Perry Ch 7-10 Practice Questions

The physician has ordered a nonstress test (NST) to be done on a 41-week-gestation client. During the half-hour test, the nurse observed three periods of fetal heart accelerations that were 15 bpm above the baseline and that lasted 15 seconds each. No contracts were observed. Based on these results, what should the nurse do next? a) Send the client home and report positive results to the MD b) Perform a nipple stimulation test to assess the fetal heart in response to contractions c) Prepare the client for induction w/ IV oxytoxin or endocervical prostaglandins d) Place the client on her side w/ oxygen via face mask

A The nurse should report the positive results to the doctor.

An ultrasound has identified that a client's pregnancy is complicated by oligohydramnios. The nurse would expect that an ultrasound may show that the baby has which of the following structural defects? a) Dysplastic kidneys b) Coarctation of the aorta c) Hydrocephalus d) Hepatic cirrhosis

A The nurse would expect that the baby has dysplastic kidneys.

A woman is about to receive methotrexate IM for an ectopic pregnancy. The nurse should teach the woman about which of the following common side effects of the therapy? Select all that apply. a) Nausea and vomiting b) Abdominal pain c) Fatigue d) Light-headedness e) Breast tenderness

A, B, C, D These are all common side effects of this medication.

A 29-week-gestation woman diagnosed w/ severe preeclampsia is noted to have BP of 170/112, 4+ proteinuria, and a weight gain of 10 pounds over the past 2 days. Which of the following S&S would the nurse also expect to see? a) Fundal height of 32 cm b) Papilledema c) Patellar reflexes of 2+ d) Nystagmus

B As a result of the ICP, the optic disk swells and papilledema is seen when the disk is viewed through an ophthalmoscope.

A client being seen in the ED has an admitting medical diagnosis of: third-trimester bleeding: rule out placenta previa. Each time a nurse passes by the client's room, the woman asks, "Please tell me, do you think the baby will be all right?" Which of the following is an appropriate nursing diagnosis for this client? a) Hopelessness r/t possible fetal loss b) Anxiety r/t inconclusive diagnosis c) Situation low self-esteem r/t blood loss d) Potential for altered parenting r/t inexperience

B This client is very anxious.

An obese gravid woman is being seen in the prenatal clinic. The nurse will monitor this client carefully throughout her pregnancy because she is high risk for which of the following complications of pregnancy? Select all that apply. a) Placenta previa b) Gestational diabetes c) Abruptio placentae d) Preeclampsia e) Chromosomal defects

B, D (Self-explanatory)

The nurse is caring for four prenatal clients in the clinic. Which of the clients is high risk for placenta previa? Select all that apply. a) Jogger w/ low BMI b) Primigravida who smokes 1 pack of cigarettes per day c) Infertility client who is carrying in vitro triplets d) Registered professional nurse who works 12-hour shifts e) Police officer on foot patrol

B, C A smoker and a women carrying triplets are at high risk for placenta previa.

The nurse is caring for a 32-week G8 P7007 w/ placenta previa. Which of the following interventions would the nurse expect to perform? Select all that apply. a) Daily contraction stress tests b) Blood type and cross match c) Bed rest w/ passive ROM exercises d) Daily serum electrolyte assessments e) Weekly BPPs

B, C, E (Self-explanatory).

A nurse is performing an assessment on four 22-week-pregnant clients. The nurse reports to the obstetrician that which of the clients may be carrying twins? a) The client who states that she feels huge b) The client w/ a weight gain of 13 pounds c) The client whose fundal height measurement is 26 cm d) The client whose alpha-fetoprotein level is one-half normal

C Because the fundal height is 4cm above the expected 22cm, it's likely that the woman is either having twins or has polyhydramnios.

A client w/ mild preeclampsia who has been advised to be on bed rest at home asks why doing so is necessary. Which of the following is the best response for the nurse to give the client? a) "Bed rest will help you to conserve energy for you labor." b) "Bed rest will help to relieve your nausea and anorexia." c) "Reclining will increase the amount of oxygen that your baby gets." d) "The position change will prevent the placenta from separating."

C Bed rest, especially side-lying, helps to improve perfusion to the placenta.

A nurse is counseling a preeclamptic client about her diet. Which should the nurse encourage the woman to do? a) Restrict sodium intake b) Increase intake of fluids c) Eat a well-balanced diet d) Avoid simple sugars

C It's important for the client to eat a well-balanced diet.

A woman has just been admitted to the ED subsequent to a head-on automobile accident. Her body appears to be uninjured. The nurse carefully monitor the woman for which of the following complications of pregnancy? Select all that apply. a) Placenta previa b) Transverse fetal lie c) Placental abruption d) Severe preeclampsia e) Preterm labor

C, E These things may happen after an auto accident.

During a prenatal interview, a client tells the nurse, "My mother told me she had toxemia during her pregnancy and almost died!" Which of the following questions should the nurse ask in response to this question? a) "Does your mother have a cardiac condition?" b) "Did your mother tell you what she was toxic from?" c) "Does your mother have diabetes now?" d) "Did your mother say whether she had a seizure or not?"

D The nurse asking whether or not the client's mother developed eclampsia.

A gravida's fundal height is noted to be at the xiphoid process. The nurse is aware that which of the following fetal changes is likely to be occurring at the same time in the pregnancy? a) Surfactant is formed in the fetal lungs b) Eyes begin to open and close c) Respiratory movements begin d) Spinal column is completely formed

A Surfactant is usually formed in the fetal lungs by the 36th weeks.

A 32-gestation client was last seen in the prenatal clinic at 28 weeks' gestation. Which of the following changes should the nurse bring to the attention of the certified nurse midwife? a) Weight change from 128 pounds to 138 pounds b) Pulse rate change from 88 to 92 bpm c) BP change from 120/80 to 118/78 d) RR change from 16 to 20 rpm

A A weight gain of 10 pounds in a 4-week period is worrisome.

A nurse remarks to a 38-week-gravid client, "It looks like your face and hands are swollen." The client responds, "Yes, you're right. Why do you ask?" The nurse's response is based on the fact that the changes may be caused by which of the following? a) Altered glomerular filtration b) Cardiac failure c) Hepatic insufficiency d) Altered splenic circulation

A Altered glomerular filtration leads to protein loss and, subsequently, to fluid retention, which can lead to swelling in the face and hands.

Which finding would the nurse view as normal when evaluating the laboratory reports of a 34-week gestation client? a) Anemia b) Thrombocytopenia c) Polycythemia d) Hyperbilirubinemia

A Anemia is an expected finding.

A client is being admitted to the labor suite w/ a diagnosis of eclampsia. The FHR tracing shows moderate variability w/ early decelerations. Which of the following actions by the nurse is appropriate at this time? a) Tape a tongue blade to the head of the bed b) Pad the side rails and head of the bed c) Provide the client w/ needed stimulation d) Provide the client w/ grief counseling

B The side rails and the headboard should be padded.

A client's 32-week clinic assessment was: BP 90/60; TPR 98.6°F, P 92, R 20; weight 145 lb; and urine negative for protein. Which of the following findings at the 34-week appointment should the nurse highlight for the certified nurse midwife? a) BP 110/70; TPR 99.2°F, 88, 20 b) Weight 155 lb; urine protein +2 c) Urine protein trace; BP 88/56 d) Weight 147 lb; TPR 99.0°F, 76, 18

B There has been a 10-lb weight gain in 2 weeks and a significant amount of protein is being spilled in the urine.

A patient who is 24 weeks pregnant has been diagnosed w/ syphilis. She asks the nurse how the infection will affect the baby. The nurse's response should be based on which of the following? a) She is high risk for premature rupture of the membranes b) The baby will be born w/ congenital syphilis c) Penicillin therapy will reduce the risk to the fetus d) The fetus will likely be born w/ a cardiac defect

C Usually a single shot of penicillin, administered to the mother, will cure her and protect the baby.

Which of the following clients is highest risk for pseudocyesis? a) The client w/ lymphatic cancer b) The client w/ celiac disease c) The client w/ multiple miscarriages d) The client w/ grand multiparity

C Women who have had a number of miscarriages are at high risk for pseudocyesis.

In anticipation of a complication that may develop in the second half of pregnancy, the nurse teaches an 18-week gravid client to call the office if she experiences which of the following? a) Headache and decreased output b) Puffy feet c) Hemorrhoids and vaginal discharge d) Backache

A Headache and decreased output are signs of preeclampsia.

The nurse notes each of the following findings in a 10-week old gestation client. Which of the findings would enable the nurse to tell the client that she is positively pregnant? a) FHR via Doppler b) Positive pregnancy test c) Positive Chadwick's sign d) Montgomery gland enlargements

A Hearing an FHR is a positive sign of pregnancy.

The laboratory reported the L/S ratio results from an amniocentesis as 1:1. How should the nurse interpret the result? a) The baby is premature b) The mother is at high risk for hemorrhage c) The infant has kernicterus d) The mother is high risk for eclampsia

A The baby is preterm. The ratio indicates that the surfactant is insufficient for extrauterine respirations.

A patient, 32 weeks pregnant with severe headache, is admitted to the hospital with preeclampsia. In addition to obtaining baseline vital signs and placing the client on bed rest, the physician ordered the following four items. Which of the orders should the nurse perform first? a) Assess deep tendon reflexes b) Obtain complete blood count c) Assess baseline weight d) Obtain routine urinalysis

A The nurse should check the client's patellar reflexes.

A woman is carrying dizygotic twins. She asks the nurse about the babies. Which of the following explanations is accurate? a) During a period of rapid growth, the fertilized egg divided completely b) When the woman ovulated, she expelled two mature ova c) The babies share one placenta and a common chorion d) The babies will definitely be the same sex and have the same blood type

B Dizygotic twins result from two mature ova that are fertilized.

An L/S ratio has been ordered by a pregnant woman's obstetrician. Which of the following data will the nurse learn from this test? a) Coagulability of maternal blood b) Maturation of the fetal lungs c) Potential for fetal development of erythroblastosis fetalis d) Potential for maternal development of gestational diabetes

B The L/S ratio indicates the maturity of the fetal lungs.

A client, G2 P1001, telephones the gynecology office complaining of left-sided pain. Which of the following questions by the triage nurse would help to determine whether the one-sided pain is due to an ectopic pregnancy? a) "When did you have your pregnancy test done?" b) "When was the first day of your last menstrual period?" c) "Did you have any complications w/ your first pregnancy?" d) "How old were you when you first got your period?"

B The date of the last menstrual period will assist the nurse in determining how many weeks pregnant the client is.

A client is admitted to the hospital w/ severe preeclampsia. The nurse is assessing for clonus. Which of the following actions should the nurse perform? a) Strike the woman's patellar tendon b) Palpate the woman's ankle c) Dorsiflex the woman's foot d) Position the woman's foot flat on the floor

C To assess clonus, the nurse should dorsiflex the woman's foot.

A 26-week-gestation woman is diagnosed w/ severe preeclampsia w/ HELLP syndrome. The nurse will assess for which of the following S&S? a) Low serum creatinine b) High serum protein c) Bloody stools d) Epigastric pain

D Epigastric pain is associated w/ the liver involvement of HELLP syndrome.

Which finding should the nurse expect when assessing a client w/ placenta previa? a) Severe occipital headache b) History of thyroid cancer c) Previous premature delivery d) Painless vaginal bleeding

D Painless vaginal bleeding is often the only symptom of placenta previa.

Which of the following statements is appropriate for the nurse to say to a patient w/ a complete placenta previa? a) "During the first phase of labor you will do slow chest breathing" b) "You should ambulate in the halls at least two times a day" c) "The doctor will deliver you once you reach 25 weeks' gestation" d) "It's important that you inform me if you become constipated"

D Straining at stool can result in enough pressure to result in placental bleeding.

A woman w/ a diagnosis of ectopic pregnancy is to receive medical intervention rather than a surgical interruption. Which of the following IM medications would the nurse expect to administer? a) Decadron (dexamathasone) b) Amethopterin (methotrexate) c) Pergonal (metotropin) d) Prometrium (progesterone)

B Methotrexate is the likely medication (antineoplastic).

An antenatal client is informing the nurse of her prenatal signs and symptoms. Which of the following findings would the nurse determine are presumptive signs of pregnancy? Select all that apply. a) Amenorrhea b) Breast tenderness c) Quickening d) Frequent urination e) Uterine growth

A, B, C, D These are all presumptive signs of pregnancy: amenorrhea, breast tenderness, quickening, and frequent urination.

A 12-week-gravid client presents in the ED w/ abdominal cramps and scant dark red bleeding. Which of the following S&S should the nurse assess this client for? Select all that apply. a) Tachycardia b) Referred shoulder pain c) Headache d) Fetal heart dysrhythmias e) Hypertension

A, C, D, E (Self-explanatory)

The nurse is caring for a prenatal client who states she is prone to developing anemia. Which of the following foods should the nurse advise the gravida is the best source of iron? a) Raisins b) Hamburger c) Broccoli d) Molasses

B Hamburger contains the most iron.

A client, 32 weeks' gestation w/ placenta previa, is on total bed rest. The physician expects her to be hospitalized on bed rest until her C-section, which is scheduled for 38 weeks' gestation. To prevent complications while in the hospital, the nurse should do which of the following? Select all that apply. a) Perform passive ROM exercise b) Restrict fluid intake of the client c) Decorate the room w/ pictures of family d) Encourage the client to eat a high-fiber diet e) Teach the client deep-breathing exercises

A, C, D, E (Self-explanatory)

A 24-week gravid client is being seen in the prenatal clinic. She states, "I have had a terrible headache for the past 2 days." Which of the following is the most appropriate action for the nurse to perform next? a) Inquire whether or not the client has allergies b) Take the woman's BP c) Assess the woman's fundal height d) Ask the woman about stressors at work

B Headache is a symptom of preeclampsia.

The midwife has just palpated the fundal height at the location noted on the picture below. It's likely that the client is how many weeks pregnant? a) 12 b) 20 c) 28 d) 36

A At 12 weeks, the fundal height is at the top of the symphysis.

A gravid client w/ 4+ proteinuria and 4+ reflexes is admitted to the hospital. The nurse must closely monitor the woman for which of the following? a) Grand mal seizure b) High platelet count c) Explosive diarrhea d) Fractured pelvis

A Clients w/ severe preeclampsia are high risk for seizure.

On ultrasound, it is noted that the pregnancy of a hospitalized woman who is carrying monochorionic twins is complicated by twin-to-twin transfusion. The nurse should carefully monitor this client for which of the following? a) Rapid fundal growth b) Vaginal bleeding c) Projectile vomiting d) CHF

A Fundal growth is often accelerated.

A mother is experiencing nausea and vomiting every afternoon. The ingestion of which of the following spices has been shown to be a safe complementary therapy for this complaint? a) Ginger b) Sage c) Cloves d) Nutmeg

A Ginger has been shown to be a safe antiemetic agent for pregnant women.

Because nausea and vomiting are such common complaints of pregnant women, the nurse provides anticipatory guidance to a 6-week gestation client by telling her to do which of the following? a) Avoid eating greasy foods b) Drink orange juice before rising c) Consume 1 teaspoon of nutmeg each morning d) Eat 3 large meals plus a bedtime snack

A Greasy foods should be avoided.

A client enters the prenatal clinic. She states that she believes she's pregnant. Which of the following hormone elevations will indicate a high probability that the client is pregnant? a) Chorionic gonadotropin b) Oxytocin c) Prolactin d) LH

A High levels of the hormone chorionic gonadotropin in the bloodstream and urine of the woman is a probable sign of pregnancy.

It is discovered that a pregnant women practices pica. Which of the following complications is most often associated w/ this disorder? a) Hypothyroidism b) Iron-deficiency anemia c) Hypercalcemia d) Overexposure to zinc

B Iron-deficiency is often seen in clients who engage in pica.

An ultrasound has identified that a client's pregnancy is complicated by hydramnios. The nurse would expect that an ultrasound may show that the baby has which of the following structural defects? a) Pulmonic stenosis b) Tracheoesophageal fistula c) Ventriculoseptal defect d) Developmental hip dysplasia

B The nurse would expect to find that the baby has tracheoesophagel fistula.

A hospitalized gravida's blood work is hematocrit 30% and hemoglobin 10 gm/dL. In light of the laboratory data, which of the following meal choices should the nurse recommend to this patient? a) Chicken livers, sliced tomatoes, and dried apricots b) Cheese sandwich, tossed salad, and rice pudding c) Veggie burger, cucumber salad, and wedge of cantaloupe d) Bagel with cream cheese, pear, and hearts of lettuce

A This meal choice is high in iron and ascorbic acid. It would be an excellent lunch choice for this client who has a below normal Hct and Hgb (anemic).

Which of the following clients is at highest risk for developing a hypertensive illness of pregnancy? a) G1 P0000, age 44 w/ history of DM b) G2 P0101, age 27 w/ history of rheumatic fever c) G3 P1102, age 25 w/ history of scoliosis d) G1 P1011, age 20 w/ history of celiac disease

A This primigravid client - age 11 and w/ a history of diabetes - is very high risk for preeclampsia.

The nurse is evaluating the effectiveness of bed rest for a client w/ mild preeclampsia. Which of the following S&S would the nurse determine is a positive finding? a) Weight loss b) 2+ proteinuria c) Decrease in plasma protein d) 3+ patellar reflexes

A Weight loss is a positive sign.

A woman provides the nurse with the following obstetrical history: Delivered a son, now 7 years old at 28 weeks gestation; delivered a daughter, now 5 years old, at 39 weeks gestation; had a miscarriage 3 years ago; and had a first trimester abortion 2 years ago. She is currently pregnant. Which of the following correctly portrays an accurate picture of this woman's gravidity and parity? a) G4 P2121 b) G4 P1212 c) G5 P1122 d) G5 P2211

C This accurately reflects this woman's gravidity and parity - G5 P1122.

A gravid woman, who is 42 weeks' gestation, has just had a 20-minute nonstress test (NST). Which of the following results would the nurse interpret as a reactive test? a) Moderate fetal heart baseline variability b) Maternal heart rate accelerations to 140 bpm lasting at least 20 seconds c) Two fetal heart accelerations of 15 bpm lasting at least 15 seconds d) Absence of maternal premature ventricular contractions

C This is the definition of a reactive NST.

A client has severe preeclampsia. The nurse would expect the primary HCP to order tests to assess the fetus for which of the following? a) Severe anemia b) Hypoprothrombinemia c) Craniosynotosis d) Intrauterine growth restriction

D The fetus should be assessed for intrauterine growth restriction.

The nurse is caring for a client who was just admitted to the hospital to rule out ectopic pregnancy. Which of the following orders is the most important for the nurse to perform? a) Take the client's temperature b) Document the time of the client's last meal c) Obtain urine for urinalysis and culture d) Assess for complaint of dizziness or weakness

D These symptoms are seen when clients develop hypovolemia from internal bleeding.

A gravid woman is carrying monochorionic twins. For which of the following complications should this pregnancy be monitored? a) Oligohydramnios b) Placenta previa c) Cephalopelvic disproportion d) Twin-to-twin transfusion

D Twin-to-twin transfusion is a relatively common complication of monozygotic twin pregnancies.

A gravid client, G6 P5005, 24 weeks' gestation, has been admitted to the hospital for placenta previa. Which of the following is an appropriate long-term goal for this client? a) The client will state an understanding of need for complete bed rest b) The client will have a reactive nonstress test on day 2 of hospitalization c) The client will be symptom free until at least 37 weeks' gestation d) The client will call her children shortly after admission

C This is a long-term goal.

The woman who has had multiple miscarriages is advised to go through genetic testing. The client asks the nurse the rationale for this recommendation. The nurse should base his/her response on which of the following? a) The woman's pedigree may exhibit a mitchondrial inheritance pattern b) The majority of miscarriages are caused by genetic defects c) A woman's chromosomal pattern determines her fertility d) There is a genetic marker that detects the presence of an incompetent cervix

B The majority of miscarriages are related to a genetic defect.

The nurse is grading a woman's reflexes. Which of the following grades would indicate reflexes that are slightly brisker than normal? a) + 1 b) +2 c) +3 d) +4

C 3+ reflexes are defined as slightly brisker than normal or slightly hyperreflexic.

A client asks the nurse what was meant when the physician told her she had a positive Chadwick's sign. Which of the following information about the finding would be appropriate for the nurse to convey at this time? a) "It's a purplish stretch on your abdomen." b) "It means that you're having heart palpitations." c) "It's a bluish discoloration of your cervix and vagina." d) "It means the doctor heard abnormal sounds when you breathed in."

C A positive Chadwick's sign means that the client's cervix and vagina are a bluish color. It's a probable sign of pregnancy.

The nurse has assessed four primigravid clients in the prenatal clinic. Which of the women would the nurse refer to the nurse midwife for further assessment? a) 10 weeks' gestation, complains of fatigue with nausea and vomiting b) 26 weeks' gestation, complains of ankle edema and chloasma c) 32 weeks' gestation, complains of epigastric pain and facial edema d) 37 weeks' gestation, complains of bleeding gums and urinary frequency

C Epigastric pain and facial edema are not normal.

A woman has been diagnosed w/ a ruptured ectopic pregnancy. Which of the following S&S is characteristic of this diagnosis? a) Dark brown rectal bleeding b) Severe nausea and vomiting c) Sharp unilateral pain d) Marked hyperthermia

C Sharp unilateral pain is a common symptom of a ruptured ectopic pregnancy.

A pregnant woman informs the nurse that her last normal menstrual period was on September 20, 2012. Using Nagele's rule, the nurse calculates the client's estimated date of delivery as: a) May 30, 2013 b) June 20, 2013 c) June 27, 2013 d) July 3, 2013

C The estimated date of delivery is June 27, 2013.

A 36-week gestation gravid client is complaining of dyspnea when lying flat. Which of the following is the likely clinical reason for this complaint? a) Maternal hypertension b) Fundal height c) Hydramnios d) CHF

C The fundal height is the likely cause of the woman's dyspnea.