OB Exam 3 Practice Questions from Saunders NCLEX

OB Exam 3 Practice Questions from Saunders NCLEX Review Leave the first rating Students also studied Terms in this set (48) Science MedicineNursing Save Intrapartum 82 terms meg_m21Preview Maternity-Intrapartum 40 terms kaytlynfPreview Maternity 38 terms NURSE1207Preview Antepa 100 term rosa The nurse is performing an assessment on a client who has just been told that a pregnancy test is positive. Which assessment finding indicates that the client is at risk for preterm labor?

• The client is a 35-year-old primigravida.
• The client has a history of cardiac disease.
• The client's hemoglobin level is 13.5 g/dL (135 mmol/L).
• The client is a 20-year-old primigravida of average

weight and height.

Answer: 2

Rationale: Preterm labor occurs after the 20th week but before the 37th week of

gestation. Several factors are associated with preterm labor, including a history of medical conditions, present and past obstetrical problems, social and environmental factors, and substance abuse. Other risk factors include a multifetal pregnancy, which contributes to overdistention of the uterus; anemia, which decreases oxygen supply to the uterus; and age younger than 18 years or first pregnancy at age older than 40 years.The nurse is monitoring a client who is in the active stage of labor. The nurse documents that the client is experiencing labor dystocia. The nurse determines which risk factors in the client's history places the client at risk for this complication? Select all that apply.

1.Age 45 years 2.Body mass index of 28 3.Previous difficulty with fertility 4.Administration of oxytocin for induction 5.Potassium level of 3.6 mEq/L (3.6 mmol/L)

Answer: 1, 2, 3

Rationale: Risk factors that increase a woman's risk for dystocia include the

following: advanced maternal age, being overweight, electrolyte imbalances,

previous difficulty with fertility, uterine overstimulation with oxytocin, short stature, prior version, masculine characteristics, uterine abnormalities, malpresentations and position of the fetus, cephalopelvic disproportion, maternal fatigue, dehydration, fear, administration of an analgesic early in labor, and use of epidural analgesia. Age 45 years is considered advanced maternal age, and a body mass index of 28 is considered overweight. Previous difficulty with fertility is another risk factor for labor dystocia. A potassium level of 3.6 mEq/L (3.6 mmol/L) is normal, and administration of oxytocin alone is not a risk factor; risk exists only if uterine hyperstimulation occurs.

The nurse in a birthing room is monitoring a client with dystocia for signs of fetal or maternal compromise. Which assessment finding would alert the nurse to a compromise?

• Maternal fatigue
• Coordinated uterine contractions
• Progressive changes in the cervix
• Persistent nonreassuring fetal heart rate

Answer: 4

Rationale: Signs of fetal or maternal compromise include a persistent,

nonreassuring fetal heart rate, fetal acidosis, and the passage of meconium.Maternal fatigue and infection can occur if the labor is prolonged but do not indicate fetal or maternal compromise. Coordinated uterine contractions and progressive changes in the cervix are a reassuring pattern in labor.The nurse in a labor room is preparing to care for a client with hypertonic uterine contractions. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. What is the priority nursing action?

• Provide pain relief measures.
• Prepare the client for an amniotomy.
• Promote ambulation every 30 minutes.
• Monitor the oxytocin infusion closely.

Answer: 1

Rationale: Hypertonic uterine contractions are painful, occur frequently, and are uncoordinated. Management of hypertonic labor depends on the cause. Relief of pain is the primary intervention to promote a normal labor pattern. An amniotomy and oxytocin infusion are not treatment measures for hypertonic contractions; however, these treatments may be used in clients with hypotonic dysfunction. A client with hypertonic uterine contractions would not be encouraged to ambulate every 30 minutes but would be encouraged to rest.The nurse is reviewing the primary health care provider's (PHCP's) prescriptions for a client admitted for premature rupture of the membranes. Gestational age of the fetus is determined to be 37 weeks. Which prescription would the nurse question?

• Monitor fetal heart rate continuously.
• Monitor maternal vital signs frequently.
• Perform a vaginal examination every shift.
• Administer an antibiotic per prescription and per

agency protocol.

Answer: 3

Rationale: Vaginal examinations should not be done routinely on a client with

premature rupture of the membranes because of the risk of infection. The nurse would expect to monitor fetal heart rate, monitor maternal vital signs, and administer an antibiotic.The nurse has created a plan of care for a client experiencing dystocia and includes several nursing actions in the plan of care. What is the priority nursing action?

• Providing comfort measures
• Monitoring the fetal heart rate
• Changing the client's position frequently
• Keeping the significant other informed of the progress

of the labor

Answer: 2

Rationale: Dystocia is difficult labor that is prolonged or more painful than

expected. The priority is to monitor the fetal heart rate. Although providing comfort measures, changing the client's position frequently, and keeping the significant other informed of the progress of the labor are components of the plan of care, the fetal status would be the priority.Fetal distress is occurring with a laboring client. As the nurse prepares the client for a cesarean birth, what is the most important nursing action?

• Slow the intravenous flow rate.
• Continue the oxytocin drip if infusing.
• Place the client in a high Fowler's position.
• Administer oxygen, 8 to 10 L/minute, via face mask.

Answer: 4

Rationale: Oxygen is administered, 8 to 10 L/minute, via face mask to optimize

oxygenation of the circulating blood. Option 1 is incorrect, because the intravenous infusion needs to be increased (per primary health care provider prescription) to increase the maternal blood volume. Option 2 is incorrect, because oxytocin stimulation of the uterus is discontinued if fetal heart rate patterns change for any reason. Option 3 is incorrect because the client is placed in the lateral position with the legs raised to increase maternal blood volume and improve fetal perfusion.

The nurse in a labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence of the umbilical cord protruding from the vagina. What is the first nursing action with this finding?

• Gently push the cord into the vagina.
• Place the client in Trendelenburg's position.
• Find the closest telephone and page the primary

health care provider stat.

• Call the delivery room to notify the staff that the client

will be transported immediately.

Answer: 2

Rationale: When cord prolapse occurs, prompt actions are taken to relieve cord

compression and increase fetal oxygenation. The client would be positioned with the hips higher than the head to shift the fetal presenting part toward the diaphragm. The nurse would push the call light to summon help, and other staff members would call the primary health care provider and notify the delivery room. If the cord is protruding from the vagina, no attempt is made to replace it because to do so could traumatize it and reduce blood flow further. Also as a first action, the examiner would place a gloved hand into the vagina and hold the presenting part off the umbilical cord. Oxygen, 8 to 10 L/minute, by face mask is administered to the client to increase fetal oxygenation.The nurse is providing instructions to a pregnant client with human immunodeficiency virus (HIV) infection regarding care of the newborn after delivery. The client asks the nurse about the feeding options that are available. Which response would the nurse make to the client?

• "You will need to bottle-feed your newborn."
• "You will need to feed your newborn by nasogastric

tube feeding."

• "You will be able to breast/chest-feed for 6 months and

then will need to switch to bottle-feeding."

• "You will be able to breast/chest-feed for 9 months and

then will need to switch to bottle-feeding."

Answer: 1

Rationale: Perinatal transmission of HIV can occur during the antepartum period, during labor and birth, or in the postpartum period if the birthing parent is breast/chest-feeding. Clients who have HIV will most likely be advised not to breast/chest-feed; however, the PHCP's recommendations regarding breast/chest-feeding are always followed. There is no physiological reason why the newborn needs to be fed by nasogastric tube.The home care nurse visits a pregnant client who has a diagnosis of preeclampsia. Which assessment finding indicates a worsening of the preeclampsia and the need to notify the primary health care provider (PHCP)?

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

Answer: 4

Rationale: If the client complains of a headache and blurred vision, the PHCP

needs to be notified because these are signs of worsening preeclampsia. Options 1, 2, and 3 are normal findings.The nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes mellitus. Which statement made by the client indicates a need for further teaching?

• "I need to stay on the diabetic diet."
• "I need to perform glucose monitoring at home."
• "I need to avoid exercise because of the negative

effects on insulin production."

• "I need to be aware of any infections and report signs

of infection immediately to my obstetrician."

Answer: 3

Rationale: Exercise is safe for a client with gestational diabetes mellitus and is helpful in lowering the blood glucose level. Dietary modifications are the mainstay of treatment, and the client is placed on a standard diabetic diet. Many clients are taught to perform blood glucose monitoring. If the client is not performing the blood glucose monitoring at home, it is performed at the clinic or obstetrician's office. Signs of infection need to be reported to the obstetrician.

The nurse is performing an assessment on a pregnant client in the last trimester with a diagnosis of preeclampsia. The nurse reviews the assessment findings and determines that which finding is most closely associated with a complication of this diagnosis?

• Enlargement of the breasts
• Complaints of feeling hot when the room is cool
• Periods of fetal movement followed by quiet periods
• Evidence of bleeding, such as in the gums, petechiae,

and purpura

Answer: 4

Rationale: Severe preeclampsia can trigger disseminated intravascular coagulation (DIC) because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and needs to be reported to the primary health care provider if noted on assessment. Options 1, 2, and 3 are normal occurrences in the last trimester of pregnancy.The nurse in a maternity unit is reviewing the clients' records. Which clients would the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)? Select all that apply.

1.A primigravida with abruptio placentae 2.A primigravida who delivered a 10-lb infant 3 hours ago 3.A gravida 2 who has just been diagnosed with dead fetus syndrome 4.A gravida 4 who delivered 8 hours ago and has lost 500 mL of blood 5.A primigravida at 29 weeks of gestation who was recently diagnosed with gestational hypertension

Answer: 1, 3, 5

Rationale: In a pregnant client, DIC is a condition in which the clotting cascade is activated, resulting in the formation of clots in the microcirculation. Predisposing conditions include abruptio placentae, amniotic fluid embolism, gestational hypertension, HELLP syndrome, intrauterine fetal death, liver disease, sepsis, severe postpartum hemorrhage, and blood loss. Delivering a large newborn is not considered a risk factor for DIC. Hemorrhage is a risk factor for DIC; however, a loss of 500 mL is not considered hemorrhage.The home care nurse is monitoring a pregnant client who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which sign of preeclampsia?

• Hypertension
• Low-grade fever
• Generalized edema
• Increased pulse rate

Answer: 1

Rationale: A sign of preeclampsia is persistent hypertension. A low-grade fever or increased pulse rate is not associated with preeclampsia. Generalized edema may occur but is not a specific sign of preeclampsia because it can occur in many conditions.The nurse is assessing a pregnant client with type 1 diabetes mellitus about an understanding regarding changing insulin needs during pregnancy. The nurse determines that further teaching is needed if the client makes which statement?

• "I will need to increase my insulin dosage during the

first 3 months of pregnancy."

• "My insulin dose will probably need to be increased

during the second and third trimesters."

• "Episodes of hypoglycemia are more likely to occur

during the first 3 months of pregnancy."

• "My insulin needs will return to prepregnant levels

within 7 to 10 days after birth if I am bottle-feeding."

Answer: 1

Rationale: Insulin needs decrease in the first trimester of pregnancy because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. The statements in options 2, 3, and 4 are accurate and signify that the client understands control of the diabetes during pregnancy.