness method of contraception. How should the nurse best meet Dana's learning needs?

The nurse should teach Dana that cervical mucus is thin and watery at ovulation. Subjective sensations of warmth, breast tenderness, and emotional lability are not safe and reliable indicators.

Dana, 17 years old, e-mails the nurse to ask how a tubal ligation prevents pregnancy. To be certain she's fully informed, which would be the nurse's best answer?

The nurse should teach Dana that tubal ligation is a minor surgical procedure in which the fallopian tubes are occluded by cautery, crushed, clamped, or blocked, thereby preventing passage of both sperm and ova.

Dana, 17 years old, wants to try female condoms as her reproductive planning method. If the nurse was creating a relevant educational handout, it should include which of the following directives?

The nursing care plan for Dana should include teaching her that female condoms should be inserted before any sexual contact, they should not be reused, and they already contain a spermicide.

Which of the following tasks is the most important task of the first trimester of pregnancy?

A. Accepting the pregnancy Rationale: Before a fetus moves, adjusting to pregnancy is a primary task; later, adjusting to having a baby becomes the primary task.

Liz Calhorn asks the nurse why her nurse midwife is concerned whether her fetus's lungs are producing surfactant. The nurse's best answer would be:

A. The nurse should explain that surfactant, a phospholipid substance, is formed and excreted by the alveolar cells of the lungs beginning at approximately the 24th week of pregnancy. This decreases alveolar surface tension on expiration, preventing alveolar collapse and improving the infant's ability to maintain respirations in the outside environment at birth.

Lauren Maxwell overheard her doctor say insulin is not as effective during pregnancy as usual. How would the nurse explain how decreased insulin effectiveness safeguards the health of her fetus?

A. The nurse should state that with insulin becoming ineffective, glucose levels rise, serving to safeguard the fetus from hypoglycemia. Maternal insulin does not cross the placenta.

Which statement by Liz Calhorn would make the nurse most worried she might have difficulty quitting smoking during the remainder of her pregnancy?

A. The study reveals alcohol consumption, low socioeconomic status, and depression contribute to smoking. The nurse should counsel the client regarding the effects of smoking and alcohol on the fetus.

A woman's diagonal conjugate measurement is 10.5 cm. You would interpret that her pelvis is which of the following?

B. Narrow anterior-posterior Rationale: A typical diagonal conjugate measurement is 12.5 cm.

Lauren wasn't totally happy about learning that she was pregnant. What psychological task is important for the woman to complete during the first trimester of her pregnancy?

B. The nurse counsels Lauren that ensuring safe passage for the fetus consists of accepting the pregnancy (first trimester), accepting the coming baby (second trimester), and preparing for parenthood (third trimester).

The nurse is reviewing Sandra's electronic health record. While doing so, the nurse asks Sandra to clarify and confirm her surgical history. Why is it important to ask Sandra about past surgery during a pregnancy health history?

B. The nurse should ask Sandra about past surgery because surgery such as for appendicitis can leave adhesions, which then might interfere with uterine growth. Risks of uterine rupture and preterm labor are not higher in women with a surgical history.

Liz Calhorn tells the nurse she is worried her baby will be born with a congenital heart disease. What assessment of the umbilical cord at birth would be most important to help detect congenital heart defects?

B. The nurse's assessment findings of a normal umbilical cord would be one vein and two arteries. Other patterns are associated with cardiac or chromosomal disorders.

Which of the following suggestions would be the best technique to help a patient relax during a pelvic examination?

C. "Count backward from 20 at a steady pace." Rationale: Tensing abdominal muscles can make a pelvic exam painful. Suggesting a method to aid relaxation can reduce discomfort.

Sandra Czerinski feels healthy, so she asks the nurse why she needs to bother coming for prenatal care. What benefit should the nurse cite when responding to Sandra's statement?

C. The nurse should state that prenatal care is a prime time for health education; during this time, nurses play an important role in effective prenatal care. Ultimately, this promotes safe pregnancy, labor, and delivery. This is more important than collecting statistical data or promoting social interaction. Allergies are not correlated with preterm labor. Despite the patient's wishes, regular prenatal care should be strongly encouraged.

Lauren Maxwell is aware she's been showing some narcissism since becoming pregnant. How would the nurse describe this phenomenon to an unlicensed care provider?

C. The nurse would tell the unlicensed care provider that narcissism refers to interest in yourself in contrast to interest in others.

A fetus is able to maintain blood circulation in utero by the presence of circulatory shunts. The nurse understands this is because the ductus arteriosus in utero shunts blood in which direction?

D. Pulmonary artery to the aorta Rationale: Because the fetal lungs are not inflated, blood must be diverted past them. The ductus arteriosus helps to do this by shunting blood from the pulmonary artery to the aorta.

Sandra has not had a pelvic examination since she was in high school. Consequently, the nurse-midwife has asked the nurse to help make her more at ease during her first prenatal pelvic examination. What action should the nurse take?

D. The nurse should know that relaxation is important to reduce pain with a pelvic examination and teach her to breathe slowly and evenly when being examined. Holding the breath or pushing down on the diaphragm does not relax abdominal muscles.

Liz Calhorn, 18 years of age, asks how much longer her nurse practitioner will refer to the baby inside her as an embryo. To ensure team members use terms consistently, the nurse would want them to know the conceptus is classified as an embryo at what time?

D. The nurse should state to team members that the baby is an embryo during the period between implantation and 5 to 8 weeks. After that, it is a fetus.

Sandra reports that the palms of her hands are always itchy, and the nurse notices scratches on them when you perform a physical examination. The nurse's plan of care should specify that this problem is most likely due to what factor in women who are pregnant?

D. The nurse should teach that palmar erythema commonly occurs from increasing estrogen levels. It is not a result of Rh incompatibility, edema, or anxiety.

Lauren Maxwell did a urine pregnancy test but was surprised to learn a positive result is not a sure sign of pregnancy. As the nurse is recording her result in the electronic health record, she asks what a positive sign would be. The nurse should cite what finding?

D. The nurse should teach that the three positive signs of pregnancy are fetal heartbeat heard by examiner or seen on sonogram and fetal movement felt by examiner.