OBTest2NCLEXquestions

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1. A 2wk neonate is admitted to the hospital Draw blood 13. A blood patch may be done to relieve: Postspinal
with a diagnosis of possible sepsis (progress cultures x 3 headache.
note) in a.m.
14. Butorphanol differs from meperidine in Should not be
2. 3 characteristics of abnormal amniotic fluid Fluid that butorphanol: used if a woman
containing is dependent on
meconium heroin.
Strong odor
15. Cardinal mechanisms of labor 1. Descent
Yellow fluid
2. Flexion
3. "4" P's Power 3. Internal
Passage rotation
Passenger 4. Extension
Psyche 5. External
Rotation
4. a 30 yr client comes to office for a routine 1-hr glucose
6. Expulsion
prenatal visit tolerance
test 16. Cervical dilation is expressed in cm
(centermeters)
5. A 35yr old client who is 28wks is admitted To prevent
for testing compression 17. Cervical effacement is expressed as % of its original
of the vena length
cava
18. Choose the abbreviation that describes LSA
6. 42wks normal findings A three- the fetus in a breech presentation:
vessel
19. Choose the best method during the Give simple
umbilical
admission process to help relieve explanations
cord
general anxiety for a woman who has about her
Peeling skin
not attended prepared childbirth classes environment and
on the feet
and who is having her first baby: what to expect
Absence of
during labor.
sole creases
Absence of 20. A client at 32wks has mild preeclampsia headache
vernix blurred vision
caseosa epigastric pain
Cyanosis of severe nausea
the hands and vomiting
and feet 21. Client in labor promptly notify physician The clients
7. According to the gate control theory, which Application membranes
technique should be most helpful in of heat. rupture and the
interrupting transmission pain to the brain? amniotic fluid is
green
8. An advantage of an epidural block is that it: Reduces pain
Late
for both
deceleration
labor and
mucous is noted
birth.
on the external
9. After amniotomy, which observation should Fetal heart fetal monitor
be reported immediately? rate of 95 strip
bpm.
22. A client who's 29wks contractions every Terbutaline
10. After a vaginal birth complicated by Clavicle 8 mins also 3cm betamethasone
shoulder dystocia, the nurse should fracture. IV fluids
particularly assess the newborn for:
11. Amniotic fluid usually turns a pH swab or Dark blue
paper:
12. A baseline fetal heart rate of 125 bpm Normal for a
during labor should be interpreted as: term fetus.
23. A client with a warm, reddened, Change the breast pads 36. Fundal massage on a client who is 2h 1. Ask the client to
painful area in the breast as frequently postpartum void
well as cracked and fissured Expose the nipples to air 2. Place the client in
nippkles for part of each day supine position
Wash hands before 3. Place one hand
handling the breast and on the abdomen
breast-feeding above sym pubis
Release the baby's grasp 4.Place one hand
on the nipple before around the top of
removing the baby from the fundus
the breast 5.Rotate the upper
hand to massage
24. Developmental dysplasia of the Positive Barlows test
the uterus until firm
hip Asymmetrical leg skin
6.Gently press the
folds
fundus between the
25. During a prenatal visit,physician Hyperemesis gravidarum hands using slight
decides to admit a client to the downward pressure
hospital
37. GTPAL is 5-2-1-1-2 The client has had
26. During general anesthesia, Avoid aspiration. four previous
cricoid pressure is applied to: pregnancies
27. During normal labor, More frequent and of The client has had
contractions characteristically longer duration. two full-term
become: children, one
premature and one
28. During the latent phase of labor, Mildly anxious, coping
abortion
the nurse should expect the with contractions.
The client has two
womans behavior to be:
living children and
29. Effleurage Stroking of the abdomen, is pregnant again
thighs, or other body
38. How should the nurse interpret the The fetal occiput is
parts
abbreviation ROP? in the mothers right
30. Endorphins Internal concentration posterior pelvis.
similar to morphine
39. Immediately after an epidural block With a small roll
31. Excessive anxiety and fear Ineffective labor pattern. is begun, the woman may be under her right hip.
during labor may result in an: positioned:
32. External version is most likely Breech presentation at 38 40. Immediately after birth, nursing care Assessing for return
to be done in which of these weeks gestation. for a woman who had subarachnoid of sensation.
situations? block anesthesia fora repeat
33. Fetal descent during labor is Ischial spines cesarean birth should include:
measured in relation to the
mothers:
34. The first nursing action if a Relieve pressure on the
visibly prolapsed umbilical cord cord.
occurs is to:
35. Focal point Intense concentration on
an object
41. An infants amniotic fluid was meconium- Postterm. 47. Nagele's rule "Nagele's rule
stained. During the admission assessment, provides a good
the nurse notes that the infant is crying approximation of the
vigorously. Her skin is peeling and she has due date."
a long, thin appearance. These facts " I will add seven
suggest that this infant is probably: days to the 1st day of
my last period and
42. A laboring woman suddenly begins Look at her
count back 3 month."
making grunting sounds and bearing down perineum for
"Nagele's rule may be
during a strong contraction. The nurse increased
used in conjunction
should initially: bloody show
with other
or perineal
assessment findings.''
bulging.
48. Neonate apnea alarm repeatedly 1.Perform a focused
43. The labor phase when the woman often Transition
triggers assessment on the
feels anxious, restless, and seems to loses
neonate
control is:
2.Count the
44. Labor Progression 1.Strong respiratory rate for
Braxton Hicks 60 seconds
Contraction 3. Silence the alarm
2.Mild to decrease
contractions environmental
lasting 20-40 stimulus
seconds 4.Check all connects
3.Cervical on apnea monitor
dilation of 7cm 5. Document
4. 100% assessment findings,
cervical interventions,neonate
effacement response
5.
49. The newborn of a woman who Slow respirations.
Uncontrollable
receives narcotic analgestics during
urge to push
labor should be observed primarily
45. The most effective way to identify Observe pulse for:
adequate maternal oxygenation after oximeter
50. A nurse assesses a client's vaginal Lochia rubra
epidural administration of a narcotic for readings.
discharge on the first postpartum
cesarean birth is to:
day (progress note)
46. A mother with a history of varicose veins Sudden
51. The nurse can anticipate that which 40 weeks gestation
dyspnea
of the following patients may be with gestational
Diaphoresis
scheduled for induction of labor? A hypertension.
Cough
woman who is:
Confusion
Chest Pain 52. A nurse caring for a pt who is 32wks evaluate maternal
pregnant and being monitored in vital signs
the antepartum unit for pregnancy- auscultate fetal heart
induced hypertension rate
monitor the amount
of vaginal bleeding
monitor intake and
output
53. The nurse is assessing a client who Ask the client to
is 4h postpartum (progress note) empty her bladder
54. A nurse is caring for a 1day Taking in
postpartum client
55. A nurse is caring for a client in Postpartum hemorrhage 62. The nurse must particularly observe for signs A prior
the 4th stage of labor and symptoms of uterine rupture if the cesarean
laboring woman just admitted at 8 cm has: birth.
56. A nurse is caring for a client who The client is focused on
is in the third stage of labor the neonates condition 63. The nurse notes a pattern of variable Change
The client states she has decelerations on the electronic fetal monitor the
discomfort from the strip. The initial nursing response should be laboring
uterine contractions to: womans
postion.
57. A nurse is caring for a Symptoms include
postpartum client suspected of delusions and 64. The nurse notes that a womans contractions Infusion of
developing postpartum psychosis hallucination during oxytocin induction of labor are every 2 oxytocin
The disorder rarely minutes; the contractions last 95 seconds, and will be
occurs without a the uterus reamins tense between stopped.
psychiatric history contractions. What is expected based on
these assessments?
58. A nurse is evaluating a client who 1. Fernlike pattern when
is 34wks for preterm rupture of vaginal fluid is placed 65. A nurse observes several interactions Talks to
the membranes (PROM) on a glass slide and between a client and her neonate son and coos
allowed to dry (attachment ) at her son
2.Presence of amniotic Cuddles
fluid in the vagina her son
3. Alkaline pH of fluid close to
when tested with her
nitrazine paper
66. The nurse should learn to evaluate labor Increases
59. A nurse is performing a Neonates toes don't progress by methods other than vaginal the risk for
neurologic assessment on a 1day curl downward when examination, primarily because vaginal infection.
neonate in the nursery (asphyxia) the soles of feet are examination:
touched
67. The nurse should observe the woman who Late
Neonate does not
received epidural opioid narcotics for: respiratory
respond when the nurse
depression.
claps hands
Neonate displays 68. The nursing intervention most likely to make An ice
weak,ineffective sucking the woman with a perineal laceration more pack.
comfortable during the first 2 hours after birth
60. A nurse is preparing to teach pt 1.embryo has a definite
is:
about fetal growth and form
development during the first 3 2.the eyes, 69. Of the following options for cesarean birth, Assess the
months of pregnancy. ears,nose,lips,tongue the most important nursing care during the fundus.
3.teeth and bone begin postanesthesia recovery is to:
to appear 70. Of the following, which is the priority for Observe
4.internal and external nursing care during the second stage of the
fetal growth continues labor? womans
61. The nurse is providing prenatal 1 caloric intake perineum.
instructions to a 32yr old increased by 300
primagravida cal/day
2 protein intake
increased by 30 g/day
3 folic acid intake
increased 800 mg/day
4 intake of all
minerals,especially iron
71. Ophthalmia neonate prophylaxis in 1.Wash hands and put 78. Post-circumcision Infant must void
order on gloves before being
2. Shield the neonates discharged
eyes from direct light Petroleum
and tilt head slightly to jelly/antibiotic
the side that will ointment should
receive treatment be applied
3. Gently raise the The circumcision
neonates upper eye lid will require
with the index finger before 2-4 days
and pull the lower after discharge
eyelid down with the
79. A postpartum client is experiencing Holds new child
thumb
thoughts and behaviors common to the and breastfeeds
4. Instill ointment in
taking-hold phase without
the lower conjunctival
prompting
sac
Expresses a
5. Close and
strong interest in
manipulate the eyelids
taking care of her
to spread the med
child
6.Repeat the procedure
for the other eye 80. Post-term pt a 41wks who is about to fetal tone
undergo a biophysical profile to fetal breathing
72. Oxytocin (Pitocin) notify RN BP of 170/92
evaluate her fetus's well-being amniotic fluid
immediately Fluid overload with
vollume
crackles in the lungs
fields 81. A pregnant woman asks if she should Provide methods
A heart rate of 60bpm take prepared childbirth classes. The to help her cope
best response of the nurse is to tell her with labor.
73. Pain threshold Least amount of
that classes will:
stimulation that a
person perceive as 82. The prepared childbirth technique that Sacral pressure.
pain is most likely to relieve back pain
during labor is:
74. Pain tolerance Maximum amount of
pain one is willing to 83. presumptive changes in order breast change
bear frequent urination
uterine
75. Parents of a newborn delivered Usually disappear in a
enlargement
with low foreceps ask about small few days.
quickening
bruises on each side of the babys
linea nigra
head. The nurse should tell the
parents that the bruises: 84. The primary means of identifying Observe the
hemorrhage after vaginal birth is to: uterine fundus
76. Phases of a uterine contactions 1.strong Braxton Hicks
and lochia.
contactions
2.Acme 85. The priority nursing observation during Vaginal bleeding.
3. Decrement the fourth stage of labor is for:
4. Relaxation 86. Return demonstration of cord care by Placing the
77. Physical assessment of a client Assess the clients vital mother of neonate diaper below
who gave birth 3h ago signs cord
Palpate the clients Sponge-bathing
fundus the infant until
cord falls off
Cleaning the
length of the cord
with alcohol
several times
daily
87. The term infant may be placed in skin-to- Maintaining 99. When the fetus is in a cephalic Clear
skin contact with the mother immediately the infants presentation, the amniotic fluid id
after birth primarily for the purpose of: temperature. expected to be:
88. The thinning of the cervix during labor is Effacement 100. When the placenta is delivered with the Schultze
called: fetal side presenting, the mechanism is
called:
89. Thirty minutes after birth, the nurse Assist her to
assesses the womans uterine fundus. It is urinate. 101. Which is the most appropriate nursing care Promote rest
firm, above her umbilicus, and deviated to for the woman having hypertonic labor? and provide
the right side. The appropriate nursing general
action is to: comfort
measures.
90. To determine the frequency of uterine Beginning of
contractions,the nurse should note the one 102. Which is the most typical labor Persistent
time from the: contraction to characteristic when the fetus is in an back
the beginning occiput posterior position? discomfort.
of the next
103. Which maternal position should be avoided Supine
contraction.
during labor?
91. Two hours after a vaginal birth with an Help her walk
104. Which nursing assessment finding should Contraction
epidural anesthesia, the nurse determines to the
promptly reported to the physician or intervals
that the womans bladder is full. The most bathroom if
nurse-midwife? shorter than
appropriate initial nursing action is to: movement
2 minutes.
and sensation
have returned. 105. Which of the following is most Stadol (
appropriately used for pain relief during butorphanol )
92. The two most important nursing Bladder
labor when the cervix is dilated less than 4 via IM
assessments immediately after a woman distention
cm?
receives an epidural block: Blood
(Select all that apply) pressure 106. Which sign or symptom normally occurs Increased
shortly before labor begins? clear vaginal
93. What drug should be immediately available Naloxone
discharge.
for emergency use when a woman (Narcan)
receives narcotics during labor? 107. Which technique is likely to be most Applying firm
effective for "back labor"? pressure in
94. What is the priority nursing action Check the
the sacral
following amniotomy? fetal heart
area.
rate.
108. A woman at 15wks comes to clinic for an chromosomal
95. What nursing intervention during labor can Encourage
aminocentesis defects
increase space in the womans pelvis: regular
neural tube
urination.
defects
96. When assessing labor contractions, the Moderate. sex of fetus
nurse notes that the contracting uterus can
109. A woman---- gravida 4, para 3---- has Hypotonic
be slightly indented with fingertips when
been 5cm dilated for 2 hours. Her labor
contractions are at their peak. Contraction
contractions are every 7 minutes, 30 dysfunction.
intensity should be recorded as:
seconds duration, and mild. The FHR is 135-
97. When assessing the duration of labor Beginning of 145/min. She is relatively comfortable. This
contractions by palpation, the nurse should one woman is most likely experiencing:
time from the: contraction to
110. A woman has an emergency cesarean Is trying to
the end of the
delivery after the umbilical cord was found understand
same
to be prolapsed. She repeatedly asks her
contraction.
similar questions about what happened at experience
98. When caring for a woman following a Poor birth. The nurses interpretation of the and move on
vehicle accident at 36 weeks of pregnancy, oxygenation. womans behavior is that she: with
the priority fetal assessment should be for: postpartum
adaption.
111. A woman has a prostagmandin vaginal "Call your nurse 120. A woman who is 32 weeks gestation Ask her to
insert placed the day before she is if you notice fluid telephones the nurse in a labor unit and have
scheduled for induction of labor at 40 leaking from says her baby seems to be "pushing down" someone
weeks. Which is the most appropriate your vagina." much of the time and that she has a bring her to
teaching immediately after the constant backache.Choose the most the labor
procedure? appropriate nursing response: unit for
further
112. A woman has ruptured membranes at 31 Maternal vital
assessment.
weeks gestation. Which nursing signs:
observation should be promptly T38.2(100.7),P102, 121. A woman who is pregnant with her first Come to the
reported? R20 child phones an intrapartum facility and facility
says her "water broke". The nurse should promptly,
113. The woman having a vaginal birth after Uterine rupture.
tell her to: but safely.
cesarean (VBAC) should be observed
during labor, particularly for signs of:
114. A woman in active labor has contraction Continue to
every 3 minutes lasting 60 seconds, and monitor closely.
her uterus relaxes between
contractions. The electronic fetal
monitor shows the FHR to reach 90 bpm
for periods lasting 20 seconds during a
uterine contraction. The appropriate
priority nursing action is to:
115. A woman in labor states she wants to During the first
have epidural analgesia. When can this stage of labor.
method of analgesia best be given?
116. A woman is being observed in the Take the womans
hospital because her membranes temperature;
ruptured at 30 weeks of gestation. report it and the
While providing morning care, the fluid odor to the
nursing students notices that the RN.
draining fluid has a strong odor.The
priority nursing action is to:
117. A woman is using prepared childbirth Tell her to exhale
breathing techniques and complains of slowly into her
dizziness and tingling. The nurse should: cupped hands.
118. A woman phones the birth center and She should come
says," I think my water broke and my to the birth
baby is due, but I'm not having any center for
contractions." The most appropriate evaluation.
nursing response is to tell her that:
119. A womans membranes rupture during Assess the
labor. The nurse notes that the fluid is womans
yellowish and cloudy. The priority temperature and
nursing response related to this the fetal heart
assessment is to: rate.