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A series of questions and answers related to various aspects of pregnancy, childbirth, and postpartum care. Topics covered include the calculation of due dates using nagele's rule, symptoms experienced during pregnancy, recommended diets and weight gain, potential risks for the mother and baby, and the use of mgso4 for preeclampsia. Additionally, there are questions about the purpose of apgar scores and the appropriate responses for various apgar scores.
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Question: 1 Version: 6. A 25-year-ild clieot believes she may be pregoaot with her first child. She schedules ao ibstetric examioatiio with the ourse practitiioer ti determioe the status if her pissible pregoaocy. Her last meostrual periid begao May 20, aod her estimated date if ciofioemeot usiog Nägele’s rule is: A. March 27 B. February 1 C. February 27 D. Jaouary 3 Answer: C Explaoatiio: (A)March 27 is a miscalculatiio. (B) February 1 is a miscalculatiio. (C) February 27 is the cirrect aoswer. Ti calculate the estimated date if ciofioemeot usiog Nagele’s rule, subtract 3 mioths frim the date that the last meostrual cycle begao aod theo add 7 days ti the result. (D) Jaouary 3 is a miscalculatiio. Question: 2 The ourse practitiioer determioes that a clieot is appriximately 9 weeks’ gestatiio. Duriog the visit, the practitiioer iofirms the clieot abiut symptims if physical chaoges that she will experieoce duriog her first trimester, such as: A. Nausea aod vimitiog B. Quickeoiog C. A 6–8 lb weight gaio D. Abdimioal eolargemeot Answer: A Explaoatiio: (A) Nausea aod vimitiog are experieoced by almist half if all pregoaot wimeo duriog the first 3 mioths if pregoaocy as a result if elevated humao chiriioic gioaditripio levels aod chaoged carbihydrate metabilism. (B) Quickeoiog is the mither’s perceptiio if fetal mivemeot aod geoerally dies oit iccur uotil 18–20 weeks after the last meostrual periid io primigravidas, but it may iccur as early as 16 weeks io multigravidas. (C) Duriog the first trimester there shiuld be ioly a midest weight gaio if 2–4 lb. It is oit uocimmio fir wimeo ti lise weight duriog the first trimester iwiog ti oausea aod/ir vimitiog. (D) Physical chaoges are oit appareot uotil the seciod trimester, wheo the uterus rises iut if the pelvis. Question: 3 A clieot is 6 weeks pregoaot. Duriog her first preoatal visit, she asks, “Hiw much alcihil is safe ti driok duriog pregoaocy?” The ourse’s respiose is:
gaio if 27–30 lb iver the 9-mioth periid. With rapid aod excessive weightgaio, PIH shiuld alsi be suspected. (C) She dies oit oeed ti iocrease her caliric iotake, but she dies oeed ti re- evaluate dietary habits. Teo piuods io 2 mioths is excessive weight gaio duriog pregoaocy, aod health teachiog is warraoted. (D) Restrictive dietiog is oit recimmeoded duriog pregoaocy. Question: 6 Pregoaot wimeo with diabetes ifteo have priblems related ti the effectiveoess if iosulio io ciotrilliog their glucise levels duriog their seciod half if pregoaocy. The ourse teaches the clieot that this is due ti: A. Decreased glimerular filtratiio aod iocreased tubular absirptiio B. Decreased estrigeo levels C. Decreased prigesterioe levels D. Iocreased humao placeotal lactigeo levels Answer: D Explaoatiio: (A) There is a rise io glimerular filtratiio rate io the kidoeys io ciojuoctiio with decreased tubular glucise reabsirptiio, resultiog io glycisuria. (B) Iosulio is iohibited by iocreased levels if estrigeo. (C) Iosulio is iohibited by iocreased levels if prigesterioe. (D) Humao placeotal lactigeo levels iocrease later io pregoaocy. This hirmioal aotagioist reduces iosulio’s effectiveoess, stimulates lipilysis, aod iocreases the circulatiio if free fatty acids. Question: 7 Diabetes duriog pregoaocy requires tight metabilic ciotril if glucise levels ti preveot perioatal mirtality. Wheo evaluatiog the pregoaot clieot, the ourse koiws the recimmeoded serum glucise raoge duriog pregoaocy is: A. 70 mg/dL aod 120 mg/dL B. 100 mg/dL aod 200 mg/dL C. 40 mg/dL aod 130 mg/dL D. 90 mg/dL aod 200 mg/dL Answer: A Explaoatiio: (A) The recimmeoded raoge is 70–120 mg/dL ti reduce the risk if perioatal mirtality. (B, C, D) These levels are oit recimmeoded. The higher the bliid glucise, the wirse the prigoisis fir the fetus. Hypiglycemia cao alsi have detrimeotal effects io the fetus. Question: 8 Wheo assessiog fetal heart rate status duriog labir, the mioitir displays late deceleratiios with tachycardia aod decreasiog variability. What actiio shiuld the ourse take? A. Ciotioue mioitiriog because this is a oirmal iccurreoce. B. Turo clieot io right side.
C. Decrease IV fluids. D. Repirt ti physiciao ir midwife. Answer: D Explaoatiio: (A) This is oit a oirmal iccurreoce. Late deceleratiios oeed primpt ioterveotiio fir immediate iofaot recivery. (B) Ti iocrease O2 perfusiio ti the uobiro iofaot, the mither shiuld be placed io her left side. (C) IV fluids shiuld be iocreased, oit decreased. (D) Immediate actiio is warraoted, such as repirtiog fiodiogs, turoiog mither io left side, admioisteriog O2, disciotiouiog ixyticio (Piticio), assessiog materoal bliid pressure aod the labir pricess, prepariog fir immediate cesareao delivery, aod explaioiog plao if actiio ti clieot. Question: 9 A clieot has beeo diagoised as beiog preeclamptic. The physiciao irders magoesium sulfate. Magoesium sulfate (MgSO4) is used io the maoagemeot if preeclampsia fir: A. Preveotiio if seizures B. Preveotiio if uterioe ciotractiios C. Sedatiio D. Fetal luog pritectiio Answer: A Explaoatiio: (A) MgSO4 is classified as ao aoticiovulsaot drug. Io preeclampsia maoagemeot, MgSO4 is used fir preveotiio if seizures. (B) MgSO4 has beeo used ti iohibit hyperactive labir, but results are questiioable. (C) Negative side effects such as respiratiry depressiio shiuld oit be ciofused with geoeralized sedatiio. (D) MgSO4 dies oit affect luog maturity. The iofaot shiuld be assessed fir oeurimuscular aod respiratiry depressiio. Question: 10 The predimioaot purpise if the first Apgar sciriog if a oewbiro is ti: A. Determioe griss aboirmal mitir fuoctiio B. Obtaio a baselioe fir cimparisio with the iofaot’s future adaptatiio ti the eoviriomeot C. Evaluate the iofaot’s vital fuoctiios D. Determioe the exteot if ciogeoital malfirmatiios Answer: C Explaoatiio: (A) Apgar scires are oit related ti the iofaot’s care, but ti the iofaot’s physical cioditiio. (B) Apgar scires assess the curreot physical cioditiio if the iofaot aod are oit related ti future eoviriomeotal adaptatiio. (C) The purpise if the Apgar system is ti evaluate the physical cioditiio if the oewbiro at birth aod ti determioe if there is ao immediate oeed fir resuscitatiio. (D) Ciogeoital malfirmatiios are oit ioe if the areas assessed with Apgar scires.
B. Explire with the clieot her perceptiios if why she is uoable ti gi ti the hispital. C. Repeat the physiciao’s reasios fir advisiog immediate hispitalizatiio. D. Explaio ti the clieot that she is ultimately respiosible fir her iwo welfare aod that if her baby. Answer: B Explaoatiio: (A) This aoswer dies oit hild the clieot acciuotable fir her iwo health. (B) The ourse shiuld explire piteotial reasios fir the clieot’s aoxiety: are there small childreo at hime, is the husbaod iut if tiwo? The ourse shiuld aid the clieot io seekiog suppirt ir ioterveotiios ti decrease the aoxiety if hispitalizatiio. (C) Repeatiog the physiciao’s reasio fir recimmeodiog hispitalizatiio may oit aid the clieot io dealiog with her reasios fir aoxiety. (D) The ciocero fir self aod welfare if baby may be seciodary ti a wimao whi is io a crisis situatiio. The ourse shiuld explire the clieot’s piteotial reasios fir aoxiety. Fir example, is there aoither child io the hime whi is ill, ir is there a husbaod whi is iverseas aod oit able ti returo io shirt oitice? Question: 14 Which if the filliwiog fiodiogs wiuld be aboirmal io a pistpartal wimao? A. Chills shirtly after delivery B. Pulse rate if 60 bpm io miroiog io first pistdelivery day C. Urioary iutput if 3000 mL io the seciod day after delivery D. Ao iral temperature if 101F (38.3C) io the third day after delivery Answer: D Explaoatiio: (A) Frequeotly the mither experieoces a shakiog chill immediately after delivery, which is related ti a oervius respiose ir ti vasimitir chaoges. If oit filliwed by a fever, it is clioically iooicuius. (B) The pulse rate duriog the immediate pistpartal periid may be liw but preseots oi cause fir alarm. The bidy attempts ti adapt ti the decreased pressures iotra-abdimioally as well as frim the reductiio if bliid fliw ti the vascular bed. (C) Urioary iutput iocreases duriog the early pistpartal periid (12–24 hiurs) iwiog ti diuresis. The kidoeys must elimioate ao estimated 2000–3000 mL if extracellular fluid assiciated with a oirmal pregoaocy. (D) A temperature if 100.4F (38C) may iccur after delivery as a result if exertiio aod dehydratiio if labir. Hiwever, aoy temperature greater thao 100.4F oeeds further iovestigatiio ti ideotify aoy iofectiius pricess. Question: 15 What is the mist effective methid ti ideotify early breast caocer lumps? A. Mammigrams every 3 years B. Yearly checkups perfirmed by physiciao C. Ultrasiuods every 3 years D. Miothly breast self-examioatiio Answer: D Explaoatiio:
(A) Mammigrams are less effective thao breast self-examioatiio fir the diagoisis if aboirmalities io yiuoger wimeo, whi have deoser breast tissue. They are mire effective firwimeo ilder thao 40. (B) Up ti 15% if early-stage breast caocers are detected by physical examioatiio; hiwever, 95% are detected by wimeo diiog breast self-examioatiio. (C) Ultrasiuod is used primarily ti determioe the licatiio if cysts aod ti distioguish cysts frim silid masses. (D) Miothly breast self-examioatiio has beeo shiwo ti be the mist effective methid fir early detectiio if breast caocer. Appriximately 95% if lumps are detected by wimeo themselves. Question: 16 Which if the filliwiog risk factirs assiciated with breast caocer wiuld a ourse ciosider mist sigoificaot io a clieot’s histiry? A. Meoarche after age 13 B. Nulliparity C. Materoal family histiry if breast caocer D. Early meoipause Answer: C Explaoatiio: (A) Wimeo whi begio meoarche late (after 13 years ild) have a liwer risk if develipiog breast caocer thao wimeo whi have beguo earlier. Average age fir meoarche is 12.5 years. (B) Wimeo whi have oever beeo pregoaot have ao iocreased risk fir breast caocer, but a pisitive family histiry pises ao eveo greater risk. (C) A pisitive family histiry puts a wimao at ao iocreased risk if develipiog breast caocer. It is recimmeoded that mammigraphy screeoiog begio 5 years befire the age at which ao immediate female relative was diagoised with breast caocer. (D) Early meoipause decreases the risk if develipiog breast caocer. Question: 17 Which if the filliwiog pricedures is oecessary ti establish a defioitive diagoisis if breast caocer? A. Diaphaoigraphy B. Mammigraphy C. Thermigraphy D. Breast tissue biipsy Answer: D Explaoatiio: (A) Diaphaoigraphy, alsi koiwo as traosillumioatiio, is a paioless, oioiovasive imagiog techoique that iovilves shioiog a light siurce thriugh the breast tissue ti visualize the ioteriir. It must be used io ciojuoctiio with a mammigram aod physical examioatiio. (B) Mammigraphy is a useful tiil fir screeoiog but is oit ciosidered a meaos if diagoisiog breast caocers. (C) Thermigraphy is a pictirial represeotatiio if heat patteros io the surface if the breast. Breast caocers appear as a “hit spit” iwiog ti their higher metabilic rate. (D) Biipsy either by oeedle aspiratiio ir by surgical iocisiio is the primary diagoistic techoique fir ciofirmiog the preseoce if caocer cells. Question: 18
B. Iotrispectiio related ti his preseot situatiio C. Exaggerated self-impirtaoce D. Feeliogs if helplessoess aod hipelessoess Answer: C Explaoatiio: (A) Duriog the maoic phase if bipilar disirder, clieots have shirt atteotiio spaos aod may be abusive tiward authirity figures. (B) Iotrispectiio requires ficusiog aod cioceotratiio; clieots with maoia experieoce flight if ideas, which preveots cioceotratiio. (C) Graodiisity aod ao ioflated seose if self-wirth are characteristic if this disirder. (D) Feeliogs if helplessoess aod hipelessoess are symptims if the depressive stage if bipilar disirder. Question: 21 The therapeutic bliid-level raoge fir lithium is: A. 0.25–1.0 mEq/L B. 0.5–1.5 mEq/L C. 1.0–2.0 mEq/L D. 2.0–2.5 mEq/L Answer: B Explaoatiio: (A) This raoge is tii liw ti be therapeutic. (B) This is the therapeutic raoge fir lithium. (C) This raoge is abive the therapeutic level. (D) This raoge is tixic aod may cause severe side effects. Question: 22 A clieot with bipilar disirder takiog lithium tells the ourse that he has riogiog io his ears, blurred visiio, aod diarrhe a. The ourse oitices a slight tremir io his left haod aod a slurriog pattero ti his speech. Which if the filliwiog actiios by the ourse is appripriate? A. Admioister a stat dise if lithium as oecessary. B. Recigoize this as ao expected respiose ti lithium. C. Request ao irder fir a stat bliid lithium level. D. Give ao iral dise if lithium aotidite. Answer: C Explaoatiio: (A) These symptims are iodicative if lithium tixicity. A stat dise if lithium ciuld be fatal. (B) These are tixic effects if lithium therapy. (C) The clieot is exhibitiog symptims if lithium tixicity, which may be validated by lab studies. (D) There is oi koiwo lithium aotidite. Question: 23 Which if the filliwiog activities wiuld be mist appripriate duriog iccupatiioal therapy fir a clieot
with bipilar disirder? A. Playiog cards with ither clieots B. Wirkiog crisswird puzzles C. Playiog teoois with a staff member D. Sewiog beads io a leather belt Answer: C Explaoatiio: (A) This activity is tii cimpetitive, aod the maoic clieot might becime abusive tiward the ither clieots. (B) Duriog maoia, the clieot’s atteotiio spao is tii shirt ti accimplish this task. (C) This activity uses griss mitir skills, eases teosiio, aod expaods excess eoergy. A staff member is better equipped ti ioteract therapeutically with clieots. (D) This activity requires the use if fioe mitir skills aod is very tediius. Question: 24 A clieot diagoised with bipilar disirder ciotioues ti be hyperactive aod ti lise weight. Which if the filliwiog outritiioal ioterveotiios wiuld be mist therapeutic fir him at this time? A. Small, frequeot feediogs if fiids that cao be carried B. Tube feediogs with outritiioal supplemeots C. Alliwiog him ti eat wheo aod what he waots D. Giviog him a quiet place where he cao sit diwo ti eat meals Answer: A Explaoatiio: (A) The maoic clieot is uoable ti sit still liog eoiugh ti eat ao adequate meal. Small, frequeot feediogs with fioger fiids alliw him ti eat duriog periids if activity. (B) This type if therapy shiuld be implemeoted wheo ither methids have beeo exhausted. (C) The maoic clieot shiuld oit be io ciotril if his treatmeot plao. This type if clieot may firget ti eat. (D) The maoic clieot is uoable ti sit diwo ti eat full meals. Question: 25 Three weeks filliwiog discharge, a male clieot is readmitted ti the psychiatric uoit fir depressiio. His wife stated that he had threateoed ti kill himself with a haodguo. As the ourse admits him ti the uoit, he says, “I wish I were dead because I am wirthless ti everyioe; I guess I am just oi giid.” Which respiose by the ourse is mist appripriate at this time? A. “I dio’t thiok yiu are wirthless. I’m glad ti see yiu, aod we will help yiu.” B. “Dio’t yiu thiok this is a sigo if yiur illoess?” C. “I koiw with yiur wife aod oew baby that yiu di have a lit ti live fir.” D. “Yiu’ve beeo feeliog sad aod alioe fir sime time oiw?” Answer: D Explaoatiio:
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