OBSTETRICAL NURSING PRACTICE TEST PART 1

1. Which of the following client statements indicates that the nurse's teaching about oral contraceptive agents has been successful?

A. "Despite their effectiveness, about 25% of women stop taking them after 1 year."

B. "These agents usually only cause a few minor side effects when you take them."

C. "Oral contraceptives inhibit ovulation and change the consistency of cervical mucus."

D. "I can make these drugs more effective by monitoring my basal body temperature."

2. A client's gestational diabetes is poorly controlled throughout her pregnancy. She goes into labor at 38 weeks and delivers a boy. Which priority intervention should be included in the care plan for the neonate during his first 24 hours?

A. Administer insulin subcutaneously.B. Administer a bolus of glucose I.V.C. Provide frequent early feedings with formula.D. Avoid oral feedings.

3. Which finding is considered normal in a neonate during the first few days after birth?

A. Weight loss of 25%B. Birth weight of 2,000 to 2,500 gC. Weight loss then return to birth weightD. Weight gain of 25%

4. The physician prescribes clomiphene citrate (Clomid) for a woman who has been having difficulty getting pregnant. When teaching the client about this drug's potential side effects, which of the following would the nurse include in the teaching plan?

A. Multiple pregnancies.B. Increase in spontaneous abortions.C. Increase in fibrocystic breast disease.D. Increase in congenital anomalies.

5. Early detection of an ectopic pregnancy is paramount in preventing a life-threatening rupture. Which symptoms should alert the nurse to the possibility of an ectopic pregnancy?

A. Abdominal pain, vaginal bleeding, and a positive pregnancy testB. Hyperemesis and weight lossC. Amenorrhea and a negative pregnancy testD. Copious discharge of clear mucus and prolonged epigastric pain

6. After the nurse instructs a client who is scheduled for in vitro fertilization (IVF) about the procedure, which of the following statements by the client indicates to the nurse that the instructions have been successful?

A. "I know that the chances of getting pregnant with this procedure are about 50%."

B. "I'll need to receive a series of estrogen injections after I have the procedure."

C. "After fertilization, three or four embryos will be transferred through the cervix."

D. "My risk for a multiple births is less with this procedure than with the GIFT procedure."

7. On the 9th postpartum day, a client breast-feeding her neonate experiences pain, redness, and swelling of her left breast. She's diagnosed with mastitis. The nurse teaching the client how to care for her infected breast should include which information?

A. Wear a loose-fitting bra to avoid constricting the milk ducts.B. Stop breast-feeding permanently.C. Take antibiotics until the pain is relieved.D. Use a warm moist compress over the painful area.

8. A 20-year-old client, having missed one menstrual period, visits the prenatal clinic because she suspects that she is pregnant. Besides amenorrhea, the client tells the nurse that she has experienced nausea and vomiting, urinary frequency, and fatigue. The nurse determines that the client has been experiencing signs of pregnancy categorized as which of the following?

A. Presumptive.B. Probable.C. Positive.D. Predictive.

9. The nurse is assessing a client who gave birth yesterday. Where should the nurse expect to find the top of the client's fundus?

A. One fingerbreadth above the umbilicusB. One fingerbreadth below the umbilicusC. At the level of the umbilicusD. Below the symphysis pubis

10. A client who tells the nurse that she would like to use the basal body temperature method for family planning receives instructions about the method. Which of the following client statements indicates to the nurse that the teaching has been successful?

A. "When my temperature remains elevated for 7 days, ovulation has occurred."

B. "Taking my temperature in the evening just after dinner or before I go to bed is best."

C. "Because this method is not very effective, I should use other forms of contraception too."

D. "It's important to take my temperature at about the same time every morning before arising."

11. The nurse is helping to prepare a client for discharge following childbirth. During a teaching session, the nurse instructs the client to do Kegel exercises. What's the purpose of these exercises?

A. To prevent urine retentionB. To relieve lower back painC. To tone the abdominal musclesD. To strengthen the perineal muscles

12. The client, 11 weeks pregnant, tells the nurse that she has been vomiting after breakfast nearly every morning. Which of the following measures should the nurse suggest to help the client cope with early morning nausea and vomiting?

A. Limiting fluid intake between meals.B. Increasing her intake of high-fat foods.C. Eating dry, unsalted crackers before arising.D. Drinking a carbonated beverage before bedtime.

13. The nurse is using Doppler ultrasound to assess a pregnant woman. When should the nurse expect to hear fetal heart tones?

A. 7 weeksB. 11 weeksC. 17 weeksD. 21 weeks

14. A client asks, "Can my partner and I still engage in sexual intercourse while I'm pregnant?" The nurse's response is based on which of the following?

A. Throughout the pregnancy, coitus interruptus is the preferred method for sexual activity.

B. Although sexual desire may change, intercourse is safe during an uncomplicated pregnancy.

C. Engaging in intercourse must be avoided until the client is at least 16 weeks pregnant.

D. The couple should refrain from engaging in sexual intercourse during the last trimester.

15. The nurse is planning care for a 16-year-old client in the prenatal clinic. Adolescents are prone to which complication during pregnancy?

A. Iron deficiency anemiaB. VaricositiesC. Nausea and vomitingD. Gestational diabetes

16. When explaining to a pregnant client about the need to take supplemental vitamins with iron during her pregnancy, the nurse would instruct the client to take the iron with which of the following to promote maximum absorption?

A. Milk.B. Tea.C. Hot chocolate.D. Orange juice.

17. The nurse is caring for a 16-year-old pregnant client. The client is taking an iron supplement. What should this client drink to increase the absorption of iron?

A. A glass of milkB. A cup of hot teaC. A liquid antacidD. A glass of orange juice

18. A client asks the nurse why vitamin C intake is so important during pregnancy. Which of the following would be the nurse's best response?

A. "Vitamin C is required to promote blood clot and collagen formation."B. "Supplemental vitamin C in large doses can prevent neural tube

defects."C. "Eating moderate amounts of foods high in vitamin C helps metabolize

fats and carbohydrates."D. "Studies have shown that vitamin C helps the growth of fetal bones."

19. The nurse is caring for a client who is on ritodrine therapy to halt premature labor. What condition indicates an adverse reaction to ritodrine therapy?

A. HypoglycemiaB. CracklesC. BradycardiaD. Hyperkalemia

20. A pregnant client tells the nurse that she has been having discomfort from her hemorrhoids. After giving instruction about strategies to decrease the discomfort, which of the following client

statements would alert the nurse to the need for additional instruction?

A. "I'll avoid straining to have a bowel movement."B. "I'll be sure to change positions frequently during the day."C. "I'll stop using my prescribed iron supplements."D. "I'll use warm sitz baths frequently during the day."

21. The nurse is caring for a client in her 34th week of pregnancy who wears an external monitor. Which statement by the client would indicate an understanding of the nurse's teaching?

A. "I'll need to lie perfectly still."B. "You won't need to come in and check on me while I'm wearing this

monitor."C. "I can lie in any comfortable position, but I should stay off my back."D. "I know that the external monitor increases my risk of a uterine

infection."

22. After the nurse instructs a pregnant client about swimming and bathing during pregnancy, which of the following client statements indicates the need for additional teaching?

A. "I can continue to swim as long as my membranes aren't ruptured."B. "I can relax in a hot tub for about 20 minutes after swimming."C. "I can take a bath daily but should be careful not to fall."D. "I should avoid sitting in a sauna for prolonged periods."

23. The nurse is developing a care plan for a client in her 34th week of gestation who is experiencing premature labor. What nonpharmacologic intervention should the plan include to halt premature labor?

A. Encouraging ambulationB. Serving a nutritious dietC. Promoting adequate hydrationD. Performing nipple stimulation

24. When the nurse instructs a pregnant client with a history of varicose veins about strategies to promote comfort, which of the following client statements indicates that the teaching has been successful?

A. "Lying down with my feet elevated should help."B. "Support hose can be put on just before bedtime."C. "Restricting milk intake may provide some relief."D. "Wearing knee-high stockings is better than pantyhose."

25. A client treated for premature labor is ready for discharge. Which instruction should the nurse include in the discharge teaching plan?

A. Report a heart rate greater than 120 beats/minute to the physician.B. Take terbutaline every 4 hours, during waking hours only.C. Call the physician if the fetus moves 10 times in 1 hour.D. Increase activity daily if not fatigued.

26. A primigravida, admitted to the hospital at 12 weeks' gestation complaining of abdominal cramping, exhibits bright red vaginal spotting without cervical dilation. The nurse determines that the client is most likely experiencing which of the following types of abortion?

A. Missed.B. Threatened.C. Inevitable.D. Complete.

27. The nurse is caring for a client in labor. Which assessment finding indicates fetal distress?

A. Lack of meconium stainingB. Early decelerations in fetal heart rate during contractionsC. An increase in fetal heart rate with fetal scalp stimulationD. Fetal blood pH less than 7.20

28. A pregnant woman states that she frequently ingests laundry starch. When assessing the client, for which of the following should the nurse be alert?

A. Muscle spasms.B. Lactose intolerance.C. Diabetes mellitus.D. Anemia.

29. The nurse is assessing a woman in labor. Her cervix is dilated 8 cm. Her contractions are occurring every 2 minutes. She's irritable and in considerable pain. What type of breathing should the nurse instruct the woman to use during the peak of a contraction?

A. Deep breathingB. Shallow chest breathingC. Deep, cleansing breathsD. Chest panting

30. A 26-year-old primigravida visiting the prenatal clinic for her regular visit at 34 weeks' gestation tells the nurse that she takes mineral oil for occasional constipation. The nurse should instruct the client to do which of the following?

A. Take the mineral oil with fruit juice to increase the action of the mineral oil.

B. Avoid mineral oil because it interferes with the absorption of fat-soluble vitamins.

C. Avoid mineral oil because it can lead to vitamin C deficiency in pregnant clients.

D. Use the mineral oil regularly on a weekly basis to prevent constipation.

31. The nurse is caring for a woman receiving a lumbar epidural anesthetic block to control labor pain. What should the nurse do to prevent hypotension?

A. Administer ephedrine to raise her blood pressure.B. Administer oxygen using a mask.C. Place the woman flat on her back with her legs raised.D. Ensure adequate hydration before the anesthetic is administered.

32. Which of the following drugs would the nurse expect to administer to the client receiving intravenous magnesium sulfate for pregnancy-induced hypertension if the client develops magnesium toxicity?

A. Calcium gluconate.B. Diazepam (Valium).C. Phenytoin (Dilantin).D. Furosemide (Lasix).

33. A woman in labor shouts to the nurse, "My baby is coming right now! I feel like I have to push!" An immediate nursing assessment reveals that the head of the fetus is crowning. After asking another staff member to notify the physician and setting up for delivery, which nursing intervention is most appropriate?

A. Gently pulling at the neonate 's head as it's deliveredB. Holding the neonate 's head back until the physician arrivesC. Applying gentle pressure to the neonate 's head as it's deliveredD. Placing the mother in a Trendelenburg position until the physician

arrives

34. Which of the following would the nurse expect to administer as the drug of choice to a pregnant client with chronic hypertension?

A. Phenobarbital.B. Diazepam (Valium).C. Methyldopa (Aldomet).D. Magnesium sulfate.

35. The nurse is caring for a client who is in labor. The physician still isn't present. After the neonate's head is delivered, which nursing intervention would be most appropriate?

A. Checking for the umbilical cord around the neonate 's neckB. Placing antibiotic ointment in the neonate 's eyesC. Turning the neonate's head to the side, to drain secretionsD. Assessing the neonate for respirations

36. Which of the following would the nurse most likely expect to find when assessing a pregnant client with abruptio placenta?

A. Excessive vaginal bleeding.B. Rigid, boardlike abdomen.C. Tetanic uterine contractions.D. Premature rupture of membranes.

37. The nurse is caring for a client during the first postpartum day. The client asks the nurse how to relieve pain from her episiotomy. What should the nurse instruct the woman to do?

A. Apply an ice pack to her perineum.B. Take a Sitz bath.C. Perform perineal care after voiding or a bowel movement.D. Drink plenty of fluids.

38. A pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the nurse tells the client that the usual treatment for partial placenta previa is which of the following?

A. Activity limited to bed rest.B. Platelet infusion.C. Immediate cesarean delivery.D. Labor induction with oxytocin.

39. The nurse is assessing a client on the second postpartum day. Under normal circumstances, the tone and location of the client's fundus is:

A. soft and one fingerbreadth below the umbilicus.B. firm and two fingerbreadths below the umbilicus.C. firm and to the right or left of midline.D. soft and at the level of the umbilicus.

40. Which of the following would the nurse use to assess a client for possible uterine atony after a cesarean delivery?

A. Check the abdominal dressing every 15 minutes for the first hour.B. Palpate the fundus every 15 minutes for at least 1 hour.C. Observe the amount of lochia immediately after delivery.D. Assess blood pressure and pulse every 15 minutes for 1 hour.

41. A 23-year-old primigravida delivers a healthy 3090.1-g boy by vaginal delivery. During an assessment the next day, the nurse is examining her lower extremities for signs and symptoms of thrombophlebitis. Which of the following signs should be assessed?

A. Chadwick's signB. Hegar's signC. Homans' signD. Goodell's sign

42. The nurse is caring for a client after evacuation of a hydatidiform molar pregnancy. The nurse should instruct the client to:

A. wait 1 month before trying to become pregnant again.B. make an appointment for follow-up human chorionic gonadotropin

(hCG) level monitoring at the end of 1 year.C. discuss options for sterilization with the physician.D. use birth control for at least 1 year.

43. A client with hyperemesis gravidarum is on a clear liquid diet. The nurse should serve this client:

A. milk and ice pops.B. decaffeinated coffee and scrambled eggs.C. tea and gelatin dessert.D. apple juice and oatmeal.

44. What's the best way to teach new parents about the care of their neonate?

A. Relate stories of other parents' experiences.B. Focus on the behavior of their own neonate.C. Show videotapes about neonate care.D. Distribute literature with photographs of neonate-care skills.

45. When monitoring the laboratory studies of a pregnant client receiving terbutaline (Brethine) therapy, which of the following would lead the nurse to suspect that the client's blood plasma volume has increased?

A. Decreased hematocrit level.B. Glycosuria.C. Hyperkalemia.D. Increased serum calcium levels.

46. The nurse is caring for a client on her second postpartum day. The nurse should expect the client's lochia to be:

A. red and moderate.B. continuous with red clots.

C. brown and scant.D. thin and white.

47. The nurse is caring for a client in labor. The external fetal monitor shows a pattern of variable decelerations in fetal heart rate. What should the nurse do first?

A. Change the client's position.B. Prepare for emergency cesarean delivery.C. Check for placenta previa.D. Administer oxygen.

48. The nurse is teaching a client how to perform perineal care to reduce the risk of puerperal infection. Which activity indicates that the client understands proper perineal care?

A. Using a peri bottle to clean the perineum after each voiding or bowel movement

B. Cleaning the perineum from back to front after a bowel movementC. Spraying water from peri bottle into the vaginaD. Changing perineal pads every 8 hours

49. A woman in her 8th month of pregnancy is having dinner with her husband at their favorite restaurant. The woman suddenly chokes on a piece of chicken and appears to lose consciousness. What would be the best action by a nurse sitting at the next table?

A. Apply abdominal thrust.B. Apply chest thrust.C. Begin cardiopulmonary resuscitation (CPR).D. Reposition the client on her side.

50. A client with type 1 diabetes mellitus is pregnant for the second time. Her previous pregnancy ended in spontaneous abortion at 18 weeks' gestation. She's now at 22 weeks' gestation. The nurse is responsible for teaching the client about exercise during her pregnancy. Which of the following statements indicates that the client has an appropriate understanding of her exercise needs?

A. "I know I need to walk with a friend or family member."B. "I know I need to vary the times of day when I exercise."C. "I know I need to exercise before meals."D. "I know I need to drink fluids while I walk."

END OF OBSTETRICAL NURSING PRACTICE EXAM PART 1

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