Client who is 34 weeks pregnant experiencing bleeding caused by placenta previa. The fetal heart
sounds are normal and the client is not in labor. Which nursing intervention should the nurse
perform?
a) Monitor the amount of vaginal blood loss.
b) Allow the client to ambulate with assistance.
c) Perform a vaginal examination to check for cervical dilation.
d) Notify the physician for a fetal heart fate of 130 beats/minute.
A 29-year-old multigravida at 17 weeks’ gestation is being treated for severe preeclampsia and has
magnesium sulfate infusing at 3g/h. To maintain safety for this client, the priority intervention is to:
a) Maintain continuous fetal monitoring.
b) Monitor maternal liver studies every 4 hours.
c) Assess reflexes, clonus, visual disturbances, and headache. (gmdr)
d) Encourage family members to remain at bedside.
A nurse is caring for a client whose membranes ruptured prematurely 12 hours ago. When assessing
this client, the nurse’s highest priority is to evaluate:
a) Cervical effacement and dilation.
b) White blood cell (WBC) count.
c) Maternal vital signs and fetal heart rate (FHR).
d) Frequency and duration of contractions.
The nurse on the antenatal unit is planning care for four clients. The nurse should assess which client
first:
a) A client at 38 weeks’ gestation hospitalized frequently during this pregnancy for placenta
previa and who two days ago was admitted with severe bright red vaginal bleeding that has tapered
off now.
b) A 9-week IUP hospitalized for hyperemesis gravidarum who has not vomited for the last 12
hours.
c) A 29-year-old client carrying twins, being treated for preterm labor at 29 weeks’ gestation and
receiving magnesium sulfate at 2 g/h, who has had no contractions for the past 2 hours; both twins
appear stable, according to the nurse’s shift report.
d) A 19-year-old 18 weeks’ gestation intrauterine pregnancy (IUP) who is now 12 hours post motor
vehicle accident with bright red vaginal bleeding.
A multigravid client thought to be at 14 weeks’ gestation report that she is experiencing such severe
morning sickness that she “has not been able to keep anything down for a week.” The nurse should
assess for signs and symptoms of which condition?
a) Hypokalemia
b) Hyperglycemia
c) Hypercalcemia
d) Hypobilirubinemia
A client, 7 months pregnant, is admitted to the unit with abdominal pain and bright red vaginal
bleeding. Which action should the nurse take first?
a) Ease the client’s anxiety by assuring her that everything will be all right.
b) Administer I.V. oxytocin, as ordered, to stimulate uterine contractions and prevent further
hemorrhage.
c) Massage the client’s fundus to help control the hemorrhage.
d) Place the client on her left side and start supplemental oxygen, as ordered, fetal oxygenation.
, A primigravid client with class II heart disease is visiting the clinic at 8 weeks’ gestation tells the nurse
that she has been maintaining a low-sodium, 1,800-calorie diet. Which instruction should the nurse
give the client?
a) Increase caloric intake to 2,200 calories daily to promote fetal growth.
b) Take iron supplements with milk to enhance absorption.
c) Avoid folic acid supplements to prevent megaloblastic anemia.
d) Severely restrict sodium intake throughout the pregnancy.
Which intervention listed in the care plan for a client with an ectopic pregnancy requires revision?
a) Providing for dietary needs and nursing in a dark quiet room.
b) Managing pain and providing emotional support.
c) Assessing vital signs and managing pain.
d) Providing emotional support and assessing per vaginal loss.
A pregnant client with diabetes mellitus is at risk for having a large-for-gestational-age neonate
because:
a) Excess insulin reduces placental functioning.
b) Excess sugar causes reduced placental functioning.
c) Insulin acts as a growth hormone on the fetus.
d) The mother follow a high-calorie diet.
A client in the last trimester of pregnancy. The nurse should instruct her to notify her primary health
care provider immediately if she notices:
a) Hemorrhoids
b) Increased vaginal mucus.
c) Blurred vision.
d) Dyspnea on exertion.
The primary health care provider (HCP) prescribes intravenous magnesium sulfate for a primigravid
client at 38 weeks’ gestation diagnosed with severe preeclampsia. Which medication would be most
important for the nurse to have readily available?
a) Hydralazine
b) Diazepam
c) Calcium gluconate
d) Phenytoin
The primary healthcare provider (HCP) orders 1,000 mL of Ringer’s Lactate intravenously over an 8-
hour period for a 29-year-old primigravid client at 16 weeks’ gestation with hyperemesis. The drip
factor is 12 gtts/mL. The nurse should administer the IV infusion at how many drops per minute?
Record your answer as a whole number.
25 ml/min
A 15-year-old female who is 26 weeks pregnant has been admitted to the labor and delivery unit with
a complaint for abdominal pain. Her parents want to speak with a nurse about to her condition. How
should the nurse respond?
a) “She is experiencing Braxton Hicks contractions and is too young to understand the difference
between these contractions and labor pains.”
b) “The physician can give you more information without consent.”
c) “I’ll need a signed consent from your daughter to give you medical information.”
d) “She will be OK. It’s just a stomachache.”
sounds are normal and the client is not in labor. Which nursing intervention should the nurse
perform?
a) Monitor the amount of vaginal blood loss.
b) Allow the client to ambulate with assistance.
c) Perform a vaginal examination to check for cervical dilation.
d) Notify the physician for a fetal heart fate of 130 beats/minute.
A 29-year-old multigravida at 17 weeks’ gestation is being treated for severe preeclampsia and has
magnesium sulfate infusing at 3g/h. To maintain safety for this client, the priority intervention is to:
a) Maintain continuous fetal monitoring.
b) Monitor maternal liver studies every 4 hours.
c) Assess reflexes, clonus, visual disturbances, and headache. (gmdr)
d) Encourage family members to remain at bedside.
A nurse is caring for a client whose membranes ruptured prematurely 12 hours ago. When assessing
this client, the nurse’s highest priority is to evaluate:
a) Cervical effacement and dilation.
b) White blood cell (WBC) count.
c) Maternal vital signs and fetal heart rate (FHR).
d) Frequency and duration of contractions.
The nurse on the antenatal unit is planning care for four clients. The nurse should assess which client
first:
a) A client at 38 weeks’ gestation hospitalized frequently during this pregnancy for placenta
previa and who two days ago was admitted with severe bright red vaginal bleeding that has tapered
off now.
b) A 9-week IUP hospitalized for hyperemesis gravidarum who has not vomited for the last 12
hours.
c) A 29-year-old client carrying twins, being treated for preterm labor at 29 weeks’ gestation and
receiving magnesium sulfate at 2 g/h, who has had no contractions for the past 2 hours; both twins
appear stable, according to the nurse’s shift report.
d) A 19-year-old 18 weeks’ gestation intrauterine pregnancy (IUP) who is now 12 hours post motor
vehicle accident with bright red vaginal bleeding.
A multigravid client thought to be at 14 weeks’ gestation report that she is experiencing such severe
morning sickness that she “has not been able to keep anything down for a week.” The nurse should
assess for signs and symptoms of which condition?
a) Hypokalemia
b) Hyperglycemia
c) Hypercalcemia
d) Hypobilirubinemia
A client, 7 months pregnant, is admitted to the unit with abdominal pain and bright red vaginal
bleeding. Which action should the nurse take first?
a) Ease the client’s anxiety by assuring her that everything will be all right.
b) Administer I.V. oxytocin, as ordered, to stimulate uterine contractions and prevent further
hemorrhage.
c) Massage the client’s fundus to help control the hemorrhage.
d) Place the client on her left side and start supplemental oxygen, as ordered, fetal oxygenation.
, A primigravid client with class II heart disease is visiting the clinic at 8 weeks’ gestation tells the nurse
that she has been maintaining a low-sodium, 1,800-calorie diet. Which instruction should the nurse
give the client?
a) Increase caloric intake to 2,200 calories daily to promote fetal growth.
b) Take iron supplements with milk to enhance absorption.
c) Avoid folic acid supplements to prevent megaloblastic anemia.
d) Severely restrict sodium intake throughout the pregnancy.
Which intervention listed in the care plan for a client with an ectopic pregnancy requires revision?
a) Providing for dietary needs and nursing in a dark quiet room.
b) Managing pain and providing emotional support.
c) Assessing vital signs and managing pain.
d) Providing emotional support and assessing per vaginal loss.
A pregnant client with diabetes mellitus is at risk for having a large-for-gestational-age neonate
because:
a) Excess insulin reduces placental functioning.
b) Excess sugar causes reduced placental functioning.
c) Insulin acts as a growth hormone on the fetus.
d) The mother follow a high-calorie diet.
A client in the last trimester of pregnancy. The nurse should instruct her to notify her primary health
care provider immediately if she notices:
a) Hemorrhoids
b) Increased vaginal mucus.
c) Blurred vision.
d) Dyspnea on exertion.
The primary health care provider (HCP) prescribes intravenous magnesium sulfate for a primigravid
client at 38 weeks’ gestation diagnosed with severe preeclampsia. Which medication would be most
important for the nurse to have readily available?
a) Hydralazine
b) Diazepam
c) Calcium gluconate
d) Phenytoin
The primary healthcare provider (HCP) orders 1,000 mL of Ringer’s Lactate intravenously over an 8-
hour period for a 29-year-old primigravid client at 16 weeks’ gestation with hyperemesis. The drip
factor is 12 gtts/mL. The nurse should administer the IV infusion at how many drops per minute?
Record your answer as a whole number.
25 ml/min
A 15-year-old female who is 26 weeks pregnant has been admitted to the labor and delivery unit with
a complaint for abdominal pain. Her parents want to speak with a nurse about to her condition. How
should the nurse respond?
a) “She is experiencing Braxton Hicks contractions and is too young to understand the difference
between these contractions and labor pains.”
b) “The physician can give you more information without consent.”
c) “I’ll need a signed consent from your daughter to give you medical information.”
d) “She will be OK. It’s just a stomachache.”
