Deck 5: Prenatal

Question 1

A 20-year-old client comes to the clinic due to abdominal cramping. She informs the 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 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 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 midwife is the most accurate?

A)"The risk of having a baby with Down syndrome is high in females 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)"Females 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 female who has a child with Down syndrome neither decreases nor increases her chances of having a child with the same diagnosis."

Answer 2

"Females 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 20 - year - old 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 midwife if she could still exercise while pregnant. Which of the following statements by the 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."

Answer 3

"You should modify the intensity and type of your exercises. Non - weight - bearing exercises are recommended."

Question 4

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

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

Question 5

A 32 - year - old G3P2 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 midwife administers which of the following medications as an additional pharmacological treatment?

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

Question 6

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 7

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

A)"You should not drink any form of alcoholic beverages when pregnant."
B)"Females who drink alcohol when pregnant usually have babies with birth defects."
C)"Females 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 females during early pregnancy is not known."

Question 8

A 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 9

A midwife is teaching a group of student midwives 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 10

A 21 - year - old client comes to the prenatal clinic after a home pregnancy test indicated a positive result. The client informs the 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 11

A 20 - year - old G1P0 client comes to the prenatal clinic for her first prenatal visit on October 8, 2010. The client informs the 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 12

A midwife is assessing a client who is at 25 weeks' gestation. The 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 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 13

A 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 14

A midwife instructs a 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 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 15

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 midwife?

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 16

A 28 - year - old client at 29 weeks' gestation comes to clinic due to decreased fetal movements. The 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 midwife orders a non - stress test. The NST records an increase in fetal heart rate by 15 beats per minute, lasting for 15 minutes, 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 midwife 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 17

A client at 30 weeks' gestation is ordered a contraction stress test after a non - stress test gave a non - reactive result. The 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 minutes, 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 18

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 19

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 midwife how much weight she should gain by the end of her pregnancy. The most appropriate statement by the 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 20

A midwife is assessing a 43 - year - old client at 23 weeks' gestation. Which of the following findings alerts the 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 21

A 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 22

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 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 23

A client at 32 weeks' gestation has been receiving magnesium sulfate IV. Which finding would prompt the 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 24

A 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 25

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 26

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 27

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 midwife during assessment. Palpation of the small parts of the fetus and auscultating the fetal heart rate are difficult. The 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 28

A midwife is reviewing the history of a client at 43 weeks' gestation. The client informs the midwife 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 female baby.
C)The client has a short menstrual cycle.
D)The client is receiving a high dose of salicylates.

Question 29

A client, who is pregnant for the first time, asks the midwife if she and her partner 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 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 partner 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 30

A midwife teaches a group of pregnant clients about good personal hygiene during pregnancy. Which of the following statements made by one of the clients 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 31

A client at 32 weeks' gestation complains of easy fatigability. During the history taking, the client tells the 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 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 32

A client at 34 weeks' gestation is ordered to have a lecithin/sphingomyelin, or L/S, ratio. The 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 33

A lecithin/sphingomyelin ratio is ordered for a client who is being considered for induced labor. The client is 37 weeks pregnant. The midwife reviews the result of the test and notes that the client's L/S ratio is 2.5. Based on this finding, the 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 34

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 midwife observes three 40 - second - long contractions in a 10 - minute window. The client has two contractions within the next five minutes. The 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 35

A 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 36

A client in her first trimester tells a midwife that she has developed tortuous veins in her lower extremities. Which of the following instructions given by the 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 37

A client at 28 weeks' gestation complains of back pain. The client's urinalysis reveals normal findings. Which of the following instructions from the 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 38

A client learns that she is pregnant with twins after an ultrasound. The client asks the midwife how much weight she should gain during the pregnancy. Which of the following statements made by the 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 39

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 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 midwife why it is important to add calories to her diet during pregnancy. Which of the following responses made by the 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 40

A 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 41

The 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 42

A client at 11 weeks' gestation complains of severe and extreme nausea and vomiting. During history taking, the 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 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 43

A 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 44

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 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 45

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)TheKleihauer - Betke test reveals that bleeding is of maternal origin.
C)The client is in her first trimester.
D)Fetal malpresentation is assessed.

Question 46

A midwife is assessing a client in her third trimester. The client is complaining of sharp, stabbing uterine pain. The 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 47

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 48

A client comes to the clinic for her first prenatal examination. The 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 49

A 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 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 50

A 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.

Question 51

A midwife is about to perform amniotomy on a client who is in her 39th week of gestation. Which of the following actions of the midwife is the least appropriate before starting the procedure?

A)Examine the cervix and measure cervical dilatation.
B)Assess the fetal heart tone.
C)Maintain aseptic technique.
D)Position the client in lithotomy position.

Question 52

A midwife assesses a client who is in her 35th week of gestation. After conducting abdominal inspection and palpation, the midwife notes that the fetus is in the transverse lie. This finding is verified by a sonogram. Which of the following actions by the midwife is the most appropriate before an external version?

A)Initially order a contraction stress test.
B)Administer a tocolytic agent.
C)Monitor the heart rate for vena cava compression.
D)Withhold RhoGAM administration.

Question 53

A client at 39 weeks' gestation is admitted to the labor and delivery unit. An external fetal heart rate monitor is attached to the client. Physical examination and laboratory test results reveal that the fetus is in breech position, and a cesarean delivery is recommended. Physical examination is conducted and laboratory tests are ordered. Before the pregnancy, the client's average heart rate was 80 beats per minute. Which of the following assessment findings necessitates immediate physician notification?

A)Hematrocrit = 38%
B)WBC = 18,000 cells/mm3
C)Maternal heart rate = 95 beats per minute
D)Fetal heart rate = 180 beats per minute

Question 54

A midwife conducts an amniotomy on a client to induce labor. Which of the following interventions is the priority of the midwife after the procedure?

A)Administer oxygen.
B)Obtain the client's blood pressure.
C)Assess the fetal heart tone.
D)Position the client in knee - chest position.

Question 55

A few weeks before labor, the client may experience subtle signs that indicate the onset of labor. One of these signs is lightening. The midwife teaches the client to recognize the signs of lightening. Which of the following is not a sign of lightening?

A)Relief from diaphragmatic pressure and shortness of breath.
B)Abdominal contour changes.
C)Increased urinary frequency.
D)Decreased amounts of vaginal discharge.

Question 56

A client at 38 weeks' gestation is admitted to the unit after complaining of painful, moderate vaginal bleeding of dark, clotted blood. A series of diagnostic and laboratory tests verify that the client is experiencing abruptio placenta. The fetal heart rate is 180 beats per minute. Which of the following actions is the priority action of the midwife?

A)Order bed rest for the remainder of the pregnancy.
B)Prepare the client for cesarean delivery.
C)Prepare the client for platelet transfusion.
D)Instruct the client to avoid sexual intercourse throughout the pregnancy.

Question 57

A midwife is assessing a client at 34 weeks' gestation. An external fetal heart monitor is attached. Which of the following assessment findings suggest fetal distress? I.Fetal heart rate decreases at the onset of contractions and returns to baseline after the contraction.
II.Fetal heart rate - 130 beats per minute
III.Greenish amniotic fluid
IV.Continuous decrease in baseline variability

A)I and II
B)I and III
C)III and IV
D)I, III and IV

Question 58

A client at 38 weeks' gestation is admitted to the facility after a midwife suspects that she has a case of premature rupture of the amniotic membranes. Which of the following information given by the client supports this diagnosis?

A)Fewer than 5 fetal movements per hour for the past 24 hours.
B)Uterine contractions with leakage of clear fluid from the vagina.
C)Contractions are not alleviated with ambulation.
D)Leakage of clear fluid from the vagina without contractions.

Question 59

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 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.

Question 60

A midwife is teaching a group of clients in the community about mammograms. Which of the following statements made by one of the clients indicates that further teaching is necessary?

A)"After the age of 40, I should have a yearly mammogram."
B)"I can obtain my first baseline mammogram between the ages of 35 and 40 years."
C)"Mammograms can detect breast tumors two years before they are palpable."
D)"I can still have a regular screening even if I am pregnant, with or without the symptoms of breast cancer."

Question 61

Throughout pregnancy, fetal nutrition occurs. Which of the following are types of fetal nutrition following fertilization?

A)Absorption
B)Histotrophic transfer
C)Haematotrophic transfer
D)All of the above

Question 62

The umbilical cord is a temporary anatomical structure connecting the fetus to the placenta. Which one of the following develops into the umbilical cord?

A)Connective stalk
B)Endoderm
C)Ectoderm
D)None of the above

Question 63

The umbilical cord is a temporary anatomical structure connecting the fetus and placenta, and permits the circulation of fetal blood. Of the following, which are included in the composition of the umbilical cord?

A)Covering epithelium
B)Blood vessels
C)Allantosis
D)All of the above

Question 64

The umbilical cord is a temporary anatomic structure connecting the fetus to the placenta, and permits the fetal circulation of blood. Which one of the following statements is true about umbilical cord?

A)Length is 15 - 30 cm
B)Diameter is 3 - 5 cm
C)Cord shows a spiral twist from left to right as early as 12th week of pregnancy
D)Only the arteries do not possess vasa vasorum

Question 65

The fetal period begins after the 8th week following conception, and ends in delivery of the newborn. Which one of the following statements is true about fetal organ system?

A)By the end of the second trimester, the nephrons secrete urine
B)The sebaceous gland appears around the 14th week of pregnancy
C)In the 23rd week of pregnancy, alveoli expand and are lined by cuiboidal epithelium
D)None of the above

Question 66

Monitoring and health promotion support of a woman during pregnancy is called "prenatal care". Which one of the following is not an aim of prenatal care?

A)To screen out high risk cases
B)To detect earliest complications
C)To educate the mother about the physiology of pregnancy
D)To motivate the child of the pregnant woman

Question 67

Monitoring and health promotion support of a woman during pregnancy is called "prenatal care". According to the World Health Organization (WHO), what is the minimum number of prenatal visits that is recommended?

A)2
B)4
C)6
D)3

Question 68

Healthcare monitoring of a woman during pregnancy is called "prenatal care". This is important to identify pregnancy and childbirth risks. Which of the following is a "too large" or "too small" fetal growth risk factor associated with the 3rd trimester?

A)Anemia, Syphilis
B)Abnormal symphysis fundal height
C)Abnormal fetal presentation
D)None of the above

Question 69

The placenta is an organ located in the gravid uterus that connects the mother and fetus via the umbilical cord. Of the following, which is a function of the umbilical cord?

A)Transports nutrients
B)Transports hormones
C)Transports oxygen and carbon dioxide
D)All of the above

Question 70

The placenta is an organ located in the gravid uterus that connects the mother and fetus via the umbilical cord. Which of the following is not a component of the placenta?

A)Amniotic membrane
B)Chorionic membrane
C)Superficial plate
D)Basal plate

Question 71

The placenta is an organ located in the gravid uterus that connects the mother and fetus via the umbilical cord. Which of the following hormones is secreted from the placenta?

A)Androgen
B)Prolactin
C)Progesterone
D)Growth hormone

Question 72

There are several mechanisms for transport of different substances through the placenta. Which of the following is not a mechanism of transfer through the placenta?

A)Simple diffusion
B)Facilitated diffusion
C)Active transport
D)None of the above

Question 73

The placental barrier limits the kind and amount of material exchanged between the pregnant woman and her fetus. Which one of the following is a structure of the placental barrier?

A)Basement membrane
B)Cytotrophoblast (Langhans' cells)
C)Stromal tissue
D)All of the above

Question 74

The placenta is an organ located in the gravid uterus that connects the mother and fetus via the umbilical cord. Of the following, which is considered a placental anomaly?

A)Placenta spuria
B)Placenta previa
C)Velamentous placenta
D)All of the above

Question 75

Polyhydramios is a complication of pregnancy in which there is an excessive amount of amniotic fluid (liquor amnii) surrounding the baby in the uterus. Which of the following is is not correlated to an increased risk of polyhydramnios?

A)Anencephaly
B)Spina bifida
C)Diabetes
D)Webbed toes

Question 76

Polyhydramios is a complication of pregnancy in which there is an excessive amount of amniotic fluid surrounding the baby in the uterus.Which of the following is a symptom of polyhydramnios?

A)Respiratory distress
B)Palpitations
C)Leg edema
D)All of the above

Question 77

Polyhydramios is a complication of pregnancy in which there is an excessive amount of amniotic fluid surrounding the baby in the uterus. Which one of the following is a maternal complication of polyhydramnios?

A)Pre eclampsia
B)Renal failure
C)Heart attack
D)Fetal distress

Question 78

A 26 years old pregnant female presents with negative changes in her normal bodily functions. Of the following, which are disorders that may be associated with pregnancy?

A)Anemia
B)Urinary tract infection
C)Gestational hypertension
D)All of the above

Question 79

A 27 years old pregnant female developed anemia at the 37th week of pregnancy. Which of the following is the possible management?

A)Increase dietary intake of iron (ferrous sulfate)
B)Oral iron supplement therapy
C)Blood transfusion
D)All of the above

Question 80

Examination reveals that a 22 years old pregnant female had preeclampsia. Which of the following is a fetal complication of preeclampsia?

A)Hemorrhage
B)Asphyxia
C)Heart failure
D)Renal failure