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A patient with preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is a
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Which clinical intervention is the only known cure for preeclampsia?
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OB exam #4
| Question | Answer |
|---|---|
| A patient with preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is a | Anticonvulsant |
| Which clinical intervention is the only known cure for preeclampsia? | Delivery of fetus |
| The clinic nurse is performing a prenatal assessment on a pregnant patient at risk for preeclampsia. Which clinical sign would not present as a symptom of preeclampsia? | Glucosuria |
| Which intrapartal assessment should be avoided when caring for a patient with HELLP syndrome? | Abdominal palpation |
| A nurse is explaining to the nursing students working on the antepartum unit how to assess for edema. Which edema assessment score indicates edema of the lower extremities, face, hands, and sacral area? | +3 |
| Which maternal condition always necessitates delivery by cesarean birth? | Total placenta previa |
| Spontaneous termination of a pregnancy is considered to be an abortion if | the pregnancy is less than 20 weeks. |
| An abortion when the fetus dies but is retained in the uterus is called | missed |
| A placenta previa when the placental edge just reaches the internal os is called | marginal |
| Which finding would indicate concealed hemorrhage in abruptio placentae? | Hard boardlike abdomen |
| The priority nursing intervention when admitting a pregnant patient who has experienced a bleeding episode in late pregnancy is to | assess fetal heart rate and maternal vital signs. |
| A patient with preeclampsia is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate | worsening disease and impending convulsion. |
| Rh incompatibility can occur if the patient is Rh-negative and the | fetus is Rh-positive. |
| In which situation would a dilation and curettage (D&C) be indicated? | Incomplete abortion at 10 weeks |
| Which data found on a patient’s health history would place her at risk for an ectopic pregnancy? | Recurrent pelvic infections |
| Which finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole? | Fundal height measurement of 18 cm |
| Which routine nursing assessment is contraindicated for a patient admitted with suspected placenta previa? | Determining cervical dilation and effacement |
| A laboratory finding indicative of DIC is one that shows | decreased fibrinogen. |
| Which assessment in a patient diagnosed with preeclampsia who is taking magnesium sulfate would indicate a therapeutic level of medication? | Normal deep tendon reflexes |
| A patient taking magnesium sulfate has a respiratory rate of 10 breaths per minute. In addition to discontinuing the medication, which action should the nurse take? | Administer calcium gluconate. |
| A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on which of the following? | Hemorrhage is the primary concern. |
| A patient who was pregnant had a spontaneous abortion at approximately 4 weeks’ gestation. At the time of the miscarriage, it was thought that all products of conception were expelled. Two weeks later, the patient presents at the clinic office complaining | Uterine infection |
| A patient with no prenatal care delivers a healthy male infant via the vaginal route, with minimal blood loss. During the labor period, vital signs were normal. At birth, significant maternal hypertension is noted. When the patient is questioned, she rela | Undiagnosed chronic hypertension |
| A high-risk labor patient progresses from preeclampsia to eclampsia. Aggressive management is instituted, and the fetus is delivered via cesarean birth. Which finding in the immediate postoperative period indicates that the patient is at risk of developin | Platelet count of 50,000/mcL |
| As the triage nurse in the emergency room, you are reviewing results for the high-risk obstetric patient who is in labor because of traumatic injury experienced as a result of a motor vehicle accident (MVA). You note that the Kleihauer–Betke test is posit | immediate birth is required. |
| A patient who had premature rupture of the membranes (PROM) earlier in the pregnancy at 28 weeks returns to the labor unit 1 week later complaining that she is now in labor. The labor and birth nurse performs the following assessments. The vaginal exam is | Hidden placental abruption |
| What is the priority nursing intervention for the patient who has had an incomplete abortion? | Insertion of IV line for fluid replacement |
| Which finding in the assessment of a patient following an abruption placenta could indicate a major complication? | Bleeding at IV insertion site |
| Which assessment by the nurse would differentiate a placenta previa from an abruptio placentae? | Pain level 0 on a scale of 0 to 10 |
| A blood-soaked peripad weighs 900 g. The nurse would document a blood loss of mL. | 900 |
| Which intervention is the priority for the patient diagnosed with an intact tubal pregnancy? | Administration of methotrexate |
| Which finding in the exam of a patient with a diagnosis of threatened abortion would change the diagnosis to inevitable abortion? | Clear fluid from vagina |
| What should the nurse recognize as evidence that the patient is recovering from preeclampsia? | Urine output >100 mL/hour |
| Fraternal twins are delivered by your Rh-negative patient. Twin A is Rh-positive and twin B is Rh-negative. Prior to administering Rho(D) immune globulin (RhoGAM), the nurse should determine the results of the | indirect Coombs test of the mother. |
| For the patient who delivered at 6:30 AM on January 10, Rho(D) immune globulin (RhoGAM) must be administered prior to | 6:30 AM on January 13 |
| The labor and birth nurse is reviewing the risk factors for placenta previa with a group of nursing students. The nurse determines that the students understood the discussion when they identify which patient being at the highest risk for developing a plac | Male fetus, African-American, previous cesarean birth |
| A labor and birth nurse receives a call from the laboratory regarding a preeclamptic patient receiving an IV infusion of magnesium sulfate. The laboratory technician reports that the patient’s magnesium level is 7.6 mg/dL. What is the nurse’s priority act | Assess the patient’s respiratory rate. |
| Which factor is most important in diminishing maternal, fetal, and neonatal complications in a pregnant patient with diabetes? | Degree of glycemic control before and during the pregnancy |
| Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? | Hypoglycemia |
| Which factor is known to increase the risk of gestational diabetes mellitus? | Previous birth of large infant |
| Which disease process improves during pregnancy? | Rheumatoid arthritis |
| Nursing intervention for pregnant patients with diabetes is based on the knowledge that the need for insulin is | varied depending on the stage of gestation. |
| Which form of heart disease in women of childbearing years usually has a benign effect on pregnancy? | Mitral valve prolapse |
| Which instructions should the nurse include when teaching a pregnant patient with Class II heart disease? | Instruct her to avoid strenuous activity. |
| Anti-infective prophylaxis is indicated for a pregnant patient with a history of mitral valve stenosis related to rheumatic heart disease because the patient is at risk of developing | bacterial endocarditis. |
| A patient, who delivered her third child yesterday, has just learned that her two school-age children have contracted chickenpox. What should the nurse tell her? | She must make arrangements to stay somewhere other than her home until the children are no longer contagious. |
| A patient has a history of drug use and is screened for hepatitis B during the first trimester. Which action is most appropriate? | Plan for retesting during the third trimester. |
| A patient has tested HIV-positive and has now discovered that she is pregnant. Which statement indicates that she understands the risks of this diagnosis? | “Even though my test is positive, my baby might not be affected.” |
| Examination of a newborn in the birth room reveals bilateral cataracts. Which disease process in the maternal history would likely cause this abnormality? | Rubella |
| Which postpartum patient requires further assessment? | G1 P1 with Class II heart disease who complains of frequent coughing |
| The nurse is reviewing the instructions given to a patient at 24 weeks’ gestation for a glucose challenge test (GCT). The nurse determines that the patient understands the teaching when she makes which statement? | “I will have blood drawn at 1 hour after I drink the glucose solution.” |
| The labor nurse is admitting a patient in active labor with a history of genital herpes. On assessment, the patient reports a recent outbreak, and the nurse verifies lesions on the perineum. What is the nurse’s next action? | Ask the patient when she last had anything to eat or drink. |
| The nurse is monitoring a patient with severe preeclampsia who is on IV magnesium sulfate. Which signs of magnesium toxicity should the nurse monitor for? (Select all that apply.) | Altered sensorium Respiratory rate of less than 12 breaths per minute Absence of deep tendon reflexes |
| The rate of obesity in the United States has reached epidemic proportions. Morbidity and mortality for both the mother and baby are increased in these circumstances. The nurse caring for the patient with an elevated BMI should be cognizant of these potent | C. Birth defects d. Venous thromboembolism e. Postpartum anemia |
| A pregnant patient who abuses cocaine admits to exchanging sex for her drug habit. This behavior puts her at a greater risk for | sexually transmitted diseases. |
| Which factor is a major barrier to health care for adolescent mothers? | c. Seeing a different nurse and/or health care provider at every visit. |
| In planning sex education classes for the middle school age group, more emphasis should be placed on | how to set limits for sexual behavior. |
| Which action should the nurse take when counseling a teenaged patient who has decided to relinquish her baby for adoption? | Affirm her decision while acknowledging her maturity in making it. |
| A patient who is older than 35 years may have difficulty achieving pregnancy because | the ovaries may be affected by the normal aging process. |
| Which health concern is most likely to be an issue for the older mother? | Having enough rest and sleep |
| Which is the most dangerous effect on the fetus of a patient who smokes cigarettes while pregnant? | Intrauterine growth restriction |
| A patient at 24 weeks of gestation reports that she has a glass of wine with dinner every evening. Which rationale should the nurse provide this patient regarding the necessity to eliminate alcohol intake? | The fetus is placed at risk for altered brain growth |
| Which of the following is an example of healthy grieving? | While holding the baby, the mother says to her husband, “He has your eyes and nose.” |
| A patient has delivered twins. The first twin was stillborn, and the second is in the intensive care nursery, recovering quickly from respiratory distress. The patient is crying softly and says, “I wish my baby could have lived.” What is the most therapeu | “I am so sorry about your loss. Would you like to talk about it?” |
| Which action is the most appropriate nursing measure when a baby has an unexpected defect at birth? | Explain the defect and show the baby to the parents as soon as possible. |
| Which environment can assist a pregnant teen to achieve the task of establishing a stable identity? | School-based mothers’ program |
| Which complication of adolescent pregnancy should the nurse plan to monitor? | Anemia |
| The nurse is seeing a 17-year-old female in the clinic for complaints of acne. The nurse plans on taking advantage of this teachable moment with the teen. Which topics will the nurse include in the teen’s teaching plan? | Sexual activity, contraception, and screening for violence |
| A patient has just acknowledged that she is 20 weeks pregnant and confides to the nurse that she has a daily heroin habit. The nurse discusses treatment options for the patient. Which patient statement requires follow-up? | “My baby will not have to go through withdrawal when I take methadone.” |
| Which data in the patient’s history should the nurse recognize as being pertinent to a possible diagnosis of postpartum depression? | Previous depressive episode |
| Which nursing diagnoses may apply to the childbearing family with special needs? (Select all that apply.) | a.Risk for spiritual distress b. Risk for injury e. Situational low self-esteem |
| Many teens wait until the second or even third trimester to seek prenatal care. The nurse should understand that the reasons behind this delay include which of the following? (Select all that apply. | a. Continuing to deny the pregnancy b. Uncertainty about where to go for care Lack of realization that they are pregnant Wanting to hide the pregnancy as long as possible |
| Which characteristics of fetal alcohol syndrome (FAS) should the nurse expect to assess in affected neonates? (Select all that apply.) | c.Epicanthal folds d. Short palpebral fissures e. Flat midface, with a low nasal bridge |
| Which congenital defects in a newborn are associated with long-term parenting problems? (Select all that apply.) | Cleft lip and palate Ambiguous genitalia |
| Which pelvic shape is most conducive to vaginal labor and birth? | Gynecoid |
| Which action by the nurse prevents infection in the labor and birth area? | Keeping underpads and linens as dry as possible |
| A pregnant patient with premature rupture of membranes is at higher risk for postpartum infection. Which assessment data indicates a potential infection? | Cloudy amniotic fluid, with strong odor |
| A patient with polyhydramnios is admitted to a labor-birth-recovery-postpartum (LDRP) suite. Her membranes rupture and the fluid is clear and odorless; however, the fetal heart monitor indicates bradycardia and variable decelerations. Which action should | Perform a vaginal examination. |
| Which technique is least effective for the patient with persistent occiput posterior position? | Lying supine and relaxing |
| Birth for the nulliparous patient with a fetus in a breech presentation is usually | cesarean birth. |
| Which patient situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor? | A multiparous patient at 39 weeks of gestation who is expecting twins |
| Which factor is most likely to result in fetal hypoxia during a dysfunctional labor? | Incomplete uterine relaxation |
| After a birth complicated by a shoulder dystocia, the infant’s Apgar scores were 7 at 1 minute and 9 at 5 minutes. The infant is now crying vigorously. The nurse in the birthing room should | palpate the infant’s clavicles. |
| A laboring patient in the latent phase is experiencing uncoordinated irregular contractions of low intensity. How should the nurse respond to complaints of constant cramping pain? | I have notified the doctor that you are having a lot of discomfort. Let me rub your back and see if that helps.” |
| Which nursing action should be initiated first when there is evidence of prolapsed cord? | Reposition the mother with her hips higher than her head. |
| A patient who has had two previous cesarean births is in active labor when she suddenly complains of pain between her scapulae. Which should be the nurse’s priority action? | Notify the health care provider promptly. |
| Which factor should alert the nurse to the potential for a prolapsed umbilical cord? | Presenting part at a station of –3 |
| The fetus in a breech presentation is often born by cesarean birth because | compression of the umbilical cord is more likely |
| A patient who is 32 weeks pregnant telephones the nurse at her obstetrician’s office and complains of constant backache. She asks what pain reliever is safe for her to take. The best nursing response is | “You should come into the office and let the doctor check you.” |
| Which is the priority nursing assessment for the patient undergoing tocolytic therapy with terbutaline (Brethine)? | Fetal heart rate, maternal pulse, and blood pressure |
| Which clinical finding during assessment indicates uterine rupture? | Contractions abruptly stop during labor |
| Which intervention should be incorporated in the plan of care for a labor patient who is experiencing hypertonic labor? Vaginal exam is unchanged from prior exam—3 cm, 80% effaced, and 0 station presenting part vertex | Preparing the patient for epidural administration as ordered by the physician |
| During the course of the birth process, the physician suspects that a shoulder dystocia is occurring and asks the nurse for assistance. Which priority action should be taken in response to this request? | Ask the physician if he or she would like you to prepare for a surgical method of birth. |
| A pregnant patient who has had a prior obstetric history of preterm labors is pregnant with her third child. The physician has ordered a fetal fibronectin test. Which instructions should be given to the patient regarding this clinical test? | Patient should refrain from sexual activity prior to testing. |
| An obstetric patient has been identified as being high risk. The patient has had activities restricted (placed on bed rest) until the end of the pregnancy. Currently, she is at 32 weeks’ gestation and has two other children at home, ages 3 and 6. The pati | The patient and husband will make arrangements for child care routine activity assistance for the rest of the pregnancy. |
| A labor patient has been diagnosed with cephalopelvic disproportion (CPD) following attempts at pushing for 2 hours with no progress. Based on this information, which birth method is most appropriate? | Cesarean section |
| A patient is diagnosed with anaphylactoid syndrome of pregnancy. Which therapeutic intervention does the nurse expect will be included in the plan of care? | Initiation of CPR and other life support measures |
| A 20-year-old gravida 1, para 0 woman, is evaluated to be at 42 weeks’ gestation on admission to the labor and birth unit. The patient is not in labor at the current time; however, she has been sent over by the physician to be admitted for the induction o | Inform the patient that there are a number of serious concerns related to a postdate pregnancy and that she would be better off to be monitored in a clinical setting. |
| Which presentation is least likely to occur with a hypotonic labor pattern? | Fetal distress |
| Which finding on vaginal examination would be a concern if a spontaneous rupture of the membranes has occurred? | Presenting part at +3 station |
| Which intervention would be most effective if the fetal heart rate drops following a spontaneous rupture of the membranes? | Position the patient in the knee-chest position. |
| Which finding would be indicative of an adverse response to terbutaline (Brethine)? | Heart rate of 122 bpm |
| A dose of dexamethasone 12 mg was administered to a patient in preterm labor at 0830 hours on March 12. The nurse knows that the next dose must be scheduled for | 0830 hours on March 13th |
| When reviewing the prenatal record of a patient at 42 weeks’ gestation, the nurse recognizes that induction of labor is based upon which indication | reduced amniotic fluid volume |
| Which assessment finding in the postpartum patient following a uterine inversion indicates normovolemia? | Urine output >30 mL/hour |
| Which assessment finding indicates a complication in the patient attempting a vaginal birth after cesarean (VBAC)? | Complaint of pain between the scapulae |
| The labor nurse is providing care to a multigravida with moderate to strong contractions every 2 to 3 minutes, duration 45 to 60 seconds. On admission, her cervical assessment was 5 cm, 80%, and +2. An epidural was administered shortly thereafter. Two hou | Palpate the patient’s bladder for fullness. |
| Which patient is most at risk for a uterine rupture? | A gravida 4 who had a classic cesarean incision |
| A pregnant woman develops hypertension. The nurse monitors the patient’s blood pressure closely at subsequent visits because the nurse is aware that hypertension is associated with which complication? | Reduced placental blood flow |
| After birth, the nurse monitors the mother for postpartum hemorrhage secondary to uterine atony. Which clinical finding would increase the nurse’s concern regarding this risk? | Prolonged use of oxytocin |
| Emergency measures used in the treatment of a prolapsed cord include which of the following? (Select all that apply.) | Administration of oxygen via face mask at 8 to 10 L/minute b. Maternal change of position to knee-chest c. Administration of tocolytic agent e. Administration of tocolytic agent |
| Which presentation is most likely to occur with a hypertonic labor pattern? (Select all that apply.) | Painful uterine contractions Increased resting tone e. Increased uterine pressure |
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