Pediatric Nursing/maternal Newborn Proctored Exam

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Sample questions from Pediatric Nursing/maternal Newborn Proctored Exam

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

1. 1.A pregnant client at 30 weeks reports 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 notify the provider
   • B.Encourage the client to walk to improve circulation
   • C.Offer oral fluids and reassess the blood pressure in 4 hours
   • D.Prepare the client for a routine nonstress test before reporting the findings

   Rationale: Severe-range blood pressure with neurologic symptoms and proteinuria suggests preeclampsia with severe features and requires prompt escalation to prevent maternal stroke or seizure. Walking is unsafe, and delaying assessment for several hours is inappropriate. A nonstress test may be part of fetal evaluation, but it does not take priority over reporting the maternal emergency.

2. 2.A client receiving magnesium sulfate for preeclampsia has a respiratory rate of 10/min, absent deep tendon reflexes, and urine output of 20 mL/hr. What is the nurse's priority action?

   • A.Stop the magnesium sulfate infusion
   • B.Increase the infusion rate to prevent seizures
   • C.Recheck the reflexes in 1 hour
   • D.Place the client flat and encourage oral fluids

   Rationale: Respiratory depression, absent reflexes, and oliguria indicate possible magnesium toxicity, so the infusion must be stopped and the provider notified. Increasing the dose could worsen toxicity, and waiting an hour is unsafe. Oral fluids and positioning do not reverse magnesium toxicity; calcium gluconate may be prescribed as the antidote.

3. 3.A laboring client has a sudden gush of fluid. The fetal heart rate drops to 70/min, and the nurse palpates a loop of umbilical cord in the vagina. What should the nurse do first?

   • A.Apply firm pressure to push the cord back into the uterus
   • B.Use a gloved hand to lift the presenting part off the cord
   • C.Place the client supine and apply fundal pressure
   • D.Clamp and cut the cord

   Rationale: With a prolapsed cord, the nurse relieves pressure on the cord by elevating the presenting part while calling for emergency assistance and preparing for birth. Pushing the cord back can cause vasospasm or injury, and fundal pressure can worsen compression. The cord is not clamped or cut while it remains prolapsed.

4. 4.A client at 32 weeks reports painless, bright-red vaginal bleeding. Which action is appropriate?

   • A.Perform a digital vaginal examination to assess cervical dilation
   • B.Prepare for an ultrasound and avoid vaginal examination
   • C.Encourage ambulation to determine whether bleeding increases
   • D.Administer an oxytocin infusion to strengthen contractions

   Answer and rationale are in the full material.

5. 5.A client at 34 weeks has sudden abdominal pain, a rigid tender uterus, and dark vaginal bleeding. Which condition should the nurse suspect?

   • A.Placenta previa
   • B.Placental abruption
   • C.Cervical insufficiency
   • D.Molar pregnancy

   Answer and rationale are in the full material.