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Answers to the "NCLEX Obstetrics" Quiz

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4. The client is admitted at 39 weeks gestation for induction of labor. If the doctor uses prostaglandin gel, the nurse should:

• Administer Stadol (butorphanol) prior to the prostaglandin gel
• Tell the client that the labor will be more painful
• Elevate the client’s hips for 30 minutes after the gel is inserted
• Insert a Foley catheter prior to insertion of the gel

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Prostaglandin gel should remain in the cervix for at least 30 minutes after insertion for optimal effect. Elevating the hips helps to ensure that the medication stays in place. Answer A is incorrect because Stadol (butorphanol) is not routinely given at the time prostaglandin gel is inserted. Answer B is incorrect because the answer will make the client more anxious. Answer D is incorrect because it is not necessary to insert a Foley catheter when prostaglandin is used. The client should not be allowed out of bed for at least 30 minutes because the gel can be lost due to pressure on the perineum with voiding.

5. Vaginal examination in the laboring client reveals the anterior fontanel is toward the rectum. The nurse should chart that the baby is in which position?

• Occipital posterior
• Transverse
• Occipital anterior
• Breech

If the anterior fontanel is toward the rectum, the occipital portion of the skull is anterior to the mother’s pelvis. This portion is known as occipital anterior. Answer A is incorrect because if the client’s fetus is positioned in the occipital posterior position, the anterior fontanel would be directly beneath the pubic bone. Answer B is incorrect because in transverse position, the suture line is directly in line with the mother’s right or left side. Answer D is incorrect because breech presentation is when the feet or buttocks present first.

6. The nurse who is caring for the laboring client notes a decline of fetal heart tones from 136 to 90 beats per minute after the acme of the contractions. Which action is most appropriate at this time?

• Monitor the client’s blood pressure
• Turn the client to her left side
• Assess the urinary output hourly
• Prepare the client for a cesarean section

The client is experiencing late decelerations caused by cord compression. Turning the client to her left side can relieve pressure on the cord and improve oxygenation to the uterus. Answers A, C and D are incorrect actions because they will not improve oxygenation.

7. The client is admitted with preeclampsia. Which finding requires that the nurse contact the physician immediately?

• The client’s blood pressure is 140/90.
• The client has a 3+ pedal edema.
• The client’s urine reveals 8 grams of protein in a 24-hour urine sample.
• The client’s platelet count is 280,000.

Urine protein levels above 5 grams in a 24-hour urine sample indicate severe preeclampsia. Answer A is incorrect because a blood pressure of 140/90 is a borderline elevation. Answer B is incorrect because pedal edema is common in pregnancy. Answer D is incorrect because a platelet count of 280,000 is a normal finding.