1. Angelina develops a DVT while in the hospital on bed rest and is prescribed low-molecular-weight heparin.

in. The nurse identifies which

action as important when planning care for her?
A. Showing her how to self-administer the drug as a rectal suppository
B. Cautioning her that her hemoglobin level will be closely monitored during therapy
C. Allowing her to choose a subcutaneous site for the injection
D. Monitoring her white blood cell count daily for decreased coagulation
2. Angelina is friends with a woman in the clinic who has sickle-cell anemia, and they often talk together about their care. Which statement
would alert the nurse that her friend may need further instruction on prenatal care?
A. "I understand why folic acid is important for red cell formation."
B. "I'm careful to drink at least eight glasses of fluid every day."
C. "I take an iron pill every day to help grow new red blood cells."
D. "I've temporarily stopped jogging so I don't risk becoming dehydrated."
3. While reviewing antenatal electronic records, the charge nurse of a prenatal clinic notes that a high number of pregnant women seen in the
clinic, including Angelina Gomez, have developed UTIs during their pregnancies. The nurse should emphasize the need for staff nurses to do
which of the following?
A. Ensure that the housekeeping department is adequately cleaning the toilets.
B. Suggest all women be prescribed a prophylactic antibiotic during their first trimester.
C. Educate women on the need for sound perineal care during pregnancy.
D. Urge women to restrict fluid to keep their urine acidic and concentrated.
4. Angelina had tuberculosis as a teenager, and her primary care provider orders a chest X-ray during pregnancy. The nurse would want care
team members to know that this is necessary because of which danger of tuberculosis during pregnancy?
A. Calcium deposits that wall off old tuberculosiS lesions can break down.
B. Latent tuberculosis can turn to pneumonia if a woman has a folic acid deficit.
C. PPD tests are always negative during pregnancy so tuberculosis often goes undetected.
D. The disease can result in neural tube defects in the fetus.
5. Angelina is prescribed an insulin pump to administer insulin for her gestational diabetes. What patient education would the nurse want to
provide to explain why nighttime is a particularly hazardous time for her fetus during pump therapy?
A. The fetus can develop hyperglycemia from excessive insulin administration.
B. Continuous insulin administration with no food intake can lead to hypoglycemia.
C. Her lack of exercise at night tends to lead to hypercalcemia from muscle disuse.
D. Her lack of fluid intake during the night causes a relative increase in serum insulin levels.
6. Women who have had a complication of pregnancy have the potential to develop depression in the postpartum period because their
pregnancy did not go the way they wanted or imagined. To see what factors tend to be associated with depression in women who develop
gestational diabetes, research- ers administered a questionnaire to 71 women at 4 to 15 weeks postpartum. Results of the study showed that
34% of the women who developed gestational diabetes showed depressive symptoms; factors most associated with depression were
cesarean birth and more weight gain than expected during pregnancy (Nicklas, Miller, Zera, et al., 2013). Based on the previous study, which
statement by Angelina would worry the nurse most that she might develop postpartum depression?
A. "I want to shed some pounds so I'll fit into the new dress bought for New Year's Eve.
B. "I hated giving insulin to myself; I'm relieved to not be doing that anymore."
C. "My baby is bigger than I expected, but his eyes are beautiful and he's cute."
D. "I think my husband adjusted better to my having diabetes than I did."
7. Beverly Mizuki had a miscarriage when she was younger. After addressing her immediate psychoso- cial needs, the nurse identifies which
advice is best for a woman who says she is miscarrying?
A. Lie down and remain on bed rest for 24 hours to stop the bleeding.
B. Continue light activity as usual because most spotting during pregnancy is harmless.
C. Save any clots or material passed for your healthcare provider to examine.
D. Use a tampon to put pressure on your cervix and stop the bleeding.
8. Beverly Muzuki has an Rh-negative blood type. Her electronic record shows she had a previous miscarriage at 16 weeks into her last
pregnancy. What medi- cation should the nurse check she received following the miscarriage to minimize isoimmunization?
A. Misoprostol (Cytotec)
B. RhIG (RhoGAM)
C. Ferrous sulfate
D. Packed red blood cell transfusion
9. Suppose a sonogram shows Beverly, who is beginning preterm labor, has a placenta previa. The nurse identi- fies which measure as the
priority to ensure her safety?
A. Keep her physically active to avoid a deep vein thrombosis.
B. Perform a daily vaginal exam to assess the extent of the previa.
C. Assess for vaginal bleeding and clear fluid leak- age every shift.
D. Keep her nothing by mouth (NPO) as she will need an emergency cesarean birth.
10. Beverly's husband drove her to the emergency room because she was having symptoms of preterm labor. The admitting nurse in the
emergency department identifies which action as the priority?
A. Encourage her to carefully walk so the fetal head maintains pressure on her cervix.
B. Position her in a side-lying position and assess fetal heart rate and contractions.
C. Obtain blood for an hCG hormone assessment.
D. Ensure no one initiates intravenous fluid infusion because hypervolemia exacerbates preterm labor.
11. The nurse routinely assesses all pregnant women for signs of hypertension while interviewing them at the prenatal clinic and then
documents the findings in the electronic health record. Which statement by Beverly would the nurse document as possible evidence that
she might be developing gestational hypertension?
A. "My feet are so swollen at night I can't put on my bedroom slippers."
B. "I never guessed I would feel as tired as I do just from being pregnant."
C. "My abdomen feels firm, as if I had a blown-up balloon inside me."
D. "I can live with my puffy feet, but now it's also my hands and wrists."
12. Because so many women of childbearing age work at physically demanding occupations, researchers assessed the work lifting
requirements of 66,693 pregnant woman when they were at 16 weeks gestational age by phone interview and then analyzed if there was an
association between their work lifting characteristics and the development of small-for-gestational- age babies. Results of the study
showed no consistent association between the work-related lifting and the incidence of small-for-gestational-age babies (Juhl, Larsen,
Anderson, et al., 2014). Based on the previous study, which statement by Beverly about her job as a secretary at a construction site would
give the nurse the most concern regarding fetal health?
A. "I think I Likely walk at least a mile every workday."
B. "I rarely have time to eat when I'm at work because I get so busy."
C. "Sometimes, I have to move boxes of files around the office."
D. "I usually help my colleague bring boxes of paper up to the office for the photocopier."
13. To broaden understanding of the reproductive health education needs of adolescent girls, researchers con- ducted in-depth 31 adolescent
mothers. These interviews included 15 who experienced a sec- ond pregnancy within one year of their first birth and 16 who had not had
another pregnancy within 1 year. The group who had not had another pregnancy within a year expressed more independent control of their
contraceptive choices than those that had a repeat pregnancy within 1 year. Adolescent mothers should be able to independently make
decisions about their contraceptive choices (Conroy, Engelhart, Martins, et al., 2015). Based on the previous study, if Mindy comes to the
clinic and tells the nurse her mother will not allow her to make independent decisions about her care, what action would be best?
A. Avoid interfering because the mother is provid- ing helpful input.
B. Tactfully ask the mother to leave the room and then interview Mindy privately.
C. Support Mindy in her attempts to take responsibility for her own care.
D. Supplant Mindy's mother's advice with the nurse's own suggestions that are in Mindy's best interests.
14. Mindy was placed on an iron supplement because her hemoglobin level was below normal. What would be the best way to determine if
Mindy is taking her iron supplement?
A. Perform a physical assessment noting if her nail beds have deepened in color.
B. Ask her to describe in her own words why she has been prescribed an iron supplement,
C. Look up her laboratory results to see her reticulocyte count has increased since her last visit.
D. Analyze her urine for color that would reveal the presence of iron deposits.
15. Women over the age of 40 years are at increased risk for developing gestational hypertension. As a result, routine screenings for this health
problem have been emphasized on the maternal unit for older moth- ers. What is the rationale for this change in nursing practice?
A. Many women over 40 years are underweight before they begin pregnancy.
B. Older women tend to have a higher fluid intake than do younger women.
C. Many older women are prone to edema due to their lower activity levels.
D. The blood vessels of older women may not be as elastic as those of younger women.
16. Mindy makes friends with an adolescent at the prenatal clinic; a 19 yr old who has a cognitive deficit. When planning care for this patient,
what would be the best way to meet this woman's educational needs?
A. Provide simple, written materials rather than providing verbal instructions.
B. Provide education to the woman's partner or another person with full cognitive function.
C. Ensure that teaching is appropriate to the woman's level of cognition.
 D. Enlist the help of a social worker when teaching the woman.
17. Mindy tells the nurse she uses methamphetamine almost daily. What priority nursing intervention should the nurse perform?
A. Obtain a urine or serum sample for toxicology.
B. Emphasize the fact that meth is not good for her.
C. Advise her to stop taking the substance immediately.
D. Refer Mindy to addictions support services.
18. Mindy has a laceration on her leg from her automo- bile accident. What priority nursing action should the nurse initiate?
A. Keep the laceration clean by irrigating it with hydrogen peroxide.
B. Control bleeding by applying a pressure dressing to the wound.
C. Administer a nonsteroidal anti-inflammatory medication for pain relief.
D. Obtain written consent for surgery from Mindy.
19. Rosann Bigalow states that her contractions are irregular in frequency and short in duration. She screams in pain, however, every time she
has a contraction. What action by the nurse would be best?
A. Recognize that this is a usual response to labor and offer her a back rub.
B. Notify the anesthesiologist that Rosann needs to have epidural anesthesia.
C. Obtain a prescription from her primary care provider for an analgesic.
D. Document/report frequency and duration of contractions plus facilitate pain relief.
20. Rosann's primary care provider is considering whether to augment her labor with oxytocin. What would make the nurse question the care
provider's use of oxytocin for her?
A. Her blood pressure is slightly elevated above normal.
B. Her membranes ruptured after only 1 hour of labor.
C. Her fetus is large for gestational age by a sonogram.
D. She had an amniocentesis performed during pregnancy.
21. The nurse notices Rosann's contractions are 70 seconds long and occur every 90 seconds when assessing the frequency of her contractions
after she receives oxyto- cin. What would be the nurse's first action?
A. Ask Rosann to turn onto her left side and breathe deeply.
B. Increase the rate of Rosann's IV fluid infusion.
C. Discontinue the administration of the oxytocin infusion.
D. Give an emergency bolus of oxytocin to relax the uterus.
22. Rosann's baby is not only large but also in an occipitoposterior position. The nurse would want the team members to know which position is
best for a woman whose baby is in the occipitoposterior position during labor?
A. On her right side to stretch the pelvic inlet
B. Walking about to encourage fetal descent
C. Sitting in a rocking chair to aid presentation
D. On her hands and knees to help fetal rotation
23. To determine which risk factors were associated with shoulder dystocia, researchers studied a cohort of births from 1967 to 2009 in Norway, a
sample of 2,014,956 vaginal births. The results of the study found an increased incidence of shoulder dystocia associated with increased fetal weight,
maternal diabetes, prolonged labor, instrumental delivery and parity (Øverland, Vatten, & Eskild, 2014). Based on this study and the fact that a
sonogram has shown Rosann's fetus to be extremely large, what assessment would the nurse want to prioritize for Rosann's baby after birth?
A. If his abdominal wall appears to be ruptured
B. If his arms feel warm and are the same length
C. If his buttocks or back have extensive bruising
D. If his eyes can focus steadily on a nearby object
24. Suppose Moja had an amniotomy during her labor. Immediately after this procedure, which nursing assessment would be most important for the
nurse to make?
A. Ask her to rate her pain level after the procedure.
B. Assess maternal heart rate to detect possible bleeding.
C. Assess FHR to detect possible cord prolapse.
D. Document the amount of amniotic fluid that has been lost.
25. The nurse gives a report to an OR nurse prior to a cesarean birth and describes actions she took to reduce the size of the patient's bladder and to
keep it away from the surgical field during the proce- dure. Which action should the nurse describe to her colleague?
A. Inserting a Foley catheter to drain the bladder and decrease its size
B. Administering an oxytocic drug to cause the bladder to forcefully contract
C. Restricting the woman's fluids for at least 16 hours before surgery
D. Administering the woman a diuretic to reduce bladder volume
26. Moja prior Hamma needs to have an IV infusion started to her cesarean procedure. Which course of action would be best?
 A. Introduce the cannula into the back of either hand.
B. Begin the IV infusion in the hand nearest to you.
C. Ask Moja which hand she would prefer you to use.
D. Explain that IVs are typically started in the right hand.
27. The nurse notices that a colleague who was helping to prepare Moja has left the room to liaise with the OR in anticipation of the cesarean birth. The
nurse also notices that the colleague left Moja's electronic health record open and in view of her support people. Which course of action would be
best?
A. Immediately close the record even though all care may not yet be recorded.
B. Locate the nurse and ask her to come back so she can close the record.
C. Minimize the record and wait for the nurse to come back and close it.
D. Report the nurse to the nurse manager for violating confidentiality.
28. The majority of women who have a cesarean birth are physically eligible to future births vaginally. Research- ers examined what influences a
woman's choice in birth mode. They looked at 20 papers reporting views of 507 women who had a previous cesarean section. Women choosing a
vaginal birth after cesarean were strongly influenced by a preconceived anticipation of vaginal birth. Women seeking repeat cesarean were often
influenced by a prior traumatic birth experi- ence. Women who were open to hearing suggestions had fewer preconceptions about the birth method
and were able to hear a range of options (Black, Entwistle, Bhattacharya, et al., 2016).
Moja tells the nurse, although she knows she will be eligible, she isn't certain if she wants to have a vaginal birth for her next child. Based on the
previous study findings, what would be the nurse's best assur- ance for her?
A. "It doesn't matter. Once a cesarean, always a cesarean is the rule."
B. "Birth is such a personal experience it's impos- sible to say.
C. "Let's talk about the risks and benefits of both types of deliveries to help you make your decision."
D. "My coworker had a vaginal birth after a cesar- ean birth and she was satisfied with her choice."
29. Moja tells the nurse she does not intend to continue breastfeeding after she returns home, stating, "My stomach's too painful." What action would
the nurse add to the plan of care that is most apt to be helpful to Moja?
A. Insist Moja speak with one of the hospital's lactation consultants.
B. Instruct her to take over-the-counter analgésics just before breastfeeding.
C. Design a study to identify factors that affect breastfeeding success.
D. Explain that her uterine pain will not last more than a few more days.
30. All postpartum women are at risk for uterine hemorrhage. What assessment data should the nurse first collect when appraising Ms. Cheshire's
risk for hemorrhage?
A. Ask her to describe her perineal care.
B. Assess the skin integrity of her abdomen.
C. Assess her oxygen saturation level.
D. Assess her uterus for height and tone.
31. Suppose Bailey Cheshire has a retained placental frag- ment that is causing extensive postpartum bleeding. Which test prescribed by her primary
care provider would best reveal a retained fragment is present?
A. Placental and cord blood estrogen
B. Progesterone
C. Human chorionic gonadotropin hormone
D. Oxytocin
32. Bailey Cheshire develops endometritis. When plan- ning nursing care, which activity would be best to advise for Bailey?
A. Walking around her room listening to music
B. Lying supine with a cold cloth on her forehead
C. Reading while resting in a slight Trendelenburg position
D. Alternating between prone and supine positions
33. Ms. Cheshire has a risk for DVT during the postpartum period. What would be the best suggestion the nurse could make to help prevent this?
A. Rest in bed as much as possible for the first several days. B.
B. Assume a knee-chest position for 15 minutes every day.
C. Increase fluid intake to reduce blood viscosity.
D. Ambulate early and consistently to improve circulation.
34. Postpartal depression affects not only the postpartum woman but also her entire family because partners can become depressed during this time
as well. To assess developmental impacts on children, researchers assessed 192 fathers, 54 who met criteria for depression, and their interactions
with their infants in a play session. Fathers with depression were more likely to be withdrawn in their behavior with their infants, providing less
stimulation for their babies (Sethna, Murray, Netsi, et al., 2015). Based on the given study, which statement by Bailey's boyfriend would concern the
nurse he might be as depressed as she seems to be?
A. "I never guessed I'd ever really be lucky enough to be a father."
 B. "I don't like talking to the baby yet. She can't talk back yet.
C. "I didn't really understand the reason that Bailey bled after the baby was born."
D. "No one told me women could become depressed after birth."
35. The nurse is making an effort to address Bailey Cheshire's psychosocial health in addition to her physiologic well-being. Which of Bailey's
statements would be most suggestive of possible postpartum psychosis?
A. "I wish my baby had longer hair."
B. "I've felt exhausted ever since birth."
C. "I'm happy not to have any children."
D. "Breastfeeding is way harder than I thought."
36. Bailey asks you, "How can I avoid becoming de- pressed after I return home with my new baby?"
● Plan a balanced program of nutrition, exercise, and sleep. Plan meals that are easy to prepare, sleep whenever your baby sleeps, and begin a
program of walking daily with your baby.
● Share your feelings with a support person. Many communities have postpartum support groups to help with this.
● Take some time every day to do something for yourself (e.g., work on a scrapbook, go shopping) so you have a break from baby care.
● Do not try to be perfect. Analyze what are the important things to do and get them done. Let unimportant things go for another day.
● Do not let yourself be isolated by baby care. Use the Internet or your cell phone to keep in contact with your friends so you are not lonely.
37. Moja tells you, "I am exhausted after my cesarean. What can do to feel stronger again?"
● Drink adequate fluid daily (at least six glasses). This helps prevent a urinary tract infection and also helps supply all the cells in your body with
adequate fluid.
● Rest twice a day for at least one-half hour each time. This helps you get adequate sleep if your baby wakes you at night
● Do not hesitate to accept help from family and friends for tasks such as house cleaning or grocery shopping.
● Limit the number of stairs you climb daily to one flight once a day. Also limit the amount of weight you lift to the weight of your new baby.
● Do not attempt to be a social hostess as well as a new mom, Put your energy toward relaxing and enjoying your new baby.
38. Mindy tells you, "I feel so clumsy since I'm pregnant. What can I do to make sure I don't hurt my baby?"
● Do not stand on step stools or step ladders (it is difficult to maintain balance on a narrow base).
● Keep small items such as footstools out of pathways (later in pregnancy, it's difficult to see your feet).
● Avoid throwing rugs without a non-skid backing so you don't slip on them.
● Use caution stepping in and out of a bathtub.
● Do not overload electrical circuits (it is difficult for a pregnant woman to escape a fire because of poor mobility).
● Do not smoke, so falling asleep with a cigarette will not be a concern.
● Do not take medicine in the dark, so you can clearly read the label.
● Avoid working to a point of fatigue, as fatigue lowers judgment.
● Avoid long periods of standing because this can lead to a drop in your blood pressure, causing you to feel dizzy and faint.
● Always use a seat belt while driving or as a passenger in an automobile.
● Refuse to ride with anyone in an automobile who has been drinking alcohol or whose judgment might be impaired in some other way.
39. Mindy says to you, "My mother was older when she had me so developed terrible varicose veins. How can I stop that from happening to me?"
● Find opportunities, such as a class or lunch break, to elevate your legs on a foot stool.
● Be certain your diet includes vitamin C every day because this is important to strengthen vein walls.
● Rest in a side-lying position with your body tipped slightly forward (Sims position) as this allows leg veins to drain and empty
● Avoid long periods of standing in one place; take "walk breaks" as active muscle contraction help venous return.
● Avoid sitting with your legs crossed.
● Do not wear anything constricting on your lower legs, such as knee-high stockings.
● If you're prescribed a support hose, put them on before you get out of bed in the morning, before veins become swollen, for best results. Don't be
fooled into thinking panty hose marked "strong support" are the same as medically prescribed support stockings.
40. Beverly Muzuki has started preterm labor and so is prescribed bed rest on home care. She asks you, "What else can I do to help prevent having this
baby early?"
● Remain on bed rest (a lounge or couch) except to use the bathroom.
● Drink 8 to 10 glasses of fluids daily (keep a pitcher by your bed so you do not have to get up).
● Keep mentally active by reading or working on a project to prevent boredom.
● Avoid activities that could stimulate labor, such as nipple stimulation.
● Consult your primary care provider regarding whether sexual relations should be restricted.
● Immediately report signs of ruptured membranes (sudden gush of vaginal fluid) or vaginal bleeding.
● Report signs of urinary tract or vaginal infection (e.g., burning or frequency of urination, vaginal itching or pain).
● Keep appointments for prenatal care.
● If uterine contractions recur:
● Empty your bladder to relieve pressure on the uterus.
 ● Lie down on your left or right side to encourage blood return to the uterus.
● Drink two or three glasses of fluid to increase hydration.
● Contact your healthcare provider to report the incident and ask for further care measures.
41. Beverly Muzuki had a spontaneous miscarriage when she was younger. She asks you, "What did I do wrong that time?"
● Early miscarriage is largely not preventable because it is caused by such things as abnormal chromo- some formation or poor uterine
implantation-things over which you have no control. Eating a nutritious diet, so you enter a pregnancy good health and avoiding cigarette or
drinking alcohol are sensible recommendations to reduce your risk of miscarriage. If you had extensive blood loss with your miscarriage, be
certain to eat foods (such as meat and green vegetables) to help restore red blood cells for a second pregnancy.