Obstetrical Nursing – Antepartum – NCLEX Quiz 3

1. Rho (D) immune globulin (RhoGAM) is prescribed for a woman following delivery of a newborn infant and the nurse provides information to the woman about the purpose of the medication. The nurse determines that the woman understands the purpose of the medication if the woman states that it will protect her next baby from which of the following?

Being affected by Rh incompatibility

Having Rh-positive blood

Developing a rubella infection

Developing physiological jaundice

Rh incompatibility can occur when an Rh-negative mom becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus who is Rh positive. During pregnancy and at delivery. some of the baby’s Rh positive blood can enter the maternal circulation. causing the woman’s immune system to form antibodies against Rh-positive blood. Administration of Rho(D) immune globulin prevents the woman from developing antibodies against Rh-positive blood by providing passive antibody protection against the Rh antigen.

Explanation

Rh incompatibility can occur when an Rh-negative mom becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus who is Rh positive. During pregnancy and at delivery. some of the baby’s Rh positive blood can enter the maternal circulation. causing the woman’s immune system to form antibodies against Rh-positive blood. Administration of Rho(D) immune globulin prevents the woman from developing antibodies against Rh-positive blood by providing passive antibody protection against the Rh antigen.

2. In the 12th week of gestation. a client completely expels the products of conception. Because the client is Rh negative. the nurse must:

Administer RhoGAM within 72 hours

Make certain she receives RhoGAM on her first clinic visit

Not give RhoGAM. since it is not used with the birth of a stillborn

Make certain the client does not receive RhoGAM. since the gestation only lasted 12 weeks.

RhoGAM is given within 72 hours postpartum if the client has not been sensitized already.

Explanation

RhoGAM is given within 72 hours postpartum if the client has not been sensitized already.

3. A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care for the client determines that the magnesium therapy is effective if:

Ankle clonus in noted

The blood pressure decreases

Seizures do not occur

Scotomas are present

For a client with preeclampsia. the goal of care is directed at preventing eclampsia (seizures).Option A: Ankle clonus indicated hyperreflexia and may precede the onset of eclampsia.Option B: Magnesium sulfate is an anticonvulsant. not an antihypertensive agent. Although a decrease in blood pressure may be noted initially. this effect is usually transient.Option D: Scotomas are areas of complete or partial blindness. Visual disturbances. such as scotomas. often precede an eclamptic seizure.

Explanation

For a client with preeclampsia. the goal of care is directed at preventing eclampsia (seizures).Option A: Ankle clonus indicated hyperreflexia and may precede the onset of eclampsia.Option B: Magnesium sulfate is an anticonvulsant. not an antihypertensive agent. Although a decrease in blood pressure may be noted initially. this effect is usually transient.Option D: Scotomas are areas of complete or partial blindness. Visual disturbances. such as scotomas. often precede an eclamptic seizure.

4. After the first four months of pregnancy. the chief source of estrogen and progesterone is the:

Placenta

Adrenal cortex

Corpus luteum

Anterior hypophysis

When the placental formation is complete. around the 16th week of pregnancy;;;

Explanation

When the placental formation is complete. around the 16th week of pregnancy;;;

5. A pregnant client is receiving magnesium sulfate for the management of preeclampsia. A nurse determines the client is experiencing toxicity from the medication if which of the following is noted on assessment?

Presence of deep tendon reflexes

Serum magnesium level of 6 mEq/L

Proteinuria of +3

Respirations of 10 per minute

Magnesium toxicity can occur from magnesium sulfate therapy. Signs of toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression. loss of deep tendon reflexes. and a sudden drop in the fetal heart rate and maternal heart rate and blood pressure.Option B: Therapeutic levels of magnesium are 4-7 mEq/L.Option C: Proteinuria of +3 would be noted in a client with preeclampsia.

Explanation

Magnesium toxicity can occur from magnesium sulfate therapy. Signs of toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression. loss of deep tendon reflexes. and a sudden drop in the fetal heart rate and maternal heart rate and blood pressure.Option B: Therapeutic levels of magnesium are 4-7 mEq/L.Option C: Proteinuria of +3 would be noted in a client with preeclampsia.

6. The nurse recognizes that an expected change in the hematologic system that occurs during the 2nd trimester of pregnancy is:

A decrease in WBC’s

In increase in hematocrit

An increase in blood volume

A decrease in sedimentation rate

The blood volume increases by approximately 40-50% during pregnancy. The peak blood volume occurs between 30 and 34 weeks of gestation. The hematocrit decreases as a result of the increased blood volume.

Explanation

The blood volume increases by approximately 40-50% during pregnancy. The peak blood volume occurs between 30 and 34 weeks of gestation. The hematocrit decreases as a result of the increased blood volume.

7. The chief function of progesterone is the:

Development of the female reproductive system

Stimulation of the follicles for ovulation to occur

Preparation of the uterus to receive a fertilized egg

Establishment of secondary male sex characteristics

Progesterone stimulates differentiation of the endometrium into a secretory type of tissue.

Explanation

Progesterone stimulates differentiation of the endometrium into a secretory type of tissue.

8. In a lecture on sexual functioning. the nurse plans to include the fact that ovulation occurs when the:

Oxytocin is too high

Blood level of LH is too high

Progesterone level is high

Endometrial wall is sloughed off.

It is the surge of LH secretion in mid cycle that is responsible for ovulation.

Explanation

It is the surge of LH secretion in mid cycle that is responsible for ovulation.

9. The developing cells are called a fetus from the:

Time the fetal heart is heard

Eighth week to the time of birth

Implantation of the fertilized ovum

End of the send week to the onset of labor

In the first 7-14 days. the ovum is known as a blastocyst; the developing cells are then called a fetus until birth.

Explanation

In the first 7-14 days. the ovum is known as a blastocyst; the developing cells are then called a fetus until birth.

10. A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for the client.

Monitor maternal vital signs every 2 hours

Notify the physician if respirations are less than 18 per minute.

Monitor renal function and cardiac function closely

Keep calcium gluconate on hand in case of a magnesium sulfate overdose

Monitor deep tendon reflexes hourly

Monitor I and O’s hourly

Notify the physician if urinary output is less than 30 ml per hour.

When caring for a client receiving magnesium sulfate therapy. the nurse would monitor maternal vital signs. especially respirations. every 30-60 minutes and notify the physician if respirations are less than 12. because this would indicate respiratory depression. Calcium gluconate is kept on hand in case of magnesium sulfate overdose because calcium gluconate is the antidote for magnesium sulfate toxicity. Deep tendon reflexes are assessed hourly. Cardiac and renal function are monitored closely. The urine output should be maintained at 30 ml per hour because the medication is eliminated through the kidneys.

Explanation

When caring for a client receiving magnesium sulfate therapy. the nurse would monitor maternal vital signs. especially respirations. every 30-60 minutes and notify the physician if respirations are less than 12. because this would indicate respiratory depression. Calcium gluconate is kept on hand in case of magnesium sulfate overdose because calcium gluconate is the antidote for magnesium sulfate toxicity. Deep tendon reflexes are assessed hourly. Cardiac and renal function are monitored closely. The urine output should be maintained at 30 ml per hour because the medication is eliminated through the kidneys.

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