Deck 1: Antepartum

Question 1

A 20-year-old female client comes to the clinic due to abdominal cramping. She informs the nurse midwife that it is more than a month and a half past the date of her expected menstrual period. The client's human chorionic gonotropin level is 5,500 mIU/mL. Pregnancy is suspected. Which diagnostic test should the nurse midwife order to obtain the most accurate diagnosis of pregnancy at this time?

A)Transabdominal ultrasound
B)Transvaginal ultrasound
C)Serum progesterone
D)Serum estrogen

Answer 1

Transvaginal ultrasound

Question 2

A 25-year-old female client at 10 weeks' gestation comes to the clinic for her first prenatal visit. It is the client's first pregnancy. The client is concerned about the chances of her child developing Down syndrome. The client's medical and family history is not remarkable. When the client asks about the risk factors associated with Down syndrome, which of the following statements by the nurse midwife is the most accurate?

A)"The risk of having a baby with Down syndrome is high in women who got pregnant below the age of 18 years."
B)"The age of the father does not affect the child's risk of developing Down syndrome; it is the age of the mother that mainly influences the child's risk."
C)"Women who have a history of three first trimester spontaneous abortions not due to hormonal deficiencies or incompetent cervix are at risk of having babies with Down syndrome."
D)"A woman who has a child with Down syndrome neither decreases nor increases her chances of having a child with the same diagnosis."

Answer 2

"Women who have a history of three first trimester spontaneous abortions not due to hormonal deficiencies or incompetent cervix are at risk of having babies with Down syndrome."

Question 3

A 35-year-old visits the nurse midwife after a home pregnancy test indicated a positive result. The client informs the nurse that the pregnancy is not planned and that she has been taking progestin-only birth control pills for the past year. During the history taking, the client informs the nurse that she has been taking isotretinoin for her severe, recalcitrant cystic acne for three months before the pregnancy. The client drinks at least three bottles of beer a day and is taking cocaine on a daily basis. Based on the client's history, which of the following substances is least likely to cause birth defects?

A)Progestin-only pills
B)Isotretinoin
C)Alcohol
D)Cocaine

Answer 3

Progestin-only pills

Question 4

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 5

A 32-year-old female client at 28 weeks' gestation complains of backache, especially at night. The nurse midwife teaches which of the following exercises to relieve the discomfort?

A)Tailor sitting
B)Kegel exercises
C)Pelvic rocking
D)Squatting

Question 6

A nurse midwife is teaching a pregnant client safe techniques for exercising. Which of the following teachings is not a safe way of exercising when pregnant?

A)Point the toes when exercising.
B)Avoid exercises that hyperextend the lower back.
C)Avoid practicing second stage pushing.
D)When rising from the floor, roll over to the side first and then push up.

Question 7

A nurse midwife is teaching a client at 20 weeks' gestation how to perform abdominal muscle contractions. Which of the following is not a benefit of this exercise?

A)It stretches the perineal muscles.
B)It prevents constipation.
C)It alleviates back pain.
D)It helps restore abdominal muscle tone after pregnancy.

Question 8

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 9

A 38-year-old client at 12 weeks' gestation tested positive for gonorrhea. Which of the following actions by the nurse midwife is the least appropriate for the client?

A)Administer a single oral dose of azithromycin.
B)Administer a single dose of ceftriaxone through the IM route.
C)Instruct the client to avoid sexual contact until the infection is cured.
D)Administer a single dose ciprofloxacin through the IM route.

Question 10

A 32-year-old G3P2 female client at 34 weeks' gestation comes to the facility due to contractions, which started about two hours ago. The contractions occur every 5 minutes. Assessment findings include cervical dilatation at 3 cm and effacement at 50%. Amniotic fluid leakage is negative. The fetal heart rate is 155 beats per minute and is reactive. The client is administered with magnesium sulfate through the intravenous route and with oral ampicillin. The nurse midwife administers which of the following medications as an additional pharmacological treatment?

A)Betamethasone
B)Penicillin
C)Tertbutaline
D)Gentamicin

Question 11

A triple screen test is ordered for a 37-year-old client, who is at 16 weeks' gestation, to evaluate her risk of having a baby with a neural tube defect. The triple screen test measures all of the following substances except:

A)Alpha-fetoprotein
B)Human chorionic gonadotropin
C)Pregnancy-associated plasma protein
D)Estriol

Question 12

A 25-year-old female client at 7 weeks' gestation comes to the clinic for her first prenatal visit. The client tells the nurse midwife that a friend recently gave birth to a baby with Down syndrome and that she is concerned about her baby's chances of developing the same diagnosis. The nurse midwife informs the client that a combined first trimester screening test may be ordered as early as the 11th week of her pregnancy to help evaluate the fetus's risk for chromosomal abnormalities. The nurse midwife informs the client that all of the following tests are included in the combined first trimester screening test except:

A)Nuchal translucency screening through ultrasound test
B)Pregnancy-associated plasma protein screening
C)Human chorionic gonadotropin test
D)Alpha-fetoprotein screening test

Question 13

A 23-year-old female client at 8 weeks' gestation is pregnant for the first time. The client asks the nurse midwife for the recommended safe limit of alcohol per day during early pregnancy. Which of the following statements by the nurse midwife is the most appropriate?

A)You should not drink any form of alcoholic beverages when pregnant.
B)Women who drink alcohol when pregnant usually have babies with birth defects.
C)Women should not drink more than 14 units of alcohol per week or no more than 3 units per day.
D)The recommended safe limit of alcohol per day for pregnant women during early pregnancy is not known.

Question 14

A nurse midwife is teaching a group of nursing students about the stages of fetal development. Which of the following terms refers to the stage from fertilization to implantation?

A)Zygote
B)Embryo
C)Ovum
D)Fetus

Question 15

A nurse midwife is teaching a group of student nurses about fetal circulation. Which of the following statements made by one of the students indicates that further teaching is necessary?

A)During the intrauterine life, the fetus obtains oxygen and excretes carbon dioxide from the placenta.
B)A fetal heart rate between 120 to 160 beats per minute is necessary to supply oxygen to cells, as the red blood cells are not fully saturated.
C)As oxygenated blood enters the right atrium, most of it is shunted into the left atrium through the foramen ovale.
D)The oxygenated blood coming from the placenta enters the fetus through the umbilical artery.

Question 16

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 17

A 20-year-old G1P0 client comes to the prenatal clinic for her first prenatal visit on October 8, 2010. The client informs the nurse midwife that her last menstrual period was on July 18, 2010. Based on Nagele's rule, which of the following data entries for the client is most accurate?

A)Expected date of birth: April 25, 2011; Estimated date of conception: August 18, 2010; Estimated fetal age: 7 weeks and 2 days.
B)Expected date of birth: April 11, 2011; Estimated date of conception: August 1, 2010; Estimated fetal age: 11 weeks and 5 days.
C)Expected date of birth: April 25, 2011; Estimated date of conception: August 1, 2010; Estimated fetal age: 9 weeks and 5 days.
D)Expected date of birth: April 11, 2011; Estimated date of conception: August 18, 2010; Estimated fetal age: 7 weeks and 2 days.

Question 18

A nurse midwife is assessing a female client who is at 25 weeks' gestation. The nurse midwife measures the client's fundal height from the symphysis pubis to the fundus to estimate fetal growth. A measurement of 30 cm is obtained. The nurse midwife should consider all of the following conditions except:

A)Multiple pregnancy
B)A large-for-gestational-age infant
C)Hydatidiform mole
D)Anencephaly

Question 19

A nurse midwife is estimating the fetal growth for each of four pregnant clients using McDonald's rule. Which of the following clients requires referral and further evaluation?

A)A client at 24 weeks' gestation with a fundal height of 24 cm
B)A client at 20 weeks' gestation with a fundus palpated at the level of the umbilicus
C)A client at 12 weeks' gestation with a fundus over the symphysis pubis
D)A client at 36 weeks' gestation with a fundus reaching between the umbilicus and xiphoid process

Question 20

A nurse midwife instructs a female client at 20 weeks' gestation to observe and record the number of fetal movements on a daily basis to assess the well-being of her baby. The nurse midwife teaches the client how to count and record fetal movements through the Cardiff method. All of the following instructions are appropriate except:

A)Feel for fetal movements for one hour at three different times a day.
B)Count the fetal movements in one session that is scheduled at the same time each day.
C)Chart how long it takes to feel 10 fetal movements.
D)Call the office or the physician if there are fewer than 10 fetal movements in 10 hours.

Question 21

A client at 30 weeks' gestation comes to the facility due to decreased fetal movements. After taking the client's history, the client is instructed to focus on fetal activity for an hour. After an hour, the client reports fewer than three fetal movements. Which of the following is the next action of the nurse?

A)Reinforce fetal movement counting.
B)Perform a non-stress test.
C)Instruct the client to count fetal movements for another hour.
D)Refer the client to a physician immediately for further evaluation.

Question 22

A 28-year-old client at 29 weeks' gestation comes to clinic due to decreased fetal movements. The nurse midwife instructs the client to focus on the fetal activity for an hour. After the specified time period, the client reports two fetal movements. The nurse midwife orders a non-stress test. The NST records an increase in fetal heart rate by 15 beats per minute, lasting for 15 seconds, after each fetal movement. This finding is recorded thrice in a period of 20 minutes. Based on the NST result, the next action of the nurse is to:

A)Reinforce fetal movement counting
B)Perform contraction stress testing
C)Order for a serial fetal assessment
D)Refer to physician immediately

Question 23

A client at 30 weeks' gestation is ordered a contraction stress test after a non-stress test gave a non-reactive result. The nurse midwife reviews the result of the contraction stress. Which of the following findings indicates a positive result? What is the meaning of a positive result?

A)Three 40-second-long contractions in a 10-minute. A positive result means further evaluation is necessary.
B)Increase of fetal heart rate by 15 beats per minute, lasting 15 seconds, per fetal movement. A positive result means the baby can tolerate labor.
C)About 50% or more of the contractions cause a dip in the fetal heart rate toward the end of each contraction and continuously after. A positive result indicates that further evaluation is necessary.
D)No fetal heart rate decelerations are present with fetal contractions. A positive result indicates that the baby can tolerate labor.

Question 24

A client at 15 weeks' gestation may be scheduled for the following tests except:

A)Amniocentesis
B)Serum alpha-fetoprotein
C)Doppler ultrasound
D)Chorionic villi sampling

Question 25

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 26

A G1P0 client at 10 weeks' gestation comes to the clinic for her prenatal visit. The client has a BMI of 32. The client asks the nurse how much weight she should gain by the end of her pregnancy. The most appropriate statement by the nurse midwife is:

A)"You need to lose weight during your pregnancy to avoid gestational diabetes. We need to come up with a diet plan that can help you restrict your food intake."
B)"You may gain no more than 20 pounds during your pregnancy."
C)"This is not the best time to go on a diet. It does not matter how much you gain. What is more important is that you eat healthy food throughout your pregnancy."
D)"You may gain 25 pounds during your pregnancy. The quality of your foods is more important than the amount of your food intake per day."

Question 27

A client at 8 weeks' gestation comes to the clinic for her first prenatal visit. The client tells the nurse midwife that a cousin of hers gave birth to a baby girl with Down syndrome a year ago. The client is anxious that her baby may develop the same genetic disorder and is requesting an immediate amniocentesis. Which of the following statements by the nurse midwife is the appropriate?

A)"It is good that you are interested in having an amniocentesis. I will schedule you for an amniocentesis within the week."
B)"We need to schedule your amniocentesis in two months. The fetus is not mature enough to give accurate results at this time."
C)"You can have an amniocentesis between 15 and 16 weeks' gestation. The amount of amniotic fluid is insufficient to be able to obtain an amniotic sample at this time."
D)"You may have a choronic villi sampling in two weeks. Amniocentesis is not performed until the third trimester."

Question 28

A nurse midwife reviews the result of a client's syphilis serology test. The client, a G2P1 at 12 weeks' gestation, tested positive. Which of the following is the priority action of the nurse midwife?

A)Administer a single dose of benzathine penicillin G through the intramuscular route.
B)Inform the client that she should avoid any form of sexual contact until she is treated.
C)Inform the client that drug treatment may not be effective at this time and that a cesarean section will be necessary during delivery.
D)Monitor the client for early detection of Jarisch-Herxheimer reaction.

Question 29

A nurse midwife is assessing a 43-year-old client at 23 weeks' gestation. Which of the following findings alerts the nurse midwife of a possible case of pre-eclampsia?

A)Pre-pregnancy blood pressure: 100/80; Present blood pressure: 130/100
B)Weight gain of one pound in one week
C)Proteinuria 0
D)Edema absent

Question 30

A nurse midwife is managing the care of a client at 28 weeks' gestation. The client is admitted to the facility due to mild pre-eclampsia. The client is on bed rest and has been closely monitored for the past 24 hours. Which of the following findings would not indicate severe pre-eclampsia in this client?

A)Blood pressure at 8:00 - 170/120; Blood pressure at 14:00 - 175/120
B)Urine output - 450 mL/24 hours
C)Proteinuria +3
D)Serum creatinine - 1.0 mg/dL

Question 31

A client at 30 weeks' gestation is admitted to the unit due to severe pre-eclampsia. The client has a blood pressure of 170/120 mm Hg on admission and has been placed on bed rest. Hydrazaline is administered. After 24 hours, the client's diastolic pressure continues to stay above 110 mm Hg. Which of the following actions by the nurse midwife is the most appropriate?

A)Confirm lung maturity through amniocentesis.
B)Induce labor.
C)Increase the dose of hydralazine.
D)Monitor the fetal heart rate with an external fetal monitor.

Question 32

A client at 32 weeks' gestation has been receiving magnesium sulfate IV. Which finding would prompt the nurse midwife to administer calcium gluconate?

A)Respiratory rate of 12 breaths per minute.
B)Urine output = 35 mL/hour
C)Serum magnesium = 7.7 mEq/L
D)Deep tendon reflex +2

Question 33

A nurse midwife is managing the care of a client who admitted to the unit due to moderate pre-eclampsia. Which of the following interventions is not included in the care plan?

A)The client is placed in a private room.
B)Offer foods low in protein and sodium.
C)Administer hydralazine.
D)Insert an indwelling urinary catheter.

Question 34

A client at 32 weeks' gestation develops tonic-clonic seizures due to eclampsia. Which of the following nursing actions is least appropriate during the tonic phase?

A)Administer oxygen by face mask.
B)Turn the client to her side.
C)Assess the oxygen status through a pulse oximeter.
D)Administer magnesium sulfate IV.

Question 35

A pregnant client comes to the facility complaining of nausea, epigastric pain and general malaise. Physical assessment reveals right upper quadrant tenderness. The nurse midwife suspects that the client has a HELLP syndrome. A series of laboratory exams are ordered for further evaluation. Which laboratory result would indicate a diagnosis other than HELLP syndrome?

A)Red blood cells appearing fragmented on a peripheral blood smear.
B)Platelet count is 180,000 platelets/µL.
C)Elevated alanine aminotransferase.
D)Elevated serum aspartate aminotransferase.

Question 36

All of the following statements accurately describe being pregnant with fraternal twins except:

A)It is the result of the fertilization of two ova by two different spermatozoa.
B)The pregnancy consists of two placentas, two chorions, two amnions and two umbilical cords.
C)It is not a complication of pregnancy.
D)Fraternal twins may be of the same or different sex.

Question 37

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 38

A nurse midwife is reviewing the history of a client at 43 weeks' gestation. The client informs the nurse that she was supposed to give birth a few weeks ago, but she has still not gone into labor. Which of the following details of information about the client may have possibly increased her risk for post-term pregnancy?

A)It is the client's third pregnancy.
B)The client is expecting a baby girl.
C)The client has a short menstrual cycle.
D)The client is receiving a high dose of salicylates.

Question 39

A client, who is pregnant for the first time, asks the nurse midwife if she and her husband can still engage in sexual intercourse during her pregnancy. She is concerned that having sex may hurt the baby and cause a miscarriage. The client is at 12 weeks' gestation. The most recent physical examination reveals normal findings. The client's history is not remarkable. Which of the following statements made by the nurse midwife is the most appropriate?

A)"You need to avoid sexual intercourse during pregnancy."
B)"Yes, you may engage in sex until the first two weeks of the third trimester."
C)"You may engage in sex as far into pregnancy as you wish. You and your husband may need to adjust your positions during sexual intercourse."
D)"You may have sex during pregnancy. Your libido will most likely increase during the third trimester."

Question 40

A nurse midwife teaches a group of pregnant women about good personal hygiene during pregnancy. Which of the following statements made by one of the women indicates that the teaching has been successful?

A)"If increased vaginal discharge makes me feel uncomfortable, I can douche one to two times a week."
B)"I need to avoid hot showers. The temperature may initiate labor."
C)"I can have tub baths during the first few months of pregnancy, unless I am at risk for premature rupture of membranes."
D)"I need to see my dentist right after birth."

Question 41

A nurse midwife is creating a teaching plan for a G1P0 client at 12 weeks' gestation. The nurse midwife focuses on breast care once colostrum secretion begins. Which of the following teachings is not included in the teaching plan?

A)Wash the breasts with clear tap water and mild soap daily.
B)Wear a firm, supportive bra with wide straps.
C)A larger bra may be needed halfway through the pregnancy.
D)If colostrum secretion is excessive, gauze squares may be placed inside the bra.

Question 42

A client at 32 weeks' gestation complains of easy fatigability. During the history taking, the client tells the nurse midwife that she has been frequently awakened from sleep almost every night for the past week due to the activity of the fetus. The client also reports shortness of breath every time she sleeps flat in bed. Which of the following instructions given by the nurse midwife is the least appropriate when managing the client's sleeping problems?

A)Sleep on two pillows, or on a couch with an armrest.
B)Sleep in a modified Sims' position, with the top leg forward.
C)Schedule a rest period during the afternoon.
D)When sitting or lying down, rest with the knees sharply bent.

Question 43

A client at 34 weeks' gestation is ordered to have a lecithin/sphingomyelin, or L/S, ratio. The nurse midwife informs the client that this test will determine:

A)The risk of the baby to develop neural tube defects.
B)The volume of the amniotic fluid.
C)The baby's tolerance of labor.
D)The maturity of fetal lungs.

Question 44

A lecithin/sphingomyelin ratio is ordered for a client who is being considered for induced labor. The client is 37 weeks pregnant. The nurse midwife reviews the result of the test and notes that the client's L/S ratio is 2.5. Based on this finding, the nurse midwife determines that:

A)The lungs of the fetus are most likely immature.
B)The fetus is not likely to develop respiratory distress syndrome.
C)A need for supplemental oxygen at the time of birth is a priority.
D)A repeat test is necessary within 72 hours.

Question 45

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 happens during more than 50% of the contractions. After stopping the oxytocin, which of the following is the next action of the nurse 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 46

A nurse midwife is seeing four clients in the clinic. Which of the following clients should be seen first?

A)A client at 12 weeks' gestation complaining of increased urinary frequency.
B)A client at 20 weeks' gestation complaining of intermittent, painless contractions.
C)A client at 20 weeks' gestation who comes for her first prenatal check up.
D)A client at 18 weeks' gestation complaining of blurring of vision.

Question 47

A client in her first trimester tells a nurse midwife that she has developed tortuous veins in her lower extremities. Which of the following instructions given by the nurse midwife is the least effective?

A)"Don elastic support stockings immediately after you are on your feet in the morning."
B)"Eat fruits and vegetables high in Vitamin C."
C)"Exercise and have walk break at least twice a day."
D)"Lie on you back with your legs raised against the wall for 15 minutes twice a day."

Question 48

A client at 28 weeks' gestation complains of back pain. The client's urinalysis reveals normal findings. Which of the following instructions from the nurse midwife would be least effective at alleviating the client's back pain?

A)"Walk with the pelvis tilted backward."
B)"Wear shoes with low to moderate heels."
C)"Perform pelvic rocking."
D)"Slide a board under the mattress."

Question 49

A client learns that she is pregnant with twins after an ultrasound. The client asks the nurse midwife how much weight she should gain during the pregnancy. Which of the following statements made by the nurse midwife is the most accurate?

A)"You need to gain one pound per month during the first trimester, and then one pound per week during the last two trimesters."
B)"You need to gain one pound per month on all three trimesters."
C)"You should gain one pound per week during the entire pregnancy."
D)"You need to control your weight gain. You must not gain more than fifteen pounds during the entire pregnancy."

Question 50

A movie actress comes to the clinic for her first prenatal visit. The client is 7 weeks pregnant. The client has a BMI of 28. The nurse midwife informs the client that she needs to add 300 calories to her daily diet. The client is concerned about getting fat. She asks the nurse why it is important to add calories to her diet during pregnancy. Which of the following responses made by the nurse midwife is the least appropriate?

A)"The added calories are needed to supply energy for the fetus and placenta."
B)"Carrying extra weight can be physically demanding. You need the added calories help you keep up with the increasing workload."
C)"The thyroid function increases during pregnancy. You must have a sufficient amount of calories to keep up with the demands of having an elevated metabolic rate."
D)"If you were obese, you would have been instructed to eat 1,200 calories per day. However, having a BMI of 28 shows that you need to add 300 more calories to support your pregnancy needs."

Question 51

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 52

A nurse midwife is creating a teaching plan for a group of adolescent girls who are pregnant for the first time. The main purpose of the teaching session is to promote nutritional health during pregnancy. Which of the following consideration is least important when creating the teaching plan?

A)The group's reactions to possible changes that concern their eating habits.
B)The involvement of the clients' families, especially the food preparers.
C)The financial status of the clients.
D)Cultural considerations.

Question 53

A client who is 8 weeks pregnant tells a nurse midwife that she has a strange craving for laundry starch. The client says, "I think I am losing my mind, but I need to tell someone about this odd behavior." Which of the following interventions is the most appropriate for the client?

A)Encourage the client to stop eating laundry starch.
B)Inform the client her behavior is an indirect way of calling attention to the pregnancy.
C)Initiate iron supplementation.
D)Initiate a high-carbohydrate diet.

Question 54

A nurse midwife is managing the nutritional status of a 13-year-old client at 12 weeks' gestation. When working with an adolescent client, which of the following interventions is the most effective?

A)Encourage the client to consume least 2,000 calories per day from food intake.
B)Allow the client to reject traditional foods, and respect her decisions.
C)Advise the client to prepare nutritious snacks for the next day before going to bed.
D)Work exclusively with the client, not with her family members or guardians, during dietary planning.

Question 55

A nurse midwife is managing the nutritional status of a 23-year-old client at 8 weeks' gestation. It is the client's first prenatal visit. The client has a BMI of 18. Which of the following interventions is the most appropriate for the client?

A)Instruct the client to eat foods high in protein.
B)Add between 500 and 1,000 calories per day to the client's total caloric intake.
C)Inform the client that she should gain as much weight as she can.
D)Develop healthy menus for the client.

Question 56

The nurse midwife is creating a dietary plan for a pregnant vegan client. Which of the following interventions for this client is inaccurate?

A)Increase the client's intake of dark-green vegetables.
B)Recommend vitamin B12 supplementation.
C)Instruct the client to combine different protein sources in one meal.
D)Instruct the client to go outside the house for 20 to 30 minutes in the early morning sun.

Question 57

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 58

A nurse midwife is reviewing the history of a client who is pregnant for the second time. Which of the following details from the client's history indicates an increased risk of gestational diabetes?
I.The client is 30 years old.
II.The client has a BMI of 28.
III.The client gave birth two years ago to a baby boy, who weighed 11 pounds at birth.
IV.The client is a Native American.

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

Question 59

A client with type 1 diabetes is on her 37th week of pregnancy. The client is scheduled to have a test that will determine the maturity of her baby's lungs. The nurse midwife orders which of the following diagnostic tests?

A)L/S ratio
B)Phosphatidyl glycerol test
C)Contraction stress test
D)Non-stress test

Question 60

A nurse midwife is managing the care of four female clients. She should administer RhoGAM to the following clients:
1.A client at 28 weeks' gestation who received a RhoGAM injection 72 hours after the delivery of her first child.
2.A G2P1 client at 28 weeks' gestation who gave birth to an Rh-positive baby two years ago.
3.An Rh-negative client at 15 weeks' gestation who develops bleeding after an amniocentesis.
4.An Rh-negative client at 12 weeks' gestation who is admitted due to ectopic pregnancy.

A)1, 2
B)1, 2, 3
C)1, 3, 4
D)1, 2, 3, 4

Question 61

A nurse midwife suspects that a client at 18 weeks' gestation has a hydatidiform mole. Which of the following assessment findings does not support this diagnosis?

A)Vaginal spotting of bright-red blood
B)The fundus height of the uterus is palpated at the umbilicus
C)A sonogram shows a snow-flake pattern
D)Urine test is determined positive for hCG

Question 62

A client is admitted to the facility and is placed on bed rest. The client is diagnosed with placenta previa. Which of the following pieces of information does not support this diagnosis?

A)The client complained of abrupt, painless and bright red vaginal bleeding.
B)The Kleihauer-Betke test reveals that bleeding is of maternal origin.
C)The client is in her first trimester.
D)Fetal malpresentation is assessed.

Question 63

A nurse midwife is assessing a client in her third trimester. The client is complaining of sharp, stabbing uterine pain. The nurse midwife suspects abruptio placenta. Which of the following interventions is the least effective for the client?

A)Administer oxygen by face mask.
B)Insert a large gauge intravenous catheter.
C)Order bed rest in the supine position.
D)Vaginal examination is not performed.

Question 64

The client's placenta abruptly separates from the uterine lining. The client is most likely to complain of:

A)Sharp, stabbing pain in the uterine fundus.
B)Painless, bright red vaginal bleeding.
C)A pink-stained vaginal discharge.
D)A gush of clear vaginal fluid.

Question 65

A client comes to the clinic for her first prenatal examination. The nurse midwife determines that the client is in her 12th week of pregnancy. Which of the following is not an expected assessment finding at this time?

A)Frequent urination
B)Sonographic evidence of fetal outline
C)Audible fetal heart through Doppler ultrasound
D)Ballotement

Question 66

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 67

A nurse midwife is about to perform a Leopold's maneuver on a client who is at 25 weeks' gestation. Before the examination, which of the following actions by the nurse midwife is the least appropriate?

A)Instruct the client to empty her bladder.
B)Wash hands, dry with a clean towel, and then palpate for the fetal outline.
C)Place the client in the dorsal recumbent position, supine with the knees flexed.
D)Use the palms to palpate for the fetal outline.

Question 68

A nurse midwife faces the foot part of the client and places both hands two inches above the inguinal ligament to perform the Leopold's maneuver. Using the palms, the nurse midwife presses downward to palpate for the fetal head. Which maneuver is this?

A)The first maneuver
B)The second maneuver
C)The third maneuver
D)The fourth maneuver

Question 69

A nurse midwife is performing the Leopold's maneuver on a client at 28 weeks' gestation. The assessment findings are noted as follows: First maneuver - the fundus is felt with soft, irregular shaped mass that is difficult to move; Second maneuver - The client's left side feels smooth and hard, and a number of angular nodulations are felt on the client's right side; Third maneuver - The presenting part is movable; Fourth maneuver - The brow is easily palpated on the same side of the angular nodulations. Which of the following conclusions is not consistent with the findings?

A)The buttocks of the fetus are located at the uterine fundus.
B)The fetus is at the anterior position.
C)The fetal back is located on the mother's left side.
D)The presenting part is not engaged.