~ob midterm~ Flashcards
1
Q
A pregnant woman at her first prenatal visit has an antibody screen showing the presence of anti-D antibodies. What is the priority intervention?
A. Administer RhoGAM.
B. Monitor for fetal anemia.
C. Repeat the antibody screen at 28 weeks.
D. Schedule a cesarean delivery.
A
Answer: B
Rationale: Anti-D antibodies indicate isoimmunization. The fetus is at risk for anemia, and monitoring with Doppler or amniocent
2
Q
A patient’s prenatal labs show HBsAG positive. What immediate action is necessary for the newborn after delivery?
A. Administer HBIG and the hepatitis B vaccine.
B. Test the infant for HBsAG.
C. Delay breastfeeding until further evaluation.
D. Start antiviral therapy for the infant.
A
Answer: A
Rationale: HBIG and the hepatitis B vaccine reduce the risk of vertical transmission and should be given within 12 hours of birth.
3
Q
A rubella screen shows non-immunity in a pregnant patient. What is the appropriate teaching?
A. Avoid pregnancy for three months after the rubella vaccine.
B. Receive the rubella vaccine during the second trimester.
C. Avoid individuals with rubella during pregnancy.
D. Rubella infection poses no risk to the fetus after 24 weeks.
A
Answer: C
Rationale: Live vaccines like MMR cannot be given during pregnancy. Avoiding exposure is essential.
4
Q
Which lab result is consistent with preeclampsia?
A. Platelets 200,000/µL.
B. Protein/creatinine ratio 0.5.
C. LDH 350 U/L.
D. Uric acid 4.0 mg/dL.
A
Answer: C
Rationale: Elevated LDH reflects hemolysis and tissue damage, common in preeclampsia.
5
Q
A GBS-positive patient is in labor. Which intervention is appropriate?
A. Administer a single dose of antibiotics postpartum.
B. Begin intrapartum penicillin G prophylaxis.
C. Test the newborn for GBS infection after delivery.
D. Schedule an immediate cesarean delivery.
A
Answer: B
Rationale: Intrapartum antibiotic prophylaxis reduces the risk of neonatal GBS infection
6
Q
A pregnant woman presents with a platelet count of 90,000/µL. What condition is suspected?
A. Gestational thrombocytopenia.
B. Idiopathic thrombocytopenic purpura.
C. Preeclampsia with severe features.
D. HELLP syndrome.
A
Answer: D
Rationale: HELLP syndrome often presents with thrombocytopenia (<100,000/µL).
7
Q
A uric acid level of 7.5 mg/dL in a pregnant patient most likely indicates:
A. Preeclampsia.
B. Hyperemesis gravidarum.
C. Gestational diabetes.
D. Normal pregnancy changes.
A
Answer: A
Rationale: Elevated uric acid is a marker for preeclampsia.
7
Q
Which lab abnormality is most concerning in a pregnant woman with hypertension?
A. Hemoglobin 12.5 g/dL.
B. Protein/creatinine ratio 0.8.
C. ALT 70 U/L.
D. WBC 14,000/µL.
A
Answer: C
Rationale: Elevated ALT suggests liver dysfunction, which can be part of severe preeclampsia.
8
Q
A fetal heart rate (FHR) strip shows moderate variability. What does this indicate about fetal well-being?
A. Fetal acidosis.
B. Adequate oxygenation and CNS function.
C. Cord compression.
D. Uteroplacental insufficiency.
A
Answer: B
Rationale: Moderate variability is a reassuring sign of fetal well-being.
9
Q
What is the significance of absent variability on a fetal heart rate strip?
A. Fetal sleep cycle.
B. Normal finding in early gestation.
C. Potential fetal hypoxia or acidosis.
D. Cord compression.
A
Answer: C
Rationale: Absent variability may indicate fetal hypoxia or metabolic acidosis.
10
Q
An FHR strip shows an increase of 20 bpm lasting 15 seconds. How should the nurse interpret this finding?
A. Early deceleration.
B. Normal acceleration.
C. Late deceleration.
D. Prolonged deceleration.
A
Answer: B
Rationale: Accelerations indicate fetal oxygenation and well-being.
11
Q
What intervention is appropriate for late decelerations on an FHR strip?
A. Administer oxygen to the mother.
B. Increase oxytocin infusion.
C. Perform an amnioinfusion.
D. Encourage maternal ambulation.
A
Answer: A
Rationale: Late decelerations indicate uteroplacental insufficiency; oxygen improves fetal oxygenation.
12
Q
A pregnant woman at 32 weeks has an elevated protein/creatinine ratio. What condition is likely?
A. Normal pregnancy finding.
B. Gestational diabetes.
C. Preeclampsia.
D. Placenta previa.
A
Answer: C
Rationale: A protein/creatinine ratio >0.3 is diagnostic for preeclampsia.
13
Q
An FHR strip shows minimal variability and recurrent late decelerations. What does this suggest about fetal status?
A. Fetal hypoxia or acidosis.
B. Cord compression.
C. Fetal sleep cycle.
D. Normal findings for gestational age.
A
Answer: A
Rationale: Minimal variability with late decelerations suggests fetal compromise.
14
Q
What is the priority intervention for a patient with severe preeclampsia and elevated liver enzymes?
A. Administer antihypertensives.
B. Administer magnesium sulfate.
C. Prepare for immediate delivery.
D. Restrict maternal fluid intake.
A
Answer: B
Rationale: Magnesium sulfate is used to prevent seizures in severe preeclampsia.
15
Q
**A pregnant woman at 36 weeks is GBS-positive and allergic to penicillin. What is the alternative prophylactic antibiotic of choice?
A. Cefazolin
B. Erythromycin
C. Vancomycin
D. Gentamicin
A
Answer: A
Rationale: Cefazolin is the first-line alternative for GBS prophylaxis in penicillin-allergic patients who are not at high risk for anaphylaxis.
16
Q
A patient with HELLP syndrome presents with hemolysis, elevated liver enzymes, and a platelet count of 85,000/µL. What is the priority nursing action?
A. Administer corticosteroids.
B. Prepare for immediate delivery.
C. Begin platelet transfusion.
D. Monitor liver function weekly.
A
Answer: B
Rationale: Delivery is the definitive treatment for HELLP syndrome, especially if maternal or fetal compromise is suspected.
17
Q
What is the purpose of testing for RPR/VDRL during pregnancy?
A. To screen for hepatitis B infection.
B. To identify syphilis infection.
C. To determine Rh incompatibility.
D. To assess for fetal neural tube defects.
A
Answer: B
Rationale: RPR/VDRL tests detect syphilis, which can cause congenital infection if untreated.
18
Q
A patient’s prenatal labs reveal positive anti-D antibodies and a high titer. What is the likely next step in care?
A. Schedule a 28-week RhoGAM injection.
B. Perform serial Doppler studies of the middle cerebral artery.
C. Administer a blood transfusion to the fetus.
D. Plan for cesarean delivery at 34 weeks.
A
Answer: B
Rationale: Doppler studies are used to monitor for fetal anemia in isoimmunization cases.
19
Q
A patient’s prenatal labs show rubella non-immunity. She delivers a healthy infant. What teaching is appropriate?
A. Breastfeeding is contraindicated.
B. Avoid contact with individuals with rubella for one year.
C. The infant needs rubella immunoglobulin.
D. Vaccination should be given before hospital discharge.
A
Answer: D
Rationale: The rubella vaccine is given postpartum to protect the mother in future pregnancies.
20
Q
A fetal heart rate tracing shows early decelerations during contractions. What is the nurse’s interpretation?
A. Normal finding due to head compression.
B. Cord compression requiring intervention.
C. Uteroplacental insufficiency.
D. Maternal hypotension causing fetal hypoxia.
A
Answer: A
Rationale: Early decelerations are normal and occur due to fetal head compression during contractions.
21
Q
A protein/creatinine ratio of 0.4 in a pregnant woman indicates:
A. Normal findings.
B. Gestational diabetes.
C. Preeclampsia.
D. Impending preterm labor.
A
Answer: C
Rationale: A protein/creatinine ratio >0.3 is diagnostic of preeclampsia.
22
Q
An FHR strip shows accelerations with no decelerations and moderate variability. How should the nurse interpret this?
A. Fetal compromise.
B. Cord compression.
C. Reassuring tracing.
D. Maternal hypotension.
A
Answer: C
Rationale: Accelerations with moderate variability are indicative of fetal well-being.
23
Q
A patient presents at 28 weeks with severe hypertension and a protein/creatinine ratio of 0.5. What is the most likely diagnosis?
A. Chronic hypertension.
B. Preeclampsia with severe features.
C. HELLP syndrome.
D. Gestational diabetes.
A
Answer: B
Rationale: Hypertension with significant proteinuria (>0.3) is diagnostic for preeclampsia.
24
During labor, a patient’s fetal heart tracing shows absent variability and recurrent late decelerations. What is the priority action?
A. Reassess in 15 minutes.
B. Start maternal IV antibiotics.
C. Encourage maternal repositioning.
D. Prepare for emergency cesarean delivery.
Answer: D
Rationale: Absent variability with late decelerations is non-reassuring and requires immediate intervention, including delivery if indicated.
25
A pregnant patient presents with painless vaginal bleeding at 32 weeks. What is the priority nursing action?
A. Perform a sterile vaginal exam.
B. Administer magnesium sulfate.
C. Assess fetal heart tones and perform an ultrasound.
D. Administer betamethasone.
Answer: C
Rationale: Painless vaginal bleeding suggests placenta previa. Ultrasound is necessary to determine placental location. Vaginal exams are contraindicated.
26
A patient diagnosed with hyperemesis gravidarum has lost 8% of her prepregnancy weight. What is the most appropriate initial intervention?
A. Administer oral antiemetics.
B. Start IV fluids with electrolyte replacement.
C. Initiate enteral feeding.
D. Suggest small frequent meals.
Answer: B
Rationale: Severe dehydration and weight loss require IV fluid and electrolyte replacement before dietary modifications.
27
What is the purpose of administering magnesium sulfate in preterm labor?
A. To decrease uterine contractions.
B. To treat maternal hypertension.
C. To promote lung maturity in the fetus.
D. To provide neuroprotection to the fetus.
Answer: D
Rationale: Magnesium sulfate is used for fetal neuroprotection to reduce the risk of cerebral palsy in preterm infants.
28
Which symptom indicates magnesium sulfate toxicity in a patient receiving the medication for preterm labor?
A. Reflexes of +3.
B. Respiratory rate of 10 breaths/min.
C. Blood pressure of 140/90 mmHg.
D. Urine output of 50 mL/hour.
Answer: B
Rationale: Respiratory depression is a key sign of magnesium sulfate toxicity.
28
A patient with preterm premature rupture of membranes (PPROM) is 33 weeks pregnant. Which intervention is most appropriate?
A. Administer betamethasone.
B. Induce labor immediately.
C. Perform a vaginal exam to assess dilation.
D. Administer RhoGAM.
Answer: A
Rationale: Betamethasone promotes fetal lung maturity and is a priority for gestations under 34 weeks.
29
What is the priority intervention for a patient experiencing abruptioN placentae?
A. Prepare for immediate delivery.
B. Administer tocolytic agents.
C. Begin betamethasone therapy.
D. Start IV magnesium sulfate.
Answer: A
Rationale: Placental abruption often requires immediate delivery due to maternal and fetal risks.
30
A patient with gestational trophoblastic disease is undergoing treatment. What is a critical nursing teaching point?
A. Avoid pregnancy for at least one year.
B. Monitor fetal kick counts daily.
C. Take folic acid supplements.
D. Limit physical activity.
Answer: A
Rationale: Pregnancy should be avoided for a year to monitor for choriocarcinoma recurrence.
31
A patient with suspected cervical insufficiency has a cervical length of 18 mm on ultrasound. What is the recommended intervention?
A. Perform a cerclage.
B. Administer tocolytics.
C. Begin bed rest and pelvic rest.
D. Start IV antibiotics.
Answer: A
Rationale: A cerclage is often used for a significantly shortened cervix to prevent preterm birth.
32
Which finding in a patient with placenta previa would require immediate intervention?
A. Active vaginal bleeding.
B. Mild abdominal cramping.
C. Fundal height measuring larger than gestational age.
D. Stable vital signs.
Answer: A
Rationale: Active bleeding in placenta previa can signal a need for urgent intervention to stabilize the mother and fetus.
33
A nurse is caring for a patient with oligohydramnios. Which complication is the greatest concern?
A. Umbilical cord prolapse.
B. Fetal growth restriction.
C. Preterm labor.
D. Maternal dehydration.
Answer: A
Rationale: Oligohydramnios increases the risk of cord prolapse during membrane rupture.
34
What is a contraindication for administering methotrexate in an ectopic pregnancy?
A. Positive beta-hCG.
B. Hemodynamically stable patient.
C. No visible intrauterine pregnancy on ultrasound.
D. Presence of fetal heart activity.
Answer: D
Rationale: Methotrexate is contraindicated when fetal heart activity is detected.
35
Which assessment finding suggests concealed abruption in a patient with suspected abruption placentae?
A. Dark red vaginal bleeding.
B. Uterine tenderness and rigidity.
C. Decreased fetal heart variability.
D. Active contractions every 2 minutes.
Answer: B
Rationale: Concealed abruption can cause uterine rigidity and tenderness without visible bleeding.
36
What is the significance of a positive fetal fibronectin (fFN) test in preterm labor?
A. Preterm birth is unlikely within 7 days.
B. Preterm birth is likely within 1-2 weeks.
C. Immediate labor induction is required.
D. A negative result indicates infection.
Answer: B
Rationale: A positive fFN test predicts a higher risk of preterm birth within 1-2 weeks.
37
patient with polyhydramnios has spontaneous rupture of membranes (SROM). What is the nurse’s priority assessment?
A. Maternal temperature.
B. Fetal heart rate.
C. Contraction pattern.
D. Fundal height.
Answer: B
Rationale: Cord prolapse is a significant risk in polyhydramnios; FHR monitoring is critical.
38
What is the primary nursing action after administering RhoGAM to an Rh-negative patient post-delivery?
A. Monitor for signs of infection.
B. Educate about the next dose at 6 months postpartum.
C. Document administration in the medical record.
D. Assess for maternal-fetal hemorrhage.
Answer: C
Rationale: Documentation is necessary to ensure the mother is protected in future pregnancies.
39
A patient at 29 weeks is admitted with preterm labor and started on magnesium sulfate. Which side effect should the nurse monitor closely?
A. Hyperreflexia.
B. Hypotension.
C. Increased respiratory rate.
D. Muscle rigidity.
Answer: B
Rationale: Magnesium sulfate can cause vasodilation, leading to hypotension. Monitoring vital signs is critical.
40
A patient at 36 weeks presents with symptoms of placental abruption. Which diagnostic test is most likely to be ordered?
A. Ultrasound.
B. Amniocentesis.
C. Non-stress test (NST).
D. Coagulation studies.
Answer: A
Rationale: Ultrasound helps evaluate placental location and degree of abruption, although it may not always confirm the diagnosis.
41
A patient with PROM at 35 weeks is febrile with foul-smelling discharge. What is the priority intervention?
A. Begin antibiotic therapy.
B. Perform a sterile vaginal exam.
C. Administer corticosteroids.
D. Prepare for immediate delivery.
Answer: A
Rationale: Fever and foul discharge indicate chorioamnionitis. Antibiotics are the first-line treatment to manage infection.
42
A patient with preterm labor is on magnesium sulfate. Which finding warrants immediate discontinuation of the infusion?
A. Urine output of 25 mL/hour.
B. Respiratory rate of 16 breaths/min.
C. Deep tendon reflexes +2.
D. Fetal heart rate variability.
Answer: A
Rationale: Oliguria (<30 mL/hour) increases the risk of magnesium toxicity. Discontinuing the infusion is necessary.
43
A patient is diagnosed with polyhydramnios. What is the most likely fetal complication?
A. Preterm delivery.
B. Cardiac arrhythmias.
C. Intrauterine growth restriction.
D. Neural tube defects.
Answer: D
Rationale: Polyhydramnios is often associated with fetal anomalies like neural tube defects that impair fetal swallowing.
44
A nurse observes a biophysical profile (BPP) score of 4 in a patient at 38 weeks. What is the next best step?
A. Repeat the test in 24 hours.
B. Prepare for immediate delivery.
C. Administer oxygen to the mother.
D. Monitor fetal heart rate continuously.
Answer: B
Rationale: A BPP score of 4 indicates significant fetal compromise, often requiring immediate delivery.
45
A patient at 12 weeks is diagnosed with a hydatidiform mole. What is a priority teaching point?
A. Avoid sexual intercourse for six months.
B. Use reliable contraception for one year.
C. Monitor for signs of preterm labor.
D. Increase dietary folic acid intake.
Answer: B
Rationale: Pregnancy should be avoided for one year to monitor hCG levels and reduce the risk of choriocarcinoma.
46
A patient with suspected ectopic pregnancy has a serum beta-hCG level of 1,200 mIU/mL and no intrauterine pregnancy on ultrasound. What is the next step?
A. Start methotrexate therapy.
B. Repeat beta-hCG in 48 hours.
C. Perform dilation and curettage.
D. Monitor vital signs every hour.
Answer: B
Rationale: A repeat beta-hCG level helps confirm the diagnosis of ectopic pregnancy, especially if levels rise abnormally.
47
A patient with preeclampsia has a protein/creatinine ratio of 0.5. What does this finding indicate?
A. Severe proteinuria.
B. Normal kidney function.
C. Mild preeclampsia.
D. Worsening preeclampsia.
Answer: C
Rationale: A protein/creatinine ratio >0.3 confirms proteinuria, a diagnostic criterion for preeclampsia.
48
A patient with hyperemesis gravidarum is discharged with dietary instructions. What should the nurse include?
A. Consume three large meals daily.
B. Avoid drinking fluids between meals.
C. Avoid high-protein foods.
D. Limit carbohydrate intake.
Answer: B
Rationale: Avoiding fluids during meals can reduce gastric distension and nausea.
49
Which nursing intervention is appropriate for a patient with cervical insufficiency and a rescue cerclage?
A. Encourage ambulation to prevent thrombosis.
B. Monitor for signs of infection.
C. Perform daily sterile vaginal exams.
D. Administer magnesium sulfate prophylactically.
Answer: B
Rationale: Infection is a significant risk following cerclage placement. Close monitoring is critical.
50
A nurse is caring for a patient with a placenta previa at 35 weeks. What is a critical teaching point?
A. Report any contractions immediately.
B. Avoid lifting objects heavier than 20 pounds.
C. Schedule a trial of labor at 38 weeks.
D. Monitor for signs of oligohydramnios.
Answer: A
Rationale: Contractions in placenta previa increase the risk of bleeding and require immediate medical evaluation.
51
A pregnant patient with Class III heart disease complains of fatigue and shortness of breath with minimal activity. What is the priority nursing intervention?
A. Administer oxygen.
B. Encourage bed rest.
C. Assess for signs of cardiac decompensation.
D. Schedule an immediate echocardiogram.
Answer: C
Rationale: Signs of cardiac decompensation (e.g., dyspnea, fatigue) require prompt assessment to prevent maternal and fetal complications.
52
Which symptom indicates cardiac decompensation in a pregnant patient with cardiovascular disease?
A. Increased appetite.
B. Moist cough with exertion.
C. Positive fetal movements.
D. Blood pressure of 120/80 mmHg.
Answer: B
Rationale: A moist, frequent cough can indicate pulmonary congestion due to cardiac decompensation.
52
What is the preferred mode of delivery for a pregnant woman with severe cardiovascular disease?
A. Cesarean delivery.
B. Spontaneous vaginal delivery without anesthesia.
C. Induction of labor at 38 weeks.
D. Vaginal delivery with epidural anesthesia.
Answer: D
Rationale: Vaginal delivery with epidural anesthesia reduces stress on the cardiovascular system.
53
A patient tests positive for hepatitis B during pregnancy. What is the most appropriate action after delivery?
A. Administer HBIG and hepatitis B vaccine to the newborn within 12 hours.
B. Begin antiviral therapy for the newborn.
C. Delay breastfeeding for six months.
D. Perform weekly liver function tests on the infant.
Answer: A
Rationale: HBIG and the hepatitis B vaccine reduce the risk of vertical transmission to the newborn.
54
A patient’s hemoglobin level is 9 g/dL during her third trimester. What is the best nursing intervention?
A. Encourage iron-rich foods and supplementation.
B. Recommend a blood transfusion.
C. Initiate vitamin D supplementation.
D. Schedule a repeat hemoglobin test postpartum.
Answer: A
Rationale: Iron deficiency anemia is treated with dietary changes and iron supplementation to restore hemoglobin levels.
55
What is the significance of hemodilution during pregnancy?
A. It indicates severe anemia.
B. It is a normal physiological change.
C. It requires immediate treatment.
D. It leads to maternal hypertension.
Answer: B
Rationale: Hemodilution occurs due to increased plasma volume in pregnancy and does not indicate true anemia.
56
A pregnant patient is receiving methadone therapy for opioid dependence. What is the nurse’s priority?
A. Reduce methadone dose gradually.
B. Ensure the patient adheres to prenatal appointments.
C. Monitor for signs of neonatal abstinence syndrome.
D. Educate on the risks of breastfeeding.
Answer: C
Rationale: Neonatal abstinence syndrome is a risk for infants exposed to methadone in utero.
57
A pregnant woman with sickle cell disease reports joint pain and fever. What is the priority intervention?
A. Administer IV fluids and oxygen.
B. Prepare for emergency delivery.
C. Administer iron supplements.
D. Perform a fetal non-stress test.
Answer: A
Rationale: IV fluids and oxygen are critical to manage a sickle cell crisis and prevent further complications.
58
What is the greatest concern for an obese patient during pregnancy?
A. Preterm labor.
B. Macrosomia.
C. Gestational diabetes and preeclampsia.
D. Placenta previa.
Answer: C
Rationale: Obesity significantly increases the risks of gestational diabetes and preeclampsia.
59
A pregnant patient with systemic lupus erythematosus (SLE) is at risk for which complication?
A. Placental abruption.
B. Fetal growth restriction.
C. Gestational diabetes.
D. Preterm labor.
Answer: B
Rationale: SLE increases the risk of placental insufficiency, leading to fetal growth restriction.`
60
A 16-year-old pregnant patient is at increased risk for which complication?
A. Low birth weight.
B. Placental abruption.
C. Fetal macrosomia.
D. Gestational hypertension.
Answer: A
Rationale: Adolescents are more likely to experience inadequate prenatal care and poor nutritional intake, increasing the risk of low birth weight.
61
A pregnant patient with Class IV heart disease reports chest pain and cyanosis. What is the priority nursing action?
A. Place the patient in a left lateral position.
B. Administer oxygen via nasal cannula.
C. Notify the provider immediately.
D. Monitor fetal heart rate continuously.
Answer: C
Rationale: Class IV heart disease symptoms like cyanosis and chest pain require immediate provider notification as they indicate critical cardiac decompensation.
62
Which dietary instruction should the nurse include for a pregnant patient taking iron supplements?
A. Take iron with antacids to avoid gastrointestinal upset.
B. Take iron with orange juice to enhance absorption.
C. Take iron on an empty stomach at bedtime.
D. Take iron with milk to increase tolerance.
Answer: B
Rationale: Vitamin C in orange juice enhances iron absorption. Antacids and milk inhibit absorption.
62
A patient diagnosed with cytomegalovirus (CMV) asks how this will affect her baby. What is the best response?
A. "There is no risk to your baby if you avoid contact with others."
B. "Your baby may develop congenital abnormalities or permanent disabilities."
C. "The virus only affects you and will not cross the placenta."
D. "A cesarean delivery will prevent transmission to your baby."
Answer: B
Rationale: CMV is the leading cause of congenital infections and may result in developmental delays and disabilities.
63
What is the most effective strategy to prevent vertical transmission of HIV from mother to baby?
A. Administer antiretroviral therapy during pregnancy.
B. Perform cesarean delivery at 34 weeks.
C. Avoid breastfeeding and vaginal delivery.
D. Delay labor induction until 40 weeks.
Answer: A
Rationale: Antiretroviral therapy during pregnancy significantly reduces the risk of perinatal HIV transmission.
64
A patient reports using methamphetamines during pregnancy. What fetal complication should the nurse anticipate?
A. Fetal macrosomia.
B. Placental abruption and growth restriction.
C. Increased fetal iron stores.
D. Neonatal abstinence syndrome.
Answer: B
Rationale: Methamphetamines cause vasoconstriction, increasing the risk of placental abruption and fetal growth restriction.
65
A pregnant patient with substance abuse reports using heroin. What is the nurse’s priority?
A. Educate about neonatal abstinence syndrome.
B. Refer the patient to a methadone maintenance program.
C. Advise immediate cessation of heroin use.
D. Schedule a fetal ultrasound to monitor growth.
Answer: B
Rationale: Methadone maintenance is safer for the fetus and mother than abrupt cessation, which could lead to withdrawal complications.
66
A pregnant patient with severe asthma is admitted in labor. What is the priority nursing intervention?
A. Administer oral prednisone.
B. Monitor maternal oxygen saturation continuously.
C. Limit IV fluids to avoid fluid overload.
D. Perform frequent peak flow measurements.
Answer: B
Rationale: Ensuring maternal oxygenation is critical to prevent fetal hypoxia during labor.
67
A pregnant patient with systemic lupus erythematosus (SLE) is at 32 weeks. What is the nurse’s priority?
A. Monitor for proteinuria and hypertension.
B. Perform non-stress tests weekly.
C. Educate about preterm labor risks.
D. Administer corticosteroids for lung maturity.
Answer: A
Rationale: SLE increases the risk of preeclampsia, characterized by proteinuria and hypertension.
68
A pregnant patient with a BMI of 35 is at risk for which labor complication?
A. Shoulder dystocia during delivery.
B. Prolonged rupture of membranes.
C. Placental insufficiency.
D. Hyperemesis gravidarum.
Answer: A
Rationale: Obesity increases the risk of fetal macrosomia, leading to complications like shoulder dystocia.
69
An adolescent patient is pregnant and experiencing food insecurity. What is the nurse’s first step?
A. Refer the patient to a dietitian.
B. Assess for prenatal supplement compliance.
C. Connect the patient to social services.
D. Provide nutritional counseling.
Answer: C
Rationale: Addressing food insecurity through social services is essential to ensure access to adequate nutrition.
70
A patient with sickle cell disease is at 34 weeks and experiencing a pain crisis. What is the nurse’s priority intervention?
A. Administer IV fluids and pain medication.
B. Monitor the fetus with continuous electronic fetal monitoring.
C. Administer iron supplements to reduce symptoms.
D. Encourage ambulation to reduce joint pain.
Answer: A
Rationale: IV fluids and pain management are crucial for stabilizing a sickle cell crisis.
71
Fetal Alcohol Syndrome (FAS)
27. A patient in her first trimester reports daily alcohol use. What is the most important teaching point?
A. Stop alcohol use immediately to prevent further harm to the fetus.
B. Limit alcohol to one drink per day during pregnancy.
C. Alcohol use only affects the fetus in the third trimester.
D. Prenatal vitamins will mitigate the effects of alcohol.
Answer: A
Rationale: Alcohol use at any stage of pregnancy can harm the fetus; cessation is critical to prevent further damage.
72
A patient presents with chickenpox at 12 weeks of pregnancy. What is the most likely complication for the fetus?
A. Fetal macrosomia.
B. Congenital varicella syndrome.
C. Neonatal abstinence syndrome.
D. Placental abruption.
Answer: B
Rationale: Early pregnancy exposure to varicella can cause congenital varicella syndrome, which includes growth restriction and malformations.
73
A pregnant patient reports marijuana use to manage nausea. What is the nurse’s best response?
A. "Marijuana can reduce fetal movements, which is beneficial."
B. "Marijuana use is linked to fetal growth restriction and should be avoided."
C. "Using marijuana is safer than taking anti-nausea medication."
D. "You should reduce marijuana use during the third trimester."
Answer: B
Rationale: Marijuana use is associated with fetal growth restriction and neurodevelopmental issues.
74
A patient with Class II heart disease is 32 weeks pregnant and reports palpitations and fatigue. What is the nurse’s priority?
A. Reassure the patient that this is normal.
B. Notify the provider for further evaluation.
C. Instruct the patient to limit physical activity.
D. Schedule a follow-up appointment in two weeks.
Answer: B
Rationale: Palpitations and fatigue in heart disease may indicate worsening cardiovascular status and require prompt evaluation.
75
A pregnant patient at 26 weeks undergoes a 50g oral glucose tolerance test (OGTT) with a result of 145 mg/dL. What is the next step?
A. Diagnose with gestational diabetes.
B. Perform a 3-hour OGTT.
C. Start insulin therapy.
D. Repeat the test at 28 weeks.
Answer: B
Rationale: A 50g OGTT result >140 mg/dL requires confirmation with a 3-hour OGTT to diagnose gestational diabetes.
76
Which value during a 3-hour OGTT is diagnostic of GDM?
A. Fasting glucose of 80 mg/dL.
B. 1-hour glucose of 185 mg/dL.
C. 2-hour glucose of 140 mg/dL.
D. 3-hour glucose of 130 mg/dL.
Answer: B
Rationale: A 1-hour glucose ≥180 mg/dL during a 3-hour OGTT is diagnostic for gestational diabetes.
77
The primary cause of insulin resistance in gestational diabetes is:
A. Genetic mutations.
B. Placental hormones like HPL and cortisol.
C. Increased maternal activity.
D. Decreased fetal glucose uptake.
Answer: B
Rationale: Placental hormones, such as human placental lactogen (HPL) and cortisol, cause insulin resistance during pregnancy.
78
A patient with gestational diabetes asks why her condition developed during pregnancy. What is the best response?
A. "It is caused by an autoimmune condition."
B. "Your body needs more insulin during pregnancy, and sometimes it cannot keep up."
C. "It happens when your pancreas stops working properly."
D. "Gestational diabetes is a result of eating too many carbohydrates."
Answer: B
Rationale: Insulin resistance and increased insulin demands during pregnancy often lead to gestational diabetes.
79
Which fetal complication is most strongly associated with GDM?
A. Neural tube defects.
B. Macrosomia.
C. Growth restriction.
D. Neonatal thrombocytopenia.
Answer: B
Rationale: GDM increases the risk of macrosomia due to elevated glucose levels and fetal hyperinsulinemia.
80
A patient with diet-controlled GDM is at 34 weeks. What fetal surveillance is recommended?
A. Weekly non-stress tests (NSTs).
B. No additional surveillance.
C. Biweekly NSTs starting at 32 weeks.
D. Induction of labor at 37 weeks.
Answer: C
Rationale: Biweekly NSTs are recommended for patients with GDM requiring pharmacologic treatment or additional risk factors.
81
During labor, what is the primary goal of managing a patient with GDM?
A. Prevent shoulder dystocia.
B. Maintain maternal blood glucose levels between 70-110 mg/dL.
C. Reduce the need for cesarean delivery.
D. Prevent neonatal hypoglycemia.
Answer: B
Rationale: Tight glucose control during labor reduces the risk of neonatal hypoglycemia and other complications.
82
What is the best mode of delivery for a patient with GDM and an estimated fetal weight (EFW) >4500g?
A. Trial of labor.
B. Elective cesarean delivery.
C. Induction of labor.
D. Vaginal delivery with vacuum assistance.
Answer: B
Rationale: Elective cesarean delivery reduces the risk of birth trauma in cases of suspected macrosomia (>4500g).
83
A newborn of a mother with GDM has a blood glucose level of 35 mg/dL. What is the priority nursing action?
A. Administer rapid-acting glucose IV.
B. Feed the newborn with formula or breastmilk.
C. Place the newborn under a radiant warmer.
D. Monitor blood glucose every 8 hours.
Answer: B
Rationale: Mild hypoglycemia in newborns is initially treated with oral feeds to stabilize glucose levels.
84
What is the primary cause of neonatal hypoglycemia in infants of mothers with GDM?
A. Hyperinsulinemia in the newborn.
B. Poor breastfeeding technique.
C. Placental insufficiency.
D. Delayed cord clamping.
Answer: A
Rationale: Neonatal hypoglycemia occurs due to fetal hyperinsulinemia after withdrawal of maternal glucose at birth.
85
What advice should the nurse provide to a patient with GDM regarding postpartum follow-up?
A. "You no longer need to monitor your blood sugar."
B. "You should schedule a glucose tolerance test 6-12 weeks postpartum."
C. "Insulin therapy will continue for six months."
D. "Your risk for diabetes is the same as before pregnancy."
Answer: B
Rationale: A glucose tolerance test postpartum evaluates for persistent diabetes or prediabetes.
86
A patient with GDM has resolved hyperglycemia postpartum. What is the long-term risk for this patient?
A. Preterm labor in subsequent pregnancies.
B. Type 2 diabetes mellitus later in life.
C. Recurrence of GDM in subsequent pregnancies.
D. Chronic hypertension.
Answer: B
Rationale: Patients with GDM have a significantly increased lifetime risk of developing type 2 diabetes.
87
Why is metformin preferred over glyburide for pharmacologic management of GDM?
A. Glyburide has fewer neonatal side effects.
B. Metformin does not cross the placenta.
C. Metformin has a lower risk of neonatal hypoglycemia.
D. Glyburide is ineffective in diet-controlled GDM.
Answer: C
Rationale: Metformin has a lower risk of neonatal hypoglycemia compared to glyburide.
88
A patient with GDM refuses insulin therapy. What is the best alternative treatment?
A. Glyburide.
B. Metformin.
C. Oral prednisone.
D. Low glycemic index diet.
Answer: B
Rationale: Metformin is an effective alternative for patients unable to use insulin.
89
What dietary recommendation is most beneficial for a patient with GDM?
A. High protein, low carbohydrate diet.
B. Low glycemic index (GI) diet.
C. Calorie-restricted diet.
D. Low-fat, high-sugar diet.
Answer: B
Rationale: A low glycemic index diet improves glucose control and reduces the risk of macrosomia.
90
Which patient is at highest risk for developing GDM?
A. A 25-year-old with a BMI of 22.
B. A 32-year-old with polycystic ovary syndrome (PCOS).
C. A 28-year-old with no family history of diabetes.
D. A 22-year-old with a sedentary lifestyle.
Answer: B
Rationale: PCOS is a significant risk factor for developing GDM.
91
A patient with GDM is on insulin therapy. What should the nurse teach regarding hypoglycemia management?
A. Carry a glucose gel or fast-acting carbohydrate.
B. Eat a meal immediately when symptoms occur.
C. Administer glucagon at the first sign of dizziness.
D. Monitor blood glucose once daily.
Answer: A
Rationale: Quick access to a carbohydrate source is essential for hypoglycemia management.
92
A patient with GDM is scheduled for induction at 39 weeks. What is the rationale for this decision?
A. Prevent macrosomia and associated birth trauma.
B. Minimize the risk of gestational hypertension.
C. Prevent preterm birth.
D. Reduce neonatal hypoglycemia risk.
Answer: A
Rationale: Induction at 39 weeks reduces the risk of macrosomia and birth trauma.
93
A nurse is educating a patient with GDM about exercise. What is the most appropriate advice?
A. Exercise should be avoided to prevent hypoglycemia.
B. Moderate exercise can help improve insulin sensitivity.
C. Strenuous exercise is recommended to lower glucose.
D. Exercise is only beneficial postpartum.
Answer: B
Rationale: Moderate exercise improves insulin sensitivity and glucose control during pregnancy.
94
A patient presents with regular contractions but no cervical change. What does this suggest?
A. True labor.
B. False labor.
C. Early active labor.
D. Transition phase.
Answer: B
Rationale: False labor involves regular contractions without cervical dilation or effacement.
94
What is the target fasting blood glucose level for a patient with GDM?
A. <80 mg/dL.
B. <92 mg/dL.
C. <100 mg/dL.
D. <110 mg/dL.
Answer: B
Rationale: A fasting blood glucose <92 mg/dL is the target for optimal management of GDM.
95
A pregnant patient reports "lightening" at 37 weeks. What does this indicate?
A. Cervical dilation has begun.
B. The baby has engaged in the pelvis.
C. Amniotic fluid has ruptured.
D. Active labor is imminent.
Answer: B
Rationale: Lightening refers to the baby descending into the maternal pelvis, often relieving pressure on the diaphragm.
96
Which sign is most reliable for identifying the active phase of labor?
A. Contractions every 5 minutes.
B. Cervical dilation of 6 cm with effacement.
C. Passage of the mucus plug.
D. Presence of bloody show.
Answer: B
Rationale: The active phase begins at 6 cm dilation with consistent cervical change.
97
During the transition phase, what maternal behavior is expected?
A. Euphoria and excitement.
B. Increased anxiety and irritability.
C. Minimal verbal communication.
D. Rapid cervical dilation and pushing urges.
Answer: B
Rationale: The transition phase is marked by intense emotions and physical discomfort.
98
A fetal station of +2 indicates:
A. The fetus is above the ischial spines.
B. The presenting part is engaged at the pelvic inlet.
C. The presenting part is 2 cm below the ischial spines.
D. The fetus is crowning.
Answer: C
Rationale: Positive station measurements indicate the fetus is descending below the ischial spines.
99
A patient with an android pelvis is in labor. What complication is most likely?
A. Cord prolapse.
B. Cephalopelvic disproportion.
C. Precipitous labor.
D. Uterine rupture.
Answer: B
Rationale: The android pelvis is narrow and may lead to cephalopelvic disproportion, requiring cesarean delivery.
100
During the cardinal movement of "extension," the fetal:
A. Head rotates internally to align with the pelvis.
B. Chin flexes to the chest.
C. Head passes beneath the symphysis pubis.
D. Shoulders rotate to the anterior-posterior position.
Answer: C
Rationale: Extension occurs as the fetal head passes under the pubic symphysis during delivery.
101
What is the correct order of the cardinal movements of labor?
A. Engagement, descent, extension, expulsion, flexion, rotation.
B. Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion.
C. Descent, engagement, internal rotation, flexion, expulsion, extension, external rotation.
D. Flexion, descent, engagement, rotation, extension, expulsion, internal rotation.
Answer: B
Rationale: The correct sequence ensures optimal navigation of the fetal head through the birth canal.
102
A patient in labor complains of severe back pain. What fetal position is likely?
A. Occiput posterior (OP).
B. Occiput anterior (OA).
C. Transverse lie.
D. Breech presentation.
Answer: A
Rationale: OP positioning increases back labor pain due to fetal skull pressure on the sacrum.
103
Which maternal position helps rotate a fetus in the OP position?
A. Lithotomy.
B. Left lateral.
C. Hands and knees. (Gaskin)
D. Semi-recumbent.
Answer: C
Rationale: The hands-and-knees position encourages rotation of an OP fetus to OA.
104
During labor, maternal cardiac output increases by:
A. 12-31% in the first stage and 50% in the second stage.
B. 20-30% in the first stage and 40% in the second stage.
C. 10-15% in the first stage and 25% in the second stage.
D. 15-20% in the first stage and 35% in the second stage.
Answer: A
Rationale: Cardiac output increases significantly during labor due to uterine contractions and maternal effort.
105
What fetal response is expected during contractions in active labor?
A. Accelerations in fetal heart rate.
B. Transient decreases in oxygenation.
C. Persistent decelerations.
D. Fetal hyperactivity.
Answer: B
Rationale: Transient decreases in oxygenation occur with reduced uteroplacental perfusion during contractions.
106
Which term describes the thinning of the cervix during labor?
A. Dilation.
B. Effacement.
C. Descent.
D. Extension.
Answer: B
Rationale: Effacement refers to the thinning and shortening of the cervix.
107
A patient’s contractions are 5 minutes apart, lasting 60 seconds, and of moderate intensity. What stage of labor is this likely?
A. Latent phase.
B. Active phase.
C. Transition phase.
D. Second stage.
Answer: B
Rationale: Contractions of this frequency and intensity are characteristic of the active phase.
108
What is the primary focus of nursing care during the second stage of labor?
A. Pain management.
B. Monitoring fetal station.
C. Encouraging effective pushing techniques.
D. Preventing perineal lacerations.
Answer: C
Rationale: Effective pushing ensures fetal descent and progression through the birth canal.
109
What indicates placental separation during the third stage of labor?
A. Absence of bleeding.
B. Lengthening of the umbilical cord.
C. Contractions cease.
D. Fetal heart tones disappear.
Answer: B
Rationale: A lengthened umbilical cord is a sign of placental detachment.
110
During the fourth stage of labor, what is the nurse’s priority?
A. Administering postpartum analgesics.
B. Checking fundal height every 8 hours.
C. Initiating breastfeeding.
D.Monitoring for signs of postpartum hemorrhage.
Answer: D
Rationale: Monitoring for hemorrhage is critical immediately postpartum.
111
High maternal anxiety during labor may result in:
A. Increased catecholamine levels and inhibited labor progress.
B. Decreased uterine contractions.
C. Shortened duration of active labor.
D. Reduced pain perception.
Answer: A
Rationale: Anxiety increases catecholamines, which interfere with uterine contractility and labor progress.
112
A patient in the second stage of labor is experiencing delayed fetal descent despite strong contractions. What is the priority nursing action?
A. Encourage the patient to change positions.
B. Perform a sterile vaginal exam to assess dilation.
C. Increase oxytocin administration.
D. Notify the provider of possible cephalopelvic disproportion.
Answer: A
Rationale: Changing positions can facilitate fetal descent by optimizing pelvic dimensions and alignment, especially in cases of delayed progress.
113
A nurse notes late decelerations on the fetal heart monitor during active labor. What is the initial nursing intervention?
A. Reposition the patient to the left lateral position.
B. Notify the healthcare provider immediately.
C. Increase the oxytocin infusion rate.
D. Administer a tocolytic medication.
Answer: A
Rationale: Late decelerations suggest uteroplacental insufficiency. Repositioning improves blood flow to the placenta and fetal oxygenation.
114
A patient in active labor is pushing, and the fetal head retracts against the perineum after delivery. What is this finding called?
A. McRoberts sign
B. Turtle sign
C. Leopold’s maneuver
D. Shoulder dystocia
Answer: B
Rationale: Turtle sign is the retraction of the fetal head against the perineum, indicating shoulder dystocia and requiring immediate intervention.
115
Which patient is at the highest risk for shoulder dystocia?
A. A G1P0 patient with an estimated fetal weight of 3,000 g and a history of gestational diabetes.
B. A G3P2 patient with an estimated fetal weight of 4,500 g and a history of macrosomic deliveries.
C. A G2P1 patient at 39 weeks with a history of preeclampsia.
D. A G4P3 patient with spontaneous rupture of membranes.
Answer: B
Rationale: Macrosomia (>4,500 g), previous macrosomic deliveries, and gestational diabetes significantly increase the risk of shoulder dystocia.
116
When shoulder dystocia is identified during delivery, what is the priority nursing action?
A. Perform fundal pressure.
B. Assist with McRoberts maneuver and apply suprapubic pressure.
C. Call for an emergency cesarean section.
D. Attempt to manually deliver the posterior shoulder.
Answer: B
Rationale: McRoberts maneuver (maternal hips flexed) and suprapubic pressure are initial, evidence-based interventions to relieve shoulder dystocia. Fundal pressure is contraindicated.
117
What should the nurse do immediately after the provider announces shoulder dystocia?
A. Encourage the patient to push harder.
B. Call for additional help and start a time clock.
C. Prepare for an emergency cesarean delivery.
D. Perform Wood’s screw maneuver.
Answer: B
Rationale: The nurse should stay calm, initiate the time clock, and call for help to assist in managing the emergency.
118
A patient with shoulder dystocia does not respond to McRoberts maneuver and suprapubic pressure. What is the next recommended step?
A. Zavanelli maneuver.
B. Gaskin maneuver.
C. Perform an episiotomy.
D. Apply fundal pressure.
Answer: B
Rationale: The Gaskin maneuver (placing the patient in hands-and-knees position) is an effective secondary intervention for shoulder dystocia.
119
The Wood’s screw maneuver is performed to:
A. Rotate the fetal head to an occiput anterior position.
B. Dislodge the anterior shoulder from the pubic bone.
C. Deliver the posterior shoulder by rotating the fetus.
D. Reduce the fetal head back into the uterus.
Answer: C
Rationale: The Wood’s screw maneuver rotates the fetus to dislodge the shoulders and facilitate delivery.
120
What is the most common neonatal complication associated with shoulder dystocia?
A. Hypoxic-ischemic encephalopathy.
B. Erb’s palsy.
C. Neonatal sepsis.
D. Clavicular fracture.
Answer: B
Rationale: Brachial plexus injury, such as Erb’s palsy, is the most common complication resulting from excessive traction during delivery.
121
What maternal complication is most likely following shoulder dystocia?
A. Uterine rupture.
B. Postpartum hemorrhage.
C. Pelvic hematoma.
D. Endometritis.
Answer: B
Rationale: Postpartum hemorrhage frequently occurs due to uterine atony or trauma following difficult deliveries like shoulder dystocia.
122
Which prenatal factor warrants consideration for an elective cesarean delivery to prevent shoulder dystocia?
A. Estimated fetal weight of 3,800 g.
B. Maternal BMI >25 with no history of macrosomia.
C. Gestational diabetes with an estimated fetal weight of 5,000 g.
D. Previous cesarean delivery.
Answer: C
Rationale: Elective cesarean delivery is recommended for patients with gestational diabetes and an estimated fetal weight >5,000 g to reduce the risk of shoulder dystocia.
123
What is the nurse’s responsibility in documentation following shoulder dystocia?
A. Document only the maneuvers used to resolve the dystocia.
B. Record the head-to-body delivery time, maneuvers used, and neonatal status.
C. Ensure the provider documents the delivery sequence.
D. Focus on documenting maternal pain levels during the delivery.
Answer: B
Rationale: Thorough documentation of head-to-body delivery time, maneuvers used, and neonatal status is critical for legal and medical accuracy.
124
Which of the following is an example of primary prevention in maternal health care?
A. Administering Rh immunoglobulin to an Rh-negative mother.
B. Conducting genetic counseling for a family with a history of cystic fibrosis.
C. Providing influenza vaccination to pregnant women.
D. Monitoring blood glucose levels in a patient with gestational diabetes.
Answer: C
Rationale: Primary prevention aims to prevent disease or harm before it occurs, such as vaccinations.
125
A nurse provides breast self-exam education to women during prenatal visits. This is an example of:
A. Primary prevention.
B. Secondary prevention.
C. Tertiary prevention.
D. Quaternary prevention.
Answer: B
Rationale: Secondary prevention includes early detection and intervention, like breast cancer screening.
126
Which of the following is true of autosomal dominant disorders?
A. Both parents must carry the gene for the disorder to be expressed.
B. There is a 50% chance of passing the disorder to offspring.
C. Males are more commonly affected than females.
D. The disorder skips generations.
Answer: B
Rationale: Autosomal dominant inheritance results in a 50% chance of passing the condition, regardless of sex.
127
A patient is a carrier for an autosomal recessive disorder. What are the chances of her child inheriting the disorder if her partner is also a carrier?
A. 25%
B. 50%
C. 75%
D. 100%
Answer: A
Rationale: Autosomal recessive disorders require both parents to pass the gene, resulting in a 25% chance of the child being affected.
128
Which test is most commonly used to detect chromosomal abnormalities such as trisomy 21?
A. Amniocentesis.
B. Non-invasive prenatal testing (NIPT).
C. Chorionic villus sampling (CVS).
D. Ultrasound.
Answer: B
Rationale: NIPT is a non-invasive screening tool with high accuracy for detecting chromosomal abnormalities.
129
What is the purpose of magnesium sulfate in the management of preeclampsia?
A. To reduce blood pressure.
B. To prevent seizures.
C. To increase urine output.
D. To treat fetal distress.
Answer: B
Rationale: Magnesium sulfate is a central nervous system depressant used to prevent eclampsia-related seizures.
130
What therapeutic magnesium level is targeted for patients receiving magnesium sulfate for preeclampsia?
A. 2-4 mg/dL.
B. 4-7 mg/dL.
C. 7-10 mg/dL.
D. 10-12 mg/dL.
Answer: B
Rationale: A therapeutic range of 4-7 mg/dL balances efficacy and safety while avoiding toxicity.
131
A patient on magnesium sulfate for preterm labor has absent deep tendon reflexes and a respiratory rate of 10. What is the priority intervention?
A. Discontinue the infusion and administer calcium gluconate.
B. Decrease the magnesium infusion rate.
C. Notify the provider and monitor vital signs.
D. Administer oxygen at 2 L/min.
Answer: A
Rationale: Absent reflexes and respiratory depression are signs of magnesium toxicity, requiring immediate cessation and calcium gluconate administration.
132
What is the purpose of the RPR or VDRL test during pregnancy?
A. To screen for syphilis.
B. To check for hepatitis B.
C. To assess Rh incompatibility.
D. To diagnose gestational diabetes.
Answer: A
Rationale: RPR and VDRL tests detect syphilis, which can lead to congenital infections if untreated.
133
A pregnant woman’s rubella titer indicates she is non-immune. What is the appropriate nursing action?
A. Administer the rubella vaccine during pregnancy.
B. Advise her to avoid exposure to individuals with rubella.
C. Administer the vaccine immediately postpartum.
D. Schedule a repeat titer in the third trimester.
Answer: C
Rationale: Live vaccines, such as MMR, are contraindicated during pregnancy but should be given postpartum to prevent future complications.
134
What is the normal range for hemoglobin levels during pregnancy?
A. >10 g/dL.
B. >11 g/dL.
C. >12 g/dL.
D. >13 g/dL.
Answer: B
Rationale: Hemoglobin levels >11 g/dL are considered normal in pregnancy, reflecting increased plasma volume.
135
A patient’s ALT level is 75 U/L and AST level is 65 U/L at 36 weeks. What condition should the nurse suspect?
A. Normal pregnancy changes.
B. Preeclampsia with severe features.
C. Gestational diabetes.
D. HELLP syndrome.
Answer: D
Rationale: Elevated liver enzymes are a hallmark of HELLP syndrome, a complication of preeclampsia.
136
Which platelet count would be concerning in a pregnant woman?
A. 150,000/µL.
B. 140,000/µL.
C. 90,000/µL.
D. 120,000/µL.
Answer: C
Rationale: Platelet counts <100,000/µL indicate thrombocytopenia, which is associated with HELLP syndrome or preeclampsia.
137
What patient education is critical for a pregnant woman receiving magnesium sulfate?
A. "You may experience an increased energy level."
B. "Notify the nurse if you experience chest pain or trouble breathing."
C. "You will need to ambulate every hour to prevent clots."
D. "This medication is used to control your blood pressure."
Answer: B
Rationale: Magnesium sulfate can cause respiratory depression; patients must report breathing difficulties.
138
A patient has a protein/creatinine ratio of 0.4. What does this indicate?
A. Normal pregnancy changes.
B. Mild preeclampsia.
C. Severe preeclampsia.
D. Gestational diabetes.
Answer: C
Rationale: A ratio >0.3 indicates proteinuria, which is diagnostic of preeclampsia.
139
A pregnant patient at 34 weeks has polyhydramnios. What complication should the nurse monitor for?
A. Preterm labor.
B. Placental abruption.
C. Cord prolapse.
D. Preeclampsia.
Answer: C
Rationale: Polyhydramnios increases the risk of cord prolapse during membrane rupture.
140
What condition is associated with oligohydramnios?
A. Neural tube defects.
B. Preterm labor.
C. Gestational diabetes.
D. Fetal growth restriction.
Answer: D
Rationale: Oligohydramnios is often linked to placental insufficiency and fetal growth restriction.
141
Elevated uric acid levels in pregnancy are indicative of:
A. HELLP syndrome.
B. Preeclampsia.
C. Gestational diabetes.
D. Intrahepatic cholestasis.
Answer: B
Rationale: Uric acid is a marker for preeclampsia due to impaired renal perfusion.
142
A WBC count of 15,000/µL in a pregnant woman at 38 weeks is:
A. Indicative of infection.
B. A normal finding in late pregnancy.
C. Suggestive of preeclampsia.
D. Concerning for sepsis.
Answer: B
Rationale: Elevated WBC counts are normal in late pregnancy due to physiological changes.
143
What is the recommended treatment for a GBS-positive pregnant woman in labor?
A. Penicillin G.
B. Ampicillin.
C. Cefazolin.
D. All of the above.
Answer: D
Rationale: All listed antibiotics are acceptable for intrapartum GBS prophylaxis, depending on allergies.
144
A patient presents with bluish-purple discoloration of the vaginal mucosa and cervix during her first prenatal visit. What is this sign called?
A. Chadwick’s sign
B. Goodell’s sign
C. Hegar’s sign
D. Ballottement
Answer: A
Rationale: Chadwick’s sign refers to the bluish discoloration of the cervix, vagina, and labia due to increased vascularity during pregnancy.
145
A nurse notes that a patient has a positive pregnancy test and abdominal enlargement but no ultrasound confirmation of a fetus. How should these findings be classified?
A. Presumptive signs of pregnancy
B. Probable signs of pregnancy
C. Positive signs of pregnancy
D. False pregnancy
Answer: B
Rationale: Probable signs of pregnancy are observed by the provider and include a positive pregnancy test and abdominal enlargement.
146
At what gestational age does the fundus typically reach the level of the umbilicus?
A. 12 weeks
B. 16 weeks
C. 20 weeks
D. 28 weeks
Answer: C
Rationale: The fundal height reaches the umbilicus at approximately 20 weeks and is a reliable indicator of gestational age until 36 weeks.
147
What is the primary cause of Braxton Hicks contractions during pregnancy?
A. Fetal movement
B. Uterine muscle stretching
C. Estrogen stimulation
D. Placental insufficiency
Answer: B
Rationale: Braxton Hicks contractions result from uterine muscle stretching and increasing contractility.
148
Which cardiovascular adaptation is expected in pregnancy?
A. Decrease in cardiac output by 30%.
B. Increased blood volume by 30-50%.
C. Decrease in clotting factors.
D. Decreased heart rate.
Answer: B
Rationale: Blood volume increases significantly during pregnancy to support maternal and fetal needs.
149
Why are pregnant women at increased risk of urinary tract infections (UTIs)?
A. Decreased renal perfusion.
B. Increased urine pH.
C. Ureteral dilation and urinary stasis.
D. Hormonal suppression of the immune system.
Answer: C
Rationale: Hormonal changes and mechanical pressure lead to ureteral dilation and urinary stasis, increasing UTI risk.
150
A patient’s obstetric history is G3 T1 P1 A0 L2. How should this be interpreted?
A. Three pregnancies, one term birth, one preterm birth, no abortions, two living children.
B. Three pregnancies, two term births, no preterm births, one abortion, two living children.
C. Three pregnancies, one term birth, no preterm births, one abortion, two living children.
D. Three pregnancies, two preterm births, one abortion, two living children.
Answer: A
Rationale: GTPAL represents gravidity, term births, preterm births, abortions, and living children.
151
How often should a pregnant woman with no complications be seen for prenatal care during weeks 29 to 36?
A. Weekly
B. Every 2 weeks
C. Every 4 weeks
D. Every 3 weeks
Answer: B
Rationale: Prenatal visits are scheduled every 2 weeks during weeks 29-36 for uncomplicated pregnancies.
152
What is the recommended total weight gain for a woman with a normal BMI during pregnancy?
A. 11-20 pounds
B. 15-25 pounds
C. 25-35 pounds
D. 28-40 pounds
Answer: C
Rationale: Women with a normal BMI should gain 25-35 pounds during pregnancy.
153
A pregnant patient practices vegetarianism. What supplement is essential for her during pregnancy?
A. Vitamin C
B. Vitamin A
C. Vitamin B12
D. Magnesium
Answer: C
Rationale: Vegetarian diets may lack adequate vitamin B12, which is critical for fetal neurological development.
154
Why does insulin resistance increase during pregnancy?
A. Decreased pancreatic function.
B. Increased secretion of human placental lactogen (hPL).
C. Decreased maternal glucose levels.
D. Increased placental estrogen levels.
Answer: B
Rationale: hPL, secreted by the placenta, antagonizes insulin to ensure glucose availability for the fetus.
155
A nurse notes that a patient’s thyroid gland is slightly enlarged during pregnancy. What does this indicate?
A. Hyperthyroidism
B. Hypothyroidism
C. Normal physiological change
D. Iodine deficiency
Answer: C
Rationale: Slight thyroid enlargement is normal due to increased metabolic demands during pregnancy.
156
What is the likely cause of melasma (“mask of pregnancy”) in pregnant women?
A. Increased estrogen and progesterone.
B. Decreased melanin production.
C. Vitamin D deficiency.
D. Dehydration.
Answer: A
Rationale: Hormonal changes stimulate melanin production, causing hyperpigmentation in pregnancy.
157
. A pregnant patient reports numbness and tingling in her hand. What is the probable cause?
A. Increased blood volume.
B. Relaxin hormone effects.
C. Carpal tunnel syndrome.
D. Vitamin B12 deficiency.
Answer: C
Rationale: Carpal tunnel syndrome is common in pregnancy due to fluid retention compressing the median nerve.
158
What is an appropriate sleep position for a pregnant woman to improve circulation?
A. Supine
B. Prone
C. Left lateral
D. Semi-Fowler’s
Answer: C
Rationale: Left lateral positioning enhances uteroplacental blood flow and reduces vena cava compression.
159
A nurse advises a pregnant patient to avoid lying flat on her back in the third trimester. What complication is this preventing?
A. Preterm labor
B. Supine hypotensive syndrome
C. Preeclampsia
D. Gestational diabetes
Answer: B
Rationale: Supine positioning can compress the inferior vena cava, reducing cardiac output and causing hypotension.
160
A pregnant patient expresses increased anxiety about labor. What is the nurse’s priority intervention?
A. Refer the patient to a psychologist.
B. Provide education about labor and delivery.
C. Administer anxiolytics as prescribed.
D. Suggest bed rest until delivery.
Answer: B
Rationale: Education reduces fear and prepares the patient for labor, alleviating anxiety.
161
A fundal height measurement of 28 cm at 32 weeks suggests:
A. Normal growth.
B. Fetal growth restriction.
C. Polyhydramnios.
D. Macrosomia.
Answer: B
Rationale: Fundal height measurements significantly below gestational age suggest fetal growth restriction.
162
At what gestational age can fetal heart tones typically be auscultated by Doppler?
A. 6 weeks
B. 10 weeks
C. 14 weeks
D. 18 weeks
Answer: B
Rationale: Fetal heart tones are usually detectable by Doppler between 10 and 12 weeks.
163
Which patient statement indicates effective learning about third-trimester self-care?
A. "I will continue taking prenatal vitamins until delivery."
B. "I can continue exercising in the supine position."
C. "I will avoid eating fish to prevent mercury exposure."
D. "I need to start preparing for labor when contractions begin."
Answer: A
Rationale: Continuing prenatal vitamins support maternal and fetal health throughout pregnancy.
164
A patient with chronic hypertension at 12 weeks gestation is on antihypertensive therapy. Which medication requires discontinuation due to teratogenic risks?
A. Labetalol
B. Hydralazine
C. Nifedipine
D. Losartan
Answer: D
Rationale: ACE inhibitors and ARBs, like Losartan, are contraindicated during pregnancy as they can cause fetal renal damage and other malformations.
165
A pregnant patient with chronic hypertension develops new-onset proteinuria at 26 weeks. What is the most likely diagnosis?
A. Gestational hypertension
B. Preeclampsia superimposed on chronic hypertension
C. Chronic kidney disease
D. HELLP syndrome
Answer: B
Rationale: Superimposed preeclampsia is diagnosed in patients with chronic hypertension who develop new proteinuria or worsening blood pressure after 20 weeks.
166
What is the hallmark feature of gestational hypertension?
A. Proteinuria
B. Hypertension without proteinuria after 20 weeks
C. Severe headaches and blurred vision
D. Thrombocytopenia and elevated liver enzymes
Answer: B
Rationale: Gestational hypertension is defined as elevated blood pressure after 20 weeks gestation without proteinuria or other severe features.
167
Which laboratory finding supports a diagnosis of preeclampsia?
A. Platelet count of 150,000/µL
B. Protein/creatinine ratio of 0.4
C. AST and ALT levels within normal range
D. Uric acid of 4 mg/dL
Answer: B
Rationale: A protein/creatinine ratio >0.3 or a 24-hour urine protein >300 mg confirms proteinuria, a diagnostic criterion for preeclampsia.
168
A nurse monitors a patient with severe preeclampsia. Which finding requires immediate action?
A. Deep tendon reflexes (DTRs) of +2
B. Blood pressure of 170/110 mmHg
C. Urine output of 40 mL/hour
D. A complaint of mild nausea
Answer: B
Rationale: Severe hypertension (SBP ≥160 or DBP ≥110) requires urgent treatment to prevent complications like stroke or placental abruption.
169
A patient with severe preeclampsia is prescribed magnesium sulfate. What is the primary purpose of this medication?
A. To lower blood pressure
B. To prevent eclamptic seizures
C. To promote diuresis
D. To reduce pulmonary edema
Answer: B
Rationale: Magnesium sulfate is the drug of choice to prevent and manage eclamptic seizures.
170
A patient on magnesium sulfate develops a respiratory rate of 10 breaths/min. What is the nurse’s priority action?
A. Notify the provider and prepare for intubation
B. Administer oxygen via nasal cannula
C. Discontinue the magnesium sulfate infusion and administer calcium gluconate
D. Increase the magnesium infusion rate to prevent seizures
Answer: C
Rationale: Respiratory depression is a sign of magnesium toxicity and requires immediate discontinuation of the infusion and administration of calcium gluconate as the antidote.
171
During a seizure in a patient with eclampsia, what is the nurse’s priority action?
A. Insert an oral airway
B. Restrain the patient to prevent injury
C. Maintain a patent airway and call for help
D. Administer magnesium sulfate immediately
Answer: C
Rationale: Maintaining the airway and ensuring patient safety are the priorities during an eclamptic seizure.
172
A patient with eclampsia is stabilized after a seizure. What is the next step in care?
A. Immediate cesarean delivery
B. Continuous fetal monitoring
C. Administration of antihypertensives
D. Transfer to the ICU
Answer: B
Rationale: Continuous fetal monitoring is essential to assess for fetal compromise following maternal seizures.
173
Which finding is most consistent with HELLP syndrome?
A. Proteinuria >300 mg in 24 hours
B. Elevated liver enzymes and thrombocytopenia
C. Hyperglycemia and ketonuria
D. Increased deep tendon reflexes
Answer: B
Rationale: HELLP syndrome involves hemolysis, elevated liver enzymes, and low platelet count.
174
A patient with HELLP syndrome complains of right upper quadrant pain and nausea. What is the nurse’s priority?
A. Administer an antiemetic
B. Assess for signs of liver rupture or hematoma
C. Provide a high-protein snack
D. Discontinue magnesium sulfate
Answer: B
Rationale: RUQ pain may indicate liver involvement or rupture, a life-threatening complication of HELLP syndrome.
175
Which assessment finding indicates the need for continued magnesium sulfate therapy postpartum?
A. Blood pressure of 130/80 mmHg
B. Urine output of 50 mL/hour
C. Normal deep tendon reflexes
D. Persistent headache and blurred vision
Answer: D
Rationale: Cerebral symptoms like headache and blurred vision suggest ongoing preeclampsia and require continued magnesium sulfate therapy.
176
Which antihypertensive medication is contraindicated for acute management of severe preeclampsia?
A. Hydralazine
B. Labetalol
C. Nifedipine
D. Methyldopa
Answer: D
Rationale: Methyldopa is not used for acute management; it is better suited for chronic hypertension management during pregnancy.
177
What is the goal systolic blood pressure when treating severe preeclampsia with antihypertensives?
A. 120-130 mmHg
B. 130-140 mmHg
C. 140-150 mmHg
D. 160-170 mmHg
Answer: C
Rationale: The goal is to lower systolic BP to a safer range (140-150 mmHg) without compromising placental perfusion.
178
A patient at risk for preeclampsia is prescribed low-dose aspirin. When should the patient begin this therapy?
A. Before conception
B. At 12 weeks gestation
C. At 20 weeks gestation
D. At the onset of symptoms
Answer: B
Rationale: Low-dose aspirin started at 12 weeks gestation reduces the risk of preeclampsia in high-risk women.
179
A nurse is teaching a patient about signs of preeclampsia. Which statement by the patient indicates understanding?
A. "I will monitor my blood sugar levels daily."
B. "I will call my provider if I develop swelling in my feet."
C. "I will report a severe headache and vision changes immediately."
D. "I will avoid all physical activity to reduce my risk."
Answer: C
Rationale: Severe headache and vision changes are warning signs of preeclampsia that require prompt evaluation.
180
A biophysical profile (BPP) is ordered for a patient with preeclampsia. What is the purpose of this test?
A. To monitor maternal kidney function
B. To assess fetal well-being
C. To confirm fetal position
D. To detect placental abruption
Answer: B
Rationale: A BPP evaluates fetal health and detects signs of compromise, such as reduced amniotic fluid or movement.
180
A patient diagnosed with gestational hypertension asks how it differs from preeclampsia. What is the nurse’s best response?
A. "Gestational hypertension only occurs after delivery, while preeclampsia occurs during pregnancy."
B. "Gestational hypertension does not involve protein in the urine, while preeclampsia does."
C. "Gestational hypertension leads to severe complications, while preeclampsia does not."
D. "Gestational hypertension requires delivery, but preeclampsia does not."
Answer: B
Rationale: Gestational hypertension is characterized by elevated blood pressure without proteinuria, while preeclampsia includes proteinuria or other severe features.
180
The nurse observes more than 5 uterine contractions in a 10-minute period on the monitor. What is the appropriate term for this finding?
A. Tachycardia
B. Tachysystole
C. Bradycardia
D. Prolonged contraction
Answer: B
Rationale: Tachysystole is defined as more than 5 uterine contractions in 10 minutes, requiring prompt evaluation and possible intervention.
181
A reactive non-stress test (NST) in a term fetus is defined by:
A. Two accelerations of 10 bpm lasting 10 seconds in a 20-minute period.
B. Two accelerations of 15 bpm lasting 15 seconds in a 20-minute period.
C. Two accelerations of 20 bpm lasting 20 seconds in a 40-minute period.
D. No accelerations in a 20-minute period.
Answer: B
Rationale: A reactive NST requires at least two accelerations of 15 bpm for at least 15 seconds in a 20-minute window in term fetuses.
181
When determining the fetal heart rate baseline, which finding should the nurse exclude?
A. Variability
B. Accelerations
C. Decelerations
D. Both accelerations and decelerations
Answer: D
Rationale: The baseline is calculated by averaging the heart rate over 10 minutes, excluding accelerations and decelerations.
181
A fetal heart rate strip shows variability with 0-5 beats of fluctuation. How should this variability be classified?
A. Moderate variability
B. Absent variability
C. Minimal variability
D. Marked variability
Answer: C
Rationale: Variability of 0-5 beats is considered minimal and may indicate fetal sleep, medication effects, or hypoxia.
182
A fetal heart rate strip with moderate variability, accelerations, and no decelerations is categorized as:
A. Category 1
B. Category 2
C. Category 3
D. Non-reassuring
Answer: A
Rationale: Category 1 indicates normal baseline, moderate variability, and no concerning decelerations or patterns.
183
A strip with absent variability and recurrent late decelerations falls under which category?
A. Category 1
B. Category 2
C. Category 3
D. Normal
Answer: C
Rationale: Absent variability with recurrent late decelerations is a Category 3 tracing and requires immediate intervention.
184
Which condition is a contraindication for a fetal scalp electrode?
A. Fetal tachycardia
B. Maternal herpes infection
C. Prolonged decelerations
D. Suspected uterine rupture
Answer: B
Rationale: Maternal infections like herpes contraindicate the use of fetal scalp electrodes due to the risk of fetal transmission.
185
What is the primary indication for an intrauterine pressure catheter (IUPC)?
A. Ruptured membranes
B. Poor contraction tracing on the external monitor
C. Preterm labor
D. Maternal tachycardia
Answer: B
Rationale: An IUPC is used when external monitoring cannot adequately measure contraction strength.
186
A nurse is preparing for an amnioinfusion. What is the primary purpose of this intervention?
A. To augment labor progress
B. To relieve variable decelerations
C. To prevent preterm labor
D. To manage maternal hypotension
Answer: B
Rationale: Amnioinfusion introduces fluid into the uterus to cushion the umbilical cord, reducing variable decelerations.
187
Which pattern requires immediate intervention?
A. Accelerations lasting 15 seconds
B. Prolonged deceleration lasting 3 minutes
C. Early decelerations with contractions
D. Moderate variability with occasional late decelerations
Answer: B
Rationale: Prolonged decelerations (>2 minutes) indicate significant fetal compromise and require immediate action.
188
Which maternal position optimizes uteroplacental blood flow?
A. Supine
B. Semi-Fowler’s
C. Left lateral
D. Prone
Answer: C
Rationale: The left lateral position reduces vena cava compression, improving placental perfusion and fetal oxygenation.
189
What is the purpose of a cord blood gas analysis after delivery?
A. To measure maternal blood pressure
B. To determine fetal acid-base status
C. To evaluate contraction strength
D. To confirm neonatal respiratory distress
Answer: B
Rationale: Cord blood gas analysis assesses fetal oxygenation and acid-base status at birth, providing insights into labor stress.
189
What should the nurse document when monitoring a Category 2 fetal heart rate pattern?
A. Time and intervention performed
B. Baseline variability only
C. Maternal pain levels
D. Fetal scalp electrode placement
Answer: A
Rationale: Documentation for Category 2 tracings must include the time, interventions, and the fetus’ response to ensure continuity of care.
190
When communicating a non-reassuring fetal heart rate pattern to the provider, what information should the nurse prioritize?
A. Maternal weight and age
B. Maternal vital signs
C. Length of labor and rupture of membranes
D.Details of the fetal heart rate pattern and interventions performed
Answer: D
Rationale: The fetal heart rate pattern and response to interventions are critical details for guiding further management.
191
A laboring patient is assessed, and the fetus is in a transverse lie. Which intervention should the nurse anticipate to facilitate delivery?
A. Encourage ambulation to promote fetal descent.
B. Perform external cephalic version (ECV) if conditions allow.
C. Prepare for a vacuum-assisted vaginal delivery.
D. Administer oxytocin to increase contraction strength.
Answer: B
Rationale: A transverse lie indicates the fetus is positioned sideways in the uterus, making vaginal delivery impossible. An external cephalic version (ECV) may be performed to rotate the fetus into a longitudinal lie if the conditions are favorable. Oxytocin (D) and ambulation (A) are ineffective for addressing transverse lie. Vacuum delivery (C) is not appropriate in this situation.
192
A primigravida patient is in labor with a fetus presenting in the occiput posterior (OP) position. Which pelvic shape is most likely to result in labor complications?
A. Gynecoid
B. Android
C. Anthropoid
D. Platypelloid
Answer: B
Rationale: An android pelvis has a narrow midpelvic diameter and is less favorable for vaginal delivery, especially with an occiput posterior (OP) presentation. A gynecoid pelvis (A) is ideal for labor, while anthropoid (C) and platypelloid (D) shapes may still allow for vaginal delivery with fewer complications.
193
A nurse notes that a laboring patient has contractions every 8 minutes, lasting 30 seconds, with mild intensity. The cervix is 3 cm dilated. What is the appropriate nursing intervention?
A. Administer oxytocin to augment labor.
B. Encourage the patient to walk and change positions.
C. Prepare the patient for cesarean delivery.
D. Initiate continuous fetal monitoring.
Answer: B
Rationale: The patient is in the early labor phase. Ambulation and position changes can help strengthen contractions and promote cervical dilation. Oxytocin (A) is premature. Cesarean delivery (C) is not indicated, and continuous fetal monitoring (D) is unnecessary unless there are risk factors.
194
A patient in active labor is experiencing back pain due to a persistent occiput posterior (OP) fetal position. Which intervention is most effective in relieving discomfort?
A. Place the patient in the supine position.
B. Apply a cold compress to the lower back.
C. Encourage the hands-and-knees position.
D. Administer epidural anesthesia immediately.
Answer: C
Rationale: The hands-and-knees position can help rotate the fetus from an OP position to an occiput anterior position, relieving back pain. A supine position (A) worsens back pain. While a cold compress (B) may provide some relief, it does not address the underlying issue. Epidural anesthesia (D) relieves pain but does not correct the fetal position.
195
The nurse assesses a laboring patient and notes that the fetal head is at station +1. What does this finding indicate?
A. The fetal head is above the ischial spines.
B. The fetal head is engaged in the pelvis.
C. The fetal head has descended past the ischial spines.
D. The fetal head has started crowning.
Answer: C
Rationale: A station of +1 indicates the fetal head has descended past the ischial spines. Engagement (B) occurs at 0 station. A station of -1 or higher (A) indicates the head is above the spines. Crowning (D) occurs at station +5.
196
A nurse is educating a patient about the descent phase of labor. Which factor does not contribute to fetal descent?
A. Uterine contractions
B. Amniotic fluid pressure
C. Maternal pushing
D. Fetal engagement
Answer: D
Rationale: While engagement indicates the fetal head is entering the pelvis, it is not a contributing factor to descent. Descent is influenced by uterine contractions (A), amniotic fluid pressure (B), and maternal pushing efforts (C).
197
A laboring patient appears anxious and is hyperventilating. How can the nurse best address the psychological aspect of labor?
A. Administer an anxiolytic medication.
B. Offer pain medication immediately.
C. Encourage slow, deep breathing and provide reassurance.
D. Explain the physiological process of labor in detail.
Answer: C
Rationale: Psychological stress can negatively impact labor progression by increasing catecholamine release. Slow, deep breathing and reassurance help calm the patient. Anxiolytics (A) and pain medications (B) are not first-line interventions for anxiety. Detailed explanations (D) may not be effective during heightened anxiety.
198
During a vaginal exam, the nurse notes that the fetal head is rotating from a transverse to an anterior position. What is the significance of this movement?
A. It facilitates engagement in the pelvis.
B. It allows the fetal head to align with the pelvic outlet.
C. It signals the start of the expulsion phase.
D. It indicates the fetal head is crowning.
Answer: B
Rationale: Internal rotation aligns the fetal head with the anteroposterior diameter of the pelvic outlet, facilitating descent. Engagement (A) occurs earlier, and crowning (D) and expulsion (C) occur after delivery of the head.
199
A laboring patient’s fetus is in a breech presentation. Which complication is most likely to occur?
A. Umbilical cord prolapse
B. Prolonged latent phase of labor
C. Rapid cervical dilation
D. Shoulder dystocia
Answer: A
Rationale: Breech presentation increases the risk of umbilical cord prolapse, as the buttocks or feet do not effectively block the cervical opening. Shoulder dystocia (D) is more common in cephalic presentations with macrosomia. Prolonged latent phase (B) and rapid cervical dilation (C) are not directly associated with breech presentations.
200
After the birth of the head, the nurse notes external rotation (restitution). What does this indicate?
A. The shoulders are realigning with the pelvis.
B. The head is preparing for crowning.
C. The fetus is transitioning into engagement.
D. The placenta is beginning to separate.
Answer: A
Rationale: External rotation, or restitution, occurs after the head is delivered as it realigns with the fetal shoulders to prepare for their delivery. Crowning (B) occurs earlier, and engagement (C) is a separate process. Placental separation (D) happens after the fetus is fully delivered.
201
Pregnant hemoglobin range
11.5-14
202
Pregnant hematocrit range
32%-40%
203
PPROM
Bag broke but not in labor so no cervical exam
204
PROM
Water broke and probably in premature labor so do FFN and then cervical exam
205
Can’t do what 24 hours before a FFN…
Intercourse or cervical exams
206
Negative FFN means…
Patient will most likely go into labor
207
A nurse is educating a pregnant client about vaccines. Which vaccine can the nurse safely recommend during any trimester of pregnancy?
A. MMR
B. Tdap
C. Varicella
D. Live nasal influenza vaccine
Answer: B. Tdap
Rationale: The Tdap vaccine (Tetanus, Diphtheria, Pertussis) is recommended during each pregnancy, ideally between 27-36 weeks gestation. MMR and varicella are live vaccines and should not be given during pregnancy. The live nasal influenza vaccine is also contraindicated due to the risk of live virus exposure.
208
A nurse is caring for a laboring client receiving Pitocin to augment labor. Which of the following would indicate a need to stop the Pitocin infusion immediately?
A. The client is having regular, strong contractions.
B. The client reports intense back pain with each contraction.
C. The fetal heart rate shows bradycardia with repetitive decelerations.
D. The client has had vaginal bleeding.
Answer: C. The fetal heart rate shows bradycardia with repetitive decelerations.
Rationale: Pitocin can cause uterine hyperstimulation, which may lead to fetal distress, such as bradycardia or abnormal patterns in fetal heart rate. When these signs occur, Pitocin should be stopped immediately to prevent complications.
209
A client presents to the clinic with vaginal bleeding and cervical dilation. The nurse anticipates that the client is likely experiencing which type of spontaneous abortion?
A. Threatened abortion
B. Inevitable abortion
C. Missed abortion
D. Complete abortion
Answer: B. Inevitable abortion
Rationale: An inevitable abortion is characterized by vaginal bleeding with cervical dilation, and it indicates that the miscarriage will likely proceed. Threatened abortion involves bleeding but no cervical dilation, and a missed abortion involves fetal demise without expulsion of tissue.
210
Which of the following represents secondary prevention during pregnancy?
A. Encouraging a pregnant client to eat a balanced diet to prevent complications.
B. Educating a client about how to avoid contracting gestational diabetes.
C. Screening a pregnant client for gestational diabetes at 24-28 weeks of pregnancy.
D. Administering a vaccine to prevent pertussis complications.
Answer: C. Screening a pregnant client for gestational diabetes at 24-28 weeks of pregnancy.
211
Normal magnesium range?
1.3-2.1
212
A pregnant client presents with vaginal bleeding but has no cervical dilation. The client denies abdominal pain. Which type of spontaneous abortion does the nurse suspect?
A. Inevitable abortion
B. Threatened abortion
C. Missed abortion
D. Complete abortion
Answer: B. Threatened abortion
Rationale: A threatened abortion is characterized by vaginal bleeding with or without mild cramping but without cervical dilation. The pregnancy may still continue with careful monitoring. In contrast, inevitable abortion would involve cervical dilation, and a complete abortion would indicate all pregnancy tissue has been expelled.
213
A client is admitted to the clinic with vaginal bleeding and cervical dilation. The nurse anticipates that the client is likely experiencing:
A. Complete abortion
B. Incomplete abortion
C. Inevitable abortion
D. Missed abortion
Answer: C. Inevitable abortion
Rationale: An inevitable abortion is indicated by vaginal bleeding accompanied by cervical dilation, signaling that a miscarriage is imminent.
214
A nurse is assessing a client with a history of three spontaneous miscarriages in a row. Which condition does this history suggest?
A. Incomplete abortion
B. Complete abortion
C. Missed abortion
D. Recurrent pregnancy loss
Answer: D. Recurrent pregnancy loss
Rationale: Recurrent pregnancy loss is defined as having three or more consecutive miscarriages. This client’s history is consistent with recurrent pregnancy loss and may warrant further investigation to identify underlying causes. Incomplete and complete abortions refer to the status of tissue expulsion during a miscarriage, and missed abortion refers to fetal death without expulsion.
215
A pregnant client had retained pregnancy tissue in her uterus following a partial miscarriage. The nurse identifies this as:
A. Complete abortion
B. Incomplete abortion
C. Threatened abortion
D. Missed abortion
Answer: B. Incomplete abortion
Rationale: An incomplete abortion occurs when some pregnancy tissue remains in the uterus after partial expulsion. This can lead to continued bleeding and may require medical intervention. A complete abortion would involve the total expulsion of all pregnancy tissue from the uterus.
216
A nurse is providing education to a client who has experienced a missed abortion. Which statement accurately describes this condition?
A. Vaginal bleeding occurs with no associated cramping.
B. The body has expelled all pregnancy tissue.
C. The fetus has died, but the body has not expelled the pregnancy.
D. The pregnancy continues, but the client is having severe abdominal pain.
Answer: C. The fetus has died, but the body has not expelled the pregnancy.
Rationale: A missed abortion occurs when the fetus has died in utero, but the body has not expelled the pregnancy. This can lead to a diagnosis during routine prenatal testing and may require medical management to remove the retained tissue. Vaginal bleeding and cramping are not typically associated with a missed abortion.
217
A nurse is educating a group of pregnant clients about disease prevention. Which of the following strategies is an example of primary prevention?
A. Administering the Tdap vaccine at 28 weeks of gestation.
B. Screening for gestational diabetes at 24 weeks of pregnancy.
C. Teaching pregnant clients about the importance of a balanced diet and exercise.
D. Monitoring a client with preeclampsia to reduce complications.
Answer: C. Teaching pregnant clients about the importance of a balanced diet and exercise.
Rationale: Primary prevention aims to prevent disease or conditions before they occur through health promotion and education, such as encouraging a healthy diet and regular exercise during pregnancy. Options A, B, and D involve early detection or treatment, which are part of secondary or tertiary prevention.
218
Which of the following represents secondary prevention in pregnancy?
A. Providing prenatal vitamins to all pregnant clients.
B. Performing routine gestational diabetes screening at 24-28 weeks gestation.
C. Administering magnesium sulfate to a client with severe preeclampsia.
D. Treating complications related to preterm labor with advanced interventions.
Answer: B. Performing routine gestational diabetes screening at 24-28 weeks gestation.
Rationale: Secondary prevention focuses on early detection and intervention to identify risks or diseases early. Gestational diabetes screening at 24-28 weeks allows for early detection, enabling timely management. Options A, C, and D involve treatment or health promotion rather than early disease detection.
219
A nurse is working with a client who has been diagnosed with severe preeclampsia and is receiving medical interventions to prevent complications. This is an example of:
A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Health education
Answer: C. Tertiary prevention
Rationale: Tertiary prevention aims to reduce complications and improve quality of life for individuals already affected by a disease or condition. Treating severe preeclampsia with medical interventions falls into this category. Primary prevention would involve measures to prevent the disease (e.g., lifestyle changes), while secondary prevention focuses on early detection.
220
Which action by the nurse is an example of primary prevention?
A. Administering the COVID-19 vaccine during pregnancy.
B. Monitoring fetal growth for signs of preterm labor.
C. Teaching a client about smoking cessation during pregnancy.
D. Screening for iron-deficiency anemia at a prenatal visit.
Answer: C. Teaching a client about smoking cessation during pregnancy.
Rationale: Primary prevention involves actions taken to prevent the onset of disease or complications. Teaching smoking cessation promotes overall health and reduces the risk of complications such as low birth weight or preterm birth. Administering vaccines and routine screening are examples of secondary and tertiary prevention strategies.
221
A nurse is caring for a client with complications from preterm labor. The nurse implements interventions to manage the condition and minimize risks. This is an example of:
A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Community health education
Answer: C. Tertiary prevention
Rationale: Tertiary prevention focuses on reducing complications and improving the quality of life for clients already affected by a health condition or disease. Managing complications in preterm labor with interventions such as medication administration and fetal monitoring aligns with tertiary prevention.
