Professional Documents
Culture Documents
College of Nursing
NCM 102
CARE OF MOTHER , CHILD AND FAMILY AT RISKS OR WITH PROBLEMS
MASTERY EXAMINATIONS- FINALS
1. To be considered a PPH, what would the estimated blood loss have to be for a C-section?
A. < 650 ML C. >1000 ML
B. >600 ML D. < 900 ML
2. What types of trauma during labour and birth would lead to PPH risk?
A. Instrumental assisted birth (vacuum or forceps) C. Lacerations of the cervix or vaginal wall
B. C-Section D. All of the above
3. During the past 6 months, a client diagnosed with acquired immunodeficiency syndrome has had chronic
diarrhea and has lost 18 pounds. Additional assessment findings include tented skin turgor, dry mucous
membranes, and listleness. Which nursing diagnosis focuses attention on the clients most immediate problem?
A. Deficient fluid volume related to diarrhea and abnormal fluid loss
B. Imbalanced nutrition: less than body requirements related to nausea and vomiting
C. Disturbed thought processes related to central nervous system effects of disease
D. Diarrhea related to the disease process and acute infection
4. For a male client who has acquired immunodeficiency syndrome with chronic diarrhea, anorexia, a history of
oral candidiasis, and weight loss, which dietary instruction would be included in the teaching plan?
A. Follow a low-protein, high-carbohydrate diet.
B. Eat three large meals per day.
C. Include unpasteurized dairy products in the diet.
D. Follow a high-protein, high-calorie diet.
5. Nurse Mary Jean is assisting in administering immunizations at a health care clinic. The nurse understands that
an immunization will provide:
A. Protection from all disease C. Natural immunity from disease
B. Innate immunity from disease D. Acquired immunity from disease
6. A client with acquired immunodeficiency syndrome has a respiratory infection from Pneumocystis jiroveci and
a nursing diagnosis of Impaired Gas Exchange written in the plan of care. Which of the following indicates that the
expected outcome of care has not yet been achieved?
A. Client has clear breath sounds
B. Client now limits his fluid intake
C. Client expectorates secretions easily
D. Client is free of complaints of shortness of breath
7. Human Papilloma Virus in AIDS patients is manifested as:
A. Cough, evening fever, night sweats, weight loss and anemia
B. Persistent fever, tachypnoea, hypoxia, cyanosis and tachycardia.
C. Genital warts, flat warts, skin warts, neoplasm of cervix, vagina and penis
D. Watery diarrhea, abdominal pain, nausea and vomiting
8. A client is diagnosed with oral candidiasis. Nurse Tina knows that this condition in AIDS is treated with:
A. Trimethoprim + sulfamethoxazole C. Acyclovir
B. Fluconazole D. Zidovudine
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20. While a client is on intravenous magnesium sulfate therapy for preeclampsia, it is essential for nurse Amy to
monitor the clients deep tendon reflexes to:
A. Determine her level of consciousness C. Determine her response to painful stimuli
B. Evaluate the mobility of the extremities D. Prevent development of respiratory distress
21. The clients history that alerts nurse Henry to assess closely for signs of postpartum infection would be:
A. Three spontaneous abortions D. Maternal temperature of 99.9 F 12 hours after
B. negative maternal blood type delivery
C. Blood loss of 850 ml after a vaginal birth
22. Nurse Wilma recognizes that failure of a newborn to make the appropriate adaptation to extrauterine life would
be indicated by:
A. flexed extremities C. A heart rate of 130 beats per minute
B. Cyanotic lips and face D. A respiratory rate of 40 breath per minute
23. - May arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago. She also tells
the nurse that a home pregnancy test was positive but she began to have mild cramps and is now having moderate
vaginal bleeding. During the physical examination of the client, the nurse notes that May has a dilated cervix. The nurse
determines that May is experiencing which type of abortion?
A. Inevitable C. Threatened
B. Incomplete D. Septic
24. Nurse Reese is reviewing the record of a pregnant client for her first prenatal visit. Which of the following data, if
noted on the clients record, would alert the nurse that the client is at risk for a spontaneous abortion?
A. Age 36 years C. History of genital herpes
B. History of syphilis D. History of diabetes mellitus
25. Nurse Hazel is preparing to care for a client who is newly admitted to the hospital with a possible diagnosis of ectopic
pregnancy. Nurse Hazel develops a plan of care for the client and determines that which of the following nursing actions
is the priority?
A. Monitoring weight C. Monitoring apical pulse
B. . Assessing for edema D. Monitoring temperature
26. Nurse Oliver is teaching a diabetic pregnant client about nutrition and insulin needs during pregnancy. The nurse
determines that the client understands dietary and insulin needs if the client states that the second half of pregnancy
require:
A. Decreased caloric intake C. Decreased Insulin
B. Increased caloric intake D. Increase Insulin
27. Nurse Michelle is assessing a 24 year old client with a diagnosis of hydatidiform mole. She is aware that one of the
following is unassociated with this condition?
A. Excessive fetal activity. C. Vaginal bleeding
B. Larger than normal uterus for gestational age. D. Elevated levels of human chorionic gonadotropin
28. A pregnant client is receiving magnesium sulfate for severe pregnancy induced hypertension (PIH). The clinical
findings that would warrant use of the antidote , calcium gluconate is:
A. Urinary output 90 cc in 2 hours C. Rapid respiratory rate above 40/min.
B. . Absent patellar reflexes. D. Rapid rise in blood pressure.
29. During vaginal examination of Janna who is in labor, the presenting part is at station plus two. Nurse,
correctly interprets it as:
A. Presenting part is 2 cm above the plane of the ischial spines.
B. Biparietal diameter is at the level of the ischial spines.
C. Presenting part in 2 cm below the plane of the ischial spines.
D. Biparietal diameter is 2 cm above the ischial spines.
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30. A pregnant client is receiving oxytocin (Pitocin) for induction of labor. A condition that warrant the nurse in-charge to
discontinue I.V. infusion of Pitocin is:
A. Contractions every 1 minutes lasting 70-80 C. Early decelerations in the fetal heart rate.
seconds. D. Fetal heart rate baseline 140-160 bpm.
B. Maternal temperature 101.2
31. Calcium gluconate is being administered to a client with pregnancy induced hypertension (PIH). A nursing action that
must be initiated as the plan of care throughout injection of the drug is:
A. Ventilator assistance C. EKG tracings
B. CVP readings D. Continuous CPR
32. A trial for vaginal delivery after an earlier caesareans, would likely to be given to a gravida, who had:
A. First low transverse cesarean was for active herpes type 2 infections; vaginal culture at 39 weeks pregnancy was positive.
B. First and second caesareans were for cephalopelvic disproportion.
C. First caesarean through a classic incision as a result of severe fetal distress.
D. First low transverse caesarean was for breech position. Fetus in this pregnancy is in a vertex presentation.
33. Malou was diagnosed with severe preeclampsia is now receiving I.V. magnesium sulfate. The adverse effects
associated with magnesium sulfate is:
A. Anemia C. Hyperreflexia
B. Decreased urine output D. Increased respiratory rate
34. A 23 year old client is having her menstrual period every 2 weeks that last for 1 week. This type of menstrual pattern is
bets defined by:
A. Menorrhagia C. Dyspareunia
B. Metrorrhagia D. Amenorrhea
35. Jannah is admitted to the labor and delivery unit. The critical laboratory result for this client would be:
A. Oxygen saturation C. Blood typing
B. Iron binding capacity D. Serum Calcium
36. Nurse Gina is aware that the most common condition found during the second-trimester of pregnancy is:
A. Metabolic alkalosis C. Mastitis
B. Respiratory acidosis D. Physiologic anemia
37. Maureen in her third trimester arrives at the emergency room with painless vaginal bleeding. Which of the following
conditions is suspected?
A. Placenta previa C. Premature labor
B. Abruptio placentae D. Sexually transmitted disease
38. In a mothers class, Nurse Lynnette discussed childhood diseases such as chicken pox. Which of the following
statements about chicken pox is correct?
A. The older one gets, the more susceptible he becomes to the complications of chickenpox.
B. A single attack of chickenpox will prevent future episodes, including conditions such as shingles.
C. To prevent an outbreak in the community, quarantine may be imposed by health authorities.
D. Chicken pox vaccine is best given when there is an impending outbreak in the community.
39. Barangay Pinoy had an outbreak of German measles. To prevent congenital rubella, what is the BEST advice that you can
give to women in the first trimester of pregnancy in the Barangay Pinoy?
A. Advise them on the signs of German measles.
B. Avoid crowded places, such as markets and movie houses.
C. Consult at the health center where rubella vaccine may be given.
D. Consult a physician who may give them rubella immunoglobulin.
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40. Myrna a public health nurse knows that to determine possible sources of sexually transmitted infections, the BEST
method that may be undertaken is:
A. Contact tracing C. Mass screening tests
B. Community survey D. Interview of suspects
41. A 33-year old female client came for consultation at the health center with the chief complaint of fever for a week.
Accompanying symptoms were muscle pains and body malaise. A week after the start of fever, the client noted
yellowish discoloration of his sclera. History showed that he waded in flood waters about 2 weeks before the onset of
symptoms. Based on her history, which disease condition will you suspect?
A. Hepatitis C. Tetanus
B. Hepatitis B D. Leptospirosis
42. Mickey a 3-year old client was brought to the health center with the chief complaint of severe diarrhea and the
passage of rice-watery stools. The client is most probably suffering from which condition?
A. Giardiasis C. Amebiasis
B. Cholera D. Dysentery
43. The most prevalent form of meningitis among children aged 2 months to 3 years is caused by which microorganism?
A. Hemophilus influenza C. Streptococcus pneumonia
B. Morbillivirus D. Neisseria meningitidis
44. The student nurse is aware that the pathognomonic sign of measles is Kopliks spot and you may see Kopliks spot by
inspecting the:
A. Nasal mucosa C. Skin on the abdomen
B. Buccal mucosa D. Skin on neck
45. It is the most effective way of controlling schistosomiasis in an endemic area?
A. Use of molluscicides C. Proper use of sanitary toilets
B. Building of foot bridges D. Use of protective footwear, such as rubber boots
46. Marjorie has just given birth at 42 weeks gestation. When the nurse assessing the neonate, which physical finding is
expected?
A. A sleepy, lethargic baby C. Desquamation of the epidermis
B. Lanugo covering the body D. Vernix caseosa covering the body
47. After reviewing the Myrnas maternal history of magnesium sulfate during labor, which condition would nurse Richard
anticipate as a potential problem in the neonate?
A. Hypoglycemia C. Respiratory depression
B. Jitteriness D. Tachycardia
48. Dr. Esteves decides to artificially rupture the membranes of a mother who is on labor. Following this procedure, the
nurse Hazel checks the fetal heart tones for which the following reasons?
A. To determine fetal well-being. C. To assess fetal position
B. To assess for prolapsed cord D. To prepare for an imminent delivery.
49. Which of the following would be least likely to indicate anticipated bonding behaviors by new parents?
A. The parents willingness to touch and hold the newborn.
B. The parents expression of interest about the size of the newborn.
C. The parents indication that they want to see the newborn.
D. The parents interactions with each other.
50. Following a precipitous delivery, examination of the clients vagina reveals a fourth-degree laceration. Which of the
following would be contraindicated when caring for this client?
A. Applying cold to limit edema during the first 12 to 24 hours.
B. Instructing the client to use two or more peri pads to cushion the area.
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1. C. . 1000 ml
2. D ALL OF THE ABOVE
3. A. Deficient fluid volume related to diarrhea and abnormal fluid loss
Based on the clients assessment findings, the most immediate problem is dehydration because of chronic diarrhea. The nursing
diagnosis of deficient fluid volume is the priority, and interventions are geared to improving the clients fluid status. Although
imbalanced nutrition, disturbed thought processes, and diarrhea are involved, they assume a lower priority at this time.
4. D. Follow a high-protein, high-calorie diet.
Dietary instructions should include the need for a high-protein, high-calorie diet. The patient should be taught to eat small, frequent
meals and include low-microbial foods, such as pasteurized dairy products, washed and peeled fruits and vegetables, and well-
cooked meats.
5. D. Acquired immunity from disease
Acquired immunity can occur by receiving an immunization that causes antibodies to a specific pathogen to form. Natural (innate)
immunity is present at birth. No immunization protects the client from all diseases.
6. B. Client now limits his fluid intake
The status of the client with a diagnosis of Impaired gas exchange would be evaluated against the standard outcome criteria for this
nursing diagnosis. These would include the client stating that breathing is easier and is coughing up secretions effectively, and has
clear breath sounds. The client should not limit fluid intake because fluids are needed to decrease the viscosity of secretions for
expectoration.
7. C. Genital warts, flat warts, skin warts, neoplasm of cervix, vagina and penis
Dermatologic human papillomavirus (HPV) infection in HIV patients manifests as both anogenital and nongenital skin disease.
Cutaneous HPV-related disease in nongenital skin is also increased in HIV-positive patients, in the form of benign common warts,
epidermodysplasia verruciformis-like skin lesions, and nonmelanoma skin cancers.
8. B. Fluconazole
Oral candidiasis usually responds to topical treatments such as clotrimazole troches and nystatin suspension (nystatin swish and
swallow). Systemic antifungal medication such as fluconazole or itraconazole may be necessary for oropharyngeal infections that do
not respond to these treatments.
9. D. All of the above
A persons CD4 count is an important factor in the decision to start ART. A low or falling CD4 count indicates that HIV is advancing
and damaging the immune system. A rapidly decreasing CD4 count increases the urgency to start ART. Regardless of CD4 count,
there is greater urgency to start ART when a person has a high viral load or any of the following conditions: pregnancy, AIDS, and
certain HIV-related illnesses and co infections.
10. B. Decreased protein absorption
Often the complications of the acquired immunodeficiency syndrome (AIDS) have a negative impact on nutritional status. Weight loss
and protein depletion are commonly seen among the AIDS population.
11. D. Elimination of HIV entirely from the body.
Eradication of HIV infection cannot be achieved with available antiretroviral (ARV) regimens even when new, potent drugs are added
to a regimen that is already suppressing plasma viral load below the limits of detection of commercially available assays.
12. C. Toxoplasmosis
Toxoplasmosis is the most common central nervous system infection in patients with the acquired immunodeficiency syndrome (AIDS)
who are not receiving appropriate prophylaxis. This infection has a worldwide distribution and is caused by the intracellular protozoan
parasite, Toxoplasma gondii.
13. C. Prepare her for a pelvic examination
Pelvic examination would reveal dilation and effacement
14. A. Change the maternal position
Stimulation of the sympathetic nervous system is an initial response to mild hypoxia that accompanies partial cord compression
(umbilical vein) during contractions; changing the maternal position can alleviate the compression.
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50. (B) Instructing the client to use two or more peri pads to cushion the area
Rationale: Using two or more peripads would do little to reduce the pain or promote perineal healing. Cold applications, sitz baths,
and Kegel exercises are important measures when the client has a fourth-degree laceration.
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TEST 1: MULTIPLE CHOICE: CHOOSE THE BEST ANSWER STRICTLY NO ERASURES PLEASE!!!!!
1. A pregnant woman accompanied by her husband, seeks admission to the labor and delivery area. She states that shes
in labor and says she attended the facility clinic for prenatal care. Which question should the nurse Oliver ask
her first?
A. Do you have any chronic illnesses? C. What is your expected due date?
B. Do you have any allergies? D. . Who will be with you during labor?
2. When a client states that her water broke, which of the following actions would be inappropriate for the nurse to do?
A. Observing the pooling of straw-colored fluid.
B. Checking vaginal discharge with nitrazine paper.
C. Conducting a bedside ultrasound for an amniotic fluid index.
D. Observing for flakes of vernix in the vaginal discharg
3. Which of the following classifications applies to monozygotic twins for whom the cleavage of the fertilized ovum
occurs more than 13 days after fertilization?
A. conjoined twins C. diamniotic monochorionic twin
B. diamniotic dichorionic twins D. monoamniotic monochorionic twins
4. Tyra experienced painless vaginal bleeding has just been diagnosed as having a placenta previa. Which of the
following procedures is usually performed to diagnose placenta previa?
A. Amniocentesis C. External fetal monitoring
B. Digital or speculum examination D. Ultrasound
5. Nurse Arnold knows that the following changes in respiratory functioning during pregnancy is considered normal:
A. Increased tidal volume C. Decreased inspiratory capacity
B. Increased expiratory volume D. Decreased oxygen consumption
6. Emily has gestational diabetes and it is usually managed by which of the following therapy?
A. Diet C. Oral hypoglycemic
B. Long-acting insulin D. Oral hypoglycemic drug and insulin
7. 91. Magnesium sulfate is given to Jemma with preeclampsia to prevent which of the following condition?
A. Hemorrhage C. Hypomagnesemia
B. Hypertension D. Seizure
8. Cammile with sickle cell anemia has an increased risk for having a sickle cell crisis during pregnancy. Aggressive
management of a sickle cell crisis includes which of the following measures?
A. Antihypertensive agents C. I.V. fluids
B. Diuretic agents D. Acetaminophen (Tylenol) for pain
9. Which of the following drugs is the antidote for magnesium toxicity?
A. Calcium gluconate (Kalcinate) C. Naloxone (Narcan)
B. Hydralazine (Apresoline) D. Rho (D) immune globulin (RhoGAM)
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10. Marlyn is screened for tuberculosis during her first prenatal visit. An intradermal injection of purified protein
derivative (PPD) of the tuberculin bacilli is given. She is considered to have a positive test for which of the following
results?
A. An indurated wheal under 10 mm in diameter appears in 6 to 12 hours.
B. An indurated wheal over 10 mm in diameter appears in 48 to 72 hours.
C. A flat circumcised area under 10 mm in diameter appears in 6 to 12 hours.
D. A flat circumcised area over 10 mm in diameter appears in 48 to 72 hours.
11. Dianne, 24 year-old is 27 weeks pregnant arrives at her physicians office with complaints of fever, nausea, vomiting,
malaise, unilateral flank pain, and costovertebral angle tenderness. Which of the following diagnoses is most likely?
A. Asymptomatic bacteriuria C. Pyelonephritis
B. Bacterial vaginosis D. Urinary tract infection (UTI)
12. Rh isoimmunization in a pregnant client develops during which of the following conditions?
A. Rh-positive maternal blood crosses into fetal blood, stimulating fetal antibodies.
B. Rh-positive fetal blood crosses into maternal blood, stimulating maternal antibodies.
C. Rh-negative fetal blood crosses into maternal blood, stimulating maternal antibodies.
D. Rh-negative maternal blood crosses into fetal blood, stimulating fetal antibodies.
13. To promote comfort during labor, the nurse John advises a client to assume certain positions and avoid others. Which
position may cause maternal hypotension and fetal hypoxia?
A. Lateral position C. Supine position
B. Squatting position D. Standing position
14. Celeste who used heroin during her pregnancy delivers a neonate. When assessing the neonate, the
nurse Lynnette expects to find:
A. Lethargy 2 days after birth C. A flattened nose, small eyes, and thin lips.
B. . Irritability and poor sucking. D. Congenital defects such as limb anomalies.
15. The uterus returns to the pelvic cavity in which of the following time frames?
A. 7th to 9th day postpartum. C. End of 6th week postpartum.
B. 2 weeks postpartum. D. When the lochia changes to alba.
16. Maureen, a primigravida client, age 20, has just completed a difficult, forceps-assisted delivery of twins. Her labor was
unusually long and required oxytocin (Pitocin) augmentation. The nurse whos caring for her should stay alert for:
A. Uterine inversion C. Uterine involution
B. Uterine atony D. Uterine discomfort
17. The nurse is teaching exercises that are good for pregnant women increasing tone and fitness and decreasing lower
backache. Which of the following should the nurse exclude in the exercise program?
A. Stand with legs apart and touch hands to floor three times per day.
B. Ten minutes of walking per day with an emphasis on good posture.
C. Ten minutes of swimming or leg kicking in pool per day.
D. Pelvic rock exercise and squats three times a day.
18. Which of the following may happen if the uterus becomes overstimulated by oxytocin during the induction of labor?
A. Weak contraction prolonged to more than 70 seconds
B. Tetanic contractions prolonged to more than 90 seconds
C. Increased pain with bright red vaginal bleeding
D. Increased restlessness and anxiety
19. When preparing a client for cesarean delivery, which of the following key concepts should be considered when
implementing nursing care?
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A. Instruct the mothers support person to remain in the family lounge until after the delivery
B. Arrange for a staff member of the anesthesia department to explain what to expect postoperatively
C. Modify preoperative teaching to meet the needs of either a planned or emergency cesarean birth
D. Explain the surgery, expected outcome, and kind of anesthetics
20. Which of the following best describes thrombophlebitis?
A. Inflammation and clot formation that result when blood components combine to form an aggregate body
B. Inflammation and blood clots that eventually become lodged within the pulmonary blood vessels
C. Inflammation and blood clots that eventually become lodged within the femoral vein
D. Inflammation of the vascular endothelium with clot formation on the vessel wall
21. . When developing a plan of care for a client newly diagnosed with gestational diabetes, which of the following
instructions would be the priority?
A. Dietary intake C. Exercise
B. Medication D. Glucose monitoring
22. A client at 24 weeks gestation has gained 6 pounds in 4 weeks. Which of the following would be the priority when
assessing the client?
A. Glucosuria C. Hand/face edema
B. Depression D. Dietary intake
23. Which of the following would be the priority nursing diagnosis for a client with an ectopic pregnancy?
A. Risk for infection C. Knowledge Deficit
B. Pain D. Anticipatory Grieving
24. The nurse assesses the vital signs of a client, 4 hours postpartum that are as follows: BP 90/60; temperature
100.4F; pulse 100 weak, thready; R 20 per minute. Which of the following should the nurse do first?
A. Report the temperature to the physician C. Assess the uterus for firmness and position
B. Recheck the blood pressure with another cuff D. Determine the amount of lochia
25. A multigravida at 38 weeks gestation is admitted with painless, bright red bleeding and mild contractions every 7 to 10
minutes. Which of the following assessments should be avoided?
A. Maternal vital sign C. Contraction monitoring
B. Fetal heart rate D. Cervical dilation
26. Rachel, a diabetic woman at 36 weeks gestation is scheduled for biophysical profile in order to:
A. ascertain correct gestational age D. determine fetal size and obvious congenital
B. determine fetal lung maturity anomaly
C. determine fetal well being
27. Which of the following changes in Dianes BP would nurse Grace not expect?
A. it tends to be highest in sitting D. It is normal for blood pressure to increase as
B. BP may increase a little in the 2nd tri much as 33 in systolic in the 3rd tri when a
C. It should be taken at every visit at the clinic woman is near delivery
28. The OB history of a woman is recorded as gravida 5 Para 3114. This indicates that the woman has
A. One abortion, one preterm delivery, 4 living children
B. three full-term deliveries, 1 post-mature delivery, four pregnancies
C. five pregnancies, three living children
D. four living children, 3 premature deliveries, 1 full-term delivery
29. The pregnant client will undergo Alpha-fetoprotein level determination. Which of the following specimen is required?
A. maternal blood sample C. amniotic fluid
B. blood from chorionic villi D. cervical secretions
30. Which of the following potential problems should the nurse be alert for in a client with pregnancy-induced hypertension (PIH)
A. abruptio placenta B. post term delivery
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53. Nurse Mary assesses a postpartum client who had an abruption placentae and suspects that disseminated
intravascular coagulation (DIC) is occurring when assessments demonstrate:
A. A boggy uterus C. Hypotension and tachycardia
B. Multiple vaginal clots D. Bleeding from the venipuncture site
54. Before an amniocentesis, nurse Alexandra should:
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74. Which of the following would be the priority nursing diagnosis for a client with an ectopic pregnancy?
A. Risk for infection C. Knowledge Deficit
B. Pain D. Anticipatory Grieving
75. The nurse assesses the vital signs of a client, 4 hours postpartum that are as follows: BP 90/60; temperature 100.4F; pulse 100
weak, thready; R 20 per minute. Which of the following should the nurse do first?
A. Report the temperature to the physician
B. Recheck the blood pressure with another cuff
C. Assess the uterus for firmness and position
JESMAR S. ESPIRITU MAN RN RM 16
D. Determine the amount of lochia
76. A multigravida at 38 weeks gestation is admitted with painless, bright red bleeding and mild contractions every 7 to 10 minutes.
Which of the following assessments should be avoided?
A. Maternal vital sign C. Contraction monitoring
B. Fetal heart rate D. Cervical dilation
77. Rachel, a diabetic woman at 36 weeks gestation is scheduled for biophysical profile in order to:
A. ascertain correct gestational age
B. determine fetal lung maturity
C. determine fetal well being
D. determine fetal size and obvious congenital anomaly
78. Which of the following changes in Dianes BP would nurse Grace not expect?
a. it tends to be highest in sitting
b. BP may increase a little in the 2nd tri
c. It should be taken at every visit at the clinic
d. It is normal for blood pressure to increase as much as 33 in systolic in the 3rd tri when a woman is near delivery
79. Nurse Tsunade referred to Diane to an Obstetrician. At 8 months she was orderd for a contraction stress test and the result is
negative. Diane asked when she should be back for her next check up?
a. Monthly b. Within 24-hours
c. Within a week d. Weekly for 2 wks then monthly
80. The OB history of a woman is recorded as gravida 5 Para 3114. This indicates that the woman has
A. One abortion, one preterm delivery, 4 living children
B. three full-term deliveries, 1 post-mature delivery, four pregnancies
C. five pregnancies, three living children
D. four living children, 3 premature deliveries, 1 full-term delivery
81. The pregnant client will undergo Alpha-fetoprotein level determination. Which of the following specimen is required?
a. maternal blood sample b. blood from chorionic villi
c. amniotic fluid d.. cervical secretions
82. Which of the following potential problems should the nurse be alert for in a client with pregnancy-induced hypertension (PIH)
a)abruptio placenta b) post term delivery
c) uterine inversion d) placenta previa
83. The nurse is caring for several clients who are in active labor. Which among these clients should she give highest priority?
a) the client with prolapsed cord
b) the client with BP of 160/100 mmHg
c) the client with oliguria
d) the client with headache and blurred vision
84. The client is diagnosed to have placenta previa. What warning sign should be placed by the nurse in client's unit?
a) no abdominal palpation b) no vaginal examination
c) no BP-taking d) no cigarette smoking
85. The client experiences abruptio placenta. Which of the following signs and symptoms supports the diagnosis?
a) painless vaginal bleeding b) rising fundal height
c) soft uterus d) elevated BP
86. The nurse is caring for a mother who experiences fetal distress. Which of the following should not be included in her nursing
care plan?
a) continue pitocin drip b) administer oxygen by face mask
c) turn to left side d) prepare for cesarean section
87. The mother delivered a dead fetus. Which of the following will not help the couple progress through the grieving process?
a) encourage the couple to give name to the new born
b) the social worker visits the couple at home
c) advise the couple to have another child
d) encourage the couple to join a support group
88. Before advising a 24 year-old client desiring oral contraceptives for family planning, the nurse would assess the client for signs
and symptoms of which of the following?
a) anemia b) hypertension
c) dysmenorrheal d) acne vulgaris
JESMAR S. ESPIRITU MAN RN RM 17
89. A newly diagnosed pregnant client tells the nurse, "If I'm going to have all of these discomforts, I'm not sure I want to be
pregnant!" The nurse interprets the client's statement as an indication of which of the following?
a) fear of pregnancy outcome
b) rejection of pregnancy
c) normal ambivalence
d) inability to care for the newborn
90. 26. Which of the following findings would lead the prenatal clinic nurse to suspect that the client has mild pre-eclampsia? Select
all that apply
a) hypertension b) seizures
c) hypotension d) edema
e) proteinuria f) blurry vision
91. Several female patients want to have Papanicolaou examination. Who among these patients should the nurse advise not to
have the examination? The patient who states
a) the first day of my menstruation came this morning and I am bleeding profusely
b) I am 21 years old, and have not had any sex at all
c) I had the test 3 months ago and it was positive
d) I have herpes simplex virus (HSV) and had sex 2 weeks ago
92. A primigravida client at 8 weeks gestation tells the nurse that since having had sexual relations with a new partner 2 weeks ago,
she has noticed flu-like symptoms, enlarged lymph nodes, and clusters of vesicles on her vagina. The nurse refers the client to a
physician because the nurse suspects which of the following sexually transmitted diseases.
a) gonorrhea b) chlamydia trachomatis
c) syphilis d) herpes genitalis
93. The client had been diagnosed to have PIH (pregnancy-induced hypertension). Which of the following should be included in her
care? Select all that apply
a) administer magnesium sulfate IV drip as ordered
b) check urine for presence of protein
c) have calcium gluconate readily available
d) monitor for elevated liver enzymes
e) observe for elevated platelet counts
f) encourage ambulation
94. A clinic nurse is teaching a pregnant client about the warning signs in pregnancy. Which of the following, if identified as a
warning sign by the client would indicate that she understands the teaching?
a) purplish discoloration of the vulva c) irregular, painless contractions
b) visual disturbances d) urinary frequenc
95. A trial for vaginal delivery after an earlier caesarean, would likely to be given to a gravida, who had:
a. First low transverse cesarean was for active herpes type 2 infections; vaginal culture at 39 weeks pregnancy was positive.
b. First and second caesareans were for cephalopelvic disproportion.
c. First caesarean through a classic incision as a result of severe fetal distress.
d. First low transverse caesarean was for breech position. Fetus in this pregnancy is in a vertex presentation.
d