MCQ – ON

OBSTETRICS AND
GYNAECOLOGY
Antepartum care and related
disorders
■ Some practice questions
■ 1. A 15-year-old client is 26 weeks pregnant.She has been admitted to the labor and
delivery unit with a complaint of abdominalpain. Her parents want to speak with the
nurse in reference to her condition. The nurse’s best response to the parents is:
■ 1 “I’ll need a signed consent from your daughter to give you medical information.”
■ 2. “The physician can give you moreinformation without consent.”
■ 3. “She’ll be OK. It’s just a stomachache.”
■ 4. “She’s experiencing Braxton-Hicks contractions and is too young to understand the
difference.”
■ Answer: 1. A pregnant minor becomes emancipated to make decisions
for herself and her baby. The client’s right to confidentiality means
that medical information of any kind can’t be divulged without a
signed consent from her. The physician can’t give out information
without consent.
■ 2. A client who is 23 years old, gravida 2, para 1 with a twin gestation,
is admitted to labor and delivery at 29 weeks’ gestation with
complaints of lower abdominal pain and decreased fetal movement.
Which interventions should a nurse perform? Select all that apply.
■ 1. Place the client on electronic fetal monitor.
■ 2. Administer betamethasone IM.
■ 3. Perform nipple stimulation stress test.
■ 4. Limit oral fluid intake.
■ 5. Place client on strict bedrest.
1. CORRECT ANSWERS: 1, 2. Answer 1 is correct
because
placing the client on an electronic fetal
monitor is an
appropriate intervention to evaluate uterine
contractions
and determine fetal well-being. Evaluate of
fetal wellbeing
is very important for this client because of
her
complaint of decreased fetal movement.
Answer 2 is
correct because betamethasone is a
corticosteroid used
to help stimulate fetal lung maturity in
infants who are
preterm. Answer 3 is incorrect because performing
a nipple
stimulation test is inappropriate for a client who is
in
preterm labor; stimulating nipples may stimulate
3. The nurse is providing instructions to a pregnant
client with human immunodeficiency virus
(HIV) infection regarding care to the newborn after
delivery. The client asks the nurse about the feeding
options that are available. Which response should
the nurse make to the client?
1. “You will need to bottle-feed your newborn.”
2. “You will need to feed your newborn by nasogastric
tube feeding.”
3. “You will be able to breast-feed for 6 months
and then will need to switch to bottle-feeding.”
4. “You will be able to breast-feed for 9 months
and then will need to switch to bottle-feeding.”
1
Rationa le: Perinatal transmission of HIV can occur during the
antepartum period, during labor and birth, or in the postpartum
period if the mother is breast-feeding. Clients who have
HIV are advised not to breast-feed. There is no physiological
reason why the newborn needs to be fed by nasogastric tube.
Test-Taking Strategy: Use knowledge regarding the transmission
of HIV. Eliminate options 3 and 4 first because these
options are comparable or alike in that they both address
breast-feeding.
4.The home care nurse visits a pregnant client who has
a diagnosis of mild preeclampsia. Which assessment
finding indicates a worsening of the preeclampsia
and the need to notify the health care provider
(HCP)?
1. Urinary output has increased.
2. Dependent edema has resolved.
3. Blood pressure reading is at the prenatal baseline.
4. The client complains of a headache and blurred
vision.
answers- 4
Rationa le: If the client complains of a headache and blurred
vision, the HCP should be notified, because these are signs
of worsening preeclampsia. Options 1, 2, and 3 are normal
findings.
Test-Taking
5.Which finding is considered normal during
the antepartum period of pregnancy?
1. Resting pulse rate fluctuations ranging
from 15 to 20 beats/minute
2. Slight decrease in respiratory rate
3. Altered breathing pattern with
thoracic breathing replacing abdominal
breathing
4. Hematocrit (HCT) increase of
about 7%
Answer: 1. Cardiovascular system
changes
associated with pregnancy lead to resting
pulse rate fluctuation with increases
ranging
from 15 to 20 beats/minute at term. Other
pregnancy-related changes include a
slight
increase (2 breaths/minute) in respiratory
rate, altered breathing pattern with
abdominal
breathing replacing thoracic breathing as
pregnancy progresses, and a decrease in
HCT
6. A client comes to the clinic for her
12-week pregnancy checkup. The client asks
the nurse when she should begin to feel her
baby move. Which response should the nurse
offer?
1. “You should have already felt it
move.”
2. “Typically women feel their baby
move for the first time when they’re
20 weeks pregnant.”
3. “You’ll probably feel your baby move
after your 16th week of pregnancy.”
4. “Each person experiences the baby’s
first movement at a different time
throughout their pregnancy.”
Answer: 3. Although each client does detect
fetal movement at a different time, it’s typically
experienced just after the 16th week. If
movement isn’t detected around this time,
problems with the pregnancy may exist.
7. Which medication promotes fetal
lung
maturity in cases of preterm labor?
1. Terbutaline
2. Betamethasone
3. Co-trimoxazole (Bactrim)
4. Clarithromycin (Biaxin)
Answer: 2. Preterm labor raises concerns
about the fetus’s respiratory potential.
Therefore,
betamethasone is used to stimulate
the development of surfactant in the lungs.
Terbutaline is a beta-adrenergic agonist used
to treat preterm labor. Co-trimoxazole is a
sulfonamide commonly used to treat urinary
tract infections, and clarithromycin is an
antibiotic used to treat upper respiratory
tract infections.
A multigravida client at 38 weeks’ gestation
has come to the emergency department
complaining of chest pain. She tells the nurse
that she has recently inhaled crack cocaine.
The nurse’s top priority is to assess the client
for:
1. abruptio placentae.
2. placenta accreta.
3. malnutrition.
4. hypotension.
Answer: 1. The use of crack cocaine
during
pregnancy is associated with abruptio
placentae, along with hypertension,
stroke,
tachycardia, hemorrhage, low birth
weight,
and preterm neonates. Crack cocaine
isn’t
associated with placenta accreta
(unusually
deep attachment of the placenta to
the uterine
A multigravida client at 39 weeks’
gestation
is diagnosed with gestational
hypertension
and HELLP syndrome. The nurse’s top
priority is to assess the client’s:
1. white blood count (WBC) count.
2. blood glucose levels.
3. serum iron levels.
4. platelet count.
Answer: 4. Women diagnosed with HELLP
syndrome have hemolysis of red blood
cells, elevated liver enzyme levels, and a low
platelet count, so the nurse should assess the
client’s platelet count. This syndrome can lead
to disseminated intravascular coagulation or
hem orrhage. Monitoring WBC count, blood
glucose levels, and serum iron levels isn’t a
priority for clients diagnosed with HELLP
syndrome.
The nurse is providing instructions to a pregnant
client with a history of cardiac disease regarding
appropriate dietary measures. Which statement, if
made by the client, indicates an understanding of
the information provided by the nurse?
1. “I should increase my sodium intake during
pregnancy.”
2. “I should lower my blood volume by limiting
my fluids.”
3. “I should maintain a low-calorie diet to prevent
any weight gain.”
4. “I should drink adequate fluids and increase my
intake of high-fiber foods.
answer is 4 4
Rationale: Constipation can cause the client to use the Valsalva
maneuver. The Valsalva maneuver should be avoided in clients
with cardiac disease because it can cause blood to rush to the
heart and overload the cardiac system. Constipation can be
prevented by the addition of fluids and a high-fiber diet.
A low-calorie diet is not recommended during pregnancy
and could be harmful to the fetus. Sodium should be restricted
as prescribed by the health care provider because excess sodium
would cause an overload to the circulating blood volume and
contribute to cardiac complications. Diets low in fluid can
cause a decrease in blood volume, which could deprive the
fetus of nutrients
A client in the first trimester of pregnancy arrives at a
health care clinic and reports that she has been
experiencing vaginal bleeding. A threatened abortion
is suspected, and the nurse instructs the client regarding
management of care. Which statement made by
the client indicates a need for further instruction?
1. “I will watch for the evidence of the passage of
tissue.”
2. “I will maintain strict bed rest throughout the
remainder of the pregnancy.”
3. “I will count the number of perineal pads used
on a daily basis and note the amount and color
of blood on the pad.”
4. “I will avoid sexual intercourse until the bleeding
has stopped, and for 2 weeks following the
last evidence of bleeding.”
Answers - 2
Rationale: Strict bed rest throughout the remainder of the
pregnancy is not required for a threatened abortion. The client
should watch for the evidence of the passage of tissue. The
client
is instructed to count the number of perineal pads used
daily and to note the quantity and color of blood on the
pad. The client is advised to curtail sexual activities until
bleeding
has ceased and for 2 weeks after the last evidence of bleeding
or as recommended by the health care provider
The nurse evaluates the ability of a hepatitis
B–positive mother to provide safe bottle-feeding
to her newborn during postpartum hospitalization.
Which maternal action best exemplifies the
mother’s knowledge of potential disease transmission
to the newborn?
1. The mother requests that the window be closed
before feeding.
2. The mother holds the newborn properly during
feeding and burping.
3. The mother tests the temperature of the formula
before initiating feeding.
4. The mother washes and dries her hands before
and after self-care of the perineum and asks for a
pair of gloves before feeding.
- answers -4
Rationa le: Hepatitis Bvirus is highly contagious and is
transmitted
by direct contact with blood and body fluids of infected
persons.
The rationale for identifying childbearing clients with this
disease is to provide adequate protection of the fetus and the
newborn,
to minimize transmission to other individuals, and to
reduce maternal complications. The correct option provides the
best evaluation of maternal understanding of disease
transmission.
Option 1 will not affect disease transmission since hepatitis
Bdoes not spread through airborne transmission. Options 2 and
3 are appropriate feeding techniques for bottle-feeding, but do
not minimize disease transmission for hepatitis B.
■ Which of these is NOT AN EFFECT CAUSED by consumption of
methamphetamines,on the fetus during pregnancy ??
■ 1. Cleft lip.
■ 2. Irritability.
■ 3. Clubfoot
■ 4. Hyperbilirubinemia.
■ 5. Gastroschisis
Answer 4
1 isin correct
because the developing fetus appears to be
vulnerable to
DNA damage from methamphetamine
exposure because it
hasn’t yet developed the enzymes that
protect it against free
radicals. Methamphetamines can cause
neural tube defects
such as cleft lip and palate. Answer 2 is
incorrect because, when
a neonate is withdrawing from
methamphetamine, there is
an increased incidence of irritability, inability
to be consoled,
and difficulty sleeping. Answer 3 is incorrect
because methamphetamine
exposure can cause skeletal malformations
such as
clubfoot. Answer 4 is correct because
A client, who is a gravida 3, para 1, presents to labor and
delivery at 41 4/7 weeks’ gestation for induction of labor.
Her cervix is 2 cm dilated, 80% effaced, and a –3 station.
A nurse anticipates that, in preparation for labor, a physician
will likely order:
Select all that apply.( can have two options as answers also
1. Hemabate 250 mcg IM.
2. Pitocin at 2 milliunits/min IV.
3. Betamethasone 6 mg IM.
4. Cytotec 200 mcg PO.
5. Cervidil 10 mg vaginally.
CORRECT ANSWERS: 2, 5. Answer 1 is incorrect because
Hemabate is used to control postpartum hemorrhage, and is
contraindicated for induction of labor. Answer 2 is correct
because pitocin at 2 milliunits/min IV is an appropriate
dose for induction of labor in a client who is past her estimated
date of delivery. Answer 3 is incorrect because
betamethasone is used to stimulate fetal lung maturity in
preterm gestation, and is not used for induction of labor.
Answer 4 is incorrect because Cytotec is used for induction of
labor, but 200 mcg is too high a dose for induction of labor and
may cause uterine hyperstimulation and uterine rupture. The
normal dose of Cytotec for induction is 25 mcg vaginally or
50 mcg orally. Answer 5 is correct because cervidil 10 mg
vaginally is an appropriate method to induce labor.
A client presents to an emergency
department at 8 weeks’
gestation. A physician suspects that the client
has an
ectopic (tubal) pregnancy. When performing
an initial
assessment, which symptom should a nurse
recognize as
consistent with a diagnosis of ectopic (tubal)
pregnancy?
1. Painless vaginal bleeding.
2. Abdominal cramping.
3. Throbbing pain in the upper quadrant.
4. Sudden, stabbing pain in the lower
quadrant.
CORRECT ANSWER: 4. Answer 1 is incorrect because
painless vaginal bleeding is a symptom of placenta
previa.
Ectopic pregnancy is a painful condition. Answer 2 is
incorrect
because abdominal cramping is related to
threatened or imminent
abortion. Ectopic pregnancy is characterized by
sharp
pain. Answer 3 is incorrect because throbbing pain
in the
upper quadrant is not a characteristic of ectopic
pregnancy.
The fallopian tubes are in the lower quadrant.
Answer 4 is
correct because sudden, stabbing pain in the
lower quadrant
is a symptom of ectopic pregnancy. The pain
is related
A client presents to a prenatal clinic
and tells a physician
that she thinks she might be pregnant
because she has
not has a period for about 5 months.
Which is the most
definitive sign of pregnancy?
1. Elevated human chorionic
gonadotropin.
2. The presence of fetal heart tones.
3. Uterine enlargement.
4. Breast enlargement and
CORRECT ANSWER: 2. Answer 1 is incorrect because
elevated human chorionic gonadotropin can been
seen in a
hydatidiform mole. Answer 2 is correct because
the presence
of fetal heart tones is a positive sign of
pregnancy. Answer 3
is incorrect because uterine enlargement can be a
result of a
tumor, a hydatidiform mole, or myomata. Answer 4
is incorrect
because breast enlargement and tenderness can
be caused by
hormonal fluctuations of the normal menstrual
cycle
A client, who is gravida 3, para 2 at
39 weeks’ gestation
with poorly controlled gestational
diabetes, has just given
birth via cesarean section. A nurse will
expect that the
neonate will most likely be:
1. Hypoglycemic, small for gestational
age.
2. Hyperglycemic, large for
gestational age.
3. Hypoglycemic, large for gestational
CORRECT ANSWER: 3. Answer 1 is incorrect because,
with poorly controlled gestational diabetes, the
neonate will
likely be hypoglycemic, but large for gestational
age, not small
for gestational age. Answer 2 is incorrect because,
with poorly
controlled gestational diabetes, the neonate will
likely be
hypoglycemic, not hyperglycemic. Answer 3 is
correct because,
with poorly controlled gestational diabetes,
the neonate
will likely be hypoglycemic and large for
gestational age.
Answer 4 is incorrect because, with poorly
controlled gestational
diabetes, the neonate will likely be hypoglycemic,
A client, who is gravida 3, para 2, is 8
cm dilated, 100%
effaced, and a 0 station. When
evaluating the fetal monitor
tracing, a nurse notes baseline heart
rate 170 bpm,
minimal variability, and consistent
late decelerations.
What is the most likely explanation of
this pattern?
1. The fetus is asleep.
2. The umbilical cord is compressed.
3. There is a head compression.
4. There is uteroplacental
insufficiency.
CORRECT ANSWER: 4. Answer 1 is incorrect because
fetal sleep can manifest as minimal variability—but
this
fetus also has tachycardia and late decelerations,
which are
not associated with fetal sleep. Answer 2 is incorrect
because
umbilical cord compression is manifested by
variable decelerations,
not late decelerations or tachycardia. Answer 3 is
incorrect
because head compressions are early
decelerations that
mirror the contractions, not late decelerations or
tachycardia.
Answer 4 is correct because late decelerations
are indicative
of uteroplacental insufficiency, and
A client, who is gravida 1, para 0,
presents to labor and
delivery with contractions every 3
minutes. The client
states that she has not felt the baby
move for the last
2 hours. What action should the nurse
take first?
1. Call the physician.
2. Place the client on an external fetal
monitor.
3. Start an IV.
CORRECT ANSWER: 2. Answer 1 is incorrect
because an assessment should be completed before calling
the physician. Answer 2 is correct because decreased
fetal movement may be a sign of hypoxia in the fetus
or a fetal demise. Placing the client on a fetal monitor
will assist the nurse to evaluate the fetal well-being.
Answer 3 is incorrect because starting an IV will not demonstrate
fetal well-being, or do anything about evaluating the
decreased fetal movement. Answer 4 is incorrect because
maternal vital signs are not as crucial at this time.
Evaluating the fetus is most important when a client
presents with decreased fetal movement.
 Aclient, who is gravida 4, para 3, is 4
cm dilated, 80%
effaced, and a +1 station. Assessment
of the fetal monitor
tracing reveals baseline 140 bpm,
moderate variability,
and accelerations and variable
decelerations to 100 bpm.
Which action should a nurse take
first?
1. Notify her physician.
2. Give a 500-mL bolus IV.
3. Reposition the client.
4. Readjust the monitor.
CORRECT ANSWER: 3. Answer 1 is incorrect because
the nurse should try to resolve the variable
decelerations
before notifying the physician. Answer 2 is incorrect
because, although giving a 500-mL bolus IV is part
of thethe client is the first action the nurse should
take. Answer 3
is correct because repositioning the client
will help to
alleviate the variable decelerations. This
should be the
first action of the nurse. Answer 4 is incorrect
because
readjusting the monitor does nothing to resolve
A gravida 4, para 2 client with gestational diabetes is
having
nonstress tests twice a week. A nurse evaluates the
fetal monitor strip. Which fetal heart rate pattern should
the nurse interpret as reassuring?
1. A baseline fetal heart rate of 170–180 bpm.
2. Baseline variability of 25–35 bpm.
3. Variable decelerations to 100 bpm.
4. Acceleration of FHR with fetal movements.
A client, who is gravida 3, para 2, receives an epidural for
labor pain relief. A nurse knows the client will need to
have a Foley catheter placed if the epidural is in place
longer than 1 hour. Which is the best rationale for this
nursing action?
1. The bladder fills more rapidly because of the medication
used for the epidural.
2. Her level of consciousness is such that she is in a
trancelike state.
3. The sensation of the bladder filling is diminished or lost.
4. She is embarrassed to ask for the bedpan that
frequently.
CORRECT ANSWER: 4. Answer 1 is incorrect because a
baseline fetal heart rate of 170 to 180 bpm is
tachycardia and
is nonreassuring. Answer 2 is incorrect because
baseline variability
of 25 to 35 bpm is marked variability, and not a
characteristic
of a reassuring fetal heart rate pattern. Answer 3 is
incorrect because variable decelerations to 100
bpm are a
result of cord compression and are not a
characteristic of a reassuring
fetal heart rate pattern. Answer 4 is correct
because
accelerations are correlated with fetal
movement and adequate
oxygen reserves in the fetus.
CORRECT ANSWER: 3. Answer 1 is incorrect because
the
bladder fills more rapidly because of the fluid bolus
given
before the epidural, not the medication used for
the epidural.
Answer 2 is incorrect because the epidural does not
affect the
level of consciousness. Answer 3 is correct
because the sensation
of the bladder filling is diminished or lost
when the
client has an epidural. Answer 4 is incorrect
because there is
no information in the stem that would indicate that
she is
embarrassed to ask for the bedpan that frequently.
Even if that
A woman is practicing natural family planning
methods.
She asks a nurse about the most likely time for her
to
conceive. The nurse explains that conception is
most likely
to occur when:
1. Estrogen levels are low.
2. Luteinizing hormone is high.
3. The endometrial lining is thin.
4. The progesterone level is low.
A client tells a nurse that she plans to use the
rhythm
method of birth control. The nurse instructs the
client
that the success of this method depends on the:
1. Age of the client.
2. Frequency of intercourse.
3. Regularity of the menses.
CORRECT ANSWER: 2. Answer 1 is incorrect because,
during the ovulatory phase, the developing follicles produce
estrogen, which is critical for the buildup of the uterine
lining. To conceive, the estrogen levels need to be elevated.
Answer 2 is correct because the luteinizing hormone
surge
is responsible for triggering ovulation, or the release
of
the egg from the ovary, and conception. Answer 3 is
incorrect
because, during the ovulatory phase, the developing
follicles produce estrogen, which is critical for the buildup
of the uterine lining. The lining must be thick to nourish the
fertilized egg. Answer 4 is incorrect because progesterone is
the reproductive hormone that is actually produced by the
corpus luteum (a part of the ovary from which the mature
egg bursts during ovulation). The levels need to be elevated
for conception to occur.
CORRECT ANSWER: 3. Answer 1 is incorrect because
the age of the client has nothing to do with the
success of
the method. Answer 2 is incorrect because the
timing of
intercourse, not the frequency of intercourse, is
the important
factor. Answer 3 is correct because the
effectiveness of the
rhythm method depends on how consistent
her cycle is
and how accurately the couple tracks when
she could be
ovulating. Answer 4 is incorrect because, although
the range
of the client’s temperature can be important, the
regularity
of the menstrual cycle and commitment to timing
A 34-year-old client with type 1 diabetes
since age 5 asks
a nurse for advice regarding methods of
birth control.
Which method of birth control is the best
choice for a
client with type 1 diabetes?
1. Intrauterine device.
2. Oral contraceptives.
3. Diaphragm.
4. Contraceptive patch.
CORRECT ANSWER: 3. Answer 1 is incorrect because
intrauterine devices have a higher rate of infection. A client
with diabetes should be protected from the risk of developing a
pelvic infection due to the intrauterine device. Answer 2 is
incorrect because oral hormonal contraceptive methods can
affect the carbohydrate metabolism and insulin utilization in
clients with type 1 diabetes. Answer 3 is correct because barrier
methods (e.g., diaphragm) are the best choice for a client
with diabetes since they do not have the undesirable side
effects that the other methods have. Answer 4 is incorrect
because a contraceptive patch is a hormonal contraceptive
method that can affect the carbohydrate metabolism and
insulin utilization in clients with type 1 diabetes.
A client, who is 44 years old, gravida 3, para 2, has just
delivered a newborn suspected of having trisomy 21.
Which characteristics should a nurse observe in an infant
with this condition? Select all that apply.
1. Simian creases.
2. Increased muscle tone.
3. Flat appearance of the face.
4. Small tongue.
5. Upward-slanting eye creases.
. A nursing student is performing an initial newborn
assessment. The newborn is observed to have a cephalohematoma.
What are the likely causes of this condition?
Select all that apply.
1. Scheduled cesarean delivery.
2. Prolonged latent phase of labor.
3. Prolonged second stage of labor.
4. Vacuum-assisted vaginal delivery.
5. Breech presentation
CORRECT ANSWERS: 1, 3, 5. Answer 1is correct
because simian creases are a typical finding in a newborn
with trisomy 21. Answer 2 is incorrect because decreased,
not increased, muscle tone is typical of newborns with trisomy
21. Answer 3 is correct because flat appearance of
the face is typical of newborns with trisomy 21. Answer 4
is incorrect because large tongue, not small tongue, is typical
of newborns with trisomy 21. Answer 5 is correct because
upward-slanting eye creases are typical of newborns with
trisomy 21
CORRECT ANSWERS: 3, 4. Answer 1 is incorrect because
cephalohematoma is an area of bleeding underneath one of the
cranial bones usually caused by a difficult birth. A scheduled
cesarean delivery does not result in trauma to the fetal head
with a result of cephalohematoma. Answer 2 is incorrect
because prolonged latent phase does not necessarily mean a
difficult birth. A prolonged latent phase is fairly common in
clients who are primigravida. This is the phase of labor when
the cervix is less than 4 cm dilated. Answer 3 is correct
because prolonged second stage of labor is a long pushing
stage that may result in a cephalohematoma, caused by
the
fetal head being in the birth canal for a prolonged period.
Answer 4 is correct because vacuum-assisted vaginal
delivery
may result in a cephalohematoma caused by the
application
of a vacuum extractor. Answer 5 is incorrect because breech
presentation does not result in fetal head trauma; therefore,
cephalohematoma does not form on the fetal head.
An 18-year-old client chooses oral contraceptives as
her method of birth control. Which instruction
should be included in a nurse’s teaching regarding
oral contraceptives?
1. Weight gain should be reported to the physician.
2. An alternate method of birth control is needed when
taking antibiotics.
3. If the client misses one or more pills, two pills
should be taken per day for 1 week.
4. Nausea or stomach upset should be reported to the
physician.
. A 27-year-old client, who is gravida 3, para 1, presents to
a labor and delivery unit at 33 weeks’ gestation. She tells
a nurse that she woke up this morning in a pool of blood
about the size of an orange, but she has no abdominal
cramping or pain. The nurse’s first action should be to:
1. Assess the fetal heart tones.
2. Check for cervical dilation.
3. Check for firmness of the uterus.
4. Obtain maternal vital signs
CORRECT ANSWER: 2. Answer 1 is incorrect because
weight gain is a common side effect of oral
contraceptives that
does not need to be reported to the physician.
Answer 2 is correct because an alternate
method of birth control is needed
when taking antibiotics due to the decreased
effectiveness
of oral contraceptives when taking
antibiotics. Answer 3 is
incorrect because, if the client misses one or more
pills, two
pills should be taken on the day that the client
remembers; and
two pills the next day if two pills are missed, not
two pills for a
week. Answer 4 is incorrect because nausea and
stomach upset
are common side effects of oral contraceptives
CORRECT ANSWER: 1. Answer 1 is correct because the
client likely has a placenta previa. Assessing the fetal heart
tones for signs of fetal distress is the most important action.
Answer 2 is incorrect because the client likely has a placenta
previa, and a cervical examination is contraindicated. Answer 3
is incorrect because the client likely has a placenta previa. The
uterus is firm with minimal relaxing with a placental abruption.
Answer 4 is incorrect because, although the client likely
has a placenta previa and obtaining maternal vital signs is
important, assessing the fetal heart tones for signs of fetal distress
is the most important action
A client, who is gravida 1, para 0 at 37 weeks’ gestation,
is admitted to labor and delivery in active labor. A vaginal
examination reveals a footling breech presentation.
Which action should the nurse take first?
1. Anticipate the need for a cesarean section.
2. Apply the fetal heart monitor.
3. Place the client in genupectoral position.
4. Perform an ultrasound exam.
A client, who is gravida 2, para 1, is admitted to a
birthing center. A nurse is using a Doppler to check fetal
heart tones. The nurse finds fetal heart tones of 160 to
170 bpm. A vaginal examination reveals that the cervix
is 4 cm dilated, with intact membranes and a –1 station.
The nurse decides to apply an external fetal monitor rather
than an internal monitor. Which is the best rationale for
this decision?
1. The cervix is closed.
2. The membranes are still intact.
3. The fetal heart tones are within normal limits.
4. The contractions are intense enough for insertion of
an internal monitor
CORRECT ANSWER: 1. Answer 1 is correct
because the client will need a cesarean
section as
quickly as possible to avoid a vaginal
delivery and
possible head entrapment. Answer 2 is incorrect
because
applying the fetal heart monitor is important, but
does not
facilitate preparation for the cesarean section.
Answer 3 is
incorrect because placing the client in
genupectoral position
is appropriate for a prolapsed cord, not for footling
breech
presentation. Answer 4 is incorrect because the
vaginal
examination has already revealed a footling
CORRECT ANSWER: 2. Answer 1 is incorrect
because the cervix is 4 cm dilated, not closed.
Answer 2 is
correct because the nurse cannot artificially
rupture
the amniotic membranes in order to apply an
internal
fetal monitor. The only choice for continuous
fetal
monitoring is an external fetal monitor. Answer
3 is
incorrect because the fetal heart tones show
tachycardia,
which is an indicator that continuous fetal
monitoring is
needed to ensure fetal well-being. Answer 4 is
incorrect
because, when the contractions are intense
enough, there
CORRECT ANSWER: 2. Answer 1 is incorrect
because the cervix is 4 cm dilated, not closed.
Answer 2 is
correct because the nurse cannot artificially
rupture
the amniotic membranes in order to apply an
internal
fetal monitor. The only choice for continuous
fetal
monitoring is an external fetal monitor. Answer
3 is
incorrect because the fetal heart tones show
tachycardia,
which is an indicator that continuous fetal
monitoring is
needed to ensure fetal well-being. Answer 4 is
incorrect
because, when the contractions are intense
enough, there
A client, who is gravida 2, para 0 at 38 weeks’
gestation,
is having sharp decreases in fetal heart rate
from a baseline
of 130 bpm to 90 to 110 bpm during the
contractions.
Which action should a nurse take first?
1. Reposition the monitor.
2. Turn the client to her left side.
3. Ask the client to ambulate.
4. Prepare the client for delivery.
CORRECT ANSWER: 2. Answer 1 is incorrect because
this action will do nothing to resolve the
decelerations of the
fetal heart tones. This would be an appropriate
action if there
was an inconsistent or broken tracing. Answer 2 is
correct
because the first action the nurse should
take is to turn the
client to her left side, which may help resolve
the variable
decelerations. Answer 3 is incorrect because
asking the client
to ambulate may make the variable decelerations
worse, especially
if the reason for the decelerations is cord
compression.
Answer 4 is incorrect because preparing the client
for delivery
A client, who is gravida 1, para 0, is dilated to 6
cm,
100% effaced, and a 0 station for the past 2
hourswithout any change in her cervix. A physician
orders
oxytocin (Pitocin) augmentation. When evaluating
the
effectiveness of IV oxytocin augmentation, which
outcome
should a nurse anticipate?
1. A painless delivery.
2. Cervical effacement.
3. Infrequent contractions.
4. Progressive cervical dilation.
CORRECT ANSWER: 4. Answer 1 is incorrect
because oxytocin makes the contractions more painful.
Painless delivery would not be a measure of the
effectiveness of IV oxytocin. Answer 2 is incorrect
because this client was already 100% effaced before the
oxytocin augmentation was started. Answer 3 is incorrect
because infrequent contractions would mean the oxytocin
was not effective. IV oxytocin increases the frequency of
the contractions. Answer 4 is correct because this client
has uterine dystocia, and the effectiveness of the
oxytocin infusion is measured by a change in the
dilation of the cervix
A client with type 1 insulin-dependent diabetes
presents to a prenatal clinic at 17 weeks’ gestation for
α-fetoprotein testing. She asks a nurse why this test is
being performed. Which explanation by the nurse
would be most accurate?
1. “This test is to determine the sex of your baby.”
2. “This test is to determine glycemic control.”
3. “This test is screening for neural tube defects.”
4. “This test is to determine fetal lung maturity.”
. A client entered the fourth stage of labor 30 minutes ago.
During an assessment, a nurse notes that there is constant
trickling of bright red vaginal blood in the presence of a
contracted uterus midline at the umbilicus. Which action
by the nurse would be most appropriate in this situation?
1. Massage the fundus.
2. Call the physician.
3. Have the client empty her bladder.
4. Increase the oxytocin infusion.
CORRECT ANSWER: 3. Answer 1 is incorrect
because analysis of amniotic fluid from
amniocentesis
allows determination of fetal gender. Answer 2 is
incorrect
because glycemic control is determined by
hemoglobin A1c,
a maternal blood test. Answer 3 is correct
because the
α-fetoprotein (AFP) is a maternal blood test
that screens
for possible neural tube defects (the most
common
anomaly) in fetuses of a client with diabetes.
It can also
indicate the presence of Down syndrome.
Answer 4 is
incorrect because the presence of
CORRECT ANSWER: 2. Answer 1 is incorrect because
fundal massage would be an appropriate
intervention for
uterine atony. Symptoms of uterine atony would
reveal a
constant trickle of bright red blood in the presence
of a
boggy uterus. In this case it is in the presence of a
contracted
uterus. Answer 2 is correct because a constant
trickling
of bright red vaginal blood in the presence of
a contracted
uterus may be an unrepaired laceration of
the birth
canal. The physician must be notified so that
the laceration
can be repaired. Answer 3 is incorrect because
excessive
bleeding caused by a full bladder would reveal a
A nurse assesses a client who delivered an 8-pound,
6-ounce infant 2 hours ago. Which assessment findings
are considered “normal” in a client during this time?
Select all that apply.
1. Fundus firm, at the umbilicus.
2. Fundus firm, 2 fingerbreadths below the umbilicus.
3. Bluish-white fluid expressed from her breasts.
4. Lochia serosa, moderate amount.
5. Moderate lochia rubra.
CORRECT ANSWERS: 1, 5. Answer 1 is correct
because
the fundus is usually at about the level of the
umbilicus
2 hours after delivery. Answer 2 is incorrect
because the fundus
is not found 2 fingerbreadths below the umbilicus
until
about 48 hours after delivery. Answer 3 is incorrect
because
bluish-white fluid in milk does not come in until 3
to 4 days
after delivery, not 2 hours after delivery. Answer 4 is
incorrect
because lochia serosa does not occur until about 5
days afterdelivery, lasting about 5 days. Answer 5
A client delivered an 8-pound, 9-ounce neonate at
39 weeks’ gestation. Which observations, if found during
the initial assessment, are normal findings and do not
need to be reported to a physician? Select all that apply.
1. Heart rate of 170 at rest.
2. Respiratory rate of 46.
3. Circumoral cyanosis.
4. Caput succedaneum over the occiput.
5. Mongolian spots.
CORRECT ANSWERS: 2, 4, 5. Answer 1is incorrect
because the normal heart rate at rest is 110 to 160. A rate of
170 is tachycardia, which is not normal after birth, and may
indicate neonatal sepsis. This needs to be reported to the
physician. Answer 2 is correct because the normal respiratory
rate is 30 to 60 breaths/min. This finding does not
require any intervention and does not need to be reported
to the physician. Answer 3 is incorrect because circumoral
cyanosis, a bluish color around the mouth, is an abnormal
finding and requires further assessment, including pulse
oximetry. Findings need to be reported to the physician.
Answer 4 is correct because caput succedaneum is edema
over the back of the fetal head caused by pressure over
the presenting part of the fetal head and it resolves
spontaneously.
This finding does not require any intervention
and does not need to be reported to the physician.
Answer 5 is correct because mongolian spots are a normal
finding in dark-skinned neonates. This finding does not
require any intervention and does not need to be reported
to the physician
A laboring client, who is gravida 1, para 0, has had no
change in her cervix for 2 hours and remains 9 to 10 cm
dilated. The fetal head has remained at 0 station. A sterile
vaginal examination reveals a position of occiput posterior.
Which action by the nurse would be most appropriate?
1. Prepare the client for a forceps rotation.
2. Assist the client to a hands-and-knees position.
3. Assist the client to a supine position.
4. Prepare the client for a cesarean delivery.
A client with preterm contractions at 34 weeks’ gestation is
dilated to 3 cm. A physician orders an amniocentesis for
fetal lung maturity. Which laboratory test will provide the
most information to a nurse about fetal lung maturity?
1. Human chorionic gonadotropin (HCG).
2. Phosphatidylglycerol (PG)
3. α-Fetoprotein (AFP).
4. Partial thromboplastin time (PTT).
CORRECT ANSWER: 2. Answer 1 is incorrect because
use of forceps when the client is not completely dilated is
not acceptable practice according to the American College of
Obstetricians and Gynecologists. Answer 2 is correct
because maternal position changes such as sitting,
kneeling,
lateral, or hands and knees can assist fetal head rotation
from an occipitoposterior to an occipitoanterior
position. Answer 3 is incorrect because, in the supine position,
the gravid uterus compresses the pelvic blood vessels
and compromises uteroplacental blood flow. This position
not only has no effect on rotation of the fetal head, but can
cause decreased perfusion to the placenta. Answer 4 is incorrect
because cesarean delivery should be considered only if
adequate contractions are documented and there is still no
change in the cervical dilation.
CORRECT ANSWER: 2. Answer 1 is incorrect because
human chorionic gonadotropin (HCG) is a hormone
produced by the developing placenta that prevents
the corpus
luteum from deteriorating and secretes estrogen
and
progesterone, which maintains the pregnancy for
the first
20 weeks of gestation. It is found in maternal blood
and
urine. Answer 2 is correct because
phosphatidylglycerol
(PG) is a major phospholipid of surfactant.
The presence
of PG in amniotic fluid indicates fetal lung
maturity.
Answer 3 is incorrect because α-fetoprotein (AFP) is
a plasma
protein that is produced by the fetus. Abnormally
high
A client, gravida 2, para 0, is admitted to a
labor
and delivery unit at 35 weeks’ gestation. Her
blood
pressure is 180/110 mm Hg, pulse 88,
respirations 18,
and temperature 98.6°F. Her urine dipstick
shows 3+
proteinuria and a physical assessment reveals
3+ deep
tendon reflexes. A physician orders
magnesium sulfateto be infused at 2 gm/hr.
Which action by a nurse
indicates understanding of the possible side
effects of
magnesium sulfate?
1. Placing a sign over the bed not to check
blood pressure
CORRECT ANSWER: 4. Answer 1 is incorrect because
checking the blood pressure in the right arm has
no association
with the side effects of magnesium sulfate. Answer
2
is incorrect because this intervention is
contraindicated in
a seizure. It acts to occlude the airway and prevent
proper
ventilation. Answer 3 is incorrect because inserting
a Foley
catheter is not associated with any side effects of
magnesium
sulfate. It may be used to carefully measure output
and
signs of worsening preeclampsia, but not for side
effects
of magnesium sulfate. Answer 4 is correct
because magnesium
A client, who is gravida 3, para 0 at 39 weeks’
gestation, is
admitted to a labor and delivery unit in active
labor. The
physician performs an amniotomy. Which
assessment
finding should a nurse anticipate after the
amniotomy?
1. Fetal heart tones 90 bpm.
2. A moderate amount of straw-colored fluid.
3. A small amount of greenish fluid.
4. A small segment of the umbilical cord.
CORRECT ANSWER: 2. Answer 1 is incorrect because
fetal heart tones less than 110 bpm is bradycardia
and not
a normal finding after amniotomy. Answer 2 is
correct
because a moderate amount of straw-colored
fluid is a
normal color and an amount of amniotic fluid
that is
expected after the artificial rupture of
membranes.
Answer 3 is incorrect because a small amount of
greenish
fluid is meconium staining, not a normal result
after
amniotomy. Answer 4 is incorrect because a small
segment
of the umbilical cord would be a prolapsed cord,