HESI OB MATERNITY V1, V2 Practice Exam Questions

HESI OB MATERNITY V1, V2 Practice Exam 2022/2023 Questions HESI OB MATERNITY V1, V2 Practice Exam 2022/2023 Questions 1. A 3-day postpartum client, who is not immune to rubella, is to receive the vaccine at discharge. Which of the following must the nurse include in her discharge teaching regarding the vaccine? 1. The woman should not become pregnant for at least 4 weeks. 2. The woman should pump and dump her breast milk for 1 week. 3. The mother must wear a surgical mask when she cares for the baby. 4. Passive antibodies transported across the placenta will protect the baby. 208 MATERNAL AND NEWBORN SUCCESS 2. A 3-day-postpartum client questions why she is to receive the rubella vaccine before leaving the hospital. Which of the following rationales should guide the nurse’s response? 1. The client’s obstetric status is optimal for receiving the vaccine. 2. The client’s immune system is highly responsive during the postpartum period. 3 . The client’s baby will be high risk for acquiring rubella if the woman does not receive the vaccine. 4 . The client’s insurance company will pay for the shot if it is given during the immediate postpartum period. 3. A patient, G2P1102, who delivered her baby 8 hours ago, now has a temperature of 100.2ºF. Which of the following is the appropriate nursing intervention at this time? 1. Notify the doctor to get an order for acetaminophen. 2. Request an infectious disease consult from the doctor. 3. Provide the woman with cool compresses. 4. Encourage intake of water and other fluids. 4 . To prevent infection, the nurse teaches the postpartum client to perform which of the following tasks? 1. Apply antibiotic ointment to the perineum daily. 2. Change the peripad at each voiding. 3. Void at least every two hours. 4. Spray the perineum with a povidone-iodine solution after toileting. 5. A 3-day-postpartum breastfeeding woman is being assessed. Her breasts are firm and warm to the touch. When asked when she last fed the baby her reply is, “I fed the baby last evening. I let the nurses feed him in the nursery last night. I needed to rest.” Which of the following actions should the nurse take at this time? 1. Encourage the woman exclusively to breastfeed her baby. 2. Have the woman massage her breasts hourly. 3. Obtain an order to culture her expressed breast milk. 4. Take the temperature and pulse rate of the woman. 6 . A breastfeeding woman has been counseled on how to prevent engorgement. Which of the following actions by the mother shows that the teaching was effective? 1. She pumps her breasts after each feeding. 2. She feeds her baby every 2 to 3 hours. 3. She feeds her baby 10 minutes on each side. 4. She supplements each feeding with formula. 7. A 2-day-postpartum breastfeeding woman states, “I am sick of being fat. When can I go on a diet?” Which of the following responses is appropriate? 1. “It is fine for you to start dieting right now as long as you drink plenty of milk.” 2. “Your breast milk will be low in vitamins if you start to diet while breastfeeding.” 3. “You must eat at least 3000 calories per day in order to produce enough milk for your baby.” 4. “Many mothers lose weight when they breastfeed because the baby consumes about 600 calories a day.” 8 . A G2P2002, who is postpartum 6 hours from a spontaneous vaginal delivery, is assessed. The nurse notes that the fundus is firm at the umbilicus, there is heavy lochia, and perineal sutures are intact. Which of the following actions should the nurse take at this time? 1. Do nothing. This is a normal finding. 2. Massage the woman’s fundus. 3. Take the woman to the bathroom to void. 4. Notify the woman’s primary health care provider. 9. A client informs the nurse that she intends to bottlefeed her baby. Which of the following actions should the nurse encourage the client to perform? 1. Increase her fluid intake for a few days. 2. Massage her breasts every 4 hours. 3. Apply heat packs to her axillae. 4. Wear a supportive bra 24 hours a day. 10. The nurse in the obstetric clinic received a telephone call from a bottlefeeding mother of a 3-day-old. The client states that her breasts are firm, red, and warm to the touch. Which of the following is the best action for the nurse to advise the client to perform? 1. Intermittently apply ice packs to her axillae and breasts. 2. Apply lanolin to her breasts and nipples every 3 hours. 3. Express milk from the breasts every 3 hours. 4. Ask the primary health care provider to order a milk suppressant. 11. A multigravid, postpartum woman reports severe abdominal cramping whenever she nurses her infant. Which of the following responses by the nurse is appropriate? 1. Suggest that the woman bottlefeed for a few days. 2. Instruct the patient on how to massage her fundus. 3. Instruct the patient to feed using an alternate position. 4. Discuss the action of breastfeeding hormones. 12 . The nurse is caring for a breastfeeding mother who asks advice on foods that will provide both vitamin A and iron. Which of the following should the nurse recommend? 1. 1⁄2 cup raw celery dipped in 1 ounce cream cheese. 2. 8 ounce yogurt mixed with 1 medium banana. 3. 12 ounce strawberry milk shake. 4. 11⁄2 cup raw broccoli. 13. A breastfeeding mother states that she has sore nipples. In response to the complaint, the nurse assists with “latch on” and recommends that the mother do which of the following? 1. Use a nipple shield at each breastfeeding. 2. Cleanse the nipples with soap 3 times a day. 3. Rotate infant positions at each feed. 4. Bottle feed for 2 days then resume breastfeeding. 14. Which of the following statements is true about breastfeeding mothers as compared to bottlefeeding mothers? 1. Breastfeeding mothers usually involute completely by 3 weeks postpartum. 2. Breastfeeding mothers have decreased incidence of diabetes mellitus later in life. 3. Breastfeeding mothers show higher levels of bone density after menopause. 4 . Breastfeeding mothers are prone to fewer bouts of infection immediately postpartum. 15. A breastfeeding woman, 11⁄2 months postdelivery, calls the nurse in the obstetrician’s office and states, “I am very embarrassed but I need help. Last night I had an orgasm when my husband and I were making love. You should have seen the milk. We were both soaking wet. What is wrong with me?” The nurse should base the response to the client on which of the following? 1. The woman is exhibiting signs of pathological galactorrhea. 2. The same hormone stimulates orgasms and the milk ejection reflex. 3. The woman should have a serum galactosemia assessment done. 4. The baby is stimulating the woman to produce too much milk. 16. A client who is 3 days postpartum asks the nurse, “When may my husband and I begin having sexual relations again?” The nurse should encourage the couple to wait until after which of the following has occurred? 1. The client has had her six-week postpartum check-up. 2. The episiotomy has healed and the lochia has stopped. 3. The lochia has turned to pink and the vagina is no longer tender. 4. The client has had her first postpartum menstrual period. 17. A breastfeeding client, 7 weeks postpartum, complains to an obstetrician’s triage nurse that when she and her husband had intercourse for the first time after the delivery, “I couldn’t stand it. It was so painful. The doctor must have done something terrible to my vagina.” Which of the following responses by the nurse is appropriate? 1. “After a delivery the vagina is always very tender. It should feel better the next time you have intercourse.” 2. “Does your baby have thrush? If so, I bet you have a yeast infection in your vagina.” 3. “Women who breastfeed often have vaginal dryness. A vaginal lubricant may remedy your discomfort.” 4. “Sometimes the stitches of episiotomies heal too tight. Why don’t you come in for an assessment?” 18. The nurse monitors his or her postpartum clients carefully because which of the following physiological changes occurs during the early postpartum period? 1. Decreased urinary output. 2. Increased blood pressure. 3. Decreased blood volume. 4 . Increased estrogen level. 19. A woman, 24 hours postpartum, is complaining of profuse diaphoresis. She has no other complaints. Which of the following actions by the nurse is appropriate? 1. Take the woman’s temperature. 2. Advise the woman to decrease her fluid intake. 3. Reassure the woman that this is normal. 4. Inform the neonate’s pediatrician. 20 . Which of the following laboratory values would the nurse expect to see in a normal postpartum woman? 1. Hematocrit 39%. 2. White blood cell count 16,000 cells/mm3. 3. Red blood cell count 5 million cells/mm 3. 4. Hemoglobin 15 grams/dL. 21. Which of the following client statements indicates a need for additional teaching about selfcare during pregnancy? ■ 1. “I should use nonskid pads when I take a shower or bath.” ■ 2. “I should avoid using soap on my nipples to prevent drying.” ■ 3. “I should sit in a hot tub for 20 minutes to relax after working.” ■ 4. “I should avoid douching even if my vaginal secretions increase.” 22. The nurse is discussing the importance of doing Kegel exercises during the postpartum period. Which of the following should be included in the teaching plan? 1. She should repeatedly contract and relax her rectal and thigh muscles. 2. She should practice by stopping the urine flow midstream every time she voids. 3. She should get on her hands and knees whenever performing the exercises. 4. She should be taught that toned pubococcygeal muscles decrease blood loss. 23. The nurse is evaluating the involution of a woman who is 3 days postpartum. Which of the following findings would the nurse evaluate as normal? 1 . Fundus 1 cm above the umbilicus, lochia rosa. 2 . Fundus 2 cm above the umbilicus, lochia alba. 3. Fundus 2 cm below the umbilicus, lochia rubra. 4. Fundus 3 cm below the umbilicus, lochia serosa. 24. During a home visit, the nurse assesses a client 2 weeks after delivery. Which of the following signs/symptoms should the nurse expect to see? 1. Diaphoresis. 2. Lochia alba. 3. Cracked nipples. 4. Hypertension. 25. The day after delivery a woman, whose fundus is firm at 1 cm below the umbilicus and who has moderate lochia, tells the nurse that something must be wrong, “All I do is go to the bathroom.” Which of the following is an appropriate nursing response? 1. Catheterize the client per doctor’s orders. 2. Measure the client’s next voiding. 3. Inform the client that polyuria is normal. 4. Check the specific gravity of the next voiding. 26. A breastfeeding client, G10P6408, delivered 10 minutes ago. Which of the following assessments is most important for the nurse to perform at this time? 1. Pulse. 2. Fundus. 3. Bladder. 4. Breast. 27. The nurse is caring for a client who had a cesarean section under spinal anesthesia less than 2 hours ago. Which of the following nursing actions is appropriate at this time? 1. Elevate the head of the bed 60 degrees. 2. Report absence of bowel sounds to the physician. 3. Have her turn and deep breathe every 2 hours. 4. Assess for patellar hyperreflexia bilaterally. 28. The nurse is caring for a postpartum client who experienced a second-degree perineal laceration at delivery 2 hours ago. Which of the following interventions should the nurse perform at this time? 1. Apply an ice pack to the perineum. 2. Advise the woman to use a sitz bath after every voiding. 3. Advise the woman to sit on a pillow. 4. Teach the woman to insert nothing into her rectum. 29. A woman had a cesarean section yesterday. She states that she needs to cough but that she is afraid to. Which of the following is the nurse’s best response? 1. “I know that it hurts but it is very important for you to cough.” 2. “Let me check your lung fields to see if coughing is really necessary.” 3. “If you take a few deep breaths in, that should be as good as coughing.” 4. “If you support your incision with a pillow, coughing should hurt less.” 30. A woman is receiving patient-controlled analgesia (PCA) post–cesarean section. Which of the following must be included in the patient teaching? 1. The client should monitor how often she presses the button. 2. The client should report any feelings of nausea or itching to the nurse. 3. The family should press the button whenever they feel the woman is in pain. 4. The family should inform the nurse if the client becomes sleepy. 31. An 18-week gestation client telephones the obstetrician’s office stating, “I’m really scared. I think I have breast cancer. My breasts are filled with tumors.” The nurse should base the response on which of the following? 1. Breast cancer is often triggered by pregnancy. 2. Nodular breast tissue is normal during pregnancy. 3. The woman is exhibiting signs of a psychotic break. 4. Anxiety attacks are especially common in the second trimester. 32. A woman states that she frequently awakens with “painful leg cramps” during the night. Which of the following assessments should the nurse make? 1. Dietary evaluation. 2. Goodell’s sign. 3. Hegar’s sign. 4. Posture evaluation. 33 . Which of the following exercises should be taught to a pregnant woman who complains of backaches? 1. Kegeling. 2. Pelvic tilting. 3. Leg lifting. 4. Crunching. 34. A woman in her third trimester advises the nurse that she wishes to breastfeed her baby, “but I don’t think my nipples are right.” Upon examination, the nurse notes that the client has inverted nipples. Which of the following actions should the nurse take at this time? 1. Advise the client that it is unlikely that she will be able to breastfeed. 2. Refer the client to a lactation consultant for advice. 3. Call the labor room and notify them that a client with inverted nipples will be admitted. 4. Teach the woman exercises in order to evert her nipples. 35 . Which of the following vital sign changes should the nurse highlight for a pregnant woman’s obstetrician? 1. Prepregnancy blood pressure (BP) 100/60 and third trimester BP 140/90. 2. Prepregnancy respiratory rate (RR) 16 rpm and third trimester RR 22 rpm. 3. Prepregnancy heart rate (HR) 76 bpm and third trimester HR 88 bpm. 4. Prepregnancy temperature (T) 98.6ºF and third trimester T 99.2ºF. 36. A nurse midwife has advised a 39-week gestation gravid to take evening primrose oil 2500 mg daily as a complementary therapy. This suggestion was made because evening primrose has been shown to perform which of the following actions? 1. Relieve back strain. 2. Improve development of colostrum. 3. Ripen the cervix. 4. Reduce the incidence of hemorrhoids. 37. A 38-week gestation client, Bishop score 1, is advised by her nurse midwife to take evening primrose daily. The office nurse advises the client to report which of the following side effects that has been attributed to the oil? 1. Skin rash. 2. Pedal edema. 3. Blurred vision. 4. Tinnitus. 38. A 37-week gravid client states that she noticed a “white liquid” leaking from her breasts during a recent shower. Which of the following nursing responses is appropriate at this time? 1. Advise the woman that she may have a galactocele. 2. Encourage the woman to pump her breasts to stimulate an adequate milk supply. 3. Assess the liquid because a breast discharge is diagnostic of a mammary infection. 4. Reassure the mother that this is normal in the third trimester. 39. A 36-week gestation gravid client is complaining of dyspnea when lying flat. Which of the following is the likely clinical reason for this complaint? 1. Maternal hypertension. 2. Fundal height. 3. Hydramnios. 4. Congestive heart failure. 40. The nurse is providing anticipatory guidance to a woman in her second trimester regarding signs/symptoms that she might experience in the coming weeks. Which of the following comments by the client indicates that further teaching is needed? 1. “During the third trimester I may experience frequent urination.” 2. “During the third trimester I may experience heartburn.” 3. “During the third trimester I may experience back pain.” 4. “During the third trimester I may experience persistent headache.” 41 . The nurse is analyzing the three-generation pedigree below. In which generation is the proband? 1. I. 2. II. 3. III. 4. There is not enough information to answer this question. 42. A woman is seeking genetic counseling during her pregnancy. She has a strong family history of diabetes mellitus. She wishes to have an amniocentesis to determine whether or not she is carrying a baby who will “develop diabetes.” Which of the following replies by the nurse would be most appropriate for the nurse to make? 1. “Doctors don’t do amniocenteses to detect diabetes.” 2. “Diabetes cannot be diagnosed by looking at the genes.” 3. “Although diabetes does have a genetic component, diet and exercise also determine whether or not someone is diabetic.” 4. “Even if the baby doesn’t carry the genes for diabetes, the baby could still develop the disease.” 43. A 25-year-old woman, G0 P0000, enters the infertility clinic stating that she has just learned she is positive for the BRCA1 and the BRCA2 genes. She asks the nurse what her options are for getting pregnant and breastfeeding her baby. The nurse should base her reply on which of the following? 1. Fertility of women who carry the BRCA1 and BRCA2 genes is similar to that of unaffected women. 2. Women with these genes should be advised not to have children because the children could inherit the defective genes. 3. Women with these genes should have their ovaries removed as soon as possible to prevent ovarian cancer. 4. Lactation is contraindicated for women who carry the BRCA1 and BRCA 2 genes. 44. A woman asks a nurse about presymptomatic genetic testing for Huntington’s disease. The nurse should base her response on which of the following? 1. There is no genetic marker for Huntington’s disease. 2. Presymptomatic testing cannot predict whether or not the gene will be expressed. 3. If the woman is positive for the gene for Huntington’s, she will develop the disease later in life. 4. If the woman is negative for the gene, her children should be tested to see whether or not they are carriers. 45. A woman, who has undergone amniocentesis, has been notified that her baby is XX with a 14/21 Robertsonian chromosomal translocation. The nurse helps the woman to understand which of the following? 1. The baby will have a number of serious genetic defects. 2. It is likely that the baby will be unable to have children when she grows up. 3. Chromosomal translocations are common and rarely problematic. 4. An abortion will probably be the best decision under the circumstances. 46. A woman who has had multiple miscarriages is advised to go through genetic testing. The client asks the nurse the rationale for this recommendation. The nurse should base his or her response on which of the following? 1. The woman’s pedigree may exhibit a mitochondrial inheritance pattern. 2. The majority of miscarriages are caused by genetic defects. 3. A woman’s chromosomal pattern determines her fertility. 4. There is a genetic marker that detects the presence of an incompetent cervix. 47. A nurse has just taken a family history on a 10-week gravid client and created the family pedigree shown below. Which of the following actions should the nurse take at this time? 1. Advise the woman that she should have an amniocentesis. 2. Encourage the doctor to send her for genetic counseling. 3. Ask the woman if she knew any of the relatives who died. 4. Inform the woman that her pedigree appears normal. 48. A woman is informed that she is a carrier for Tay Sachs disease, an autosomal recessive illness. What is her phenotype? 1. She has one recessive gene and one normal gene. 2. She has two recessive genes. 3. She exhibits all symptoms of the disease. 4. She exhibits no symptoms of the disease. 49. During a genetic evaluation, it is discovered that the woman is carrying one autosomal dominant gene for a serious late adult-onset disease while her partner’s history is unremarkable. Based on this information, which of the following family members should be considered high risk and in need of genetic counseling? Select all that apply. 1. The woman’s fetus. 2. The woman’s sisters. 3. The woman’s brothers. 4. The woman’s parents. 5. The woman’s partner. 50. Which statement by a gravid client who is a carrier for muscular dystrophy, an X-linked recessive disease, indicates that she understands the implications of her status? 1. “If I have a girl, she will be healthy.” 2. “None of my children will be at risk of the disease.” 3. “If I have a boy, he will be a carrier.” 4. “I am going to abort my fetus because it will be affected.” 51. A woman, G1 P0000, 40 weeks’ gestation, entered the labor suite stating that she is in labor. Upon examination it is noted that the woman is 2 cm dilated, 30% effaced, contracting every 12 min 30 sec. Fetal heart rate is in the 140s with good variability and spontaneous accelerations. What should the nurse conclude when reporting the findings to the primary health care practitioner? 1. The woman is high risk and should be placed on tocolytics. 2. The woman is in early labor and could be sent home. 3. The woman is high risk and could be induced. 4. The woman is in active labor and should be admitted to the unit. 52. A nurse concludes that a woman is in the latent phase of labor. Which of the following signs/symptoms would lead a nurse to that conclusion? 1. The woman talks and laughs during contractions. 2. The woman complains about severe back labor. 3. The woman performs effleurage during a contraction. 4. The woman asks to go to the bathroom to defecate. 53. A G1P0, 8 cm dilated, is to receive pain medication. The health care practitioner has decided to order an opiate analgesic with an analgesic-potentiating medication. Which of the following medications would the nurse expect to be ordered as the analgesic-potentiating medication? 1. Seconal (secobarbital ). 2. Phenergan (promethazine ). 3. Benadryl (diphenhydramine ). 4. Tylenol (acetaminophen ). 54. On vaginal examination, it is noted that a woman with a well-functioning epidural is in the second stage of labor. The station is 2 and the baseline fetal heart rate is 130 with no decelerations. Which of the following nursing actions is appropriate at this time? 1. Coach the woman to hold her breath while pushing 3 to 4 times with each contraction. 2. Administer oxygen via face mask at 8 to 10 liters per minute. 3. Delay pushing until the baby descends further and the mother has a strong urge to push. 4. Place the woman on her side and assess her oxygen saturation. 55. A nurse is assisting an anesthesiologist who is inserting an epidural catheter. Which of the following positions should the nurse assist the woman into? 1. Fetal position. 2. Lithotomy position. 3. Trendelenburg position. 4. Lateral recumbent position. 56. Which of the following actions would the nurse expect to perform immediately before a woman is to have regional anesthesia? Select all that apply. 1. Assess fetal heart rate. 2. Infuse 1000 cc of Ringer’s lactate. 3. Place woman in Trendelenburg position. 4. Monitor blood pressure every 5 minutes for 15 minutes. 5. Have woman empty her bladder. 57. Immediately following administration of an epidural anesthesia, the nurse must monitor the mother for which of the following? 1. Paresthesias in her feet and legs. 2. Drop in blood pressure. 3. Increase in central venous pressure. 4. Fetal heart accelerations. 58. A client, G2P1001, 5 cm dilated and 40% effaced, has just received an epidural. Which of the following actions is important for the nurse to make at this time? 1. Assess the woman’s temperature. 2. Place a wedge under the woman’s side. 3. Place a blanket roll under the woman’s feet. 4. Assess the woman’s pedal pulses. 59. The practitioner is performing a fetal scalp stimulation test. Which of the following fetal responses would the nurse expect to see? 1. Spontaneous fetal movement. 2. Fetal heart acceleration. 3. Increase in fetal heart variability. 4. Resolution of late decelerations. 60. The nurse is interpreting the results of a fetal blood sampling test. Which of the following reports would the nurse expect to see? 1. Oxygen saturation of 99%. 2. Hgb of 11 gm/dL. 3. Serum glucose of 140 mg/dL. 4. pH of 7.30. 61. Which of the following actions is appropriate for the nurse to perform when caring for a Chinese-speaking woman in active labor? 1. Apply heat to the woman’s back. 2. Inquire regarding the woman’s pain level. 3. Make sure that the woman’s head is covered. 4. Accept the woman’s loud verbalizations. 62 . A nurse is caring for women from four different countries. Which of the women is most likely to request that her head be kept covered throughout her hospitalization? 1. Arabic woman. 2. Chinese woman. 3. Russian woman. 4. Greek woman. 63. The nurse is caring for an Orthodox Jewish woman in labor. It would be appropriate for the nurse to include which of the following in the plan of care? 1. Encourage the father to hold his partner’s hand during labor. 2. Ask the woman if she would like to speak with her priest. 3. Provide the woman with a long-sleeved hospital gown. 4. Place an order for the woman’s postpartum vegetarian diet. 64. Which of the following nonpharmacological interventions recommended by nurse midwives may help a client at full term to go into labor? Select all that apply. 1. Engage in sexual intercourse. 2. Ingest evening primrose oil. 3. Perform yoga exercises. 4. Eat raw spinach. 5. Massage the breast and nipples. 65 . The nurse is providing acupressure to provide pain relief to a woman in labor. Where is the best location for the acupressure to be applied? 1. On the malleolus of the wrist. 2. Above the patella of the knee. 3. On the medial aspect of the lower leg. 4. Below the medial epicondyle of the elbow. 66. The nurse is assessing fetal position for a 32-year-old client in her eighth month of pregnancy. As shown below, the fetal position can be described as which of the following? ■ 1. Left occipital transverse. ■ 2. Left occipital anterior. ■ 3. Right occipital transverse. ■ 4. Right occipital anterior. 67. Which of the following statements by the nurse would be most appropriate when responding to a primigravid client who asks, “What should I do about this brown discoloration across my nose and cheeks?” ■ 1. “This usually disappears after delivery.” ■ 2. “It is a sign of skin melanoma.” ■ 3. “The discoloration is due to dilated capillaries.” ■ 4. “It will fade if you use a prescribed cream.” 68. A 36-year-old primigravid client at 22 weeks’ gestation without any complications to date is being seen in the clinic for a routine visit. The nurse should assess the client’s fundal height to: ■ 1. Determine the level of uterine activity. ■ 2. Identify the need for increased weight gain. ■ 3. Assess the location of the placenta. ■ 4. Estimate the fetal gestational age. 69. After the nurse reviews the physician’s explanation of amniocentesis with a multigravid client, which of the following indicates that the client understands a serious risk of the procedure.? ■ 1. Premature rupture of the membranes. ■ 2. Possible premature labor. ■ 3. Fetal limb malformations. ■ 4. Fetal organ malformations. 70. A primigravid client at 28 weeks’ gestation tells the nurse that she and her husband wish to drive to visit relatives who live several hundred miles away. Which of the following recommendations by the nurse would be best? ■ 1. “Try to avoid traveling anywhere in the car during your third trimester.” ■ 2. “Limit the time you spend in the car to a maximum of 4 to 5 hours.” ■ 3. “Taking the trip is okay if you stop every 1 to 2 hours and walk.” ■ 4. “Avoid wearing your seat belt in the car to prevent injury to the fetus.” 71. Which of the following recommendations would be most helpful to suggest to a primigravid client at 37 weeks’ gestation who is complaining of leg cramps? ■ 1. Change positions frequently throughout the day. ■ 2. Alternately flex and extend the legs. ■ 3. Straighten the knee and flex the toes toward the chin. ■ 4. Lie prone in bed with the legs elevated. 72. Which of the following recommendations would be the most appropriate preventive measure to suggest to a primigravid client at 30 weeks’ gestation who is experiencing occasional heartburn? ■ 1. Eat smaller and more frequent meals during the day. ■ 2. Take a pinch of baking soda with water before meals. ■ 3. Decrease fluid intake to four glasses daily. ■ 4. Drink several cups of regular tea throughout the day. 73. When performing Leopold’s maneuvers on a primigravid client at 22 weeks’ gestation, the nurse performs the first maneuver to do which of the following? ■ 1. Locate the fetal back and spine. ■ 2. Determine what is in the fundus. ■ 3. Determine whether the fetal head is at the pelvic inlet. ■ 4. Identify the degree of fetal descent and flexion. 74. A primigravid adolescent client at approximately 15 weeks’ gestation who is visiting the prenatal clinic with her mother is to undergo alphafetoprotein (AFP) screening. When developing the teaching plan for this client, the nurse should include which of the following? ■ 1. Ultrasonography usually accompanies AFP testing. ■ 2. Results are usually very accurate until 20 weeks’ gestation. ■ 3. A clean-catch midstream urine specimen is needed. ■ 4. Increased levels of AFP are associated with neural tube defects. 75. Which of the following statements best identifies the rationale for why the nurse reinforces the need for continued prenatal care throughout the pregnancy with an adolescent primigravid client? ■ 1. Pregnant adolescents are at high risk for pregnancy-induced hypertension. ■ 2. Gestational diabetes during pregnancy commonly develops in adolescents. ■ 3. Adolescents need additional instruction related to common discomforts. ■ 4. The father of the baby is rarely involved in the pregnancy. Antepartal Care 39 76. Which of the following would be included in the teaching plan about pregnancy-related breast changes for a primigravid client? ■ 1. Growth of the milk ducts is greatest during the first 8 weeks of gestation. ■ 2. Enlargement of the breasts indicates adequate levels of progesterone. ■ 3. Colostrum is usually secreted by about the 16th week of gestation. ■ 4. Darkening of the areola occurs during the last month of pregnancy. 77. A primigravid client at 32 weeks’ gestation is enrolled in a breast-feeding class. Which of the following statements indicate that the client understands the breast-feeding education? Select all that apply. ■ 1. “My milk supply will be adequate since I have increased a whole bra size during pregnancy.” ■ 2. “I can hold my baby several different ways during feedings.” ■ 3. “If my infant latches on properly, I won’t develop mastitis.” ■ 4. “If I breast-feed, my uterus will return to prepregnancy size more quickly.” ■ 5. “Breast milk can be expressed and stored at room temperature since it is natural.” ■ 6. “I need to feed my baby when I see feeding cues and not wait until she is crying.” 78. When planning a class for primigravid clients about the common discomforts of pregnancy, which of the following physiologic changes of pregnancy should the nurse include in the teaching plan? ■ 1. The temperature decreases slightly early in pregnancy. ■ 2. Cardiac output increases by 25% to 50% during pregnancy. ■ 3. The circulating fibrinogen level decreases as much as 50% during pregnancy. ■ 4. The anterior pituitary gland secretes oxytocin late in pregnancy. 79. When teaching a primigravid client at 24 weeks’ gestation about the diagnostic tests to determine fetal wellbeing, which of the following should the nurse include? ■ 1. A fetal biophysical profile involves assessments of breathing movements, body movements, tone, amniotic fluid volume, and fetal heart rate reactivity. ■ 2. A reactive nonstress test is an ominous sign and requires further evaluation with fetal echocardiography. ■ 3. Contraction stress testing, performed on most pregnant women, can be initiated as early as 16 weeks’ gestation. ■ 4. Percutaneous umbilical blood sampling uses a needle inserted through the vagina to obtain a sample. 80. When teaching a primigravid client how to do Kegel exercises, the nurse explains that the expected outcome of these exercises is to: ■ 1. Prevent vulvar edema. ■ 2. Alleviate lower back discomfort. ■ 3. Strengthen the perineal muscles. ■ 4. Strengthen the abdominal muscles. 81. During a routine clinic visit, a 25-year-old multigravid client who initiated prenatal care at 10 weeks’ gestation and is now in her third trimester states, “I’ve been having strange dreams about the baby. Last week I dreamed he was covered with hair.” The nurse should tell the mother: ■ 1. “Dreams like the ones that you describe are very unusual. Please tell me more about them.” ■ 2. “Commonly when a mother has these dreams, she is trying to cope with becoming a parent.” ■ 3. “Dreams about the baby late in pregnancy usually mean that labor is about to begin soon.” ■ 4. “It’s not uncommon to have dreams about the baby, particularly in the third trimester.” 82. A primigravid client at 36 weeks’ gestation tells the nurse that she has been experiencing insomnia for the past 2 weeks. Which of the following suggestions would be most helpful? ■ 1. Practice relaxation techniques before bedtime. ■ 2. Drink a cup of hot chocolate before bedtime. ■ 3. Drink a small glass of wine with dinner. ■ 4. Exercise for 30 minutes just before bedtime. 83. A woman with postpartum depression has been prescribed Zoloft (sertraline) 50 mg daily. Which of the following should the client be taught about the medication? 1. Chamomile tea can potentiate the effect of the drug. 2. Therapeutic effect may be delayed a week or more. 3. The medication should only be taken whole. 4. A weight gain of up to ten pounds is commonly seen. 84 . A breastfeeding woman has been diagnosed with retained placental fragments 4 days postdelivery. Which of the following breastfeeding complications would the nurse expect to see? 1. Engorgement. 2. Mastitis. 3. Blocked milk duct. 4. Low milk supply. 85. The nurse assesses a 2-day postpartum, breastfeeding client. The nurse notes blood on the mother’s breast pad and a crack on the mother’s nipple. Which of the following actions should the nurse perform at this time? 1. Advise the woman to wash the area with soap to prevent mastitis. 2. Provide the woman with a tube of topical lanolin. 3. Remind the woman that the baby can become sick if he drinks the blood. 4. Get the woman an order for a topical anesthetic. 86 . A client just delivered the placenta pictured below. The nurse will document that the woman delivered which of following placentas? 1. Circumvallate placenta. 2. Succenturiate placenta. 3. Placenta with velamentous insertion. 4. Battledore placenta. 87. The nurse administers RhoGAM to a postpartum client. Which of the following is the goal of the medication? 1. Inhibit the mother’s active immune response. 2. Aggressively destroy the Rh antibodies produced by the mother. 3. Prevent fetal cells from migrating throughout the mother’s circulation. 4. Change the maternal blood type to Rh positive. 88. Which of the following comments suggest that a client, whose baby was born with a congenital defect, is in the bargaining phase of grief? 1. “I hate myself. I caused my baby to be sick.” 2. “I’ll take him to a specialist. Then he will get better.” 3. “I can’t seem to stop crying.” 4. “This can’t be happening.” 89. A client is 1-day post–cesarean section with spinal anesthesia. Even though the nurse advised against it, the client has had the head of her bed in high Fowler’s position since delivery. Which of the following complications would the nurse expect to see in relation to the client’s action? 1. Postpartum hemorrhage. 2. Severe postural headache. 3. Pruritic skin rash. 4. Paralytic ileus. 90. A client is receiving IV heparin for deep vein thrombosis. Which of the following medications should the nurse obtain from the pharmacy to have on hand in case of heparin overdose? 1. Vitamin K. 2. Protamine. 3. Vitamin E. 4. Mannitol. 91. A client, who had no prenatal care, delivers a 10 lb 10 oz–baby boy whose serum glucose result 1 hour after delivery was 20 mg/dL. Based on these data, which of the following tests should the mother have at her 6-week postpartum checkup? 1. Glucose tolerance test. 2. Indirect Coombs’ test. 3. Blood urea nitrogen (BUN ). 4. Complete blood count (CBC ). 92. A client is to receive a blood transfusion after significant blood loss following a placenta previa delivery. Which of the following actions by the nurse is critical prior to starting the infusion? Select all that apply. 1. Look up the client’s blood type in the chart. 2. Check the client’s arm bracelet. 3. Check the blood type on the infusion bag. 4. Obtain an infusion bag of dextrose and water. 5. Document the time the infusion begins. 93. A nurse is caring for the following four laboring patients. Which client should the nurse be prepared to monitor closely for signs of postpartum hemorrhage (PPH)? 1. G1P0000, delivery at 29 weeks’ gestation. 2. G2P1001, prolonged first stage of labor. 3. G2P0010, delivery by cesarean section. 4. G3P0200, delivery of 2200-gram neonate. 94. A client is 3-days post–cesarean delivery for eclampsia. The client is receiving hydralazine (Apresoline) 10 mg 4 times a day by mouth. Which of the following findings would indicate that the medication is effective? 1. The client has had no seizures since delivery. 2. The client’s blood pressure has dropped from 160/120 to 130/90. 3. The client’s postoperative weight has dropped from 154 to 144 lb. 4. The client states that her headache is gone. 95. A home care nurse is visiting a breastfeeding client who is 2 weeks postdelivery of a 7-lb baby girl over a midline episiotomy. Which of the following findings should take priority? 1. Lochia is serosa. 2. Client cries throughout the visit. 3. Nipples are cracked. 4. Client yells at the baby for crying. 96. A client who is post–cesarean section for severe preeclampsia is receiving magnesium sulfate via IV pump and morphine sulfate via patient-controlled anesthesia (PCA) pump. The nurse enters the room on rounds and notes that the client is not breathing. Which of the following actions should the nurse perform first? 1. Give two breaths. 2. Discontinue medications. 3. Call a code. 4. Check carotid pulse. 97 . A breastfeeding client is being seen in the emergency department with a hard, red, warm nodule in the upper outer quadrant of her left breast. Her vital signs are: T 104.6ºF, P 100, R 20, and BP 110/60. She has a recent history of mastitis and is crying in pain. Which of the following nursing diagnoses is highest priority? 1. Ineffective breastfeeding. 2. Infection. 3. Ineffective individual coping. 4. Pain. 98. A client is receiving an IV heparin drip at 16 mL/hr via an infusion pump for a diagnosis of deep vein thrombosis. The label on the liter bag of D5W indicates 50,000 units of heparin have been added. How many units of heparin is the client receiving per hour? __800____ units per hour. 99. A nurse massages the atonic uterus of a woman who delivered 1 hour earlier. The nurse identifies the nursing diagnosis: Risk for injury related to uterine atony. Which of the following outcomes indicates that the client’s condition has improved? 1. Moderate lochia flow. 2. Decreased pain level. 3. Stable blood pressure. 4. Fundus above the umbilicus. 100 . Intermittent positive pressure boots have been ordered for a client who had an emergency cesarean section. Which of the following is the rationale for that order? 1. Postpartum clients are high risk for thrombus formation. 2. Post–cesarean clients are high risk for fluid volume deficit. 3. Postpartum clients are high risk for varicose vein development. 4. Post–cesarean clients are high risk for poor milk ejection reflex. 2020/2021 HESI OB/MATERNITY V 2 1. The nurse is caring for a client who had an emergency cesarean section, with her husband in attendance the day before. The baby’s Apgar was 9/9. The woman and her partner had attended childbirth education classes and had anticipated having a water birth with family present. Which of the following comments by the nurse is appropriate? a) “Sometimes babies just don’t deliver the way we expect them to.” b) “With all of your preparations, it must have been disappointing for you to have had a cesarean.” c) “I know you had to have surgery, but you are very lucky that your baby was born healthy.” d) “At least your husband was able to be with you when the baby was born.” 2. A nurse has brought a 2-hour-old baby to a mother from the nursery. The nurse is going to assist the mother with the first breastfeeding experience. Which of the following actions should the nurse perform first? a) Compare mother’s and baby’s identification bracelets. b) Help the mother into a comfortable position. c) Teach the mother about a proper breast latch. d) Tickle the baby’s lips with the mother’s nipple. 3. The obstetrician has ordered that a post-op cesarean section client’s patient-controlled analgesia (PCA) be discontinued. Which of the following actions by the nurse is appropriate? a) Discard the remaining medicatio b) Recommend waiting until her pain level is zero to discontinue n in the presence of another nurse. the medicine. c) Discontinue the medication only after the analgesia is completely absorbed. d) Return the unused portion of medication to the narcotics cabinet. 4. A client is receiving an epidural infusion of a narcotic for pain relief after a cesarean section. The nurse would report to the anesthesiologist if which of the following were assessed? a) Respiratory rate 8 rpm. b) Complaint of thirst. c) Urinary output of 250 cc/hr. d) Numbness of feet and ankles. 5. A client, 2 days postoperative from a cesarean section, complains to the nurse that she has yet to have a bowel movement since the surgery. Which of the following responses by the nurse would be appropriate at this time? a) “That is very concerning. I will request that your physician order an enema for you.” b) “Two days is not that bad. Some patients go four days or longer without a movement.” c) “You have been taking antibiotics through your intravenous. That is probably why you are constipated.” d) “Fluids and exercise often help to combat constipation. Take a stroll around the unit and drink lots of fluid.” 6. A post–cesarean section, breastfeeding client, whose subjective pain level is 2/5, requests her as needed (prn) narcotic analgesics every 3 hours. She states, “I have decided to make sure that I feel as little pain from this experience as possible.” Which of the following should the nurse conclude in relation to this woman’s behavior? a) The woman needs a stronger narcotic order. b) The woman is high risk for severe constipation. c) The woman’s breast milk volume may drop while taking the medicine. d) The woman’s newborn may become addicted to the medication. 7. A nurse is assessing a 1-day postpartum woman who had her baby by cesarean section. Which of the following should the nurse report to the surgeon? a) Fundus at the umbilicus. b) Nodular breasts. c) Pulse rate 60 bpm. d) Pad saturation every 30 minutes. 8. The nurse is assessing the midline episiotomy on a postpartum client. Which of the following findings should the nurse expect to see? a) Moderate serosanguinous drainage. b) Well-approximated edges. c) Ecchymotic area distal to the episiotomy. d) An area of redness adjacent to the incision. 9. A client, G1P1, who had an epidural, has just delivered a daughter, Apgar 9/9, over a mediolateral episiotomy. The physician used low forceps. While recovering, the client states, “I’m a failure. I couldn’t stand the pain and couldn’t even push my baby out by myself!” Which of the following is the best response for the nurse to make? a) “You’ll feel better later after you have had a chance to rest and to eat.” b) “Don’t say that. There are many women who would be ecstatic to have that baby.” c) “I am sure that you will have another baby. I bet that it will be a natural delivery.” d) “To have things work out differently than you had planned is disappointing.” 10. The nurse is developing a standard care plan for postpartum clients who have had midline episiotomies. Which of the following interventions should be included in the plan? a) Assist with stitch removal on third postpartum day. b) Administer analgesics every four hours per doctor orders. c) Teach client to contract her buttocks before sitting. d) Irrigate incision twice daily with antibiotic solution. 11. A client, G1P1001, 1-hour postpartum from a spontaneous vaginal delivery with local anesthesia, states that she needs to urinate. Which of the following actions by the nurse is appropriate at this time? a) Provide the woman with a bedpan. b) Advise the woman that the feeling is likely related to the trauma of delivery. c) Remind the woman that she still has a catheter in place from the delivery. d) Assist the woman to the bathroom. 12. A nurse is assessing the fundus of a client during the immediate postpartum period. Which of the following actions indicates that the nurse is performing the skill correctly? a) The nurse measures the fundal height using a paper centimeter tape. b) The nurse stabilizes the base of the uterus with his or her dependent hand. c) The nurse palpates the fundus with the tips of his or her fingers. d) The nurse precedes the assessment with a sterile vaginal exam. 13. A 1-day postpartum woman states, “I think I have a urinary tract infection. I have to go to the bathroom all the time.” Which of the following actions should the nurse take? a) Assure the woman that frequent urination is normal after delivery. 14. The nurse is assessing the laboratory report on a 2-day postpartum G1P1001. The woman had a normal postpartum Which of the following results should the nurse report to the primary health care provider? b) Obtain an order for a urine culture. c) Assess the urine for cloudiness. d) Ask the woman if she is prone to urinary tract infections. a. White blood cells—12,500 cells/mm3. b. Red blood cells—4,500,000 cells/mm3. c. Hematocrit—26%. d. Hemoglobin—11 g/dL 15. A bottle-feeding woman, 11⁄2 weeks postpartum from a vaginal delivery, calls the obstetric office to state that she has saturated 2 pads in the past 1 hour. Which of the following responses by the nurse is appropriate? a) “You must be doing too much. Lie down for a few hours and call back if the bleeding has not subsided.” b) “You are probably getting your period back. You will bleed like that for a day or two and then it will lighten up.” c) “It is not unusual to bleed heavily every once in a while, after a baby is born. It should subside shortly.” d) “It is important for you to be examined by the doctor today. Let me check to see when you can come in.” 16. A client, 2 days postpartum from a spontaneous vaginal delivery, asks the nurse about postpartum exercises. Which of the following responses by the nurse is appropriate? a) “You must wait to begin to perform exercises until after your six-week postpartum checkup.” b) “You may begin Kegel exercises today, but do not do any other exercises until the doctor tells you that it is safe.” c) “By next week you will be able to return to the exercise schedule you had during your prepregnancy.” d) “You can do some Kegel exercises today and then slowly increase your toning exercises over the next few weeks.” 17. The nurse is examining a 2-day postpartum client whose fundus is 2 cm below the umbilicus and whose bright red lochia saturates about 4 inches of a pad in 1 hour. What should the nurse document in the nursing record? a) Abnormal involution, lochia rubra heavy. b) Abnormal involution, lochia serosa scant. c) Normal involution, lochia rubra moderate. d) Normal involution, lochia serosa heavy. 18. The nurse palpates a distended bladder on a woman who delivered vaginally 2 hours earlier. The woman refuses to go to the bathroom, “I really don’t need to go.” Which of the following responses by the nurse is appropriate? a) “Okay. I must be palpating your uterus.” b) “I understand but I still would like you to try to urinate.” c) “You still must be numb from the local anesthesia.” d) “That is a problem. I will have to catheterize you.” 19. A client, G1P0101, postpartum 1 day, is assessed. The nurse notes that the client’s lochia rubra is moderate and her fundus is boggy 2 cm above the umbilicus and deviated to the right. Which of the following actions should the nurse take first? a) Notify the woman’s primary health care provider. b) Massage the woman’s fundus. c) Escort the woman to the bathroom to urinate. d) Check the quantity of lochia on the peripad. 20. The nurse has taught a new admission to the postpartum unit about pericare. Which of the following indicates that the client understands the procedure? a) The woman performs the procedure twice a day. b) The woman sits in warm tap water for ten minutes. c) The woman sprays her perineum from front to back. d) The woman mixes tap water with hydrogen peroxide. 21. The nurse informs a postpartum woman that ibuprofen (Advil) is especially effective for afterbirth pains. What is the scientific rationale for this? a) Ibuprofen is taken every two hours. b) Ibuprofen has an antiprostaglandin effect. c) Ibuprofen is given via the parenteral route. d) Ibuprofen is administered in high doses. 22. It is 4 p.m. A client, G1P0000, 3 cm dilated, asks the nurse when the dinner tray will be served. The nurse replies a) “Laboring clients are never allowed to eat.” b) “Believe me, you will not want to eat by the time it is the dinner hour. Most women throw up, you know.” c) “The dinner tray should arrive in an hour or two.” d) “A heavy meal is discouraged. I can get clear fluids for you whenever you would like them, though.” 23. A physician has ordered an iron supplement for a postpartum woman. The nurse strongly suggests that the woman take the medicine with which of the following drinks? a) Skim milk. b) Ginger ale. c) Orange juice. d) Chamomile tea. 24.On admission to the labor and delivery unit, a client’s hemoglobin (Hgb) was assessed at 11.0 gm/dL, and her hematocrit (Hct) at 33%. Which of the following values would the nurse expect to see 2 days after a normal spontaneous vaginal delivery? a) Hgb 12.5 gm/dL; Hct 37%. b) Hgb 11.0 gm/dL; Hct 33%. c) Hgb 10.5 gm/dL; Hct 31%. d) Hgb 9.0 gm/dL; Hct 27%. 25. During a postpartum assessment, it is noted that a G1P1001 woman, who delivered vaginally over an intact perineum, has a cluster of hemorrhoids. Which of the following would be appropriate for the nurse to include in the woman’s health teaching? Select all that apply. a) The client should use a sitz bath daily as a relief measure. b) The client should digitally replace external hemorrhoids into her rectum. c) The client should breastfeed frequently to stimulate oxytocin to reduce the size of the hemorrhoids. d) The client should be advised that the hemorrhoids will increase in size and quantity with subsequent pregnancies. e) The client should apply topical anesthetic as a relief measure. a) b) 26. Which of the following is the priority nursing action during the immediate postpartum period? Palpate fundus. Check pain level. c) Perform pericare. d) Assess breasts. 27. Immediately after delivery, a woman is shaking uncontrollably. Which of the following nursing actions is most appropriate? a. Provide the woman with warm blankets. b. Put the woman in Trendelenburg position. c. d. Notify the primary health care provider. Increase the intravenous infusion. 28. One nursing diagnosis that a nurse has identified for a postpartum client is: Risk for intrauterine infection r/t vaginal delivery. During the postpartum period, which of the following goals should the nurse include in the care plan in relation to this diagnosis? Select all that apply. a) The client will drink sufficient quantities of fluid. b) The client will have a stable white blood cell count. c) The client will have a normal temperature. d) The client will have normal-smelling vaginal discharge. e) The client will take two or three sitz baths each day. 29. Which of the following nursing interventions would be appropriate for the nurse to perform in order to achieve the client care goal: The client will not develop postpartum thrombophlebitis? a) Encourage early ambulation. b) Promote oral fluid intake. c) d) Massage the legs of the client twice daily. Provide the client with high fiber foods. 30. The nurse is developing a plan of care for the postpartum client during the “taking in” phase. Which of the following should the nurse include in the plan? a) Teach baby care skills like diapering. b) Discuss the labor and birth with the mother. c) Discuss contraceptive choices with the mother. d) Teach breastfeeding skills like pumping. 31. The nurse is developing a plan of care for the postpartum client during the “taking hold” phase. Which of the following should the nurse include in the plan? a) b) c) Provide the client with a nutritious meal. Encourage the client to take a nap. Assist the client with activities of daily living. d) Assure the client that she is an excellent mother. 32. Which finding would the nurse view as normal when evaluating the laboratory reports of a 34-week gestation client? a) Anemia. b) Thrombocytopenia. c) d) Polycythemia. Hyperbilirubinemia. 33. The nurse asks a 31-week gestation client to lie on the examining table during a prenatal examination. In which of the following positions should the client be placed? a) b) c) Orthopneic. Lateral-recumbent. Sims’. d) Semi-Fowler’s. 34. A third-trimester client is being seen for routine prenatal care. Which of the following assessments will the nurse perform during the visit? Select all that apply. a) Blood glucose. b) Blood pressure. c) Fetal heart rate. d) Urine protein. e) Pelvic ultrasound. 35. A nurse is working in the prenatal clinic. Which of the following findings seen in third-trimester pregnant women would the nurse consider to be within normal limits? Select all that apply. a) Leg cramps. b) Varicose veins. c) Hemorrhoids. d) Fainting spells. e) Lordosis. 36. A 36-week gestation gravid lies flat on her back. Which of the following maternal signs/symptoms would the nurse expect to observe? a) Hypertension. b) Dizziness. c) Rales. d) Chloasma. 37. The nurse is interviewing a 38-week gestation Muslim woman. Which of the following questions would be inappropriate for the nurse to ask? a) “Do you plan to breastfeed your baby?” b) “What do you plan to name the baby?” c) “Which pediatrician do you plan to use?” d) “How do you feel about having an episiotomy?” 38. A woman is 36-weeks’ gestation. Which of the following tests will be done during her prenatal visit? a) b) Glucose challenge test. Amniotic fluid volume assessment. c) Vaginal and rectal cultures. d) Karyotype analysis. 39. A 34-week gestation woman calls the obstetric office stating, “Since last night I have had three nosebleeds.” Which of the following responses by the nurse is appropriate? a) “You should see the doctor to make sure you are not becoming severely anemic.” b) “Do you have a temperature?” c) “One of the hormones of pregnancy makes the nasal passages prone to bleeds.” “Do you use any inhaled drugs?” d) 40. The nurse asks a woman about how the woman’s husband is dealing with the pregnancy. The nurse concludes that counseling is needed when the woman makes which of the following statements? a) “My husband is ready for the pregnancy to end so that we can have sex again.” “My husband has gained quite a bit of weight during this b) pregnancy.” c) d) “My husband seems more worried about our finances now than before the pregnancy.” “My husband plays his favorite music for my belly so the baby will learn to like it.” 41. A man has inherited the gene for familial adenomatous polyposis (FAP), an autosomal dominant disease. He and his wife wish to have a baby. Which of the following would provide the couple with the highest probability of conceiving a healthy child? a) Amniocentesis. b) Chorionic villus sampling. c) Pre-implantation genetic diagnosis. d) Gamete intrafallopian transfer. 42. A woman asks the obstetrician’s nurse about cord blood banking. Which of the following responses by the nurse would be best? a) “I think it would be best to ask the doctor to tell you about that.” b) “The cord blood is frozen in case your baby develops a serious illness in the future.” c) “The doctors could transfuse anyone who gets into a bad accident with the blood.” d) “Cord blood banking is very expensive and the blood is rarely ever used.” 43. A 3-month-old baby has been diagnosed with cystic fibrosis. The mother states, “How could this happen? I had an amniocentesis during my pregnancy and everything was supposed to be normal!” What does the nurse understand about this situation? a) Cystic fibrosis cannot be diagnosed by amniocentesis. b) The baby may have an uncommon genetic variant of the disease. c) It is possible that the laboratory technician made an error. d) Instead of obtaining fetal cells the doctor probably harvested maternal cells. 44. The nurse discusses the results of a 3-generation pedigree with the proband who has breast cancer. Which of the following information must the nurse consider? a) The proband should have a complete genetic analysis done. b) The proband is the first member of the family to be diagnosed. c) The proband’s first degree rel atives should be included in the discussion. d) The proband’s sisters will likely develop breast cancer during their lives. 45. The nurse is analyzing the pedigree shown below. How should the nurse interpret the genotype of the individual in location II-4? a) b) c) d) Affected male. Unaffected female. Stillborn child. Child of unknown sex. 46. The nurse is analyzing the pedigree shown below. How should the nurse interpret the genotype of the individuals in locations IV-9 and IV-10? a) b) c) d) Fraternal twins. Unaffected couple. Proband and sister. Known heterozygotes. 47. A woman who is a carrier for sickle cell anemia is advised that if her baby has two recessive genes, the penetrance of the disease is 100%, but the expressivity is variable. Which of the following explanations will clarify this communication for the mother? All babies with 2 recessive sickle cell genes will: a) b) Develop painful vaso-occlusive crises during their first year of life. Exhibit at least some signs of the disease while in the neonatal nursery. c) Show some symptoms of the disease but the severity of the symptoms will be individual. d) Be diagnosed with sickle cell trait but will be healthy and disease-free throughout their lives. 48. Analyze the pedigree below. Which of the following inheritance patterns does the pedigree depict? a) b) c) d) Autosomal recessive. Mitochondrial inheritance. X-linked recessive. Y-linked trait. 49. A client, in her third trimester, is concerned that she will not know the difference between labor contractions and normal aches and pains of pregnancy. How should the nurse respond? a) “Don’t worry. You’ll know the difference when the contractions start.” b) “The contractions may feel just like a backache, but they will come and go.” c) “Contractions are a lot worse than your pregnancy aches and pains.” d) “I understand. You don’t want to come to the hospital before you are in labor.” 50. The nurse is counseling a pregnant couple who are both carriers for phenylketonuria (PKU), an autosomal recessive disease. Which of the following comments by the nurse is appropriate? a) “I wish I could give you good news, but because this is your first pregnancy, your child will definitely have PKU.” b) “Congratulations, you must feel relieved that the odds of having a sick child are so small.” c) “There is a 2 out of 4 chance that your child will be a carrier like both of you.” d) “There is a 2 out of 4 chance that your child will have PKU.” 51. To obtain the obstetric conjugate measurement, the nurse would do which of the following? a) Add 1.5 cm to the transverse diameter. b) First measure the angle of the pubic arch. c) Subtract 1.5 to 2 cm from the diagonal conjugate. d) Measure the diameter of the pelvic inlet. 40 The Nursing Care of the Childbearing Family The Pregnant Client in Childbirth Preparation Classes 52. The nurse is developing a teaching plan for a client entering the third trimester of her pregnancy. The nurse should include which of the following in the plan? Select all that apply. a) Differentiating the fetus from the self. b) Ambivalence concerning pregnancy. c) Experimenting with mothering roles. d) Realignment of roles and tasks. e) Trying various caregiver roles. f) Concern about labor and delivery. 53. A new antenatal G 6, P 4, Ab 1 client attends her fi rst prenatal visit with her husband. The nurse is assessing this couple’s psychological response to their pregnancy. Which of the following requires the most immediate follow up? a) The couple are concerned with fi nancial changes this pregnancy causes. b) The couple expresses ambivalence about the current pregnancy. c) The father of the baby states that the pregnancy has changed the mother’s focus. d) The father of the baby is irritated that the mother is not like she was before pregnancy. 54. When preparing a t endocrine changes that normally occur during pregnancy, the nurse should include information about which of the following subjects? a) Human placental lactogen maintains the corpus luteum. b) Progesterone is responsible for hyperpigmentation and vascular skin changes. c) Estrogen relaxes smooth muscle in the respiratory tract. d) The thyroid enlarges with an increase in basal metabolic rate. 55. When developing a series of parent classes on fetal development, which of the following should the nurse include as being developed by the end of the third month (9 to 12 weeks)? a) External genitalia. b) Myelinization of nerves. c) Brown fat stores. d) Air ducts and alveoli. 56. A primigravid client attending parenthood classes tells the nurse that there is a history of twins in her family. What should the nurse tell the client? a) Monozygotic twins result from fertilization of two ova by different sperm. b) Monozygotic twins occur by chance regardless of race or heredity. c) Dizygotic twins are usually of the same sex. d) Dizygotic twins occur more often in primigravid than in multigravid clients. 57. During a 2-hour childbirth preparat