Question 1

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?

Accepted Answer

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. B

Question 2

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?

Accepted Answer

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

Question 3

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?

Accepted Answer

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

Question 4

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:

Accepted Answer

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

Question 5

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?

Accepted Answer

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

Question 6

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?

Accepted Answer

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 7

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:

Accepted Answer

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

Question 8

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?

Accepted Answer

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 9

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

Accepted Answer

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 10

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?

Accepted Answer

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 11

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?

Accepted Answer

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 12

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:

Accepted Answer

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

Question 13

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?

Accepted Answer

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

Question 14

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?

Accepted Answer

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 15

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?

Accepted Answer

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.

Question 16

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?

Accepted Answer

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 17

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?

Accepted Answer

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 18

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?

Accepted Answer

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

Question 19

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?

Accepted Answer

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 20

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

Accepted Answer

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.

Exam 11: Midwifery