Strategies for Answering OB Questions on NCLEX

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Strategies for Answering OB Questions on NCLEX
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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

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TIPS

• ABCs
• Maslows hierarchy
• Safety
• ASSESS first, then intervene
• Calling the MD is not usually the first response
  by the nurse
• Visualize the position

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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 patients plan of care?

1. Fluid replacement
2. Pain relief
3. Emotional support
4. Respiratory therapy

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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

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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.

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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.

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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.

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SELECTING THE MOST THERAPEUTIC RESPONSE

• Eliminate dont worry
• Offers false reassurance
• Eliminate explore answers
• Dont be a junior psychiatrist
• Dont 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.

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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 friends baby died when the umbilical
cord came out when her water broke. I dont 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
  babys head is engaged.
• d. We will monitor you carefully to prevent
  cord prolapse.

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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.

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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.

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A woman comes to the clinic because she thinks
she is pregnant. Tests are performed and the
pregnancy is confirmed. The patients 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

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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.

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A woman comes to the physicians 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 mothers left
  side.
• b. Below the umbilicus, on the mothers right
  side.
• c. Above the umbilicus, on the mothers left
  side.
• d. Above the umbilicus, on the mothers right
  side.

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During labor, the fetal heart rate drops below
baseline into the 80s 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 patients IV rate

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• A client who is 34 wks pregnant is
  experiencing bleeding caused by placenta previa.
  The fetal heart sounds are WNL and the client
  isnt 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

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• 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 neonates nose and mouth with a
  bulb syringe

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• 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

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• 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.

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• A patients 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

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• . 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.

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• 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

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• 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

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• 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

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Calculation

• How many ounces of formula does a 6.6 lb newborn
  need every 24 hours, based on caloric
  requirements? (formula20cal/oz)
• 12 ounces
• 16 ounces
• 20 ounces
• 24 ounces

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• Upon admission to LD, 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.

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• 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

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• 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

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