OBSTETRIC NURSING

INSTRUCTIONS: Read and understand the questions properly and choose the BEST answer among the four answer choices. By using the answer sheet provided. Good luck!
1. After receiving large doses of an ovulatory stimulant such as menotropins (Pergonal), a client comes in for her office visit. Assessment reveals the following: 6-lb (3-kg) weight gain, ascites, and pedal edema. This assessment indicates the client is: a. exhibiting normal signs of an ovulatory stimulant. c. is probably pregnant. b. demonstrating signs of hyperstimulation syndrome. d. is having a reaction to the menotropins. 2. When assessing a postpartum client, Nurse Addison notes a continuous flow of bright red blood from the vagina. The uterus is firm and no clots can be expressed. Which action should Addison take? a. Apply an ice pack to the perineum. c. Notify the physician. b. Massage the uterus every 15 minutes. d. Reassure the client that such bleeding is normal. 3. A client is experiencing an early postpartum hemorrhage. Which of the following actions would be inappropriate? a. Inserting an indwelling urinary catheter c. Administration of oxytoxics b. Fundal massage d. Pad count 4. Which of the following would be an inappropriate indication of placental detachment? a. An abrupt lengthening of the cord c. Relaxation of the uterus b. An increase in the number of contractions d. Increased vaginal bleeding 5. A client, age 19, goes into labor at 40 weeks' gestation. When assessing the fetal monitor strip, Nurse Arlene sees that the fetal heart rate (FHR) has decreased to 60 beats/minute and that the waveforms sometimes resemble a U and begin and end abruptly. Arlene should interpret this pattern as: a. variable decelerations. c. increased long-term variability. b. decreased short-term variability. d. early decelerations. 6. A primigravid client is admitted to the labor and delivery area, where Nurse Bert evaluates her. Which assessment finding may indicate the need for cesarean delivery? a. Insufficient perineal stretching c. Umbilical cord prolapse b. Rapid, progressive labor d. Fetal prematurity 7. When caring for a client who has had a cesarean section, which of the following actions is not appropriate for Nurse Bert to do? a. Removing the initial dressing for incision inspection b. Monitoring pain status and providing necessary relief c. Supporting self-esteem concerns about delivery d. Assisting with parental newborn bonding 8. Nurse Jenny demonstrates infant bathing to a primiparous client. Which statement by the client indicates a lack of understanding? a. "I'm going to bathe the baby in the kitchen because it's nice and warm there." b. "I have all kinds of pretty, scented soaps and lotions to bathe the baby with." c. "I'll sponge-bathe the baby until the cord area heals." d. "I'll wash the baby's eyes and face first." 9. At 39 weeks' gestation, a pregnant client is admitted to the labor and delivery area in active labor. During the admission interview, she reports that her membranes haven't ruptured. Her history reveals that this is her third pregnancy, she previously experienced a stillbirth at 38 weeks' gestation, and she has one child at home. Which of these findings indicates the need for electronic fetal monitoring (EFM)? a. Third pregnancy c. 39 weeks' gestation b. Intact membranes d. Previous stillbirth 10. The nurse is caring for a woman with a fetus with a brow presentation. Which intervention is appropriate for this client? a. Schedule a cesarean delivery. b. Have the mother stand to push c. Give a tocolytic to stop contractions. d. Put the mother in Trendelenburg's position to lessen pressure on the fetal head. 11. A client is in her second trimester of pregnancy. During her routine prenatal visit, she states that she frequently has calf pain when she walks, which of the following should the nurse assess to assist in identifying the origin of the discomfort? a. Chadwicks Sign b. Leopolds Sign c. Homans Sign d. Kernigs Sign 12. A client comes to the hospital at 36 weeks complaining that her "water broke" but denying any contractions. Which of the following assessment data provides the most reliable indication of premature rupture of membranes? a. A dried specimen shows a microscopic fern pattern. b. Fluid from the perineum turns nitrazine paper dark blue. c. No membranes are felt on a sterile vaginal exam d. The client has a visible watery vaginal discharge 13. A client's amniotic fluid is greenish-tinged. The fetal presentation is vertex. Fetal heart rate (FHR) and uterine activity have remained within normal limits. At the time of delivery, the nurse should anticipate the need for: a. An infant laryngoscope and suction catheters c. A transport isolette

b. Forceps d. Emergency cesarean set-up 14. Following amniotomy, the most important action is to: a. Reposition the mother on her left side c. Listen to fetal heart tones b. Place a clean underpad on the bed d. Observe the color and consistency of the amniotic fluid. 15. The nurse encourages limiting the number of vaginal examinations to minimize the client's risk of: a. Cervical lacerations b. Bleeding c. Infection d. Loss of control 16. Which of the following statements best describes hyperemesis gravidarum? a. Severe anemia leading to electrolyte, metabolic and nutritional imbalances in the absence of other medical problems b. Severe nausea and vomiting leading to electrolyte, metabolic and nutritional imbalances in the absence of other medical problems c. Loss of appetite and continuous vomiting that commonly results in dehydration and ultimately decreasing maternal nutrients d. Severe nausea and diarrhea that can cause gastrointestinal irritation and possibly internal bleeding 17. The nurse has just admitted a client in the labor-and-delivery unit who has been diagnosed by her physician as having DM. Which of the following measures is most appropriate for this situation? a. Ask the client about her most recent blood glucose level b. Prepare oral hypoglycemic medications for administration during labor c. Notify the neonatal intensvie care unit that you will be admitting a client with DM d. Prepare the client for cesarean delivery 18. A client in labor is admitted with blood flowing down her legs. Which of the following interventions would be most appropriate? a. Place an indwelling Foley catheter c. Perform vaginal examination b. Assess FHT d. Prepare client for CS
SITUATION: Fernandez has been married for 1 years. She stopped taking oral contraceptives several months ago and now suspects she is pregnant. She is being seen by her physician for the first time. 19. Mrs. Fernandez has neumerous common signs and symptoms associated with pregnancy. Which of the following signs suggests she is probably pregnant? a. Amenorrhea c. Enlarged and tender abdomen b. Frequent micturation d. Goodells sign 20. Which of the following is true of pregnancy test done on urine samples? a. A positive test is based on increased estrogen excretion in the urine b. They are 100% accurate if done to 10-14 days after fertilization c. A positive test is based on the excretion of chorionic gonadotropin in the urine d. Home pregnancy tests are not accurate, and clients should be cautioned not to use them. 21. Mrs. Fernandez is concerned about eating the proper foods during her pregnancy. Which of the following actions is the most appropriate? a. Give her a list of foods to refer her in planning her meals b. Emphasize the importance of limiting highly seasoned and salty foods c. Ask Mrs. Fernandez to list her food intake for the last 3 days d. Instruct her to continue her usual diet, as she appears to be nutritionally fit 22. Mrs. Fernandez has a low hemoglobin . When counseling her to increase her iron intake, which of the following meals should the nurse recommend to her? a. Ham sandwich, corn pudding, c. Chicken liver, sliced tomatoes, tossed salad dried fruits b. Hamburger, green beans, fruit d. Omelet with mushrooms, spinach cup salad 23. The nurse should instruct Mrs. Fernandez to notify the physician immediately if which of the following symptoms occur? a. Swelling of the face c. Increased vaginal discharge b. Frequent micturition d. The presence of chloasma 24. Which of the following changes is a pregnant woman most likely to notice in her breast? a. Darkening of the areola, tingling sensation, engorgement b. Lightening of the areola, colostrum, increased size c. Colostrum, tingling sensation, darkening of the areola d. Increased nipple size, tenderness, flattening of the nipples 25. Mrs. Fernandez is treated for syphilis during the first trimester with IM injections of Penicillin. The babys diagnosis at birth should most likely be: a. Congenital defects c. Normal newborn b. Stillborn d. Premature newborn 26. Constipation in pregnancy is best prevented by: a. Regular use of mild laxative c. Limiting excessive weight gain b. Increased bulk and fluid in the diet d. Regular use of Bisacodil (Dulcolax) suppositories 27. Which of the following symptoms would be considered normal if found while assessing Mrs. Fernandez: a. Vaginal bleeding and 1+ albuminuria c. In the urine, 1+ sugar and urinary frequency

Oliguria and Glycosuria d. Swelling of the face and increased vaginal discharge 28. Occurs with physical and psychological stimulation (ex. Sight, emotion, sound or thought) that causes parasympathetic nerve stimulation. a. Excitement b. Orgasm c. Plateau d. Resolution 29. Is a person who finds sexual fulfillment with a member of his or her own sex. a. Heterosexual b. Homosexual c. Bisexual d. Transexual 30. Client has never completed a pregnancy; may or may not have aborted a. Nullipara b. Nulligravida c. Primipara d. Primigraida 31. A client asks you how would she know her estimate EDD, when her last menstrual period was Nov. 2, 2008 a. Aug 9, 2009 c. Aug, 26, 2009 b. Feb. 9, 2009 d. Feb. 26, 2009 32. A clients AOG is 30 weeks AOG, using her AOG what is her estimate fundal height? a. 30 in b. 30 cm c. 30 m d. 30 g

b.

33. What is the 3rd maneuver in Leopolds maneuver?

a. Stand at the foot of the client, facing her and place both hands flat on her abdomen b. Face the client and place the palms on each hand on either side of the abdomen c. Grasp gently the lower portion of the abdomen just above the symphysis pubis between the thumb and index finger and try to press the thumb and finger d. Place fingers on both sides of the uterus approximately 2 inches above the inguinal ligaments. SITUATION: Diane Smith, a 26 yrs old primigravida in her 40th week of pregnancy, is admitted to the labor area. She has had no antepartal care. She is accompanied by her husband. Her membranes ruptured in the car on the way to the hospital. 34. Which of the following initial assessments would be least important during her admission? a. Type of anesthesia requested for delivery c. Maternal vital signs b. Location, rate, and rhythm of feral heart tones d. Onset, duration and frequency of contractions 35. The admitting vaginal exam reveals that Mrs. Smiths cervix is 6 cm dilated and 100% effaced. The fetus is at 1+ station and left occiput anterior. She is having difficulty coping with her contractions, which are occurring every 3 minutes. Which of these actions is appropriate during her next contraction? a. Encourage her to bear down with the contraction b. Check the perineum for crowning c. Provide direct coaching using chest-abdominal breathing techniques d. Show her husband how to apply firm pressure to her sacral area 36. The nurse knows that Mrs. Smith is in the transition phase of labor when she: a. Begins accelerated breathing c. Requests sacral pressure b. Requests pain medication d. Becomes irritable and frightened 37. Mrs. Smith is in the transition phase. Her contractions are lasting 75 seconds and occurring every 2 minutes. She begins to grunt and says she has to push. Upon vaginal exam, the nurse finds her cervix is dilated 9 cm. What is the most appropriate immediate action? a. Roll her on her side and tell her to breath slowly b. Tell her to blow out, until the urge passes c. Explain the pushing will cause the cervix to swell and delay dilatation d. Tell her to push with each contraction 38. Mrs. Smith begins to show symptoms of hyperventilation with her rapid panting during contractions. The nurse instructs her to slow down her breathing and breathe into her cupped hands. Which of the following would best indicate effectiveness of this action? a. Dizziness and finger tingling subsides c. Amnesia between contractions lessens b. Nausea increases d. The urge to push subsides 39. Mrs. Smith has an uneventful vaginal delivery with a midline episiotomy done under local anesthesia. During the fourth stage of labor, the nurse should include which of the following in a care plan? a. Massage the fundus constantly c. Palpate the uterus to check muscle tone every 15 minutes b. Monitor temperature every 30 minutes d. Monitor BP every 5 minutes 40. Baby girl Smith weighed 6 lbs at birth and received routine care. Her eyes were treated prophylactically with 1% Erythromycin. This treatment is done to prevent? a. Chemical conjunctivitis c. Herpes Infection b. Neonatal Syphilis d. Opthalmia Neonatorum SITUATION: Guiliana, aged 41 is admitted to the labor and delivery unit at 4:00 pm. While taking the history, the nurse notes the following: gravid , para 7, 41 AOG, membranes ruptures at 10:00 am that day, contractions occur every 3 minutes; strong intensity with a duration of 60 seconds. 41. What action would take the highest priority at this time? a. Get blood and urine samples b. Do perineal prep and give enema

c. Attach monitors to the client d. Determine extent of cervical dilatation 42. Guiliana has just been given epidural anesthesia. What is the most important assessment at this time? a. Maternal blood pressure c. Maternal level of consciousness b. Fetal heart rate d. Fetal position 43. Guiliana has a normal spontaneous delivery. Why would she be considered at risk for development of post partal hemorrhage: a. Grand multiparity c. Post term delivery b. Premature rupture of membranes d. Anesthesia 44. The patient asks to be discharged after 24 hours, and her physician agrees. What is the most important for the nurse to include in the discharge instructions? a. Family planning information c. Need to have infant tested for phenylketonuria b. Newborn-care information d. Referral to social service SITUATION: Mrs. Guia was admitted to the OB ward in active labor 45. The patient begins to experience contractions 2-3 minutes apart that last about 45 seconds. Between contractions, the nurse records a fetal heart rate of 100 beats per min. The nurse should? a. Closely monitor c. Notify the physician immediately b. Chart the rate as a normal response to contractions d. Continue to monitor the fetal heart rate 46. During delivery, episiotomy was performed. When caring for the patient during the post-partum period, the nurse encourages sitz bath (Perilight) tid for 15 minutes Sitz bath (Perilight) primarily aids the healing process by: a. Softening of the incision site c. Cleansing the perineal area b. Promoting vasodilation d. Tightening the perineal sphincter 47. When preparing Mrs. Guia to care for her episiotomy after discharge, the nurse should include as a priority, instructions to: a. Continue the sitz bath (Perilight) tid if it provides comfort b. Discontinue the sitz bath once she is at home c. Continue perineal care after toileting until healing occurs d. Avoid climbing for at least a few days after discharge SITUATION: The nurse-nurse assigned to the labor and delivery unit of the hospital is required to manage care for a group of clients. The use of electronic fetal monitoring has enhanced the assessment of fetal response to labor, yet the nurse must constantly apply knowledge to interpret the tracing. 48. The nurse sees that there are many variable decelerations on a patients fetal monitor strip. Variable decelerations most likely are due to: a. Head compression c. Uteroplacental insufficiency b. Cord compression d. Posterior presentation 49. Which of the following reading would be considered normal? a. Late decelerations, good variability b. Early decelerations, no variability c. Early decelerations, good variability d. Variable decelerations, no variability

SITUATION: Jaycee, aged 32 is admitted for induction of labor. It is estimated by ultrasound that the fetus is 42 weeks AOG. She is very impatient for the birth of this planned child. The physician elects to rupture the membranes artificially. Subsequently, FHR is stable at 144 bpm. Amniotic fluid is clear. 50. Jaycee experiences sudden onset of dysnea, cyanosis and severe apprehension. This is followed by a severe chest pain. Which of the following conditions is suggested by these data? a. Acute myocardial infarction c. Hysterical reaction b. Pulmonary embolus d. Massive infection 51. Jaycee is transferred to the ICU. The husband remains in the waiting room, stunned. He refuses to talk to the resident and insists he will wait there for the safe delivery of his child. How could the nurse best meet his needs at this time? a. Insist that he go to the ICU c. Allow him privacy and leave him alone b. Remain with him for the next few minutes d. Ask the attending physician to see him later 52. After 30 minutes, the husband joins his wife in the ICU. She is unresponsive. There is evidence of massive internal hemorrhage associated with disseminated intravascular coagulation (DIC). The physician orders immediate transfusion, but the husband refuses on religious grounds. Which action by the nurse is least appropriate at this time? a. Call the clergymen to speak with the father b. Emphasize that religious values are not important as saving lives c. Clarify the physicians explanation of the situation d. Ask the father if he wishes to consult with his family 53. While awaiting the decision on the use of blood transfusion, the clients status is best evaluated by which of the following? a. Level of consciousness c. Observation of bleeding b. BP and pulse d. Repeated hematocrit levels 54. After discussion with the clergy and physicians, the husband agrees to life-saving measures and transfusions. However the client does not respond to therapy, and both mother and fetus die. Which statement made by the distraught father by the nurse is most appropriate? a. Im so sorry b. Try not to feel guilty

c.

It must be very difficult for you

d. At least you have other children at home

SITUATION: Chloe Rivera a primipara who is trying to breastfeed her infant for the first time. 55. Which of the following would be least helpful to Chloe? a. Stimulate the infant to suck by rubbing the check on the side closest to the nipple b. Use nipple rolling to get the nipple erect c. Use a breast pump to bring the milk forward to the areola d. Place most of the areola in the infants mouth 56. Which of the following statement by Chloe would indicate that she would need more teaching before her discharge? a. I know how and when to bath the infant b. I know that if my lochia becomes bright red I will need to rest and call my doctor c. I need to increase my calorie intake by 500 calories d. I plan on doing pushups and sit ups when I return home 57. A nurse is conducting a prenatal teaching class and is reviewing the functions of the female reproductive system. A client in the class asks the nurse about the function of the fallopian tubes. The nurse tells the client that: a. estrogen and progesterone are secreted from the fallopian tube b. the fallopian tubes are the passageway for the fetus c. the fetus develops in the fallopian tubes d. fertilization occurs in the fallopian tubes 58. An instructor is discussing the menstrual cycle with a group of students to describe the follicle- stimulating hormone (FSH) and leutinizing hormone (LH). The student 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 gland d. FSH and LH stimulate the formation of milk during pregnancy. 59. A nurse employed in a prenatal clinic reviews a clients chart and notes that the physician documented that the client has gynecoid pelvis. The nurse plans care for this client knowing that this type of pelvis: a. is not favorable for labor c. Is a wide pelvis with a short diameter b. has a narrow pubic arch d. Is the most favorable for labor and birth 60. A client asks the nurse about the purpose of the placenta. The nurse responds most appropriately by telling the client that the placenta: a. prevents antibodies and viruses from passing to the fetus b. Cushions and protects the fetus c. Provides an exchange of nutrients and waste products between the mother and the fetus d. Maintains the body temperature of the fetus 61. Engel, a student nurse is assigned to a client in labor. Maam Jane, the instructor asks Engel to describe the fetal circulation, specifically the ductus venosus. Maam Jane determines that he understands fetal circulation if the he states that the ductus venosus: a. Connects the pulmonary artery to the aorta c. Connects the umbilical artery to the inferior vena cava b. is an opening between the right and the left atria d. Connects the umbilical vein to the inferior vena cava 62. Nurse Ann is caring for a client during the prenatal period. The client tells Nurse Ann that she wants to know the sex of the fetus as soon as it can be determined. Nurse Ann responds to the client, knowing that the sex of the fetus is recognizable as early as week: a. 4 b. 6 c. 8 d. 12 63. Nurse Ann prepares to assess a fetal heart beat. She uses a fetoscope, knowing that the fetal heart beat can first be heard with a fetoscope at gestational week: a. 5 b. 10 c. 16 d. 20 64. During a prenatal visit, nurse Engel assesses the fetal heart rate. Nurse Engel 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 65. Melinda, a 5 y/o pregnant client on her first trimester comes to the prenatal clinic for her prenatal check up. She complains of having nausea and vomiting. Nurse Diane should include in her plan of care the following interventions: a. Eating 3 large fatty meals per day c. Eating small, frequent, low fat meals during the day b. Eating fried foods d. Drinking soda/ cola in between meals 66. One of the discomforts during pregnancy is urinary frequency which occurs during the first and the third trimester of pregnancy, due to the pressure on the bladder by the enlarging uterus. All of the following are implementations to be taught by the nurse to the pregnant woman except: a. Drinking 2 quarts of fluid per day b. Limiting fluid intake of the pregnant woman

c.

Voiding at regular interval

d. Wearing perineal pads if necessary

67. Melissa who is 28 weeks pregnant complains to nurse Ann about a burning sensation in the chest. When explaining to Melissa about her condition, Nurse Ann should tell Melissa that: a. It is an abnormal finding which indicates hypertension, medication should be taken b. It is an abnormal finding caused by increased blood volume c. It is a normal finding caused by decreased GIT motility; you should lie down immediately after meals d. it is a normal finding, caused by the displacement of the stomach by the enlarging uterus, you should sit upright for 30 minutes following a meal

68. Constipation usually occurs during the 2nd and 3rd trimester of pregnancy. When Nurse Ann is explaining the causes of
constipation to Melissa, she should include the following except: a. decrease intestinal motility b. displacement of the intestines c. hormonal changes d. iron supplement

69. If a fetus is LOA, in which maternal location should the nurse anticipate finding the fetal heart tones (FHTs)? a. Below the umbilicus on the left side. c. Above the umbilicus on the left side. b. Below the umbilicus on the right side. d. Above the umbilicus on the right side. 70. Anticipatory guidance may be indicated to help expectant parents achieve the normal developmental tasks of the beginning family. What is least likely to cause anxiety and stress at 18 weeks of gestation? a. Economic demands of having a child. b. Change in intra-family relationships. c. Increasing awareness of the need to be responsible for another individual (the infant). d. Feelings of having to compete for attention. 71. Two hours after birth, the nurse determines that further evaluation and possible intervention are needed when the new mother: a. Has voided 75 mL. b. States that her 4-year-old daughter is anxiously waiting to play with the new baby. c. Has a moderate amount of lochia rubra. d. Comments that she has never been so happy to be done with a pregnancy. 72. A new mother tells the nurse she is breastfeeding because she cant stand the thought of the infant being vaccinated. Which response demonstrates effective health teaching? a. Thats great. Vaccinations arent needed if you breastfeed. b. Oh you still need to have the infant vaccinated against DPT, measles, and polio before the infant is 6 months old. c. You can only give temporary protection to the infant against the diseases you have had yourself. d. The most protection comes from colostrums just after birth. Unfortunately, you didnt start feeding the infant right away. 73. A woman in labor is becoming less interactive with visitors and staff, evidences a malar flush, and tends to hyperventilate with contractions. These signs occur most commonly during which phase? a. Latent b. Active c. Transitional d. Pushing 74. A mother is in the third stage of labor. The nurse is observing for signs of separation of the placenta, which include: a. The uterus becomes globular. c. The umbilical cord is shortened. b. The fundus appears at the introitus. d. Mucoid discharge is increased. 75. Most accidental pregnancies in couples using natural family planning methods are related to unprotected intercourse before ovulation. Which factor best explains why pregnancy may be achieved by unprotected intercourse during the preovulatory period? a. Spermatozoa viability. c. Tubal motility. b. Ovum viability. d. Secretory endometrium. 76. The nurse explains to a nursing student that oxytocin (Pitocin), 10 units (IV or IM), is given following birth of the fetus and placenta to: a. Minimize discomfort from afterpains. c. Suppress lactation. b. Prevent endometritis. d. Maintain uterine tone. 77. In discussing dos and donts, which health-teaching aspect should be emphasized as important for health maintenance during pregnancy? a. Keeping appointments for prenatal visits, remembering to ask questions when necessary, and following the medical/nursing recommendations. b. Making preparation for childbirth classes. c. Exercising moderately, eating a high-carbohydrated diet, and getting adequate rest. d. Taking multivitamins and iron, drinking six glasses of milk daily, and minimizing physical exertion.

78. A woman in the first stage of labor requests medication for discomfort Butorphanol (Stadol) 1 mg IV is ordered. Butorphanol is a mixed narcotic agonist-antagonist compound. Before administering the medication, the nurse reviews the clients chart for a history of any contraindication, which include: a. Hypertension c. Respiratory rate of 18-22/min b. Narcotic dependency d. Constipation 79. The nurse should know that taking care of physical comfort needs is an important nursing intervention in labor. Which of the following is not an effective nursing intervention for active labor? a. Encourage frequent voiding to prevent a full bladder from slowing the progress of labor. b. Encourage ambulation to use the force of gravity to aid descent of the fetus and reduce the discomfort of lying in bed. c. Encourage hydration by monitoring IV intake and use of ice and lip balm to relieve dry mouth. d. Encourage relaxation in a sitting position to relieve pressure on leg veins and back pressure. 80. The nurse in labor and delivery is very carefully observing the behavior of a woman who is a primipara at term in active labor. The nurse determines that the client is entering transition when the nurse observes the client: a. Breathing slowly and deeply with contractions. b. Asking questions about fetal heart rate tracing between contractions. c. Yelling at her coach to keep quite during a contraction. d. Requesting to ambulate in the hallway. 81. A woman who is pregnant is advised by the nurse to take an iron supplement: a. With citrus juice 2 hours after a meal. b. One hour before breakfast, with milk every other day. c. In an enteric-coated form, with citrus, each evening. d. Dissolved in tea, with a bread product, before each meal. 82. The nurse is providing nursing care to a mother who is in active labor with her second full-term infant. Her first delivery was by cesarean for cephalopelvic disproportion. The mother is being given a trial of labor and was 7 cm dilated and 80% effaced at the last exam. The mother complains of sudden sharp abdominal pain. The nurse should: a. Comfort and reassure the mother that she is experiencing typical transition contractions. b. Check for rupture of membranes. c. Check for vaginal bleeding and notify the physician of the possibility of abruptio placenta. d. Check the fetal heart rate and notify the physician of the possibility of uterine rupture. 83. A woman has been diagnosed with mild preeclampsia. The couple is concerned about what effect the disease may have on the fetus. Which indicator or test of fetal well-being should the nurse teach the couple to expect most commonly during the rest of the prenatal period? a. Nonstress test c. Lecithin-sphingomyelin (L/S) ratio. b. Amniocentesis d. Fetal blood gases 84. A woman who is pregnant has a history that reveals one pregnancy, terminated by elective abortion at 10 weeks; birth of twins at 37 weeks; and a spontaneous abortion at 12 weeks. According to the TPAL system, which of the following describes her present parity? a. 0-2-2-2 b. 2-0-2-2 c. 0-1-2-2 d. 1-0-2-2 85. Assessment findings at 16 weeks of gestation include marked chloasma and secondary pigmented areola; in addition, the womans umbilicus is flushed with her abdominal skin. During which trimester are these physical changes of pregnancy commonly found? a. First b. Second c. Third d. Fourth 86. The nurse questions orders for the treatment of mastitis in the breastfeeding woman when which of the following appears on the order sheet? a. IV antibiotic therapy. b. Discontinuation of breastfeeding and emptying of the breasts. c. Firm support of the breasts. d. Application of heat for comfort. 87. A woman appears excited, euphoric, and eager to learn about her labor status. Her behavior supports the nursing assessment that she is progressing through which phase of labor? a. Latent b. Active c. Transitional d. Prodromal 88. During the first stage of labor, maternal and fetal vital signs must be closely monitored. The best time to observe maternal vital signs is: a. Immediately before a contraction. c. Immediately after a contraction. b. Between contractions d. Anytime the mother feels totally comfortable. 89. A woman in labor suddenly screams and shouts in Spanish. Her husband translates that she has a terrible pain in her calf. What should the nurse do immediately? a. Inform the doctor that the woman has signs of abruptio placenta.

b. Administer oxygen by mask to expedite conversion of muscle lactic acid. c. Straighten the womans knee and dorsiflex her foot. d. Turn the woman on her left side to increase placental perfusion. 90. A woman has just delivered her first full-term infant and is showing signs of placental separation. She complains to the nurse that she cannot catch her breath and that she has pain in her ribs. She starts to cough. The first action by the nurse should be to: a. Start an IV. c. Administer oxytocin (Pitocin) IM. b. Administer nasal oxygen at 6 to 8 L. d. Ask if she has asthma. 91. A nurse on the postpartum unit has been ordered to discharge a mother who delivered the day before. The nurse is concerned that the mother does not understand how to take care of herself and the infant. The mother is not interested in discussing these topics or viewing videotapes. Which resources would adequately fulfill the nurses obligation to prepare the mother for discharge? a. A full set of pamphlets describing maternal and infant care. b. A list of phone numbers, including the postpartum unit, where the mother can call to get questions answered. c. No resources are needed because the nurse has no obligation. d. Referral to a nursing agency for a home visit, making sure the mother has a car seat in which to take the infant home. 92. A new mother saturates her perineal pad in 15 minutes. Her fundus is firm and smooth, and there is a constant trickle of blood from the vagina. No clots can be expressed when the fundus is massaged. Which action should the nurse take immediately? a. Notify the physician, because the site of her bleeding must be located. b. Notify the physician, because the site of her bleeding must be located. c. Administer oxytocin according to PRN order. d. Reapply the perineal pad and evaluate the bleeding in 15 minutes. 93. A womans history reveals a pregnancy at age 15 that was terminated by elective abortion at 10 weeks, birth of twin girls at 37 weeks, and a spontaneous abortion at 12 weeks, 1 year ago. She is currently pregnant. Analyzing these data, the nurse selects which of the following to describe her present gravidity and parity? a. G5P2 b. G5P1 c. G4P4 d. G4P1 94. A woman who is pregnant calls the labor and delivery unit to speak to the nurse. She states that she is at term with her first infant and wants to know if she should come to the hospital. She explains that she has had contractions for 12 hours, and the last 3 have been 5 minutes apart. She has some bright-red spots of blood from her vagina, and her bag of waters has not broken. The infant has been moving less than usual, about five movements per hour. The nurse should: a. Advise her to come immediately to the hospital because she is bleeding and that is abnormal. b. Advise her that she might be in labor and should try walking around. If the contractions keep coming, then she should come to the hospital. c. Advise her that she is not in labor if her contractions are not strong and close together after 12 hours. She should lie down and try to sleep. d. Advise her to wait until her bag of water breaks before she comes to the hospital. 95. During a home visit to a mother who is 2-weeks postpartum and breastfeeding, the nurse is discussing the resumption of fertility, offering information about contraception and sexual activity. The nurse should know that the client understands the information when the client states: a. Because I am breastfeeding and mu hormones are decreased, I may need to use a vaginal lubricant when I have sex. b. Breastfeeding protects me from pregnancy because it keeps my hormones down, so I dont need any contraception until I stop breastfeeding. c. Because breastfeeding speeds the healing process after birth, I can have sex right away and not worry about infection. d. After birth, you have to have a period before you can get pregnant again. 96. Immediately before a woman is to give birth, her husband expresses anxiety about staying with her. The most appropriate response the nurse could make would be: a. Many people feel frightened at this time. c. Think of your wife. How will she feel if you dont stay? b. Youll do fine, dont worry. d. Once things get going, youll forget about being afraid. 97. Which nursing intervention should be implemented to reduce a womans stress in the first trimester regarding her feelings about mood swings, tingling, tender breasts, and fluctuating sexual desire? a. Validate normalcy of emotional lability. c. Refer her to a psychologist for counseling. b. Recommend high-protein, high-vitamin diet. d. Reinforce positive feelings about the pregnancy. 98. Nursing assessment of a woman in labor notes marked introspection, irritability and inability to focus. She is diaphoretic, and cries, I cant take it! These behaviors are characteristic of which stage or phase of labor? a. Active phase c. Second stage b. Transitional phase d. Third stage

99. The nurse in labor and delivery has assumed care of a woman who is a primipara at 39 2/7 weeks gestation and 5 cm dilation. The client is on continuous fetal monitoring. The nurse noted that the fetal heart rate baseline is 120, with a range from 116 to 128. Contractions are 4 to 5 minutes apart. At the peak of the last three contractions, the fetal heart rate has been 116. At the conclusion of each contraction, the fetal heart rate has returned to the baseline. The nurse should: a. Document these observations as a normal contraction pattern with early decelerations. b. Turn the client on her left side and administer nasal oxygen at 6 L flow. c. Call the physician to report an ominous fetal heart rate tracing. d. Suggest to the nurse manager that there is a high probability of a cesarean delivery. 100. Which assessment finding provides data to confirm a pregnancy at 8-weeks gestation? a. Fundal height c. Abdominal ultrasound b. Auscultation of fetal heart tones d. Leopold maneuvers