NCLEX Obstetrics and Gynecological Conditions, study concepts, example questions and explanations

Which of the following is a possible complication of amniocentesis?

• Miscarriage
• All of these
• RH sensitization
• Needle Injury

Answer: All of these

Explanation: –

• There are several risks to amniocentesis, including (but not limited to) miscarriage, infection, needle injury, and RH sensitization. The rate of miscarriage due to amniocentesis is between 1 in 300 and 1 in 500. The other complications listed are relatively rare

ORDER YOUR PAPER NOW

Fundal height of a pregnant woman is measured from.

• The middle of the public bone to the top of the uterus
• The bottom of the public bone to the top of the uterus
• The top of the public bone to the middle of the uterus
• The top of the public bone to the top of the uterus
• The middle of the public bone to the bottom of the uterus

Answer. The top of the pubic bone to the top of the uterus

Explanation: –

• Fundal height (sometimes referred to as McDonald’s rule) is measured in centimeters from the top of the pubic bone to the top of the uterus. The top of the uterus may also be called the fundus of the uterus. It is used to assess the growth and development of the fetus inside the womb.

 

Anne is 17 weeks pregnant. She comes into the clinic to get an alpha-fetoprotein test. A low result could indicate all of the following except

• The gestational age of the baby is incorrect
• Fetal trisomy 18
• Fetal trisomy 21
• Hydatidiform mole
• Preeclampsia

Answer.  Preeclampsia

Explanation: –

• Alpha-fetoprotein is made by the fetus. Congenital abnormalities NCLEX Obstetrics and Gynecological Conditions, study concepts, example questions and explanations (fetal trisomy 18, fetal trisomy 21) are associated with low levels of this protein. Additionally, so is hydatidiform mole. Hydatidiform mole is the presence of an abnormal mass or growth inside the uterus. Based on a low result, the physician may want to conduct further testing. Preeclampsia is a dangerous medical condition characterized by high blood pressure. It is not associated with alpha-fetoprotein

 

The nurse is assessing a woman in labor. He knows that fetal bradycardia occurs when the heart rate drops below

• 110 beats per minute
• 120 beats per minute
• 100 beats per minute
• 130 beats per minute
• 90 beats per minute

Answer: 110 beats per minute

Explanation: –

• Fetal bradycardia is recognized when fetal heart rate drops below 110 beats per minute for 10 minutes or longer. The normal fetal heart rate is between 120 beats per minute and 160 beats per minute. Fetal tachycardia is a heart rate above 160 beats per minute.

 

Anne, a 32-year-old woman, presents for her first prenatal visit. The doctor orders a CBC (complete blood count). Which of the following is not included in a CBC?

• Platelets
• Blood type
• Hematocrit
• White blood cells
• Hemoglobin

Answer: Blood type

Explanation:

• A separate test called a “type and screen” is needed to assess the blood type. Complete blood counts (CBC’s) typically contain hemoglobin and hematocrit, platelet counts, white blood cell counts, and red blood cell counts among many other measures. They are among the most frequently ordered laboratory tests by providers. The physician will use this information to diagnose conditions such as anemia.

 

The nurse is assessing fetal heart rate in a pregnant patient. The nurse records a pulse of 82 beats per minute. The nurse should

• Ask the mother to lay on her right side
• Try another doppler device
• Add lubricant to the doppler’s surface
• Move the doppler device
• Call the physician immediately

Answer: Move the doppler device

Explanation:

• An 82 beat per minute reading could be the mother’s heart rate, indicating that the nurse does not have the doppler in the correct position. A normal fetal heart rate is between 120 and 160 beats per minute. The nurse must always remember to take the mother’s pulse before assessing the fetal heart rate. Before calling the physician, it is important to determine that the data is accurate. To increase oxygen perfusion to the fetus, ask the mother to lay on her left side.

 

Brittany is 40 weeks pregnant and calls because she is seeing pink-tinged discharge for the first time. The nurse should tell Brittany to

• Lie on her back and place her feet in the air until help arrives
• Drive to the hospital immediately
• Continue to monitor
• Eat a bland diet and continue regular exercise
• Call an ambulance

Answer: Continue to monitor

Explanation:

• This is most likely the normal “bloody show” at the beginning of labor. There is no need to immediately arrive at the hospital, change position, or eat a bland diet. The patient should continue to monitor and call back or seek care when she experiences regular contractions that are becoming more intense and frequent.

PLACE YOUR ORDER HERE

Sarah is a seventeen-year-old female who has not gotten her first period and is visiting her doctor for an exam. She has displayed the normal growth and development of several secondary sex characteristics. The nurse would describe to the doctor that Sarah is showing signs of

• Primary dysmenorrhea
• Primary amenorrhea
• Oligomenorrhea
• Secondary dysmenorrhea
• Secondary amenorrhea

Answer: Primary amenorrhea

Explanation:

• Primary amenorrhea occurs when a female is fourteen years old and has not gotten her first period and has not developed secondary sex characteristics. Primary amenorrhea also occurs when a female sixteen or older has not gotten her first period but has developed secondary sex characteristics. Primary dysmenorrhea refers to painful menstruation not linked to a physiological disorder. Secondary dysmenorrhea refers to painful menstruation due to an underlying cause such as endometriosis. Oligomenorrhea refers to the absence of a period, typically for at least 35 days NCLEX Obstetrics and Gynecological Conditions, study concepts, example questions and explanations.

 

Amber is a 39-year-old woman who is experiencing secondary dysmenorrhea. The nurse knows that Amber could be suffering from which of the following?

• Low levels of aldosterone
• Turner syndrome
• Amenorrhea
• Endometriosis
• High levels of prostaglandin

Answer: Endometriosis

Explanation:

• Secondary dysmenorrhea refers to painful menstruation due to an underlying condition. Endometriosis, an example of a condition that frequently causes secondary dysmenorrhea, refers to the growth of uterine tissue in inappropriate places such as the ovary or rectum. High levels of prostaglandin are frequently found in women with primary dysmenorrhea which is painful menstruation without an underlying condition. Low levels of aldosterone would not likely cause painful menstruation. Turner syndrome is a chromosomal disorder that can frequently cause amenorrhea, or absence of a period.

 

A nurse is assessing an 18-year-old woman who has come into the emergency department for bilateral abdominal pain. Which of the following should the nurse not consider a risk factor for ectopic pregnancy?

• Yeast infection
• Chlamydia trachomatis
• Endometriosis
• Uterine fibroids
• Neisseria gonorrhoeae

Answer: Yeast infection

Explanation:

• Uterine conditions such as endometriosis and uterine fibroids increase the risk of ectopic pregnancy. Endometriosis is the inappropriate growth of uterine tissue outside the uterus. Uterine fibroids are benign tumors within the uterus. Sexually transmitted infections can cause a condition called pelvic inflammatory disease which can result in scarring. Scarring of the reproductive system greatly increases the risk of ectopic pregnancy and infertility. Yeast infections are common after antibiotic therapy and are treated with an over-the-counter medication. They generally do not cause permanent damage to the body.

 

A woman who is 20 weeks pregnant calls the clinic because she is experiencing pink-tinged discharge for the first time. The nurse should advise the patient to

• Make an appointment to be seen tomorrow
• Decrease her activity level
• Call back if she experiences an increase in pelvic pressure
• Call back if the symptoms have not subsided in 24 hours
• Seek medical attention immediately

Answer: Seek medical attention immediately

Explanation:

• This woman could be experiencing pre-term labor. A 20-week pregnancy is not considered viable. She should be seen immediately to determine if there is a cause such as cervical insufficiency (premature dilation of the cervix).

 

Hanna is a 21-year-old woman who is presenting at the emergency room for severe vaginal bleeding. She is 32 weeks pregnant. Upon further examination, she is found to be suffering from abruptio placentae. Which of the following assessment findings would be of least concern to the nurse?

• Shortness of breath
• A tender uterus
• Small red dots on the skin
• Decreasing blood pressure
• Bleeding from oral mucosa

Answer: A tender uterus

Explanation:

• Abruptio placentae is a serious condition where the placenta inappropriately and prematurely detaches from the uterus. Women with obstetric complications such as abruptio placentae can quickly develop disseminated intravascular coagulation (DIC). DIC is a clotting disorder in which the blood inappropriately clots. Severe bleeding can also occur as clotting proteins become scarce. Symptoms of DIC include blood clots, and bleeding into the tissues such as the skin and oral mucosa. A decreasing blood pressure is concerning due to the severe bleeding caused by the combination of DIC and abruptio placentae. Shortness of breath could indicate the presence of a blood clot. Although uterine tenderness is of concern, it is common with abruptio placentae and does not indicate an immediately life-threatening condition.

 

The nurse completes a cervical exam on her laboring patient. She determines that her patient’s cervix is 1cm in length. How would the nurse describe this length?

• 50% effaced
• 25% effaced
• 100% effaced
• 30% effaced
• 25% effaced

Answer: 50% effaced

Explanation:

• The normal cervical canal is 2cm in length. Effacement is the thinning of the cervix as the body prepares for delivery. Thus, a 2cm cervix is 0% effaced and a 0cm cervix is 100% effaced.

 

The nurse helps the healthcare team to deliver a healthy baby girl. Upon delivery of the placenta, the nurse notices that it is not 100% intact. What is the nurse’s first concern?

• Deep vein thrombosis
• Hemorrhage
• Infection
• Pulmonary embolism
• Tissue perfusion
• Answer: Hemorrhage

Explanation:

• If the placenta is not whole upon delivery, a piece may still be present in the uterus. This inhibits the ability of the uterus to shrink in size and may cause hemorrhage. NCLEX Obstetrics and Gynecological Conditions, study concepts, example questions and explanations. The missing piece needs to be located immediately.

 

While monitoring a laboring patient, the nurse notices that the fetal heart rate at baseline varies from 110-145 beats per minute. The nurse’s first action would be which of the following?

• Administer oxygen at 1Lmin via nasal cannula
• Turn the mother on her left side
• Decrease IV fluids
• No action is required
• Have the mother bear down

Answer: Turn the mother on her left side

Explanation:

• Marked fetal heart rate baseline variability of 25 beats per minute or more may be cause for concern. Similar findings may indicate that there is poor oxygenation of the fetus. Turn the mother to her left side (to increase perfusion) and notify the physician. Note that this is still in the normal range for fetal heart rate for a laboring patient (about 130 beats per minute), and that the low end of this spectrum is of slightly more concern.

 

Which of the following is not a risk factor for gestational diabetes?

• Prior birth of a child with a congenital disorder
• Newborn weighing 9lbs 2oz
• Advanced maternal age
• Asian ethnicity
• High blood pressure

Answer: Asian ethnicity

Explanation:

• Asian ethnicity is not considered a risk factor. Hispanic, Native American and African American ethnicities are considered risk factors for gestational diabetes. Others include maternal obesity, previous pregnancies with gestational diabetes, delivery of a very large baby, and a family history of diabetes.

 

A woman arrives at the birthing center for evaluation. She thinks she may be in labor. She is multiparous and experiencing contractions every 3 minutes. Upon examination, the nurse notes that she is 5cm dilated and 50% effaced. Which stage and phase of labor is the woman experiencing?

• Stage 2, phase 1
• Stage 1, phase 3
• Stage 1, phase 1
• Stage 2, phase 2
• Stage 1, phase 2

Answer: Stage 1, phase 2

Explanation:

• The woman is experiencing the first stage labor and the second phase. The first stage of labor exists when the woman’s cervix is dilating from 0-10cm. The second phase of the first stage occurs during dilation from 4-7cm and when the cervix is 40-80% effaced. The second stage of labor is when the cervix is dilated 10cm until the delivery of the baby. The third stage of labor is the delivery of the placenta. The first phase of labor is the onset of labor until the cervix is dilated 3cm. The third phase of labor is when the cervix fully dilates from 7cm to 10cm.

 

The nurse is called to a room by a laboring patient. The patient complains of a backache and appears restless. Her fingers are trembling and beads of sweat fall from her forehead. The nurse suspects she might be experiencing which stage of labor?

• Stage 1, phase 3
• Stage 1, phase 2
• Stage 2, phase 1
• Stage 3, phase 1
• Stage 2, phase 2

Answer: Stage 1, phase 3

Explanation:

• During the third phase of the first stage of labor, the cervix dilates from 8-10 cm and effacement reaches 80-100%. The woman will be less able to focus on other things and may require more support from support persons. Labor may progress quickly and the nurse should be preparing for the second stage of labor, in which the cervix is fully dilated at 10cm.

PLACE YOUR ORDER HERE

Andrea comes to the office for a prenatal visit. She mentions that lately she has been excessively hungry, thirsty, and very tired. Which of the following would the nurse suspect?

• Gestational diabetes
• Pre-eclampsia
• Toxoplasmosis
• Parvovirus B19
• Anemia

Answer: Gestational diabetes

Explanation:

• Polyphagia (excessive hunger), polydipsia (excessive thirst) and polyuria (excessive urination) are three hallmark signs that point to diabetes. While increased fatigue is common in pregnancy, combined with the other two symptoms, it may be concerning. Pre-eclampsia involves elevated blood pressure, swelling of the hands and feet, and protein in the urine. Toxoplasmosis results from infection by a parasite and can effect fetal development. An amniocentesis is performed to diagnose the infection of the fetus. Depending on the suspected duration of infection and the gestational age, drugs may be administered to decrease the chance of the parasite from infecting the fetus. Anemia, and parvovirus B19 are unlikely to cause all three of these symptoms occurring together.

 

All of the following may trigger asthma in a pregnant woman except

• Esophageal reflux
• Animal dander
• Stress
• Unwashed sheets
• Moist air

Answer: Moist air

Explanation:

• All those listed may be asthma triggers with the exception of moist air. Typically, cold air may trigger asthma exacerbation. Additional triggers include exercise, respiratory illness, smoke, and mold.

 

Sally arrives at the clinical office for a routine prenatal appointment. She becomes red in the face as she states that lately she has been craving and ingesting dirt. Which of the following is the most appropriate response from the nurse?

• “You must be admitted to the hospital.”
• “Why would you eat dirt?”
• “Do you have a history of psychiatric illness?”
• “You must stop immediately.”
• “Where have you been obtaining the dirt that you’re ingesting?”

Answer: “Where have you been obtaining the dirt that you’re ingesting?”

Explanation:

• During pregnancy, many women crave and eat substances that adults do not generally ingest. This condition is normal and is called pica. Often, the substances do not have high nutritional value. Examples are dirt, chalk, rocks, toothpaste, toilet paper, etc. It is important to determine the risks involved with ingesting these materials. For example, the nurse must determine that a woman who is eating dirt does not ingest potting soil mixed with fertilizer and other potentially toxic chemicals NCLEX Obstetrics and Gynecological Conditions, study concepts, example questions and explanations.

 

Your patient is under 24-hour fetal monitoring and observation. The fetal monitoring strip begins to show decelerations, starting after the peak of contractions and recovering late. Which of the following interventions does the nurse anticipate doing?

• Reposition mother
• Increasing rate of oxytocin
• Administering medication
• Fluid bolus with normal saline (NS)
• Removing oxygen supplementation

Answer: Reposition mother

Explanation:

• Late decelerations are caused by uteroplacental insufficiency. The nurse should anticipate many interventions to promote uteroplacental blood flow. Initially, the nurse should implement oxygen supplementation, stop the oxytocin infusion, reposition the mother to the left side, and introduce a fluid bolus of lactated Ringer’s solution (LR).

 

The nurse is reviewing a fetal monitoring strip. Decelerations are onset with the beginning of each contraction and recover at the end of each contraction. Which type of deceleration is this, and why does it occur?

• Early decelerations; head compression
• Variable decelerations; head compression
• Variable decelerations; umbilical cord compression
• Early decelerations; uteroplacental insufficiency
• Late decelerations; uteroplacental insufficiency

Answer: Early decelerations; head compression

Explanation:

• A fetal heart rate (FHR) deceleration occurs when the FHR drops 15 bpm below baseline for a period of 15 seconds when the gestation is more than 32 weeks and 10 bpm below baseline for 10 seconds when gestation is less than 32 weeks. When the onset of the deceleration occurs at the onset of a new contraction and recovers with the end of the same contraction, the strip is demonstrating early decelerations, and the fetus is exhibiting head compression. Late decelerations occur when the deceleration begins after the start of a contraction and does not resolve until after the contraction has finished; late decelerations are the result of uteroplacental insufficiency. A variable deceleration is caused by cord compression, and appears as a brief drop in FHR from baseline that resolves quickly, creating a “V” shape on the strip.

 

Which of the following describes a category II fetal heart rate (FHR) tracing?

• Baseline FHR145 bpm; moderate variability; two accelerations; zero decelerations
• Baseline FHR170 bpm; moderate variability; two accelerations; zero decelerations
• Baseline FHR 100bpm; minimal variability; zero accelerations; variable decelerations
• Baseline 100bpm; absent variability; one acceleration; prolonged decelerations
• Baseline FHR 90bpm; marked variability; zero accelerations; late decelerations

Answer: Baseline FHR 100bpm; minimal variability; zero accelerations; variable decelerations

Explanation:

• A category II fetal heart rate tracing include all FHR tracings that are not category I or category III. Category I FHR tracings are as follows: baseline 110-160bpm, moderate variability, absent late or variable decelerations, present or absent early decelerations, and present or absent accelerations. Category III FHR tracings are as follows: absent baseline FHR variability, recurrent late decelerations, recurrent variable decelerations, bradycardia, and sinusoidal patterns.

 

Which of the following is not a risk factor for gestational diabetes?

• Obesity
• Previous stillbirth
• Poor diet
• Previous macrosomic infant
• Family history of diabetes

Answer: Poor diet

Explanation:

• Risk factors for gestational diabetes include: obesity, family history of diabetes, history of gestational diabetes, hypertension, pre-eclampsia/eclampsia, recurrent urinary tract infections, vaginitis, polyhydramnios, previous large infants (9lbs or greater than 4000g), glycosuria or proteinuria on two or more occasions. While poor diet may contribute to diabetic concerns, it is not directly associated with a higher risk of gestation diabetes as the other risk factors are. During the prenatal period, nurses are responsible for educating their patients on all of these risk factors as well as a proper prenatal diet.

 

The nurse is observing the fetal monitoring strip of a 37-week-old fetus. He observes a visually apparent and abrupt increase in fetal heart rate (FHR) from a baseline of 140 to a peak of 159. The FHR returns to baseline after 20 seconds. What type of fetal heart rate characteristic has occurred?

• Recurrent acceleration
• Deceleration
• Tachycardia
• Prolonged acceleration
• Acceleration

Answer: Acceleration

Explanation:

• An acceleration in fetal heart rate is defined as a visually apparent and abrupt increase in FHR, where the FHR increases from the onset of the acceleration to the peak in less than 30 seconds. At less than 32 weeks, the acceleration must peak at least 10 bpm above baseline and last at least 10 seconds. At more than 32 weeks, the acceleration must peak at least 15 bpm above baseline and last at least 15 seconds. A prolonged acceleration follows the same guidelines as an acceleration, but lasts more than 2 minutes and is not longer than 10 minutes in duration; after 10 minutes, it is a change in baseline FHR. NCLEX Obstetrics and Gynecological Conditions, study concepts, example questions and explanations. A deceleration is a visually apparent decrease in FHR from the baseline, gradual or abrupt, that returns to the original baseline. Recurrent accelerations occur with more than 50% of contracts in any 20-minute window. Tachycardia is a baseline FHR of more than 160 bpm.

 

The nurse observes an electronic fetal monitoring strip. Upon review, the fetal heart rate (FHR) undulates from 140bpm to 160bpm and back down to 140bpm in a consistent cycle over a period of 35 minutes. What type of fetal heart rate characteristic is occurring on this electronic fetal monitoring strip?

• Variable
• Intermittent
• Recurrent
• Bradycardia
• Sinusoidal

Answer: Sinusoidal

Explanation:

• A sinusoidal pattern is a visually apparent, smooth, sine wave-like undulating pattern in fetal heart rate baseline with a cycle frequency of at least 3−5min that persists for more than 20 minutes. Variable describes an abrupt deceleration of visually apparent decrease and return in fetal heart rate (FHR) from baseline lasting less than 30 seconds. Bradycardia occurs when the baseline FHR is less than 110 bpm. Intermittent describes an acceleration or deceleration occurring with less than 50% of contractions in any 20-minute window. Recurrent describes an acceleration or deceleration occurring with more than 50% of contractions in any 20-minute window.

 

In a fetus positioned at left occiput anterior (LOA), where should the nurse assess the fetal heart rate (FHR)?

• Below umbilicus on mother’s left side
• At level of umbilicus
• Above umbilicus on mother’s left side
• Below umbilicus on mother’s right side
• Above umbilicus on mother’s right side

Answer: Below umbilicus on mother’s left side

Explanation:

• When considering where to hear fetal heart rate best, the nurse must consider the location of the fetal back. Weeks’ gestation or size may also effect the location of the best place to assess fetal heart rate. LOA, or left occiput anterior, is the most common fetal lie. A fetus in LOA is in vertex presentation with the fetal occiput on the mother’s left side toward the front of her pelvis. In LOA, the FHR is best heard below the umbilicus on the mother’s left side.
• In LOP (left occiput posterior), the FHR is best heard on the mother’s left side at the level of the umbilicus. In ROA (right occiput anterior): the mother’s right side below the umbilicus. In ROP (right occiput posterior): the mother’s right side at the level of the umbilicus. In LSA (left sacrum anterior): the mother’s left side above the umbilicus. In RSA (right sacrum anterior): the mother’s right side above the umbilicus.

 

What is the triad of presenting symptoms with endometriosis?

• Hirsutism, infertility, and oligomenorrhea
• Dysmenorrhea, infertility, and dyspareunia
• Dysmenorrhea, metrorrhagia, and dysuria
• Menorrhagia, infertility, and dyspareunia

Answer: Dysmenorrhea, infertility, and dyspareunia

Explanation:

• The triad of presenting symptoms for endometriosis is dysmenorrhea (painful menses), infertility, and dyspareunia (pain on sexual intercourse). The most common presenting symptom is extreme, intense uterine cramps which may radiate to the back or down the thighs. Endometriosis is also a common cause of infertility due to a local paracrine effect. Pain on intercourse may be due to the implantation of endometrial cells in the vagina or the area around the cervix. Endometriosis will not necessarily result in menorrhagia, or excessively heavy bleeding. Hirsutism, infertility, and oligomenorrhea are symptoms commonly seen in polycystic ovarian syndrome (PCOS), rather than endometriosis.

PLACE YOUR ORDER HERE

Which of the following increase the risk of endometriosis?

• Presence of an intrauterine device (IUD)
• All of these are correct
• Family history of endometriosis
• Lack of exercise

Answer: All of these are correct

Explanation:

• The incidence of endometriosis increases significantly in individuals with a family history of the condition. Other contributing factors are sedentary lifestyle (lack of exercise), presence of an intrauterine device, a diet high in fat, the presence of estrogen dominance, and liver dysfunction (due to decreased estrogen metabolism).

 

Which of the following is a possible cause of vaginal bleeding in early pregnancy?

• Trophoblastic disease
• Cervical ectropion
• Spontaneous abortion/miscarriage
• All of these are correct

Answer: All of these are correct

Explanation:

• All of these could be possible reasons for bleeding in early pregnancy, including physiologic or implantation bleeding. Bleeding may indicate threatened miscarriage or other serious condition, or it may simply be due to the implantation of the embryo into the endometrium.

 

Which of the following terms denotes a menstrual cycle that is irregular, of shorter duration than normal, and of excessive volume or duration?

• Metrorrhagia
• Oligomenorrhea
• Menometrorrhagia
• Amenorrhea

Answer: Menometrorrhagia

Explanation:

• Menometrorrhagia is a term used to NCLEX Obstetrics and Gynecological Conditions, study concepts, example questions and explanations describe a menstrual cycle that is irregular, of shorter duration than normal, and of excessive volume or duration. Amenorrhea is the absence of a menstrual cycle. Metrorrhagia is a term for a menstrual cycle that is of normal flow duration and volume, but which is irregular and has a shorter-than normal cycle length. Oligomenorrhea describes a menstrual cycle that is longer than 35 days, often characterized by a prolonged follicular phase.

 

Pregnant individuals with gestational hypertension, proteinuria, and signs of liver or kidney dysfunction should be evaluated for what potentially life-threatening condition?

• Gestational diabetes
• Ectopic pregnancy
• Preeclampsia
• Placenta previa

Answer: Preeclampsia

Explanation:

• Preeclampsia is a potentially life-threatening disorder that generally includes gestational hypertension, proteinuria, edema, red-blood cell dysfunction, and signs of liver or kidney dysfunction. It is more common in weeks 32-40 and develops in 2-8% of pregnancies worldwide.

 

At what point does preeclampsia develop into eclampsia?

• When blood pressure exceeds 160/95 mmHg
• When there is evidence of vascular dysregulation
• At the progression into seizures
• At the initiation of kidney failure

Answer: At the progression into seizures

Explanation:

• Preeclampsia develops into eclampsia at the onset of seizures. Seizures are tonic-clonic and may appear during pregnancy, during labor, or postpartum. It is relatively rare, affecting only approximately 1.2-1.8% of pregnancies.

 

What is the most common time for miscarriages to occur?

• 0-12 weeks
• 22-28 weeks
• 16-24 weeks
• 12-20 weeks

Answer: 0-12 weeks

Explanation:

• The most common time for miscarriage to occur is during the first trimester, between 8 and 12 weeks. This may even occur before an individual is aware that they are pregnant. Chromosomal abnormalities are identified in approximately 50% of first trimester miscarriages, while later miscarriages may be more likely in individuals with uterine malformations or cervical incompetence.

 

Which of the following is a risk for preeclampsia?

• Possible Answers:
• History of hypertension
• All of these
• Diabetes
• Primigravida

Answer: All of these

Explanation:

• There are several risk factors for preeclampsia. These include history of hypertension, diabetes, older maternal age, first-time pregnancies (primigravida), and pregnancies with twins or multiples.

 

A labor and delivery nurse is assessing a newborn infant and notes that the infant appears to be jaundiced. What is a possible cause for this condition?

• The mother had gestational diabetes causing jaundice of the infant.
• The mother’s blood is Rh negative and gave birth to her second Rh positive child without receiving Rhogam during the pregnancy.
• The mother has exposed the infant to an active genital herpes outbreak.
• The baby has been born HIV positive, as the mother was unable to afford HIV medications.
• The infant is experiencing fetal alcohol syndrome, as the mother admitted to utilizing drugs and alcohol throughout the pregnancy.

Answer: The mother’s blood is Rh negative and gave birth to her second Rh positive child without receiving Rhogam during the pregnancy.

Explanation:

• Jaundice of a newborn may be either pathologic or physiologic. Pathologic jaundice is usually the result of Rh incompatibility between the mother and the fetus. It occurs during a subsequent birth after the mother’s blood has been exposed to the infant’s blood during the first birth. Rhogam is given to the mother to prevent her immune system from attacking the second fetus, causing erythroblastosis fetalis and subsequent pathological jaundice.

 

A labor and delivery nurse is monitoring a client in active labor after receiving epidural anesthetic. Upon assessing the client, she notes that the patient’s blood pressure has fallen to 95/75.

The nurse’s first action should be?

• Increase IV fluids
• Obtain an ECG
• Contact the physician immediately
• Place in semi fowler’s position
• Give 1 mg Epinephrine

Answer: Increase IV fluids

Explanation:

• The first action should be to increase fluids, place on their left side and give oxygen. It is not necessary to contact the physician until all nursing interventions have failed. Epinephrine, a vasopressor should be reserved for emergent situations only.

 

A 26 year old female primigravida presents to the clinic to discuss her estimated date of birth (EDB). The nurse records the client’s first day of her last menstrual period as February 28th 2015. What would be her (EDB)?

• November 28, 2015
• December 6, 2015
• November 5, 2015
• December 7, 2015
• December 5, 2015

Answer: December 5, 2015

Explanation:

• The calculation of an estimated date of birth requires applying Naegele’s rule, where once determining the first day of the client’s last menstral period, subtract 3 months and add 7 days and one year.

ORDER YOUR PAPER NOW

A labor and delivery nurse is caring for a pregnant client that is experiencing contractions and has been on an external tocodynamometer to measure fetal heart tones as well as uterine contractions. The nurse notes that there are decreases in the fetal heart rate at different times of a contraction.

The nurse is aware that this type of finding is consistent with variable decelerations, which are indicative of which of the following?

• An utero-placental insufficiency
• The effects of decreased pitosin infusion
• Fetal head compression during contraction
• The third stage of labor
• A prolapsed umbilical cord or nuchal cord

Answer: A prolapsed umbilical cord or nuchal cord

Explanation:

• Variable decelerations can occur at any time during a contraction, or without a contraction. They are caused by the umbilical cord that is prolapsed or wrapped around the fetal neck also known as a “nuchal cord.” The compression of the cord can ultimately lead to fetal hypoxia and therefore an intervention will be required to alleviate the compression.

 

A 24-year-old primigravida client has just given birth to a Rh positive child and she herself is Rh negative. The nurse recognizes this situation can lead to future problems in terms of future pregnancies due to this blood type mismatch.

All of the following are associated with Rh factor incompatibility except

• Kernicterus is a potentially serious effect due to pathological jaundice that can have long lasting neurological effects on the child if not prevented.
• The mixing of fetal blood with maternal blood may occur during an amniocentesis or early separation of the placenta during birth.
• A major effect of Rh incompatibility is an increased risk of blood clotting and thrombosis in the fetus during subsequent pregnancies
• May lead to fetal anemia and lead to an acceleration of red blood cell production if the mother is not given Rho-D immune globulin to prevent antibodies from destroying fetal blood cells.
• The mother will form IgG and IgM antibodies in response to being exposed to a fetus’ incompatible blood type.

Answer: A major effect of Rh incompatibility is an increased risk of blood clotting and thrombosis in the fetus during subsequent pregnancies

Explanation:

• Blood clots are not a common effect in the fetus due to Rh incompatibility. A disorder known as erythroblastosis fetalis is a type of hemolytic disease that occurs in the fetus due to an immune reaction NCLEX Obstetrics and Gynecological Conditions, study concepts, example questions and explanations of the Rh-negative mother and an Rh-positive fetus. All other choices are associated with this type of incompatibility.

 

Which type of abortion is associated with sepsis, cramping, abdominal tenderness and an open cervical os?

• Complete abortion
• Missed abortion
• Inevitable abortion
• Spontaneous abortion
• Threatened abortion

Answer: Missed abortion

Explanation:

• A missed abortion is marked by the death of the fetus in utero but is not expelled from the uterus. If left untreated can lead to infection in the womb, it is marked by foul odor and bleeding as well as an elevated temperature and sepsis.

 

Which of the following statements is true about a hydatidiform molar pregnancy?

• A molar pregnancy can proceed without incident once Rho-D immune globulin is administered to the mother.
• The cause of a molar pregnancy is due multiple ovum becoming fertilized and coalescing to form a cluster of atypical cells containing a haploid number of chromosomes.
• An ultrasound usually reveals a mass resembling a “cluster of grapes”, and a blood test will reveal a positive pregnancy result due to elevated HCG (human chorionic gonadotropin) hormone.
• A molar pregnancy is a type of ectopic pregnancy in need of dilation and curettage to prevent internal hemorrhaging or possible hysterectomy.
• A hydatidiform molar pregnancy is reported to cause malignancy in approximately 60% of cases.

Answer: An ultrasound usually reveals a mass resembling a “cluster of grapes”, and a blood test will reveal a positive pregnancy result due to elevated HCG (human chorionic gonadotropin) hormone.

Explanation:

• A hydatidiform molar pregnancy is mostly a benign process that may occur due to an abnormal ovum becoming fertilized and growing into collection of cells in a cluster like formation. They are benign over 80% of the time. Rho-D immune globulin is a medication administered to a Rh-negative mother that will give birth to a second Rh positive child to prevent an immune reaction that may harm the child.

 

A woman is hospitalized for preeclampsia. Which medication may the nurse administer to prevent the occurrence of seizures?

• Nubain
• Pitocin
• Zolpidem
• Magnesium sulfate
• Calcium gluconate

Answer: Magnesium sulfate

Explanation:

• Magnesium sulfate is used to prevent seizures in women with severe preeclampsia. Calcium gluconate is the antidote if magnesium toxicity is assessed. It should be readily available when a woman is receiving magnesium sulfate. Pitocin is used to stimulate the uterus, often to induce labor. Nubain is an opioid that can be given to women during labor to treat pain. Zolpidem (Ambien) is a sleep aid.

 

Jean is a 33-year-old woman who has previously had regular periods but has not gotten her period for six months. Which of the following would the nurse rule out as the cause?

• Yoga once per week
• Poor eating habits
• Antidepressant use
• Cross country running five times per week
• Kidney disease

Answer: Yoga once per week

Explanation:

• Yoga once per week (light exercise) is the least likely of the above to cause a change in regular menstruation. Cross country or long distance running (vigorous exercise) is more likely to cause changes to a woman’s cycle. Poor lifestyle choices such as eating habits and health issues such as kidney disease can also cause irregular menstruation. Likewise, pharmaceuticals can have the same effect.

 

Sandy is 29 years old and experiences bleeding between periods. The nurse marks which of the following on sandy’s medical chart?

• Polymenorrhea
• Metrorrhagia
• Oligomenorrhea
• Menometrorrhagia
• Menorrhagia

Answer: Metrorrhagia

Explanation:

• Metrorrhagia is bleeding between periods. Menorrhagia refers to excessively heavy periods. Oligomenorrhea refers to light, scattered periods (typically spaced by greater than 35 days). Polymenorrhea is used to describe short cycles of equal to or less than 21 days. Menometrorrhagia is used to describe periods that are heavier, sporadic, and more frequent than normal periods.

PLACE YOUR ORDER HERE

A patient tells the nurse that she is practicing fertility awareness. The nurse tells the patient that the “unsafe period” can range from

• Seven days before and seven days after ovulation
• Two days before and one day after ovulation
• One day before and one day after ovulation
• Two days before and two days after ovulation
• One day before and two days after ovulation

Answer: Seven days before and seven days after ovulation

Explanation:

• According to the family planning method of contraception, the period in which conception can occur and one should refrain from intercourse is up to 7 days before and 7 days after ovulation. Some references show that sperm can live for up to five to seven days inside the female reproductive system. An unfertilized egg can live from between 12-24 hours. This greatly increases the window in which conception can occur.

 

Which of the following is false regarding oral contraceptives?

• They may decrease the severity of menstrual cramps
• They may heighten the risk of depression
• They may reduce the risk of uterine cancer
• They may decrease the risk of breast cancer
• They may increase the risk of developing a blood clot

Answer: They may decrease the risk of breast cancer

Explanation:

• Oral contraceptives may increase the risk of breast cancer, increase the risk of depression, and increase the risk of developing a blood clot (higher in women who smoke cigarettes). They can reduce the risk of uterine cancer and are frequently used in women with primary dysmenorrhea. Primary dysmenorrhea refers to painful menstrual cycles without an underlying cause.

 

A 51-year-old female arrives at her doctor’s office because she has not had any periods for 12 months. The nurse should suspect

• Menopause
• Pelvic inflammatory disease
• Polycystic ovarian syndrome
• Endometriosis
• Pregnancy

Answer: Menopause

Explanation:

• Amenorrhea is the complete absence of a period. There are many different causes for amenorrhea. One of the most frequent causes of amenorrhea for women in the fifth decade of life, is menopause. Menopause is the most likely cause of amenorrhea in this particular patient because she has not been experiencing periods for 12 months and is 51-years-old. NCLEX Obstetrics and Gynecological Conditions, study concepts, example questions and explanations. While pregnancy is possible, the nurse would suspect menopause first. Pelvic inflammatory disease (PID) is a pelvic infection usually resulting in severe pain. Endometriosis is a condition in which uterine tissue inappropriately grows in areas such as the rectum or ovary, also typically causing severe pain. Polycystic ovarian syndrome is a condition causing hormone imbalance. It can cause amenorrhea. This question requires the use of strategy to answer. There are several choices that could be responsible for amenorrhea, but which one is the most correct?

 

Jody is a 40-year-old woman seeking care for dysmenorrhea for the first time. Which would not be considered an appropriate treatment?

• Oral contraceptives
• Oxycodone/acetaminophen
• Ibuprofen
• Lifestyle modifications
• Naproxen

Answer: Oxycodone/acetaminophen

Explanation:

• There are many different ways to treat painful periods (dysmenorrhea). Ibuprofen and naproxen are anti-inflammatory agents that do not require a prescription and can be very effective. They have relatively few side effects. Lifestyle modification (such as exercise) is another good alternative. The use of oral contraceptives are also frequently used to give women lighter and milder periods. Percocet is not generally used because it is an opioid analgesic and not recommended for long term use because they carry potential for addiction.

 

Which of the following is false regarding the respiratory system of pregnant women?

• The rib cage becomes slightly more compact
• Total lung capacity decreases
• The diaphragm elevates
• There is increased metabolic demand for oxygen from the body
• Oxygen consumption is increased

Answer: The rib cage becomes slightly more compact

Explanation:

• In pregnancy, the ribs start to flare (expand slightly) as the pressure from the growing fetus moves the diaphragm upwards. Many women experience this during the third trimester as the baby is at it’s largest. The flaring of the ribs is assisted by maternal hormones that enable more flexibility throughout the body.

 

Which of the following reasons does not indicate the need to induce labor?

• Hypertension
• Diabetes
• Postmaturity
• Fetal jeopardy
• Fetal macrosomia

Answer: Fetal macrosomia

Explanation:

• Induction of labor may occur for various indications: diabetes, postmaturity, hypertensive disorders or pregnancy, fetal jeopardy, or logistical factors including distance from qualified hospital or a rate of rapid birth. Induction of labor may only occur if the mother does not have cephalopelvic disproportion (CPD), the fetus has a vertex presentation with an engaged head, and the mother has a “ripened” cervic or is prepared to be “ripened”. Fetal macrosomia is a concerning condition and may require intervention, but is typically not resolved by inducing labor. With fetal macrosomia, a cesarean section may be considered instead of vaginal delivery, due to the potential risks of delivering a large infant vaginally.

 

What is the most common form of female reproductive tumor?

• Yolk sac tumor
• Choriocarcinoma
• Uterine leiomyoma
• Endometrial adenocarcinoma

Answer: Uterine leiomyoma

Explanation:

• The most common tumor of the female reproductive tract by far is uterine leiomyoma, also known as a uterine fibroid. Uterine fibroids are benign smooth muscle tumors that grow into the myometrium. They can often cause pain in the lower back or pain during penetration, dysmenorrhea, and menorrhagia.

 

Sudden onset of severe abdominal pain with a unilateral adnexal mass would most likely be which of the following conditions?

• Pelvic inflammatory disease
• Teratoma
• Ovarian torsion
• Polycystic ovarian syndrome

Answer: Ovarian torsion

Explanation:

• While any of the conditions listed can cause abdominal or pelvic pain, the most likely cause of severe pain of sudden onset is ovarian torsion. This is an emergency condition which can result in loss of the affected ovary if not treated within four hours.

 

Clear-cell adenocarcinoma of the vagina is strongly linked to pre-birth exposure to what medication?

• Acetaminophen
• Diethylstilbestrol (DES)
• Clomiphene
• Thalidomide

Answer: Diethylstilbestrol (DES)

Explanation:

• Diethylstilbestrol (DES), a medication used from 1940 to 1971 to reduce the risk of miscarriage, resulted in the later development of clear-cell adenocarcinoma in many of the unborn children of these pregnancies.

 

A patient enters the labor and delivery unit. She is having a singleton birth and the baby is showing minimal variability on the fetal monitor. Interventions may include all but

• Suggesting that the patient walk with a portable monitor
• Placing the patient on a non-rebreather mask
• Giving the patient a 500mL IV fluid bolus
• Placing the patient flat on her back
• Contacting the provider

Answer: Placing the patient flat on her back

Explanation:

• Increasing fluid and oxygen administration may increase the overall oxygenation of the fetus and result in greater variability in heart rate. It is advisable to change the position of the patient, however, a supine position is not compatible with pregnancy. Contacting the provider is an acceptable intervention given concern for fetal well-being.

 

What is the most common cause of mucopurulent cervicitis?

• Chlamydia trachomatis
• Neisseria gonorrhea
• Herpes simplex virus
• Human papillomavirus

Answer: Chlamydia trachomatis

Explanation:

• The most common cause of mucopurulent cervicitis is chlamydia trachomatis, followed by neisseria gonorrhea. Human papillomavirus, while it is associated with increased risk of development of cervical cancer, does not cause mucopurulent cervicitis, nor does herpes simplex NCLEX Obstetrics and Gynecological Conditions, study concepts, example questions and explanations.

 

Which of the following conditions can result in temporary masculinization of a pregnant woman which resolves after delivery?

• Growth hormone deficiency
• Chloasma
• Placental aromatase deficiency
• Polycystic ovarian syndrome

Answer: Placental aromatase deficiency

Explanation:

• Placental aromatase deficiency is a condition that prevents testosterone from being aromatized into estrogen during pregnancy. This results in a temporary masculinization of the mother that does not continue past delivery. Neither chloasma nor growth hormone deficiency result in masculinization, and masculinizing symptoms of polycystic ovarian syndrome often improve during pregnancy, rather than getting worse.

 

Which of the following conditions presents as vulvar pruritus and pain with porcelain-white vaginovulvular atrophy?

• Lichen sclerosus
• Bacterial vaginosis
• Contact vulvitis
• Herpes simplex

Answer: Lichen sclerosus

Explanation:

• Lichen sclerosus is a condition that presents as vulvar pruritus and pain with porcelain-white vaginovulvular atrophy. It is most common in post-menopausal women, though it does occur on occasion in younger women and girls. While all of the other conditions listed can cause puritis and pain, none of them are associated with frank atrophy.

 

All of the following are part of the Amsel criteria for bacterial vaginosis except

• All of there are part of the Amsel criteria for bacterial vaginosis
• A positive “whiff” test on addition of potassium hydroxide to the vaginal discharge
• Thin gray or white vaginal discharge
• Vaginal pH > 4.5

Answer: All of there are part of the Amsel criteria for bacterial vaginosis

Explanation:

• The Amsel criteria for bacterial vaginosis are as follows: clue cells seen on microscopic examination, a positive “whiff” test on addition of potassium hydroxide to the vaginal discharge, a vaginal pH > 4.5, and thin gray or white vaginal discharge.

 

Which of the following is not a risk-factor for uterine leiomyoma?

• Obesity
• Family history
• Red meat consumption
• Smoking

Answer: Smoking

Explanation:

• The main risk factors for uterine leiomyoma are family history, obesity, and red meat consumption. Smoking is not a risk factor.

 

Up to 90% of cases of pelvic inflammatory disease have what etiology?

• Human papillomavirus only
• Neisseria gonorrhoeae and chlamydia trachomatis
• Neisseria gonorrhoeae only
• Chlamydia trachomatis only

Answer: Neisseria gonorrhoeae and chlamydia trachomatis

Explanation:

• 75 to 90% of cases of pelvic inflammatory disease are caused by neisseria gonorrhoeae and/or chlamydia trachomatis infections. This condition, typified by adhesion formation in the uterus and fallopian tubes, can result in serious issues such as infertility, ectopic pregnancy, or reproductive cancer.

 

Which of the following is part of the diagnostic criteria for pelvic inflammatory disease (PID)?

• All of these
• Leukocytosis
• Fever
• Elevated erythrocyte sedimentation rate (ESR)

Answer: All of these

Explanation:

• The criteria for diagnosis of PID are as follows: fever, cervical motion tenderness, abdominal pain, leukocytosis, elevated ESR, and purulent cervical discharge.

 

What would be the primary concern in the case of rubella infection during pregnancy?

• Gestational diabetes
• Maternal ocular damage
• Maternal death
• Birth defects

Answer: Birth defects

Explanation:

• The primary risk in rubella infection during pregnancy is to the fetus. The rubella virus is able to cross the placenta, and acts as a teratogen by inducing apoptosis in fetal cells. This is termed congenital rubella syndrome. Birth defects can include deafness, ocular damage, cataracts, congenital heart defects, hepatomegaly, and developmental disability or delays.

ORDER YOUR PAPER NOW

At what time during gestation is a fetus most susceptible to congenital rubella syndrome?

• Week 12-20
• Week 20-30
• The first 12 weeks after conception
• Week 30-40

Answer: The first 12 weeks after conception

Explanation:

• Infants who are exposed to rubella during weeks 0-12 of gestation have a 51% chance of developing congenital rubella syndrome. If the fetus is exposed to the virus between 12 and 26 weeks, the incidence of defects drops to 23%. Congenital rubella syndrome is rare in infants whose mothers were initially exposed to the virus after 26 weeks of gestation. Interestingly, the fetus is more likely to have birth defects if the mother contracted rubella before conception – infants whose mothers contracted the virus 0-4 weeks before conception have as much as 43% incidence of congenital rubella syndrome, due to its long incubation period.

 

Which of the following is the definition of gestational hypertension?

• Blood pressure over 160/95 mmHg or rise of more than 30 mmHg systolic or 15 mmHg diastolic over baseline
• Blood pressure over 140/90 mmHg or rise of more than 40 mmHg systolic or 25 mmHg diastolic over baseline
• Blood pressure over 140/90 mmHg or rise of more than 30 mmHg systolic or 15 mmHg diastolic over baseline
• Blood pressure over 130/85 mmHg or rise of more than 35 mmHg systolic or 20 mmHg diastolic over baseline

Answer: Blood pressure over 140/90 mmHg or rise of more than 30 mmHg systolic or 15 mmHg diastolic over baseline

Explanation:

• Gestational hypertension is defined as a blood pressure over 140/90 mmHg or rise of more than 30 mmHg systolic or 15 mmHg diastolic over baseline. It generally develops after week 20 of pregnancy and returns to normal after delivery.

 

Which of the following is NOT a part of the triad of gestational hypertension?

• Proteinuria
• Headache
• Edema
• High blood pressure

Answer: Headache

Explanation:

• The classic triad of gestational hypertension is high blood pressure, proteinuria, and edema. New-onset headaches during a pregnancy that includes gestational hypertension may be a sign of a more severe condition, such as preeclampsia.

 

At what point in a pregnancy is preeclampsia most likely to develop?

• 12-24 weeks
• 0-12 weeks
• After 32 weeks
• 20-32 weeks

Answer: After 32 weeks

Explanation:

• Preeclampsia occurs more frequently in the last 8 weeks of pregnancy. Occurrence at an earlier gestational age is associated with increased severity and poorer outcomes for both mother and fetus.

 

Which of the following increases risk of ectopic pregnancy?

• Endometriosis
• History of pelvic inflammatory disease
• All of these are correct
• Post-tubal ligation

Answer: All of these are correct

Explanation:

• Ectopic pregnancy is a serious condition in which an embryo implants in tissue outside the uterus. Risk factors include pelvic inflammatory disease, tubal ligation, endometriosis, tobacco smoking, history of infertility, and the use of assisted reproductive technology.

 

Which of the following is a risk factor for development of toxoplasmosis in pregnancy?

• Contaminated water
• Undercooked meat
• All of these
• Exposure to cat feces (often via a litter box)

Answer: All of these

Explanation:

• Toxoplasmosis is a parasitic infection that is capable of crossing the placenta. It can cause birth defects such as hearing loss, learning disorders, and visual impairment. Toxoplasmosis infection is primarily a concern only in individuals who have never been exposed to the parasite before pregnancy, as most people develop immunity to infection 6-9 months after their first exposure (often through contact with cat feces in litter boxes or soil). NCLEX Obstetrics and Gynecological Conditions, study concepts, example questions and explanations The main routes of toxoplasmosis infection in pregnant women are exposure to cat feces, water contamination, consumption of undercooked meats, and blood transfusion.

 

Which of the following conditions can be triggered by Rh incompatibility between mother and fetus?

• Postpartum hemorrhage
• Hyperemesis gravidarum
• Hemolytic disease of the newborn
• Preeclampsia
• Gestational diabetes

Answer: Hemolytic disease of the newborn

Explanation:

• Of the conditions listed, the only one that is associated with Rh incompatibility between mother and fetus is hemolytic disease of the newborn (otherwise known as hemolytic disease of the fetus and newborn). In this condition, antibodies from the mother’s blood attack the blood of the fetus. This is a major cause of fetal and newborn mortality and morbidity.

 

Which of the following maternal/fetal blood types can lead to hemolytic disease of the newborn?

• Rh positive mother, Rh negative fetus
• Rh negative mother, Rh negative fetus
• Rh positive mother, Rh positive fetus
• Rh negative mother, Rh positive fetus

Answer: Rh negative mother, Rh positive fetus

Explanation:

• Hemolytic disease of the newborn occurs when an Rh negative mother is carrying an Rh positive fetus. The mother must have previously carried an Rh-positive fetus and become sensitized to Rh-D antigen during miscarriage, pregnancy (due to placental rupture), or during delivery. Then, during a second pregnancy, anti-RhD antibodies from the mother’s immune system can cross the placenta and attack the blood cells of the fetus, causing hemolytic anemia.

 

What treatment can prevent the development of sensitization to Rh-D antigen in an Rh-negative mother carrying an Rh positive fetus?

• Therapeutic abortion
• Rho(D) immune globulin
• Short-course immunosuppressant treatment
• Rh-D fetal serum injections

Answer: Rho(D) immune globulin

Explanation:

• Rh sensitization can be prevented by treatment of an Rh negative mother with Rho(D) immunoglobulin at 28 weeks, then again within 72 hours of delivery. This is a solution of IgG antibody to Rh-D, which is able to destroy any fetal red blood cells that enter the mother’s bloodstream before her own immune system is able to form develop a sensitization.

 

A nurse working in labor and delivery is caring for a client that has been diagnosed with an incompetent cervix. The client has been informed by the physician she is now at risk for a spontaneous abortion. The client asks the nurse about possible interventions.

The nurse is aware the procedure performed for an incompetent cervix is called

• Dilation and curettage
• Colporrhaphy
• McReynold’s procedure
• A Shirodkar procedure
• Tubal ligation

Answer: A Shirodkar procedure

Explanation:

• A Shirodkar procedure involves sewing a suture in and around the cervix to hold it closed. This is usually performed within the first trimester and later removed when the risk of miscarriage has lessened.

 

A pregnant woman at 43 weeks gestation is having labor augmented with oxytocin infusion. Which of the following best categorizes this particular drug?

• Anti-diuretic hormone
• Erythropoietin
• Thyroid-stimulating hormone
• Prolactin
• Growth hormone

Answer: Anti-diuretic hormone

Explanation:

• Oxytocin is often used to help augment labor by inducing contractions. This hormone is naturally made in the body and works as an anti-diuretic hormone (thus promotes the excretion of water). In labor, this hormone also works to stimulate uterine contractility.

 

You are the nurse taking care of a 76-year-old female who complains of vaginal dryness that is occasionally painful during intercourse. She is diagnosed with vulvovaginal atrophy. Which of the following is the best initial treatment?

• Systemic estrogen
• Diphenhydramine
• Propranolol
• Oxybutinin
• Topical estrogen

Answer: Topical estrogen

Explanation:

• In a patient with atrophic vulvovaginitis, a condition that causes thinning of the vaginal and vulvar tissue, resulting in inflammation, diminished lubrication, and subsequent pain, the best initial treatment option if the condition is distressing to the patient is application of topical estrogen. Atrophic vulvovaginitis is a common condition in post-menopausal women as the level of circulating estrogen decreases, and therefore estrogen-mediated effects on female tissues are diminished. With the significant decrease in estrogen to the vagina and vulva, inflammatory and painful symptoms may occur, as in this patient. By applying a topical estrogen cream to the affected tissues, this allows the patient to supplement the estrogen that was lost following menopause, while not exposing the patient to the potentially negative effects (e.g. cardiovascular) of systemic estrogen supplementation.
• Propranolol is a beta-adrenergic antagonist and has no role in the treatment of atrophic vulvovaginitis.
• Oxybutinin is an anti-cholinergic medication that is used to treat spastic bladder, among other conditions. It has no role in the treatment of atrophic vulvovaginitis.
• Diphenhydramine is an anti-histamine medication that has a wide variety of uses, but none known to treat atrophic vulvovaginitis.

 

You are the nurse taking care of a 28-year-old G3P2 who is at 33 weeks gestation. She goes into labor, and the physician orders administration of a tocolytic medication. Which of the following medications is a tocolytic?

• Terbinafine
• Terbutaline
• Lisinopril
• Sertraline
• Furosemide

Answer: Terbutaline

Explanation:

• The correct answer is “Terbutaline.” This is the correct answer, as terbutaline, a beta-2-adrenergic agonist, is the only medication listed that has tocolytic, or labor-repressing (anti-contraction) properties. It is one of the most common medications used for tocolysis in pregnant women. Another commonly used tocolytic agent is nifedipine, a calcium-channel blocker.
• The other choices are incorrect. Lisinopril is an angiotensin-converting enzyme inhibitor (ACE-I) that is commonly used to treat hypertension, among other conditions. It has no reported use as a tocolytic. Furosemide is a loop diuretic that is commonly used in the treatment of hypertension. It has no reported tocolytic properties. Sertraline is a selective serotonin reuptake inhibitor medication used to treat a number of conditions including major depressive disorder and generalized anxiety disorder, among others. Terbinafine is an allylamine anti-fungal medication used to treat conditions such as tinea corporis or tinea cruris.

 

Basal body temperature is determined by

• Taking the temperature before rising
• Taking the temperature in the afternoon
• Taking the temperature in the evening
• Taking the temperature mid-morning
• Taking the temperature before bed

Answer: Taking the temperature before rising

Explanation:

• The basal body temperature is a method many women use to determine when ovulation occurs. To take a basal body temperature, one must use a basal thermometer (which is more sensitive) and take their body temperature before getting out of bed (or even sitting up) each morning. This method is utilized the best if a woman wakes up and takes her temperature at the same time daily.

 

A nursing student is participating in clinical practice on a labor and delivery unit. He is learning how to measure contractions. He knows that contractions are measured by frequency, duration, and intensity. Which timeframe correctly describes how the student should measure the frequency of contractions?

• The increment of the first contraction to the decrement of the first
• The increment of the first contraction to the increment of the second
• The increment of the first contraction to the decrement of the second
• The increment of the first contraction to the acme of the second
• The acme of the first contraction to the acme of the second

Answer: The increment of the first contraction to the increment of the second

Explanation:

• Increment is the beginning or rise of the contraction. Acme is the peak of the contraction. Decrement is the fall of the contraction. Frequency is measured from the beginning of one contraction to the beginning of another, so it should be measured from the increment of the first contraction to the increment of the second contraction.

 

While caring for a laboring patient, the nurse is called into the room because her patient felt a “gush” of fluid. Which of the following should be the nurse’s next action?

• Alert the physician
• Assess fetal heart rate
• Change the sheets
• Turn the mother to her right side
• Inform the mother of what she should expect next

Answer: Assess fetal heart rate

Explanation:

• The nurse must suspect rupture of the membranes (amniotic sac). Assess fetal heart rate if rupture of the membranes may have occurred. With rupture comes the potential for cord prolapse. Assess fetal heart rate for baseline variability. Marked variability may be cause for concern and the nurse should monitor the patient for signs of infection

 

Which of the following symptoms is not a danger sign of pregnancy?

• Increased urination
• Vaginal bleeding
• Fever or chills
• Swelling in face or fingers
• Persistent vomiting

Answer: Increased urination

Explanation:

• It is important for the obstetric registered nurse to recognize the following danger signs of pregnancy: profuse vaginal bleeding, severe headaches/visual disturbances/abdominal pain, persistent vomiting, fever, chills, or swelling in the face or fingers. These may be signs of placental abnormalities, hypertensive disorders or pregnancy, maternal infection, or hyperemesis. Increased urination may be concerning to some women, but during pregnancy, the increased mass of the uterus induces pressure upon the bladder.

 

Which of the following tests may be used to assess the risk for neural tube defects in the fetus during pregnancy?

• Non-stress test (NST)
• Chorionic villus sampling (CVS)
• Amniocentesis
• Ultrasound
• Alpha-fetal protein (AFP) test

Answer: Alpha-fetal protein (AFP) test

Explanation:

• The alpha-fetal protein (AFP) test is the only test that can predict neural tube defects in a fetus during pregnancy. CVS can detect fetal karyotype, sickle-cell anemia, phenylketonuria (PKU), Down syndrome, and Duchenne muscular dystrophy. Amniocentesis can detect genetic disorders and lung maturity. Ultrasounds provide images of the fetal position, measurements of the fetus and placenta, and can confirm pregnancy and gestational age. NCLEX Obstetrics and Gynecological Conditions, study concepts, example questions and explanations Non-stress tests (NST) are used to record fetal heart rate to assess fetal well being after 28 weeks gestation.

ORDER YOUR PAPER NOW

What is the proper management of atypical squamous cells of undetermined significance (ASC-US) or low-grade intraepithelial lesion (LSIL) in women age 21-24?

• Possible Answers:
• Repeat cytology in 6 months
• Repeat cytology in 1 year
• Cervical conization
• LEEP (loop electrosurgical excision procedure)

Answer: Repeat cytology in 1 year

Explanation:

• ASC-US or LSIL in women age 21-24 should be managed by repeat cytology in one year. Neither cervical conization nor LEEP (loop electrosurgical excision procedure) would be appropriate in a patient of this age or presentation.

 

What follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels would be present in a patient with premature ovarian failure?

• FSH>80\ \frac{\mu\textup{IU}}{\textup{mL}} and LH>120\ \frac{\mu\textup{IU}}{\textup{mL}}
• FSH>40\ \frac{\mu\textup{IU}}{\textup{mL}} and LH>25\ \frac{\mu\textup{IU}}{\textup{mL}}
• FSH>25\ \frac{\mu\textup{IU}}{\textup{mL}} and LH>40\ \frac{\mu\textup{IU}}{\textup{mL}}
• FSH>120\ \frac{\mu\textup{IU}}{\textup{mL}} and LH>80\\frac{\mu\textup{IU}}{\textup{mL}}

Answer: FSH>40\ \frac{\mu\textup{IU}}{\textup{mL}} and LH>25\ \frac{\mu\textup{IU}}{\textup{mL}}

Explanation:

• Premature ovarian failure is the loss of ovarian function in an individual under the age of 40. A FSH>40\ \frac{\mu\textup{IU}}{\textup{mL}} and LH>25\ \frac{\mu\textup{IU}}{\textup{mL}} would be indicative of this condition.

 

What are the signs and symptoms of ectopic pregnancy?

• Abdominal pain and vaginal bleeding
• Cramping and abdominal mass
• Nausea and diplopia
• Fundal tenderness and vertigo

Answer: Abdominal pain and vaginal bleeding

Explanation:

• The most common symptoms of ectopic pregnancy are moderate to severe abdominal pain and vaginal bleeding. Pain may be cramping or sharp. Bleeding can be heavy and the individual can even begin to bleed into their abdominal cavity. Ectopic pregnancy is not consistent with fetal survival and requires treatment with methotrexate or, in the case of bleeding, surgery may be indicated.

 

A patient tells her nurse that since week twenty-six of her current pregnancy, she has been experiencing a raised, itchy red rash on her abdomen and chest. This is her first pregnancy. She has never had this before and she has made no other changes in diet, detergents, or lifestyle. Which of the following might describe her condition?

• Heat rash
• Pruritic urticarial papules and plaques of pregnancy (PUPPP)
• Dermatitis herpetiformis
• Urticaria from food allergy

Answer: Pruritic urticarial papules and plaques of pregnancy (PUPPP)

Explanation:

• The most likely cause of her rash is pruritic urticarial papules and plaques of pregnancy (PUPPP), a condition affecting about 1 in every 200 pregnancies. While she could be having an allergic reaction (dermatitis herpetiformis or urticaria) or an inflammatory eruption such as heat rash, these are less likely due to their absence before pregnancy and the absence of any significant changes in her diet or lifestyle.

 

How is glomerular filtration rate (GFR) affected during a normal pregnancy?

• Increases by 50%
• No change
• Decreases by 15%
• Increases by 15%

Answer: Increases by 50%

Explanation:

• In the average normal pregnancy, the GFR increases by upwards of 50%. This correlates with an overall 50% increase in blood plasma volume.

PLACE YOUR ORDER HERE

The term placenta previa describes which of the following conditions?

• The placenta develops before the uterine lining is mature
• The fetus is inferior to the placental position
• The placenta separates from the uterine wall
• All or part of the placenta is positioned between the fetus and the cervix

Answer: All or part of the placenta is positioned between the fetus and the cervix

Explanation:

• In placenta previa, the placenta develops in such a way that all or part of it is positioned in the lower one-third of the uterus, placing it between the fetus and the cervix. This can cause the placenta to tear and bleed. The most common sign is painless vaginal bleeding in the third trimester (generally after week 32).

 

A 25-year-old female primigravida presents to the clinic for a prenatal visit and is concerned with new onset skin changes she has noticed lately. The nurse caring for this client is aware that there are several skin changes associated with pregnancy.

All of the following are skin changes associated with pregnancy except

• Linea nigra
• Subclinical jaundice
• Hegar’s sign
• Chloasma gravidarum
• Palmar erythema

Answer: Hegar’s sign

Explanation:

• Hegar’s sign is indicated by a softening of the portion of the uterus between the uterus and a portion of the cervix. The remaining choices are all examples of various skin discolorations commonly associated with pregnancy.

 

The nurse advises a woman with mild pre-eclampsia to do all of the following except

• Keep track of fetal movement
• Weigh herself daily
• Check blood pressure often
• Limit water intake
• Measure the protein in her urine

Answer: Limit water intake

Explanation:

• It is not necessary to limit water intake in women with pre-eclampsia. It is important that women with pre-eclampsia drink at least 8 glasses of water per day. The ingestion of water may even help reduce swelling. Checking blood pressure and body weight frequently are important in tracking fluid levels. It is also important to keep track of fetal movement and notify a provider immediately if decrease in movement is noted. Women who are preeclamptic may spill protein into their urine as a result of malfunctioning kidneys.

 

The nurse is assessing a “high-risk” woman in labor. She notices that the baby’s fetal heart rate is decreasing to 50 beats per minute for 80 second periods and recurring. The nurse should immediately

• Turn the mother on her left side
• Turn the mother on her right side
• Place the mother in the tripod position
• Have the mother raise her legs
• Place the mother in Trendelenburg

Answer: Turn the mother on her left side

Explanation:

• Placing the mother on her left side can increase placental blood flow and increase the baby’s oxygenation. Placing the mother on her right side, in Trendelenburg (head down), in the tripod position (sitting forward, hands on knees), or with her feet in the air is not of equal benefit.

 

Which of the following assessments is not a focal point of the postpartum assessment?

• Stool assessment, including consistency and color
• Lochia, including color and volume
• Bonding, including maternal/fetal and family dynamics
• Fundus, including height, location, and consistency.
• Vital signs, including blood pressure and pulse

Answer: Stool assessment, including consistency and color

Explanation:

• The postpartum assessment includes vital signs (blood pressure, pulse), fundus (location, height, consistency), lochia (color, volume), urinary output (measure first void), and bonding between the mother and infant. The postpartum assessment is valuable because it allows for nursing interventions at warning signs of postpartum complications, including infection, hemorrhage, and uterine atony. Stool assessment is not a vital part of the postpartum assessment because it does not lend information to the assessment of potential danger signs.

 

Which of the following ethnic groups should consider genetic counseling for thalassemia?

• Northern Europeans
• Jewish
• Native Americans
• African American
• Mediterranean ancestry

Answer: Mediterranean ancestry

Explanation:

• Thalassemia, an inherited autosomal recessive blood disorder, is characterized by an abnormal form of hemoglobin. Those of Mediterranean ancestry may be carriers of the disease and genetic counseling is recommended. African Americans are at risk for carrying the gene for sickle-cell disease, another inherited blood disorder that alters the form of hemoglobin. Northern European descendants of Jewish ancestry are at risk for carrying Tay-Sachs disease, a rare, inherited nervous system disorder. Native Americans are not commonly at risk for passing on genetically inherited disorders NCLEX Obstetrics and Gynecological Conditions, study concepts, example questions and explanations.

 

How can endometriosis affect fertility and miscarriage rates?

• Decreases fertility and decreases risk of miscarriage
• Decreases fertility and increases risk of miscarriage
• Increases fertility and increases risk of miscarriage
• Increases fertility and decreases risk of miscarriage

Answer: Decreases fertility and increases risk of miscarriage

Explanation:

• Endometriosis will increase risk of both infertility and of miscarriage. This may be due to a paracrine effect as hormones are released locally by ectopic endometrial tissue, causing disruptions in hormone levels required for implantation and for sustaining an implanted embryo before the formation of the placenta.

ORDER YOUR PAPER NOW

Endometriosis is more common in the presence of what food allergy-related condition?

• Anaphylaxis
• Lactose intolerance
• Celiac disease (gluten allergy)
• Endometriosis is unrelated to any type of food allergy

Answer: Celiac disease (gluten allergy)

Explanation:

• In a study surveying 120 women with endometriosis, the prevalence of celiac disease, an autoimmune condition triggered by ingestion of gluten, was nearly four times higher than the general population. No association has been made between the presence of endometriosis and lactose intolerance or incidence of anaphylaxis.