Maternal and Child Nursing Pre-Test 1 A 22-year-old multigravida at 22 weeks gestation complains during routine prenatal visit of a 5-lb

weight gain and vaginal discharge. Her assessment included a normal speculum examination. The nurse examines the patients abdomen and finds that the tip of the uterus is 20 cm above the symphysis pubis. This upper rounded portion of the uterus is the: a. Corpus b. Isthmus c. Fundus d. Bladder Ans: C -a nurse examines a patient at 22 weeks gestation and finds that the tip of the uterus is 20 cm above the symphysis pubis. The upper portion of the uterus is the fundus. These options are incorrect as seen in rationale (C). 2. A patient is pregnant for the 3rd time. She has a 2-year-old son and had spontaneous abortion at 10 weeks gestation. The correct gravida and para for this patient is: a. Gravida II, para I b. Gravida II, para II c. Gravida III, para I d. Gravida III, para II Ans: C - a patient is pregnant for the third time; therefore, she is gravida III. Having a 2-year-old son counts as a para. Having had a spontaneous or elective abortion (less than 24 weeks) does not cunt as a para; therefore, she is para I. These options are incorrect as seen in rationale (C). 3. Upon pelvic examination, it was noted that a patients cervix is a bluish-purple color. This is known as: a. Goodells sign b. Braxton Hicks contraction c. Chadwicks sign d. Homans sign Ans: C -when the nurse performed a pelvic examination on the patient, the nurse noted that the cervix was bluish-purple color, which is known as Chadwicks sign. This occurs from about from the fourth week of pregnancy and is caused by increased vascularity of the vagina. Goodells sign (softening of the cervix), a probable sign of pregnancy, occur during the second month. Braxtons Hicks contractions (sign) are mild, irregular, painless uterine contractions that occur more frequently in late pregnancy. These contractions do not represent true labor. Homans sign is an early of phenothrombosis of the deep veins of the calf in which the patient complains of pain when the leg extended and the foot is dorsiflexed. 4. The active and latent phase of labor is stage: a. One b. Two c. Three

d. Four Ans: A -the latent and active phase of labor, as well as the transitional phase, occur in stage one. During latent phase, the cervix dilates to 3 cm and effaces to 40 percent. During the active phase, the cervix dilates to 10 cm (complete) with 100 percent effacement, and the station increases to approximately 1 to + 1. Note: stage one lasts from the onset of regular uterine contractions to the full dilation of the cervix. These options are incorrect as seen in rationale (A), 5. The stage that begins after the delivery of the newborn is stage: a. One b. Two c. Three d. Four Ans: C - the stage that begins after the delivery of the newborn is stage three of labor. The third stage of labor. The third stage of labor lasts from delivery of the fetus to delivery of the placenta. Stage one is explained in answer 6 rationale (A). the second stage of labor lasts from full dilation of the cervix to delivery of the fetus and is generally shorter in multimanic status is observed closely. 6. Which one of the following hormones most likely inhibits uterine contractions throughout pregnancy? a. Progesterone b. Prostaglandin c. Estrogen d. Oxytocin Ans: A - progesterone inhibits uterine contractions throughout pregnancy. Prograstaglandin plays a role in ovulation, formation of corpus luteum, uterine contractility, and milk ejection prostaglandins are used to induce labor in second-trimester abortions and may be used to ripen (or prepare) a cervix for Pitocin (oxytocin) induction of labor. Estrogen is produced by the ovary and adrenal cortex in a prepregnant state; however, the principal source during pregnancy is the placenta. Estrogen increases from the onset of pregnancyis the placenta. Estrogen increases from the onset of pregnancy to term. Oxytocin is produced by the posterior lobe of the pituitary gland and causes uterine contractions. 7. A condition that predisposes a patient to postpartum hemorrhage is: a. Twin pregnancy b. Breech presentation c. Premature rupture of membranes d. Cesarean birth Ans: A - twin pregnancy or any condition that overdistends the uterus will predipose a patient to postpartum hemorrhage.overdistention of the uterus causes poor uterine muscle tone, which inturn causes poor post partum uterine contractions, leading to an increased risk of postpartum hemorrhage. Breech presentation, in which the buttocks, feet, or both are nearest the cervical opening and are delivered first, is the most common exmale of malpresentation. The major concern in breech presentation is cord prolapse andhead entrapment. Premature or preterm rupture of the membranes will not cause postpartum hemorrhage. With preterm or prolonged rupture of membranes, there may

be a danger of infection. Cesarean birth does not increase the incidence of postpartum hemorrhage. 8. During the fourth stage of labor, the mother asks the nurse, Why are you pressing on my uterus? It hurts. The nurse best response is: a. We massage every mothers uterus after she delivers. b. I know it hurts, but it has to be done. c. If I dont massage your uterus, you will not pass the placenta, and then you may hemorrhage. d. I am checking your uterus frequently to make sure it stays firm, so you wont bleed excessively. Ans: D - after the baby is born, the nurse needs to massage the patient uterus gently to encourage it to contract, and check it frequently to be sure the uterus stays firm to decrease blood loss. Telling a patient, We massage the uterus of every patent after they deliver, does not indicative to the patient the rationale for why the message must be done. Telling the patient, I know it hurts, but it has to be done, is not the reason it is done. The patient will more readily accept the uncomfortable feeling of having her uterus massaged if she knows it may prevent her from hemorrhaging. The physician makes sure the placenta is passed or delivered. 9. Shortly after delivery, the nurse assesses the new mothers uterus. It is firm and one fingerbreadth above the umbilicus and is displaced to the left of the abdomen. The nurses first priority is: a. Encourage mother to void b. Administer an oxytoxic drug c. Administer a tocolytic drug d. Vigorously massage the mothers uterus Ans: A - if, shortly after delivery, the patients uterus is firm and one finger above the umbilicus and is displaced slightly to the left of the abdomen, the nurse needs to encourage the patient to void. A full bladder is most likely causing displacement of the uterus. These options are incorrect as seen in rationale (A). 10. A patient is admitted to the obstetric floor with a diagnosis of abruptio placenta. With this complication, blood loss usually is: a. Seldom present b. Minimal c. Less than observed d. Greater the observed Ans: D -blood loss with abruption placenta is greater than observed because some blood remains in the uterus. These options are incorrect as seen in rationale (D). 11. A patient is given Methergine (methyllergonovine) 2 mg IM, 4 hours post delivery because she is experiencing postpartum bleeding. The nurse should assess for: a. blood pressure variations b. severe fluid retention c. severe hyperglycemia d. uterine rupture

Ans: A - a patient receiving Methergene for postpartum bleeding should be assessed for hypertension. Methergene causes vasoconstriction and stimulates uterine contractions, which decrease bleeding. Side effects include headache, dizziness, chest pain, and hypertension. A drop in blood pressure may indicative hypovolemia. These are not side effects of Methergene. 12. During a pelvic examination. The physician notes a definite softening of the lower uterine segment, discoloration of the mucous membranes of the vagina, and softening of the cervix. These signs are referred to respectively as: a. hegars; chadwicks goodells b. goodells; chadwicks; hegars c. chadwicks; goodells; hegars d. none of the above Ans: A - a definite softening of the lower uterine segment is called Hegars sign. Discoloration of mucous membranes of the vagina is called Chadwicks sign. Softening of the cervix is called Goodells sign. These options are incorrect as seen in rationale (A). 13. A patient at 9-weeks gestation is admitted to the emergency room complaining of a sharp pain in her right side with some vaginal spotting and nausea and vomiting. The nurse would expect: a. ectopic pregnancy b. abruptio placentae c. placenta previa d. threatening abortion Ans: A - a 9-week pregnant mother with sharp right-sided pain, some vaginal spotting, and nausea and vomiting may be experiencing entopic pregnancy. Abruption placenta will demonstrate enlarged abdomen, which is painful and rigid on palpation (and occurs much later in pregnancy). Signs and symptoms of placenta previa are painless uterine bleeding. The bright red blood may be inytermittent, occur in gushes, or more rarely, may be continuous. Abdominal examination reveals a soft (relaxed), nontender uterus. Signs and a symptoms of threatening abortion would be abdominal cramping. Uterine irritability or contractions, usually associated with minimal to moderate vaginal bleeding. 14. The first sign of preeclampsia usually is: a. hypertension b. epigastric pain c. pedal edema d. proteinuria Ans: A - the earliest sign of preeclampsia most commonly is hypertension, followed by proteinuria, and generalized edema. All of these signs and symptoms may not be present and may not present in this order. Epigastria pain is generally a late sign of preeclampsia and indicates liver involvement. Pedal edema is a normal occurrence in pregnancy. An increase in proteinuria indicates kidney involvement and generally follows hypertension.

15. Signs and symptoms of preeclampsia are: a. hyperreflexia, tachycardia, facial edema, and sudden weight loss b. fever, weight gain, fluid retention, and proteinuria c. tachycardia, hypergylcemia, and generalized d. hypertension., ptoteinuria, generalized edema, and weight gain Ans: D - signs and symtpoms of preeclampsia are hypertension, proteinuria, generalized edema, and weight gain. These options are incorrect as seen in rationale (D). 16. Rh incompatibility was once a leading cause of kernicterus and a significant cause of neonatal death. Incidence of Rh incompatibility has been greatly reduced by the administration of RhoD immune globulin (RhoGam) to: a. all Rh-negative mothers during pregnancy and within 72 hours of delivery or abortion of an Rhpositive infant or fetus b. all Rh-positive neonates immediately after birth c. all Rh-negative mothers within 72 hours after delivery d. all Rh-negative mothers every trimester and following delivery, if the fetus is Rh-positive Ans: A - the incidence of kerniterus has been greatly reduced by the administration of Rho (D) immune globulin (RhoGam) to all Rh-negative mothers during pregnancy and all unsentisized Rhnegative mothers within 72 hours after the delivery or abortion of Rh-positive newborns or fetuses. Kernicterus is a high level bilirubin in the blood, causing neurologic symtpoms. Rh incompatibility was a leading cause of kerniterus and a significant cause of neonatal death before RhoGam was developed. These options are incorrect as seen in rationale (A). 17. The nurse teaches patients that they should examine their breasts for lumps. a. One week after menstrual period b. One week before menstrual periods begins c. Each motion on the same date d. Two weeks after menstrual period Ans: A- the nurse teaches patient that all women over 20 years of age should examine their breasts for lumps 1 week after menstrual period. These options are incorrect as seen in rationale (B). 18. The following is considered essential to diagnose breast cancer: a. ultrasonography b. core-needle biopsy c. mammography d. x-ray Ans: B- core-needle biopsy is considered essential to diagnose breast cancer. An ultrasonography mammography or x-rays are used to determine clinical manifestation of cancer of the breast but are considered essential to diagnose malignancy. These options are incorrect as seen in rationale (B).

19. Early clinical manifestations of breast cancer are: a. single painless, nontender, hard, Irregular, nonmobile mass b. multiple lumps, tender, soft movable mass c. one large nodule, tender, soft movable mass d. very small, painless, multiple, movable soft mass Ans: A- Early clinical manifestations of breast cancer are single painless, nontender, hard irregular nonmobile masses. Multiple lumps would not be an early sign of breast cancer but may be a late sign. The lump would not be a tender, soft movable mass. This may indicate a breast cyst. There may be one large nodule. This would be a late sign, but it would not be a tender, soft movable mass. Very small, painless, multiple, movable, soft masses may be cyst. 20. Women most at risk for breast cancer are: a. Over 65 years of age, married younger than 16 at first pregnancy b. Over 55 years, never married, with a family history of cancer c. Over 65 years of age, married, multiple sex partners at a young age d. Over40 years of age, never married, with a family history of lung cancer Ans: B- women over 55 years of age, who have never married, and who have a family history of cancer are the greatest risk for breast cancer. These options are incorrect as seen in rationale (B). 21. Radiation to the breast causes the skin to be: a. Dry, tender, red, swollen, and itchy b. Pale, moist, painful, and rash over area treated c. Cyanotic, dry, pigmented and painful d. Jaundiced, itchy, ulcerated and painful Ans: A-radiation will cause skin to become tender, red, swollen, and itchy. These options are incorrect as seen in rationale (A). The skin does not become pale, cyanotic, jaundiced, and painful. Ulcerated, or have a rash develop on treated area. 22. Side effects of chemotherapy are: a. Ptosis, diaphoresis, hypoxia, nausea and vomiting b. Photosensitivity, peripheral neuropathy and stomatitis c. Tremor, dizziness, diaphoresis and severe headaches d. Weight loss, irritability, diarrhea and ataxia, and severe headache Ans: B- side effects of chemotherapy are photosensitivity; peripheral neuropathy; symptomatitis; alopecia (hair loss); depressed red blood cells, white blood cells, and platelets; diarrhea, fatigue; menopausal symptoms; nausea; vomiting; peripheral nueropathy; sterility; and weight loss.

23. A standard radical mastectomy involves the removal of: a. Cancerous mass and all normal tissue for clean margin b. The breast, axillary lymph nodes and pectoral muscles

c. Axillary lymph nodes and pectoral muscles d. Resection of breast tissue and some skin from clavicle to costal margin Ans: B- a standard radical mastectomy involves the removal of the breast, axillary lymph nodes, and pectoral muscles. The whole breast, not just the cancerous mass, is removed in a standard radical mastectomy. Some normal tissue for a clean margin will be removed but not all-normal tissue. When you see all it is usually not the right answer. The removal of axillary lymph nodes, removal of breast, and overlying skin is a modified radical mastectomy. The difference between a modified radical and standard radical mastectomy is that, in the standard radical, the pectoral muscles are removed. The modified radical mastectomy is the most commonly performed procedure. Resection of breast tissue does not tell you how much breast tissue is being rejected or if it is cancerous or normal tissue. Skin would not be removed from the clavicle in any of the mastectomies. 24. Endometrosis is: a. abnormal location of endometrial tissue that is hormone dependent b. abnormal growth of endometrial tissue within the uterus c. small endometrial abcessess with bleeding outside the uterine cavity causing severe pain d. excessive endometrial tissue in the uterus causing pain, bloating, and premenstrual tension Ans: A- endometriosis is the abnormal location of endometriosis tissue that is hormone dependent. Endometriosis is the extra uterine, endometriosis is progressive and may have widespread dissemination. The etiology is unknown. It has an inherited predisposition. It etiology is unknown. It has an inherited predisposition. it causes pelvic pain and infertility. It is not abnormal for endometrial tissue to grow in the uterus. This is normal. Endometriosis is not associated with abscesses or bleeding outside the uterine cavity. Excessive endometrial tissue in the uterus is not endmetriosis. 25. It is generally accepted that estrogen should not given to women: a. after a surgical procedure to enlarge the breast or intestinal disorders b. mastitis or when breastfeeding an infant c. with bone cancer, osteoporosis, or mastitis d. with known or suspected breast or uterine cancer Ans: D-estrogens should not be given to women with known or suspected breast or uterine cancer, or present thrombophlebitis, acute liver disease, cerebrovascular disease, or combined risks, such as obesity, varicosities, high blood pressure and heavy smoking. These options are incorrect as seen in rationale (D). 26. Treatment for endometriosis include: a. premain and dexamethasone b. pronestyl and dextran c. oral contraceptives and danocaine d. diazepam and miltown Ans: C-treatment for endometriosis includes oral contraceptives and Danocrine, a hormone that suppresses ovarian function. Premarin is hormone used to treat various estrogen deficiency stages. Dexamethasone is a glucocorticoid, long-acting, anti-inflammatory agent. Pronestyl is an antiarrhythmic

used to treat a wide variety of ventricular and atrial arrhythmias. Dextrin is a volume expanderanticoagulant used in the emergency treatment of hypovolemic shock. Diazepam (Valium) is a sedativehypnotic, anticonvulsant, and skeletal muscle relaxant used in the management of anxiety to provide preoperative sedation, light anesthesia, and to relax skeletal muscles. Miltown is a sedative hypnotic used as a sedative in the management of anxiety disorders.

27. Side effects of oral contraceptive are: a. pulmonary embolism, pulmonary edema, and hypertension b. anemia, mental depression, and hypotension c. syncope, diaphoresis, and hemorrhage d. iron loss, mental depression, and hypotension Ans: A- side effects of oral contraceptives are pulmonary embolism pulmonary edema, and hypertension. Anemia is a condition in which there is a reduction in the number of circulating red blood cells per cubic millimeter or the amount of hemoglobin per 100 mL; or the volume of packed red cells per 100 mL of blood. It exists when hemoglobin content is less than that required providing the oxygen demands of the body. Anemia may result from excessive blood loss, with use of chemotherapy), or in decreased blood cell formation, which is caused by drugs, ionizing radiation, deficiencies of vitamins (vitamin B12 deficiency, as in pernicious anemia), deficiency and folic acid. These options are incorrect as seen in rationale (A). 28. Oral contraceptives effects of: a. Prednisone, hydrocortisone, and medrol b. Anticoagulants, insulin, and antihypertensive agents c. Calcium gluconate, medrol, and dilantin d. Robitussin, dilaudid, and sudafed Ans: B- oral contraceptives decrease the effects of anticoagulants, insulin, and antihypertensive agents. Oral contraceptives are considered safest when given to nonsmoking women under 35 years of age that do not have a history of thromboembolism problems, diabetes mellitus, hypertension, or migraine headaches. Contraceptives do not decrease the effects of these drugs. Prednisone, hydrocortisone, and Medrol are steroids used to treat inflammations. Calcium gluconate is an electrolyte used in the treatment and prevention of calcium depletion in diseases associated with hypocalcemia (eg, hypoparathyroidism). Medrol is a steroid, and Dilantin is an anticonvulsant drug. Robitussin is used in the management of the cough associated with upper respiratory infections. Dilaudid, a n analgesic, is used in the treatment of moderate to severe pain. Sudafed is used in the symptomatic management of nasal congestion. Sudafed is a decongestant. 29. A woman in labor should be encouraged to void frequently so that a. The descent of the presenting part is not hindered. b. Catheterization is not necessary c. Urine specimens are available to monitor labor. d. Rupture of the bladder does not occur.

Ans: A- A full bladder will impede the descent of the presenting part because it fills the space through which the fetus needs to pass. It also significantly increases the amount of discomfort during contractions because the presenting part causes pressure on the distended bladder. 30. Which of the following factors in a mothers history would put a newborn at risk for infection? a. Rupture of membranes more than 24 hours before delivery. b. Bleeding episodes during the second trimester. c. Urinary tract infection during her third trimester. d. Use of Pitocin during labor. Ans: A- once the membranes ruptured, the infants protection from external organisms is compromised. When membranes have been ruptured more than 24 hours, the chance of infection is greatly increased.