Question set A: antepartum, monitoring, and labor

QUESTION SET A

TARGET 10 MINUTES · MARK, DO NOT CHECK

1. A nurse reviews the record of a client at 34 weeks gestation with chronic hypertension. The contraction stress test performed this morning is documented as negative. What does this result indicate?

1. Late decelerations occurred with at least half of the contractions produced.
2. No late decelerations occurred with the contractions produced.
3. The fetal heart rate failed to accelerate with fetal movement.
4. The test was inconclusive and must be repeated in 24 hours.

2. A client at 33 weeks gestation is admitted with newly diagnosed preeclampsia. Which findings would the nurse document as severe features? Select all that apply.

1. A new headache that does not resolve with acetaminophen
2. Scotomata and blurred vision
3. Severe persistent right upper quadrant pain
4. An estimated fetal weight below the 10th percentile
5. Pulmonary edema
6. Pitting edema of both ankles at the end of the day

3. A client at 35 weeks gestation with preeclampsia with severe features is receiving a magnesium sulfate infusion. Which assessment findings would lead the nurse to stop the infusion and notify the provider? Select all that apply.

1. Patellar reflexes are absent bilaterally
2. Respiratory rate has fallen to 10 breaths per minute
3. Urine output has been 15 milliliters per hour for the past 2 hours
4. The client reports feeling warm and flushed
5. The client is difficult to arouse and her speech is slurred
6. The client reports a dry mouth

4. A nurse monitoring a client in active labor at 39 weeks observes a fetal heart rate pattern in which the rate decreases gradually, reaches its lowest point at the same time as the peak of each contraction, and returns to baseline as the contraction ends. The baseline is 140 beats per minute with moderate variability. Which action should the nurse take?

1. Reposition the client to a lateral position and discontinue the oxytocin infusion.
2. Continue to monitor and document the pattern; no intervention is required.
3. Perform a vaginal examination to rule out umbilical cord prolapse.
4. Apply oxygen by nonrebreather mask and notify the provider immediately.

5. A client at 30 weeks gestation is admitted with regular contractions and documented cervical change. Which orders would the nurse anticipate? Select all that apply.

1. Antenatal corticosteroids for fetal lung maturity
2. Magnesium sulfate for fetal neuroprotection
3. A tocolytic agent to delay birth for approximately 48 hours
4. Group B streptococcus prophylaxis per protocol
5. Oxytocin augmentation to complete the birth
6. Ambulation in the hallway every 2 hours

6. A client at 40 weeks gestation receiving an oxytocin infusion develops recurrent late decelerations with minimal variability. Place the nursing actions in the order they should be performed.

1. Perform a vaginal examination to rule out cord prolapse and assess descent
2. Reposition the client to a lateral position
3. Notify the provider and prepare for possible operative birth
4. Stop the oxytocin infusion
5. Administer oxygen by nonrebreather mask as ordered
6. Open the maintenance intravenous fluid or give the ordered bolus

7. A client at 32 weeks gestation arrives at obstetric triage reporting a sudden episode of painless bright red vaginal bleeding that soaked one perineal pad. The uterus is soft and nontender between contractions, and the fetal heart rate baseline is 145 beats per minute with moderate variability. Which action should the nurse take first?

1. Perform a digital cervical examination to determine dilation.
2. Apply continuous external fetal heart rate and uterine activity monitoring.
3. Insert a sterile speculum to visualize the cervix.
4. Massage the fundus and evaluate uterine tone.

8. MATRIX. A client at 28 weeks gestation is seen for a routine prenatal visit. Sort each finding as expected pregnancy adaptation or requires follow-up.

9. HOT SPOT. Refer to FIG 12.12. On the fetal heart rate trace, mark the point that represents the nadir of the deceleration. Then complete the two lines below.

Pattern shown: ______________________ First nursing action: ______________________

10. TREND. A client at 36 weeks gestation is admitted for observation. Review the three time points.

Which conclusion is supported by this trend?

1. Gestational hypertension without severe features; continue routine monitoring.
2. Preeclampsia with severe features; anticipate magnesium sulfate for seizure prophylaxis.
3. Chronic hypertension with superimposed anxiety; provide reassurance.
4. HELLP syndrome is excluded because the blood pressure is elevated.

Margin notecircle the two you guessed. Rationales → BOOK 12 · P13

Takeawaythe reader leaves this page with a scored self-assessment, not an impression.