MADA WALABU UNIVERSITY

GOBA REFERRAL HOSPITAL

COLLEGE OF MEDICINE AND HEALTH SCIENCES
NURSING DEPARTMENT

OBSTETRICS & GYNECOLOGICAL NURSING

1. For the nurse to distinguish that the bleeding of the patient is placenta previa or abruptio
placenta what should she ask the woman?
a. Whether there was accompanying pain
b. What she has done for bleeding
c. Estimation of blood loss
d. All of the above
RATIONALE :- Placenta previa presents bleeding without pain whilst the bleeding in abruptio
placenta is painful.
2. The nurse is assessing the lochia on a 1 day post partum patient. The nurse notes that the
lochia is red and has a foul-smelling odor. The nurse determines that this assessment finding is:
a. Normal
b. Indicates the presence of infection
c. Indicates the need for increasing oral fluids
d. Indicates the need for increasing ambulation
RATIONALE :- Lochia, the discharge present after birth, is red for the first 1 to 3 days and
gradually decreases in amount. Foul smelling or purulent lochia usually indicates infection, and
these findings are not normal. Normal lochia has a fleshy odor. Encouraging the woman to drink
fluids or increase ambulation is not an accurate nursing intervention.

3. A nurse is preparing to assess the uterine fundus of a client in the immediate postpartum
period. When the nurse locates the fundus, she notes that the uterus feels soft and boggy. Which
of the following nursing interventions would be most appropriate initially?

a. Massage the fundus until it is firm

b. Elevate the mother’s legs
c. Push on the uterus to assist in expressing clots
d. Encourage the mother to void

RATIONALE :- If the uterus is not contracted firmly, the first intervention is to massage the
fundus until it is firm and to express clots that may have accumulated in the uterus. Elevating the
client’s legs and encouraging the client to void will not assist in managing uterine atony. If the
uterus does not remain contracted as a result of the uterine massage, the problem may be
distended bladder and the nurse should assist the mother to urinate, but this would not be the
initial action. Pushing on an uncontracted uterus can invert the uterus and cause massive
hemorrhage.
4. A nurse is assessing a mother who delivered a healthy newborn infant by C-section. The nurse
is assessing for signs and symptoms of superficial venous thrombosis. Which of the following
signs or symptoms would the nurse note if superficial venous thrombosis were present?

a. Paleness of the calf area

b. Enlarged, hardened veins
c. Coolness of the calf area
d. Palpable dorsalis pedis pulses

RATIONALE :- Thrombosis of the superficial veins is usually accompanied by signs and

symptoms of inflammation. These include swelling of the involved extremity and redness,
tenderness, and warmth.

5. A nurse is assessing a client in the 4th stage of labor and notes that the fundus is firm but that
bleeding is excessive. The initial nursing action would be which of the following?

a. Massage the fundus

b. Place the mother in the Trendelenburg’s position
c. Notify the physician
d. Record the findings

RATIONALE :- Notify the physician if the bleeding is excessive, the cause may be laceration
of the cervix or birth canal. Massaging the fundus if it is firm will not assist in controlling the
bleeding. Trendelenburg’s position is to be avoided because it may interfere with cardiac
function.

6. Methergin is prescribed for a woman to treat post partum hemorrhage. Before administration
of these medications, the priority nursing assessment is to check the:

a. Amount of lochia
b. Blood pressure
c. Deep tendon reflexes
d. Uterine tone

RATIONALE :- Methergin is used to prevent or control postpartum hemorrhage by contracting

the uterus. They cause continuous uterine contractions and may elevate blood pressure. A
priority nursing intervention is to check blood pressure. The physician should be notified if
hypertension is present.

7. A client is complaining of painful contractions, or after pains, on postpartum day 2. Which of

the following condition could increase the severity of afterpains?

a. Bottle-feeding
b. Diabetes
c. Multiple gestation
d. Primiparity
RATIONALE :- Multiple gestation, breastfeeding, multiparity, and conditions that cause
overdistention of the uterus will increase the intensity of after-pains. Bottle-feeding and diabetes
aren’t directly associated with increasing severity of afterpains unless the client has delivered a
macrosomic infant.

8. Mrs. Diane is diagnosed with Placenta previa. The main difference with the bleeding in
placenta previa and abruptio placenta is that placenta previa has:
a. Painful bleeding
b. Rigid abdomen
c. Bright-red blood
d. Blood filled with clots
RATIONALE :- In placenta previa the bleeding that occurs is abrupt, painless, bright-red and
sudden to frighten a woman. With abruptio placenta, the bleeding is painful, the abdomen is rigid
or board-like and the blood is filled with clots.
9. Which of the following complications is most likely responsible for a delayed postpartum
hemorrhage?

a. Cervical laceration
b. Clotting deficiency
c. Perineal laceration
d. Uterine subinvolution

RATIONALE :- Late postpartum bleeding is often the result of subinvolution of the uterus.
Retained products of conception or infection often cause subinvolution. Cervical or perineal
lacerations can cause an immediate postpartum hemorrhage. A client with a clotting deficiency
may also have an immediate PP hemorrhage if the deficiency isn’t corrected at the time of
delivery

10. After the expulsion of the placenta in a client who has six living children, an infusion of
lactated ringer’s solution with 10 units of Pitocin is ordered. The nurse understands that this is
indicated for this client because:

a. She had a precipitate birth

b. This was an extramural birth
c. Retained placental fragments must be expelled
d. Multigravidas are at increased risk for uterine atony.

RATIONALE :- Multiple full-term pregnancies and deliveries result in overstretched uterine

muscles that do not contract efficiently and bleeding may ensue.

11. A patient is in the second stage of labor. During this stage, how frequently should the nurse
in charge assess her uterine contractions?
a. Every 5 minutes
 b. Every 15 minutes
c. Every 30 minutes
d. Every 60 minutes
RATIONALE :- During the second stage of labor, the nurse should assess the strength,
frequency, and duration of contraction every 15 minutes. If maternal or fetal problems are
detected, more frequent monitoring is necessary. An interval of 30 to 60 minutes between
assessments is too long because of variations in the length and duration of patient’s labor.
12. A client makes a routine visit to the prenatal clinic. Although she is 14 weeks pregnant, the
size of her uterus approximates that in an 18- to 20-week pregnancy. Dr. Charles diagnoses
gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography
to reveal:
a. An empty gestational sac.
b. Grapelike clusters.
c. A severely malformed fetus.
d. An extrauterine pregnancy.
RATIONALE :- In a client with gestational trophoblastic disease, an ultrasound performed
after the 3rd month shows grapelike clusters of transparent vesicles rather than a fetus. The
vesicles contain a clear fluid and may involve all or part of the decidual lining of the uterus.
Usually no embryo (and therefore no fetus) is present because it has been absorbed. Because
there is no fetus, there can be no extrauterine pregnancy. An extrauterine pregnancy is seen with
an ectopic pregnancy
13. The nurse is caring for a client in labor. The external fetal monitor shows a pattern of
variable decelerations in fetal heart rate. What should the nurse do first?
a. Change the client’s position.
b. Prepare for emergency cesarean section.
c. Check for placenta previa.
d. Administer oxygen
RATIONALE :- Variable decelerations in fetal heart rate are an ominous sign, indicating
compression of the umbilical cord. Changing the client’s position from supine to side-lying may
immediately correct the problem. An emergency cesarean section is necessary only if other
measures, such as changing position and amnioinfusion with sterile saline, prove unsuccessful.
Administering oxygen may be helpful, but the priority is to change the woman’s position and
relieve cord compression.
14. The nurse in charge is caring for a postpartum client who had a vaginal delivery with a
midline episiotomy. Which nursing diagnosis takes priority for this client?
a. Risk for deficient fluid volume related to hemorrhage
b. Risk for infection related to the type of delivery
c. Pain related to the type of incision
d. Urinary retention related to periurethral edema
RATIONALE :- Hemorrhage jeopardizes the client’s oxygen supply — the first priority among
human physiologic needs. Therefore, the nursing diagnosis of Risk for deficient fluid volume
related to hemorrhage takes priority over diagnoses of Risk for infection, Pain, and Urinary
retention.
15. When administering magnesium sulfate to a client with preeclampsia, the nurse understands
that this drug is given to:
a. Prevent seizures
b. Reduce blood pressure
c. Slow the process of labor
d. Increase diuresis
RATIONALE :- The chemical makeup of magnesium is similar to that of calcium and,
therefore, magnesium will act like calcium in the body. As a result, magnesium will block
seizure activity in a hyper stimulated neurologic system by interfering with signal transmission at
the neuromuscular junction
16. A client with eclampsia begins to experience a seizure. Which of the following would the
nurse in charge do first?
a. Pad the side rails
b. Place a pillow under the left buttock
c. Insert a padded tongue blade into the mouth
d. Maintain a patent airway
RATIONALE :- The priority for the pregnant client having a seizure is to maintain a patent
airway to ensure adequate oxygenation to the mother and the fetus. Additionally, oxygen may be
administered by face mask to prevent fetal hypoxia.
17. A patient is in her last trimester of pregnancy. Nurse Vickie should instruct her to notify her
primary health care provider immediately if she notices:
a. Blurred vision
b. Hemorrhoids
c. Increased vaginal mucus
d. Shortness of breath on exertion
RATIONALE :- Blurred vision or other visual disturbance, excessive weight gain, edema, and
increased blood pressure may signal severe preeclampsia. This condition may lead to eclampsia,
which has potentially serious consequences for both the patient and fetus. Although hemorrhoids
may be a problem during pregnancy, they do not require immediate attention. Increased vaginal
mucus and dyspnea on exertion are expected as pregnancy progresses.
18. The nurse in-charge is reviewing a patient’s prenatal history. Which finding indicates a
genetic risk factor?
a. The patient is 25 years old
b. The patient has a child with cystic fibrosis
 c. The patient was exposed to rubella at 36 weeks’ gestation
d. The patient has a history of preterm labor at 32 weeks’ gestation
RATIONALE :- Cystic fibrosis is a recessive trait; each offspring has a one in four chance of
having the trait or the disorder. Maternal age is not a risk factor until age 35, when the incidence
of chromosomal defects increases. Maternal exposure to rubella during the first trimester may
cause congenital defects. Although a history or preterm labor may place the patient at risk for
preterm labor, it does not correlate with genetic defects.
19. The multigravida mother with a history of rapid labor who us in active labor calls out to the
nurse, “The baby is coming!” which of the following would be the nurse’s first action?
a. Inspect the perineum
b. Time the contractions
c. Auscultate the fetal heart rate
d. Contact the birth attendant
RATIONALE :- When the client says the baby is coming, the nurse should first inspect the
perineum and observe for crowning to validate the client’s statement. If the client is not
delivering precipitously, the nurse can calm her and use appropriate breathing techniques.
20. The history of Mrs. Dela Cruz revealed that she is a multipara. When should the nurse
transport the client from the labor room to the delivery room?
a. When the cervical dilatation is 8 cm.
b. When the cervical dilatation is 10 cm.
c. When the cervical dilatation is 9 cm.
d. When the client feels the urge to push.
RATIONALE :- Multiparas are transported to the delivery room when the cervical dilatation is
7-8 cm because in multiparas dilatation may proceed before effacement is completed.
Effacement must occur at the end of dilatation, however, before the fetus can be safely pushed
through the cervical canal; otherwise, cervical tearing could result. Primiparas are transported to
when the cervical dilatation is 9-10 cm.