FINAL COACHING MATERIALS (OBSTETRIC NURSING)

Prof. M. T. Vanguardia

ANTEPARTUM (20 items)

1. The nurse is counseling the client who is trying to become pregnant. To promote fetal health when
the client is unaware of a pregnancy, the nurse should stress the inclusion of which nutrient in daily
food intake?
A. Potassium
B. Calcium
C. Folic acid
D. Sodium

2. The nurse is reviewing the medication history of the client during preconception counseling. The
client reports taking isotretinoin for acne. Which is the nurse’s best response?
A. “Stop taking isotretinoin now! It can cause serious birth defects if you become pregnant.”
B. “You need to be on some type of birth control right now. Getting pregnant is not an option.”
C. “Talk with your HCP about changing isotretinoin before you consider becoming pregnant.”
D. “Once you are off of isotretinoin for treating acne, you can then safely become pregnant.”

3. The nurse is counseling the client who has SLE. The client tells the nurse that she plans to become
pregnant in the next year. Which response by the nurse is correct?
A. “It is best to plan for your pregnancy when you have been in remission for 6 months.”
B. “Having systemic lupus erythematosus will not impact your pregnancy in any way.”
C. “Your chances of having an infant with congenital malformations are increased with SLE.”
D. “You will need to be scheduled for a cesarean delivery to prevent disease transmission.”

4. The 22-year-old client tells the clinic nurse that her last menstrual period was 3 months ago, which
began on November 21. She has a positive urine pregnancy test. Using Naegele’s rule, which date
should the nurse calculate to be the client’s estimated date of confinement (EDC)?
A. August 28
B. January 28
C. August 15
D. January 15

5. The client, who is Chinese American and pregnant, is receiving nutritional counseling about the
need for increased amounts of calcium in her diet. Which response by the nurse is most helpful when
the client states she does not consume any dairy products?
A. “Tell me how you perceive dairy products in your culture.”
B. “Try having a glass of soy milk at each meal and at bedtime.”
C. “Tell me about your intake of fortified tom and leafy green vegetables.”
D. “Rice milk fortified with calcium and nettle tea are good calcium choices.”
6 . The client tells the nurse, “Most days, I am so happy I am pregnant, but other days, I am not sure
that I am ready to have a baby.” Which is the most accurate response from the nurse?
A. “This is such a happy time in your life. You need to be optimistic to feel happy.”
B. “How does your spouse feel about the pregnancy? I hope he is happy about the baby.”
C. “Feeling differently from day to day is normal. How do you feel today?”
D. “Why do you feel this way? Is there something I can do to make it better for you?”

7. The nurse is teaching the pregnant client during her first trimester. The nurse identifies that which
decision is most important for her to make first?
A. Bottle versus breastfeeding
B. Labor and delivery location
C. Pain management during labor
D. Method for delivery of the baby

8. The pregnant client is experiencing low back pain. After determining that the client is not in labor,
the nurse instructs the client to perform which exercises to increase comfort and decrease the
incidence of the low back pain? Select all that apply.
A. Kegel exercises
B. Pelvic tilt exercises
C. Leg raises
D. Back stretch
E. Stepping

9. 22. The nurse is conducting a physical assessment of the pregnant client. Which physiological
cervical changes associated with pregnancy should the nurse expect to find? Select all that apply.
A. Formation of mucus plug
B. Chadwick’s sign
C. Presence of colostrum
D. Goodell’s sign
E. Cullen’s sign

10. The pregnant client and her significant other are attending childbirth classes. The client asks for
guidance on preparing her school-aged child for the new baby’s birth. Which strategies might the
nurse suggest that the client use with her child? Select all that apply.
A. Read books about bringing home a new baby.
B. Think of unique names for the new baby.
C. Help pack a bag for bringing the new baby home.
D. Explain how pregnancy occurred, if asked.
E. Help the child buy presents for the new baby.

11. The nurse is counseling the client who is pregnant. The nurse should teach that which assessment
finding requires follow-up with the HCP?
A. Dependent edema
B. Edema in the hands
C. Generalized edema
D. Edema occurring every evening
12. The client expresses concerns related to nausea in the first trimester of pregnancy. Which
recommendation should the nurse make?
A. Eat crackers while still in bed in the morning.
B. Lie down and rest whenever nausea occurs.
C. Eat more frequently throughout the day.
D. Avoid food items containing ginger.

13. The nurse is providing nutrition counseling to the client during her first prenatal clinical visit.
Which statement, if made by the client, indicates that the client has an understanding of some of the
nutritional requirements during pregnancy?
A. “I can eat cheese as an alternative to milk, as I don’t care for milk.”
B. “I should be eating more at each meal because I’m eating for two.”
C. “I will need to limit my calories because I am already overweight.”
D. “I should limit myself to eating only three healthy meals per day.”

14. The nurse is providing nutrition counseling to a primigravida who is 10 weeks pregnant. Which
meal choice stated by the client indicates she needs additional information?
A. Black beans, wild rice, collard greens
B. Dry cereal, milk, dried cranberries
C. Tuna, broccoli, baked potato
D. Beef strips, lentils, red peppers

15. The nurse evaluates the pregnant client with sickle cell disease during her second trimester. The
nurse should identify which manifestation as being related to sickle cell disease and not the
pregnancy?
A. Hand and lower extremities edema
B. 2- Elevated serum blood glucose level
C. Decreased oxygen saturation level
D. Elevated blood pressure

16. The client who is 32 weeks pregnant asks how the nurse will monitor the baby’s growth and
determine if the baby is “really okay.” Which assessments should the nurse identify for evaluating the
fetus for adequate growth and viability? Select all that apply.
A. Auscultate maternal heart tones.
B. Measure the height of the fundus.
C. Measure the client’s abdominal girth.
D. Complete a third-trimester ultrasound.
E. Auscultate the fetal heart tones (F HT).

17. The client tells the nurse that she is using cocoa butter on her abdomen to prevent stretch marks.
Which is the most accurate response from the nurse?
A. “That is wonderfull. If you continue to use cocoa butter daily, you should have no stretch marks
after delivery.”
B. “The cocoa butter will not prevent stretch marks completely, but it will help to reduce their
number.”
C. “The cocoa butter will not prevent stretch marks but Will decrease the appearance of the linea
nigra.”
D. “Cocoa butter does not prevent stretch marks, but it soothes itching that occurs as your
 abdomen enlarges.”

18. The nurse is caring for the 24-year-old client whose pregnancy history is as follows: elective
termination age 18 years, spontaneous abortion age 21 years, term vaginal delivery at 22 years old,
and currently pregnant again. Which documentation by the nurse of the client’s gravidity and parity is
correct?
A. G4P1
B. G4P2
C. G3Pl
D. G2P1

19. The nurse is caring for the pregnant client at 20 weeks’ gestation. At what level should the clinic
nurse expect to palpate the client’s uterine height?
A. Two finger-breadths above the symphysis pubis
B. Halfway between the symphysis pubis and the umbilicus
C. At the level of the umbilicus
D. Two finger-breadths above the umbilicus

20. The nurse assesses the fundal height for multiple pregnant clients. For which client should the
nurse conclude that a fundal height measurement is most accurate?
A. The pregnant client with uterine fibroids
B. The pregnant client who is obese
C. The pregnant client with polyhydramnios
D. The pregnant client experiencing fetal movement

INTRAPARTUM (20 items)

1. The nurse assesses the pregnant client who comes to the triage unit and determines that she is at
4/50/—l and that the fetal HR is 148. What priority information should the nurse collect before
proceeding?
A. Time and amount of last meal
B. Number of weeks’ gestation
C. Who is attending the delivery
D. History of previous illnesses

2. The nurse, admitting a 40-week primigravida to the labor unit, just documented the results of a
recent vaginal exam: 3/lOO/—2, RSP. How should the oncoming shift nurse interpret this
documentation?
A. The fetus is approximately 2 cm below maternal ischial spines.
B. The cervix is totally dilated and effaced, with fetal engagement.
C. The fetus is breech and posterior to the client’s pelvis.
D. The fetal lie is transverse, and the fetal attitude is flexion.

3. The nurse is caring for the low-risk laboring client during the first stage of labor. When should the
nurse assess the FHR pattern? Select all that apply.
A. Before administering medications
 B. At least every fifteen minutes
C. Alter vaginal examinations
D. During a hard contraction
E. When giving Oxycontin

4. The 39-year-old client with type 1 DM presents at 36 weeks’ gestation with regular contractions. An
HCP decides to do an amniocentesis. Which statement best supports why the nurse and NA should
prepare the client for an amniocentesis now?
A. Diabetic women have a higher incidence of birth defects, and the HCP wants to determine if a
birth defect is present.
B. The client is over 35, at 36 weeks’ gestation with regular contractions, and is at risk for
chromosomal disorders.
C. An amniocentesis performed at 36 weeks’ gestation is being completed to detemiine if the fetal
lungs have matured.
D. The amniocentesis is more accurate than the fetal fibronectin test in determining if delivery is
imminent.

5. The laboring client in the first stage of labor is talking and laughing with her husband. The nurse
should conclude that the client is probably in what phase?
A. Transition
B. Active
C. Active pushing
D. Latent

6. The nurse just administered butorphanol tartrate as prescribed to the client in active labor.
Following administration of butorphanol tartrate, what is the nurse’s most important action to help
prevent side effects?
A. Assess the client’s bladder for distention
B. Place the client on seizure precautions
C. Assess the client’s body for itchy rash
D. Evaluate her vital signs and pulse oximetry

7. The nurse is caring for the Muslim client in labor. What should the nurse be most aware of as a
possible belief of the client?
A. Male health care providers should enter the room after receiving permission from her husband.
B. The client may prefer to eat only “hot” foods and to drink only special tea and warm water.
C. Fathers, rather than female relatives, are usually present to provide support during the labor.
D. She will be more likely to moan, scream, or cry out in pain during each labor contraction.

8. The laboring client is at 5/100/0, RCA, and having difficulty coping with her contractions. She does
not want an epidural analgesia or medications. How can the nurse best assist the client and her
partner at this time?
A. Apply counter pressure to sacral area with a firm object.
B. Implement effleurage (light massage) of the abdomen.
C. Provide a quiet, calm, and relaxed labor environment.
D. Re-emphasize modified-paced breathing techniques.
9. The labor nurse observes a sinusoidal FHR pattern on the monitor tracing. How should the nurse
interpret this pattern?
A. The fetus may be in a sleep state.
B. Congenital anomalies are possible.
C. This may indicate severe fetal anemia.
D. This predicts normal fetal well-being.

10. The continuous electronic FHR monitor tracing on the laboring client is no longer recording. How
should the nurse immediately respond?
A. Conclude that there is a problem with the baby and call for help.
B. Check that there is adequate gel under the transducer and reposition.
C. Give the client oxygen via facemask at 8 to 10 liters per minute.
D. Auscultate fetal heart rate by fetoscope and assess maternal vital signs.

11 . The nurse is caring for the client in labor. Which assessment finding would help the nurse
determine whether the client is in the third stage of labor?
A. Lengthening of fetal cord
B. Increased bloody show
C. A strong urge to push
D. More frequent contractions

12. The client in labor tells the nurse that it feels like her membranes just ruptured. Which assessment
finding of the amniotic fluid would indicate that it is normal?
A. Cloudy in color
B. Has a strong odor
C. Meconium stained
D. Has a pH of 7.1

13. The laboring multigravida client’s last vaginal examination was 8/90/+1. The client new states
feeling rectal pressure. Which action should the nurse perform first?
A. Encourage the client to push.
B. Notify the obstetrician or midwife.
C. Help the client to the bathroom.
D. Complete another vaginal exam.

14. The laboring client’s amniotic membranes have just ruptured. Which nursing action should be
priority?
A. Monitor maternal temperature.
B. Inspect characteristics of the fluid.
C. Perform a sterile vaginal examination.
D. Assess the fetal heart rate pattern.

15. The client in labor received an epidural anesthesia 20 minutes ago. The nurse assesses that the
client’s BP is 98/62 mm Hg and that the client is lying supine. What should the nurse do next?
A. Increase the lactated Ringer’s infusion rate.
B. Elevate the client’s legs for 2 to 3 minutes.
C. Place the bed in 10- to 20-degree Trendelenburg.
D. Position the client in a left side-lying position.
16. The nurse explained the process of cervical effacement to the client in early labor. Which
statement by the client indicates that she understands the information?
A. “The cervix will widen from less than 1 cm to about 10 cm.”
B. “The cervix will pull or draw up and become paper-thin.”
C. “The cervical changes will cause my membranes to rupture.”
D. “The cervical changes will help my baby to change position.”

17. The nurse observes on the monitor tracing of the client in the transition phase of labor that the
baseline FHR is 160 and that there is moderate variability with V-shaped decelerations unrelated to
contractions. What should the nurse do first?
A. Prepare for delivery.
B. Notify the obstetrician.
C. Apply oxygen nasally.
D. Reposition the client.

18. The nurse is caring for the pregnant client. Which assessment findings help the nurse determine
that she may be in true labor? Select all that apply.
A. Progressive cervical dilation and effacement
B. Walking usually increases contraction intensity
C. Warm tub baths and rest lessen contractions
D. Discomfort is usually in the client’s abdomen
E. Contractions increase in duration and intensity

19. The nurse is assessing the laboring client who is morbidly obese. The nurse is unable to determine
the fetal position. Which action should be performed by the nurse to obtain the most accurate
method of detemiining fetal position in this client?
A. Inspect the client’s abdomen.
B. Palpate the client’s abdomen.
C. Perform a vaginal examination.
D. Perform transabdominal ultrasound.

20. The nurse is caring for multiple clients. The nurse determines that which client would be a
candidate for intermittent fetal monitoring during labor?
A. The client with a previous cesarean birth
B. The primigravida client at 41 weeks
C. The client with preeclampsia
D. The client with gestational diabetes

POSTPARTUM (20 items)

1. The Caucasian postpartum client asks the nurse if the stretch marks (striae gravidarum) on her
abdomen will ever go away. Which response by the nurse is most accurate?
A. “Your stretch marks should totally disappear over the next month.”
B. “Your stretch marks will always appear raised and reddened.”
C. “Your stretch marks will lighten in color with good skin hydration.”
D. “Your stretch marks will fade to pale white over the next 3 to 6 months.”
2. Immediately after delivery of the client’s placenta, the nurse palpates the client’s uterine fundus.
The fundus is firm and located halfway between the umbilicus and symphysis pubis. Which action
should the nurse take based on the assessment findings?
A. Immediately begin to massage the uterus
B. Document the findings of the fundus
C. Assess the client for bladder distention
D. Monitor for increased vaginal bleeding

3. The client, who delivered a 4200-g baby 4 hours ago, continues to have bright red, heavy vaginal
bleeding. The nurse assesses the client’s fundus and finds it to be firm and midway between the
symphysis pubis and umbilicus. What should the nurse do next?
A. Continue to monitor the client’s bleeding and weigh the peripads.
B. Call the client’s HCP and request an additional visual examination.
C. Prepare to give oxytocin to stimulate uterine muscle contraction.
D. Document the findings as normal with no interventions needed at that time.

4. When looking in the mirror at her abdomen, the postpartum client says to the nurse, “My stomach
still looks like I’m pregnant!” The nurse explains that the abdominal muscles, which separate during
pregnancy, will undergo which change?
A. Regain tone Within the first week after birth
B. Regain prepregnancy tone with exercise
C. Remain separated, giving the abdomen a slight bulge
D. Regain tone as the weight gained during pregnancy is lost

5. In the process of preparing the client for discharge after cesarean section, the nurse addresses all of
the following areas during discharge education. Which should be the priority advice for the client?
A. How to manage her incision
B. Flaming for assistance at home
C. Infant care procedures
D. Increased need for rest

6. The client, who is 12 days postpartum, telephones the clinic and tells the nurse that she is
concerned that she may have an infection because her vaginal discharge has been creamy white for
two days now. Which response by the nurse is correct?
A. “You need to come to the clinic as soon as possible.”
B. “You’ll need an antibiotic; which pharmacy do you use?”
C. “Take your temperature and let me know if it is elevated.”
D. “A creamy white discharge 10 days postpartum is normal.”

7. Twenty-four hours post—vaginal delivery, the postpartum client tells the nurse that she is
concerned because she has not had a bowel movement (BM) since before delivery. Which action
should be taken by the nurse?
A. Document the data in the client’s health care records
B. Notify the health care provider immediately
C. Administer a laxative that has been prescribed pm
D. Assess the client’s abdomen and bowel sounds
8. The RN and the student nurse are caring for the postpartum client who is 16 hours postdelivery.
The RN evaluates that the student needs more education about uterine assessment when the student
is observed doing which activity?
A. Elevating the client’s head 30 degrees before doing the assessment
B. Supporting the lower uterine segment during the assessment
C. Gently palpating the. uterine fundus for firmness and location
D. Observing the abdomen before beginning palpation

9. The nurse is assessing the postpartum client, who is 5 hours postdelivery. Initially, the nurse is
unable to palpate the client’s uterine fundus. Prioritize the nurse’s actions to locate the client’s fundus
by placing each step in the correct sequence.
A. Place the side of one hand just above the client’s symphysis pubis.
B. Press deeply into the abdomen.
C. Place the other hand at the level of the umbilicus.
D. Massage the abdomen in a circular motion.
E. Position the client in the supine position.
F. If the fundus is not felt, move the upper hand lower on the abdomen and repeat the massage.

10. The client delivered a healthy newborn 4 hours ago after being induced with oxytocin. While being
assisted to the bathroom to void for the first time after delivery, the client tells the nurse that she
doesn’t feel a need to urinate. Which explanation should the nurse provide when the client expresses
surprise after voiding 900 mL of urine?
A. “A decreased sensation of bladder filling is normal after childbirth.”
B. “The oxytocin you received in labor makes it difficult to feel voiding.”
C. “You probably didn’t empty completely. I will need to scan your bladder.”
D. “Your bladder capacity is large; you likely won’t void again for 6—8 hours.”

11. When up to the bathroom for the first time after a vaginal delivery, the client states, “A friend told
me that I’m going to have trouble with urinary incontinence now that I have had a baby.” Which is the
best response by the nurse?
A. “That’s not true. You won’t need to worry about this until menopause.”
B. “I will teach you how to do Kegel exercises to strengthen your muscles.”
C. “Wearing a pad similar to a sanitary pad will help contain the incontinence.”
D. “If this occurs, notify your HCP to have surgery to correct urinary incontinence.”

12. The client, who had preeclampsia and delivered vaginally 4 hours ago, is still receiving magnesium
sulfate IV. When assessing the client’s deep tendon reflexes (DTRs), the nurse finds that they are both
weak, at 1+, whereas previously they were 2+ and 3+. Which actions should the nurse plan? Select all
that apply.
A. Notify the client’s HCP about the reduced DTRs.
B. Prepare to increase the magnesium sulfate dose.
C. Prepare to administer calcium gluconate IV-
D. Assess the level of consciousness and vital signs.
E. Ask the HCP about drawing a serum calcium level.
13. The postpartum client delivered a full-term infant 2 days previously. The client states to the nurse,
“My breasts seem to be growing, and my bra no longer fits.” Which statement should be the basis for
the nurse’s response to the client’s concern?
A. Rapid enlargement of breasts usually is a symptom of infection-
B. Increasing breast tissue may be a sign of postpartum fluid retention.
C. Thrombi may form in veins of the breast and cause increased breast size-
D. Breast tissue increases in the early postpartum period as milk forms.

14. While assessing the postpartum client who is 10 hours post—vaginal delivery, the nurse notes a
perineal pad that is totally saturated. To determine the significance of this finding, which question
should the nurse ask the client first?
A. “How often are you experiencing uterine cramping?”
B. “When was the last time you changed your peri-pad?”
C. “Are you having any bladder urgency or frequency?”
D. “Did you pass clots that required changing your peri-pad?”

15. Two hours after the client’s vaginal delivery, she reports feeling “several large, warm gushes of
fluid” from her vagina. The nurse assesses the client’s perineum and finds a large pool of blood on the
client’s bed. Which nursing action is priority?
A. Encourage the client to ambulate to the bathroom in order to empty her bladder.
B. Place two hands on the uterine fundus and prepare to vigorously massage the uterus.
C. Reassure the client that heavy bleeding is expected in the first few hours postpartum.
D. Support the lower uterine segment with one hand and assess the fundus with the other.

16. The oncoming shift nurse assesses the fundus of the postpartum client 6 hours after a vaginal birth
and finds that it is firm. When the nurse then assists the client out of bed for the first time, blood
begins to run down the client’s leg. Which action by the nurse in response to the client’s bleeding is
correct?
A. Explain that extra bleeding can occur with initial standing
B. Immediately assist the client back into bed
C. Push the emergency call light in the room
D. Call the HCP to report this increased bleeding

17. The postpartum client, who is 24 hours post—cesarean section, tells the nurse that she has much
less lochial discharge after this birth than with her vaginal birth 2 years ago. The client asks if this is
normal after a cesarean birth. Which statement should be the basis for the nurse’s response?
A. A decrease in her lochia is not expected; flirther assessment is needed.
B. Women usually have increased lochial discharge after cesarean births.
C. Women normally have less lochial discharge after a cesarean birth.
D. The lochia amount depends on whether surgery was emergent or planned.

18. The nurse is caring for the client who just gave birth. Which observation of the client should lead
the nurse to be concerned about the client’s attachment to her male infant?
A. Asking the caregiver about how to change his diaper
B. Comparing her newborn’s nose to her brother’s nose
C. Calling the baby “Kelly,” which was the name selected
D. Repeatedly telling her husband that she wanted a girl
19. The nurse is caring for the postpartum family. The nurse determines that paternal engrossment is
occurring when which observation is made of the newbom’s father?
A. Talks to his newborn from across the room
B. Shows similarities between his and the baby’s ears
C. Expresses feeling frustrated when the infant cries
D. Seems to be hesitant to touch his newborn

20. The nurse is caring for the postpartum primiparous client who is 13 hours post—vaginal delivery.
The nurse observes that the client is passive and hesitant about making decisions about her own and
her newbom’s care. In response to this observation, which interventions should be implemented by
the nurse? Select all that apply.
A. Question her closely about the presence of pain.
B. Ask if she would like to talk about her birth experience.
C. Encourage her to nap when her infant is napping.
D. Encourage attendance in teaching sessions about infant care.
E. Suggest that she begin to write her birth announcements.

THANK YOU & GOD BLESS!!!