NCM 107 RLE EXAM COMBINED
SET QUESTIONS WITH CORRECT
ANSWERS
The clinic nurse teaches the new nurse about pregnancy-induced blood clotting
changes. The nurse explains that a pregnant woman is at risk for venous thrombosis
due to (select all that apply):
a. Increased fibrinogen volume
b. Increased blood factor V
c. Increased blood factor X
d. Venous stasis - Answer- ANS: a, c, d
Although the platelet cell count does not change significantly during pregnancy,
fibrinogen volume has been shown to increase by as much as 50%. This alteration
leads to an increase in the sedimentation rate. Blood factors VII, VIII, IX, and X are also
increased, and this change causes hypercoagulability. The hypercoagulability state,
coupled with venous stasis (poor blood return from the lower extremities) places the
pregnant woman at an increased risk for venous thrombosis, embolism, and, when
complications are present, disseminated intravascular coagulation (DIC). Blood factor V
does not increase.
The clinic nurse describes possible interventions for the pregnant woman who is
experiencing pain and numbness in her wrists. The nurse suggests (select all that
apply):
a. Elevating the arms and wrists at night
b. Reassessment during the postpartum period
c. The use of "cock splints" to prevent wrist flexion
d. Massaging the hands and wrists with alcohol - Answer- ANS: a, b, c
Edema from vascular permeability can lead to a collection of fluid in the wrist that puts
pressure on the median nerve lying beneath the carpal ligament, leading to carpal
tunnel syndrome. Elevation of the hands at night may help to reduce the edema.
Occasionally, a woman may need to wear a "cock splint" to prevent the wrist from
flexing. Reassessment in the postpartum period is indicated because although carpal
tunnel syndrome usually subsides after the pregnancy has ended, some women may
require surgical treatment if symptoms persist. Massaging the hands and wrists with
alcohol does not improve pain and numbness.
The clinic nurse advocates for smoking cessation during pregnancy. Potential harmful
effects of prenatal tobacco use include (select all that apply):
a. Preterm birth
b. Gestational hypertension
c. Gestational diabetes
,d. Low birth weight - Answer- ANS: a, d
Nurses can help to improve the fetal environment by educating women about the
dangers of direct and passive smoking during pregnancy. Effects of tobacco use during
pregnancy are well documented and predispose to premature rupture of the
membranes, preterm labor, placental abruption, placenta previa, and infants who are
low birth weight or small for gestational age (SGA). Gestational hypertension and
diabetes are not associated with smoking during pregnancy.
Asking the pregnant woman about her use of recreational drugs is an essential
component of the prenatal history. Harmful fetal effects that may occur from recreational
drugs include (select all that apply):
a. Miscarriage/spontaneous abortion
b. Low birth weight
c. Macrosomia
d. Post-term labor/birth - Answer- ANS: a, b
Illegal or recreational drug use can have a number of detrimental effects on maternal
and fetal health, including spontaneous abortion, low birth weight, placental abruption,
and preterm labor.
The clinic nurse schedules Tracy for her first prenatal appointment with the certified
nurse-midwife (CNM) in the clinic. Tracy has appropriate questions for her potential
health-care provider that include (select all that apply):
a. Complementary and alternative methods used during labor and birth
b. An opportunity to meet other providers in the practice
c. Beliefs and practices concerning an episiotomy and an epidural anesthetic
d. Whether the nurse-midwife will be continually available for support during labor -
Answer- ANS: a, b, c
A woman's journey through the pregnancy experience can have long-term effects on
her self-perception and self-concept. Therefore, it is especially important that the patient
choose a care provider and group with whom she can openly relate and who shares the
same philosophical views on the management of pregnancy. At the first prenatal visit, it
is not common to explore whether the nurse-midwife will be continually available for
support during labor.
The clinic nurse explains to Margaret, a newly diagnosed pregnant woman at 10 weeks'
gestation, that her rubella titer indicates that she is not immune. Margaret should be
advised to (select all that apply):
a. Avoid contact with all children
b. Be retested in 3 months
c. Receive the rubella vaccine postpartum
d. Report signs or symptoms of fever, runny nose, and generalized red rash to the
health-care provider - Answer- ANS: c, d
Testing for rubella (German measles) is not necessary as titers are reliable indicators of
immunity. Rubella (German measles) is one of the most commonly recognized viral
infections known to cause congenital problems. If a woman contracts rubella during the
first 12 weeks of pregnancy, the fetus has a 90% chance of being adversely affected. A
,maternity patient who is not immune to rubella should be offered the rubella
immunization following childbirth, ideally prior to hospital discharge. The patient should
report signs or symptoms of rubella during pregnancy to her health-care provider. It is
not realistic for a woman to avoid contact with all children.
...
An overweight or obese pre-pregnancy weight increases the risk for which poor
maternal outcomes? (Select all that apply.)
a. Preeclampsia
b. Hemorrhage
c. Difficult delivery
d. Vaginal infections - Answer- ANS: a, b, c
Being overweight or obese can substantially increase perinatal risk; however, no data
support an increase in vaginal infections for the obese pregnant population.
Presumptive signs of pregnancy include (select all that apply):
a. Nausea
b. Fatigue
c. Ballottement
d. Amenorrhea - Answer- ANS: a, b, d
Nausea and vomiting, fatigue, and amenorrhea are all common during pregnancy and
are the presumptive signs of pregnancy. Ballottement is a probably sign, noted during a
vaginal exam.
73. Physiologic changes that occur in the renal system during pregnancy predispose the
pregnant woman to urinary tract infections (UTIs). Symptoms of a UTI include (select all
that apply):
a. Dysuria
b. Hematuria
c. Urgency
d. Delayed urination - Answer- ANS: a, b, c
Urinary tract infection (UTI) symptoms include dysuria, hematuria, and urgency.
74. Urinary tract infection (UTI) prevention measures during pregnancy include
counseling the pregnant woman to (select all that apply):
a. Delay urination until bladder is full
b. Limit hydration
c. Wipe from front to back
d. Urinate after intercourse - Answer- ANS: a, c, d
Anticipatory guidance for urinary tract infection prevention includes delaying urination,
wipe front to back, and maintaining adequate hydration.
75. Interventions for low back pain during pregnancy should include (select all that
apply):
a. Utilizing proper body mechanics
b. Applying ice or heat to affected area
, c. Avoiding pelvic rock and pelvic tilt
d. Using additional pillows for support during sleep - Answer- ANS: a, b, d
Interventions for back pain during pregnancy include utilizing proper body mechanics,
applying heat or ice to the area, using additional pillows during sleep, and not avoiding
pelvic rock/tilt, but encouraging pelvic rock/tilt.
76. Jorgina is a 24-year-old pregnant woman at 26 weeks' gestation. This is Jorgina's
third pregnancy, and her obstetrical history includes one full-term birth, one preterm
birth, and two living children. Today Jorgina arrives at the clinic with complaints of
fatigue, insomnia, and backache. She reports that she is a nurse on an oncology unit
and is worried about continuing with working her 12-hour shifts. The perinatal nurse
identifies concerns in Jorgina's history and work environment including (select all that
apply):
a. Risk of preterm birth
b. Presence of chemotherapeutic agents
c. Requirement for heavy lifting
d. History of diabetes - Answer- ANS: a, b, c
Women who are currently experiencing pregnancy complications and those who have a
history of pregnancy complications (such as history of preterm birth) or other preexisting
health disorders may be required to reduce their hours or stop working. The potential for
maternal exposure to toxic substances such as chemotherapeutic agents, lead, and
ionizing radiation (found in laboratories and health-care facilities); heavy lifting; and use
of heavy machinery and other hazardous equipment should prompt reassignment to a
different work area. If reassignment is not possible, Jorgina may need to stop working
until the pregnancy has been completed. In this scenario there is no history of diabetes.
77. The clinic nurse is assessing the complete blood count results for Kim-Ly, a 23-
year-old pregnant woman. Kim-Ly's hemoglobin is 9.8 g/dL. This laboratory finding
places Kim-Ly's pregnancy at risk for (select all that apply):
a. Preterm birth
b. Placental abruption
c. Intrauterine growth restriction
d. Thrombocytopenia - Answer- ANS: a, c
True anemia, or iron-deficiency anemia, occurs when the hemoglobin level drops below
10 g/dL. The blood's decreased oxygen-carrying capacity causes a reduction in oxygen
transport to the developing fetus. Decreased fetal oxygen transport has been
associated with intrauterine growth restriction (IUGR) and preterm birth. There is not a
risk factor for abruption or thrombocytopenia.
78. Teera is a 22-year-old woman who is experiencing her third pregnancy. Her
obstetrical history includes one first-trimester elective abortion and one first-trimester
spontaneous abortion. Teera is a semi-vegetarian who drinks milk and eats yogurt and
fish as part of her daily intake. The perinatal nurse discusses Teera's diet with her as
she may be deficient in (select all that apply):
a. Iron
b. Magnesium
SET QUESTIONS WITH CORRECT
ANSWERS
The clinic nurse teaches the new nurse about pregnancy-induced blood clotting
changes. The nurse explains that a pregnant woman is at risk for venous thrombosis
due to (select all that apply):
a. Increased fibrinogen volume
b. Increased blood factor V
c. Increased blood factor X
d. Venous stasis - Answer- ANS: a, c, d
Although the platelet cell count does not change significantly during pregnancy,
fibrinogen volume has been shown to increase by as much as 50%. This alteration
leads to an increase in the sedimentation rate. Blood factors VII, VIII, IX, and X are also
increased, and this change causes hypercoagulability. The hypercoagulability state,
coupled with venous stasis (poor blood return from the lower extremities) places the
pregnant woman at an increased risk for venous thrombosis, embolism, and, when
complications are present, disseminated intravascular coagulation (DIC). Blood factor V
does not increase.
The clinic nurse describes possible interventions for the pregnant woman who is
experiencing pain and numbness in her wrists. The nurse suggests (select all that
apply):
a. Elevating the arms and wrists at night
b. Reassessment during the postpartum period
c. The use of "cock splints" to prevent wrist flexion
d. Massaging the hands and wrists with alcohol - Answer- ANS: a, b, c
Edema from vascular permeability can lead to a collection of fluid in the wrist that puts
pressure on the median nerve lying beneath the carpal ligament, leading to carpal
tunnel syndrome. Elevation of the hands at night may help to reduce the edema.
Occasionally, a woman may need to wear a "cock splint" to prevent the wrist from
flexing. Reassessment in the postpartum period is indicated because although carpal
tunnel syndrome usually subsides after the pregnancy has ended, some women may
require surgical treatment if symptoms persist. Massaging the hands and wrists with
alcohol does not improve pain and numbness.
The clinic nurse advocates for smoking cessation during pregnancy. Potential harmful
effects of prenatal tobacco use include (select all that apply):
a. Preterm birth
b. Gestational hypertension
c. Gestational diabetes
,d. Low birth weight - Answer- ANS: a, d
Nurses can help to improve the fetal environment by educating women about the
dangers of direct and passive smoking during pregnancy. Effects of tobacco use during
pregnancy are well documented and predispose to premature rupture of the
membranes, preterm labor, placental abruption, placenta previa, and infants who are
low birth weight or small for gestational age (SGA). Gestational hypertension and
diabetes are not associated with smoking during pregnancy.
Asking the pregnant woman about her use of recreational drugs is an essential
component of the prenatal history. Harmful fetal effects that may occur from recreational
drugs include (select all that apply):
a. Miscarriage/spontaneous abortion
b. Low birth weight
c. Macrosomia
d. Post-term labor/birth - Answer- ANS: a, b
Illegal or recreational drug use can have a number of detrimental effects on maternal
and fetal health, including spontaneous abortion, low birth weight, placental abruption,
and preterm labor.
The clinic nurse schedules Tracy for her first prenatal appointment with the certified
nurse-midwife (CNM) in the clinic. Tracy has appropriate questions for her potential
health-care provider that include (select all that apply):
a. Complementary and alternative methods used during labor and birth
b. An opportunity to meet other providers in the practice
c. Beliefs and practices concerning an episiotomy and an epidural anesthetic
d. Whether the nurse-midwife will be continually available for support during labor -
Answer- ANS: a, b, c
A woman's journey through the pregnancy experience can have long-term effects on
her self-perception and self-concept. Therefore, it is especially important that the patient
choose a care provider and group with whom she can openly relate and who shares the
same philosophical views on the management of pregnancy. At the first prenatal visit, it
is not common to explore whether the nurse-midwife will be continually available for
support during labor.
The clinic nurse explains to Margaret, a newly diagnosed pregnant woman at 10 weeks'
gestation, that her rubella titer indicates that she is not immune. Margaret should be
advised to (select all that apply):
a. Avoid contact with all children
b. Be retested in 3 months
c. Receive the rubella vaccine postpartum
d. Report signs or symptoms of fever, runny nose, and generalized red rash to the
health-care provider - Answer- ANS: c, d
Testing for rubella (German measles) is not necessary as titers are reliable indicators of
immunity. Rubella (German measles) is one of the most commonly recognized viral
infections known to cause congenital problems. If a woman contracts rubella during the
first 12 weeks of pregnancy, the fetus has a 90% chance of being adversely affected. A
,maternity patient who is not immune to rubella should be offered the rubella
immunization following childbirth, ideally prior to hospital discharge. The patient should
report signs or symptoms of rubella during pregnancy to her health-care provider. It is
not realistic for a woman to avoid contact with all children.
...
An overweight or obese pre-pregnancy weight increases the risk for which poor
maternal outcomes? (Select all that apply.)
a. Preeclampsia
b. Hemorrhage
c. Difficult delivery
d. Vaginal infections - Answer- ANS: a, b, c
Being overweight or obese can substantially increase perinatal risk; however, no data
support an increase in vaginal infections for the obese pregnant population.
Presumptive signs of pregnancy include (select all that apply):
a. Nausea
b. Fatigue
c. Ballottement
d. Amenorrhea - Answer- ANS: a, b, d
Nausea and vomiting, fatigue, and amenorrhea are all common during pregnancy and
are the presumptive signs of pregnancy. Ballottement is a probably sign, noted during a
vaginal exam.
73. Physiologic changes that occur in the renal system during pregnancy predispose the
pregnant woman to urinary tract infections (UTIs). Symptoms of a UTI include (select all
that apply):
a. Dysuria
b. Hematuria
c. Urgency
d. Delayed urination - Answer- ANS: a, b, c
Urinary tract infection (UTI) symptoms include dysuria, hematuria, and urgency.
74. Urinary tract infection (UTI) prevention measures during pregnancy include
counseling the pregnant woman to (select all that apply):
a. Delay urination until bladder is full
b. Limit hydration
c. Wipe from front to back
d. Urinate after intercourse - Answer- ANS: a, c, d
Anticipatory guidance for urinary tract infection prevention includes delaying urination,
wipe front to back, and maintaining adequate hydration.
75. Interventions for low back pain during pregnancy should include (select all that
apply):
a. Utilizing proper body mechanics
b. Applying ice or heat to affected area
, c. Avoiding pelvic rock and pelvic tilt
d. Using additional pillows for support during sleep - Answer- ANS: a, b, d
Interventions for back pain during pregnancy include utilizing proper body mechanics,
applying heat or ice to the area, using additional pillows during sleep, and not avoiding
pelvic rock/tilt, but encouraging pelvic rock/tilt.
76. Jorgina is a 24-year-old pregnant woman at 26 weeks' gestation. This is Jorgina's
third pregnancy, and her obstetrical history includes one full-term birth, one preterm
birth, and two living children. Today Jorgina arrives at the clinic with complaints of
fatigue, insomnia, and backache. She reports that she is a nurse on an oncology unit
and is worried about continuing with working her 12-hour shifts. The perinatal nurse
identifies concerns in Jorgina's history and work environment including (select all that
apply):
a. Risk of preterm birth
b. Presence of chemotherapeutic agents
c. Requirement for heavy lifting
d. History of diabetes - Answer- ANS: a, b, c
Women who are currently experiencing pregnancy complications and those who have a
history of pregnancy complications (such as history of preterm birth) or other preexisting
health disorders may be required to reduce their hours or stop working. The potential for
maternal exposure to toxic substances such as chemotherapeutic agents, lead, and
ionizing radiation (found in laboratories and health-care facilities); heavy lifting; and use
of heavy machinery and other hazardous equipment should prompt reassignment to a
different work area. If reassignment is not possible, Jorgina may need to stop working
until the pregnancy has been completed. In this scenario there is no history of diabetes.
77. The clinic nurse is assessing the complete blood count results for Kim-Ly, a 23-
year-old pregnant woman. Kim-Ly's hemoglobin is 9.8 g/dL. This laboratory finding
places Kim-Ly's pregnancy at risk for (select all that apply):
a. Preterm birth
b. Placental abruption
c. Intrauterine growth restriction
d. Thrombocytopenia - Answer- ANS: a, c
True anemia, or iron-deficiency anemia, occurs when the hemoglobin level drops below
10 g/dL. The blood's decreased oxygen-carrying capacity causes a reduction in oxygen
transport to the developing fetus. Decreased fetal oxygen transport has been
associated with intrauterine growth restriction (IUGR) and preterm birth. There is not a
risk factor for abruption or thrombocytopenia.
78. Teera is a 22-year-old woman who is experiencing her third pregnancy. Her
obstetrical history includes one first-trimester elective abortion and one first-trimester
spontaneous abortion. Teera is a semi-vegetarian who drinks milk and eats yogurt and
fish as part of her daily intake. The perinatal nurse discusses Teera's diet with her as
she may be deficient in (select all that apply):
a. Iron
b. Magnesium
