Maternal and Child Health Nursing Exam 1 B. Modify preoperative teaching to meet the needs of either a
planned or emergency cesarean birth.
1. A client asks the nurse what a third degree laceration is. She was
informed that she had one. The nurse explains that this is: C. Arrange for a staff member of the anesthesia department to
explain what to expect post-operatively.
A. that extended their anal sphincter
D. Instruct the mother’s support person to remain in the family
B. through the skin and into the muscles lounge until after the delivery.
C. that involves anterior rectal wall 7. Bettine Gonzales is hospitalized for the treatment of severe
preecplampsia. Which of the following represents an unusual finding
for this condition?
D. that extends through the perineal muscle.
A. generalized edema
2. Betina 30 weeks AOG discharged with a diagnosis of placenta
previa. The nurse knows that the client understands her care at home
when she says: B. proteinuria 4+
A. I am happy to note that we can have sex occasionally when I C. blood pressure of 160/110
have no bleeding.
D. convulsions
B. I am afraid I might have an operation when my due comes
8. Nurse Geli explains to the client who is 33 weeks pregnant and is
C. I will have to remain in bed until my due date comes experiencing vaginal bleeding that coitus:
D. I may go back to work since I stay only at the office. A. Need to be modified in any way by either partner
3. The uterus has already risen out of the pelvis and is experiencing B. Is permitted if penile penetration is not deep.
farther into the abdominal area at about the:
C. Should be restricted because it may stimulate uterine activity.
A. 8th week of pregnancy
D. Is safe as long as she is in side-lying position.
B. 10th week of pregnancy
9. Mrs. Precilla Abuel, a 32 year old mulripara is admitted to labor
C. 12th week of pregnancy and delivery. Her last 3 pregnancies in short stage one of labor. The
nurses decide to observe her closely. The physician determines that
Mrs. Abuel’s cervix is dilated to 6 cm. Mrs. Abuel states that she is
D. 18th week of pregnancy
extremely uncomfortable. To lessen Mrs. Abuel’s discomfort, the
nurse can advise her to:
4. Which of the following urinary symptoms does the pregnant
woman most frequently experience during the first trimester:
A. lie face down
A. frequency
B. not drink fluids
B. dysuria
C. practice holding breaths between contractions
C. incontinence
D. assume Sim’s position
D. burning
10. Which is true regarding the fontanels of the newborn?
5. Mrs. Jimenez went to the health center for pre-natal check-up. the
A. The anterior is large in shape when compared to the posterior
student nurse took her weight and revealed 142 lbs. She asked the
fontanel.
student nurse how much should she gain weight in her pregnancy.
B. The anterior is triangular shaped; the posterior is diamond
A. 20-30 lbs
shaped.
B. 25-35 lbs
C. The anterior is bulging; the posterior appears sunken.
C. 30- 40 lbs
D. The posterior closes at 18 months; the anterior closes at 8 to 12
months.
D. 10-15 lbs
11. Mrs. Quijones gave birth by spontaneous delivery to a full term
6. The nurse is preparing Mrs. Jordan for cesarean delivery. Which of baby boy. After a minute after birth, he is crying and moving actively.
the following key concept should the nurse consider when His birth weight is 6.8 lbs. What do you expect baby Quijones to
implementing nursing care? weigh at 6 months?
A. Explain the surgery, expected outcome and kind of anesthetics.
,A. 13 -14 lbs 17. Which of the following situations would alert you to a potentially
developmental problem with a child?
B. 16 -17 lbs
A. Pointing to body parts at 15 months of age.
C. 22 -23 lbs
B. Using gesture to communicate at 18 months.
D. 27 -28 lbs
C. Cooing at 3 months.
12. During the first hours following delivery, the post partum client is
given IVF with oxytocin added to them. The nurse understands the D. Saying “mama” or “dada” for the first time at 18 months of age.
primary reason for this is:
18. Isabelle, a 2 year old girl loves to move around and oftentimes
A. To facilitate elimination manifests negativism and temper tantrums. What is the best way to
deal with her behavior?
B. To promote uterine contraction
A. Tell her that she would not be loved by others is she behaves that
C. To promote analgesia way..
D. To prevent infection B. Withholding giving her toys until she behaves properly.
13. Nurse Luis is assessing the newborn’s heart rate. Which of the C. Ignore her behavior as long as she does not hurt herself and
following would be considered normal if the newborn is sleeping? others.
A. 80 beats per minute D. Ask her what she wants and give it to pacify her.
B. 100 beats per minute 19. Baby boy Villanueva, 4 months old, was seen at the pediatric
clinic for his scheduled check-up. By this period, baby Villanueva has
C. 120 beats per minute already increased his height by how many inches?
D. 140 beats per minute A. 3 inches
14. The infant with Down Syndrome should go through which of the B. 4 inches
Erikson’s developmental stages first?
C. 5 inches
A. Initiative vs. Self doubt
D. 6 inches
B. Industry vs. Inferiority
20. Alice, 10 years old was brought to the ER because of Asthma. She
C. Autonomy vs. Shame and doubt was immediately put under aerosol administration of Terbutaline.
After sometime, you observe that the child does not show any relief
from the treatment given. Upon assessment, you noticed that both the
D. Trust vs. Mistrust
heart and respiratory rate are still elevated and the child shows
difficulty of exhaling. You suspect:
15. The child with phenylketonuria (PKU) must maintain a low
phenylalanine diet to prevent which of the following complications?
A. Bronchiectasis
A. Irreversible brain damage
B. Atelectasis
B. Kidney failure
C. Epiglotitis
C. Blindness
D. Status Asthmaticus
D. Neutropenia
21. Nurse Jonas assesses a 2 year old boy with a tentative diagnosis
of nephroblastoma. Symptoms the nurse observes that suggest this
16. Which age group is with imaginative minds and creates imaginary problem include:
friends?
A. Lymphedema and nerve palsy
A. Toddler
B. Hearing loss and ataxia
B. Preschool
C. Headaches and vomiting
C. School
D. Abdominal mass and weakness
D. Adolescence
, 22. Which of the following danger sings should be reported On the 18th week, the uterus has already risen out of the pelvis
immediately during the antepartum period? and is expanding into the abdominal area.
A. blurred vision 4. (A) frequency. Pressure and irritation of the bladder by the
growing uterus during the first trimester is responsible for
B. nasal stuffiness causing urinary frequency. Dysuria, incontinence and burning
are symptoms associated with urinary tract infection.
C. breast tenderness
5. (B) 25-35 lbs. A weight gain of 11. 2 to 15.9 kg (25 to 35 lbs) is
D. constipation currently recommended as an average weight gain in pregnancy.
This weight gain consists of the following: fetus- 7.5 lb;
23. Nurse Jacob is assessing a 15 month old child with acute otitis placenta- 1.5 lb; amniotic fluid- 2 lb; uterus- 2.5 lb; breasts- 1.5
to 3 lb; blood volume- 4 lb; body fat- 7 lb; body fluid- 7 lb.
media. Which of the following symptoms would the nurse anticipate
finding?
6. (B) Modify preoperative teaching to meet the needs of either
A. periorbital edema, absent light reflex and translucent tympanic a planned or emergency cesarean birth. A key point to
membrane consider when preparing the client for a cesarean delivery is to
modify the preoperative teaching to meet the needs of either
planned or emergency cesarean birth, the depth and breadth of
B. irritability, purulent drainage in middle ear, nasal congestion and
instruction will depend on circumstances and time available.
cough
7. (D) convulsions. Options A, B and C are findings of severe
C. diarrhea, retracted tympanic membrane and enlarged parotid
preeclampsia. Convulsions is a finding of eclampsia—an
gland
obstetrical emergency.
D. Vomiting, pulling at ears and pearly white tympanic membrane
8. (C) Should be restricted because it may stimulate uterine
activity.. Coitus is restricted when there is watery discharge,
24. Which of the following is the most appropriate intervention to uterine contraction and vaginal bleeding. Also those women with
reduce stress in a preterm infant at 33 weeks gestation? a history of spontaneous miscarriage may be advised to avoid
coitus during the time of pregnancy when a previous miscarriage
A. Sensory stimulation including several senses at a time occurred.
B. tactile stimulation until signs of over stimulation develop 9. (D) assume Sim’s position. When the woman is in Sim’s
position, this puts the weight of the fetus on bed, not on the
C. An attitude of extension when prone or side lying woman and allows good circulation in the lower extremities.
D. Kangaroo care 10. (A) The anterior is large in shape when compared to the
posterior fontanel.. The anterior fontanel is larger in size than
25. The parent of a client with albinism would need to be taught which the posterior fontanel. Additionally, the anterior fontanel, which
preventive healthcare measure by the nurse: is diamond shaped closes at 18 month, whereas the posterior
fontanel, which is triangular in shape closes at 8 to 12 weeks.
A. Ulcerative colitis diet Neither fontanel should appear bulging, which may indicate
increases ICP or sunken, which may indicate hydration.
B. Use of a high-SPF sunblock
11. (A) 13 -14 lbs. The birth weight of an infant is doubled at 6
C. Hair loss monitoring months and is tripled at 12 months.
D. Monitor for growth retardation 12. (B) To promote uterine contraction. Oxytocin is a hormone
produced by the pituitary gland that produces intermittent
uterine contractions, helping to promote uterine involution.
Answers and Rationales
13. (B) 100 beats per minute. The normal heart rate for a newborn
1. (A) that extended their anal sphincter. Third degree laceration that is sleeping is approximately 100 beats per minute. If the
involves all in the second degree laceration and the external newborn was awake, the normal heart rate would range from 120
sphincter of the rectum. Options B, C and D are under the second to 160 beats per minute.
degree laceration.
14. (D) Trust vs. Mistrust. The child with Down syndrome will go
2. (C) I will have to remain in bed until my due date through the same first stage, trust vs. mistrust, only at a slow rate.
comes. Placenta previa means that the placenta is the presenting Therefore, the nurse should concentrate on developing on bond
part. On the first and second trimester there is spotting. On the between the primary caregiver and the child.
third trimester there is bleeding that is sudden, profuse and
painless.
15. (A) Irreversible brain damage. The child with PKU must
maintain a strict low phenylalanine diet to prevent central
3. (D) 18th week of pregnancy. On the 8th week of pregnancy, nervous system damage, seizures and eventual death.
the uterus is still within the pelvic area. On the 10th week, the
uterus is still within the pelvic area. On the 12th week, the uterus
16. (B) Preschool. During preschool, this is the time when children
and placenta have grown, expanding into the abdominal cavity.
do imitative play, imaginative play—the occurrence of
planned or emergency cesarean birth.
1. A client asks the nurse what a third degree laceration is. She was
informed that she had one. The nurse explains that this is: C. Arrange for a staff member of the anesthesia department to
explain what to expect post-operatively.
A. that extended their anal sphincter
D. Instruct the mother’s support person to remain in the family
B. through the skin and into the muscles lounge until after the delivery.
C. that involves anterior rectal wall 7. Bettine Gonzales is hospitalized for the treatment of severe
preecplampsia. Which of the following represents an unusual finding
for this condition?
D. that extends through the perineal muscle.
A. generalized edema
2. Betina 30 weeks AOG discharged with a diagnosis of placenta
previa. The nurse knows that the client understands her care at home
when she says: B. proteinuria 4+
A. I am happy to note that we can have sex occasionally when I C. blood pressure of 160/110
have no bleeding.
D. convulsions
B. I am afraid I might have an operation when my due comes
8. Nurse Geli explains to the client who is 33 weeks pregnant and is
C. I will have to remain in bed until my due date comes experiencing vaginal bleeding that coitus:
D. I may go back to work since I stay only at the office. A. Need to be modified in any way by either partner
3. The uterus has already risen out of the pelvis and is experiencing B. Is permitted if penile penetration is not deep.
farther into the abdominal area at about the:
C. Should be restricted because it may stimulate uterine activity.
A. 8th week of pregnancy
D. Is safe as long as she is in side-lying position.
B. 10th week of pregnancy
9. Mrs. Precilla Abuel, a 32 year old mulripara is admitted to labor
C. 12th week of pregnancy and delivery. Her last 3 pregnancies in short stage one of labor. The
nurses decide to observe her closely. The physician determines that
Mrs. Abuel’s cervix is dilated to 6 cm. Mrs. Abuel states that she is
D. 18th week of pregnancy
extremely uncomfortable. To lessen Mrs. Abuel’s discomfort, the
nurse can advise her to:
4. Which of the following urinary symptoms does the pregnant
woman most frequently experience during the first trimester:
A. lie face down
A. frequency
B. not drink fluids
B. dysuria
C. practice holding breaths between contractions
C. incontinence
D. assume Sim’s position
D. burning
10. Which is true regarding the fontanels of the newborn?
5. Mrs. Jimenez went to the health center for pre-natal check-up. the
A. The anterior is large in shape when compared to the posterior
student nurse took her weight and revealed 142 lbs. She asked the
fontanel.
student nurse how much should she gain weight in her pregnancy.
B. The anterior is triangular shaped; the posterior is diamond
A. 20-30 lbs
shaped.
B. 25-35 lbs
C. The anterior is bulging; the posterior appears sunken.
C. 30- 40 lbs
D. The posterior closes at 18 months; the anterior closes at 8 to 12
months.
D. 10-15 lbs
11. Mrs. Quijones gave birth by spontaneous delivery to a full term
6. The nurse is preparing Mrs. Jordan for cesarean delivery. Which of baby boy. After a minute after birth, he is crying and moving actively.
the following key concept should the nurse consider when His birth weight is 6.8 lbs. What do you expect baby Quijones to
implementing nursing care? weigh at 6 months?
A. Explain the surgery, expected outcome and kind of anesthetics.
,A. 13 -14 lbs 17. Which of the following situations would alert you to a potentially
developmental problem with a child?
B. 16 -17 lbs
A. Pointing to body parts at 15 months of age.
C. 22 -23 lbs
B. Using gesture to communicate at 18 months.
D. 27 -28 lbs
C. Cooing at 3 months.
12. During the first hours following delivery, the post partum client is
given IVF with oxytocin added to them. The nurse understands the D. Saying “mama” or “dada” for the first time at 18 months of age.
primary reason for this is:
18. Isabelle, a 2 year old girl loves to move around and oftentimes
A. To facilitate elimination manifests negativism and temper tantrums. What is the best way to
deal with her behavior?
B. To promote uterine contraction
A. Tell her that she would not be loved by others is she behaves that
C. To promote analgesia way..
D. To prevent infection B. Withholding giving her toys until she behaves properly.
13. Nurse Luis is assessing the newborn’s heart rate. Which of the C. Ignore her behavior as long as she does not hurt herself and
following would be considered normal if the newborn is sleeping? others.
A. 80 beats per minute D. Ask her what she wants and give it to pacify her.
B. 100 beats per minute 19. Baby boy Villanueva, 4 months old, was seen at the pediatric
clinic for his scheduled check-up. By this period, baby Villanueva has
C. 120 beats per minute already increased his height by how many inches?
D. 140 beats per minute A. 3 inches
14. The infant with Down Syndrome should go through which of the B. 4 inches
Erikson’s developmental stages first?
C. 5 inches
A. Initiative vs. Self doubt
D. 6 inches
B. Industry vs. Inferiority
20. Alice, 10 years old was brought to the ER because of Asthma. She
C. Autonomy vs. Shame and doubt was immediately put under aerosol administration of Terbutaline.
After sometime, you observe that the child does not show any relief
from the treatment given. Upon assessment, you noticed that both the
D. Trust vs. Mistrust
heart and respiratory rate are still elevated and the child shows
difficulty of exhaling. You suspect:
15. The child with phenylketonuria (PKU) must maintain a low
phenylalanine diet to prevent which of the following complications?
A. Bronchiectasis
A. Irreversible brain damage
B. Atelectasis
B. Kidney failure
C. Epiglotitis
C. Blindness
D. Status Asthmaticus
D. Neutropenia
21. Nurse Jonas assesses a 2 year old boy with a tentative diagnosis
of nephroblastoma. Symptoms the nurse observes that suggest this
16. Which age group is with imaginative minds and creates imaginary problem include:
friends?
A. Lymphedema and nerve palsy
A. Toddler
B. Hearing loss and ataxia
B. Preschool
C. Headaches and vomiting
C. School
D. Abdominal mass and weakness
D. Adolescence
, 22. Which of the following danger sings should be reported On the 18th week, the uterus has already risen out of the pelvis
immediately during the antepartum period? and is expanding into the abdominal area.
A. blurred vision 4. (A) frequency. Pressure and irritation of the bladder by the
growing uterus during the first trimester is responsible for
B. nasal stuffiness causing urinary frequency. Dysuria, incontinence and burning
are symptoms associated with urinary tract infection.
C. breast tenderness
5. (B) 25-35 lbs. A weight gain of 11. 2 to 15.9 kg (25 to 35 lbs) is
D. constipation currently recommended as an average weight gain in pregnancy.
This weight gain consists of the following: fetus- 7.5 lb;
23. Nurse Jacob is assessing a 15 month old child with acute otitis placenta- 1.5 lb; amniotic fluid- 2 lb; uterus- 2.5 lb; breasts- 1.5
to 3 lb; blood volume- 4 lb; body fat- 7 lb; body fluid- 7 lb.
media. Which of the following symptoms would the nurse anticipate
finding?
6. (B) Modify preoperative teaching to meet the needs of either
A. periorbital edema, absent light reflex and translucent tympanic a planned or emergency cesarean birth. A key point to
membrane consider when preparing the client for a cesarean delivery is to
modify the preoperative teaching to meet the needs of either
planned or emergency cesarean birth, the depth and breadth of
B. irritability, purulent drainage in middle ear, nasal congestion and
instruction will depend on circumstances and time available.
cough
7. (D) convulsions. Options A, B and C are findings of severe
C. diarrhea, retracted tympanic membrane and enlarged parotid
preeclampsia. Convulsions is a finding of eclampsia—an
gland
obstetrical emergency.
D. Vomiting, pulling at ears and pearly white tympanic membrane
8. (C) Should be restricted because it may stimulate uterine
activity.. Coitus is restricted when there is watery discharge,
24. Which of the following is the most appropriate intervention to uterine contraction and vaginal bleeding. Also those women with
reduce stress in a preterm infant at 33 weeks gestation? a history of spontaneous miscarriage may be advised to avoid
coitus during the time of pregnancy when a previous miscarriage
A. Sensory stimulation including several senses at a time occurred.
B. tactile stimulation until signs of over stimulation develop 9. (D) assume Sim’s position. When the woman is in Sim’s
position, this puts the weight of the fetus on bed, not on the
C. An attitude of extension when prone or side lying woman and allows good circulation in the lower extremities.
D. Kangaroo care 10. (A) The anterior is large in shape when compared to the
posterior fontanel.. The anterior fontanel is larger in size than
25. The parent of a client with albinism would need to be taught which the posterior fontanel. Additionally, the anterior fontanel, which
preventive healthcare measure by the nurse: is diamond shaped closes at 18 month, whereas the posterior
fontanel, which is triangular in shape closes at 8 to 12 weeks.
A. Ulcerative colitis diet Neither fontanel should appear bulging, which may indicate
increases ICP or sunken, which may indicate hydration.
B. Use of a high-SPF sunblock
11. (A) 13 -14 lbs. The birth weight of an infant is doubled at 6
C. Hair loss monitoring months and is tripled at 12 months.
D. Monitor for growth retardation 12. (B) To promote uterine contraction. Oxytocin is a hormone
produced by the pituitary gland that produces intermittent
uterine contractions, helping to promote uterine involution.
Answers and Rationales
13. (B) 100 beats per minute. The normal heart rate for a newborn
1. (A) that extended their anal sphincter. Third degree laceration that is sleeping is approximately 100 beats per minute. If the
involves all in the second degree laceration and the external newborn was awake, the normal heart rate would range from 120
sphincter of the rectum. Options B, C and D are under the second to 160 beats per minute.
degree laceration.
14. (D) Trust vs. Mistrust. The child with Down syndrome will go
2. (C) I will have to remain in bed until my due date through the same first stage, trust vs. mistrust, only at a slow rate.
comes. Placenta previa means that the placenta is the presenting Therefore, the nurse should concentrate on developing on bond
part. On the first and second trimester there is spotting. On the between the primary caregiver and the child.
third trimester there is bleeding that is sudden, profuse and
painless.
15. (A) Irreversible brain damage. The child with PKU must
maintain a strict low phenylalanine diet to prevent central
3. (D) 18th week of pregnancy. On the 8th week of pregnancy, nervous system damage, seizures and eventual death.
the uterus is still within the pelvic area. On the 10th week, the
uterus is still within the pelvic area. On the 12th week, the uterus
16. (B) Preschool. During preschool, this is the time when children
and placenta have grown, expanding into the abdominal cavity.
do imitative play, imaginative play—the occurrence of
