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1. Accompanied by her husband, a patient seeks admission to the labor and delivery
area. The client states that she is in labor and says she attended the hospital clinic
for prenatal care. Which question should the nurse ask her first?
A. Do you have any chronic illness?
B. Do you have any allergies?
C. What is your expected due date?
D. Who will be with you during labor?
2. A patient is in the second stage of labor. During this stage, how frequently should
the nurse in charge assess her uterine contractions?
A. Every 5 minutes
B. Every 15 minutes
C. Every 30 minutes
D. Every 60 minutes
3. A patient is in her last trimester of pregnancy. Nurse Vickie should instruct her to
notify her primary health care provider immediately if she notices:
A. Blurred vision
B. Hemorrhoids
C. Increased vaginal mucus
D. Shortness of breath on exertion
4. The nurse in-charge is reviewing a patients prenatal history. Which finding
indicates a genetic risk factor?
A. The patient is 25 years old
B. The patient has a child with cystic fibrosis
C. The patient was exposed to rubella at 36 weeks gestation
D. The patient has a history of preterm labor at 32 weeks gestation

5. A adult female patient is using the rhythm (calendar-basal body temperature)

method of family planning. In this method, the unsafe period for sexual intercourse is
indicated by:
A. Return preovulatory basal body temperature
B. Basal body temperature increase of 0.1 degrees to 0.2 degrees on the 2nd or 3rd day of
cycle
C. 3 full days of elevated basal body temperature and clear, thin cervical mucus
D. Breast tenderness and mittelschmerz
6. During a nonstress test (NST), the electronic tracing displays a relatively flat line
for fetal movement, making it difficult to evaluate the fetal heart rate (FHR). To mark
the strip, the nurse in charge should instruct the client to push the control button at
which time?
A. At the beginning of each fetal movement
B. At the beginning of each contraction
C. After every three fetal movements
D. At the end of fetal movement
7. When evaluating a clients knowledge of symptoms to report during her pregnancy,
which statement would indicate to the nurse in charge that the client understands the
information given to her?
A. Ill report increased frequency of urination.
B. If I have blurred or double vision, I should call the clinic immediately.
C. If I feel tired after resting, I should report it immediately.
D. Nausea should be reported immediately.
8. When assessing a client during her first prenatal visit, the nurse discovers that the
client had a reduction mammoplasty. The mother indicates she wants to breast-feed.
What information should the nurse give to this mother
regarding breastfeedingsuccess?
A. Its contraindicated for you to breastfeed following this type of surgery.
B. I support your commitment; however, you may have to supplement each feeding with

formula.
C. You should check with your surgeon to determine whether breast-feeding would be
possible.
D. You should be able to breastfeed without difficulty.
9. Following a precipitous delivery, examination of the clients vagina reveals a
fourth-degree laceration. Which of the following would be contraindicated when
caring for this client?
A. Applying cold to limit edema during the first 12 to 24 hours
B. Instructing the client to use two or more peri pads to cushion the area
C. Instructing the client on the use of sitz baths if ordered
D. Instructing the client about the importance of perineal (Kegel) exercises
10. A client makes a routine visit to the prenatal clinic. Although she is 14 weeks
pregnant, the size of her uterus approximates that in an 18- to 20-week pregnancy. Dr.
Charles diagnoses gestational trophoblastic disease and orders ultrasonography.
The nurse expects ultrasonography to reveal:
A. an empty gestational sac.
B. grapelike clusters.
C. a severely malformed fetus.
D. an extrauterine pregnancy.
11. After completing a second vaginal examination of a client in labor, the nursemidwife determines that the fetus is in the right occiput anterior position and at (1)
station. Based on these findings, the nurse-midwife knows that the fetal presenting
part is:
A. 1 cm below the ischial spines.
B. directly in line with the ischial spines.
C. 1 cm above the ischial spines.
D. in no relationship to the ischial spines.
12. Which of the following would be inappropriate to assess in a mother whos
breastfeeding?

A. The attachment of the baby to the breast.

B. The mothers comfort level with positioning the baby.
C. Audible swallowing.
D. The babys lips smacking
13. During a prenatal visit at 4 months gestation, a pregnant client asks whether tests
can be done to identify fetal abnormalities. Between 18 and 40 weeks gestation,
which procedure is used to detect fetal anomalies?
A. Amniocentesis.
B. Chorionic villi sampling.
C. Fetoscopy.
D. Ultrasound
14. A client, 30 weeks pregnant, is scheduled for a biophysical profile (BPP) to
evaluate the health of her fetus. Her BPP score is 8. What does this score indicate?
A. The fetus should be delivered within 24 hours.
B. The client should repeat the test in 24 hours.
C. The fetus isnt in distress at this time.
D. The client should repeat the test in 1 week.
15. A client who is 36 weeks pregnant comes to the clinic for a prenatal checkup. To
assess the clients preparation for parenting, the nurse might ask which question?
A. Are you planning to have epidural anesthesia?
B. Have you begun prenatal classes?
C. What changes have you made at home to get ready for the baby?
D. Can you tell me about the meals you typically eat each day?
16. A client whos admitted to labor and delivery has the following assessment
findings: gravida 2 para 1, estimated 40 weeks gestation, contractions 2 minutes
apart, lasting 45 seconds, vertex +4 station. Which of the following would be the
priority at this time?

A. Placing the client in bed to begin fetal monitoring.

B. Preparing for immediate delivery.
C. Checking for ruptured membranes.
D. Providing comfort measures.
17. 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 clients position.
B. Prepare for emergency cesarean section.
C. Check for placenta previa.
D. Administer oxygen.
18. The nurse in charge is caring for a postpartum client who had a vaginal delivery
with a midline episiotomy. Which nursing diagnosis takes priority for this client?
A. Risk for deficient fluid volume related to hemorrhage
B. Risk for infection related to the type of delivery
C. Pain related to the type of incision
D. Urinary retention related to periurethral edema
19. Which change would the nurse identify as a progressive physiological change in
postpartum period?
A. Lactation
B. Lochia
C. Uterine involution
D. Diuresis
20. A 39-year-old at 37 weeks gestation is admitted to the hospital with complaints of
vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is
most likely causing the clients complaint of vaginal bleeding?
A. Placenta previa
B. Abruptio placentae

C. Ectopic pregnancy
D. Spontaneous abortion
21. A client with type 1 diabetes mellitus who is a multigravida visits the clinic at 27
weeks gestation. The nurse should instruct the client that for most pregnant women
with type 1 diabetes mellitus:
A. Weekly fetal movement counts are made by the mother.
B. Contraction stress testing is performed weekly.
C. Induction of labor is begun at 34 weeks gestation.
D. Nonstress testing is performed weekly until 32 weeks gestation
22. When administering magnesium sulfate to a client with preeclampsia, the nurse
understands that this drug is given to:
A. Prevent seizures
B. Reduce blood pressure
C. Slow the process of labor
D. Increase dieresis
23. What is the approximate time that the blastocyst spends traveling to the uterus
for implantation?
A. 2 days
B. 7 days
C. 10 days
D. 14 weeks
24. After teaching a pregnant woman who is in labor about the purpose of the
episiotomy, which of the following purposes stated by the client would indicate to the
nurse that the teaching was effective?
A. Shortens the second stage of labor
B. Enlarges the pelvic inlet
C. Prevents perineal edema
D. Ensures quick placenta delivery

25. A primigravida client at about 35 weeks gestation in active labor has had no
prenatal care and admits to cocaine use during the pregnancy. Which of the following
persons must the nurse notify?
A. Nursing unit manager so appropriate agencies can be notified
B. Head of the hospitals security department
C. Chaplain in case the fetus dies in utero
D. Physician who will attend the delivery of the infant
26. When preparing a teaching plan for a client who is to receive a rubella vaccine
during the postpartum period, the nurse in charge should include which of the
following?
A. The vaccine prevents a future fetus from developing congenital anomalies
B. Pregnancy should be avoided for 3 months after the immunization
C. The client should avoid contact with children diagnosed with rubella
D. The injection will provide immunity against the 7-day measles.
27. A client with eclampsia begins to experience a seizure. Which of the following
would the nurse in charge do first?
A. Pad the side rails
B. Place a pillow under the left buttock
C. Insert a padded tongue blade into the mouth
D. Maintain a patent airway
28. While caring for a multigravida client in early labor in a birthing center, which of
the following foods would be best if the client requests a snack?
A. Yogurt
B. Cereal with milk
C. Vegetable soup
D. Peanut butter cookies

29. The multigravida mother with a history of rapid labor who us in active labor calls
out to the nurse, The baby is coming! which of the following would be the nurses
first action?
A. Inspect the perineum
B. Time the contractions
C. Auscultate the fetal heart rate
D. Contact the birth attendant
30. While assessing a primipara during the immediate postpartum period, the nurse
in charge plans to use both hands to assess the clients fundus to:
A. Prevent uterine inversion
B. Promote uterine involution
C. Hasten the puerperium period
D. Determine the size of the fundus

Answers and Rationale

1. Answer: C. What is your expected due date?
When obtaining the history of a patient who may be in labor, the nurses highest priority is to
determine her current status, particularly her due date, gravidity, and parity. Gravidity and
parity affect the duration of labor and the potential for labor complications. Later, the nurse
should ask about chronic illness, allergies, and support persons.
2. Answer: B. Every 15 minutes
During the second stage of labor, the nurse should assess the strength, frequency, and
duration of contraction every 15 minutes. If maternal or fetal problems are detected, more
frequent monitoring is necessary. An interval of 30 to 60 minutes between assessments is
too long because of variations in the length and duration of patients labor.
3. Answer: A. Blurred vision

Blurred vision or other visual disturbance, excessive weight gain, edema, and increased
blood pressure may signal severe preeclampsia. This condition may lead to eclampsia,
which has potentially serious consequences for both the patient and fetus. Although
hemorrhoids may be a problem during pregnancy, they do not require immediate attention.
Increased vaginal mucus and dyspnea on exertion are expected as pregnancy progresses.
4. Answer: B. The patient has a child with cystic fibrosis
Cystic fibrosis is a recessive trait; each offspring has a one in four chance of having the trait
or the disorder. Maternal age is not a risk factor until age 35, when the incidence of
chromosomal defects increases. Maternal exposure to rubella during the first trimester may
cause congenital defects. Although a history or preterm labor may place the patient at risk
for preterm labor, it does not correlate with genetic defects.
5. Answer: C. 3 full days of elevated basal body temperature and clear, thin cervical
mucus
Ovulation (the period when pregnancy can occur) is accompanied by a basal body
temperature increase of 0.7 degrees F to 0.8 degrees F and clear, thin cervical mucus. A
return to the preovulatory body temperature indicates a safe period for sexual intercourse. A
slight rise in basal temperature early in the cycle is not significant. Breast tenderness and
mittelschmerz are not reliable indicators of ovulation.
6. Answer: A. At the beginning of each fetal movement
An NST assesses the FHR during fetal movement. In a healthy fetus, the FHR accelerates
with each movement. By pushing the control button when a fetal movement starts, the client
marks the strip to allow easy correlation of fetal movement with the FHR. The FHR is
assessed during uterine contractions in the oxytocin contraction test, not the NST. Pushing
the control button after every three fetal movements or at the end of fetal movement
wouldnt allow accurate comparison of fetal movement and FHR changes.
7. Answer: B. If I have blurred or double vision, I should call the clinic immediately.
Blurred or double vision may indicate hypertension or preeclampsia and should be reported
immediately. Urinary frequency is a common problem during pregnancy caused by

increased weight pressure on the bladder from the uterus. Clients generally experience
fatigue and nausea during pregnancy.
8. Answer: B. I support your commitment; however, you may have to supplement
each feeding with formula.
Recent breast reduction surgeries are done in a way to protect the milk sacs and ducts, so
breast-feeding after surgery is possible. Still, its good to check with the surgeon to
determine what breast reduction procedure was done. There is the possibility that reduction
surgery may have decreased the mothers ability to meet all of her babys nutritional needs,
and some supplemental feeding may be required. Preparing the mother for this possibility is
extremely important because the clients psychological adaptation to mothering may be
dependent on how successfully she breast-feeds.
9. Answer: B. Instructing the client to use two or more peri pads to cushion the area
Using two or more peripads would do little to reduce the pain or promote perineal healing.
Cold applications, sitz baths, and Kegel exercises are important measures when the client
has a fourth-degree laceration.
10. Answer: B. grapelike clusters.
In a client with gestational trophoblastic disease, an ultrasound performed after the 3rd
month shows grapelike clusters of transparent vesicles rather than a fetus. The vesicles
contain a clear fluid and may involve all or part of the decidual lining of the uterus. Usually
no embryo (and therefore no fetus) is present because it has been absorbed. Because there
is no fetus, there can be no extrauterine pregnancy. An extrauterine pregnancy is seen with
anectopic pregnancy.
11. Answer: C. 1 cm above the ischial spines.
Fetal station the relationship of the fetal presenting part to the maternal ischial spines
is described in the number of centimeters above or below the spines. A presenting part
above the ischial spines is designated as 1, 2, or 3. A presenting part below the ischial
spines, as +1, +2, or +3.

12. Answer: D. The babys lips smacking

Assessing the attachment process for breast-feeding should include all of the answers
except the smacking of lips. A baby whos smacking his lips isnt well attached and can
injure the mothers nipples.
13. Answer: D. Ultrasound
Ultrasound is used between 18 and 40 weeks gestation to identify normal fetal growth and
detect fetal anomalies and other problems. Amniocentesis is done during the third trimester
to determine fetal lung maturity. Chorionic villi sampling is performed at 8 to 12 weeks
gestation to detect genetic disease. Fetoscopy is done at approximately 18 weeks gestation
to observe the fetus directly and obtain a skin or blood sample.
14. Answer: C. The fetus isnt in distress at this time.
The BPP evaluates fetal health by assessing five variables: fetal breathing movements,
gross body movements, fetal tone, reactive fetal heart rate, and qualitative amniotic
fluidvolume. A normal response for each variable receives 2 points; an abnormal response
receives 0 points. A score between 8 and 10 is considered normal, indicating that the fetus
has a low risk of oxygen deprivation and isnt in distress. A fetus with a score of 6 or lower is
at risk for asphyxia and premature birth; this score warrants detailed investigation. The BPP
may or may not be repeated if the score isnt within normal limits.
15. Answer: C. What changes have you made at home to get ready for the baby?
During the third trimester, the pregnant client typically perceives the fetus as a separate
being. To verify that this has occurred, the nurse should ask whether she has made
appropriate changes at home such as obtaining infant supplies and equipment. The type of
anesthesia planned doesnt reflect the clients preparation for parenting. The client should
have begun prenatal classes earlier in the pregnancy. The nurse should have obtained
dietary information during the first trimester to give the client time to make any necessary
changes.
16. Answer: B. Preparing for immediate delivery.

This question requires an understanding of station as part of the intrapartum assessment

process. Based on the clients assessment findings, this client is ready for delivery, which is
the nurses top priority. Placing the client in bed, checking for ruptured membranes, and
providing comfort measures could be done, but the priority here is immediate delivery.
17. Answer: A. Change the clients position.
Variable decelerations in fetal heart rate are an ominous sign, indicating compression of
theumbilical cord. Changing the clients position from supine to side-lying may immediately
correct the problem. An emergency cesarean section is necessary only if other measures,
such as changing position and amnioinfusion with sterile saline, prove unsuccessful.
Administering oxygen may be helpful, but the priority is to change the womans position and
relieve cord compression.
18. Answer: A. Risk for deficient fluid volume related to hemorrhage
Hemorrhage jeopardizes the clients oxygen supply the first priority among human
physiologic needs. Therefore, the nursing diagnosis of Risk for deficient fluid volume related
to hemorrhage takes priority over diagnoses of Risk for infection, Pain, and Urinary
retention.
19. Answer: A. Lactation
Lactation is an example of a progressive physiological change that occurs during
thepostpartum period.
20. Answer: B. Abruptio placentae
The major maternal adverse reactions from cocaine use in pregnancy include
spontaneousabortion first, not third, trimester abortion and abruptio placentae.
21. Answer: D. Nonstress testing is performed weekly until 32 weeks gestation
For most clients with type 1 diabetes mellitus, non stress testing is done weekly until 32
weeks gestation and twice a week to assess fetal well-being.

22. Answer: A. Prevent seizures

The chemical makeup of magnesium is similar to that of calcium and, therefore, magnesium
will act like calcium in the body. As a result, magnesium will block seizure activity in a hyper
stimulated neurologic system by interfering with signal transmission at the neuromuscular
junction.
23. Answer: B. 7 days
The blastocyst takes approximately 1 week to travel to the uterus for implantation.
24. Answer: A. Shortens the second stage of labor
An episiotomy serves several purposes. It shortens the second stage of labor, substitutes a
clean surgical incision for a tear, and decreases undue stretching of perineal muscles. An
episiotomy helps prevent tearing of the rectum but it does not necessarily relieves pressure
on the rectum. Tearing may still occur.
25. Answer: D. Physician who will attend the delivery of the infant
The fetus of a cocaine-addicted mother is at risk for hypoxia, meconium aspiration, and
intrauterine growth retardation (IUGR). Therefore, the nurse must notify the physician of the
clients cocaine use because this knowledge will influence the care of the client and
neonate. The information is used only in relation to the clients care.
26. Answer: B. Pregnancy should be avoided for 3 months after the immunization
After administration of rubella vaccine, the client should be instructed to avoid pregnancy for
at least 3 months to prevent the possibility of the vaccines toxic effects to the fetus.
27. Answer: D. Maintain a patent airway
The priority for the pregnant client having a seizure is to maintain a patent airway to ensure
adequate oxygenation to the mother and the fetus. Additionally, oxygen may be
administered by face mask to prevent fetal hypoxia.

28. Answer: A. Yogurt

In some birth settings, intravenous therapy is not used with low-risk clients. Thus, clients in
early labor are encouraged to eat healthy snacks and drink fluid to avoid dehydration.
Yogurt, which is an excellent source of calcium and riboflavin, is soft and easily digested.
During pregnancy, gastric emptying time is delayed. In most hospital settings, clients are
allowed only ice chips or clear liquids.
29. Answer: A. Inspect the perineum
When the client says the baby is coming, the nurse should first inspect the perineum and
observe for crowning to validate the clients statement. If the client is not delivering
precipitously, the nurse can calm her and use appropriate breathing techniques.
30. Answer: A. Prevent uterine inversion
Using both hands to assess the fundus is useful for preventing uterine inversion.