1.

A nursing instructor is conducting a lecture and is reviewing the functions

of the female reproductive system. She asks the student nurse to describe
the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH).
The student nurse accurately responds by stating that:
A. FSH and LH are released from the anterior pituitary gland.
B. FSH and LH are secreted by the corpus luteum of the ovary
C. FSH and LH are secreted by the adrenal glands
D. D. FSH and LH stimulate the formation of milk during pregnancy.

Correct Answer: A. FSH and LH are released from the anterior pituitary
gland.
FSH and LH, when stimulated by the gonadotropin-releasing hormone from the
hypothalamus, are released from the anterior pituitary gland to stimulate
follicular growth and development, the growth of the Graafian follicle, and
production of progesterone.

2. 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:
A. Two umbilical veins and one umbilical artery.
B. Two umbilical arteries and one umbilical vein.
C. Arteries carrying oxygenated blood to the fetus.
D. Veins carrying deoxygenated blood to the fetus.

Correct Answer: B. Two umbilical arteries and one umbilical vein.

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.

3. 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?
A. 80 BPM B. 100 BPM
C. 150 BPM D. 180 BPM
Correct Answer: C. 150 BPM.
The fetal heart rate depends on 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.

4. 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:
A. July 26, 2013 B. June 12, 2014
C. June 26, 2014 D. July 12, 2014

Correct Answer: C. June 26, 2014.

Accurate use of Naegele’s rule requires that the woman has a regular 28-day
menstrual cycle. Add 7 days to the first day of the last menstrual period, subtract
three months, and then add one year to that date.

5. 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:
A. Gravida 3, para 2001 B. Gravida 2, para 0101
C. Gravida 1, para 1101 D. Gravida 2, para 1001

Correct Answer: D. Gravida 2, para 1001

Pregnancy outcomes can be described with the acronym GTPAL.
You can learn more about obstetric history with our GTPAL Guide here.
• “G” is Gravidity, the number of pregnancies.
• “T” is term births, the number of born at term (37 weeks or after).
• “P” is preterm births, the number born between 20-36 weeks gestation.
• “A” is abortions or miscarriages, losses before 20 weeks.
• “L” is live births, the number of births of living children.
 6. 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?
A. Consistent increase in fundal height
B. Fetal heart rate of 180 BPM
C. Braxton Hicks contractions
D. Quickening

Correct Answer: B. Fetal heart rate of 180 BPM.

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.

7. 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. A softening of the cervix.
B. A soft blowing sound that corresponds to the maternal pulse during
auscultation of the uterus.
C. The presence of hCG in the urine.
D. The presence of fetal movement.

Correct Answer: A. A softening of the cervix.

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

8. 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?
A. “It is the irregular, painless contractions that occur throughout
pregnancy.”
 B. “It is the soft blowing sound that can be heard when the uterus is
auscultated.”
C. “It is the fetal movement that is felt by the mother.”
D. “It is the thinning of the lower uterine segment.”

Correct Answer: C. “It is the fetal movement that is felt by the mother.”
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. A thinning of the lower uterine segment occurs about the
6th week of pregnancy and is called Hegar’s sign.

9. 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?
A. Auscultating for fetal heart sounds.
B. Palpating the abdomen for fetal movement.
C. Assessing the cervix for thinning.
D. Initiating a gentle upward tap on the cervix.

Correct Answer: D. Initiating a gentle upward tap on the cervix.

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.

10. 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. Which of the following signs indicates a probable sign of
pregnancy? Select all that apply.
A. Uterine enlargement
B. Fetal heart rate detected by nonelectric device
C. Outline of the fetus via radiography or ultrasound
D. Chadwick’s sign
E. Braxton Hicks contractions
 F. Ballottement

Correct Answer: A, D, E, and F.

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

11. 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:
A. Dorsiflex the foot while extending the knee when the cramps occur.
B. Dorsiflex the foot while flexing the knee when the cramps occur.
C. Plantar flex the foot while flexing the knee when the cramps occur.
D. Plantar flex the foot while extending the knee when the cramps occur.

Correct Answer: A. Dorsiflex the foot while extending the knee when the
cramps occur.
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.
 12. 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:
A. Avoid wearing a bra.
B. Wash the nipples and areola area daily with soap and massage the
breasts with lotion.
C. Wear tight-fitting blouses or dresses to provide support.
D. Wash the breasts with warm water and keep them dry.

Correct Answer: D. Wash the breasts with warm water and keep them dry.
The pregnant woman should be instructed to wash the breasts with warm water
and keep them dry. Breasts can become sore in early pregnancy for several
reasons, but one of the primary causes is changing hormone levels (such as
estrogen, progesterone, and prolactin).

13. 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:
A. Any bleeding, such as in the gums, petechiae, and purpura.
B. Enlargement of the breasts.
C. Periods of fetal movement followed by quiet periods.
D. Complaints of feeling hot when the room is cool.

Correct Answer: A. Any bleeding, such as in the gums, petechiae, and

purpura.
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.

14. 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?
 A. “I will maintain strict bedrest throughout the remainder of the
pregnancy.”

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

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

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

Correct Answer: A. “I will maintain strict bedrest throughout the remainder

of the pregnancy.”
Strict bed rest throughout the remainder of pregnancy is not required. Bedrest
and other activity restrictions have not been found to be efficacious in the
prevention of a threatened abortion progressing to spontaneous abortion and
have been shown to increase the risk of other complications including deep vein
thrombosis and/or pulmonary embolism and therefore should not be
recommended

15. A prenatal nurse is providing instructions to a group of pregnant clients

regarding measures to prevent toxoplasmosis. Which statement if made by
one of the clients indicates a need for further instructions?
A. “I need to cook meat thoroughly.”
B. “I need to avoid touching mucous membranes of the mouth or eyes
while handling raw meat.”
C. “I need to drink unpasteurized milk only.”
D. “I need to avoid contact with materials that are possibly contaminated
with cat feces.”

Correct Answer: C. “I need to drink unpasteurized milk only.”

All pregnant women should be advised to do the following to prevent the
development of toxoplasmosis. Everyone, including immunocompetent patients,
should be educated about toxoplasmosis risk factors and ways to minimize the
risks. Preventing toxoplasmosis is particularly important in seronegative
immunocompromised patients and in pregnant women.
 16. 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?
A. Blood pressure reading is at the prenatal baseline.
B. Urinary output has increased.
C. The client complains of a headache and blurred vision.
D. Dependent edema has resolved.

Correct Answer: C. The client complains of a headache and blurred vision.

If the client complains of a headache and blurred vision, the physician should be
notified because these are signs of worsening preeclampsia.

17. 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?
A. “I need to stay on the diabetic diet.”
B. “I will perform glucose monitoring at home.”
C. “I need to avoid exercise because of the negative effects of insulin
production.”
D. “I need to be aware of any infections and report signs of infection
immediately to my health care provider.”

Correct Answer: C. “I need to avoid exercise because of the negative effects

of insulin production.”
Exercise is safe for the client with gestational diabetes and is helpful in lowering
the blood glucose level.

18. 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?
A. Urinary output of 20 ml since the previous assessment
B. Deep tendon reflexes of 2+
C. Respiratory rate of 10 BPM
 D. Fetal heart rate of 120 BPM

Correct Answer: C. Respiratory rate of 10 BPM.

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.

19. 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:
A. Administer magnesium sulfate intravenously
B. Assess the blood pressure and fetal heart rate.
C. Clean and maintain an open airway.
D. Administer oxygen by face mask.

Correct Answer: C. Clean and maintain an open airway.

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.

20. 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.
A. Elevated blood pressure
B. Negative urinary protein
C. Facial edema
D. Increased respirations
E. Polydipsia

Correct Answer: A & C. Elevated blood pressure and facial edema.

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

21. 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?
A. Being affected by Rh incompatibility.
B. Having Rh-positive blood.
C. Developing a rubella infection.
D. Developing physiological jaundice.

Correct Answer: A. Being affected by Rh incompatibility.

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. 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.

22. 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?
A. Presence of deep tendon reflexes.
B. Serum magnesium level of 6 mEq/L.
C. Proteinuria of +3.
D. Respirations of 10 per minute.

Correct Answer: D. Respirations of 10 per minute.

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.

23. A woman with preeclampsia is receiving magnesium sulfate. The nurse

assigned to care for the client determines that the magnesium therapy is
effective if:
A. Ankle clonus is noted.
B. The blood pressure decreases.
C. Seizures do not occur.
 D. Scotomas are present.

Correct Answer: C. Seizures do not occur.

For a client with preeclampsia, the goal of care is directed at preventing
eclampsia (seizures). Seizures were a half or a third less likely to recur after
treatment with magnesium. Maternal mortality was also lower in women
allocated magnesium rather than phenytoin or diazepam, although this did not
achieve statistical significance. Recent Cochrane reviews, however, indicated a
significant reduction in maternal mortality with magnesium.

24. 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.
A. Monitor maternal vital signs every 2 hours.
B. Notify the physician if respirations are less than 18 per minute.
C. Monitor renal function and cardiac function closely.
D. Keep calcium gluconate on hand in case of a magnesium sulfate
overdose.
E. Monitor deep tendon reflexes hourly.
F. Monitor I and O’s hourly.
G. Notify the physician if urinary output is less than 30 ml per hour.

Correct Answer: C, D, E, F, and G.

• Option A: BP should be assessed with the goal of maintaining the diastolic
BP at less than 110 mm Hg with administration of antihypertensive
medications as needed (eg, hydralazine, labetalol, nifedipine).
• Option B: 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.
• Option C: Cardiac and renal function are monitored closely. Eclampsia-
associated renal abnormalities can include decreases in glomerular
filtration rate, renal plasma flow, and uric acid clearance as well as
proteinuria. Eclampsia is associated with cardiovascular derangements such
as generalized vasospasm, increased peripheral vascular resistance, and
increased left ventricular stroke work index. Pulmonary capillary wedge
pressure (PCWP) may vary from low to elevated. Importantly, central
 venous pressure (CVP) may not correlate with PCWP in patients with severe
preeclampsia or eclampsia.
• Option D: Calcium gluconate is kept on hand in case of magnesium sulfate
overdose because calcium gluconate is the antidote for magnesium sulfate
toxicity.
• Option E: Deep tendon reflexes are assessed hourly. Ankle clonus
indicated hyperreflexia and may precede the onset of eclampsia. Although
brisk or hyperactive reflexes are common during pregnancy, clonus is a
sign of neuromuscular irritability that usually reflects severe preeclampsia.
• Option F: Monitor fluid intake and urine output, maternal respiratory rate,
and oxygenation, as indicated, and continuously monitor fetal status.
Pulmonary arterial pressure monitoring is rarely indicated but may be
helpful in patients who have evidence of pulmonary edema or
oliguria/anuria.
• Option G: The urine output should be maintained at 30 ml per hour
because the medication is eliminated through the kidneys.
25. In the 12th week of gestation, a client completely expels the products of
conception. Because the client is Rh-negative, the nurse must:
A. Administer RhoGAM within 72 hours.
B. Make certain she receives RhoGAM on her first clinic visit.
C. Not give RhoGAM, since it is not used with the birth of a stillborn.
D. Make certain the client does not receive RhoGAM since the gestation
only lasted 12 weeks.

Correct Answer: A. Administer RhoGAM within 72 hours.

RhoGAM is given within 72 hours postpartum if the client has not been sensitized
already. When the blood of an Rh-positive fetus gets into the bloodstream of an
Rh-negative woman, her body will recognize that the Rh-positive blood is not
hers. Her body will try to destroy it by making anti-Rh antibodies. These
antibodies can cross the placenta and attack the fetus’s blood cells. This can lead
to serious health problems, even death, for a fetus or a newborn.