Chapter 01: Maternity and Women’s Health Care Today
1. A nurse educator is teaching a group of nursing students about the history of family-centered
maternity care. Which statement should the nurse include in the teaching session?
a. The Sheppard-Towner Act of 1921 promoted family-centered care.
b. Changes in pharmacologic management of labor prompted family-centered care.
c. Demands by physicians for family involvement in childbirth increased the practice of
family-centered care.
d. Parental requests that infants be allowed to remain with them rather than in a
nursery initiated the practice of family-centered care.
2.
Expectant parents ask a prenatal nurse educator, “Which setting for childbirth limits the
amount of parent–infant interaction?” Which answer should the nurse provide for these
parents in order to assist them in choosing an appropriate birth setting?
a. Birth center
b. Home birth
c. Traditional hospital birth
d. Labor, birth, and recovery room
3. Which statement best describes the advantage of a labor, birth, recovery, and postpartum
(LDRP) room?
a. The family is in a familiar environment.
b. They are less expensive than traditional hospital rooms.
c. The infant is removed to the nursery to allow the mother to rest.
d. The woman’s support system is encouraged to stay until discharge.
4. Which nursing intervention is an independent function of the professional nurse?
a. Administering oral analgesics
b. Requesting diagnostic studies
c. Teaching the patient perineal care
d. Providing wound care to a surgical incision
5. Which response by the nurse is the most therapeutic when the patient states, “I’m so afraid to
have a cesarean birth”?
a. “Everything will be OK.”
b. “Don’t worry about it. It will be over soon.”
c. “What concerns you most about a cesarean birth?”
d. “The physician will be in later and you can talk to him.”
6. In which step of the nursing process does the nurse determine the appropriate interventions for
the identified nursing diagnosis?
a. Planning
b. Evaluation
c. Assessment
d. Intervention
7. Which goal is most appropriate for the collaborative problem of wound infection?
a. The patient will not exhibit further signs of infection.
b. Maintain the patient’s fluid intake at 1000 mL/8 hour.
c. The patient will have a temperature of 98.6F within 2 days.
d. Monitor the patient to detect therapeutic response to antibiotic therapy.
8. Which nursing intervention is written correctly?
a. Force fluids as necessary.
b. Observe interaction with the infant.
c. Encourage turning, coughing, and deep breathing.
d. Assist to ambulate for 10 minutes at 8 AM, 2 PM, and 6 PM.
9. The patient makes the statement: “I’m afraid to take the baby home tomorrow.” Which
response by the nurse would be the most therapeutic?
a. “You’re afraid to take the baby home?”
b. “Don’t you have a mother who can come and help?”
c. “You should read the literature I gave you before you leave.”
d. “I was scared when I took my first baby home, but everything worked out.”
10. The nurse is writing an expected outcome for the nursing diagnosis—acute pain related to tissue
trauma, secondary to vaginal birth, as evidenced by patient stating pain of 8 on a scale of 10.
Which expected outcome is correctly stated for this problem?
a. Patient will state that pain is a 2 on a scale of 10.
b. Patient will have a reduction in pain after administration of the prescribed
analgesic.
c. Patient will state an absence of pain 1 hour after administration of the prescribed
analgesic.
d. Patient will state that pain is a 2 on a scale of 10, 1 hour after the administration of the
prescribed analgesic.
11. Which nursing diagnosis should the nurse identify as a priority for a patient in active labor?
a. Risk for anxiety related to upcoming birth
b. Risk for imbalanced nutrition related to NPO status
c. Risk for altered family processes related to new addition to the family
d. Risk for injury (maternal) related to altered sensations and positional or physical
changes
12. Regarding advanced roles of nursing, which statement related to clinical practice is the most
accurate?
a. Family nurse practitioners (FNPs) can assist with childbirth care in the hospital
setting.
b. Clinical nurse specialists (CNSs) provide primary care to obstetric patients.
c. Neonatal nurse practitioners provide emergency care in the postbirth setting to high-risk
infants.
d. A certified nurse midwife (CNM) is not considered to be an advanced practice
nurse.
13. Which statement is true regarding the shortage of nurses in the United States?
a. There are a larger proportion of younger nurses in the workforce as compared with
older nurses.
b. As a result of decreased RN-to-patient ratios, there is a decrease in patient
mortality in the clinical setting.
c. Nursing programs are turning away qualified applicants.
d. There are adequate classroom and clinical facilities for training RNs.
14. A hospital has achieved Magnet status. Which indicators would be consistent with this type of
certification?
a. There is stratification of communication in a directed manner between nursing
staff and administration.
b. There is increased job satisfaction of nurses, with a lower staff turnover rate.
c. Physicians are certified in their respective specialty areas.
d. All nurses have baccalaureate degrees and certification in their clinical specialty
area.
15. Which of the following statements highlights the nurse’s role as a researcher?
a. Reading peer-reviewed journal articles
b. Working as a member of the interdisciplinary team to provide patient care
c. Helping patient to obtain home care postdischarge from the hospital
d. Delegating tasks to unlicensed personnel to allow for more teaching time with
patients
16. Which patient could safely be cared for by a certified nurse-midwife?
a. Gravida 3, para 2, with no complications
b. Gravida 1, para 0, with mild hypertension
c. Gravida 2, para 1, with insulin-dependent diabetes
d. Gravida 1, para 0, with borderline pelvic measurements
17. A primipara patient asks about possible support options for her during the labor process. She is
apprehensive that her family members will not be prepared to assist her during this time. Which
option would be most effective for this patient?
a. Reassure the patient that the labor and birth staff consists of highly trained nurses who
are well educated to take care of laboring patients so that should be sufficient.
b. Encourage the patient to take prepared childbirth classes with her husband because
that should provide the best support by a family member.
c. Provide information to the patient about obtaining a doula during the labor process.
d. Tell the patient that this is a normal feeling based on fear of the unknown and that it
will subside once she starts the labor process.
18. The nurse states to the newly pregnant patient, “Tell me how you feel about being pregnant.”
Which communication technique is the nurse using with this patient?
a. Clarifying
b. Paraphrasing
c. Reflection
d. Structuring
19. When reviewing a new patient’s birth plan, the nurse notices that the patient will be bringing a
doula to the hospital during labor. What does the nurse think that this means?
a. The patient will have her grandmother as a support person.
b. The patient will bring a paid, trained labor support person with her during labor.
c. The patient will have a special video she will play during labor to assist with
relaxation.
d. The patient will have a bag that contains all the approved equipment that may help
with the labor process.
MULTIPLE RESPONSE
1. In consideration of the historic evolution of maternity care, which treatment options were used
over the past century? (Select all that apply.)
a. During the nineteenth century, women of privilege were delivered by midwives in a
hospital setting.
b. Granny midwives received their training through a period of apprenticeship.
c. The recognition of improved obstetric outcomes was related to increased usage of
hygienic practices.
d. A shift to hospital-based births occurred as a result of medical equipment designed to
facilitate birth.
e. The use of chloroform by midwives led to decreased pain during birth.
2. Many communities now offer the availability of free-standing birth centers to provide care for
low-risk women during pregnancy, birth, and postpartum. When counseling the newly pregnant
patient regarding this option, the nurse should be aware that this type of care setting includes
which advantages? (Select all that apply.)
a. Staffing by lay midwives
b. Equipped for obstetric emergencies
c. Less expensive than acute care hospitals
d. Safe, homelike births in a familiar setting
e. Access to follow-up care for 6 weeks postpartum
3. The nurse is assessing a patient’s use of complementary and alternative therapies. Which
should the nurse document as an alternative or complementary therapy practice? (Select all
that apply.)
a. Practicing yoga daily
b. Drinking green tea in the morning
c. Taking omeprazole (Prilosec) once a day
d. Using aromatherapy during a relaxing bath
e. Wearing a lower back brace when lifting heavy objects
4. The nurse is formulating a nursing care plan for a postpartum patient. Which actions by the
nurse indicate use of critical thinking skills when formulating the care plan? (Select all that
apply.)
a. Using a standardized postpartum care plan
b. Determining priorities for each diagnosis written
c. Writing interventions from a nursing diagnosis book
d. Reflecting and suspending judgment when writing the care plan
e. Clustering data during the assessment process according to normal versus
abnormal
5. The RN is delegating tasks to the unlicensed assistive personnel (UAP). Which tasks can the
nurse delegate? (Select all that apply.)
a. Teaching the patient about breast care
b. Assessment of a patient’s lochia and perineal area
c. Assisting a patient to the bathroom for the first time after birth
d. Vital signs on a postpartum patient who delivered the night before
e. Assisting a postpartum patient to take a shower on the second postpartum day
Chapter 02: Social, Ethical, and Legal Issues
1. During which phase of the cycle of violence does the batterer become contrite and
remorseful?
a. Battering
b. Honeymoon
c. Tension-building
d. Increased drug taking
2. The United States ranks poorly in terms of worldwide infant mortality rates. Which factor has the
greatest impact on decreasing the mortality rate of infants?
a. Providing more women’s shelters
b. Ensuring early and adequate prenatal care
c. Resolving all language and cultural differences
d. Enrolling pregnant women in the Medicaid program by their eighth month of
pregnancy
3. The nurse is planning a teaching session for staff on ethical theories. Which situation best
reflects the Deontologic theory?
a. Approving a physician-assisted suicide
b. Supporting the transplantation of fetal tissue and organs
c. Using experimental medications for the treatment of AIDS
d. Initiating resuscitative measures on a 90-year-old patient with terminal cancer
4. Which step of the nursing process is being used when the nurse decides whether an ethical
dilemma exists?
a. Analysis
b. Planning
c. Evaluation
d. Assessment
5. The nurse is interviewing a patient who is 6-weeks pregnant. The patient asks the nurse, “Why is
elective abortion considered such an ethical issue?” Which response by the nurse is most
appropriate?
a. Abortion requires third-party consent.
b. The U.S. Supreme Court ruled that life begins at conception.
c. Abortion law is unclear about a woman’s constitutional rights.
d. There is a conflict between the rights of the woman and the rights of the fetus.
6. At the present time, which agency governs surrogate parenting?
a. State law
b. Federal law
c. Individual court decision
d. Protective child services
7. Which patient will most likely seek prenatal care?
a. A 15-year-old patient who tells her friends, “I just don’t believe that I am
pregnant”
b. A 28-year-old who is in her second pregnancy and abuses drugs and alcohol
c. A 20-year-old who is in her first pregnancy and has access to a free prenatal clinic
d. A 30-year-old who is in her fifth pregnancy and delivered her last infant at home
with the help of her mother and sister
8. A medical-surgical nurse is asked to float to a women’s health unit to care for patients who are
scheduled for therapeutic abortions. The nurse refuses to accept this assignment and expresses
her personal beliefs as being incongruent with this medical practice. The nursing supervisor
states that the unit is short-staffed and the nurse is familiar with caring for postoperative
patients. In consideration of legal and ethical practices, can the nursing supervisor enforce this
assignment?
a. The staff nurse has the responsibility of accepting any assignment that is made while
working for a health care unit, so the nursing supervisor is within his or her rights to
enforce this assignment.
b. Because the unit is short-staffed, the staff nurse should accept the assignment to
provide care by benefit of her or his experience to patients who need care.
c. The staff nurse has expressed a legitimate concern based on his or her feelings; the
nursing supervisor does not have the authority to enforce this assignment.
d. The nursing supervisor should emphasize that this assignment requires care of a
surgical patient for which the staff nurse is adequately trained and should therefore
enforce the assignment.
9. With regard to an obstetric litigation case, a nurse working in labor and birth is found to be
negligent. Which intervention performed by the nurse indicates that a breach of duty has
occurred?
a. The nurse did not document fetal heart tones (FHR) during the second stage of
labor.
b. The patient was only provided ice chips during the labor period, which lasted 8
hours.
c. The nurse allowed the patient to use the bathroom rather than a bedpan during the
first stage of labor.
d. The nurse asked family members to leave the room when she prepared to do a
pelvic exam on the patient.
10. A nurse is working with an active labor patient who is in preterm labor and has been designated
as high risk. The patient is very apprehensive and asks the nurse, “Is everything going to be all
right?” The nurse replies, “Yes, everything will be okay.” Following delivery via an emergency
cesarean birth, the newborn undergoes resuscitation and does not survive. The patient is
distraught over the outcome and blames the nurse for telling her that everything would be okay.
Which ethical principle did the nurse violate?
a. Autonomy
b. Fidelity
c. Beneficence
d. Accountability
11. A nurse is working in the area of labor and birth. Her assignment is to take care of a gravida 1
para 0 woman who presents in early labor at term. Vaginal exam reflects the following: 2 cm,
cervix posterior, –1 station, and vertex with membranes intact. The patient asks the nurse if she
can break her water so that her labor can go faster. The nurse’s response, based on the ethical
principle of nonmaleficence, is which of the following?
a. Tell the patient that she will have to wait until she has progressed further on the
vaginal exam and then she will perform an amniotomy.
b. Have the patient write down her request and then call the physician for an order to
implement the amniotomy.
c. Instruct the patient that only a physician or certified midwife can perform this
procedure.
d. Give the patient an enema to stimulate labor.
12. A nurse working in a labor and birth unit is asked to take care of two high-risk patients in the
labor and birth suite: a 34 weeks’ gestation 28-year-old gravida 3, para 2 in preterm labor and
a 40-year-old gravida 1, para 0 who is severely preeclamptic. The nurse refuses this assignment
telling the charge nurse that based on individual patient acuity, each patient should have one-onone care. Which ethical principle is the nurse advocating?
a. Accountability
b. Beneficence
c. Justice
d. Fidelity
13. A charge nurse is working on a postpartum unit and discovers that one of the patients did not
receive AM care during her shift assessment. The charge nurse questions the nurse assigned to
provide care and finds out that the nurse thought “the patient should just do it by herself because
she will have to do this at home.” On further questioning of the nurse, it is determined that the
rest of her assigned patients were provided AM care. The assigned nurse has violated which
ethical principle?
a. Justice
b. Truth
c. Confidentiality
d. Autonomy
14. A nurse is entering information on the patient’s electronic health record (EHR) and is called to
assist in an emergency situation with regard to another patient in the labor and birth suite. The
nurse rushes to the scene to assist; however, she leaves the chart open on the computer screen.
The emergent patient situation is resolved satisfactorily, and the nurse comes back to the
computer entry screen to complete charting. At the end of the shift, the nurse manager asks to
speak with the nurse and tells her that she is concerned with what happened today on the unit
because there was a breach in confidentiality. Which response by the nurse indicates that she
understands the nurse manager’s concerns?
a. The nurse acknowledges that she should have made sure that her patient was safe
before assisting with the emergency.
b. The nurse states that she should have logged out of the EHR prior to attending to the
emergency.
c. The nurse indicates that the unit was understaffed.
d. The nurse indicates that the she changed her password following the clinical
emergency to maintain confidentiality.
15. A nurse is admitting a patient to the labor and birth unit in early labor that was sent to the facility
following a checkup with her health care provider in the office. The patient is a gravida 1, para 0,
and is at term. No health issues are discerned from the initial assessment, and the nurse prepares
to initiate physician orders based on standard procedures. Which action by the nurse manager is
warranted in this situation?
a. No action is indicated because the nurse is acting within the scope of practice.
b. The nurse manager should intervene and ask the nurse to clarify admission orders
directly with the physician.
c. The nurse manager should review standard procedures with the nurse to validate
that orders are being carried out accurately.
d. The nurse manger should review the admission procedure with the nurse.
16. A nurse who works in the emergency department (ED) is assigned to a patient who is
experiencing heavy vaginal bleeding at 12 weeks’ gestation. An ultrasound has confirmed the
absence of a fetal heart rate, and the patient is scheduled for a dilation and evacuation of the
pregnancy. The nurse refuses to provide any further care for this patient based on moral
principles. What is the nurse manager’s initial response to the nurse?
a. “I recall you sharing that information in your interview. I will arrange for another
nurse to take report on this patient.”
b. “Because we are shorthanded today, you have to continue to provide care. There is no
one else available to provide care for this patient.”
c. “I understand your point of view. You were hired to work here in the ED so you
had to know this situation was possible.”
d. “Abandonment is a serious issue. I have to advise you to continue to provide care for
this patient.”
17. The nurse is providing care to a patient who was just admitted to the labor and birth unit in
active labor at term. The patient informed the nurse, “I have not received any prenatal care
because I cannot afford to go to the doctor. And, this is my third baby, so I know what to
expect.” What is the nurse’s primary concern when developing the patient’s plan of care? a.
Low birth weight
b. Oligohydramnios
c. Gestational diabetes
d. Gestational hypertension
18. A nurse is reviewing evidence-based teaching and learning principles. Which situation is most
conducive to learning with patients of other cultures?
a. An auditorium is being used as a classroom for 300 students.
b. A teacher who speaks very little Spanish is teaching a class of Hispanic students
c. A class is composed of students of various ages and educational backgrounds.
d. An Asian nurse provides nutritional information to a group of pregnant Asian
women.
19. The nurse is teaching a parenting class to new parents. Which statement should the nurse
include in the teaching session about the characteristics of a healthy family?
a. Adults agree on the majority of basic parenting principles.
b. The parents and children have rigid assignments for all the family tasks.
c. Young families assume total responsibility for the parenting tasks, refusing any
assistance.
d. The family is overwhelmed by the significant changes that occur as a result of
childbirth.
20. A patient who is 6 months pregnant has sought medical attention, saying she fell down the stairs.
Which scenario would cause an emergency department nurse to suspect that the woman has been
battered?
a. She avoids making eye contact and is hesitant to answer questions.
b. The woman and her partner are having an argument that is loud and hostile.
c. The woman has injuries on various parts of her body that are in different stages of
healing.
d. Examination reveals a fractured arm and fresh bruises. Her husband asks her about her
pain.
21. Which situation is most representative of an extended family?
a. It includes adoptive children.
b. It is headed by a single-parent.
c. It contains children from previous marriages.
d. It is composed of children, parents, and grandparents living in the same house.
ANS: D
An extended family is defined as a family having members from three generations living
under the same roof. A family with adoptive children is a nuclear family. A single-parent
family is headed by a single parent. A blended family is one that contains children from
previous marriages.
DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment
MSC: Patient Needs: Health Promotion and Maintenance
22. The nurse is reviewing the principles of family-centered care with a primiparous patient.
Which patient statement will the nurse need to correct?
a. “Remaining focused on my family will help benefit me and my baby.”
b. “Most of the time, childbirth is uncomplicated and a healthy event for the family.”
c. “Because childbirth is normal, after my baby’s birth our family dynamics will not
change.”
d. “With correct information, I am able to make decisions regarding my health care
while I am pregnant.”
23. Which issue is a major concern among members of lower socioeconomic groups?
a. Practicing preventive health care
b. Meeting health needs as they occur
c. Maintaining an optimistic view of life
d. Maintaining group health insurance for their families
24. While teaching an Asian patient regarding prenatal care, the nurse notes that the patient
refuses to make eye contact. Which is the most likely cause for this behavior?
a. A submissive attitude
b. Lack of understanding
c. Embarrassment about the subject
d. Cultural beliefs about eye contact
25. The nurse in labor and birth is caring for a Muslim patient during the active phase of labor. The
nurse notes that the patient quickly draws away when touched. Which intervention should the
nurse implement?
a. Ask the charge nurse to reassign you to another patient.
b. Assume that she does not like you and decrease your time with her.
c. Continue to touch her as much as you need to while providing care.
d. Limit touching to a minimum because physical contact may not be acceptable in
her culture.
26. Which patient may require more help and understanding when integrating the newborn into the
family?
a. A primipara from an upper income family
b. A primipara who comes from a large family
c. A multipara (gravida 2) who has a supportive husband and mother
d. A multipara (gravida 6) who has two children younger than 3 years
27. A patient arrives to the clinic 2 hours late for her prenatal appointment. This is the third time
she has been late. What is the nurse’s best action in response to this patient’s tardiness?
a. Ask the patient if she has a way to tell the time.
b. Ask the patient if she is deliberately being late for her appointments.
c. Determine if the patient wants this baby and if this is her way of acting out.
d. Determine if the patient arrives after the start time for other types of appointments.
MULTIPLE RESPONSE
1. The clinic nurse often cares for patients who are considering an abortion. Which
responsibilities does this nurse have in regard to this issue? (Select all that apply.)
a. Informing the patient about pro-life options
b. Informing the patient about pro-choice support groups
c. Being informed about abortion from a legal standpoint
d. Being informed about abortion from an ethical standpoint
e. Recognizing that this issue may result in confusion for the patient
2. A couple asks the nurse about the procedure for surrogate parenting. Which correct responses
should the nurse provide for this couple? (Select all that apply.)
a. Donated embryos can be implanted into the surrogate mother.
b. The surrogate mother needs to have carried one previous birth to term.
c. You both need to be infertile to be eligible for surrogate parenting.
d. Conception can take place outside the surrogate mother’s body and then implanted.
e. The surrogate mother can be inseminated artificially with sperm from the intended
father.
3. Which actions by the nurse indicate compliance with the Health Insurance Portability and
Accountability Act (HIPAA)? (Select all that apply.)
a. The nurse posts an update about a patient on Facebook.
b. The nurse gives the report to the oncoming nurse in a private area.
c. The nurse gives information about the patient’s status over the phone to the
patient’s friend.
d. The nurse logs off any computer screen showing patient data before leaving the
computer unattended.
e. The nurse puts any documentation with the patient’s information in the shred bin at the
hospital before leaving for the day.
4. In some Middle Eastern and African cultures, female genital mutilation (female cutting) is a
prerequisite for marriage. Women who now live in North America need care from nurses who are
knowledgeable about the procedure and comfortable with the abnormal appearance of their
genitalia. When caring for this patient, the nurse can formulate a diagnosis with the
understanding that the patient may be at risk for which of the following? (Select all that apply.)
a. Infection
b. Laceration
c. Hemorrhage
d. Obstructed labor
e. Increased signs of pain response
5. A Vietnamese patient who speaks little English is admitted to the labor and birth unit in early
labor. The nurse plans to use an interpreter during an initial assessment. Which should the nurse
plan to implement with regard to using an interpreter? (Select all that apply.)
a. Face the interpreter when speaking.
b. Listen carefully to what the patient says.
c. Speak slowly and smile when appropriate.
d. Plan to use a male interpreter, even if a female interpreter is available.
e. Ask the interpreter to explain exactly what is said as much as possible, instead of
paraphrasing.
Chapter 03: Reproductive Anatomy and Physiology
1. A postpartum patient who has had a vaginal birth asks the nurse, “I was wondering if my cervix
will return to its previous shape before I had the baby?” Which is the best response by the nurse?
a. The cervix will now have a slit-like shape.
b. The cervix will be round and smooth after healing occurs.
c. The cervix will remain 50% effaced now that you have had a baby.
d. The cervix will be slightly dilated to 2 cm for about 6 months.
2. The school nurse is conducting health education classes for a group of adolescents. Which
statement best describes a secondary sexual characteristic?
a. Maturation of ova
b. Production of sperm
c. Female breast development
d. Secretion of gonadotropin-releasing hormone
3. Which 16-year-old female patient is most likely to experience secondary amenorrhea?
a. 5 ft 2 in, 130 lb
b. 5 ft 9 in, 180 lb
c. 5 ft 7 in, 96 lb
d. 5 ft 4 in, 125 lb
4. Which characteristic best describes the levator ani?
a. Division of the fallopian tube
b. Collection of three pairs of muscles
c. Imaginary line that divides the true pelvis and false pelvis
d. Basin-shaped structure at the lower end of the spine
5. The nurse is describing the size and shape of the nonpregnant uterus to a patient. Which is an
accurate description?
a. The nonpregnant uterus is the size and shape of a pear.
b. The nonpregnant uterus is the size and shape of a cantaloupe.
c. The nonpregnant uterus is the size and shape of a grapefruit.
d. The non-pregnant uterus is the size and shape of a large orange.
6. If a woman’s menstrual cycle began on June 2, on which date should ovulation mostly likely
have occurred?
a. June 10
b. June 16
c. June 29
d. July 5
7. A patient states, “My breasts are so small. I don’t think I will be able to breastfeed my baby.”
Which is the nurse’s best response?
a. “It may be difficult but you should try anyway.”
b. “You can always supplement with formula.”
c. “All women have about the same amount of glandular tissue necessary to secrete
milk.”
d. “The ability to produce breast milk depends on increased levels of estrogen and
progesterone.”
8. The nurse is explaining the function of the male’s cremaster muscle to a group of nursing
students. Which statement accurately describes the function of the cremaster muscle?
a. Assists with transporting sperm
b. Aids in temperature control of the testicles
c. Aids in voluntary control of excretion of urine
d. Entraps blood in the penis to produce an erection
9. A newly pregnant patient asks the nurse, “What is a false pelvis?” Which statement by the
nurse will best explain this anatomy to the patient?
a. It is the total anterior portion of the pelvis.
b. It is considered to be the lower portion of the pelvis.
c. It provides support for the internal organs and the upper part of the body.
10. The clinic nurse is reviewing breastfeeding with a pregnant patient. Which hormone will the
nurse explain is responsible for milk production after the birth of the placenta?
a. Pitocin
b. Prolactin
c. Estrogen
d. Progesterone
11. Which hormonal effect is noted during the menstrual cycle?
a. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secretion rise
during the ovulatory phase.
b. A negative feedback mechanism is exhibited by the anterior pituitary gland and
ovaries.
c. The posterior pituitary gland secretes LH.
d. Estrogen secretion enhances FSH secretion.
12. A female patient who has gone through puberty and started menstruating without any
problems has developed cessation of periods after 2 years of normal cycles. Which finding
would indicate a possible cause for this occurrence?
a. Lag in development of secondary sexual characteristics
b. Overproduction of androgenic hormones
c. Negative pregnancy test
d. Clinical diagnosis of primary amenorrhea
13. On speculum examination of the cervix, it is found to be round and smooth. These findings
suggest that the patient
a. is a multipara.
b. has had previous vaginal deliveries.
c. is nulliparous.
d. is a gravida 1, para 0.
14. Which statement with regard to reproductive anatomy and physiology is inaccurate?
a. Female patients who are past puberty and sexually active can become pregnant
even if they have not had a menstrual cycle.
b. Puberty symptoms are more prominent in males than females.
c. Females enter puberty earlier than their male counterparts.
d. Secondary sexual characteristics develop during puberty.
15. The nurse is reviewing normal female development with a mother of a 10-year-old daughter. The
mother states, “I noticed that my daughter developed breast buds about a year ago. When do you
think she will start her menstrual cycle?” What is the nurse’s best response?
a. “In about a year.”
b. “Likely any time now.”
c. “Does your daughter know what to expect?”
d. “It is impossible to predict when she will start her cycle.”
16. The middle school nurse is reviewing the phases of the endometrial cycle with a group of
female students. Which statement by a student will the nurse need to correct?
a. “The proliferative phase occurs when the ovum is maturing.”
b. “The expulsion phase occurs when the ovum is discharged from the ovary.”
c. “The secretory phase occurs during the second half of the menstrual cycle.”
d. “The menstrual phase occurs after the levels of estrogen and progesterone fall.”
MULTIPLE RESPONSE
1. A young female patient comes to the health unit at school to discuss her irregular periods. In
providing education regarding the female reproductive cycle, the nurse describes the regular
and recurrent changes related to the ovaries and the uterine endometrium. Although this is
generally referred to as the menstrual cycle, the ovarian cycle includes which phases? (Select all
that apply.)
a. Follicular
b. Ovulatory
c. Luteal
d. Proliferative
e. Secretory
2. The school nurse is conducting health education classes for a group of adolescent girls. Select the
actions of the estrogen hormone that the nurse should include in the lessons. (Select all that
apply.)
a. Stimulates contractions during birth
b. Relaxes pelvic ligaments during pregnancy
c. Stimulates the endometrium before ovulation
d. Stimulates growth of uterus during pregnancy
e. Stimulates the let-down reflex during breastfeeding
Chapter 04: Hereditary and Environmental Influences on Childbearing Foundations
1. A clinic nurse is planning a teaching session for childbearing-age female patients. Which
information should the nurse include in the teaching session with regard to avoiding exposing
a fetus to teratogens?
a. Eliminate use of acne medications.
b. Immunizations should be updated during the first trimester of pregnancy.
c. Use of saunas and hot tubs during pregnancy should be during the winter months
only.
d. Alcoholic beverages can be consumed in the first and third trimesters of
pregnancy.
2. The parents of a child with a karyotype of 47,XY,+21 ask the nurse what this means. Which is
the most accurate response by the nurse?
a. This karyotype is for a normal male.
b. This karyotype is for a normal female.
c. This karyotype is for a male with Down syndrome.
d. This karyotype is for a female with Turner’s syndrome.
3. People who have two copies of the same abnormal autosomal dominant gene are generally
a. mildly affected with the disorder.
b. infertile and unable to transmit the gene.
c. carriers of the trait but not affected with the disorder.
d. more severely affected by the disorder than people with one copy of the gene.
4. An infant is born with blood type AB. The father is type A and the mother is type B. The
father asks why the baby has a blood type different from that of the parents. The nurse’s
answer should be based on the knowledge that
a. both A and B blood types are dominant.
b. types A and B are recessive when linked together.
c. the baby has a mutation of the parents’ blood types.
d. type A is recessive and links more easily with type B.
5. Which statement regarding multifactorial disorders is correct?
a.
b.
c.
d.
They may not be evident until later in life.
They are usually present and detectable at birth.
The disorders are characterized by multiple defects.
Secondary defects are rarely associated with them.
6. Which information should the nurse include when discussing the prenatal diagnosis of genetic
disorders with an expectant couple?
a. The diagnosis may be slow and could be inconclusive.
b. A comprehensive evaluation will result in an accurate diagnosis.
c. Common disorders can be quickly diagnosed through blood tests.
d. Diagnosis can be obtained promptly through most hospital laboratories.
7. A patient tells the nurse at a prenatal interview that she has quit smoking, and only has one
glass of wine with dinner. Which response by the nurse will be most helpful in promoting a
lifestyle change?
a. “Those few things won’t cause any trouble. Good for you.”
b. “You need to do a lot better than that. You are still hurting your baby.”
c. “Here are some pamphlets for you to study. They will help you to find more ways to
improve.”
d. “You have made some good progress toward having a healthy baby. Let’s talk
about the changes you have made.”
8. A 35-year-old patient has an amniocentesis performed to identify whether her baby has a
chromosomal defect. Which statement indicates that the patient understands the situation?
a. “The doctor will tell me if I should have an abortion when the test results come
back.”
b. “When all the lab results come back, my husband and I will make a decision about the
pregnancy.”
c. “My mother must not find out about all this testing. If she does, she will think I’m
having an abortion.”
d. “I know there are support groups for parents who have a baby with birth defects, but
we have plenty of insurance to cover what we need.”
9. Which characteristic is related to Down syndrome?
a. Up-slanting eyes
b. Abnormal genitalia
c. Bleeding tendency
d. Edema of extremities
ANS: A
Up-slanting eyes, wide short fingers, and low-set ears are often seen in infants with Down
syndrome. Bleeding tendency, edema of extremities, and abnormal genitalia are not
characteristics of Down syndrome.
DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment
MSC: Patient Needs: Physiologic Integrity
10. Which question posed by the nurse will most likely promote the sharing of sensitive
information during a genetic counseling interview?
a. “What kind of defects or diseases seem to run in the family?”
b. “How many people in your family are mentally retarded or handicapped?”
c. “Did you know that you can always have an abortion if the fetus is abnormal?”
d. “Are there any members of your family who have learning or developmental
problems?”
11. Testing for the cause of anomalies in a stillborn infant is underway. The mother angrily asks the
nurse how long these tests are going to take. The nurse should understand that this mother is
a. exhibiting normal grief behavior.
b. trying to place blame on someone.
c. being impatient and unreasonable.
d. feeling guilty and blaming herself.
12. While obtaining a genetic history from a female patient, you note that there is a family history of
a genetic disease on the maternal side; however, no evidence of symptomatology in the patient or
the patient’s children, two girls. Which observation can you make related to genetic expression?
a. Autosomal dominant expression is observed.
b. X-linked dominant trait is observed.
c. More information is needed to determine the answer.
d. Autosomal recessive expression is observed and both the children will be carriers of
the disease process.
13. A couple is undergoing genetic counseling and are very concerned about the possibility of
having a child with a birth defect as a result of a strong family history on both sides of the
family. Which statement made by the nurse is evidence of therapeutic communication?
a. “It is important to ask other members of your family for any information they can
provide that will help obtain more insight into the health history.”
b. “Given what you have told me, there is little that anyone can do to improve
outcomes.”
c. “Although you may feel that you have no options, I can’t really discuss these
matters as only the physician can provide you with information.”
d. “Do you have all your forms filled out correctly? This will make the review easier to
accomplish. ”
14. A patient presents with curly hair and blue eyes. These findings are consistent with
a. phenotype.
b. genotype.
c. dominant alleles.
d. recessive traits.
15. The nurse is working with a patient to obtain information necessary for genetic counseling.
Which tool will be used to obtain this information?
a. Braden scale
b. Genogram
c. Chorionic villus sampling (CVS)
d. Serum protein electrophoresis
16. The nurse receives report on an infant whose analysis indicates 47 total chromosomes, with the
abnormality noted at chromosome 21. Which additional assessments will the nurse include when
evaluating the infant?
a. Cleft palate
b. Protruding tongue
c. Extra fingers or toes (polydactyly)
d. Intellectual developmental delay
17. The patient indicates to the clinic nurse that she is trying to become pregnant. The clinic nurse
reviews the patient’s chart and notes the following laboratory values: Blood type O−, RPR
nonreactive, rubella non-immune, HCT 35%. Which laboratory value is most concerning to the
nurse?
a. HCT 35%
b. Blood type O−
c. RPR nonreactive
d. Rubella non-immune
MULTIPLE RESPONSE
1. The clinic nurse is reviewing charts on prenatal patients. Which patient histories indicate that
a referral to a genetic counselor is warranted? (Select all that apply.)
a. A father who is aged 35
b. A patient having a first baby at age 30
c. A family history of unexplained stillbirths
d. A patient with a family history of birth defects
e. A patient who is a carrier of an X-linked disorder
2. The nurse is teaching prenatal patients about avoiding substances or conditions that can harm the
fetus. Which should the nurse include in the teaching session? (Select all that apply.)
a. Elimination of use of alcohol
b. Avoidance of supplemental folic acid replacement
c. Stabilization of blood glucose levels in a diabetic patient with insulin
d. Avoidance of nonurgent radiologic procedures during the pregnancy
e. Avoidance of maternal hyperthermia to temperatures of 37.8C (100F) or higher
3. The nurse is explaining genetics to a group of nursing students. Which are autosomal recessive
disorders that the nurse should discuss during the teaching session? (Select all that
apply.)
a. Hemophilia
b. Cystic fibrosis
c. Sickle cell disease
d. Turner’s syndrome
e. Phenylketonuria (PKU) disease
Chapter 05: Conception and Prenatal Development
1. An expectant father asks the nurse, “Which part of the mature sperm contains the male
chromosome?” What is the correct response by the nurse?
a. X-bearing sperm
b. The tail of the sperm
c. The head of the sperm
d. The middle portion of the sperm
2. One of the assessments performed in the birth room is checking the umbilical cord for blood
vessels. Which finding is considered to be within normal limits?
a. One artery and one vein
b. Two veins and one artery
c. Two arteries and one vein
d. Two arteries and two veins
3. What is the purpose of the ovum’s zona pellucida?
a. Prevents multiple sperm from fertilizing the ovum
b. Stimulates the ovum to begin mitotic cell division
c. Allows the 46 chromosomes from each gamete to merge
d. Makes a pathway for more than one sperm to reach the ovum
4. The nurse is explaining the process of cell division during the preembryonic period to a group of
nursing students. Which statement best describes the characteristics of the morula?
a. Fertilized ovum before mitosis begins
b. Double layer of cells that becomes the placenta
c. Flattened, disk-shaped layer of cells within a fluid-filled sphere
d. Solid ball composed of the first cells formed after fertilization
5. The upper uterus is the best place for the fertilized ovum to implant due to which anatomical
adaptation?
a. Maternal blood flow is lower.
b. Placenta attaches most firmly.
c. Uterine endometrium is softer.
d. Developing baby is best nourished.
6. Some of the embryo’s intestines remain within the umbilical cord during the embryonic
period because the
a. intestines need this time to grow until week 15.
b. nutrient content of the blood is higher in this location.
c. abdomen is too small to contain all the organs while they are developing.
d. umbilical cord is much larger at this time than it will be at the end of pregnancy.
7. A patient who is 16 weeks pregnant with her first baby asks how long it will be before she
feels the baby move. Which is the nurse’s best answer?
a. “You should have felt the baby move by now.”
b. “The baby is moving, but you can’t feel it yet.”
c. “Some babies are quiet and you don’t feel them move.”
d. “Within the next month you should start to feel fluttering sensations.”
8. Which statement best describes the changes that occur during the fetal period of development?
a. Maturation of organ systems
b. Development of basic organ systems
c. Resistance of organs to damage from external agents
d. Development of placental oxygen–carbon dioxide exchange
9. An expectant mother says to the nurse, “When my sister’s baby was born, it was covered in a
cheese-like coating. What is the purpose of this coating?” The correct response by the nurse is to
explain that the purpose of vernix caseosa is to
a. regulate fetal temperature.
b. protect the fetal skin from amniotic fluid.
c. promote normal peripheral nervous system development.
d. allow the transport of oxygen and nutrients across the amnion.
10. An expectant mother, diagnosed with oligohydramnios, asks the nurse what this condition
means for the baby. Which statement should the nurse provide for the patient?
a. Oligohydramnios can cause poor fetal lung development.
b. Oligohydramnios means that the fetus is excreting excessive urine.
c. Oligohydramnios could mean that the fetus has a gastrointestinal blockage.
d. Oligohydramnios is associated with fetal central nervous system abnormalities.
11. The nurse is conducting a staff in-service on multifetal pregnancy. Which statement regarding
dizygotic twin development should the nurse include in the teaching session?
a. Dizygotic twins arise from two fertilized ova and are the same sex.
b. Dizygotic twins arise from a single fertilized ovum and are always of the same sex.
c. Dizygotic twins arise from two fertilized ova and may be the same sex or different
sexes.
d. Dizygotic twins arise from a single fertilized ovum and may be the same sex or
different sexes.
12. An infant is diagnosed with fetal anemia. Which information would support this clinical
diagnosis?
a. Presence of excess maternal hormones
b. Maternal blood type O-negative, Rh-negative, and infant blood type O-negative,
Rh-negative
c. Passive immunity
d. Rh-negative mother and Rh-positive baby
13. The nurse is explaining the function of the placenta to a pregnant patient. Which statement
indicates to the nurse that further clarification is necessary?
a. “My baby gets oxygen from the placenta.”
b. “The placenta functions to help excrete waste products.”
c. “The nourishment that I take in passes through the placenta.”
d. “The placenta helps maintain a stable temperature for my baby.”
14. The nurse is assessing a newborn immediately after birth. After assigning the first Apgar score of
9, the nurse notes two vessels in the umbilical cord. What is the nurse’s next action?
a. Assess for other abnormalities of the infant.
b. Note the assessment finding in the infant’s chart.
c. Notify the health care provider of the assessment finding.
d. Call for the neonatal resuscitation team to attend the infant immediately.
15. A pregnant patient asks the nurse how her baby gets oxygen to breathe. What is the nurse’s
best response?
a. “Oxygen-rich blood is delivered through the umbilical vein to the baby.”
b. “Take lots of deep breaths because the baby gets all of its oxygen from you.”
c. “You don’t need to be concerned about your baby getting enough oxygen.”
d. “The baby’s lungs are not mature enough to actually breathe, so don’t worry
MULTIPLE RESPONSE
1. Which physical characteristics decrease as the fetus nears term? (Select all that apply.)
a. Vernix caseosa
b. Lanugo
c. Port wine stain
d. Brown fat
e. Eyebrows or head hair
2. Along with gas exchange and nutrient transfer, the placenta produces many hormones
necessary for normal pregnancy, including which of the following? (Select all that apply.)
a. Insulin
b. Estrogen
c. Progesterone
d. Testosterone
e. Human chorionic gonadotropin (hCG)
3. The nurse is planning a prenatal class on fetal development. Which characteristics of prenatal
development should the nurse include for a fetus of 24 weeks, based on fertilization age? (Select
all that apply.)
a. Ear cartilage firm
b. Skin wrinkled and red
c. Testes descending toward the inguinal rings
d. Surfactant production nears mature levels
e. Fetal movement becoming progressively more noticeable
4. The nurse is explaining fetal circulation to a group of nursing students. Which information
should be included in the teaching session? (Select all that apply.)
a. After birth the ductus venosus remains open, but the other shunts close.
b. The foramen ovale shunts blood from the right atrium to the left atrium.
c. The ductus venosus shunts blood from the liver to the inferior vena cava.
d. The ductus arteriosus shunts blood from the right ventricle to the left ventricle.
5. A nurse is conducting prenatal education classes for a group of expectant parents. Which
information should the nurse include in her discussion of the purpose of amniotic fluid?
(Select all that apply.)
a. Cushions the fetus
b. Protects the skin of the fetus
c. Provides nourishment for the fetus
d. Allows for buoyancy for fetal movement
e. Maintains a stable temperature for the fetus
Chapter 06: Maternal Adaptations to Pregnancy
1. During vital sign assessment of a pregnant patient in her third trimester, the patient complains of
feeling faint, dizzy, and agitated. Which nursing intervention is most appropriate?
a. Have the patient stand up and retake her blood pressure.
b. Have the patient sit down and hold her arm in a dependent position.
c. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.
d. Have the patient lie supine for 5 minutes and recheck her blood pressure on both
arms.
2.
A pregnant woman has come to the emergency department with complaints of nasal
congestion and epistaxis. Which is the correct interpretation of these symptoms by the health
care provider?
a. Nasal stuffiness and nosebleeds are caused by a decrease in progesterone.
b. These conditions are abnormal. Refer the patient to an ear, nose, and throat
specialist.
c. Estrogen relaxes the smooth muscles in the respiratory tract, so congestion and
epistaxis are within normal limits.
d. Estrogen causes increased blood supply to the mucous membranes and can result in
congestion and nosebleeds.
3. While providing education to a primiparous patient regarding the normal changes of
pregnancy, what is an important information for the nurse to share regarding Braxton Hicks
contractions?
a. These contractions may indicate preterm labor.
b. These are contractions that never cause any discomfort.
c. Braxton Hicks contractions only start during the third trimester.
d. These occur throughout pregnancy, but you may not feel them until the third
trimester.
4. What is the physiologic reason for vascular volume increasing by 40% to 60% during
pregnancy?
a. Prevents maternal and fetal dehydration
b. Eliminates metabolic wastes of the mother
c. Provides adequate perfusion of the placenta
d. Compensates for decreased renal plasma flow
5. Physiologic anemia often occurs during pregnancy due to
a. inadequate intake of iron.
b. the fetus establishing iron stores.
c. dilution of hemoglobin concentration.
d. decreased production of erythrocytes.
6. Which finding is a positive sign of pregnancy?
a. Amenorrhea
b. Breast changes
c. Fetal movement felt by the woman
d. Visualization of fetus by ultrasound
7. A patient in her first trimester complains of nausea and vomiting. The patient asks, “Why is
this happening?” What is the nurse’s best response?
a. “It is due to an increase in gastric motility.”
b. “It may be due to changes in hormones.”
c. “It is related to an increase in glucose levels.”
d. “It is caused by a decrease in gastric secretions.”
8. The patient has just learned that she is pregnant and overhears the gynecologist saying that she
has a positive Chadwick’s sign. When the patient asks the nurse what this means, how would the
nurse respond?
a. “Chadwick’s sign signifies an increased risk of blood clots in pregnant women
because of a congestion of blood.”
b. “That sign means the cervix has softened as the result of tissue changes that
naturally occur with pregnancy.”
c. “This means that a mucus plug has formed in the cervical canal to help protect you
from uterine infection.”
d. “This sign occurs normally in pregnancy, when estrogen causes increased blood
flow in the area of the cervix.”
9. An expected change during pregnancy is a darkly pigmented vertical midabdominal line. The
nurse recognizes this alteration as
a. epulis.
b. linea nigra.
c. melasma.
d. striae gravidarum.
10. What is the best explanation that the nurse can provide to a patient who is concerned that she has
“pseudoanemia” of pregnancy?
a. Have her write down her concerns and tell her that you will ask the physician to
respond once the lab results have been evaluated.
b. Tell her that this is a benign self-limiting condition that can be easily corrected by
switching to a high-iron diet.
c. Inform her that because of the pregnancy, her blood volume has increased, leading to
a substantial dilution effect on her serum blood levels, and that most women
experience this condition.
d.
Contact the physician and get a prescription for iron pills to correct this condition.
11. Which physiologic finding is consistent with normal pregnancy?
a. Systemic vascular resistance increases as blood pressure decreases.
b. Cardiac output increases during pregnancy.
c. Blood pressure remains consistent independent of position changes.
d. Maternal vasoconstriction occurs in response to increased metabolism.
12. A pregnant woman complains of frequent heartburn. The patient states that she has never had
these symptoms before and wonders why this is happening now. The most appropriate response
by the nurse is to
a. examine her dietary intake pattern and tell her to avoid certain foods.
b. tell her that this is a normal finding during early pregnancy and will resolve as she
gets closer to term.
c. explain to the patient that physiologic changes caused by the pregnancy make her
more likely to experience these types of symptoms.
d. refer her to her health care provider for additional testing because this is an
abnormal finding.
13. Which physiologic adaptation of pregnancy may lead to increased constipation during the
pregnancy?
a. Increased emptying time in the intestines
b. Abdominal distention and bloating
c. Decreased absorption of water
d. Decreased motility in the intestines
14. Which physiologic findings related to gallbladder function may lead to the development of
gallstones during pregnancy?
a. Decrease in alkaline phosphatase levels compared with nonpregnant women
b. Increase in albumin and total protein as a result of hemodilution
c. Hypertonicity of gallbladder tissue
d. Prolonged emptying time
15. Which of these findings would indicate a potential complication related to renal function
during pregnancy?
a. Increase in glomerular filtration rate (GFR)
b. Increase in serum creatinine level
c. Decrease in blood urea nitrogen (BUN)
d. Mild proteinuria
16. A pregnant woman notices that she is beginning to develop dark skin patches on her face. She
denies using any different type of facial products as a cleansing solution or makeup. What would
the priority nursing intervention be in response to this situation?
a. Refer the patient to a dermatologist for further examination.
b. Ask the patient if she has been eating different types of foods.
c. Take a culture swab and send to the lab for culture and sensitivity (C&S).
d. Let the patient know that this is a common finding that occurs during pregnancy.
17. A patient reports to the clinic nurse that she has not had a period in over 12 weeks, she is tired,
and her breasts are sore all of the time. The patient’s urine test is positive for hCG. What is the
correct nursing action related to this information?
a. Ask the patient if she has had any nausea or vomiting in the morning.
b. Schedule the patient to be seen by a health care provider within the next 4 weeks.
c. Send the patient to the maternity screening area of the clinic for a routine
ultrasound.
d. Determine if there are any factors that might prohibit her from seeking medical
care.
18. Which comment made by a patient in her first trimester indicates ambivalent feelings?
a. “My body is changing so quickly.”
b. “I haven’t felt well since this pregnancy began.”
c. “I’m concerned about the amount of weight I’ve gained.”
d. “I wanted to become pregnant, but I’m scared about being a mother.”
19. A patient who is 7 months pregnant states, “I’m worried that something will happen to my
baby.” Which is the nurse’s best response?
a. “Your baby is doing fine.”
b. “Tell me about your concerns.”
c. “There is nothing to worry about.”
d. “The doctor is taking good care of you and your baby.”
20. What is the term for the step in maternal role attainment that relates to the woman giving up
certain aspects of her previous life?
a. Fantasy
b. Grief work
c. Role playing
d. Looking for a fit
21. An expectant patient in her third trimester reports that she developed a strong tie to her baby
from the beginning and now is really in tune to her baby’s temperament. The nurse interprets
this as the development of which maternal task of pregnancy?
a. Learning to give of herself
b. Developing attachment with the baby
c. Securing acceptance of the baby by others
d. Seeking safe passage for herself and her baby
22. Which situation best describes a man trying on fathering behaviors?
a. Reading books on newborn care
b. Spending more time with his siblings
c. Coaching a little league baseball team
d. Exhibiting physical symptoms related to pregnancy
23. A 36-year-old divorcee with a successful modeling career finds out that her 18-year-old
daughter is expecting her first child. Which is a major factor in determining how this woman
will respond to becoming a grandmother?
a. Her age
b. Her career
c. Being divorced
d. Age of the daughter
24. Which comment made by a new mother to her own mother is most likely to encourage the
grandmother’s participation in the infant’s care?
a. “Could you help me with the housework today?”
b. “The baby is spitting up a lot. What should I do?”
c. “I know you are busy, so I’ll get John’s mother to help me.”
d. “The baby has a stomachache. I’ll call the nurse to find out what to do.”
25. Which comment made by a new mother exhibits understanding of her toddler’s response to a
new sibling?
a. “I can’t believe he is sucking his thumb again.”
b. “He is being difficult and I don’t have time to deal with him.”
c. “When we brought the baby home, we made Michael stop sleeping in the crib.”
d. “My husband is going to stay with the baby so I can take Michael to the park tomorrow.”
26. An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for
the baby. What information should the nurse provide?
a. Intercourse is safe until the third trimester.
b. Safer sex practices should be used once the membranes rupture.
c. Intercourse should be avoided if any spotting from the vagina occurs afterward.
d. Intercourse and orgasm are often contraindicated if a history of or signs of preterm
labor are present.
27. A pregnant patient comes into the medical clinic stating that her family and friends are telling her
that she is always talking about the pregnancy and nothing else. She is concerned that something
is wrong with her. What psychological behavior is she exhibiting?
a. Antepartum obsession
b. Ambivalence
c. Uncertainty
d. Introversion
28. A patient relates a story of how her boyfriend is feeling her aches and pains associated with her
pregnancy. She is concerned that her boyfriend is making fun of her concerns. How would you
respond to this patient statement?
a. Tell her not to worry because it is natural for her boyfriend to make her feel better by
identifying with her pregnancy.
b. Refer the patient to a psychologist for counseling to deal with this problem because it
is clearly upsetting her.
c. Explain that her boyfriend may be experiencing couvade syndrome and that this is a
normal finding seen with male partners.
d. Ask the patient specifically to define her concerns related to her relationship with her
boyfriend and suggest methods to stop this type of behavior by her significant other.
MULTIPLE RESPONSE
1. The nurse is assessing a patient in her 37th week of pregnancy for the psychological responses
commonly experienced as birth nears. Which psychological responses should the nurse expect to
evaluate? (Select all that apply.)
a. The patient is excited to see her baby.
b. The patient has not started to prepare the nursery for the new baby.
c. The patient expresses concern about how to know if labor has started.
d. The patient and her spouse are concerned about getting to the birth center in time.
e. The patient and her spouse have not discussed how they will share household
tasks.
2. The nurse is teaching a pregnant patient about signs of possible pregnancy complications.
Which should the nurse include in the teaching plan? (Select all that apply.)
a. Report watery vaginal discharge.
b. Report puffiness of the face or around the eyes.
c. Report any bloody show when you go into labor.
d. Report visual disturbances, such as spots before the eyes.
e. Report any dependent edema that occurs at the end of the day.
3. Which findings are presumptive signs of pregnancy? (Select all that apply.)
a. Quickening
b. Amenorrhea
c. Ballottement
d. Goodell’s sign
e. Chadwick’s sign
Chapter 07: Antepartum Assessment, Care, and Education
1. Which suggestion is most helpful for the pregnant patient who is experiencing heartburn?
a. Drink plenty of fluids at bedtime.
b. Eat only three meals a day so the stomach is empty between meals.
c. Drink coffee or orange juice immediately on arising in the morning.
d. Use Tums or Rolaids to obtain relief, as directed by the health care provider.
2. What is the rationale for a woman in her first trimester of pregnancy to expect to visit her
health care provider every 4 weeks?
a. Problems can be eliminated.
b. She develops trust in the health care team.
c. Her questions about labor can be answered.
d. The conditions of the expectant mother and fetus can be monitored.
3. Which advice to the patient is one of the most effective methods for preventing venous stasis?
a. Sit with the legs crossed.
b. Rest often with the feet elevated.
c. Sleep with the foot of the bed elevated.
d. Wear elastic stockings in the afternoon.
4. What is the gravida and para for a patient who delivered triplets 2 years ago and is now
pregnant again?
a. 2, 3
b. 1, 2
c. 2, 1
d. 1, 3
5. A patient, gravida 2, para 1, comes for a prenatal visit at 20 weeks of gestation. Her fundus is
palpated 3 cm below the umbilicus. This finding is
a. appropriate for gestational age.
b. a sign of impending complications.
c. lower than normal for gestational age.
d. higher than normal for gestational age.
6. Which complaint made by a patient at 35 weeks of gestation requires additional assessment?
a. Abdominal pain
b. Ankle edema in the afternoon
c. Backache with prolonged standing
d. Shortness of breath when climbing stairs
7. A gravida 1 patient at 32 weeks of gestation reports that she has severe lower back pain. What
should the nurse’s assessment include?
a. Palpation of the lumbar spine
b. Exercise pattern and duration
c. Observation of posture and body mechanics
d. Ability to sleep for at least 6 hours uninterrupted
8. Which laboratory result would be a cause for concern if exhibited by a patient at her first
prenatal visit during the second month of her pregnancy?
a. Rubella titer, 1:6
b. Platelets, 300,000/mm3
c. White blood cell count, 6000/mm3
d. Hematocrit 38%, hemoglobin 13 g/dL
9. A patient in her third trimester of pregnancy is asking about safe travel. Which statement
should the nurse provide regarding safe travel during pregnancy?
a. “Only travel by car during pregnancy.”
b. “Avoid use of the seat belt during the third trimester.”
c. “You can travel by plane until your 38th week of gestation.”
d. “If you are traveling by car stop to walk every 1 to 2 hours.”
10. When a pregnant woman develops ptyalism, which guidance should the nurse provide?
a. Chew gum or suck on lozenges between meals.
b. Eat nutritious meals that provide adequate amounts of essential vitamins and
minerals.
c. Take short walks to stimulate circulation in the legs and elevate the legs
periodically.
d. Use pillows to support the abdomen and back during sleep.
11. When documenting a patient encounter, which term will the nurse use to describe the woman
who is in the 28th week of her first pregnancy?
a. Multigravida
b. Multipara
c. Nullipara
d. Primigravida
12. You are performing assessments for an obstetric patient who is 5 months pregnant with her
third child. Which finding would cause you to suspect that the patient was at risk?
a. Patient states that she doesn’t feel any Braxton Hicks contractions like she had in her
prior pregnancies.
b. Fundal height is below the umbilicus.
c. Cervical changes, such as Goodell’s sign and Chadwick’s sign, are present.
d. She has increased vaginal secretions.
13. Determine the obstetric history of a patient in her fifth pregnancy who has had two spontaneous
abortions in the first trimester, one infant at 32 weeks’ gestation, and one infant at 38 weeks’
gestation.
a. G5 T1 P2 A2 L 2
b. G5 T1 P1 A1 L2
c. G5 T0 P2 A2 L2
d. G5 T1 P1 A2 L2
14. Use Nägele’s rule to determine the EDD (estimated day of birth) for a patient whose last
menstrual period started on April 12.
a. February 19
b. January 19
c. January 21
d. February 7
15. Which of the patient health behaviors in the first trimester would the nurse identify as a risk
factor in pregnancy?
a. Sexual intercourse two or three times weekly
b. Moderate exercise for 30 minutes daily
c. Working 40 hours a week as a secretary in a travel agency
d. Relaxing in a hot tub for 30 minutes a day, several days a week
16. A patient who smokes one pack of cigarettes daily has a positive pregnancy test. The nurse
will explain that smoking during pregnancy increases the risk of which condition?
a. Congenital anomalies
b. Death before or after birth
c. Neonatal hypoglycemia
d. Neonatal withdrawal syndrome
17. A patient with an IUD in place has a positive pregnancy test. When planning care, the nurse
will base decisions on which anticipated action?
a. A therapeutic abortion will need to be scheduled since fetal damage is inevitable.
b. Hormonal analyses will be done to determine the underlying cause of the
false-positive test result.
c. The IUD will need to be removed to avoid complications such as miscarriage or
infection.
d. The IUD will need to remain in place to avoid injuring the fetus.
18. The health care provider reports that the primigravida’s fundus can be palpated at the
umbilicus. Which priority question will the nurse include in the patient’s assessment?
a. “Have you noticed that it is easier for you to breathe now?”
b. “Would you like to hear the baby’s heartbeat for the first time?”
c. “Have you felt a fluttering sensation in your lower pelvic area yet?”
d. “Have you recently developed any unusual cravings, such as for chalk or dirt?”
19. The nurse is scheduling the next appointment for a healthy primigravida currently at 28 weeks
gestation. When will the nurse schedule the next prenatal visit?
a. 1 week
b. 2 weeks
c. 3 weeks
d. 4 weeks
20. Which information is covered by early pregnancy classes offered in the first and second
trimesters?
a. Methods of pain relief
b. The phases and stages of labor
c. Coping with common discomforts of pregnancy
d. Prebirth and postbirth care of a patient having a cesarean birth
21. Which is the method of childbirth that helps prevent the fear-tension-pain cycle by using slow
abdominal breathing in early labor and rapid chest breathing in advanced labor?
a. Bradley
b. Lamaze
c. Leboyer
d. Dick-Read
22. Which type of cutaneous stimulation involves massage of the abdomen?
a. Imagery
b. Effleurage
c. Mental stimulation
d. Thermal stimulation
23. What does a birth plan help the parents accomplish?
a. Avoidance of an episiotomy
b. Determining the outcome of the birth
c. Assuming complete control of the situation
d. Taking an active part in planning the birth experience
24. A relaxation technique that can be used during the childbirth experience to decrease maternal
pain perception is
a. using increased environmental stimulation as a method of distraction.
b. restricting family and friends from visiting during the labor period to keep the
patient focused on breathing techniques.
c. medicating the patient frequently to reduce pain perception.
d. assisting the patient in breathing methods aimed at taking control of pain
perception based on the contraction pattern.
25. Which technique would provide the best pain relief for a pregnant woman with an occiput
posterior position?
a. Neuromuscular disassociation
b. Effleurage
c. Psychoprophylaxis
d. Sacral pressure
26. The labor nurse is reviewing breathing techniques with a primiparous patient admitted for
induction of labor. When is the best time to encourage the laboring patient to use slow, deep
chest breathing with contractions?
a. During labor, when she can no longer talk through contractions
b. During the first stage of labor, when the contractions are 3 to 4 minutes apart
c. Between contractions, during the transitional phase of the first stage of labor
d. Between her efforts to push to facilitate relaxation between contractions
27. In a prenatal education class, the nurse is reviewing the importance of using relaxation
techniques during labor. Which patient statement will the nurse need to correct?
a. “We will practice relaxation techniques only in a quiet setting so I can focus.”
b. “Relaxation is important during labor because it will help me conserve my
energy.”
c. “If I relax in between contractions, my baby will get more oxygen during labor.”
d. “My partner and I will practice relaxation throughout the remainder of my
pregnancy.”
MULTIPLE RESPONSE
1. A pregnant patient reports that she works in a long-term care setting and is concerned about the
impending flu season. She asks about receiving the flu vaccine. As the nurse, you are aware
that some immunizations are safe to administer during pregnancy, whereas others are not.
Which vaccines could this patient receive? (Select all that apply.)
a. Tetanus
b. Varicella
c. Influenza
d. Hepatitis A and B
e. Measles, mumps, rubella (MMR)
2. The nurse is planning care for a patient in her first trimester of pregnancy. The patient is
experiencing nausea and vomiting. Which interventions should the nurse plan to share with
this patient? (Select all that apply.)
a. Suck on hard candy.
b. Take prenatal vitamins in the morning.
c. Try some herbal tea to relieve the nausea.
d. Drink fluids frequently but separate from meals.
e. Eat crackers or dry cereal before arising in the morning.
3. Which factors contribute to the presence of edema in the pregnant patient? (Select all that
apply.)
a.
b.
c.
d.
e.
Diet consisting of processed foods
Hemoconcentration
Increase in colloid osmotic pressure
Last trimester of pregnancy
Decreased venous return
4. The prenatal nurse educator is teaching couples the technique of applying sacral pressure
during labor. Which should be included in the teaching session? (Select all that apply.)
a. The technique can be combined with heat to the area.
b. A jiggling motion should be used while applying the pressure.
c. Tennis balls may be used to apply the pressure to the sacral area.
d. The pressure against the sacrum should be intermittent during the contraction.
e. The hand may be moved slowly or remain positioned directly over the sacrum.
Chapter 08: Nutrition for Childbearing
1. When planning a healthy diet with a pregnant patient, what should the nurse’s first action be?
a. Teach the patient about MyPlate.
b. Review the patient’s current dietary intake.
c. Instruct the patient to limit the intake of fatty foods.
d. Caution the patient to avoid large doses of vitamins, especially those that are fatsoluble.
2. The nurse is meeting with a patient with an elevated BMI regarding an optimal diet for
pregnancy. Which major source of nutrients should be a significant component of this
patient’s diet?
a. Fats
b. Fiber
c. Simple sugars
d. Complex carbohydrates
3. In order to increase the absorption of iron by a pregnant patient, which beverage should an
iron preparation be given with?
a. Tea
b. Milk
c. Coffee
d. Orange juice
4. When should iron supplementation during a normal pregnancy begin?
a. Before pregnancy
b. In the first trimester
c. In the third trimester
d. In the second trimester
5. A patient in her fifth month of pregnancy asks the nurse, “How many more calories should I be
eating daily?” What is the correct response by the nurse?
a. 180 more calories a day
b. 340 more calories a day
c. 452 more calories a day
d. 500 more calories a day
6. A pregnant patient’s diet may not meet her need for folate. Which food choice is an excellent
source of this nutrient?
a. Chicken
b. Cheese
c. Potatoes
d. Green leafy vegetables
7. A pregnant patient asks the nurse if she can double her prenatal vitamin dose because she does
not like to eat vegetables. What is the nurse’s response regarding the danger of taking excessive
vitamins?
a. Increases caloric intake
b. Has toxic effects on the fetus
c. Increases absorption of all vitamins
d. Promotes development of pregnancy-induced hypertension (PIH)
8. The nurse is conducting a prenatal nutrition education class for a group of nursing students.
Which statement best describes the condition known as pica?
a. Iron-deficiency anemia
b. Intolerance to milk products
c. Ingestion of nonfood substances
d. Episodes of anorexia and vomiting
9. Which effect is a common response to both smoking and cocaine use in the pregnant patient?
a. Vasoconstriction
b. Increased appetite
c. Increased metabolism
d. Changes in insulin metabolism
10. Which is the most important reason for evaluating the pattern of weight gain in pregnancy?
a. Prevents excessive adipose tissue deposits
b. Determines cultural influences on the woman’s diet
c. Assesses the need to limit caloric intake in obese women
d. Identifies potential nutritional problems or complications of pregnancy
11. A pregnant patient would like to know which foods, other than dairy products, contain the
most calcium. Which food group would the nurse recommend?
a. Legumes
b. Lean meat
c. Whole grains
d. Yellow vegetables
12. To determine cultural influences on a patient’s diet, what is the nurse’s primary action?
a. Evaluate the patient’s weight gain during pregnancy.
b. Assess the socioeconomic status of the patient.
c. Discuss the four food groups with the patient.
d. Identify the food preferences and methods of food preparation common to the
patient’s culture.
13. In teaching a pregnant adolescent about nutrition, what should the nurse include in the care
plan?
a. Determine the weight gain needed to meet adolescent growth and add 35 lb.
b. Suggest that she does not eat at fast food restaurants to avoid foods of poor
nutritional value.
c. Realize that most adolescents are unwilling to make dietary changes during
pregnancy.
d. Emphasize the need to eliminate common teen snack foods because they are too
high in fat and sodium.
14. The traditional diet of Asian women includes little meat and few dairy products and may be
low in calcium and iron. The nurse can assist a patient increase her intake of these foods by
which action?
a. Suggest that she eat more tofu, bok choy, and broccoli.
b. Suggest that she eat more hot foods during pregnancy.
c. Emphasize the need for increased milk intake during pregnancy.
d. Tell her husband that she must increase her intake of fruits and vegetables for the
baby’s sake.
15. Which patient would require additional calories and nutrients?
a. A 36-year-old female gravida 2, para 1, in her first trimester of pregnancy
b. An 18-year-old female who delivered a 7-lb baby and is bottle feeding
c. A 23-year-old female who had a cesarean birth and is bottle feeding
d. A 20-year-old female who had a vaginal birth 5 months ago and is breastfeeding
16. A patient postdelivery is concerned about getting back to her prepregnancy weight as soon as
possible. She had only gained 15 lb during her pregnancy. Which assessment factor would be of
concern at her 6-week postpartum checkup?
a. Patient has lost 30 lb during the 6-week period prior to her scheduled checkup.
b. Patient states that she is eating healthy and limiting intake of processed foods.
c. Patient relates increased consumption of fruits and vegetables in her diet postbirth.
d. Patient has resumed her usual exercise pattern of walking around the neighborhood for
10 minutes each night.
17. Which clinical finding is associated with inadequate maternal weight gain during pregnancy?
a. Prolonged labor
b. Preeclampsia
c. Gestational diabetes
d. Low-birth-weight infant
18. A pregnant patient arrives for her first prenatal visit at the clinic. She informs the nurse that she
has been taking an additional 400 mcg of folic acid prior to becoming pregnant. Based on the
patient’s history, she has reached 8 weeks’ gestation. Which recommendation would the nurse
provide regarding folic acid supplementation?
a. Have the patient continue to take 400 mcg folic acid throughout her pregnancy.
b. Tell the patient that she no longer has to take additional folic acid because it will be
included in her prenatal vitamins.
c. Have the patient increase her folic acid intake to 1000 mcg throughout the rest of her
pregnancy.
d. Schedule the patient to go for an AFP (alpha-fetoprotein) test.
19. Which patient is most at risk for a low-birth-weight infant?
a. 22-year-old, 60 inches tall, normal prepregnant weight
b. 18-year-old, 64 inches tall, body mass index is <18.5
c. 30-year-old, 78 inches tall, prepregnant weight is 15 lb above the norm
d. 35-year-old, 75 inches tall, total weight gain in previous pregnancies was 33 lb
20. Changes in the diet of the pregnant patient who has phenylketonuria would include
a. adding foods high in vitamin C.
b. eliminating drinks containing aspartame
c. restricting protein intake to <20 g a day.
d. increasing caloric intake to at least 1800 cal/day.
21. When explaining the recommended weight gain to your patient, the nurse’s teaching should
include which statement?
a.
b.
c.
d.
“All pregnant women need to gain a minimum of 25 to 35 lb.”
“The fetus, amniotic fluid, and placenta require 15 lb of weight gain.”
“Weight gain in pregnancy is based on the patient’s prepregnant body mass index.”
“More weight should be gained in the first and second trimesters and less in the
third.”
22. Which patient has correctly increased her caloric intake from her recommended pregnancy
intake to the amount necessary to sustain breastfeeding in the first 6 postpartum months?
a. From 1800 to 2200 calories per day
b. From 2000 to 2500 calories per day
c. From 2200 to 2530 calories per day
d. From 2500 to 2730 calories per day
23. A pregnant woman of normal weight enters her 13th week of pregnancy. If the patient eats
and exercises as directed, what will the nurse anticipate as the ongoing weight gain for the
remaining trimesters?
a. 0.3 lb every week
b. 1 lb every week
c. 1.8 lb every week
d. 2 lb every week
24. A patient with a BMI of 32 has a positive pregnancy test. What is the maximum number of
pounds that the nurse will advise the patient gain during the pregnancy?
a. 20 lb
b. 25 lb
c. 28 lb
d. 40 lb
25. A pregnant patient with significant iron-deficiency anemia is prescribed iron supplements.
The patient explains to the nurse that she cannot take iron because it makes her nauseous.
What is the best response by the nurse?
a. “Iron will be absorbed more readily if taken with orange juice.”
b. “It is important to take this drug regardless of this side effect.”
c. “Taking the drug with milk may decrease your symptoms.”
d. “Try taking the iron at bedtime on an empty stomach.”
26. Which guidance related to a healthy diet during pregnancy will the nurse provide to a patient in
her 1st trimester?
a. “Every day you need to have at least 6 ounces of protein from sources such as
meat, fish, eggs, beans, nuts, soybean products, and tofu.”
b. “High-dose vitamin A supplements will promote optimal vision while preventing a
common cause of blindness in neonates.”
c. “Meals such as sushi with a cold deli salad made with raw sprouts combine
high-fiber foods with protein sources to meet multiple nutritional needs.”
d. “Vitamin and mineral supplements can meet your nutrient needs if you have
inadequate intake because of nausea or a sensation of fullness.”
27. For the pregnant patient who is a vegan, what combination of foods will the nurse advise to
meet the nutritional needs for all essential amino acids?
a. Eggs and beans
b. Fruits and vegetables
c. Grains and legumes
d. Vitamin and mineral supplements
28. A pregnant patient has lactose intolerance. Which recommendation will the nurse provide to
best help the patient meet dietary needs for calcium?
a. Add foods such as nuts, dried fruit, and broccoli to the diet.
b. Consume dairy products but take an over-the-counter anti-gas product.
c. Increase the intake of dark leafy vegetables, such as spinach and chard.
d. Use powdered milk instead of liquid forms of milk.
29. The nurse is reviewing a list of foods high in folic acid with a patient who is considering
becoming pregnant. The nurse determines that the patient understands the teaching when the
patient states she will include which list of foods in her diet?
a. Peaches, yogurt, and tofu
b. Strawberries, milk, and tuna
c. Asparagus, lemonade, and chicken breast
d. Spinach, orange juice, and fortified bran flakes
30. A patient at 8 weeks’ gestation complains to the nurse, “I feel sick almost every morning. And I
throw up at least two or three times a week.” What is the nurse’s best guidance for this patient?
a. “Do you like cheese?”
b. “Try eating four meals a day instead of three meals a day.”
c. “Try eating peanut butter on whole wheat bread right before going to bed.”
d. “If you can eat enough throughout the day, you don’t have to worry about being
sick.”
MULTIPLE RESPONSE
1. The nurse is teaching a patient taking prenatal vitamins how to avoid constipation. Which
should the nurse plan to include in the teaching session? (Select all that apply.)
a. Advise taking a daily laxative for constipation.
b. Recommend a diet high in fruits and vegetables.
c. Encourage an increase in fluid consumption during the day.
d. Increase the intake of whole grains and whole grain products.
e. Suggest increasing the intake of dairy products, especially cheeses.
2. The nurse is teaching a breastfeeding patient about substances to avoid while she is
breastfeeding. Which substances should the nurse include in the teaching session? (Select all
that apply.)
a. Caffeine
b. Alcohol
c. Omega-6 fatty acids
d. Appetite suppressants
e. Polyunsaturated omega-3 fatty acids
3. The nurse is advising a lactose-intolerant pregnant patient about calcium intake. Which
calcium sources are approximately equivalent to 1 cup of milk? (Select all that apply.)
a.
cup yogurt
b. 1 cup of sherbet
c.
oz of hard cheese
d.
cups of ice cream
e.
cup of low-fat cottage cheese
4. The nurse is teaching a pregnant patient about food safety during pregnancy and lactation.
Which statements by the patient indicate she understood the teaching? (Select all that apply.)
a. “I will limit my intake of shrimp to 12 oz a week.”
b.
c.
d.
e.
“I will avoid the soft cheeses made with unpasteurized milk.”
“I plan to continue to pack my bologna sandwich for lunch.”
“I am glad I can still go to the sushi bar during my pregnancy.”
“I will not eat any swordfish or shark while I am pregnant or nursing.”
Chapter 12: Processes of Birth
1. The nurse is explaining the physiology of uterine contractions to a group of nursing students.
Which statement best explains the maternal-fetal exchange of oxygen and waste products during
a contraction?
a. Little to no affect
b. Increases as blood pressure decreases
c. Diminishes as the spiral arteries are compressed
d. Continues except when placental functions are reduced
2. The nurse is directing an unlicensed assistive personnel (UAP) to obtain maternal vital signs
between contractions. Which statement is the appropriate rationale for assessing maternal vital
signs between contractions rather than at another interval?
a. Vital signs taken during contractions are inaccurate.
b. During a contraction, assessing fetal heart rate is the priority.
c. Maternal blood flow to the heart is reduced during contractions.
d. Maternal circulating blood volume increases temporarily during contractions.
3. Uncontrolled maternal hyperventilation during labor results in
a. metabolic acidosis.
b. metabolic alkalosis.
c. respiratory acidosis.
d. respiratory alkalosis.
4. Which mechanism of labor occurs when the largest diameter of the fetal presenting part passes
the pelvic inlet?
a. Extension
b. Engagement
c. Internal rotation
d. External rotation
5. The laboring patient asks the nurse how the labor contractions cause the cervix to dilate. The
nurse responds that labor contractions facilitate cervical dilation by
a. promoting blood flow to the cervix.
b. contracting the lower uterine segment.
c. enlarging the internal size of the uterus.
d. pulling the cervix over the fetus and amniotic sac.
6. Pregnant patients can usually tolerate the normal blood loss associated with childbirth because of
which physiologic adaptation to pregnancy?
a. A higher hematocrit
b. Increased leukocytes
c. Increased blood volume
d. A lower fibrinogen level
7. The nurse is assessing the duration of a patient’s labor contractions. Which method does the
nurse implement to assess the duration of labor contractions?
a. Assess the strongest intensity of each contraction.
b. Assess uterine relaxation between two contractions.
c. Assess from the beginning to the end of each contraction.
d. Assess from the beginning of one contraction to the beginning of the next.
8. Which physiologic event is the key indicator of the commencement of true labor?
a. Bloody show
b. Cervical dilation and effacement
c. Fetal descent into the pelvic inlet
d. Uterine contractions every 7 minutes
9. Which factor ensures that the smallest anterior-posterior diameter of the fetal head enters the
pelvis?
a. Station
b. Flexion
c. Descent
d. Engagement
10. An increase in urinary frequency and leg cramps after the 36th week of pregnancy are an
indication of
a. lightening.
b. breech presentation.
c. urinary tract infection.
d. onset of Braxton-Hicks contractions.
11. A patient just delivered her baby via the vaginal route. The patient asks the nurse why the
baby’s head is not round, but oval. Which explanation should the nurse provide the patient? a.
This results from molding.
b. This results from lightening.
c. This results from the fetal lie.
d. This results from the fetal presentation.
12. A patient whose cervix is dilated to 6 cm is considered to be in which phase of labor?
a. Latent phase
b. Active phase
c. Second stage
d. Third stage
13. The nurse is assessing a patient in the active phase of labor. What should the nurse expect
during this phase?
a. The patient is sociable and excited.
b. The patient is requesting pain medication.
c. The patient begins to experience the urge to push.
d. The patient experiences loss of control and irritability.
14. A laboring patient asks the nurse how she will know that the contraction is at its peak. The
nurse explains that the contraction peaks during which stage of measurement?
a. The acme
b. The interval
c. The increment
d. The decrement
15. A patient in labor presents with a breech presentation. The nurse understands that a breech
presentation is associated with
a. more rapid labor.
b. a high risk of infection.
c. maternal perineal trauma.
d. umbilical cord compression.
16. The primary difference between the labor of a nullipara and that of a multipara is
a. total duration of labor.
b. level of pain experienced.
c. amount of cervical dilation.
d. sequence of labor mechanisms.
17. Which maternal factor may inhibit fetal descent during labor?
a. A full bladder
b. Decreased peristalsis
c. Rupture of membranes
d. Reduction in internal uterine size
18. Which assessment finding would cause a concern for a patient who had delivered vaginally?
a. Estimated blood loss (EBL) of 500 mL during the birth process
b. White blood cell count of 28,000 mm3 postbirth
c. Patient complains of fingers tingling
d. Patient complains of thirst
19. On admission to the labor and birth unit, a 38-year-old female, gravida 4, para 3, at term in
early labor is found to have a transverse lie on vaginal examination. What is the priority
intervention at this time?
a. Perform a vaginal exam to denote progress.
b. Notify the health care provider.
c. Initiate parenteral therapy.
d. Apply oxygen via nasal cannula at 8 L/minute.
20. Which assessment finding indicates that cervical dilation and/or effacement has occurred?
a. Onset of irregular contractions
b. Cephalic presentation at 0 station
c. Bloody mucus drainage from vagina
d. Fetal heart tones (FHTs) present in the lower right quadrant
21. If a notation on the patient’s health record states that the fetal position is LSP, this indicates
that the
a. head is in the right posterior quadrant of the pelvis.
b. head is in the left anterior quadrant of the pelvis.
c. buttocks are in the left posterior quadrant of the pelvis.
d. buttocks are in the right upper quadrant of the abdomen.
22. To determine if the patient is in true labor, the nurse would assess for changes in
a. cervical dilation.
b. amount of bloody show.
c. fetal position and station.
d. pattern of uterine contractions.
23. The health care provider for a laboring patient makes the following entry into the patient’s
record: 3/50%/. What instruction will the nurse implement with the patient?
a. “You will need to remain in bed attached to the electronic fetal monitor.”
b. “Breathe with me slowly, in through your nose and out through your mouth.”
c. “I will begin the administration of 1000 mL of IV fluid so you can have an
epidural.”
d. “Your partner will need to change into scrub attire to attend the imminent birth.”
24. The examiner indicates to the labor nurse that the fetus is in the left occiput anterior (LOA)
position. To facilitate the labor process, how will the nurse position the laboring patient?
a. On her back
b. On her left side
c. On her right side
d. On her hands and knees
25. The primiparous patient at 39 weeks’ gestation states to the nurse, “I can breathe easier now.”
What is the nurse’s most appropriate response?
a. “Your labor will start any day now since the baby has dropped.”
b. “That process is called lightening. Do you have to urinate more frequently?”
c. “Contact your health care provider when your contractions are every 5 minutes for 1
hour.”
d. “You will likely not feel you baby’s movements as much now, so do not be
concerned.”
26. The nurse assesses a laboring patient’s contraction pattern and notes the frequency at every 3
to 4 minutes, duration 50 to 60 seconds, and the intensity is moderate by palpation. What is
the most accurate documentation for this contraction pattern?
a. Stage 1, latent phase
b. Stage 2, latent phase
c. Stage 1, active phase
d. Stage 2, active phase
27. A laboring patient states to the nurse, “I have to push!” What is the next nursing action?
a. Contact the health care provider.
b. Examine the patient’s cervix for dilation.
c. Review with her how to bear down with contractions.
d. Ask her partner to support her head with each push.
28. After birth of the placenta the patient states, “All of a sudden I feel very cold.” What is the
most appropriate nursing action at this time?
a. Place a warm blanket over the patient.
b. Place the baby on the patient’s abdomen.
c. Tell the patient that chills are expected after birth.
d. “What do you mean by your words ‘very cold’?”
MULTIPLE RESPONSE
1. A 28-year-old gravida 1, para 0 patient who is at term calls the labor and birth unit stating that she
thinks she is in labor. She states that she does have some vaginal discharge and feels wet;
however, it is not bloody in nature. She relates a contraction pattern that is irregular, ranging from
5 to 7 minutes and lasting 30 seconds. Which questions should the nurse pose to the patient
during this telephone triage? (Select all that apply.)
a. Does she think that her membranes have ruptured?
b. Is there any evidence of bloody show?
c. Instruct the patient to keep monitoring her contraction pattern and call you back if
they become more regular.
d. When is her next scheduled visit with her health care provider?
e. Tell her to come into the hospital for evaluation.
2. A patient asks the nurse how she can tell if labor is real. Which information should the nurse
provide to this patient? (Select all that apply.)
a. In true labor, the cervix begins to dilate.
b. In true labor, the contractions are felt in the abdomen and groin.
c. In true labor, contractions often resemble menstrual cramps during early labor.
d. In true labor, contractions are inconsistent in frequency, duration, and intensity in the
early stages.
e. In true labor your contractions tend to increase in frequency, duration, and
intensity with walking.
3. The nurse who elects to practice in the area of obstetrics often hears discussion regarding the
four Ps. What are the four Ps that interact during childbirth? (Select all that apply.)
a. Powers
b. Passage
c. Position
d. Passenger
e. Psyche
4. The nurse is planning care for a patient during the fourth stage of labor. Which interventions
should the nurse plan to implement? (Select all that apply.)
a. Offer the patient a warm blanket.
b. Place an ice pack on the perineum.
c. Massage the uterus if it is boggy.
d. Delay breastfeeding until the patient is rested.
e. Explain to the patient that the lochia will be light pink in color.
5. Which clinical finding should the nurse expect to assess in the third stage of labor that
indicates the placenta has separated from the uterine wall? (Select all that apply.)
a. A gush of blood appears.
b. The uterus rises upward in the abdomen.
c. The fundus descends below the umbilicus.
d. The cord descends further from the vagina.
e. The uterus becomes boggy and soft, with an elongated shape.
6. The clinical nurse educator is providing instruction to a group of new nurses during labor
orientation. Which information regarding the factors that have a role in the initiation of labor
should the educator include in this teaching session? (Select all that apply.)
a. Progesterone levels become higher than estrogen levels.
b. Natural oxytocin in conjunction with other substances plays a role.
c. Stretching, pressure, and irritation of the uterus and cervix increase.
d. The secretion of prostaglandins from the fetal membranes decreases.
Chapter 13: Pain Management During Childbirth
1. Childbirth preparation can be considered successful if which of the following outcomes is
achieved?
a. Labor was pain-free.
b. The birth experiences of friends and families were ignored.
c. Only nonpharmacologic methods for pain control were used.
d. The patient rehearsed labor and practiced skills to master pain.
2. A woman with a known heroin habit is admitted in early labor. Which drug is contraindicated
with opiate-dependent patients?
a. Nalbuphine (Nubain)
b. Hydroxyzine (Vistaril)
c. Promethazine (Phenergan)
d. Diphenhydramine (Benadryl)
3. A patient is admitted to the labor and birth room in active labor; contractions are 4 to 5
minutes apart and last for 30 seconds. The nurse needs to perform a detailed assessment.
When is the best time to ask questions or perform procedures?
a. After the contraction is over
b. When it is all right with the coach
c. During the increment of the next contraction
d. After administration of analgesic-anesthetic
4. Childbirth pain is different from other types of pain in that it is
a. less intense.
b. associated with a physiologic process.
c. more responsive to pharmacologic management.
d. designed to make one withdraw from the stimulus.
5. Excessive anxiety during labor heightens the patient’s sensitivity to pain by increasing
a. muscle tension.
b. the pain threshold.
c. blood flow to the uterus.
d. rest time between contractions.
6. Which fetal position may cause the laboring patient increased back discomfort?
a. Left occiput anterior
b. Left occiput posterior
c. Right occiput anterior
d. Right occiput transverse
7. A major advantage of nonpharmacologic pain management is
a. a more rapid labor is likely.
b. more complete pain relief is possible.
c. the woman remains fully alert at all times.
d. there are no side effects or risks to the fetus.
8. The best time to teach nonpharmacologic pain control methods to an unprepared laboring
patient is during which stage?
a. Latent phase
b. Active phase
c. Second stage
d. Transition phase
9. The primary side effect of maternal narcotic analgesia in the newborn is
a. tachypnea.
b. bradycardia.
c. acrocyanosis.
d. respiratory depression.
10. The nerve block used in labor that provides anesthesia to the lower vagina and perineum is
referred to as a(n)
a. local.
b. epidural.
c. pudendal.
d. spinal block.
11. The nurse is teaching a childbirth education class. Which information regarding excessive
pain in labor should the nurse include in the session?
a. It usually results in a more rapid labor.
b. It has no effect on the outcome of labor.
c. It is considered to be a normal occurrence.
d. It may result in decreased placental perfusion.
12. Which patient will most likely have increased anxiety and tension during labor?
a. Gravida 2 who refused any medication
b. Gravida 2 who delivered a stillborn baby last year
c. Gravida 1 who did not attend prepared childbirth classes
d. Gravida 3 who has two children younger than 3 years
13. Which method of pain management would be safest for a gravida 3, para 2, admitted at 8 cm
cervical dilation?
a. Narcotics
b. Spinal block
c. Epidural anesthesia
d. Breathing and relaxation techniques
14. A laboring patient who imagines her body opening to let the baby out is using a mental
technique called
a. imagery.
b. effleurage.
c. distraction.
d. dissociation.
15. When administering a narcotic to a laboring patient, which statement explains why the nurse
should inject the medication at the beginning of a contraction?
a. The medication will be rapidly circulated.
b. Less medication will be transferred to the fetus.
c. The maternal vital signs will not be adversely affected.
d. Full benefit of the medication is received during that contraction.
16. The method of anesthesia in labor that is considered the safest for the fetus is
a. epidural block.
b. pudendal block.
c. local infiltration.
d. spinal (subarachnoid) block.
17. To improve placental blood flow immediately after the injection of an epidural anesthetic, the
nurse should
a. give the woman oxygen.
b. turn the woman to the right side.
c. decrease the intravenous infusion rate.
d. place a wedge under the woman’s right hip.
18. Which physiologic effect may occur in the presence of increased maternal pain perception
during labor?
a. Increase in uterine contractions in response to catecholamine secretion
b. Decrease in blood pressure in response to alpha receptors
c. Decreased perfusion to the placenta in response to catecholamine secretion
d. Increased uterine blood flow, causing increase in maternal blood pressure
19. Which of the following factors would affect pain perception or tolerance for the laboring
patient?
a. Right occiput posterior fetal position during labor
b. Bishop score of 10 prior to the induction of labor
c. Gynecoid pelvis
d. Absence of Ferguson’s reflex
20. A patient in labor is approaching the transition stage and already has an epidural in place. An
additional dose of medication has been prescribed and administered to the patient. Which priority
intervention should be performed in order to evaluate the clinical response to treatment?
a. Obtain a pain scale response from the patient based on a 0 to 10 scale.
b. Document maternal blood pressure and fetal heart rates following medication
administration and observe for any variations.
c. Document intake and output on the electronic health record (EHR).
d. Increase the flow rate of prescribed parenteral fluid to maintain hydration
21. The process of labor places significant metabolic demands on the obstetric patient. Which
physiologic findings would be expected?
a. Decreased maternal blood pressure as a result of stimulation of alpha receptors
b. Uterine vasoconstriction as a result of stimulation of beta receptors
c. Increased maternal demand for oxygen
d. Increased blood flow to placenta because of catecholamine release
22. A labor patient, gravida 2, para 1, at term has received meperidine (Demerol) for pain control
during labor. Her most recent dose was 15 minutes ago and birth is now imminent. Maternal vital
signs have been stable and the EFM tracing has not shown any baseline changes. Which
medication does the nurse anticipate would be required in the birth room for administration?
a. Oxytocin (Pitocin)
b. Naloxone (Narcan)
c. Bromocriptine (Parlodel)
d. Oxygen
23. Which statement is true with regard to the type of pain associated with childbirth experience?
a. Pain is constant throughout the labor experience.
b. Labor pain during childbirth is considered to be an abnormal response.
c. Pain associated with childbirth is self-limiting.
d. Pain associated with childbirth does not allow for adequate preparation.
24. A patient in labor reports a feeling of burning pain during the second stage of labor. This type of
pain is associated with
a. visceral pain.
b. tissue ischemia.
c. somatic pain.
d. cervical dilation.
25. A patient presents to the labor and birth area for emergent birth. Vaginal exam reveals that the
patient is fully dilated, vertex, +2 station, with ruptured membranes. The patient is extremely
apprehensive because this is her first childbirth experience and asks for an epidural to be
administered now. What is the priority nursing response based on this patient assessment?
a. Use contact anesthesia for an epidural and prepare the patient per protocol.
b. Tell the patient that she will not need any pain medication because the birth will be
over in a matter of minutes and the pain will stop.
c. Assist the patient with nonpharmacologic methods of pain distraction during this
time as you prepare for vaginal birth.
d. Call the physician for admitting orders.
26. A labor patient has brought in a photograph of her two children and asks the nurse to place it on
the wall so that she can look at it during labor contractions. This is an example of
a. focal point.
b. distraction.
c. effleurage.
d. relaxation.
27. A pregnant woman in labor is quite anxious and has been breathing rapidly during
contractions. She now complains of a tingling sensation in her fingers. What is the priority
nursing intervention at this time?
a.
b.
c.
d.
Perform a vaginal exam to denote progress.
Reposition the patient to a side lying position.
Instruct the patient to breathe into her cupped hands.
Notify the physician about current findings.
28. A laboring patient has asked the nurse to assist her in utilizing a cutaneous stimulation
strategy for pain management. The nurse would
a. assist her into the shower.
b. apply a heat pack to lower back.
c. help her to create a relaxing mental scene.
d. encourage cleansing breaths and slow-paced breathing.
29. To relieve a mild postdural puncture headache, the nurse should encourage the intake of
a. milk.
b. orange juice.
c. tea or coffee.
d. beef or chicken bouillon.
30. Which patient will be most receptive to teaching about nonpharmacologic pain control
methods?
a. Gravida 1, para 0, in transition
b. Gravida 2, para 1, admitted at 8 cm
c. Gravida 1, para 0, dilated 2 cm, 80% effaced
d. Gravida 3, para 2, complaining of intense perineal pressure
31. The nurse is providing care to a patient in the active phase of the first stage of labor. The
patient is crying out loudly with each contraction. What is the nurse’s most respectful
approach for this patient?
a. Ask the patient’s labor coach if this is a usual expression of pain for her.
b. Refer to the patient’s chart to determine any orders for pain medication.
c. Tell the patient that she is disturbing the other laboring patients on the unit.
d. Encourage the patient to try to suppress her noisiness during contractions.
32. A multipara’s labor plan includes the use of jet hydrotherapy during the active phase of labor.
What is the priority patient assessment prior to assisting the patient with this request?
a. Maternal pulse
b. Maternal temperature
c. Maternal blood pressure
d. Maternal blood glucose level
33. A patient in active labor requests an epidural for pain management. What is the nurse’s most
appropriate intervention at this juncture?
a. Assess the fetal heart rate pattern over the next 30 minutes.
b. Take the patient’s blood pressure every 5 minutes for 15 minutes.
c. Determine the patient’s contraction pattern for the next 30 minutes.
d. Initiate an IV infusion of lactated Ringer’s solution at 2000 mL/hour over 30
minutes.
MULTIPLE RESPONSE
1. You are preparing a patient for epidural placement by a nurse anesthetist in the LDR. Which
interventions should be included in the plan of care? (Select all that apply.)
a. Administer a bolus of 500 to 1000 mL of D5 normal saline prior to catheter
placement.
b. Have ephedrine available at bedside during catheter placement.
c. Monitor blood pressure of patient frequently during catheter insertion and for the
first 15 minutes of epidural administration.
d. Insert a Foley catheter prior to epidural catheter placement.
e. Monitor the patient for hypertension in response to epidural insertion.
2. While developing an intrapartum care plan for the patient in early labor, it is important that the
nurse recognize that psychosocial factors may influence a woman’s experience of pain.
These include which of the following? (Select all that apply.)
a. Culture
b. Anxiety and fear
c. Support systems
d. Preparation for childbirth
e. Previous experiences with pain
f.
3. The nurse detects hypotension in a laboring patient after an epidural. Which actions should the
nurse plan to implement? (SATA)
a. Encourage the patient to drink fluids.
b. Place the patient in a Trendelenburg position.
c. Administer a normal saline bolus as prescribed.
d. Administer oxygen at 8 to 10 L/minute per face mask.
e. Administer IV ephedrine in 5- to 10-mg increments as prescribed.
4. The nurse is preparing a patient for a cesarean birth scheduled to be performed under general
anesthesia. Which should the nurse plan to administer, if ordered by the health care provider, to
prevent aspiration of gastric contents? (Select all that apply.)
a. Citric acid (Bicitra)
b. Ranitidine (Zantac)
c. Hydroxyzine (Vistaril)
d. Glycopyrrolate (Robinul)
e. Promethazine (Phenergan)