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Obstetrics Practice Tests

Obstetrics Practice Tests

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Published by ashleymallory

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Published by: ashleymallory on Feb 16, 2010
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09/09/2014

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Name:_____________________________________________________________Date:_____________ 
1.
A client, now 37 weeks pregnant, calls the clinic because she's concerned aboutbeing short of breath and is unable to sleep unless she places three pillows under herhead. After listening to the client's concerns, the nurse should take which action?a. Make an appointment because the dent needs to be evaluated.
b. Explain that these are expected problems for the latter stages of pregnancy.
c. Arrange for the dent to be admitted to the birth center and prepare for birth.d. Tell
 
the client to go to the hospital; she may be experiencing signs of heart failure.
RATIONALE:
The nurse must distinguish between normal physiologic complaints of the latter stages of pregnancy and those that need referral to the health careprovider. In this case, the client indicates normal physiologic changes caused by thegrowing uterus and pressure on the diaphragm. These signs don't indicate heartfailure. The client doesn't need to be seen or admitted to the birth center.Reference: Maternal & Child Health Nursing: Care of the Childbearing andChildrearing Family, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 230.
2.
During the first trimester, a nurse evaluates a pregnant client for factors that suggestshe might abuse a child. Which parental characteristic is of most concern to thenurse?a. The client didn’t graduate high school.
b. The client states she is stupid and ugly.
 c. The client is carrying twins. The client eats fast food every day.
RATIONALE:
Typically, the abusive parent has low self-esteem, which may beevident by self-deprecating statements, and many unmet needs. Lack of nurturingexperience and inadequate knowledge of childhood growth and development mayalso contribute to the potential for child abuse. A low educational level, multiplegestations, and poor diet aren't direct risk factors for committing child abuse.
REFERENCE:
Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearingand Childrearing Family, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p.1743.
3.
A client in her 15th week of pregnancy has presented with abdominal cramping andvaginal bleeding for the past 8 hours. She has passed several clots. What is theprimary nursing diagnosis for this client?a. Deficient knowledge of pregnancyb
. Deficient fluid volume
 c. Anticipatory grievingd. Acute pain
RATIONALE:
If bleeding and clots are excessive, this client may becomehypovolemic , leading to a nursing diagnosis of Deficient fluid volume. AlthoughDeficient knowledge (pregnancy), Anticipatory grieving, and Acute pain areapplicable to this client, they aren't the primary diagnosis 
REFERENCE:
Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearingand Childrearing Family 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p.400.
4.
A nurse is obtaining a prenatal history from a client who's 8 weeks pregnant. To helpdetermine whether the client is at risk for a TORCH infection , the nurse shouldask:a. “Have you ever had osteomyelitis?”b. “
Do you have any cats at home?
 c. “Do you have any birds at home?’d. “Have you recently had a rubeola vaccination?”
RATIONALE:
Toxoplasmosis, Other Rubella virus, Cytomegalovirus, and Herpessimplex virus and agents that may infect the fetus or neonate, causing numerous illeffects. Toxoplasmosis is transmitted to humans through contact with the feces oinfected cats (which may occur when emptying a litter box), through ingesting rawmeat, or through contact with raw meat followed by improper hand washing.Osteomyelitis , a serious bone infection; histoplasmosis, which can be transmitted bybirds; and rubeola aren't TORCH infections 
REFERENCE:
Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearingand Childrearing Family, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p.288.
1
 
5.
A client, 38 weeks pregnant, arrives in the emergency department complaining of contractions. To help confirm that she's in true labor, the nurse should assess for:a. irregular contractions.b. increased fetal movement.
c. changes in cervical effacement and dilation atter 1 to 2 hours.
 d. contractions that feel like pressure in the abdomen and qroin.
RATIONALE:
True labor is characterized by progressive cervical effacement anddilation after 1 to 2 hours, regular contractions, discomfort that moves from the backto the front of the abdomen and, possibly, bloody show. False labor causes irregularcontractions that are felt primarily in the abdomen and groin and commonly decreasewith walking, increased fetal movement, and lack of change in cervical effacement ordilation even after 1 or 2 hours.
REFERENCE:
Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearingand Childrearing Family, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p.227.
6.
A nurse is caring for a client during the first postpartum day. The client asks thenurse how to relieve pain from her episiotomy . What should the nurse instruct thewoman to do?a.
Apply an ice pack to her perineum.
 b. Take a sitz bath.c. Perform perineal care after voiding or a bowel movement.d. Drink plenty of fluids.
RATIONALE:
A cold pack applied to an episiotomy during the first 24 hours afterchidbirth may reduce edema and tension on the incision line, thereby reducing pain.After the first 24 hours, a sitz bath may reduce discomfort by promoting circulationand healing. Although perineal care should be performed after each voiding andbowel movement, its purpose is to prevent infection — not reducediscomfort. Drinking plenty of fluids is also important, especially for the breast-feeding woman, but it doesn't relieve perineal discomfort.
REFERENCE:
Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearingand Childrearing Family, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p.637.
7.
A client who's 24 weeks pregnant has sickle cell anemia . When preparing the careplan, the nurse should identify which factor as a potential trigger for a sickle cellcrisis during pregnancy?a. Sedative use
b. Dehydration
c. Hypertensiond. Tachycardia
RATIONALE:
Factors that may precipitate a sickle cell crisis during pregnancyinclude dehydration , infection , stress, trauma, fever, fatigue, and strenuousactivity. Sedative use, hypertension, and tachycardia aren't known to precipitate asickle cell crisis 
REFERENCE:
Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearingand Childrearing Family, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p.363.8.A nurse is caring for a 1-day postpartum mother who's very talkative but isn'tconfident in her decision-making skills. The nurse is aware that this is a normalphase for the mother. What is this phase called?
a. Taking-in phase
 b. Taking-hold phasec. Letting-go phased. Taking-over phase
RATIONALE:
The taking-in phase is a normal first phase for a mother when she'sfeeling overwhelmed by the responsibilities of caring for the neonate while stillfatigued from childbirth. Taking hold is the next phase, when the mother has restedand she can think and learn mothering skills with confidence. During the letting-go ortaking-over phase, the mother gives up her previous role. She separates herself fromthe neonate, giving up the fantasy of birth, and readjusting to the reality of caring forthe neonate. Depression may occur during this stage.
REFERENCE:
Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearingand Childrearing Family, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p.624.
2
 
9.
Which intervention listed in the care plan for a client with an ectopic pregnancyrequires revision?a. Assessing vital signs
b. Providing for dietary needs
 c. Managing paind. Providing emotional support
RATIONALE:
Providing for the client's dietary needs isn't appropriate because theclient shouldn't eat or drink anything pending surgery. Assessing vital signs forindicators of potential shock , managing pain, and providing emotional support areessential nursing interventions in caring for a client with an ectopic pregnancy.
REFERENCE:
Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearingand Childrearing Family, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p.409.
10.
A client who's 19 weeks pregnant comes to the clinic for a routine prenatal visit. Inaddition to checking the client's fundal height, weight, and blood pressure, whatshould the nurse assess for at each prenatal visit?a.
Edema
b. Pelvic adequacyc. Rh factor changesd. Hemoglobin alterationsRATIONALE: At each prenatal visit, the nurse should assess the client for edemabecause edema, increased blood pressure, and proteinuria are cardinal signs of gestational hypertension. Pelvic measurements and Rh typing are determined at thefirst visit only because they don't change. The nurse should monitor the hemoglobinlevel on the client's first visit, at 24 to 28 weeks' gestation, and at 36 weeks'gestation.REFERENCE: Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearingand Childrearing Family, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p.257.
11.
A nurse is caring for a client whose membranes ruptured prematurely 12 hours ago.When assessing this client, the nurse's highest priority is to evaluate:a. cervical effacement and dation.
b. maternal vital signs and fetal heart rate (FHR).
 c. frequency and duration of contractions.d. white blood cell (WBC) count.
RATIONALE:
After premature rupture of the membranes (PROM), monitoringmaternal vital signs and FHR takes priority. Maternal vital signs, especiallytemperature and pulse, may suggest maternal infection caused by PROM. FHR is themost accurate indicator of fetal status after PROM and may suggest sepsis caused byascending pathogens. Assessing cervical effacement and dilation should be avoidedin this client because it requires a pelvic examination, which may introducepathogens into the birth canal. Evaluating the frequency and duration of contractionsdoesn't provide insight into fetal status. The WBC count may suggest maternalinfection; however, it can't be measured as often as maternal vital signs and FHR canand therefore provides less current information
REFERENCE:
Ricci, S.S. Essentials of Maternity, Newborn, and Women’s HealthNursing. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 531.
12.
A client is told that she needs to have a nonstress test to determine fetal well-being.After 20 minutes of monitoring, the nurse reviews the strip and finds two 15-beataccelerations that lasted for 15 seconds. What should the nurse do next ?a. Continue to monitor the baby for fetal distress.b. Notify the physician and transfer the mother to labor and delivery for imminentdelivery.
c. Inform the physician and prepare for discharge: this client has areassuring strip.
d. Ask the mother to eat something and return for a repeat test; the results areinconclusive.
RATIONALE:
Fetal well-being is determined during a nonstress test by twoaccelerations occurring within 20 minutes that demonstrate a rise in heart rate of atleast 15 beats. This fetus has successfully demonstrated that the intrauterineenvironment is still favorable. The test results don't suggest fetal distress, soimmediate delivery is unnecessary. In research studies, eating foods or drinkingfluids hasn't been shown to influence the outcome of a nonstress test.
REFERENCE:
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