Deck 6: Maternal & Newborn Health

Question 1

The nurse is obtaining a client's history during an initial prenatal visit.  The client's last menstrual period was from March 1 to March 5.  Unprotected intercourse occurred on March 15.  Slight vaginal spotting was noted on March 23.  The client's menstrual cycles are regular and 28 days long.  Using the Nägele rule, what is the estimated date of birth?

A)December 8
B)December 12
C)December 22
D)December 30

Answer 1

December 8

Question 2

The nurse is admitting a client at 41 weeks gestation for induction of labor due to oligohydramnios.  Considering the client's indication for induction, what should the nurse anticipate?

A)Additional neonatal personnel present for birth
B)Intermittent fetal monitoring during labor
C)Need for forceps-assisted vaginal birth
D)Need for uterotonic drugs for postpartum hemorrhage

Answer 2

Additional neonatal personnel present for birth

Question 3

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

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

Answer 3

"Are you having any pain in your lower back or flank area?"

Question 4

A client at 39 weeks gestation with preeclampsia has a blood pressure of 170/100 mm Hg, 2+ proteinuria, and moderate peripheral edema.  Immediately after hospital admission, she develops seizures and uterine contractions.  Magnesium sulfate is prescribed.  Which finding indicates that the drug has achieved the desired therapeutic effect?

A)Blood pressure <130/80 mm Hg
B)Seizure activity stops
C)Urine has 1+ protein
D)Uterine contractions stop

Question 5

A pregnant client comes in for a routine first prenatal examination.  According to the last menstrual period, the estimated gestational age is 12 weeks.  Where would the nurse expect to palpate the uterine fundus in this client?

A)12 cm above the umbilicus
B)At the level of the umbilicus
C)Halfway between the symphysis pubis and the umbilicus
D)Just above the symphysis pubis

Question 6

A client comes to the clinic indicating that a home pregnancy test was positive.  The client's last menstrual period was September 7.  Today is December 7.  Which are true statements for this client?  Select all that apply.

A)According to Naegele's rule, the expected date of delivery is June 14
B)Detection of the fetal heart rate via Doppler is possible
C)Fundal height should be 24 cm above the symphysis pubis
D)The client should be feeling fetal movement
E)Urinary frequency is a common symptom

Question 7

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

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

Question 8

The nurse is preparing to assess a client visiting the women's health clinic.  The client's obstetric history is documented as G₅T₁P₂A₁L₂.  Which interpretation of this notation is correct?

A)The client had 1 birth at 37 wk 0 d gestation or beyond
B)The client had 3 births between 20 wk 0 d and 36 wk 6 d gestation
C)The client has 3 currently living children
D)The client is currently not pregnant

Question 9

The nurse is providing nutrition counseling during a preconception visit to a client who does not eat green vegetables.  In addition to a daily prenatal vitamin, which foods can the client add to the daily diet to decrease the risk of neural tube defects?  Select all that apply.

A)Black beans and rice
B)Fortified breakfast cereal and milk
C)Medium baked sweet potato
D)Peanut butter on whole wheat toast
E)Raw carrots with cheese dip

Question 10

Which client in a prenatal clinic should the nurse assess first?

A)Client at 11 weeks gestation with backache and pelvic pressure
B)Client at 16 weeks gestation with earache and sinus congestion
C)Client at 27 weeks gestation with headache and facial edema
D)Client at 37 weeks gestation with white vaginal discharge and urinary frequency

Question 11

The initial prenatal laboratory screening results of a client at 12 weeks gestation indicate a rubella titer status of nonimmune.  What will the nurse anticipate as the plan of care for this client?

A)Administer measles-mumps-rubella (MMR) vaccine now
B)Administer MMR vaccine immediately postpartum
C)Administer MMR vaccine in the third trimester
D)An MMR vaccine is not indicated for this client

Question 12

The nurse is caring for a client in the first trimester during an initial prenatal clinic visit.  Based on the information provided by the client, which factor places the client at an increased risk for preterm labor?

A)Age 25
B)Periodontal disease
C)Vegetarian diet
D)White ethnicity

Question 13

A client indicates the desire to become pregnant.  Which of the following are important preconception education topics for the nurse to provide?  Select all that apply.

A)Aim for BMI of 18.5-24.9 kg/m²
B)Avoid alcohol consumption and tobacco products
C)Ensure daily intake of 400 mcg of folic acid
D)Obtain testing for rubella immunity
E)Schedule dental wellness appointment

Question 14

Which meal should the nurse recommend for a pregnant client at 13 weeks gestation?

A)Baked chicken, turnip greens, peanut butter cookie, and grape juice
B)Baked swordfish, fries, baked apples, and fat-free milk
C)Chilled ham and cheese sandwich, broccoli, orange slices, and water
D)Fried liver and onions, pasteurized cheese squares, fresh fruit cup, and water

Question 15

A client at 38 weeks gestation is brought to the emergency department after a motor vehicle crash.  She reports severe, continuous abdominal pain.  The nurse notes frequent uterine contractions and mild, dark vaginal bleeding.  What actions should the nurse take?  Select all that apply.

A)Anticipate emergent cesarean birth
B)Apply continuous external fetal monitoring
C)Assess routine vital signs every 4 hours
D)Draw blood for type and crossmatch
E)Initiate IV access with a 22-gauge catheter

Question 16

A client at 35 weeks gestation is admitted to the labor and delivery unit for severe pre-eclampsia.  She is started on IV magnesium sulfate for seizure prophylaxis.  Which of the following signs indicate that the client has developed magnesium sulfate toxicity?  Select all that apply.

A)0/4 patellar reflex
B)Blood pressure of 156/84 mm Hg
C)Client voiding 600 mL in 8 hours
D)Respirations of 10/min
E)Serum magnesium level of 8.0 mEq/L (4 mmol/L)

Question 17

The nurse is teaching a client, gravida 1 para 0, at 8 weeks gestation about expected weight gain during pregnancy.  The client's prepregnancy BMI is 21 kg/m².  Which statement by the client indicates an appropriate understanding about weight gain?

A)"I should gain 10-15 lb (4.5-6.8 kg) during the first trimester."
B)"I should gain a total of about 30 lb (13.6 kg) during my pregnancy."
C)"I should gain no more than 0.5 lb (0.2 kg) per week during the third trimester."
D)"If I gain <20 lb (9.1 kg) during pregnancy, it will be easier to lose weight postpartum."

Question 18

A pregnant client at 39 weeks gestation is brought to the emergency department in stable condition following a motor vehicle collision.  The client, who is secured supine on a backboard, suddenly becomes pale with a blood pressure of 88/50 mm Hg.  Which action should the nurse take first?

A)Administer normal saline fluid bolus
B)Ask about any prenatal complications
C)Initiate fetal heart rate monitoring
D)Tilt the backboard to one side

Question 19

A pregnant client at 30 weeks gestation comes to the prenatal clinic.  Which vaccines may be administered safely at this prenatal visit?  Select all that apply.

A)Influenza injection
B)Influenza nasal spray
C)Measles, mumps, and rubella
D)Tetanus, diphtheria, and pertussis
E)Varicella

Question 20

A client with diabetes visits the clinic reporting breast tenderness, vaginal discharge, and urinary frequency.  Which action is most important for the nurse to perform?

A)Ask if the client performs breast self-exams
B)Ask the client about characteristics of vaginal discharge
C)Assess the date of the client's last menstrual period
D)Review the client's home blood sugar logs

Question 21

The nurse is documenting assessments of pregnant clients in the antepartum unit.  Which client's assessment findings are most important to report to the health care provider?

A)Client at 28 weeks gestation with an asymptomatic systolic murmur
B)Client at 34 weeks gestation with 1+ edema of bilateral lower extremities
C)Client at 35 weeks gestation with painful genital lesions
D)Client at 39 weeks gestation with brownish, mucoid vaginal discharge

Question 22

A client suspects she is pregnant and comes for prenatal evaluation.  Which assessment findings indicate definitive evidence (positive signs) of pregnancy?  Select all that apply.

A)Cervical softening on examination
B)Fetal heart tones detected by Doppler device
C)Positive serum human chorionic gonadotropin test
D)Report of fetal movement felt by client
E)Visualization of fetus by ultrasound

Question 23

A pregnant client arrives in the labor and delivery unit with mild contractions and brisk, painless vaginal bleeding.  The client received no prenatal care and reports being "about 7-8 months."  Which actions should the nurse anticipate?  Select all that apply.

A)Blood draw for type and screen
B)Electronic fetal monitoring
C)Initiation of 2 large-bore IV catheters
D)Pad counts to assess bleeding
E)Vaginal examination for cervical dilation

Question 24

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

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

Question 25

The nurse is caring for a client who reports severe abdominal pain and vaginal spotting.  The client had a positive urine pregnancy test at home, and her last menstrual period was 8 weeks ago.  Which client report to the nurse is most concerning?

A)Abdominal pain rated as 8 out of 10
B)History of pelvic inflammatory disease
C)Intermittent nausea and vomiting for the past 7 days
D)Right shoulder pain and dizziness

Question 26

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

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

Question 27

The nurse is providing education to several first-trimester pregnant clients.  Which client requires priority anticipatory teaching?

A)Client who gardens and eats homegrown vegetables
B)Client who has gained 4 lb (1.8 kg) from prepregnancy weight
C)Client who has noticed thin, milky white vaginal discharge
D)Client who practices yoga and swims in a pool 3 times a week

Question 28

The nurse is caring for a client at 21 weeks gestation with reports of occasional, bothersome heartburn (pyrosis).  Which of the following lifestyle changes should the nurse recommend?  Select all that apply.

A)Avoid intake of dairy products
B)Drink large amounts of fluid with meals
C)Eat several small meals each day
D)Eliminate fried, fatty foods
E)Lie down on the left side after meals

Question 29

A client at 34 weeks gestation reports constipation.  The client has been taking 325 mg ferrous sulfate tid for anemia since the last appointment 4 weeks ago.  Which recommendations should the nurse make for this client?  Select all that apply.

A)Decreased daily dairy intake
B)Increased fruit and vegetable intake
C)Moderate-intensity regular exercise
D)One laxative twice daily for a week
E)Two cups of hot coffee each morning

Question 30

The nurse receives report on 4 first-trimester pregnant clients.  Which client should the nurse assess first?

A)Client with hydatidiform mole reporting dark brown vaginal discharge
B)Client with hyperemesis gravidarum reporting excessive vomiting and weight loss
C)Client with suspected ectopic pregnancy reporting abdominal and shoulder pain
D)Client with threatened miscarriage who says, "I am a Jehovah's Witness."

Question 31

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

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

Question 32

A nurse is caring for a pregnant client at 27 weeks gestation after a motor vehicle collision with side airbag deployment.  The client's blood type is O negative.  Which laboratory test should the nurse anticipate?

A)Group B streptococcal culture
B)Indirect Coombs test
C)Rubella immunity titer
D)Serum alpha-fetoprotein

Question 33

A client who is being evaluated for suspected ectopic pregnancy reports sudden-onset, severe, right lower abdominal pain and dizziness.  Which additional assessment findings will the nurse anticipate if the client is experiencing a ruptured ectopic pregnancy?  Select all that apply.

A)Blood pressure 82/64 mm Hg
B)Crackles on auscultation
C)Distended jugular veins
D)Pulse 120/min
E)Shoulder pain

Question 34

A nurse on the antepartum unit is caring for a pregnant client at 30 weeks gestation who was admitted with reports of vaginal bleeding.  A diagnosis of placenta previa was confirmed by ultrasound.  What should the nurse tell the client to anticipate?  Select all that apply.

A)Additional ultrasound around 36 weeks gestation
B)Clearance for sexual activity if bleeding stops
C)Discharge home if bleeding stops and fetal status is reassuring
D)Scheduled cesarean birth before onset of labor
E)Weekly vaginal examinations to assess for cervical change

Question 35

The nurse assesses a client at term gestation who reports having contractions for the last 2 hours.  The client states, "I'm not sure, but I think my water broke."  The nurse performs a nitrazine pH test, which turns blue.  When documenting the results of the test, which client statement is most concerning to the nurse?

A)"I did have sexual intercourse with my partner 1 hour before coming in today."
B)"I have noticed constant wetness in my panties since I thought my water broke."
C)"It is difficult for me to tell if my water broke or if I just peed on myself a little bit."
D)"With my last three pregnancies, my water never broke on its own."

Question 36

The clinic nurse is collecting data on a pregnant client in the first trimester.  Which finding is most concerning and warrants priority intervention?

A)Client has not been taking prenatal vitamins
B)Client is taking lisinopril to control hypertension
C)Client reports a whitish vaginal discharge
D)Client reports mild cramping pain in the lower abdomen

Question 37

A nurse is caring for a client at 12 weeks gestation who is admitted for hyperemesis gravidarum.  Which clinical manifestation should the nurse expect?

A)Abdominal pain and low-grade fever
B)Blood pressure ≥140/90 mm Hg
C)High urine protein level
D)Moderate to high urine ketones

Question 38

A client at 20 weeks gestation states that she started consuming an increased amount of cornstarch about 3 weeks ago.  Based on this assessment, the nurse should anticipate that the health care provider will order which laboratory test(s)?

A)Hemoglobin and hematocrit levels
B)Human chorionic gonadotropin level
C)Serum folate level
D)White blood cell count

Question 39

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

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

Question 40

When triaging 4 pregnant clients in the obstetric clinic, the nurse should alert the health care provider to see which client first?

A)First-trimester client reporting frequent nausea and vomiting
B)Second-trimester client with dysuria and urinary frequency
C)Second-trimester client with obesity reporting decrease in fetal movement
D)Third-trimester client with right upper quadrant pain and nausea

Question 41

The nurse is planning education for clients in group prenatal care who are entering the second trimester of pregnancy.  Which of the following are appropriate for the nurse to include in second-trimester teaching?  Select all that apply.

A)Anticipate light fetal movements around 16-20 weeks gestation
B)Expect to have an abdominal ultrasound for fetal anatomy evaluation
C)Gain about 1 lb (0.5 kg) per week if pre-pregnancy BMI was normal
D)Increase consumption of iron-rich foods like meat and dried fruit
E)Plan for gestational diabetes screening near the end of the second trimester

Question 42

The nurse is reinforcing education to a group of clients that are pregnant or planning pregnancy.  Which of the following client statements about alcohol use in pregnancy should concern the nurse?  Select all that apply.

A)"As long as I don't binge drink, an occasional glass of wine is fine."
B)"I drank alcohol heavily before realizing I was pregnant, so there is no benefit to quitting now."
C)"If I drink alcohol, my baby may have withdrawal after birth but no permanent damage."
D)"It is important to stop drinking while I am trying to conceive."
E)"Third-trimester alcohol use is less harmful because the baby is fully developed."

Question 43

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

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

Question 44

The graduate nurse (GN) is caring for a client at 20 weeks gestation with secondary syphilis.  The client reports an allergic reaction to penicillin as a child but does not know what kind of reaction occurred.  When discussing the client's potential treatment plan with the precepting nurse, which statement by the GN indicates an appropriate understanding?

A)"Doxycycline is an acceptable alternative to penicillin for treatment of syphilis during pregnancy."
B)"The client will require penicillin desensitization to receive appropriate treatment."
C)"The newborn can be treated after birth if antepartum treatment is contraindicated."
D)"Treatment is only effective if provided during the primary stage of syphilis."

Question 45

The nurse is reinforcing instructions to a client at 34 weeks gestation who is preparing to travel by airplane.  Which of the following instructions are appropriate?  Select all that apply.

A)Avoid getting up during the flight unless you need the restroom
B)Carry a copy of your most up-to-date prenatal record
C)Increase fluid intake before and during the flight
D)Secure the lap belt below the abdomen and across your hips when seated
E)Wear compression hose and loose-fitting clothing

Question 46

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

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

Question 47

The nurse is counseling a pregnant client who is HIV positive.  Which information is appropriate to discuss?

A)Infant should be exclusively breastfed for 6 months to receive maternal antibodies
B)Infant will not require treatment for HIV after birth
C)Prescribed antiretroviral therapy should be continued during pregnancy
D)Tetanus-diphtheria-pertussis vaccine should be avoided until after birth

Question 48

The nurse provides discharge instructions to a client at 14 weeks gestation who has received a prophylactic cervical cerclage.  Which client statement indicates an understanding of teaching?

A)"I need to be on bed rest for the duration of my pregnancy."
B)"I will notify my health care provider if I start having low back aches."
C)"Pelvic pressure is to be expected after cerclage placement."
D)"The cerclage will be removed once my baby is at 28 weeks."

Question 49

The nurse is performing assessments of several clients during routine prenatal visits.  Which client should the nurse discuss with the health care provider first?

A)Client at 30 weeks gestation with darkened patches of skin on the face
B)Client at 32 weeks gestation with painless, flesh-colored bumps on the perianal area
C)Client at 34 weeks gestation with intense itching on the hands and feet that worsens at night but no rash
D)Client at 38 weeks gestation with stretch marks on the abdomen that have become reddened and pruritic

Question 50

The nurse is assessing a client at 36 weeks gestation during a routine prenatal visit.  Which statement by the client should the nurse investigate first?

A)"I am not sleeping as well due to cramps in my calves at night."
B)"I have noticed less kicking movements as the baby grows bigger."
C)"Over the last few weeks, I have not been able to wear any of my shoes."
D)"Sometimes I feel short of breath after walking up a flight of stairs."

Question 51

The nurse is providing teaching to a prenatal client about the 1-hour glucose challenge test that will be performed at the next visit.  Which client statement indicates a need for further teaching?

A)"Fasting is required before the 1-hour glucose challenge test."
B)"One blood sample is obtained at the end of the test."
C)"The test includes drinking a 50-g glucose solution."
D)"The test's purpose is to screen for gestational diabetes, not diagnose it."

Question 52

Four clients in labor are requesting pain relief.  The nurse understands that which client can safely receive a dose of IV butorphanol tartrate, an opioid agonist-antagonist, at this time?

A)Multipara at 6 cm dilation with recent heroin use
B)Multipara at 9 cm dilation with an urge to push
C)Nullipara at 3 cm dilation desiring to ambulate
D)Nullipara at 7 cm dilation moaning with contractions

Question 53

A pregnant client in the first trimester tells the clinic nurse she will be traveling to an area with a known Zika virus outbreak and expresses concern regarding disease transmission.  Which statement by the nurse is most appropriate?

A)"If you experience Zika symptoms, notify your health care provider."
B)"Take precautions against mosquito bites throughout the trip."
C)"You are not far enough along for the Zika virus to affect your baby."
D)"You should consider postponing your trip until after you have the baby."

Question 54

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

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

Question 55

A client who is 8 weeks pregnant reports morning sickness.  What is the most appropriate response by the nurse?

A)Advise the client to consume hot, versus cold, foods
B)Instruct the client to drink 2 glasses of water with each meal
C)Suggest the client consume high-protein snacks on awakening
D)Tell the client that morning sickness should pass in a few weeks

Question 56

The graduate nurse (GN) is assisting the nurse preceptor to provide education to a client diagnosed with a molar pregnancy.  Which statement by the GN requires the precepting nurse to intervene?

A)"A uterine evacuation procedure is the typical treatment for removing the abnormal tissue."
B)"We can provide you with resources for coping with perinatal loss if needed."
C)"You may start trying to conceive again as soon as you and your partner feel ready."
D)"You will need Rh immune globulin following a molar pregnancy because you have a Rh-negative blood type."

Question 57

The graduate nurse (GN) and supervising nurse are preparing to follow-up with a client who had a spontaneous abortion at 6 weeks gestation at home.  Which of the following statements by the GN are appropriate?  Select all that apply.

A)"Although the client is Rh negative, it is unnecessary to administer Rh immune globulin due to the client's early gestational age."
B)"I will reinforce teaching with the client about abstaining from sexual intercourse for two weeks."
C)"The client should call the health care provider for foul-smelling vaginal discharge, heavy vaginal bleeding, or severe pain."
D)"The client should continue prenatal vitamins with iron and take ibuprofen as needed for pain."
E)"To maintain perineal hygiene, the client should soak nightly in a bathtub and use mild soap."

Question 58

A client gives birth within an hour of arriving at the labor and delivery unit and delivers the placenta 5 minutes later.  During assessment, the nurse notes that the uterus is midline and boggy.  Which action should the nurse take first?

A)Check for pooled blood under buttocks
B)Increase IV oxytocin infusion rate
C)Monitor blood pressure and pulse
D)Perform firm fundal massage

Question 59

A pregnant client comes to the labor and delivery unit stating, "My water just broke at home."  On assessment of the client's perineal area, the nurse visualizes a loop of umbilical cord protruding from the vagina.  Which nursing intervention would be appropriate?

A)Apply suprapubic pressure
B)Assist the client to the knee-chest position
C)Perform Leopold maneuvers
D)Perform the McRoberts maneuver

Question 60

A 14-year-old client confides to the school nurse that she is pregnant, likely in the second trimester, and has not had prenatal care.  Which of the following topics should the nurse discuss with the client at this time?  Select all that apply.

A)Desire for adoption planning services
B)Emotional response to the pregnancy
C)Family/social support systems
D)Nutritional habits and substance abuse
E)Plan for finishing high school

Question 61

The precepting nurse is supervising a new obstetric nurse performing a labor admission assessment on a client with suspected spontaneous rupture of membranes.  Which action by the new nurse would cause the precepting nurse to intervene?

A)Documenting a positive nitrazine test result when the test strip turns blue
B)Donning nonsterile gloves and using soluble gel for vaginal examination
C)Palpating the client's abdomen before applying external fetal monitors
D)Providing the client with a variety of clear liquids to drink

Question 62

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

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

Question 63

A laboring client at 35 weeks gestation comes to the labor and delivery unit with preterm rupture of membranes "about 18 hours ago."  The client's group B Streptococcus status is unknown.  What intervention is a priority for this client?

A)Administration of prophylactic antibiotics
B)Assessment of uterine contraction frequency
C)Collection of a clean-catch urine specimen
D)Vaginal examination to assess cervical dilation

Question 64

The labor and delivery nurse is receiving report for a pregnant client who is having a scheduled cesarean birth for placenta accreta.  Which information is priority for the nurse to ascertain?

A)The client has a history of three previous cesarean births
B)The client has a signed consent form for a cesarean hysterectomy
C)The client has removed all metal jewelry and contact lenses
D)The client has two 18-gauge IVs and a blood type and crossmatch

Question 65

The labor and delivery nurse is performing a vaginal examination to assess for cervical dilation and effacement.  While palpating the presenting fetal part, the nurse feels a diamond-shaped structure that feels soft in the middle.  What is the nurse's best action?

A)Document fetal presentation as breech
B)Document fetal presentation as cephalic
C)Elevate the fetal presenting part away from the prolapsed cord
D)Request that the health care provider confirm fetal presentation

Question 66

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

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

Question 67

A nurse is preparing to administer an oxytocin IV infusion to a client for labor induction.  The nurse recognizes that an oxytocin infusion may increase the client's risk for which of the following?  Select all that apply.

A)Abnormal or indeterminate fetal heart rate patterns
B)Delayed breast milk production
C)Placenta previa
D)Postpartum hemorrhage
E)Uterine tachysystole

Question 68

A client in labor with a history of a previous cesarean birth has chosen to attempt a vaginal birth.  During labor, which finding would be most concerning to the nurse?

A)Cessation of contractions and maternal tachycardia
B)Fetal tachycardia with moderate variability
C)Increased anxiety and discomfort with contractions
D)Painful, strong contractions every 3-4 minutes

Question 69

A client at 41 weeks gestation is admitted to the labor and delivery unit for labor induction.  The nurse is assisting the health care provider with an amniotomy.  What actions should the nurse anticipate?  Select all that apply.

A)Assessing the fetal heart rate before and after the procedure
B)Checking the client's temperature every 2 hours
C)Informing the client she will feel a sharp pain during the procedure
D)Keeping the client in a supine position after the procedure
E)Noting the characteristics of the amniotic fluid

Question 70

A nulliparous client asks about being in "real" labor.  The nurse should teach that which signs are most indicative of true labor?  Select all that apply.

A)Contractions that increase in frequency
B)Contractions that lessen after resting
C)Increased blood-tinged, mucoid vaginal discharge
D)Pain in lower back that moves to lower abdomen
E)Progressive cervical effacement and dilation

Question 71

A nurse is caring for a client following a forceps-assisted vaginal birth.  The client reports severe vaginal pain and fullness.  On assessment, the nurse notices a firm, midline uterine fundus.  Lochia rubra is light.  Which diagnosis should the nurse anticipate?

A)Cervical lacerations
B)Inversion of the uterus
C)Uterine atony
D)Vaginal hematoma

Question 72

The nurse is monitoring a client who is in active labor with a cervical dilation of 6 cm.  Which uterine assessment finding requires an intervention by the nurse?

A)Contraction duration of 95 seconds
B)Contraction frequency of every 3 minutes
C)Contraction intensity of 45 mm Hg
D)Uterine resting tone of 10 mm Hg

Question 73

A primigravid client in early labor is admitted and reports intense back pain with contractions.  The fetal position is determined to be right occiput posterior.  Which action by the nurse would be most helpful for alleviating the client's back pain during early labor?

A)Applying counterpressure to the client's sacrum during contractions
B)Encouraging the client to remain in bed during early labor
C)Positioning the client on the left side with pillows for support
D)Requesting that the nurse anesthetist administer epidural anesthesia

Question 74

A pregnant client is brought to the emergency department by ambulance after her water broke.  She is screaming and bearing down with every contraction.  Which of the following assessment questions are essential to ask in preparation for the birth and possible newborn resuscitation?  Select all that apply.

A)"Did you receive the influenza vaccine during pregnancy?"
B)"Do you take any medications or illicit drugs?"
C)"How many babies are you expecting?"
D)"What color was the fluid when your water broke?"
E)"When is your due date?"

Question 75

The nurse is admitting a pregnant client who is experiencing intense "back labor."  The nurse suspects the fetus is in which position?

A)
B)
C)
D)

Question 76

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

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

Question 77

The charge nurse is observing fetal heart rate (FHR) tracings of 4 clients who have just been admitted to labor and delivery triage.  Which FHR pattern would be most concerning to the nurse?

A)
B)
C)
D)

Question 78

Following the precipitous birth of a term newborn, what is the best action by the nurse while awaiting expulsion of the placenta and arrival of the health care provider?

A)Clean the perineal area
B)Gently pull on the cord
C)Keep the infant warm
D)Massage the fundus

Question 79

A client is admitted to the labor and delivery unit with a diagnosis of severe preeclampsia.  IV magnesium sulfate is prescribed.  Which nursing measures should the nurse include in this client's plan of care?  Select all that apply.

A)Assess deep tendon reflexes hourly
B)Ensure availability of calcium gluconate
C)Ensure bright lighting to prevent falls
D)Have supplemental oxygen at bedside
E)Limit visitors to minimize stimulation

Question 80

The nurse is caring for a client at 39 weeks gestation in active labor who is receiving an oxytocin infusion.  The nurse notes persistent late decelerations on the fetal monitor.  Which of the following actions should the nurse take?  Select all that apply.

A)Administer oxygen via a nonrebreather face mask
B)Change maternal position to the left side
C)Discontinue the oxytocin infusion
D)Notify the health care provider
E)Perform a nitrazine test