OB exam 4 with Complete Solutions
The nurse is caring for a client with preeclampsia who is receiving an intravenous (IV)
magnesium sulfate (Sulfamag) infusion. The nurse assesses the client every 20
minutes. Which maternal findings require immediate intervention by the nurse?
A. DTR 2+
B. urinary output of 30mL/hr
C. BP 130/90
D. RR of 9 breaths per minute - ANSWER-D. Respiratory rate of 9 breaths per minute
What does the nurse tell a pregnant client with genital herpes simplex virus (HSV)
infection about the risk or adverse effect on her pregnancy?
A."There is a high probability of stillbirth."
B. "The infant may have neonatal herpes after birth."
C. "There is a risk for miscarriage in the last trimester."
D. "There is no potential risk for a congenital infection. - ANSWER-B. "The infant may
have neonatal herpes after birth."
Stillbirth is not a complication, there is an increased risk of miscarriage in the first
trimester, congenital infection is rare but sometimes possible.
Which hypertensive disorders can occur during pregnancy? Select all that apply.
A. Chronic hypertension
B. Preeclampsia-eclampsia
C. Hyperemesis gravidarum
D. Gestational hypertension
E. Gestational trophoblastic disease - ANSWER-A. Chronic hypertension
B. Preeclampsia-eclampsia
C. Hyperemesis gravidarum
Chronic HTN refers to HTN that developed in the pregnant patient before 20 weeks of
gestation. Preeclampsia refers to HTN and proteinuria that develops 20 weeks after
gestation. Eclampsia is the onset of seizure activity in a pregnant patient with
preeclampsia. Gestational HTN is the onset of HTN after 20 weeks of gestation.
,Gestational trophoblastic disease and hyperemesis gravidarum are not hypertensive
disorders. Gestational trophoblastic disease refers to a disorder without a viable fetus
that is caused by abnormal fertilization. Hyperemesis gravidarum is excessive vomiting
during pregnancy that may result in weight loss and electrolyte imbalance.
Which instructions does the nurse give to a client who is prescribed methotrexate
therapy for dissolving the tubal pregnancy?
A. "Discontinue folic acid supplements."
B. "Get adequate exposure to sunlight."
C. "Take stronger analgesics for severe pain."
D. "Vaginal intercourse is safe during the therapy." - ANSWER-A. "Discontinue folic acid
supplements."
The nurse advises the client to discontinue folic acid supplements, because they
interact with methotrexate and may exacerbate ectopic rupture in the patient. Exposure
to sunlight is avoided, because the therapy makes the patient photosensitive.
Analgesics stronger than acetaminophen are avoided, because they may mask
symptoms of tubal rupture. Vaginal intercourse is avoided until the pregnancy is
dissolved completely.
What are the manifestations of HELLP syndrome?
A. Hemolysis
B. Tachycardia
C. Hyperventilation
D. Low platelet count
E. Elevated liver enzymes - ANSWER-A. Hemolysis
D. Low platelet count
E. Elevated liver enzymes
HELLP syndrome is a serious condition that may develop during pregnancy in a client
with preeclampsia. It is characterized by hemolysis due to the breakdown of red blood
cells. The client may have a low platelet count, increasing the risk of bleeding and
elevated liver enzymes due to impaired functioning of the liver. HELLP is not associated
with an increase in heart rate, and may not result in tachycardia. The pulmonary
functioning is not impaired in the client with HELLP syndrome. Therefore,
hyperventilation is not a manifestation of HELLP syndrome.
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 what?
A. Hydralazine
B. Magnesium sulfate bolus
C. Diazepam
D. Calcium gluconate - ANSWER-A. Hydralazine
Hydralazine is an antihypertensive commonly used to treat hypertension in severe
preeclampsia. An additional bolus of magnesium sulfate may be ordered for increasing
signs of central nervous system irritability related to severe preeclampsia (e.g., clonus)
or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic
seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The
patient is not currently displaying any signs or symptoms of magnesium toxicity.
The nurse observes that an Rh-negative patient gave birth to an Rh-positive infant.
What dosage of RhO(D) immunoglobulin should the nurse prepare to administer?
A. 50 mcg
B. 300 mcg
C. 400 mcg
D. 500 mcg - ANSWER-B. 300 mpg
300 mcg RhoGAM is injected intramuscularly to the Rh-negative mother within 72 hours
of the birth. 50 mpg RhoGAM is administered after chorionic villus sampling, ectopic
pregnancy, miscarriage, or abortion before 13 weeks of gestation; 400 mcg and 500
mcg (more than 300 mcg) RhoGAM are used in cases of large transplacental
hemorrhage and mismatched blood transfusion.
The laboratory reports of a client who is in the 8th week of gestation and reports
abdominal cramps and pain, shows an abnormally slow increase in the client's levels of
human chorionic gonadotropin (hCG). What risk does this finding indicate?
A. Multiple fetuses
B. Down syndrome
C. Ectopic pregnancy
D. Gestational trophoblastic disease - ANSWER-C. Ectopic pregnancy
The earliest biomarker of pregnancy is hCG. A woman's hCG levels peak after 60 to 70
days of pregnancy and decline to the lowest level at 100 to 130 days of pregnancy. An
abnormally slow rise in hCG levels accompanied by abdominal pain and cramping
The nurse is caring for a client with preeclampsia who is receiving an intravenous (IV)
magnesium sulfate (Sulfamag) infusion. The nurse assesses the client every 20
minutes. Which maternal findings require immediate intervention by the nurse?
A. DTR 2+
B. urinary output of 30mL/hr
C. BP 130/90
D. RR of 9 breaths per minute - ANSWER-D. Respiratory rate of 9 breaths per minute
What does the nurse tell a pregnant client with genital herpes simplex virus (HSV)
infection about the risk or adverse effect on her pregnancy?
A."There is a high probability of stillbirth."
B. "The infant may have neonatal herpes after birth."
C. "There is a risk for miscarriage in the last trimester."
D. "There is no potential risk for a congenital infection. - ANSWER-B. "The infant may
have neonatal herpes after birth."
Stillbirth is not a complication, there is an increased risk of miscarriage in the first
trimester, congenital infection is rare but sometimes possible.
Which hypertensive disorders can occur during pregnancy? Select all that apply.
A. Chronic hypertension
B. Preeclampsia-eclampsia
C. Hyperemesis gravidarum
D. Gestational hypertension
E. Gestational trophoblastic disease - ANSWER-A. Chronic hypertension
B. Preeclampsia-eclampsia
C. Hyperemesis gravidarum
Chronic HTN refers to HTN that developed in the pregnant patient before 20 weeks of
gestation. Preeclampsia refers to HTN and proteinuria that develops 20 weeks after
gestation. Eclampsia is the onset of seizure activity in a pregnant patient with
preeclampsia. Gestational HTN is the onset of HTN after 20 weeks of gestation.
,Gestational trophoblastic disease and hyperemesis gravidarum are not hypertensive
disorders. Gestational trophoblastic disease refers to a disorder without a viable fetus
that is caused by abnormal fertilization. Hyperemesis gravidarum is excessive vomiting
during pregnancy that may result in weight loss and electrolyte imbalance.
Which instructions does the nurse give to a client who is prescribed methotrexate
therapy for dissolving the tubal pregnancy?
A. "Discontinue folic acid supplements."
B. "Get adequate exposure to sunlight."
C. "Take stronger analgesics for severe pain."
D. "Vaginal intercourse is safe during the therapy." - ANSWER-A. "Discontinue folic acid
supplements."
The nurse advises the client to discontinue folic acid supplements, because they
interact with methotrexate and may exacerbate ectopic rupture in the patient. Exposure
to sunlight is avoided, because the therapy makes the patient photosensitive.
Analgesics stronger than acetaminophen are avoided, because they may mask
symptoms of tubal rupture. Vaginal intercourse is avoided until the pregnancy is
dissolved completely.
What are the manifestations of HELLP syndrome?
A. Hemolysis
B. Tachycardia
C. Hyperventilation
D. Low platelet count
E. Elevated liver enzymes - ANSWER-A. Hemolysis
D. Low platelet count
E. Elevated liver enzymes
HELLP syndrome is a serious condition that may develop during pregnancy in a client
with preeclampsia. It is characterized by hemolysis due to the breakdown of red blood
cells. The client may have a low platelet count, increasing the risk of bleeding and
elevated liver enzymes due to impaired functioning of the liver. HELLP is not associated
with an increase in heart rate, and may not result in tachycardia. The pulmonary
functioning is not impaired in the client with HELLP syndrome. Therefore,
hyperventilation is not a manifestation of HELLP syndrome.
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 what?
A. Hydralazine
B. Magnesium sulfate bolus
C. Diazepam
D. Calcium gluconate - ANSWER-A. Hydralazine
Hydralazine is an antihypertensive commonly used to treat hypertension in severe
preeclampsia. An additional bolus of magnesium sulfate may be ordered for increasing
signs of central nervous system irritability related to severe preeclampsia (e.g., clonus)
or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic
seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The
patient is not currently displaying any signs or symptoms of magnesium toxicity.
The nurse observes that an Rh-negative patient gave birth to an Rh-positive infant.
What dosage of RhO(D) immunoglobulin should the nurse prepare to administer?
A. 50 mcg
B. 300 mcg
C. 400 mcg
D. 500 mcg - ANSWER-B. 300 mpg
300 mcg RhoGAM is injected intramuscularly to the Rh-negative mother within 72 hours
of the birth. 50 mpg RhoGAM is administered after chorionic villus sampling, ectopic
pregnancy, miscarriage, or abortion before 13 weeks of gestation; 400 mcg and 500
mcg (more than 300 mcg) RhoGAM are used in cases of large transplacental
hemorrhage and mismatched blood transfusion.
The laboratory reports of a client who is in the 8th week of gestation and reports
abdominal cramps and pain, shows an abnormally slow increase in the client's levels of
human chorionic gonadotropin (hCG). What risk does this finding indicate?
A. Multiple fetuses
B. Down syndrome
C. Ectopic pregnancy
D. Gestational trophoblastic disease - ANSWER-C. Ectopic pregnancy
The earliest biomarker of pregnancy is hCG. A woman's hCG levels peak after 60 to 70
days of pregnancy and decline to the lowest level at 100 to 130 days of pregnancy. An
abnormally slow rise in hCG levels accompanied by abdominal pain and cramping
