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Directions: Choose the letter of the correct answer. Answer in capital letter only.

1. The inner membrane that encloses the fluid medium for the embryo is the:
a. funis b. amnion c. chorion d. yolk sac

2. The chief function of progesterone is the:


a. stimulation of follicles for ovulation to occur
b. development of female reproductive organs
c. preparation of the uterus to receive a fertilized ovum
d. establishment of the secondary male sex characteristics

3. During the process of gametogenesis, the male and female sex divide, and each mature sex cell
contains:
a. twenty two pairs of autosomes in their nuclei
b. forty six pairs of chromosomes in their nuclei
c. a diploid number of chromosomes in their nuclei
d. a haploid number of chromosomes in their nuclei

4. The placenta does NOT produce:


a. somatotropin c. follicle stimulating hormone
b. chorionic gonadotropin d. progesterone precursor substances

5. The developing cells are called a fetus from the:


a. time the fetal heart is heard c. implantation of the fertilized ovum
b. eight week to the time of birth d. end of 2nd week to the onset of labor

6. During pregnancy the volume of tidal air increases because there is:
a. an increase in total blood volume
b. increased expansion of the lower ribs
c. upward displacement of the diaphragm
d. a relative increase in the height of the rib cage

7. The uterus rises out the pelvis an becomes an abdominal organ at about the:
a. 10th week of pregnancy c. 12th week of pregnancy
th
b. 8 week of pregnancy d. 18th week of pregnancy

8. First fetal movements felt by the mother are known as:


a. lightening b. quickening c. ballottement d. engagement

9. In prenatal development, fetal weight gain is greatest in the:


a. 1st trimester b. 2nd trimester c. 3rd trimester d. implantation

10. After the first three months of pregnancy the chief source of estrogen and progesterone is the:
a. placenta b. adrenal cortex c. corpus luteum d. anterior hypophysis

11. In fetal blood vessels the oxygen content is highest in the:


a. umbilical artery b. ductus venosus c. pulmonary artery d. ductus arteriosus

12. A client relates that the first day of her last menstrual period was July 22. The estimated date of
birth would be:
a. May 5 b. May 14 c. April 15 d. April 29

13. A client visits the prenatal clinic to confirm her suspicions that she is pregnant and, if so, to begin
prenatal care. The client states her last menstrual period began June 10. According to Nageles
Rule, her expected date of delivery (EDD) would be:
a. March 17 b. April 17 c. March 10 d. April 10

14. Anticipatory guidance during the first trimester of pregnancy is primarily directed toward
increasing the pregnant woman’s knowledge of:
a. labor and delivery c. role transition into parenthood
b. signs of complications d. physical changes resulting from pregnancy

15. The anterior/posterior diameter of the pelvic inlet is an important measurement of the pelvis and
is known as the:
a. conjugate vera c. transverse diameter
b. diagonal conjugate d. transverse conjugate

16. During pregnancy, the uterine musculature hypertrophies and is greatly stretched as the fetus
grows. This stretching:
a. By itself inhibits uterine contraction until oxytocin stimulates the birth process
b. Is prevented from stimulating uterine contraction by high levels of estrogen during late
pregnancy
c. Inhibits uterine contraction along with the combined inhibitory effects of estrogen and
progesterone
d. Would ordinarily stimulate uterine contraction but is prevented by high levels of
progesterone during pregnancy.

17. The nurse recognizes that a normal, expected change in hematologic system that occurs during
the second trimester of pregnancy is:
a. a decrease in WBCs c. an increase in blood volume
b. an increase in hematocrit d. a decrease in sedimentation rate
18. The nurse is aware that a normal adaptation of pregnancy is an increased blood supply to the
pelvic region that results in purplish discoloration of the vaginal mucosa, which is known as:
a. Ladin’s sign b. Hegar’s sign c. Goodell’s sign d. Chadwick’s sign

19. Physiological anemia during pregnancy is a result of:


a. decreased dietary intake of iron
b. increased plasma volume of the mother
c. decreased erythropoiesis after the first trimester
d. increased detoxification demands on the mother’s liver

20. On a first prenatal visit, a client asks thenurse, “Is it true the doctor will do an internal
examination today?” The nurse should respond:
a. “Yes, an internal is done on all mothers on the first visit.”
b. “Are you fearful of having an internal examination done?”
c. “Yes. Have you ever had an internal examination done before?”
d. “Yes, an internal is done on all mothers, but it is slightly uncomfortable.”

21. A normal cardiopulmonary system experienced by most pregnant women is:


a. tachycardia c. progressive dependent enema
b. dyspnea at rest d. shortness of breath on exertion

22. A client asks the nurse why menstruation ceases once pregnancy occurs. The nurse’s best
response would be that this occurs because of the:
a. “Reduction in the secretion of hormones by the ovaries.”
b. “Production of estrogen and progesterone by the ovaries.”
c. “Secretion of luteinizing hormone produced by the by the pituitary.”
d. “Secretion of follicle stimulating hormone produced by the pituitary.”

23. The nurse is aware that the nausea and vomiting commonly experienced by many women during
the first trimester of pregnancy is an adaptation to the increased level of:
a. estrogen b. progesterone c. luteinizing hormone d. chorionic gonadotropin

24. A pregnant client works as a keypunch operator. This would necessarily have implications for her
plan of care during pregnancy. The nurse should recommend that the client:
a. Try to walk about every few hours during the workday
b. Ask for time in the morning and afternoon to elevate her legs
c. Tell her employer she cannot walk beyond the second trimester
d. Ask for time in the morning and afternoon to obtain nourishment

25. The nurse in the prenatal clinic should provide nutritional counseling to all newly pregnant women
because:
a. Most weight gain during pregnancy is fluid retention
b. Dietary allowances should not increase during pregnancy
c. Pregnant women must adhere to a specific pregnancy diet
d. Dietary sources of essential nutrients are favored by different cultural groups

26. Aprimigravida in her tenth week of gestation is concerned because she had read that nutrition
during pregnancy is important for proper growth and development of the baby. She wants to
know something about the foods she should eat. The nurse should:
a. Instruct her to continue eating a normal diet
b. Assess what she eats by taking a diet history
c. Give her a list of foods so she can better plan her meals
d. Emphasize the importance of limiting salt and highly seasoned foods

27. A client, in her eight week of pregnancy complaints of having to go to the bathroom often to
urinate. The nurse explains to the client that urinary frequency often occurs because the capacity
of the bladder during pregnancy is diminished by:
a. atony of the detrusor muscle
b. compression by the enlarging uterus
c. compromise of the autonomic reflexes
d. constriction of the urethral entrance at the trigone

28. A client who is 10 weeks pregnant calls the clinic and complains of morning sickness. To promote
relief, the nurse should suggest:
a. eating dry crackers before arising
b. increasing her fat intake before bed time
c. having two small meals daily and a snack at noon
d. drinking more high carbohydrate fluid with her meals

29. When attending the prenatal clinic, a newly pregnant client, having her first child, expresses
concern about her “dark nipples” and a “dark line” from her navel to the pubis. The nurse
explains that these adaptations are due to the hyperactivity of the:
a. ovaries b. thyroid gland c. adrenal gland d. pituitary gland

30. The nurse can try to help a pregnant client overcome first trimester morning sickness by
suggesting that the client:
a. eat protein before sleeping c. eat nothing until the nausea subsides
b. take an antacid before bedtime d. request her nurse to prescribe and antiemetic
31. Nutritional planning for a newly pregnant woman on average height weighing 130 pounds should
include:
a. a decrease to 1000 calories per day c. an increase to 1800 to 2000 calories per day
b. a decrease in fat and protein consumption d. an increase in caloric intake to 2800 cal per day

32. A client is concerned about gaining weight during pregnancy. The nurse explains that the large
part of weight gain during pregnancy is because of:
a. the fetus b. fluid retention c. metabolic alterations d. increased blood
volume

33. A client who is pregnant for the first time attends the prenatal clinic. She tells the nurse, “I’m
worried about gaining too much weight because I have heard that it is bad for me.” The nurse’s
best response would be:
a. “Yes, weight gain causes complications during pregnancy.”
b. “If you gain over 15 pounds, you’ll have to follow a low caloric diet.”
c. “Don’t worry about gaining weight. We are more concerned if you don’t gain enough
weight to ensure proper growth of your baby.”
d. “A 25 –pound weight gain is recommended, however, the pattern of your weight gain will
be of more importance than the total amount.”

34. A client, 7 weeks pregnant, confides to the nurse in the prenatal clinic that she is very sick every
morning with nausea and vomiting and is sure that she is being punished for having initially
thought of aborting the pregnancy. The nurse assures her that this is not punishment but a
common occurrence in early pregnancy and will probably disappear by the end of the:
a. 5th month b. 4th month c. 3rd month d. 2nd month

35. A client who is pregnant is being prepared for a pelvic examination. The client complaints of
feeling very tired and sick to her stomach, especially in the morning. The best response for the
nurse to make is:
a. “This is common. There is no need to worry.”
b. “Can you tell me how you feel in the morning?”
c. “Perhaps you might ask the nurse midwife about it.”
d. “Let’s discuss some ways to deal with these common problems.”

36. During a prenatal examination the nurse draws blood from a young client and explains that the
determination of Rh is routinely performed on expectant mothers to predict whether the fetus is
at risk for developing:
a. acute hemolytic anemia c. physiologic hyperbilirubinemia
b. protein metabolism deficiency d. respiratory distress syndrome

37. The best advice the nurse can give to a pregnant woman in her first trimester is to:
a. Cut down on drugs, alcohol and cigarettes
b. Avoid all drugs and refrain from smoking and ingesting alcohol
c. Avoid smoking, limit alcohol consumption, and do not take any aspirin
d. Take only prescription drugs, especially in the second and third trimesters

38. A client is in her 4th month of pregnancy. When she comes for her monthly examination, the nurse
asks if she would like to listen to the baby’s heartbeat. The woman, commenting on how rapid it
is, appears frightened and asks if this is normal. The nurse should respond:
a. “The baby’s heart rate is usually twice the mother’s pulse rate.”
b. “The baby’s heartbeat is rapid to accommodate the nutritional needs.”
c. “A baby’s heart rate is rapid, and your baby’s is within the normal range.”
d. “It is far better that the heart rate is rapid; when it is slow, there is no need to worry.”

39. A client who is pregnant asks the nurse if she can continue to have sexual relations. The nurse’s
response is based on the knowledge that coitus during pregnancy would be contraindicated in the
presence of:
a. leukorrhea c. gestation of 30 weeks of more
b. increased fetal heart rate d. premature rupture of membranes

40. When involved in prenatal teaching, the nurse should inform clients that an increase in vaginal
secretions during pregnancy is called leucorrhea caused by increased:
a. metabolic rates c. functioning of the Bartholin’s glands
b. production of estrogen d. supply of NaCl to the cells of the vagina

41. A primigravida, unsure of the date of her last menstrual period, is told by the obstetrician that she
appears to be about 20 weeks pregnant. The nurse explains that this is because the fundus:
a. is 18cm, and the baby has just started to move
b. is 28cm, and the fetal heart can be heard with a Doppler
c. is just over the symphysis, and the fetal heart cannot be heard
d. is at the umbilicus, and the fetal heart can be heard with a fetoscope

42. A 21-year old client who is 6 months into her second pregnancy is experiencing increasing edema
in the lower extremities. Besides advising rest with the legs elevated, the nurse discusses and
gives instructions concerning the diet. In this instance:
a. The nutritionist should be brought in to plan and diet
b. The foods selected should have a normal salt content
c. Dietary preferences must influence the food that is eaten
d. The client should be advised to see the physician at the prenatal clinic

43. The nurse explains the treatment for fluid retention during pregnancy, which is:
a. Adequate fluid and low salt diet
b. A low salt diet and elevation of the lower extremities
c. Adequate fluid and elevation of the lower extremities
d. Judicious use of directions and elevaion of the lower extremities

44. In the thirty seventh week of gestation a client is scheduled for a nonstress test. The nurse, after
explaining the procedure, evaluates that the client understands the teaching when she says:
a. “I hope that this test does not cause my labor to begin early.”
b. “I hope the baby doesn’t get too restless after this procedure.”
c. “I hate having needles in my arm, but now I understand why it is necessary.”
d. “If my baby’s heart reacts normally during the test, he should do okay during the
delivery.”

45. A client in the thirty second week of pregnancy is scheduled for ultrasonography. The nurse
explains the procedure and informs the client that for this test she will have to:
a. Be given an enema before the night of examination
b. Refrain from voiding for at least 3 hours before the test
c. Be monitored closely afterward for signs of precipitate labor
d. Be kept NPO for 12hours to minimize the possibility of vomiting

46. At a prenatal visit at 36 weeks’ gestation, a client complaints of discomfort with Braxton Hicks
contractions. The nurse instructs the client to:
a. Lie down until they stop c. Time the contraction for ½ hour
b. Walk around until they subside d. Take 10 grains of aspirin for the
discomfort

47. When teaching a young primigravida about labor, the nurse should tell her to come to the hospital
when:
a. contractions are 10-15 minutes apart
b. she has a bloody show and back pressure
c. Membranes rupture or contractions are 5 to 8 minutes apart
d. Contractions are 2 to 3 minutes apart and she cannot walk about

48. True labor can be differentiated from false labor because in true labor, contractions will:
a. bring about progressive cervical dilation
b. occur immediately after membranes rupture
c. stop when the client is encouraged to walk around
d. be less uncomfortable if client is in a side lying position

49. A nurse teaches a pregnant woman to avoid lying on her back during labor. The nurse has based
this statement on the knowledge that supine position can:
a. unduly prolong labor c. interfere with free movement of the coccyx
b. cause decreased placental perfusion d. lead to transient episodes of hypertension

50. The nurse should teach pregnant women importance of conserving the “Spurt of Energy” before
labor because:
a. Fatigue may influence need for pain medication
b. Energy helps to increase the progesterone level
c. Energy is needed to push during the first stage of labor
d. The energy will decrease the intensity of uterine contractions

51. A client is admitted to the labor room in early active labor. The priority nursing intervention on
admission of this laboring client would be:
a. auscultating the fetal heart c. asking the client when she ate last
b. taking an obstetric history d. ascertaining if the membranes are ruptured

52. A client who is gravida 1, para 0, is admitted in labor. Her cervix is 100% effaced and she is
dilated 3 cm. Her fetus is at a +1 station. The nurse is aware that the fetus’ head is:
a. not yet engaged c. below the ischial spines
b. entering the pelvic inlet d. visible at the vaginal opening

53. After doing Leopold’s maneuvers on a laboring client, the nurse determines that the fetus is in
ROP position. To best auscultate the fetal heart tones, the Doppler is placed:
a. above the umbilicus in the midline c. below the umbilicus on the right side
b. above the umbilicus on the left side d. below the umbilicus near the left groin

54. A client in active labor begins to tremble, becomes very tense with contractions and is quite
irritable. She frequently states, “I cannot stand this a minute longer.” This kind of behavior
,maybe indicative of the fact that the client:
a. is entering the transition phase of labor
b. needs immediate administration of an analgesic or anesthetic
c. has been very poorly prepared for labor in the parents’ classes
d. is developing some abnormality in terms of uterine contractions

55. The physician asks the nurse the frequency of a laboring client’s contractions. The nurse assesses
the client’s contractions by timing from the beginning of one contraction:
a. until the time it is completely over c. to the beginning of the next contraction
b. to the end of a second contraction d. until the time the uterus becomes very firm

56. The nurse observes the client’s amniotic fluid and decides that it appears normal, because it is:
a. clear and dark amber in color
b. milky, greenish yellow, containing shreds of mucus
c. clear, almost colorless, containing little white specks
d. cloudy, greenish-yellow, containing little white specks

57. A multigravida has a normal spontaneous vaginal delivery of a healthy infant. Five minutes after
delivery of the infant, the placenta is expressed. The nurse upon assessing the fundus at this time
would expect the fundus to be:
a. difficulty to find c. at the umbilicus in the upper right quadrant
b. just below the xiphoid process d. halfway between symphysis pubis and
umbilicus

58. One problem that confronts the client when an external fetal monitor is being used is the:
a. restriction of movement c. interference with Lamaze techniques
b. inability to take sedatives d. increased frequency of vaginal examinations

59. A laboring client is placed on an external fetal monitor. The nurse notes that the fetal heart
decelerates in a uniform wave shape reflecting the shape of contraction. The nurse should:
a. Notify the physician because there maybe head compression
b. Place the client in a knee-chest position to avoid cord compression
c. Continue to observe for return of fetal heart rate to baseline when contraction ends
d. Put the client in a dorsal recumbent position to prevent compression of the vena cava

60. When examining the fetal monitor strip following rupture of the membranes in a laboring client,
the nurse notes decelerations in the fetal heart rate. The nurse should:
a. stop the oxytocin infusion c. prepare for immediate delivery
b. change the client’s position d. take the client’s blood pressure

61. A client in active labor spontaneously ruptures membranes. The nurse should first:
a. monitor the FHR c. check bp and pulse
b. call the physician d. time the contractions

62. The membranes of a client who is 39 weeks pregnant have ruptured spontaneously. She comes to
the hospital accompanied by her husband. Her cervix is 4 cm dilated and 75% effaced. The fetal
heart rate is 136. The nurse should:
a. place the mother in bed and attach an external fetal monitor
b. let the mother undress while the nurse takes history from the father
c. introduce the staff nurses to the couple and try to make them feel welcome
d. have them wait in the examining room while the nurse notifies the physician that
theyhave arrived

63. A primigravida, 40 weeks gestation, is admitted with q3 to 5mins contractions, a bloody show, and
intact membranes. Vaginal examination reveals that the cervix is fully effaced, 6 cm dilated, and
the head is at +1 station. The nurse is aware that according to these data, the client is in the:
a. latent phase of labor c. transition phase of labor
b. active phase of labor d. accelerated phase of labor

64. A client, 41 weeks gestation, comes to the labor suite with a bloody show and no contractions. A
vaginal exam reveals that the baby’s head is at +1 station. To induce labor, the nurse should
expect an order for:
a. a tap water enema c. artificial rupture of membranes
b. an iM injection of oxytocin d. administration of prostaglandins

65. A client is admitted at the hospital in active labor. After an amniotomy, the nurse would expect:
a. diminished bloody show c. less discomforts with contractions
b. increased fetal heart rate d. progressive dilation and effacement

66. A primigravida, 40 weeks’ gestation, arrives at the birthing center with abdominal cramping and
bloody show. Her membranes ruptured 30 minutes before arrival. A vaginal examination reveals
1cm dilation and presenting part at -1 station. After obtaining the fetal heart rate and maternal
vital signs, the nurse should:
a. teach the client how to push
b. review Lamaze breathing techniques with the client
c. provide the client with comfort measures used for women in labor
d. prepare to type and cross-match the client’s blood for a possible transfusion

67. A primigravida at term is admitted with contractions q5 to 8 minutes and a bloody show. She and
her husband attended childbirth preparation classes. Vaginal examination reveals 3cm dilation
and 75% effacement, +1 station with occiput anterior and intact membranes. The client is
cheerful and relaxed and asks the nurse if it is all right for her to walk around. Based on the
observations of the client’s contractions and knowledge of the physiology and mechanism of
labor, the nurse could best respond:
a. “I can’t make a decision on that; you will have to ask the doctor.”
b. “Please stay in ed. Walking may interfere with proper uterine contractions.”
c. “It is quite all right for you to be up and about as long as you feel comfortable and your
membranes are intact.”
d. “You will have to stay in bed. Otherwise your contractions cannot be timed and no one
can listen to the fetal heart.”

68. A client and her husband are working together during the wife’s labor. The client is now 7cm
dilated and the presenting part is low in the midpelvis. To alleviate discomfort during contactions,
the nurse should instruct the husband to encourage his wife to:
a. pant b. pelvic rock c. deep breathe slowly d. athletic chest breathe
69. The expectant couple asks the nurse about the cause of low back pain in labor. The nurse replies
that this pain occurs most when the position of the fetus is:
a. breech b. transverse c. occiput anterior d. occiput posterior

70. A laboring client complaints of low back pain. To increase the client’s comfort, the nurse should
recommend that the client’s husband:
a. instruct her to flex her knees c. apply back pressure during contractions
b. place her in the supine position d. help her perform neuromuscular control
exercises

71. To promote comfort during back labor, the nurse teaches the client to avoid the:
a. sitting position b. supine position c. side lying position d. knee chest
position

72. The nurse withholds foods and limits fluids as a laboring client approaches the second stage of
labor because:
a. The mechanical and chemical digestive process requires energy that is needed for labor
b. Undigested food and fluid may cause nausea and vomiting and limit the choice of
anesthesia
c. Food will further aggravate gastric peristalsis, which is already increased because of the
stress of labor
d. The gastric phase of digestion stimulates the release of hydrochloric acid and may cause
dyspepsia

73. The management of a client in the transition phase of labor is primarily directed toward:
a. helping the client maintain control
b. decreasing the intravenous fluid intake
c. reducing the client’s discomfort with medications
d. having the client breathe simple breathing patterns during contractions

74. The breathing technique that the mother should be instructed to use during delivery of the fetus’
head is crowning is:
a. blowing b. slow chest c. shallow breaths d.accelerated decelerated

75. When a client is positioned for delivery, both legs should be positioned simultaneously to prevent:
a. venous stasis in the legs c. excessive pull on the fascia
b. pressure on the perineum d. trauma to the uterine ligaments

76. A laboring primapara should be prepared for delivery when the nurse observes:
a. The client becoming irritable and not following instructions
b. That the perineum is beginning to bulge with each contraction
c. An increase in the amount of bloody discharge from the vagina
d. The contractions are occurring every 2 to 3 minutes and lasting 60 seconds

77. During the period of induction of labor, a client should be observed carefully for signs of:
a. severe pain c. hypoglycemia
b. uterine tetany d. prolapse of the umbilical cord

78. A client in labor is fully ditaled, totally effaced and the head is at +2. During each contraction the
nurse should encourage her to:
a. push with glottis open c. relax by closing her eyes
b. blow as not to grunt d. pant to prevent cervical edema

79. During labor, station +1 indicates that the presenting part is:
a. on the perineum c. slightly below the ischial spines
b. high in the false pelvis d. slightly above the ischial spines

80. A client is admitted in active labor; the baby’s head is crowning, the client is bearing down and
delivery appears imminent. The nurse should:
a. Transfer her immediately by stretcher to the delivery room
b. Tell her to breathe through her mouth and not to bear down
c. Instruct the client to pant during contractions and to breathe through her mouth
d. Support the perineum with the hand to prevent tearing and tell the client to pant

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