Maternal Newborn & Pedia

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Sample questions from Maternal Newborn & Pedia

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 29-year-old client at 34 weeks of gestation arrives at the obstetric triage unit with a severe headache and blurred vision. Blood pressure is 168/112 mm Hg, and urine protein is 3+. Which action should the nurse take first?

   • A.Place the client in a quiet, dimly lit room and institute seizure precautions
   • B.Encourage oral fluids and reassess the blood pressure in 1 hour
   • C.Obtain a nonstress test before notifying the health care provider
   • D.Teach the client to reduce dietary sodium and monitor blood pressure at home

   Rationale: A blood pressure of 168/112 mm Hg with neurologic symptoms and proteinuria indicates severe preeclampsia and risk for seizure and stroke, so immediate safety measures and urgent escalation are needed. Option B delays treatment despite severe findings, and option C prioritizes fetal assessment over maternal stabilization. Option D is inadequate for an acute emergency and does not address the immediate risk.

2. 2.A 26-year-old client at 32 weeks of gestation is receiving magnesium sulfate for preeclampsia in the labor and delivery unit. The nurse notes respirations of 10/min, absent patellar reflexes, and urine output of 20 mL/hr. Which action is the priority?

   • A.Stop the magnesium sulfate infusion and notify the health care provider
   • B.Increase the infusion rate because urine output is low
   • C.Place the client in a supine position and reassess in 15 minutes
   • D.Administer the next scheduled dose of nifedipine

   Rationale: Respiratory depression, absent reflexes, and oliguria suggest magnesium toxicity, so the infusion must be stopped and the provider notified immediately; prepare to give calcium gluconate as prescribed. Option B increases toxicity risk, and option C may worsen vena cava compression and delays action. Option D does not treat magnesium toxicity.

3. 3.A 24-year-old client at 39 weeks is in active labor on the birthing unit. The fetal heart rate falls to 90/min for 3 minutes after a contraction, and the client is receiving oxytocin. What should the nurse do first?

   • A.Stop the oxytocin infusion
   • B.Increase the oxytocin rate to shorten labor
   • C.Prepare the client for discharge because labor is progressing
   • D.Ask the client to begin pushing with each contraction

   Rationale: A prolonged fetal bradycardia during oxytocin infusion requires immediate intrauterine resuscitation, beginning with stopping the uterotonic. Increasing oxytocin worsens uterine stimulation, and pushing is inappropriate until the fetal status and labor stage are assessed. Discharge is unsafe with an acute fetal heart rate abnormality.

4. 4.A 31-year-old client at 40 weeks is receiving oxytocin for labor augmentation. The nurse observes six contractions in 10 minutes and recurrent late fetal heart rate decelerations. Which action is most appropriate?

   • A.Discontinue oxytocin and reposition the client laterally
   • B.Continue oxytocin and document the contraction pattern
   • C.Encourage the client to ambulate in the hallway
   • D.Perform fundal pressure during the next contraction

   Answer and rationale are in the full material.

5. 5.A 22-year-old client at 38 weeks reports a sudden gush of clear fluid while at home and arrives at the birth unit 30 minutes later. The fetal heart rate is 140/min, and the presenting part is high. Which assessment should the nurse perform first?

   • A.Assess the fetal heart rate
   • B.Perform a digital cervical examination
   • C.Obtain a maternal urine specimen
   • D.Encourage the client to walk to promote labor

   Answer and rationale are in the full material.