Obstetric Practice Test

• A 21-year-old married woman thinks she may be pregnant. She goes

to her physician and tells the Midwife that the drugstore test was
positive for pregnancy. She asks the Midwife if the test is reliable.
What is the best response for the Midwife to make?
• 1. “The tests are quite reliable. In order to be sure you are pregnant, I
need to get some more information from you.”
• 2. “The tests are less reliable than the one the doctor does. We will
have to repeat it.”
• 3. “Those kits are not very reliable. Your doctor should make the
diagnosis.”
• 4. “They are very reliable. You can be sure you are pregnant.”
• The Midwife is assessing a woman who thinks she may be pregnant.
Which information from the client is most significant in confirming the
diagnosis of pregnancy?
• 1. The client is experiencing nausea before bedtime and after meals.
• 2. The client says she has gained six pounds and her slacks are tight.
• 3. The client has noticed it is difficult to sleep on her “stomach”
because her breasts are tender.
• 4. The client has a history of regular menstrual periods since age 13,
and she has missed her second period.
• After her examination by the physician, the antepartal client tells the
Midwife that the doctor said she had positive Chadwick’s and
Goodell’s signs. She asks the Midwife what this means. What is the
best response for the Midwife to make?
• 1. “Chadwick’s sign is a dark blue coloring of the vagina and cervix.
Goodell’s sign is softening of the cervix of the uterus.”
• 2. “These help to confirm pregnancy. They refer to color changes and
changes in the uterus caused by increased hormones of pregnancy.”
• 3. “Those are medical terms. You don’t need to be concerned about
them.”
• 4. “It refers to changes that occasionally happen in pregnancy but are
unlikely to cause problems.”
• An antepartal client asks when her baby is due. Her last menstrual
period was August 28. Using Naegele’s rule, calculate the estimated
date of delivery.
• 1. May 21
• 2. May 28
• 3. June 4
• 4. June 28
• In establishing a teaching plan for a client who is in the first trimester
of pregnancy, the Midwife identifies a long list of topics to discuss.
Which is most appropriate for the first visit?
• 1. Preparation for labor and delivery
• 2. Asking the woman what questions and concerns she has about
parenting
• 3. Nutrition and activity during pregnancy
• 4. Dealing with heartburn and abdominal discomfort
• When a woman in early pregnancy is leaving the clinic, she blushes
and asks the Midwife if it is true that sex during pregnancy is bad for
the baby. What is the best response for the Midwife to make?
• 1. “The baby is protected by his sac. Sex is perfectly alright.”
• 2. “It is unlikely to harm the baby. What you do with your personal life
is your concern.”
• 3. “In a normal pregnancy, intercourse will not harm the baby.
However, many women experience a change in desire. How are you
feeling?”
• 4. “Intercourse during pregnancy is usually alright, but you need to
ask the doctor if it is acceptable for you.”
• The doctor told a pregnant woman to eat a wellbalanced diet and
increase her iron intake. She says, “I hate liver. How can I increase my
iron?” What is the best response for the Midwife to make?
• 1. “Although liver is a good source of iron, beets, poultry, and milk are
also good sources.”
• 2. “Many people dislike liver. Red meats, dark green vegetables, and
dried fruits are also good sources of iron.”
• 3. “You should eat liver as it is the best source of iron. There are lots
of ways to disguise the taste.”
• 4. “You can eat almost anything you like because your prenatal
vitamins have all the vitamins and minerals needed for a healthy
pregnancy
• The Midwife is teaching a prenatal class. A woman in the class who is
eight months pregnant asks why her feet swell. The Midwife includes
which of the following information in the answer?
• 1. Swollen feet during pregnancy can indicate a serious problem.
• 2. The enlarging baby reduces venous return, causing retention of
fluid in the feet and ankles.
• 3. Swelling of the feet during pregnancy is usually related to PIH.
• 4. Swelling of the feet during pregnancy is due to the increased blood
volume and will disappear after delivery
• A woman who is at about six weeks gestation asks if she can listen to
the baby’s heartbeat today. What should be included in the Midwife’s
reply?
• 1. The heart is not beating at six weeks.
• 2. The heart is formed and beating but is too weak to be heard with a
stethoscope.
• 3. The heartbeat can be heard with an electronic fetoscope.
• 4. The heart does not start beating until 20 weeks gestation.
• A woman who is in early pregnancy asks the Midwife what to do
about her “morning sickness.” What should the Midwife include in the
reply?
• 1. Eating a heavy bedtime snack containing fat helps to keep nausea
from developing in the morning.
• 2. Eating dry crackers before getting out of bed may help.
• 3. Drinking liquids before getting up in the morning helps relieve
nausea.
• 4. The doctor can prescribe an antiemetic if she has had three or
more vomiting episodes.
• A woman who is 38 weeks gestation tells the Midwife that she
sometimes gets dizzy when she lies down. Which information is it
important for the Midwife to give the client?
• 1. This is a sign of a serious complication and should be reported to
the physician whenever it occurs.
• 2. Try to sleep in an upright position on your back to prevent the
dizziness.
• 3. Try lying on your left side rather than on your back.
• 4. Sleeping on your back with several pillows should help
• The Midwife asks the newly pregnant woman if she has a cat for
which of the following reasons?
• 1. Cats may suffocate new babies and should not be in the home
when a baby arrives.
• 2. Cat feces may cause toxoplasmosis, which can lead to blindness,
brain defects, and stillbirth.
• 3. If the mother gets scratched by a cat, the baby may develop heart
defects.
• 4. Cats are jealous of babies and may try to kill them during infancy.
• The Midwife is caring for a woman who is 30 weeks gestation, has
gained 17 pounds during the pregnancy, and has a blood pressure of
110/70. The woman states that she feels warmer than everyone
around her. Which interpretation of these findings is most correct?
• 1. All of these findings are normal.
• 2. Her weight gain is excessive for this point in pregnancy.
• 3. The blood pressure is abnormal.
• 4. She should be evaluated for a serious infection because pregnant
women are usually cooler than other people.
• What should the Midwife do to assess for a positive sign of
pregnancy? 1. Perform a pregnancy test on the woman’s urine.
• 2. Auscultate for fetal heart sounds.
• 3. Ask the woman when she had her last menstrual period.
• 4. Ask the woman if her breasts are tender.
• An oxytocin challenge test is ordered for a woman who is 42 weeks
pregnant. What should the Midwife plan for in the care of this client?
• 1. Place her in the supine position during the test.
• 2. Keep her NPO before the test.
• 3. Have her empty her bladder before the test.
• 4. Prepare the client for the insertion of internal monitors.
• A woman comes to the doctor’s office for her routine checkup. She is
34 weeks gestation. The Midwife notes all of the following. Which
would be of greatest concern to the Midwife?
• 1. Weight gain of 2 lb in two weeks
• 2. Small amount of dependent edema
• 3. Fetal heart rate of 155 bpm
• 4. Blood pressure of 150/94
• A pregnant woman is admitted to the hospital. Her initial admitting
vital signs are blood pressure 160/94; pulse 88; respirations 24; and
temperature 98°F. She complains of epigastric pain and headache.
What should the Midwife do initially?
• 1. Insert an indwelling catheter. 2.
• Give Maalox 30 cc now.
• 3. Contact the doctor stat with findings.
• 4. Provide supportive care for impending convulsion.
• Magnesium sulfate is ordered for a client who is hospitalized for
pregnancy-induced hypertension (PIH). What effects would the
Midwife expect to see as a result of this medication?
• 1. CNS depression
• 2. Decreased gastric acidity
• 3. Onset of contractions
• 4. Decrease in number of bowel movements
• A client with PIH asks the Midwife, “When will I get over this?” What
is the best response for the Midwife to make?
• 1. “Your disease can be controlled with medication.”
• 2. “After your baby is born.”
• 3. “After delivery, you will need further testing.”
• 4. “You could have this condition for years.”
• A 40-year-old woman who is 28 weeks gestation comes to the
emergency room with painless, bright red bleeding of 1.5 hours
duration. What condition does the Midwife suspect this client has?
• 1. Abruptio placenta
• 2. Placenta previa
• 3. Hydatidiform mole
• 4. Prolapsed cord
• A woman who is 28 weeks gestation comes to the emergency room
with painless, bright red bleeding of 1.5 hours in duration. Which of
the following would the Midwife expect during assessment of this
woman?
• 1. Alterations in fetal heart rate
• 2. Board-like uterus
• 3. Severe abdominal pain
• 4. Elevated temperature
• A woman is admitted with suspected placenta previa. What test does
the Midwife expect will be done to confirm the diagnosis?
• 1. Internal exam
• 2. Nonstress test
• 3. Oxytocin challenge test
• 4. Ultrasound
• A pregnant 16-year-old asks the Midwife if she should have an
abortion. How should the Midwife respond initially?
• 1. “You should ask your parents for advice.”
• 2. “Abortion is the deliberate killing of a human being.”
• 3. “An abortion would let you finish growing up before you have
children.”
• 4. “What are your feelings about abortion?”
• A 25-year-old woman is four months pregnant. She had rheumatic
fever at age 15 and developed a systolic murmur. She reports
exertional dyspnea. What instruction should the Midwife give her?
• 1. “Try to keep as active as possible, but eliminate any activity that
you find tiring.”
• 2. “Carry on all your usual activities, but learn to work at a slower
pace.”
• 3. “Avoid heavy housework, shopping, stair climbing, and all
unnecessary physical effort.”
• 4. “Get someone to do your housework, and stay in bed or in a
wheelchair.”
• 50. A pregnant woman comes for her sixth-month checkup and
mentions to the Midwife that she is gaining so much weight that even
her shoes and rings are getting tight. What should the Midwife plan to
include in her care?
• 1. Teaching about the food pyramid and the importance of a well-
balanced diet
• 2. Further assessment of her weight, blood pressure, and urine
• 3. Encouraging the use of a comfortable walking shoe with a medium
heel
• 4. Reassurance that weight gain is normal as long as it does not
exceed 25 lb
• A woman who had a normal vaginal delivery two hours ago has just
arrived on the postpartum floor. Vital signs are normal. When
assessing her uterus, the Midwife notes that it is boggy. What should
be the Midwife’s initial intervention?
• 1. Massage the uterus
• 2. Report to the charge Midwife
• 3. Contact the doctor stat
• 4. Continue to assess it frequently
• The Midwife is caring for a woman who had a normal vaginal delivery
two hours ago and has just arrived on the postpartum floor. Two
hours later, her uterus is displaced to the right. What is the most likely
explanation for this?
• 1. A fibroid tumor
• 2. A full bladder
• 3. An increase in interstitial fluid
• 4. Retained placental fragments
• The day after delivery, a new mother asks why her milk is so creamy
and yellow. What is the best response for the Midwife to make?
• 1. “I wouldn’t worry about it.”
• 2. “This is normal. It will soon turn to real milk.”
• 3. “You’re coming along fine.”
• 4. “You haven’t gotten your milk in yet.”
• A new mother is in the first period of adjustment following birth
called the taking-in phase. What type of maternal behavior would the
Midwife expect her to exhibit?
• 1. Passivity and dependence
• 2. Preoccupation with baby’s needs
• 3. Independence
• 4. Resuming control of life
• A new mother has decided not to breastfeed her baby. Which
statement indicates the best understanding of the management of
engorgement?
• 1. “I will stand with my back to the shower.”
• 2. “I will take a sitz bath every day.”
• 3. “I will apply a warm compress to my breasts three times a day.”
• 4. “I will drink a lot of liquids for the next few days.”
• A new mother is about to be discharged from the hospital. Which
statement made by a new mother indicates a need for more
instruction?
• 1. “I will use my old diaphragm for contraception.”
• 2. “I have an appointment for my six-week checkup.”
• 3. “My mother will be helping me with the children for the next two
weeks.”
• 4. “I plan to go back to my job as a secretary in six weeks.”
• A woman who delivered today by cesarean delivery asks the Midwife,
“How come my baby has such a round head? My other baby’s head
was not so round, and she was more red.” What is the best response
for the Midwife to make?
• 1. “Each baby is different. It is not a good idea to compare your
children.”
• 2. “Were forceps used when your older child was delivered?”
• 3. “Babies born by cesarean have rounder heads because they do not
go through the birth canal.”
• 4. “A round head is a sign the baby is very intelligent. Your child
should do very well in school.”
• The Midwife is caring for a woman who delivered a healthy infant via
cesarean delivery 30 minutes ago. The mother says to the Midwife,
“Please don’t touch my belly. I had an operation.” What is the
Midwife’s best response?
• 1. “Alright I won’t. Be sure to let me know if you have any pain or
bleeding.”
• 2. “I do need to look at your abdomen to check your incision.”
• 3. “I must touch your abdomen to check you uterus, but I won’t touch
your incision.”
• 4. “I can wait two more hours before I will need to check your uterus.”
• A woman is admitted to the postpartum unit two hours after delivery
of a baby. What action is especially important because the
membranes were ruptured for 28 hours before delivery?
• 1. Monitor her temperature every two hours
• 2. Provide perineal care with Zephiran every four hours
• 3. Maintain a strict perineal pad count
• 4. Have the mother take a sitz bath four times a day
• The Midwife is caring for a woman who delivered a baby three hours
ago. The woman pulls the emergency call light and says she is
bleeding all over the bed. The Midwife enters the room and sees the
blood-soaked bed. What is the best initial action for the Midwife to
take?
• 1. Assess and massage the fundus if soft
• 2. Take vital signs
• 3. Place the client in sharp Trendelenburg position
• 4. Notify the physician immediately
• Methergine 5 mg qid is ordered for a postpartum client. An hour after
taking the drug, the woman complains of uterine cramping. What is
the best explanation for the Midwife to give her?
• 1. “This is an unfortunate side effect, but you need the medicine.”
• 2. “The cramping is uncomfortable, but it is a sign that the drug is
keeping your uterus contracted so you won’t bleed too much.”
• 3. “Since you are experiencing cramps, I’ll ask the doctor to
discontinue the drug.”
• 4. “The cramping should decrease soon. If it does not, let me know.
I’ll see if the doctor will decrease the dosage.”
• The Midwife is caring for a woman who had a postpartum
hemorrhage. Which of the following facts about her delivery most
likely contributed to her hemorrhage?
• 1. The baby weighed 10 lb 6 oz.
• 2. She received Pitocin after delivery of the placenta.
• 3. She delivered 10 days after her due date.
• 4. Her second stage of labor lasted an hour.
• The Midwife is caring for several immediate postpartum women.
Which client should the Midwife attend to first?
• 1. A woman who had a cesarean delivery asks for a drink of water.
• 2. A woman who had a natural childbirth says she needs to urinate.
• 3. A woman whose baby is nursing says her uterus hurts.
• 4. A woman says her bed suddenly feels wet beneath her bottom.
• The Midwife is observing a new mother for good maternal–infant
attachment. Which observation would be a sign of inappropriate
attachment?
• 1. Calling the baby “little bit.”
• 2. Holding the baby in “en face” position.
• 3. Telling the baby, “You look just like your daddy.”
• 4. Continually saying, “I’m too tired to hold the baby.”
• A woman who had a cesarean section tells the Midwife, “I guess I
flunked natural childbirth because I had to have a cesarean.” This
statement is most indicative of which phase of postpartum
adjustment?
• 1. Taking in
• 2. Working through
• 3. Taking hold
• 4. Letting go
• Six hours after delivery, the Midwife notes that a woman’s fundus is
two finger breadths above the umbilicus and deviated to the right of
the midline. What is the most likely cause of this finding?
• 1. Retained placental fragments
• 2. Bladder distention
• 3. Normal involution
• 4. Second-degree uterine atony
• Which area of health teaching will a new mother be most responsive
to during the taking in phase of the postpartum period?
• 1. Family planning
• 2. Newborn care
• 3. Community support groups
• 4. Perineal care
• On the first day after a cesarean section, the client is ambulating. She
is uncomfortable and asks the Midwife, “Why am I being made to
walk so soon after surgery?” What is the Midwife’s best response?
• 1. “You can get to hold your baby more quickly if you walk around.”
• 2. “Early walking keeps the blood from pooling in your legs and
prevents blood clots.”
• 3. “Walking early will prevent your wound from opening.”
• 4. “Early walking helps lower the incidence of wound infection.”
• A pregnant woman tells the Midwife that she is planning to
breastfeed because “You don’t have to take contraceptives until you
wean the baby.” What is the best response for the Midwife?
• 1. “Lactation does suppress ovulation, so you are not likely to get
pregnant.”
• 2. “You will not get pregnant until you start to menstruate again.”
• 3. “When a woman is breastfeeding, she may not menstruate,
although she may ovulate. It is best to use some type of birth
control.”
• 4. “You will find that you won’t be interested in resuming sexual
activity until after you wean the baby.”
• A new mother who has been breastfeeding her infant for six weeks
calls the Midwife at the doctor’s office and says her right nipple is
cracked and sore; she has a temperature and feels as though she had
the flu. How should the Midwife respond to the woman?
• 1. “Try putting warm compresses over your right breast.”
• 2. “Immediately stop nursing and apply cold compresses to your
breasts.”
• 3. “Come to see the physician. You may need medication to help.”
• 4. “Reduce the time the baby Midwifes on your right breast, and call
again if the breast is not better in two days.”
• The obstetrician sees a 31-year-old multipara client in the fi rst
trimester of pregnancy. When sharing a health history, the client tells
the Midwife that the last pregnancy ended in a spontaneous abortion
because of an incompetent cervix. The client asks the Midwife to
clarify what is meant by an incompetent cervix.
• Which statement by the Midwife best explains the meaning of an
incompetent cervix?
• [ ] 1. The cervix is not large enough for passage of the fetus.
• [ ] 2. The cervix cannot support the weight of the fetus.
• [ ] 3. The cervix has an external opening but not an internal opening.
• [ ] 4. The cervix has an internal opening but not an external opening.
• At the end of the fi rst trimester, the physician puts a cerclage in the
client’s cervix. The client asks the Midwife how long the cerclage will
remain in place. The Midwife correctly explains to the client that the
physician will probably leave the cerclage in place until what occurs?
• [ ] 1. The client goes into labor.
• [ ] 2. The client’s baby is delivered.
• [ ] 3. The second trimester ends.
• [ ] 4. The client is near term.
• Which of the following is most indicative of the presence of
hydatidiform mole?
• [ ] 1. A blotchy brown discoloration on the face
• [ ] 2. A positive Chadwick’s sign
• [ ] 3. The presence of ballottement
• [ ] 4. A uterus that is larger than expected
• A 21-year-old multigravid client who is 8 months’ pregnant is admitted to the
obstetric unit for observation. The admission diagnosis is partial placenta
previa. The client’s partner asks the Midwife, “What is placenta previa
• Which response by the Midwife provides the best explanation regarding
placenta previa?
• [ ] 1. “The placenta is implanted over or close to the internal cervical
opening.”
• [ ] 2. “The placenta isn’t producing the hormones needed to maintain the
pregnancy.”
• [ ] 3. “The placenta is invaded by polyps that cause premature uterine
contractions.”
• [ ] 4. “The placenta is producing antibodies that are destroying the baby’s red
blood cells.”
• The client’s partner verbalizes concern about how placenta previa is
treated. The Midwife correctly states that the physician is most likely
to do which of the following if the client’s condition remains stable?
• [ ] 1. Induce labor prematurely.
• [ ] 2. Perform an emergency cesarean birth.
• [ ] 3. Place the client on bed rest until full term.
• [ ] 4. Start the client on ritodrine (Yutopar).