Nclex questions for OB exam 2

Nclex questions for OB exam 2

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Practice NCLEX Q's: Preeclampsia, E...

13 terms maci_mclainPreview High Risk Pregnancy NCLEX Questi...14 terms brittbarnwell91 Preview Preecla 54 terms cici A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with the

diagnosis and assesses the client for:

1.Any bleeding, such as in the gums, petechiae, and purpura.

2.Enlargement of the breasts 3.Periods of fetal movement followed by quiet periods 4.Complaints of feeling hot when the room is cool

• Severe Preeclampsia can trigger disseminated intravascular coagulation (DIC;

remember the Peds lecture?) because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the M.D A homecare nurse visits a pregnant client who has a diagnosis of mild Preeclampsia and who is being monitored for pregnancy induced hypertension (PIH).Which assessment finding indicates a worsening of the Preeclampsia and the need to notify the physician?

1.Blood pressure reading is at the prenatal baseline 2.Urinary output has increased 3.The client complains of a headache and blurred vision 4.Dependent edema has resolved

• If the client complains of a headache and blurred vision, the physician should

be notified because these are signs of worsening Preeclampsia.A primagravida is receiving magnesium sulfate for the treatment of pregnancy induced hypertension (PIH). The nurse who is caring for the client is performing assessments every 30 minutes. Which assessment finding would be of most concern to the nurse?A.Urinary output of 20 ml since the previous assessment B.Deep tendon reflexes of 2+ C.Respiratory rate of 10 BPM D.Fetal heart rate of 120 BPM

• Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less

than 12 breaths per minute, the physician or other health care provider needs to be notified, and continuation of the medication needs to be reassessed. A urinary output of 20 ml in a 30 minute period is adequate; less than 30 ml in one hour needs to be reported. Deep tendon reflexes of 2+ are normal. The fetal heart rate is WNL for a resting fetus.

A nurse is caring for a pregnant client with Preeclampsia.The nurse prepares a plan of care for the client and documents in the plan that if the client progresses from

Preeclampsia to eclampsia, the nurse's first action is to:

A.Administer magnesium sulfate intravenously B.Assess the blood pressure and fetal heart rate C.Clean and maintain an open airway D.Administer oxygen by face mask

• The immediate care during a seizure (eclampsia) is to ensure a patent airway.

The other options are actions that follow or will be implemented after the seizure has ceased.A nurse is monitoring a pregnant client with pregnancy induced hypertension who is at risk for Preeclampsia. The nurse checks the client for which specific signs of Preeclampsia (select all that apply)?A.Elevated blood pressure B.Negative urinary protein C.Facial edema D.Increased respirations A and C. The three classic signs of preeclampsia are hypertension, generalized edema, and protenuria. Increased respirations are not a sign of preeclampsia A pregnant client is receiving magnesium sulfate for the management of preeclampsia. A nurse determines the client is experiencing toxicity from the medication if which of the following is noted on assessment?A.Presence of deep tendon reflexes B.Serum magnesium level of 6 mEq/L C.Proteinuria of +3 D.Respirations of 10 per minute

• Magnesium toxicity can occur from magnesium sulfate therapy. Signs of toxicity

relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden drop in the fetal heart rate and maternal heart rate and blood pressure. Therapeutic levels of magnesium are 4-7 mEq/L. Proteinuria of +3 would be noted in a client with preeclampsia.A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care for the client

determines that the magnesium therapy is effective if:

A.Ankle clonus in noted B.The blood pressure decreases C.Seizures do not occur D.Scotoma's are present

• For a client with preeclampsia, the goal of care is directed at preventing

eclampsia (seizures). Magnesium sulfate is an anticonvulsant, not an antihypertensive agent. Although a decrease in blood pressure may be noted initially, this effect is usually transient. Ankle clonus indicated hyperrelexia and may precede the onset of eclampsia. Scotomas are areas of complete or partial blindness. Visual disturbances, such as scotomas, often precede an eclamptic seizure.nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate.Select all nursing interventions that apply in the care for the client.

1.Monitor maternal vital signs every 2 hours 2.Notify the physician if respirations are less than 18 per minute.

3.Monitor renal function and cardiac function closely 4.Keep calcium gluconate on hand in case of a magnesium sulfate overdose 5.Monitor deep tendon reflexes hourly 6.Monitor I and O's hourly 7.Notify the physician if urinary output is less than 30 ml per hour.3, 4, 5, 6, and 7. When caring for a client receiving magnesium sulfate therapy, the nurse would monitor maternal vital signs, especially respirations, every 30-60 minutes and notify the physician if respirations are less than 12, because this would indicate respiratory depression. Calcium gluconate is kept on hand in case of magnesium sulfate overdose, because calcium gluconate is the antidote for magnesium sulfate toxicity. Deep tendon reflexes are assessed hourly. Cardiac and renal function is monitored closely. The urine output should be maintained at 30 ml per hour because the medication is eliminated through the kidneys.

The antagonist for magnesium sulfate should be readily available to any client receiving IV magnesium. Which of the following drugs is the antidote for magnesium toxicity?A.Calcium gluconate B.Hydralazine (Apresoline) C.Narcan D.RhoGAM

• Calcium gluconate is the antidote for magnesium toxicity. Ten ml of 10% calcium

gluconate is given IV push over 3-5 minutes. Hydralazine is given for sustained elevated blood pressures in preeclamptic clients.A client who is 32 weeks pregnant is being monitored in the antepartum unit for PIH. She suddenly complains of continuous abdominal pain and vaginal bleeding. Which of the following nursing internventions should be included in the care of this client? Check all that apply

• Evaluate VS
• Prepare for vaginal delivery
• Reassure client that she'll be able to continue

pregnancy

• Evaluate FHT
• Monitor amt of vaginal bleed
• Monitor I&O
• Evaluate VS
• Evaluate FHT
• Monitor amt of vaginal bleed
• Monitor I&O

The clients Sx indicate that she's experiencing abruptio placenta.The nurse must immed eval the moms well being by eval VS, FWB, by auscultation of heart tones, monitoring amt of blood loss and eval the vol status by measuring I&O.After the severity of the abruption has been determined and blood and fluid have been replaced, prompt C-SECTION delivery of the fetus (not vaginal) is indicated if the fetus is in distress A home care nurse visits a pregnant client who ad a diagnosis of mild preeclampsia. Which assessment finding indicates a worsening of the preeclampsia and the need to notify the physician?

• Urinary output as increased
• Dependent edema has resolved
• BP reading is at the prenatal baseline
• The client complains of a headache and blurred vision.
• The client complains of a headache and blurred vision.

A home care nurse is monitoring a pregnant client with gestational HTN who is at risk for preeclampsia. At each home care visit, the nurse assess the client for which classic signs of preeclampsia? SELECT ALL THAT APPLY.

• Proteinuria

2. HTN

• Low grade fever
• Generalized edema
• Increased pulse rate
• Increased respirator rate
• Proteinuria

2. HTN

• Generalized edema

A nurse is assessing a pregant client in the 2nd trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this condition is present?

• Soft abdomen
• Uterine tenderness
• Absence of abdominal pain
• Painless, bright red vaginal bleeding
• Uterine tenderness

A maternity nurse is preparing for the admission of a client in the 3rd trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse review the physican's prescriptions and would question which prescription?

• Prepare the client for an ultrasound
• Obtain equipment for a manual pelvic examination
• Prepare to draw a hemoglobin and hematocrit blood

sample

• Obtain equipment for external electronic FHR

monitoring.

• Obtain equipment for a manual pelvic examination

An ultrasound is performed on a client at term gestation who is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that abruptio placentae is present. Based on these findings, the nurse would

prepare the client for:

• Delivery of the fetus
• Strict monitoring of I/O
• Complete bedrest for the remainder of the pregnancy
• The need for weekly monitoring of coagulation studies

until the time of delivery

• Delivery of the fetus

A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which risk associated with placenta previa?

• Infection
• Hemorrhage
• Chronic HTN

4. DIC

• Hemorrhage