Obstetrics Review Questions

7/28/2019 Obstetrics Review Questions

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Obstetrics Review Questions

Ana H. Corona, MSN, FNP-C

Nursing Instructor

November 2007Study Guide Zone 2007; Examcram2

NCLEX RN-PN 2007



Q1

• Gerry C. and her roommate, Anne B., eachdelivered a child two days ago. Gerry is breast-feeding; Anne is using formula. Which of thefollowing instructions can the nurse give to bothmothers?

• A) Apply warm compresses to breast if too full.

• B) Do not apply any soap to your nipples.• C) Wear a good, well-supporting bra.

• D) Apply cold compresses to breast if too full.



A1

• The correct answer is C. A well-fitting,

supportive bra with wide straps can be

recommended for both the nursing and the

nonnursing mother, for the support of the

breasts and for comfort. The nursing

mother's bra should have front flaps over

each breast for easy access duringnursing periods.



Q2

• Which of the following is NOT one of thefour stages of labor and delivery?

A: onset of labor through complete dilation

of the cervixB: cervical dilation through the delivery of the placentaC: placenta delivery through complete

stabilization of the mother D: birth through the delivery of theplacenta



Answer 2

• B. The correct answer combines two of the

four stages of labor and delivery.



Q3

• Which of the following is not scored

with the APGAR?

A. 02 Stats

B. Heart Rate

C. Color

D. Tone



Answer 3

• A. The right answer was 02 Stats.



Q4

• Ms. S. delivers a 6 lb 4 oz (2835 g) baby boy.Which of the following statements would indicateto the nurse that the mother has begun tointegrate her new baby into the family structure?

• A) My parents wanted a granddaughter.

• B) When he yawns, he looks just like his brother.

• C) I wish he had curly hair like my husband.• D) All this baby does is cry. He's not like my

other child.



A4

• The correct answer is B. Family identification of

the newborn is an important part of attachment.The first step in identification is defined in termsof likeness to family members. By saying "Allthis baby does is cry. He's not like my other

child," the mother is emphasizing a negativecharacteristic of the baby and comparing himunfavorably to her other child. By saying "I wishhe had curly hair like my husband," the mother iswishing that he had curly hair like her husband;

she is not looking at a positive characteristic of the baby that will fit in with the family. By saying"My parents wanted a granddaughter," themother is thinking that the baby should havebeen a girl instead of a boy.



Q5

• If a newborn exhibits a heart rate of 80

bpm the APGAR score should be?

A. 0

B. 1

C. 2

D. 3



Answer 5

• B. The right answer was 1.



Q6

• If a newborn exhibits blue extremities

and the body is pink the APGAR score

should be?

A. 0

B. 1

C. 2D. 3



Answer 6

• B. The right answer was 1.



Q7

• The licensed vocational nurse may not

assume the primary care for a client:

A. In the fourth stage of labor

B. Two days post-appendectomy

C. With a venous access device

D. With bipolar disorder



A7

• Answer C is correct. The licensed

vocational nurse may not assume primary

care of the client with a central venous

access device. The licensed vocationalnurse may care for the client in labor, the

client post-operative client, and the client

with bipolar disorder; therefore, answers A, B, and D are incorrect.



Q8

• The 5-minute Apgar of a baby delivered

by C-section is recorded as 9. The most

likely reason for this score is:

A. The mottled appearance of the trunk

B. The presence of conjunctival

hemorrhages

C. Cyanosis of the hands and feet

D. Respiratory rate of 20 –28 per minute



A8

• Answer C is correct. Although cyanosisof the hands and feet is common in thenewborn, it accounts for an Apgar score of

less than 10. Answer B suggests cooling,which is not scored by the Apgar. Answer B is incorrect because conjunctivalhemorrhages are not associated with the

Apgar. Answer D is incorrect because it iswithin normal range as measured by the

Apgar.



Q9

• The LPN is preparing to administer an

injection of vitamin K to the newborn.

The nurse should administer the injection

in the:

A. Rectus femoris muscle

B. Vastus lateralis muscle

C. Deltoid muscle

D. Dorsogluteal muscle



A9

• Answer B is correct. The nurse should

administer the injection in the vastus

lateralis muscle. Answers A and C are not

as well developed in the newborn;therefore, they are incorrect. Answer D is

incorrect because the dorsogluteal muscle

is not used for IM injections until the childis 3 years of age.



Q10

• A newborn weighed 7 pounds at birth. At

6 months of age, the infant could be

expected to weigh:

A. 14 pounds

B. 18 pounds

C. 25 poundsD. 30 pounds



A10

• Answer A is correct. The infant’s birth

weight should double by 6 months of age.

Answers B, C, and D are incorrect

because they are greater than theexpected weight gain by 6 months of age.



Q11

• Assessment of a newborn male reveals that the

infant has hypospadias. The nurse knows that:

A. The infant should not be circumcised.

B. Surgical correction will be done by 6 months of age.

C. Surgical correction is delayed until 6 years of

age.D. The infant should be circumcised to facilitate

voiding.



A11

• Answer A is correct. The infant with

hypospadias should not be circumcised

because the foreskin is used in

reconstruction. Answer B and C areincorrect because reconstruction is done

between 16 and 18 months of age, before

toilet training. Answer D is incorrectbecause the infant with hypospadias

should not be circumcised.



Q12

• When performing a newborn assessment, the

nurse measures the circumference of the

neonate's head and chest. Which assessment

finding is expected in the normal newborn? A. The head and chest circumference are the

same.

B. The head is 2cm larger than the chest.

C. The head is 3cm smaller than the chest.

D. The head is 4cm larger than the chest.



A12

• Answer B is correct. The head circumference

of the normal newborn is approximately 33cm,

while the chest circumference is 31cm. Answer

A is incorrect because the head and chest arenot the same circumference. Answer C is

incorrect because the head is larger in

circumference than the chest. Answer D is

incorrect because the difference in headcircumference and chest circumference is too

great.



Q13

• A newborn male has been diagnosed with

hypospadias with chordee. The nurse

understands that the infant will have altered

patterns of urination because: A. The urinary meatus is on the dorsum of the

penis.

B. The ureters will reflux urine into the kidneys.

C. The urinary meatus is on the top of the penis.

D. The bladder lies outside the abdominal cavity



A13

• Answer A is correct. The infant withhypospadias has altered patterns of urinary elimination caused by the location

of the urinary meatus on the dorsum, or underside, of the penis. Answer B isincorrect because it refers to ureteralreflux. Answer C is incorrect because it

refers to epispadias. Answer D is incorrectbecause it refers to exstrophy of thebladder.



Q14

• The physician has ordered an externalmonitor for a laboring client. If the fetus isin the left occipital posterior (LOP)

position, the nurse knows that theultrasound transducer will be located:

A. Near the symphysis pubis

B. Near the umbilicusC. Over the fetal back

D. Over the fetal abdomen



A14

• Answer C is correct. In the left occipital

posterior position, the heart sounds will be

heard loudest through the fetal back.

Answers A, B, and D are incorrectlocations.



15

• The nurse is caring for a 7 lb 9 oz infant

born 24-hours ago by cesarean section due

to maternal herpes simplex virus. It would

be MOST important for the nurse to takewhich of the following actions?

A. Wear gloves when caring for the infant.

B. Administer immune globulin.

C. Place the infant in isolation.

D. Encourage the mother to bottle feed the infant.



15

• A.

• Explanation of Answer:

The nurse should also inspect the eyes,

mouth, and skin for lesions.



16

• Which of the following observations of a 8lb 4 oz newborn boy, if made by the nurse,would require an intervention?

A. The infant’s respirations are 36, shallow and

irregular in rate, rhythm, and depth.B. The infant’s axillary temperature is 96.2° F

(35.6° C).

C. Rapid pulsations are visible in the fifth

intercostal space, left midclavicular line.D. There is asynchronous spontaneous movement

of the infant’s extremities.



16

• B.


This subnormal temperature indicates

prematurity, infection, low environment

temperature, inadequate clothing, and/or

dehydration



17

• The nurse on postpartum is preparing four patientsfor discharge. It would be MOST important for thenurse to refer which of the following patients for home care?

A. A 15-year-old primapara who delivered a7 lb male 2days ago.

B. An 18-year-old multipara who delivered a 9 lb female bycesarean section 2 days ago.

C. A 20-year-old multipara who delivered 1 day and iscomplaining of cramping.

D. A 22-year-old who delivered by cesarean section and iscomplaining of burning on urination.



17

• D.


This indicates urinary tract infection and

requires a follow-up.



18

• A new mother has some questions about (PKU).

Which of the following statements made by a

nurse is not correct regarding PKU?

A: A Guthrie test can check the necessary labvalues.

B: The urine has a high concentration of

phenylpyruvic acidC: Mental deficits are often present with PKU.

D: The effects of PKU are reversible.



18

• (D) The effects of PKU stay with the infant

throughout their life.



19

• A nurse is caring for an infant that hasrecently been diagnosed with a congenitalheart defect. Which of the following

clinical signs would most likely bepresent?

A: Slow pulse rate

B: Weight gainC: Decreased systolic pressure

D: Irregular WBC lab values



19

• (B) Weight gain is associated with CHF

and congenital heart deficits



20

• A mother has recently been informed that her

child has Down’s syndrome. You will be

assigned to care for the child at shift

change. Which of the following characteristics isnot associated with Down’s syndrome?

A: Simian crease

B: Brachycephaly

C: Oily skin

D: Hypotonicity



20

• (C) The skin would be dry and not oily.



21

• THE NURSE IS TEACHING BASIC INFANT CARE TO A GROUP OF FIRST-TIME PARENTS. THE NURSESHOULD EXPLAIN THAT A SPONGE BATH ISRECOMMENDED FOR THE FIRST 2 WEEKS OF LIFEBECAUSE:

A. NEW PARENTS NEED TIME TO LEARN HOW TOHOLD THE BABY.

B. THE UMBILICAL CORD NEEDS TIME TO SEPARATE.

C. NEWBORN SKIN IS EASILY TRAUMATIZED BYWASHING.

D. THE CHANCE OF CHILLING THE BABY OUTWEIGHSTHE BENEFITS OF BATHING.



21

• Answer B is correct. The umbilical cord

needs time to dry and fall off before putting

the infant in the tub. Although answers A,

C, and D might be important, they are notthe primary answer to the question.



22

• WHEN THE NURSE CHECKS THE FUNDUS OF ACLIENT ON THE FIRST POSTPARTUM DAY, SHENOTES THAT THE FUNDUS IS FIRM, IS AT THELEVEL OF THE UMBILICUS, AND IS DISPLACED TOTHE RIGHT. THE NEXT ACTION THE NURSESHOULD TAKE IS TO:

A. CHECK THE CLIENT FOR BLADDER DISTENTION

B. ASSESS THE BLOOD PRESSURE FORHYPOTENSION

C. DETERMINE WHETHER AN OXYTOCIC DRUG WASGIVEN

D. CHECK FOR THE EXPULSION OF SMALL CLOTS



22

• Answer A is correct. If the fundus of the

client is displaced to the side, this might

indicate a full bladder. The next action by

the nurse should be to check for bladder distention and catheterize, if necessary.

The answers in B, C, and D are actions

that relate to postpartal hemorrhage.



23

• A CLIENT IS ADMITTED TO THE LABOR ANDDELIVERY UNIT IN ACTIVE LABOR. DURINGEXAMINATION, THE NURSE NOTES APAPULAR LESION ON THE PERINEUM.

WHICH INITIAL ACTION IS MOST APPROPRIATE?

A. DOCUMENT THE FINDING

B. REPORT THE FINDING TO THE DOCTOR

C. PREPARE THE CLIENT FOR A C-SECTIOND. CONTINUE PRIMARY CARE ASPRESCRIBED



23

• Answer B is correct. Any lesion should bereported to the doctor. This can indicate aherpes lesion. Clients with open lesions relatedto herpes are delivered by Cesarean section

because there is a possibility of transmission of the infection to the fetus with direct contact tolesions. It is not enough to document the finding,so answer A is incorrect. The physician must

make the decision to perform a C-section,making answer C incorrect. It is not enough tocontinue primary care, so answer D is incorrect.



Q24

• On the second day postpartum, the nurseasks the new mother to describe her vaginal bleeding. The nurse should expect

her to say that it is

• A) red with clots.

• B) thin and white.• C) red and moderate.

• D) scant and brown.



A24

• The correct answer is C. Lochia rubra ismoderate red discharge, present for thefirst 2-3 days postpartum. Multiple clots

are a sign of lack of tone in the uterinemusculature. Scant, brown discharge(lochia serosa) would be present 7-10days after delivery. Thin, white discharge

(lochia alba) begins around the tenth dayand ends about three weeks followingdelivery.



Q25

• During delivery, a mediolateral episiotomy isperformed and Ms. L. delivers a 7 lb 8 oz girl. Todetect postpartum complications in Ms. L. assoon as possible, the nurse should be

particularly alert for all of the following except

• A) ecchymosis and edema of the perineum.

• B) a foul lochial odor.• C) separation of the episiotomy wound edges.

• D) discomfort while sitting.



A25

• D. Discomfort while sitting is

normal/common after an episiotomy. A

foul lochia odor may be a sign of infection.

Ecchymosis and edema may indicate aprolonged labor with a large baby, difficult

fetal lie or presentation or forceps delivery.

Separation of the episiotomy may indicateinfection or trauma.



Q26

• During labor, the nurse observes variabledecelerations on the external fetal monitor. Thebest action for the nurse to take at this time is to

• A) change the woman's position to left side-lying.

• B) apply an oxygen mask.

• C) get the woman out of bed and walk her around.

• D) move the woman to the delivery room.



26

• The correct answer is A. Changing theposition of the mother will relieve transientpressure on the umbilical cord. The fetus

is not in distress at this time so there is noneed for oxygen. Labor has progressedtoo far to permit ambulation. The client isnot ready for the delivery room because

she is only 8 cm dilated. Progression to fulldilation might still take two hours for aprimipara; variable time for a multipara.



27

• The client has elected to have epidural

anesthesia to relieve labor pain. If the client

experiences hypotension, the nurse would:

A. PLACE HER IN TRENDELENBURGPOSITION

B. DECREASE THE RATE OF IV INFUSION

C. ADMINISTER OXYGEN PER NASAL

CANNULA

D. INCREASE THE RATE OF THE IV INFUSION



27

• Answer D is correct. If the client experienceshypotension after an injection of epidural anesthetic, thenurse should turn her to the left side, apply oxygen bymask, and speed the IV infusion. If the blood pressuredoes not return to normal, the physician should be

contacted. Epinephrine should be kept for emergencyadministration. Answer A is incorrect because placingthe client in Trendelenburg position (head down) willallow the anesthesia to move up above the respiratorycenter, thereby decreasing the diaphragm’s ability tomove up and down and ventilate the client. In answer B,the IV rate should be increased, not decreased. Inanswer C, the oxygen should be applied by mask, notcannula.



28

• Ms. L. is placed on an external fetal monitor.The nurse notices that the fetal heart rate iserratic during contractions but returns tobaseline at the end of each contraction. This

should be recorded as

• A) variable decelerations.

• B) early decelerations.• C) late decelerations.

• D) fetal distress.



28

• The correct answer is A. Variable decelerations arefrequently caused by transient fetal pressure on the cordand are not a sign of fetal distress. A change in themother's position will usually relieve the problem. Earlydeceleration is normal. It is characterized by a drop infetal heart rate early in the contraction, typically due tohead compression. Late deceleration is characterized bya drop in fetal heart rate late in the contraction. This isindicative of placental insufficiency. The client should be

turned on her left side and prepared for possible C-section. The client's monitor does not indicate fetaldistress. Late deceleration would indicate fetal distress.



29

• The nurse is caring for a woman who is in

labor. She is 8 cm dilated. To support her

during this phase of her labor, the nurse should

• A) offer her a back rub during contractions.

• B) leave her alone most of the time.

• C) offer her sips of oral fluids.• D) provide her with warm blankets.



29

• The correct answer is A. The

counterpressure of a back rub during a

contraction may relieve discomfort. The

nurse should stay with the client at thistime. The client should not be having sips

of water by mouth at this time. She will

most likely be getting IV fluids. The clientwill most likely be hot because of the

increased metabolic demands of labor.





30

• Answer B is correct. An amniotomy is an

artificial rupture of membranes and normal

amniotic fluid is straw-colored and odorless.

Fetal heart tones of 160 indicate tachycardia,and greenish fluid is indicative of meconium, so

answers A and C are incorrect. If the nurse

notes the umbilical cord, the client is

experiencing a prolapsed cord, so answer D isincorrect and would need to be reported

immediately.



31

• THE CLIENT IS ADMITTED TO THE UNIT. A VAGINALEXAM REVEALS THAT SHE IS 2CM DILATED.WHICH OF THE FOLLOWING STATEMENTS WOULDTHE NURSE EXPECT HER TO MAKE?

A. "WE HAVE A NAME PICKED OUT FOR THE BABY."B. "I NEED TO PUSH WHEN I HAVE A CONTRACTION."

C. "I CAN'T CONCENTRATE IF ANYONE IS TOUCHINGME."

D. "WHEN CAN I GET MY EPIDURAL?"



31

• Answer D is correct. Dilation of 2cm

marks the end of the latent phase of labor.

Answer A is a vague answer, answer B

indicates the end of the first stage of labor,and answer C indicates the transition

phase.



32

• THE CLIENT IS HAVING FETAL HEARTRATES OF 90 –110BPM DURING THECONTRACTIONS. THE FIRST ACTION

THE NURSE SHOULD TAKE IS: A. REPOSITION THE MONITOR

B. TURN THE CLIENT TO HER LEFT SIDE

C. ASK THE CLIENT TO AMBULATED. PREPARE THE CLIENT FOR

DELIVERY



32

• Answer B is correct. The normal fetal

heart rate is 120 –160bpm; 100 –110bpm is

bradycardia. The first action would be to

turn the client to the left side and applyoxygen. Answer A is not indicated at this

time. Answer C is not the best action for

clients experiencing bradycardia. There isno data to indicate the need to move the

client to the delivery room at this time.



33

• IN EVALUATING THEEFFECTIVENESS OF IV PITOCIN FOR

A CLIENT WITH SECONDARY

DYSTOCIA, THE NURSE SHOULDEXPECT:

A. A PAINLESS DELIVERY

B. CERVICAL EFFACEMENT

C. INFREQUENT CONTRACTIONS

D. PROGRESSIVE CERVICAL DILATION



33

• Answer D is correct. The expected effect

of Pitocin is cervical dilation. Pitocin

causes more intense contractions, which

can increase the pain, making answer Aincorrect. Cervical effacement is caused

by pressure on the presenting part, so

answer B is incorrect. Answer C isopposite the action of Pitocin.



34

• A VAGINAL EXAM REVEALS A FOOTLINGBREECH PRESENTATION. THE NURSESHOULD TAKE WHICH OF THE FOLLOWING

ACTIONS AT THIS TIME?

A. ANTICIPATE THE NEED FOR A CAESAREANSECTION

B. APPLY THE FETAL HEART MONITOR

C. PLACE THE CLIENT IN GENU PECTORALPOSITION

D. PERFORM AN ULTRASOUND EXAM



34

• Answer B is correct. Applying a fetal

heart monitor is the correct action at this

time. There is no need to prepare for a

Caesarean section or to place the client inGenu Pectoral position (knee-chest), so

answers A and C are incorrect. Answer D

is incorrect because there is no need for an ultrasound based on the finding.



35

• A VAGINAL EXAM REVEALS THAT THE CERVIX IS4CM DILATED, WITH INTACT MEMBRANES AND AFETAL HEART TONE RATE OF 160 –170BPM. THENURSE DECIDES TO APPLY AN EXTERNAL FETALMONITOR. THE RATIONALE FOR THISIMPLEMENTATION IS:

A. THE CERVIX IS CLOSED.

B. THE MEMBRANES ARE STILL INTACT.

C. THE FETAL HEART TONES ARE WITHIN NORMAL

LIMITS.D. THE CONTRACTIONS ARE INTENSE ENOUGH FOR

INSERTION OF AN INTERNAL MONITOR.



35

• Answer B is correct. The nurse decides

to apply an external monitor because the

membranes are intact. Answers A, C, and

D are incorrect. The cervix is dilatedenough to use an internal monitor, if

necessary. An internal monitor can be

applied if the client is at 0-station.Contraction intensity has no bearing on

the application of the fetal monitor.



36

• The following are all nursing diagnoses appropriate for a gravida 1 para 0 in labor. Which one would be mostappropriate for the primagravida as she completes theearly phase of labor?

A. IMPAIRED GAS EXCHANGE RELATED TOHYPERVENTILATION

B. ALTERATION IN PLACENTAL PERFUSION RELATEDTO MATERNAL POSITION

C. IMPAIRED PHYSICAL MOBILITY RELATED TO

FETAL-MONITORING EQUIPMENTD. POTENTIAL FLUID VOLUME DEFICIT RELATED TO

DECREASED FLUID INTAKE



36

• Answer D is correct. Clients admitted inlabor are told not to eat during labor, toavoid nausea and vomiting. Ice chips may

be allowed, but this amount of fluid mightnot be sufficient to prevent fluid volumedeficit. In answer A, impaired gasexchange related to hyperventilation would

be indicated during the transition phase. Answers B and C are not correct inrelation to the stem



37

• As the client reaches 8cm dilation, the nursenotes late decelerations on the fetal monitor.The FHR baseline is 165 –175bpm withvariability of 0 –2bpm. What is the most likely

explanation of this pattern? A. THE BABY IS ASLEEP.

B. THE UMBILICAL CORD IS COMPRESSED.

C. THERE IS A VAGAL RESPONSE.D. THERE IS UTEROPLACENTALINSUFFICIENCY



37

• Answer D is correct. This information

indicates a late deceleration. This type of

deceleration is caused by uteroplacental

lack of oxygen. Answer A has no relationto the readings, so it’s incorrect; answer B

results in a variable deceleration; and

answer C is indicative of an earlydeceleration.



38

• THE NURSE NOTES VARIABLEDECELERATIONS ON THE FETALMONITOR STRIP. THE MOST

APPROPRIATE INITIAL ACTIONWOULD BE TO:

A. NOTIFY HER DOCTOR

B. START AN IV

C. REPOSITION THE CLIENT

D. READJUST THE MONITOR



38

• Answer C is correct. The initial action by thenurse observing a late deceleration should turn

the client to the side—preferably, the left side.

Administering oxygen is also indicated. Answer

A might be necessary but not before turning the

client to her side. Answer B is not necessary at

this time. Answer D is incorrect because there is

no data to indicate that the monitor has beenapplied incorrectly.



39

• THE RATIONALE FOR INSERTING A FRENCHCATHETER EVERY HOUR FOR THE CLIENT WITHEPIDURAL ANESTHESIA IS:

A. THE BLADDER FILLS MORE RAPIDLY BECAUSE OFTHE MEDICATION USED FOR THE EPIDURAL.

B. HER LEVEL OF CONSCIOUSNESS IS SUCH THATSHE IS IN A TRANCELIKE STATE.

C. THE SENSATION OF THE BLADDER FILLING ISDIMINISHED OR LOST.

D. SHE IS EMBARRASSED TO ASK FOR THE BEDPANTHAT FREQUENTLY.

39



39

• Answer C is correct. Epidural anesthesiadecreases the urge to void and sensation

of a full bladder. A full bladder will

decrease the progression of labor. Answers A, B, and D are incorrect for the

stem.

40



40

• Ms. L. is admitted to the hospital in labor.Vaginal examination reveals that she is 8 cmdilated. At this point in her labor, which of thefollowing statements would the nurse expecther to make?

• A) I can't decide what to name my baby.

• B) It feels good to push with each contraction.

• C) This isn't as bad as I expected.• D) Take your hand off my stomach when I have

a contraction.

40



40

• The correct answer is D. At 8 cm dilated theclient is in the transition stage of her labor. Many

women experience hyperesthesia of the skin at

this time and would not want to be touched

during a contraction. Transition is the most

difficult stage of labor. The client would not be

trying to decide what to name the baby at this

time. The client would not be instructed to pushuntil the cervix is fully dilated.

41



41

• The nurse is discussing breastfeedingwith a postpartum client. Breastfeeding is

contraindicated in the postpartum client

with: A. DIABETES

B. POSITIVE HIV

C. HYPERTENSION

D. THYROID DISEASE

41



41

• Answer B is correct. Clients with HIVshould not breastfeed because the

infection can be transmitted to the baby

through breast milk. The clients in answers A, C, and D—those with diabetes,

hypertension, and thyroid disease—can be

allowed to breastfeed

42



42

• Mary had a midline episiotomy performedat delivery. The primary purpose of the

episiotomy is to

• A) enlarge the vaginal opening.

• B) allow forceps to be applied.

• C) eliminate the possibility of lacerations.

• D) eliminate the need for cesarean birth.

42



42

• The correct answer is A. An episiotomy isan incision made in the perineum to

enlarge the vaginal opening, allowing

additional room for the birth of the baby. An episiotomy reduces the likelihood of

perineal lacerations but does not eliminate

it. Cesarean birth for women with largebabies is related to the size of the pelvis

not the size of the vaginal opening.

43



43

• A CLIENT TELEPHONES THE EMERGENCY ROOMSTATING THAT SHE THINKS THAT SHE IS INLABOR. THE NURSE SHOULD TELL THE CLIENTTHAT LABOR HAS PROBABLY BEGUN WHEN:

A. HER CONTRACTIONS ARE 2 MINUTES APART.

B. SHE HAS BACK PAIN AND A BLOODY DISCHARGE.

C. SHE EXPERIENCES ABDOMINAL PAIN ANDFREQUENT URINATION.

D. HER CONTRACTIONS ARE 5 MINUTES APART.

43



43

• Answer D is correct. The client should beadvised to come to the labor and delivery unitwhen the contractions are every 5 minutes andconsistent. She should also be told to report to

the hospital if she experiences rupture of membranes or extreme bleeding. She shouldnot wait until the contractions are every 2minutes or until she has bloody discharge, so

answers A and B are incorrect. Answer C is avague answer and can be related to a urinarytract infection.

44



44

• AFTER THE PHYSICIAN PERFORMS AN AMNIOTOMY, THE NURSE'S FIRST

ACTION SHOULD BE TO ASSESS

THE: A. DEGREE OF CERVICAL DILATION

B. FETAL HEART TONES

C. CLIENT'S VITAL SIGNS

D. CLIENT'S LEVEL OF DISCOMFORT

44



44

• Answer B is correct. When the membranesrupture, there is often a transient drop in the fetal

heart tones. The heart tones should return to

baseline quickly. Any alteration in fetal heart

tones, such as bradycardia or tachycardia,

should be reported. After the fetal heart tones

are assessed, the nurse should evaluate the

cervical dilation, vital signs, and level of discomfort, making answers A, C, and D

incorrect.

45



45

• A CLIENT IS ADMITTED TO THE LABOR ANDDELIVERY UNIT. THE NURSE PERFORMS AVAGINAL EXAM AND DETERMINES THATTHE CLIENT'S CERVIX IS 5CM DILATEDWITH 75% EFFACEMENT. BASED ON THENURSE'S ASSESSMENT THE CLIENT IS INWHICH PHASE OF LABOR?

A. ACTIVE

B. LATENT

C. TRANSITIOND. EARLY

45



45

• Answer A is correct. The active phase of labor occurs when the client is dilated 4 –

7cm. The latent or early phase of labor is

from 1cm to 3cm in dilation, so answers Band D are incorrect. The transition phase

of labor is 8 –10cm in dilation, making

answer C incorrect.

46



46

• A NEWBORN WITH NARCOTIC ABSTINENCESYNDROME IS ADMITTED TO THE NURSERY.NURSING CARE OF THE NEWBORN SHOULDINCLUDE:

A. TEACHING THE MOTHER TO PROVIDE TACTILESTIMULATION

B. WRAPPING THE NEWBORN SNUGLY IN A BLANKET

C. PLACING THE NEWBORN IN THE INFANT SEAT

D. INITIATING AN EARLY INFANT-STIMULATION

PROGRAM

46



46

• Answer B is correct. The infant of an addictedmother will undergo withdrawal. Snuglywrapping the infant in a blanket will help preventthe muscle irritability that these babies oftenexperience. Teaching the mother to providetactile stimulation or provide for early infantstimulation are incorrect because he is irritableand needs quiet and little stimulation at this time,so answers A and D are incorrect. Placing the

infant in an infant seat in answer C is incorrectbecause this will also cause movement that canincrease muscle irritability.

47



47

• A CLIENT ELECTS TO HAVE EPIDURAL ANESTHESIA TO RELIEVE THEDISCOMFORT OF LABOR. FOLLOWING THEINITIATION OF EPIDURAL ANESTHESIA,THE NURSE SHOULD GIVE PRIORITY TO:

A. CHECKING FOR CERVICAL DILATION

B. PLACING THE CLIENT IN A SUPINEPOSITION

C. CHECKING THE CLIENT'S BLOODPRESSURE

D. OBTAINING A FETAL HEART RATE

47



47

• Answer C is correct. Following epiduralanesthesia, the client should be checked for hypotension and signs of shock every 5 minutesfor 15 minutes. The client can be checked for

cervical dilation later after she is stable. Theclient should not be positioned supine becausethe anesthesia can move above the respiratorycenter and the client can stop breathing. Fetal

heart tones should be assessed after the bloodpressure is checked. Therefore, answers A, B,and D are incorrect.

48



48

• Mary W.'s baby has just been delivered, andhe weighs 9 lb 10 oz. After the delivery, thenurse notices that Mary is chilly and that her fundus has relaxed. The nurse administers theoxytocin that the physician orders. The nurseknows that it has had the expected effect when

• A) the uterus becomes firm.

• B) Mary states that she feels warmer now.

• C) Mary falls asleep.

• D) the baby cries.

48



48

• The correct answer is A. Oxytoxicmedications such as Pitocin, Methergine,

and Ergotrate are administered to

stimulate uterine contractility and reversefundal relaxation in the postdelivery client

49



49

• A client who delivered this morning tellsthe nurse that she plans to breastfeedher baby. The nurse is aware thatsuccessful breastfeeding is mostdependent on the:

A. MOTHER'S EDUCATIONAL LEVEL

B. INFANT'S BIRTH WEIGHT

C. SIZE OF THE MOTHER'S BREAST

D. MOTHER'S DESIRE TO BREASTFEED

49



49

• Answer D is correct. Success withbreastfeeding depends on many factors,but the most dependable reason for success is desire and willingness tocontinue the breastfeeding until the infantand mother have time to adapt. Theeducational level, the infant’s birth weight,

and the size of the mother’s breast havenothing to do with success, so answers A,B, and C are incorrect.

50



50

• THE NURSE IS MONITORING THEPROGRESS OF A CLIENT IN LABOR. WHICHFINDING SHOULD BE REPORTED TO THEPHYSICIAN IMMEDIATELY?

A. THE PRESENCE OF SCANT BLOODYDISCHARGE

B. FREQUENT URINATION

C. THE PRESENCE OF GREEN-TINGED AMNIOTIC FLUID

D. MODERATE UTERINE CONTRACTIONS

50



50

• Answer C is correct. Green-tingedamniotic fluid is indicative of meconium

staining. This finding indicates fetal

distress. The presence of scant bloodydischarge is normal, as are frequent

urination and moderate uterine

contractions, making answers A, B, and Dincorrect.

51



51

• THE NURSE IS MEASURING THE DURATION OF THE CLIENT'SCONTRACTIONS. WHICH STATEMENT IS TRUE REGARDINGTHE MEASUREMENT OF THE DURATION OF CONTRACTIONS?

A. DURATION IS MEASURED BY TIMING FROM THE BEGINNINGOF ONE CONTRACTION TO THE BEGINNING OF THE NEXTCONTRACTION.

B. DURATION IS MEASURED BY TIMING FROM THE END OF ONECONTRACTION TO THE BEGINNING OF THE NEXTCONTRACTION.

C. DURATION IS MEASURED BY TIMING FROM THE BEGINNINGOF ONE CONTRACTION TO THE END OF THE SAMECONTRACTION.

D. DURATION IS MEASURED BY TIMING FROM THE PEAK OFONE CONTRACTION TO THE END OF THE SAMECONTRACTION.

51



51

• Answer C is correct. Duration ismeasured from the beginning of one

contraction to the end of the same

contraction. Answer A refers to frequency. Answer B is incorrect because we do not

measure from the end of one contraction

to the beginning of the next contraction.Duration is not measured from the peak of

the contraction to the end, as stated in D.

52



52

• THE PHYSICIAN HAS ORDERED ANINTRAVENOUS INFUSION OF PITOCIN FORTHE INDUCTION OF LABOR. WHEN CARINGFOR THE OBSTETRIC CLIENT RECEIVING

INTRAVENOUS PITOCIN, THE NURSESHOULD MONITOR FOR:

A. MATERNAL HYPOGLYCEMIA

B. FETAL BRADYCARDIA

C. MATERNAL HYPERREFLEXIA

D. FETAL MOVEMENT

52



52

• Answer B is correct. The client receivingPitocin should be monitored for

decelerations. There is no association with

Pitocin use and hypoglycemia, maternalhyperreflexia, or fetal movement;

therefore, answers A, C, and D are

incorrect.

53



53

• A CLIENT WITH A MISSED ABORTION AT 29 WEEKS GESTATION IS ADMITTED TO THE HOSPITAL. THECLIENT WILL MOST LIKELY BETREATED WITH:

A. MAGNESIUM SULFATE

B. CALCIUM GLUCONATE

C. DINOPROSTONE (PROSTIN E.)

D. BROMOCRYSTINE (PARDEL)

53



53

• Answer C is correct. The client with a missedabortion will have induction of labor. Prostin E. is

a form of prostaglandin used to soften the cervix.

Magnesium sulfate is used for preterm labor and

preeclampsia, calcium gluconate is the antidote

for magnesium sulfate, and Pardel is a

dopamine receptor stimulant used to treat

Parkinson’s disease; therefore, answers A, B,and D are incorrect. Pardel was used at one

time to dry breast milk.

54



54

• Jane S. is a gravida 1, in the active phase of stage 1 labor. The fetal position is LOA. WhenJane's membranes rupture, the nurse shouldexpect to see

• A) a moderate amount of clear to straw-coloredfluid.

• B) a large amount of bloody fluid.

• C) a small amount of greenish fluid.

• D) a small segment of the umbilical cord.

54



54

• The correct answer is A. With the baby ina vertex, LOA presentation and no other

indicators of distress, amniotic fluid should

have a clear to straw-colored appearance.Too much or too little amniotic fluid may

be an indication of congenital anomalies in

the fetus.

55



55

• THE NURSE IS RESPONSIBLE FORPERFORMING A NEONATAL

ASSESSMENT ON A FULL-TERMINFANT. AT 1 MINUTE, THE NURSECOULD EXPECT TO FIND:

A. AN APICAL PULSE OF 100

B. AN ABSENCE OF TONUS

C. CYANOSIS OF THE FEET AND HANDS

D. JAUNDICE OF THE SKIN AND SCLERA

55



55

• Answer C is correct. Cyanosis of the feetand hands is acrocyanosis. This is a

normal finding 1 minute after birth. An

apical pulse should be 120 –160, and thebaby should have muscle tone, making

answers A and B incorrect. Jaundice

immediately after birth is pathological jaundice and is abnormal, so answer D is

incorrect.

56



56

• The nurse is caring for a woman in stage1 labor. The fetal position is LOA. Whenher membranes rupture, the nurse's firstaction should be to

• A) measure the amount of fluid.

• B) perform a vaginal examination.

• C) count the fetal heart rate.

• D) notify the physician.

56



56

• The correct answer is C. Immediately after the rupture of membranes, fetal heart

tones are checked, then checked again

after the next contraction or after 5-10minutes. With the fetus in a LOA

presentation, there is less chance for a

prolapsed cord. However, if the FHR dropssignificantly at any of the above times, a

sterile vaginal exam is indicated.

57



57

• A full-term male has hypospadias. Whichstatement describes hypospadias?

A. THE URETHRAL OPENING IS ABSENT.

B. THE URETHRA OPENS ON THE DORSALSIDE OF THE PENIS.

C. THE PENIS IS SHORTER THAN USUAL.

D. THE URETHRA OPENS ON THE VENTRAL

SIDE OF THE PENIS.

57



57

• Answer B is correct. Hypospadia is acondition in which there is an opening on

the dorsal side of the penis. Answer A is

incorrect because hypospadia does notconcern the urethral opening. Answer C is

incorrect because the size of the penis is

not affected. Answer D is incorrectbecause the opening is on the dorsal side,

not the ventral side.

58



58

• A GRAVIDA III PARA II IS ADMITTED TO THE LABORUNIT. VAGINAL EXAM REVEALS THAT THECLIENT'S CERVIX IS 8CM DILATED, WITHCOMPLETE EFFACEMENT. THE PRIORITYNURSING DIAGNOSIS AT THIS TIME IS:

A. ALTERATION IN COPING RELATED TO PAIN

B. POTENTIAL FOR INJURY RELATED TOPRECIPITATE DELIVERY

C. ALTERATION IN ELIMINATION RELATED TO

ANESTHESIAD. POTENTIAL FOR FLUID VOLUME DEFICIT RELATED

TO NPO STATUS

58



58

• Answer A is correct. Transition is thetime during labor when the client loses

concentration due to intense contractions.

Potential for injury related to precipitatedelivery has nothing to do with the dilation

of the cervix, so answer B is incorrect.

There is no data to indicate that the clienthas had anesthesia or fluid volume deficit,

making answers C and D incorrect.

59



59

• During the assessment of a laboring client, thenurse notes that the FHT are loudest in theupper-right quadrant. The infant is most likely inwhich position?

A. RIGHT BREECH PRESENTATIONB. RIGHT OCCIPITAL ANTERIOR

PRESENTATION

C. LEFT SACRAL ANTERIOR PRESENTATION

D. LEFT OCCIPITAL TRANSVERSEPRESENTATION

59



59

• Answer A is correct. If the fetal heart tones areheard in the right upper abdomen, the infant is ina breech presentation. If the infant is positionedin the right occipital anterior presentation, the

FHTs will be located in the right lower quadrant,so answer B is incorrect. If the fetus is in thesacral position, the FHTs will be located in thecenter of the abdomen, so answer C is incorrect.

If the FHTs are heard in the left lower abdomen,the infant is most likely in the left occipitaltransverse position, making answer D incorrect.

60



60

• THE NURSE IS PROVIDING POSTPARTUMTEACHING FOR A MOTHER PLANNING TOBREASTFEED HER INFANT. WHICH OF THECLIENT'S STATEMENTS INDICATES THENEED FOR ADDITIONAL TEACHING?

A. "I'M WEARING A SUPPORT BRA."B. "I'M EXPRESSING MILK FROM MY BREAST."

C. "I'M DRINKING FOUR GLASSES OF FLUIDDURING A 24-HOUR PERIOD."

D. "WHILE I'M IN THE SHOWER, I'LL ALLOWTHE WATER TO RUN OVER MY BREASTS."

60



60

• Answer C is correct. Mothers who plan tobreastfeed should drink plenty of liquids, andfour glasses is not enough in a 24-hour period.Wearing a support bra is a good practice for themother who is breastfeeding as well as the

mother who plans to bottle-feed, so answer A isincorrect. Expressing milk from the breast willstimulate milk production, making answer Bincorrect. Allowing the water to run over thebreast will also facilitate "letdown," when the milkbegins to be produced; thus, answer D isincorrect.

61



61

• WHILE ASSESSING THE POSTPARTALCLIENT, THE NURSE NOTES THAT THEFUNDUS IS DISPLACED TO THE RIGHT.BASED ON THIS FINDING, THE NURSE

SHOULD: A. ASK THE CLIENT TO VOID

B. ASSESS THE BLOOD PRESSURE FORHYPOTENSION

C. ADMINISTER OXYTOCIN

D. CHECK FOR VAGINAL BLEEDING

61



61

• Answer A is correct. If the nurse checks thefundus and finds it to be displaced to the right or

left, this is an indication of a full bladder. This

finding is not associated with hypotension or

clots, as stated in answer B. Oxytoxic drugs(Pitocin) are drugs used to contract the uterus,

so answer C is incorrect. It has nothing to do

with displacement of the uterus. Answer D is

incorrect because displacement is associated

with a full bladder, not vaginal bleeding.

62



62

• AN OBSTETRIC CLIENT IS ADMITTEDWITH DEHYDRATION. WHICH IVFLUID WOULD BE MOST

APPROPRIATE FOR THE CLIENT?

A. .45 NORMAL SALINE

B. DEXTROSE 1% IN WATER

C. LACTATED RINGER'S

D. DEXTROSE 5% IN .45 NORMALSALINE

62



6

• Answer A is correct. The best IV fluid for correction of dehydration is normal saline

because it is most like normal serum.

Dextrose pulls fluid from the cell, lactatedRinger’s contains more electrolytes than

the client’s serum, and dextrose with

normal saline will also alter the

intracellular fluid. Therefore, answers B, C,

and D are incorrect.

63



• The nurse is performing an initialassessment of a newborn Caucasianmale delivered at 32 weeks gestation.The nurse can expect to find thepresence of:

A. MONGOLIAN SPOTS

B. SCROTAL RUGAE

C. HEAD LAG

D. VERNIX CASEOSA

63



• Answer C is correct. The infant who is 32weeks gestation will not be able to controlhis head, so head lag will be present.Mongolian spots are common in African

American infants, not Caucasian infants;the client at 32 weeks will have scrotalrugae or redness but will not have vernix

caseosa, the cheesy appearing coveringfound on most full-term infants. Therefore,answers A, B, and D are incorrect.

64



• AN INFANT'S APGAR SCORE IS 9 AT 5MINUTES. THE NURSE IS AWARE THAT

THE MOST LIKELY CAUSE FOR THE

DEDUCTION OF ONE POINT IS:

A. THE BABY IS COLD.

B. THE BABY IS EXPERIENCING

BRADYCARDIA.

C. THE BABY'S HANDS AND FEET ARE BLUE.D. THE BABY IS LETHARGIC.

64



• Answer C is correct. Infants with an Apgar of 9 at 5 minutes most likely have

acryocyanosis, a normal physiologic

adaptation to birth. It is not related to theinfant being cold, experiencing

bradycardia, or being lethargic; thus,

answers A, B, and D are incorrect.

65



• The infant is admitted to the unit withtetrology of falot. The nurse would

anticipate an order for which medication?

A. DIGOXINB. EPINEPHRINE

C. AMINOPHYLINE

D. ATROPINE

65



• Answer A is correct. The infant withtetrology of falot has five heart defects. He

will be treated with digoxin to slow and

strengthen the heart. Epinephrine,aminophyline, and atropine will speed the

heart rate and are not used in this client;

therefore, answers B, C, and D are

incorrect.

67



• The nurse is caring for a woman who is

admitted to the hospital in active labor.What information is most important for thenurse to assess to avoid respiratorycomplications during labor and delivery?

• A) Family history of lung disease.

• B) Food or drug allergies.

• C) When the client last ate.

• D) Number of cigarettes smoked daily.

67



• The correct answer is C. Gastric motility isdecreased in pregnancy. Food eaten severalhours prior to the onset of labor may still be inthe stomach undigested. This will influence thetype of anesthesia the client may receive. Client

history of lung disease would be more importantthan family history at this time. Information onfood or drug allergies will not help avoidrespiratory complications during labor.Information on the number of cigarettes smokedper day will not help avoid respiratorycomplications during labor.

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