Transcript The OB Review - University of North Carolina at Chapel Hill

Strategies for Answering
OB Questions on
NCLEX
TIPS
 Read
question carefully. Be sure you know
what it is asking

What to do “FIRST” or to select action that is
“BEST”
 Look
for key words (except, not, first, next)
 Attempt to answer question before you
look at answers
TIPS
 ABC’s
 Maslow’s
hierarchy
 Safety
 ASSESS
first, then intervene
 Calling the MD is not usually the first
response by the nurse
 Visualize the position
A woman is admitted to the hospital with a
ruptured ectopic pregnancy. A laparotomy is
scheduled. Preoperatively, which of the following
goals is most important for the nurse to include
on the patient’s plan of care?
a.
b.
c.
d.
Fluid replacement
Pain relief
Emotional support
Respiratory therapy
The nurse obtains a diet history from a pregnant 16 year
old. The client tells the nurse that her typical daily diet
includes cereal and milk for breakfast, pizza and soda for
lunch, and a cheeseburger, milkshake, fries, and salad for
dinner. Which of the following is the MOST accurate
nursing diagnosis based on this data?

a. Altered nutrition: more than body
requirements related to high fat intake
 b. Knowledge deficit: nutrition in pregnancy
 c. Altered nutrition: less than body requirements
related to increased nutritional demands of
pregnancy
 d. Risk for injury: fetal malnutrition related to
poor maternal diet
The nurse in the newborn nursery has just
received report. Which of the following infants
should the nurse see first?

a. A two day old infant is lying quietly alert with a
heart rate of 185.
 b. A one day old is crying and the anterior
fontanel is bulging.
 c. A 12 hour old infant is being held; the
respirations are 45 breaths/minute and irregular.
 d. A five hour old infant is sleeping and the
hands and feet are blue bilaterally.
A one day old newborn diagnosed with intrauterine
growth retardation is observed by the nurse to be
restless, irritable, fist-sucking, and having a highpitched shrill cry. Based on this data, which of the
following actions should the nurse take FIRST?
a. Discourage stimulation of the baby by rocking.
b. Tightly swaddle the infant in a flexed position.
c. Schedule feeding times every three to four
hours.
d. Encourage eye contact with the infant during
feedings.
The nurse is caring for a woman at 37 weeks gestation.
The client was diagnosed with insulin-dependent diabetes
mellitus at 7 years of age. The client states, “I am so
thrilled that I will be breastfeeding my baby.” Which of the
following responses by the nurse is BEST?
a. “You will probably need less insulin while you
are breastfeeding.”
b. “You will need to initially increase your insulin
after the baby is born.”
c. “You will be able to take an oral hypoglycemic
instead of insulin after the baby is born.”
d. “You will probably require the same dose of
insulin that you are now taking.”
SELECTING THE MOST
THERAPEUTIC RESPONSE

Eliminate “don’t
worry”



Offers false reassurance
Eliminate “explore”
answers

Don’t be a junior
psychiatrist
Don’t ask “why?”


Implies disapproval of
patient
Eliminate
authoritarian answers


Nurse telling patient
what to do
Eliminate “focus on
the nurse” answers

“That happened to me
once.”
The nurse at the birthing facility is caring for a primiparous
woman in labor who is 4 cm dilated, 25% effaced, and
whose fetal vertex is at +1. The physician informs the
patient that an amniotomy is to be performed. The patient
states, “My friend’s baby died when the umbilical cord
came out when her water broke. I don’t want you to do that
to me!” Which of the following responses by the nurse is
BEST?
a. “If you are that concerned, you should refuse
the procedure.”
 b. “The procedure will help your labor go faster.”
 c. “That should not happen to you since the
baby’s head is engaged.”
 d. “We will monitor you carefully to prevent cord
prolapse.”

The nurse is teaching a class on natural family
planning. Which of the following statements, if
made by a client, indicates that teaching has been
successful?
a. “When I ovulate, my basal body temperature
will be elevated for two days and then will
decrease.”
 b. “My cervical mucus will be thick, cloudy, and
sticky when I ovulate.”
 c. “Since I am regular, I will be fertile about 14
days after the beginning of my period.”
 d. “When I ovulate, my cervix will feel firm.”

The nurse in the postpartum unit cares for a patient who
delivered her first child the previous day. During her
assessment of the patient, the nurse notes multiple
varicosities on the patient's lower extremities. Which of the
following actions should the nurse perform?

a. Teach the patient to rest in bed when the
baby sleeps.
 b. Encourage early and frequent ambulation.
 c. Apply warm soaks for 20 minutes every four
hours.
 d. Perform passive range of motion exercises
three times daily.
A woman comes to the clinic because she thinks
she is pregnant. Tests are performed and the
pregnancy is confirmed. The patient’s last
menstrual period began on September 8 and
lasted for 6 days. The nurse calculates that her
expected date of birth is:
 a.
May 15
 b. June 15
 c. June 21
 d. July 8
A woman comes to the clinic at 32 weeks
gestation. A diagnosis of pregnancy induced
hypertension is made. The nurse performs
teaching. Which of the following statements, if
made by the patient, indicates to the nurse that
further teaching is required?
a. “Lying in bed on my left side is likely to
increase my urinary output.”
 b. “If the bed rest works, I may lose a pound or
two in the next few days.”
 c. “I should be sure to maintain a diet that has a
good amount of protein.”
 d. “I will have to keep my room darkened and not
watch too much television.”

A woman comes to the physician’s office for a
routine prenatal checkup at 34 weeks’ gestation.
Abdominal palpation reveals the fetal position as
right occipital anterior (ROA). At which of the
following sites would the nurse expect to find the
fetal heart rate?
a. Below the umbilicus, on the mother’s left
side.
 b. Below the umbilicus, on the mother’s right
side.
 c. Above the umbilicus, on the mother’s left
side.
 d. Above the umbilicus, on the mother’s right
side.

During labor, the fetal heart rate drops below
baseline into the 80’s during a contraction and
does not return to baseline until after the
contraction is over. The first action by the nurse
should be to:
 a.
Call the physician
 b. Turn the patient on her left side
 c. Start oxygen at 10 liters/minute
 d. Increase the patient’s IV rate
a.
b.
c.
d.
A client who is 34 wks pregnant is experiencing
bleeding caused by placenta previa. The fetal
heart sounds are WNL and the client isn’t in
labor. What nursing intervention should the
RN perform?
Allow the client to ambulate with assistance
Perform a vaginal exam to check for cervical
dilation
Monitor the amount of vaginal blood loss
Notify the MD for a fetal HR of 130 bpm
A neonate begins to gag and turns a
dusky color. What should the RN do
first?
a.
b.
c.
d.
Calm the neonate
Notify the MD
Provide 02 via face mask
Aspirate the neonate’s nose and mouth
with a bulb syringe
The purpose of preconception care is to:
a. Ensure pregnancy complications do not
occur
b. Identify women who should not get
pregnant
c. Encourage healthy lifestyles to facilitate
families desiring pregnancy
d. Ensure women know about prenatal care
A patient with preclampsia has received
education from the RN about her condition.
What statement would indicate the need for
more education?
a. If I have changes in my vision, I will notify my
MD.
b. I will weight myself every morning and notify
my MD if I notice a weight gain of 1 lb or
greater in a week.
c. I will count my babies movements twice per
day, once in the morning and once in the
evening after I eat.
d. If I have a headache, I will take Tylenol.
A patient’s amniotic membranes rupture.
Prolapsed cord is suspected. What
nursing intervention should be
performed?
a.
b.
c.
d.
Knee to chest position
Cover the cord in a saline soaked gauze
Prepare the woman for a cesarean birth
Start O2 by face mask





. Sandra Thomas comes to the clinic seeking
confirmation of her pregnancy. The following information
is obtained. She is 24 years old, is 5 feet 8 inches tall
and weighs 107 lbs. She admits to having used cocaine
several times during the past year and drinks alcohol
occasionally. Her blood pressure is 108/70, pulse is 72,
and her respirations at 16. Family history is positive for
diabetes mellitus and cancer; her sister recently gave
birth to a baby with a neural tube defect. Which
characteristics place Ms. Thomas in a high-risk
category?
a. Blood pressure, age, height/weight ratio.
b. Drug/alcohol use, age, family history.
c. Family history, blood pressure, height/weight ratio.
d. Family history, height/weight ratio, drug/alcohol use.
Screening at 24 weeks revealed that a
pregnant woman has gestational diabetes
mellitus (GDM). In planning her care, the nurse
and the woman mutually agree that an
expected outcome is to prevent injury to the
fetus as a result of GDM. The nurse identifies
that the fetus is at greatest risk for:
a. Macrosomia
b. Congenital anomalies of the central nervous
system
c. Preterm birth
d. Low birth weight
A 40 yr. old gravida 4 at 10 weeks gestation
asks which tests are available during the
first or early second trimester to
diagnose fetal anomalies. Which are
appropriate?
CHECK ALL THAT APPLY
a. Electrocardiogram
b. Chorionic villus sampling
c. Amniocentesis
d. Triple Screen
e. External fetal monitoring
Which of the following are signs of true labor?
CHOOSE ALL THAT APPLY
a.
b.
c.
d.
e.
Contractions coming every 8- 15 minutes
Walking around decreases strength of
contractions
Contractions are felt in the top of the fundus
Contractions increase in strength and
frequency
Passage of mucous and blood from vagina
Calculation
How many ounces of formula does a 6.6 lb
newborn need every 24 hours, based on
caloric requirements? (formula=20cal/oz)
a. 12 ounces
b. 16 ounces
c. 20 ounces
d. 24 ounces
Upon admission to L&D, the woman states,”My
water broke last night, but my labor pains
started two hours ago.” Which of the following
assessment data are cause for concern?
CHECK ALL THAT APPLY
a. Maternal VS: T.99.5F HR80 R24 BP 130/80
b. Blood tinged mucous on perineal pad
c. Baseline FHR 140
d. Peripad stained with green fluid
e. The client states” This baby keeps kicking me.”
 On
examining Sharon two hours after her
delivery, you find that she has completely
 saturated a perineal pad with 15 minutes.
Your first nursing action is to:

a. Palpate the fundus

b. Administer an oxytocic drug

c. Check her vital signs

d. Increase her intravenous fluid rate
A client in the 4th stage of labor asks to use the
bathroom for the first time following delivery.
The client has oxytocin (Pitocin) infusing which
response by the RN is best?
a. You have to wait until the vaginal bleeding
stops
b. You have to wait until the oxytocin stops
infusing
c. You may use the bathroom with my assistance
d. You may get up to the bathroom anytime you
like