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Worksheets2205 Exam 1 OT pt.3
Total questions: 103
Worksheet time: 52mins
A client at 34 weeks is having a nonstress test (NST). Which finding is reactive?
Two accelerations in 20 min, each ≥15 bpm above baseline lasting ≥15 sec
Two late decelerations with contractions
No accelerations in 20 min with fetal movement felt
Baseline fetal heart rate 100 bpm with minimal variability
A 31-week client is undergoing an NST. Which finding meets reactive criteria for this gestational age?
One acceleration lasting 10 seconds
Two accelerations in 20 min, each ≥10 bpm lasting ≥10 sec
Variable decelerations with each fetal movement
No accelerations but moderate variability
A 33-week client’s NST shows no accelerations after 20 minutes. How should the nurse document this result?
Normal NST
Sinusoidal pattern
Nonreactive NST
Biophysical profile 8/10
Which situation is an indication for an NST?
Screening at 8 weeks for all pregnancies
Confirming fetal lung maturity
Diagnosing endometrial cancer
Decreased fetal movement in the third trimester
Maternal serum alpha-fetoprotein (AFP) screening is typically performed at which gestational age range?
15–20 weeks
6–10 weeks
28–32 weeks
36–40 weeks
Which AFP result pattern is most consistent with increased AFP?
Down syndrome risk
Neural tube defect risk
Rh incompatibility
Hyperemesis gravidarum
Which AFP result pattern is most consistent with decreased AFP?
Placental abruption
Spina bifida
Down syndrome risk
Cervical insufficiency
A client asks what AFP screening means. Which response is best?
“It is diagnostic and confirms fetal anomalies.”
“It predicts labor onset within 48 hours.”
“It’s only done after 28 weeks.”
“It is a screening test; abnormal results require follow-up testing.”
A client has a high AFP screening result. Which follow-up test is most appropriate?
Targeted ultrasound evaluation
Pap smear
NST
Wet mount microscopy
A client at 26 weeks has an elevated 1-hour glucose screening value. What is the next step?
Repeat the 1-hour test at 36 weeks
Schedule a 3-hour oral glucose tolerance test (OGTT)
Diagnose gestational diabetes immediately
Start insulin infusion now
A nurse prepares teaching for the 3-hour OGTT. Which instruction is correct?
No fasting is required
Avoid all protein for 24 hours
Overnight fasting is required before the test
Drink the glucose solution only after a fatty meal
A client asks how the 3-hour OGTT is performed. Which description is correct?
50 g glucose load with one draw at 1 hour
Urine ketones measured every hour
100 g glucose load with fasting, then blood draws at 1, 2, and 3 hours
Continuous glucose monitoring for 24 hours only
Which OGTT result confirms gestational diabetes mellitus (GDM)?
Two glucose values out of range
One value out of range
Any fasting glucose above 70 mg/dL
Ketones present in urine
A client newly diagnosed with GDM asks what treatment begins first. Which response is best?
Immediate IV insulin for all clients
Diet and exercise modifications
Strict bedrest
Oral hypoglycemics for all clients
A client’s glucose remains elevated despite diet/exercise. Which plan is expected?
Stop glucose monitoring
Restrict all carbohydrates completely
Initiate insulin therapy as prescribed
Discontinue fetal kick counts
A client with hyperemesis gravidarum has ketonuria and high urine specific gravity. What do these findings indicate?
Normal pregnancy changes
Urinary tract infection
Placenta previa
Dehydration with starvation ketosis
Which first-line medication regimen is commonly used to treat nausea/vomiting in pregnancy?
Pyridoxine (vitamin B6) with or without doxylamine
High-dose aspirin
Methotrexate
Oxytocin
A client with hyperemesis gravidarum is hypotensive. Which intervention is priority?
Encourage ambulation
Give IV isotonic fluids as prescribed
Provide a high-fat meal
Restrict oral fluids
Which dietary instruction is appropriate for hyperemesis gravidarum?
Two large meals daily
Avoid bland foods
Small frequent meals; dry crackers/toast as tolerated
Nothing by mouth until delivery
A client with refractory hyperemesis gravidarum may receive which therapy?
Rh immune globulin
Cerclage
Ceftriaxone
Corticosteroids as prescribed
A client at 10 weeks has unilateral pelvic pain and vaginal bleeding. What is the priority concern?
Ectopic rupture and hemorrhage
Placenta previa
Endometriosis flare
Gestational diabetes
A client with suspected ectopic pregnancy reports shoulder pain. What does this suggest?
Normal pregnancy discomfort
Possible intraabdominal bleeding
Expected effect of prenatal vitamins
Fetal macrosomia
A provider suspects ectopic pregnancy. Which evaluation/plan is expected?
Pap smear only
Immediate D&C for all clients
Serial hCG and ultrasound with possible methotrexate if stable
NST to confirm location
Which history increases the risk for ectopic pregnancy?
Daily prenatal vitamins
Normal BMI
First pregnancy
Prior PID/tubal scarring
A client is diagnosed with gestational trophoblastic disease (GTD). Which finding is expected?
Excessively high hCG levels
Low hCG levels
Decreased uterine size for gestational age
No nausea/vomiting
Which ultrasound finding is most consistent with a molar pregnancy?
Placenta covering the cervix with fetus present
“Snowstorm/cluster of grapes” appearance with no fetus
Oligohydramnios only
Normal placenta with growth restriction only
Which manifestation is associated with GTD?
Mild nausea only
Decreased hCG
Preeclampsia developing before 20 weeks
Uterine size smaller than dates
Which treatment is used to evacuate a molar pregnancy?
Oral glucose tolerance test
Pelvic rest only
Antihypertensive therapy only
Suction curettage (uterine evacuation)
A client is diagnosed with placenta previa. Which manifestation is most expected?
Painless bright-red vaginal bleeding
Painful bleeding with rigid abdomen
Unilateral stabbing pain with shoulder pain
Fever and foul discharge
A client has painless vaginal bleeding and suspected placenta previa. Which action is contraindicated?
Obtain ultrasound
Perform a digital vaginal exam
Monitor fetal heart rate
Draw CBC and type & screen
Which diagnostic test is prioritized for a client with painless bleeding suspected of placenta previa?
MRI first-line
Kleihauer-Betke test first-line
Ultrasound
Digital cervical exam
Which discharge teaching is appropriate for placenta previa?
Encourage intercourse to reduce stress
Perform nipple stimulation daily
Use tampons to monitor bleeding
Pelvic rest and avoid strenuous activity/heavy lifting
Which follow-up plan is expected for placenta previa management?
Repeat ultrasound later in pregnancy as prescribed
No further imaging after diagnosis
Weekly amniocentesis
Repeat CVS each trimester
A client at 34 weeks has painful bleeding and uterine tenderness. Which complication is likely?
Hyperemesis gravidarum
Placental abruption
Placenta previa
Cervical insufficiency
Which risk factor is associated with placental abruption?
Daily kick counts
Low folic acid intake only
Cocaine use
First pregnancy at age 25
In suspected placental abruption, which lab evaluation is appropriate?
AFP only
Wet prep only
Pap smear
CBC and coagulation studies (including fibrinogen)
A client with suspected abruption is unstable with fetal distress. What is the priority intervention?
Prepare for emergent birth
Delay until ultrasound confirms
Perform a digital exam
Encourage oral fluids and ambulation
A pregnant adolescent has BP 150/96 at 30 weeks. Which interpretation is most appropriate?
Expected due to increased blood volume
Elevated BP after 20 weeks suggests hypertensive disorder of pregnancy
Indicates placenta previa
Confirms gestational diabetes
Which BP meets criteria for severe-range hypertension in pregnancy?
140/90
150/95
160/110
130/80
Which manifestation supports a diagnosis of preeclampsia?
Thick white discharge
Painless bleeding with soft abdomen
Dysuria with vesicles
New-onset hypertension after 20 weeks with proteinuria or severe features
Which finding is a severe feature of preeclampsia?
Platelets <100,000/mm3
Mild nausea relieved by crackers
Increased appetite
Mittelschmerz
Which medication is first-line for seizure prevention/treatment in severe preeclampsia/eclampsia?
Labetalol
Magnesium sulfate
Ceftriaxone
Metronidazole
A client receiving magnesium sulfate has respiratory rate 10/min. What is the priority action?
Continue infusion and reassess in 1 hour
Give pyridoxine
Stop magnesium sulfate and notify provider
Encourage ambulation
Which medication is the antidote for magnesium sulfate toxicity?
Naloxone
Flumazenil
Protamine sulfate
Calcium gluconate
Which finding confirms eclampsia?
Seizure activity in a client with preeclampsia
Painless bleeding with placenta previa
Ketonuria with vomiting only
Unilateral pelvic pain without bleeding
A client has acute severe-range BP in pregnancy. Which medication may be used for rapid BP control per common algorithms?
Pyridoxine
Hydralazine IV
Acyclovir
Metformin
Which medication may also be used for acute severe hypertension in pregnancy?
Ceftriaxone
Doxycycline
Nifedipine (immediate-release oral) as prescribed
Leuprolide
Which clinical scenario is most consistent with HELLP syndrome?
Elevated AFP only
Thick white discharge
Bradycardia with hypothermia
Hemolysis, elevated liver enzymes, and low platelets
A client has cervical insufficiency. Which finding is expected?
Pelvic pressure and increased vaginal discharge
Rigid abdomen with severe pain
Painless bright-red bleeding with previa
Vesicular lesions with dysuria
Cervical insufficiency is best described as:
Premature separation of the placenta
Structural weakness of the cervix causing painless dilation
Infection caused by HSV
Excessively high hCG from molar pregnancy
Which treatment may be prescribed for cervical insufficiency?
Methotrexate therapy
Oxytocin infusion
Cerclage placement as indicated
Induction of labor at diagnosis
Cerclage removal is commonly planned for which timing if no complications occur?
20–22 weeks
24–28 weeks
32–34 weeks
36–37 weeks
A client had a D&C after pregnancy loss. Which discharge instruction is correct?
Avoid intercourse, douching, tampons, and tub baths for about 2 weeks
Use tampons to monitor bleeding
Resume intercourse in 48 hours if bleeding stops
Return only if nausea persists
After a D&C, which symptom should the client report immediately?
Mild cramping
Fever
Light spotting that decreases
Mild fatigue
Which finding is most consistent with genital herpes?
Fishy odor and clue cells
Painless chancre
Painful vesicular genital lesions with possible dysuria
Frothy green discharge
Which diagnostic test is preferred for confirming HSV infection?
Wet mount
RPR
AFP screening
NAAT/PCR testing of lesions
Which management is commonly used in late pregnancy for clients with recurrent genital herpes?
Begin suppressive antiviral therapy in the third trimester as prescribed
Stop all antivirals at 20 weeks
Avoid reporting outbreaks
Use metronidazole prophylactically
Which statement about gonorrhea testing is correct?
It is diagnosed by AFP screening
NAAT is commonly used for diagnosis
It is confirmed by RPR
It is confirmed by KOH prep
Which medication is used to treat gonorrhea?
Metronidazole
Acyclovir
Ceftriaxone
Leuprolide
A pregnant client asks about vaccines. Which vaccine is routinely recommended during pregnancy?
Live varicella vaccine
MMR vaccine
HPV vaccine
Tdap (as recommended during pregnancy)
Which nutrient is most important for preventing neural tube defects?
Folic acid
Vitamin K
Vitamin A
Zinc
A client asks what the placenta does. Which statement is correct?
It produces fetal urine
It provides oxygen and removes waste products for the fetus
It prevents fetal circulation
It forms the fetal lungs
A client asks what the umbilical cord contains. Which is correct?
One artery and one vein
Two veins and one artery
Two arteries and one vein
Three veins
Which vessel carries oxygenated blood from the placenta to the fetus?
Umbilical arteries
Ductus arteriosus
Inferior vena cava
Umbilical vein
A client has postmenopausal bleeding. Which provider order should the nurse anticipate?
Endometrial biopsy
Pap smear only
NST
AFP screening
What is the hallmark sign of endometrial cancer?
Pelvic pressure only
Abnormal uterine bleeding
Shoulder pain
Fishy vaginal odor
Which client has the highest risk for endometrial cancer?
32-year-old with regular cycles
45-year-old on combined oral contraceptives
58-year-old with obesity and chronic anovulation
40-year-old with history of HPV
Which statement best describes endometriosis?
Implantation of placenta over the cervix
Placental separation after 20 weeks
Implantation of embryo outside uterus
Growth of endometrial tissue outside the uterus
Which medication class may be used to treat endometriosis by suppressing estrogen?
GnRH agonist (e.g., leuprolide)
Ceftriaxone
Metronidazole
Oxytocin
Which adverse effect should be included when teaching a client taking leuprolide?
Severe hypoglycemia
Bone density loss
Hyperkalemia
Increased libido
A client has HIV. Which teaching is appropriate?
HIV medications should be stopped in pregnancy
Only topical therapy is needed
Adherence to antiretroviral therapy is essential
Follow-up testing is unnecessary
Which action reduces perinatal HIV transmission risk?
Avoiding all prenatal care
No antiretrovirals until delivery
Sharing needles to “build immunity”
Antiretroviral therapy during pregnancy as prescribed
A client with herpes zoster (shingles) is pregnant. Which intervention is appropriate?
Start antiviral therapy (e.g., acyclovir) as prescribed and manage pain
Administer live varicella vaccine during pregnancy
Use aspirin as first-line pain control in all trimesters
Encourage contact with non-immune pregnant clients
Which precaution is appropriate for a hospitalized client with shingles and active lesions?
Standard precautions only
Airborne and contact precautions if disseminated or immunocompromised
Droplet precautions only
No precautions are needed
Which instruction is appropriate for shingles lesion care?
Share towels to reduce stigma
Scratch lesions to release fluid
Keep lesions clean and dry; avoid scratching
Apply heat continuously for 24 hours
A client with painless vaginal bleeding is suspected of placenta previa. Which action is priority?
Perform a digital exam
Obtain an ultrasound
Insert an internal fetal monitor
Avoid vaginal exams and obtain ultrasound evaluation
A nurse teaches pelvic rest for placenta previa. Which instruction is correct?
No intercourse
Use tampons for bleeding
Frequent vaginal exams
Daily nipple stimulation
Which finding is most consistent with placenta previa?
Rigid abdomen and severe pain
Painless bright-red bleeding
Shoulder pain and Cullen sign
Ketonuria with vomiting
Which finding is most consistent with placental abruption?
Painless bright-red vaginal bleeding
Sudden onset of severe abdominal pain with a rigid, tender uterus
Fishy vaginal odor with pruritus
Painless loss of amniotic fluid with pooling
A client with suspected abruption is unstable. What is the priority?
Wait for ultrasound confirmation
Perform a digital exam
Encourage oral fluids
Prepare for emergent delivery
Which clinical finding suggests severe preeclampsia?
BP 160/110
Mild ankle edema only
Thick white discharge
Fishy odor
Which medication is used to prevent seizures in severe preeclampsia?
Ceftriaxone
Magnesium sulfate
Metronidazole
Azithromycin
A client on magnesium sulfate has absent deep tendon reflexes. What is the nurse’s priority?
Continue infusion and document
Give doxylamine
Stop infusion and notify provider
Encourage ambulation
A nurse is teaching about preeclampsia labs. Which labs are important to monitor?
Wet prep only
AFP only
RPR only
Platelets and liver enzymes (AST/ALT)
A nurse suspects HELLP. Which finding supports this?
Low platelets with elevated liver enzymes
High AFP
Ketonuria only
Fishy odor
A pregnant client has active genital herpes lesions at onset of labor. What is the priority?
Encourage vaginal delivery
Prepare for cesarean birth
Induce labor with oxytocin
Delay delivery until lesions resolve
Which statement about HSV is correct?
Metronidazole treats HSV
HSV causes clue cells
NAAT/PCR testing is a preferred diagnostic method
HSV cannot be transmitted during delivery
Which client teaching is appropriate for genital herpes?
Share towels during outbreaks
Stop all antivirals permanently
Use alcohol to scrub lesions
Inform sexual partners and avoid sexual contact during outbreaks
After a D&C, which instruction is correct?
Report fever immediately
Use tampons to monitor bleeding
Resume intercourse in 48 hours
Douche daily to prevent infection
Which topic best fits “test for client with elevated glucose” in pregnancy?
NST
3-hour OGTT
AFP screening
RPR test
Which client statement indicates understanding of folic acid teaching?
“Folic acid is only needed after 28 weeks.”
“Folic acid prevents HSV.”
“I should take folic acid to reduce neural tube defect risk.”
“Folic acid replaces prenatal care.”
Which finding suggests vasa previa as an emergency?
Maternal painless bleeding with stable fetal status
Vaginal itching with thick white discharge
Unilateral stabbing pelvic pain at 10 weeks
Vaginal bleeding with sudden fetal heart rate abnormalities after ROM
Which teaching is appropriate for a pregnant client regarding COVID vaccination?
Vaccination is recommended by major guidelines for pregnant clients
Vaccination is contraindicated in pregnancy
Only postpartum vaccination is allowed
Vaccination is only for clients with HSV
Which statement best defines eclampsia?
Proteinuria without symptoms
New-onset seizures in a client with preeclampsia
Painless vaginal bleeding
Hypertension before pregnancy
Which medication may be used to treat acute severe hypertension in pregnancy?
Doxylamine
Metformin
Hydralazine
Ceftriaxone
Which finding is most consistent with placenta previa?
Uterine tenderness and rigidity
Severe abdominal pain with dark bleeding
Fever with foul discharge
Painless bright-red vaginal bleeding
Which clinical finding is most consistent with ectopic pregnancy rupture?
Shoulder pain and signs of internal bleeding
Fishy odor and clue cells
Reactive NST
Elevated AFP
Which intervention is appropriate for herpes zoster exposure prevention?
Recommend live varicella vaccine during pregnancy
Avoid contact with susceptible pregnant clients; follow provider guidance for exposure management
Encourage sharing towels to build immunity
Ignore lesions if mild
Which lab test is appropriate for diagnosing gonorrhea?
RPR
AFP level
NAAT
KOH prep
A client asks why preeclampsia is dangerous. Which complication is the priority concern?
Neural tube defect
Maternal seizures
Yeast infection
Endometrial polyps
Which outcome is a major complication of worsening preeclampsia?
Yeast infection
Neural tube defect
BV recurrence
Seizure development
A nurse in a provider's office is caring for a client who has a new diagnosis of herpes zoster. The nurse should anticipate a prescription for which of the following medications?
Zoster vaccine
Amoxicillin
Infliximab
Acyclovir
A nurse is assessing a client who has an exacerbation of herpes zoster. Which of the following manifestations of the client's skin should the nurse expect?
Confluent, honey-colored, crusted lesions
Unilateral, localized, nodular skin lesions
A large, tender nodule located on a hair follicle
A fluid-filled vesicular rash in the genital region
