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WorksheetsNCM 107 Review Midterm Exam
Total questions: 80
Worksheet time: 40mins
A pregnant woman complains of feeling easily tired and short of breath when walking. This is likely due to:
Increased progesterone causing lung expansion
Increased cardiac workload and physiologic anemia
Decreased blood volume and dehydration
Decreased cardiac output during pregnancy
A nurse explains that edema of the lower extremities in late pregnancy is common because:
The growing uterus compresses major veins, reducing venous return
There is decreased sodium retention in pregnancy
The woman consumes too much water
Protein levels in the blood are increased
A pregnant woman reports dizziness when lying flat. The nurse should advise her to:
Lie on her back with legs elevated
Sleep in high Fowler’s position
Lie on her left side to prevent vena cava compression
Lie on her right side with knees bent
The nurse notes hyperpigmentation of the cheeks (“mask of pregnancy”). This is primarily due to:
Elevated estrogen levels
Melanocyte-stimulating hormone secretion from the pituitary
Vitamin deficiency
Iron overload
A woman at 8 weeks gestation experiences nausea each morning. The best nursing advice is to:
Eat large, protein-rich meals three times daily
Eat dry crackers before getting out of bed
Avoid fluids between meals
Lie down immediately after eating
Constipation in pregnancy is most often caused by:
Reduced intestinal motility from progesterone
High dietary fiber intake
Dehydration from morning sickness
Increased calcium intake
A nurse reminds a pregnant woman not to use mineral oil for constipation because it:
Interferes with absorption of fat-soluble vitamins
Causes uterine contractions
Leads to dehydration
Increases constipation
A pregnant woman complains of leg cramps at night. The nurse’s priority teaching is to:
Massage the affected leg
Increase calcium intake and dorsiflex the foot during cramps
Limit fluid intake before bed
Apply warm compresses only
A pregnant client asks why her gums bleed easily. The nurse’s best explanation is:
Gingivitis from infection
Hormonal changes increase vascularity and tissue sensitivity
Vitamin B12 deficiency
Low blood sugar
A primigravida asks about safe sexual activity. The nurse explains that intercourse is allowed unless:
She is in the third trimester
The cervix is incompetent or vaginal bleeding occurs
Which physiologic change helps protect the fetus from infection?
Increased vaginal acidity
Reduced WBC production
Decreased body temperature
Dilated cervical os
The nurse expects urinary frequency to be most noticeable during which trimesters?
A. First and third
B. First and second
C. Second and third
D. Only first
During pregnancy, a woman’s parathyroid gland enlarges. The primary purpose is to:
Increase calcium withdrawal from bone for fetal growth
Decrease maternal bone density
Improve thyroid activity
Promote sodium and water retention
A pregnant client has visible varicose veins on her legs. The nurse should advise her to:
Avoid elevating her legs
Wear tight elastic stockings continuously
Rest frequently with legs elevated
Stand for long periods to improve circulation
A pregnant woman experiences excessive salivation. The nurse identifies this as:
Ptyalism
Pica
Pyrosis
Hyperemesis
The nurse explains that “Lordosis,” or exaggerated lumbar curve, develops during pregnancy because:
The uterus shifts backward
The body compensates for altered center of gravity
The pelvic ligaments tighten
The muscles become flaccid
A woman in her second trimester expresses excitement and begins shopping for baby items. This reflects the psychological task of:
Accepting the pregnancy
Accepting the baby
Preparing for parenthood
Adjusting to body changes
A pregnant woman’s partner complains of feeling tired and having back pain similar to her symptoms. The nurse recognizes this as:
Role rejection
Couvade syndrome
Psychological regression
Anxiety reaction
During which trimester does sexual desire typically increase due to improved sense of well-being and pelvic congestion?
First
Second
Third
Postpartum
A nurse observes that a pregnant client shows mixed feelings about her condition, alternating between happiness and worry. This is best described as:
Denial
Ambivalence
Regression
Acceptance
A nurse identifies Chadwick’s sign during a pelvic exam. The nurse correctly interprets this as:
Softening of the cervix
Bluish discoloration of the vaginal wall due to vascular congestion
Softening of the lower uterine segment
A woman reports missing her period, morning nausea, and fatigue. These are classified as:
A. Presumptive signs of pregnancy
B. Probable signs of pregnancy
C. Positive signs of pregnancy
D. Diagnostic findings
During an assessment, the nurse notes a softening of the lower uterine segment. This is documented as:
Hegar’s sign
Goodell’s sign
Chadwick’s sign
Ballottement
A nurse performing a pelvic exam detects “bouncing” of the fetus upon gentle tapping of the cervix. This finding is:
Ballottement
Quickening
Engagement
Lightening
A mother at 20 weeks reports feeling the baby move for the first time. The nurse documents this as:
Braxton Hicks contractions
Ballottement
Quickening
Effacement
A client asks, “How do I know for sure that I’m pregnant?” The nurse responds that the most reliable positive sign is:
Positive urine pregnancy test
Absence of menstruation
Fetal heart tones detected by Doppler
Softening of the cervix
During preconception counseling, a woman with a history of neural tube defects in the family asks about prevention. The nurse emphasizes:
Folic acid supplements before conception
Iron-rich diet after conception
Calcium supplements in late pregnancy
Vitamin D and sunlight exposure
A pregnant woman asks why she needs prenatal visits every month during early pregnancy. The nurse explains that:
Fetal growth is minimal early on
Regular monitoring ensures early detection of complications
Weight gain occurs only after the second trimester
Immunizations are given every visit
A woman’s prenatal schedule should change from every 4 weeks to every 2 weeks beginning at:
28 weeks
32 weeks
36 weeks
38 weeks
The nurse measures a woman’s fundal height at 20 cm. This finding most likely corresponds to:
12 weeks’ gestation
20 weeks’ gestation
30 weeks’ gestation
36 weeks’ gestation
A pregnant woman says she feels well and wants to continue working as a cashier. The nurse advises she may continue if:
She avoids prolonged standing and heavy lifting
She works only night shifts
She limits fluid intake at work
She takes iron pills before each shift
Before performing a pelvic exam on a pregnant woman, the nurse’s priority is to:
Ask the woman to empty her bladder
Check fetal heart tones
Assess fundal height
Prepare sterile gloves
The nurse reviews the immunization record of a pregnant woman. She received TT1 last week. The next dose (TT2) should be administered:
2 weeks later
1 month later
6 months later
1 year later
A pregnant client asks, “Why do I need several tetanus shots?” The nurse correctly explains that:
The baby will need the antibodies for protection against neonatal tetanus
It prevents urinary tract infection
It increases the mother’s milk supply
It shortens labor
The nurse evaluates a woman who completed TT5 before her current pregnancy. Which action is appropriate?
Restart the tetanus series
Give a booster every year
No tetanus vaccine needed; she has lifetime protection
Repeat TT3
During urinalysis, albumin is detected. The nurse recognizes this as:
A sign of renal disease or preeclampsia risk
A normal finding due to hormonal changes
Indication of dehydration
Sign of urinary infection only
A nurse counsels a client about the importance of iron in pregnancy. The main purpose of iron supplementation is to:
Prevent anemia due to increased blood volume
Improve appetite
Enhance fetal brain development
Prevent morning sickness
The nurse educates a mother about folic acid intake. A good dietary source would be:
Green leafy vegetables and fortified grains
Citrus fruits and dairy
Red meat and poultry
Root crops and cereals
The nurse explains that smoking during pregnancy may result in:
High birth weight due to oxygen increase
Low birth weight due to vasoconstriction
Dehydration from reduced fluid intake
Increased placental circulation
A pregnant woman’s laboratory results show mild anemia. The nurse identifies this as:
Normal physiologic anemia due to plasma expansion
Pathologic anemia due to blood loss
Sign of dehydration
Early symptom of preeclampsia
A mother in her 39th week reports increased urinary frequency and easier breathing. The nurse recognizes this as:
Engagement
Lightening
Crowning
Descent
During assessment, the nurse notes a blood-tinged mucus discharge. The client asks if she is in labor. The best response is:
A. “That is a show; labor will start soon.”
B. “That means your water broke.”
C. “You are already in active labor.”
D. “That discharge is abnormal and must be reported.”
A client experiencing contractions every 10 minutes that are irregular and relieved by rest is most likely experiencing:
True labor
False labor
The nurse identifies true labor when:
Contractions are irregular and short
Discomfort is felt only in the abdomen
Contractions increase in frequency and intensity, and cervical change occurs
Rest decreases pain
The nurse explains that labor begins when:
The cervix dilates completely
The membranes rupture
Regular uterine contractions cause cervical dilation and effacement
The fetus engages in the pelvis
A nurse explains to a student that labor is initiated partly because of increased oxytocin sensitivity. This supports which theory?
Uterine stretch theory
Oxytocin stimulation theory
Aging placenta theory
Prostaglandin theory
A nurse explains that labor occurs when progesterone levels drop and estrogen becomes dominant. This describes:
Oxytocin theory
Prostaglandin theory
Progesterone deprivation theory
Uterine stretch theory
As pregnancy nears term, the placenta becomes less efficient in hormone production, leading to increased contractions. This is consistent with:
A. Aging placenta theory
B. Estrogen dominance theory
C. Uterine stretch theory
D. Cervical pressure theory
During the latent phase of the first stage of labor, the nurse expects:
Cervical dilation of 0–3 cm with mild contractions
Cervical dilation of 8–10 cm with strong contractions
Full dilation and bearing down
Fetal head crowning
The best nursing intervention for a woman in the latent phase of labor is to:
Encourage rest and light activity
Instruct her to push with each contraction
Administer IV oxytocin
Begin perineal shaving
During the active phase, the nurse expects contractions to occur:
Every 15–20 minutes, mild intensity
Every 3–5 minutes, moderate intensity
Every 10 minutes, weak
Every 1–2 minutes, very strong
The nurse assists a woman who is in the transition phase of labor. The nurse anticipates the client may:
Be calm and cooperative
Feel anxious, irritable, and have an urge to push
Sleep between contractions
Have minimal discomfort
A nurse observes that a client’s contractions are very close together and last 90 seconds. The nurse’s priority action is to:
Increase IV fluids
Turn the client to her side and monitor fetal heart rate
Encourage her to push harder
Notify the physician immediately for delivery
During the second stage of labor, the nurse should instruct the client to:
Push only during contractions with an open glottis
Breathe rapidly and shallowly through the mouth
Hold her breath and bear down
The nurse notices the perineum bulging during pushing. This indicates:
A. Crowning and imminent delivery
B. Early stage of labor
C. Fetal distress
D. Uterine rupture
The nurse observes that the umbilical cord is looped loosely around the baby’s neck after delivery of the head. The appropriate action is to:
Cut the cord immediately
Slip the cord gently over the baby’s head
Clamp the cord and wait for the placenta
Pull the baby quickly to avoid asphyxia
After delivery of the baby, the nurse monitors for signs of placental separation. Which sign confirms this process?
Fundus soft and displaced to the right
Calkin’s sign — uterus becomes globular and rises in the abdomen
Uterus relaxes and flattens
Bleeding stops completely
When the placenta separates at the center and presents the shiny fetal surface first, this is known as:
Duncan mechanism
Schultz mechanism
Central cord mechanism
Maternal mechanism
During the third stage of labor, the nurse should avoid pulling on the umbilical cord to prevent:
Placental retention
Uterine inversion and hemorrhage
Prolonged labor
Infection
In the fourth stage of labor, the nurse’s priority assessment is:
Maternal bladder fullness
Uterine tone and vaginal bleeding
Fetal heart rate
Amniotic fluid color
During a vaginal examination, the nurse palpates a firm, rounded part that moves independently of the body and identifies sutures and fontanels. This finding indicates the presenting part is the:
Shoulder
Breech
Head
Abdomen
A nurse palpates the diamond-shaped fontanel during assessment. The student asks what this means. The nurse replies:
It’s the anterior fontanel, which closes at 12–18 months.
It’s the posterior fontanel, which closes at birth.
It’s the sphenoidal fontanel, which closes immediately after delivery.
It’s the mastoid fontanel, which closes after one year.
During delivery, molding of the fetal head helps the baby:
Prevent brain compression
Fit through the birth canal by overlapping cranial bones
Maintain normal temperature
Stimulate respiratory effort
The nurse explains that the suboccipitobregmatic diameter represents:
The narrowest anteroposterior diameter of the fetal head
The widest transverse diameter
The longest occipitomental diameter
The circumference of the head
When assessing fetal lie, the nurse identifies that the fetal spine is parallel to the mother’s spine. This indicates a:
Transverse lie
Oblique lie
Longitudinal lie
Breech lie
The degree of flexion or extension of the fetal head in the uterus is referred to as:
Fetal lie
Fetal attitude
Fetal position
Fetal presentation
A fetus with its chin flexed on the chest is in:
Full flexion (vertex presentation)
Partial flexion (brow presentation)
Hyperextension (face presentation)
Extension (mentum presentation)
The nurse determines that the fetal presenting part is the buttocks and legs. This presentation is termed:
Breech
Shoulder
Vertex
Transverse
The most common and favorable fetal position for childbirth is:
Left occiput anterior (LOA)
Right occiput posterior (ROP)
Right mentum anterior (RMA)
Left sacrum posterior (LSP)
A nurse reviewing a delivery record notes “ROP position.” This position is likely to cause:
Shorter labor and less back pain
Prolonged labor and intense back pain
Faster descent of the fetus
Immediate delivery
During pelvic assessment, the nurse identifies a heart-shaped inlet with a narrow pubic arch. This is characteristic of a/an:
Gynecoid pelvis
Android pelvis
Platypelloid pelvis
Anthropoid pelvis
A nurse explains that the pelvis type most favorable for normal vaginal birth is:
Android
Anthropoid
Gynecoid
Platypelloid
A client asks what “powers” of labor mean. The nurse replies:
They refer to the strength and frequency of uterine contractions
They describe the mother’s emotional endurance
They are the pelvic bones and ligaments
They refer to the fetal movements during descent
During monitoring, the nurse notes contractions lasting 60 seconds with a 2-minute interval. The nurse interprets this pattern as:
Normal uterine activity
Hyperstimulation requiring tocolytics
Weak contractions needing oxytocin
Second-stage distress
The peak of each uterine contraction, when the intensity is greatest, is called:
Increment
Acme
Decrement
Plateau
During a contraction, the uterus is palpated as firm and hard, then gradually softens. The relaxation period between contractions is called the:
Interval
Acme
Increment
Decrement
The nurse observes that a client’s uterus fails to contract properly after delivery. The most appropriate initial nursing...
Massage the fundus
Administer oxytocin
Encourage ambulation
Monitor vital signs
On postpartum assessment, the nurse finds the fundus displaced to the right and boggy. The nurse should:
Document as normal
Ask the client to void, then reassess fundal tone
Prepare for oxytocin infusion immediately
Call for emergency uterine exploration
The nurse is assessing lochial discharge. She documents the finding as lochia serosa when it is:
Dark red with small clots, lasting 0–3 days
Pink to brownish, lasting 4–7 days
Creamy yellow, lasting 2–3 weeks
Clear, watery, and odorless
During postpartum rounds, a nurse notes that a mother becomes tearful, anxious, and easily fatigued on the third day after giving birth. The best interpretation is:
Postpartum blues, a normal adjustment period
Postpartum psychosis needing immediate referral
Severe depression requiring medication
Fatigue from blood loss and dehydration
