Nurse-Midwifery Clinical Practicum Q & A w/ Rationales, Exams of Nursing

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NURSING 7288

Nurse-Midwifery

Clinical Practicum

Q & A w/ Rationales

1. Which of the following is the primary goal of a Nurse- Midwifery Clinical Practicum? a) To provide basic primary care to women and newborns b) To perform routine prenatal and postpartum assessments c) To develop advanced clinical skills in women's health and childbirth d) To educate patients on birth control methods and family planning Answer: c) To develop advanced clinical skills in women's health and childbirth Rationale: The primary goal of a Nurse-Midwifery Clinical Practicum is to provide nursing students with opportunities to develop advanced clinical skills in women's health and childbirth beyond basic primary care.
2. When providing antepartum care as a nurse-midwife, which of the following assessments is most critical for identifying potential high-risk pregnancies? a) Blood pressure measurement b) Fetal movement counting c) Leopold's maneuvers d) Fundal height measurement Answer: a) Blood pressure measurement Rationale: Monitoring blood pressure is crucial in identifying potential high-risk pregnancies, such as preeclampsia, which can have severe adverse effects on

5. When caring for a woman in the first stage of labor, the nurse-midwife should prioritize: a) Providing emotional support and relaxation techniques b) Monitoring maternal vital signs and fetal heart rate c) Administering pain medication as ordered by the physician d) Assisting with amniotomy to accelerate labor Answer: b) Monitoring maternal vital signs and fetal heart rate Rationale: During the first stage of labor, continuous monitoring of maternal vital signs and fetal heart rate helps identify any signs of distress or complications that require immediate intervention.
6. A nurse-midwife is conducting a routine prenatal visit at 38 weeks gestation. Which of the following assessments is most important to determine fetal well-being? a) Maternal weight measurement b) Blood glucose level testing c) Non-stress test d) Group B streptococcus screening Answer: c) Non-stress test Rationale: A non-stress test is an important assessment to determine fetal well-being by evaluating the fetal heart rate and its response to fetal movement during the third

trimester.

7. When assessing a postpartum woman's fundus, the nurse-midwife notes excessive bleeding and a boggy consistency. The nurse-midwife's immediate intervention should be to: a) Administer uterotonic medication b) Perform vaginal exam to assess for retained placental fragments c) Apply gentle fundal massage d) Start intravenous fluids Answer: c) Apply gentle fundal massage Rationale: A boggy uterus with excessive bleeding suggests uterine atony. The initial intervention is to stimulate uterine contractions by massaging the fundus gently.
8. A nurse-midwife suspects a postpartum woman is experiencing mastitis. The most appropriate initial management should include: a) Prescribing antibiotics and pain medication b) Encouraging continued breastfeeding from the affected breast c) Applying warm compresses and advising breast engorgement massage d) Instructing the woman to temporarily discontinue breastfeeding

b) Initiating insulin therapy to maintain normal blood glucose levels c) Monitoring fetal kick counts and evaluating fetal growth regularly d) Administering oral hypoglycemic medications as prescribed Answer: a) Strict dietary control and monitoring blood glucose levels Rationale: Managing gestational diabetes primarily involves strict dietary control by maintaining appropriate blood glucose levels, along with close monitoring through glucose testing.

11. Which of the following actions should a nurse-midwife prioritize when providing care to a woman in active labor? a) Monitoring maternal vital signs every 4-6 hours b) Assisting the woman with frequent position changes c) Administering narcotic pain medication as requested d) Preparing for potential complications and emergencies Answer: b) Assisting the woman with frequent position changes Rationale: Frequent position changes help optimize labor progress, relieve discomfort, and promote maternal-fetal circulation and oxygenation.
12. In a newborn assessment, a nurse-midwife notices the

absence of anal opening. This finding indicates a potential: a) Ventricular septal defect b) Cleft palate c) Esophageal atresia d) Imperforate anus Answer: d) Imperforate anus Rationale: The absence of an anal opening suggests imperforate anus, a congenital anomaly that requires immediate evaluation and surgical intervention.

13. Which of the following signs or symptoms in a postpartum woman is most indicative of a potential deep vein thrombosis (DVT)? a) Redness and warmth over the area of the affected leg b) Slight swelling of both lower extremities c) Mild calf pain during ambulation d) Unilateral leg swelling and tenderness Answer: d) Unilateral leg swelling and tenderness Rationale: Unilateral leg swelling and tenderness are classic signs of a deep vein thrombosis (DVT), and immediate evaluation and treatment are required to prevent potential complications.
14. A nurse-midwife is providing a postpartum woman with education on contraception methods. Which option is considered safe and effective for breastfeeding women?

B:

1. A 32-year-old woman with a history of gestational diabetes and preeclampsia is in labor at 38 weeks of gestation. She has been receiving oxytocin infusion for augmentation of labor and magnesium sulfate for seizure prophylaxis. Her blood pressure is 160/100 mmHg and her fetal heart rate is 150 beats per minute with minimal variability and late decelerations. What is the most appropriate action for the nurse-midwife to take? a) Increase the oxytocin infusion rate to achieve stronger contractions. b) Administer hydralazine intravenously to lower the blood pressure. c) Prepare for an emergency cesarean section due to fetal distress. * d) Discontinue the magnesium sulfate infusion and monitor the patient closely. Rationale: The patient has severe preeclampsia with signs of fetal compromise, which is an indication for urgent delivery by cesarean section. Increasing the oxytocin infusion rate could worsen the fetal distress and increase the risk of uterine rupture. Hydralazine is an antihypertensive agent that can lower the blood pressure, but it does not address the underlying cause of preeclampsia or improve the fetal condition. Magnesium sulfate is a tocolytic agent that can prevent seizures and reduce the risk of eclampsia, but it does not reverse the preeclampsia or improve the fetal condition.

2. A 28-year-old woman with a singleton pregnancy is admitted to the labor and delivery unit at 41 weeks of gestation. She has no significant medical or obstetric history and her prenatal care has been unremarkable. She is in active labor with regular contractions and her cervix is dilated to 6 cm. She requests epidural analgesia for pain relief. What is the most appropriate response for the nurse- midwife to give? a) Explain that epidural analgesia is not recommended after 40 weeks of gestation because it can prolong labor and increase the risk of cesarean section. b) Explain that epidural analgesia is only available for high-risk pregnancies or complicated labors that require close monitoring and intervention. c) Explain that epidural analgesia is a safe and effective option for pain relief during labor and obtain informed consent from the patient. * d) Explain that epidural analgesia is not necessary for normal labor and encourage the patient to use non- pharmacological methods of pain relief such as breathing techniques, massage, or hydrotherapy. Rationale: Epidural analgesia is a form of regional anesthesia that blocks the transmission of pain signals from the lower part of the body to the brain. It is a safe and effective option for pain relief during labor that does not affect the progress of labor or increase the risk of cesarean section. It also allows the patient to remain alert and participate in the birth process. Epidural analgesia is not contraindicated after 40 weeks of gestation, nor is it

twins are in vertex presentation or if the first twin is in vertex presentation and the second twin is in breech presentation. Cesarean section is indicated if both twins are in breech presentation or if the first twin is in breech presentation and the second twin is in vertex presentation. ECV is a procedure that involves applying pressure on the abdomen to rotate the fetus into vertex presentation. It is not recommended for the second twin because it can cause umbilical cord compression, placental abruption, or fetal distress. IPV is a procedure that involves inserting a hand into the uterus to grasp the feet of the fetus and deliver breech. It is a safe and effective technique for delivering the second twin in breech presentation as long as there are no contraindications such as placenta previa, cord prolapse, or fetal anomalies. C: Question: During a prenatal visit, a pregnant woman at 28 weeks gestation complains of sudden onset of blurred vision, severe headache, and epigastric pain. What should the nurse-midwife suspect as the most likely condition? Answer: The correct answer is pre-eclampsia. The sudden onset of blurred vision, severe headache, and epigastric pain are classic symptoms of pre-eclampsia, a condition characterized by high blood pressure and organ damage in pregnant women. Rationale: Pre-eclampsia is a

serious pregnancy complication that requires immediate medical attention as it can lead to serious complications for both the mother and the baby. Question: A 32-year-old woman who is 38 weeks pregnant presents to the clinic with complaints of leaking amniotic fluid. What action should the nurse-midwife prioritize? Answer: The correct answer is assess the characteristics of the amniotic fluid and perform a sterile speculum examination. Rationale: It is essential to confirm if the leaking fluid is indeed amniotic fluid, as premature rupture of membranes can lead to increased risks of infection and other complications for both the mother and the baby. Question: A 24-year-old primigravida at 39 weeks gestation presents with regular contractions every 5 minutes. Upon examination, the cervix is found to be dilated at 3 cm. What stage of labor is the woman most likely in? Answer: The correct answer is early labor (latent phase). Rationale: In the latent phase of labor, the cervix dilates from 0 to 6 cm, and contractions are typically mild to moderate in intensity and occur at regular intervals. Question: A postpartum woman complains of persistent perineal pain and discomfort despite receiving appropriate pain management. On examination, the nurse-midwife notes redness, swelling, and discharge from the perineal area. What condition should the nurse-midwife suspect? Answer: The correct answer is perineal infection.

What is the most appropriate intervention for this condition? Answer: The correct answer is teach proper latching technique and encourage the use of lanolin cream for nipple healing. Rationale: Proper latching technique and the use of lanolin cream can help alleviate nipple pain and promote healing of cracked and blistered nipples, thereby improving the breastfeeding experience for the mother. Question: A laboring woman with a history of previous cesarean section expresses her desire for a vaginal birth after cesarean (VBAC). What information should the nurse-midwife provide to the patient regarding VBAC? Answer: The correct answer is discuss the risks and benefits of VBAC and ensure informed consent. Rationale: It is essential for the nurse-midwife to engage in a comprehensive discussion with the patient regarding the potential risks and benefits associated with VBAC, allowing the patient to make an informed decision. Question: A 28-year-old pregnant woman with a body mass index (BMI) of 32 presents with gestational diabetes mellitus (GDM). What dietary advice should the nurse- midwife provide to the patient? Answer: The correct answer is recommend a balanced diet with controlled carbohydrate intake and regular physical activity. Rationale: Dietary management is crucial in controlling blood sugar levels in patients with GDM, and a balanced diet with controlled carbohydrate intake, along with regular physical activity, plays a key role in managing

the condition. Question: A 34-year-old woman at 30 weeks gestation presents with symptoms of deep vein thrombosis (DVT), including unilateral leg swelling and pain. What action should the nurse-midwife prioritize? Answer: The correct answer is refer the patient for immediate ultrasound evaluation of the affected leg. Rationale: Prompt diagnosis and management of DVT are essential to prevent potential complications such as pulmonary embolism, especially in pregnant women who are at an increased risk of developing DVT. Question: A pregnant woman at 36 weeks gestation presents to the clinic with persistent, severe itching, particularly on the palms and soles. What condition should the nurse-midwife suspect based on these symptoms? Answer: The correct answer is intrahepatic cholestasis of pregnancy (ICP). Rationale: Persistent, severe itching, especially on the palms and soles, can be indicative of ICP, a liver disorder that can have adverse effects on both the mother and the baby, necessitating close monitoring and management. Question: A 26-year-old woman at 34 weeks gestation presents with complaints of frequent, painful urination and lower abdominal discomfort. On examination, the nurse- midwife notes tenderness over the suprapubic area. What condition should the nurse-midwife suspect as the most likely cause?

presents with signs of ruptured membranes and meconium- stained amniotic fluid. What immediate action should the nurse-midwife prioritize? Answer: The correct answer is prepare for expedited delivery and neonatal resuscitation if indicated. Rationale: Meconium-stained amniotic fluid can be indicative of fetal distress, necessitating expedited delivery and preparedness for neonatal resuscitation to ensure the well-being of the newborn.