OB Practice Questions

Before advising a 24-year-old client desiring oral contraceptives for family planning, the nurse would assess the client for signs and symptoms of which of the following? ■ 1. Anemia. ■ 2. Hypertension. ■ 3. Dysmenorrhea. ■ 4. Acne vulgaris.

■ 2. Hypertension.

Fertilization takes place in the _____________. A. Ovaries B. Fallopian tube C. Uterus

B. Fallopian tube

True or False: Genetics is the study of genes and their function and related technology. A. True B. False

B. False genetics looks at SINGLE genes for function and composition. genome: looks at ALL genes and their interrelationships

Which of the following lab results indicates anemia? A. Hemoglobin 11.2 B. Hemoglobin 10 C. Hematocrit 34% D. Hematocrit 38%

B. Hemoglobin 10

Screening tests are designed to: A. Be offered to all pregnant women B. Identify those not affected by a disease C. Identify a particular disease D. Make a specific diagnosis

B. Identify those not affected by a disease

The purpose of preconception care is to: A. Prevent unwanted pregnancies B. Improve perinatal outcomes C. Facilitate desired pregnancy D. Screen for sexually transmitted diseases

B. Improve perinatal outcomes

Risk management is an approach to the prevention of: A. Morbidity and mortality B. Litigation C. Staff conflicts D. Poor care

B. Litigation

Assessment for risk factors includes: A. Cultural factors B. Medical and obstetrical issues C. Religion D. Sexual preference

B. Medical and obstetrical issues

Nursing interventions that facilitate adaptation to pregnancy in the first trimester focus on: A. Physiological changes in pregnancy B. Promoting pregnancy and birth as a family experience C. Readiness for parenting D. Partners' role during labor and birth

B. Promoting pregnancy and birth as a family experience

A FHR that increases 15 beats above baseline for 15 seconds twice in 20 minutes is considered: A. Category III B. Reactive C. Nonreactive D. Negative

B. Reactive

To be effective advocates for patients and their families, the nurse needs to: A. Talk to patients about their concerns B. Recognize themselves as equal partners in the health care team C. Assume the patients' needs D. Ask family members about key health care decisions

B. Recognize themselves as equal partners in the health care team

A maternal and infant goal stated in Healthy People 2020 is: A. Increase abstinence from smoking during pregnancy to 100%. B. Reduce cesarean birth for first-time mothers to 23.9%. C. Increase the proportion of infants who are breastfed at 6 months to 50%. D. Reduce the rate of maternal mortality to 5%.

B. Reduce cesarean birth for first-time mothers to 23.9%.

A client has just had a cesarean section for a prolapsed cord. In reviewing the client's history, which of the following factors places a client at risk for cord prolapse? Select all that apply. ■ 1. −2 station. ■ 2. Low birth weight infant. ■ 3. Rupture of membranes. ■ 4. Breech presentation. ■ 5. Prior abortion. ■ 6. Low lying placenta.

1, 2, 3, 4

As the nurse enters the room of a newly admitted primigravid client diagnosed with severe preeclampsia, the client begins to experience a seizure. The nurse should do which in order of priority from fi rst to last? 2. Turn the client to her side. 3. Note the time when the seizure began. 4. Maintain airway. 1. Call for immediate assistance. Answers, Rationales, and Test Taking Strategies The answers and rationales for each question follow below, along with keys ( ) to the client need (CN) and cognitive level (CL) for each question. Use these keys to further develop your test-taking skills. For additional information about test-taking skills and strategies for answering questions, refer to pages 10-21, and pages 25-26 in Part 1 of this book. The Pregnant Client with Preeclampsia or Eclampsia 1. 50 mL CN: Pharmacological and parenteral therapies; CL:

1, 3, 2, 4

The nurse is administering intravenous magnesium sulfate as ordered for a client at 34 weeks' gestation with severe preeclampsia. Which of the following are desired outcomes of this therapy? Select all that apply. ■ 1. T 98, P 72, R 14. ■ 2. Urinary output <30 mL/hr. ■ 3. HR 120 BPM. ■ 4. Fetal heart rate with late decelerations. ■ 5. BP of <140/90. ■ 6. DTR's 2+. ■ 7. Magnesium level= 5.6 mg/dL. ■ 8. Clonus = 2+.

1, 3, 5, 6, 7

The triage nurse is giving a telephone report to the receiving nurse in the labor and delivery unit. The client is a G4 P3 who is 8 cm dilated and is being transferred to the labor and delivery unit. How should the labor and delivery nurse manage the next ten minutes with the client? Select all that apply. ■ 1. Place client on the fetal and contraction monitor. ■ 2. Call other staff to set up the delivery table. ■ 3. Assess comfort needs of client. ■ 4. Determine support systems for client. ■ 5. Prepare to give an early report to the nurse arriving on the next shift.

1,2,3,4

A 22-year-old client tells the nurse that she and her husband are trying to conceive a baby. When teaching the client about reducing the incidence of neural tube defects, the nurse would emphasize the need for increasing the intake of which of the following foods? Select all that apply. ■ 1. Leafy green vegetables. ■ 2. Strawberries. ■ 3. Beans. ■ 4. Milk. ■ 5. Sunfl ower seeds. ■ 6. Lentils.

1,2,3,5,6

The nurse is assessing a multigravida client at 12 weeks' gestation who has been admitted to the emergency department with sharp right-sided abdominal pain and vaginal spotting. Which of the following should the nurse obtain about the client's history? Select all that apply. ■ 1. History of sexually transmitted infections. ■ 2. Number of sexual partners. ■ 3. Last menstrual period. ■ 4. Cesarean section. ■ 5. IUD use. ■ 6. Contraceptive use.

1,2,3,5,6

A primiparous client has just delivered her baby. The physician has informed the labor nurse that he believes the uterus has inverted. Which of the following would help to confi rm this diagnosis? Select all that apply. ■ 1. Hypotension. ■ 2. Gush of blood from the vagina. ■ 3. Intense, severe, tearing type of abdominal pain. ■ 4. Uterus is hard and in a constant state of contraction. ■ 5. Inability to palpate the uterus. ■ 6. Diaphoresis.

1,2,5,6

The nurse assesses a primiparous client in labor for 20 hours. The nurse identifi es late decelerations on the monitor and initiates standard procedures for the labor client with this wave pattern. Which interventions should the nurse perform? Select all that apply. ■ 1. Administering oxygen via mask to the client. ■ 2. Questioning the client about the effectiveness of pain relief. ■ 3. Placing the client on her side. ■ 4. Readjusting the monitor to a more comfortable position. ■ 5. Applying an internal fetal monitor to help identify the cause of the decelerations.

1,3,5

After reinforcing the danger signs to report with a gravida 2 client at 32 weeks' gestation with an elevated blood pressure, which client statements would demonstrate her understanding of when to call the physician's offi ce? Select all that apply. ■ 1. "If I get up in the morning and feel dizzy, even if the dizziness goes away." ■ 2. "If I see any bleeding, even if I have no pain." ■ 3. "If I have a pounding headache that doesn't go away." ■ 4. "If I notice the veins in my legs getting bigger." ■ 5. "If the leg cramps at night are waking me up." ■ 6. "If the baby seems to be more active than usual."

2, 3, 6

The nurse and a nursing assistant are caring for clients in a birthing center. Which of the following tasks should the nurse delegate to the nursing assistant? Select all that apply. ■ 1. Removing a Foley catheter from a preeclamptic client. ■ 2. Assisting an active labor client with breathing and relaxation. ■ 3. Ambulating a postcesarean client to the bathroom. ■ 4. Calculating hourly I.V. totals for a preterm labor client. ■ 5. Intake and output catheterization for culture and sensitivity. ■ 6. Calling a report of normal fi ndings to the health care provider. ■ 7. Removing lunch trays and documenting lunch intake

2, 3, 7

After instructing participants in a childbirth education class about methods for coping with discomforts in the fi rst stage of labor, the nurse determines that one of the pregnant clients needs further instruction when she says that she has been practicing which of the following? ■ 1. Biofeedback. ■ 2. Effl eurage. ■ 3. Guided imagery. ■ 4. Pelvic tilt exercises.

■ 4. Pelvic tilt exercises.

A client with pregnancy-induced hypertension is to receive magnesium sulfate to run at 3 grams per hour with normal saline to maintain the total I.V. rate at 125 mL/hour. The nurse giving end of shift report stated the client's blood pressures have been elevated during the night. The oncoming nurse checked the client and found magnesium sulfate running at 2 grams per hour. Identify the nursing actions to be taken from fi rst to last. 1. Notify the physician of the incident. 2. Assess the client's current status 3. Correct the I.V. rates to magnesium sulfate running at 3 grams/hour and normal saline to complete total rate at 125 mL/hour. 4. Initiate an incident report.

3, 2, 1, 4

The nurse notices that a client who has just delivered her infant is short of breath, ashen in color, and begins to cough. She becomes limp on the delivery table. At last assessment ½ hour ago, her tempature was 98, pulse 78, respirations 16. Determine the nursing actions in the order they should occur. 1. Open airway using head tilt-chin lift. 2. Ask staff to activate emergency response system. 3. Establish unresponsiveness. 4. Give 2 breaths. 5. Check the pulse

3,2,1,4,5

A nurse is assigned to the obstetrical triage area. When beginning the assignment, the nurse is given a report about four clients waiting to be seen. Place the clients in the order in which the nurse should see them. 1. A primigravid client at 10 weeks' gestation complaining of not feeling well with nausea and vomiting, urinary frequency, and fatigue. 2.A multiparous client at 32 weeks' gestation asking for assistance with fi nding a new physician. 3. A single mother at 4 months postpartum fearful of shaking her baby when he cries. 4. An antenatal client at 16 weeks' gestation who has occasional sharp pain on her left side radiating from her symphysis to her fundus.

3,4,1,2 3. A single mother at 4 months postpartum fearful of shaking her baby when he cries. 4. An antenatal client at 16 weeks' gestation who has occasional sharp pain on her left side radiating from her symphysis to her fundus. 1. A primigravid client at 10 weeks' gestation complaining of not feeling well with nausea and vomiting, urinary frequency, and fatigue. 2.A multiparous client at 32 weeks' gestation asking for assistance with fi nding a new physician.

The nurse assesses a woman at 24 weeks' gestation and is unable to find the fetal heart beat. The fetal heart beat was heard at the client's last visit 4 weeks ago. According to priority, the nurse should do the following tasks in which order? 1. Call the health care provider. 2. Explain that the fetal heart beat could not be found at this time. 3. Obtain different equipment and recheck. 4. Ask client if baby is or has been moving.

4,3,2,1

Treatment with IV antibiotics is indicated for patients with all of the following except: A. History of group B streptococcus (GBS) in the urine during pregnancy B. Scheduled for cesarean delivery prior to rupture of membranes or labor with a history of positive GBS C. GBS status unknown with a history of an infant with invasive GBS infection D. Screened negative for GBS at 37 weeks, now in labor with temperature >100.4° F (38° C)

B. Scheduled for cesarean delivery prior to rupture of membranes or labor with a history of positive GBS

The developing human is most vulnerable to teratogens during A. The first 4 weeks of gestation B. The first 8 weeks of gestation C. The first 12 weeks of gestation D. The first 16 weeks of gestation

B. The first 8 weeks of gestation

Ambivalent feelings toward pregnancy in the third trimester may indicate: A. Normal expected finding B. Unresolved conflict C. Depression D. Unwanted pregnancy

B. Unresolved conflict

You are a nurse working in a prenatal clinic. Your patient, an 18-year-old woman, is in her 10th gestational week. She wants to know when her baby's heart will start to beat. You inform her that it usually begins to beat around: A. The 2nd week of gestation B. The 3rd week of gestation C. The 4th week of gestation D. The 5th week of gestation

C. The 4th week of gestation

Which of the following statements best identifi es the rationale for why the nurse reinforces the need for continued prenatal care throughout the pregnancy with an adolescent primigravid client? ■ 1. Pregnant adolescents are at high risk for pregnancy-induced hypertension. ■ 2. Gestational diabetes during pregnancy commonly develops in adolescents. ■ 3. Adolescents need additional instruction related to common discomforts. ■ 4. The father of the baby is rarely involved in the pregnancy.

■ 1. Pregnant adolescents are at high risk for pregnancy-induced hypertension.

Factors that place a man at risk for infertility are: (select all of the correct answers) A. Cigarette smoking B. Eating disorders C. Excessive exercising D. Use of marijuana

A, B

You are a nurse in a family planning clinic. Your patient has been married for 5 years. She used an IUD, which was removed 12 months ago. She informs you that she and her husband have been trying to get pregnant for the past 12 months. Initial screening to determine the cause of infertility includes (select all of the correct answers): A. Sperm analysis B. Testicular biopsy C. Assessing for ovulation D. Hysterosalpingogram

A, C, D

The highest percentage of women who smoke during pregnancy are ____________. A. American Indian and/or Alaskan Native B. Asian and/or Pacific Islander C. Hispanic D. Non-Hispanic black E. Non-Hispanic white

A. American Indian and/or Alaskan Native

A 25-year-old woman is seeing her gynecologist for a preconception visit. She has been married for 3 years. Her brother has hemophilia. Which of these genetic tests would be recommended for this woman? A. Carrier testing B. Predictive testing C. Preimplantation testing D. Prenatal testing

A. Carrier testing

Signs of possible maladaptation to pregnancy include: A. Denial of fears about childbirth and unrealistic expectations about birth B. Excessive maternal weight gain and limiting physical activity C. Denial of physical symptoms of pregnancy and emotional lability D. Changes in couple's interactions and sexual activity

A. Denial of fears about childbirth and unrealistic expectations about birth

Nurses have the professional responsibility to provide high-quality, impartial nursing care to all patients in ______________, regardless of the nurses' personal beliefs. A. Emergency situations B. Urgent situations C. Safe situations D. Every situation

A. Emergency situations

Your patient delivered a full-term baby 12 hours ago. The woman and her husband, who are in their early 20s, have just been informed by their pediatrician that their baby has trisomy 21 (Down syndrome). This is their first child and they did not have prenatal genetic testing. Your nursing care will include (select all of the correct nursing actions): A. Explaining that they will go through a grieving process over the loss of their "dream" child. B. Explaining the importance of talking openly to each other about their feelings and concerns regarding their child. C. Explaining they will benefit from seeing a genetic counselor. D. Explaining that they should direct questions regarding the baby's diagnosis to their pediatrician.

A. Explaining that they will go through a grieving process over the loss of their "dream" child. B. Explaining the importance of talking openly to each other about their feelings and concerns regarding their child. C. Explaining they will benefit from seeing a genetic counselor.

The two most important predictors of an infant's health and survival after birth are: A. Gestational age and birth weight B. Gestational age and early prenatal care C. Gestational age and complication during labor and birth D. Gestational age and Apgar score

A. Gestational age and birth weight

Measurable outcomes of social support interventions during pregnancy include: A. Improved coping and functional status B. Improves relationship with mother C. Reduced stress D. Reduced depression

A. Improved coping and functional status

A woman who gets pregnant within 45 days of delivering a baby is at a higher risk for: A. Iron deficiency anemia B. Periodontal disease C. Urinary stasis D. Striae gravidarum

A. Iron deficiency anemia

Amniocentesis done after 15 weeks is associated with a fetal death rate of: A. Less than 1% B. Less than 5% C. Greater than 1% D. Approximately 5%

A. Less than 1%

Specialized ultrasounds are involved in all the following except: A. Maternal assays B. BPP C. Assessment of amniotic fluid D. Measurement of fetal structures

A. Maternal assays

True or False: Very low birth weight (VLBW) neonates account for 1.45% of births but account for 45% of all infant deaths. A. True B. False

A. True

True or false: Meiosis is a process of two successive cell divisions that produces two haploid cells. A. True B. False

A. True

When caring for a woman who speaks limited English, the appropriate method for translating information is: A. Using a trained medical interpreter B. Asking a student nurse who speaks the woman's primary language to translate C. Providing printed material for the woman to take home D. Asking for a family member to translate

A. Using a trained medical interpreter

While caring for a 24-year-old primigravid client scheduled for emergency surgery because of a probable ectopic pregnancy, the nurse should: ■ 1. Prepare to witness an informed consent for surgery. ■ 2. Assess the client for massive external bleeding. ■ 3. Explain that the fallopian tube can be salvaged. ■ 4. Monitor the client for uterine contractions.

■ 1. Prepare to witness an informed consent for surgery.

A primigravid client whose cervix is 7 cm dilated with the fetus at 0 station and in a left occipitoposterior (LOP) position requests pain relief for severe back pain. The nurse should: ■ 1. Provide fi rm pressure to the client's sacral area. ■ 2. Prepare the client for a cesarean delivery. ■ 3. Prepare the client for a precipitate delivery. ■ 4. Maintain the client in a left side-lying position.

■ 1. Provide fi rm pressure to the client's sacral area.

The nurse is discussing dietary concerns with pregnant teens. Which of the following choices are convenient for teens yet nutritious for both the mother and fetus? Select all that apply. ■ 1. Milkshake or yogurt with fresh fruit or granola bar. ■ 2. Chicken nuggets with tater tots. ■ 3. Cheese pizza with spinach and mushroom topping. ■ 4. Peanut butter with crackers and a juice drink. ■ 5. Buttery light popcorn with diet cola. ■ 6. Cheeseburger with tomato, lettuce, pickle, ketchup, and baked potato.

■ 1. Milkshake or yogurt with fresh fruit or granola bar. ■ 3. Cheese pizza with spinach and mushroom topping. ■ 4. Peanut butter with crackers and a juice drink.

A primigravid client is admitted as an outpatient for an external cephalic version. The nurse should assess the client for which of the following contraindications for the procedure? ■ 1. Multiple gestation. ■ 2. Breech presentation. ■ 3. Maternal Rh-negative blood type. ■ 4. History of gestational diabetes.

■ 1. Multiple gestation.

While planning care for the lesbian client, it is most important for the nurse to include a goal that addresses the need for: A. Referrals to a perinatal social worker on admission to the hospital B Establishing a trusting relationship with health care providers C. Providing counseling to lesbian mothers regarding legal issues they may face with parenting D. Choosing a name for the infant and obtaining supplies for the new baby

B Establishing a trusting relationship with health care providers

What BPP score would indicate the need for immediate delivery of the fetus? A. 6 B. 2 C. 12 D. 4

B. 2

An ethical dilemma is: A. A violation of patient autonomy B. A choice that violates ethical principles C. A conflict between advocacy and respect D. A conflict between what is just and good

B. A choice that violates ethical principles

Physiological changes in pregnancy: A. Involve primarily reproductive organs B. Are protective of the woman and/or fetus C. Are most profound in the first trimester D. Primarily impact the musculoskeletal system

B. Are protective of the woman and/or fetus

To facilitate adaptation to pregnancy during the first trimester, an appropriate nursing action would be to: A. Encourage the woman to sign up for prepared childbirth classes B. Assess the woman's response to pregnancy C. Encourage the woman to "tune in" to fetal movement D. Give anticipatory guidance regarding breastfeeding

B. Assess the woman's response to pregnancy

The leading cause of infant death in 2010 was _______. A. Sudden infant death syndrome (SIDS) B. Congenital malformations C. Respiratory distress syndrome of newborns D. Accidents

B. Congenital malformations

Prescriptive behavior is: A. Behavior during the childbearing period that is limited for pregnant women B. Expected behavior for pregnant women C. Behavior that is restricted for pregnant women that has supernatural consequences D. An unacceptable practice that has implications for pregnant women

B. Expected behavior for pregnant women

A laboring client at -2 station has a spontaneous rupture of the membranes and a cord immediately protrudes from the vagina. The nurse should fi rst: ■ 1. Place gentle pressure upward on the fetal head. ■ 2. Place the cord back into the vagina to keep it moist. ■ 3. Begin oxygen by face mask at 8 to 10 L/min. ■ 4. Turn the client on her left side.

■ 1. Place gentle pressure upward on the fetal head.

When instructing a client about the proper use of condoms for pregnancy prevention, which of the following instructions would be included to ensure maximum effectiveness? ■ 1. Place the condom over the erect penis before coitus. ■ 2. Withdraw the condom after coitus when the penis is fl accid. ■ 3. Ensure that the condom is pulled tightly over the penis before coitus. ■ 4. Obtain a prescription for a condom with nonoxynol 9.

■ 1. Place the condom over the erect penis before coitus.

Infant mortality is defined as a death before _________. A. 28 days of age B. 6 months of age C. 1 year of age D. 18 months of age

C. 1 year of age

Very low birth weight (VLBW) is defined as a birth weight less than __________. A. 500 grams B. 1,000 grams C. 1,500 grams D. 2,000 grams

C. 1,500 grams

Blood volume increases during pregnancy by: A. 20%-30% B. 30%-40% C. 40%-50% D. 50%-60%

C. 40%-50%

What lamellar body count (LBC) value is highly indicative of fetal lung maturity? A. 20,000 B. 35,000 C. 55,000 D. 40,000

C. 55,000

Evidence-based decision making should include consideration of: A. Best research evidence, patient's clinical state, and clinical setting B. Best research evidence, patient's acuity, and financial considerations C. Best research evidence, clinical expertise, and patient values D. Best research evidence, clinical resources, and patient values

C. Best research evidence, clinical expertise, and patient values

RhoGAM would be administered during pregnancy at 28 weeks' gestation to women with the following: A. Blood type O+ B. Blood type A+ C. Blood type O- D. Blood type AB

C. Blood type O-

Failing to use the latest health care research is A. Unsafe B. Costly and harmful C. Costly, harmful, and can lead to use of ineffective care D. Risky

C. Costly, harmful, and can lead to use of ineffective care

Intimate partner violence: A. Consists of physical abuse B. Decreases during pregnancy C. Crosses all ethnic, racial, religious, and socioeconomic levels D. Primarily impacts maternal health

C. Crosses all ethnic, racial, religious, and socioeconomic levels

The nurse's role in antepartal testing includes: A. Interpreting results B. Obtaining consent C. Explaining how and why test is performed D. Referring the woman's question to a physician

C. Explaining how and why test is performed

When conducting a psychosocial assessment, it is important to determine the ____, _____, and ____ of mood or emotional disturbances. A. Anxiety, depression, level B. Coping, support, distress C. Frequency, duration, intensity D. Acceptance, avoidance, character

C. Frequency, duration, intensity

Softening of the cervix that occurs in the second month of pregnancy is known as: A. Hegar's sign B. Braxton's sign C. Goodell's sign D. Chadwick's sign

C. Goodell's sign

According to May's research, it is during the _______ phase that many expectant fathers appear to put conscious thought of their partner's pregnancy aside. A. Announcement B. Transition C. Moratorium D. Developing

C. Moratorium

Presumptive signs of pregnancy are: A. All the objective signs of pregnancy B. Those perceived by the healthcare provider C. Physiological changes perceived by the woman herself D. Those attributed to the fetus.

C. Physiological changes perceived by the woman herself

Which hormone is responsible for maintaining pregnancy by relaxing smooth muscles leading to decreased uterine activity and decreasing the risk of spontaneous abortion? A. Estrogen B. Human chorionic gonadatropin (hCG) C. Progesterone D. Oxytocin

C. Progesterone

Autonomy is defined as the right to: A. Do good B. Equal treatment C. Self-determination D. Be valued

C. Self-determination

A _____________ is a framework developed through expert consensus and review of the literature. A. Guideline B. Outcome C. Standard D. Evaluation

C. Standard

The appropriate recommended weight gain during pregnancy for a woman with a normal BMI is: A. 10-15 lbs. B. 6-20 lbs. C. 21-25 lbs. D. 25-35 lbs.

D. 25-35 lbs.

The greatest increase in birthrate is in women ________. A. 15-19 years of age B. 25-29 years of age C. 30-34 years of age D. 40-45+ years of age

D. 40-45+ years of age

The population with the lowest birthrate but highest premature birthrate is: A. Non-Hispanic white B. Non-Hispanic black C. American Indian or Alaska Native D. Asian or Pacific Islanders E. Hispanic

D. Asian or Pacific Islanders

The organization that publishes standards and guidelines for maternity nursing is the: A. National Perinatal Association B. American Nurses Association C. American Academy of Pediatrics D. Association of Women's Health, Obstetrics and Neonatal Nursing

D. Association of Women's Health, Obstetrics and Neonatal Nursing

Moderately premature neonates are neonates born: A. At less than 28 weeks of gestation B. Between 28 weeks and 30 weeks of gestation C. Between 30 and 32 weeks of gestation D. Between 32 and 34 weeks of gestation E. Between 34 and 36 weeks of gestation

D. Between 32 and 34 weeks of gestation

Using Naegele's rule, calculate the EDD for a patient with a LMP of 10 March. A. December 3 B. December 7 C. December 10 D. December 17

D. December 17

Umbilical Artery Doppler Flow can replace which antepartal test? A. Amniocentesis B. Chorionic Villus Sampling C. Multiple Marker Screen D. Delta OD 450

D. Delta OD 450

A response to nursing interventions that are measurable and observable are: A. Variables B. Guidelines C. Health dimensions D. Expected outcomes

D. Expected outcomes

A woman presents for prenatal care at 10 weeks' gestation reporting nausea and vomiting. Self-care and relief measures include: A. Suggest a high protein diet B. Suggest avoiding eating early in the day C. Suggest increasing fluid intake D. Suggest small, frequent meals

D. Suggest small, frequent meals

Daily fetal movement counts are done: A. Only in high-risk pregnancies B. By care providers during prenatal visits C. As soon as the pregnancy is confirmed D. To identify potentially hypoxic fetuses

D. To identify potentially hypoxic fetuses

Which placental hormone is responsible for regulating glucose availability to the fetus? A. Progesterone B. Estrogen C. hCG D. hPL

D. hPL

After suctioning to clear the airway of a term neonate who appears in good condition after spontaneous vaginal delivery, which of the following would the nurse do next? ■ 1. Place the infant in a radiant warmer. ■ 2. Instill erythromycin in the eyes. ■ 3. Obtain the neonate's weight. ■ 4. Put identifi cation bracelets on each wrist.

■ 1. Place the infant in a radiant warmer.

A 39-year-old multigravid client asks the nurse for information about female sterilization with a tubal ligation. Which of the following client statements indicates effective teaching? ■ 1. "My fallopian tubes will be tied off through a small abdominal incision." ■ 2. "Reversal of a tubal ligation is easily done, with a pregnancy success rate of 80%." ■ 3. "After this procedure, I must abstain from intercourse for at least 3 weeks." ■ 4. "Both of my ovaries will be removed during the tubal ligation procedure."

■ 1. "My fallopian tubes will be tied off through a small abdominal incision."

As a nurse begins her shift on the obstetrical unit, there are several new admissions. The client with which of the following conditions would be a candidate for induction? ■ 1. Pregnancy-induced hypertension (PIH). ■ 2. Active herpes. ■ 3. Face presentation. ■ 4. Fetus with late decelerations.

■ 1. Pregnancy-induced hypertension (PIH).

A multigravid client admitted to the labor area is scheduled for a cesarean delivery under spinal anesthesia. After instructions by the anesthesiologist, the nurse determines that the client has understood the instructions when she says which of the following? ■ 1. "The medication will be administered while I am in a side-lying position." ■ 2. "The anesthetic may cause a severe headache which is treatable." ■ 3. "My blood pressure may increase if I lie down too soon after the injection." ■ 4. "I can expect immediate anesthesia that can be reversed very easily."

■ 1. "The medication will be administered while I am in a side-lying position."

A 38-year-old client at about 14 weeks' gestation is admitted to the hospital with a diagnosis of complete hydatidiform mole. Soon after admission, the nurse would assess the client for signs and symptoms of which of the following? ■ 1. Pregnancy-induced hypertension. ■ 2. Gestational diabetes. ■ 3. Hypothyroidism. ■ 4. Polycythemia.

■ 1. Pregnancy-induced hypertension.

After conducting a class for female adolescents about human reproduction, which of the following statements indicates that the school nurse's teaching has been effective? ■ 1. "Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes, resulting in pregnancy." ■ 2. "I won't become pregnant if I abstain from intercourse during the last 14 days of my menstrual cycle." ■ 3. "Sperm from a healthy male usually remain viable in the female reproductive tract for 96 hours." ■ 4. "After an ovum is fertilized by a sperm, the ovum then contains 21 pairs of chromosomes."

■ 1. "Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes, resulting in pregnancy."

primiparous client at 10 weeks' gestation questions the nurse about the need for an ultrasound. She states "I don't have health insurance and I can't afford it. I feel fi ne, so why should I have the test?" The nurse should incorporate which statements as the underlying reason for performing the ultrasound now? Select all that apply. ■ 1. "We must view the gross anatomy of the fetus." ■ 2. "We need to determine gestational age." ■ 3. "We want to view the heart beating to determine that the fetus is viable." ■ 4. "We must determine fetal position." ■ 5. "We must determine that there is a suffi cient nutrient supply for the fetus."

■ 1. "We must view the gross anatomy of the fetus." ■ 2. "We need to determine gestational age."

When providing care to the client who has undergone a dilatation and curettage (D&C) after a spontaneous abortion, the nurse administers hydroxyzine (Vistaril) as ordered. Which of the following is an expected outcome? ■ 1. Absence of nausea. ■ 2. Minimized pain. ■ 3. Decreased uterine cramping. ■ 4. Improved uterine contractility.

■ 1. Absence of nausea.

A primigravid client at 39 weeks' gestation is admitted to the hospital for induction of labor. The physician has ordered prostaglandin E2 gel (Dinoprostone) for the client. Before administering prostaglandin E2 gel to the client, which of the following should the nurse do fi rst? ■ 1. Assess the frequency of uterine contractions. ■ 2. Place the client in a side-lying position. ■ 3. Determine whether the membranes have ruptured. ■ 4. Prepare the client for an amniotomy.

■ 1. Assess the frequency of uterine contractions.

A primigravid client at 39 weeks' gestation is admitted to the hospital in active labor. On admission, the client's cervix is 6 cm dilated. After 2 hours of active labor, the client's cervix is still dilated at 6 cm with 100% effacement at 21 station. Contractions are 3 to 5 minutes apart, lasting 45 seconds, and of moderate intensity. The nurse determines that the client is most likely experiencing which of the following? ■ 1. Cephalopelvic disproportion. ■ 2. Prolonged latent phase. ■ 3. Prolonged transitional phase. ■ 4. Hypotonic contraction pattern.

■ 1. Cephalopelvic disproportion.

A primigravid client at 38 weeks' gestation is admitted to the labor suite in active labor. The client's physical assessment reveals a chlamydial infection. The nurse explains that if the infection is left untreated, the neonate may develop which of the following? ■ 1. Conjunctivitis. ■ 2. Heart disease. ■ 3. Harlequin sign. ■ 4. Brain damage.

■ 1. Conjunctivitis.

A multigravid client at 36 weeks' gestation has been diagnosed with condylomata acuminata. Which of the following should the nurse include when teaching the client about the disorder and current therapies? ■ 1. Cryotherapy may be used to remove the warts. ■ 2. Podophyllin solution may be used to decrease the size of the warts. ■ 3. A 25% trichloroacetic acid solution can eradicate the disorder. ■ 4. Condylomata acuminata has been associated with ovarian cancer.

■ 1. Cryotherapy may be used to remove the warts.

For the client who is receiving intravenous magnesium sulfate for severe preeclampsia, which of the following assessment fi ndings would alert the nurse to suspect hypermagnesemia? ■ 1. Decreased deep tendon refl exes. ■ 2. Cool skin temperature. ■ 3. Rapid pulse rate. ■ 4. Tingling in the toes.

■ 1. Decreased deep tendon refl exes.

After teaching a diabetic primigravida about symptoms of hyperglycemia and hypoglycemia, the nurse determines that the client understands the instruction when she says that hyperglycemia may be manifested by which of the following? ■ 1. Dehydration. ■ 2. Pallor. ■ 3. Sweating. ■ 4. Nervousness.

■ 1. Dehydration.

On arrival at the emergency department, a client tells the nurse that she suspects that she may be pregnant but has been having a small amount of bleeding and has severe pain in the lower abdomen. The client's blood pressure is 70/50 mm Hg and her pulse rate is 120 bpm. The nurse notifi es the physician immediately because of the possibility of: ■ 1. Ectopic pregnancy. ■ 2. Abruptio placentae. ■ 3. Gestational trophoblastic disease. ■ 4. Complete abortion.

■ 1. Ectopic pregnancy.

When developing the plan of care for a multiparous client in active labor who receives an epidural anesthetic, which of the following would the nurse anticipate that the physician will order if the client develops moderate hypotension? ■ 1. Ephedrine sulfate. ■ 2. Epinephrine (Adrenalin Chloride). ■ 3. Methylergonovine (Methergine). ■ 4. Atropine sulfate.

■ 1. Ephedrine sulfate.

The nurse in the labor and delivery area receives a telephone call from the emergency room announcing that a multigravid client in active labor is being transferred to the labor area. The client has had no prenatal care. When the client arrives by stretcher, she says, "I think the baby's coming ... Help!" The fetal skull is crowning. The nurse should obtain which of the following information fi rst? ■ 1. Estimated date of delivery. ■ 2. Amniotic fl uid status. ■ 3. Gravida and parity. ■ 4. Prenatal history.

■ 1. Estimated date of delivery.

Which of the following anticoagulants would the nurse expect to administer when caring for a primigravid client at 12 weeks' gestation who has class II cardiac disease due to mitral valve stenosis? ■ 1. Heparin. ■ 2. Warfarin (Coumadin). ■ 3. Enoxaparin (Lovenox). ■ 4. Ardeparin (Normifl o).

■ 1. Heparin.

A primigravid client has completed her fi rst prenatal visit and blood work. Her laboratory test for the hepatitis B surface antigen (HBsAg) is positive. The nurse can advise the client that the plan of care for this newborn will include? Select all that apply. ■ 1. Hepatitis B immune globulin at birth. ■ 2. Series of three hepatitis B vaccinations per recommended schedule. ■ 3. Hepatitis B screening when born. ■ 4. Isolation of infant during hospitalization. ■ 5. Universal precautions for mother and infant. ■ 6. Contraindication for breast-feeding because the mother is HBsAg positive.

■ 1. Hepatitis B immune globulin at birth. ■ 2. Series of three hepatitis B vaccinations per recommended schedule. ■ 5. Universal precautions for mother and infant.

A multigravid client is in active labor with twins at 38 weeks' gestation. The nurse should monitor the client closely for symptoms of which of the following? ■ 1. Pregnancy-induced hypertension. ■ 2. Urinary tract infection. ■ 3. Chorioamnionitis. ■ 4. Precipitous delivery.

■ 1. Pregnancy-induced hypertension.

A multigravid client at 34 weeks' gestation with premature rupture of the membranes tests positive for group B streptococcus. The client is having contractions every 4 to 6 minutes. Her vital signs are as follows: blood pressure, 120/80 mm Hg; temperature, 100° F (37.8° C); pulse, 100 bpm; respirations, 18 breaths/minute. Which of the following would the nurse expect the physician to order? ■ 1. Intravenous penicillin. ■ 2. Intravenous gentamicin sulfate (Garamycin). ■ 3. Intramuscular betamethasone (Celestone). ■ 4. Intramuscular cefaclor (Ceclor).

■ 1. Intravenous penicillin.

The nurse is assessing fetal position for a 32-year-old client in her eighth month of pregnancy. As shown below, the fetal position can be described as which of the following? ■ 1. Left occipital transverse. ■ 2. Left occipital anterior. ■ 3. Right occipital transverse. ■ 4. Right occipital anterior.

■ 1. Left occipital transverse.

The health care provider has performed an amniotomy on a laboring client. Which of the following details must be included in the documentation of this procedure? Select all that apply. ■ 1. Time of rupture. ■ 2. Color and clarity of fl uid. ■ 3. Fetal heart rate (FHR) and pattern before and after the procedure. ■ 4. Size of amnio-hook used during the procedure. ■ 5. Odor and amount of fl uid.

everything but 4

A nurse is eating lunch at a restaurant when she sees a pregnant woman showing signs of airway obstruction. When the nurse asks the woman if she needs help, the woman nods her head yes. Indicate the area where the nurse's fi st should be placed to effectively administer thrusts to clear the foreign body from the airway.

middle of sternum

A client has received epidural anesthesia to control pain during a cesarean section. Place an X over the highest point on the body locating the level of anesthesia expected for a cesarean birth.

top of belly

A client asks the nurse why taking folic acid is so important before and during pregnancy. The nurse should instruct the client that: ■ 1. "Folic acid is important in preventing neural tube defects in newborns and preventing anemia in mothers." ■ 2. "Eating foods with moderate amounts of folic acid helps regulate blood glucose levels." ■ 3. "Folic acid consumption helps with the absorption of iron during pregnancy." ■ 4. "Folic acid is needed to promote blood clotting and collagen formation in the newborn."

■ 1. "Folic acid is important in preventing neural tube defects in newborns and preventing anemia in mothers."

An antenatal client is discussing her anemia with the nurse in the prenatal clinic. After a discussion about sources of iron to be incorporated into her daily meals, the nurse knows the client needs further instruction when she responds with which of the following? ■ 1. "I can meet two goals when I drink milk, lots of iron and meeting my calcium needs at the same time." ■ 2. "Drinking coffee, tea, and sodas decrease the absorption of iron." ■ 3. "I can increase the absorption of iron by drinking orange juice when I eat." ■ 4. Cream of wheat and molasses are excellent sources of iron."

■ 1. "I can meet two goals when I drink milk, lots of iron and meeting my calcium needs at the same time."

A multigravid client at 34 weeks' gestation is being treated with indomethacin (Indocin) to halt preterm labor. If the client delivers a preterm infant, the nurse should notify the nursery personnel about this therapy because of the possibility for which of the following? ■ 1. Pulmonary hypertension. ■ 2. Respiratory distress syndrome (RDS). ■ 3. Hyperbilirubinemia. ■ 4. Cardiomyopathy.

■ 1. Pulmonary hypertension.

A primigravid client in active labor has had no anesthesia. The client's cervix is 7 cm dilated, and she is starting to feel considerable discomfort during contractions. The nurse should instruct the client to change from slow chest breathing to which of the following? ■ 1. Rapid, shallow chest breathing. ■ 2. Deep chest breathing. ■ 3. Rapid pant-blow breathing. ■ 4. Slow abdominal breathing.

■ 1. Rapid, shallow chest breathing.

Which of the following would the nurse include in the teaching plan for a 16-year-old primigravid client in early labor concerning active relaxation techniques to help her cope with pain? ■ 1. Relaxing uninvolved body muscles during uterine contractions. ■ 2. Practicing being in a deep, meditative, sleeplike state. ■ 3. Focusing on an object in the room during the contractions. ■ 4. Breathing rapidly and deeply between contractions.

■ 1. Relaxing uninvolved body muscles during uterine contractions.

Soon after admission of a primigravid client at 38 weeks' gestation with severe preeclampsia, the physician orders a continuous intravenous infusion of 5% dextrose in Ringer's solution and 4 g of magnesium sulfate. While the medication is being administered, which of the following assessment fi ndings should the nurse report immediately? ■ 1. Respiratory rate of 12 breaths/minute. ■ 2. Patellar refl ex of +2. ■ 3. Blood pressure of 160/88 mm Hg. ■ 4. Urinary output exceeding intake.

■ 1. Respiratory rate of 12 breaths/minute.

Which of the following instructions about activities during menstruation would the nurse include when counseling an adolescent who has just begun to menstruate? ■ 1. Take a mild analgesic if needed for menstrual pain. ■ 2. Avoid cold foods if menstrual pain persists. ■ 3. Stop exercise while menstruating. ■ 4. Avoid sexual intercourse while menstruating.

■ 1. Take a mild analgesic if needed for menstrual pain.

The nurse is obtaining information to support the need for improved prenatal care services in the community. Which of the following information is most important to include? ■ 1. The maternal mortality rate. ■ 2. The infant mortality rate. ■ 3. The perinatal mortality rate. ■ 4. The neonatal mortality rate.

■ 1. The maternal mortality rate.

With plans to breast-feed her neonate, a pregnant client with insulin-dependent diabetes asks the nurse about insulin needs during the postpartum period. Which of the following statements about postpartal insulin requirements for breastfeeding mothers should the nurse include in the explanation? ■ 1. They fall signifi cantly in the immediate postpartum period. ■ 2. They remain the same as during the labor process. ■ 3. They usually increase in the immediate postpartum period. ■ 4. They need constant adjustment during the fi rst 24 hours.

■ 1. They fall signifi cantly in the immediate postpartum period.

The physician orders an amnioinfusion for a primigravid client at term who is diagnosed with oligohydramnios. Which of the following should the nurse include in the client's teaching plan about the purpose of this procedure? ■ 1. To decrease the frequency and severity of variable decelerations. ■ 2. To minimize the possibility of fetal metabolic alkalosis. ■ 3. To increase the fetal heart rate accelerations during a contraction. ■ 4. To raise the amniotic fl uid index to more than 15 cm.

■ 1. To decrease the frequency and severity of variable decelerations.

Before placing the fetal monitoring device on a primigravid client's fundus, the nurse performs Leopold's maneuvers. When performing the third maneuver, the nurse explains that this maneuver is done for which of the following reasons? ■ 1. To determine whether the fetal presenting part is engaged. ■ 2. To locate the fetal cephalic prominence. ■ 3. To distinguish between a breech and a cephalic presentation. ■ 4. To locate the position of the fetal arms and legs.

■ 1. To determine whether the fetal presenting part is engaged.

A 34-year-old primigravid client at 39 weeks' gestation admitted to the hospital in active labor has type B Rh-negative blood. The nurse should instruct the client that if the neonate is Rh positive, the client will receive an Rh immune globulin (RHIG) injection for which of the following reasons? ■ 1. To prevent Rh-positive sensitization with the next pregnancy. ■ 2. To provide active antibody protection for this pregnancy. ■ 3. To decrease the amount of Rh-negative sensitization for the next pregnancy. ■ 4. To destroy fetal Rh-positive cells during the next pregnancy.

■ 1. To prevent Rh-positive sensitization with the next pregnancy.

A client is experiencing pain during the fi rst stage of labor. What should the nurse instruct the client to do to manage her pain? Select all that apply. ■ 1. Walk in the hospital room. ■ 2. Use slow chest breathing. ■ 3. Request pain medication on a regular basis. ■ 4. Lightly massage her abdomen. ■ 5. Sip ice water.

■ 1. Walk in the hospital room. ■ 2. Use slow chest breathing. ■ 4. Lightly massage her abdomen.

A 40-year-old client at 8 weeks' gestation has a 3-year-old child with Down syndrome. The nurse is discussing amniocentesis and chorionic villus sampling as genetic screening methods for the expected baby. The nurse is confi dent that the teaching has been understood when the client states which of the following? ■ 1. "Each test identifi es a different part of the infant's genetic makeup." ■ 2. "Chorionic villus sampling can be performed earlier in pregnancy." ■ 3. "The test results take the same length of time to be completed." ■ 4. "Amniocentesis is a more dangerous procedure for the fetus."

■ 2. "Chorionic villus sampling can be performed earlier in pregnancy."

The nurse is explaining the medication options available for pain relief during labor. The nurse realizes the client needs further teaching when the client states which of the following? ■ 1. "Nubain (nalbuphine) and Phenergan (promethazine) will give relief from pain and nausea during early labor." ■ 2. "I can have an epidural as soon as I start contracting." ■ 3. "If I have a cesarean, I can have an epidural." ■ 4. "If I have an emergency cesarean, I may be put to sleep for the delivery."

■ 2. "I can have an epidural as soon as I start contracting."

A primigravid client at 32 weeks' gestation is enrolled in a breast-feeding class. Which of the following statements indicate that the client understands the breast-feeding education? Select all that apply. ■ 1. "My milk supply will be adequate since I have increased a whole bra size during pregnancy." ■ 2. "I can hold my baby several different ways during feedings." ■ 3. "If my infant latches on properly, I won't develop mastitis." ■ 4. "If I breast-feed, my uterus will return to prepregnancy size more quickly." ■ 5. "Breast milk can be expressed and stored at room temperature since it is natural." ■ 6. "I need to feed my baby when I see feeding cues and not wait until she is crying."

■ 2. "I can hold my baby several different ways during feedings." ■ 4. "If I breast-feed, my uterus will return to prepregnancy size more quickly." ■ 6. "I need to feed my baby when I see feeding cues and not wait until she is crying."

The nurse is teaching a new prenatal client about her iron defi ciency anemia during pregnancy. Which statement indicates that the client needs further instruction about her anemia? ■ 1. "I will need to take iron supplements now." ■ 2. "I may have anemia because my family is of Asian descent." ■ 3. "I am considered anemic if my hemoglobin is below 11 g/dL." ■ 4. "The workload on my heart is increased when there is not enough oxygen in my system."

■ 2. "I may have anemia because my family is of Asian descent."

After instructing a multigravid client at 10 weeks' gestation diagnosed with chronic hypertension about the need for frequent prenatal visits, the nurse determines that the instructions have been successful when the client states which of the following? ■ 1. "I may develop hyperthyroidism because of my high blood pressure." ■ 2. "I need close monitoring because I may have a small-for-gestational-age infant." ■ 3. "It's possible that I will have excess amniotic fl uid and may need a cesarean section." ■ 4. "I may develop placenta accreta, so I need to keep my clinic appointments."

■ 2. "I need close monitoring because I may have a small-for-gestational-age infant."

One week after her prenatal visit, a primigravid client at 38 weeks' gestation diagnosed with mild pre-eclampsia calls the clinic nurse complaining of a continuous headache for the past 2 days accompanied by nausea. The client does not want to take aspirin. The nurse should tell the client: ■ 1. "Take two acetaminophen tablets. They aren't as likely to upset your stomach." ■ 2. "I think the doctor should see you today. Can you come to the clinic this morning?" ■ 3. "You need to lie down and rest. Have you tried placing a cool compress over your head?" ■ 4. "I'll ask the doctor to call in a prescription for aspirin with codeine. What's your pharmacy's number?"

■ 2. "I think the doctor should see you today. Can you come to the clinic this morning?"

A woman who is Rh-negative has delivered an Rh-positive infant. The nurse explains to the client that she will recieve RhoGAM. The nurse determines that the client understands the purpose of RhoGAM when she states: ■ 1. "RhoGAM will protect my next baby if it is Rh-negative." ■ 2. "RhoGAM will prevent antibody formation in my blood." ■ 3. "RhoGAM will be given to prevent German measles." ■ 4. "RhoGAM will be used to prevent bleeding in my newborn."

■ 2. "RhoGAM will prevent antibody formation in my blood."

After suction and evacuation of a complete hydatidiform mole, the 28-year-old multigravid client asks the nurse when she can become pregnant again. The nurse would advise the client not to become pregnant again for at least which of the following time spans? ■ 1. 6 months. ■ 2. 12 months. ■ 3. 18 months. ■ 4. 24 months.

■ 2. 12 months.

A multigravid client in active labor has been diagnosed with class II heart disease and has had a prosthetic valve replacement. When developing the plan of care for this client, the nurse should anticipate that the physician most likely will order which of the following medications? ■ 1. Anticoagulants. ■ 2. Antibiotics. ■ 3. Diuretics. ■ 4. Folic acid supplements.

■ 2. Antibiotics.

The nurse is caring for a multigravid client at 34 weeks' gestation diagnosed with preterm labor. The client has delivered two stillborn infants at 30 weeks' gestation. The client is scheduled for a sonogram before an amniocentesis. Which of the following would be a priority nursing diagnosis for the client? ■ 1. Acute pain related to abnormal uterine contractions. ■ 2. Anxiety related to diagnostic tests for fetal well-being. ■ 3. Ineffective coping related to hospitalization. ■ 4. Defi cient knowledge related to consequences of preterm birth.

■ 2. Anxiety related to diagnostic tests for fetal well-being.

A newly delivered client is asking to go to the bathroom 45 minutes after delivery. She had an epidural for labor & delivery, has an IV infusing, and every 15 minutes assessments are in progress. To provide the safest care for this client the nurse should: ■ 1. Ask her to remain in bed until the 15-minute assessments are complete. ■ 2. Assess client's ability to stand and bear weight before going to the bathroom. ■ 3. Encourage the client to sit at the side of the bed before ambulating to the bathroom. ■ 4. Ask the client to ambulate the fi rst time with a staff member at her side.

■ 2. Assess client's ability to stand and bear weight before going to the bathroom.

The physician plans to perform an amniotomy on a multiparous client admitted to the labor area at 41 weeks' gestation for labor induction. After the amniotomy, the nurse should fi rst: ■ 1. Monitor the client's contraction pattern. ■ 2. Assess the fetal heart rate (FHR) for 1 full minute. ■ 3. Assess the client's temperature and pulse. ■ 4. Document the color of the amniotic fl uid.

■ 2. Assess the fetal heart rate (FHR) for 1 full minute.

When measuring the fundal height of a primigravid client at 20 weeks' gestation, the nurse will locate the fundal height at which of the following points? ■ 1. Halfway between the client's symphysis pubis and umbilicus. ■ 2. At about the level of the client's umbilicus. ■ 3. Between the client's umbilicus and xiphoid process. ■ 4. Near the client's xiphoid process and compressing the diaphragm.

■ 2. At about the level of the client's umbilicus.

A 24-year-old woman is being assessed for a malformation of the uterus. The fi gure below indicates which of the following uterine malformations? ■ 1. Septate uterus. ■ 2. Bicornate uterus. ■ 3. Double uterus. ■ 4. Uterus didelphys.

■ 2. Bicornate uterus.

After surgery to remove a ruptured fallopian tube, a multigravid client receives discharge instructions about potential complications to report to her physician. Which of the following, if stated by the client as a complication, indicates a need for additional teaching? ■ 1. Pain. ■ 2. Headache. ■ 3. Fever. ■ 4. Bleeding.

■ 2. Headache.

A primigravid client in early labor tells the nurse that she was exposed to rubella at about 14 weeks' gestation. After delivery, the nurse should assess the neonate for which of the following? ■ 1. Hydrocephaly. ■ 2. Cardiac disorders. ■ 3. Renal disorders. ■ 4. Bulging fontanels.

■ 2. Cardiac disorders. -thrombocytopenia, cataracts, cardiac disorders, deafness, microcephaly and motor/cognitive impairment with RUBELLA VIRUS

When preparing a multigravid client who has undergone evacuation of a hydatidiform mole for discharge, the nurse explains the need for follow-up care. The nurse determines that the client understands the instruction when she says that she is at risk for developing which of the following? ■ 1. Ectopic pregnancy. ■ 2. Choriocarcinoma. ■ 3. Multifetal pregnancies. ■ 4. Infertility.

■ 2. Choriocarcinoma.

A client with a past medical history of ventricular septal defect repaired in infancy is seen at the prenatal clinic. She is complaining of dyspnea with exertion and being very tired. Her vital signs are 98, 80, 20, BP 116/72. She has + 2 pedal edema and clear breath sounds. As the nurse plans this client's care, which of the following is her cardiac classification according to the New York Heart Association Cardiac Disease classification? ■ 1. Class I. ■ 2. Class II. ■ 3. Class III. ■ 4. Class IV.

■ 2. Class II.

When developing the collaborative plan of care with the health care provider for a multigravid client at 10 weeks' gestation with a history of cardiac disease who was being treated with digitalis therapy before this pregnancy, the nurse should instruct the client about which of the following regarding the client's drug therapy regimen? ■ 1. Need for an increased dosage. ■ 2. Continuation of the same dosage. ■ 3. Switching to a different medication. ■ 4. Addition of a diuretic to the regimen.

■ 2. Continuation of the same dosage.

The labor and delivery room nurse has received a telephone call from the emergency room indicating that a multigravid client in early labor and diagnosed with probable placenta previa will be arriving soon. In preparation for the client's arrival, the nurse anticipates that the physician will order which of the following? ■ 1. Whole blood replacement. ■ 2. Continuous blood pressure monitoring. ■ 3. Internal fetal heart rate monitoring. ■ 4. An immediate cesarean delivery.

■ 2. Continuous blood pressure monitoring. -hypovolemic shock is a complication of placental previa

A primigravida is admitted to the labor area with ruptured membranes and contractions occurring every 2 to 3 minutes, lasting 45 seconds. After 3 hours of labor, the client's contractions are now every 7 to 10 minutes, lasting 30 seconds. The nurse administers oxytocin (Pitocin) as ordered. The expected outcome of this drug is: ■ 1. The cervix will begin to dilate 2 centimeters per hour. ■ 2. Contractions will occur every 2 to 3 minutes, lasting 40 to 60 seconds, moderate intensity, resting tone between contractions. ■ 3. The cervix will change from fi rm to soft, efface to 40% to 50%, and move from a posterior to anterior position. ■ 4. Contractions will be every 2 minutes, lasting 60 to 90 seconds, with intrauterine pressure of 70 mm Hg.

■ 2. Contractions will occur every 2 to 3 minutes, lasting 40 to 60 seconds, moderate intensity, resting tone between contractions.

A multigravid client diagnosed with chronic hypertension is now in preterm labor at 34 weeks' gestation. The physician has ordered magnesium sulfate at 3 g/hour. Which assessment fi nding indicates that the intended therapeutic effect has occurred? ■ 1. Decrease in fetal heart rate accelerations. ■ 2. Decrease in the frequency and number of contractions. ■ 3. Decrease in maternal blood pressure rate. ■ 4. Decrease in maternal respiratory rate.

■ 2. Decrease in the frequency and number of contractions.

When performing Leopold's maneuvers on a primigravid client at 22 weeks' gestation, the nurse performs the fi rst maneuver to do which of the following? ■ 1. Locate the fetal back and spine. ■ 2. Determine what is in the fundus. ■ 3. Determine whether the fetal head is at the pelvic inlet. ■ 4. Identify the degree of fetal descent and fl exion.

■ 2. Determine what is in the fundus.

When performing Leopold's maneuvers, which of the following would the nurse ask the client to do to ensure optimal comfort and accuracy? ■ 1. Breathe deeply for 1 minute. ■ 2. Empty her bladder. ■ 3. Drink a full glass of water. ■ 4. Lie on her left side.

■ 2. Empty her bladder.

Which of the following would be included in the teaching plan about pregnancy-related breast changes for a primigravid client? ■ 1. Growth of the milk ducts is greatest during the fi rst 8 weeks of gestation. ■ 2. Enlargement of the breasts indicates adequate levels of progesterone. ■ 3. Colostrum is usually secreted by about the 16th week of gestation. ■ 4. Darkening of the areola occurs during the last month of pregnancy.

■ 2. Enlargement of the breasts indicates adequate levels of progesterone.

A multigravid client is admitted at 16 weeks' gestation with a diagnosis of hyperemesis gravidarum. The nurse should explain to the client that hyperemesis gravidarum is thought to be related to high levels of which of the following hormones? ■ 1. Progesterone. ■ 2. Estrogen. ■ 3. Somatotropin. ■ 4. Aldosterone.

■ 2. Estrogen.

The physician orders intermittent fetal heart rate monitoring for a 20-year-old obese primigravid client at 40 weeks' gestation who is admitted to the birthing center in the fi rst stage of labor. The nurse should monitor the client's fetal heart rate pattern at which of the following intervals? ■ 1. Every 15 minutes during the latent phase. ■ 2. Every 30 minutes during the active phase. ■ 3. Every 60 minutes during the initial phase. ■ 4. Every 2 hours during the transition phase.

■ 2. Every 30 minutes during the active phase.

After giving instruction about the cause of the vaginal bleeding to a multigravid client at 36 weeks' gestation diagnosed with placenta previa, the nurse determines that the teaching has been effective when the client says that the bleeding results from which of the following? ■ 1. Diminished clotting factors. ■ 2. Exposure of maternal blood sinuses. ■ 3. Increased platelet levels. ■ 4. A large-for-gestational-age fetus.

■ 2. Exposure of maternal blood sinuses.

A couple is visiting the clinic because they have been unable to conceive a baby after 3 years of frequent coitus. After discussing the various causes of male infertility, the nurse determines that the male partner needs further instruction when he states which of the following as a cause? ■ 1. Seminal fl uid with an alkaline pH. ■ 2. Frequent exposure to heat sources. ■ 3. Abnormal hormonal stimulation. ■ 4. Immunologic factors.

■ 2. Frequent exposure to heat sources.

The topic of physiologic changes that occur during pregnancy is to be included in a parenting class for primigravid clients who are in their fi rst half of pregnancy. Which of the following would be important for the nurse to include in the teaching plan? ■ 1. Decreased plasma volume. ■ 2. Increased risk for urinary tract infections. ■ 3. Increased peripheral vascular resistance. ■ 4. Increased hemoglobin levels.

■ 2. Increased risk for urinary tract infections.

When preparing a 20-year-old client who reports missing one menstrual period and suspects that she is pregnant for a radioimmunoassay pregnancy test, the nurse should tell the client which of the following about this test? ■ 1. It has a high degree of accuracy within 1 week after ovulation. ■ 2. It is identical in nature to an over-the-counter home pregnancy test. ■ 3. A positive result is considered a presumptive sign of pregnancy. ■ 4. A urine sample is needed to obtain quicker results.

■ 2. It is identical in nature to an over-the-counter home pregnancy test.

The nurse is reviewing results for clients who are having antenatal testing. The assessment data from which client warrants prompt notifi cation of the health care provider and a further plan of care? ■ 1. Primigravida who reports fetal movement 6 times in 2 hours. ■ 2. Multigravida who had a positive oxytocin challenge test. ■ 3. Primigravida whose infant has a biophysical profi le of 9. ■ 4. Multigravida whose infant has a reactive nonstress test.

■ 2. Multigravida who had a positive oxytocin challenge test.

The nurse is caring for a primigravid client in active labor at 42 weeks' gestation. The client has had no analgesia or anesthesia and has been pushing for 2 hours. The nurse can be most helpful to this client by: ■ 1. Changing her pushing position every 15 minutes. ■ 2. Notifying the health care provider of her current status. ■ 3. Continuing with current pushing technique. ■ 4. Assessing the client's current pain and fetal status.

■ 2. Notifying the health care provider of her current status.

The nurse is caring for a multigravid client who speaks little English. As the nurse enters the client's room, the nurse observes the client squatting on the bed and the fetal head crowning. After calling for assistance and helping the client lie down, which of the following actions should the nurse do next? ■ 1. Tell the client to push between contractions. ■ 2. Provide gentle support to the fetal head. ■ 3. Apply gentle upward traction on the neonate's anterior shoulder. ■ 4. Massage the perineum to stretch the perineal tissues.

■ 2. Provide gentle support to the fetal head.

A multigravid client in labor at 38 weeks' gestation has been diagnosed with Rh sensitization and probable fetal hydrops and anemia. When the nurse observes the fetal heart rate pattern on the monitor, which of the following patterns is most likely? ■ 1. Early deceleration pattern. ■ 2. Sinusoidal pattern. ■ 3. Variable deceleration pattern. ■ 4. Late deceleration pattern.

■ 2. Sinusoidal pattern.

A 23-year-old nulliparous client visiting the clinic for a routine examination tells the nurse that she desires to use the basal body temperature method for family planning. The nurse should instruct the client to do which of the following? ■ 1. Check the cervical mucus to see if it is thick and sparse. ■ 2. Take her temperature at the same time every morning before getting out of bed. ■ 3. Document ovulation when her temperature decreases at least 1° F. ■ 4. Avoid coitus for 10 days after a slight rise in temperature.

■ 2. Take her temperature at the same time every morning before getting out of bed.

A primigravida at 8 weeks' gestation tells the nurse that she wants an amniocentesis because there is a history of Hemophilia A in her family. The nurse informs the client that she will need to wait until she is 15 weeks gestation for the amniocentesis. Which of the following provides the most appropriate rationale for the nurse's statement regarding amniocentesis at 15 weeks' gestation? ■ 1. Fetal development needs to be complete before testing. ■ 2. The volume of amniotic fl uid needed for testing will be available by 15 weeks. ■ 3. Cells indicating Hemophilia A are not produced until 15 weeks' gestation. ■ 4. Fetal anomalies are associated with amniocentesis prior to 15 weeks' gestation.

■ 2. The volume of amniotic fl uid needed for testing will be available by 15 weeks.

A 30-year-old multigravid client at 8 weeks' gestation has a history of insulin-dependent diabetes since age 20. When explaining about the importance of blood glucose control during pregnancy, the nurse should tell the client that which of the following will occur regarding the client's insulin needs during the fi rst trimester? ■ 1. They will increase. ■ 2. They will decrease. ■ 3. They will remain constant. ■ 4. They will be unpredictable.

■ 2. They will decrease.

The nurse explains the complications of pregnancy that occur with diabetes to a primigravid client at 10 weeks' gestation who has a 5-year history of insulin-dependent diabetes. Which of the following, if stated by the client as a complication, indicates the need for additional teaching? ■ 1. Candida albicans infection. ■ 2. Twin-to-twin transfer. ■ 3. Polyhydramnios. ■ 4. Preeclampsia.

■ 2. Twin-to-twin transfer.

A 28-year-old multigravida at 37 weeks' gestation arrives at the emergency department with a blood pressure of 160/104 mm Hg and +3 refl exes without clonus. The client is diagnosed with severe preeclampsia. The nurse collaborates with the health care provider to develop a plan of care that care will fi rst include: ■ 1. Administration of glucocorticoids (Betamethasone). ■ 2. Vaginal or cesarean delivery of the fetus. ■ 3. Prevention of seizures with phenytoin (Dilantin). ■ 4. Reduction of fl uid retention with thiazides.

■ 2. Vaginal or cesarean delivery of the fetus.

After instruction of a primigravid client at 8 weeks' gestation diagnosed with class I heart disease about self-care during pregnancy, which of the following client statements would indicate the need for additional teaching? ■ 1. "I should avoid being near people who have a cold." ■ 2. "I may be given antibiotics during my pregnancy." ■ 3. "I should reduce my intake of protein in my diet." ■ 4. "I should limit my salt intake at meals."

■ 3. "I should reduce my intake of protein in my diet."

An antenatal G 2, T 1, P 0, Ab 0, L 1 client is discussing her postpartum plans for birth control with her health care provider. In analyzing the available choices, which of the following factors has the greatest impact on her birth control options? ■ 1. Satisfaction with prior methods. ■ 2. Preference of sexual partner. ■ 3. Breast- or bottle-feeding plan. ■ 4. History of clotting disease.

■ 3. Breast- or bottle-feeding plan.

18. A client is scheduled to have in vitro fertilization (IVF) as an infertility treatment. Which of the following client statements about IVF indicates that the client understands this procedure? ■ 1. "IVF requires supplemental estrogen to enhance the implantation process." ■ 2. "The pregnancy rate with IVF is higher than that with gamete intrafallopian transfer." ■ 3. "IVF involves bypassing the blocked or absent fallopian tubes." ■ 4. "Both ova and sperm are instilled into the open end of a fallopian tube."

■ 3. "IVF involves bypassing the blocked or absent fallopian tubes."

A primagravid client at 16 weeks' gestation has had an amniocentesis and has received teaching concerning signs and symptoms to report. Which statement indicates that the client needs further teaching? ■ 1. "I need to call if I start to leak fl uid from my vagina." ■ 2. "If I start bleeding, I will need to call back." ■ 3. "If my baby does not move, I need to call my health care provider." ■ 4. "If I start running a fever, I should let the offi ce know."

■ 3. "If my baby does not move, I need to call my health care provider."

After instructing a multigravid client diagnosed with mild preeclampsia how to keep a record of fetal movement patterns at home, the nurse determines that the teaching has been effective when the client says that she will count the number of times the baby moves during which of the following time spans? ■ 1. 30-minute period three times a day. ■ 2. 45-minute period after lunch each day. ■ 3. 1-hour period each day. ■ 4. 12-hour period each week.

■ 3. 1-hour period each day.

The nurse is planning care for a group of pregnant clients. Which of the following clients should be referred to a health care provider immediately? ■ 1. A woman who is at 10 weeks' gestation, is having nausea and vomiting, and has +1 ketones in her urine. ■ 2. A woman who is at 37 weeks' gestation and has insulin-dependent diabetes experiencing 2-3 hyperglycemic episodes weekly. ■ 3. A woman at 32 weeks' gestation and is preeclamptic with +3 proteinuria. ■ 4. A primigravida at 15 weeks' gestation who reports she is not feeling fetal movement.

■ 3. A woman at 32 weeks' gestation and is preeclamptic with +3 proteinuria.

The physician determines that the fetus of a multiparous client in active labor is in distress, necessitating a cesarean delivery with general anesthesia. Before the cesarean delivery, the anesthesiologist orders cimetidine (Tagamet) 300 mg PO. After administering the drug, the nurse should assess the client for reduction in which of the following? ■ 1. Incidence of bronchospasm. ■ 2. Oral and respiratory secretions. ■ 3. Acid level of the stomach contents. ■ 4. Incidence of postoperative gastric ulcer.

■ 3. Acid level of the stomach contents.

The nurse is managing care of a primigrada at full term who is in active labor. What should be included in developing the plan of care for this client? ■ 1. Oxygen saturation monitoring every half hour. ■ 2. Supine positioning on back, if it is comfortable. ■ 3. Anesthesia/pain level assessment every 30 minutes. ■ 4. Vaginal bleeding, ROM assessment every shift.

■ 3. Anesthesia/pain level assessment every 30 minutes.

A 19-year-old nulligravid client visiting the clinic for a routine examination asks the nurse about cervical mucus changes that occur during the menstrual cycle. Which of the following statements would the nurse expect to include in the client's teaching plan? ■ 1. About midway through the menstrual cycle, cervical mucus is thick and sticky. ■ 2. During ovulation, the cervix remains dry without any mucus production. ■ 3. As ovulation approaches, cervical mucus is abundant and clear. ■ 4. Cervical mucus disappears immediately after ovulation, resuming with menses.

■ 3. As ovulation approaches, cervical mucus is abundant and clear.

While the nurse is caring for a multiparous client in active labor at 36 weeks' gestation, the client tells the nurse, "I think my water just broke." Which of the following should the nurse do fi rst? ■ 1. Turn the client to the right side. ■ 2. Assess the color, amount, and odor of the fl uid. ■ 3. Assess the fetal heart rate pattern. ■ 4. Check the client's cervical dilation.

■ 3. Assess the fetal heart rate pattern.

The nurse has obtained a urine specimen from a G 6, P 5 client admitted to the labor unit. The woman asks to go to the bathroom and reports that she feels she has to move her bowels. Which actions would be appropriate? Select all that apply. ■ 1. Assisting her to the bathroom. ■ 2. Applying an external fetal monitor to obtain fetal heart rate. ■ 3. Assessing her stage of labor. ■ 4. Asking if she had back labor pains like this with any of her other deliveries. ■ 5. Allowing her support person to take her to the bathroom to maintain privacy. ■ 6. Checking the degree of fetal descent.

■ 3. Assessing her stage of labor. ■ 6. Checking the degree of fetal descent.

While a client is being admitted to the birthing unit she states, "My water broke last night, but my labor started two hours ago." Which of the following is a concern? Select all that apply. ■ 1. Maternal vital signs: T. 99.5, HR 80, R 24, BP 130/80 mm Hg. ■ 2. Blood and mucus on perineal pad. ■ 3. Baseline fetal heart rate of 140 with a range between 110 and 160 with contractions. ■ 4. Peripad stained with green fl uid. ■ 5. The client states, "This baby wants out—he keeps kicking me."

■ 3. Baseline fetal heart rate of 140 with a range between 110 and 160 with contractions. ■ 4. Peripad stained with green fluid. ■ 5. The client states, "This baby wants out—he keeps kicking me."

When developing the teaching plan for a primigravid client at 30 weeks' gestation diagnosed with mild preeclampsia who is being treated at home, which of the following would the nurse identify as the most appropriate client-centered goal? ■ 1. Return visit to the prenatal clinic in approximately 4 weeks. ■ 2. Decreased edema after 1 week of a lowprotein, low-fi ber diet. ■ 3. Bed rest on the left side during the day, with bathroom privileges. ■ 4. Immediate reporting of adverse reactions to magnesium sulfate therapy

■ 3. Bed rest on the left side during the day, with bathroom privileges.

A multigravid client at 34 weeks' gestation visits the hospital because she suspects that her water has broken. After testing the leaking fl uid with nitrazine paper, the nurse confi rms that the client's membranes have ruptured when the paper turns which of the following colors? ■ 1. Yellow. ■ 2. Green. ■ 3. Blue. ■ 4. Red.

■ 3. Blue.

The physician orders intravenous magnesium sulfate for a primigravid client at 38 weeks' gestation diagnosed with severe preeclampsia. Which of the following medications should the nurse have readily available at the client's bedside? ■ 1. Diazepam (Valium). ■ 2. Hydralazine (Apresoline). ■ 3. Calcium gluconate. ■ 4. Phenytoin (Dilantin).

■ 3. Calcium gluconate.

As the nurse enters the room of a newly admitted primigravid client diagnosed with severe preeclampsia, the client begins to experience a seizure. Which of the following should the nurse do fi rst? ■ 1. Insert an airway to improve oxygenation. ■ 2. Note the time when the seizure begins and ends. ■ 3. Call for immediate assistance. ■ 4. Turn the client to her left side.

■ 3. Call for immediate assistance.

When developing a teaching plan for an 18 year old client who asks about treatments for sexually transmitted diseases, the nurse should explain that? ■ 1. Acyclovir (Zovirax) can be used to cure herpes genitalis. ■ 2. Chlamydia trachomatis infections are usually treated with penicillin. ■ 3. Ceftriaxone sodium (Rocephin) may be used to treat Neisseria gonorrhoeae infections. ■ 4. Metronidazole (Flagyl) is used to treat condylomata acuminata.

■ 3. Ceftriaxone sodium (Rocephin) may be used to treat Neisseria gonorrhoeae infections.

A client, approximately 11 weeks pregnant, and her husband are seen in the antepartal clinic. The client's husband tells the nurse that he has been experiencing nausea and vomiting and fatigue along with his wife. The nurse interprets these fi ndings as suggesting that the client's husband is experiencing which of the following? ■ 1. Ptyalism. ■ 2. Mittelschmerz. ■ 3. Couvade syndrome. ■ 4. Pica.

■ 3. Couvade syndrome.

A client in the triage area who is at 19 weeks' gestation states that she has not felt her baby move in the past week and no fetal heart tones are found. While evaluating this client, the nurse identifi es her as being at the highest risk for developing which problem? ■ 1. Abruptio placentae. ■ 2. Placenta previa. ■ 3. Disseminated intravascular coagulation. ■ 4. Threatened abortion.

■ 3. Disseminated intravascular coagulation.

Assessment reveals that the fetus of a multigravid client is at + 1 station and 8 cm dilated. Based on these data, the nurse should fi rst: ■ 1. Ask anesthesia to increase epidural rate. ■ 2. Assist the client to push if she feels the need to do so. ■ 3. Encourage the client to breathe through the urge to push. ■ 4. Support family members in providing comfort measures.

■ 3. Encourage the client to breathe through the urge to push.

A 36-year-old multigravid client is admitted to the hospital with possible ruptured ectopic pregnancy. When obtaining the client's history, which of the following would be most important to identify as a predisposing factor? ■ 1. Urinary tract infection. ■ 2. Marijuana use during pregnancy. ■ 3. Episodes of pelvic infl ammatory disease. ■ 4. Use of estrogen-progestin contraceptives.

■ 3. Episodes of pelvic infl ammatory disease.

A primigravid client in early labor with abruptio placentae develops disseminated intravascular coagulation (DIC). Which of the following should the nurse expect the physician to order? ■ 1. Magnesium sulfate. ■ 2. Warfarin sodium (Coumadin). ■ 3. Fresh-frozen platelets. ■ 4. Meperidine hydrochloride (Demerol).

■ 3. Fresh-frozen platelets.

A multigravid client thought to be at 14 weeks' gestation reports that she is experiencing such severe morning sickness that "she has not been able to keep anything down for a week." The nurse should assess for signs and symptoms of which of the following? ■ 1. Hypercalcemia. ■ 2. Hypobilirubinemia. ■ 3. Hypokalemia. ■ 4. Hyperglycemia.

■ 3. Hypokalemia.

One-half hour after vaginal delivery of a term neonate, the nurse palpates the fundus of a primigravid client, noting several large clots and a small trickle of bright red vaginal bleeding. The client's blood pressure is 136/92 mm Hg. Which of the following would the nurse do fi rst? ■ 1. Continue to monitor the client's fundus every 15 minutes. ■ 2. Ask the physician for an order for methylergonovine (Methergine). ■ 3. Immediately notify the physician of the client's symptoms. ■ 4. Change the client's perineal pads every 15 minutes.

■ 3. Immediately notify the physician of the client's symptoms.

A primigravid client with insulin-dependent diabetes tells the nurse that the contraction stress test performed earlier in the day was suspicious. The nurse interprets this test result as indicating that the fetal heart rate pattern showed which of the following? ■ 1. Frequent late decelerations. ■ 2. Decreased fetal movement. ■ 3. Inconsistent late decelerations. ■ 4. Lack of fetal movement.

■ 3. Inconsistent late decelerations.

The nurse should do which of the following actions fi rst when admitting a multigravid client at 36 weeks' gestation with a probable diagnosis of abruptio placentae? ■ 1. Prepare the client for a vaginal examination. ■ 2. Obtain a brief history from the client. ■ 3. Insert a large-gauge intravenous catheter. ■ 4. Prepare the client for an ultrasound scan.

■ 3. Insert a large-gauge intravenous catheter.

The physician determines that outlet forceps are needed to assist in the delivery of a primigravid client in active labor with a large-for-gestational-size fetus. The nurse reinforces the physician's explanation for using forceps based on the understanding about which of the following concerning the location of the fetal skull? ■ 1. It is engaged past the inlet. ■ 2. It is at +1 station. ■ 3. It is visible at the perineal fl oor. ■ 4. It has reached the level of the ischial spines.

■ 3. It is visible at the perineal fl oor.

The nurse is performing effl eurage for a primigravid client in early labor. The nurse should do which of the following? ■ 1. Deep kneading of superfi cial muscles. ■ 2. Secure grasping of muscular tissues. ■ 3. Light stroking of the skin surface. ■ 4. Prolonged pressure on specifi c sites.

■ 3. Light stroking of the skin surface.

A primigravida admitted to the hospital with a diagnosis of hyperemesis gravidarum is placed on nothing-by-mouth (NPO) status and is receiving intravenous (IV) fl uid replacement therapy. In planning this client's care, the nurse should collaborate with the health care provider (HCP) to carry out which of the following? ■ 1. Withhold oral fl uids indefi nitely until acidosis is corrected. ■ 2. Give oral fl uids in small quantities whenever the client desires. ■ 3. Per HCP orders, provide clear liquids by mouth after 24 hours if vomiting subsides. ■ 4. Withhold oral fl uids until total parenteral nutrition replaces lost electrolytes.

■ 3. Per HCP orders, provide clear liquids by mouth after 24 hours if vomiting subsides.

When preparing the room for admission of a multigravid client at 36 weeks' gestation diagnosed with severe preeclampsia, which of the following should the nurse obtain? ■ 1. Oxytocin infusion solution. ■ 2. Disposable tongue blades. ■ 3. Portable ultrasound machine. ■ 4. Padding for the side rails.

■ 4. Padding for the side rails.

A nurse and an LPN are working in the labor and delivery unit. Of the following assessments and interventions that must be done immediately, which should the nurse assign to the LPN? ■ 1. Complete an initial assessment on a client. ■ 2. Increase the oxytocin (Pitocin) rate on a laboring client. ■ 3. Perform a straight catheterization for protein analysis. ■ 4. Assess a laboring client for a change in labor pattern.

■ 3. Perform a straight catheterization for protein analysis.

A 32-year-old multigravida returns to the clinic for a routine prenatal visit at 36 weeks' gestation. She has had a prior pregnancy with pregnancyinduced hypertension. The assessments during this visit include BP 140/90, P 80, and + 2 edema of the ankles and feet. Based on the client's past history and current assessment, what further information should the nurse obtain to determine if this client is becoming preeclamptic? ■ 1. Headaches. ■ 2. Blood glucose level. ■ 3. Proteinuria. ■ 4. Edema in lower extremities.

■ 3. Proteinuria.

Approximately 15 minutes after delivery of a viable term neonate, a multiparous client complains of a chill. Which of the following should the nurse do next? ■ 1. Assess the client's pulse rate. ■ 2. Decrease the rate of intravenous fl uids. ■ 3. Provide the client with a warm blanket. ■ 4. Assess the amount of blood loss.

■ 3. Provide the client with a warm blanket.

When teaching a multigravid client diagnosed with mild preeclampsia about nutritional needs, which of the following types of diet should the nurse discuss? ■ 1. High-residue diet. ■ 2. Low-sodium diet. ■ 3. Regular diet. ■ 4. High-protein diet.

■ 3. Regular diet.

A multigravida in active labor is 7 cm dilated. The fetal heart rate baseline is 130 bpm with moderate variability. The client begins to have variable decelerations to 100 to 110 bpm. What should the nurse do next? ■ 1. Perform a vaginal examination. ■ 2. Notify the physician of the decelerations. ■ 3. Reposition the client and continue to evaluate the tracing. ■ 4. Administer oxygen via mask at 2 L/minute.

■ 3. Reposition the client and continue to evaluate the tracing.

A 16-year-old primigravid client, with a history of attending one prenatal visit, is admitted to the hospital in active labor at 37 weeks' gestation. Her cervix is 7 cm dilated with the presenting part at 0 station. She enters the labor unit appearing anxious and hyperventilating. Because of the hyperventilation, the nurse should assess the client for: ■ 1. Metabolic alkalosis. ■ 2. Metabolic acidosis. ■ 3. Respiratory alkalosis. ■ 4. Respiratory acidosis.

■ 3. Respiratory alkalosis.

A 16-year-old primigravid client admitted at 38 weeks' gestation with severe pregnancy-induced hypertension is given intravenous magnesium sulfate and lactated Ringer's solution. The nurse should obtain which of the following information? ■ 1. Urinary output every 8 hours. ■ 2. Deep tendon refl exes every 4 hours. ■ 3. Respiratory rate every hour. ■ 4. Blood pressure every 6 hours.

■ 3. Respiratory rate every hour.

A woman who has delivered a healthy newborn is being discharged. As a part of the discharge teaching, the nurse should instruct the client to observe vaginal discharge for postpartum hemorrhage and notify the healthcare provider about? ■ 1. Bleeding that becomes lighter each day ■ 2. Clots the size of golf balls ■ 3. Saturating a pad in an hour ■ 4. Lochia that last longer than 1 week

■ 3. Saturating a pad in an hour

The physician has ordered prostaglandin gel to be administered vaginally to a newly admitted primigravid client. Which of the following indicate that the client has had a therapeutic response to the medication? ■ 1. Resting period of 2 minutes between contractions. ■ 2. Normal patellar and elbow refl exes for the past 2 hours. ■ 3. Softening of the cervix and beginning effacement. ■ 4. Leaking of clear amniotic fl uid in small amounts.

■ 3. Softening of the cervix and beginning effacement.

Which of the following recommendations would be most helpful to suggest to a primigravid client at 37 weeks' gestation who is complaining of leg cramps? ■ 1. Change positions frequently throughout the day. ■ 2. Alternately fl ex and extend the legs. ■ 3. Straighten the knee and fl ex the toes toward the chin. ■ 4. Lie prone in bed with the legs elevated.

■ 3. Straighten the knee and fl ex the toes toward the chin.

To obtain the obstetric conjugate measurement, the nurse would do which of the following? ■ 1. Add 1.5 cm to the transverse diameter. ■ 2. First measure the angle of the pubic arch. ■ 3. Subtract 1.5 to 2 cm from the diagonal conjugate. ■ 4. Measure the diameter of the pelvic inlet.

■ 3. Subtract 1.5 to 2 cm from the diagonal conjugate.

A primigravid client who has had a prolonged labor but now is completely dilated has received epidural anesthesia. Which of the following should the nurse include in the teaching plan about pushing? ■ 1. The client needs to push for at least 1 to 3 minutes. ■ 2. Pushing is most effective when the client holds her breath. ■ 3. The client should be urged to push with an open glottis. ■ 4. Pushing is limited to times when she feels the urge.

■ 3. The client should be urged to push with an open glottis.

The health care provider has determined that a preterm labor client at 34 weeks' gestation has no fetal fi bronectin present. The nurse should assess the client for which of the following outcomes in the next week? ■ 1. The client will develop preeclampsia. ■ 2. The fetus will develop mature lungs. ■ 3. The client will not likely develop preterm labor. ■ 4. The fetus will not develop gestational diabetes.

■ 3. The client will not likely develop preterm labor.

When performing Leopold's maneuvers on a primigravid client, the nurse is palpating the uterus as shown below. Which of the following maneuvers is the nurse performing? ■ 1. First maneuver. ■ 2. Second maneuver. ■ 3. Third maneuver. ■ 4. Fourth maneuver.

■ 3. Third maneuver.

The nurse is caring for a 22-year-old G 2, P 2 client who has disseminated intravascular coagulation after delivering a dead fetus. Which fi ndings are the highest priority to report to the health care provider? ■ 1. Activated partial thromboplastin time (APTT) of 30 seconds. ■ 2. Hemoglobin of 11.5 g/dL. ■ 3. Urinary output of 25 mL in the past hour. ■ 4. Platelets at 149,000/mm3.

■ 3. Urinary output of 25 mL in the past hour.

The nurse is planning care for a multigravid client hospitalized at 36 weeks' gestation with confi rmed rupture of membranes and no evidence of labor. Which of the following would the nurse expect the physician to order? ■ 1. Frequent assessments of cervical dilation. ■ 2. Intravenous oxytocin administration. ■ 3. Vaginal culture for Neisseria gonorrhoeae. ■ 4. Sonogram for amniotic fl uid volume index.

■ 3. Vaginal culture for Neisseria gonorrhoeae.

After instructing a primigravid client about desired weight gain during pregnancy, the nurse determines that the teaching has been successful when the client states which of the following? ■ 1. "A total weight gain of approximately 20 lb (9 kg) is recommended." ■ 2. "A weight gain of 6.6 lb (3 kg) in the second and third trimesters is considered normal." ■ 3. "A weight gain of about 12 lb (5.5 kg) every trimester is recommended." ■ 4. "Although it varies, a gain of 25 to 35 lb (11.4 to 14.5 kg) is about average.

■ 4. "Although it varies, a gain of 25 to 35 lb (11.4 to 14.5 kg) is about average.

primigravid client at 36 weeks' gestation with premature rupture of the membranes is to be discharged home on bed rest with follow-up by the home health nurse. After instruction about care while at home, which of the following client statements indicates effective teaching? ■ 1. "It is permissible to douche if the fl uid irritates my vaginal area." ■ 2. "I can take either a tub bath or a shower when I feel like it." ■ 3. "I should limit my fl uid intake to less than 1 quart daily." ■ 4. "I should contact the doctor if my temperature is 100.4° F or higher."

■ 4. "I should contact the doctor if my temperature is 100.4° F or higher."

A multigravid client is admitted to the labor area from the emergency room. At the time of admission, the fetal head is crowning, and the client yells, "The baby's coming!" To help the client remain calm and cooperative during the imminent delivery, which of the following responses by the nurse is most appropriate? ■ 1. "You're right, the baby is coming, so just relax." ■ 2. "Please don't push because you'll tear your cervix." ■ 3. "Your doctor will be here as soon as possible." ■ 4. "I'll explain what's happening to guide you as we go along."

■ 4. "I'll explain what's happening to guide you as we go along."

An antenatal client receives education concerning medications that are safe to use during pregnancy. The nurse evaluates the client's understanding of the instructions and determines that she needs further information when she states which of the following? ■ 1. "If I am constipated, Milk of Magnesia is okay but mineral oil is not." ■ 2. "If I have heartburn, it is safe to use Tums, Rolaids, Mylanta, and Maalox." ■ 3. "I can take Tylenol if I have a headache." ■ 4. "If I need to have a bowel movement, Ex-Lax is preferred."

■ 4. "If I need to have a bowel movement, Ex-Lax is preferred."

The nurse is instructing a preeclamptic client about monitoring the movements of her fetus to determine fetal well-being. Which statement by the client indicates that she needs further instruction about when to call the health care provider concerning fetal movement? ■ 1. "If the fetus is becoming less active than before." ■ 2. "If it takes longer each day for the fetus to move 10 times." ■ 3. "If the fetus stops moving for 12 hours." ■ 4. "If the fetus moves more often than 3 times an hour."

■ 4. "If the fetus moves more often than 3 times an hour."

After the nurse instructs a 20-year-old nulligravid client on how to perform a breast selfexamination, which of the following client statements indicates that the teaching has been successful? ■ 1. "I should perform breast self-examination on the day my menstrual fl ow begins." ■ 2. "It's important that I perform breast selfexamination on the same day each month." ■ 3. "If I notice that one of my breasts is much smaller than the other, I shouldn't worry." ■ 4. "If there is discharge from my nipples, I should call my health care provider."

■ 4. "If there is discharge from my nipples, I should call my health care provider."

During a Preparation for Parenting class, one of the participants asks the nurse, "How will I know if I am really in labor?" The nurse should tell the participant which of the following about true labor contractions? ■ 1. "Walking around helps to decrease true contractions." ■ 2. "True labor contractions may disappear with ambulation, rest, or sleep." ■ 3. "The duration and frequency of true labor contractions remain the same." ■ 4. "True labor contractions are felt fi rst in the lower back, then the abdomen."

■ 4. "True labor contractions are felt fi rst in the lower back, then the abdomen."

The nurse is admitting a primigravid client at 37 weeks' gestation who has been diagnosed with pregnancy-induced hypertension to the labor and delivery area. Which of the following client care rooms is most appropriate for this client? ■ 1. A brightly lit private room at the end of the hall from the nurses' station. ■ 2. A semiprivate room midway down the hall from the nurses' station. ■ 3. A private room with many windows that is near the operating room. ■ 4. A darkened private room as close to the nurses' station as possible.

■ 4. A darkened private room as close to the nurses' station as possible.

Which of the following would the nurse identify as the priority to achieve when developing the plan of care for a primigravid client at 38 weeks' gestation who is hospitalized with severe preeclampsia and receiving intravenous magnesium sulfate? ■ 1. Decreased generalized edema within 8 hours. ■ 2. Decreased urinary output during the fi rst 24 hours. ■ 3. Sedation and decreased refl ex excitability within 48 hours. ■ 4. Absence of any seizure activity during the fi rst 48 hours.

■ 4. Absence of any seizure activity during the fi rst 48 hours.

The cervix of a primigravid client in active labor who received epidural anesthesia 4 hours ago is now completely dilated, and the client is ready to begin pushing. Before the client begins to push, the nurse should assess: ■ 1. Fetal heart rate variability. ■ 2. Cervical dilation again. ■ 3. Status of membranes. ■ 4. Bladder status.

■ 4. Bladder status.

The nurse is working with four clients on the obstetrical unit. Which client will be the highest priority for a cesarean section? ■ 1. Client at 40 weeks' gestation whose fetus weighs 8 lb by ultrasound estimate. ■ 2. Client at 37 weeks' gestation with fetus in ROP position. ■ 3. Client at 32 weeks' gestation with fetus in breech position. ■ 4. Client at 38 weeks' gestation with active herpes lesions.

■ 4. Client at 38 weeks' gestation with active herpes lesions.

A 28-year-old multigravid client at 28 weeks' gestation diagnosed with acute pyelonephritis is receiving intravenous fl uids and antibiotics. After teaching the client about the rationale for the aggressive therapy, the nurse determines that the client needs further instruction when she says that acute pyelonephritis can lead to which of the following? ■ 1. Preterm labor. ■ 2. Maternal sepsis. ■ 3. Intrauterine growth retardation. ■ 4. Congenital fetal anomalies.

■ 4. Congenital fetal anomalies.

Rho(D) immune globulin (RhoGAM) is ordered for a client before she is discharged after a spontaneous abortion. The nurse instructs the client that this drug is used to prevent which of the following? ■ 1. Development of a future Rh-positive fetus. ■ 2. An antibody response to Rh-negative blood. ■ 3. A future pregnancy resulting in abortion. ■ 4. Development of Rh-positive antibodies.

■ 4. Development of Rh-positive antibodies.

A client is induced with oxytocin (Pitocin). The fetal heart rate is showing accelerations lasting 15 seconds and exceeding the baseline with fetal movement. What action associated with this fi nding should the nurse take? ■ 1. Turn the client to her left side. ■ 2. Administer oxygen via facemask at 10 to 12 L/minute. ■ 3. Notify the health care provider of the situation. ■ 4. Document fetal well-being.

■ 4. Document fetal well-being.

A 36-year-old primigravid client at 22 weeks' gestation without any complications to date is being seen in the clinic for a routine visit. The nurse should assess the client's fundal height to: ■ 1. Determine the level of uterine activity. ■ 2. Identify the need for increased weight gain. ■ 3. Assess the location of the placenta. ■ 4. Estimate the fetal gestational age.

■ 4. Estimate the fetal gestational age.

Following a positive pregnancy test, a client begins discussing the changes that will occur in the next several months with the nurse. The nurse should include which of the following information about changes the client can anticipate in the fi rst trimester? ■ 1. Differentiating the self from the fetus. ■ 2. Enjoying the role of nurturer. ■ 3. Preparing for the reality of parenthood. ■ 4. Experiencing ambivalence about pregnancy.

■ 4. Experiencing ambivalence about pregnancy.

Using Nägele's rule for a client whose last normal menstrual period began on May 10, the nurse determines that the client's estimated date of delivery would be which of the following? ■ 1. January 13. ■ 2. January 17. ■ 3. February 13. ■ 4. February 17.

■ 4. February 17.

A multigravid client in active labor at term is diagnosed with polyhydramnios. The physician has instructed the client about possible neonatal complications related to the polyhydramnios. The nurse determines that the client has understood the instructions when the client states that polyhydramnios is associated with which of the following in the fetus or neonate? ■ 1. Renal dysfunction. ■ 2. Intrauterine growth retardation. ■ 3. Pulmonary hypoplasia. ■ 4. Gastrointestinal disorders.

■ 4. Gastrointestinal disorders.

The nurse is preparing to administer terbutaline (Brethine) to a multigravid client in preterm labor. Before administering this drug intravenously, the nurse should determine the results of the following? ■ 1. Hematocrit. ■ 2. Weight gain. ■ 3. Urinary output. ■ 4. Heart rate.

■ 4. Heart rate.

After instructing a female client about the radioimmunoassay pregnancy test, the nurse determines that the client understands the instructions when the client states that which of the following hormones is evaluated by this test? ■ 1. Prolactin. ■ 2. Follicle-stimulating hormone. ■ 3. Luteinizing hormone. ■ 4. Human chorionic gonadotropin (hCG).

■ 4. Human chorionic gonadotropin (hCG).

A primigravid client with class II heart disease who is visiting the clinic at 8 weeks' gestation tells the nurse that she has been maintaining a lowsodium, 1,800-calorie diet. Which of the following instructions should the nurse give the client? ■ 1. Avoid folic acid supplements to prevent megaloblastic anemia. ■ 2. Severely restrict sodium intake throughout the pregnancy. ■ 3. Take iron supplements with milk to enhance absorption. ■ 4. Increase caloric intake to 2,200 calories daily to promote fetal growth.

■ 4. Increase caloric intake to 2,200 calories daily to promote fetal growth.

A primigravid adolescent client at approximately 15 weeks' gestation who is visiting the prenatal clinic with her mother is to undergo alphafetoprotein (AFP) screening. When developing the teaching plan for this client, the nurse should include which of the following? ■ 1. Ultrasonography usually accompanies AFP testing. ■ 2. Results are usually very accurate until 20 weeks' gestation. ■ 3. A clean-catch midstream urine specimen is needed. ■ 4. Increased levels of AFP are associated with neural tube defects.

■ 4. Increased levels of AFP are associated with neural tube defects.

A multigravid client at 32 weeks' gestation has experienced hemolytic disease of the newborn in a previous pregnancy. The nurse should prepare the client for frequent antibody titer evaluations obtained from which of the following? ■ 1. Placental blood. ■ 2. Amniotic fl uid. ■ 3. Fetal blood. ■ 4. Maternal blood.

■ 4. Maternal blood.

A multigravid client is receiving oxytocin (Pitocin) augmentation. When the client's cervix is dilated to 6 cm, her membranes rupture spontaneously with meconium-stained amniotic fl uid. Which of the following actions should the nurse do fi rst? ■ 1. Increase the rate of the oxytocin infusion. ■ 2. Turn the client to a knee-to-chest position. ■ 3. Assess cervical dilation and effacement. ■ 4. Monitor the fetal heart rate continuously.

■ 4. Monitor the fetal heart rate continuously.

A multigravid client at 39 weeks' gestation diagnosed with insulin-dependent diabetes is admitted for induction of labor with oxytocin (Pitocin). Which of the following should the nurse include in the teaching plan as a possible disadvantage of this procedure? ■ 1. Urinary frequency. ■ 2. Maternal hypoglycemia. ■ 3. Preterm birth. ■ 4. Neonatal jaundice.

■ 4. Neonatal jaundice.

A client at 15 weeks' gestation is admitted with dark brown vaginal bleeding and continuous nausea and vomiting. Her blood pressure is 142/98 and fundal height is 19 cm. The nurse should prepare to do which of the following? ■ 1. Transfer the client to the antenatal unit. ■ 2. Keep the client NPO for 24 hours. ■ 3. Administer magnesium sulfate. ■ 4. Obtain an ultrasound.

■ 4. Obtain an ultrasound.

When preparing a multigravid client at 34 weeks' gestation experiencing preterm labor for the shake test performed on amniotic fl uid, the nurse would instruct the client that this test is done to evaluate the maturity of which of the following fetal systems? ■ 1. Urinary. ■ 2. Gastrointestinal. ■ 3. Cardiovascular. ■ 4. Pulmonary.

■ 4. Pulmonary.

A multigravid client diagnosed with a probable ruptured ectopic pregnancy is scheduled for emergency surgery. In addition to monitoring the client's blood pressure before surgery, which of the following would the nurse assess? ■ 1. Uterine cramping. ■ 2. Abdominal distention. ■ 3. Hemoglobin and hematocrit. ■ 4. Pulse rate.

■ 4. Pulse rate

During a scheduled cesarean delivery of a primigravid client with a fetus at 39 weeks' gestation in a breech presentation, a neonatologist is present in the operating room. The nurse explains to the client that the neonatologist is present because neonates born by cesarean delivery tend to have an increased incidence of which of the following? ■ 1. Congenital anomalies. ■ 2. Pulmonary hypertension. ■ 3. Meconium aspiration syndrome. ■ 4. Respiratory distress syndrome.

■ 4. Respiratory distress syndrome.

A primigravid client in the second stage of labor feels the urge to push. The client has had no analgesia or anesthesia. Anatomically, which of the following would be the best position for the client to assume? ■ 1. Dorsal recumbent. ■ 2. Lithotomy. ■ 3. Hands and knees. ■ 4. Squatting.

■ 4. Squatting.

At 38 weeks' gestation, a primigravid client with poorly controlled diabetes and severe preeclampsia is admitted for a cesarean delivery. The nurse explains to the client that delivery helps to prevent which of the following? ■ 1. Neonatal hyperbilirubinemia. ■ 2. Congenital anomalies. ■ 3. Perinatal asphyxia. ■ 4. Stillbirth.

■ 4. Stillbirth.

A primigravid client at 30 weeks' gestation has been admitted to the hospital with premature rupture of the membranes without contractions. Her cervix is 2 cm dilated and 50% effaced. The nurse should next assess the client's: ■ 1. Red blood cell count. ■ 2. Degree of discomfort. ■ 3. Urinary output. ■ 4. Temperature.

■ 4. Temperature.

After instructing a primigravid client about the functions of the placenta, the nurse determines that the client needs additional teaching when she says that which of the following hormones is produced by the placenta? ■ 1. Estrogen. ■ 2. Progesterone. ■ 3. Human chorionic gonadotropin (hCG). ■ 4. Testosterone.

■ 4. Testosterone.

A new antenatal G 6, P 4, Ab 1 client attends her fi rst prenatal visit with her husband. The nurse is assessing this couple's psychological response to their pregnancy. Which of the following requires the most immediate follow up? ■ 1. The couple are concerned with fi nancial changes this pregnancy causes. ■ 2. The couple expresses ambivalence about the current pregnancy. ■ 3. The father of the baby states that the pregnancy has changed the mother's focus. ■ 4. The father of the baby is irritated that the mother is not like she was before pregnancy.

■ 4. The father of the baby is irritated that the mother is not like she was before pregnancy.

When preparing a prenatal class about endocrine changes that normally occur during pregnancy, the nurse should include information about which of the following subjects? ■ 1. Human placental lactogen maintains the corpus luteum. ■ 2. Progesterone is responsible for hyperpigmentation and vascular skin changes. ■ 3. Estrogen relaxes smooth muscle in the respiratory tract. ■ 4. The thyroid enlarges with an increase in basal metabolic rate.

■ 4. The thyroid enlarges with an increase in basal metabolic rate.

The nurse, while shopping in a local department store, hears a multiparous woman say loudly, "I think the baby's coming." After asking someone to call 911, the nurse assists the client to deliver a term neonate. While waiting for the ambulance, the nurse suggests that the mother initiate breast-feeding, primarily for which of the following reasons? ■ 1. To begin the parental-infant bonding process. ■ 2. To prevent neonatal hypothermia. ■ 3. To provide glucose to the neonate. ■ 4. To contract the mother's uterus.

■ 4. To contract the mother's uterus.

A primigravid client's baseline blood pressure at her initial visit at 12 weeks' gestation was 110/70 mm Hg. During an assessment at 38 weeks' gestation, which of the following data would indicate mild preeclampsia? ■ 1. Blood pressure of 160/110 mm Hg on two separate occasions. ■ 2. Proteinuria, more than 5 g in 24 hours. ■ 3. Serum creatinine concentration of 1.4 mL/dL. ■ 4. Weight gain of 2 lb in the last week.

■ 4. Weight gain of 2 lb in the last week.

Which diagnostic test would be the most important to have for a primigravid client in the second trimester of her pregnancy? ■ 1. Culdocentesis to detect abnormalities. ■ 2. Chorionic villus sampling. ■ 3. Ultrasound testing. ■ 4. α-fetoprotein (AFP) testing.

■ 4. α-fetoprotein (AFP) testing.