UWorld Maternity UPDATED ACTUAL
Exam Questions and CORRECT Answers
A client at 20 weeks gestation reports "running to the bathroom all the time," pain with urination,
and foul-smelling urine. Which question is most important for the nurse to ask when assessing
the client?
1. "Are you having any pain in your lower back or flank area?"
2. "Do you wipe from front to back after urinating?"
3. "Have you found that you urinate more frequently since becoming pregnant?"
4. "Have you had a urinary tract infection in the past?" - CORRECT ANSWER - 1. "Are
you having any pain in your lower back or flank area?"
Urinary tract infections (UTIs) are common during pregnancy due to physiologic renal system
changes (eg, ureter dilation, urine stasis). Most UTIs are confined to the lower urinary tract (ie,
cystitis, or bladder infection). Symptoms include urinary frequency, dysuria, urgency, foul-
smelling urine, and a sensation of bladder fullness. Diagnostic testing includes urinalysis and
urine culture. Oral antibiotics are required to appropriately treat cystitis.
If cystitis goes unreported or untreated, the infection may ascend to the kidneys and cause
pyelonephritis. During pregnancy, pyelonephritis requires IV antibiotics and hospitalization
because of the increased risk of preterm labor. Therefore, priority assessment is to rule out
indicators of pyelonephritis (eg, flank pain, fever) in clients who report UTI symptoms to ensure
appropriate diagnosis and treatment (Option 1).
(Option 2) Wiping front to back after urination may help prevent Escherichia coli (a common
UTI pathogen found in stool) from contaminating the urethra. Reviewing toileting hygiene is
important but does not help assess current symptoms.
(Option 3) Urinary frequency and nocturia are common during pregnancy. However, the nurse
should not focus on the normalcy of urinary frequency since the client has reported additional
symptoms (eg, dysuria).
(Option 4) Pregnancy predisposes clients to UTIs. Furthermore, assessing for history of UTI
does little to address the client's current symptoms.
,Educational objective: Urinary tract infections are common during pregnancy. If the client
reports signs and symptoms of cystitis, the nurse's priority is to rule out ascending infection (ie,
pyelonephritis), which would require hospitalization and IV antibiotics.
A nurse is measuring a uterine fundal height for a client who is at 36 weeks gestation in supine
position. The client suddenly reports dizziness and the nurse observes pallor and damp, cool
skin. What should the nurse do first?
1. Assess fetal heart rate and pattern
2. Assess heart and lung sounds
3. Notify the health care provider (HCP) immediately
4. Reposition the client into a lateral position - CORRECT ANSWER -4
Supine hypotensive syndrome occurs when the weight of the abdominal contents compresses the
vena cava causing decreased venous return to the heart. This results in low cardiac output
(maternal hypotension) and reflex tachycardia. Manifestations include dizziness, pallor, and cold
and clammy skin. The client should be immediately repositioned onto the right or left side until
the symptoms subside. Prevention of this condition includes using a wedge under the client's hip
while in a supine position.
(Option 1) Decreased maternal cardiac output can result in decreased placental blood flow and
fetal heart rate (FHR) abnormalities. FHR assessment also follows after the client is placed in the
right or left lateral position.
(Option 2) When supine hypotension is suspected, the client should first be placed in a lateral
position. Blood pressure and pulse are checked to confirm the diagnosis. Assessing lung and
heart sounds is not a priority.
(Option 3) The HCP is notified after placing the client in a lateral position and completing the
assessment.
Educational objective: Supine hypotensive syndrome is usually seen in the third trimester of
pregnancy when the weight of the uterine contents compresses the inferior vena cava. The
resultant maternal hypotension is best treated initially by turning the client to the right or left side
to relieve pressure on the vena cava.
, The nurse is assessing a client at 36 weeks gestation during a routine prenatal visit. Which
statement by the client should the nurse investigate first?
1. "I am not sleeping as well due to cramps in my calves at night."
2. "I have noticed less kicking movements as the baby grows bigger."
3. "Over the last few weeks, I have not been able to wear any of my shoes."
4. "Sometimes I feel short of breath after walking up a flight of stairs." - CORRECT
ANSWER -2
Fetal movement is a sign of fetal health and indicates an intact fetal central nervous system. Fetal
movement may occur numerous times per hour during the last trimester of pregnancy, although
the client may not perceive every movement. Multiple factors (eg, maternal substance abuse,
medications, fasting, fetal sleep) can affect fetal movement. However, fetal movements should
not decrease as the fetus increases in size.
Decreased fetal movement is a potential warning sign of fetal compromise (ie, impaired
oxygenation), which may precede fetal death (Option 2). The nurse prioritizes assessment of
client reports of decreased fetal movement to evaluate fetal well-being (eg, nonstress test).
(Option 1) Leg cramps commonly occur in the third trimester, especially at night, due to the
weight of the gravid uterus applying pressure to nerves affecting calf muscles. Home
interventions include stretching legs, massaging calves, and increasing fluid intake.
(Option 3) Dependent edema in the lower extremities is common in the third trimester due to
decreased venous return (gravid uterus pressure on vena cava), especially with prolonged
sitting/standing. This is not a priority over decreased fetal movement.
(Option 4) As the uterus rises in the third trimester, the diaphragm is prevented from allowing
full lung expansion, causing dyspnea, especially with exertion.
Educational objective: Fetal movement is a sign of fetal health and represents an intact fetal
central nervous system. The nurse should educate clients that fetal movements do not decrease in
the late third trimester and prioritize assessment of clients reporting decreased fetal movement.
A 14-year-old client confides to the school nurse that she is about 22 weeks pregnant and has not
had prenatal care. Which topics are most important and priorities for the nurse to discuss with the
client in anticipation of referral for prenatal care? Select all that apply.
Exam Questions and CORRECT Answers
A client at 20 weeks gestation reports "running to the bathroom all the time," pain with urination,
and foul-smelling urine. Which question is most important for the nurse to ask when assessing
the client?
1. "Are you having any pain in your lower back or flank area?"
2. "Do you wipe from front to back after urinating?"
3. "Have you found that you urinate more frequently since becoming pregnant?"
4. "Have you had a urinary tract infection in the past?" - CORRECT ANSWER - 1. "Are
you having any pain in your lower back or flank area?"
Urinary tract infections (UTIs) are common during pregnancy due to physiologic renal system
changes (eg, ureter dilation, urine stasis). Most UTIs are confined to the lower urinary tract (ie,
cystitis, or bladder infection). Symptoms include urinary frequency, dysuria, urgency, foul-
smelling urine, and a sensation of bladder fullness. Diagnostic testing includes urinalysis and
urine culture. Oral antibiotics are required to appropriately treat cystitis.
If cystitis goes unreported or untreated, the infection may ascend to the kidneys and cause
pyelonephritis. During pregnancy, pyelonephritis requires IV antibiotics and hospitalization
because of the increased risk of preterm labor. Therefore, priority assessment is to rule out
indicators of pyelonephritis (eg, flank pain, fever) in clients who report UTI symptoms to ensure
appropriate diagnosis and treatment (Option 1).
(Option 2) Wiping front to back after urination may help prevent Escherichia coli (a common
UTI pathogen found in stool) from contaminating the urethra. Reviewing toileting hygiene is
important but does not help assess current symptoms.
(Option 3) Urinary frequency and nocturia are common during pregnancy. However, the nurse
should not focus on the normalcy of urinary frequency since the client has reported additional
symptoms (eg, dysuria).
(Option 4) Pregnancy predisposes clients to UTIs. Furthermore, assessing for history of UTI
does little to address the client's current symptoms.
,Educational objective: Urinary tract infections are common during pregnancy. If the client
reports signs and symptoms of cystitis, the nurse's priority is to rule out ascending infection (ie,
pyelonephritis), which would require hospitalization and IV antibiotics.
A nurse is measuring a uterine fundal height for a client who is at 36 weeks gestation in supine
position. The client suddenly reports dizziness and the nurse observes pallor and damp, cool
skin. What should the nurse do first?
1. Assess fetal heart rate and pattern
2. Assess heart and lung sounds
3. Notify the health care provider (HCP) immediately
4. Reposition the client into a lateral position - CORRECT ANSWER -4
Supine hypotensive syndrome occurs when the weight of the abdominal contents compresses the
vena cava causing decreased venous return to the heart. This results in low cardiac output
(maternal hypotension) and reflex tachycardia. Manifestations include dizziness, pallor, and cold
and clammy skin. The client should be immediately repositioned onto the right or left side until
the symptoms subside. Prevention of this condition includes using a wedge under the client's hip
while in a supine position.
(Option 1) Decreased maternal cardiac output can result in decreased placental blood flow and
fetal heart rate (FHR) abnormalities. FHR assessment also follows after the client is placed in the
right or left lateral position.
(Option 2) When supine hypotension is suspected, the client should first be placed in a lateral
position. Blood pressure and pulse are checked to confirm the diagnosis. Assessing lung and
heart sounds is not a priority.
(Option 3) The HCP is notified after placing the client in a lateral position and completing the
assessment.
Educational objective: Supine hypotensive syndrome is usually seen in the third trimester of
pregnancy when the weight of the uterine contents compresses the inferior vena cava. The
resultant maternal hypotension is best treated initially by turning the client to the right or left side
to relieve pressure on the vena cava.
, The nurse is assessing a client at 36 weeks gestation during a routine prenatal visit. Which
statement by the client should the nurse investigate first?
1. "I am not sleeping as well due to cramps in my calves at night."
2. "I have noticed less kicking movements as the baby grows bigger."
3. "Over the last few weeks, I have not been able to wear any of my shoes."
4. "Sometimes I feel short of breath after walking up a flight of stairs." - CORRECT
ANSWER -2
Fetal movement is a sign of fetal health and indicates an intact fetal central nervous system. Fetal
movement may occur numerous times per hour during the last trimester of pregnancy, although
the client may not perceive every movement. Multiple factors (eg, maternal substance abuse,
medications, fasting, fetal sleep) can affect fetal movement. However, fetal movements should
not decrease as the fetus increases in size.
Decreased fetal movement is a potential warning sign of fetal compromise (ie, impaired
oxygenation), which may precede fetal death (Option 2). The nurse prioritizes assessment of
client reports of decreased fetal movement to evaluate fetal well-being (eg, nonstress test).
(Option 1) Leg cramps commonly occur in the third trimester, especially at night, due to the
weight of the gravid uterus applying pressure to nerves affecting calf muscles. Home
interventions include stretching legs, massaging calves, and increasing fluid intake.
(Option 3) Dependent edema in the lower extremities is common in the third trimester due to
decreased venous return (gravid uterus pressure on vena cava), especially with prolonged
sitting/standing. This is not a priority over decreased fetal movement.
(Option 4) As the uterus rises in the third trimester, the diaphragm is prevented from allowing
full lung expansion, causing dyspnea, especially with exertion.
Educational objective: Fetal movement is a sign of fetal health and represents an intact fetal
central nervous system. The nurse should educate clients that fetal movements do not decrease in
the late third trimester and prioritize assessment of clients reporting decreased fetal movement.
A 14-year-old client confides to the school nurse that she is about 22 weeks pregnant and has not
had prenatal care. Which topics are most important and priorities for the nurse to discuss with the
client in anticipation of referral for prenatal care? Select all that apply.
