Q&A | Galen College
1. Which statement by a client indicates an understanding of true labor?
A) My contractions will be irregular and stop when I rest.
B) I will feel contractions in my back that stay the same intensity.
C) My contractions will increase in intensity and occur closer together.
D) I will have a show of bloody mucus but no regular contractions.
Correct Answer: My contractions will increase in intensity and occur closer
together.
Rationale: True labor is characterized by regular contractions that progressively
increase in frequency, duration, and intensity. False labor contractions are irregular
and often subside with walking or rest. Progressive cervical change is the most
reliable indicato r of true labor. The other statements describe characteristics of
false labor or are incomplete descriptions.
2. What is the expected date of delivery for a client whose last menstrual period
began on October 13?
A) July 20
B) July 27
C) August 13
D) August 20
Correct Answer: July 20
Rationale: Naegele's rule calculates the estimated date of delivery by subtracting
three months from the first day of the last menstrual period and adding seven days.
October 13 minus three months is July 13, plus seven days is July 20. This
calculation assumes a 28 - day cycle with ovulation on day 14.
,3. An Rh - negative mother at 28 weeks' gestation is scheduled to receive Rho(D)
immune globulin. The nurse explains that this medication prevents which condition?
A) Gestational diabetes
B) Rh sensitization
C) Preeclampsia
D) Preterm labor
Correct Answer: Rh sensitization
Rationale: Rho(D) immune globulin prevents an unsensitized Rh - negative client
from forming antibodies against Rh - positive fetal red blood cells. It is given at 28
weeks' gestation and within 72 hours after delivery of an Rh - positive infant. It does
not prevent gesta tional diabetes, preeclampsia, or preterm labor.
4. A client at 34 weeks of gestation is receiving magnesium sulfate for severe
preeclampsia. Which finding indicates magnesium toxicity?
A) Respiratory rate of 10/min
B) Hyperactive deep tendon reflexes
C) Urine output of 60 mL/hr
D) Blood pressure of 150/90 mm Hg
Correct Answer: Respiratory rate of 10/min
Rationale: Magnesium toxicity causes neuromuscular and respiratory depression. A
respiratory rate below 12/min is an important warning sign requiring immediate
intervention. Loss of deep tendon reflexes is an earlier sign, and urine output must
be monitored because magnesium is excreted renally. Blood pressure elevation is
not a sign of magnesium toxicity.
5. Which additional finding should the nurse monitor for in a client receiving
magnesium sulfate?
A) Increased deep tendon reflexes
B) Absent deep tendon reflexes
, C) Increased urine output
D) Tachycardia
Correct Answer: Absent deep tendon reflexes
Rationale: Loss of deep tendon reflexes is a classic manifestation of magnesium
toxicity. The nurse should assess deep tendon reflexes hourly and hold the infusion
if reflexes are absent. Increased reflexes, increased urine output, and tachycardia
are not signs of m agnesium toxicity.
6. Which finding is most important to monitor because magnesium sulfate is
primarily excreted through the kidneys?
A) Hourly urine output
B) Bowel sounds
C) Blood glucose
D) Fetal position
Correct Answer: Hourly urine output
Rationale: Reduced renal clearance can cause magnesium accumulation and
toxicity, so adequate urine output must be maintained. A urine output of at least 30
mL/hr is generally required. Bowel sounds, blood glucose, and fetal position are
important assessments but ar e not directly related to magnesium excretion.
7. Which cervical finding indicates that the client has entered the second stage of
labor?
A) 4 cm dilation
B) 6 cm dilation
C) 8 cm dilation
D) Complete dilation
Correct Answer: Complete dilation