​ 1.

Worldwide, which of the following is the most common problem during

pregnancy?
​ A.Iron-deficiency Anemia
​ B. Urinary Tract Infection (UTI)
​ C. Heart Disease
​ D. Diabetes
​ E. Pre-Eclampsia
​
​ 2. In the United States, it appears that maternal mortality is increasing after
years of decline. To address this increase, efforts must be directed toward the
leading causes. Which of the following choices lists those leading causes?
​ A. Embolism, hypertension, and ectopic pregnancy
​ B. Infection, cardiomyopathy, and stroke
​ C. Complications related to abortion and anesthesia
​ D. Human immunodeficiency virus (HIV) and infections related to
immunodeficiency
​
​ 3.A patient presents with a positive pregnancy test, the exact date of the
start of her last normal menses, and the date of her luteinizing hormone (LH)
surge from a urine kit. Her expected date of delivery can most correctly be
calculated by which of the following?
​ A. Counting 280 from the first day of the LMP
​ B. Adding 254 to the date of the start of the last menstrual period (LMP)
​ C. Counting 10 lunar months from the time of ovulation
​ D. Counting 40 weeks from the last day of the LMP
​ E. Adding 256 to the date of the elevated urinary LH when detected by home
testing
​
​ 4. A friend mentions to you she just had a positive pregnancy test and
wonders if you can tell her when she is likely due. The LMP was June 30. Her
expected date of confinement (EDC) is approximate which of the following?
​ A. April 7
​ B. March 23
​ C. April 23
​ D. March 7
​
​ 5. A patient presents to your clinic complaining of nausea and vomiting. She
is currently ingesting combined oral contraceptive pills (OCP) and has used
them for over a year. When you tell her she has a positive pregnancy test,
she reports that her last bleeding on the OCPs was 8 weeks ago. In such a
situation, determine
​ A. Obtaining fetal biometry by ultrasound prior to 20 weeks’ gestation
​ B. Asking the patient when she first felt pregnant
​ C. Counting 280 days from the first positive serum pregnancy test
​ D. Assessing uterine size by physical examination
​ E. Eliciting when breast tenderness or morning sickness began
​
​ 6. A 24-year-old patient who has signs and symptoms of renal lithiasis is to
have an intravenous pyelogram (IVP) as part of a urologic investigation.
Before proceeding with the study, which of the following should you
determine?
​ A. Whether she may be pregnant
​ B. Whether she has a history of children with birth defects
​ C. Whether she is sexually active
​ D. Whether she is in the follicular phase of a menstrual cycle
​ E. Whether she is using contraception
​
​ 7. A 20-year-old primigrávida, who is 24 weeks pregnant, expresses concern
about the normality of her fetus after learning that a close friend has just
delivered an infant with hydrocephalus. Which of the following details about
hydrocephalus should be included in her counseling?
​ A. Has a multifactorial etiology
​ B. Occurs spontaneously in 1 in 500 pregnancies
​ C. Is usually an isolated defect
​ D. Can be cured by intrauterine placement of shunts
​ E. Can be identified as early as 10 weeks’ gestation
​
​ 8. Fundal height, part of the obstetric examination, is taken from the top of
the symphysis pubis to the top of the fundus. How is it measured?
​ A. In centimeters, approximating the weeks of gestation beyond 22 weeks
​ B. By calipers in centimeters, prognosticating the fetal weight
​ C. In centimeters and divided by 3.5, approximating the lunar months of
gestation
​ D. In inches, approximating the lunar month of gestation
​ E. By calipers, approximating the week of gestation
​
​ 9. Using your knowledge of normal maternal physiology, which of the
following would you employ if a patient at 38 weeks became faint while lying
supine on your examination table?
​ A. Turning the patient on her side
​ B. Aromatic ammonia spirit (smelling salts)
​ C. Oxygen by face mask
​ D. Intravenous (IV) drugs to increase blood pressure
​ E. IV saline solution
​
​ 10. A woman in early pregnancy is worried because of some recent
discomfort in her left breast. On examination, her skin appears normal, she
has no axillary or clavicular adenopathy, but you palpate a smooth,
nontender, 2-cm mass. Your immediate management should be which of the
following?
​ A. Breast ultrasound
​ B. Needle aspiration of the mass
​ C. Excisional biopsies of the mass
​ D. Mammography
​ E. Warm compresses and antibiotics
​
​ 11. The management of vaginal bleeding in a first-trimester pregnancy
requires a trending of human chorionic gonadotropin (hCG) levels. Because
urine pregnancy tests can typically be less expensive and results are more
rapidly available, it is important to know their sensitivity. Immunologic tests
for pregnancy can detect hCG in the urine in which of the following
concentrations?
​ A. 2 IU/L
​ B. 20 IU/L
​ C. 100 IU/L
​ D. 200 IU/L n 4
​ E. 1,000 IU/L
​
​ 12. The new obstetrical visit typically includes a general well-woman
assessment as well as pregnancy evaluation. Which of the following is true
about Pap smears taken from the uterine cervix during a normal pregnancy?
​ A. They should be part of routine obstetric care, if needed, based on pap
frequency for the
​ B. They are indicated only in patients with clinically assessed risks.
​ C. They are difficult to interpret because of gestational changes.
​ D. They are a cost-effective replacement for cultures for sexually transmitted
diseases (STDs).
​ E. They are likely to induce uterine irritability.
​
​ 13. Prenatal care is a structured approach to obstetric care to assess for
increase risk of complications or the actual development of problems. Which
of the following would most predispose the patient to obstetrical
complications?
​ A. Maternal age 39
​ B. Maternal age 17, with menarche at age 13
​ C. History of four normal deliveries
​ D. History of ovarian dermoid cyst removed 4 years ago
​ E. A clinically measured pelvic diagonal conjugate of 12 cm
​
​ 14. A pregnant woman at 4 weeks’ gestation had an upper gastrointestinal
(GI) series and is worried about possible fetal effects from radiation. You
inform her that the risk for mental retardation to the fetus is greatest during
which phase of pregnancy?
​ A. 8th through 15th week of gestation
​ B. 15th through 25th week of gestation
​ C. Last trimester
​ D. 1st to 8th week of gestation
​ E. Implantation stage from 0 to 9 days
​
​ 15. Advising a 34-year-old woman at 12 weeks’ gestation about the risk of
chromosomal defects in the fetus, you can correctly state which of the
following?
​ A. Efficacy of screening for Down Syndrome is improved by adding estriol,
inhibin A, and hCG concentration to the MSAFP (quadruple screen)
​ B. Screening for Down syndrome can be improved by checking amniotic fluid
for acetylcholinesterase level.
​ C.Maternal serum alpha-fetoprotein (MSAFP) is a very specific test for Down
syndrome.
​ D. Paternal age is very important in the etiology of Down syndrome.
​ E. There is little worry regarding Down syndrome before the age of 35.
​
​ 16. The most worrisome sign or symptom of potentially serious pathology in
late pregnancy is which of the following?
​ A.Visual changes
​ B. Swollen ankles
​ C. Constipation
​ D. Nocturia
​ E. Heartburn
​
​ 17. During late pregnancy, which of the following implies urinary tract
disease?
​ A. Decreased creatinine clearance
​ B. Dilation of the ureters
​ C. Failure to excrete concentrated urine after 18 hours without fluids
​ D. Glucosuria
​ E. Decreased serum creatinine
​
​ 18. Because the treatment of HIV during pregnancy and labor can
significantly decrease fetal transmission as well as maternal morbidity, which
of the following is the standard of care regarding HIV testing in pregnancy?
​ A. Universal screening using an opt-out approach is recommended.
​ B. It should not be offered to patients in low-risk populations.
​ C. Universal screening is required by law.
​ D. It is performed routinely without patient consent in federal facilities
serving high-risk populations.
​ E. Testing is done only at the request of the patient.
​
​ 19. Routine screening procedures at her first prenatal care visit for a
35-year-old primigravida with an estimated gestational age (EGA) of 8 weeks
should include which of the following
​ A. Family history
​ B. Quadruple test
​ C. 1-hour glucose challenge
​ D. Toxoplasma titer
​ E. Ultrasound
​
​ 20. Many fetal anomalies found on ultrasound are associated with other
anomalies that the sonographer must assess. Which of the following
abnormal ultrasound findings of the fetus are usually found in isolation and
not as part of a collection of abnormalities or a syndrome?
​ A. Posturethral value
​ B. Duodenal atresia
​ C. Diaphragmatic hernia
​ D. Gastroschisis
​ E. Omphalocele
​
​ 21. An abnormal biophysical profile (BPP) predicts which of the following?
​ A. Higher risk for antepartum death within 1 week
​ B. A baby that will be small for gestational age (SGA)
​ C. Maternal preeclampsia
​ D. Meconium staining
​ E. Placental abruption
​
​ 22. A pregnant woman not previously known to be diabetic, who is at 26
weeks’ gestation, had a routine 50-g (GTT) with a 1-hour blood glucose value
 of 144 mg/dL. A follow-up 100-g, 3-hour oral GTT revealed plasma values of
fasting blood sugar of 102; 1 hour, 180; 2 hours, 162; and 3 hours, 144. You
should do which of the following?
​ A. Begin American Diabetes Association (ADA) diet and daily glucose
monitoring
​ B. Repeat the GTT in early or mid-third trimester
​ C. Start oral hypoglycemic agents in the diet
​ D. Perform an immediate Contraction Stress Test (CST)
​ E. Treat the patient as one with normal gestation
​
​ 23. A patient is measuring size larger than dates at her initial obstetric visit
at 24 weeks’ EGA. She is worried about twins since they “run” in the family.
The best method to safely and reliably diagnose twins is by which of the
following?
​ A. Ultrasonography
​ B. Leopold’s maneuvers
​ C. Auscultation
​ D. X-rays
​ E. Computed tomography (CT) scan
​
​ 24. Of the following evaluations done during routine prenatal care in a
normal pregnancy, which of the following is most important in the initial clinic
visit?
​ A. Determination of the gestational age
​ B. Routine measurement of the fundus
​ C.Determination of maternal blood pressure
​ D. Maternal urinalysis
​ E. Maternal weight
​
​ 25. There is good evidence that a woman who gave birth to an infant with a
neural tube defect (NTD) can substantially reduce the risk of recurrence by
taking periconceptional folic acid supplementation. What is the recommended
dose?
​ A. 0.4 mg
​ B. 0.8 mg
​ C. 1.0 mg
​ D. 4 mg
​ E. 8
​
​ 26. A 32-year-old woman has a twin pregnancy at 8 weeks' gestation. During
her initial prenatal care visit, you review risks for multifetal pregnancies.
 Which of the following statements reflects the most frequent risks in twin
pregnancies?
​ A. Pregnancy-induced hypertension occurs at a higher rate than in singletons.
​ B. Shoulder dystocia occurs more in the aftercoming vertex twin, as
compared to a singleton.
​ C. Cesarean delivery is necessary in greater than 90% of twin deliveries.
​ D. Congenital anomalies occur at the same rate as in singletons.
​ E. Perinatal death rate is less than that of singletons
​
​ 27. Pregnancy should be avoided within 1 month of receiving which of the
following vaccinations?
​ A.Measles, mumps, rubella (MMR)
​ B. Hepatitis B
​ C. Pneumococcus
​ D. Tetanus
​ E. Influenza
​
​ 28. Between obesity, irregular menses, erratic use of contraception and
unknown LMP ultrasound is commonly used to determine the EDC. How many
weeks after LMP is ultrasound most accurate in dating a pregnancy?
​ A. Between 2 and 4 weeks after LMP
​ B. Between 19 and 21 weeks after LMP
​ C. Between 7 and 9 weeks after LMP
​ D. Between 2 and 4 weeks after LMP
​
​ 29. An 18-year-old single, sedentary, obese female (gravida 1, para 0) is first
seen by you for prenatal care at 16 weeks' gestation. Her history is
unremarkable, and she claims to be in good health. Her dietary history
includes high carbohydrate intake with no fresh vegetables. Physical
examination is within normal limits except that she is somewhat pale.
Suggested nutritional counseling should include which of the following?
​ A. A strict diet to maintain her current weight
​ B. At least 1 hour of vigorous aerobic exercise daily
​ C. 25–30 g of protein in the diet everyday
​ D. Folic acid supplementation
​ E. Intake of 1,200 calories a day
​
​ 30. Periconceptional dietary adjustments have been shown to have a
profound impact on which of the following diseases or malformations?
​ A. Diabetes mellitus
​ B. Cystic fibrosis
​ C. Clubfoot (talipes equinovarus)
​ D. Preeclampsia
​ E. Tay-Sachs disease
​
​ 31. A 19-year-old primigravida with unsure LMP presents to initiate prenatal
care. You attempt to estimate gestational age. The uterine fundus is palpable
at the level of the pubic symphysis, and fetal heart tones are audible by
electronic Doppler. On the basis of this information, what is the approximate
gestational age?
​ A. 8 weeks
​ B. 20 weeks
​ C. 24 weeks
​ D. 16 weeks
​ E. 12 weeks
​
​ 32. A 24-year-old G1P0 at 38 weeks' EGA presents to labor and delivery for a
complaint of decreased fetal movement. The nonstress test (NST) results are
shown in Figure 8–1. What is the interpretation of this NST? (grafico).
​ A.This is a reactive NST, indicating that the fetus is not likely to be acidotic.
​ B. A fetus with this pattern is at risk for fetal death in utero within the next
week.
​ C. The pattern is common during the sleep cycle of the fetus.
​ D. The pattern demonstrates short-term but not long-term variability
​
​ 33. Which of the following is the most prominent cause of pregnancy loss?
​ A. stillbirths
​ B. Contraception
​ C. Neonatal Mortality
​ D.Fetal deaths in utero
​ E. Abortion
​
​ 34. A 32-year-old G2P1 female presents for routine prenatal visit at 36
weeks' EGA. You note a 7-lb weight gain in the last 2 weeks? Which of the
following should be your first priority?
​ A. Give the patient diuretics
​ B. Encourage vigorous exercise
​ C. Markedly restrict her diet
​ D. Place her on bed rest
​ E. Assess for signs and symptoms of preeclampsia
​
​ 35. Which of the following nutrients is most likely to be deficient during
pregnancy?
​ A. Vitamin A
​ B. Vitamin D
​ C. Calcium
​ D. Folate
​ E. Iron
​
​ 36. A 32-year-old (gravida 2, para 1) initiates care at 8 weeks' gestation.
Which of the following is most worrisome for the poor obstetric outcomes?
​ A. Blood pressure of 144/92 mm Hg
​ B. Inaudible fetal heart tone by electronic Doppler
​ C. Maternal height of 4 ft 10 in.
​ D. The presence of curd-like discharge consistent with Candida on speculum
examination
​ E. Trace proteinuria on urine dipstick
​
​ 37. How many weeks after LMP is ultrasound most useful in evaluating fetal
anatomy?
​ A. Between 2 and 4 weeks after LMP
​ B. Between 19 and 21 weeks after LMP
​ C. Between 12 and 14 weeks after LMP
​ D. Between 30 and 32 weeks after LMP
​ E. Between 7 and 9 weeks after LMP
​
​ 38. A 28-year-old (gravida 3, para 1, abortus 1) at 30 weeks' gestation
reports some recent intermittent contractions. Which of the following
correlates with the greatest risk for preterm labor?
​ A. Prior 32-week delivery
​ B. History of colposcopy
​ C. History of Chlamydia trachomatis
​ D. Prior 8-week spontaneous abortion
​ E. Patient is a smoker (half pack per day)
​
​ 38. The following is/are considered a positive finding in ectopic pregnancy:
​ A. Cervical Excitation
​ B. +ve urine test
​ C. P.V bleeding
​ D. All of the above
​ E. None of the above
​
​ 39. Case: A patient who is gravida 8 presents with a missed period of 7 weeks.
P.V. bleeding. Cervical excitation, lower abdominal pain, fainting 2 times
yesterday. Your diagnosis is:
​ A. Pancreatitis
​ B. Ectopic pregnancy
​ C. Abortion
​ D. None of these
​
​ 40. Ectopic pregnancy can be reliably diagnosed by:
​ A. US
​ B. Laparoscopy
​ C. Pregnancy test
​ D.HSG
​
​ 41. Which type of the following ectopic pregnancies would rupture earlier:
​ A. Isthmus
​ B. Interstitial
​ C. Ampulla
​ D. Fimbria
​ E. No difference
​
​ 42. Regarding ectopic pregnancy, which is true:
​ A. Bleeding precedes pain
​ B. Shoulder tip pain is an important symptom.
​ C. Both
​ D. None
​
​ 43. Which of the following is not a sign of ruptured ectopic pregnancy:
​ A. Fast thready pulse
​ B. Heavy vaginal bleeding
​ C. Rebound tenderness of the abdomen
​ D. +ve cervical excitation
​ E. Cold and clammy extremities
​
​ 44. The most common cause of ectopic pregnancy:
​ A. Congenital anomalies of the tube
​ B. Inflammation of the tubes
​ C. Uterine abnormalities
​ D. Using OCPs
​ E. Pelvic adhesions
​
​ 45. Regarding interstitial ectopic pregnancy:
​ A. Bleeds heavily
​ B. Less dangerous than ampullary
​ C. Salpingectomy is the surgery indicated
​ D. More common than ampullary
​
​ 46. The commonest surgical procedure used to treat ruptured tubal pregnancy:
​ A. Total hysterectomy
​ B. Salpingostomy
​ C. Salpingectomy
​ D. Salpingo-oophorectomy
​ E. Electrical cauterization
​
​ 47. In an ectopic pregnancy, which of the following is always important:
​ A. Amenorrhea for 8 weeks
​ B. Pain before vaginal bleeding
​ C. Shoulder tip pain
​ D. Pregnancy test
​ E. Decidual cast
​
​ 48.A client with preeclampsia is being treated with bed rest and intravenous
magnesium sulfate. The drug classification of this medication is a:
​ a. diuretic.
​ b. tocolytic.
​ c. anticonvulsant.
​ d. Antihypertensive.
​
​ 49. Which is the only known cure for preeclampsia?
​ a. Magnesium sulfate
​ b. Delivery of the fetus
​ c. Antihypertensive medications
​ d. Administration of aspirin (ASA) every day of the pregnancy
​
​ 50. The clinic nurse is performing a prenatal assessment on a pregnant client at
risk for preeclampsia. Which clinical sign is not included as a symptom of
preeclampsia?
​ a. Edema
​ b. Proteinuria
​ c. Glucosuria
​ d. Hypertension
​
​ 51. Which intrapartal assessment should be avoided when caring for a client with
HELLP syndrome?
​ a. Abdominal palpation
​ b. Venous sample of blood
​ c. Checking deep tendon reflexes
​ d. Auscultation of the heart and lungs
​
​ 52. A nurse is explaining to the nursing students working on the antepartum unit
how to assess edema. Which edema assessment score indicates edema of the
lower extremities, face, hands, and sacral area?
​ a. +1
​ b. +2
​ c. +3
​ d. +4
​
​ 53. A client is admitted with vaginal bleeding at approximately 10 weeks of
gestation. Her fundal height is 13 cm. Which potential problem should be
investigated?
​ a. Placenta previa
​ b. Hydatidiform mole
​ c. Abruptio placentae
​ d. Disseminated intravascular coagulation (DIC)
​
​ 54. Which maternal condition always necessitates birth by cesarean section?
​ a. Partial abruptio placentae
​ b. Total placenta previa
​ c. Ectopic pregnancy
​ d. Eclampsia
​
​ 55. Spontaneous termination of a pregnancy is considered to be an abortion if:
​ a. the pregnancy is less than 20 weeks.
​ b. the fetus weighs less than 1000 g.
​ c. the products of conception are passed intact.
​ d. there is no evidence of intrauterine infection.
​
​ 56. An abortion when the fetus dies but is retained in the uterus is called:
​ a. inevitable.
​ b. missed.
​ c. incomplete.
​ d. Threatened.
​
​ 57. A placenta previa when the placental edge just reaches the internal os is
called:
​ a. total.
​ b. partial.
​ c. low-lying.
​ d. Marginal.
​
​ 58. Which would indicate concealed hemorrhage in abruptio placentae?
​ a. Bradycardia
​ b. Hard boardlike abdomen
​ c. Decrease in fundal height
​ d. Decrease in abdominal pain
​
​ 59. The priority nursing intervention when admitting a pregnant client who has
experienced a bleeding episode in late pregnancy is to:
​ a. monitor uterine contractions.
​ b. assess fetal heart rate and maternal vital signs.
​ c. place clean disposable pads to collect any drainage.
​ d. perform a venipuncture for hemoglobin and hematocrit levels.
​
​ 60. A primigravida of 28 years of age is admitted to the antepartum unit with a
diagnosis of hyperemesis gravidarum. Nursing care is based on which of the
following?
​ a. She should be isolated from her family.
​ b. This condition is caused by psychogenic factors.
​ c. The treatment is similar to that for morning sickness.
​ d. She should be assessed for signs of dehydration and starvation.
​
​ 61. A 17-year-old primigravida has gained 4 pounds since her last prenatal visit.
Her blood pressure is 140/92 mm Hg. The most important nursing action is to:
​ a. advise her to cut down on fast foods that are high in fat.
​ b. caution her to avoid salty foods and to return in 2 weeks.
​ c. assess weight gain, location of edema, and urine for protein.
​ d. recommend she stay home from school for a few days to reduce stress.
​
​ 62. A client with preeclampsia is admitted complaining of pounding headache,
visual changes, and epigastric pain. Nursing care is based on the knowledge that
these signs indicate:
​ a. gastrointestinal upset.
​ b. effects of magnesium sulfate.
​ c. anxiety caused by hospitalization.
​ d. worsening disease and impending convulsion.
​
​ 63. Rh incompatibility can occur if the client is Rh-negative and the:
​ a. fetus is Rh-negative.
​ b. fetus is Rh-positive.
​ c. father is Rh-positive.
​ d. father and fetus are both Rh-negative.
​ 64. In which situation would a dilation and curettage (D&C) be indicated?
​ a. Complete abortion at 8 weeks
​ b. Incomplete abortion at 16 weeks
​ c. Threatened abortion at 6 weeks
​ d. Incomplete abortion at 10 weeks
​ 65. Which orders should the nurse expect for a client admitted with a threatened
abortion?
​ a. NPO
​ b. Pad count
​ c. Ritodrine IV
​ d. Meperidine (Demerol), 50 mg now
​
​ 66. Which data found on a clients health history would place her at risk for an
ectopic pregnancy?
​ a. Ovarian cyst 2 years ago
​ b. Recurrent pelvic infections
​ c. Use of oral contraceptives for 5 years
​ d. Heavy menstrual flow of 4 days duration
​
​ 67. Which finding on a prenatal visit at 10 weeks might suggest a hydatidiform
mole?
​ a. Blood pressure of 120/80 mm Hg
​ b. Complaint of frequent mild nausea
​ c. Fundal height measurement of 18 cm
​ d. History of bright red spotting for 1 day weeks ago
​
​ 68. Which routine nursing assessment is contraindicated for a client admitted
with suspected placenta previa?
​ a. Determining cervical dilation and effacement
​ b. Monitoring FHR and maternal vital signs
​ c. Observing vaginal bleeding or leakage of amniotic fluid
​ d. Determining frequency, duration, and intensity of contractions
​
​ 69. The primary symptom present in abruptio placentae that distinguishes it from
placenta previa is:
​ a. vaginal bleeding.
​ b. rupture of membranes.
​ c. presence of abdominal pain.
​ d. changes in maternal vital signs.
​
​ 70. A laboratory finding indicative of DIC is:
​ a. decreased fibrinogen.
​ b. increased platelets.
​ c. increased hematocrit.
​ d. decreased thromboplastin time.
​
​ 80. Which assessment in a client diagnosed with preeclampsia who is taking
magnesium sulfate would indicate a therapeutic level of medication?
​ a. Drowsiness
​ b. Urinary output of 20 mL/hr
​ c. Normal deep tendon reflexes
​ d. Respiratory rate of 10 to 12 breaths/min
​ 81. A client taking magnesium sulfate has a respiratory rate of 10 breaths/min. In
addition to discontinuing the medication, which action should the nurse take?
​ a. Increase the clients IV fluids.
​ b. Administer calcium gluconate.
​ c. Vigorously stimulate the client.
​ d. Instruct the client to take deep breaths.
​
​ 82. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy.
Nursing care is based on which of the following?
​ a. Hemorrhage is the major concern.
​ b. She will be unable to conceive in the future.
​ c. Bed rest and analgesics are the recommended treatment.
​ d. A D&C will be performed to remove the products of conception.
​
​ 83. You are taking care of a client who had a therapeutic abortion following an
episode of vaginal bleeding and ultrasound confirmation of a blighted ovum. Lab
work is ordered 2 weeks postprocedure as a follow-up to medical care. Which
result indicates that additional intervention is needed?
​ a. Hemoglobin, 13.2 mg/dL
​ b. White blood cell count, 10,000 mm3
​ c. Beta-hCG detected in serum
​ d. Fasting blood glucose level, 80 mg/dL
​
​ 84. A female client presents to the emergency room complaining of lower
abdominal cramping with scant bleeding of approximately 2 days duration. This
morning, the quality and location of the pain changed and she is now
experiencing pain in her shoulder. The clients last menstrual period was 28 days
ago, but she reports that her cycle is variable, ranging from 21 to 45 days. Which
clinical diagnosis does the nurse suspect?
​ a. Ectopic pregnancy
​ b. Appendicitis
​ c. Food poisoning
​ d. Gastroenteritis
​
​ 85. A client who was pregnant had a spontaneous abortion at approximately 4
weeks gestation. At the time of the miscarriage, it was thought that all products of
conception were expelled. Two weeks later, the client presents at the clinic office
complaining of crampy abdominal pain and a scant amount of serosanguineous
vaginal drainage with a slight odor. The pregnancy test is negative. Vital signs
reveal a temperature of 100 F, with blood pressure of 100/60 mm Hg, irregular
 pulse 88 beats/min (bpm), and respirations, 20 breaths/min. Based on these
assessment data, what does the nurse anticipate as a clinical diagnosis?
​ a. Ectopic pregnancy
​ b. Uterine infection
​ c. Gestational trophoblastic disease
​ d. Endometriosis
​
​ 86. A client with no prenatal care delivers a healthy male infant via the vaginal
route, with minimal blood loss. During the labor period, vital signs were normal.
At birth, significant maternal hypertension is noted. When the client is
questioned, she relates that there is history of heart disease in her family but that
she has never been treated for hypertension. Blood pressure is treated in the
hospital setting and the client is discharged. The client returns at her scheduled
6-week checkup and is found to be hypertensive. Which type of hypertension do
you think the client is exhibiting?
​ a. Pregnancy-induced hypertension (PIH)
​ b. Gestational hypertension
​ c. Preeclampsia superimposed on chronic hypertension
​ d. Undiagnosed chronic hypertension
​
​ 87. A high-risk labor client progresses from preeclampsia to eclampsia.
Aggressive management is instituted, and the fetus is delivered via cesarean
section. Which finding in the immediate postoperative period indicates that the
client is at risk of developing HELLP syndrome?
​ a. Platelet count of 50,000/mL
​ b. Liver enzyme levels within normal range
​ c. Negative for edema
​ d. No evidence of nausea or vomiting
​
​ 88. As the triage nurse in the emergency room, you are reviewing results for the
high- risk obstetric client who is in labor because of traumatic injury experienced
as a result of a motor vehicle accident (MVA). You note that the Kleihauer-Betke
test is positive. Based on this information, you anticipate that:
​ a. immediate birth is required.
​ b. the client should be transferred to the critical care unit for closer observation.
​ c. RhoGAM should be administered.
​ d. a tetanus shot should be administered.
​ 89. A client who had premature rupture of the membranes (PROM) earlier in the
pregnancy at 28 weeks returns to the labor unit 1 week later complaining that she
is now in labor. The labor and birth nurse performs the following assessments.
The vaginal exam is deferred until the physician is in attendance. The client is
placed on electronic fetal monitoring (EFM) and a baseline FHR of 130 bpm is
noted. No contraction pattern is observed. The client is then transferred to the
antepartum unit for continued observation. Several hours later, the client
complains that she does not feel the baby move. Examination of the abdomen
reveals a fundal height of 34 cm. Muscle tone is no different from earlier in the
hospital admission. The client is placed on the EFM and no fetal heart tones are
observed. What does the nurse suspect is occurring?
​ a. Placental previa
​ b. Active labor has started
​ c. Placental abruption
​ d. Hidden placental abruption
​
​ 90. The most appropriate nursing action for the client complaining of continuous
headache 24 hours postpartum after a normal vaginal birth is to:
​ a. encourage bed rest.
​ b. administer analgesic.
​ c. assess blood pressure.
​ d. assess for pitting edema.
​
​ 91. Which assessment finding indicates an adverse response to magnesium
sulfate?
​ a. Urine output of 30 mL/hr
​ b. Respiratory rate of 11 breaths/min
​ c. Hypoactive patellar reflex
​ d. Blood pressure reading of 110/80 mm Hg
​
​ 92. Which finding could cause the nurse to suspect gestational trophoblastic
disease in a client at 8 weeks gestation?
​ a. Blood pressure of 128/70 mm Hg
​ b. Fundal height of 12 cm
​ c. Nausea and vomiting
​ d. Weight gain of 3 pounds
​
​ 93. Which finding should be the nurse's priority in a client suspected as having
gestational trophoblastic disease?
​ a. Uterine contractions
​ b. Nausea and vomiting
​ c. Blood pressure of 130/80 mm Hg
​ d. Increase discharge of vaginal mucus
​
​ 94. What is the priority nursing intervention for the client who has had an
incomplete abortion?
​ a. Methylergonovine (Methergine), 0.2 mg IM
​ b. Preoperative teaching for surgery
​ c. Insertion of IV line for fluid replacement
​ d. Positioning of client in left side-lying position
​
​ 95. Which finding in the assessment of a client following an abruption placenta
could indicate a major complication?
​ a. Urine output of 30 mL in 1 hour
​ b. Blood pressure of 110/60 mm Hg
​ c. Bleeding at IV insertion site
​ d. Respiratory rate of 16 breaths/min
​ 96. Which assessment by the nurse would differentiate a placenta previa from an
abruptio placentae?
​ a. Saturated perineal pad in 1 hour
​ b. Pain level 0 on a scale of 0 to 10
​ c. Cervical dilation at 2 cm
​ d. Fetal heart rate at 160 bpm
​
​ 97. A blood-soaked peripad weighs 900 g. The nurse would document a blood
loss of _____ mL.
​ a. 1800
​ b. 450
​ c. 900
​ d. 90
​
​ 98. Which assessment finding on the fetal monitor strip supports a diagnosis of
abruptio placentae?
​ a. FHR of 150 bpm
​ b. Moderate variability of FHR
​ c. Contractions every 3 minutes
​ d. Uterine resting tone of 30 mm Hg
​
​ 99. In addition to obtaining vital signs and FHT, what is a priority for the client
with placenta previa?
​ a. Determining cervical dilation
​ b. Monitoring uterine contractions
​ c. Estimating blood loss
​ d. Starting a Pitocin drip
​
​ 100. Which explanation of a marginal placenta previa would the nurse provide to
her client?
​ a. The placenta is in the lower uterus, completely covering the internal cervical
os.
​ b. The placenta is in the lower uterus, more than 3 cm from the internal cervical
os.
​ c. The placenta is in the lower uterus, less than 3 cm from the internal cervical
os.
​ d. The placenta is in the lower uterus, at the edge and partially covering the
cervical os.
​
​ 101. Which information should the labor nurse recognize as being pertinent to a
possible diagnosis of abruptio placentae?
​ a. Low back pain
​ b. Firm, tender uterus
​ c. Regular uterine contractions
​ d. Scant vaginal mucus drainage
​
​ 102. What history would lead you to suspect an ectopic pregnancy in a client at 8
weeks gestation presenting with abdominal pain and bleeding?
​ a. Treated 1 year ago for pelvic inflammatory disease (PID)
​ b. Oral contraception for last 3 years
​ c. Urinary frequency for 1 week
​ d. Irregular cycles for 1 year prior to conception
​
​ 103. Which of these interventions should the nurse recognize as the priority for
the client diagnosed with an intact tubal pregnancy?
​ a. Assessment of pain level
​ b. Administration of methotrexate
​ c. Administration of Rh immune globulin
​ d. Explanation of the common side effects of the treatment plan
​
​ 104. Which finding in the exam of a client with a diagnosis of threatened abortion
would change the diagnosis to inevitable abortion?
​ a. Presence of backache
​ b. Rise in hCG level
​ c. Clear fluid from vagina
​ d. Pelvic pressure
​
​ 105. Which assessment finding indicates the development of preeclampsia in the
antepartum client?
​ a. Slight edema of feet and ankles.
​ b. Increased urine output
​ c. Blood pressure of 128/80 mm Hg
​ d. Weight gain of 3 pounds in 1 week
​
​ 106. Which assessment finding suggests that your laboring client's blood
magnesium level is too high?
​ a. Hyperactive reflexes
​ b. Absent reflexes
​ c. Generalized seizure
​ d. Urine output of 60 mL/hr
​
​ 107. What should the nurse recognize as evidence that the client is recovering
from preeclampsia?
​ a. 1+ protein in urine
​ b. 2+ pitting edema in lower extremities
​ c. Urine output >100 mL/hr
​ d. Deep tendon reflexes +2
​
​ 108. Fraternal twins are delivered by your Rh-negative client. Twin A is
Rh-positive and twin B is Rh-negative. Prior to administering Rho(D) immune
globulin (RhoGAM), the nurse should determine the results of the:
​ a. direct Coombs test of twin A.
​ b. direct Coombs test of twin B.
​ c. indirect Coombs test of the mother.
​ d. transcutaneous bilirubin level for both twins.
​
​ 109. The nurse is providing care to a patient who just learned her baby has died
in utero at 26 weeks gestation. What is the nurse's next action?
​ a. Contact the patients clergy member.
​ b. Enroll the patient in a grief and loss class.
​ c. Determine if the patient is a victim of violence.
​ d. Ask the patient when she last felt the baby move.
​
​ 110. A patient reports to the emergency room nurse that she is 10 weeks
pregnant, with unilateral pelvic pain, shoulder pain, and faintness. Her color is
pale, she is diaphoretic, and her heart rate is 140 bpm. What is the nurse's
priority action?
​ a. Initiate an ordered IV of lactated Ringer's at 200 mL/hr.
​ b. Take the patient for her ordered pelvic ultrasound.
​ c. Ask the patient if she has had any recent vaginal bleeding.
​ d. Ask the patient if she has ever been told she has had salpingitis.

​
​
​