OB Exam 3 PQ 1

1. Nurses should be aware that HELLP syndrome:a) Is associated with preterm labor but not perinatal mortality.b) Is characterized by hemolysis, elevated liver enzymes, and low platelets.c) Is a mild form of preeclampsia.d) Can be diagnosed by a nurse alert to its symptoms.

2. Magnesium sulfate is given to women with preeclampsia and eclampsia to:a) Prevent a boggy uterus and lessen lochial flow.b) Improve patellar reflexes and increase respiratory efficiency.c) Prevent and treat convulsions.d) Shorten the duration of labor.

3. A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature of 37.3° C, pulse rate of 88 beats/min, respiratory rate of 10 breaths/min, blood pressure (BP) of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The client's response to questions are sluggish are hard to understand. The nurse:

a) Calls for a stat magnesium sulfate level.b) Discontinues the magnesium sulfate infusion.c) Prepares to administer hydralazine.d) Administers oxygen.

4. The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman’s latest laboratory test findings, which reveal an hematocrit of 41%, a creatinine of 6.2, a platelet count of 90,000, an elevated aspartate transaminase (AST) level, and decreased serum haptoglobin. The nurse notifies the physician because the laboratory results are indicative of:

a) Disseminated intravascular coagulation (DIC).b) Eclampsia.c) HELLP syndrome.d) Idiopathic thrombocytopenia

5. A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature of 37.1° C, pulse rate of 96 beats/min, respiratory rate of 24 breaths/min, blood pressure (BP) of 175/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for:

a) Diazepam.b) Hydralazine.c) Calcium gluconate.d) Magnesium sulfate bolus.

6. A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse?

a) Weight gain of 0.5 kg during the past 2 weeksb) Pitting pedal edema at the end of the dayc) Blood pressure (BP) increase to 138/86 mm Hgd) A dipstick value of 3+ for protein in her urine

7. What nursing diagnosis would be the most appropriate for a woman experiencing severe preeclampsia?a) Risk for injury to the fetus related to uteroplacental insufficiencyb) Risk for eclampsiac) Risk for deficient fluid volume related to increased sodium retention secondary to administration of

MgSO4d) Risk for increased cardiac output related to use of antihypertensive drugs

8. A woman with preeclampsia has a seizure. The nurse’s primary duty during the seizure is to:a) Administer oxygen by mask.b) Suction the mouth to prevent aspiration.c) Stay with the client and call for help.d) Insert an oral airway.

9. A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits:

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OB Exam 3 PQ 1

a) Absent ankle clonus.b) A sleepy, sedated affect.c) A respiratory rate of 10 breaths/min.d) Deep tendon reflexes of 2.

10. Your client has been on magnesium sulfate for 20 hours for treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings would you expect to observe/assess in this client?

a) A fundus firm below the level of the umbilicusb) A boggy uterus with heavy lochia flowc) Scant lochia flowd) Absence of uterine bleeding in the postpartum period

11. A woman has been having contractions since 4 A.M. At 8 A.M., her cervix is dilated to 5 cm. At 10 am her cervix is still 5 cm. Contractions are frequent, and mild to moderate in intensity. Cephalopelvic disproportion (CPD) has been ruled out. The nurse would anticipate preparing for:

a) Cesarean section.b) Documentation your assessment and assess again in an hour.c) Increased intravenous infusion.d) Oxytocin induction of labor.

12. A nurse is comparing advantages of using active management of labor (AMOL) with a less interventional approach. The nurse knows that the goal of AMOL is:

a) Preventing protracted labor and arrest of progress.b) Relieving the anxiety and fear accompanying labor.c) Detecting and intervening in cases of precipitous labor.d) Preventing infection from prolonged rupture of membranes.

13. Which of the following is true with respect to chorioamninitis?a) Once a woman who has had chorioamnionitis has delivered the antibiotics will be stopped.b) If a woman has chorioamnionitis she will be treated with broad spectrum antibiotics and allowed to

continue in labor.c) Most often chorioamnionitis is caused by pathogens such as GBBS.d) An epidural can cause maternal fever and fetal tachycardia.

14. Which symptoms diagnose chorioamnionitis? (Select all that apply)a) Maternal or Fetal Tachycardiab) Maternal fever > or = 38o Cc) Foul discharged) Uterine tenderness

15. Approximately 50% of all women who give birth prematurely have no identifiable risk factors, and about 50% of preterm births could not be prevented.

a) Falseb) True

16. With regard to the care management of preterm labor, nurses should be aware that:a) Because all women must be considered at risk for preterm labor and prediction is so hit-and-miss,

teaching pregnant women the symptoms probably causes more harm through false alarms.b) Because preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait

several hours before contacting the primary caregiver.c) Braxton Hicks contractions often signal the onset of preterm labord) The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical

change.17. A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly.

The purpose of this pharmacologic treatment is to:a) Stimulate fetal surfactant production.b) Suppress uterine contractions.c) Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.d) Reduce maternal and fetal tachycardia associated with ritodrine administration.

18. Complications and risks associated with cesarean births include (choose all that apply):

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OB Exam 3 PQ 1

a) Wound dehiscence.b) Pulmonary edema.c) Urinary tract infections.d) Fetal injuries.e) Hemorrhage.

19. During labor, the patient at 4 cm suddenly becomes dyspneic, cyanotic, and hypotensive. The nurse must prepare immediately for: (Select all that apply.)

a) CPR.b) McRobert's maneuver.c) Immediate vaginal delivery.d) Cesarean delivery

20. Nurses should be aware that the induction of labor:a) Is also known as a trial of labor (TOL).b) Is rated for likelihood of induction success by a Bishop score.c) Is almost always done for medical reasons.d) Can be achieved by external and internal version techniques

21. A client is in active labor. The nurse determines that the fetus's position is occiput posterior. Which nursing diagnosis will apply to this woman's care if the occiput posterior position becomes persistent?

a) Risk for injuryb) Acute painc) Fluid volume deficitd) Impaired gas exchange

22. A pregnant client was in an automobile accident, and presents to the labor suite from the Emergency Department after she presented at the ED with a deep gash on her forearm from the crash. The client was not wearing a seat belt, and was speeding. She now seems highly agitated, is pacing continuously, and is talking very rapidly. The nurse should suspect that this client has what type of psychological disorder?

a) Schizophreniab) Social anxiety disorderc) Obsessive-compulsive disorderd) Bipolar disorder, manic phase

23. The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is:a) Intense abdominal pain.b) Uterine activity.c) Cramping.d) Bleeding.

24. After delivery it is determined that there is a placenta accreta. Which intervention should the nurse anticipate?a) Surgery with possible Hysterectomyb) 2 L oxygen by maskc) Intravenous antibioticsd) Intravenous oxytocin

25. Which of the following is true about placenta previa.a) Once placenta previa is diagnosed by a 20 week ultrasound, it is very likely the placenta previa will

resolve in the third trimester.b) In evaluating the bleeding, a vaginal exam would be done to determine the cause of the bleeding.c) Symptoms of placenta previa are painful frequent contractions and bright red vaginal bleedingd) The bleeding from placenta previa usually occurs late in pregnancy at term.

26. With regard to the process of inducing labor, nurses should be aware that:a) Ripening the cervix usually results in a decreased success rate for inductionb) Amniotomy can be used to make the cervix more favorable for labor.c) Oxytocin is less expensive than prostaglandins and more effective but creates greater health risks.d) Labor sometimes can be induced with balloon catheters or laminaria tents.

27. When the provider indicates a shoulder dystocia is occurring during the delivery of a macrosomic fetus, the nurse would assist by:

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OB Exam 3 PQ 1

a) Calling a second physician to assist.b) Utilizing fundal pressure to push the fetus out.c) Assisting the woman into McRobert's maneuver.d) Preparing for an immediate cesarean delivery.

28. A primigravida is admitted to the birth setting in early labor. She is 3 cm dilated, -2 station, with intact membranes and FHR of 150 bpm. Her membranes rupture spontaneously, and the FHR drops to 90 bpm with variable decelerations. The initial response from the nurse would be to:

a) Notify the physician.b) Administer oxygen at 2 l per nasal cannula.c) Perform a vaginal exam.d) Place the client in a left lateral position

29. A multipara is having intense uterine contractions with little uterine relaxation between contractions. Vaginal examination reveals rapid cervical dilation and fetal descent. The nurse should

a) Place the woman in knee—chest positionb) Notify the physician of these findings.c) Turn off the lights to make it easier for the woman to relax.d) Assemble supplies to prepare for a cesarean birth.

30. Which of the following is the correct about care for a pregnant woman who has experienced blunt trauma in a car accident?

a) The two most common risks are preterm labor and fetal death.b) If the woman does not have more than 6 ctx an hour she may go home after 4 hours.c) In the ER she is evaluated and treated to hemodynamically stabilize her, then she is evaluated with

an electronic fetal monitor for a minimum of 4 hours.d) Rhogam is not necessary for rH negative pregnant women after a blunt force trauma.

31. A woman has been in labor for 16 hours. Her cervix is dilated to 3 cm and is 80% effaced. The fetal presenting part is not engaged. The nurse would suspect:

a) Abruptio placentaeb) Breech malpresentation.c) Fetal demise.d) Cephalopelvic disproportion (CPD).

32. For a woman at 42 weeks of gestation, which finding would require more assessment by the nurse?a) Score of 8 on the biophysical profileb) One fetal movement noted in 1 hour of assessment by the motherc) Cervix dilated 2 cm and 50% effacedd) Fetal heart rate of 116 beats/min

33. The nurse is caring for a client whose labor is being augmented with oxytocin. He or she recognizes that the oxytocin should be discontinued immediately if there is evidence of:

a) Rupture of the client’s amniotic membranes.b) Uterine contractions occurring every 8 to 10 minutesc) A fetal heart rate (FHR) of 180 with absence of variability.d) The client needing to void.

34. In evaluating the effectiveness of oxytocin induction, the nurse would expect:a) At least 30 mU/min of oxytocin will be needed to achieve cervical dilationb) Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart.c) The intensity of contractions to be at least 110 to 130 mm Hg.d) Labor to progress at least 2 cm/hr dilation.

35. A pregnant woman’s amniotic membranes rupture. Prolapsed cord is suspected. What intervention would be the top priority?

a) Preparing the woman for a cesarean birthb) Placing the woman in the knee-chest positionc) Covering the cord in sterile gauze soaked in salined) Starting oxygen by face mask

36. With regard to the use of tocolytic therapy to suppress premature uterine activity, nurses should be aware that:

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OB Exam 3 PQ 1

a) There are no important maternal (as opposed to fetal) contraindications.b) Its most important function is to afford the opportunity to administer antenatal glucocorticoids.c) The drugs can be given efficaciously up to the designated beginning of term at 37 weeks.d) If the client develops pulmonary edema while on tocolytics, intravenous (IV) fluids should be given.

37. A woman arrive in the admission area of L&D. She is complaining of severe abdominal pain which she thinks are contractions and vaginal bleeding. You notice the sheet on the bed is about 1/3 covered with port wine fluid. You would do all of the following EXCEPT:

a) NOtify the charge nurse and patient's provider.b) Put her on the monitorc) Take a complete medical history and measure her vital signs.d) Start an IVe) Position on her side and give her oxygen if the fetal heart rate was category II.

38. The nurse providing care for the laboring woman should understand that amnioinfusion is used to treata) Variable decelerations (intermittent umbilical cord compression)b) Fetal tachycardia.c) Late decelerations.d) Fetal bradycardia

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