Question 1

Dalacha is a primipara presents one week after delivery. She is tearful, has spells of cry and lack of appetite and sleep. What is the most likely diagnosis?

Accepted Answer

Answer reason: Symptoms at one week postpartum with tearfulness, crying spells, insomnia and decreased appetite are classic for postpartum (post-natal) blues, which occur within the first 1–2 weeks and are self-limited. Postpartum depression is more persistent/severe and typically beyond 2 weeks.

Question 2

Meseret is 24 years old G3P2 presentes to you at 34 weeks of gestation with preterm premature rupture of membranes for ten days. She is complaining of pain in lower abdomen, fever with rigors and chills and purulent vaginal discharge. What is her diagnosis?

Accepted Answer

Answer reason: PPROM for 10 days with maternal fever, abdominal pain, and purulent discharge indicates intra-amniotic infection (chorioamnionitis), not puerperal fever or FUO.

Question 3

A primigravida is in second stage of labour for the past two hours. Fetal head is at +1 station. Inspite of effective uterine contractions, mother is unable to push as she is exhausted. What will be the next step is her management?

Accepted Answer

Answer reason: Second stage has lasted 2 hours in a primigravida with effective contractions and the head at +1 station; the mother is exhausted and cannot push. The appropriate next step is assisted vaginal delivery (forceps/vacuum), not waiting, sedating, or cesarean.

Question 4

Pregnancy induced hypertension is diagnosed when?

Accepted Answer

Answer reason: Gestational (pregnancy-induced) hypertension is defined as new-onset BP elevation after 20 weeks’ gestation without prior chronic hypertension; earlier onset suggests chronic hypertension.

Question 5

What is the Bishop score used to assess?

Accepted Answer

Answer reason: The Bishop score evaluates cervical favorability/readiness and predicts the likelihood of successful induction of labor.

Question 6

A premature baby is born before how many weeks of gestation?

Accepted Answer

Answer reason: Prematurity is defined as birth before 37 completed weeks of gestation; term pregnancy is 37–42 weeks.

Question 7

Which of the following is NOT a complication of the third stage of labor?

Accepted Answer

Answer reason: Third-stage complications include postpartum hemorrhage and retained placenta; obstructed labor occurs during the first/second stage when fetal descent is impeded, not during placental delivery.

Question 8

What occurring in the second trimester helps the expectant mother to accept pregnancy?

Accepted Answer

Answer reason: Quickening—the mother’s first perception of fetal movement—occurs around 16–20 weeks and helps her accept the reality of pregnancy. Lightening occurs late in pregnancy, ballottement is a provider finding, and pseudocyesis is false pregnancy.

Question 9

Eclampsia is mostly seen during which period?

Accepted Answer

Answer reason: Eclamptic seizures can occur antepartum, intrapartum, or postpartum, but classically the highest proportion present during the antepartum period.

Question 10

What is the first sign seen in pregnancy?

Accepted Answer

Answer reason: The earliest presumptive sign of pregnancy is missed menses (amenorrhea). Quickening occurs later in the second trimester, and Hegar’s sign is a probable sign found on pelvic exam later than amenorrhea.

Question 11

If the client's first day of her last menstrual period was January 24, what is her expected date of delivery?

Accepted Answer

Answer reason: Use Naegele's rule: add 7 days and subtract 3 months from the first day of the LMP, then add 1 year. Jan 24 + 7 days = Jan 31; minus 3 months = Oct 31; +1 year = October 31.

Question 12

Which of the following pregnancy/neonatal complications is NOT associated with maternal cigarette smoking?

Accepted Answer

Answer reason: Maternal smoking is linked to low birth weight, SIDS, preterm labor, and PROM; it is not associated with increased risk of pre-eclampsia (risk is reduced).

Question 13

Which supplement is most important in early pregnancy to prevent neural tube defects?

Accepted Answer

Answer reason: Periconceptional folic acid supplementation reduces the risk of fetal neural tube defects; iron, vitamin D, and calcium are important in pregnancy but do not prevent NTDs.

Question 14

The nurse is monitoring a client with a history of stillborn infants. The nurse is aware that a nonstress test can be ordered for this client to?

Accepted Answer

Answer reason: A nonstress test evaluates fetal heart rate accelerations with fetal movement to assess adequate oxygenation and CNS integrity, thus indicating fetal well-being. Lung maturity is assessed via amniotic fluid testing, and effects of contractions are assessed with a contraction stress test.

Question 15

While caring for a client in the second stage of labor, the nurse notices a pattern of early decelerations. The nurse should?

Accepted Answer

Answer reason: Early decelerations are benign, typically due to fetal head compression and are expected in the second stage of labor. No immediate intervention is required; the appropriate action is to observe and document.

Question 16

Which nursing assessment indicates that involutional changes have occurred in a client who is 3 days postpartum?

Accepted Answer

Answer reason: By day 3 postpartum, normal uterine involution lowers the fundus about 1 fingerbreadth per day, so it should be ~3 fingerbreadths below the umbilicus and firm. Lochia serosa typically begins after day 3–4; the other findings reflect earlier postpartum status.

Question 17

To reduce the possibility of having a baby with a neural tube defect, the client should be told to increase her intake of folic acid. Dietary sources of folic acid include?

Accepted Answer

Answer reason: Folic acid is found in leafy green vegetables, some fruits, and certain vegetables; spinach, beets, and cantaloupe are good sources. Meat/poultry/fish provide little folate, and while beans and Brussels sprouts have folate, sweet potatoes are not significant sources, making option C the best set.

Question 18

What is excessive vomiting in early pregnancy known as?

Accepted Answer

Answer reason: Excessive, persistent vomiting in early pregnancy is termed hyperemesis gravidarum, distinguishing it from normal morning sickness.

Question 19

What contraceptive method is advised for a client with molar pregnancy?

Accepted Answer

Answer reason: After evacuation of a molar pregnancy, pregnancy should be avoided for 6–12 months while monitoring hCG levels. Reliable contraception is needed; combined oral contraceptives are preferred and safe. An IUD is contraindicated, barrier methods are less reliable, and implants (Norplant) are not first-line.

Question 20

Which type of fetal presentation is identified as the head entering the birth canal first?

Accepted Answer

Answer reason: Head-first entry into the birth canal is the cephalic presentation; breech is buttocks/feet-first, shoulder is transverse, and flank is not a standard obstetric presentation.

Question 21

Folic acid is usually prescribed for which group?

Accepted Answer

Answer reason: Folic acid supplementation is recommended before conception and in early pregnancy to prevent neural tube defects, so it is typically prescribed for pregnant individuals.

Question 22

When the nurse checks the fundus of a client on the first postpartum day, she notes that the fundus is firm, is at the level of the umbilicus, and is displaced to the right. The next action the nurse should take is to?

Accepted Answer

Answer reason: A firm fundus displaced to the right at the level of the umbilicus on postpartum day 1 indicates a distended bladder pushing the uterus laterally. The priority is to assess for and relieve bladder distention (assist to void).

Question 23

Which selection would provide the most calcium for the client who is 4 months pregnant?

Accepted Answer

Answer reason: Yogurt is a dairy product rich in calcium and provides more calcium than granola, bran muffins, or standard fruit juice.

Question 24

Which observation would the nurse expect to make after an amniotomy?

Accepted Answer

Answer reason: Normal fluid after artificial rupture of membranes is clear (may have white flecks of vernix). Dark yellow, green, or red suggest pathology such as infection/bilirubin, meconium, or bleeding.

Question 25

The obstetric client's fetal heart rate is 80–90 during the contractions. The first action the nurse should take is?

Accepted Answer

Answer reason: FHR of 80–90 during contractions indicates fetal bradycardia. The priority first intervention is to improve uteroplacental perfusion by positioning the mother in the left lateral position, which relieves vena cava compression. Repositioning the monitor delays care; ambulation is inappropriate; preparing for delivery is premature.

Question 26

A vaginal exam reveals a footling breech presentation. The nurse should take which of the following actions at this time?

Accepted Answer

Answer reason: Footling breech has high risks of cord prolapse and head entrapment; standard management is to plan for cesarean delivery. Internal monitoring is contraindicated, knee-chest is used for cord prolapse, and ultrasound is not the immediate nursing action.

Question 27

A vaginal exam reveals that the cervix is 4cm dilated, with intact membranes and a fetal heart tone rate of 160–170bpm. The nurse decides to apply an external fetal monitor. The rationale for this implementation is?

Accepted Answer

Answer reason: Internal fetal monitoring requires ruptured membranes and an accessible presenting part. Because the membranes are intact, an external monitor is appropriate.

Question 28

The following are all nursing diagnoses appropriate for a gravida 1 para 0 in labor. Which one would be most appropriate for the primagravida as she completes the early phase of labor?

Accepted Answer

Answer reason: As latent (early) labor progresses, oral intake is often limited and insensible losses from breathing and perspiration increase, placing the primigravida at risk for dehydration. Hyperventilation is more typical of later, more painful stages; placental perfusion issues and mobility restriction are not the priority at this time.

Question 29

The nurse notes variable decelerations on the fetal monitor strip. The most appropriate initial action would be to?

Accepted Answer

Answer reason: Variable decelerations indicate umbilical cord compression. The first nursing action is to change the maternal position to relieve compression and improve fetal oxygenation; notifying the provider or starting IV may follow if unresolved. Readjusting the monitor does not treat the cause.

Question 30

Which of the following is a characteristic of an ominous periodic change in the fetal heart rate?

Accepted Answer

Answer reason: Late decelerations—recurrent fetal heart rate falling to 90–100 bpm at the end of contractions—indicate uteroplacental insufficiency and are ominous. The other findings (baseline 120–130 bpm, variability 6–10 bpm, and accelerations with movement) are generally reassuring.

Question 31

A client in the family planning clinic asks the nurse about the most likely time for her to conceive. The nurse explains that conception is most likely to occur when?

Accepted Answer

Answer reason: Fertility peaks at ovulation, which is triggered by the LH surge. At this time the endometrium is thickening and estrogen has just peaked; LH high is the best indicator of likely conception.

Question 32

The nurse is teaching a pregnant client about nutritional needs during pregnancy. Which menu selection will best meet the nutritional needs of the pregnant client?

Accepted Answer

Answer reason: Option C provides a balanced meal with lean protein (baked chicken), fruits/vegetables, and a calcium source (yogurt) while limiting fried foods and sugary soda. Other options are high in fried/chip items, lack dairy, or include more caffeine/soda.

Question 33

A client tells the doctor that she is about 20 weeks pregnant. The most definitive sign of pregnancy is?

Accepted Answer

Answer reason: Positive (definitive) signs of pregnancy include fetal heart tones, fetal movement felt by the examiner, and ultrasound visualization. Elevated hCG, uterine and breast changes are presumptive/probable, not definitive.

Question 34

The nurse is discussing breastfeeding with a postpartum client. Breastfeeding is contraindicated in the postpartum client with?

Accepted Answer

Answer reason: Breast milk can transmit HIV to the infant; therefore, in high-resource settings breastfeeding is contraindicated. Diabetes, hypertension, and thyroid disease are not contraindications with appropriate management.

Question 35

A client is admitted to the labor and delivery unit complaining of vaginal bleeding with very little discomfort. The nurse’s first action should be to?

Accepted Answer

Answer reason: Painless vaginal bleeding suggests placenta previa. Priority is to assess fetal status first; vaginal exams (checking dilation) are contraindicated. Uterine firmness and history can follow after confirming fetal well-being.

Question 36

The nurse is teaching a group of prenatal clients about the effects of cigarette smoke on fetal development. Which characteristic is associated with babies born to mothers who smoked during pregnancy?

Accepted Answer

Answer reason: Maternal smoking causes placental vasoconstriction and fetal hypoxia, leading to intrauterine growth restriction. Infants are typically small with reduced weight and length, not LGA nor appropriate-sized preterm.

Question 37

The physician has ordered an injection of RhoGam for the postpartum client whose blood type is A negative but whose baby is O positive. To provide postpartum prophylaxis, RhoGam should be administered?

Accepted Answer

Answer reason: Postpartum Rho(D) immune globulin is given within 72 hours after delivery of an Rh-positive infant to an Rh-negative mother to prevent maternal Rh sensitization.

Question 38

A client is admitted to the labor and delivery unit. The nurse performs a vaginal exam and determines that the client's cervix is 5 cm dilated with 75% effacement. Based on the nurse's assessment the client is in which phase of labor?

Accepted Answer

Answer reason: Cervical dilation of 4–7 cm with increasing effacement corresponds to the active phase of the first stage of labor; latent is 0–3 cm and transition is 8–10 cm.

Question 39

A client who delivered this morning tells the nurse that she plans to breastfeed her baby. The nurse is aware that successful breastfeeding is most dependent on the?

Accepted Answer

Answer reason: Maternal motivation and commitment are the strongest predictors of breastfeeding success; breast size, infant birth weight, and educational level do not determine the ability to breastfeed.

Question 40

The nurse is monitoring the progress of a client in labor. Which finding should be reported to the physician immediately?

Accepted Answer

Answer reason: Green-tinged amniotic fluid indicates meconium staining, a sign of possible fetal distress and risk for meconium aspiration; it requires immediate provider notification. The other findings can be normal during labor.

Question 41

A primigravida, age 42, is 6 weeks pregnant. Based on the client's age, her infant is at risk for?

Accepted Answer

Answer reason: Advanced maternal age (≥35) increases the risk of chromosomal nondisjunction, especially trisomy 21 (Down syndrome). The other options are not specifically associated with maternal age.

Question 42

A pregnant client, age 32, asks the nurse why her doctor has recommended a serum alpha fetoprotein. The nurse should explain that the doctor has recommended the test?

Accepted Answer

Answer reason: Maternal serum alpha-fetoprotein screening is primarily used to detect open neural tube defects such as spina bifida and anencephaly, not mandated by law, related to maternal age, or used for cardiovascular defects.

Question 43

A gravida III para II is admitted to the labor unit. Vaginal exam reveals that the client's cervix is 8cm dilated, with complete effacement. The priority nursing diagnosis at this time is?

Accepted Answer

Answer reason: At 8 cm dilation with complete effacement in a multipara, delivery may be imminent and rapid. The highest priority is preventing maternal/fetal injury from a precipitous birth. Pain coping and NPO-related fluid deficit are lower priorities; anesthesia is not yet in use.

Question 44

During the assessment of a laboring client, the nurse notes that the FHT are loudest in the upper-right quadrant. The infant is most likely in which position?

Accepted Answer

Answer reason: Fetal heart tones heard best above the umbilicus (upper quadrant) indicate a breech presentation; being loudest in the upper-right quadrant suggests the fetal back is on the maternal right—right breech. Vertex (occipital) positions would be heard in the lower quadrants.

Question 45

While assessing the postpartal client, the nurse notes that the fundus is displaced to the right. Based on this finding, the nurse should?

Accepted Answer

Answer reason: A fundus deviated to the right postpartum indicates a distended bladder pushing the uterus laterally. The priority action is to have the client void to empty the bladder and allow the uterus to return to midline.

Question 46

An adolescent primigravida who is 10 weeks pregnant attends the antepartal clinic for a first check-up. To develop a teaching plan, the nurse should initially assess?

Accepted Answer

Answer reason: At the initial prenatal visit—especially with an adolescent—the priority is to establish rapport and assess acceptance and feelings about the pregnancy to guide individualized teaching. Knowledge of preterm labor and future family planning can be addressed later.

Question 47

Inadequate intake of which vitamin by the pregnant woman can cause neural tube defect?

Accepted Answer

Answer reason: Folate deficiency in early pregnancy is a proven cause of neural tube defects (e.g., spina bifida, anencephaly); supplementation before conception and in the first trimester prevents these defects.

Question 48

What is the expected date of delivery (EDD) using Naegele’s Rule for a patient with a regular 28-day menstrual cycle whose last menstrual period (LMP) started on July 10?

Accepted Answer

Answer reason: Using Naegele’s Rule (add 7 days, subtract 3 months, add 1 year): LMP July 10 -> July 17 -> April 17.

Question 49

A pregnant woman reports that the first day of her last menstrual period was November 5; when should she expect her baby to arrive?

Accepted Answer

Answer reason: Use Naegele's rule: add 7 days and subtract 3 months from the first day of the LMP. November 5 + 7 days = November 12; minus 3 months = August 12.

Question 50

Which maternal position is most beneficial during a non-stress test to promote fetal heart rate accelerations?

Accepted Answer

Answer reason: Left lateral positioning maximizes uteroplacental perfusion and prevents supine hypotension, promoting fetal heart rate accelerations during an NST.

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