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ANTEPARTUM

COMPLICATIONS
1. Which of the following statements best

describes hyperemesis gravidarum?


a. Severe anemia leading to electrolyte,
metabolic, and nutritional imbalances in the
absence of other medical problems
b. Severe nausea an vomiting leading to
electrolyte, metabolic, and nutritional imbalances
in the absence of other medical problems
c. Loss of appetite and continuous vomiting that
commonly results in dehydration and ultimately
decreasing maternal nutrients
d. Severe nausea and diarrhea that can cause
GI irritation and possibly internal bleeding

2. In which of the following clients would the


nurse suspect anemia?
a. Client in her first trimester with a
hemoglobin level of 12 g/dl
b. Client in her second trimester with
hemoglobin level of 11 g/dl
c. Client in her third trimester with
hemoglobin level of 8 g/dl
d. Client in her first trimester with a
hemoglobin of 10.5 g/dl

3. Which of the following would the nurse


identify as a classic sign of PIH?
a. Edema of the feet and ankles
b. Edema of the hands and face
c. Weight gain of 1 lb/week
d. Early morning headache

4. Which of the following medications would the


nurse expect to administer for prevention of
hemolytic disease of the fetus and newborn?
a. Magnesium sulfate
b. Diazepam
c. Rohm
d. Phenobarbia

5. Which of the following factors would the


nurse suspect as predisposing a client to
placenta previa?
a. Multiple gestation
b. Uterine anomalies
c. Abdominal trauma
d. Renal or vascular disease

6. Which of the following would the nurse


assess in a client experiencing abruptio
placentae?
a. Bright red, painless vaginal bleeding
b. Concealed or external dark red bleeding
c. Palpable fetal outline
d. Soft and nontender abdomen

7. Tracy King, a 35-year-old gravida II, para


0, comes to the clinic after her second
spontaneous abortion. She asks the
nurse, Why am I having miscarriages?
The nurses best response would be that
each case is different, but most
spontaneous abortion are linked to:
a. fetal defects incompatible with life
b. advanced maternal age
c. inadequate maternal nutrition
d. placental abnormalities

8. When caring for a patient with a possible


diagnosis of placenta previa, which of the
following admission procedures should the
nurse omit?
a. perineal shave
b. enema
c. urine specimen collection
d. blood specimen collection

9. Mary Santos came to the clinic in the last week


before her estimated date of confinement
complaining of headaches, blurred vision, and
vomiting. Suspecting advance PIH, the nurse
would best respond to Marys complaints with
which of the following statements?
a. The doctor probably will want to admit you for
observation.
b. The doctor probably will order bed rest at
home.
c. These are really dangerous signs.
d. The doctor will prescribe some medicine for
you.

10. Which of the following blood pressure


parameters indicates PIH? Elevation over
baseline of
a. 30 mmHg systolic and/or 15 mmHg
b. 40 mmHg systolic and/or 20 mmHg
c. 10 mmHg systolic and/or 5 mmHg
d. 20 mmHg systolic and/or 20 mmHg diatolic

11. What is the primary nursing diagnosis for a


client with ruptured ectopic pregnancy?
a. Anxiety
b. Pain
c. Fluid volume deficit
d. Anticipatory grieving

12. Early detection of an ectopic pregnancy is a


paramount in preventing a life-threatening
rupture. Which symptoms should alert the
nurse to the possibility of an ectopic
pregnancy?
a. abdominal pain, vaginal bleeding, and a
positive pregnancy test
b. hyperemesis and weight loss
c. amenorrhea and a negative pregnancy test
d. copious discharge of clear mucous and
prolonged epigastric pain

13. A client is admitted to the facility with a


suspected ectopic pregnancy. When
reviewing the clients health history for risk
factors for this abnormal condition, the nurse
expects to find:
a. a history of pelvic inflammatory disease
b. grand multiparity (five or more births)
c. use of an intrauterine device for one year
d. use of an oral contraceptive for 5 years

14. The nurse assesses a client for signs and


symptoms of ectopic pregnancy. What is the
most common finding associated with this
antepartum complication?
a. temperature elevation
b. vaginal bleeding
c. nausea and vomiting
d. abdominal pain

15. A 36-year-old client is admitted with a


possible ruptured ectopic pregnancy. When
planning the clients care, which of the
following procedures should the nurse
anticipate preparing the client for soon after
admission?
a. dilation and curettage
b. ultrasound
c. evacuation of the uterus
d. Oophorectomy

6. 5. A primigravida, admitted to the hospital at


12 weeks gestation complaining of
abdominal cramping, exhibits bright vaginal
spotting without cervical dilation. The nurse
determines that the client is most likely
experiencing which of the following types of
abortion?
a. Missed
c. Inevitable
b. Threatened
d. complete

17. A client in the first trimester of pregnancy arrives at


a health care clinic and reports that she has been
experiencing vaginal discharge. A threatened
abortion is suspected, and a nurse instructs the
client regarding management of care. Which
statement if made by the client indicates a need for
further education?
a. I will maintain strict bed rest throughout the
remainder of pregnancy.
b. I will avoid sexual intercourse until the bleeding
has stopped, and for 2 weeks following the last
evidence of bleeding.
c. I will count the number of perineal pads used on
a daily basis and note the amount and color of blood
on the pad.
d. I will watch for the evidence of the passage of
tissue.

18. A client whos 4 months pregnant with her


first child reports that she has had increasing
morning sickness for the past month. Nursing
assessment reveals a fundal height of 20 cm
and no audible fetal heart tones. The nurse
should suspect which complication of
pregnancy?
a. fetal demise
b. ectopic pregnancy
c. hyperemesis gravidarum
d. gestational trophoblastic disease

19. The nurse is for a client after evacuation of


a hydatidiform molar pregancy. The nurse
should tell the woman to:
a. wait 1 month before trying to become
pregnant again
b. make an appointment for follow-up
chorionic gonadotropin (HCG ) level
monitoring at the end of one year
c. discuss options for sterilization with the
physician
d. use birth control for one year

20. Which of the following best describes gestational


trophoblastic disease?
a. a hypertensive disorder of pregnancy that
develops after 20 weeks gestation and is
characterized by edema, hypertension, and
proteinuria
b. The implantation of products of conception in the
fallopian tubes, ovaries, cervix, or peritoneal cavity
c. Expulsion of the fetus and other products of
conception from the uterus before the fetus is viable
d. An alteration of early embryonic growth, causing
placental disruption, rapid proliferation of abnormal
cells, and destruction of the embryo.

21. A client whos 34 weeks pregnant is


experiencing bleeding caused by placenta
previa. The fetal heart tones are normal and
the client isnt in labor. Which nursing
intervention should the nurse perform?
a. allow the client to ambulate with assistance
b. perform a vaginal examination to check for
cervical dilation
c. monitor the amount of vaginal blood loss
d. notify the physician for a fetal heart rate of
130 beats/minute

22. The nurse is caring for a client with mild


active bleeding from placenta previa. Which
assessment indicates that an emergency
cesarean section may be necessary?
a. Increased maternal blood pressure of
150/100 mm Hg
b. Decreased amount of vaginal bleeding
c. Fetal heart rate of 80 beats/minute
d. Maternal heart rate of 65 beats/minute

23. A nurse in the postpartum unit is caring for


a client who has just delivered a newborn
infant following a pregnancy with a placenta
previa. The nurse reviews the plan of care
and prepares to monitor the client for which
of the following risks associated with placenta
previa?
a. Disseminated intravascular coagulation
b. Chronic hypertension
c. Infection
d. Hemorrhage

24. A maternity nurse is preparing for the admission of


a client in the third trimester of pregnancy who is
experiencing vaginal bleeding and has a suspected
diagnosis of placenta previa. The nurse reviews the
diagnosis of placenta previa and would question
which order?
a. Prepare the client for an ultrasound
b. Obtain equipment for external electronic fetal
heart rate monitoring]
c. Obtain equipment for a manual pelvic
examination
d. Prepare to draw a hemoglobin and hematocrit
blood sample

25. Which of the following factors would the


nurse suspect a predisposing a client to
placenta previa?
a. Multiple gestation
b. Uterine anomalies
c. Abdominal trauma
d. Renal or vascular disease

26. Which of the following would the nurse


most likely to find when assessing a pregnant
client with abruptio placenta?
a. excessive vaginal bleeding
b. rigid, board like abdomen
c. tetanic uterine contractions
d. premature rupture of membranes

27. A nurse is assessing a pregnant client in the


second trimester of pregnancy who was
admitted to the maternity unit with a
suspected diagnosis of abruptio placentae.
Which of the following assessment findings
would the nurse expect to note if this
condition is present?
a. Absence of abdominal pain
b. A soft abdomen
c. Uterine tenderness
d. Painless, bright red vaginal bleeding

28. An ultrasound is performed on a client at


term gestation who is experiencing moderate
vaginal bleeding. The results of the
ultrasound indicate that abruptio placentae is
present. Based on these findings, the nurse
would prepare the client for:
a. Complete bed rest for the remainder of the
pregnancy
b. Delivery of the fetus
c. Strict monitoring of intake and output
d. The need for weekly monitoring of
coagulation studies until the time of delivery

29. A clinic nurse is performing a prenatal


assessment on a pregnant client. The nurse
would implement teaching related to the risk
of abruptio placentae if which of the following
information was obtained on assessment?
a. The client has a history of hypertension
b. The client performs moderate exercise on
a regular daily schedule
c. The client is 28 years of age
d. This is the second pregnancy

30. Which of the following is described as


premature separation of a normally implanted
placenta during the second half of pregnancy,
usually with severe hemorrhage?
a. Placenta previa
b. Ectopic pregnancy
c. Incompetent cervix
d. Abruptio placentae

31. A client with pregnancy-induced


hypertension (PIH) probably exhibits which of
the following symptoms?
a. Proteinuria, headaches, and vaginal
bleeding
b. Headaches, double vision, and vaginal
bleeding
c. Proteinuria, headaches, and double vision
d. Proteinuria, double vision, and uterine
contractions

32. At 32 weeks gestation, a client is admitted


to the facility with a diagnosis of pregnancyinduced hypertension. Based on this
diagnosis, the nurse expects assessment to
reveal:
a. edema
c. fever
b. glycosuria
d. vomiting

33. When administering magnesium sulfate to a


client with preeclampsia, the nurse
understands that this drug is given to do
which of the following?
a. prevent seizures
b. reduce blood pressure
c. slow the process of labor
d. increase diuresis

34. The physician orders 5% dextrose in


Ringers solution and magnesium sulfate
intravenously for an adolescent client with
pregnancy-induced hypertension (PIH).
Before the magnesium sulfate is
administered, which of the following
assessments would be the priority?
a. fetal heart rate variability
b. maternal urinary output
c. fetal position
d. maternal respiratory rate

35. A client with eclampsia begins to


experience seizures. Which of the following
would the nurse do first?
a. Pad the side rails
b. Place a pillow under the left buttock
c. Insert a padded tongue blade into the
mouth
d. maintain a patent airway

36. A client with pregnancy-induced


hypertension is being treated on an
ambulatory basis, a bed rest for 3 days is
prescribed. The nurse encourages the client
to stay in bed and assume the:
a. supine position
b. side-lying position
c. semi-Fowlers position
d. slight Trendelenburgs position

37. A pregnant client in the last trimester has


been admitted to the hospital with a diagnosis
of severe preeclampsia. A nurse monitors for
complications associated with the diagnosis
and assesses the client for:
a. Any bleeding, such as in the gums,
petechiae, and purpura
b. Enlargement of the breasts
c. Periods of fetal movement followed by
quiet periods
d. Complaints of feeling hot when the room is
cool

38. A home care nurse visits a pregnant client


who has a diagnosis of mild preeclampsia
and who is being monitored for pregnancy
induced hypertension (PIH). Which
assessment finding indicates a worsening of
the preeclampsia and the need to notify the
physician?
a. Blood pressure reading is at the prenatal
baseline
b. Urinary output has increased
c. The client complains of a headache and
blurred vision
d. Dependent edema has resolved

39. Which of the following would the nurse


identify as a classic sign of PIH?
a. Edema of the feet and ankles
b. Edema of the hands and face
c. Weight gain of 1 lb/week
d. Early morning headache

40. A 39-year-old multiparous client at 39


weeks gestation diagnosed with class II heart
disease is admitted to the hospital in active
labor. Which of the following would the nurse
need to assess first after admission to the
birthing area?
a. time of last food and fluid intake
b. fetal position and station
c. contraction and frequency and intensity
d. ability to follow directions

41. When assessing a pregnant client with


diabetes mellitus, the nurse stays alert for
signs and symptoms of a vaginal or urinary
tract infection (UTI). Which condition makes
this client more susceptible to such
infections?
a. electrolyte imbalances
b. decreased insulin needs
c. hypoglycemia
d. glycosuria

42. Which of the following would the nurse


expect to include in the plan of care for a
client with diabetes who is in labor?
a. measuring urine output every 4 hours
b. administering insulin subcutaneously every
4 hours
c. checking deep tendon reflexes every 2
hours
d. monitoring blood glucose levels every hour

43. A nurse implements a teaching plan for a


pregnant client who is newly diagnosed with
gestational diabetes mellitus. Which
statement if made by the client indicates a
need for further education?
a. I will to stay on the diabetic diet.
b. I will perform glucose monitoring at
home.
c. I need to avoid exercise because of the
negative effects on insulin production.
d. I need to be aware of any infections and
report signs of infection immediately to my
health care provider.

44. The nurse is caring for a client with


hyperemesis gravidarum who will need close
monitoring at home. When should the nurse
begin to discharge planning?
a. On the day of discharge
b. When the client expresses readiness to
learn
c. When the clients vomiting has stopped
d. On admission to the facility

45. A client in the 13th week of pregnancy


develops hyperemesis gravidarum. Which
laboratory findings indicates the need for
intervention?
a. urine specific gravity 1.010
b. serum potassium 4 mEq/L
c. serum sodium 140 mEq/L
d. ketones in urine

46. A client, 2 months pregnant, has


hyperemesis gravidarum. Which expected
outcome is most appropriate for her?
a. Client will accept the pregnancy and stop
vomiting.
b. Client will gain weight according to the
expected pattern for pregnancy.
c. Client will remain hospitalized for the
duration of pregnancy to relieve stress.
d. Client will exhibit uterine growth within the
expected norms for gestational age.

47. When caring for a pregnant with


hyperemesis gravidarum, the nurse would
further assess the client for which of the
following?
a. abdominal pain
b. leaking amniotic fluid
c. pinkish vaginal discharge
d. dehydration

INTRAPARTUM
COMPLICATIONS
1. Which of the following may happen if the

uterus becomes overstimulated by oxytocin


during the induction of labor?
a. Weak contractions prolonged to more than
70 seconds
b. Tetanic contractions prolonged to more
than 90 seconds
c. Increased pain with bright red vaginal
bleeding
d. Increased restlessness and anxiety

2. When preparing a client for cesarean birth,


which of the following key concepts should be
considered when implementing nursing care/
a. Instruct the mothers support person to
remain in the family lounge until after delivery
b. Arrange for a staff member of the
anesthesia department to explain what to
expect postoperatively
c. Modify preoperative teaching to meet the
needs of either a planned or emergency
cesarean birth
d. Explain the surgery, expected outcome
and kind of anesthetics that will be used

3. Which of the following best describes


preterm labor?
a. Labor that begins after 20 weeks gestation
and before 37 weeks gestation
b. Labor that begins after 15 weeks gestation
and before 37 weeks gestation
c. Labor that begins after 24 weeks gestation
and before 28 weeks gestation
d. Labor that begins after 28 weeks gestation
and before 40 weeks gestation

4. Following administration of tocolytic agent for


preterm labor, which of the following would
the nurse report to the physician
immediately?
a. FHR of 160 beats/minute
b. maternal blood pressure 120/80 mmHG
c. Maternal respiratory rate of 22
breaths/minute
d. Complaints of chest pain

5. When PROM occurs, which of the following


provides evidence of the nurses
understanding of the clients immediate
needs?
a. The chorion and amnion rupture 4 hours
before the onset of labor
b. PROM removes the fetuss most effective
defense against infection
c. Nursing care is based on fetal viability and
gestational age
d. PROM is associated with malpresentation
and possibly incompetent cervix

6. Which of the following factors is the


underlying cause of dystocia?
a. Nutritional
b. Mechanical
c. Environmental
d. Medical

7. 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

8. Which of the following would alert the nurse


to the possibility of uterine inversion?
a. Appearance of a large tissue mass within
the vagina
b. Vaginal hemorrhage with hypervolemia
c. Dramatic increase in vaginal bleeding
d. Complaints of severe abdominal pain

9. Which of the following is the nurses 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

10. When assessing a patient whose


membranes have ruptured, the nurse notes
that the fluid is a greenish color. What is the
cause of this greenish coloration?
a. Blood
b. Meconium
c. Hydramnios
d. Caput

11. With a breech presentation, the nurse must


be particularly alert for which of the following?
a. quickening
b. ophthalmia neonatorum
c. pica
d. prolapsed umbilical cord

12. Following the rupture of membranes, fetal


distress in a vertex presentation may be
indicated by which of the following?
a. bloody show
b. hydramnios
c. oligohydramnios
d. meconium

13. Based on the preceding questions, which of


the following nursing interventions should
receive the highest priority?
a. Assess FHR
b. Call the physician
c. Assess maternal vital signs
d. Assess maternal emotional status

14. Which of the following nursing interventions


would not be appropriate for a patient just
admitted with vaginal bleeding in the third
trimester of pregnancy?
a. careful admission
b. Specific assessment of amount of bleeding
c. vaginal examination to determine progress
of cervical dilation
d. vital signs every 15 minutes

15. A primigravid client is admitted to the labor


and delivery area, where the nurse evaluates
her. Which assessment finding may indicate
the need for cesarean delivery?
a. insufficient perineal stretching
b. rapid progressive labor
c. umbilical cord prolapse
d. fetal prematurity

16. Which fetal organ is frequently injured


during traumatic vaginal delivery of breech
presentation?
a. liver
b. spinal cord
c. brain
d. spleen

17. The nurse is caring for a primipara after a


cesarean section delivery 12 hours ago. The
nurse observes that the clients fundus is at
the umbilicus and firm. The nurse should:
a. Ask the client if she feels the urge to void
b. Document this as a normal finding
c. Contact the physician for an order for an
oxytocic
d. Encourage the client to remain on bed rest

18. Terbutaline (Brenthine) therapy is ordered


for a client with preterm labor. Before
beginning therapy, which of the following
assessments would be most important?
a. contraction intensity
b. deep tendon reflexes
c. estimated fetal size
d. maternal heart rate

19. The multigravid client with a history of rapid


labor who is in active labor calls out to the
nurse, The baby is coming! Which of the
following would be the nurses first action?
a. Inspect the perineum
b. Time of contractions
c. Auscultate the fetal heart rate
d. Contact the birth attendant

20. Which of the following would the nurse use


to assess a client for possible uterine atony
after a cesarean delivery?
a. Check abdominal dressing every 15
minutes for the first hour
b. Palpate the fundus every 15 minutes for at
least 1 hour
c. Observe the amount of lochia immediately
after delivery
d. Assess blood pressure and pulse every 15
minutes for 1 hour

21. After teaching a woman who is in labor


about the purpose of the episiotomy, which of
the following purposes stated by the client
would indicate to the nurse that the teaching
was effective?
a. shortens the second stage of labor
b. enlarges the pelvic inlet
c. prevents perineal edema
d. ensures quick placental delivery

22. The nurse determines that a multigravid


client in active labor is about to deliver. The
nurse has no help immediately available.
Which of the following should the nurse do
first?
a. have a client push with a contraction
b. ask the client to take a deep breath and
hold it
c. prepare a clean area on which to deliver
the neonate
d. lower the head of the bed to a flat position

23. Umbilical cord prolapse occurs after


spontaneous rupture of the membranes.
Which of the following should the nurse do
immediately?
a. place the client in a Trendelenburg position
b. administer oxytocin immediately
c. ask the client to begin pushing
d. cover the cord with sterile towels

24. During the immediate postpartum period


after delivering twins, the client experiences
uterine atony. Which of the following should
the nurse do first?
a. gently massage the fundus
b. assess client for infection
c. determine if the uterus has ruptured
d. increase the intravenous fluid rate

25. The physician orders magnesium sulfate


intravenously for a pregnant client with
premature rupture of the membranes who
begins to have contractions every 15
minutes. The nurse explains to the client that
the primary purpose of magnesium sulfate is
to do which of the following?
a. provide sedation
b. combat hypomagnesemia
c. improve fetal lung function
d. inhibit contractions

26. A client is being prepared for an emergency


cesarean birth because of fetal distress. The
most important thing for the nurse to assess
before the surgery is that:
a. a signed consent is on the chart
b. a foley catheter has been inserted
c. an IV of Ringers lactate has been started
d. the abdomen has been shaved and
prepared

27. The nurse should be aware that the chief


hazard to an infant during a precipitate
delivery is:
a. brachial plexus
b. dislocated hip
c. fractured clavicle
d. intracranial hemorrhage

28. A client in preterm labor has received a


course of corticosteroids to promote fetal lung
maturity. The test that would most accurately
determine fetal lung maturity is:
a. amniocentesis
b. ultrasonography
c. contraction stress test
d. chorionic villi sampling

29. A nurse is assigned to care for a client with


hypotonic uterine dysfunction and signs of
slowing labor. The nurse is reviewing the
physicians orders and would expect to note
which of the following prescribed treatments
for this condition?
a. Medication that will provide sedation
b. Increased hydration
c. Oxytocin (Pitocin) infusion
d. Administration of a tocolytic medication

30. A nurse is in labor room is preparing to care


for a client with hypertonic uterine
dysfunction. The nurse is told that the client is
experiencing uncoordinated that are erratic in
their frequency, duration, and intensity. The
priority nursing intervention in caring for the
client is to:
a. Monitor the oxytocin (Pitocin) infusion
closely
b. Provide pain relief measures
c. Prepare the client for an amniotomy
d. Promote ambulation every 30 minutes

31. A nurse has developed a plan of care for a


client experiencing dystocia and includes
several nursing interventions in the plan of
care. The nurse prioritizes the plan of care
and selects which of the following nursing
interventions as the highest priority?
a. Keeping the significant other informed of
the progress of labor
b. Providing comfort measures
c. Monitoring the fetal heart rate
d. Changing the clients position frequently

32. A nurse in a labor room is performing a


vaginal assessment on a pregnant client in
labor. The nurse notes the presence of the
umbilical cord protruding from the vagina.
Which of the following would be the initial
nursing action?
a. Place the client in Trendelenburgs position
b. Call the delivery room to notify the staff
that the client will be transported immediately
c. Gently push the cord into the vagina
d. Find the closest telephone and stat page
the physician

33. A nurse in a labor room is assisting with the


vaginal delivery of a newborn infant. The
nurse would monitor the client closely for the
risk of uterine rupture if which of the following
occurred?
a. Hypotonic contractions
b. Forceps delivery
c. Schultz presentation
d. Weak bearing down efforts

34. A nurse is monitoring a client who is in the


active stage of labor. The client has been
experiencing contractions that are short,
irregular, and weak. The nurse documents
that the client is experiencing which type of
labor dystocia?
a. Hypotonic
b. Precipitous
c. Hypertonic
d. Preterm labor

35. 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. Increased maternal blood pressure
c. Maternal respiratory rate of 22
d. Complaints of chest pain

36. 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

37. Which of the following is the nurses initial


action when umbilical cord prolapse occurs?
a. Begin monitoring maternal vital signs
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

POSTPARTUM
1. With todays shorter postpartum hospitalizations (24
COMPLICATIONS
to 72 hours), the focus of nursing revolves around
which of the following essential concepts?
a. Promotion of comfort and recovery through
physical care measures and plan relief measures
b. Exploration of the emotional aspects of care of
the high-risk newborn and the family
c. Parenteral assistance to care for themselves and
their newborn safely and effectively
d. Client and family assistance to deal with anxiety
effectively and completely

2. Which of the following is most important


when caring for high-risk postpartum clients?
a. Discussing hygiene and nutrition
b. Referring the mother to others for
emotional support
c. Discussing complications and treatment
d. Promoting mother-newborn contact

3. Which of the following amounts of blood loss


following birth marks the criterion for
describing postpartum hemorrhage?
a. More than 200 ml
b. More than 300 ml
c. More than 400 ml
d. More than 500 ml

4. Which of the following best describes


subinvolution?
a. Bleeding with an onset in the first 24 hours
after delivery
b. Delayed return of the enlarged uterus to
normal size and function
c. Inflammation of the vascular endothelium
with clot formation
d. Inability to form an effective clot structure,
leading to continued bleeding

5. Which of the following best signals early


puerperal infection?
a. Temperature elevation of 38o C (100.4o F)
or higher after the first 24 hours postpartum
b. Local infections of the vagina, vulva, and
perineum after the first 24 hours postpartum
c. Elevated temperature, dyspnea,
hypovolemia, and malaise after the first 12
hours postpartum
d. Lower abdominal pain, inability to void, and
anxiety following the first postpartum week

6. Which of the following is the primary


predisposing factor related to mastitis?
a. Epidemic infection from nosocomial
sources localizing in the lactiferous glands
and ducts
b. Endemic infection occurring randomly and
localizing in the periglandular connective
tissue
c. Temporary urine retention due to
decreased perception of the urge to void
d. Breast injury caused by overdistention,
stasis, and crackling of the nipples

7. Which of the following best describes


thrombophlebitis?
a. Inflammation and clot formation that result
when blood components combine to form an
aggregate body
b. Inflammation and blood clots that
eventually become lodged within the
pulmonary blood vessels
c. Inflammation and blood clots that
eventually become lodged within the femoral
vein
d. Inflammation of the vascular endothelium
with clot formation on the vessel wall

8. Which of the following assessment findings


would the nurse expect if the client develops
DVT?
a. Midcalf pain and tenderness and redness
along the vein
b. Chills, fever, and malaise occurring 2
weeks after delivery
c. Muscle pain, the presence of Homans
sign, and swelling in the affected limb
d. Chills, fever, stiffness, and pain occurring
10 to 14 days after delivery

9. Which of the following are the most


commonly assessed findings in cystitis?
a. Frequency, urgency, dehydration, nausea,
chills, and flank pain
b. Nocturia, frequency, urgency, dysuria,
hematuria, fever, and suprapubic pain
c. Dehydration, hypertension, dysuria,
suprapubic pain, chills, and fever
d. High fever, chills, flank pain, nausea,
vomiting, dysuria, and frequency

10. When assessing a client 1 hour after


vaginal delivery, the nurse notes blood
gushing for the vagina, pallor, and rapid,
thready pulse. What do these findings
suggest ?
a. uterine involution
b. cervical laceration
c. placental separation
d. postpartum hemorrhage

11. Which of the following hormones is


responsible for let-down reflex?
a. oxytocin
c. estrogen
b. prolactin
d. progesterone

12. A 28 year-old woman gave birth 1 hour ago


to a full term baby boy. Which finding should
the nurse expect when palpating the clients
fundus?
a. soft, at the level of umbilicus
b. firm, 2 cm below umbilicus
c. firm, at the level of umbilicus
d. boggy, between the umbilicus and
symphysis pubis

13. During the postpartum period, the nurse


should assess for signs of normal involution.
Which of the following would indicate that the
client is progressing normally?
a. the uterus is descending at the rate of one
fingerbreadth per day
b. blood pressure drops as a result of the
birth and changed circulatory overload
c. urine output remains about the same as in
the clients prenatal period
d. pad usage remains at 10 to 15 per day

14. Lochia normally progresses in which of the


following patterns?
a. rubra, serosa, alba
b. serosa, rubra, alba
c. serosa, alba, rubra
d. rubra, alba, serosa

15. As a postpartum client adapts to her


maternal role, she progresses through
several phases. During which phase does
she begin to accept the neonate as a
separate individual?
a. letting-go phase
c. dependent phase
b. taking hold phase
d. taking-in phase

16. Which of the correctly defines puerperium?


a. the 1st hour after birth
b. the six weeks following birth
c. the days spent in the hospital
d. the duration of breast-feeding

17. During a home visit with a primipara who


delivered 7 days ago, the client tells the
nurse that her lochia serosa has been
profuse and foul smelling and she has had
chills. During palpation of the uterus, the
client indicates that she is very sore. Which of
the following would the nurse expect?
a. normal uterine involution
b. retained placental fragments
c. puerperal infection
d. uterine atony

18. A nurse in monitoring a new mother in the


postpartum period for signs of hemorrhage.
Which of the following signs, if noted in the
mother, would be an early sign of excessive
blood loss?
a. A temperature of 100.4 oF
b. An increase in the pulse rate from 88 to
102 beats per minute
c. An increase in the respiratory rate from 18
to 22 breaths per minute
d. A blood pressure change from 130/88 to
124/80 mm Hg

19. A nurse is preparing to assess the uterine


fundus of a client in the immediate
postpartum period. When the nurse locates
the fundus, she notes that the uterus feels
soft and boggy. Which of the following
nursing interventions would be most
appropriate initially?
a. Massage the fundus until is it firm
b. Elevate the mothers legs
c. Push on the uterus to assist in expressing
clots
d. Encourage the mother to void

20. A client in a postpartum unit complains of


sudden sharp pain sharp pain. The nurse
notes that the client is tachycardic and the
respiratory rate is elevated. The nurse
suspects a pulmonary embolism. The initial
nursing action would be which of the
following?
a. Assess the clients blood pressure
b. Initiate an intravenous line
c. Administer oxygen at 8 to 10 L/min by face
mask
d. Prepare to administer morphine sulfate

21. A nurse is developing a plan of care for a


new mother recovering from a cesarean
delivery. To prevent thrombophlebitis, the
nurse plans to encourage the woman to:
a. ambulate frequently
b. Apply warm moist packs to the legs
c. Remain on bed rest
d. Elevate the legs

22. A postpartum client is being treated for


deep venous thrombophlebitis. A nurse
understands that the clients response to
treatment will be evaluated by regularly
assessing the client for:
a. Dysuria, ecchymosis, and vertigo
b. Epistaxis, hematuria, and dysuria
c. Hematuria, ecchymosis, and epistaxis
d. Hematuria, ecchymosis, and vertigo

23. A nurse performs an assessment on a client


who is 4 hours postpartum. The nurse notes
that the client has cool, clammy skin and is
restless and excessively thirsty. The nurse
prepares immediately to:
a. Assess for hypovolemia and notify the
health care provider
b. Begin hourly pad counts and reassure the
client
c. Begin fundal massage and start oxygen by
mask
d. Elevate the head of the bed and assess
vital signs

24. A nurse is providing instructions to a mother


who is breast-feeding her newborn infant
regarding measures to prevent postpartum
mastitis. Which of the following if stated by
the mother would indicate a need for further
instructions?
a. I should change the breast pads
frequently.
b. I should wash the nipples daily with soap
and water.
c. I should wash my hands well before
breastfeeding.
d. I should breast-feed every 2 to 3 hours.

NEONATAL COMPLICATIONS
1. Which of the following is the most important concept
associated with all high-risk newborns?
a. Support the high-risk newborns cardiopulmonary
adaptation by maintaining an adequate airway
b. Identify complications with early intervention in
the high-risk newborn to reduce morbidity and
mortality
c. Assess the high-risk newborn for any physical
complications that may interfere with parental
bonding
d. Support the mother and significant others in their
quest toward adaptation to the high-risk newborn

2. Which of the following would the nurse


expect to find in a newborn with birth
asphyxia?
a. Hyperoxemia
b. Hypocarbia
c. Acidosis
d. Ketosis

3. When planning and implementing care for


the newborn who has been successfully
resuscitated, which of the following would be
important to assess?
a. Muscle flaccidity
b. Decreased intracranial pressure
c. Hypoglycemia
d. Spontaneous respirations

4. When describing a preterm newborn, the


nurse would describe the newborn as being
born at which of the following?
a. Before 25 weeks gestation
b. After 25 weeks gestation
c. After 37 weeks gestation
d. Before 37 weeks gestation

5. Which of the following assessment findings would


the nurse expect in the preterm newborn?
a. Tachypnea, decreased or absent parental visits,
constant return to fetal position, hyperpnea
b. Tachypnea, abnormal arterial blood gas (ABG)
values, decreased sucking reflex, temperature
instability
c. Cyanosis, abnormal ABG values, unstable body
core temperature, increased gag and sucking
reflexes
d. Hyperpnea, unstable body core temperature,
bradycardia, cyanosis, arching behaviors with
hyperextension

6. When implementing supportive measures for


airway clearance for the preterm newborn,
the nurse would plan to do which of the
following?
a. Assess for hypoglycemia and other
complications, such as fractures and Bells
palsy
b. Perform suctioning as needed, positioning
the newborn to facilitate chest expansion
c. Observe for hypercalcemia, respiratory
distress, polycythemia, and altered parenting
d. Provide chest physiotherapy before
feedings, assessing for potential respiratory
distress

7. Which of the following characteristics is most


commonly associated with an LGA newborn?
a. Weight under 4,000 g
b. Dysmorphic features
c. Risk for birth injury
d. Hypothermia

8. When assessing a postterm newborn, which


of the following would the nurse expect?
a. Meconium-stained skin
b. Round, red face
c. Hypoglycemia
d. Poor feeding

END

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