1. Accompanied by her husband, a patient seeks admission to the labor and delivery area. The client states that she is in labor, and says she attended the hospital clinic for prenatal care. Which question should the nurse ask her first?
a. “Do you have any chronic illness?”
b. “Do you have any allergies?”
c. “What is your expected due date?”
d. “Who will be with you during labor?”
2. A patient is in the second stage of labor. During this stage, how frequently should the nurse in charge assess her uterine contractions?
a. Every 5 minutes
b. Every 15 minutes
c. Every 30 minutes
d. Every 60 minutes
3. A patient is in last trimester of pregnancy. Nurse Jane should instruct her to notify her primary health care provider immediately if she notices:
a. Blurred vision
c. Increased vaginal mucus
d. Shortness of breath on exertion
4. The nurse in charge is reviewing a patient’s prenatal history. Which finding indicates a genetic risk factor?
a. The patient is 25 years old
b. The patient has a child with cystic fibrosis
c. The patient was exposed to rubella at 36 weeks’ gestation
d. The patient has a history of preterm labor at 32 weeks’ gestation
5. A adult female patient is using the rhythm (calendar-basal body temperature) method of family planning. In this method, the unsafe period for sexual intercourse is indicated by;
a. Return preovulatory basal body temperature
b. Basal body temperature increase of 0.1 degrees to 0.2 degrees on the 2nd or 3rd day of cycle
c. 3 full days of elevated basal body temperature and clear, thin cervical mucus
d. Breast tenderness and mittelschmerz
6. During a nonstress test (NST), the electronic tracing displays a relatively flat line for fetal movement, making it difficult to evaluate the fetal heart rate (FHR). To mark the strip, the nurse in charge should instruct the client to push the control button at which time?
a. At the beginning of each fetal movement
b. At the beginning of each contraction
c. After every three fetal movements
d. At the end of fetal movement
7. When evaluating a client’s knowledge of symptoms to report during her pregnancy, which statement would indicate to the nurse in charge that the client understands the information given to her?
a. “I’ll report increased frequency of urination.”
b. “If I have blurred or double vision, I should call the clinic immediately.”
c. “If I feel tired after resting, I should report it immediately.”
d. “Nausea should be reported immediately.”
8. When assessing a client during her first prenatal visit, the nurse discovers that the client had a reduction mammoplasty. The mother indicates she wants to breast-feed. What information should the nurse give to this mother regarding breast-feeding success?
a. “It’s contraindicated for you to breast-feed following this type of surgery.”
b. “I support your commitment; however, you may have to supplement each feeding with formula.”
c. “You should check with your surgeon to determine whether breast-feeding would be possible.”
d. “You should be able to breast-feed without difficulty.”
9. Following a precipitous delivery, examination of the client’s vagina reveals a fourth-degree laceration. Which of the following would be contraindicated when caring for this client?
a. Applying cold to limit edema during the first 12 to 24 hours
b. Instructing the client to use two or more peripads to cushion the area
c. Instructing the client on the use of sitz baths if ordered
d. Instructing the client about the importance of perineal (Kegel) exercises
10. A client makes a routine visit to the prenatal clinic. Although she’s 14 weeks pregnant, the size of her uterus approximates that in an 18- to 20-week pregnancy. Dr. Diaz diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal:
a. an empty gestational sac.
b. grapelike clusters.
c. a severely malformed fetus.
d. an extrauterine pregnancy.
11. After completing a second vaginal examination of a client in labor, the nurse-midwife determines that the fetus is in the right occiput anterior position and at –1 station. Based on these findings, the nurse-midwife knows that the fetal presenting part is:
a. 1 cm below the ischial spines.
b. directly in line with the ischial spines.
c. 1 cm above the ischial spines.
d. in no relationship to the ischial spines.
12. Which of the following would be inappropriate to assess in a mother who’s breast-feeding?
a. The attachment of the baby to the breast.
b. The mother’s comfort level with positioning the baby.
c. Audible swallowing.
d. The baby’s lips smacking
13. During a prenatal visit at 4 months gestation, a pregnant client asks whether tests can be done to identify fetal abnormalities. Between 18 and 40 weeks’ gestation, which procedure is used to detect fetal anomalies?
b. Chorionic villi sampling.
14. A client, 30 weeks pregnant, is scheduled for a biophysical profile (BPP) to evaluate the health of her fetus. Her BPP score is 8. What does this score indicate?
a. The fetus should be delivered within 24 hours.
b. The client should repeat the test in 24 hours.
c. The fetus isn’t in distress at this time.
d. The client should repeat the test in 1 week.
15. A client who’s 36 weeks pregnant comes to the clinic for a prenatal checkup. To assess the client’s preparation for parenting, the nurse might ask which question?
a. “Are you planning to have epidural anesthesia?”
b. “Have you begun prenatal classes?”
c. “What changes have you made at home to get ready for the baby?”
d. “Can you tell me about the meals you typically eat each day?”
16. A client who’s admitted to labor and delivery has the following assessment findings: gravida 2 para 1, estimated 40 weeks’ gestation, contractions 2 minutes apart, lasting 45 seconds, vertex +4 station. Which of the following would be the priority at this time?
a. Placing the client in bed to begin fetal monitoring.
b. Preparing for immediate delivery.
c. Checking for ruptured membranes.
d. Providing comfort measures.
17. Nurse Roy is caring for a client in labor. The external fetal monitor shows a pattern of variable decelerations in fetal heart rate. What should the nurse do first?
a. Change the client’s position.
b. Prepare for emergency cesarean section.
c. Check for placenta previa.
d. Administer oxygen.
18. The nurse in charge is caring for a postpartum client who had a vaginal delivery with a midline episiotomy. Which nursing diagnosis takes priority for this client?
a. Risk for deficient fluid volume related to hemorrhage
b. Risk for infection related to the type of delivery
c. Pain related to the type of incision
d. Urinary retention related to periurethral edema
19. Which change would the nurse identify as a progressive physiological change in postpartum period?
c. Uterine involution
20. A 39-year-old at 37 weeks’ gestation is admitted to the hospital with complaints of vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is most likely causing the client’s complaint of vaginal bleeding?
a. Placenta previa
b. Abruptio placentae
c. Ectopic pregnancy
d. Spontaneous abortion
21. A client with type 1 diabetes mellitus who’s a multigravida visits the clinic at 27 weeks gestation. The nurse should instruct the client that for most pregnant women with type 1 diabetes mellitus:
a. Weekly fetal movement counts are made by the mother.
b. Contraction stress testing is performed weekly.
c. Induction of labor is begun at 34 weeks’ gestation.
d. Nonstress testing is performed weekly until 32 weeks’ gestation
22. When administering magnesium sulfate to a client with preeclampsia, the nurse understands that this drug is given to:
a. Prevent seizures
b. Reduce blood pressure
c. Slow the process of labor
d. Increase dieresis
23. What’s the approximate time that the blastocyst spends traveling to the uterus for implantation?
a. 2 days
b. 7 days
c. 10 days
d. 14 weeks
24. After teaching a pregnant woman who is in labor about the purpose of the episiotomy, which of the following purposes stated by the client would indicate to the nurse that the teaching was effective?
a. Shortens the second stage of labor
b. Enlarges the pelvic inlet
c. Prevents perineal edema
d. Ensures quick placenta delivery
25. A primigravida client at about 35 weeks gestation in active labor has had no prenatal care and admits to cocaine use during the pregnancy. Which of the following persons must the nurse notify?
a. Nursing unit manager so appropriate agencies can be notified
b. Head of the hospital’s security department
c. Chaplain in case the fetus dies in utero
d. Physician who will attend the delivery of the infant
26. When preparing a teaching plan for a client who is to receive a rubella vaccine during the postpartum period, the nurse in charge should include which of the following?
a. The vaccine prevents a future fetus from developing congenital anomalies
b. Pregnancy should be avoided for 3 months after the immunization
c. The client should avoid contact with children diagnosed with rubella
d. The injection will provide immunity against the 7-day measles.
27. A client with eclampsia begins to experience a seizure. Which of the following would the nurse in charge do first?
a. Pad the side rails
b. Place a pillow under the left buttock
c. Insert a padded tongue blade into the mouth
d. Maintain a patent airway
28. While caring for a multigravida client in early labor in a birthing center, which of the following foods would be best if the client requests a snack?
b. Cereal with milk
c. Vegetable soup
d. Peanut butter cookies
29. The multigravida mother with a history of rapid labor who us in active labor calls out to the nurse, “The baby is coming!” which of the following would be the nurse’s first action?
a. Inspect the perineum
b. Time the contractions
c. Auscultate the fetal heart rate
d. Contact the birth attendant
30. While assessing a primipara during the immediate postpartum period, the nurse in charge plans to use both hands to assess the client’s fundus to:
a. Prevent uterine inversion
b. Promote uterine involution
c. Hasten the puerperium period
d. Determine the size of the fundus
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