Menstrual Cycle

1. Which hormone stimulates the development of the ovum?

a. Follicles stimulating hormone (FSH)
b. Human chorionic gonadotropin (hCG)
c. Luteininzing Hormone (LH)
d. Gonadotropin Releasing Hormone (GnRH)
2. Which of following is TRUE regarding the proliferative phase of the endometrial cycle?
a. increased blood supply and secretions on the inner lining of uterus
b. changes is due to hormone produced by the corpus luteum
c. it occurs after the ovulatory phase of ovarian cycle
d. estrogen stimulates thickening of the endometrium
3. If conception fails to occur, menstruation takes place about 2 weeks after ovulation as a result of:
a. Increased progesterone and estrogen levels
b. Stimulation of the graafian follicle
c. Collapse of graafian follicle
d. Regression of corpus luteum

Fertility
4. You are assessing the health history of the male partner. Which of the following data is most likely to be related
to an infertility problem?
a. 30 years of age.
b. Employment as a taxi driver.
c. Intercourse approximately every third day.
d. Jogs frequently
5. Another client named Lilia is diagnosed as having endometriosis. This condition interfere with fertility because
a. Endometrial implants can block the fallopian tubes
b. The uterine cervix becomes inflamed and swollen
c. The ovaries stop producing enough estrogen
d. Pressure in the pituitary glands leads to decreased FSH levels
6. Lilia is scheduled to have a hysterosalphingogram. Which of the following instructions would you give her
regarding this procedure?
a. She will not be able to conceive for 3 months after the procedure
b. The sonogram of the uterus will reveal any tumors present
c. Many women experience mild bleeding as an after effect
d. She may feel some cramping when the dye is inserted

Fertilization and Fetal Structures

7. Alvie, a 25 year-old primigravida is on her second trimester. She and her husband asks the nurse about fetal
growth and development. Alvie asks how much longer will the Nurse refer to the baby inside her as an embryo.
What would be your best explanation?
a. her baby will be a fetus as soon as the placenta forms
b. from the time of implantation until 5-8 weeks, the baby is an embryo
c. After 20th week of pregnancy, the baby is called a zygote
d. this term is used during the time before fertilization
8. The client asks the nurse to specifically describe the process through the umbilical cord. The best response from
the nurse is which of the following:
a. “The one artery carries freshly oxygenated blood and nutrient- rich blood back from the placenta to the
fetus.”
b. “The two arteries carry freshly oxygenated blood and nutrient- rich blood back from the placenta to the
fetus.”
c. “The two arteries in the umbilical cord carry blood that is high in carbon dioxide and other waste products
away from the fetus to the placenta.”
d. “The two veins in the umbilical cord carry blood that is high in carbon dioxide and other waste products away
from the fetus to the placenta
9. Lea is worried that her baby will be born with congenital heart disease. What assessment of a fetus at birth is
important to help detect congenital heart defect?
a. determining that the color of the umbilical cord is not green
b. assessing whether the umbilical cord has two arteries and one vein
c. Assessing whether Wharton’s jelly of the cord has pH higher than 7.2
d. measuring the length of the cord to be certain that it is longer than 3 feet

Contraceptive Methods
10. A 20-year-old nulligravid client expresses a desire to learn more about the symptothermal method of family
planning. Which of the following would the nurse include in teaching plan?
 a. This method has a 50% failure during the first year of use.
b. Couples must abstain from coitus for 5 days after the menses.
c. Cervical mucus is carefully monitored for changes.
d. The male partner uses condoms for significant effectiveness.
11. After instructing a 20-year-old nulligravid client about side effects of oral contraceptives, the nurse determined
that further instruction is needed when the client states of the following as a side effect?
a. Weight gain.
b. Nausea.
c. Headache.
d. Ovarian cancer.
12. Before advising a 24-year-old client oral contraceptives for family planning, the nurse would assess the client for
signs and symptoms of which of the following?
a. Anemia.
b. Hypertension.
c. Dysmenorrhea.
d. Acne vulgaris.
13. A 25-year-old client who is taking oral contraceptive pills reports that she experiencing the chest pain and
shortness of breath. The nurse should instruct the client to:
a. Assure the client that those are expected side effects of the pills
b. Go to the nearest hospital for to be evaluation
c. Inform the doctor on her next medical check up
d. Take over-the-counter analgesics

14. A 22-year-old nulligravid client tells the nurse that she and her husband have been considering using of condoms
for family planning. Which of the following instructions would the nurse include about the use of condoms as a
method of family planning?
a. Using a spermicide with the condom offers added protection against pregnancy.
b. Natural skin condoms protect against sexually transmitted diseases.
c. The typical failure rate for couples using condoms is 25%.
d. Condoms users frequently report penile gland sensitivity.
15. After being examined and fitted for a diaphragm, a 24-year-old client receives instructions about its use. Which
of the following client statements indicates a need for further teaching?
a. “I can continue to use the diaphragm for about 2 to 3 years if I keep it protected case.”
b. “If I get pregnant, I will have to be refitted for another diaphragm after the delivery.”
c. “Before inserting the diaphragm I should coat the rim with contraceptive jelly.”
d. If I gain or lose 20 pounds, I can still use the same diaphragm.”
16. Which of the following conditions, if Julie might be a hindrance in IUD insertion?
a. STD
b. Multiparity
c. She is 30 years old
d. History of having twin pregnancy
17. The nurse should explain that a common problem associated with the use of IUD is:
a. Perforation of uterus
b. Discomforted associated with coitus
c. Development of vaginal infections
d. Spontaneous expulsion of the device
18. The client seeking advice about contraception asks the nurse about an IUD. The nurse explains that the IUD
provides contraception by
a. Blocking the cervical os
b. Increasing the motility of the uterus
c. Preventing sperm from reaching the cervix
d. Interfering the either fertilization or implantation
19. Which of the following should be included in the teaching plan for a client who has an IUD inserted
a. Missed periods will be occasional experienced
b. Check the length of string periodically
c. IUD should be replaced every year
d. IUD prevents ovulation
20. A breastfeeding client asks the nurse what contraception method she and her husband can use until she has her
6-week postpartum examination?
a. Condom with spermicide c. Oral contraceptives
b. calendar method d. cervical mucous method

Physiologic Changes and Discomforts of Pregnancy

21. You are completing an assessment on Sandra. Her hemoglobin level of 12 g/dL. What is the priority nursing
action at this time?
a. Instruct client to eat iron rich food
b. Instruct to take iron supplementation
c. Obtain an order for type and cross match.
d. Evaluate the client for signs of infection
22. While the patient is lying supine on the examination table, she tells the nurse that she is feeling dizzy. After
observing that the client is pale and perspiring freely, the nurse interprets this as
a. complication of amniocentesis
b. supine hypotension syndrome
c. sign of labor
d. respirarory alkalosis
23. Marie noted that she has beginning varicosities. You informed Marie that varicosities are caused by pooling of
blood in the large veins of the legs. Prevention of this condition involves the following, EXCEPT:
a. Walk around to stimulate blood flow if working in prolonged sitting position.
b. When sitting for a long time elevate legs at the knees.
c. Do not wear tight clothings or crossing legs at the knees.
d. When getting out of bed, use support stockings above varicosities.
24. Bernadette, 4 months pregnant develops deep vein thrombosis following an automobile accident and is
prescribed heparin subq. What should Joanne educate her about in regard to this?
a. Some infants will be born with allergic reaction to heparin
b. Her infants will be born with scattered petechiae on his trunk
c. Heparin can cause darkened skin in the fetus
d. Heparin does not cross placenta and so does not affect the fetus
25. Mrs. Ramirez came to the clinic for check. She missed her period about 2 weeks already and she complains of
excessive vomiting. In hyperemesis gravidarum, there is severe nausea and vomiting. What would be the
implication of this:
a. H-mole
b. Increase HCG level
c. Increase estrogen level
d. Phychogenic factor
26. Which statement by a Sandra indicates that further teaching about nausea and vomiting of pregnancy needs to
be done by the nurse?
a. “I need to drink an extra glass of water with every meal”
b. “I will ask my husband not to wear aftershave because it upsets my stomach”
c. “I will try to eat 5 to 6 smaller meals during the day”
d. “I hope that taking nap when I get home from work makes me feel better”
27. The nurse is providing instructions to the Anne regarding measures that will assist in alleviating heartburn.
Which statement if made by the client indicates an understanding of measures to alleviate heartburn?
a. “I should lie down for an hour after eating”
b. “I should avoid between-meal snacks”
c. “I should substitute spices for cooking rather than using salt”
d. “I should avoid eating gas-producing foods and fatty foods”
28. Marie, 7 months pregnant, complained about difficulty in elimination and worried that she might develop
hemorrhoids. You may advise Marie to:
1. Take fiber-rich foods e.g. fresh fruits and vegetables, fruits juices, salads, oatmeal.
2. Drink up to 8 glasses of water daily including coffee, tea and softdrinks.
3. Exercise regularly and establish a regular time for elimination.
4. During elimination use footrest to avoid straining.
a. 1, 2, 3 and 4 c. 1, 2 and 3
b. 1, 3 and 4 d. 2, 3 and 4
29. Marie, primigravida, complains that she doesn’t get enough rest and sleep because of her frequent trips to the
bathroom to urinate. The BEST advise you can give is for her to:
a. Bring urine specimen for urinalysis to check for possible infection.
b. Bring a commode to the bedroom to reduce trips to the bathroom.
c. Hold urge to urinate to improve muscle tone and bladder capacity.
d. Drink more fluids at daytime and decrease intake at night.
30. Minda, 6 months pregnant tells the nurse that she thinks she has developed an allergy, since her nose is often
very congested. The nurse states:
a. Using nasal decongestant once or twice a day will help
b. It is common for women to develop allergies during pregnancy
c. This is not normal; perhaps you have a chronic respiratory infection
d. It is an expected occurrence; the increased hormones are responsible for the congestion.
 31. In the later part of the 3rd trimester, the mother may experience shortness of breath. This complaint maybe
explained as:
a. The woman maybe experiencing complication of pregnancy
b. The fundus of the uterus is high pushing the diaphragm upwards
c. The woman is having allergic reaction to the pregnancy and its hormones
d. A normal occurrence in pregnancy because the fetus is using more oxygen
32. Which of the following would be included in the teaching plan about pregnancy-related breast changes for a
primigravid client?
a. Growth of the milk ducts is greatest during the first 8 weeks of gestation.
b. Enlargement of the breasts indicates adequate levels of progesterone.
c. Colostrums is usually secreted by about the 16th week of gestation.
d. Darkening of the areola occurs during the last month of pregnancy.
33. Sabrina, 28 years –old, married, G3P1 visit at 28 wks AOG. Which of the following findings indicates
development of complication of pregnancy?
a. Dark line between symphisis pubis and umbilicus
b. Weight gain of 2 lbs in a week
c. Silver lines on the breast
d. Increased mucoid vaginal discharge
34. A nurse is performing an assessment of a pregnant client who is at 28-weeks of gestation. The nurse measures the fundal
height in centimetres and expects the findings to be which of the following?
a. 22 cm c. 36 cm
b. 28 cm d. 40 cm
35. Anne complains of discomfort with irregular, painless contractions. How should the nurse respond to the client?
a. Lie down until they stop
b. Walk around until they subside
c. Time the contraction for 30 minutes
d. Take aspirin for relief
36. Mary Ann, 25 year-old is a primigavida at 20 weeks of gestation. The nurse should instruct the client to seek
medical consultation if she experiences which of the following?
a. ankle edema b. lordosis c. severe headache d. fatigue
37. The nurse assesses the client at 8 weeks AOG and expects to note which of the following?
a. hear the fetal heart tone using a Doppler
b. palpate the uterus just above the symphisis pubis
c. client complains of breast sensitivity
d. increase in clients lumbosacral curvature
38. Liza, 34-year-old primigravida has experienced no complication to date at 28 weeks’ gestation.The tells the
nurse that she and her husband wish to drive to visit relatives who live several hundred miles away. Which of
the following recommendations by the nurse would be best?
a. “Try to avoid traveling anywhere in the car during your third trimester.”
b. “Limit the time you spend in the car to a maximum of 4 to 5 hours.”
c. “Taking the trip is okay if you stop every 1 to 2 hours and walk.”
d. “Avoid wearing your seat belt in the car to prevent injury to the fetus.”
39. A prenatal client at 10 weeks' gestation is complaining of leakage of urine. Which self-care strategy should the nurse teach?
a. Decrease the amount of fluid intake.
b. Empty bladder every four hours.
c. Empty bladder every hour.
d. Wear panty liners during the day.

Signs of Pregnancy
40. A 20-year-old client visits Julie at her Nursing Prenatal Clinic because suspects she is pregnant. She tells the
nurse that she missed one menstrual period that she experienced nausea and vomiting, urinary frequency and
fatigue. Based on her assessment, Nurse Julie suspects that her client has signs of pregnancy categorized as
which of the following?
a. presumptive c. probable
b. predictive d. positive
41. At 17 weeks’ gestation, a fetus isn’t considered ballotable. Ballotment means that
a. The examiner feels rebound movement of the fetus
b. The examiner feels fetal movements
c. The client feels irregular, painless uterine contractions
d. The client feels fetal movement
42. The client asked the nurse when can she hear the fetal heart tone. The nurse’s most appropriate response
would be
a. “Ultrasound is needed for you to be able to listen to your baby’s heart tone”
b. “Your baby’s heart tone can be heard with a stethoscope anytime in your pregnancy”
 c. “You can listen to your baby’s heart tone using a stethoscope starting 20 weeks’ gestation”
d. “Counting the fetal movement is the best way to assess if the baby is doing good”

Psychological Changes of Pregnancy

43. Nancy tells the nurse, “If I’m going to have of these discomforts, I’m not sure I want not be pregnant!” The
nurse interprets the client statement as an indication of which of the following?
a. Fear of pregnancy outcome.
b. Rejection of the pregnancy.
c. Normal ambivalence.
d. Inability to care for newborn.
44. Mrs Anna Gabriel, 20 year-old,consults clinic because of amenorrhea for 3 monthsThe client had a positive
pregnancy test and states “Is it really true? I can ‘t believe I’m going to have a baby!” Which of the following
response by the nurse would be most appropriate at this time?
a. “Would you like some booklets on the pregnancy experience?”
b. “Yes it is true. How does that make you feel?”
c. “You should be delighted that you are pregnant.”
d. “Weren’t you and your husband trying to have a baby?”
45. Which of the following statements by Carlota indicates that she had achieved the psychological task of the
second trimester?
a. “ I am pregnant”
b. “I am excited on how my baby would look like.”
c. “ My friend said positive pregnancy test doesn’t confirm pregnancy”
d. “ I discuss with my obstetrician childbirth methods”

Prenatal Care
46. Nursing care during pregnancy focuses on
a. Forward look on the peurperium care
b. Healthy adaptation to pregnancy
c. Diet to avoid excessive weight gain
d. Safe delivery of the baby
47. A nurse assesses four clients in the prenatal clinic. Which client will present with the most accurate fundal height related to
gestational age?
a. The client who develops hydramnios.
b. The client with uterine fibroids.
c. The client who develops hypertension.
d. The client with a 70-pound weight gain.
48. A client who is 8 weeks' pregnant gives the following pregnancy history to the nurse: This is her fourth pregnancy; she had
one abortion at 12 weeks, she had a girl born at home at 35 weeks, and she gave birth to a stillborn at 38 weeks. Which of
the following is the correct documentation for this client's obstetric history?
a. Gravida 4 para 1111
b. Gravida 3 para 0110
c. Gravida 3 para 1111
d. Gravida 4 para 2102
49. The nurse prepares to auscultate the FHR by using a Doppler ultrasound device. The nurse most accurately
determines that the fetal heart sounds are heard by:
a. Noting if the heart rate is above 140 bpm
b. Placing the diaphragm of Doppler on mother’s abdomen
c. Performing Leopold’s maneuver first to determine the location of the fetal heart
d. Palpating the maternal radial pulse while listening to the FHR
Leopold’s Manuever
50. When performing Leopold’s maneuvers, which of the following would the nurse ask the client to do to ensure
optimal comfort and accuracy?
a. Breathe deeply for 1 minute.
b. Empty her bladder.
c. Drink a full glass of water.
d. Lie on her left side.
51. The nurse performs Leopold’s maneuver on Liza. The nurse performs the first maneuver to do which of the
following?
a. Locate the fetal back and spine.
b. Determine what is in the fundus.
c. Determine whether the fetal head is at the pelvic inlet.
d. Identify the degree of fetal descent and flexion.
52. While doing the first maneuver, the nurse palpates something that is soft, irregularly shaped and moves in
conjunction with the body. The nurse interprets this as
a. the baby is in transverse lie
 b. the baby is has breech presentation
c. fetal head presents first
d. the baby is not yet engaged
53. You are preparing to auscultate FHT. Abdominal palpation reveals a hard, round mass over the fundus; a softer,
round mass just above the symphisis pubis; small irregular shapes in the left side of the abdomen, and a long
firm mass on the right side of the abdomen. Based on these findings, what is the best place to auscultate FHT?
a. Right lower abdominal quadrant
b. Right upper abdominal quadrant
c. Left upper abdominal quadrant
d. Left lower abdominal quadrant
54. What is the correct sequence of doing Leopold’s maneuver?
1. Determine whether presenting part moves easily or engaged
2. Facing the mother, assess fetal attitude of relationship of body part to one another
3. Palpate fetal part at the fundus and identify the presenting part
4. Palpate fetal part at the abdomen for smooth side and small parts of the fetus
a. 3,2,1,4 c. 3,4,1,2
b. 1,2,3,4 d. 2,1,4,3

Laboratory Tests
55. Which of the following laboratory values is significant?
a. WBC 13,000 cells/cu mm c. Rubella titer 1:8
b. OGTT 135 mg/dL d. Hgb 13g/dL
56. A pregnant woman in her second trimester calls the prenatal clinic nurse to report a recent exposure to a child with
rubella. Which of the following responses by the nurse would be appropriate and supportive to the woman?
a. “There is no need to be concerned if you don’t have fever or rash within the next 2 days”
b. “Be sure to tell the doctor on your next prenatal visit, but there is little risk in the second trimester”
c. “You should avoid all school-age children during pregnancy”
d. “You were wise to call. I will check your rubella titer screening results and we can immediately identify if future
interventions are needed”
57. A primigravida at 15 weeks gestation visit the clinic for first pre natal check up. She asks why she has to have a routine
alpha fetoprotein serum level drawn. You explain that this:
a. Is a screening test for placental function
b. Tests the ability of her heart to accommodate to pregnancy
c. May reveal chromosomal abnormalities
d. Measures the fetal liver function

Diagnostic Tests
58. Marichu, G2P1 at 24 weeks’ gestation, is scheduled to have an ultrasound examination. What instruction would
you give her before the examination?
a. You can have medicine for pain for any contractions caused by the test
b. You will need to drink at least 3 glasses of fluid before the procedure
c. The intravenous fluid infused to dilate your uterus will not hurt the fetus
d. Void immediately before the procedure to reduce the bladder size
59. The nurse is preparing a prenatal client for a transvaginal ultrasound. What nursing action should the
a. Advise the client not to empty her bladder.
b. Encourage the client to drink 1.5 quarts of fluid.
c. Apply transmission gel over the client's abdomen.
d. Place client in lithotomy position.
60. A multigravida at 37 weeks gestation is scheduled to undergo amniocentesis. The nurse determines that the
patient needs further explanation when the patient says:
a. “About 3 teaspoons of amniotic fluid will be removed.”
b. “A sonogram will be done during the procedure.”
c. “I may feel pressure when the needle is inserted.”
d. “I should have a full bladder before the procedure.”
61. Nancy is scheduled to have amniocentesis to test for fetal lung maturity. What instruction would you give her
before this procedure?
a. the x-ray used to reveal your fetus’ position has no long term effects
b. the intravenous fluid infused used to dilate your uterus does not hurt the fetus
c. no more amniotic fluid forms afterward, which is why only a small amount is removed
d. void immediately before the procedure to reduce bladder size
62. The physician orders an amniocentesis for a primigravid client at 37 weeks’ gestation in early labor to determine
fetal lung maturity. The nurse expects the fluid sample to be tested for which of the following?
a. lecitihin-sphingomyelin ratio
b. amount of bilirubin present
 c. presence of red blood cells
d. rubella titer
63. A nurse is teaching a client about chorionic villi sampling (CVS). The nurse knows that the client has correctly
understood the information when the client states:
a. “With CVS, there is a slight risk I could go into preterm labor.”
b. “With CVS, we can confirm whether the fetus has neural tube defects.”
c. “With CVS, we can confirm the L/S ratio.”
d. “With CVS, we can get genetic information as early as 8-12 weeks.”
64. Which of the following client statement indicates that the client understands teaching about Chorionic villi
sampling?
1. “I can undergo CVS anytime during my pregnancy”
2. “This test will tell us if my baby’s lungs are matured already”
3. “I need someone to drive me home after the procedure”
4. “The doctor will be guided by ultrasound as he insert catheter inside my uterus”
a. 1,2,3,4 b. 1,4 c. 3,4 d. 2,4
65. A prenatal client at 30 weeks gestation is scheduled for a nonstress test (NST) and asks the nurse, "What is this
test for?" The nurse correctly responds that the test is used to determine the following EXCEPT
a. Fetal lung maturity
b. Adequate fetal oxygenation
c. Accelerations of fetal heart rate
d. Fetal well-being
66. Which client would be an appropriate referral for a contraction stress test (CST)?
a. A client with intrauterine growth retardation
b. A client with a multifetal gestation
c. A client with placenta previa
d. A client with a cerclage
67. A contraction stress test is scheduled for the pregnant client and the client asks the nurse about the test. The
nurse tells the client that
a. Small amounts of oxytocin are administered during internal fetal monitoring to stimulate uterine
contractions
b. An external fetal monitor is attached and the woman ambulates on a treadmill until contractions begin
c. The uterus is stimulated to contract by small amounts of oxytocin or nipple stimulation
d. Uterine contractions are stimulated by Leopold’s maneuvers
68. A biophysical profile consists of all of the following measures EXCEPT:
a. fetal breathing c. non stress test
b. femur length d. amniotic fluid index

Prenatal Complications
PIH
Situation: At 32week’s AOG, a 15-year-old primigravid client 5 feet tall gained a total of 20lbs with 2-lbs gain in the last 2
weeks. The client’s baseline blood pressure at her initial visit at 12 weeks’ gestation was 110/70 mmHg.
69. The nurse determines that which of the following factors increases this client’s risk for preeclampsia?
a. total weight gain c. adolescent age group
b. short stature d. proteinuria
70. A nurse in a prenatal clinic is assessing a 28-year-old woman who’s 24 weeks pregnant. Which findings would lead
this nurse to suspect that the client has mild preeclampsia?
a. glycosuria, hypertension, seizures
b. hematuria, blurry vision, reduced urine output
c. burning on urination, hypotension, abdominal pain
d. hypertension, edema, proteinuria
71. When developing a teaching plan for this client, which of the following would the nurse identify as the most
appropriate client-centered goal?
a. Return visit to the prenatal clinic in 4 weeks
b. Decreased edema after 1 week of low-protein, low-fiber diet
c. Bed rest on the left side during the day with bathroom privileges
d. Immediate reporting of adverse reaction to magnesium sulfate therapy

Situation: Queenie, a 19-year-old primigravida has gained a total of 20 pounds since her last clinic visit. On examination,
the nurse obtained the following findings: 130/90mmHg, proteinuria +2, puffiness of the face and lower extremity
edema.
72. Which of the following is most indicative that a client has severe preeclampsia?
a. Bp 138/94 c. less than 2g protein in a 24-hour sample
b. severe blurring of vision d. weight gain of 0.5 lb in a week
73. The nurse instructs the client to report prodromal symptom of seizures so that timely intervention can be instituted
such as:
a. Urine output of 15 ml/hr c. Sudden increase in BP
b. (-) Deep tendon reflex d. Epigastric pain
74. After knowing that the findings about her are not within normal range, Quennie worried about her baby. As a nurse
you are aware that the following complications are possible except:
a. Intrauterine growth retardation
b. Myelomeningocele
c. Abruptio placenta
d. Prematurity
75. The client is prescribed magnesium sulfate. When administering this medication the nurse should watch for which
adverse reaction?
a. flushing
b. hyperactivity
c. increased reflexes
d. increased respiratory rate
76. If the client begins to exhibit symptoms of labor after the eclamptic seizures, the nurse plans to assess the client for
a. ruptured membranes c. uterine atony
b. placenta previa d. abruption placenta
77. A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia.
The nurse monitors for complications associated with the diagnosis and assesses the client for which of the
following conditions?
a. Enlargement of the breast
b. Complaints of feeling hot when the room is cold.
c. Periods of fetal movement followed by quiet periods
d. Any bleeding, such as in the gums, petechiae and purpura

Abortion
Situation: Bianca 6 weeks pregnant with her first baby, calls the clinic to tell the nurse that she has slight vaginal
bleeding without abdominal cramping
78. In spontaneous abortion, if membranes have ruptured and the cervix is open, it is known as:
a. inevitable c. threatened
b. complete d. incomplete
79. D and C is performed on the client in order to:
a. Prevent hemorrhage c. Deliver the fetus
b. Prevent infection d. Stop bleeding
80. After D and C, which observation by the nurse on the client indicates further assessment:
a. Shoulder pain c. Temp of 37 centigrade
b. Vaginal bleeding d. Pulse rate of 80 bpm
81. A few hours after being diagnosed of inevitable abortion, a client begins to experience bearing-down sensations and
suddenly expels the products of conception in bed. What should the nurse do first?
a. Notify the physician
b. Give sedative as ordered
c. Check her fundus for firmness
d. Take her to the operating room

Ectopic pregnancy

Situation: A nurse is preparing to care for a client who is being admitted to the hospital with a possible diagnosis of
ectopic pregnancy.
85. The doctor suspects that the client has an ectopic pregnancy. Which symptom is consistent with a diagnosis of ectopic
pregnancy?
a. Painless vaginal bleeding
b. Abdominal cramping
c. Throbbing pain in the upper quadrant
d. Sudden, stabbing pain in the lower quadrant
82. The nurse develops a plan of care for the client and determines that which of the following nursing actions is the
priority?
a. Monitoring daily weight
b. Assessing for edema
c. Monitoring the apical pulse
d. Monitoring the temperature
83. A client with possible ruptured ectopic pregnancy is admitted. For which of the following procedures should the
nurse plan to prepare the client soon after admission?
a. dilation and curettage c. evacuation of uterus
b. culdocentesis d. bilateral oophorectomy
84. A 25 year-old multigravida is admitted with the diagnosis of ectopic pregnancy. You would anticipate that the client
will need
a. complete bed rest during the 1st and 2nd trimester
b. monitoring FHR and maternal Bp every hour
c. Immediate surgery
d. fluid restriction

H-mole
Situation: Connie, 34 years old and 24 weeks pregnant, is admitted for evacuation of hydatidiform mole.
85. Connie asked you why is it that her elder sister who is 43 years old underwent hysterectomy and not D and C when
she had H-mole. Your response is:
a. More damage is sustained by the endometrium in women above 40 years old
b. They have a higher risk of uterine perforation with D and C.
c. Women over 40 years old have higher incidence of choriocarcinoma
d. Maybe her sister does not want to get pregnant anymore
86. The nurse provide teachings to the client. Which of the following statements if made by the client indicates that the
client needs further instructions?
a. “I should not get pregnant for at least a year”
b. “After evacuation of the mole, my hCG level will be monitored”
c. “High levels of hCG caused me marked vomiting”
d. “I should not use contraceptive pills for at least 3 months:
87. On discharge, the nurse includes which of the following in making clients discharge teaching plan?
a. Do not become pregnant for at least 1 year
b. Have an amniocentesis as soon as you get pregnant
c. Avoid sex for the next 2 to 3 months
d. You will receive Rhogam before you become pregnant again.
88. Six weeks after removal of mole via D&C, the client’s hCG level is still elevated. The nurse should anticipate that the
patient will initially undergo
1. hysterectomy
2. tissue biopsy
3. methotrexate therapy
4. estrogen therapy
5. repeat D & C
a. 1,3
b. 2, 3, 5
c. 2, 5
d. 1,4,5
89. A 38-year-old client at about 14 weeks’ gestation is admitted to the hospital with a diagnosis of complete H mole.
Soon after admission, the nurse would assess the client for sign and symptoms of which of the following?
a. Gestational diabetes
b. Polycythemia
c. Pregnancy induced hypertension
d. hypothyroidism
90. 25 year old mother was admitted for hyperemesis gravidarum. While taking the history of this client it would be
MOST important to report Which of the following?
a. The client has cool lower extremity bilaterally.
b. The client has diminished palpable peripheral pulses.
c. The client is anxious about the effect of her condition to the baby.
d. The client has allergy to shellfish.

Incompetent Cervix
Situation: Vicky, gravid 3 and 28 years old, is admitted to the high risk obstetrical unit due to passage of fluid at 20 weeks
gestation. Vicky has incompetent cervix.
91. Which of the following findings while interviewing the client is not associated with incompetent cervix?
a. The client has previous history of first trimester spontaneous abortions
b. The client is unable to carry pregnancy to term
c. The client had D and C in the last pregnancy
d. The client complains of passage of fluid per vagina
92. Which of the following is a characteristic of incompetent cervix?
 1. Expulsion of immature fetus
2. Painless cervical dilatation in the second and early third trimester
3. Rupture of membranes
a. 1,3 b. 1,2 c. 2,3 d. 1,2,3
93. The nurse understands the client should be placed on bed rest in the following position?
a. Trendelenburg’s position
b. Semi Fowler’s position
c. Upright position
d. Supine position
94. The nurse observes occurrence of regular uterine contractions on Vicky. Which is an appropriate initial nursing
action:
a. Record findings
b. Continue to observe the client
c. Take the client’s V/S
d. Immediately report finding to physician
95. On Vicky’s subsequent pregnancy, the doctor recommended cervical cerclage. Which is not true of this procedure?
a. Ideally it should be applied around 14 weeks gestation before the cervix dilates and membranes rupture.
b. The woman may deliver either vaginally or by CS depending on the type of cerclage applied
c. It involves suturing of the cervix to prevent dilatation
d. If membranes rupture after application, the woman should be given antibiotics for two weeks to prevent
infection and placed on bed rest to prevent uterine contractions

Placenta Previa
Situation: Situation: Myla, 37 years old, G6P5 is diagnosed of total placenta previa
96. Which of the following in the history of Myla is a factor in development of placenta previa?
1. age
2. parity
3. previous CS deliver
4. previous multiple pregnancy
a. 1,2,3,4
b. 1,2,3
c. 3
d. 1,2,4
97. At 28 weeks AOG, Myla showed signs of uterine contractions. Which of the following will the nurse anticipate to
prescribed for Myla?
a. oxytocin
b. magnesium sulfate
c. morphine sulfate
d. hydralazine
98. At 36 weeks, AOG the client gave birth via CS. Which of the following assessment is the priority?
a. apical pulse
b. WBC count
c. temperature
d. level of consciousness

99. A pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which of the following would
be the included in the plan of care of this client?
a. Perform vaginal examination to assess cervical dilatation.
b. Assist to client to ambulate to promote circulation
c. Assess fetal heart tones by use of an external monitor.
d. Administer oxytocin to induce labor

Abruptio Placenta
Situation: Lori, 24-year-old primigravida in her third trimester, is admitted for vaginal bleeding and severe abdominal
pain. After examining the patient, the resident on duty comes up with a diagnosis of abruptio placenta.
100. The measures appropriate for this condition include all of the following, except:
a. Monitoring the patients vital signs
b. Monitoring fetal heart tones for signs of fetal distress
c. Doing vaginal exam to assess dilation
d. Noting the amount of vaginal bleeding
101. Abruptio placenta threatens fetal well-being primarily because it:
a. Increases uterine pressure
b. Lowers the number of placental oxygen exchange sites
 c. Decreases uterine tone
d. Increases the risk of umbilical cord prolapsed
102. Other pertinent signs and symptoms of abruptio placenta are the following except:
a. Polyuria
b. Uterus is firm and tender to palpation
c. Hypotension
d. Portwine-colored amniotic fluid
103. A big government hospital Nurse Cory is taking care of a woman with a diagnosis of abruptio placenta. What
complication of this condition is of most concern to Nurse Cory?
a. Urinary tract infection c. DIC
b. pulmonary embolism d. placenta previa

PROM
Situation: A primigravida at 28 weeks AOG was rushed at the ER after a sudden gush of fluid flowed down her perineal
area.
104. Which nursing diagnosis is a priority?
a. Potential for injury related to prolapse of the cord
b. Risk for infection related to rupture of membrane
c. Anxiety related to strong uterine contractions
d. Pain related to rupture of the membrane
105. A pregnant woman informs the nurse that she felt wetness on her peri-pad and found some clear fluid. The nurse
immediately inspects the perineum and notes the presence of umbilical cord. The nurse initial action is to:
a. Notify the physician
b. Monitor the fetal heat rate
c. Prepare for immediate delivery of the baby
d. Place the woman in trendelenburg position
106. While the nurse is caring for a multiparous client in active labor at 36 weeks gestation, the client tells the nurse, “I
think my water just broke.” Which of the following would the nurse do first?
a. Turn the client to the right side.
b. Assess the color, amount, and odor of the fluid.
c. Assess the fetal heart rate pattern.
d. Check the client’s cervical dilation

Diabetes Mellitus
Situation: A nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes
mellitus.
107. A nurse is reviewing the record of a pregnant client seen in the health care clinic for the first prenatal visit. Which of
the following data if noted on the client’s record would alert the nurse that the client is at risk for developing
gestational diabetes during this pregnancy?
a. The client’s last baby weighed 10 lbs at birth
b. the client’s previous deliveries were by caesarean birth
c. the client has a family history of cardiovascular disease
d. The client is 5 feet 3 inches in height and weighs 115lbs
108. The nurse explains to the client that screening for gestational diabetes is typically performed at
a. 8-12 weeks’ gestation c. 24-28 weeks’ gestation
b. 12 – 16 weeks’ gestation d. 32 to 36 weeks’ gestation
109. A fasting blood glucose screening is performed on a pregnant client. The results indicate that the glucose level is
140mg/dl. Which of the following would the nurse anticipate to be prescribed for the mother?
a. an oral hypoglycemic agent
b. NPH insulin on as daily basis
c. A 3-hour glucose tolerance test
d. regular insulin every meal
110. Mrs. Gabriel, a 38 year old gravida 3 para 0111 is diagnosed with gestational diabetes mellitus at 30 weeks
gestation. She asks whether she will have to use insulin. The nurse’s best response would be:
a. “Yes, you’ll definitely need to use insulin to control your glucose level.”
b. “No, only people with diabetes mellitus type II need to use insulin; you only need to regulate
your diet.”
c. “That depends on how well your glucose level is controlled by diet.”
d. “No, you’ll be given oral hypoglycemics to control your glucose level.”
111. Which finding should the nurse expect when assessing the neonate of a diabetic mother?
a. hypertonia c. macrosomia
b. hyperactivity d. scaly skin
Situation: A 30-year-old multigravida client at 8 weeks’ gestation has history of insulin-dependent diabetes since age 15.
112. Which of the following would the nurse expect to occur with respect to the client’s insulin needs during the first
trimester?
a. they will increase c. they will remain constant
b. they will decease d. they will be unpredictable.
113. The client states, “I am so thrilled that I will be breastfeeding my baby.” Which of the following responses by the
nurse is best?
a. “You will probably need less insulin while you are breastfeeding”
b. “You will need to initially increase your insulin after the baby is born.”
c. “You will be able to take an oral hypoglycemic instead of insulin after the baby is born.”
d. “You will probably require the same dose of insulin that you are now taking”
114. The nurse should anticipate that on the first postpartum day, the insulin requirement of a client with diabetes will:
a. Rapidly increase
b. Remain unchanged
c. Decrease sharply and suddenly
d. Demonstrate a slow and steady decrease

Preterm Labor
SITUATION: Corina, 20 years old, at 32 weeks gestation is rushed to the emergency room because of strong uterine
contractions and passage of fluid per vagina.
115. As the nurse reviews the client’s record, which finding increases the client’s risk to premature labor:
a. Fundic height 40 cm
b. Gravida 3
c. Blood pressure 130/80
d. Height of 68 inches
116. Which of the following assessment findings is NOT associated with premature labor?
a. uterine contractions lasting 40 seconds
b. 3 cm cervical dilatation
c. Rupture of membranes
d. 38 weeks AOG
117. Upon admission which of the following nursing intervention should be done first?
a. instruct her to have NPO c. Place her on complete bed rest
b. Start intravenous infusion d. Administer sedatives as prescribed

Situation: Jody, 30 years old, at 26 weeks’ AOG is brought to the hospital because of uterine contractions. She is
diagnosed of premature labor.
118. The patient has a subcutaneous terbutaline (Brethine) pump for treatment of preterm labor. Which of the
following findings warrants a call to the physician?
a.Fetal movements are fewer than 12 per hour.
b.The patient feels nervous and jittery.
c. The patient's pulse is 124 beats per minute.
d.Fetal movements are more than 12 per hour.
119. A client is receiving subcutaneous Terbutaline (Brethine) tocolytic therapy, during the initial administration of
Brethine. The nurse should:
a. Check the clients reflexes every two hours
b. Monitor the client’s pulse every 15 minutes
c. Institute safety measures because of altered consciousness
d. Insert an indwelling catheter to monitor the urinary output

SITUATION: Annalyn, a pregnant client is brought to the Emergency department. She is diagnosed of preterm Labor.
120. Aside from preterm labor the client also has Gestational diabetes. Which medical order should the nurse
QUESTION?
a. terbutaline c. magnesium sulfate
b. bed rest without bathroom privilege d. IV fluids

Rh incompatibility
SITUATION: Rh incompatibility can occur if a mother’s Rh factor is different from the Rh factor of the fetus she
conceives.
121. An Rh negative woman asks the nurse why she needs to have a shot of RhoGAM. The nurse explains to the client
that the immunization:
a. Prevents her red blood cells from entering fetal circulating at any time during pregnancy.
b. Prevents her antibodies from entering fetal circulation at any time during labor.
c. Prevents fetal red blood cells from entering maternal circulation at any time during pregnancy.
 d. Prevents her from producing antibodies against fetal red blood cells that enter her circulation.
122. Which of the following findings in Kikay's history would identify a need for her to receive Rho (D) immune globulin
(RhoGAM)?
a. Rh negative, Coombs positive
b. Rh negative, Coombs negative
c. Rh positive, Coombs negative
d. Rh positive, Coombs positive
123. The nurse provides teaching to the client regarding RhoGAM. Which of the following statements by the client
indicates that the teaching is effective?
a. “I should receive the injection within a week after I give birth”
b. “RhoGAM will remain in my blood permanently”
c. “RhoGAM will given to me by intramuscular injection”
d. “The injection will prevent my baby from forming antibodies against his own blood.”

Situation: Donna, G1P0, at 28 weeks gestation is Rh negative. Rh incompatibility can occur if a mother’s Rh factor is
different from the Rh factor of the fetus she conceives.
124. Donna’s blood type is O negative. After delivery, she tells you that she received RhOGAM at 28 weeks gestation
and wonders if she needs another dose now. What is your first action?
a. call the doctor for new order
b. call the blood bank to see if the medication is ready
c. Ascertain the baby’s blood type
d. Order an antibody titer for the patient

CARDIAC Patient
Situation: Carmen is a 28 year old gravidocardiac patient pregnant for the first time. She had Rheumatic fever when she
was 10 years old. She regularly visits the clinic for her prenatal check up.
125. Carmen does not complain of any signs and symptoms under ordinary conditions. In fact, she continues to work as
a bank teller and plans to file her sick leave 2 weeks before her EDC. You classify Carmen as:
a. Class I
b. Class II
c. Class III
d. Class IV
126. Carmen tells the nurse that she wants her delivery to be as normal as possible and that she does not want to
undergo CS. The nurse explains:
a. She have no choice but to undergo CS because the life of her baby is at risk
b. She will deliver vaginally with the aid of forceps
c. She will deliver NSD under general anesthesia
d. She will need to undergo CS because NSD is to strenuous for her weak heart
127. Carmen asked you if she will be able to deliver her baby by normal spontaneous delivery as this is what she wants.
You reply by telling her that:
a. Her heart disease contraindicates pushing during labor so she will have to deliver the baby by
CS.
b. If her present condition keeps up until her labor time, she can deliver the baby vaginally but she
may not be allowed to push.
c. She can deliver vaginally but she will be placed under general anesthesia so she will not feel
pain
d. If she plans to deliver the baby vaginally, she must stop working after 30 weeks gestation to
be able to have adequate rest and energy for labor.
128. Nurse assists Carmen disease to identify resources to help her care for her 18 month- old child during the last
trimester of pregnancy. The nurse encourages the pregnant client to use these resources primarily to:
a.Reduce excessive maternal stress and fatigue
b.Help the mother prepare for labor and delivery
c. Avoid exposure to potential pathogens and resulting infections
d.Prepare the 18 month- old child for maternal separation during hospitalization
129. During labor, which will you NOT institute in the care of Claire?
a. Teaching Carmen how to bear down properly and effectively
b. Placing Carmen in Semi Fowler's position
c. Monitoring Carmen's vital signs
d. Avoid placing Carmen in lithotomy position

Situation: Anabelle, 25 year-old married client is pregnant at 30 weeks AOG. She has Class 1 heart disease.
130. The nurse is providing teaching to the client. Which statement, if made by the client, indicates a need for further
instructions?
 a. “It is best that I rest lying on my side to promote blood return to the heart.”
b. “I need to avoid excessive weight gain to prevent increased demands on my heart”
c. “I need to try to avoid stressful situations because stress increases the workload on the heart.”
d. “During the pregnancy, I need to avoid contact with other individuals as much as possible to prevent infection”

131. A nurse is providing instructions to a maternity client with a history of cardiac disease regarding appropriate
dietary measures. Which statement, if made by the client, indicates an understating of the information provided by
the nurse?
a. “I should drink adequate fluids and increase my intake of high-fiber foods”
b. “I should maintain a low-calorie diet to prevent any weight gain”
c. “I should lower my blood volume by limiting my fluids”
d. “I should increase my sodium intake during pregnancy”
132. Which pregnancy-related physiological change would place a client with a history of cardiac disease at the greatest
risk of developing severe cardiac problems?
a. decreased heart rate c. increased plasma volume
b. decreased cardiac output d. increased blood pressure
133. When providing health teaching to the cardiac client related to her diet, the nurse emphasized that she should eat
a balanced diet with:
a. No sodium
b. High sodium
c. Controlled calories
d. No fat

LABOR and DELIVERY

Components of Labor
134. A client who is having a difficult labor is diagnosed with cephalopelvic disproportion. The nurse would
question the medical order that states:
a. Maintain NPO status
b. Start perpheral IV of D51/4 NS
c. Record fetal heart tones every 15 minutes
d. Add 10 units of oxytocin (pitocin) to 1000 mL of IV solution
135. When describing fetal position, the first letter in the series denotes which of the following?
a. Presenting part of the fetus c. Size of the maternal pelvis
b. Side of the maternal pelvis d. Type of fetal delivery
136. The fetal position is LOP. Which of the following INCORRECT regarding this position?
a. the lie is longitudinal
b. the fetal occiput is pointing towards the symphisis pubis
c. Fetal spine is parallel to the maternal spine
d. it is associated with longer more painful labor
137. A primigravid client whose cervix is 7 cm dilated with the fetus at 0 station and in a left occipitoposterior
(LOP) position requests pain relief for severe back pain. In developing the plan of care for this client, the nurse
would anticipate which of the following?
a. Providing firm pressure to the client’s sacral area.
b. Preparing the client for a cesarean delivery.
c. Preparing a client for a precipitate delivery.
d. Maintaining the client in a left side-lying position.
138. The nurse notes the fetal position as ROA. The nurse expects to auscultate the FHT in the client’s
a. right side of the abdomen below the umbilicus
b. right side of the abdomen above the umbilicus
c. left side of the abdomen below the umbilicus
d. left side of the abdomen above the umbilicus
139. If a fetus is in an ROA position during labor, you would interpret this to mean the fetus is
a. in a longitudinal lie facing the left posterior.
b. facing the right anterior abdominal quadrant.
c. in a common breech delivery position.
d. presenting with the face as the presenting part.

Signs of Labor
140. The nurse teaches Anne regarding signs of labor. The includes which of the following in the teaching
plan?
a. Near labor she will experience weight gain of 2 lbs in a week
b. Two weeks before labor her fundic height rises 2 cm above her xiphoid process
c. More Braxton hick’s contractions is expected which is usually relieved by walking
 d. Ruptured membranes indicates onset of normal labor and delivery
141. A 36 weeks gestation primigravida visited the clinic. The nurse informs her with lightening and the
following may be experienced:
a. Urinary frequency, shortness of breath and leg pains
b. Leg pains, dysuria and constipation
c. Urinary frequency, leg cramps and easier breathing
d. Easier breathing, dysuria and urinary frequency
142. On May 12, 2012 a primigravida mother named Mrs. Kim Gabriel came to Nurse Korina for check-up.
Her EDC happens to be May 21. What can you expect to find during assessment?
a. Cervix open, FH-2 fingers below xyphoid process, floating
b. FH at least at the level of the xyphoid process, engaged.
c. FH-2 fingers below xyphoid process, engaged.
d. Cervix closed, uneffaced, fundic height (FH) – midway between the umbilicus and symphysis pubis.

STAGES OF LABOR
Situation: Alpha, 24 years old, is in latent phase of labor, -2 station, membrane ruptured 15 minutes ago.
143. The FHR is 113 beats per minute. Your immediate action should to
a. Reassess after 15 minutes
b. Place client on left lateral position
c. Administer oxygen inhalation
d. Refer the client to the hospital
144. Alpha asks the nurse “ Why should I be in complete bed rest? I am not comfortable.” Which of the
following is your most appropriate response?
a. Keeping you in bed rest will prevent cord prolapse
b. Keeping you in bed rest will prevent amniotic fluid to escape
c. You need to rest to save your energy so that you are strong when you push late
d. Let’s ask the obstetrician if you can walk

Situation: A primigravida comes to the hospital with her husband. Her cervix is 2cm dilated, 75% effaced. The fetal heart
rate is 136, intact membranes
145. After admission, the nurse instructs a client that the most effective position for cervical dilatation is:
a. right lateral recumbent c. standing
b. left lateral recumbent d. sitting on a chair.
146. The client says, “The doctor said that the baby is at +1 station. What does that mean?” After providing
the instruction, the nurse determines that the teaching is effective if the client states that the fetal
presenting part is located:
a. 1 cm above ischial spine c. at the level of ischial spine
b. 1 cm below ischial spine d. 2cm above the ischial spine.

Situation: Lalaine is a newly registered nurse who is hired on a tertiary hospital to work on the Labor and delivery
department.
147. A client is admitted to the birthing department in early active labor. Which admission nursing
interventions takes priority?
a. Auscultating fetal heart tones
b. Obtaining an obstetric history
c. Determine when the last meal was eaten
d. Determining whether the membranes have ruptured
148. Which of the following is a characteristic of the active phase of labor?
a. uterine contraction lasting 50 seconds
b. 8cm cervical dilatation
c. Contractions occurring every 10 minutes
d. Contractions lasting 120 seconds
149. A woman asks if she can walk with her husband while she is in labor. You will instruct the client that this
is contraindicated if
a. She received a narcotic analgesic 3 hours ago.
b. Membranes have ruptured, and the fetal head is not engaged.
c. The woman is currently in the latent stage of labor.
d. The fetus is in an ROA position and a vertex presentation.
150. The cervix of a 15-year-old primigravid client admitted to the labor area is 2 cm dilated and 50% effaced.
Her membranes are intact, and contractions are occurring every 5 to 6 minutes. Which of the following would
the nurse recommend after the client is admitted?
a. Resting in the right lateral recumbent position.
b. Lying in the left lateral recumbent position.
c. Walking around in the hallway until she gets tired.
d. Sitting in a comfortable chair for a period of time.
151. The client is breathing rapidly and complains of feeling dizzy and lightheaded. The client’s cervix is 5 cm
dilated. The nurse determines that she is most likely experiencing effects of:
a. rapid cervical dilatation c. hyperventilation
b. elevated blood pressure d. excitement about labor process
152. The fetal heart rate is checked following rupture of the bag of waters in order to:
a. Check if the fetus is suffering from head compression
b. Determine if cord compression followed the rupture
c. Determine if there is utero-placental insufficiency
d. Check if fetal presenting part has adequately descended following the rupture
153. A 31-year-old multigravida at 39 weeks’ gestation is admitted to the hospital in active labor. While the
nurse begins the admission process, the amniotic membranes rupture spontaneously. The clients’ cervix is 5cm
dilated and the presenting part is at 0 station. The nurse should first
a. perform vaginal examination to determine dilation
b. auscultate the client’s blood pressure
c. note the color, amount and odor of amniotic fluid
d. prepare the client for imminent delivery
154. The cervical dilatation taken at 8:00 A.M. in a G1P0 patient was 6 cm. A repeat I.E. done at 10 A.M.
showed that cervical dilation was 7 cm. The correct interpretation of this result is:
a. Labor is progressing as expected
b. The latent phase of Stage 1 is prolonged
c. The active phase of Stage 1 is protracted
d.The duration of labor is normal
155. A client in labor received an epidural anesthetic when her dilation reached 5cm. Which nursing diagnosis
would have the highest priority for her at this time?
a. Impaired urinary elimination related to the effects of the anesthesia’
b. Deficient knowledge related to lack information about regional anesthesia
c. Risk for injury related to hypotension secondary to vasodilation and pooling in extremities
d. Risk for impaired skin integrity related to inability to move lower extremities
156. Two hours ago, a multigravid client was admitted in active labor with her cervix dilated at 5 cm and
completely effaced and the fetus 0 station. Currently, the client is experiencing nausea and vomiting, a slight
chill with perspiration beads on her lips and extreme irritability. Which of the following actions would be most
appropriate at this time?
a. Warm the temperature of the room by a few degrees
b. Increase the rate of IV fluids
c. Obtain an order for anti emetics IM
d. Assess the client’s cervical dilatation station
157. A nurse is caring for a client in labor. The nurse determines that the client is beginning the second stage
of labor when which of the following assessments is noted?
a. The contractions are regular.
b. The membranes have ruptured.
c. The cervix is dilated completely.
d. The client begins to expel clear vaginal fluid
158. The client’s cervix is 10cm dilated, and she begins to push. The nurse notes early decelerations of the
fetal heart rate and determines that early deceleration pattern is most likely due to
a. cord compression c. inadequate uteroplacental perfusion
b. fetal head compression d. fetal bradycardia
159. When caring for a client during the second stage of labor, which action would be most appropriate?
a. ensuring the client’s legs are positioned appropriately
b. encouraging the client to ambulate
c. allowing the client clear liquids
d. initiating electronic monitoring
160. The nurse has obtained a urine specimen from a gravida 6 para 5 client admitted to the labor unit. The
woman asks to go to the bathroom and reports that she feels she has to move her bowels. Which action would
be appropriate initially?
a. Assisting her to the bathroom.
b. Assessing her stage of labor.
c. Allowing her support person to take her to the bathroom. To maintain privacy.
d. Offer bedpan
161. The cervix of a primigravid client in active labor who received epidural anesthesia 4 hours ago is now
completely dilated, and the client is ready to begin pushing. Before the client begins to push, which of the
following would the nurse assess?
a. Fetal heart rate variability.
b. Cervical dilation again.
c. Vital signs.
d. Bladder status
162. Which finding would be an indication of placental detachment?
a. an abrupt shortening of the cord
b. an increase in the number of contractions
c. relaxation of the uterus
d. decreased vaginal bleeding
163. During the fourth stage of labor and delivery, the nurse should
a. coach the client while pushing
b. check the vital signs every hour
c. assist in the delivery of the placenta
d. check if the fundus is well contracted
164. In 4th degree perineal laceration the tissue involve reach up to:
a. Anal sphincter
b. Rectal mucosa
c. Fascia and muscles of perineal body
d. Vaginal mucous and perineal skin
165. Approximately 15 minutes after delivery of a viable term neonate, a multiparous client complains of a
chill. Which of the following would the nurse do next?
a. Assess the client’s pulse rate.
b. Decreased the rate of intravenous fluids.
c. Provide the client with a warm blanket.
d. Assess the amount of blood loss.
166. The nurse is preparing a woman for epidural anesthesia. The woman asks “Why should my IV running so
fast? It feels so cold?” What reply by the nurse is BEST?
a. “IV hydration helps prevent the blood pressure from dropping so low”
b. “Don’t worry, this is a routine procedure in preparation for an epidural”
c. “I’ll slow the IV down so that you wont feel cold”
d. “IV fluids help prevent spinal headaches”
167. The nurse in the labor and delivery area receives a telephone call from the emergency room announcing
that a multigravid client in active labor is being transferred to the labor area. The client has had no prenatal care.
When the client arrives by stretcher , she says, “ I think the baby’s coming…Help!” the fetal skull is crowning.
Which of the following would be a priority assessment for the nurse to make?
a. Estimated date of delivery.
b. Amniotic fluid status.
c. Gravid and parity
d. Prenatal history.
168. A nurse is caring for a client who is experiencing a precipitous birth. The nurse is waiting for the
physician to arrive. When the infant’s head crowns, the nurse would instruct the client to:
a. Bear down
b. Push with each contraction
c. Breathe rapidly
d. Hold her breath
169. What is the most common complication associated with too rapid expulsion of the fetus in a precipitate
labor that you anticipate during delivery?
a. Earlier separation of the placenta during the delivery
b. Pitting edema of the fetal scalp
c. Dural or subdural tears in fetal brain tissue
d. Rapid delivery
170. Oxytocin is administered to Mila to augment labor. What are the first symptoms of water intoxication to
observe during this procedure?
a. Headache and vomiting
b. A swollen tender tongue
c. A high choking voice
d. Abdominal bleeding and pain
171. You assess Elvira’s uterine contractions. In relation to the contraction, when does a late deceleration
begin?
a. 45 seconds after the contraction is over
b. 30 seconds after the contraction starts
c. After every tenth or more contraction
d. After a typical contraction ends
172. A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the
following is noted on the external monitor tracing during a contraction?
a. Early decelerations c. Late decelerations
 b. Variable decelerations d. Short term variability
173. While the client is being admitted to the birthing unit she states, “My water broke last night, but my
labor started two hours ago. Which of the following assessment findings would be cause for concern?
1. Maternal VS: T. 99.5, HR 80, R 24, B/P 130/80.
2. Blood and mucus on perineal pad.
3. Peripad stained with green fluid.
4. The client states, “This baby wants out- he keeps kicking me”.
a. 1,2,3,4 b. 2,3,4 c. 3,4 d. 2,3
174. The rationale for using prostaglandin gel for a client prior to induction of labor is to
a. Soften and efface the cervix
b. Numb the cervix pain receptors
c. Prevent cervical lacerations
d. Stimulate uterine contractions
175. Carol chooses to have epidural anesthesia. What are two risks associated with this?
a. Hypotension and prolonged second stage of labor
b. Severe headaches and coldness of extremeties
c. Continued back pain and short first stage of labor
d. Hypertension and reduced RBC count

PARTOGRAPH
176. Which of the following best describes partograph?
a. A tool used to record all observation of client in active phase of labor
b. A tool used to monitor progress of labor
c. A record of the client’s progress of labor during latent and active phase
d. A record of client’s intrapartal and postpartal condition
177. Which of the following describes the alert line?
a. A line from 4cm to 10 cm at a rate of 4 cm/hr
b. A line from 0cm to 10 cm at a rate of 1 cm/hr
c. A line from 4cm to 10 cm at a rate of 1 cm/hr
d. A line from 4cm to 10 cm at a rate of 4 cm/hr
178. The line 4cm to the right and parallel to the alert line is the
a. Action line
b. Referral line
c. Progress line
d. Parallel line
179. The nurse knows that the client’s cervical dilatation is progressing normally if the graph
a. Stays on the action line or to its right
b. Stays between the alert line and action line
c. Stays on the alert line or to its right
d. Stays on the alert line or to its left
180. The main feature of the partograph is the graph showing
a. Fetal head descent
b. Mother’s vital signs
c. Uterine contractions
d. Cervical dilatation
181. During the latent phase of labor the nurse should do the following EXCEPT
a. Encourage client to ambulate
b. Allow mother to eat and drink
c. Record all observations on the partograph
d. Encourage client to void

POSTPARTUM
SITUATION: Among the nurse’s responsibility after delivery is the provision of safe physical, emotional and psychological
support for the mother’s well being
182. When developing the plan of care for a primiparous client during the first 12 hours after vaginal delivery,
which of the following concerns of the client would be the nurse’s primary focus of care?
a. The neonate.
b. The family.
c. The client’s own comfort.
d. The client’s significant other.
183. While making a home visit to a woman on her third day postpartum, you discover this new mother
sitting by her bed crying. She states nothing is wrong; she just “feels sad.” Which of the following would be your
best response to her?
a. “I’ll keep confidential any problem you want to discuss with me.”
b. “You have a beautiful boy; you shouldn’t feel sad about that.”
c. “Do you wish you’d had a girl instead of a boy?”
d. “Feeling sad when you know you shouldn’t must be very confusing.”
184. When checking the client’s vital signs 8 hours after delivery, the nurse expects to find
 a. bradycardia with no changes in respirations
b. subnormal temperature for the first 24 hours
c. elevated temperature during the first 3 days
d. elevated blood pressure in the first 18-24 hours
185. Which of the following assessment findings of a multigravida client who delivered a term neonate
vaginally 30 hours ago requires further assessment?
a. Pulse rate of 100bpm
b. WBC 17,000/mm3
c. Excessive perspiration
d. Frequent voiding in large amounts
186. A day after a vaginal delivery, the client complains of afterpains. Which of the following interventions is
inappropriate?
a. Instruct mother to keep her bladder empty by regular voiding
b. Instruct woman to assume prone position
c. Massage uterus gently
d. Apply heat to abdomen
187. When assessing another client who gave birth 4 hours ago, the nurse finds the uterus to be firm 2
fingerbreadths above the umbilicus, and displaced to the right. Lochia rubra is moderate. What would be the
first nursing action?
a. Gently massage the fundus
b. Insert a Foley catheter
c. Encourage the woman to urinate
d. Record these as normal findings
188. On the second day postpartum following a cesarean birth, at which of the following locations would you
expect to palpate the woman’s fundus?
a. Two fingerbreadths above the umbilicus.
b. At the umbilicus.
c. Two fingerbreadths below the umbilicus.
d. Four fingerbreadths below the umbilicus.
189. While making a home visit to a postpartum client on day 10, the nurse would anticipate that the client’s
lochia is
a. pink and fundus palpable midway between umbilicus and symphisis pubis
b. dark red and fundus palpable at the level of umbilicus
c. brown and fundus no longer palpable
d. white and fundus no longer palpable
190. To promote comfort on an episiotomy site, which nursing intervention should the nurse perform 8 hours
after delivery?
a. apply ice compress on the area
b. use perilight on the perineal area
c. place patient on sitz bath
d. decrease fluid intake
191. After a vaginal delivery, a postpartum nurse has provided information to a new mother about
performing sitz bath. The nurse explains that sitz bath will
a. Numb the tissue
b. Stimulate bowel movement
c. Reduce the edema and swelling
d. Promote healing and provide comfort
192. Eight hours after delivery, Mrs. Castro tells the nurse that she feels dirty and wants to take a shower.
She says that she never feels clean after bed baths. The nurse’s best response would be:
a. “You require bed rest for the first 24 hours after delivery.”
b. “You can shower, but I must stay nearby.”
c. “Bathing or showering isn’t permitted because they may cause chills.”
d. “I’m sorry, but you’re not allowed to shower, I’ll give you a bed bath instead.”
193. A breast- feeding primiparous client with a midline episiotomy is prescribed ibuprofen 200 mg orally.
The nurse instructs the client to make the medication at which of the following times?
a. Before going to bed.
b. Midway between feedings.
c. Immediately after the feeding.
d. When providing supplemental formula.
194. A multiparous client who delivered a term neonate vaginally 5 days complains of persistent lochia rubra
in a moderate to heavy amount. The nurse instructs the client that this type of postpartum bleeding is usually
caused by which of the following?
a. uterine atony
b. cervical lacerations
 c. vaginal lacerations
d. retained placental fragments
195. Prior to administering Methergine, the nurse contacts the physician who prescribed the medication if
which of the following is documented in the client’s medical history?
a. Peripheral vascular disease
b. Hypothyroidism
c. Hypotension
d. Diabetes mellitus
196. Nurse Paula is caring for a client during the first hour after a precipitous delivery. What assessment data
would require immediate intervention?
a. BP 140/80, P 86, R 20 T 100.6
b. Fundus firm at the umbilicus, steady trickle of bright red bleeding
c . Fundus firm, dark red bleeding with clots
d. Fundus at 3 cm above and to the right of the umbilicus
197. A primiparous client who delivered a viable term neonate vaginally 48 hours ago has a midline
episiotomy and repair of a third degree laceration. When preparing the client for discharge, which of the
following assessments would be most important?
a. Constipation
b. Diarrhea
c. Excessive bleeding
d. Rectal fistula
198. A nurse is preparing a plan of care for a postpartum client who is at risk for endometritis. Which of the
following nursing interventions will the nurse include in the plan of care to minimize this risk?
a. Instruct the client in proper positioning of the newborn to facilitate breastfeeding
b. Encourage early ambulation
c. Review handwashing techniques and pericare procedures with the client
d. Discuss the resumption of home care and other activities with client
199. Which of the following if noted during the first 24 hours following delivery would support a diagnosis of
postpartum endometritis?
a. Maternal temperature of 37.9C
b. Uterus 2 fingerbreadths below midline and firm
c. Abdominal tenderness and chills
d. Increased perspiration and urine output

200. A nurse is preparing a list of self-care instructions for a postpartum client who was diagnosed with
mastitis. Which of the following instructions would be included on the list?
1. Rest during the acute phase
2. Continue to breastfeed if the breast is not too sore
3. Take the prescribed antibiotics until soreness subsides
4. Avoid decompression of the breasts by breastfeeding or breast pump
a. 1,2,3, 4 b. 2,3 c. 1,2 d. 1,4