Maternal and Child Health Nursing

Prenatal period
1. Which of the following would occur first in the process of fetal development? a. Appearance of vernix caseosa b. Muscle contraction c. Increased fat deposits d. Secretion of urine by the kidneys

2. During intrauterine life, the fetus receives O2 & excretes its wastes through: a. The amniotic fluid b. 2 umbilical arteries & 1 umbilical vein c. 1 umbilical artery & 2 umbilical veins d. The placenta

3. The first movements of the fetus in the uterus are referred to as: a. Lightening b. Quickening c. Involution d. Contractions

4. The mother first feels these to movements: a. 2 weeks prior to delivery b. At about 8 weeks c. Within the first week after conception d. Between 16 to 20 weeks of gestation

5. Normal changes that are experienced during pregnancy include: a. An increase in vaginal discharge b. Persistent vomiting for the 1st trimester c. Headaches & vertigo d. Edema of fingers & ankles first thing in the morning

6. Hemoglobin & hematocrit counts vary during the pregnancy. The normal variations include: a. A decrease in both, due to increased blood volume b. An increase in both, due to the decreased blood volume c. An increase in the hemoglobin & a decrease in the hematocrit d. Neither actually varies consistently during pregnancy

7. Symptoms of placenta previa would include: a. Spotting in the early months of pregnancy b. Painless bleeding in the last months of pregnancy c. Sharp pains in the absence of bleeding d. Watery discharge prior to birth

8. Your client is admitted with a diagnosis of hyperemesis gravidarum. Your nursing interventions will include: a. Placing a padded tongue blade at the head of the bed. b. Measuring I & O accurately. c. Identification of foods especially nauseating to your client. d. Spending a minimum amount of time with her so she can get plenty of rest.

9. Fetal embodiment occurs during the second trimester. A common sign of this process would be: a. Introversion b. An attempt to incorporate fetus into body image as a part of self. c. Daydreaming about self as mother & about the baby. d. Shock & denial.

10. Endocrine changes associated with pregnancy do not include: a. Increased estrogen levels. b. Increased melanocyte-stimulating hormones. c. Increased HCG levels. d. Decreased aldosterone.

11. Which of the following is not a change in oxygenation associated with pregnancy? a. Enlargement of the heart b. Decrease in cardiac output c. Blood volume increases d. Improved O2 & CO2 exchange at the cellular level

12. Which of the following is not a metabolic change associated with pregnancy? a. Gastric acids & pepsin levels increase b. Nutritional requirement increases c. Heartburn from esophageal reflux increases d. Better absorption of nutrients with delayed gastric transit time

13. Which of the following is considered a presumptive sign of pregnancy? a. Ballotement b. Uterine enlargement c. Positive pregnancy test d. Amenorrhea

14. Which of the following is the probable sign of pregnancy? a. Braxton Hicks contraction b. Breast sensitivity c. Nausea & vomiting d. Quickening

15. At what stage of fetal development does the fetus begin to develop subcutaneous fat? a. 12 weeks b. 28 weeks c. 32 weeks d. 36 weeks

Johna, age 20, first visits a clinic in the 28th week of her pregnancy. Assessment reveal that she is overweight for her height & stature & there is slight edema of her feet & ankles.

1. In addition to emphasizing regular visits for the rest of pregnancy, which goal is a priority for Johna? a. She will report leg cramping. b. She will include roughage in her diet. c. She will notify the clinic of headaches. d. She will sleep in left lateral position.

2. At Johnas next visit two weeks later, her urine is negative for protein, her BP has increased for 110/70 to 115/75 & she has gained 5 lbs. She has some SOB when sleeping on her back, & reports that the fetus is very active at night. Which assessment is most indicative of potential problems? a. BP changes c. respiratory problems b. Weight gain d. fetal activity

3. When discussing health habits with Johna, you review diet, exercise, & use of OTC medications. Which of the following should be avoided considering her present condition? a. Use of bicarbonate of soda for heartburn b. Apple slices as snacks c. Brisk walking as exercise d. Skim milk with meals

4. Johnas symptoms become more severe as pregnancy advances. At a routine visit in the 36th week, it is noted that her urine is 3+ for CHON, her BP is 140/110, & there is facial edema. She is hospitalized on strict bedrest. Magnesium sulfate is ordered. Which of the following assessments are critical while administering this medication intravenously?

a. b. c. d.

Respirations & DTR BP & temperature State of consciousness FHR & apical pulse

5. In addition to monitoring Johnas condition closely, which of the following nursing measures is most important? a. Maintaining a quiet environment. b. Providing sufficient oral fluids. c. Encouraging ambulation. d. Promoting diversional activities.

6. Which of the following is a priority goal for the client with severe pregnancy-induced hypertension? a. Client will comply with diet modifications. b. Client will report visual changes. c. Client will remain on bedrest. d. Client will communicate her feelings.

7. Several hours after treatment with magnesium sulfate is begun, each of the following observations is noted. Which one indicates that the treatment is effective? a. Hourly output is 50 ml. b. Blood pressure is 150/110. c. Reflexes are hypotonic. d. No seizures have occurred.

8. Johna awakens from sleep complaining of sudden sharp abdominal pain. Assessments reveal that the uterus is hard & tender to touch. FHR is 90. Maternal pulse is 130, BP is 100/60, skin is cold & moist to the touch, & moderate vaginal bleeding is noted. The diagnosis is abruptio placenta. This problem is directly related to:

a. b. c. d.

Infarcts caused by vasoconstriction High magnesium blood levels Abnormal placental position Potential for eclamptic seizures

Tina, aged 30, visits the antepartal clinic with her husband after missing 2 menstrual periods. Physical assessment, date of LMP, & urine analysis for HCG indicate that she is probably 7 weeks pregnant. History includes the information that this is her 1st pregnancy, her health has been excellent, she is employed as a secretary, & she is nonsmoker.

9. Which of the following is an appropriate long term goal for Tina? a. She will work reduced hours throughout her pregnancy. b. She will comply with a regular prenatal visit schedule. c. She will omit sodium & fat from her daily diet. d. She will begin an aerobic exercise program.

10. At the second prenatal visit one month later, Tina reports that she is experiencing occasional nausea that is relieved with dry foods. She is also feeling very tired, & she has urinary frequency & periods of weeping. In reviewing the assessment data, identify a potential problem. a. Lab data shows a hematocrit of 36 with a hemoglobin of 12. b. Urinalysis reveals a trace of glucose with negative bacteria.

c. Interview reveals mixed feelings about the pregnancy. d. 24 hour diet recall: high carbohydrate, high fiber vegetarian diet.

11. Tina feels much better at the 22nd week. She expresses surprise that the Dr. ordered a glucose tolerance test. Which explanation is appropriate for this order? a. Because you are a vegetarian, it is necessary to check carbohydrate metabolism. b. Since there was sugar in your urine at your 2nd visit, the blood test is a precaution.

c. Because you have little regular exercise, your metabolism may be very slow. d. This test of blood sugar levels is now routine to identify gestational diabetes.

12. The results of the test show an elevated blood sugar. The problem is diagnosed as gestational diabetes. Health teaching would not include which of the following? a. Review her understanding of basic four food sources. b. Emphasize adequate CHON & vitamin intake. c. Caution her to eliminate all carbohydrates. d. Suggest that she eat 4 small meals each day.

13. Tina follows all dietary suggestions & increases regular mild exercise. She feels well, but the blood sugar levels remain elevated. The Dr. orders regular insulin on a sliding scale appropriate to daily glucose levels. Which statement made by the client shows that she understands the problem? a. I resent that I now face a lifetime on insulin. b. My vegetarian diet must have caused this diabetes. c. This temporary condition is frustrating to control. d. My grandmother has diabetes, so I guess its inevitable.

14. In the 36th week, a non-stress test is ordered. The result is reactive. Select an appropriate explanation of this result that could be given to a nursing student who observed the diagnostic procedure. a. The result shows fetal response to contractions. b. The FHR increased with activity. c. The absence of decelerations shows good oxygenation. d. The heart rate variability is more than 15 beats.

Martha is admitted with preeclampsia in her 32nd week of pregnancy. Her BP is 160/110, she has 3+ albumin in her urine, and she is complaining of severe headaches. 15. Which of the following would not be appropriate in your care of Martha? a. Keeping her on complete bedrest. b. Monitoring the FHT every 4 hours. c. Checking her BP every7 shift. d. Measuring I&O accurately.

16. The Dr. orders that IV magnesium sulfate be given. Nursing interventions required while Martha is receiving this medication must include: a. Monitoring respirations and patellar reflexes. b. Administering calcium gluconate concurrently. c. Encourage her to ambulate. d. Avoiding BP measurements until after medication has infused.

17. Martha begins to experience convulsions. Your priority nursing intervention will be to: a. Leave and get help immediately. b. Put on the call light and ask for help. c. Yell for help. d. Ask her roommate to get help.

18. Which of the following nursing interventions would be inappropriate for the nurse to implement with a pregnant client during a convulsion? a. Place a tongue blade between her unclenched jaws. b. Put a blanket over the side rails to protect her. c. Monitor the FHR. d. Raise the side rails to prevent falling.

19. Which of the following expectant mothers would be at the greatest risk for developing toxemia? a. A 22-year-old Rh-negative multigravida b. A 17-year-old primigravida with a positive roll-over test c. A 25-year-old anemic primigravida d. A 28-year-old slightly obese primigravida

Gail de la Cruz is a 26-year old white woman who has registered at the clinic for prenatal care for her pregnancy. 20. In eliciting her health history, the nurse discovers that Gails LMP was July 10, 2007. which of the following dates would be the appropriate EDC? a. April 3, 2008 c. April 17, 2008 b. April 10, 2008 d. April 20, 2008

21. Gail provides a maternal history, including the following data: 1 healthy female delivered at term five years ago; 1 miscarriage at 8 weeks four years ago; 1 stillborn male delivered at term three years ago; 1 therapeutic abortion at six weeks, two years ago; 1 premature male delivered at 32 weeks last year. During this pregnancy, Gail would be considered as: a. Gravida vi, para iii c. Gravida v, para iii b. Gravida v, para ii d. Gravida vi, para ii

22. Which of the following assessment findings reflects Gails normal physiological response to the pregnancy? a. Augmented peristalsis b. Decreased GFR c. Increased cardiac output d. Increased respiratory rate

23. A complete blood count is done. The results indicate that Gails hemoglobin level is 11.4 gm. Which of the following possibilities most likely explains this finding? a. Pregnancy induced decreased vitamin B12 levels b. The presence of iron deficiency anemia c. Depressed bone marrow function d. Hemodilution of pregnancy

24. What other essential screening tests should be conducted during the course of Gails pregnancy? a. Blood typing b. Sickle cell screen c. Chest X-ray d. Serological test for gonorrhea

Post test: Prenatal Period

1. Marthas LMP started on October 1, 2007. using Nageles rule, her expected date of confinement will be: a. July 1, 2008 b. July 8, 2008 c. August 1, 2008 d. July 28, 2008

2. Martha is scheduled for an ultrasound to confirm her pregnancy. Nursing care to prepare her for this test would include: a. Administering enemas until clear. b. Keeping her NPO for 12 hours. c. Starting an IV to maintain hydration. d. Having her drink 8 glasses of water and not void.

3. Martha has non-stress test done. The results are found to be non reactive. Based on this, the nurse knows that which of the following must have occurred during the test? a. 2 FHR accelerations above base-line for 15 seconds b. Acceleration less than 15 bpm c. Fetal movement in a 10 to 20 minute period d. FHR acceleration greater than 15 bpm

4. Because of the results of the non stress test, Martha scheduled for an oxytocin challenge test. The results show the presence of late deceleration of FHR with 3 contractions during a 10-minute period; positive window. This test would be reported as: a. Abnormal b. Normal c. Suspicious d. Unsatisfactory

5. The risk of amniocentesis would not include which of the following? a. Fetal death b. Infection c. Placenta abruptio d. Chromosomal damage

6. Which of the following treatments would be inappropriate for the pregnant client who is suffering from nausea and vomiting? a. Eat small frequent meals. b. Maintain a low fat diet. c. Take antiemetics before arising. d. Drink liquids before meals.

7. Which of the following is contraindicated in the pregnant client who is suffering from heartburn? a. Take Gaviscon for the problem. b. Drink milk between meals. c. Sit up after meals. d. Take Maalox occasionally.

8. Many pregnant clients suffer from headaches during pregnancy. Which of the following is contraindicated in treating these headaches? a. Change positions slowly. b. Apply cool cloths to the forehead. c. Take aspirin sparingly. d. Take Tylenol sparingly.

9. Many women have leg cramps during pregnancy. Which of the following would not be an appropriate way to treat leg cramps? a. Walk regularly. b. Elevate the legs when sitting. c. Maintain bedrest when cramps are severe. d. Increase milk intake.

10. Which of the following is true about most abortions? a. They are usually caused by maternal infections. b. The cause of most abortions is unknown. c. An incompetent maternal cervical os is the common cause. d. Most are the result of fetal abnormalities.

11. When some of the products of conception remain in utero after fetal death, it is referred to as: a. Spontaneous abortion b. Missed abortion c. Incomplete abortion d. Inevitable abortion

12. Which of the following is not considered a typical sign of an ectopic pregnancy? a. Nausea & vomiting, especially after rupture b. Fever around 100F c. Leukocytosis & an elevated ESR d. Heavy, bright red vaginal bleeding

13. Which of the following is a typical S/Sx of H-mole? a. Brownish vaginal discharge aroun week 12 b. Hypotension c. Uterus small for estimated gestational age d. Hard, distended lower uterine segment

14. Which of the following is a predisposing factor for abruptio placenta? a. Young, primigravida b. Hypertension c. Multiparity d. Presence of myomas

15. Using Whites classification, the presence of vascular disease in a client who became diabetic at age 8 and has been a diabetic for 21 years places the client in: a. Class B b. Class C c. Class D d. Class E

16. Which of the following women should be screened for diabetes during their 2nd trimester, with a two-hour-postprandial blood sugar? a. Obese women b. Older women c. Adolescents d. All women

17. Mary is a 38-year-old multigravida with a history of rheumatic heart disease. She has been classified as Class II. Which of the following symptoms would you expect her to exhibit? a. Dyspnea, fatigue, and angina with normal activity b. Symptoms of cardiac insuficiency at rest c. No symptoms at normal activities d. Dyspnea, fatigue, & angina with less than normal activity

18. Which of the following is incorrect concerning rubella & pregnancy? a. Women with low titers should be vaccinated 2 months before pregnancy. b. Rubella is extremely teratogenic in the 1st trimester. c. The rubella virus does not cross the placenta. d. All women should have rubella titers before their 1st pregnancy.

Russel, registered at the clinic for prenatal care for her pregnancy. 19. Russel reports feelings of fatigue as well as constipation & nausea. The hormone which most likely contributes to these symptoms is: a. Chorionic gonadotropin b. Relaxin c. Prolactin d. Progesterone

20. A change in vaginal mucosal color from pink to violet is recorded on her chart. This referred to as: a. Goodells sign b. Chadwicks sign c. Hegars sign d. Montgomerys sign

21. When Russels pregnancy has reached the last trimester, the nurse conducts Leopolds maneuvers during the course of a prenatal examination. Which step in this maneuver assists in locating the fetal head? a. First b. Second c. Third d. Fourth

22. McDonalds measurements indicate that Russels fundal height is 31 cm. Which gestational age is compatible with this assessment? a. 28 weeks b. 32 weeks c. 35 weeks d. 39 weeks

23.Which of the following statements should guide the nurses understanding in preparing a teaching plan for Russel? a. Fetal needs for calcium causes demineralization & loss of maternal teeth during pregnancy. b. Calories must be regulated to 1,800 calories/day to prevent excess weight gain & difficult labor. c. Ambivalence about the pregnancy & mood swings are evidence of rejection of the pregnancy. d. Uterine muscles activity known as Braxton Hicks contractions occur throughout the pregnancy.

Normal Labor and Delivery: 1. When the uterus moves downward and forward about 2 weeks prior to delivery, this is referred to as: a. Quickening b. Lightening c. Braxton Hicks contractions d. False labor

2. Which of the following is not one of the prodromes to labor? a. Sudden burst of energy, nesting b. Brownish or bloody show c. Sudden gain of 2-3 pounds from fluid shifts d. Increased Braxton Hicks contractions

3. Which of the following characteristics is not typical of false labor? a. An increase in the force & frequency of contractions when walking b. Contractions that do not produce dilation, effacement or descent c. Absence of bloody show d. Irregular contractions

4. During the latent phase of the first stage of labor, the mother often complains of cramps & backache. Nursing measures to decrease these symptoms include: a. Medicate with Demerol as ordered. b. Encourage the client to lay on her back. c. Provide a pillow for clients back. d. Have the client bear down with contractions.

5. During the transitional phase of the first stage of labor, the client is often nauseated, hot, and sweaty. Which of the following nursing interventions is appropriate for the client at this time? a. Administer antiemetics as ordered. b. Provide the client with cool liquids to drink. c. Encourage open-mouthed deep breathing. d. Set up a fan in the room to cool the client.

6. Which of the following characteristics is typical of second stage of labor? a. Moderately increased pain b. Severe rectal pressure c. Circumoral pallor d. Decreased bloody show

Sandy is a 20-year old overweight primigravida who suffers from pregnancyinduced hypertension. 7. Immediately following the cesarean birth under general anesthesia of a four-pound infant, Sandy is monitored closely. Which of the ff is not a part of critical nursing care? a. Administer transfusions & IV fluids. b. Monitor hematocrit & fibrinogen levels closely. c. Allow family & clergy to remain at bedside. d. Suggest early breast-feeding to promote bonding.

8. The disturbed father is concerned about the health of mother and the infant in intensive care. Which of the following statements meets his needs at this time? a. Dont worry; the doctors are doing all they can. b. Lets talk about what you are feeling now. c. It wont help your loved ones to be so upset. d. You must remain strong to support your family.

9. Several days later the mother is discharged. Discharge teaching should not include which of the following? a. Report strong contractions. b. Measure I&O. c. Observe any discomfort. d. Note behavioral changes.

10. Several days later the mother is discharged. Discharge teaching should not include which of the following? a. Be sure to report any elevated temperature. b. Include liver & dried fruits in your diet often . c. Call the ICU anytime to check on your baby. d. Breast-feeding the baby may cause increased bleeding.

11. Which of the following is the desired outcome of the second stage of labor? a. The client will be fully dilated. b. The fetal head will be fully engaged. c. The client will deliver a healthy infant. d. The client will safely deliver the placenta.

12. Which of the following is not a typical manifestation of the third stage of labor? a. Fundus rises b. Uterus assumes a globular shape c. Blood gushes from uterus d. Perineum bulges

13. Your client is a 25-year-old primigravida who is attached to a fetal monitor. The base-line FHR is 145 to 150 bpm. You notice that the FHR slows every time the client has a contraction & then returns to normal. This is best described as: a. Type 1 deceleration b. Type 2 deceleration c. Type 3 deceleration d. Fetal distress

14. The treatment for the above alteration is to: a. Do nothing; this is a transient phenomenon b. Prepare for emergency cesarean section c. Reposition client on her side d. Prepare the client for impending vaginal delivery.

15. Ann, a 26-year-old multigravida, is complaining of severe pain during the 1st stage of labor. Which of the following measures would treat the pain without interfering with the labor? a. Tranquilizers to calm her down b. Amnesiacs c. Paracervical block d. Pudendal block

16. Part of your initial assessment on a client admitted in labor is to perform Leoplds maneuver to determine: a. Contractions b. Fetal position c. Fetal heart rate d. Presence of fetal distress

17. Your clients membranes rupture spontaneously and in checking, you note that the umbilical cord has prolapsed. Which of the following is the priority nursing action for this situation? a. Call the physician. b. Administer oxygen. c. Turn the mother to her side. d. Place the mother in Trendelenburg position.

18. Which if the ff is the correct nursing intervention to help the client to push down during delivery? a. Instruct the client to take 2 breaths, hold, and bear down between contractions. b. Turn the client to her side and use short breaths. c. Instruct the client to take 2 breaths, hold and bear down with contractions. d. Encourage the client not to bear down since it may result in tears.

19. Your client is suffering from dystocia in the form of hypotonic uterine contractions. Which of the following is a symptom of the hypotonic contractions? a. Increased frequency & intensity of contractions. b. Nonsynchronous uterine tension. c. Increased muscle tonus. d. Pain out of proportion to contraction.

20. Which of the following is not a S/Sx of prolonged labor? a. Latent phase of 22 hours in primigravida. b. Prolonged active phase. c. Dilation of 1 cm per hour in a multipara. d. Descent of less than 2 cm per hour in multigravida.

21. Which of the following is an indication for the use of oxytocin for your client in labor? a. Prolapse of the cord. b. History of the previous cesarean section more than 5 years ago. c. Cervical dilation less than 3 cm. d. Hypotonic uterine contractions.

22. Which of the following is not an indication for delivery of a preterm mother in labor? a. Placental separation with hemorrhage. b. Severe eclampsia. c. Preterm contractions d. Chorioamnionitis

23. Ritodrine is often used to treat preterm labor. Which of the following is not a side effect of this drug? a. Palpitations b. Nausea and vomiting c. Alterations in maternal BP d. Constipation

24. Which of the following is not an indication for induction of labor? a. Premature rupture of membranes b. Uncontrolled diabetes c. Hypertonic uterine contractions d. History of precipitous delivery

25. Which of the following is not a predisposing factor for rupture of the uterus? a. Previous cesarean section b. Hypotonic contractions c. Labor that is not progressing d. Cephalopelvic disproportion

25. Which of the following is not a predisposing factor for rupture of the uterus? a. Previous cesarean section b. Hypotonic contractions c. Labor that is not progressing d. Cephalopelvic disproportion

26. Which of the following is not a rationale for using a medial episiotomy? a. Effective & easily repaired b. Less painful c. Minimizes risk of extension to rectum d. Less blood loss

27. Nursing care of an episiotomy would not include which of the following? a. Using an icepack for 1st 24 hours. b. Avoiding the use of analgesic ointments. c. Applying a heat lamp TID as ordered. d. Administering a sitz bath, especially after a bowel movement.

28. Which of the following is not a maternal predisposing factor for the use of forceps for delivery? a. Shortened 2nd stage of labor in dystocia b. Deficiency of expulsive efforts c. Inability to push d. Prolapse of the cord

29. Which of the following is not a prerequisite to the use of forceps in a delivery of a fetus. a. Cephalopelvic disproportion b. Fully dilated cervix c. Engaged head d. Empty bowel & bladder

30. Which of the following is likely to cause postpartum rectal incontinence and continued rectal problems? a. First degree lacerations b. Second degree lacerations c. Third degree lacerations d. Mediolateral episiotomies

31. Which of the following complications is more likely to occur postpartum when the client has had a cesarean section rather than a normal vaginal delivery? a. Abdominal distension b. Uterine bleeding c. Thrombophlebitis d. Lochia rubra

Lynn Reyes, aged 38, is admitted in the 39th week for a planned cesarean delivery because of total placenta previa. 32. Which of the following assessments is not routine in this situation? a. Taking fetal heart rate b. Checking maternal vital signs c. Monitoring for uterine contractions d. Checking for cervical dilation/effacement

33. The chief potential problem for this fetus is: a. Potential for impaired gas exchange related to impaired circulation b. Alteration in nutrition: less than body requirements c. Potential for infection related to cesarean birth d. Potential for injury related to placental placement

34. A primary goal to Lynns delivery is: a. Client if free from undetected complications b. Client & significant others are together during preparation and surgery c. Client expresses her fears and concerns d. Patient is well hydrated before deluivery

35. A spinal anesthesia is administered, and the client appears relaxed. Immediately afterwards, the BP changes from 120/88 to 100/70 and FHT drops from 144 to 118. What is the probable reason for this change? a. Adverse response to regional anesthetic b. Pressure on aorta and vena cava while supine c. Poor oxygenation due to placenta previa d. Anxiety about the cesarean delivery

36. What is the appropriate intervention for the above problem at this time? a. Elevate the feet and legs. b. Administer oxygen by mask. c. Increase the IV infusion rate. d. Turn the client slightly to the left.

37. A seven-pound daughter is delivered several minutes later. Apgar score is 9 and 10. Which of the following assessments would receive a score of 1 at the initial scoring? a. Heart rate 128 b. Cry loud c. Feet blue d. Body flexed

38. The total blood loss during delivery is 700 ml. The couple prefer to avoid transfusion if possible. Based on her history and intrapartal situation, which of the following recovery room assessments is critical in addition to observing lochia? a. Blood pressure b. Pulse rate c. Temperature d. Level of consciousness

39. In assessing physiological adaptation to the postpartum period, which of the following statements made by the client indicates that she is able to be transferred to her regular room? a. I have a little pain in the incision. b. Id like to sleep in my own room now. c. I am thirsty and would like my lips sponged. d. I feel my legs again as I move them.

40. The Dr. orders 1000 ml of Ringers lactate at 124 ml per hour with Pitocin 10 units added to the IV. The drip factor is 10 gtt/ml. Select the appropriate rate of infusion. a. 17 gtt per minute b. 21 gtt per minute c. 27 gtt per minute d. 31 gtt per minute

Post Partum Period

Lisa Cruz, aged 37, delivered her 5th son three hours ago in the birthing room.

1. Which of the following data shared at morning report indicates a potential problem? a. The fundus is firm, just above the umbilicus. b. The client is complaining about severe uterine cramps. c. Episiotomy is slightly swollen with a small bruise. d. The vital signs are temperature 98F, pulse 68, respirations 20.

2. Lisas blood type is O negative; the baby is O positive. RhoGam is ordered prior to discharge after results of the Coombs test are known. What information is essential before giving the RhoGam? a. Isoimmunization has occurred. b. RhoGam was given after the last birth. c. No antibodies are present. d. There are no known allergies.

3. Ms. Cruz is concerned about how her other children, ages 2,3,5 and 15 will accept the baby. Which response shows an understanding of her feelings? a. Things will be difficult in the first weeks. b. Their reactions will depend on how you prepared them. c. Lets talk about what concerns you. d. Sometimes its better to avoid worrying too much.

4. The client, who bottle-fed her older children, has many questions about breast-feeding. What approach is most helpful in this situation? a. Assess her knowledge and be available during feedings. b. Use pamphlets and films as a first step in teaching. c. Introduce her to a successful breastfeeding mother. d. Tell her the reasons why breastfeeding is beneficial.

5. Before discharge, Lisa discusses family planning. Which statement indicates that she needs further teaching? a. Ill start to take oral contraceptives immediately. b. If I want to use a diaphragm, Ill need to be checked first. c. Well avoid intercourse when cervical mucous is stretchable. d. I will not rely on breast-feeding as contraception.

6. As the newborn is prepared for discharge, the father asks about care of the umbilical cord stump. Select the appropriate response. a. Apply an antibiotic ointment to the area daily. b. Use alcohol to the cord and base with each diaper change. c. Let the baby soak in the bath until the cord falls off. d. No special care is needed. The cord will heal in a week.

Chita Perlas, aged 15, delivered a baby girl an hour ago. She held her infant daughter and appeared joyful at her alertness. As the initial newborn assessments are made, she asks many questions about the babys condition. 1. Which of the ff delivery room observations is abnormal? a. Severe molding of the head b. Cyanosis of the hands & feet c. Irregular abdominal respirations d. Temperature of 35C

2. Baby Girl Perlas is later assessed by the nurse who determines that the infant is small for gestational age on the Ballard scale. Reasons for intrauterine growth retardation include: a. Maternal infection and smoking b. Malnutrition and chromosomal abnormalities c. Anemia and exposure to chemical agents d. Alcohol use and emotional distress

3. In observing an adolescent parent with her first child, it is important that the nurse assess: a. Signs that the mother is tuned in to infant cues b. Evidence that the mother is aware of safety c. Behaviors that indicate early bonding d. All of the above

4. Which question focuses on gathering data about the young mothers mastery of her developmental tasks? a. What is your relationship with the babys father? b. How do you feel about your parents interest in the baby? c. Tell me how you feel about yourself as a young woman? d. Do you feel that you can give love to an infant?

5. Which of the following is an appropriate short-term goal for this young mother? a. She will be aware of the developmental needs of childhood. b. She will feed, nurture, and provide care for her newborn. c. She will resolve social problems within her family. d. She will delay another pregnancy for a year.

6. At the time of discharge, much time is spent reinforcing teaching of self-care & infant care. Which statement made by Chita indicates that further teaching is necessary? a. If I need to, Ill use non-fat dry milk for feedings. b. Ill hold and love the baby even when she doesnt cry. c. After feeding, Ill put her to sleep on her tummy. d. Until the cord is dry, Ill give her a sponge bath.

Grace , a diabetic, is admitted for termination of pregnancy in the 37th week when pelvic examination shows cervical softening and effacement. The physician and couple have agreed on labor induction. 7. The primary reason that a gestational diabetic is delivered early is to: a. Prevent problems that may result from placental insufficiency. b. Reduce maternal stress during the 2nd stage of labor c. Eliminate fetal hyperglycemia in the immediate newborn period d. Control maternal glucose/insulin balance in intrapartum

8. During the labor induction, which assessment is critical? a. Monitoring contractions and rest phase. b. Observing maternal pain and relaxation. c. Measuring I&O. d. Noting BP and pulse.

9. After a ten-hour labor, a nine-pound son is delivered to Grace. Parents and newborn enjoy early contact and breast-feeding is initiated. Which of the following assessments of the newborn indicates a need for immediate intervention? a. Respiratory rate is 30. b. Dextrostick (glucose) is 25. c. Hematocrit is 48. d. Coombs test is negative.

10. Baby and mother are discharged after 24 hours of hospitalization. Both appear to be in good health. Which statement made by Grace shows that discharge teaching was effective? a. Well bring the baby for his PKU test tomorrow. b. Both the baby and I probably will always be diabetic. c. Breast-feeding will help space the next pregnancy. d. Ill start active exercise again right away.

11. Baby James, 6 pounds 1 ounce, was just delivered after a long labor. His initial Apgar is 4. Which of the following is likely nursing care for James? a. Suction him. b. Dry him with a dry towel. c. Ventilate him with 100% O2 at 40 to 60 breaths. d. Place baby under warmer to maintain body temperature.

12. Baby James is in the newborn nursery. In assessing his eyes and vision, which of the following would be an abnormal finding? a. Crossed eyes b. Absent blink reflex c. Positive red reflex d. Edema of the eyelids

13. Which of the following would be an abnormal finding when the nurse assesses Jamess cardiovascular system? a. Heart rate of 154 b. Irregular heartbeats c. Acrocyanosis of the extremities d. Circumoral cyanosis

14. James is breathing with 10 to 15 second periods of apnea. The nurse knows that this means: a. Nothing, it is normal b. Impending respiratory distress c. James will eventually develop asthma d. James may be developing a respiratory infection

15.When the nurse is assessing Jamess renal system, which of the following would be considered an abnormal assessment? a. Urine specific gravity 1.008 b. First void after first 24 hours c. Voiding up to 20 times a day d. Brick dust colored urine with the first void

16. Which of the following is not part of the care of an infant with hyperbilirubinemia? a. Withhold fluids during treatment. b. Maintain neutral temperature. c. Administer phototherapy. d. Assist with exchange transfusion if needed.

Mrs. C., gravida i para i, and has just delivered a 7 pound 3 ounce baby girl after a ten-hour labor. The baby was delivered vaginally with no complications. 17. In order to assess this newborns adaptation to extrauterine life, the nurse should perform which of the following tests? a. Apgar b. Silverman c. Ballard/Dubowitz d. Brazelton

18. To avoid heat loss by evaporation, the nurse should: a. Keep the baby away from drafts b. Avoid placing the baby on a cold surface c. Dry the baby immediately after delivery d. Pad the scale before weighing the baby

19. In order to prevent abnormal bleeding in the newborn, the nurse should: a. Keep the baby away from drafts. b. Avoid placing the baby on a cold surface. c. Dry the baby immediately after delivery. d. Pad the scale before weighing the baby.

20. The newborns first stool is: a. Yellow and loose b. Yellow and seedy c. Thick and greenish black d. Loose and green

21. In order to rule out PKU, the nurse should test the baby: a. Immediately after delivery b. Prior to the first feeding c. 2 to 3 days after birth d. At the six-week check up

Baby Susan is a 9 pound 2 ounce infant born to a diabetic mother. She was delivered by cesarean section 12 hours ago. Her Apgar scores in the delivery room were 7 and 9. 22. You notice that Susan is lethargic, jittery, and has irregular respirations. Appropriate nursing interventions would include: a. Feeding the infant glucose water (10%) b. Administering insulin subcutaneously c. Giving oxygen d. Administering Phenobarbital IM

23. Ten hours later, Susan develops tetany. Which of the following complications will you most likely give IV? a. Glucose b. Insulin c. Calcium gluconate d. Valium

24. Jaundice that appears after the first 48 hours of a newborns life usually indicates: a. Rh or ABO incompatibility b. Normal physiological adaptation c. Breast milk intolerance d. Liver abnormality

25. Expiratory grunting is: a. Normal bowel transit in the newborn b. A sign of respiratory distress c. Common in babies of Rh negative mothers d. Transitory in most instances

Baby Den Rick is a 9 pound 8 ounce infant born at 43 weeks gestation. He was delivered vaginally ten hours ago. His Apgar scores were 7 and 8. 26. Den Ricks physical characteristics include: a. cracked, peeling skin, and scant vernix caseosa b. Abundant lanugo & thin, transparent skin c. Yellow-stained skin and abundant subcutaneous fat d. Ruddy complexion & flaccid extremities

27. Den Ricks gestational age puts him at risk for: a. Juvenile onset diabetes b. Meconium Aspiration Syndrome c. Hemolytic anemia d. Hyperthermia

28. Baby Sarah, 7 pounds 8 ounces, was born today. She is in the newborn nursery and you are caring for her cord. Which of the following nursing interventions is appropriate when caring for the umbilical cord. a. Apply a vaseline gauze dressing over the site. b. Apply a simple dry dressing over the site. c. Clean the site vigorously with soap and water everyday. d. Apply topical triple dye or bacitracin ointment initially.

29. Bowel transit time in the newborn is about: a. 1 to 1 hours b. 2 to 3 hours c. 1 to 2 hours d. 3 to 3 hours

30. The newborn needs approximately how many calories per day? a. 50 calories per kg per day b. 75 calories per kg per day c. 120 calories per kg per day d. 150 calories per kg per day

31. The newborn infant exhibits a number of reflexes at birth. Which of the following is not present at birth? a. Parachute reflex b. Moro reflex c. Sucking reflex d. Extrusion reflex

32. Which of the following is not a risk factor for respiratory distress syndrome? a. Prematurity b. Maternal diabetes c. Birth trauma d. Post term birth