Maternity Exam 2 Practice Questions 2 (main)

Which complaint made by a client at 35 weeks of gestation requires additional assessment? A. Abdominal pain B. Ankle edema in the afternoon C. Shortness of breath when climbing stairs D. Backache with prolonged standing

A. Abdominal pain Rationale: Abdominal pain may indicate preterm labor or serious placental abnormalities.

A client in her 10th week of pregnancy exhibits presumptive signs of pregnancy that the nurse may detect, including which of the following?Select all that apply. A. Amenorrhea B. Positive urine pregnancy test C. Abdominal enlargement D. Breast changes E. Urinary frequency

A. Amenorrhea C. Abdominal enlargement D. Breast changes E. Urinary frequency

The nurse who performs vaginal examinations to assess a woman's progress in labor should: A. Discuss the findings with the woman and her partner. B. Wear two clean gloves for each examination. C. Perform an examination at least once every hour during the active phase of labor. D. Perform the examination with the woman in the supine position.

A. Discuss the findings with the woman and her partner. Rationale: The nurse should discuss the findings of the vaginal examination with the woman and her partner and report them to the primary care provider.

A woman in week 34 of pregnancy reports that she is very uncomfortable because of heartburn. The nurse would suggest that the woman: A. Eat five small meals daily B. Reduce the amount of fiber she consumes C. Substitute other calcium sources for milk in her diet D. Lie down after each meal

A. Eat five small meals daily Rationale: Eating small, frequent meals may help with heartburn, nausea, and vomiting.

A pregnant woman experiencing nausea and vomiting should: A. Eat small, frequent meals (every 2 to 3 hours) B. Increase her intake of high-fat foods to keep the stomach full and coated C. Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning D. Limit fluid intake throughout the day

A. Eat small, frequent meals (every 2 to 3 hours) Rationale: This is a correct suggestion for a woman experiencing nausea and vomiting.

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include when possible: A. Encouraging the woman to try various upright positions, including squatting and standing B. Telling the woman to start pushing as soon as her cervix is fully dilated C. Starting an epidural so that pain is reduced and the woman can relax D. Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction

A. Encouraging the woman to try various upright positions, including squatting and standing Rationale: Upright positions and squatting both may enhance the progress of fetal descent.

When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman's risk for _____ has increased A. Intrauterine infection B. Precipitous labor C. Hemorrhage D. pine hypotensio

A. Intrauterine infection Rationale: When the membranes rupture, microorganisms from the vagina can ascend into the amniotic sac, causing chorioamnionitis and placentitis.

The patient received a narcotic analgesic during the transition stage of labor. Which of the following will the nurse assess for in the newborn? A. Respiratory depression. B. Bradycardia. C. Acrocyanosis. D. Tachypnea.

A. Respiratory depression. Rationale: An infant delivered within 1 to 4 hours of maternal analgesic administration is at risk for respiratory depression from the sedative effects of the narcotic.

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be teaching about what this woman that she should take in what? A. Several glasses of fluid B. Easily digested sources of carbohydrate C. Salty foods to replace lost sodium D. Extra protein sources, such as peanut butter

A. Several glasses of fluid Rationale: If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. Also, the woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.

A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The nurse reviews the client's laboratory values and notes that the woman's hemoglobin is 14 g/dl, hematocrit is 39%, platelets are 67,000, and white blood cells (WBCs) are 11,000/mm3. Which factor would contraindicate an epidural for the woman? A. She has thrombocytopenia B. She is anemic. C. She is too far dilated. D. She is septic.

A. She has thrombocytopenia Rationale: The patient has thrombocytopenia and the epidural is contraindicated.

A nurse is conducting the admission assessment of a client who is positive for Group B Streptococcus (GBS). Which finding is of most concern to the nurse? A. Spontaneous rupture of membranes 3 hours ago B. Cervical dilation of 4 cm C. Contractions every 4 minutes D. Continued bloody show

A. Spontaneous rupture of membranes 3 hours ago Rationale: Rupture of the membranes before intrapartum treatment of GBS increases the chances that infection will ascend into the uterus. GBS infection is a leading cause of neonatal morbidity and mortality. Continued bloody show, cervical dilation of 4 cm, and contractions every 4 minutes are all normal findings for a client in labor.

The diagnosis of pregnancy is based on which positive signs of pregnancy? Choose all that apply. A. Verification of fetal movement B. Identification of fetal heartbeat C. Palpation of fetal outline D. Positive hCG test E. Visualization of the fetus

A. Verification of fetal movement B. Identification of fetal heartbeat E. Visualization of the fetus

In order to reassure and educate pregnant clients about the functioning of their kidneys in eliminating waste products, maternity nurses should be aware that: A. Renal (kidney) function is more efficient when the woman assumes a supine position. B. Increased bladder sensitivity and then compression of the bladder by the enlarging uterus results in the urge to urinate even if the bladder is almost empty. C. Increased urinary output makes pregnant women less susceptible to urinary infection. D. Using diuretics during pregnancy can help keep kidney function regular.

B. Increased bladder sensitivity and then compression of the bladder by the enlarging uterus results in the urge to urinate even if the bladder is almost empty. Rationale: First bladder sensitivity and then compression of the bladder by the uterus result in the urge to urinate more often.

Which FHR finding would concern the nurse during labor? A. Accelerations with fetal movement B. Late decelerations C. Early decelerations D. An average FHR of 126 beats/min

B. Late decelerations Rationale: Late decelerations are caused by uteroplacental insufficiency and are associated with fetal hypoxemia. They are considered ominous if persistent and uncorrected.

A 20-week pregnant client is being seen in the prenatal clinic. Her fundus is palpated 3 cm below the umbilicus. This finding is: A. Higher than normal for gestational age. B.Lower than normal for gestational age. C. A sign of impending complications. D. Appropriate for gestational age.

B. Lower than normal for gestational age. By 20 weeks the fundus should reach the umbilicus.

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly, you see the FHR drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal exam. The cervix has not changed. Five minutes have passed, and the fetal heart rates remain in the 80s. What additional nursing measures should you take? A. Start pitocin B. Notify the care provider immediately C. Insert a Foley catheter D. Scream for help

B. Notify the care provider immediately Rationale: To relieve an FHR deceleration, the nurse can reposition the mother, increase IV fluid, and provide oxygen. Also, if oxytocin is infusing, it should be discontinued. If the FHR does not resolve, the primary care provider should be notified immediately.

A woman is in the second stage of labor with a strong urge to push. Which of the following actions by the nurse is appropriate at this time? A. Assess maternal vital signs every 5 minutes B. Notify the provider that the woman is having the urge to push C. Assess the fetal heart rate (FHR) every 5 to 15 minutes D. Instruct the mother to push with contractions and rest in between E. Perform a sterile vaginal examination (SVE)

B. Notify the provider that the woman is having the urge to push D. Instruct the mother to push with contractions and rest in between

Uteroplacental insufficiencey can be the result of maternal hypotension. Understanding that maternal hypotension is a potential side effect of regional anesthesia and analgesia, what nursing interventions could you use to raise the client's blood pressure? Choose all that apply. A. Place the woman in a supine position B. Place the woman in a lateral position C. Increase IV fluids D. Administer oxygen E. Perform a vaginal exam

B. Place the woman in a lateral position C. Increase IV fluids D. Administer oxygen Rationale: Nursing interventions for maternal hypotension arising from analgesia or anesthesia include turning the woman to a lateral position, increasing IV fluids, administering oxygen via face mask, elevating the woman's legs, notifying the physician, administering an IV vasopressor, and monitoring the maternal and fetal status at least every 5 minutes until these are stable.

The nurse caring for the pregnant client must understand that the hormone essential for maintaining pregnancy is: A. Estrogen B. Progesterone C. hCG D. Oxytocin

B. Progesterone Rationale: Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles. This reduces uterine activity and prevents miscarriage.

A primigravida is pushing with contractions. The nurse notes that the woman's perineum is beginning to bulge and that there is an increase in bloody show. Which of the following actions by the nurse is appropriate at this time? A. Monitor the fetal heart rate every 60 minutes. B. Report the findings to the woman's health care provider C. Immediately assess the woman's pulse and blood pressure. D. Place the client on her side with oxygen via face mask.

B. Report the findings to the woman's health care provider. Rationale: The provider will need to be notified the patient is pushing effectively with descent of the fetal head.

After an emergency birth, the nurse encourages the woman to breastfeed her newborn. The primary purpose of this activity is to: A. Facilitate maternal-newborn interaction B. Stimulate the uterus to contract C. Initiate the lactation cycle D. Prevent neonatal hypoglycemia

B. Stimulate the uterus to contract Rationale: Stimulation of the nipples through breastfeeding or manual stimulation causes the release of oxytocin and prevents maternal hemorrhage.

Fetal well-being during labor is assessed by: A. Maternal pain control B. The response of the FHR to uterine contractions (UCs) C. An FHR above 110 beats/min D. Accelerations in the FHR

B. The response of the FHR to uterine contractions (UCs) Rationale: Fetal well-being during labor can be measured by the response of the FHR to UCs. In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/min with no periodic changes and a moderate baseline variability, and accelerations with fetal movement.

A G1P0 patient, 40 weeks pregnant, is laboring in bed, flat on her back, in the supine position. She becomes pale, her skin becomes clammy, and she states she feels dizzy. What is the first action by the nurse? A. Administer 250 ml Lactated Ringer's IV fluid bolus. B. Turn the patient to her side. C. Notify her medical provider. D.Apply oxygen 10 liters by simple face mask.

B. Turn the patient to her side. Rationale: The patient is experiencing supine hypotensive syndrome. She is experiencing low blood pressure due to the pressure of the gravid uterus on the vena cava and decreasing the blood return to the heart. Turning the patient to the side resolves the problem.

Which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant woman to her health care provider? A. Nausea with occasional vomiting B. Vaginal bleeding C. Urinary frequency D. Fatigue

B. Vaginal bleeding Rationale: t: Signs and symptoms that must be reported include severe vomiting, fever and chills, burning on urination, diarrhea, abdominal cramping, and vaginal bleeding. These symptoms may be signs of potential complications of the pregnancy

A woman is 3 months pregnant. At her prenatal visit, she tells the nurse that she doesn't know what is happening; one minute she's happy that she is pregnant, and the next minute she cries for no reason. Which response by the nurse is most appropriate? A. "Perhaps you really don't want to be pregnant." B. "Don't worry about it; you'll feel better in a month or so." C. "Hormonal changes during pregnancy commonly result in mood swings." D. "Have you talked to your partner about how you feel?"

C. "Hormonal changes during pregnancy commonly result in mood swings." Rationale: "Hormonal changes during pregnancy commonly result in mood swings" is an accurate statement and the most appropriate response by the nurse.

The nurse is teaching a 25 year old pregnant woman about nutrition and weight gain. Which of the following statements demonstrates the woman understands the teaching? A. "I should maintain a weight gain of one pound per month so that by gestation week 40, I would have gained 40 pounds (18 kg), which is the minimum healthy weight gain I need for my baby." B. "Even though I'm obese, I should not be concerned because obesity is not associated with pregnancy loss." C. "The normal weight gain for pregnancy is 25-35 (11.5-16 kg) pounds for a woman with a normal BMI." D. "A weight gain of 2.2 pounds (1 kg) per month is a healthy weight gain for the baby and for me."

C. "The normal weight gain for pregnancy is 25-35 (11.5-16 kg) pounds for a woman with a normal BMI." Rationale: Total weight gain throughout pregnancy should be about 11.5 to 16kg (25-35lb) for women with a normal BMI.

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system? A. 2-0-0-1-1 B. 3-0-1-1-0 C. 3-1-0-1-0 D. 2-1-0-1-0

C. 3-1-0-1-0

A client is admitted to the birthing suite in early active labor. Which nursing action takes priority during the admission process? A. Determining when the last meal was eaten B. Ascertaining whether the membranes have ruptured C. Auscultating the fetal heart D. Obtaining an obstetric history

C. Auscultating the fetal heart Rationale: Determining fetal well-being takes priority over all other measures. If the fetal heart rate is absent or persistently decelerating, immediate intervention is required. Although obtaining an obstetric history, determining when the client had her last meal, and ascertaining whether the membranes have ruptured are all important, the determination of fetal well-being takes priority.

With regard to primary and secondary powers, the maternity nurse should know that: A. Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs. B. Effacement generally is well ahead of dilation in women giving birth for the first time; they are more together in subsequent pregnancies. C. Primary powers are responsible for effacement and dilation of the cervix D. Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation.

C. Primary powers are responsible for effacement and dilation of the cervix Rationale: The primary powers are responsible for dilation and effacement; secondary powers are concerned with expulsion of the fetus.

With regard to their role in the personal hygiene of the expectant mother, maternity nurses should be aware that: A. Expectant mothers should use specially treated soap to cleanse the nipples. B. The perineum should be wiped from back to front. C. Tub bathing is permitted even in late pregnancy unless membranes have ruptured. D. Bubble bath and bath oils are permissible because they add an extra soothing and cleansing action to the bath.

C. Tub bathing is permitted even in late pregnancy unless membranes have ruptured. Rationale: This is a correct statement. The main danger from taking baths is falling in the tub

A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant at 3 months. She asks the nurse: "One of my friends told me I need to take folic acid. Why do I have to do that?" The nurse's best response is: A. "Folic acid is not needed in pregnancy. You do not need to take it." B. "Folic acid is in enriched breads and cereals. You do not need any extra in pregnancy." C. "Folic acid is used to treat certain types of anemia." D. "Folic acid prevents neural tube defects like spina bifida."

D. "Folic acid prevents neural tube defects like spina bifida." Rationale: Folic acid is to be taken before and during the first trimester of pregnancy to prevent neural tube defects. She will need to use the folic acid supplement to achieve enough amounts to prevent the defects.

The nurse is taking an advice call from woman at 40 weeks' gestation. The nurse instructs the patient to go to the hospital to be evaluated when the patient states which of the following? A. "The baby has been moving." B. "I passed the mucous plug." C. "I have had irregular contractions for the last hour." D. "I have a trickle of fluid leaking from my vagina."

D. "I have a trickle of fluid leaking from my vagina."

During labor a fetus with an average heart rate of 135 beats/min over a 10- minute period would be considered to have: A. Hypoxia B. Tachycardia C. Bradycardia D. A normal baseline heart rate

D. A normal baseline heart rate Rationale: The baseline heart rate is measured over 10 minutes; a normal range is 110 to 160 beats/min.

A client in labor and delivery has just received a dose of ephedrine. Which of the following signs will the nurse should the nurse expect to see? A. A decrease in blood pressure. B. A decrease in respiratory rate. C. An increase in temperature. D. An increase in the blood pressure.

D. An increase in the blood pressure. Rationale: The nurse should expect increased blood pressure, which is a side effect of ephedrine use.

The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is: A. A positive pregnancy test B. Braxton Hicks contractions C. Quickening D. Auscultated Fetal Heart rate or Fetal movement palpated by the nurse-midwife

D. Auscultated Fetal Heart rate or Fetal movement palpated by the nurse-midwife Rationale: Positive signs of pregnancy are those that are attributed to the presence of a fetus, such as hearing the fetal heartbeat or palpating fetal movement.

The patient has shared a copy of her birth plan with the nurse. When is the best time for the nurse to review the birth plan and discuss the patient's options for pharmacologic pain relief in labor? A. The second stage of labor. B. During a uterine contraction. C. The third stage of labor. D. Before a uterine contraction.

D. Before a uterine contraction. Rationale: Before a contraction,, the mother is able to focus and ask appropriate questions regarding her care.

When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive sign that uterine contractions are effective would be: A. Descent of the fetus B. Increase in bloody show C. Rupture of the amniotic membranes D. Dilation of the cervix

D. Dilation of the cervix Rationale: The vaginal examination reveals whether the woman is in true labor. Cervical change, especially dilation, in the presence of adequate labor indicates that the woman is in true labor.

The most common cause of decreased variability in the FHR is: A. Altered cerebral blood flow B. Fetal hypoxemia C. Umbilical cord compression D. Fetal sleep cycles

D. Fetal sleep cycles Rationale: A temporary decrease in variability can occur when the fetus is in a sleep state. These sleep states do not usually last longer than 30 minutes.

With regard to the position of the laboring woman, maternity nurses should be able to tell the woman that: A. The supine position commonly used in the United States increases blood flow. B. The "all fours" position, on her hands and knees, is hard on her back. C. In a sitting or squatting position, her abdominal muscles will have to work harder. D. Frequent changes in position will help relieve her fatigue and increase her comfort

D. Frequent changes in position will help relieve her fatigue and increase her comfort Rationale: Frequent position changes relieve fatigue, increase comfort, and improve circulation.

Which client at term should go to the hospital or birth center the soonest after labor begins? A. Gravida 2, para 1 whose first labor lasted 16 hours B. Gravida 2, para 1 who lives 10 minutes away C. Gravida 1, para 0 who lives 40 minutes away D. Gravida 3, para 2 whose longest previous labor was 4 hours

D. Gravida 3, para 2 whose longest previous labor was 4 hours Rationale: Multiparous women usually have shorter labors than do nulliparous women. The woman described is multiparous with a history of rapid labors, increasing the likelihood that her infant might be born in uncontrolled circumstances.

The nurse caring for a pregnant client knows that her health teaching regarding fetal circulation has been effective when the client reports that she has been sleeping: A. With her head elevated on two pillows. B. On her back with a pillow under her knees. C. On her abdomen. D. In a side-lying position.

D. In a side-lying position. Rationale: Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. Previously it was believed that the left lateral position promoted maternal cardiac output, thereby enhancing blood flow to the fetus. However, it is now known that either side-lying position enhances uteroplacental blood flow.

The nurse expects to administer an oxytocic (e.g., Pitocin, Methergine) to a woman after expulsion of her placenta to: A. Prevent infection B. Relieve pain C. Facilitate rest and relaxation D. Stimulate uterine contraction

D. Stimulate uterine contraction Oxytocics stimulate uterine contractions, which reduce blood loss after the third stage of labor.

A major advantage of nonpharmacologic pain management is that: A. A slower labor decreases the risk of complications. B. Elimination of pain is possible. C. The woman remains fully alert at all times. D. There are no side effects or risks to the fetus.

D. There are no side effects or risks to the fetus. Rationale: Because nonpharmacologic pain management does not include analgesics, adjunct drugs, or anesthesia, it is harmless to the mother and the fetus.

A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure would be to use: A. Effleurage B. Counterpressure against the sacrum C. Conscious relaxation or guided imagery D. Pant-blow (breaths and puffs) breathing techniques

B. Counterpressure against the sacrum Rationale: Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back.

Immediately following administration of epidural anesthesia of the patient, the nurse must monitor the mother for which of the following? A. Paresthesia in her feet and leg B. Decrease in her blood pressure C. Increase in her central venous pressure D. Fetal heart rate accelerations

B. Decrease in her blood pressure Rationale: After epidural administration, the mother will show signs of hypotension if no other therapeutic interventions are performed. This decrease in blood pressure is due to the dilation of the vessels in the pelvis and the increased compression of the vena cava.

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurse's first priority is to: A. Insert a scalp electrode B. Change the woman's position C. Notify the care provider D. Assist with amnioinfusion

B. Change the woman's position Late decelerations may be caused by maternal supine hypotension syndrome. They usually are corrected when the woman turns on her side to displace the weight of the gravid uterus from the vena cava.

Which statement made by a pregnant woman would lead the nurse to believe that the woman might have lactose intolerance? A. "Sometimes I notice that I have bad breath after I drink a cup of milk." B. "If I drink more than a cup of milk, I usually have abdominal cramps and bloating." C. "Drinking milk usually makes me break out in hives." D. "I always have heartburn after I drink milk."

B. "If I drink more than a cup of milk, I usually have abdominal cramps and bloating." Rationale: These symptoms are consistent with lactose intolerance.

The client has just received and epidural and is concerned about having a bowel movement while pushing and delivering her baby. Which of the following statements by the nurse is appropriate? A. "Don't worry, we can get you to the bathroom and you can have a bowel movement before delivery." B. "You are at risk for falling if you try to get out of bed. I will assist you in keeping clean while you are pushing." C. "This happens with most deliveries. You shouldn't worry about having a bowel movement." D. "When you visited the bathroom before your epidural was placed, that was your opportunity to have a bowel movement."

B. "You are at risk for falling if you try to get out of bed. I will assist you in keeping clean while you are pushing." Rationale: Because the patient has regional anesthesia, she is a fall risk, and should not ambulate until after the anesthesia has worn off. The nurse can assist with perineal care during the second stage of labor.

A woman who is pregnant for the first time is dilated 3 cm and having contractions every 5 minutes. She is groaning and perspiring excessively; she states that she did not attend childbirth classes. The most important nursing action is to: A. Notify the woman's health care provider B. Assist her with simple breathing and relaxation instructions C. Assure her that her labor will be over soon D. Administer the prescribed narcotic analgesic

B. Assist her with simple breathing and relaxation instructions Rationale: By reducing tension and stress, focusing and relaxation techniques allow the woman in labor to rest and conserve energy for the task of giving birth. For those who have had no preparation, instruction in simple breathing and relaxation can be given in early labor and often is successful.

External fetal monitoring cannot detect the ____________________ of uterine contractions.

intensity