PN 136-01 Maternal Health Nursing Exam at Nightingale College
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Free PN 136-01 Maternal Health Nursing Exam at Nightingale College Questions
Which of the following are one of the 5 Ps of labor? Select all that apply.
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Position
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Psychological response
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Powers
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Passenger
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Passageway
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Placenta
Explanation
A. Position
Position refers to the posture and movements of the laboring mother. The woman’s position affects the mechanics of labor by influencing pelvic dimensions, fetal alignment, and uterine efficiency. Positions such as squatting, side-lying, or hands-and-knees can facilitate descent and rotation of the fetus. Frequent position changes also promote comfort and enhance circulation to both the mother and fetus.
B. Psychological response
Psychological response refers to the emotional and mental state of the mother during labor. Anxiety, fear, and tension can release catecholamines that reduce uterine contractility and blood flow to the uterus, slowing labor. A calm, supported, and confident mother typically experiences more effective contractions and smoother labor progression.
C. Powers
Powers represent the forces that expel the fetus. These include the primary powers (involuntary uterine contractions) and secondary powers (voluntary maternal pushing efforts). Effective contractions lead to cervical dilation, effacement, and fetal descent. Coordination between contractions and pushing ensures safe and efficient delivery.
D. Passenger
Passenger refers to the fetus and its relationship to the maternal pelvis. Key aspects include fetal size, presentation, lie, attitude, and position. For example, a cephalic presentation and proper fetal alignment usually lead to an easier labor, while abnormal presentations like breech can complicate delivery.
E. Passageway
Passageway encompasses the mother’s bony pelvis and soft tissues through which the baby passes. The size, shape, and flexibility of the pelvis, along with the condition of the cervix, vagina, and perineum, affect how smoothly the baby descends. Adequate pelvic dimensions and tissue elasticity are crucial for safe delivery.
The nurse instructs a pregnant patient to breathe through the mouth and keep it open while pushing during labor. Which is the rationale for this nursing intervention?
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To decrease the efforts required for pushing
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To avoid nasal congestion in the patient
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To facilitate increased oxygen to the fetus
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To avoid deceleration in the fetal heart rate
Explanation
During labor, open-mouth breathing ensures a steady flow of oxygen to both the mother and the fetus. Controlled breathing helps the woman avoid prolonged breath-holding (Valsalva maneuver), which can reduce venous return and cardiac output, thereby decreasing uteroplacental blood flow and leading to fetal hypoxia. By keeping the mouth open and breathing rhythmically, the patient maintains better oxygenation, which supports effective contractions and reduces stress on the fetus.
Which is the most likely reason for preeclampsia in a pregnant patient during the second trimester of her pregnancy?
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Body mass index (BMI) of 34.2 kg/m²
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Severe hypotension
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Hypervitaminosis
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Lower extremity edema
Explanation
A BMI of 34.2 kg/m² indicates obesity, which is a major risk factor for preeclampsia. Obesity contributes to endothelial dysfunction, insulin resistance, and chronic inflammation, all of which impair placental perfusion and increase blood pressure. Preeclampsia typically develops after 20 weeks of gestation and is characterized by hypertension and proteinuria due to abnormal placental vascular development. Obese women are at higher risk for complications such as gestational hypertension, preeclampsia, and eclampsia.
Which guidance will the nurse provide to a pregnant patient with iron-deficiency anemia who was recently started on iron supplementation, when the patient reports nausea?
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Take the supplement at bedtime
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Take the supplement between meals
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Take a double dose of iron if a dose is missed
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Take the supplement with a glass of whole milk
Explanation
Iron supplements often cause gastrointestinal discomfort, including nausea, constipation, and stomach upset. Taking the supplement at bedtime may help reduce nausea because the patient is lying down and less likely to feel the side effects. This adjustment improves adherence while still allowing for adequate absorption. The nurse should also encourage taking iron with vitamin C (e.g., orange juice) to enhance absorption and avoid taking it with dairy, tea, or coffee.
A patient in the first trimester of pregnancy tells the nurse, "I urinate frequently and am not able to hold urine even for a short time." Which strategy would the nurse suggest to ease the patient's discomfort?
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Apply local heat or ice
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Perform Kegel exercises
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Eat dry carbohydrates
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Get back rubs regularly
Explanation
Kegel exercises help strengthen the pelvic floor muscles, which support the bladder and urethra. During early pregnancy, hormonal changes and uterine growth increase pressure on the bladder, causing urinary frequency or slight leakage. Regularly performing Kegel exercises improves bladder control, reduces incontinence, and enhances pelvic muscle tone. This practice also prepares the pelvic muscles for childbirth and promotes faster postpartum recovery of bladder function.
Which medication would the nurse expect the primary health care provider to prescribe to a postpartum patient with uterine atony?
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Methylergonovine
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Misoprostol
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Ergonovine
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Oxytocin
Explanation
Oxytocin (Pitocin) is the first-line medication used to treat uterine atony, which is the failure of the uterus to contract effectively after childbirth—a major cause of postpartum hemorrhage. Oxytocin stimulates the smooth muscle of the uterus, promoting strong, rhythmic contractions that compress blood vessels and reduce bleeding. It can be given intravenously (IV) or intramuscularly (IM) and is usually administered immediately after delivery of the placenta as part of active management of the third stage of labor.
A 5-month pregnant female reports to the nurse that she feels dizzy after waking up in the morning. Which advice would the nurse give to the patient?
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"Use two pillows for your head while sleeping."
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"Try sleeping in the side-lying (lateral) position."
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"Try to spend less of your time sleeping."
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"Keep your legs elevated while sleeping."
Explanation
At around 20 weeks of gestation and beyond, the enlarging uterus can compress the inferior vena cava when the woman lies flat on her back. This causes supine hypotensive syndrome, leading to dizziness, pallor, and lightheadedness due to decreased venous return and cardiac output. The side-lying (especially left lateral) position prevents this compression, promotes optimal blood flow to the heart and placenta, and relieves dizziness.
A pregnant patient is receiving tocolytic therapy with magnesium sulfate. Under which patient circumstance would the nurse suggest discontinuing the therapy?
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Urine output is 40 mL/hr.
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Respiratory rate is 10 breaths/min.
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Blood pressure is 120/80 mm Hg.
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Serum magnesium level is 5 mEq/L.
Explanation
Magnesium sulfate can cause respiratory depression when serum magnesium levels become toxic. A respiratory rate below 12 breaths per minute indicates potential magnesium toxicity and requires immediate discontinuation of the drug. The nurse should notify the provider, stop the infusion, and administer calcium gluconate as the antidote if ordered. Continuous monitoring of reflexes, respiratory rate, and urine output is critical during magnesium sulfate therapy to ensure maternal safety.
Which is the factor that enables the baby to initiate respiration immediately postpartum?
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Arterial carbon dioxide pressure is decreased.
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Fetal respiratory movements increase during labor.
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Fetal lung fluid is cleared from the air passage.
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Arterial pH and bicarbonate levels are increased.
Explanation
At birth, clearing of fetal lung fluid from the airways is essential for the newborn to initiate effective respiration. During labor and delivery, thoracic compression and hormonal changes help expel lung fluid, allowing the alveoli to fill with air upon the first breath. This clearance decreases pulmonary vascular resistance, increases oxygen exchange, and establishes functional residual capacity—key steps in the newborn’s adaptation to extrauterine life.
Nurses should be aware of which factor regarding the use of tocolytic therapy to suppress uterine activity?
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If the woman develops pulmonary edema while on tocolytics, intravenous (IV) fluids should be given.
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There are no important maternal (as opposed to fetal) contraindications.
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Its most important function is to afford the opportunity to administer antenatal glucocorticoids.
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The drugs can be given efficaciously up to the designated beginning of term at 37 weeks.
Explanation
The primary purpose of tocolytic therapy is to delay preterm labor long enough to allow the administration of antenatal glucocorticoids, which accelerate fetal lung maturity and reduce neonatal complications such as respiratory distress syndrome. Tocolytics do not prevent preterm birth indefinitely but provide critical time (usually 24–48 hours) for steroid therapy to take effect, improving neonatal outcomes if preterm delivery becomes unavoidable.
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