NCM 109 CARE OF THE MOTHER, CHILD
AT RISK OR WITH PROBLEMS (ACUTE
AND CHRONIC)
A client is diagnosed with gestational
hypertension and is receiving magnesium
sulfate. Which finding would the nurse interpret
as indicating a therapeutic level of medication?
A) Urinary output of 20 mL per hour
B) Respiratory rate of 10 breaths/minute
C) Deep tendons reflexes 2+
D) Difficulty in arousing
ANSWER: C
The nurse is developing a plan of care for a
woman who is pregnant with twins. The nurse
includes interventions focusing on which of the
following because of the woman's increased
risk?
A) Oligohydramnios
B) Preeclampsia
C) Post-term labor
D) Chorioamnionitis
ANSWER: B
A woman hospitalized with severe preeclampsia
is being treated with hydralazine to control
blood pressure. Which of the following would
the lead the nurse to suspect that the client is
having an adverse effect associated with this
drug?
A) Gastrointestinal bleeding
B) Blurred vision
C) Tachycardia
D) Sweating
ANSWER: C
After reviewing a client's history, which factor
would the nurse identify as placing her at risk
for gestational hypertension?
A) Mother had gestational hypertension during
pregnancy.
B) Client has a twin sister.
C) Sister-in-law had gestational hypertension.
D) This is the client's second pregnancy.
ANSWER: A
The nurse is reviewing the laboratory test results
of a pregnant client. Which one of the following
findings would alert the nurse to the
development of HELLP syndrome?
A) Hyperglycemia
B) Elevated platelet count
C) Leukocytosis
D) Elevated liver enzymes
ANSWER: D
Which of the following would the nurse have
readily available for a client who is receiving
magnesium sulfate to treat severe preeclampsia?
A) Calcium gluconate
B) Potassium chloride
C) Ferrous sulfate
D) Calcium carbonate
ANSWER: A
A nurse is teaching a pregnant woman with
preterm premature rupture of membranes who is
about to be discharged home about caring for
herself. Which statement by the woman
indicates a need for additional teaching?
A) "I need to keep a close eye on how active my
baby is each day."
B) "I need to call my doctor if my temperature
increases."
C) "It's okay for my husband and me to have
sexual intercourse."
D) "I can shower but I shouldn't take a tub bath."
ANSWER: C
A nurse is assessing a pregnant woman with
gestational hypertension. Which of the following
would lead the nurse to suspect that the client
has developed severe preeclampsia?
A) Urine protein 300 mg/24 hours
B) Blood pressure 150/96 mm Hg
C) Mild facial edema
D) Hyperreflexia
ANSWER: D
A nurse suspects that a pregnant client may be
experiencing abruption placenta based on
assessment of which of the following? (Select all
that apply.)
A) Dark red vaginal bleeding
B) Insidious onset
C) Absence of pain
D) Rigid uterus
E) Absent fetal heart tones
ANSWER: A,D,E
A nursing student is reviewing an article about
preterm premature rupture of membranes. Which
of the following would the student expect to find
as factor placing a woman at high risk for this
condition? (Select all that apply.)
A) High body mass index
B) Urinary tract infection
C) Low socioeconomic status
D) Single gestations
E) Smoking
ANSWER: B,C,E
A woman with placenta previa is being treated
with expectant management. The woman and
fetus are stable. The nurse is assessing the
woman for possible discharge home. Which
statement by the woman would suggest to the
nurse that home care might be inappropriate?
A) "My mother lives next door and can drive me
here if necessary."
B) "I have a toddler and preschooler at home
who need my attention."
C) "I know to call my health care provider right
away if I start to bleed again."
D) "I realize the importance of following the
instructions for my care."
ANSWER: B
A woman with gestational hypertension
experiences a seizure. Which of the following
would be the priority?
A) Fluid replacement
B) Oxygenation
C) Control of hypertension
D) Delivery of the fetus
ANSWER: B
A woman is receiving magnesium sulfate as part
of her treatment for severe preeclampsia. The
nurse is monitoring the woman's serum
magnesium levels. Which level would the nurse
identify as therapeutic?
A) 3.3 mEq/L
B) 6.1 mEq/L
C) 8.4 mEq/L
D) 10.8 mEq/L
ANSWER: B
When preparing a schedule of follow-up visits
for a pregnant woman with chronic
hypertension, which of the following would be
most appropriate?
A) Monthly visits until 32 weeks, then bimonthly visits
B) Bi-monthly visits until 28 weeks, then
weekly visits
C) Monthly visits until 20 weeks, then bimonthly visits
D) Bi-monthly visits until 36 weeks, then
weekly
ANSWER: B
A woman who is at 36 weeks of gestation is
having a nonstress test. Which statement by the
woman would indicate a correct understanding
of the test?
A) "I will need to have a full bladder for the test
to be done accurately."
B) "I should have my husband drive me home
after the test because I may be nauseous."
C) "This test will help to determine if the baby
has Down syndrome or a neural tube defect."
D) None of the above
ANSWER: D – Ultrasound is the test that
requires a full bladder
What is an indicator for performing a
contraction stress test?
A) Increased fetal movement and small for
gestational age
B) Maternal diabetes mellitus and postmaturity
C) Adolescent pregnancy and poor prenatal care
D) History of preterm labor and intrauterine
growth restriction
ANSWER: B
A 40-year-old woman with a high body mass
index (BMI) is 10 weeks pregnant. Which
diagnostic tool is appropriate to suggest to her at
this time?
A) Biophysical profile
B) Amniocentesis
C) Maternal serum alpha-fetoprotein (MSAFP)
D) Transvaginal ultrasound
ANSWER: D
A nurse providing care for the antepartum
woman should understand that the contraction
stress test (CST):
A) Sometimes uses vibroacoustic stimulation.
B) Is an invasive test; however, contractions are
stimulated.
C) Is considered negative if no late decelerations
are observed with the contractions.
D) Is more effective than nonstress test (NST) if
the membranes have already been ruptured.
ANSWER: C
The nurse sees a woman for the first time when
she is 30 weeks pregnant. The woman has
smoked throughout the pregnancy, and fundal
height measurements now are suggestive of
growth restriction in the fetus. In addition to
ultrasound to measure fetal size, what would be
another tool useful in confirming the diagnosis?
A) Doppler blood flow analysis
B) Contraction stress test (CST)
C) Amniocentesis
D) Daily fetal movement counts
ANSWER: A
Nurses should be aware of the strengths and
limitations of various biochemical assessments
during pregnancy, including that:
A) Chorionic villus sampling (CVS) is
becoming more popular because it provides
early diagnosis.
B) Screening for maternal serum alphafetoprotein (MSAFP) levels is recommended
only for women at risk for neural tube defects.
C) Percutaneous umbilical blood sampling
(PUBS) is one of the quad-screen tests for Down
syndrome.
D) MSAFP is a screening tool only; it identifies
candidates for more definitive procedures.
ANSWER: D
Prior to the patient undergoing amniocentesis,
the most appropriate nursing intervention is to:
A) Administer RhoD immunoglobulin.
B) Administer anticoagulant.
C) Send the patient for a computed tomography
(CT) scan before the procedure.
D) Assure the mother that short-term radiation
exposure is not harmful to the fetus.
ANSWER: A
The nurse is reviewing lab values to determine
Rh incompatibility between mother and fetus.
The nurse should assess which specific lab
result?
A) Indirect Coombs test
B) Hemoglobin level
C) hCG level
D) Maternal serum alpha-fetoprotein (MSAFP)
The health care provider has ordered a magnetic
resonance imaging (MRI) study to be done on a
pregnant patient to evaluate fetal structure and
growth. The nurse should include which
instructions when preparing the patient for this
test? (Select all that apply.)
A) A lead apron must be worn during the test.
B) A full bladder is required prior to the test.
C) An intravenous line must be inserted before
the test.
D) Jewelry must be removed before the test.
E) Remain still throughout the test.
ANSWER: D,E
A nonstress test (NST) is ordered on a pregnant
woman at 37 weeks gestation. What are the most
appropriate teaching points to include when
explaining the procedure to the patient? (Select
all that apply)
A) After 20 minutes, a nonreactive reading
indicates the test is complete.
B) Vibroacoustic stimulation may be used
during the test.
C) Drinking orange juice before the test is
appropriate.
D) A needle biopsy may be needed to stimulate
contractions.
E) Two sensors are placed on the abdomen to
measure contractions and fetal heart tones.
ANSWER: B,C,E
The nurse is caring for a woman with mitral
stenosis who is in the active stage. Which action
should the nurse take to promote cardiac
function?
A. Maintain the woman in a side-lying position
with the head and shoulders elevated to facilitate
hemodynamics
B. Prepare the woman for delivery by cesarean
section since this is the recommended delivery
method to sustain hemodynamics
C. Encourage the woman to avoid the use of
narcotics or epidural regional analgesia since
this alters cardiac function
D. Promote the use of the Valsalva maneuver
during pushing in the second stage to improve
diastolic ventricular filling
ANSWER: A
Maternal and neonatal risks associated with
gestational diabetes mellitus are:
A. maternal premature rupture of membranes
and neonatal sepsis.
B. maternal hyperemesis and neonatal low birth
weight.
C. Maternal preeclampsia and fetal macrosomia.
D. maternal placenta previa and fetal
prematurity.
ANSWER: C
In planning for the care of a 30-year-old woman
with pregestational diabetes, the nurse
recognizes that the most important factor
affecting pregnancy outcome is the:
A. mother's age.
B. number of years since diabetes was
diagnosed.
C. amount of insulin required prenatally.
D. degree of glycemic control during pregnancy.
ANSWER: D
Diabetes in pregnancy puts the fetus at risk in
several ways. Nurses should be aware that:
section because this is the recommended
delivery method to sustain hemodynamics.
C. Encourage the woman to avoid the use of
narcotics or epidural regional analgesia because
this alters cardiac function.
D. Promote the use of the Valsalva maneuver
during pushing in the second stage to improve
diastolic ventricular filling.
ANSWER: A
During a physical assessment of an at-risk client,
the nurse notes generalized edema, crackles at
the base of the lungs, and some pulse
irregularity. These are most likely signs of:
A. euglycemia.
B. rheumatic fever.
C. pneumonia.
D. cardiac decompensation.
ANSWER: D
A. with good control of maternal glucose levels,
sudden and unexplained stillbirth is no longer a
major concern.
B. the most important cause of perinatal loss in
diabetic pregnancy is congenital malformations.
C. infants of mothers with diabetes have the
same risks for respiratory distress syndrome
because of the careful monitoring.
D. at birth, the neonate of a diabetic mother is no
longer at any greater risk.
ANSWER: B
A pregnant woman at 28 weeks of gestation has
been diagnosed with gestational diabetes. The
nurse caring for this client understands that:
A. oral hypoglycemic agents can be used if the
woman is reluctant to give herself insulin.
B. dietary modifications and insulin are both
required for adequate treatment.
C. glucose levels are monitored by testing urine
4r times a day and at bedtime.
D. dietary management involves distributing
nutrient requirements over three meals and two
or three snacks.
ANSWER: D
A nurse is caring for a woman with mitral
stenosis who is in the active stage. Which action
should the nurse take to promote cardiac
function?
A. Maintain the woman in a side-lying position
with the head and shoulders elevated to facilitate
hemodynamics.
B. Prepare the woman for delivery by cesarean
Thalassemia is a relatively common anemia in
which:
A. an insufficient amount of hemoglobin is
produced to fill the red blood cells (RBCs).
B. RBCs have a normal life span but are sickled
in shape.
C. folate deficiency occurs.
D. there are inadequate levels of vitamin B12.
ANSWER: A
From 4% to 8% of pregnant women have
asthma, making it one of the most common
preexisting conditions of pregnancy. Severity of
symptoms usually peaks:
A. in the first trimester.
B. between 24 to 36 weeks of gestation.
C. during the last 4 weeks of pregnancy.
D. immediately postpartum
ANSWER: B
A pregnant woman with cardiac disease is
informed about signs of cardiac decompensation.
She should be told that the earliest sign of
decompensation is most often:
A. orthopnea.
B. decreasing energy levels.
C. moist frequent cough and frothy sputum.
D. crackles (rales) at the bases of the lungs on
auscultation.
ANSWER: B
Which opiate causes euphoria, relaxation,
drowsiness, and detachment from reality and has
possible effects on the pregnancy, including
preeclampsia, intrauterine growth restriction,
and premature rupture of membranes?
A. Heroin
B. Alcohol
C. Phencyclidine palmitate (PCP)
D. Cocaine
ANSWER: A
During pregnancy, alcohol withdrawal may be
treated using:
A. disulfiram (Antabuse).
B. corticosteroids.
C. benzodiazepines.
E. aminophylline.
ANSWER: C
A pregnant woman is being examined by the
nurse in the outpatient obstetric clinic. The nurse
suspects systemic lupus erythematosus (SLE)
after revealing which symptoms? (Select all that
apply.)
A. Muscle aches
B. Hyperactivity
C. Weight changes
D. Fever
E. Hypotension
ANSWER: A,C,D
A pregnant woman in her first trimester with a
history of epilepsy is transported to the hospital
via ambulance after suffering a seizure in a
restaurant. The nurse expects which health care
provider orders to be included in the plan of
care? (Select all that apply.)
A. valproate (Depakote).
B. Serum lab levels of medications.
C. Abdominal ultrasounds.
D. Prenatal vitamins with vitamin D.
E. carbamazepine (Tegretol).
ANSWER: B,C,D
Hypothyroidism occurs in 2 to 3 pregnancies per
1000. Pregnant women with untreated
hypothyroidism are at risk for: (Select all that
apply.)
A. miscarriage.
B. macrosomia.
C. gestational hypertension.
D. placental abruption.
E. stillbirth.
ANSWER: A,C,D,E
You are preparing the client for a bone marrow
aspiration and biopsy. Which of the following
statements, if made by the patient, indicates the
need for further teaching?
A) After the procedure I should avoid
ambulating for 24-48 hours
B) Pain and discomfort is expected after the
surgery. I can take some Tylenol for the
discomfort.
C) I should not take a bath for about 24 hours
D) The surgeon will collect the samples from my
hip bone
ANSWER: A
The patient who underwent a bone biopsy
yesterday calls the office thinking something is
wrong. Which of the following would be cause
for concern by the nurse? SATA:
A) Swelling and redness at the site
B) Red streaks spreading away from the area
C) T of 99.5
D) Pain in the area
E) Small amount of blood on dressing
ANSWER: A,B
A young mother of three with history of Type 1
diabetes comes into the clinic c/o of fatigue and
says "my Fitbit has been rating my heart rate
higher than it used to be" Her Hgb is taken and
found to be 11 g/dL. Which of the following
factors most likely influenced this patient's
ability to feel anemia symptoms (fatigue)?
A) Hx of diabetes
B) Stressful lifestyle
C) Lack of exercise
D) Multipara status
ANSWER: B
The patient diagnosed with iron deficiency
anemia tells you that she constantly feels tired
and exhausted. She tells you that she is
concerned about this problem. What is the
nurse's best initial response?
A) Keep taking your supplements and report
back to me in a couple to days
B) How has this affected your life?
C) You are going to need to take a break from
those things for a period of time to rest
D) Try to help get rid of the stress in your life.
This will help with the tired feeling
ANSWER: B
Which medication might the nurse question if
administered to the client with anemia?
A) Cipro
B) Lisinopril
C) Acetaminophen
D) Ferrous sulfate
ANSWER: B
The patient with anemia has been prescribed an
iron supplement. With which beverage should
the nurse encourage the patient to take the
supplement?
A) Milk
B) Water only
C) Orange Juice
D) Tea
ANSWER: C
Which of the following symptoms do you expect
to see in a patient diagnosed with acute
pyelonephritis?
Which patient is at greatest risk for developing
a urinary tract infection (UTI)?
A. A 35 y.o. woman with a fractured wrist
B. A 20 y.o. woman with asthma
C. A 50 y.o. postmenopausal woman
D. A 28 y.o. with angina
ANSWER: C
What is the first sign of hydramnios in a
pregnant woman?
A. Shortness of breath
B. Varicosities and hemorrhoids
C. Difficulty in auscultating the fetal heart rate
D. Rapid growth of the uterus
ANSWER: D
What is the common reason for
oligohydramnios?
A. A bladder or renal disorder in the fetus that
interferes with voiding
B. Decrease production of amniotic fluid
C. A small uterine capacity to hold the amniotic
fluid
D. Perforation of the amniotic sac
ANSWER: A
A) Jaundice and flank pain
B) Costovertebral angle tenderness and chills
C) Burning sensation on urination
D) Polyuria and nocturia
ANSWER: B
You have a patient that might have a urinary
tract infection (UTI). Which statement by the
patient suggests that a UTI is likely?
A. “I pee a lot.”
B. “It burns when I pee.”
C. “I go hours without the urge to pee.”
D. “My pee smells sweet.”
ANSWER: B
Which instructions do you include in the
teaching care plan for a patient with cystitis
receiving phenazopyridine (Pyridium)?
A. If the urine turns orange-red, call the doctor.
B. Take phenazopyridine just before urination to
relieve pain.
B. Take phenazopyridine just before urination to
relieve pain.
D. After painful urination is relieved, stop
taking phenazopyridine.
ANSWER: D
What precipitates meconium aspiration in a
fetus?
A. Hydramnios
B. Oligohydramnios
C. Preterm labor
D. Post term birth
ANSWER: D
How would you know if the findings in a
Doppler velocity test are normal?
A. The reading is low
B. The reading is high
C. The reading at first is high, then becomes low
at the second reading
D. The reading is low at first, then becomes high
at the second reading
ANSWER: B
When does administration of RhIG occur?
A. Before the birth of the fetus
B. During labor
C. On the first hour after birth
D. 72 hours after birth of the newborn
ANSWER: D
A woman who's 36 weeks pregnant comes into
the labor & delivery unit with mild contracts.
Which of the following complications should the
nurse watch out for when the client informs her
that she has placenta prevue?
A) Sudden rupture of membranes
B) Vaginal bleeding
C) Emesis
D) Fever
ANSWER: B
The doctor suspects that the client has an ectopic
pregnancy. Which symptom is consistent with a
diagnosis of ectopic pregnancy?
A) Painless vaginal bleeding
B) Abdominal cramping
C) Throbbing pain in the upper quadrant
D) Sudden, stabbing pain in the lower quadrant
ANSWER: D
A 21y.o. client has been diagnosed with
hydatidiform mole. Which of the following
factors is considered a risk factor for developing
hydatidiform mole?
A) Age in 20s or 30s
B) High in SES
C) Primigravida
D) Prior molar gestation
ANSWER: D
A 21 y.o. has arrives to the ER with c/o
cramping abdominal pain and mild vaginal
bleeding. Pelvic exam shows a left adnexal mass
that's tender when palpated. Culdocentesis
shows blood in the culdesac. This client
probably has which of the following conditions?
C) Molar Pregnancy
D) Ectopic Pregnancy
ANSWER: A
A 21 y.o. client, 6 weeks pregnant, is diagnosed
with hyperemesis gravidum. This excessive
vomiting during pregnancy will often result in
which of the following?
A) Bowel perforation
B) Electrolyte imbalance
C) Miscarriage
D) PIH
ANSWER: B
A client is being admitted to the antepartum unit
for hypovolemia secondary to hyperemesis
gravidarum. WHich of the following factors
predisposes a client to the development of this?
A) Trophoblastic disease
B) Maternal age > 35 y.o.
C) Malnourished or underweight clients
D) Low levels of HCG
ANSWER: A
Clients with gestational diabetes are usually
managed by which of the following therapies?
A) Diet
B) Long acting insulin
C) Oral hypoglycemic drugs
D) Oral hypoglycemic drugs/insulin
ANSWER: A
Which of the following complications can be
potentially life threatening and can occur in a
client receiving a tocolytic agent?
A) Abruptio placentae
B) Ecoptic pregnancy
C) Hydatidiform mole
D) Pelvic Inflammatory Disease
A) Diabetic ketoacidosis
B) Hyperemesis gravidarum
C) Pulmonary edema
D) Sickle cell anemia
ANSWER: B
ANSWER: C
A client, 34 weeks pregnant, arrives at the ER
with SEVERE abdominal pain, uterine
tenderness and an increased uterine tone. The
client denies vaginal bleeding. The external fetal
monitor shows fetal distress with severe,
variable decels. The client most likely has which
of the following?
A client is 33 weeks pregnant and has had
diabetes since she was 21. When checking her
fasting blood sugar level, which values indicate
the clients disease was controlled.
A) Abruptio Plantae
B) Placenta Previa
A) 45 mg/dl
B) 85 mg/dl
C) 120 mg/dl
D) 136 mg/dl
ANSWER: B
A client has just given birth at 42 weeks
gestation. When assessing the neontate, which
phsycial finding is expected?
A) A sleepy, lethargic baby
B) Lanugo covering body
C) Desquamation of the epidermis
D) Vernix caseosa covering the body
ANSWER: C
The SGA neonate is at increased risk during the
transitional period for which complication?
A) Anemia probably due to chronic fetal
hypoxia
B) Hyperthermia due to decreased glycogen
stores
C) Hyperglycemia due to decreased glycogen
stores
D) Polycythemia probably due to chronic fetal
hypoxia
ANSWER: D
Which finding might be seem in a neonate
suspected of having an infection?
A) Flushed cheeks
B) Increased temp
C) Decreased temp
D) Increased activity level
ANSWER: C
After reviewing the client's maternal history of
magnesium sulfate during labor, which condition
would the nurse anticipate as a potential problem
in the neonate?
A) Hypoglycemia
B) Jitteriness
C) Resp depression
D) Tachycardia
A client at 42 weeks gest is 3cm dilated, 30%
effaced, with membranes intact and the fetus at
+2 station. FHR is at 140-150 bpm. After 2
hours, the nurse notes on the EFM that, for the
past 10 min, the FHR ranged from 160-190bpm.
The client states that her baby has been
extremely active. UCs are strong, occurring
every 3-4 min. and lasting 40-60 sec. Which of
the following findings would indicate fetal
hypoxia?
A) Abnormally long UCs
B) Abnormally strong uterine intensity
C) Excessively frequent contractions with rapid
fetal movement
D) Excessive fetal activity and fetal tachycardia
ANSWER: D
A client at 33 weeks gestation and leaking
amniotic fluid is place on an EFM. The monitor
indicates uterine irritability and contractions
occuring every 4-6 min. The doctor orders
terbutaline. Which of the following teaching
statements is approp for this client?
A) This medicine will make you breathe better
B) You may feel fluttering or tight sensation in
your chest
C) This will dry your mouth and make you
thirsty
D) You'll need to replace potassium lost by this
drug
ANSWER: B
Which Sx would indicate the neonate was
adapting approp to extrauterine life w/out
difficulty?
A) Nasal flare
B) Light audible grunting
C) Resp rate 40-60 breaths/min
D) Resp rate 60-80 breaths/min
ANSWER: C
ANSWER: C
3 day old neonate needs phototherapy for
hyperbilirubinemia. nursery care of a neonate
getting phototherapy would include which
nursing intervention?
A) tube feedings
B) feeding the neonate under phototheraphy
lights
C) mask over the eyes to prevent retinal damage
D) temp monitored every 6 hours during
phototherapy
ANSWER: C