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OB PrepU Chapter 19 Exam Questions And Answers
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OB PrepU Chapter 19 Exam Questions And AnswersA pregnant client is admitted to a health care unit with DIC. Which of the following
orders is the nurse most likely to receive regarding the therapy for this client?
a) Administer cryoprecipitate and platelets
b) Give each unit of blood to raise the hematocrit by 3 g/dL
c) Transfuse 1 unit of blood to 4 units of frozen plasma
d) Maintain the client's hematocrit above 20%
Answer a) Transfuse cryoprecipitate and platelets.
Rationale:
The nurse may be ordered to transfuse a pregnant client with DIC cryoprecipitate and
platelets. Whole blood does not contain clotting factors. Ratio: In this case, therefore, 4
units of blood to 1 unit of fresh frozen plasma and not 1 unit of blood to 4 units frozen
plasma, should be considered. Maintaining the client's hematocrit above 30% instead of
just 20% is what the nurse should aim to do. One unit of blood can increase the
hematocrit by 1.5 g/dL, and the nurse should expect that - instead of an increase of
3g/dL.
A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this
has occurred. The nurse knows that which of the following is a known risk factor for
ectopic pregnancy?
a) High number of pregnancies
b) Multiple gestation pregnancy
c) Use of IUD for contraception
d) Use of oral contraceptives
Answer c) Use of IUD for contraception
Rationale:
There is a known increased risk of ectopic pregnancies when using an IUD with
progesterone. The nurse should do a complete history of the patient to determine if
other risks for an ectopic pregnancy were involved. Adhesions, scarring, and narrowing
,of the tubal lumen may block the zygote's passage into the uterus. Any condition or
surgical procedure that may damage a fallopian tube increases the risk. Examples
include salpingitis, which is an infection of the fallopian tube, endometriosis, previous
ectopic pregnancy, any type of tubal surgery, congenital malformation of the tube, and
many elective abortions. Conditions that impede peristalsis of the tube can lead to tubal
pregnancy. Also, hormonal factors can play a part, as tubal pregnancy is more
frequently found in women taking drugs for fertility and those who have progesterone
intrauterine contraceptive devices. Multiple gestation pregnancy and oral
contraceptives are some of several factors that do not have an identified risk
association with ectopic pregnancy.
A young woman presents to the emergency department with complaints of lower
abdominal cramping and spotting at 12 weeks' gestation. The physician performs an
exam of the patient's pelvis and finds that the cervix is closed. For what does the
physician suspect the cause of the cramps and spotting?
a) Cervical insufficiency
b) Threatened abortion
c) Habitual abortion
d) Ectopic pregnancy
Answer b) Threatened abortion
Rationale:
Spontaneous abortion occurs along a continuum: threatened, inevitable, incomplete,
complete, missed. Each category is defined based upon whether or not the uterus is
emptied, or for how long the products of conception are retained.
A female client is admitted with a diagnosis of ectopic pregnancy. For which of the
following would you expect to initiate preparation?
a) Bed rest for the next 4 weeks.
b) Intravenous administration of a tocolytic.
c) Immediate surgery.
d) Internal uterine monitoring. - Answer c) Immediate surgery.
Reason:
Ectopic pregnancy means an embryo has implanted outside the uterus-usually in the
,fallopian tube. Surgery is usually necessary to remove the growing structure before the
tube ruptures or repair the tube if rupture has already occurred. Bed rest will not
correct the problem of an ectopic pregnancy. Administering a tocolytic is not indicated,
nor is internal uterine monitoring. Thus, options A, B, and D are incorrect.
The nurse receives the following hourly assessments on a patient who is diagnosed with
preeclampsia and has been receiving Magnesium Sulfate: 97.3, P88, R10, blood
pressure 148/110. What other priority physical assessment by the nurse should be
implemented to assess for potential toxicity?
a) Reflexes
b) Magnesium sulfate level
c) Lung sounds
d) Oxygen saturation
Answer a) Reflexes
Rationale:
Reflex assessment is part of the standard assessment for patients on magnesium
sulfate. One of the first changes when developing magnesium toxicity may be a
decrease in reflex activity. The health care provider should be notified immediately. A
change in lung sounds and oxygen saturation are not indicative of magnesium sulfate
toxicity. Hourly blood draws to gain information on the magnesium sulfate level are not
indicated.
A female client with severe preeclampsia is receiving a medication of magnesium
sulfate. Which of the following would alert the nurse to the development of magnesium
toxicity? a) Seizures b) Elevated liver enzymes c) Diminished reflexes d) Serum
magnesium level of 6.5 mEq/L Answer c) Diminished reflexes Rationale:
When a client develops magnesium toxicity, the client will demonstrate decreased or
absent reflexes. Elevated liver enzymes are not associated with magnesium toxicity and
can be suggestive of the development of HELLP syndrome. The development of seizure
activity indicates eclampsia. A serum magnesium level of 6.5 mEq/L would be within the
therapeutic range of 4 to 7 mEq/L.
A woman you care for has an Rh-negative blood type. After the birth of her infant you
administer her RhIG (D immune globulin). This is done to
a) increase maternal D antibody formation.
, b) prevent maternal D antibody formation.
c) enhance maternal D immune antigens.
d) prevent fetal Rh blood formation. - Answer b) prevent maternal D antibody formation.
Rationale:
Because RhIG contains passive antibodies, the solution will prevent the woman from
making long-lasting antibodies.
At 11 weeks' gestation a client has a pregnancy loss. The client asks the nurse if the
bleeding and cramping that occurred with the miscarriage were caused by working long
hours in a stressful environment. What is the best response by the nurse?
a) "I can understand your need to find an answer to what caused this. Let's talk about
this further."
b) "It is hard to know why a woman bleeds during early pregnancy."
c) "Your spontaneous bleeding is not work-related."
d) "Something was wrong with the fetus." Answer a) "I can understand your need to find
an answer to what caused this. Let's talk about this further."
Rationale:
Discussion with the client may be helpful in coming to terms with her feelings. She and
her family may search for a cause of a spontaneous early bleeding to plan for future
pregnancies. A direct cause, however, cannot be established in most instances even
with present technology and medical advances.
A pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which
of the following would be the priority for this woman on admission?
a) Performing a vaginal examination to assess the extent of bleeding
b) Helping the woman remain ambulatory to reduce bleeding
c) Assessing fetal heart tones by use of an external monitor
c) Monitoring of uterine contraction with internal pressure gauge - Answer c) Evaluation
of fetal heart tones with use of an external monitor
Rationale:
The major concern is not disturbing the placenta, so the internal monitor, vaginal
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