Question 1

A client at 11 weeks' gestation complains of severe and extreme nausea and vomiting. During history taking, the midwife learns that the client vomits at least three times a day. An ultrasound is performed and reveals that the client is negative for hydatidiform mole and multiple pregnancy. The midwife suspects a case of hyperemesis gravidarum. The client is admitted for monitoring. Which of the following interventions is the least appropriate for the client?

Accepted Answer

During monitoring for hyperemesis gravidarum, oral fluids are usually withheld for the first 24 hours. If there is no vomiting after the first 24 hours, the client may have small amounts of clear fluids. Intravenous Ringer's lactate is administered, usually with vitamin B1 to increase hydration during monitoring. The midwife may also administer metoclopramide, an anti-emetic. Research has shown that this medication is not linked to congenital anomalies. Fluid intake and urinary output must be monitored to assess the blood volume.

Question 2

A midwife tells a client who is trying to get pregnant to eat fresh fruits and green and leafy vegetables before conceiving. The midwife also recommends 400 mcg of folic acid a day. Once she gets pregnant, the midwife may recommend that the client increase her folic acid intake to 600 mcg per day during the first trimester. Which of the following is not a benefit of folic acid supplementation before and during pregnancy?

Accepted Answer

Iodine, not folic acid, improves thyroid function. The other options are all benefits of folic acid supplementation. As the blood volume doubles during pregnancy, the body's need for folic acid increases. Without supplementation, the mother may develop megaloblastic anemia, which is manifested by the formation of large but ineffective red blood cells. Folic acid is essential for the production, repair and functioning of DNA. Folic acid deficiency may cause neural tube defects and other birth defects like cleft lip, cleft palate and heart defects.

Question 3

A client is in her 18th week of pregnancy. Which of the following psychosocial changes is expected at this time?

Accepted Answer

During the 18th week of pregnancy, the client begins to concentrate on how it will feel to be a parent or how she will feel during the delivery. This is manifested by role-playing. During the first trimester, the major developmental task is to accept the pregnancy. Ambivalence is a common reaction, and it can also occur in women who planned for the pregnancy. During the second trimester, an important developmental task is to accept the baby as a separate entity, and during during the third trimester, the major developmental task is to prepare for the baby. Options C and D are commonly seen in clients during the third trimester.

Question 4

The midwife is creating a teaching plan for a program that encourages women to have their regular Pap smear. Which of the following groups of women is the midwife's priority?

Accepted Answer

Human papillomavirus (HPV) is associated with increased risk of cervical cancer, so it is important to encourage women with a history of HPV, or who were never vaccinated, to have their regular Pap smear. A Pap smear can detect early changes in cells located in the cervix.

Question 5

A pregnant client asks the midwife about nonpharmacologic methods for managing labor pains. The midwife informs her about a method that is based on the idea that childbirth is a natural and joyful process. This method also stresses the importance of having the husband's support during the pregnancy, labor and early postpartum period. It also encourages walking during labor. The midwife is teaching which method to the client?

Accepted Answer

The nurse is teaching the Bradley method. This method includes interventions that promote childbirth as a joyous and natural process. It includes muscle toning exercises, limiting of foods that contain preservatives and abdominal breathing. The Bradley method encourages women to walk during labor and use an internal focus point as a disassociation technique. The Lamaze method utilizes controlled breathing to reduce pain during labor. The Psychosexual method includes conscientious relaxation techniques and progressive breathing to encourage women to flow with the contractions. The Dick-Read method intends to break the chain of events that may lead to tension, as it can cause or worsen the pain.

Question 6

A client at 20 weeks' gestation asks the midwife if she will be able to breastfeed her baby after birth. The client has a history of type 2 diabetes, which has been well-controlled before and during the pregnancy. The client has a BMI of 34. Which of the following statements by the midwife is the most appropriate?

Accepted Answer

The nurse should inform the client that mothers with type 2 diabetes are encouraged to breastfeed their babies after birth and that she may need less insulin while breastfeeding. Within hours after birth, the client's need for insulin may abruptly drop. It is believed that the lowering effect of breastfeeding is caused by the process of milk production. Serum glucose is the main substance used in producing the breast milk and energy is much needed for milk production. The client may have to adjust her caloric levels, physical activity and insulin needs after birth to ensure the well-beings of both the mother and child during breastfeeding. Insulin does not cross into the breast milk.

Question 7

A 21-year-old female client comes to the prenatal clinic after a home pregnancy test indicated a positive result. The client informs the midwife that her last menstrual period was on October 28, 2010. Using Nagele's rule, the client's expected date of birth is on:

Accepted Answer

The client's expected date of birth using Nagele's rule is August 4, 2011. Nagele's rule is the standard method used to predict the length of pregnancy. To calculate the estimated date of delivery (EDD or EDC, for estimated date of confinement), add one year to the date of the last menstrual period (LMP), count back 3 months and add 7 days.

Question 8

A client at 30 weeks' gestation complains of shortness of breath and an unusually rapid enlargement of the uterus. A tense uterus is noted by the midwife during assessment. Palpation of the small parts of the fetus and auscultating the fetal heart rate are difficult. The midwife suspects severe hydramnios. Which of the following interventions are appropriately included in the care plan?
I. Encourage ambulation.
II. Increase intake of foods high in fiber.
III. Perform amniocentesis.
IV. Administer indomethacin.

Accepted Answer

The midwife may increase the client's intake of foods high in fiber, perform amniocentesis and administer indomethacin. Hydramnios may cause fetal malpresentation, premature rupture of the membranes and pre-term labor. The client should increase her fiber intake to prevent constipation because straining to defecate could increase the uterine pressure and cause rupture of the membranes. Amniocentesis may be performed to remove some of the excess amniotic fluid, but this intervention is a temporary measure, as amniotic fluid is replaced rapidly. Indomethacin may reduce the total volume.

Question 9

A contraction stress test is ordered to a client at 35 weeks' gestation. After half an hour, the client's uterus begins to contract and the midwife observes three 40-second-long contractions in a 10-minute window. The client has two contractions within the next five minutes. The midwife notes that the fetal heart rate decreases toward the end of the contraction and afterward. This happends during more than 50% of the contractions. After stopping the oxytocin, which of the following is the next action of the midwife?

Accepted Answer

The next action of the nurse is to turn the client onto her left side after stopping the oxytocin. Turning to the left side alleviates vena cava compression, which improves the flow of oxygenated blood to the fetus. After turning, the midwife administers oxygen. The client will be referred to the physician after the initial interventions. Assessing the client's blood pressure is an appropriate intervention, but it is not the priority action for the midwife.

Question 10

A 20-year-old female client is pregnant for the first time. The client is a marathon runner and has been on a rigorous exercise and training program. The client asks the midwife if she could still exercise while pregnant. Which of the following statements by the midwife is the most appropriate for the client?

Accepted Answer

The client may still exercise as long as the intensity and type of exercises are modified and that non-weight-bearing exercises are incorporated into the exercise program. If a client is used to exercising before pregnancy, she may incorporate non-weight-bearing exercises, such as swimming or water aerobics, into the program. These exercises are non-impact activities and can decrease the risk of injuries. The client may return to her pre-pregnancy exercise program about six weeks after the delivery to give her body sufficient time for recovery.

Question 11

A client has just given vaginal birth to an eight-pound baby boy. A few minutes after the delivery, the midwife observes lengthening of the umbilical cord and a gush of vaginal blood. The midwife interprets these observations as:

Accepted Answer

The midwife interprets these as signs of placental separation. Placenta separation occurs minutes after birth as the uterus resumes contractions. The signs of placental separation include lengthening of the umbilical cord, a gush of vaginal blood and change in the shape of the uterus.

Question 12

A client with a multiple pregnancy is scheduled for cesarean delivery and is transported to the delivery operating room. The midwife reminds the staff nurse to position the client in which of the following positions in the operating room?

Accepted Answer

The midwife reminds the staff nurse to position the client in supine position, with a wedge placed under the right hip, in the operating room. The enlarging uterus compresses the vena cava and the descending aorta of the client, which impedes blood flow to the lower extremities and uterus. The side-lying position is the most ideal position during pregnancy, as it displaces the uterus off the compressed structures. In an abdominal surgery, the client should be positioned in supine position. To displace the uterus and to prevent decreased blood flow to the uterus, a wedge should be placed under the right hip.

Question 13

A midwife is reviewing the laboratory tests of a client who is in labor. The laboratory findings include a hemoglobin level of 10 g/dL and a hematocrit concentration of 34%. The midwife is correct if she determines that the client is at risk for which of the following during the postpartum period?

Accepted Answer

The client is at risk for postpartum infection. Research reveals that clients in labor who have anemia, which is demonstrated by low hemoglobin and hematocrit levels, have increased risk for postpartum infection, cardiac decompensation and poor wound healing. Decreased hemoglobin or hematocrit does not increase a client's risk of hemorrhage.

Question 14

Which of the following clients in labor is most likely considered for artificial induction of labor?

Accepted Answer

A client who gave birth to an Rh-positive baby and failed to get a RhoGAM after birth is most likely considered for induction of labor. The indications for induction of labor include: Rh-sensitization, pregnancies at more than 42 weeks' gestation, prolonged rupture of membrane (longer than 24 hours), eclampsia, pre-eclampsia, intrauterine growth retardation and severe hypertension.

Question 15

A client in labor is administered with an anesthetic through the spinal subarachnoid space. Which of the following actions by the nurse is the least appropriate when managing the client?

Accepted Answer

The midwife should monitor the client for hypotension, not hypertension Subarachnoid or spinal block relieves uterine and perineal pain and numbs the lower extremities, vagina and perineum. The anesthetic may cause headaches. The client should be flat on the bed for 8 to 12 hours. Administration of IV fluids is also appropriate.

Question 16

A midwife is teaching a 14-year-old girl about contraceptives. The client gave birth to a healthy baby girl three days ago. The midwife is correct when she says that the most effective way to protect against conception is through:

Accepted Answer

Abstinence is the most effective way to protect against conception. Natural family planning has a failure rate of about 20%. Oral contraception has a failure rate of about 3%. If used correctly, oral contraceptives are 99.5% effective. Surgical methods have a failure rate between 0.1 and 0.4%.

Question 17

A midwife is assessing four female clients with signs and symptoms involving the reproductive system. All clients are engaging in heterosexual sexual relationships. The midwife requires identification and treatment of sexual partners of all of the following clients except:

Accepted Answer

A client diagnosed with bacterial vaginosis is not required to identify her sexual partners for treatment. Engaging in unprotected sex increases the risk for bacterial vaginosis for women only, and it is believed that bacterial vaginosis can be transmitted between women. Therefore, only women who engage in sexual relationships with other women need to identify their sexual partners for treatment of bacterial vaginosis.

Question 18

A midwife is assessing the fertility of couples who have been trying to conceive for a period of time without success. Which of the following couples has primary infertility?

Accepted Answer

Infertility is engaging in unprotected sex for one year without an occurring pregnancy. If the couple has no previous conceptions, it is called primary infertility. If the couple reported a previous conception, it is called secondary infertility.

Question 19

Which of the following female clients has the greatest risk for uterine fibroids?

Accepted Answer

The 25-year-old Black American who has a BMI of 32 and denies cigarette smoking has the greatest risk for uterine fibroids. The risk factors for uterine fibroids include: obesity, pregnancy, race (Black women are more likely to have fibroids) and heredity. Research has revealed that smoking is associated with low occurrence of uterine fibroids. This is most likely due to the lowering effect of smoking on the bioavailability of estrogen.

Question 20

A couple is considering artificial insemination after the man fails to respond to medications that intend to increase his sperm count. Which of the following statements about artificial insemination is false?

Accepted Answer

Artificial insemination does not involve selective termination of gestational sacs. Selective termination is performed in in vitro fertilization. Artificial insemination may be considered if the man has inadequate sperm count or if the woman has a condition that interferes with sperm motility.

Quiz 8: Midwifery