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OBSTETRICAL NURSING PRACTICE TEST PART 1

1. Which of the following client statements indicates that the


nurse's teaching about oral contraceptive agents has been
successful?

A. "Despite their effectiveness, about 25% of women stop taking them


after 1 year."
B. "These agents usually only cause a few minor side effects when you
take them."
C. "Oral contraceptives inhibit ovulation and change the consistency of
cervical mucus."
D. "I can make these drugs more effective by monitoring my basal body
temperature."

2. A client's gestational diabetes is poorly controlled throughout her


pregnancy. She goes into labor at 38 weeks and delivers a boy.
Which priority intervention should be included in the care plan for
the neonate during his first 24 hours?

A. Administer insulin subcutaneously.


B. Administer a bolus of glucose I.V.
C. Provide frequent early feedings with formula.
D. Avoid oral feedings.

3. Which finding is considered normal in a neonate during the first


few days after birth?

A. Weight loss of 25%


B. Birth weight of 2,000 to 2,500 g
C. Weight loss then return to birth weight
D. Weight gain of 25%

4. The physician prescribes clomiphene citrate (Clomid) for a woman


who has been having difficulty getting pregnant. When teaching the
client about this drug's potential side effects, which of the following
would the nurse include in the teaching plan?

A. Multiple pregnancies.
B. Increase in spontaneous abortions.
C. Increase in fibrocystic breast disease.
D. Increase in congenital anomalies.

5. Early detection of an ectopic pregnancy is paramount in


preventing a life-threatening rupture. Which symptoms should alert
the nurse to the possibility of an ectopic pregnancy?

A. Abdominal pain, vaginal bleeding, and a positive pregnancy test


B. Hyperemesis and weight loss
C. Amenorrhea and a negative pregnancy test
D. Copious discharge of clear mucus and prolonged epigastric pain
6. After the nurse instructs a client who is scheduled for in vitro
fertilization (IVF) about the procedure, which of the following
statements by the client indicates to the nurse that the instructions
have been successful?

A. "I know that the chances of getting pregnant with this procedure are
about 50%."
B. "I'll need to receive a series of estrogen injections after I have the
procedure."
C. "After fertilization, three or four embryos will be transferred through
the cervix."
D. "My risk for a multiple births is less with this procedure than with the
GIFT procedure."

7. On the 9th postpartum day, a client breast-feeding her neonate


experiences pain, redness, and swelling of her left breast. She's
diagnosed with mastitis. The nurse teaching the client how to care
for her infected breast should include which information?

A. Wear a loose-fitting bra to avoid constricting the milk ducts.


B. Stop breast-feeding permanently.
C. Take antibiotics until the pain is relieved.
D. Use a warm moist compress over the painful area.

8. A 20-year-old client, having missed one menstrual period, visits


the prenatal clinic because she suspects that she is pregnant.
Besides amenorrhea, the client tells the nurse that she has
experienced nausea and vomiting, urinary frequency, and fatigue.
The nurse determines that the client has been experiencing signs of
pregnancy categorized as which of the following?

A. Presumptive.
B. Probable.
C. Positive.
D. Predictive.

9. The nurse is assessing a client who gave birth yesterday. Where


should the nurse expect to find the top of the client's fundus?

A. One fingerbreadth above the umbilicus


B. One fingerbreadth below the umbilicus
C. At the level of the umbilicus
D. Below the symphysis pubis

10. A client who tells the nurse that she would like to use the basal
body temperature method for family planning receives instructions
about the method. Which of the following client statements
indicates to the nurse that the teaching has been successful?
A. "When my temperature remains elevated for 7 days, ovulation has
occurred."
B. "Taking my temperature in the evening just after dinner or before I go
to bed is best."
C. "Because this method is not very effective, I should use other forms of
contraception too."
D. "It's important to take my temperature at about the same time every
morning before arising."

11. The nurse is helping to prepare a client for discharge following


childbirth. During a teaching session, the nurse instructs the client
to do Kegel exercises. What's the purpose of these exercises?

A. To prevent urine retention


B. To relieve lower back pain
C. To tone the abdominal muscles
D. To strengthen the perineal muscles

12. The client, 11 weeks pregnant, tells the nurse that she has been
vomiting after breakfast nearly every morning. Which of the
following measures should the nurse suggest to help the client cope
with early morning nausea and vomiting?

A. Limiting fluid intake between meals.


B. Increasing her intake of high-fat foods.
C. Eating dry, unsalted crackers before arising.
D. Drinking a carbonated beverage before bedtime.

13. The nurse is using Doppler ultrasound to assess a pregnant


woman. When should the nurse expect to hear fetal heart tones?

A. 7 weeks
B. 11 weeks
C. 17 weeks
D. 21 weeks

14. A client asks, "Can my partner and I still engage in sexual


intercourse while I'm pregnant?" The nurse's response is based on
which of the following?

A. Throughout the pregnancy, coitus interruptus is the preferred method


for sexual activity.
B. Although sexual desire may change, intercourse is safe during an
uncomplicated pregnancy.
C. Engaging in intercourse must be avoided until the client is at least 16
weeks pregnant.
D. The couple should refrain from engaging in sexual intercourse during
the last trimester.
15. The nurse is planning care for a 16-year-old client in the
prenatal clinic. Adolescents are prone to which complication during
pregnancy?

A. Iron deficiency anemia


B. Varicosities
C. Nausea and vomiting
D. Gestational diabetes

16. When explaining to a pregnant client about the need to take


supplemental vitamins with iron during her pregnancy, the nurse
would instruct the client to take the iron with which of the following
to promote maximum absorption?

A. Milk.
B. Tea.
C. Hot chocolate.
D. Orange juice.

17. The nurse is caring for a 16-year-old pregnant client. The client
is taking an iron supplement. What should this client drink to
increase the absorption of iron?

A. A glass of milk
B. A cup of hot tea
C. A liquid antacid
D. A glass of orange juice

18. A client asks the nurse why vitamin C intake is so important


during pregnancy. Which of the following would be the nurse's best
response?

A. "Vitamin C is required to promote blood clot and collagen formation."


B. "Supplemental vitamin C in large doses can prevent neural tube
defects."
C. "Eating moderate amounts of foods high in vitamin C helps metabolize
fats and carbohydrates."
D. "Studies have shown that vitamin C helps the growth of fetal bones."

19. The nurse is caring for a client who is on ritodrine therapy to


halt premature labor. What condition indicates an adverse reaction
to ritodrine therapy?

A. Hypoglycemia
B. Crackles
C. Bradycardia
D. Hyperkalemia

20. A pregnant client tells the nurse that she has been having
discomfort from her hemorrhoids. After giving instruction about
strategies to decrease the discomfort, which of the following client
statements would alert the nurse to the need for additional
instruction?

A. "I'll avoid straining to have a bowel movement."


B. "I'll be sure to change positions frequently during the day."
C. "I'll stop using my prescribed iron supplements."
D. "I'll use warm sitz baths frequently during the day."

21. The nurse is caring for a client in her 34th week of pregnancy
who wears an external monitor. Which statement by the client would
indicate an understanding of the nurse's teaching?

A. "I'll need to lie perfectly still."


B. "You won't need to come in and check on me while I'm wearing this
monitor."
C. "I can lie in any comfortable position, but I should stay off my back."
D. "I know that the external monitor increases my risk of a uterine
infection."

22. After the nurse instructs a pregnant client about swimming and
bathing during pregnancy, which of the following client statements
indicates the need for additional teaching?

A. "I can continue to swim as long as my membranes aren't ruptured."


B. "I can relax in a hot tub for about 20 minutes after swimming."
C. "I can take a bath daily but should be careful not to fall."
D. "I should avoid sitting in a sauna for prolonged periods."

23. The nurse is developing a care plan for a client in her 34th week
of gestation who is experiencing premature labor. What
nonpharmacologic intervention should the plan include to halt
premature labor?

A. Encouraging ambulation
B. Serving a nutritious diet
C. Promoting adequate hydration
D. Performing nipple stimulation

24. When the nurse instructs a pregnant client with a history of


varicose veins about strategies to promote comfort, which of the
following client statements indicates that the teaching has been
successful?

A. "Lying down with my feet elevated should help."


B. "Support hose can be put on just before bedtime."
C. "Restricting milk intake may provide some relief."
D. "Wearing knee-high stockings is better than pantyhose."

25. A client treated for premature labor is ready for discharge.


Which instruction should the nurse include in the discharge
teaching plan?
A. Report a heart rate greater than 120 beats/minute to the physician.
B. Take terbutaline every 4 hours, during waking hours only.
C. Call the physician if the fetus moves 10 times in 1 hour.
D. Increase activity daily if not fatigued.

26. A primigravida, admitted to the hospital at 12 weeks' gestation


complaining of abdominal cramping, exhibits bright red vaginal
spotting without cervical dilation. The nurse determines that the
client is most likely experiencing which of the following types of
abortion?

A. Missed.
B. Threatened.
C. Inevitable.
D. Complete.

27. The nurse is caring for a client in labor. Which assessment


finding indicates fetal distress?

A. Lack of meconium staining


B. Early decelerations in fetal heart rate during contractions
C. An increase in fetal heart rate with fetal scalp stimulation
D. Fetal blood pH less than 7.20

28. A pregnant woman states that she frequently ingests laundry


starch. When assessing the client, for which of the following should
the nurse be alert?

A. Muscle spasms.
B. Lactose intolerance.
C. Diabetes mellitus.
D. Anemia.

29. The nurse is assessing a woman in labor. Her cervix is dilated 8


cm. Her contractions are occurring every 2 minutes. She's irritable
and in considerable pain. What type of breathing should the nurse
instruct the woman to use during the peak of a contraction?

A. Deep breathing
B. Shallow chest breathing
C. Deep, cleansing breaths
D. Chest panting

30. A 26-year-old primigravida visiting the prenatal clinic for her


regular visit at 34 weeks' gestation tells the nurse that she takes
mineral oil for occasional constipation. The nurse should instruct
the client to do which of the following?
A. Take the mineral oil with fruit juice to increase the action of the mineral
oil.
B. Avoid mineral oil because it interferes with the absorption of fat-soluble
vitamins.
C. Avoid mineral oil because it can lead to vitamin C deficiency in
pregnant clients.
D. Use the mineral oil regularly on a weekly basis to prevent constipation.

31. The nurse is caring for a woman receiving a lumbar epidural


anesthetic block to control labor pain. What should the nurse do to
prevent hypotension?

A. Administer ephedrine to raise her blood pressure.


B. Administer oxygen using a mask.
C. Place the woman flat on her back with her legs raised.
D. Ensure adequate hydration before the anesthetic is administered.

32. Which of the following drugs would the nurse expect to


administer to the client receiving intravenous magnesium sulfate
for pregnancy-induced hypertension if the client develops
magnesium toxicity?

A. Calcium gluconate.
B. Diazepam (Valium).
C. Phenytoin (Dilantin).
D. Furosemide (Lasix).

33. A woman in labor shouts to the nurse, "My baby is coming right
now! I feel like I have to push!" An immediate nursing assessment
reveals that the head of the fetus is crowning. After asking another
staff member to notify the physician and setting up for delivery,
which nursing intervention is most appropriate?

A. Gently pulling at the neonate 's head as it's delivered


B. Holding the neonate 's head back until the physician arrives
C. Applying gentle pressure to the neonate 's head as it's delivered
D. Placing the mother in a Trendelenburg position until the physician
arrives

34. Which of the following would the nurse expect to administer as


the drug of choice to a pregnant client with chronic hypertension?

A. Phenobarbital.
B. Diazepam (Valium).
C. Methyldopa (Aldomet).
D. Magnesium sulfate.

35. The nurse is caring for a client who is in labor. The physician still
isn't present. After the neonate's head is delivered, which nursing
intervention would be most appropriate?
A. Checking for the umbilical cord around the neonate 's neck
B. Placing antibiotic ointment in the neonate 's eyes
C. Turning the neonate's head to the side, to drain secretions
D. Assessing the neonate for respirations

36. Which of the following would the nurse most likely expect to find
when assessing a pregnant client with abruptio placenta?

A. Excessive vaginal bleeding.


B. Rigid, boardlike abdomen.
C. Tetanic uterine contractions.
D. Premature rupture of membranes.

37. The nurse is caring for a client during the first postpartum day.
The client asks the nurse how to relieve pain from her episiotomy.
What should the nurse instruct the woman to do?

A. Apply an ice pack to her perineum.


B. Take a Sitz bath.
C. Perform perineal care after voiding or a bowel movement.
D. Drink plenty of fluids.

38. A pregnant client is diagnosed with partial placenta previa. In


explaining the diagnosis, the nurse tells the client that the usual
treatment for partial placenta previa is which of the following?

A. Activity limited to bed rest.


B. Platelet infusion.
C. Immediate cesarean delivery.
D. Labor induction with oxytocin.

39. The nurse is assessing a client on the second postpartum day.


Under normal circumstances, the tone and location of the client's
fundus is:

A. soft and one fingerbreadth below the umbilicus.


B. firm and two fingerbreadths below the umbilicus.
C. firm and to the right or left of midline.
D. soft and at the level of the umbilicus.

40. Which of the following would the nurse use to assess a client for
possible uterine atony after a cesarean delivery?

A. Check the abdominal dressing every 15 minutes for the first hour.
B. Palpate the fundus every 15 minutes for at least 1 hour.
C. Observe the amount of lochia immediately after delivery.
D. Assess blood pressure and pulse every 15 minutes for 1 hour.
41. A 23-year-old primigravida delivers a healthy 3090.1-g boy by
vaginal delivery. During an assessment the next day, the nurse is
examining her lower extremities for signs and symptoms of
thrombophlebitis. Which of the following signs should be assessed?

A. Chadwick's sign
B. Hegar's sign
C. Homans' sign
D. Goodell's sign

42. The nurse is caring for a client after evacuation of a


hydatidiform molar pregnancy. The nurse should instruct the client
to:

A. wait 1 month before trying to become pregnant again.


B. make an appointment for follow-up human chorionic gonadotropin
(hCG) level monitoring at the end of 1 year.
C. discuss options for sterilization with the physician.
D. use birth control for at least 1 year.

43. A client with hyperemesis gravidarum is on a clear liquid diet.


The nurse should serve this client:

A. milk and ice pops.


B. decaffeinated coffee and scrambled eggs.
C. tea and gelatin dessert.
D. apple juice and oatmeal.

44. What's the best way to teach new parents about the care of
their neonate?

A. Relate stories of other parents' experiences.


B. Focus on the behavior of their own neonate.
C. Show videotapes about neonate care.
D. Distribute literature with photographs of neonate-care skills.

45. When monitoring the laboratory studies of a pregnant client


receiving terbutaline (Brethine) therapy, which of the following
would lead the nurse to suspect that the client's blood plasma
volume has increased?

A. Decreased hematocrit level.


B. Glycosuria.
C. Hyperkalemia.
D. Increased serum calcium levels.

46. The nurse is caring for a client on her second postpartum day.
The nurse should expect the client's lochia to be:

A. red and moderate.


B. continuous with red clots.
C. brown and scant.
D. thin and white.

47. The nurse is caring for a client in labor. The external fetal
monitor shows a pattern of variable decelerations in fetal heart
rate. What should the nurse do first?

A. Change the client's position.


B. Prepare for emergency cesarean delivery.
C. Check for placenta previa.
D. Administer oxygen.

48. The nurse is teaching a client how to perform perineal care to


reduce the risk of puerperal infection. Which activity indicates that
the client understands proper perineal care?

A. Using a peri bottle to clean the perineum after each voiding or bowel
movement
B. Cleaning the perineum from back to front after a bowel movement
C. Spraying water from peri bottle into the vagina
D. Changing perineal pads every 8 hours

49. A woman in her 8th month of pregnancy is having dinner with


her husband at their favorite restaurant. The woman suddenly
chokes on a piece of chicken and appears to lose consciousness.
What would be the best action by a nurse sitting at the next table?

A. Apply abdominal thrust.


B. Apply chest thrust.
C. Begin cardiopulmonary resuscitation (CPR).
D. Reposition the client on her side.

50. A client with type 1 diabetes mellitus is pregnant for the second
time. Her previous pregnancy ended in spontaneous abortion at 18
weeks' gestation. She's now at 22 weeks' gestation. The nurse is
responsible for teaching the client about exercise during her
pregnancy. Which of the following statements indicates that the
client has an appropriate understanding of her exercise needs?

A. "I know I need to walk with a friend or family member."


B. "I know I need to vary the times of day when I exercise."
C. "I know I need to exercise before meals."
D. "I know I need to drink fluids while I walk."

END OF OBSTETRICAL NURSING PRACTICE EXAM


PART 1

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