Maternal and Child Health Nursing Exam 4 and 5 PDF

CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 ABORTION...

CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 ABORTION c. Administer prescribed pain medication to alleviate discomfort. 1. A nurse is providing care for a patient d. Advise the patient to increase iron-rich following a spontaneous abortion at 10 food intake to prevent anemia. weeks of gestation. Which of the following nursing interventions is MOST appropriate? ECTOPIC PREGNANCY a. Prepare the patient for an immediate 6. A patient presents to the emergency dilation and curettage (D&C). department with lower abdominal pain and b. Administer Rh immunoglobulin if the reports a missed period. Which of the patient is Rh-negative. following actions should the nurse take c. Encourage the patient to try conceiving FIRST to assess for a possible ectopic again immediately. pregnancy? d. Provide detailed explanations of the a. Perform a pelvic examination. genetic reasons for the abortion. b. Obtain a serum pregnancy test. c. Prepare the patient for an immediate 2. A patient admitted for an elective abortion ultrasound. expresses feelings of guilt and sadness. d. Administer analgesics to manage pain. What is the nurse’s BEST response? a. Reassure the patient that these feelings 7. Which of the following symptoms would are not common. MOST likely suggest an ectopic pregnancy b. Inform the patient about the legal rights in a patient who is 6 weeks pregnant? concerning abortion. a. Nausea and vomiting. c. Validate the patient’s feelings and b. Breast tenderness. provide emotional support. c. Unilateral pelvic pain. d. Advise the patient to consider d. Frequent urination. alternative options to abortion. 8. A nurse is reviewing the medical history of 3. Which of the following is a priority nursing a patient with a suspected ectopic assessment in a patient experiencing a pregnancy. Which of the following risk suspected ectopic pregnancy? factors is MOST associated with ectopic a. Monitoring for signs of depression. pregnancy? b. Assessing for abdominal pain and a. History of multiple gestations. shoulder tip pain. b. Previous pelvic inflammatory disease c. Checking for changes in the fetal heart (PID). rate pattern. c. Use of oral contraceptive pills. d. Evaluating the patient’s understanding d. Advanced maternal age. of contraceptive methods. 9. During the initial assessment of a patient 4. A nurse is caring for a patient who has with a ruptured ectopic pregnancy, what is decided to undergo a medical abortion. the nurse’s PRIORITY intervention? Which medication does the nurse a. Assessing the patient’s blood pressure anticipate will be prescribed? and heart rate. a. Methotrexate. b. Providing emotional support to the b. Oxytocin. patient. c. Misoprostol. c. Administering prescribed methotrexate. d. Magnesium sulfate. d. Preparing the patient for laparoscopic surgery. 5. During the post-abortion care, a patient reports heavy bleeding with clots. What is 10. A patient with a confirmed ectopic the nurse’s INITIAL action? pregnancy is scheduled for methotrexate a. Instruct the patient to rest and monitor therapy. Which of the following nursing the bleeding for one more hour. actions is MOST important before b. Prepare the patient for an ultrasound to administering the medication? assess for retained products of conception. CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 a. Ensuring the patient has a designated 15. After the evacuation of a hydatidiform driver for transportation home. mole, the nurse should be alert for which b. Confirming the absence of fetal cardiac of the following complications? activity via ultrasound. a. Gestational diabetes. c. Providing the patient with dietary b. Hemorrhage. restrictions post-administration. c. Pre-eclampsia. d. Educating the patient about the d. Infection. importance of follow-up beta-hCG levels. INCOMPETENT CERVIX HYDATIDIFORM MOLE 16. A pregnant patient at 16 weeks of 11. A nurse is caring for a patient diagnosed gestation is diagnosed with an incompetent with a complete hydatidiform mole. Which cervix. Which of the following interventions of the following symptoms is MOST is MOST appropriate? commonly associated with this condition? a. Immediate delivery of the fetus. a. Hypertension. b. Administration of tocolytic medication. b. Hyperemesis gravidarum. c. Placement of a cervical cerclage. c. Oligohydramnios. d. Bed rest for the remainder of the d. Fetal movement. pregnancy. 12. During the follow-up care of a patient who 17. A nurse is providing education to a patient had a hydatidiform mole evacuation, which with an incompetent cervix. Which of the of the following instructions should the following statements by the patient nurse emphasize? indicates a need for further teaching? a. Attempt pregnancy again after one a. “I should report any signs of labor normal menstrual cycle. immediately.” b. Monitor serial hCG levels for at least one b. “I can continue my routine exercise year. program.” c. Use hormonal contraception as the only c. “I will need to have the cerclage acceptable form of birth control. removed before delivery.” d. Expect heavy menstrual periods as a d. “I should avoid heavy lifting and normal occurrence post-evacuation. prolonged standing.” 13. A patient with a partial hydatidiform mole 18. Which of the following is a risk factor for is scheduled for a suction dilation and developing an incompetent cervix? curettage (D&C). What is the PRIMARY goal a. Previous cesarean delivery. of this procedure? b. History of multiple gestations. a. To relieve symptoms of hyperemesis c. Prior cervical surgery or trauma. gravidarum. d. Overweight or obesity. b. To remove the molar tissue from the uterus. 19. After a cervical cerclage, a patient reports a c. To prevent the development of gush of fluid and vaginal spotting. What is choriocarcinoma. the nurse’s FIRST action? d. To preserve the patient’s fertility for a. Reassure the patient that this is a normal future pregnancies. postoperative occurrence. b. Prepare the patient for immediate 14. Which of the following findings on an delivery. ultrasound would MOST likely indicate a c. Assess for signs of infection or cerclage hydatidiform mole? failure. a. Clear amniotic fluid. d. Administer prescribed antibiotics b. A “snowstorm” pattern. prophylactically. c. Presence of fetal heartbeat. d. Normal placental thickness. 20. During a routine prenatal visit, a patient with a history of incompetent cervix asks CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 when the cervical cerclage will be removed. a. Immediate bed rest is necessary to The nurse should inform the patient that prevent progression to placenta previa. the cerclage is typically removed at which b. The placenta often migrates upward as gestational age? the pregnancy progresses. a. 28 weeks. c. A cesarean delivery will be scheduled in b. 32 weeks. the next few weeks. c. 36 weeks. d. Vigorous exercise is restricted for the d. 38 weeks. remainder of the pregnancy. PLACENTA PREVIA ABRUPTIO PLACENTA 21. A nurse is assessing a patient with 26. A nurse is caring for a patient with suspected placenta previa. Which symptom suspected abruptio placentae. Which of is MOST indicative of this condition? the following clinical manifestations is a. Sudden, painless vaginal bleeding. MOST indicative of this condition? b. Intense abdominal cramping. a. Painless vaginal bleeding. c. Continuous lower back pain. b. Hypertension without proteinuria. d. Frequent uterine contractions. c. Sudden onset of intense abdominal pain. d. Uterine softening and relaxation. 22. Which of the following nursing interventions is appropriate for a patient 27. Which of the following nursing with a confirmed diagnosis of placenta interventions is a PRIORITY for a patient previa? with confirmed abruptio placentae? a. Encourage the patient to engage in a. Encouraging the patient to lie flat on her moderate exercise. back. b. Perform vaginal examinations to assess b. Monitoring fetal heart rate and maternal bleeding. vital signs. c. Prepare the patient for a potential c. Administering oral iron supplements to cesarean delivery. the patient. d. Advise the patient to sleep in a prone d. Preparing the patient for an immediate position. vaginal delivery. 23. A patient with placenta previa is 28. A patient with abruptio placentae is experiencing vaginal bleeding. What is the experiencing vaginal bleeding and uterine nurse’s PRIORITY action? tenderness. What is the nurse’s FIRST a. Administer oral iron supplements. action? b. Place the patient in the Trendelenburg a. Administer prescribed tocolytics. position. b. Perform a sterile vaginal examination. c. Monitor maternal vital signs and fetal c. Place the patient in the left lateral heart rate. position. d. Instruct the patient to use tampons to d. Prepare for an emergency cesarean manage bleeding. section. 24. Which of the following is a risk factor for 29. Which of the following risk factors is MOST placenta previa? associated with abruptio placentae? a. Nulliparity. a. Maternal age over 35 years. b. Maternal age under 20. b. History of gestational diabetes. c. History of cesarean delivery. c. Cigarette smoking during pregnancy. d. Low body mass index (BMI). d. Previous cesarean delivery. 25. During a routine ultrasound, a low-lying 30. During the management of abruptio placenta is noted at 20 weeks of gestation. placentae, which laboratory test is MOST What should the nurse inform the patient important for the nurse to monitor? regarding this finding? a. Complete blood count (CBC). CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 b. Urinalysis. c) Encourage the patient to use relaxation c. Liver function tests. techniques. d. Thyroid function tests. d) Provide the patient with oral iron supplementation. NURSING INTERVENTIONS FOR BLEEDING ANEMIA DURING PREGNANCY DISORDERS IN PREGNANCY 36. A nurse is assessing a pregnant patient who 31. A nurse is caring for a patient with a has been diagnosed with iron-deficiency diagnosis of placenta previa. Which of the anemia. Which of the following dietary following interventions should the nurse recommendations is MOST appropriate? prioritize? a) Increase intake of dairy products. a) Encourage the patient to perform Kegel b) Consume more whole grain cereals. exercises. c) Add more citrus fruits to the diet. b) Prepare the patient for an immediate d) Limit consumption of red meat. vaginal delivery. 37. During a prenatal visit, a patient with c) Instruct the patient to maintain strict anemia reports fatigue and shortness of bed rest in a side-lying position. breath. What is the nurse’s PRIORITY d) Advise the patient to take aspirin for any action? discomfort. a) Advise the patient to get more sleep. 32. A patient with vasa previa is experiencing b) Instruct the patient to increase fluid painless vaginal bleeding. What is the intake. nurse’s FIRST action? c) Assess the patient’s hemoglobin and a) Administer oxygen at 2-3 L/min via nasal hematocrit levels. cannula. d) Encourage the patient to start an b) Prepare for an emergency cesarean exercise program. section. c) Perform a digital pelvic examination. 38. A pregnant patient is prescribed oral iron d) Encourage the patient to ambulate to supplements for anemia. Which of the reduce bleeding. following instructions should the nurse include when educating the patient? 33. During the assessment of a patient with a) Take the supplement with a glass of milk. suspected abruptio placentae, which b) Take the supplement with a meal to finding would the nurse report increase absorption. IMMEDIATELY? c) Expect stools to become dark green or a) Mild uterine cramping. black in color. b) Dark red vaginal bleeding. d) Discontinue the supplement if c) Firm, tender uterus. constipation occurs. d) Fetal movements felt by the patient. 39. Which of the following laboratory values 34. A nurse is developing a care plan for a would the nurse expect to find in a patient patient with a bleeding disorder during with megaloblastic anemia during pregnancy. Which intervention is MOST pregnancy? important for preventing complications? a) Decreased mean corpuscular volume a) Monitoring weight daily. (MCV). b) Assessing for signs of fetal distress. b) Increased red blood cell distribution c) Providing a diet high in vitamin K. width (RDW). d) Teaching the patient to avoid stress. c) Decreased serum folate levels. 35. A pregnant patient presents with heavy d) Increased platelet count. bleeding and a suspected uterine rupture. 40. A nurse is planning care for a pregnant What is the nurse’s PRIORITY intervention? patient with sickle cell anemia. Which of a) Apply a fetal monitor to assess fetal well- the following interventions is MOST being. important to include? b) Start an IV line and begin fluid a) Restrict physical activity to prevent joint resuscitation. CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 pain. infections. b) Administer oxygen therapy to manage d) To enhance fetal lung maturity. hypoxia. PSEUDOCYESIS c) Provide genetic counseling regarding the condition. 46. A nurse is assessing a patient who reports d) Encourage high-calorie, high-protein symptoms of pregnancy, but the urine dietary intake. pregnancy test is negative. Which of the following conditions should the nurse HYDRAMNIOS suspect? 41. A nurse is monitoring a patient with a a) Ectopic pregnancy diagnosis of hydramnios. Which of the b) Pseudocyesis following fetal conditions is MOST c) Hydramnios commonly associated with this diagnosis? d) Molar pregnancy a) Down syndrome 47. A patient with pseudocyesis is experiencing b) Anencephaly emotional distress. What is the nurse’s c) Cystic fibrosis BEST response to support the patient? d) Sickle cell anemia a) Dismiss the patient’s symptoms as 42. During a routine prenatal visit, a patient imaginary. with hydramnios reports discomfort and b) Validate the patient’s experience and difficulty breathing. What is the nurse’s provide psychological support. PRIORITY action? c) Encourage the patient to take another a) Instruct the patient to reduce fluid pregnancy test. intake. d) Advise the patient to announce her b) Advise the patient to rest in a semi- pregnancy to friends and family. Fowler’s position. 48. Which of the following is an appropriate c) Prepare the patient for immediate nursing intervention for a patient delivery. diagnosed with pseudocyesis? d) Administer diuretics as prescribed. a) Schedule regular prenatal visits. 43. A nurse is caring for a patient with b) Provide education on contraceptive hydramnios and notes a rapid increase in methods. fundal height. Which complication should c) Refer the patient for mental health the nurse be MOST alert for? counseling. a) Gestational diabetes d) Prescribe prenatal vitamins. b) Preterm labor 49. During a health history interview, a patient c) Uterine atony with pseudocyesis mentions a strong desire d) Fetal growth restriction to become pregnant. Which of the 44. Which of the following maternal conditions following responses by the nurse is MOST is a risk factor for developing hydramnios? therapeutic? a) Hypertension a) “Why do you think you’re not able to b) Diabetes mellitus become pregnant?” c) Anemia b) “It’s common for women to have d) Thyroid disorders difficulty conceiving.” c) “Let’s focus on your current health 45. A patient with hydramnios is scheduled for concerns instead of pregnancy.” an amnioreduction procedure. What is the d) “Tell me more about your feelings and PRIMARY goal of this intervention? desires regarding pregnancy.” a) To collect amniotic fluid for genetic testing. 50. A patient with pseudocyesis reports b) To relieve maternal discomfort and abdominal enlargement and amenorrhea. respiratory distress. Which of the following actions should the c) To prevent the risk of congenital nurse take FIRST? a) Reassure the patient that these are CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 normal symptoms of pregnancy. Which of the following instructions should b) Perform a comprehensive physical the nurse include? examination. a) “Avoid strong odors and spicy foods.” c) Prepare the patient for an ultrasound to b) “Lie down immediately after eating.” confirm pregnancy. c) “Take prenatal vitamins on an empty d) Discuss the possibility of adoption or stomach.” fertility treatments. d) “Increase your intake of milk products.” HYPEREMESIS GRAVIDARUM PREGNANCY-INDUCED HYPERTENSION 51. A nurse is caring for a patient diagnosed 56. A nurse is monitoring a patient for signs of with hyperemesis gravidarum. Which of preeclampsia. Which of the following the following interventions should the symptoms would indicate the onset of this nurse prioritize? condition? a) Encourage the patient to eat large, well- a) Sudden weight loss balanced meals. b) Hypotension b) Administer antiemetic medication as c) Persistent headache prescribed. d) Decreased urine output c) Instruct the patient to drink fluids only 57. Which of the following interventions is with meals. MOST appropriate for a patient with d) Recommend starting a vigorous exercise gestational hypertension? program. a) Encourage a diet high in sodium. 52. During the assessment of a patient with b) Initiate magnesium sulfate therapy. hyperemesis gravidarum, which finding c) Monitor blood pressure regularly. would the nurse report IMMEDIATELY? d) Restrict fluid intake. a) Weight loss of 5% from pre-pregnancy 58. A patient with preeclampsia has a blood weight. pressure reading of 160/110 mmHg. What b) Urine specific gravity of 1.005. is the nurse’s PRIORITY action? c) Mild epigastric pain. a) Administer an antihypertensive d) Ketones present in the urine. medication as prescribed. 53. A pregnant patient with hyperemesis b) Prepare the patient for immediate gravidarum is experiencing dehydration. cesarean delivery. Which of the following nursing actions is c) Instruct the patient to perform deep MOST appropriate? breathing exercises. a) Offer the patient ice chips. d) Place the patient in a supine position. b) Start an IV infusion of dextrose 5% in 59. During the assessment of a patient with normal saline. preeclampsia, which laboratory finding c) Encourage the patient to drink would be a cause for concern? caffeinated beverages. a) Decreased liver enzymes d) Provide oral rehydration solutions every b) Low serum creatinine two hours. c) Thrombocytopenia 54. Which of the following dietary d) Elevated white blood cell count recommendations is MOST suitable for a 60. A nurse is caring for a patient with patient recovering from hyperemesis eclampsia. Which of the following actions gravidarum? should the nurse take FIRST if the patient a) Consume a high-fiber diet. has a seizure? b) Eat frequent small meals throughout the a) Insert an oral airway. day. b) Restrain the patient’s limbs. c) Increase intake of fatty foods. c) Ensure a patent airway and safety. d) Drink fluids only during meal times. d) Administer oxygen at 10 L/min. 55. A nurse is providing discharge teaching for 61. Which of the following signs would indicate a patient with hyperemesis gravidarum. magnesium sulfate toxicity in a patient CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 being treated for severe preeclampsia? 67. Which of the following findings on a 24- a) Hyperreflexia hour urine collection would indicate b) Respiratory rate of 12 breaths per proteinuria in a patient with preeclampsia? minute a) Less than 300 mg of protein c) Urine output of 30 mL/hr b) 500 mg of protein d) Absent deep tendon reflexes c) 1 gram of protein d) 5 grams of protein 62. A patient with severe preeclampsia is receiving magnesium sulfate. Which of the 68. A patient with preeclampsia is prescribed following medications should the nurse bed rest. Which position is MOST beneficial have available in case of magnesium for this patient? sulfate overdose? a) Supine a) Naloxone b) Prone b) Calcium gluconate c) Left lateral c) Vitamin K d) Sitting upright d) Protamine sulfate 69. A patient with eclampsia is post-seizure. 63. A patient with gestational hypertension is Which of the following assessments is the advised to perform daily fetal kick counts. nurse’s PRIORITY? Which rationale BEST explains this a) Checking blood pressure instruction? b) Assessing pupil response a) To monitor for potential fetal growth c) Evaluating level of consciousness restriction. d) Monitoring for vaginal bleeding b) To assess for fetal well-being. 70. Which of the following symptoms would c) To encourage maternal-fetal bonding. the nurse expect in a patient with HELLP d) To evaluate the effectiveness of syndrome, a variant of severe antihypertensive therapy. preeclampsia? 64. Which of the following dietary a) Hemolysis modifications is recommended for a b) Elevated liver enzymes patient with mild gestational hypertension? c) Low platelet count a) Increase protein intake. d) All of the above b) Restrict fluid consumption. CARDIAC DISEASES DURING PREGNANCY c) Limit intake of fruits and vegetables. d) Reduce sodium intake. 71. A nurse is caring for a pregnant patient with a history of rheumatic heart disease. 65. A patient with preeclampsia is experiencing Which of the following assessments is blurred vision. What is the nurse’s BEST MOST important to monitor? response to this symptom? a. Daily weight a) Reassure the patient that this is a normal b. Urine output change during pregnancy. c. Fetal heart rate b) Schedule an appointment with an d. Oxygen saturation ophthalmologist. c) Assess for other signs of central nervous 72. Which of the following medications is system involvement. commonly prescribed to manage heart d) Instruct the patient to rest her eyes failure in a pregnant patient with more frequently. cardiomyopathy? a. ACE inhibitors 66. A nurse is educating a patient with b. Beta-blockers gestational hypertension about warning c. Calcium channel blockers signs. Which of the following should the d. Diuretics nurse include? a) Increased appetite 73. A pregnant patient with congenital heart b) Swelling of the face and hands disease is experiencing dyspnea and c) Decreased frequency of urination fatigue. What is the nurse’s PRIORITY d) Weight loss action? CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 a. Encourage bed rest in a semi-Fowler’s What is the nurse’s FIRST action? position a. Administer 50% dextrose intravenously b. Administer supplemental oxygen as b. Give the patient a glucagon injection prescribed c. Provide 15 grams of fast-acting c. Instruct the patient to increase fluid carbohydrate intake d. Check the patient’s urine for ketones d. Prepare for an emergency cesarean 79. During prenatal education, a nurse advises section a patient with gestational diabetes to 74. During labor, a patient with a history of perform self-monitoring of blood glucose. mitral valve stenosis develops pulmonary How often should this be done? edema. Which of the following nursing a. Once a day at a random time interventions is MOST appropriate? b. Twice a week before meals a. Place the patient in a supine position c. Four times a day, including fasting and b. Administer a rapid IV fluid bolus after meals c. Provide continuous positive airway d. Only when the patient feels pressure (CPAP) symptomatic d. Encourage deep breathing and coughing 80. A nurse is discussing dietary management exercises with a patient who has gestational 75. A nurse is providing education to a diabetes. Which of the following pregnant patient with a mechanical heart recommendations is MOST appropriate? valve. Which of the following points should a. Increase intake of simple sugars the nurse emphasize regarding b. Follow a low-carbohydrate diet anticoagulation therapy? c. Distribute carbohydrates evenly a. Discontinue anticoagulants prior to throughout the day delivery d. Skip breakfast to lower fasting glucose b. Switch from warfarin to heparin in the levels first trimester 81. Which of the following maternal risks is c. Take aspirin instead of anticoagulants associated with diabetes mellitus during during pregnancy pregnancy? d. Maintain the same dose of anticoagulant a. Decreased risk of urinary tract infections throughout pregnancy b. Increased risk of preeclampsia DIABETES MELLITUS DURING PREGNANCY c. Reduced likelihood of cesarean delivery d. Lower chance of developing anemia 76. A nurse is providing care for a pregnant patient with gestational diabetes mellitus 82. A nurse is caring for a patient with (GDM). Which of the following fetal gestational diabetes. Which of the complications should the nurse monitor following medications might be prescribed for? to manage the patient’s blood glucose a. Intrauterine growth restriction (IUGR) levels? b. Macrosomia a. Metformin c. Congenital heart disease b. Glyburide d. Oligohydramnios c. Insulin d. All of the above 77. Which of the following is the MOST appropriate initial screening test for 83. A pregnant patient with diabetes mellitus gestational diabetes mellitus? reports feeling dizzy and shaky. Which a. Fasting plasma glucose test nursing intervention is MOST appropriate? b. Oral glucose tolerance test (OGTT) a. Have the patient lie down and elevate c. Hemoglobin A1c test her feet d. Random plasma glucose test b. Offer the patient a snack with protein and complex carbohydrates 78. A pregnant patient with Type 1 diabetes c. Check the patient’s blood glucose level mellitus is experiencing hypoglycemia. immediately CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 d. Encourage the patient to drink a glass of 89. A nurse is providing education to a water pregnant patient with hypothyroidism. Which of the following points should the 84. What is the goal of blood glucose control in nurse emphasize about taking a patient with pre-existing diabetes during levothyroxine? pregnancy? a. Take the medication with food to a. To maintain blood glucose as close to increase absorption normal as possible b. Skip doses if experiencing symptoms of b. To keep blood glucose levels slightly hyperthyroidism higher than normal c. Take the medication on an empty c. To allow for occasional hyperglycemia stomach in the morning d. To prevent any episodes of d. Adjust the dose based on symptoms hypoglycemia without consulting a healthcare provider 85. Postpartum care for a patient with 90. A pregnant patient with a history of gestational diabetes should include which thyroidectomy is being monitored for of the following? thyroid hormone levels. Which of the a. Continuing the diabetes diet as during following lab results would indicate the pregnancy need for an increase in thyroid hormone b. Discontinuing blood glucose monitoring replacement therapy? c. Screening for Type 2 diabetes a. Decreased TSH (thyroid-stimulating d. Increasing caloric intake immediately hormone) after delivery b. Increased free T4 THYROID DISEASES DURING PREGNANCY c. Decreased free T4 d. Increased total T3 86. A nurse is caring for a pregnant patient with a diagnosis of hypothyroidism. Which MULTIPLE GESTATION of the following symptoms would MOST 91. A nurse is assessing a patient with a twin likely warrant an adjustment in thyroid pregnancy. Which of the following signs medication? should the nurse expect? a. Weight loss a. Decreased fundal height b. Insomnia b. Lower levels of human chorionic c. Constipation gonadotropin (hCG) d. Heat intolerance c. Increased occurrence of morning 87. During a prenatal visit, a patient with sickness hyperthyroidism reports experiencing d. Reduced fetal movement palpitations and tremors. What is the 92. During an ultrasound of a multiple nurse’s PRIORITY action? gestation pregnancy, the nurse notes that a. Advise the patient to avoid caffeine the fetuses share a single placenta. What b. Check the patient’s thyroid hormone type of twins does this indicate? levels a. Dizygotic twins c. Instruct the patient to perform relaxation b. Monozygotic monochorionic twins techniques c. Monozygotic dichorionic twins d. Increase the patient’s dose of antithyroid d. Conjoined twins medication 93. A patient with a quadruplet pregnancy is at 88. Which of the following fetal complications increased risk for which of the following is associated with uncontrolled complications? hyperthyroidism during pregnancy? a. Gestational diabetes a. Macrosomia b. Preterm labor b. Congenital hypothyroidism c. Intrauterine growth restriction (IUGR) c. Fetal tachycardia d. All of the above d. Intrauterine growth restriction (IUGR) CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 94. Which of the following interventions is the following findings would be a cause for MOST important for a nurse to perform concern? when caring for a patient in labor with a. Weight gain of 25 pounds twins? b. Fundal height of 35 cm a. Prepare for a vaginal delivery for both c. Regular contractions every 10 minutes twins d. Presence of fetal movement for both b. Monitor the mother and both fetuses twins continuously 100. Postpartum care for a mother who c. Encourage ambulation between delivered triplets should include deliveries of twins monitoring for which of the following d. Administer tocolytics to delay the second conditions? twin’s delivery a. Postpartum hemorrhage 95. A nurse is providing education to a patient b. Rapid weight loss pregnant with twins. Which of the c. Decreased milk production following nutritional recommendations d. Hypertension should the nurse make? a. Consume the same amount of calories as a singleton pregnancy b. Double the intake of prenatal vitamins c. Increase caloric intake by approximately 300-500 calories per day d. Restrict fluid intake to prevent edema 96. A patient with a twin pregnancy is experiencing back pain and varicose veins. Which of the following measures should the nurse suggest? a. Limit physical activity to bed rest b. Wear supportive stockings and elevate legs when possible c. Apply heat to the affected veins d. Increase intake of sodium to improve circulation 97. During a prenatal visit, a patient with triplets reports feeling short of breath. What is the nurse’s BEST response? a. Reassure the patient that this is a normal symptom of triplet pregnancy b. Instruct the patient to practice deep breathing exercises c. Assess for signs of anemia or cardiac issues d. Advise the patient to sleep in a recliner 98. Which of the following is a risk factor for developing multiple gestation pregnancy? a. Maternal age under 20 b. Use of assisted reproductive technologies (ART) c. Low body mass index (BMI) d. Previous singleton pregnancies 99. A nurse is caring for a patient with a twin pregnancy at 32 weeks gestation. Which of CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 PREMATURE LABOR 7. A nurse is monitoring a patient for signs of preterm labor. Which of the following 1. A nurse is caring for a patient experiencing symptoms should prompt the nurse to premature labor at 34 weeks gestation. contact the healthcare provider? Which of the following medications should a) Occasional nausea the nurse anticipate administering to b) Frequent urination accelerate fetal lung maturity? c) Low backache a) Oxytocin d) Pelvic pressure b) Betamethasone c) Ibuprofen 8. A patient at 32 weeks gestation with a d) Magnesium sulfate history of premature labor is experiencing contractions every 10 minutes. What is the 2. Which of the following signs and symptoms nurse’s BEST response? would MOST likely indicate premature a) Advise the patient to take a warm bath. labor? b) Instruct the patient to lie down on her left a) Braxton Hicks contractions side. b) Decreased fetal movement c) Tell the patient to wait until the c) Regular uterine contractions contractions are 5 minutes apart. d) Increased energy levels d) Prepare to administer tocolytic therapy 3. A nurse is providing education to a patient as prescribed. at risk for premature labor. Which of the 9. Which of the following assessments is following instructions is MOST important? MOST important for a nurse to perform on a) Limit physical activity and rest as much as a patient at risk for premature labor? possible. a) Daily weight measurement b) Drink at least eight glasses of water per b) Vaginal pH testing day. c) Fetal heart rate monitoring c) Ignore mild contractions unless they d) Measurement of fundal height become painful. d) Perform daily fetal kick counts. 10. A nurse is caring for a patient who delivered prematurely. Which of the 4. During an assessment of a patient in following postpartum complications should premature labor, the nurse notes a bulging the nurse monitor for? amniotic sac. What is the nurse’s PRIORITY a) Postpartum hemorrhage action? b) Postpartum depression a) Instruct the patient to push. c) Subinvolution of the uterus b) Prepare for immediate delivery. d) All of the above c) Place the patient in the Trendelenburg position. HEMOLYTIC DISEASE DURING PREGNANCY d) Administer tocolytic medication as 11. A nurse is caring for a pregnant patient prescribed. with a known risk for hemolytic disease of 5. A patient in premature labor is prescribed the fetus and newborn (HDFN). Which of nifedipine. What is the PRIMARY purpose the following laboratory tests is MOST of this medication? important to monitor? a) To relieve pain a) Maternal serum alpha-fetoprotein b) To reduce blood pressure b) Maternal serum indirect bilirubin c) To suppress contractions c) Fetal umbilical cord blood hemoglobin d) To prevent infection d) Fetal scalp blood pH 6. Which of the following risk factors is MOST 12. Which of the following interventions is associated with premature labor? MOST appropriate for a newborn with a) Advanced maternal age HDFN? b) Multiparity a) Immediate breastfeeding initiation c) History of cervical conization b) Phototherapy d) Gestational diabetes CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 c) Oral iron supplementation b) Neonatal conjunctivitis d) Routine vaccination c) Congenital heart disease d) Umbilical hernia 13. A nurse is providing education to a Rh- negative mother who has just given birth to 19. During a prenatal visit, a patient tests an Rh-positive baby. Which of the following positive for chlamydia. Which of the medications should the nurse prepare to following treatments should the nurse administer? expect to be prescribed? a) Rho(D) immune globulin a) Oral metronidazole b) Intravenous immunoglobulin b) Intramuscular penicillin c) Erythropoietin c) Oral azithromycin d) Folic acid d) Topical antifungal cream 14. During a prenatal visit, a patient with a SYPHILIS DURING PREGNANCY history of a child with HDFN asks about the 20. A nurse is caring for a pregnant patient risk to her current pregnancy. Which of the diagnosed with syphilis. Which of the following factors MOST influences the risk? following interventions is MOST important a) Maternal blood type to prevent congenital syphilis in the b) Paternal blood type newborn? c) Presence of maternal antibodies a) Administering penicillin to the mother d) Gestational age during pregnancy 15. A nurse is assessing a newborn for signs of b) Performing a cesarean section HDFN. Which of the following findings c) Giving the newborn hepatitis B vaccine would be a cause for concern? d) Treating the newborn with antiviral a) Pale skin color medication b) Jaundice within the first 24 hours of life 21. During a prenatal visit, a patient tests c) A high-pitched cry positive for syphilis. Which of the following d) All of the above findings should the nurse anticipate in the GONORRHEA DURING PREGNANCY newborn if congenital syphilis occurs? a) Cleft lip and palate 16. A nurse is caring for a pregnant patient b) Hepatosplenomegaly and rash diagnosed with gonorrhea. Which of the c) Polydactyly following complications should the nurse d) Congenital heart disease monitor for in the newborn? a) Cleft lip CANDIDIASIS DURING PREGNANCY b) Ophthalmia neonatorum 22. A nurse is caring for a pregnant patient c) Congenital heart defect who presents with a thick, white vaginal d) Talipes equinovarus (clubfoot) discharge and pruritus. Which of the 17. During a prenatal visit, a patient tests following treatments should the nurse positive for gonorrhea. Which of the anticipate to be prescribed? following treatments should the nurse a) Oral fluconazole expect to be prescribed? b) Intravenous acyclovir a) Oral metronidazole c) Topical clotrimazole b) Intramuscular ceftriaxone d) Oral metronidazole c) Oral acyclovir 23. During a prenatal visit, a patient reports d) Topical miconazole symptoms suggestive of vaginal candidiasis. CHLAMYDIA DURING PREGNANCY Which of the following is an important nursing intervention to help prevent 18. A nurse is caring for a pregnant patient recurrence? diagnosed with chlamydia. Which of the a) Advise the patient to wear tight-fitting following complications should the nurse synthetic underwear. monitor for in the newborn? b) Recommend the use of scented feminine a) Cleft palate hygiene products. CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 c) Suggest dietary changes such as reducing c) High likelihood of congenital heart sugar intake. defects d) Instruct the patient to take warm baths d) Increased chance of preterm labor daily. 29. During a prenatal visit, a patient with HPV Trichomoniasis During Pregnancy expresses concern about the mode of delivery. Which of the following is the 24. A nurse is caring for a pregnant patient MOST appropriate response by the nurse? diagnosed with trichomoniasis. Which of a) “HPV has no impact on the mode of the following symptoms should the nurse delivery; you can proceed with a vaginal expect the patient to report? birth.” a) Abdominal cramping b) “A cesarean section is necessary for all b) Profuse, frothy, greenish-yellow vaginal HPV-positive mothers to prevent discharge transmission.” c) Absence of vaginal discharge c) “The mode of delivery will be d) Fever and chills determined by the type of HPV and 25. During a prenatal visit, a patient tests presence of genital warts.” positive for trichomoniasis. Which of the d) “You should consider only elective following treatments should the nurse cesarean section to eliminate the risk of expect to be prescribed? transmission.” a) Oral metronidazole HIV/AIDS INFECTION DURING PREGNANCY b) Topical antifungal cream c) Intravenous acyclovir 30. A nurse is providing prenatal care to a d) Oral fluconazole patient with HIV. Which of the following antiretroviral regimens should the nurse BACTERIAL VAGINOSIS DURING PREGNANCY expect to be prescribed to reduce the risk 26. A nurse is caring for a pregnant patient of mother-to-child transmission? diagnosed with bacterial vaginosis. Which a) Zidovudine (AZT) monotherapy of the following symptoms is the patient b) Highly active antiretroviral therapy MOST likely to report? (HAART) a) Itching and redness around the vulva c) Intermittent short-course therapy b) Pain during urination d) No antiretroviral therapy during c) Fishy vaginal odor and thin, gray pregnancy discharge 31. Which of the following is a recommended d) Lesions on the external genitalia method to reduce the risk of HIV 27. During a prenatal visit, a patient is found to transmission from mother to baby during have bacterial vaginosis. Which of the the birthing process? following treatments should the nurse a) Vaginal delivery with episiotomy expect to be prescribed? b) Elective cesarean section before the a) Oral fluconazole onset of labor b) Intravenous acyclovir c) Natural water birth c) Oral metronidazole or clindamycin d) Home birth with a midwife d) Topical antifungal cream 32. A pregnant patient with HIV presents with HUMAN PAPILLOMAVIRUS DURING a CD4 count of 250 cells/mm³. What is the PREGNANCY nurse’s PRIORITY concern? a) The patient is at increased risk for 28. A nurse is providing care to a pregnant opportunistic infections. patient diagnosed with HPV. Which of the b) The patient is likely to transmit HIV to following fetal risks should the nurse the baby. discuss with the patient? c) The patient will require immediate a) Increased risk of fetal macrosomia initiation of antiretroviral therapy b) Potential for respiratory papillomatosis postpartum. in the newborn CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 d) The patient’s CD4 count indicates an indicate the greatest risk for perinatal immediate need for cesarean delivery. transmission? a) Undetectable viral load 33. During labor, a nurse notes that a patient b) Viral load of 200 copies/mL with HIV has a ruptured membrane for c) Viral load of 1,000 copies/mL over 4 hours. Which of the following d) Viral load of 10,000 copies/mL actions should the nurse take? 38. Which of the following statements by a a) Continue to monitor the patient as this is pregnant patient with HIV indicates a need a normal finding. for further education? b) Prepare for an immediate vaginal a) “I will need to take antiretroviral delivery. medication throughout my pregnancy.” c) Administer intravenous antibiotics as b) “I can reduce the risk of transmitting HIV prescribed. to my baby by having a vaginal delivery.” d) Notify the healthcare provider to c) “I should not breastfeed my baby to consider an emergency cesarean section. prevent transmission of HIV.” d) “My baby will receive medication after 34. A nurse is counseling a patient with HIV on birth to prevent HIV infection.” infant feeding options. Which of the following is the MOST appropriate 39. A nurse is planning postpartum care for a recommendation? patient with HIV. Which of the following is the MOST important aspect of care? a) Breastfeeding exclusively for the first 6 a) Encouraging the patient to express months emotions about her diagnosis b) Mixed feeding with breast milk and b) Coordinating care with a formula multidisciplinary team for ongoing c) Exclusive formula feeding from birth management d) Pumping and discarding breast milk to c) Advising the patient to avoid future stimulate supply pregnancies d) Recommending natural remedies to 35. Which of the following is an important boost the immune system consideration for a nurse when caring for a newborn whose mother is HIV-positive? HEPATITIS B INFECTION DURING PREGNANCY a) Delaying the first bath to preserve maternal antibodies 40. A nurse is caring for a pregnant patient b) Administering zidovudine (AZT) with hepatitis B. Which of the following is prophylaxis to the newborn the MOST effective way to prevent c) Encouraging immediate skin-to-skin perinatal transmission of hepatitis B to the contact to promote bonding newborn? d) Initiating breastfeeding within the first a) Administer hepatitis B vaccine to the hour of life newborn within 12 hours of birth. 36. A pregnant patient with HIV is experiencing b) Give the newborn hepatitis B immune preterm labor. Which of the following globulin (HBIG) within 24 hours of birth. factors should the nurse consider when c) Both A and B planning care? d) Avoid breastfeeding a) The use of tocolytics may be contraindicated due to potential drug 41. A nurse is assessing a newborn whose interactions. mother has hepatitis B. Which of the b) Preterm labor is unrelated to the following findings would be a cause for patient’s HIV status. concern? c) Immediate delivery is preferred a) Jaundice within the first 24 hours of life regardless of gestational age. b) Weight within the normal range for d) Antiretroviral therapy should be gestational age discontinued during preterm labor. c) Hepatitis B vaccination given at birth 37. A nurse is reviewing the laboratory results d) HBIG administration within 12 hours of of a pregnant patient with HIV. Which of birth the following viral load results would CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 42. Which of the following is an important 47. The nurse concludes that both clotting and nursing intervention for a newborn of a bleeding occur during DIC due to which hepatitis B positive mother? process? a) Delay the first dose of the hepatitis B a) Tissue damage from bleeding uses up vaccine until the baby is 6 months old. clotting factors quicker than they can be b) Administer the first dose of the hepatitis replaced. B vaccine within 12 hours of birth. b) Activation of intrinsic pathways results in c) Wait for confirmation of HBsAg status in release of excess clotting factors. the newborn before administering the c) Only clotting occurs during DIC, as vaccine. clotting factors are replaced and available d) Provide the hepatitis B vaccine only if to prevent excess bleeding. the mother’s viral load is high. d) Excess release of thrombin uses up clotting factors quicker than they can be CHORIOAMNIONITIS replaced. 43. A nurse is caring for a patient in labor who 48. A patient with DIC during pregnancy is has developed a fever, tachycardia, and exhibiting signs of microvascular uterine tenderness. Which of the following thrombosis. Which of the following conditions should the nurse suspect? interventions should the nurse prioritize? a) Urinary tract infection a) Administration of clotting factors b) Chorioamnionitis b) Administration of anticoagulants c) Preeclampsia c) Application of a tourniquet to affected d) Endometritis limbs 44. Which of the following interventions is d) Immediate initiation of thrombolytic MOST appropriate for a patient diagnosed therapy with chorioamnionitis? 49. Which condition should the nurse identify a) Immediate cesarean delivery as a trigger for the clotting cascade in DIC b) Administration of intravenous antibiotics during pregnancy? c) Oral administration of antipyretics only a) Aortic aneurysm d) Expectant management with close b) Preeclampsia monitoring c) Placental abruption 45. A nurse is reviewing the risk factors for d) Sepsis developing chorioamnionitis with a FETAL DEATH IN UTERO pregnant patient. Which of the following should the nurse include as a risk factor? 50. A nurse is caring for a patient at 32 weeks a) Multiple gestation pregnancy gestation who has not felt fetal movement b) Maternal diabetes for the past 12 hours. Which of the c) Prolonged rupture of membranes following actions should the nurse take d) Advanced maternal age FIRST? a) Perform a non-stress test. DISSEMINATED INTRAVASCULAR b) Provide reassurance that this is normal COAGULATION DURING PREGNANCY in late pregnancy. 46. A nurse is caring for a pregnant patient c) Schedule an immediate ultrasound. with suspected DIC. Which of the following d) Instruct the patient to drink cold water laboratory findings should the nurse to stimulate fetal movement. expect? 51. Which of the following risk factors is MOST a) Elevated platelet count associated with fetal death in utero? b) Prolonged prothrombin time (PT) a) Maternal age over 40 c) Decreased fibrin degradation products b) History of preterm labor (FDP) c) Maternal hypertension d) Shortened activated partial d) Gestational diabetes well-controlled thromboplastin time (aPTT) with diet CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 52. A nurse finds no fetal heart tones on b) Apply warm compresses to the affected Doppler auscultation during a routine area. prenatal visit. What is the nurse’s NEXT c) Administer prescribed pain medication step? and apply ice packs. a) Reassure the patient that the fetus is d) Instruct the patient to perform Kegel likely in a position that makes heart tones exercises every hour. difficult to detect. TORCH COMPLEX b) Refer the patient for a biophysical profile. 57. A nurse is caring for a pregnant patient c) Attempt to locate the fetal heart tones who has been diagnosed with a TORCH with a fetoscope. infection. Which of the following is the d) Arrange for an expedited obstetric MOST likely cause of this diagnosis? evaluation. a) Trauma during a previous delivery b) A group of infections that can cause 53. During the management of a patient with a congenital anomalies confirmed fetal death in utero, which of c) Exposure to teratogenic medications the following nursing interventions is d) Genetic abnormalities in the fetus MOST important? a) Preparing for immediate induction of 58. Which of the following infections is NOT labor typically included in the TORCH complex? b) Providing emotional support and grief a) Toxoplasmosis counseling b) Rubella c) Administering Rho(D) immune globulin if c) Hepatitis B the patient is Rh-negative d) Cytomegalovirus d) All of the above 59. A newborn exhibits signs of a TORCH POSTPARTUM HEMATOMA infection. Which of the following symptoms would the nurse expect to find? (Select all 54. A nurse is assessing a patient 12 hours that apply.) postpartum who reports severe perineal a) Jaundice pain unrelieved by analgesics. On b) Purpuric rash examination, the nurse notes swelling and c) Microcephaly discoloration in the perineal area. Which of d) Cardiac murmurs the following actions should the nurse take e) Hepatosplenomegaly FIRST? a) Apply an ice pack to the perineal area. 60. A pregnant patient is concerned about the b) Administer additional analgesics as risk of contracting a TORCH infection. prescribed. Which of the following measures should c) Notify the healthcare provider the nurse advise to prevent immediately. Toxoplasmosis? d) Encourage the patient to use a sitz bath. a) Avoid changing cat litter b) Receive the annual flu vaccine 55. Which of the following risk factors is MOST c) Practice safe sex associated with the development of a d) Wash hands frequently postpartum hematoma? a) Prolonged second stage of labor 61. During a prenatal visit, a patient tests b) History of chronic hypertension positive for a TORCH infection. Which of c) Maternal age below 20 years the following treatments should the nurse d) Gestational diabetes expect to be prescribed? a) Antibiotics, antivirals, or other specific 56. A patient develops a vulvar hematoma treatments depending on the infection after a vaginal delivery. Which of the b) Corticosteroids to reduce inflammation following nursing interventions is MOST c) No treatment, as TORCH infections are appropriate to manage the patient’s pain self-limiting and promote healing? a) Encourage frequent ambulation. CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 d) Immediate delivery regardless of c) Keep the home well-ventilated gestational age d) Breastfeed to provide the baby with antibodies TUBERCULOSIS DURING PREGNANCY e) Avoid public transportation 62. A nurse is caring for a pregnant patient 67. Which of the following symptoms in a diagnosed with TB. Which of the following pregnant patient would MOST likely medications is considered safe to continue suggest TB and warrant further during pregnancy? investigation? a) Rifampin a) Intermittent nausea and vomiting b) Pyrazinamide b) Persistent cough lasting more than three c) Ethambutol weeks d) Isoniazid c) Occasional shortness of breath after 63. Which of the following is a priority nursing activity intervention for a pregnant patient with d) Frequent urination active TB? OBESITY IN PREGNANCY a) Placing the patient in airborne isolation b) Encouraging increased fluid intake 68. Which of the following complications is a c) Administering a bacillus Calmette-Guérin pregnant patient with obesity at an (BCG) vaccine increased risk for? d) Recommending bed rest throughout the a) Gestational diabetes pregnancy b) Oligohydramnios c) Fetal growth restriction 64. A pregnant patient with TB is concerned d) Low birth weight about the risk of transmission to the fetus. Which of the following statements by the 69. A nurse is assessing a pregnant patient with nurse is MOST accurate? obesity. Which of the following findings a) “TB can cross the placenta and infect the would warrant further investigation for fetus during pregnancy.” preeclampsia? b) “TB does not cross the placenta, but a) Blood pressure of 120/80 mmHg your baby can be infected during delivery.” b) Trace proteinuria c) “There is no risk of transmitting TB to c) Sudden weight gain and edema your baby during pregnancy or delivery.” d) Fasting blood glucose of 90 mg/dL d) “The risk of transmission is high, but 70. Which of the following is an important taking your medications can reduce this consideration for postpartum care in a risk.” patient with obesity? 65. During a prenatal visit, a nurse identifies a a) Encouraging rapid weight loss patient at high risk for TB. Which of the immediately after delivery following actions should the nurse take b) Monitoring for signs of postpartum FIRST? hemorrhage a) Administer a tuberculin skin test (TST) c) Recommending a strict diet to return to b) Start the patient on prophylactic TB pre-pregnancy weight treatment d) Discontinuing blood glucose monitoring c) Schedule the patient for a chest X-ray after delivery d) Isolate the patient immediately PREMATURE RUPTURE OF MEMBRANES 66. A nurse is educating a pregnant patient on (PROM) how to prevent TB transmission to family 71. A nurse is caring for a patient at 34 weeks members. Which of the following gestation who reports a sudden gush of instructions should the nurse include? fluid from the vagina. What is the nurse’s (Select all that apply.) FIRST action? a) Wear a surgical mask when around a) Perform a sterile speculum examination. others b) Prepare for immediate delivery. b) Take all TB medications as prescribed c) Administer tocolytics. CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 d) Confirm fluid is amniotic fluid using a a) Push the cord back into the uterus. Nitrazine test. b) Cover the cord with a warm, moist sterile saline gauze. 72. Which of the following maternal conditions c) Instruct the patient to pant and avoid is associated with an increased risk of pushing. PROM? d) Elevate the presenting fetal part off the a) Chronic hypertension cord manually. b) Gestational diabetes c) Intrauterine infection 79. Which maternal position is recommended d) Pre-existing renal disease to reduce the risk of umbilical cord compression in the event of a prolapsed 73. Following PROM, the nurse should cord? prioritize monitoring for which of the a) Supine. following complications? b) Trendelenburg. a) Maternal hypotension c) Left lateral. b) Fetal bradycardia d) Sitting upright. c) Signs of maternal infection d) Immediate onset of labor 80. During delivery, the umbilical cord prolapses. Which medication might the 74. A patient with PROM at 36 weeks gestation nurse administer to relieve cord has no signs of labor. What is the MOST compression? appropriate nursing intervention? a) Oxytocin. a) Encourage ambulation to induce labor. b) Tocolytics. b) Administer corticosteroids for fetal lung c) Magnesium sulfate. maturity. d) Methylergonovine. c) Prepare for cesarean delivery. d) Monitor for signs of placental abruption. SUPINE HYPOTENSION SYNDROME (VENA CAVA SYNDROME) 75. The nurse is reviewing orders on a patient admitted for PROM. Which physician order 81. What is the primary cause of supine will the nurse question? hypotension syndrome in pregnancy? a) Perform a vaginal exam every shift. a) Dehydration. b) Monitor maternal temperature every 4 b) Compression of the vena cava. hours. c) Gestational diabetes. c) Continuous fetal heart rate monitoring. d) Preeclampsia. d) Ampicillin 1 gm IVPB q 6 hours. 82. Which symptom is MOST indicative of PROLAPSED UMBILICAL CORD supine hypotension syndrome? a) Epigastric pain. 76. Upon suspicion of a prolapsed umbilical b) Dizziness when lying on the back. cord, what is the nurse’s FIRST action? c) Swelling in the legs. a) Prepare for a cesarean section. d) Shortness of breath. b) Place the patient in the knee-chest position. 83. What is the BEST nursing intervention for a c) Administer oxygen at 10 L/min. patient experiencing supine hypotension d) Perform a vaginal exam. syndrome? a) Elevate the head of the bed. 77. Which fetal heart rate pattern is MOST b) Have the patient lie on her left side. concerning for a prolapsed umbilical cord? c) Increase intravenous fluid rate. a) Tachycardia. d) Administer oxygen. b) Bradycardia. c) Variable decelerations. 84. Which complication is associated with d) Late decelerations. untreated supine hypotension syndrome? a) Fetal tachycardia. 78. A patient’s water breaks and the umbilical b) Maternal hypoxia. cord is visible at the vaginal opening. What c) Decreased fetal movement. should the nurse do IMMEDIATELY? d) Maternal bradycardia. CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH SCIENCES BSN – COMPETENCY APPRAISAL MATERNAL AND CHILD HEALTH NURSING EXAM 4 AND 5 85. A pregnant patient reports feeling faint and a. Encourage the patient to rest. nauseous when lying flat. What should the b. Provide continuous fetal monitoring. nurse advise? c. Administer a tocolytic medication. a) “Try to rest in a semi-Fowler’s position.” d. Initiate oxytocin infusion. b) “This is normal and will pass.” 92. A patient in labor has not progressed past 4 c) “Increase your fluid intake.” cm dilation after 8 hours. What condition d) “Lie on your right side instead.” does this indicate? PRECIPITOUS LABOR AND DELIVERY a. Prolonged latent phase. b. Active labor. 86. What is the definition of precipitous labor? c. Early labor. a. Labor that lasts more than 18 hours. d. Transition phase. b. Labor that progresses to delivery in less than 3 hours. 93. What is the FIRST line of management for a c. Labor that requires induction. patient diagnosed with arrest disorder d. Labor that begins before 37 weeks of during labor? gestation. a. Cesarean delivery. b. Augmentation with oxytocin. 87. Which maternal condition is a risk factor c. Immediate use of forceps. for precipitous labor? d. Epidural analgesia. a. Obesity. b. Multiparity. 94. Which maternal factor is MOST commonly c. Hypertension. associated with protraction disorders? d. Diabetes. a. Inadequate uterine contractions. b. Excessive analgesic use. DYSTOCIA (PROTRACTION DISORDERS, c. Maternal exhaustion. ARREST DISORDERS, PROLONGED SECOND d. Overdistended bladder. STAGE, INEFFECTIVE UTERINE FORCES, PROLONGED LABOR) 95. During labor, a patient’s cervix dilates from 4cm to 5cm over 4 hours. What does this 88. A nurse is caring for a patient in labor who suggest? has been diagnosed with a protraction a. Normal labor progression. disorder. Which intervention should the b. Protraction disorder. nurse prioritize? c. Arrest disorder. a. Administering IV fluids. d. Ineffective pushing. b. Providing pain relief. c. Augmenting labor with oxytocin. 96. A patient in active labor has not d. Preparing for cesarean delivery. experienced cervical change for 2 hours. What is the nurse’s NEXT step? 89. Which of the following is a risk factor for a. Encourage the patient to walk around. arrest disorders during labor? b. Perform a sterile vaginal exam. a. Maternal age under 20. c. Prepare for an emergency cesarean b. Multiparity. section. c. Epidural analgesia. d. Administer oxytocin as prescribed. d. Previous rapid labor. 97. Which intervention is MOST appropriate 90. A patient has been pushing for 3 hours with for a patient with a prolonged second stage little progress. What condition does this of labor? suggest? a. Encouraging the patient to push harder. a. Prolonged second stage of labor. b. Administering pain relief as needed. b. Ineffective uterine forces. c. Preparing for operative vaginal delivery. c. Precipitous labor. d. Increasing the frequency of vaginal d. Cephalopelvic disproportion. exams. 91. During labor, a patient exhibits weak and 98. A patient with a prolon