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MATERNAL AND CHILD NURSING

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ANATOMY AND PHYSIOLOGY
1. The hormone responsible for a positive pregnancy test is:
A. Follicle Stimulating hormone
B. Human Chorionic Gonadotropin
C. Estrogen
D. Progesterone
Answer: B
Human chorionic gonadotropin (HCG) is the hormone secreted by the chorionic villi which is the
precursor of the placenta. In the early stage of pregnancy, while the placenta is not yet fully
developed, the major hormone that sustains the pregnancy is HCG.
2. The most common and normal site of nidation in the uterus is
A. Upper uterine portion
B. Mid-uterine area
C. Lower uterine segment
D. Lower cervical segment
Answer: (A) Upper uterine portion
The embryos normal nidation site is the upper portion of the uterus. If the implantation is in the
lower segment, this is an abnormal condition called placenta previa.
3. Which of the following are signs of ovulation?
1. Mittelschmerz
2. Spinnbarkeit
3. Thin watery cervical mucus;
4. Elevated body temperature of 3.0 degrees centigrade
A. 1 and 2
B. 1 and 3
C. 1, 2 and 3
D. 1, 2, 3, 4
Answer: C
Mittelschmerz, spinnabarkeit and thin watery cervical mucus are signs of ovulation. When
ovulation occurs, the hormone progesterone is released which can cause a slight elevation of
temperature between 0.2-0.4 degrees centigrade and not 4 degrees centigrade.
HUMAN SEXUALITY
4. Which of the following factors would be most influential to the outcome of a class on human
sexuality that includes both males and females ranging in age from adolescence through middleaged adults?
A. Environmental setting where the class will take place
B. Availability of written handouts to reinforce the content
C. The nurse's comfort level in discussing the subject matter
D. Cognitive level of the information to be presented
Answer C
Rationale: The nurse must demonstrate comfort with human sexuality content to facilitate an
effective presentation to a class. Although reinforcement of concepts is important, availability of
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written handouts is not the most important aspect to influence the outcome of the class. Although
cognitive level of the information to be presented is also an important factor still it is not the best
indicator in the determination of the effectiveness of the class. The setting for the class
presentation facilitates effectiveness, but it is not the primary factor in the determination of the
clients learning outcomes.
5. The client begins to question the nurse about sexuality and becoming sexually active. During
sexual counseling, the nurse should place a major point of emphasis on:
A. Douching after sexual intercourse
B. Sex during menstruation
C. Performing Kegels exercises
D. Safe and responsible sex
Answer: D
A and B options are not advisable. Kegels exercise is merely done to strengthen the perineal
muscles. Option D is the best answer since being sexually active is the primary concern of the
client. Safe and responsible sex will prevent the occurrence of STIs and unwanted pregnancies.
FAMILY PLANNING
6. During the postpartum period, a cardiac client with type 2 diabetes asks the nurse, "Which
contraceptives will I be able to use to prevent pregnancy in the near future?" The nurse's best
response would be:
A. "You may use oral contraceptives. They are almost 100% effective in preventing pregnancy."
B. "You may want to use a foam and a condom to prevent pregnancy until you consult
with your doctor at your postpartum visit."
C. "The intrauterine device is best for you because it does not allow a fertilized ovum to become
implanted in the urerine lining."
D. "You do not need to worry about becoming pregnant in the near future. Clients with cardiac
conditions usually become infertile."
Answer B
Explanation: A. Oral contraceptives are not recommended for this client because of their tendency
to alter glucose tolerance. B. Some type of a barrier contraceptive (condom) is usually
recommended for the client with diabetes mellitus and a cardiac condition. C. An IUD is not
recommended because it may predispose this client to infection. D. This is untrue; clients with a
cardiac condition can become pregnant again in the future.
7. The nurse recognizes that the client understands how to take her oral contraceptive when the
nurse hears the client tell her friend which of the following?
A. "If I take antibiotics, I should stop taking my pills."
B. "The pills have practically few serious side effects."
C. "I have to take one pill each day at the same time."
D. "I will need to have a complete physical every 3 months."
Answer C
Rationale: To maintain a constant hormone level, the pill should be taken at the same time each
day. The client will need to have a physical exam and Pap smear once a year. If antibiotic therapy
is needed, it is best to continue the pills as usual. In addition, an alternative method of
contraception should be used. Some of the adverse effects, such as blood clots and pulmonary
embolism, are life-threatening.
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8. A client calls the clinic because she has forgotten to take her oral contraceptive for the past 2
days. Which of the following should the nurse advise the client to do?
A. Continue to take the remaining pills for the rest of the cycle
B. Discontinue the pills for the rest of the cycle and use condoms
C. Take two pills immediately and change to condoms for the rest of the cycle
D. Take two pills for the next 2 days and use condoms the rest of the cycle
Answer D
Rationale: To maintain hormone levels, the client should take the two pills for the next 2 days (to
compensate for the missed pills) and then complete the rest of the pills. To decrease the risk of
pregnancy, the client should also use an alternative method of contraception such as condoms for
the rest of cycle. When two pills have been missed, an alternative form of contraception must be
used. Discontinuing the pills for the rest of the cycle would cause a sudden drop in estrogen and
progesterone levels with resultant physiologic effects. Taking two pills immediately and then
changing to condoms would also cause a drop in the levels of estrogen and progesterone with
resultant physiologic effects.
9. The nurse determines that a client understands the natural cervical mucus contraceptive
method when the client describes the cervical mucus during her fertile period as which of the
following?
A. Thick, cloudy and scanty
B. Cloudy, white, and sticky
C. Clear, wet, and sticky
D. Clear, thick and sticky
Answer C
Rationale: In response to high estrogen and progesterone levels during the fertile period, the
mucus is clear, wet, sticky and slippery (like an egg white) is more abundant. Cloudy white and
sticky mucus occurs after ovulation. Thick cloudy mucus is present in the postovulatory phase.
The mucus has a yellowish color in the preovulatory phase.
10. Which of the following terms best describes the conscious process by which a couple decides
on the number and spacing of children and the timing of births?
A. Preconception planning
B. Fertility management
C. Family planning
D. Emergency contraception
Answer C
Rationale: Family planning is allowing the couple to freely choose when they want to conceive and
have children, not just the prevention of pregnancy. It empowers them to feel ready physically,
emotionally, and financially for the roles and tasks of parenthood. Emergency contraception is a
hormonal form of birth control given within 72 hours of unprotected sexual intercourse to prevent
implantation and pregnancy. This is a situational crisis and it is not considered planning. Although
family planning may involve management of infertility, this answer is not inclusive of all aspects of
planning for a family. Preconception planning offers couples an opportunity to enhance the
probability of having a healthy newborn by examining the health history of both partners and
providing appropriate guidance and counseling.
11. The nurse correctly teaches that the most frequent side effect associated with the use of IUD's
is:
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A. Expulsion of the IUD
B. Excessive menstrual flow
C. Rupture of the uterus
D. Ectopic pregnancy
Answer B
Explanation: B. Subsequent to IUD insertion, there may be an excessive menstrual flow for several
cycles; this is because of an increase in the blood supply resulting from the inflammatory process
because the IUD is really a foreign body. A. This may occur but is not classified as a side effect. C.
This may occur upon insertion but is fairly uncommon. D. There is no documentation of this.
12. For which of the following would the nurse be alert if the client is receiving
medroxyprogesterone (Depo-Provera) injections?
A. Hepatitis A
B. Pelvic inflammatory disease
C. Myocardial infarction
D. Venous thrombosis
Answer D
Rationale: Medroxyprogesterone (Depo-Provera) carries an increased risk of venous thrombosis
and thromboembolism. Hepatitis B is transmitted by contact with contaminated blood and body
fluids. Myocardial infarction is not associated with the use of Depo-Provera. Pelvic inflammatory
disease is primarily caused by microorganisms that ascend from the vagina to the uterus and
adnexa.
13. Which of the following is the primary factor to consider when assisting a client in choosing the
optimum contraceptive method?
A. Compatibility with cultural values
B. Consistent and correct use
C. Few side effects
D. Lowest failure rate
Answer B
Rationale: The efficacy of the method chosen by the partners is directly proportional to the
consistent and correct use of the method chosen. The optimal contraceptive method, therefore, is
the one that is most effective for that couple when used consistently and correctly. Although
cultural compatibility is important, it is not the most important aspect of the choice of
contraception. Although few side effects are important, this is not the most important aspect of
the chosen method of contraception. No contraceptive method has been scientifically proven to
be 100% effective in the prevention of conception. Even with a low failure rate, if the method is
not used consistently and correctly, optimal effectiveness will not be achieved.
INFERTILITY
14. Mr. and Mrs. Bravo are in the fertility clinic due to becoming very discouraged regarding their
efforts to conceive. The nurse can best support them by understanding that the most stressful
aspect of the process is:
A. Obtaining the necessary specimens
B. Visitng the fertility clinic frequently
C. Discovering which partner is infertile
D. Planning when intercourse should take place
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Answer D
Explanation: A. Obtaining and delivering the necessary specimens may be inconvenient but
should not be stressful. B. The number of office visits and examinations that are required may be
cumbersome but should not be stressful. C. The couple probably knows that one of them has a
fertility problem; it may be helpful knowing that the problem is so that measures can be taken to
correct it. D. A strategy for increasing the chances of conceiving requires the couple to plan
intercourse only while the woman is ovulating; this removes spontaneity and is often stressful.
15. A couple with one child has been trying, without success, for several years to have another
child. Which of the following terms would describe this situation?
A. primary infertility
B. secondary infertility
C. irreversible infertility
D. sterility
Answer: B
Because the couple successfully conceived previously, their situation would be accurately
described as secondary infertility. Primary infertility would apply if the couple had never conceived
a child. This scenario does not suggest irreversible infertility, also called sterility. (Lippincotts
Maternal-Newborn Nursing, p 58)
16. The causes of female infertility could be functional, anatomic, or psychological. Which of the
following causes of infertility in the female is primarily psychological in origin?
A. Dyspareunia
B. Impotence
C. Endometriosis
D. Vaginismus
Answer: D
Vaginismus is primarily psychological in origin. Endometriosis is a condition that is caused by
organic abnormalities. Dyspareunia is usually caused by infection, endometriosis or hormonal
changes in menopause although may sometimes be psychological in origin.
17. When assessing the adequacy of sperm to conception to occur, which of the following is the
most useful criterion?
A. sperm count
B. sperm maturity
C. sperm motility
D. semen volume
Answer: C
Although all the factors listed are important, sperm motility is the most significant criterios when
assessing the male infertility. Sperm count, sperm maturity, and semen volume are all significant,
but they are not as significant as sperm motility. (Lippincotts Maternal-Newborn Nursing, p 58)
CHANGES DURING PREGNANCY
18. When measuring the fundal height of a client during a prenatal visit, the nurse finds the
fundus at the level of the umbilicus. The nurse would document the approximate gestational age
of the fetus as which of the following?
A. 12 weeks
B. 20 weeks
C. 32 weeks
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D. 40 weeks
Answer B
Rationale: At 20 weeks' gestation, the fundus is normally at the level of the umbilicus. At 12
weeks, the fundus would be below the symphysis pubis and therefore unmeasurable. The uterus
rises into the pelvis at about 12 weeks. At 32 weeks, the fundus would be above the umbilicus. At
40 weeks, the fundus would be at the level of the xiphoid process.
19. Which of the following would the nurse identify as a presumptive sign of pregnancy?
a. Hegars sign
b. Skin pigmentation changes
c. Nausea and vomiting
d. Positive pregnancy test
Answer: C
Presumptive signs are subjective signs. (Lippincotts Maternal-Newborn Nursing, p 74)
20. Which of the following urinary symptoms does the pregnant woman most frequently
experience during first trimester?
a. Burning
b. Dysuria
c. Incontinence
d. Frequency
Answer: D
Pressure and irritation of the bladder by the growing uterus during the first trimester is the one
responsible for causing urinary frequency. A, B, C are associated with UTI. (Lippincotts MaternalNewborn Nursing, p 74)
21. Research concerning the emotional factors of pregnancy indicates:
A. A rejected pregnancy will result in a rejeted infant
B. Ambivalence and anxiety about mothering are common
C. Maternal love is fully developed within the first week after birth
D. An effective mother experiences neither ambivalence nor anxiety about mothering
Answer B
Explanation: A. Frequently the maternal instinct is nurtured by the sight of the infant. B. Because
mothering is not an inborn instinct, almost all mothers, including multiparas, report some
ambivalence and anxiety about their ability to be good mothers. C. It may take a much longer
time. D. Ambivalent feelings are universal in response to a neonate.
22. The expected weight gain in a normal pregnancy during the last 3 months of pregnancy
A. 1 pound a week
B. 2 pounds a week
C. 1 kg a week
D. 2 kgs a week
Answer: (A) 1 pound a week
During the 3rd trimester the fetus is gaining more subcutaneous fat and is growing fast in
preparation for extra uterine life. Thus, one pound a week is expected.
23. Chloasma or skin pigmentation is expected during pregnancy. On what body parts would you
expected chloasma to be observed?
a. Forehead, nose cheeks
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b. Breast, areola, nipple
c. Breast, abdomen, thighs
d. Neck and chest, arms and legs
Answer: A
Chloasma, also known as the mask of pregnancy, is an irregular pigmented area found on the
face. It is not seen on the breast, areola, nipples, chest, neck, abdomen, arms, and legs.
(Lippincotts Maternal-Newborn Nursing, p 74)
24. Which of the following common emotional reactions to pregnancy would the nursing expect to
occur during the third trimester?
a. ambivalence, fear, fantasies
b. awkwardness, clumsiness, unattractiveness
c. introversion, egocentrism, narcissism
d. anxiety, passivity, extroversion
Answer: B
During the first trimester, the common reactions are fear, ambivalence, anxiety. During the
second trimester, the woman is expected to be introvert and passive, with increasing need to
learn about fetal growth and development. During the third trimester, the woman becomes
awkward, clumsy and unattractive and becomes reflective of her own childhood. (Lippincotts
Maternal-Newborn Nursing, p 74)
25. In the later part of the third trimester, the mother may experience shortness of breath. This
complaint maybe explained as
a. The woman maybe experiencing complication of pregnancy
b. The woman is having allergic reaction to the pregnancy and its hormones
c. The fundus of the uterus is high pushing the diaphragm upwards
d. A normal occurrence in pregnancy because the fetus is using more oxygen
Answer: C - The fundus of the uterus is high pushing the diaphragm upwards from the 32nd week
of the pregnancy, the fundus of the enlarged uterus is pushing the respiratory diaphragm
upwards. Thus, the lungs have reduced space for expansion consequently reducing the oxygen
supply.
FETAL GROWTH AND DEVELOPMENT
26. Viability is the ability of the fetus to live, growth, and develop on the outside environment. The
lower limit of viability for infants in terms of age of gestation is:
A. 21-24 weeks
B. 25-27 weeks
C. 28-30 weeks
D. 38-40 weeks
Answer: A
Viability means the capability of the fetus to live/survive outside of the uterine environment. With
the present technological and medical advances, 21 weeks AOG is considered as the minimum
fetal age for viability.
27. Which of the following refers to the single cell that reproduces itself after conception?
A. Chromosome
B. Blastocyst
C. Zygote
D. Trophoblast
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Answer: C
The zygote is the single cell that reproduces itself after conception. The chromosome is the
material that makes up the cell and is gained from each parent. Blastocyst and trophoblast are
later terms for the embryo after zygote.
28. The fontanels are soft spots formed by the:
A. blood accumulated between the bone and periosteum.
B. edema of the scalp from birth pressure.
C. junction of individual skull bones.
D. pressure of a vacuum extractor.
Answer: C
CHILDBIRTH EDUCATION
29. There are many ways of childbirth preparation to ease the stress and anxiety of the mother
during labor and delivery. The following are natural childbirth procedures EXCEPT:
A. Ritgens maneuver
B. Dick-Read method
C. Psychoprophylactic method
D. Lamaze method
Answer: A
Ritgens method is used to prevent perineal tear/laceration during the delivery of the fetal head.
Lamaze method is also known as psychoprophylactic method and Dick-Read method are
commonly known natural childbirth procedures which advocate the use of non-pharmacologic
measures to relieve labor pain.
ANTEPARTUM CARE
30. Josie, 15 years old, comes to the prenatal clinic because she has missed three menstrual
periods. Before her physical examination, she says. "I don't know what the problem is, but I can't
be pregnant." The nurse's most therapeutic response to this statement would be:
A. "What brought you to the prenatal clinic then?"
B. "The doctor will let you know shortly."
C. "If you have had intercourse, you are probably pregnant."
D. "Many young women are irregular at your age."
Answer A
Explanation: A. This response points out reality and allow the client to elaborate.B. This response
would close off any future communication with the client. C. This response sounds rather critical
or judgmental and would probably cut off further discussion with the client. D. This may be true
statement, but it does not allow for much discussion to follow
31. You performed the Leopolds maneuver and found the following: breech presentation, fetal
back at the left side of the mother. Based on these findings, you can hear the fetal heart beat
(PMI) BEST in which location?
A. Left lower quadrant
B. Right lower quadrant
C. Left upper quadrant
D. Right upper quadrant
Answer: C
The landmark to look for when looking for PMI is the location of the fetal back in relation to the
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right or left side of the mother and the presentation. The best site is the fetal back nearest the
head.
32. Between 24 and 28 weeks, all pregnant women should be screened for:
A. Anemia
B. Bladder infections
C. Diabetes
D. Neural tube defects
Answer: C
33. While preparing a primigravida for her first pelvic exam, the client begins to cry. Which of the
following would be the nurse's best response?
A. "The physician will tell you exactly what he is going to do."
B. "I will make sure that you are covered with a sheet at all times."
C. "We'll postpone the exam until you are more comfortable."
D. "Can you tell me what is making you so afraid?"
Answer D
Rationale: Because the client is upset and verbalizing fear, the nurse needs to gather additional
information for use in developing a plan for a most appropriate action. Although telling the client
that the nurse will keep her covered is reassuring, the nurse is ignoring the client's anxiety and
making assumptions about the cause of the client's upset. It is important to explain all procedures
to the client, but telling the client that the physician will tell her exactly what's going on ignores
the client's fears and also makes assumptions about the cause of the client's upset. The pelvic
examination at this time is important to obtain data to determine the client's risk status.
Postponing the exam would possibly place the client at risk for complications. Additionally, this
response doesn't address the client's feelings or the cause of her fears.
34. An amniocentesis done on a client at 16 weeks' gestation reveals a fetus with Down
syndrome. The client and her husband elect to have the pregnancy terminated. The nurse giving
care to a client whose pregnancy is surgically terminated should be aware that:
A. The client is emotionally unstable at this time
B. There is a high risk for a postoperative infection
C. Contraceptive counseling should be deferred to a later time
D. The client needs to express her feeling of guilt, anger, and frustration
Answer D
Explanation: A. This is a false assumption. B. This is a sterile procedure and should not predispose
the client to postoperative infection. C. Studies show that contraceptive counseling at this time is
most important, because the client may not return after the abortion. D. The client must feel
comfortable enough to verbalize her feelings of guilt; this helps to complete the grieving process.
35. At what point in the pregnancy would the nurse expect to administer a 1-hour, 50-gram
glucose-screening test to low to moderate risk clients?
A. Between 12 and 20 weeks' gestation
B. Between 24 and 28 weeks' gestation
C. Between 34 and 38 weeks' gestation
D. Between 8 and 12 weeks' gestation
Answer B
Rationale: Beginning in the second trimester, many women have pregnancy-induced glucose
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intolerance. Early detection provides opportunity to prevent complications arising from the
intolerance. Typically, a screening test for glucose is obtained between 24 and 28 weeks'
gestation. At 12 and 20 weeks and 8 and 12 weeks, it is too early for physiologic changes in
carbohydrate metabolism to produce glucose intolerance. Signs of gestational diabetes commonly
occur before 34 and 38 weeks' gestation. Waiting until this time would be too late.
36. In Leopolds maneuver step #1, you palpated a soft broad mass that moves with the rest of
the mass. The correct interpretation of this finding is:
A. The presentation is breech
B. The mass palpated is the buttocks
C. The mass palpated is the back
D. The mass palpated at the fundal part is the head part
Answer: B
The palpated mass is the fetal buttocks since it is broad and soft and moves with the rest of the
mass.
37. In Leopolds maneuver step # 3 you palpated a hard round movable mass at the supra pubic
area. The correct interpretation is that the mass palpated is:
A. The mass palpated is the fetal small part
B. The mass is the fetal back
C. The buttocks because the presentation is breech
D. The mass palpated is the head
Answer: D
38. When the mass palpated is hard round and movable, it is the fetal head.
Which of the following would the nurse use to explain the term quickening to a client who is at 18
weeks' gestation?
A. A light fluttering sensation when the fetus moves
B. A vaginal infection caused by yeast
C. Descent of the fetus into the pelvis
D. Vascular congestion and tenderness of the breast tissue
Answer A
Rationale: Quickening is defined as maternal perception of fetal movement, usually as a light
fluttering sensation when the fetus moves, typically between the 16th and 20th weeks of
pregnancy. A vaginal yeast infection is candidiasis, a vaginitis caused by Candida albicans.
Descent of the fetus into the pelvis is engagement and occurs in the last weeks of pregnancy.
Vascular congestion and tenderness of the breast tissue is commonly called engorgement which is
a sign in preparation to breast feeding.
39. Which of the following nursing diagnoses would be most appropriate for a woman in her third
trimester who tells her husband that she does not want to go out in public because she is
pregnant"?
A. Body Image Disturbance
B. Altered Role Performance
C. Anxiety
D. Ineffective Family Coping
Answer A
Rationale: Bodily changes during pregnancy often cause a negative body image. At the end of the
pregnancy, the woman often feels "out of shape" and "fat," leading to a nursing diagnosis of body
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image disturbance. Altered role performance applies to the state in which an individual
experiences or is at risk for experiencing a disruption in the way she perceives her role
performance. There is no evidence in this situation to suggest this nursing diagnosis. Anxiety
applies to a state in which an individual experiences feelings of uneasiness (apprehension) with
activation of the autonomic nervous system in response to a vague, nonspecific threat. There is no
evidence in this situation to suggest this nursing diagnosis. Ineffective family coping focuses on
family, not on an individual problem.
40. Getting the obstetrical history of the mother is part of the prenatal assessment. Which of the
following denotes the correct obstetric history for a client who is became pregnant 3 times already
and is currently at 5 weeks gestation, has a son born at 36 weeks, daughter born at 42 weeks'
gestation and a twin at 38 weeks?
A. G3 T1 P2 A0 L3
B. G3 T2 P1 A0 L4
C. G4 T2 P1 A0 L4
D. G4 T2 P1 A0 L3
Answer C
Rationale: This is the client's fourth pregnancy (G4). Her daughter and her twin were born at term
(40 and 37 weeks; T2) and one was delivered prior to 37 weeks' gestation (preterm; P1). There is
no history of abortions (A0) and all children are living (L4).
41. What is the obstetrical history of the mother who is 4 months pregnant, with twin daughters at
39 weeks, had lost a son at 4 weeks, and with a baby girl born 1 week before term?
A. G4 T1 P1 A1 L3
B. G4 T2 P1 A1 L2
C. G3 T1 P1 A0 L3
D. G4 T2 P1 A1 L3
Answer A
Rationale: This is the client's fourth pregnancy (G4). Her twin were born at term (39 weeks; T1)
and one was delivered prior to 37 weeks' gestation (preterm; P1), with history of abortion (A1) and
have 3 living children (L3).
42. Which of the following would be the nurse's best response to a client who asks the nurse to
explain the purpose of a nonstress test (NST)?
A. "The test provides information about the size of the baby."
B. "The test demonstrates the fetus's response to oxytocin."
C. "It determines how the baby's heart responds to uterine contractions."
D. "The test helps to give an accurate estimate of the gestational age."
Answer C
Rationale: An NST demonstrates the fetal heart response to spontaneous or induced uterine
contractions, which stress the fetus by decreasing uterine perfusion. If the fetus is already
compromised, the contractions may alter the heart rate. Oxytocin is not used in an NST. An NST
does not give information about the gestational age or the size of the infant.
43. Which of the following would the nurse include in a client's teaching plan about the danger
signs of pregnancy?
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A. Edematous feet
B. Quickening
C. Backache
D. Blurred vision
Answer D
Rationale: Blurred vision is a sign of pregnancy-induced hypertension that requires further
investigation. It may be cause by an increase in intraocular pressure causing visual disturbances
such as blurring of vision. Backache is a common discomfort of pregnancy associated with the
hormonal effects on the musculoskeletal system. Edema in the lower extremity is normally a sign
of venous stasis, especially if there is no edema of the hands or face. Although it may be
uncomfortable, edematous feet are not a danger sign. Quickening is fetal movement as perceived
by the mother and is normally occuring during pregnancy.
44. The rationale why pregnant women are prescribed with iron supplements during pregnancy is
A. The mother may have a problem of digestion because of pica
B. The mother may suffer anemia because of poor appetite
C. The mother may have physiologic anemia due to the increased need for red blood
cell mass as well as the fetal requires about 350-400 mg of iron to grow
D. The fetus has an increased need for RBC which the mother must supply
Answer: C
About 400 mgs of Iron is needed by the mother in order to produce more RBC mass to be able to
provide the needed increase in blood supply for the fetus. Also, about 350-400 mgs of iron is need
for the normal growth of the fetus. Thus, about 750-800 mgs iron supplementation is needed by
the mother to meet this additional requirement.
45. The most appropriate and recommended diet during pregnancy is a diet high in
A. Proteins, carbohydrates and fats
B. Carbohydrates and vitamins
C. Protein, minerals and vitamins
D. Fats and minerals
Answer: C
In normal pregnancy there is a higher demand for protein (body building foods), vitamins (esp.
vitamin A, B, C, folic acid) and minerals (esp. iron, calcium, phosphorous, zinc, iodine, magnesium)
because of the need of the growing fetus.
INTRAPARTUM CARE
46. During labor a client who has been receiving epidural anesthesia has a sudden episode of
severe nausea, and her skin becomes pale and clammy. The nurse's immediate reaction should be
to:
A. Notify the physician
B. Elevate the client's legs
C. Check for vaginal bleeding
D. Monitor the FHR every 3 minutes
Answers B
Explanation: A. If signs and symptoms do not abate after elevation of the legs, the physician
should be notified. B. Maternal hypotension is a common complication of this anesthesia for labor,
and nausea is one of the first clues that this has occurred. Elevating the extremities restores blood
to the central circulation. C. This is not a specific observation after caudal anesthesia; it is part of
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the general nursing care during labor. D. If the FHR is being monitored, it is a constant process; if
not, the FHR should be monitored every 15 minutes.
47. The mechanisms involved in fetal delivery is
A. Internal rotation, extension, external rotation, flexion
B. Descent, extension, flexion, external rotation
C. Descent, flexion, external rotation, extension, internal rotation
D. Descent, flexion, internal rotation, extension, external rotation
Answer: D
The mechanism of fetal delivery begins with descent into the pelvic inlet which may occur several
days before true labor sets in the primigravida. Flexion, internal rotation and extension are
mechanisms that the fetus must perform as it accommodates through the passageway/birth
canal. Eternal rotation is done after the head is delivered so that the shoulders will be easily
delivered through the vaginal introitus.
48. The primis duration of the 4 stage of labor is different from the multis. The cervical dilatation
taken at 8:00 A.M. in a G1P0 patient was 6 cm. A repeat I.E. done at 10 A.M. showed that cervical
dilation was 7 cm. The correct interpretation of this result is:
A. The duration of labor is normal
B. The active phase of Stage 1 is protracted
C. The latent phase of Stage 1 is prolonged
D. Labor is progressing as expected
Answer: B
The active phase of Stage I starts from 4cm cervical dilatation and is expected that the uterus will
dilate by 1cm every hour. Since the time lapsed is already 2 hours, the dilatation is expected to be
already 8 cm. Hence, the active phase is protracted.
49. When the bag of waters ruptures, the nurse should check the characteristic of the amniotic
fluid, specifically its color. The normal color of amniotic fluid is
A. Yellowish transparent
B. Clear as water
C. Greenish
D. Bluish
Answer: B
The normal color of amniotic fluid is clear like water. If it is yellowish, there is probably Rh
incompatibility. If the color is greenish, it is probably meconium stained.
50. A client in labor was rushed into the hospital. After obtaining the history, it was found out that
the pregnancy is only at 36 weeks gestation. The physician orders terbutaline sulfate (Brethine).
After its administration, the nurse assesses the client for the therapeutic effect of:
A. Reduction of pain in the perineal area
B. Decrease in blood pressure from 120/80 to 90/60
C. Decrease in frequency and duration of contractions
D. Dilation of the cervix from 1 to 1.5 cm for every hour of labor
Answer C
Explanation: Terbutaline sulfate (Brethine) is a beta-mimetic drug that acts on the smooth muscles
of the uterus to reduce contractilitiy, which in turns inhibits dilation and contractions. It has no
analgesic effects, does not act to decrease blood pressure, acts to arrest preterm labor by relaxing
the uterus; this would result in stopping cervical dilation rather than increasing it.
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51. During delivery, once the baby is done with external rotation, the first thing that a nurse must
ensure when the babys head comes out is
A. The cord is still attached to the placenta
B. The cord is intact
C. The cord is still pulsating
D. No part of the cord is encircling the babys neck
Answer: D
The nurse should check right away for possible cord coil around the neck because if it is present,
the baby can be strangulated by it and the fetal head will have difficulty being delivered.
52. At about 5 cm dilation, a laboring client receives medication for pain. The nurse is aware that
one of the medications given to women in labor that could cause respiratory depression of the
newborn is:
A. Meperidine (Demerol)
B. Promazine (Sparine)
C. Promethazine (Phenergan)
D. Scopolamine
Answer A
Explanation: Respiratory depression occurs with the use of meperidine (Demerol) and produces
significant depression of the infant at birth if circulating levels are high at time of birth.
Scopolamine induces amnesia and forgetfulness in the mother but does not cause respiratory
depression; this medication is not presently used. Prpmazine (Sparine), an anxiolytic, augments
the effects of demerol, thereby lessening the amount of drug needed. Promethazine (Phenergan),
an antihistamine, does not cause respiratory depression.
53. A pregnant woman, 38 weeks AOG, is admitted to the birthing unit in active labor. The client is
excited about the anticipated birth because she has 2 daughters and the amniocentesis indicates
that she will have a boy. The nurse recognizes that there are implications for newborn
observations and care when the nursing history reveals that:
A. The membranes ruptured 2 hours ago
B. There was a placenta previa in a previous pregnancy
C. Her first child was diagnozed with hemophilia
D. She has taken NSAIDs for frequent sinus headaches
Answer D
Explanation: NSAID as well as other over-the counter drugs (OCT) taken during pregnancy may
cause problems in the newborn during the neonatal period. The membranes ruptured 2 hours ago
is not a cause of concern; if membranes ruptured over 24 hours before birth, infection may ensue.
Hemophilia affects males; this fetus is known to be a female may be a carrier but would not have
hemophilia. Placenta previa would have been diagnosed before active labor; a history of a
placenta previa in an earlier pregnancy would not have implication for this newborn.
POSTPARTUM CARE
54. A client who is 24 hours postpartum has the following morning vital signs: Temperature 99.8
F; BP 124/78; PR 58bpm; RR 16cpm. The nurse should do which of the following?
A. Recognize the client's vital signs are normal.
B. Assess the vital signs hourly instead of every 4 hours.
C. Retake the pulse rate after the client ambulates.
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D. Report the changes in vital signs to the physician.
Answer A
Rationale: A temperature elevation greater than 100.4 F on any two consecutive readings is
considered febrile on the other hand a temperature of 99.8 F reflects the body's normal response
to tissue damage or repair and to slight dehydration from labor. Because the client's vital signs are
within normal limits, there is no indication to assess vital signs more frequently. All of the vital
signs are within normal limits and therefore do not need to be reported to the physician. As a
result of the increased stroke volume from a large amount of venous blood returning to the heart
(because it is no longer obstructed by the gravid uterus), the pulse rate may range from 50 to 90
beats/minute the first 1 to 2 days after delivery. Counting the pulse rate after ambulation would
not be necessary.
55. Which of the following would denote a positive maternal-infant bonding interaction during the
first 3 days?
A. Calling the infant "he" or "she" on the day of discharge
B. Carrying the infant slightly away from own body
C. Holding the infant in the "en-face" position
D. Laying the infant at the foot of the bed
Answer C
Explanation: Eye contact with the infant in the "en-face" position appears to have a cementing
effect on the development of a trusting relationship. Calling the infant "he" or "she" at discharge
indicates recognition of the infant's individuality and comes early in the postpartum period.
Enfolding the infant in the parent's arms, not away from the body, signals feelings of closeness.
Parents who are bonding want to have the infant close to them.
56. A primipara client just gave birth to average-for-gestational-age infant. Which of the following
assessment findings about the uterus would the nurse expect to find 12 hours post delivery?
A. Fundus soft, to the right of the midline, 2 fingerbreadths above the umbilicus
B. Fundus firm, midline, 2 fingerbreadths below the umbilicus
C. Fundus firm, midline, at the level of the umbilicus
D. Fundus firm, to the right of the midline, at the umbilical level
Answer C
Explanation: One hour after birth, the fundus rises to the level of the umbilicus, where it remains
for approximately 24 hours. It should be firm and in the middle. The fundus should be firm and
midline, but should not be 2 fingerbreadths below the umbilicus on the day of delivery. A fundus
that is to the right of the midline denotes urinary bladder distention. The fundus should be firm to
provide hemostasis. The fundus is up too far in the abdomen and is deviated to the right, denoting
a distended bladder.
57. Which of the following behaviors would the nurse expect to observe in a primipara client by
the third postpartum day?
A. Very talkative about the birth experience to friends
B. Greater interest in learning about infant care
C. Sleeping most of the time when the infant is not in the room
D. Requests for help with her activities of daily living
Answer B
Rationale: A greater interest in learning about infant care reflects the "taking hold" phase of
expressing interests outside of self and taking interest in the infant. Requests for help with
activities of daily living reflect passive, dependent behavior characteristic of the "taking in" phase
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(1 to 2 days after delivery). Basic needs of the woman need to be met in the passive, dependent
"taking in" phase. During the "taking in" phase, the client integrates the birth experience into her
being by frequently reviewing the experience.
58. Based on the protocol of the Department of Health, after how many weeks after delivery
should a woman have her postpartal check-up?
A. within a week
B. after 2 weeks
C. 4 weeks
D. 6 weeks
Answer: D
According to the DOH protocol postpartum check-up is done 6-8 weeks after delivery to make sure
complete involution of the reproductive organs has be achieved.
59. What is the nurse's best response for a client who asks, "How will sitting in a sitz bath help
me?"
A. "It is the best way to prevent you from getting a uterine and episiotomy infection."
B. "It will increase your urinary bladder muscle tone and facilitate bladder emptying."
C. "The healing process is basically brought by the warm temperature of the water."
D. "Sitting in the water promotes muscle contraction and prevents hemorrhaging."
Answer C
Rationale: Local moist heat, such as with a sitz bath, increases circulation to the area and brings
white blood cells thus removing waste products from the area, thereby facilitating healing.
Although warmth facilitates the healing process, there is no guarantee that infection will be
prevented. Heat does not increase muscle tone and will not facilitate bladder emptying. Warmth
promotes muscle relaxation. Heat would increase blood flow and increase bleedingnot prevent
hemorrhaging.
60. The correct technique for fundal massage for a postpartum client exhibiting a large amount of
blood on the perineal pad is by
A.
B.
C.
D.
Pressing deeply into the abdomen while compressing the fundus with both hands
Supporting the fundus while massaging the uterus just above the symphysis pubis
Compressing the fundus on one side while supporting the other side of the uterus
Massaging above the symphysis pubis while one hand supports the uterine fundus
Answer B
Rationale: Supporting the fundus while massaging the uterus just above the symphysis pubis
provides support to the lower uterine segment while stimulating contraction of the fundus. It also
prevents inversion of the uterus (uterine inversion), which is an obstetric emergency. The top
(fundus) of the uterus is massaged, not the sides. Massaging at the symphysis pubis would not
provide effective uterine contractions. One hand is used to massage the fundus. It is not
necessary to press deep into the abdomen.
61. The following are nursing interventions to relieve episiotomy wound pain EXCEPT
A. Perineal heat
B. Perineal care
C. Giving analgesic as ordered
D. Sitz bath
Answer: B
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Perineal care is primarily done for personal hygiene regardless of whether there is pain or not;
episiotomy wound or not.
NEWBORN CARE
62. Which of the following groups of newborn reflexes below are present at birth and remain
unchanged through adulthood?
A. Blink, cough, rooting, and gag
B. Blink, cough, sneeze, gag
C. Rooting, sneeze, swallowing, and cough
D. Stepping, blink, cough, and sneeze
Answer: B
Blink, cough, sneeze, swallowing and gag reflexes are all present at birth and remain unchanged
through adulthood. Reflexes such as rooting and stepping subside within the first year.
63. A newly delivered mother with three young children at home comment to the nursery nurse
that she cannot hold the baby for feedings once she gets home. She has just too much to do, and
anyhow, it spoils the baby. The best response for the nurse to make is:
. "You seem concerned about time. Let's talk about it."
B. "That's entirely up to you; you have to do what works for you."
C. "Holding the baby when feeding is important for development."
D. "It is very unsafe to prop a bottle. The baby could aspirate the fluid."
Answer A
Explanation: A. This opens up an area of communication to get at what really is troubling the
mother about feeding the baby. B. Because the nurse is aware that this is not the best method,
the problem of time should be explored with the mother. C. Holding can be accomplished at times
other than feeding periods; it does not explore the client's feelings. D. This is true, but the mother
should not be frightened; a more gentle explanation should be used.
64. The normal respiration of a newborn immediately after birth is characterized as:
A. 20-30 breaths per minute, abdominal breathing with active use of intercostals muscles
B. 30-50 breaths per minute with apnea lasting more than 15 seconds, abdominal breathing
C. 20-40 breaths per minute, active use of abdominal and intercostal muscles
D. Shallow and irregular with short periods of apnea lasting not longer than 15
seconds, 30-60 breaths per minute
Answer: D
A newly born baby still is adjusting to xtra uterine life and the lungs are just beginning to function
as a respiratory organ. The respiration of the baby at this time is characterized as usually shallow
and irregular with short periods of apnea, 30-60 breaths per minute. The apneic periods should be
brief lasting not more than 15 seconds otherwise it will be considered abnormal.
65. The anterior fontanelle is characterized as:
A. 2-3 cm antero-posterior diameter and 3-4 cm transverse diameter and diamond shape
B. 2-3 cm in both antero-posterior and transverse diameter and triangular shape
C. 3-4 cm antero-posterior diameter and 2-3 cm transverse diameter, diamond shape
D. 3-4 cm antero-posterior diameter and 2-3 cm transverse diameter, triangular shape
Answer: C
The anterior fontanelle is diamond shape with the antero-posterior diameter being longer than the
transverse diameter. The posterior fontanelle is triangular shape.
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66. The most efficient way for a baby to regulate temperature is to:
A. Burn body fat
B. Move arms and legs
C. Shiver
D. Use brown fat
Answer: D
67. The mother asks the nurse. Whats wrong with my sons breasts? Why are they so enlarged?
Whish of the following would be the best response by the nurse?
A. The breast tissue is inflamed from the trauma experienced with birth
B. A decrease in material hormones present before birth causes enlargement,
C. You should discuss this with your doctor. It could be a malignancy
D. The tissue has hypertrophied while the baby was in the uterus
Answer: B
The presence of excessive estrogen and progesterone in the maternal-fetal blood followed by
prompt withdrawal at birth precipitates breast engorgement, which will spontaneously resolve in 4
to 5 days after birth. The trauma of the birth process does not cause inflammation of the
newborns breast tissue. Newborns do not have breast malignancy. This reply by the nurse would
cause the mother to have undue anxiety. Breast tissue does not hypertrophy in the fetus or
newborns.
68. Which measure would be most effective in preventing the transfer of gonorrhea or Chlamydia
to the infants eyes from the mother?
A. Administering Vitamin K
B. Bathing the newborn
C. Cleaning the infants eyes with warm saline
D. Applying erythromycin ointment
Answer: D
69. During the postpartum period, while considering nursing measures to help parent-child
relationships, the nurse should be aware that the most important factor at this time is the:
A. Anesthesia during labor
B. Duration and difficulty of labor
C. Physical condition of the infant
D. Health status during pregnancy
Answer C
Explanation: A. Though the effect of an anesthesia is a factor, the most important factor is the
physical condition of the infant.B. Though the duration and difficulty of labor is a factor, the most
important factor is the physical condition of the infant. C. Bonding between parent and baby is
most successful when interaction is possible right after birth; if the child is ill, contact is limited. D.
Health status during pregnancy may be a factor, but the most important factor is the physical
condition of the infant.
70. Which position should newborns be placed when sleeping?
A. Back
B. Head of bed elevated
C. Prone
D. Side lying with pillow
Answer: A
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ANTEPARTUM COMPLICATIONS
ABORTION
71. When differentiating the different types of abortion, as a knowledgeable nurse, you know that
the signs that will distinguish threatened abortion from imminent abortion is
A. Dilation of the cervix
B. Presence of uterine contractions
C. Nature and location of pain
D. Severity of bleeding
Answer: A
In imminent abortion, the pregnancy will definitely be terminated because the cervix is already
open unlike in threatened abortion where the cervix is still closed.
72. A young couple attends the prenatal clinic. The wife is 8 weeks' pregnant and asks the clinic
nurse for information about an abortion. The nurse expresses the opinion that abortion is immoral
and that many women have long-term guilt feelings after an abortion. The couple leave the clinic
in a very disturbed state. Legally, the:
A. Physician should have been called in, since nurses should not discuss abortion
B. Nurse's statements need not be based on scientific knowledge
C. Client had a right to receive correct, unbiased information
D. Nurse had a right to state feelings as long as they were identified as the nurse's own
Answer C
Explanation: A. The nurse is capable of giving information about abortion and need not defer to
the physician. B. Nursing practice necessitates scientific knowledge; statements must be based on
fact, not personal feelings or beliefs. C. Nurses with positive attitudes toward abortion should
counsel women who are thinking of undergoing the procedure; they should know what services
are available and the various methods that are used to induce abortion. D. The nurse should give
the client only the information requested and should not state personal feelings.
HEMOLYTIC DISEASE OF THE NEWBORN
73. In the 12th week of gestation, a client completely expels the products of conception. Because
the client is Rh-negative, the nurse must:
A. Administer RhoGAM within 72 hours
B. Make certain she recieves RhoGAM on her first clinic visit
C. Not give RhoGAM, since it is not used with the birth of a stillborn
D. Make certain the client does not receive RhoGAM, since the gestation lasted only 12 weeks
Answer A
Explanation: A. It is given within 72 hours postpartum if the client has not been sensitized
previously. B. It would be useless at this time. C. RhoGAM is always indicated at the termination of
a pregnancy, even with fetal demise. D. RhoGAM is always indicated at the termination of a
pregnancy, even with a short-term pregnancy.
74. Which of the following is TRUE in Rh incompatibility?
A. On the first pregnancy of the Rh(-) mother, the fetus will not be affected
B. RhoGam is given only during the first pregnancy to prevent incompatibility
C. The condition can occur if the mother is Rh(+) and the fetus is Rh(-)
D. Every pregnancy of an Rh(-) mother will result to erythroblastosis fetalis
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Answer: A
On the first pregnancy, the mother still has no contact with Rh(+) blood thus it has not antibodies
against Rh(+). After the first pregnancy, even if terminated into an abortion, there is already the
possibility of mixing of maternal and fetal blood so this can trigger the maternal blood to produce
antibodies against Rh(+) blood. The fetus takes its blood type usually form the father.
75. Which of the following would be the most important action for the nurse to determine if the
prenatal blood panel of a primigravida reveals that she is Rh negative?
A. Hemoglobin and hematocrit levels
B. Previous administration of RhoGAM
C. Blood type of the father of the baby
D. Her religious preference
Answer C
Rationale: If the father is Rh positive (or if his blood type is unknown), an antibody screen is done
to determine if the woman has developed isoimmunity to the Rh antigen. If the father is negative,
there is less chance of this problem. Although hemoglobin and hematocrit are important in
prenatal blood work, they are unrelated to the client's Rh status and possible Rh isoimmunization.
Religious preference would only be pertinent if isoimmunization was severe enough to require
exchange transfusion of the infant (e.g. Jehovahs Witness). RhoGAM is only administered during
or following a pregnancy with a fetus that is Rh positive (or an abortus in which the blood Rh is
unknown) within 24- 48 hours in the clients first pregnancy.
ECTOPIC PREGNANCY
76. Which assessment most closely relates to a diagnosis of ectopic pregnancy?
A. Brownish red, tapioca-like vesicles
B. Elevated temperature
C. Spotting or bleeding 2 to 3 weeks after a missed menstrual period
D. Sudden absence of fetal movement
Answer: C
77. Nurse Alvin is preparing to care for a client who is newly admitted to the hospital with a
possible diagnosis of ectopic pregnancy. Nurse alvin develops a plan of care for the client and
determines that which of the following nursing actions is the priority?
a. Monitoring weight
b. Assessing for edema
c. Monitoring apical pulse
d. Monitoring temperature
Answer: C
Rationale: Nursing care for the client with a possible ectopic pregnancy is focused on preventing
or identifying hypovolemic shock and controlling pain. An elevated pulse rate is an indicator of
shock.
GESTATIONAL DIABETES
78. When obtaining an intake history from a new client in the antepartum clinic, which of the
following factors, if found in the multigravida's history, would identify her as being at increased
risk for gestational diabetes?
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A. Age of 25
B. Five living children
C. Prior birth of a large infant
D. Smoking two packs a day
Answer C
Rationale: An elevated glucose level stimulates the secretion of fetal insulin and results in
macrosomia and an infant with a birth weight greater than 9 pounds. Thus, a history suggesting
previous birth of a large infant would be a risk factor. Maternal age over 30 years is a risk factor
for gestational diabetes. Increased number of pregnancies is not a risk factor for gestational
diabetes. Smoking does not alter glucose metabolism. Because of the vasoconstrictive effects of
nicotine, a substance contained in cigarettes, these infants usually have a low birth weight.
79. During a prenatal visit, the nurse is explaining dietary management to a client with gestational
diabetes mellitus. The nurse determines that teaching has been effective if the client makes which
statement?
A. I will need to eat 600 more calories every day since I am pregnant.
B. I can continue with the same diet as before pregnancy, as long as it is well-balanced.
C. I will plan my diet based on the results of urine glucose testing.
D. Diet and insulin needs change during pregnancy.
Answer: D
The diet for a pregnant client with GDM is individualized to allow for increased fetal and metabolic
requirements, whi consideration to such factors as prepregnancy weight and dietary habits,
overall health, ethnic background, lifestyle, stage of pregnancy, and insulin therapy. Option A is
not required. In the 3rd trimester, insulin needs increase. Option C is incorrect because blood, not
urine testing, is more reliable.
80. The neonate of a mother with diabetes mellitus is prone to developing hypoglycemia because:
A. His kidneys are immature leading to a high tolerance for glucose
B. The pancreas is immature and unable to secrete the needed insulin
C. There is rapid diminution of glucose level in the babys circulating blood and his
pancreas is normally secreting insulin
D. The baby is reacting to the insulin given to the mother
Answer: C
If the mother is diabetic, the fetus while in utero has a high supply of glucose. When the baby is
born and is now separate from the mother, it no longer receives a high dose of glucose from the
mother. In the first few hours after delivery, the neonate usually does not feed yet thus this can
lead to hypoglycemia.
PREGNANCY-INDUCED HYPERTENSION
81. A pre-eclamptic client is for repeat dose of magnesium sulfate. Before giving a repeat dose,
the nurse should assess the patients condition. Which of the following conditions will require the
nurse to temporarily suspend a repeat dose of magnesium sulfate?
A. Knee jerk reflex is (+)1
B. 100 ml of urine in 4 hours
C. BP of 105/70mmHg
D. RR of 16/cpm
Answer: B
The minimum urine output expected for a repeat dose of MgSO4 is 30 cc/hr. If in 4 hours the urine
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output is only 100 cc this is low and can lead to poor excretion of Magnesium with a possible
cumulative effect, which can be dangerous to the mother.
82. A mother receiving medications for pregnancy-induced hypertension should have her diastolic
blood pressure maintained in the range of 90 to 100 mmHg to:
A. Avoid causing fetal anoxia
B. Ensure progression of labor
C. Prevent premature contractions
D. Present sudden elevations in pulse
Answer: A
83. A client reports swelling of her feet and hands on arising each morning. A 24-hour dietary
recall reveals a salt intake in excess of 2 g/day. Which of the following should the nurse
recommend?
A. Restriction of fluid intake
B. Avoidance of salty foods
C. Elimination of all salt from her diet
D. Request to the physician for a diuretic
Answer B
Rationale: Avoiding foods high in sodium is recommended to prevent fluid retention while providing
the recommended sodium requirements for pregnancy. Neither sodium nor fluid can be severely
restricted without untoward effects. During pregnancy, sodium needs are slightly increased.
Therefore, elimination of all dietary salt intakes is problematic. Diuretics are contraindicated in
pregnancy unless they are essential for an accompanying medical problem. Water intake is essential
for expanding and maintaining ECF and to facilitate adequate renal perfusion.
ANEMIA
84. The nurse recognizes that an expected change in the hematologic system that occurs during
the second trimester of pregnancy is:
A. A decrease in WBCs
B. An icrease in blood volume
C. An increase in blood volume
D. A decrease in sedimanation rate
Answer C
Explanation: A. White blood cell values remain stable during the antepartum period. B. The
hematocrit decreases as a result of hemodilution. C. The blood volume increases by approximately
50% during pregnancy. Peak blood volume occurs between 30 and 34 weeks of gestation. D. The
sedimentation rate increases because of a decrease in plasma proteins.
INFECTIONS
85. Which of the following is the primary predisposing factor related to mastitis?
A. Epidemic infection from nosocomial sources localizing in the lactiferous glands and ducts
B. Endemic infection occurring randomly and localizing in the periglandular connective tissue
C. Temporary urinary retention due to decreased perception of the urge to avoid
D. Breast injury caused by overdistention, stasis, and cracking of the nipples
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Answer: D
With mastitis, injury to the breast, such as overdistention, stasis, and cracking of the nipples, is
the primary predisposing factor. Epidemic and endemic infections are probable sources of
infection for mastitis. Temporary urinary retention due to decreased perception of the urge to void
is a contributory factor to the development of urinary tract infection, not mastitis.
86. A client at 10 weeks' gestation is receiving antibiotic theraphy for pyelonephritis. The nurse is
aware that the safest antibitioc for administration during pregnancy is:
A. Tetracycline
B. Nitrofurantoin
B. Gantrisin
D. Ampicillin
Answer D
Explanation: Ampicillin has no know tertogenic effect associated with penicillin. Gantrisin
sulfonamides may cause hemolysis in the fetus. Tetracycline causes permanent yellow staining of
teeth in children whose mothers receive the drug during pregnancy. Nitrofurantion is
contraindicated in severe renal disease.
87. A clinic nurse is performing a psychosocial assessment to Samantha, who has been told that
she is pregnant. Which assessment finding indicates to a nurse that Samantha is a risk for
contracting Human Immunodeficiency Virus?
A. Has a significant other who is heterosexual
B. Has had one sexual partner for the past 10 years
C. History of intravenous drug abuse
D. History of sexually transmitted disease
Answer: C
HIV is transmitted by intimate sexual contact and the exchange of body fluids, exposure to
infected blood, and passing from a n infected woman to her fetus. Clients who fall into the high
risk category for HIV infection include those with persistent and recurrent STD, a history of
multiple sexual partner, or have used intravenous drugs. A heterosexual partner, particularly a
partner who has had only one sexual partner in 10 years, does not have a high risk for contracting
HIV.
88. A nurse is providing instructions to a pregnant client with HIV infection regarding care to the
newborn infant following delivery. The client asked that nurse about the feeding options that are
available. The best response by the nurse is:
A. You will need to feed the infant by nasogastric tube feeding.
B. You will need to bottle-feed the newborn infant.
C. You will be able to breast-feed for 4 months and then will need to switch to bottle-feeding.
D. You will be able to breast-feed for 6 months and then will need to switch to bottle-feeding.
PLACENTA PREVIA
89. There are different types of placenta previa. In placenta previa marginalis, the placenta is
found at the:
A. Lower portion of the uterus completely covering the cervix
B. Lower segment of the uterus with the edges near the internal cervical os
C. Internal cervical os partly covering the opening
D. External cervical os slightly covering the opening
Answer: B
Placenta marginalis is a type of placenta previa wherein the placenta is implanted at the lower
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segment of the uterus thus the edges of the placenta are touching the internal cervical
opening/os. The normal site of placental implantation is the upper portion of the uterus.
90. Mrs. Pam was rushed to the hospital with the chief complaint of profuse vaginal bleeding.
Based on assessment of nurse Loveth, Mrs.Pam is on her 36th week of pregnancy and no signs of
labor has been noted. Nurse Loveth must always consider which of the following precautions:
A. The preferred manner of delivering the baby is vaginal
B. Internal exam must be done following routine procedure
C. The internal exam is done only at the delivery under strict asepsis with a double setup
D. An emergency delivery set for vaginal delivery must be made ready before examining the
patient
Answer: C
Painless vaginal bleeding during the third trimester maybe a sign of placenta praevia. If internal
examination is done in this kind of condition, this can lead to even more bleeding and may require
immediate delivery of the baby by cesarean section. If the bleeding is due to soft tissue injury in
the birth canal, immediate vaginal delivery may still be possible so the set up for vaginal delivery
will be used. A double set-up means there is a set up for cesarean section and a set-up for vaginal
delivery to accommodate immediately the necessary type of delivery needed. In both cases, strict
asepsis must be observed.
91. Which of the following would be the nurses most appropriate response to a client who asks
why she must have a cesarean delivery if she has a complete placenta previa?
A. You will have to ask your physician when he returns.
B. You need a cesarean to prevent hemorrhage.
C. The placenta is covering most of your cervix.
D. The placenta is covering the opening of the uterus and blocking your baby.
Answer: D
A complete placenta previa occurs when the placenta covers the opening of the uterus, thus
blocking the passageway for the baby. This response explains what a complete previa is and the
reason the baby cannot come out except by cesarean delivery. Telling the client to ask the
physician is a poor response and would increase the patients anxiety. Although a cesarean would
help to prevent hemorrhage, the statement does not explain why the hemorrhage could occur.
With a complete previa, the placenta is covering all the cervix, not just most of it.
INTRAPARTUM COMPLICATIONS
PREMATURE RUPTURE OF MEMBRANES
92. The fetal heart rate is checked following rupture of the bag of waters in order to:
A. Check if fetal presenting part has adequately descended following the rupture
B. Check if the fetus is suffering from head compression
C. Determine if there is utero-placental insufficiency
D. Determine if cord compression followed the rupture
Answer: D
After the rupture of the bag of waters, the cord may also go with the water because of the
pressure of the rupture and flow. If the cord goes out of the cervical opening, before the head is
delivered (cephalic presentation), the head can compress on the cord causing fetal distress. Fetal
distress can be detected through the fetal heart tone. Thus, it is essential do check the FHB right
after rupture of bag to ensure that the cord is not being compressed by the fetal head.
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POST TEST
93. Which assessment relates most directly to rupture membranes and release of amniotic fluid?
A. Bloody show
B. Fluid with a pH of 7.0 to 7.5 with nitrazine test
C. Fluid with a pH of 5.0 with nitrazine test
D. Woman complains of urge to push
Answer: B
94. When PROM occurs, which of the following provides evidence of the nurses understanding of
the clients immediate needs?
A. The chorion and amnion rupture 4 hours before the onset of labor.
B. PROM removes the fetus most effective defense against infection
C. Nursing care is based on fetal viability and gestational age.
D. PROM is associated with malpresentation and possibly incompetent cervix
Answer: B
PROM can precipitate many potential and actual problems; one of the most serious is the fetus
loss of an effective defense against infection. This is the clients most immediate need at this
time. Typically, PROM occurs about 1 hour, not 4 hours, before labor begins. Fetal viability and
gestational age are less immediate considerations that affect the plan of care. Malpresentation
and an incompetent cervix may be causes of PROM.
LACERATION
95. If the labor period lasts only for 2 and 1/2 hours, the nurse should suspect that the following
conditions may occur
1. Fetal anoxia
2. Cranial hematoma in the fetus
3. Laceration of perineal muscles
4. Laceration of cervix
A. 1, 2, 3, 4
B. 1 and 3
C. 3 and 4
D. 2, 3, and 4
Answer: A
all the above conditions can occur following a precipitate labor and delivery of the fetus because
there was little time for the baby to adapt to the passageway. If the presentation is cephalic, the
fetal head serves as the main part of the fetus that pushes through the birth canal which can lead
to cranial hematoma, and possible compression of cord may occur which can lead to less blood
and oxygen to the fetus (hypoxia). Likewise the maternal passageway (cervix, vaginal canal and
perineum) did not have enough time to stretch which can lead to laceration.
DYSFUNCTIONAL LABOR
96. The following are common causes of dysfunctional labor. Which of these can be managed
using independent nursing action?
A. Cervical rigidity
B. Pelvic bone contraction
C. Full bladder
D. Extension rather than flexion of the head
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POST TEST
Answer: C
Full bladder can impede the descent of the fetal head. The nurse can readily manage this problem
by doing a simple catheterization of the mother.
CEASARIAN BIRTH
97. When preparing a client for cesarean delivery, which of the following key concepts should be
considered when implementing nursing care?
A. Instruct the mothers support person to remain in the family lounge until after the delivery
B. Arrange for a staff member of the anesthesia department to explain what to expect
postoperatively
C. Modify preoperative teaching to meet the needs of either a planned or emergency
cesarean birth
D. Explain the surgery, expected outcome, and kind of anesthetics
Answer: C
A key point to consider when preparing the client for a cesarean delivery is to modify the
preoperative teaching to meet the needs of either a planned or emergency cesarean birth, the
depth and breadth of instruction will depend on circumstances and time available. Allowing the
mothers support person to remain with her as much as possible is an important concept, although
doing so depends on many variables. Arranging for necessary explanations by various staff
members to be involved with the clients care is a nursing responsibility. The nurse is responsible
for reinforcing the explanations about the surgery, expected outcome, and type of anesthetic to
be used. The obstetrician is responsible for explaining about the surgery and outcome and the
anesthesiology staff is responsible for explanations about the type of anesthesia to be used.
98. A trial for vaginal delivery after an earlier caesarean, would likely to be given to a gravida, who
had:
A. First low transverse cesarean was for active herpes type 2 infections; vaginal culture at 39
weeks pregnancy was positive.
B. First and second caesareans were for cephalopelvic disproportion.
C. First caesarean through a classic incision as a result of severe fetal distress.
D. First low transverse caesarean was for breech position. Fetus in this pregnancy is in
a vertex presentation.
Answer: D
This type of client has no obstetrical indication for a caesarean section as she did with her first
caesarean delivery.
PRETERM LABOR
99. To prevent preterm labor from progressing, drugs are usually prescribed to halt the labor. The
drugs commonly given are:
A. Prostaglandin and oxytocin
B. Dexamethasone and prostaglandin
C. Progesterone and estrogen
D. Magnesium sulfate and terbutaline
Answer: D
Magnesium sulfate acts as a CNS depressant as well as a smooth muscle relaxant. Terbutaline is a
drug that inhibits the uterine smooth muscles from contracting. On the other hand, oxytocin and
prostaglandin stimulates contraction of smooth muscles.
100. Which of the following drugs can be given to the mother before a preterm birth to help
reduce the severity of respiratory distress syndrome?
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POST TEST
A. Betamethasone
B. Diazepam
C. Phenobarbital
D. RhoGAM
Answer: A
PROLONGED LABOR
101. The response that conveys acceptance of the client's expressions of frustration and hostility
when caring for a client who is having a prolonged labor, would be:
A. "I'll rub your back; tell me if it helps."
B. "I'll leave as you can talk to your husband."
C. "All women get weary and frustrated during labor."
D. "Would you like to talk about what's bothering you?"
Answer A
Explanation: A. This response provides the client with a comfort measure while giving her an
opportunity to get verbalize her fears about having a prolonged labor. B. This closes off
communication with the client. C. This is of no help to the client; she is concerned with what is
happening to her. D. This can be answered "yes" or "no" and leaves no further avenue for
discussion.
UTERINE INVERSION
102. Techniques during delivery are essential to prevent problems that may occur to the uterus
like uterine inversion and uterine rupture. Which of the following techniques during labor and
delivery can lead to uterine inversion?
A. Fundal pressure applied to assist the mother in bearing down during delivery of the fetal head
B. Strongly tugging on the umbilical cord to deliver the placenta and hasten placental separation
C. Massaging the fundus to encourage the uterus to contract
D. Applying light traction when delivering the placenta that has already detached from the uterine
wall
Answer: (B) Strongly tugging on the umbilical cord to deliver the placenta and hasten
placental separation
When the placenta is still attached to the uterine wall, tugging on the cord while the uterus is
relaxed can lead to inversion of the uterus. Light tugging on the cord when placenta has detached
is alright in order to help deliver the placenta that is already detached.
POSTPARTUM COMPLICATIONS
POSTPARTUM HEMORRHAGE
103. Nurse Mae should anticipate that hemorrhage related to uterine atony may occur
postpartally if this condition was present during the delivery:
A. The labor and delivery lasted for 12 hours
B. Excessive analgesia was given to the mother
C. An episiotomy had to be done to facilitate delivery of the head
D. Placental delivery occurred within thirty minutes after the baby was born
Answer: B
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POST TEST
Excessive analgesia can lead to uterine relaxation thus lead to hemorrhage postpartally. Both B
and D are normal and C is at the vaginal introitus thus will not affect the uterus.
104. A client who had a postpartum hemorrhage is to receive 1 unit of PRBC. When observing the
staff nurse administering the packed red blood cells without wearing gloves, the nurse manager
correctly comes to the conclusion that the:
A. Donor blood is free of bloodborne pathogens
B. Client does not have an infection
C. Nurse was skilled enough to prevent exposure to the blood
D. Nurse should have worn gloves for self-protection
Answer D
Explanation: A. All blood is considered to be potentially infectious.B. Even if the client does not
have an infection gloves are always worn when exposure to blood is a possibility. C. Nurses are
required to take precautions that limit exposure; gloves must be worn. D. According to the Centers
for Disease Control (CDC) recommendations for isolation precautions, gloves should be worn when
there is potential contact with blood or other body fluids.
THROMBOSIS AND THROMBOPHLEBITIS
105. Which of the following best describes thrombophlebitis?
A. Inflammation and clot formation that result when blood components combine to form an
aggregate body
B. Inflammation and blood clots that eventually become lodged within the pulmonary blood
vessels
C. Inflammation and blood clots that eventually become lodged within the femoral vein
D. Inflammation of the vascular endothelium with clot formation on the vessel wall
Answer: D
Thrombophlebitis refers to an inflammation of the vascular endothelium with clot formation on the
wall of the vessel. Blood components combining to form an aggregate body describe a thrombus
or thrombosis. Clots lodging in the pulmonary vasculature refers to pulmonary embolism; in the
femoral vein, femoral thrombophlebitis.
106. The nurse dorsiflexed the clients right foot and noted (-) Homans sign but warm and flushed
legs are noted. An appropriate nursing intervention when caring for a postpartum mother with
these findings is:
A. Elevate the affected leg and keep the patient on bedrest
B. Encourage the mother to ambulate to relieve the pain in the leg
C. Apply warm compress on the affected leg to relieve the pain
D. Instruct the mother to apply elastic bondage from the foot going towards the knee to improve
venous return flow
Answer: A
If the mother already has thrombophlebitis, the nursing intervention is bedrest to prevent the
possible dislodging of the thrombus and keeping the affected leg elevated to help reduce the
inflammation.
PSYCHOSOCIAL PROBLEMS
107. Postpartum blues is one of the psychosocial problems related to pregnancy. Postpartum blues
is said to be normal based on the following criteria:
1. Maybe more severe symptoms in primipara
2. Starting with the 3rd postpartum day up to day 10 only
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POST TEST
3. Manifestations like episodic tearfulness, fatigue, oversensitivity, and poor appetite
A. 1 and 3
B. 2 and 3
C. 3 only
D. All of the above
Answer: D
All the symptoms 1-3 are characteristic of postpartal blues. It will resolve by itself because it is
transient and is due to a number of reasons like changes in hormonal levels and adjustment to
motherhood. If symptoms lasts more than 2 weeks, this could be a sign of abnormality like
postpartum depression and needs treatment.
108. Which of the following best reflects the frequency of reported postpartum blues?
A. Between 10% and 40% of all new mothers report some form of postpartum blues
B. Between 30% and 50% of all new mothers report some form of postpartum blues
C. Between 50% and 80% of all new mothers report some form of postpartum blues
D. Between 25% and 70% of all new mothers report some form of postpartum blues
Answer: C
According to statistical reports, between 50% and 80% of all new mothers report some form of
postpartum blues. The ranges of 10% to 40%, 30% to 50%, and 25% to 70% are incorrect.
Archie D. Alviz

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