Nursing Maternity Notes PDF | Complete Maternal and Newborn Care
Study Guide | Obstetric Nursing Exam Revision Bundle | Antenatal,
Intrapartum, Postnatal & Neonatal Care | Labor and Delivery
Management | Midwifery Comprehensive Notes for Diploma & Degree
Students
QUESTION 1: WHICH OF THE FOLLOWING BEST DESCRIBES THE PRIMARY
PHYSIOLOGIC RATIONALE: E FOR ADMINISTERING OXYTOCIN DURING THE
THIRD STAGE OF LABOR?
A. To induce uterine relaxation and reduce maternal pain.
B. To stimulate uterine contractions that promote placental separation and reduce postpartum
hemorrhage.
C. To prevent infection by increasing uterine blood flow.
D. To increase fetal oxygenation by improving placental perfusion.
✔ CORRECT ANSWER: B. To stimulate uterine contractions that promote placental
separation and reduce postpartum hemorrhage.
RATIONALE: E:
Oxytocin is given in the third stage to cause effective uterine contractions, which help shear the
placenta from the uterine wall and compress uterine blood vessels to reduce blood loss. Option A
is incorrect because oxytocin does not relax the uterus nor primarily reduce pain. Option C is
incorrect: while blood flow is affected, oxytocin’s primary role is mechanical contraction and not
infection prevention. Option D is incorrect because oxytocin’s immediate purpose is uterine
contraction postpartum, not improving fetal oxygenation.
QUESTION 2: IN A TERM PREGNANT WOMAN PRESENTING WITH SUDDEN
ONSET OF SEVERE HYPERTENSION, PROTEINURIA, AND NEW-ONSET
HEADACHE AT 36 WEEKS, WHICH DIAGNOSIS IS MOST LIKELY AND WHICH
COMPLICATIONS MUST BE MOST PROMPTLY ADDRESSED?
A. Gestational hypertension; manage with lifestyle changes only.
B. Preeclampsia with severe features; address risk of eclampsia, placental abruption, and fetal
compromise.
C. Chronic hypertension; adjust antihypertensive medication and continue pregnancy to term.
D. HELLP syndrome; immediate administration of tocolytics.
✔ CORRECT ANSWER: B. Preeclampsia with severe features; address risk of eclampsia,
placental abruption, and fetal compromise.
RATIONALE: E:
New-onset hypertension after 20 weeks with proteinuria and severe headache indicates
preeclampsia with severe features. Immediate concerns include progression to eclampsia
,(seizures), placental abruption, maternal end-organ damage, and fetal compromise; therefore
urgent evaluation and management are required. Option A is incorrect because the picture is
more severe than gestational hypertension and lifestyle changes are insufficient. Option C is
incorrect because chronic hypertension would be present before 20 weeks or known earlier.
Option D is incorrect: HELLP (hemolysis, elevated liver enzymes, low platelets) is a variant and
not diagnosed by the features given; tocolytics are not indicated for HELLP.
QUESTION 3: WHICH INTERVENTION IS MOST APPROPRIATE FOR A
NEWBORN WITH SUSPECTED TRANSIENT TACHYPNEA OF THE NEWBORN
(TTN)?
A. Immediate intubation and surfactant administration.
B. Supportive care with oxygen supplementation, thermoregulation, and monitoring; expect
improvement in 24–72 hours.
C. Aggressive diuretic therapy to remove excess lung fluid.
D. Early broad-spectrum antibiotics for presumed infection.
✔ CORRECT ANSWER: B. Supportive care with oxygen supplementation, thermoregulation,
and monitoring; expect improvement in 24–72 hours.
RATIONALE: E:
TTN is due to delayed clearance of fetal lung fluid, typically self-limited. Supportive care
(oxygen, neutral thermal environment, monitoring) is usually sufficient, with symptoms
improving over 24–72 hours. Option A is excessive: intubation and surfactant are indicated for
RDS or severe respiratory failure, not routine TTN. Option C is incorrect because diuretics are
not indicated for TTN. Option D is incorrect unless there are signs of infection; routine
antibiotics are not required for isolated TTN.
QUESTION 4: A POSTPARTUM PATIENT 6 HOURS AFTER VAGINAL DELIVERY
HAS UTERINE FUNDUS PALPATED 3 FINGER- BREATHS ABOVE THE
UMBILICUS, SOFT AND BOGGY, WITH HEAVY LOCHIAL BLEEDING. WHAT IS
THE MOST APPROPRIATE INITIAL MANAGEMENT STEP?
A. Immediate laparotomy.
B. Uterine massage and assessment for retained tissue or uterine atony; administer uterotonics as
indicated.
C. Start broad-spectrum antibiotics for endometritis.
D. Observe and repeat exam in 6 hours.
✔ CORRECT ANSWER: B. Uterine massage and assessment for retained tissue or uterine
atony; administer uterotonics as indicated.
, RATIONALE: E:
A boggy, enlarged fundus with heavy bleeding suggests uterine atony—the most common cause
of early postpartum hemorrhage. Immediate uterine massage is the first-line action, followed by
uterotonic agents (oxytocin, methylergonovine, carboprost) and evaluation for retained placenta.
Option A (immediate laparotomy) is only for uncontrolled hemorrhage after conservative
measures. Option C (antibiotics) is for infection, typically later and with fever/lochia changes.
Option D (observation) is inappropriate given active heavy bleeding.
QUESTION 5: WHICH FACTOR MOST STRONGLY PREDICTS THE NEED FOR
NEONATAL THERAPEUTIC HYPOTHERMIA AFTER HYPOTONIC BIRTH
ASPHYXIA?
A. Apgar score of 9 at 5 minutes.
B. Metabolic acidosis at birth with arterial pH < 7.0 and base deficit ≥ 12 mmol/L plus moderate-
to-severe encephalopathy.
C. Transient bradycardia for 1 minute resolving spontaneously.
D. Low birth weight with no neurologic signs.
✔ CORRECT ANSWER: B. Metabolic acidosis at birth with arterial pH < 7.0 and base deficit
≥ 12 mmol/L plus moderate-to-severe encephalopathy.
RATIONALE: E:
Eligibility for therapeutic hypothermia typically requires evidence of perinatal asphyxia such as
severe metabolic acidosis (pH < 7.0, base deficit ≥ 12) and signs of moderate-to-severe hypoxic–
ischemic encephalopathy. Option A is incorrect because an Apgar of 9 implies good transition.
Option C is an isolated transient event and not an indication for hypothermia. Option D (low
birth weight without neurologic signs) is not an indication.
QUESTION 6: WHEN COUNSELING A PREGNANT WOMAN WITH PREVIOUS
CLASSICAL (VERTICAL) UTERINE INCISION REGARDING MODE OF DELIVERY
FOR HER CURRENT PREGNANCY, WHICH CONSIDERATION IS MOST
CRITICAL?
A. Vaginal birth after classical cesarean (VBAC) is routinely encouraged and safe.
B. Elective repeat cesarean delivery is generally recommended due to increased risk of uterine
rupture with labor.
C. Trial of labor is preferred to minimize surgical scarring, regardless of incision type.
D. Timing of delivery is irrelevant in classical incision cases.
✔ CORRECT ANSWER: B. Elective repeat cesarean delivery is generally recommended due
to increased risk of uterine rupture with labor.
Study Guide | Obstetric Nursing Exam Revision Bundle | Antenatal,
Intrapartum, Postnatal & Neonatal Care | Labor and Delivery
Management | Midwifery Comprehensive Notes for Diploma & Degree
Students
QUESTION 1: WHICH OF THE FOLLOWING BEST DESCRIBES THE PRIMARY
PHYSIOLOGIC RATIONALE: E FOR ADMINISTERING OXYTOCIN DURING THE
THIRD STAGE OF LABOR?
A. To induce uterine relaxation and reduce maternal pain.
B. To stimulate uterine contractions that promote placental separation and reduce postpartum
hemorrhage.
C. To prevent infection by increasing uterine blood flow.
D. To increase fetal oxygenation by improving placental perfusion.
✔ CORRECT ANSWER: B. To stimulate uterine contractions that promote placental
separation and reduce postpartum hemorrhage.
RATIONALE: E:
Oxytocin is given in the third stage to cause effective uterine contractions, which help shear the
placenta from the uterine wall and compress uterine blood vessels to reduce blood loss. Option A
is incorrect because oxytocin does not relax the uterus nor primarily reduce pain. Option C is
incorrect: while blood flow is affected, oxytocin’s primary role is mechanical contraction and not
infection prevention. Option D is incorrect because oxytocin’s immediate purpose is uterine
contraction postpartum, not improving fetal oxygenation.
QUESTION 2: IN A TERM PREGNANT WOMAN PRESENTING WITH SUDDEN
ONSET OF SEVERE HYPERTENSION, PROTEINURIA, AND NEW-ONSET
HEADACHE AT 36 WEEKS, WHICH DIAGNOSIS IS MOST LIKELY AND WHICH
COMPLICATIONS MUST BE MOST PROMPTLY ADDRESSED?
A. Gestational hypertension; manage with lifestyle changes only.
B. Preeclampsia with severe features; address risk of eclampsia, placental abruption, and fetal
compromise.
C. Chronic hypertension; adjust antihypertensive medication and continue pregnancy to term.
D. HELLP syndrome; immediate administration of tocolytics.
✔ CORRECT ANSWER: B. Preeclampsia with severe features; address risk of eclampsia,
placental abruption, and fetal compromise.
RATIONALE: E:
New-onset hypertension after 20 weeks with proteinuria and severe headache indicates
preeclampsia with severe features. Immediate concerns include progression to eclampsia
,(seizures), placental abruption, maternal end-organ damage, and fetal compromise; therefore
urgent evaluation and management are required. Option A is incorrect because the picture is
more severe than gestational hypertension and lifestyle changes are insufficient. Option C is
incorrect because chronic hypertension would be present before 20 weeks or known earlier.
Option D is incorrect: HELLP (hemolysis, elevated liver enzymes, low platelets) is a variant and
not diagnosed by the features given; tocolytics are not indicated for HELLP.
QUESTION 3: WHICH INTERVENTION IS MOST APPROPRIATE FOR A
NEWBORN WITH SUSPECTED TRANSIENT TACHYPNEA OF THE NEWBORN
(TTN)?
A. Immediate intubation and surfactant administration.
B. Supportive care with oxygen supplementation, thermoregulation, and monitoring; expect
improvement in 24–72 hours.
C. Aggressive diuretic therapy to remove excess lung fluid.
D. Early broad-spectrum antibiotics for presumed infection.
✔ CORRECT ANSWER: B. Supportive care with oxygen supplementation, thermoregulation,
and monitoring; expect improvement in 24–72 hours.
RATIONALE: E:
TTN is due to delayed clearance of fetal lung fluid, typically self-limited. Supportive care
(oxygen, neutral thermal environment, monitoring) is usually sufficient, with symptoms
improving over 24–72 hours. Option A is excessive: intubation and surfactant are indicated for
RDS or severe respiratory failure, not routine TTN. Option C is incorrect because diuretics are
not indicated for TTN. Option D is incorrect unless there are signs of infection; routine
antibiotics are not required for isolated TTN.
QUESTION 4: A POSTPARTUM PATIENT 6 HOURS AFTER VAGINAL DELIVERY
HAS UTERINE FUNDUS PALPATED 3 FINGER- BREATHS ABOVE THE
UMBILICUS, SOFT AND BOGGY, WITH HEAVY LOCHIAL BLEEDING. WHAT IS
THE MOST APPROPRIATE INITIAL MANAGEMENT STEP?
A. Immediate laparotomy.
B. Uterine massage and assessment for retained tissue or uterine atony; administer uterotonics as
indicated.
C. Start broad-spectrum antibiotics for endometritis.
D. Observe and repeat exam in 6 hours.
✔ CORRECT ANSWER: B. Uterine massage and assessment for retained tissue or uterine
atony; administer uterotonics as indicated.
, RATIONALE: E:
A boggy, enlarged fundus with heavy bleeding suggests uterine atony—the most common cause
of early postpartum hemorrhage. Immediate uterine massage is the first-line action, followed by
uterotonic agents (oxytocin, methylergonovine, carboprost) and evaluation for retained placenta.
Option A (immediate laparotomy) is only for uncontrolled hemorrhage after conservative
measures. Option C (antibiotics) is for infection, typically later and with fever/lochia changes.
Option D (observation) is inappropriate given active heavy bleeding.
QUESTION 5: WHICH FACTOR MOST STRONGLY PREDICTS THE NEED FOR
NEONATAL THERAPEUTIC HYPOTHERMIA AFTER HYPOTONIC BIRTH
ASPHYXIA?
A. Apgar score of 9 at 5 minutes.
B. Metabolic acidosis at birth with arterial pH < 7.0 and base deficit ≥ 12 mmol/L plus moderate-
to-severe encephalopathy.
C. Transient bradycardia for 1 minute resolving spontaneously.
D. Low birth weight with no neurologic signs.
✔ CORRECT ANSWER: B. Metabolic acidosis at birth with arterial pH < 7.0 and base deficit
≥ 12 mmol/L plus moderate-to-severe encephalopathy.
RATIONALE: E:
Eligibility for therapeutic hypothermia typically requires evidence of perinatal asphyxia such as
severe metabolic acidosis (pH < 7.0, base deficit ≥ 12) and signs of moderate-to-severe hypoxic–
ischemic encephalopathy. Option A is incorrect because an Apgar of 9 implies good transition.
Option C is an isolated transient event and not an indication for hypothermia. Option D (low
birth weight without neurologic signs) is not an indication.
QUESTION 6: WHEN COUNSELING A PREGNANT WOMAN WITH PREVIOUS
CLASSICAL (VERTICAL) UTERINE INCISION REGARDING MODE OF DELIVERY
FOR HER CURRENT PREGNANCY, WHICH CONSIDERATION IS MOST
CRITICAL?
A. Vaginal birth after classical cesarean (VBAC) is routinely encouraged and safe.
B. Elective repeat cesarean delivery is generally recommended due to increased risk of uterine
rupture with labor.
C. Trial of labor is preferred to minimize surgical scarring, regardless of incision type.
D. Timing of delivery is irrelevant in classical incision cases.
✔ CORRECT ANSWER: B. Elective repeat cesarean delivery is generally recommended due
to increased risk of uterine rupture with labor.
