Study sets, textbooks, questions
Upgrade to remove ads
Leifer NCLEX Review Questions CH 1-8
Terms in this set (30)
A group of women are discussing childbirth experiences. Which statement would most likely indicate that the woman gave birth in the 1950s?
1. "My husband stayed with me throughout labor and birth."
2. "The suite allowed me to deliver and recover in the same room."
3. "I was discharged from the hospital 1 week following delivery."
4. "The birthing center rooms were decorated in a homelike fashion."
During the 1950s, the hospital stay for labor and delivery was 1 week. The other situations described would not have occurred until after 1960 with the natural childbirth movement.
During a prenatal clinic visit, a woman states that she probably will not plan to breastfeed her infant because she has very small breasts and believes she cannot provide adequate milk for a full-term infant. The best response of the nurse would be:
1. "Ask the physician if he or she will prescribe hormones to build up the breasts."
2. "I can provide you with exercises that will build up your breast tissue."
3. "The fluid intake of the mother will determine the milk output."
4. "The size of the breast has no relationship to the ability to produce adequate
The nurse is responsible to examine the umbilical cord of the newborn infant. The nurse knows that:
a. the umbilical cord has 2 veins and 1 artery
b. the umbilical cord has 2 arteries and 1 vein
c. the umbilical cord has 2 arteries and 2 veins
d. umbilical arteries carry blood away from the fetus
e. umbilical arteries carry blood to the fetus
1. a and e
2. b and e
3. b and d
4. c and d
The arteries and vein in the umbilical cord of the fetus function differently than arteries and veins in the rest of the body.
A woman arrives in the clinic for her prenatal visit. She states that she is currently 28 weeks pregnant with twins, she has a 5-year-old son who was delivered at 39 weeks gestation and a 3-year-old daughter delivered at 34 weeks gestation, and her last pregnancy terminated at 16 weeks gestation. The nurse will interpret her obstetric history as:
1. G4 T2 P2 A1 L4.
2. G3 T2 P0 A1 L2.
3. G3 T1 P1 A1 L2.
4. G4 T1 P1 A1 L2.
G stands for gravida or how many pregnancies the woman has had. In this scenario there is a history of four pregnancies. The TPALM system is used to describe parity. T stands for term; this woman has had one child delivered at 39 weeks, which is considered term. P stands for preterm; this woman has had one child delivered at 34 weeks' gestation, which is considered preterm. A stands for abortion; this woman reports a pregnancy that terminated at 16 weeks' gestation. L stands for living; this woman has two living children. M stands for multiple, which is optional and not provided as a choice in this question.
A woman being seen for her first prenatal care appointment has a positive home pregnancy test, and her chart shows a TPALM recording of 40120. The nurse would anticipate that:
1. minimal prenatal teaching will be required because this is her fourth pregnancy.
2. the woman will need help in planning the care of her other children at home during her labor and delivery.
3. the woman should experience minimal anxiety because she is familiar with the progress of pregnancy.
4. this pregnancy will be considered high risk, and measures to reduce anxiety will be needed.
According to the TPALM system, these numbers indicate that the woman has had 4 children at term, has had 0 children at preterm, has 2 children now living, and has had 0 multiples. Because it is indicated that she had 4 children at term but only 2 are living now, the system indicates this pregnancy would be high risk, and anxiety-reduction techniques will be required.
A woman's LNMP was on April 1, 2019. She has been keeping her prenatal clinic appointments regularly but states she needs to alter the dates of a future appointment because she and her husband are going on an ocean cruise vacation for the New Year's celebration from December 30 through January 7, 2020. The best response of the nurse would be:
1. "Prenatal visits can never be altered. Every visit is important."
2. "Be sure to take antinausea medication when going on an ocean cruise."
3. "Perhaps you might consider rescheduling your vacation around the Thanksgiving holiday rather than the New Year's dates."
4. "I will reschedule your clinic appointment to accommodate your vacation plans."
The woman's EDC (estimated date of confinement), using Naegele's rule, is calculated to be January 8, 2014. Scheduling a vacation that ends one day prior to the due date should be discouraged. Suggesting that the vacation be rescheduled is the best response by the nurse.
When an expectant mother asks why she should see a physician so often during her pregnancy, what is the nurse's best response?
1. "It helps the health care facilities know how many expectant mothers are expected to deliver within the next year, as well as possible health risks."
2. "It helps hospitals know what health problems infants might have after delivery."
3. "It helps the mother to maintain good health and promote a good outcome for the fetus."
4. "It allows the doctor to screen for contagious disease that might harm the mother or fetus."
Promoting a good outcome for the fetus and mother is listed as one of the major goals for prenatal care.
The health care provider gives magnesium sulfate intravenously to a woman with a diagnosis of preeclampsia. Which of the following nursing interventions are priority when caring for a patient who has received magnesium sulfate? (Select all that apply.)
a. Monitor uterine tone.
b. Monitor urine output.
c. Keep patient NPO.
d. Monitor respiratory rate.
1. a and b
2. c and d
3. b and d
4. a and c
ANS: 1, 3
(tone, urine, respiratory)
Priority nursing interventions for a patient receiving magnesium sulfate for preeclampsia include monitoring uterine muscle tone to assess for complications or signs of labor, as well as monitoring urine output and respiratory rate to assess for signs of toxicity. The woman receiving magnesium sulfate can have ice chips and sips of water during treatment.
Select the primary difference between the symptoms of placenta previa and abruptio placentae.
1. Fetal presentation
2. Presence of pain
3. Abnormal blood clotting
4. Presence of bleeding
Manifestations of placenta previa include painless vaginal bleeding that is usually bright red. Bleeding accompanied by abdominal or low back pain is a typical characteristic of abruptio placentae.
At what point does preeclampsia become eclampsia?
1. Onset of diplopia and headache
2. Blood pressure of 150/100 mm Hg or above
3. Presence of facial edema and proteinuria
4. One or more generalized tonic-clonic seizures
Progression to eclampsia occurs when the woman has one or more generalized tonic-clonic seizures.
A patient is 28 weeks pregnant and has pregnancy-induced hypertension. Which symptom would indicate that her condition is worsening?
1. Epigastric pain
2. Dependent edema
3. Feelings of lethargy
4. Blood pressure of 138/90 mm Hg
Epigastric pain is a sign of worsening preeclampsia. Blood pressure of 138/90 mm Hg, dependent edema, and feelings of lethargy are not signs that preeclampsia is worsening.
The first sign of fluid retention in the pregnant woman diagnosed with gestational hypertension is
1. sudden, excessive weight gain.
3. abdominal pain.
4. blurred vision.
Sudden, excessive weight gain is the first sign of fluid retention. Visible edema follows the weight gain.
To determine the frequency of uterine contractions, the nurse should note the time from the:
1. beginning to end of the same contraction.
2. end of one contraction to the beginning of the next contraction.
3. beginning of one contraction to the beginning of the next contraction.
4. contraction's peak until the contraction begins to relax.
Frequency is the time it takes from the beginning of one contraction to the beginning of the next contraction. Duration is from the beginning to the end of the same contraction. Interval is from the end of one contraction to the beginning of the next contraction.
Excessive anxiety and fear during labor may result in a(n):
1. ineffective labor pattern.
2. abnormal fetal presentation or position.
3. release of oxytocin from the pituitary gland.
4. rapid labor and uncontrolled birth.
Anxiety can increase a woman's perception of pain and reduce her tolerance of it. Anxiety and fear also cause the secretion of stress compounds from the adrenal glands. These compounds, called catecholamines, inhibit uterine contractions and divert blood flow from the placenta.
A para 0, gravida 1 woman is admitted in active labor. She states she has completed prenatal care and wishes for a natural, unmedicated childbirth. However, she states she now does not feel she can cope with the increasing levels of pain and asks if it is okay if she takes pain medication. What is the best response of the nurse?
Giving permission for the woman to ask for medication if she believes that she needs it relieves the woman of guilt and anxiety. Analgesic agents and regional blocks are available, and the woman can still actively participate in the birth process while using those medications.
What would the nurse expect a normal finding to be during assessment of the fundus of the uterus every 15 minutes during the fourth stage of labor?
1. Firm and at the umbilicus
2. Soft and deviated to the left
3. Firm and deviated to the right
4. Soft to touch, but firm with massage
During the fourth stage, recovery of labor, the uterus is normally found firmly contracted at or below the umbilicus level. Deviation to the right can indicate a full bladder. A boggy or soft uterus can indicate a potential complication. The uterus is not usually found deviated to the left.
The physician performs a nitrazine paper test and the nurse observes the strip paper to be deep blue in color. What is the significance of this assessment?
1. The woman is at risk for placenta previa.
2. The woman is in the active phase of labor.
3. The fluid is acidic and is most likely urine.
4. The fluid is alkaline and most likely amniotic fluid.
A blue-green or deep blue color of the nitrazine paper indicates the fluid is alkaline and most likely amniotic fluid. A yellow to yellow-green color of the strip paper indicates the fluid is acidic and is most likely urine. The nitrazine paper test does not indicate stage of labor nor can it identify placenta previa.
At what point during the labor process does the health care provider know that the second stage of labor has begun?
1. The fetus is at +1 station.
2. The placenta is delivered.
3. The woman feels the urge to push.
4. The cervix is fully dilated at 10 cm.
Stage 2 is from full dilation of the cervix until birth of the fetus. Pushing before full dilation can be dangerous to the fetus and exhausting to the mother. The +1 station is too high. Delivery of the placenta is stage 3.
Which nursing action has the highest priority for a patient in the second stage of labor?
1. Check the fetal position.
2. Administer pain medication.
3. Help the mother push effectively.
4. Prepare the mother to breastfeed on the delivery table.
The second stage of labor is the pushing stage. The nurse should help the mother push effectively. The mother cannot breastfeed in the second stage of labor. Checking fetal position is not the highest priority during the second stage of labor. Pain medication should not be administered in the second stage because it will cause a lethargic neonate and possibly depress the newborn's respirations.
Which is a sign of imminent birth?
1. Increased vaginal discharge
2. Baby dropping
3. Grunting sounds
Sitting on one buttock, making grunting sounds, bearing down with contractions, stating "the baby is coming", and bulging of the perineum are all signs of imminent birth and the nurse should not leave the patient.
Which statement made by an expectant mother demonstrates understanding of the significant risks of home delivery?
1. "I know I will have access to the technology that monitors my well-being."
2. "I know that there will be a delay in emergency care if there is a complication."
3. "The physician will only come to my home if I have a complication."
4. "The midwife can perform most emergency procedures at home."
Mothers will not have access to technology at home. Most physicians will not come to the home for medical care. Most emergency procedures can only be performed in the hospital per standard of care. It is important that this mother understands that there will be a delay, creating significant risk, if there is a complication.
If the sacrum of the fetus in a breech presentation is in the mother's right posterior pelvis, it is described as
1. right sacrum posterior.
2. left mentum anterior.
4. left occiput posterior.
The first word refers to what side of the mom's pelvis the presenting part is facing, the second is the fetal reference point (occiput for vertex presentations, mentum for face, and sacrum for breech), and the third references the front (anterior) or back (posterior) of the mother's pelvis. If the fetus is neither anterior nor posterior, then it is transverse.
What signs of respiratory distress in the neonate should be reported immediately? (Select all that apply.)
1. Grunting respirations
2. Flaring of the nostrils
3. Heart rate above 110 beats/minute
4. Cyanosis of the hands and feet
5. Respiratory rate higher that 60 breaths/minute
1, 2, 5
Some signs of respiratory distress that should be immediately reported include grunting respirations, persistent cyanosis (other than hands and feet), flaring of the nostrils, retractions, sustained respiratory rate higher than 60 breaths/minute, and sustained heart rate greater than 160 beats/minute or less than 110 beats/minute.
The nurse notes that a woman's contractions during oxytocin induction of labor are every 2 minutes; the contractions last 95 seconds, and the uterus remains tense between contractions. What action is expected based on these assessments?
1. No action is expected; the contractions are normal.
2. The rate of oxytocin administration will be increased slightly.
3. Pain medication or an epidural block will be offered.
4. Infusion of oxytocin will be stopped.
Oxytocin is discontinued, or its rate reduced, if signs of fetal compromise or excessive uterine contractions occur. Excessive uterine contractions are most often evidenced by contractions closer than every 2 minutes, durations longer than 90 seconds, or resting intervals shorter than 60 seconds.
The nurse can anticipate that which of the following patients may be scheduled for induction of labor? A woman who is:
1. 38 weeks' gestation with fetus in transverse lie.
2. 40 weeks' gestation with fetal macrosomia.
3. 40 weeks' gestation with gestational hypertension.
4. 40 weeks' gestation with a fetal prolapsed cord.
Labor is induced if continuing the pregnancy is hazardous for the woman or the fetus. An indication for labor induction is gestational hypertension. Risk factors are too great for induction in the other choices.
A woman is being observed in the hospital because her membranes ruptured at 30 weeks gestation. While providing morning care, the nursing student notices that the draining fluid has a strong odor. The priority nursing action is to:
1. caution the woman to remain in bed until her physician visits.
2. ask the woman if she is having any more contractions than usual.
3. take the woman's temperature; report it and the fluid odor to the RN.
4. help to prepare the woman for an immediate cesarean delivery.
Amniotic fluid should be clear, possibly with flecks of vernix, and should not have a bad odor. The nurse should take the woman's temperature every 2 to 4 hours after her membranes rupture and observe, document, and report maternal temperature above 38 C (100.4 F), fetal tachycardia, tenderness over the uterine area, and foul-smelling fluid. These symptoms are suggestive of infection. A vaginal or cervical infection may cause membranes to rupture prematurely.
What is the principal goal of nursing care during labor?
1. Promoting relaxation and helping the woman to conserve resources
2. Preparation of the delivery room with needed supplies
3. Assisting the obstetrician to gown and glove
4. Documenting the progression of the labor process
Which statement indicates that an expectant mother understands the diagnosis of placenta previa?
1. "My doctor will not let my pregnancy go beyond my due date before he induces me."
2. "My doctor will monitor for rupture of membranes each week at my appointment."
3. "My doctor will not induce labor at any time during this pregnancy."
4. "My baby will probably come early because of my condition."
The physician will not induce a patient with this diagnosis. Rupture of membranes is not a primary risk for this complication. This diagnosis does not have a high correlation with preterm births.
What is used to assess the status of the cervix in determining its response to induction?
1. Apgar score
2. Bishop score
4. Prostaglandin secretion
Which are considered pharmacological methods to stimulate contractions? (Select all that apply.)
1. Prostaglandin gel
3. Oxytocin administration
4. Nipple stimulation
Cervical ripening using prostaglandin gel and oxytocin administration (IV) is considered pharmacological methods to stimulate contractions. Amniotomy is the artificial rupture of membranes by using a sterile sharp instrument and can stimulate contractions but is not considered pharmacological. Stimulation of the nipples causes natural secretion of oxytocin and is a nonpharmacological method to stimulate contractions. Version is a method of changing the fetal presentation, usually from breech to cephalic.
Other sets by this creator
LEIFER: L&D EXAM 2 Nursing Care of Mother and Infa…
Maternity Chap 14
Maternity Chap 13
Maternity Chap 12
Recommended textbook solutions
The Human Body in Health and Disease
Gary A. Thibodeau, Kevin T. Patton
Pharmacology and the Nursing Process
Julie S Snyder, Linda Lilley, Shelly Collins
Clinical Reasoning Cases in Nursing
Julie S Snyder, Mariann M Harding
Other Quizlet sets
Ch 11 19231G Psychopaths and Sociopath 1-26 Final…
Crime Scene Investigating Final Exam Review
AP Environmental Science | Unit 1 - 4 Review