OB Exam 3
A woman is being prepared for a contraction stress test (CST). What should the nurse explain to the woman before the test? 1 "The test will be discontinued after at least six contractions are observed." 2 "You'll need to provide a double-voided urine specimen before the test." Correct 3 "The fetal heart rate will be monitored for about 20 minutes before the test begins." 4 "You'll be placed in a right lateral position that must be maintained throughout the test
The fetal heart rate will be monitored for about 20 minutes before the test begins." The fetal heart rate (FHR) is measured for about 20 minutes before the CST to determine baseline variability and to detect any FHR alterations without induced stress. The test involves monitoring the fetal heart rate during three to five uterine contractions over a 10-minute period. A urine sample is unnecessary. The semi-Fowler position with a left-sided tilt is the position of choice.
A nurse is caring for a client whose contraction stress test result (CST) is positive. The nurse remains with the client and continues to assess the fetal and maternal monitor strips. What complication does the nurse anticipate? Preeclampsia Placenta previa Fetal prematurity Uteroplacental insufficiency
Uteroplacental insufficiency: A positive CST result is indicative of a compromised fetus; late decelerations during contractions are associated with uteroplacental insufficiency. Preeclampsia does not cause a positive CST result. A CST is contraindicated for a client with a suspected placenta previa because the contractions may cause bleeding. A CST is contraindicated for a client with a suspected preterm birth or a gestation less than 33 weeks' duration because the contractions may induce true labor.
A client at 32 weeks' gestation is admitted to the prenatal unit in preterm labor. An infusion of magnesium sulfate is started. What physiologic response indicates to the nurse that the magnesium sulfate is having a therapeutic effect? Dilation of the cervix by 1 cm every hour Tightening and pain in the perineal area A decrease in blood pressure to 120/80 mm Hg A decrease in frequency and duration of contractions
A decrease in frequency and duration of contractions: The purpose of administering magnesium sulfate is to stop preterm labor. It is a tocolytic agent that relaxes uterine smooth muscle. Labor is progressing if dilation of the cervix continues. Perineal discomfort is usually felt as the fetus moves down the birth canal and labor is progressing. A decrease in blood pressure to 120/80 mm Hg is not a therapeutic effect of magnesium sulfate for a woman in preterm labor.
After the removal of a hydatidiform mole, the nurse assesses the client's laboratory data during a follow-up visit. The nurse notes that a prolonged increase of the serum human chorionic gonadotropin (hCG) level is a danger sign. What condition is a possible outcome? Uterine rupture Choriocarcinoma Hyperemesis gravidarum Disseminated intravascular coagulation (DIC
Choriocarcinoma: hCG increases shortly after the onset of pregnancy, peaks at the end of the second month, then decreases and is sustained at a lower level until the end of pregnancy; a continued increase indicates retained trophoblastic tissue and possible choriocarcinoma. Uterine rupture is characterized by persistent, localized abdominal pain; it does not have a higher incidence in women with hydatidiform mole. Hyperemesis gravidarum cannot occur after termination of a pregnancy. DIC is manifested by shock, bleeding, a low platelet count, and elevated prothrombin time and partial thromboplastin time; it does not have a higher incidence in women with hydatidiform mole.
The nurse explains to a pregnant client undergoing a nonstress test that the test is a way of evaluating the condition of the fetus by comparing the fetal heart rate with: Fetal lie Fetal movement Maternal blood pressure Maternal uterine contractions
Fetal Movement: In a healthy well-oxygenated fetus the heart rate increases with fetal movement; there should be an acceleration of 15 beats with fetal movement. Fetal lie is not a part of the evaluation of the fetus in the nonstress test. Maternal blood pressure is not a part of the evaluation of the fetus in the nonstress test. Maternal uterine contractions are used in the contraction stress test.
A client with abruptio placentae has an emergency cesarean birth. Subsequently the nurse notes bloody urine in the indwelling catheter collection bag. What impending problem does the nurse suspect? Incisional nick in the bladder Urinary infection from the catheter Uterine relaxation with increased lochia Disseminated intravascular coagulopathy
Incisional nick in the bladder: During an emergency cesarean birth the urinary bladder may be nicked during attempts to reach the uterus. Bleeding associated with a urinary tract infection is unlikely to develop so soon after a birth. Lochia is expelled from the vagina, not the bladder. With dissociated intravascular coagulopathy there would be bleeding from other sites, such as the incision and the IV, not just the bladder.
A left modified radical mastectomy is performed on a client with breast cancer. What is the most important measure to be included in the care plan for the first postoperative day? Having someone from Reach to Recovery visit the client Emptying the portable wound drainage system after each shift Keeping the left arm and shoulder immobile until drainage ceases Placing the client in the semi-Fowler position with the left arm and hand elevated
Placing the client in the semi-Fowler position with the left arm and hand elevated: Placing the client in the semi-Fowler position with the left arm and hand elevated promotes drainage from the operative site by means of gravity, thereby preventing edema. Basic physiologic needs must be met first; because of shortened hospital stays, Reach to Recovery visits may be made in the home. The portable wound drainage system is emptied as necessary, usually when it becomes half full. Arm mobility should be encouraged. Using the arm for activities of daily living helps prevent lymphedema. Initially abduction of the arm on the affected side should be limited to prevent tension on the suture line.
A practitioner orders doxycycline (Vibramycin) for a sexually active woman with a history of a mucopurulent discharge and bleeding associated with cervical dysplasia, dysuria, and dyspareunia. With which sexually transmitted infection are these clinical findings and medication therapy commonly associated? Herpes simplex 2 Correct 2 Chlamydial infection 3 Treponema pallidum 4 Neisseria gonorrhoeae
The signs and symptoms listed and the treatment ordered (doxycycline or azithromycin) indicate that the client has a chlamydial infection. Painful blisters on the genitalia, fever, malaise, dysuria, and dyspareunia are signs of herpes simplex virus 2 infection. Chancre formation is a sign of primary syphilis; a symmetrical rash accompanied by malaise, fever, anorexia, and headache is indicative of secondary syphilis. Dysuria, heavy greenish-yellow purulent discharge, and swollen Bartholin glands are signs of gonorrhea.
A client is scheduled for a modified radical mastectomy. What nursing intervention is most important in the client's preoperative plan of care? Allowing her to express her feelings about surgery Encouraging range-of-motion exercise of the arms Increasing her knowledge about postoperative expectations Arranging for a visit by a woman who has had a mastectomy
Allowing her to express her feelings about surgery: The freedom to vent feelings about the loss of a body part and its meaning to the client influences the client's willingness to participate in the postoperative regimen, consequently affecting healing and rehabilitation. Encouraging range-of-motion exercise of the upper extremities is not the initial preoperative focus. First the client's level of anxiety must be identified; teaching is not effective if the client is even moderately anxious. Arranging for a visit by a woman who has had a mastectomy is not an initial action; it is usually arranged after surgery. 65% of students nationwide answered this question correctly.
A nurse is caring for a client who has had a spontaneous abortion. The client asks why spontaneous abortions occur. The nurse responds that they are most commonly caused by: Physical trauma Unresolved stress Congenital defects Embryonic defects
Embryonic: About 75% of all spontaneous abortions take place between 8 and 12 weeks' gestation and reveal embryonic defects. Though possible, physical trauma rarely causes an abortion. Unresolved stress is rarely associated with spontaneous abortions. Congenital defects are asymptomatic during pregnancy and do not usually cause abortion
A nurse is caring for a client who has contracted a trichomonal infection. Which oral drug should the nurse anticipate that the health care provider will most likely prescribe? Penicillin G 2 Gentian violet 3 Nystatin (Mycostatin) Correct 4 Metronidazole (Flagyl
Metronidazole (Flagyl) is a potent amebicide. It is effective in eradicating the protozoan Trichomonas vaginalis. Penicillin is administered for its effect on bacterial, not protozoal, infections. Gentian violet is a local antiinfective that is applied topically; it may cause discoloration of the skin. It is effective against Candida albicans. Nystatin (Mycostatin) is an antifungal for infections caused by C. albicans.
