Antepartum, postpartum Exam 4:

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Fall 2014 Nursing program
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1

A 26-year-old pregnant woman, gravida 2, para 1-0-0-1 is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, what would be an expected diagnostic procedure?

Ultrasound for placental location

2

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her:

'You may find that you need to modify your exercise later in your pregnancy.'

3

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a girl that died 24 hours later. What is her gravidity and parity using the GTPAL system?

31010

4

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a girl that died 24 hours later. What is her gravidity and parity using the GTPAL system?

'HPV is a sexually transmitted infection (STI) that may lead to cervical cancer.'

5

Order: V-cillin K suspension 500,000 units p.o. q.i.d.
Available: V-Cillin K oral solution 200,000 units per 5 mL.
How many milliliters does the nurse give?

12.5

6

A maternal serum alpha-fetoprotein (AFP) test indicates an elevated level. It is repeated and again is reported as higher than normal. What would be the next step in the assessment sequence to determine the well-being of the fetus?

Ultrasound for fetal anomalies

7

A woman arrives at the clinic for her annual examination. She tells the nurse that she thinks she has a vaginal infection and she has been using an over-the-counter cream for the past 2 days to treat it. The nurse"s initial response should be to:

Ask the woman to describe the symptoms that indicate to her that she has a vaginal infection.

8

A couple comes to the clinic and is considering having a child. The husband is heterozygous for an autosomal dominant disorder, the woman is disease free. They want to know what the odds are of their child being born with the same disorder as the husband.

50%

9

A woman has chosen the calendar method of conception control. During the assessment process it is most important that the nurse:

Obtain a history of menstrual cycle lengths for the past 6 to 12 months.

10

Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who provides care for a client with this condition should be aware that the optimal pharmacologic therapy for pain relief is:

Motrin

11

A pregnant woman at the clinic asks about the purpose of amniotic fluid. The nurse responds knowing amniotic fluid provides for all of the following except:

Nutritional needs

12

Signs and symptoms that a woman should report immediately to her health care provider include (choose all that apply):

a.
Vaginal bleeding.

b.
Rupture of membranes.

d.
Severe headache.

13

A woman will be taking oral contraceptives using a 28-day pack. The nurse should advise this woman to protect against pregnancy by:

*** THIS IS THE WRONG ANSWER***
Don't pick this option on an exam:
Throwing away the pack and using a backup method if she misses two pills during week 1 of her cycle.

14

Sally comes in for her first prenatal examination. This is her first child. She asks you (the nurse), 'How does my baby get air inside my uterus?' The correct response is:

'The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream.'

15

During a health history interview, a woman states that she thinks that she has 'bumps' on her labia. She also states that she is not sure how to check herself. The correct response would be to:

Show the self-examination to the woman and have her practice in the office. Explain normal and abnormal findings during the examination.

16

When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended?

Using a heating pad on the abdomen to relieve cramping

17

A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant. The nurse's most appropriate response is:

"Smoking may reduce the quality of your sperm."

18

A client complains of GI upset when taking her iron supplementation during pregnancy. The nurse should instruct the client to take the iron supplementation:

***NOT WITH BREAKFAST***
Take at night on an empty stomach with orange juice to help absorption. If they get an upset stomach then they can take with food that don't delay absorption ...like milk.

19

Which statement would indicate that the client requires additional instruction about breast self-examination?

"While performing my BSE during my period a non-movable lump is normal."

20

The nurse caring for a pregnant client knows that her health teaching regarding fetal circulation has been effective when the client reports that she has been sleeping:

In a side-lying position.

21

A couple comes to the clinic and state they both have an X-linked dominant disease. The woman is heterozygous. They want to know the chance they can have a child unaffected by this disease.

25%

22

What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy?

The blood pressure (BP) cuff should not be applied to the affected arm.

23

You (the nurse) are reviewing the educational packet provided to a client about tubal ligation. What is an important fact you should point out? Choose all that apply.

a.
'Sterilization offers no protection against STIs.'

b. **THIS OPTION IS WRONG, DON'T PICK IT**
'This is an effective form of 100% permanent sterilization. You won"t be able to get pregnant.'

d.
'It is highly unlikely that you will become pregnant after the procedure.'

24

Diethylstilbestrol (DES) was a drug commonly used to prevent miscarriage and premature birth between 1938 and 1971. Most nurses who provide gynecologic care are aware of the increased risk of adenocarcinoma to the vagina and cervix for the daughters of women who used DES. Fortunately there were no known side effects to their sons.

False

25

What represents a typical progression through the phases of a woman's establishing a relationship with the fetus?

*** THIS IS THE INCORRECT OPTION, DON'T PICK IT***
Xd.
Views the child as part of herself--has feelings of well-being--accepts the biologic fact of pregnancy

26

The nurse providing care to the pregnant woman should know that all are normal gastrointestinal changes in pregnancy except:

c. Pica

27

The diagnosis of pregnancy is based on which positive signs of pregnancy? Choose all that apply.

b.
Identification of fetal heartbeat

c.
Verification of fetal movement

e.
Visualization of the fetus

28

A 31-year-old woman believes that she may be pregnant. She took an OTC pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview the nurse inquires about the woman's last menstrual period and asks whether she is taking any medications. The woman states that she takes diuretics and medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. She also has a history of irregular periods. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which reveals that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result?

a.
She takes anticonvulsants.

29

A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. She shows the nurse her readings for the past few days. Which one should the nurse tell her indicates a need for adjustment (insulin or sugar)?

d.
60 mg/dl after waking up from a nap; this is too low, maybe eat a snack before going to sleep.

30

A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. The nurse suspects that:

a.
This is a normal respiratory change in pregnancy caused by elevated levels of estrogen.

31

A father and mother are carriers of phenylketonuria (PKU) an autosomal recessive trait. Their 2-year-old daughter has PKU. The couple tells the nurse that they are planning to have a second baby. Because their daughter has PKU, they are sure that their next baby won't be affected. What response by the nurse is most accurate?

***THIS IS FALSE, DON'T SELECT THIS ANSWER***
b.
'The ultrasound indicates a boy, and boys are not affected by PKU.'

32

A woman"s cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate?

c.
'They occur by the fifth week of development.'

33

With regard to the assessment of female, male, and couple infertility, nurses should be aware that:

d.
The investigation takes 3 to 4 months and a lot of money.

34

Order: Humulin regular U-100 15 units/hr. The IV solution contains 100 units of Humulin regular in 250 mL of NS.
At what rate in mL/hr should the IV infuse?
Answer in a whole number.

38

35

Order: Codeine gr 3/4 p.o. q4h p.r.n. for pain.
Available: Codeine 30 mg scored tablets.
How many tablets do you give? Answer in a decimal if necessary.

1.5

36

A woman is homozygous for an X-linked recessive disease. She asks the clinic nurse what is the percentage of chance her son will be born with the disease if the father does not have the disease?

100%

37

Order: D5RL with 20 units Pitocin in 2L at 125 mL/hr.
Drop factor: 15 gtt/mL
Calculate the flow rate in gtt/min.
Answer with a whole number only.

X

38

A 62-year-old woman has not been to the clinic for an annual examination for 5 years. The recent death of her husband reminded her that she should come for a visit. Her family doctor has retired, and she is going to see the women's health nurse practitioner for her visit. To facilitate a positive health care experience, the nurse should:

c.
Listen carefully and allow extra time for this woman's health history interview.

39

An unmarried young woman describes her sex life as 'active' and involving 'many' partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). The nurse"s most appropriate response is:

a.
'The risk of pelvic inflammatory disease (PID) will be higher for you.'

40

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

d.
A dipstick value of 3+ for protein in her urine

41

A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is charted as:

a.
Negative.

42

A woman currently uses a diaphragm and spermicide for contraception. She asks the nurse what the major differences are between the cervical cap and diaphragm. The nurse"s most appropriate response is:

d.
'The cervical cap can safely be used for repeated acts of intercourse without adding more spermicide later.'

43

A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant in 3 months. She can expect the following advice:

a.
'Make sure that you include adequate folic acid in your diet.'

44

In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the client states:

***THIS IS THE INCORRECT ANSWER, DON'T PICK IT***
a.
'Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding.'

45

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 (99.14), pulse of 88 beats/min, respiratory rate of 10 breaths/min, blood pressure of 148/90, absent deep tendon reflexes and no ankle clonus. The client complains, "I'm so thirsty and warm." The nurse:

Discontinues the magnesium sulfate infusion.

46

During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of:

b.
Cardiac decompensation.

47

Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a client with diabetes mellitus, the nurse is aware that she is at a greater risk for:

b.
Polyhydramnios.

48

A pregnant woman at 25 weeks" gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate?

b.
'Babies respond to sound starting at about 24 weeks of gestation.'