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    Exam Review

    1. A pregnant woman at 37 weeks’ gestation has had ruptured membranes for 38 hours. A cesarean is performed for failure to progress. FHR baseline before birth was 180 BPM with marked variability. At birth, the newborn had Apgar scores of 6 and 7 at one and five minutes and is now noted to be pale and tachypneic. Based on the maternal history, what is the most likely cause of this newborn’s distress?
      A)
      Hypoxia.
      B)
      Respiratory distress syndrome.
      C)
      Sepsis.
      D)
      Phrenic nerve injury.
    2. A full-term LGA infant is 3 hours of age and has a blood glucose level of 35 g/dL. The neonate appears to be trembling. Which of the following actions should the nurse perform at this time?
      A)
      Tightly swaddle the baby.
      B)
      Feed the baby formula or breast milk, and recheck the glucose 30 minutes after feeding.
      C)
      Monitor the baby’s urinary output.
      D)
      Transfer the infant to the NICU immediately.
    3. A macrosomic infant is born after a difficult delivery. After stabilization, the infant is weighed, and the birth weight is 4550 g (9 pounds, 6 ounces). The nurse’s most appropriate action is to:
      A)
      Leave the infant in the room with the mother.
      B)
      Take the infant immediately to the nursery.
      C)
      Monitor blood glucose levels frequently, and observe closely for signs of hypoglycemia.
      D)
      Perform a gestational age assessment to determine if the infant is LGA.
    4. There is a baby in the neonatal intensive care unit (NICU) who is exhibiting signs of neonatal abstinence syndrome. Which of the following medications are contraindicated for this neonate?
      A)
      Narcan.
      B)
      Phenobarbital.
      C)
      Methadone.
      D)
      Morphine.
    Page 1 of 12

    Exam Review

    1. Which of the following statements most accurately describes postpartum depression (PPD)?
      A)
      PPD will disappear on its own without outside help.
      B)
      PPD is the baby blues” that includes a visit with a counselor or psychologist.
      C)
      PPD is more common among older Caucasian women.
      D)
      PPD is distinguished by irritability, severe anxiety, and panic attacks.
    2. A baby is born with a diaphragmatic hernia. Which of the following signs/symptoms would the nurse likely observe in the delivery room?
      A)
      Projectile vomiting.
      B)
      High-pitched crying.
      C)
      Respiratory distress.
      D)
      Fecal incontinence.
    3. A baby is in the NICU whose mother was addicted to heroin during the pregnancy. Which of the following nursing actions would be appropriate?
      A)
      Place the infant prone in the crib.
      B)
      Tightly swaddle the infant and dim the lights.
      C)
      Provide needed stimulation to the baby.
      D)
      Feed the baby half-strength formula.
    4. A 42-week gestation baby has been admitted to the neonatal intensive care unit. At delivery, thick green amniotic fluid was noted. Which of the following actions by the nurse is most critical at this time?
      A)
      Ophthalmic assessment to check for conjunctival irritation.
      B)
      Rectal temperature to assess for septic hyperthermia.
      C)
      Bath to remove meconium-stained fluid from the skin.
      D)
      Respiratory evaluation to monitor for respiratory distress.
    Page 2 of 12

    Exam Review

    1. A mother of a preterm baby is performing skin-to-skin contact in the neonatal nursery. Which of the following responses would the nurse evaluate as a positive neonatal outcome?
      A)
      Respiratory rate of 75.
      B)
      Temperature of 96.5°F.
      C)
      Sucking or licking of mother’s nipples.
      D)
      Flaring of the baby’s nares.
    2. Which measure would the nurse expect for preventing postpartum hemorrhage?
      A)
      Manually removing the placenta after delivery.
      B)
      Administering broad-spectrum antibiotics for 48 hours.
      C)
      Applying pressure to the umbilical cord to remove the placenta.
      D)
      Encouraging frequent urination.
    3. The nurse is caring for a couple who are in the labor and delivery unit immediately after the birth of a stillborn baby who exhibited severe birth defects. Which of the following actions by the nurse is appropriate?
      A)
      Advise the parents that their baby had birth defects.
      B)
      Discourage the parents from naming the baby.
      C)
      Give the parents a lock of the baby’s hair and a copy of the footprint sheet, and let them hold the baby.
      D)
      Transport the baby to the morgue as soon as possible to avoid further emotional distress.
    4. When a woman is diagnosed with postpartum depression (PPD) with psychotic features, what is the nurse’s primary concern in planning the client’s care?
      A)
      Harm to herself or her infant.
      B)
      Displaying outbursts of anger.
      C)
      Neglecting her hygiene.
      D)
      Losing trust in her husband.
    Page 3 of 12

    Exam Review

    1. A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests:
      A)
      Infection of the uterus.
      B)
      Uterine atony.
      C)
      Perineal hematoma.
      D)
      Lacerations of the genital tract.
    2. On day 3 of life, a newborn continues to require 100% oxygen by nasal cannula. The parents ask whether they can hold their infant during his next gavage feeding. Given that this newborn is physiologically stable, what response would the nurse give?
      A)
      Parents are not allowed to hold infants who depend on oxygen.
      B)
      You may hold your baby during the feeding.
      C)
      You may hold only your baby’s hand during the feeding.
      D)
      Feedings cause more physiological stress, so the baby should not be held during feedings.
    3. The parents of a 28-week gestation neonate ask the nurse, “Why does he have to be fed through a tube in his mouth? What is the nurse’s best response?”
      A)
      The baby’s sucking, swallowing, and breathing are not coordinated yet.
      B)
      The baby’s stomach cannot digest formula at this time.
      C)
      It allows us to accurately determine the baby’s intake since he is so small.
      D)
      It helps to prevent thrush, an infection that could affect the baby’s mouth.
    4. Medications used to manage postpartum hemorrhage (PPH) include: (Select all that apply)
      A)
      Hemabate.
      B)
      Terbutaline.
      C)
      Oxytocin.
      D)
      Methergine.
    Page 4 of 12

    Exam Review

    1. A patient, one day postpartum, is being monitored carefully after a significant postpartum hemorrhage. Which of the following should the nurse report to the obstetrician?
      A)
      Urine output of 40 mL in the last 8 hours.
      B)
      Drop in hematocrit of 2% since admission.
      C)
      Weight decrease of 2 lbs since delivery.
      D)
      Pulse rate of 68 beats per minute.
    2. A nurse has administered methergine (methylergonovine) 0.2 mg to a grand multipara (G7, P6) who delivered vaginally 30 minutes earlier. Which of the following outcomes indicates that the medication is effective?
      A)
      Pulse rate 80 and regular.
      B)
      Fundus firm at umbilicus, lochia moderate.
      C)
      Blood pressure 120/80.
      D)
      Increase in prothrombin time.
    3. The nurse is making a home visit three weeks postpartum. The nurse suspects the client is experiencing postpartum depression when she makes which of the following statements?
      A)
      “I am really tired, and look forward to someday sleeping all night again.”.
      B)
      “I have been getting a headache every once in a while, but it subsides when I take Tylenol.”.
      C)
      “I feel like I am crying for no apparent reason, and I feel sad every day.”.
      D)
      “I am feeling restless a lot lately.”.
    4. A client who is two weeks postpartum calls her obstetrician’s nurse and states that she has had a white discharge for about a week but today she is bleeding and saturating one pad about every 30 minutes. Which of the following is the appropriate response from the nurse?
      A)
      “That is normal; you may have loosened your stitches.”.
      B)
      “You may be starting to menstruate again.”.
      C)
      “Go to the emergency department.”.
      D)
      “You should stay on complete bed rest until the bleeding subsides.”.
    Page 5 of 12

    Exam Review

    1. The nurse caring for the postpartum client who has developed thrombophlebitis is providing instructions in the management of this condition. Which client statement indicates the need for further instruction?
      A)
      “I will wear my elastic stockings as prescribed.”.
      B)
      “I will massage my affected leg regularly.”.
      C)
      “I will avoid prolonged sitting.”.
      D)
      “I will elevate my leg if it is swollen.”.
      E)
      “I will elevate my leg if it is swollen.”.
    2. The initial nursing intervention when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to:
      A)
      Prepare the woman for surgical intervention.
      B)
      Perform fundal massage.
      C)
      Establish venous access.
      D)
      Catheterize the bladder.
    3. Which instruction should be included in the discharge teaching plan to assist the patient in recognizing early signs of complications?
      A)
      “Palpate the fundus daily to ensure it is soft.”.
      B)
      “The passage of clots is expected.”.
      C)
      “Report any decrease in the amount of brownish-red lochia.”.
      D)
      “Notify the physician of any increase in the amount of lochia or a return to bright red bleeding.”.
    4. Which instruction should be included in the discharge teaching plan to assist the patient in recognizing early signs of complications?
      A)
      “Palpate the fundus daily to ensure it is soft.”.
      B)
      “The passage of clots is expected.”.
      C)
      “Report any decrease in the amount of brownish-red lochia.”.
      D)
      “Notify the physician of any increase in the amount of lochia or a return to bright red bleeding.”.
    Page 6 of 12