Maternity Nursing Ob
Content
MATERNITY NURSING
NAME_______________________________
DATE____________
SCORE___________
Instruction: Select the correct answer for each of the following questions. Mark only one answer for each item by shading the corresponding letter of your choice on the answer sheet provided. STRICTLY NO ERASURES ALLOWED. Use pencil no. 2 only. 1. Which of the following prenatal laboratory test values would the nurse consider as significant? a. Rubella titer less than 1:8 c. One hour glucose challenge test 110 g/dL b. Hematocrit 33.5% d. White blood cells 8,000/mm3 2. In response to an expectant couple's questions, the nurse is explaining various hormones and their functions during pregnancy. Which of the following should the nurse include in the discussion? a. Estrogen maintains the growth of the endometrial lining of the uterus b. Human chorionic gonadotropin ensures continued production of progesterone & estrogen c. Progesterone contributes to mammary gland development & uterine growth d. All of the above 3. A 36-year old primigravida at 12 weeks gestation asks the nurse, "What is the purpose of an alpha fetoprotein test?" the best response by the nurse is to instruct the patient that this test can detect fetal: a. Kidney defects b. Cardiac defects c. Neural tube defects d. Urinary tract defects 4. A multigravida at 36 weeks gestation is scheduled to undergo amniocentesis. The nurse determines that the patient needs further explanation when the patient says: a. "bout 3 teaspoons of amniotic fluid will be removed." b. "I should have a full bladder before the procedure. c. "A sonogram will be done during the procedure." d. "I may feel pressure when the needle is inserted." 5. The nurse is caring for a primigravida who is scheduled for a fetal acoustic stimulation test (FAST). The nurse should explain to the patient that the primary purpose of this test is to: a. Shorten the contraction stress test C. Induce fetal heart rate accelerations b. Induce contractions D. Determine fluid volume 6. Which of the following would a client identify as the underlying cause for development of hemorrhoids in the early postpartum period? a. Pressure on the pelvic floor & straining during labor b. Slowed return of gastrointestinal motility to the prepregnant state c. Gradual decrease in melanin after delivery d. Elevation of glomerular filtration rate 7. Mrs. Mercedez rubella titer is negative. The physician prescribes a rubella vaccination. Which information should the nurse emphasize to Mrs. Mercedez before administering the vaccine? a. The rubella vaccine has no adverse effects b. She should avoid contact with her neonate for at least 24 hours after vaccination c. She must avoid pregnancy for at least 3 months d. The rubella vaccine provides passive immunity to the patient & protect her neonate from acquiring the disease 8. A primigravid client's baseline blood pressure at her initial visit at 15 weeks gestation was 110/70 mmHg. During an assessment at 38 weeks gestation, which of the following would indicate mild preeclampsia? a. Weight gain of 1 lb in the last week b. Proteinuria, more than 5 g in 24 hours c. Blood pressure of 160/110 mmHg on two separate occasions d. All of the above 1
9. A client who is seeking help in becoming pregnant reveals that her mother took Diethylstilbestrol while her mother was pregnant with the client. The nurse's response would be based on the knowledge that maternal use of DES is associated with which of the following? a. Pelvic inflammatory disease (PID) in female offspring b. Cervical incompetence in female offspring c. Reproductive problems in male offspring d. No specific problems in either male or female offspring 10. What will be the BEST intervention for a client if she develops hyperventilation during labor? a. Instruct her to deep breathe and exhale through pursed lips b. Administer oxygen through nasal cannula c. Encourage shallow breathing d. Instruct her to breathe through a paper bag 11. Mrs. Jane Lacsamana, a 28-year-old G3P3 at 3 day postpartum is visited by the nurse at home. Upon palpation of her abdomen, the nurse will likely feel the radius of the uterus to be at: a. The level of the symphisis pubis b. Three fingerbreadths below the umbilicus c. The level of the umbilicus d. Midpoint between umbilicus and symphisis pubis 12. Introduction of radiopaque material into the uterus and fallopian tubes to assess tubal patency is known as which of the following? a. Hysterosalpingography b. Spinnbarkeit test c. Hysteroscopy d. Ferning test 13. Resabel, a student nurse, is asked by a patient, "What determines my baby's lung maturity?" The student's nurse correct response is the: a. Lecithin-sphingomyelin (L/S) ratio c. Nitrazine Test b. Fern Test d. Phosphatidylglycerol (pg) test 14. A 22-year old woman is pregnant with her first baby. During her 7th month, she complaints of backache. The nurse teaches her to: a. Perform Kegel exercises once/day C. Wear barefoot at least once/day b. Wear low-heeled shoes D. . Sleep on a soft mattress 15. Which of the following would cause a false-positive result on a pregnancy test? a. The uterine uterine sample was stored too long at room temperature b. A spontaneous abortion or a missed abortion is impending c. Taking oral contraceptive d. All of the above 16. Which of the following additional assessment findings would be most suspicious and lead the nurse to suspect postpartum "blues" in a client who is anxious and crying? a. Loss of appetite, constipation, abdominal pain b. Increased appetite, urinary retention, diarrhea c. Mood lability, loss of appetite, difficulty sleeping d. Poor concentration, constipation, diarrhea 17. Mrs. Isabel delivers a 7-lb (3.2 kg) girl. After the neonate is delivered, the physician instructs the nurse to add 10 units of oxytocin (Pitocin) to Mrs. Isabels' IV to: a. Prevent DIC c. Contract the uterine muscles b. Relax the uterine muscles d. Augment the clotting action of the platelets 18. A client pregnant with her third child is deciding about having tubal ligation after she delivers. When evaluating a client's teaching plan about tubal ligation, which of the following client statements would indicate the need for additional teaching? a. "The procedure requires a small surgical incision in my abdomen." 2
b. "I can have the procedure reversed if we change our mind and want more children." c. "I can have the procedure done immediately after I deliver my baby." d. "I still have to be careful about sexually transmitted diseases even after the procedure." 19. After having a vasectomy, Dan asks the nurse if he'll become sterile immediately. The nurse's best response is: a. "You'll be sterile in 2 to 3 days." b. "If the procedure is done correctly, you'll be sterile immediately." c. "No, you'll remain fertile. This procedure doesn't make you infertile." d. "It may take several weeks and as many as 10 to 20 ejaculations to remove all the live sperm." 20. Disseminated Intravascular Coagulation (DIC) is a possible complication of abruptio placenta. Which assessment finding would indicate that the patient has developed DIC? a. Bleeding of the nose and gums c. Increased central venous pressure b. Joint pain d. Rapid clotting at venipuncture sites 21. Human beings have which chromosomal structure? a. 22 chromosomes: 46 autosomes and two pairs of sex chromosomes b. 38 chromosomes: 17 pairs of autosomes and two pairs of sex chromosomes c. 46 chromosomes: 22 pairs of autosomes and 1 pair of sex chromosomes d. 46 chromosomes: 1 pairs of autosomes and 22 pair of sex chromosomes 22. Which of the following interventions would the nurse recommend to a client having severe heartburn during her pregnancy? a. Drink a preparation of salt and vinegar c. Eat crackers in the morning b. Eat small, frequent meals a day d. Drink orange juice frequently during the day 23. Which of the following characterizes the orgasm stage of Human Sexual Response? a. Physical & psychological stimulations cause PNS activation b. Initial increase in vital signs c. Shortest stage where vigorous contractions of pelvic muscles excel blood & fluid d. Genital organs return to pre-aroused state 24. A client tells you that she often feel painful menstruation. You would explicate to her that the physiologic cause of dysmenorrhea is which of the following? a. High levels of progesterone b. Increased uterine muscle contraction b. Uterine ischemia c. Coitus during menses 25. Mrs. Perez and her husband are discussing family planning methods with the nurse. They are planning to have the symptothermal method for birth control. The nurse teaches them that this method includes which of the following? a. Basal body temperature and cervical mucus methods b. Menstrual cycle charting based on observable, physiologic changes and use of barrier contraception c. The predictor test for ovulation d. Fertility awareness technology 26. A client asks you about the hormone responsible for causing a rise in basal body temperature after ovulation. Which of the following is the appropriate answer of the nurse? a. Estrogen b. Oxytocin c. Prolactin d. Progesterone 27. After the 3rd stage of labor, you palpated the client’s uterine fundus to be soft and boggy. What must be your immediate nursing management? a. Initiate breastfeeding to stimulate let-down reflex b. Infuse D5LRs 1 L + Oxytocin 10 units to run fast drip c. Massage the fundus with the other hand d. Do nipple stimulation then refer to the OB-gyne on duty STAT Situation: In the OB-ER, the outgoing nurse endorses to you patient Mrs. Maricar Ramos, for ultrasound with a clinical impression of Abruptio Placenta. V/S: 150/100 mmHg, PR: 93/min, RR: 21/min. 3
28. As the nurse attending to Mrs. Ramos, which clinical manifestation would you not expect to find in your assessment? a. couvelaire uterus b. (-) abdominal pain c. profuse vaginal bleeding d. tense uterus 29. In what position would you ask Mrs. Ramos to assume on the ER bed and while being transported to the ultrasound unit? a. Lateral position b. Fowler’s position c. Supine position d. Trendelenburg 30. What would be an appropriate immediate management to a gravid woman in labor with an AOG >42 weeks but with no signs of neither maternal nor fetal distress? a. Augmentation of labor c. Emergency CS b. Induction of labor d. NSD with assisted forceps 31. Mrs. Samson, G1P0, was brought to the hospital due to labor pains 6 hours prior to consult. If the above client is having true labor pains, she must be experiencing one of the following characteristics: a. Braxton-hicks contraction are getting stronger b. Pain relieved by rest or sleep c. Relief from diaphragmatic pressure due to descent of the fetal head d. Pain emanating from the lumbosacral area sweep around the abdomen 32. On internal examination, the OB-gyne palpates the fetal sacrum in the right lower quadrant of the mother’s pelvis. What is the fetal position? a. RSaA b. RSaP c. LSaA d. LSaP 33. The fetal head is composed of sutures. Which of the following explains why cranial bones are not fused during fetal growth? a. Allows the reshaping of the head during the birthing process b. To accommodate the hyperplasia of the brain cells during neonatal stage c. Allows the formation of caput succedaneum d. Gives space for any possible increase in ICP during labor 34. Which of the following drugs is commonly administered to a pregnant patient undergoing preterm labor to decrease uterine contractions? a. Betamethasone b. Magnesium sulfate c. Indomethacin d. all of the above 35. Mae who has a history of repeated trichomoniasis underwent Pap smear which reveals a result of class I. This refers to: a. Presence of malignant cells b. Presence of atypical cells c. Presence of benign cells d. No signs of cervical cancer 36. Which fetal vessel carries blood from the placenta villi to the fetus? a. umbilical artery b. umbilical vein c. inferior vena cava 37. Oxygen and carbon dioxide are exchanged in the placenta through which process? a. Pinocytosis b. Facilitated transport c. Active transport d. Simple diffusion 38. Early postpartum hemorrhage is defined as: a. Blood loss more than 500 mL during the 1st 2 postpartum days b. Blood loss more than 1000 mL during the 1st postpartum day c. Blood loss more than 500 mL during the 1st postpartum day d. Blood loss more than 1000 mL during the 1st 2 postpartum days 39. Mrs. Macapagal comes in for a checkup at 20-21 weeks. Which of the following expect to find? a. Fundal height above the umbilicus, history of Braxton-Hicks contractions, ballottement present b. Fundal height at the umbilicus, awareness of fetal movement 4
d. aorta
c. Fundal height one fingerbreadth below the umbilicus, lightening present d. Fundal height above the umbilicus, loss of mucus plug, dilatation of the cervix 40. Which of the following women is most likely to have twins? a. Gee-Ann, age 37, pregnant for the third time b. Dion, age 25, pregnant for the second time c. Wendy, age 32, pregnant for the first time d. Bea, age 15, pregnant for the first time 41. The physician performs an episiotomy on Mrs. Barbara. Which of the following statements reflect reasons for performing an episiotomy at the beginning of the 2nd stage of labor? a. Trauma to the fetal head is decreased as the opening is enlarged b. It substitutes a clean cut for a ragged tear c. Shortens the second stage of labor d. All of the above 42. What is the primary objective for the emergency care given for cord prolapse? a. To prevent rupture of the uterus b. To prevent cold air from stimulating respirations in the fetus c. To prevent cord from drying d. To prevent or relieve pressure on the umbilical cord 43. Laboratory findings indicate that the neonate's hemoglobin is 17 g/100 mL of blood. The nurse should: a. Document this as normal finding b. Notify the physician promptly c. Assess for symptoms of polycythemia d. Explain to the mother that the neonate may need a transfusion 44. During your interview with Aling Nena, you noticed that she is a chain smoker, the habit she inherited from her mother. Which of the following statements accurately presents the possible effects of smoking on pregnancy? a. Because of increased maternal blood levels of carbon monoxide, the fetus receives less oxygen b. Blood flow to the placenta is reduced due to vasoconstriction of the placental vessel. c. Infants of woman who smoke weigh less at birth than infants of women who don’t d. All of the above 45. The Lamaze method for coping with the physical discomfort of childbirth includes all of the following except: a. hypnosis b. conditioning c. breath control d. none of the above
46. When performing Leopold's maneuvers, which of the following would the nurse ask the client to do to ensure optimal comfort and accuracy? a. Breathe deeply for 1 minute c. Drink a full glass of water b. Empty her bladder d. Lie on her left side 47. Mrs. Tomas asks the nurse how soon she can resume sexual intercourse. The most appropriate response would be: a. “Usually as soon as lochia serosa stops & it is comfortable for you & your husband.” b. “You will have to discuss this with your doctor.” c. “It is advisable to wait at least 6 weeks after delivery.” d. “Are you really concerned about sexual relations now?” 48. Mrs. Rowena, a 25 year old primigravida is seen for the first time in the antenatal clinic. She offers a history of 2 months amenorrhea and a tingling sensation in her breast. On examination, a diagnosis of a probable pregnancy is made. To manage Mrs. George’s care. It is most important at this time for the nurse to assess her: a. sexual history c. nutritional status b. attitude toward the pregnancy d. social and economic resources 5
49. Mrs. Lilia wants to know when her baby will be born. Her last menstrual period began August 10 and ended on August 17. You calculate her delivery date to be: a. May 17 b. May 24 c. May 10 d. May 7 50. At the next prenatal visit, a client (16 weeks pregnant), asks what her baby looks like now. What is the most accurate answer? a. embryonic organs are beginning to form c. the fetus weighs 3.5-4 lbs b. major fetal organs are beginning to function d. the baby’s sex is now obvious 51. Gloria, a 30 year old multiparous woman is attending the antepartum clinic with her fourth pregnancy. Gloria explains to the nurse that she must work to augment the family income, but her mother advised her to stop working after her seventh month. An appropriate reply by the nurse would be: a. “Your mother has more experience than you so why not follow her advice?” b. “If you have to work, there is nothing anyone can do about it.” c. “You can stop working after the seventh month.” d. “You can work as long as possible, provided there are no complications or health hazards.” 52. Magnesium sulfate is one of the drugs used as a sedative, a diuretic, and anticonvulsant in patients with severe pre-eclampsia. Before a repeat dose is given, which of the following is the most important to ascertain? a. urinary output b. level of reflexes c. level of blood pressure d. pulse rate 53. Mrs. Blass is scheduled for a caesarean section. The nurse enters and finds her in tears. When the nurse asked why she is crying, Mrs. Blass states that she is afraid that the baby will die. Which of the following responses would be the most appropriate? a. Don’t worry Mrs. Blass, the doctors know what they are doing.” b. “You have nothing to worry about, just leave everything up to the doctors.” c. “Your baby is healthy, don’t worry nothing will happen.” d. “What makes you afraid that the baby will die?” 54. A client tells the nurse that she was looking forward to breastfeeding the baby. Breast milk contains secretory immunoglobulin A (IgA). Which of the following reduces the incidence of diarrhea in breastfed babies? a. Lysozyme b. Interferon c. Lactoferrin d. Lactobacillus bifidus 55. A client is now 34 weeks pregnant and is admitted for observation and fetal assessment. Which of the following tests would now be done to determine placental sufficiency and L/S ratio? a. amniocentesis & estriol c. estriol levels & ultrasonic scanning b. amniocentesis & ultrasonic scanning d. amniocentesis & blood sugar levels 56. Mrs. Manalo is in labor and her contractions are of 40 seconds duration with intervals of 8 minutes. Which factor influence labor? a. sympathetic nerve fibers c. the position of the fetus in the uterus b. parasympathetic nerve fibers d. uterine muscle stretching c. 57. A ruptured uterus is a serious complication of oxytocin infusion. Which of the following is a warning sign of impending uterine rupture? a. once strong contraction are now sustained aide 30 seconds b. contractions last 90 seconds c. a retraction ring is noted at the lower uterine segment d. contractions change from regular to irregular Situation: Mrs. Bell, a 39 year old multipara, was admitted to the labor and delivery room in active labor. On palpitation it was found out that the fetus was on breech position. 58. Mrs. Bell’s labor is progressing satisfactory, but the nurse must constantly be on alert for any sign of impending danger. Which of the following, signs would be considered normal for Mrs. Bell? a. meconium in the vagina b. fetal heart rate below 100 beats/minute c. fetal heart rate over 180 beats/minute d. maternal diastolic pressure that rises 30 mm Hg during a contraction 6
59. When Mrs. Bell is 6-cm dilated she request medication for pain and the epidural anesthesia is given. One of the most common complications of epidural anesthesia is: a maternal hypertension c. maternal hypotension b fetal inactivity with tachycardia d. fetal inactivity with bradycardia 60. Mrs. Peralta, a 26 year old primipara has just delivered a boy, 6 lbs, and 7 ounces. At the completion of the third stage, the doctor ordered methylgonovine (methegine) G R 1/320 intramascularly. This drug is ordered for Mrs. Peralta to prevent: a Bladder spasm b involution c Uterine Atony d engorgement 61. When an object is placed in Jennifer’s hand, she will take hold of it momentarily. This is a result of: a. Moro reflex b. Cling reflex c. Grasp reflex d. Rooting reflex 62. Mrs. Sanchez, a 20 year old primipara returns to the clinic 3 weeks after she has been discharge from the hospital. She is diagnosed as having mastitis. Which of the following signs would be found when examining Mrs. Sanchez? a. increase lactation b. bilateral breast pain, swelling, redness & increased temperature c. inverted nipples d. cracked nipples with fissures in the areola 63. From Barangay San Felipe, Aling Bising, a factory worker comes to Health Center for the first time. She missed her menstrual period and she thinks she is pregnant. You are a Health Center Nurse on Duty. What would be the most appropriate question to ask Aling Bising regarding her EDC at this time? a. “How many children do you have?” c. “Where do you intend to deliver?” b. “Did you plan this pregnancy?” d. “When was your last period?”
64. The minimum sperm count in normal ejaculation of semen is: a. 100,000 c. 1,000,000 b. 500,000 d. . 50,000,000 65. Human chorionic gonadotropin is an important hormone because: a. its detection is a significant indicator of pregnancy b. it promotes mammary gland growth during pregnancy c. site that is nearest to the entrance of uterine arteries d. area that is most distal to the upper margins of the uterus 66. As part of the prenatal exam, several lab tests were done on a client. Two of these are the VDRL and Rubella Titer. They give information concerning maternal infectious diseases which could be contracted by the fetus. These diseases are: a. gonorrhea & measles c. gonorrhea & syphilis b. herpes & mumps d. syphilis & German measles
67. A pregnant client mentions that at times she feels very tired. Your best response to her is: a. “You’re probably working too much. You must cut down your activities & get more rest.” b. “Fatigue is normal occurrence as your body adjusts to pregnancy. But try to find out if you can have extra periods for rest.” c. “This will pass as you go on with your pregnancy.” d. “You need to see your doctor immediately. Something is wrong with your pregnancy.” 68. When talking with a pregnant client who is experiencing aching, swollen leg veins, the nurse would explain that this is most probably the result of which of the following? a. Pregnancy-induced hypertension b. Thrombophlebitis c. The force of gravity pulling down on the uterus d. Pressure on blood vessels from the enlarging uterus 7
69. The underlying cause of hypoglycemia in infant of diabetic mother is due to: a. lack of glucose source with high level of insulin in extrauterine life b. depleted level of both glucose and insulin c. high level of glucose but with depleted source of insulin d. high level of both glucose and insulin 70. Preferred method of delivery of overt diabetic pregnant women a. forcep b. NSD c. CS d. induced 71. These are the management of diabetic gravida mother, EXCEPT: a. encourage to eat complex form of carbohydates b. administer oral hypoglycemic agent as ordered c. inject insulin per SC prn d. perform diagnostic procedures to determine fetal well being and placental insufficiency Situation: Elena believes that she is pregnant since she missed her period for 2 months. She likewise is experiencing nausea and vomiting with positive pregnant test result. Ultrasound revealed no fetal parts and no fetal heart activity. HCG titer revealed abnormally high level. 72. An increasing titer of HCG after D&C may indicate: a. Choriocarcinoma b. DIC c. Uterine rupture
d. Rh incompatibility
73. Which prophylactic drug is most expected to be given to Elena? a. Oxytocin b. Methergin c. Methothrexate d. Dexamethasone 74. The client has come to the family planning clinic to discuss the use of contraceptives. The nurse should do which of the following to facilitate a productive discussion? a. Only discuss contraceptive option with the married client if partner is present b. Instruct the client in which contraceptive option she should use. c. Inform the client about use, side effects, and effectiveness of different contraceptive option so that the client can select one that meets her needs. d. Avoid discussion of side effects as this might frighten the client and result in her not using contraceptive. 75. Which of the following statement by a male client would indicate that he understands the instructions for use of a condom? a. “I should lubricate the condom with an oil-based product to avoid friction that could rupture the condom.” b. “I should unroll the condom and check it for hole before applying it.” c. “I should hold the rim of the condom while withdrawing my penis from the vagina to avoid leakage.” d. “I should begin sexual intercourse without the condom and don the condom just before ejaculation.” 76. A client at 8 months gestation is diagnosed with oligohydramnios. She asks the nurse if this can harm the fetus. The nurse’s best response is: a. “Yes, oligohydramnios can lead to umbilical cord compression.” b. “Yes, it means the fetus swallowed too much fluid.” c. “No, this commonly occurs toward the end of pregnancy.” d. “No, this is a sign that the lungs are maturing.”
77. In explaining to the client who has come in for her initial prenatal exam the reason why it is important to test pregnant women for gonorrhea, the nurse should tell the client that gonorrhea can cause neonatal: a. Vaginal discharge c. Liver damage b. Eye infections d. Congenital anomalies. 78. A client continues to pass large amount of clots and bright red lochia despite the nurse’s attempt to massage the fundus. Upon reexamination, the nurse finds that the client’s uterine fundus remains boggy. 8
The nursing actions and oxytocin (Pitocin) do not seem to be helping to keep the fundus firm. What second medication might the physician request the nurse to administer to manage uterine atony? a. Dinoprostone (Cervidil). c. Magnesium sulfate b. Terbutaline sulfate (Brethine) d. Carboprost (Protin 15-M or Hemabate) 79. If the nurse suspects a uterine infection in the postpartum, the nurse should assess the: a. Pulse and blood pressure c. Episiotomy site b. Odor of the lochia d. The abdomen for distention. 80. A postpartal client develops a temperature during her postpartal course. Which of the following temperatures indicate the presence of postpartal infections? a. 99.O 0 F 12 hours after delivery that decrease after 18 hours. b. 100.2 0 F 24 hours after delivery that decreases the second postpartum day. c. 100.4 0 F 24 hours after delivery that remains until the second postpartum day. d. 100.6 0 F 48 hours after delivery that continues into the third postpartum day. 81. Semen analysis of Mrs. Lagdameo’s husband is requested. Which of the following should NOT be a part of the instruction to be given to the husband? a. Abstain from intercourse for several days then collect fresh ejaculate for testing b. Immerse the specimen in a tumbler of ice cubes and transport it immediately to the testing facility c. Keep the specimen warm by placing the container under the arm or close to the skin d. Entire specimen is collected in a clean, dry container and immediately transported to the laboratory 82. Aimee, 31 year old woman has been pushing in the second stage of labor for 2 hours. The vertex is at the +2 station. Each contraction is associated with a fetal bradycardia as low as 100 beats per minute (bpm) that lasts for 30 seconds. This clinical scenario suggests which of the following situations? a. Systemic fetal hypoxia c. An association with oligohydramnios b. Poor fetal outcome d. Fetal head compression 83. Kim with ruptured membranes is in the active phase of labor and is 5-cm dilated with sustained, deep variable decelerations. The decision is made to perform a cesarean section. Which of the following would not be an appropriate intrauterine resuscitative measure done before the cesarean section? a. Increase the intravenous fluids c. Start nasal oxygen b. Place the client in supine position d. Start amnioinfusion 84. After having identified a fetus at risk in prolonged pregnancy, management should consist of: a. Amniocentesis for maturity studies b. Delivery regardless of the status of the cervix c. Fetal sampling of scalp pH d. Measurement of human chorionic somatomammotropin 85. Which of the following findings would be unexpected in the progression of a normal pregnancy? a. A weight gain of 11 lbs at 20 weeks b. Fetal heart tones at 13 weeks detected by Doppler ultrasound c. The fundus of the uterus at the level of the umbilicus at 20 weeks d. Real-time ultrasonographic evidence of fetal heart motion 4 weeks after the last menstrual period (LMP). 86. Bernadette who is known to use cocaine presents with seizures, a temperature of 1040F, and a blood pressure of 180/120. She is 36 weeks pregnant. After a thorough evaluation, the physician excludes preeclampsia and intrauterine infection. The diagnosis is cocaine toxicity. Action to be taken include all of the following except: a. delivering the infant expeditiously b. providing oxygen and considering intubation c. providing a cooling blanket d. treating with intravenous propanolol
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87. Factors that are important in the pathophysiology of pelvic inflammatory disease (PID) include all of the following except: a. intrauterine device use b. intercourse c. menstruation d. uterine fibroids 88. A class II cardiac patient Alena, who is 38 weeks pregnant presents to the hospital in labor with dyspnea on exertion and chest rales. Proper management of this management of this pregnant patient includes all of the following except: a. epidural anesthesia b. diuretics c. cesarean delivery d. digitalis 89. Portia presents to the labor floor complaining of painful contractions that occur every 2 minutes. She is 2 cm dilated. Two hours later, she continues to complain of frequent painful contractions, but she is still only 2 cm dilated. What is the diagnosis that describes Portia’s condition? a. False labor c. Hypotonic uterine dysfunction b. Hypertonic uterine dysfunction d. Active phase of labor 90. Freda presents to the labor floor with contractions 8 to 12 minutes apart. She complains of lower abdominal discomfort with her contractions, which last for only 20 seconds each. Sedation causes the contraction to be spaced at intervals of 15 to 20 minutes. a. False labor c. Hypotonic uterine dysfunction b. Hypertonic uterine dysfunction d. Active phase of labor 91. When preparing a 20-year-old client who reports missing one menstrual period and suspects that she is pregnant for a radioimmunoassay pregnancy test, which of the following would the nurse need to keep in mind about this test? a. It has high degree of accuracy within 1 week after ovulation b. It is identical in nature to an over-the-counter home pregnancy test c. A positive result is considered a presumptive sign of pregnancy d. A urine sample is needed to obtain quicker results 92. A client about 8 weeks pregnant, asks the nurse when will she be able to hear the fetal heartbeat. The nurse would respond by telling the client that the fetal heartbeat can be heard with a Doppler ultrasound device when the gestation is as early as which of the following? a. 4 weeks b. 8 weeks c. 15 weeks d. 18 weeks 93. Which of the following refers to a creamy-cheese-like substance which serves as protective covering during intrauterine life? a. Operculum b Lanugo. c. Vernix caseosa d. Canal
94. Which of the following is NOT observed in Leboyer method? a. Birth occurs in a well-lighted and quiet room b. The cord is cut after the pulsation ceases c. Neonate is placed immediately on the mother’s abdomen d. Neonate is immersed in a tub of warm water 95. A pregnant client verbalizes that she plans to breastfeed her baby. Which of the following measures will be most effective to ensure adequate milk secretion? a. Use breast pump in expressing milk b. Manual expression of breastmilk c. Allow the newborn to empty each breasts alternately d. Increase intake of hot soups and milk Situation: Anna is 24 weeks AOG. She complains of “hardening” of her uterus every 10 minutes. She is admitted with a diagnosis of threatened premature labor, 24 weeks AOG. 96. Which of the following will be the immediate nursing intervention for Anna? a. Give her sedatives c. Place her on complete bed rest b. Allow her to have bathroom privileges d. Start fluids as ordered 10
c. 97. Terbutaline sulfate was ordered. Anna developed palpitations after 1 hour of Terbutaline sulfate infusion. What is the immediate nursing action for this problem? a. Stop the infusion c. Secure order for beta blockers b. Replace IV infusion with oral dose d. Regulate the infusion according to cardiac rate c. 98. In a complete hydatidiform mole, which of the following karyotypes is typically found? a. 46 xx b. 69 xxy c. 69 xxx d. 69 xxy b. 99. Ara is complaining of painful contractions, or after pains, on postpartum day 2. Which of the following conditions could increase the severity of after pains? a. Bottle-feeding c. Multiple gestation b. Diabetes d. Primiparity 100. Mrs. Kristina is in her 2nd trimester and admitted in the hospital with a chief complaint of hypertension. With BP= 170/100. Further assessment revealed edema on face and upper extremities. Mrs. Kristina is diagnosed of PIH. Which of the following statements is INCORRECT regarding this condition? a. Occurs most frequently in primiparas younger than age 20 years or older than 40 years b. The cause is unknown c. Danger of seizure is present until 24 hours post-partum d. Seizure usually occurs 72 hours after birth
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NAME_______________________________
DATE____________
SCORE___________
Instruction: Select the correct answer for each of the following questions. Mark only one answer for each item by shading the corresponding letter of your choice on the answer sheet provided. STRICTLY NO ERASURES ALLOWED. Use pencil no. 2 only. 1. Which of the following prenatal laboratory test values would the nurse consider as significant? a. Rubella titer less than 1:8 c. One hour glucose challenge test 110 g/dL b. Hematocrit 33.5% d. White blood cells 8,000/mm3 2. In response to an expectant couple's questions, the nurse is explaining various hormones and their functions during pregnancy. Which of the following should the nurse include in the discussion? a. Estrogen maintains the growth of the endometrial lining of the uterus b. Human chorionic gonadotropin ensures continued production of progesterone & estrogen c. Progesterone contributes to mammary gland development & uterine growth d. All of the above 3. A 36-year old primigravida at 12 weeks gestation asks the nurse, "What is the purpose of an alpha fetoprotein test?" the best response by the nurse is to instruct the patient that this test can detect fetal: a. Kidney defects b. Cardiac defects c. Neural tube defects d. Urinary tract defects 4. A multigravida at 36 weeks gestation is scheduled to undergo amniocentesis. The nurse determines that the patient needs further explanation when the patient says: a. "bout 3 teaspoons of amniotic fluid will be removed." b. "I should have a full bladder before the procedure. c. "A sonogram will be done during the procedure." d. "I may feel pressure when the needle is inserted." 5. The nurse is caring for a primigravida who is scheduled for a fetal acoustic stimulation test (FAST). The nurse should explain to the patient that the primary purpose of this test is to: a. Shorten the contraction stress test C. Induce fetal heart rate accelerations b. Induce contractions D. Determine fluid volume 6. Which of the following would a client identify as the underlying cause for development of hemorrhoids in the early postpartum period? a. Pressure on the pelvic floor & straining during labor b. Slowed return of gastrointestinal motility to the prepregnant state c. Gradual decrease in melanin after delivery d. Elevation of glomerular filtration rate 7. Mrs. Mercedez rubella titer is negative. The physician prescribes a rubella vaccination. Which information should the nurse emphasize to Mrs. Mercedez before administering the vaccine? a. The rubella vaccine has no adverse effects b. She should avoid contact with her neonate for at least 24 hours after vaccination c. She must avoid pregnancy for at least 3 months d. The rubella vaccine provides passive immunity to the patient & protect her neonate from acquiring the disease 8. A primigravid client's baseline blood pressure at her initial visit at 15 weeks gestation was 110/70 mmHg. During an assessment at 38 weeks gestation, which of the following would indicate mild preeclampsia? a. Weight gain of 1 lb in the last week b. Proteinuria, more than 5 g in 24 hours c. Blood pressure of 160/110 mmHg on two separate occasions d. All of the above 1
9. A client who is seeking help in becoming pregnant reveals that her mother took Diethylstilbestrol while her mother was pregnant with the client. The nurse's response would be based on the knowledge that maternal use of DES is associated with which of the following? a. Pelvic inflammatory disease (PID) in female offspring b. Cervical incompetence in female offspring c. Reproductive problems in male offspring d. No specific problems in either male or female offspring 10. What will be the BEST intervention for a client if she develops hyperventilation during labor? a. Instruct her to deep breathe and exhale through pursed lips b. Administer oxygen through nasal cannula c. Encourage shallow breathing d. Instruct her to breathe through a paper bag 11. Mrs. Jane Lacsamana, a 28-year-old G3P3 at 3 day postpartum is visited by the nurse at home. Upon palpation of her abdomen, the nurse will likely feel the radius of the uterus to be at: a. The level of the symphisis pubis b. Three fingerbreadths below the umbilicus c. The level of the umbilicus d. Midpoint between umbilicus and symphisis pubis 12. Introduction of radiopaque material into the uterus and fallopian tubes to assess tubal patency is known as which of the following? a. Hysterosalpingography b. Spinnbarkeit test c. Hysteroscopy d. Ferning test 13. Resabel, a student nurse, is asked by a patient, "What determines my baby's lung maturity?" The student's nurse correct response is the: a. Lecithin-sphingomyelin (L/S) ratio c. Nitrazine Test b. Fern Test d. Phosphatidylglycerol (pg) test 14. A 22-year old woman is pregnant with her first baby. During her 7th month, she complaints of backache. The nurse teaches her to: a. Perform Kegel exercises once/day C. Wear barefoot at least once/day b. Wear low-heeled shoes D. . Sleep on a soft mattress 15. Which of the following would cause a false-positive result on a pregnancy test? a. The uterine uterine sample was stored too long at room temperature b. A spontaneous abortion or a missed abortion is impending c. Taking oral contraceptive d. All of the above 16. Which of the following additional assessment findings would be most suspicious and lead the nurse to suspect postpartum "blues" in a client who is anxious and crying? a. Loss of appetite, constipation, abdominal pain b. Increased appetite, urinary retention, diarrhea c. Mood lability, loss of appetite, difficulty sleeping d. Poor concentration, constipation, diarrhea 17. Mrs. Isabel delivers a 7-lb (3.2 kg) girl. After the neonate is delivered, the physician instructs the nurse to add 10 units of oxytocin (Pitocin) to Mrs. Isabels' IV to: a. Prevent DIC c. Contract the uterine muscles b. Relax the uterine muscles d. Augment the clotting action of the platelets 18. A client pregnant with her third child is deciding about having tubal ligation after she delivers. When evaluating a client's teaching plan about tubal ligation, which of the following client statements would indicate the need for additional teaching? a. "The procedure requires a small surgical incision in my abdomen." 2
b. "I can have the procedure reversed if we change our mind and want more children." c. "I can have the procedure done immediately after I deliver my baby." d. "I still have to be careful about sexually transmitted diseases even after the procedure." 19. After having a vasectomy, Dan asks the nurse if he'll become sterile immediately. The nurse's best response is: a. "You'll be sterile in 2 to 3 days." b. "If the procedure is done correctly, you'll be sterile immediately." c. "No, you'll remain fertile. This procedure doesn't make you infertile." d. "It may take several weeks and as many as 10 to 20 ejaculations to remove all the live sperm." 20. Disseminated Intravascular Coagulation (DIC) is a possible complication of abruptio placenta. Which assessment finding would indicate that the patient has developed DIC? a. Bleeding of the nose and gums c. Increased central venous pressure b. Joint pain d. Rapid clotting at venipuncture sites 21. Human beings have which chromosomal structure? a. 22 chromosomes: 46 autosomes and two pairs of sex chromosomes b. 38 chromosomes: 17 pairs of autosomes and two pairs of sex chromosomes c. 46 chromosomes: 22 pairs of autosomes and 1 pair of sex chromosomes d. 46 chromosomes: 1 pairs of autosomes and 22 pair of sex chromosomes 22. Which of the following interventions would the nurse recommend to a client having severe heartburn during her pregnancy? a. Drink a preparation of salt and vinegar c. Eat crackers in the morning b. Eat small, frequent meals a day d. Drink orange juice frequently during the day 23. Which of the following characterizes the orgasm stage of Human Sexual Response? a. Physical & psychological stimulations cause PNS activation b. Initial increase in vital signs c. Shortest stage where vigorous contractions of pelvic muscles excel blood & fluid d. Genital organs return to pre-aroused state 24. A client tells you that she often feel painful menstruation. You would explicate to her that the physiologic cause of dysmenorrhea is which of the following? a. High levels of progesterone b. Increased uterine muscle contraction b. Uterine ischemia c. Coitus during menses 25. Mrs. Perez and her husband are discussing family planning methods with the nurse. They are planning to have the symptothermal method for birth control. The nurse teaches them that this method includes which of the following? a. Basal body temperature and cervical mucus methods b. Menstrual cycle charting based on observable, physiologic changes and use of barrier contraception c. The predictor test for ovulation d. Fertility awareness technology 26. A client asks you about the hormone responsible for causing a rise in basal body temperature after ovulation. Which of the following is the appropriate answer of the nurse? a. Estrogen b. Oxytocin c. Prolactin d. Progesterone 27. After the 3rd stage of labor, you palpated the client’s uterine fundus to be soft and boggy. What must be your immediate nursing management? a. Initiate breastfeeding to stimulate let-down reflex b. Infuse D5LRs 1 L + Oxytocin 10 units to run fast drip c. Massage the fundus with the other hand d. Do nipple stimulation then refer to the OB-gyne on duty STAT Situation: In the OB-ER, the outgoing nurse endorses to you patient Mrs. Maricar Ramos, for ultrasound with a clinical impression of Abruptio Placenta. V/S: 150/100 mmHg, PR: 93/min, RR: 21/min. 3
28. As the nurse attending to Mrs. Ramos, which clinical manifestation would you not expect to find in your assessment? a. couvelaire uterus b. (-) abdominal pain c. profuse vaginal bleeding d. tense uterus 29. In what position would you ask Mrs. Ramos to assume on the ER bed and while being transported to the ultrasound unit? a. Lateral position b. Fowler’s position c. Supine position d. Trendelenburg 30. What would be an appropriate immediate management to a gravid woman in labor with an AOG >42 weeks but with no signs of neither maternal nor fetal distress? a. Augmentation of labor c. Emergency CS b. Induction of labor d. NSD with assisted forceps 31. Mrs. Samson, G1P0, was brought to the hospital due to labor pains 6 hours prior to consult. If the above client is having true labor pains, she must be experiencing one of the following characteristics: a. Braxton-hicks contraction are getting stronger b. Pain relieved by rest or sleep c. Relief from diaphragmatic pressure due to descent of the fetal head d. Pain emanating from the lumbosacral area sweep around the abdomen 32. On internal examination, the OB-gyne palpates the fetal sacrum in the right lower quadrant of the mother’s pelvis. What is the fetal position? a. RSaA b. RSaP c. LSaA d. LSaP 33. The fetal head is composed of sutures. Which of the following explains why cranial bones are not fused during fetal growth? a. Allows the reshaping of the head during the birthing process b. To accommodate the hyperplasia of the brain cells during neonatal stage c. Allows the formation of caput succedaneum d. Gives space for any possible increase in ICP during labor 34. Which of the following drugs is commonly administered to a pregnant patient undergoing preterm labor to decrease uterine contractions? a. Betamethasone b. Magnesium sulfate c. Indomethacin d. all of the above 35. Mae who has a history of repeated trichomoniasis underwent Pap smear which reveals a result of class I. This refers to: a. Presence of malignant cells b. Presence of atypical cells c. Presence of benign cells d. No signs of cervical cancer 36. Which fetal vessel carries blood from the placenta villi to the fetus? a. umbilical artery b. umbilical vein c. inferior vena cava 37. Oxygen and carbon dioxide are exchanged in the placenta through which process? a. Pinocytosis b. Facilitated transport c. Active transport d. Simple diffusion 38. Early postpartum hemorrhage is defined as: a. Blood loss more than 500 mL during the 1st 2 postpartum days b. Blood loss more than 1000 mL during the 1st postpartum day c. Blood loss more than 500 mL during the 1st postpartum day d. Blood loss more than 1000 mL during the 1st 2 postpartum days 39. Mrs. Macapagal comes in for a checkup at 20-21 weeks. Which of the following expect to find? a. Fundal height above the umbilicus, history of Braxton-Hicks contractions, ballottement present b. Fundal height at the umbilicus, awareness of fetal movement 4
d. aorta
c. Fundal height one fingerbreadth below the umbilicus, lightening present d. Fundal height above the umbilicus, loss of mucus plug, dilatation of the cervix 40. Which of the following women is most likely to have twins? a. Gee-Ann, age 37, pregnant for the third time b. Dion, age 25, pregnant for the second time c. Wendy, age 32, pregnant for the first time d. Bea, age 15, pregnant for the first time 41. The physician performs an episiotomy on Mrs. Barbara. Which of the following statements reflect reasons for performing an episiotomy at the beginning of the 2nd stage of labor? a. Trauma to the fetal head is decreased as the opening is enlarged b. It substitutes a clean cut for a ragged tear c. Shortens the second stage of labor d. All of the above 42. What is the primary objective for the emergency care given for cord prolapse? a. To prevent rupture of the uterus b. To prevent cold air from stimulating respirations in the fetus c. To prevent cord from drying d. To prevent or relieve pressure on the umbilical cord 43. Laboratory findings indicate that the neonate's hemoglobin is 17 g/100 mL of blood. The nurse should: a. Document this as normal finding b. Notify the physician promptly c. Assess for symptoms of polycythemia d. Explain to the mother that the neonate may need a transfusion 44. During your interview with Aling Nena, you noticed that she is a chain smoker, the habit she inherited from her mother. Which of the following statements accurately presents the possible effects of smoking on pregnancy? a. Because of increased maternal blood levels of carbon monoxide, the fetus receives less oxygen b. Blood flow to the placenta is reduced due to vasoconstriction of the placental vessel. c. Infants of woman who smoke weigh less at birth than infants of women who don’t d. All of the above 45. The Lamaze method for coping with the physical discomfort of childbirth includes all of the following except: a. hypnosis b. conditioning c. breath control d. none of the above
46. When performing Leopold's maneuvers, which of the following would the nurse ask the client to do to ensure optimal comfort and accuracy? a. Breathe deeply for 1 minute c. Drink a full glass of water b. Empty her bladder d. Lie on her left side 47. Mrs. Tomas asks the nurse how soon she can resume sexual intercourse. The most appropriate response would be: a. “Usually as soon as lochia serosa stops & it is comfortable for you & your husband.” b. “You will have to discuss this with your doctor.” c. “It is advisable to wait at least 6 weeks after delivery.” d. “Are you really concerned about sexual relations now?” 48. Mrs. Rowena, a 25 year old primigravida is seen for the first time in the antenatal clinic. She offers a history of 2 months amenorrhea and a tingling sensation in her breast. On examination, a diagnosis of a probable pregnancy is made. To manage Mrs. George’s care. It is most important at this time for the nurse to assess her: a. sexual history c. nutritional status b. attitude toward the pregnancy d. social and economic resources 5
49. Mrs. Lilia wants to know when her baby will be born. Her last menstrual period began August 10 and ended on August 17. You calculate her delivery date to be: a. May 17 b. May 24 c. May 10 d. May 7 50. At the next prenatal visit, a client (16 weeks pregnant), asks what her baby looks like now. What is the most accurate answer? a. embryonic organs are beginning to form c. the fetus weighs 3.5-4 lbs b. major fetal organs are beginning to function d. the baby’s sex is now obvious 51. Gloria, a 30 year old multiparous woman is attending the antepartum clinic with her fourth pregnancy. Gloria explains to the nurse that she must work to augment the family income, but her mother advised her to stop working after her seventh month. An appropriate reply by the nurse would be: a. “Your mother has more experience than you so why not follow her advice?” b. “If you have to work, there is nothing anyone can do about it.” c. “You can stop working after the seventh month.” d. “You can work as long as possible, provided there are no complications or health hazards.” 52. Magnesium sulfate is one of the drugs used as a sedative, a diuretic, and anticonvulsant in patients with severe pre-eclampsia. Before a repeat dose is given, which of the following is the most important to ascertain? a. urinary output b. level of reflexes c. level of blood pressure d. pulse rate 53. Mrs. Blass is scheduled for a caesarean section. The nurse enters and finds her in tears. When the nurse asked why she is crying, Mrs. Blass states that she is afraid that the baby will die. Which of the following responses would be the most appropriate? a. Don’t worry Mrs. Blass, the doctors know what they are doing.” b. “You have nothing to worry about, just leave everything up to the doctors.” c. “Your baby is healthy, don’t worry nothing will happen.” d. “What makes you afraid that the baby will die?” 54. A client tells the nurse that she was looking forward to breastfeeding the baby. Breast milk contains secretory immunoglobulin A (IgA). Which of the following reduces the incidence of diarrhea in breastfed babies? a. Lysozyme b. Interferon c. Lactoferrin d. Lactobacillus bifidus 55. A client is now 34 weeks pregnant and is admitted for observation and fetal assessment. Which of the following tests would now be done to determine placental sufficiency and L/S ratio? a. amniocentesis & estriol c. estriol levels & ultrasonic scanning b. amniocentesis & ultrasonic scanning d. amniocentesis & blood sugar levels 56. Mrs. Manalo is in labor and her contractions are of 40 seconds duration with intervals of 8 minutes. Which factor influence labor? a. sympathetic nerve fibers c. the position of the fetus in the uterus b. parasympathetic nerve fibers d. uterine muscle stretching c. 57. A ruptured uterus is a serious complication of oxytocin infusion. Which of the following is a warning sign of impending uterine rupture? a. once strong contraction are now sustained aide 30 seconds b. contractions last 90 seconds c. a retraction ring is noted at the lower uterine segment d. contractions change from regular to irregular Situation: Mrs. Bell, a 39 year old multipara, was admitted to the labor and delivery room in active labor. On palpitation it was found out that the fetus was on breech position. 58. Mrs. Bell’s labor is progressing satisfactory, but the nurse must constantly be on alert for any sign of impending danger. Which of the following, signs would be considered normal for Mrs. Bell? a. meconium in the vagina b. fetal heart rate below 100 beats/minute c. fetal heart rate over 180 beats/minute d. maternal diastolic pressure that rises 30 mm Hg during a contraction 6
59. When Mrs. Bell is 6-cm dilated she request medication for pain and the epidural anesthesia is given. One of the most common complications of epidural anesthesia is: a maternal hypertension c. maternal hypotension b fetal inactivity with tachycardia d. fetal inactivity with bradycardia 60. Mrs. Peralta, a 26 year old primipara has just delivered a boy, 6 lbs, and 7 ounces. At the completion of the third stage, the doctor ordered methylgonovine (methegine) G R 1/320 intramascularly. This drug is ordered for Mrs. Peralta to prevent: a Bladder spasm b involution c Uterine Atony d engorgement 61. When an object is placed in Jennifer’s hand, she will take hold of it momentarily. This is a result of: a. Moro reflex b. Cling reflex c. Grasp reflex d. Rooting reflex 62. Mrs. Sanchez, a 20 year old primipara returns to the clinic 3 weeks after she has been discharge from the hospital. She is diagnosed as having mastitis. Which of the following signs would be found when examining Mrs. Sanchez? a. increase lactation b. bilateral breast pain, swelling, redness & increased temperature c. inverted nipples d. cracked nipples with fissures in the areola 63. From Barangay San Felipe, Aling Bising, a factory worker comes to Health Center for the first time. She missed her menstrual period and she thinks she is pregnant. You are a Health Center Nurse on Duty. What would be the most appropriate question to ask Aling Bising regarding her EDC at this time? a. “How many children do you have?” c. “Where do you intend to deliver?” b. “Did you plan this pregnancy?” d. “When was your last period?”
64. The minimum sperm count in normal ejaculation of semen is: a. 100,000 c. 1,000,000 b. 500,000 d. . 50,000,000 65. Human chorionic gonadotropin is an important hormone because: a. its detection is a significant indicator of pregnancy b. it promotes mammary gland growth during pregnancy c. site that is nearest to the entrance of uterine arteries d. area that is most distal to the upper margins of the uterus 66. As part of the prenatal exam, several lab tests were done on a client. Two of these are the VDRL and Rubella Titer. They give information concerning maternal infectious diseases which could be contracted by the fetus. These diseases are: a. gonorrhea & measles c. gonorrhea & syphilis b. herpes & mumps d. syphilis & German measles
67. A pregnant client mentions that at times she feels very tired. Your best response to her is: a. “You’re probably working too much. You must cut down your activities & get more rest.” b. “Fatigue is normal occurrence as your body adjusts to pregnancy. But try to find out if you can have extra periods for rest.” c. “This will pass as you go on with your pregnancy.” d. “You need to see your doctor immediately. Something is wrong with your pregnancy.” 68. When talking with a pregnant client who is experiencing aching, swollen leg veins, the nurse would explain that this is most probably the result of which of the following? a. Pregnancy-induced hypertension b. Thrombophlebitis c. The force of gravity pulling down on the uterus d. Pressure on blood vessels from the enlarging uterus 7
69. The underlying cause of hypoglycemia in infant of diabetic mother is due to: a. lack of glucose source with high level of insulin in extrauterine life b. depleted level of both glucose and insulin c. high level of glucose but with depleted source of insulin d. high level of both glucose and insulin 70. Preferred method of delivery of overt diabetic pregnant women a. forcep b. NSD c. CS d. induced 71. These are the management of diabetic gravida mother, EXCEPT: a. encourage to eat complex form of carbohydates b. administer oral hypoglycemic agent as ordered c. inject insulin per SC prn d. perform diagnostic procedures to determine fetal well being and placental insufficiency Situation: Elena believes that she is pregnant since she missed her period for 2 months. She likewise is experiencing nausea and vomiting with positive pregnant test result. Ultrasound revealed no fetal parts and no fetal heart activity. HCG titer revealed abnormally high level. 72. An increasing titer of HCG after D&C may indicate: a. Choriocarcinoma b. DIC c. Uterine rupture
d. Rh incompatibility
73. Which prophylactic drug is most expected to be given to Elena? a. Oxytocin b. Methergin c. Methothrexate d. Dexamethasone 74. The client has come to the family planning clinic to discuss the use of contraceptives. The nurse should do which of the following to facilitate a productive discussion? a. Only discuss contraceptive option with the married client if partner is present b. Instruct the client in which contraceptive option she should use. c. Inform the client about use, side effects, and effectiveness of different contraceptive option so that the client can select one that meets her needs. d. Avoid discussion of side effects as this might frighten the client and result in her not using contraceptive. 75. Which of the following statement by a male client would indicate that he understands the instructions for use of a condom? a. “I should lubricate the condom with an oil-based product to avoid friction that could rupture the condom.” b. “I should unroll the condom and check it for hole before applying it.” c. “I should hold the rim of the condom while withdrawing my penis from the vagina to avoid leakage.” d. “I should begin sexual intercourse without the condom and don the condom just before ejaculation.” 76. A client at 8 months gestation is diagnosed with oligohydramnios. She asks the nurse if this can harm the fetus. The nurse’s best response is: a. “Yes, oligohydramnios can lead to umbilical cord compression.” b. “Yes, it means the fetus swallowed too much fluid.” c. “No, this commonly occurs toward the end of pregnancy.” d. “No, this is a sign that the lungs are maturing.”
77. In explaining to the client who has come in for her initial prenatal exam the reason why it is important to test pregnant women for gonorrhea, the nurse should tell the client that gonorrhea can cause neonatal: a. Vaginal discharge c. Liver damage b. Eye infections d. Congenital anomalies. 78. A client continues to pass large amount of clots and bright red lochia despite the nurse’s attempt to massage the fundus. Upon reexamination, the nurse finds that the client’s uterine fundus remains boggy. 8
The nursing actions and oxytocin (Pitocin) do not seem to be helping to keep the fundus firm. What second medication might the physician request the nurse to administer to manage uterine atony? a. Dinoprostone (Cervidil). c. Magnesium sulfate b. Terbutaline sulfate (Brethine) d. Carboprost (Protin 15-M or Hemabate) 79. If the nurse suspects a uterine infection in the postpartum, the nurse should assess the: a. Pulse and blood pressure c. Episiotomy site b. Odor of the lochia d. The abdomen for distention. 80. A postpartal client develops a temperature during her postpartal course. Which of the following temperatures indicate the presence of postpartal infections? a. 99.O 0 F 12 hours after delivery that decrease after 18 hours. b. 100.2 0 F 24 hours after delivery that decreases the second postpartum day. c. 100.4 0 F 24 hours after delivery that remains until the second postpartum day. d. 100.6 0 F 48 hours after delivery that continues into the third postpartum day. 81. Semen analysis of Mrs. Lagdameo’s husband is requested. Which of the following should NOT be a part of the instruction to be given to the husband? a. Abstain from intercourse for several days then collect fresh ejaculate for testing b. Immerse the specimen in a tumbler of ice cubes and transport it immediately to the testing facility c. Keep the specimen warm by placing the container under the arm or close to the skin d. Entire specimen is collected in a clean, dry container and immediately transported to the laboratory 82. Aimee, 31 year old woman has been pushing in the second stage of labor for 2 hours. The vertex is at the +2 station. Each contraction is associated with a fetal bradycardia as low as 100 beats per minute (bpm) that lasts for 30 seconds. This clinical scenario suggests which of the following situations? a. Systemic fetal hypoxia c. An association with oligohydramnios b. Poor fetal outcome d. Fetal head compression 83. Kim with ruptured membranes is in the active phase of labor and is 5-cm dilated with sustained, deep variable decelerations. The decision is made to perform a cesarean section. Which of the following would not be an appropriate intrauterine resuscitative measure done before the cesarean section? a. Increase the intravenous fluids c. Start nasal oxygen b. Place the client in supine position d. Start amnioinfusion 84. After having identified a fetus at risk in prolonged pregnancy, management should consist of: a. Amniocentesis for maturity studies b. Delivery regardless of the status of the cervix c. Fetal sampling of scalp pH d. Measurement of human chorionic somatomammotropin 85. Which of the following findings would be unexpected in the progression of a normal pregnancy? a. A weight gain of 11 lbs at 20 weeks b. Fetal heart tones at 13 weeks detected by Doppler ultrasound c. The fundus of the uterus at the level of the umbilicus at 20 weeks d. Real-time ultrasonographic evidence of fetal heart motion 4 weeks after the last menstrual period (LMP). 86. Bernadette who is known to use cocaine presents with seizures, a temperature of 1040F, and a blood pressure of 180/120. She is 36 weeks pregnant. After a thorough evaluation, the physician excludes preeclampsia and intrauterine infection. The diagnosis is cocaine toxicity. Action to be taken include all of the following except: a. delivering the infant expeditiously b. providing oxygen and considering intubation c. providing a cooling blanket d. treating with intravenous propanolol
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87. Factors that are important in the pathophysiology of pelvic inflammatory disease (PID) include all of the following except: a. intrauterine device use b. intercourse c. menstruation d. uterine fibroids 88. A class II cardiac patient Alena, who is 38 weeks pregnant presents to the hospital in labor with dyspnea on exertion and chest rales. Proper management of this management of this pregnant patient includes all of the following except: a. epidural anesthesia b. diuretics c. cesarean delivery d. digitalis 89. Portia presents to the labor floor complaining of painful contractions that occur every 2 minutes. She is 2 cm dilated. Two hours later, she continues to complain of frequent painful contractions, but she is still only 2 cm dilated. What is the diagnosis that describes Portia’s condition? a. False labor c. Hypotonic uterine dysfunction b. Hypertonic uterine dysfunction d. Active phase of labor 90. Freda presents to the labor floor with contractions 8 to 12 minutes apart. She complains of lower abdominal discomfort with her contractions, which last for only 20 seconds each. Sedation causes the contraction to be spaced at intervals of 15 to 20 minutes. a. False labor c. Hypotonic uterine dysfunction b. Hypertonic uterine dysfunction d. Active phase of labor 91. When preparing a 20-year-old client who reports missing one menstrual period and suspects that she is pregnant for a radioimmunoassay pregnancy test, which of the following would the nurse need to keep in mind about this test? a. It has high degree of accuracy within 1 week after ovulation b. It is identical in nature to an over-the-counter home pregnancy test c. A positive result is considered a presumptive sign of pregnancy d. A urine sample is needed to obtain quicker results 92. A client about 8 weeks pregnant, asks the nurse when will she be able to hear the fetal heartbeat. The nurse would respond by telling the client that the fetal heartbeat can be heard with a Doppler ultrasound device when the gestation is as early as which of the following? a. 4 weeks b. 8 weeks c. 15 weeks d. 18 weeks 93. Which of the following refers to a creamy-cheese-like substance which serves as protective covering during intrauterine life? a. Operculum b Lanugo. c. Vernix caseosa d. Canal
94. Which of the following is NOT observed in Leboyer method? a. Birth occurs in a well-lighted and quiet room b. The cord is cut after the pulsation ceases c. Neonate is placed immediately on the mother’s abdomen d. Neonate is immersed in a tub of warm water 95. A pregnant client verbalizes that she plans to breastfeed her baby. Which of the following measures will be most effective to ensure adequate milk secretion? a. Use breast pump in expressing milk b. Manual expression of breastmilk c. Allow the newborn to empty each breasts alternately d. Increase intake of hot soups and milk Situation: Anna is 24 weeks AOG. She complains of “hardening” of her uterus every 10 minutes. She is admitted with a diagnosis of threatened premature labor, 24 weeks AOG. 96. Which of the following will be the immediate nursing intervention for Anna? a. Give her sedatives c. Place her on complete bed rest b. Allow her to have bathroom privileges d. Start fluids as ordered 10
c. 97. Terbutaline sulfate was ordered. Anna developed palpitations after 1 hour of Terbutaline sulfate infusion. What is the immediate nursing action for this problem? a. Stop the infusion c. Secure order for beta blockers b. Replace IV infusion with oral dose d. Regulate the infusion according to cardiac rate c. 98. In a complete hydatidiform mole, which of the following karyotypes is typically found? a. 46 xx b. 69 xxy c. 69 xxx d. 69 xxy b. 99. Ara is complaining of painful contractions, or after pains, on postpartum day 2. Which of the following conditions could increase the severity of after pains? a. Bottle-feeding c. Multiple gestation b. Diabetes d. Primiparity 100. Mrs. Kristina is in her 2nd trimester and admitted in the hospital with a chief complaint of hypertension. With BP= 170/100. Further assessment revealed edema on face and upper extremities. Mrs. Kristina is diagnosed of PIH. Which of the following statements is INCORRECT regarding this condition? a. Occurs most frequently in primiparas younger than age 20 years or older than 40 years b. The cause is unknown c. Danger of seizure is present until 24 hours post-partum d. Seizure usually occurs 72 hours after birth
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