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Performance
Exit

OB Final Exam
Due Aug 13, 2024 by 11:59 pm

Final Score

84%
42 out of 50 questions answered correctly

Completed on Aug 13, 2024 10:58 am

Incorrect (8)

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A pregnant client is admitted with abdominal pain and heavy

vaginal bleeding. Which is the immediate nursing action?
Establish intravenous access

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Elevate the head of the bed

Position the client laterally to the left

Administer an intramuscular analgesic

Rationale
Abdominal pain and heavy vaginal bleeding indicate significant blood loss.
Establishing intravenous access is essential to provide care for this patient
who may need a blood transfusion, surgery, and IV fluids. Elevating the
head of the bed will decrease blood flow to vital centers in the brain. The
client should be placed in the left lateral position following the
establishment of adequate IV access. Giving an intramuscular analgesic
may mask abdominal pain and sedate an already compromised fetus.
Delivery via cesarean section is likely.

Report content error

A pregnant client has a history of preterm births followed by

neonatal deaths. Which is an indication of preterm labor that
this client would be instructed to report?
Leg cramps

Pelvic pressure

Nausea after 11 AM

No fetal movement at 12 weeks

Rationale
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Pelvic pressure or a feeling that the fetus is pushing down is one

symptom of preterm labor and should be taught to the client so that she
may seek care immediately. Leg cramps are not a danger sign of preterm
labor, nor is nausea. Fetal movement is not felt until approximately 16
weeks.

Report content error

In the second hour after a client gives birth, her uterus is firm
above the level of the umbilicus and to the right of midline.
Which is the appropriate nursing intervention at this time?
Checking for signs of retained placental fragments

Massaging the uterus to prevent hemorrhage

Assisting the client to the bathroom to empty her bladder

Telling the client that this is a sign of uterine stabilization

Rationale
A full bladder commonly elevates the uterus and displaces it to the right.
Even though the uterus feels firm, it may relax enough to foster bleeding;
therefore, the bladder must be emptied to maintain uterine tone.
Incomplete expulsion of parts of the placenta, umbilical cord, or fetal
membranes during the third stage of labor limits uterine contraction and
involution; a boggy uterus and bleeding will be evident. The uterus is firm
and does not need massaging; however, if the bladder is not emptied, the
uterus will not stay contracted, and massage will not make it firm. The
positioning of this client’s uterus is not a sign of uterine stabilization; the
uterus cannot remain contracted in the presence of a full bladder.

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Report content error

Which client statement indicates understanding of prenatal

instructions in the third trimester regarding when to consult
with a health care provider?
"I’ll call the clinic if I have abdominal pain."

"Mild, irregular contractions mean that my labor is starting."

"I need to call the clinic if my ankles start to swell a little in the
evening."

"A whitish vaginal discharge means that I’m getting an infection."

Rationale
Abdominal pain should be reported immediately, because it may indicate
abruptio placentae or the epigastric discomfort of severe preeclampsia.
Mild, irregular contractions are preparatory (Braxton-Hicks) contractions,
which are common and are believed to help prepare the uterus for labor.
Swelling of the ankles in the evening is physiologic edema of pregnancy,
caused by pressure of the gravid uterus that impedes venous return; it
disappears with elevation of the legs. Leukorrhea occurs during pregnancy
as a result of increases in the estrogen and progesterone levels, which
cause the vaginal discharge to become more alkaline.

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Report content error

Where on the maternal abdomen would the nurse place the

fetal heart transducer when the fetus is in the left sacrum
anterior position?
Left lower quadrant
Left upper quadrant

Right upper quadrant

Midline lower quadrant

Rationale
The left sacrum anterior position indicates that the fetus is in a breech
presentation and the head is in the fundus; fetal heart sounds are best
heard in the left upper quadrant. Fetal heart sounds will be in the left
lower quadrant if the fetus is in the left occiput anterior position. Fetal
heart sounds will be in the right upper quadrant if the fetus is in the right
sacrum anterior position. The fetal heart sounds will not be heard in the
midline part of a lower quadrant in a single-fetus pregnancy.

Report content error

Which fetal heart rate pattern suggests compromised fetal

oxygenation?
Early decelerations with moderate variability
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Changes in baseline variability from 5 to 10 beats/min

Increases in fetal heart rate from 135 to 150 beats/min with fetal
activity

Recurrent variable decelerations that last 60 seconds with minimal

baseline variability

Rationale
Variable decelerations indicate cord compression. Tachycardia indicates
fetal hypoxia, maternal fever, infection, or some other factor that is
stressing the fetus. Early decelerations and changes in baseline variability
are both expected, benign findings. Increases in fetal heart rate with fetal
movement are an expected finding. Minimal variability over a prolonged
period of time may suggest an interruption in fetal oxygenation.

Report content error

An infant born at 36 weeks’ gestation weighs 4 lb 3 oz (1899 g)

and has Apgar scores of 7 and 9. Which nursing action(s) will
be performed upon the infant’s admission to the nursery?
Select all that apply. One, some, or all responses may be
correct.
Recording the neonate’s vital signs

Administration of nasal cannula oxygen

Offering a bottle of dextrose in water

Evaluation of the neonate’s health status

Keeping the neonate’s body warm

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Rationale
Recording of vital signs is an important part of recordkeeping for all
newborns. All newborns are evaluated on their admission to the nursery.
All newborns should be kept warm to maintain a stable body temperature.
The neonate’s Apgar scores (7 and 9) do not indicate a need for oxygen.
Newborns are either breast-fed or formula-fed; glucose water is not
offered first even for infants with a low blood glucose level. In those cases,
glucose is given intravenously.

Report content error

The parents of a newborn who is undergoing phototherapy

ask the nurse why their baby’s eyes are covered with eye
patches. How would the nurse respond?
"They keep the baby’s eyes closed."

"They reduce overstimulation from bright lights."

"They prevent injury to the conjunctiva and retina."

"They limit excessive rapid eye movements and anxiety."

Rationale
Eye patches are applied while an infant is undergoing phototherapy to
prevent drying of the conjunctiva, injury to the retina, and alterations in
biorhythms. The infant will close the eyes automatically in response to
bright lights and application of a patch. The infant should be exposed to
bright lights periodically so that circadian rhythms will become
established. Rapid eye movements are automatic during different phases

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of sleep and will not be affected by eye patches.

Test-Taking Tip: Work with a study group to create and take practice tests.
Think of the kinds of questions you would ask if you were composing the
test. Consider what would be a good question, what would be the right
answer, and what would be other answers that would appear right but
would in fact be incorrect.

Correct (42)

Report content error

Which information would the nurse include when teaching a

client experiencing a postterm pregnancy? Select all that
apply. One, some, or all responses may be correct.
Monitor for signs of labor.

Perform daily fetal movement counts.

Go to the birthing facility soon after labor begins.

Call the primary health care provider if the membranes rupture.

Keep appointments for fetal assessment tests and cervical checks.

Rationale
Safety and infection control are priorities when planning care for clients
experiencing a postterm pregnancy. The client would be instructed to
monitor for signs of labor, perform daily fetal movement counts, go to the
birthing facility soon after labor begins, call the primary health care
provider if rupture of membranes occurs, and keep appointments for fetal
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assessment tests and cervical checks.

Test-Taking Tip: Read the question carefully before looking at the answers:
(1) Determine what the question is really asking; look for key words; (2)
read each answer thoroughly, and see if it completely covers the material
asked by the question; and (3) narrow the choices by immediately
eliminating answers you know are incorrect.

Report content error

A client with a history of a congenital heart defect is admitted

to the birthing unit in early labor. Which position would the
nurse encourage the client to assume?
Supine

Semi-Fowler
Trendelenburg
Lithotomy

Rationale
The head of the bed should be elevated 45 degrees; this is known as the
semi-Fowler position and permits maximal chest expansion for ventilation.
The laboring woman should not assume the supine position, because this
would increase the risk of hypotension as a result of decreased venous
return. The Trendelenburg position interferes with optimal cardiac
function during labor and is contraindicated. The lithotomy position would
not be appropriate for any client in early labor.

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Test-Taking Tip: Study wisely, not hard. Use study strategies to save time
and be able to get a good night’s sleep the night before your exam.
Cramming is not smart, and it is hard work that increases stress while
reducing learning. When you cram, your mind is more likely to go blank
during a test. When you cram, the information is in your short-term
memory so you will need to relearn it before a comprehensive exam.
Relearning takes more time. The stress caused by cramming may interfere
with your sleep. Your brain needs sleep to function at its best.

Report content error

Which position increases cardiac output in the obstetrical

client with cardiac disease?
Trendelenburg

Low semi-Fowler
Lateral positioning

Supine with legs elevated

Rationale
Lateral positioning improves the cardiac output of an obstetrical client
with cardiac disease. Trendelenburg, low semi-Fowler, and the supine
position are not appropriate positions to improve the cardiac output of an
obstetrical client with cardiac disease. Placing the client in these positions
allows the weight of the uterus to remain on the vena cava, impeding the
blood flow.

Test-Taking Tip: Have confidence in your initial response to an item

because it more than likely is the correct answer.
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Report content error

Which intervention would the nurse recommend for post-

cesarean gas pain?
Lying on the right side
Walking around the room

Using a straw when drinking water

Supporting the incision when moving

Rationale
Walking around as much as possible can help expel excess gas after a
cesarean birth. The client also may be advised to lie on the left (not right)
side and rock in a rocking chair. The client should avoid using a straw
when drinking water or other fluids. Supporting the incision when moving
relieves incisional pain, but does not promote expulsion of gas.

Report content error

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A few hours after being admitted to the hospital with a

diagnosis of inevitable abortion, a client at 16 weeks’ gestation
begins to experience a bearing-down sensation and suddenly
expels the products of conception in the bed. Which would be
the nurse’s immediate action?
Notify the primary health care provider.
Administer the prescribed sedative.

Take the client to the operating room.

Monitor and measure vaginal bleeding.

Rationale
After a spontaneous abortion bleeding may continue to be heavy.
Occassionally, not all products of conception are expelled from the uterus
which can lead to increased bleeding and infection. The nurse would notify
the primary health care provider if necessary after assessing vaginal
bleeding. Administering the prescribed sedative is not the priority; the
potential for hemorrhage must be monitored. Taking the client to the
operating room is unnecessary.

Report content error

Which intervention is a priority when a client’s membranes

spontaneously rupture at 37 weeks and there are no
contractions?
Assessing maternal temperature

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Monitoring for signs of preeclampsia

Assessing for heavy vaginal bleeding

Placing a fetal scalp electrode

Rationale
The possibility of an ascending infection increases when membranes have
ruptured and birth is not imminent; the client must be monitored for
signs of infection. Preeclampsia is unrelated to spontaneous rupture of the
membranes. Assessing the color, consistency, and odor of the amniotic
fluid is a priority. Spontaneous rupture of membranes should not result in
vaginal bleeding. A fetal scalp electrode is not indicated with spontaneous
rupture of membranes unless there is difficulty monitoring the fetal heart
rate externally.

Report content error

A multiparous client with a history of gestational hypertension

and previous history of abruption is in the transition phase of
labor. The electronic fetal monitor shows bradycardia, and a
change is seen in the contour of the client’s abdomen. Which
is the nurse’s immediate action?
Checking the client’s vital signs
Placing the client on her left side

Applying an internal scalp electrode on the fetus

Alerting staff to the need for immediate cesarean delivery

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Rationale
Client history, fetal bradycardia, and change of abdominal contour indicate
uterine rupture, which requires immediate cesarean delivery. Another
nurse would be immediately enlisted to notify the operating room staff,
primary health care provider, anesthesiologist, and neonatal team to
prepare. Vital signs may be checked immediately after another nurse has
been asked to bring the team together. Positioning on the left side does
not address uterine rupture. Placing an internal fetal monitor is a poor use
of valuable time and requires a prescription from the primary health care
provider.

Report content error

Assessment of a primigravida at 32 weeks’ gestation shows a

blood pressure of 170/110 mm Hg, 4+ proteinuria, and
edema of the face and extremities. With which complication
are these findings consistent?
Eclampsia
Severe preeclampsia
Chronic hypertension

Gestational hypertension

Rationale
With severe preeclampsia, arteriolar spasms result in hypertension and
decreased arterial perfusion of the kidneys. This in turn causes an
alteration in the glomeruli, resulting in oliguria and proteinuria, retention
of sodium and water, and edema. Eclampsia is characterized by seizures;
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there are no data to indicate that the client is having or has had seizures.
Chronic hypertension is hypertension diagnosed before pregnancy or
before 20 weeks’ gestation. Hypertension that is first diagnosed during
pregnancy that persists beyond the postpartum period is also considered
chronic hypertension. Gestational hypertension is hypertension that first
occurs during midpregnancy without proteinuria; it is definitively
diagnosed when the hypertension resolves 12 weeks after delivery.

Report content error

After an incomplete abortion, a client asks the nurse to tell her

again what is meant by an "incomplete abortion." Which
response by the nurse is appropriate?
"I don’t think you should focus on this anymore."
"It’s when the fetus dies but is retained in the uterus for at least 2
months."
"It’s when parts of the pregnancy tissues are expelled and parts
remain in the uterus."
"I think it’s best for you to ask your primary health care provider
for the answer to that question."

Rationale
A correct and simple definition answers the question and fulfills the
client’s need to know. Telling the client not to focus on the topic anymore
denies the client’s right to know. The definition of a missed abortion is
when the fetus dies but is retained in the uterus for at least 2 months.
Telling the client to ask her primary health care provider for the answer is

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an abdication of the nurse’s responsibility; the nurse can independently

reinforce information and correct misconceptions.

Report content error

Which is a primary teaching point for a pregnant adolescent

at the first prenatal clinic visit?
Instructing her about the care of an infant
Informing her of the risks of bottle-feeding
Advising her to watch for danger signs of preeclampsia
Encouraging her to continue regularly scheduled prenatal care

Rationale
It is not uncommon for adolescents to avoid prenatal care; many do not
recognize the deleterious effect that lack of prenatal care can have on them
and their infants. Instruction in the care of an infant can be done in the
later part of pregnancy and reinforced during the postpartum period.
Informing the client of the benefits of breast-feeding are important.
However, a discussion of the risks of bottle feeding may not be
appropriate at the first prenatal visit. Advising the client to watch for
danger signs of preeclampsia is necessary, but it is not the priority
intervention at this time as the onset of preeclampsia is after 20 weeks'
gestation.

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Report content error

Immediately following rupture of membranes, the fetal heart

rate monitor shows variable decelerations of more than 90
seconds followed by bradycardia. Which condition does the
nurse suspect?
Fetal acidosis
Prolapsed cord

Head compression
Uteroplacental insufficiency

Rationale
This variable pattern with bradycardia is an ominous sign; it is indicative of
a prolapsed cord, or cord compression, which can result in fetal hypoxia.
Immediate intervention is required. Fetal acidosis, not fetal heart rate
changes, occurs with uteroplacental insufficiency. Early decelerations are
associated with head compression and are benign. Late decelerations and
tachycardia, not variable decelerations followed by bradycardia, are
associated with uteroplacental insufficiency.

Test-Taking Tip: If the question asks for an immediate action or response,

all the answers may be correct, so base your selection on identified
priorities for action.

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Report content error

Which comfort intervention would the nurse recommend to a

client’s coach when the client reports low back pain?
Instruct her to flex her knees.
Place her in the supine position.
Apply pressure to her back during contractions.

Perform neuromuscular control exercises with her.

Rationale
The application of back pressure combined with frequent position changes
will help alleviate this discomfort. Although flexing the knees may be
comfortable for some individuals, rubbing the back and alternating
positions are usually more effective. The supine position places increased
pressure on the back and often aggravates the pain. Neuromuscular
control exercises are used to teach selective relaxation in childbirth classes;
they will not relieve back pain during labor.

STUDY TIP: In the first pass through the exam, answer what you know and
skip what you do not know. Answering the questions you are sure of
increases your confidence and saves time. This is buying you time to
devote to the questions with which you have more difficulty.

Report content error

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For which complication would the nurse closely monitor a

client with a diagnosis of abruptio placentae?
Cerebral hemorrhage
Pulmonary edema
Impending seizures

Hypovolemic shock

Rationale
With abruptio placentae, uterine bleeding can result in massive internal
hemorrhage, causing hypovolemic shock. A cerebral hemorrhage may
occur with a dangerously high blood pressure; there is no information
indicating the presence of a dangerously high blood pressure. Pulmonary
edema may occur with severe preeclampsia or heart disease, and seizures
are associated with severe preeclampsia; there is no information indicating
the presence of these conditions.

Report content error

Which statement made by a postpartum client indicates that

teaching about lochia was effective?
"If I pass any clots, I’ll notify the clinic."
"I’ll call the clinic if my lochia changes from red to pink."

"I’ll notify the clinic if my lochia starts to smell bad."

"If my vaginal discharge continues for 3 weeks, I’ll call the clinic."

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Rationale
Lochia has a characteristic menstrual musky or fleshy smell. A foul-
smelling discharge, along with fever and uterine tenderness, suggests an
infection. Passing clots is a common occurrence. Lochia changing from
red to pink is expected as lochia rubra progresses to lochia serosa.
Although many women have a minimal discharge after 2 weeks, it is not
uncommon for lochia alba to last 6 weeks.

STUDY TIP: Establish your study priorities and the goals by which to
achieve these priorities. Write them out and review the goals during each
of your study periods to ensure focused preparation efforts.

Report content error

Which test is used to confirm breech presentation?

Ultrasound
Fetal scalp pH
Amniocentesis

Digital pelvimetry

Rationale
A sonogram of the pelvis is an accurate and safe test for breech
presentation. Fetal scalp pH is performed to assess fetal well-being.
Amniocentesis is a test of the components of the amniotic fluid; it does
not reveal the position of the fetus. Digital pelvimetry is an external
measurement obtained by the primary health care provider. While a

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vaginal exam may give clues to the presentation of the fetus, it is best
practice to confirm a suspected breech presentation with ultrasound.

Report content error

A breast-feeding mother experiences redness and pain in the

left breast, a temperature of 100.8°F (38.2°C), chills, and
malaise. Which condition would the nurse suspect?
Mastitis

Engorgement
Blocked milk duct
Inadequate milk production

Rationale
Because of the presence of generalized symptoms, the nurse would
suspect mastitis. Engorgement would involve both breasts, not one. A
blocked milk duct is usually marked by swelling and pain in one area of
the breast but does not have systemic symptoms. There is no indication of
the volume of milk being produced.

Report content error

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After receiving a diagnosis of placenta previa, the client asks

the nurse what this means. Which is an appropriate response?
"It’s premature separation of a normally implanted placenta."
"Your placenta isn’t implanted securely in place on the uterine
wall."
"You have premature aging of a placenta that is implanted in your
uterine fundus."
"The placenta is implanted in the lower uterine segment, and it’s
covering part or all of the cervical opening."

Rationale
Implantation of the placenta in the lower uterine segment is the accepted
definition of placenta previa. Premature separation of a normally
implanted placenta is known as abruptio placentae; it occurs because the
placenta is attached insecurely to the uterine wall. Premature aging of a
placenta may not lead to placenta previa but will put the fetus in jeopardy.

Report content error

A client with a blood pressure of 150/90 mm Hg, 3+

proteinuria, and edema of the hands and face is diagnosed
with severe preeclampsia. Which other clinical findings
support this diagnosis? Select all that apply. One, some, or all
responses may be correct.
Headache

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Constipation
Abdominal pain
Vaginal bleeding
Visual disturbances

Rationale
Headache in severe preeclampsia is related to cerebral edema. Abdominal
pain in severe preeclampsia is related to decreased circulating blood
volume and generalized edema. Visual disturbances in severe
preeclampsia are related to retinal edema. Constipation and vaginal
bleeding are not related to preeclampsia.

Report content error

Which method would the nurse use to assess blood loss in a

client with placenta previa?
Count or weigh perineal pads.
Monitor pulse and blood pressure.

Check hemoglobin and hematocrit values.

Measure or estimate the height of the fundus.

Rationale
An accurate measurement of the amount of blood loss may be obtained by
counting or weighing perineal pads. The vital signs will reflect the effects
of the blood loss rather than the amount. Laboratory results demonstrate
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the effects of the blood loss rather than the amount. The fundus may be
higher than expected, because the low-lying placenta prevents the descent
of the fetus into the pelvis, but the height cannot be used to estimate
blood loss.

Test-Taking Tip: Relax during the last hour before an exam. Your brain
needs some recovery time to function effectively.

Report content error

On entering the room of a client in active labor the nurse

notes the client is ashen gray, dyspneic, and clutching her
chest. Which is the nurse’s immediate action after pressing
the emergency light?
Administer oxygen by face mask.
Check for rupture of the membranes.

Begin cardiopulmonary resuscitation (CPR).

Increase the rate of intravenous (IV) fluids.

Rationale
The client is exhibiting signs and symptoms of an amniotic fluid
embolism; increasing oxygen intake is essential. The client is experiencing
an emergency situation; checking for rupture of membranes is irrelevant
at this time. The client is breathing and conscious; CPR is not indicated,
but it may become necessary if her condition worsens. It is not necessary
to increase the IV fluid rate, although the current rate should be
maintained.

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Report content error

Which condition is most commonly associated with late

decelerations of the fetal heart rate?
Head compression
Maternal hypothyroidism

Uteroplacental insufficiency

Umbilical cord compression

Rationale
Late decelerations, suggestive of fetal hypoxia, occur in the setting of
uteroplacental insufficiency. Head compression results in early
decelerations; this finding is considered benign. Hypothyroidism is
unrelated to late decelerations. Umbilical cord compression results in
variable decelerations.

Report content error

Which assessment finding would the nurse expect in a client

with preeclampsia?
Ketonuria

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Tonic-clonic seizure
Hemoglobin 10g/dL

Systolic blood pressure higher than 140 mmHg

Rationale
A blood pressure higher than 140 mm Hg systolic and 90 mm Hg diastolic
along with proteinuria, not ketonuria is diagnostic of preeclampsia;
assessments should be performed twice, 4 to 6 hours apart. Low platelets,
not hemoglobin are associated with preeclampsia. A tonic-clonic seizure is
associated with eclampsia, not preeclampsia.

Report content error

Which guideline regarding sexual intercourse would be given

to a client with preterm contractions and cervical dilation of 2
cm?
It should be limited to once a week.

It is prohibited because it may stimulate labor.

It should be restricted to the side-lying position.

It is permitted as long as penile penetration is shallow.

Rationale
Prostaglandins in semen may stimulate labor, and penile contact with the
cervix may increase myometrial contractility. Sexual intercourse may cause
labor to progress; it is contraindicated for the rest of the pregnancy. The
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position is irrelevant, because sexual intercourse is contraindicated for the

rest of the pregnancy. Regardless of the extent of penile penetration,
sexual intercourse may precipitate labor; it is contraindicated for the rest
of the pregnancy.

Report content error

Two days after delivery a client has a temperature of 101°F

(38.3°C), general malaise, anorexia, and chills. Which clinical
finding would the nurse expect to identify on the client’s
laboratory report?
Increased hemoglobin level
Decreased C-reactive protein

Increased white blood cell (WBC) count

Right-shift differential WBC count

Rationale
An increased WBC count is indicative of an infectious process. In
postpartum clients hemoglobin values usually decrease because of the
typical blood loss during the birth process. C-reactive protein is increased
during an infectious process. A right-shift differential WBC count occurs in
clients with liver disease and pernicious anemia; a shift to the left occurs in
an infectious process and is related to an increase in immature
neutrophils.

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Report content error

Which preexisting condition is an indication for a cesarean

birth?
Gonorrhea

Chlamydia
Chronic hepatitis

Active genital herpes

Rationale
Once the membranes have ruptured, an active herpes infection can infect
the fetus; because herpes does not cross the placenta, a cesarean birth
prevents transfer of the virus to the fetus. Gonorrhea, chlamydia, and
chronic hepatitis are not indications for a cesarean birth; treatment is
pharmacological.

Report content error

Which assessment finding indicates that disseminated

intravascular coagulation (DIC) is occurring in a postpartum
client who has experienced an abruptio placentae?
Boggy uterus

Hypovolemic shock

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Multiple vaginal clots

Bleeding at the venipuncture site

Rationale
Bleeding at the venipuncture site indicates afibrinogenemia; massive
clotting in the area of the separation has resulted in a decrease in the
circulating fibrinogen level. A boggy uterus indicates uterine atony.
Although hypovolemic shock may occur with DIC, there are other causes
of hypovolemic shock, not just DIC. Blood clots indicate an adequate
fibrinogen level; however, vaginal clots may indicate a failure of the uterus
to contract and should be explored further.

Test-Taking Tip: If you are unable to answer a multiple-choice question

immediately, eliminate the alternatives that you know are incorrect and
proceed from that point. The same goes for a multiple-response question
that requires you to choose two or more of the given alternatives. If a fill-
in-the-blank question poses a problem, read the situation and essential
information carefully and then formulate your response.

Report content error

Cramping and vaginal spotting at 12 weeks’ gestation with an

audible fetal heart rate and a closed cervix is characteristic of
which problem?
Missed abortion

Inevitable abortion

Incomplete abortion

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Threatened abortion

Rationale
Because the cervix is closed, this is considered a threatened abortion. The
lifeless products of conception are retained in a missed abortion. Once the
cervix is dilated abortion is inevitable. Portions of the products of
conception will have to be passed for a diagnosis of incomplete abortion.

Test-Taking Tip: Multiple-choice questions can be challenging, because

students think that they will recognize the right answer when they see it or
that the right answer will somehow stand out from the other choices. This
is a dangerous misconception. The more carefully the question is
constructed, the more each of the choices will seem like the correct
response.

Report content error

Which is an appropriate response to a 24-year-old client with

type 1 diabetes who asks how her pregnancy will affect her
diet and insulin needs?
"Insulin needs will decrease; the excess glucose will be used for
fetal growth."

"Diet and insulin needs won’t change, and maternal and fetal
needs will be met."

"Protein needs will increase, and adjustments to insulin dosage

will be necessary."
"Insulin dosage and dietary needs will be adjusted in accordance
with the results of blood glucose monitoring."

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Rationale
Insulin requirements may decrease in early pregnancy because of
increased fetal needs for nutrients and the possibility of maternal nausea
and vomiting. Insulin requirements increase in the second and third
trimesters as resistance to insulin develops. The blood glucose level is
monitored to prevent ketoacidosis and harm to both the mother and fetus.
Telling the client that protein needs will increase and adjustments to the
insulin dosage will be necessary conveys information that is true only
during early pregnancy. Even the nondiabetic woman makes dietary
adjustments necessary to keep pace with the increased nutritional
demands of pregnancy; in addition, insulin requirements increase in the
second and third trimesters. Most nutrient requirements, not just protein,
increase during pregnancy.

Test-Taking Tip: Be alert for grammatical inconsistencies. If the response

is intended to complete the stem (an incomplete sentence) but makes no
grammatical sense to you, it might be a distractor rather than the correct
response. Question writers typically try to eliminate these inconsistencies.

Report content error

Which client is at the greatest risk for a postpartum infection?

A primipara who gives birth to an infant weighing more than 8.5
lb

A woman who required catheterization after voiding less than 75

mL

A multipara with a hemoglobin level of 11 g at the time of

admission

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A woman who loses at least 350 mL of blood during the birthing

process

Rationale
Catheterization is associated with the risk of introducing bacteria into the
bladder. Repeated catheterizations as needed when urinary retention
occurs increase the risk. The size of the newborn does not predispose the
mother to postpartum infection. A hemoglobin level of 11 g does not
reflect the highest risk for infection; a hemoglobin of 11 g is at the low end
of the acceptable range. A loss of 250 to 500 mL of blood is considered
acceptable.

Test-Taking Tip: The following are crucial requisites for doing well on the
NCLEX exam: (1) A sound understanding of the subject; (2) The ability to
follow explicitly the directions given at the beginning of the test; (3) The
ability to comprehend what is read; (4) The patience to read each question
and set of options carefully before deciding how to answer the question;
(5) The ability to use the computer correctly to record answers; (6) The
determination to do well; (7) A degree of confidence.

Report content error

Which is a neonatal effect of maternal smoking during

pregnancy?
Low birth weight
Facial abnormalities

Chronic lung problems

Hyperglycemic reactions
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Rationale
Smoking during pregnancy causes a decrease in placental perfusion,
resulting in a newborn who is small for gestational age (SGA). Facial
abnormalities and developmental restriction may occur if the woman
ingests alcoholic drinks during pregnancy, resulting in fetal alcohol
syndrome. Smoking during pregnancy and chronic lung problems in
newborns are not related. Maternal smoking may result in an SGA
neonate; these neonates may experience hypoglycemia, not
hyperglycemia.

Test-Taking Tip: Make educated guesses when necessary.

Report content error

Which precaution would the nurse implement for a client with

a diagnosis of severe preeclampsia?
Padding the side rails on the bed
Having a vacuum extractor available at the time of birth

Placing 2 Units of Packed Red Blood Cells (PRBCs) on hold in the

blood bank

Assigning a nursing assistant to stay with the client

Rationale
A client with severe preeclampsia is at risk for developing seizures.
Padded side rails help prevent injury during the clonic-tonic phase of a
seizure. The client must be protected from injury if there is a seizure. A
vacuum extractor is not a precaution that is necessary for a client with
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severe pre-eclampsia. This client is at risk for seizures, placing blood

products on hold for this client is inappropriate at this time. Assigning a
staff member to stay with the client in anticipation of a seizure is
impractical and unproductive.

Report content error

Which type of isolation precautions would the postpartum

nurse plan to implement for a client who has given birth by
urgent cesarean section related to active herpes simplex virus
(genitalia) following onset of labor and rupture of membranes
8 hours ago?
Standard
Droplet

Contact
Airborne

Rationale
Contact precautions include a gown, mask, and gloves; the client should
be in a private room. Airborne and droplet precautions are not necessary
for a person with genital herpes. The client and newborn should be placed
in contact precautions until infant culture results are available and
neonatal infection has been ruled out. This neonate may have been
exposed to genital herpes when the client arrived with ruptured
membranes in active labor. Normally, the amniotic sac serves as another
protection against neonatal exposure. Maternal genital herpes, when

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neonatal exposure is not suspected following rupture of membranes,

requires only standard precautions.

Report content error

A full-term client in active labor arrives to the birthing unit

with a recent history of a chlamydial infection. She reports not
taking all of her prescribed medication because she "felt
better." Which would the nurse anticipate as part of the plan of
care?
Administration of antibiotics before delivery

Administration of antiviral medication before delivery

Administration of epidural anesthesia before delivery

Administration of oxytocin before delivery

Rationale
A maternal chlamydial infection can be transmitted to the newborn during
passage through the birth canal; therefore, administration of antibiotics
before delivery is necessary. Chlamydia is not a virus. Antiviral medication
is not indicated. A cesarean birth may be indicated following a discussion
between the provider and the patient. Epidural anesthesia is not indicated
based upon the information provided in the question. Oxytocin is not
indicated based upon the information provided in the question.

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Report content error

At 12 weeks’ gestation a client with a history of several

spontaneous abortions says to the nurse, "Every day I wonder
whether I’ll be able to have this baby." How would the nurse
respond?
"I can understand why you’re worried; however, you’ll have other
chances in the future to get pregnant."
"You’re getting the best of care. Please tell me about the problems
with your previous pregnancies."

"It’s understandable for you to be worried that you won’t be able

to carry this pregnancy to term. You’ve had a difficult time."

"Your pregnancy has lasted past the time when most early
spontaneous abortions occur. I think you’ll be able to continue the
pregnancy."

Rationale
Affirming the validity of the client’s concerns acknowledges her fearful
feelings. It also permits further communication. Assuring the client that
she will have other chances to get pregnant in the future does not
acknowledge the client’s feelings; it also instills fear by implying that the
current pregnancy may not go to term, even though there is no evidence
to indicate this. Asking the client to talk about the problems with her prior
pregnancies does not acknowledge her feelings of fear and changes the
focus of the conversation. Telling the client that she should be able to
continue the pregnancy is false assurance and does not address the client’s
feelings.

Test-Taking Tip: On a test day, eat a normal meal before going to school. If

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the test is late in the morning, take a high-powered snack with you to eat
20 minutes before the examination. The brain works best when it has the
glucose necessary for cellular function.

Report content error

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After a difficult labor a client gives birth to a 9-lb (4-kg) boy

who dies shortly afterward. That evening the client tearfully
describes to the nurse her projected image of her son and
what his future might have been. Which is the nurse’s most
therapeutic response?
"I guess you wanted a son very much."
"It must be difficult to think of him now."

"I’m sure he would have been a wonderful child."

"If you dwell on this now, your grief will be harder to bear."

Rationale
Stating that it must be difficult to think of him now demonstrates
empathy; the nurse is attempting to show understanding of the client’s
feelings. Stating that the client must have wanted a son very much is
nontherapeutic; the nurse has no way of knowing this. Stating the
certainty that the infant would have been a wonderful child switches the
focus away from the client, whose needs should be met at this time.
Stating that dwelling on the death will make her grief harder to bear
denies the client’s feelings and implies that the client should curb painful
emotions.

Report content error

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A pregnant client who has type 2 diabetes and a history of

three spontaneous abortions is scheduled for an ultrasound.
Before the test she begins to cry while answering the nurse’s
questions regarding her previous pregnancies. She states, "I
know it’s my diabetes. This baby will never live. It’s all my
fault." Which is the best response by the nurse?
"This must be very difficult for you."

"Diabetes is a difficult disease to manage during pregnancy."

"This baby will live because it is being very closely monitored."

"I know you’re worried, but getting upset can alter your test
results."

Rationale
By acknowledging the situation is difficult for the client, the nurse
empathizes with the client and keeps the lines of communication open
without being judgmental. Stating that diabetes is a difficult disease to
manage during pregnancy does not address the client’s feelings and may
increase the client’s anxiety. Stating that the baby will live constitutes false
reassurance; close monitoring does not guarantee a live baby. Stating that
getting upset can alter test findings denies the client’s right to emotions
and may evoke more feelings of guilt about her obstetric history.

Report content error

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Which combination of maternal and infant blood type would

be an indication for administration of Rho (D) immune
globulin (RhoGAM) to the postpartum client?
Mother A positive and infant O positive
Mother O negative and infant O positive

Mother AB negative and infant B negative

Mother B positive and infant B negative

Rationale
All Rh-negative mothers with Rh-positive infants are candidates for Rho(D)
immune globulin; postpartum RhoGAM is not indicated if the mother is
Rh positive or if both the mother and the infant are Rh negative.

Report content error

Which finding would the nurse expect when examining a

newborn’s neurological system?
Palate intact

Anterior fontanel soft and flat

Abdomen soft without distention

Heart rate greater than 100 beats/min

Rationale
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In newborns, a soft, flat anterior fontanel is an expected neurological

finding. An intact palate is a normal finding for the eyes, nose, mouth. A
soft abdomen without distention is a normal finding for the
gastrointestinal system. A heart rate greater than 100 beats/min is a
normal finding for the cardiovascular system.

Report content error

Which stool finding would the nurse anticipate in a breastfed

neonate?
Mustard yellow in color

Light brown in color

Firm consistency
Smooth consistency

Rationale
The breastfed neonate would have a mustard yellow stool with a seedy,
pasty consistency . Bottle-fed infants typically have stool that is pale yellow
to light brown in color and firm, smooth consistency.

Report content error

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Which finding in a newborn is a behavioral response to pain?

Crying
Tachypnea

Diaphoresis

Tachycardia

Rationale
Crying is a behavioral response. Tachypnea, diaphoresis, and tachycardia
are physiological responses to pain.

Report content error

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The nurse is assessing the Apgar scores of 4 different

newborns in a pediatric ward. Which newborn would the
nurse anticipate is experiencing severe distress?

Newborn A
Newborn B

Newborn C

Newborn D

Rationale
Newborn A has a heart rate of 75 beats per minute, which is given a score
of 1. The newborn’s cry is irregular and weak, which receives a score of 1.
The newborn has limp muscle tone, which scores a 0, no reflex irritability,
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which is also given a score of 0, and blue skin tone, which is given a score
of 0. The total Apgar score of newborn A is 2. Newborn A has severe
distress. The total Apgar score of newborn B is 10, indicating an absence of
difficulty adjusting. The total Apgar score of newborn C is 5. Newborn C
has moderate difficulty adjusting to the new environment. The total Apgar
score of newborn D is 6. Newborn D has moderate difficulty adjusting to
the new environment.

Test-Taking Tip: Chart/exhibit items present a situation and ask a question.

A variety of objective and subjective information is presented about the
client in formats such as the medical record (e.g., laboratory test results,
results of diagnostic procedures, progress notes, primary health care
provider prescriptions, medication administration record, health history),
physical assessment data, and assistant/client interactions. After analyzing
the information presented, the test-taker answers the question. These
questions usually reflect the analyzing level of cognitive thinking.

Report content error

Which is the most common complication for which the nurse

must monitor preterm infants?
Hemorrhage

Brain damage
Respiratory distress

Aspiration of mucus

Rationale

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Immaturity of the respiratory tract in preterm infants is evidenced by a lack

of functional alveoli, smaller lumina with increased possibility of collapse
of the respiratory passages, weakness of respiratory musculature, and
insufficient calcification of the bony thorax, leading to respiratory distress.
Hemorrhage is not a common occurrence at the time of birth unless
trauma has occurred. Brain damage is not a primary concern unless severe
hypoxia occurred during labor; it is difficult to diagnose at this time.
Aspiration of mucus may be a problem, but generally the air passageway is
suctioned as needed.

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