NLE-Obstetrics sample questions

82. Constipation is common problem during the postpartum period. Which of the following factors contributes to constipation? a) relaxation of the lower bowel b) relaxation of the intestinal and abdominal muscles c) lack of food and fluid intake d) all of the above 83. Woman typically experience diuresis during first five postpartum days; this diuresis occurs as a result of a) constriction of the bladder b) water retention during pregnancy c) relief of pressure on the uterus d) all of the above 84. A nurse caring for the woman in the taking-in phase of the puerperium should be sure to a) instruct her how to bath an infant b) allow her as much rest as needed c) have her begin postpartum exercises d) all of the above 85. The woman in taking-in phase of the immediate period most likely would want to discuss a) their delivery b) the care of their baby c) discharge plan d) all of these Situation: Mrs. O, G2p1, is admitted to the labor and delivery area in labor. Initial assessment reveals cervical dilatation of 5 cm; cervical effacement 80%; station negative 3; frequency of contractions every 58 mins; duration of contractions 40 to 50 seconds; membranes ruptured spontaneously 1 hour before admission; presentation is vertex with LOA position. 86. Based om Mrs. O's initial assessment findings, the fetal presenting part is: a) at the level of the pelvic inlet b) at the level of the ischial spines c) 1 cm below the ischial spines d) at the perineum 87. The FHR should be most audible in which quadrant of Mrs. O's abdomen? a) LLQ b) LUQ

c) RLQ d) RUQ 88. The physician places Mrs. O. on bed rest. Which assessment finding necessitates this action? a) 5 cm cervical dilatation b) 80& cervical effacement c) contractions every 5-8 mins d) negative 3 station 89. When should the nurse assess Mrs. O's blood pressure? a) during the increment of contraction b) between the contractions c) during the decrement of the contraction d) during the acme of a contraction 90. Which factor would be most helpful in assessing the adequacy of Mrs. O's placental perfusion? a) the duration and intensity of her contractions b) her ability to cope with the discomfort of labor c) the duration of the rest phases between contractions d) the effectiveness of her breathing techniques during the contractions 91. A client you care for in labor asks you what causes labor to begin. Which statement below is a possible explanation? a) progesterone levels arise at term to initiate contractions b) the ovary releases additional estrogen at term c) prostaglandin may be the causative factor of labor d) calcium is drawn from bones to block relaxation fibers 92. In order for a fetus to best transverse the birth canal, the smallest head diameter must be presented to the birth canal. Which of the following is the smallest anterioposterior cranial diameter of a fetus? a) suboccipitpbregmic b) biparietal c) occipitofrontal d) occipitomental 93. During the labor, effacement of the cervix occurs. This is: a) widening of the cervical os b) turning "inside out" of the vertical os c) molding and elongation of the cervix d) thinning and shortening of the cervix 94. A placenta delivers with the maternal surface evident. Which statement below is a true statement

concerning this presentation? a) this is a common placental delivery presentation b) this is an abnormal placental delivery presentation c) the uterus does not contract well following this presentation d) this presentation reflects a placental abnormality 95. The largest portion of the uterus is the: a) myometrium b) endometrium c) perimetrium d) decidua 96. Which term refers to the upper triangular portion of the uterus? a) cervix b) fundus c) isthmus d) corpus 97. The vaginal portion of the cervix that dilates during labor is called the a) external os b) internal os c) anterior lip d) cervical canal 98. In response to the APG stimulation, the graafian follicle secretes: a) progesterone b) estrogen c) glycogen d) prolactin 99. The increased activity of the endometrial glands during luteal phase of the female reproductive cycle stimulated by: a) progesterone b) estrogen c) prolactin d) glycogen 100. Increased levels of gonadotrophic hormones stimulate the APG to secrete a) progesterone b) FSH c) oxytocon

d) prolactin

ANSWERS 82) d ..... 83) d ..... 84) b ..... 85) a 86) a ..... 87) a ..... 88) d ..... 89) b ..... 90) c 91) c ..... 92) a ..... 93) d ..... 94) b ..... 95) a 96) b ..... 97) a ..... 98) b ..... 99) a ..... 100) b

61. Mrs. M asks if there is a danger of this problemoccurring in the future in pregnancies. Which of these understanding about Rh factors is most important for the nurse to communicate to Mrs. M? a) administration of RhoGAM will provide life-long immunity against fetal Rh disease b) if Mrs. M delivers another Rh positive infant, she will require a subsequent dose of RhoGAM c) the protective antibodies formed during this pregnancies increase the risk of hemolytic diseases in the future d) it is safe to assume that the future infants have 50% chance of being Rh negative Situation: Mrs. K, a 35 year old gravida 5 para4, complains of severe pain and edema of her right leg and thigh on the second day after a cesarean delivery. The physician suspects femoral thrombophlebitis 62. Which sign should the nurse attempt to solicit to help determine if Mrs. K has femoral thrombophlebitis? a) kernig's sign b) babinski sign c) homan's sign d) hegar's sign Situation: Dolli calls her pre-natal clinic to report that she had intermittent lower abdominal cramping and occasional spotting for the last 24 hrs. Her last menstrual period was eight weeks ago. Two weeks ago she had a positivepregnancy test 63. The most likely diagnosis for Dolli's condition on the basis of the information presented is: a) inevitable abortion b) incomplete abortion c) threatened abortion d) spontaneous abortion 64. Dolli comes to clinic. Pelvic examination, which reveals vaginal bleeding but no dilatation of the cervix, confirms the tentative diagnosis. Which of the following should not be considered in the management of

Dolli's disorder? a) bed rest b) administering of diethylstilbestrol (synthetic estrogen) c) abstinence from intercourse d) administration of mild sedative 65. A week later Dolli comes back to the emergency room because of heavy bleeding and severe cramps. Vaginal examinations reveals that her cervix is dilated and tissue is bulging through the OS. Which of the following would be the best procedure in managing this new condition? a) dilation and curretage b) saline infusion c) oxytocin stimulation d) shirodrak procedure 66. Carrie 23 year old, in the 16th week of her second pregnancy. She comes to an emergency room complaining of sudden onset of painless vaginal bleeding preceded by a sudden gush of fluid. On examination, the cervix is soft and dilated 4 to 5 cm, fetal part are visible in the OS. Which of the following is the most likely diagnosis? a) tubal pregnancy b) molar pregnancy c) incompetent cervical os d) missed abortion 67. Which of the following symptoms is considered theclassic defining criterion of placenta previa? a) irregular fetal heart beat b) painless vaginal bleeding c) unengaged presenting part d) uterine irritability 68. The nursing management of women hospitalized with hyperemesis gravidarum is challenge. Which of the following nursing actions, would NOT be appropriate for most of these women? a) removing vomitus promptly b) protecting them from dehydration c) regulating the appearance and temperature of their food d) encouraging the expressions of their feelings 69. Which procedure provides the most accurate estimate of the pelvic size? a) sonography b) william's pelvimetry c) x-ray pelvimetry d) thom's pelvimetry

70. The chief function of the enlarged corpus luteum during early pregnancy is production of a) estrogen b) progesterone c) HCG d) all of these 71. Which of the following is the primary source of estrogen during the latter half of pregnancy? a) APG b) placenta c) PPG d) ovaries Situation: Andrea is a 32 yr. old primigravida admitted at term to a hospital at 8 am with the following signs: contractions which began at 3am coming now every 10 mins. Lasting 30 seconds, and causing little discomfort: intact membranes; no blood show, stable vital signs; fetal hear rate, 13/min. Examination reveals that the cervix is 3 cm dilated, 80% effaced, with the vertex presenting at minus 1 station. 74. On the basis of the data presented above, the nurse caring for Andrea could conclude that Andrea is: a) false labor b) in the latent phase of labor c) in the active phase of labor d) in the transitional phase of labor 75. Artificial rupturing of membranes probably would not be employed to stimulate Andrea's labor because: a) cervical dilatation is only 3 cm b) her contractions are not occurring frequently c) the presenting part is at minus 1 station d) all of these 76. An intravenous drip pitocin 10 units in 1000 ml of D5 water is started for Andrea. Possible side effects of oxytocin administration include all of the following except: a) water intoxication b) hypertension c) tonic uterine contractions d) diuresis 77. Janice who G3P2, is in active labor. Vaginal examination reveals that she is 5 cm dilated and 100% effaced at minus 1 station. At the peak of contraction, fluid gushes suddenly. The nurse should immediately a) notify the attending physician b) change Janice's linens and see that she is dry and comfortable

c) check the perineal area to see if the presenting part is showing d) determine fetal heart rate and check for regularly 78. Nurses should observe the amniotic fluid released by the rupture of the membranes for signs of meconeum staining. Meconeum staining is associated with which of the following situations would give the LEAST cause of alarm? a) vertex presentation b) transverse presentation c) breech presentation d) posterior presentation 79. Which of the following characteristic of false labor? a) contractions that are regular and increase in frequency and duration b) contractions that are left to begin at the back and swing around the abdomen c) cervical dilatation and effacement d) none of the above 80. The process by which the cervical canal becomes paper thin and indistinct from the uterus is called: a) dilatation b) lightening c) effacement d) labor

ANSWERS 61) b ..... 62) c ..... 63) c ..... 64) b ..... 65) c 66) c ..... 67) b ..... 68) c ..... 69) c ..... 70) d 74) b ..... 75) d 76) d ..... 77) d ..... 78) c ..... 79) d ..... 80) c 41. Clomiphen is a drug to treat infertile women. It is effective because it plays the role in stimulating a) fertilization b) ovulation c) tubal patency d) endometrial proliferation 42. All of the following antacids would be safe for a pregnant woman complaining of pyrosis Except: a) magnesium hydroxide

b) milk of magnesia c) aluminum hydroxide d) sodium bicarbonate 43. Janice who G3P2, is in active labor. Vaginal examination reveals that she is 5 cm dilated and 100% effaced at minus 1 station. At the peak of contraction, fluid gushes suddenly. The nurse should immediately a) notify the attending physician b) change Janice's linens and see that she is dry and comfortable c) check the perineal area to see if the presenting part is showing d) determine fetal heart rate and check for regularity 44. Lochia is a post partum vaginal discharge that contains 1. RBC 2. mucus 3. WBC 4. decidual remnants a) 1,3,4 b) 1,2,3 c) 1,4 d) all of these 46. A nurse caring for the woman in the taking-in phase of the puerperium should be sure to a) instruct her on how to bath an infant b) allow her as much rest as needed c) have her begin postpartum exercises d) all of the above 47. When a tubal ligation is performed on a woman of childbearing age, she can expect sterility: a) without menopausal symptoms b) with menopausal symptoms c) resulting in loss of libido d) that can be readily reversed by surgery 48. Which of the following would be the most accurate description of the occurrence of the ovulation in the menstrual cycle? a) midway in the cycle, regardless of the length of the cycle b) two weeks after the onset of menses c) two weeks before the onset of menses d) ten days after the cessation of the menstrual flow 49. The LOA position means that the:

a) lie is longitudinal and the fetal occiput is directed toward the left posterior portion of the maternal pelvis b) lie is transverse and the fetal mentum is directed toward the left posterior portion of the maternal pelvis c) lie is longitudinal and the fetal occiput is directed toward the left anterior portion of the maternal pelvis d) lie is oblique and the fetal anterior fontanel is directed toward the left posterior portion of the maternal pelvis 50. The most common cause of early postpartum uterine bleeding is: a) inertia b) lacerations c) subinvolution d) atony 51. If fetus is in a LOA position during labor, you would interpret this mean the fetus is a) in a longitudinal lie facing the right posterior b) facing the right anterior abdominal quadrant c) in a common breech delivery position d) presenting with the face as the presenting part 52. A class II Pap smear a) is suggestive, but not conclusive for malignancy b) is strongly suggestive for malignancy c) indicates atypical cells, but is no suggestive for malignancy d) indicates no abnormal or atypical cells 53. A woman you care for has an RH-negative blood type. Following the birth of her infant, you administer her RHIG (D immune globulin). The purpose of this is to a) promote maternal D antibody formation b) prevent maternal D antibody formation c) stimulate maternal D immune antigens d) prevent fetal RH blood formation 54. A woman who is Rh negative asks you how many children she will be able to have before Rh incompatibility causes them to die in utero. Your best response would be: a) no more than 3 children b) as long as she receives RHIG there is no limit c) only her next child will be affected d) she will have to ask her physician 55. A pregnant woman in pre-eclampsia is to receive magnesium sulfate IV. Which assessment would be most important to make before administrations of a new dose of this? a) blood pressure

b) patellar reflex c) pulse rate d) anxiety level 56. The best nursing diagnosis in relation to a woman with hypertension of pregnancy would be: a) fluid volume deficit related to vasoplasm of arteries b) altered tissue perfusion related to poor heart contraction c) potential for injury related to fetal distress d) altered nutrition relation to decrease sodium levels 57. A woman is admitted to your hospital unit with a diagnosis of ectopic pregnancy. Which intervention would you anticipate and begin preparations for? a) bed rest for the next 4 weeks b) immediate surgery c) intravenous administrations of tocolytic d) internal uterine monitoring 58. Mrs. A's blood is Rh negative. The physician would schedule administration of human Rho (D) immune globulin (RhoGAM) at the 28th week of gestation if Mrs. A had a: a) negative direct Coombs test result b) negative indirect Commbs test result c) positive coombs test result d) positive indirect coombs test result 59. Disemminated intravascular coagulation (DIC) is a possible complication of PIH. Which assessment finding would indicate that the patient has developed DIC? a) bleeding of the nose and gums b) joint pain c) rapid clotting at the puncture site d) increased central venous pressure 60. Which of the following best describes how rhoGAM acts in the maternal system? a) it attaches to maternal anti-Rh antibodies and directly destroy them b) it suppresses the immunological production of maternal antibodies c) it destroy fetal Rh positive RBC in the maternal circulation d) it prevents fetal-maternal bleeding episodes from a occurring at the former placental site

ANSWERS 41) b ..... 42) d ..... 43) d ..... 44) d

46) b ..... 47) a ..... 48) c ..... 49) c ..... 50) d 51) a ..... 52) c ..... 53) b ..... 54) b ..... 55) b 56) a ..... 57) a ..... 58) b ..... 59) a ..... 60) c 21. A patient delivers a baby boy spontaneous delivery. Her fundus is firm and she has moderate rubra lochia. Upon palpation 30 minutes later, the nurse finds the fundus displaced to the right. What nursing intervention would be appropriate at this time? a) give her a bedpan to void b) call the doctor c) massage the fundus d) encourage breast-feeding 22. The obstetrician performed a routine episiotomy on a newly delivered patient. Which of the following reasons would not be appropriate to perform an episiotomy? a) shortened recovery time from the 3rd stage of labor b) prevent perineal lacerations c) avoid 3rd degree tearing of perineum d) shorten the 2nd stage of labor 23. During discharge teaching for a patient who had a hydatidiform mole the nurse must include: a) avoid pregnancy for 1 year b) a hysterectomy will be required in the future c) avoid taking birth control pills d) no specific restrictions are indicated 24. When a prolapsed cord is the presenting part the nurse would not: a) cover the cord with saline soaked gauze b) change the maternal position c) continue monitoring the FHR d) try to push the cord back into the vagina 25. When using Depo Provera the patient should be instructed: a) use of condoms in addition for at least 2 weeks b) come in for follow up every month c) you will not have a period d) your periods will be very light and last only a few days 26. A patient with a history of PIH asks the nurse if she will have PIH in a subsequent pregnancy. The nurse responds by saying

a) having PIH puts you into a risk group for having PIH again b) there is no relationship between one pregnancy and another c) you will definitely have PIH with each pregnancy d) you have the same chance a t the general population 27. a patient with hyperemesis gravidarum is admitted. An important nursing intervention at the time of admission is: a) keep the patient's room cool b) explain the rationale for fasting c) question the patient about daily eating habits d) assess the patient for low blood sugar 28. A woman in labor has been pushing for 1 1/2 hours with no progress in decent of the fetus. The doctor recommends a rest period. During the rest period the fetus baseline heart rate becomes 170's which of the following interventions would be indicated a) left side lying position with supplemental oxygen b) a C-section c) increase pitocin d) an enema 29. During the monitoring of a laboring patient the nurse notes several early decelerations. Which action should the nurse take? a) call the MD immediately b) turn the patient to left side c) give oxygen d) document the findings 30. Which of the following is an early sign of magnesium sulfate toxicity: a) decreased BP b) decreased reflexes c) decreased respiration d) increased urinary output 31. Identifying gestational diabetes is part of the prenatal care. When would the nurse schedule a patient for a glucose tolerance test: a) 6th week of pregnancy b) 12th week of pregnancy c) 24th week of pregnancy d) 32nd week of pregnancy 32. A laboring patient has begun to have late decelerations. The nurse has turned the mother on her left side. What other intervention should be nurse employ at this time:

a) give a bolus of IV fluid b) stop the pitocin c) have the mother pant breathe d) turn the lights off in the room and let the mother rest 33. A woman who has had PROM (premature rupture of membranes) is at risk for a) infection b) C-section delivery c) hypertension d) placenta abruption 34. Which of the following positions should the nurse place the patient who has been diagnosed with a prolapsed cord a) supine b) trendelenberg c) left lateral recumbent d) high fowlers 35. A woman has been in preterm labor off and on for 2 weeks. She is 28 weeks pregnant. It seems inevitable that she will delivery soon. Which of the following medications would the nurse prepare to give this patient? a) celestone b) pitocin c) magnesium sulfate d) terbutaline 36. Condoms are spermicidal jellies, creams, and foams, all contraceptive devices-chare which of the following characteristics? a) available without prescription b) lack of adverse side effects c) noninterference with intercourse d) all of these 37. Susan comes to the local birth control clinic for fitting of diaphragm. A nurse is instructing her on its use. When Susan asks how diaphragm works, the nurse should explain that the device a) prevents implantation b) prevents the ejaculate from entering the vagina c) blocks access to the birth canal d) increase acidity of the vagina 38. Susan's nurse should be sure to mention that after intercourse, a diaphragm must be left in place for a minimum of

a) 3 hrs b) 4 hrs c) 5 hrs d) 6 hrs 39. Oral contraceptives prevents pregnancy by: a) changing the character of the cervical mucus b) preventing implantation c) suppressing ovulation d) impending fertilization 40. Vasectomy produces sterility in men by a) causing semen to be sperm free b) inhibiting sperm production c) inhibiting sperm motility d) all of these

ANSWERS

21) a ..... 22) a ..... 23) a ..... 24) d ..... 25) a 26) a ..... 27) b ..... 28) a ..... 29) d ..... 30) b 31) c ..... 32) b ..... 33) a ..... 34) b ..... 35) b 36) a ..... 37) c ..... 38) d ..... 39) c ..... 40) a 1. A 23 year old primigravida arrives at the clinic for a check up. She is complaining of nausea and vomiting upon rising and increase urination. She reports that her last menstrual period was 2 months ago. A blood test confirms that she is pregnant. Which of the following findings would be considered abnormal? a) a bluish tinge to the vagina upon cervical exam b) a white, non-malodorous discharge from the vagina c) mild contractions radiating from back to the abdomen d) increase vascularity, sensitivity and fullness of the breasts 2. A pregnant women who is 28 weeks gestation has the following lab findings. Hemoglobin = 12.1, hematocrit = 36.3. She is worried because they were 13.9 and 41.7 during her first month of pregnancy. Which of the following would be the most reassuring answer? a) during pregnancy, blood volume expands as much as 50% and a slight drop in hemoglobin and hematocrit is normal

b) don't worry. If the levels continue to drop you will be admitted for blood transfusion c) the MD will be notified immediately to determine any internal bleeding d) your original blood levels were too high. Your present levels are more normal 3. A client is diagnosed with thrombophlebitis and 5,000 units of heparin are ordered Q 12h, SQ. The client asks why she is on heparin. The nurse explains: a) this will decrease your risk of developing disseminated b) this will prevent additional clot formation c) this will cause the clot dissolve d) this will increase the clotting factors in your blood 4. A client is admitted for preterm labor and is stable. She is sent home on oral terbutaline. The purpose of the drug for use in preterm labor is to; a) decrease the chance of pulmonary edema b) relax uterine muscles and inhibit uterine contractions c) acts a bronchodilator d) decrease tachycardia from anxiety caused by preterm labor 5. Women who develop gestational diabetes are at risk for which of the following: a) placenta previa, DKA and hypoglycemia b) polyhydramnios, macrosomia and pre-eclampsia c) HELLP syndrome, mitral valve prolapse and placenta abruption d) diabetic coma, hypotension and multiple gestation 6. During pregnancy a diabetic's need for insulin typically a) increases during the entire pregnancy b) decreases during the entire pregnancy c) decreases during the first trimester and increases in the second and third d) increases during the first trimester and decreases during the second and third 7. A 40 year old woman with a class 3 cardiac condition is pregnant. Which of the following nursing diagnoses would receive top priority? a) knowledge deficit related to cardiac disease b) alteration in nutrition related to low Na diet c) anxiety related to outcome of pregnancy d) activity intolerance related to compromised cardiac status 8. In teaching a client about the onset of labor, the nurse should include: a) you should go to the hospital as soon as contractions begin b) you should wait to go to the hospital until the contractions are 3 minutes apart c) if your membranes are ruptured you should take a warm bath d) bloody vaginal discharge is a sign of impending labor

9. A newly diagnosed Class I cardiac patient is 6 weeks pregnant. The patient asks the nurse to explain what this means. The nurse's best response would be: a) this means that although there has been a cardiac problem identified you will be able to continue with ordinary physical activity b) this means that you will require significant amounts of bed rest during your pregnancy c) this means that you will be on strict bed rest from 24th week on d) this means that your fetus has a cardiac defect 10. A pregnant woman with cardiac disease is on anticoagulant therapy. Which of the following is most commonly used for pregnant women? a) heparin b) coumadin c) streptokinase d) aspirin 11. Which of the following interventions would be unnecessary for the pregnant cardiac patient who is on anticoagulant therapy? a) avoid taking aspirin b) measure the amount of fluid you drink compared with the amount of urine you put out daily c) brush your teeth with a soft toothbrush d) report any black colored stool 12. A 14 year old teenaged patient is 37 week pregnant and admitted on the antepartum unit with a diagnosis of PIH. Her BP is 190/110, she has generalized edema, 3+ proteinuria and has gained 8 lbs. in the last week. She is complaining of nausea and pounding headache. The priority of caring this patient would be: a) give labetolol to decrease the blood pressure b) prevent seizure activity c) maintain strict I & O d) induce labor 13. A 35 week pregnant woman has severe PIH with BP 198/114, 4+ proteinuria and is placed on MgSO4 (Magnesium sulfate). Her husband wants to know how will this medication help his wife. The nurse explains MgSO4 will: a) decrease the body's sensitivity to calcium, therefore reducing the chance of a seizure b) increase the body's sensitivity to calcium therefore reducing the chance of a seizure c) reduce systemic vascular resistance therefore reducing blood pressure d) decrease neuromuscular irritability 14. If a patient receiving MgSO4 for preeclampsia begins to seizure the most appropriate nursing action would be to:

a) begin chest compression b) assess fetal heart tones c) decrease the MgSO4 d) establish and maintain a patent airway 15. A patient with preeclampsia begins to complain of epigastric pain. The nurse knows this is a sign of: a) preterm labor b) seizure c) placental abruption d) indigestion 16. During seizure in an eclamptic patient the nurse should do the following intervention first: a) increase the MgSO4 b) call the doctor c) turn the patient on her side d) ask the husband to leave the room 17. A laboring patient is walking in the hallway. She is 80% effaced and at 0 station. She suddenly experiences a gush of fluid. Which of the following actions should the nurse take first: a) have the patient return to her bed to assess the fetal heart b) call the doctor c) perform a vaginal exam to determine the dilation d) place the patient in trendelenburg to prevent cord prolapse 18. A patient in labor is examined and is told she is 100% effaced, 5cm dilated and at +1 station. Her husband asks what does this mean. The nurse explains: a) she is in active labor, but the head is not yet engaged b) she is active labor, and the head is engaged c) she is transitional labor and about to deliver d) she is in the latent phase, the head is fully engaged 19. During labor the patient is sometimes catheterized. The rationale is: a) to prevent urinary stasis b) to encourage fetal descent c) minimize discomfort d) prevent the patient from having to get up to void 20. A laboring patient suddenly feels the urge to have a bowel movement. Vaginal exam shows she is 8 cm dilated. Which of the following nursing interventions would receive top priority: a) encourage patient to pant breath b) encourage patient to bear down because she is going to deliver c) give her a bedpan

d) allow the patient to go to the bathroom

ANSWERS 1) C ..... 2) A ..... 3) B ..... 4) B ..... 5) B 6) A ..... 7) D ..... 8) D ..... 9) A ..... 10)A 11) B ...12) B ...13) D ....14) D ......15) B 16) C ...17) A ....18) B ....19) B .....20) A