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PRACTICE TEST 1: Infections 1. The nurse is caring for a pregnant woman with herpes zoster or, shingles.

What should the nurse expect to find during the initial assessment? A. Rhinorrhea, small red lesions including some with vesicles that are widespread over the face and body B. A painful vesicular eruption following a nerve pathway C. Blisters on the lips and in the corners of the mouth D. Painful fluid-filled vesicles in the genital area 2. The nurse is assessing a pregnant woman for sexually transmitted diseases. Which symptom would be most apt to be present in a woman with a Trichomonas vaginalis vaginal infection? A. A profuse bubbly yellowish-gray discharge B. White cheese-like patches in the vagina C. Perineal deformity D. An ulcer or lesion of the vulva or vagina 3. 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 treatment of this condition. Which of the following statements if 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 everyday.” 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.” 4. A pregnant client has been diagnosed with a vaginal infection from the organism Candida albicans. Which findings would the nurse expect to note on assessment of the client? A. Absence of any signs and symptoms B. Pain, itching, and vaginal discharge C. Proteinuria, hematuria, edema, and hypertension D. Costovertebral angle pain 5. A nurse is caring for a pregnant client with a history of human immunodeficiency virus (HIV). Which nursing diagnosis, if formulated by the nurse, has the highest priority for this client? A. Self care deficit C. Nutrition deficit B. Risk for infection D. Activity intolerance 6. A nurse performs an initial assessment on a pregnant client and determines that the client is at risk for toxoplasmosis. The nurse

High Risk Pregnancy 8. Which of the following statements made by a pregnant client with a chlamydial infection indicates understanding of the potential complications A. “I need to prepare myself and my family for a baby with congenital anomalies.” B. “I hope this medicine works before this disease gets into my urine and destroys my kidneys.” C. “I can have a normal vaginal delivery.” D. “I need to treat this infection so it doesn’t spread into my pelvis because I want to have more children someday.” 9. A pregnant client tests positive for the Hepatitis B virus. The client asks the nurse if she will be able to breastfeed her baby as planned after delivery. Which of the following responses by the nurse is most appropriate? A. “You will not be able to breastfeed the baby until 6 months after delivery.” B. “Breastfeeding is not a problem and you will be able to breastfeed immediately after delivery.” C. “Breastfeeding is allowed if the baby receives prophylaxis at birth and remains on the scheduled immunization.” D. “Breastfeeding is not advised, and you should seriously consider bottle-feeding the baby.” 10. A hepatitis B screen is performed on a pregnant client, and the results indicate the presence of antigens in the maternal blood. Which of the following would the nurse anticipate to be prescribed? A. Repeat hepatitis screen B. Retesting the mother in 1 week C. Administration of hepatitis vaccine and hepatitis B immune globulin to the neonate within 12 hours after birth D. Administration of antibiotics during pregnancy 11. A nurse is instructing a client with hepatitis about measures to control fatigue. The nurse avoids telling the client to A. Plan rest periods after meals B. Rest in-between activities C. Perform personal hygiene if not fatigued D. Complete all daily activities in the morning when the client is most rested 12. A pregnant client is treated for syphilis during the first trimester with intramuscular injections of penicillin. Her baby’s diagnosis at birth would most likely be A. Congenital syphilis C. Normal newborn B. Stillborn D. Premature newborn Hematologic 13. Which of the following conditions is the

would teach the client which of the following to prevent exposure to this disease? A. Wash hands only before meals B. Eat raw meats C. Avoid exposure to litter boxes used by cats D. Use topical corticosteroid treatments prophylactically 7. A client with gonorrhea asks the nurse if it can cause cancer. The nurse tells her that the organism associated with up to 90% of cervical malignancies and may be linked to other genital cancers is A. Neisseria gonorrhoea C. Human papilloma virus B. Chlamydia trachomatis D. Herpes simplex virus

most common cause of anemia in pregnancy? A. Alpha thalassemia C. Iron deficiency anemia B. Beta thalassemia D. Sickle cell anemia 14. A pregnant client is suspected of having iron deficiency anemia. Which of the following would the nurse expect to note regarding the client’s status? A. A low hemoglobin and hematocrit level B. A high hemoglobin and hematocrit level C. Fluid volume excess D. Fluid volume deficit

15. A pregnant client is taking iron supplements to correct iron-deficiency anemia. The nurse teaches the client which of the following special considerations while on iron therapy? A. Avoid taking iron with milk or antacids B. Limit intake of meat, fish, and poultry C. Eat a low-fiber diet D. Limit intake of fluids 16. A nurse is preparing to teach a pregnant client about the dietary sources of iron that are easy for the body to absorb. Which of the following food items would the nurse include in the teaching plan? A. Cereals C. Fruits B. Poultry D. Vegetables 17. A clinic nurse instructs a pregnant adolescent with iron deficiency anemia about the administration of oral iron preparations. The nurse instructs the adolescent that it is best to take the iron with A. Water C. Tomato juice B. Soda D. Cola 18. During a nutritional counseling session, a pregnant woman asks why a person needs more iron during pregnancy. The nurse answers that increased demand for iron during pregnancy is most likely caused by A. A decrease in red blood cell formation occurring in the third trimester B. The rise in blood cell concentration occurring between 24 and 32 weeks’ gestation. C. An increase in total blood cell volume and hemoglobin mass by approximately 25% to 50% during pregnancy. D. A decreased efficiency of iron absorption during pregnancy and fetal inability to absorb the mineral 19. A nurse is administering iron dextran to a client by the intravenous route. The nurse

23. A pregnant client is admitted to the hospital with a diagnosis of sickle cell crisis. The nurse contacts the physician to question which order documented in the child’s record? A. Intravenous fluids C. Bedrest B. Supplemental oxygen D. Meperidine hydrochloride 24. A pregnant client is admitted to the hospital with a suspected diagnosis of immune thrombocytopenic purpura. Diagnostic studies are performed. Which of the following diagnostic results is indicative of this disorder? A. Bone marrow examination indicating an increased number of immature white blood cells B. Bone marrow examination showing an increased number of megakaryocytes. C. Elevated platelet count D. Elevated hemoglobin and hematocrit levels Renal and Urinary 25. The most common microorganism responsible for urinary tract infection is A. Escherichia coli C. group B streptococcus B. Staphylococcus aureus D. Pneumocystis carinii 26. A primigravid client in her 12th week of gestation asks the nurse ways on how to prevent urinary tract infection. Which of the following responses of the nurse is correct? A. “Do vaginal douching after intercourse.” B. “ Void frequently at least every two hours.” C. “Wear loose, comfortable synthetic underwear.” D. “Wipe from the back to the front after bowel movement.” 27. A nurse has provided instructions to a pregnant client with urinary tract infection regarding food and fluids to consume that

checks that which of the following medications is available for use if needed as an antidote to the iron? A. Deferoxamine C. Ferrous fumarate B. Dirithromycin D. Ferrous sulfate 20. A pregnant client with sickle cell anemia is at an increased risk for having a sickle cell crisis during pregnancy. Aggressive management of a sickle cell crisis includes which of the following measures? A. Antihypertensive agents C. I.V. Fluids B. Diuretic agents D. Acetaminophen for pain 21. A client in labor has a concurrent diagnosis of sickle cell anemia. Because the client is at high risk for sickling crisis, which nursing 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 22. A pregnant client is admitted to the hospital with sickle cell crisis. The nurse monitors this client for which of the following most frequent symptoms of this disorder? A. Bradycardia C. Diarrhea C. Pain D. Blurred vision

will acidify the urine. Which of the following fluids, if identified by the mother, indicates a need for further education regarding fluids that will acidify the urine? A. Apricot juice C. Prune juice B. Carbonated drinks D. Cranberry juice 28. Which of the following medications is not to be used in managing urinary tract infection during the third trimester? A. Ampicillin C. Sulfonamides B. Amoxicillin D. Cephalosporin 29. A pregnant client with chronic renal failure has been treated with sodium polysterene sulfonate (Kayexalate) by mouth. The nurse would evaluate this therapy as effective if which of the following values was noted on follow-up laboratory testing? A. Potassium 4.9mEq/L C. Phosphorus 3.9 mEq/L B. Sodium 142mEq/L D. Calcium 9.8 mEq/L 30. Pregnant women with renal disease and taking corticosteroids at a maintenance level is highly likely to have newborns experiencing which of the following conditions? A. Hyperglycemia C. Hypoglycemia B. Respiratory depression D. Increased irritability 31. A client at 16 weeks’ gestation is receiving antibiotic therapy for pyelonephritis. The nurse is aware that the safest antibiotic for administration during pregnancy is A. Gantrisin C. Ampicillin B. Tetracycline D. Nitrofurantoin

Respiratory 32. A pregnant client is screened for tuberculosis during her first prenatal visit. An intradermal injection of purified protein derivative of the tuberculin bacilli is given. The client is considered to have a positive test for which of the following results? A. An indurated wheal under 10mm in diameter appears in 6-12 hours B. An indurated wheal over 10mm in diameter appears in 48-72 hours C. A flat circumscribed area under 10mm in diameter appears in 6-12 hours D. A flat circumscribed area over 10mm in diameter appears in 48-72 hours

39. A nurse is conducting a clinic visit with a prenatal client with heart disease. The nurse carefully assesses the client’s vital signs, weight, and fluid and nutritional status to detect complications caused by A. Hypertrophy and increased contractility of the heart B. The increase in circulating blood volume C. Fetal cardiomegaly D. Rh incompatibility 40. A prenatal client is admitted to an obstetric unit during an exacerbation of a heart condition. When planning for the nutritional requirements of the client, a nurse

33. A pregnant client who had asthma claims that her asthma attacks became infrequent since she got pregnant. Which of the following conditions during pregnancy could have contributed to the decreased frequency of attacks? A. High circulating levels of corticosteroid B. Increased histamine release C. Increased lung capacity D. High circulating levels of progesterone 34. A nurse is reviewing the results of a sweat test performed on a pregnant client with cystic fibrosis. The nurse would expect to note which finding? A. A sweat sodium concentration less than 40mEq/L B. A sweat potassium concentration less than 40mEq/L C. A sweat potassium concentration greater than 40mEq/L D. A sweat chloride concentration greater than 60mEq/L Rheumatoid 35. A nurse is assigned to care for a prenatal client with juvenile rheumatoid arthritis. The nurse reviews the plan of care, knowing that which of the following is the priority nursing diagnosis? A. Body Image Disturbance related to activity intolerance B. Potential for Self Care Deficit related to immobility C. High Risk for Injury related to impaired physical mobility D. Pain related to the inflammatory process GI 36. A pregnant client with hiatal hernia is asking the nurse for something to drink. The nurse offers the client which of the following items? A. Tomato juice C. Grapefruit juice B. Orange juice D. Apple juice Cardiovascular 37. A nurse is performing a cardiovascular assessment on a pregnant client. Which of the following items would the nurse assess to gain the best information about the client’s left-sided heart function? A. Breath sounds C. Jugular vein distention B. Peripheral edema D. Hepatojugular reflux 38. A nurse is performing a cardiovascular assessment on a pregnant client. Which of the following items would the nurse assess to gain the best information about the client’s right-sided heart function? A. Breath sounds C. Presence of dyspnea

would consult with a dietitian to ensure which of the following? A. A low-calorie diet to ensure absence of weight gain B. A diet low in fluids and fiber to decrease blood volume C. A diet high in fluids and fiber to decrease constipation D. Unlimited sodium intake to increase circulating blood volume 41. After instruction of a primigravid client at 8 weeks’ gestation diagnosed with heart disease about self-care during pregnancy, which of the following client statements would indicate the need for additional teaching? A. “I should avoid being near people who have a cold.” B. “I may be given antibiotics during my pregnancy.” C. “I should reduce my intake of protein in my diet.” D. “I should limit my salt intake at meals.” 42. While caring for a primigravid client with congestive heart disease at 28 weeks’ gestation, the nurse would instruct the client to contact her physician immediately if the client experiences which of the following? A. Mild ankle edema B. Emotional stress on the job C. Weight gain of 1 pound in 1 week D. Increased dyspnea at rest 43. A nurse is providing diet teaching to a pregnant client with congestive heart failure. The nurse tells the client to avoid A. Leafy green vegetables C. Cooked cereal B. Catsup D. Sherbet 44. A nurse is assessing a pregnant client with left sided heart failure. The client states that it is necessary to use three pillows under the head and chest at night to be able to breathe comfortably while sleeping. The nurse documents that the client is experiencing A. Dyspnea on exertion B. Dyspnea at rest C. Orthopnea D. Paroxysmal nocturnal dyspnea 45. A primigravid client with heart disease who is visiting the clinic at 8 weeks’ gestation tells the nurse that she has been maintaining a low-sodium, 1,800-calorie diet. Which of the following instructions should the nurse give the client? A. Avoid folic acid supplements to prevent megaloblastic anemia B. Severely restrict sodium intake throughout the pregnancy C. Take iron supplements with milk to enhance absorption D. Increase calorie intake to 2,200 calories

B. Peripheral edema rate

D. Respiratory

daily to promote fetal growth 46. A pregnant client is diagnosed with thrombophlebitis of the left leg. A nurse documents in the nursing care plan that the client should be placed on bed rest with A. The left leg kept flat D. Bathroom privileges B. Elevation of the left leg C. The left leg in a dependent position 55. A woman who has had diabetes mellitus for 3 years becomes pregnant. On her initial prenatal visit, she asks the nurse how this pregnancy will affect her insulin requirements. Which of the following is true regarding insulin needs during pregnancy? A. Insulin needs during pregnancy will be essentially the same as before pregnancy, as long as the client maintains a well-balanced diet. B. Insulin needs will vary throughout the pregnancy and will need to be watched closely. It is not possible to predict when insulin needs will be greatest. C. With a proper balance of nutrition and exercise, the client may not need insulin during pregnancy. This is because the baby will be producing insulin, which will be available for the mother’s body to use. D. Insulin needs will vary throughout the pregnancy. Need is likely to decrease during the first trimester and then continue to increase throughout the remainder of the pregnancy 56. At 38 weeks’ gestation, a primigravid client with poorly controlled diabetes and severe preeclampsia is admitted for a cesarean delivery. The nurse explains to the client that delivery helps to prevent which of the following? A. Neonatal hyperbilirubinemia B. Congenital anomalies C. Perinatal asphyxia D. Stillbirth Bleeding 57. Which of the following rationales best explains why a pregnant client should lie on her left side when resting or sleeping in the later stages of pregnancy? A. To facilitate digestion B. To facilitate bladder emptying C. To prevent compression of the vena cava D. To avoid the development of fetal anomalies 58. A 21-year-old client arrives at the emergency department with complaints of cramping lower abdominal pain that radiates to the shoulders and mild vaginal bleeding. Pelvic examination shows a left adnexal mass that is tender when palpated. Culdocentesis shows blood in the cul-de-sac. This client probably has which of the following conditions? A. Abruptio placentae C.

47. A pregnant client with mitral valve prolapse is receiving anticoagulant therapy during pregnancy. A nurse performs an assessment on the client and expects that the client will indicate that which of the following medications is prescribed? A. Oral intake of 15mg of warfarin (Coumadin) daily B. Intravenous infusion of heparin sodium, 5000 units daily C. Subcutaneous administration of heparin sodium 5000 units daily D. Subcutaneous administration of terbutaline (Brethine) daily Endo 48. A primigravid client with diabetes at 39 weeks’ age of gestation is seen in the highrisk clinic. The physician estimates that the fetus weighs at least 4,500g. The client asks, ”What causes the baby to be so large?” The nurses’ response is based on the understanding that fetal macrosomia is usually related to which of the following? A. Family history of large infants B. Fetal anomalies C. Maternal hyperglycemia D. Maternal hypertension 49. Clients with gestational diabetes are usually managed by which of the following therapies? A. Diet B. Long-acting insulin C. Oral hypoglycemic drugs D. Oral Hypoglycemic drugs and insulin 50. Which of the following problems typically result from uncontrolled gestational diabetes? A. Maternal hyperglycemia C. Insufficient amniotic fluid B. Fetal demise D. Maternal hypertension 51. A 27-year old primigravid client with insulin-dependent diabetes at 34 weeks’ gestation undergoes a nonstress test, the results of which are documented as reactive. The nurse tells the client that the test results indicate which of the following? A. A contraction stress test is necessary B. The nonstress test should be repeated C. Chorionic villus sampling is necessary D. There is evidence of fetal well-being. 52. A primigravid client with insulin-

dependent diabetes tells the nurse that the contraction stress test performed earlier in the day was suspicious. The nurse interprets this test result as indicating that the fetal heart rate pattern showed which of the following? A. Frequent late decelerations B. Decreased fetal movement C. Inconsistent late decelerations D. Lack of fetal movement 53. When teaching a primigravid client with diabetes about common causes of hyperglycemia during pregnancy, which of the following would the nurse include? A. Fetal macrosomia B. Obesity before conception C. Maternal infection D. Pregnancy-induced hypertension 54. After teaching a diabetic primigravida about symptoms of hyperglycemia and hypoglycemia, the nurse determines that the client understands the instruction when she says that hyperglycemia may be manifested by which of the following? A. Dehydration C. Sweating B. Pallor D. Nervousness

Hydatidiform mole B. Ectopic pregnancy inflammatory disease

D. Pelvic

59. Before surgery to remove an ectopic pregnancy and the fallopian tube, which of the following would alert the nurse to the possibility of tubal rupture? A. Amount of vaginal bleeding and discharge B. Falling hematocrit and hemoglobin levels C. Slow, bounding pulse rate of 80 beats per minute D. Marked abdominal edema 60. A 36-year old multigravid client is admitted to the hospital with possible ruptured ectopic pregnancy. When obtaining the client’s history, which of the following would be most important to identify as a predisposing factor? A. Urinary tract infection B. Cocaine use during pregnancy C. Episodes of pelvic inflammatory disease D. Use of estrogen-progestin contraceptives 61. A multigravid client is admitted to the hospital with a diagnosis of ectopic pregnancy. The nurse anticipates that, because the client’s fallopian tube has not yet ruptured, which of the following may be ordered? A. Progestin contraceptives C. Methotrexate B. Medroxyprogesterone D. Betamethasone 70. Which of the following findings would indicate that a woman might be developing complications from an abruptio placentae A. The woman’s temperature is 100 degrees F (38.3 degrees C) B. Fluid-filled vesicles appear in the vaginal discharge C. A venipuncture site continuous to bleed for 15 minutes D. Urinary output is approximately 50ml/hr 71. In assessing the client with vaginal bleeding in the third trimester of pregnancy. Abruptio placenta is suspected. Which of the following procedures would the nurse perform? A. Monitor urine output by inserting a Foley catheter B. Perform a vaginal examination to evaluate progression of labor C. Check the client’s vital signs every 30 minutes. D. Conduct an abdominal examination for signs of tenderness and rigidity 72. In providing nursing care for the woman with abruptio placenta, which of the following measures would be appropriate and provide the most benefit to the fetus?

62. A woman who is 8 weeks pregnant comes to the emergency department with moderate bright red vaginal bleeding. On examination, the physician finds the client’s cervix 2cm dilated. Which term best describes the client’s condition? A. Incomplete abortion C. Threatened Abortion B. Inevitable abortion D. Missed abortion 63. A multigravida is admitted to the hospital with a diagnosis of threatened abortion. Her initial nursing management would include which of the following? A. Examining all perineal pads for tissues and clots B. Placing the patient in Trendelenburg position C. Preparing her for a Shirodkar procedure. D. Restricting all physical activity and fluid intake 64. The physician tells a woman who experienced bleeding in the first trimester that she has had “a missed abortion.” The woman asks the nurse to explain what this means. Which response is most appropriate? A. “It’s another name for a miscarriage.”

B. “The baby is deformed, resulting in an abortion.” C. “The baby is no longer alive and growing, but your body hasn’t expelled it yet.” D. “There was no pregnancy; your body just responded as if there was one.” 65. A client with painless vaginal bleeding has just been diagnosed as having placenta previa. Which of the following procedures is usually performed to diagnosed placenta previa? A. Amniocentesis B. Digital or speculum examination C. External or fetal monitoring D. Ultrasound 66. A pregnant client who reports painless vaginal bleeding at 28 weeks’ gestation is diagnosed with placenta previa. The placental edge reaches the internal os. This type of placenta previa is known as which of the following types? A. Low-lying placenta previa C. Partial placenta previa B. Marginal placenta previa D. Total placenta previa 67. After giving instruction about the cause of the vaginal bleeding to a multigravid client at 36 weeks’ gestation diagnosed with placenta previa, the nurse determines that the teaching has been effective when the client says that the bleeding results from which of the following? A. Diminished clotting factors B. Exposure of maternal blood sinuses C. Increased platelet levels D. A large-for-gestational age fetus 68. A woman in the eighth month of pregnancy has mild vaginal bleeding associated with a diagnosis of placenta previa. In caring for this client, the nurse would A. Prepare for a vaginal examination B. Expect an emergency cesarean birth C. Keep the woman on bedrest D. Place the woman in Trendelenburg position 69. A woman is hospitalized with placenta previa. Which of the following is most important for the nurse to teach this client regarding her condition? A. Reduce external stimuli in the room B. Decrease fluid intake C. Limit physical activity D. Avoid emotional upset 78. In complete hydatidiform mole, which of the following karyotypes is typically found? A. 46XX C. 69XXX B. 69XXY D. 69XYY 79. When caring for a multigravid client admitted to the hospital with vaginal

A. Turn the client every 30 minutes B. Administer oxygen C. Estimate amount of blood loss D. Observe for changes in the pattern of uterine contractions 73. The nurse is caring for a woman with a diagnosis of abruptio placentae. What complication of this condition is of most concern to the nurse? A. Disseminated intravascular coagulation syndrome B. Pulmonary embolus C. Hypocalcemia D. Urinary tract infection 74. Which of the following symptoms occurs with a hydatidiform mole? A. Heavy, bright red bleeding every 21 days B. Fetal cardiac motion after 6 weeks’ gestation C. Benign tumors found in the smooth muscle of the uterus D. “Snowstorm” pattern on ultrasound with no fetus or gestational sac 75. A client is being admitted to the emergency room for hypovolemia secondary to hyperemesis gravidarum. Which of the following factors predisposes a client to the development of this condition? A. Trophoblastic disease B. Maternal age older than 35 years C. Malnourished or underweight clients D. Low levels of human chorionic gonadotropin 76. A 21-year old client has just been diagnosed with having a hydatidiform mole. Which of the following factors is considered a risk factor for developing a hydatidiform mole? A. Age in 20s or 30s C. Primigravida B. High socioeconomic status D. Prior molar gestation 77. After suction and evacuation of a complete hydatidiform mole, The 28 year-old primigravid client asks the nurse when she can become pregnant again. The nurse would advise the client not to become pregnant again for at least which of the following time spans? A. 6 months C. 18 months B. 12 months D. 24 months 86. The physician orders betamethasone (Celestone) for a 34-year old multigravid client at 32 weeks’ gestation who is experiencing preterm labor. The nurse explains that this drug is given for which of the following reasons? A. Enhance fetal lung maturity

bleeding at 38 weeks’ gestation, which of the following would the nurse anticipate administering intravenously if the client develops disseminated intravascular coagulation (DIC)? A. Ringer’s lactate solution C. 5% dextrose solution B. Fresh frozen platelets D. Warfarin sodium 80. Which of the following drugs is the antidote for Heparin toxicity? A. Calcium gluconate C. Hydralazine B. Phytomenadione D. Protamine sulfate Preterm Labor 81. A client is diagnosed with preterm labor at 28 weeks’ gestation. Later she comes to the emergency department saying,”I think I’m in labor.” The nurse would expect her physical examination to show which of the following conditions? A. Painful contractions with no cervical dilation B. Regular uterine contractions with cervical dilation C. Irregular uterine contraction with no cervical dilation D. Irregular uterine contractions with cervical effacement 82. A client hospitalized for premature labor tells the nurse she’s having occasional contractions. Which of the following nursing interventions would be most appropriate? A. Teach the client the possible complications of premature birth B. Tell the client to walk to see if she can get rid of the contractions C. Encourage her to empty her urinary bladder and drink plenty of fluids, and give I.V. fluids D. Notify anesthesia dept. for immediate epidural placement to relieve the pain associated with contractions 83. A 31-year old client at 32 weeks’ gestation, is admitted to the hospital with contractions of moderate intensity occurring every 3-4 minutes. The client, who has previously delivered two nonviable fetuses at 30 weeks’ gestation, is crying on admission. The client asks, “What causes preterm labor?” After giving instruction about various risks for preterm labor, the nurse determines that additional explanation is needed when the client says that preterm labor is often associated with which of the following? A. Age older than 30 years C. Chronic hypertension B. Polyhydramnios D. Multifetal gestation 84. A multigravid client at 34 weeks’ gestation is being treated with indomethazine to halt preterm labor. If the

B. To counter the effects of tocolytic therapy C. To treat chorioamnionitis D. To decrease neonatal production of surfactant 87. When preparing a multigravid client at 34 weeks’ gestation experiencing preterm labor for the shake test performed on amniotic fluid, the nurse would instruct the client that this test is done to evaluate the maturity of which of the following fetal systems? A. Urinary C. Cardiovascular B. Gastrointestinal D. Pulmonary PROM 88. A multigravid client at 34 weeks’ gestation visits the hospital because because she suspects that her water has broken. After testing the leaking fluid with nitrazine paper, the nurse confirms that the client’s membranes have ruptured when the paper turns which of the following colors? A. Yellow C. Blue B. Green D. Red 89. When premature rupture of the membranes (PROM) occurs, which of the following provides evidence of the nurse’s understanding of the client’s immediate needs? A. The chorion and the amnion rupture 4 hours before the onset of labor. B. PROM removes the fetus’ 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 90. A primigravid client at 30 weeks’ gestation has been admitted to the hospital with premature rupture of the membranes without contractions. Her cervix is 2cm dilated and 50% effaced. Which of the following would be a priority assessment for this client? A. Red blood cell count C. Urinary output B. Degree of discomfort D. Temperature 91. A primigravid client at 34 weeks’ gestation is experiencing contractions every 3 to 4 minutes lasting for 35 seconds. Her cervix is 2cm dilated and 50% effaced. While the nurse is assessing the client’s vital signs, the client says, “I think my bag of water just broke.” Which of the following would the nurse do first? A. Check the status of the fetal heart rate. B. Turn the client to her right side C. Test the leaking fluid with nitrazine paper D. Perform a sterile vaginal examination Trauma

93. A primigravid client comes to the clinic for her initial prenatal visit. She is at 32 weeks’ gestation. The client says that she has had periodic headaches during her pregnancy, and that she is continually bumping into things. The nurse notes numerous bruises in various stages of healing around the client’s breasts and abdomen. Vital signs are: BP=120/80, pulse 72, respirations 18, and FHT 142. Which of the following responses by the nurse is best? A. “Are you battered by your partner?” B. “How do you feel about being pregnant?” C. “Tell me about your headaches.” D. “You may be more clumsy due to your size.” 94. A pregnant woman who is at 32 weeks’ gestation is admitted to the obstetric unit for observation after an automobile accident. The client is experiencing slight vaginal bleeding and mild cramps. The nurse does which of the following to determine the viability of the fetus? A. Inserts an intravenous line and begins an infusion at 125ml/hr B. Administers oxygen to the woman via face mask at 7-10L/min C. Positions and connects the ultrasound transducer and the tocotransducer to the external fetal monitor D. Positions and connects a spiral electrode to the fetal monitor for internal fetal monitoring PIH 95. Which of the following maternal complications is associated with obesity in pregnancy? A. Anemia C. Preeclampsia B. Placenta previa D. Rh isoimmunization 96. At 32 weeks’ gestation, a 15-year old primigravid client who is 5 feet, 2 inches tall has gained a total of 20 pounds, with a 1pound gain in the last two weeks. Urinalysis reveals negative glucose and a trace of protein. The nurse determines that which of the following factors increases this client risk for preeclampsia? A. Total weight gain C. Adolescent age group B. Short stature D. Proteinuria 97. A primigravid client’s baseline blood pressure at her initial visit at 12 weeks’ gestation was 110/70mmHg. During an assessment at 38 weeks’ gestation, which of the following data would indicate mild preeclampsia? A. Blood pressure of 160/100mmHg on two separate occasions B. Proteinuria, more than 5 grams in 24 hours

100. Magnesium sulfate is given to clients with pregnancy-induced hypertension to prevent seizure activity. Which of the following magnesium levels is therapeutic for clients with preeclampsia? A. 4 to 7 mEq/L C. 10 to 12 mEq/L B. 8 to 10 mEq/L D. greater than 15 mEq/L 101. A client is receiving magnesium sulfate for severe preeclampsia. Which of the following adverse effects is associated with magnesium sulfate? A. Anemia C. Hyperreflexia B. Decreased urine output D. Increased respiratory rate 102. Which of the following drugs is the antidote for magnesium toxicity? A. Calcium gluconate C. Hydralazine B. Naloxone D. Protamine sulfate 103. A client is receiving magnesium sulfate and asks the nurse if the drug will affect her baby. What would be the best response? A. “No, the placenta acts as a barrier to the medication.” B. “The doctor wouldn’t order it if it would hurt the baby.” C. “It has a minor effect; however, the effects of a convulsion are much more severe.” D. “We don’t know if this drug crosses the placental barrier.” 104. When developing the teaching plan for a primigravid client at 30 weeks’ gestation diagnosed with mild preeclampsia who is being treated at home, which of the following would the nurse identify as the most appropriate client-centered goal? A. Return visit to the prenatal clinic in approximately 4 weeks B. Decreased edema after 1 week of a lowprotein, low-fiber diet C. Bed rest on the left side during the day, with bathroom privileges D. Immediate reporting of adverse reactions to magnesium sulfate therapy 105. After instructing a primigravid client at 38 weeks’ gestation about how preeclampsia can affect both the client and the growing fetus, the nurse realizes that the client needs additional instruction when she says that preeclampsia can lead to which of the following? A. Hydrocephalic infant C. Intrauterine growth retardation B. Abruptio placentae D. Poor placental perfusion

C. Serum creatinine concentration of 1.4mg/dl D. Weight gain of 2 pounds in the last week 98. Magnesium sulfate is given to pregnant clients to prevent which of the following conditions? A. Hemorrhage C. Hypomagnesemia B. Hypertension D. Seizures 99. Which of the following would the nurse identify as the priority to achieve when developing the plan of care for a primigravid client at 38 weeks’ gestation who is hospitalized with severe preeclampsia and receiving intravenous magnesium sulfate? A. Decreased generalized edema within 8 hours B. Decreased urinary output during the first 24 hours C. Sedation and decreased reflex excitability within 48 hours D. Absence of any seizure activity during the first 48 hours

106. When teaching a multigravid client diagnosed with mild preeclampsia about nutritional needs, which of the following types of diet would the nurse discuss? A. High- residue diet C. Regular diet B. Low-sodium diet D. High-protein diet 107. When reviewing the prenatal records of a 16-year old primigravid client at 37 week’ gestation diagnosed with severe preeclampsia, the nurse would interpret which of the following as most indicative of the client’s diagnosis? A. Blood pressure of 138/94mmHg B. Severe blurring of vision C. Less than 2 gram protein in a 24-hour urine sample D. Weight gain of 0.5 pound in 1 week 108. A primigravid client with severe preeclampsia exhibits hyperactive, very brisk patellar reflexes with ankle clonus present and two movements after the reflex. The nurse documents these findings as which of the following? A. 1+ C. 3+ B. 2+ D. 4+ 117. Which of the following doses of Rho (D) immune globulin (RhoGAM) is appropriate for a pregnant client at 28 weeks’ gestation? A. 50mcg in a sensitized client B. 50mcg in an unsensitized client C. 300mcg in a sensitized client D. 300mcg in an unsensitized client 118. Rh isoimmunization in a pregnant client develops during which of the following conditions? A. Rh-positive maternal blood crosses into fetal blood, stimulating fetal antibodies B. Rh-positive fetal blood crosses into maternal blood, stimulating maternal antibodies C. Rh-negative fetal blood crosses into maternal blood, stimulating maternal antibodies D. Rh-negative maternal blood crosses into fetal blood, stimulating fetal antibodies Multiple Pregnancy 119. One of the most common causes of hypotonic uterine dystocia is A. Twin gestation C. Maternal anemia B. Pelvic contracture D. PIH 120. Usually, individual twins will grow appropriately and at the same rate as singletons until how many weeks’ gestation? A. 16-18 wks C. 30-32 wks B. 18-22 wks D. 38-40 wks 121. In twin-to-twin transfusion syndrome,

109. A 28-year old multigravid client at 37 weeks’ gestation arrives at the emergency department with a blood pressure of 160/104mmHg and 3+ reflexes without clonus. The client, who is diagnosed with severe preeclampsia, asks the nurse, “What is the cure for my high blood pressure?” Which of the following would the nurse identify as the primary cure? A. Administration of glucocorticoids B. Vaginal or cesarean delivery of the fetus C. Sedation with phenytoin (Dilantin) D. Reduction of fluid retention with thiazide diuretics 110. A 16-year old primigravid client at 37 weeks’ gestation with severe preeclampsia is in early active labor. The client’s blood pressure is 164/110mmHg. Which of the following would alert the nurse that the client may be about to experience a seizure? A. Decreased contraction intensity B. Decreased temperature C. Epigastric pain D. Hyporeflexia 111. As the nurse enters the room of a newly admitted primigravid client diagnosed with severe preeclampsia, the client begins to experience a seizure. Which of the following should the nurse do first? A. Insert an airway to improve oxygenation B. Note the time when seizure begins and ends C. Call for immediate assistance D. Insert a padded tongue blade in her mouth

112. If a client at 36 weeks’ gestation with eclampsia begins to exhibit signs of labor after an eclamptic seizure, for which of the following would the nurse assess? A. Abruptio placentae C. Placenta accreta B. Transverse lie D. Uterine atony 113. The nurse evaluates that the danger of a seizure in a client with eclampsia ends A. After labor begins C. 24 hours postpartum B. After delivery occurs D. 48 hours postpartum 114. For a multigravid client at 39 weeks’ gestation with suspected HELLP syndrome, the nurse would immediately notify the physician for which of the following laboratory test results? A. Hyperfibrogenemia C. Decreased liver enzymes B. Thrombocytopenia D. Hypernatremia 115. For a multigravid client at 39 weeks’ gestation with suspected HELLP syndrome, the nurse would immediately notify the physician for which of the following laboratory test results? A. Hyperfibrogenemia C. Decreased liver enzymes B. Decreased RBC count D. Hypernatremia Isoimmunization 116. Which of the following answers best describes the stage of pregnancy in which maternal and fetal blood are exchanged? A. Conception B. 9 weeks’ gestation when the fetal heart is well developed C. 32 to 34 weeks’ gestation (third trimester) D. Maternal and fetal blood are never exchanged

the arterial circulation of one twin is in communication with the venous circulation of the other twin. One fetus is considered the “donor” twin and one becomes the “recipient” twin. Assessment of the recipient twin would most likely show which of the following conditions? A. Anemia C. Polycythemia B. Oligohydramnios D. Small fetus 122. A nurse in the prenatal clinic is monitoring a client who is pregnant with twins. The nurse monitors the client most closely for which complication that is most likely associated with a twin pregnancy? A. Maternal anemia C. Hemorrhoids B. Postterm labor D. Gestational diabetes 123. The presence of multiple gestation should be detected as early as possible and the pregnancy managed with high risk in mind because A. Postpartum hemorrhage is an expected complication B. Perinatal mortality is two to three times greater than single births C. Maternal mortality is much higher during the prenatal period in multiple gestation D. The mother needs time to adjust psychologically and physiologically after delivery Fetal Death 124. A nurse receives report at the beginning of the shift regarding a client with an intrauterine fetal demise. On assessment of the client, the nurse expects to note which of the following? A. Elevated blood pressure, proteinuria, and edema B. Regression of pregnancy symptoms and absence of fetal heart tones C. Uterine size greater than expected for gestational age D. Intractable vomiting and dehydration