OB HESI: ULTIMATE QUESTION PACK WITH RATIONALES (Distinction Level Guide. Has everything.) 2023
OB HESI: ULTIMATE QUESTION PACK During the postpartum period, a client tells a nurse that she has been having leg cramps. Which foods should the nurse encourage the client to eat? A) Liver and raisins B) Cheese and broccoli C) Eggs and lean meats D) Whole-wheat bread and cereals ANSWER- B) cheese and broccoli - need calcium for stopping leg cramps A client arrives at the clinic in preterm labor, and terbutaline (Brethine) is prescribed. For what therapeutic effect should the nurse monitor the client? A) increased blood pressure and pulse B) Reduction of pain in the perineal area C) Gradual cervical dilation as labor progresses D) Decreased frequency and duration of contractions ANSWER- D) Decreased frequency and duration of contractions Terbutaline sulfate (Brethine) is a β-mimetic that acts on the smooth muscles of the uterus to reduce contractility, which in turn inhibits dilation and the frequency and duration of contractions. Although terbutaline may increase blood pressure and pulse, this is a side, not a therapeutic, effect requiring frequent assessments. Terbutaline is not an analgesic. It should stop cervical dilation rather than increase it. A pregnant client with severe preeclampsia is receiving IV magnesium sulfate. What should the nurse keep at the bedside to prepare for the possibility of magnesium sulfate toxicity? A) Oxygen B) Naloxone C) Calcium gluconate D) Suction equipment ANSWER- C) Calcium gluconate The antagonist of magnesium sulfate is calcium gluconate. Oxygen is ineffective if the action of magnesium is not reversed. Naloxone is unnecessary; it is an opioid antagonist. Suction equipment may be necessary if the client has excessive secretions after a seizure. The priority intervention is trying to prevent a seizure. Question: greenish amniotic fluid indicates ANSWER- Meconium in amniotic fluid and MD should be notified immediately Question: Pt on magnesium sulfide, what baseline assessment is needed? ANSWER- Respiration rate (LOC is also affected but do not need a baseline) Question about hydatidiform mole ANSWER- Causes extra large uterus (Hydatidiform mole is the common type of disease arising from gestational trophoblastic disease. Tons of nonviable masses of cells divide and cause uterine enlargement) Question: Lepolds maneuver on a patient with placental previa expects ANSWER- High floating, presenting part (Possibly related to placenta blocking birth canal & cervical os) A client's membranes rupture during labor. The nurse immediately assesses the electronic fetal heart rate. Variable decelerations lasting more than 90 seconds, followed by bradycardia, are observed on the monitoring strip. What does the nurse suspect is the cause of this change? A) Fetal acidosis B) Prolapsed cord C) Head compression D) Uteroplacental insufficiency ANSWER- B) Prolapsed cord This variable pattern with bradycardia is an ominous sign; it is indicative of cord compression, which can result in fetal hypoxia. Immediate intervention is required. Fetal acidosis occurs with uteroplacental insufficiency, not in response to a prolapsed cord. Early decelerations are associated with head compression and are benign. Late decelerations and tachycardia are associated with uteroplacental insufficiency, not a prolapsed cord. Question: heartburn while pregnant ANSWER- Don't take antacids with sodium A 36-year-old woman comes to the emergency department complaining of severe abdominal cramping and heavy bleeding. She informs the nurse that she is 10 weeks pregnant. Cervical examination reveals heavy bleeding; the cervical os is open and tissue is present. Which type of miscarriage is the client experiencing? A) Missed B) Complete C) Inevitable D) Threatened ANSWER- C) Inevitable Miscarriage is inevitable because the cervical os has opened, heavy bleeding is occurring, and tissue is present with the bleeding. In a missed miscarriage, the fetus has died but the products of conception are retained in utero for as long as several weeks. There may be no bleeding or cramping, and the os is closed. In a complete miscarriage all fetal tissue has already passed and the cervix is closed; there may be slight bleeding. Symptoms of a threatened miscarriage include spotting and a closed cervical os. There may be mild cramping. Question: Blood in urine in catheter back during c-section indicates ANSWER- Incisional injury in the bladder Question: Risk for hypotonic uterine dystocia ANSWER- Twin gestation Question: likely to get placental previa ANSWER- Most likely to have it is a 30y/0m G6 P5 Question: Signs of a ruptured tubal pregnancy occur when ANSWER- 6 weeks into pregnancy this is when the fallopian tube is no longer able to get any larger Question: megaloblastic anemia in pregnancy ANSWER- Can cause neural tube defects Mother needs to be started on folic acid supplements asap Question: vaginal hematoma ANSWER- Pain is severe and vagina feels full and heavy Question: Classification of magnesium sulfate ANSWER- CNS depressant Question: Pt. receiving Lovenox for DVT, what sign is most concerning? ANSWER- Dyspnea Question: When a patient is on magnesium sulfate ANSWER- Keep room dark and quiet Question: magnesium sulfate and the importance of deep tendon reflexes ANSWER- indicates respiratory depression (If decreased DTR, it means CNS is too depressed, and it can lead to decreased breathing reflexes) Question: nursing intervention for pt. with placental previa ANSWER- Document amount of bleeding Question: after internal fetal heart monitor placement, MD listens to fetal heart rate for 1 full minute to monitor ANSWER- Uterine cord prolapse Question: risk factor for abruptio placentae ANSWER- hypertension Question: Positive Contraction stress test indicates ANSWER- Late decelerations of the fetal heart rate are occurring with each contraction. also uteroplacental insufficiency A nurse administers two serial intramuscular injections of betamethasone (Celestone) to a woman at 32 weeks gestation who has been admitted to preterm labor. The nurse knows that this medication is given in order to: ANSWER- Stimulate surfactant production. Corticosteroids stimulate surfactant production; they also have been shown to reduce the incidence of intraventricular hemorrhage. Betamethasone (Celestone) does not affect the labor process, increase placental perfusion, or affect the intensity of contractions. Question: Low lying placenta in the third trimester puts mom at risk for ANSWER- Painless vaginal bleeding (PLACENTA PREVIA) Question: Pt. with pre-eclampsia is admitted after vitals are taken what is the next priority ANSWER- Checking pt. reflexes Question: Chorionic villi sampling when can it be done ANSWER- 10 weeks and no later than 12 weeks Question: magnesium sulfate - how to know when you have reached therapeutic level ANSWER- deep tendon reflexes +2 Question: what to assess before administration of magnesium sulfate ANSWER- patellar reflexes and urinary output Question: S/S of threatened abortion ANSWER- vaginal spotting, abdominal cramping, closed cervix Question: risk when undergoing IVF ANSWER- tubal pregnancy Question: mom with mitral valve stenosis, what symptom indicates cardiac difficulties ANSWER- Syncope on exertion Question: what contraindicates pitocin ANSWER- Herpes infection Question: Patient with eclampsia, when does risk for seizure decrease ANSWER- 48 hours postpartum Question: Folic acid in a patient with sickle cell is important for ANSWER- compensating for a rapid turnover of red blood cells Question: What is a danger sign for a mom with a history of preterm multi gestational neonatal deaths ANSWER- Pelvic pressure Question: Type 1 diabetes in pregnancy puts mom at risk for ANSWER- hypertensive states Question: What assessments are priority for pt with diagnosed abruptio placentae ANSWER- fundal height, vital signs, skin color, urine output, FHR Question: for patient with abuse what is priority action of the nurse ANSWER- develop a safety plan Question: sign of preeclampsia other than high blood pressure ANSWER- weight gain of 6 pounds in 1 month Question: priority nursing intervention for pt admitted with abdominal pain and vaginal bleeding ANSWER- administer oxygen Question: Creatinine ANSWER- should be between 0.4-0.9. if higher indicates kidney problems Question: reason for increased pain in abruptio placentae ANSWER- concealed hemorrhage Question: multiple UTI's can cause what ANSWER- preterm birth Question: signs of hypoglycemia in newborn ANSWER- high-pitched cry, jitteriness, and irregular respirations Question: red tinged mucus in the diaper of a female new born ANSWER- is normal reaction to mothers hormones Question: necrotizing enterocolitis (NEC): what will the nurse expect to find as a complication ANSWER- Increased amount of residual gastric volume from earlier feedings Question: when a newborn has a meningocele priority nursing intervention is ANSWER- covering sac with sterile moist gauze Question: giving o2 to a infant can cause what ANSWER- retinopathy of prematurity Question: PKU test will not be done until ANSWER- the baby has enough milk for the test to be accurate (24 hours) ** Question: circumoral pallor can indicate ANSWER- a cardiac problem Question: when newborn is small for gestational age priority nursing intervention is ANSWER- Glucose test reading (Small infant: don't have fat pads yet Post mature: already used up the fat pads) Question: when newborn has necrotizing enterocolitis (NEC) it is important to ANSWER- measure the abdominal girth frequently Question: when pregnant with twins mom is at higher risk for hemorrhage due to ANSWER- uterine atony Question: medication to strop pre-term labor ANSWER- a beta-adrenergic (has tocolytic agents) Question: Pt. arrives at high risk unit for delivery with abdominal pain and vaginal bleeding what does nurse do ANSWER- adminster oxygen Question: When fetus makes a rapid decent the nurse worries about ANSWER- fetal head trauma Question: Primigravida in labor, priority nursing assessment is to ANSWER- monitor FHR Question: Positive CST result means ANSWER- the function of the placenta has diminished you need to tell the HCP is happening Question: what to avoid for a pt who is breastfeeding with PKU ANSWER- amino acids Question: safest position for mom with a prolapsed cord ANSWER- Trendelenburg A 3-day postpartum client, who is not immune to rubella, is to receive the vaccine at discharge. Which of the following must the nurse include in her discharge teaching regarding the vaccine? A) The woman should not become pregnant for at least 4 weeks. B) The woman should pump and dump her breast milk for 1 week. C) The mother must wear a surgical mask when she cares for the baby. D) Passive antibodies transported across the placenta will protect the baby. ANSWER- A) The woman should not become pregnant for at least 4 weeks. A 3-day-postpartum client questions why she is to receive the rubella vaccine before leaving the hospital. Which of the following rationales should guide the nurse's response? A) The client's obstetric status is optimal for receiving the vaccine. B)The client's immune system is highly responsive during the postpartum period. C) The client's baby will be high risk for acquiring rubella if the woman does not receive the vaccine. D) The client's insurance company will pay for the shot if it is given during the immediate postpartum period. ANSWER- A) The client's obstetric status is optimal for receiving the vaccine. A patient, G2P102, who delivered her baby 8 hours ago, now has a temperature of 100.2ºF. Which of the following is the appropriate nursing intervention at this time? A) Notify the doctor to get an order for acetaminophen. B) Request an infectious disease consult from the doctor. C) Provide the woman with cool compresses. D) Encourage intake of water and other fluids. ANSWER- D) Encourage intake of water and other fluids. To prevent infection, the nurse teaches the postpartum client to perform which of the following tasks? A) Apply antibiotic ointment to the perineum daily. B) Change the peripad at each voiding. C) Void at least every two hours. D) Spray the perineum with a povidone-iodine solution after toileting. ANSWER- B) Change the peripad at each voiding. The amniotic membranes of a client in active labor spontaneously rupture. The fluid is greenish brown with a foul odor. What action is a priority for the nurse? A) Evaluate the labor pattern. B) Administer oxygen. C) Place the client into the knee-chest position. D) Apply internal fetal heart monitor and note the time of membrane rupture ANSWER- ANS: D Rationale:In the presence of greenish brown amniotic fluid, the fetal heart rate should be monitored continuously using an internal fetal heart rate monitor, and the time of membrane rupture should be noted since birth should occur within 24 hours of the rupture of membranes. A primigravida in labor has complete cervical dilatation. Contractions are occurring every 1.5 to 2 minutes lasting 60 to 90 seconds. Upon examination, the nurse determines that birth is imminent because what has occurred? A) An increase in bloody show B) Perineum is bulging. C) Perineum is flattened. D) Crowning ANSWER- ANS: D) CROWNING The nurse, assessing a client who is 32 weeks pregnant during a routine visit, is concerned that the fetus is in the breech presentation. What did the nurse assess in the client? ANSWER- Fetal heart rate above the umbilicus. A client in the last trimester of pregnancy is prescribed sulfonamide for a urinary tract infection. What risk will this medication be to the developing fetus? ANSWER- Jaundice The fetal heart rate of a client in active labor shows variable decelerations. The cervix is 7cm dilated and the membranes are intact. What intervention should the nurse implement first? ANSWER- Assist client with turning to the left side. A 38-week primigravida who works as a secretary & sits at a computer for 8 hours each day tells the nurse that her feet have begun to swell. Which instruction would be most effective in preventing pooling of blood in lower extremities? ANSWER- Move about every hour A 26-year old, G2 P1 client is admitted to the hospital at 28-weeks gestation in preterm labor. She is given 3 doses of terbutaline sulfate (Brethine) 0.25 mg SQ to stop her labor contractions. The nurse ********************************CONTINUED****************************
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Duquesne University
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OB HESI (UPNS348)
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ob hesi ultimate question pack with rationales distinction level guide has everything 2022
