EVALUATIVE EXAMINATION – ABNORMAL OB

Situation: Vaginal bleeding during pregnancy is always a deviation from the normal, is always potentially
serious, may occur at any point during pregnancy, and is always frightening. The nurse is knowledgeable
in assessing and managing bleeding at different points in pregnancy.

1. Beverly, 20 years old is 10 weeks pregnant. She came to the clinic and stated "I have had episodes of
vaginal bleeding in the past 2 days, I think I am miscarrying". Which advice is best given to Beverly at this
point?

A. Lie down and remain on bed rest for 24 hrs to stop the bleeding
B. Continue light activity as usual because most spotting during pregnancy is harmless
C. Save any clots or material passed for your healthcare provider to examine
D. Use a tampon to put pressure on your cervix and stop the bleeding

2. Gina is a 32-year-old teacher who visited the clinic. She complains of sharp stabbing pain in her right
lower abdomen and stated she has been having vaginal spotting. Upon ultrasound, Gina was diagnosed
to have an Ectopic pregnancy. She asked you what was seen in the ultrasound exam.

A. "Degenerated cells were seen which are fluid-filled and they appear as fluid-filled, grape-sized
vesicles" - H.mole or gestational trophoblastic disease
B. "Implantation of fertilized ovum outside the uterine cavity"
C. "A normal growing fetus of 5 weeks AOG was seen"
D. "A sloughing off of the endometrial layer"

3. Rose 37 years old came to the clinic reporting she is pregnant after having a urine pregnancy test at
home. After careful assessment of diagnostic workups, she was diagnosed to have Hydatidiform mole.
Which assessment findings are consistent with the diagnosis? Select all that apply.

I. Fundic height larger than AOG

II. HCG levels lower than normal - higher (1-2 million IU compared to normal 400,000 IU)
III. Strongly positive HCG after 100th day of pregnancy
IV. Symptoms of PIH at 1st trimester
V. Fetal Heart sound is heard - no fetal heart sound as there is no viable fetus

A. I, III, IV
B. I, IV, V
C. III, IV. V
D. II, III, IV

4. Missy has an RH-negative blood type. Her electronic record shows she had a previous miscarriage at
16 weeks into her last pregnancy. What medication should the nurse check she received following the
miscarriage for isoimmunization protection in future childbearing?

A. Packed red blood cell transfusion

B. Misoprostol (Cytotec)
C. Ferrous Sulfate
D. RhIG (RhoGAM)

5. Anje, who is 16 weeks pregnant was rushed to the ER after having heavy vaginal bleeding, passage of
clots, abdominal pain and cramping. Expelled materials were examined and it was determined that part
of the conceptus was expelled but the placenta was retained. The nurse understands that this is what
type of miscarriage?

A. Missed miscarriage
B. Imminent miscarriage
C. Threatened miscarriage
D. Incomplete miscarriage

Situation: Third-trimester bleeding is an occurrence that poses great risks to both the mother and the
baby. The most common causes of third-trimester bleeding are placenta previa and abruptio placentae.

6. A 26-year-old female, who is 31 weeks pregnant with her second child, has uncontrolled
hypertension. What risk factor below found in the patient's health history places her at risk for
abruptio placentae?

A. childhood polio
B. preeclampsia
C. c-section
D. her age

7. Which of the patients below is at risk for developing placenta previa?

A. A 37-year-old woman who is pregnant with her 7th child.

B. A 28-year-old pregnant female with chronic hypertension.
C. A 25-year-old female who is 36 weeks pregnant that has experienced trauma to abdomen.
D. A 20-year-old primigravida

8. You're performing a head-to-toe assessment on a patient admitted with abruptio placentae. Which of
the following assessment findings would you immediately report to the physician?

A. Oozing around the IV site

B. Tender uterus
C. Hard abdomen
D. Vaginal bleeding

9. A patient who is 25 weeks pregnant has partial placenta previa. As the nurse you're educating the
patient about the condition and self-care. Which statement by the patient requires you to re-educate
the patient?
A. "I will avoid sexual intercourse and douching throughout the rest of the pregnancy."
B. "I may start to experience dark red bleeding with pain."
C. "I will have another ultrasound at 32 weeks to re-assess the placenta's location."
D. "My uterus should be soft and non-tender."

10. Disseminated intravascular coagulation (DIC) can occur in _____________. This happens because
when the placenta becomes damaged and detaches from the uterine wall, large amounts of __________
are released into the mom's circulation, leading to clot formation and then clotting factor depletion.

A. Placenta previa, fibrinogen

B. Placenta previa, platelets
C. Abruptio placentae, fibrinogen
D. Abruptio placentae, thromboplastin

Situation: Nurse Analynn is a nurse educator. She visited a birthing center where three multigravida
women just gave birth. The nurse educator opted to conduct health education on postpartum
hemorrhage.

11. Nurse Analyn explains to the mother indications of post-partum hemorrhage leading to
hypovolemia. Early manifestations include

A. Pale mucous membrane

B. Dizziness and Lethargy
C. Falling blood pressure and rapid weak pulses
D. Decreasing level of consciousness

12. One of the clients asked nurse Analynn what are the risk factors for postpartum hemorrhage. The
nurse explained the following risk factors except

A. Uterine atony
B. Trauma
C. Retained tissue
D. Anteverted uterus

13. During a normal postpartum course, where does the nurse expect to palpate the uterus the day after
the delivery?

A. In line with the Umbilicus

B. 1 fingerbreadth below the umbilicus
C. 1 inch below the umbilicus
D. halfway between the umbilicus and symphysis pubis
14. The nurse wants to assess the mothers' level of understanding regarding post-partum discharges.
Which statement from a client will nurse Analynn determines as in need of further teaching?

A. "I know about lochia; I'll use tampons just like I do for my periods."
B. "I admit I don't like having lochia, but I understand its purpose"
C. "I should wash my hands after I change perineal pads and before handling the baby"
D. "I'll watch out for the color changes occurring in my discharges"

15. Two days postpartum, Nurse Analynn assessed and performed a massage of a mother's fundus.
What assessment finding should prompt the nurse to immediately refer the client to a primary health
care provider?

A. Fundal height 2cm below the umbilicus

B. Uterus does not become firm when massaged
C. Firm massages of the fundus result in pain
D. Client reports afterpains

Situation: 10 days postpartum, Ivy visited back to the clinic presenting with a fever and complained that
her breast feels painful and appears red and swollen. Assessment revealed Mastitis.

16. Ivy verbalized to the nurse "I hurt too much to breastfeed any longer. How can I be a good mother if
I don't breastfeed my baby?" What is the priority nursing diagnosis of the nurse for Ivy?

A. Risk for impaired parenting

B. Risk for impaired attachment
C. Ineffective Role performance
D. Pain related to development of mastitis

17. Assessment shows extent of mastitis localized in the left breast. What nursing intervention should
Nurse Dar implement for the patient?

A. Encourage patient to continue breastfeeding as usual

B. Temporary cessation of breastfeeding until pain is relieved
C. Recommend that they shift to bottle-feed their infant
D. Teach patient to start breastfeeding in the unaffected breast then shift to the affected breast

18. The patient asked the nurse what could have led to the development of this infection. How will
Nurse Dar respond to the mother ensuring that mother-infant relationship will not be affected?

A. "This is caused by an organism that came from the nasal-oral cavity of your infant and invaded your
breast"
B. "This infection is called epidemic mastitis because it spreads from the infant to the mother"
C. "This happens when the nipple becomes cracked and an acquired bacteria in the hospital infects your
infant and infection spreads to the breast"
D. "This is infection is most commonly caused by lack of proper hygiene"

19. Nurse Dar provide instructions about measures to prevent postpartum mastitis on mothers
breastfeeding their newborn. This includes all of the following, except?

A. Wiping the breast area with cotton and alcohol

B. Exposing nipples to air for at least part of the day
C. Using Vitamin E ointment daily to soften the nipple
D. Making certain the Baby is positioned correctly

20. Active infection cause a lot of pain to the patient. Ivy raised questions on possible ways of relieving
her breast discomfort. Which of the following indicated understanding?

A. "I will nurse my infant as often as possible"

B. "I may apply moist heat such as warm packs at home"
C. "I cannot wear a bra during active infection"
D. "Breastfeeding starts in the affected breast then shift to the other breast"

Situation: Nurse Momo assists a primigravida mother who just gave birth 12 hours ago. Nurse Evelynn
puts in the effort to help the patient transition into motherhood.

21. As the patient takes hold of her newborn, nurse Momo would be correct to suggest which position
to ensure maternal and child bonding?

A. She lies in bed and places the infant on her

B. She slowly rocks with her infant while sitting in a rocking chair
C. She gently burps the infant while holding the infant over her shoulder
D. She speaks and looks directly at the infant's face

22. Nurse Momo visits the patient 3 days after giving birth and notices that the patient is occupied with
taking care of the baby as she is "getting to know" the baby as much as possible. Nurse Momo knows
that according to Reva Rubin, the mother is in what phase of behavioral adjustment?

A. Taking-in phase
B. Letting-in phase
C. Taking-hold phase
D. Letting-go phase

23. Nurse Momo has been suspecting post-partum blues since the patient verbalized a sense of
disappointment, periods of sadness, and agitation. Nurse Momo would be correct if she gave which
advice?

A. Refer the patient to a psychiatrist

B. Comfort the patient and reassure her that this is normal among post-partum mothers
C. Allow these feelings to run its course as all of these will pass
D. Recommend consistent breastfeeding of the infant

24. The patient asks about ways to avoid post-partum blues when she returns home. Nurse Momo
would be correct to give the following advice, except?

A. Recommend that she take some time every day to do something for herself
B. Advise the patient to strive for perfection so that she won't feel bad about herself
C. Help the client build a healthy balance in sleep, exercise, and nutrition
D. Encourage the client to verbalize emotions to support person

25. As nurse Momo further assesses the patient's condition, nurse Momo would be most concerned
about which of the following statements as it would be indicative of post-partum psychosis?

A. "I've been extremely tired since giving birth"

B. "I wish my baby had a fairer complexion"
C. "The baby was heavier than I thought when I carried her"
D. "Motherhood is tiring; I'm glad I haven't had any children"

Situation: Gestational Diabetes

26. Which of the following is a risk factor for developing gestational diabetes?

A. Prior delivery of a baby greater than 7lb

B. Having a body mass index greater than 25
C. First-degree relative with diabetes mellitus
D. Age younger than 30 years

27. A 31-year-old pregnant client comes into the clinic for an oral glucose tolerance screening at 28
weeks' gestation. After taking the test, the nurse notes that the client's blood glucose level is 180 mg/dL,
1 hour after the test. Which of the following is the indication of this result?

A. Type 2 diabetes
B. Impaired fasting glucose
C. Gestational diabetes
D. A second glucose test is indicated

28. The nurse is caring for a 34-week pregnant client with gestational diabetes. Despite nutritional and
pharmacological interventions, the client's glucose has been poorly controlled. What glucose monitoring
is most accurate in measuring blood glucose level and compliance in therapy?

A. 50-gram OGTT
B. 100-gram OGTT
C. CBG (Capillary Blood glucose)
D. HbA1c (glycosylated hemoglobin)

29. A client with gestational diabetes is scheduled to have a 50g glucose tolerance test. What result is
considered normal?

A. Two-hour glucose level less than 140 mg/dL

B. One-hour glucose level less than 140 mg/dL
C. Fasting glucose level greater than 126 mg/dL
D. Fasting glucose level greater than 95 mg/dL

30. A nurse is educating a client on the physiologic changes in pregnancy. What is true about the
pregnant woman's insulin needs at the beginning of a pregnancy?

A. Insulin needs to rapidly increase because of insulin resistance

B. Insulin needs to stay the same in the beginning
C. Insulin needs first decrease then will increase later in pregnancy
D. Insulin needs don't change during pregnancy

Situation: Hypertensive Disorders during pregnancy

31. The nurse knows that preeclampsia tends to occur during what time in a pregnancy?

A. before 20 weeks
B. in the third trimester and postpartum
C. after 20 weeks
D. in the first and second trimesters

32. Your patient with preeclampsia is started on Magnesium Sulfate. The nurse knows to have what
medication on standby

A. Acetylcysteine
B. Naloxone
C. Oxytocin
D. Calcium gluconate

33. A 39-week pregnant patient is in labor. The patient has preeclampsia. The patient is receiving IV
Magnesium Sulfate. Which finding below indicates Magnesium Sulfate toxicity and requires you to notify
the physician?

A. Deep tendon reflex present

B. Respiratory rate of 11 breaths per minute
C. Urinary output of 150 mL over 3 hours
D. Patient reports flushing or feeling hot
34. A 37-week pregnant patient is admitted with severe preeclampsia. The patient begins to experience
a tonic-clonic seizure. Which of the following would the nurse AVOID during the seizure?

A. Placing the patient in a side-lying position

B. Holding down the patient's head to prevent injury
C. Staying with the patient and activating the emergency response team
D. Timing the seizure

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

A. Ankle clonus in noted

B. The blood pressure decreases
C. Seizures do not occur
D. Scotomas are present

Situation: Miscarriage

36. A nurse is caring for a client who has had a missed abortion at 9 weeks gestation. Which of the
following treatments should the nurse prepare the client for?

A. MgSo4
B. D & C
C. Ultrasound
D. Oxytocin

37. A client who is 13 weeks pregnant comes to the clinic. During the ultrasound, no heart tones are
detected. The client denies having had any bleeding. The nurse would be correct in explaining this to the
client as what type of abortion/miscarriage?

A. Complete
B. Inevitable
C. Incomplete
D. Missed

38. A client is upset about a miscarriage that she had and wants to know why it happened. What is the
best response by the nurse?

A. "Unfortunately most losses are from genetic abnormalities we can't control"

B. "It is not your fault; I am sure the next pregnancy will be fine"
C. "You were probably overdoing it and not getting enough rest"
D. "It just was not the right timing; everything happens for a reason"
39. A client who has been diagnosed with an inevitable miscarriage at 12 weeks wants miscarry at home
instead of having a D&C. The nurse should instruct the client to call immediately for which scenario?

A. If the bleeding stops

B. Loss of tissue
C. Cramping
D. Heavy Bleeding

40. Kim, who is 16 weeks pregnant was rushed to the ER after having heavy vaginal bleeding & passage
of clots. Expelled materials were examined and it was determined that all parts of the conceptus were
expelled. The nurse understands that this is what type of miscarriage?

A. Complete miscarriage
B. Missed miscarriage
C. Imminent miscarriage
D. Threatened miscarriage

41. The home care nurse is monitoring a pregnant client with gestational hypertension who is at risk for
preeclampsia. At each home care visit, the nurse assesses the client for classic signs of preeclampsia,
which includes the following except;

A. Proteinuria
B. Edema
C. Low-grade fever
D. Increased BP

42. A client in the first trimester of pregnancy arrives at a healthcare clinic and reports that she has been
experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client
regarding the management of care. Which statement made by the client indicates a need for further
instruction?

A. "I will watch for the evidence of the passage of tissue."

B. "I will maintain strict bed, rest throughout the remainder of the pregnancy"
C. "I will count the number of perineal pads used on a daily basis and note the amount and color of
blood on the pad."
D. "I will avoid sexual intercourse until the bleeding has stopped and for 2 weeks following the last
evidence of bleeding

43. The nurse is performing an assessment on a client diagnosed With placenta previa. All but which of
the assessment findings should the nurse expect to note?

A. Bright red vaginal bleeding

B. Soft, relaxed, non-tender uterus
C. Abnormally low funds in proportion to gestational age
d. Fundal height may be greater than expected

44. While assessing a 29-year-old gravida 2, para 2 patient who had a normal spontaneous vaginal
delivery 30 minutes ago, the nurse notes a large amount of red vaginal bleeding. What would be the
priority nursing action?

A. Check vital signs

B. Notify health care provider
C. Firmly massage the uterine fundus
D. Put the baby on breast

45. A 22-year-old woman is 6 weeks postpartum. In the clinic, she admits to crying every day, feeling
overwhelmed, and sometimes thinking that she may hurt the baby. What would be the priority nursing
action at this time?

A. Advise the patient of community resources, parent groups and depression hotlines
B. Counsel the mother that the "baby blues" are common at this time and assess her nutrition, rest, and
availability of help at home
C. Contact the health care provider to evaluate the patient before allowing her to leave the clinic
D. Advise the woman that she cannot use the medication for depression because she is breastfeeding

46. 74. Rho (D) immune globulin (Rhogam) is prescribed for a client before she is discharged after a
spontaneous abortion. The nurse instructs the client that this drug is used to prevent which condition?

A. Development of a future Rh-positive fetus

B. An antibody response to Rh-negative blood
C. A future pregnancy resulting in abortion
D. Development of Rh-positive antibodies

47. When caring for a multigravida client admitted to the hospital with vaginal bleeding at 38 weeks
gestation, which therapeutic agent would the nurse anticipate administering intravenously if the client
develops disseminated intravascular coagulation?

A. Aspirin
B. Heparin
C. Streptokinase
D. Warfarin

48. When developing a teaching plan for a primigravid client with insulin-dependent diabetes about
monitoring blood glucose control and insulin dosage at home, what would the nurse expect to include
as the desired target range for blood glucose levels?

A. 40 - 60 mg/dL
B. 70 - 100 mg/dL
C. 110 - 140 mg/dL
D. 160 - 180 mg/dL

49. A woman is diagnosed with complete molar (H.mole) pregnancy. The nurse understands that the
woman requires more teaching when she makes which statement?

A. "I need to make follow-up appointments to have my hormone levels checked."

B. " know the placenta caused problems, and my baby died in my uterus."
C. "I plan to get pregnant again after a year."
D. "I understand I may develop a serious type of cancer."

50. A client at 4 weeks postpartum tells the nurse that she cannot come any longer and is overwhelmed
by her newborn. The baby has a new formula on her clothes and under her neck. The mother does not
remember when she last bath bathed the baby. The nurse should encourage the client and her
husband to call their healthcare provider because the mother should be further evaluated for:

A. Postpartum blues
B. Poor bonding
C. Postpartum depression
D. Infant abuse