Maternity Q's
A clinic nurse is preparing diagrams of pelvic shapes. Which pelvic shapes are considered least adequate for vaginal childbirth? Select all that apply. A) Android B) Anthropoid C) Gynecoid D) Platypelloid E) Lambdoidal suture
A) Android D) Platypelloid
Premonitory signs of labor include which of the following? Select all that apply. A) Braxton Hicks contractions B) Cervical softening and effacement C) Weight gain D) Rupture of membranes E) Sudden loss of energy
A) Braxton Hicks contractions B) Cervical softening and effacement D) Rupture of membranes
A pregnant patient's healthcare provider is using the Hadlock method to determine gestational age and growth of the fetus. Which measurements will be used to make this fetal determination? Select all that apply. 1. Femur length 2. Biparietal diameter .3. Head circumference 4. Abdominal circumference 5. Crown to rump measurement
1, 2, 3, 4
A patient in the first trimester of pregnancy recently emigrated from a foreign country and is diagnosed with rubella. What can occur to the developing fetus because of this infection? Select all that apply. 1. Congenital cataracts 2. Sensorineural deafness 3. Ophthalmia neonatorum 4. Congenital heart defects 5. Intrauterine growth restriction
1, 2, 4 The most common clinical signs of rubella syndrome are congenital cataracts, sensorineural deafness, and congenital heart defects. Ophthalmia neonatorum is associated with maternal gonorrhea at the time of birth. Intrauterine growth restriction is not associated with rubella.
How would the nurse best analyze the results from a client's sonogram that shows the fetal shoulder as the presenting part? A) Breech, transverse B) Breech, longitudinal C) Breech, frank D) Vertex, transverse
A) Breech, transverse
During a prenatal exam, a client describes several psychosomatic symptoms and has several vague complaints. What could these behaviors indicate? A) Abuse B) Mental illness C) Depression D) Nothing, they are normal
A) Abuse
A pregnant patient weighing 165 lb is diagnosed with preeclampsia and is prescribed to ingest 1.5 g/kg/day of protein. How many grams of protein should the nurse instruct the patient to ingest?
112.5 grams First convert the patient's weight in lb to kg by dividing the weight by 2.2 or 165/2.2 = 75 kg. Next multiply the weight in kg by 1.5 grams of protein or 75 x 1.5 = 112.5 grams. The nurse should instruct the patient to ingest 112.5 grams of protein each day
The pregnant client and her partner are both 40 years old. The nurse is explaining the options of chorionic villus sampling (CVS) and amniocentesis for genetic testing. The nurse should correct the client if she makes which statement? A) "Amniocentesis results are available sooner than CVS results are." B) "CVS carries a higher risk of limb abnormalities." C) "Amniocentesis cannot detect a neural tube defect." D) "CVS is performed through my belly or my cervix."
A) "Amniocentesis results are available sooner than CVS results are."
At 32 weeks' gestation, a woman is scheduled for a second nonstress test (following one she had at 28 weeks' gestation). Which statement by the client would indicate an adequate understanding of this procedure? A) "I can't get up and walk around during the test." B) "I'll have an IV started before the test." C) "I can still smoke before the test." D) "I need to have a full bladder for this test."
A) "I can't get up and walk around during the test."
The nurse is caring for a client at 35 weeks' gestation who has been critically injured in a shooting. Which statement by the paramedics bringing the woman to the hospital would cause the greatest concern? A) "Blood pressure 110/68, pulse 90." B) "Entrance wound present below the umbilicus." C) "Client is positioned in a left lateral tilt." D) "Clear fluid is leaking from the vagina."
B) "Entrance wound present below the umbilicus." Penetrating trauma includes gunshot wounds and stab wounds. The mother generally fares better than the fetus if the penetrating trauma involves the abdomen, as the enlarged uterus is likely to protect the mother's bowel from injury
The nurse is admitting a client to the birthing unit. What question should the nurse ask to gain a better understanding of the client's psychosocial status? A) "How did you decide to have your baby at this hospital?" B) "Who will be your labor support person?" C) "Have you chosen names for your baby yet?" D) "What feeding method will you use for your baby?"
B) "Who will be your labor support person?"
Which maternal-child client should the nurse see first? A) Blood type O, Rh-negative B) Indirect Coombs' test negative C) Direct Coombs' test positive D) Blood type B, Rh-positive
C) Direct Coombs' test positive A direct Coombs' test is done on the infant's blood to detect antibody-coated Rh-positive RBCs. If the mother's indirect Coombs' test is positive and her Rh-positive infant has a positive direct Coombs' test, Rh immune globulin is not given; in this case, the infant is carefully monitored for hemolytic disease.
The nurse knows that a lecithin/sphingomyelin (L/S) ratio finding of 2:1 in amniotic fluid means which of the following? A) Fetal lungs are still immature. B) The fetus has a congenital anomaly. C) Fetal lungs are mature. D) The fetus is small for gestational age.
C) Fetal lungs are mature
The labor and delivery nurse is preparing a prenatal class about facilitating the progress of labor. Which of the following frequent responses to pain should the nurse indicate is most likely to impede progress in labor? A) Increased pulse B) Elevated blood pressure C) Muscle tension D) Increased respirations
C) Muscle tension
The charge nurse has received the shift change report. Which client requires immediate intervention? A) Woman at 6 cm undergoing induction of labor, strong contractions every 3 minutes B) Woman at 4 cm whose fetus is in a longitudinal lie with a cephalic presentation C) Woman at 10 cm and fetus at +2 station experiencing a strong expulsion urge D) Woman at 3 cm screaming in fear because her mother died during childbirth
D) Woman at 3 cm screaming in fear because her mother died during childbirth This client requires education and a great deal of support, and is therefore the top priority.
The fetus of a patient in labor is determined to be in the brow presentation. How should the nurse explain this position?
In the brow presentation, the fetal head is in partial (halfway) extension. The occipitomental diameter, which is the largest diameter of the fetal head, presents to the pelvis.
A pregnant patient's fetus is in the left-occiput-transverse position. How should the nurse explain this position to the patient?
LOT or left-occiput-transverse position
The midwife performs a vaginal exam and determines that the fetal head is at a -2 station. What does this indicate to the nurse about the birth? A) The birth is imminent. B) The birth is likely to occur in 1-2 hours. C) The birth will occur later in the shift. D) The birth is difficult to predict.
D) The birth is difficult to predict.
If the woman is Rh negative and not sensitized, she is given Rh immune globulin to prevent what? A) The potential for hemorrhage B) Hyperhomocysteinemia C) Antibody formation D) Tubal pregnancy
C) Antibody formation
The nurse is working in an outpatient clinic. Which client's indications most warrant fetal monitoring in the third trimester? A) Gravida 4, para 3, 39 weeks, with a history of one spontaneous abortion at 8 weeks B) Gravida 1, para 0, 40 weeks, with a history of endometriosis and a prior appendectomy C) Gravida 3, para 2, with a history of gestational diabetes controlled by diet D) Gravida 2, para 1, 36 weeks, with a history of preterm labor or cervical insufficiency
D) Gravida 2, para 1, 36 weeks, with a history of preterm labor or cervical insufficiency
Which of the following tests provides information about the fetal number? A) Amniocentesis B) Standard second-trimester sonogram C) Beta hCG D) Maternal serum alpha-fetoprotein
B) Standard second-trimester sonogram
The nurse anticipates that the physician will most likely order a cervicovaginal fetal fibronectin test for which client? A) The client at 34 weeks' gestation with gestational diabetes B) The client at 32 weeks' gestation with regular uterine contractions C) The client at 37 weeks' multi-fetal gestation D) The client at 20 weeks' gestation with ruptured amniotic membranes
B) The client at 32 weeks' gestation with regular uterine contractions
The nurse is reviewing amniocentesis results. Which of the following would indicate that client care was appropriate? A) The client who is Rh-positive received Rh immune globulin after the amniocentesis. B) The client was monitored for 30 minutes after completion of the test. C) The client began vaginal spotting before leaving for home after the test. D) The client identified that she takes insulin before each meal and at bedtime.
B) The client was monitored for 30 minutes after completion of the test.
The nurse is teaching a prenatal class about false labor. The nurse should teach clients that false labor will most likely include which of the following? Select all that apply. A) Contractions that do not intensify while walking B) An increase in the intensity and frequency of contractions C) Progressive cervical effacement and dilation D) Pain in the abdomen that does not radiate E) Contractions are at regular intervals
A) Contractions that do not intensify while walking D) Pain in the abdomen that does not radiate
A client who is having false labor most likely would have which of the following? Select all that apply. A) Contractions that do not intensify while walking B) An increase in the intensity and frequency of contractions C) Progressive cervical effacement and dilation D) Pain in the abdomen that does not radiate E) Contractions that lessen with rest and warm tub baths
A) Contractions that do not intensify while walking D) Pain in the abdomen that does not radiate E) Contractions that lessen with rest and warm tub baths
The nurse is preparing a client for amniocentesis. Which statement would indicate that the client clearly understands the risks of amniocentesis? A) "I might go into labor early." B) "It could produce a congenital defect in my baby." C) "Actually, there are no real risks to this procedure." D) "The test could stunt my baby's growth."
A) "I might go into labor early."
The client with blood type A, Rh-negative, delivered yesterday. Her infant is blood type AB, Rh-positive. Which statement indicates that teaching has been effective? A) "I need to get RhoGAM so I don't have problems with my next pregnancy." B) "Because my baby is Rh-positive, I don't need RhoGAM." C) "If my baby had the same blood type I do, it might cause complications." D) "Before my next pregnancy, I will need to have a RhoGAM shot."
A) "I need to get RhoGAM so I don't have problems with my next pregnancy." Rh-negative mothers who give birth to Rh-positive infants should receive Rh immune globulin (RhoGAM) to prevent alloimmunization.
The prenatal clinic nurse is explaining test results to a client who has had an assessment for fetal well-being. Which statement indicates that the client understands the test results? A) "The normal Doppler velocimetry wave result indicates my placenta is getting enough blood to the baby." B) "The reactive nonstress test means that my baby is not growing because of a lack of oxygen." C) "Because my contraction stress test was positive, we know that my baby will tolerate labor well." D) "My biophysical profile score of 6 points to everything being normal and healthy for my baby."
A) "The normal Doppler velocimetry wave result indicates my placenta is getting enough blood to the baby."
A client is concerned because she has been told that her blood type and her baby's are incompatible. What is the nurse's best response? A) "This is called ABO incompatibility. It is somewhat common but rarely causes significant hemolysis, a breakdown of red blood cells." B) "This is a serious condition, and additional blood studies are currently in process to determine whether you need a medication to prevent it from occurring with a future pregnancy." C) "This is a condition caused by a blood incompatibility between you and your husband, but does not affect the baby." D) "This type of condition is very common, and the baby can receive a medication to prevent jaundice from occurring."
A) "This is called ABO incompatibility. It is somewhat common but rarely causes significant hemolysis, a breakdown of red blood cells." When blood types, not Rh, are incompatible, it is called ABO incompatibility. The incompatibility occurs as a result of the maternal antibodies present in her serum and interaction between the antigen sites on the fetal RBCs.
A 27-year-old married woman is 16 weeks pregnant and has an abnormally low maternal serum alpha-fetoprotein test. Which statement indicates that the couple understands the implications of this test result? A) "We have decided to have an abortion if this baby has Down syndrome." B) "If we hadn't had this test, we wouldn't have to worry about this baby." C) "I'll eat plenty of dark green leafy vegetables until I have the ultrasound." D) "The ultrasound should be normal because I'm under the age of 35."
A) "We have decided to have an abortion if this baby has Down syndrome."
The client has asked the nurse why her cervix has only changed from 1 to 2 cm in 3 hours of contractions occurring every 5 minutes. What is the nurse's best response to the client? A) "Your cervix has also effaced, or thinned out, and that change in the cervix is also labor progress." B) "When your perineal body thins out, your cervix will begin to dilate much faster than it is now." C) "What did you expect? You've only had contractions for a few hours. Labor takes time." D) "The hormones that cause labor to begin are just getting to be at levels that will change your cervix."
A) "Your cervix has also effaced, or thinned out, and that change in the cervix is also labor progress."
The client at 14 weeks' gestation has undergone a transvaginal ultrasound to assess cervical length. The ultrasound revealed cervical funneling. How should the nurse explain these findings to the client? A) "Your cervix has become cone-shaped and more open at the end near the baby." B) "Your cervix is lengthened, and you will deliver your baby prematurely." C) "Your cervix is short, and has become wider at the end that extends into the vagina." D) "Your cervix was beginning to open but now is starting to close up again."
A) "Your cervix has become cone-shaped and more open at the end near the baby."
The nurse is responding to phone calls. Whose call should the nurse return first? A) A client at 37 weeks' gestation reports no fetal movement for 24 hours. B) A client at 29 weeks' gestation reports increased fetal movement. C) A client at 32 weeks' gestation reports decreased fetal movement X 2 days. D) A client at 35 weeks' gestation reports decreased fetal movement X 4 hours.
A) A client at 37 weeks' gestation reports no fetal movement for 24 hours.
A nurse needs to evaluate the progress of a woman's labor. The nurse obtains the following data: cervical dilation 6 cm; contractions mild in intensity, occurring every 5 minutes, with a duration of 30-40 seconds. Which clue in this data does not fit the pattern suggested by the rest of the clues? A) Cervical dilation 6 cm B) Mild contraction intensity C) Contraction frequency every 5 minutes D) Contraction duration 30-40 seconds
A) Cervical dilation 6 cm
While caring for a client in labor, the nurse notes the following FHR pattern: Which action should the nurse perform? A) Continue to monitor the client B) Fetal scalp stimulation C) Palpate contraction strength D) Discontinue oxytocin
A) Continue to monitor the client
A woman at 7 weeks' gestation is diagnosed with hyperemesis gravidarum. Which nursing diagnosis would receive priority? A) Fluid Volume: Deficient B) Cardiac Output, Decreased C) Injury, Risk for D) Nutrition, Imbalanced: Less than Body Requirements
A) Fluid Volume: Deficient The newly admitted client with hyperemesis gravidarum has been experiencing excessive vomiting, and is in a fluid volume-deficit state.
Infants of women with preeclampsia during pregnancy tend to be small for gestational age (SGA) because of which condition? A) Intrauterine growth restriction B) Oliguria C) Proteinuria D) Hypertension
A) Intrauterine growth restriction Infants of women with preeclampsia during pregnancy tend to be small for gestational age (SGA) because of intrauterine growth restriction. The cause is related specifically to maternal vasospasm and hypovolemia, which result in fetal hypoxia and malnutrition.
Childbirth preparation offers several advantages including which of the following? Select all that apply. A) It helps a pregnant woman and her support person understand the choices in the birth setting. B) It promotes awareness of available options. C) It provides tools for a pregnant woman and her support person to use during labor and birth. D) Women who receive continuous support during labor require more analgesia, and have more cesarean and instrument births. E) Each method has been shown to shorten labor.
A) It helps a pregnant woman and her support person understand the choices in the birth setting. B) It promotes awareness of available options. C) It provides tools for a pregnant woman and her support person to use during labor and birth. E) Each method has been shown to shorten labor.
The nurse is caring for a client undergoing fetal heart rate monitoring, and the FHR is greater than 162 beats/min for 12 minutes. For what cause(s) should the nurse anticipate treatment? Select all that apply. A) Maternal anxiety B) Fetal asphyxia C) Prematurity D) Fetal anemia E) Maternal hypotension
A) Maternal anxiety B) Fetal asphyxia C) Prematurity D) Fetal anemia
The labor nurse would not encourage a mother to bear down until the cervix is completely dilated, to prevent which of the following? Select all that apply. A) Maternal exhaustion B) Cervical edema C) Tearing and bruising of the cervix D) Enhanced perineal thinning E) Having to perform an episiotomy
A) Maternal exhaustion B) Cervical edema C) Tearing and bruising of the cervix
The nurse is reviewing the FHR monitor for a client in labor. The rhythm strip yields the following result: How should the nurse interpret this pattern? A) Moderate variability B) Minimal variability C) Absent variability D) Marked variability
A) Moderate variability
A primary herpes simplex infection in the first trimester can increase the risk of which of the following? A) Spontaneous abortion B) Preterm labor C) Intrauterine growth restriction D) Neonatal infection
A) Spontaneous abortion A primary herpes simplex infection can increase the risk of spontaneous abortion when infection occurs in the first trimester.
To identify the duration of a contraction, the nurse would do which of the following? A) Start timing from the beginning of one contraction to the completion of the same contraction. B) Time between the beginning of one contraction and the beginning of the next contraction. C) Palpate for the strength of the contraction at its peak. D) Time from the beginning of the contraction to the peak of the same contraction.
A) Start timing from the beginning of one contraction to the completion of the same contraction.
A woman has a hydatidiform mole (molar pregnancy) evacuated, and is prepared for discharge. The nurse should make certain that the client understands that what is essential? A) That she not become pregnant until after the follow-up program is completed B) That she receive RhoGAM with her next pregnancy and birth C) That she has her blood pressure checked weekly for the next 30 days D) That she seek genetic counseling with her partner before the next pregnancy
A) That she not become pregnant until after the follow-up program is completed Because of the risk of choriocarcinoma, the woman treated for hydatidiform mole should receive extensive follow-up therapy. Follow-up care includes a baseline chest X-ray to detect lung metastasis and a physical examination including a pelvic examination. The woman should avoid pregnancy during this time because the elevated hCG levels associated with pregnancy would cause confusion as to whether cancer had developed.
A 28-year-old woman has been an insulin-dependent diabetic for 10 years. At 36 weeks' gestation, she has an amniocentesis. A lecithin/sphingomyelin (L/S) ratio test is performed on the sample of her amniotic fluid. Because she is a diabetic, what would an obtained 2:1 ratio indicate for the fetus? A) The fetus may or may not have immature lungs. B) The amniotic fluid is contaminated. C) The fetus has a neural tube defect. D) There is blood in the amniotic fluid.
A) The fetus may or may not have immature lungs
The nurse is performing a preoperative assessment on a client who is in the second trimester of pregnancy. For which finding(s) should the nurse monitor? Select all that apply. A) Respiratory infection B) Fever C) Urinary tract infection D) Anemia E) ABO incompatibility
A, B, C, D
When blood pressure and other signs indicate that preeclampsia is worsening, hospitalization is necessary to monitor the woman's condition closely. At that time, which of the following should be assessed? Select all that apply. A) Fetal heart rate B) Blood pressure C) Temperature D) Urine color E) Pulse and respirations
A, B, C, E
The client and her partner are carriers of sickle cell disease. They are considering prenatal diagnosis with either amniocentesis or chorionic villus sampling (CVS). Which statements indicate that further teaching is needed on these two diagnostic procedures? Select all that apply. A) "Chorionic villus sampling carries a lower risk of miscarriage." B) "Amniocentesis can be done earlier in my pregnancy than CVS." C) "Neither test will conclusively diagnose sickle cell disease in our baby." D) "The diagnosis comes sooner if we have CVS, not amniocentesis." E) "Amniocentesis is more accurate in diagnosis than the CVS."
A, B, E
The client at 34 weeks' gestation has been stabbed in the low abdomen by her boyfriend. She is brought to the emergency department for treatment. Which statements indicate that the client understands the treatment being administered? Select all that apply. A) "The baby needs to be monitored to check the heart rate." B) "My bowel has probably been lacerated by the knife." C) "I might need an ultrasound to look at the baby." D) "The catheter in my bladder will prevent urinary complications." E) "The IV in my arm will replace the amniotic fluid if it is leaking.
A, C
The client at 40 weeks' gestation reports to the nurse that she has had increased pelvic pressure and increased urinary frequency. Which response by the nurse is best? A) "Unless you have pain with urination, we don't need to worry about it." B) "These symptoms usually mean the baby's head has descended further." C) "Come in for an appointment today and we'll check everything out." D) "This might indicate that the baby is no longer in a head-down position."
B) "These symptoms usually mean the baby's head has descended further."
A woman is 16 weeks pregnant. She has had cramping, backache, and mild bleeding for the past 3 days. Her physician determines that her cervix is dilated to 2 centimeters, with 10% effacement, but membranes are still intact. She is crying, and says to the nurse, "Is my baby going to be okay?" In addition to acknowledging the client's fear, what should the nurse also say? A) "Your baby will be fine. We'll start IV, and get this stopped in no time at all." B) "Your cervix is beginning to dilate. That is a serious sign. We will continue to monitor you and the baby for now." C) "You are going to miscarry. But you should be relieved because most miscarriages are the result of abnormalities in the fetus." D) "I really can't say. However, when your physician comes, I'll ask her to talk to yoU
B) "Your cervix is beginning to dilate. That is a serious sign. We will continue to monitor you and the baby for now."
Of all the clients who have been scheduled to have a biophysical profile, the nurse should check with the physician to clarify the order for which client? A) A gravida with intrauterine growth restriction B) A gravida with mild hypotension of pregnancy C) A gravida who is postterm D) A gravida who complains of decreased fetal movement for 2 days
B) A gravida with mild hypotension of pregnancy
The maternity nurse is preparing material for a staff development seminar on ectopic pregnancy. When using the diagram below, which area should the nurse identify as being the most common location for the implantation of an ectopic pregnancy? A) A - fimbrae B) B - fallopian tube C) C - uterine wall D) D - ovary
B) B
Which client requires immediate intervention by the labor and delivery nurse? A) Client at 8 cm, systolic blood pressure has increased 35 mmHg B) Client who delivered 1 hour ago with WBC of 50,000/mm3 C) Client at 5 cm with a respiratory rate of 22 between contractions D) Client in active labor with polyuria
B) Client who delivered 1 hour ago with WBC of 50,000/mm3
The labor and delivery nurse is reviewing charts. The nurse should inform the supervisor about which client? A) Client at 5 cm requesting labor epidural analgesia B) Client whose cervix remains at 6 cm for 4 hours C) Client who has developed nausea and vomiting D) Client requesting her partner to stay with her
B) Client whose cervix remains at 6 cm for 4 hours
A patient who is 10 weeks pregnant is scheduled for a sonogram. Why is this test being used? A) Estimate fetal weight B) Determine gestational age C) Evaluate placenta integrity D) Calculate pelvis dimensions
B) Determine gestational age
The nurse is assisting in the delivery of a pregnant patient's placenta post-delivery. The placenta appears as follows. What term should the nurse use to document this placental delivery? *pic on back*
B) Duncan mechanism of delivery
A client at 10 weeks' gestation has developed cholecystitis. If surgery is required, what is the safest time during pregnancy? A) Immediately, before the fetus gets any bigger B) Early in the second trimester C) As close to term as possible D) The risks are too high to do it anytime in pregnancy
B) Early in the second trimester The early second trimester is the best time to operate because there is less risk of spontaneous abortion or early labor, and the uterus is not so large as to impinge on the abdominal field
The prenatal clinic nurse is caring for a client with hyperemesis gravidarum at 14 weeks' gestation. The vital signs are: blood pressure 95/48, pulse 114, respirations 24. Which order should the nurse implement first? A) Weigh the client. B) Give 1 liter of lactated Ringer's solution IV. C) Administer 30 mL Maalox (magnesium hydroxide) orally. D) Encourage clear liquids orally.
B) Give 1 liter of lactated Ringer's solution IV The vital signs indicate hypovolemia from dehydration, which leads to hypotension and increased pulse rate. Giving this client a liter of lactated Ringer's solution intravenously will reestablish vascular volume and bring the blood pressure up, and the pulse and respiratory rate down
The nurse prepares teaching material for a patient who is experiencing a spontaneous abortion. Based upon the material selected, which type of abortion is the patient experiencing? A) Threatened B) Imminent C) Incomplete D) Complete
B) Imminent For an imminent abortion the placenta has separated from the uterine wall, the cervix has dilated, and the amount of bleeding has increased. For a threatened abortion the cervix is not dilated, and the placenta is still attached to the uterine wall, but some bleeding occurs. For an incomplete abortion the embryo/fetus has passed out of the uterus; however, the placenta remains. In a complete abortion all contents of the pregnancy have been expelled from the uterus.
A client arrives in the labor and delivery unit and describes her contractions as occurring every 10-12 minutes, lasting 30 seconds. She is smiling and very excited about the possibility of being in labor. On exam, her cervix is dilated 2 cm, 100% effaced, and -2 station. What best describes this labor? A) Second phase B) Latent phase C) Active phase D) Transition phase
B) Latent phase
A client calls the labor and delivery unit and tells the nurse that she is 39 weeks pregnant and over the last 4 or 5 days, she has noticed that although her breathing has become easier, she is having leg cramps, a slight amount of edema in her lower legs, and an increased amount of vaginal secretions. The nurse tells the client that she has experienced which of the following? A) Engagement B) Lightening C) Molding D) Braxton Hicks contractions
B) Lightening
A client at 37 weeks' gestation has a mildly elevated blood pressure. Her antenatal testing demonstrates three contractions in 10 minutes, no decelerations, and accelerations four times in 1 hour. What would this test be considered? A) Positive nonstress test B) Negative contraction stress test C) Positive contraction stress test D) Negative nonstress test
B) Negative contraction stress test
The nurse is assessing a client who has severe preeclampsia. What assessment finding should be reported to the physician? A) Excretion of less than 300 mg of protein in a 24-hour period B) Platelet count of less than 150,000/mm3 C) Urine output of 50 mL per hour D) 12 respirations
B) Platelet count of less than 150,000/mm3 HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) complicates 10% to 20% of severe preeclampsia cases and develops prior to 37 weeks' gestation 50% of the time. Vascular damage is associated with vasospasm, and platelets aggregate at sites of damage, resulting in low platelet count (less than 150,000/mm3)
A client is admitted to the labor unit with contractions 1-2 minutes apart lasting 60-90 seconds. The client is apprehensive and irritable. This client is most likely in what phase of labor? A) Active B) Transition C) Latent D) Second
B) Transition
Four minutes after the birth of a baby, there is a sudden gush of blood from the mother's vagina, and about 8 inches of umbilical cord slides out. What action should the nurse take first? A) Place the client in McRoberts position. B) Watch for the emergence of the placenta. C) Prepare for the delivery of an undiagnosed twin. D) Place the client in a supine position.
B) Watch for the emergence of the placenta.
The client presents to the clinic for an initial prenatal examination. She asks the nurse whether there might be a problem for her baby because she has type B Rh-positive blood and her husband has type O Rh-negative blood, or because her sister's baby had ABO incompatibility. What is the nurse's best answer? Select all that apply. A) "Your baby would be at risk for Rh problems if your husband were Rh-negative." B) "Rh problems only occur when the mother is Rh-negative and the father is not." C) "ABO incompatibility occurs only after the baby is born." D) "We don't know for sure, but we can test for ABO incompatibility." E) "Your husband's being type B puts you at risk for ABO incompatibility."
B, C
The nurse is preparing a client in her second trimester for a three-dimensional ultrasound examination. Which statement indicates that teaching has been effective? A) "If the ultrasound is normal, it means my baby has no abnormalities." B) "The nuchal translucency measurement will diagnose Down syndrome." C) "I might be able to see who the baby looks like with the ultrasound." D) "Measuring the length of my cervix will determine whether I will deliver early."
C) "I might be able to see who the baby looks like with the ultrasound."
The client in early labor asks the nurse what the contractions are like as labor progresses. What would the nurse respond? A) "In normal labor, as the uterine contractions become stronger, they usually also become less frequent." B) "In normal labor, as the uterine contractions become stronger, they usually also become less painful." C) "In normal labor, as the uterine contractions become stronger, they usually also become longer in duration." D) "In normal labor, as the uterine contractions become stronger, they usually also become shorter in duration."
C) "In normal labor, as the uterine contractions become stronger, they usually also become longer in duration."
The community nurse is working with a client at 32 weeks' gestation who has been diagnosed with preeclampsia. Which statement by the client would indicate that additional information is needed? A) "I should call the doctor if I develop a headache or blurred vision." B) "Lying on my left side as much as possible is good for the baby." C) "My urine could become darker and smaller in amount each day." D) "Pain in the top of my abdomen is a sign my condition is worsening."
C) "My urine could become darker and smaller in amount each day." Oliguria is a complication of preeclampsia. Specific gravity of urine readings over 1.040 correlate with oliguria and proteinuria and should be reported to the physician.
A client who is 11 weeks pregnant presents to the emergency department with complaints of dizziness, lower abdominal pain, and right shoulder pain. Laboratory tests reveal a beta-hCG at a lower-than-expected level for this gestational age. An adnexal mass is palpable. Ultrasound confirms no intrauterine gestation. The client is crying and asks what is happening. The nurse knows that the most likely diagnosis is an ectopic pregnancy. Which statement should the nurse include? A) "You're feeling dizzy because the pregnancy is compressing your vena cava." B) "The pain is due to the baby putting pressure on nerves internally." C) "The baby is in the fallopian tube; the tube has ruptured and is causing bleeding." D) "This is a minor problem. The doctor will be right back to explain it to you."
C) "The baby is in the fallopian tube; the tube has ruptured and is causing bleeding." The woman who experiences one-sided lower abdominal pain or diffused lower abdominal pain, vasomotor disturbances such as fainting or dizziness, and referred right shoulder pain from blood irritating the subdiaphragmatic phrenic nerve is experiencing an ectopic pregnanCY
The client with an abnormal quadruple screen is scheduled for an ultrasound. Which statement indicates that the client understands the need for this additional antepartal fetal surveillance? A) "After the ultrasound, my partner and I will decide how to decorate the nursery." B) "During the ultrasound we will see which of us the baby looks like most." C) "The ultrasound will show whether there are abnormalities with the baby's spine." D) "The blood test wasn't run correctly, and now we need to have the sonogram."
C) "The ultrasound will show whether there are abnormalities with the baby's spine."
A woman is experiencing preterm labor. The client asks why she is on betamethasone. Which is the nurse's best response? A) "This medication will halt the labor process until the baby is more mature." B) "This medication will relax the smooth muscles in the infant's lungs so the baby can breathe." C) "This medication is effective in stimulating lung development in the preterm infant." D) "This medication is an antibiotic that will treat your urinary tract infection, which caused preterm labor."
C) "This medication is effective in stimulating lung development in the preterm infant." Betamethasone or dexamethasone is often administered to the woman whose fetus has an immature lung profile to promote fetal lung maturation
The client at 39 weeks' gestation calls the clinic and reports increased bladder pressure but easier breathing and irregular, mild contractions. She also states that she just cleaned the entire house. Which statement should the nurse make? A) "You shouldn't work so much at this point in pregnancy." B) "What you are describing is not commonly experienced in the last weeks." C) "Your body may be telling you it is going into labor soon." D) "If the bladder pressure continues, come in to the clinic tomorrow."
C) "Your body may be telling you it is going into labor soon."
During a nonstress test, the nurse notes that the fetal heart rate decelerates about 15 beats during a period of fetal movement. The decelerations occur twice during the test, and last 20 seconds each. The nurse realizes these results will be interpreted as which of the following? A) A negative test B) A reactive test C) A nonreactive test D) An equivocal test
C) A nonreactive test
When assisting with a transabdominal ultrasound sampling, which of the following would the nurse do? A) Obtain preliminary urinary samples. B) Have the woman empty her bladder before the test begins. C) Assist the woman into a supine position on the examining table. D) Instruct the woman to eat a fat-free meal 2 hours before the scheduled test time
C) Assist the woman into a supine position on the examining table.
The nurse is supervising care in the emergency department. Which situation most requires an intervention? A) Moderate vaginal bleeding at 36 weeks' gestation; client has an IV of lactated Ringer's solution running at 125 mL/hour B) Spotting of pinkish-brown discharge at 6 weeks' gestation and abdominal cramping; ultrasound scheduled in 1 hour C) Bright red bleeding with clots at 32 weeks' gestation; pulse = 110, blood pressure 90/50, respirations = 20 D) Dark red bleeding at 30 weeks' gestation with normal vital signs; client reports an absence of fetal movement
C) Bright red bleeding with clots at 32 weeks' gestation; pulse = 110, blood pressure 90/50, respirations = 20 Bleeding in the third trimester is usually due to placenta previa or placental abruption. Observe the woman for indications of shock, such as pallor, clammy skin, perspiration, dyspnea, or restlessness. Monitor vital signs, particularly blood pressure and pulse, for evidence of developing shock.
The nurse is admitting a client to the labor and delivery unit. Which aspect of the client's history requires notifying the physician? A) Blood pressure 120/88 B) Father a carrier of sickle-cell trait C) Dark red vaginal bleeding D) History of domestic abuse
C) Dark red vaginal bleeding
A standard ultrasound examination is performed during the second or third trimester and includes an evaluation of which of the following? Select all that apply. A) Confirm fetal heart activity. B) Evaluate the cervix. C) Determine fetal presentation. D) Assess amniotic fluid volume. E) Determine fetal number
C) Determine fetal presentation D) Assess amniotic fluid volume. E) Determine fetal number
A female patient seeks medical attention for vaginal discharge that at times is bright red but is mostly dark brown in color. When preparing materials to share with this patient, why should the nurse include this diagram? *diagram = hydropic vessels in uterus* A) It shows the size of the uterus. B) It explains the location of the cervix. C) It portrays the vessels within the uterus. D) It demonstrates the location of the uterus.
C) It portrays the vessels within the uterus. A common sign of a hydatidiform mole is vaginal bleeding, often brownish (the characteristic "prune juice" appearance), but sometimes bright red. In this figure, some of the hydropic vessels are being passed. This occurrence is diagnostic for hydatidiform mole. This diagram is not being used because it shows the size of the uterus, the location of the cervix, or the location of the uterus
Whether sensitization is the result of a blood transfusion or maternal-fetal hemorrhage for any reason, what test can be performed to determine the amount of Rh(D) positive blood present in the maternal circulation, and to calculate the amount of Rh immune globulin needed? A) Indirect Coombs' test B) Non-stress test C) Kleihauer-Betke or rosette test D) Direct Coombs' test
C) Kleihauer-Betke or rosette test A Kleihauer-Betke or rosette test can be performed to determine the amount of Rh(D) positive blood present in the maternal circulation and to calculate the amount of Rh immune globulin needed
Which of the following tests has become a widely accepted method of evaluating fetal status? A) Contraction stress test (CST) B) MSAFP test C) Nonstress test (NST) D) Nuchal translucency test
C) Nonstress test (NST)
The nurse is aware that labor and birth will most likely proceed normally when the fetus is in what position? A) Right-acromion-dorsal-anterior B) Right-sacrum-transverse C) Occiput anterior D) Posterior position
C) Occiput anterior
A woman is hospitalized with severe preeclampsia. The nurse is meal-planning with the client and encourages a diet that is high in what? A) Sodium B) Carbohydrates C) Protein D) Fruits
C) Protein
A client is admitted to the labor and delivery unit with contractions that are 2 minutes apart, lasting 60 seconds. She reports that she had bloody show earlier that morning. A vaginal exam reveals that her cervix is 100 percent effaced and 8 cm dilated. The nurse knows that the client is in which phase of labor? A) Active B) Latent C) Transition D) Fourth
C) Transition
The nurse is preparing a client education handout on the differences between false labor and true labor. What information is most important for the nurse to include? A) True labor contractions begin in the back and sweep toward the front. B) False labor often feels like abdominal tightening, or "balling up." C) True labor can be diagnosed only if cervical change occurs. D) False labor contractions do not increase in intensity or duration.
C) True labor can be diagnosed only if cervical change occurs.
The nurse is caring for laboring clients. Which women are experiencing problems related to a critical factor of labor? Select all that apply. A) Woman at 7 cm, fetus in general flexion B) Woman at 3 cm, fetus in longitudinal lie C) Woman at 4 cm, fetus with transverse lie D) Woman at 6 cm, fetus at -2 station, mild contractions E) Woman at 5 cm, fetal presenting part is right shoulder
C) Woman at 4 cm, fetus with transverse lie D) Woman at 6 cm, fetus at -2 station, mild contractions E) Woman at 5 cm, fetal presenting part is right shoulder
The client at 24 weeks' gestation is experiencing painless vaginal bleeding after intercourse. The physician has ordered a transvaginal ultrasound examination. Which statements by the client indicate an understanding of why this exam has been requested? Select all that apply. A) "This ultrasound will show the baby's gender." B) "This ultrasound might cause the miscarriage of my baby." C) "This ultrasound carries a risk of creating a uterine infection." D) "This ultrasound can determine the location of my placenta." E) "This ultrasound might detect whether the placenta is detaching prematurely."
D) "This ultrasound can determine the location of my placenta." E) "This ultrasound might detect whether the placenta is detaching prematurely."
The community health nurse is teaching a class about causes of traumatic injury leading to pregnancy complications. What statement should the nurse include in the teaching? A) "Although falls are an uncommon cause of trauma, it is important to know what to do in the case of these incidents." B) "In early pregnancy, the woman is at a greater risk for injury due to decreased balance and coordination." C) "The pregnant woman should be given the same care as any person suffering from trauma." D) "Violence, including domestic violence, is the most common cause of injury for pregnant women, after motor vehicle accidents."
D) "Violence, including domestic violence, is the most common cause of injury for pregnant women, after motor vehicle accidents."
A woman at 28 weeks' gestation is asked to keep a fetal activity record and to bring the results with her to her next clinic visit. One week later, she calls the clinic and anxiously tells the nurse that she has not felt the baby move for more than 30 minutes. Which of the following would be the nurse's most appropriate initial comment? A) "You need to come to the clinic right away for further evaluation." B) "Have you been smoking?" C) "When did you eat last?" D) "Your baby might be asleep."
D) "Your baby might be asleep."
Each of the following pregnant women is scheduled for a 14-week antepartal visit. In planning care, the nurse would give priority teaching on amniotic fluid alpha-fetoprotein (AFP) screening to which client? A) 28-year-old with history of rheumatic heart disease B) 18-year-old with exposure to HIV C) 20-year-old with a history of preterm labor D) 35-year-old with a child with spina bifida
D) 35-year-old with a child with spina bifida
The nurse is returning phone calls from clients. Which client does the nurse anticipate would not require a serum beta hCG? A) A client with a risk of ectopic pregnancy B) A client with spotting during pregnancy C) A client with previous pelvic inflammatory disease D) A client with a previous history of twins
D) A client with a previous history of twins
A clinic nurse is planning when to administer Rh immune globulin (RhoGAM) to an Rh-negative pregnant client. When should the first dose of RhoGAM be administered? A) After the birth of the infant B) 1 month postpartum C) During labor D) At 28 weeks' gestation
D) At 28 weeks' gestation When the woman is Rh negative and not sensitized and the father is Rh positive or unknown, Rh immune globulin is given prophylactically at 28 weeks' gestation
When comparing the anterior and posterior fontanelles of a newborn, the nurse knows that both are what? A) Both are approximately the same size. B) Both close within 12 months of birth. C) Both are used in labor to identify station. D) Both allow for assessing the status of the newborn after birth.
D) Both allow for assessing the status of the newborn after birth.
During the fourth stage of labor, the client's assessment includes a BP of 110/60, pulse 90, and the fundus is firm midline and halfway between the symphysis pubis and the umbilicus. What is the priority action of the nurse? A) Turn the client onto her left side. B) Place the bed in Trendelenburg position. C) Massage the fundus. D) Continue to monitor.
D) Continue to monitor.
While caring for a client in labor, the nurse notices during a vaginal exam that the fetus's head has rotated internally. What would the nurse expect the next set of cardinal movements for a fetus in a vertex presentation to be? A) Flexion, extension, restitution, external rotation, and expulsion B) Expulsion, external rotation, and restitution C) Restitution, flexion, external rotation, and expulsion D) Extension, restitution, external rotation, and expulsion
D) Extension, restitution, external rotation, and expulsion
The nurse is presenting a class to newly pregnant families. What form of trauma will the nurse describe as the leading cause of fetal and maternal death? A) Falls B) Domestic violence C) Gun accidents D) Motor vehicle accidents
D) Motor vehicle accidents
The nurse is caring for a laboring client. A cervical exam indicates 8 cm dilation. The client is restless, frequently changing position in an attempt to get comfortable. Which nursing action is most important? A) Leave the client alone so she can rest. B) Ask the family to take a coffee-and-snack break. C) Encourage the client to have an epidural for pain. D) Reassure the client that she will not be left alone.
D) Reassure the client that she will not be left alone.
The nurse has just palpated a laboring woman's contractions. The uterus cannot be indented during a contraction. What would the intensity of these contractions best be characterized as? A) Weak B) Mild C) Moderate D) Strong
D) Strong
