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NMC CBT Mock Test 9:

1. The following are all nursing diagnoses appropriate for a gravida 1 para 0 in labour. Which one would be most appropriate for the primagravida as she completes the early phase of labour?

• Impaired gas exchange related to hyperventilation
• Alteration in placental perfusion related to maternal position
• Impaired physical mobility related to fetal-monitoring equipment
• Potential fluid volume deficit related to decreased fluid intake

2. A client with a missed abortion at 29 weeks gestation is admitted to the hospital. The client will most likely be treated with:

• Magnesium sulfate
• Calcium gluconate
• Dinoprostone (Prostin E.)
• Bromocrystine (Parlodel)..

3. A full-term male has hypospadias. Which statement describes hypospadias?

• The urethral opening is absent
• The urethra opens on the top side of the penis
• The urethral opening is enlarged
• The urethra opens on the under side of the penis

4. The nurse is assessing the deep tendon reflexes of a client with pre­ eclampsia. Which method is used to elicit the biceps reflex?

• The nurse places her thumb on the muscle inset in the antecubital space and taps the thumb briskly with the reflex hammer.
• The nurse loosely suspends the client’s arm in an open hand while tapping the back of the client’s elbow.
• The nurse instructs the client to dangle her legs as the nurse strikes the area below the patella with the blunt side of the reflex hammer.
• The nurse instructs the client to place her arms loosely at her side as the nurse strikes the muscle insert just above the wrist.

5. The nurse notes variable decelerations on the fetal monitor strip. The most appropriate initial action would be to:

• Notify her doctor.
• Start an IV.
• Reposition the client.
• Readjust the monitor.

6. The nurse is teaching a group of prenatal clients about the effects of cigarette smoke on fetal development. Which characteristic is associated with babies born to mothers who smoked during pregnancy?

• Low birth weight
• Large for gestational age
• Preterm birth, but appropriate size for gestation
• Growth retardation in weight and length

7. The nurse is discussing breastfeeding with a postpartum client. Breastfeeding is contraindicated in the postpartum client with:

• Diabetes
• HIV
• Hypertension
• Thyroid disease

8. As the client reaches 6cm dilation, the nurse notes late decelerations on the fetal monitor. What is the most likely explanation of this pattern?

• The baby is sleeping.
• The umbilical cord is compressed.
• There is head compression.
• There is uteroplacental insufficiency.

9. A 15-year-old primigravida is admitted with a tentative diagnosis of HELLP syndrome. Which laboratory finding is associated with HELLP syndrome?

• Elevated blood glucose
• Elevated platelet count
• Elevated creatinine clearance
• Elevated hepatic enzymes

10. The nurse is monitoring a client with a history of stillborn infant. The nurse is aware that nonstress test can be ordered for the client to:

• Determine lung maturity
• Measure the fetal activity
• Show the effect of contractions on fetal heart rate
• Measure the well-being of the fetus

11. A client elects to have epidural anesthesia to relieve the discomfort of labour. Following the initiation of epidural anesthesia, the nurse should give priority to:

• Checking for cervical dilation
• Placing the client in a supine position
• Checking the client’s blood pressure
• Obtaining a fetal heart rate

12. In a G.P clinic when you assessing a pregnant lady you observe some bruises on her hand. When you asked her about this she remains silent. What is your action?

• Call her husband to know what is happening
• Tell her that you are concerned of her welfare and you may need to share this information appropriately with the people who offer help
• Do nothing as she does not want to speak anything
• Call the police

13. The nurse is monitoring the progress of a client in labour. Which finding should be reported to the physician immediately?

• The presence of scant bloody discharge
• Frequent urination
• The presence of green-tinged amniotic fluid
• Moderate uterine contractions

14. A newborn with narcotic abstinence syndrome is admitted to the nursery. Nursing care of the newborn should include:

• Teaching the mother to provide tactile stimulation
• Wrapping the newborn snugly in a blanket
• Placing the newborn in the infant seat
• Initiating an early infant-stimulation program

15. A client tells the doctor that she is about 20 weeks pregnant. The most definitive sign of pregnancy is:

• Elevated human chorionic gonadatropin
• The presence of fetal heart tones
• Uterine enlargement
• Breast enlargement and tenderness

16. A primigravida, age 42, is six weeks pregnant. Based on the client’s age, her infant is at risk for:

• Down syndrome
• Respiratory distress syndrome
• Turner’s syndrome
• Pathological jaundice

17. A client with diabetes visits the prenatal clinic at 28 weeks gestation. Which statement is true regarding insulin needs during pregnancy?

• Insulin requirements moderate as the pregnancy progresses.
• A decreased need for insulin occurs during the second trimester.
• Elevations in human chorionic gonadotrophin decrease the need for insulin.
• Fetal development depends on adequate insulin regulation.

18. An infant who weighs 8 pounds at birth would be expected to weigh how many pounds at one year?

• 14 pounds
• 16 pounds
• 18 pounds
• 24 pounds

19. The nurse is measuring the duration of the client’s contractions. Which statement is true regarding the measurement of the duration of contractions?

• Duration is measured by timing from the beginning of one contraction to the beginning of the next contraction.
• Duration is measured by timing from the end of one contraction to the beginning of the next contraction.
• Duration is measured by timing from the beginning of one contraction to the end of the same contraction.
• Duration is measured by timing from the peak of one contraction to the end of the same contraction.

20. A client with sickle cell anaemia is admitted to the labour and delivery unit during the first phase of labour. The nurse should anticipate the client’s need for:

• Supplemental oxygen
• Fluid restriction
• Blood transfusion
• Delivery by Caesarean section

21. Which statement made by the nurse describes the inheritance pattern of autosomal recessive disorders?

• An affected newborn has unaffected parents.
• An affected newborn has one affected parent.
• Affected parents have a one in four chance of passing on the defective gene.
• Affected parents have unaffected children who are carriers.

22. The physician has ordered an injection of RhoGam for the postpartum client whose blood type is A negative but whose baby is O positive. To provide postpartum prophylaxis, RhoGam should be administered:

• Within 72 hours of delivery
• Within one week of delivery
• Within two weeks of delivery
• Within one month of delivery

23. The physician has ordered an intravenous infusion of Pitocin for the induction of labour. When caring for the obstetric client receiving intravenous Pitocin, the nurse should monitor for:

• Maternal hypoglycemia
• Fetal bradycardia
• Maternal hyperreflexia
• Fetal movement

24. The nurse caring for a client receiving intravenous magnesium sulfate must closely observe for side effects associated with drug therapy. An expected side effect of magnesium sulfate is:

• Decreased urinary output
• Hypersomnolence
• Absence of knee jerk reflex
• Decreased respiratory rate

25. A pregnant client with a history of alcohol addiction is scheduled for a nonstress test. The nonstress test:

• Determines the lung maturity of the fetus
• Measures the activity of the fetus
• Shows the effect of contractions on the fetal heart rate
• Measures the neurological well-being of the fetus

26. A client in the prenatal clinic is assessed to have a blood pressure of 180/96. The nurse should give priority to:

• Providing a calm environment
• Obtaining a diet history
• Administering an analgesic
• Assessing fetal heart tones

27. A pregnant client, age 32, asks the nurse why her doctor has recommended a serum alpha fetoprotein. The nurse should explain that the doctor has recommended the test:

• Because it is a state law
• To detect cardiovascular defects
• Because of her age
• To detect neurological defects

28. A vaginal exam reveals that the cervix is 4cm dilated, with intact membranes and a fetal heart tone rate of 160-170bpm. The nurse decides to apply an external fetal monitor. The rationale for this implementation is:

• The cervix is closed.
• The membranes are still intact.
• The fetal heart tones are within normal limits.
• The contractions are intense enough for insertion of an internal monitor.

29. After the physician performs an amniotomy, the nurse’s first action should be to assess the:

• Degree of cervical dilation
• Fetal heart tones
• Client’s vital signs
• Client’s level of discomfort

30. The doctor suspects that the client has an ectopic pregnancy. Which symptom is consistent with a diagnosis of a ruptured ectopic pregnancy?

• Painless vaginal bleeding
• Abdominal cramping
• Throbbing pain in the upper quadrant
• Sudden, stabbing pain in the lower quadrant

31. The client with pre-eclampsia is admitted to the unit with an order for magnesium sulfate. Which action by the nurse indicates the understanding of magnesium toxicity?

• The nurse performs a vaginal exam every 30 minutes.
• The nurse places a padded tongue blade at the bedside.
• The nurse inserts a Foley catheter.
• The nurse darkens the room.

32. Which selection would provide the most calcium for the client who is four months pregnant?

• A granola bar
• A bran muffin
• A cup of yogurt
• A glass of fruit juice

33. A new mother is admitted to the acute psychiatric unit with severe postpartum depression. She is tearful and states, "I don't know why this happened to me I was so excited for my baby to come, but now I don't know!" Which of the following responses by the nurse is MOST therapeutic?

• Maybe you weren't ready for a child after all."
• Having a new baby is stressful, and the tiredness and different hormone levels don't help. It happens to many new mothers and is very treatable.
• What happened once you brought the baby home? Did you feel nervous?
• Has your husband been helping you with the housework at all?"

34. Which observation in the newborn of a diabetic mother would require immediate nursing intervention?

• Crying
• Wakefulness
• Jitteriness
• Yawning

35. The nurse is caring for a neonate whose mother is diabetic. The nurse will expect the neonate to be:

• Hypoglycemic, small for gestational age
• Hyperglycemic, large for gestational age
• Hypoglycemic, large for gestational age
• Hyperglycemic, small for gestational age

36. The nurse is teaching basic infant care to a group of first-time parents. The nurse should explain that a sponge bath is recommended for the first two weeks of life because:

• New parents need time to learn how to hold the baby.
• The umbilical cord needs time to separate.
• Newborn skin is easily traumatized by washing.
• The chance of chilling the baby outweighs the benefits of bathing.

37. The obstetric client’s fetal heart rate is 80-90 during the contractions. The first action the nurse should take is:

• Reposition the monitor.
• Turn the client to her left side.
• Ask the client to ambulate.. The client’s T-cell count is extremely low.
• Prepare the client for delivery

38. A client telephones the emergency room stating that she thinks that she is in labour. The nurse should tell the client that labour has probably begun when:

• Her contractions are two minutes apart.
• She has back pain and a bloody discharge.
• She experiences abdominal pain and frequent urination.
• Her contractions are five minutes apart.

39. The nurse is teaching a pregnant client about nutritional needs during pregnancy. Which menu selection will best meet the nutritional needs of the pregnant client?

• Hamburger patty, green beans, French fries, and iced tea
• Roast beef sandwich, potato chips, baked beans, and cola
• Baked chicken, fruit cup, potato salad, coleslaw, yogurt, and iced tea
• Fish sandwich, gelatin with fruit, and coffee

40. Which of the following is a characteristic of an ominous periodic change in the fetal heart rate?

• A fetal heart rate of 120-130bpm
• A baseline variability of 6-10bpm
• Accelerations in FHR with fetal movement
• A recurrent rate of 90-100bpm at the end of the contractions

41. Which observation would the nurse expect to make after an amniotomy?

• Dark yellow amniotic fluid
• Clear amniotic fluid
• Greenish amniotic fluid
• Red amniotic fluid

42. When the nurse checks the fundus of a client on the first postpartum day, she notes that the fundus is firm, is at the level of the umbilicus, and is displaced to the right. The next action the nurse should take is to:

• Check the client for bladder distention.
• Assess the blood pressure for hypotension.
• Determine whether an oxytocic drug was given.
• Check for the expulsion of small clots.

43. A vaginal exam reveals a footling breech presentation. The nurse should take which of the following actions at this time?

• Anticipate the need for a Caesarean section.
• Apply an internal fetal monitor.
• Place the client in Genu Pectoral position.
• Perform an ultrasound.

44. A client with hypothyroidism asks the nurse if she will still need to take thyroid medication during the pregnancy. The nurse’s response is based on the knowledge that:

• There is no need to take thyroid medication because the fetus’s thyroid produces a thyroid-stimulating hormone.
• Regulation of thyroid medication is more difficult because the thyroid gland increases in size during pregnancy.
• It is more difficult to maintain thyroid regulation during pregnancy due to a slowing of metabolism.
• Fetal growth is arrested if thyroid medication is continued during pregnancy.

45. A client who delivered this morning tells the nurse that she plans to breastfeed her baby. The nurse is aware that successful breastfeeding is most dependent on the:

• Mother’s educational level
• Infant’s birth weight
• Size of the mother’s breast
• Mother’s desire to breastfeed

46. A client is admitted to the labour and delivery unit complaining of vaginal bleeding with very little discomfort. The nurse’s first action should be to:

• Assess the fetal heart tones.
• Check for cervical dilation.
• Check for firmness of the uterus.
• Obtain a detailed history

47. A client is admitted to the labour and delivery unit. The nurse performs a vaginal exam and determines that the client’s cervix is 5cm dilated with 75% effacement. Based on the nurse’s assessment the client is in which phase of labour?

• Active
• Latent
• Transition
• Early

48. A client is admitted to the labour and delivery unit in active labour. During examination, the nurse notes a papular lesion on the perineum. Which initial action is most appropriate?

• Document the finding.
• Report the finding to the doctor.
• Prepare the client for a C-section.
• Continue primary care as prescribed.

49. When assessing a labouring client, the nurse finds a prolapsed cord. The nurse should:

• Attempt to replace the cord.
• Place the client on her left side.
• Elevate the client’s hips.

50. The nurse is responsible for performing a neonatal assessment on a full­ term infant. At one minute, the nurse could expect to find:

• An apical pulse of 100
• An absence of tonus
• Cyanosis of the feet and hands
• Jaundice of the skin and sclera