PROFESSIONAL SERVICES
CLINICAL DIVISION
L & D/OB ASSESSMENT TEST
1. 20-year old woman who is G 1 P0 comes to the prenatal clinic for her initial exam. She is 10 weeks pregnant. She asks why the baby needs amniotic fluid. The nurse would explain that amniotic fluid:
a) Keeps the fetus’s skin moist
b) Provides a cushion for trauma and facilitates movement
c) Contains the blood vessels that oxygenate the fetus
d) Provides an acidic medium for the fetus to swallow
2. The nurse discusses with a client a prenatal test to screen for spinal anomalies done between 16 and 20 weeks gestation, which is called the:
a) Enzyme-linked immonosorbent assay (ELISA)
b) VDRL
c) BHCG
d) a-Fetoprotein (AFP)
3. A female client wants to know how she can be positively sure she is pregnant. The nurse answers:
a) Breast tenderness with pigment changes
b) Enlargement of the abdomen
c) FHR by Doppler at 10-12 weeks
d) Amenorrhea
4. In taking a client’s history at her first visit to the prenatal clinic, the nurse would determine the following information.
a) The first day of the last normal menstrual period
b) The partner’s physiological symptoms of pregnancy
c) The number of pregnancies the mother had
d) The energy level of the client
5. In screening for factors that place the pregnancy at risk, the nurse would assess a client at her first prenatal visit for:
a) Emotional ability
b) Nausea and vomiting
c) Changes in bowel habits
d) Vaginal bleeding and cramping
6. A client has missed two menstrual periods and has a positive pregnancy test and exam. After counseling, she decides to have an elective abortion. The nurse should explain that the procedure used for termination in early pregnancy is:
a) PG suppository
b) Saline infusion
c) Dilation and Suction
d) Laminaria
7. The nurse instructs a client in signs of post-abortion complications requiring return to the physician. Which statement by the client indicated she needs additional teaching?
a) “I should take Tylenol if I have abdominal pain and tenderness.”
b) “ I may have feelings of sadness after the abortion.”
c) “My vaginal bleeding should be scant for 2 weeks.”
d) “I should call the physician if my temperature in 98.6oF (37oC).”
8. A 40-year old primigravida is scheduled for an amniocentesis at 16 weeks’ gestation. The nurse explains that the purpose of the procedure is to:
a) Evaluate the sex of the fetus
b) Perform genetic studies
c) Assess L/S ratio
d) Monitor the bilirubin level
9. Following an amniocentesis, a client will be monitored 1 hour by the nurse for:
a) Temperature elevation
b) Bladder spasms
c) Spontaneous rupture of the membranes
d) Increased fetal activity
10. A client who is G2 P1 arrives for her 28-week appointment. She is complaining of hemorrhoids and constipation. A nursing recommendation would include:
a) Decrease daily exercise
b) Take laxatives at bedtime
c) Take prenatal vitamins every other day
d) Increase daily water and fiber intake
11. At her 28-week appointment, a client is to receive a RhoGam injection. The Nurse explains this is to:
a) Prevent 3-day measles
b) Protect the fetus from isoimmunization
c) Prevent neonatal jaundice
d) Protect the mother from fetal bacteria
12. At the clinic, the nurse would perform the following procedure to determine the position of the fetus:
a) Leopold’s
b) Valsalva’s
c) Ritgen’s
d) Credé’s
13. A client reports lack of fetal movement at her scheduled ante partum visit. No FHTs are auscultated and ultrasound confirms intrauterine fetal demise. The nurse would expect the client to exhibit the following behavior, initially, after hearing the news:
a) Bargaining
b) Acceptance
c) Anger
d) Denial
14. A client and her husband arrive at the hospital for induction of labor postfetal demise. Because she is 28 weeks pregnant, her cervix is unripe. The nurse expects which of the following will be used to soften and efface her cervix?
a) Pitocin IV
b) Laminaria
c) Amniotomy
d) Normal Saline solution
15. PG gel is ordered for induction of labor postfetal demise in a 28-week gestational pregnancy. The nurse explains that side effects might include:
a) Dysuria
b) Muscle weakness
c) Nausea, vomiting, and diarrhea
d) Headaches
16. When planning care for a client postfetal demise, a physiological complication of intrauterine fetal demise that can be serious is:
a) Heart murmurs
b) Disseminated intravascular coagulation
c) Pyelonephritis
d) Endometriosis
17. A couple expresses uncertainty about seeing and holding the baby after postfetal demise delivery. Based on the theories of grief, the nurse responds:
a) “That is a difficult decision to make, but I will support you.”
b) “Perhaps only your husband should see the baby.”
c) “Many parents have nightmares afterwards.”
d) “It is only good to see normal babies.”
18. A couple that has just undergone postfetal demise delivery want to visit a friend down the hall who just delivered a beautiful baby girl. The nurse’s best response is to:
a) Discourage this visit; it will increase their depression
b) Discourage walking; it is too strenuous
c) State, “It will make your friend feel guilty; don’t go”
d) Agree to accompany them to the room
19. A woman who is G1 P0 is attending the prenatal clinic for her 37th-week exam. She asks many questions about complications and labor signs. She asks the nurse when is it appropriate to go to the labor and delivery unit. The nurse responds:
a) “When you pass the mucus plug”
b) “If you feel pressure over your bladder”
c) “When you have a large gush of fluid from your vagina”
d) “If you have nausea and vomiting”
20. An obese 28-year old client is seen for the first time at the clinic. The nurse is assessing her for PIH. The sign (s) that indicate possible PIH is (are):
a) Swollen hands, face and feet
b) Abdominal cramping
c) Headache relieved by acetaminophen
d) Clear nipple discharge
21. A rapid plasma regain (RPR) test is ordered on a client at her 37th-week prenatal visit. The nurse explains that it screens for:
a) Chlamydia
b) Syphilis
c) Human papiloma virus (HPV)
d) Gonorrhea
22. The nurse arranges for a client who is 37 weeks pregnant to have a NST. The nurse explains to her that the purpose of this test is to:
a) Determine readiness for labor
b) Evaluate diabetic control
c) Measure the age of the placenta
d) Evaluate the condition of the fetal CNS
23. A client has class I cardiac disease. She is 37 weeks pregnant. The nurse would instruct her to:
a) Reduce physical activity
b) Avoid emotional stress
c) Plan for a vaginal delivery with a regional block
d) Anticipate cesarean delivery
24. A woman who is G1 P0 arrives at the hospital with questionable ruptured membranes. In order to confirm ruptured membranes, the following test will be done:
a) Sterile vaginal exam
b) Gram’s stain of the fluid
c) Sterile speculum exam testing with nitrazine paper
d) Ultrasound
25. A sample of a clients’ vaginal fluid is evaluated under the microscope. The nurse would report positive ruptured membranes if:
a) The fluid has a fern shape
b) Yeast buds are present
c) The odor is fishy
d) There are many WBC’s
26. A client is at 26 weeks’ gestation with prematurely ruptured membranes. In order to help mature the fetus’ lungs in utero, the nurse would anticipate the physician would order:
a) MgSO4
b) Betamethasone
c) Exosurf
d) Ritodrine
27. Nursing care for effective management of preterm PROM includes:
a) Administering narcotics
b) Reassuring the mother that the “baby will be fine”
c) Encouraging ambulation
d) Monitoring for signs of infection
28. A client delivers a 26-week old baby boy by cesarean section. Immediate nursing care of the infant includes:
a) Apgar scoring
b) Dubowitz assessment
c) Weighing and measuring
d) Gavage feeding
29. Complications of preterm birth for the newborn can serious. The nurse must observe for:
a) Undescended testicles
b) Sole creases and lanugo
c) Changes in respiratory status
d) Hyperglycemia
30. In the immediate postpartum period, a common complication of cesarean birth that the nurse must assess for is:
a) Full bladder
b) Hemorrhage due to uterine atony
c) Shivering
d) Elevated temperature
31. The nurse might expect a family’s reaction to a preterm birth to be:
a) Lack of interest
b) Realistic expectations
c) Happiness about a “perfect baby”
d) Impaired perceptions of the baby’s status
32. A client is in active labor. She desires to have epidural anesthesia for the pain. While assisting with administration of the epidural block, the nurse’s role is to:
a) Position the patient
b) Scrub the client back
c) Inject the medication
d) Encourage breath-holding during the procedure
33. The nurse must remain alert for signs of dangerous complications following epidural administration for the woman in labor, which include:
a) Drowsiness
b) Severe headaches
c) Hypotension
d) Numbness in legs and feel
34. A nursing intervention that a woman in labor needs during the time an epidural block is in effect includes:
a) Decreaseing IV fluids
b) Dipsticking urine for protein
c) Range of motion in lower extremities
d) Catheterizing her bladder
35. A client has a postpartum hemorrhage. Nursing action for this problem is to:
a) Insert vaginal packing
b) Massage the uterus
c) Apply ice to the perineum
d) Administer a blood transfusion
36. A 15-year old woman who is G1 P0 is preeclamptic. The nurse caring for the client will be administering MgSO4. The primary reason the nurse MgSO4 is to:
a) Prevent seizures
b) Lower blood pressure
c) Promote uterine relaxation
d) Decrease urine output
37. During as assessment of a client, who is receiving MgSO4 for preeclampsia, the nurse recognizes the following as a dangerous sign:
a) Systolic heart murmur
b) BP 110/80
c) Urine output of 10 ml/hr
d) Decreased deep tendon reflexes (DTR)
38. The antidote the nurse would administer for a client with an overdose of MgSO4 is:
a) Calcium gluconate
b) Sodium bicarbonate
c) Calcium carbonate
d) Folic Acid
39. A diabetic client is 10 weeks pregnant. She takes regular and NPH insulin twice a day. The nurse should warn her that in the first trimester, she should watch for:
a) Hypoglycemia episodes
b) Rapid weight gain
c) Vision changes
d) Hypertension
40. Immediately after birth of a baby, the nurse plans for a diabetic woman’s change in insulin requirements to:
a) Remain the same
b) Increase
c) Drop precipitously
d) Decrease slightly
41. Nursing care of the infant of a diabetic mother (IDM) includes assessment for:
a) Low blood pressure
b) Edema
c) Change in muscle tone
d) Hypoglycemia
42. A client who is 3 days old is slightly jaundiced. He was born at 38 weeks’ gestation. The nursery nurse is aware that this jaundice is related to:
a) Prematurity
b) ABO incompatibility
c) Physiological jaundice
d) Extravascular homolysis
43. Nursing care of the infant with hyperbilirubinemia who is under bilirubin lights includes:
a) Daily bath
b) Shielding infant’s eyes while under the lights
c) Bottle-feeding only
d) Observing for bloody, mucous stools
44. When teaching a mother whose baby has hyperbilirubinemia, predisposing factors for hyperbilirubinemia include:
a) Rh isoimmunization
b) Postmaturity
c) Cesarean birth
d) Teenage mother
45. A client is 35 weeks pregnant. At her scheduled appointment, she is having heavy, painful bleeding. The nurse knows that this is a sign of:
a) Placenta previa
b) Normal bloody show
c) Passage of the mucus plug
d) Abruptio placenta
46. At the hospital, a client is attached to the fetal monitor for abruptio placenta. A common pattern of decelerations often seen with this condition is:
a) Late decelerations
b) Early decelerations
c) Variable decelerations
d) Mid-decelerations
47. A client has abruptio placenta and labor is precipitous. Fetal heart tones should be monitored by the nurse every:
a) Minute
b) 5 minutes
c) 10 minutes
d) 15 minutes
48. A client receives a midline episiotomy. A priority of nursing care is to:
a) Promote healing of sutures
b) Prevent bladder distention
c) Prevent swelling of the perineum
d) Reduce hemorrhoids
49. A client is diagnosed with mastisis 10 days after delivery. The nurse assesses the client for a sign of this problem:
a) Lack of milk production
b) Nipple burning with breast-feeding
c) Hard, reddened, tender breasts
d) Dimpled skin on breasts
50. A client who is at 42 weeks gestation is scheduled for a CST. She is admitted for evaluation and possible induction of labor. The nurse explains to her that the purpose if this antepartum test is to evaluate:
a) Cervical dilation
b) Readiness for induction
c) Braxton Hicks contractions
d) Respiratory function of the placenta
51. A client is scheduled for an ultrasound. The nurse explains to the client that the primary use of the ultrasound in post-term pregnancy is to:
a) Determine sex of the fetus
b) Evaluate placental age
c) Confirm fetal presentation
d) Assess for fetal abnormalities
52. A client who is at 42 weeks’ gestation is scheduled for induction. Her physician performs an amniotomy. The nurse’s role in this procedure is to:
a) Listen to FHT’s
b) Give fundal pressure
c) Have the client empty bladder
d) Perform vaginal exam to evaluate for prolapsed cord
53. A client at 38 weeks’ gestation has irregular contractions. Her physician orders Pitocin induction. The safest way to administer Pitocin is:
a) IM for comfort
b) Mainline IV
c) IV piggyback as a secondary solution
d) Orally
54. A client still has irregular contractions. Her physician orders Pitocin. She expresses concern about induction, and the nurse replies: