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Womens Health N582 Comprehensive Practice
Questions Section 1: Obstetric and Pregnancy-
Related Conditions
1. A 28-year-old patient at 32 weeks gestation presents with new-onset
hypertension (148/96 mmHg), proteinuria (1+ on dipstick), and mild epigastric
pain. Which condition should the nurse prioritize in the differential diagnosis?
A. Gestational hypertension
B. Preeclampsia
C. Chronic hypertension
D. Normal pregnancy variation
Answer: B. Preeclampsia.
Rationale: Preeclampsia is defined as new-onset hypertension (≥140/90 mmHg)
after 20 weeks gestation PLUS proteinuria OR signs of end-organ dysfunction
(e.g., epigastric pain, thrombocytopenia, elevated liver enzymes). This patient
meets criteria with hypertension, proteinuria, and epigastric pain (suggesting
hepatic involvement). Gestational hypertension lacks proteinuria or systemic
features. Epigastric pain in pregnancy is never a "normal variation" and warrants
urgent evaluation per ACOG guidelines .
2. Which finding in a pregnant patient at 24 weeks gestation requires immediate
notification of the provider?
A. Mild ankle edema
B. Fetal heart rate of 140 bpm
C. Vaginal bleeding with abdominal pain
D. Braxton Hicks contractions
Answer: C. Vaginal bleeding with abdominal pain.
Rationale: Vaginal bleeding with abdominal pain in the second trimester may
indicate placental abruption, placenta previa, or preterm labor—all requiring
,2
urgent evaluation. Mild edema (A), normal fetal heart rate (B), and Braxton Hicks
(D) are common, benign findings in pregnancy .
3. Which assessment finding suggests placental abruption in a pregnant patient?
A. Painless vaginal bleeding
B. Uterine tenderness with dark red vaginal bleeding
C. Decreased fetal movement only
D. Mild cramping without bleeding
Answer: B. Uterine tenderness with dark red vaginal bleeding.
Rationale: Placental abruption classically presents with painful vaginal bleeding
(often dark red), uterine tenderness, and possible fetal distress. Painless bleeding
(A) suggests placenta previa. While decreased fetal movement (C) warrants
evaluation, it is not specific to abruption .
4. A pregnant patient at 38 weeks gestation presents with bright red, painless
vaginal bleeding. Which condition should the nurse suspect?
A. Placental abruption
B. Placenta previa
C. Uterine rupture
D. Preterm labor
Answer: B. Placenta previa.
Rationale: Placenta previa (placenta covering the cervical os) classically presents
with painless, bright red vaginal bleeding in the third trimester. Abruption (A)
presents with painful bleeding. Uterine rupture (C) presents with acute abdominal
pain and fetal distress. Preterm labor (D) presents with contractions and cervical
change .
5. Which intervention is most effective for preventing neural tube defects in
pregnancy?
A. Iron supplementation
B. Folic acid 400-800 mcg daily before conception and in early pregnancy
,3
C. Calcium supplementation
D. Vitamin D supplementation
Answer: B. Folic acid 400-800 mcg daily before conception and in early
pregnancy.
Rationale: Periconceptional folic acid supplementation (400-800 mcg daily)
reduces the risk of neural tube defects by up to 70%. CDC and ACOG recommend
all patients capable of pregnancy take folic acid daily, as neural tube closure
occurs by day 28 post-conception—often before pregnancy is recognized .
6. A patient at 16 weeks gestation reports new-onset headache, visual changes,
and epigastric pain. Blood pressure is 158/102 mmHg. What is the priority
nursing action?
A. Administer acetaminophen for headache
B. Reassure the patient these are common pregnancy symptoms
C. Notify the provider immediately and prepare for further evaluation
D. Schedule a follow-up appointment in 1 week
Answer: C. Notify the provider immediately and prepare for further evaluation.
Rationale: This presentation suggests preeclampsia with severe features
(significant hypertension + symptoms). Severe headache, visual changes, and
epigastric pain are signs of end-organ involvement requiring immediate
evaluation and likely hospitalization. Delaying care (A, B, D) could lead to
eclampsia or other maternal/fetal complications .
7. What is the diagnostic criteria for preeclampsia?
A. Hypertension before 20 weeks gestation
B. New-onset hypertension after 20 weeks with proteinuria or end-organ
dysfunction
C. Isolated gestational hypertension
D. Chronic hypertension with superimposed proteinuria
Answer: B. New-onset hypertension after 20 weeks with proteinuria or end-
organ dysfunction.
Rationale: Preeclampsia requires new-onset hypertension (≥140/90) after 20
, 4
weeks AND either proteinuria (≥300 mg/24h or protein/creatinine ratio ≥0.3) OR
evidence of end-organ dysfunction (thrombocytopenia, elevated liver enzymes,
renal insufficiency, pulmonary edema, cerebral/visual symptoms). Hypertension
before 20 weeks (A) suggests chronic hypertension .
8. Which finding is a contraindication to trial of labor after cesarean (TOLAC)?
A. One prior low-transverse cesarean incision
B. Prior classical uterine incision
C. Maternal request for VBAC
D. Interpregnancy interval of 18 months
Answer: B. Prior classical uterine incision.
Rationale: A prior classical (vertical) uterine incision is an absolute
contraindication to TOLAC due to high risk of uterine rupture. One prior low-
transverse incision (A) is generally eligible for TOLAC. Maternal request (C) and
adequate interpregnancy interval (D) support VBAC consideration .
9. A patient in active labor has a history of one prior low-transverse cesarean
section. Which assessment finding would most concern the nurse for uterine
rupture?
A. Moderate bloody show
B. Contractions every 3 minutes
C. Sudden onset of sharp abdominal pain with fetal bradycardia
D. Cervical dilation progressing from 4 to 7 cm in 2 hours
Answer: C. Sudden onset of sharp abdominal pain with fetal bradycardia.
Rationale: Uterine rupture presents with sudden, sharp abdominal pain (often
described as "tearing"), fetal heart rate decelerations (especially bradycardia),
loss of station, and possible maternal hypovolemia. These findings require
immediate surgical intervention. Normal labor progress (D) and contractions (B)
are expected. Bloody show (A) is normal in labor.
Womens Health N582 Comprehensive Practice
Questions Section 1: Obstetric and Pregnancy-
Related Conditions
1. A 28-year-old patient at 32 weeks gestation presents with new-onset
hypertension (148/96 mmHg), proteinuria (1+ on dipstick), and mild epigastric
pain. Which condition should the nurse prioritize in the differential diagnosis?
A. Gestational hypertension
B. Preeclampsia
C. Chronic hypertension
D. Normal pregnancy variation
Answer: B. Preeclampsia.
Rationale: Preeclampsia is defined as new-onset hypertension (≥140/90 mmHg)
after 20 weeks gestation PLUS proteinuria OR signs of end-organ dysfunction
(e.g., epigastric pain, thrombocytopenia, elevated liver enzymes). This patient
meets criteria with hypertension, proteinuria, and epigastric pain (suggesting
hepatic involvement). Gestational hypertension lacks proteinuria or systemic
features. Epigastric pain in pregnancy is never a "normal variation" and warrants
urgent evaluation per ACOG guidelines .
2. Which finding in a pregnant patient at 24 weeks gestation requires immediate
notification of the provider?
A. Mild ankle edema
B. Fetal heart rate of 140 bpm
C. Vaginal bleeding with abdominal pain
D. Braxton Hicks contractions
Answer: C. Vaginal bleeding with abdominal pain.
Rationale: Vaginal bleeding with abdominal pain in the second trimester may
indicate placental abruption, placenta previa, or preterm labor—all requiring
,2
urgent evaluation. Mild edema (A), normal fetal heart rate (B), and Braxton Hicks
(D) are common, benign findings in pregnancy .
3. Which assessment finding suggests placental abruption in a pregnant patient?
A. Painless vaginal bleeding
B. Uterine tenderness with dark red vaginal bleeding
C. Decreased fetal movement only
D. Mild cramping without bleeding
Answer: B. Uterine tenderness with dark red vaginal bleeding.
Rationale: Placental abruption classically presents with painful vaginal bleeding
(often dark red), uterine tenderness, and possible fetal distress. Painless bleeding
(A) suggests placenta previa. While decreased fetal movement (C) warrants
evaluation, it is not specific to abruption .
4. A pregnant patient at 38 weeks gestation presents with bright red, painless
vaginal bleeding. Which condition should the nurse suspect?
A. Placental abruption
B. Placenta previa
C. Uterine rupture
D. Preterm labor
Answer: B. Placenta previa.
Rationale: Placenta previa (placenta covering the cervical os) classically presents
with painless, bright red vaginal bleeding in the third trimester. Abruption (A)
presents with painful bleeding. Uterine rupture (C) presents with acute abdominal
pain and fetal distress. Preterm labor (D) presents with contractions and cervical
change .
5. Which intervention is most effective for preventing neural tube defects in
pregnancy?
A. Iron supplementation
B. Folic acid 400-800 mcg daily before conception and in early pregnancy
,3
C. Calcium supplementation
D. Vitamin D supplementation
Answer: B. Folic acid 400-800 mcg daily before conception and in early
pregnancy.
Rationale: Periconceptional folic acid supplementation (400-800 mcg daily)
reduces the risk of neural tube defects by up to 70%. CDC and ACOG recommend
all patients capable of pregnancy take folic acid daily, as neural tube closure
occurs by day 28 post-conception—often before pregnancy is recognized .
6. A patient at 16 weeks gestation reports new-onset headache, visual changes,
and epigastric pain. Blood pressure is 158/102 mmHg. What is the priority
nursing action?
A. Administer acetaminophen for headache
B. Reassure the patient these are common pregnancy symptoms
C. Notify the provider immediately and prepare for further evaluation
D. Schedule a follow-up appointment in 1 week
Answer: C. Notify the provider immediately and prepare for further evaluation.
Rationale: This presentation suggests preeclampsia with severe features
(significant hypertension + symptoms). Severe headache, visual changes, and
epigastric pain are signs of end-organ involvement requiring immediate
evaluation and likely hospitalization. Delaying care (A, B, D) could lead to
eclampsia or other maternal/fetal complications .
7. What is the diagnostic criteria for preeclampsia?
A. Hypertension before 20 weeks gestation
B. New-onset hypertension after 20 weeks with proteinuria or end-organ
dysfunction
C. Isolated gestational hypertension
D. Chronic hypertension with superimposed proteinuria
Answer: B. New-onset hypertension after 20 weeks with proteinuria or end-
organ dysfunction.
Rationale: Preeclampsia requires new-onset hypertension (≥140/90) after 20
, 4
weeks AND either proteinuria (≥300 mg/24h or protein/creatinine ratio ≥0.3) OR
evidence of end-organ dysfunction (thrombocytopenia, elevated liver enzymes,
renal insufficiency, pulmonary edema, cerebral/visual symptoms). Hypertension
before 20 weeks (A) suggests chronic hypertension .
8. Which finding is a contraindication to trial of labor after cesarean (TOLAC)?
A. One prior low-transverse cesarean incision
B. Prior classical uterine incision
C. Maternal request for VBAC
D. Interpregnancy interval of 18 months
Answer: B. Prior classical uterine incision.
Rationale: A prior classical (vertical) uterine incision is an absolute
contraindication to TOLAC due to high risk of uterine rupture. One prior low-
transverse incision (A) is generally eligible for TOLAC. Maternal request (C) and
adequate interpregnancy interval (D) support VBAC consideration .
9. A patient in active labor has a history of one prior low-transverse cesarean
section. Which assessment finding would most concern the nurse for uterine
rupture?
A. Moderate bloody show
B. Contractions every 3 minutes
C. Sudden onset of sharp abdominal pain with fetal bradycardia
D. Cervical dilation progressing from 4 to 7 cm in 2 hours
Answer: C. Sudden onset of sharp abdominal pain with fetal bradycardia.
Rationale: Uterine rupture presents with sudden, sharp abdominal pain (often
described as "tearing"), fetal heart rate decelerations (especially bradycardia),
loss of station, and possible maternal hypovolemia. These findings require
immediate surgical intervention. Normal labor progress (D) and contractions (B)
are expected. Bloody show (A) is normal in labor.
