Online NCLEX Practice Test about
Obstetric Nursing I

1. The structure left after the ovum has been discharged is called

A. Graafian follicle
B. Corpus Luteum
C. Blastocyst
D. Chorion

2. The clinical instructor is having discussion with her students on fetal circulation. Which of the following statements when made by a student indicates understanding about the umbilical cord?

A. the umbilical cord is of 2 arteries and 1 vein
B. the umbilical cord is of2 veins and 1 artery
C. the umbilical cord is of1 artery and 2 veins
D. the umbilical cord is of2 veins

3. Which of the following statements in not true about the placenta?

A. it provides exchange of nutrients and waste between fetus and mother
B. it develops by the third month of gestation
C. it allows transfer of maternal immunoglobulin
D. allows passage of bacteria and virus

4. The mother reported to the clinic for prenatal check-up. She asks the nurse when will the sex of the fetus be determined by the ultrasound. Which of the following would be the most appropriate response by the nurse?

A. on the 16th week of pregnancy
B. on the 20th week of pregnancy
C. on the 24th week of pregnancy
D. on the 28th week of pregnancy

5. Which of the following assessment indicates that the newborn is delivered full-term?

A. Lanugo is woolly patches
B. skin is dry and cracked
C. fingernails extend beyond fingertips
D. profuse scalp hair

6. The OB history of a woman is recorded as gravida 5 Para 3114. This indicates that the woman has

A. One abortion, one preterm delivery, 4 living children
B. three full-term deliveries, 1 post-mature delivery, four pregnancies
C. five pregnancies, three living children
D. four living children, 3 premature deliveries, 1 full-term delivery

7. Which of the following assessment data is most accurate indication that the woman is pregnant?

A. positive pregnancy test
B. presence of fetal heart rate
C. absence of menstruation
D. quickening

8. the client is on her first trimester of pregnancy. She is experiencing nausea and vomiting each morning that she wakes up. Which of the following should not be included when giving health teachings to this client?

A. take small, frequent feedings
B. take dry toast or crackers
C. take anti-emetics
D. take low-fat diet

9. The pregnant client complains of feeling of faintness. Which position does the nurse recommend to relieve this symptom?

A. supine position
B. modified trendelenburg position
C. right side-lying position
D. left-lying position

10. The pregnant client will undergo Alpha-fetoprotein level determination. Which of the following specimen is required?

A. maternal blood sample
B. blood from chorionic villi
C. amniotic fluid
D. cervical secretions

11. The nurse is giving health teachings to a pregnant client. Which of the following information should be included for prevention of toxoplasmosis?

a) avoid traveling to foreign countries during the entire pregnancy
b) avoid persons with cough and colds
c) avoid eating raw meats or handling cat litters
d) avoid overcrowded places

12. Which of the following potential problems should the nurse be alert for in a client with pregnancy-induced hypertension (PIH)

a)abruptio placenta
b) post term delivery
c) uterine inversion
d) placenta previa

13. Which of the following anti-tubecular drugs is most appropriate to be administered to a neonate delivered by tuberculosis - infected mother?

a) streptomycin
b) ethambutol
c) rifampicin
d) INH (isoniazid)

14. The nurse is caring for several clients who are in active labor. Which among these clients should she give highest priority?

a) the client with prolapsed cord
b) the client with BP of 160/100 mmHg
c) the client with oliguria
d) the client with headache and blurred vision

15. The presenting part of the fetus is at 2 cm. below the ischial spine. The nurse properly assesses that the fetus is at

a) station 0
b) station negative 2
c) station positive 2
d) station (+-) 2

16. The nurse is performing Leopold's maneuver. During the first maneuver, the fetal part palpated is hard, round and movable. The nurse concludes that the fetal presentation is:

a) cephalic
b) breech
c) shoulder
d) footling

17. Which of the following assessment findings indicates that the woman is experiencing false labor?

a) Contractions decrease in duration and intensity
b) back pain not relieved by walking
c) dilatation and effacement of the cervix are noted
d) bloody show occurs

18. Which of the following conditions when noted by the nurse in a woman in active labor needs follow-up?

a) uterine contractions that occur every 3 to 5 minutes
b) uterine contractions that last more than 90 seconds
c) uterine contractions intensity of 50-60 mmHg
d) uterine contractions that occur every 30 minutes

19. The pregnant client is the latent phase of labor. Which of the following findings characterize this stage of labor?

a) the client is helpless and restless
b) the client feels out of control
c) the client is talkative and eager
d) the client is tired and anxious

20. Prolonged, difficult, very painful labor is called

a) precipitous labor
b) dyspareunia
c) preterm labor
d) dystocia
e) uterine contractions that occur 3 to 5 minutes

21. Which of the following findings indicate s that Yutopar (Ritodrine) is effective?

a) decreased frequency of uterine contractions
b) increased duration of uterine contractions
c) increased frequency of uterine contractions
d) increased duration and frequency of uterine contractions

22. The client is diagnosed to have placenta previa. What warning sign should be placed by the nurse in client's unit?

a) no abdominal palpation
b) no vaginal examination
c) no BP-taking
d) no cigarette smoking

23. The client experiences abruptio placenta. Which of the following signs and symptoms supports the diagnosis?

a) painless vaginal bleeding
b) rising fundal height
c) soft uterus
d) elevated BP

24. The client is in active labor. Fetal heart rate monitoring is done. Bradycardia is noted at the start of uterine contraction. The nurse correctly interprets this finding as indicative of

a) head compression
b) prolapsed cord
c) uteropracental insufficiency
d) false labor

25. The nurse noted that prolapse of the cord occurred in a client after rupture of membrane. Which of the following is inappropriate nursing action?

a) place the mother in knee-chest position
b) elevate presenting part by finger pressure with sterile gloved hand
c) push the cord into the uterus
d) prepare client for emergency cesarean section

26. The nurse is caring for a mother who experiences fetal distress. Which of the following should not be included in her nursing care plan?

a) continue pitocin drip
b) administer oxygen by face mask
c) turn to left side
d) prepare for cesarean section

27. The mother delivered a dead fetus. Which of the following will not help the couple progress through the grieving process?

a) encourage the couple to give name to the new born
b) the social worker visits the couple at home
c) advise the couple to have another child
d) encourage the couple to join a support group

28. The client has delivered a live baby boy 4 hours ago. Which of the following findings should be given highest priority by the nurse?

a) bright red vaginal discharge
b) fundus at the level of the umbilicus, palpated towards the right side of the abdomen
c) urine output of 25o ml since after delivery
d) body temperture of 37.6 C

29. The mother had breastfed her newborn. Which of the following actions of the mother indicates the need for further teaching?

a) the mother inserts a clean finger into the baby's mouth before removing him from breast
b) the mother burps the baby after feeding from each breast
c) the mother places the baby on the left side after feeding
d) the mothe exposes her nipples to air for 10-20 minutes after feeding

30. The pregnant client had undergone delivery with forceps. She develops hematoma in the perineal area. Which of the following is inappropriate nursing action to relieve discomfort from hematoma?

a) apply ice at hematoma site for the first 24 hours
b) perform warm sitz bath for the first 24 hours
c) administer analgesic as prescribed
d) perform urinary catheterization as ordered

31. The mother who breastfeeds her newborn experiences pain from engorgement, 2 days after delivery. Which of the following actions by the LVN needs intervention by the RN?

a) The LVN advises the mother to wear support bra
b) The LVN applies ice pack over the mother's engorged breasts
c) The LVN applies warm compress over the mother's engorged breasts
d) The LVN administers the prescribed analgesics

32. The postpartum client who delivered her newborn 4 days ago has been observed by the nurse to have started assuming tasks of mothering. She has started doing tasks for herself, not asking assistance. In which postpartum stage of regeneration is the client?

a) taking-in phase
b) taking-hold phase
c) letting-go phase
d) recovery phase

33. Which of the following signs and symptoms indicates that a postpartum client is experiencing cystitis?

a) urinary retention
b) burning sensation on urination
c) dribbling of urine
d) difficulty in starting urinary stream

34. The client with urinary tract infection has been prescribed to take nitrofurantoin. Which of the following will enhance effectiveness of the medication?

a) cranberry juice
b) tomato juice
c) strawberry juice
d) grapefruit juice

35. The postpartum client who delivered her newborn 5 hours ago is receiving methergine (methylergonovine maleate). Which of the following should be given highest priority when monitoring the client?

a) perineal pad count
b) vital signs
c) intake and output
d) calf pain

36. The charge nurse assigned a postpartum client with thrombophlebitis to an RN. Which of the following actions by the RN needs intervention by the charge nurse?

a) the RN elevates the legs of the client with pillows
b) the RN applies support hose to the client
c) the RN massages the legs of the client
d) the RN applies moist heat on the legs of the client

37. Which of the following is a side effect of bricanyl (terbutaline)?

a) palpitations
b) decreased urine output
c) drowsiness
d) increased blood pressure

38. The client who had undergone cesarean section is receiving Demerol (Meperidine HCL). Which of the following drugs does the nurse anticipate to be ordered by the physician to prevent hypertension?

a) plasil ( metochlopramine)
b) compazine ( prochlorperazine)
c) tigan ( trimethobenzamide)
d) phenergan (promethazine)

39. Which of the following drugs does the nurse expect to be ordered if preterm delivery is inevitable?

a) yutopar (ritodrine)
b) pitocin (oxytocin)
c) bricanyl (terbutaline)
d) betamethasone

40. Which of the following drugs is recommended as eye prophylaxis for newborn?

a) neomycin
b) gentamycin
c) erythromycin
d) streptomycin

41. Before advising a 24 year-old client desiring oral contraceptives for family planning, the nurse would assess the client for signs and symptoms of which of the following?

a) anemia
b) hypertension
c) dysmenorrhea
d) acne vulgaris

42. Using Nagele's rule for a client whose last normal menstrual period began on May 10, the nurse determines that the client's estimated date of delivery would be which of the following?

a) January 13
b) January 17
c) February 13
d) February 17

43. A newly diagnosed pregnant client tells the nurse, "If I'm going to have all of these discomforts, I'm not sure I want to be pregnant!" The nurse interprets the client's statement as an indication of which of the following?

a) fear of pregnancy outcome
b) rejection of pregnancy
c) normal ambivalence
d) inability to care for the newborn

44. Which of the following is a common problem in the newborn of a diabetic mother?

a) hyperglycemia
b) large for gestational age (LGA)
c) changes in facial features
d) meconium aspiration syndrome

45. The type of assisted reproductive method which is done by instilling ova and sperm into the fallopian tube for fertilization is

a) in-vitro fertilization
b) gamete intrafallopian transfer (GIFT)
c) zygote intrafallopian transfer (ZIFT)
d) cloning

46. How should the nurse determine the frequency of uterine contraction?

a) time from the beginning of one contraction to the beginning of the next contraction
b) time from the beginning of one contraction to the end of the same contraction
c) time from the peak of one contraction to the peak of the next contraction
d) time from the end of one contraction to the beginning of the next contraction

47. Which of the following findings would lead the prenatal clinic nurse to suspect that the client has mild pre-eclampsia? Select all that apply

a) hypertension
b) seizures
c) hypotension
d) edema
e) proteinuria
f) blurry vision

48. In the nursery, the nurse expects to assess which of these signs in a neonate whose mother used heroin during the latter half of the pregnancy?

a) lethargy at age 2 days
b) irritability and weak sucking
c) flattened nose, small eyes, and thin lips
d) congenital defects, such as limb anomalies

49. The nurse places a neonate with hyperbilirubinemia under a phototherapy lamp. What is the goal of phototherapy?

a) to prevent hypothermia
b) to promote respiratory stability
c) to decrease the serum level of conjugated bilirubin
d) to decrease the serum level of unconjugated bilirubin

50. Two hours after birth, the neonate begins to gag and turn a dusky color. What is the nurse's first action?

a) calm the neonate
b) notify the physician
c) provide oxygen using a face mask
d) aspirate the nose and mouth with a bulb syringe

51. Which of the following drugs is the antidote for magnesium sulfate toxicity?

a) protamine sulfate
b)vitamin K
c) naloxone hydrochloride
d) calcium gluconate

52. A pregnant woman experiencing severe abruptio placenta would most likely exhibit:

a) fetal bradycardia
b) painless vaginal bleeding
c) rigid, boardlike abdomen
d) vague abdominal discomfort

53. Which of the following drugs is used to treat the candidal infection of a pregnant woman?

a) doxycycline (vibramycin)
b) azithromycin (zithromax)
c) acyclovir (zovirax)
d) miconazole (monistat)

54. During the transition phase of the first stage labor, which of the following occurs?

a) irregular short contractions
b) feeling the urge to push
c) onset of the first contractions
d) cervical dilatation of 4 to 7 cm

55. Which of the following signs indicate that the placenta has separated and is ready to be delivered? Select all that apply:

a) slowing of vaginal bleeding
b) cessation of uterine contractions
c) lengthening of the umbilical cord
d) round firm uterine shape e) discoid uterine shape f) sudden gush of vaginal blood

56. Which of the following measurements indicates that the fetal presenting part is engaged?

a) -2
b) 0
c) +2
d) +4

57. Which of the following would the nurse administer as antidote for Terbutaline?

a) calcium gluconate
b) propranolol
c) vitamin K
d) protamine sulfate

58. Which of the following are possible causes of early postpartum hemorrhage? Select all that apply

a) uterine atony
b) PROM
c) perineal laceration
d) small size for gestational age
e) retained placental fragments
f) DIC

59. Which of the following signs would likely indicate fetal distress?

a) FHR of 140 beats/minute
b) short-term variability of 7 beats/min
c) early decelerations
d) severe variable decelerations

60. Which of the following findings on the neonate is characterized by a localized area of swelling on the neonate's head that crosses the suture lines?

a) caput succedaneum b) molding c) cephalhematoma d) acrocyanosis

61. When determining the Apgar score, the nurse flicks the sole of the neonate's foot to assess which of the following?

a) muscle tone
b) reflex irritability
c) color
d) heart rate

62. When palpating a neonate's anterior fontanel, which of the following would the nurse consider a normal finding?

a) complete closure
b) bulging
c) depression
d) softness

63. On the second postpartum day, where would the nurse expect to palpate the fundus?

a) 1 cm. above the umbilicus
b) at the level of the umbilicus
c) 1 cm. below the umbilicus
d) 2 cm. below the umbilicus

64. When assessing a woman's lochia on the sixth postpartum day, what would the nurse expect to find?

a) lochia rubra
b) lochia serosa
c) lochia alba
d) absence of lochia

65. Which instruction about care of the neonate would the nurse include in the discharge-teaching plan for a woman and her male neonate?

a) pull the foreskin back from head of the penis when bathing him
b) report any foul odor coming from the circumcision or umbilical cord site
c) be sure to check the child's rectal temperature every morning
d) use soap and water to wash the neonate's face

66. Which of the following is the most common cause of mastitis?

a) escherichia coli
b) neisseria gonorrhea
c) staphylococcus aureus
d) treponema pallidum

67. Which drug would the nurse expect to administer to a woman experiencing subinvolution of the uterus?

a) heparin
b) methylergonovine
c) protamine
d) warfarin

68. Which finding is most characteristic of perineal hematoma?

a) fever
b) lethargy
c) positive Homan's sign
d) severe vulvar pain

69. Which drug would the nurse expect to administer to a woman with infertility secondary to anovulation to suppress the hypothalamus?

a) clomiphene (clomid)
b) bromocriptine (parlodel)
c) levothyroxine (synthroid)
d) testosterone cypionate

70. Which cervical mucus assessment finding suggests that a woman is about to ovulate?

a) thick cervical mucus
b) absence of ferning
c) highly strechable mucus
d) highly viscous mucus


ANSWERS AND RATIONALE

1. B - corpus luteum is the structure left after the mature ovum is discharged. Graafian follicle is a mature ovum with corpus luteum. Blastocyst is the fertilized ovum. Chorion forms the fetal part of the placenta.

2. A - the umbilical cord is composed of two arteries and 1 vein (to remember, use the mnemonic AVA: Artery-Vein-Artery)

3. D - the placenta allows passage of virus, but not bacteria. Choices no. 1, 2, and 3 are true statements about the placenta

4. A - the sex of the fetus can be determined by ultrasound on the 16th week of pregnancy.

5. C - Rationale: a full-term newborn has fingernails that extend beyond fingertips. Lanugo in woolly patches is observed in pre-term newborn. Dry and cracked skin and profuse scalp hair are observed in postmature newborn.

6. A - to determine gravidity and parity, use GTPAL. G-gravida (the number of pregnancies regardless of the number of fetus); T-term deliveries; P-preterm deliveries; A-abortion; L-living children. Gravida 5 Para 3 1 1 4 means that the woman had 5 pregnancies, 3 term deliveries, 1 preterm delivery, 1 abortion, and 4 living children.

7. B - presence of fetal heart rate, fetal movement, and fetal outline are the positive signs of pregnancy. Absence of menstruation and quickening are presumptive signs of pregnancy.

8. C - to relieve nausea and vomiting during the first trimester, the woman is advised to take dry toast or crackers. Other measures include: small frequent feedings, low fat meals or avoidance of fried foods, liquids between meals. The woman should not take medications during pregnancy, unless prescribed by the physician.

9. D - left-sided lying position relieves feeling of faintness. This position relieves compression of the inferior vena cava by the gravid uterus. Therefore, it improves venous return to the heart, which increases cardiac output.

10. A - maternal blood sample is required for alpha-fetoprotein (AFP) level determination. High levels of AFP may indicate presence of neural tube defect (e.g. spina bifida) or chromosomal defect (Down's syndrome).

11. C - toxoplasmosis is an infection contacted through eating raw meats or handling cat litters. It is transmitted through placenta. It may cause spontaneous abortion. It can also cause hydrocephalus, intracranial calcifications, or chorioretinitis in the infant.

12. A - abruptio placenta, which is premature separation of normally implanted placenta in the third trimester is a potential complication of PIH (gestational hypertension). This is due to impaired circulation and oxygenation to the placenta and uterus.

13. D - INH (isoniazid) is the anti-tuberculosis drug most appropriate to be administered to a neonate delivered by tuberculosis-infected mother. It is the anti-TB drug which is safe to be administered to clients at any age and among pregnant mothers.

14. A - the client with prolapsed cord should be given highest priority by the nurse. Prolapsed cord decreases blood flow and oxygen available to and from the placenta and to the fetus.

15. C - station is the relationship between presenting part and ischial spine. Station 0 means that the presenting part is at ischial spine. Station (+) means that the presenting part is below ischial spine; station (-) means that the presenting part is above ischial spine. If the presenting part of the fetus is at 2 cm below the ischial spine, it is station (+) 2.

16. B - during the first maneuver, the part of the part of the fetus in fundus of the uterus is determined. The head is hard, round, and movable. Therefore the presentation is breech (buttocks first)

17. A - Rationale: contractions that decrease in duration and intensity is false labor. True labor is characterized by contractions that increase in duration and intensity; cervical dilatation and effacement; back pain not relieved by walking; and bloody show.

18. B - Rationale: uterine contractions that last more than 90 seconds and with frequency of less than 2 minutes leads to tetanic contractions. This may cause rupture of the uterus, massive bleeding, shock, and fetal and maternal death. Therefore, the client needs immediate management.

19. C - Rationale: during the latent phase of labor, duration of uterine contractions is 10 to 30 seconds only, and the frequency is every 15 to 30 min. The mother is still talkative and eager.

20. D - Rationale: dystocia is prolonged, difficult, very painful labor. Precipitous labor is labor that lasts less than 3 hours. Dyspareunia is painful intercourse. Preterm labor is labor occurring after 20th week but before 37th week of pregnancy.

21) A - Rationale: Yutopar (Ritodrine) is a tocolytic agent. It promotes uterine relaxation and stops premature delivery. Decreased frequency of uterine contractions indicates effectiveness of the medication

22) B - Rationale: placenta previa is characterized by improperly implanted placenta in the lower uterine segment near or over the internal cervical os. Therefore nursing intervention should include avoidance of invasive procedures like vaginal examination and internal fetal heart rate monitoring

23) B - Rationale: abruptio placenta is premature separation of placenta from the uterine wall after the 20th week of gestation and before the fetus is delivered. It is usually caused by poor uteroplacental circulation due to hypertension, smoking, alcohol, cocaine abuse. A manifestation is rising fundal height from blood trapped behind placenta. Other signs and symptoms are as follows: painful vaginal bleeding; hypertonic to tetanic, enlarged uterus; boardlike rigidity of abdomen; abnormal or absent fetal heart tones; bloody amniotic fluid; signs of shock

24) A - Rationale: early decelaration indicates head compression; variable deceleration indicates cord compression; while late deceleration is characteristic of uteroplacental insufficiency

25. C - Rationale: when prolapse of he cord occurs; pushing the cord into uterus is inappropriate nursing action. This may cause trauma to the cord that leads to poor placental and fetal circulation and oxygenation. Choices no. 1, 2, and 4 are appropriate nursing interventions for prolapsed cord

26) A - Rationale: during fetal distress, pitocin drip should be discontinued. This is because uterine contractions will further reduce fetal oxygenation. Therefore, choice no. 1 should not be included in the client's nursing care plan

27) C - Rationale: advising the couple to have another child is non-therapeutic. The couple should be encouraged to give name to the dead newborn to make him realize that their child is real. The social worker visits the couple to further assess their perception of their current situation and to provide psychosocial support. Encouraging the couple will realize that their problem is not unique. The environment is non-threatening and the couple will be encouraged to verbalize their feelings, fears, and concerns

28) B - Rationale: deviation of the fundus of the uterus to the side of the abdomen indicates distended bladder. Distended bladder inhibits contraction of the uterus. This increases risk for bleeding

29) C - Rationale: placing the bay on the left side after feeding indicates knowledge deficit of the mother. The baby should be placed on the right side after feeding to prevent gastroesophageal reflux and aspiration

30) B - Rationale: it is inappropriate to perform warm sitz bath for the first 24 hours after delivery. This causes vasodilatation and may lead to further bleeding. Appropriate nursing actions to relieve discomfort from hematoma are as follows: ice application for the first 24 hours to promote vasoconstriction and to prevent bleeding; analgesic to relieve pain; urinary catheterization to minimize discomfort during urination.

31) B - Rationale: application of ice pack over the mother's engorged breasts inhibits milk production. This action by the LVN needs intervention by the RN. Choices A, C, and D are correct nursing interventions.

32) B - Rationale: taking-hold phase is characterized by the following: mother becomes more independent; she begins to assume tasks of mothering. This phase of regeneration occurs 3 to 10 days postpartum. Taking-in phase is the time when mother is focused more on her own needs like food and sleep. Letting-go phase is characterized by feeling of deep loss by the mother, for separation of the baby from part of the body. She is caught in a dependent-independent role. She wants to feel safe and secure, yet wanting to make decisions.

33) B - Rationale: burning sensation on urination is experienced in cystitis

34)A - Rationale: nitrofurantoin becomes more effective in acidic pH. Cranberry juice acidifies urine and will enhance effectiveness of the medication

35) A - Rationale: methergine promotes uterine contraction and will prevent bleeding. Uterine bleeding is monitored by perineal pad count. Perineal pad sturated within 2 hours indicates heavy bleeding.

36) C - Rationale: massaging the legs of a client with thrombophlebitis may dislodge blood clots that will lead to pulmonary embolism. Therefore, this action by the RN needs intervention by the charge nurse.

37) A - Rationale: the side effects of and adverse reaction to Bricanyl (terbutaline) are as follows: tachycardia, anxiety, nervousness, tremors, headache, palpitaitons, arrythmias, and hypertension

38) D - Rationale: phenergan (promethazine) prevents nausea due to meperidine (demerol) administration

39) D - Rationale: betamethasone (celestone) is oredred if preterm delivery is inevitable. This medication increases surfactant production and thereby, increasing probability of the fetus to survive.

40) C - Rationale: erythromycin and tetracycline are the medications used as eye prophylaxis for gonorrhea and chlamydia. Preventive treatment of gonorrhea is provided by law.

41) B - Rationale: before starting oral contraceptives, the nurse should assess the client for signs and symptoms of hypertension. The estrogen component of the oral contraceptive stimulates angiotensinogen production which is converted into angiotensin I and II. Angiotensin II causes vasoconstriction and stimulates adrenal cortex to increase aldosterone secretion. Aldosterone increases sodium and water retention, thus increasing plasma volume. Vasoconstriction and increased plasma volume cause hypertension. Another contraindication of oral contraceptives is thrombophlebitis

42) D - Rationale: to determine the client's estimated date of delivery, Nagele's rule uses this formula: from the last normal menstrual period, subtract 3 from the month, add 7 for the day, and add 1 year.

43) C - Rationale: During the first trimester, it is normal for the pregnant woman to experience ambivalence. After the first trimester, the woman moves towards acceptance of the pregnancy.

44) D - Rationale: meconium aspiration syndrome is a common problem in the newborn of a diabetic mother

45) B - Rationale: gamete intrafallopian transfer (GIFT) is instillation of ova and sperm into fallopian tube by laparoscopy. In-vitro fertilization is introduction of ova and sperm into uterus via the vagina. Zygote intrafallopian transfer (ZIFT) is instillation of fertilized ovum into the fallopian tube by laparoscopy

46) A - Rationale: frequency of contraction is determined by timing from the beginning of one contraction to the beginning of the next contraction. Timing from the beginning of one contraction to the end of the same contraction determines duration.

47) A,D,E - Rationale: mild pre-eclampsia is characterized by hypertension, edema, and proteinuria. Seizures are signs of eclampsia. Abdominal pain, blurry vision and decreased urine output are signs of severe pre-eclampsia.

48) B - Rationale: neonates of heroin-addicted mothers are physically dependent on the drug and experience withdrawal when the drug is no longer supplied. Signs of heroin withdrawal include irritability, restlessness, and poor sucking patterns. A flattened nose, small eyes, and thin lips are signs of fetal alcohol syndrome (FAS)

49) D - Rationale: the goal of phototherapy is to reduce the serum level of unconjugated bilirubin because a high level may lead to bilirubin encephalophathy (kernicterus). It has no effect on conjugated bilirubin, which is a water-soluble substance that is excreted easily in urine and stool.

50) D - Rationale: the nurse's first action should be to clear the airway with a bulb syringe. Then, comfort and calm the neonate. If the problem recurs and color doesn't improve readily, the nurse should notify the physician. Oxygen is administered only when the airway is clear. Otherwise it is ineffective.

51) D - Rationale: calcium gluconate is the antidote for magnesium toxicity. Protamine sulfate is the antidote for heparin; Vitamin K is the antidote for coumadin; naloxone is the antidote for opioid

52) C - Rationale: rigid, boardlike abdomen with moderate vaginal bleeding and signs and symptoms of shock are manifestations of abruptio placenta. Fetal bradycardia is associated with moderate abruptio placenta previa. Vague abdominal discomfort is associated with mild abruptio placenta.

53) D - Rationale: miconazole is used to treat candida (fungal infections). Chlamydia in pregnant women is treated with azithromycin or amoxicillin (amoxil). Doxycycline is used to treat women with chlamydia who are not pregnant. Acyclovir is used to treat genital herpes.

54) B - Rationale: during transition phase, the woman typically feels the urge to push. Irregular contractions are typical of the latent phase. The onset of the first contractions signifies the beginning of the first stage of labor. Cervical dilatation of 4 to 7 cm. occurs during the active phase.

55) C, E, F - Rationale: signs that the placenta has separated and is ready to be delivered includes: lengthening of the umbilical cord, sudden gush of vaginal blood, and change in the shape of the uterus from round to discoid. After delivery of the neonate, uterine contractions commonly cease for several minutes. The uterus can be felt as a round mass, firm to touch, just below the level of the umbilicus. After the brief period of rest, when the contractions resume, the uterus takes on a discoid shape and remains that way until the placenta has separated from the uterus. Separation of the placenta from the uterus occurs after uterus resumes contractions.

56) B - Rationale: engagement occurs when the fetal presenting part is at the level of the ischial spines, or station 0. A -2 station indicates that the fetal presenting part is 2 cm above the ischial spines; A +2 station indicates that the fetal presenting part is 2 cm below the ischial spines. A +4 station indicates that the fetal presenting part is at the perineum commonly called "crowning"

57) B - Rationale: propranolol a beta-adrenergic blocker is the antidote for terbutaline a beta-agonist. Calcium gluconate is the antidote for magnesium sulfate, Vitamin K is the antidote for warfarin, and protamine sulfate is the antidote for heparin

58) A, C, E, F - causes of postpartal hemorrhage include uterine atony, perineal laceration, retained placental fragments, and DIC

59) D -Rationale: severe variable decelerations are an ominous sign indicating continued cord compression, which subsequently interferes with fetal oxygenation. An FHR of 140 beats/minute is within normal limits. Short term variability in the range of 6 to 10 beats/min. and early decelerations, which indicate fetal head compression during a contraction, are reassuring FHR patterns

60) A - Rationale: caput succedaneum is localized swelling over the presenting part that can cross the suture line. Molding refers to asymmetry of the skull from overriding of cranial sutures during labor and delivery as the presenting part of the ftal head, usually the vertex, adjusts to fit the shape of the birth canal. Cephalhematoma is the collection of blood between a skull bone and the periosteum that doesn't cross suture lines and appears egg shape. Acrocyanosis refers to the cyanosis of the hands and feet resulting from adjustments to extrauterine circulation.

61) B - Rationale: flicking the sole of the neonate's foot is used to assess reflex irritability. Nasal suctioning can also be used. Flexing and resistance to extension are used to assess muscle tone. Observing the neonate's skin, especially the extremities, is done to assess color. Auscultating the heartbeat with a stethoscope is used to assess heart rate.

62) D - Rationale: the anterior fontanel should feel soft and flat to touch. It typically closes at 12 to 18 moths of age. Bulging suggests increased intracranial pressure. Depressed anterior fontanel indicates dehydration.

63) D - Rationale: for each postpartum day, the uterus descends about 1 cm. Therefore, on the second postpartum day, the uterus would be 2 cm. below the umbilicus. The uterus would be 1 cm. above or at the level of the umbilicus approximately 12 hours after delivery and 1 cm. below the umbilicus by the first postpartum day

64) B - Rationale: from postpartum days 4 through about 9, lochia serosa is found. Lochia rubra is found during the first three postpartum days. Lochia alba typically begins on the 10th postpartum day, possibly lasting 2 to 6 weeks. Lochia should never be absent by the time the woman goes for her 6 weeks follow-up appointment

65) B - Rationale: parents need to be instructed to report any foul odor coming from the circumcision or umbilical cord site. This could indicate an infection which requires prompt treatment. The foreskin should not be pulled back on the neonate because it is adherent to the glans. Temperature should be monitored, but not rectally. The neonate's temperature should be checked via the axillary or tymphanic route. It is not necessary to check the neonate's temperature everyday. When washing the neonate's face, only water should be used and the eyes should be wiped with a clean corner of a washcloth from the inner to the outer canthus.

66) C - Rationale: the most common cause of mastitis is staphylococcus aureus. E.coli is a common cause of urinary tract infection. N. gonorrhea causes gonorrhea. T. pallidum causes syphillis

67) B - Rationale: to treat subinvolution, the physician may order methylergonovine to aid in uterine contraction. Heparin and warfarin are anticoagulants which may increase the risk of bleeding. Protamine is the antidote for heparin toxicity

68) D - Rationale: with perineal hematoma, the most characteristic finding is severe vulvar pain. Fever and lethargy are seen with any infection. A positive Homan's sign may suggest thrombophlebitis

69) A - Rationale: clomiphene (clomid), is drug used to treat infertility due to anovulation. Bromocriptine (parlodel) is used to increase prolactin levels in women with infertility who are anovulatory. Levothyroxine is used to treat infertility secondary to hypothyroidism. Depo-testosterone, increases virilization and is used to treat males with infertility.

70) C - Rationale: when estrogen stimulation is high, just before ovulation, cervical mucus is highly stretchable and thin, demonstrates ferning, and has low viscosity.

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