A 24-year-old woman arrives at the clinic to confirm her pregnancy.
She has a body mass index (BMI) of 17, admits to occasional cocaine use and alcohol consumption, and has a blood pressure of 108/70 mm Hg. Her family history includes diabetes mellitus and cancer, including a sister who recently gave birth to an infant with a neural tube defect (NTD). Which factors place her in a high-risk category?

Drug/alcohol use, age, and family history.

Blood pressure, age, and BMI.

Family history, BMI, and drug/alcohol abuse.

Age, BMI, and family history.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Drug/alcohol use: While substance abuse during pregnancy can lead to adverse outcomes such as preterm labor, fetal growth restriction, and birth defects, it is not considered a primary factor in determining high-risk status for this patient. The specific substances involved (cocaine and alcohol) are indeed associated with risks, but they are not as significant as other factors in this case.

Age: The patient's age of 24 is not considered a high-risk factor for pregnancy. Advanced maternal age (typically defined as 35 years or older) is associated with increased risks for chromosomal abnormalities and other complications, but this patient falls below that age threshold.

Family history: Family history of diabetes mellitus, cancer, and neural tube defects can be relevant to pregnancy risk, but in this case, other factors outweigh their significance.

Choice B rationale:

Blood pressure: The patient's blood pressure of 108/70 mm Hg is within the normal range and does not contribute to highrisk categorization. High blood pressure (hypertension) during pregnancy can lead to preeclampsia and other complications, but this patient does not present with hypertension.

Age: As explained in Choice A, the patient's age is not a high-risk factor.

BMI: A BMI of 17 is considered underweight, which can increase the risk of certain pregnancy complications such as preterm birth and low birth weight. However, in this case, other factors are more significant in determining high-risk status.

Choice C rationale:

Family history: The patient's family history of a neural tube defect (NTD) in a close relative is a significant risk factor for NTDs in her own pregnancy. NTDs are serious birth defects that affect the brain and spinal cord, and they can have lifelong implications for the child. This factor alone warrants a high-risk categorization.

BMI: The patient's underweight BMI of 17 further contributes to her high-risk status, as it can increase the likelihood of certain complications as mentioned earlier.

Drug/alcohol abuse: The patient's admission of cocaine and alcohol use, even if occasional, is a concerning factor for pregnancy. Cocaine, in particular, is a potent vasoconstrictor that can negatively impact fetal growth and development. Alcohol consumption during pregnancy can lead to fetal alcohol spectrum disorders (FASDs), which can cause a range of physical, cognitive, and behavioral problems.

Choice D rationale:

Age: As explained previously, the patient's age is not a high-risk factor.

BMI: The patient's BMI is a contributing factor, but not the most significant one in this case.

Family history: The patient's family history is relevant, but the presence of a neural tube defect in a close relative is the most significant aspect of her family history in terms of pregnancy risk.

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Correct Answer is C

Explanation

Choice A rationale:

It is true that a laboring client may not be able to eat, but this is not the primary reason for starting an IV. The client can receive fluids and electrolytes through the IV to maintain hydration and energy levels.

However, this response does not directly address the client's question about why the IV is necessary for the epidural.

It's important to provide a clear and accurate explanation to help the client understand the purpose of the intervention.

Choice B rationale:

This response is dismissive of the client's concerns and does not provide any information about why the IV is necessary.

It's important to acknowledge the client's concerns and provide them with the information they need to make informed decisions about their care.

Choice C rationale:

This is the correct response. The IV is necessary to administer medication for relaxation before the epidural is placed.

The epidural is a regional anesthetic that blocks pain signals from the lower body.

The medication for relaxation helps to reduce anxiety and discomfort, which can make it easier to place the epidural.

It also helps to prevent the client from moving during the procedure, which could lead to complications.

Choice D rationale:

This response is not accurate. An IV bolus is not typically given to minimize the side effects of the epidural.

Side effects of the epidural, such as hypotension and nausea, are usually managed with other medications.

A. Urine output (UO) completely stops. B. Urine output (UO) is less than 400 mL/24 hours. C. Urine output (UO) is not measured. D. Urine output (UO) is greater than 500 mL/24 hours.

Correct Answer is B

Explanation

Choice A rationale:

Urine output (UO) does not completely stop during the oliguric phase of acute renal failure. While it is significantly reduced, some urine production still occurs. Complete cessation of urine output is known as anuria, which is a more severe condition and a medical emergency.

Anuria may occur in the most severe cases of acute renal failure, but it is not the defining characteristic of the oliguric phase.

It's crucial to distinguish between oliguria and anuria, as their management approaches differ significantly.

Choice B rationale:

During the oliguric phase of acute renal failure, urine output (UO) is less than 400 mL/24 hours. This is the defining characteristic of this phase.

The decrease in urine output is due to damage to the kidneys' filtering units, known as nephrons. As a result, the kidneys are unable to filter waste products and excess fluids effectively from the blood, leading to their accumulation in the body.

This reduced urine output can lead to various complications, including fluid overload, electrolyte imbalances, and a buildup of waste products in the blood (uremia).

Choice C rationale:

Urine output (UO) is always measured during the oliguric phase of acute renal failure. It is a vital clinical indicator to monitor the severity of kidney dysfunction and guide treatment decisions.

Accurate measurement of urine output is essential for assessing fluid balance, kidney function, and the effectiveness of treatment interventions.

Choice D rationale:

Urine output (UO) is not greater than 500 mL/24 hours during the oliguric phase of acute renal failure. A urine output greater than 500 mL/24 hours would indicate a non-oliguric phase of acute renal failure or a potential recovery phase.

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a laboring client who is requesting an epidural. As the nurse prepares to start an IV, the client asks why it is necessary. What would be the nurse’s best response?

Correct Answer is C

Explanation

During the oliguric phase of acute renal failure, which of the following occurs?

Correct Answer is B

Explanation

A nurse is caring for a patient in labor who is receiving oxytocin (Pitocin) by IV infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued?

The nurse is examining a female patient in an OB clinic who complains of severe pain during menstruation and intercourse. The nurse suspects endometriosis. Which of the following is true?

The nurse is discussing the pros and cons of IV opioid administration during active labor with a client. Which statement by the client indicates a need for further education?

In addition to oxytocin (Pitocin) administration, what other methods can induce labor?

The emergency department nurse notes that a patient with chronic kidney failure has a potassium level of 6.5 mEq/L. Which medications would the nurse expect to administer? Select all that apply.

A postpartum nurse is conducting a newborn screening for a 36-hour old baby. The parents inquire about the purpose of this test since the baby is not showing any signs of illness. What would be the nurse’s best response?

In addition to oxytocin (Pitocin) administration, what other methods can induce labor?

Which of the following practices reflect safe administration of oxytocin (Pitocin)?