PRELIM NCM 109: Care of Mother and child at risk… (OB2)

1.A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. Which finding would the nurse interpret as indicating a
therapeutic level of medication?

A) Urinary output of 20 mL per hour

B) Respiratory rate of 10 breaths/minute

C) Deep tendons reflexes 2+

D) Difficulty in arousing Ans: C

2.The nurse is developing a plan of care for a woman who is pregnant with twins. The nurse includes interventions focusing on which of the following
because of the woman's increased risk?

A) Oligohydramnios

B) Preeclampsia

C) Post-term labor

D) Chorioamnionitis Ans: B

3.A woman hospitalized with severe preeclampsia is being treated with hydralazine to control blood pressure. Which of the following would the lead the
nurse to suspect that the client is having an adverse effect associated with this drug?

A) Gastrointestinal bleeding

B) Blurred vision

C) Tachycardia

D) Sweating Ans: C

4.After reviewing a client's history, which factor would the nurse identify as placing her at risk for gestational hypertension?

A) Mother had gestational hypertension during pregnancy.

B) Client has a twin sister.

C) Sister-in-law had gestational hypertension.

D) This is the client's second pregnancy. Ans: A

5.The nurse is reviewing the laboratory test results of a pregnant client. Which one of the following findings would alert the nurse to the development of
HELLP syndrome?

A) Hyperglycemia

B) Elevated platelet count

C) Leukocytosis

D) Elevated liver enzymes Ans: D

6.Which of the following would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia?

A) Calcium gluconate

B) Potassium chloride

C) Ferrous sulfate

D) Calcium carbonate Ans: A

7.A nurse is teaching a pregnant woman with preterm premature rupture of membranes who is about to be discharged home about caring for herself.
Which statement by the woman indicates a need for additional teaching?

A) "I need to keep a close eye on how active my baby is each day."

B) "I need to call my doctor if my temperature increases."

C) "It's okay for my husband and me to have sexual intercourse."

D) "I can shower but I shouldn't take a tub bath." Ans: C

8.A nurse is assessing a pregnant woman with gestational hypertension. Which of the following would lead the nurse to suspect that the client has
developed severe preeclampsia?

A) Urine protein 300 mg/24 hours

B) Blood pressure 150/96 mm Hg

C) Mild facial edema

D) Hyperreflexia D

9.A nurse suspects that a pregnant client may be experiencing abruption placenta based on assessment of which of the following? (Select all that apply.)

A) Dark red vaginal bleeding

B) Insidious onset

C) Absence of pain

D) Rigid uterus

E) Absent fetal heart tones Ans: A, D, E

10.A nursing student is reviewing an article about preterm premature rupture of membranes. Which of the following would the student expect to find as
factor placing a woman at high risk for this condition? (Select all that apply.)

A) High body mass index

B) Urinary tract infection

C) Low socioeconomic status

D) Single gestations

E) Smoking Ans: B, C, E

11.A pregnant patient has a systolic blood pressure that exceeds 160 mm Hg. Which action should the nurse take for this patient?

A. Administer magnesium sulfate intravenously.

B. Obtain a prescription for antihypertensive medications.

C. Restrict intravenous and oral fluids to uterine contractions (UCs).125 mL/hr.

D. Monitor fetal heart rate (FHR) and uterine contractions. B....

12.The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the
woman would indicate a correct understanding of the discharge instructions?

A. "I will not experience mood swings since I was only at 10 weeks of gestation."

B. "I will avoid sexual intercourse for 60 weeks and pregnancy for 6 months."

C. "I should eat foods that are high in iron and protein to help my body heal."

D. "I should expect the bleeding to be heavy and bright red for at least 1 week." C..

13.A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman
exhibits:
A. a sleepy, sedated affect.

B. a respiratory rate of 10 breaths/min.

C. deep tendon reflexes of 2+.

D. absent ankle clonus. B..

14.A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if:

A. blood pressure is reduced to prepregnant baseline.

B. seizures do not occur.

C. deep tendon reflexes become hypotonic.

D. diuresis reduces fluid retention. B...

15.A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and
documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+
deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for:

A. hydralazine.

B. magnesium sulfate bolus.

C. diazepam.

D. calcium gluconate. A....

16.The most prevalent clinical manifestation of abruption placentae (as opposed to placenta previa) is:

A. bleeding.

B. intense abdominal pain.

C. uterine activity.

D. cramping. B...

17.A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased
contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of:

A. eclamptic seizure.

B. rupture of the uterus.

C. placenta previa.

D. placental abruption. D...

18.In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate?

A. Administration of blood

B. Preparation of the woman for invasive hemodynamic monitoring

C. Restriction of intravascular fluids

D. Administration of steroids A..

19.Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this
type of abortion?

A. Prepare the woman for a dilation and curettage (D&C).

B. Place the woman on bed rest for at least 1 week and reevaluate.

C. Prepare the woman for an ultrasound and blood work. C…..

D. Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month.

20.A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time she is at the greatest risk for:

A. hemorrhage.

B. infection.

C. urinary retention.

D. thrombophlebitis A...

21.The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms would the nurse
expect to observe? (Select all that apply.)

A. Decreased urinary output and irritability

B. Transient headache and +1 proteinuria

C. Ankle clonus and epigastric pain

D. Platelet count of less than 100,000/mm3 and visual problems

E. Seizure activity and hypotension ACD...

22.The emergency department nurse is assessing a pregnant trauma victim who just arrived at the hospital. What are the nurse's MOST appropriate
actions? (Select all that apply)

A. Place the patient in a supine position. B. Assess for point of maximal impulse at fourth intercostal space.

C. Collect urine for urinalysis and culture.

D. Frequent vital sign monitoring.

E. Assist with ambulation to decrease risk of thrombosis BCD…

23.A pregnant woman presents to the emergency department complaining of persistent nausea and vomiting. She is diagnosed with hyperemesis
gravidarum. The nurse should include which information when teaching about diet for hyperemesis? (Select all that apply)

A. Eat three larger meals a day.

B. Eat a high-protein snack at bedtime.

C Ice cream may stay down better than other foods

D. Avoid ginger tea or sweet drinks.

E. Eat what sounds good to you even if your meals are not well-balanced BCE...

24.A pregnant patient has a systolic blood pressure that exceeds 160 mm Hg. Which action should the nurse take for this patient?

A. Administer magnesium sulfate intravenously.

B. Obtain a prescription for antihypertensive medications. B…

C. Restrict intravenous and oral fluids to uterine contractions (UCs).125 mL/hr.

D. Monitor fetal heart rate (FHR) and uterine contractions

25.The nurse observes that maternal hypotension has decreased uterine and fetal perfusion in a pregnant patient. What does the nurse need to assess
further to understand the maternal status?

A. D-dimer blood test

B. Kleihauer-Betke (KB) test

C. Electronic fetal monitoring. C….

D. Electrocardiogram reading
26. What does the nurse advise a pregnant patient who is prescribed phenazopyridine (Pyridium) for cystitis?

A. "Avoid sweet foods in diet."

B. "Limit exposure to sunlight."

C. "Do not wear contact lenses." C…

D. "Restrict oral fluids to 125 mL per hour."

27.A patient reports excessive vomiting in the first trimester of the pregnancy, which has resulted in nutritional deficiency and weight loss. The urinalysis
report of the patient indicates ketonuria. Which disorder does the patient have?

A. Preeclampsia

B. Hyperthyroid disorder

C. Gestational hypertension

D. Hyperemesis gravidarum. D….

28.The emergency department nurse is assessing a pregnant trauma victim who just arrived at the hospital. What are the nurse's MOST appropriate
actions? (Select all that apply)

A. Place the patient in a supine position.

B. Assess for point of maximal impulse at fourth intercostal space.

C. Collect urine for urinalysis and culture.

D. Frequent vital sign monitoring.

E. Assist with ambulation to decrease risk of thrombosis BCD..

29.Which hypertensive disorders can occur during pregnancy? Select all that apply.

A. Chronic hypertension D. Gestational hypertension

B. Preeclampsia-eclampsia E. Gestational trophoblastic disease.

C. Hyperemesis gravidarum A,B,D…..

30.A pregnant patient in the first trimester reports spotting of blood with the cervical os closed and mild uterine cramping. What does the nurse need to
assess? Select all that apply.

A. Progesterone levels A,B,C….

B. Transvaginal ultrasounds

C. Human chorionic gonadotropin (hCG) measurement

D. Blood pressure

E. Kleihauer-Betke (KB) test reports.

31.Which conditions during pregnancy can result in preeclampsia in the patient? Select all that apply.

A. Genetic abnormalities A,B,C,D….

B. Dietary deficiencies

C. Abnormal trophoblast invasion

D. Cardiovascular changes

E. Maternal hypotension

32.Which condition is seen in a pregnant patient if uterine artery Doppler measurements in the second trimester of pregnancy are abnormal?

A. Preeclampsia A…
B. HELLP syndrome

C. Molar pregnancy

D. Gestational hypertension

33.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 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+
deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for:

A. hydralazine. A….

B. magnesium sulfate bolus.

C. diazepam.

D. morphine

34.After being rehydrated in the emergency department, a 24 year-old primipara in her 18th week of pregnancy is at home and is to rest at home for the
next two days and take in small but frequent fluids and food as possible. Discharge teaching at the hospital by the nurse has been effective if the patient
makes which statement?

"A. I'm going to eat five to six small servings per day, which contain such foods and fluids as tea, crackers or a few bites of baked potato

B. "A strip of bacon and a fried egg will really taste good as long as I eat them slowly."

C. As long as I eat small amounts and allow enough time for digestion, I can eat almost anything, like barbequed chicken or spaghetti

D. "I'm going to stay only on clear fluids for the next 24 hours and then add dairy products like eggs and milk” A...

35.Which intervention does the nurse implement for a patient immediately after a severe abdominal trauma?

A. Prep the patient for cesarean birth.

B. Send the patient for pelvic computed tomography (CT) scanning.

C. Provide fluids to the patient as part of the protocol for ultrasound examination.

D. Prepare to administer Rho(D) immunoglobulin B...

36.A woman at 37 weeks of gestation is admitted with a placental abruption after a motor vehicle accident. Which assessment data are most indicative
of her condition worsening?

A. Pulse (P) 112, respiration (R) 32, blood pressure (BP) 108/60; fetal heart rate (FHR)166-178

B. P 98, R 22, BP 110/74; FHR 150—162 A…

C. P 88, R 20, BP 114/70; FHR 140--158

D. P 80, R 18, BP 120/78; FHR 138--150..

37.The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms should the nurse
expect to observe? Select all that apply.

A. Decreased urinary output and irritability

B. Transient headache and 1 proteinuria

C. Ankle clonus and epigastric pain

D. Platelet count of less than 100,000/mm3 and visual problems

E. Seizure activity and hypotension A,C,D…

38.A pregnant patient reports abdominal pain in the right lower quadrant, along with nausea and vomiting. The patient's urinalysis report shows an
absence of any urinary tract infection in the patient. A chest x-ray also rules out lower-lobe pneumonia. Which condition does the nurse suspect in the
patient?

A. Appendicitis A…
B. Cholelithiasis

C. Placenta previa

D. Uterine rupture

39.The nurse observes that a pregnant patient with gestational hypertension who is on magnesium sulfate therapy is prescribed nifedipine (Adalat).
What action does the nurse take?

A. Evaluates the patient's renal function test

B. Obtains a prescription for a change of drug B.

C. Reduces the nifedipine (Adalat) dose by 50% simultaneously

D. Administers both medications

40. A pregnant woman presents to the emergency department complaining of persistent nausea and vomiting. She is diagnosed with hyperemesis
gravidarum. The nurse should include which information when teaching about diet for hyperemesis? Select all that apply.

A. Eat three larger meals a day

B. Eat a high-protein snack at bedtime. B,C,E

C. Ice cream may stay down better than other foods

D. Avoid ginger tea or sweet drinks.

E Eat what sounds good to you even if your meals are not well-balanced.

41. A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time, she is at the greatest risk for:

A. hemorrhage. A,…

B. infection.

C. urinary retention.

D. thrombophlebitis.

42.Which condition in a pregnant patient with severe preeclampsia is an indication for administering magnesium sulfate?

A. Seizure activity D. Low Blood Pressure (BP)

B. Renal dysfunction A……

C. Pulmonary edema

43.What action does the nurse take to relieve choking in a pregnant patient who is in the third trimester?

A. Administering anesthesia

B. Administering chest thrusts B…….

C. Placing a towel under the hips

D. Positioning the patient onto one side

44.Which clinical reports does the nurse evaluate to identify ectopic pregnancy in a patient? Select all that apply.

A. Quantitative human chorionic gonadotropin (B-hCG) levels

B. Transvaginal ultrasound A,B,C….

C. Progesterone level

D. Thyroid test reports

E. Kleihauer-Betke (KB) test

45.The nurse is caring for a pregnant patient who is receiving antibiotic therapy to treat a urinary tract infection (UTI). Which dietary changes does the
nurse suggest for the pregnant patient who is receiving antibiotic therapy for UTI?

A. "Include yogurt, cheese, and milk in your diet." A….

B. "Avoid folic acid supplements until the end of therapy.

C. "Include vitamins C and E supplementation in your diet."

D. "Reduce your dietary fat intake by 40 to 50 g per day.

46.A pregnant patient with severe preeclampsia who is being transported to a tertiary care center needs to be administered magnesium sulfate injection
for seizure activity. What actions does the nurse take when administering the drug? Select all that apply.

A. A 10-g dose is administered in the buttock.

B. A local anesthetic is added to the solution. B,C,D……..

C. The Z-track technique is used to inject

D. The injection site is massaged after the drug injection.

E. The subcutaneous route is used to inject the drug.

47. At 37 weeks of gestation, the patient is in a severe automobile crash where her abdomen was hit by the steering wheel and her seat belt. What
actions would the emergency room nurse expect to perform upon the patient's arrival at the hospital?

A. Stay with the patient, assure a patent airway is present, and keep the patient as calm as possible

B. Move the patient's skirt to determine if any vaginal bleeding is present, find out who to call, and monitor the level of consciousness.

C. Assess the patient's vital signs. determine location and severity of pain, and establish continual fetal heart rate monitoring.

D. Obtain arterial blood gases, obtain a hemoglobin and hematocrit, and oxygen saturation rate C...

48. A.24-year-old primipara, who is 18 weeks pregnant, has been having increasing vomiting since she was 8 weeks pregnant Upon arrival at the
emergency department, her sin turgor is diminished temperature is 992 (0), pulse is 102, respiration is, blood pressure is 102/68 and she has deep
furrows on her tongue What would the nurse expect to do to care for her? Select all that apply.

A. Start an intravenous infusion ABDE….

B. Check her urine for ketones

C Cross match blood for a transfusion

D. Obtain a complete history

E. Obtain blood for a complete blood count.

49. A pregnant patient is at risk for cardiac arrest as a result of profound hypovolemia after a trauma. Which action does the nurse take? The nurse:

A. Assesses airway, breathing, and pulse rate. B…..

B. Administers warmed crystalloid solutions

C. Administers calcium gluconate intravenously.

D. Obtains a prescription for magnesium sulfate.

50.Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this
type of abortion?

A. Prepare the woman for a dilation and curettage (D&C).

B. Place the woman on bed rest for at least 1 week and reevaluate.

C. Prepare the woman for an ultrasound and bloodwork.

D. Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month. C...
51.Which intervention will help prevent the risk of pulmonary edema in a pregnant patient with severe preeclampsia?

A. Assess fetal heart rate (FHR) abnormalities regularly.

B. Place the patient on bed rest in a darkened environment

C. Restrict total intravenous (IV.) and oral fluids to 125 mL/hr.

D. Ensure that magnesium sulfate is administered as prescribed. C....

52. A blunt abdominal trauma causes fetal hemorrhage in a pregnant patient. The nurse finds that the patient is Rh negative. What action does the nurse
take?

A. Initiate magnesium sulfate per protocol.

B. Administer oxytocin (pitocin).

C. Administer prescribed Rho (D) immunoglobulin.

D. Prepare the patient for magnetic resonance imaging (MRI). C...

53.Which is an important nursing intervention when a patient has an incomplete miscarriage with heavy bleeding?

A. Initiate expectant management at once.

B. Prepare the patient for dilation and curettage.

C. Administer the prescribed oxytocin (Pitocin).

D. Obtain a prescription for ergonovine (Methergine) B.....

54.What does the nurse include in the plan of care of a pregnant patient with mild preeclampsia? Select all that apply.

A. Ensure prolonged bed rest B. Provide diversionary activities.

C. Encourage the intake of more fluids.

D. Restrict sodium and zinc in the diet.

E. Refer to Internet-based support group BCE...

55.The quantitative human chorionic gonadotropin (B-hCG) levels are high in a patient who is on methotrexate therapy for dissolving abdominal
pregnancy. Which instruction does the nurse give to this patient?

A. Avoid sexual activity." A…..

B. "Avoid next pregnancy."

C. "Avoid feeling sad and low."

D. "Take folic acid without fail."

56. A pregnant patient with chronic hypertension is at risk for placental abruption. Which symptoms of abruption does the nurse instruct the patient to be
alert for? Select all that apply.

A. Weight loss

B. Abdominal pain.

C. Vaginal bleeding D. Shortness of breath

E. Uterine tenderness BCE...

57. Which is a priority nursing action when a pregnant patient with severe gestational hypertension is admitted to the health care facility?

A. Prepare the patient for cesarean delivery.

B. Administer intravenous (IV.) and oral fluids.

D. Administer the prescribed magnesium sulfate.

C. Provide diversionary activities during bed rest D...

58.What are the possible causes of miscarriage during early pregnancy? Select all that apply.

A. Premature dilation of cervix

B. Chromosomal abnormalities

C. Endocrine imbalance

D. Hypothyroidism

E. Antiphospholipid antibodies BCDE...

59.A patient with gestational hypertension is prescribed labetalol hydrochloride (Normodyne) therapy, which is continued after giving birth. What does
the nurse instruct the patient about breastfeeding?

A. "You may breastfeed the infant if you desire." A……

B. "Breastfeeding may cause convulsions in the infant."

C. "Breastfeed only once a day and use infant formulas."

D. "There may be high levels of the drug in the breast milk."

60.What does the nurse assess to detect the presence of a hypertensive disorder in a pregnant patient? Select all that apply.

A. Proteinuria A,B,D,E

B. Epigastric pain

C. Placenta previa

D. Presence of edema

E. Blood pressure (BP)

61.The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the
woman indicates a correct understanding of the discharge instructions?

A. "I will not experience mood swings since I was only at 10 weeks of gestation."

B. "I will avoid sexual intercourse for 6 weeks and pregnancy for 6 months."

C. "I should eat foods that are high in iron and protein to help my body heal."

D. "I should expect the bleeding to be heavy and bright red for at least 1 week." C...

62.A 24-year-old primipara, 10 weeks pregnant, who has been experiencing vomiting every morning for the past few weeks, asks the nurse at her
check-up how long this "morning sickness" will continue. Which statement by the nurse is most accurate?

A. "It will end by the 15th week of pregnancy.

B. "It usually subsides by the 20th week of pregnancy." B……

C. "It's a very common but not serious problem."

D. "In some women, it can last throughout the pregnancy and become serious."

63.What does the nurse administer to a patient if there is excessive bleeding after suction curettage?

A. Nifedipine (Procardia)

B. Methyldopa (Aldomet) C. Hydralazine (Apresoline)

D. Ergonovine (Methergine) D……

64.What instruction does the nurse provide to a pregnant patient with mild preeclampsia?

A. "You need to be hospitalized for fetal evaluation.

B. "Nonstress testing can be done once every month."

C. "Fetal movement counts need to be entire pregnancy." evaluated daily."

D. "Take complete bed rest during the entire pregnancy. C...

65.Which fetal risk is associated with an ectopic pregnancy?

A. Miscarriage

B. Fetal anemia D……

C. Preterm birth

D. Fetal deformity

66.Which instructions does the nurse give to a patient who is prescribed methotrexate therapy for dissolving the tubal pregnancy?

A. "Discontinue folic acid supplements." A…..

B. "Get adequate exposure to sunlight."

C. "Take stronger analgesics for severe pain."

D. "Vaginal intercourse is safe during the therapy."

67. A woman with severe preeclampsia is being treated with an intravenous infusion of magnesium sulfate. This treatment is considered successful if:

A. blood pressure is reduced to pre-pregnant baseline.

B. seizures do not occur. B…..

C. deep tendon reflexes become hypotonic.

D. diuresis reduces fluid retention

68.The most prevalent clinical manifestation of abruption placentae (as opposed to placenta previa) is:

A. bleeding.

B. intense abdominal pain. B…..

C. uterine activity.

D. cramping