Unit 2 Maternity Exam Eves Greater Lowell Technical School
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Free Unit 2 Maternity Exam Eves Greater Lowell Technical School Questions
The nurse caring for a pregnant woman who is receiving an intravenous infusion with magnesium sulfate will:
- Count respirations and report a rate of less than 12 breaths per minute
- Check blood pressure and report a rate of less than 100/60
- Count respirations and report a rate of more than 20 breaths per minute
- Monitor urinary output and report a rate of less than 100 ml per hour
Explanation
Explanation:
Correct Answer: (A) Count respirations and report a rate of less than 12 breaths per minute
Magnesium sulfate toxicity causes respiratory depression, which is one of the most dangerous and potentially fatal complications. The nurse must closely monitor the respiratory rate and immediately report a rate below 12 breaths per minute, as this is a critical sign of magnesium toxicity requiring prompt intervention including administration of calcium gluconate.
Why Other Options are Incorrect:
B. Check blood pressure and report a rate of less than 100/60 — While blood pressure monitoring is important in pre-eclampsia management, hypotension at 100/60 is not the primary toxicity concern with magnesium sulfate infusion.
C. Count respirations and report a rate of more than 20 breaths per minute — A respiratory rate above 20 is not a sign of magnesium toxicity. The concern is respiratory depression, indicated by a rate below 12.
D. Monitor urinary output and report a rate of less than 100 ml per hour — While urinary output should be monitored (and output below 30 ml/hour is concerning), the threshold of less than 100 ml/hour is not the standard reporting parameter, and respiratory status remains the priority toxicity concern.
A nursing assessment reveals heavy vaginal bleeding, a firm, board-like abdomen, contractions lasting 3 minutes with less than 30 seconds between them, and uterine tenderness in a woman last assessed to be 3 cm dilated and in early labor. Which is the nurse's priority of care?
- Frequent vital signs and fetal heart tones
- Assessment and documentation of pain
- Notification of the healthcare provider
- Providing patient with emotional support
Explanation
Explanation:
Correct Answer: (C) Notification of the healthcare provider
The clinical presentation — heavy vaginal bleeding, a rigid board-like abdomen, tetanic contractions with minimal rest intervals, and uterine tenderness — is highly indicative of abruptio placentae, which is a life-threatening obstetric emergency. The nurse's priority is to immediately notify the healthcare provider so that emergency intervention can be initiated without delay to prevent maternal and fetal death.
Why Other Options are Incorrect:
A. Frequent vital signs and fetal heart tones — While continuous monitoring of vital signs and fetal heart tones is critical and will be done simultaneously, it cannot take priority over immediately notifying the provider about a suspected obstetric emergency requiring urgent intervention.
B. Assessment and documentation of pain — Pain assessment is an ongoing nursing responsibility but is not the priority when the patient is showing signs of a potentially fatal complication requiring immediate medical intervention.
D. Providing patient with emotional support — Emotional support is an important aspect of holistic nursing care but is not the priority in an acute, life-threatening emergency situation such as suspected abruptio placentae.
The nurse performing a biophysical profile on a client who is 41 weeks gestation. The nurse knows that positive fetal wellbeing is indicated by a score of:
- 6 or >
- 8 or >
- Between 4 and 8
- 10 or
Explanation
Explanation:
Correct Answer: (B) 8 or >
The biophysical profile (BPP) is scored out of 10, with each of the five parameters worth 2 points. A score of 8 or greater is considered normal and indicates positive fetal wellbeing. A score of 6 is equivocal and requires further evaluation, while a score of 4 or below is abnormal and indicates fetal compromise requiring immediate intervention.
Why Other Options are Incorrect:
A. 6 or > — A score of 6 is considered equivocal, not reassuring. While it does not definitively indicate compromise, it requires repeat testing or further evaluation and does not confirm positive fetal wellbeing.
C. Between 4 and 8 — This range includes both equivocal and abnormal scores and does not specifically define positive fetal wellbeing.
D. 10 or < — This includes all possible scores including abnormally low ones and therefore does not define a threshold for positive fetal wellbeing.
The nurse would suspect abruptio placentae when the pregnant woman presents with:
- Painless vaginal bleeding
- Vaginal bleeding and back pain
- Uterine irritability with contractions
- Premature rupture of membranes
Explanation
Explanation:
Correct Answer: (B) Vaginal bleeding and back pain
Abruptio placentae (placental abruption) classically presents with sudden, painful vaginal bleeding accompanied by abdominal or back pain and uterine rigidity. The pain results from blood accumulating behind the placenta and the resulting uterine irritation. Back pain is particularly associated with a posterior placental abruption.
Why Other Options are Incorrect:
A. Painless vaginal bleeding — Painless vaginal bleeding is the hallmark presentation of placenta previa, not abruptio placentae. The key distinguishing feature of abruption is the presence of pain.
C. Uterine irritability with contractions — While uterine irritability can be associated with abruption, contractions alone without the combination of painful bleeding are not the defining presentation of abruptio placentae.
D. Premature rupture of membranes — PROM involves the spontaneous rupture of the amniotic sac before the onset of labor and is not a characteristic sign of placental abruption.
A woman who is 35 weeks pregnant has a total placenta previa. She asks the nurse, "Will I be able to deliver vaginally?" The nurse should explain:
- "A vaginal delivery can be attempted, but if bleeding occurs, a cesarean section is done."
- "A cesarean section is performed when the mother has a total placenta previa."
- "There is no reason why you cannot have a vaginal delivery."
- "Yes, you can deliver vaginally until 36 weeks."
Explanation
Explanation:
Correct Answer: (B) "A cesarean section is performed when the mother has a total placenta previa."
Total placenta previa means the placenta completely covers the cervical os. A vaginal delivery is absolutely contraindicated in this case because dilation and descent of the fetus would cause massive, life-threatening hemorrhage. Cesarean delivery is the only safe mode of birth for a patient with total placenta previa.
Why Other Options are Incorrect:
A. "A vaginal delivery can be attempted, but if bleeding occurs, a cesarean section is done." — This is incorrect and dangerous. A vaginal delivery should never be attempted with total placenta previa. Waiting for bleeding to occur before performing a cesarean places both mother and fetus at extreme risk.
C. "There is no reason why you cannot have a vaginal delivery." — This is factually incorrect and provides false reassurance. Total placenta previa is a definitive indication for cesarean birth.
D. "Yes, you can deliver vaginally until 36 weeks." — This is incorrect. Gestational age does not change the contraindication to vaginal delivery in total placenta previa. The delivery route is determined by the position of the placenta, not the gestational age.
A prenatal client at 14 weeks complains of continuous nausea, vomiting, and a severe headache. Her blood pressure is elevated and her fundal height is 21 centimeters. Which diagnostic test does the nurse anticipate will be ordered to confirm a hydatidiform mole?
- Biophysical profile
- Maternal serum alpha-fetoprotein
- Human chorionic gonadotropin
- Ultrasound
Explanation
Explanation:
Correct Answer: (D) Ultrasound
Ultrasound is the definitive diagnostic test for confirming a hydatidiform mole. It reveals the classic "snowstorm" appearance of the uterus due to the proliferating trophoblastic tissue replacing normal pregnancy structures. It also confirms the absence of a viable fetus and the presence of abnormal uterine contents consistent with molar pregnancy.
Why Other Options are Incorrect:
A. Biophysical profile — A biophysical profile is used to assess fetal wellbeing in viable pregnancies and is not applicable in the evaluation of a suspected hydatidiform mole.
B. Maternal serum alpha-fetoprotein — AFP screening is used to detect neural tube defects and chromosomal abnormalities in a viable fetus. It is not the confirmatory test for hydatidiform mole.
C. Human chorionic gonadotropin — While hCG levels are markedly elevated in hydatidiform mole and are used as a supporting finding, elevated hCG alone is not diagnostic. Ultrasound is required for definitive confirmation of the diagnosis.
A woman who is 4 weeks pregnant becomes concerned when she has light vaginal bleeding accompanied by abdominal pain. An ectopic pregnancy is confirmed by ultrasound. The statement that indicated that the woman understands the explanation of an ectopic pregnancy is:
- The chorionic villi develop vesicles within the uterus.
- The fetus dies in the uterus during the first half of the pregnancy.
- The placenta develops in the lower part of the uterus.
- The embryo is implanted in the fallopian tube.
Explanation
Explanation:
Correct Answer: (D) The embryo is implanted in the fallopian tube.
An ectopic pregnancy most commonly occurs when the fertilized egg implants in the fallopian tube rather than the uterine cavity. This statement correctly reflects the patient's understanding of what an ectopic pregnancy means and why it causes pain and bleeding, as the fallopian tube cannot support fetal growth.
Why Other Options are Incorrect:
A. The chorionic villi develop vesicles within the uterus — This describes a hydatidiform mole, a gestational trophoblastic disease, not an ectopic pregnancy.
B. The fetus dies in the uterus during the first half of the pregnancy — This describes a missed abortion or intrauterine fetal demise, not an ectopic pregnancy.
C. The placenta develops in the lower part of the uterus — This describes placenta previa, a condition where the placenta partially or fully covers the cervical os, which is unrelated to ectopic pregnancy.
The nurse is collecting a patient's personal information for the client history. How should the nurse question the woman regarding physical abuse and safety in her living situation?
- "Does your partner ever hit you?"
- "Tell me about your home life."
- "Are you happily married?"
- "Tell me about your husband."
Explanation
Explanation:
Correct Answer: (B) "Tell me about your home life."
This open-ended, non-threatening question creates a safe and comfortable space for the patient to share information about her living situation at her own pace. It avoids assumptions about relationship status, does not use alarming language, and allows the woman to disclose concerns about abuse or safety without feeling directly confronted or judged.
Why Other Options are Incorrect:
A. "Does your partner ever hit you?" — While direct screening for abuse is important, this phrasing is too abrupt and confrontational as an opening question. It may cause the patient to become defensive and deny abuse before trust has been established.
C. "Are you happily married?" — This question assumes the patient is married, is closed-ended, and does not effectively screen for abuse or assess the safety of her living situation.
D. "Tell me about your husband." — This assumes the patient is married and heterosexual, which is presumptuous and excludes patients in other types of relationships. It also does not directly address safety concerns.
The nurse educates prenatal patients about the threat of TORCH infections. These infections include (Select all that apply.)
- Herpes simplex
- Toxoplasmosis
- Rubella
- Toxemia
- Cytomegalovirus
Explanation
Explanation:
Correct Answer: (A) Herpes simplex, (B) Toxoplasmosis, (C) Rubella, and (E) Cytomegalovirus
TORCH is an acronym representing a group of infections that can be transmitted from mother to fetus and cause serious congenital complications. T — Toxoplasmosis, O — Other infections, R — Rubella, C — Cytomegalovirus, H — Herpes simplex. All four of these are classic TORCH infections known to cause significant fetal harm including neurological damage, vision and hearing loss, and developmental disabilities.
Why Other Options are Incorrect:
D. Toxemia — Toxemia is an outdated term for preeclampsia, which is a hypertensive disorder of pregnancy, not an infectious disease. It is not part of the TORCH acronym or classification.
Early intervention to assess a pregnant woman at risk for battering includes:
- Interviewing all women at the time of first prenatal visit
- Interviewing women of low social economic status at time of first prenatal visit
- Interviewing high risk women after delivery
- Interviewing her partner at time of labor
Explanation
Explanation:
Correct Answer: (A) Interviewing all women at the time of first prenatal visit
Universal screening for intimate partner violence should be conducted with all pregnant women at the first prenatal visit, regardless of socioeconomic status, race, or perceived risk level. Battering during pregnancy affects women across all demographics, and early identification allows for timely intervention and safety planning.
Why Other Options are Incorrect:
B. Interviewing women of low social economic status at time of first prenatal visit — Limiting screening to women of low socioeconomic status introduces bias and misses victims from other demographic groups. Domestic violence occurs across all social and economic classes.
C. Interviewing high risk women after delivery — Waiting until after delivery delays intervention. Screening must occur early in pregnancy to protect both the mother and the developing fetus throughout the pregnancy.
D. Interviewing her partner at time of labor — Screening should never be done in the presence of the partner, as this creates an unsafe environment where the woman cannot speak freely and may put her at greater risk.
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