Question 1

A 37-weeks-pregnant woman comes to the emergency department with a fractured ankle.  Which assessment finding is most concerning and requires the nurse to follow up?

Accepted Answer

A) Fetal heart rate remains 206/min 
B) Fetus kicked 4 times in the past hour 
C) Mother reports feeling 2 contractions every hour 
D) Mother's hemoglobin is 11 g/dL (110 g/L)

Question 2

A nurse is admitting a client at 42 weeks gestation to the labor and delivery unit for induction of labor.  What is a predictor of a successful induction?

Accepted Answer

A) Bishop score of 10 
B) Firm and posterior cervix 
C) History of precipitous labor 
D) Reactive nonstress test

Question 3

The nurse is caring for a client at 30 weeks gestation who is hospitalized for preeclampsia.  After reviewing the client's chart and performing an initial assessment, the nurse notes several abnormal findings.  Which finding should the nurse discuss with the health care provider immediately?

Accepted Answer

A) Dark red vaginal bleeding 
B) Edema of the hands and face 
C) Elevated liver enzymes 
D) Urine output of 150 mL in 4 hours

Question 4

The nurse is evaluating a client's understanding of postcircumcision care for a 24-hour-old newborn.  Circumcision was performed using the clamp method.  Which statement by the client demonstrates a need for further teaching?

Accepted Answer

A) "Bleeding should be no larger than the size of a quarter." 
B) "I should cleanse the glans with warm water occasionally." 
C) "I should expect at least 2 wet diapers in the next 24 hours." 
D) "Yellow exudate on the glans penis indicates infection."

Question 5

A client at 38 weeks gestation is in latent labor with ruptured membranes and is receiving an oxytocin infusion for labor augmentation.  The client is requesting IV pain medication.  When administering an IV narcotic during labor, which nursing action is appropriate?

Accepted Answer

A) Discontinue the oxytocin infusion prior to giving the medication 
B) Give the medication slowly during the peak of the next contraction 
C) Hold until contractions are occurring at least every 4 minutes for an hour 
D) Withdraw 5 mL of lactated Ringer from the IV tubing to dilute the medication

Question 6

A nurse is caring for a postpartum client who is breastfeeding and has been diagnosed with mastitis of the right breast.  Which of the following instructions should the nurse include in client teaching?  Select all that apply.

Accepted Answer

A) Apply warm compresses to breast 
B) Discontinue breastfeeding until symptoms resolve 
C) Increase oral fluid intake 
D) Take ibuprofen as needed for pain 
E) Wear a tight-fitting bra as much as possible

Question 7

A nurse is preparing to administer oxytocin to induce labor in a pregnant client at term gestation.  Which of the following nursing actions are appropriate during oxytocin infusion?  Select all that apply.

Accepted Answer

A) Administer oxytocin through the primary IV line 
B) Assess the uterine contraction pattern 
C) Initiate continuous fetal heart rate monitoring 
D) Place IV oxytocin on an electronic infusion pump 
E) Titrate oxytocin to achieve cervical dilation of 1 cm every 2 hours

Question 8

A client at 20 weeks gestation reports "running to the bathroom all the time," pain with urination, and foul-smelling urine.  Which question is most important for the nurse to ask when assessing the client?

Accepted Answer

A) "Are you having any pain in your lower back or flank area?" 
B) "Do you wipe from front to back after urinating?" 
C) "Have you found that you urinate more frequently since becoming pregnant?" 
D) "Have you had a urinary tract infection in the past?"

Question 9

A nurse is participating in an obstetrical emergency simulation in which the health care provider announces shoulder dystocia.  Which of the following interventions should the assisting nurse implement?  Select all that apply.

Accepted Answer

A) Assist maternal pushing efforts by applying fundal pressure during each contraction 
B) Document the time the fetal head was born 
C) Flex the client's legs back against the abdomen and apply downward pressure above the symphysis pubis 
D) Prepare for a forceps-assisted birth 
E) Request additional assistance from other nurses immediately

Question 10

A nurse is caring for a client following delivery of a stillborn infant.  Which actions should the nurse take?  Select all that apply.

Accepted Answer

A) Ask the parents if they would like to help bathe the infant 
B) Discourage the parents from naming the infant 
C) Discuss the importance of organ donation with the parents 
D) Encourage the parents and family members to hold the infant 
E) Offer to obtain handprints, footprints, and photographs of the infant

Question 11

The nurse is performing the initial assessment of a newborn.  Which finding should the nurse report to the health care provider?

Accepted Answer

A) A sudden jarring of the client's crib does not produce a Moro reflex. 
B) The client has swollen labia and a thin, white vaginal discharge. 
C) The posterior fontanel is triangular and smaller than the anterior fontanel. 
D) There are pearly, white pinpoint papules on the client's face and nose.

Question 12

A client in labor has reached 8 cm dilation, is fully effaced, and feels an urge to push.  The nurse observes thick, blood-tinged mucus during the vaginal examination.  What is the nurse's best action?

Accepted Answer

A) Administer prescribed IV meperidine for pain relief 
B) Encourage client to bear down with spontaneous urges to push 
C) Place client in the lithotomy position in preparation for birth 
D) Provide encouragement and coaching in breathing techniques

Question 13

The obstetric nurse is reviewing phone messages.  Which client should the nurse call first?

Accepted Answer

A) Client at 18 weeks gestation taking ceftriaxone and reporting mild diarrhea 
B) Client at 22 weeks gestation with twins who is taking acetaminophen twice a day 
C) Client at 28 weeks gestation taking metronidazole and reporting dark-colored urine 
D) Client at 32 weeks gestation taking ibuprofen for moderate back pain

Question 14

The nurse is preparing a nutritional teaching plan for a client planning to become pregnant.  Which foods would best prevent neural tube defects?

Accepted Answer

A) Calcium-rich snacks 
B) Fortified cereals 
C) Organ meats 
D) Wild salmon

Question 15

The nurse is reviewing laboratory results for several prenatal clients.  Which finding is most important to report to the health care provider?

Accepted Answer

A) Client at 24 weeks gestation with hemoglobin of 9 g/dL (90 g/L) and hematocrit of 29% 
B) Client at 26 weeks gestation whose 1-hour (50 g) oral glucose challenge test result is 120 mg/dL (6.7 mmol/L) 
C) Client at 36 weeks gestation with blood pressure of 125/85 mm Hg and trace protein detected on urine dipstick 
D) Client at 37 weeks gestation with a WBC count of 13,000/mm3 (13.0 x 109/L)

Question 16

A nurse is caring for a client at 30 weeks gestation who is admitted for preterm labor.  Which of the following interventions should the nurse anticipate?  Select all that apply.

Accepted Answer

A) Administering IM betamethasone 
B) Administering penicillin via IV piggyback 
C) Assisting with artificial rupture of membranes 
D) Initiating IV magnesium sulfate 
E) Obtaining fetal heart tones once per shift

Question 17

The nurse performs initial assessments of four clients in a prenatal clinic.  Which client findings are abnormal and require further assessment?

Accepted Answer

A) Client at 9 weeks gestation with a normal BMI and a weight gain of 2 lb (1 kg) from pre-pregnancy weight 
B) Client at 15 weeks gestation with headaches relieved by acetaminophen 
C) Client at 19 weeks gestation with bleeding gums after brushing and flossing teeth 
D) Client at 20 weeks gestation with an increase in diastolic blood pressure of 15 mm Hg since last visit

Question 18

A laboring client reports feeling the need to have a bowel movement and begins vomiting.  The nurse notes that the client's legs are trembling.  What cervical examination finding would the nurse most expect this client to have?

Accepted Answer

A) 2 cm dilated, 50% effaced, −2 station 
B) 6 cm dilated, 70% effaced, −1 station 
C) 7 cm dilated, 80% effaced, 0 station 
D) 8 cm dilated, 100% effaced, +1 station

Question 19

The nurse is preparing to discharge a client following a first trimester miscarriage.  Which of the following statements should the nurse include in discharge teaching for the client and partner?  Select all that apply.

Accepted Answer

A) "Attending a support group with other people who had a pregnancy loss can be helpful." 
B) "Genetic counseling is recommended for couples after their first miscarriage." 
C) "One of the most important things you can do right now is communicate with your partner." 
D) "The grieving period only lasts about 6 months following a miscarriage." 
E) "Trying to conceive again can help you cope by giving you something to look forward to."

Question 20

The postpartum nurse is assessing a client who gave birth by cesarean section 5 hours ago and is requesting pain medication.  The client appears restless, has a heart rate of 110/min, and admits to recent onset of anxiety.  What priority action should the nurse take?

Accepted Answer

A) Assess for lower extremity warmth and redness 
B) Instruct the client in relaxation breathing techniques 
C) Obtain oxygen saturation reading by pulse oximeter 
D) Offer the client prescribed PRN pain medication

Exam 6: Maternal & Newborn Health

A 37-weeks-pregnant woman comes to the emergency department with a fractured ankle. Which assessment finding is most concerning and requires the nurse to follow up?

A nurse is admitting a client at 42 weeks gestation to the labor and delivery unit for induction of labor. What is a predictor of a successful induction?

The nurse is caring for a client at 30 weeks gestation who is hospitalized for preeclampsia. After reviewing the client's chart and performing an initial assessment, the nurse notes several abnormal findings. Which finding should the nurse discuss with the health care provider immediately?

The nurse is evaluating a client's understanding of postcircumcision care for a 24-hour-old newborn. Circumcision was performed using the clamp method. Which statement by the client demonstrates a need for further teaching?

A client at 38 weeks gestation is in latent labor with ruptured membranes and is receiving an oxytocin infusion for labor augmentation. The client is requesting IV pain medication. When administering an IV narcotic during labor, which nursing action is appropriate?

A nurse is caring for a postpartum client who is breastfeeding and has been diagnosed with mastitis of the right breast. Which of the following instructions should the nurse include in client teaching? Select all that apply.

A nurse is preparing to administer oxytocin to induce labor in a pregnant client at term gestation. Which of the following nursing actions are appropriate during oxytocin infusion? Select all that apply.

A client at 20 weeks gestation reports "running to the bathroom all the time," pain with urination, and foul-smelling urine. Which question is most important for the nurse to ask when assessing the client?

A nurse is participating in an obstetrical emergency simulation in which the health care provider announces shoulder dystocia. Which of the following interventions should the assisting nurse implement? Select all that apply.

A nurse is caring for a client following delivery of a stillborn infant. Which actions should the nurse take? Select all that apply.

The nurse is performing the initial assessment of a newborn. Which finding should the nurse report to the health care provider?

A client in labor has reached 8 cm dilation, is fully effaced, and feels an urge to push. The nurse observes thick, blood-tinged mucus during the vaginal examination. What is the nurse's best action?

The obstetric nurse is reviewing phone messages. Which client should the nurse call first?

The nurse is preparing a nutritional teaching plan for a client planning to become pregnant. Which foods would best prevent neural tube defects?

The nurse is reviewing laboratory results for several prenatal clients. Which finding is most important to report to the health care provider?

A nurse is caring for a client at 30 weeks gestation who is admitted for preterm labor. Which of the following interventions should the nurse anticipate? Select all that apply.

The nurse performs initial assessments of four clients in a prenatal clinic. Which client findings are abnormal and require further assessment?

A laboring client reports feeling the need to have a bowel movement and begins vomiting. The nurse notes that the client's legs are trembling. What cervical examination finding would the nurse most expect this client to have?

The nurse is preparing to discharge a client following a first trimester miscarriage. Which of the following statements should the nurse include in discharge teaching for the client and partner? Select all that apply.

The postpartum nurse is assessing a client who gave birth by cesarean section 5 hours ago and is requesting pain medication. The client appears restless, has a heart rate of 110/min, and admits to recent onset of anxiety. What priority action should the nurse take?