Situation : Marie Cris who is 10 weeks pregnant with her first baby, calls

the clinic to tell the nurse that she has slight vaginal bleeding without
abdominal cramping.

1. Recognizing that Marie Cris has signs and symptoms of a threatened

abortion, the nurse should inform the physician and advise the client
to:

A) Come to the clinic immediately

B) Restrict her activities and call again if bleeding persist
C) Elevate her legs whenever she rests
D) Continue her activities, but limit her oral intake to fluids only

2. The nurse should also advise Marie Cris to:

A) Take a laxative so that she does not strain at stool

B) Save all perineal pads, clots and expelled tissue
C) Call the clinic when the bleeding stops
D) Record fluid intake and urinary output for 48hrs

3. Marie Cris asked the nurse if she will lose her baby, which of the
following is the best response?

A) There is always that possibility, but we will try to save your

pregnancy
B) Most women who have mild bleeding w/o cramps continue
their pregnancy
C) You seem upset, this must be difficult for you
D) Try not to worry now, everything will be alright

4. Marie Cris asked the nurse how long after the bleeding stops can she
and her husband resume sexual intercourse. The nurse should advise
her that coitus may be resumed after:

A) 48hrs B) 1 week C) 2 weeks D) 6 weeks

5. One week later Marie Cris has spontaneous abortion. Examination of

the aborted embryo reveals a gross defect that is incompatible with
life. After receiving this information from the doctor Marie Cris
begins to cry. What is the most therapeutic assurance the nurse can
give to Marie Cris?

A) Recommended genetic counseling for her and for her husband

B) Explain why defects are the most common cause of early
spontaneous abortion.
C) Reflect her feelings by asking why she is upset
D) Suggest that she speak with the physician about when she can
begin another pregnancy
Situation: Mrs. Mary Jane is admitted to the labor and delivery suite in
active labor. She is 34 years old and is a gravida 4, para 2. At the start of the
second stage of labor, she complains of severe abdominal pain that does not
subside between contractions. Her abdomen has become rigid. The physician
is notified and a diagnosed of abruptio placentae is made.

6. In which of the following types of high – risk pregnancy would

abruptio placentae most likely occur?

A) Cardiac Disease C) Drug Addiction

B) Chronic Hypertension D) Hyperthyroidism

7. The priority nursing actions for Mrs. Jane are to prepare for a blood
transfusion and:

A) Observe changes in her vital signs and skin color

B) Obtain a clean-catch urine specimen for culture and
sensitivity
C) Prepare a solution of calcium gluconate for I.V infusion
D) Maintain her in a supine position

8. After delivery, while Mrs. Jane is in the recovery room, she begins to
have hemorrhage. Which of the following is most likely the cause of
hemorrhage?

A) Her uterus was not massage adequately

B) She developed hypofibrinogenemia, a coagulation defect
C) Her rigid abdomen result in atony of the uterine muscles
D) Placental fragments remained in her uterus

Situation: Mrs. Joy is admitted into the labor and delivery suit 1 week later.
Her membranes have ruptured and she is in active labor.

9. As the nurse prepares Mrs. Joy for vaginal examination, a loop of

pulsating umbilical cord is observed at the vaginal introitus. The nurse
should first:

A) Put on a sterile glove and gently reinsert the cord into the vaginal
opening
B) Listen for the FHT with Doppler device or electronic fetal monitor
C) Place Mrs. Joy in the knee – chest position and use pillows to
support her abdomen
D) Prepare her for immediate delivery

10.While awaiting the physician’s arrival, the nurse observes that the
loop of the cord now extends past the vaginal introitus. The nurse
should:

A) Not touch it
B) Try to replace it
C) Place Mrs. Joy in the knee – chest position and use pillows to
support her abdomen
D) Cover it with dry, sterile towel
Situation: Gina Ruth is primigravida who is 20 years old. Her estimated date
of confinement was two weeks ago. The doctor ordered an oxytocin
challenge test (OCT).

11.the OCT was ordered for Gina to help determine:

A) fetal age
B) maternal pelvic adequacy
C) fetal well – being
D) maternal uterine irritability

12.Gina’s OCT showed 7 contractions in 20 minutes. The decelerations

occurred in the following order: 2 late, 2 early, and 3 late. The nurse
should interpret these findings by recording the test as

A) Positive B) Suspicious C) Negative D) Unsatisfactory

Situation: the morning after the OCT, Gina Ruth is admitted to the labor
and delivery suite. She tells the nurse that her contractions started hours after
the OCT and continued throughout the evening and during the night. She
adds that the contractions have been very irregular, but they are strong and
painful. The nurse assesses the Gina Ruth is very tired. Physical examination
reveals that her cervix is 2 cm dilated.

13. Gina asks the nurse what will be done to ease the pain and help labor
progress more rapidly. How should the nurse response?

A) Every woman’s labor is different, and the doctor will have to

decide if you need any medication.
B) A first labor is usually long and difficult. I will try to make you
as comfortable as possible.
C) The doctor will probably prescribe a sedative to help you rest.
When you awaken, your contractions should become more
regular.
D) Oxytocin is usually administered. It will make your
contractions more effective and allow labor to progress more
rapidly.

14.The nurse assesses that the presentation of the fetus is:

A) Breech B) Occipitoanterior C) face D) Occipitoposterior

15.Which comfort measure is most effective for relieving Gina’s pain

during a contraction?

A) Effleurage B) Sitting Upright C) Sacral Pressure D) Rapid Breathing

16.During the transitional phase of labor, Gina’s membranes rupture. The

color of the amniotic fluid is green. The FHR on the EFM drops to
110 bpm during the next contraction and returns to 140bpm after the
contraction is over. The nurse should:
A) Inform Gina Ruth that labor is progressing as expected.
B) Notify the physician and record findings
 C) Check the amniotic fluid for meconium with Nitrazine paper
D) Observe the fetal heart rate during the next two contractions

17. Gina Ruth gave birth to as baby boy. The baby’s head is elongated,
and there is a soft, edematous area on occiput. The nurse should
explain that his head is molded because of her difficult labor and the
edema is:

A) Caput succedanum, which will disappear in few days

B) Cephalhematoma, which will disappear in a few weeks.
C) Craniotabes, which will disappear in a few months.
D) Overriding sutures, which will disappear in a few hours

Situation: Evelyn, a 34 year old multipara, is pregnant with her fourth child.
She had rheumatic heart fever when she was 8 years old, and a diagnosis of
rheumatic heart disease was made when became pregnant for the first time.
During her initial antepartum clinic examination for this pregnancy, she has
informed that she has mitral stenosis.

18.During an early clinic visit, Evelyn asks the nurse how much weight
she can expect to gain during her pregnancy. The nurse’s most
appropriate response is that:

A) The average weight gain during pregnancy should be 25 – 30 pounds

B) Depending on height and pregnant weight, the average weight gain
should be between 20 and 40 pounds.
C) Nutrition is very important to the fetus, that maternal weight gain is
no longer restricted.
D) Caloric intake will be restricted to limit weight gain, thus conserving
the cardiac work load.

19.During the antepartum teaching period, the nurse should specially

stress the need for:

A) A quart of whole milk daily C) Counseling for acute emotional problems

B) Complete bed rest D) Abstaining from sexual intercourse

20.When Evelyn is 30 weeks pregnant, she calls the clinic and states that
she has a persistent cough and increasing difficulty with breathing.
The nurse’s most appropriate response to this complaint is that:

A) This is to be expected during the second trimester; try to get more rest
B) The symptoms sound as though you have influenza
C) You should come to the clinic immediately and be prepared for
hospitalization
D) Your symptoms will subside if you remain on bed rest for at least 1
week

21.The major goal of care for Evelyn is to:

A) Surgically correct the mitral stenosis before she goes to term

B) Reduce cardiac demands by terminating the pregnancy
C) Assist her to go to term without increasing heart problems
D) Assist her to recognize that the fetus cannot survive because the
cardiac medication crosses the placental barrier.

22. Evelyn appears to have lost an interest in her physical appearance. She
states, “ I don’t care how I look.” Which of the following questions
represents the nursing approach that would be most therapeutic in this
situation?

A) Is there a problem with you and your husband?

B) Do you have a fear of childbirth?
C) How do you feel about the changes in your body?
D) What are your feelings about becoming a mother?

23.As Evelyn approaches term, she tells the nurse that she and her
husband wish to participate in prepared childbirth classes so that they
can be together during labor and delivery. To help Evelyn understand
the therapeutic goals for cardiac patient during labor and delivery, the
nurse should explain that she probably will have:

A) Regional anesthesia at the end of the first stage of labor with low
forceps delivery
B) Analgesics during the first stage of labor that produce sleep with
amnesia, and will awaken after delivery
C) General anesthesia at the beginning of second stage, and will be
asleep during delivery
D) A cesarean section, and the hospital may allow her husband to be
present

24.Which of the following actions is of most benefit in helping to prevent

Evelyn from contracting bacterial endocarditis during labor and after
delivery?

A) Asking if she has this infection before

B) Inquiring whether she is allergic to penicillin
C) Explaining why a CS may be necessary
D) Encouraging deep breathing and isometric exercises

25.Shortly after delivery, the nurse checks Evelyn’s chart for medication
order: “ ergonovine maleate” ( Ergotrate ), 0.4mg four times a day.
The nurse should question the order because the drug:

A) Can be administered either by oral or intramuscular routes

B) Is rarely ordered to more than 2 days, with a maximum of 1 week
C) Is usually prescribed in a dosage of 0.2mg four times a day
D) Is usually contraindicated for cardiac patients