Question 1

A client at 30 weeks' gestation comes to the facility due to decreased fetal movements. After taking the client's history, the client is instructed to focus on fetal activity for an hour. After an hour, the client reports fewer than three fetal movements. Which of the following is the next action of the nurse?

Accepted Answer

The next action of the nurse is to perform a non-stress test. If the NST is non-reactive, the client should be referred to a physician for further evaluation. Reinforcing fetal movement counting is indicated if the client fails to count three or more fetal movements in an hour.

Question 2

A 28-year-old client at 29 weeks' gestation comes to clinic due to decreased fetal movements. The nurse midwife instructs the client to focus on the fetal activity for an hour. After the specified time period, the client reports two fetal movements. The nurse midwife orders a non-stress test. The NST records an increase in fetal heart rate by 15 beats per minute, lasting for 15 seconds, after each fetal movement. This finding is recorded thrice in a period of 20 minutes. Based on the NST result, the next action of the nurse is to:

Accepted Answer

The next action of the nurse is to reinforce fetal movement counting. The NST is reactive because more than two accelerations were recorded in a period of 20 minutes. Acceleration is the increase of the fetal heart rate by 15 beats per minute, lasting for 15 seconds, after each fetal movement. A reactive NST indicates fetal well-being. A contraction stress test, an order for serial fetal assessment and referral to a physician are not indicated because the NST is reactive.

Question 3

A client at 30 weeks' gestation is ordered a contraction stress test after a non-stress test gave a non-reactive result. The nurse midwife reviews the result of the contraction stress. Which of the following findings indicates a positive result? What is the meaning of a positive result?

Accepted Answer

If the fetal heart rate significantly decreases toward the end of each contraction and continuously after, and if this observation occurs in about 50% or more of the contractions, a positive contraction stress test is indicated. Option A describes the procedure, rather than the results, of a contraction stress test. Option B describes acceleration, which is observed during the non-stress test. Absence of fetal heart decelerations with fetal contractions (option D) is a normal finding. A positive result indicates a need for further evaluation, whereas a negative result indicates fetal well-being.

Question 4

A client at 15 weeks' gestation may be scheduled for the following tests except:

Accepted Answer

A client at 15 weeks' gestation should not be scheduled for chorionic villi sampling. Chorionic villi sampling is a biopsy of the chorionic villi for chromosomal analysis that is usually done between 10 to 12 weeks of pregnancy. Amniocentesis is performed between 14 and 16 weeks' gestation. Serum alpha-fetoprotein may be scheduled between 11 and 15 weeks' gestation. A Doppler ultrasound may be ordered all throughout the pregnancy.

Question 5

A client at 20 weeks' gestation asks the nurse 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 nurse 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 6

A G1P0 client at 10 weeks' gestation comes to the clinic for her prenatal visit. The client has a BMI of 32. The client asks the nurse how much weight she should gain by the end of her pregnancy. The most appropriate statement by the nurse midwife is:

Accepted Answer

The client may gain no more than 20 pounds during the pregnancy. Based on the assessment, the client is obese, meaning her BMI is equal or greater than 30. Pregnant clients who are obese should gain between 11 and 20 pounds before delivery. The optimal weight gain for women in the normal weight and slightly overweight categories is between 24 and 25 pounds. Women should not be on restrictive food diets during pregnancy. Dieting when pregnant can be dangerous to both mother and child. Some pregnant women with obesity lose weight during the pregnancy because of vomiting and decreased appetite, not because of dieting.

Question 7

A client at 8 weeks' gestation comes to the clinic for her first prenatal visit. The client tells the nurse midwife that a cousin of hers gave birth to a baby girl with Down syndrome a year ago. The client is anxious that her baby may develop the same genetic disorder and is requesting an immediate amniocentesis. Which of the following statements by the nurse midwife is the appropriate?

Accepted Answer

The nurse midwife should inform the client that amniocentesis is usually performed between 15 and 16 weeks' gestation to ensure sufficient amniotic fluid. Chorionic villi sampling may be performed between 10 and 12 weeks' gestation.

Question 8

A nurse midwife reviews the result of a client's syphilis serology test. The client, a G2P1 at 12 weeks' gestation, tested positive. Which of the following is the priority action of the nurse midwife?

Accepted Answer

The priority action of the nurse midwife is to administer a single dose of benzathine penicillin G through the intramuscular route. The nurse midwife should monitor the client for any signs of Jarisch-Herxheimer reaction, a reaction to syphilis treatment occurring during the first 24 hours of the therapy. Penicillin G can effectively treat syphilis if it is given before 16 weeks' gestation. Options B and C are appropriate actions but they are not the nurse midwife's priority action. Syphilis may be transmitted from mother to child starting from 16 weeks' gestation and through vaginal delivery, so cesarean section should be considered if the client is untreated. Untreated syphilis may cause congenital syphilis, which is characterized by failure to thrive, saddle nose and rash on the palms, toes, genitalia, anus, mouth and face.

Question 9

A nurse midwife is assessing a 43-year-old client at 23 weeks' gestation. Which of the following findings alerts the nurse midwife of a possible case of pre-eclampsia?

Accepted Answer

A possible case of pre-eclampsia is considered if the client's most recent blood pressure increases to 130/100 mm Hg from a pre-pregnancy blood pressure of 100/80 mm Hg. If the client's systolic blood pressure increases 30 mm Hg, or if the diastolic pressure increases 15 mm Hg above the pre-pregnancy level, pre-eclampsia is more likely.
A weight gain of one pound per week during the second trimester does not indicate a possible pre-eclampsia. Pre-eclampsia is more likely if the client gains more than two pounds per week during the second trimester. Absence of proteinuria and edema indicate good maternal health.

Question 10

A nurse midwife is managing the care of a client at 28 weeks' gestation. The client is admitted to the facility due to mild pre-eclampsia. The client is on bed rest and has been closely monitored for the past 24 hours. Which of the following findings would not indicate severe pre-eclampsia in this client?

Accepted Answer

A serum creatinine of 1.0 mg/dL, a level within the normal range, does not indicate severe pre-eclampsia. Severe pre-eclampsia is characterized by an increase of the blood pressure to 160 mm Hg systolic and 110 mm Hg diastolic on at least two occasions, 6 hours apart. Indicators of severe pre-eclampsia include: urine output of less than 500 mL in 24 hours, proteinuria +3 or +4 and a serum creatinine level above 1.2 mg/dL indicate severe pre-eclampsia.

Question 11

A client at 30 weeks' gestation is admitted to the unit due to severe pre-eclampsia. The client has a blood pressure of 170/120 mm Hg on admission and has been placed on bed rest. Hydrazaline is administered. After 24 hours, the client's diastolic pressure continues to stay above 110 mm Hg. Which of the following actions by the nurse midwife is the most appropriate?

Accepted Answer

The most appropriate action of the nurse midwife is to confirm lung maturity through amniocentesis. If the client's diastolic pressure stays above the level of 110 mm Hg for more than a day, induced labor should be considered. If the pregnancy is less than 36 weeks along, an amniocentesis should be performed before inducing labor.

Question 12

A client at 32 weeks' gestation has been receiving magnesium sulfate IV. Which finding would prompt the nurse midwife to administer calcium gluconate?

Accepted Answer

The nurse midwife administers calcium gluconate when the client has a serum magnesium level of 7.7 mEq/L. Calcium gluconate is the antidote for magnesium toxicity. A client receiving magnesium sulfate IV should be monitored every hour. A respiratory rate below 12 breaths per minute, a urine output of less than 30 mL/hour, a serum magnesium level greater than 7.5 mEq/L, absent or decreased deep tendon reflex and decreased consciousness indicate magnesium toxicity.

Question 13

A nurse midwife is managing the care of a client who admitted to the unit due to moderate pre-eclampsia. Which of the following interventions is not included in the care plan?

Accepted Answer

Offering foods low in protein and sodium is not included in the care plan. The client should be started on a moderate-to-high protein, moderate-sodium diet to compensate for the protein that is lost in the urine. Moderate pre-eclampsia is characterized by proteinuria of 1 to 2+. The client should be placed in a private room because noise and other stressors may trigger a seizure, causing eclampsia. Hydralazine is an antihypertensive medication and may be administered to reduce hypertension. An indwelling urinary catheter may be inserted to allow accurate recording of urine output.

Question 14

A client at 32 weeks' gestation develops tonic-clonic seizures due to eclampsia. Which of the following nursing actions is least appropriate during the tonic phase?

Accepted Answer

Administering magnesium sulfate IV is the least appropriate nursing action during the tonic phase. An eclamptic seizure is a tonic-clonic type. During the tonic phase, maintaining a patent airway is the priority action of the nurse midwife. Oxygen is administered by face mask to protect the fetus during this phase. The client is turned on her side to drain the secretions and prevent aspiration. The mother's oxygen status and the heart rate of the fetus are closely monitored to ensure adequate perfusion. The nurse midwife may administer magnesium sulfate during the clonic phase.

Question 15

A pregnant client comes to the facility complaining of nausea, epigastric pain and general malaise. Physical assessment reveals right upper quadrant tenderness. The nurse midwife suspects that the client has a HELLP syndrome. A series of laboratory exams are ordered for further evaluation. Which laboratory result would indicate a diagnosis other than HELLP syndrome?

Accepted Answer

A platelet count higher than 100,000 platelets/µL does not support the diagnosis of HELLP syndrome. HELLP syndrome, a variation of pregnancy-induced hypertension, is characterized by hemolysis, elevated liver enzymes and low platelets. Hemolysis is manifested by the RBCs appearing fragmented on a peripheral blood smear. The liver enzymes alanine aminotransferase and aspartate aminotransferase are elevated because of hemorrhage and necrosis of the liver.

Question 16

All of the following statements accurately describe being pregnant with fraternal twins except:

Accepted Answer

Being pregnant with fraternal twins is considered a complication of pregnancy. Multiple gestation is a complication of pregnancy because the mother's body has to adjust to the effects of having or supporting more than one fetus for the next months. The other options accurately describe fraternal twins.

Question 17

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 nurse midwife during assessment. Palpation of the small parts of the fetus and auscultating the fetal heart rate are difficult. The nurse 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 nurse 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 18

A nurse midwife is reviewing the history of a client at 43 weeks' gestation. The client informs the nurse that she was supposed to give birth a few weeks ago, but she has still not gone into labor. Which of the following details of information about the client may have possibly increased her risk for post-term pregnancy?

Accepted Answer

A client receiving a high dose of salicylates increases her risk for post-term pregnancy. Salicylates interfere with the synthesis of prostaglandins, the substances responsible for the initiation of labor. The other risk factors for post-term pregnancy include primiparity, male gender of the fetus, a prior post-term pregnancy and genetics. Inaccurate dating is the common cause of post-term pregnancies. Women who have long menstrual cycles do not ovulate on day 14 of the cycle, so women ovulating on day 25 or 30 may give birth late by as many as 17 days.

Question 19

A client, who is pregnant for the first time, asks the nurse midwife if she and her husband can still engage in sexual intercourse during her pregnancy. She is concerned that having sex may hurt the baby and cause a miscarriage. The client is at 12 weeks' gestation. The most recent physical examination reveals normal findings. The client's history is not remarkable. Which of the following statements made by the nurse midwife is the most appropriate?

Accepted Answer

The nurse midwife may inform the client that she and her husband may engage in sex as far into pregnancy as they wish and that they may need to adjust their positions during sexual intercourse. A position in which partners are side-by-side or the woman is in the superior position may be more comfortable, especially during the third trimester. There is no harm in engaging in sexual intercourse during pregnancy unless the client has a history of spontaneous miscarriage or vaginal spotting, or if she is at risk for premature rupture of membranes. Sexual intercourse should also be avoided in cases of untreated sexually transmitted diseases. The libido is most heightened during the second trimester. Increased sexual desire during pregnancy is due to increased blood flow to the pelvic area, increasing the sensations, and increased vaginal discharges.

Question 20

A nurse midwife teaches a group of pregnant women about good personal hygiene during pregnancy. Which of the following statements made by one of the women indicates that the teaching has been successful?

Accepted Answer

The client may have tub baths on a daily basis, unless she is at risk for premature rupture of membranes or if she has a history of vaginal spotting. Only a minimal amount of tub water can enter the cervix. Douching must be avoided because it can alter the vaginal pH, increasing the risk of bacteria growth and infections. Hot showers do not initiate labor. The client has to see her dentist at least once during the pregnancy.

Quiz 1: Antepartum