Maternal and Child Health

Nursing

Prenatal period
1.

a.
b.
c.
d.

Which of the following would occur

first in the process of fetal
development?
Appearance of vernix caseosa
Muscle contraction
Increased fat deposits
Secretion of urine by the kidneys

2. During intrauterine life, the fetus

receives O2 & excretes its wastes
through:
a. The amniotic fluid
b. 2 umbilical arteries & 1 umbilical vein
c. 1 umbilical artery & 2 umbilical veins
d. The placenta

3. The first movements of the fetus in

the uterus are referred to as:
a. Lightening
b. Quickening
c. Involution
d. Contractions

4. The mother first feels these to

movements:
a. 2 weeks prior to delivery
b. At about 8 weeks
c. Within the first week after conception
d. Between 16 to 20 weeks of gestation

5. Normal changes that are experienced

during pregnancy include:
a. An increase in vaginal discharge
b. Persistent vomiting for the 1st
trimester
c. Headaches & vertigo
d. Edema of fingers & ankles first thing
in the morning

6. Hemoglobin & hematocrit counts vary

during the pregnancy. The normal
variations include:
a. A decrease in both, due to increased
blood volume
b. An increase in both, due to the
decreased blood volume
c. An increase in the hemoglobin & a
decrease in the hematocrit
d. Neither actually varies consistently
during pregnancy

7. Symptoms of placenta previa would

include:
a. Spotting in the early months of
pregnancy
b. Painless bleeding in the last months
of pregnancy
c. Sharp pains in the absence of
bleeding
d. Watery discharge prior to birth

8. Your client is admitted with a

diagnosis of hyperemesis
gravidarum. Your nursing
interventions will include:
a. Placing a padded tongue blade at the
head of the bed.
b. Measuring I & O accurately.
c. Identification of foods especially
nauseating to your client.
d. Spending a minimum amount of time
with her so she can get plenty of
rest.

9. Fetal embodiment occurs during the

second trimester. A common sign of
this process would be:
a. Introversion
b. An attempt to incorporate fetus into
body image as a part of self.
c. Daydreaming about self as mother &
about the baby.
d. Shock & denial.

10. Endocrine changes associated with

pregnancy do not include:
a. Increased estrogen levels.
b. Increased melanocyte-stimulating
hormones.
c. Increased HCG levels.
d. Decreased aldosterone.

11. Which of the following is not a

change in oxygenation associated
with pregnancy?
a. Enlargement of the heart
b. Decrease in cardiac output
c. Blood volume increases
d. Improved O2 & CO2 exchange at the
cellular level

12. Which of the following is not a

metabolic change associated with
pregnancy?
a. Gastric acids & pepsin levels increase
b. Nutritional requirement increases
c. Heartburn from esophageal reflux
increases
d. Better absorption of nutrients with
delayed gastric transit time

13. Which of the following is considered

a presumptive sign of pregnancy?
a. Ballotement
b. Uterine enlargement
c. Positive pregnancy test
d. Amenorrhea

14. Which of the following is the

probable sign of pregnancy?
a. Braxton Hicks contraction
b. Breast sensitivity
c. Nausea & vomiting
d. Quickening

15. At what stage of fetal development

does the fetus begin to develop
subcutaneous fat?
a. 12 weeks
b. 28 weeks
c. 32 weeks
d. 36 weeks

Johna, age 20, first visits a clinic in the

28th week of her pregnancy.
Assessment reveal that she is
overweight for her height & stature &
there is slight edema of her feet &
ankles.

1. In addition to emphasizing regular

visits for the rest of pregnancy, which
goal is a priority for Johna?
a. She will report leg cramping.
b. She will include roughage in her diet.
c. She will notify the clinic of
headaches.
d. She will sleep in left lateral position.

2. At Johnas next visit two weeks later,

her urine is negative for protein, her
BP has increased for 110/70 to
115/75 & she has gained 5 lbs. She
has some SOB when sleeping on her
back, & reports that the fetus is very
active at night. Which assessment is
most indicative of potential
problems?
a. BP changes
c. respiratory problems
b. Weight gain
d. fetal activity

3. When discussing health habits with

Johna, you review diet, exercise, &
use of OTC medications. Which of the
following should be avoided
considering her present condition?
a. Use of bicarbonate of soda for
heartburn
b. Apple slices as snacks
c. Brisk walking as exercise
d. Skim milk with meals

4. Johnas symptoms become more

severe as pregnancy advances. At a
routine visit in the 36th week, it is
noted that her urine is 3+ for CHON,
her BP is 140/110, & there is facial
edema. She is hospitalized on strict
bedrest. Magnesium sulfate is
ordered. Which of the following
assessments are critical while
administering this medication
intravenously?

a.
b.
c.
d.

Respirations & DTR

BP & temperature
State of consciousness
FHR & apical pulse

5. In addition to monitoring Johnas

condition closely, which of the
following nursing measures is most
important?
a. Maintaining a quiet environment.
b. Providing sufficient oral fluids.
c. Encouraging ambulation.
d. Promoting diversional activities.

6. Which of the following is a priority

goal for the client with severe
pregnancy-induced hypertension?
a. Client will comply with diet
modifications.
b. Client will report visual changes.
c. Client will remain on bedrest.
d. Client will communicate her feelings.

7. Several hours after treatment with

magnesium sulfate is begun, each of
the following observations is noted.
Which one indicates that the
treatment is effective?
a. Hourly output is 50 ml.
b. Blood pressure is 150/110.
c. Reflexes are hypotonic.
d. No seizures have occurred.

8. Johna awakens from sleep

complaining of sudden sharp
abdominal pain. Assessments reveal
that the uterus is hard & tender to
touch. FHR is 90. Maternal pulse is
130, BP is 100/60, skin is cold &
moist to the touch, & moderate
vaginal bleeding is noted. The
diagnosis is abruptio placenta. This
problem is directly related to:

a.
b.
c.
d.

Infarcts caused by vasoconstriction

High magnesium blood levels
Abnormal placental position
Potential for eclamptic seizures

Tina, aged 30, visits the antepartal

clinic with her husband after missing
2 menstrual periods. Physical
assessment, date of LMP, & urine
analysis for HCG indicate that she is
probably 7 weeks pregnant. History
includes the information that this is
her 1st pregnancy, her health has
been excellent, she is employed as a
secretary, & she is nonsmoker.

9. Which of the following is an

appropriate long term goal for Tina?
a. She will work reduced hours
throughout her pregnancy.
b. She will comply with a regular
prenatal visit schedule.
c. She will omit sodium & fat from her
daily diet.
d. She will begin an aerobic exercise
program.

10. At the second prenatal visit one

month later, Tina reports that she is
experiencing occasional nausea that
is relieved with dry foods. She is also
feeling very tired, & she has urinary
frequency & periods of weeping. In
reviewing the assessment data,
identify a potential problem.
a. Lab data shows a hematocrit of 36
with a hemoglobin of 12.
b. Urinalysis reveals a trace of glucose
with negative bacteria.

c. Interview reveals mixed feelings

about the pregnancy.
d. 24 hour diet recall: high
carbohydrate, high fiber vegetarian
diet.

11. Tina feels much better at the 22nd

week. She expresses surprise that
the Dr. ordered a glucose tolerance
test. Which explanation is
appropriate for this order?
a. Because you are a vegetarian, it is
necessary to check carbohydrate
metabolism.
b. Since there was sugar in your urine
at your 2nd visit, the blood test is a
precaution.

c. Because you have little regular

exercise, your metabolism may be
very slow.
d. This test of blood sugar levels is now
routine to identify gestational
diabetes.

12. The results of the test show an elevated

blood sugar. The problem is diagnosed as
gestational diabetes. Health teaching
would not include which of the following?
a.
Review her understanding of basic four
food sources.
b.
Emphasize adequate CHON & vitamin
intake.
c.
Caution her to eliminate all carbohydrates.
d.
Suggest that she eat 4 small meals each
day.

13. Tina follows all dietary suggestions &

increases regular mild exercise. She feels
well, but the blood sugar levels remain
elevated. The Dr. orders regular insulin on
a sliding scale appropriate to daily glucose
levels. Which statement made by the client
shows that she understands the problem?
a.
I resent that I now face a lifetime on
insulin.
b.
My vegetarian diet must have caused this
diabetes.
c.
This temporary condition is frustrating to
control.
d.
My grandmother has diabetes, so I guess
its inevitable.

14. In the 36th week, a non-stress test is

ordered. The result is reactive. Select an
appropriate explanation of this result that
could be given to a nursing student who
observed the diagnostic procedure.
a.
The result shows fetal response to
contractions.
b.
The FHR increased with activity.
c.
The absence of decelerations shows good
oxygenation.
d.
The heart rate variability is more than 15
beats.

Martha is admitted with preeclampsia in

her 32nd week of pregnancy. Her BP
is 160/110, she has 3+ albumin in
her urine, and she is complaining of
severe headaches.
15. Which of the following would not be
appropriate in your care of Martha?
a. Keeping her on complete bedrest.
b. Monitoring the FHT every 4 hours.
c. Checking her BP every7 shift.
d. Measuring I&O accurately.

16. The Dr. orders that IV magnesium

sulfate be given. Nursing
interventions required while Martha
is receiving this medication must
include:
a. Monitoring respirations and patellar
reflexes.
b. Administering calcium gluconate
concurrently.
c. Encourage her to ambulate.
d. Avoiding BP measurements until after
medication has infused.

17. Martha begins to experience

convulsions. Your priority nursing
intervention will be to:
a. Leave and get help immediately.
b. Put on the call light and ask for help.
c. Yell for help.
d. Ask her roommate to get help.

18. Which of the following nursing

interventions would be inappropriate
for the nurse to implement with a
pregnant client during a convulsion?
a. Place a tongue blade between her
unclenched jaws.
b. Put a blanket over the side rails to
protect her.
c. Monitor the FHR.
d. Raise the side rails to prevent falling.

19. Which of the following expectant

mothers would be at the greatest
risk for developing toxemia?
a. A 22-year-old Rh-negative
multigravida
b. A 17-year-old primigravida with a
positive roll-over test
c. A 25-year-old anemic primigravida
d. A 28-year-old slightly obese
primigravida

Gail de la Cruz is a 26-year old white

woman who has registered at the
clinic for prenatal care for her
pregnancy.
20. In eliciting her health history, the
nurse discovers that Gails LMP was
July 10, 2007. which of the following
dates would be the appropriate EDC?
a. April 3, 2008
c. April 17, 2008
b. April 10, 2008
d. April 20, 2008

21. Gail provides a maternal history, including

the following data: 1 healthy female
delivered at term five years ago; 1
miscarriage at 8 weeks four years ago; 1
stillborn male delivered at term three
years ago; 1 therapeutic abortion at six
weeks, two years ago; 1 premature male
delivered at 32 weeks last year. During this
pregnancy, Gail would be considered as:
a.
Gravida vi, para iii c. Gravida v, para iii
b.
Gravida v, para ii d. Gravida vi, para ii

22. Which of the following assessment

findings reflects Gails normal
physiological response to the
pregnancy?
a. Augmented peristalsis
b. Decreased GFR
c. Increased cardiac output
d. Increased respiratory rate

23. A complete blood count is done. The

results indicate that Gails
hemoglobin level is 11.4 gm. Which
of the following possibilities most
likely explains this finding?
a. Pregnancy induced decreased
vitamin B12 levels
b. The presence of iron deficiency
anemia
c. Depressed bone marrow function
d. Hemodilution of pregnancy

24. What other essential screening tests

should be conducted during the
course of Gails pregnancy?
a. Blood typing
b. Sickle cell screen
c. Chest X-ray
d. Serological test for gonorrhea

Post test: Prenatal Period

1.

a.
b.
c.
d.

Marthas LMP started on October 1,

2007. using Nageles rule, her
expected date of confinement will be:
July 1, 2008
July 8, 2008
August 1, 2008
July 28, 2008

2. Martha is scheduled for an ultrasound

to confirm her pregnancy. Nursing
care to prepare her for this test
would include:
a. Administering enemas until clear.
b. Keeping her NPO for 12 hours.
c. Starting an IV to maintain hydration.
d. Having her drink 8 glasses of water
and not void.

3. Martha has non-stress test done. The

results are found to be non reactive.
Based on this, the nurse knows that
which of the following must have
occurred during the test?
a. 2 FHR accelerations above base-line
for 15 seconds
b. Acceleration less than 15 bpm
c. Fetal movement in a 10 to 20 minute
period
d. FHR acceleration greater than 15
bpm

4. Because of the results of the non

stress test, Martha scheduled for an
oxytocin challenge test. The results
show the presence of late
deceleration of FHR with 3
contractions during a 10-minute
period; positive window. This test
would be reported as:
a. Abnormal
b. Normal
c. Suspicious
d. Unsatisfactory

5. The risk of amniocentesis would not

include which of the following?
a. Fetal death
b. Infection
c. Placenta abruptio
d. Chromosomal damage

6. Which of the following treatments

would be inappropriate for the
pregnant client who is suffering from
nausea and vomiting?
a. Eat small frequent meals.
b. Maintain a low fat diet.
c. Take antiemetics before arising.
d. Drink liquids before meals.

7. Which of the following is

contraindicated in the pregnant client
who is suffering from heartburn?
a. Take Gaviscon for the problem.
b. Drink milk between meals.
c. Sit up after meals.
d. Take Maalox occasionally.

8. Many pregnant clients suffer from

headaches during pregnancy. Which
of the following is contraindicated in
treating these headaches?
a. Change positions slowly.
b. Apply cool cloths to the forehead.
c. Take aspirin sparingly.
d. Take Tylenol sparingly.

9. Many women have leg cramps during

pregnancy. Which of the following
would not be an appropriate way to
treat leg cramps?
a. Walk regularly.
b. Elevate the legs when sitting.
c. Maintain bedrest when cramps are
severe.
d. Increase milk intake.

10. Which of the following is true about

most abortions?
a. They are usually caused by maternal
infections.
b. The cause of most abortions is
unknown.
c. An incompetent maternal cervical os
is the common cause.
d. Most are the result of fetal
abnormalities.

11. When some of the products of

conception remain in utero after fetal
death, it is referred to as:
a. Spontaneous abortion
b. Missed abortion
c. Incomplete abortion
d. Inevitable abortion

12. Which of the following is not

considered a typical sign of an
ectopic pregnancy?
a. Nausea & vomiting, especially after
rupture
b. Fever around 100F
c. Leukocytosis & an elevated ESR
d. Heavy, bright red vaginal bleeding

13. Which of the following is a typical

S/Sx of H-mole?
a. Brownish vaginal discharge aroun
week 12
b. Hypotension
c. Uterus small for estimated
gestational age
d. Hard, distended lower uterine
segment

14. Which of the following is a

predisposing factor for abruptio
placenta?
a. Young, primigravida
b. Hypertension
c. Multiparity
d. Presence of myomas

15. Using Whites classification, the

presence of vascular disease in a
client who became diabetic at age 8
and has been a diabetic for 21 years
places the client in:
a. Class B
b. Class C
c. Class D
d. Class E

16. Which of the following women

should be screened for diabetes
during their 2nd trimester, with a twohour-postprandial blood sugar?
a. Obese women
b. Older women
c. Adolescents
d. All women

17. Mary is a 38-year-old multigravida with a

history of rheumatic heart disease. She
has been classified as Class II. Which of
the following symptoms would you expect
her to exhibit?
a.
Dyspnea, fatigue, and angina with normal
activity
b.
Symptoms of cardiac insuficiency at rest
c.
No symptoms at normal activities
d.
Dyspnea, fatigue, & angina with less than
normal activity

18. Which of the following is incorrect

concerning rubella & pregnancy?
a. Women with low titers should be
vaccinated 2 months before
pregnancy.
b. Rubella is extremely teratogenic in
the 1st trimester.
c. The rubella virus does not cross the
placenta.
d. All women should have rubella titers
before their 1st pregnancy.

Russel, registered at the clinic for

prenatal care for her pregnancy.
19. Russel reports feelings of fatigue as
well as constipation & nausea. The
hormone which most likely
contributes to these symptoms is:
a. Chorionic gonadotropin
b. Relaxin
c. Prolactin
d. Progesterone

20. A change in vaginal mucosal color

from pink to violet is recorded on her
chart. This referred to as:
a. Goodells sign
b. Chadwicks sign
c. Hegars sign
d. Montgomerys sign

21. When Russels pregnancy has

reached the last trimester, the nurse
conducts Leopolds maneuvers during
the course of a prenatal examination.
Which step in this maneuver assists
in locating the fetal head?
a. First
b. Second
c. Third
d. Fourth

22. McDonalds measurements indicate

that Russels fundal height is 31 cm.
Which gestational age is compatible
with this assessment?
a. 28 weeks
b. 32 weeks
c. 35 weeks
d. 39 weeks

23.Which of the following statements should

guide the nurses understanding in
preparing a teaching plan for Russel?
a.
Fetal needs for calcium causes
demineralization & loss of maternal teeth
during pregnancy.
b.
Calories must be regulated to 1,800
calories/day to prevent excess weight gain
& difficult labor.
c.
Ambivalence about the pregnancy & mood
swings are evidence of rejection of the
pregnancy.
d.
Uterine muscles activity known as Braxton
Hicks contractions occur throughout the
pregnancy.

Normal Labor and Delivery:

1. When the uterus moves downward
and forward about 2 weeks prior to
delivery, this is referred to as:
a. Quickening
b. Lightening
c. Braxton Hicks contractions
d. False labor

2. Which of the following is not one of

the prodromes to labor?
a. Sudden burst of energy, nesting
b. Brownish or bloody show
c. Sudden gain of 2-3 pounds from fluid
shifts
d. Increased Braxton Hicks contractions

3. Which of the following characteristics

is not typical of false labor?
a. An increase in the force & frequency
of contractions when walking
b. Contractions that do not produce
dilation, effacement or descent
c. Absence of bloody show
d. Irregular contractions

4. During the latent phase of the first

stage of labor, the mother often
complains of cramps & backache.
Nursing measures to decrease these
symptoms include:
a. Medicate with Demerol as ordered.
b. Encourage the client to lay on her
back.
c. Provide a pillow for clients back.
d. Have the client bear down with
contractions.

5. During the transitional phase of the first

stage of labor, the client is often
nauseated, hot, and sweaty. Which of the
following nursing interventions is
appropriate for the client at this time?
a.
Administer antiemetics as ordered.
b.
Provide the client with cool liquids to drink.
c.
Encourage open-mouthed deep breathing.
d.
Set up a fan in the room to cool the client.

6. Which of the following characteristics

is typical of second stage of labor?
a. Moderately increased pain
b. Severe rectal pressure
c. Circumoral pallor
d. Decreased bloody show

Sandy is a 20-year old overweight

primigravida who suffers from pregnancyinduced hypertension.
7. Immediately following the cesarean birth
under general anesthesia of a four-pound
infant, Sandy is monitored closely. Which
of the ff is not a part of critical nursing
care?
a.
Administer transfusions & IV fluids.
b.
Monitor hematocrit & fibrinogen levels
closely.
c.
Allow family & clergy to remain at bedside.
d.
Suggest early breast-feeding to promote
bonding.

8. The disturbed father is concerned about the

health of mother and the infant in
intensive care. Which of the following
statements meets his needs at this time?
a.
Dont worry; the doctors are doing all
they can.
b.
Lets talk about what you are feeling now.
c.
It wont help your loved ones to be so
upset.
d.
You must remain strong to support your
family.

9. Several days later the mother is

discharged. Discharge teaching
should not include which of the
following?
a. Report strong contractions.
b. Measure I&O.
c. Observe any discomfort.
d. Note behavioral changes.

10. Several days later the mother is

discharged. Discharge teaching should not
include which of the following?
a.
Be sure to report any elevated
temperature.
b.
Include liver & dried fruits in your diet
often .
c.
Call the ICU anytime to check on your
baby.
d.
Breast-feeding the baby may cause
increased bleeding.

11. Which of the following is the desired

outcome of the second stage of
labor?
a. The client will be fully dilated.
b. The fetal head will be fully engaged.
c. The client will deliver a healthy
infant.
d. The client will safely deliver the
placenta.

12. Which of the following is not a

typical manifestation of the third
stage of labor?
a. Fundus rises
b. Uterus assumes a globular shape
c. Blood gushes from uterus
d. Perineum bulges

13. Your client is a 25-year-old

primigravida who is attached to a
fetal monitor. The base-line FHR is
145 to 150 bpm. You notice that the
FHR slows every time the client has a
contraction & then returns to normal.
This is best described as:
a. Type 1 deceleration
b. Type 2 deceleration
c. Type 3 deceleration
d. Fetal distress

14. The treatment for the above

alteration is to:
a. Do nothing; this is a transient
phenomenon
b. Prepare for emergency cesarean
section
c. Reposition client on her side
d. Prepare the client for impending
vaginal delivery.

15. Ann, a 26-year-old multigravida, is

complaining of severe pain during
the 1st stage of labor. Which of the
following measures would treat the
pain without interfering with the
labor?
a. Tranquilizers to calm her down
b. Amnesiacs
c. Paracervical block
d. Pudendal block

16. Part of your initial assessment on a

client admitted in labor is to perform
Leoplds maneuver to determine:
a. Contractions
b. Fetal position
c. Fetal heart rate
d. Presence of fetal distress

17. Your clients membranes rupture

spontaneously and in checking, you
note that the umbilical cord has
prolapsed. Which of the following is
the priority nursing action for this
situation?
a. Call the physician.
b. Administer oxygen.
c. Turn the mother to her side.
d. Place the mother in Trendelenburg
position.

18. Which if the ff is the correct nursing

intervention to help the client to push
down during delivery?
a.
Instruct the client to take 2 breaths, hold,
and bear down between contractions.
b.
Turn the client to her side and use short
breaths.
c.
Instruct the client to take 2 breaths, hold
and bear down with contractions.
d.
Encourage the client not to bear down
since it may result in tears.

19. Your client is suffering from dystocia

in the form of hypotonic uterine
contractions. Which of the following
is a symptom of the hypotonic
contractions?
a. Increased frequency & intensity of
contractions.
b. Nonsynchronous uterine tension.
c. Increased muscle tonus.
d. Pain out of proportion to contraction.

20. Which of the following is not a S/Sx

of prolonged labor?
a. Latent phase of 22 hours in
primigravida.
b. Prolonged active phase.
c. Dilation of 1 cm per hour in a
multipara.
d. Descent of less than 2 cm per hour in
multigravida.

21. Which of the following is an

indication for the use of oxytocin for
your client in labor?
a. Prolapse of the cord.
b. History of the previous cesarean
section more than 5 years ago.
c. Cervical dilation less than 3 cm.
d. Hypotonic uterine contractions.

22. Which of the following is not an

indication for delivery of a preterm
mother in labor?
a. Placental separation with
hemorrhage.
b. Severe eclampsia.
c. Preterm contractions
d. Chorioamnionitis

23. Ritodrine is often used to treat

preterm labor. Which of the following
is not a side effect of this drug?
a. Palpitations
b. Nausea and vomiting
c. Alterations in maternal BP
d. Constipation

24. Which of the following is not an

indication for induction of labor?
a. Premature rupture of membranes
b. Uncontrolled diabetes
c. Hypertonic uterine contractions
d. History of precipitous delivery

25. Which of the following is not a

predisposing factor for rupture of the
uterus?
a. Previous cesarean section
b. Hypotonic contractions
c. Labor that is not progressing
d. Cephalopelvic disproportion

25. Which of the following is not a

predisposing factor for rupture of the
uterus?
a. Previous cesarean section
b. Hypotonic contractions
c. Labor that is not progressing
d. Cephalopelvic disproportion

26. Which of the following is not a

rationale for using a medial
episiotomy?
a. Effective & easily repaired
b. Less painful
c. Minimizes risk of extension to rectum
d. Less blood loss

27. Nursing care of an episiotomy would

not include which of the following?
a. Using an icepack for 1st 24 hours.
b. Avoiding the use of analgesic
ointments.
c. Applying a heat lamp TID as ordered.
d. Administering a sitz bath, especially
after a bowel movement.

28. Which of the following is not a

maternal predisposing factor for the
use of forceps for delivery?
a. Shortened 2nd stage of labor in
dystocia
b. Deficiency of expulsive efforts
c. Inability to push
d. Prolapse of the cord

29. Which of the following is not a

prerequisite to the use of forceps in a
delivery of a fetus.
a. Cephalopelvic disproportion
b. Fully dilated cervix
c. Engaged head
d. Empty bowel & bladder

30. Which of the following is likely to

cause postpartum rectal incontinence
and continued rectal problems?
a. First degree lacerations
b. Second degree lacerations
c. Third degree lacerations
d. Mediolateral episiotomies

31. Which of the following complications

is more likely to occur postpartum
when the client has had a cesarean
section rather than a normal vaginal
delivery?
a. Abdominal distension
b. Uterine bleeding
c. Thrombophlebitis
d. Lochia rubra

Lynn Reyes, aged 38, is admitted in the

39th week for a planned cesarean
delivery because of total placenta
previa.
32. Which of the following assessments
is not routine in this situation?
a. Taking fetal heart rate
b. Checking maternal vital signs
c. Monitoring for uterine contractions
d. Checking for cervical
dilation/effacement

33. The chief potential problem for this

fetus is:
a. Potential for impaired gas exchange
related to impaired circulation
b. Alteration in nutrition: less than body
requirements
c. Potential for infection related to
cesarean birth
d. Potential for injury related to
placental placement

34. A primary goal to Lynns delivery is:

a. Client if free from undetected
complications
b. Client & significant others are
together during preparation and
surgery
c. Client expresses her fears and
concerns
d. Patient is well hydrated before
deluivery

35. A spinal anesthesia is administered, and

the client appears relaxed. Immediately
afterwards, the BP changes from 120/88 to
100/70 and FHT drops from 144 to 118.
What is the probable reason for this
change?
a. Adverse response to regional anesthetic
b. Pressure on aorta and vena cava while
supine
c. Poor oxygenation due to placenta previa
d. Anxiety about the cesarean delivery

36. What is the appropriate intervention

for the above problem at this time?
a. Elevate the feet and legs.
b. Administer oxygen by mask.
c. Increase the IV infusion rate.
d. Turn the client slightly to the left.

37. A seven-pound daughter is delivered

several minutes later. Apgar score is
9 and 10. Which of the following
assessments would receive a score of
1 at the initial scoring?
a. Heart rate 128
b. Cry loud
c. Feet blue
d. Body flexed

38. The total blood loss during delivery

is 700 ml. The couple prefer to avoid
transfusion if possible. Based on her
history and intrapartal situation,
which of the following recovery room
assessments is critical in addition to
observing lochia?
a. Blood pressure
b. Pulse rate
c. Temperature
d. Level of consciousness

39. In assessing physiological adaptation to

the postpartum period, which of the
following statements made by the client
indicates that she is able to be transferred
to her regular room?
a.
I have a little pain in the incision.
b.
Id like to sleep in my own room now.
c.
I am thirsty and would like my lips
sponged.
d.
I feel my legs again as I move them.

40. The Dr. orders 1000 ml of Ringers

lactate at 124 ml per hour with
Pitocin 10 units added to the IV. The
drip factor is 10 gtt/ml. Select the
appropriate rate of infusion.
a. 17 gtt per minute
b. 21 gtt per minute
c. 27 gtt per minute
d. 31 gtt per minute

Post Partum Period

Lisa Cruz, aged 37, delivered her 5th son
three hours ago in the birthing room.

1. Which of the following data shared at

morning report indicates a potential
problem?
a. The fundus is firm, just above the
umbilicus.
b. The client is complaining about
severe uterine cramps.
c. Episiotomy is slightly swollen with a
small bruise.
d. The vital signs are temperature 98F,
pulse 68, respirations 20.

2. Lisas blood type is O negative; the

baby is O positive. RhoGam is
ordered prior to discharge after
results of the Coombs test are
known. What information is essential
before giving the RhoGam?
a. Isoimmunization has occurred.
b. RhoGam was given after the last
birth.
c. No antibodies are present.
d. There are no known allergies.

3. Ms. Cruz is concerned about how her

other children, ages 2,3,5 and 15 will
accept the baby. Which response
shows an understanding of her
feelings?
a. Things will be difficult in the first
weeks.
b. Their reactions will depend on how
you prepared them.
c. Lets talk about what concerns you.
d. Sometimes its better to avoid
worrying too much.

4. The client, who bottle-fed her older

children, has many questions about
breast-feeding. What approach is
most helpful in this situation?
a. Assess her knowledge and be
available during feedings.
b. Use pamphlets and films as a first
step in teaching.
c. Introduce her to a successful breastfeeding mother.
d. Tell her the reasons why breastfeeding is beneficial.

5.

a.

b.

c.

d.

Before discharge, Lisa discusses

family planning. Which statement
indicates that she needs further
teaching?
Ill start to take oral contraceptives
immediately.
If I want to use a diaphragm, Ill
need to be checked first.
Well avoid intercourse when cervical
mucous is stretchable.
I will not rely on breast-feeding as
contraception.

6. As the newborn is prepared for

discharge, the father asks about care
of the umbilical cord stump. Select
the appropriate response.
a. Apply an antibiotic ointment to the
area daily.
b. Use alcohol to the cord and base
with each diaper change.
c. Let the baby soak in the bath until
the cord falls off.
d. No special care is needed. The cord
will heal in a week.

Chita Perlas, aged 15, delivered a baby girl an

hour ago. She held her infant daughter and
appeared joyful at her alertness. As the
initial newborn assessments are made, she
asks many questions about the babys
condition.
1.
Which of the ff delivery room observations
is abnormal?
a.
Severe molding of the head
b.
Cyanosis of the hands & feet
c.
Irregular abdominal respirations
d.
Temperature of 35C

2. Baby Girl Perlas is later assessed by

the nurse who determines that the
infant is small for gestational age on
the Ballard scale. Reasons for
intrauterine growth retardation
include:
a. Maternal infection and smoking
b. Malnutrition and chromosomal
abnormalities
c. Anemia and exposure to chemical
agents
d. Alcohol use and emotional distress

3. In observing an adolescent parent

with her first child, it is important
that the nurse assess:
a. Signs that the mother is tuned in to
infant cues
b. Evidence that the mother is aware of
safety
c. Behaviors that indicate early bonding
d. All of the above

4. Which question focuses on gathering

data about the young mothers
mastery of her developmental tasks?
a. What is your relationship with the
babys father?
b. How do you feel about your parents
interest in the baby?
c. Tell me how you feel about yourself
as a young woman?
d. Do you feel that you can give love
to an infant?

5. Which of the following is an

appropriate short-term goal for this
young mother?
a. She will be aware of the
developmental needs of childhood.
b. She will feed, nurture, and provide
care for her newborn.
c. She will resolve social problems
within her family.
d. She will delay another pregnancy for
a year.

6. At the time of discharge, much time is

spent reinforcing teaching of self-care &
infant care. Which statement made by
Chita indicates that further teaching is
necessary?
a.
If I need to, Ill use non-fat dry milk for
feedings.
b.
Ill hold and love the baby even when she
doesnt cry.
c.
After feeding, Ill put her to sleep on her
tummy.
d.
Until the cord is dry, Ill give her a sponge
bath.

Grace , a diabetic, is admitted for termination

of pregnancy in the 37th week when pelvic
examination shows cervical softening and
effacement. The physician and couple have
agreed on labor induction.
7. The primary reason that a gestational
diabetic is delivered early is to:
a.
Prevent problems that may result from
placental insufficiency.
b.
Reduce maternal stress during the 2nd
stage of labor
c.
Eliminate fetal hyperglycemia in the
immediate newborn period
d.
Control maternal glucose/insulin balance in
intrapartum

8. During the labor induction, which

assessment is critical?
a. Monitoring contractions and rest
phase.
b. Observing maternal pain and
relaxation.
c. Measuring I&O.
d. Noting BP and pulse.

9. After a ten-hour labor, a nine-pound

son is delivered to Grace. Parents
and newborn enjoy early contact and
breast-feeding is initiated. Which of
the following assessments of the
newborn indicates a need for
immediate intervention?
a. Respiratory rate is 30.
b. Dextrostick (glucose) is 25.
c. Hematocrit is 48.
d. Coombs test is negative.

10. Baby and mother are discharged after 24

hours of hospitalization. Both appear to be
in good health. Which statement made by
Grace shows that discharge teaching was
effective?
a.
Well bring the baby for his PKU test
tomorrow.
b.
Both the baby and I probably will always
be diabetic.
c.
Breast-feeding will help space the next
pregnancy.
d.
Ill start active exercise again right away.

11. Baby James, 6 pounds 1 ounce, was

just delivered after a long labor. His
initial Apgar is 4. Which of the
following is likely nursing care for
James?
a. Suction him.
b. Dry him with a dry towel.
c. Ventilate him with 100% O2 at 40 to
60 breaths.
d. Place baby under warmer to maintain
body temperature.

12. Baby James is in the newborn

nursery. In assessing his eyes and
vision, which of the following would
be an abnormal finding?
a. Crossed eyes
b. Absent blink reflex
c. Positive red reflex
d. Edema of the eyelids

13. Which of the following would be an

abnormal finding when the nurse
assesses Jamess cardiovascular
system?
a. Heart rate of 154
b. Irregular heartbeats
c. Acrocyanosis of the extremities
d. Circumoral cyanosis

14. James is breathing with 10 to 15

second periods of apnea. The nurse
knows that this means:
a. Nothing, it is normal
b. Impending respiratory distress
c. James will eventually develop asthma
d. James may be developing a
respiratory infection

15.When the nurse is assessing Jamess

renal system, which of the following
would be considered an abnormal
assessment?
a. Urine specific gravity 1.008
b. First void after first 24 hours
c. Voiding up to 20 times a day
d. Brick dust colored urine with the
first void

16. Which of the following is not part of

the care of an infant with
hyperbilirubinemia?
a. Withhold fluids during treatment.
b. Maintain neutral temperature.
c. Administer phototherapy.
d. Assist with exchange transfusion if
needed.

Mrs. C., gravida i para i, and has just delivered

a 7 pound 3 ounce baby girl after a tenhour labor. The baby was delivered
vaginally with no complications.
17. In order to assess this newborns
adaptation to extrauterine life, the nurse
should perform which of the following
tests?
a.
Apgar
b.
Silverman
c.
Ballard/Dubowitz
d.
Brazelton

18. To avoid heat loss by evaporation,

the nurse should:
a. Keep the baby away from drafts
b. Avoid placing the baby on a cold
surface
c. Dry the baby immediately after
delivery
d. Pad the scale before weighing the
baby

19. In order to prevent abnormal

bleeding in the newborn, the nurse
should:
a. Keep the baby away from drafts.
b. Avoid placing the baby on a cold
surface.
c. Dry the baby immediately after
delivery.
d. Pad the scale before weighing the
baby.

20. The newborns first stool is:

a. Yellow and loose
b. Yellow and seedy
c. Thick and greenish black
d. Loose and green

21. In order to rule out PKU, the nurse

should test the baby:
a. Immediately after delivery
b. Prior to the first feeding
c. 2 to 3 days after birth
d. At the six-week check up

Baby Susan is a 9 pound 2 ounce infant born

to a diabetic mother. She was delivered by
cesarean section 12 hours ago. Her Apgar
scores in the delivery room were 7 and 9.
22. You notice that Susan is lethargic, jittery,
and has irregular respirations. Appropriate
nursing interventions would include:
a.
Feeding the infant glucose water (10%)
b.
Administering insulin subcutaneously
c.
Giving oxygen
d.
Administering Phenobarbital IM

23. Ten hours later, Susan develops

tetany. Which of the following
complications will you most likely
give IV?
a. Glucose
b. Insulin
c. Calcium gluconate
d. Valium

24. Jaundice that appears after the first

48 hours of a newborns life usually
indicates:
a. Rh or ABO incompatibility
b. Normal physiological adaptation
c. Breast milk intolerance
d. Liver abnormality

25. Expiratory grunting is:

a. Normal bowel transit in the newborn
b. A sign of respiratory distress
c. Common in babies of Rh negative
mothers
d. Transitory in most instances

Baby Den Rick is a 9 pound 8 ounce infant

born at 43 weeks gestation. He was
delivered vaginally ten hours ago. His
Apgar scores were 7 and 8.
26. Den Ricks physical characteristics include:
a.
cracked, peeling skin, and scant vernix
caseosa
b.
Abundant lanugo & thin, transparent skin
c.
Yellow-stained skin and abundant
subcutaneous fat
d.
Ruddy complexion & flaccid extremities

27. Den Ricks gestational age puts him

at risk for:
a. Juvenile onset diabetes
b. Meconium Aspiration Syndrome
c. Hemolytic anemia
d. Hyperthermia

28. Baby Sarah, 7 pounds 8 ounces, was born

today. She is in the newborn nursery and
you are caring for her cord. Which of the
following nursing interventions is
appropriate when caring for the umbilical
cord.
a.
Apply a vaseline gauze dressing over the
site.
b.
Apply a simple dry dressing over the site.
c.
Clean the site vigorously with soap and
water everyday.
d.
Apply topical triple dye or bacitracin
ointment initially.

29. Bowel transit time in the newborn is

about:
a. 1 to 1 hours
b. 2 to 3 hours
c. 1 to 2 hours
d. 3 to 3 hours

30. The newborn needs approximately

how many calories per day?
a. 50 calories per kg per day
b. 75 calories per kg per day
c. 120 calories per kg per day
d. 150 calories per kg per day

31. The newborn infant exhibits a

number of reflexes at birth. Which of
the following is not present at birth?
a. Parachute reflex
b. Moro reflex
c. Sucking reflex
d. Extrusion reflex

32. Which of the following is not a risk

factor for respiratory distress
syndrome?
a. Prematurity
b. Maternal diabetes
c. Birth trauma
d. Post term birth