2016 Maternity Questions NCLEX 1-10

Let us try to answer Maternity Questions NCLEX and read the rationale later . . .
1. The nursing student is preparing to teach a prenatal class about fetal circulation. Which statement should be included in the teaching plan?

a) “One artery carries oxygenated blood from the placenta to the fetus.”
b) “Two arteries carry oxygenated blood from the placenta to the fetus.”
c) “Two arteries carry deoxygenated blood and waste products away from the fetus to the placenta.” d) “Two veins carry blood that is high in carbon dioxide and other waste products away from the fetus to the placenta.”

2. Maternity Questions NCLEX about a nursing student is assigned to care for a client in labor. The nursing instructor asks the student to describe fetal circulation, specifically the ductus venosus. Which statement is correct regarding the ductus venosus?

a) Connects the pulmonary artery to the aorta
b) Is an opening between the right and left atria
c) Connects the umbilical vein to the inferior vena cava
d) Connects the umbilical artery to the inferior vena cava

3. A pregnant client tells the clinic nurse that she wants to know the gender of her baby as soon as it can be determined. The nurse understands that the client should be able to find out the gender at 12 weeks’ gestation because of which factor?

a) The appearance of the fetal external genitalia
b) The beginning of differentiation in the fetal groin
c) The fetal testes are descended into the scrotal sac
d) The internal differences in males and females become apparent

4. Maternity Questions NCLEX about the nurse who is performing an assessment on a client who is at 38 weeks’ gestation and notes that the fetal heart rate is 174 beats/minute. On the basis of this finding, what is the priority nursing action?

a) Document the finding.
b) Check the mother’s heart rate.
c) Notify the health care provider (HCP).
d) Tell the client that the fetal heart rate is normal.

5. The nurse is conducting a prenatal class on the female reproductive system. When a client in the class asks why the fertilized ovum stays in the fallopian tube for 3 days, what is the nurse’s best response?

a) “It promotes the fertilized ovum’s chances of survival.”
b) “It promotes the fertilized ovum’s exposure to estrogen and progesterone.”
c) “It promotes the fertilized ovum’s normal implantation in the top portion of the uterus.”
d) “It promotes the fertilized ovum’s exposure to luteinizing hormone and follicle-stimulating hormone.”

6. Maternity Questions NCLEX about the nursing instructor who asks a nursing student to list the characteristics of the amniotic fluid. The student responds correctly by listing which as characteristics of amniotic fluid? Select all that apply.

a) Allows for fetal movement
b) Surrounds, cushions, and protects the fetus
c) Maintains the body temperature of the fetus
d) Can be used to measure fetal kidney function
e) Prevents large particles such as bacteria from passing to the fetus
f) Provides an exchange of nutrients and waste products between the mother and the fetus

7. A couple comes to the family planning clinic and asks about sterilization procedures. Which question by the nurse would determine whether this method of family planning would be most appropriate?

a) “Has either of you ever had surgery?”
b) “Do you plan to have any other children?”
c) “Do either of you have diabetes mellitus?”
d) “Do either of you have problems with high blood pressure?”

8. The nurse should include which statement to a pregnant client found to have a gynecoid pelvis?

a) “Your type of pelvis has a narrow pubic arch.”
b) “Your type of pelvis is the most favorable for labor and birth.”
c) “Your type of pelvis is a wide pelvis, but has a short diameter.”
d) “You will need a cesarean section because this type of pelvis is not favorable for a vaginal delivery.”

9. Which explanation should the nurse provide to the prenatal client about the purpose of the placenta?

a) It cushions and protects the baby.
b) It maintains the temperature of the baby.
c) It is the way the baby gets food and oxygen.
d) It prevents all antibodies and viruses from passing to the baby.

10. Maternity Questions NCLEX about a 55-year-old male client who confides in the nurse that he is concerned about his sexual function. What is the nurse’s best response?

a) “How often do you have sexual relations?”
b) “Please share with me more about your concerns.”
c) “You are still young and have nothing to be concerned about.”
d) “You should not have a decline in testosterone until you are in your 80s.”




Maternity Questions NCLEX
Answers and Rationale

1) C
- Rationale: Blood pumped by the embryo’s heart leaves the embryo through two umbilical arteries. When oxygenated, the blood is returned by one umbilical vein. Arteries carry deoxygenated blood and waste products from the fetus, and the umbilical vein carries oxygenated blood and provides oxygen and nutrients to the fetus.

- Test-Taking Strategy: Focus on the subject , fetal circulation. Recall that three umbilical vessels are within the umbilical cord (two arteries and one vein) and that the vein carries oxygenated blood and the arteries carry deoxygenated blood.

2) C
- Maternity Questions NCLEX Rationale: The ductus venosus connects the umbilical vein to the inferior vena cava. The foramen ovale is a temporary opening between the right and left atria. The ductus arteriosus joins the aorta and the pulmonary artery.

- Test-Taking Strategy: Focus on the subject , the description of the ductus venosus. Note the relationship of the word venosus in the question and vein in the correct option.

3) A
- Rationale: By the end of the twelfth week, the external genitalia of the fetus have developed to such a degree that the gender of the fetus can be determined visually. Differentiation of the external genitalia occurs at the end of the ninth week. Testes descend into the scrotal sac at the end of the thirty-eighth week. Internal differences in the male and female occur at the end of the seventh week.

- Test-Taking Strategy: Focus on the subject, gender of the fetus. Remember that the gender of the fetus can be recognizable visually by the appearance of the external genitalia by gestational week 12.

4) C
- Maternity Questions NCLEX Rationale: The fetal heart rate (FHR) depends on gestational age and ranges from 160 to 170 beats/minute in the first trimester, but slows with fetal growth to 110 to 160 beats/minute near or at term. At or near term, if the FHR is less than 110 beats/minute or more than 160 beats/minute with the uterus at rest, the fetus may be in distress. Because the FHR is increased from the reference range, the nurse should notify the HCP. Options B and D are inappropriate actions based on the information in the question. Although the nurse documents the findings, based on the information in the question, the HCP needs to be notified.

- Test-Taking Strategy: Note the strategic word , “priority.” Also note the FHR and that the client is at 38 weeks of gestation. Remember that the normal FHR at or near term is 110 to 160 beats/minute.

5) C
- Rationale: The tubal isthmus remains contracted until 3 days after conception to allow the fertilized ovum to develop within the tube. This initial growth of the fertilized ovum promotes its normal implantation in the fundal portion of the uterine corpus. Estrogen is a hormone produced by the ovarian follicles, corpus luteum, adrenal cortex, and placenta during pregnancy. Progesterone is a hormone secreted by the corpus luteum of the ovary, adrenal glands, and placenta during pregnancy. Luteinizing hormone and follicle-stimulating hormone are excreted by the anterior pituitary gland. The survival of the fertilized ovum does not depend on it staying in the fallopian tube for 3 days.

- Maternity Questions NCLEX Test-Taking Strategy: Note the strategic word “best” and use knowledge of the anatomy and physiology of the female reproductive system. Remember that fertilization occurs in the fallopian tube and the fertilized ovum remains in the fallopian tube for about 3 days. This promotes its normal implantation.

6) A, B, C, D
- Rationale: The amniotic fluid surrounds, cushions, and protects the fetus. It allows the fetus to move freely and maintains the body temperature of the fetus. In addition, the amniotic fluid contains urine from the fetus and can be used to assess fetal kidney function. The placenta prevents large particles such as bacteria from passing to the fetus and provides an exchange of nutrients and waste products between the mother and the fetus.

- Maternity Questions NCLEX Test-Taking Strategy: Focus on the subject of the question: the characteristics of amniotic fluid. Visualizing the location of the amniotic fluid will assist in answering this question.

7) B
- Rationale: Sterilization is a method of contraception for couples who have completed their families. It should be considered a permanent end to fertility because reversal surgery is not always successful. The nurse would ask the couple about their plans for having children in the future. Options A, C, and D are unrelated to this procedure.

- Test-Taking Strategy: Note the strategic words , most appropriate. Focus on the subject , sterilization procedure. Noting the relationship between the word sterilization and the correct option will direct you to this option.

8) B
- Maternity Questions NCLEX Rationale: A gynecoid pelvis is a normal female pelvis and is the most favorable for successful labor and birth. An android pelvis (resembling a male pelvis) would be unfavorable for labor because of the narrow pelvic planes. An anthropoid pelvis has an outlet that is adequate, with a normal or moderately narrow pubic arch. A platypelloid pelvis (flat pelvis) has a wide transverse diameter, but the anteroposterior diameter is short, making the outlet inadequate.

- Test-Taking Strategy: Focus on the subject , female pelvis types. Recalling that the gynecoid pelvis is the normal female pelvis will direct you to the correct option.

9) C
- Rationale: The placenta provides an exchange of oxygen, nutrients, and waste products between the mother and the fetus. The amniotic fluid surrounds, cushions, and protects the fetus and maintains the body temperature of the fetus. Nutrients, drugs, antibodies, and viruses can pass through the placenta.

- Test-Taking Strategy: Focus on the subject , the purpose of the placenta. Remember that the placenta provides oxygen and nutrients.

10) B
- Maternity Questions NCLEX Rationale: The nurse needs to establish trust when discussing sexual relationships with men. Open the conversation with broad statements to determine the true nature of the client’s concerns. The frequency of intercourse is not a relevant first question to establish trust. Testosterone declines with the aging process.

- Test-Taking Strategy: Note the strategic word best. Determine whether further assessment or validation is needed. In this case, more information is needed to determine the nature of the client’s concerns. Keeping these concepts in mind and focusing on the subject will assist in directing you to the correct option.


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Maternity Questions NCLEX 11-20

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NCLEX Review about Obstetrical Malpractice (96-100)

NCLEX Review about Obstetrical Malpractice

96. A nurse is performing an assessment on a client diagnosed with placenta previa. Which of these assessment findings would the nurse expect to note? Select all that apply

a) uterine rigidity
b) uterine tenderness
c) severe abdominal pain
d) bright red vaginal bleeding
e) soft, relaxed, nontender uterus
f) fundal height may be greater than expected fro gestational age

97. A nurse is caring for four 1-day postpartum clients. Which client has an abnormal finding that would require further intervention?

a) the client with mild after pains
b) the client with a pulse rate of 60 bpm
c) the client with colostrum discharge from both breast
d) the client with lochia that is red and has foul-smelling odor  

98. A nursing student is preparing to perform a cardiovascular assessment on a postpartum client. A nursing instructor asks the student about the procedure to elicit Homan's sign. Which response by the nursing student would indicate an understanding of this assessment technique?

a) I will ask the client to raise her legs up to her waist and then to lower her legs slowly
b) I will ask the client to raise her legs and to try to lower them against pressure from my hand
c) I will ask the client to extend her legs flat on the bed, and I will grasp her foot gently dorsiflex it forward
d) I will ask the client to extend her legs flat on the bed, and I will grasp her foot and sharply extend it backward

99. A nurse is planning care for a postpartum client who had a vaginal delivery 2 hours ago. The client had a midline episiotomy and has several hemorrhoids. What is the priority nursing diagnosis for this client?

a) acute pain
b) disturbed body image
c) impaired urinary elimination
d) risk for imbalanced fluid volume

100. A nurse is providing postpartum instructions to a client who will be breast-feeding her newborn. The nurse determines that the client has understood the instructions if she makes which of the following statements? Select all that apply.

a) I will use soap to wash my breasts often
b) drinking alcohol can affect my milk supply
c) the use of caffeine can decrease my milk supply
d) I will start my estrogen birth control pills again as soon as I get home
e) I know if my breasts get engorged I will limit my breast-feeding and supplement the baby
f) I plan on having bottled water available in the refrigerator so I can get additional fluids easily




NCLEX Review about Obstetrical Malpractice:
ANSWERS AND RATIONALE

96) D, E, F
- painless, bright red vaginal bleeding in the second or third trimester of pregnancy is a sign of placenta previa. The client will have a soft, relaxed, nontender uterus, and the fundal height may be more than expected for gestational age. In abruptio placentae, severe abdominal pain is present. Uterine tenderness accompanies placental abruption. Additionally, in abruptio placentae, the abdomen will feel hard and board-like on palpation as the blood penetrates the myometrium and causes uterine irritability.

97) D
- lochia, the discharge present after birth, is red for the first 1 to 3 days and gradually decreases in amount. Normal lochia has a fleshy odor or an odor similar to menstrual flow. Foul-smelling or purulent lochia usually indicates infection, and these findings are not normal. The other options are normal findings for 1-day postpartum client.

98) C
- to elicit Homan's sign, the nurse asks the client to extend her legs flat on bed. The nurse grasps the foot and dorsiflexes it forward. If this causes any discomfort or resistance, the nurse should notify the physician or midwife that Homan'ss sign is present. Option A, B, and D are incorrect descriptions of this assessment technique.

99) A
- the priority nursing diagnosis for a client who delivered 2 hours ago and who has a midline episiotomy and hemorrhoids is acute pain. Most clients have some degree of discomfort during the immediate postpartum period. There is no data in the question that indicate the presence of Disturbed body image, Impaired urinary elimination, Risk for imbalanced fluid volume.

100) B, C, F
- breast-feeding client should increase their daily fluid intake; therefore, having bottled water available indicates that the postpartum client understands the importance of increasing fluids. If engorgement occurs, the client should not limit breast-feeding, but should breast-feed frequently. Oral contraceptives containing estrogen are not recommended fro breast-feeding mothers and soap should not be used on the breasts because it tends to remove natural oils, which increases the chance of cracked nipples. Common causes of decreased milk supply include formula use, inadequate rest or diet, smoking by the mother or others in the home, and use of caffeine, alcohol, or other medications.

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NCLEX Review about Obstetrical Malpractice (91-95)

NCLEX Review about Obstetrical Malpractice

91. A nurse in labor room is assisting with the vaginal delivery of a newborn infant. The nurse would monitor the client closely for risk of uterine rupture if which of the following occurred?

a) forcep delivery
b) schultz presentation
c) hypotonic contractions
d) weak bearing-down efforts

92. A clinic nurse is performing a prenatal assessment on a pregnant client. The nurse would implement teaching related to the risk of abruptio placentae if which of the following information was obtained on assessment?

a) the client is 28 years of age
b) this is the second pregnancy
c) the client has a history of hypertension
d) the client performs moderate exercise on a regular daily schedule  

93. A nurse is performing an initial assessment on a client who has just been told that pregnancy test is positive. Which assessment finding would indicate that the client is at risk of preterm labor?

a) the client is a 35-year old primigravida
b) the client has history of cardiac disease
c) the client's hemoglobin level is 13.5 g/dL
d) the client is a 20-year old primigravida of average weight and height

94. A nurse in labor room is monitoring a client with dysfunctional labor for signs of fetal or maternal compromise. Which of the following assessment findings would alert the nurse to compromise?

a) maternal fatigue
b) coordinated uterine contractions
c) progressive changes in the cervix
d) persistent nonreassuring fetal heart rate

95. A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of slowing labor. The nurse is reviewing the physician's orders and would expect to note which of the following prescribed treatments for this condition?

a) increased hydration
b) oxytocin (Pitoxin) infusion
c) medication that will provide sedation
d) administration of a tocolytic medication



NCLEX Review about Obstetrical Malpractice : ANSWERS AND RATIONALE

91) A
- excessive fundal pressure, forcep delivery, violent bearing-down efforts, tumultuous labor, and shoulder dystocia can place a client at risk for traumatic uterine rupture. Hypotonic contractions and weak bearing-down efforts do not add to the risk of rupture because they do not add to the stress on the uterine wall. Schultz presentation is the expulsion of the placenta with the fetal side presenting first and is not associated with uterine rupture.

92) C
- abruptio placentae is associated with conditions characterized by poor uteroplacental circulation, such as hypertension, smoking, and alcohol or cocaine abuse. The condition is also associated with physical and mechanical factors, such as overdistention of the uterus, which occurs with multiple gestation or polyhydramios. In addition, a short umbilical cord, physical trauma, and increased maternal age and parity are risk factors.

93) B
- several factors are associated with preterm labor. These include the history of medical conditions, present and past obstetric problems, social and environmental factors, and demographic factors such as race and age. Other risk factors include a multifetal pregnancy, which contributes to overdistention of the uterus, anemia, which decreases oxygen supply to the uterus, and age younger than 18 years or first pregnancy older than the age of 40.

94) D
- signs of fetal or maternal compromise include a persistent, nonreassuring fetal heart rate, fetal acidosis, and the passage of meconium. Maternal exhaustion and infection can occur if the labor is prolonged but do not indicate fetal or maternal compromise. Progressive changes in the cervix and coordinated uterine contractions are a reassuring pattern in labor.

95) B
- therapeutic management for hypotonic uterine dysfunction includes oxytocin augmentation and amniotomy to stimulate a labor that slows. A cesarean birth will be performed if no progress in labor occurs. Option A, C, and D identify therapeutic measures for a client with hypertonic dysfunction.

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Sample NCLEX about Obstetrics Nursing (86-90)

--> Sample NCLEX about Obstetrics Nursing

86.A nurse is reviewing the physician's orders for a client admitted for premature rupture of membranes. Gestational age of the fetus is determined to be 37 weeks. Which physician's order should the nurse question?

a) perform a vaginal examination every shift
b) monitor maternal vital signs every 4 hours
c) monitor fetal heart rate (FHR) continuously
d) administer ampicillin 1gm as an intravenous piggyback (IVPB) every 6 hours

87. A nurse is providing emergency measures to a client in labor who has been diagnosed with a prolapsed cord. The mother becomes anxious and frightened and says to the nurse, "Why are all of these people in here? Is my baby going to be all right?" Which of the following nursing diagnosis would be most appropriate for this client at this time?

a) fear
b) fatigue
c) powerlessness
d) ineffective coping

88. A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with a placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks associated with placenta previa?

a) infection
b) hemorrhage
c) chronic hypertension
d) disseminated intravascular coagulation

89. A maternity nurse is caring for a client with abruptio placentae and is monitoring the client for disseminated intravascular coagulopathy. Which assessment finding is least likely to be associated with DIC?

a) prolonged clotting times
b) decreased platelet count
c) swelling of the calf of one leg
d) petechiae, oozing from injection sites, and hematuria

90. A nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this condition is present?

a) a soft abdomen
b) uterine tenderness
c) absence of abdominal pain
d) painless, bright red vaginal bleeding





Sample NCLEX about Obstetrics Nursing
ANSWERS AND RATIONALE

86) A
- vaginal examinations should not be done routinely on a client with premature rupture of the membranes because of the risk of infection. The nurse would expect to administer an antibiotic, monitor maternal vital signs, and monitor the FHR.

87) A
- the mother is anxious and frightened, and the most appropriate nursing diagnosis for the client at this time is fear. No data in the question support a nursing diagnosis of powerlessness, ineffective coping, or fatigue, although these nursing diagnoses may be considered for this client at some point during the hospitalization experience.

88) B
- because the placenta is implanted in the lower uterine segment, which does not contain the same intertwining musculature as the fundus of the uterus, this site is more prone to bleeding. Option A, C, and D are not risks that are related specifically to placenta previa.

89) C
- disseminated intravascular coagulation (DIC) is a state of diffuse clotting in which clotting factors are consumed, leading to widespread bleeding. Platelets are decreased because they are consumed by the process, coagulation studies show no clot formation (and are thus normal to prolonged), and fibrin plugs may clog the microvasculature diffusely, rather than in an isolated area. The presence of petichiae, oozing from injection sites, and hematuria are signs associated with DIC. Swelling and pain in the calf of one leg are more likely associated with thrombophlebitis.

90) B
- painless, bright red vaginal bleeding in the second trimester of pregnancy is a sign of placenta previa. In abruptio placentae, acute abdominal pain is present. Uterine tenderness accompanies placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen will feel hard and board-like on palpation as the blood penetrates the myometrium and causes uterine irritability. Observation of the fetal monitor often reveals increased uterine resting tone, caused by failure of the uterus to relax in attempt to constrict blood vessels and control bleeding

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Sample NCLEX about Obstetrics Nursing (81-85)

Sample NCLEX about Obstetrics Nursing

81. A nurse is caring for a client in labor and prepares to auscultate the fetal heart rate by using a Doppler ultrasound device. The nurse accurately determines that the fetal heart sounds are heard by:

a) Noting whether the heart rate is greater than 140 bpm
b) placing the diaphragm of the Doppler on the mother's abdomen
c) palpating the maternal radial pulse while listening to the fetal heart rate
d) Performing Leopold's maneuver first to determine the location of the fetal heart

82. A nurse is caring for a client in labor who is receiving oxytoxin (Pitocin) by intravenous infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued?

a) increased urinary output
b) a fetal heart rate of 90 bpm
c) three contractions occurring within a 10-minute period
d) adequate resting tone of the uterus palpated between contractions

83. A nurse is reviewing the record of a client in the labor room and notes that the nurse-midwife has documented that the fetus is at negative 1 (-1) station. The nurse determines that the fetal presenting part is:

a) 1 inch below the coccyx
b) 1 inch below the iliac crest
c) 1 cm above the ischial spine
d) 1 fingerbreath below the symphysis pubis

84. nurse is monitoring a client in labor. The nurse suspects umbilical cord compression. If which of the following is noted on the external monitor tracing during a contraction?

a) late decelerations
b) early decelerations
c) short-term variability
d) variable decelerations

85. A labor and delivery room nurse has just received report on four clients. The nurse should assess which client first?
a) a primiparous client in the active stage of labor
b) a multiparous client who was admitted for induction of labor
c) a client who is not contracting but has suspected premature rupture of the membranes
d) a client who has just received an Iv loading dose of magnesium sulfate to stop preterm labor





Sample NCLEX about Obstetrics Nursing:
ANSWERS AND RATIONALE

81) C
- the nurse must simultaneously palpate the maternal radial or carotid pulse and auscultate the fetal heart rate (FHR) to differentiate the two. If the fetal and maternal heart rates are similar, the nurse may mistake the maternal heart rate for the FHR. Noting whether the heart rate is more than 140 bpm or placing the diaphragm of the Doppler on the mother's abdomen will not ensure accuracy in obtaining the FHR. Leopold's maneuver may help the examiner locate the position of the fetus but will not ensure a distinction between the heart rates

82) B
- a normal fetal heart rate is 120 to 160 bpm. Bradycardia or late or variable decelerations indicate fetal distress and the need to discontinue the oxytocin. The goal of labor augmentation is to achieve three good-quality contractions (appropriate intensity and duration) in a 10-minute period. The uterus should return to resting tone between contractions, and there should be no evidence of fetal distress. Increased urinary output is unrelated to the use of oxytocin.

83) C
- station is the relationship of the presenting part to an imaginary line drawn between the ischial spines, measured in centimeters, and noted as a negative number above the line and a positive number below the line. At negative 1 (-1) station, the fetal presenting part is 1 cm above the ischial spines.

84) D
- variable decelerations occur if the umbilical cord becomes compressed, thus reducing blood flow between the placenta and the fetus. Early decelerations result from pressure on the fetal head during a contraction. Late decelerations are an ominous pattern in labor because they suggest uteroplacental insufficiency during a contraction. Short-term variability refers to the beat-to-beat range in fetal heart rate.

85) D
- magnesium sulfate is a central nervous system (CNS) depressant and the client could experience adverse effects that includes depressed respiratory rate (below 12 cpm), severe hypotension, and absent tendon reflexes (DTRs). This client should be seen before the clients in option A, B, and C because these clients conditions represent stable ones. 

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Obstetric Nursing CEUS Practice Test (76-80)

Obstetric Nursing CEUS Practice Test

76. A nurse is reviewing true and false labor signs with multiparous client. The nurse determines that the client understands the signs of true labor if she makes which statement?

a) I won't be in labor until the baby engages
b) my contractions will be felt in the abdominal area
c) my contractions will not be as painful if I walk around
d) my contractions will increase in duration and intensity

77. A client in labor has been pushing effectively for 1 hour. A nurse determines that the client,s primary physiological need at this time is to:

a) ambulate
b) rest between contractions
c) change positions frequently
d) consume oral food and fluids  


78. A nurse is caring for a client in labor. The nurse determines that the client is beginning the second stage of labor when which of the following assessments is noted?

a) the contractions are regular
b) the membranes have ruptured
c) the cervix is dilated completely
d) the client begins to expel clear vaginal fluids

79. A nurse is performing an assessment of a client who is scheduled for a cesarean delivery. Which assessment finding would indicate a need to contact the physician?

a) hemoglobin of 11.0 g/dL
b) fetal heart rate of 180 bpm
c) maternal pulse rate of 85 bpm
d) white blood cell count of 12,000/mm3

80. A nurse has provided discharge instructions to a client who delivered a healthy newborn infant by cesarean delivery. Which statement, if made by the client, indicates a need fro further instructions?

a) I will begin abdominal exercises immediately
b) I will notify the physician if I develop a fever
c) I will turn on my side and push up with my arms to get out of bed
d) I will lift nothing heavier than the newborn infant for at least two weeks





Obstetric Nursing CEUS Practice Test:
ANSWERS AND RATIONALE

76) D
- true labor for multiparous client is present when the contractions increase in duration and intensity. A multiparous client experiences true labor before the fetus engages. Contractions felt in the abdominal area and contractions that ease with walking are signs of false labor.

77) B
- the birth process expends a great deal of energy. Encouraging rest between contractions conserves maternal energy, facilitating voluntary pushing efforts with contractions. Uteroplacental perfusion also is enhanced, which promotes fetal tolerance to stress of labor. Changing positions frequently is not the primary physiological need. Ambulation is encouraged during early labor. Ice chips should be provided. Food and fluids likely are to be withheld at this time.

78) C
- the second stage of labor begins when the cervix is dilated completely and ends with birth of the neonate. Options A, B, and D are not specific assessment findings of the second stage of labor.

79) B
- a normal fetal heart rate is 120 to 160 bpm. A count of 180 bpm could indicate fetal distress and would warrant physician notification. White blood cell counts in a normal pregnancy begin to rise in the second trimester and peak in the third trimester, with a normal range of 11,000 to 15,000/mm3, up to 18,000/mm3. During the initial postpartum period, the count may be as high as 25,000 to 30,000/mm3 as a result of increased leukocytosis during delivery. By full term, a normal maternal hemoglobin range is 11 to 13 g/dL as a result of the hemodilution caused by an increase in plasma volume during pregnancy. The maternal pulse rate increases 10 to 15 bpm over prepregnancy readings to facilitate increased cardiac output, oxygen transport, and kidney filtration.

80) A
- abdominal exercises should not start immediately following abdominal surgery, and the client should wait at least 3 to 4 weeks postoperatively to allow for healing of the incision. Option B, C, and D are appropriate instructions for the client following a cesarean delivery. 

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Obstetric Nursing CEUS Practice Test (71-75)

Obstetric Nursing CEUS Practice Test

71.A nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes mellitus. Which statement, if made by the client, indicates a need for further teaching?

a) I should stay on the diabetic diet
b) I should perform glucose monitoring at home
c) I should avoid exercise because of the negative effects on insulin production
d) I should be aware of any infections and report signs of infection immediately to my health care provider

72. A client has just had surgery to deliver a nonviable fetus resulting from abruptio placentae. As a result of abruptio placentae, the client develops disseminated intravascular coagulation (DIC) and is told about the complication. The client begins to cry and screams, "God, just let me die now!" Which nursing diagnosis should direct care for this client at time?

a) grieving related to the loss of the baby
b) situational low self-esteem related to being ill
c) deficient knowledge related to the disease process
d) hopelessness related to the loss of the baby and personal health

73. A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with the diagnosis and assesses the client for:

a) enlargement of the breast
b) complaints of feeling hot when the room is cool
c) periods of fetal movement followed by quiet periods
d) evidence of bleeding, such as in the gums, petechia, and purpura

74. A nurse in a maternity unit is reviewing the records of the clients on the unit. Which client would the nurse identify as being at the greatest risk for developing disseminated intravascular coagulation (DIC)?

a) a primigravida with mild preeclampsia
b) a primigravida who delivered a 10-lb baby 3 hours ago
c) a gravida II who has just been diagnosed with dead fetus syndrome
d) a gravida IV who delivered 8 hours ago and has lost 500 ml of blood

75. A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement, if made by the client, indicates a need for further instructions.

a) I will watch for the evidence of the passage of tissue
b) I will maintain strict bed rest throughout the remainder of the pregnancy
c) I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad
d) I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding





Obstetric Nursing CEUS Practice Test:
ANSWERS AND RATIONALE

71) C
- exercise is safe for the client with gestational diabetes mellitus and is helpful in lowering the blood glucose level. Dietary modifications are the mainstay of treatment, and the client is placed on a standard diabetic diet. Many client are taught to perform blood glucose monitoring. If the client is not performing the blood glucose monitoring at home, then it will be performed at the clinic or health care provider's office. Signs of infection need to be reported to the health care provider.

72) D
- by seeing no way out of the situation except for death, the client meets the criteria for hopelessness. A person who lacks hope thinks that life is too much to handle. Option A is a possible nursing diagnosis at a later time; however, at this time, the diagnosis of hopelessness should take precedence. Option C is a possible nursing diagnosis later, but not enough data support it at this point. The data given do not support the nursing diagnosis of situational self-esteem.

73) D
- severe preeclampsia can trigger disseminated intravascular coagulation (DIC) because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the health care provider if noted on assessment. Option A, B, and C are normal occurrences in the last trimester of pregnancy.

74) C
- dead fetus syndrome is considered a risk factor for DIC. Sever preeclampsia is considered a risk factor for DIC; a mild case is not. Delivering a large baby is not considered a risk factor for DIC. Hemorrhage is a risk factor with DIC; however, a loss of 500 ml is not considered hemorrhage.

75) B
- strict bed rest throughout the remainder of the pregnancy is not required. The client is advised to curtail sexual activities until bleeding has ceased, and for 2 weeks following the last evidence of bleeding or as recommended by the physician or other health care provider. The client is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The client also should watch for the evidence of the passage of tissue.

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Obstetric Nursing CEUS Practice Test (66-70)

Obstetric Nursing CEUS Practice Test

66. A clinic nurse is performing a psychosocial assessment of a client who has been told that she is pregnant. Which assessment finding indicates to the nurse that the client is at high risk for contracting immunodeficiency virus (HIV)?

a) a client who has a history of intravenous drug use
b) a client who has a significant other who is heterosexual
c) a client who has a history of sexually transmitted diseases
d) a client who has had one sexual partner for the past 10 years

67. A nurse in maternity unit is providing emotional support to a client and her husband who are preparing to be discharged from the hospital after the birth of a dead fetus. Which statement, if made by the client, indicates a component of the normal grieving process?

a) we want to attend a support group
b) we never want to try to have a baby again
c) we are going to try to adopt a child immediately
d) we are okay, and we are going to have another baby immediately

68. A nurse evaluates a hepatitis B-positive mother' ability for safe bottle-feeding of her infant during postpartum hospitalization. Which maternal action best exemplifies the mother's knowledge of potential disease transmission to the infant.

a) the mother requests that the window be closed before feeding
b) the mother holds the infant properly during feeding and burping
c) the mother tests the temperature of the formula before initiating feeding
d) the mother washes and dries her hands before and following self-care of the perineum and asks for a pair of gloves before feeding

69. A home care nurse visits a pregnant client who has a diagnosis of mild preeclampsia and who is being monitored for gestational hypertension. Which assessment finding indicates a worsening of the preeclampsia and the need to notify the physician?

a) urinary output has increased
b) dependent edema has resolved
c) blood pressure reading is at the prenatal baseline
d) the client complaints of headache and blurred vision

70. A client with a 38-week twin gestation is admitted to a birthing center in early labor. One of the fetuses is a breech presentation. Of the following interventions, which is the lowest priority in planning the nursing care of this client?

a) measure fundal height
b) attach electronic fetal monitoring
c) prepare the client for possible cesarean section
d) visually examine the perineum and vaginal opening





Obstetric Nursing CEUS Practice Test:
ANSWERS AND RATIONALE

66) A
- human immunodeficiency virus (HIV) is transmitted by intimate sexual contact and the exchange of body fluids, exposure to infected blood, and passing from infected woman to her fetus. Clients who fall into the high-risk category for HIV infection include those with persistent and recurrent sexually transmitted diseases, a history of multiple partners, or have used intravenous drugs. A heterosexual partner, in 10 years, does not have a high risk for contracting HIV.

67) A
- a support group can help the parents work through their pain by nonjudgmental sharing of feelings. Option A identifies a statement that would indicate positive, normal grieving. Although the other options may indicate reactions of the client and significant other, they are not specifically a part of the normal grieving process.

68) D
- hepatitis B virus is highly contagious and transmitted by direct contact with blood and body fluids of infected persons. The rationale for identifying childbearing clients with this disease is to provide adequate protection of the fetus and the newborn infant, to minimize transmission to other human beings, and to reduce maternal complications. Option D provides the best evaluation of maternal understanding of disease transmission. Option A will not affect disease transmission. Option B and C are appropriate feeding techniques for bottle-feeding but do not minimize disease transmission for hepatitis B.

69) D
- if the client complains of headache and blurred vision, the physician should be notified because these are signs of worsening preeclampsia. Option A, B, and C are normal signs.

70) A
- option A is a low priority because fundal height should be measured at each antepartum clinic visit, not in the intrapartum period. Option B, C and D are high priorities. Intrapartum management and assessment require careful attention to maternal and fetal status. The fetuses should be monitored by dual electronic fetal monitoring, and any signs of distress need to be reported to the physician or health care provider. A cesarean section may be necessary if a fetus is breech. The nurse should examine the perineum and vaginal opening visually for signs of the cord, which sometimes will prolapse through the cervix.

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Obstetric Nursing CEUS Practice Test (61-65)

Obstetric Nursing CEUS Practice Test

61. A pregnant client visits a clinic for a scheduled prenatal appointment. The client tells the nurse that she frequently has a backache, and the nurse provides instructions regarding measures that will assist in relieving the backache. Which statement by the client indicates a need for further instructions?

a) I should wear flat-heeled shoes
b) I should sleep on firm mattress
c) I should try to maintain good posture
d) I should do more exercises to strengthen my back muscles

62. A clinic nurse has instructed a pregnant client in measures to prevent varicose veins during pregnancy. Which statement by the client indicates a need for further instructions?

a) I should wear panty hose
b) I should wear support hose
c) I should be wearing flat nonslip shoes that have good support
d) I should wear knee-high hose as long as I don't leave them on longer than 8 hours

63. A clinic nurse is providing instructions to a pregnant client regarding measures that will assist in alleviating heartburn. Which statement by the client indicates an understanding of the instructions?

a) I should avoid between-meal snacks
b) I should lie down for an hour after eating
c) I should use spices for cooking rather than using salt
d) I should avoid eating foods that produce gas, such as beans, vegetables, and fatty foods like deep fried chicken

64. A nurse in a health care clinic is instructing a pregnant client about how to perform "kick counts." Which statement by the client indicates a need for further instructions?

a) I will record the number of movements or kicks
b) I need to lie flat on my back to perform the procedure
c) a count of fewer than 10 kicks in a 12-hour period indicates the need to contact the physician
d) I should place my hands on the largest part of my hands on the largest part of my abdomen and concentrate on the fetal movements to count the kicks

65. During a prenatal visit, the nurse is explaining dietary management to a client with diabetes mellitus. The nurse determines that the teaching has been effective if the client makes which statement?

a) diet and insulin needs change during pregnancy
b) I will plan my diet based on the results of urine glucose testing
c) I will need to eat 600 more calories every day since I am pregnant
d) I can continue with the same diet as before pregnancy, as long as it is well-balanced





Obstetric Nursing CEUS Practice Test:
ANSWERS AND RATIONALE

61) D

- some measures that will assist in relieving a backache include maintaining good posture and body mechanics, resting and avoiding fatigue, wearing flat-heeled shoes, and sleeping on a firm mattress. The back discomfort that occurs in pregnant client is often caused by the exaggerated lumbar and cervicorthoracic curves resulting from a change in the center of gravity because of the enlarged uterus. Performing more exercises to strengthen the back muscles could be harmful to a pregnant client.

62.  D

- varicose veins often develop in the lower extremities during pregnancy. Any constrictive clothing, such as knee-high hose, impedes venous return from the lower legs and places the client at risk for developing varicosities. The client should be encouraged to wear support hose or panty hose. Flat nonslip shoes with proper support are important to assist the pregnant woman to maintain proper posture and balance and minimize falls.

63) D

- lying down is likely to lead reflux of stomach contents, especially immediately following a meal. The client should be instructed to avoid spices, along with salt, because spices will trigger heartburn. Salt will produce edema. The client should be encouraged to eat between-meal snacks and should instructed that to control heartburn, eating smaller, more frequent portions is preferred over eating three large meals. The client also should limit or avoid gas-producing and fatty foods.

64) B

- the client should sit or lie quietly on her side to perform kick counts. Lying flat on the back is not necessary to perform this procedure, can cause discomfort, and presents a risk of vena cava (hypotensive) syndrome. The client is instructed to place her hands on the largest part of the abdomen and concentrate on the fetal movements. The client records the number of movements felt during a specified time period. The client needs to notify the physician or nurse-midwife if there are fewer than 10 kicks in a 12-hour period or as instructed by the physician or nurse-midwife.

65) A

- the diet for a pregnant client with diabetes mellitus is individualized to allow for increased fetal and metabolic requirements, with consideration of such factors as pre-pregnancy weight and dietary habits, overall health, ethnic background, lifestyle, stage of pregnancy, knowledge of nutrition, and insulin therapy. An increase of 600 additional calories a day is not required. Diet and insulin needs change during the pregnancy in direct correlation to hormonal changes and energy needs. In the third trimester, insulin needs increase. Dietary management during diabetic pregnancy must be based on blood, not urine, glucose changes.


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NCLEX Flashcards on Obstetric Nursing (56-60)

NCLEX Flashcards on Obstetric Nursing

56. A nurse has performed a nonstress test on a pregnant client and is reviewing the fetal monitor strip. The nurse interprets the test as reactive and understands that this indicates:

a) normal findings
b) abnormal findings
c) the need for further evaluation
d) that the findings on the monitor were difficult to interpret

57. A nonstress test is performed on a client who is pregnant and the results of the test indicate nonreactive findings. The physician orders a contraction stress test to be done and the results are documented as negative. The nurse interprets this finding as indicating:

a) a normal test result
b) an abnormal test result
c) a high risk for fetal demise
d) the need for a cesarean delivery  

58. A nurse is reviewing a nutritional plan of care with a pregnant client and is identifying the food items highest in folic acid. The nurse determines that the client understands the foods that supply the highest amounts of folic acid if the client states that she will include which of the following in the daily diet?

a) milk
b) yogurt
c) bananas
d) leafy, green vegetables

59. A pregnant client tells a nurse that she has been craving "unusual foods." The nurse gathers additional assessment data from the client and discovers that the client has been ingesting daily amounts of white clay dirt from her backyard. Laboratory studies are performed on the client. The nurse reviews the laboratory results and determines that which of the following indicates a physiological consequence of this client's practice?

a) hematocrit, 38%
b) glucose, 86 mg/dL
c) hemoglobin, 9.1 g/dL
d) white blood cell count, 12,400 mm3

60. A pregnant client who is at 30 weeks gestation comes to the clinic for a routine visit, and the nurse performs an assessment on the client. Which observation made by the nurse during the assessment indicates need for teaching?

a) the client is wearing sneakers
b) the client is wearing knee-high hose
c) the client is wearing flat shoes with rubber soles
d) the client is wearing pants with an elastic waistband





NCLEX Flashcards on Obstetric Nursing:
ANSWERS AND RATIONALE

  56) A
- a reactive nonstress is a normal result. To be considered reactive, the baseline fetal heart rate must be within normal range (120 to 160 bpm) with good long-term variability. In addition, two or more fetal heart rate accelerations of at least 15 bpm must occur, each with a duration of at least 15 seconds, in a 20-minute interval.

57) A
- contraction stress test results may be interpreted as negative (normal), positive (abnormal), or equivocal. A negative test result indicates that no late decelerations occurred in the fetal heart rate, although the fetus was stressed by three contractions of at least 40 seconds duration in a 10-minute period. Therefore, options B, C, and D are incorrect interpretations.

58) D
- leafy green vegetables are rich in folate (folic acid). Bananas provide potassium, milk and yogurt supply calcium.

59) C
- Pica cravings often lead to iron deficiency anemia, resulting in a lowered hemoglobin level. The laboratory values options A, B, and D are within normal limits for the pregnant client.

60) B
- varicose veins often develop in the lower extremities during pregnancy. Any constricting clothing such as knee-high hose impede venous return from the lower legs and thus place the client at high risk for developing varicosities. Client should be encourage to wear panty hose or support hose. Flat nonslip shoes with proper support are important to assist the pregnant woman to maintain proper posture and balance and minimize the risk for falls. Pants with an elastic waistband are comfortable and not constricting.

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NCLEX Flashcards on Obstetric Nursing (51-55)

NCLEX Flashcards on Obstetric Nursing

51. A nurse is performing an assessment of primipara who is being evaluated in clinic during her second trimester of pregnancy. Which of the following indicates an abnormal physical finding that necessities further testing?

a) quickening
b) braxton hicks contractions
c) consistent increase in fundal height
d) fetal heart rate of 180 bpm

52. A nurse is performing an assessment of a pregnant client who is at 28 weeks of gestation. The nurse measures the fundal height in centimeters and expects the finding to be which of the following?

a) 22 cm
b) 30 cm
c) 36 cm
d) 40 cm

53. A nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The physician has documented the presence of Goodell's sign. The nurse determines that his sign indicates:

a) a softening of the cervix
b) the presence of fetal movement
c) the presence of human chorionic gonadotrophin in the urine
d) a soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus.

54. A nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Select all probable signs of pregnancy.

a) ballotment
b) chadwick's sign
c) uterine enlargement
d) braxton hicks contractions
e) outline of fetus via radiography or ultrasonography
f) fetal heart rate detected by a nonelectronic device

55. A nurse is providing instructions regarding treatment of hemorrhoids to a client who is in the second trimester of pregnancy. Which statement by the client indicates a need for further teaching?

a) I should avoid straining during bowel movements
b) I can gently replace the hemorrhoids into the rectum
c) I can apply ice packs to the hemorrhoids to reduce the swelling
d) I should apply heat packs to the hemorrhoids to help the hemorrhoids shrink




NCLEX Flashcards on Obstetric Nursing:
ANSWERS AND RATIONALE

51) D
- the normal range of the fetal heart rate depends on gestational age. The heart rate is usually 160 to 170 bpm in the first trimester and slows with fetal growth. Near at term, the fetal heart rate ranges from 120 to 160 bpm. Option A, B and C are normal expected findings.

52) B
- during the second and third trimester (weeks 18 to 30), fundal height in centimeters approximately equal s the fetus age in weeks +- 2cm. At 16 weeks, the fundus can be located halfway between the symphysis pubis and the umbilicus. At 20 to 22 weeks, the fundus is at the umbilicus, and at 36 weeks the fundus is at the xiphoid process.

53) A
- in the early weeks of pregnancy, the cervix becomes softer as a result of increased vascularity and hyperplasia, which cause Goodell's sign. Cervical softening is noted by the examiner dung pelvic examination. A soft blowing sound that corresponds to the maternal pulse may be auscultated over the uterus and is caused by blood circulating through the placenta. Human chorionic gonadotrophin is noted in maternal urine in a positive urine pregnancy test. Goodell's sign does not indicate the presence of fetal movement.

54) A, B, C, D
- the probable signs of pregnancy include uterine enlargement, hegar's sign (softening and thinning of the lower uterine segment that occurs about week 6), goodell's sign (softening of the cervix that occurs at the beginning of the second month), chadwick's sign (bluish coloration of the mucous membranes of the cervix, vagina and vulva that occurs about week 6), ballotment (rebounding of the fetus against the examiner's fingers on palpation), braxton hicks contractions, and a positive pregnancy test for the presence of human chorionic gonadotrophin (HCG). Positive signs of pregnancy include fetal heart rate detected by electronic device (doppler tranducer) at 10 to 12 weeks and by a nonelectronic device (fetoscope) at 20 weeks of gestation, active fetal movements palpable by the examiner, and an outline of the fetus by radiography or ultrasonography.

55) D
- measures that provide relief from hemorrhoids include avoiding constipation and straining during bowel movements; applying ice packs to reduce the hemorrhoidal swelling; gently replacing the hemorrhoids into the rectum; using stool softeners; ointments or sprays as prescribed; and assuming certain positions to relieve pressure on the hemorrhoids. Heat packs will increase the blood flow to the area and worsen the discomfort from hemorrhoids. 

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Obstetric Nursing Test (46-50)

Obstetric Nursing Test Questions 46-50

46. A mother complains of pain due to breast engorgement and is bottle-feeding her newborn. Which action by the mother needs follow-up?

a) the mother applies warm compress on her breasts
b) the mother wears support bra
c) the mother applies cold compress on her breasts
d) the mother takes prescribed analgesics

47. A nurse is assisting a client who is in first stage of labor (active phase). A priority nursing action for the nurse is:

a) encourage the woman to blow out strong, short breaths
b) assist the client to a comfortable position in bed
c) monitor client's temperature every hour
d) evaluate fetal heart rate (FHR) every hour

48. A nurse on the obstetric unit is providing care to a woman in the active phase of the first stage of labor. Which statement if made by the mother should be a priority concern for the nurse?

a) I will like to take a nap between contractions
b) I have not voided in the last hour, although I feel I need to
c) I am feeling some rectal pressure that is relieved when I push
d) I am feeling contractions every 5 minutes

49. A nursing instructor asks a nursing student to describe the procedure for performing the Helmlich maneuver on an unconscious pregnant woman at 8 month's gestation. The student describes the procedure correctly if the student states that she or he will:

a) place the hands in the pelvis to perform the thrusts
b) perform abdominal thrusts until the object is dislodged
c) perform left lateral abdominal thrusts until the object is dislodged
d) place a rolled blanket under the right abdominal flank and hip area

50. A nursing student is assigned to a client in labor. A nursing instructor asks the student to describe fetal circulation, specially the ductus venosus. The nursing instructor determines that the student understands fetal circulation if the student states that the ductus venosus:

a) connects the pulmonary artery to the aorta
b) is an opening between the right and left atria
c) connects the umbilical vein to the inferior vena cava
d) connects the umbilical artery to the inferior vena cava




Obstetric Nursing Test:
ANSWERS AND RATIONALE

46) A
- the mother who bottle-feeds her infant should apply cold compress on her breasts to relieve engorgement; not warm compress. Warm compress stimulates milk production.

47) A
- during active labor, pant-blow breathing exercises may minimize discomfort during uterine contraction. Pushing is done only when there is full cervical dilatation (10cm) to prevent exhaustion of the mother and to prevent laceration.

48) A
- the client should relax and be alert, but not to take a nap between contractions. Taking a nap may also make the fetus sleep and labor will be prolonged.

49) D
- to perform the Helmlich maneuver on an unconscious woman in an advanced stage of pregnancy, place a wedge, such as a pillow or rolled blanket, under the right abdominal flank and hip to displace the uterus to the left side of the abdomen. Option A, B and C are incorrect and can harm the woman and the fetus.


50) C
- the ductus venosus connects the umbilical vein to the inferior vena cava. Option A, B, and D are incorrect. The foramen ovale is a temporary opening between the right and left atria. The ductus arteriosus joins the aorta and the pulmonary artery. 

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Intrapartum NCLEX Questions 41-45

Let us try to answer Intrapartum NCLEX Questions . . .


41. The client had been diagnosed to have PIH (pregnancy-induced hypertension). Which of the following should be included in her care? Select all that apply

a) administer magnesium sulfate IV drip as ordered
b) check urine for presence of protein
c) have calcium gluconate readily available
d) monitor for elevated liver enzymes
e) observe for elevated platelet counts
f) encourage ambulation

42. A clinic nurse is teaching a pregnant client about the warning signs in pregnancy. Which of the following, if identified as a warning sign by the client would indicate that she understands the teaching?

a) purplish discoloration of the vulva
b) visual disturbances
c) irregular, painless contractions
d) urinary frequency

43. The breastfeeding mother of infant with lactose intolerance asks a nurse about dietary measures. The nurse tells the mother to avoid

a) hard cheeses
b) green leafy vegetables
c) dried beans
d) egg yolk

44. A newborn has a temperature of 35.8 C, pulse rate of 126/min, respiratory rate of 65/min. What action should the nurse take first?

a) dry the newborn and wrap him with blanket
b) put the newborn in a radiant warmer
c) check the newborn's blood sugar level
d) perform phototherapy to the newborn

45. The nurse on a night shift finds a multiparous patient 8 hours postpartum drenched in perspiration. The temperature is 99F, pulse is 66 bpm, and BP is 120/80 mmHg. Which of the following nursing diagnosis would be appropriate?

a) risk for infection related to birth trauma
b) ineffective thermoregulation related to hormonal changes
c) ineffective tissue perfusion
d) excess fluid volume related to normal postpartal diuresis




Intrapartum NCLEX Questions
ANSWERS AND RATIONALE

41) A, B, C, D
- these are appropriate nursing care for a client with PIH. PIH may lead to HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count). Magnesium sulfate is given to the patient to prevent seizures. Calcium gluconate is administered if magnesium toxicity occurs. The client with PIH should be on complete bedrest to prevent further elevation of blood pressure and to prevent seizures.

42) B
- visual disturbances may indicate presence of pregnancy-induced hypertension (PIH). Choices 1, 3, and 4 are normal assessment findings in pregnancy

43) A
- lactose intolerance is characterized by inability to digest and absorb milk and milk products like cheese.

44) A
- drying the newborn and wrapping him with blanket will prevent further heat loss by evaporation.

45) B
- during postpartum period, hormonal changes cause alterations in body temperature. There may be slight dehydration and diuresis.

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Test Prep for Nursing Exam about Obstetric Nursing (36-40)

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36. Several female patients want to have Papanicolaou examination. Who among these patients should the nurse advise not to have the examination? The patient who states

a) the first day of my menstruation came this morning and I am bleeding profusely
b) I am 21 years old, and have not had any sex at all
c) I had the test 3 months ago and it was positive
d) I have herpes simplex virus (HSV) and had sex 2 weeks ago

37. A mother who has just delivered a term baby, wants to delay breastfeeding for 3 days. What is the best interpretation of this mother's behavior?

a) she has knowledge deficit regarding breastfeeding
b) she doesn't want to breastfeed her child
c) she doesn't want to have bonding with her child
d) she doesn't want to accept her responsibility of caring for her child

38. A primigravid client at 8 weeks gestation tells the nurse that since having had sexual relations with a new partner 2 weeks ago, she has noticed flu-like symptoms, enlarged lymph nodes, and clusters of vesicles on her vagina. The nurse refers the client to a physician because the nurse suspects which of the following sexually transmitted diseases.

a) gonorrhea
b) chlamydia trachomatis
c) syphilis
d) herpes genitalis

39. A middle-aged woman has just returned from the recovery room after a right mastectomy. A top priority in planning her care is to minimize the pain she is experiencing.

a) risk for ineffective airway clearance
b) alteration in comfort
c) potential for injury
d) alteration in nutrition

40. A patient who is on her 39 weeks gestation comes to the hospital accopmpanied by her husband. She tells the nurse she thinks she is in labor. Which of the following questions should the nurse ask to help confirm if the patient is in true labor?

a) do your contractions feel like severe menstrual cramps?
b) do you feel pressure in your legs
c) do you feel as if you can breathe easier?
d) does your pain increase in intensity when you are moving around?



ANSWERS AND RATIONALE

36) B
- papanicolaou examination is done in all sexually active women at any age. If the woman is not sexually active, baseline examination is at age 40.

37) A
- the mother needs to know that breastfeeding is best started as soon as possible to stimulate milk production and to promote bonding between the mother and the child.

38) D
- herpes genitalis is characterized by clusters of vesicles in the vaginal area. Trachomatis infection is often asymptomatic in women, but symptoms may include yellowish discharge and dysuria. Some women have no symptoms of gonorrhea. Others may experience vaginal itching and a thick purulent vaginal discharge. Syphilis is characterized by painless chanchroid.

39) B
- comfort is being free from pain. Alteration in comfort indicates presence of pain.

40) D
- in true labor, pain is intensified by walking. In false labor, pain is relieved by walking.

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Test Prep for Nursing Exam about Obstetric Nursing (31-35)

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31. Which of the following findings should the nurse report to the physician when observed in a 6-month old infant?

a) absent moro reflex
b) positive kernig's sign
c) positive babinski's sign
d) absent tonic neck reflex

32. A pregnant client is admitted in the emergency room, with cervix fully dilated. Which of the following is the priority action by the RN to facilitate proper bearing down?

a) put the client in sitting position with shoulders supported
b) put the client in lithotomy position
c) put the client in right side-lying position
d) put the client in semi-sitting position and use elbows for support

33. The client is 3 days postpartum, and she bottle-feeds her newborn. She complains of hardness and swelling of hr breasts. Which of the following is the most essential intervention?

a) apply ice cap over the breasts
b) massage the breasts
c) use breast pump to express the milk
d) apply warm compress over the breasts

34. A woman is in active labor. In what position does the nurse properly place the client?

a) semi-fowler's position
b) side-lying position
c) trendelenburg position
supine position

35. The client has been diagnosed to have placenta previa. Which of the following should be included in the nursing care plan of the client? Select all that apply

a) promote bed rest with bathroom privileges
b) ask for prescription of internal fetal heart rate (FHR) monitoring
c) perform vaginal examination every 8 hours
d) place the client in the left lateral position
e) administer blood transfusion as prescribed
f) administer Rh globulin as prescribed if the mother is Rh negative
g) prepare for premature delivery or cesarean section



ANSWERS AND RATIONALE

31) B
- positive kernig's sign is a manifestation of meningeal irritation. This should be reported to the physician. Moro reflex and tonic neck reflex disappear at 3 to 4 months of age. Babinski's sign disappears at 1-year of age.

32) B
- lithotomy position facilitates bearing down in a woman whose cervix is fully dilated.

33) A
- ice cap is used to relieve swelling of the breasts when the mother will not breastfeed. Cold application inhibits milk production. Massaging the breasts, using breast pump, and applying warm compress stimulate milk production.

34) B
- side-lying position relieves compression of the inferior vena cava.

35) D, E, F, G
- these are appropriate nursing interventions for a client with placenta previa. Placenta previa is low implantation of placenta. The client should be on complete bed rest; invasive procedures like vaginal examination and internal FHR monitoring should be avoided



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Test Prep for Nursing Exam about Obstetric Nursing (26-30)

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26. A baby has been delivered 2 hours ago by a diabetic mother. The baby manifests high-pitched cry. The nurse should assess for which of the following conditions?

a) fetal alcohol syndrome
b) increased intracranial pressure
c) prematurity
d) hypoglycemia

27. Which of the following situations in a newborn necessitates urgent attention by the nurse?

a) irregular respiratory patterns
b) body temperature of 36.5 degree centigrade
c) blood pressure of 65/41 mmHg
d) meconium staining on the infant's body

28. A pregnant woman on 36 weeks gestation experiences sudden gush of fluids from the vagina. Which of the following should be the initial action by the nurse?

a) notify the physician
b) check the fluid pH
c) prepare the client for delivery
d) place the client in knee-to-chest position

29. The client with endometriosis is taking Danazol. Which of the following is the expected effect of the medication?

a) it inhibits ovulation
b) it relieves uterine spasm
c) it reduces menstrual bleeding
d) it prevents pregnancy

30. The nurse is giving health teachings to several pregnant clients. Which of the following statements of the clients should be given highest priority by the nurse?

a) I enjoy working in the garden and keeping my hands dirty. It relaxes me
b) I walk a mile every morning and 3 miles on weekends
c) I watch the recipes on TV shows and cook them
d) I drive myself to work



ANSWERS AND RATIONALE

26) D
- hypoglycemia is common among newborn of diabetic mothers. This is because the fetal pancreas increases insulin secretion in response to high glucose levels passed on by the mother to the fetus. The fetal pancreas hypertrophies. After birth, the glucose from the mother is no longer available, and yet the fetal pancreas continues to secrete high levels of insulin.

27) D
- meconium staining on the infant's body indicates fetal distress. Meconium aspiration may also had occurred. Therefore, this situation necessitates urgent attention by the nurse.

28) B
- check the fluid for pH to ascertain if it is amniotic fluid. Amniotic fluid is alkaline. Yellow Nitrazine turns to blue, if it is amniotic fluid.

29) B
- danazol relieves uterine spasm

30) A
- infection may occur from keeping hands dirty. Cat/dog litters and bird droppings may be found in the soil. Infections like toxoplasmosis, histoplasmosis, etc. are associated with these factors.



Related Topics:

• Test Prep for Nursing Exam about Obstetric Nursing (31-35) 
• Or go back to Test Prep for Nursing Exam about Pediatric Nursing (1-5) to start the practice test from the beginning.

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Test Prep for Nursing Exam about Obstetric Nursing (21-25)

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21. Which of the following indicates that Brethine (Theophylline) is effective in a woman on premature labor?

a) uterine contractions become more frequent
b) uterine contractions stop
c) cervical dilatation progresses
d) rupture of membrane occurs

22. The woman isi n active labor. The presentation of the fetus is left occiput posterior (LOP). Which of the following measures should be included when caring for the client?

a) provide foods and fluids
b) assist the client to ambulate
c) provide back massage
d) allow the client to sleep

23. The postpartum client is bleeding heavily 2 hours after delivery. The fundus of the uterus is firm; uterus at the center of the abdomen. Which of the following actions should the nurse do next?

a) change perineal pads
b) notify the physician
c) massage the uterus
d) check perineum

24. The client is on her second trimester of pregnancy. Her BP is 159/95 mmHg. Which of the following would give clue to make a diagnosis?

a) weight loss
b) increased urine output
c) protein in the urine
d) fundal height at the level of umbilicus

25. Which of the following assessment findings indicates adverse reaction to Morphine Sulfate in a gravida 5 para 5 client?

a) elevated blood pressure
b) increased respiratory rate
c) boggy fundus of the uterus
d) restlessness



ANSWERS AND RATIONALE

21) B
- brethine (theophylline) is a tocolytic agent. It promotes uterine relaxation and prevents premature labor.

22) C
- LOP presentation causes sever back pain to the mother. The head of the fetus causes pressure on nerves in the spinal area. Providing back massage helps relieve the discomfort.

23) D
- postpartal bleeding may be caused by uterine atony, retained placenta, subinvolution, vaginal lacerations, and perineal lacerations.

24) C
- PIH (pregnancy-induced hypertension) is characterized by: hypertension, edema, proteinuria and hyperlipidemia.

25) C
- morphine sulfate causes relaxation of muscles including uterine muscles.


Related Topics:

• Test Prep for Nursing Exam about Obstetric Nursing (26-30) 
• Or go back to Test Prep for Nursing Exam about Pediatric Nursing (1-5) to start the practice test from the beginning.

Read More