1. The nurse is caring for a client in the first trimester during an initial prenatal clinic visit.

Based on the
information provided by the client, which factor places the client at an increased risk for preterm labor?
a) Age 25
b) Periodical disease
c) Vegetarian diet
d) White ethnicity
2. The nurse is reinforcing instructions to a client at 34 weeks gestation who is preparing to travel by
airplane. Which of the following instructions are appropriate? Select all that apply.
a) Avoid getting up during the flight unless you need the restroom.
b) Carry a copy of your most up-to-date prenatal record
c) Increase fluid intake before and during the flight
d) Secure the lap belt below the abdomen and across your hips when seated
e) Wear compression hose and loose-fitting clothing
3. The nurse is caring for a client at 30 weeks gestation who is hospitalized for preeclampsia. After
reviewing the client’s chart and performing an initial assessment, the nurse notes several abnormal
findings. Which finding should the nurse discuss with the health care provider immediately?
a) Dark red vaginal bleeding
b) Edema of the hands and face
c) Elevated liver enzymes
d) Urine output of 150 mL in 4 hours
4. The nurse receives report on 4 first-trimester pregnant clients. Which client should the nurse assess
first?
a) Client with hydatidiform mole reporting dark brown vaginal discharge
b) Client with hyperemesis gravidarum reporting excessive vomiting and weight loss
c) Client suspected ectopic pregnancy reporting abdominal and shoulder pain
d) Client with threatened miscarriage who says, “I am a Jehovah’s Witness.”
5. A client who is being evaluated for suspected ectopic pregnancy reports sudden-onset, severe, right
lower abdominal pain and dizziness. Which additional assessment findings will the nurse anticipate if
the client is experiencing a ruptured ectopic pregnancy? Select all that apply
a) Blood pressure 82/64 mm Hg
b) Crackles on auscultation
c) Distended jugular veins
d) Pulse 120/min
e) Shoulder pain
6. A nurse is caring for a client at 30 weeks gestation who is admitted for preterm labor. Which of the
following interventions should the nurse anticipate? Select all that apply.
a) Administering IM betamethasone
b) Administering penicillin via IV piggybank
c) Assisting with artificial rupture of membranes
d) Initiating IV magnesium sulfate
e) Obtaining fetal heart tones once per shift
7. A nurse is participating in an obstetrical emergency simulation in which the health care provider
announces shoulder dystocia. Which of the following interventions should the assessing nurse
implement? Select all that apply.
a) Assist maternal pushing efforts by apply fundal pressure during each contraction
b) Document the time the fetal head was born
 c) Flex the client’s legs back against the abdomen and apply downward pressure above the symphysis
pubis
d) Prepare for a forceps-assisted birth
e) Request additional assistance from other nurse immediately
8. The nurse is monitoring a client who is in active labor with a cervical dilation of 6 cm. Which uterine
assessment finding requires an intervention by the nurse?
a) Contraction duration of 95 seconds
b) Contraction frequency of every 3 minutes
c) Contraction intensity of 45 mm Hg
d) Uterine resting tone of 10 mm Hg
9. A client is admitted to the labor and delivery unit with a diagnosis of severe preeclampsia. IV
magnesium sulfate is prescribed. Which nursing measures should the nurse include in this client’s plan
of care? Select all that apply.
a) Assess deep tendon reflexes hourly
b) Ensure availability of calcium gluconate
c) Ensure bright lighting to prevent falls
d) Have supplement oxygen at bedside
e) Limit visitors to minimize stimulation
10. The nurse is reviewing laboratory results for several prenatal clients. Which finding is most important to
report to the health care provider?
a) Client at 24 weeks gestation with hemoglobin of 9g/dL (90 h/L) and hematocrit of 29%
b) Client at 26 weeks gestation whose 1-hour (50 g) oral glucose challenge test result is 120 mg/dL
(6.7 mmol/L)
c) Client at 36 weeks gestation with blood pressure of 125/85 mm Hg and trace
d) Client at 37 weeks gestation with a WBC count of 13,000/mm 3 (13.0 * 109/L)
11. A client in labor has reached 8 cm dilation, is fully effaced, and feels an urge to push. The nurse
observes thick, blood-tinged mucus during the vaginal examination. What is the nurse’s best action?
a) Administer prescribed IV meperidine for pain relief
b) Encourage client to bear down with spontaneous urges to push
c) Place client in the lithotomy position in preparation for birth
d) Provide encouragement and coaching in breathing techniques
12. A laboring client reports feeling the need to have a bowel movement and begins vomiting. The nurse
notes that the client’s legs are trembling. What cervical examination finding would the nurse most
expect this client to have?
a) 2 cm dilated, 50% effaced, -2 station
b) 6 cm dilated, 70% effaced, -1 station
c) 7 cm dilated, 80% effaced, 0 station
d) 8 cm dilated, 100% effaced, +1 station
13. The initial results of prenatal laboratory screening results of a client at 12 weeks gestation indicate a
rubella titer status of nonimmune. What will the nurse anticipate as the plan of care for this client?
a) Administer measles-mumps-rubella (MMR) vaccine now
b) Administer MMR vaccine immedaitely postpartum
c) Administer MMR vaccine in the third trimester
d) An MMR is not indicated for this client
14. The nurse provides discharge instructions to a client at 14 weeks gestation who has received a
prophylactic cervical cerclage. Which client statement indicates an understanding of teaching?
a) “I need to be on bed rest for the duration of my pregnancy.”
 b) “I will notify my health care provider if I start having low back aches.”
c) “Pelvic pressure is to be experienced after cerclage placement”
d) “The cerclage will be removed once my baby is at 28 weeks.”
15. The nurse cares for a client who gave birth an hour ago to a 9-lb (4.1-kg) newborn. The client’s lochia is
heavy with large clots, and the fundus remains boggy after fundal massage and an oxytocin bolus.
Which prescription from the health care provider should the nurse question? The client’s vital signs:
Blood pressure 168/95 mm Hg and 98/min
a) Administer 0.2-mg methylergonovine IM
b) Administer 800-mcg misoprostol rectally
c) Collect a hemoglobin and hematocrit STAT
d) Initiate second IV line with 18-gauge needle
16. A nurse is preparing to administer oxytocin to induce labor in a pregnant client at term gestation.
Which of the following nursing actions are appropriate during oxytocin infusion? Select all that apply.
a) Administer oxytocin through the primary IV line
b) Assess the uterine contraction pattern
c) Initiate continuous fetal heart rate monitoring
d) Place IV oxytocin on an electronic infusion pump
e) Titrate oxytocin to achieve cervical dilation of 1 cm every 2 hours
17. The postpartum nurse is assessing a client who gave birth by cesarean section 5 hours ago and is
requesting pain medication. The client appears restless, has a heart rate of 110/min, and admits to
recent onset anxiety. What priority action should the nurse take?
a) Assess for lower extremity warmth and redness
b) Instruct the client in relaxation breathing techniques
c) Obtain oxygen saturation reading by pulse oximeter
d) Offer the client prescribed PRN pain medication
18. The nurse is providing teaching to a prenatal client about the 1-hour glucose test that will be performed
at the next visit. Which client statement indicates a need for further teaching?
a) “Fasting is required before the 1-hour glucose challenge test.”
b) “One blood sample is obtained at the end of the test.”
c) “The test includes drinking a 50-g glucose solution.”
d) “The test’s purpose is to screen for gestational diabetes, not diagnose it.”
19. The nurse receives report for a client at 36 weeks gestation who is being transferred to the unit for
labor induction from a rural health care facility with an intrauterine fetal demise of unknown duration.
Which intervention is the most important when receiving care of the client?
a) Apply tocodynamometer and evaluate current contraction pattern
b) Ask the client about the family’s desire for speaking with a chaplain
c) Draw coagulation tests, fibrinogen, and complete blood count with platelets
d) Initiate oxytocin prescription to begin induction of labor
20. The graduate nurse (GN) is caring for a laboring client with epidural anesthesia. After the client pushes
for 3 hours during the second stage of labor, the health care provider (HCP) decides to use forceps to
assist the client to deliver secondary to maternal exhaustion. Which action by the GN requires the
nurse preceptor to intervene?
a) Begins to apply fundal pressure when the HCP applies traction to forceps
b) Drains the client’s bladder using a catheter before the placement of forceps
c) Notes the exact time the forceps are applied on a card documentation in the birth record
d) Palpitates for contractions and notifies the HCP when they are present
21. The nurse is verifying the medical history of a client who is admitted for a scheduled labor induction.
Which client statement should prompt the nurse to request further evaluation for a primary cesarean
birth from the health care provider?
a) “A vacuum was used to help deliver my last baby because the baby’s heart rate was dropping.”
b) “I have an atrial septal defect that has never given me any problems, and I plan to receive an
epidural during labor.”
c) “I lost my acyclovir prescription, and I’ve noticed lesions on my labia that are stinging and burning.”
d) “I took enoxaparin during this pregnancy due to a history of blood clots, and my last dose was
yesterday.”
22. A nurse on the antepartum unit is caring for a pregnant client at 30 weeks gestation who was admitted
with reports of vaginal bleeding. A diagnosis of placenta previa was confirmed by ultrasound. What
should the nurse tell the client to anticipate? Select all that apply.
a) Additional ultrasound around 36 weeks gestation
b) Clearance for sexual activity if bleeding stops
c) Discharge home if bleeding stops and fetal status is reassuring
d) Scheduled cesarean birth before onset of labor
e) Weekly vaginal examinations to assess for cervical damage
23. The nurse is caring for a pregnant client at 27 weeks gestation after a motor vehicle collision with side
airbag deployment. The client’s blood is type O negative. Which laboratory test should the nurse
anticipate?
a) Group B streptococcal culture
b) Indirect Coombs test
c) Rubella immunity titer
d) Serum alpha fetoprotien
24. A nurse is preparing to administer an oxytocin IV infusion to a client for labor induction. The nurse
recognizes that an oxytocin infusion may increase the client’s risk for which of the following? Select all
that apply.
a) Abnormal or indeterminate fetal heart rate patterns
b) Delayed breast milk production
c) Placenta previa
d) Postpartum hemorrage
e) Uterine tachysystole
25. The graduate nurse (GN) is caring for a client at 20 weeks gestation with secondary syphilis. The client
reports an allergic reaction to penicillin as child but does not know what kind of reaction occurred.
When discussing the client’s potential treatment plan with the precepting nurse, which statement by
the GN indicates an appropriate understanding?
a) “Doxycycline is an acceptable alternative to penicillin for treatment of syphilis during pregnancy.”
b) “The client will require penicillin desensitization to receive appropriate treatment.”
c) “The newborn can be treated after birth if antepartum treatment is contraindicated.”
d) “Treatment is only effective if provided during the primary stage of syphilis.”
26. The nurse is performing a postpartum assessment 12 hours after the prolonged vaginal delivery of a
tern infant. Which assessment findings should be reported to the health care provider?
a) Complaints of discomfort during fundal palpitation
b) Foul-smelling lochia
c) Oral temperature
d) White blood cell(WBC) count 24,000/mm3 (24.0 * 109/L)
27. A client who is 8 weeks pregnant reports morning sickness. What is the most appropriate response by
the nurse?
a) Advise the client to consume hot, versus cold, foods
b) Instruct the client to drink 2 glasses of water with each meal
c) Suggest the client consume high-protein snacks on awakening
d) Tell the client that morning sickness should pass in a few weeks.
28. Which actions should the labor and deliver nurse perform when caring for a client who has decided to
relinquish of her newborn to an adoptive parent? Select all that apply.
a) Avoid discussing the adoption details until after the birth
b) Encourage the birth mother to hold the newborn
c) Notify other staff who may interact with the client of the adoption plan
d) Offer the birth mother a chance to say goodbye to the newborn
e) Use phrases that illustrate adoption is a decision of love, not abandonment
29. A client at 41 weeks gestation is admitted to the labor and delivery unit for labor induction. The nurse is
assisting the health care provider with an amniotomy. What actions should the nurse anticipate? Select
all that apply.
a) Assessing the fetal heart rate before and after the procedure
b) Checking the client’s temperature every 2 hours
c) Informing the client she will feel a sharp pain during the procedure
d) Keeping the client in a supine position after the procedure
e) Noting the characteristics of the amniotic fluid
30. A client at 38 weeks gestation is in latent labor with ruptured membranes and is receiving an oxytocin
infusion for labor augmentation. The client is requesting IV pain medication. When administering an IV
narcotic during labor, which nursing action is appropriate?
a) Discontinue the oxytocin infusion prior to giving the medication
b) Give the medication slowly during the peak of the next contraction
c) Hold until contractions are occurring at least every 4 minutes for an hour
d) Withdraw 5 mL of lactated Ringer from the IV tubing to dilute the medication
31. The nurse receives report on several postpartum clients who gave birth at term gestation. Which client
should the nurse assess first?
a) Client, G1P1, who is in 24 hours postcesarean birth with cramping and foul-smelling lochia
b) Client, G1P1, who is 72 hours postvaginal birth, on bed rest, and taking enoxaparin for a deep
venous thrombosis
c) Client G4P3, who is 72 hours postcesarean birth with a temperature of 100.8 F (38.2 C) and a red,
swollen breast
d) Client G5P5, who is 12 hours postvaginal birth and saturating perineal pads every hour for 2 hours
with lochia rubra
32. The graduate nurse (GN) receives report on a postpartum client with an Rh-negative blood type. Which
statement by the GN regarding the Rh immune globulin injection requires the preceptor to provide
further teaching?
a) “Additional doses of Rh immune globulin may be required if excessive fetomaternal hemorrhage is
suspected.”
b) “I should administer Rh immune globulin to the client within 72 hours after birth.”
c) “If the maternal antibody screen is negative, I will hold Rh immune globulin and contact the health
care provider.”
d) “Rh immune globulin is not required if the newborn’s blood type is Rh negative.”
33. A client at 34 weeks gestation reports constipation. The client has been taking 325 mg ferrous sulfate
tid for anemia since the last appointment 4 weeks ago. Which recommendations should the nurse
make for this client? Select all that apply.
a) Decreased daily dairy intake
b) Increased fruit and vegetable intake
c) Moderately-intensity regular exercise
d) One laxative twice daily for a week
e) Two cups of hot coffee each morning
34. A nurse is caring for a postpartum client who is breastfeeding and has been diagnose with mastitis of
the right breast. Which of the following instructions should the nurse include in client teaching? Select
all that apply.
a) Apply warm compresses to breast
b) Discontinue breastfeeding until symptoms resolve
c) Increase oral fluid intake
d) Take ibuprofen as needed for pain
e) Wear a tight-fitting bra as much as possible
35. The nurse is providing education to several first-trimester pregnant clients. Which client requires
priority anticipatory teaching?
a) Client who gardens and eats homegrown vegetables
b) Client who has gained 4lb (1.8kg) from prepregnancy weight
c) Client who has noticed thin, milky white vaginal discharge
d) Client who practices yoga and swims in a pool 3 times a week
36. The clinic nurse is collecting data on a pregnant client in the first trimester. Which finding is most
concerning and warrants priority intervention?
a) Client has not been taking prenatal vitamins
b) Client is taking lisinopril to control hypertension
c) Client reports a whitish vaginal discharge
d) Client reports mild cramping pain in the lower abdomen
37. The nurse performs initial assessments of four clients in a prenatal clinic. Which client findings are
abnormal and require further assessment?
a) Client at 9 weeks gestation with a normal BMI and a weight gain of 2 lb (1 kg) from pre-pregnancy
weight
b) Client at 15 weeks gestation with headaches relieved by acetaminophen
c) Client at 19 weeks gestation with bleeding gums after brushing and flossing teeth
d) Client at 20 weeks gestation with an increase in diastolic blood pressure of 15 mm Hg since last visit
38. A client indicates the desire to become pregnant. Which of the following are important preconception
education topics for the nurse to provide? Select all that apply.
a) Aim for BMI of 18.5-24.9 kg/m2
b) Avoid alcohol consumption and tobacco products
c) Ensure daily intake of 400 mcg of folic acid
d) Obtain testing for rubella immunity
e) Schedule dental wellness appointment
39. Which client in a prenatal clinic should the nurse assess first?
a) Client at 11 weeks gestation with backache and pelvic pressure
b) Client at 16 weeks gestation with earache and sinus congestion
c) Client at 27 weeks gestation with headache and facial edema
d) Client at 37 weeks gestation with white vaginal discharge and urinary frequency
40. A laboring client at 35 weeks gestation to the labor and delivery unit with preterm rupture of
membranes “about 18 hours ago.” The client’s group B Streptococcus status is unknown. What
intervention is a priority for this client?
a) Administration of prophylactic antibiotics
b) Assessment of uterine contraction frequency
c) Collection of a clean-catch urine specimen
d) Vaginal examination to assess cervical dilation
41. A laboring client with epidural anesthesia experiences spontaneous rupture of membranes,
immediately followed by an abrupt change in the fetal heart rate, which action should be taken
first?

a) Administer IV fluid bolus

b) Assess for umbilical cord prolapse
c) Notify the health care provider
d) Reposition client to alternate side
42. A pregnant client admitted for induction of labor is receiving an oxytocin infusion. The baseline
fetal heart rate is 140/min and the strip is shown in the exhibit. What is the nurse’s best course
of action?

a) Apply oxygen 10L/min face mask

b) Continue to monitor the client
c) Discontinue oxytocin infusion
d) Notify the health care provider(HCP)
43. The charge nurse is observing fetal heart rate (FHR) tracing of 4 clients who have just been
admitted to labor and delivery triage. Which FHR pattern would be most concerning to the
nurse?
 a)

b)

c)

d)
44. The labor and deliver nurse is performing a vaginal examination to assess for cervical dilation
and effacement. While palpating the presenting fetal part, the nurse feels a diamond-shaped
structure that feels soft in the middle. What is the nurse’s best action?
a) Document fetal presentation as breach
b) Document fetal presentation as cephalic
c) Elevate the fetal presenting part away from the prolapsed cord
d) Request that the health care provider confirm fetal presentation
45. A graduate nurse is caring for a client at 39 weeks gestation who is receiving an oxytocin
infusion. Oxytocin is infusing at 20 mU/min. Based on the electronic fetal monitor strip, which
action by the graduate nurse would cause the registered nurse to intervene?
 a) Administers oxygen by face mask at 10L/min
b) Decreases oxytocin to 10 mU/min
c) Notifies the health care provider
d) Reposition the client in the left lateral position
46. The nurse is caring for a client at 39 weeks gestation in active labor who is receiving an
oxytocin infusion. The nurse notes persistent late decelerations on the fetal monitor. Which of
the following actions should the nurse take? Select all that apply.
a) Administer oxygen via a nonrebreather face mask
b) Change material position to the left side
c) Discontinue the oxytocin infusion
d) Notify the health care provider
e) Perform a nitrazine test