OB GYNE QUESTIONS AND RATIONALE

Compiled by: Rachelle C. Martinez, RN, US - RN

1. Cynthia, 18 year old nulligraid client, i!it! the clinic "or a routine
e#amination. She a!$ed the nur!e, %&hat are the cerical mucu! change!
that occur during the men!trual cycle'( &hich o" the "ollo)ing !tatement!
)ould be the appropriate re!pon!e by the nur!e'
*. %*bout mid)ay through the men!trual cycle, cerical mucu! i! thic$ and
!tic$y.(
+. %,uring oulation, the ceri# remain! dry )ithout any mucu! production.(
C. %*! oulation approache!, cerical mucu! i! abundant and clear.(
,. %Cerical mucu! di!appear! immediately a"ter oulation, re!uming )ith
men!e!.(
Correct answer: C.
Rationale:
*. ,uring the luteal pha!e o" the cycle, )hich occur! a"ter oulation, the cerical
mucu! i! thic$ and !tic$y, ma$ing it di-cult "or !perm to pa!!. Change! in the
cerical mucu! are related to the in.uence o" e!trogen and proge!terone.
+. ,uring oulation, cerical mucu! i! abundant and clear.
C. As o!lation a""roac#es$ cerical %!c!s is a&!n'ant an' clear$
rese%&lin( raw e(( w#ite. O!lation (enerall) occ!rs *+ 'a)s ,"l!s
or %in!s - 'a)s. &e/ore t#e &e(innin( o/ %enses.
,. Cerical mucu! i! al)ay! pre!ent.
/. Mr. and Mr!. Maray$it are !een in the antepartal clinic. Mr!. Maray$it i!
appro#imately 11 )ee$! pregnant. Mr. Maray$it tell! the nur!e that he ha!
been e#periencing nau!ea, omiting and "atigue together )ith hi! )i"e. 0he
nur!e $no)! that Mr. Maray$it i! e#periencing )hich o" the "ollo)ing'
*. 1tyali!m. +. Mittel!chmerz. C. Couade !yndrome.
,. 1ica.
Correct answer: C.
Rationale:
*. 1tyali!m i! the term "or e#ce!!ie !aliation.
+. Mittel!chmerz i! the lo)er abdominal di!com"ort "elt by !ome )omen during
oulation.
C. Co!a'e s)n'ro%e re/ers to t#e sit!ation in w#ic# t#e e0"ectant
/at#er e0"eriences so%e o/ t#e 'isco%/orts o/ "re(nanc) alon( wit#
t#e "re(nant wo%an as a %eans o/ i'enti/)in( wit# t#e "re(nanc).
,. 1ica re"er! to an oral craing "or !ub!tance! !uch a! clay or !tarch that !ome
pregnant client! e#perience.
2. Nina, a primigraid client, ha! been receiing health teaching! "rom Nur!e
Sonya about the importance o" !u-cient itamin * in her diet. &hich o" the
"ollo)ing !tatement coming "rom Nina )ould indicate to Nur!e Sonya
ade3uate $no)ledge o" 4itamin * !ource! )a! achieed'
*. %5 hae been incorporating buttermil$ and chee!e in my meal!.(
+. %Stra)berrie! and cantaloupe are my "aorite !o it )ill be no problem at all.(
C. %My meal! hae been "ull o" egg yol$! and !3ua!h.(
,. %5 loe eating orange! eeryday and incorporate tomatoe! in my meal! a!
)ell.(
Correct answer: C.
Rationale:
*. +uttermil$ and chee!e are good !ource! o" calcium.
+. Stra)berrie! and cantaloupe are good !ource! o" itamin C, not *.
C. E(( )ol1s an' s2!as# an' ot#er )ellow e(eta&les are ric# so!rces
o/ ita%in A. 3re(nant wo%en s#o!l' aoi' %e(a'oses o/ ita%in A
&eca!se /etal %al/or%ation %a) occ!r.
,. Citru! "ruit! and tomatoe! are good !ource! o" itamin C, rather than *.
6. Nur!e 7lenda i! preparing a prenatal cla!! about endocrine change! that
normally occur during pregnancy. &hich among the "ollo)ing !hould Nur!e
7lenda include in the lecture'
*. 8uman placental lactogen maintain! the corpu! luteum.
+. 1roge!terone i! re!pon!ible "or hyperpigmentation and a!cular !$in
change!.
C. 9!trogen rela#e! !mooth mu!cle in the re!piratory tract.
,. 0he thyroid enlarge! )ith an increa!e in ba!al metabolic rate.
Correct answer: D.
Rationale:
*. 8uman placental lactogen enhance! mil$ production.
+. 9!trogen i! re!pon!ible "or hyperpigmentation and a!cular !$in change!.
C. 1roge!terone rela#e! !mooth mu!cle in the re!piratory tract.
D. T#)roi' enlar(e%ent an' increase' &asal &o') %eta&olis% are
co%%on occ!rrences '!rin( "re(nanc).
:. /; < year < old ,anica i! a ne) antenatal client being !een "or the =r!t time.
*ccording to ,anica>! hi!tory, !he ha! had a!thma !ince !he )a! 2 year! <
old and it i! under control )hen !he ta$e! her medicine correctly and
con!i!tency. &hich among the "ollo)ing !tatement! o" ,anica indicate! the
need "or "urther in!truction'
*. %5 need to continue ta$ing my a!thma medication a! pre!cribed.(
+. %5t i! my goal to preent or limit a!thma attac$!.(
C. %,uring an a!thma attac$, o#ygen need! continue to be high "or mother and
"etu!.(
,. %+ronchodilator! !hould be u!ed only )hen nece!!ary becau!e o" the ri!$
they pre!ent to the "etu!.(
Correct answer: D.
Rationale:
*. Regular u!e o" a!thma medication )ill u!ually preent a!thma attac$!.
+. 1reention and limitation o" an a!thma attac$ i! the goal o" care "or a client
)ho i! or i! not pregnant and i! the appropriate care !trategy.
C. ,uring an a!thma attac$, o#ygen need! continue a! )ith any pregnant client
but the air)ay! are edematou!, decrea!ing per"u!ion. *!thma e#acerbation!
during pregnancy may occur a! a re!ult o" in"re3uent u!e o" medication
rather than a! a re!ult o" the pregnancy.
D. Ast#%a %e'ications an' &ronc#o'ilators s#o!l' &e contin!e' '!rin(
"re(nanc) as "rescri&e' &e/ore t#e "re(nanc) &e(an. T#e
%e'ications 'o not ca!se #ar% to t#e %ot#er or /et!s.
?. Nur!e Su!ie i! caring "or a client )ho undergone dilatation and curettage
preceded by a !pontaneou! abortion. Nur!e Su!ie admini!ter! hydro#yzine
@4i!tarilA a! ordered. &hich o" the "ollo)ing i! the primary rea!on "or !uch
interention'
*. 0o counteract nau!ea. C. 0o decrea!e uterine
cramping.
+. 0o reduce pain. ,. 0o promote uterine
contractility.
Correct answer: A.
Rationale:
A. 4)'ro0)5ine ,6istaril. #as a tran2!ili5in( e7ect an' also 'ecreases
na!sea an' o%itin(. It 'oes not 'ecrease 8!i' retention$ re'!ce
"ain$ 'ecrease !terine cra%"in( or "ro%ote !terine contractilit).
One o/ t#e a'erse e7ect o/ t#e %e'ication is slee"iness.
+. 5bupro"en may decrea!e pain "rom uterine cramping.
C. 5bupro"en may be u!ed to decrea!e uterine cramping.
,. B#ytocin may be u!ed to increa!e uterine contractility.
C. Mr!. DeEemon, )ho i! diagno!ed )ith mild preeclamp!ia, ha! been taught by
Nur!e 1intor on ho) to $eep a record o" "etal moement pattern! at home.
Nur!e 1intor determine! that the teaching ha! been eFectie )hen Mr!.
DeEemon !tate! that !he )ill count the number o" time! the baby moe!
during )hich o" the "ollo)ing time !pan!'
*. 2; < minute period three time! a day.
+. 6: < minute period a"ter lunch eat day.
C. 1 < hour period each day.
,. 1/ < hour period each )ee$.
Correct answer: C.
Rationale:
*. 0hi! i! not enough to ealuate "etal moement accurately.
+. 0hi! i! time i! not enough to accurately apprai!e "etal moement.
C. N!%ero!s %et#o's #ae &een "ro"ose' to recor' t#e %aternal
"erce"tions o/ t#e /etal %oe%ent or 91ic1 co!nts.: A co%%onl)
!se' %et#o' is t#e Car'i7 co!nt to *; %et#o'. T#e client &e(ins
co!ntin( /etal %oe%ents at a s"eci<e' ti%e an' notes t#e ti%e
w#en t#e *;
t#
%oe%ent is /elt. I/ t#e client 'oes not /eel at least =
%oe%ents in a * #o!r "erio'$ s#e s#o!l' noti/) t#e #ealt# care
"roi'er. T#e /et!s t)"icall) %oes an aera(e o/ * to - ti%es eer)
*; %in!tes or *; to *- ti%es "er #o!rs.
,. 0he client !hould monitor "etal moement! more "re3uently than 1 time per
)ee$. Bne hour o" monitoring each day i! ade3uate.
8. Nur!e 7abby enter! the room )hen Mr!. Granci!co, a ne)ly admitted
primigraid and diagno!ed )ith !eere preeclamp!ia, )a! e#periencing
!eizure. &hich o" the "ollo)ing !hould Nur!e 7abby do =r!t'
*. 5n!ert an air)ay to improe o#ygenation.
+. Note the time )hen the !eizure begin! and end!.
C. Call "or immediate a!!i!tance.
,. 0urn the client to her le"t !ide.
Correct answer: C.
Rationale:
*. *n air)ay can be in!erted can be in!erted, i" appropriate, a"ter the !eizure
end!.
+. 0hi! i! done a"ter a!!i!tance i! obtained.
C. I/ a client &e(ins to #ae a sei5!re$ t#e <rst action &) t#e n!rse is to
re%ain wit# t#e client an' call /or i%%e'iate assistance. T#e n!rse
nee's to #ae so%e assistance in %ana(in( t#is client. A/ter t#e
sei5!re$ t#e client nee's intensie %onitorin(.
,. 0urning the client to her le"t !ide )ill be done a"ter a!!i!tance i! obtained.
H. 0he nur!e i! handling a multigraid client )ho i! at 1; )ee$!> ge!tation and
diagno!ed )ith chronic hyperten!ion. 0he nur!e in!tructed the client about
the need "or "re3uent prenatal i!it!. &hich o" the "ollo)ing client !tatement!
)ould indicate to the nur!e that the teaching ha! been !ucce!!"ul'
*. %5 may deelop hyperthyroidi!m becau!e o" my high blood pre!!ure.(
+. %5 need clo!e monitoring becau!e 5 may hae a !mall < "or < ge!tational < age
in"ant.(
C. %5t>! po!!ible that 5 )ill hae e#ce!! amniotic .uid and may need a ce!arean
!ection.(
,. %5 may deelop placenta accreta, !o 5 need to $eep my clinic appointment!.(
Correct answer: B.
Rationale:
*. 0here i! no a!!ociation bet)een chronic hyperten!ion and hyperthyroidi!m.
B. >o%en wit# c#ronic #)"ertension '!rin( "re(nanc) are at ris1 /or
co%"lications s!c# as "reecla%sia ,a&o!t -?@.$ a&r!"tio "lacentae$
an' intra!terine (rowt# retar'ation$ res!ltin( in a s%all /or
(estational a(e in/ant.
C. 1regnant )omen )ith chronic hyperten!ion are not at an increa!ed ri!$ "or
hydramnio! @polyhydramnio!A, an abnormally large amount o" amniotic .uid.
Client! )ith diabete! and multiple ge!tation! are at ri!$ "or thi! condition.
,. 1alcenta accreta, a rare placental abnormality, re"er! to a condition in )hich
the placenta abnormally adhere! to the uterine lining. 5t i! not a!!ociated
)ith chronic hyperten!ion.
1;.Nur!e Cecilia i! receiing a /: < year < old client, 7 2, 1 1, at 2/ )ee$!>
ge!tation, in the emergency room ho!pital due to aginal bleeding. *"ter
reie)ing the client>! hi!tory, )hich o" the "ollo)ing )ould Nur!e Cecilia
anticipate admini!tering intraenou!ly i" the client deelop! di!!eminated
intraa!cular coagulation @,5CA'
*. Ringer>! lactate !olution. C. :I de#tro!e !olution.
+. Gre!h "rozen platelet!. ,. &ar"arin !odium @CoumadinA.
Correct answer: B.
Rationale:
*. *lthough Ringer>! lactate !olution may be u!ed a! intraenou! .uid
replacement, the client need! blood component! therapy. 0here"ore, normal
!aline mu!t be u!ed.
B. Treat%ent o/ DIC incl!'es treatin( t#e ca!satie /actor$ re"lacin(
%aternal coa(!lation /actors$ an' s!""ortin( "#)siolo(ic /!nctions.
Intraeno!s in/!sions o/ w#ole &loo'$ /res# /ro5en "las%a$ or
"latelets are !se' to re"lace 'e"lete' %aternal coa(!lation /actors.
C. *lthough : I de#tro!e !olution i! con!idered to be u!ed a! intraenou! .uid
replacement, the "act that the client need! blood component therapy, normal
!aline i! more appropriate to be u!ed.
,. 5ntraenou! heparin, not )ar"arin !olution @CoumadinA may be admini!tered
to halt the clotting ca!cade.
11.Mr!. Jim J i! at her 26 )ee$! o" ge!tation and came "or her prenatal i!it.
0he nur!e caring "or Mr!. Jim J a!!e!!ed the "etu!> po!ition and "ound that it
i! in a KB* po!ition. 0he nur!e )ould place the ultra!ound tran!ducer o" the
e#ternal electronic "etal heart rate monitor in )hich o" the "ollo)ing
location!'
*. Near the !ymphy!i! pubi!. C. +elo) the umbilicu! on the le"t
!ide.
+. 0)o inche! aboe the umbilicu!. ,. *t the leel o" the umbilicu!.
Correct answer: C.
Rationale:
*. 5" the "etal bac$ i! near the !ymphy!i! pubi!, the "etu! i! pre!enting in a
tran!er!e lie.
+. 5" the "etu! i! in a breech po!ition, the "etal bac$ i! aboe or at the umbilicu!.
C. As t#e !ter!s contracts$ t#e a&'o%inal wall rises an'$ w#en e0ternal
%onitorin( is !se'$ "resses a(ainst t#e trans'!cer. T#is %oe%ent
is trans%itte' into an electrical c!rrent$ w#ic# is t#en recor'e'.
>it# t#e /et!s in t#e LOA "osition$ t#e car'iotrans'!cer s#o!l' &e
"lace' &elow t#e !%&ilic!son t#e si'e w#ere t#e /etal &ac1 is
locate' an' !terine 'is"lace%ent '!rin( contractions is (reatest.
,. 0hi! location i! more appropriate )hen the "etu! i! in a breech po!ition.
1/.Kilian, a primigraid at 2; )ee$!> ge!tation, )a! ru!hed to the ho!pital by her
hu!band. 0he nur!e admit! Kilian )ith complaint o" premature rupture o" the
membrane! )ithout contraction!. Kilian>! ceri# i! / cm dilated and :;I
eFaced. &hich o" the "ollo)ing )ould be the priority a!!e!!ment o" the
nur!e'
*. Red blood cell count. C. Urinary output.
+. ,egree o" di!com"ort. ,. 0emperature.
Correct answer: D.
Rationale:
*. Red blood cell count )ould proide in"ormation related to anemia, not
in"ection.
+. 0he client i! not in labor. 0here"ore, a!!e!!ing the degree o" di!com"ort i! not
in a priority at thi! time.
C. Urinary output i! not a reliable indicator o" an in"ection !uch a!
chorioamnioniti!.
D. 3re%at!re r!"t!re o/ t#e %e%&ranes is co%%onl) associate' wit#
c#orioa%nionitis$ or an in/ection. A "riorit) assess%ent /or t#e n!rse
to %a1e is to 'oc!%ent t#e clientAs te%"erat!re eer) - to + #o!rs.
Te%"erat!re eleation %a) in'icate an in/ection. Let#ar() an' an
eleate' w#ite &loo' cell co!nt also in'icate' an in/ection.
12.Mr!. Snob, a primigraid at 28 )ee$!> ge!tation, i! )ith poorly controlled
diabete! and !eere preeclamp!ia and i! admitted "or a ce!arean deliery.
Nur!e Jring e#plain! to Mr!. Snob that delier help! to preent )hich o" the
"ollo)ing'
*. Neonatal hyperbilirubinemia. C. 1erinatal a!phy#ia.
+. Congenital anomalie!. ,. Stillbirth.
Correct answer: D.
Rationale:
*. 5nduction and ce!arean deliery do no preent neonatal hyperbilirubinemia.
+. Congenital anomalie! cannot be preented by induction and ce!arean
deliery.
C. 5nduction and ce!arean deliery do not preent the e#i!tence o" perinatal
a!phy#ia.
D. Still&irt#s ca!se' &) "lacental ins!Bcienc) occ!r wit# increase'
/re2!enc) in wo%en wit# 'ia&etes an' seer "reecla%"sia. Clients
wit# "oorl) controlle' 'ia&etes %a) e0"erience !nantici"ate'
still&irt# as a res!lt o/ "re%at!re a(in( o/ t#e "lacenta. T#ere/ore$
la&or is co%%onl) in'!ce' in t#ese clients &e/ore ter%.
16.&hich o" the "ollo)ing anticoagulant! )ould Nur!e 1aulo e#pect to admini!ter
)hen caring "or Mr!. Kongbottom )ho i! at 1/ )ee$!> ge!tation and ha! cla!!
55 cardiac di!ea!e due to mitral ale !teno!i!'
*. 8eparin. C. 9no#aparin @Koeno#A.
+. &ar"arin @CoumadinA. ,. *rdeparin @Normi.oA.
Correct answer: A.
Rationale:
A. Alt#o!(# t#ere is no co%"letel) sa/e anticoa(!lant t#era") '!rin(
"re(nanc)$ #e"arin is t)"icall) t#e 'r!( o/ c#oice.
+. &ar"arin @CoumadinA, a pregnancy category , drug, can cau!e "etal
mal"ormation!.
C. 9no#aparin @Koeno#A i! not typically pre!cribed becau!e it can re!ult in
thrombocytopenia.
,. *rdeparin @Normi.oA al!o can cau!e "etal mal"ormation!.
1:.* ne)ly hired regi!tered nur!e i! caring "or a pregnant client !cheduled "or
!urgery to remoe an ectopic pregnancy and the "allopian tube. +e"ore the
!aid !urgery, )hich o" the "ollo)ing )ould alert the nur!e to the po!!ibility o"
tubal rupture'
*. *mount o" aginal bleeding and di!charge.
+. Galling hematocrit and hemoglobin leel!.
C. Slo), bounding pul!e rate o" 8; bpm.
,. Mar$ed abdominal edema.
Correct answer: B.
Rationale:
*. 0he amount o" aginal bleeding that i! eident i! a poor e!timate o" actual
blood lo!!. Slight aginal bleeding, commonly de!cribed a! !potting i!
common.
B. Callin( #e%atocrit an' #e%o(lo&in leels in'icate s#oc1$ w#ic#
occ!rs i/ t#e t!&e r!"t!res. Ot#er co%%on s)%"to%s o/ t!&al
r!"t!re incl!'e seere 1ni/e li1e lower 2!a'rant a&'o%inal "ain
an' re/erre' s#o!l'er "ain.
C. * rapid, thread pul!e, a !ymptom o" !hoc$, i! more common )ith tubal
rupture than a !lo), bounding pul!e.
,. *bdominal edema i! a late !ign o" tubal rupture in ectopic pregnancy.
1?.Mr!. 1u!ti!o i! diagno!ed )ith hypereme!i! graidarum. 0he nur!e note! that
Mr!. 1u!ti!o i! a 1? )ee$!> ge!tation and a multigraid client. 0he nur!e
!hould e#plain to Mr!. 1u!ti!o that her diagno!i! i! thought to be related to
high leel! o" )hich o" the "ollo)ing hormone!'
*. 1roge!terone. C. Somatotropin.
+. 9!trogen. ,. *ldo!terone.
Correct answer: B.
Rationale:
*. 1roge!terone i! a rela#ant u!ed during pregnancy and )ould not !timulate
omiting.
B. Alt#o!(# t#e ca!se o/ #)"ere%esis is still !nclear$ it is t#o!(#t to &e
relate' to #i(# estro(en an' #!%an c#orionic (ona'otro"in leels or
to tro"#o&lastic actiit) or (ona'otro"#in "ro'!ction. 4)"ere%esis
is also associate' wit# in/ectio!s con'itions$ s!c# as #e"atitis or
ence"#alitis$ intestinal o&str!ction "e"tic !lcer$ an' #)'ati'i/or%
%ole.
C. Somatotropin i! a gro)th hormone u!ed in children.
,. *ldo!terone i! a male hormone.
1C.Nur!e Da!mine i! caring "or a 6; < year < old client at about 16 )ee$!>
ge!tation and i! admitted )ith a diagno!i! o" complete hydatidi"orm mole.
Soon a"ter admin!!ion, Nur!e Da!mine )ould a!!e!! the client "or !ign! and
!ymptom! o" )hich o" the "ollo)ing'
*. 1regnancy < induced hyperten!ion. C. 8ypothyroidi!m.
+. 7e!tational diabete!. ,. 1olycythemia.
Correct answer: A.
Rationale:
*. 4)'ati'i/or% %ole is s!s"ecte' w#en t#e /ollowin( are "resent:
"re(nanc) in'!ce' #)"ertension &e/ore t#e -+
t#
wee1 o/ (estation$
&rownis# or "r!ne colore' a(inal &lee'in($ ane%ia$ a&sence o/
/etal #eart tones$ "assa(e o/ #)'ro"ic essels$ !terine enlar(e%ent
(reater t#an e0"ecte' /or (estational a(e$ an' increase' #!%an
c#orionic (ona'otro"#in leels.
+. 7e!tational diabete! i! related to an increa!ed ri!$ o" preeclamp!ia and
urinary tract in"ection!, but it i! not a!!ociated )ith hydatidi"orm mole.
C. 8yperthyroidi!m, not hypothyroidi!m, occur! occa!ionally )ith hydatidi"orm
mole. 5" it doe! occur, it can be a !eriou! complication, po!!ible li"e <
threatening to the mother and "etu! "rom cardiac problem!.
,. 1olycythemia i! not a!!ociated )ith hydatidi"orm mole. Rather, anemia "rom
blood lo!! i! a!!ociated )ith molar pregnancie!.
18./: < year < old Suzette recently deliered her in"ant. *nn, the nur!e on duty,
notice! that Suzette become! !hort o" breath "ollo)ing the deliery. *! *nn
immediately a!!e!!e! and implement! care "or Suzette, )hich diagno!i!
!hould the nur!e !u!pect'
*. 8eart "ailure. C. Septic !hoc$.
+. 1reeclamp!ia. ,. *mniotic .uid emboli!m.
Correct answer: D.
Rationale:
*. 5n cardiac di!ea!e, cardiac arre!t may occur but other !ign! and !ymptom!
are typically noticeable prior to heart "ailure.
+. 0here are no !ymptom! o" preeclamp!ia @high blood pre!!ure, proteinuriaA
!een )ith thi! client.
C. 0here i! no eidence o" in"ection leading to !eptic !hoc$.
D. T#ese si(ns an' s)%"to%s all in'icate a%niotic 8!i' e%&olis%$ also
calle' ana"#)lactoi' s)n'ro%e. In t#is 'isor'er$ a%niotic 8!i' enters
t#e %aternal circ!lation an' is trans"orte' to t#e %ot#erAs l!n(s.
3artic!late %atter in t#e 8!i'$ s!c# as erni0 an' %econi!%$
o&str!ct t#e essels in t#e "!l%onar) s)ste%. T#e %ortalit) rate is
aro!n' ?;@ i/ i%"le%entation o/ care is not i%%e'iate.
1H.0he nur!e i! caring "or a primigraid client )ho i! admitted a! an outpatient
"or an e#ternal cephalic er!ion. Gor )hich o" the "ollo)ing )ould the nur!e
a!!e!! the client a! a po!!ible contraindication "or the procedure'
*. Multiple ge!tation.
+. +reech pre!entation.
C. Maternal Rh < negatie blood type.
,. 8i!tory o" ge!tational diabete!.
Correct answer: A.
Rationale:
A. E0ternal ce"#alic ersion is t#e t!rnin( o/ t#e /et!s /ro% a &reec#
"osition to t#e erte0 "osition to "reent t#e nee' /or a cesarean
'elier). Gentle "ress!re is !se' to rotate t#e /et!s in a /orwar'
'irection to a ce"#alic lie.
+. Contraindication! to the procedure include multiple ge!tation becau!e o" the
potential "or "etal inEury or uterine inEury, !eere oligohydramnio!,
contraindication! to a aginal birth @e.g. cephalopelic di!proportionA, and
une#plained third trime!ter bleeding.
C. 5" the mother ha! Rh < negatie blood type, the procedure can be per"ormed
and Rh immunoglobulin !hould be admini!tered in ca!e minimal bleeding
occur!.
,. * hi!tory o" ge!tational diabete! i! not a contraindication unle!! the "etu! i!
large "or ge!tational age and the client ha! cephalopelic di!proportion.
/;.0he ceri# o" a primigraid client, Samantha )ho i! in actie labor and ha!
receied an epidural ane!the!ia 6 hour! ago, i! no) completely dilated.
Samantha i! no) ready to begin pu!hing. 1rior to thi!, )hich o" the "ollo)ing
)ould the nur!e a!!e!!'
*. Getal heart rate ariability. C. Statu! o" membrane!.
+. Cerical dilation again. ,. +ladder !tatu!.
Correct answer: D.
Rationale:
*. *lthough it i! important to monitor the "etal heart rate ariability throughout
labor, thi! doe! not aFect the client>! ability to pu!h.
+. 0here i! no need to rechec$ cerical dilatation becau!e increa!ing "re3uency
o" e#amination! can increa!e the client>! ri!$ "or in"ection.
C. *lthough thi! i! important to monitor throughout labor, thi! doe! not aFect
the pu!hing ability o" the client.
D. T#e &la''er stat!s s#o!l' &e %onitore' t#ro!(#o!t t#e la&or
"rocess$ &!t es"eciall) &e/ore t#e client &e(ins "!s#in(. A /!ll
&la''er can i%"e'e t#e "ro(ress o/ la&or an' slow /etal 'escent.
Beca!se s#e #as #a' an e"i'!ral anest#etic$ it is %ost li1el) t#at t#e
client is receiin( intraeno!s 8!i's$ contri&!tin( to a /!ll &la''er.
T#e client also 'oes not /eel t#e !r(e to oi' &eca!se o/ t#e
anest#etic.
/1.* multigraid clien i! in actie labor and C cm dilated. 0he nur!e record! the
ba!eline "etal heart rate i! 12; bpm )ith moderate ariability. 5n a "e)
minute!, the client begin! to hae ariable deceleration! to 1;; to 11; bpm.
&hat !hould be the nur!e>! ne#t action'
*. 1er"orm a aginal e#amination.
+. Noti"y the phy!ician o" the deceleration.
C. Repo!ition the client and continue to ealuate the tracing.
,. *dmini!ter o#ygen ia ma!$ at /KLminute.
Correct answer: C.
Rationale:
*. 1er"orming a aginal e#amination )ill let the nur!e $no) ho) "ar dilated the
client i! but )ill not reliee the cord compre!!ion.
+. Noti"ying the phy!ician !hould occur i" turning the client and admini!tering
o#ygen do not reliee the deceleration!.
C. T#e ca!se o/ aria&le 'ecelerations is cor' co%"ression$ w#ic# %a)
&e reliee' &) %oin( t#e client to one si'e or anot#er. I/ t#e client
is alrea') on t#e le/t si'e$ c#an(in( t#e client to t#e ri(#t si'e is
a""ro"riate.
,. 5" the deceleration! are not relieed by po!ition change!, o#ygen !hould be
initiated but the rate !hould be 8 to 1;KLminute.
//.Nur!e Miggy begin! hi! !hi"t on the ob!tetrical unit. 0here )ere !eeral ne)
admi!!ion! to hi! unit. 0he client )ith )hich o" the "ollo)ing condition! )ould
be a candidate "or induction'
*. 1regnancy < induced hyperten!ion.
+. *ctie herpe!.
C. Gace pre!entation.
,. Getu! )ith late deceleration!.
Correct answer: A.
Rationale:
A. T#e client wit# 3I4 wo!l' &e a can'i'ate /or t#e in'!ction "rocess
&eca!se en'in( t#e "re(nanc) is t#e onl) wa) to c!re 3I4.
+. * client )ith actie herpe! )ould be a candidate "or ce!arean !ection to
preent the "etu! "rom contracting the iru! )hile pa!!ing through the birth
canal.
C. 0he )oman )ith a "ace pre!entation )ill not be able to delier aginally due
to the e#tended po!ition o" the nec$.
,. 0he client )ho!e "etu! e#hibit! late deceleration! )ithout o#ytocin @1itocinA
)ould be at greater ri!$ "or "etal di!tre!! )ith u!e o" thi! drug. Kate
deceleration! indicate the "etu! doe! not hae enough placental re!ere! to
remain o#ygenated during the entire contraction. 0hi! client may re3uire
ce!arean !ection.
/2.Mr!. Den$in!, primigraid at term, ha! been diagno!ed )ith oligohydramnio!.
0he phy!ician order! an amnioin"u!ion "or Mr!. Den$in!. &hich o" the "ollo)ing
!hould the nur!e include in Mr!. Den$in!> teaching plan about the purpo!e o"
thi! procedure'
*. 0o decrea!e the "re3uency and !eerity o" ariable deceleration!.
+. 0o minimize the po!!ibility o" "etal metabolic al$alo!i!.
C. 0o increa!e the "etal heart rate acceleration! during a contraction.
,. 0o rai!e the amniotic .uid inde# to more than 1: cm.
Correct answer: A.
Rationale:
A. Oli(o#)'ra%nios or a 'ecrease in t#e ol!%e o/ a%niotic 8!i' is
associate' wit# aria&le /etal #eart rate 'ecelerations '!e to cor'
co%"ression. Daintenance o/ an a'e2!ate a%niotic 8!i' ol!%e
'!rin( la&or "roi'es "rotectie c!s#ionin( o/ t#e !%&ilical cor' an'
%ini%i5es cor' co%"ression.
+. Cord compre!!ion can re!ult in "etal metabolic acido!i!, not al$alo!i!.
C. *mnioin"u!ion i! u!ed to minimize cord compre!!ion, not to increa!e the "etal
heart rate acceleration during a contraction.
,. 0he goal i! to maintain the amniotic .uid inde# at 8 cm. thi! can be
determined by ultra!ound.
/6.0he nur!e i! caring "or a multigraid client in labor at 28 )ee$!> ge!tation.
0he nur!e note! that the client )a! diagno!ed )ith Rh !en!itization and
probable "etal hydrop! and anemia. &hen the nur!e ob!ere! the "etal heart
rate pattern on the monitor, )hich "o the "ollo)ing pattern! i! mo!t li$ely'
*. 9arly deceleration pattern.
+. Sinu!oidal pattern.
C. 4ariable deceleration pattern.
,. Kate deceleration pattern.
Correct answer: B.
Rationale:
*. 9arly deceleration! are a!!ociated )ith head compre!!ion.
B. T#e /etal #eart rate o/ a %!lti"ara 'ia(nose' wit# R# sensiti5ation
an' "ro&a&le /etal #)'ro"s an' ane%ia will %ost li1el) 'e%onstrate
a sin!soi'al "attern t#at rese%&les a sine wae. It #as &een
#)"ot#esi5e' t#at t#is "attern re8ects an a&sence o/ a%niotic
nero!s control oer t#e /etal #eart rate res!ltin( /ro% seere
#)"o0ia. T#is client will %ost li1el) re2!ire a cesarean 'elier) to
i%"roe t#e /etal o!tco%e.
C. 4ariable deceleration! are a!!ociated )ith cord compre!!ion.
,. Kate deceleration! are a!!ociated )ith poor placental per"u!ion.
/:.Nur!e Denny i! currently deeloping a plan o" care "or a primiparou! client
during the =r!t 1/ hour! po!t deliery. &hich o" the "ollo)ing concern! o" the
client !hould nur!e Denny primarily "ocu!'
*. 0he neonate.
+. 0he "amily.
C. 0he client>! o)n com"ort.
,. 0he client>! !igni=cant other.
Correct answer: C.
Rationale:
*. *"ter the =r!t 1 to 2 day! po!tpartum, the client i! in the ta$ing < hold pha!e
and can "ocu! more on the need! o" the neonate.
+. *lthough the "amily pre!ent! a! important people to !upport the mother
emotionally, during the ta$ing < in pha!e, the mother i! more concerned
about her!el".
C. T#e <rst *- #o!rs a/ter 'elier) are "art o/ t#e ta1in( in "#ase o/
%aternal "ost"art!% a'E!st%ent$ w#ic# t)"icall) lasts /ro% * to F
'a)s. D!rin( t#e ta1in( in "#ase$ t#e client is "ri%aril) concerne'
wit# #er own nee's.
,. *lthough the "amily i! an important unit o" care and the !igni=cant other i!
important "or the mother>! emotional !upport, during the ta$ing < in pha!e
the mother i! "ocu!ed on her!el".
/?.&hich o" the "ollo)ing )ould Nur!e 7ibo include in the teaching plan "or a
pimiparou! Mr!. Kenon about the "re3uency o" brea!t < "eeding the neonate
during the =r!t "e) day!'
*. Geeding the neonate )heneer he or !he crie!.
+. Re!tricting "eeding! to 1 to / minute! per !ide.
C. Geeding the neonate "or at lea!t 1; minute! per !ide.
,. Maintaining "eeding "or /; to 2; minute! per !ide.
Correct answer: C.
Rationale:
*. Geeding the in"ant )heneer the in"ant crie! i! not appropriate and can lead
to maternal e#hau!tion.
+. Geeding "or 1 to / minute! per !ide i! in!u-cient "or the let < do)n re.e#.
*l!o, thi! !hort period o" time preent! the neonate "rom latching on and
obtaining the needed nutrition.
C. D!rin( t#e <rst /ew 'a)s "ost"art!%$ t#e %ot#er s#o!l' &e
enco!ra(e' to n!rse /re2!entl). Breast /ee'in( /or at least *;
%in!tes "er si'e is reco%%en'e' /or t#e let 'own re8e0 to &e(in.
,. 5nitially, "eeding "or 1; minute! per !ide i! !u-cient until the in"ant become!
more com"ortable )ith brea!t < "eeding. 0hen the mother can increa!e the
brea!t < "eeding time gradually to /; to 2; minute!.
/C.Nur!e Candilaria i! conducting a home i!it on the "ourth po!tpartum day o"
Mr!. &ee. Mr!. &ee, a primiparou! client, tell! the Nur!e Candilaria that !he
ha! been e#periencing brea!t engorgement. 5n order to reliee the
engorgement, Nur!e Candilaria teache! the Mr!. Candilaria that be"ore
nur!ing the baby, !he !hould do )hich o" the "ollo)ing'
*. *pply an ice cube to the nipple!.
+. Rub her nipple! gently )ith lanolin cream.
C. 9#pre!! a !mall amount o" brea!t mil$.
,. BFer the neonate a !mall amount o" "ormula.
Correct answer: C.
Rationale:
*. *pplying ice to the nipple! doe! not reliee brea!t engorgement. 8o)eer, it
may temporarily reliee the di!com"ort a!!ociated )ith brea!t engorgement.
+. U!ing lanolin on the nipple! doe! not reliee brea!t engorgement and i!
unnece!!ary. U!e o" lanolin may cau!e !en!itiity and irritation.
C. E0"ressin( a little %il1 &e/ore n!rsin($ %assa(in( t#e &reasts
(entl)$ or ta1in( a war% s#ower &e/ore /ee'in( also %a) #el" to
i%"roe %il1 8ow. Alt#o!(# ario!s %eas!res s!c# as ice$ #eat$ an'
%assa(e %a) &e trie' to reliee &reast en(or(e%ent$ "reention /or
&reast en(or(e%ent &) /re2!ent /ee'in(s is t#e %et#o' o/ c#oice.
,. 8aing "re3uent brea!t < "eeding !e!!ion!, rather than oFering the neonate a
!mall amount o" "ormula, i! the method o" choice "or preenting and relieing
brea!t engorgement. 5n addition, oFering the neonate !mall amount! o"
"ormula may re!ult in nipple con"u!ion.
/8.%&hat i! the be!t po!ition "or the baby a"ter "eeding'( a!$ed Mr!. DeFer!on, a
primiparou! client )ho decided to bottle < "eed her baby, to the nur!e. &hich
o" the "ollo)ing po!ition! !hould the nur!e recommend a! be!t to aid
dige!tion'
*. Supine po!ition.
+. Bn the le"t !ide.
C. 1rone )ithout pillo).
,. Sitting on mom>! lap "or /; minute!.
Correct answer: A.
Rationale:
A. To ai' 'i(estion$ t#e neonate s#o!l' &e "lace' in a s!"ine "osition
or on t#e ri(#t si'e "ro""e' wit# a s%all &lan1et roll a/ter a /ee'in(.
+. 1lacing the neonate on the right, rather than the le"t, !ide promote! ga!tric
emptying and dige!tion.
C. 1lacing the neonate in a prone po!ition ha! been a!!ociated )ith !udden
in"ant death !yndrome.
,. *lthough the mother may de!ire to hold the in"ant in her lap a"ter "eeding,
thi! i! not nece!!ary "or the neonate>! dige!tion.
/H.* 2; < year < old 76, 16 )oman gae birth to a healthy "emale neonate ia
ce!arean deliery due to a nonrea!uring "etal heart rate tracing. 0)o hour!
po!tpartum, the nur!e a!!e!!e! the client>! urine and note! that it i! !lightly
red tinged. &hich o" the "ollo)ing )ould the nur!e do ne#t'
*. Continue to monitor the client>! input and output.
+. 1alpate the client>! "undu! gently eery 1: minute!.
C. *!!e!! the placement o" the retention catheter.
,. Contact the client>! phy!ician "or "urther order!.
Correct answer: D.
Rationale:
*. Continuing to monitor the client>! input and output !hould be done a"ter the
phy!ician i! contacted.
+. 1alpating the "undu! eery 1: minute! i! not nece!!ary unle!! the client>!
"undu! become! !o"t or %boggy.(
C. *!!e!!ment o" the retention catheter i! a normal part o" the elimination
a!!e!!ment by the nur!e, but di!placement i! not the cau!e o" the red <
tinged urine.
D. Sli(#tl) re' tin(e' !rine %a) in'icate t#at t#e &la''er was
acci'entall) c!t '!rin( t#e cesarean 'elier). T#e n!rse s#o!l'
noti/) t#e "#)sician as soon as "ossi&le a&o!t t#e !rine color.
2;.&hich o" the "ollo)ing mea!ure! )ould Nur!e Dilian e#pect to include in the
teaching plan "or Mr!. Ra!onabe )ho i! a multiparou! client deliered /6
hour! ago and i! receiing intraenou! antibiotic therapy "or cy!titi!'
*. Kimiting .uid inta$e to 1K daily to preent oerload.
+. 9mptying the bladder eery / to 6 hour! )hile a)a$e.
C. &a!hing the perineum )ith poidone iodine a"ter oiding.
,. *oiding the inta$e o" acidic "ruit Euice! until the treatment i! di!continued.
Correct answer: B.
Rationale:
*. 0he client !hould maintain ade3uate .uid inta$eM 2;;; ml per day i!
recommended.
B. T#e client 'ia(nose' wit# c)stitis nee's to oi' eer) - to + #o!rs
w#ile awa1e to 1ee" #er &la''er e%"t).
C. She doe! not need to )a!h )ith poidone iodine a"ter oiding. 1lain )arm
)ater i! !u-cient to $eep the perineal area clean.
,. 5nta$e o" acidic "ruit Euice! @e.g. cranberry, apricotA i! recommended becau!e
o" their a!!ociation )ith reducing the ri!$ "or in"ection. 0he client !hould )ear
cotton under)ear and oid tight =tting !lac$!.