Obstetrical Nursing: Intrapartum Practice Quiz (60

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Question 1

CORRECT

A laboring client complains of low back pain. The nurse replies that this pain occurs most when
the position of the fetus is:

Breech

Transverse

Occiput anterior

Occiput posterior

Question 1 Explanation: 
A persistent occiput-posterior position causes intense back pain because of fetal compression
of the sacral nerves. Occiput anterior is the most common fetal position and does not cause
back pain.

Question 2

CORRECT

Labor is a series of events affected by the coordination of the five essential factors. One of
these is the passenger (fetus). Which are the other four factors?

Contractions, passageway, placental position and function, pattern

of care

Contractions, maternal response, placental position, psychological

 response

Passageway, contractions, placental position and function,

psychological response

Passageway, placental position and function, paternal response,

psychological response

Question 2 Explanation: 
The five essential factors (5 P’s) are passenger (fetus), passageway (pelvis), powers
(contractions), placental position and function, and psyche (psychological response of the
mother).

Question 3

WRONG

Perineal care is an important infection control measure. When evaluating a postpartum

woman’s perineal care technique, the nurse would recognize the need for further instruction if
the woman:

Uses soap and warm water to wash the vulva and perineum

Washes from symphysis pubis back to episiotomy

Changes her perineal pad every 2 – 3 hours

Uses the peribottle to rinse upward into her vagina

Question 3 Explanation: 
Responses 1, 2, and 3 are all appropriate measures. The peri bottle should be used in a
backward direction over the perineum. The flow should never be directed upward into the
vagina since debris would be forced upward into the uterus through the still-open cervix.

Question 4

CORRECT

A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant
following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to
monitor the client for which of the following risks associated with placenta previa?
 Disseminated intravascular coagulation

Chronic hypertension

Infection

Hemorrhage

Question 4 Explanation: 
Because the placenta is implanted in the lower uterine segment, which does not contain the
same intertwining musculature as the fundus of the uterus, this site is more prone to bleeding

Question 5

WRONG

A nurse in the labor room is preparing to care for a client with hypertonic uterine dysfunction.
The nurse is told that the client is experiencing uncoordinated contractions that are erratic in
their frequency, duration, and intensity. The priority nursing intervention would be to:

Monitor the Pitocin infusion closely

Provide pain relief measures

Prepare the client for an amniotomy

Promote ambulation every 30 minutes

Question 5 Explanation: 
Management of hypertonic labor depends on the cause. Relief of pain is the primary
intervention to promote a normal labor pattern.

Question 6

WRONG

Which of the following observations indicates fetal distress?

Fetal scalp pH of 7.14

 Fetal heart rate of 144 beats/minute

Acceleration of fetal heart rate with contractions

Presence of long term variability

Question 6 Explanation: 
A fetal scalp pH below 7.25 indicates acidosis and fetal hypoxia.

Question 7

CORRECT

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

Three contractions occurring within a 10-minute period

A fetal heart rate of 90 beats per minute

Adequate resting tone of the uterus palpated between contractions

Increased urinary output

Question 7 Explanation: 
A normal fetal heart rate is 120-160 BPM. Bradycardia or late or variable decelerations indicate
fetal distress and the need to discontinue to pitocin. The goal of labor augmentation is to
achieve three good-quality contractions in a 10-minute period.

Question 8

CORRECT

A nurse is reviewing the record of a client in the labor room and notes that the nurse midwife
has documented that the fetus is at (-1) station. The nurse determines that the fetal presenting
part is:

1 cm above the ischial spine

 1 fingerbreadth below the symphysis pubis

1 inch below the coccyx

1 inch below the iliac crest

Question 8 Explanation: 
Station is the relationship of the presenting part to an imaginary line drawn between the ischial
spines, is measured in centimeters, and is noted as a negative number above the line and a
positive number below the line. At -1 station, the fetal presenting part is 1 cm above the ischial
spines.

Question 9

CORRECT

An ultrasound is performed on a client at term gestation that is experiencing moderate vaginal

bleeding. The results of the ultrasound indicate that an abruptio placenta is present. Based on
these findings, the nurse would prepare the client for:

Complete bed rest for the remainder of the pregnancy

Delivery of the fetus

Strict monitoring of intake and output

The need for weekly monitoring of coagulation studies until the

time of delivery

Question 9 Explanation: 
The goal of management in abruptio placentae is to control the hemorrhage and deliver the
fetus as soon as possible. Delivery is the treatment of choice if the fetus is at term gestation or
if the bleeding is moderate to severe and the mother or fetus is in jeopardy.

Question 10

CORRECT

A maternity nurse is caring for a client with abruptio placenta and is monitoring the client for
disseminated intravascular coagulopathy. Which assessment finding is least likely to be
associated with disseminated intravascular coagulation?
 Swelling of the calf in one leg

Prolonged clotting times

Decreased platelet count

Petechiae, oozing from injection sites, and hematuria

Question 10 Explanation: 
DIC is a state of diffuse clotting in which clotting factors are consumed, leading to widespread
bleeding. Platelets are decreased because they are consumed by the process; coagulation
studies show no clot formation (and are thus normal to prolonged); and fibrin plugs may clog
the microvasculature diffusely, rather than in an isolated area. The presence of petechiae,
oozing from injection sites, and hematuria are signs associated with DIC. Swelling and pain in
the calf of one leg are more likely to be associated with thrombophlebitis.

Question 11

CORRECT

A nurse assists in the vaginal delivery of a newborn infant. After the delivery, the nurse
observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse
documents these observations as signs of:

Hematoma

Placenta previa

Uterine atony

Placental separation

Question 11 Explanation: 
As the placenta separates, it settles downward into the lower uterine segment. The umbilical
cord lengthens, and a sudden trickle or spurt of blood appears.

Question 12

CORRECT
A client is admitted to the birthing suite in early active labor. The priority nursing intervention
on admission of this client would be:

Auscultating the fetal heart

Taking an obstetric history

Asking the client when she last ate

Ascertaining whether the membranes were ruptured

Question 12 Explanation: 
Determining the fetal well-being supersedes all other measures. If the FHR is absent or
persistently decelerating, immediate intervention is required.

Question 13

CORRECT

The physician asks the nurse the frequency of a laboring client’s contractions. The nurse
assesses the client’s contractions by timing from the beginning of one contraction:

Until the time it is completely over

To the end of a second contraction

To the beginning of the next contraction

Until the time that the uterus becomes very firm

Question 13 Explanation: 
This is the way to determine the frequency of the contractions

Question 14

CORRECT

A client arrives at a birthing center in active labor. Her membranes are still intact, and the
nurse-midwife prepares to perform an amniotomy. A nurse who is assisting the nurse-midwife
explains to the client that after this procedure, she will most likely have:
 Less pressure on her cervix

Increased efficiency of contractions

Decreased number of contractions

The need for increased maternal blood pressure monitoring

Question 14 Explanation: 
Amniotomy can be used to induce labor when the condition of the cervix is favorable (ripe) or
to augment labor if the process begins to slow. Rupturing of membranes allows the fetal head
to contact the cervix more directly and may increase the efficiency of contractions.

Question 15

CORRECT

A nurse explains the purpose of effleurage to a client in early labor. The nurse tells the client
that effleurage is:

A form of biofeedback to enhance bearing down efforts during

delivery

Light stroking of the abdomen to facilitate relaxation during

labor and provide tactile stimulation to the fetus

The application of pressure to the sacrum to relieve a backache

Performed to stimulate uterine activity by contracting a specific

muscle group while other parts of the body rest

Question 15 Explanation: 
Effleurage is a specific type of cutaneous stimulation involving light stroking of the abdomen
and is used before transition to promote relaxation and relieve mild to moderate pain.
Effleurage provides tactile stimulation to the fetus.

Question 16

WRONG
Which of the following findings meets the criteria of a reassuring FHR pattern?

FHR does not change as a result of fetal activity

Average baseline rate ranges between 100 – 140 BPM

Mild late deceleration patterns occur with some contractions

Variability averages between 6 – 10 BPM

Question 16 Explanation: 
Variability indicates a well oxygenated fetus with a functioning autonomic nervous system. FHR
should accelerate with fetal movement. Baseline range for the FHR is 120 to 160 beats per
minute. Late deceleration patterns are never reassuring, though early and mild variable
decelerations are expected, reassuring findings.

Question 17

CORRECT

A nurse is caring for a client in labor and prepares to auscultate the fetal heart rate by using a
Doppler ultrasound device. The nurse most accurately determines that the fetal heart sounds
are heard by:

Noting if the heart rate is greater than 140 BPM

Placing the diaphragm of the Doppler on the mother abdomen

Performing Leopold’s maneuvers first to determine the location of

the fetal heart

Palpating the maternal radial pulse while listening to the fetal

heart rate

Question 17 Explanation: 
The nurse simultaneously should palpate the maternal radial or carotid pulse and auscultate
the fetal heart rate to differentiate the two. If the fetal and maternal heart rates are similar, the
nurse may mistake the maternal heart rate for the fetal heart rate. Leopold’s maneuvers may
help the examiner locate the position of the fetus but will not ensure a distinction between the
two rates.
Question 18

CORRECT

A nurse is performing an assessment of a client who is scheduled for a cesarean delivery. Which
assessment finding would indicate a need to contact the physician?

Fetal heart rate of 180 beats per minute

White blood cell count of 12,000

Maternal pulse rate of 85 beats per minute

Hemoglobin of 11.0 g/dL

Question 18 Explanation: 
A normal fetal heart rate is 120-160 beats per minute. A count of 180 beats per minute could
indicate fetal distress and would warrant physician notification. By full term, a normal maternal
hemoglobin range is 11-13 g/dL as a result of the hemodilution caused by an increase in plasma
volume during pregnancy.

Question 19

WRONG

A laboring client has external electronic fetal monitoring in place. Which of the following
assessment data can be determined by examining the fetal heart rate strip produced by the
external electronic fetal monitor?

Gender of the fetus

Fetal position

Labor progress

Oxygenation

Question 19 Explanation: 
Oxygenation of the fetus may be indirectly assessed through fetal monitoring by closely
examining the fetal heart rate strip. Accelerations in the fetal heart rate strip indicate good
oxygenation, while decelerations in the fetal heart rate sometimes indicate poor fetal
oxygenation.

Question 20

WRONG

At 38 weeks gestation, a client is having late decelerations. The fetal pulse oximeter shows 75%
to 85%. The nurse should:

Discontinue the catheter, if the reading is not above 80%

Discontinue the catheter, if the reading does not go below 30%

Advance the catheter until the reading is above 90% and

continue monitoring

Reposition the catheter, recheck the reading, and if it is 55%, keep

monitoring

Question 20 Explanation: 
Adjusting the catheter would be indicated. Normal fetal pulse oximetry should be between 30%
and 70%. 75% to 85% would indicate maternal readings.

Question 21

WRONG

A client is admitted to the L & D suite at 36 weeks’ gestation. She has a history of C-section and
complains of severe abdominal pain that started less than 1 hour earlier. When the nurse
palpates tetanic contractions, the client again complains of severe pain. After the client vomits,
she states that the pain is better and then passes out. Which is the probable cause of her signs
and symptoms?

Hysteria compounded by the flu

Placental abruption

Uterine rupture
 Dysfunctional labor

Question 21 Explanation: 
Uterine rupture is a medical emergency that may occur before or during labor. Signs and
symptoms typically include abdominal pain that may ease after uterine rupture, vomiting,
vaginal bleeding, hypovolemic shock, and fetal distress. With placental abruption, the client
typically complains of vaginal bleeding and constant abdominal pain.

Question 22

WRONG

Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby,
stating that she is too tired and just wants to sleep. The nurse should:

Tell the woman she can rest after she feeds her baby

Recognize this as a behavior of the taking-hold stage

Record the behavior as ineffective maternal-newborn attachment

Take the baby back to the nursery, reassuring the woman that her
rest is a priority at this time

Question 22 Explanation: 
Response 1 does not take into consideration the need for the new mother to be nurtured and
have her needs met during the taking-in stage. The behavior described is typical of this stage
and not a reflection of ineffective attachment unless the behavior persists. Mothers need to
reestablish their own well-being in order to effectively care for their baby.

Question 23

CORRECT

A nurse is admitting a pregnant client to the labor room and attaches an external electronic
fetal monitor to the client’s abdomen. After attachment of the monitor, the initial nursing
assessment is which of the following?

Identifying the types of accelerations

Assessing the baseline fetal heart rate

 Determining the frequency of the contractions

Determining the intensity of the contractions

Question 23 Explanation: 
Assessing the baseline fetal heart rate is important so that abnormal variations of the baseline
rate will be identified if they occur. Options 1 and 3 are important to assess, but not as the first
priority.

Question 24

CORRECT

A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted to
the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following
assessment findings would the nurse expect to note if this condition is present?

Absence of abdominal pain

A soft abdomen

Uterine tenderness/pain

Painless, bright red vaginal bleeding

Question 24 Explanation: 
In abruptio placentae, acute abdominal pain is present. Uterine tenderness and pain
accompanies placental abruption, especially with a central abruption and trapped blood behind
the placenta. The abdomen will feel hard and boardlike on palpation as the blood penetrates
the myometrium and causes uterine irritability. Observation of the fetal monitoring often
reveals increased uterine resting tone, caused by failure of the uterus to relax in attempt to
constrict blood vessels and control bleeding.

Question 25

CORRECT

A client in labor is transported to the delivery room and is prepared for a cesarean delivery. The
client is transferred to the delivery room table, and the nurse places the client in the:

Trendelenburg’s position with the legs in stirrups

 Semi-Fowler position with a pillow under the knees

Prone position with the legs separated and elevated

Supine position with a wedge under the right hip

Question 25 Explanation: 
Vena cava and descending aorta compression by the pregnant uterus impedes blood return
from the lower trunk and extremities. This leads to decreasing cardiac return, cardiac output,
and blood flow to the uterus and the fetus. The best position to prevent this would be side-lying
with the uterus displaced off of abdominal vessels. Positioning for abdominal surgery
necessitates a supine position; however, a wedge placed under the right hip provides
displacement of the uterus.

Question 26

CORRECT

During the period of induction of labor, a client should be observed carefully for signs of:

Severe pain

Uterine tetany

Hypoglycemia

Umbilical cord prolapse

Question 26 Explanation: 
Uterine tetany could result from the use of oxytocin to induce labor. Because oxytocin
promotes powerful uterine contractions, uterine tetany may occur. The oxytocin infusion must
be stopped to prevent uterine rupture and fetal compromise.

Question 27

CORRECT

The breathing technique that the mother should be instructed to use as the fetus’ head is
crowning is:
 Blowing

Slow chest

Shallow

Accelerated-decelerated

Question 27 Explanation: 
Blowing forcefully through the mouth controls the strong urge to push and allows for a more
controlled birth of the head.

Question 28

WRONG

A laboring client is in the first stage of labor and has progressed from 4 to 7 cm in cervical
dilation. In which of the following phases of the first stage does cervical dilation occur most
rapidly?

Preparatory phase

Latent phase

Active phase

Transition phase

Question 28 Explanation: 
Cervical dilation occurs more rapidly during the active phase than any of the previous phases.
The active phase is characterized by cervical dilation that progresses from 4 to 7 cm. The
preparatory, or latent, phase begins with the onset of regular uterine contractions and ends
when rapid cervical dilation begins. Transition is defined as cervical dilation beginning at 8 cm
and lasting until 10 cm or complete dilation.

Question 29

CORRECT
A multiparous client who has been in labor for 2 hours states that she feels the urge to move
her bowels. How should the nurse respond?

Let the client get up to use the potty

Allow the client to use a bedpan

Perform a pelvic examination

Check the fetal heart rate

Question 29 Explanation: 
A complaint of rectal pressure usually indicates a low presenting fetal part, signaling imminent
delivery. The nurse should perform a pelvic examination to assess the dilation of the cervix and
station of the presenting fetal part.

Question 30

WRONG

Parents can facilitate the adjustment of their other children to a new baby by:

Having the children choose or make a gift to give to the new baby
upon its arrival home

Emphasizing activities that keep the new baby and other

children together

Having the mother carry the new baby into the home so she can
show the other children the new baby

Reducing stress on other children by limiting their involvement in

the care of the new baby

Question 30 Explanation: 
Special time should be set aside just for the other children without interruption from the
newborn. Someone other than the mother should carry the baby into the home so she can give
full attention to greeting her other children. Children should be actively involved in the care of
the baby according to their ability without overwhelming them.

Question 31
 CORRECT

A pregnant client is admitted to the labor room. An assessment is performed, and the nurse
notes that the client’s hemoglobin and hematocrit levels are low, indicating anemia. The nurse
determines that the client is at risk for which of the following?

A loud mouth

Low self-esteem

Hemorrhage

Postpartum infections

Question 31 Explanation: 
Anemic women have a greater likelihood of cardiac decompensation during labor, postpartum
infection, and poor wound healing. Anemia does not specifically present a risk for hemorrhage.
Having a loud mouth is only related to the person typing up this test.

Question 32

WRONG

When monitoring the fetal heart rate of a client in labor, the nurse identifies an elevation of 15
beats above the baseline rate of 135 beats per minute lasting for 15 seconds. This should be
documented as:

An acceleration

An early elevation

A sonographic motion

A tachycardic heart rate

Question 32 Explanation: 
An acceleration is an abrupt elevation above the baseline of 15 beats per minute for 15
seconds; if the acceleration persists for more than 10 minutes it is considered a change in
baseline rate. A tachycardic FHR is above 160 beats per minute.
Question 33

CORRECT

When making a visit to the home of a postpartum woman one week after birth, the nurse
should recognize that the woman would characteristically:

Express a strong need to review events and her behavior during the
process of labor and birth

Exhibit a reduced attention span, limiting readiness to learn

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

Have reestablished her role as a spouse/partner

Question 33 Explanation: 
One week after birth the woman should exhibit behaviors characteristic of the taking-hold
stage as described in response 3. This stage lasts for as long as 4 to 5 weeks after birth.
Responses 1 and 2 are characteristic of the taking-in stage, which lasts for the first few days
after birth. Response 4 reflects the letting-go stage, which indicates that psychosocial recovery
is complete.

Question 34

WRONG

When examining the fetal monitor strip after rupture of the membranes in a laboring client, the
nurse notes variable decelerations in the fetal heart rate. The nurse should:

Stop the oxytocin infusion

Change the client’s position

Prepare for immediate delivery

Take the client’s blood pressure

Question 34 Explanation: 
Variable decelerations usually are seen as a result of cord compression; a change of position
will relieve pressure on the cord.

Question 35

WRONG

A maternity nurse is preparing to care for a pregnant client in labor who will be delivering twins.
The nurse monitors the fetal heart rates by placing the external fetal monitor:

Over the fetus that is most anterior to the mother’s abdomen

Over the fetus that is most posterior to the mother’s abdomen

So that each fetal heart rate is monitored separately

So that one fetus is monitored for a 15-minute period followed

by a 15 minute fetal monitoring period for the second fetus

Question 35 Explanation: 
In a client with a multi-fetal pregnancy, each fetal heart rate is monitored separately.

Question 36

WRONG

A nurse in the delivery room is assisting with the delivery of a newborn infant. After the delivery
of the newborn, the nurse assists in delivering the placenta. Which observation would indicate
that the placenta has separated from the uterine wall and is ready for delivery?

The umbilical cord shortens in length and changes in color

A soft and boggy uterus

Maternal complaints of severe uterine cramping

Changes in the shape of the uterus

Question 36 Explanation: 
Signs of placental separation include lengthening of the umbilical cord, a sudden gush of dark
blood from the introitus (vagina), a firmly contracted uterus, and the uterus changing from a
discoid (like a disk) to a globular (like a globe) shape. The client may experience vaginal fullness,
but not severe uterine cramping.

Question 37

WRONG

A nurse is monitoring a client in active labor and notes that the client is having contractions
every 3 minutes that last 45 seconds. The nurse notes that the fetal heart rate between
contractions is 100 BPM. Which of the following nursing actions is most appropriate?

Encourage the client’s coach to continue to encourage breathing

exercises

Encourage the client to continue pushing with each contraction

Continue monitoring the fetal heart rate

Notify the physician or nurse midwife

Question 37 Explanation: 
A normal fetal heart rate is 120-160 beats per minute. Fetal bradycardia between contractions
may indicate the need for immediate medical management, and the physician or nurse midwife
needs to be notified.

Question 38

WRONG

A nurse is caring for a client in labor and is monitoring the fetal heart rate patterns. The nurse
notes the presence of episodic accelerations on the electronic fetal monitor tracing. Which of
the following actions is most appropriate?

Document the findings and tell the mother that the monitor
indicates fetal well-being

Take the mother’s vital signs and tell the mother that bed rest is
required to conserve oxygen

Notify the physician or nurse midwife of the findings

 Reposition the mother and check the monitor for changes in
the fetal tracing

Question 38 Explanation: 
Accelerations are transient increases in the fetal heart rate that often accompany contractions
or are caused by fetal movement. Episodic accelerations are thought to be a sign of fetal-well
being and adequate oxygen reserve.

Question 39

CORRECT

A maternity nurse is preparing for the admission of a client in the 3rd trimester of pregnancy
that is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The
nurse reviews the physician’s orders and would question which order?

Prepare the client for an ultrasound

Obtain equipment for external electronic fetal heart monitoring

Obtain equipment for a manual pelvic examination

Prepare to draw a Hgb and Hct blood sample

Question 39 Explanation: 
Manual pelvic examinations are contraindicated when vaginal bleeding is apparent in the 3rd
trimester until a diagnosis is made and placental previa is ruled out. Digital examination of the
cervix can lead to maternal and fetal hemorrhage. A diagnosis of placenta previa is made by
ultrasound. The H/H levels are monitored, and external electronic fetal heart rate monitoring is
initiated. External fetal monitoring is crucial in evaluating the fetus that is at risk for severe
hypoxia.

Question 40

CORRECT

A nurse is monitoring a client in labor who is receiving Pitocin and notes that the client is
experiencing hypertonic uterine contractions. List in order of priority the actions that the nurse
takes. 1. Stop of Pitocin infusion 2. Perform a vaginal examination 3. Reposition the client 4.
Check the client’s blood pressure and heart rate 5. Administer oxygen by face mask at 8 to 10
L/min
 1, 2, 3, 4, 5

1, 4, 2, 3, 5

1, 4, 3, 5, 2

1, 2, 4, 5, 3

Question 40 Explanation: 
If uterine hypertonicity occurs, the nurse immediately would intervene to reduce uterine activity
and increase fetal oxygenation. The nurse would (1) stop the Pitocin infusion and increase the
rate of the nonadditive solution, (4) check maternal BP for hyper or hypotension, (3) position
the woman in a side-lying position, and (5) administer oxygen by snug face mask at 8-10 L/min.
The nurse then would attempt to determine the cause of the uterine hypertonicity and (2)
perform a vaginal exam to check for prolapsed cord.

Question 41

WRONG

Fetal presentation refers to which of the following descriptions?

Fetal body part that enters the maternal pelvis first

Relationship of the presenting part to the maternal pelvis

Relationship of the long axis of the fetus to the long axis of the
mother

A classification according to the fetal part

Question 41 Explanation: 
Presentation is the fetal body part that enters the pelvis first; it’s classified by the presenting
part; the three main presentations are cephalic/occipital, breech, and shoulder. The
relationship of the presenting fetal part to the maternal pelvis refers to fetal position. The
relationship of the long axis to the fetus to the long axis of the mother refers to fetal lie; the
three possible lies are longitudinal, transverse, and oblique.

Question 42
 WRONG

Which of the following fetal positions is most favorable for birth?

Vertex presentation

Transverse lie

Frank breech presentation

Posterior position of the fetal head

Question 42 Explanation: 
Vertex presentation (flexion of the fetal head) is the optimal presentation for passage through
the birth canal. Transverse lie is an unacceptable fetal position for vaginal birth and requires a
C-section. Frank breech presentation, in which the buttocks present first, can be a difficult
vaginal delivery. Posterior positioning of the fetal head can make it difficult for the fetal head to
pass under the maternal symphysis pubis.

Question 43

CORRECT

A nurse in a labor room is assisting with the vaginal delivery of a newborn infant. The nurse
would monitor the client closely for the risk of uterine rupture if which of the following
occurred?

Hypotonic contractions

Forceps delivery

Schultz delivery

Weak bearing down efforts

Question 43 Explanation: 
Excessive fundal pressure, forceps delivery, violent bearing down efforts, tumultuous labor, and
shoulder dystocia can place a woman at risk for traumatic uterine rupture. Hypotonic
contractions and weak bearing down efforts do not alone add to the risk of rupture because
they do not add to the stress on the uterine wall.
Question 44

WRONG

Which measure would be least effective in preventing postpartum hemorrhage?

Administer Methergine 0.2 mg every 6 hours for 4 doses as ordered

Encourage the woman to void every 2 hours

Massage the fundus every hour for the first 24 hours following
birth

Teach the woman the importance of rest and nutrition to enhance

healing

Question 44 Explanation: 
The fundus should be massaged only when boggy or soft. Massaging a firm fundus could cause
it to relax. Responses 1, 2, and 4 are all effective measures to enhance and maintain contraction
of the uterus and to facilitate healing.

Question 45

WRONG

Late deceleration patterns are noted when assessing the monitor tracing of a woman whose
labor is being induced with an infusion of Pitocin. The woman is in a side-lying position, and her
vital signs are stable and fall within a normal range. Contractions are intense, last 90 seconds,
and occur every 1 1/2 to 2 minutes. The nurse’s immediate action would be to:

Change the woman’s position

Stop the Pitocin

Elevate the woman’s legs

Administer oxygen via a tight mask at 8 to 10 liters/minute

Question 45 Explanation: 
Late deceleration patterns noted are most likely related to alteration in uteroplacental
perfusion associated with the strong contractions described. The immediate action would be to
stop the Pitocin infusion since Pitocin is an oxytocic which stimulates the uterus to contract. The
woman is already in an appropriate position for uteroplacental perfusion. Elevation of her legs
would be appropriate if hypotension were present. Oxygen is appropriate but not the
immediate action.

Question 46

CORRECT

A nurse in the labor room is caring for a client in the active phases of labor. The nurse is
assessing the fetal patterns and notes a late deceleration on the monitor strip. The most
appropriate nursing action is to:

Place the mother in the supine position

Document the findings and continue to monitor the fetal patterns

Administer oxygen via face mask

Increase the rate of pitocin IV infusion

Question 46 Explanation: 
Late decelerations are due to uteroplacental insufficiency as the result of decreased blood flow
and oxygen to the fetus during the uterine contractions. This causes hypoxemia; therefore
oxygen is necessary. The supine position is avoided because it decreases uterine blood flow to
the fetus. The client should be turned to her side to displace pressure of the gravid uterus on
the inferior vena cava. An intravenous pitocin infusion is discontinued when a late deceleration
is noted.

Question 47

CORRECT

After doing Leopold’s maneuvers, the nurse determines that the fetus is in the ROP position. To
best auscultate the fetal heart tones, the Doppler is placed:

Above the umbilicus at the midline

Above the umbilicus on the left side

Below the umbilicus on the right side

 Below the umbilicus near the left groin

Question 47 Explanation: 
Fetal heart tones are best auscultated through the fetal back; because the position is ROP (right
occiput presenting), the back would be below the umbilicus and on the right side.

Question 48

CORRECT

A nurse in the labor room is performing a vaginal assessment on a pregnant client in labor. The
nurse notes the presence of the umbilical cord protruding from the vagina. Which of the
following would be the initial nursing action?

Place the client in Trendelenburg’s position

Call the delivery room to notify the staff that the client will be
transported immediately

Gently push the cord into the vagina

Find the closest telephone and stat page the physician

Question 48 Explanation: 
When cord prolapse occurs, prompt actions are taken to relieve cord compression and increase
fetal oxygenation. The mother should be positioned with the hips higher than the head to shift
the fetal presenting part toward the diaphragm. The nurse should push the call light to
summon help, and other staff members should call the physician and notify the delivery room.
No attempt should be made to replace the cord. The examiner, however, may place a gloved
hand into the vagina and hold the presenting part off of the umbilical cord. Oxygen at 8 to 10
L/min by face mask is delivered to the mother to increase fetal oxygenation

Question 49

CORRECT

A nurse is caring for a client in labor. The nurse determines that the client is beginning in the
2nd stage of labor when which of the following assessments is noted?

The client begins to expel clear vaginal fluid

 The contractions are regular

The membranes have ruptured

The cervix is dilated completely

Question 49 Explanation: 
The second stage of labor begins when the cervix is dilated completely and ends with the birth
of the neonate.

Question 50

CORRECT

A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which
of the following is noted on the external monitor tracing during a contraction?

Early decelerations

Variable decelerations

Late decelerations

Short-term variability

Question 50 Explanation: 
Short-term variability

Question 51

CORRECT

A nurse is beginning to care for a client in labor. The physician has prescribed an IV infusion of
Pitocin. The nurse ensures that which of the following is implemented before initiating the
infusion?

Placing the client on complete bed rest

Continuous electronic fetal monitoring

 An IV infusion of antibiotics

Placing a code cart at the client’s bedside

Question 51 Explanation: 
Continuous electronic fetal monitoring should be implemented during an IV infusion of Pitocin.

Question 52

CORRECT

The nurse observes the client’s amniotic fluid and decides that it appears normal, because it is:

Clear and dark amber in color

Milky, greenish yellow, containing shreds of mucus

Clear, almost colorless, and containing little white specks

Cloudy, greenish-yellow, and containing little white specks

Question 52 Explanation: 
By 36 weeks’ gestation, normal amniotic fluid is colorless with small particles of vernix caseosa
present.

Question 53

WRONG

A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of a slowing
labor. The nurse is reviewing the physician’s orders and would expect to note which of the
following prescribed treatments for this condition?

Medication that will provide sedation

Increased hydration

Oxytocin (Pitocin) infusion

 Administration of a tocolytic medication

Question 53 Explanation: 
Therapeutic management for hypotonic uterine dysfunction includes oxytocin augmentation
and amniotomy to stimulate a labor that slows.

Question 54

WRONG

The nurse should realize that the most common and potentially harmful maternal complication
of epidural anesthesia would be:

Severe postpartum headache

Limited perception of bladder fullness

Increase in respiratory rate

Hypotension

Question 54 Explanation: 
Epidural anesthesia can lead to vasodilation and a drop in blood pressure that could interfere
with adequate placental perfusion. The woman must be well hydrated before and during
epidural anesthesia to prevent this problem and maintain an adequate blood pressure.
Headache is not a side effect since the spinal fluid is not disturbed by this anesthetic as it would
be with a low spinal (saddle block) anesthesia; 2 is an effect of epidural anesthesia but is not the
most harmful. Respiratory depression is a potentially serious complication.

Question 55

WRONG

A client arrives at the hospital in the second stage of labor. The fetus’ head is crowning, the
client is bearing down, and the birth appears imminent. The nurse should:

Transfer her immediately by stretcher to the birthing unit

Tell her to breathe through her mouth and not to bear down
 Instruct the client to pant during contractions and to breathe
through her mouth

Support the perineum with the hand to prevent tearing and tell the
client to pant

Question 55 Explanation: 
Gentle pressure is applied to the baby’s head as it emerges so it is not born too rapidly. The
head is never held back, and it should be supported as it emerges so there will be no vaginal
lacerations. It is impossible to push and pant at the same time.

Question 56

CORRECT

A client who is gravida 1, para 0 is admitted in labor. Her cervix is 100% effaced, and she is
dilated to 3 cm. Her fetus is at +1 station. The nurse is aware that the fetus’ head is:

Not yet engaged

Entering the pelvic inlet

Below the ischial spines

Visible at the vaginal opening

Question 56 Explanation: 
A station of +1 indicates that the fetal head is 1 cm below the ischial spines.

Question 57

CORRECT

A nurse is caring for a client in the second stage of labor. The client is experiencing uterine
contractions every 2 minutes and cries out in pain with each contraction. The nurse recognizes
this behavior as:

Exhaustion

Fear of losing control

 Involuntary grunting

Valsalva’s maneuver

Question 57 Explanation: 
Pains, helplessness, panicking, and fear of losing control are possible behaviors in the 2nd stage
of labor.

Question 58

WRONG

Upon completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6 cm,
-1. Which of the following is a correct interpretation of the data?

Fetal presenting part is 1 cm above the ischial spines

Effacement is 4 cm from completion

Dilation is 50% completed

Fetus has achieved passage through the ischial spines

Question 58 Explanation: 
Station of – 1 indicates that the fetal presenting part is above the ischial spines and has not yet
passed through the pelvic inlet. A station of zero would indicate that the presenting part has
passed through the inlet and is at the level of the ischial spines or is engaged. Passage through
the ischial spines with internal rotation would be indicated by a plus station, such as + 1.
Progress of effacement is referred to by percentages with 100% indicating full effacement and
dilation by centimeters (cm) with 10 cm indicating full dilation.

Question 59

WRONG

A laboring client is to have a pudendal block. The nurse plans to tell the client that once the
block is working she:

Will not feel the episiotomy

 May lose bladder sensation

May lose the ability to push

Will no longer feel contractions

Question 59 Explanation: 
A pudendal block provides anesthesia to the perineum.

Question 60

WRONG

A nurse is developing a plan of care for a client experiencing dystocia and includes several
nursing interventions in the plan of care. The nurse prioritizes the plan of care and selects
which of the following nursing interventions as the highest priority?

Keeping the significant other informed of the progress of the labor

Providing comfort measures

Monitoring fetal heart rate

Changing the client’s position frequently

Question 60 Explanation: 
The priority is to monitor the fetal heart rate.

Question 1

CORRECT

A nurse is providing instructions to a client in the first trimester of pregnancy regarding

measures to assist in reducing breast tenderness. The nurse tells the client to:
 Avoid wearing a bra

Wash the nipples and areola area daily with soap, and massage the
breasts with lotion.

Wear tight-fitting blouses or dresses to provide support

Wash the breasts with warm water and keep them dry

Question 1 Explanation: 
The pregnant woman should be instructed to wash the breasts with warm water and keep
them dry. The woman should be instructed to avoid using soap on the nipples and areola area
to prevent the drying of tissues. Wearing a supportive bra with wide adjustable straps can
decrease breast tenderness. Tight-fitting blouses or dresses will cause discomfort.

Question 2

WRONG

An expected cardiopulmonary adaptation experienced by most pregnant women is:

Tachycardia

Dyspnea at rest

Progression of dependent edema

Shortness of breath on exertion

Question 2 Explanation: 
This is an expected cardiopulmonary adaptation during pregnancy; it is caused by an increased
ventricular rate and elevated diaphragm.

Question 3

CORRECT

A nurse is reviewing the record of a client who has just been told that a pregnancy test is
positive. The physician has documented the presence of a Goodell’s sign. The nurse determines
this sign indicates:
 A softening of the cervix

A soft blowing sound that corresponds to the maternal pulse during

auscultation of the uterus.

The presence of hCG in the urine

The presence of fetal movement

Question 3 Explanation: 
In the early weeks of pregnancy the cervix becomes softer as a result of increased vascularity
and hyperplasia, which causes the Goodell’s sign.

Question 4

CORRECT

A nurse is collecting data during an admission assessment of a client who is pregnant with
twins. The client has a healthy 5-year old child that was delivered at 37 weeks and tells the
nurse that she doesn’t have any history of abortion or fetal demise. The nurse would document
the GTPAL for this client as:

G = 3, T = 2, P = 0, A = 0, L =1

G = 2, T = 0, P = 1, A = 0, L =1

G = 1, T = 1. P = 1, A = 0, L = 1

G = 2, T = 0, P = 0, A = 0, L = 1

Question 4 Explanation: 
Pregnancy outcomes can be described with the acronym GTPAL. “G” is Gravidity, the number of
pregnancies. “T” is term births, the number of born at term (38 to 41 weeks). “P” is preterm
births, the number born before 38 weeks gestation. “A” is abortions or miscarriages, included in
“G” if before 20 weeks gestation, included in parity if past 20 weeks AOE. “L” is live births, the
number of births of living children. Therefore, a woman who is pregnant with twins and has a
child has a gravida of 2. Because the child was delivered at 37 weeks, the number of preterm
births is 1, and the number of term births is 0. The number of abortions is 0, and the number of
live births is 1.
Question 5

CORRECT

Which of the following terms applies to the tiny, blanched, slightly raised end arterioles found
on the face, neck, arms, and chest during pregnancy?

Epulis

Linea nigra

Striae gravidarum

Telangiectasias

Question 5 Explanation: 
The dilated arterioles that occur during pregnancy are due to the elevated level of circulating
estrogen. The linea nigra is a pigmented line extending from the symphysis pubis to the top of
the fundus during pregnancy.

Question 6

CORRECT

A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care for the
client determines that the magnesium therapy is effective if:

Ankle clonus in noted

The blood pressure decreases

Seizures do not occur

Scotomas are present

Question 6 Explanation: 
For a client with preeclampsia, the goal of care is directed at preventing eclampsia (seizures).
Magnesium sulfate is an anticonvulsant, not an antihypertensive agent. Although a decrease in
blood pressure may be noted initially, this effect is usually transient. Ankle clonus indicated
hyperreflexia and may precede the onset of eclampsia. Scotomas are areas of complete or
partial blindness. Visual disturbances, such as scotomas, often precede an eclamptic seizure.
Question 7

CORRECT

Which of the following symptoms occurs with a hydatidiform mole?

Heavy, bright red bleeding every 21 days

Fetal cardiac motion after 6 weeks gestation

Benign tumors found in the smooth muscle of the uterus

“Snowstorm” pattern on ultrasound with no fetus or

gestational sac

Question 7 Explanation: 
The chorionic villi of a molar pregnancy resemble a snowstorm pattern on ultrasound. Bleeding
with a hydatidiform mole is often dark brown and may occur erratically for weeks or months.

Question 8

CORRECT

The pituitary hormone that stimulates the secretion of milk from the mammary glands is:

Prolactin

Oxytocin

Estrogen

Progesterone

Question 8 Explanation: 
Prolactin is the hormone from the anterior pituitary gland that stimulates mammary gland
secretion. Oxytocin, a posterior pituitary hormone, stimulates the uterine musculature to
contract and causes the “let down” reflex.

Question 9
 CORRECT

A client arrives at a prenatal clinic for the first prenatal assessment. The client tells a nurse that
the first day of her last menstrual period was September 19th, 2013. Using Naegele’s rule, the
nurse determines the estimated date of confinement as:

July 26, 2013

June 12, 2014

June 26, 2014

July 12, 2014

Question 10

CORRECT

A nursing instructor is conducting lecture and is reviewing the functions of the female
reproductive system. She asks Mark to describe the follicle-stimulating hormone (FSH) and the
luteinizing hormone (LH). Mark accurately responds by stating that:

FSH and LH are released from the anterior pituitary gland.

FSH and LH are secreted by the corpus luteum of the ovary

FSH and LH are secreted by the adrenal glands

FSH and LH stimulate the formation of milk during pregnancy.

Question 10 Explanation: 
FSH and LH, when stimulated by gonadotropin-releasing hormone from the hypothalamus, are
released from the anterior pituitary gland to stimulate follicular growth and development,
growth of the graafian follicle, and production of progesterone.

Question 11

CORRECT

Which of the following conditions is common in pregnant women in the 2nd trimester of
pregnancy?
 Mastitis

Metabolic alkalosis

Physiologic anemia

Respiratory acidosis

Question 11 Explanation: 
Hemoglobin and hematocrit levels decrease during pregnancy as the increase in plasma
volume exceeds the increase in red blood cell production.

Question 12

CORRECT

A homecare nurse visits a pregnant client who has a diagnosis of mild Preeclampsia and who is
being monitored for pregnancy induced hypertension (PIH). Which assessment finding indicates
a worsening of the Preeclampsia and the need to notify the physician?

Blood pressure reading is at the prenatal baseline

Urinary output has increased

The client complains of a headache and blurred vision

Dependent edema has resolved

Question 12 Explanation: 
If the client complains of a headache and blurred vision, the physician should be notified
because these are signs of worsening Preeclampsia.

Question 13

CORRECT

A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has
been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs
the client regarding management of care. Which statement, if made by the client, indicates a
need for further education?
 “I will maintain strict bedrest throughout the remainder of
pregnancy.”

“I will avoid sexual intercourse until the bleeding has stopped, and
for 2 weeks following the last evidence of bleeding.”

“I will count the number of perineal pads used on a daily basis and
note the amount and color of blood on the pad.”

“I will watch for the evidence of the passage of tissue.”

Question 13 Explanation: 
Strict bed rest throughout the remainder of pregnancy is not required. The woman is advised to
curtail sexual activities until the bleeding has ceased, and for 2 weeks following the last
evidence of bleeding or as recommended by the physician. The woman is instructed to count
the number of perineal pads used daily and to note the quantity and color of blood on the pad.
The woman also should watch for the evidence of the passage of tissue.

Question 14

CORRECT

Clients with gestational diabetes are usually managed by which of the following therapies?

Diet

NPH insulin (long-acting)

Oral hypoglycemic drugs

Oral hypoglycemic drugs and insulin

Question 14 Explanation: 
Clients with gestational diabetes are usually managed by diet alone to control their glucose
intolerance. Oral hypoglycemic agents are contraindicated in pregnancy. NPH isn’t usually
needed for blood glucose control for GDM.

Question 15
 WRONG

The nurse teaches a pregnant woman to avoid lying on her back. The nurse has based this
statement on the knowledge that the supine position can:

Unduly prolong labor

Cause decreased placental perfusion

Lead to transient episodes of hypotension

Interfere with free movement of the coccyx

Question 15 Explanation: 
This is because impedance of venous return by the gravid uterus, which causes hypotension
and decreased systemic perfusion.

Question 16

PARTIAL-CREDIT

A nurse is assisting in performing an assessment on a client who suspects that she is pregnant
and is checking the client for probable signs of pregnancy. Select all probable signs of
pregnancy.

Uterine enlargement

Fetal heart rate detected by nonelectric device

Outline of the fetus via radiography or ultrasound

Chadwick’s sign

Braxton Hicks contractions

Ballottement

Question 16 Explanation: 
The probable signs of pregnancy include: >Uterine Enlargement >Hegar’s sign or softening and
thinning of the uterine segment that occurs at week 6. >Goodell’s sign or softening of the cervix
that occurs at the beginning of the 2nd month >Chadwick’s sign or bluish coloration of the
mucous membranes of the cervix, vagina and vulva. Occurs at week 6. >Ballottement or
rebounding of the fetus against the examiner’s fingers of palpation >Braxton-Hicks contractions
Positive pregnancy test measuring for hCG. >Positive signs of pregnancy include: >Fetal Heart
Rate detected by electronic device (doppler) at 10-12 weeks >Fetal Heart rate detected by
nonelectronic device (fetoscope) at 20 weeks AOG >Active fetal movement palpable by the
examiners >Outline of the fetus via radiography or ultrasound

Question 17

CORRECT

During a prenatal visit at 38 weeks, a nurse assesses the fetal heart rate. The nurse determines
that the fetal heart rate is normal if which of the following is noted?

80 BPM

100 BPM

150 BPM

180 BPM

Question 17 Explanation: 
The fetal heart rate depends in gestational age and ranges from 160-170 BPM in the first
trimester but slows with fetal growth to 120-160 BPM near or at term. At or near term, if the
fetal heart rate is less than 120 or more than 160 BPM with the uterus at rest, the fetus may be
in distress.

Question 18

WRONG

The chief function of progesterone is the:

Development of the female reproductive system

Stimulation of the follicles for ovulation to occur

 Preparation of the uterus to receive a fertilized egg

Establishment of secondary male sex characteristics

Question 18 Explanation: 
Progesterone stimulates differentiation of the endometrium into a secretory type of tissue.

Question 19

CORRECT

The nurse is aware than an adaptation of pregnancy is an increased blood supply to the pelvic
region that results in a purplish discoloration of the vaginal mucosa, which is known as:

Ladin’s sign

Hegar’s sign

Goodell’s sign

Chadwick’s sign

Question 19 Explanation: 
A purplish color results from the increased vascularity and blood vessel engorgement of the
vagina.

Question 20

CORRECT

When involved in prenatal teaching, the nurse should advise the clients that an increase in
vaginal secretions during pregnancy is called leukorrhea and is caused by increased:

Metabolic rates

Production of estrogen

Functioning of the Bartholin glands

 Supply of sodium chloride to the cells of the vagina

Question 20 Explanation: 
The increase of estrogen during pregnancy causes hyperplasia of the vaginal mucosa, which
leads to increased production of mucus by the endocervical glands. The mucus contains
exfoliated epithelial cells.

Question 21

CORRECT

A primigravida is receiving magnesium sulfate for the treatment of pregnancy induced

hypertension (PIH). The nurse who is caring for the client is performing assessments every 30
minutes. Which assessment finding would be of most concern to the nurse?

Urinary output of 20 ml since the previous assessment

Deep tendon reflexes of 2+

Respiratory rate of 10 BPM

Fetal heart rate of 120 BPM

Question 21 Explanation: 
Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less than 12 breaths
per minute, the physician or other health care provider needs to be notified, and continuation
of the medication needs to be reassessed. A urinary output of 20 ml in a 30 minute period is
adequate; less than 30 ml in one hour needs to be reported. Deep tendon reflexes of 2+ are
normal. The fetal heart rate is WNL for a resting fetus.

Question 22

WRONG

At a prenatal visit at 36 weeks’ gestation, a client complains of discomfort with irregularly

occurring contractions. The nurse instructs the client to:

Lie down until they stop

Walk around until they subside

 Time contraction for 30 minutes

Take 10 grains of aspirin for the discomfort

Question 22 Explanation: 
Ambulation relieves Braxton Hicks.

Question 23

WRONG

The developing cells are called a fetus from the:

Time the fetal heart is heard

Eighth week to the time of birth

Implantation of the fertilized ovum

End of the send week to the onset of labor

Question 23 Explanation: 
In the first 7-14 days the ovum is known as a blastocyst; it is called an embryo until the eighth
week; the developing cells are then called a fetus until birth.

Question 24

CORRECT

A nurse is caring for a pregnant client with Preeclampsia. The nurse prepares a plan of care for
the client and documents in the plan that if the client progresses from Preeclampsia to
eclampsia, the nurse’s first action is to:

Administer magnesium sulfate intravenously

Assess the blood pressure and fetal heart rate

Clean and maintain an open airway

 Administer oxygen by face mask

Question 24 Explanation: 
The immediate care during a seizure (eclampsia) is to ensure a patent airway. The other options
are actions that follow or will be implemented after the seizure has ceased.

Question 25

WRONG

In a lecture on sexual functioning, the nurse plans to include the fact that ovulation occurs
when the:

Oxytocin is too high

Blood level of LH is too high

Progesterone level is high

Endometrial wall is sloughed off.

Question 25 Explanation: 
It is the surge of LH secretion in mid cycle that is responsible for ovulation.

Question 26

PARTIAL-CREDIT

A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium
sulfate. Select all nursing interventions that apply in the care for the client.

Monitor maternal vital signs every 2 hours

Notify the physician if respirations are less than 18 per minute.

Monitor renal function and cardiac function closely

Keep calcium gluconate on hand in case of a magnesium sulfate

overdose
 Monitor deep tendon reflexes hourly

Monitor I and O’s hourly

Notify the physician if urinary output is less than 30 ml per

hour.

Question 26 Explanation: 
When caring for a client receiving magnesium sulfate therapy, the nurse would monitor
maternal vital signs, especially respirations, every 30-60 minutes and notify the physician if
respirations are less than 12, because this would indicate respiratory depression. Calcium
gluconate is kept on hand in case of magnesium sulfate overdose, because calcium gluconate is
the antidote for magnesium sulfate toxicity. Deep tendon reflexes are assessed hourly. Cardiac
and renal function is monitored closely. The urine output should be maintained at 30 ml per
hour because the medication is eliminated through the kidneys.

Question 27

CORRECT

A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of
severe preeclampsia. A nurse monitors for complications associated with the diagnosis and
assesses the client for:

Any bleeding, such as in the gums, petechiae, and purpura.

Enlargement of the breasts

Periods of fetal movement followed by quiet periods

Complaints of feeling hot when the room is cool

Question 27 Explanation: 
Severe Preeclampsia can trigger disseminated intravascular coagulation because of the
widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be
reported to the M.D.

Question 28

CORRECT
Rho (D) immune globulin (RhoGAM) is prescribed for a woman following delivery of a newborn
infant and the nurse provides information to the woman about the purpose of the medication.
The nurse determines that the woman understands the purpose of the medication if the
woman states that it will protect her next baby from which of the following?

Being affected by Rh incompatibility

Having Rh positive blood

Developing a rubella infection

Developing physiological jaundice

Question 28 Explanation: 
Rh incompatibility can occur when an Rh-negative mom becomes sensitized to the Rh antigen.
Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus who is
Rh positive. During pregnancy and at delivery, some of the baby’s Rh positive blood can enter
the maternal circulation, causing the woman’s immune system to form antibodies against Rh
positive blood. Administration of Rho(D) immune globulin prevents the woman from
developing antibodies against Rh positive blood by providing passive antibody protection
against the Rh antigen.

Question 29

WRONG

A pregnant client calls the clinic and tells a nurse that she is experiencing leg cramps and is
awakened by the cramps at night. To provide relief from the leg cramps, the nurse tells the
client to:

Dorsiflex the foot while extending the knee when the cramps occur

Dorsiflex the foot while flexing the knee when the cramps occur

Plantar flex the foot while flexing the knee when the cramps occur

Plantar flex the foot while extending the knee when the cramps
occur.

Question 29 Explanation: 
Legs cramps occur when the pregnant woman stretches the leg and plantar flexes the foot.
Dorsiflexion of the foot while extending the knee stretches the affected muscle, prevents the
muscle from contracting, and stops the cramping.

Question 30

WRONG

The nurse recognizes that an expected change in the hematologic system that occurs during
the 2nd trimester of pregnancy is:

A decrease in WBC’s

In increase in hematocrit

An increase in blood volume

A decrease in sedimentation rate

Question 30 Explanation: 
The blood volume increases by approximately 40-50% during pregnancy. The peak blood
volume occurs between 30 and 34 weeks of gestation. The hematocrit decreases as a result of
the increased blood volume.

Question 31

CORRECT

A pregnant woman’s last menstrual period began on April 8, 2005, and ended on April 13. Using
Naegele’s rule her estimated date of birth would be:

January 15, 2006

January 20, 2006

July 1, 2006

November 5, 2005

Question 31 Explanation: 
Naegele’s rule requires subtracting 3 months and adding 7 days and 1 year if appropriate to the
first day of a pregnant woman’s last menstrual period. When this rule, is used with April 8, 2005,
the estimated date of birth is January 15, 2006.

Question 32

CORRECT

A pregnant woman at 32 weeks’ gestation complains of feeling dizzy and lightheaded while her
fundal height is being measured. Her skin is pale and moist. The nurse’s initial response would
be to:

Assess the woman’s blood pressure and pulse

Have the woman breathe into a paper bag

Raise the woman’s legs

Turn the woman on her left side

Question 32 Explanation: 
During a fundal height measurement the woman is placed in a supine position. This woman is
experiencing supine hypotension as a result of uterine compression of the vena cava and
abdominal aorta. Turning her on her side (specifically left side) will remove the compression
and restore cardiac output and blood pressure. Then vital signs can be assessed. Raising her
legs will not solve the problem since pressure will still remain on the major abdominal blood
vessels, thereby continuing to impede cardiac output. Breathing into a paper bag is the solution
for dizziness related to respiratory alkalosis associated with hyperventilation.

Question 33

CORRECT

Which of the following answers best describes the stage of pregnancy in which maternal and
fetal blood are exchanged?

Conception

9 weeks’ gestation, when the fetal heart is well developed

32-34 weeks gestation

 maternal and fetal blood are never exchanged

Question 33 Explanation: 
Only nutrients and waste products are transferred across the placenta. Blood exchange only
occurs in complications and some medical procedures accidentally.

Question 34

WRONG

A pregnant client is receiving magnesium sulfate for the management of preeclampsia. A nurse
determines the client is experiencing toxicity from the medication if which of the following is
noted on assessment?

Presence of deep tendon reflexes

Serum magnesium level of 6 mEq/L

Proteinuria of +3

Respirations of 10 per minute

Question 34 Explanation: 
Magnesium toxicity can occur from magnesium sulfate therapy. Signs of toxicity relate to the
central nervous system depressant effects of the medication and include respiratory
depression, loss of deep tendon reflexes, and a sudden drop in the fetal heart rate and
maternal heart rate and blood pressure. Therapeutic levels of magnesium are 4-7 mEq/L.
Proteinuria of +3 would be noted in a client with preeclampsia.

Question 35

CORRECT

A 21-year old client, 6 weeks’ pregnant is diagnosed with hyperemesis gravidarum. This
excessive vomiting during pregnancy will often result in which of the following conditions?

Bowel perforation

Electrolyte imbalance
 Miscarriage

Pregnancy induced hypertension (PIH)

Question 35 Explanation: 
Excessive vomiting in clients with hyperemesis gravidarum often causes weight loss and fluid,
electrolyte, and acid-base imbalances.

Question 36

CORRECT

A prenatal nurse is providing instructions to a group of pregnant client regarding measures to

prevent toxoplasmosis. Which statement if made by one of the clients indicates a need for
further instructions?

“I need to cook meat thoroughly.”

“I need to avoid touching mucous membranes of the mouth or eyes

while handling raw meat.”

“I need to drink unpasteurized milk only.”

“I need to avoid contact with materials that are possibly

contaminated with cat feces.”

Question 36 Explanation: 
All pregnant women should be advised to do the following to prevent the development of
toxoplasmosis. Women should be instructed to cook meats thoroughly, avoid touching mucous
membranes and eyes while handling raw meat; thoroughly wash all kitchen surfaces that come
into contact with uncooked meat, wash the hands thoroughly after handling raw meat; avoid
uncooked eggs and unpasteurized milk; wash fruits and vegetables before consumption, and
avoid contact with materials that possibly are contaminated with cat feces, such as cat litter
boxes, sandboxes, and garden soil.

Question 37

WRONG

A nurse is describing the process of fetal circulation to a client during a prenatal visit. The nurse
accurately tells the client that fetal circulation consists of:
 Two umbilical veins and one umbilical artery

Two umbilical arteries and one umbilical vein

Arteries carrying oxygenated blood to the fetus

Veins carrying deoxygenated blood to the fetus

Question 37 Explanation: 
Blood pumped by the embryo’s heart leaves the embryo through two umbilical arteries. Once
oxygenated, the blood then is returned by one umbilical vein. Arteries carry deoxygenated
blood and waste products from the fetus, and veins carry oxygenated blood and provide
oxygen and nutrients to the fetus.

Question 38

CORRECT

A nurse implements a teaching plan for a pregnant client who is newly diagnosed with
gestational diabetes. Which statement if made by the client indicates a need for further
education?

“I need to stay on the diabetic diet.”

“I will perform glucose monitoring at home.”

“I need to avoid exercise because of the negative effects of

insulin production.”

“I need to be aware of any infections and report signs of infection

immediately to my health care provider.”

Question 38 Explanation: 
Exercise is safe for the client with gestational diabetes and is helpful in lowering the blood
glucose level.

Question 39

CORRECT
A pregnant client is making her first Antepartum visit. She has a two year old son born at 40
weeks, a 5 year old daughter born at 38 weeks, and 7 year old twin daughters born at 35 weeks.
She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, the nurse
should identify that the client is:

G4 T3 P2 A1 L4

G5 T2 P2 A1 L4

G5 T2 P1 A1 L4

G4 T3 P1 A1 L4

Question 39 Explanation: 
5 pregnancies; 2 term births; twins count as 1; one abortion; 4 living children.

Question 40

WRONG

Nutritional planning for a newly pregnant woman of average height and weighing 145 pounds
should include:

A decrease of 200 calories a day

An increase of 300 calories a day

An increase of 500 calories a day

A maintenance of her present caloric intake per day

Question 40 Explanation: 
This is the recommended caloric increase for adult women to meet the increased metabolic
demands of pregnancy.

Question 41

CORRECT
A nursing instructor asks a nursing student who is preparing to assist with the assessment of a
pregnant client to describe the process of quickening. Which of the following statements if
made by the student indicates an understanding of this term?

“It is the irregular, painless contractions that occur throughout

pregnancy.”

“It is the soft blowing sound that can be heard when the uterus is
auscultated.”

“It is the fetal movement that is felt by the mother.”

“It is the thinning of the lower uterine segment.”

Question 41 Explanation: 
Quickening is fetal movement and may occur as early as the 16th and 18th week of gestation,
and the mother first notices subtle fetal movements that gradually increase in intensity.
Braxton Hicks contractions are irregular, painless contractions that may occur throughout the
pregnancy. A thinning of the lower uterine segment occurs about the 6th week of pregnancy
and is called Hegar’s sign.

Question 42

CORRECT

A nurse is performing an assessment of a primipara who is being evaluated in a clinic during

her second trimester of pregnancy. Which of the following indicates an abnormal physical
finding necessitating further testing?

Consistent increase in fundal height

Fetal heart rate of 180 BPM

Braxton hicks contractions

Quickening

Question 42 Explanation: 
The normal range of the fetal heart rate depends on gestational age. The heart rate is usually
160-170 BPM in the first trimester and slows with fetal growth, near and at term, the fetal heart
rate ranges from 120-160 BPM. The other options are expected.
Question 43

CORRECT

A 26-year old multigravida is 14 weeks’ pregnant and is scheduled for an alpha-fetoprotein test.
She asks the nurse, “What does the alpha-fetoprotein test indicate?” The nurse bases a
response on the knowledge that this test can detect:

Kidney defects

Cardiac defects

Neural tube defects

Urinary tract defects

Question 43 Explanation: 
The alpha-fetoprotein test detects neural tube defects and Down syndrome.

Question 44

CORRECT

The antagonist for magnesium sulfate should be readily available to any client receiving IV
magnesium. Which of the following drugs is the antidote for magnesium toxicity?

Calcium gluconate

Hydralazine (Apresoline)

Narcan

RhoGAM

Question 44 Explanation: 
Calcium gluconate is the antidote for magnesium toxicity. Ten ml of 10% calcium gluconate is
given IV push over 3-5 minutes. Hydralazine is given for sustained elevated blood pressures in
preeclamptic clients.

Question 45
 CORRECT

A nurse is monitoring a pregnant client with pregnancy induced hypertension who is at risk for
Preeclampsia. The nurse checks the client for which specific signs of Preeclampsia (select all
that apply)?

Elevated blood pressure

Negative urinary protein

Facial edema

Increased respirations

Question 45 Explanation: 
The three classic signs of preeclampsia are hypertension, generalized edema, and proteinuria.
Increased respirations are not a sign of preeclampsia.

Question 46

WRONG

During a prenatal examination, the nurse draws blood from a young Rh negative client and
explain that an indirect Coombs test will be performed to predict whether the fetus is at risk
for:

Acute hemolytic disease

Respiratory distress syndrome

Protein metabolic deficiency

Physiologic hyperbilirubinemia

Question 46 Explanation: 
When an Rh negative mother carries an Rh positive fetus there is a risk for maternal antibodies
against Rh positive blood; antibodies cross the placenta and destroy the fetal RBC’s.

Question 47
 CORRECT

A nurse midwife is performing an assessment of a pregnant client and is assessing the client for
the presence of ballottement. Which of the following would the nurse implement to test for the
presence of ballottement?

Auscultating for fetal heart sounds

Palpating the abdomen for fetal movement

Assessing the cervix for thinning

Initiating a gentle upward tap on the cervix

Question 47 Explanation: 
Ballottement is a technique of palpating a floating structure by bouncing it gently and feeling it
rebound. In the technique used to palpate the fetus, the examiner places a finger in the vagina
and taps gently upward, causing the fetus to rise. The fetus then sinks, and the examiner feels a
gentle tap on the finger.

Question 48

WRONG

After the first four months of pregnancy, the chief source of estrogen and progesterone is the:

Placenta

Adrenal cortex

Corpus luteum

Anterior hypophysis

Question 48 Explanation: 
When placental formation is complete, around the 16th week of pregnancy; it produces
estrogen and progesterone.

Question 49
 CORRECT

In the 12th week of gestation, a client completely expels the products of conception. Because
the client is Rh negative, the nurse must:

Administer RhoGAM within 72 hours

Make certain she receives RhoGAM on her first clinic visit

Not give RhoGAM, since it is not used with the birth of a stillborn

Make certain the client does not receive RhoGAM, since the
gestation only lasted 12 weeks.

Question 49 Explanation: 
RhoGAM is given within 72 hours postpartum if the client has not been sensitized already.

Question 50

CORRECT

Gravida refers to which of the following descriptions?

A serious pregnancy

Number of times a female has been pregnant

Number of children a female has delivered

Number of term pregnancies a female has had

Question 50 Explanation: 
Gravida refers to the number of times a female has been pregnant, regardless of pregnancy
outcome or the number of neonates delivered.

Which of the following is a possible complication of amniocentesis?

Possible Answers:

All of these
RH sensitization

Miscarriage

Needle injury

Correct answer:

All of these

Explanation:

There are several risks to amniocentesis, including (but not limited to)
miscarriage, infection, needle injury, and RH sensitization. The rate of
miscarriage due to amniocentesis is between 1 in 300 and 1 in 500. The other
complications listed are relatively rare.
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Example Question #1 : Obstetrics And Gynecological Conditions

Fundal height of a pregnant woman is measured from __________.
Possible Answers:

the top of the pubic bone to the middle of the uterus

the top of the pubic bone to the top of the uterus

the bottom of the pubic bone to the top of the uterus

the middle of the pubic bone to the top of the uterus

the middle of the pubic bone to the bottom of the uterus

Correct answer:

the top of the pubic bone to the top of the uterus

Explanation:

Fundal height (sometimes referred to as McDonald's rule) is measured in

centimeters from the top of the pubic bone to the top of the uterus. The top of
the uterus may also be called the fundus of the uterus. It is used to assess the
growth and development of the fetus inside the womb. 
 Report an Error

Example Question #1 : Obstetrics And Gynecological Conditions

Alex is 17 weeks pregnant. She comes into the clinic to get a alpha-fetoprotein test. A low result
could indicate all of the following except __________.
Possible Answers:

fetal trisomy 18

hydatidiform mole

preeclampsia

fetal trisomy 21

the gestational age of the baby is incorrect

Correct answer:

preeclampsia

Explanation:

Alpha-fetoprotein is made by the fetus. Congenital abnormalities (fetal trisomy

18, fetal trisomy 21) are associated with low levels of this protein. Additionally,
so is hydatidiform mole. Hydatidiform mole is the presence of an abnormal
mass or growth inside the uterus. Based on a low result, the physician may
want to conduct further testing. Preeclampsia is a dangerous medical
condition characterized by high blood pressure. It is not associated with alpha-
fetoprotein.
Report an Error

Example Question #1 : Obstetrics And Gynecological Conditions

The nurse is assessing a woman in labor. He knows that fetal bradycardia occurs when the heart
rate drops below __________.
Possible Answers:

130 beats per minute

110 beats per minute

100 beats per minute

90 beats per minute

120 beats per minute

Correct answer:

110 beats per minute

Explanation:

Fetal bradycardia is recognized when fetal heart rate drops below 110 beats
per minute for 10 minutes or longer. The normal fetal heart rate is between
120 beats per minute and 160 beats per minute. Fetal tachycardia is a heart
rate above 160 beats per minute. 
Report an Error

Example Question #1 : Obstetrics And Gynecological Conditions

Anne, a 32-year-old woman, presents for her first prenatal visit. The doctor orders a CBC
(complete blood count). Which of the following is not included in a CBC?

Possible Answers:

Hematocrit

Hemoglobin

Platelets

White blood cells

Blood type

Correct answer:

Blood type

Explanation:

A separate test called a "type and screen" is needed to assess the blood type.
Complete blood counts (CBC's) typically contain hemoglobin and hematocrit,
platelet counts, white blood cell counts, and red blood cell counts among
many other measures. They are among the most frequently ordered
laboratory tests by providers. The physician will use this information to
diagnose conditions such as anemia. 
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Example Question #976 : Nclex

The nurse is assessing fetal heart rate in a pregnant patient. The nurse records a pulse of 82 beats
per minute. The nurse should __________.
Possible Answers:

move the doppler device

ask the mother to lay on her right side

call the physician immediately

try another doppler device

add lubricant to the doppler's surface

Correct answer:

move the doppler device

Explanation:

An 82 beat per minute reading could be the mother's heart rate, indicating that
the nurse does not have the doppler in the correct position. A normal fetal
heart rate is between 120 and 160 beats per minute. The nurse must always
remember to take the mother's pulse before assessing the fetal heart rate.
Before calling the physician, it is important to determine that the data is
accurate. To increase oxygen perfusion to the fetus, ask the mother to lay on
her left side.
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Example Question #1 : Obstetrics And Gynecological Conditions

Brittany is 40 weeks pregnant and calls because she is seeing pink-tinged discharge for the first
time. The nurse should tell Brittany to __________.
Possible Answers:

drive to the hospital immediately

lie on her back and place her feet in the air until help arrives

eat a bland diet and continue regular exercise

call an ambulance

continue to monitor

Correct answer:

continue to monitor

Explanation:

This is most likely the normal "bloody show" at the beginning of labor. There is
no need to immediately arrive at the hospital, change position, or eat a bland
diet. The patient should continue to monitor and call back or seek care when
she experiences regular contractions that are becoming more intense and
frequent.
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Example Question #1 : Obstetrics And Gynecological Conditions

Sarah is a seventeen-year-old female who has not gotten her first period and is visiting her doctor
for an exam. She has displayed the normal growth and development of several secondary sex
characteristics. The nurse would describe to the doctor that Sarah is showing signs
of __________.
Possible Answers:

secondary amenorrhea

primary dysmenorrhea

oligomenorrhea 

primary amenorrhea

secondary dysmenorrhea

Correct answer:

primary amenorrhea

Explanation:
Primary amenorrhea occurs when a female is fourteen years old and has not
gotten her first period and has not developed secondary sex characteristics.
Primary amenorrhea also occurs when a female sixteen or older has not
gotten her first period but has developed secondary sex characteristics.
Primary dysmenorrhea refers to painful menstruation not linked to a
physiological disorder. Secondary dysmenorrhea refers to painful
menstruation due to an underlying cause such as endometriosis.
Oligomenorrhea refers to the absence of a period, typically for at least 35
days. 
Report an Error

Example Question #979 : Nclex

Amber is a 39-year-old woman who is experiencing secondary dysmenorrhea. The nurse knows
that Amber could be suffering from which of the following?

Possible Answers:

Amenorrhea

Low levels of aldosterone

High levels of prostaglandin

Endometriosis

Turner syndrome

Correct answer:

Endometriosis

Explanation:

Secondary dysmenorrhea refers to painful menstruation due to an underlying

condition. Endometriosis, an example of a condition that frequently causes
secondary dysmenorrhea, refers to the growth of uterine tissue in
inappropriate places such as the ovary or rectum. High levels of prostaglandin
are frequently found in women with primary dysmenorrhea which is painful
menstruation without an underlying condition. Low levels of aldosterone would
not likely cause painful menstruation. Turner syndrome is a chromosomal
disorder that can frequently cause amenorrhea, or absence of a period.
 Report an Error

Example Question #1 : Obstetrics And Gynecological Conditions

A nurse is assessing an 18-year-old woman who has come into the emergency department for
bilateral abdominal pain. Which of the following should the nurse not consider a risk factor for
ectopic pregnancy?

Possible Answers:

Uterine fibroids

Neisseria gonorrhoeae

Endometriosis

Yeast infection

Chlamydia trachomatis

Correct answer:

Yeast infection

Explanation:

Uterine conditions such as endometriosis and uterine fibroids increase the risk
of ectopic pregnancy. Endometriosis is the inappropriate growth of uterine
tissue outside the uterus. Uterine fibroids are benign tumors within the uterus.
Sexually transmitted infections can cause a condition called pelvic
inflammatory disease which can result in scarring. Scarring of the reproductive
system greatly increases the risk of ectopic pregnancy and infertility. Yeast
infections are common after antibiotic therapy and are treated with an over-
the-counter medication. They generally do not cause permanent damage to
the body.