NCLEX Exam: Obstetrical Nursing – Antepartum (50 9. A nurse midwife is performing an assessment of a
Items) pregnant client and is assessing the client for the
presence of ballottement. Which of the following would
1. A nursing instructor is conducting lecture and is the nurse implement to test for the presence of
reviewing the functions of the female reproductive ballottement?
system. She asks Mark to describe the follicle- 1. Auscultating for fetal heart sounds
stimulating hormone (FSH) and the luteinizing 2. Palpating the abdomen for fetal movement
hormone (LH). Mark accurately responds by stating 3. Assessing the cervix for thinning
that: 4. Initiating a gentle upward tap on the cervix
1. FSH and LH are released from the anterior pituitary gland. 10. A nurse is assisting in performing an assessment
2. FSH and LH are secreted by the corpus luteum of the ovary on a client who suspects that she is pregnant and is
3. FSH and LH are secreted by the adrenal glands checking the client for probable signs of
4. FSH and LH stimulate the formation of milk during pregnancy. Select all probable signs of pregnancy.
pregnancy. 1. Uterine enlargement
2. A nurse is describing the process of fetal circulation 2. Fetal heart rate detected by nonelectric device
to a client during a prenatal visit. The nurse accurately 3. Outline of the fetus via radiography or ultrasound
tells the client that fetal circulation consists of: 4. Chadwick’s sign
1. Two umbilical veins and one umbilical artery 5. Braxton Hicks contractions
2. Two umbilical arteries and one umbilical vein 6. Ballottement
3. Arteries carrying oxygenated blood to the fetus 11. A pregnant client calls the clinic and tells a nurse
4. Veins carrying deoxygenated blood to the fetus that she is experiencing leg cramps and is awakened
3. During a prenatal visit at 38 weeks, a nurse by the cramps at night. To provide relief from the leg
assesses the fetal heart rate. The nurse determines cramps, the nurse tells the client to:
that the fetal heart rate is normal if which of the 1. Dorsiflex the foot while extending the knee when the
following is noted? cramps occur
1. 80 BPM 2. Dorsiflex the foot while flexing the knee when the cramps
2. 100 BPM occur
3. 150 BPM 3. Plantar flex the foot while flexing the knee when the
4. 180 BPM cramps occur
4. A client arrives at a prenatal clinic for the first 4. Plantar flex the foot while extending the knee when the
prenatal assessment. The client tells a nurse that the cramps occur.
first day of her last menstrual period was September 12. A nurse is providing instructions to a client in the
19th, 2013. Using Naegele’s rule, the nurse determines first trimester of pregnancy regarding measures to
the estimated date of confinement as: assist in reducing breast tenderness. The nurse tells
1. July 26, 2013 the client to:
2. June 12, 2014 1. Avoid wearing a bra
3. June 26, 2014 2. Wash the nipples and areola area daily with soap, and
4. July 12, 2014 massage the breasts with lotion.
5. A nurse is collecting data during an admission 3. Wear tight-fitting blouses or dresses to provide support
assessment of a client who is pregnant with twins. The 4. Wash the breasts with warm water and keep them dry
client has a healthy 5-year old child that was delivered 13. A pregnant client in the last trimester has been
at 37 weeks and tells the nurse that she doesn’t have admitted to the hospital with a diagnosis of severe
any history of abortion or fetal demise. The nurse preeclampsia. A nurse monitors for complications
would document the GTPAL for this client as: associated with the diagnosis and assesses the client
1. G = 3, T = 2, P = 0, A = 0, L =1 for:
2. G = 2, T = 0, P = 1, A = 0, L =1 1. Any bleeding, such as in the gums, petechiae, and purpura.
3. G = 1, T = 1. P = 1, A = 0, L = 1 2. Enlargement of the breasts
4. G = 2, T = 0, P = 0, A = 0, L = 1 3. Periods of fetal movement followed by quiet periods
6. A nurse is performing an assessment of a primipara 4. Complaints of feeling hot when the room is cool
who is being evaluated in a clinic during her second 14. A client in the first trimester of pregnancy arrives
trimester of pregnancy. Which of the following at a health care clinic and reports that she has been
indicates an abnormal physical finding necessitating experiencing vaginal bleeding. A threatened abortion
further testing? is suspected, and the nurse instructs the client
1. Consistent increase in fundal height regarding management of care. Which statement, if
2. Fetal heart rate of 180 BPM made by the client, indicates a need for further
3. Braxton hicks contractions education?
4. Quickening 1. “I will maintain strict bedrest throughout the remainder of
7. A nurse is reviewing the record of a client who has pregnancy.”
just been told that a pregnancy test is positive. The 2. “I will avoid sexual intercourse until the bleeding has
physician has documented the presence of a Goodell’s stopped, and for 2 weeks following the last evidence of
sign. The nurse determines this sign indicates: bleeding.”
1. A softening of the cervix 3. “I will count the number of perineal pads used on a daily
2. A soft blowing sound that corresponds to the maternal basis and note the amount and color of blood on the pad.”
pulse during auscultation of the uterus. 4. “I will watch for the evidence of the passage of tissue.”
3. The presence of hCG in the urine 15. A prenatal nurse is providing instructions to a
4. The presence of fetal movement group of pregnant client regarding measures to
8. A nursing instructor asks a nursing student who is prevent toxoplasmosis. Which statement if made by
preparing to assist with the assessment of a pregnant one of the clients indicates a need for further
client to describe the process of quickening. Which of instructions?
the following statements if made by the student 1. “I need to cook meat thoroughly.”
indicates an understanding of this term? 2. “I need to avoid touching mucous membranes of the mouth
1. “It is the irregular, painless contractions that occur or eyes while handling raw meat.”
throughout pregnancy.” 3. “I need to drink unpasteurized milk only.”
2. “It is the soft blowing sound that can be heard when the 4. “I need to avoid contact with materials that are possibly
uterus is auscultated.” contaminated with cat feces.”
3. “It is the fetal movement that is felt by the mother.” 16. A homecare nurse visits a pregnant client who has
4. “It is the thinning of the lower uterine segment.” a diagnosis of mild Preeclampsia and who is being
,monitored for pregnancy induced hypertension (PIH). 1. Monitor maternal vital signs every 2 hours
Which assessment finding indicates a worsening of the 2. Notify the physician if respirations are less than 18 per
Preeclampsia and the need to notify the physician? minute.
1. Blood pressure reading is at the prenatal baseline 3. Monitor renal function and cardiac function closely
2. Urinary output has increased 4. Keep calcium gluconate on hand in case of a magnesium
3. The client complains of a headache and blurred vision sulfate overdose
4. Dependent edema has resolved 5. Monitor deep tendon reflexes hourly
17. A nurse implements a teaching plan for a pregnant 6. Monitor I and O’s hourly
client who is newly diagnosed with gestational 7. Notify the physician if urinary output is less than 30 ml per
diabetes. Which statement if made by the client hour.
indicates a need for further education? 25. In the 12th week of gestation, a client completely
1. “I need to stay on the diabetic diet.” expels the products of conception. Because the client
2. “I will perform glucose monitoring at home.” is Rh negative, the nurse must:
3. “I need to avoid exercise because of the negative effects of 1. Administer RhoGAM within 72 hours
insulin production.” 2. Make certain she receives RhoGAM on her first clinic visit
4. “I need to be aware of any infections and report signs of 3. Not give RhoGAM, since it is not used with the birth of a
infection immediately to my health care provider.” stillborn
18. A primigravida is receiving magnesium sulfate for 4. Make certain the client does not receive RhoGAM, since the
the treatment of pregnancy induced hypertension gestation only lasted 12 weeks.
(PIH). The nurse who is caring for the client is 26. In a lecture on sexual functioning, the nurse plans
performing assessments every 30 minutes. Which to include the fact that ovulation occurs when the:
assessment finding would be of most concern to the 1. Oxytocin is too high
nurse? 2. Blood level of LH is too high
1. Urinary output of 20 ml since the previous assessment 3. Progesterone level is high
2. Deep tendon reflexes of 2+ 4. Endometrial wall is sloughed off.
3. Respiratory rate of 10 BPM 27. The chief function of progesterone is the:
4. Fetal heart rate of 120 BPM 1. Development of the female reproductive system
19. A nurse is caring for a pregnant client with 2. Stimulation of the follicles for ovulation to occur
Preeclampsia. The nurse prepares a plan of care for 3. Preparation of the uterus to receive a fertilized egg
the client and documents in the plan that if the client 4. Establishment of secondary male sex characteristics
progresses from Preeclampsia to eclampsia, the 28. The developing cells are called a fetus from the:
nurse’s first action is to: 1. Time the fetal heart is heard
1. Administer magnesium sulfate intravenously 2. Eighth week to the time of birth
2. Assess the blood pressure and fetal heart rate 3. Implantation of the fertilized ovum
3. Clean and maintain an open airway 4. End of the send week to the onset of labor
4. Administer oxygen by face mask 29. After the first four months of pregnancy, the chief
20. A nurse is monitoring a pregnant client with source of estrogen and progesterone is the:
pregnancy induced hypertension who is at risk for 1. Placenta
Preeclampsia. The nurse checks the client for which 2. Adrenal cortex
specific signs of Preeclampsia (select all that apply)? 3. Corpus luteum
1. Elevated blood pressure 4. Anterior hypophysis
2. Negative urinary protein 30. The nurse recognizes that an expected change in
3. Facial edema the hematologic system that occurs during the
4. Increased respirations 2nd trimester of pregnancy is:
21. Rho (D) immune globulin (RhoGAM) is prescribed 1. A decrease in WBC’s
for a woman following delivery of a newborn infant and 2. In increase in hematocrit
the nurse provides information to the woman about 3. An increase in blood volume
the purpose of the medication. The nurse determines 4. A decrease in sedimentation rate
that the woman understands the purpose of the 31. The nurse is aware than an adaptation of
medication if the woman states that it will protect her pregnancy is an increased blood supply to the pelvic
next baby from which of the following? region that results in a purplish discoloration of the
1. Being affected by Rh incompatibility vaginal mucosa, which is known as:
2. Having Rh positive blood 1. Ladin’s sign
3. Developing a rubella infection 2. Hegar’s sign
4. Developing physiological jaundice 3. Goodell’s sign
22. A pregnant client is receiving magnesium sulfate 4. Chadwick’s sign
for the management of preeclampsia. A nurse 32. A pregnant client is making her
determines the client is experiencing toxicity from the first Antepartum visit. She has a two year old son born
medication if which of the following is noted on at 40 weeks, a 5 year old daughter born at 38 weeks,
assessment? and 7 year old twin daughters born at 35 weeks. She
1. Presence of deep tendon reflexes had a spontaneous abortion 3 years ago at 10 weeks.
2. Serum magnesium level of 6 mEq/L Using the GTPAL format, the nurse should identify that
3. Proteinuria of +3 the client is:
4. Respirations of 10 per minute 1. G4 T3 P2 A1 L4
23. A woman with preeclampsia is receiving 2. G5 T2 P2 A1 L4
magnesium sulfate. The nurse assigned to care for the 3. G5 T2 P1 A1 L4
client determines that the magnesium therapy is 4. G4 T3 P1 A1 L4
effective if: 33. An expected cardiopulmonary adaptation
1. Ankle clonus in noted experienced by most pregnant women is:
2. The blood pressure decreases 1. Tachycardia
3. Seizures do not occur 2. Dyspnea at rest
4. Scotomas are present 3. Progression of dependent edema
24. A nurse is caring for a pregnant client with severe 4. Shortness of breath on exertion
preeclampsia who is receiving IV magnesium sulfate. 34. Nutritional planning for a newly pregnant woman
Select all nursing interventions that apply in the care of average height and weighing 145 pounds should
for the client. include:
,1. A decrease of 200 calories a day 45. Clients with gestational diabetes are usually
2. An increase of 300 calories a day managed by which of the following therapies?
3. An increase of 500 calories a day 1. Diet
4. A maintenance of her present caloric intake per day 2. NPH insulin (long-acting)
35. During a prenatal examination, the nurse draws 3. Oral hypoglycemic drugs
blood from a young Rh negative client and explain that 4. Oral hypoglycemic drugs and insulin
an indirect Coombs test will be performed to predict 46. The antagonist for magnesium sulfate should be
whether the fetus is at risk for: readily available to any client receiving IV magnesium.
1. Acute hemolytic disease Which of the following drugs is the antidote for
2. Respiratory distress syndrome magnesium toxicity?
3. Protein metabolic deficiency 1. Calcium gluconate
4. Physiologic hyperbilirubinemia 2. Hydralazine (Apresoline)
36. When involved in prenatal teaching, the nurse 3. Narcan
should advise the clients that an increase in vaginal 4. RhoGAM
secretions during pregnancy is called leukorrhea and is 47. Which of the following answers best describes the
caused by increased: stage of pregnancy in which maternal and fetal blood
1. Metabolic rates are exchanged?
2. Production of estrogen 1. Conception
3. Functioning of the Bartholin glands 2. 9 weeks’ gestation, when the fetal heart is well developed
4. Supply of sodium chloride to the cells of the vagina 3. 32-34 weeks gestation
37. A 26-year old multigravida is 14 weeks’ pregnant 4. maternal and fetal blood are never exchanged
and is scheduled for an alpha-fetoprotein test. She 48. Gravida refers to which of the following
asks the nurse, “What does the alpha-fetoprotein test descriptions?
indicate?” The nurse bases a response on the 1. A serious pregnancy
knowledge that this test can detect: 2. Number of times a female has been pregnant
1. Kidney defects 3. Number of children a female has delivered
2. Cardiac defects 4. Number of term pregnancies a female has had.
3. Neural tube defects 49. A pregnant woman at 32 weeks’ gestation
4. Urinary tract defects complains of feeling dizzy and lightheaded while her
38. At a prenatal visit at 36 weeks’ gestation, a client fundal height is being measured. Her skin is pale and
complains of discomfort with irregularly occurring moist. The nurse’s initial response would be to:
contractions. The nurse instructs the client to: 1. Assess the woman’s blood pressure and pulse
1. Lie down until they stop 2. Have the woman breathe into a paper bag
2. Walk around until they subside 3. Raise the woman’s legs
3. Time contraction for 30 minutes 4. Turn the woman on her side.
4. Take 10 grains of aspirin for the discomfort 50. A pregnant woman’s last menstrual period began
39. The nurse teaches a pregnant woman to avoid lying on April 8, 2005, and ended on April 13. Using
on her back. The nurse has based this statement on Naegele’s rule her estimated date of birth would be:
the knowledge that the supine position can: 1. January 15, 2006
1. Unduly prolong labor 2. January 20, 2006
2. Cause decreased placental perfusion 3. July 1, 2006
3. Lead to transient episodes of hypotension 4. November 5, 2005
4. Interfere with free movement of the coccyx
40. The pituitary hormone that stimulates the Answers and Rationale
secretion of milk from the mammary glands is: 1. Answer: 1. FSH and LH are released from the
1. Prolactin anterior pituitary gland. FSH and LH, when stimulated by
2. Oxytocin gonadotropin-releasing hormone from the hypothalamus, are
3. Estrogen released from the anterior pituitary gland to stimulate
4. Progesterone follicular growth and development, growth of the graafian
41. Which of the following symptoms occurs with a follicle, and production of progesterone.
hydatidiform mole? 2. Answer: 2. Two umbilical arteries and one umbilical
1. Heavy, bright red bleeding every 21 days vein. Blood pumped by the embryo’s heart leaves the
2. Fetal cardiac motion after 6 weeks gestation embryo through two umbilical arteries. Once oxygenated, the
3. Benign tumors found in the smooth muscle of the uterus blood then is returned by one umbilical vein. Arteries carry
4. “Snowstorm” pattern on ultrasound with no fetus or deoxygenated blood and waste products from the fetus, and
gestational sac veins carry oxygenated blood and provide oxygen and
42. Which of the following terms applies to the nutrients to the fetus.
tiny, blanched, slightly raised end arterioles found on 3. Answer: 3. 150 BPM. The fetal heart rate depends in
the face, neck, arms, and chest during pregnancy? gestational age and ranges from 160-170 BPM in the first
1. Epulis trimester but slows with fetal growth to 120-160 BPM near or
2. Linea nigra at term. At or near term, if the fetal heart rate is less than 120
3. Striae gravidarum or more than 160 BPM with the uterus at rest, the fetus may
4. Telangiectasias be in distress.
43. Which of the following conditions is common in 4. Answer: 3. June 26, 2014. Accurate use of Naegele’s
pregnant women in the 2nd trimester of pregnancy? rule requires that the woman have a regular 28-day menstrual
1. Mastitis cycle. Add 7 days to the first day of the last menstrual period,
2. Metabolic alkalosis subtract three months, and then add one year to that date.
3. Physiologic anemia 5. Answer: 2. G = 2, T = 0, P = 1, A = 0, L =1. Pregnancy
4. Respiratory acidosis outcomes can be described with the acronym GTPAL.
44. A 21-year old client, 6 weeks’ pregnant is “G” is Gravidity, the number of pregnancies.
diagnosed with hyperemesis gravidarum. This “T” is term births, the number of born at term (38 to 41
excessive vomiting during pregnancy will often result weeks).
in which of the following conditions? “P” is preterm births, the number born before 38 weeks
1. Bowel perforation gestation.
2. Electrolyte imbalance “A” is abortions or miscarriages, included in “G” if before 20
3. Miscarriage weeks gestation, included in parity if past 20 weeks AOE.
4. Pregnancy induced hypertension (PIH) “L” is live births, the number of births of living children.
, Therefore, a woman who is pregnant with twins and has a woman also should watch for the evidence of the passage of
child has a gravida of 2. Because the child was delivered at 37 tissue.
weeks, the number of preterm births is 1, and the number of 15. Answer: 3. “I need to drink unpasteurized milk
term births is 0. The number of abortions is 0, and the number only.” All pregnant women should be advised to do the
of live births is 1. following to prevent the development of toxoplasmosis.
6. Answer: 2. Fetal heart rate of 180 BPM. The normal Women should be instructed to cook meats thoroughly, avoid
range of the fetal heart rate depends on gestational age. The touching mucous membranes and eyes while handling raw
heart rate is usually 160-170 BPM in the first trimester and meat; thoroughly wash all kitchen surfaces that come into
slows with fetal growth, near and at term, the fetal heart rate contact with uncooked meat, wash the hands thoroughly after
ranges from 120-160 BPM. The other options are expected. handling raw meat; avoid uncooked eggs and unpasteurized
7. Answer: 1. A softening of the cervix. In the early milk; wash fruits and vegetables before consumption, and
weeks of pregnancy the cervix becomes softer as a result of avoid contact with materials that possibly are contaminated
increased vascularity and hyperplasia, which causes the with cat feces, such as cat litter boxes, sandboxes, and
Goodell’s sign. garden soil.
8. Answer: 3. “It is the fetal movement that is felt by 16. Answer: 3. The client complains of a headache and
the mother.” Quickening is fetal movement and may occur blurred vision. If the client complains of a headache and
as early as the 16th and 18th week of gestation, and the blurred vision, the physician should be notified because these
mother first notices subtle fetal movements that gradually are signs of worsening Preeclampsia.
increase in intensity. Braxton Hicks contractions are irregular, 17. Answer: 3. “I need to avoid exercise because of the
painless contractions that may occur throughout the negative effects of insulin production.” Exercise is safe
pregnancy. A thinning of the lower uterine segment occurs for the client with gestational diabetes and is helpful in
about the 6th week of pregnancy and is called Hegar’s sign. lowering the blood glucose level.
9. Answer: 4. Initiating a gentle upward tap on the 18. Answer: 3. Respiratory rate of 10 BPM. Magnesium
cervix. Ballottement is a technique of palpating a floating sulfate depresses the respiratory rate. If the respiratory rate is
structure by bouncing it gently and feeling it rebound. In the less than 12 breaths per minute, the physician or other health
technique used to palpate the fetus, the examiner places a care provider needs to be notified, and continuation of the
finger in the vagina and taps gently upward, causing the fetus medication needs to be reassessed. A urinary output of 20 ml
to rise. The fetus then sinks, and the examiner feels a gentle in a 30 minute period is adequate; less than 30 ml in one hour
tap on the finger. needs to be reported. Deep tendon reflexes of 2+ are normal.
10. Answers: 1, 4, 5, and 6. The fetal heart rate is WNL for a resting fetus.
The probable signs of pregnancy include: 19. Answer: 3. Clean and maintain an open airway. The
Uterine Enlargement immediate care during a seizure (eclampsia) is to ensure a
Hegar’s sign or softening and thinning of the uterine segment patent airway. The other options are actions that follow or will
that occurs at week 6. be implemented after the seizure has ceased.
Goodell’s sign or softening of the cervix that occurs at the 20. Answers: 1 Elevated blood pressure and 3 Facial
beginning of the 2nd month edema. The three classic signs of preeclampsia are
Chadwick’s sign or bluish coloration of the mucous hypertension, generalized edema, and proteinuria. Increased
membranes of the cervix, vagina and vulva. Occurs at week 6. respirations are not a sign of preeclampsia.
Ballottement or rebounding of the fetus against the 21. Answer: 1. Being affected by Rh incompatibility. Rh
examiner’s fingers of palpation incompatibility can occur when an Rh-negative mom becomes
Braxton-Hicks contractions sensitized to the Rh antigen. Sensitization may develop when
Positive pregnancy test measuring for hCG. an Rh-negative woman becomes pregnant with a fetus who is
Positive signs of pregnancy include: Rh positive. During pregnancy and at delivery, some of the
Fetal Heart Rate detected by electronic device (doppler) at baby’s Rh positive blood can enter the maternal circulation,
10-12 weeks causing the woman’s immune system to form antibodies
Fetal Heart rate detected by nonelectronic device (fetoscope) against Rh positive blood. Administration of Rho(D) immune
at 20 weeks AOG globulin prevents the woman from developing antibodies
Active fetal movement palpable by the examiners against Rh positive blood by providing passive antibody
Outline of the fetus via radiography or ultrasound protection against the Rh antigen.
11. Answer: 1. Dorsiflex the foot while extending the 22. Answer: 4. Respirations of 10 per
knee when the cramps occur. Legs cramps occur when the minute. Magnesium toxicity can occur from magnesium
pregnant woman stretches the leg and plantar flexes the foot. sulfate therapy. Signs of toxicity relate to the central nervous
Dorsiflexion of the foot while extending the knee stretches the system depressant effects of the medication and include
affected muscle, prevents the muscle from contracting, and respiratory depression, loss of deep tendon reflexes, and a
stops the cramping. sudden drop in the fetal heart rate and maternal heart rate
12. Answer: 4. Wash the breasts with warm water and and blood pressure. Therapeutic levels of magnesium are 4-7
keep them dry. The pregnant woman should be instructed mEq/L. Proteinuria of +3 would be noted in a client with
to wash the breasts with warm water and keep them dry. The preeclampsia.
woman should be instructed to avoid using soap on the 23. Answer: 3. Seizures do not occur. For a client with
nipples and areola area to prevent the drying of tissues. preeclampsia, the goal of care is directed at preventing
Wearing a supportive bra with wide adjustable straps can eclampsia (seizures). Magnesium sulfate is an anticonvulsant,
decrease breast tenderness. Tight-fitting blouses or dresses not an antihypertensive agent. Although a decrease in blood
will cause discomfort. pressure may be noted initially, this effect is usually transient.
13. Answer: 1. Any bleeding, such as in the gums, Ankle clonus indicated hyperreflexia and may precede the
petechiae, and purpura. Severe Preeclampsia can trigger onset of eclampsia. Scotomas are areas of complete or partial
disseminated intravascular coagulation because of the blindness. Visual disturbances, such as scotomas, often
widespread damage to vascular integrity. Bleeding is an early precede an eclamptic seizure.
sign of DIC and should be reported to the M.D. 24. Answers: 3, 4, 5, 6, and 7. When caring for a client
14. Answer: 1. “I will maintain strict bedrest receiving magnesium sulfate therapy, the nurse would
throughout the remainder of pregnancy.” Strict bed rest monitor maternal vital signs, especially respirations, every 30-
throughout the remainder of pregnancy is not required. The 60 minutes and notify the physician if respirations are less
woman is advised to curtail sexual activities until the bleeding than 12, because this would indicate respiratory depression.
has ceased, and for 2 weeks following the last evidence of Calcium gluconate is kept on hand in case of magnesium
bleeding or as recommended by the physician. The woman is sulfate overdose, because calcium gluconate is the antidote
instructed to count the number of perineal pads used daily for magnesium sulfate toxicity. Deep tendon reflexes are
and to note the quantity and color of blood on the pad. The assessed hourly. Cardiac and renal function is monitored
closely. The urine output should be maintained at 30 ml per
Items) pregnant client and is assessing the client for the
presence of ballottement. Which of the following would
1. A nursing instructor is conducting lecture and is the nurse implement to test for the presence of
reviewing the functions of the female reproductive ballottement?
system. She asks Mark to describe the follicle- 1. Auscultating for fetal heart sounds
stimulating hormone (FSH) and the luteinizing 2. Palpating the abdomen for fetal movement
hormone (LH). Mark accurately responds by stating 3. Assessing the cervix for thinning
that: 4. Initiating a gentle upward tap on the cervix
1. FSH and LH are released from the anterior pituitary gland. 10. A nurse is assisting in performing an assessment
2. FSH and LH are secreted by the corpus luteum of the ovary on a client who suspects that she is pregnant and is
3. FSH and LH are secreted by the adrenal glands checking the client for probable signs of
4. FSH and LH stimulate the formation of milk during pregnancy. Select all probable signs of pregnancy.
pregnancy. 1. Uterine enlargement
2. A nurse is describing the process of fetal circulation 2. Fetal heart rate detected by nonelectric device
to a client during a prenatal visit. The nurse accurately 3. Outline of the fetus via radiography or ultrasound
tells the client that fetal circulation consists of: 4. Chadwick’s sign
1. Two umbilical veins and one umbilical artery 5. Braxton Hicks contractions
2. Two umbilical arteries and one umbilical vein 6. Ballottement
3. Arteries carrying oxygenated blood to the fetus 11. A pregnant client calls the clinic and tells a nurse
4. Veins carrying deoxygenated blood to the fetus that she is experiencing leg cramps and is awakened
3. During a prenatal visit at 38 weeks, a nurse by the cramps at night. To provide relief from the leg
assesses the fetal heart rate. The nurse determines cramps, the nurse tells the client to:
that the fetal heart rate is normal if which of the 1. Dorsiflex the foot while extending the knee when the
following is noted? cramps occur
1. 80 BPM 2. Dorsiflex the foot while flexing the knee when the cramps
2. 100 BPM occur
3. 150 BPM 3. Plantar flex the foot while flexing the knee when the
4. 180 BPM cramps occur
4. A client arrives at a prenatal clinic for the first 4. Plantar flex the foot while extending the knee when the
prenatal assessment. The client tells a nurse that the cramps occur.
first day of her last menstrual period was September 12. A nurse is providing instructions to a client in the
19th, 2013. Using Naegele’s rule, the nurse determines first trimester of pregnancy regarding measures to
the estimated date of confinement as: assist in reducing breast tenderness. The nurse tells
1. July 26, 2013 the client to:
2. June 12, 2014 1. Avoid wearing a bra
3. June 26, 2014 2. Wash the nipples and areola area daily with soap, and
4. July 12, 2014 massage the breasts with lotion.
5. A nurse is collecting data during an admission 3. Wear tight-fitting blouses or dresses to provide support
assessment of a client who is pregnant with twins. The 4. Wash the breasts with warm water and keep them dry
client has a healthy 5-year old child that was delivered 13. A pregnant client in the last trimester has been
at 37 weeks and tells the nurse that she doesn’t have admitted to the hospital with a diagnosis of severe
any history of abortion or fetal demise. The nurse preeclampsia. A nurse monitors for complications
would document the GTPAL for this client as: associated with the diagnosis and assesses the client
1. G = 3, T = 2, P = 0, A = 0, L =1 for:
2. G = 2, T = 0, P = 1, A = 0, L =1 1. Any bleeding, such as in the gums, petechiae, and purpura.
3. G = 1, T = 1. P = 1, A = 0, L = 1 2. Enlargement of the breasts
4. G = 2, T = 0, P = 0, A = 0, L = 1 3. Periods of fetal movement followed by quiet periods
6. A nurse is performing an assessment of a primipara 4. Complaints of feeling hot when the room is cool
who is being evaluated in a clinic during her second 14. A client in the first trimester of pregnancy arrives
trimester of pregnancy. Which of the following at a health care clinic and reports that she has been
indicates an abnormal physical finding necessitating experiencing vaginal bleeding. A threatened abortion
further testing? is suspected, and the nurse instructs the client
1. Consistent increase in fundal height regarding management of care. Which statement, if
2. Fetal heart rate of 180 BPM made by the client, indicates a need for further
3. Braxton hicks contractions education?
4. Quickening 1. “I will maintain strict bedrest throughout the remainder of
7. A nurse is reviewing the record of a client who has pregnancy.”
just been told that a pregnancy test is positive. The 2. “I will avoid sexual intercourse until the bleeding has
physician has documented the presence of a Goodell’s stopped, and for 2 weeks following the last evidence of
sign. The nurse determines this sign indicates: bleeding.”
1. A softening of the cervix 3. “I will count the number of perineal pads used on a daily
2. A soft blowing sound that corresponds to the maternal basis and note the amount and color of blood on the pad.”
pulse during auscultation of the uterus. 4. “I will watch for the evidence of the passage of tissue.”
3. The presence of hCG in the urine 15. A prenatal nurse is providing instructions to a
4. The presence of fetal movement group of pregnant client regarding measures to
8. A nursing instructor asks a nursing student who is prevent toxoplasmosis. Which statement if made by
preparing to assist with the assessment of a pregnant one of the clients indicates a need for further
client to describe the process of quickening. Which of instructions?
the following statements if made by the student 1. “I need to cook meat thoroughly.”
indicates an understanding of this term? 2. “I need to avoid touching mucous membranes of the mouth
1. “It is the irregular, painless contractions that occur or eyes while handling raw meat.”
throughout pregnancy.” 3. “I need to drink unpasteurized milk only.”
2. “It is the soft blowing sound that can be heard when the 4. “I need to avoid contact with materials that are possibly
uterus is auscultated.” contaminated with cat feces.”
3. “It is the fetal movement that is felt by the mother.” 16. A homecare nurse visits a pregnant client who has
4. “It is the thinning of the lower uterine segment.” a diagnosis of mild Preeclampsia and who is being
,monitored for pregnancy induced hypertension (PIH). 1. Monitor maternal vital signs every 2 hours
Which assessment finding indicates a worsening of the 2. Notify the physician if respirations are less than 18 per
Preeclampsia and the need to notify the physician? minute.
1. Blood pressure reading is at the prenatal baseline 3. Monitor renal function and cardiac function closely
2. Urinary output has increased 4. Keep calcium gluconate on hand in case of a magnesium
3. The client complains of a headache and blurred vision sulfate overdose
4. Dependent edema has resolved 5. Monitor deep tendon reflexes hourly
17. A nurse implements a teaching plan for a pregnant 6. Monitor I and O’s hourly
client who is newly diagnosed with gestational 7. Notify the physician if urinary output is less than 30 ml per
diabetes. Which statement if made by the client hour.
indicates a need for further education? 25. In the 12th week of gestation, a client completely
1. “I need to stay on the diabetic diet.” expels the products of conception. Because the client
2. “I will perform glucose monitoring at home.” is Rh negative, the nurse must:
3. “I need to avoid exercise because of the negative effects of 1. Administer RhoGAM within 72 hours
insulin production.” 2. Make certain she receives RhoGAM on her first clinic visit
4. “I need to be aware of any infections and report signs of 3. Not give RhoGAM, since it is not used with the birth of a
infection immediately to my health care provider.” stillborn
18. A primigravida is receiving magnesium sulfate for 4. Make certain the client does not receive RhoGAM, since the
the treatment of pregnancy induced hypertension gestation only lasted 12 weeks.
(PIH). The nurse who is caring for the client is 26. In a lecture on sexual functioning, the nurse plans
performing assessments every 30 minutes. Which to include the fact that ovulation occurs when the:
assessment finding would be of most concern to the 1. Oxytocin is too high
nurse? 2. Blood level of LH is too high
1. Urinary output of 20 ml since the previous assessment 3. Progesterone level is high
2. Deep tendon reflexes of 2+ 4. Endometrial wall is sloughed off.
3. Respiratory rate of 10 BPM 27. The chief function of progesterone is the:
4. Fetal heart rate of 120 BPM 1. Development of the female reproductive system
19. A nurse is caring for a pregnant client with 2. Stimulation of the follicles for ovulation to occur
Preeclampsia. The nurse prepares a plan of care for 3. Preparation of the uterus to receive a fertilized egg
the client and documents in the plan that if the client 4. Establishment of secondary male sex characteristics
progresses from Preeclampsia to eclampsia, the 28. The developing cells are called a fetus from the:
nurse’s first action is to: 1. Time the fetal heart is heard
1. Administer magnesium sulfate intravenously 2. Eighth week to the time of birth
2. Assess the blood pressure and fetal heart rate 3. Implantation of the fertilized ovum
3. Clean and maintain an open airway 4. End of the send week to the onset of labor
4. Administer oxygen by face mask 29. After the first four months of pregnancy, the chief
20. A nurse is monitoring a pregnant client with source of estrogen and progesterone is the:
pregnancy induced hypertension who is at risk for 1. Placenta
Preeclampsia. The nurse checks the client for which 2. Adrenal cortex
specific signs of Preeclampsia (select all that apply)? 3. Corpus luteum
1. Elevated blood pressure 4. Anterior hypophysis
2. Negative urinary protein 30. The nurse recognizes that an expected change in
3. Facial edema the hematologic system that occurs during the
4. Increased respirations 2nd trimester of pregnancy is:
21. Rho (D) immune globulin (RhoGAM) is prescribed 1. A decrease in WBC’s
for a woman following delivery of a newborn infant and 2. In increase in hematocrit
the nurse provides information to the woman about 3. An increase in blood volume
the purpose of the medication. The nurse determines 4. A decrease in sedimentation rate
that the woman understands the purpose of the 31. The nurse is aware than an adaptation of
medication if the woman states that it will protect her pregnancy is an increased blood supply to the pelvic
next baby from which of the following? region that results in a purplish discoloration of the
1. Being affected by Rh incompatibility vaginal mucosa, which is known as:
2. Having Rh positive blood 1. Ladin’s sign
3. Developing a rubella infection 2. Hegar’s sign
4. Developing physiological jaundice 3. Goodell’s sign
22. A pregnant client is receiving magnesium sulfate 4. Chadwick’s sign
for the management of preeclampsia. A nurse 32. A pregnant client is making her
determines the client is experiencing toxicity from the first Antepartum visit. She has a two year old son born
medication if which of the following is noted on at 40 weeks, a 5 year old daughter born at 38 weeks,
assessment? and 7 year old twin daughters born at 35 weeks. She
1. Presence of deep tendon reflexes had a spontaneous abortion 3 years ago at 10 weeks.
2. Serum magnesium level of 6 mEq/L Using the GTPAL format, the nurse should identify that
3. Proteinuria of +3 the client is:
4. Respirations of 10 per minute 1. G4 T3 P2 A1 L4
23. A woman with preeclampsia is receiving 2. G5 T2 P2 A1 L4
magnesium sulfate. The nurse assigned to care for the 3. G5 T2 P1 A1 L4
client determines that the magnesium therapy is 4. G4 T3 P1 A1 L4
effective if: 33. An expected cardiopulmonary adaptation
1. Ankle clonus in noted experienced by most pregnant women is:
2. The blood pressure decreases 1. Tachycardia
3. Seizures do not occur 2. Dyspnea at rest
4. Scotomas are present 3. Progression of dependent edema
24. A nurse is caring for a pregnant client with severe 4. Shortness of breath on exertion
preeclampsia who is receiving IV magnesium sulfate. 34. Nutritional planning for a newly pregnant woman
Select all nursing interventions that apply in the care of average height and weighing 145 pounds should
for the client. include:
,1. A decrease of 200 calories a day 45. Clients with gestational diabetes are usually
2. An increase of 300 calories a day managed by which of the following therapies?
3. An increase of 500 calories a day 1. Diet
4. A maintenance of her present caloric intake per day 2. NPH insulin (long-acting)
35. During a prenatal examination, the nurse draws 3. Oral hypoglycemic drugs
blood from a young Rh negative client and explain that 4. Oral hypoglycemic drugs and insulin
an indirect Coombs test will be performed to predict 46. The antagonist for magnesium sulfate should be
whether the fetus is at risk for: readily available to any client receiving IV magnesium.
1. Acute hemolytic disease Which of the following drugs is the antidote for
2. Respiratory distress syndrome magnesium toxicity?
3. Protein metabolic deficiency 1. Calcium gluconate
4. Physiologic hyperbilirubinemia 2. Hydralazine (Apresoline)
36. When involved in prenatal teaching, the nurse 3. Narcan
should advise the clients that an increase in vaginal 4. RhoGAM
secretions during pregnancy is called leukorrhea and is 47. Which of the following answers best describes the
caused by increased: stage of pregnancy in which maternal and fetal blood
1. Metabolic rates are exchanged?
2. Production of estrogen 1. Conception
3. Functioning of the Bartholin glands 2. 9 weeks’ gestation, when the fetal heart is well developed
4. Supply of sodium chloride to the cells of the vagina 3. 32-34 weeks gestation
37. A 26-year old multigravida is 14 weeks’ pregnant 4. maternal and fetal blood are never exchanged
and is scheduled for an alpha-fetoprotein test. She 48. Gravida refers to which of the following
asks the nurse, “What does the alpha-fetoprotein test descriptions?
indicate?” The nurse bases a response on the 1. A serious pregnancy
knowledge that this test can detect: 2. Number of times a female has been pregnant
1. Kidney defects 3. Number of children a female has delivered
2. Cardiac defects 4. Number of term pregnancies a female has had.
3. Neural tube defects 49. A pregnant woman at 32 weeks’ gestation
4. Urinary tract defects complains of feeling dizzy and lightheaded while her
38. At a prenatal visit at 36 weeks’ gestation, a client fundal height is being measured. Her skin is pale and
complains of discomfort with irregularly occurring moist. The nurse’s initial response would be to:
contractions. The nurse instructs the client to: 1. Assess the woman’s blood pressure and pulse
1. Lie down until they stop 2. Have the woman breathe into a paper bag
2. Walk around until they subside 3. Raise the woman’s legs
3. Time contraction for 30 minutes 4. Turn the woman on her side.
4. Take 10 grains of aspirin for the discomfort 50. A pregnant woman’s last menstrual period began
39. The nurse teaches a pregnant woman to avoid lying on April 8, 2005, and ended on April 13. Using
on her back. The nurse has based this statement on Naegele’s rule her estimated date of birth would be:
the knowledge that the supine position can: 1. January 15, 2006
1. Unduly prolong labor 2. January 20, 2006
2. Cause decreased placental perfusion 3. July 1, 2006
3. Lead to transient episodes of hypotension 4. November 5, 2005
4. Interfere with free movement of the coccyx
40. The pituitary hormone that stimulates the Answers and Rationale
secretion of milk from the mammary glands is: 1. Answer: 1. FSH and LH are released from the
1. Prolactin anterior pituitary gland. FSH and LH, when stimulated by
2. Oxytocin gonadotropin-releasing hormone from the hypothalamus, are
3. Estrogen released from the anterior pituitary gland to stimulate
4. Progesterone follicular growth and development, growth of the graafian
41. Which of the following symptoms occurs with a follicle, and production of progesterone.
hydatidiform mole? 2. Answer: 2. Two umbilical arteries and one umbilical
1. Heavy, bright red bleeding every 21 days vein. Blood pumped by the embryo’s heart leaves the
2. Fetal cardiac motion after 6 weeks gestation embryo through two umbilical arteries. Once oxygenated, the
3. Benign tumors found in the smooth muscle of the uterus blood then is returned by one umbilical vein. Arteries carry
4. “Snowstorm” pattern on ultrasound with no fetus or deoxygenated blood and waste products from the fetus, and
gestational sac veins carry oxygenated blood and provide oxygen and
42. Which of the following terms applies to the nutrients to the fetus.
tiny, blanched, slightly raised end arterioles found on 3. Answer: 3. 150 BPM. The fetal heart rate depends in
the face, neck, arms, and chest during pregnancy? gestational age and ranges from 160-170 BPM in the first
1. Epulis trimester but slows with fetal growth to 120-160 BPM near or
2. Linea nigra at term. At or near term, if the fetal heart rate is less than 120
3. Striae gravidarum or more than 160 BPM with the uterus at rest, the fetus may
4. Telangiectasias be in distress.
43. Which of the following conditions is common in 4. Answer: 3. June 26, 2014. Accurate use of Naegele’s
pregnant women in the 2nd trimester of pregnancy? rule requires that the woman have a regular 28-day menstrual
1. Mastitis cycle. Add 7 days to the first day of the last menstrual period,
2. Metabolic alkalosis subtract three months, and then add one year to that date.
3. Physiologic anemia 5. Answer: 2. G = 2, T = 0, P = 1, A = 0, L =1. Pregnancy
4. Respiratory acidosis outcomes can be described with the acronym GTPAL.
44. A 21-year old client, 6 weeks’ pregnant is “G” is Gravidity, the number of pregnancies.
diagnosed with hyperemesis gravidarum. This “T” is term births, the number of born at term (38 to 41
excessive vomiting during pregnancy will often result weeks).
in which of the following conditions? “P” is preterm births, the number born before 38 weeks
1. Bowel perforation gestation.
2. Electrolyte imbalance “A” is abortions or miscarriages, included in “G” if before 20
3. Miscarriage weeks gestation, included in parity if past 20 weeks AOE.
4. Pregnancy induced hypertension (PIH) “L” is live births, the number of births of living children.
, Therefore, a woman who is pregnant with twins and has a woman also should watch for the evidence of the passage of
child has a gravida of 2. Because the child was delivered at 37 tissue.
weeks, the number of preterm births is 1, and the number of 15. Answer: 3. “I need to drink unpasteurized milk
term births is 0. The number of abortions is 0, and the number only.” All pregnant women should be advised to do the
of live births is 1. following to prevent the development of toxoplasmosis.
6. Answer: 2. Fetal heart rate of 180 BPM. The normal Women should be instructed to cook meats thoroughly, avoid
range of the fetal heart rate depends on gestational age. The touching mucous membranes and eyes while handling raw
heart rate is usually 160-170 BPM in the first trimester and meat; thoroughly wash all kitchen surfaces that come into
slows with fetal growth, near and at term, the fetal heart rate contact with uncooked meat, wash the hands thoroughly after
ranges from 120-160 BPM. The other options are expected. handling raw meat; avoid uncooked eggs and unpasteurized
7. Answer: 1. A softening of the cervix. In the early milk; wash fruits and vegetables before consumption, and
weeks of pregnancy the cervix becomes softer as a result of avoid contact with materials that possibly are contaminated
increased vascularity and hyperplasia, which causes the with cat feces, such as cat litter boxes, sandboxes, and
Goodell’s sign. garden soil.
8. Answer: 3. “It is the fetal movement that is felt by 16. Answer: 3. The client complains of a headache and
the mother.” Quickening is fetal movement and may occur blurred vision. If the client complains of a headache and
as early as the 16th and 18th week of gestation, and the blurred vision, the physician should be notified because these
mother first notices subtle fetal movements that gradually are signs of worsening Preeclampsia.
increase in intensity. Braxton Hicks contractions are irregular, 17. Answer: 3. “I need to avoid exercise because of the
painless contractions that may occur throughout the negative effects of insulin production.” Exercise is safe
pregnancy. A thinning of the lower uterine segment occurs for the client with gestational diabetes and is helpful in
about the 6th week of pregnancy and is called Hegar’s sign. lowering the blood glucose level.
9. Answer: 4. Initiating a gentle upward tap on the 18. Answer: 3. Respiratory rate of 10 BPM. Magnesium
cervix. Ballottement is a technique of palpating a floating sulfate depresses the respiratory rate. If the respiratory rate is
structure by bouncing it gently and feeling it rebound. In the less than 12 breaths per minute, the physician or other health
technique used to palpate the fetus, the examiner places a care provider needs to be notified, and continuation of the
finger in the vagina and taps gently upward, causing the fetus medication needs to be reassessed. A urinary output of 20 ml
to rise. The fetus then sinks, and the examiner feels a gentle in a 30 minute period is adequate; less than 30 ml in one hour
tap on the finger. needs to be reported. Deep tendon reflexes of 2+ are normal.
10. Answers: 1, 4, 5, and 6. The fetal heart rate is WNL for a resting fetus.
The probable signs of pregnancy include: 19. Answer: 3. Clean and maintain an open airway. The
Uterine Enlargement immediate care during a seizure (eclampsia) is to ensure a
Hegar’s sign or softening and thinning of the uterine segment patent airway. The other options are actions that follow or will
that occurs at week 6. be implemented after the seizure has ceased.
Goodell’s sign or softening of the cervix that occurs at the 20. Answers: 1 Elevated blood pressure and 3 Facial
beginning of the 2nd month edema. The three classic signs of preeclampsia are
Chadwick’s sign or bluish coloration of the mucous hypertension, generalized edema, and proteinuria. Increased
membranes of the cervix, vagina and vulva. Occurs at week 6. respirations are not a sign of preeclampsia.
Ballottement or rebounding of the fetus against the 21. Answer: 1. Being affected by Rh incompatibility. Rh
examiner’s fingers of palpation incompatibility can occur when an Rh-negative mom becomes
Braxton-Hicks contractions sensitized to the Rh antigen. Sensitization may develop when
Positive pregnancy test measuring for hCG. an Rh-negative woman becomes pregnant with a fetus who is
Positive signs of pregnancy include: Rh positive. During pregnancy and at delivery, some of the
Fetal Heart Rate detected by electronic device (doppler) at baby’s Rh positive blood can enter the maternal circulation,
10-12 weeks causing the woman’s immune system to form antibodies
Fetal Heart rate detected by nonelectronic device (fetoscope) against Rh positive blood. Administration of Rho(D) immune
at 20 weeks AOG globulin prevents the woman from developing antibodies
Active fetal movement palpable by the examiners against Rh positive blood by providing passive antibody
Outline of the fetus via radiography or ultrasound protection against the Rh antigen.
11. Answer: 1. Dorsiflex the foot while extending the 22. Answer: 4. Respirations of 10 per
knee when the cramps occur. Legs cramps occur when the minute. Magnesium toxicity can occur from magnesium
pregnant woman stretches the leg and plantar flexes the foot. sulfate therapy. Signs of toxicity relate to the central nervous
Dorsiflexion of the foot while extending the knee stretches the system depressant effects of the medication and include
affected muscle, prevents the muscle from contracting, and respiratory depression, loss of deep tendon reflexes, and a
stops the cramping. sudden drop in the fetal heart rate and maternal heart rate
12. Answer: 4. Wash the breasts with warm water and and blood pressure. Therapeutic levels of magnesium are 4-7
keep them dry. The pregnant woman should be instructed mEq/L. Proteinuria of +3 would be noted in a client with
to wash the breasts with warm water and keep them dry. The preeclampsia.
woman should be instructed to avoid using soap on the 23. Answer: 3. Seizures do not occur. For a client with
nipples and areola area to prevent the drying of tissues. preeclampsia, the goal of care is directed at preventing
Wearing a supportive bra with wide adjustable straps can eclampsia (seizures). Magnesium sulfate is an anticonvulsant,
decrease breast tenderness. Tight-fitting blouses or dresses not an antihypertensive agent. Although a decrease in blood
will cause discomfort. pressure may be noted initially, this effect is usually transient.
13. Answer: 1. Any bleeding, such as in the gums, Ankle clonus indicated hyperreflexia and may precede the
petechiae, and purpura. Severe Preeclampsia can trigger onset of eclampsia. Scotomas are areas of complete or partial
disseminated intravascular coagulation because of the blindness. Visual disturbances, such as scotomas, often
widespread damage to vascular integrity. Bleeding is an early precede an eclamptic seizure.
sign of DIC and should be reported to the M.D. 24. Answers: 3, 4, 5, 6, and 7. When caring for a client
14. Answer: 1. “I will maintain strict bedrest receiving magnesium sulfate therapy, the nurse would
throughout the remainder of pregnancy.” Strict bed rest monitor maternal vital signs, especially respirations, every 30-
throughout the remainder of pregnancy is not required. The 60 minutes and notify the physician if respirations are less
woman is advised to curtail sexual activities until the bleeding than 12, because this would indicate respiratory depression.
has ceased, and for 2 weeks following the last evidence of Calcium gluconate is kept on hand in case of magnesium
bleeding or as recommended by the physician. The woman is sulfate overdose, because calcium gluconate is the antidote
instructed to count the number of perineal pads used daily for magnesium sulfate toxicity. Deep tendon reflexes are
and to note the quantity and color of blood on the pad. The assessed hourly. Cardiac and renal function is monitored
closely. The urine output should be maintained at 30 ml per
