MIDTERM QUIZ

1. A nurse is caring for a group of newly pregnant clients. Which 8. Rosann’s fetus is going to have fetal blood sampling performed.
client is at the highest risk for a molar pregnancy?  What would be your priority assessment before the procedure? *
A. Determine if Rosann’s membranes have already ruptured
A. A client who suffers from autoimmune disease B. Determine if her fetus has rotated to an anterior position
B. A client who hasn’t been pregnant before C. Determine if Rosann’s diastolic blood pressure is within
C. A 38-year-old client reference ranges
D. A client with a history of a prior molar pregnancy D. Determine if Rosann knows her fetus’ head will be shaved
9. To evaluate the effectiveness of ART, the nurse will schedule the
2. A nurse is caring for a client in labor. The nurse determines patient for *
that the client is beginning in the 2nd stage of labor when which A. viral load testing.
of the following assessments is noted? B. enzyme immunoassay.
A. The client begins to expel clear vaginal fluid C. rapid HIV antibody testing.
B. The contractions are regular D. immunofluorescence assay
C. The membranes have ruptured 10. Abnormal positions of the vertex of the fetal head (with the
D. The cervix is dilated completely occiput as the reference point) relative to the maternal pelvis. *
A. Occiput posterior
3. A nurse is assisting in the care of a client in labor who is having B. Occiput transverse
an amniotomy performed. The nurse should assess that the C. Asynclitism
amniotic fluid is normal if it has which characteristics? D. Malposition
11. Refers to the fetal anatomic part which is the first part to
A. Clear and dark amber color proceed into and through the pelvic inlet. *
B. Light green color with no odor A. Fetal lie
C. Thick white color with no odor B. Fetal position
D. Straw-colored, with flecks of vernix C. Presentation
4. The nurse is instructing an unlicensed health care worker on the D. Fetal vertex
care of the client with HIV who also has active genital herpes. 12. A nurse in a labor room is assisting with the vaginal delivery of
Which statement by the health care worker indicates effective a newborn infant. The nurse would monitor the client closely for
teaching of standard precautions? the risk of uterine rupture if which of the following occurred? *
A. ''I need to know my HIV status, so I must get tested before A. Hypotonic contractions
caring for any clients." B. Forceps delivery
B. ''Putting on a gown and gloves will cover up the itchy sores C. Schultz delivery
on my elbows.'' D. Weak bearing down efforts
C. ''Washing my hands and putting on a gown and gloves is 13. Which statement made to the nurse by a health care worker
what I must do before starting care.'' assigned to care for the client with HIV indicates a breach of
D. ''I will wash my hands before going into the room, and confidentiality and requires further education by the nurse?
then put on gown and gloves only for direct contact with A. ''I told the family members they needed to wash their
the client's genitals." hands when they enter and leave the room.''
5. When teaching a patient with HIV infection about ART, the nurse B. ''The other health care worker and I were out in the
explains that these drugs hallway discussing how we were concerned about getting
A. work in various ways to decrease viral replication in the HIV from our client, so no one could hear us in the client's
blood. room.''
B. boost the ability of the immune system to destroy the C. ''Yes, I understand the reasons why I have to wear gloves
virus. when I bathe my client.''
C. destroy intracellular virus as well as lowering the viral D. ''The client's spouse told me she got HIV from a blood
load. transfusion.
D. increase the number of CD4+ cells available to fight the 14. Upon assessment the nurse found the following: fundus at 2
HIV. fingerbreadths above the umbilicus, last menstrual period (LMP) 5
6. A nurse in the labor room is caring for a client in the active months ago, fetal heart beat (FHB) not appreciated. Which of the
phases of labor. The nurse is assessing the fetal patterns and notes following is the most possible diagnosis of this condition? *
a late deceleration on the monitor strip. The most appropriate A. Hydatidiform mole
nursing action is to B. Missed abortion
A. Place the mother in the supine position C. Pelvic inflammatory disease
B. Document the findings and continue to monitor the fetal D. Ectopic pregnancy
patterns 15. A woman is receiving magnesium sulfate as part of her
C. Administer oxygen via face mask treatment for severe preeclampsia. The nurse is monitoring the
D. Increase the rate of Pitocin IV infusion woman's serum magnesium levels. Which level would the nurse
7. Which of the following is the nurse’s initial action when identify as therapeutic? *
umbilical cord prolapse occurs? A. 3.3 mEq/L
A. Place the client in a knee-chest position in bed B. 6.1 mEq/L
B. Begin monitoring maternal vital signs and FHR C. 8.4 mEq/L
C. Notify the physician and prepare the client for delivery D. 10.8 mEq/L
D. Apply a sterile warm saline dressing to the exposed cord
16. Which of the following characteristics most accurately describe A. Methotrexate
first-degree and second-degree perineal lacerations following B. Uterine ultrasounds
vaginal delivery? * C. Frequent hCG levels
A. They are accompanied by maternal pain and discomfort D. Contraception for 6 weeks
B. They rarely lead to long-term sequelae 26. A nurse in the postpartum unit is caring for a client who has
C. They commonly become infected just delivered a newborn infant following a pregnancy with
D. A and B placenta previa. The nurse reviews the plan of care and prepares to
17. A nurse is caring for a client in labor who is receiving Pitocin by monitor the client for which of the following risks associated with
IV infusion to stimulate uterine contractions. Which assessment placenta previa? *
finding would indicate to the nurse that the infusion needs to be A. Disseminated intravascular coagulation
discontinued? * B. Chronic hypertension
A. Three contractions occurring within a 10-minute period C. Infection
B. Increased urinary output D. Hemorrhage
C. Adequate resting tone of the uterus palpated between 27. Which of the following would the nurse have readily available
contractions for a client who is receiving magnesium sulfate to treat severe
D. A fetal heart rate of 90 beats per minute preeclampsia? *
18. The first thing that a nurse must ensure when the baby’s head A. Calcium gluconate
comes out is * B. Potassium chloride
A. The cord C. Ferrous sulfate
B. No part of the cord is encircling the baby’s neck D. Calcium carbonate
C. The cord is still attached to the placenta 28. The nurse is caring for a client who just had a hydatiform mole
D. The cord is still pulsating removed and is emotional and upset. She is currently receiving
19. The complication of CPD may affect the: * oxytocin and IV fluids. What is the nurse’s priority at this time? *
A. Mother A. Providing emotional support
B. Mother and Child B. Assessing a blood sugar
C. Child C. Checking the IV for infiltration
20. Which of the following symptoms occurs with a hydatidiform D. Ensuring the specimen is sent to the lab for appropriate
mole? * pathology
A. Heavy, bright red bleeding every 21 days 29. A nurse is admitting a pregnant client to the labor room and
B. Fetal cardiac motion after 6 weeks gestation attaches an external electronic fetal monitor to the client's
C. Benign tumors found in the smooth muscle of the uterus abdomen. After attachment of the monitor, the initial nursing
D. “Snowstorm” pattern on ultrasound with no fetus or assessment is which of the following? *
gestational sac A. Identifying the types of accelerations
21. Which of the following signs will require a mother to seek B. Assessing the baseline fetal heart rate
immediate medical attention? * C. Determining the frequency of the contractions
A. When the first fetal movement is felt D. Determining the intensity of the contractions
B. No fetal movement is felt on the 6th month 30. A maternity nurse is preparing to care for a pregnant client in
C. Mild uterine contraction labor who will be delivering twins. The nurse monitors the fetal
D. Slight dyspnea on the last month of gestation heart rates by placing the external fetal monitor: *
22. Which of the following risk factors is NOT associated with A. Over the fetus that is most anterior to the mothers
severe perineal lacerations? * abdomen
A. Younger maternal age B. Over the fetus that is most posterior to the mothers
B. Asian race or ethnicity abdomen
C. Nulliparity C. So that each fetal heart rate is monitored separately
D. Median episiotomy D. So that one fetus is monitored for a 15-minute period
23. At the health promotion level of care for HIV infection, which followed by a 15 minute fetal monitoring period for the
question is most appropriate for the nurse to ask? * second fetus
A. “Are you having any symptoms such as severe weight loss 31. Which of the following signs and symptoms will most likely
or confusion?” make the nurse suspect that the patient is having hydatidiform
B. “Are you experiencing any side effects from the mole? *
antiretroviral medications? A. Slight bleeding
C. “Do you need any assistance to obtain antiretroviral drugs B. Passage of clear vesicular mass per vagina
or other treatments?” C. Absence of fetal heart beat
D. “Do you use any injectable drugs or have sexual activity D. Enlargement of the uterus
with multiple partners?” 32. A patient who has tested positive for the human
24. A nurse at an obstetrics clinic receives a call from a 9-week immunodeficiency virus (HIV) arrives at the clinic with a report of
pregnant client to report disturbing symptoms. Which symptom fever, nonproductive cough, and fatigue. The patient's CD4 count is
would indicate a possible molar pregnancy? * 184 cells/mcL. How should the healthcare provider interpret these
A. Dark brown or bright red vaginal bleeding findings? Please choose from one of the following options.
B. Lightheadedness on standing A. The patient is diagnosed with acquired immunodeficiency
C. Abdominal cramping and nausea syndrome (AIDS).
D. No fetal movements B. The patient is now in the latent stages of HIV infection
25. A nurse is providing care for a client who has undergone a D&C C. these findings provide evidence that the patient has
for a molar pregnancy. What will be included in the plan of care seroconverted.
after discharge? *
 D. This is an expected finding because the patient has tested C. renal toxicity
positive for HIV. D. increased beat-to-beat variability in the FHR
33. When the bag of waters ruptures spontaneously, the nurse 41. The nurse has received end of shift report in the high-risk
should inspect the vaginal introitus for possible cord prolapse. If maternity unit. Which client should the nurse see first? *
there is part of the cord that has prolapsed into the vaginal A. 35 weeks' gestation with grade 1 abruptio placentae in
opening the correct nursing intervention is: * labor who has a strong urge to push.
A. Push back the prolapse cord into the vaginal canal B. 30 weeks' gestation with placenta previa whose fetal
B. Place the mother on semi fowler's position to improve monitor strip shows late decelerations.
circulation C. 26 weeks' gestation with placenta previa experiencing
C. Cover the prolapse cord with sterile gauze wet with sterile blood on toilet tissue after a bowel movement.
NSS and place the woman on trendelenburg position D. 37 weeks' gestation with pregnancy-induced hypertension
D. Push back the cord into the vagina and place the woman whose membranes ruptured spontaneously.
on sims position 42. A nurse is providing discharge instructions for a client who has
34. For which reason should the nurse suspect hydramnios in a undergone a D&C for a trophoblastic molar pregnancy. What
pregnant client? * should be included in the teaching? *
A. The client is pregnant with twins. A. No intercourse for 3 months
B. The quadruple screen comes back positive. B. Contraception use for 1 year
C. There is less amniotic fluid than normal for gestation. C. Take weekly home pregnancy tests to monitor hCG
D. The fundal height increases disproportionately to the D. Take blood pressures at home
gestation. 43. The nurse is discharging a client who just had a hydatidiform
35. A nurse is developing a plan of care for a client experiencing mole removed, without complications. The nurse is educating the
dystocia, and includes several nursing interventions in the plan. client on the follow-up care required for this. Which of the
The nurse prioritizes the plan and selects which nursing following is most appropriate to explain to this client? *
intervention as the highest priority? * A. "You will need to have your hCG levels drawn weekly for
A. Monitoring fetal status one year"
B. Providing comfort measures B. "You will have an hCG level every 1-2 weeks until you're
C. Changing the client’s position frequently back to pre-pregnancy levels, then every 1-2 months for a
D. Keeping the significant other informed of the progress of total of one year"
the labor C. "Follow-up is not necessary, but if you become pregnant
36. A client has a mid pelvic contracture from a previous pelvic again, let your provider know immediately because there
injury due to a motor vehicle accident as a teenager. The nurse is are multiple tests that must be completed once pregnancy
aware that this could prevent a fetus from passing through or is confirmed again"
around which structure during childbirth? * D. "You will need to have your hCG levels and a CBC drawn
A. Symphysis pubis monthly for 1 year"
B. Sacral promontory 44. A nurse is developing a plan of care for a client experiencing
C. Ischial spines dystocia, and includes several nursing interventions in the plan.
D. Pubic arch The nurse prioritizes the plan and selects which nursing
37. A client makes a routine visit to the prenatal clinic. Although intervention as the highest priority? *
she’s 14 weeks pregnant, the size of her uterus approximates that A. Monitoring fetal status
in an 18- to 20-week pregnancy. Dr. Diaz diagnoses gestational B. Providing comfort measures
trophoblastic disease and orders ultrasonography. The nurse C. Changing the client's position frequently
expects ultrasonography to reveal: D. Keeping the significant other informed of the progress of
A. an empty gestational sac. the labor
B. grapelike clusters 45. The nurse instructs a laboring client to use accelerated blow
C. a severely malformed fetus. breathing. The client begins to complain of tingling fingers and
D. an extrauterine pregnancy dizziness. Which action should the nurse take? *
38. While teaching community groups about AIDS, the nurse A. Administer oxygen by face mask.
informs people that the most common method of transmission of B. Notify the health care provider of the client's symptoms.
the HIV virus currently is * C. Have the client breathe into her cupped hands.
A. perinatal transmission to the fetus. D. Check the client's blood pressure and fetal heart rate
B. sharing equipment to inject illegal drugs. 46. A nurse is reviewing lab results for a client that had a D&C to
C. transfusions with HIV-contaminated blood. remove a molar pregnancy 6 months ago. Her hCG levels have not
D. sexual contact with an infected partner. decreased. What management should the nurse expect for this
39. A POSTPARTUM CLIENT IS DIAGNOSED WITH CYSTITIS. THE client? *
NURSE PLANS FOR WHICH PRIORITY NURSING INTERVENTION IN A. An ultrasound should be done because she is probably
THE CARE OF THE CLIENT? pregnant
A. Providing Sitz baths B. Continue the hCG levels until it returns to baseline
B. Encouraging fluid intake C. Continue contraception for another year
C. Placing ice on the perineum D. Hysterectomy to remove the uterus
D. Monitoring hemoglobin and hematocrit levels 47. When designing a program to decrease the incidence of HIV
40. A client in labor receives epidural anesthesia. The nurse should infection in the community, the nurse will prioritize education
assess carefully for which adverse reaction to the anesthetic about *
agent? * A. how to prevent transmission between sexual partners.
A. hypotensive crisis B. methods to prevent perinatal HIV transmission.
B. fetal tachycardia C. ways to sterilize needles used by injectable drug users.
 D. means to prevent transmission through blood B. Footling breech
transfusions. C. Frank breech
48. Which member of the health care team demonstrates reducing D. Malpresentation
the risk for infection for the client with acquired immunodeficiency 50. When preparing the newly diagnosed client with HIV and
syndrome (AIDS)? * significant other for discharge, which explanation by the nurse
A. The dietary worker hands the disposable meal trays to the accurately describes proper condom use? *
LPN assigned to the client. A. ''Condoms should be used when lesions on the penis are
B. The social worker encourages the client to verbalize about present.''
stressors at home. B. ''Always position the condom with a space at the tip of an
C. Housekeeping thoroughly cleans and disinfects the erect penis.''
hallways near the client's room. C. ''Make sure it fits loosely to allow for penile erection.''
D. Health care provider orders vital signs including D. ''Use adequate lubrication such as petroleum jelly.''
temperature every 8 hours.
49. Type of breech presentation that the hips are flexed, and legs
extended over anterior surface of body. * NCM 109- Reviewer: DELIVERY ROOM EXPOSURE
A. Complete breech
HIV IN PREGNANCY

1. Aim of treating HIV positive women during pregnancy is to:  Around 30% intrapartum transmission
 minimize harm to both the mother and fetus,  Around 70% in utero transmission
and to reduce the chance of vertical 10. Standard of Care to Prevent Maternal Transmission of HIV
transmission.  AZT (retrovir/zidovudine)
2. Factors which reduce vertical transmission (from 25-30% to 11. Beyond AZT what drug combinations have been used
2%)  Commonly used regimens
 maternal antiretroviral therapy  Truvada (FTC/TDV) + Reyataz/norvir
 mode of delivery (caesarean section)  Combivir (AZT/3TC) + Kaletra (lopinavir/norvir)
 neonatal antiretroviral therapy 12. What Anti-Viral Therapy should be avoided in Pregnant
 infant feeding (bottle feeding) women
3. Screening for HIV in pregnancy  1) stavudine (Zerit)/didanosine (Videx)
 NICE guidelines recommend offering HIV  2) Efavirenz (Sustiva) in the first trimester
screening to all pregnant women  Consider avoiding if pregnancy potential, but
4. Mode of delivery: don't switch if they are already on it and
 vaginal delivery is recommended if viral load is suppressed
less than 50 copies/ml at 36 weeks, otherwise  Teratogenic in animal studies
caesarian section is recommended  3) Nevirapine (Viramune) with CD4 >250
 a zidovudine infusion should be started four  4) oral amprenavir solution (dissolved in
hours before beginning the caesarean section propylene glycol)
5. Neonatal antiretroviral therapy 13. When does perinatal HIV transmission occur most commonly?
 Zidovudine is usually administered orally to the  3rd trimester, esp. week 36 through labor
neonate if maternal viral load is <50 copies/ml. 14. When C-section to avoid HIV transmission? VL and time?
Otherwise triple ART should be used. Therapy  Viral Load >1,000 after 36 weeks
should be continued for 4-6 weeks.
6. Infant feeding
 All women should be advised not to breast feed
7. Initial infection
 Many people have no noticeable symptoms, but
within a few weeks, fever, rashes, swollen lymph
nodes, fatigue, and a variety of less common
symptoms may develop. Symptoms of initial
(primary) HIV infection last from a few days to 1
to 2 weeks.
 Symptoms specific to women include frequent
or severe vaginal infections, abnormal Pap
smears, pelvic infections (PID) that are difficult
to treat, changes in the menstrual cycle, genital
ulcers or warts and severe mucosal herpes
infections.
8. When should a women be given an HIV test during Pregnancy
 1) As Early, in Pregnancy as possible
 2) Late 3rd Trimester
9. Timing of Transmission of HIV to Fetus