1. A nurse is discussing sexual arousal during a 2.

Returning from a recent trip abroad is not likely

preadolescent boys’ sex education class. Which of the related to the symptoms the client is reporting, which
following should the nurse base her reply on when a boy are symptoms of a UTI.
asks, “What exactly happens when my body gets aroused, 3. Stopping hormone replacement therapy (HRT) is
anyway?” unlikely related to the symptoms reported by the
A. The vas deferens thickens and expands. client.
B. The sympathetic nerves of the penis are stimulated. 4. It is unlikely that starting a weight-lifting program is
C. The corpora of the penis become engorged. related to the symptoms of a UTI that the client is
D. The prepuce of the penis elongates. reporting.
1. The vas deferens is the internal structure through 5. A woman’s temperature has just risen 0.4°F and will
which the semen passes from the testes to the urethra. remain elevated during the remainder of her cycle. She
Its shape is unaffected by sexual arousal. expects to menstruate in about 2 weeks. Which of the
2. The parasympathetic nerves are stimulated during following hormones is responsible for the change?
sexual arousal, not the sympathetic nerves. A. Estrogen.
3. When arousal occurs, the penile blood vessels B. Progesterone.
become engorged and an erection is achieved. C. Luteinizing hormone (LH).
4. The prepuce, or foreskin, does not increase in length D. Follicle-stimulating hormone (FSH).
during arousal. 1. Estrogen begins to elevate before ovulation. It is not
2. A woman, whose menstrual cycle is 35 days long, states responsible for the temperature elevation.
that she often has a slight pain on one side of her lower 2. Progesterone elevation occurs after ovulation and
abdomen on day 21 of her cycle. She wonders whether or spikes at about 5-6 days after ovulation.
not she has ovarian cancer. What is the nurse’s best Progesterone is thermogenic—that is, heat
response? producing. Progesterone is the reason why
A. “Women often feel a slight twinge when ovulation women’s temperatures are elevated following
occurs.” ovulation.
B. “Ovarian cancer is a possibility and you should seek 3. LH spikes at the time of ovulation.
medical attention as soon as possible.” 4. FSH promotes the maturation of the ovum.
C. “Ovarian cancer is unlikely because the pain is not a 6. A woman is menstruating. If hormonal studies were to be
constant pain.” done at this time, which of the following hormonal levels
D. “It is more likely that such pain indicates an ovarian would the nurse expect to see?
cyst because pain is more common with that A. Both estrogen and progesterone are high.
problem.” B. Estrogen is high and progesterone is low.
1. This statement is true and the discomfort, at the C. Estrogen is low and progesterone is high.
location of the ovary where ovulation occurs, is D. Both estrogen and progesterone are low.
called mittleschmerz. Ovulation usually occurs 14 1. When the ovum is not fertilized, both estrogen and
days before the first day of the menses. progesterone levels drop. The drop in hormones is
2. The history given by the woman is not indicative of followed by menstruation.
ovarian cancer. 2. When the ovum is not fertilized, both estrogen and
3. The timing of the pain is more significant than the progesterone levels drop. The drop in hormones is
type of pain. followed by menstruation.
4. The timing of the pain is more significant than the 3. When the ovum is not fertilized, both estrogen and
type of pain. progesterone levels drop. The drop in hormones is
3. A nurse is explaining to a client about monthly hormonal followed by menstruation.
changes. Starting with Day 1 of the menstrual cycle, 4. When the ovum is not fertilized, both estrogen and
please place the following four hormones in the progesterone levels drop. The hormonal drop is
chronological order in which they elevate during the followed by menstruation.
menstrual cycle. 7. A nurse teaches a woman who wishes to become pregnant
1. Follicle-stimulating hormone. that if she assesses for spinnbarkeit she will be able
2. Gonadotropin-releasing hormone. closely to predict her time of ovulation. Which technique
3. Luteinizing hormone. should the client be taught in order to assess for
4. Progesterone. spinnbarkeit?
A. 2,1,3,4 A. Take her temperature each morning before rising.
B. 2,3,1,4 B. Carefully feel her breasts for glandular development.
C. 2,4,1,3 C. Monitor her nipples for signs of tingling and
D. 2,4,3,1 sensitivity.
2, 1, 3, 4 Gonadotropin-releasing hormone stimulates D. Assess her vaginal discharge for elasticity and
the production of follicle-stimulating hormone (FSH) slipperiness.
and lutenizing hormone (LH). FSH rises first and LH 1. The temperature does elevate after ovulation, but the
follows. After ovulation, progesterone rises. elevation is not defined as spinnbarkeit
4. A 54-year-old client calls her health care practitioner 2. The breasts do become sensitive and some women do
complaining of frequency and burning when she urinates. palpate tender nodules in the breasts at the time of
Which of the following factors that occurred within the ovulation, but those changes are not spinnbarkeit.
preceding 3 days likely contributed to this client’s 3. The nipples may tingle and become sensitive.
problem? 4. Spinnbarkeit is defined as the “thread” that is
A. She had intercourse with her partner. created when the vaginal discharge is slippery and
B. She returned from a trip abroad. elastic at the time of ovulation. The changes are in
C. She stopped taking hormone replacement therapy. response to high estrogen levels. The woman
D. She started a weight-lifting exercise program. inserts her index and middle fingers into her
1. The fact that the client had intercourse in the last vagina and touches her cervix. After removing her
3 days likely led to the symptoms she is reporting, fingers, she separates her fingers and “spins a
which are symptoms of a urinary tract infection thread” between her fingers. When she is not in
(UTI) her fertile period, the mucus is thick and gluey.
8. In analyzing the need for teaching regarding sexual health system. Ova, however, do not have the ability to
in a client who is sexually active, which of the following propel themselves, but rather are propelled externally
questions is the most important for a nurse to ask? by the cilia in the fallopian tubes.
A. “How old are your children?” 12. A client complaining of secondary amenorrhea is seeking
B. “Did you have intercourse last evening?” care from her gynecologist. Which of the following may
C. “With whom do you have intercourse?” have contributed to her problem?
D. “Do you use vaginal lubricant?” A. Athletic activities.
B. Vaccination history.
1. The ages of a client’s children may be important, but C. Pet ownership.
it is not the most important information for the nurse D. Genetic history.
to ask about. 1. If the young woman exercises excessively— for
2. Whether or not the client had intercourse the example, as a competitive gymnast or runner—
preceding night is important, but it is not the most her body fat index will be so low she will become
important information for the nurse to ask about. amenorrheic.
3. This question is the most important for the nurse 2. Vaccination history has not been shown to be related
to ask. The nurse is trying to learn whether or not to secondary amenorrhea.
the client is having intercourse with more than 3. Pet ownership has not been shown to be related to
one partner and/or whether the client has secondary amenorrhea.
intercourse with men, women, or both. 4. Genetic history has not been shown to be related to
4. Whether or not the client uses vaginal lubricant is secondary amenorrhea.
important, but it is not the most important 13. A couple is seeking infertility counseling. During the
information for the nurse to ask about. history, it is noted that the man is a cancer survivor,
9. When a nurse is teaching a woman about her menstrual drinks one beer every night with dinner, and takes a sauna
cycle she mentions that which of the following is the most every day after work. Which of the following is an
important change that happens during the follicular phase appropriate response by the nurse?
of the menstrual cycle? A. It is unlikely that any of these factors is impacting his
A. Maturation of the graafian follicle. fertility.
B. Multiplication of the fimbriae. B. Daily alcohol consumption could be causing his
C. Secretion of human chorionic gonadotropin. infertility problems.
D. Proliferation of the endometrium. C. Sperm may be malformed when exposed to the heat
1. FSH is elevated during the follicular phase and of the sauna.
the graafian follicle matures. D. Cancer survivors have the same fertility rates as
2. The fimbriae are located at the ends of the fallopian healthy males.
tubes. They do not multiply in number. 1. This response is incorrect because exposing the testes
3. The hormone hCG is not produced during the to the heat of the sauna can alter the normal
menstrual cycle. It is produced by the fertilized egg morphology of the sperm.
in early pregnancy. 2. Alcohol consumed in excessive amounts can alter
4. Endometrial proliferation occurs during the secretory spermatogenesis, but one beer per day has not been
phase of the menstrual cycle. shown to be a problem.
10. It is day 17 of a woman’s menstrual cycle. She is 3. The high temperature of the sauna could alter the
complaining of breast tenderness and pain in her lower number and morphology of the sperm.
left quadrant. The woman states that her cycle is usually 4. Chemotherapy has been shown to affect the ability of
31 days long. Which of the following is an appropriate males to create sperm.
reply by the nurse? 14. A nurse is teaching an infertile couple about how the
A. “You are probably ovulating.” sperm travel through the man’s body during ejaculation.
B. “Your hormone levels should be checked.” Please put the following five major structures in order,
C. “You will probably menstruate early.” beginning with the place where spermatogenesis occurs
D. “Your breast changes are a worrisome sign.” and continuing through the path that the sperm and semen
1. This statement is true. Breast tenderness and travel until ejaculation.
mittleschmerz often occur at the time of ovulation. 1. Epididymis.
2. Breast tenderness and mittleschmerz are symptoms of 2. Prostate.
ovulation, not of abnormal hormonal levels. 3. Testes.
3. Menstruation occurs approximately 14 days after 4. Urethra.
ovulation. 5. Vas deferens.
4. The breast changes are normal and often are felt by A. 3,1,5,2,4
women at the time of ovulation. B. 3,1,2,5,4
11. The nurse is teaching a class on reproduction. When C. 3,2,1,5,4
asked about the development of the ova, the nurse would D. 3,2,5,1,4
include which of the following? 3, 1, 5, 2, 4. The sperm are produced in the testes (3). They
A. Meiotic divisions begin during puberty. then proceed to the epididymis (1) where they mature. The
B. At the end of meiosis, four ova are created. vas deferens (5) is the conduit through which the sperm
C. Each ovum contains the diploid number of first travel during ejaculation. The prostate (2), encircling
chromosomes. the neck of the urethra, produces a fluid that protects the
D. Like sperm, ova have the ability to propel sperm, and, finally, the sperm exit the male body via the
themselves. urethra (4).
1. This answer is correct. Meiosis I occurs during 15. The nurse is providing counseling to a group of sexually
puberty. active single women. Most of the women have expressed
2. This response is not true. At the completion of a desire to have children in the future, but not within the
oogenesis only 1 ovum is created. At the completion next few years. Which of the following actions should the
of spermatogenesis, 4 sperm are created. nurse suggest the women take to protect their fertility for
3. This response is not true. Each ovum contains the the future? Select all that apply.
haploid number of chromosomes. 1. Use condoms during intercourse.
4. This response is not true. Sperm have flagella that 2. Refrain from smoking cigarettes.
propel them through the woman’s reproductive 3. Maintain an appropriate weight for height.
 4. Exercise in moderation. 4. This response is not true. Although some causes of
5. Refrain from drinking carbonated beverages. infertility may not be discovered, in the majority of
A. 1,2,3 cases a cause is found: 1/3 of cases related to female
B. 1,2,3,4 problems, 1/3 of cases related to male problems, and
C. 1,2,3,5 1/3 of cases a combination of male and female
D. 1,2,3,4,5 problems.
1, 2, 3, 4 are the correct choices. 18. An infertile woman has been diagnosed with
1. Condoms should be worn during sexual contacts endometriosis. She asks the nurse why that diagnosis has
to prevent becoming infected with a sexually made her infertile. Which of the following explanations is
transmitted disease, which can impact the long- appropriate for the nurse to make?
term health of the woman’s reproductive system. A. “Scarring surrounds the ends of your tubes
2. Women who smoke have a higher incidence of preventing your eggs from being fertilized by your
infertility than those who do not smoke. (See partner’s sperm.”
[Link] B. “You are producing insufficient quantities of follicle-
.pdf ) stimulating hormone that is needed to mature an egg
3. Women who are either overweight or underweight every month.”
have increased incidence of infertility. C. “Inside your uterus is a benign tumor that makes it
4. Body mass index (BMI) is related to the amount of impossible for the fertilized egg to implant.”
exercise a woman engages in. Those who exercise D. “You have a chronic infection of the vaginal tract that
excessively are more likely to have a very low BMI makes the secretions hostile to your partner’s sperm.”
and those who rarely exercise to be obese. Since 1. Endometriosis is characterized by the presence of
fertility is related to body weight, it is endometrial tissue outside the uterine cavity. The
recommended that women exercise in moderation. tissue may be on, for example, the tubes, ovaries,
5. There is some evidence that caffeine in large or colon. Adhesions develop from the monthly
quantities may affect fertility, but decaffeinated bleeding at the site of the misplaced endometrial
carbonated beverages have never been cited as tissue, often resulting in infertility.
impacting one’s fertility. 2. Endometriosis is not characterized by hormonal
16. A couple is seeking advice regarding actions that they can imbalances. Hormonal imbalances can, however, lead
take to increase their potential of becoming pregnant. to infertility.
Which of the following recommendations should the 3. A benign tumor of the muscle of the uterus is called a
nurse give to the couple? fibroid. It can interfere with pregnancy, but it is not
A. The couple should use vaginal lubricants during related to endometriosis.
intercourse. 4. Endometriosis is not caused by an infection.
B. The couple should delay having intercourse until the 19. Infertility increases a client’s risk of which of the
day of ovulation. following diseases?
C. The woman should refrain from douching. A. Diabetes mellitus.
D. The man should be on top during intercourse. B. Nystagmus.
1. Use of vaginal lubricants is not recommended. C. Cholecystitis.
Vaginal lubricants may alter the pH of the D. Ovarian cancer.
reproductive system, adversely affecting the couple’s 1. Diabetes has been shown to affect a woman’s
potential of becoming pregnant. fertility, but infertility has not been shown to increase
2. Delaying intercourse until the day of ovulation is a a woman’s risk of developing diabetes.
poor recommendation. The sperm live for about 3 2. Infertility has not been shown to increase a woman’s
days. If the couple has daily intercourse beginning 5 risk of developing nystagmus.
or 6 days before ovulation and continuing until the 3. Infertility has not been shown to increase a woman’s
day of ovulation, they will maximize their potential risk of developing cholecystitis.
of becoming pregnant. (See Wilcox AJ, et al. Timing 4. Infertility has been shown to increase a woman’s
of sexual intercourse in relation to ovulation. N Engl risk of developing ovarian cancer.
J Med 1995; 333:1517–21.) 20. A 35-year-old client is being seen for her yearly
3. The woman should refrain from douching. gynecological examination. She states that she and her
Douching can change the normal flora and the pH partner have been trying to become pregnant for a little
in the vagina, making the environment hostile to over 6 months, and that a friend had recently advised her
the sperm. partner to take ginseng to improve the potency of his
4. The position of the couple during intercourse will not sperm. The woman states that they have decided to take
affect the potential fertility of the woman. their friend’s advice. On which of the following
17. A nurse working in an infertility clinic should include information should the nurse base his or her reply?
which of the following in her discussions with the couple? A. Based on their history, the client and her partner have
A. Adoption as an alternative to infertility treatments. made the appropriate decision regarding their
B. The legal controversy surrounding artificial fertility.
insemination. B. Ginseng can cause permanent chromosomal
C. The need to seek marriage counseling before mutations and should be stopped immediately.
undergoing infertility treatments. C. It is unnecessary to become concerned about this
D. Statistics regarding the number of couples who never woman’s fertility because she has only tried to
learn why they are infertile. become pregnant for a few months.
1. It is important for the couple to be provided with D. Although ginseng may be helpful, it would be
all relevant information. Adoption is a viable prudent to encourage the woman to seek fertility
alternative to infertility treatments. counseling.
2. Although there are moral/ethical issues surrounding 1. On the web, there are sites that state that ginseng
artificial insemination, there are no legal improves the quality and quantity of sperm, although
controversies. Artificial insemination is a legal there is no strong evidence to show that that is true.
procedure. In addition, there is nothing in the question to suggest
3. Although it is not without merit, marriage counseling that the infertility problem is caused by the poor
is not mandatory before seeking infertility treatments. quality of her partner’s sperm.
 2. There is no evidence that ginseng causes mutations; C. Inform the client that these are common and may
rather there is some evidence to show that it is occur throughout the pregnancy.
antimutagenic. D. Call the maternity unit and inform them that the
3. There is cause for concern for this woman since she client will be admitted in a pre-labor condition.
is 35 years old and has been unable to get pregnant Braxton Hicks contractions are irregular, painless contractions
for over 6 months. that may occur intermittently throughout pregnancy. Because
4. Because fertility drops as a woman ages, it is Braxton Hicks contractions may occur and are normal in some
advisable to encourage the couple to use pregnant women during pregnancy, options 1, 2, and 4 are
conventional therapies in conjunction with the unnecessary and inappropriate actions.
complementary therapy to maximize their 25. A pregnant client visits a clinic for a scheduled prenatal
potential of becoming pregnant. appointment. The client tells the nurse that she frequently
21. A couple is seeking infertility counseling. The practitioner has a backache, and the nurse provides instructions
has identified the factors listed below in the woman’s regarding measures that will assist in relieving the
health history. Which of these findings may be backache. Which statement by the client indicates a need
contributing to the couple’s infertility? for further instructions?
A. The client is 36 years old. A. "I should wear flat-heeled shoes."
B. The client was 13 years old when she started to B. "I should sleep on a firm mattress.'
menstruate. C. "I should try to maintain good posture."
C. The client works as a dental hygienist 3 days a week. D. "I should do more exercises to strengthen my
D. The client jogs 2 miles every day. back muscles."
22. The nursing instructor asks the nursing student about the Some measures that will assist in relieving a backache include
physiology related to the cessation of ovulation that maintaining good posture and body mechanics, resting and
occurs during pregnancy. Which of the following avoiding fatigue, wearing flat-heeled shoes, and sleeping on a
responses, if made by the student, indicates an firm mattress. The back discomfort that occurs in a pregnant
understanding of this physiological process? client is often caused by the exaggerated lumbar and
A. "Ovulation ceases during pregnancy because the cervicothoracic curves resulting from a change in the center of
circulating levels of estrogen and progesterone are gravity because of the enlarged uterus. Performing more
high." exercises to strengthen the back muscles could be harmful to a
B. "Ovulation ceases during pregnancy because the pregnant client.
circulating levels of estrogen and progesterone are 26. A nurse is providing instructions to a pregnant client who
low." is scheduled for an amniocentesis. The nurse tells the
C. The low levels of estrogen and progesterone increase client that:
the release of the follicle-stimulating hormone and A. Strict bed rest is required following the procedure.
luteinizing hormone.* B. An informed consent will need to be signed before
D. The high levels of estrogen and progesterone promote the procedure.
the release of the follicle-stimulating hormone and C. Hospitalization is necessary for 24 hours following
luteinizing hormone.* the procedure.
Ovulation ceases during pregnancy because the circulating D. A fever is expected following the procedure because
levels of estrogen and progesterone are high, inhibiting the of the trauma to the abdomen.
release of follicle-stimulating and luteinizing hormones, which Amniocentesis is an invasive procedure, informed consent will
are necessary for ovulation. Options 2, 3, and 4 are incorrect. need to be obtained before the procedure. After the procedure,
23. A nurse is collecting data during an admission assessment the client is instructed lo rest but may resume light activity
of a client who is pregnant with twins. The client has a after the camping subsides. The client is instructed to keep the
healthy 5-year-old child that was delivered at 38 weeks puncture site clean and to report any complications such as
and tells the nurse that she does not have a history of any vaginal discharge, severe, persistent cramping, or onset of
type of abortion or fetal demise. The nurse would fever. Amniocentesis is an outpatient procedure and may be
document the GTPAL for this client as done in a physician's pnvale office or in a special prenatal
A. G-3.T-2, P-O.A-O.L-1 testing unit. Hospitalization is not necessary following the
B. G-2.T=1.P-0.A-O.L-1 procedure.
C. G=1.T=1.P=1,A = 0.L=1 27. The nurse is interviewing a 16-year-old client during her
D. G = 2, T = 0, P = 0, A = 0. L-1 initial prenatal clinic visit. The client is beginning week
Pregnancy outcomes can be described with the acronym 18 of her first pregnancy. Which statement, if made by the
GTPAL G is gravidity, the number of pregnancies. G is term client, indicates an immediate need for further
births. the number born at term (longer than 37 weeks), P is investigation?
preterm births, the number born before 37 weeks' gestation, A A. "I don't like my face any more. I always look like
is abortions or miscarriages, the number of abortions or I have been crying."
miscarriages (included in gravida if before 20 weeks' B. "I don't like my breasts anymore. These silver lines
gestation; included in parity if past 20 weeks' gestation), and L are ugly."
is the number of current living children. Therefore, a woman C. "I don't like my stomach anymore. That brown line is
who is pregnant with twins and has a child has a gravida of 2. disgusting."
Because the child was delivered at 38 weeks, the number of D. "I don't like my figure anymore. My clothes are all
term births is 1 and the number of preterm births is 0. The too tight."
number of abortions is 0 and the number of living children is In option 1, there is an implication of periorbital and facial
1. edema, which could be indicative of gestational hypertension.
24. A pregnant client is seen in a health care clinic for a Because the question identifies an adolescent who has not
regular prenatal visit. The client tells the nurse that she is sought early prenatal care, she is at higher risk for the
experiencing irregular contractions, and the nurse development of gestational hypertension. Options 2, 3. and 4
determines that she is experiencing Braxton Hicks also deal with body image and, although these comments
contractions. Based on this finding, which nursing action should not be ignored, the need for follow-up is not urgent.
is appropriate? 28. A nurse is using Nagele's rule to calculate a pregnant
A. Contact the physician. woman's estimated date of delivery. The woman tells the
B. Instruct the client to maintain bed rest for the nurse that her last period began on June 17, 2008, and
remainder of the pregnancy. ended 6 days later. The nurse should compute the
estimated date of delivery to be:
 A. March 10, 2008 A. A primigravida with mild preeclampsia
B. March 15, 2008 B. A primigravida who delivered a 10-lb baby 3 hours
C. March 24, 2009 ago
D. March 29, 2009 C. A gravida II who has just been diagnosed with
Nagele's rule is a noninvasive method for estimating the dale dead fetus syndrome
of birth. The rule slates the following: add 7 days to the first D. A gravida IV who delivered 8 hours ago and has lost
day of the last menstrual period, subtract 3 months, and add 1 500 mL of blood
year. This is based on the assumption that the cycle is 28 days. Dead fetus syndrome is considered a risk factor for DIC.
June 17, 2008. plus 7 days minus 3 months is March 24, 2008. Severe preeclampsia is considered a risk factor for DIC; a
Adding 1 year brings the delivery date to March 24, 2009. mild case is not. Delivering a large baby is not considered a
29. A prenatal clinic nurse is providing instructions to a group risk factor for DIC. Hemorrhage is a risk factor with DIC;
of pregnant clients regarding measures to prevent however, a loss of 500 mL is not considered hemorrhage.
toxoplasmosis. Which statement if made by one of the 33. A nurse is assessing a pregnant client in the second
clients indicates a need for further instruction? trimester of pregnancy who was admitted to the maternity
A. "I should cook meal thoroughly.' unit with a suspected diagnosis of abruptio placentae.
B. "I should drink unpasteurized milk only." Which of the following assessment findings would the
C. "I should avoid contact with materials that are nurse expect to note if this condition is present?
possibly contaminated with cat feces.” A. A soft abdomen
D. "I should avoid touching mucous membranes of the B. Uterine tenderness
mouth or eyes while handling raw meat." C. Absence of abdominal pain
All pregnant clients should be advised to do the following to D. Painless, bright red vaginal bleeding
prevent the development of toxoplasmosis: Clients should be Painless, bright red vaginal bleeding in the second or third
instructed to cook meats thoroughly, particularly pork, beef, trimester of pregnancy is a sign of placenta previa. In abruptio
and lamb; avoid touching mucous membranes of the mouth or placentae, acute abdominal pain is present. Uterine tenderness
eyes while handling raw meat; thoroughly wash all kitchen accompanies placental abruption, especially with a central
surfaces that come in contact with uncooked meat; wash the abruption and trapped blood behind the placenta. The
hands thoroughly after handling raw meat; avoid uncooked abdomen will feel hard and board-like on palpation as the
eggs and unpasteurized milk; wash fruits and vegetables blood penetrates the myometrium and causes uterine
before consumption; and avoid contact with materials that irritability. Observation of the fetal monitor often reveals
possibly are contaminated with cat feces, such as cat litter increased uterine resting tone, caused by failure of the uterus
boxes, sand boxes, or garden soil. to relax in an attempt to constrict blood vessels and control
30. A nurse is doing an assessment of a pregnant client who bleeding.
states that she smokes one pack of cigarettes each day. 34. A maternity nurse is preparing for the admission of a
The nurse should: client in the third trimester of pregnancy that is
A. ask the client to cut down to half a pack a day. experiencing vaginal bleeding and has a suspected
B. inform the client of the risks to the fetus and ask if diagnosis of placenta previa. The nurse reviews the
she'd like a referral to a smoking cessation physician's orders and would question which order?
support group. A. Prepare the client for an ultrasound.
C. insist that the client stop smoking immediately for the B. Obtain equipment for a manual pelvic
health of her baby, examination.
D. do nothing; smoking is a personal decision. C. Prepare to draw a hemoglobin and hematocrit blood
RATIONALE: B. Smoking can be detrimental to fetal sample.
development and cause low birth weight and preterm birth. D. Obtain equipment for external electronic fetal heart
Informing the client of the risk factors and offering to help rate monitoring.
with a referral to a support group provides encouragement and Manual pelvic examinations are contraindicated when vaginal
respect for the client's right to make the decision. Reducing bleeding is apparent in the third trimester until a diagnosis is
the number of cigarettes won't lessen the risks to the fetus. made and placenta previa is ruled out. Digital examination of
Insisting that the client stop smoking could result in a the cervix can lead to maternal and fetal hemorrhage. A
breakdown of established trust. Not taking any action results diagnosis of placenta previa is made by ultrasound. The
in not providing adequate health care information. hemoglobin and hematocrit levels are monitored, and external
31. A client who's 7 months pregnant reports severe leg electronic fetal heart rate monitoring is initiated. Electronic
cramps at night. Which nursing action would be most fetal monitoring (external) is crucial in evaluating the status of
effective in helping her cope with these cramps? the fetus that is at risk for severe hypoxia.
A. Suggesting that she walk for 1 hour twice per day 35. A nurse is assigned to care for a client with hypotonic
B. Advising her to take over-the-counter calcium uterine dysfunction and signs of a slowing labor. The
supplements twice per day nurse is reviewing the physician's orders and would
C. Teaching her to dorsiflex her foot during the expect to note which of the following prescribed
cramp treatments for this condition?
D. Instructing her to increase milk and cheese intake to 8 A. Increased hydration
to 10 servings per day B. Oxytocin (Pitocin) infusion
RATIONALE: C. Common during late pregnancy, leg cramps C. Medication that will provide sedation
cause shortening of the gastrocnemius muscle in the calf. D. Administration of a tocolytic medication
Dorsiflexing or standing on the affected leg extends that Therapeutic management for hypotonic uterine dysfunction
muscle and relieves the cramp. Although moderate exercise includes oxytocin augmentation and amniotomy to stimulate a
promotes circulation, walking 2 hours per day is excessive labor that slows. A cesarean birth will be performed if no
during the third trimester. Excessive calcium intake may cause progress in labor occurs. Options 1, 3, and 4 identify
hypercalcemia, promoting leg cramps; the physician must therapeutic measures for a client with hypertonic dysfunction.
evaluate the client's need for calcium supplements. If the client 36. Immediately after a spontaneous rupture of the
eats a balanced diet, calcium supplements or additional membranes, the nurse observes a loop of umbilical cord
servings of high-calcium foods may be unnecessary. protruding from the vagina. The first nursing action
32. A nurse in a maternity unit is reviewing the records of the would be to:
clients on the unit. Which client would the nurse identify A. administer oxygen.
as being at the greatest risk for developing disseminated B. notify the physician,
intravascular coagulation (DIC)? C. document the deceleration,
 D. elevate the hips on two pillows. A. Headache, blurred vision, and facial and
RATIONALE: D. The first nursing action would be to elevate extremity swelling
the hips on two pillows. The primary goal with prolapse of the B. Abdominal pain, urinary frequency, and pedal edema
umbilical cord is to remove the pressure from the cord. C. Diaphoresis, nystagmus, and dizziness
Changing the maternal position is the first intervention. D. Lethargy, chest pain, and shortness of breath
Acceptable positions include knee-chest, side-lying, and RATIONALE: A. The client is exhibiting signs of
elevation of the hips. The nurse may also perform a vaginal preeclampsia. In addition to hypertension and hyperreflexia,
examination and attempt to push the presenting part of the most preeclamptic clients have edema. Headache and blurred
cord while being careful not to add any pressure to the cord. vision are indications of the effects of the hypertension-
Administering oxygen benefits the fetus only if circulation Abdominal pain, urinary frequency, diaphoresis, nystagmus,
through the cord has been reestablished- The nurse does notify dizziness, lethargy, chest pain, and shortness of breath are
the physician and document the deceleration, care provided, inconsistent with a diagnosis of preeclampsia.
and outcome but only after providing the initial emergency 41. A nurse is reviewing the record of a pregnant client seen
care to the client in the health care clinic for the first prenatal visit. Which
37. A pregnant client is diagnosed with oligohydramnios of the following data if noted on the client's record would
during a clinic visit. Before the client delivers, the nurse alert the nurse that the client is at risk for a spontaneous
should notify the nurses working in the nursery about the abortion?
diagnosis so they can be alert for which complication A. Age of 35 years
commonly associated with oligohydramnios? B. History of syphilis
A. Hypospadias C. History of genital herpes
B. Talipes equiluinovarus D. History of diabetes mellitus
C. Presence of the Babinski reflex
D. Renal malformations
RATIONALE: D. Oligohydramnios is commonly associated Maternal infections such as syphilis, toxoplasmosis, and
with renal malformations in the neonate. These malformations rubella are causes of spontaneous abortion. There is no
include renal aplasia, dysplastic kidneys, and obstructive evidence thai genital herpes is a causative agent in abortion
lesions of the lower urinary tract. Hypospadias, an abnormal although the presence of active lesions at the time of birth
congenital opening of the male urethra on the underside of the presents concerns. Maternal age over 40 and diabetes mellitus
penis, isn't associated with oligohydramnios. Talipes are considered high-risk factors in a pregnancy but are related
equinovarus, commonly known as clubfoot, isn't associated to an increased risk of congenital malformations.
with oligohydramnios. The Babinski reflex, dorsiflexion of the 42. A nurse is caring for a client in labor. The nurse
great toe when the sole of the foot is stimulated, is a normal determines that the client is beginning the second stage of
reflex in neonates. labor when which of the following assessments is noted?
38. Early detection of an ectopic pregnancy is paramount in A. The contractions are regular.
preventing a life-threatening rupture. Which symptoms B. The membranes have ruptured.
should alert a nurse to the possibility of an ectopic C. The cervix is dilated completely.
pregnancy? D. The client begins to expel clear vaginal fluid.
A. Abdominal pain, vaginal bleeding, and a positive The second stage of labor begins when the cervix is dilated
pregnancy test completely and ends with birth of the neonate. Options 1, 2.
B. Hyperemesis and weight loss and 4 are not specific assessment findings of the second stage
C. Amenorrhea and a negative pregnancy test of labor.
D. Copious discharge of clear mucus and prolonged 43. A nurse is performing an assessment of a client who is
epigastric pain scheduled for a cesarean delivery. Which assessment
RATIONALE: A. Abdominal pain, vaginal bleeding, and a finding would indicate a need to contact the physician?
positive pregnancy test are cardinal signs of an ectopic A. Hemoglobin of 11.0 g/dL
pregnancy. Nausea and vomiting may occur before rupture, B. Fetal heart rate of 180 beats/min
but significantly increase after rupture. Amenorrhea and a C. Maternal pulse rate of 85 beats/min
negative pregnancy test may indicate another type of D. White blood cell count of 12.000/mm3
metabolic disorder such as hypothyroidism. Discharge of clear A normal fetal heart rate is 120 to 160 beats/mm. A count of
mucus isn't indicative of an ectopic pregnancy, and referred 180 beats/min could indicate fetal distress and would warrant
shoulder pain, not epigastric pain, should be expected. physician notification. White blood cell counts in a normal
39. A nurse is caring for a client after evacuation of a pregnancy begin to rise in the second trimester and peak in the
hydatidiform mole. The nurse should instruct the client to: third trimester, with a normal range of 11,000 to 15,000/mm3.
A. wait 1 month before trying to become pregnant again. up to 18,000/mm3. During the immediate postpartum period,
B. make an appointment for follow-up human chorionic the count may be as high as 25,000 to 30.000/mm3 as a result
gonadotropin (hCG) level monitoring at the end of 1 of increased leukocytosis during delivery. By full term, a
year. normal maternal hemoglobin range is 11 to 13 g/dL as a result
C. discuss options for sterilization with the physician. of the hemodilution caused by an increase in plasma volume
D. use birth control for at least 1 year. dunng pregnancy. The maternal pulse rate during pregnancy
RATIONALE: D. After experiencing a hydatidiform mole, the increases 10 to 15 beats/min over prepregnancy readings to
client should be counseled to use a reliable method of birth facilitate increased cardiac output, oxygen transport, and
control for at least 1 year. Because of the risk of kidney filtration.
choriocarcinoma, her hCG levels need to be monitored 44. A nurse is caring for a client in labor who is receiving
monthly for 1 to 2 years. Sterilization isn't necessary after oxytocin (Pitocin) by intravenous infusion to stimulate
hydatidiform mole. If hCG levelsremain low, the client may uterine contractions. Which assessment finding would
try to become pregnant after a year. The risk of recurrence of a indicate to the nurse that the infusion needs to be
hydatidiform mole is low. discontinued?
40. Initial client assessment information includes the A. Increased urinary output
following: blood pressure 160/110 mm Hg, pulse 88 B. A fetal heart rate of 90 beats/min
beats/minute, respiratory rate 22 breaths/minute, reflexes C. Three contractions occurring within a 10-minute
+3/+4 with 2 beat clonus. A urine specimen reveals +3 period
protein, and negative glucose and ketones. Based on these D. Adequate resting tone of the uterus palpated between
findings, the nurse would expect the client to have which contractions
complaints? A normal fetal heart rate is 120 to 160 beats/min. Bradycardia
or late or variable decelerations indicate fetal distress and the
need to discontinue the oxytocin. The goal of labor RATIONALE: B. The nitrazine test determines whether the
augmentation is to achieve three good-quality contractions client's membranes have ruptured. The nurse performs a sterile
(appropriate intensity and duration) in a 10-minute period. The vaginal examination, inserts the nitrazine test tape, then
uterus should return to resting tone between contractions, and assesses the tape for a color change. If the membranes are
there should be no evidence of fetal distress. Increased urinary ruptured, the tape becomes bluish, which indicates that the
output is unrelated to the use of oxytocin. vaginal environment is alkaline. If the test tape remains yellow
45. A nurse is monitoring a client in active labor and notes or green, the vaginal environment is acidic, indicating that the
that the client is having contractions every 3 minutes that membranes aren't ruptured. False-positive results may be
last 45 seconds. The nurse notes that the fetal heart rate obtained if a large amount of bloody show or vaginal bleeding
between contractions is 100 beats/min. Which of the is present, if previous vaginal examinations have been done
following nursing actions is appropriate? using sterile lubricant, or if the tape is touched by the nurse's
A. Notify the physician or nurse-midwife. fingers. Microscopic examination (fern test) can also validate
B. Continue monitoring the fetal heart rate. rupture of the membranes. Observing for pink mucus
C. Encourage the client to continue pushing with each discharge; assessing temperature, pulse, and blood pressure;
contraction. and culturing a urine specimen don't validate rupture of the
D. Instruct the client's coach to continue to encourage membranes.
breathing techniques. 50. During the admission assessment of a female neonate, the
A normal fetal heart rate is 120 lo 160 beats/mm. Fetal nurse notes a large lump on the neonate's head. Concerned
bradycardia between contractions may indicate the need for about making the correct assessment, the nurse
immediate medical management, and the physician or nurse- differentiates between caput succedaneum and a
midwife needs to be notified. Options 2, 3, and 4 are not cephalohematoma based on the knowledge that:
appropriate nursing actions in this situation. A. cephalohematoma doesn't cross the suture lines.
B. caput succedaneum occurs primarily with
46. A nurse is reviewing the record of a client in the labor primigravidas.
room and notes that the nurse-midwife has documented C. a cephalohematoma occurs with a birth that required
that the fetus is at negative 1 (-1) station. The nurse instrumentation.
determines that the fetal presenting part is: D. caput succedaneum occurs primarily with a
A. 1 inch below the coccyx. prolonged second stage of labor.
B. 1 inch below Ihe iliac crest. RATIONALE: B. Cephalohematomas don't cross the suture
C. 1 cm above the ischial spine. lines and are the result of blood vessels rupturing in the
D. 1 fingerbreadth below the symphysis pubis. neonate's scalp during labor. They don't always occur when
Station is the relationship of the presenting part to an instrumentation is required. Blood outside the vasculature in a
imaginary line drawn between the ischial spines, measured in neonate increases the possibility of jaundice as the neonate's
centimeters, and noted as a negative number above the line body tries to reabsorb the blood. Caput succedaneum, which is
and a positive number below the line. At negative 1 (-1) simply soft tissue edema of the scalp, can occur in any labor
station, the fetal presenting part is 1 cm above the ischial and isn't limited to a prolonged second stage of labor.
spines. 51. A client in labor for the past 10 hours shows no change in
47. A nurse assists in the vaginal delivery of a newborn cervical dilation and has stayed at 5 to 6 cm for the past 2
infant. After the delivery, the nurse observes the umbilical hours. Her contractions remain regular at 2-minute
cord lengthen and a spurt of blood from the vagina. The intervals, lasting 40 to 45 seconds. What would be the
nurse documents these observations as signs of: nurse's initial action?
A. Hematoma A. Assess for presence of a full bladder.
B. Uterine atony B. Suggest the placement of an internal uterine pressure
C. Placenta previa catheter to determine adequacy of contractions.
D. Placental separation C. Encourage the mother to relax by assisting her with
As the placenta separates, it settles downward into the lower appropriate breathing techniques.
uterine segment. The umbilical cord lengthens, and a sudden D. Suggest to the physician that oxytocin (Pitocin)
trickle or spurt of blood appears. Options 1, 2, and 3 are augmentation be started to stimulate labor.
incorrect interpretations. RATIONALE: A. The nurse should assess for a full bladder,
48. A delivery room nurse is caring for a client in labor. The which will slow or stop cervical dilation and produce
client tells the nurse that she feels that something is symptoms that could be misdiagnosed as arrest in labor. Other
coming through the vagina. The nurse performs an strategies, such as internal uterine monitoring, relaxation, and
assessment and notes the presence of the umbilical cord oxytocin augmentation, would be appropriate later, but
protruding from the vagina. The nurse immediately places assessing the bladder first is key.
the client in what position? 52. A nurse is caring for four 1-day postpartum clients.
A. Prone Which client has an abnormal finding that would require
B. Supine further intervention?
C. Reverse Trendelenburg A. The client with mild afterpains
D. On the side B. The client with a pulse rate of 60 beats/min
If cord prolapse or compression is suspected, the client is C. The client with colostrum discharge from both
immediately repositioned. Cord compression needs to be breasts
relieved so that adequate fetal oxygenation occurs. The client D. The client with lochia that is red and has a foul-
may be turned to the side or the hips can be elevated to shift smelling odor
the fetal presenting part toward her diaphragm, thereby Lochia, the discharge present after birth, is red for the first 1 to
relieving cord compression. A hands-and-knees position may 3 days and gradually decreases in amount. Normal lochia has a
reduce compression on a cord that is entrapped behind the fleshy odor or an odor similar to menstrual flow. Foul-
fetus. smelling or purulent lochia usually indicates infection, and
49. Which assessment would a nurse perform to validate that these findings are not normal. The other options are normal
the membranes are ruptured? findings for a 1 -day postpartum client.
A. Observe for a pink, mucus vaginal discharge. 53. A nurse is assessing a client who is 6 hours postpartum
B. Test the leaking fluid with nitrazine paper. after delivering a full-term healthy newborn infant. The
C. Assess the client's temperature, pulse, and blood client complains to the nurse of feelings of faintness and
pressure. dizziness. Which of the following nursing actions would
D. Send a urine specimen to be cultured. be most appropriate?
 A. Elevate the client's legs. A. oxytocin (Pitocin)
B. Determine hemoglobin and hematocrit levels. B. ibuprofen
C. Instruct the client to request help when getting out C. Rh0(D) immune globulin (RhoGAM)
of bed. D. magnesium sulfate
D. Inform the nursery room nurse to avoid bringing the RATIONALE: A. Oxytocin would be given to cause the
newborn infant to the client until the feelings of uterus to maintain a firm contraction. When the uterus remains
lightheadedness and dizziness have subsided. boggy, the myometrium isn't contracted, and bleeding occurs
Orthostatic hypotension may be evident during the first 8 at the placental attachment site. Ibuprofen has anti-
hours after birth. Feelings of faintness or dizziness are signs inflammatory properties but doesn't prevent a boggy uterus.
that caution the nurse to beware for the client's safety. The Rh0 (D) immune globulin is given to prevent Rh
nurse should advise the client lo get help the first few times isoimmunization. Magnesium sulfate is given to stop preterm
the mother gets out of bed. Option 1 is not the most labor contractions because it causes the uterine smooth muscle
appropriate or helpful action in this situation. Option 2 to relax.
requires a physician's order. Option 4 is unnecessary. 58. A client is 24 hours postpartum. The nurse anticipates that
54. A nurse on a postpartum unit is instructing a client the client's body is returning to homeostasis. Which
regarding lochia and the amount of expected lochia assessment finding requires immediate intervention?
drainage. The nurse instructs the client that the normal A. Maternal chills
amount of lochia may vary but should never exceed the B. Elevated temperature
need for: C. Bradycardia
A. One peripad a day D. Positive Homan’s sign
B. Two peripads a day RATIONALE: D. Positive Homans' sign indicates thrombosis,
C. Eight peripads a day which is abnormal for a postpartum client. This sign requires
D. Three peripads a day immediate intervention. Maternal chills are a normal
The normal amount of lochia may vary with the individual but vasomotor response to the birth. An elevated temperature in
should never exceed 4 to 8 peripads a day. The average the first 24 hours is also normal. Bradycardia in the
number of peripads used is 6 per day. postpartum period is common as the body adjusts to the
decreased cardiac output and begins to eliminate fluid.
59. A nurse in the physician's office is assessing a client who
55. A pregnant human immunodeficiency virus (HlV)- came in for her 6-week postpartum follow-up
positive woman delivers a newborn infant and the nurse appointment. Which assessment finding would the nurse
provides instructions to help the mother regarding the expect?
newborn infant care. Which statement by the client A. Lochia rubra
indicates the need for further instructions? B. Lochia serosa
A. "I will be sure to wash my hands before and after C. Lochia alba
bathroom use." D. Absence of lochia
B. "Support groups are available to assist me with RATIONALE: D. By postpartum week 6, lochia usually has
understanding my diagnosis of HIV." ceased. Lochia rubra typically lasts from postpartum days 1 to
C. “I need to breast-feed, especially for the first 6 3; lochia serosa, from days 3 to 10; and lochia alba, from days
weeks postpartum." 10 to 14.
D. "My newborn infant should be on antiviral 60. Which action would be appropriate to include in the care
medications for the first 6 weeks after delivery.” plan for a client during the fourth stage of labor?
The mode of perinatal transmission of HIV to the fetus or A. Monitoring vital signs and doing fundal checks every
neonate of an HIV-positive woman can occur during the hour
antenatal, intrapartal. or postpartum period. HIV transmission B. Providing time with the neonate to initiate breast-
can occur during breast-feeding. Therefore, HIV-positive feeding
clients should be encouraged to bottle-feed their neonates. C. Catheterization to protect the bladder from trauma
Frequent hand washing is encouraged. Support groups and D. Examination of the placenta to make sure it's intact
community agencies can be identified to assist the parents RATIONALE: B. During the fourth stage of labor, the client
with the newborn infant's home care, the impact of the should have time with the neonate to initiate breast-feeding.
diagnosis of HIV infection, and available financial resources. Vital signs should be monitored and fundal checks performed
It is recommended that newborn infants of HIV-positive every 15 minutes for a minimum of 1 hour. Catheterization
clients receive antiviral medications for their first 6 weeks of isn't routinely done to protect the bladder from trauma. It's
life. done, however, for a postpartum complication of urinary
56. A nurse is monitoring a postpartum client who is at risk retention. The placenta should be examined to make sure it's
for developing endometritis. Which of the following if intact during the third stage of labor, not the fourth stage.
noted during the first 24 hours after delivery would 61. Which aspect of nursing care is most important in the
support a diagnosis of postpartum endometritis? postpartum period?
A. Maternal oral temperature of 100.2° F A. Supporting the mother's ability to successfully
B. Uterus two fingerbreadths below midline and firm feed and care for her neonate
C. Abdominal tenderness and chills B. Involving the family in the teaching
D. Increased perspiration and appetite C. Providing group discussions on infant care
Signs and symptoms in the postpartum period heralding D. Monitoring the normal progression of lochia
endometritis include delayed uterine involution, foul-smelling RATIONALE: A. Most of the nursing interventions during the
lochia, tachycardia, abdominal tenderness, and temperature postpartum period are directed toward helping the mother
elevations up to 104° F. This intrauterine infection may lead to successfully adapt to the parenting role. Although family
further maternal complications, such as infections of the involvement in teaching, group discussions on infant care, and
fallopian tubes, ovaries, and blood (sepsis). Options 1, 2, and 4 lochia monitoring are important aspects of care, the mother's
represent normal maternal physiological responses in the ability to feed and care for her infant takes priority.
immediate postpartum period. 62. The nurse recognizes that an expected change in the
57. A nurse palpates a multipara's fundus immediately after hematologic system that occurs during the second
delivery of the placenta and assesses that it's boggy. The trimester of pregnancy is:
nurse massages the client's uterus until it's firm. Which A. A decrease in WBCs
medication would the nurse expect to administer if the B. An increase in hematocrit
uterus becomes boggy again? C. An increase in blood volume
 D. A decrease in sedimentation rate can be confirmed only if vaginal examination reveals
Correct Answer: C cervical dilation. D. Spotting in the firs trimester may
Rationale: A. White blood cell values remain stable during indicate that the client may be having a threatened
the antepartum period. B. The hematocrit decreases as a result abortion; any client with the possibility of
of hemodilution. C. The blood volume increases by hemorrhage should not be left alone; therefore
approximately 50% during pregnancy. Peak blood volume admitting this client for observation is safe medical
occurs between 30 and 34 weeks of gestation. D. The practice; abortion is usually inevitable if
sedimentation rate increases because of a decrease in plasma accompanied by pain and cervical dilation.
proteins. 67. At about 5 cm dilation, a laboring client receives
63. In the 12th week of gestation, a client completely expels medication for pain. The nurse is aware that one of the
the products of conception. Because the client is Rh- medications given to women in labor that could cause
negative, the nurse must: respiratory depression of the newborn is:
A. Administer RhoGAM within 72 hours A. Scopolamine
B. Make certain she recieves RhoGAM on her first B. Promazine (Sparine)
clinic visit C. Meperidine (Demerol)
C. Not give RhoGAM, since it is not used with the birth D. Promethazine (Phenergan)
of a stillborn Correct Answer: C
D. Make certain the client does not receive RhoGAM, Rationale: Respiratory depression occurs with the
since the gestation lasted only 12 weeks use of meperidine (Demerol) and produces
Correct Answer: A significant depression of the infant at birth if
Rationale: A. It is given within 72 hours postpartum if the circulating levels are high at time of birth.
client has not been sensitized previously. B. It would be Scopolamine induces amnesia and forgetfulness in
useless at this time. C. RhoGAM is always indicated at the the mother but does not cause respiratory depression;
termination of a pregnancy, even with fetal demise. D. this medication is not presently used. Prpmazine
RhoGAM is always indicated at the termination of a (Sparine), an anxiolytic, augments the effects of
pregnancy, even with a short-term pregnancy. demerol, thereby lessening the amount of drug
64. During prenatal development, fetal weight gain is greatest needed. Promethazine (Phenergan), an antihistamine,
in the: does not cause respiratory depression.
A. First Trimester 68. When caring for a client who is having a prolonged labor,
B. Third Trimester the nurse must be aware that the client is very concerned
C. Second Trimester when her labor deviates from what she sees as the norm.
D. Implantation Period A response conveying acceptance of the client’s
Correct  Answer: B expressions of frustration and hostility would be:
Rationale: A. The first trimester is the period of A. “I’ll rub your back; tell me if it helps.”
organogenesis, when cells differentiate into major organ B. “I’ll leave as you can talk to your husband.”
systems. B. This is the period in which the fetus sores deposits C. “All women get weary and frustrated during labor.”
of fat fetal weight gain is greatest. C. Growth is occurring, but D. “Would you like to talk about what’s bothering you?”
fat deposition does not occur in this period. D. This is the Correct Answer: A
period of the blastocyst, when initial cell division takes place. Rationale: A. This response provides the client with
65. A client at 38 weeks’ gestation is admitted for induction a comfort measure while giving her an opportunity to
of labor. She has a history of ruptured membranes for the get verbalize her fears about having a prolonged
past 12 hours. She has no other symptoms of labor. The labor. B. This closes off communication with the
nurse is aware that if the proper conditions exist, the client. C. This is of no help to the client; she is
physician will prescribe: concerned with what is happening to her. D. This can
A. Progesterone be answered “yes” or “no” and leaves no further
B. Oxytocin (Pitocin) avenue for discussion.
C. Lututrin (Lutrexin) 69. A pregnant woman is at term is admitted to the birthing
D. Ergonovine maleate unit in active labor. The client is excited about the
Correct Answer: B anticipated birth because has three sons and the
Rationale: Oxytocin is a small polypeptide hormone amniocentesis indicates that she will have a girl. The
normally synthesized in the hypothalamus and nurse recognizes that there are implications for newborn
secreted from the neurohypophysis during parturition observations and care when the nursing history reveals
or suckling; the synthetic form promotes powerful that:
uterine (smooth muscle) contracitons and thus is used A. The membranes ruptured 2 hours ago
to induce labor. Progesterone builds up the B. Her first child was diagnosed with hemophilia
endometrium; it does not initiate uterine contractions. C. She has taken NSAIDs for frequent sinus
Lututrin no drug by this name for this purpose. headaches
Ergonovine can lead to sustained contractions, which D. There was a placenta previa in a previous pregnancy
would be undesirable labor. Correct Answer: C
66. A client, whose husband is overseas in the military, is Rationale: NSAID as well as other over-the counter
admitted to the hospital with vaginal staining but no pain. drugs (OCT) taken during pregnancy may cause
The client’s history reveals amenorrhea for the last 2 problems in the newborn during the neonatal period.
months and pregnancy confirmation by her physician The membranes ruptured 2 hours ago is not a cause
after her first missed period. She is admitted for of concern; if membranes ruptured over 24 hours
observation with a possible diagnosis of : before birth, infection may ensue. Hemophilia affects
A. Missed abortion males; this fetus is known to be a female may be a
B. Ectopic pregnancy carrier but would not have hemophilia. Placenta
C. Inevitable abortion previa would have been diagnosed before active
D. Threatened abortion labor; a history of a placenta previa in an earlier
Correct Answer: D pregnancy would not have implication for this
Rationale: A. This may not cause any outward newborn.
symptoms, only the signs of pregnancy disappearing. 70. A 16-year-old comes to the prenatal clinic because she
B. This is usually accompanied by severe pain has missed three menstrual periods. Before her physical
radiating to the shoulder on the affected side. C. This examination, the client says. “I don’t know what the
 problem is, but I can’t be pregnant.” The nurse’s most B. “That’s entirely up to you; you have to do what
therapeutic response to this statement would be: works for you.”
A. “The doctor will let you know shortly.” C. “Holding the baby when feeding is important for
B. “What brought you to the prenatal clinic then?” development.”
C. “Many young women are irregular at your age.” D. “It is very unsafe to prop a bottle. The baby could
D. “If you have had intercourse, you are probably aspirate the fluid.”
pregnant.” Correct Answer: A
Correct Answer: B Rationale: A. This opens up an area of
Rationale: A. This response would close off any communication to get at what really is troubling the
future communication with the client. B. This mother about feeding the baby. B. Because the nurse
response points out reality and allow the client to is aware that this is not the best method, the problem
elaborate.C. This may be true statement, but it does of time should be explored with the mother. C.
not allow for much discussion to follow. D. This Holding can be accomplished at times other than
response sounds rather critical or judgmental and feeding periods; it does not explore the client’s
would probably cut off further discussion with the feelings. D. This is true, but the mother should not be
client. frightened; a more gentle explanation should be used.
71. After an 8-hour, uneventful labor a client gives birth to a 74. Which of the following is the most important nursing
baby boy spontaneously under epidural block anesthesia. action when caring for a client who is 6 hours post
As the nurse places the baby in the mother’s arms cesarean birth?
immediately after the birth, the mother asks, “Is he A. Turning, coughing, and deep breathing every 4
normal?” The most appropriate response by the nurse hours
would be: B. Applying anesthetic spray to her perineum
A. “Most babies are normal; of course he is” C. Assisting the client to the bathroom for a shower
B. “He must be all right, he has such a good strong cry.” D. Encouraging a sitz bath three times a day
C. “Yes, because your pregnancy and labor were so Correct Answer: A
normal.” Rationale: A cesarean birth is a surgical procedure
D. “Shall we unwrap him so you can look him over involving an abdominal incision. Immobility in the
for yourself?” postoperative period causes secretions to pool. Also,
Correct Answer: D abdominal incisions cause pain on deep breathing.
Rationale: A. This is false reassurance; this comment Clients with abdominal incisions need to turn, cough,
closes off communication with the mother at a very and deep breathe to mobilize secretions to prevent
opportune moment. B. Crying is not indicative of atelectasis and pneumonia. Anesthetic spray is
congenital defects; a strong cry does not ensure applied to the episiotomy to provide local analgesia.
“normalcy”. C. The “normalcy” of the mother’s Clients who have had a cesarean birth do not have a
pregnancy and labor does not always have a perineal incision. Six hours post cesarean birth is too
relationship to the “normalcy” of the infant. D. soon for a shower. The client may be very weak for
Mothers need to explore their infants visually and the first 24 hours. Safety might be an issue. Sitz baths
through touch to assure themselves that the infants provide cleansing and warmth to perineal areas for
are normal in all respects. clients with episiotomies.
75. The husband of a client who is in the transitional phase of
72. A young couple attends the prenatal clinic. The wife is 8 labor becomes very tense and nervous during this period
weeks’ pregnant and asks the clinic nurse for information and asks the nurse, “Do you think it is best for me to
about an abortion. The nurse expresses the opinion that leave, since I don’t seem to do my wife much good?” The
abortion is immoral and that many women have long-term most appropriate response by the nurse would be:
guilt feelings after an abortion. The couple leave the clinic A. “This is the time your wife needs you. Don’t run out
in a very disturbed state. Legally, the: on her now.”
A. Client had a right to receive correct, unbiased B. “This is hard for you. Let me try to help you
information coach her during this difficult phase.”
B. Nurse’s statements need not be based on scientific C. “I know this is hard for you. Why don’t you go have
knowledge a cup of coffee and relax and come back later if you
C. Physician should have been called in, since nurses feel like it?”
should not discuss abortion D. “If you feel that way, you’d best go out and sit in the
D. Nurse had a right to state feelings as long as they father’s waiting room for a while because you may
were identified as the nurse’s own transmit your anxiety to your wife.”
Correct Answer: A Correct Answer: B
Rationale: A. Nurses with positive attitudes toward Rationale: A. This statement is judgmental; this
abortion should counsel women who are thinking of approach suggest that he will be failing his wife. B.
undergoing the procedure; they should know what Both the father and the mother need additional
services are available and the various methods that support during the transitional stage of labor. C. The
are used to induce abortion. B. Nursing practice husband should be present throughout labor to
necessitates scientific knowledge; statements must be support his wife; he should be assisted in this role. D.
based on fact, not personal feelings or beliefs. C. The This does not encourage him to fulfill his role in
nurse is capable of giving information about abortion supporting the mother during labor.
and need not defer to the physician. D. The nurse 76. A decision to withhold “extraordinary care” for a
should give the client only the information requested newborn with severe abnormalities is actually:
and should not state personal feelings. A. A decision to let the newborn die
73. A newly delivered mother with three young children at B. The same as pediatric euthanasia
home comment to the nursery nurse that she cannot hold C. Presuming that the newborn has no rights
the baby for feedings once she gets home. She has just too D. Unethical and illegal medical nursing practice
much to do, and anyhow, it spoils the baby. The best Correct Answer: A
response for the nurse to make is: Rationale: A. Based on the family’s decision,
A. “You seem concerned about time. Let’s talk about extraordinary care does not have to be employed; the
it.” infant’s basic needs are met, and nature is allowed to
take its course.B. Euthanasia is a deliberate
 intervention to cause death. C. If the infant’s physical Correct Answer: D Explanation: A. Obtaining and
needs are met and comfort is provided, the infant’s delivering the necessary specimens may be
rights are not ignored; “extraordinary,” not “all,” care inconvenient but should not be stressful. B. The
is being withheld. D. It is neither unethical or illegal number of office visits and examinations that are
to withhold extraordinary treatments; once such required may be cumbersome but should not be
treatment is started, it becomes a legal issue. stressful. C. The couple probably knows that one of
77. In dealing with a couple identified as having an infertility them has a fertility problem; it may be helpful
problem, the nurse knows that: knowing that the problem is so that measures can be
A. Infertility is usually psychologic in origin taken to correct it. D. A strategy for increasing the
B. Infertility and sterility are essentially the same chances of conceiving requires the couple to plan
problem intercourse only while the woman is ovulating; this
C. The couple have been unable to have a child after removes spontaneity and is often stressful.
trying for a year 81. During the taking-hold phase, the nurse would expect the
D. One partner has a problem that makes that person new mother to:
unable to have children A. Talk about the baby
Correct Answer: C B. Call the baby by name
Rationale: A. Infertility may be psychogenic; however, C. Touch the baby with her fingertips
statistics show that physiologic problems are more often D. Be passively involved with the baby
the cause. B. This is untrue; infertility may be corrected, Correct Answer: B
but sterility is irreversible. C. Infertility is the inability of Rationale: A. This may occur in either phase. B. The
a couple to conceive after at least 1 year of adequate mother has completed the taking-in phase (the
exposure to the possibility of pregnancy. D. This may or mother’s needs predominate) and has moved into
may not be true; it is possible that there is a problem with taking-hold the taking-hold phase (active maternal
both. involvement with self and infant) when she calls the
78. Which of the following assessment findings about the baby by name. C. This is the initial early action of the
uterus would the nurse expect to find in a primipara client taking-in phase. D. This is part of the taking-in phase.
6 hours post-delivery of an average-for-gestational-age 82. Supportive nursing care in the beginning mother-infant
infant? relationship should include:
A. Fundus firm, midline, 2 fingerbreadths below the A. Requiring the mother to assist with simple aspects of
umbilicus her infant’s care
B. Fundus firm, midline, at the level of the umbilicus
C. Fundus firm, to the right of the midline, at the B. Encouraging the mother to decide between
umbilical level breastfeeding and formula feeding
D. Fundus soft, to the right of the midline, 2
fingerbreadths above the umbilicus C. Allowing the mother ample time to undress and to
Correct Answer: B carefully inspect her infant
Rationale: One hour after birth, the fundus rises to
the level of the umbilicus, where it remains for
approximately 24 hours. It should be firm and in the D. Unobtrusive observation of the mother and her infant
middle. The fundus should be firm and midline, but to watch for a disturbed relationship
should not be 2 fingerbreadths below the umbilicus Correct Answer: C
on the day of delivery. A fundus that is to the right of Rationale: A. The client will proceed at her own
the midline denotes urinary bladder distention. The rate; requiring her to do things is not supportive. B.
fundus should be firm to provide hemostasis. The The mother should have made this decision before
fundus is up too far in the abdomen and is deviated to delivery. C. Allowing the mother time to inspect the
the right, denoting a distended bladder. child permits viewing, touching, and holding,
79. An amniocentesis done on a client at 16 weeks’ gestation promoting bonding. D. This can be done only by
reveals a fetus with Down syndrome. The client and her allowing the mother ample time to interact with her
husband elect to have the pregnancy terminated. The baby.
nurse giving care to a client whose pregnancy is 83. A client undergoing treatment for infertility is diagnosed
surgically terminated should be aware that: as having endometriosis. The nurse is aware that one of
A. The client is emotionally unstable at this time the drugs that may be used to treat this condition is:
B. There is a high risk for a postoperative infection A. Relaxin (Releasin)
C. Contraceptive counseling should be deferred to a B. Leuprolide (Lupron)
later time C. Ergonovine (Ergotrate)
D. The client needs to express her feeling of guilt, D. Esterfied estrogen (Climestrone)
anger, and frustration Correct Answer: B
Correct Answer: D Rationale: Continuous administration of Lupron
Rationale: A. This is a false assumption. B. This is a decreases LH and FSH, as well as hormone-
sterile procedure and should not predispose the client to dependent tissue. Relaxin is used for dysmenorrhea;
postoperative infection. C. Studies show that it causes relaxation of the symphysis pubis. Ergotrate
contraceptive counseling at this time is most important, is used to contract the uterus. Esterfied estrogen
because the client may not return after the abortion. D. (Climestrone) is an estrogen that affects release of
The client must feel comfortable enough to verbalize her pituitary gonadotropins and inhibits ovulation.
feelings of guilt; this helps to complete the grieving 84. Research concerning the emotional factors of pregnancy
process. indicates:
80. A couple in the fertility clinic have become very A. A rejected pregnancy will result in a rejected infant
discouraged regarding their efforts to conceive. The nurse B. Ambivalence and anxiety about mothering are
can best support them by understanding that the most common
stressful aspect of the process is: C. Maternal love is fully developed within the first week
A. Obtaining the necessary specimens after birth
B. Visiting the fertility clinic frequently D. An effective mother experiences neither ambivalence
C. Discovering which partner is infertile nor anxiety about mothering
D. Planning when intercourse should take place Correct Answer: B
Rationale: A. Frequently the maternal instinct is
 nurtured by the sight of the infant. B. Because (46 chromosomes) is reached when fertilization
mothering is not an inborn instinct, almost all occurs. D. This is the result of a reduced
mothers, including multiparas, report some chromosome number, from 46 to 23, readying the sex
ambivalence and anxiety about their ability to be cells for fertilizaiton.
good mothers. C. It may take a much longer time. D. 88. During the postpartum period, a cardiac client with type 2
Ambivalent feelings are universal in response to a diabetes asks the nurse, “Which contraceptives will I be
neonate. able to use to prevent pregnancy in the near future?” The
85. Which of the following instructions would be included in nurse’s best response would be:
a client’s postpartum teaching plan about performing A. “You may use oral contraceptives. They are almost
Kegel exercises to restore perineal muscle tone? 100% effective in preventing pregnancy.”
A. Alternately flexing and extending each foot while B. “You may want to use a foam and a condom to
raising her leg 6 inches off the bed prevent pregnancy until you consult with your
doctor at your postpartum visit.”
B. Contracting and relaxing perineal muscles as if C. “The intrauterine device is best for you because it
stopping and starting a urinary stream does not allow a fertilized ovum to become implanted
in the uterine lining.”
C. Contracting the abdominal muscles while raising her D. “You do not need to worry about becoming pregnant
legs 1 inch off the bed in the near future. Clients with cardiac conditions
usually become infertile.”
Correct Answer: B
D. Taking deep breaths and slowly exhaling while Rationale: A. Oral contraceptives are not
compressing the buttocks together recommended for this client because of their
Correct Answer: B tendency to alter glucose tolerance. B. Some type of
Rationale: Kegel exercises require contracting the a barrier contraceptive (condom) is usually
pubococcygeal muscle, the major muscle of the recommended for the client with diabetes mellitus
pelvic floor, to increase muscle tone and provide and a cardiac condition. C. An IUD is not
support to the vaginal wall, bladder, and rectum. recommended because it may predispose this client
Alternate flexing and extending the foot with raising to infection. D. This is untrue; clients with a cardiac
will facilitate venous return and help prevent condition can become pregnant again in the future.
thrombophlebitis. However, this exercise will not 89. A client at 6 weeks’ gestation is receiving antibiotic
affect perineal muscle tone. Contracting the therapy for pyelonephritis. The nurse is aware that the
abdominal muscles with leg raises will increase safest antibiotic for administration during pregnancy is:
abdominal, but not perineal, muscle tone. Deep A. Gantrisin
breathing expands the lungs. Contracting gluteal B. Ampicillin
muscles will not affect the perineal, muscle tone. C. Tetracycline
86. A client visiting the prenatal clinic for the first time asks D. Nitrofurantoin
the nurse about the probability of having twins because Correct Answer: B
her husband is one of a pair of fraternal twins. The nurse Rationale: Ampicillin has no know tertogenic effect
should explain that: associated with penicillin. Gantrisin sulfonamides
A. The probability of having twins is 25% may cause hemolysis in the fetus. Tetracycline causes
permanent yellow staining of teeth in children whose
B. She will be monitored closely for the presence of mothers receive the drug during pregnancy.
twins Nitrofurantion is contraindicated in severe renal
disease.
C. Her husband’s history of being a twin raises the 90. A client with multiple sclerosis has just confirmed her
probability of having twins pregnancy. She states she is taking ACTH and wonders
whether she can continue taking it. The best response by
D. There is no greater probability of having twins the nurse would be:
than in the general population A. ACTH is safe to take during pregnancy
Correct Answer: D
Rationale: A. If there is no maternal family history of B. ACTH may make you prone to nausea and vomiting
twin pregnancies, it would be a chance occurrence
that is equal to the probability found in the general C. This medication is untested in pregnancy. Check with
population. B. Pregnant women are routinely your physician.
monitored for multiple pregnancies; this client needs
information about her risk for having twins. C. If D. This is used during plasmapheresis and should be
there is no maternal family history of twin safe to continue taking.
pregnancies, it would be a chance occurrence that is Correct Answer: A
equal to the probability found in the general Rationale: Although ACTH is a pregnancy category
population. D. Fraternal twins may occur as a result C drug and it is not known whether it is harmful to
of a hereditary trait, but is related to the ovaries the fetus, the client’s health must be considered as
releasing two eggs during one ovulation; the fact that well as the life of the fetus; it acts to strengthen nerve
the father is a fraternal twin would not influence the conduction. Nausea and vomiting are not side effects
female to release two eggs during one ovulation. of ACTH. ACTH has been tested in pregnancy. Used
87. During the process of gametogenesis, the male and female during plasmapheresis is not the reason ACTH has
sex cells divide, and each mature sex cell contains: been prescribed; the client has multiple sclerosis.
A. 24 pairs of autosomes in their nuclei 91. After the first 3 months of pregnancy, the chief source of
B. 46 pairs of chromosomes in their nuclei estrogen and progesterone is the:
C. A diploid number of chromosomes in their nuclei A. Placenta
D. A haploid number of chromosomes in their nuclei B. Adrenal Cortex
Correct Answer: D C. Corpus luteum
Rationale: A. They each have one set of D. Anterior hypophysis
chromosomes (23). B. There are only 23 pairs of Correct Answer: A
chromosomes in the nuclei. C. The diploid number Rationale: A. When placental formation is complete,
 around the 12th week of pregnancy, it produces The intravenous fluid may facilitate elimination, but
progesterone and estrogen. B. This is not the chief oxytocin does not affect bowel or bladder
source of progesterone and estrogen; only small elimination. Oxytocin has no antibacterial or
amounts are secreted. C. The corpus luteum supplies analgesic action.
the estrogen and progesterone needed to sustain the 96. During the postpartum period, while considering nursing
pregnancy until the placenta is ready to take over. D. measures to help parent-child relationships, the nurse
FSH is secreted by the anterior hypophysis, but it is should be aware that the most important factor at this time
not secreted during pregnancy. is the:
92. An infant is born with a bilateral cleft palate. Plans are A. Anesthesia during labor
made to begin reconstruction immediately. Nursing B. Duration and difficulty of labor
intervention to promote parent-infant bonding should C. Physical condition of the infant
include: D. Health status during pregnancy
A. Demonstrating a positive acceptance of the infant. Correct Answer: C
B. Placing the baby in a nursery away from view of the Rationale: A. Though the effect of an anesthesia is a
general public. factor, the most important factor is the physical
C. Explaining to the parents that the infant will look condition of the infant. B. Though the duration and
normal after the surgery. difficulty of labor is a factor, the most important
D. Encouraging the parents to limit contact with the factor is the physical condition of the infant. C.
infant until after surgery. Bonding between parent and baby is most successful
Correct Answer: A when interaction is possible right after birth; if the
Rationale: A. By demonstrating acceptance of the child is ill, contact is limited. D. Health status during
infant, without regard for the defect, the nurse acts as pregnancy may be a factor, but the most important
a role model for the parents, thus enhancing their factor is the physical condition of the infant.
acceptance. B. Infants with cleft palates can remain 97. The uterus rise out of the pelvis and becomes an
in the newborn nursery; they should not be hidden. C. abdominal organ at about the:
This is false reassurance; it does not promote parent- A. 10th week of pregnancy
infant bonding.D. The parents should be encouraged B. 8th week of pregnancy
to have frequent contact with their infant to promote C. 12th week of pregnancy
bonding. D. 18th week of pregnancy
93. A pregnant client’s labor is to be induced at 39 week’s Correct Answer: C
gestation. The nurse is aware that several drugs are Rationale: A. The uterus is still within the pelvic
currently utilized for inducing labor. Select all that apply. area. B. The uterus is still within the pelvic area. C.
A. Oxytocin (Pitocin) By this time the fetus and placenta have grown,
B. Misprostol (Cytotec) expanding the size of the uterus. The extended uterus
C. Ergonovine (Ergotrate) expands into the abdominal cavity. D. The uterus has
D. Carboprost (Hemabate) already risen out of the pelvis and is expanding
Correct Answer:: A farther into the abdominal area.
Rationale: Pitocin is an oxytocic used for labor 98. A client suspects that she is pregnant, but because she is
induction. Cytotec is a prostaglandin used for the only wage earner in her family, she is ambivalent
cervical ripening and labor induction. Ergotrate is an about continuing the pregnancy. The nurse recognizes that
oxytocis used for postpartum or postabortion the client is in crisis and also remembers that pregnancy
hemorrhage, not labor induction. Hemobate is a and birth are considered crises because:
prostaglandin used for pospartum hemmorrhage, not A. There are mood changes during pregnancy
labor induction. Prepidil is used for cervical ripening, B. They are periods of change and adjustment to
not labor induction. change
94. It is important for the nurse to support the parent’s C. There are hormonal and physiologic changes in the
decision to abort a fetus with a birth defect because: mother
A. Supporting them will eliminate feelings of guilt D. Narcissism is the mother affects the husband wife
B. The parents are legally responsible for the decision relationship
C. It is essential for maintenance of family  Correct Answer: B
equilibrium Rationale: A. These are transient; they are similar to
D. The nurse’s support will relieve the pressure previous mood changes and should not affect the
associated with decision making mother’s ability to cope. B. Expected periods of
Correct Answer: C marked change and adjustment are called
Rationale: A. Support may help, but it does not developmental crises and predispose the woman to a
completely alleviate guilt feelings. B. Support does situational crisis. C. These occur throughout the life
not affect the legal responsibility of the parents. C. cycle of a mature woman and should not now be
Although support will help minimize guilt, it will not classified as a crisis. D. It becomes a crisis only if the
eliminate it; however will sustain family cohesion husband withdraws support.
and unity. D. This may help, but it cannot completely
relieve pressure.  

95. During the first hours following delivery, the postpartum 99. When caring for a family on a postpartum unit, the nurse
client is given intravenous fluids with oxytocin (Pitocin) must be aware that all the tasks, responsibilities, and
added to them. The nurse understands the primary reason attitudes that make up child care can be called parenting
for this is: and that either parent can exhibit these qualities. A person
A. To facilitate elimination is able to perform parenting because of:
B. To prevent infection A. A marriage with flexible roles
C. To promote analgesia B. An inborn ability based on instinct
D. To promote uterine contraction C. Positive childhood roles and concepts
Correct Answer: D D. A good education in growth and development
Rationale: Oxytocin is a hormone produced by the Correct Answer: C
pituitary gland that produces intermittent uterine Rationale: A. Marriage is not essential for good
contractions, helping to promote uterine involution. parenting. B. Parenting is learned, not inborn. C.
 Parenting is not an inborn instinct rather a learned
behavior based on past experiences or current
instruction. D. This knowledge does not ensure the
ability to parent.
[Link] labor a client who has been receiving epidural
anesthesia has a sudden episode of severe nausea, and her
skin becomes pale and clammy. The nurse’s immediate
reaction should be to:
A. Notify the physician
B. Elevate the client’s legs
C. Check for vaginal bleeding
D. Monitor the FHR every 3 minutes
Correct Answer: B
Rationale: A. If signs and symptoms do not abate
after elevation of the legs, the physician should be
notified. B. Maternal hypotension is a common
complication of this anesthesia for labor, and nausea
is one of the first clues that this has occurred.
Elevating the extremities restores blood to the central
circulation. C. This is not a specific observation after
caudal anesthesia; it is part of the general nursing
care during labor. D. If the FHR is being monitored,
it is a constant process; if not, the FHR should be
monitored every 15 minutes.