Strategies for Answering Strategies for Answering OB Questions on OB Questions on

NCLEXNCLEX

TIPS TIPS

Read question carefully. Be sure you know Read question carefully. Be sure you know what it is askingwhat it is asking What to do “FIRST” or to select action that is What to do “FIRST” or to select action that is

“BEST”“BEST” Look for key words (except, not, first, next)Look for key words (except, not, first, next) Attempt to answer question before you Attempt to answer question before you

look at answerslook at answers

TIPSTIPS

ABC’sABC’s Maslow’s hierarchyMaslow’s hierarchy SafetySafety ASSESS first, then interveneASSESS first, then intervene Calling the MD is not usually the first Calling the MD is not usually the first

response by the nurseresponse by the nurse Visualize the positionVisualize the position

A woman is admitted to the hospital with a A woman is admitted to the hospital with a ruptured ectopic pregnancy. A laparotomy is ruptured ectopic pregnancy. A laparotomy is scheduled. Preoperatively, which of the scheduled. Preoperatively, which of the following goals is following goals is most importantmost important for the nurse for the nurse to include on the patient’s plan of care?to include on the patient’s plan of care?

a.a. Fluid replacementFluid replacement

b.b. Pain reliefPain relief

c.c. Emotional supportEmotional support

d.d. Respiratory therapyRespiratory therapy

The nurse obtains a diet history from a pregnant 16 year The nurse obtains a diet history from a pregnant 16 year old. The client tells the nurse that her typical daily diet old. The client tells the nurse that her typical daily diet includes cereal and milk for breakfast, pizza and soda for includes cereal and milk for breakfast, pizza and soda for lunch, and a cheeseburger, milkshake, fries, and salad for lunch, and a cheeseburger, milkshake, fries, and salad for dinner. Which of the following is the MOST accurate dinner. Which of the following is the MOST accurate nursing diagnosis based on this data?nursing diagnosis based on this data?

a.a. Altered nutrition: more than body Altered nutrition: more than body requirements related to high fat intakerequirements related to high fat intake

b. Knowledge deficit: nutrition in pregnancyb. Knowledge deficit: nutrition in pregnancy c. Altered nutrition: less than body requirements c. Altered nutrition: less than body requirements

related to increased nutritional demands of related to increased nutritional demands of pregnancypregnancy

d. Risk for injury: fetal malnutrition related to d. Risk for injury: fetal malnutrition related to poor maternal dietpoor maternal diet

The nurse in the newborn nursery has just The nurse in the newborn nursery has just received report. Which of the following infants received report. Which of the following infants should the nurse see should the nurse see firstfirst??

a. A two day old infant is lying quietly alert with a a. A two day old infant is lying quietly alert with a heart rate of 185.heart rate of 185.

b. A one day old is crying and the anterior b. A one day old is crying and the anterior fontanel is bulging.fontanel is bulging.

c. A 12 hour old infant is being held; the c. A 12 hour old infant is being held; the respirations are 45 breaths/minute and irregular.respirations are 45 breaths/minute and irregular.

d. A five hour old infant is sleeping and the d. A five hour old infant is sleeping and the hands and feet are blue bilaterally.hands and feet are blue bilaterally.

A one day old newborn diagnosed with intrauterine A one day old newborn diagnosed with intrauterine growth retardation is observed by the nurse to be growth retardation is observed by the nurse to be restless, irritable, fist-sucking, and having a high-restless, irritable, fist-sucking, and having a high-pitched shrill cry. Based on this data, which of the pitched shrill cry. Based on this data, which of the following actions should the nurse take FIRST?following actions should the nurse take FIRST?

a. Discourage stimulation of the baby by rocking.a. Discourage stimulation of the baby by rocking.

b. Tightly swaddle the infant in a flexed position.b. Tightly swaddle the infant in a flexed position.

c. Schedule feeding times every three to four c. Schedule feeding times every three to four hours.hours.

d. Encourage eye contact with the infant during d. Encourage eye contact with the infant during feedings.feedings.

The nurse is caring for a woman at 37 weeks gestation. The nurse is caring for a woman at 37 weeks gestation. The client was diagnosed with insulin-dependent diabetes The client was diagnosed with insulin-dependent diabetes mellitus at 7 years of age. The client states, “I am so mellitus at 7 years of age. The client states, “I am so thrilled that I will be breastfeeding my baby.” Which of the thrilled that I will be breastfeeding my baby.” Which of the following responses by the nurse is BEST?following responses by the nurse is BEST?

a. “You will probably need less insulin while you a. “You will probably need less insulin while you are breastfeeding.”are breastfeeding.”

b. “You will need to initially increase your insulin b. “You will need to initially increase your insulin after the baby is born.”after the baby is born.”

c. “You will be able to take an oral hypoglycemic c. “You will be able to take an oral hypoglycemic instead of insulin after the baby is born.”instead of insulin after the baby is born.”

d. “You will probably require the same dose of d. “You will probably require the same dose of insulin that you are now taking.”insulin that you are now taking.”

SELECTING THE MOST SELECTING THE MOST THERAPEUTIC RESPONSETHERAPEUTIC RESPONSE

Eliminate “don’t Eliminate “don’t worry”worry”

Offers false reassuranceOffers false reassurance

Eliminate “explore” Eliminate “explore” answersanswers

Don’t be a junior Don’t be a junior psychiatristpsychiatrist

Don’t ask “why?”Don’t ask “why?” Implies disapproval of Implies disapproval of

patientpatient

Eliminate Eliminate authoritarian answersauthoritarian answers Nurse telling patient Nurse telling patient

what to dowhat to do

Eliminate “focus on Eliminate “focus on the nurse” answersthe nurse” answers ““That happened to me That happened to me

once.”once.”

The nurse at the birthing facility is caring for a primiparous The nurse at the birthing facility is caring for a primiparous woman in labor who is 4 cm dilated, 25% effaced, and woman in labor who is 4 cm dilated, 25% effaced, and whose fetal vertex is at +1. The physician informs the whose fetal vertex is at +1. The physician informs the patient that an amniotomy is to be performed. The patient patient that an amniotomy is to be performed. The patient states, “My friend’s baby died when the umbilical cord states, “My friend’s baby died when the umbilical cord came out when her water broke. I don’t want you to do that 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 to me!” Which of the following responses by the nurse is BEST?BEST?

a. “If you are that concerned, you should refuse a. “If you are that concerned, you should refuse the procedure.”the procedure.”

b. “The procedure will help your labor go faster.”b. “The procedure will help your labor go faster.” c. “That should not happen to you since the c. “That should not happen to you since the

baby’s head is engaged.”baby’s head is engaged.” d. “We will monitor you carefully to prevent cord d. “We will monitor you carefully to prevent cord

prolapse.”prolapse.”

The nurse is teaching a class on natural family The nurse is teaching a class on natural family planning. Which of the following statements, if planning. Which of the following statements, if made by a client, indicates that teaching has been made by a client, indicates that teaching has been successful?successful?

a. “When I ovulate, my basal body temperature a. “When I ovulate, my basal body temperature will be elevated for two days and then will will be elevated for two days and then will decrease.”decrease.”

b. “My cervical mucus will be thick, cloudy, and b. “My cervical mucus will be thick, cloudy, and sticky when I ovulate.”sticky when I ovulate.”

c. “Since I am regular, I will be fertile about 14 c. “Since I am regular, I will be fertile about 14 days after the beginning of my period.”days after the beginning of my period.”

d. “When I ovulate, my cervix will feel firm.”d. “When I ovulate, my cervix will feel firm.”

The nurse in the postpartum unit cares for a patient who The nurse in the postpartum unit cares for a patient who delivered her first child the previous day. During her delivered her first child the previous day. During her assessment of the patient, the nurse notes multiple assessment of the patient, the nurse notes multiple varicosities on the patient's lower extremities. Which of the varicosities on the patient's lower extremities. Which of the following actions should the nurse perform?following actions should the nurse perform?

a. Teach the patient to rest in bed when the a. Teach the patient to rest in bed when the baby sleeps.baby sleeps.

b. Encourage early and frequent ambulation.b. Encourage early and frequent ambulation. c. Apply warm soaks for 20 minutes every four c. Apply warm soaks for 20 minutes every four

hours.hours. d. Perform passive range of motion exercises d. Perform passive range of motion exercises

three times daily. three times daily.

A woman comes to the clinic because she thinks A woman comes to the clinic because she thinks she is pregnant. Tests are performed and the she is pregnant. Tests are performed and the pregnancy is confirmed. The patient’s last pregnancy is confirmed. The patient’s last menstrual period began on September 8 and menstrual period began on September 8 and lasted for 6 days. The nurse calculates that her lasted for 6 days. The nurse calculates that her expected date of birth is:expected date of birth is:

a. May 15a. May 15 b. June 15b. June 15 c. June 21c. June 21 d. July 8d. July 8

A woman comes to the clinic at 32 weeks A woman comes to the clinic at 32 weeks gestation. A diagnosis of pregnancy induced gestation. A diagnosis of pregnancy induced hypertension is made. The nurse performs hypertension is made. The nurse performs teaching. Which of the following statements, if teaching. Which of the following statements, if made by the patient, indicates to the nurse that made by the patient, indicates to the nurse that further teaching is required?further teaching is required?

a. “Lying in bed on my left side is likely to a. “Lying in bed on my left side is likely to increase my urinary output.”increase my urinary output.”

b. “If the bed rest works, I may lose a pound or b. “If the bed rest works, I may lose a pound or two in the next few days.”two in the next few days.”

c. “I should be sure to maintain a diet that has a c. “I should be sure to maintain a diet that has a good amount of protein.”good amount of protein.”

d. “I will have to keep my room darkened and not d. “I will have to keep my room darkened and not watch too much television.”watch too much television.”

A woman comes to the physician’s office for a A woman comes to the physician’s office for a routine prenatal checkup at 34 weeks’ gestation. routine prenatal checkup at 34 weeks’ gestation. Abdominal palpation reveals the fetal position as Abdominal palpation reveals the fetal position as right occipital anterior (ROA). At which of the right occipital anterior (ROA). At which of the following sites would the nurse expect to find the following sites would the nurse expect to find the fetal heart rate?fetal heart rate?

a. Below the umbilicus, on the mother’s left a. Below the umbilicus, on the mother’s left side.side.

b. Below the umbilicus, on the mother’s right b. Below the umbilicus, on the mother’s right side.side.

c. Above the umbilicus, on the mother’s left c. Above the umbilicus, on the mother’s left side.side.

d. Above the umbilicus, on the mother’s right d. Above the umbilicus, on the mother’s right side.side.

During labor, the fetal heart rate drops below During labor, the fetal heart rate drops below baseline into the 80’s during a contraction and baseline into the 80’s during a contraction and does not return to baseline until after the does not return to baseline until after the contraction is over. The first action by the nurse contraction is over. The first action by the nurse should be to:should be to:

a. Call the physiciana. Call the physician b. Turn the patient on her left sideb. Turn the patient on her left side c. Start oxygen at 10 liters/minutec. Start oxygen at 10 liters/minute d. Increase the patient’s IV rated. Increase the patient’s IV rate

A client who is 34 wks pregnant is A client who is 34 wks pregnant is experiencing bleeding caused by placenta experiencing bleeding caused by placenta previa. The fetal heart sounds are WNL and previa. The fetal heart sounds are WNL and the client isn’t in labor. What nursing the client isn’t in labor. What nursing intervention should the RN perform?intervention should the RN perform?

a.a. Allow the client to ambulate with assistanceAllow the client to ambulate with assistance

b.b. Perform a vaginal exam to check for cervical Perform a vaginal exam to check for cervical dilationdilation

c.c. Monitor the amount of vaginal blood lossMonitor the amount of vaginal blood loss

d.d. Notify the MD for a fetal HR of 130 bpmNotify the MD for a fetal HR of 130 bpm

A neonate begins to gag and turns a A neonate begins to gag and turns a dusky color. What should the RN do dusky color. What should the RN do first?first?

a.a. Calm the neonateCalm the neonate

b.b. Notify the MDNotify the MD

c.c. Provide 02 via face maskProvide 02 via face mask

d.d. Aspirate the neonate’s nose and mouth Aspirate the neonate’s nose and mouth with a bulb syringewith a bulb syringe

The purpose of preconception care is to:The purpose of preconception care is to:

a.a. Ensure pregnancy complications do not Ensure pregnancy complications do not occuroccur

b.b. Identify women who should not get Identify women who should not get pregnantpregnant

c.c. Encourage healthy lifestyles to facilitate Encourage healthy lifestyles to facilitate families desiring pregnancyfamilies desiring pregnancy

d.d. Ensure women know about prenatal careEnsure women know about prenatal care

A patient with preclampsia has received A patient with preclampsia has received education from the RN about her condition. education from the RN about her condition. What statement would indicate the need for What statement would indicate the need for more education?more education?

a.a. If I have changes in my vision, I will notify my If I have changes in my vision, I will notify my MD.MD.

b.b. I will weight myself every morning and notify I will weight myself every morning and notify my MD if I notice a weight gain of 1 lb or my MD if I notice a weight gain of 1 lb or greater in a week.greater in a week.

c.c. I will count my babies movements twice per I will count my babies movements twice per day, once in the morning and once in the day, once in the morning and once in the evening after I eat.evening after I eat.

d.d. If I have a headache, I will take Tylenol.If I have a headache, I will take Tylenol.

A patient’s amniotic membranes rupture. A patient’s amniotic membranes rupture. Prolapsed cord is suspected. What Prolapsed cord is suspected. What nursing intervention should be nursing intervention should be performed?performed?

a.a. Knee to chest positionKnee to chest position

b.b. Cover the cord in a saline soaked gauzeCover the cord in a saline soaked gauze

c.c. Prepare the woman for a cesarean birthPrepare the woman for a cesarean birth

d.d. Start O2 by face maskStart O2 by face mask

. Sandra Thomas comes to the clinic seeking . Sandra Thomas comes to the clinic seeking confirmation of her pregnancy. The following information confirmation of her pregnancy. The following information is obtained. She is 24 years old, is 5 feet 8 inches tall is obtained. She is 24 years old, is 5 feet 8 inches tall and weighs 107 lbs. She admits to having used cocaine and weighs 107 lbs. She admits to having used cocaine several times during the past year and drinks alcohol several times during the past year and drinks alcohol occasionally. Her blood pressure is 108/70, pulse is 72, occasionally. Her blood pressure is 108/70, pulse is 72, and her respirations at 16. Family history is positive for and her respirations at 16. Family history is positive for diabetes mellitus and cancer; her sister recently gave diabetes mellitus and cancer; her sister recently gave birth to a baby with a neural tube defect. Which birth to a baby with a neural tube defect. Which characteristics place Ms. Thomas in a high-risk characteristics place Ms. Thomas in a high-risk category?category?

a. a. Blood pressure, age, height/weight ratio.Blood pressure, age, height/weight ratio. b. b. Drug/alcohol use, age, family history.Drug/alcohol use, age, family history. c. c. Family history, blood pressure, height/weight Family history, blood pressure, height/weight

ratio.ratio. d. d. Family history, height/weight ratio, drug/alcohol Family history, height/weight ratio, drug/alcohol

use.use.

Screening at 24 weeks revealed that a Screening at 24 weeks revealed that a pregnant woman has gestational diabetes pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an and the woman mutually agree that an expected outcome is to prevent injury to the expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for: that the fetus is at greatest risk for:

a.a. Macrosomia Macrosomia b.b. Congenital anomalies of the central nervous Congenital anomalies of the central nervous

system system c.c. Preterm birth Preterm birth d.d. Low birth weight Low birth weight

A 40 yr. old gravida 4 at 10 weeks gestation A 40 yr. old gravida 4 at 10 weeks gestation asks which tests are available during the asks which tests are available during the first or early second trimester to first or early second trimester to diagnose fetal anomalies. Which are diagnose fetal anomalies. Which are appropriate?appropriate?

CHECK ALL THAT APPLYCHECK ALL THAT APPLYa.a. ElectrocardiogramElectrocardiogramb.b. Chorionic villus samplingChorionic villus samplingc.c. AmniocentesisAmniocentesisd.d. Triple ScreenTriple Screene.e. External fetal monitoringExternal fetal monitoring

Which of the following are signs of true labor? Which of the following are signs of true labor? CHOOSE ALL THAT APPLYCHOOSE ALL THAT APPLY

a.a. Contractions coming every 8- 15 minutesContractions coming every 8- 15 minutes

b.b. Walking around decreases strength of Walking around decreases strength of contractionscontractions

c.c. Contractions are felt in the top of the fundusContractions are felt in the top of the fundus

d.d. Contractions increase in strength and Contractions increase in strength and frequencyfrequency

e.e. Passage of mucous and blood from vaginaPassage of mucous and blood from vagina

CalculationCalculation

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

a.a. 12 ounces12 ounces

b.b. 16 ounces16 ounces

c.c. 20 ounces20 ounces

d.d. 24 ounces24 ounces

Upon admission to L&D, the woman states,”My Upon admission to L&D, the woman states,”My water broke last night, but my labor pains water broke last night, but my labor pains started two hours ago.” Which of the following started two hours ago.” Which of the following assessment data are cause for concern? assessment data are cause for concern? CHECK ALL THAT APPLYCHECK ALL THAT APPLY

a.a. Maternal VS: T.99.5F HR80 R24 BP 130/80Maternal VS: T.99.5F HR80 R24 BP 130/80

b.b. Blood tinged mucous on perineal padBlood tinged mucous on perineal pad

c.c. Baseline FHR 140Baseline FHR 140

d.d. Peripad stained with green fluidPeripad stained with green fluid

e.e. The client states” This baby keeps kicking me.”The client states” This baby keeps kicking me.”

On examining Sharon two hours after her On examining Sharon two hours after her delivery, you find that she has completely delivery, you find that she has completely

saturated a perineal pad with 15 minutes. saturated a perineal pad with 15 minutes. Your Your first first nursing action is to:nursing action is to:

a. Palpate the fundusa. Palpate the fundus b. Administer an oxytocic drugb. Administer an oxytocic drug c. Check her vital signsc. Check her vital signs d. Increase her intravenous fluid d. Increase her intravenous fluid

raterate

A client in the 4A client in the 4thth stage of labor asks to use the stage of labor asks to use the bathroom for the first time following delivery. bathroom for the first time following delivery. The client has oxytocin (Pitocin) infusing which The client has oxytocin (Pitocin) infusing which response by the RN is best?response by the RN is best?

a.a. You have to wait until the vaginal bleeding You have to wait until the vaginal bleeding stopsstops

b.b. You have to wait until the oxytocin stops You have to wait until the oxytocin stops infusinginfusing

c.c. You may use the bathroom with my assistanceYou may use the bathroom with my assistance

d.d. You may get up to the bathroom anytime you You may get up to the bathroom anytime you likelike