Maternal NAME: SECTION MULTIPLE CHOICE: CHOOSE THE BEST ANSWER 1.

May arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago. She also tells the nurse that a home pregnancy test was positive but she began to have mild cramps and is now having moderate vaginal bleeding. During the physical examination of the client, the nurse notes that May has a dilated cervix. The nurse determines that May is experiencing which type of abortion? a. Inevitable c. Threatened b. Incomplete d. Septic Rationale: An inevitable abortion is termination of pregnancy that cannot be prevented. Moderate to severe bleeding with mild cramping and cervical dilation would be noted in this type of abortion. 2. Nurse Reese is reviewing the record of a pregnant client for her first prenatal visit. Which of the following data, if noted on the clients record, would alert the nurse that the client is at risk for a spontaneous abortion? a. Age 36 years b. History of syphilis c. History of genital herpes d. History of diabetes mellitus Rationale: Maternal infections such as syphilis, toxoplasmosis, and rubella are causes of spontaneous abortion. 3. Nurse Hazel is preparing to care for a client who is newly admitted to the hospital with a possible diagnosis of ectopic pregnancy. Nurse Hazel develops a plan of care for the client and determines that which of the following nursing actions is the priority? a. Monitoring weight b. Assessing for edema c. Monitoring apical pulse d. Monitoring temperature Rationale: Nursing care for the client with a possible ectopic pregnancy is focused on preventing or identifying hypovolemic shock and controlling pain. An elevated pulse rate is an indicator of shock. 4. Nurse Oliver is teaching a diabetic pregnant client about nutrition and insulin needs during pregnancy. The nurse determines that the client understands dietary and insulin needs if the client states that the second half of pregnancy require: a. Decreased caloric intake b. Increased caloric intake c. Decreased Insulin d. Increase Insulin Rationale: Glucose crosses the placenta, but insulin does not. High fetal demands for glucose, combined with the insulin resistance caused by hormonal changes in the last half of pregnancy can result in elevation of maternal blood glucose levels. This increases the mothers demand for insulin and is referred to as the diabetogenic effect of pregnancy. 5. Nurse Michelle is assessing a 24 year old client with a diagnosis of hydatidiform mole. She is aware that one of the following is unassociated with this condition? a. Excessive fetal activity. b. Larger than normal uterus for gestational age. c. Vaginal bleeding d. Elevated levels of human chorionic gonadotropin. Rationale: The most common signs and symptoms of hydatidiform mole includes elevated levels of human chorionic gonadotropin, vaginal bleeding, larger than normal uterus for gestational age, failure to detect fetal heart activity even with sensitive instruments, excessive nausea and vomiting, and early development of pregnancy-induced hypertension.

Fetal activity would not be noted. 6. A pregnant client is receiving magnesium sulfate for severe pregnancy induced hypertension (PIH). The clinical findings that would warrant use of the antidote , calcium gluconate is: a. Urinary output 90 cc in 2 hours. b. Absent patellar reflexes. c. Rapid respiratory rate above 40/min. d. Rapid rise in blood pressure. Rationale: Absence of patellar reflexes is an indicator of hypermagnesemia, which requires administration of calcium gluconate 7. During vaginal examination of Janah who is in labor, the presenting part is at station plus two. Nurse, correctly interprets it as: a. Presenting part is 2 cm above the plane of the ischial spines. b. Biparietal diameter is at the level of the ischial spines. c. Presenting part in 2 cm below the plane of the ischial spines. d. Biparietal diameter is 2 cm above the ischial spines. Rationale: Fetus at station plus two indicates that the presenting part is 2 cm below the plane of the ischial spines. 8. A pregnant client is receiving oxytocin for induction of labor. A condition that warrant the nurse incharge to discontinue I.V. infusion of oxytocin is: a. Contractions every 1 . minutes lasting 70-80 seconds. b. Maternal temperature 101.2 c. Early decelerations in the fetal heart rate. d. Fetal heart rate baseline 140-160 bpm. Rationale: Contractions every 1 . minutes lasting 70-80 seconds, is indicative of hyperstimulation of the uterus, which could result in injury to the mother and the fetus if Pitocin is not discontinued. 9. Calcium gluconate is being administered to a client with pregnancy induced hypertension (PIH). A nursing action that must be initiated as the plan of care throughout injection of the drug is: a. Ventilator assistance b. CVP readings c. EKG tracings d. Continuous CPR Rationale: A potential side effect of calcium gluconate administration is cardiac arrest. Continuous monitoring of cardiac activity (EKG) throught administration of calcium gluconate is an essential part of care. 10. A trial for vaginal delivery after an earlier caesareans, would likely to be given to a gravida, who had: a. First low transverse cesarean was for active herpes type 2 infections; vaginal culture at 39 weeks pregnancy was positive. b. First and second caesareans were for cephalopelvic disproportion. c. First caesarean through a classic incision as a result of severe fetal distress. d. First low transverse caesarean was for breech position. Fetus in this pregnancy is in a vertex presentation. Rationale: This type of client has no obstetrical indication for a caesarean section as she did with her first caesarean delivery. 11. Malou was diagnosed with severe preeclampsia is now receiving I.V. magnesium sulfate. The adverse effects associated with magnesium sulfate is: a. Anemia b. Decreased urine output c. Hyperreflexia d. Increased respiratory rate Rationale: Decreased urine output may occur in clients receiving I.V. magnesium and should be monitored closely to keep urine output at greater than 30 ml/hour, because magnesium is excreted through the kidneys and can easily accumulate to toxic levels. 12. A 23 year old client is having her menstrual period every 2 weeks that last for 1 week. This type of menstrual pattern is bets defined by:

a. Menorrhagia c. Dyspareunia b. Metrorrhagia d. Amenorrhea Rationale: Menorrhagia is an excessive menstrual period 13. .Jannah is admitted to the labor and delivery unit. The critical laboratory result for this client would be: a. Oxygen saturation c. Blood typing b. Iron binding capacity d. Serum Calcium Rationale: Blood type would be a critical value to have because the risk of blood loss is always a potential complication during the labor and delivery process. Approximately 40% of a womans cardiac output is delivered to the uterus, therefore, blood loss can occur quite rapidly in the event of uncontrolled bleeding.

14. Nurse Gina is aware that the most common condition found during the second-trimester of
pregnancy is: a. Metabolic alkalosis b. Respiratory acidosis c. Mastitis d. Physiologic anemia Rationale: Hemoglobin values and hematocrit decrease during pregnancy as the increase in plasma volume exceeds the increase in red blood cell production

15. Maureen in her third trimester arrives at the emergency room with painless vaginal bleeding.
Which of the following conditions is suspected? a. Placenta previa b. Abruptio placentae c. Premature labor d. Sexually transmitted disease Rationale: Placenta previa with painless vaginal bleeding. 16. To evaluate a womans understanding about the use of diaphragm for family planning, Nurse Trish asks her to explain how she will use the appliance. Which response indicates a need for further health teaching? a. I should check the diaphragm carefully for holes every time I use it b. I may need a different size of diaphragm if I gain or lose weight more than 20 pounds c. The diaphragm must be left in place for atleast 6 hours after intercourse d. I really need to use the diaphragm and jelly most during the middle of my menstrual cycle. Rationale: The woman must understand that, although the fertile period is approximately midcycle, hormonal variations do occur and can result in early or late ovulation. To be effective, the diaphragm should be inserted before every intercourse

17. The nurse explains to a breastfeeding mother that breast milk is sufficient for all of the babys nutrient needs only up to: a. 5 months c. 1 year b. 6 months d. 2 years Rationale: After 6 months, the babys nutrient needs, especially the babys iron requirement, can no longer be provided by mothers milk alone.
18 . Nurse Ron is aware that the gestational age of a conceptus that is considered viable (able to live outside the womb is: a. 8 weeks c. 24 weeks b. 12 wee)ks d. 32 weeks Rationale: At approximately 23 to 24 weeks gestation, the lungs are developed enough to sometimes maintain extrauterine life. The lungs are the most immature system during the gestation period. Medical care for premature labor begins much earlier (aggressively at 21 weeks gestation) 19. Dr. Esteves decides to artificially rupture the membranes of a mother who is on labor. Following this procedure, the nurse Hazel checks the fetal heart tones for which the following reasons? a. To determine fetal well-being. b. To assess for prolapsed cord

c. To assess fetal position d. To prepare for an imminent delivery. Rationale: After a client has an amniotomy, the nurse should assure that the cord isn't prolapsed and that the baby tolerated the procedure well. The most effective way to do this is to check the fetal heart rate. Fetal well-being is assessed via a nonstress test. Fetal position is determined by vaginal examination. Artificial rupture of membranes doesn't indicate an imminent delivery. 20. Following a precipitous delivery, examination of the client's vagina reveals a fourth-degree laceration. Which of the following would be contraindicated when caring for this client? a. Applying cold to limit edema during the first 12 to 24 hours. b. Instructing the client to use two or more peripads to cushion the area. c. Instructing the client on the use of sitz baths if ordered. d. Instructing the client about the importance of perineal (kegel) exercises. Rationale: Using two or more peripads would do little to reduce the pain or promote perineal healing. Cold applications, sitz baths, and Kegel exercises are important measures when the client has a fourth-degree laceration 21. A pregnant woman accompanied by her husband, seeks admission to the labor and delivery area. She states that she's in labor and says she attended the facility clinic for prenatal care. Which question should the nurse Oliver ask her first? a. Do you have any chronic illnesses? b. Do you have any allergies? c. What is your expected due date? d. Who will be with you during labor? Rationale: When obtaining the history of a client who may be in labor, the nurse's highest priority is to determine her current status, particularly her due date, gravidity, and parity. Gravidity and parity affect the duration of labor and the potential for labor complications. Later, the nurse should ask about chronic illnesses, allergies, and support persons.

22. When a client states that her "water broke," which of the following actions would be
inappropriate for the nurse to do? a. Observing the pooling of straw-colored fluid. b. Checking vaginal discharge with nitrazine paper. c. Conducting a bedside ultrasound for an amniotic fluid index. d. Observing for flakes of vernix in the vaginal discharge. Rationale: It isn't within a nurse's scope of practice to perform and interpret a bedside ultrasound under these conditions and without specialized training. Observing for pooling of straw-colored fluid, checking vaginal discharge with nitrazine paper, and observing for flakes of vernix are appropriate assessments for determining whether a client has ruptured membranes.

23. Nurse John is knowledgeable that usually individual twins will grow appropriately and at the same
rate as singletons until how many weeks? a. 16 to 18 weeks c. 30 to 32 weeks b. 18 to 22 weeks d. 38 to 40 weeks Rationale: Individual twins usually grow at the same rate as singletons until 30 to 32 weeks gestation, then twins dont gain weight as rapidly as singletons of the same gestational age. The placenta can no longer keep pace with the nutritional requirements of both fetuses after 32 weeks, so theres some growth retardation in twins if they remain in utero at 38 to 40 weeks. 24. Which of the following classifications applies to monozygotic twins for whom the cleavage of the fertilized ovum occurs more than 13 days after fertilization? a. conjoined twins b. diamniotic dichorionic twins c. diamniotic monochorionic twin d. monoamniotic monochorionic twins Rationale: The type of placenta that develops in monozygotic twins depends on the time at which cleavage of the ovum occurs. Cleavage in conjoined twins occurs more than 13 days after fertilization. Cleavage that occurs less than 3 day after fertilization results in diamniotic dicchorionic

twins. Cleavage that occurs between days 3 and 8 results in diamniotic monochorionic twins. Cleavage that occurs between days 8 to 13 result in monoamniotic monochorionic twins.

25. Tyra experienced painless vaginal bleeding has just been diagnosed as having a placenta previa.
Which of the following procedures is usually performed to diagnose placenta previa? a. Amniocentesis b. Digital or speculum examination c. External fetal monitoring d. Ultrasound Rationale: Once the mother and the fetus are stabilized, ultrasound evaluation of the placenta should be done to determine the cause of the bleeding. Amniocentesis is contraindicated in placenta previa. A digital or speculum examination shouldnt be done as this may lead to severe bleeding or hemorrhage. External fetal monitoring wont detect a placenta previa, although it will detect fetal distress, which may result from blood loss or placenta separation. 26. Nurse Arnold knows that the following changes in respiratory functioning during pregnancy is considered normal: a. Increased tidal volume b. Increased expiratory volume c. Decreased inspiratory capacity d. Decreased oxygen consumption Rationale: A pregnant client breathes deeper, which increases the tidal volume of gas moved in and out of the respiratory tract with each breath. The expiratory volume and residual volume decrease as the pregnancy progresses. The inspiratory capacity increases during pregnancy. The increased oxygen consumption in the pregnant client is 15% to 20% greater than in the nonpregnant state. 27. Emily has gestational diabetes and it is usually managed by which of the following therapy? a. Diet c. Oral Hypoglycemic b. Long-acting insulin d. Oral hypoglycemic and insulin Rationale: Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Oral hypoglycemic drugs are contraindicated in pregnancy. Long-acting insulin usually isnt needed for blood glucose control in the client with gestational diabetes 28. MgSO4 is given to Jemma with preeclampsia to prevent which of the following condition? a. Hemorrhage c. Hypomagnesemia b. Hypertension d. Seizure Rationale: The anticonvulsant mechanism of magnesium is believes to depress seizure foci in the brain and peripheral neuromuscular blockade. Hypomagnesemia isnt a complication of preeclampsia. Antihypertensive drug other than magnesium are preferred for sustained hypertension. Magnesium doesnt help prevent hemorrhage in preeclamptic clients 29. Camile with sickle cell anemia has an increased risk for having a sickle cell crisis during pregnancy. Aggressive management of a sickle cell crisis includes which of the following measures? a. Antihypertensive agents b. Diuretic agents c. I.V. fluids d. Acetaminophen for pain Rationale: A sickle cell crisis during pregnancy is usually managed by exchange transfusion oxygen, and L.V. Fluids. The client usually needs a stronger analgesic than acetaminophen to control the pain of a crisis. Antihypertensive drugs usually arent necessary. Diuretic wouldnt be used unless fluid overload resulted 30. Which of the following drugs is the antidote for magnesium toxicity? a. Calcium gluconate (Kalcinate) b. Hydralazine (Apresoline) c. Naloxone (Narcan) d. Rho (D) immune globulin (RhoGAM) Rationale: Calcium gluconate is the antidote for magnesium toxicity. Ten milliliters of 10% calcium gluconate is given L.V. push over 3 to 5 minutes. Hydralazine is given for sustained elevated blood pressure in preeclamptic clients. Rho (D) immune globulin is given to women with Rh-negative blood

to prevent antibody formation from RH-positive conceptions. Naloxone is used to correct narcotic toxicity. 31. Marlyn is screened for tuberculosis during her first prenatal visit. An intradermal injection of purified protein derivative (PPD) of the tuberculin bacilli is given. She is considered to have a positive test for which of the following results? a. An indurated wheal under 10 mm in diameter appears in 6 to 12 hours. b. An indurated wheal over 10 mm in diameter appears in 48 to 72 hours. c. A flat circumcised area under 10 mm in diameter appears in 6 to 12 hours. d. A flat circumcised area over 10 mm in diameter appears in 48 to 72 hours. Rationale: A positive PPD result would be an indurated wheal over 10 mm in diameter that appears in 48 to 72 hours. The area must be a raised wheal, not a flat circumcised area to be considered positive 32. Dianne, 24 year-old is 27 weeks pregnant arrives at her physicians office with complaints of fever, nausea, vomiting, malaise, unilateral flank pain, and costovertebral angle tenderness. Which of the following diagnoses is most likely? a. Asymptomatic bacteriuria b. Bacterial vaginosis c. Pyelonephritis d. Urinary tract infection (UTI) Rational: The symptoms indicate acute pyelonephritis, a serious condition in a pregnant client. UTI symptoms include dysuria, urgency, frequency, and suprapubic tenderness. Asymptomatic bacteriuria doesnt cause symptoms. Bacterial vaginosis causes milky white vaginal discharge but no systemic symptoms. 33. Rh isoimmunization in a pregnant client develops during which of the following conditions? a. Rh-positive maternal blood crosses into fetal blood, stimulating fetal antibodies. b. Rh-positive fetal blood crosses into maternal blood, stimulating maternal antibodies. c. Rh-negative fetal blood crosses into maternal blood, stimulating maternal antibodies. d. Rh-negative maternal blood crosses into fetal blood, stimulating fetal antibodies. Rationale: Rh isoimmunization occurs when Rh-positive fetal blood cells cross into the maternal circulation and stimulate maternal antibody production. In subsequent pregnancies with Rh-positive fetuses, maternal antibodies may cross back into the fetal circulation and destroy the fetal blood cells. 34. To promote comfort during labor, the nurse John advises a client to assume certain positions and avoid others. Which position may cause maternal hypotension and fetal hypoxia? a. Lateral position b. Squatting position c. Supine position d. Standing position Rationale: The supine position causes compression of the client's aorta and inferior vena cava by the fetus. This, in turn, inhibits maternal circulation, leading to maternal hypotension and, ultimately, fetal hypoxia. The other positions promote comfort and aid labor progress. For instance, the lateral, or side-lying, position improves maternal and fetal circulation, enhances comfort, increases maternal relaxation, reduces muscle tension, and eliminates pressure points. The squatting position promotes comfort by taking advantage of gravity. The standing position also takes advantage of gravity and aligns the fetus with the pelvic angle 35. Celeste who used heroin during her pregnancy delivers a neonate. When assessing the neonate, the nurse expects to find: a. Lethargy 2 days after birth. b. Irritability and poor sucking. c. A flattened nose, small eyes, and thin lips. d. Congenital defects such as limb anomalies. 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, poor sucking, and restlessness. Lethargy isn't associated with neonatal heroin addiction. A flattened nose, small eyes, and thin lips are seen in infants with fetal alcohol syndrome. Heroin use during pregnancy hasn't been linked to specific congenital anomalies.

36. The uterus returns to the pelvic cavity in which of the following time frames? a. 7th to 9th day postpartum. b. 2 weeks postpartum. c. End of 6th week postpartum. d. When the lochia changes to alba. Rationale: The normal involutional process returns the uterus to the pelvic cavity in 7 to 9 days. A significant involutional complication is the failure of the uterus to return to the pelvic cavity within the prescribed time period. This is known as subinvolution 37. A primigravida client, age 20, has just completed a difficult, forceps-assisted delivery of twins. Her labor was unusually long and required oxytocin augmentation. The nurse who's caring for her should stay alert for: a. Uterine inversion b. Uterine atony c. Uterine involution d. Uterine discomfort Rationale: Multiple fetuses, extended labor stimulation with oxytocin, and traumatic delivery commonly are associated with uterine atony, which may lead to postpartum hemorrhage. Uterine inversion may precede or follow delivery and commonly results from apparent excessive traction on the umbilical cord and attempts to deliver the placenta manually. Uterine involution and some uterine discomfort are normal after delivery.

38.During an initial prenatal visit, a woman states that her last menstrual period began on
November 21; She also reports some vaginal bleeding about December 19 . The nurse would calculate that clients expected date of birth would be a. July 21 (same formula) b. August 28 ( if a woman has a menstrual pd. every 28 days and was not taking oral contraceptives. Naegels rule may be fairly accurate determiner of her predicted birth date. To use this method begin with the 1st day of last menstruation, subtract 3 mos and add 7 days.) c. September 26. same formula some women do experience some vaginal bleeding around the time of what would have been their next pd. Though theyre pregnant. d. October 1. 39. A 24 year-old woman comes to the clinic because she thinks she is pregnant. Which of the following is a probable sign of pregnancy that the nurse expect this client to have? a. fetal heart tone ( is a positive sign ( clearly demonstrates the presence of fetus) that can be detected with a doppler instrument, as early as 10 weeks) b. nausea and vomiting (presumptive symptom of pregnancy, because it can be caused by other factors other than pregnancy) c. Amenorrhea ( presumptive symptom) d. Chadwicks sign ( probable signs are the result of physiologic changes in the pelvic organs and hormonal influences; for example the mucus membrane of the vulva, vagina and cervix becomes bluish as a result of hyperemia and proliferation of cells. 40. Ms. R had her pregnancy confirmed and has completed her first prenatal visit. Considering all data were found to be within normal limits, the nurse should plan that the next visit should be in a. 1 week (too frequent) c. 1 month ( in a low risk pregnancy, the recommended frequency of prenatal visit is every 4 weeksfor the first 28 weeks, every 2 weeks until the 36th week, then every week until birth) b. 2 weeks (too frequent) d. 2 months ( inadequate to detect any danger) 41. Mrs. C age 40, G3P2 is eight weeks pregnant. She is a full-time office manager, states that she usually unwinds with a few glasses of wine with dinner, smokes about five cigarettes a day, and was surprised by this pregnancy. And after the assessment, which of the following would the nurse select as the priority nursing diagnosis? a. High risk for an alteration in bonding related to an unplanned pregnancy.(even if the pregnancy is planned,there is an element of surprise that conception has occurred) this feeling of ambivalence does not in itself indicate that acceptance and normal bonding will not occur) b. High risk for injury to the fetus related to advanced age (a major risk for to older expectant couple relate to the increased incidence of downs syndrome in children born to women over age of 35 or 40, however the risk for injury to fetus is greater from substance abuse)

c. Ineffective individual coping related to low self-esteem. ( no support data) d. knowledge deficit related to effects of substance abuse. ( evidence exist that smoking, consuming alcohol or using social drugs during pregnancy may be harmful to the fetus) 42. Mrs. M is completely dilated and at +2 station. Her contractions are strong and last 50-70 seconds. Based on this information, the nurse should know that Mrs. M is in which stage of labor? a. first stage(extends until the cervix is fully dilated) c. Third stage(extends from delivery of the fetus to the delivery of the placenta) b. Second stage ( 2nd stage extends from complete cervical dilatation to delivery of the infant) d. Fourth stage (extends from delivery of the placenta through the early postpartum pd.) 43.A pregnant woman, in the first trimester, is to have a transabdominal ultrasound. The nurse would include which of the following instructions? a. NPO from 6am to in the morning the test ( no diet restrictions) b. Drink one to two quarts of water and do not urinate before the test. (To obtain the images during 1st tri clearly drink H2O to fill the urinary bladder and thereby push the uterus higher) c. come to the clinic first for injection of contrast dye (No contrast dye is needed, ultrasound involves high-tech sound waves) d. No special instructions are needed for this test. ( there are special instructions needed whena women in the 1st trimester is to have transabdominal ultz. 44. Using Leopolds Maneuver to determine fetal position, The nurse finds that Mrs. Ls fetus is in a vertex position with the back on the left side. Where is the place for the nurse to listen for FHT? a. RUQ of the mothers abdomen ( place to be auscultated if the back were on the right and the breech is in the pelvis) b. LUQ of the mothers abdomen ( if the back were on the left and the breech on the pelvis) c. RLQ of the mothers abdomen (is the back were on the right side. d. LLQ of the mothers abdomen (since the back is on the left and the vertex is on the pelvis) 45.Mrs. N has just delivered for her first baby who will be breast fed. Thu nurse should include which of the following instruction to the teaching plan? a. Try to schedule feeding at least every 3-4 hours (successful lactation is fostered by feeding soon after delivery and then feeding when the newborn is ready to nurse.) b. Wash nipples with soap and water before each feeding ( simple wash mothers hands before breast feeding, soap is discouraged) c. Avoid nursing bras with plastic lining (though plastic lining protects clothing from leaking milk, the nipples may become sore and prone to infection from trapped moisture) d. Supplement with water between feedings when necessary.( not needed for normal term infant.This feeding may impede breast feeding by decreasing the volume of the milk required and would create nipple confusion.) 46. Mrs. Pots delivered her baby 12 hours ago. During the post partum assessment, the uterus is found to be boggy with a heavy lochia flow. The initial action is to a. notify the physician ( if the uterus continue not to contract well or the bleeding is excessive. The physician should be contacted) b. administer prn oxytocin (if the uterus continue not to contract the physician may order oxytocin) c. encourage to increase ambulation (The intervention is not related to emergency situation described) d. massage uterus until firm. ( clots may be expressed during massage and these often tends to contract the uterus more effectively. 47. A woman is entering her 20th week of pregnancy. Which normal change would the nurse expect to find on assessment?

a. Fundus just below the diaphragm ( uterine growth in pregnancy follows a pattern by 20th wk fundus should reach the umbilicus, at about 38th week it is just below the diaphragm) b. pigment changes in skin ( may occur from action of hormones. Includes linea nigra, melasma on the face, and straie gravidarum (stretch marks)) c. complains of frequent urination (occurs in the 1st tri ( 0-12 weeks)and last tri (28-40) from the pressure of the gravid uterus on the bladder) d. BP returing to prepregnancy level( BP in the 1st 24 wks usually decreases by 5-10 systolic and 1015 diastolic. Due to relaxation of the vascular smooth muscle and the formation of the new peripheral vascular beds. The BP rises to prepregnancy level by the time labor begins) 48. Mrs D is 36 weeks gestation and the nurse is taking with her during a prenatal visit. Which statements indicates that Mrs. D understands the onset of labr? a. I need to go to the hospital as soon as the contractions become painful (perception of ain with contraction is not a reliable indicator of true labor) b. If I experience bright red vaginal bleeding I know that I am about to deliver (is a sign of complication, not onset of labor) c. I need to go to the hospital when I am having regular contractions and bloody show ( regular contractions with bloody show suggest tyat cervical changes are occurring as a result of contractions) d. My labor will not start until after my membranes rupture and I gush fluid (does not necessarily occur prior to the onset of labor) 49. On the second day postpartum, the nurse asks the new mother to describe her vaginal bleeding. Thu nurse expect her to say that it is a. red and moderate (present for the first 2-3 days postpartum b. red with clots ( sign of lack of tone in the uterine musculature) c. scant and brown (lochia serosa, present 7-10 days postpartum) d. thin and white ( lochia alba, begins around 10th day and ends about 3 weeks following delivery) 50. The nurse is caring for patient in stage 1 labor. The fetal position is LOA, Whenever membranes rupture, the nurses first action should be to a. notify the physician b. measure the amount of fluid c. count the fetal heart rate (immediately after the rupture of membranes FHT are checked, then checked again after the next contraction or after 5-10minutes) d. perform vaginal examination