Question 1

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

Accepted Answer

Answer reason: Maternal HIV can be transmitted to the infant via breastfeeding, so this condition is a classic contraindication in standard nursing exam guidance (especially where safe alternatives to breast milk are available). In contrast, diabetes, hypertension, and most thyroid disorders are not absolute contraindications; they generally require medication review and maternal stability rather than stopping breastfeeding. The safest teaching is to recommend an alternative feeding plan and coordinate care with obstetrics/pediatrics and infectious disease guidance.

Question 2

RhoGAM is most often used to treat ____ mothers who have an ____ infant?

Accepted Answer

Answer reason: This is clinically indicated when an Rh-negative mother is exposed to Rh-positive fetal blood, most commonly after delivery of an Rh-positive infant (and also after sensitizing events like bleeding or invasive procedures). If the infant is Rh-negative, there is no Rh(D) antigen exposure risk and prophylaxis is not needed. If the mother is Rh-positive, she will not produce anti-D against Rh(D), so the medication is not indicated for that pairing.

Question 3

The first thing that a nurse must ensure when the baby’s head comes out is?

Accepted Answer

Answer reason: Checking for and managing a cord around the neck is a rapid, critical step that directly affects oxygenation in the next moments of birth. If a nuchal cord is present, the nurse/clinician can attempt to slip it over the head or take appropriate measures if it is tight, reducing the risk of asphyxia. The other choices describe cord characteristics that are not the most immediate life-threatening concern at the moment the head emerges.

Question 4

A patient has experienced an uneventful pregnancy but begins to have vaginal spotting at 38 weeks gestation. The health care provider (HCP) suspects placenta previa initiated by cervical thinning. Which testing does the nurse expect the HCP to schedule?

Accepted Answer

Answer reason: Ultrasound (typically transvaginal for best accuracy when needed) is the first-line diagnostic test and guides delivery planning while minimizing the risk of provoking hemorrhage. Fetal surveillance tests like a nonstress test assess fetal well-being but do not diagnose placental location. Doppler studies primarily evaluate blood flow (eg, growth restriction), and MRI is reserved for selected cases when ultrasound is inconclusive or for suspected accreta spectrum rather than routine previa diagnosis.

Question 5

What is the name given to light stroking of the abdomen in rhythm with the patient’s breathing during labor contractions?

Accepted Answer

Answer reason: Light abdominal stroking in a circular or sweeping pattern is the defining feature of this method. By engaging tactile stimulation and focused breathing, it can reduce anxiety and improve coping during contractions. A common distractor is firm pressure to the sacrum for back labor, which is a different technique aimed at countering fetal pressure rather than providing light rhythmic stroking.

Question 6

The following are signs that the placenta has detached, except?

Accepted Answer

Answer reason: These include a firm, more globular uterus, a sudden gush of blood as the placenta shears from the uterine wall, and apparent lengthening of the umbilical cord as the placenta moves downward. A feeling of “bearing down” is more characteristic of fetal descent and the second stage of labor rather than a reliable indicator of placental detachment. Therefore, this choice is the exception among typical signs of placental separation.

Question 7

Vaccine Used for Pregnant Female ?

Accepted Answer

Answer reason: Tetanus vaccine (Td/Tdap) is safely administered during pregnancy to protect both the mother and the newborn from neonatal tetanus. Live vaccines such as BCG and rubella are contraindicated in pregnancy, and DPT is not given as a combined vaccine in adults; instead, Td or Tdap is used.

Question 8

A patient receiving an IUD asks the nurse how often they need to check the string length. What is the best response by the nurse?

Accepted Answer

Answer reason: Checking about once a month (often after menses when the cervix is slightly more open and expulsion is more likely to be noticed) provides reasonable surveillance without causing unnecessary manipulation or anxiety. Daily or weekly checking is excessive and may increase discomfort or lead to accidental pulling on the strings. Annual checking is too infrequent because expulsion can occur soon after insertion and at any time thereafter, and delayed recognition increases pregnancy risk.

Question 9

When performing Leopold's maneuvers, which of the following would the nurse ask the client to do to ensure optimal comfort and accuracy?

Accepted Answer

Answer reason: A full bladder can cause suprapubic discomfort and can interfere with palpation by adding fullness and increasing uterine displacement, reducing exam accuracy. Asking the client to void improves comfort and helps the examiner palpate fetal parts more clearly. Drinking water would worsen bladder fullness, and lying on the left side is more relevant to relieving supine hypotension than optimizing abdominal palpation.

Question 10

During a childbirth preparation class, a primigravid client at 36 weeks’ gestation tells the nurse, “My lower back has really been bothering me lately.” Which of the following exercises suggested by the nurse would be most helpful?

Accepted Answer

Answer reason: Late pregnancy low back pain is commonly related to postural changes, increased lumbar lordosis, and pelvic ligament laxity from hormonal effects. This exercise promotes pelvic mobility and gentle stretching of the lumbar and pelvic muscles, which can reduce muscle strain and improve comfort. It also encourages optimal fetal positioning and can relieve pressure on the lower back by improving maternal posture and alignment. Deep breathing mainly aids relaxation during labor, tailor sitting primarily opens the pelvis and stretches inner thighs, and squatting is more useful for facilitating descent in labor but can increase strain or instability if back pain is the main complaint.

Question 11

The nurse is caring for a client in labor. Which assessment finding indicates to the nurse that the client is beginning the second stage of labor?

Accepted Answer

Answer reason: Complete dilation indicates the presenting part can descend through the birth canal and maternal pushing efforts become effective and appropriate. Regular contractions and rupture of membranes are expected in labor but can occur in the first stage and do not define the transition to second stage. Expelling clear vaginal fluid is nonspecific and more consistent with amniotic fluid leakage or normal secretions rather than a stage-defining finding.

Question 12

In evaluating the effectiveness of IV Pitocin for a client with secondary dystocia, the nurse should expect?

Accepted Answer

Answer reason: Oxytocin (Pitocin) is used to augment uterine contractions in dysfunctional labor to restore an effective contraction pattern that produces cervical change and fetal descent. Secondary dystocia implies labor progress has slowed or arrested after initially being adequate, so effectiveness is best reflected by renewed, ongoing cervical dilation over time. Infrequent contractions indicates inadequate uterine activity and would suggest ineffective therapy rather than improvement. A painless delivery is not an expected effect of oxytocin and pain often increases as contractions strengthen; effacement may occur but progressive dilation is the clearest measurable indicator of successful augmentation.

Question 13

Which of the following is the most appropriate action for a nurse to take when a client is in labor?

Accepted Answer

Answer reason: The nurse should assess baseline rate, variability, and the presence of accelerations/decelerations to detect early fetal compromise and guide timely interventions. Administering analgesia may be appropriate but should follow assessment and requires verifying maternal-fetal status and timing relative to delivery. Assisting with delivery or preparing for emergency cesarean are not universally indicated for all laboring clients and would be driven by assessment findings such as nonreassuring fetal status or obstetric emergencies.

Question 14

A pregnant client asks the nurse what to expect during her first months of pregnancy. Which response by the nurse is correct?

Accepted Answer

Answer reason: This makes nosebleeds a common, benign discomfort in the first trimester. Dysuria suggests a urinary tract infection rather than a normal physiologic change (pregnancy more commonly causes frequency/urgency without burning). Dependent edema is more typical later in pregnancy with increased venous pressure, and noticeable colostrum leakage is more common in the second trimester and beyond.

Question 15

A prenatal nurse is providing teaching to a patient on proper nutrition during pregnancy. The patient is of average/ normal BMI. How much weight should the nurse advise this patient to gain during pregnancy?

Accepted Answer

Answer reason: For a person with a normal BMI, standard guidelines recommend a total gain in the mid-20s to mid-30s (lb) over the pregnancy, reflecting expected increases from fetal/placental tissues, amniotic fluid, expanded blood volume, and maternal fat stores. Gains below this range raise concern for inadequate fetal growth and preterm birth risk, while gains above it increase risk for macrosomia, cesarean birth, and postpartum weight retention. The other ranges either align more with underweight (higher) or overweight (lower) BMI categories rather than normal BMI counseling.

Question 16

A 36-year-old multigravida client is admitted to the hospital with possible ruptured ectopic pregnancy. When obtaining the client history, which finding would be most important to identify as a predisposing factor?

Accepted Answer

Answer reason: This tubal damage predisposes implantation within the tube, and rupture can occur as the pregnancy grows. Group B streptococcus colonization is primarily relevant to neonatal infection prevention rather than tubal pathology. Placenta previa is a uterine placentation problem and does not predispose to extrauterine implantation; cocaine use is linked to placental abruption and fetal growth issues rather than ectopic implantation.

Question 17

Which is the MOST APPROPRIATE health teaching for a client with pre-eclampsia at 20 weeks AOG?

Accepted Answer

Answer reason: Preeclampsia is defined by new-onset hypertension after 20 weeks with evidence of end-organ involvement, most classically proteinuria, so teaching should emphasize monitoring for protein in the urine to detect/worsen disease early. Urine protein assessment is a practical, direct surveillance tool and aligns with key diagnostic criteria and ongoing monitoring needs. Dietary salt restriction to 1 g/day is not a standard recommendation and can risk inadequate intake without improving outcomes. While renal labs (BUN/creatinine) help assess severity, they are clinician-ordered evaluations rather than the most appropriate client-focused teaching compared with urine protein monitoring.

Question 18

A G1P0 client currently in the 28th week of gestation whose blood type is A negative was advised to receive a Rho(D) immune globulin intramuscular injection today. Which statement by the client indicates the need for further teaching about this therapy by the nurse?

Accepted Answer

Answer reason:  Rho(D) immune globulin provides passive anti-D antibodies to an Rh-negative pregnant client to prevent maternal sensitization after fetal-maternal blood exposure. The goal is to stop the mother from forming her own anti-D IgG that could cross the placenta and hemolyze an Rh-positive fetus in a current or future pregnancy. A fetus/newborn does not “develop antibodies against my blood” as the primary problem; instead, maternal antibodies target fetal RBCs. The other statements correctly reflect that prophylaxis is given at ~28 weeks and again postpartum if the newborn is Rh-positive, and that repeat prophylaxis is needed in subsequent pregnancies or sensitizing events.

Question 19

The following are correct statements about false labor, except?

Accepted Answer

Answer reason: False labor (Braxton Hicks) contractions are typically irregular and do not become longer, stronger, or closer together in a progressive pattern. A key distinguishing feature of true labor is uterine activity that increases in duration and intensity and results in progressive cervical change. In false labor, the cervix generally remains closed without ongoing effacement/dilation, and there is usually no bloody show. A progressive lengthening of contractions therefore aligns with true labor rather than false labor.

Question 20

Which of the following is a characteristic of a reassuring fetal heart rate pattern?

Accepted Answer

Answer reason: These accelerations reflect fetal well-being and appropriate central nervous system responsiveness. By contrast, sustained tachycardia in the 170–180 bpm range is concerning for fetal stress (e.g., infection, hypoxia, medications) rather than reassurance. “Ominous periodic changes” describes nonreassuring decelerations/abnormal patterns. Marked variability of 25–35 bpm exceeds the usual reassuring moderate range and may indicate instability rather than normal baseline variability.

Question 21

The client is having fetal heart rates of 90–110 bpm during the contractions. The first action the nurse should take is?

Accepted Answer

Answer reason: Left lateral positioning decreases aortocaval compression by the gravid uterus, improving maternal venous return, cardiac output, and blood flow to the placenta. This is a rapid, low-risk intervention that can correct many transient fetal heart rate decreases without delaying care. Repositioning the monitor may improve tracing quality but does not treat the underlying perfusion problem, and ambulation or preparing for delivery is not the first step before attempting basic corrective measures.

Question 22

The client is admitted to the unit. A vaginal exam reveals that she is 2cm dilated. Which of the following statements would the nurse expect her to make?

Accepted Answer

Answer reason: At 2 cm dilation the client is typically in the latent/early phase of the first stage of labor, when contractions are becoming established but coping demands are usually still manageable. In this phase, clients are often talkative, social, and able to focus on plans and anticipatory aspects of birth, consistent with discussing baby names. The urge to push is expected much later with complete dilation and fetal descent, making that statement inconsistent with the findings. Requests reflecting intense coping needs (e.g., difficulty concentrating with touch) are more typical as labor progresses into active/transition phases.

Question 23

A client in premature labor is scheduled to receive a dose of betamethasone. In teaching the client about this medication, how should the nurse explain the purpose and expected action of the medication?

Accepted Answer

Answer reason: Betamethasone is not a tocolytic, so it does not directly stop uterine contractions. It also is not an antibiotic, so it does not prevent infection. Cervical dilation prevention is not its mechanism; it is administered to improve neonatal outcomes when preterm delivery is likely.

Question 24

The postpartum nurse who is reviewing the client assignment determines that which client is at greatest risk for early postpartum hemorrhage?

Accepted Answer

Answer reason: Poor uterine tone prevents the myometrium from compressing maternal blood vessels (“living ligatures”), making brisk bleeding more likely in the immediate postpartum period. Infection such as endometritis can contribute to subinvolution and later bleeding, but it is typically less immediate and less common as the primary cause of early hemorrhage than inadequate uterine contraction. Low birth weight and young maternal age are not major direct drivers of early postpartum hemorrhage compared with impaired uterine tone.

Question 25

Rho(D) immune globulin (RhoGAM) is given to a pregnant woman after delivery and the nurse is giving information to the patient about the indication of the medication. The nurse determines that the patient understands the purpose of the medication if the patient tells that it will protect her baby from which of the following?

Accepted Answer

Answer reason: Rho(D) immune globulin prevents maternal sensitization to Rh(D) antigen when an Rh-negative mother is exposed to Rh-positive fetal red blood cells. By blocking the mother from forming anti-D IgG antibodies, it reduces the risk of hemolytic disease in a future Rh-positive fetus/newborn. It does not change the baby’s Rh type or prevent infections or nutritional anemias. A common misconception is that it “protects the current baby” from being Rh+; instead, it prevents antibody formation that would cause incompatibility-related hemolysis in subsequent pregnancies (and can also help if given appropriately antenatally).

Question 26

The second stage of labor begins with __ and ends with __?

Accepted Answer

Answer reason: The stages of labor are defined by key clinical milestones: cervical change marks transition from the first stage to the second, and birth of the neonate marks completion of the second stage. Once the cervix is fully dilated (10 cm) and effaced, the presenting part can descend and the client begins pushing, which characterizes stage two. The endpoint is delivery of the infant; delivery of the placenta belongs to the third stage. Options that start with “true labor pains” or “show” describe early labor events rather than the onset of the second stage.

Question 27

During her shift in the maternity ward, Nurse Jackson cares for Ms. Greene, who is at 42 weeks of gestation and shows no signs of labor. Given that the fetus is now considered postmature, Nurse Jackson recalls the risks associated with postmaturity. Among the following potential complications, which one is primarily linked to the postmature status of the fetus?

Accepted Answer

Answer reason: This placental “wearing out” drives key postmaturity risks such as oligohydramnios, fetal distress, and meconium passage/aspiration. While some postterm infants can be large, macrosomia is more classically linked to maternal diabetes and is not the primary mechanism unique to postmaturity. The characteristic postmature appearance (thin, wrinkled, decreased fat) is a downstream effect of chronic placental insufficiency rather than the primary underlying complication.

Question 28

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

Accepted Answer

Answer reason: External fetal monitoring is used when internal monitoring is not indicated or cannot be performed safely. Internal fetal monitoring (fetal scalp electrode/intrauterine pressure catheter) generally requires ruptured membranes and sufficient cervical dilation so the device can be applied to the presenting part. With intact membranes, an internal monitor cannot be placed, so an external monitor is the appropriate choice to assess fetal status given the elevated baseline fetal heart rate. The other options are incorrect because the cervix is not closed, the stated fetal heart rate is tachycardic rather than normal, and contraction intensity does not override the requirement for ruptured membranes for internal monitoring.

Question 29

A nurse is monitoring the contractions of a client in the first stage of labor. Which of the following sequences correctly represents the phases of a uterine contraction from beginning to end?

Accepted Answer

Answer reason: A normal uterine contraction begins with the increment phase, where the intensity gradually increases. It then reaches the acme, which is the peak of contraction strength. After the peak, the contraction enters the decrement phase as the intensity decreases, followed by relaxation where the uterus returns to baseline tone. This sequence reflects normal labor physiology.

Question 30

A nurse is preparing to administer oxytocin to induce labor in a client. The nurse recognizes that the oxytocin infusion can lead to which of the following?

Accepted Answer

Answer reason: Nonreassuring fetal status from uterine hyperstimulation often prompts escalation of interventions and may culminate in cesarean delivery. This is a recognized risk of induction/augmentation with oxytocin when titration and monitoring are not carefully managed. By contrast, placenta previa is determined by placental implantation location and is not caused by oxytocin infusion.

Question 31

A nurse is admitting a post-date client at 43 weeks gestation to the labor and delivery unit for induction of labor. What is a predictor of a successful induction?

Accepted Answer

Answer reason: The Bishop score quantifies these cervical and fetal factors, and higher scores correlate with higher likelihood of successful induction; a score around 8 or more is generally considered favorable, making 10 highly predictive. A firm, posterior cervix reflects an unfavorable, unripe cervix and is associated with failed induction or need for cervical ripening. A reactive nonstress test indicates reassuring fetal status but does not predict cervical readiness or induction success, and a history of precipitous labor does not directly measure current cervical favorability.

Question 32

Which of the following factors would the nurse suspect as predisposing a client to placenta previa?

Accepted Answer

Answer reason: Multifetal pregnancy increases placental mass and the likelihood that part of the placenta will implant near or over the cervical os. In contrast, abdominal trauma is more classically linked to placental abruption rather than previa. Renal/vascular disease more strongly relates to uteroplacental insufficiency, fetal growth restriction, and hypertensive disorders than to low-lying placental implantation.

Question 33

Breast engorgement usually occurs on?

Accepted Answer

Answer reason: This typically happens around postpartum days 3–4 when mature milk “comes in,” especially if milk removal is infrequent or ineffective. Day 1 is usually characterized by colostrum production with much lower volume, making significant engorgement less likely. Days 7–10 are later than the usual physiologic timing and would suggest other contributors (e.g., skipped feeds) rather than the typical onset window.

Question 34

The fourth stage of labour lasts for?

Accepted Answer

Answer reason: Standard obstetric teaching defines this stage as the first 1–2 hours after placental delivery, when uterine atony and postpartum bleeding are most likely. Choosing the upper end of the accepted window best matches exam conventions and emphasizes the key surveillance period for vital signs, fundal tone, and lochia. Options shorter than this underrepresent the critical monitoring timeframe, while longer durations are not the typical definition of this stage.

Question 35

False labour pain is relieved by?

Accepted Answer

Answer reason: Rest reduces uterine irritability and often stops these non-progressive contractions, distinguishing them from true labor. True labor contractions usually persist and become stronger despite rest or position changes. Walking more often intensifies true labor patterns and does not reliably relieve false labor discomfort.

Question 36

A 27-year-old primigravida asks the nurse how much iron she needs during her pregnancy. The correct response of the nurse is?

Accepted Answer

Answer reason: A standard recommended intake during pregnancy is about 27–30 mg elemental iron daily, making this option the best match for typical prenatal guidance. 18 mg/day reflects the usual requirement for nonpregnant women and is therefore insufficient for pregnancy. Much higher amounts (e.g., 150 mg/day or 1 g/day) are not routine recommendations and would generally be reserved for treating significant iron-deficiency anemia under provider direction due to adverse-effect risk.

Question 37

A nurse is caring for a client following a forceps-assisted vaginal birth. The client reports severe vaginal pain and fullness. On assessment the nurse notices a firm, midline uterine fundus. Lochia rubra is light. Which diagnosis should the nurse anticipate?

Accepted Answer

Answer reason: A firm, midline fundus with light lochia indicates the uterus is well contracted and argues against uterine atony as the cause of postpartum hemorrhage. Forceps use increases risk of trauma to vaginal vessels, leading to a hematoma that may not produce heavy external bleeding. Cervical laceration typically presents with persistent bright-red bleeding despite a firm fundus rather than prominent localized pain/pressure.

Question 38

The nurse is collecting data from a client who is at 30 weeks gestation. The client tells the nurse, "It seems like I have been incontinent of urine for the last few days." Which of the following should the nurse make available in the client's examination room?

Accepted Answer

Answer reason: Nitrazine testing helps differentiate amniotic fluid from urine by assessing pH; amniotic fluid is typically alkaline and turns the strip toward blue. Rapid identification of possible PPROM is important because it increases risk for infection and preterm birth and guides next steps such as avoiding digital exams and notifying the provider. A urine container may help assess UTI or true incontinence, but it does not directly rule in/out membrane rupture, which is the higher-risk concern suggested by the history.

Question 39

A nurse is teaching a client about breastfeeding. Which statement by the client indicates correct understanding of the teaching?

Accepted Answer

Answer reason: Breaking suction before removing the infant prevents nipple trauma and pain by avoiding forceful pulling on the nipple. Proper technique is to insert a clean finger into the corner of the baby’s mouth to release the seal, then relatch. A fixed feeding time per breast is not the primary goal; infants should feed effectively and may vary in duration, and switching too soon can limit hindmilk intake. Holding the infant by the back of the head can prompt the baby to arch away and worsen latch, and an effective latch requires taking a good portion of the areola into the mouth, not nipple-only.

Question 40

When caring for a client who's having her second baby, the nurse can anticipate the client's labor will be which of the following?

Accepted Answer

Answer reason: This makes the overall labor course commonly shorter in a second pregnancy compared with a first. An exact fraction (such as half as long) is not reliably predictable because labor duration varies with fetal size/position, uterine contractility, and maternal factors. Nonetheless, anticipating a shorter labor supports nursing readiness for quicker progression and delivery.

Question 41

Partogram is used to monitor?

Accepted Answer

Answer reason: Its main purpose is early detection of abnormal or prolonged labor patterns so timely interventions (e.g., augmentation, operative delivery, or referral) can be initiated to reduce maternal and neonatal morbidity. It is not designed to assess fetal growth, which is evaluated antenatally using fundal height and ultrasound. Postnatal monitoring focuses on postpartum bleeding, uterine involution, and newborn adaptation rather than labor progression.

Question 42

Normal duration of each uterine contraction?

Accepted Answer

Answer reason: A much longer duration suggests uterine tachysystole or hypertonus, which can reduce placental perfusion and lead to fetal heart rate abnormalities. Very short durations (e.g., 5–10 seconds) are more consistent with uterine irritability or mild Braxton Hicks–type activity rather than effective labor contractions. Therefore, the duration range that best matches expected intrapartum physiology is the mid-range option provided.

Question 43

Uterus after delivery feels?

Accepted Answer

Answer reason: A firm, midline fundus is the expected normal finding on postpartum assessment. A soft or boggy uterus suggests uterine atony, which is a leading cause of excessive postpartum bleeding and requires prompt interventions (e.g., fundal massage and uterotonics). “Flaccid” similarly indicates poor tone and is abnormal in the immediate postpartum period. “Not palpable” is inconsistent with routine early postpartum findings because the fundus is typically palpable abdominally soon after birth.

Question 44

Preterm baby is born before?

Accepted Answer

Answer reason: This cutoff reflects the point at which fetal organ maturity, especially pulmonary and neurologic development, is more consistent with term outcomes. Therefore, any birth earlier than 37 weeks is classified as preterm. Options like 20 or 28 weeks describe earlier subcategories (e.g., extremely/very preterm) rather than the overall definition, and 45 weeks would be post-term.

Question 45

A client who is 8 weeks pregnant reports morning sickness. What is the most appropriate response by the nurse?

Accepted Answer

Answer reason: Eating a small snack (often protein-rich) before getting out of bed can blunt nausea by stabilizing glucose and reducing gastric irritation. This is a practical, evidence-based, nonpharmacologic first-line intervention for mild nausea and vomiting of pregnancy. Encouraging large fluid intake with meals can increase gastric distention and worsen nausea, while reassurance alone does not provide symptom relief strategies.

Question 46

After instructing participants in a birth education class about methods for coping with discomforts in the first stage of labor, the nurse determines that one of the pregnant clients needs further instruction when she says that she has been practicing which technique?

Accepted Answer

Answer reason: Biofeedback, effleurage, and guided imagery are classic nonpharmacologic comfort measures taught for intrapartum use in early labor. Pelvic tilt exercises are primarily prenatal exercises for posture, back discomfort, and strengthening, not a primary method for managing contraction pain during the first stage of labor. Therefore, identifying this as her “coping technique” indicates misunderstanding of what is intended for first-stage labor discomfort management.

Question 47

The nurse is taking the history and physical of a woman who has just discovered that she is pregnant. This nurse knows that the purpose of asking a prenatal client about her history with rheumatic fever has the most to do with?

Accepted Answer

Answer reason: Pregnancy increases circulating blood volume and cardiac output, which can decompensate preexisting structural heart disease. A history of rheumatic fever is important because it can cause chronic rheumatic valvular disease (classically mitral stenosis/regurgitation), creating higher maternal risk for heart failure and arrhythmias as gestation progresses. Identifying this history prompts focused cardiac assessment and risk stratification (symptoms, murmurs, echocardiography if indicated) to prevent maternal-fetal complications. The other options reflect misconceptions: rheumatic fever is not a teratogenic condition transmitted to the fetus, and routine intrapartum antibiotics are not given solely for remote rheumatic fever history.

Question 48

A woman was admitted to the obstetric unit in active labor and has had a frank rupture of membranes. A fetal scalp electrode and intrauterine pressure catheter were inserted promptly. The woman had progressed to 8-cm dilation when the nurse noted abrupt decreases in the fetal heart rate of 15-20 bpm that quickly returned to baseline. The changes in fetal heart rate occurred with and without contractions. At this point, the nurse should prepare to initiate a client teaching about the possibility of which procedure?

Accepted Answer

Answer reason: Variable decelerations that are abrupt, transient drops in fetal heart rate occurring with or without contractions after rupture of membranes most strongly suggest umbilical cord compression from reduced cushioning amniotic fluid. Infusing warmed isotonic fluid via the intrauterine pressure catheter increases intrauterine fluid volume to relieve cord compression and reduce variable decelerations. Oxytocin would risk worsening fetal stress by increasing uterine activity rather than addressing cord compression. Operative delivery or cesarean is reserved for persistent nonreassuring patterns or failure of corrective measures, not as the first teaching focus when a reversible cause is likely.

Question 49

Imagine you are attending a patient in labor. The baby's heart rate suddenly drops during a contraction. What would be your immediate course of action?

Accepted Answer

Answer reason: Maternal repositioning (e.g., left lateral, right lateral, hands-and-knees) is a first-line intrauterine resuscitation measure that can rapidly relieve aortocaval compression and improve fetal oxygenation. This action is immediate, low-risk, and can be done while simultaneously assessing the tracing and contraction pattern. Waiting delays correction of fetal hypoxia, while pain medication does not address the cause; calling for emergency delivery is considered if bradycardia persists despite initial corrective maneuvers.

Question 50

Instrument used for fetal heart monitoring?

Accepted Answer

Answer reason: This device is designed to transmit low-frequency fetal heart tones clearly and is commonly used for intermittent fetal heart rate assessment during pregnancy and labor. The other instruments measure unrelated parameters (blood pressure or temperature) or assess neurologic reflexes, so they cannot directly monitor fetal heart rate. In settings without electronic fetal monitoring, this method remains a standard, safe approach to confirm fetal cardiac activity and rate.

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