OBSTETRIC NURSING: ABNORMALS

BY: CLIFFORD MIGUEL PACIO BSN, RN, LPT, MDu

1. In selecting the BEST contraceptive methods, which of the following should be at the highest priority?
a. The culture of the couple
b. The religious belief of the couple
c. The expert opinion of the nurse
d. The acceptance of the couple
• Rationale: The couple’s acceptance is the most crucial factor in contraceptive use since they must be
willing and comfortable with the chosen method for it to be effective.3333

2. Mr. and Mrs. Chinoepah, a couple in their late twenties, happily received the news that Mrs. Chinoepah is
pregnant. A year before, Mrs. Chinoepah had a spontaneous abortion at the sixteenth week. It is determined that
she is 8 weeks pregnant and healthy. While in the office for a prenatal checkup during the 12th week of her
pregnancy, Mrs. Chinoepah says to the nurse, “Every day I wonder if I’ll ever have this child.” The nurse’s best
response will be:
a. “You have the best doctor’s possible. What was the problem with your previous pregnancy?”
b. “I can understand why you’re worried. You will have other chances in the future.”
c. “It must be difficult to lose something that was important to you both.”
d. “It’s understandable for you to feel concerned that you may not carry this pregnancy to term.”
• Rationale: This response acknowledges the patient’s feelings and reassures her without dismissing her
concerns. It validates her emotions and provides empathetic support.

3. Sixteen weeks into her pregnancy, Mrs. Chinoepah begins to experience heavy bleeding and severe
abdominal cramping. She is admitted to the hospital with an incomplete abortion. Her doctor orders a dilatation
and curettage (D&C). She says to the nurse, “We wanted this baby so much.” The nurse’s best response would
be:
a. “You must be disappointed, but don’t feel guilty. These things sometimes happen.”
b. “It is not your fault. This is nature’s way of making sure the baby will have no problems.”
c. “It must be difficult to lose something that is important to you both.”
d. “The D&C will give you a new start. I bet you’ll become pregnant again soon.”
Answer: C. “It must be difficult to lose something that is important to you both.”
• Rationale: This response shows empathy and acknowledges the patient’s grief rather than offering false
reassurances or dismissing emotions.

4. Mrs. Chinoepah tells the nurse that her doctor explained that she had an incomplete abortion, but she does not
understand what it means. Which best response should the nurse give to the question?
a. “I think it would be best if you asked your doctor to explain it again.”
b. “An incomplete abortion means fetal tissue is retained but needs to be removed.”
c. “I really don’t think you should dwell on what happened right now.”
d. “This is when the fetus dies but is retained in the uterus for 8 weeks or more.”
• Rationale: This provides a clear and factual explanation without causing unnecessary distress to the
patient.

5. The evening after the D&C, Mrs. Chinoepah says, “We’ve always wanted this pregnancy. How come this
happened to us again?” The nurse is aware that Mrs. Chinoepah is exhibiting the usual initial reaction to a loss:
a. Apathy and sadness
b. Shock and denial
c. Despair and anger
d. Dissociation and rationalization

6. When making rounds during the night, the nurse enters Mrs. Chinoepah’s room and finds her crying. The
most appropriate action would be:
a. Document on the chart that Mrs. Chinoepah is having difficulty accepting the loss of her baby
b. Pull the curtain to provide privacy for Mrs. Chinoepah
c. Sit down and stay with Mrs. Chinoepah, allowing her to cry
d. Explain to Mrs. Chinoepah that her feelings are normal for delivery and diet

7. A couple who is unable to conceive after consistent attempts for a 1-year period is termed:
a. Sterility
b. Infertility
c. Impotent
d. Anovulation
• Rationale: Infertility is defined as the inability to conceive after one year of regular unprotected
intercourse. Sterility, on the other hand, refers to the absolute inability to conceive, while anovulation is
the failure of the ovary to release an egg.

8. Absolute factor making a person unable to produce offspring:

a. Lack of lubrication
b. Infertility
c. Impotent
d. Anovulation
• Answer: a. Sterility (Corrected choice: If "sterility" were present, it would be the most accurate answer, but
since it's not listed, none of these fully define absolute infertility.)
• Rationale: Absolute infertility, also known as sterility, means a person is permanently unable to
reproduce. Infertility (choice b) may be reversible or treatable. Impotence (choice c) refers to the
inability to maintain an erection, which is not the same as sterility. Anovulation (choice d) is the failure
to ovulate, but it is not necessarily permanent.

9. This is the abnormal development of placental villi into grape-like cysts:

a. Ectopic Pregnancy
b. Gestational Trophoblastic Disease
c. Hydatidiform Mole
d. Extrauterine Implantation

10. The nurse is assessing a pregnant woman. Which signs or symptoms indicate a hydatidiform mole?
a. Rapid fetal heart tones
b. Abnormally high human chorionic gonadotropin (hCG) levels
c. Slow uterine growth
d. Lack of symptoms of pregnancy
• Rationale: Hydatidiform moles produce excessive hCG, leading to exaggerated pregnancy
symptoms such as severe nausea, vomiting, and rapid uterine enlargement.

11. A client has just expelled a hydatidiform mole. She's visibly upset over the loss and wants to know when she
can try to become pregnant again. Which of the following would be Nurse Cole Bhoy's best response?
a. "I can see you're upset. Why don't we discuss this with you at a later time when you're feeling better?"
b. "She's not upset right now; however, you must wait at least 1 year before becoming pregnant again."
c. "Let me check with your physician and get you something that will help you relax."
d. "Pregnancy should be avoided until all of your testing is normal."

SITUATION: Mrs. Naty Rah, 9 months pregnant, is admitted with placenta previa.

12. The nurse following the physician’s orders begins administering oxygen by mask. The client’s apprehension
is increasing, and she asks what is happening. The nurse tells her not to worry, that she is going to be all right
and everything is under control. The nurse’s statements are:
a. Correct, since only the physician should explain why treatments are being done
b. Proper, since the client’s anxieties would be increased if she knew the dangers
c. Adequate, since all preparations are routine and need no explanation
d. Questionable, since the client has the right to know what treatment is being given and why
13. Care of Mrs. Naty Rah includes:
a. Withholding food and fluids
b. Encouraging ambulation with supervision
c. Inspecting for hemorrhage
d. Avoiding all extraneous stimuli
• Rationale: Placenta previa increases the risk of hemorrhage, so continuous monitoring for
bleeding is crucial. Ambulation is contraindicated, as it may worsen bleeding.

14. If a vaginal examination is to be performed on Mrs. Naty Rah, the nurse must be prepared for an immediate:
a. Induction of labor
b. Cesarean delivery
c. Forceps delivery
d. X-ray examination
• Rationale: A vaginal examination can trigger massive hemorrhage in placenta previa, so
emergency cesarean section should be anticipated.

SITUATION: Nina, a 39-year-old primipara, is admitted for sonography due to a large-for-gestational-

age uterus.

15. Before the test begins, Nina complains of severe abdominal pain, her BP drops from 120/80 to 102/60, and
her pulse increases from 80 to 104. Heavy vaginal bleeding begins with the onset of pain. The nurse should
suspect:
a. Marginal placenta previa
b. Complete abruptio placentae
c. Vena cavae syndrome
d. Hydatidiform mole
• Rationale: Abruptio placentae presents with sudden pain, vaginal bleeding, hypotension, and
tachycardia, indicating placental separation.

16. The nurse notifies the physician and immediately prepares for:
a. A high forceps delivery
b. An immediate cesarean section
c. The insertion of a fetal monitor
d. The administration of oxytocin (Pitocin)

17. Nina is prepared for delivery. Care should include obtaining:

a. An abdominal prep and administration of a fleet enema
b. Inserting a Foley catheter and administration of a tap water enema
c. Obtaining informed consent and assessing for drug allergies
d. Assessing and teaching coughing and deep-breathing techniques

SITUATION: A woman with placenta previa at 30 weeks is admitted.

18. To help avoid premature delivery, the nurse anticipates the client will:
a. Receive a blood transfusion
b. Be placed on bed rest
c. Receive Betamethasone
d. Avoid sexual intercourse upon discharge
• Rationale: Betamethasone is a corticosteroid given to enhance fetal lung maturity in case of
preterm birth.

19. The nurse realizes that the discharge instructions are understood when the client tells her husband:
a. “We can’t have sex.”
b. “I have to return in a few days for a vaginal exam.”
c. “I will have to have a cesarean for this and other pregnancies.”
d. “I can go back to part-time work beginning tomorrow.”

20. A woman at 35 weeks comes to the emergency department with painless vaginal bleeding. In caring for her,
the nurse should avoid:
a. Allowing her husband to stay with her
b. Keeping her at rest
c. Shaving the perineum
d. Performing a vaginal examination

21. A woman with placenta previa at 38 weeks has ruptured membranes, greenish amniotic fluid, and has started
bleeding again. The nurse should immediately:
a. Administer oxygen
b. Place her in Trendelenburg’s position
c. Call the physician and prepare for a cesarean birth
d. Move her to the delivery room immediately

SITUATION: Mrs. Fuke Thailand, age 20, is 37 weeks pregnant. She is admitted with preeclampsia and
sudden abdominal pain.

22. On Mrs. Fuke Thailand’s admission to the unit, the nurse should observe for:
a. Decrease in size of the uterus, cessation of contractions, visible or concealed hemorrhage
b. Firm and tender uterus, concealed or external hemorrhage, shock
c. Increase in size of the uterus, visible bleeding, no associated pain
d. Shock, decrease in size of the uterus, absence of external bleeding
• Rationale: A firm and tender uterus suggests placental abruption, a complication of preeclampsia.
Bleeding can be concealed or external, leading to hypovolemic shock.

23. Mrs. Fuke Thailand is given a unit of blood. The nurse realizes that this is necessary since the bleeding
following severe abruptio placentae is usually caused by:
a. Hypofibrinogenemia
b. Hyperfibrinogenemia
c. Thrombocytopenia
d. Polycythemia
• Rationale: Hypofibrinogenemia (low fibrinogen levels) occurs due to disseminated intravascular
coagulation (DIC), a common consequence of abruptio placentae, leading to severe bleeding.

SITUATION: Pennice, aged 18, has begun to show early signs of PIH (Pregnancy-Induced Hypertension).

24. Which of the following statements best indicates that Pennice may have PIH?
a. There is an increase in renal and uterine circulation because of vascular constriction
b. There is a decrease in aldosterone production and an increase in fluid retention
c. There is an increase in circulating blood volume and a decrease in cardiac output
d. There is a decrease in renal and uterine circulation because of vascular constriction
• Rationale: PIH causes vasoconstriction, which leads to decreased renal and uterine perfusion,
increasing the risk of fetal distress and maternal complications.

25. Pennice’s symptoms worsen, and she is admitted to the hospital. The physician orders an IV of 200 ml
magnesium sulfate diluted in 10% dextrose in water. Which of the following findings would most likely lead the
nurse to withhold magnesium sulfate and notify the physician?
a. An apical pulse of 75/min
b. A hyperactive knee-jerk reflex
c. A respiratory rate of less than 12/min
d. A urinary output of 50 ml/hr
• Rationale: Hyperactive reflexes indicate impending seizures (eclampsia) in severe PIH.
Magnesium sulfate is given to prevent seizures, but it should be withheld if there are signs of
toxicity (e.g., respiratory depression, absent reflexes, or oliguria).

26. Pennice’s labor is to be induced with 10 units of Oxytocin (Pitocin). After the oxytocin is started, Pennice
becomes very uncomfortable during contractions and states, “I don’t think I’ll be able to stand this pain.” What
would be the most appropriate initial action?
a. Call the physician
b. Give an analgesic
c. Help her try some breathing exercises
d. Increase the rate of the IV
• Rationale: Non-pharmacologic pain relief methods such as breathing exercises should be tried
first before resorting to medication.

27. Pennice delivers a healthy infant at 38 weeks gestation. On Pennice’s first postpartum day, the nurse finds
that her fundus is boggy. What is the first action the nurse should take?
a. Lower the head of the bed
b. Firmly massage her boggy fundus
c. Give 1 ampule of Oxytocin (Pitocin) intramuscularly
d. Take her vital signs
• Rationale: A boggy uterus indicates uterine atony, which can cause postpartum hemorrhage.
Fundal massage is the immediate intervention to stimulate uterine contractions.

28. A woman with severe PIH delivered two hours ago. Which action should be included in continuing the plan
of care for her postpartum hospital stay?

a. Continuing to monitor blood pressure, respirations, and reflexes

b. Encouraging frequent family visitors
c. Keeping her NPO
d. Maintaining an IV access to the circulatory system
• Rationale: Postpartum women with severe PIH remain at risk for seizures, hypertension, and
respiratory depression, requiring close monitoring.

SITUATION: The physician examines Mrs. Fake Fick and determines that she is 35 weeks pregnant and
that she has PIH. She is admitted to the hospital. She is receiving an IV, and she is started on IV
Magnesium sulfate therapy. An indwelling catheter is inserted and attached to gravity drainage. Mrs.
Fake Fick’s mother is with her.

29. The major purpose of magnesium sulfate therapy for Mrs. Fake Fick is to:
a. Increase kidney perfusion
b. Increase CNS irritability
c. Reduce proteinuria
d. Reduce CNS irritability

30. Mrs. Fake Fick is observed for adverse reactions to the magnesium sulfate therapy, which include:
a. Hematuria
b. Tinnitus
c. Decreased respiratory rate
d. Increased respirations

SITUATION: Mrs. Fukikoh, 27 years old, has type 1 DM. She and her husband want to have a child, so
they consulted her diabetologist, who gave her information on pregnancy and diabetes.

31. Of primary importance for the diabetic woman who is considering pregnancy should be:
a. A review of the dietary modification that is necessary
b. Early prenatal medical care
c. Adoption instead of conception
d. Understanding that this is a major health risk to the mother
• Rationale: Early prenatal care is essential for preconception counseling, glycemic control, and
reducing the risk of congenital anomalies in infants of diabetic mothers.

32. The nurse knows that Mis, Fukikoh understands her dietary needs when she says:
a. I will eat low protein foods
b. I will continue my normal intake of simple carbohydrates
c. I will increase my water consumption
d. 50 % of the foods I eat will be bread, grains and vegetables

33. The nurse knows that Mrs. Fukikoh understands the management of her diabetes during pregnancy when
she says, “My blood sugar level should be”
a. 80 to 110 mg/dL
b. 150 to 200 mg/dL
c. 200 to 250 mg/dL
d. No greater than 300 mg/dL
• Rationale: During pregnancy, tight glucose control is essential to prevent complications like fetal
macrosomia and neonatal hypoglycemia. The recommended fasting blood glucose level in
pregnant diabetic women is 80–110 mg/dL to minimize risks to both mother and baby.

34. The nurse is assessing Mrs. Fukikoh for signs and symptoms of hyperglycemia. Which symptom does NOT
indicate hyperglycemia?
a. Lethargy
b. Polyuria
c. Thirst
d. Sweating

35. Mrs. Fukikoh asks the nurse if there are any special problems that she might encounter during labor and
delivery because of her diabetes. The nurse responds that during labor and delivery, diabetic mothers may
develop:
a. Hypoglycemia
b. Hyperglycemia
c. Metabolic alkalosis
d. Hyperosmolar nonketotic coma
• Rationale: Labor is a high-energy-demanding process that can cause rapid drops in blood sugar
levels in diabetic mothers. Frequent glucose monitoring and IV glucose administration may be
required to prevent hypoglycemia.

36. When assessing a client during her first prenatal visit, the nurse discovers that the client had a reduction
mammoplasty. The mother indicates she wants to breast-feed. What information should the nurse provide?
a. “It’s contraindicated for you to breast-feed following this type of surgery.”
b. “I support your commitment; however, you may have to supplement each feeding with formula.”
c. “You should check with your surgeon to determine whether breast-feeding would be possible.”
d. “You should be able to breast-feed without difficulty.”
• Rationale: Reduction mammoplasty can disrupt milk ducts and nerve supply, potentially
reducing milk production. Some women can breastfeed successfully, but supplementation may
be necessary.

37. A client has meconium-stained amniotic fluid. Fetal scalp sampling indicates a blood pH of 7.12; fetal
bradycardia is present. Based on these findings, the nurse should:
a. Administer amnioinfusion.
b. Prepare for cesarean delivery.
c. Reposition the client.
d. Start IV oxytocin infusion as prescribed.

38. After developing severe hydramnios, a primigravid client exhibits dyspnea, along with edema of the legs
and vulva. Which procedure should the nurse expect her to undergo and why?
a. Artificial rupture of the membranes to reduce uterine pressure
b. Amniocentesis to temporarily relieve discomfort
c. IV oxytocin administration to induce labor
d. Cesarean delivery to prevent further fetal damage

39. The nurse is teaching a client with gestational diabetes about insulin therapy. Which statement by the client
indicates effective teaching?
a. “I won’t use insulin if I’m sick.”
b. “I need to use insulin each day.”
c. “If I give myself an insulin injection, I don’t need to watch what I eat.”
d. “I’ll monitor my blood glucose levels twice a week.”

40. A diabetic client in labor tells the nurse she has had trouble controlling her blood glucose level recently. She
now reports increased nausea and a flushed feeling. The nurse notes a fruity odor to her breath. What do these
findings suggest?
a. Diabetic ketoacidosis (DKA)
b. Hypoglycemia
c. Infection
d. Transition to the active phase of labor
• Rationale: DKA occurs due to insulin deficiency, leading to hyperglycemia, ketosis, metabolic
acidosis, and dehydration. The fruity breath odor is due to ketone production.

41. A client is receiving ergonovine (Ergotrate Maleate) to treat postpartum hemorrhage. Which are common
adverse reactions?
a. Abdominal cramps and diarrhea
b. Nausea and vomiting
c. Headache and facial flushing
d. Blurred vision and dizziness
• Rationale: Ergonovine is an ergot alkaloid that stimulates uterine contractions but often causes
nausea and vomiting as side effects.

42. Why must oxytocin therapy require close fluid monitoring?

a. Because oxytocin causes water intoxication.
b. Because oxytocin causes excessive thirst
c. Because oxytocin has a diuretic effect
d. Because oxytocin is toxic to the kidney
• Rationale: Oxytocin has an antidiuretic effect, which can cause fluid retention and hyponatremia,
leading to water intoxication.

43. A client with moderate pregnancy-induced hypertension (PIH) is a poor candidate for regional anesthesia
because it may cause:
a. Hypotension.
b. Hypertension.
c. Seizures.
d. Renal toxicity.
• Rationale: Regional anesthesia can cause vasodilation, leading to severe hypotension, which can
compromise placental perfusion.

44. A primigravid client is admitted to the labor and delivery area. Assessment reveals fetal malpresentation,
yellow amniotic fluid, and a fetal heart rate (FHR) of 98 beats/min. What should the nurse do?
a. Increase the IV oxytocin flow rate, as ordered, to hasten labor and delivery.
b. Prepare for emergency cesarean delivery.
c. Help the client into the lithotomy position for delivery.
d. Reassess the client for continued normal findings in 15 minutes.

45. After admission to the labor and delivery area, a client undergoes routine tests, including a complete blood
count, urinalysis, Venereal Disease Research Laboratory test, and gonorrhea culture. The gonorrhea culture is
positive, although the client lacks signs and symptoms of this disease. What is the significance of this finding?
a. Maternal gonorrhea may cause a neural tube defect in the fetus.
b. Maternal gonorrhea may cause an eye infection in the neonate.
c. Maternal gonorrhea may cause acute liver changes in the fetus.
d. Maternal gonorrhea may cause anemia in the neonate.

46. A client is admitted to the emergency department at 37 weeks’ gestation after a motor vehicle accident and is
diagnosed with a fractured femur that will need surgical repair. What efforts on the part of the operating room
team will best avoid risk to the fetus during the procedure?
a. Use general anesthesia to avoid vasodilatation.
b. Hydrate with 5% dextrose in lactated Ringer’s solution.
c. Monitor the fetus with a scalp lead during the procedure.
d. Position the client on her left side and prop her with a wedge.

47. A pregnant client’s blood tests show HELLP syndrome. Which abnormal blood component is found with
these results?
a. Low platelet count
b. High platelet count
c. High fibrin split product level
d. Low fibrin split product level

48. A 22-year-old woman arrives at the emergency department with abdominal pain. Which signs and symptoms
would lead the nurse to suspect ectopic pregnancy?
a. Unilateral cramps and tenderness, nausea and vomiting, and a missed menses
b. Epigastric or periumbilical pain, tenderness at McBurney’s point, and nausea and vomiting
c. Mild to severe uterine cramping, amenorrhea followed by spotting, and slightly enlarged uterus
d. Pain in both lower quadrants, bilateral tenderness on movement of the cervix, and infrequent nausea and
vomiting

49. A 22-year-old client has been admitted to the hospital with severe preeclampsia. An infusion of magnesium
sulfate is started to decrease the incidence of seizure activity. The nurse assesses the client frequently to monitor
for signs of magnesium toxicity. Which assessment finding is a sign of possible magnesium toxicity?
a. Urine output of 30 to 40 ml/hour
b. Respiratory rate of 10 breaths/minute
c. Blood pressure of 140/80 mm Hg
d. Uterine contractions every 3 to 5 minutes

50. Which pregnancy-related disorder is characterized by painless vaginal bleeding, most commonly occurring
after 20 weeks’ gestation?
a. Placenta previa
b. Abruptio placentae
c. Threatened abortion
d. Spontaneous abortion

51. Which pregnant client is at risk for delivering a neonate with ABO incompatibility?
a. Type AB client with type O fetus
b. Type AB client with type A fetus
c. Type O client with type O fetus
d. Type O client with type A fetus

52. The history of a 45-year-old primigravida client shows that she was exposed to diethylstilbestrol (DES) as a
fetus. This client is at risk for which complication during her pregnancy?
a. Placenta previa
b. Incompetent cervix
c. Postterm pregnancy
d. Multiple gestation

53. Which client is at risk for Rh sensitization and therefore should receive RhoGAM as soon as possible?
a. An Rh-positive woman who delivers an Rh-negative neonate
b. An Rh-positive woman who has a tubal pregnancy
c. An Rh-negative woman who has a spontaneous abortion at 15 weeks
d. An Rh-negative woman who delivers an Rh-negative neonate

54. A client has arrived at the labor and delivery unit in active labor. The assessment reveals a history of
recurrent genital herpes and the presence of lesions in the genital tract. The nurse plans to:
a. Prepare the client for a cesarean delivery
b. Limit visitors and maintain reverse isolation
c. Prepare the client for spontaneous vaginal delivery
d. Rupture the membranes artificially, looking for meconium-stained fluid

55. Following delivery, the postpartum nurse instructs the client with known cardiac disease to call for the nurse
when she needs to get out of bed or when she plans to care for her infant. The nurse informs the mother that this
is necessary to:
a. Minimize the potential of postpartum hemorrhage
b. Help the mother assume the parenting role
c. Provide an opportunity for the nurse to teach infant care techniques
d. Avoid maternal/infant injury that may occur because of the potential for syncope or overexertion

56. A nurse is assigned to care for a woman with preeclampsia. The nurse plans to initiate which action to
provide a safe environment?
a. Turn off room lights and draw the window shades
b. Maintain fluid and sodium restrictions
c. Take the vital signs every four hours
d. Encourage visits from family and friends for psychological support

57. A nurse is caring for a client with severe toxemia of pregnancy. The client is receiving an intravenous
infusion of magnesium sulfate. Of the following items, which item is considered to be of highest priority to
have available?
a. Percussion hammer
b. Tongue blade
c. Potassium chloride injection
d. Calcium gluconate injection

58. A clinic nurse is caring for a pregnant client with herpes genitalis. The nurse provides instructions to the
mother regarding treatment modalities that may be necessary for treating this condition. Which of the following
statements made by the mother indicates an understanding of these treatment measures?
a. “I need to abstain from sexual intercourse until after delivery.”
b. “I need to use vaginal creams after the douche every day.”
c. “I need to douche and perform a sitz bath three times a day.”
d. “It may be necessary to have a cesarean section for delivery.”

59. A pregnant client tests positive for the hepatitis B virus. The client asks the nurse if she will be able to
breastfeed the baby as planned after delivery. Which of the following responses is most appropriate by the
nurse?
a. “Breastfeeding is not a problem as long as you use formula between feedings.”
b. “Breastfeeding is allowed if the baby receives prophylaxis at birth and remains on the scheduled
immunization.”
c. “Breastfeeding is allowed if you wait 6 months after delivery.”
d. “Breastfeeding is not advised, and you should seriously consider bottle-feeding the baby.”
• Rationale: Infants born to hepatitis B-positive mothers can breastfeed if they receive hepatitis B
immune globulin (HBIG) and the hepatitis B vaccine at birth.

60. A nurse is caring for a client with cervical cancer who has an internal radiation implant. Which of the
following items would the nurse ensure is kept in the client’s room during this treatment?
a. A bedside commode
b. A lead apron
c. Long-handled forceps and a lead container
d. A number 16 Foley catheter

61. During an assessment of a perinatal client with a history of left-sided heart failure, a nurse notes that the
client is experiencing unusual episodes of a nonproductive cough on minimal exertion. The nurse interprets that
this finding may be the first indicator of which important cardiac problem?
a. Orthopnea
b. Decreased blood volume
c. Right-sided heart failure
d. Pulmonary edema

62. A nurse is caring for a postpartum client. Which finding would make the nurse suspect endometritis in this
client?
a. Fever over 38°C, beginning 3 days postpartum
b. Lochia rubra on the second day postpartum
c. Elevated white blood cell count
d. Breast engorgement

63. A nurse is performing an assessment on a client with pregnancy-induced hypertension (PIH) who is in labor.
The nurse most likely expects to note:
a. Decelerations and increased variability of the fetal heart rate
b. Increased blood pressure
c. Decreased brachial reflexes
d. Increased urine output

64. A client in labor has a concurrent diagnosis of sickle cell anemia. Because the client is at high risk for a
sickling crisis, which action is the priority to assist in preventing a crisis from occurring during labor?
a. Reassure the client
b. Administer oxygen as ordered throughout labor
c. Maintain strict asepsis
d. Prevent bearing down

65. A nurse is assigned to care for a client with hypertonic labor contractions. The nurse plans to conserve the
client’s energy and promote rest by:
a. Avoiding uncomfortable procedures such as intravenous infusions or epidural anesthesia.
b. Assisting the client with breathing and relaxation techniques.
c. Keeping the room brightly lit so the client can watch her monitor.
d. Keeping the television (TV) or radio on to provide distraction.

66. A clinic nurse is caring for a client suspected of the diagnosis of pregnancy-induced hypertension (PIH). The
nurse assesses the client expecting to note which of the following if PIH is present?
a. Glycosuria, hypertension, and obesity
b. Edema, ketonuria, and obesity
c. Edema, tachycardia, and ketonuria
d. Hypertension, edema, and proteinuria

67. A nurse is caring for a pregnant client with a history of human immunodeficiency virus (HIV). Which
diagnosis, if formulated by the nurse, has the highest priority for this client?
a. Self-Care Deficit
b. Risk of Infection
c. Activity Intolerance

68. A nurse is caring for a client with pre-eclampsia. The nurse develops a plan of care knowing that if the client
progresses from pre-eclampsia to eclampsia, the nurse’s first action is to:
a. Administer IV magnesium sulfate
b. Assess the blood pressure and fetal heart tones
✔ c. Clear and maintain an open airway
d. Administer oxygen by face mask

69. A client at 10 weeks gestation is receiving prenatal care at a high-risk clinic. She is an insulin-dependent
diabetic. The nurse teaches the client about the early signs of hyperglycemia. The nurse evaluates the teaching
as effective when the client states that an early sign of hyperglycemia is:
✔ a. Polyuria
b. Nervousness
c. Shakiness

70. A postpartum client with gestational diabetes is scheduled for discharge. During the discharge teaching, the
client asks the nurse, “Do I have to worry about this diabetes anymore?” The best response by the nurse is
which of the following?
a. “Your blood glucose level is within normal limits now, you will be all right.”
b. “You will only have to worry about the diabetes if you become pregnant again.”
✔ c. “You will be at risk for developing gestational diabetes with your next pregnancy and developing diabetes
mellitus.”
d. “Once you have gestational diabetes, you have overt diabetes and must be treated with medication for the rest
of your life.”

71. A nurse is caring for a young woman dying from breast cancer. The nurse determines that a defining
characteristic of anticipatory grief is present when the woman:
a. Verbalizes unrealistic goals and plans for the future
✔ b. Discusses thoughts and feelings related to loss
c. Has prolonged emotional reactions and outbursts
d. Ignores untreated medical conditions that require treatment

72. A nurse determines a gravida 3, para 3 client is beginning to go into shock and is hemorrhaging as a result of
partial inversion of the uterus. The nurse pages the obstetrician STAT and calls for assistance. The client asks in
an apprehensive voice, “What is happening to me? I feel so funny, and I know I am bleeding. Am I dying?” The
nurse responds to the client, knowing that the client is feeling:
a. Panic secondary to shock
✔ b. Fear and anxiety related to unexpected and ambiguous sensations
c. Anticipatory grieving related to the fear of dying
d. Depression related to postpartum hormonal changes

73. A perinatal home health nurse has just assessed the fetal status of a client with a diagnosis of partial
placental abruption at 20 weeks gestation. The client is experiencing new bleeding and reports less fetal
movement. The nurse informs the client that the physician will be contacted for possible hospital admission.
The client begins to cry quietly while holding her abdomen with her hands. She murmurs, “No. no, you can’t
go, my little man.” The nurse recognizes the client’s behavior as an indication of:
a. Pain related to abdominal tetany
b. Cognitive confusion secondary to shock
✔ c. Anticipatory grieving related to perceived potential loss
d. Situational crisis, death of fetus related to fear and loss

74. A primigravida client comes to the clinic and has been diagnosed with a urinary tract infection. She has
repeatedly verbalized concern regarding the safety of the fetus. Which of the following diagnoses is most
appropriate at this time?
a. Pain
b. Impaired Tissue Integrity
c. Urinary Tract Infection
✔ d. Fear

75. A nurse is planning interventions for counseling a maternal client newly diagnosed with sickle cell anemia.
The most important psychological intervention at this time would be which of the following?
a. Provide all information regarding the disease
✔ b. Provide emotional support
c. Allow the client to be alone if she is crying
d. Avoid the topic of the disease at all costs

76. A 20-year-old gravida 2 para 0 at 37 weeks gestation calls the nurse because she is experiencing contractions
every 7 to 8 minutes. Her first pregnancy ended with a spontaneous abortion at 18 weeks, and the client had a
MacDonald cerclage placed early in the current pregnancy. Which of the following instructions by the nurse is
the most appropriate?
a. “Try a warm bath and relaxation techniques to see if the contractions will go away.”
b. “You must wait until your contractions are every 5 minutes before going to the hospital.”
c. “You need to go to the hospital so we can stop your premature labor this time.”
✔ d. “You should go to the hospital to be evaluated and have the cerclage removed.”

77. Following administration of a tocolytic agent for preterm labor, which of the following would the nurse
report to the physician immediately?
a. FHR of 160 beats/min
b. Increase in maternal blood pressure
c. Maternal respiratory rate of 22
✔ d. Complaints of chest pain

78. When PROM occurs, which of the following provides evidence of the nurse’s understanding of the client’s
immediate needs?
a. The chorion and amnion rupture 4 hours before the onset of labor
✔ b. PROM removes the fetus’ most effective defense against infection
c. Care is based on fetal viability and gestational age
d. PROM is associated with malpresentation and possibly incompetent cervix

79. When uterine rupture occurs, which of the following would be the priority?
✔ a. Limiting hypovolemic shock
b. Obtaining blood specimens
c. Instituting complete bed rest
d. Inserting a urinary catheter

80. Which of the following would alert the nurse to the possibility of uterine inversion?
✔ a. Appearance of a large tissue mass within the vagin
b. Vaginal hemorrhage with hypervolemia
c. Dramatic increase in vaginal bleeding
d. Complaints of severe abdominal pain
81. Which of the following is the nurse’s initial action when umbilical cord prolapse occurs?
a. Begin monitoring maternal vital signs and FHR
✔ b. Place the client in a knee-chest position in bed
c. Notify the physician and prepare the client for delivery
d. Apply a sterile warm saline dressing to the exposed cord

82. Which nursing intervention is most likely to be included in the plan of care during the first postpartum day
for a woman with heart disease?
a. Push oral and IV fluids to stimulate diuresis and prevent fluid-volume overload
b. Encourage early ambulation and exercise to reduce the risk of thrombophlebitis
✔ c. Monitor vital signs, skin color, and pulmonary status to identify cardiac decompensation
d. Encourage breastfeeding on the first day to reduce the cardiac workload

83. Nursing assessments during the fourth stage of labor following placenta previa will include close monitoring
for signs of hemorrhage. This nursing decision is based on which rationale?
✔ a. The placenta was implanted in the lower uterine segment, where there are fewer muscle fibers to contract
the placental site
b. The area under an abrupted placenta never contracts as strongly as when there is no premature separation
c. Because the placenta was surgically removed, the uterine muscle does not contract as efficiently
d. The woman lost 250 mL of blood during the 3rd stage of labor

84. Anticipatory guidance planned for a woman with gestational diabetes who has just given birth includes
health teaching regarding self-care and health maintenance actions in the postpartum period. She wants to
breastfeed her infant. Which instruction should be emphasized as part of her postpartum plan?
a. Breastfeeding is contraindicated because it stimulates gluconeogenesis
b. Caloric needs are decreased during the postpartum period, so she must be alert for signs of hyperglycemia
c. Stress inhibits the flow of breast milk; she should breastfeed the infant before feeding herself so that she can
relax
✔ d. Hypoglycemia can inhibit the let-down reflex and decrease her milk supply, so she must try to prevent it

85. All women who are pregnant should be screened for gestational diabetes. Which event in the history of a
woman who is pregnant would signal an increased risk for gestational diabetes?
a. The father of the infant is a diabetic who is insulin-dependent
b. The woman’s sister is a diabetic who is insulin-dependent
c. The woman is 34 years old with her first infant
✔ d. The woman had a previous stillbirth at term

86. The obstetrician has just performed a vaginal exam on a woman who is a multipara in active labor. The
physician informs the nurse that the client is 7 cm dilated, 80% effaced, and station 0. The nurse should know
that station 0:
a. Measures the size of the midpelvis in relation to the fetal head
b. Means that the head is on the perineum
c. Means that the fetus has made no progress in descent
✔ d. Indicates that the head has passed the pelvic inlet

87. A client is a 17-year-old primigravida. At 30 weeks of gestation, she is diagnosed with iron deficiency
anemia. The client takes her iron and vitamin supplements sporadically because of unacceptable GI side effects
but eats many foods high in iron. In planning diet teaching, which nutrient will the nurse emphasize to promote
heme production?
a. Niacin
b. Vitamin A
c. Vitamin D
✔ d. Folic acid

88. A nurse is taking care of a woman who is a multipara at 42 weeks of gestation and having an induction
of labor. The oxytocin infusion has been running at 16 mU for 10 minutes. The nurse observes that the
frequency of contractions is 2 minutes, duration 60 to 80 seconds with moderate strength. The next contraction
is 100 seconds in duration with moderate strength. The nurse should:
a. Monitor changes in maternal pulse, BP, and fetal heart rate and observe contractions for a consistent pattern.
b. Monitor changes in fetal heart rate, start the mother on nasal oxygen, and notify the physician.
✔ c. Stop the infusion, turn the mother on her left side, start nasal oxygen, and notify the physician.
d. Reduce the infusion, monitor changes in contraction pattern and fetal heart rate, and observe closely.

89. For which reason must a woman with preeclampsia be carefully assessed for fluid intake and urine output?
a. Oliguria is a grave sign. ✔
b. Daily intake should never exceed 2000 mL.
c. Sudden diuresis can precipitate convulsion.
d. If urine is less than 100 mg/4 hours, a repeat bolus of magnesium sulfate is needed.

90. A woman who is pregnant verbalizes concern about the possibility of having to remain hospitalized for the
next 8 weeks because of her preeclampsia. The most therapeutic response the nurse could make would be:
a. “It may not be that bad if you keep busy.”
b. “Tell me what worries you the most.” ✔
c. “It’s so you will have a fine baby.”
d. “Maybe you should tell your doctor how you are feeling.”

91. A woman 36 weeks pregnant is admitted directly from the clinic, with a blood pressure of 146/98, puffy face
and hands, and “awful headaches and problems seeing.” Admission notes state: Admit for preeclampsia. Which
is correct?
a. Up as desired, activities as desired.
b. Assess deep tendon reflexes, amount and distribution of edema on every shift. ✔
c. Admission and daily weight.
d. Test urine for protein every 4 hours.

92. A woman experienced an incomplete spontaneous abortion. After evacuation of the uterus, an oxytocic agent
is ordered to prevent hemorrhage. An ergot product (e.g., ergonovine) is ordered. The nurse should know that
ergot products are contraindicated:
a. Until the uterus is emptied.
b. When the woman is hypotensive. ✔
c. If her religion prescribes the use of blood products.
d. If she is a candidate for receiving RhoGAM (immune globulin).

93. A client is admitted to the labor and delivery unit in active labor. Upon inspection, the nurse notes a papular
lesion on the perineum. Which initial action is most appropriate?
a. Document the finding.
b. Report the finding to the doctor. ✔
c. Prepare the client for a C-section.
d. Continue primary care as prescribed.

94. A client with a diagnosis of HPV is at risk for which of the following?
a. Hodgkin’s lymphoma
b. Cervical cancer ✔
c. Multiple myeloma
d. Ovarian cancer

95. During the initial interview, the client reports that she has a lesion on the perineum. Further investigation
reveals a small blister on the vulva that is painful to touch. The nurse is aware that the most likely source of the
lesion is:
a. Syphilis
b. Gonorrhea
c. Herpes
d. Condylomata

96. A client visiting a family planning clinic is suspected of having an STD. The most diagnostic test for
Treponema pallidum is:
a. Venereal Disease Research Lab (VDRL)
b. Rapid plasma reagin (RPR) ✔
c. Fluorescent treponemal antibody (FTA)
d. Thayer-Martin culture (TMC)

97. A 15-year-old primigravida is admitted with a tentative diagnosis of HELLP syndrome. Which laboratory
finding is associated with HELLP syndrome?
a. Elevated blood glucose
b. Elevated creatinine clearance
c. Elevated platelet count
d. Elevated hepatic enzymes ✔

98. The nurse is assessing the deep tendon reflexes of a client with preeclampsia. Which method is used to elicit
the biceps reflex?
a. The nurse places her thumb on the muscle insert in the antecubital space and taps the thumb briskly with the
reflex hammer. ✔
b. The nurse loosely suspends the client’s arm in an open hand while tapping the back of the client’s elbow.
c. The nurse instructs the client to dangle her legs as the nurse strikes the area below the patella with the
hammer.
d. The nurse instructs the client to place her arms loosely at her side as the nurse strikes the muscle insert just
above the wrist.

99. A diabetic multigravida is scheduled for an amniocentesis at 32 weeks’ gestation to determine the L/S ratio
and phosphatidylglycerol level. The L/S ratio is 1:1, and the presence of phosphatidylglycerol is noted. The
nurse’s assessment of this data is:
a. The infant is at low risk for congenital anomalies.
b. The infant is at high risk for intrauterine growth retardation.
c. The infant is at high risk for respiratory distress syndrome. ✔
d. The infant is at high risk for birth trauma.

100. Which observation in the newborn of a diabetic mother would require immediate nursing intervention?
a. Crying
b. Wakefulness
c. Jitteriness ✔
d. Yawning