Title EVAL EXAM - ABNORMAL OB (KEY) FINAL COPY.pdf ✅

REFRESHER PHASE EVALUATIVE EXAMINATION ABNORMAL OB NOVEMBER 2024 Philippine Nurse Licensure Examination Review Situation 1: 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. 1. 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 2. 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 3. 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 4. 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 everyday 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 5. 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” 6. A client at 4 weeks postpartum tells the nurse that she cannot cone any longer and is overwhelmed by her newborn. The baby has new formula on her clothes and under her neck. The mother does not remember when she last bath the 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 7. 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. А. 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 patient before allowing her to leave the clinic D. Advise the woman that she cannot use the medication for depression because she is breast feeding 8. 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 9. 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." 10. 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 Situation 2: Gestational Diabetes 11. 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 12. 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 13. 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) 14. A client with gestational diabetes is scheduled to have a 50 g glucose tolerance test. What result is considered normal? TOP RANK REVIEW ACADEMY, INC. Page 1 | 4
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 15. 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 rapidly increase because of insulin resistance B. Insulin needs 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 3: 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 is placenta previa and abruptio placentae. 16. 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. preeclampisa C. c-section D. her age 17. Which of 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 18. 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 19. 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.” 20. 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 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 21. 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 22. While assessing a 29-year-old gravida 2, para 2 patient who had a normal spontaneous vaginal delivery 30 minutes ago, the nurse notes 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 to breast 23. A client in the first trimester of pregnancy arrives at a health Care clinic and reports that she has beer experiencing vaginal bleeding. A threatened abortion' is suspested, and the nurse instructs the client regarding 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 24. 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 bleedin B. Soft, relaxed, nontender uterus C. Abnormally low funds in proportion to gestational age D. d. Fundal height may be greater than expected 25. Rho (D) immune globulin (Rhogam) is prescribed for a client before she is discharged after 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 Situation 4: Hypertensive Disorders during pregnancy 26. 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 trimester 27. our 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 28. 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 29. A 37 week pregnant patient is admitted with severe preeclampsia. The patient begins to experiences 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 30. 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 5: 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. TOP RANK REVIEW ACADEMY, INC. Page 2 | 4
31. 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 32. 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’’ 33. 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 work ups, 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 1 st trimester V. Fetal Heart sound is heard – no fetal heart sound as there is no viable fetus A. I, III, IV C. III, IV. V B. I, IV, V D. II, III, IV 34. 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 chlidbearing? A. Packed red blood cell transfusion B. Misoprostol (Cytotec) C. Ferrous Sulfate D. RhIG ( RhoGAM) 35. 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 were 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 6: 10 days postpartum, Ivy visited back to the clinic presenting with fever and complained that her her breast feels painful and appears red and swollen. Assessment revealed Mastitis. 36. 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 37. 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 38. 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” 39. 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 40. 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 7: Miscarriage 41. 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 42. 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 43. 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 over doing it and not getting enough rest” D. “It just was not the right timing, everything happens for a reason” 44. 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 45. 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 Situation 8: Nurse Analynn is a nurse educator. She visited a birthing center where three multigravida TOP RANK REVIEW ACADEMY, INC. Page 3 | 4
women just gave birth. The nurse educator opted to conduct health education on postpartum hemorrhage. 46. 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 47. 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 48. 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 49. 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 occuring in my discharges” 50. Two days postpartum, Nurse Analynn assessed and performed 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 results in pain D. Client reports afterpains TOP RANK REVIEW ACADEMY, INC. Page 4 | 4