Deck 11: Midwifery

Question 1

A client is in the second stage of labor and has been pushing for almost an hour. Which of the following interventions is the most appropriate for the client at this stage?

A)Offer clear fluids in between contractions.
B)Encourage ambulation.
C)Instruct the client to push with each contraction.
D)Encourage frequent changes in position.

Answer 1

Instruct the client to push with each contraction.

Question 2

A client at 38 weeks' gestation comes to the facility after experiencing leakage of clear fluid from the vagina without contractions. Premature rupture of membranes is suspected. Which of the following actions by the nurse midwife would be inappropriate for a client with this condition?

A)Perform digital vaginal examination.
B)Administer ampicillin IV.
C)Assess the client's cervix and vaginal cavity through sterile speculum vaginal examination.
D)Order L/S ratio.

Answer 2

Perform digital vaginal examination.

Question 3

A nurse midwife is monitoring a client in labor who is receiving intravenous oxytocin. The fetal heart rate monitor tracing reveals decelerations occurring 35 seconds after the onset of each contraction and continuously past the end of the each contraction. Which of the following is the priority action of the midwife?

A)Change the client's position to side-lying position.
B)Position the client to Trendelenburg position.
C)Stop the administration of oxytocin.
D)Administer oxygen.

Answer 3

Stop the administration of oxytocin.

Question 4

A nurse midwife is assessing a client and her infant one week after delivery. The infant's birth weight was 7.5 pounds. Which of the following findings indicate that the infant is getting enough milk?
I.The mother reports that the infant is wetting 6 to 8 diapers a day.
II.The mother informs the nurse midwife that the infant appears content between feedings.
III.The infant's weight is 6.8 pounds.
IV.The mother reports that the infant quietly swallows during breastfeeds.

A)I and II
B)I, II and III
C)I, II and IV
D)All of the findings indicate sufficient milk intake.

Question 5

On assessment, the nurse midwife notes that a female newborn has pink patches at the nape of the neck. The nurse midwife informs the mother that these patches:

A)Occur more often in males than in females.
B)Are caused by an injury during labor.
C)Do not fade.
D)Disappear by school age without treatment.

Question 6

A client is given oxytocin for the induction of labor. The nurse midwife should monitor the client for which of the following side effects of oxytocin?

A)Vomiting
B)Increased urine outflow
C)Hypertension
D)Bradycardia

Question 7

A nurse midwife is monitoring a client who is in labor. Assessment findings reveal that the fetus is in LOA position. The nurse midwife notes that the presenting part of the fetus is at 0 station. This finding indicates that:

A)The presenting part is at the perineum, and the fetal head is crowning.
B)The presenting part is at the level of the ischial spines, and the fetal head is engaged.
C)The presenting part is above the level of the ischial spines, and the fetal head is floating.
D)The presenting part has descended to within the pelvic inlet.

Question 8

A nurse midwife is monitoring a client who was admitted to the labor and delivery unit about 5 hours ago. The nurse midwife notes a cervical dilatation of 5 cm. The contractions occurring every 5 minutes usually last between 50 and 55 seconds. The client is in which phase of labor?

A)Latent phase
B)Active phase
C)Transition phase
D)Second stage of labor

Question 9

A nurse midwife is monitoring a client with a cervical dilatation of 3 cm. The nurse midwife determines that the client has contractions occurring every 3 minutes. Each contraction lasts for 50 seconds. The fetal heart rate is determined at 100 beats per minute. Which of the following is the priority action of the midwife?

A)Encourage the client to push with every contraction and to rest in between contractions.
B)Administer oxygen via face mask.
C)Document the findings as normal.
D)Encourage frequent change of position.

Question 10

A nurse midwife is reviewing the fetal heart rate monitor tracing obtained from a G2P1 client who is in labor. The nurse midwife notes decelerations at unpredictable times in relation to contractions. The nurse midwife suspects which of the following conditions?

A)Cephalopelvic disproportion
B)Good fetal-well being
C)Uteroplacental insufficiency
D)Cord compression

Question 11

A nurse midwife is teaching a female client how to perform a breast self-examination. On return demonstration, which of the following actions by the client indicates that further teaching is necessary?

A)The client uses the tips of her second, third and fourth fingers to press every part of her breast.
B)Using the right hand to examine the left breast, the client examines the entire breast using small circular motions in a spiral pattern.
C)In a supine position, the client places a folded towel under her right shoulder and puts her right hand behind her head. Using the left hand, she palpates her right breast.
D)In a standing position, the client places her hands on her hips and presses down firmly.

Question 12

A nurse midwife is assessing four clients who recently gave birth through vaginal delivery. A part of the examination is measuring the fundal height. Which of the following clients needs further evaluation?

A)A client who gave birth 24 hours ago; the fundus is 1 fingerbreadth below the umbilicus.
B)A client who gave birth one hour ago; the fundus is at the level of the umbilicus.
C)A client who gave birth 72 hours ago; the fundus is 2 cm below the umbilicus.
D)A client who gave birth 10 days ago; the fundus is non-palpable.

Question 13

A female client is admitted to the facility due to alcohol abuse. During the first 24 hours, which of following interventions is the least appropriate?

A)Orient the client frequently.
B)Initiate seizure precautions.
C)Provide a quiet, non-stimulating environment.
D)Initiate bleeding precautions.

Question 14

There are many reasons why nurse midwives should be concerned with professional ethics. Which of the following is the main and critical purpose of applied professional ethics?

A)To foster professional identity.
B)To protect consumers and care providers.
C)To maintain internal regulation and avoid external regulation.
D)To signal professional maturity.

Question 15

A series of laboratory examinations are conducted for a client who is admitted to the facility for an annual checkup. Blood is drawn for serum electrolyte testing. Which of the following assessment findings requires further evaluation?

A)Sodium = 137 mEq/L
B)Potassium = 4.3 mEq/L
C)Chloride = 93 mEq/L
D)Bicarbonate = 27 mEq/L

Question 16

A nurse midwife is managing the care of a 25-year-old postpartum client who gave birth 18 hours ago. No complications were noted during the labor process. The newborn is brought to the client for feeding and to have the mother and child bond for the night. The client says, "I'm too tired. Please get her back to the nursery, just for tonight. I need to get some sleep." Which of the following is the most appropriate action of the midwife?

A)Create a teaching plan for the mother that focuses on breast feeding.
B)Encourage the client to join a parenting skill class.
C)Accept the client's behavior as an indication that she is in the taking-in phase.
D)Accept the client's behavior as an indication that she is in the taking-hold phase.

Question 17

A nurse midwife is assessing a mature female neonate born to a 21-year-old G3P2 client. Which of the following findings suggests that further evaluation and notification of the physician are necessary?

A)Birth length = 53 cm
B)Head circumference = 35 cm
C)Birth weight = 11 pounds
D)Chest circumference is 2 cm less than the head circumference.

Question 18

A client who gave birth to a healthy newborn experiences crying and expresses feelings of sadness and emptiness. The client delivered her baby 3 days ago. The nurse midwife suspects that the client has:

A)Postpartum depression.
B)Postpartum blues.
C)Postpartum psychosis.
D)A normal behavior during the taking-hold phase.

Question 19

A nurse midwife is receiving a client who gave birth an hour ago. Which of the following nursing interventions is the priority action of the nurse during the immediate postpartum period?

A)Obtain the client's blood glucose level.
B)Palpate for the height of fundus.
C)Order hemoglobin and hematrocrit tests.
D)Administer oxygen.

Question 20

A client had a cesarean delivery. The client informs the nurse midwife that she intends to breastfeed her baby. Which of the following instructions is the most effective for a client who wants to breastfeed after a cesarean delivery?

A)"Use the football hold when breastfeeding."
B)"Choose the position that is most comfortable during breastfeeding."
C)"Breast feeding is withheld for the first 12 hours of life."
D)"Breastfeed the newborn every 4 to 8 hours."

Question 21

A client at 11 weeks' gestation complains of severe and extreme nausea and vomiting. During history taking, the nurse midwife learns that the client vomits at least three times a day. An ultrasound is performed and reveals that the client is negative for hydatidiform mole and multiple pregnancy. The nurse midwife suspects a case of hyperemesis gravidarum. The client is admitted for monitoring. Which of the following interventions is the least appropriate for the client?

A)Increase oral intake of fluids.
B)Administer 3,000 mL of Ringer's lactate.
C)Administer metoclopramide.
D)Monitor fluid intake and urinary output.

Question 22

A nurse midwife tells a client who is trying to get pregnant to eat fresh fruits and green and leafy vegetables before conceiving. The nurse midwife also recommends 400 mcg of folic acid a day. Once she gets pregnant, the nurse midwife may recommend that the client increase her folic acid intake to 600 mcg per day during the first trimester. Which of the following is not a benefit of folic acid supplementation before and during pregnancy?

A)It prevents the formation of large but ineffective red blood cells.
B)It prevents neural tube defects.
C)It decreases the baby's risk for cleft lip or palate.
D)It ensures proper functioning of the thyroid gland.

Question 23

A client is in her 18th week of pregnancy. Which of the following psychosocial changes is expected at this time?

A)The client is ambivalent about being pregnant.
B)The client begins to imagine how she will feel during the delivery.
C)The client is excited to attend childbirth educational classes.
D)The client engages in nest-building activities.

Question 24

The nurse midwife is creating a teaching plan for a program that encourages women to have their regular Pap smear. Which of the following groups of women is the midwife's priority?

A)Women infected with Treponema pallidum.
B)Women with a history of genitalia herpes.
C)Women who are on oral contraceptives.
D)Women who have plans of conceiving within the next year.

Question 25

A pregnant client asks the nurse midwife about nonpharmacologic methods for managing labor pains. The nurse midwife informs her about a method that is based on the idea that childbirth is a natural and joyful process. This method also stresses the importance of having the husband's support during the pregnancy, labor and early postpartum period. It also encourages walking during labor. The nurse midwife is teaching which method to the client?

A)Lamaze method
B)Bradley method
C)Psychosexual method
D)Dick-Read method

Question 26

A client at 20 weeks' gestation asks the nurse midwife if she will be able to breastfeed her baby after birth. The client has a history of type 2 diabetes, which has been well-controlled before and during the pregnancy. The client has a BMI of 34. Which of the following statements by the nurse midwife is the most appropriate?

A)"Whether or not you can breastfeed your baby will depend on your blood glucose levels after birth."
B)"Mothers with type 2 diabetes are encouraged to breastfeed their babies after birth. Breastfeeding may also lower your need for insulin."
C)"You may not breastfeed your baby after birth. Insulin can cross into the breast milk and may cause your baby to develop hypoglycemia. Your baby may be nourished with formula milk."
D)"Breastfeeding is encouraged for women with type 2 diabetes. However, you may need to increase your insulin when nursing."

Question 27

A 21-year-old female client comes to the prenatal clinic after a home pregnancy test indicated a positive result. The client informs the nurse midwife that her last menstrual period was on October 28, 2010. Using Nagele's rule, the client's expected date of birth is on:

A)August 4, 2011
B)July 21, 2011
C)July 4, 2011
D)August 21, 2011

Question 28

A client at 30 weeks' gestation complains of shortness of breath and an unusually rapid enlargement of the uterus. A tense uterus is noted by the nurse midwife during assessment. Palpation of the small parts of the fetus and auscultating the fetal heart rate are difficult. The nurse midwife suspects severe hydramnios. Which of the following interventions are appropriately included in the care plan?
I.Encourage ambulation.
II.Increase intake of foods high in fiber.
III.Perform amniocentesis.
IV.Administer indomethacin.

A)I and II
B)II and III
C)II, III and IV
D)All of the above

Question 29

A contraction stress test is ordered to a client at 35 weeks' gestation. After half an hour, the client's uterus begins to contract and the nurse midwife observes three 40-second-long contractions in a 10-minute window. The client has two contractions within the next five minutes. The nurse midwife notes that the fetal heart rate decreases toward the end of the contraction and afterward. This happends during more than 50% of the contractions. After stopping the oxytocin, which of the following is the next action of the midwife?

A)Administer oxygen.
B)Turn the client to the left side.
C)Assess the client's blood pressure.
D)Refer the client to a physician for further evaluation.

Question 30

A 20-year-old female client is pregnant for the first time. The client is a marathon runner and has been on a rigorous exercise and training program. The client asks the nurse midwife if she could still exercise while pregnant. Which of the following statements by the nurse midwife is the most appropriate for the client?

A)"You should stop exercising when pregnant as it can cause miscarriage or intrauterine growth retardation."
B)"If you are an athlete, you may proceed with your pre-pregnancy exercise program without limitations."
C)"You may continue exercising, but make sure to decrease the intensity of exercises. You may return to your pre-pregnancy exercise program two weeks after delivery."
D)"You should modify the intensity and type of your exercises. Non-weight-bearing exercises are recommended."

Question 31

A client has just given vaginal birth to an eight-pound baby boy. A few minutes after the delivery, the nurse midwife observes lengthening of the umbilical cord and a gush of vaginal blood. The nurse midwife interprets these observations as:

A)Signs of hemorrhage.
B)Signs of placenta previa.
C)Signs of placental separation.
D)Signs of retained placental fragment.

Question 32

A client with a multiple pregnancy is scheduled for cesarean delivery and is transported to the delivery operating room. The nurse midwife reminds the staff nurse to position the client in which of the following positions in the operating room?

A)Left side-lying position
B)Semi-Fowler position
C)Supine position, with a wedge placed under the right hip.
D)Supine position, with a wedge placed under the left hip.

Question 33

A nurse midwife is reviewing the laboratory tests of a client who is in labor. The laboratory findings include a hemoglobin level of 10 g/dL and a hematocrit concentration of 34%. The nurse midwife is correct if she determines that the client is at risk for which of the following during the postpartum period?

A)Anemia
B)Increased cardiac output
C)Postpartum infection
D)Hemorrhage

Question 34

Which of the following clients in labor is most likely considered for artificial induction of labor?

A)A client who gave birth to an Rh-positive baby and failed to get a RhoGAM after birth.
B)A client at 43 weeks' gestation who has been in the second stage of labor for one hour.
C)A client who ruptured her membranes 18 hours ago.
D)A client with severe hypertension.

Question 35

A client in labor is administered with an anesthetic through the spinal subarachnoid space. Which of the following actions by the nurse is the least appropriate when managing the client?

A)The nurse midwife maintains the client flat on bed for 8 to 12 hours.
B)Inform the client that headaches may occur.
C)Monitor the client for hypertension.
D)Administer IV fluids.

Question 36

A nurse midwife is teaching a 14-year-old girl about contraceptives. The client gave birth to a healthy baby girl three days ago. The nurse midwife is correct when she says that the most effective way to protect against conception is through:

A)Natural family planning.
B)Abstinence.
C)Oral contraception.
D)Surgical methods.

Question 37

A nurse midwife is assessing four female clients with signs and symptoms involving the reproductive system. All clients are engaging in heterosexual sexual relationships. The nurse midwife requires identification and treatment of sexual partners of all of the following clients except:

A)A client diagnosed with genital herpes.
B)A client diagnosed with chlamydia.
C)A client diagnosed with bacterial vaginosis.
D)A client with hepatitis B.

Question 38

A nurse midwife is assessing the fertility of couples who have been trying to conceive for a period of time without success. Which of the following couples has primary infertility?

A)A couple engaging in unprotected sex for half a year. No previous conceptions are reported.
B)A couple engaging in unprotected sex for one year. A previous conception is reported.
C)A couple engaging in unprotected sex for one year. No previous conceptions are reported.
D)A couple engaging in unprotected sex for half a year. A previous conception is reported.

Question 39

Which of the following female clients has the greatest risk for uterine fibroids?

A)A 30-year-old Chinese American who has a BMI of 30 and smokes 2 packs of cigarettes a day.
B)A 43-year-old Caucasian who has a BMI of 32 and smokes 2 packs of cigarettes daily.
C)A 25-year-old Black American who has a BMI of 32; cigarette smoking is denied.
D)A 25-year-old of Meditteranean descent who has a BMI of 30; cigarette smoking is denied.

Question 40

A couple is considering artificial insemination after the man fails to respond to medications that intend to increase his sperm count. Which of the following statements about artificial insemination is false?

A)A donor's sperm can be used.
B)The sperm is instilled into the female reproductive tract one day after ovulation.
C)It involves selective termination of gestational sacs.
D)The sperm is instilled into the cervix or uterus.