MATERNAL CHILD NURSING EXAM 3 PRACTICE QUESTIONS AND RATIO-
NALES
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1. At what age is a woman who d. After 35 years old
becomes pregnant for the first
time described as an "elderly Rationale: A woman over the age of 35 who becomes preg-
primip"? nant for the first time is described as an "elderly primip."
a. After 25 years old
b. After 28 years old
c. After 30 years old
d. After 35 years old
2. The health care provider asks A. Lithotomy
the nurse to prepare the client
for a pelvic examination. The RATIONALE: The lithotomy position is the standard position
nurse correctly assists the used for pelvic examinations because it provides optimal vi-
client into what position? sualization and access to the perineal and pelvic structures.
A. Lithotomy Rationales for each option:
B. Prone A. Lithotomy Correct. The client lies on the back with hips
C. Sims and knees flexed and feet supported in stirrups for pelvic
D. Trendelenburg examination.
B. Prone Incorrect. The client lies face down. This position is
not used for pelvic exams.
C. Sims Incorrect. A side-lying position mainly used for rectal
exams, enemas, and some procedures.
D. Trendelenburg Incorrect. The body is tilted with the head
lower than the feet. This is not used for routine pelvic exami-
nations.
3.
, MATERNAL CHILD NURSING EXAM 3 PRACTICE QUESTIONS AND RATIO-
NALES
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The nurse in the OB-GYN clinic CORRECT ANSWERS: A, C, D
is working with a client who
is seeking her initial prenatal
Rationale:
visit. The nurse will use the
TPAL is a system used to summarize a client's obstetric histo-
acronym TPAL to document
ry.
the client's number of which
T = Term births P = Preterm births A = Abortions or miscar-
of the following? Select all that
riages (spontaneous or elective before viability) L = Living
apply.
children
A. Term infants born
Rationales for each option:
B. Children living in the home
A. Term infants born Correct. "T" in TPAL refers to pregnancies
C. Pregnancies ending in abor-
carried to term (37 weeks or greater).
tion
D. Preterm infants born
B. Children living in the home Incorrect. This is not part of
E. Pregnancies that occurred
TPAL. Only living children related to pregnancies are counted,
and they fall under "L," not general household children.
C. Pregnancies ending in abortion Correct. "A" represents
abortions or miscarriages.
D. Preterm infants born Correct. "P" represents births before
37 weeks gestation.
E. Pregnancies that occurred Incorrect. Total pregnancies are
not part of TPAL. That is recorded separately as gravida (G) in
GTPAL.
4. A pregnant client in the first B. The vaginal discharge may be bothersome but it is a normal
trimester, calls the nurse at occurrence
a health care clinic and re-
ports that they have no- RATIONALE: A thin, colorless or white vaginal discharge in the
, MATERNAL CHILD NURSING EXAM 3 PRACTICE QUESTIONS AND RATIO-
NALES
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ticed a thin, colorless vaginal first trimester is known as leukorrhea. It is a completely normal
drainage. The nurse should occurrence caused by increased estrogen levels and pelvic
make which statement to the blood flow
client?
A. Come to the clinic immedi-
ately
B. The vaginal discharge may
be bothersome but it is a nor-
mal occurrence
C. Report to the emergency
department at the maternity
center immediately
D. Use tampons if the dis-
charge is bothersome but be
sure to change the tampon
every 2 hours
5. A nonstress test is performed A. a normal test result
on a client who is pregnant,
and the results of the test rationale:
indicate nonreactive findings. Contraction stress test results may be interpreted as negative
The PHCP orders a contrac- (normal), positive (abnormal), or equivocal. A negative test
tion stress test, and the results result indicates that no late decelerations occurred in the fetal
are documented as negative. heart rate, although the fetus was stressed by 3 contractions
How would the nurse docu- of at least 40 seconds' duration in a 10-minute period.
ment this finding?
A. a normal test result
B. an abnormal test result
C. A high risk for fetal demise
, MATERNAL CHILD NURSING EXAM 3 PRACTICE QUESTIONS AND RATIO-
NALES
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D. the need for a cesarean sec-
tion
6. Nurses should be aware that a. is an accurate indicator of impending fetal death.
the biophysical profile (BPP):
An abnormal BPP score is an indication that labor should be
a. is an accurate indicator of induced. The BPP evaluates the health of the fetus, requires
impending fetal death. many different measures, and is a noninvasive procedure.
b. is a compilation of health
risk factors of the mother dur-
ing the later stages of preg-
nancy.
c. consists of a Doppler blood
flow analysis and an amniotic
fluid index.
d. involves an invasive form of
ultrasound examination.
7. A pregnant woman's biophys- a. "The test results are within normal limits."
ical profile score is 8. She
asks the nurse to explain the RATIONALE: The normal biophysical score ranges from 8 to 10
results. The nurse's best re- points if the amniotic fluid volume is adequate. A normal score
sponse is: allows conservative treatment of high risk patients. Delivery
can be delayed if fetal well-being is indicated. Scores less
a. "The test results are within than 4 should be investigated, and delivery could be initiated
normal limits." sooner than planned. This score is within normal range, and
b. "Immediate delivery by ce- no further testing is required at this time. The results of the
sarean birth is being consid- biophysical profile are usually available immediately after the
ered." procedure is performed.
NALES
Study online at https://quizlet.com/_jio3by
1. At what age is a woman who d. After 35 years old
becomes pregnant for the first
time described as an "elderly Rationale: A woman over the age of 35 who becomes preg-
primip"? nant for the first time is described as an "elderly primip."
a. After 25 years old
b. After 28 years old
c. After 30 years old
d. After 35 years old
2. The health care provider asks A. Lithotomy
the nurse to prepare the client
for a pelvic examination. The RATIONALE: The lithotomy position is the standard position
nurse correctly assists the used for pelvic examinations because it provides optimal vi-
client into what position? sualization and access to the perineal and pelvic structures.
A. Lithotomy Rationales for each option:
B. Prone A. Lithotomy Correct. The client lies on the back with hips
C. Sims and knees flexed and feet supported in stirrups for pelvic
D. Trendelenburg examination.
B. Prone Incorrect. The client lies face down. This position is
not used for pelvic exams.
C. Sims Incorrect. A side-lying position mainly used for rectal
exams, enemas, and some procedures.
D. Trendelenburg Incorrect. The body is tilted with the head
lower than the feet. This is not used for routine pelvic exami-
nations.
3.
, MATERNAL CHILD NURSING EXAM 3 PRACTICE QUESTIONS AND RATIO-
NALES
Study online at https://quizlet.com/_jio3by
The nurse in the OB-GYN clinic CORRECT ANSWERS: A, C, D
is working with a client who
is seeking her initial prenatal
Rationale:
visit. The nurse will use the
TPAL is a system used to summarize a client's obstetric histo-
acronym TPAL to document
ry.
the client's number of which
T = Term births P = Preterm births A = Abortions or miscar-
of the following? Select all that
riages (spontaneous or elective before viability) L = Living
apply.
children
A. Term infants born
Rationales for each option:
B. Children living in the home
A. Term infants born Correct. "T" in TPAL refers to pregnancies
C. Pregnancies ending in abor-
carried to term (37 weeks or greater).
tion
D. Preterm infants born
B. Children living in the home Incorrect. This is not part of
E. Pregnancies that occurred
TPAL. Only living children related to pregnancies are counted,
and they fall under "L," not general household children.
C. Pregnancies ending in abortion Correct. "A" represents
abortions or miscarriages.
D. Preterm infants born Correct. "P" represents births before
37 weeks gestation.
E. Pregnancies that occurred Incorrect. Total pregnancies are
not part of TPAL. That is recorded separately as gravida (G) in
GTPAL.
4. A pregnant client in the first B. The vaginal discharge may be bothersome but it is a normal
trimester, calls the nurse at occurrence
a health care clinic and re-
ports that they have no- RATIONALE: A thin, colorless or white vaginal discharge in the
, MATERNAL CHILD NURSING EXAM 3 PRACTICE QUESTIONS AND RATIO-
NALES
Study online at https://quizlet.com/_jio3by
ticed a thin, colorless vaginal first trimester is known as leukorrhea. It is a completely normal
drainage. The nurse should occurrence caused by increased estrogen levels and pelvic
make which statement to the blood flow
client?
A. Come to the clinic immedi-
ately
B. The vaginal discharge may
be bothersome but it is a nor-
mal occurrence
C. Report to the emergency
department at the maternity
center immediately
D. Use tampons if the dis-
charge is bothersome but be
sure to change the tampon
every 2 hours
5. A nonstress test is performed A. a normal test result
on a client who is pregnant,
and the results of the test rationale:
indicate nonreactive findings. Contraction stress test results may be interpreted as negative
The PHCP orders a contrac- (normal), positive (abnormal), or equivocal. A negative test
tion stress test, and the results result indicates that no late decelerations occurred in the fetal
are documented as negative. heart rate, although the fetus was stressed by 3 contractions
How would the nurse docu- of at least 40 seconds' duration in a 10-minute period.
ment this finding?
A. a normal test result
B. an abnormal test result
C. A high risk for fetal demise
, MATERNAL CHILD NURSING EXAM 3 PRACTICE QUESTIONS AND RATIO-
NALES
Study online at https://quizlet.com/_jio3by
D. the need for a cesarean sec-
tion
6. Nurses should be aware that a. is an accurate indicator of impending fetal death.
the biophysical profile (BPP):
An abnormal BPP score is an indication that labor should be
a. is an accurate indicator of induced. The BPP evaluates the health of the fetus, requires
impending fetal death. many different measures, and is a noninvasive procedure.
b. is a compilation of health
risk factors of the mother dur-
ing the later stages of preg-
nancy.
c. consists of a Doppler blood
flow analysis and an amniotic
fluid index.
d. involves an invasive form of
ultrasound examination.
7. A pregnant woman's biophys- a. "The test results are within normal limits."
ical profile score is 8. She
asks the nurse to explain the RATIONALE: The normal biophysical score ranges from 8 to 10
results. The nurse's best re- points if the amniotic fluid volume is adequate. A normal score
sponse is: allows conservative treatment of high risk patients. Delivery
can be delayed if fetal well-being is indicated. Scores less
a. "The test results are within than 4 should be investigated, and delivery could be initiated
normal limits." sooner than planned. This score is within normal range, and
b. "Immediate delivery by ce- no further testing is required at this time. The results of the
sarean birth is being consid- biophysical profile are usually available immediately after the
ered." procedure is performed.
