OB Comprehensive Review for the NCLEX-PN Exam, 6th Edition

A female who thinks she could be pregnant calls her neighbor, a practical nurse (PN), to ask when she should use a home pregnancy test to diagnose pregnancy. Which response is best?

a. "A home pregnancy test can be used right after your first missed period." Rationale: Home urine tests are based on the chemical detection of human chorionic gonadotrophin, which begins to increase 6 to 8 days after conception and is best detected at 2 weeks' gestation or immediately after the first missed period

The nurse is assisting with data collection for a 16-year-old client who is 12 weeks pregnant. Which client statement indicates instruction is necessary to ensure a safe pregnancy? (Select all that apply.) a. "I hate milk." b. "I only want to gain 10 pounds." c. "I will never have sex again." d. "My sister is pregnant too." e. "My mom smokes cigarettes when she was pregnant with me, so I can smoke too then."

a. "I hate milk." b. "I only want to gain 10 pounds." e. "My mom smokes cigarettes when she was pregnant with me, so I can smoke too then." Rationale: Pregnant adolescents need 1300 mg of calcium daily. Other sources of calcium will need to be taken if the client does not like milk. A weight gain of less than 20 pounds can lead to fetal complications. Cigarette smoking is associated with smaller birth weight babies. Not wanting to have sex again and having a pregnant sister may have a psychosocial impact but not a physical impact.

Twenty-four hours after a full-term newborn is admitted to the newborn nursery, the practical nurse (PN) observes a localized swelling on the right side of the head of the newborn that does not cross the suture line. How does the nurse document this finding?

a. A cephalohematoma Rationale: Cephalohematoma, a slight abnormal variation of the newborn, usually arises within the first 24 hours after delivery.

A client at 38 weeks' gestation calls the antepartal clinic stating she just experienced a small amount of bright red vaginal bleeding that has subsided. She denies uterine contractions or abdominal pain. What information should the practical nurse (PN) provide?

a. Come to the clinic today to see the provider. Rationale: The PN should instruct the client to come in to see the provider third-trimester painless bleeding is characteristic of a placenta previa. Bright red bleeding may be intermittent, occur in gushes, or be continuous.

Two hours following vaginal delivery in a birthing suite, the practical nurse (PN) observes that a newborn has respirations that are 58 breaths/min and cyanotic hands and feet. What action should the PN implement?

a. Continue to observe the infant. Rationale: A newborn infant's respirations should range between 40 and 60 breaths/min. Acrocyanosis (bluing of the hands and feet) is a normal occurrence at birth.

The nurse is assisting with data collection on a woman in her first trimester of pregnancy. Which findings should be reported to the health care provider immediately? (Select all that apply.) a. Cramping with bright red spotting b. Increased urination c. Lack of breast tenderness d. Increased amount of vaginal discharge e. Right-sided flank pain

a. Cramping with bright red spotting c. Lack of breast tenderness e. Right-sided flank pain Rationale: Cramping with bright red spotting and lack of breast tenderness could indicate that miscarriage is occurring. Option E could be an indication of an ectopic pregnancy, which could be fatal if not treated before rupture. Options B and D are common occurrences during the first trimester of pregnancy.

The nurse is preparing a 3-day-old, full-term newborn for discharge home. The baby's mother is HIV-positive. For which procedures should the practical nurse (PN) wear gloves? (Select all that apply.) a. Diaper changes b. Obtaining vital signs c. Formula feeding d. Newborn hearing screening e. Heel stick for metabolic screening f. Discharge bath

a. Diaper changes e. Heel stick for metabolic screening Rationale: The PN should wear gloves after diaper changes and only in those situations in which there is the potential for the presence of HIV-positive blood and body fluids.

The practical nurse (PN) is caring for a gravida 4, para 3, with a history of rheumatic heart disease, admitted to the antepartum unit in preterm labor at 32 weeks' gestation. Which assessment findings indicate the onset of cardiac failure requiring immediate intervention?

a. Edema, adventitious lung sounds, and tachycardia Rationale: Edema, adventitious lung sounds, and an irregular pulse indicate cardiac decompensation and require immediate intervention.

The nurse is taking the temperature of a client who is 6 hours postpartum. The nurse notes that the client's temperature is 38° C (100.4° F). Which intervention should the nurse implement?

a. Encourage fluids to increase hydration. Rationale: It is normal for the postpartum client to have a temperature up to 38° C (100.4° F) because of dehydration caused by labor. The most appropriate intervention is to encourage fluids to rehydrate the patient.

The practical nurse (PN) attempts to help a teenage client with her feelings following a spontaneous abortion at 8 weeks' gestation. What type of emotional response should the PN anticipate?

a. Grief related to her perceptions about the loss of this child. Rationale: A grief and loss response occurs at all stages of pregnancy loss.

The nurse is assisting with data collection on a client who is in her last trimester of pregnancy. Which findings should the nurse report urgently to the health care provider? (Select all that apply.) a. Increased heartburn that is not relieved with doses of antacids b. Increase of the fetal heart rate from 126 to 156 beats/min from the last visit c. Shoes and rings which are too tight because of peripheral edema in extremities d. Decrease in ability for the client to sleep for more than 2 hours at a time e. Headaches that have been lingering for a week behind the client's eyes

a. Increased heartburn that is not relieved with doses of antacids e. Headaches that have been lingering for a week behind the client's eyes Rationale: Intractable indigestion and lingering headaches are not unusual during pregnancy, but can be symptoms of preeclampsia and should be reported to the health care provider. The fetal heart rate normally ranges between 120 and 160. Peripheral edema and difficulty sleeping are common during pregnancy and do not warrant immediate notification of the health care provider.

A client who is 40 weeks into pregnancy is having a vaginal examination at the clinic when the nurse notes a sudden gush of yellowish, clear fluid from the vaginal area. What should be the nurse's first action?

a. Measure the fetal heart rate. Rationale: When the amniotic sac ruptures, there is a risk that the umbilical cord could prolapse, causing fetal bradycardia and decreased blood supply to the fetus. The nurse should measure the fetal heart rate immediately when the amniotic sac ruptures. If the cord has prolapsed, the fetus needs to be delivered immediately. It is important to note the color and odor of the fluid for signs of infection and to assess for uterine contractions; however, the priority is assessing for a prolapsed cord by assessing the fetal heart rate. Placing a dry pad under the client is not a priority action.

Twenty minutes after a continuous epidural anesthetic is administered, a laboring client's blood pressure drops from 120/80 to 90/60 mm Hg. Which actions should the practical nurse (PN) take immediately? (Select all that apply.) a. Notify the registered nurse (RN) or anesthesiologist. b. Continue to assess the blood pressure every 5 minutes. c. Place the client in a lateral position. d. Turn off the continuous epidural. e. Elevate the head of the bed.

a. Notify the registered nurse (RN) or anesthesiologist. b. Continue to assess the blood pressure every 5 minutes. c. Place the client in a lateral position. Rationale: The PN should immediately turn the client to a lateral position and place a pillow or wedge under one hip to tilt the uterus. Administer oxygen by face mask at 10 to 12 L/m and notify the RN and increase the rate of the main line IV infusion. If the blood pressure remains low or decreases further after these interventions, the anesthesiologist should be notified.

A client at term presents to the labor and delivery in spontaneous labor; contractions are occurring every 3 to 4 minutes and they are 60 seconds in durations. The client states to the nurse, "I think I am having a breakout of my genital herpes." What actions will the nurse take next? (Select all that apply.) a. Observe the client's perineum. b. Contact the health care provider. c. Ask the patient about her antiviral therapy. d. Open a vaginal delivery pack. e. Assess her partner's penis for lesions

a. Observe the client's perineum. b. Contact the health care provider. c. Ask the patient about her antiviral therapy. Rationale: The nurse needs to assess the client's perineum, and the health care provider will determine the status of the lesions. If active lesions are present, the recommendation is for a Cesarean section; therefore, opening a vaginal delivery pack may be unnecessary. It would not be appropriate for the nurse to assess the partner's penis.

A pregnant client is scheduled for an amniocentesis. The client asks the practical nurse (PN) what to expect during the procedure. How should the PN respond? (Select all that apply.) a. The nurse will be checking your vital signs every 15 minutes. b. You should expect to have a low-grade fever after the procedure. c. Amniocentesis is noninvasive, and it is used to look for fetal anomalies. d. You will be positioned on your back during the procedure and on your left side following the procedure. e. Uterine contractions or cramping following the procedure are not normal and should be reported to your health care provider.

a. The nurse will be checking your vital signs every 15 minutes. d. You will be positioned on your back during the procedure and on your left side following the procedure. e. Uterine contractions or cramping following the procedure are not normal and should be reported to your health care provider. Rationale: During the procedure and recovery, the client's vital signs should be monitored every 15 minutes. The client should expect to be positioned supine during the procedure and on the left side following the procedure. Uterine contractions or cramping may be a sign of premature labor and should be reported to the health care provider immediately.

During labor, a client is experiencing a fetal heart rate of 68, which lasts longer than 45 seconds. Which is the nurse's first action?

a. Turn the client to her left side. Rationale: The client should be turned to her left side immediately, as turning her may take the weight of the uterus and reduce the pressure the heavy uterus is placing on the client's blood vessels. Administering oral fluids may be contraindicated, because a Caesarian section may be required if the fetal bradycardia persists. The client's symptoms do not correlate with a blood sugar disorder. Assessing the client's vital signs and oxygen saturation is necessary, but it is not a priority action.

The practical nurse (PN) is assessing a client at 20 weeks' gestation. Which measurement should be compared with the client's current weight to obtain data about her weight gain during the entire pregnancy?

a. Usual pre-pregnancy weight Rationale: Comparing the client's current weight with her pre-pregnancy weight allows for a calculation of total weight gain.

The nurse is assisting with data collection for a newborn that is 1 hour old, with an estimated gestational age of 39 to 40 weeks. Which findings does the nurse expect to note? (Select all that apply.) a. Vernix in the creases of the neck b. Lanugo covering the entire back c. Creases over the anterior 1/3 of the foot d. Breast tissue less than 0.5 cm in both breasts e. The labia majora cover the labia minora

a. Vernix in the creases of the neck e. The labia majora cover the labia minora Rationale: Vernix in neck creases and the labia majora covering the labia minora are signs of a term infant. Lanugo covering the back, foot creases on the anterior third of the foot, and breast tissue less than 0.75 cm are assessment findings associated with preterm infants.

A new mother asks the practical nurse (PN), "How do I know that my daughter is getting enough breast milk?" Which explanation best supports that the mother has adequate milk supply?

b. "Your milk is sufficient if the baby is voiding pale, straw-colored urine 6 to 10 times a day." Rationale: The urine will be dilute (straw-colored) and frequent (greater than six to ten times/day) if the infant is adequately hydrated.

While reviewing a new postpartum client's plan of care, the practical nurse (PN) notes that the client has a fourth-degree laceration. Based on this, which interventions should the PN implement? (Select all that apply.) a. Apply ice to the perineum for the next 48 hours. b. Administer prescribed docusate sodium (Colace). c. Ambulate with assistance q4-6h prn. d. Medicate client for pain q4-6h prn. e. Demonstrate positions of comfort when sitting.

b. Administer prescribed docusate sodium (Colace). d. Medicate client for pain q4-6h prn. e. Demonstrate positions of comfort when sitting. Rationale: The PN should administer the prescribed stool softener because a fourth-degree laceration extends through the anal sphincter and anterior rectal wall, to prevent constipation or straining with stool from causing damage to the repaired tissue. Ice is recommended only for the first 24 hours; after that, heat should be used. A comfortable position and pain management are useful interventions for clients with fourth-degree lacerations.

The practical nurse (PN) caring for a laboring client encourages her to void at least every 2 hours and records each time the client empties her bladder. What is the rationale for implementing this nursing intervention?

b. An overdistended bladder could be traumatized during labor and could prolong the progress of labor. Rationale: A full bladder can impair the efficiency of the uterine contractions and impede descent of the fetus during labor. Also, because of the close proximity of the bladder to the uterus, the bladder can be traumatized by the descent of the fetus.

The practical nurse (PN) is caring for a client who has had a normal vaginal delivery. The first 4 hours after delivery, the nurse palpates the uterine fundus and bladder every hour. What is the primary reason for implementing this nursing intervention?

b. An overdistended bladder could inhibit uterine contraction and predispose to postpartum bleeding. Rationale: A distended, full bladder can impair the efficiency of uterine contraction, which will allow uterine sinuses to bleed and result in the fundus becoming displaced and boggy in consistency.

A client in active labor begins to experience cramps in her leg. What intervention should the practical nurse (PN) implement?

b. Extend the leg and dorsiflex the foot. Rationale: Dorsiflexing the foot by pushing the foot upward or by standing and putting the heel of the foot on the floor is the best means of relieving leg cramps, because it creates an opposing action to relax the gastrocnemius.

During a prenatal visit, the practical nurse (PN) discusses with a client the effects that smoking has on the fetus. The nurse realizes the teaching is effective if the client identifies which possible effect on the fetus?

b. Lower initial weight documented at birth. Rationale: Smoking is associated with low-birth-weight infants.

During a routine prenatal visit, a female at 38 weeks' gestation tells the practical nurse (PN) that both her cousin and her cousin's 1-year-old daughter have phenylketonuria (PKU). The client is concerned that her unborn child may also have PKU and become mentally retarded. Which information should the PN provide?

b. PKU screening is performed after the newborn ingests milk. Rationale: PKU is an inborn error of metabolism resulting in an elevated serum amino acid, phenylalanine, which causes mental retardation; therefore, it's important to PKU screening after the newborn has ingested breast milk or formula milk protein.

A mother who is positive for the HIV virus delivers a 7-pound boy. Which intervention should the practical nurse initiate to prevent transfer of the virus to the infant?

b. Prevent breastfeeding but encourage rooming-in. Rationale: Rooming-in should be allowed, but transmission of the mother's body fluids (breast milk) should be prevented. Standard precautions should be instituted.

Which maternal behavior is the practical nurse (PN) most likely to see when a new mother receives her infant for the first time?

b. She receives the infant and touches the infant's face with her fingertips. Rationale: Attachment/bonding theory indicates that most mothers will touch the infant's face during the first visit with the newborn.

The nurse is assisting with data collection for a client who is at 20 weeks' gestation. Which findings does the nurse expect to note? (Select all that apply.) a. The fundus is located under the xiphoid process. b. The mother's areolae have darkened. c. The mother has noted fetal movement. d. The fetal outline is palpable. e. Urinary frequency is common

b. The mother's areolae have darkened. c. The mother has noted fetal movement. Rationale: The mother's areolae have darkened and the mother has noted fetal movement by 20 weeks' gestation. The fundus is at the level of the umbilicus. The fetal outline is not palpable and urinary frequency does not occur until later in the pregnancy.

The nurse is reinforcing instructions regarding nutritional needs during pregnancy. Which client instructions should be included?

b. Your calories should increase by 300 calories/day. Rationale: Calorie intake is increased by 300 calories/day. Protein intake should increase by 30 g/day. The pregnant client should drink 8 to 10 glasses of fluid daily. Weight loss should not be undertaken during pregnancy.

The nurse has reinforced education for a client who is 11 weeks pregnant and has had no pregnancy complications. Which client comment indicates adequate understanding of the instructions?

c. "I can expect my nausea to be reduced in the next few weeks." Rationale: Pregnancy-related nausea usually resolves by the 13th week. If the client travels via airplane, the client should take additional fluids to prevent deep vein thrombosis. The healthy client can exercise as long as she is able to converse easily while exercising. No level of alcohol is considered safe while pregnant.

A client at 30 weeks' gestation is on bed rest at home because of increased blood pressure. The home health nurse has taught her how to take her own blood pressure (BP). When the client calls the clinic complaining of indigestion and headache, which information is best for the practical nurse (PN) to provide?

c. "Take your blood pressure, and if it has significantly increased, go to the hospital immediately." Rationale: Obtaining a BP reading is the best instruction. An elevated blood pressure (140/90 mm Hg, or an increase of 15 mm Hg diastolic and/or 30 mm Hg systolic) is a sign of gestational hypertension (GH); headache and epigastric pain can be the signs of an impending seizure (eclampsia).

Before discharge, what information should the practical nurse (PN) give to parents regarding the newborn's umbilical cord care at home?

c. Allow the cord to air dry as much as possible. Rationale: Recent studies indicate that air drying or plain water application may be equal to or more effective than alcohol in the cord-healing process.

Which over-the-counter medication should the practical nurse recommend that a breastfeeding mother avoid?

c. Aspirin Rationale: Breastfeeding mothers should avoid any products containing aspirin because of the possible association with Reye syndrome in the infant.

When should the practical nurse (PN) encourage a laboring client to begin pushing? (Select all that apply.) a. At complete cervical effacement b. When the client describes the need to have a bowel movement c. At complete cervical dilation d. Upon palpation of an anterior or posterior lip of the cervix e. At complete cervical effacement and dilation

c. At complete cervical dilation e. At complete cervical effacement and dilation Rationale: Pushing begins with the second stage of labor, when the cervix is completely dilated at 10 cm.

A newborn infant is breathing satisfactorily but appears dusky. What action should the practical nurse (PN) take first?

c. Check the infant's oxygen saturation rate. Rationale: The PN should first obtain measurable objective data; an oxygen saturation rate provides such information. The pediatrician should be notified if the oxygen saturation rate is below 90%.

A client at 30 weeks' gestation is complaining of pressure over the pubic area. At the client's admission to the antepartum unit for observation, vaginal examination shows that her cervix is closed, thick, and high. The fetal monitor reveals irregular contractions and underlying uterine irritability. Which intervention should the practical nurse (PN) implement first?

c. Collect a specimen for urine analysis. Rationale: Obtaining a urine analysis should be done first, because preterm clients with uterine irritability and contractions are often experiencing a urinary tract infection, and this should be ruled out first.

A client who is in labor with her 3rd child tells the nurse, "I have to push." The health care provider had performed a vaginal examination on the client an hour ago and determined the client was 5 cm dilated, 50% effaced. What should be the nurse's next action?

c. Contact the client's health care provider to assess the client's cervix. Rationale: The nurse's next action should be to contact the health care provider to assess the client's cervix. Clients who have had more than one delivery can progress through labor quickly. The client should not push when she has a contraction until her cervix has been assessed. The nurse should not inform the client she is not dilated enough until her cervix has been assessed. The client should not be left alone to relax, as delivery is likely imminent.

A new mother is having trouble breastfeeding her newborn son. He is making frantic rooting motions and will not grasp the nipple. Which intervention should the practical nurse (PN) implement?

c. Encourage the mother to stop feeding for a few minutes and comfort the infant. Rationale: The infant is becoming frustrated and so is the mother; both need a time-out. The mother should be encouraged to comfort the infant and to relax herself.

A new father asks the practical nurse (PN) why ointment is instilled into the eyes of his newborn infant. Which infection should the PN identify when describing the purpose of this treatment?

c. Gonorrhea Rationale: Erythromycin ointment is instilled into the lower conjunctiva of each eye within 2 hours after birth to prevent ophthalmia neonatorum, an infection caused by gonorrhea, and inclusion conjunctivitis, an infection caused by Chlamydia.

A 25-year-old client has a positive pregnancy test. One year earlier she had a spontaneous abortion at 3 months' gestation. What is the description that the practical nurse (PN) should use to document gravida and parity in this client's medical record?

c. Gravida 2, para 0 Rationale: This is the client's second pregnancy or second "gravid" event, the spontaneous abortion occurred at 3 months' gestation (12 weeks), so she is a para 0. Parity when delivery occurs at 20 weeks' gestation or beyond.

Which parental behavior is a warning to the practical nurse that there may be negative bonding between parents and a newborn infant?

c. Parents frequently leave the newborn infant wrapped in blankets. Rationale: Attachment/bonding theory indicates that parents have an extreme interest in visualizing every part of the newborn in a head to toe examination and exploration process.

A new mother has delivered her first baby vaginally and says to the practical nurse (PN), I saw the baby in the recovery room. The baby sure has a funny-looking head. Which response by the PN is best?

c. That is normal. The head will return to a round shape within 7 to 10 days. Rationale: Reassure the mother that this shape is normal in the newborn and then provide information regarding the return to a normal shape of the molded neonate's head after a vaginal delivery.

Following a vaginal delivery, a postpartum client complains of severe cramping after breastfeeding her newborn. Which explanation describes the most likely reason for the client's pain?

c. The release of oxytocin hormone Rationale: During breastfeeding, oxytocin is released and will cause uterine contractions and cramping.

The nurse is reinforcing instructions on newborn care for expectant parents. Which instruction is correct for the nurse to include concerning the newborn infant born at term?

c. Vernix is a white cheesy substance, predominately seen in skin folds. Rationale: Vernix, found in skin folds, is a common characteristic of term infants. Milia are white pinpoint spots usually found over the nose and chin, caused by sebaceous glands blockages. Meconium is the first stool, but it is tarry black, not golden yellow. Pseudostrabismus (crossed eyes) is normal at birth and does not require surgery.

A client is in active labor with her first child. She has expressed a firm desire to not receive pain medications. Her pulse is 92 beats/min and her respirations are 28 breaths/min. She tells the nurse "My fingers are tingling, and I'm beginning to feel dizzy. What's wrong with me?" Which nursing intervention should the nurse provide?

d. Ask the client to breathe into her cupped hands, and assist her with relaxation techniques. Rationale: The client is hyperventilating and experiencing respiratory alkalosis. She can be helped by cupping her hands and breathing into them at a slow, relaxed rate. The nurse can also assist her with relaxation techniques. It is inappropriate for the nurse to suggest she reconsider pain medication if she does not want it. An oxygen mask will not benefit the client, since the client is not experiencing a low oxygen level, she has a low carbon dioxide level

During labor, the fetal heart rate slowly decelerates at the beginning of the contraction and returns to baseline at the end of the contraction. What action should the nurse take?

d. Continue to monitor the progress of the client's labor. Rationale: Early decelerations during labor are frequently caused by head compression within the uterus, and no nursing intervention is required except to monitor the mother's progress during labor.

What nursing intervention does the nurse expect to see in the plan of care to aid in preventing postpartum thrombophlebitis for a client who has had a Caesarean delivery?

d. Encourage early ambulation after delivery. Rationale: Early ambulation increases venous return and prevents thrombophlebitis. Clotting factors are normally elevated in the postpartum period to heal the placental site, thereby predisposing clients to thrombus formation.

The nurse is assisting the health care provider who will be performing an amniocentesis on a client who is 37 weeks pregnant. Which is the priority action for the nurse to take prior to the procedure?

d. Instruct the client to empty her bladder prior to the procedure. Rationale: The client who is in late pregnancy should empty her bladder before the procedure to prevent injury to the bladder. It is not necessary to give the client fluids prior to the procedure, or to turn the client to the left lateral position. It is not normal to experience contractions after this procedure, if these happen, the health care provider should be notified.

Just after delivery, a new mother tells the practical nurse (PN) that breastfeeding was unsuccessful with the client's first child, but the client would like to try with this baby. Which intervention should the PN implement first?

d. Provide assistance to the mother to begin breastfeeding as soon as possible after delivery. Rationale: Infants respond to breastfeeding best when feeding is initiated in the active phase soon after delivery.

The practical nurse (PN) is reviewing characteristics of the newborn and is sharing common growth and development milestones with new parents when they ask, when will the soft spots close? The PN should respond that they can expect the infant's fontanels to close during what age span?

d. The anterior fontanel closes at 12 to 18 months and the posterior by the end of the second month. Rationale: In the normal infant, the anterior fontanel closes at 12 to 18 months of age and the posterior fontanel by the end of the second month.