Question 1

A nurse midwife suspects that a client at 18 weeks' gestation has a hydatidiform mole. Which of the following assessment findings does not support this diagnosis?

Accepted Answer

Vaginal spotting of dark-brown blood, not bright red blood, is usually associated with hydatidiform mole. The uterus tends to expand more rapidly than the usual rate in cases of hydatidiform mole. The fundus height is normally palpated at the umbilicus at 20 weeks.

Question 2

A client is admitted to the facility and is placed on bed rest. The client is diagnosed with placenta previa. Which of the following pieces of information does not support this diagnosis?

Accepted Answer

Placenta previa is one of the most common causes of bleeding during the second to third trimesters. It usually occurs after the 20th week of gestation. Placenta previa involves low implantation of the placenta, and it is manifested by abrupt, painless and bright red vaginal bleeding of maternal origin. Fetal malpresentation is common because the low-lying placenta prevents engagement of the presenting part.

Question 3

A nurse midwife is assessing a client in her third trimester. The client is complaining of sharp, stabbing uterine pain. The nurse midwife suspects abruptio placenta. Which of the following interventions is the least effective for the client?

Accepted Answer

The client should be on bed rest in a lateral position, not the supine position, to alleviate the pressure on the vena cava and to improve fetal circulation. The nurse midwife should administer oxygen by face mask to limit the effects of the absence of oxygen supply to the fetus. A large gauge intravenous catheter is inserted for fluid replacement. In order to prevent further trauma, the nurse midwife should not perform a vaginal or pelvic examination.

Question 4

The client's placenta abruptly separates from the uterine lining. The client is most likely to complain of:

Accepted Answer

When the placenta abruptly separates from the uterine, the client complains of sharp, stabbing pain in the uterine fundus. This condition is called abruptio placenta, and it usually occurs during the third trimester. Painless, bright-red vaginal bleeding is a sign of placenta previa, which is the low implantation of the placenta. A pink-stained vaginal discharge is usually manifested in premature cervical dilatation. A gush of clear vaginal fluid is manifested in premature rupture of membranes.

Question 5

A client comes to the clinic for her first prenatal examination. The nurse midwife determines that the client is in her 12th week of pregnancy. Which of the following is not an expected assessment finding at this time?

Accepted Answer

Ballotement usually occurs during the 16th week of pregnancy. Frequent urination is a common complaint during the first trimester. Sonographic evidence of fetal outline is observed as early as the 8th week of pregnancy. The fetal heart is audible with Doppler ultrasound between weeks 10 and 12.

Question 6

A client is in her 18th week of pregnancy. Which of the following psychosocial changes is expected at this time?

Accepted Answer

During the 18th week of pregnancy, the client begins to concentrate on how it will feel to be a parent or how she will feel during the delivery. This is manifested by role-playing. During the first trimester, the major developmental task is to accept the pregnancy. Ambivalence is a common reaction, and it can also occur in women who planned for the pregnancy. During the second trimester, an important developmental task is to accept the baby as a separate entity, and during during the third trimester, the major developmental task is to prepare for the baby. Options C and D are commonly seen in clients during the third trimester.

Question 7

A nurse midwife is about to perform a Leopold's maneuver on a client who is at 25 weeks' gestation. Before the examination, which of the following actions by the nurse midwife is the least appropriate?

Accepted Answer

The nurse midwife should wash her hands, dry them with a clean towel and then rub her hands together before palpating for the fetal outline. If the hands are not warmed after washing, the cold temperature may stimulate uterine contractions. The other options are appropriate actions before starting the Leopold's maneuver.

Question 8

A nurse midwife faces the foot part of the client and places both hands two inches above the inguinal ligament to perform the Leopold's maneuver. Using the palms, the nurse midwife presses downward to palpate for the fetal head. Which maneuver is this?

Accepted Answer

The nurse midwife is performing the fourth maneuver. This maneuver determines the degree of flexion of the fetal head and attitude. The first maneuver determines the fetal presentation. The second maneuver identifies the location of the fetal back. The third maneuver determines engagement of the presenting part.

Question 9

A nurse midwife is performing the Leopold's maneuver on a client at 28 weeks' gestation. The assessment findings are noted as follows: First maneuver - the fundus is felt with soft, irregular shaped mass that is difficult to move; Second maneuver - The client's left side feels smooth and hard, and a number of angular nodulations are felt on the client's right side; Third maneuver - The presenting part is movable; Fourth maneuver - The brow is easily palpated on the same side of the angular nodulations. Which of the following conclusions is not consistent with the findings?

Accepted Answer

The fetus is at the posterior position. If the brow is easily palpated, the fetus is at the posterior position, where the occiput is pointing toward the client's back. The first maneuver indicates that the buttocks are located at the uterine fundus. The uterus would feel hard, firm and round if the fetal head in the uterine fundus. The second maneuver indicates that the fetal back is located on the mother's left side. The angular nodulations are the knees and the elbows. The presenting part is not engaged because it is not movable.

Quiz 1: Antepartum