Unit 2 test

1. The nurse places his or her hands on the maternal abdomen to gently palpate the fundal region of the uterus. This action is described as which Leopold maneuver? A. First maneuver B. Second maneuver C. Third maneuver D. Fourth maneuver

A. First maneuver

Quickening - can be felt as early as the

14th-16th week of gestation (provides tentative dates)​

22. A woman who is in her third trimester and is at risk for preterm birth calls the clinic to get the results of her fetal fibronectin test (fFN). The nurse sees the result is negative. Which advice to the patient is most appropriate? A. Come to the perinatal clinic for a screening ultrasound. B. Continue the current management plan as directed. C. Go to the hospital immediately for imminent delivery. D. Plan to continue taking betamethasone (Celestone) for 1 week.

B. Continue the current management plan as directed.

What type of cultural concern is the most likely deterrent to many women seeking prenatal care? A. Modesty B. Religion C. Belief that physicians are evil D. Ignorance

A. Modesty

3. During the first prenatal visit, a nurse teaches a pregnant woman about emergencies for which she needs to be seen immediately. Which situations does the nurse include in this education? (Select all that apply.) A. Headache not associated with visual disturbances B. Low, dull backache or pelvic pressure C. Maternal fever over 100.5°F (38.1°C) D. Nausea and vomiting especially upon arising in the morning E. Reduction in fetal movements

B. C, E

The nurse manager in a perinatal clinic is reviewing research related to care of patients with cervical insufficiency and preterm birth. What practice change might result from this review of the literature? A. Administering fewer doses of Rho(D) immune globulin (RhoGAM) B. Decreased utilization of cerclage placement in women with preterm labor C. Measuring serial cervical lengths in all women pregnant with singletons D. Providing betamethasone (Celestone) as long-term therapy

B. Decreased utilization of cerclage placement in women with preterm labor

21. The nurse reads "positive Hegar's sign" in a patient's chart. What can the nurse conclude about the patient? A. Patient had a miscarriage B. Patient is post-partum C. Patient is pregnant D. Patient may be pregnant

D. Patient may be pregnant

3. A woman is 10 weeks pregnant with her third baby. She has two living children with normal delivery histories. Using the GTPAL system, the nurse would document this woman's obstetrical history as ____________________.

ANS: G3T2P0A0L2The woman is pregnant for the third time: G3. She has carried two pregnancies to term: T2. She has had no preterm deliveries: P0. She has not had any abortions: A0. She has two living children: L2.

1. A pregnant woman's last normal menstrual period started on June 8, 2013. Calculate her expected date of birth (EDB) using Naegle's rule. Her EDB is what date?

ANS: March 15, 2014 The calculation is based on the first date of the woman's last normal menstrual period. Add 7 days to that date (= June 15, 2013). Subtract 3 months (= March 15, 2013). Add 1 year (= March 15, 2014).

43. A pregnant woman is HIV-positive. She is asking about ways to decrease the risk of vertical transmission to her baby. Which option given by the nurse would confer the least risk to the baby? A. Antiretroviral medications (zidovudine [ZDV]) B. Cesarean delivery C. Cesarean delivery plus antiretroviral medications for the newborn D. Vaginal delivery plus antiretroviral medications for the newborn

C. Cesarean delivery plus antiretroviral medications for the newborn

41. A pregnant woman who has diabetes mellitus is in the high-risk OB clinic for a checkup. The nurse notes that her hemoglobin A1C (HbAIC) is 5%. Which action by the nurse is most appropriate? A. Arrange a referral to the diabetic nurse educator. B. Assess for factors leading to noncompliance. C. Document the findings in the patient's chart. D. Schedule another HbAIC in 4 weeks.

C. Document the findings in the patient's chart.

33. A woman has returned to the clinic for her second prenatal visit. Her blood pressure is significantly higher than on her previous visit. What action should the nurse do first? A. Administer oxygen and inform the provider. B. Ask the woman to lie down on the table. C. Ensure that the blood pressure cuff is the appropriate size. D. Take the blood pressure again.

C. Ensure that the blood pressure cuff is the appropriate size.

3. The clinic nurse talks with a patient about her possible pregnancy. The patient has experienced amenorrhea for 2 months, nausea during the day with vomiting every other morning, and breast tenderness. She is convinced she is pregnant and is reluctant to pay for a pregnancy test. Which action by the nurse is best? A. Agree that these signs usually signal pregnancy so no test is needed. B. Delete the order for the pregnancy test and inform the provider. C. Explain that these symptoms can be caused by other conditions. D. Inform the woman that this is standard procedure and must be done.

C. Explain that these symptoms can be caused by other conditions.

8. A pregnant woman in the perinatal clinic complains of a diffuse, reddish discoloration of her palms. What action by the nurse is most appropriate? A. Ask if she has been exposed to measles. B. Assess her for Reynaud's phenomenon. C. Explain that this is a normal finding. D. Take the woman's vital signs.

C. Explain that this is a normal finding.

19. A nurse has admitted a woman pregnant in her third trimester with moderate vaginal bleeding and severe abdominal pain. After assessing maternal vital signs, obtaining the fetal heart rate, and starting an IV line, which action should the nurse do next? A. Administer betamethasone (Celestone) just prior to delivery. B. Discuss pros and cons of continuous fetal monitoring. C. Facilitate laboratory work, including blood type and screen. D. Obtain informed consent for emergent delivery.

C. Facilitate laboratory work, including blood type and screen.

11. A woman in the emergency department is in her third trimester and is bleeding heavily from a laceration on her thigh from a car crash. She is pale and diaphoretic. Her blood pressure is 138/82 mm Hg. What can the nurse conclude from this information? A. Blood loss from the laceration has not been that great. B. She is in shock from the trauma of the injury and blood loss. C. Her increased blood volume is maintaining the blood pressure. D. Her vital signs and physical assessment do not match.

C. Her increased blood volume is maintaining the blood pressure.

22. A patient in the emergency department is complaining of fever, burning with urination, bloody urine, and amenorrhea for 1 month. To evaluate her symptoms, what action by the nurse is best? A. Ask the woman if her menstrual periods are usually regular. B. Collect a urine sample for a pregnancy test. C. Instruct her in obtaining a midstream urine sample. D. Obtain an order for an intravenous pyelogram (x-ray of the urinary tract).

C. Instruct her in obtaining a midstream urine sample.

42. A student nurse is working in the OB clinic as part of a preceptorship. The student is counseling a woman in her first trimester who complains of insomnia due to nasal congestion. Which action by the student warrants intervention by the student's preceptor? A. Advises the woman to use over-the-counter nasal saline spray B. Assesses the patient for other allergy and cold symptoms C. Instructs the woman to use decongestants and antihistamines D. Suggests the woman take a hot, steamy bath at bedtime

C. Instructs the woman to use decongestants and antihistamines

10. A student in a perinatal clinic asks the clinic nurse what an incomplete abortion is. Which response by the nurse is best? A. Complete loss of all products of conception before 20 weeks' gestation B. Fetal death before 20 weeks with retention of all products of conception C. Loss of some, but not all, products of conception before 20 weeks D. When the patient initiates an abortion, but then stops the procedure

C. Loss of some, but not all, products of conception before 20 weeks

35. A woman pregnant with triplets is a patient in the high-risk OB unit. Which action by the nurse is most appropriate? A. Document serial, individual fetal monitor strips. B. Label the monitor lines in descending fetal order. C. Monitor the fetuses simultaneously with a triplet monitor. D. Obtain fetal monitor strips in presenting order.

C. Monitor the fetuses simultaneously with a triplet monitor.

33. A pregnant woman in her third trimester presents to the emergency department after fainting upon rising from a supine position. Which activity should the nurse perform first? A. Call the cardiology department for an EKG. B. Determine the fetal heart rate. C. Obtain a blood glucose reading. D. Teach her to rise slowly from a reclining position.

C. Obtain a blood glucose reading.

4. The perinatal nurse is caring for a woman at 26 weeks' gestation who has a history of hypertension that has been well controlled. Today she presents with a blood pressure of 156/102 mm Hg and she has 2+ protein on urine dipstick. Which initial action by the nurse is most appropriate? A. Arrange admission to the high-risk OB unit. B. Instruct the woman on strict bedrest. C. Obtain a clean-catch urine sample. D. Prepare to administer IV anti-hypertensives.

C. Obtain a clean-catch urine sample.

34. A woman who is 26 weeks pregnant has a blood pressure of 158/100 mm Hg. Which action by the nurse is most appropriate? A. Assess the woman's risk for other cardiovascular problems. B. Have her rest for 20 minutes, then reassess her blood pressure. C. Obtain a urine dipstick for proteinuria and assess for headache. D. Prepare to teach the woman about anti-hypertensive medication.

C. Obtain a urine dipstick for proteinuria and assess for headache.

11. The nurse finds a woman who has recently suffered her third complete abortion crying and saying "Why me? What did I do to deserve being punished like this?" Which response by the nurse is best? A. Ask the woman if she uses illicit drugs or drinks alcohol during pregnancy. B. Explain that most miscarriages are related to genetic abnormalities. C. Offer to call a clergy member or social worker to visit with the woman. D. Reassure the woman that she is not being punished.

C. Offer to call a clergy member or social worker to visit with the woman.

18. A nurse is teaching a woman pregnant in the second trimester who has been diagnosed with a partial placenta previa. Which information is most important to document? A. Patient and partner show no anxiety or helplessness and were given educational support material. B. Patient instructed that bleeding may occur as placenta totally covers the cervical os. C. Patient instructed to tell all health-care providers that vaginal exams are prohibited. D. Patient received information about placenta previa and understood it well.

C. Patient instructed to tell all health-care providers that vaginal exams are prohibited.

16. A woman who is a Jehovah's Witness returns for a second prenatal visit and is discussing her plan of care with the nurse. The patient has returned a signed form in which she refuses all blood products. What action by the nurse is best? A. Advise the woman of potential complications. B. Inform the health-care provider of her choice. C. Place the signed form on the patient's chart. D. Refer the woman to a tertiary birthing center.

C. Place the signed form on the patient's chart.

17. A pregnant patient in the second trimester is in the emergency department after a motor vehicle crash. She has a severe laceration of her arm resulting in a large blood loss. Which assessment should the nurse perform first? A. Blood pressure B. Fetal heart tones C. Pulse D. Respiratory rate

C. Pulse

15. A pregnant woman is complaining of frequent heartburn. What statement by the patient indicates to the nurse that teaching has been effective? A. "Drinking less alcohol should prevent this." B. "Eating larger, less frequent meals will help." C. "I should take antacids before each meal." D. "I will not lie down for 1 hour after eating."

D. "I will not lie down for 1 hour after eating."

9. The nursing student in the perinatal clinic asks the registered nurse why so many pregnant women seem to be stressed despite their "happy" condition. What response by the nurse is best? A. "It's the effect of all those hormones." B. "Many are afraid of labor and birth." C. "Most pregnant women don't feel well." D. "Pregnancy is a developmental crisis."

D. "Pregnancy is a developmental crisis."

12. The nurse assesses a pregnant patient during the first prenatal visit. Which question by the nurse is the best example of therapeutic communication? A. "Do you understand the prenatal visit schedule?" B. "Do you use drugs or drink alcohol?" C. "Have you experienced quickening?" D. "To begin, what questions may I answer?"

D. "To begin, what questions may I answer?"

13. A woman in her second trimester of pregnancy is in the clinic for a checkup. She complains of feeling short of breath at times. Her lungs are clear and her oxygen saturation is 98%. Her vital signs are all normal. What action by the nurse is best? A. Alert the provider to the symptoms. B. Encourage slow, deep breathing. C. Document the findings. D. Facilitate a chest x-ray.

B. Encourage slow, deep breathing.

18. A woman undergoing her first prenatal visit for a current pregnancy is reluctant to discuss her past obstetrical history with the nurse. Which action by the nurse is best? A. Document the woman's refusal to answer these particular questions in the chart. B. Explain that past obstetrical experiences frequently recur in later pregnancies. C. Inform the woman that the clinic cannot provide comprehensive care without a complete history. D. Tell the woman that you need the information in order to continue with the prenatal visit.

B. Explain that past obstetrical experiences frequently recur in later pregnancies.

8. A nurse is assessing a 52-year-old primigravida woman who presents complaining of moderate dark-brown vaginal bleeding. On physical exam, her uterus is large for dates. Which action by the nurse is most appropriate? A. Assess the woman's diet for folic acid intake. B. Facilitate an ultrasound examination. C. Instruct the woman on a fetal kick count. D. Prepare the woman for pelvic cultures.

B. Facilitate an ultrasound examination.

8. The prenatal nurse believes in advocating for the patient. What action by the nurse best reflects this role? A. Documenting the patient's preferences for childbirth care B. Helping the woman formulate and vocalize questions C. Informing women of options related to labor and birth D. Teaching women about physical changes during pregnancy

B. Helping the woman formulate and vocalize questions

21. The nurse is explaining to a student that a pregnant woman needs to complete a process called "binding in." Which is the best explanation of this phenomenon? A. Becoming excited about the impending childbirth B. Incorporating the pregnancy into the woman's reality C. Learning to not focus on one's own discomforts D. Renegotiating roles within the woman's family

B. Incorporating the pregnancy into the woman's reality

4. A nurse is assessing a patient in the women's clinic for Chadwick's sign. How does the nurse perform this assessment? A. Auscultates the woman's abdomen for fetal heart tones B. Inspects the vulva and vagina for a bluish tint C. Palpates the woman's abdomen for a fluid wave D. Percusses the woman's abdomen for uterine margins

B. Inspects the vulva and vagina for a bluish tint

1. A woman presents to the perinatal clinic with abdominal pain. She has missed one period and, following a transvaginal ultrasound, pregnancy is confirmed. However, implantation has occurred in the right fallopian tube. The ectopic mass is 3 cm and has not ruptured. The nurse prepares the patient for which therapy? A. Laparoscopic salpingostomy B. Methotrexate C. Partial salpingectomy D. Salpingectomy by laparotomy

B. Methotrexate

23. A woman who is 36 weeks pregnant presents to the perinatal clinic with complaints of backache, pelvic fullness, and uterine contractions. Which action by the nurse is most appropriate? A. Arrange admission to the hospital. B. Obtain a clean-catch, midstream urine sample. C. Obtain blood for a type and screen. D. Prepare to administer a tocolytic agent.

B. Obtain a clean-catch, midstream urine sample.

23. A woman is in the first trimester of her first pregnancy and confides to the nurse that she is not really sure if she is happy because so many things in her life will change. She is not sure she is willing to alter her current lifestyle. What action by the nurse is most appropriate? A. Ask the woman if she would like to see a counselor. B. Reassure the woman that ambivalence is normal now. C. Refer the woman to an expectant-mother support group. D. Tell the woman she needs to think of her unborn child.

B. Reassure the woman that ambivalence is normal now.

2. The nurse includes screening for intimate partner violence in the first prenatal visit for all patients. Which of the following is an appropriate question for the nurse to ask? A. "I need to ask you, do you feel safe from abuse right now?" B. "Is your partner threatening or harming you in any way right now?" C. "This is something we ask everyone: Do you have any abuse in your life right now?" D. "We ask everyone this: Do you feel safe in your living environment and relationships?"

D. "We ask everyone this: Do you feel safe in your living environment and relationships?"

14. A nurse has taught a pregnant woman about good nutrition during pregnancy at her first prenatal visit. What statement by the patient indicates that more teaching is needed? A. "I buy a lot of yellow and orange vegetables." B. "I have switched to buying only 1% milk." C. "We eat a lot more poultry these days." D. "We eat salmon once a week at least."

D. "We eat salmon once a week at least."

25. A nurse is assessing a woman who is at 29 weeks of gestation. The nurse measures the woman's fundal height, which is 58.42 cm (23 inches). What does the nurse conclude about this information? A. The nurse cannot make a conclusion. B. Fundal height is just right. C. Fundal height is too big. D. Fundal height is too small.

D. Fundal height is too small.

7. A nurse is caring for a patient who has been diagnosed with an incomplete molar pregnancy. Which action by the nurse is most appropriate? A. Advise the woman that she can try to get pregnant in 3 months. B. Arrange a consultation with a radiation oncology nurse. C. Facilitate screening for systemic lupus erythematosus (SLE). D. Give the patient information on perinatal loss support groups.

D. Give the patient information on perinatal loss support groups.

6. A nurse is teaching a woman who is in her first trimester of pregnancy about physical changes she can expect. Which information should the nurse provide? A. Diminishing sexual interest occurs. B. Harmful agents are able to invade the uterus. C. Leukorrhea is an abnormal condition. D. Pregnant women are more susceptible to yeast infections.

D. Pregnant women are more susceptible to yeast infections.

40. A patient on the high-risk OB unit is receiving magnesium sulfate. The nurse notes that her magnesium level is 14 mEq/L. Which of the following actions by the nurse is most appropriate? A. Bring the crash cart to the patient's room. B. Document the findings in the woman's chart. C. Order another blood level in 6 hours. D. Prepare to administer calcium gluconate.

D. Prepare to administer calcium gluconate.

1. The nurse has learned that which hormone is primarily responsible for maintaining a pregnancy? A. Estrogen B. Human chorionic gonadotropin C. Oxytocin D. Progesterone

D. Progesterone

26. A nurse is performing the third Leopold maneuver on a woman who is gravida 3, para 3 and is currently 37 weeks' gestation. The nurse's fingers can be pressed together below the presenting part, which is firm to the touch. What action should the nurse take regarding this assessment data? A. Facilitate a referral to a perinatologist. B. Inform the health-care provider immediately. C. Prepare the woman for a breech delivery. D. Reassure the woman and document the findings.

D. Reassure the woman and document the findings.

3. The perinatal nurse is assessing a woman who is at 35 weeks' gestation in her first pregnancy. She is worried about having her baby "too soon," and she is experiencing uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats/minute. A vaginal examination performed by the health-care provider reveals no cervical changes since her last examination. Ultrasound examination reveals the presence of V-shaped cervical funneling. Which action by the nurse is most appropriate? A. Educate the woman on benefits of corticosteroids. B. Facilitate admission to the high-risk OB unit. C. Prepare to administer a dose of magnesium sulfate. D. Reassure the woman that she is not in preterm labor.

D. Reassure the woman that she is not in preterm labor.

15. A woman is hospitalized with hyperemesis gravidarum. Which other member of the health-care team should the nurse ensure is involved in this patient's care as a priority? A. Chaplain B. Diabetic educator C. Mental health nurse practitioner D. Registered dietician

D. Registered dietician

27. A new nurse is caring for a woman previously diagnosed with preeclampsia who was admitted to the high-risk OB unit after suffering a seizure in the perinatal clinic. The new nurse is preparing to administer a dose of magnesium sulfate (Sulfamag). Which action by the nurse warrants intervention by the unit manager? A. Explains to the patient that her vital signs and EKG will be monitored frequently B. Piggybacks the Sulfamag into a main line using an infusion pump C. Places 10% calcium gluconate in a secure location in the patient's room D. Runs the Sulfamag as the main IV line through an infusion pump

D. Runs the Sulfamag as the main IV line through an infusion pump

5. A 22-year-old woman presents to the emergency department with abdominal pain and vaginal bleeding. Her blood pressure is 90/58 mm Hg, her pulse is 120 beats/minute, and she complains of dizziness. Which action by the nurse takes priority? A. Assess the woman for sexually transmitted infections. B. Collect a urine sample for pregnancy testing. C. Obtain informed consent for a salpingectomy. D. Start two large-bore IVs for fluid replacement.

D. Start two large-bore IVs for fluid replacement.

23. A nurse reads in a pregnant woman's chart that she is "para 3." What does the nurse understand about this woman's obstetrical history? A. Is now in her third trimester B. Currently pregnant with triplets C. Three babies born alive D. Three pregnancies delivered past 24 weeks of gestation

D. Three pregnancies delivered past 24 weeks of gestation

1. A nursing instructor informs the class of the many benefits of prenatal care. What benefits does the instructor include? (Select all that apply.) A. Allows women informed decision making B. Decreased pregnancy-related maternal death C. Improved pregnancy outcomes D. Increased cost associated with more frequent visits E. Increased early identification of abnormal findings

A, B, C, E

11. The perinatal nurse describes risk factors for placenta previa to the student nurse. Which of the following risk factors does the nurse include? (Select all that apply.) A. Cocaine use B. Previous cesarean birth C. Previous use of medroxyprogesterone (Depo-Provera) D. Tobacco use E. Young maternal age

A, B, D

19. A nurse is teaching a group of middle school girls about the complications associated with teen pregnancy. What topics should the nurse include? (Select all that apply.) A. Anemia B. Hypertensive problems C. Gestational diabetes D. Preeclampsia E. Preterm birth

A, B, D, E

16. The perinatal nurse explains to a group of nursing students that there are positive signs of pregnancy. Which of the following does the nurse include in this explanation? (Select all that apply.) A. Fetal heartbeat B. Fetal movement palpated by the examiner C. Intermittent uterine contractions D. Positive pregnancy test E. Visualization of the fetus

A, B, E

15. A student nurse asks the OB clinic nurse why a pregnancy test is needed if a woman has missed several menstrual periods in a row. The nurse explains that amenorrhea can be caused by several conditions other than pregnancy, including which of the following? (Select all that apply.) A. Chronic illness B. Endocrine disorders C. Fatigue D. Infections E. Psychological factors

A, B. D, E

6. A woman comes for her first prenatal appointment at 31 weeks' gestation with her first pregnancy. Which of the following are appropriate statements by the nurse? (Select all that apply.) A. "Do you have questions before I begin your prenatal history and information sharing?" B. "Have you had care in another clinic? I can't believe this is your first appointment!" C. "I am interested in hearing about your life and what prompted you to begin your prenatal care today." D. "It is nice to meet you and I will try to help you get caught up in your prenatal care." E. "Now that you are finally here, we need you to come monthly for the next two visits and then weekly."

A, C, D

13. The nurse provides increased support to a woman during her first prenatal visit for her current pregnancy. The patient's first pregnancy ended in a miscarriage. The nurse understands that the reasons the patient may be ambivalent about this baby include which of the following? (Select all that apply.) A. Awareness of a new 24-hour responsibility B. Needs related to a second pregnancy C. Potential role/relationship changes D. Previous perinatal loss E. Unresolved grief and mourning

A, C, D, E

6. In providing anticipatory guidance to a couple expecting their first child, which tasks and activities does the nurse discuss with the parents? (Select all that apply.) A. Honing communication and listening skills B. Learning to cope with a lack of sexual activity C. Negotiating household roles and daily tasks D. Reorganizing the house for a new member E. Reviewing patterns of money management

A, C, D, E

9. A nurse is assessing all patients in the perinatal clinic for culturally related increased risk for gestational diabetes mellitus. Which patients would the nurse assess as being in the highest risk groups? (Select all that apply.) A. African American B. Caucasian C. Chinese D. Hispanic E. Native American

A, C, D, E

17. A pregnant woman in the perinatal clinic is a commercial sex worker and states that she frequently has unprotected sexual intercourse. The nurse should educate this woman about which complications of sexually transmitted diseases (STDs)? (Select all that apply.) A. Ectopic pregnancy B. Frequent multi-fetal pregnancy C. Gestational hypertension D. Preterm labor E. Spontaneous abortion

A, D, E

8. The nurse advocates for smoking cessation during pregnancy and teaches pregnant women about the effects of tobacco exposure. Which of the following are potential harmful effects of prenatal tobacco use that the nurse should plan to include in the teaching? (Select all that apply.) A. Continued childhood respiratory problems B. Congenital diabetes C. Gestational hypertension D. Preterm labor and birth E. Small-for-gestational-age infant

A, D, E

The nursing instructor explains to a class of students that the pituitary gland has many functions related to pregnancy. Which of the following functions are performed by hormones secreted by this gland? (Select all that apply.) A. Influence ovarian follicular development B. Stimulate the uterine lining C. Prompt ovulation D. Cause the corpus luteum to produce progesterone E. Maintain the pregnancy

A,B,C, E

The nurse recognizes that a pregnant adolescent must successfully complete developmental tasks to be an effective mother. Which tasks does the nurse understand this to include? (Select all that apply.) A. Accepting this pregnancy and telling parents/friends B. Growing up and accepting responsibility C. Maintaining her freedom D. Seeing herself as a mother E. Setting reasonable goals for herself

A,B,D,E

32. A patient who has a previous diagnosis of round ligament pain is in the clinic for a follow-up visit. Which statement by the patient would indicate that teaching objectives for this problem have been met? A. "I have been supporting my uterus with a pillow when resting." B. "I have been trying all sorts of over-the-counter medications." C. "I haven't had any black, tarry stools at all since I was here." D. "That black cohosh has really helped with my abdominal pain."

A. "I have been supporting my uterus with a pillow when resting."

2. A patient who is 28 weeks pregnant calls the obstetrical clinic and complains of irregular, painless contractions that last for 10 to 15 seconds. What response by the nurse is best? A. "If they last more than 60 seconds or become regular, come in." B. "Oh, you are just having what are called Braxton Hicks contractions." C. "Pregnant women often experience this type of contraction." D. "You should come in to the clinic as soon as possible today."

A. "If they last more than 60 seconds or become regular, come in."

20. A student nurse asks the faculty about the importance of preconception counseling. Which response by the faculty is best? A. "It is the best time to find any conditions that could have a negative effect on a pregnancy." B. "It's a good time to educate women about birth control options before they need them." C. "Reproductive care is an important part of any woman's health care." D. "The Centers for Disease Control mandates that all women get preconception care."

A. "It is the best time to find any conditions that could have a negative effect on a pregnancy."

A pregnant woman has the nursing diagnosis of risk for ineffective role performance. What statement by the patient indicates that she is meeting a maternal task associated with the second trimester? A. "This baby seems so real to me since I feel him move." B. "I really will miss my girls' nights out at the local bars." C. "I don't understand why I feel drawn to pregnant women." D. "All of this morning sickness and fatigue are distressing."

A. "This baby seems so real to me since I feel him move."

38. A nurse is preparing to dismiss a woman and her infant from the hospital. The woman is Rh(D)-negative and the infant is Rh(D)-positive. This was her first pregnancy. Which nursing action is most appropriate? A. Administer Rho(D) immune globulin (RhoGAM) and document accurately. B. Assess the father to see if he has ever received an injection of RhoGAM. C. Educate the woman on the need for RhoGAM if she delivers an Rh(D)-negative baby. D. Instruct the woman to get RhoGAM with her next pregnancy, not for this one.

A. Administer Rho(D) immune globulin (RhoGAM) and document accurately.

39. A woman with a history of heart failure is in labor and has the following vital signs: blood pressure: 100/58 mm Hg, pulse: 120 beats/minute, respiratory rate: 36 breaths/minute, oxygen saturation: 88%. Which action should the nurse perform first? A. Administer oxygen at 10 L/min per rebreather mask. B. Call the health-care provider to report the results. C. Document the findings in the patient's chart. D. Increase the woman's IV infusion to 150 mL/hour.

A. Administer oxygen at 10 L/min per rebreather mask.

9. A woman in her third trimester of pregnancy complains of a painful burning sensation in her hands and lower arms. Which action by the nurse is best? A. Advise the woman to elevate her hands at night. B. Document the finding and alert the provider. C. Encourage the woman to see a neurologist. D. Request a prescription for pregabalin (Lyrica).

A. Advise the woman to elevate her hands at night.

28. The nursing faculty member explains to a class of nursing students that the ethnic/cultural group with the highest rate of teen pregnancy is which group? A. African Americans B. Asian Americans C. European Americans D. Hispanic Americans

A. African Americans

34. A woman asks the perinatal nurse about gestational diabetes because she has been reading about it. The nurse should inform the patient that screening for this condition is usually done at what time during the pregnancy? A. Around 24 to 28 weeks' gestation B. End of the first trimester C. Mid-pregnancy D. Normally offered around week 37

A. Around 24 to 28 weeks' gestation

22. A woman in her second trimester continues to smoke a pack of cigarettes a day despite stating that she understands why smoking is bad for her and for her fetus. Which action by the nurse is best? A. Assess the patient for past trauma and abuse. B. Document the information in the patient's chart. C. Review prior teaching done regarding smoking. D. Show photos of babies born with abnormalities.

A. Assess the patient for past trauma and abuse.

17. A patient being seen for the first time in the perinatal clinic has multiple complaints, such as fatigue, anger outbursts, chronic pelvic pain, and feelings of anxiety. What action by the nurse is best? A. Assess the woman for a history of sexual assault. B. Document the patient's complaints on the chart. C. Refer the woman to a psychiatric nurse practitioner. D. Review the woman's past medical history with her.

A. Assess the woman for a history of sexual assault.

20. A nurse is assessing a patient for Chadwick's sign. In order to do this correctly, what action does the nurse take? A. Assesses the color of the patient's vaginal mucosa and cervix. B. Feels the patient's abdomen for passive fetal movement. C. Obtains a urine specimen for a pregnancy test. D. Palpates the patient's abdomen for uterine asymmetry.

A. Assesses the color of the patient's vaginal mucosa and cervix.

12. A nurse is assessing a woman in the perinatal clinical with diagnosed cervical insufficiency. The woman is in her 18th week of a viable pregnancy. Which action by the nurse is most appropriate? A. Assist with obtaining informed consent for a cerclage. B. Draw blood to assess the maternal Rh status. C. Facilitate a transvaginal and abdominal ultrasound. D. Refer the woman to a perinatal grief specialist.

A. Assist with obtaining informed consent for a cerclage.

16. A nurse has admitted a patient with hyperemesis gravidarum and is reviewing the physician's orders. Which order should the nurse question? A. Betamethasone (Celestone) 100 mg IV every 8 hours B. Dimenhydrinate (Dramamine) 75 mg rectally every 4-6 hours C. Metoclopramide (Reglan) 10 mg IV every 8 hours D. Promethazine (Phenergan) 25 mg IV every 4 hours

A. Betamethasone (Celestone) 100 mg IV every 8 hours

42. A pregnant patient is admitted with possible deep venous thrombosis (DVT). Orders are left to start warfarin (Coumadin) 5 mg p.o., once daily. Which of the following actions by the nurse is most appropriate? A. Call the physician to clarify the order and document the conversation. B. Instruct the patient not to get out of bed without assistance. C. Start the warfarin as soon as it is available from the pharmacy. D. Teach the patient about the risks and benefits of anticoagulation.

A. Call the physician to clarify the order and document the conversation.

2. The prenatal clinic nurse assesses a woman at 15 weeks' gestation. The patient's blood pressure, measured twice at intervals 1 hour apart with a cuff that fits appropriately, is 146/96 mm Hg. The nurse understands the patient has which condition? A. Chronic hypertension B. Gestational hypertension C. Preeclampsia D. Transient hypertension

A. Chronic hypertension

26. A woman who is 28 weeks pregnant is admitted to the high-risk OB unit with preterm premature rupture of the membranes. Four hours after admission, the nurse notes the following: temperature: 38.5°C (101.5°F), maternal pulse: 122 beats/minute, and white blood cell count: 23,000 mm3. Which action by the nurse takes priority? A. Document the findings and notify the health-care provider. B. Facilitate fern testing or Nitrazine testing on vaginal fluid. C. Prepare to administer a prn dose of acetaminophen (Tylenol). D. Reassure the woman that these are expected findings.

A. Document the findings and notify the health-care provider.

The nurse caring for perinatal patients understands the term decidua to mean which of the following? A. Endometrial lining of the uterus B. Endometrial tissue covering the embryo C. Placental remnants left in the uterus D. Collateral uterine circulation

A. Endometrial lining of the uterus

26. A woman is in her fourth month of pregnancy and is in the clinic for a scheduled visit. She confides to the nurse that her husband seems detached and is no longer interested in hearing about the pregnancy. Which action by the nurse is best? A. Explain that paternal reactions vary widely. B. Offer a referral to a marriage counselor. C. Reassure the woman that this behavior changes after the birth. D. Tell her that men are usually jealous of the baby.

A. Explain that paternal reactions vary widely.

20. A father accompanies his partner to her OB clinic visit. The woman is near term. The father confides to the nurse that the patient is cranky, irritable, and yells at him for no reason. Which action by the nurse is best? A. Explain why the woman needs emotional support. B. Instruct the mother to get more rest during the day. C. Reassure the father that this behavior is normal in pregnancy. D. Teach the father assertive communication skills.

A. Explain why the woman needs emotional support.

33. A patient in the high-risk OB unit has suffered a seizure and is now postictal. She is on oxygen at 2L/minute. Which assessment by the nurse warrants immediate intervention? A. Fetal heart rate is 98 beats/minute on electronic fetal monitor strip. B. Maternal oxygen saturation is 94% by pulse oximetry. C. Mother is sleeping soundly and is difficult to arouse. D. Mother's respiratory rate is 12 breaths/minute.

A. Fetal heart rate is 98 beats/minute on electronic fetal monitor strip.

19. According to Rubin (1975), completion of what task is paramount for a pregnant woman to master in order to have successful integration of the maternal role? A. Incorporating the pregnancy into her total identity B. Learning to adapt to all the physiological changes C. Recognizing a "before pregnant" and "after pregnant" self D. Reorienting all relationships to put the pregnancy first

A. Incorporating the pregnancy into her total identity

19. A student asks what the phrase "probable signs of pregnancy" means. The instructor provides which answer? A. Objective signs seen by an examiner; can be from other conditions B. Objective signs seen by an examiner; only caused by pregnancy C. Subjective signs reported by the patient; can be from other conditions D. Subjective signs reported by the patient; only caused by pregnancy

A. Objective signs seen by an examiner; can be from other conditions

14. A nurse is caring for a pregnant 16-year-old who is homeless and occasionally spends time in a homeless shelter. She has been seen in the clinic before for sexually transmitted infections (STIs). She weighs 92 lb (41.8 kg) and occasionally uses crack cocaine. Which risk factors does this patient have for a negative pregnancy outcome? (Select all that apply.) A. Age of 16 years B. Being homeless C. Crack cocaine use D. History of STIs E. Low weight

B, C, D, E

3. Which of the following does the nurse recognize as complications of premature birth? (Select all that apply.) A. Osteoporosis B. Cerebral palsy and mental retardation C. Diabetes mellitus type 1 D. Intraventricular hemorrhage E. Retinopathy of prematurity

B, D, E

A nurse is providing anticipatory guidance to a pregnant woman regarding normal changes in the nose and nasal passages. What information should the nurse provide? (Select all that apply.) A. Use decongestant spray. B. Stuffiness is common. C. Increase your fluid intake. D. Blow your nose gently. E. Dry mucous membranes cause bleeding.

B,C,D

2. After questioning a pregnant woman about her fluid intake, the nurse discovers that the patient is drinking four glasses of diet cola per day. Which response by the nurse is best? A. "As long as you get enough fluid, soda is all right to drink." B. "Less than two cups of caffeine a day is probably OK." C. "The major worry with soda is the sugar content." D. "You really should switch to decaffeinated colas."

B. "Less than two cups of caffeine a day is probably OK."

5. A nurse is working with a pregnant woman who has the nursing diagnosis of altered family processes. What statement by the patient indicates that a major goal for this diagnosis has been met? A. "At least I'm getting better sleep now that I don't urinate every 2 hours." B. "My husband has been doing more around the house so I can rest more." C. "The kids are really excited about getting a new baby brother or sister." D. "We finally have the nursery painted and furnished so it's ready for baby."

B. "My husband has been doing more around the house so I can rest more."

6 . A nurse is reviewing the prenatal care schedule for a woman who is 10 weeks pregnant. When does the nurse advise the woman to return for her next appointment? A. 2 weeks B. 4 weeks C. 6 weeks D. 8 weeks

B. 4 weeks

27. The nurse auscultates fetal heart tones on a woman in her third trimester of pregnancy and counts a heart rate of 92 beats/minute. Which action by the nurse is best? A. Apply oxygen at 6 L/minute. B. Assess the maternal heart rate. C. Document the findings in the chart. D. Turn the woman on her left side.

B. Assess the maternal heart rate.

28. A pregnant patient is brought to the emergency department after a roll-over motor vehicle crash. After assessing and stabilizing the patient's airway, breathing, and circulation, which of the following actions should the nurse perform next? A. Assess the woman for further injuries. B. Attach continuous fetal monitoring leads. C. Determine the date of the patient's last tetanus booster. D. Prepare to transfer the woman to the delivery suite.

B. Attach continuous fetal monitoring leads.

32. The nurse has admitted a patient to the high-risk OB unit with preterm premature rupture of the membranes. After obtaining maternal vital signs and the fetal heart rate, which action should the nurse do next? A. Assess for coping skills in the woman and her partner. B. Attach the woman to continuous electronic fetal monitoring. C. Consult social work for diversionary activities to enhance bedrest. D. Prepare to administer antibiotics for presumed chorioamnionitis.

B. Attach the woman to continuous electronic fetal monitoring.

25. A woman is admitted to the high-risk OB unit with the diagnosis of preterm labor. Orders include bedrest with continuous fetal monitoring, administration of magnesium sulfate (Sulfamag) and betamethasone (Celestone), and laboratory work. In reviewing the patient's record, the nurse notes a history of hypertension that is well controlled with nifedipine (Procardia) and diet-controlled diabetes mellitus type 2. Which action by the nurse is best? A. Assist the woman to choose appropriate food items from the menu. B. Call the physician to question the orders and document the conversation. C. Order a pressure-relieving mattress overlay and perform a skin assessment. D. Prepare to give the magnesium sulfate and betamethasone as ordered.

B. Call the physician to question the orders and document the conversation.

5. An instructor is explaining to students in the OB rotation that Goodell's sign is which of the following? A. Bluish cervical discoloration B. Cervical softening C. False labor contractions D. Slowed fetal heart tones

B. Cervical softening

9. A woman who recently had a miscarriage is in the clinic for follow-up. She sees the diagnosis "spontaneous abortion" on her chart and becomes visibly upset, stating, "I did not have an abortion!" Which response by the nurse is best? A. "Don't be upset; that is just a medical term used commonly." B. "I can come back and talk to you when you are not so upset." C. "I see you are upset. Does it help to know this means miscarriage?" D. "No one is accusing you of having an abortion."

C. "I see you are upset. Does it help to know this means miscarriage?"

4. A woman in the prenatal clinical is concerned because her partner, who was supportive and excited about becoming pregnant, has suddenly become more withdrawn and seems ambivalent toward the pregnancy. What response by the nurse is best? A. "Are you in a relationship that causes you to be afraid?" B. "Oh don't worry; they all feel this way sometimes." C. "This is a normal reaction to the reality of the pregnancy." D. "Your partner will come around to being excited soon."

C. "This is a normal reaction to the reality of the pregnancy."

10. A 24-year-old pregnant woman at 26 weeks' gestation is experiencing her third pregnancy. The patient's obstetric history includes one full-term birth and one preterm birth; both children are alive and well. Today, the patient arrives at the clinic with complaints of fatigue, insomnia, and continuous backache. She reports that she is a nurse on an oncology unit and is worried about continuing to work her 12-hour shifts. What advice by the nurse would be most appropriate? A. "Can you ask your manager about light-duty work at your job?" B. "See if you can take more breaks at work to rest and drink water." C. "With your previous premature birth, you might need to reduce your working hours." D. "You can continue to work as long as you want to and feel able to."

C. "With your previous premature birth, you might need to reduce your working hours."

24. A woman calls the prenatal clinic to inquire if she should have the seasonal influenza vaccination. What advice should the nurse provide? A. "Flu does not cause many problems in pregnancy." B. "No, vaccinations are not safe in pregnancy." C. "Yes, you should get the flu vaccination." D. "You should wait until your third trimester."

C. "Yes, you should get the flu vaccination."