OB Exam 1
A pregnant client in the first trimester asks the nurse about taking medications while she is pregnant. She tells the nurse that she heard that it can be harmful to the fetus if medications are taken at certain times during pregnancy. What is the best response by the nurse?
"Exposure to certain substances during the embryonic phase may be harmful to the developing fetus." Explanation: Exposure to a teratogen during the embryonic stage produces the greatest damage
A mother is talking to the nurse and is concerned about managing her asthma while she is pregnant. Which response to the nurse's teaching indicates that the woman needs further instruction?
"I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." Explanation: A pregnant woman with a history of asthma needs to be proactive, taking her inhalers and other asthma medications to prevent an acute asthma attack. She needs to understand that it is far more dangerous to not take the medications and have an asthma attack. She also needs to monitor her peak flow for decreases, be aware of triggers, and avoid them if possible. However, a pregnant woman should never begin allergy shots if she has not been taking them previously, due to the potential of an adverse reaction.
The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurse's teaching was successful?
"Pregnancy affects insulin production, so I'll need to make adjustments in my diet." Explanation: In pregnancy, placental hormones cause insulin resistance at a level that tends to parallel growth of the fetoplacental unit. Nutritional management focuses on maintaining balanced glucose levels. Thus, the woman will probably need to make adjustments in her diet. Protein needs increase during pregnancy, but this is unrelated to diabetes. Blood glucose monitoring results typically guide therapy.
Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant. This is her 4th pregnancy. She gave birth to one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation.
4, 1, 1, 1, 1 Explanation: The GTPAL system is used to classifying pregnancy status. G = gravida, T= term, P = preterm, A = number of abortions, L= number of living children.
A nurse is caring for a 45-year-old pregnant client with a cardiac disorder who has been instructed by her primary care provider to follow class I functional activity recommendations. The nurse correctly instructs the client to follow which limitations? A: "It is important for you to rest after any physical activity in order to prevent any cardiac complications." B: "You do not need to limit your physical activity unless you experience any problems such as fatigue, chest pain, or shortness of breath."
B Class I recommendations (no physical activity limitations) are suggested for clients who are asymptomatic and exhibit no objective evidence of cardiac disease. The functional classifications system consists of classes I to IV, based on past and present disability and physical signs resulting from cardiac disease.
A nurse is giving a talk to a local group about the benefits of genetic counseling and identifies diseases known as autosomal-dominant disorders. Which of the following diseases should the nurse include? (Select all that apply.)
Huntington's disease Marfan syndrome Breast cancer syndrome Breast/ovarian cancer syndrome Explanation: With an autosomal dominant condition, either a person has two unhealthy genes (ie, homozygous dominant) or is heterozygous, with the gene causing the disease stronger than the corresponding healthy recessive gene for the same trait. Huntington's disease, Marfan syndrome, breast, and breast/ovarian cancer syndrome are examples.
Which of the following is the best description of the pathophysiology of preeclampsia? It is a multisystem disorder resulting in generalized vasoconstriction It is a localized condition impacting uteroplacental perfusion It is a multisystem disorder resulting in generalized vasodilatation
It is a multisystem disorder resulting in generalized vasoconstriction Rationale: Preeclampsia results in generalized vasoconstriction and impacts multiple systems, including the maternal cardiac, renal, neurologic, and hepatic systems, as well as uteroplacental perfusion.
Which client immunization titer is most important to assess and document in the prenatal record of the pregnant woman?
Rubella Explanation: Rubella (German measles) is an infection caused by the rubella virus. The virus causes a rash and mild symptoms in children but can be teratogenic to a fetus. A rubella titer determines if the mother is immune to the virus. If the mother is not immune, the mother will receive a rubella immunization immediately after delivery. Diphtheria and polio are infant vaccines but not as teratogenic to the fetus. Rotavirus is a gastrointestinal virus typically mild in adults.
The nurse recognizes that blood pressure measurement is lowest when the pregnant patient is in which position? Side lying Supine Sitting
Side lying Rationale: A side-lying position results in the lowest blood pressure measurements because it displaces the weight of the gravid uterus from the major vessels, decreasing resistance to blood flow.
The nurse is caring for a patient who desires to become pregnant within a few months. Which outcome regarding folic acid intake would be appropriate for this patient?
The client will begin taking 400 μg of folic acid every day.
A nurse is caring for a pregnant client with heart disease in a labor unit. Which intervention is most important in the first 48 hours postpartum?
assessing for cardiac decompensation Explanation: The nurse should assess the client with heart disease for cardiac decompensation, which is most common from 28 to 32 weeks' gestation and in the first 48 hours postpartum. Limiting sodium intake, inspecting the extremities for edema, and ensuring that the client consumes a high-fiber diet are interventions during pregnancy not in the first 48 hours postpartum.
A nurse is teaching a 30-year-old gravida 1 who has sickle cell anemia. Providing education on which topic is the highest nursing priority?
avoidance of infection Explanation: Prevention of crises, if possible, is the focus of treatment for the pregnant woman with sickle cell anemia. Maintaining adequate hydration, avoiding infection, getting adequate rest, and eating a balanced diet are all common-sense strategies that decrease the risk of a crisis. Fat intake does not need to be decreased and immunoglobulins are not normally administered. Constipation is not usually a result of sickle cell anemia.
A nurse is conducting a program for pregnant women with gestational diabetes that discusses reducing complications during the pregnancy. The nurse determines that the teaching was successful when the group identifies which factor as being most important in helping to reduce complications associated with pregnancy and diabetes?
degree of blood glucose control achieved during the pregnancy Explanation: Therapeutic management for the woman with diabetes focuses on tight glucose control, thereby minimizing the risks to the mother, fetus, and neonate. The woman's emotional and psychological status is highly variable and may or may not affect the pregnancy. Evaluating for long-term diabetic complications such as retinopathy or nephropathy, as evidenced by laboratory testing such as BUN levels, is an important aspect of preconception care to ensure that the mother enters the pregnancy in an optimal state.
A couple who is in for fertility testing ask the nurse what tests are commonly performed to assess fertility. The nurse replies that there are only three primary tests that are used. What are these tests?
semen analysis, ovulation monitoring, and tubal patency assessment
An expectant mother in week 30 of her pregnancy reports to the nurse that she has been doing her kick counts several times a day and the fetus has been kicking at a rate of about 10 to 12 times per hour, on average. What is most likely indicated by this finding?
the fetus is healthy A healthy fetus moves with a degree of consistency, at about 10 times per hour. In contrast, a fetus who is not receiving enough nutrients because of poor maternal nutrition or placental insufficiency has greatly decreased movements. Activity in the mother would not explain the decreased movement in the fetus. There is no indication in this scenario that the client is performing the counts incorrectly.
A client is 33 weeks' pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled?
85 mg/dl Explanation: Recommended fasting blood glucose levels in pregnant clients with diabetes are 60 to 95 mg/dl. A fasting blood glucose level of 45 g/dl is low and may result in symptoms of hypoglycemia. A blood glucose level below 120 mg/dl is recommended for 2-hour postprandial values. A blood glucose level above 136 mg/dl in a pregnant client indicates hyperglycemia.
Charlene McCoy, who has several children already, reports for a first prenatal visit. She seems preoccupied and withdrawn, and she makes consistently negative remarks about the pregnancy. Reviewing her records, you note that she is receiving a serotonin reuptake inhibitor. What should you do?
Alert the RN or primary care provider Explanation: A patient on an SSRI or SRI (serotonin reuptake inhibitor) might be in current treatment for a psychiatric disorder. The medication may also be one which is not safe during pregnancy. The RN and the health care provider need to be alerted to seek more information from the patient. Reassurance is good practice, but not enough in this case. You do not have enough information to refer her for drug and alcohol counseling. She is under the care of another provider for her mental disorder, so do not confuse her with more material to read.
A pregnant woman with sickle cell anemia is very concerned her infant will also develop the disease and questions the nurse about that possibility. Which is the best response from the nurse?
Both parents have to carry the trait. Explanation: Sickle cell anemia is an autosomal recessive disease requiring that the person have two genes for the disease, one from each parent. If one parent has the disease and the other is free of the disease and trait, the chances of the child inheriting the disease is zero. The infant will not develop the disease just because the mother has a crisis during the pregnancy.
A pregnant client in her 20th week of gestation, having systemic lupus erythematosus (SLE), is admitted to the healthcare unit for management of the exacerbation of SLE. Which of the following would be most appropriate to treat the client's condition?
Corticosteroids Explanation: Corticosteroid therapy is the treatment of choice for pregnant clients with SLE. SLE is an autoimmune disorder where there is deposition of immune complexes in the capillaries and in visceral structure. Corticosteroid therapy in pregnant clients with SLE has a favorable outcome. Hydroxyurea, beta2 agonists and prostaglandin E are not used in the treatment of pregnant clients with SLE. Hydroxyurea is a drug used in the treatment of sickle cell anemia. Beta2 agonists are drugs given to asthmatic clients. Prostaglandin E is a drug used for the induction of labor.
While being prepared for discharge, the patient asks the nurse, "What signs would mean that my preeclampsia is getting worse?" Which of the following signs and symptoms are consistent with increased severity of preeclampsia? (Select all that apply) Dependent edema Epigastric pain Headache Blurred vision Rupture of membranes
Epigastric pain Headache Blurred vision Headache and blurred vision are associated with central nervous system irritability due to vasoconstriction. Epigastric pain is associated with decreased liver perfusion. These are signs associated with worsening of preeclampsia. Dependent edema is a normal discomfort of late pregnancy, and rupture of membranes is associated with the onset of labor.
Which of the following findings in a patient's prenatal history would indicate to the nurse a risk for developing preeclampsia? (Select all that apply) First pregnancy Low socioeconomic status Body mass index (BMI) less than 20 African-American ethnicity
First pregnancy Low socioeconomic status African-American ethnicity Risk factors include first pregnancy, low socioeconomic status, poor nutrition, obesity, and African-American ethnicity. Low BMI and Asian ethnicity are not risk factors for preeclampsia.
While providing the discharge education for a pregnant woman with preeclampsia, the nurse would inform the patient that which fetal test will be done twice a week until the baby is born? Nonstress test Biophysical profile Fetal kick counts
Nonstress test Rationale: A nonstress test is done to assess fetal heart rate (FHR) reactivity to fetal movement and is an indicator of fetal well-being. A biophysical profile would be done if the nonstress test was nonreactive. Fetal kick counts are done daily by the patient. An L/S ratio is a measure of pulmonary maturity and not specific to care of the patient with preeclampsia.
The nurse is preparing to teach a pregnant client with iron deficiency anemia about the various iron-rich foods to include in her diet. Which food should the nurse point out will help increase the absorption of her iron supplement?
ORANGE juice Anemia is a condition in which the blood is deficient in red blood cells, from an underlying cause. The woman needs to take iron to manufacture enough red blood cells. Taking an iron supplement will help improve her iron levels, and taking iron with foods containing ascorbic acid, such as orange juice, improves the absorption of iron. Dried fruit (such as apples), fortified grains, and dried beans are additional food choices that are rich in iron and should be included in her daily diet.
The nurse is assessing a client who believes she is pregnant. The nurse points out a more definitive assessment is necessary due to which sign being considered a probable sign of pregnancy?
Positive home pregnancy test Explanation: A urine pregnancy test is considered a probable sign of pregnancy as the hCG may be from another source other than pregnancy. Fatigue, amenorrhea, and vomiting are presumptive or possible signs of pregnancy and can also have other causes.
The client is 32 weeks' pregnant and has been referred for a biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective?
The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume. Explanation: A biophysical profile uses a combination of factors to determine fetal well-being based upon five fetal biophysical variables. An NST is done to measure FHR acceleration. Then an ultrasound is done to measure breathing, body movements, tone, and amniotic fluid volume. Each variable receives a score from 0 to 2 for a maximum score of 10. A score of 6 or less indicates altered fetal well-being and indicates a need for further assessment. A needle is not involved with the BPP. The BPP does not detect placental problems, and the BPP is not a screening for neural tube defects.
A 29-year-old client has gestational diabetes. The nurse is teaching her about managing her glucose levels. Which therapy would be most appropriate for this client?
diet Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Long-acting insulin usually is not needed for blood glucose control in the client with gestational diabetes. Oral hypoglycemic drugs are contraindicated in pregnancy. Glucagon raises blood glucose and is used to treat hypoglycemic reactions.
A pregnant client tells the nurse that she has a 2-year-old child at home who was born at 38 weeks; she had a miscarriage at 9 weeks; and she gave birth to a set of twins at 34 weeks. Which documentation would be appropriate for the nurse? gravida 3, para 4 gravida 4, para 2
Gravida (G) indicates the number of pregnancies. When a nurse calculates the GP of a pregnant client, the current pregnancy counts as one, the twin pregnancy counts as one, and the previous pregnancies count as two for a gravida of 4. Para (P) indicates the number of pregnancies that result in birth at a viable gestational age. The birth of multiples count as one. Thus, this client has a 2-year-old and one set of twins, for a para of 2.
