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When administering magnesium sulfate to a client with preeclampsia, the midwife understands that this drug is given to: a. Prevent seizures b. Reduce blood pressure c. Slow the process of labor d. Increase diuresis 2. When preparing a teaching plan for a client who is to receive a rubella vaccine during the postpartum period, the midwife in charge should include which of the following? a. The vaccine prevents a future fetus from developing congenital anomalies b. Pregnancy should be avoided for 3 months after the immunization c. The client should avoid contact with children diagnosed with rubella d. The injection will provide immunity against the 7-day measles.
After administration of rubella vaccine, the client should be instructed to avoid pregnancy for at least 3 months to prevent the possibility of the vaccines toxic effects to the fetus.

3. A 39-year-old at 18 weeks gestation is admitted to the hospital with complaints of vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is most likely causing the clients complaint of vaginal bleeding? a. Placenta previa b. Abruptio placentae c. Ectopic pregnancy d. Spontaneous abortion
The major maternal adverse reactions from cocaine use in pregnancy include spontaneous abortion for the first trimester and abruption placentae in the third trimester.

4. A client makes a routine visit to the prenatal clinic. Although shes 14 weeks pregnant, the size of her uterus approximates that in an 18- to 20-week pregnancy. Dr. Diaz diagnoses gestational trophoblastic disease and orders ultrasonography. The midwifeexpects ultrasonography to reveal: a. an empty gestational sac. b. grapelike clusters. c. a severely malformed fetus. d. an extrauterine pregnancy.
In a client with gestational trophoblastic disease, an ultrasound performed after the 3rd month shows grapelike clusters of transparent vesicles rather than a fetus. The vesicles contain a clear fluid and may involve all or part of the decidual lining of the uterus. Usually no embryo (and therefore no fetus) is present because it has been absorbed. Because there is no fetus, there can be no extrauterine pregnancy. An extrauterine pregnancy is seen with an ectopic pregnancy.

5. The midwife in charge is reviewing a patients prenatal history. Which finding indicates a genetic risk factor? a. The patient is 25 years old b. The patient has a child with cystic fibrosis c. The patient was exposed to rubella at 36 weeks gestation d. The patient has a history of preterm labor at 32 weeks gestation 6. A patient is in last trimester of pregnancy. Midwife Jane should instruct her to notify her primary health care provider immediately if she notices: a. Blurred vision b. Hemorrhoids c. Increased vaginal mucus d. Shortness of breath on exertion
Blurred or double vision may indicate hypertension or preeclampsia and should be reported immediately. Urinary frequency is a common problem during pregnancy caused by increased weight pressure on the bladder from the uterus. Clients generally experience fatigue and nausea during pregnancy.

7. A patient with pregnancy-induced hypertension probably exhibits which of the following symptoms? a. Proteinuria, headaches, vaginal bleeding b. Headaches, double vision, vaginal bleeding c. Proteinuria, headaches, double vision d. Proteinuria, double vision, uterine contractions

8. Which of the following would the midwife Sandra most likely expect to find when assessing a pregnant client with abruption placenta? a. Excessive vaginal bleeding b. Rigid, boardlike abdomen c. Titanic uterine contractions d. Premature rupture of membranes
The most common assessment finding in a client with abruption placenta is a rigid or boardlike abdomen. Pain, usually reported as a sharp stabbing sensation high in the uterine fundus with the initial separation, also is common.

9. A pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the midwife tells the client that the usual treatment for partial placenta previa is which of the following? a. Activity limited to bed rest b. Platelet infusion c. Immediate cesarean delivery d. Labor induction with oxytocin

10. A client with eclampsia begins to experience a seizure. Which of the following would the midwife in charge do first? a. Pad the side rails b. Place a pillow under the left buttock c. Insert a padded tongue blade into the mouth d. Maintain a patent airway
The priority for the pregnant client having a seizure is to maintain a patent airway to ensure adequate oxygenation to the mother and the fetus. Additionally, oxygen may be administered by face mask to prevent fetal hypoxia.

11. When reviewing the prenatal records of a 16 year old primigravida client at 37 weeks gestation diagnosed with severe preeclampsia, the midwife would interpret which of the following as most indicative of the clients diagnosis. a. Blood pressure of 138/94 mm Hg b. Severe blurring of vision c. Less than 2 g protein in a 24 hour sample d. Weight gain of 0.5 pounds in 1 week. 12. The physician orders intravenous magnesium sulfate for a primigravid client at 38 weeks gestation diagnosed with severe pre-eclampsia. Which of the following medications woult the midwife have readily available at the clients bedside. a. Diazepam (Vallium) b. Hydralazine (Apresoline) c. Calcium Gluconate d. Phenytoin (Dilantin) 13. For the client who is receiving intravenous magnesium sulfate for severe pre-eclampsia, which of the following assessment findings would alert the midwife to suspect hypermagnesemia. a. Decreased deep tendon reflexes b. Cool skin temperature c. Rapid pulse rate d. Tingling in the toes. 14. When teaching a multigravid client diagnosed with mild preeclampsia about nutritional needs which of the following types of diet would the midwife discuss. a. High residue diet b. Low-sodium diet c. Regular diet d. High-protein diet.

15. In response to a question from a 40 year old multigravid client diagnosed with mild pre-eclampsia about the causes of this problem, the midwife teaches the client about the various factors associated with pre-eclampsia. Which of the following is stated by the client as an associated condition, would indicate the need for additional teaching? a. Multifetal pregnancy b. Fiabetes mellitus c. Age older than 35 years. d. Iron deficiency 16. During a home visit to a 16-year-old client at 24 weeks gestation diagnosed with mild preeclampsia, assessment reveals that the client has gained 2 pounds in the past week and her current blood pressure is 130 mmHg. Which of the following assessment findings would further evidence to support the client diagnosis. a. Pounding headache after reading b. History of urinary tract infection c. Frequent voiding in large amounts d. Mild edema in hands and face. 17. If a client at 36 weeks gestation with eclampsia begins to exhibit signs of labor after an eclamptic seizure, for which of the following should the midwife assess a. Abruption placentae b. Transverse lie c. Placenta Accreta d. Uterine Atony 18. When assessing a 34 year old multigravid client at 35 weeks gestation experiencing moderate vaginal bleeding, which of the following would most likely alert the midwife that placenta previa is present. a. Painless vaginal bleeding b. Uterine Tetany c. Intermittent pain with spotting d. Dull lower back pain. 19. When preparing a multigravid client who has undergone evacuation of a hydatidiform mole for discharge, the midwife explains the need for follow-up care. The midwife determines that the client understands the instruction when she says that she is at risk for developing which of the following? a. Ectopic Pregnancy b. Choriocarcinoma c. Multifetal Pregancies d. Infertility 20. After suction and evacuation of a complete hydatidiform mole, the 28-year-old multigravid client asks the midwife she can become pregnant again. The midwife would advise the client not to become pregnant again for at least which of the following time spans? a. 6 months b. 12 months c. 18 months

d. 24 months 21. A multigravid client though to be at 14 weeks gestation reports that she is experiencing such severe morning sickness that she has not been able to keep anything down for a week. The midwife would assess for signs and symptoms of the following. a. Hypercalcemia b. Hypobilirubinemia c. Hypokalemia d. Hyperglycemia 22. On arrival at the emergency department, a client tells the nurse that she suspects that she may be pregnant but has been having a small amount of bleeding and has severe pain in the lower abdomen. The clients blood pressure is 70/50 mmHg and her pulse is 120 bpm. The nurse notifies the physician immediately because which of the following is suspected? a. Ectopic Pregnancy b. Abruptio Placentae c. Gestational Trophoblastic Disease d. Complete Abortion 23. A multigravid client seen in the emergency department complaining of sharp abdominal pain and vaginal spotting is diagnosed with an ectopic pregnancy. When explaining to the client and family members about ectopic pregnancy, which of the following would the nurse include as the most common site of implantation. a. Fallopian Tube b. Intestine c. Interstitial Lining d. Ovary 24. A multigravid client diagnosed with a probable ruptured ectopic pregnancy is scheduled for emergency surgery. In addition to monitoring clients history, which of the following would the midwife assess. a. Uterine cramping b. Abdominal Distention c. Hemoglobin and hematocrit d. Pulse 25. A 36 year old client is admitted to the hospital with possible ruptured ectopic pregnancy. When obtaining the clients history, which of the following would be most important to identify as a predisposing factor. a. Urinary tract infection b. Marijuana use during pregnancy c. Episodes of pelvic inflammatory disease d. Use of estrogen-progestin contraceptives. 26. After teaching a diabetic primigravida about symptoms of hyperglycemia, the nurse determines thath the client understands the instructions when she says that hyperglycemia may be manifested by which of the following: a. Dehydration b. Pallor

c.

Sweating

d. Nervousness 27. The midwife explains the complications of pregnancy that occur with diabetes to a primigravid client at 10 weeks gestation who has a 5 year history of insulin dependent diabetes. Which of the following, if stated by the client as a complication, indicates the need for additional teaching. a. Candida Albicans Infection b. Twin to twin transfer c. Polyhydramnios d. Pre-eclampsia. 28. The client asks for information about ectopic pregnancy. The nurse correctly responds by saying ectopic pregnancy is caused by which of the following, except? a. Pelvic inflammatory disease (PID) b. Endometriosis c. Presence of an IUD d. Eclampsia 29.