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1. A nurse is counseling a woman who was just diagnosed with a multiple gestation. Why does the nurse consider this pregnancy as high risk?

• Postpartum hemorrhage is an expected complication.
• Perinatal mortality is 2 to 3 times greater in multiple than in single births.
• Maternal mortality is higher during the prenatal period with a multiple gestation.
• Optimum adjustment following a multiple birth requires 6 months to 1 year of time.

2. A client tells a nurse in the prenatal clinic that she has vaginal staining but no pain. Her history reveals amenorrhea for the last 2 months and pregnancy confirmation after her first missed period. She is admitted to the high-risk unit because she may be having a spontaneous abortion. What type of abortion is suspected?

• Missed
• Inevitable
• Threatened
• Incomplete

3. Despite medication, a client’s preterm labor continues, her cervix dilates, and birth appears to be inevitable. Which medication does the nurse anticipate will be prescribed to increase the chance of the newborn’s survival?

• Ritodrine (Yutopar)
• Misoprostil (Cytotec)
• Terbutaline (Brethine)
• Betamethasone (Celestone)

4. A client at 9 weeks’ gestation asks the nurse in the prenatal clinic if she can have her chorionic villi sampling (CVS) done at this visit. At what week gestation should the nurse respond is the best time for this test?

• 8 weeks and less than 10 weeks
• 10 weeks and less than 12 weeks
• 12 weeks and less than 14 weeks
• 14 weeks and less than 16 weeks

5. A client tells a nurse that she does not want an episiotomy and would rather tear naturally. What information should be offered regarding each birthing method?

• Lacerations are more painful than an episiotomy.
• Lacerations are easier to repair than an episiotomy.
• An episiotomy causes less posterior trauma than lacerations.
• An episiotomy is preferred over lacerations according to evidence-based practice.

6. A nurse is caring for a postpartum client who is formula feeding. What should the nurse teach her about minimizing breast discomfort?

• Apply covered ice packs to her breasts.
• Gently apply cocoa butter to her nipples.
• Place warm, wet washcloths on her nipples.
• Manually express colostrum from her breasts.

7. A nurse is caring for a client who is having a prolonged labor. The client is annoyed and very concerned because her labor is deviating from what she perceives as normal. After the nurse has acknowledged the clients feelings, what is the next best intervention?

• “I’ll leave so you can talk to your partner.”
• “I’ll rub your back, and you tell me if it helps.”
• “Let’s talk some more about what’s really bothering you.”
• “Women usually become weary and frustrated during labor.”

8. A client asks the nurse at the prenatal clinic whether she can continue to have sexual relations while pregnant. What is an indication that the client should refrain from intercourse during pregnancy?

• Fetal tachycardia
• Presence of leukorrhea
• Premature rupture of membranes
• Being close to expected date of birth

9. A 16-year-old adolescent visits the prenatal clinic because she has missed three menstrual periods. Before her physical examination she says, “I don’t know what the problem is, but I can’t be pregnant.” What is the nurse’s most therapeu tic response?

• “Many young women are irregular at your age.”
• “You probably are pregnant if you had intercourse.”
• “Why did you decide to come to the prenatal clinic?”
• “Should I ask the health care provider to talk to you?”

10. Sitz baths are ordered for a client with an episiotomy during the postpartum period. A nurse encourages her to take the sitz baths because they aid the healing process by:

• promoting vasodilation.
• cleansing perineal tissue.
• softening the incision site.
• tightening the rectal sphincter.

11. A few hours after being admitted to the hospital with a diagnosis of inevitable abortion, a client, at 16 weeks’ gestation, begins to experience bearing-down sensations and suddenly expels the products of conception in bed. What should the nurse do first?

• Notify the health care provider.
• Administer the prescribed sedative.
• Take the client to the operating room.
• Check the client’s fundus for firmness.

12. A client is receiving magnesium sulfate therapy for severe preeclampsia. What initial sign of toxicity should alert the nurse to intervene?

• Hyperactive sensorium
• Increase in respiratory rate
• Lack of the knee-jerk reflex
• Development of a cardiac dysrhythmia

13. Why does a nurse encourage continued health care supervision for a pregnant woman with pyelonephritis?

• Preeclampsia frequently occurs after pyelonephritis.
• Antibiotic therapy should be administered until the urine is sterile.
• Pelvic inflammatory disease can occur with untreated pyelonephritis.
• Nutritional needs change to accommodate the prescribed low-protein diet.

14. A nurse is monitoring a client with severe preeclampsia who is receiving an infusion of magnesium sulfate. Assessment reveals a pulse rate of 5 5/minute, respirations of 12/minute, and a flushed face. What is the next nursing action?

• Continue the infusion and notify the health care provider.
• Stop the infusion and start an infusion of dextrose and water.
• Continue the infusion and document the findings on the clinical record.
• Decrease the rate of the infusion and obtain blood for a magnesium level.

15. Which sign or symptom leads a nurse to suspect that a client has a tubal pregnancy?

• A painful mass centered in the abdomen
• Lower abdominal cramping for one week
• A sharp lower right or left abdominal pain radiating to the shoulder
• Leukorrhea or dysuria a few days after the first missed menstrual period

16. A primigravida is concerned about the health of her baby and asks the nurse, “What is the most common cause of death of babies?” The nurse explains that the cause of more than half of the neonatal deaths in the United States is due to:

• atelectasis
• preterm births
• congenital heart disease
• respiratory distress syndrome

17. A laboring client reports low back pain. What should a nurse recommend to the client’s coach that will promote comfort?

• Instruct her to flex her knees.
• Place her in the supine position.
• Apply pressure to her back during contractions.
• Perform neuromuscular control exercises with her.

18. What assessment finding of a pregnant client should alert the nurse to notify the health care provider?

• Dependent edema at 38 weeks’ gestation
• Fundal height at the umbilicus at 16 weeks’ gestation
• Fetal heart rate of 150 beats/min at 24 weeks’ gestation
• Maternal heart rate of 92 beats/min at 28 weeks’ gestation

19. A nurse is assessing a client with a tentative diagnosis of hydatidiform mole. Which clinical finding should the nurse anticipate?

• Hypotension
• Decreased fetal heart rate
• Unusual uterine enlargement
• Painless, heavy vaginal bleeding

20. A client at 37 weeks’ gestation arrives at the emergency department stating that she has abdominal pain but no vaginal bleeding. The health care provider diagnoses abruptio placentae. The client asks the nurse why it is so painful. What should the nurse consider is the initial cause of the abdominal pain before responding in language the client will understand?

• Hemorrhagic shock
• Concealed hemorrhage
• Blood in the myometrium
• Disseminated intravascular coagulation

21. A nurse is caring for a client who had a spontaneous abor tion. The client asks why spontaneous abortions occur. The nurse responds that they are most commonly caused by:

• physical trauma.
• unresolved stress.
• congenital defects.
• embryonic defects.

22. What is the initial responsibility of a nurse when teaching the pregnant adolescent?

• Instructing her about the care of an infant
• Informing her of the benefits of breastfeeding
• Advising her to watch for danger signs of preeclampsia
• Encouraging her to continue regularly scheduled prenatal care

23. A client at 26 weeks’ gestation is admitted to the high-risk unit with an influenza infection. She is in labor. Which of these instructions should a nurse question?

• Betamethasone 12 mg IV every 12 hours
• I&O and IV Ringer lactate 500 mL/24 hours
• Vital signs and fetal heart rate every 30 minutes
• Loading dose 4 g IV magnesium sulfate, continue per protocol

24. An infant is born precipitously in the emergency depart ment. What should the nurse do first?

• Tie and cut the umbilical cord.
• Establish an airway for the newborn.
• Ascertain the condition of the uterine fundus
• Arrange transport for mother and infant to the birthing unit.

25. Sonography of a primigravida who is at 15 weeks’ gestation reveals a twin pregnancy. The nurse reviews with the client the risks of a multiple pregnancy that were explained by the health care provider. Which condition does the client identify that indicates the need for further instruction about complications associated with a multiple gestation?

• Preterm birth
• Down syndrome
• Twin to twin transfusion
• Gestational hypertension

26. A nurse is caring for a client who had a spontaneous abor tion. For what complication should the nurse assess this client?

• Hemorrhage
• Dehydration
• Hypertension
• Subinvolution

27. Two days after having had a cesarean birth, a client tells a nurse that she has pain in her right leg, and after an assessment the nurse suspects that the client may have a thrombus. What is the nurse’s initial response?

• Maintain bed rest.
• Apply warm soaks.
• Encourage leg exercises.
• Massage the affected area.

28. A client arrives at the clinic in preterm labor and terbutaline (Brethine) is prescribed. For what therapeutic effect should the nurse monitor the client?

• Increased blood pressure and pulse
• Reduction of pain in the perineal area
• Gradual cervical dilation as labor progresses
• Decreased frequency and duration of contractions

29. A teenager at 32 weeks’ gestation is hospitalized with preeclampsia. She is anorexic and appears depressed. Which comment indicates to the nurse that further exploration of the client’s emotional status is indicated?

• “I’m tired of feeling so clumsy.”
• “I’ll be glad when I can sleep all night.”
• “I dreamed my baby had only one arm.”
• “I was really happy before I got pregnant.”

30. A pregnant client with severe abdominal pain and heavy bleeding is prepared for a cesarean birth. What is the prior ity nursing intervention?

• Teaching coughing and deep-breathing techniques
• Sterilizing the surgical site and administering an enema
• Providing a sterile gown and inserting an indwelling catheter
• Obtaining an informed consent and assessing for drug allergies

31. A client visiting the prenatal clinic for the first time asks a nurse about the probability of having twins because her husband is one of a pair of fraternal twins. What is the appropriate response by the nurse?

• “A sonogram will confirm if there is a twin pregnancy.”
• “There is a twenty-five percent probability of having twins.”
• “The husband’s history of being a twin increases the chance of having twins.”
• “There is no greater probability of having twins than in the general population.”

32. A nurse teaches a multipara who has just given birth to a large baby how she can maintain a contracted uterus. Which statement indicates to the nurse that the teaching was effective?

• “If I start to bleed, I will call for help.”
• “I will massage my uterus regularly to keep it firm.”
• “If I urinate frequently, my uterus will stay contracted.”
• “I will call you every 15 minutes to massage my uterus.”

33. What should a nurse include in the discharge teaching of a postpartum client?

• The prenatal perineal tightening exercises should be continued.
• The episiotomy sutures will be removed at the first postpartum visit.
• She may not have a bowel movement for up to a week after the birth.
• She should schedule a postpartum checkup as soon as her menses return.

34. After an incomplete abortion, a client tells a nurse that although her health care provider explained what an incomplete abortion was, she did not understand. What is the nurse’s best response?

• “I don’t think you should focus on this anymore.”
• “This is when the fetus dies but is retained in the uterus for at least two months.”
• “I think it is best if you asked your health care provider for the answer to that question.”
• “This is when the fetus is expelled but other parts of the pregnancy remain in the uterus.”

35. A nurse is obtaining the health history from a client with a diagnosis of a ruptured tubal pregnancy. At what point in the pregnancy does the nurse expect the client to state when the low abdominal pain and vaginal bleeding started?

• At the end of the first trimester
• About the sixth week of pregnancy
• Midway through the second trimester
• When the first menstrual period was missed

36. A client arrives at the hospital in the second stage of labor. The head of the fetus is crowning, the client is bearing down, and birth appears imminent. What should the nurse tell the client to do?

• Pant while pushing gently.
• Breathe with her mouth closed.
• Hold her breath while bearing down.
• Pant while resisting the urge to bear down.

37. An expectant couple asks the nurse about the cause of low back pain in labor. The nurse replies that this pain occurs most often when the position of the fetus is:

• breech.
• transverse.
• occiput anterior.
• occiput posterior.

38. A client who had a postpartum hemorrhage is to receive 1 unit of packed red blood cells (RBCs). The nurse manager observes a staff nurse administering the packed RBCs with out wearing gloves. What does the nurse manager conclude?

• Client does not have an infection.
• Donor blood is free of bloodborne pathogens.
• Nurse should have worn gloves for self-protection.
• Nurse was skilled enough to prevent exposure to the blood.

39. A client on the postpartum unit asks the nurse why the nurses are always encouraging her to walk. What should the nurse consider when forming a response in language the client will understand?

• Respirations are enhanced.
• Bladder tonicity is increased.
• Abdominal muscles are strengthened.
• Peripheral vasomotor activity is promoted.

40. A client is admitted to the birthing unit in active labor. Cervical dilation has progressed from 2 to 3 cm during an 8-hour period. The health care provider determines that she has hypotonic dystocia, and an infusion of oxytocin (Pitocin) is prescribed to augment her contractions. What is the most important nursing action at this time?

• Checking the perineum for bulging
• Documenting the fetal heart rate and its variations
• Preparing the client for an emergency cesarean birth
• Monitoring the duration and intensity of the contractions

41. A client is scheduled for a sonogram at 36 weeks’ gestation. Shortly before the test she tells the nurse that she has severe abdominal pain. Assessment reveals heavy vaginal bleeding, a drop in blood pressure, and an increased pulse rate. What complication does the nurse suspect?

• Hydatidiform mole
• Vena caval syndrome
• Marginal placenta previa
• Complete abruptio placentae

42. A client admitted with preeclampsia is receiving magnesium sulfate. Which assessment indicates that a therapeutic level of the medication has been reached?

• Respiratory rate of 12
• Increased fetal activity
• Decreased urine output
• Deep tendon reflexes of +2

43. When caring for a woman who had a positive contraction stress test (CST), what complication does the nurse suspect?

• Preeclampsia
• Placenta previa
• Imminent preterm birth
• Uteroplacental insufficiency

44. A nurse examines a client who had a cesarean birth. It is 3 days since the birth and the client is about to be discharged. Where does the nurse expect the fundus to be located?

• 1 fingerbreadth below the umbilicus
• 2 fingerbreadths below the umbilicus
• 3 fingerbreadths below the umbilicus
• 4 fingerbreadths below the umbilicus

45. A client at 38 weeks’ gestation is admitted for induction of labor. Her membranes ruptured 12 hours ago. There are no other signs of labor. Which medication does the nurse anticipate will be prescribed?

• Oxytocin (Pitocin)
• Estrogen (Premarin)
• Ergonovine (Ergotrate)
• Progesterone (Prometrium)

46. A client at 28 weeks’ gestation has a sonogram. The results reveal a small for gestational age (SGA) fetus and a low-lying placenta. For what complication should the nurse assess this client during the last trimester of pregnancy?

• Preterm labor
• Placenta previa
• Premature separation of the placenta
• Premature rupture of the membranes

47. A client who is at 26 weeks’ gestation tells a nurse at the prenatal clinic that she has pain when urinating, back ten­derness, and pink-tinged urine. A diagnosis of pyelonephri­tis is made. What is the most important nursing intervention at this time?

• Limiting fluid intake
• Examining her urine for protein
• Observing for signs of preterm labor
• Maintaining her on a moderate sodium diet

48. What position should a nurse teach a client to avoid when the client is experiencing back pain during labor?

• Sims
• Sitting
• Supine
• Side-lying

49. A nurse in the birthing unit is caring for several clients. Which factor should the nurse anticipate will increase the risk for hypotonic uterine dystocia?

• Twin gestation
• Gestational anemia
• Hypertonic contractions
• Gestational hypertension

50. A client at 37 weeks’ gestation is admitted to the birthing unit from the emergency department. She had arrived by ambulance following a motor vehicle accident. Her vital signs are BP: 90/60; P: 108; R: 24. She is reporting sharp abdominal pain. What is the priority nursing intervention at this time?

• Apply an electronic fetal monitor.
• Prepare for a possible cesarean birth.
• Draw blood for a type and crossmatch.
• Assess the amount of vaginal bleeding.