Maternity Nursing / Midwifery | This is your first set of practice questions for maternity nursing. Items may include questions about labor and delivery, antepartum, intrapartum, and postpartum nursing care.
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Question 1 |
A postpartum patient was in labor for 30 hours and had ruptured membranes for 24 hours. For which of the following would the nurse be alert?
A | A. Endometritis |
B | B. Endometriosis |
C | C. Salpingitis |
D | D. Pelvic thrombophlebitisv |
Question 1 Explanation:
Correct Answer: A. (Endometritis).
Endometritis is an infection of the uterine lining and can occur after prolonged rupture of membranes. Symptoms include swelling of the abdomen, abnormal vaginal bleeding or discharge, fever, discomfort with bowel movement, and pain in the lower abdomen or pelvic region.
Question 2 |
A client at 36 weeks gestation is scheduled for a routine ultrasound prior to amniocentesis. After teaching the client about the purpose of the ultrasound, which of the following client statements would indicate to the nurse in charge that the client needs further instruction?
A | A. The ultrasound will help to locate the placenta. |
B | B. The ultrasound identifies blood flow through the umbilical cord. |
C | C. The test will determine where to insert the needle. |
D | D. The ultrasound locates a pool of amniotic fluid. A. The ultrasound will help to locate the placenta. |
Question 2 Explanation:
Correct Answer: B. (The ultrasound identifies blood flow through the umbilical cord).
Before amniocentesis, a routine ultrasound is valuable in locating the placenta, locating a pool of amniotic fluid, and showing the physician where to insert the needle. Color Doppler imaging ultrasonography identifies blood flow through the umbilical cord. A routine ultrasound does not accomplish this.
Question 3 |
While the postpartum client is receiving heparin for thrombophlebitis, which of the following drugs would the nurse expect to administer if the client develops complications related to heparin therapy?
A | A. Calcium gluconate |
B | B. Protamine sulfate |
C | C. Methylergonovine (Methergine) |
D | D. Nitrofurantoin (Macrodantin) |
Question 3 Explanation:
Correct Answer: B. (Protamine sulfate).
Protamine sulfate is a heparin antagonist given intravenously to counteract bleeding complications caused by heparin overdose.
Question 4 |
When caring for a 3-day-old neonate who is receiving phototherapy to treat jaundice, the nurse in charge would expect to do which of the following?
A | A. Turn the neonate every 6 hours |
B | B. Encourage the mother to discontinue breastfeeding |
C | C. Notify the physician if the skin becomes bronze in color. |
D | D. Check the vital signs every 2 to 4 hours. |
Question 4 Explanation:
Correct Answer: D. (Check the vital signs every 2 to 4 hours).
While caring for an infant receiving phototherapy for treatment of jaundice, vital signs are checked every 2 to 4 hours because hyperthermia can occur due to the phototherapy lights.
Question 5 |
A primigravida in active labor is about 9 days post-term. The client desires a bilateral pudendal block anesthesia before delivery. After the nurse explains this type of anesthesia to the client, which of the following locations identified by the client as the area of relief would indicate to the nurse that the teaching was effective?
A | A. Back |
B | B. Abdomen |
C | C. Fundus |
D | D. Perineum |
Question 5 Explanation:
Correct Answer: D. (Perineum).
A bilateral pudendal block is used for vaginal deliveries to relieve pain primarily in the perineum and vagina. Pudendal block anesthesia is adequate for episiotomy and its repair.
Question 6 |
The nurse is caring for a primigravida at about 2 months and 1-week gestation. After explaining self-care measures for common discomforts of pregnancy, the nurse determines that the client understands the instructions when she says:
A | A. “Nausea and vomiting can be decreased if I eat a few crackers before rising.” |
B | B. “If I start to leak colostrum, I should cleanse my nipples with soap and water.” |
C | C. “If I have a vaginal discharge, I should wear nylon underwear.” |
D | D. “Leg cramps can be alleviated if I put an ice pack on the area.” |
Question 6 Explanation:
Correct Answer: A. “Nausea and vomiting can be decreased if I eat a few crackers before arising”
Eating dry crackers before arising can assist in decreasing the common discomfort of nausea and vomiting. Avoiding strong food odors and eating a high-protein snack before bedtime can also help.
Question 7 |
Forty-eight hours after delivery, the nurse in charge plans discharge teaching for the client about infant care. By this time, the nurse expects that the phase of postpartum psychological adaptation that the client would be in would be termed which of the following?
A | A. Taking in |
B | B. Letting go |
C | C. Taking hold |
D | D. Resolution |
Question 7 Explanation:
Correct Answer: C. Taking hold
Beginning after completion of the taking-in phase, the taking-hold phase lasts about 10 days. During this phase, the client is concerned with her need to resume control of all facets of her life in a competent manner. At this time, she is ready to learn self-care and infant care skills.
Question 8 |
A pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the nurse tells the client that the usual treatment for partial placenta previa is which of the following?
A | A. Activity limited to bed rest. |
B | B. Platelet infusion. |
C | C. Immediate cesarean delivery. |
D | D. Labor induction with oxytocin. |
Question 8 Explanation:
Correct Answer: A. Activity limited to bed rest
Treatment of partial placenta previa includes bed rest, hydration, and careful monitoring of the client’s bleeding.
Question 9 |
The nurse plans to instruct the postpartum client about methods to prevent breast engorgement. Which of the following measures would the nurse include in the teaching plan?
A | A. Feeding the neonate a maximum of 5 minutes per side on the first day. |
B | B. Wearing a supportive brassiere with nipple shields. |
C | C. Breastfeeding the neonate at frequent intervals. |
D | D. Decreasing fluid intake for the first 24 to 48 hours. |
Question 9 Explanation:
Correct Answer: C. Breastfeeding the neonate at frequent intervals
Prevention of breast engorgement is key. The best technique is to empty the breast regularly while feeding. Engorgement is less likely when the mother and neonate are together, as in single-room maternity care continuous rooming-in, because nursing can be done conveniently to meet the neonate’s and mother’s needs.
Question 10 |
When the nurse on duty accidentally bumps the bassinet, the neonate throws out its arms, hands open, and begins to cry. The nurse interprets this reaction as indicative of which of the following reflexes?
A | A. Startle reflex |
B | B. Babinski reflex |
C | C. Grasping reflex |
D | D. Tonic neck reflex |
Question 10 Explanation:
Correct Answer: A. Startle reflex
The Moro, or startle, reflex occurs when the neonate responds to stimuli by extending the arms, hands open, and then moving the arms in an embracing motion. The Moro reflex, present at birth, disappears at about age 3 months.
Question 11 |
A primigravida client at 25 weeks gestation visits the clinic and tells the nurse that her lower back aches when she arrives home from work. The nurse should suggest that the client perform:
A | A. Tailor sitting |
B | B. Leg lifting Hint: Option B: The leg raise is a great way to strengthen the abdominal muscles. It targets the lower abdominal muscles and hip muscles. |
C | C. Shoulder circling
|
D | D. Squatting exercises |
Question 11 Explanation:
Correct Answer: A. Tailor sitting
Tailor sitting is an excellent exercise that helps to strengthen the client’s back muscles and also prepares the client for the process of labor. The client should be encouraged to rest periodically during the day and avoid standing or sitting in one position for a long time.
Question 12 |
Which of the following would the nurse in charge do first after observing a 2-cm circle of bright red bleeding on the diaper of a neonate who just had a circumcision?
A | A. Notify the neonate’s pediatrician immediately. |
B | B. Check the diaper and circumcision again in 30 minutes. |
C | C. Secure the diaper tightly to apply pressure on the site. |
D | D. Apply gentle pressure to the site with a sterile gauze pad. |
Question 12 Explanation:
Correct Answer: D. (Apply gentle pressure to the site with a sterile gauze pad).
If bleeding occurs after circumcision, the nurse should first apply gentle pressure on the area with sterile gauze. Bleeding is not common but requires attention when it occurs.
Question 13 |
Which of the following would the nurse most likely expect to find when assessing a pregnant client with abruption placenta?
A | A. Excessive vaginal bleeding |
B | B. Rigid, board-like abdomen |
C | C. Tetanic uterine contractions |
D | D. Premature rupture of membranes |
Question 13 Explanation:
Correct Answer: B. (Rigid, board-like abdomen).
The most common assessment finding in a client with abruption placenta is a rigid or boardlike abdomen. Pain, usually reported as a sharp stabbing sensation high in the uterine fundus with the initial separation, also is common.
Question 14 |
While the client is in active labor with twins and the cervix is 5 cm dilated, the nurse observes contractions occurring at a rate of every 7 to 8 minutes in a 30-minute period. Which of the following would be the nurse’s most appropriate action?
A | A. Note the fetal heart rate patterns. |
B | B. Notify the physician immediately. |
C | C. Administer oxygen at 6 liters by mask. |
D | D. Have the client pant-blow during the contractions. |
Question 14 Explanation:
Correct Answer: B. (Notify the physician immediately).
The nurse should contact the physician immediately because the client is most likely experiencing hypotonic uterine contractions. These contractions tend to be painful but ineffective. The usual treatment is oxytocin augmentation unless cephalopelvic disproportion exists.
Question 15 |
A client tells the nurse, “I think my baby likes to hear me talk to him.” When discussing neonates and stimulation with sound, which of the following would the nurse include as a means to elicit the best response?
A | A. High-pitched speech with tonal variations. |
B | B. Low-pitched speech with a sameness of tone. |
C | C. Cooing sounds rather than words. |
D | D. Repeated stimulation with loud sounds. |
Question 15 Explanation:
Correct Answer: A. (High-pitched speech with tonal variations).
Providing stimulation and speaking to neonates is important. Some authorities believe that speech is the most important type of sensory stimulation for a neonate. Neonates respond best to speech with tonal variations and a high-pitched voice. A neonate can hear all sound louder than about 55 decibels.
Question 16 |
A 31-year-old multipara is admitted to the birthing room after initial examination reveals her cervix to be at 8 cm, completely effaced (100 %), and at 0 station. What phase of labor is she in?
A | A. Active phase
|
B | B. Latent phase |
C | C. Expulsive phase |
D | D. Transitional phase |
Question 16 Explanation:
Correct Answer: D. (Transitional phase).
The transitional phase of labor extends from 8 to 10 cm; it is the shortest but most difficult and intense for the patient.
Question 17 |
A pregnant patient asks the nurse if she can take castor oil for her constipation. How should the nurse respond?
A | A. “Yes, it produces no adverse effect.” |
B | B. “No, it can initiate premature uterine contractions.” |
C | C. “No, it can promote sodium retention.” |
D | D. “No, it can lead to increased absorption of fat-soluble vitamins.” |
Question 17 Explanation:
Correct Answer: B. (“No, it can initiate premature uterine contractions.”)
Castor oil can initiate premature uterine contractions in pregnant women. It also can produce other adverse effects, but it does not promote sodium retention.
Question 18 |
A patient in her 14th week of pregnancy has presented with abdominal cramping and vaginal bleeding for the past 8 hours. She has passed several clots. What is the primary nursing diagnosis for this patient?
A | A. Knowledge deficit |
B | B. Fluid volume deficit |
C | C. Anticipatory grieving |
D | D. Pain |
Question 18 Explanation:
Correct Answer: B. (Fluid volume deficit).
If bleeding and clots are excessive, this patient may become hypovolemic. Pad count should be instituted. Blood volume expands during pregnancy, and a considerable portion of the weight of a pregnant woman is retained water.
Question 19 |
Immediately after delivery, the nurse-midwife assesses the neonate’s head for signs of molding. Which factors determine the type of molding?
A | A. Fetal body flexion or extension |
B | B. Maternal age, body frame, and weight |
C | C. Maternal and paternal ethnic backgrounds |
D | D. Maternal parity and gravidity |
Question 19 Explanation:
Correct Answer: A. (Fetal body flexion or extension).
Fetal attitude—the overall degree of body flexion or extension—determines the type of molding in the head of a neonate.
Question 20 |
For a patient in active labor, the nurse-midwife plans to use an internal electronic fetal monitoring (EFM) device. What must occur before the internal EFM can be applied?
A | A. The membranes must rupture. |
B | B. The fetus must be at 0 station. |
C | C. The cervix must be dilated fully. |
D | D. The patient must receive anesthesia. |
Question 20 Explanation:
Correct Answer: A. (The membranes must rupture).
Internal fetal heart rate monitoring uses an electronic transducer connected directly to the fetal skin. A wire electrode is attached to the fetal scalp or other body parts through the cervical opening and is connected to the monitor. Internal EFM can be applied only after the patient’s membranes have ruptured when the fetus is at least at the -1 station, and when the cervix is dilated at least 2 cm.
Question 21 |
A primigravida patient is admitted to the labor delivery area. Assessment reveals that she is in the early part of the first stage of labor. Her pain is likely to be most intense:
A | A. Around the pelvic girdle |
B | B. Around the pelvic girdle and in the upper arms |
C | C. Around the pelvic girdle and at the perineum |
D | D. At the perineum |
Question 21 Explanation:
Correct Answer: A. (Around the pelvic girdle)
During most of the first stage of labor, pain centers around the pelvic girdle. During the late part of this stage and the early part of the second stage, pain spreads to the upper legs and perineum. The pain of early labor is referred to T10-T12 dermatomes such that the pain is felt in the lower abdomen, sacrum, and back. This pain is dull in character and is not always sensitive to opioid drugs.
Question 22 |
A female adult patient is taking a progestin-only oral contraceptive or mini pill. Progestin use may increase the patient’s risk for:
A | A. Endometriosis |
B | B. Female hypogonadism |
C | C. Premenstrual syndrome |
D | D. Tubal or ectopic pregnancy |
Question 22 Explanation:
Correct Answer: D. (Tubal or ectopic pregnancy)
Women taking the mini pill have a higher incidence of tubal and ectopic pregnancies, possibly because progestin slows ovum transport through the fallopian tubes.
Question 23 |
A patient with pregnancy-induced hypertension probably exhibits which of the following symptoms?
A | A. Proteinuria, headaches, vaginal bleeding |
B | B. Headaches, double vision, vaginal bleeding |
C | C. Proteinuria, headaches, double vision |
D | D. Proteinuria, double vision, uterine contractions |
Question 23 Explanation:
Correct Answer: C. (Proteinuria, headaches, double vision)
A patient with pregnancy-induced hypertension complains of a headache, double vision, and sudden weight gain. A urine specimen reveals proteinuria.
Question 24 |
Because cervical effacement and dilation are not progressing in a patient in labor, the doctor orders I.V. administration of oxytocin (Pitocin). Why should the nurse monitor the patient’s fluid intake and output closely during oxytocin administration?
A | A. Oxytocin causes water intoxication. |
B | B. Oxytocin causes excessive thirst. |
C | C. Oxytocin is toxic to the kidneys. |
D | D. Oxytocin has a diuretic effect. |
Question 24 Explanation:
Correct Answer: A. (Oxytocin causes water intoxication)
The nurse should monitor fluid intake and output because prolonged oxytocin infusion may cause severe water intoxication, leading to seizures, coma, and death. In addition, oxytocin may cause water intoxication via an antidiuretic hormone-like activity when administered in excessive doses with electrolyte-free solution.
Question 25 |
Five hours after birth, a neonate is transferred to the nursery, where the nurse intervenes to prevent hypothermia. What is a common source of radiant heat loss?
A | A. Low room humidity |
B | B. Cold weight scale |
C | C. Cool incubator walls |
D | D. Cool room temperature |
Question 25 Explanation:
Correct Answer: C. (Cools incubator walls)
A common source of radiant heat loss includes cool incubator walls and windows. Radiant heat loss constitutes the transfer of heat from an infant’s warm skin, via infrared electromagnetic waves, to the cooler surrounding walls that absorb heat.
Question 26 |
After administering bethanechol to a patient with urine retention, the nurse in charge monitors the patient for adverse effects. Which is most likely to occur?
A | A. Decreased peristalsis |
B | B. Increase heart rate |
C | C. Dry mucous membranes |
D | D. Nausea and Vomiting |
Question 26 Explanation:
Correct Answer: D. (Nausea and Vomiting)
Bethanechol will increase GI motility, which may cause nausea, belching, vomiting, intestinal cramps, and diarrhea. Bethanechol directly stimulates cholinergic receptors in the parasympathetic nervous system while stimulating the ganglia to a lesser extent.
Question 27 |
The nurse in charge is caring for a patient who is in the first stage of labor. What is the shortest but most difficult part of this stage?
A | A. Active phase |
B | B. Complete phase |
C | C. Latent phase |
D | D. Transitional phase |
Question 27 Explanation:
Correct Answer: D. (Transitional phase)
The transitional phase, which lasts 1 to 3 hours, is the shortest but most difficult part of the first stage of labor. This phase is characterized by intense uterine contractions that occur every 1 ½ to 2 minutes and last 45 to 90 seconds.
Question 28 |
After 3 days of breastfeeding, a postpartum patient reports nipple soreness. To relieve her discomfort, the nurse should suggest that she:
A | A. Apply warm compresses to her nipples just before feeding. |
B | B. Lubricate her nipples with expressed milk before feeding. |
C | C. Dry her nipples with a soft towel after feeding. |
D | D. Apply soap directly to her nipples, and then rinse. |
Question 28 Explanation:
Correct Answer: B. (Lubricate her nipples with expressed milk before feeding)
Measures that help relieve nipple soreness in a breastfeeding patient include lubricating the nipples with a few drops of expressed milk before feedings, applying ice compresses just before feeding, letting the nipples air dry after feedings, and avoiding the use of soap on the nipples.
Question 29 |
The nurse is developing a teaching plan for a patient who is 8 weeks pregnant. The nurse should tell the patient that she can expect to feel the fetus move at which time?
A | A. Between 10 and 12 weeks’ gestation |
B | B. Between 16 and 20 weeks’ gestation. |
C | C. Between 21 and 23 weeks’ gestation. |
D | D. Between 24 and 26 weeks’ gestation. |
Question 29 Explanation:
Correct Answer: B. (Between 16 and 20 weeks’ gestation)
A pregnant woman usually can detect fetal movement (quickening) between 16 and 20 weeks’ gestation.
Question 30 |
Normal lochial findings in the first 24 hours post-delivery include:
A | A. Bright red blood |
B | B. Large clots or tissue fragments |
C | C. A foul odor |
D | D. The complete absence of lochia |
Question 30 Explanation:
Correct Answer: A. (Bright red blood)
Lochia should never contain large clots, tissue fragments, or membranes. A foul odor may signal infection, as may absence of lochia.
Question 31 |
Accompanied by her husband, a patient seeks admission to the labor and delivery area. The client states that she is in labor and says she attended the hospital clinic for prenatal care. Which question should the nurse ask her first?
A | A. “Do you have any chronic illness?” |
B | B. “Do you have any allergies?” |
C | C. “What is your expected due date?” |
D | D. “Who will be with you during labor?” |
Question 31 Explanation:
Correct Answer: C. (“What is your expected due date?”)
When obtaining the history of a patient who may be in labor, the nurse’s highest priority is to determine her current status, particularly her due date, gravidity, and parity. Gravidity and parity affect the duration of labor and the potential for labor complications. Later, the nurse should ask about chronic illness, allergies, and support persons.
Question 32 |
A patient is in the second stage of labor. During this stage, how frequently should the nurse in charge assess her uterine contractions?
A | A. Every 5 minutes. |
B | B. Every 15 minutes. |
C | C. Every 30 minutes. |
D | D. Every 60 minutes. |
Question 32 Explanation:
Correct Answer: B. (Every 15 minutes)
During the second stage of labor, the nurse should assess the strength, frequency, and duration of contraction every 15 minutes. If maternal or fetal problems are detected, more frequent monitoring is necessary.
Question 33 |
A patient is in her last trimester of pregnancy. Nurse Vickie should instruct her to notify her primary health care provider immediately if she notices:
A | A. Blurred vision |
B | B. Hemorrhoids |
C | C. Increased vaginal mucus |
D | D. Shortness of breath on exertion |
Question 33 Explanation:
Correct Answer: A. (Blurred vision).
Blurred vision or other visual disturbance, excessive weight gain, edema, and increased blood pressure may signal severe preeclampsia. This condition may lead to eclampsia, which has potentially serious consequences for both the patient and fetus.
Question 34 |
The nurse in-charge is reviewing a patient’s prenatal history. Which finding indicates a genetic risk factor?
A | A. The patient is 25 years old. |
B | B. The patient has a child with cystic fibrosis. |
C | C. The patient was exposed to rubella at 36 weeks’ gestation. |
D | D. The patient has a history of preterm labor at 32 weeks’ gestation. |
Question 34 Explanation:
Correct Answer: B. (The patient has a child with cystic fibrosis).
Cystic fibrosis is a recessive trait; each offspring has a one in four chance of having the trait or the disorder.
Question 35 |
An adult female patient is using the rhythm (calendar-basal body temperature) method of family planning. In this method, the unsafe period for sexual intercourse is indicated by:
A | A. Return preovulatory basal body temperature. |
B | B. Basal body temperature increase of 0.1 degrees to 0.2 degrees on the 2nd or 3rd day of cycle. |
C | C. 3 full days of elevated basal body temperature and clear, thin cervical mucus. |
D | D. Breast tenderness and mittelschmerz. |
Question 35 Explanation:
Correct Answer: C. 3 (Full days of elevated basal body temperature and clear, thin cervical mucus).
Ovulation (the period when pregnancy can occur) is accompanied by a basal body temperature increase of 0.7 degrees F to 0.8 degrees F and clear, thin cervical mucus.
Question 36 |
During a nonstress test (NST), the electronic tracing displays a relatively flat line for fetal movement, making it difficult to evaluate the fetal heart rate (FHR). To mark the strip, the nurse in charge should instruct the client to push the control button at which time?
A | A. At the beginning of each fetal movement. |
B | B. At the beginning of each contraction. |
C | C. After every three fetal movements |
D | D. At the end of fetal movement. |
Question 36 Explanation:
Correct Answer: A. (At the beginning of each fetal movement).
An NST assesses the FHR during fetal movement. In a healthy fetus, the FHR accelerates with each movement. By pushing the control button when a fetal movement starts, the client marks the strip to allow easy correlation of fetal movement with the FHR.
Question 37 |
When evaluating a client’s knowledge of symptoms to report during her pregnancy, which statement would indicate to the nurse in charge that the client understands the information given to her?
A | A. “I’ll report increased frequency of urination.” |
B | B. “If I have blurred or double vision, I should call the clinic immediately.” |
C | C. “If I feel tired after resting, I should report it immediately.” |
D | D. “Nausea should be reported immediately.” |
Question 37 Explanation:
Correct Answer: B. (“If I have blurred or double vision, I should call the clinic immediately.”)
Blurred or double vision may indicate hypertension or preeclampsia and should be reported immediately. It can affect the visual pathways, from the anterior segment to the visual cortex.
Question 38 |
When assessing a client during her first prenatal visit, the nurse discovers that the client had a reduction mammoplasty. The mother indicates she wants to breast-feed. What information should the nurse give to this mother regarding breastfeeding success?
A | A. “It’s contraindicated for you to breastfeed following this type of surgery.” |
B | B. “I support your commitment; however, you may have to supplement each feeding with formula.” |
C | C. “You should check with your surgeon to determine whether breast-feeding would be possible.” |
D | D. “You should be able to breastfeed without difficulty.” |
Question 38 Explanation:
Correct Answer: B. (“I support your commitment; however, you may have to supplement each feeding with formula.”)
Recent breast reduction surgeries are done in a way to protect the milk sacs and ducts, so breastfeeding after surgery is possible. Still, it’s good to check with the surgeon to determine what breast reduction procedure was done. There is the possibility that reduction surgery may have decreased the mother’s ability to meet all of her baby’s nutritional needs, and some supplemental feeding may be required. Preparing the mother for this possibility is extremely important because the client’s psychological adaptation to mothering may be dependent on how successfully she breast-feeds.
Question 39 |
Following a precipitous delivery, examination of the client’s vagina reveals a fourth-degree laceration. Which of the following would be contraindicated when caring for this client?
A | A. Applying cold to limit edema during the first 12 to 24 hours. |
B | B. Instructing the client to use two or more peri pads to cushion the area. |
C | C. Instructing the client on the use of sitz baths if ordered. |
D | D. Instructing the client about the importance of perineal (Kegel) exercises. |
Question 39 Explanation:
Correct Answer: B. (Instructing the client to use two or more peri pads to cushion the area).
Using two or more peripads would do little to reduce the pain or promote perineal healing. A fourth-degree perineal laceration is the injury to the perineum involving the anal sphincter complex and anorectal mucosa.
Question 40 |
A client makes a routine visit to the prenatal clinic. Although she is 14 weeks pregnant, the size of her uterus approximates that in an 18- to 20-week pregnancy. Dr. Charles diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal:
A | A. An empty gestational sac. |
B | B. Grapelike clusters. |
C | C. A severely malformed fetus. |
D | D. An extrauterine pregnancy. |
Question 40 Explanation:
Correct Answer: B. (Grapelike clusters).
In a client with gestational trophoblastic disease, an ultrasound performed after the 3rd month shows grapelike clusters of transparent vesicles rather than a fetus. The vesicles contain a clear fluid and may involve all or part of the decidual lining of the uterus. Usually, no embryo (and therefore no fetus) is present because it has been absorbed.
Question 41 |
After completing a second vaginal examination of a client in labor, the nurse-midwife determines that the fetus is in the right occiput anterior position and at (–1) station. Based on these findings, the nurse-midwife knows that the fetal presenting part is:
A | A. 1 cm below the ischial spines. |
B | B. Directly in line with the ischial spines. |
C | C. 1 cm above the ischial spines. |
D | D. In no relationship to the ischial spines. |
Question 41 Explanation:
Correct Answer: C. (1 cm above the ischial spines).
Fetal station — the relationship of the fetal presenting part to the maternal ischial spines — is described in the number of centimeters above or below the spines. A presenting part above the ischial spines is designated as –1, –2, or –3.
Question 42 |
Which of the following would be inappropriate to assess in a mother who’s breastfeeding?
A | A. The attachment of the baby to the breast. |
B | B. The mother’s comfort level with positioning the baby. |
C | C. Audible swallowing. |
D | D. The baby’s lips smacking. |
Question 42 Explanation:
Correct Answer: D. (The baby’s lips smacking).
Assessing the attachment process for breast-feeding should include all of the answers except the smacking of lips. A baby who’s smacking his lips isn’t well attached and can injure the mother’s nipples.
Question 43 |
During a prenatal visit at 4 months gestation, a pregnant client asks whether tests can be done to identify fetal abnormalities. Between 18 and 40 weeks gestation, which procedure is used to detect fetal anomalies?
A | A. Amniocentesis |
B | B. Chorionic villi sampling |
C | C. Fetoscopy |
D | D. Ultrasound |
Question 43 Explanation:
Correct Answer: D. (Ultrasound).
Ultrasound is used between 18 and 40 weeks’ gestation to identify normal fetal growth and detect fetal anomalies and other problems.
Question 44 |
A client, 30 weeks pregnant, is scheduled for a biophysical profile (BPP) to evaluate the health of her fetus. Her BPP score is 8. What does this score indicate?
A | A. The fetus should be delivered within 24 hours. |
B | B. The client should repeat the test in 24 hours. |
C | C. The fetus isn’t in distress at this time. |
D | D. The client should repeat the test in 1 week. |
Question 44 Explanation:
Correct Answer: C. (The fetus isn’t in distress at this time).
The BPP evaluates fetal health by assessing five variables: fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate, and qualitative amniotic fluid volume. A normal response for each variable receives 2 points; an abnormal response receives 0 points. A score between 8 and 10 is considered normal, indicating that the fetus has a low risk of oxygen deprivation and isn’t in distress. A fetus with a score of 6 or lower is at risk for asphyxia and premature birth; this score warrants detailed investigation. The BPP may or may not be repeated if the score isn’t within normal limits.
Question 45 |
A client who is 36 weeks pregnant comes to the clinic for a prenatal checkup. To assess the client’s preparation for parenting, the nurse might ask which question?
A | A. “Are you planning to have epidural anesthesia?” |
B | B. “Have you begun prenatal classes?” |
C | C. “What changes have you made at home to get ready for the baby?” |
D | D. “Can you tell me about the meals you typically eat each day?” |
Question 45 Explanation:
Correct Answer: C. (“What changes have you made at home to get ready for the baby?”)
During the third trimester, the pregnant client typically perceives the fetus as a separate being. To verify that this has occurred, the nurse should ask whether she has made appropriate changes at home such as obtaining infant supplies and equipment.
Question 46 |
A client who’s admitted to labor and delivery has the following assessment findings: gravida 2 para 1, estimated 40 weeks gestation, contractions 2 minutes apart, lasting 45 seconds, vertex +4 station. Which of the following would be the priority at this time?
A | A. Placing the client in bed to begin fetal monitoring. |
B | B. Preparing for immediate delivery. |
C | C. Checking for ruptured membranes. |
D | D. Providing comfort measures. |
Question 46 Explanation:
Correct Answer: B. (Preparing for immediate delivery).
This question requires an understanding of station as part of the intrapartum assessment process. Based on the client’s assessment findings, this client is ready for delivery, which is the nurse’s top priority.
Question 47 |
The nurse is caring for a client in labor. The external fetal monitor shows a pattern of variable decelerations in fetal heart rate. What should the nurse do first?
A | A. Change the client’s position. |
B | B. Prepare for an emergency cesarean section. |
C | C. Check for placenta previa. |
D | D. Administer oxygen. |
Question 47 Explanation:
Correct Answer: A. (Change the client’s position).
Variable decelerations in fetal heart rate are an ominous sign, indicating compression of the umbilical cord. Changing the client’s position from supine to side-lying may immediately correct the problem.
Question 48 |
The nurse in charge is caring for a postpartum client who had a vaginal delivery with a midline episiotomy. Which nursing diagnosis takes priority for this client?
A | A. Risk for deficient fluid volume related to hemorrhage. |
B | B. Risk for infection related to the type of delivery. |
C | C. Pain related to the type of incision. |
D | D. Urinary retention related to periurethral edema. |
Question 48 Explanation:
Correct Answer: A. (Risk for deficient fluid volume related to hemorrhage).
Hemorrhage jeopardizes the client’s oxygen supply — the first priority among human physiological needs. Therefore, the nursing diagnosis of Risk for deficient fluid volume related to hemorrhage takes priority over-diagnoses of Risk for Infection, Pain, and Urinary retention.
Question 49 |
Which change would the nurse identify as a progressive physiological change in the postpartum period?
A | A. Lactation |
B | B. Lochia |
C | C. Uterine involution |
D | D. Diuresis |
Question 49 Explanation:
Correct Answer: A. (Lactation).
Lactation is an example of a progressive physiological change that occurs during the postpartum period. Lactation is the process of milk production.
Question 50 |
A 39-year-old at 37 weeks gestation is admitted to the hospital with complaints of vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is most likely causing the client’s complaint of vaginal bleeding?
A | A. Placenta previa |
B | B. Abruptio placentae |
C | C. Ectopic pregnancy |
D | D. Spontaneous abortion |
Question 50 Explanation:
Correct Answer: B. (Abruptio placentae).
The major maternal adverse reactions from cocaine use in pregnancy include spontaneous abortion first, not third, trimester abortion and abruptio placentae. The hypertension and increased levels of catecholamines caused by cocaine abuse are thought to be responsible for a vasospasm in the uterine blood vessels that causes placental separation and abruption.
Question 51 |
A client with type 1 diabetes mellitus who is a multigravida visits the clinic at 27 weeks gestation. The nurse should instruct the client that for most pregnant women with type 1 diabetes mellitus:
A | A. Weekly fetal movement counts are made by the mother. |
B | B. Contraction stress testing is performed weekly. |
C | C. Induction of labor begins at 34 weeks’ gestation. |
D | D. Nonstress testing is performed weekly until 32 weeks’ gestation. |
Question 51 Explanation:
Correct Answer: D. (Nonstress testing is performed weekly until 32 weeks’ gestation).
For most clients with type 1 diabetes mellitus, non-stress testing is done weekly until 32 weeks’ gestation and twice a week to assess fetal well-being.
Question 52 |
When administering magnesium sulfate to a client with preeclampsia, the nurse understands that this drug is given to:
A | A. Prevent seizures. |
B | B. Reduce blood pressure. |
C | C. Slow the process of labor. |
D | D. Increase diuresis. |
Question 52 Explanation:
Correct Answer: A. (Prevent seizures).
The chemical makeup of magnesium is similar to that of calcium and, therefore, magnesium will act like calcium in the body. As a result, magnesium will block seizure activity in a hyper-stimulated neurologic system by interfering with signal transmission at the neuromuscular junction.
Question 53 |
What is the approximate time that the blastocyst spends traveling to the uterus for implantation?
A | A. 2 days |
B | B. 7 days |
C | C. 10 days |
D | D. 14 weeks |
Question 53 Explanation:
Correct Answer: B. (7 days).
The blastocyst takes approximately 1 week to travel to the uterus for implantation. Implantation is a process in which a developing embryo, moving as a blastocyst through a uterus, makes contact with the uterine wall and remains attached to it until birth.
Question 54 |
After teaching a pregnant woman who is in labor about the purpose of the episiotomy, which of the following purposes stated by the client would indicate to the nurse that the teaching was effective?
A | A. Shortens the second stage of labor. |
B | B. Enlarges the pelvic inlet. |
C | C. Prevents perineal edema. |
D | D. Ensures quick placenta delivery. |
Question 54 Explanation:
Correct Answer: A. (Shortens the second stage of labor).
An episiotomy serves several purposes. It shortens the second stage of labor, substitutes a clean surgical incision for a tear, and decreases undue stretching of perineal muscles. An episiotomy helps prevent tearing of the rectum but it does not necessarily relieve pressure on the rectum. Tearing may still occur.
Question 55 |
A primigravida client at about 35 weeks gestation in active labor has had no prenatal care and admitted to cocaine use during the pregnancy. Which of the following persons must the nurse notify?
A | A. Nursing unit manager so appropriate agencies can be notified. |
B | B. Head of the hospital’s security department. |
C | C. Chaplain in case the fetus dies in utero. |
D | D. Physician who will attend the delivery of the infant. |
Question 55 Explanation:
Correct Answer: D. (Physician who will attend the delivery of the infant).
The fetus of a cocaine-addicted mother is at risk for hypoxia, meconium aspiration, and intrauterine growth retardation (IUGR). Therefore, the nurse must notify the physician of the client’s cocaine use because this knowledge will influence the care of the client and neonate. The information is used only in relation to the client’s care.
Question 56 |
When preparing a teaching plan for a client who is to receive a rubella vaccine during the postpartum period, the nurse in charge should include which of the following?
A | A. The vaccine prevents a future fetus from developing congenital anomalies. |
B | B. Pregnancy should be avoided for 3 months after the immunization. |
C | C. The client should avoid contact with children diagnosed with rubella. |
D | D. The injection will provide immunity against the 7-day measles. |
Question 56 Explanation:
Correct Answer: B. (Pregnancy should be avoided for 3 months after the immunization).
After administration of rubella vaccine, the client should be instructed to avoid pregnancy for at least 3 months to prevent the possibility of the vaccine’s toxic effects to the fetus.
Question 57 |
A client with eclampsia begins to experience a seizure. Which of the following would the nurse in charge do first?
A | A. Pad the side rails. |
B | B. Place a pillow under the left buttock. |
C | C. Insert a padded tongue blade into the mouth. |
D | D. Maintain a patent airway. |
Question 57 Explanation:
Correct Answer: D. (Maintain a patent airway).
The priority for the pregnant client having a seizure is to maintain a patent airway to ensure adequate oxygenation to the mother and the fetus. Additionally, oxygen may be administered by face mask to prevent fetal hypoxia.
Question 58 |
While caring for a multigravida client in early labor in a birthing center, which of the following foods would be best if the client requests a snack?
A | A. Yogurt |
B | B. Cereal with milk |
C | C. Vegetable soup |
D | D. Peanut butter cookies |
Question 58 Explanation:
Correct Answer: A. (Yogurt).
In some birth settings, intravenous therapy is not used with low-risk clients. Thus, clients in early labor are encouraged to eat healthy snacks and drink fluid to avoid dehydration. Yogurt, which is an excellent source of calcium and riboflavin, is soft and easily digested. During pregnancy, gastric emptying time is delayed. In most hospital settings, clients are allowed only ice chips or clear liquids.
Question 59 |
The multigravida mother with a history of rapid labor who is in active labor calls out to the nurse, “The baby is coming!” Which of the following would be the nurse’s first action?
A | A. Inspect the perineum |
B | B. Time the contractions |
C | C. Auscultate the fetal heart rate |
D | D. Contact the birth attendant. |
Question 59 Explanation:
Correct Answer: A. (Inspect the perineum).
When the client says the baby is coming, the nurse should first inspect the perineum and observe for crowning to validate the client’s statement. If the client is not delivering precipitously, the nurse can calm her and use appropriate breathing techniques.
Question 60 |
While assessing a primipara during the immediate postpartum period, the nurse in charge plans to use both hands to assess the client’s fundus to:
A | A. Prevent uterine inversion. |
B | B. Promote uterine involution. |
C | C. Hasten the puerperium period. |
D | D. Determine the size of the fundus. |
Question 60 Explanation:
Correct Answer: A. (Prevent uterine inversion).
Using both hands to assess the fundus is useful for preventing uterine inversion. The recent uterine inversion with placenta already separated from it may often be replaced by manually pushing up on the fundus with the palm and fingers in the direction of the long axis of the vagina.
Question 61 |
Which behaviors would be exhibited during the letting-go phase of maternal role adaptation. Select all that apply.
A | A. Emergence of the family unit. |
B | B. Dependent behaviors. |
C | C. Sexual intimacy continues. |
D | D. Defining one's individual roles. |
E | E. Being talkative and excited about becoming a mother. |
Question 61 Explanation:
Correct Answer: (Answer: A, C, & D).
The emergence of family unit, sexual intimacy relationship continuing and defining one’s individual roles represent interdependent behaviors associated with the letting-go phase. During the letting go phase, the woman finally accepts her new role and gives up her old roles like being a childless woman or just a mother of one child.
Question 62 |
While making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically:
A | A. Express a strong need to review the events and her behavior during the process of labor and birth. |
B | B. Exhibit a reduced attention span, limiting readiness to learn. |
C | C. Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn. |
D | D. Have reestablished her role as a spouse or partner. |
Question 62 Explanation:
Correct Answer: C. (Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn).
One week after birth the woman should exhibit behaviors characteristic of the dependent-independent or taking-hold stage. She still has needs for nurturing and acceptance by others.
Question 63 |
Which of the following is the most common kind of placental adherence seen in pregnant women?
A | A. Accreta |
B | B. Placenta previa |
C | C. Percreta |
D | D. Increta |
Question 63 Explanation:
Correct Answer: A. (Accreta).
Placenta accreta is the most common kind of placental adherence seen in pregnant women and is characterized by slight penetration of myometrium.
Question 64 |
A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time?
A | A. Biophysical profile |
B | B. Amniocentesis |
C | C. Maternal serum alpha-fetoprotein (MSAFP) |
D | D. Transvaginal ultrasound |
Question 64 Explanation:
Correct Answer: D. (Transvaginal ultrasound).
An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age. Transvaginal ultrasound is especially useful for obese women, whose thick abdominal layers cannot be penetrated adequately with the abdominal approach.
Question 65 |
A nurse providing care for the antepartum woman should understand that the contraction stress test (CST):
A | A. Sometimes uses vibroacoustic stimulation. |
B | B. Is an invasive test; however, contractions are stimulated. |
C | C. Is considered to have a negative result if no late decelerations are observed with the contractions. |
D | D. Is more effective than nonstress test (NST) if the membranes have already been ruptured. |
Question 65 Explanation:
Correct Answer: C. (Is considered to have a negative result if no late decelerations are observed with the contractions).
No late decelerations indicate a positive CST result.
Question 66 |
In the past, factors to determine whether a woman was likely to have a high-risk pregnancy were evaluated primarily from a medical point of view. A broader, more comprehensive approach to high-risk pregnancy has been adopted. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. Which of the options listed here is not included as a category?
A | A. Biophysical |
B | B. Psychosocial |
C | C. Geographic |
D | D. Environmental |
Question 66 Explanation:
Correct Answer: C. (Geographic).
The fourth category is correctly referred to as the sociodemographic risk category. Several risk factors for high-risk pregnancy were present before pregnancy, including multiple pregnancies, maternal age under 16 or over 35 years, and interval between pregnancies less than one year.
Question 67 |
A woman who is at 36 weeks of gestation is having a nonstress test. Which statement indicates her correct understanding of the test?
A | A. "I will need to have a full bladder for the test to be done accurately." |
B | B. "I should have my husband drive me home after the test because I may be nauseated." |
C | C. "This test will help to determine whether the baby has Down syndrome or a neural tube defect." |
D | D. "This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby." |
Question 67 Explanation:
Correct Answer: D. (“This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby.”)
The nonstress test is one of the most widely used techniques to determine fetal well-being and is accomplished by monitoring fetal heart rate in conjunction with fetal activity and movements.
Question 68 |
What is an appropriate indicator for performing a contraction stress test?
A | A. Increased fetal movement and small for gestational age. |
B | B. Maternal diabetes mellitus and postmaturity. |
C | C. Adolescent pregnancy and poor prenatal care. |
D | D. History of preterm labor and intrauterine growth restriction. |
Question 68 Explanation:
Correct Answer: B. (Maternal diabetes mellitus and postmaturity).
The contraction stress test helps predict how the baby will do during labor. The test triggers contractions and registers how the baby’s heart reacts. A normal heartbeat is a good sign that the baby will be healthy during labor.
Question 69 |
The midwife sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis?
A | A. Doppler blood flow analysis |
B | B. Contraction stress test (CST) |
C | C. Amniocentesis |
D | D. Daily fetal movement counts |
Question 69 Explanation:
Correct Answer: A. (Doppler blood flow analysis).
Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high-risk pregnancy due to intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor.
Question 70 |
A nurse is providing instruction for an obstetrical patient to perform a daily fetal movement count (DFMC). Which instructions could be included in the plan of care? Select all that apply.
A | A. The fetal alarm signal is reached when there are no fetal movements noted for 5 hours. |
B | B. The patient can monitor fetal activity once daily for a 60-minute period and note activity. |
C | C. Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fetal movements are noted. |
D | D. Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted. |
Question 70 Explanation:
Correct Answer: (B, C, & D).
The fetal alarm signal is reached when no fetal movements are noted for a period of 12 hours. Fetal movement is one show of a baby’s health in the womb. Each woman should learn the normal pattern and number of movements for her own baby. A change in the normal pattern or number of fetal movements may mean the baby is under stress. And it’s not normal for a baby to stop moving with the start of labor.
Question 71 |
A patient has undergone an amniocentesis for evaluation of fetal well-being. Which intervention would be included in the nurse’s plan of care after the procedure? Select all that apply.
A | A. Perform ultrasound to determine fetal positioning. |
B | B. Observe the patient for possible uterine contractions. |
C | C. Administer RhoGAM to the patient if she is Rh-negative. |
D | D. Perform a mini catheterization to obtain a urine specimen to assess for bleeding. |
Question 71 Explanation:
Correct Answer: (B & C).
Ultrasound is used prior to the procedure as a visualization aid to assist with insertion of the transabdominal needle. RhoGAM is a prescription medicine that is used to prevent Rh immunization, a condition in which an individual with Rh-negative blood develops antibodies after exposure to Rh-positive blood. RhoGAM is administered by intramuscular (IM) injection. RhoGAM is purified from human plasma containing anti-Rh (anti-D).
Question 72 |
With regard to small-for-gestational-age (SGA) infants and intrauterine growth restriction (IUGR), nurses should be aware that:
A | A. In the first trimester, diseases or abnormalities result in asymmetric IUGR. |
B | B. Infants with asymmetric IUGR have the potential for normal growth and development. |
C | C. In asymmetric IUGR, weight is slightly more than SGA, whereas length and head circumference are somewhat less than SGA. |
D | D. Symmetric IUGR occurs in the later stages of pregnancy. |
Question 72 Explanation:
Correct Answer: B. (Infants with asymmetric IUGR have the potential for normal growth and development).
The infant with asymmetric IUGR has the potential for normal growth and development. SGA infants have reduced brain capacity. The asymmetric form occurs in the later stages of pregnancy.
Question 73 |
A client who delivered by cesarean section 24 hours ago is using a patient-controlled analgesia (PCA) pump for pain control. Her oral intake has been ice chips only since surgery. She is now complaining of nausea and bloating, and states that because she had nothing to eat, she is too weak to breastfeed her infant. Which nursing diagnosis has the highest priority?
A | A. Altered nutrition, less than body requirements for lactation. |
B | B. Alteration in comfort related to nausea and abdominal distention. |
C | C. Impaired bowel motility related to pain medication and immobility. |
D | D. Fatigue related to cesarean delivery and physical care demands of infant. |
Question 73 Explanation:
Correct Answer: C. (Impaired bowel motility related to pain medication and immobility).
Impaired bowel motility caused by surgical anesthesia, pain medication, and immobility is the priority nursing diagnosis and addresses the potential problem of a paralytic ileus.
Question 74 |
The midwife is teaching care of the newborn to a childbirth preparation class and describes the need for administering antibiotic ointment into the eyes of the newborn. An expectant father asks, “What type of disease causes infections in babies that can be prevented by using this ointment?” Which response by the nurse is accurate?
A | A. Herpes |
B | B. Trichomonas |
C | C. Gonorrhea |
D | D. Syphilis |
Question 74 Explanation:
Correct Answer: C. (Gonorrhea).
Erythromycin ointment is instilled into the lower conjunctiva of each eye within 2 hours after birth to prevent ophthalmia neonatorum, an infection caused by gonorrhea (C), and inclusion conjunctivitis, an infection caused by Chlamydia. The infant may be exposed to these bacteria when passing through the birth canal.
Question 75 |
A new mother is having trouble breastfeeding her newborn. The child is making frantic rooting motions and will not grasp the nipple. Which intervention should the nurse implement?
A | A. Encourage frequent use of a pacifier so that the infant becomes accustomed to sucking. |
B | B. Hold the infant's head firmly against the breast until he latches onto the nipple. |
C | C. Encourage the mother to stop feeding for a few minutes and comfort the infant. |
D | D. Provide a formula for the infant until he becomes calm, and then offer the breast again. |
Question 75 Explanation:
Correct Answer: C. (Encourage the mother to stop feeding for a few minutes and comfort the infant).
The infant is becoming frustrated and so is the mother; both need a time out. The mother should be encouraged to comfort the infant and to relax herself. After such a time out, breastfeeding is often more successful.
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