D447 - Women and Children

Question 21: A nurse is caring for a patient at 35 weeks gestation who suddenly reports severe abdominal pain. The abdomen feels rigid and boardlike on palpation, and dark red vaginal bleeding is present. The fetal monitor shows late decelerations. Which intervention should the nurse implement first?

Apply electronic fetal monitoring and establish IV access

Perform a vaginal exam to assess dilation

Administer oral pain medication for comfort

Position the patient upright and encourage ambulation

Question 22: A charge nurse is educating new graduates about differentiating obstetric hemorrhage presentations. A patient presents with painful, dark red vaginal bleeding at 34 weeks with a rigid abdomen and reports the pain started suddenly. Which characteristic best distinguishes this presentation as abruption rather than another cause?

The bleeding is bright red and painless

A rigid boardlike abdomen with sudden pain

Gradual onset of mild cramping over days

Bleeding that stops with bed rest alone

Question 23: A nurse notes that a patient at 36 weeks gestation is tachycardic and hypotensive with a rigid, tender abdomen, but only a small amount of dark vaginal bleeding is visible. The nurse recognizes that the severity of shock symptoms seems disproportionate to the visible blood loss. Which explanation accounts for this discrepancy?

The patient is overreacting to mild pain

Vital sign changes are normal at this stage

Blood is trapped behind the placenta internally

The monitors are producing inaccurate readings

Question 24: A nurse is reviewing the chart of a patient admitted with suspected placental abruption and is identifying relevant risk factors from her history. Which finding from the patient's history is most strongly associated with abruption?

The patient is a vegetarian

She had an uncomplicated prior delivery

She has a history of chronic hypertension

She began prenatal care at eight weeks

Question 25: A patient with confirmed placental abruption at 37 weeks shows persistent late decelerations on the fetal heart rate monitor despite repositioning and oxygen administration. The bleeding is increasing and the patient is becoming hemodynamically unstable. Which action should the nurse anticipate next?

Preparation for emergency cesarean delivery

Administration of tocolytics to stop contractions

Discharge home with instructions to return if worsening

Switching to intermittent fetal monitoring only

Question 26: A nurse is reviewing the birth plan with a patient at 38 weeks who has a history of genital herpes. During today's examination, the patient reports tingling and burning in the genital area, and small vesicular lesions are visible. The patient had hoped for a vaginal delivery. Which response by the nurse is most appropriate?

Vaginal delivery is safe with active lesions

Antiviral therapy will clear lesions before labor

Lesions at this stage pose no risk to newborns

Cesarean delivery is recommended with active lesions

Question 27: A nurse is educating a pregnant patient with recurrent genital herpes about the plan to start antiviral medication in late pregnancy. The patient asks why she needs to take medication now if she does not currently have an active outbreak. Which explanation by the nurse best addresses the rationale?

The medication treats existing fetal infection

Suppressive therapy reduces outbreak risk at delivery

Antivirals boost immune function during pregnancy

Late pregnancy is when herpes is least active

Question 28: A nurse is providing prenatal education to an HIV-positive patient about reducing the risk of transmitting the virus to her baby. The patient asks whether breastfeeding will be safe after delivery. Considering a resource-rich healthcare setting, which response by the nurse is most accurate?

Breastfeeding is contraindicated with HIV

Breast milk carries no transmission risk

Breastfeeding is safe with antiviral therapy alone

Only pumped milk is safe for the infant

Question 29: A nurse in the newborn nursery is caring for an infant born to an HIV-positive mother who received antiretroviral therapy throughout pregnancy. The nurse is reviewing the newborn medication orders. Which medication and timing does the nurse anticipate for this infant to reduce vertical transmission risk?

Acyclovir within 24 hours of birth

Hepatitis B immune globulin at 48 hours

Zidovudine within 6 to 12 hours of birth

Erythromycin ointment within one hour of birth

Question 30: A nursing student asks the instructor how HIV diagnosis progresses from initial screening to confirmation. The student also wants to know at what point the diagnosis shifts from HIV to AIDS. Which explanation by the instructor is most accurate?

Diagnosis is based on symptoms and white cell count

ELISA screening confirmed by Western Blot with AIDS below CD4 of 200

A single positive rapid test confirms AIDS diagnosis

HIV becomes AIDS after two years regardless of treatment

Question 31: A nurse is reviewing prenatal lab results for a patient at 17 weeks gestation and notes that the maternal serum alpha-fetoprotein level is significantly elevated. The patient is anxious and asks what this could mean. Which explanation by the nurse is most appropriate?

This confirms the baby has a birth defect

Elevated results always require immediate delivery

It may indicate a chromosomal abnormality present

It suggests a possible neural tube defect or dating error

Question 32: A nurse is interpreting prenatal screening results for a patient at 16 weeks and notes that the AFP level is lower than expected for gestational age. The patient's ultrasound dating was confirmed accurate at an earlier visit. Given accurate dating, which condition should the nurse recognize as the primary concern associated with this finding?

Chromosomal abnormality such as Down syndrome

An open neural tube defect like spina bifida

Gestational diabetes developing in the second trimester

Normal variation requiring no additional evaluation

Question 33: A patient at her first prenatal visit at 10 weeks asks the nurse when she will have her alpha-fetoprotein blood test drawn. The nurse is explaining the appropriate timing for this screening test. Which response by the nurse is most accurate?

It can be drawn at any point during pregnancy

It is typically drawn between 15 and 20 weeks

The test is performed immediately after delivery

Most providers draw it during the first trimester

Question 34: A nurse is counseling a patient whose AFP screening returned abnormal results. The patient is very upset and convinced that something is wrong with her baby. The nurse needs to provide accurate reassurance without minimizing the finding. Which statement by the nurse is most therapeutic and accurate?

Your baby almost certainly has a serious defect

This result means nothing and should be ignored

AFP is a screening tool and further testing is needed

We should schedule a termination consultation now

Question 35: A nurse educator is teaching students about conditions that can produce falsely abnormal AFP results without any actual fetal defect being present. The students need to understand which non-pathologic factor most commonly causes AFP values to appear elevated when the fetus is actually healthy.

Incorrect gestational dating making the pregnancy older

Maternal obesity affecting blood concentration levels

Recent caffeine intake before the blood draw

The patient having eaten a high-protein meal beforehand

Question 36: A pregnant patient at 14 weeks tells the nurse she has been having an occasional glass of wine with dinner and asks whether small amounts of alcohol are safe during the second trimester. She states her friend told her a little bit of wine is fine after the first trimester ends. Which response by the nurse is most appropriate?

A small glass of wine weekly is acceptable

Alcohol is only harmful in the first trimester

Red wine in moderation benefits the pregnancy

No amount of alcohol is considered safe in pregnancy

Question 37: A pregnant patient mentions that her partner has been experiencing nausea, weight gain, and fatigue that seem to mirror her own pregnancy symptoms. She asks the nurse whether this is a cause for concern. Which explanation by the nurse best describes this phenomenon?

The partner likely has an unrelated medical condition

Sympathetic pregnancy symptoms are a recognized phenomenon

These symptoms always indicate a serious underlying illness

Partners cannot experience any pregnancy-related changes

Question 38: A nurse is assessing psychosocial adaptation during a prenatal visit at 30 weeks. The patient describes talking to the baby, imagining what the baby will look like, and has already chosen a name. The patient's partner has been attending every appointment and assembling the nursery at home. Which interpretation of these behaviors is most appropriate?

These behaviors suggest unhealthy fixation on the pregnancy

The partner's involvement is excessive and should be limited

Both parents are demonstrating healthy prenatal attachment

Naming the baby before birth indicates unrealistic expectations

Question 39: A nurse is conducting a prenatal assessment at 28 weeks and notices the patient avoids discussing the pregnancy, has not made any preparations for the baby, and repeatedly states she does not feel connected to the fetus. The patient appears emotionally detached and has declined previous referrals to support groups. Which nursing action is most appropriate?

Reassure the patient that detachment is completely normal

Document the behavior and take no further action

Insist the patient attend a parenting preparation class

Gently explore her feelings and offer counseling referral

Question 40: A pediatric nurse is caring for a newborn whose mother consumed alcohol regularly throughout pregnancy. The nurse is assessing for features associated with fetal alcohol spectrum disorders. Which combination of findings is most characteristic of prenatal alcohol exposure?

Growth restriction with facial and brain abnormalities

Macrosomia with large head circumference at birth

Jaundice with elevated bilirubin in the first day

Respiratory distress with underdeveloped lung tissue