1. The nurse is caring for a client in the first trimester during an initial prenatal clinic visit. Based on the

• 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) Periodical disease

c) Vegetarian diet

d) White ethnicity

• 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

• 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

• 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 suspected ectopic pregnancy reporting abdominal and shoulder pain

d) Client with threatened miscarriage who says, “I am a Jehovah’s Witness.”

• 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

• 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 piggybank

c) Assisting with artificial rupture of membranes

d) Initiating IV magnesium sulfate

e) Obtaining fetal heart tones once per shift

• A nurse is participating in an obstetrical emergency simulation in which the health care provider

announces shoulder dystocia. Which of the following interventions should the assessing nurse implement? Select all that apply.

a) Assist maternal pushing efforts by apply fundal pressure during each contraction

b) Document the time the fetal head was born

c) Flex the client’s legs back against the abdomen and apply downward pressure above the symphysis

pubis

d) Prepare for a forceps-assisted birth

e) Request additional assistance from other nurse immediately

• 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

• 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 supplement oxygen at bedside

e) Limit visitors to minimize stimulation

• 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 9g/dL (90 h/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

d) Client at 37 weeks gestation with a WBC count of 13,000/mm

3

(13.0 * 10

9 /L)

• 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

• A laboring client reports feeling the need to have a bowel movement and begins vomiting. The nurse

notes that the client’s legs are trembling. What cervical examination finding would the nurse most expect this client to have?

• 2 cm dilated, 50% effaced, -2 station
• 6 cm dilated, 70% effaced, -1 station
• 7 cm dilated, 80% effaced, 0 station
• 8 cm dilated, 100% effaced, +1 station
• The initial results of 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 immedaitely postpartum

c) Administer MMR vaccine in the third trimester

d) An MMR is not indicated for this client

• 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?

• “I need to be on bed rest for the duration of my pregnancy.”

• “I will notify my health care provider if I start having low back aches.”
• “Pelvic pressure is to be experienced after cerclage placement”
• “The cerclage will be removed once my baby is at 28 weeks.”
• The nurse cares for a client who gave birth an hour ago to a 9-lb (4.1-kg) newborn. The client’s lochia is

heavy with large clots, and the fundus remains boggy after fundal massage and an oxytocin bolus.Which prescription from the health care provider should the nurse question? The client’s vital signs: Blood pressure 168/95 mm Hg and 98/min

a) Administer 0.2-mg methylergonovine IM

b) Administer 800-mcg misoprostol rectally

c) Collect a hemoglobin and hematocrit STAT

d) Initiate second IV line with 18-gauge needle

• 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

• The postpartum nurse is assessing a client who gave birth by cesarean section 5 hours ago and is

requesting pain medication. The client appears restless, has a heart rate of 110/min, and admits to recent onset anxiety. What priority action should the nurse take?

a) Assess for lower extremity warmth and redness

b) Instruct the client in relaxation breathing techniques

c) Obtain oxygen saturation reading by pulse oximeter

d) Offer the client prescribed PRN pain medication

• The nurse is providing teaching to a prenatal client about the 1-hour glucose test that will be performed

at the next visit. Which client statement indicates a need for further teaching?

• “Fasting is required before the 1-hour glucose challenge test.”
• “One blood sample is obtained at the end of the test.”
• “The test includes drinking a 50-g glucose solution.”
• “The test’s purpose is to screen for gestational diabetes, not diagnose it.”
• The nurse receives report for a client at 36 weeks gestation who is being transferred to the unit for

labor induction from a rural health care facility with an intrauterine fetal demise of unknown duration.Which intervention is the most important when receiving care of the client?

a) Apply tocodynamometer and evaluate current contraction pattern

b) Ask the client about the family’s desire for speaking with a chaplain

c) Draw coagulation tests, fibrinogen, and complete blood count with platelets

d) Initiate oxytocin prescription to begin induction of labor

• The graduate nurse (GN) is caring for a laboring client with epidural anesthesia. After the client pushes

for 3 hours during the second stage of labor, the health care provider (HCP) decides to use forceps to assist the client to deliver secondary to maternal exhaustion. Which action by the GN requires the nurse preceptor to intervene?

a) Begins to apply fundal pressure when the HCP applies traction to forceps

b) Drains the client’s bladder using a catheter before the placement of forceps

c) Notes the exact time the forceps are applied on a card documentation in the birth record

d) Palpitates for contractions and notifies the HCP when they are present

• The nurse is verifying the medical history of a client who is admitted for a scheduled labor induction.

Which client statement should prompt the nurse to request further evaluation for a primary cesarean birth from the health care provider?

• “A vacuum was used to help deliver my last baby because the baby’s heart rate was dropping.”
• “I have an atrial septal defect that has never given me any problems, and I plan to receive an

epidural during labor.”

• “I lost my acyclovir prescription, and I’ve noticed lesions on my labia that are stinging and burning.”
• “I took enoxaparin during this pregnancy due to a history of blood clots, and my last dose was

yesterday.”

• 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 damage

• The nurse is caring for a pregnant client at 27 weeks gestation after a motor vehicle collision with side

airbag deployment. The client’s blood is type 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 fetoprotien

• 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 hemorrage

e) Uterine tachysystole

• 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 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?

• “Doxycycline is an acceptable alternative to penicillin for treatment of syphilis during pregnancy.”
• “The client will require penicillin desensitization to receive appropriate treatment.”
• “The newborn can be treated after birth if antepartum treatment is contraindicated.”
• “Treatment is only effective if provided during the primary stage of syphilis.”
• The nurse is performing a postpartum assessment 12 hours after the prolonged vaginal delivery of a

tern infant. Which assessment findings should be reported to the health care provider?

a) Complaints of discomfort during fundal palpitation

b) Foul-smelling lochia

c) Oral temperature

d) White blood cell(WBC) count 24,000/mm

3

(24.0 * 109/L)

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

the nurse?