OB nclex Exam 3 Practice questions & Answers, 100% Accurate, rated A+

OB nclex Exam 3 Practice questions & Answers, 100% Accurate, rated A+ Your pregnant patient is in her first trimester and is scheduled for an abdominal ultrasound. When explaining the rationale for early pregnancy ultrasound, the best response is: a. "The test will help to determine the baby's position." b. "The test will help to determine how many weeks you are pregnant." c. "The test will help to determine if your baby is growing appropriately." d. "The test will help to determine if you have a boy or girl." - -b. Fetal growth and size are fairly consistent during the first trimester and are a reliable indicator of the weeks of gestation. Your pregnant patient is having maternal alpha-fetoprotein (AFP) screening. She does not understand how a test on her blood can indicate a birth defect in the fetus. The best reply by the nurse is: a. "We have done this test for a long time." b. "If babies have a neural tube defect, alpha-fetoprotein leaks out of the fetus and is absorbed into your blood, causing your level to rise. This serum blood test detects that rise." c. "Neural tube defects are a genetic anomaly, and we examine the amount of alpha-fetoprotein in your DNA." d. "If babies have a neural tube defect, this results in a decrease in your level of alpha-fetoprotein." - -b. When a neural tube defect is present, AFP is absorbed in the maternal circulation, resulting in a rise in the maternal AFP level. The primary complications of amniocentesis are: a. Damage to fetal organs b. Puncture of umbilical cord c. Maternal pain d. Infection - -d. Amniocentesis involves insertion of a needle into the amniotic sac, and infection is the primary complication. Your patient is 34 weeks pregnant and during a regular prenatal visit tells you she does not understand how to do "kick counts." The best response by the nurse would be to explain: a. "Here is an information sheet on how to do kick counts." b. "It is not important to do kick counts because you have a low-risk pregnancy." c. "Fetal kick counts are not a reliable indicator of fetal well-being in the third trimester." d. "Fetal movements are an indicator of fetal well-being. You should count twice a day, and you should feel 10 fetal movements in 2 hours." - -d. This response provides the patient with information on how to do kick counts and the rationale for doing kick counts and criteria for normal fetal movement. Your patient is a 37-year-old pregnant woman who is 5 weeks pregnant and is considering genetic testing. During your discussion, the woman asks the nurse what the advantages of chorionic villus sampling (CVS) are over amniocentesis. The best response is: a. "You will need anesthesia for amniocentesis, but not for CVS." b. "CVS is a faster procedure." c. "CVS provides more detailed information than amniocentesis." d. "CVS can be done earlier in your pregnancy, and the results are available more quickly." - -d. CVS can be done earlier in gestation The clinic nurse meets with Rebecca, a 30-year-old woman who is experiencing her first pregnancy. Rebecca's quadruple marker screen result is positive at 17 weeks' gestation. The nurse explains that Rebecca needs a referral to: a. A genetics counselor/specialist b. An obstetrician c. A gynecologist d. A social worker - -a. All women should be offered screening with maternal serum markers. The Triple Marker screen and the Quadruple Marker screen test for the presence of alpha-fetoprotein (AFP), estradiol, human chorionic gonadotropin (hCG), and other markers. These tests screen for potential neural tube defects, Down syndrome, and Trisomy 18. If the screen is positive, the woman should be referred to a genetics specialist for counseling, and further testing, such as chorionic villus sampling (CVS) or amniocentesis, should be performed. A 37-year-old woman who is 17 weeks pregnant has had an amniocentesis. Before discharge, the nurse teaches the woman to call her doctor if she experiences which of the following side effects? a. Pain at the puncture site b. Macular rash on the abdomen c. Decrease in urinary output d. Cramping of the uterus - -d. The woman should report any uterine cramping. Although rare, amniocentesis could stimulate preterm labor. A laboratory report indicates the L/S ratio (lecithin/sphingomyelin) results from an amniocentesis of a gravid patient with preeclampsia are 2:1. The nurse interprets the result as which of the following? a. The baby's lung fields are mature. b. The mother is high risk for hemorrhage. c. The baby's kidneys are functioning poorly. d. The mother is high risk for eclampsia. - -a. An L/S ratio of 2:1 usually indicates that the fetal lungs are mature. A client on 2 gm/hr of magnesium sulfate has decreased deep tendon reflexes. Identify the priority nursing assessment to ensure client safety. a. Assess uterine contractions continuously. b. Assess fetal heart rate continuously. c. Assess urinary output. d. Assess respiratory rate. - -d. Respiratory effort and deep tendon reflexes (DTRs) are involuntary, and a decrease in DTRs could indicate the risk of magnesium sulfate toxicity and the risk for decreased respiratory effort. A pregnant client with a history of multiple sexual partners is at highest risk for which of the following complications: a. Premature rupture of membranes b. Gestational diabetes c. Ectopic pregnancy d. Pregnancy-induced hypertension - -c. A history of multiple sexual partners places the client at a higher risk of having contracted a sexually transmitted disease that could have ascended the uterus to the fallopian tubes and caused fallopian tube blockage, placing the client at high risk for an ectopic pregnancy. Identify the hallmark of placenta previa that differentiates it from abruptio placenta. a. Sudden onset of painless vaginal bleeding b. Board-like abdomen with severe pain c. Sudden onset of bright red vaginal bleeding d. Severe vaginal pain with bright red bleeding - -a. When the placenta attaches to the lower uterine segment near or over the cervical os, bleeding may occur without the onset of contractions or pain. Which of the following assessments would indicate instability in the client hospitalized for placenta previa? a. BP <90/60 mm/Hg, Pulse <60 BPM or >120 BPM b. FHR moderate variability without accelerations c. Dark brown vaginal discharge when voiding d. Oral temperature of 99.9°F - -a. A decrease in BP accompanied by bradycardia or tachycardia is an indication of hypovolemic shock. During pregnancy, poorly controlled asthma can place the fetus at risk for: a. Hyperglycemia b. IUGR c. Hypoglycemia d. Macrosomia - -b. Compromised pulmonary function can lead to decompensation and hypoxia that decrease oxygen flow to the fetus and can cause intrauterine growth restriction (IUGR). Which of the following nursing diagnoses is of highest priority for a client with an ectopic pregnancy who has developed disseminated intravascular coagulation (DIC)? a. Risk for deficient fluid volume b. Risk for family process interrupted c. Risk for disturbed identity d. High risk for injury - -a. The client is at high risk for hypovolemia which is life threatening and takes precedence over any psychosocial or less pressing diagnoses. Which of the following laboratory values is most concerning in a client with pregnancy-induced hypertension? a. Total urine protein of 200 mg/dL b. Total platelet count of 40,000 mm c. Uric acid level of 8 mg/dL d. Blood urea nitrogen 24 mg/dL - -b. A platelet count of £50,000 is a critical value and should be reported to the health-care provider immediately. This client is at increased risk of hemorrhage. Which of the following medications administered to the pregnant client with GDM and experiencing preterm labor requires close monitoring of the client's blood glucose levels? a. Nifedipine b. Betamethasone c. Magnesium sulfate d. Indomethacin - -b. Beta-sympathomimetics may stimulate hyperglycemia which will require an increased need for insulin. While educating the client with class II cardiac disease, at 28 weeks' gestation, the nurse instructs the client to notify the physician if she experiences which of the following conditions? a. Emotional stress at work b. Increased dyspnea while resting c. Mild pedal and ankle edema d. Weight gain of 1 pound in 1 week - -b. Increasing dyspnea, at rest, can be a sign of cardiac decompensation leading to increased congestive heart failure The nurse working in a prenatal clinic is providing care to three primigravida patients. Which of the patient findings would the nurse highlight for the physician? a. 15 weeks, denies feeling fetal movement b. 20 weeks, fundal height at the umbilicus c. 25 weeks, complains of excess salivation d. 30 weeks, states that her vision is blurry - -d. Blurred vision is a sign of pregnancy-induced hypertension (PIH). This finding should be reported to the woman's health-care practitioner. The perinatal nurse is assessing a woman in triage who is 34 + 3 weeks' gestation in her first pregnancy. She is worried about having her baby "too soon," and she is experiencing uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats per minute. A vaginal examination performed by the health-care provider reveals that the cervix is closed, long, and posterior. The most likely diagnosis would be: a. Preterm labor b. Term labor c. Back labor d. Braxton-Hicks contractions - -d. Braxton-Hicks contractions are regular contractions occurring after the third month of pregnancy. They may be mistaken for regular labor, but unlike true labor, the contractions do not grow consistently longer, stronger, and closer together, and the cervix is not dilated. Some patients present with preterm contractions, but only those who demonstrate changes in the cervix are diagnosed with preterm labor. The perinatal nurse knows that the term to describe a woman at 26 weeks' gestation with a history of elevated blood pressure who presents with a urine showing 2+ protein (by dipstick) is: a. Preeclampsia b. Chronic hypertension c. Gestational hypertension d. Chronic hypertension with superimposed preeclampsia - -d. The following criteria are necessary to establish a diagnosis of superimposed preeclampsia: hypertension and no proteinuria early in pregnancy (prior to 20 weeks' gestation) and new-onset proteinuria, a sudden increase in protein—urinary excretion of 0.3 g protein or more in a 24-hour specimen, or two dipstick test results of 2+ (100 mg/dL), with the values recorded at least 4 hours apart, with no evidence of urinary tract infection; a sudden increase in blood pressure in a woman whose blood pressure has been well controlled; thrombocytopenia (platelet count lower than 100,000/mmC); and an increase in the liver enzymes alanine transaminase (ALT) or aspartate transaminase (AST) to abnormal levels. A patient is receiving magnesium sulfate for severe preeclampsia. The nurse must notify the attending physician immediately of which of the following findings? a. Patellar and biceps reflexes of +4 b. Urinary output of 50 mL/hr c. Respiratory rate of 10 rpm d. Serum magnesium level of 5 mg/dL - -c. The drop in respiratory rate may indicate that the patient is suffering from magnesium toxicity. The nurse should report the finding to the physician. A woman in labor and delivery is being given subcutaneous terbutaline for preterm labor. Which of the following common medication effects would the nurse expect to see in the mother? a. Serum potassium level increases b. Diarrhea c. Urticaria d. Complaints of nervousness - -d. Complaints of nervousness are commonly made by women receiving subcutaneous beta agonists. Which of the following signs or symptoms would the nurse expect to see in a woman with concealed abruptio placentae? a. Increasing abdominal girth measurements b. Profuse vaginal bleeding c. Bradycardia with an aortic thrill d. Hypothermia with chills - -a. The nurse would expect to see increasing abdominal girth measurements. A woman who has had no prenatal care was assessed and found to have hydramnios on admission to the labor unit and has since delivered a baby weighing 4500 grams. Which of the following complications of pregnancy likely contributed to these findings? a. Pyelonephritis b. Pregnancy-induced hypertension c. Gestational diabetes d. Abruptio placentae - -c. Untreated gestational diabetics often have hydramnios and often deliver macrosomic babies. For the patient with which of the following medical problems should the nurse question a physician's order for beta agonist tocolytics? a. Type 1 diabetes mellitus b. Cerebral palsy c. Myelomeningocele d. Positive group B streptococci culture - -a. Beta agonists often elevate serum glucose levels. The nurse should question the order. The nurse is caring for two laboring women. Which of the patients should be monitored most carefully for signs of placental abruption? a. The patient with placenta previa b. The patient whose vagina is colonized with group B streptococci c. The patient who is hepatitis B surface antigen positive d. The patient with eclampsia - -d. Patients with eclampsia are high risk for placental abruption. The nurse is caring for a woman at 28 weeks' gestation with a history of preterm delivery. Which of the following laboratory data should the nurse carefully assess in relation to this diagnosis? a. Human relaxin levels b. Amniotic fluid levels c. Alpha-fetoprotein levels d. Fetal fibronectin levels - -d. A rise in the fetal fibronectin levels in cervical secretions has been associated with preterm labor. Which of the following statements is most appropriate for the nurse to say to a patient with a complete placenta previa? a. "During the second stage of labor you will need to bear down." b. "You should ambulate in the halls at least twice each day." c. "The doctor will likely induce your labor with oxytocin." d. "Please promptly report if you experience any bleeding or feel any back discomfort." - -d. Labor often begins with back pain. Labor is contraindicated for a patient with complete placenta previa A woman at 32 weeks' gestation is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will identify which of the following as a positive patient care outcome? a. Rise in serum creatinine b. Drop in serum protein c. Resolution of thrombocytopenia d. Resolution of polycythemia - -c. Resolution of thrombocytopenia is a positive sign. It indicates that the platelet count is returning to normal A 16-year-old patient is admitted to the hospital with a diagnosis of severe preeclampsia. The nurse must closely monitor the woman for which of the following? a. High leukocyte count b. Explosive diarrhea c. Fractured pelvis d. Low platelet count - -d. Low platelet count is one of the signs associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. A woman at 10 weeks' gestation is diagnosed with gestational trophoblastic disease (hydatiform mole). Which of the following findings would the nurse expect to see? a. Platelet count of 550,000/ mm3 b. Dark brown vaginal bleeding c. White blood cell count 17,000/ mm3 d. Macular papular rash - -b. The nurse would expect to see dark brown vaginal discharge After an education class, the nurse overhears an adolescent woman discussing safe sex practices. Which of the following comments by the young woman indicates that additional teaching about sexually transmitted infection (STI) control issues is needed? a. "I could get an STI even if I just have oral sex." b. "Girls over 16 are less likely to get STDs than younger girls." c. "The best way to prevent an STI is to use a diaphragm." d. "Girls get human immunodeficiency virus (HIV) easier than boys do." - -c. This statement is untrue. The young woman needs further teaching. Condoms protect against STDs and pregnancy. In addition, condoms can be kept in readiness for whenever sex may occur spontaneously. Using condoms does not require the teen to plan to have sex. A diaphragm is not an effective infection-control method. Plus, it would require the teen to plan for intercourse. A woman who is admitted to labor and delivery at 30 weeks' gestation, is 1 cm dilated, and is contracting q 5 minutes. She is receiving magnesium sulfate IV piggyback. Which of the following maternal vital signs is most important for the nurse to assess each hour? a. Temperature b. Pulse c. Respiratory rate d. Blood pressure - -c. The respiratory rate is the most important vital sign. Respiratory depression is a sign of magnesium toxicity. You are caring for a patient who was admitted to labor and delivery at 32 weeks' gestation and diagnosed with preterm labor. She is currently on magnesium sulfate, 2 gm per hour. Upon your initial assessment you note that she has a respiratory rate of 8 with absent deep tendon reflexes. What will be your first nursing intervention? a. Elevate head of the bed b. Notify the MD c. Discontinue magnesium sulfate d. Draw a serum magnesium level - -c Initial nursing intervention needs to be discontinuing magnesium sulfate because the patient is exhibiting signs of magnesium toxicity with absent deep tendon reflexes and decreased respiratory rate. A 34-weeks' gestation multigravida, G3 P1 is admitted to the labor suite. She is contracting every 7 minutes and 40 seconds. The woman has several medical problems. Which of the following of her comorbidities is most consistent with the clinical picture? a. Kyphosis b. Urinary tract infection c. Congestive heart failure d. Cerebral palsy - -b. Urinary tract infections often precipitate preterm labor. A primiparous woman has been admitted at 35 weeks' gestation and diagnosed with HELLP syndrome. Which of the following laboratory changes is consistent with this diagnosis? a. Hematocrit dropped to 28%. b. Platelets increased to 300,000 cells/mm3. c. Red blood cells increased to 5.1 million cells/mm3. d. Sodium dropped to 132 mEq/dL. - -a. The nurse would expect to see a drop in the hematocrit: The H in HELLP stands for hemolysis. A labor nurse is caring for a patient, 39 weeks' gestation, who has been diagnosed with placenta previa. Which of the following physician orders should the nurse question? a. Type and cross-match her blood. b. Insert an internal fetal monitor electrode. c. Administer an oral stool softener. d. Assess her complete blood count. - -b. This action is inappropriate. When a patient has a placenta previa, nothing should be inserted into the vagina. A type 1 diabetic patient has repeatedly experienced elevated serum glucose levels throughout her pregnancy. Which of the following complications of pregnancy would the nurse expect to see? a. Postpartum hemorrhage b. Neonatal hyperglycemia c. Postpartum oliguria d. Neonatal macrosomia - -d. The nurse would expect to see neonatal macrosomia. According to agency policy, the perinatal nurse provides the following intrapartal nursing care for the patient with preeclampsia: a. Take the patient's blood pressure every 6 hours b. Encourage the patient to rest on her back c. Notify the physician of a urine output greater than 30 mL/hr d. Administer magnesium sulfate according to agency policy - -d. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The nurse administers medications as ordered and should adhere to hospital protocol for a magnesium sulfate infusion. The perinatal nurse is providing care to Marilyn, a 25-year-old G1 TPAL 0000 woman hospitalized with severe hypertension at 33 weeks' gestation. The nurse is preparing