Women's Health: OB Exam 1 Study Guide

Exam 1 1. A client is 24 weeks pregnant. The nurse notes on the prenatal record that the patients BP was 120/70 before pregnancy. Today the patients BP is 110/62. The nurse should take which of the following actions? a. Chart the findings 2. A multigravida who is O negative will have which routine screening tests to determine if Rh sensitization has occurred? a. Indirect Coombs test 3. A pregnant woman is married to an intravenous drug user. She had a negative HIV screening test just after missing her first menstrual period. What would indicate that the patient needs to be retested if occurring later in pregnancy? a. Unusual fatigue, recurring candida vaginitis (yeast) and other recurrent infection. 4. A couple are both known to be carriers of the autosomal recessive disorder cystic fibrosis. They are unaffected, but their 2-year-old daughter has the condition. They are planning a second pregnancy and would like to understand their chances of a second child being affected. Which of the following responses by the nurse is accurate? a. “The chances are 1 in 4 of your children being affected the chances are the same with each pregnancy.” 5. After an early ultrasound, a woman and her spouse learn they are having twins. Which statements by the nurse are correct and could be included in the teaching plan? SATA a. Identical twins are the same sex and phenotype b. Identical twins usually have a common placenta, and may have one chorion and two amnions c. Fraternal twins have two placentas, two chorions and two amnions 6. A woman is 34 weeks pregnant. When she comes for an early morning clinic visit, she mentions that she only had time for a doughnut and juice for breakfast this morning. Results of her urine specimen show a small amount of glucose (1+ by dipstick) present. This most likely indicates: a. A decreased renal threshold for glucose due to the normal changes of pregnancy. 7. A woman is being treated for pre-eclampsia with magnesium sulfate. The nurse is concerned that the pt is in early drug toxicity. What assessment finding by the nurse indicates early magnesium sulfate toxicity? a. Diminished patellar tendon reflexes 8. A new OB pt reports that her last normal menses started August 16th and ended August 21st. which of the following is her EDC, according to Nagele’s Rule? a. May 23rd 9. A new pt is having her first prenatal visit and wants to continue with her vegan diet. The nurse would advise the patient that: a. Adequate protein intake is possible with this diet, but B vitamins may need to be supplemented 10. An HIV client presents to clinic for prenatal care. The nurse knows that the recommended medication for the prevention of HIV perinatal (vertical) transmission is: a. Zidovudine (Retrovir) 11. Which is true about human reproduction? a. An ovum is usually fertile for up to 24 hours 12. Which of the following is true regarding fetal circulation? SATA a. The fetal lungs are effectively bypassed and blood is shunted right to left b. The placenta is the major site of respiratory gas exchange c. Fetal circulation delivers high oxygen concentrations to the head, neck, brain and heart d. The umbilical vein carries oxygenated blood from the placenta to fetal circulation 13. Folic acid supplements are recommended for women of childbearing age. The addition of folic acid to the diet may have prevented which of the following circumstances? a. 35-year-old with a prior child with spina bifida 14. An essential part of discharge teaching for a pt who had a molar pregnancy (gestational trophoblastic neoplasm) includes that the pt should: a. Not get pregnant for at last one year after the molar pregnancy 15. Males are more often affected by X-linked recessive disorders because: a. Males only have one X chromosome 16. A 22-year-old primigravida is 10 weeks pregnant. She has had nausea periodically throughout the day for the past few weeks. What is the most common primary cause of this complication? a. Increased levels of hCG 17. Noelle O’Malley is a 40-year-old G5P4 who presents to the office for a regular prenatal visit. Her midwife recommends a flu vaccine and Ms. O’Malley agrees and signs a consent form. The order reads “Give 45 mcg influenza vaccine IM times one”. The nurse has on hand a 10 ml multi dose vial with 90mcg per 0.5 mL. how many milliliters will the nurse draw into the syringe? a. 0.25 mL 18. A woman is 6 weeks pregnant. She has had cramping, backache, and bleeding for the past three days. Her cervix is now dilating. She is crying and says to the nurse: “Is my baby going to be Ok?”. In consoling the woman, the nurse does understand that the pt is now experiencing: a. An inevitable abortion 19. The nurse is preparing to give discharge teaching to a pt who just had an spontaneous abortion followed by a D&C (dilation & curettage). The nurse knows the priority teaching includes? a. Contact the doctor if there is heavy bleeding 20. A pt is concerned that she has been taking medication in the first trimester before she was aware of her pregnancy. The nurse looks up the medication and finds that it is categorized for level of fetal risk as FDA Category A for drug use during pregnancy. She would inform the pt: a. The medication is not known to cause fetal harm based on current research 21. On a prior visit, the nurse has advised a patient to increase her intake of iron-rich foods due to her irondeficiency anemia. On follow up, the nurse knows the pt has had effective teaching if she reports increased intake of: a. Enriched cereals b. Meat c. Beans 22. A 25year old client pregnant with twins is at an increased risk for which of the following gestational conditions? a. Preterm labor 23. Because of the normal physiologic changes occurring during pregnancy, the nurse can expect to find which lab results on a pregnant pt, compared to pre-pregnant levels? a. A decrease in hematocrit 24. A pt presents to the clinic with a history of preterm labor. Based on knowledge of the action of different hormones in pregnancy, which hormone would the nurse expect to be used clinically to prevent premature labor? a. Progesterone 25. A woman arrived for her first prenatal visit. The practitioner determines she is 8 weeks pregnant. What lab work would normally be obtained at this visit? SATA a. Rubella status b. Gonorrhea culture c. HbsAg 26. Of the following infections, the one known to be a powerful, multi-system teratogen is: a. Rubella 27. Which of the following are true regarding fetal development? a. A 25-week fetus can be considered “viable” because he can survive outside the womb with specialized care 28. A woman is 30-week gestation by LMP. Her fundal height measurement at this clinic appointment is 24 cm. based on this finding, the nurse should: a. Suspect a possible fetal growth restriction (IUGR) 29. The nurse is discussing immunizations with a 12-week antepartum pt who is rubella nonimmune. What statement by the nurse would be correct? a. We can give you the flu shot today, but we will need to wait until after you give birth to administer the MMR vaccine 30. What goal is most important for the nurse to include in the plan of care of a pregnant client with insulin dependent diabetes? a. Maintain euglycemia 31. Which maternal condition or disease would you expect might improve during pregnancy due to the physiologic changes of pregnancy? a. Rheumatoid arthritis 32. The order reads: administer 1 gm Ampicillin IV q 4 hours. The pharmacy sends the medication diluted in 50 ml with the instructions to administer over 30 minutes. The infusion pump runs in Ml/hour. The nurse will set the pump to how many mL/hr? a. 100 33. A high risk pt at 28 weeks gestation is asked to keep track of fetal movements. One week later, she calls the clinic and anxiously tells the nurse that although she has been paying close attention, she has not felt the baby move at all for over 8 hours, which is unusual for this baby. The most appropriate response by the nurse would be: a. “Please come to the clinic right away for further evaluation. We will work you in to be seen when you get here”. 34. A woman has come to the clinic because she suspects she is pregnant. Which would be probable signs of pregnancy? a. Positive Chadwick’s sign b. Presence of hCG in the serum or urine c. Positive Hagar’s sign 35. A mother is 35 years old and is asking whether it is “safe” for her to get pregnant at her age? The nurses answer should be based on which of the following? a. There is an increased risk of come problems due to the natural aging of the mother’s eggs 36. A pt is learning to self-assess for signs of ovulation to time intercourse in order to achieve a planned pregnancy. Which is a sign associated with ovulation? a. Spinbarkeit (stringy) characteristic of the cervical mucous around the time of ovulation 37. Which of the following is true regarding the cytomegalovirus (CMV)? a. It can be passed transplacental to the fetus 38. A pt complains during her first months of pregnancy, “It seems like I have to go to the bathroom every 5 minutes.” Which statement would be the best explanation to give the pt? a. “The growing uterus puts pressure on the bladder.” 39. A Rh-negative mother and a Rh-positive father are expecting a child. Screening revealed a positive indirect coombs test. Which statement regarding this result is correct? a. There is no need to administer RhoGAM to this woman 40. A 20-year-old pt at 10 weeks gestation is preparing for her first prenatal visit. She confides, “This pregnancy was unplanned, I’m not sure if I want to be pregnant or not. I haven’t even decided whether I’m going to continue the pregnancy.” Which of the following is the best response? a. “It’s common to feel ambivalent about pregnancy in the first trimester. Let’s talk about your situation.” 41. A woman is hospitalized with severe pre-eclampsia at 32 weeks. Which would be expected as part of her plan of care? SATA a. Activity restriction and avoidance of excessive stimulation b. Anticonvulsant therapy with Magnesium sulfate c. Administration of corticosteroids 42. A woman demonstrates an understanding of the importance of increasing her intake of foods high in iron when she includes which of the following foods in her diet? a. Eggs 43. A currently pregnant woman reports the following pregnancy outcomes: A vaginal delivery of a stillbirth at 30 weeks One child born via c/s at 32 weeks (still living) A spontaneous abortion at 10 weeks gestation A vaginal delivery at 39 weeks gestation (still living) Which of the following accurately expresses this OB history using the 5-digit system (G_T_P_A_L_)? a. Gravida 5 T1 P2 A1 L2 44. A pt has an ectopic pregnancy and is being treated with methotrexate. What parameter will be monitored to be sure the treatment is working, and what would be the expected findings by one week of therapy? a. hCG levels will be monitored and they should be falling 45. a primigravida at 14 weeks gestation states that she hasn’t felt fetal movement yet. The best response by the nurse, based on her knowledge of when quickening occurs, is: a. “Movements is usually felt around 18-20 weeks gestation” 46. A pt with Class III heart disease is being treated for her 1st prenatal visit. Which of the following points would the nurse stress for this pt? a. Appropriate nutrition to prevent anemia and avoid excessive weight gain are important 47. A pt in her 3rd trimester of pregnancy reports a headache and ankle edema at the end of the day and frequent leg cramps, especially at night. What strategies would be most appropriate for the nurse to suggest? SATA a. Dorsiflex her foot b. Perform pelvic tilt exercises c. Elevate her legs throughout the day 48. A pregnant pt at 28 weeks has a hematocrit that is slightly lower than her pre-pregnancy hematocrit. Which statement by the nurse is the best way to explain this to the pt? a. “Your hematocrit has dropped because the increase in your blood volume is greater than the increase in red blood cells.” 49. A woman at 36 weeks of gestation assumes a supine position fr a fundal assessment and Leopold’s maneuvers. She begins to complain about feeling dizzy and nauseous. Her skin feels damp and cool. The nurses first action would be to: a. Assist the mother onto her side 50. In the 16th week, a pt phones the clinic to report symptoms of frequency and burning on urination. Which statement indicates she understood prior prenatal teaching related to bladder infection? a. “I called immediately. I understand this can be serious.” 51. A 26 multi para is 24-weeks pregnant. Her previous births include 2 large for gestational age babies and one unexplained stillbirth. With this history what assessment should be made in order to identify her most probable pregestational problems? a. Blood glucose 52. A teenage pregnant client is diagnosed with iron deficiency anemia. Which nutrients should the nurse encourage her to take with her iron supplements to increase iron absorption? a. Vitamin C 53. During her first prenatal visit to the clinic at seven-week gestation, a 24-year-old pregnant client comments, “My blood type is A negative. Will that cause problems?” The nurse’s best response would be: a. “We will do an initial test to see if you are already sensitized. If not, we will give you some medication at about 7 months to prevent future problems.” 54. A client with pre-eclampsia is prescribed to receive magnesium sulfate 72 grams per 24 hrs. the solution sent by the pharmacy contains 20 mg/mL. how many mL should the client receive per hour? a. 150 mL/hr