Ob/peds Nclex-Pn Questions

Front 1

A client that is 6 months' pregnant comes to the clinic for a routine visit. She asks what she can do to relieve constipation. The nurse should teach the client that the most appropriate measures to alleviate this problem include which of the following recommendations?

1. Take a mild laxative and use a Fleet enema as needed.
2. Drink 8-10 cups of water and take a daily walk.
3. Add more protein and fat to the daily diet.
4. Drink hot coffee or tea each morning at breakfast.

Back 1

2. Drink 8-10 cups of water and take a daily walk.

RATIONALE
1. Laxatives and enemas stimulate the intestinal tract, but also can initiate uterine contractions.
2. Intestinal motility is slowed in pregnancy due to the influence of progesterone. Increasing fluid intake and exercise stimulates peristalsis.
3. High-fat and high-protein foods contribute to constipation.
4. Caffeine can cause tachycardia in the fetus and its use during pregnancy is discouraged.

Front 2

A client at 26 weeks of gestation asks why she is having trouble with constipation during her pregnancy. Which of the following explanations by the nurse would be most accurate?
1. The muscle movement of the intestines slows down, which causes dry, hard stools.
2. the muscl emovmeentn of the intestines speeds up, which ccauses dry, hard stools.
3. The intestines are compressed during pregnancy, which causes stool stasis.
4. The intestines are expanded during pregnancy, which causes stool stasis.

Back 2

1. The muscle movement of the intestines slows down, which causes dry, hard stools.

RATIONALE
1. Progesterone causes peristalsis to slow so more nutrients can be absorbed.
2. An increase in intestinal motility causes diarrhea.
3. Compression of the intestines during pregnancy does not contribute to constipation.
4. The intestines do not increase in diameter due to pregnancy.

Front 3

A client was admitted to the obstetric unit on 9/10/02 with c/o labor. The nurse palpated regular uterine contractions every 5 minutes with moderate intensity. A sterile vaginal exam revealed a soft cervix that was 85% effaced and dilated to 2 cm. Which of the following admission information is most important in planning nursing care?
1. The client's blood type and Rh were A+.
2. The client's hemoglobin was 11 g/dL.
3. The client's LMP was 2/15/02.
4. The client's blood pressure was 100/64 mm Hg.

Back 3

3. The client's LMP was 2/15/02.

RATIONALE
1. Blood type A with Rh+ does not present any problems in patient care. Maternal blood type O and/or Rh- blood types can cause severe jaundice in the newborn due to maternal antibodies that destroy fetal RBCs.
2. RBCs are diluted by the increase in plasma volume in pregnancy. A hemoglobin of 11 g/dL is phyiological anemia, as opposed to true anemia.
3. Using Nagle's rule, and LMP of 2/15/02 would give an EDD of 11/29/02. This client is in preterm labor at 28 5/7 weeks' gestation.
4. During the first two trimesters of pregnancy, meternal blood pressure normally decreases by 5-10 mmHg in both systolic and diastolic pressures. This decrease is due to peripheral vasodilation caused by pregnancy hormones.

Front 4

A 22-year-old client at 7 weeks' gestation attended the first trimester class on nutrition. Which of the following statements indicatea a need for further teaching?
1. "I should gain around 30 pounds by my due date."
2. "Planning meals around the food pyramid guide is best."
3. "Frozen foods are more nutritious than canned foods."
4. "My craving are probably caused by iron deficiency."

Back 4

4. "My craving are probably caused by iron deficiency."

RATIONALE
1. Appropriate weight gain for pregnancy is between 25 and 35 lbs.
2. Intrauterinie growth retardation can be caused by poor maternal diets. The U.S.F.D.A. recommends following the food pyramid recommendations for improving dietary intake.
3. Canned foods lose some nutrients in processing. Foods that are frozen are processed less and more nutritious.
4. Pica is more related to cultural values and beliefs than to dietary deficiencies. Pica is more likely to cause iron deficiency than to be caused by it.

Front 5

A client admitted to the obstetric unit with contractions every 8-10 minutes, with cervical effacement of 100%, and dilation of 3 cm, reported that she and her support person planned to use prepared childbirth techniques. The nurse would expect the couple to utilize which of the following pain relief methods during this phase of labor?
1. Slow, deep breathing
2. Rapid, shallow breathing
3. Local anesthesia
4. Narcotic analgesia

Back 5

1. Slow, deep breathing

RATIONALE
1. This client is in the early phase of labor; slow, deep breathing and relaxation techniques are usually effective in relieving contraction pain during this phase.
2. Rapid, shallow breathing, or hyperventilation, is inappropriate for any phase of labor.
3. Local anesthesia is used for numbing of the perineum immediately before performance of an episiotomy and delivery of the fetus during the last phase of the first stage of labor.
4. Narcotic analgesia is not appropriate for use during early phases of labor. It can slow or stop labor if given before 5 cm dilation. In addition, minimizing use of narcotics is preferred when prepared childbirth techniques are used.

Front 6

A 30-year-old gravida 5, para 4 (all female) client at 12 weeks' gestation asks the nurse, "Do you think I'm having a boy? If I don't have a boy this time, my husband will probably divorce me." Which of the following explanations by the nurse would be most accurate?

1. "Girls probably run in your family, there's nothing you can do about it."
2. "The heartbeat of the baby is fast, that means it's a boy."
3. "The father's sperm determines if the baby is male or female."
4. "Don't worry, you are carrying this baby low, that means it's a boy."

Back 6

3. "The father's sperm determines if the baby is male or female."

RATIONALE

1. The sex chromosome of males is XY; the sex chromosome for females is XX. The mother contributes one X chromosome to the fetus, the father contributes either an X or a Y chromosome.
2. The heart rate of the fetus is neither faster nor slower according to fetal gender. The range for the fetal heart rate is 110-160 bpm regardless of gender.
3. Meiosis results in the X and Y chromosomes of the male splitting so that each sperm carries either an X or a Y chromosome, thus determining the gender of the fetus.
4. How a fetus is carried is related to meternal uterine and abdominal muscle tone. The gender of the fetus does not determine how high or low it is carried.

Front 7

A client at term states, "I would like to breastfeed, but my mother-in-law told me my breasts are too small and I won't have enough milk for my baby." The best response by the nurse would be which of the following?

1. "Your breasts are small, but if you don't produce enough milk, you can give the baby some formula."
2. "The size of the breasts doesn't matter. All women have about the same amount of milk-producing tissue."
3. "You will produce more milk if you use a breast pump and then give it to your baby in a bottle."
4. "Milk production is increased by the hormone estrogen. You can ask your doctor for a prescription to take."

Back 7

2. "The size of the breasts doesn't matter. All women have about the same amount of milk-producing tissue."

RATIONALE

1. The volume of breast milk produced is related to how often the breasts are emptied of milk. Formula supplementation decreases breast milk production since the infant nurses less often.
2. The amount of milk producing glandular tissue in all women is approximately the same. The size of large breasts is due to increased fatty tissue.
3. An infant is more efficient at emptying a breast than a breast pump. In addition, oral stimulation of the nipples by the infant stimulates the release of oxytocin, which triggers the let-down reflex.
4. Estrogen does not stimulate milk production. Oxytocin and prolactin are the hormones responsible for breast milk production and breastfeeding success.

Front 8

A 32-hour-old baby has yellowish skin undertones and a serum bilirubin level of 14 mg/100 mL. The blood type of the baby is B+. The mother's blood type os O+. The infant is being breast-fed. The nurse would include which of the following measures in her plan of care?

1. No special measures are necessary, newborns normally get a little jaundiced.
2. Tell the mother to stop breast-feeding and give the baby formula instead.
3. Place the infant under the bililights and prepare for an exchange transfusion.
4. Encourage the mother to increase the frequency of breastfeeding sessions.

Back 8

4. Encourage the mother to increase the frequency of breastfeeding sessions.

RATIONALE

1. Bilirubin levels in excess of 12 mg/100 mL may indicate the presence of a pathological process. This jaundice is most likely due to an ABO incompatibility.
2. Breastfeeding jaundice occurs around the third day of age. Encouraging early and frequent feedings at the breast lowers neonatal bilirubin levels.
3. Light therapy requires an order from the physician. Exchange transfusions for ABO incompatibilities are seldom necessary.
4. Early and frequent breastfeeding tends to lower serum bilirubin levels.

Front 9

A primiparous client at 18 weeks' gestation had an ultrasound examination done which showed the fetus in a breech position. The client asked the nurse, "Does this mean I will have to have a C-section?" Which of the following responses by the nurse would be most accurate?

1. "If a first baby is breech, it must always be delivered by cesarean section."
2. "The baby will have more room to turn as your delivery date nears."
3. "You can probably deliver normally, most babies are born breech."
4. "Many babies are breech at this stage of pregnancy, most turn by term."

Back 9

4. "Many babies are breech at this stage of pregnancy, most turn by term."

RATIONALE

1. If the fetus remains in a breech position, external version may be attempted at approximately 37 weeks' gestation to change position of the fetus. If version is unsuccessful in the nulliparous woman with a fetus in a breech position, cesarean delivery is almost always certain.
2. The uterus becomes more crowded, not less, as pregnancy progresses.
3. Few fetuses (3%-4%) are in a breech position by delivery; even fewer breech positions are delivered vaginally.
4. Approximately 96% of fetuses in a breech position will turn to a cephalic position by term.

Front 10

A laboring client has been dilated 9-10 cm for 2 hours. The fetal head has remained at zero station for 45 minutes despite adequate pushing efforts by the client. A sterile vaginal exam reveals a position of occiput posterior. Which of the following actions by the nurse would be most appropriate?

1. Assist the client to a hands and knees position.
2. Assist the client to a supine position.
3. Prepare the client for a forceps rotation.
4. Prepare the client for a cesarean delivery.

Back 10

1. Assist the client to a hands and knees position.

RATIONALE

1. Maternal position changes such as sitting, kneeling, lateral, or hands and knees, can assist fetal head rotation to an occiput anterior position.
2. The gravid uterus compresses the pelvic blood vessels and compromises uteroplacental blood flow. This position not only has no effect on rotation of the fetal head, but can cause fetal compromise.
3. Use of forceps at zero station is considered to be a high forceps classification and is not acceptable practice according to the American College of Obstetricians and Gynecologists.
4. Cesarean delivery should be considered only if adequate pushing efforts of 2 or more hours do not result in descent of the fetal head.