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50 Cards in this Set

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A 29-year-old pregnant woman reported to the OB nurse that she had twins at 36 weeks with her first pregnancy. When filling out the OB history form, the nurse would note that the patient is considered:

a. Gravida 1, para 1
b. Gravida 2, para 1
c. Gravida 3, para 2
d. Gravida 2, para 2
B. Gravida 2, para 1

Gravidity represents the number of pregnancies the woman has had, including the present one. Parity is the number of pregnancies that have reaches 20 or more gestation weeks before birth. The patient is still considered gravida 2, para 1 until she gives birth at 38 weeks when she would be then become gravida 2, para 2.
Which of the following medications can cause false-negative results in a pregnancy test?

a. Anticonvulsants
b. Diuretics
c. Vitamin D supplement
d. Ibuprofen
B. Diuretics

Medications such as diuretics and promethazine can cause false-negative results in pregnancy tests. Anticonvulsants can cause false-positive results.
Which of the following are positive signs of pregnancy? [select all that apply]

a. Nausea
b. Fatigue
c. Palpable fetal movements
d. Positive result of a pregnancy test
e. Braxton Hicks contractions
f. Fetal visualization by ultrasound
C. Palpable fetal movements

F. Fetal visualization by ultrasound

Positive signs of pregnancy are signs that are attributable only to the presence of fetus. Nausea and fatigue are examples of presumptive signs of pregnancy.
Positive result of a pregnancy test and Braxton Hicks contractions are examples of probable signs of pregnancy.
During assessment of a pregnant patient, the OB nurse noted musty, gray-colored vaginal discharge. Which of the following would be the most appropriate action by the nurse?

a. Inform physician about finding
b. Collect sample for testing
c. Document finding
d. Administer PRN antibiotic
C. Document finding

Leukorrhea is a white or slightly gray mucoid discharge w/ a faint and musty odor. It occurs in response to cervical stimulation by estrogen and progesterone during pregnancy.
A nurse is ordered to perform assessments on patients in the OB unit. Which of the following assessment findings wouldn’t be present in pregnancy?

a. Striae gravidarum over the lower abdominal area
b. Dependent edema in the lower extremities
c. Increased heart rate
d. Increased hemoglobin and hematocrit
D. Increased hemoglobin and hematocrit

Because the plasma increase exceeds the increase in RBC production, a decrease in hemoglobin and hematocrit values occur during pregnancy.
A woman who is 30-weeks pregnant is brought by her husband to the ER. During assessment, the patient reports having multiple short contractions and is relieved by walking. The nurse would note the patient is experiencing:

a. Early-stage labor
b. Lightening
c. Braxton hicks sign
d. Ballottement
C. Braxton hicks sign

Braxton Hicks contractions are irregular, painless, and usually cease with walking or exercise. They occur intermittently throughout pregnancy and can be mistaken for true labor, however, they don’t increase in intensity or frequency or cause cervical dilation.
A nursing student is performing an OB assessment on a patient who is 28-weeks pregnant. During assessment, the patient reported she had given birth at 32-weeks for her first child, gave birth to twins at 38-weeks, and a therapeutic abortion at 10-weeks gestation 2 years ago. How should the nursing student fill out the OB history of the patient using the GTPAL system?

a. 4-1-1-1-3
b. 3-1-1-1-3
c. 4-2-1-1-3
d. 3-2-1-1-3
A. 4-1-1-1-3

The GTPAL system provides more specific information about women’s OB history. The first digit represents gravidity, the second digit represents term births, the third digit indicates pre-term births, the fourth identifies the number of abortions (miscarriages, or elective termination of pregnancy), and the fifth is the number if living children.
A nurse is performing nutrition teaching to a patient who is 24-weeks pregnant. Which of the following statements should not be included in the teaching?

a. Food intake should not be doubled
b. Patient should eat foods rich in folate
c. Pregnancy isn’t the time for a weight reduction diet
d. High-protein supplements should be taken to promote fetal development
D. High-protein supplements should be taken to promote fetal development

High-protein supplements aren’t recommended because they have been associated with an increased incidence of preterm births. Emphasis on the quality of food intake, rather than quantity, should be noted for the patient during pregnancy.
The husband of a pregnant patient expressed concern to the nurse about his wife’s overconsumption of cornstarch. In explaining the behavior to the husband, the nurse would note that consumption of nonfood substances is related to low levels of:

a. Folic acid levels
b. Hemoglobin
c. Vitamin D
d. Potassium
B. Hemoglobin

Pica is the practice of consuming nonfood substances (soil, clay) or excessive amounts of foods low in nutritional value (baking powder, cornstarch). Women who practice pica have been found to have lower hemoglobin levels than those who don’t practice pica.
To increase absorption of iron, the nurse would recommend to a pregnant patient to have adequate intake of:

a. Zinc
b. Calcium
c. Vitamin C
d. Folic acid
C. Vitamin C

Vitamin C plays an important role in tissue formation and enhances absorption of iron.
The husband of a pregnant patient expressed concern to the nurse about his wife’s overconsumption of cornstarch. In explaining the behavior to the husband, the nurse would note that overconsumption of cornstarch predisposes the patient to develop:

a. Gestational diabetes
b. Gestational hypertension
c. PKU
d. Preeclampsia
A. Gestational diabetes

Cornstarch is a source of “empty” calories and contains no vitamins, minerals, or protein. Overuse of cornstarch can contribute to development of gestational diabetes.
A nurse is reviewing a teaching plan for a group of adolescent pregnant patients. Which of the following statements should not be included in the teaching?

a. A desirable body weight should be attained before giving birth to prevent excessive weight gain
b. Iron supplements should be taken in between meals
c. Moderate exercise is beneficial during pregnancy
d. Progressive weight gain during pregnancy is essential to ensure normal fetal growth and development
A. A desirable body weight should be attained before giving birth to prevent excessive weight gain

A desirable body weight should be attained before pregnancy. Whenever possible, a woman should achieve a weight in a normal range for her height before pregnancy.
An OB nurse is teaching a patient about nutrition needs during lactation. Which of the following statements shouldn’t be included in the teaching?

a. Nutrition needs during lactation are similar to those during pregnancy
b. Many lactating women have a delay in the return of menses
c. There is no need to consume more fluids than those needed to satisfy thirst
d. Needs for iron and folic acid are higher than those during pregnancy
D. Needs for iron and folic acid are higher than those during pregnancy

With the decrease in maternal blood volume to non-pregnant levels after birth, maternal iron and folic acid needs also decrease. Fluid intake must be adequate to maintain milk production, but the mother’s level of thirst is the best guide to the right amount.
When teaching a pregnant patient about physical activity during pregnancy, it is important to encourage the patient to consume adequate fluid intake because dehydration can:

a. Cause gestational hypertension
b. Trigger premature labor
c. Cause preeclampsia
d. Cause pyrosis
B. Trigger premature labor

A liberal amount of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. Calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.
A nurse is taking an OB history of a 30-year-old woman who is gravida-2, para-1. The nurse noted that the patient gave birth to a large-for-gestational-age (LGA) child 2 years ago. Knowing the patient’s history, the nurse would note that the patient may have which of the following?

a. Pica and foods cravings
b. Sickle-cell anemia
c. Diabetes
d. Family history of obesity
C. Diabetes

Birth of a large-for-gestational-age (LGA) infant often indicates the existence of maternal diabetes mellitus.
A nurse performed discharge teaching for a patient about iron supplementation. Which of the following statements by the patient indicate a need for further teaching?

a. Iron may cause dark-colored stools
b. Constipation is common with iron supplementation
c. I can take my iron supplement at bedtime
d. I should take iron with milk before meals to prevent GI discomfort
D. I should take iron with milk before meals to prevent GI discomfort

Bran, tea, coffee, and milk decrease iron absorption. Iron is absorbed best if it is taken when the stomach is empty.
The husband of a pregnant patient expressed concern to the nurse about his wife’s nausea and vomiting or “morning sickness”. Which of the following would the nurse suggest to the husband and patient to manage the patient’s nausea and vomiting?

a. Avoid consuming dry, starchy foods such as crackers when nausea occurs
b. Encourage fluids early in the day or when feeling nauseated
c. Eat small, frequent meals
d. Avoid high-carbohydrate foods such as toast, rice, or potatoes
C. Eat small, frequent meals

Patient should eat small amounts frequently (Q2-3H) and avoid large meals that distend the stomach. Patient should avoid consuming excessive amounts of fluids early in the day or when nauseated.
A 26-year-old patient who is 10-weeks pregnant asks the nurse how to determine the estimated date of birth of the child. The patient reported that the first day of her last menstrual period (LMP) was in January 3, 2012. Using the Nagel’s rule, the nurse would determine the estimated date of birth will be:

a. October 10, 2012
b. September 10, 2012
c. October 6, 2012
d. September 6, 2012
A. October 10, 2012

After determining the first day of LMP, subtract 3 calendar months and add 7 days; or alternatively, add 7 days to LMP and count forward 9 calendar months on the estimated date of birth.
In monitoring for potential complications in pregnancy, the nurse should note which of the following as a sign of infection?

a. Glycosuria
b. Diarrhea
c. Persistent vomiting
d. Abdominal cramping
B. Diarrhea

Signs and symptoms of infection during pregnancy include chills, fever, burning on urination, and diarrhea.
In monitoring for potential complications in pregnancy, the nurse should note that a miscarriage is manifested by which of the following signs and symptoms?

a. Abdominal cramping and vaginal bleeding
b. Absence of fetal movements after quickening
c. Sudden discharge of fluid from vagina before 37 weeks
d. Uterine contractions; cramping before 37 weeks
A. Abdominal cramping and vaginal bleeding

Signs and symptoms of a miscarriage include severe abdominal cramping, and vaginal bleeding. Absence of fetal movements after quickening is a sign of fetal jeopardy or intrauterine fetal death.
A nurse is reviewing home care instructions for a 34-year-old pregnant patient. Which of the following interventions should the nurse question?

a. Avoid spicy, fried, greasy foods to reduce incidence of nausea and vomiting
b. Use stool softener to prevent constipation
c. Place pillows between legs when in side-lying position for support
d. Take oatmeal baths or Keri baths to relieve pruritus
B. Use stool softener to prevent constipation

Patient should not take any laxatives, stool softeners, or enemas without first consulting the primary healthcare provider to prevent any injuries to the fetus
A patient pregnant with twins visits the clinic for a routine checkup. The patient had a 3-year-old child who was delivered at 38 weeks gestation and has no history of abortions or miscarriages. Using the GTPAL system, the nurse would document the patient’s data as:

a. 2-1-0-0-1
b. 2-0-1-0-1
c. 3-1-0-0-1
d. 3-0-1-0-1
A. 2-1-0-0-1

A woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 38 weeks, the number of term births is 1.
A pregnant patient asks the nurse about exercises that she can do during pregnancy. Which of the following exercises should the nurse recommend for the patient?

a. Jogging
b. Rock climbing
c. Swimming
d. Skydiving
C. Swimming

Pregnant patients should avoid weight-bearing exercises such as jogging or running and concentrating on non-weight bearing activities such as swimming or stretching.
A nurse is performing discharge teaching for a patient after an early miscarriage. Which of the following statements of the patient indicate understanding of the teaching?

a. Iron supplements should be avoided to prevent hemorrhage
b. Tampons should be regularly changed to prevent infection
c. I can take a shower when I get home
d. I have to use a type of contraception during intercourse
C. I can take a shower when I get home

Tampons and vaginal intercourse should be avoided for 2 weeks after an early miscarriage. Iron supplements are ordered for the patient if significant blood loss has occurred.
A pregnant patient asks her nurse why she needs to take folic acid supplements. The nurse would explain to the patient that folic acid helps prevent which disorder?

a. PKU
b. Gestational diabetes
c. Preterm labor
d. Neural tube defects
D. Neural tube defects

Neural tube defects, or failures in closure of the neural tube, are common in infants of women w/ poor folic acid intake. Proper closure of the neural tube is required for normal formation of the spinal cord.
During assessment of a pregnant patient, the nurse noted blotchy, dark-brown pigmentation around the patient’s face. The nurse would document the finding as indication of:

a. Maternal anemia
b. Striae gravidarum
c. Chloasma
d. Linea nigra
C. Chloasma

Facial melasma, also called chloasma or mask of pregnancy, is a blotchy, brownish hyperpigmentation of the skin over the cheeks, nose, and the forehead. It appears after the 16th week and increasing gradually until term.
A 23-year-old pregnant patient at 18-weeks gestation reports to the emergency department of severe abdominal cramping and heavy vaginal bleeding. Further assessment by the nurse reveals that the patient’s cervix is 4cm dilated. Which of the following should the nurse expect?

a. Complete miscarriage
b. Preterm labor
c. Inevitable miscarriage
d. Premature rupture of membranes (PROM)
C. Inevitable miscarriage

An inevitable miscarriage involves a moderate to heavy amount of bleeding w/ an open cervical os and is often accompanied by rupture of membranes. Mild to severe uterine cramping may be present.
Which of the following conditions would be manifested at the beginning (first stage) of labor?

a. bearing-down efforts (pushing) by the woman
b. increased intra-abdominal pressure
c. involuntary uterine contractions
d. full cervical dilation
C. Involuntary uterine contractions

Involuntary uterine contractions, called primary powers, signal the beginning of labor. Once the cervix has dilated, voluntary bearing-down efforts by the woman, called secondary powers, augment the force of involuntary contractions.
All of the following maternal physiologic changes occur during labor, except:

a. increased blood glucose levels
b. increased respiratory rate
c. increased WBC
d. increased cardiac output
A. increased blood glucose levels

During labor, metabolism increases and blood glucose levels may decrease with the work of labor.
A nurse is performing an assessment on a patient who is at 38 weeks gestation and noted a fetal heart rate (FHR) of 170 beats per minute. Which of the following action should the nurse do next?

a. Document finding as normal
b. Notify physician
c. Check mother’s HR
d. Reassess FHR after 5 minutes
B. Notify physician

The average FHR at term is 140 beats/min. The normal range is 110-160 beats/min. Earlier in gestation the FHR is higher and decreases progressively as the maturing fetus reaches term.
A patient who is pregnant at 20-weeks gestation asks the nurse about having a gynecoid pelvis. The nurse’s response should be based on the fact that a gynecoid pelvis:

a. Is the most favorable pelvic type for giving birth
b. Has a higher incidence of cesarean births than other pelvic types
c. Is less common in women who have a history of diabetes mellitus
d. Has a higher incidence of pre-term births
A. Is the most favorable pelvic type for giving birth

Gynecoid pelvis is a normal female pelvis and is the most favorable for successful labor and birth.
Shortening and thinning of the cervix during the first stage of labor is described as:

a. Dilation
b. Quickening
c. Effacement
d. Lightening
C. Effacement

Effacement of the cervix means the shortening and thinning of the cervix during the first stage of labor. Dilation of the cervix is the enlargement or widening of the cervical opening and the cervical canal that occurs once labor has begun.
A nurse is teaching a pregnant patient about preventing UTIs during pregnancy. Which of the following statements by the patient indicates a need for further teaching?

a. I have to avoid bubble baths
b. I can wear cotton underpants or pantyhose
c. Yogurt prevents urinary tract or vaginal infections
d. I have to limit my fluid intake to prevent frequent urination
D. I have to limit my fluid intake to prevent frequent urination

Pregnant patients should drink at least 2L of liquid a day, preferably water, to maintain an adequate fluid intake that ensures frequent urination. Pregnant women shouldn’t limit fluids in an effort to reduce frequency of urination. Consumption of yogurt or acidophilus milk may help prevent UTIs.
A nurse is teaching a pregnant patient about performing Kegel exercises. Teaching has been effective if the patient reports which of the following?

a. Less occurrence of morning sickness
b. Increased control of urine flow
c. Less back pain
d. Reduced Braxton Hick’s contractions
B. Increased control of urine flow

Kegel exercises (deliberate contraction and relaxation of the pubococcygeus muscle) strengthen muscles around the reproductive organs and improve muscle tone. Teaching has been effective if the patient reports and increased ability to control urine flow and greater muscular control during sexual intercourse.
Poor dental hygiene places the pregnant patient at risk for which of the following conditions?

a. Gestational diabetes
b. Upper GI infections
c. Pre-term labor
d. PKU
C. Pre-term labor

Dental care during pregnancy is especially important because nausea may lead to poor oral hygiene, allowing dental caries to develop. Research links periodontal disease w/ preterm births and low birth weights.
During a fundus assessment, the patient reports feeling nauseous and light headed. Upon further assessment, the nurse noted an increased HR and clammy, sweaty skin. Which of the following should be the nurse’s first action?

a. Administer antiemetic
b. Elevate patient’s head of bed
c. Position patient to her side
d. Provide patient with an emesis basin
C. Position patient to her side

Supine hypotension occurs when the ascending vena cava and descending aorta are compressed. Signs and symptoms include dizziness, tachycardia, nausea, and clammy skin. The patient should be positioned to her side until signs and symptoms subside and vital signs are within normal limits.
Intense, sharp and burning pain most commonly occurs at which stage of labor?

a. First stage of labor
b. Second stage of labor
c. Third stage of labor
d. Fourth stage of labor
B. Second stage of labor

During the second stage of labor the woman has somatic pain, which is often described as intense, sharp, burning, and well localized.
After administration of an intradermal water block for pain relief, the patient reports intense stinging around the injection site. Which of the following should be the nurse’s next action?

a. Place patient in a side-lying position
b. Notify physician
c. Administer a repeat dose
d. Reassure patient that stinging sensation is normal
D. Reassure patient that stinging sensation is normal

An intradermal water block involves the injection of small amounts of sterile water into four locations on the lower back to relieve low back pain. Intense stinging will occur for about 20-30 seconds after injection, but relief of back pain for up to 2 hours has been reported.
A pregnant patient who received Dilaudid for pain experiences severe respiratory depression. The nurse administered a dose of naloxone (Narcan) IV. Which of the following should the nurse assess after administration of Narcan?

a. Fetal heart rate
b. Patient’s pain level
c. Frequency and intensity of contractions
d. Patient’s heart rate
B. Patient’s pain level

As an opioid antagonist, Narcan will reverse the effects of the opioid agonist analgesic administered for pain. The patient should be told that the pain relieved w/ the use of opioid analgesic will return w/ the administration of an opioid antagonist.
All of the following statements are true about pudendal nerve block, except:

a. It is primarily used during the first stage of labor
b. It doesn’t relieve pain from uterine contractions
c. Useful if an episiotomy is to be performed to facilitate birth
d. Doesn’t affect maternal vital signs or FHR
A. It is primarily used during the first stage of labor

Pudendal nerve block is administered late in the second stage of labor and is useful if an episiotomy is to be performed to facilitate birth. Although it doesn’t relieve pain from uterine contractions, it does relieve pain in the lower vagina, vulva, and perineum.
A nurse is assessing a pregnant patient after administration of a spinal anesthesia (block). The nurse noted the patient’s BP is 80/60, and a low FHR w/ minimal variability. What should be the nurse’s most appropriate action?

a. Position patient supine with head of bed elevated
b. Administer 6L of oxygen by nasal cannula
c. Stop IV infusion and notify physician
d. Administer IV ephedrine
D. Administer IV ephedrine

Interventions for maternal hypotension include turning patient to lateral position or place a pillow or wedge under hip, maintain IV infusion, administer oxygen by nonrebreather face mask at 10-12 L/min, and administration of IV ephedrine.
A nurse is providing teaching instructions for a pregnant patient receiving spinal anesthesia. Which of the following statements should be included in the teaching?

a. Avoid an upright position after administration of anesthetic
b. Avoid placing a wedge under the hips to prevent supine hypotension
c. We will tell you when to bear down during birth
d. Anesthetic will be administered slowly during contractions
C. We will tell you when to bear down during birth

Because the woman is unable to sense her contractions when spinal anesthesia is administered, she must be instructed when to bear down during a vaginal birth. After anesthetic administration, the patient may be positioned upright to allow anesthetic solution to flow downward to obtain lower level of anesthesia suitable for vaginal birth.
A patient in labor complains of abdominal pain during contractions. Which of the following non-pharmacologic pain management technique can the nurse use on the patient?

a. Use of focal points
b. Application of heat or cold
c. Counterpressure
d. Effleurage
D. Effleurage

Effleurage is light stroking, usually of the abdomen, in rhythm w/ breathing during contractions. It is used to distract the woman from contraction pain.
Side effects of epidural and spinal anesthesia include all of the following, except:

a. Hypertension
b. Fever
c. Urinary retention
d. Longer second stage of labor
A. Hypertension

Severe hypotension as a result of sympathetic blockade can be an outcome of an epidural block. Women who receive an epidural have a higher rate of fever, especially when labor lasts longer than 12 hours.
A nurse is ordered to give Dilaudid for a pregnant patient experiencing labor pain. The nurse should administer the medication:

a. IV in a large bolus
b. During a contraction
c. In between contractions
d. IV push over 30 seconds
B. During a contraction

The medication is given slowly, in small doses, during a contraction to decrease fetal exposure to the medication because uterine blood vessels are constricted during contractions.
Which of the following is a nursing intervention that has the highest priority for the patient before receiving an epidural anesthesia?

a. Assist patient to void
b. Obtaining the patient’s signature on the informed consent form
c. Start an IV infusion of dextrose
d. Insertion of a foley catheter
A. Assist patient to void

Because spinal nerve blocks can reduce bladder sensation, resulting in difficulty voiding, the woman should empty her bladder before induction of the block and should be encouraged to void at least every 2 hours thereafter. An indwelling catheter is often routinely inserted immediately after epidural anesthesia is initiated.
A nurse is reviewing the FHR and contraction patterns of patients in the L&D unit. Which of the following findings would require for further intervention by the nurse?

a. FHR = 160 beats/min
b. Sudden accelerations of FHR in response to fetal stimulation
c. Absent FHR variability
d. No late or variable FHR decelerations
C. Absent FHR variability

Depending on other characteristics of the FHR tracing, absent variability is classified as either abnormal or indeterminate. It can result from fetal hypoxemia and metabolic acidemia.
Possible causes of fetal tachycardia lnclude:

a. Maternal hypoglycemia
b. Maternal fever
c. Viral infections
d. Fetal heart failure
B. Maternal fever

Possible causes of fetal tachycardia include maternal fever, fetal anemia, medications (atropine), drugs (caffeine, illicit drugs).
A nurse is monitoring a patient during insertion of an intrauterine pressure catheter (IUPC). During insertion, the nurse noted early decelerations of the FHR from a baseline of 160 beats/minute down to 130 beats/minute. What should the nurse do next?

a. Position patient to her side
b. Elevate patient’s legs
c. Administer oxygen at 8-10L/min via nonrebreather face mask
d. Continue monitoring patient
D. Continue monitoring patient

Early decelerations are thought to be caused by transient fetal head compression and are considered a normal and benign finding. Because they are considered benign, interventions aren’t necessary.
A nurse is reviewing a care plan for a patient experiencing late decelerations of FHR. Which of the following interventions from the care plan should the nurse question?

a. Assist w/ vaginal examination to assess for cord prolapse
b. Increase rate of IV infusion
c. Administer oxygen at 8-10L/min via nonrebreather mask
d. Palpate uterus to assess for tachysystole
A. Assist w/ vaginal examination to assess for cord prolapse

Late decelerations are caused by uteroplacental insufficiency. Persistent and late decelerations usually indicate the presence of fetal hypoxemia stemming from insufficient placental infusion during uterine contractions.