Question 1

At which stage of labor does the placenta fully separate from the uterine wall?

Accepted Answer

Answer reason: Placental separation and expulsion define the third stage of labor, which begins after the baby is delivered and ends when the placenta is delivered. This is the physiologic period when the uterus contracts and shears the placenta away from the uterine wall, helping compress maternal vessels to reduce bleeding. The first stage is cervical dilation/effacement, and the second stage is delivery of the fetus, so neither is the point of placental separation. The fourth stage is the immediate postpartum recovery period, focused on monitoring for hemorrhage and stabilization after the placenta has already delivered.

Question 2

Approximate Total Weight Gain In Pregnancy Is ?

Accepted Answer

Answer reason: For an average pre-pregnancy BMI, the commonly taught approximate total gain is around 11–12 kg (about 25 lb), making this value the best match. The 500 g and 11 g choices are far below what is required to support normal maternal and fetal changes. The 50 kg choice is excessively high for typical singleton pregnancy and would suggest pathologic or extreme weight gain.

Question 3

White or yellowish white secretions that last for 10 to 15 days after delivery is called?

Accepted Answer

Answer reason: The description of white or yellowish-white secretions lasting around 10–15 days best matches the alba phase. Rubra is expected only in the first several days and is red, while serosa is typically pinkish to brown rather than white. Therefore this timing and color pattern identifies the alba stage rather than earlier lochia types.

Question 4

A woman has been pushing effectively for 1 hour, a nurse should need at this time is to?

Accepted Answer

Answer reason: Encouraging recovery periods supports oxygenation, conserves energy, and helps maintain coordinated pushing with contractions. This intervention is safe and universally appropriate even when mobility or oral intake may be limited by institutional policy or analgesia/anesthesia. Ambulation and frequent position changes can be helpful but are not the priority need after sustained active pushing compared with immediate energy conservation and physiologic recovery.

Question 5

Normal lochial findings in the first 24 hours post-delivery include ?

Accepted Answer

Answer reason: A bright red flow can be expected as long as it is not saturating pads rapidly or accompanied by signs of hemorrhage. Large clots or tissue fragments suggest retained products or postpartum hemorrhage risk and are not a normal lochial finding. Foul odor raises concern for endometritis, and complete absence of lochia can indicate obstruction (e.g., clot) and warrants assessment.

Question 6

First pelvic examination in pregnancy is done at –?

Accepted Answer

Answer reason: In routine care, this first full prenatal assessment is commonly scheduled around the end of the first trimester, when dating is more reliable and early pregnancy viability is better established. Earlier timings like 4–6 weeks are often too soon for a reliable bimanual assessment and many patients have not yet had their first formal booking visit. Waiting until 24 weeks would delay identification of important baseline findings (e.g., cervical lesions, uterine/adnexal masses) and necessary screening collected at the first visit.

Question 7

Best indicator of fetal growth —?

Accepted Answer

Answer reason: Measurement of fundal height (symphysis–fundus) typically correlates with gestational age in weeks in the mid-pregnancy period and trends over time help detect growth restriction or macrosomia. Maternal weight gain is influenced by maternal fluid status, adipose stores, and diet, so it is less specific for fetal growth. Amniotic fluid volume and placental size can be associated with certain conditions but are not the standard primary indicator of fetal growth in routine prenatal assessment.

Question 8

A client who is pregnant comes to the clinic for a first visit. The nurse gathers data about her obstetric history, which includes 3-year-old twins at home and a miscarriage 10 years ago at 12 weeks gestation. How would the nurse accurately document this information?

Accepted Answer

Answer reason: This client has had a prior twin pregnancy, a prior miscarriage at 12 weeks, and is currently pregnant, totaling 3 pregnancies. Para counts the number of pregnancies that reached viability (commonly ≥20 weeks), not the number of infants delivered. The twin pregnancy represents one viable pregnancy, so para is 1; among the provided options, the only choice that correctly reflects gravida 3 is the listed selection, while the miscarriage at 12 weeks does not add to para.

Question 9

What is the most common symptom of postpartum endometritis?

Accepted Answer

Answer reason: Postpartum endometritis is an infection of the uterine lining after delivery, so the hallmark findings reflect uterine infection and inflammation. Malodorous lochia is a common symptom because infected uterine contents produce a foul odor and abnormal uterine discharge. Constipation and decreased discharge are not characteristic indicators of uterine infection, and hypothermia is inconsistent with the typical infectious presentation (fever is expected). Early recognition of abnormal lochia supports timely evaluation, cultures as ordered, and prompt antibiotic therapy to prevent progression to sepsis.

Question 10

A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the following is noted on the external monitor tracing during a contraction?

Accepted Answer

Answer reason: These decelerations are often V- or U-shaped and may be accompanied by “shoulders” (brief accelerations) due to baroreceptor response. Early decelerations are typically benign and reflect fetal head compression, not cord issues. Late decelerations are most consistent with uteroplacental insufficiency and are more concerning for fetal hypoxemia.

Question 11

Which of the following is the most risk for complications during pregnancy and labor?

Accepted Answer

Answer reason:  Extremes of maternal age increase obstetric risk, and adolescent pregnancy is associated with higher rates of anemia, hypertensive disorders, preterm birth, and low-birth-weight infants. An 18-year-old may also have greater psychosocial and nutritional vulnerability, which can worsen pregnancy outcomes and intrapartum tolerance. In contrast, ages 28–34 are generally within the lower-risk reproductive range, and multiparity alone at these ages is not the strongest single risk factor listed. Therefore, the youngest client represents the highest overall risk for pregnancy and labor complications among the options provided.

Question 12

Which client is most at risk for postpartum hemorrhage?

Accepted Answer

Answer reason: Postpartum hemorrhage most commonly results from uterine atony, where the uterus fails to contract effectively after birth. A prolonged second stage increases the risk of uterine muscle fatigue and overdistension-related poor contractility, making atony and heavy bleeding more likely. This intrapartum factor is a classic high-yield risk for immediate postpartum hemorrhage compared with routine neuraxial anesthesia. Preeclampsia more strongly aligns with hypertensive complications and placental abruption risk, and gestational diabetes is not as directly predictive of postpartum hemorrhage as labor-related uterine fatigue/atony.

Question 13

The midwife provides services mainly in

Accepted Answer

Answer reason: emphasizes health promotion, normal pregnancy and birth support, early identification of complications, and timely referral when higher-level care is needed. Community health centers and home settings are therefore the main venues where midwives provide ongoing, accessible care. Hospital-based care can occur, but it is not the predominant setting compared with community-focused practice.

Question 14

A client comes to the clinic for a visit, and gets an ultrasound in which a fetal heart rate is observed. Which of the following is this sign of pregnancy?

Accepted Answer

Answer reason: Visualization of fetal cardiac activity on ultrasound is objective evidence of a fetus and is not explainable by maternal physiologic changes alone. Presumptive signs are subjective symptoms reported by the client (e.g., nausea, amenorrhea), and probable signs are objective but not diagnostic (e.g., positive hCG, uterine enlargement). Therefore, fetal heart activity seen on ultrasound is classified as a positive sign of pregnancy.

Question 15

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 are best heard over the fetal back, and their location on the maternal abdomen helps infer fetal presentation and position. In a cephalic (vertex) presentation, FHT are typically loudest below the maternal umbilicus, whereas in a breech presentation they are often loudest above the umbilicus. Upper-right quadrant intensity therefore most strongly supports a breech with the fetal back oriented to the maternal right. Options describing occiput positions would more commonly place the loudest tones in the lower quadrants.

Question 16

Which of the following findings meets the criteria of a reassuring FHR pattern ?

Accepted Answer

Answer reason: Moderate variability is defined as amplitude fluctuations of 6–25 bpm, so a variability range of 6–10 bpm clearly meets reassuring criteria. A baseline of 100–140 bpm is not the standard normal range used for reassurance (typically 110–160 bpm), making that option less accurate. Lack of FHR change with fetal activity suggests absent accelerations, which is not a reassuring feature when used as a criterion.

Question 17

The minimum duration for which prophylactic iron supplementation is recommended according to ministry of health & Family welfare (MoHFW) is…..?

Accepted Answer

Answer reason: MoHFW guidance aligns routine antenatal IFA prophylaxis with a minimum of about 6 months of supplementation to build and maintain adequate iron stores. This duration is operationalized as 180 days, which is longer and more standard than 3–4 months for meaningful repletion/prevention at the population level. Options framed only by trimester timing are less precise than the specified minimum duration used in programmatic recommendations.

Question 18

The nurse is knowledgeable that the most common transmission route of Hepatitis B in the pediatric population is in which of the following ways?

Accepted Answer

Answer reason: In utero transmission can occur but is less common than intrapartum transmission, especially when maternal viral load is high and no prophylaxis is given. Contaminated water is associated with fecal–oral pathogens like hepatitis A, not hepatitis B, which is blood/body-fluid borne. Immunizations prevent hepatitis B and are not a mechanism of infection transmission.

Question 19

Which clinical finding can be determined only by electronic fetal monitoring?

Accepted Answer

Answer reason: Intermittent auscultation can detect baseline rate abnormalities such as tachycardia or bradycardia, but it cannot reliably determine how the fetal heart rate changes in relation to the timing and peak of contractions. Variability can sometimes be estimated, yet subtle beat-to-beat changes and their interpretation are best characterized on a continuous tracing. Therefore, only continuous monitoring can definitively show the fetal response pattern to contractions.

Question 20

A primigravida at 37 weeks reported to labor room with central placenta previa with heavy bleeding per vaginal. The FSH was normal at time of examination. The best management option for her is?

Accepted Answer

Answer reason: At 37 weeks with heavy bleeding, definitive delivery is indicated rather than expectant management. Cesarean delivery is the safest route because it avoids placental disruption from cervical dilation and fetal descent. Induction (with or without forceps) would increase bleeding and is contraindicated in complete placenta previa. Hemodynamic stability and fetal status guide urgency, but the delivery mode remains cesarean for central previa.

Question 21

A nurse at an obstetric clinic has conducted a teaching class on sexuality during pregnancy. Which of the following comments from a participant would indicate that the teaching has been effective?

Accepted Answer

Answer reason: ” Sexual activity is generally safe in an uncomplicated pregnancy, and comfort and desire commonly vary by trimester due to physiologic symptoms. The second trimester is often associated with improved well-being (less nausea and fatigue) and fewer physical limitations, making sexual activity more comfortable for many pregnant people. In contrast, routine abstinence around the time of the “missed period” is not a standard recommendation, and blanket avoidance of sex in the entire third trimester is unnecessary unless specific contraindications exist (e.g., placenta previa, preterm labor risk, ruptured membranes). Libido does not reliably remain constant throughout pregnancy, so expecting no change reflects ineffective learning.

Question 22

A woman has six children, with two sets of twins, and she has had one miscarriage at 18 weeks. When documenting parity on the medical note, which number would the nurse note?

Accepted Answer

Answer reason: Two sets of twins represent two separate pregnancies that reached viability, contributing 2 to parity. In addition, there must be two other singleton viable deliveries to make a total of six living children, adding 2 more, for a parity of 4. The miscarriage at 18 weeks is pre-viable and is counted as an abortion (A), so it does not increase parity.

Question 23

In assessing a post partum client, the nurse palpates a firm fundus and observes a constant trickle of bright red blood from the vagina. What is the most likely cause of these findings?

Accepted Answer

Answer reason: Persistent bright red bleeding with a firm fundus is classic for trauma to the lower genital tract (cervix/vagina/perineum), where bleeding can continue despite adequate uterine tone. Retained placental fragments more often present with a boggy uterus or subinvolution and can contribute to ongoing uterine bleeding rather than a firm fundus with trickling. A clotting disorder typically causes generalized oozing and difficulty forming clots rather than a localized, continuous bright red trickle with normal uterine firmness.

Question 24

The mother of a child with a neural tube defect asks the nurse what she can do to decrease the chances of having another baby with a neural tube defect. What is the best response by the nurse?

Accepted Answer

Answer reason: " Neural tube closure occurs very early in embryonic development, often before a person knows they are pregnant, so prevention depends on adequate folate status in the preconception period and early first trimester. Periconceptional folic acid supplementation is the most evidence-based intervention to reduce recurrence risk of neural tube defects in subsequent pregnancies. A general multivitamin or “well balanced diet” is beneficial but is less specific and may not provide the needed folate dose or ensure timing before conception. Iron intake supports maternal hematologic health but does not prevent neural tube defects, making it an inferior choice for this risk-focused counseling question.

Question 25

Which of the following situations is most likely to produce sepsis in the neonate?

Accepted Answer

Answer reason: This exposure can lead to chorioamnionitis and early-onset neonatal sepsis, especially when rupture is prolonged (classically >18 hours) or accompanied by maternal fever/GBS colonization. The other choices may be associated with different neonatal risks (e.g., hypoglycemia with maternal diabetes), but they are less directly linked to a high-probability infectious pathway. Therefore, the scenario most strongly associated with neonatal sepsis risk is prolonged rupture prior to delivery.

Question 26

The nurse is teaching a smoking cessation class and notices there are 2 pregnant women in the group. Which information is a priority for these women?

Accepted Answer

Answer reason: Smoking in pregnancy causes fetal hypoxia and vasoconstriction from nicotine and carbon monoxide exposure, which reduces uteroplacental blood flow and impairs fetal growth. The most testable priority teaching point is the well-established association with adverse fetal outcomes, especially intrauterine growth restriction and low birth weight. This information directly supports urgent behavior change by linking smoking to a concrete, high-risk pregnancy complication. A common misconception is that “low tar” or “moderate” smoking is safer, but there is no safe level of tobacco exposure during pregnancy. The placenta does not protect the fetus from nicotine; many toxic components cross and still harm fetal development.

Question 27

A client who is pregnant comes to the clinic for a first visit. The nurse gathers data about her obstetric history, which includes 3 year-old twins at home and a miscarriage 10 years ago at 12 weeks gestation. How would the nurse accurately document this information?

Accepted Answer

Answer reason: She has had one prior viable delivery event (twins) and one prior pregnancy loss at 12 weeks, and she is currently pregnant, totaling three pregnancies. The twins increase the number of infants but still represent a single birth event, so para remains 1 before this pregnancy and is documented as para 2 in the GTPAL-style shorthand used by many exam items to reflect two pregnancy outcomes beyond 20 weeks including the current ongoing pregnancy status. The other options either overcount pregnancies or miscount parity by treating twins as two separate deliveries or by excluding the miscarriage from gravida.

Question 28

At a routine health assessment, a client tells the nurse that she is planning a pregnancy in the near future. She asks about preconception diet changes. Which of the statements made by the nurse is best?

Accepted Answer

Answer reason: Preconception counseling prioritizes prevention of neural tube defects through adequate folate intake before conception and during early pregnancy. Green leafy vegetables are a key dietary source of folate, aligning with the highest-yield, time-sensitive nutrition change for someone planning pregnancy. The other options are generally healthy but are less directly linked to a major preconception-specific teratogenic risk reduction. Fish intake can be beneficial, but guidance must also consider mercury exposure, making it a less universally “best” single recommendation than folate-focused advice.

Question 29

A woman comes to the antepartum clinic for a routine prenatal examination. She is 12 weeks pregnant with her second child. Which of the following shows proper documentation of the client's obstetric history by the nurse?

Accepted Answer

Answer reason: Para counts the number of pregnancies that reached viability (commonly ≥20 weeks), not the number of fetuses, and does not include the current 12-week pregnancy. Being pregnant with her second child implies she has had one prior pregnancy and is currently in her second pregnancy, making her gravida 2. Since she is only 12 weeks now, her parity reflects only the prior birth(s) to viability, which is para 1, making the documentation G2 P1.

Question 30

Which of the following represents the average amount of weight gained during pregnancy?

Accepted Answer

Answer reason: This range reflects physiologic increases from the fetus, placenta, amniotic fluid, expanded maternal blood volume, uterine/breast tissue growth, and maternal fat stores. Lower ranges like 12–22 lb and 15–25 lb align more with overweight/obese prepregnancy categories rather than the typical average patient. A very broad 25–40 lb span is less precise and includes excessive gain, which is associated with complications such as macrosomia and gestational hypertension.

Question 31

In following which is not a subjective symptom of pregnancy during the first trimester-?

Accepted Answer

Answer reason: g., missed period, nausea/vomiting, urinary frequency). Quickening is the maternal perception of fetal movement, which typically occurs later, around 16–20 weeks, making it a second-trimester finding rather than first-trimester. Therefore it is not a subjective symptom of pregnancy during the first trimester. This distinguishes normal early pregnancy symptoms from later maternal-perceived fetal activity.

Question 32

The nurse is providing postpartum teaching for a mother planning to breastfeed her infant. Which of the client’s statements indicates the need for additional teaching?

Accepted Answer

Answer reason: ” Breastfeeding increases maternal fluid requirements, and inadequate hydration can contribute to fatigue and reduced milk production. A lactating postpartum client should generally drink enough fluids to satisfy thirst, which commonly exceeds only four glasses per day. The other statements reflect appropriate self-care measures for breastfeeding comfort and milk management (supportive bra, expressing milk when needed, gentle shower water over breasts). Therefore, the fluid-intake statement signals misunderstanding and warrants additional teaching.

Question 33

A nurse is working with a new graduate nurse to perform a contraction stress test on a pregnant client. Which action by the new graduate nurse requires intervention by the nurse?

Accepted Answer

Answer reason: A contraction stress test aims for an adequate pattern of contractions while avoiding uterine tachysystole and prolonged contractions that can reduce uteroplacental perfusion and precipitate fetal hypoxemia. The target is typically about 3 contractions in 10 minutes, each around 40–60 seconds, rather than insisting they be prolonged. Pursuing contractions of 90 seconds is unsafe and increases the risk of fetal heart rate abnormalities and uterine hyperstimulation. By contrast, stopping the test for late decelerations is appropriate because late decelerations indicate uteroplacental insufficiency during contractions.

Question 34

A client with diabetes visits the prenatal clinic at 28 weeks gestation. Which statement is true regarding insulin needs during pregnancy?

Accepted Answer

Answer reason: Maternal glucose crosses the placenta, while maternal insulin does not, so fetal glucose exposure is driven by the mother’s glycemic control. Poor maternal insulin regulation leads to fetal hyperglycemia and compensatory fetal hyperinsulinemia, increasing risks such as macrosomia and neonatal hypoglycemia. At around 28 weeks, placental hormones (e.g., human placental lactogen, cortisol, progesterone) increase insulin resistance, typically increasing insulin needs rather than moderating or decreasing them. hCG is not the primary driver of late-pregnancy insulin resistance, making that rationale inaccurate compared with the core principle of tight glycemic control for fetal well-being.

Question 35

The nurse working in the maternity ward is caring for a 24-hour post-partum client. When assessing the client, the nurse notes that her fundus is firm at the level of the umbilicus and is veering a little bit to the right. The initial action for the nurse is to?

Accepted Answer

Answer reason: Bladder distention interferes with uterine position and can contribute to subinvolution and increased bleeding risk even if the fundus feels firm. The nurse should therefore assess for urinary retention/fullness and facilitate bladder emptying (e.g., assist to void, assess last void, consider catheterization per protocol if unable). Checking pad count or blood pressure may be needed if hemorrhage is suspected, but they do not address the likely cause of the uterine deviation as the first action.

Question 36

The nurse is working in a maternity clinic. A primigravida client in her 2nd trimester calls the OB office to report a dark line on her skin in the middle of her abdomen. The phone triage nurse would recognize this as which of the following?

Accepted Answer

Answer reason: A dark vertical midline on the abdomen (often from the symphysis pubis toward the umbilicus/xyphoid) is the classic description of this finding. Chloasma instead presents as facial “mask of pregnancy,” and striae gravidarum are linear stretch marks rather than a single midline pigmented stripe. Goodell sign refers to softening of the cervix, not a skin change.

Question 37

A nurse massages the uterus of a postpartum client. Which assessment finding best indicates that the intended effect of this nursing action has been achieved?

Accepted Answer

Answer reason: Fundal massage is performed to stimulate uterine contraction and improve uterine tone, which helps compress uterine blood vessels and reduce postpartum bleeding from uterine atony. A firm, midline fundus is the key assessment indicator that effective contraction has been achieved. Passing clots can indicate ongoing bleeding/retained products and is not the therapeutic target. Uterine contractions stopping would suggest worsening atony rather than improvement.

Question 38

A pregnant client with a history of alcohol addiction is scheduled for a nonstress test. The nonstress test?

Accepted Answer

Answer reason: Because it correlates fetal heart rate reactivity with movement, it is essentially a measure of fetal activity/response in utero. Lung maturity is assessed with tests like amniotic fluid lecithin/sphingomyelin ratio rather than an NST. The effect of contractions on fetal heart rate is assessed with a contraction stress test, not a nonstress test.

Question 39

The nurse is collecting data on clients who are in their first trimester of pregnancy. The nurse is concerned with identifying clients who may be at risk for the development of postpartum complications. Which client is least likely to be at risk for the development of thrombophlebitis in the postpartum period?

Accepted Answer

Answer reason: Smoking, advanced maternal age with obesity and multiparity, and a prior episode of thrombophlebitis associated with estrogen exposure all represent higher-risk clinical profiles for venous thromboembolism. A family history alone can suggest possible inherited thrombophilia, but without a personal history or additional major risk factors it is generally less predictive than the other options listed. Therefore, among these clients, the one with only a family history is least likely to be at risk relative to the others.

Question 40

Which finding should be of greatest concern to the nurse?

Accepted Answer

Answer reason: This finding is higher priority because it can signal an immediate threat to fetal oxygenation and requires prompt follow-up (e.g., further assessment, biophysical profile, or intervention based on context). Tachycardia and edema can be concerning but are nonspecific and often have benign or reversible causes compared with evidence of possible fetal distress. “Blood pressure” is incomplete without an abnormal value, so it cannot be prioritized over a clearly abnormal fetal surveillance result.

Question 41

As the client reaches 8 cm dilation, the nurse notes late decelerations on the fetal monitor. The FHR baseline is 165–175 bpm with variability of 0–2bpm. What is the most likely explanation of this pattern?

Accepted Answer

Answer reason: Late decelerations reflect impaired oxygen transfer during uterine contractions due to decreased placental perfusion. The concurrent fetal tachycardia (165–175 bpm) and minimal variability (0–2 bpm) indicate fetal hypoxemia with reduced autonomic nervous system responsiveness, making placental insufficiency the unifying cause. Cord compression more typically produces variable decelerations rather than late decelerations. A sleep cycle may reduce variability, but it does not explain persistent tachycardia with late decelerations at advanced dilation.

Question 42

A patient who is eight months pregnant is diagnosed with high blood pressure and her physician orders her to be on complete bed rest. What instructions would the nurse most likely give this patient?

Accepted Answer

Answer reason: Better maternal cardiac output and placental blood flow can help support fetal oxygenation and may reduce hypertensive-related risk from decreased perfusion. Supine positioning is a common trigger for supine hypotensive syndrome and can worsen uteroplacental blood flow. “Complete bed rest” is an order, but the key nursing teaching is the safest therapeutic position while resting, which is side-lying—preferably left.

Question 43

This procedure is done for the purpose of .........?

Accepted Answer

Answer reason: The pictured procedure shows an examiner listening over the gravid abdomen with a fetal listening device, which directly corresponds to detecting fetal heart sounds. Maternal heart sounds can also be heard, but the clinical purpose of this specific obstetric assessment is to locate and count the fetal heart rate, distinguishing it from the maternal pulse. Measuring fundal height is performed by palpation and tape measurement, and estimating EDD is based on menstrual history/ultrasound rather than auscultation.

Question 44

Nurse Jenna observes variable decelerations on the fetal monitor strip. What should be her first action?

Accepted Answer

Answer reason: Variable decelerations are most commonly caused by umbilical cord compression, so the priority is an immediate bedside intervention that relieves compression and improves fetal oxygenation. Maternal repositioning (e.g., lateral, knee-chest) is a rapid, low-risk first-line maneuver and can correct the pattern without delay. Starting an IV or notifying the provider may be appropriate if decelerations persist or worsen, but they do not address the likely cause as quickly as repositioning. Adjusting the monitor is not the priority when a true recurrent deceleration pattern is being observed.

Question 45

The normal duration of the third stage of labour?

Accepted Answer

Answer reason: In uncomplicated births, placental separation and delivery usually happens within about 5–10 minutes, especially with active management (uterotonic use, controlled cord traction). Longer durations increase concern for retained placenta and postpartum hemorrhage risk, so options extending well beyond this are less consistent with “normal” in many nursing exam references. A common distractor is 15–30 minutes, which can be cited as an upper limit in some contexts, but the question asks for normal duration rather than maximum acceptable time.

Question 46

The nurse is conducting a prenatal class with a group of clients. Which vitamin should the nurse encourage to prevent neural tube defects in the newborn?

Accepted Answer

Answer reason: Neural tube closure occurs very early in embryonic development, so adequate folate status before conception and during early pregnancy is essential to support DNA synthesis and normal neural tube formation. Supplementation with folate is evidence-based to reduce the risk of spina bifida and anencephaly. Vitamin B12 is important for neurologic function and hematopoiesis but is not the primary prenatal vitamin targeted for neural tube defect prevention. Iron primarily prevents/treats maternal anemia and supports fetal growth rather than preventing neural tube closure defects.

Question 47

A client is in the active phase of the first stage of labor. Which of the following is a priority during this time?

Accepted Answer

Answer reason: Nursing care emphasizes monitoring FHR patterns, maternal oxygenation/positioning, and prompt recognition of nonreassuring signs to prevent fetal hypoxia/acidemia. Pushing with a closed glottis is not indicated until the second stage and can increase maternal fatigue and reduce oxygen delivery. Skin-to-skin bonding and placental delivery occur after birth (third stage/postpartum) and are not priorities in first-stage active labor.

Question 48

The nurse notes the presence of accelerations on the electronic fetal monitor tracing. What is most appropriate?

Accepted Answer

Answer reason: Fetal heart rate accelerations are a reassuring (Category I) sign, reflecting an intact fetal autonomic nervous system and adequate oxygenation. When accelerations are present without other nonreassuring patterns, the appropriate nursing action is routine care: document the assessment and provide patient education/reassurance. Escalation to the provider is not required for a normal finding in an otherwise reassuring tracing. Maternal repositioning and further interventions are typically reserved for concerning patterns (e.g., recurrent decelerations) rather than accelerations.

Question 49

Placenta is expelled in?

Accepted Answer

Answer reason: Placental separation and expulsion occur after the infant is delivered and are accompanied by uterine contraction to reduce postpartum bleeding. The fourth stage refers to the immediate postpartum recovery period with ongoing assessment for hemorrhage and maternal stabilization, not placental delivery. Therefore, the event described belongs to the third stage.

Question 50

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: C. Baked chicken, fruit cup, potato salad, coleslaw, yogurt, and iced tea Pregnancy nutrition prioritizes adequate protein plus key micronutrients (especially calcium/vitamin D, iron, folate) while limiting empty-calorie, high-fat choices. This meal provides a balanced pattern: lean protein (chicken), multiple fruits/vegetables for vitamins/folate/fiber, and a dairy source (yogurt) supporting calcium needs for fetal skeletal development. Compared with the other menus, it minimizes fried foods and sugary caffeinated beverages that add calories without improving nutrient density. It also avoids a pattern dominated by chips/fries/cola or coffee, which tends to displace higher-quality nutrients needed in pregnancy.

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