Obstetrics NCLEX questions

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NCLEX-Style Questions: Obstetrics ...

73 terms fiore_joseph5Preview Sherpath chapter 8 35 terms brooks__morgan Preview

Chapter 10: assessment of high risk ...

10 terms amanda_coon5 Preview peds a 38 terms am A woman whose pregnancy has been confirmed asks the healthcare provider when her baby is due. The first day of her last menstrual period was March 20. Using Naegele's rule, the healthcare provider estimates the date of birth to be which of the following?December 27 January 17 December 20 February 13 December 27 Rationale: to estimate EDD, begin with the first day of the woman's last menstrual period and add 7 days. Next, subtract 3 months.The healthcare provider is assessing a pregnant woman during her first prenatal visit. The patient reports she has a 5 year old at home who was delivered at 39 weeks gestation. Her last pregnancy ended at 12 weeks gestation due to a spontaneous abortion. She delivered a set of twins at 22 weeks gestation. The twins died within 12 hours of birth. How will the healthcare provider document this patient's obstetrical history using the GTPAL system?

G4 T1 P1 A1 L1

G4 T1 P2 A1 L1

G5 T2 P1 A0 L3

G3 T2 P2 A0 L2

G4 T1 P2 A1 L1

G → gravida (number of times a woman is pregnant, regardless of duration). T → babies delivered at term (after 37 weeks). P → babies delivered preterm (after 20 weeks but prior to 37). A → number of pregnancies that terminate in spontaenous abortion (miscarriage) or therapeutic abortion. L → number of living children.

A primigravida who is at 38 weeks gestation calls the nurse's hotline stating she felt several contractions in her abdomen during the past hour.She reports that the contractions were irregular and they decreased after she took a walk around the block. Based on this information, what is the nurse's best response?Come to the hospital when your contractions are regular and about 1 minute apart Come to the hospital when your contractions are regular and about 5 minutes apart You should wait 1-2 hours and then come to the hospital Birth is imminent so you should come to the hospital immediately Come to the hospital when your contractions are regular and about 5 minutes apart Rationale: Contractions of true labor are regular and gradually increase in frequency, duration, and intensity. They usually start in the back and move to the front of the abdomen, and they are not relieved by walking. The beginning (latent) stage of labor is characterized by contractions every 10 to 30 minutes, progressing to every 5 to 7 minutes. False labor contractions are irregular, are usually felt only in the front of the abdomen, and often stop or decrease with activity.The healthcare provider is reviewing the laboratory results of a woman in her second trimester of pregnancy. Which of the following are expected results for this patient? Select all that apply.Increased RBC count Decreased Hgb Increased WBC count Decreased hematocrit Increased fibrinogen Decreased Hgb Increased WBC count Decreased hematocrit Increased fibrinogen Rationale: As a protection against hemorrhage during childbirth, coagulation factors like fibrinogen increase during pregnancy. White blood cell counts increase during pregnancy to help fight off infections that could harm the fetus. The growing uterus, placenta, and uterus require increased oxygen delivery. Red blood cells increase, but plasma volume increases even more, causing hemodilution.

A woman who has a diagnosis of preeclampsia is in active labor and is receiving an IV infusion of magnesium sulfate. When planning care for this woman, which of these are a priority for the healthcare provider to monitor? Select all that apply.Respiratory rate BUN and creatinine Blood glucose Deep tendon reflexes Blood pressure Urine intake and output Respiratory rate BUN and creatinine Deep tendon reflexes Blood pressure Urine intake and output Rationale: at therapeutic levels, mag sulf slows neuromuscular conduction and depresses CNS irritability. Magnesium toxicity causes loss of deep tendon reflexes, progressive muscle weakness (diaphragm) and depression of the respiratory center of the brain. Magnesium is eliminated primarily via the renal system, so urine output, BUN, and creatinine are a priority to monitor to ensure adequate renal function and prevent hypermagnesemia. BP is essential to monitor because one of the symptoms of preeclampsia is elevated BP.A woman is admitted to the birthing center with a diagnosis of severe preeclampsia. Assessment findings include: BP of 165/95 mmHg, 3+ proteinuria, and visual disturbances. Which of these additional assessment findings should the healthcare provider expect? Select all that apply.Edema of the hands and face Clonus Fetal HR accelerations Right upper quadrant pain Headache Vaginal bleeding Edema of the hands and face Clonus Right upper quadrant pain Headache Rationale: edema → caused by vasospasm, vasoconstriction, and increased vascular permeability. Clonus → neuromuscular irritability. RUQ pain → hepatocellular damage caused by vasospasm and ischemia (may also present as epigastric pain). Headache → vasospasm of the cerebral vasculature.Fetal HR → vasoconstriction and edema results in decreased perfusion to organs, including uterus and placenta. Fetal hypoxia would manifest in decreased variability, and fetal HR accelerations are a sign of fetal well-being. Vaginal bleeding → not an expected finding in preeclampsia.A nurse is preparing to perform a fundal assessment on a postpartum client. The initial nursing action in performing this assessment is which of the following?Ask the client to turn on her side Ask the client to lie flat on her back with the knees and legs flat and straight Ask the mother to urinate and empty her bladder Massage the fundus gently before determining the level of the fundus Ask the mother to urinate and empty her bladder

The nurse is assessing the lochia on a 1 day PP patient. The nurse notes that the lochia is red and has a foul-smelling odor. The nurse determines

that this assessment finding is:

Normal Indicates the presence of infection Indicates the need for increasing oral fluids Indicates the need for increasing ambulation Indicates the presence of infection Rationale: red lochia 1 day PP is a normal assessment finding. Normal lochia has a fleshy odor. Foul smelling or purulent lochia usually indicates infection.When performing a PP assessment on a client, the nurse notes the presence of clots in the lochia. The nurse examines the clots and notes that they are larger than 1cm. Which of the following nursing actions is most appropriate?Document the findings Notify the physician Reassess the client in 2 hours Encourage increased intake of fluids Notify the physician Rationale: clots larger than 1cm are considered abnormal. The cause of these clots, such as uterine atony or retained placental fragments, needs to be determined and treated to prevent PPH.A nurse on the maternity unit is instructing a mother regarding lochia and the amount of expected lochia drainage. The nurse instructs the mother that the normal amount of lochia may vary, but should never exceed the need for: One peripad per day Two peripads per day Three peripads per day Eight peripads per day Eight peripads per day A PP nurse is providing instructions to a woman after the vaginal delivery of a healthy newborn infant. The nurse instructs the mother that she

should expect normal bowel elimination to return:

One the day of the delivery

• days PP
• days PP

Within 2 weeks PP

• days PP