OB Practice Exam III (50 Questions)

Question 1

Obstetric Nursing

Which of the following are functions of the placenta?

1. Passing nutrients from the mother’s blood to the fetus
2. Excreting wastes from fetal metabolism into the maternal blood
3. Transmission of oxygen from the maternal to the fetal circulation
4. Inhibiting the passage of large molecules to the fetus
5. Production of hormones required for the sustenance of pregnancy

A. 1 and 2
B. 3 and 4
C. All but 5
D. All

Answer 1

Correct Answer: D. All

The placenta provides nutrients, oxygen, and hormonal support, eliminates fetal wastes, and acts as a selective barrier.

Question 2

Obstetric Nursing

Which of the following statements is correct?

A. Amniotic fluid must be sufficient enough to bathe the baby inside the uterus with about 3000 ml average amount.

B. Amniotic fluid volume can be assessed through amniocentesis.

C. Amniotic fluid’s amount is affected by the swallowed fluid by the fetus and excreted as urine.

D. More than 1500 ml is associated with renal malfunctions.

Answer 2

Correct Answer: C. Amniotic fluid’s amount is affected by the swallowed fluid by the fetus and excreted as urine.

Fetal swallowing and urination regulate amniotic fluid levels. The fetus swallows fluid, which is absorbed in the gut and returned to the amniotic sac as urine.

A. Amniotic fluid must be sufficient enough to bathe the baby inside the uterus with about 3000 ml average amount – Normal amniotic fluid volume at term is about 800–1200 mL. 3000 mL is excessive and may indicate polyhydramnios.

B. Amniotic fluid volume can be assessed through amniocentesis – While amniocentesis obtains fluid for analysis, volume is not measured directly this way. It is assessed via ultrasound, using Amniotic Fluid Index (AFI).

D. More than 1500 ml is associated with renal malfunctions – Low amniotic fluid (oligohydramnios) is linked to fetal renal issues, not high volume. Excess fluid may relate to GI or neurological problems, not renal.

Question 3

Obstetric Nursing

A woman who comes to her health care provider for her first prenatal visit at 10 weeks of gestation says, “My husband says he doesn’t know how we are going to pay for another baby; we already have two children. I am not sure how this is going to work out.” What response to pregnancy does this indicate?

A. Attachment to the fetus began to occur.
B. Normal ambivalence about the pregnancy is being expressed.
C. Partner relationship is changing in anticipation of the birth.
D. The couple has accepted the fetus as an individual separate from the mother.

Answer 3

Correct Answer: B. Normal ambivalence about the pregnancy is being expressed.

Ambivalence during the first trimester is normal, especially when unplanned or when financial/emotional concerns are present. This reflects uncertainty, not rejection.

A. Attachment to the fetus began to occur – Attachment typically begins later in pregnancy, especially after quickening (fetal movement), not during early emotional uncertainty.

C. Partner relationship is changing in anticipation of the birth – The statement reflects concern about finances, not a specific change in relationship dynamics.

D. The couple has accepted the fetus as an individual separate from the mother – This level of acceptance usually occurs in the third trimester, not at 10 weeks.

Question 4

Obstetric Nursing

Which of the following is a correct example of psychological tasks performed during the trimester discussed?

A. Women begin “nesting period” activities during the first trimester.

B. Women experience “quickening” which contributes to acceptance of the baby.

C. During the third trimester, the father-to-be begins the process of accepting the pregnancy.

D. During the first trimester, the mother-to-be prepares for parenthood.

Answer 4

Correct Answer: B. Women experience “quickening” which contributes to acceptance of the baby.

Quickening occurs around 16–20 weeks (second trimester). Feeling fetal movement helps the mother view the fetus as real and strengthens emotional attachment.

A. Women begin “nesting period” activities during the first trimester – Nesting behaviors are more typical in the third trimester, as the mother prepares for labor and the newborn’s arrival.

C. During the third trimester, the father-to-be begins the process of accepting the pregnancy – The father usually begins adjusting to the pregnancy in the first or second trimester, not just in the third.

D. During the first trimester, the mother-to-be prepares for parenthood – Early pregnancy is often focused on self and physical changes; preparation for parenthood becomes more evident in the second and third trimesters.

Question 5

Obstetric Nursing

During which of the following would the focus of classes be mainly on fetal development and nutrition?

A. Pre-pregnant period
B. First trimester
C. Second trimester
D. Third trimester

Answer 5

Correct Answer: B. First trimester

First trimester classes focus on fetal development and nutrition because organogenesis occurs during this period. Nutritional education supports healthy fetal growth and helps prevent congenital anomalies.

A. Pre-pregnant period – Pre-pregnant period education emphasizes fertility, lifestyle changes, and preparation for conception, not fetal development, which hasn’t started yet.

C. Second trimester – Second trimester education focuses more on body changes, comfort measures, and beginning parenting roles, as the fetus is already formed and growing steadily.

D. Third trimester – Third trimester classes typically address labor preparation, delivery, and newborn care, not fetal development or nutritional foundation, which are emphasized earlier.

Question 6

Obstetric Nursing

The pregnant patient is in her third month when she makes her second prenatal visit. She asks the nurse, “What is happening right now in the development of the baby?” The nurse answers:

A. “The heart is beginning to pump blood.”
B. “The brain is dividing into sections.”
C. “Lanugo and vernix caseosa are forming to protect the embryo.”
D. “The embryo is becoming a fetus and sex is determined.”

Answer 6

Correct Answer: D. “The embryo is becoming a fetus and sex is determined.”

By the end of the third month (week 12), the embryo transitions to a fetus, and external genitalia begin to show differentiation, making the sex visible via ultrasound soon after.

A. “The heart is beginning to pump blood.” – The fetal heart begins beating as early as week 3 and is circulating blood by week 4, which occurs in the first month, not the third.

B. “The brain is dividing into sections.” – Brain development, including basic divisions, occurs during weeks 4 to 8, which is still in the embryonic period, prior to the third month.

C. “Lanugo and vernix caseosa are forming to protect the embryo.” – Lanugo and vernix develop later, around weeks 20 and 24, in the second trimester, not during the third month.

Question 7

Obstetric Nursing

The nurse knows that the following change in respiratory functioning during pregnancy is considered normal:

A. Increased tidal volume
B. Increased expiratory volume
C. Decreased inspiratory capacity
D. Decreased oxygen consumption

Answer 7

Correct Answer: A. Increased tidal volume

Tidal volume increases by 30–40% during pregnancy to meet the growing fetus’s oxygen demands. This results in deeper breaths and enhanced oxygen exchange.

B. Increased expiratory volume – Expiratory reserve volume actually decreases due to the elevated diaphragm compressing the lungs as the uterus enlarges.

C. Decreased inspiratory capacity – Inspiratory capacity is typically increased, not decreased, as the body adapts to improve oxygenation for the fetus.

D. Decreased oxygen consumption – Oxygen consumption is increased by about 20%, driven by fetal metabolic needs and maternal tissue growth.

Question 8

Obstetric Nursing

The pregnant woman lives in a state of chronic compensated:

A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Respiratory acidosis

Answer 8

Correct Answer: C. Respiratory alkalosis

Pregnancy causes mild hyperventilation due to elevated progesterone, leading to decreased PaCO₂. The kidneys compensate by excreting bicarbonate, resulting in a state of chronic compensated respiratory alkalosis.

A. Metabolic acidosis – Metabolic acidosis is not typical in normal pregnancy; it may occur in pathologic states like diabetic ketoacidosis, not as a physiological adaptation.

B. Metabolic alkalosis – Pregnancy does not induce metabolic alkalosis; the compensatory renal changes reduce bicarbonate, not increase it.

D. Respiratory acidosis – Respiratory acidosis involves hypoventilation, the opposite of the increased ventilation seen in pregnancy.

Question 9

Obstetric Nursing

A pregnant patient has her urine glucose tested. The glucose is negative but ketone is positive. The nurse should ask the patient about:

A. Her exercise
B. Her diet
C. Bladder infection
D. Possibility of pica

Answer 9

Correct Answer: B. Her diet

Presence of urinary ketones indicates the body is using fat for energy, often due to inadequate carbohydrate intake or prolonged fasting. Assessing the patient’s nutritional intake is the priority.

A. Her exercise – While excessive exercise can lead to ketosis, dietary intake is the more direct cause of ketone presence without glucose in the urine.

C. Bladder infection – Ketones are not a primary indicator of urinary tract infection; nitrites, leukocytes, and bacteria would be more relevant findings.

D. Possibility of pica – Pica is the craving of non-nutritive substances, which may cause anemia or GI issues but is not directly associated with ketonuria.

Question 10

Obstetric Nursing

The pregnant patient asks, “How often can a healthy woman who is eight months pregnant have sex?” The nurse answers:

A. Once a week
B. Once a month
C. Not at all
D. As often as desired

Answer 10

Correct Answer: D. As often as desired

In a healthy pregnancy without complications, sexual activity is considered safe throughout all trimesters, including the eighth month. Frequency is based on comfort and mutual desire.

A. Once a week – Sexual activity is not restricted to a set frequency in an uncomplicated pregnancy.

B. Once a month – Limiting sexual activity to once a month has no clinical basis in the absence of pregnancy complications.

C. Not at all – Abstinence is not required unless there are specific medical indications such as placenta previa, preterm labor, or ruptured membranes.

Question 11

Obstetric Nursing

The doctor has instructed the nurse to prepare Mrs. Aragon for an abdominal ultrasound. Which of the following actions would be appropriate to prepare Mrs. Aragon for this procedure?

A. Instruct the patient to empty the bladder
B. Instruct the patient to drink water before the procedure
C. Shave the patient’s abdomen
D. Place the patient in semi-Fowler’s position with legs elevated

Answer 11

Correct Answer: B. Instruct the patient to drink water before the procedure

A full bladder acts as an acoustic window, pushing the uterus upward for better visualization of pelvic structures during early pregnancy abdominal ultrasound.

A. Instruct the patient to empty the bladder – A full, not empty, bladder is needed for optimal imaging in a non-transvaginal (abdominal) ultrasound, especially during the first trimester.

C. Shave the patient’s abdomen – Shaving is not required for abdominal ultrasound as the procedure is noninvasive and involves no skin penetration.

D. Place the patient in semi-Fowler’s position with legs elevated – The supine position is typically used; leg elevation is not necessary and is not part of standard preparation for this procedure.

Question 12

Obstetric Nursing

Joselle, age 41, is pregnant and has been scheduled for a serum Alpha-Fetoprotein (AFP) level. The nurse would explain which of the following to Joselle?

A. One purpose of the test is to determine whether a chromosomal defect is present

B. An amniocentesis will not provide the fetal serum specimen needed for the test

C. Conditions like open spinal cord cannot be diagnosed through this test

D. The test must be performed before 12 weeks of pregnancy to prevent fetal damage

Answer 12

Correct Answer: A. One purpose of the test is to determine whether a chromosomal defect is present

The maternal serum AFP test is used for screening certain chromosomal abnormalities (e.g., trisomy 21) and neural tube defects (e.g., spina bifida, anencephaly).

B. An amniocentesis will not provide the fetal serum specimen needed for the test – Maternal serum AFP is drawn from the mother’s blood, not directly from the fetus. However, amniotic fluid AFP can also be measured if needed through amniocentesis, especially after an abnormal result.

C. Conditions like open spinal cord cannot be diagnosed through this test – Elevated AFP levels are associated with open neural tube defects such as spina bifida, making the test valuable in screening for those conditions.

D. The test must be performed before 12 weeks of pregnancy to prevent fetal damage – The ideal time for maternal serum AFP testing is between 15 and 18 weeks of gestation. It is not done before 12 weeks, and it is a screening, not a therapeutic, test.

Question 13

Obstetric Nursing

Mrs. Aragon complained of discomfort after having an amniocentesis procedure. She is at 20 weeks gestation and is 45 years old. Which of the following symptoms would prompt immediate action?

A. Lab results reveal abnormal chromosomal cells
B. Amniotic fluid contains fetal urine
C. Mrs. Aragon describes symptoms of vaginal bleeding
D. Mrs. Aragon describes symptoms of Braxton Hicks contractions

Answer 13

Correct Answer: C. Mrs. Aragon describes symptoms of vaginal bleeding

Vaginal bleeding after amniocentesis may indicate placental disruption, infection, or potential miscarriage, requiring immediate medical evaluation.

A. Lab results reveal abnormal chromosomal cells – Abnormal findings are expected outcomes of the test and require follow-up counseling, not emergency action.

B. Amniotic fluid contains fetal urine – Fetal urine is a normal component of amniotic fluid, especially after the first trimester, and does not indicate a complication.

D. Mrs. Aragon describes symptoms of Braxton Hicks contractions – Mild, irregular contractions can occur after stimulation of the uterus (such as with amniocentesis) and are typically benign and self-limiting.

Question 14

Obstetric Nursing

A pregnant client with Gestational Diabetes Mellitus at 36 weeks gestation is at risk for premature labor. The doctor informs her that he may have to conduct which of the following procedures to ensure that the baby is fit to be delivered?

A. A biophysical profile to determine L/S ratio and maturation of lung tissue prior to labor

B. A contraction stress test to determine L/S ratio and maturation of lung tissue prior to labor

C. An amniocentesis to determine L/S ratio and maturation of lung tissue prior to labor

D. CVS to determine lung maturity

Answer 14

Correct Answer: C. An amniocentesis to determine L/S ratio and maturation of lung tissue prior to labor

Amniocentesis allows direct sampling of amniotic fluid to assess the lecithin/sphingomyelin (L/S) ratio, a standard test for fetal lung maturity, especially in high-risk pregnancies like GDM where delayed lung development is possible.

A. A biophysical profile to determine L/S ratio and maturation of lung tissue prior to labor – A biophysical profile evaluates fetal well-being using ultrasound and NST, but does not assess the L/S ratio or lung maturity.

B. A contraction stress test to determine L/S ratio and maturation of lung tissue prior to labor – A contraction stress test evaluates the placenta’s response to uterine contractions, but does not provide data on the L/S ratio or lung maturity.

D. CVS to determine lung maturity – Chorionic villus sampling (CVS) is done in the first trimester for early genetic testing, not for assessing lung maturity, and is not appropriate in the third trimester.

Question 15

Obstetric Nursing

RhoGAM is prescribed for a client before she is discharged after a spontaneous abortion. The nurse instructs the client that this drug is used to prevent which of the following?

A. Development of future Rh-positive fetus
B. An antibody response to Rh-positive fetus
C. A future pregnancy resulting in abortion
D. Development of Rh-positive antibodies

Answer 15

Correct Answer: B. An antibody response to Rh-positive fetus

Rho(D) immune globulin (RhoGAM) prevents the maternal immune system from forming anti-Rh antibodies if fetal blood is Rh-positive, reducing the risk of isoimmunization in future pregnancies.

A. Development of future Rh-positive fetus – RhoGAM does not affect the genetics of future fetuses or their Rh status; it only prevents maternal sensitization.

C. A future pregnancy resulting in abortion – RhoGAM is used to prevent Rh sensitization, not to prevent spontaneous abortion.

D. Development of Rh-positive antibodies – The body does not develop Rh-positive antibodies. RhoGAM prevents the production of anti-Rh (Rh-negative) antibodies in an Rh-negative mother exposed to Rh-positive fetal blood.

Question 16

Obstetric Nursing

A favorable result of a contraction stress test is:

A. Reactive
B. Non-reactive
C. Positive
D. Negative

Answer 16

Correct Answer: D. Negative

A negative contraction stress test (CST) means there are no late decelerations of the fetal heart rate with contractions, indicating the fetus can tolerate labor well. This is a reassuring (favorable) result.

A. Reactive – “Reactive” is a term used to describe a normal result in a non-stress test (NST), not a contraction stress test.

B. Non-reactive – A non-reactive result applies to the non-stress test (NST) and suggests the fetus may not be well oxygenated, not a favorable result.

C. Positive – A positive CST means there are late decelerations following 50% or more of contractions, which indicates uteroplacental insufficiency and is non-reassuring.

Question 17

Obstetric Nursing

A client who has an order of abdominal ultrasound asks what preparation she’ll take. Appropriate preparations for this client include:

A. Explanation of the procedure
B. Voiding
C. Informed consent
D. NPO 4 hours before

Answer 17

Correct Answer: A. Explanation of the procedure

Providing a simple, clear explanation is a key preparation step. It helps reduce anxiety, gain cooperation, and ensure the client understands that a full bladder is often needed to improve visualization during the procedure.

B. Voiding – Voiding is not advised before an abdominal ultrasound in early to mid-pregnancy; a full bladder helps lift the uterus and enhances the imaging of pelvic structures.

C. Informed consent – Routine abdominal ultrasound is noninvasive and does not require written informed consent unless used as part of an invasive procedure (e.g., amniocentesis).

D. NPO 4 hours before – Fasting (NPO) is not required before a standard abdominal ultrasound. The emphasis is on hydration, particularly for early pregnancy scans.

Question 18

Obstetric Nursing

You also attend to another young diabetic mother who is in her first trimester of pregnancy. As her pregnancy continues, what changes in her medication needs should you also anticipate?

A. A steady increase in insulin requirements
B. The variable pattern of insulin absorption throughout the pregnancy requires constant close adjustments
C. Oral hypoglycemic drugs will be given several times daily
D. Pre-pregnant insulin dosage will remain unchanged

Answer 18

Correct Answer: B. The variable pattern of insulin absorption throughout the pregnancy requires constant close adjustments

During pregnancy, insulin needs fluctuate: they may decrease in the first trimester due to increased insulin sensitivity, then increase progressively in the second and third trimesters due to placental hormones causing insulin resistance. This requires frequent monitoring and adjustments in dosage to maintain glycemic control.

A. A steady increase in insulin requirements – Insulin needs do not increase steadily throughout pregnancy. They often decrease in the first trimester and then rise later, especially in the third trimester, making this pattern non-linear.

C. Oral hypoglycemic drugs will be given several times daily – Oral hypoglycemics are generally avoided in pregnancy due to their potential teratogenic effects and placental transfer, especially in the first trimester.

D. Pre-pregnant insulin dosage will remain unchanged – Insulin requirements almost always change during pregnancy due to hormonal shifts, so maintaining the pre-pregnant dose is not appropriate.

Question 19

Obstetric Nursing

When preparing to listen to the fetal heart rate at 12 weeks gestation, the nurse would use which of the following?

A. Stethoscope placed midline at the umbilicus
B. Doppler placed midline at the suprapubic region
C. Fetoscope placed midway between the umbilicus and the xiphoid process
D. External electronic fetal monitor placed at the umbilicus

Answer 19

Correct Answer: B. Doppler placed midline at the suprapubic region

At 12 weeks gestation, the uterus is just above the symphysis pubis, and the fetal heart rate is best detected using a Doppler ultrasound device placed at the suprapubic midline.

A. Stethoscope placed midline at the umbilicus – A regular stethoscope cannot detect fetal heart tones this early; also, the fundus is still low in the pelvis at 12 weeks.

C. Fetoscope placed midway between the umbilicus and the xiphoid process – A fetoscope is not sensitive enough to detect fetal heart sounds before 18–20 weeks, and that placement is too high for a 12-week pregnancy.

D. External electronic fetal monitor placed at the umbilicus – External electronic monitoring is primarily used during labor (typically in the third trimester), and at 12 weeks the fetal heart may be too deep to detect at the umbilicus.

Question 20

Obstetric Nursing

Which of the following fundal heights indicates less than 12 weeks gestation when the date of LMP is unknown?

A. Uterus in the pelvis
B. Uterus at the xiphoid
C. Uterus in the abdomen
D. Uterus at the umbilicus

Answer 20

Correct Answer: A. Uterus in the pelvis

A uterus that remains within the pelvic cavity suggests a gestational age of less than 12 weeks, as the uterus typically becomes palpable abdominally only after the first trimester.

B. Uterus at the xiphoid – A fundus at the xiphoid process occurs in the third trimester, typically around 36 weeks gestation.

C. Uterus in the abdomen – Once the uterus is palpable in the abdomen, the pregnancy is usually past 12 weeks.

D. Uterus at the umbilicus – The uterus typically reaches the level of the umbilicus at 20 weeks gestation.

Question 21

Obstetric Nursing

When measuring a client’s fundal height, which of the following techniques denotes the correct method of measurement used by the nurse?

A. From the xiphoid process to the umbilicus
B. From the symphysis pubis to the xiphoid process
C. From the symphysis pubis to the fundus
D. From the fundus to the umbilicus

Answer 21

Correct Answer: C. From the symphysis pubis to the fundus

The standard technique for fundal height measurement is using a non-elastic measuring tape, placing the zero mark at the symphysis pubis and measuring up to the top of the uterine fundus. This method helps estimate gestational age in weeks, especially from 20 to 36 weeks.

A. From the xiphoid process to the umbilicus – Measuring from the xiphoid to the umbilicus does not align with the uterus’s full vertical growth and would give inaccurate measurements of fundal height.

B. From the symphysis pubis to the xiphoid process – This would overestimate fundal height in most cases unless the uterus is already near term; it does not localize the top of the fundus, which is the key reference point.

D. From the fundus to the umbilicus – This measures only a portion of the uterus and would miss the actual fundal height, leading to inaccurate assessment of gestational age.

Question 22

Obstetric Nursing

During the examination of a pregnant client, while lying in the lithotomy position, the client complains of dizziness and nausea. What would be an appropriate nursing action to relieve the discomfort?

A. Administer antiemetic medication
B. Offering sips of ginger ale
C. Assisting the client in side lying position
D. Discontinue the examination

Answer 22

Correct Answer: C. Assisting the client in side lying position

Dizziness and nausea in the supine/lithotomy position during pregnancy are classic signs of supine hypotensive syndrome (also called aortocaval compression), caused by the gravid uterus compressing the inferior vena cava. Turning the client to the side (especially the left side) relieves pressure and restores blood flow, quickly improving symptoms.

A. Administer antiemetic medication – Nausea in this case is positional, not due to a GI cause. Giving antiemetics would not address the underlying issue of vena cava compression.

B. Offering sips of ginger ale – While ginger can help with mild nausea, it would not be effective for dizziness caused by supine hypotensive syndrome.

D. Discontinue the examination – Stopping the procedure alone does not relieve the cause of the symptoms. Repositioning is necessary to alleviate the circulatory compression.

Question 23

Obstetric Nursing

Which of the following would the nurse use as the basis for the teaching plan when caring for a pregnant woman concerned about gaining too much weight during pregnancy?

A. 10 pounds per trimester
B. 1 pound per week for 40 weeks
C. 1/2 pound per week for 40 weeks
D. A total gain of 25 to 35 pounds

Answer 23

Correct Answer: D. A total gain of 25 to 35 pounds

This is the recommended total weight gain for a woman with a normal pre-pregnancy BMI (18.5–24.9). It includes a small gain in the first trimester (about 1–4.5 pounds) and approximately 1 pound per week during the second and third trimesters.

A. 10 pounds per trimester – Weight gain is not evenly distributed across trimesters. The first trimester has minimal weight gain, while the majority occurs in the second and third trimesters.

B. 1 pound per week for 40 weeks – This would result in a total gain of 40 pounds, which exceeds recommendations for women with a normal BMI and is more appropriate for women who are underweight.

C. 1/2 pound per week for 40 weeks – This results in only 20 pounds total, which is below the recommendation for normal-weight women and more appropriate for overweight or obese women with provider guidance.

Question 24

Obstetric Nursing

Jasmin, 2 months pregnant, has reported for her first prenatal visit. The nurse should instruct her to do which of the following?

A. Eat foods high in protein, iron, and other nutrients to provide additional 300 calories each day
B. Increase intake of bread and sweets to prevent protein metabolism
C. Eat small frequent meals to decrease nausea
D. Limit intake of protein-rich food

Answer 24

Correct Answer: C. Eat small frequent meals to decrease nausea

In the first trimester, many pregnant women experience nausea and vomiting due to hormonal changes. The best recommendation is to eat small, frequent meals to help stabilize blood sugar and reduce gastric irritation.

A. Eat foods high in protein, iron, and other nutrients to provide additional 300 calories each day – While eating nutrient-dense food is correct, the 300-calorie increase is typically needed during the second and third trimesters, not at 2 months (which is early in the first trimester).

B. Increase intake of bread and sweets to prevent protein metabolism – Eating sweets is not recommended, and preventing protein metabolism is not a nutritional goal in pregnancy. The focus should be on balanced, nutrient-rich intake, not excess carbohydrates.

D. Limit intake of protein-rich food – Protein is essential in pregnancy for fetal development, especially in early organ formation. It should not be limited, but adequately increased.

Question 25

# *Obstetric Nursing* **What is the common discomfort experienced during the first trimester of pregnancy?** A. Hemorrhoids B. Breast tenderness C. Constipation D. Vulvar varicosities

Answer 25

**Correct Answer: B. Breast tenderness** This is a **common early discomfort** in the **first trimester**, caused by **hormonal changes** (mainly estrogen and progesterone) that lead to **increased vascularization and growth of mammary tissue** in preparation for lactation. ## Footnote **A. Hemorrhoids** – These are more commonly experienced during the **second and third trimesters**, as increased uterine pressure on the pelvic veins and straining from constipation contribute to their development. **C. Constipation** – While it can begin in the first trimester, constipation is more prevalent **later** in pregnancy due to progesterone-induced smooth muscle relaxation and mechanical pressure on the bowel. **D. Vulvar varicosities** – These typically occur in the **second and third trimesters**, due to venous congestion from the growing uterus and increased blood volume.

Question 25

# *Obstetric Nursing* **One of the following statements of vitamin A intake during pregnancy is incorrect.** A. A good source of this vitamin is sunlight B. Doses of more than 10,000 IU is teratogenic C. Drinking alcohol lowers vitamin A levels D. This vitamin helps prevent night blindness

Answer 25

**Correct Answer: A. A good source of this vitamin is sunlight** **Sunlight** is not a source of vitamin A. It is a source of **vitamin D**, not vitamin A. Vitamin A is obtain ed from dietary sources, such as **liver, dairy, eggs, and carotenoid-rich vegetables** (e.g., carrots, spinach). ## Footnote **B. Doses of more than 10,000 IU is teratogenic** – Excessive intake of vitamin A, especially in the form of **retinol** (animal sources or supplements), **can cause birth defects**, particularly craniofacial and cardiac anomalies. **C. Drinking alcohol lowers vitamin A levels** – Alcohol interferes with the metabolism and storage of vitamin A in the liver, leading to reduced serum vitamin A levels and potential deficiency. **D. This vitamin helps prevent night blindness** – Vitamin A is essential for retinal function and prevents night blindness, especially during pregnancy when deficiency risk increases.

Question 26

# *Obstetric Nursing* **The nurse assesses a woman at 24 weeks gestation and is unable to find the fetal heartbeat. According to priority, the nurse should do the following tasks in which order?** 1. Call the health care provider 2. Explain that the FHT could not be found at this time 3. Obtain different equipment and recheck 4. Ask the client if the baby is or has been moving A. 4-3-2-1 B. 1-2-4-3 C. 3-4-2-1 D. 3-1-2-4

Answer 26

**Correct Answer: A. 4-3-2-1** First, **ask the client if fetal movement has been felt** to gather subjective data. Then, **try using different equipment** (e.g., another Doppler or ultrasound device) to rule out technical error. Next, **inform the client** that the fetal heart tone (FHT) could not be located **without causing alarm**. Finally, **call the healthcare provider** to report findings and seek further orders. This sequence follows the nursing process: **assess → validate → inform → act**. ## Footnote **B. 1-2-4-3** – Calling the provider first is premature without doing a thorough reassessment. Skipping reassessment may cause unnecessary anxiety or delay. **C. 3-4-2-1** – Rechecking equipment before asking about fetal movement misses subjective input, which could provide important insight into fetal wellbeing. **D. 3-1-2-4** – Contacting the provider before asking about fetal movement or informing the client interrupts the priority flow and omits key assessment steps.

Question 27

# *Obstetric Nursing* **Flexing the lumbar spine can relieve backache during pregnancy and early labor. This exercise is called:** A. Kegels exercise B. Pelvic rocking C. Squatting D. Pelvic tailoring

Answer 27

**Correct Answer: B. Pelvic rocking** This exercise involves **flexing and extending the lumbar spine**, which **relieves lower back pain** by improving posture, reducing pelvic pressure, and enhancing spinal flexibility. It is commonly taught during **prenatal classes** and **early labor** for comfort. ## Footnote **A. Kegels exercise** – Kegels involve contracting and relaxing the pelvic floor muscles, used to **strengthen pelvic support** and help prevent **urinary incontinence**, not for relieving backache. **C. Squatting** – Squatting helps to **open the pelvic outlet** and is useful during **second stage** of labor, but it does not focus on lumbar spine flexion or back pain relief. **D. Pelvic tailoring** – Pelvic tailoring aims to **increase flexibility of hip and pelvic joints** to prepare for delivery, but it is not primarily used to relieve backache through spinal movement.

Question 28

# *Obstetric Nursing* **A client in her third trimester tells you, “I’m constipated all the time!” Which of the following should you recommend?** A. Daily enemas B. Laxatives C. Mild stool softeners D. Decreased fluid intake

Answer 28

**Correct Answer: C. Mild stool softeners** Stool softeners such as **docusate sodium** are commonly recommended during pregnancy to relieve constipation. They work by **softening stool consistency**, making it easier to pass, without stimulating bowel contractions that could **induce uterine irritability**. ## Footnote **A. Daily enemas** – Enemas are **not recommended for regular use** during pregnancy due to the risk of stimulating uterine contractions and fluid-electrolyte imbalances. **B. Laxatives** – Strong laxatives can cause **abdominal cramping and fluid loss**, and some may stimulate the uterus, so they should be used only **under provider supervision**. **D. Decreased fluid intake** – Adequate hydration is essential to prevent constipation. Decreasing fluids would worsen constipation and contribute to harder stool formation.

Question 29

# *Obstetric Nursing* **Heartburn and flatulence, common in the second trimester, are most likely the result of which of the following?** A. Increased plasma HCG levels B. Decreased intestinal motility C. Decreased gastric acidity D. Elevated estrogen levels

Answer 29

**Correct Answer: B. Decreased intestinal motility** **Progesterone** levels **increase** during pregnancy, causing **relaxation of smooth muscles**, including the **gastrointestinal tract**. This leads to delayed gastric emptying and slower intestinal motility, resulting in **heartburn, flatulence, and constipation**. ## Footnote **A. Increased plasma HCG levels** – Human chorionic gonadotropin (hCG) peaks in the **first** trimester and is associated with **nausea and vomiting**, not heartburn or flatulence in the second trimester. **C. Decreased gastric acidity** – Gastric acidity typically remains unchanged or increases slightly. The cause of heartburn is **reflux**, not reduced acidity. **D. Elevated estrogen levels** – While estrogen rises in pregnancy, **progesterone** has the greater impact on smooth muscle relaxation, including effects on GI motility.

Question 30

# *Obstetric Nursing* **A primigravid client at 16 weeks AOG has had an amniocentesis and has received teaching concerning signs and symptoms to report. Which statement indicates that the client needs further teaching?** A. “I need to call if I start to leak fluid from my vagina.” B. “If I start bleeding, I will need to call back.” C. “If my baby doesn’t move, I need to call my health care provider.” D. “If I start running a fever, I should let the office know.”

Answer 30

**Correct Answer: C. “If my baby doesn’t move, I need to call my health care provider.”** At **16 weeks gestation**, fetal movement is typically **not yet consistently felt**, especially for **primigravid clients**. Teaching about reporting decreased fetal movement usually begins around **20 weeks** when quickening is expected. This indicates a need for further teaching. ## Footnote **A. “I need to call if I start to leak fluid from my vagina.”** – Leaking amniotic fluid post-amniocentesis may indicate **membrane rupture** or procedure-related complications, and should be reported immediately. **B. “If I start bleeding, I will need to call back.”** – Vaginal bleeding after an amniocentesis is a potential **complication** and should be reported. **D. “If I start running a fever, I should let the office know.”** – A fever can be a sign of **infection**, such as **chorioamnionitis**, which is a possible complication of amniocentesis.

Question 31

# *Obstetric Nursing* **A pregnant client states that she “waddles” when she walks. The nurse’s explanation is based on which of the following as the cause?** A. The large size of the newborn B. Pressure on the pelvic muscles C. Relaxation of the pelvic joints D. Excessive weight gain

Answer 31

**Correct Answer: C. Relaxation of the pelvic joints** During pregnancy, the hormone **relaxin** causes the **softening and relaxation of pelvic ligaments and joints** to prepare for childbirth. This leads to instability in gait and a characteristic **“waddling” walk**, especially in the **third** trimester. ## Footnote **A. The large size of the newborn** – Fetal size contributes to **abdominal distention** but is not the primary cause of waddling gait. **B. Pressure on the pelvic muscles** – While pressure on pelvic structures increases, waddling is more related to **joint laxity** than muscle compression. **D. Excessive weight gain** – Although weight gain affects posture and balance, the waddling gait is more directly related to pelvic joint relaxation, not weight alone.

Question 32

# *Obstetric Nursing* **When talking with a pregnant client who is experiencing aching, swollen leg veins, the nurse would explain that this is most probably the result of which of the following?** A. Thrombophlebitis B. Pregnancy-induced hypertension C. Pressure on blood vessels from the enlarging uterus D. The force of gravity pulling down on the uterus

Answer 32

**Correct Answer: C. Pressure on blood vessels from the enlarging uterus** As the uterus grows, it exerts **mechanical pressure** on the **inferior vena cava and pelvic veins**, leading to **venous congestion** and the development of **varicose veins**, particularly in the **lower extremities**. This pressure impairs venous return, causing swelling and discomfort. ## Footnote **A. Thrombophlebitis** – Thrombophlebitis involves **inflammation and clot formation** in veins, typically accompanied by **redness, heat, and localized tenderness**, not just swelling and aching from varicosities. **B. Pregnancy-induced hypertension** – This condition is characterized by **elevated blood pressure, proteinuria, and edema**, but does not directly cause varicose veins or venous congestion in the legs. **D. The force of gravity pulling down on the uterus** – Gravity affects circulation generally, but it is not the primary cause of varicose veins in pregnancy. **Uterine pressure on pelvic vessels** is the main factor.

Question 33

# *Obstetric Nursing* **Which of the following danger signs should be reported promptly during the antepartum period?** A. Constipation B. Breast tenderness C. Nasal stuffiness D. Bloody show

Answer 33

**Correct Answer: D. Bloody show** Vaginal bleeding or blood-tinged discharge during pregnancy may indicate **placenta previa, placental abruption, or early labor**, especially if it occurs **before term**. It is a **danger sign** that must be reported immediately for evaluation. ## Footnote **A. Constipation** – This is a **common discomfort** caused by **progesterone-induced decreased bowel motility** and **uterine pressure** on the intestines. It is not an alarming symptom unless severe or associated with other complications. **B. Breast tenderness** – Breast changes such as tenderness and enlargement are **normal signs of pregnancy**, especially in the **first** trimester, due to hormonal shifts. **C. Nasal stuffiness** – **Increased estrogen levels** cause nasal mucosal swelling, leading to stuffiness or congestion, which is a **common and expected** discomfort, not a danger sign.

Question 34

# *Obstetric Nursing* **Which of the following prenatal laboratory test values would the nurse consider as significant?** A. Hematocrit 35% B. Rubella titer less than 1:8 C. White blood cells 9,000/mm³ D. One hour 50 g glucose challenge load test 120 mg/dL

Answer 34

**Correct Answer: B. Rubella titer less than 1:8** A titer **< 1:8** indicates **non-immunity to rubella**. Pregnant women without rubella immunity are at risk for congenital rubella syndrome if exposed. This is **clinically significant** and requires **postpartum immunization** to protect future pregnancies. ## Footnote **A. Hematocrit 35%** – This value is **within the normal range** for pregnancy (typically **32–42%**). Mild hemodilution is expected due to increased plasma volume. **C. White blood cells 9,000/mm³** – WBC count during pregnancy is normally **elevated**, especially in the third trimester (**up to 16,000/mm³**). A WBC count of 9,000/mm³ is within normal limits. **D. One hour 50 g glucose challenge load test 120 mg/dL** – A result **below 130–140 mg/d**L is considered **normal**. This value does not indicate gestational diabetes.

Question 35

# *Obstetric Nursing* **The nurse documents positive ballottement in the client’s prenatal record. The nurse understands that this indicates which of the following?** A. Palpable contractions on the abdomen B. Passive movement of the unengaged fetus C. Fetal kicking felt by the client D. Enlargement and softening of the uterus

Answer 35

**Correct Answer: B. Passive movement of the unengaged fetus** **Ballottement** is a **probable sign** of pregnancy identified when the examiner **taps the cervix**, causing the **fetus to rise in the amniotic fluid and then rebound back**. This indicates the fetus is **not yet engaged** in the pelvis. ## Footnote **A. Palpable contractions on the abdomen** – This refers to **Braxton Hicks contractions**, which are **painless, irregular** uterine contractions, not related to ballottement. **C. Fetal kicking felt by the client** – This is known as **quickening**, a **presumptive** sign of pregnancy, usually felt around **18–20 week**s, and is reported subjectively by the mother. **D. Enlargement and softening of the uterus** – This describes **Hegar’s sign**, which involves softening of the uterine isthmus and is a **probable** sign, but distinct from ballottement.

Question 36

# *Obstetric Nursing* **The nurse is assigned to the obstetrical triage. When beginning the assignment, the nurse is given a report about four clients waiting to be seen. Which client has the lowest priority?** A. A primigravid client at 10 weeks gestation stating she is not feeling well with nausea and vomiting, urinary frequency, and fatigue B. A multiparous client at 32 weeks gestation asking for assistance with a new primary health care provider C. A single mother at 4 months postpartum fearful of shaking her baby when she cries D. An antenatal client at 16 weeks gestation who has occasional sharp pain on her left side radiating from her symphysis pubis to her fundus

Answer 36

**Correct Answer: B. A multiparous client at 32 weeks gestation asking for assistance with a new primary health care provider** This client is **stable**, has **no physical or emotional complaints**, and her concern is non-urgent administrative assistance, making her the **lowest priority** in triage. ## Footnote **A. A primigravid client at 10 weeks gestation stating she is not feeling well with nausea and vomiting, urinary frequency, and fatigue** – These symptoms could indicate dehydration from hyperemesis gravidarum or UTI, both of which require assessment to prevent complications. **C. A single mother at 4 months postpartum fearful of shaking her baby when she cries** – This is a potential sign of postpartum depression or risk of harm to the infant. This client requires immediate psychosocial evaluation and support. **D. An antenatal client at 16 weeks gestation who has occasional sharp pain on her left side radiating from her symphysis pubis to her fundus** – This may be round ligament pain, a normal discomfort, but it still warrants assessment to rule out more serious causes such as preterm labor or appendicitis.

Question 37

# *Obstetric Nursing* **A 22-year-old client tells the nurse that she and her husband are trying to conceive a baby. When teaching a client about reducing the incidence of neural tube defects, the nurse would emphasize the need for increasing the intake of which of the following foods?** A. Strawberries, beans, leafy green vegetables, lentils B. Milk and leafy vegetables C. Strawberries, fats, leafy vegetables D. Beans, leafy green vegetables, lentils and milk

Answer 37

**Correct Answer: A. Strawberries, beans, leafy green vegetables, lentils** These foods are **rich in folate (vitamin B9)**, which is essential in the **prevention of neural tube defect**s such as spina bifida and anencephaly. Adequate folate intake **before conception and during early pregnancy** is crucial. ## Footnote **B. Milk and leafy vegetables** – Milk is not a significant source of folate. While leafy vegetables are good sources, this combination alone does not provide sufficient folate-rich foods. **C. Strawberries, fats, leafy vegetables** – Fats do not contribute to folate intake. Although strawberries and leafy greens contain folate, the inclusion of fats dilutes the nutritional focus needed for neural tube prevention. **D. Beans, leafy green vegetables, lentils and milk** – Although beans, greens, and lentils are rich in folate, milk adds little folate.

Question 38

# *Obstetric Nursing* **Which of the following medication is considered to be detrimental during pregnancy?** **a. Accutane** **b. Penicillin** **c. Folic acid** **d. Live vaccines** A. A, B, D B. B and D C. A and D D. C only

Answer 38

**Correct Answer: C. A and D** **Accutane (isotretinoin)** is a known **teratogen** associated with severe birth defects and is contraindicated in pregnancy. **Live vaccines (e.g., MMR, varicella)** pose a **risk of transmitting infection to the fetus** and are not recommended during pregnancy. ## Footnote **A. Accutane, B. Penicillin, D. Live vaccines** – While Accutane and live vaccines are detrimental, **penicillin is generally safe** in pregnancy and commonly used for infections like **syphilis and UTIs**. **B. Penicillin and D. Live vaccines** – This combination wrongly includes penicillin, which is a safe antibiotic in most cases during pregnancy. **D. C only** – **Folic acid is beneficial** and essential in preventing **neural tube defects**, not harmful during pregnancy.

Question 39

# *Obstetric Nursing* A client at her first visit to the prenatal clinic asks the nurse which immunization can be administered safely to a pregnant woman. The nurse should reply: A. Inactivated polio vaccine B. Mumps C. Rubella D. Measles

Answer 39

**Correct Answer: A. Inactivated polio vaccine** **Inactivated (killed) vaccines**, such as the inactivated polio vaccine (IPV), are **safe to administer during pregnancy** if there is a specific indication (e.g., travel to polio-endemic areas). They do **not contain live virus** and pose no known risk to the fetus. ## Footnote **B. Mumps** – The mumps vaccine is a live attenuated vaccine and is not given during pregnancy due to the theoretical risk of fetal infection. **C. Rubella** – The rubella vaccine is also a live attenuated vaccine. It is contraindicated during pregnancy because of the potential risk of congenital rubella syndrome if transmitted to the fetus. **D. Measles** – Like mumps and rubella, the measles vaccine is live attenuated and should be avoided in pregnancy for the same safety concerns.

Question 40

# *Obstetric Nursing* **The patient is treated for syphilis in the first trimester. At birth, the baby is most likely to:** A. Have congenital syphilis B. Be normal C. Have low birth weight D. Be delivered stillborn

Answer 40

**Correct Answer: B. Be normal** When **syphilis** is identified and **treated effectively** in the **first trimester** with appropriate antibiotic therapy (usually **benzathine penicillin G**), vertical transmission to the fetus can be **prevented**, and the baby is most likely to be healthy at birth. ## Footnote **A. Have congenital syphilis** – Congenital syphilis occurs when treatment is **delayed**, inadequate, or missed entirely. Early treatment significantly reduces the risk of fetal infection. **C. Have low birth weight** – While untreated syphilis can cause **IUGR** and low birth weight, timely and proper treatment in the first trimester lowers this risk. **D. Be delivered stillborn** – Stillbirth is a known complication of untreated or inadequately treated syphilis, especially in the second or third trimester. Early treatment drastically reduces this outcome.

Question 41

# *Obstetric Nursing* **When a pregnant woman contracts rubella in the first trimester, which congenital anomaly is likely to occur?** A. Mental retardation B. Missing digits C. Absence of limbs D. Cardiac defects

Answer 41

**Correct Answer: D. Cardiac defects** **Rubella infection** in the **first trimester**, especially before **12 weeks**, is strongly associated with congenital rubella syndrome, which commonly includes **cardiac defects** (e.g., **patent ductus arteriosus**, pulmonary artery stenosis), **sensorineural deafness**, and **ocular abnormalities**. ## Footnote **A. Mental retardation** – Although developmental delays may occur as part of congenital rubella syndrome, cardiac anomalies are more common and characteristic. **B. Missing digits** – Limb deformities like missing digits are typically linked to **amniotic band syndrome**, not rubella infection. **C. Absence of limbs** – This is more often associated with **teratogenic** drugs like **thalidomide**, not viral infections such as rubella.

Question 42

# *Obstetric Nursing* **In chlamydia infection, drugs like tetracycline should not be taken because of the harm to the fetus resulting to:** A. Pulmonary distress B. Atrial septal defect C. Congenital blindness D. Discolored teeth

Answer 42

**Correct Answer: D. Discolored teeth** **Tetracyclines**, when taken during pregnancy, especially after the **second trimester**, can deposit in developing **fetal bones and teeth**, causing **yellow-gray-brown discoloration** and enamel hypoplasia. This is why tetracycline is **contraindicated** during pregnancy. ## Footnote **A. Pulmonary distress** – Pulmonary issues are not associated with tetracycline use in pregnancy. **B. Atrial septal defect** – This is a congenital heart defect and is not a known teratogenic effect of tetracyclines. **C. Congenital blindness** – While untreated chlamydia can cause neonatal conjunctivitis, tetracycline itself does not cause blindness. The concern with tetracycline is dental and bone abnormalities, not ocular effects.

Question 43

# *Obstetric Nursing* **A nurse explains to a mother that her newborn is being admitted to the neonatal intensive care unit with a probable diagnosis of fetal alcohol syndrome (FAS). The nurse explains the expected effects of FAS to the mother. The nurse evaluates the effectiveness of the explanation when the mother states:** A. “Withdrawal symptoms will occur after 3 days.” B. “Mental retardation is unlikely to happen.” C. “Withdrawal symptoms are tremors, crying, seizures, and reflexes that aren’t normal.” D. “The reason the child is so large is because of the fetal alcohol syndrome.”

Answer 43

**Correct Answer: C. “Withdrawal symptoms are tremors, crying, seizures, and reflexes that aren’t normal.”** This reflects an accurate understanding of common **neonatal withdrawal symptoms** seen in FAS, including **hyperactivity, high-pitched crying, tremors, seizures**, and **abnormal reflexes**. These are **neurological signs** due to central nervous system involvement from alcohol exposure. ## Footnote **A. “Withdrawal symptoms will occur after 3 days.”** – Symptoms of FAS can begin **at birth** and are not delayed for several days. Delayed onset is more typical of **narcotic withdrawal**, not alcohol. **B. “Mental retardation is unlikely to happen.”** – Neurodevelopmental impairment, including intellectual disabilities, is a core and common feature of fetal alcohol syndrome. **D. “The reason the child is so large is because of the fetal alcohol syndrome.”** – Infants with FAS are typically **small** for gestational age, with **growth restriction** before and after birth, not large.

Question 44

# *Obstetric Nursing* **The nurse monitoring a patient who is experiencing a miscarriage episode must consider which of the following facts?** A. Miscarriage occurring before 6th week of pregnancy often result in severe bleeding and hypovolemia. B. D and C can be performed to prevent a threatened abortion from advancing to an imminent abortion. C. A missed abortion will result in no expulsion of the blood or fetal material until the fetus actually dies. D. Incomplete abortion presents a greater potential for hemorrhage than do complete abortions.

Answer 44

**Correct Answer: D. Incomplete abortion presents a greater potential for hemorrhage than do complete abortions.** In **incomplete abortion**, parts of the **products of conception** (e.g., placenta) remain in the uterus, preventing effective uterine contraction. This increases the risk for **prolonged bleeding and hemorrhage**, requiring immediate intervention. ## Footnote **A. Miscarriage occurring before 6th week of pregnancy often result in severe bleeding and hypovolemia.** – Very early miscarriages (before 6 weeks) are often **similar to a heavy menstrual period**, and severe bleeding or hypovolemia is uncommon unless associated with complications. **B. D and C can be performed to prevent a threatened abortion from advancing to an imminent abortion.** – Dilation and curettage (D&C) is **not performed for threatened abortion**, as the pregnancy is still viable. Management is usually supportive unless it progresses to inevitable or incomplete abortion. **C. A missed abortion will result in no expulsion of the blood or fetal material until the fetus actually dies.** – In missed abortion, the fetus has already **died**, but **products of conception are retained** in the uterus without symptoms of expulsion.

Question 45

# *Obstetric Nursing* **Bleeding and cramping occur with the cervix closed and membranes intact is what type of abortion?** A. Inevitable B. Habitual C. Missed D. Threatened

Answer 45

**Correct Answer: D. Threatened** A **threatened abortion** presents with **vaginal bleeding, mild cramping**, but with the **cervix closed** and **membranes intact**. The pregnancy may still be viable at this stage, and management focuses on close monitoring and rest. ## Footnote **A. Inevitable** – In an inevitable abortion, there is bleeding, cramping, and cervical **dilation**, often with ruptured membranes, indicating that pregnancy loss is unavoidable. **B. Habitual** – Habitual abortion refers to **three or more consecutive spontaneous abortions**, not a single episode with current signs and symptoms. **C. Missed** – In a missed abortion, the fetus has died, but there is **no bleeding, cramping, or cervical dilation**, and the products of conception remain in the uterus.

Question 46

# *Obstetric Nursing* **Ana is 16 weeks pregnant. She was rushed to the emergency department because of vaginal bleeding. Upon internal exam, the doctor noted that Ana’s cervix is not dilated nor effaced. No visible product of conception was noted, but with a scanty to moderate amount of bleeding. She has what type of abortion?** A. Threatened B. Spontaneous C. Incomplete D. Inevitable

Answer 46

**Correct Answer: A. Threatened** A **threatened abortion** is characterized by vaginal bleeding, no cervical dilation or effacement, and no expulsion of products of conception. Pregnancy may still continue, and the condition is managed with close observation and supportive care. ## Footnote **B. Spontaneous** – Spontaneous abortion is a general term for any unintentional pregnancy loss before 20 weeks. It includes all types such as **threatened, incomplete, missed, and inevitable**, but is not specific to this clinical scenario. **C. Incomplete** – Incomplete abortion involves **partial expulsion** of the products of conception and usually presents with open cervix and active bleeding. Ana’s cervix is closed, and no products were expelled. **D. Inevitable** – In an inevitable abortion, the cervix is **dilated**, and there is active bleeding with possible ruptured membranes. In Ana’s case, the cervix remains closed and membranes are intact.

Question 47

# *Obstetric Nursing* **The woman, 12 weeks pregnant, presents with bleeding and cramping. Assessment reveals tissue protruding from the cervix. The spontaneous abortion is called as:** A. Extraction B. Inevitable C. Complete D. Incomplete

Answer 47

**Correct Answer: D. Incomplete** **An incomplete abortion** occurs when **some but not all products of conception are expelled**, often presenting with **cramping**, **bleeding**, and **tissue protruding from the cervical os**. Immediate management is needed to prevent hemorrhage or infection. ## Footnote **A. Extraction** – Extraction is a **procedure**, not a classification of abortion. It refers to a method used to remove retained products, not the type of abortion itself. **B. Inevitable** – An inevitable abortion involves **cervical dilation and active bleeding**, but **no expulsion of tissue** has occurred yet. **C. Complete** – A complete abortion is when **all products of conception are expelled**, and the uterus is empty. There would be no tissue remaining or protruding from the cervix.

Question 48

# *Obstetric Nursing* **In which of the following types of spontaneous abortions would the nurse assess dark brown vaginal discharge and a negative pregnancy test?** A. Threatened B. Imminent C. Missed D. Incomplete

Answer 48

**Correct Answer: C. Missed** A **missed abortion** occurs when the embryo or fetus has **died**, but **no products of conception are expelled**. Over time, the body may reabsorb fetal tissue, and **dark brown vaginal discharge** (known as “old blood”) may be noted. A **pregnancy test may turn negative** as **hCG levels declin**e. ## Footnote **A. Threatened** – In a threatened abortion, there is **bright red bleeding**, usually scant, and the **pregnancy test remains positive** because the fetus is still alive. **B. Imminent** – Imminent (inevitable) abortion is marked by **active bleeding**, **cramping**, and an **open cervix**, but not dark brown discharge and the **pregnancy test is still positive** until after expulsion. **D. Incomplete** – Incomplete abortion involves **heavy bleeding and cramping**, with tissue passed or retained, but discharge is typically **bright red** and **pregnancy test remains positive** until all tissue is cleared.

Question 49

# *Obstetric Nursing* **A client 12 weeks pregnant comes to the emergency department with abdominal pain and moderate vaginal bleeding. Speculum examination reveals 2 to 3 cm cervical dilatation. The nurse would document these findings as which of the following?** A. Threatened abortion B. Imminent abortion C. Complete abortion D. Missed abortion

Answer 49

**Correct Answer: B. Imminent abortion** Also known as **inevitable abortion**, this occurs when there is **moderate to heavy bleeding**, abdominal **cramping**, and cervical **dilation**, indicating that **pregnancy loss cannot be prevented**. The presence of **2 to 3 cm cervical dilation** confirms this classification. ## Footnote **A. Threatened abortion** – In a threatened abortion, there may be bleeding and cramping, but the cervix remains **closed**. **C. Complete abortion** – A complete abortion occurs when **all** products of conception have been expelled, bleeding and pain subside, and the uterus is empty. . **D. Missed abortion** – In a missed abortion, the fetus has **died**, but **no** bleeding or cramping occurs, and the products of conception are **retained**. The cervix is **closed**, which is not consistent with this case.