maternal health

Question 1

The client is seen in the prenatal clinic. She tells the nurse that she has been trying to get pregnant for the
past six months. Which vitamin will help to decrease the chances of neural tube defects in the baby?
a) B3
b) B2
c) B9
d) B1

Answer 1

c) B9

Question 2

The client who is at 20 weeks’ gestation asks the nurse how much weight she should gain during her pregnancy. The nurse should tell the client that:
a) The client should try not to gain more than 11 kg during pregnancy.
b) The client should gain about 11.5-16 kg during pregnancy.
c) The client should gain 25 kg during pregnancy
d) The client should not gain more than 6 kg.

Answer 2

b) The client should gain about 11.5-16 kg during pregnancy.

Question 3

The doctor is performing an amniocentesis on the client at 17 weeks’ gestation to detect genetic anomalies. Which statement indicates the nurse understands the proper instructions for the client having an amniocentesis at 17 weeks’ gestation?
a) After the ultrasound exam, the client should empty the bladder.
b) After the ultrasound exam, the client should not void for the amniocentesis.
c) The ultrasound exam will be done at least eight hours prior to the amniocentesis.
d) The amniocentesis cannot be done prior to 20 weeks’ gestation

Answer 3

b) After the ultrasound exam, the client should not void for the amniocentesis.

Question 4

The client is admitted at 39 weeks’ gestation for induction of labour. If the doctor uses prostaglandin gel, the nurse should:
a) Administer Prostin (dinoprostone) prior to the prostaglandin gel
b) Tell the client that the labour will be more painful
c) Elevate the client’s hips for 30 minutes after the gel is inserted
d) Insert a Foley catheter prior to insertion of the gel

Answer 4

c) Elevate the client’s hips for 30 minutes after the gel is inserted

Question 5

Vaginal examination in the labouring client reveals the anterior fontanel is toward the rectum. The nurse should chart that the baby is in which position?
a) Occipital posterior
b) Transverse
c) Occipital anterior
d) Breech

Answer 5

c) Occipital anterior

Question 6

he nurse who is caring for the labouring client notes a decline of foetal heart tones from 136 to 90 beats per minute after the acme of the contractions. Which action is most appropriate at this time?
a) Monitor the client’s blood pressure
b) Turn the client to her left side
c) Assess the urinary output hourly
d) Prepare the client for a caesarean section

Answer 6

b) Turn the client to her left side

Question 7

The client is admitted with preeclampsia. Which finding requires that the nurse contact the physician immediately?
a) The client’s blood pressure is 140/90.
b) The client has a 3+ pedal oedema.
c) The client’s urine reveals 8 grams of protein in a 24-hour urine sample
d) The client’s platelet count is 280,000.

Answer 7

c) The client’s urine reveals 8 grams of protein in a 24-hour urine sample

Question 8

The client is admitted with foetal demise. A diagnosis of missed abortion requires that the foetus be evacuated by induction of labour. If the physician uses prostaglandin, the nurse should anticipate that the client will:
a) Complain of nausea
b) Become constipated
c) Need treatment with potassium supplementation
d) Require that a Foley catheter be inserted

Answer 8

a) Complain of nausea

Question 9

The client is experiencing a drop in the foetal heart rate. The decelerations are V-shaped and do not correlate to the contractions. The nurse is aware that this type of deceleration is which of the following?
a) Expected during the transition phase of labour
b) Ominous and requires intervention
c) Related to foetal head compression
d) Likely caused by utero-placental insufficiency

Answer 9

b) Ominous and requires intervention

Question 10

The client has decided to use epidural anaesthesia to control pain during labour. Prior to the epidural anaesthesia, the nurse should:
a) Offer liquids by mouth
b) Insert a Foley catheter
c) Offer pain medications
d) Bolus the client with 2,000 mL of intravenous fluids

Answer 10

d) Bolus the client with 2,000 mL of intravenous fluids

Question 11

A post-partum patient and her partner have been discussing whether they are going to have their son circumcised. The patient tells the nurse that she has heard it is healthier for the baby. The nurse’s best response would include which of the following information?
a) Circumcision should be performed only for religious reasons
b) The nurse’s personal beliefs regarding the need for circumcision
c) Circumcision is not recommended as a routine practice
d) There is clear evidence that circumcision is beneficial and should be performed in infancy

Answer 11

c) Circumcision is not recommended as a routine practice

Question 12

The nurse at the community health centre is conducting a prenatal class on maternal nutrition in pregnancy. He tells the class that during pregnancy, the need for most nutrients increases. But he cautions that one nutrient taken in excessive amounts has been associated with teratogenic effects on the newborn. Which nutrient should not be taken in increased or supplemented amounts in pregnancy?
a) Calcium
b) Folic acid c) Iron
d) Vitamin A

Answer 12

d) Vitamin A

Question 13

James, age 2 months, has diaper dermatitis (diaper rash). What would the nurse recommend to the parents to treat this problem?
a) Expose the diaper area to air whenever possible
b) Use a hair dryer or heat lamp to dry the area
c) Wash the area completely with commercial wipes after every diaper change
d) Use talc on the diaper area to absorb moisture

Answer 13

a) Expose the diaper area to air whenever possible

Question 14

During the transitional changes at birth when the newborn breathes independently, what causes the foramen ovale to close?
a) Oxygen levels increase
b) The umbilical cord is clamped
c) Pressure in the left atria of the heart becomes greater than that in the right atria of the heart
d) Pulmonary blood vessels constrict, and pulmonary blood pressure increases

Answer 14

c) Pressure in the left atria of the heart becomes greater than that in the right atria of the heart

Question 15

Nurse Roy is caring for a client in labour. The external foetal monitor shows a pattern of variable decelerations in foetal heart rate. What should the nurse do first?
a) Change the client’s position.
b) Prepare for emergency caesarean section.
c) Check for placenta previa.
d) Administer oxygen.

Answer 15

a) Change the client’s position.

Question 16

Which of the following would be inappropriate to assess in a mother who’s breast-feeding?
a) The attachment of the baby to the breast.
b) The mother’s comfort level with positioning the baby.
c) Audible swallowing.
d) The baby’s lips smacking

Answer 16

d) The baby’s lips smacking

Question 17

When assessing a client during her first prenatal visit, the nurse discovers that the client had a reduction mammoplasty. The mother indicates she wants to breast-feed. What information should the nurse give to this mother regarding breast-feeding success?
a) “It’s contraindicated for you to breast-feed following this type of surgery.”
b) “I support your commitment; however, you may have to supplement each feeding with formula.”
c) “You should check with your surgeon to determine whether breast-feeding would be possible.”
d) “You should be able to breast-feed without difficulty.”

Answer 17

b) “I support your commitment; however, you may have to supplement each feeding with formula.”

Question 18

A client with eclampsia begins to experience a seizure. Which of the following would the nurse in charge do first?
a) Pad the side rails
b) Place a pillow under the left buttock
c) Insert a padded tongue blade into the mouth
d) Maintain a patent airway

Answer 18

d) Maintain a patent airway

Question 19

When preparing a teaching plan for a client who is to receive a rubella vaccine during the postpartum period, the nurse in charge should include which of the following?
a) The vaccine prevents a future foetus from developing congenital anomalies
b) Pregnancy should be avoided for 3 months after the immunization
c) The client should avoid contact with children diagnosed with rubella
d) The injection will provide immunity against the 7-day measles.

Answer 19

b) Pregnancy should be avoided for 3 months after the immunization

Question 20

While caring for a multigravida client in early labour in a birthing centre, which of the following foods would be best if the client requests a snack?
a) Yogurt
b) Cereal with milk
c) Vegetable soup
d) Peanut butter cookies

Answer 20

a) Yogurt

Question 21

A client, 30 weeks’ pregnant, is scheduled for a biophysical profile (BPP) to evaluate the health of her foetus. Her BPP score is 8. What does this score indicate?
a) The foetus should be delivered within 24 hours.
b) The client should repeat the test in 24 hours.
c) The foetus isn’t in distress at this time.
d) The client should repeat the test in 1 week.

Answer 21

c) The foetus isn’t in distress at this time.

Question 22

During a prenatal visit at 4 months gestation, a pregnant client asks whether tests can be done to identify foetal abnormalities. Between 18 and 40 weeks’’ gestation, which procedure is used to detect foetal anomalies?
a) Amniocentesis.
b) Chorionic villi sampling.
c) Fetoscopy
d) Ultrasound

Answer 22

c) Fetoscopy

Question 23

Nurse Julia plans to instruct the postpartum client about methods to prevent breast engorgement. Which of the following measures would the nurse include in the teaching plan?

a) Decreasing fluid intake for the first 24 to 48 hours

b) Wearing a supportive brassiere with nipple shields

c) Breast-feeding the baby at frequent intervals

d) Feeding the baby a maximum of 5 minutes per side on the first day

Answer 23

c) Breast-feeding the baby at frequent intervals

Question 24

A new mother calls the clinic crying because her 2-day-old infant now weighs 7 pounds, 2 ounces, when he weighed 7 pounds, 8 ounces at birth. She says, “I must be doing something wrong.” The best nursing response would be:

a) “You are right to be concerned. I will schedule an appointment for tomorrow.”

b) “The infant is obviously not eating enough. Try feeding every two hours.”

c) “The infant should be taken to the nearest emergency room immediately.”

d) “This is normal weight loss. The infant should be back to birth weight in 5-7 days”.

Answer 24

d) “This is normal weight loss. The infant should be back to birth weight in 5-7 days”.

Question 25

A nurse advises a female client to learn pubococcygeal exercises. What is the purpose of these exercises?

a) Preventing constipation

b) Contracting and relaxing the muscles of the pelvic floor

c) Contracting and relaxing the gluteus maximus muscle

d) Helping prevent pregnancy

Answer 25

b) Contracting and relaxing the muscles of the pelvic floor

Question 26

A client tells the nurse, “I think my baby likes to hear me talk to him.” When discussing neonates and stimulation with sound, which of the following would the nurse include as a means to elicit the best response?

a) Cooing sounds rather than words

b) High-pitched speech with tonal variations

c) Repeated stimulation with loud sounds

d) Low-pitched speech with a sameness of tone

Answer 26

b) High-pitched speech with tonal variations

Question 27

When the nurse on duty accidentally bumps the bassinet, the neonate throws out its arms, hands opened, and begins to cry. The nurse interprets this reaction as indicative of which of the following reflexes

a) Babinski reflex

b) Tonic neck reflex

c) Grasping reflex

d) Startle reflex

Answer 27

d) Startle reflex

Question 28

When caring for a 3-day-old neonate who is receiving phototherapy to treat jaundice, the nurse in charge would expect to do which of the following?

a) Encourage the mother to discontinue breast-feeding

b) Notify the physician if the skin becomes bronze in colour

c) Turn the neonate every 6 hours

d) Check the vital signs every 2 to 4 hours

Answer 28

d) Check the vital signs every 2 to 4 hours

Question 29

A female adult client is taking a progestin-only oral contraceptive, or mini pill. Progestin use may increase the patient’s risk for:

a) Tubal or ectopic pregnancy

b) Female hypogonadism

c) Premenstrual syndrome

d) Endometriosis

Answer 29

a) Tubal or ectopic pregnancy

Question 30

A pregnant patient asks the nurse Kate if she can take castor oil for her constipation. How should the nurse respond?

a) “No, it can promote sodium retention.”

b) “No, it can initiate premature uterine contractions.”

c) “Yes, it produces no adverse effect.”

d) “No, it can lead to increased absorption of fat-soluble vitamins.”

Answer 30

b) “No, it can initiate premature uterine contractions.”

Question 30

A primigravida client at 25 weeks’ gestation visits the clinic and tells the nurse that her lower back aches when she arrives home from work. The nurse should suggest that the client perform:

a) Leg lifting

b) Tailor sitting

c) Shoulder circling

d) Squatting exercises

Answer 30

b) Tailor sitting

Question 31

The nurse is developing a teaching plan for a patient who is 8 weeks pregnant. The nurse should tell the patient that she can expect to feel the foetus move at which time?

a) Between 24 and 26 weeks’ gestation

b) Between 16 and 20 weeks’ gestation

c) Between 10 and 12 weeks’ gestation

d) Between 21 and 23 weeks’ gestation

Answer 31

b) Between 16 and 20 weeks’ gestation

Question 32

A pregnant woman with pregnancy-induced hypertension probably exhibits which of the following symptoms?

a) Headaches, double vision, vaginal bleeding

b) Proteinuria, headaches, vaginal bleeding

c) Proteinuria, double vision, uterine contractions

d) Proteinuria, headaches, double vision

Answer 32

d) Proteinuria, headaches, double vision

Question 32

The nurse is seeing several pregnant women at a general practice surgery. Which woman is at highest risk for having a low-birth weight infant or one with birth defects, and is in need of prenatal education?

a) A 30-year-old woman who was 10 pounds overweight before becoming pregnant

b) A 32-year-old, unmarried middle class executive secretary.

c) A 25-year-old woman who smokes and drinks two beers a day

d) An 18-year-old woman who is in her eighth month and has gained 22 pounds

Answer 32

c) A 25-year-old woman who smokes and drinks two beers a day

Question 33

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) “Studies have shown that vitamin C helps the growth of foetal bones.”

b) “Supplemental vitamin C in large doses can help prevent neural tube defects.”

c) “Vitamin C is required to promote blood clot and collagen formation”.

d) “Eating moderate amounts of food high in vitamin C helps metabolize fats and carbohydrates.”

Answer 33

c) “Vitamin C is required to promote blood clot and collagen formation”.

Question 34

Sally calls to report that she is having pain with intercourse following insertion of an IUD (intrauterine device). Which nursing intervention is appropriate?

a) Enquire about nausea and vomiting.

b) Refer her to a sexual counsellor.

c) Encourage the client to take a herbal supplement prior to intercourse.

d) Ask the client to come to the clinic for an appointment.

Answer 34

d) Ask the client to come to the clinic for an appointment.

Question 34

A client who has recently initiated use of an IUD (intrauterine device) for contraception reports to you that she has not had a period for three months. How should you respond to this?

a) “Amenorrhea is associated with anorexia nervosa. Are you eating normally?”

b) “Amenorrhea can be a normal side effect of IUD use”

c) “Maybe early menopause is occurring.”

d) “You are probably pregnant.”

Answer 34

b) “Amenorrhea can be a normal side effect of IUD use”

Question 34

A young woman who is contemplating pregnancy and has a diet consisting mainly of “junk food” tells the nurse, “I will begin eating right and taking multiple vitamins after I become pregnant.” The best nursing response is:

a) “You must eat well and may take multiple vitamins both before and during pregnancy.”

b) “You must begin eating well and may take multiple vitamins as soon as you suspect that you are pregnant.”

c) “As long as you consume enough calories, there will not be problems if you become pregnant.”

d) “Eating well and taking multiple vitamins are not important until the second trimester of pregnancy.”

Answer 34

a) “You must eat well and may take multiple vitamins both before and during pregnancy.”

Question 35

A bilingual nurse practitioner working in a rural clinic is working with a pregnant mother of four children. The woman who does not speak English has been in the country for several years with her children attending the local public school. In an attempt to teach the expectant mother the value of good nutrition on the neonate’s health, the nurse could incorporate which tactic for health promotion activities?

a) Include the bilingual children in the discussion on good nutrition.

b) Give the client a poster with pictures of nutritionally balanced meals and move on.

c) Write the information on an information sheet in English for the children to read.

d) Ask the mother to bring an older friend into the clinic for health promotion activities since the children are too young.

Answer 35

a) Include the bilingual children in the discussion on good nutrition.

Question 36

The home health nurse has been assigned to an elderly woman who is cohabitating with her daughter and her son in a one bedroom apartment on the edge of town. The grandson is the primary caregiver at the age of fourteen since his mother is an alcoholic and often absent from caring for her mother. The home health nurse completes a health history of the client but realizes:

a) The nurse should create a plan of care that includes all members of the family

b) The nurse should report the daughter to Child Welfare Agency as an abusive mother

c) The nurse should congratulate the grandson on his impeccable care of his grandmother

d) The focus of client teaching should be with the grandson

Answer 36

a) The nurse should create a plan of care that includes all members of the family

Question 36

The nurse is caring for a primigravida at about 2 months and 1 week gestation. After explaining self-care measures for common discomforts of pregnancy, the nurse determines that the client understands the instructions when she says:

a) “If I start to leak colostrum, I should cleanse my nipples with soap and water”

b) “Nausea and vomiting can be decreased if I eat a few crackers before arising”

c) “If I have a vaginal discharge, I should wear nylon underwear”

d) “Leg cramps can be alleviated if I put an ice pack on the area”

Answer 36

b) “Nausea and vomiting can be decreased if I eat a few crackers before arising”

Question 37

The nurse approaches a family who is living in a shelter for abused women. The mother has bruises around her mouth and on her arms. The nurse asks her if she can perform a physical examination to assess the extent of her injuries. As the nurse begins the examination, the woman recoils from the nurse’s touch and screams, “Don’t touch me!” The nurse’s best response would be:

a) “Would you prefer to have another nurse examine you?”

b) “I am not going to hurt you.”

c) “Relax. I have to check how badly you were beaten.”

d) “I know that you have been hurt and will try not to hurt you with my touch.”

Answer 37

d) “I know that you have been hurt and will try not to hurt you with my touch.”

Question 38

Which of the following should a nurse consider when evaluating a family’s coping resources?

a) Preventive health practices within the family

b) Family structure

c) Availability of support persons

d) Roles of family members

Answer 38

c) Availability of support persons

Question 38

What instruction is most important for the nurse discharging a client home who has had a 14 week amniocentesis?

a) Bedrest in the side lying position for 24 hours

b) Drink plenty for 24 hours

c) Report round ligament pain

d) Report contractions or abdominal pain

Answer 38

d) Report contractions or abdominal pain

Question 38

You are questioning a client about how she is enjoying her pregnancy. She replies that she is terrified of labour but hasn’t attended childbirth classes. You assess her need for:

a) Informational support

b) Physical support

c) Family support

d) Advocacy support

Answer 38

a) Informational support

Question 38

In order to prepare new parents for their first visit to their baby in the NICU, which statement by the nurse would be the least helpful?

a) Saying “Your baby is small, but has a good cry”

b) “Your baby’s primary nurse will talk to you when you arrive at the NICU”

c) “I will explain the equipment”

d) “Your baby is lucky; it could have been much worse”

Answer 38

d) “Your baby is lucky; it could have been much worse”

Question 39

After 3 days of breast-feeding, a postpartum patient reports nipple soreness. To relieve her discomfort, the nurse should suggest that she:

a) Dry her nipples with a soft towel after feedings

b) Lubricate her nipples with expressed milk before feeding

c) Apply soap directly to her nipples, and then rinse

d) Apply warm compresses to her nipples just before feedings

Answer 39

b) Lubricate her nipples with expressed milk before feeding

Question 39

Four female clients at the clinic where you work want information about contraception. Which person is the best candidate for an intrauterine device (IUD)?

a) 22 year old client with multiple sex partners.

b) 40 year old woman who is a smoker.

c) 16 year old client who is nulliparous.

d) 32 year old client with untreated Chlamydia.

Answer 39

b) 40 year old woman who is a smoker.

Question 40

The nurse asks a client taking combined oral contraceptives to describe her menstrual cycle. The client reports frequent episodes of break-through bleeding. What information will the nurse ask for next?

a) Symptoms of sexually transmitted diseases.

b) Type of menstrual protection used.

c) Number of sex partners.

d) Regularity of taking the pill.

Answer 40

d) Regularity of taking the pill.

Question 40

You see four pregnant clients in one day at the outpatient department where you work. Which client is most at risk for spontaneous preterm birth?

a) 40 year old with anaemia

b) 26 year old with a history of diabetes

c) 17 year old client with twins

d) 19 year old with a hyperthyroid disorder

Answer 40

c) 17 year old client with twins

Question 41

A client is having difficulty with her combined oral contraceptive pill. In order to ascertain whether or not the side effects are due to progesterone ingestion, the nurse asks about which of the following symptoms?

a) Weight gain, headache and hypertension.

b) Breast tenderness, chloasma, and fluid retention.

c) Nausea, nervousness and irritability.

d) Decreased libido, acne and fatigue

Answer 41

d) Decreased libido, acne and fatigue

Question 42

A pregnant client at 27 weeks’ gestation telephones you to check that her LMC is correct in saying she does not need to be seen more often than four weekly for checkups at this stage of her pregnancy. You tell her that she needs to be seen again by her LMC:

a) Only when symptoms change or worsen

b) In one week

c) In four weeks

d) In two weeks

Answer 42

c) In four weeks

Question 43

A client at 18 weeks’ gestation has requested you measure her blood pressure. Her “booking” blood pressure with her midwife was 122/82. Which of the following blood pressure recordings would be considered normal at this visit?

a) 130/90

b) 126/82

c) 110/70

d) 118/76

Answer 43

d) 118/76

Question 44

You are measuring blood pressure on a client at 32 weeks’ gestation. She begins to feel dizzy while lying supine. What nursing intervention would be most appropriate?

a) Administer oxygen at 4L via Hudson mask

b) Start IV fluids

c) Place client on her left side

d) Notify the GP

Answer 44

c) Place client on her left side

Question 45

A client at eight weeks gestation asks why she is experiencing nausea and vomiting so early in her pregnancy. Which of the following statements best explains the nurse’s understanding of pregnancy hormones which contribute to nausea and vomiting?

a) “increased levels of prostaglandin contribute to nausea and vomiting during pregnancy.”

b) “increased levels of progesterone contribute to nausea and vomiting during pregnancy.”

c) “increased levels of oestrogen contribute to nausea and vomiting during pregnancy.”

d) “increased levels of human chorionic gonadotrophin (hCG) contribute to nausea and vomiting during pregnancy.”

Answer 45

d) “increased levels of human chorionic gonadotrophin (hCG) contribute to nausea and vomiting during pregnancy.”