1. A nurse is assessing a patient at 33 weeks’ gestation. Leopold’s maneuvers indicate that the fetus is in a breach position. Which is the best location for the nurse to auscultate fetal heart tones?
a. Midway between the symphysis pubis and the umbilicus
b. Right lower quadrant of the abdomen
c. Right upper quadrant of the abdomen
d. Above the level of the umbilicus
2. Before the placenta functions, the corpus luteum is the primary source for synthesis of which hormone?
a. Cortisol and thyroxine
b. Estrogen and progesterone
c. Luteinizing hormone (LH) and follicle-stimulation hormone (FSH)
d. Thyroxine (T4) and triiodothyronine (T3)
3. A nurse is taking an initial history on a pregnant patient who asks about the chances of having dizygotic twins. Which statement by the nurse is correct?
a. “They occur most frequently in Asian women.”
b. “There’s a decreased risk with increased parity.”
c. “There’s an increased risk with increased maternal age.”
d. “There’s no increased risk with the use of fertility drugs.”
4. Prevention of which condition should be included in the plan of care for a patient in the second trimester of pregnancy?
a. Mastitis
b. Metabolic alkalosis
c. Physiologic anemia
d. Respiratory acidosis
5. Which statement describes negative CST (contraction stress test) results?
a. Persistent late decelerations in fetal heartbeat occurred, with at least three contractions in a 10-minute window.
b. Accelerations of fetal heartbeat occurred, with at least 15 beat/minute, lasting 15 to 30 seconds in a 20-minute period.
c. Accelerations of fetal heartbeat were absent or didn’t increase by 15 beats/minute for 15 to 30 seconds in a 20-minute period.
d. There was good fetal heart rate (FHR) variability and no decelerations from contraction in a 10-minute period in which there were three contractions.
6. A 23-year-old client who is at 27 weeks’ gestation arrives at her physician’s office with complaints of fever, nausea, vomiting, malaise, unilateral flank pain, and costovertebral angle tenderness. On which diagnosis would the nurse base care?
a. Asymptomatic bacteriuria
b. Bacterial vaginosis
c. Pyelonephritis
d. Urinary tract infection (UTI)
7. The phrase gravida 4, para 2 indicates which maternal history?
a. A patient has been pregnant four times and had two miscarriages.
b. A patient has been pregnant four times and had two children born after 20 weeks’ gestation.
c. A patient has been pregnant four times and had two cesarean deliveries.
d. A patient has been pregnant four times and had two spontaneous abortions.
8. Which answer best describes the stage of pregnancy in which maternal and fetal blood are exchanged?
a. Conception
b. 9 weeks’ gestation, when the fetal heart is well developed
c. 32 to 34 weeks’ gestation (third trimester)
d. Maternal and fetal blood are never exchanged
9. Which rationale best explains why a pregnant patient should lie on her left side when resting or sleeping in the later stages of pregnancy?
a. To facilitate digestion
b. To facilitate bladder emptying
c. To prevent compression of the vena cava
d. To avoid the development of fetal anomalies
10. A pregnant patient is concerned about lack of fetal movement. What instructions should the nurse give that might offer reassurance?
a. Start taking two prenatal vitamins.
b. Take a warm bath to facilitate fetal movement.
c. Eat foods that contain a high sugar content to enhance fetal movement.
d. Lie down once a day and count the number of fetal movements for 15 to 30 minutes.
11. What would be the most appropriate recommendation to a pregnant patient who complains of swelling in her feet and ankles?
a. Limit fluid intake
b. Buy walking shoes
c. Sit and elevate the feet
d. Start taking a diuretic as needed daily
12. Which intervention should a nurse recommend to a patient having severe heartburn during her pregnancy?
a. Eat several small meals daily
b. Eat crackers on waking every a.m.
c. Drink a preparation of salt and vinegar
d. Drink orange juice frequently during the day
13. A patient at 18 weeks’ gestation reports fluttering sensation in her abdomen. Which statement made by the patient indicates that the nurse’s teaching was successful?
a. “This is my baby moving.”
b. “I will seek prompt medical attention if this happens again.”
c. “This is an early sign of labor.”
d. “I will avoid spicy food.”
14. Which test should the nurse expect to be ordered to confirm a diagnosis of beta thalassemia?
a. Complete blood count (CBC)
b. Hemoglobin A1c
c. Hemoglobin electrophoresis
d. Iron level
15. During the second and third trimesters, common pregnancy discomforts may increase in number and severity. Which discomforts are normal during this time?
a. Ankle edema, hemorrhoids, nausea and vomiting, and shortness of breath
b. Ankle edema, shortness of breath, leg cramps, and oligouria
c. Leg cramps, Braxton Hicks contractions, and nausea and vomiting
d. Leg cramps, ankle edema, shortness of breath
16. A patient with a term, uncomplicated pregnancy, comes into the labor and delivery unit in early labor. While returning from the bathroom, she states that she thinks her water has broken. Which action by a nurse would be the most appropriate?
a. Prepare the woman for delivery
b. Note the color, amount, and odor of the fluid
c. Immediately contact the physician
d. Collect a sample of the fluid for microbial analysis
17. A patient in labor has been receiving oxytocin (Pitocin) to aid her progress. The nurse caring for her notes that contractions are lasting 100 seconds. Which action should the nurse take first?
a. Stop the oxytocin infusion
b. Notify the physician
c. Monitor fetal heart tones as usual
d. Turn the patient on her left side
18. A patient at term arrives in the labor unit experiencing contractions every 4 minutes. The nurse assesses the patient. Which observation should alert the nurse to an increased potential for fetal distress?
a. Total weight gain of 30 lb (13.6 kg)
b. Maternal age of 32
c. Blood pressure of 146/90 mm Hg
d. Treatment for an STI at 15 weeks’ gestation
19. To detect fetal distress during labor, a nurse should be alert for which finding?
a. Fetal scalp pH of 7.14
b. Fetal heart rate of 144 beats/minute
c. Acceleration of fetal heart rate with contractions
d. Presence of long-term variability
20. During the labor of a patient with a breech presentation, the amniotic membranes rupture. Meconium is present in the amniotic fluid. Which statement by a nurse is most appropriate?
a. “This often happens during a prolonged delivery.”
b. “This indicates a blood incompatibility between the fetus and mother.”
c. “This is a sign of fetal distress.”
d. “This is normal in a breech delivery.”
21. A patient at 42 weeks’ gestation is 3 cm dilated, 30% effaced, with membranes intact and the fetus at +2 station. Fetal heart rate (FHR) is 140 to 150 beats/minute. After 2 hours, the nurse notes on the external fetal monitor that, for the past 10 minutes, the FHR ranged from 160 to 190 beats/minute. The client states that her baby has been extremely active. Uterine contractions are strong, occurring every 3 to 4 minutes and lasting 40 to 60 seconds. Which finding would indicate fetal hypoxia?
a. Abnormally long uterine contractions
b. Abnormally strong uterine intensity
c. Excessively frequent contractions, with rapid fetal movement
d. Excessive fetal activity and fetal tachycardia
e.
22. Which fetal position is most favorable for birth?
a. Vertex presentation
b. Transverse lie
c. Frank breech presentation
d. Posterior position of the fetal head
23. Which stage of labor is the one in which birth occurs?
a. First stage of labor
b. Second stage of labor
c. Third stage of labor
d. Fourth stage of labor
24. A laboring patient has external electronic fetal monitoring in place. Which assessment data can be determined by examining the fetal heart rate strip produced by the external electronic fetal monitor?
a. Gender of the fetus
b. Fetal position
c. Labor progress
d. Fetal oxygenation
25. Which nursing action is required before a patient in labor receives an epidural?
a. Give a fluid bolus of 500 ml IV.
b. Check for maternal pupil dilation
c. Assess maternal reflexes
d. Assess maternal gait
26. A patient in early labor states that she has a thick, yellow discharge from both of her breasts. Which action by the nurse would be most appropriate?
a. Tell her that her milk is starting to come in because she’s in labor
b. Complete a thorough breast examination, and document the results in the chart
c. Perform a culture on the discharge, and inform the client that she might have mastitis
d. Inform the client that the discharge is colostrum, normally present after the 4th month of pregnancy
27. A patient is early labor is concerned about the pinkish “stretch marks” on her abdomen. Which statement by the client indicates that the nurse’s teaching has been effective?
a. “My stretch marks will completely fade away within 6 weeks.”
b. “My stretch marks will fade but not disappear after delivery.”
c. “An emollient cream will help fade my stretch marks.”
d. “A regular exercise program will help my stretch marks go away.”
28. Which position is most comfortable for a patient with a fetus in persistent occiput posterior presentation?
a. Supine
b. Sitting
c. Hands and knees
29. Which range is considered severe bradycardia for a full-term fetus?
a. Fewer than 70 beats/minute
b. 70 to 100 beats/minute
c. 120 to 160 beats/minute
d. 160 to 200 beats/minute
30. A nurse is performing Leopold’s maneuvers on a patient in the early stages of labor. Which finding should alert the nurse to a potential problem?
a. Palpation of the upper fundus reveals a firm, round shape
b. Palpation of the upper fundus reveals a soft, less-defined shape
c. Palpation of the side of the fundus reveals a smooth, firm shape
d. Palpation of the lower fundus reveals a firm, round shape
31. Which description best defines the term effacement?
a. Enlargement of the cervical canal
b. Expulsion of the mucus plug
c. Shortening and thinning of the cervical canal
d. Downward movement of the fetal head
32. A nurse is monitoring a patient in labor and notes on the external fetal monitor that the fetal heart rate (FHR) drops with each contraction and then recovers after the contraction. Which action should the nurse take?
a. Turn the patient to the left side
b. Continue to observe FHR
c. Administer oxygen by face mask
d. Place the patient in Trendelenburg position
33. During which stage of labor does crowning take place?
a. First
b. Second
c. Third
d. Fourth
34. A 30-year-old multiparous client admitted to the labor and delivery unit hasn’t received prenatal care for this pregnancy. Which data is most relevant to the nursing assessment?
a. Date of last menstrual period (LMP)
b. Family history of sexually transmitted disease (STDs)
c. Name of insurance provider
d. Number of siblings
35. While performing a cervical examination, a nurse’s fingertips feel pulsating tissue. What would be the most appropriate nursing intervention?
a. Leave the patient, and call the physician
b. Put the patient in a semi-Fowler position
c. Ask the patient to push with the next contraction
d. Leave the fingers in place, and press the nurse call light
36. An amniotomy is performed on a patient in labor. Following this procedure what is the priority nursing intervention?
a. Encourage the client to use breathing exercises as contractions increase
b. Assess fetal heart tones
c. Assist the client to ambulate to promote labor
d. Position the client on her left side
37. Which characteristics best describes variable decelerations?
a. Predictable
b. Indicators of fetal well-being
c. Indicators of cord compression
d. Suggests pressure on the fetal head
38. Which characteristics best describes early decelerations?
a. Reassuring, beginning at the onset of the contraction and ending with the end of the contraction
b. Decelerations initiated 30 to 40 seconds after the onset of the contraction
c. Decreased blood flow to the fetus due to uteroplacental insufficiency
d. Loss of variability with fetal hypoxia
39. The first day of a client’s last menstrual period (LMP) was October 10. Using Nagele’s rule, what is the estimated date of delivery?
a. July 10
b. July 17
c. August 10
d. August 17
40. Which component must the nurse evaluate when assessing labor contractions?
a. Pelvic type, duration, and frequency
b. Contraction type and frequency, and pelvic type
c. Contraction duration, frequency, and intensity
d. Contraction type, duration, and intensity
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