Level 3 Maternal

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Sample questions from Level 3 Maternal

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

1. 1.In the labor and delivery unit, a 29-year-old client at 39 weeks' gestation is receiving oxytocin. The fetal heart rate is 170/min with recurrent late decelerations, and contractions occur every 1.5 minutes and last 90 seconds. The client's blood pressure is 118/72 mm Hg. Which action should the nurse take first?

   • A.Document the pattern and reassess in 30 minutes.
   • B.Stop the oxytocin infusion.
   • C.Increase the oxytocin infusion to improve labor progress.
   • D.Prepare the client for immediate discharge.

   Rationale: Stopping oxytocin is the priority because tachysystole with recurrent late decelerations indicates impaired fetal oxygenation. Increasing oxytocin could worsen uteroplacental perfusion, and discharge is unsafe with a nonreassuring fetal pattern. Waiting 30 minutes to reassess delays intervention; the nurse should also initiate intrauterine resuscitation and promptly notify the provider.

2. 2.Refer to the client's chart. Which actions should the nurse take now to manage the client's condition? Select all that apply.

   • A.Prepare to administer the prescribed uterotonic medication.
   • B.Massage the uterine fundus while assessing its tone.
   • C.Activate the obstetric hemorrhage response and call for assistance.
   • D.Encourage the client to walk to the bathroom unassisted.
   • E.Delay notifying the provider until the next routine assessment.

   Rationale: Activating the hemorrhage response is indicated by the increasing quantified blood loss and tachycardia documented at 0915. Fundal massage is appropriate because the fundus is boggy, and preparing the prescribed uterotonic addresses uterine atony. Walking unassisted risks a fall in a client with active bleeding and dizziness; delaying notification could allow hemorrhage and shock to progress.

3. 3.At change of shift in a high-risk obstetric unit, a 34-year-old client at 33 weeks' gestation has a blood pressure of 168/112 mm Hg, severe persistent headache, and new visual spots. Which client should the nurse assess first?

   • A.A client at 36 weeks' gestation requesting an update on the birth plan.
   • B.A client at 28 weeks' gestation reporting mild nausea after breakfast.
   • C.A client 12 hours after cesarean birth reporting incisional pain of 5 on a 0-to-10 scale.
   • D.The client with severe-range blood pressure and neurologic symptoms.

   Rationale: Severe-range hypertension with headache and visual symptoms can indicate worsening preeclampsia and risk of seizure or stroke, requiring immediate assessment and escalation. Mild nausea without additional warning signs is less urgent. A birth-plan question and expected incisional pain are important but do not take priority over an acute neurologic and hypertensive emergency.

4. 4.In a community prenatal clinic, a 16-year-old client at 12 weeks' gestation asks the nurse not to tell a parent about the pregnancy. The client appears calm and denies being unsafe at home. Which response best supports the client's care?

   • A.Explain that confidentiality and parental notification requirements depend on local law, and discuss the limits of confidentiality before sharing information.
   • B.Call the client's parent immediately because all pregnant minors require parental notification.
   • C.Promise that no information will ever be shared with anyone.
   • D.Refuse to provide prenatal care until the client brings a parent.

   Answer and rationale are in the full material.

5. 5.On a postpartum unit, a 26-year-old client who had a cesarean birth 8 hours ago has stable vital signs and needs routine oral medications. Which task is appropriate for the registered nurse to delegate to an experienced unlicensed assistive personnel (UAP)?

   • A.Assess the incision for separation and drainage.
   • B.Evaluate the client's response to the prescribed analgesic.
   • C.Obtain and report the client's routine vital signs.
   • D.Teach the client how to splint the incision when coughing.

   Answer and rationale are in the full material.