Strategies for Answering OB Questions on NCLEX

1. Strategies for Answering OB Questions on NCLEX

2. 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

3. 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

4. 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? • Fluid replacement • Pain relief • Emotional support • Respiratory therapy

5. 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

7. 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.

8. A one day old newborn diagnosed with intrauterine growth retardation is observed by the nurse to be restless, irritable, fist-sucking, and having a high-pitched 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.

9. 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.”

10. 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.” SELECTING THE MOST THERAPEUTIC RESPONSE

11. 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.”

12. 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.”

13. 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.

14. 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

15. 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.”

16. 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.

18. 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

20. 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? a. Allow the client to ambulate with assistance b. Perform a vaginal exam to check for cervical dilation c. Monitor the amount of vaginal blood loss d. Notify the MD for a fetal HR of 130 bpm

22. A neonate begins to gag and turns a dusky color. What should the RN do first? a. Calm the neonate b. Notify the MD c. Provide 02 via face mask d. Aspirate the neonate’s nose and mouth with a bulb syringe

23. 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

24. 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.

25. A patient’s amniotic membranes rupture. Prolapsed cord is suspected. What nursing intervention should be performed? a. Knee to chest position b. Cover the cord in a saline soaked gauze c. Prepare the woman for a cesarean birth d. Start O2 by face mask

26. . 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.

27. 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

28. 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 • Electrocardiogram • Chorionic villus sampling • Amniocentesis • Triple Screen • External fetal monitoring

29. Which of the following are signs of true labor? CHOOSE ALL THAT APPLY • 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

30. Calculation How many ounces of formula does a 6.6 lb newborn need every 24 hours, based on caloric requirements? (formula=20cal/oz) • 12 ounces • 16 ounces • 20 ounces • 24 ounces

31. 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 • Maternal VS: T.99.5F HR80 R24 BP 130/80 • Blood tinged mucous on perineal pad • Baseline FHR 140 • Peripad stained with green fluid • The client states” This baby keeps kicking me.”

32. 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

33. 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