ANSWERS AND RATIONALES

HPM Post-test 1
1. (B)
RATIONALE: (A) Vernix keeps the skin moist, not the fluid. (B) The amniotic fluid has five functions: provides a cushion to
prevent trauma, allows fetal ease of movement, maintains a uniform fetal temperature, provides fluid for swallowing, and
protects the fetal head during labor. (C) Amniotic fluid does not contain blood vessels. (D) Amniotic fluid is an alkaline, not
an acid.

2. (D)
RATIONALE (A) ELISA is used for HIV screening. (B) VDRL is used for syphilis screening. (C) BHCG is used to determine
pregnancy, especially ectopic pregnancy. (D) Elevated levels of AFP in amniotic fluid or maternal serum have been found to
reflect open neural tube defects.

3. (C)
RATIONALE (A) Breast tenderness can be due to hormonal changes other than pregnancy. (B) Enlargement can be related to
gas, weight gain, and abdominal conditions other than pregnancy. (C) The positive signs of pregnancy include FHR by
Doppler at 10–12 weeks and by fetoscope at 18–20 weeks; fetal movement perceived by trained examiner; fetal ECG;
ultrasound visualization of fetal parts. (D) Amenorrhea is influenced by endocrine, metabolic, psychological changes and
systemic disease.

4. (A)
RATIONALE (A) The LMP is useful in calculating the EDC. Mothers need to know this information to master the tasks of
pregnancy. (B) A partner’s physiological symptoms are not part of the medical record. (C) The parity of the client’s mother
is not important; however, the number of multiple gestations can be influential in treatment. (D) Most pregnant women are
tired in the first trimester; this is not crucial information.

5. (D)
RATIONALE (A) Emotional lability may last through the pregnancy, but it generally is not pathological. (B) Unless nausea
and vomiting cause severe dehydration and electrolyte imbalance, the pregnancy is not at risk. (C) Bowel changes are
affected by the progesterone levels of pregnancy; constipation is expected. (D) Danger signs of pregnancy include bleeding
from the vagina, sudden gush of clear fluid from the vagina; fever and chills, severe headaches with blurred vision;
abdominal pain; generalized swelling of the face and limbs; and absence of fetal movement.

6. (C)
RATIONALE (A) PG suppositories are used for second-trimester fetal demise. (B) Saline infusion is unsafe and should no
longer be used. (C) The method of choice for first-trimester elective abortion is suction curettage because it is safe and
can be done at minimal expense. (D) Laminaria is used to soften and efface a cervix prior to induction of labor.

7. (A)
RATIONALE (A) Abdominal tenderness and pain can be signs of uterine infection and should be reported to a physician. (B)
Sadness after abortion is normal, even if the termination is elective. (C) Bleeding after termination can last up to a month.
(D) Fever is indicated by a temperature of 101F (38.3C) in women postabortion.

8. (B)
RATIONALE (A) Fetal sex cannot be determined until after 20 weeks. (B) Amniocentesis performed at this point in
pregnancy would be for genetic purposes. The woman’s age places her at risk for a Down syndrome baby. (C) L/S ratio is
used to determine the lung maturity of the fetus during the third trimester. (D) Bilirubin levels are drawn from the fluid to
monitor fetuses compromised by isoimmunization.

9. (C)
RATIONALE (A) Temperature elevation related to the procedure would not occur for at least 24 hours. (B) Bladder spasms
are uncommon. (C) Rupture of the membranes is a potential complication of amniocentesis. (D) FHR patterns are
monitored, not fetal activity.

10. (D)
RATIONALE (A) Increased daily activity is recommended. (B) Stool softeners are used in pregnancy after all other measures
have failed. (C) Prenatal vitamins do not cause constipation and should be taken daily. (D) Increased fluid intake, adequate
roughage or bulk in diet, regular bowel habits, and adequate daily exercise can often maintain good bowel function in
women who have not had a previous problem.

11. (A)
RATIONALE (A) The purpose of MgSO4 is to depress the CNS and avert maternal seizures and fetal hypoxia. (B) Initially the
blood pressure may drop, but it will return to hypertensive levels. (C) Uterine relaxation may be a side effect of MgSO4, but
higher dosages of the medication are given to stop preterm labor than for PIH. (D) Decreased urine output may be caused
by MgSO4, but that is not the purpose of administration.

12. (B)
RATIONALE (A) Peroxide does not dry the cord. (B) The infant may be put in a tub after the cord has fallen off and the
circumcision site is healed (approximately 2 weeks). (C) Pus from the cord is a sign of infection. (D) The cord dries in about
2 weeks.

13. (C)
RATIONALE (A) All newborns have some acrocyanosis at delivery. (B) A sucking reflex is necessary for breast-feeding after
delivery, but it is not the priority. (C) The first breath of life—the gasp in response to mechanical, chemical, thermal, and
sensory and physical changes associated with birth—initiates the serial opening of the alveoli. (D) Meconium passage can
happen in the first 24 hours of life and signifies a patent intestinal tract.

14. (B)
RATIONALE (A) IV Pitocin is used to induce contractions, not soften the cervix, especially prior to the third trimester. (B)
Laminaria (dehydrated seaweed) may be inserted into the cervical canal. The secretions of the cervix are absorbed, and the
laminaria expands to aid with effacement and dilation. (C) Amniotomy will aid in descent of the fetal head once labor is
established, but in fetal demise, it is not effective in effacing the cervix. (D) Normal saline solution is no longer used for
midtrimester abortions.

15. (C)
RATIONALE (A) Pitocin may be ordered IM after delivery. (B) Pitocin is never given mainline during labor. (C) After the
infusion is started, the oxytocin solution is piggybacked into the primary tubing part closest to the catheter insertion. (D)
Buccal Pitocin was taken off the market in the early 1980s because absorption was sporadic.

16. (A)
RATIONALE (A) The purpose of the Apgar score is to evaluate the physical condition of the newborn at birth and the
immediate need for resuscitation. (B) Dubowitz scoring is done 4–6 hours after birth. (C) Weighing and measuring is done
in the nursery, not at the delivery. (D) Gavage feeding is postponed until the baby is stabilized; in premature infants it may
be several weeks.

17. (B)
RATIONALE (A) Vaginal packing is performed by a physician. (B) Fundal massage should be performed until the uterus
contracts. (C) Perineal ice will not affect the uterine tone. (D) Blood transfusions are given on physician’s orders only.

18. (B)
RATIONALE (A) Nurses cannot do this without a continuous fetal monitor, and then charting every 1 minute would not
make sense. (B) As this more rapid pattern is identified, the need for more frequent assessments will be apparent. During
the second stage of labor, some protocols recommend charting FHTs after each contraction. (C) Standards say that FHTs
should be charted no more often than every 5 minutes close to delivery. (D) A precipitous delivery would probably end
before 15 minutes were up.

19. (C)
RATIONALE (A) Physical activity can be continued throughout pregnancy with a class I cardiac condition. (B) Emotional
stress should not adversely affect the client’s condition. (C) Use of low forceps provides the safest method of birth, with
lumbar epidural anesthesia to reduce the stress of pushing. (D) Surgery is a stress on the cardiovascular system and can
cause complications in women with cardiac disease.

20. (B)
RATIONALE (A) Turning on the side would decrease BP, which is contraindicated with ruptured uterus. (B) When blood
supply to the uterus is interrupted, about 80% of fetuses demonstrate fetal distress. Preparation is needed to resuscitate
the infant. (C) In an emergency, povidone-iodine is poured over the abdomen and formal scrub is bypassed. (D) Usually a
prolapsed cord does not coincide with a ruptured uterus.

21. (C)
RATIONALE (A) The bladder fills rapidly after delivery and may need to be emptied several times during the first 12 hours.
(B) Diuresis occurs in the first 12–24 hours postpartum. (C) A careful monitoring of intake and output should be
maintained, and the bladder should be assessed for distention until the woman demonstrates complete emptying of the
bladder with each voiding. (D) Dehydration is common, but diuresis occurs anyway.

22. (C)
RATIONALE (A) Lack of uterine enlargement and FHTs are signs of ectopic pregnancy. (B) Bleeding in spontaneous rupture
of membranes has no relationship to bleeding in the first trimester. (C) Unexplained bleeding, cramping, and backache
jeopardize the fetus. (D) Incompetent cervix does not cause uterine bleeding.

23. (D)
RATIONALE (A) Placenta previa is painless bleeding, which may be scant to heavy. (B) Normal show is combined with mucus
and is usually small to moderate in amount. (C) A mucus plug is clear without blood. (D) Signs of abruptio placentae
include severe and steady pain, sudden onset, external bleeding, dark venous blood.

24. (B)
RATIONALE (A) MgSO4 is used to stop preterm labor or to control seizure activity in PIH. (B) Betamethasone is a
glucocorticoid that acts to accelerate fetal lung maturation and prevent hyaline membrane disease. (C) Exosurf is lung
surfactant given after preterm delivery to help mature the lungs. (D) Ritodrine is used to stop preterm labor.

25. (C)
RATIONALE (A) Milk production starts 3–4 days postpartum. (B) Nipple burning is related to positioning at the breast and
initiation of feeding. (C) Erythema and swelling are present in the upper, outer quadrant of the breast. Axillary lymph
nodes are enlarged and tender. (D) Dimpled skin is a sign of breast cancer.

26. (A)
RATIONALE (A) The woman is positioned on her left side with her shoulders parallel and her legs slightly flexed. (B) The
anesthesia provider cleans the client’s back prior to injection of anesthetic. (C) Medication initially is injected by the person
administering the anesthesia. (D) Regular, slow chest breathing is encouraged during epidural administration.
27. (B)
RATIONALE (A) Ultrasound is never done for sex determination unless it involves genetic studies. (B) Assessment of
placental age in a postterm pregnancy provides a gauge of placental functioning and risk to the fetus of continuing the
pregnancy. (C) Fetal presentation can be determined by Leopold’s maneuvers. (D) Visualization to identify anomalies is
poorer at term.

28. (C)
RATIONALE (A) Check the healing of the perineum; sutures cannot be seen. (B) An empty bladder will not affect the
perineum. (C) Apply ice glove or ice pack the first 24 hours. (D) Hemorrhoids will shrink with perineal care and medication,
and they are not manually reduced after delivery.

29. (D)
RATIONALE (A) Bargaining is the third stage of grieving. This may or may not be present, depending on the couple’s
preparation for the death of the fetus. (B) The final stage is acceptance, which may take months for resolution. (C) Anger is
the second stage, resulting from feelings of loneliness, loss, and maybe guilt. (D) The first stage is denial of the death of
the fetus. Even when the initial healthcare provider suspects fetal demise, the couple is hoping that a second opinion will
be different.

30. (C)
RATIONALE (A) A healthy respect for Pitocin should be developed. (B) “Emergency” implies danger when administering the
drug. (C) Additional information about the client’s fears needs to be gathered before any explanations are appropriate. (D)
Mentioning “complications” implies that some are expected.

31. (A)
RATIONALE (A) Ectopic pregnancy may result from a number of different causes, including tubal damage caused by PID,
previous pelvic or tubal surgery, etc. (B) Molar pregnancy causes early PIH and rapid uterine enlargement, not pain. (C)
Placenta previa involves painless bleeding. (D) Scarring of the tubes and uterus can cause difficulty with implantation, but
not spontaneous abortion once pregnancy is established.

32. (C)
RATIONALE (A) Thirty-eight weeks is considered term. (B) ABO incompatibility will show up within the first 24 hours. (C)
About 50% of full-term neonates and 80% of preterm neonates exhibit physiological jaundice on about the second or third
day after birth. (D) Extravascular hemolysis results from bruising at delivery.

33. (D)
RATIONALE (A) Cervical dilation is evaluated by vaginal exam. (B) Bishop score is used for inducibility. (C) True labor is
evaluated by cervical change with contractions. Braxton Hicks contractions do not cause dilation. (D) It is a means of
evaluating the O2 and CO2 exchange of the placenta.

34. (A)
RATIONALE (A) It is imperative that the FHT be auscultated before and immediately after the procedure so that any changes
from the previous FHT pattern can be noted. (B) Fundal pressure should not be used with amniotomy. (C) Bladder status
does not affect amniotomy. (D) The physician who performs the amniotomy checks for prolapsed cord, not the nurse.

35. (A)
RATIONALE (A) No maternal death in association with VBAC in a client with a previous lower-segment incision has been
reported for decades in industrialized countries. (B) Breech presentation is frequently associated with a specific pelvic
shape and will recur in subsequent pregnancies. (C) Previous CPD is a contraindication for VBAC. (D) Multiple gestation
following a previous cesarean section is an indication for a repeated cesarean section.
36. (B)
RATIONALE (A) The umbilicus may pop outward during pregnancy and returns to normal after delivery. (B) Often pressure
of the enlarging uterus on the abdominal muscles causes the rectus abdominis muscle to separate, producing diastasis
recti. (C) Inguinal hernia is not caused by pregnancy. (D) Hiatal hernia may be caused by pregnancy, but it is not visible in
the abdomen.

37. (A)
RATIONALE (A) Some couples may not be convinced of the death until they view and hold the stillborn. If they choose to
see the stillborn, prepare the couple for what they will be seeing: “the baby is bruised” and other appropriate statements.
(B) It is therapeutic for the couple to view the baby together. (C) Seeing the actual baby is less traumatic than imagining a
horribly disfigured baby. (D) It helps parents to see fetal anomalies as well as normal baby features, so that grief can
eventually be resolved.

38. (D)
RATIONALE (A) Facing reality and other children is difficult, but it may help the couple acknowledge their grief. (B)
Ambulation is encouraged after delivery to prevent thrombophlebitis. (C) A close friend may be a source of support to the
grieving couple. (D) Seeing healthy babies is a necessary step in acceptance. Support from people will make it easier.

39. (A)
RATIONALE (A) Rapid treatment of hypoglycemia is essential to prevent brain damage, because the brain requires glucose
to function. (B) Weight loss is common in the first trimester. (C) Increased estrogen levels cause vision changes. (D)
Hypertension will not show up until the late second trimester or early third trimester.

40. (A)
RATIONALE (A) The incidence of preterm birth is 12 times that of single births, and only 5% of twins reach 40 weeks’
gestation. (B) Weight gain is based on the body size and height of the pregnant woman as well as on the number of fetuses
she is carrying. (C) It is not possible to ensure fetuses of equal growth. (D) Prevention of striae has to do with the elasticity
of the skin, not prenatal care.

41. (C)
RATIONALE (A) Precipitous labor would probably have a good outcome if the baby was smaller than the other three. (B)
Placenta previa would present with bleeding. (C) A ruptured uterus involves the tearing of previously intact uterine muscle
or of an old uterine scar. (D) Dysfunctional labor is not common with a history of previous cesarean sections.

42. (C)
RATIONALE (A) Five minutes is too short. (B) Seven minutes is too short. (C) Total feeding time is usually no longer than
10–15 minutes at each breast. (D) After 10–15 minutes, the baby uses the breast as a pacifier.

43. (B)
RATIONALE (A) Taking hold occurs on the 2nd–3rd day postpartum and involves becoming proficient in caring for the
baby. (B) During the first day or two following birth, the woman tends to be passive and somewhat dependent. She may
have a great need to talk about her perceptions of her labor and birth. In Rubin’s early work (1961), she labeled this the
“taking-in” phase. (C) Letting go has to do with grief, not attachment. (D) Attachment is the general term for the bonding
that takes place between mother and child.

44. (D)
RATIONALE (A) IV fluids need to be increased during epidural administration to prevent cardiovascular collapse. (B) Urine
protein is used for PIH and pyelonephritis. (C) Motor and sensory neurons for the lower extremities are often blocked by
the epidural anesthesia. (D) The bladder should be assessed at frequent intervals because the epidural block lessens the
urge to urinate. Catheterization may be necessary because most women are unable to void.
45. (B)
RATIONALE (A) Chlamidiazyme is the test for chlamydia. (B) Diagnosis for syphilis is made by dark-field microscopy for
spirochetes. Blood tests such as the VDRL, RPR, and more specific fluorescent treponemal antibody absorption tests are
commonly done. (C) The Pap smear is currently the most common screening test for HPV. (D) A gonorrhea culture, or
gonozyme test, is diagnostic for gonorrhea.

46. (A)
RATIONALE (A) A small amount of fluid can be placed on a glass slide, allowed to dry, and then looked at under a
microscope. A ferning pattern confirms the presence of amniotic fluid. (B) Yeast buds are present with Monilia. (C) Fishy
odor is caused by bacterial vaginosis. (D) Many WBCs are indicative of inflammation.

47. (C)
RATIONALE (A) Vaginal examination is only done if the client is in labor and is deferred if membranes are ruptured. (B)
Gram’s stain is performed to look for infection. (C) Amniotic fluid is alkaline, and an alkaline fluid turns the nitrazine test
tape a dark blue. (D) Ultrasound can be used to visualize pockets of amniotic fluid, but it is not routinely used to determine
ruptured membranes.

48. (C)
RATIONALE (A) The mucus plug can be passed several weeks prior to the onset of labor. (B) When the fetus settles into the
pelvis, the mother will probably experience bladder pressure and frequency. (C) When membranes rupture, the amniotic
fluid may be expelled in large amounts. If engagement has not occurred, the danger of the umbilical cord washing out with
the fluid exists. (D) Nausea and vomiting can be prodromal signs of labor, but they are not indicative of actual labor.

49. (B)
RATIONALE (A) PROM can occur with a cerclage in place. (B) The treatment most commonly used is the Shirodkar-Barter
operation (cerclage). Once the suture is in place, a cesarean birth may be planned. The success rate of carrying a
pregnancy to term is 80%–90%. (C) If a cerclage is in place during delivery, the cervix can be torn or a cesarean section may
be necessary. (D) Cerclage does not have anything to do with Pap smears.

50. (A)
RATIONALE (A) A BP of 150/100 is sometimes designated as moderate preeclampsia. Generalized edema, seen as puffy
face, hands, and dependent areas such as ankles and lower legs, may be present. (B) Abdominal cramping may be a sign of
early labor, but not PIH. (C) Severe headaches with photophobia that are not relieved by medication can be caused by PIH.
(D) Clear nipple discharge is early milk letdown, not PIH.

51. (B)
RATIONALE (A) Rubella vaccine prevents 3-day measles, but it cannot be administered until after delivery. (B) An Rh-
negative woman who delivers an Rh-positive, ABO-compatible infant has a 16% risk of being sensitized as a result of her
pregnancy. RhoGam prevents this. (C) RhoGam will not prevent neonatal jaundice unless it is caused solely from
isoimmunization. (D) The mother cannot be infected from the fetus, and RhoGam is not bacteriocidal.

52. (A)
RATIONALE (A) Leopold’s maneuvers are four maneuvers of abdominal palpation used to assess fetal lie and position. (B)
Valsalva’s maneuver is the act of holding one’s breath and pushing on the perineum. (C) Ritgen maneuver is used to
support the fetal head on the perineum at delivery. (D) Credé’s maneuver is a method of external bladder massage that is
no longer used in obstetrics.

53. (A)
RATIONALE (A) If fetal hypoxia progresses unchecked, irreversible brain damage or fetal demise may result. If fetal hypoxia
occurs because of a decrease in uteroplacental blood flow, late decelerations generally occur. (B) Early decelerations are
benign patterns associated with fetal head compression. (C) Variable decelerations are related to cord compression. (D) A
mid-deceleration is not distinguishable from a variable deceleration.

54. (C)
RATIONALE (A) Undescended testicles in the preterm male newborn is expected—with maturity they should descend
normally. (B) Sole creases will be absent; lanugo will be present on all preterm babies. (C) All preterm newborns and
especially IDMs are at risk for RDS. (D) Very small babies are at risk for hypoglycemia, not hyperglycemia.

55. (C)
RATIONALE (A) Systolic heart murmur is frequently heard during the stress of labor. (B) A BP 140/90 is considered normal
when MgSO4 is run via IV. (C) Hourly output can be assessed. Output should be 700 mL in 24 hours or at least 30 mL/hr.
(D) Decreased DTRs are the desired effect of the drug.

56. (D)
RATIONALE (A) Side positioning is helpful to increase oxygenation to the fetus; Trendelenberg is used for prolapsed cord.
(B) O2will not help much during a tetanic contraction, but it should be started. (C) Hydration to correct hypotension should
be started. (D) When there is evidence of possible fetal distress, treatment is centered on relieving the hypoxia and
minimizing the effects of anoxia on the fetus. If oxytocin is in use, it should be discontinued.

57. (C)
RATIONALE (A) Pain and cramping are related to UTI, not hemorrhage. (B) Hemorrhoids do not bleed after delivery. (C)
Uterine atony can frequently be anticipated in the presence of overdistention of the uterus; dysfunctional labor, when the
uterus does not contract properly; oxytocin use in labor; and use of anesthesia that produces uterine relaxation. (D)
Breast-feeding does help to prevent uterine atony, but overdistention of the uterus is the usual cause following twin
delivery.

58. (D)
RATIONALE (A) Erythema neonatorum toxicum is a newborn rash that normally appears in the first 2 days of life. (B) Stork
bites are hemangiomas. (C) Milia are small white pimples on the face resulting from mother’s hormones. (D) Mongolian
spots are macular areas of bluish black pigmentation found on the dorsal area and the buttocks.

59. (C)
RATIONALE (A) Three months prior to pregnancy, insulin levels should remain steady. (B) Insulin levels increase steadily
during pregnancy. (C) Postpartum maternal insulin requirements fall significantly. This occurs because levels of HPL,
progesterone, and estrogen fall after placental separation and their anti-insulin effect ceases. (D) Insulin levels decrease
significantly.

60. (D)
RATIONALE (A) “Rest period” begins at the end of one contraction to the start of the next. (B) “Duration” is the time that the
contraction lasts. (C) Peak-to-peak timing is incorrect, because this varies with the duration and strength of the
contraction. (D) The correct way to time frequency of contractions is from the beginning of one contraction to the
beginning of the next contraction. The interval from the beginning to the end of a single contraction is the duration.

61. (B)
RATIONALE (A) The bladder stays empty with a Foley catheter. (B) The dressing and perineal pad must be checked every 15
minutes for at least an hour, and the fundus should be gently palpated to determine whether it is remaining firm. (C)
Shivering is a side effect of anesthetic withdrawal, and not a complication. (D) Hypothermia is common immediately
following delivery, not fever.
62. (D)
RATIONALE (A) Narcotics are not used because they could neurologically depress the fetus. (B) If the baby is prematurely
delivered, it is unrealistic to give false reassurance. (C) Bed rest with bathroom privileges is the usual treatment. (D) The
nurse observes the woman for signs and symptoms of infection by frequently monitoring vital signs (especially
temperature and pulse), describing the character of the amniotic fluid, and reporting elevated WBC to the physician or
nurse-midwife.

63. (D)
RATIONALE (A) Blood pressure should be normal. (B) Edema of the eyelids is common. (C) Poor muscle tone of a limb may
signify birth injury, especially after shoulder dystocia. (D) After birth the most common problem of the IDM is
hypoglycemia.

64. (B)
RATIONALE (A) A daily bath is not given to preserve natural skin lubrication. (B) Because it is not known if phototherapy
injures the delicate eye structures, particularly the retina, the nurse applies eye patches over the newborn’s closed eyes
during exposure. (C) Babies can still be breast-fed during phototherapy. (D) Observe stools for meconium or other
brownish black heme being passed. Bloody stools should not be found.

65. (C)
RATIONALE (A) Dysuria may be caused by a UTI or a cervicovaginal infection. (B) Muscle weakness may be caused by grief.
(C) Prostaglandin E2 suppositories or gel are used extensively in the management of intrauterine fetal demise in the
second trimester of pregnancy. GI side effects are caused by smooth-muscle stimulation. (D) Headaches may be caused by
intense crying, elevated blood pressure, or electrolyte imbalance, not PGs.

66. (C)
RATIONALE (A) The nurse cannot perform the delivery, because the client will not be able to push with a ruptured uterus.
(B) The nurse should stabilize the client first, then call the physician. (C) Sudden searing abdominal pain is indicative of
uterine rupture. The IV rate should be increased in anticipation of severe hemorrhage and shock prior to transfer to the
operating room. (D) Contraction pattern will no longer show up.

67. (A)
RATIONALE (A) Calcium gluconate is the antidote for MgSO4. (B) Sodium bicarbonate is used to neutralize acidosis. (C)
Calcium carbonate is used for epigastric distress. (D) Folic acid is used for normal neurological development of the fetus.

68. (B)
RATIONALE (A) A manual exploration of the uterus is commonly done with twin deliveries so that fragments are not left. (B)
In some instances the second twin may need to be born by cesarean section. Complications that would require this include
profound fetal distress, prolapse of the cord, and contractions of the uterus that trap the second twin. (C) Meconium fluid
is found in twin deliveries with the same frequency as single deliveries. (D) Placenta previa will be diagnosed prior to
delivery.

69. (D)
RATIONALE (A) Readiness for labor is determined by a Bishop score. (B) Diabetic control is evaluated by blood glucose
monitoring. (C) Placental age is determined by ultrasound. (D) Accelerations of the FHR imply an intact central and
autonomic nervous system that is not being affected by intrauterine hypoxia.

70. (C)
RATIONALE (A) Amniocentesis may determine if the twins are identical or fraternal. (B) NST can determine the well-being of
both the fetuses, but not the size or growth. (C) Serial ultrasounds are done to assess the growth of each fetus and to
provide early recognition of IUGR. (D) GTT is used to diagnose diabetes mellitus, not fetal growth.

71. (D)
RATIONALE (A) Families are extremely nervous and interested in the well-being of the preterm baby. (B) Often unrealistic
expectations of the growth and development of the preterm baby are held by the family. (C) Many of the premies have
anomalies. Preterm babies do not look like the “perfect” baby of the magazines. (D) Denial is the first stage normally
experienced in the grieving process. The parents need careful and complete explanations and the opportunity to take part
in the decision making.

72. (C)
RATIONALE (A) Relaxation may cause drowsiness, which is welcomed. (B) Severe headaches are a complication of spinal
anesthesia. (C) If hypotension occurs, the nurse assists with corrective measures. The nurse takes the woman’s blood
pressure and pulse every 1–2 minutes during the first 15 minutes after injection. (D) Numbness in legs and feet is a sign of
effective anesthesia.

73. (C)
RATIONALE (A) A cervix is only mechanically dilated with a dilatation and curettage. (B) Pap smears are done postpartum.
(C) The suture may be released at term and vaginal birth permitted. (D) Cultures are only done if the client is symptomatic
for infection

74. (B)
RATIONALE (A) Mitral valve prolapse may be caused by untreated streptococcal infections, not fetal demise. (B) Prolonged
retention of the dead fetus may lead to the development of DIC. (C) Pyelonephritis is not associated with fetal demise. (D)
Endometriosis is a cause of infertility, not fetal demise.

75. (A)
RATIONALE (A) A primary cause of hyperbilirubinemia is hemolytic disease of the newborn secondary to Rh incompatibility.
(B) Prematurity predisposes the infant to jaundice, not postmaturity. (C) Cesarean delivery has no effect on jaundice. (D) A
mother’s age has no influence on jaundice.