Obst

etr
ical
nur
singr
evi
ewquest
ions

Sit
uation:Youar ewor ki
ngonauni tcaringt
opr enat
alpati
entswithproblems.Mi ssJay ,
16
yearsold,
isadmi t
tedwiththeelevatedBP, i
ncreasedweightgain,andedema.Herdi agnosi
s
i
spr eecl
ampsi a.Ordersincl
udeI&Oev ery4hours,t
emperature,pulseandrespir
ations
every4hour s,
BPanddeept endonr ef
lexes(DTRs)everyhour,andmagnesi um sulf
at e1g
everyhourintr
av enously
.

1.Magnesi
um sul
fat
eisaCNSdepr
essantandshoul
dnotbegi
veni
f:

a.BPi
sel
evat
ed

b.DTRsar
eabsent

c. DTRsar
ebr
isk

d.Shoul
dnev
erbewi
thhel
dforanyr
eason

unb

2.MissJay’
smagnesium sul
fatei
n100mlDSW i
sduetorunouti
n1hour
.The
admini
str
ati
onsethas15gt t
/ml.Howmanydr
opsperminut
ewoul
dyourunt
heI
V?

a.18gt
t/mi
n

b.15gt
t/mi
n

c. 25gt
t/mi
n

d.100gt
t/mi
n

3.MissJayappear
stobeani
mpendingeclampt
ic.Shehascompl
ainedofvi
sual
di
stur
banceandsever
eEpi
gast
ri
cpain.Youwouldobser
vehercl
oselyf
orsignsof
:

a.Sei
zur
e

b.El
evat
edBP

c. Lower
edBP

d.Labor

4.BecauseMissLayis36weeks’pr
egnantandi
ndangerofbecomingeclampti
c.She
del
iver
yisi
nduced.Shedel
i
versa5Lb8oz( 2500g)boyaf
terjust6hoursofl
abor.
Shemustconti
nuetobewatchedforimpendi
ngecl
ampsiaforhowlong?

a.2hour
s

b.1hour
 c. 24hour
s

d.72hour
s

5.Nut
ri
ti
onal
l
y,becauseMi
ssJayi
s16y
ear
sol
d,herneedf
orcal
cium:

a.Woul
dbehi
ghert
hant
hatofamot
her21y
ear
sol
dorol
der

b.Lowert
hant
hatofamot
her21y
ear
sol
dorol
der

c.Thesameasamot
her21y
ear
sol
dorol
der

d.I
sal
way
smeti
nper
sonst
hisage

6.Whi
chwoul
dbet
hebestsour
ceofcal
cium?

a.Cal
cium t
abl
ets

b.Mi
l
k

c. Gr
eens

d.Mul
ti
vi
tami
nD

7.Oneofti
lequest
ionsEl
i
zabethwantstoknowi swhatsubstancei
nheruri
ne
speci
menshowedshewasposi t
iveforpregnancy.Asheri
nstr
uct
oryouwould
expl
aint
hatahormonepresent
sitsel
fatimplantati
onanscanbedet
ectedint
he
uri
newit
hin42daysaft
ertheLMP.Itiscall
ed:

a.Est
rogen

b.Pr
ogest
erone

c. Rel
axi
nhor
mone

d.Chor
ioni
cgonadot
ropi
n

8.El
i
zabet
hwant
stoknowhowoxy
genget
stot
hef
etus,
soy
ouwoul
dshowher
:

a.Achar
toft
heumbi
l
ical
cor
d

b.Achar
toft
hef
etal
cir
cul
ati
on

c. Thatt
heumbi
l
ical
vei
ncar
ri
esoxy
gen

d.Thatt
heumbi
l
ical
art
erycar
ri
esoxy
gen
 9.Eli
zabethi
scur
ioust
oknowwhent
hef
etal
hear
tbegi
nst
ofunct
ion.Yout
ell
heri
tis
usuall
y

a.Byt
het
hir
dorf
our
thweekaf
terLMP

b.Wi
thi
n6weeksaf
teri
mpl
ant
ati
on

c. Byt
hef
ir
stt
ri
mest
er

d.Byt
het
imet
hepl
acent
aisf
ormed

10.Nutr
it
ioni
sanimport
antcomponentofpr
enat
alcar
e,soy
out
eacht
hatt
hepr
imar
y
needfort
hegr
owing,dev
elopi
ngfet
usis:

a.I
ron

b.Pr
otei
ns

c. Vi
tami
nK

d.Cal
cium suppl
ement
s

Si
tuat
ions:
Mrs.Carnil
l
eChar
keisamotherofa5-y
ear
-ol
dson.Herl
astmenstrual
peri
odof
5daysbeganonMay18.Herfir
stpr
enat
alvisi
twasonJul
y22.Herf
irstpr
egnancywas
normali
nallr
espects.

11.Asherpr
egnancyprogresses,
herur
inespecimenoccasi
onal
l
yrev
eal
str
acesof
sugar
.Whati
sy ourassessmentoft
hisfi
nding?

a.Shei
seat
ingadi
ethi
ghi
ncar
bohy
drat
es

b.Shei
sexper
ienci
ngpr
egnancy
-i
nduceddi
abet
es

c. Thi
sispr
obabl
yther
esul
tofabsor
pti
onofl
act
osef
rom t
hebr
east
s

d.Becauseshei
samul
ti
par
a,t
her
eismor
eabsor
pti
onofl
act
osef
rom t
hebr
east
s

12.Cami
l
lewoul
dbecl
assi
fi
edas:

a.Gr
avi
da1par
a1

b.Gr
avi
da2par
a2

c. Gr
avi
da2par
a1

d.Gr
avi
da2nul
l
ipar
a
13.Ifabl
oodtypi
ngshowedMrs.Charket
obeRhnegat
ive,
ther
ewoul
dbeno
compli
cat
ionstot
henewbabyif:

a.Mr
.Char
kewasI
Lianegat
ive

b.Mr
.Char
kewasRhposi
ti
ve

c. HersonwasRhposi
ti
ve

d.Si
tedi
dnotr
ecei
veRhoGAM af
tert
hebi
rt
hofherf
ir
stson

14.TheEDCf
orMr
s.Char
kewoul
dbe

a.Febr
uar
y9

b.Febr
uar
y11

c. Febr
uar
y18

d.Febr
uar
y25

15.Duri
ngdaispr
egnancyCamill
eisexper
ienci
ngsomel
egcr
amps.Yournur
sing
i
nter
vent
ionwouldincl
ude:

a.Adv
isi
nghotcompr
essbi
d

b.I
nst
ruct
inghert
oel
evat
eherl
egsatl
east15mi
nut
es3t
imesdai
l
y

c. I
nst
ruct
ionast
ocause(
excessi
vephosphor
us)andencour
agi
ngdr
inki
ngmi
l
k

d.Adv
isi
nghert
ochewTunasf
orcal
cium

16.Forr
eli
efofherl
owbackpai
ns,
youmi
ghtsuggest
:

a.Si
tzbat
hs

b.Heat
ingpai
l
stoherback

c. Pel
vi
crocki
ngorpel
vi
cti
l
tingexeci
ses

d.Vi
sit
stot
hechi
ropr
act
or

17.Yourassessmentduri
ngCami
l
le’
spr
enat
alv
isi
tsi
ncl
uder
out
ineur
inal
ysi
s,bl
ood
pressur
e,andweight.Why
?
 a.Topr
eventt
oxemi
aofpr
egnancy

b.I
tispar
tofgoodpr
enat
alcar
e

c. Todet
ectdi
abet
es,
highbl
oodpr
essur
e,andedema

d.Becauseshei
samul
ti
par
aandhi
ghr
iskbecausehersoni
s5y
ear
sol
d

18.I
nlooki
ngoverCami
l
le’
schar
tyouseet
hatherhemogl
obi
nis7.Whatdoest
his
meantoyou?

a.Thaty
ourcl
i
enti
sanemi
candneedst
reat
mentsl
at

b.Thatt
hisi
spr
obabl
yduet
oincr
easedbl
oodv
olumeofpr
egnancy

c. Thatt
hismustbeherbasel
i
ne

d.Thaty
oushoul
dgi
veherZt
ractI
nfer
no

19.Shoul
dCami l
lehaveneededtohaveherpr
egnancyconf
ir
med,howwouldyouhav
e
i
nstr
uctedherregar
dingthespeci
menofuri
neyouwouldhaverequi
red?

a.Gi
veav
oidedspeci
mendur
ingherf
ir
stv
isi
t

b.I
nst
ructheronhowt
ogi
veast
eri
l
especi
meni
ntheof
fi
ce

c. Tell
hertowit
hhol
dfl
uidi
ntakedur
ingt
heni
ghtandbr
ingi
nthef
ir
stv
oided
specimeni
nthemorni
ng

d.Acat
het
eri
zedspeci
menwi
l
lber
equi
red

20.Cami
llei
snowinhersevent
hmont
hofpregnancy
,andy
ounot
icet
hatshei
sst
il
l
wear
inghi
ghheel
s,soyouwoul
dadvi
seherto:

a.Av
oidv
enouspr
essur
eint
hel
egs

b.Wearl
owerheel
stopr
eventv
ari
cosev
eins

c. Wearl
owerheel
stoav
oidaddi
ti
onal
backst
rai
n

d.Wearat
hlet
icshoesf
orwal
ki
ng

21.Youar
etaki
ngahist
oryduri
ngCami l
le’
sfi
rstv
isi
t.Whatar
esomeoft
hesi
gnsand
sympt
omsyouaregoingtoassess?
 a.Enl
argementoft
heut
erus

b.Exami
nef
orGoodel
l
’ssi
gn

c. Enl
argementandt
ender
nessoft
hebr
east
s,amenor
rhea,
andf
requency

d.Fet
almov
ement
s,f
etal
hear
ttone,
andst
ati
on

22.Aft
erarev
iewofpr
enat
alcareforcanai
l
le,
youwoul
dincl
udeanadv
isor
ythatshe
not
ifyt
hedoct
orimmediat
ely:

a.I
fsheexper
iencesabdomi
nal
pai
n,di
schar
geofbr
ightr
edbl
ood,
chi
l
ls,
andf
ever

b.Bl
ood-
str
eakedmucus,
Braxt
onHi
cks’
ssi
gn

c. Const
ipat
ion,
urgency
,hemor
rhoi
ds

d.Qui
ckeni
ng,
var
icosi
ti
es,
anddi
scomf
ort

23.MarciaMendesisawor ki
ngmother,r
ecent
lydivorced,andshei sstr
ugglingtokeep
herfamilyt
oget
her.Shehasa4- yearol
dboy, a2-yearoldgir
l,andispregnantwith
herthi
rd.Shei
sat t
endingthepr
enatalcl
ini
catJacobi Hospi
talandinnowi nher
nint
hmont hofpregnancy.Shewantstoknowi fthereisawayt ohelpherwi t
hextra
foodaftert
hebabycomesandasksy ouforinfor
mat ion.Youranswermi ghtbe:

a.Thefoodstampprogr
am wil
lpr
ovi
deadequat
efoodf
ory
ourf
ami
l
y;t
hesoci
al
workerwi
ll
helpyoutoappl
y

b.I
fyouareeli
gibl
e,t
herei
safeder
alsupplementar
ypr
ogr
am t
hatpr
ovi
des
nut
ri
ti
onal
lygoodfoodsf
ory
ouandy ourchi
ldr
en

c. TheWICprogr
am wil
lpr
ovi
depl
ent
yoff
oodf
ory
ou,
youri
nfant
,andchi
l
dren
under5y
earsofage

d.Youshoul
dappl
yforwel
far
eimmedi
atel
y

Si
tut
aion:Normal laboranddel i
very.Virgi
niaBauerhasbeenadmi tt
edinacti
velabor.
Admissi
onnot es:primipar
a,aged33y ears,excel
l
enthealt
h.Lamazemot her,
well
pr
epared.I
nit
ialexami nati
on:7cm di l
ated,75%ef f
aced,0stat
ion,membranesintact
.
Cont
racti
onsq2mi n,ver
ystrong,considerablebl
oodyshow.Tol er
ati
ngpainwell
.
Rout
inehospitalprocedurescompl eted.

24.Dr
.Sonohasjustr
upt
uredt
hemembr
anes.Yourpr
imar
yresponsi
bil
i
tyast
he
at
tendi
ngnur
seisto:
 a.Cl
eanupaf
tert
hepr
ocedur
e

b.Not
ethet
imeoft
hepr
ocedur
e,col
or,
odor
,ot
herper
ti
nentdat
a

c. Char
tthedoct
or’
snameandt
hepr
ocedur
edone,
signy
ournamei
sful
l

d.Hol
dcl
i
ent
’shand,
reassur
eher
,changet
hebed

25.Iti
simpor
tantthatyouasthelaborr
oom nur
seencour
ageMr
s.Bauert
ovoi
dand
avoi
daful
l bl
adder,
therat
ionalebei
ngt
hat:

a.Af
ull
bladderdur
ingl
abormaycausepost
par
tum hemor
rhage

b.I
tmaycausear
upt
ureoft
hebl
adderdur
ingdescentoft
hehead

c. I
tmaycausecy
sti
ti
s

d.Mayi
mpedet
hepr
ogr
essofl
abor

26.Mrs.Bauer,
whohasbeenbusycoachingMrs.Bauer ,sayst
hathiswif
eisgrunti
ng
andsaysshewantst
opushDr.Sonoexami nesVirginiaandsayssheiscomplete,
so
yougointother
oom t
ohel
pMr s.BauerassistVi
rginiatobeardowncorrect
ly:

a.Headback,
armsf
orwar
d,hi
psback,
li
pscl
osed,
andpushdown

b.I
nhale,
headup,pushdownt
owar
danus,
headonchi
n,el
bowsout
,pusht
ocount
of10pelv
ict
il
thelps

c. Spr
eadl
egsapar
t,t
akedeepbr
eat
h,andbeardownwhi
l
eexhal
i
ng

d.Pantandbl
owunt
ilt
hef
etusi
sdel
i
ver
ed

27.Aft
erthepl
acent
aisdeli
ver
edandt hesut
uri
ngcomplet
e,y
ounoti
cet
hatVi
rgini
ais
begi
nningt
oshiver
.Youquickl
ygetsomewarm bl
anket
stocov
erher
.Thereason
whysheprobabl
yisshi
veri
ngis:

a.Thesuddenemptyi
ngoft
heuter
inecontents,pl
ustheretur
nofthebody
chemist
ryandhor
monestot
hepr e-
pregnantstat
e,causesacer
tainshockt
othe
syst
em

b.Lossofbl
ood,lengt
hofl
abor
,andacer
tai
nti
rednesscauset
hel
ower
ingoft
he
bodytemper
ature;t
hewar
m bl
anket
swil
lhel
p

c. Pitoci
nisgi
venaf
terthedel
i
ver
yoft
hepl
acent
aandmaycauset
hebodyt
o
respondbyshi
ver
ing
 d.Theshiv
erisanor
malreact
ion,si
nceshehasbeeninacol
ddel
i
ver
yroom,
swal
lowingi
cechi
ps,
andonl ycover
edwit
hathinsheet

28.Thegreat
estcomf
orty
oucangi
veVi
rgi
niaoranywomani
nlabori
stoassur
eher
that
:

a.Herpr
ogr
essi
snor
mal

b.Thatshewi
l
lnotbel
eftal
one

c. Thatherdoct
ori
sint
hebui
l
ding

d.Thatshewi
l
lbeabl
etohol
dthebabyaf
terdel
i
ver
y

Situati
on:KathyandGeor geConehav eat t
endedpr i
vatepsychopr ophyl
acticLamaze
classes.Botharelookingfor
war dtothei rf
irstbaby.Laborhasst artedathome, and
bot hKathyandGeor gehavemanagedf or3hour sdoingsimplebr eathi
ng.Asudden
shar ppainmadeKat hygaspforbr eath.Shehadbeadsofper spirationonher
forehead,becomeal mostashen, col
dandcl ammy .Georgenoticedal sothatKat hy
’s
abdomenwasr i
gidandboardlike.Fri
ghtened, hecall
edthedoct or,whoor deredhim
togot othehospitalimmediatelyandaddedt hathewoul dbether ewaiti
ngf orthem.

29.GeorgeandKathyarr
iveatt
hehospit
alminutesl
ater
,andyouaret
headmi
tt
ing
obstet
ri
calnur
se.Themostli
kelycompl
icat
ion,j
udgi
ngfrom t
hesympt
oms
descri
bed,
wouldleadyoutosuspect
:

a.Lowmar
ginal
placent
apr
evi
a

b.Appendi
cit
is

c. Pr
emat
uresepar
ati
onoft
hepl
acent
a

d.Rupt
ureoft
heut
erus

30.Geor
getel
lsyouhecannotunderst
andwhyKathyl
ookssopal
eandweakwhent
her
e
i
snosigni
fi
cantbl
eed.Yourbestanswerwoul
dbeanexpl
anat
iont
hat
:

a.Thebl
eedi
ngi
sal
li
nter
nal
.Per
hapsy
oushoul
dli
neupsomebl
ooddonor
s.

b.Inthiscondi
ti
on,shockisoutofpr
opor
ti
ont
obl
oodl
oss,
butwear
ewat
chi
ngher
closelyandwil
lnotleav
eherbedsi
de.
 c. I
tisagoodsi
gnt
haty
oucan’
tseemuchbl
eedi
ng

d.Asyoucanseewear
edoi
ngev
ery
thi
ngt
otr
eatt
heshock;
sheshoul
dbecomi
ng
outofi
tsoon.

31.Thedoctori
schecki
ngKathy
’sbloodq15mi nutes.Heisdoi
ngthi
sint
her
oom.Mr
.
Coneasksyouwhatthedoct
orisdoing.Yourbestanswerwoul
dbe:

a.“
Askt
hedoct
ory
our
sel
f.
”

b.“
Doy
ouwantmet
oaskt
hedoct
orf
ory
ou?
”

c. “Heischecki
ngthefi
bri
nogenlev
eltodet
erminet
hestat
usofthecl
ott
ingf
act
or
d.“Heisfi
ndi
ngoutwhetherheshouldgi
veherabloodt
ransf
usi
onorwhet
her
heshoul
doperat
e.”

d.?

32.Asthenurseresponsibl
eforobt
aini
ngequi
pmentf
ort
hedoct
or,
youwoul
dqui
ckl
y
pr
eparethedeli
veryroom for
:

a.Acesar
eansect
ion

b.Anat
ural
vagi
nal
del
i
ver
y

c. Adoubl
eset
up

d.Apr
eci
pit
atedel
i
ver
y

33.Kathy’
spainhassubsidedasquicklyasitstar
ted,andsheisl aughi
ngandt el
li
ngt he
doctorshecannotbeli
evewhatjusthappened.Shepr ogr
essesv erywellanddeliv
ers
ababygi r
l,Apgarscor
e9-10.Bat
hmot herandbabyar ef
ine.Afterthedeli
ver
y,the
doctorsayshewoul dl
iketoexaminetheplacentamor et
hor oughly
.Why ?

a.Thepl
acent
awi
l
lrev
eal
atearwher
etheor
igi
nal
abr
upt
ionoccur
red:

b.Thepl
acent
awi
l
lcl
ear
lyshowcal
cif
iedar
east
hatcausedt
hepr
obl
em.

c. Thepl
acent
awi
l
lbemuchheav
ieri
nwei
ghtt
hannor
mal

d.Thepl
acent
awi
l
lbesentt
othel
abor
ator
yforf
urt
heranal
ysi
s.
 Situati
on: OlgaNabor ,30y earsol
d,isadmi t
tedtothehospi
tal
inearl
ylabor.Gr
avi
da
IVpar aII
;pelv i
cmeasur ement snormal;contr
acti
onsevery7minut
esand45
seconds; membr anesintactlef
tsacrum posteri
orexami
nati
onbymi dwif
e;FHT136
regular;
phy sici
an’sorders:prepar
ef ordeli
very
,soapsudsenema,watchBOW; at
signsoff et
al distr
ess,notif
ystat.

34.Thedoct
orhasaskedyout
ocheckedthef
etalhear
trat
ewi
thaf
etoscope.Youknow
thatt
hebestl
ocat
iont
oheart
hefetal
hear
tbeatis:

a.Abov
etheumbi
l
icus

b.Bel
owt
heumbi
l
icus

c. Upperr
ightquadr
ant

d.Upperl
eftquadr
ant

35.Whi
choft
hef
oll
owi
ngf
act
orswoul
dinv
okey
out
ocal
lthedoct
orst
at?

a.Meconi
um i
ntheamni
oti
cfl
uid

b.Nopal
pabl
emov
ementoft
hef
etus

c. Spont
aneousr
upt
ureoft
hemembr
anes

d.Fet
alhear
trat
eof90

Sit
uati
on:Mr s.Downs,gr
avidI
Ipar
aI,
isbroughttot
helaboranddel
iver
yuni
tper
ambulance(stret
cher
).Deli
ver
yisi
mminent,andshei
sbearingdown.Youar
ethe
nurseadmit
tingher:

36.Witht
henextcontr
act
ionMrs.Downsdel
i
versa7lb8oz( 3400g)babygi
rl
spont
aneousl
y.Youar
esti
ll
alone,soy
oufir
str
esponsi
bil
i
tyisto:

a.Ascer
tai
nwhet
hert
hef
undusi
sli
kel
ytohemor
rhage

b.Est
abl
i
shanai
rwayf
ort
hebabybymi
l
kingt
het
racheaandmai
ntai
ningt
hehead
l
owert
hant
hebody

c. Qui
ckl
yti
eandcutt
heumbi
l
ical
cor
d

d.Lookfort
heut
erust
ori
se,
whi
cht
heper
ineum f
orat
ri
ckl
eofbl
ood,
anddel
i
ver
thepl
acent
a
37.Thedoct orarriv
esafterthebabyisdeli
v er
ed,exami nesthebaby,thenexami nesthe
mother.Hehasherwheel edi
ntoadelivery,r
oom, wherehedeliversthesecundines
i
ntact.Her eexaminesthemot heri
nternall
y,ordersoxytoci
n(Pit
ocin)IM, andstart
s
anIVwi t
hapi ggybackofanant i
biot
ic.SinceMr s.Downhadapr ecipi
tousdeliv
ery,
yournursingresponsibil
i
tywouldbet o:

a.Wat
hfori
nfi
l
trat
ionoft
il
eIVanobser
vef
orant
ibi
oti
creact
ion

b.Wat
chf
orexcessi
vebl
eedi
ngorsi
gnsofhemor
rhage

c. Ant
ici
pat
eMr
s.Downs’
legsshaki
ngandchi
l
ls

d.Watchforsuddenelev
ati
onoft
emper
atur
easaf
orer
unnerofani
nfect
ionor
i
nfect
iousprocess

38.Si
ncethedel
iver
yist
ermednonst
eri
l
ebi
rt
h(NSB)
,yourr
esponsi
bil
i
tiesast
he
emer
gencyroom nur
sewil
li
ncl
ude:

a.Checki
ngt
hecor
d,t
heApgarscor
e,maki
ngI
dent
ibandsasf
oranor
mal
del
i
ver
y

b.I
nformingthenur
seryofti
lebaby’
sstatussot
heywill
observepredesi
gnat
ed
hospi
talpr
ecauti
onsfordeli
ver
iesper
formedout
sidethehospi
tal

c. Or
der
inganant
ibi
oti
cbecauseoft
heci
rcumst
ancesofbi
rt
h

d.Pl
aci
ngt
hebabyi
nanI
sol
ett
eforobser
vat
ion

39.Afteraparti
cul
arl
ystormylabor,posteriorpresentati
on,sev
er ebackpains,nausea,
andv omit
ingduri
ngtransit
ionanddi ff
icult
,pushing,MaryAnder sondel
ivereda9
pound14ouncebabyboy .Thepl acentawasnoty etdeli
ver
edwhensuddenl yMary
start
edtohemor r
hagepr of
uselyf r
om thev aginalori
fi
ce.Withinminut
esy ousee
bl
oodt ri
ckli
ngfr
om hernosear idmout h.Whatcany oudot ohelpinall
eviati
ngthis
conditi
onthedoctorhaslabeledasDI C?

a.Call
thelabor
ator
y,forbloodrepl
acement(
freshwhol
ebl
ood)and,
assi
stt
he
doctort
odeli
verti
leplacent
aasquickl
yaspossibl
e

b.Prepar
eal lnecessary
,equipmentf
orpossibl
ebloodr epl
acement,getextr
aIV
polesforpossiblefi
bri
nogenandhepari
nadmi nist
rat
ionifor
dered,getextr
a
warm blanketsforbothfet
usandmot her
,moni t
orbloodpressur
e,prepare
dressi
ngsasnecessar y

c. Appl
yfundal
pressur
etohel
pdel
i
vert
il
epl
acent
ast
at

d.Hol
dpat
ient
’shandandr
eassur
eher
40.Mrs.GwenAmor ai
saprimi
para.Shehaspassedherduedateby2weeks.Sheis
apprehensi
veanddoesnotknowwhyshewasi nst
ruct
edtocomeinf
orat est
.She
appearsconfusedandbewi
l
dered.Howcany ouhelpher?

a.Toeaseherdist
ressyoucoul
dengageheri
ntr
ivi
alconv
ersat
ionr
egar
dingt
he
weat
her,
currentsty
les,
andthel
i
ke

b.Explai
nthatshewil
lbepl
acedonamoni torfor20minutestoanhourtoseei
f
herbabyrespondst
oherdri
nkingwaterortogentl
eexternalpr
essur
ebythe
nurseonherabdomen.Theprocedur
eiscalledanonstr
esstest

c. Tel
lGwenshemayhav
etohav
eanOCTatl
aterdat
ebutt
hati
tisi
nci
siv
e

d.Tel
lhermanypeopl
ear
eof
tenpastdue,
andshepr
obabl
ymi
scal
cul
atedher
dat
es

41.I
fGwenisover35y
ear
sofage,
herbl
oodshoul
dhav
ebeent
est
edear
li
eri
nher
pr
egnancy
,for
:

a.Gest
ati
onal
diabet
es

b.Al
pha-
fet
opr
otei
nlev
elt
oident
if
y,hi
gh-
ri
semot
her
sandpossi
blef
etal
probl
ems

c. Het
erozy
got
etest
ingf
orr
ecogni
zedgenet
icpr
obl
ems

d.Est
ri
oll
evel
sforf
etal
wel
l
-bei
ng

42.Asy ouwatchedti
memoni t
orduri
nganOCTpr ocedureonGweny ounot
edatl
east
thr
eelatedecel
erat
ionsdur
ingatl
eastt
hreecontract
ions.Whatwoul
dyoudo?

a.Thi
sindi
cat
esaposi
ti
vet
est
.SoIwoul
dcal
ltheheadnur
sei
mmedi
atel
y

b.Thi
sisnotaposi
ti
vet
est
,soIwoul
dwai
tunt
ilt
hepat
ter
nchanged

c. Iwoul
dst
opt
hePi
toci
nandadmi
nist
ernasal
oxy
gen

d.Wheel
heri
ntot
hedel
i
ver
yroom f
ori
mmedi
atedel
i
ver
y

43.Atherage(
over55y
earpl
us)Gwenwoul
dundoubt
edl
ybecl
assi
fi
edas:

a.Agoodcandi
dat
eforanor
mal
pregnancyanddel
i
ver
y

b.Ahi
gh-
ri
skcl
i
entf
orpr
egnant
c. Acandi
dat
eforecl
ampsi
a

d.Agr
anmul
ti
par
a

44.Youwoul
dexpl
aintoGwent
hatt
heOCTt
esti
sani
nvasi
vet
estbecausemedi
cat
ion
i
sgiv
eninthev
einsand:

a.I
suncomf
ort
abl
eforashor
twhi
l
e

b.I
snotpai
nful
atal
l

c. Wi
l
ltakeaf
ewmi
nut
est
ocompl
ete

d.I
sar
out
inepr
ocedur
eforal
lpr
egnantwomen

45.I
fGwenwer
etr
ulyov
erdue,
hernewbor
nbabymayhav
e:

a.Pol
ydact
yly
,phocomel
i
a,andj
aundi
ce

b.Desquamat
edpal
msofhandsandsol
e~oft
imef
eet

c. Ov
erwei
ght
,meconi
um-
stai
nedamni
oti
cfl
uid

d.Noneoft
imeabov
e

Situat
ion:Gerr
iFyourpostpar
tum pati
ent
.Thi
sisherthir
dday
,andshecompl
ains
thatherleftl
egaches.Younoti
ceitiswarmtothetouch.

46.Whatshoul
dyoudowhi
l
eawai
ti
ngt
hear
ri
val
oft
hedoct
or?

a.Appl
yicebagst
othel
eg

b.Appl
yheatt
othel
eg

c. Exer
ciset
hel
egv
igor
ousl
y

d.El
evat
ethel
egonpi
l
lows

Sit
uat
ion:BabyJoec.
,3daysold,ver
texdeli
ver
y,10lb2oz( 4500g) ,
fourt
hbabyofMr.
andMr s.
C.,
hasacondit
ionoft
endescr i
bedaspathologi
cjaundice.Hisscl
erai
syel
l
ow,
hi
sbil
irubi
nindexi
s17,andhei snotnursi
ngwell.

47.I
fBabyJoe’
sbi
l
irubi
nindexcont
inuest
ori
se,
youwoul
d:
 a.Tellt
heot
herthebabywi
ll
probabl
yneedanexchanget
ransf
usi
onandpl
ana
teachi
ngmoduleofpr
osandcons

b.Pr
epareuni
tforpossi
bleexchangetr
ansf
usi
onpr
ocedur
e;obt
ainsuppl
i
es,
rev
iew
pr
ocedur
e,waitf
ordoctor’
sorders

c. Placethebabyunderbi
l
l-l
i
ghtf
orl
ongerper
iodsoft
ime;
off
erwat
erev
ery2hour
s
unti
ljaundi
cebegi
nstofate

d.Suggestt
hatf
ami
l
yal
lhet
est
edf
orpr
operbl
oodt
ype

Sit
uation:Whenadmi ttedtothehospit
al,Mrs.Sweeneyseemedal ertandcalm.She
couldnotrecallanyt
hingthathadhappenedsi ncenoon.Iti
snow3PM.Mr .Sweeney
saidhiswife.38weeks’ pr
egnant ,
hadbeenbot heredbyheadachesand“ bl
indspots”
foraboutaweek.Shegotupi nt hemorni
ng, complaini
ngofseverepainintheupper
abdomen, thenhadaconv ulsionaboutnoon.Mr .Sweeneydidnotreali
zethisunti
l
l
ater;hethencalledthedoctorwhot ol
dhimt otakehi swi
fetothehospitalstat
Admi t
tingrecor
d:

BP190/
112 Cer
vixel
faced,
dil
ati
on3cm

Al
bumi
n4+ Pr
esent
ingpar
t:st
ati
on0

FHT140st
rong Membr
anesi
ntact

48.Astheadmit
ti
ngnur
seonmat
erni
ty,
appr
isedoft
hesi
tuat
ion,
youwoul
dpl
aceMr
s
Sweeneyi
n:

a.Asemi
pri
vat
eroom wi
thpl
ent
yofsunl
i
ghtandai
r

b.Asemi
pri
vat
eroom,
dar
kenedandqui
et;
rest
ri
ctedv
isi
tor
s

c. Asi
ngl
e,dar
kenedr
oom,
nov
isi
tor
s,cl
oset
onur
sesst
ati
on

d.Si
ngl
eroom,
plent
yofsunl
i
ght,
nov
isi
tor
s,awayf
rom st
ati
on

49.Thesy
mptom exper
iencedbyMrs.Sweeneyt
hati
sof
tenconsi
der
edawar
ningsi
gn
ofani
mpendi
ngconv ul
sioni
nthetoxi
cmotheri
s:

a.Headache

b.Sev
ereepi
gast
ri
c

c. Scot
oma

d.Puf
fyf
ace
50.Thedoct
ori
sgi
vi
ng50%magnesi
um sul
fat
eIV,
whi
chy
ouknowwi
l
l:

a.Reducepul
ser
ate

b.St
imul
atel
aborcont
ract
ionssol
aborwi
l
lpr
ogr
ess

c. Reduceedemaont
hebr
ainandr
educeCNSsy
mpt
oms

d.I
ncr
easeper
ist
alsi
stor
eli
eveepi
gast
ri
cpai
n

51.Howwoul
dyouexpl
ainnat
ural
chi
l
dbi
rt
heducat
iont
opar
ent
s?

a.“I
tisamet
hodf
reef
rom t
heuseofdr
ugsdur
ingl
aboranddel
i
ver
y”

b.“Basi
call
y,i
tisprepar
ati
onforl
aboranddeli
ver
ybyt eachi
ngrel
axat
ionexerci
sesand
breat
hingexerci
sestobeusedduri
ngpregnancy,
labor,del
iv
ery
,andpostpart
um.”

c. “I
tpreparesyoungcoupl
estobegoodpar
entsbyt
eachi
ngaboutnewbor
ns,
nut
ri
ti
on,
exer
cises,l
aboranddeli
ver
y,andchi
l
dcar
e.”

d.“
Iti
spr
epar
ingtohaveyourbabyi
nasnat
ural
aset
ti
ngasy
oucan,
freef
rom noi
se,
i
naqui
etenvi
ronmentwit
hsoftmusi
c.

52.Classesi
npsychopr
ophy
lat
icorLamazemet
hodofnat
ural
chi
l
dbi
rt
heducat
ionar
e
usuall
ybegun:

a.Assoonast
hepr
egnancyi
sdi
agnosed

b.Shor
tl
yaf
terqui
ckeni
ng

c. Af
terl
i
ght
eni
ng

d.6t
o8weeksbef
oreEDC(
expect
eddat
eofconf
inement
)

Sit
uati
on:Fr
edandAmyHaasewi shtohavechil
dren.Theyhav
ebeenmar
ri
ed5
yearsandhavenodemonst
rabl
ephysical
defect
s

53.AmyhasreadthatallI
UDsaredanger
ousandarebei
ngrecal
led.Shesaysshe
knowssev
eralfr
iendswhoareusingt
hem andwonder
sifsheshouldaler
tthem.
Whatwoul
dy ousaytoher?

a.“
IUDsof
tencausepel
vi
cinf
lammat
orydi
sease.
”

b.“
Onl
ytheDal
konshi
eldhasbeenr
ecal
l
ed;
othert
ypesofI
USsar
est
il
lusedwi
than
 80%orhighersuccessr
ate.Ther
ear
eot
heropt
ions,
howev
er.Woul
dyoul
i
kemet
o
tel
lyouaboutthem?”

c. “
Ther
ear
eot
heral
ter
nat
ivest
oIUDs.Woul
dyoul
i
kemet
oexpl
oret
hem wi
thy
ou?
”

d.“
iti
snoneofy
ourbusi
nesswhatot
herpeopl
euse.
”

54.BothAmyandFredwishtoknowaboutrhyt
hm orsaf
emethodofcont
racept
ion,
eventhought
hei
rpr
oblem i
sfer
ti
li
tyandnotfami
lypl
anni
ngper
use.Youwouldteach
tem t
hat:

a.I
nvestigat
ionsbyt
hewomanandherhusbandt
odet
ermi
net
het
imeofov
ulat
ionar
e
necessary

b.Abst
inencefr
om coi
tusf
or10day
sbef
oreandaf
tert
hecal
cul
ateddat
eofov
ulat
ion
i
simperati
ve

c. Arecor
dofhermenst
rual
cycl
eforatl
east3mont
hsi
snecessar
ybef
orei
nit
iat
ing
t
hemet hod

d.Regul
ar30day
smenst
rual
cycl
esar
enecessar
yfort
hemet
hodt
obeusef
ul

Situati
on: Marydeli
ver
edherf i
rstbaby
,aboy ,severalhoursago.Shehasbeen
admi tt
edt oherpostpar
tum room inst
ablecondi ti
on.Shei seuphori
cov erher
successf uli
mpl ement
ati
onoft heLamazet echniques.Youf i
ndheruterusfir
m,
sl
ight l
yabovet heumbil
icus.Shehassaturatedonepadwi thredlochi
a.Her
episiotomyappear scl
ean,butherlabi
aandper inealareaareswollenandslight
ly
blackandbl ue.

55.Youf
ir
stpr
ior
it
yinnur
singcar
ewoul
dbe:

a.Toappl
yani
cegl
ovet
otheper
ineal
area

b.Tomessageherut
erussoi
twi
l
lgodownbel
owt
heumbi
l
icus

c. Toadmi
nist
erat
ransqui
l
izersi
nceshei
ssoeuphor
ic

d.Towat
chf
orhemor
rhagesi
nceherl
ochi
aissor
ed

56.Post
partal
nursi
ngcareforMarywil
li
ncludeteachi
ngofsev
eral
procedur
es.An
i
mportantonethatshoul
dbetaughtr
ightawayis:

a.Per
ineal
car
e
 b.Br
eastcar
e

c. Howt
ogi
vet
hebabyabat
h

d.Howt
ohol
dandbubbl
ethebaby

57.
Mrywantst
oknowwhenshecal
lnur
seandi
sanxi
ousf
orhermi
l
ktost
art
.What
canyout
ell
her
?

a.“
Asky
ourdoct
or.

b.“Yourbabywi l
lbebr
oughtt
oyoufort
henextf
eedi
ngti
me.Yourmil
kwil
lprobabl
y
startr
ightaft
erthat
.
c.“Weencour ageyout
onurseassoonasy
oucan.Yourmil
kwil
lpr
obabl
ystarti
n
about3day s.

d.“
Thebabycannurseanyt
imeaf
terbir
th,andaf
tery
ourcol
ost
rum i
sgone(
3to4
day
s),
ourmil
kwillcomein(5t
o6day s).

Situati
on:Lamaze-i
nstruct
edmot her,
Mrs.Davi
d,pri
mipara,i
snowt ell
i
ngy oushe
feelsli
kepushing.Thedoctorexaminesherandsaysshei s10cm di
lated,
100%
effaced,wit
hthefetalheadatstati
on0.Shehashadal otmor ebl
ood,showi nthe
l
asthour ,andshestatesshewant stousethebedpan.

58.Yournur
singcar
ewoul
dbe:

a.Get
ti
ngherr
eadyt
obet
ransf
err
edt
othedel
i
ver
yroom st
at

b.Assist
inghertoheardowncor
rect
lydur
inghercont
ract
ionsunt
ilaquar
ter–si
ze
partofthecaputi
sshowing

c. Pr
epar
ingt
ocat
het
eri
zehersi
nceshef
eel
sli
keusi
nghebedpan

d.Tot
ell
hert
orel
ax;
thebabywi
l
lbebor
nin5mi
nut
es

59.Mr
.Davidisworri
edthatt
heincr
easedshowi
sawar
ningofandi
mpendi
ng
hemor
rhage.Yourbestanswerwoul
dbe:

a.Toreassur
ethefatherbyr
evi
ewinghowbl oodyshowdevel
ops(
sincehehas
beenLamazetrai
ned)andthenormalsequenceofprogr
ess

b.Cal
lthedoct
orst
art
oexami
net
hemot
heroncemor
eforpossi
bleabr
upt
ion
 pl
acent
ae

c. Takebl
oodpr
essur
eandr
epor
tanychanges

d.Appl
yext
raper
ineal
padst
otheper
ineum

60.Thef
irstor
gani
zat
iont
odi
ssemi
nat
emat
eri
alsonbi
rt
hcont
rol
int
heUni
tedSt
ates
was:

a.Sheppar
dTowner(
Congr
essoft
il
eUni
tesSt
ates)

b.Pl
annedPar
ent
hoodOr
gani
zat
ion

c. Mar
gar
etSangerResear
chBur
eau

d.TheChi
l
dren’
sBur
eau(
Uni
tedSt
atesgov
ernment
alagency
)

61.Accor
dingtot
hehist
oryofmaterni
tycar
eintheUnit
edStat
esthesi
ngl
egr
eat
est
det
err
enttomater
nalcompl
icati
ons,par
ti
cul
arl
ytoxemi
a,hasbeen:

a.Di
scov
eryanduseofant
ihy
per
tensi
vedr
ugs

b.Goodpr
enat
alcar
e

c. Theadv
ocat
ionofsal
t-
fr
eedi
et

d.Theageofmot
her

62.Int
heprenatalcli
nicyouobser
veMr s.EdwardsbeingexaminedbyDr .Jones.He
says,
“Hmm, yourut er
usi
satthelevelofyourumbili
cus.“Aft
ertheexami nat
ion,
Mrs.
Edwardsasksy ouwhatthedoctormeantbyt hatst
atement.Yourbestanswerwould
be:

a.“
Itmeansy
ouhav
ejustpassedy
ourf
ir
stt
ri
mest
eroft
hepr
egnancy
.

b. “Youar
eappr
oxi
mat
elyi
nyoursi
xthmont
hofpr
egnancy
.

c. “
Youshoul
dbef
eel
i
ngy
ourbabydr
opsoon.

d.“
Youar
eabout6weeksf
rom del
i
ver
ynow”

63.Rochel
leBrownwasdi agnosedashav i
ngcontract
edAIDSfrom shari
ng
cont
aminatedneedleswithherhusband,Wil
l
ie.TheyhaveonechildJason,15
months,whom hermot heri
stakingcar
eof.Shehasjustdi
scoveredthatsheis5
monthspregnant
.InordertoguideandhelpRochell
eandherhusband, whatshoul
d
 y
ouknowaboutAI
DS?

a.I
tisahi
ghl
ycont
agi
ousdi
seasesocl
i
ent
smustbei
sol
ated

b.Iti
sli
kel
ythatherunbor
nchi
l
dwi
l
lbei
nfect
edwi
tht
heHI
Vvi
rusandmayhav
ea
short
enedli
feexpect
ancy

c. I
tisunl
i
kelyt
hatherunbor
nchi
l
dwi
l
lbei
nfect
edandmayexpectt
oenj
oya
nor
malli
fe

d.Readal
lyoucanboutt
heet
iol
ogyoft
hedi
sease

64.DuringRochel
le’
sstayinthel
aboranddeliver
yarea,whatpr
ecaut
ionswouldy
ouasa
nurse,f
amili
arwiththeAI
DSprotecti
veproceduresoutl
i
nedbytheCenter
sfor
DiseaseControl
,useini
mplementingyournursi
ngcare?

a.Maskeandgl
oveswi
thbl
oodandbodyf
lui
dpr
ecaut
ionsf
orcar
ingf
ort
henewbor
n
andthemot
her

b.Gl
oveswi
thbl
oodandbodyf
lui
dpr
ecaut
ionsf
orcar
ingf
ort
hemot
herandbaby

c. Gown,
mask,
andgl
oveswi
thbl
oodandbodyf
lui
dpr
ecaut
ions;
dur
ingl
aborand
del
i
ver
y

d.Rev
ersei
sol
ati
ont
echni
queswhencar
ingf
orAI
DSi
nfect
edcl
i
ent
s

65.I
fyouasthenursecar
ingf
orRochel
l
e,ar
epr
egnant
,whatshoul
dyouknowabout
y
ourvul
nerabi
l
ity?

a.Youar
eatagr
eat
err
iskofcont
ract
ingt
heHI
Vvi
rus

b.Nur
sesar
enotknownt
obeatgr
eat
err
iskofcont
ract
ingt
heHI
Vinf
ect
ion

c. St
ri
ctadher
encet
opr
ecaut
ionswi
l
lnotpr
otecty
ouf
rom cont
ract
ingt
hei
nfect
ion

d.AnHIVinf
ect
iondur
ingpr
egnancywi
l
lputt
hei
nfantatr
isk,
sodonotcar
efor
Rochel
l
e.