NCLEX-PN Prenatal questions

NCLEX-PN Prenatal questions 5.0 (2 reviews) Students also studied Terms in this set (28) Science MedicineObstetrics Save Antepartum NCLEX questions 50 terms smbauer2Preview Prenatal Period NCLEX Questions 10 terms katherine_wilkins Preview High Risk Pregnancy NCLEX Questi...14 terms brittbarnwell91 Preview Pregna 109 term Bro A 37 year old gravida 1 at 38 weeks' gestation is scheduled for an amniocentesis. After learning the client was diagnosed with diabetes at age 17, the nurse concludes that the procedure is most likely being done to assess for what potential problem?

• Neural tube defects
• Down syndrome
• Effects of TORCH syndrome
• Lung Maturity

D Rationale: Amniocentesis for genetic testing is usually done early in the second trimester. Amniocentesis for a client with diabetes mellitus at 38 weeks' gestation isprobably being done to assess lung maturity in anticiaption of delivery.A client at 24 weeks' gestation has been scheduled for an amniocentesis. Which actions should the nurse plan to take in the care of this client? SATA

• Monitor maternal vital signs and fetal heart rate during

procedure.

• Instruct that an ultrasound machine will be used during

the procedure.

• Assist the woman in assuming a supine position with a

wedge under left hip.

• Have a consent signed for an epidural analgesia.
• Explain that 60 mL of amniotic fluid will be withdrawn.

A, B, C

Rationale: Maternal vital signs and FHR are monitored during oricedure. The test is completed on an outpatient basis under guidance of ultrasound visulaization. The client is positioned on her back with a wedge under her left hip to avoid hypotension from pressure of the uterus on the vena cava. Epidural analgesia is not used for the procedure. Approxiamtely 15-20 mL of amniotic fluid are aspirated for the procedure

The client is scheduled to have an amniocentesis for an assessment of lung maturity. She seems upset, and says that she doesn't understand how this test could tell if a baby's lungs are mature. What is the best response by the nurse?

• "Please try not to worry about that. Your doctor knows

the procedure well."

• "The fluid changes color as the fetal lungs mature. We

look at the color to determine lung maturity."

• "A chemical called lecithin is made by the fetal lungs

and increases as pregnancy continues. It flows into amniotic fluid, where we can measure it."

• "The amount of bilirubin in amniotic fluid increases as

the lung matures. We check for yellow colored fluid to assess lung maturity.C Rationale: The amount of lecithin increases as the fetal lungs mature. The ration of lecithin to sphingomyelin is used to assesslung maturity. To ask the client not to worry or state the doctor knows the procedure well does not provide information to the client. The color of amniotic fluid is not useful in determining lung maturity.Bilirubin levels in amniotic fluid do not determine lung maturity.The nurse formulate which nursing diagnosis as highest priority for a client about to undergo an amniocentesis?

A. Imbalanced Nutrition: Less than body requirements

related to NPO status.

• Risk for Aspiration related to anesthesia
• Anxiety related to concern for fetal well-being.
• Risk foe Deficient Fluid Volume related to removal of

amniotic fluid.C Rationale: Most women view invasive antenatal testing with anxiety because of the reason for the test, theimpending results, and concern about maternal and fetus complications. A client does not have to be NPO prior to amnicentesis.Amniocentesis does not require anesthesia, althoug a local anesthetic may be used to numb the skin before needle insertion. Because only 15-20 mL of fluid removed, the client is not at risk for Deficient Fluid Volume.The nurse assesses that which maternal condition in the third trimester would be a contraindication for conducting a contraction stress test? SATA

• Intrauterine growth restriction
• Diabetes mellitus
• Pregnancy at 42 weeks' gestation
• Marginal abruptio placentae
• Third trimester bleeding

D, E Rationale: Intrauterine growth restriciton, diabetes mellitus, and post-term (42 weeks) pregnancy are all indications for completing a contraction stress test.Contraindications elicited during the test could cause increased bleeding if an abruption is present or if there is already bleeding in the third trimester.A primigravida is hospitalized at 32 weeks' gestation after a second hemorrhage from a complete placenta previa.The client appears subdued and sad after learning she will remain hospitalized until delivery. She says she is worried about her husband, who will be at home alone much of the time. The nurse interprets the client's response as indicating which psychological state?

• Anxiety
• Denial
• Immaturity
• Ineffective coping

A Rationale: The client has stated that she is worried, which creates anxiety. The information presented does not represent denial or immaturity. There is not enough data to to determine whether the client's coping is effective at this time The nurse reviews the clients chart for results of which diagnostic test that will best indicate a diagnosis of crythroblastosis fetalis?

• Amniocentesis
• Biophysical profile
• Indirect Coombs' test
• Percutaneous umbilical blood sampling

D

Rationale: Percutaneous umbilical blood sampling (PUBS) obtains an actual

sample of fetal blood for analysis. Amniocentesis , biophysical profile, and indirect Coomb's test provide information about fetal well-being,but do not directly sample the fetal erythrocytes

The nurse is caring for a client with a concealed abruption placentae prepares to assess the client for which complications a priority after delivery?

• Retained placental fragments
• Urinary tract infection
• Uterine atony
• Vaginal hematoma

C

Rationale: A concealed abruption could result in a Couvelaire uterus, which

doesn't contract effectively after delivery, leading to uterine atony. Retained placental fragments, vaginal hematoma, or urinary tract infection could occur in any client.A pregnant client with class II heart disease progressed through pregnancy without complications and is admitted to the hospital in active labor. Soon after admission, the client reports shortness of breath and the nurse auscultates lung crackles. The nurse anticipates administering which medication based on client's history?

SATA

• Penicililn (generic)
• Metoprolol (Lopressor)
• Furosemide (Lasix)
• Digoxin (Lanosin)
• Procainamide (Proestyl)

A, C, D

Rationale: Prophylatctic antibiotics such as peicillin are given during labor to prevent bacterial endocarditis. A cardiac glycoside such as digoxin and diuretic such as furosemide may help counteract the new signs of decreased cardiac output (crackles and shortness of breath). An antihypertensive such as metoprolol or antidysrhythmic such as procainamide would be used only as needed.The nurse conducts client teaching with a pregnant client who has placenta previa and who states she has religious beliefs that prohibit receiving blood or blood products.The nurse evaluates that the teaching has been effective if the client makes which statement?

• "A judge will force me to accept a transfusion if I really

need it"

• "I might have to sign out of the hospital against medical

advice (AMA)."

• "I will meet with the dietician to increase the amount of

iron in my diet."

• "There is little chance that I will bleed heavily during

this pregnancy." C Rationale: The client is likely to lose some blood with a placenta previa. Increasing ironin her diet is a positive response that does not interfere with her religious beliefs. A judge will not force a transfusion. The client wil not need to sign out AMA to avoid receiving a transfusion, even if one is indicated. It isn ot possible to predict that amount of bleeding that could be expeirenced by a specific client with placenta previa.The nurse would assess the preganant client with a history of multiple sexual partners for which complication of preganancy of greatest concern in this situation?

• Ectopic pregnancy
• Premature rupture of membranes
• Preeclampsia
• Rh-incompatibility

A Rationale: The client with multiple partners is at high risk for sexually transmitted diseases and ascending infection that can lead to blockage in the fallopian tubes.Ultimately, this process could lead to ectopic pregnancy. The other options do not address this particular pathophysiological concern.The nurse anticipates that a pregnant client with a history of which health problem might benefit from a scheduled Cesarean birth to have an improved outcome for the infant? SATA

• Diabetes mellitus
• Active genital herpes lesions
• Human immunodeficiency virus
• Systemic lupus erythematosus
• Class I heart disease

B, C Rationale: A client with active herpes lesions should be delivered by Cesarean to prevent transmission of the virus during vaginal birth. The chance of transmission of HIV is less than 1% if the infant is delivered by Cesarean prior to rupture of membrane. A client with diabetes, systemic lupus erythematosus or heart disease does not require Cesarean delivery based on this diagnosis alone.

Which short term client outcome would be most appropriate for a client admitted to the hospital with hyperemesis gravidarum and the nursing diagnosis of

Imbalanced Nutrition: Less than body requirements?

• Measures own hourly intake and output (I&O)
• Maintains present weight
• Identifies favorite foods in the diet
• Verbalizes risks to the fetus

B

Rationale: A short-term outcome of maintained weight is appropriate while the

client is being stablized in the hospital. While I & O are important measurements, they do not need to be done hourly, and this intervention would help evaluate whether a goal of fluid balance is maintained. Being able to identify favorite foods is not sufficient to assure a client outcome of Adequate Nutritional Intake.Verbalizing risks of malnutrition to the fetus does nothing to alter the condition.A prenatal client with type I diabetes mellitus asks the clinic nurse whether she will be able to breastfeed her baby. Which response by the nurse is most accurate?

• "Breastfeeing is contrainicated for insulin-dependent

moms"

• "Certainly, breastfeeding will be beneficial for both of

you"

• "I think this is a good idea because it also prevents

pregnancy"

• "You will have a lot of difficulty maintaining a stable

blood sugar" B

Rationale: Breastfeeding should be encouraged because it benefits both the

mother and her infant. Breastfeeding is not contraindicated for diabetic mothers.Breastfeeding might or might not help prevent future pregnancy during lactation.Breastfeeding does not necessarily lead to loss of blood glucose control with careful management A client is admitted with membranes that ruptured 4 hours ago and occasional mild contractions. The term fetus looks healthy on external monitoring. What is the priority intervention in the nursing plan of care for this client?

• Encourage ambulation
• Monitor vital signs
• Promote rest
• Provide clear liquids

B Rationale: The client with premature ruptured membranes is at risk for developing infection and should have vital signs, specifically temperature, monitored every 2 hours. The client may be on bedrest, not ambulating, following ruptureof the membranes. Promoting rest and providing clear liquids are slightly lower priorities for this client.A prenatal client at 14 weeks' gestation reports continuous nausea and vomiting, and severe headache.The blood pressure is elevated and fundal height is 21 cm.Which diagnostic test does the nurse anticipate will be ordered to confirm a hydatidiform mole?

• Biophysical profile
• Human chorionic gonadotropin
• Maternal serum alpha-fetoprotein
• Sonography

D Rationale: Ultrasound confirms the diagnosis of molar pregnancy that is indicated by the client's symptoms. The client will have high hCG levles and low maternal serum alpha-fetoprotein levels , but these are not conclusive for hydatidiform mole. Biophysical profile is inappropriate before the third trimester because that test evaluates the fetus.An HIV positive client in active labor with newly ruptured membranes is being transported to the hospital via ambulance. The labor and delivery nurse anticipates priority administration of which medication to this client?

• Antibiotics
• Immune globulin
• Oxytocin (pitocin)
• Zidovudine (Retrovir)

D Rationale: The rate of transmission of HIV to the newborn decreases sharply if the mother is given prophylactic zidovudine (Retrovir) orally during pregnancy and by IV during labor.