VATI PN Maternal Newborn Exam
Complete Question Bank with Evidence-Based
Rationales Updated Per Latest NGN Guidelines |
Graded A+
ANTEPARTUM CARE (Questions 1-50) — 20%
Q1. A patient with a history of severe preeclampsia at 32 weeks gestation
develops a blood pressure of 180/110 mm Hg and reports a severe headache. The
nurse prepares to administer intravenous labetalol. Which mechanism of action
best explains why labetalol is preferred over hydralazine in this scenario?
A. Labetalol causes direct arterial vasodilation with reflex tachycardia, while
hydralazine may worsen headache.
B. Labetalol blocks both alpha- and beta-adrenergic receptors, reducing blood
pressure without causing reflex tachycardia.
C. Labetalol selectively dilates cerebral vessels, reducing the risk of stroke.
D. Labetalol is a calcium channel blocker that decreases myocardial contractility.
Correct Answer: B
Rationale: Labetalol is a combined alpha- and beta-adrenergic blocker, which
lowers blood pressure by reducing systemic vascular resistance (alpha blockade)
and heart rate (beta blockade), avoiding reflex tachycardia. Hydralazine is a direct
vasodilator that can cause reflex tachycardia and worsen headache, a symptom of
severe preeclampsia.
Why Wrong:
A - Labetalol does not cause reflex tachycardia; it blocks beta receptors,
preventing tachycardia.
C - Labetalol does not selectively dilate cerebral vessels; its effect is systemic.
D - Labetalol is not a calcium channel blocker; it is an adrenergic blocker.
Reference: Cunningham, F. G., et al. (2022). Williams Obstetrics, 26th Ed., Ch. 40;
ACOG Practice Bulletin No. 222.
1|Page
,Q2. During a scheduled cesarean birth under spinal anesthesia, the patient
suddenly becomes hypotensive, nauseated, and reports difficulty breathing. The
heart rate drops from 90 to 50 bpm. Which nursing action should be performed
first?
A. Administer ephedrine 10 mg IV push.
B. Increase the IV fluid rate and place the patient in left lateral tilt.
C. Administer oxygen via non-rebreather mask at 15 L/min.
D. Prepare for endotracheal intubation.
Correct Answer: B
Rationale: The scenario describes supine hypotension syndrome due to aortocaval
compression by the gravid uterus. Increasing IV fluids and left lateral tilt relieves
compression and improves venous return, addressing the cause. Ephedrine may
be given later if hypotension persists, but the first action is to optimize preload.
Why Wrong:
A - Ephedrine is a second-line intervention after positioning and fluids; it does not
address the mechanical obstruction.
C - Oxygen is appropriate but does not treat the underlying hypotension.
D - Intubation is premature; the patient is breathing, and the priority is
hemodynamic support.
Reference: Chestnut, D. H., et al. (2020). Chestnut's Obstetric Anesthesia, 6th Ed.,
Ch. 12.
Q3. A nurse is assessing a newborn who is 24 hours old and notes a respiratory
rate of 65 breaths per minute, intermittent nasal flaring, and mild intercostal
retractions. Oxygen saturation is 92% on room air. Which intervention should the
nurse anticipate?
A. Initiate continuous positive airway pressure (CPAP) at 5 cm H₂O.
B. Begin bag-mask ventilation with 100% oxygen.
C. Administer surfactant via endotracheal tube.
D. Place the newborn in an oxyhood with 30% oxygen.
2|Page
,Correct Answer: D
Rationale: The newborn has mild respiratory distress with borderline oxygen
saturation. Supplemental oxygen via oxyhood at 30% is appropriate for mild
distress. CPAP is indicated for moderate to severe distress, bag-mask ventilation
for apnea or severe hypoxia, and surfactant for respiratory distress syndrome in
preterm infants.
Why Wrong:
A - CPAP is too aggressive for mild distress with saturations of 92%.
B - Bag-mask ventilation is reserved for apnea or severe respiratory failure.
C - Surfactant is indicated for RDS in preterm infants, not for mild distress in a 24-
hour-old newborn.
Reference: AAP/AHA (2021). Neonatal Resuscitation Program, 8th Ed.; Gomella, T.
L. (2020). Neonatology, 8th Ed.
Q4. A client at 8 weeks' gestation with type 1 diabetes mellitus has a hemoglobin
A1c of 9.2%. The PN should recognize that this places the fetus at highest risk for
which complication?
A. Macrosomia
B. Neural tube defects
C. Respiratory distress syndrome
D. Neonatal hypoglycemia
Correct Answer: B
Rationale: Poor glycemic control in the first trimester (HbA1c >8.5%) is strongly
associated with congenital anomalies, particularly neural tube defects and cardiac
defects. Elevated glucose levels during organogenesis (weeks 3-8) disrupt
embryonic development. Macrosomia and neonatal hypoglycemia are risks of
third-trimester hyperglycemia; RDS is associated with prematurity and maternal
diabetes.
Why Wrong:
A - Macrosomia results from fetal hyperinsulinemia in the third trimester.
C - RDS is more common in infants of diabetic mothers due to delayed surfactant
3|Page
, production but is not the highest risk in the first trimester.
D - Neonatal hypoglycemia occurs after birth due to fetal hyperinsulinism.
Reference: ACOG Practice Bulletin No. 201 (2022); American Diabetes Association
(2024).
Q5. A prenatal client at 36 weeks' gestation with preeclampsia is receiving
magnesium sulfate. The PN notes the client's respiratory rate is 10 breaths/min.
What is the priority nursing action?
A. Administer oxygen via face mask at 10 L/min
B. Prepare to administer calcium gluconate IV
C. Decrease the magnesium sulfate infusion rate
D. Notify the provider and prepare for intubation
Correct Answer: B
Rationale: A respiratory rate of 10 breaths/min indicates magnesium toxicity
(normal >12). The priority is to administer the antidote, calcium gluconate 1 g IV
push, to reverse respiratory depression. The infusion should be stopped, oxygen
administered, and the provider notified, but calcium gluconate is the immediate
antidote.
Why Wrong:
A - Oxygen supports breathing but does not reverse the magnesium effect.
C - Decreasing the infusion is necessary but not the priority over administering the
antidote.
D - Intubation may be needed if respiratory arrest occurs, but calcium gluconate
should be given first.
Reference: Cunningham, F. G., et al. (2022). Williams Obstetrics, 26th Ed., Ch. 40;
ACOG Practice Bulletin No. 222.
Q6. The PN is providing preconception counseling to a client with a body mass
index (BMI) of 32 kg/m². Which statement indicates that the client understands
the risks associated with obesity during pregnancy?
4|Page
Complete Question Bank with Evidence-Based
Rationales Updated Per Latest NGN Guidelines |
Graded A+
ANTEPARTUM CARE (Questions 1-50) — 20%
Q1. A patient with a history of severe preeclampsia at 32 weeks gestation
develops a blood pressure of 180/110 mm Hg and reports a severe headache. The
nurse prepares to administer intravenous labetalol. Which mechanism of action
best explains why labetalol is preferred over hydralazine in this scenario?
A. Labetalol causes direct arterial vasodilation with reflex tachycardia, while
hydralazine may worsen headache.
B. Labetalol blocks both alpha- and beta-adrenergic receptors, reducing blood
pressure without causing reflex tachycardia.
C. Labetalol selectively dilates cerebral vessels, reducing the risk of stroke.
D. Labetalol is a calcium channel blocker that decreases myocardial contractility.
Correct Answer: B
Rationale: Labetalol is a combined alpha- and beta-adrenergic blocker, which
lowers blood pressure by reducing systemic vascular resistance (alpha blockade)
and heart rate (beta blockade), avoiding reflex tachycardia. Hydralazine is a direct
vasodilator that can cause reflex tachycardia and worsen headache, a symptom of
severe preeclampsia.
Why Wrong:
A - Labetalol does not cause reflex tachycardia; it blocks beta receptors,
preventing tachycardia.
C - Labetalol does not selectively dilate cerebral vessels; its effect is systemic.
D - Labetalol is not a calcium channel blocker; it is an adrenergic blocker.
Reference: Cunningham, F. G., et al. (2022). Williams Obstetrics, 26th Ed., Ch. 40;
ACOG Practice Bulletin No. 222.
1|Page
,Q2. During a scheduled cesarean birth under spinal anesthesia, the patient
suddenly becomes hypotensive, nauseated, and reports difficulty breathing. The
heart rate drops from 90 to 50 bpm. Which nursing action should be performed
first?
A. Administer ephedrine 10 mg IV push.
B. Increase the IV fluid rate and place the patient in left lateral tilt.
C. Administer oxygen via non-rebreather mask at 15 L/min.
D. Prepare for endotracheal intubation.
Correct Answer: B
Rationale: The scenario describes supine hypotension syndrome due to aortocaval
compression by the gravid uterus. Increasing IV fluids and left lateral tilt relieves
compression and improves venous return, addressing the cause. Ephedrine may
be given later if hypotension persists, but the first action is to optimize preload.
Why Wrong:
A - Ephedrine is a second-line intervention after positioning and fluids; it does not
address the mechanical obstruction.
C - Oxygen is appropriate but does not treat the underlying hypotension.
D - Intubation is premature; the patient is breathing, and the priority is
hemodynamic support.
Reference: Chestnut, D. H., et al. (2020). Chestnut's Obstetric Anesthesia, 6th Ed.,
Ch. 12.
Q3. A nurse is assessing a newborn who is 24 hours old and notes a respiratory
rate of 65 breaths per minute, intermittent nasal flaring, and mild intercostal
retractions. Oxygen saturation is 92% on room air. Which intervention should the
nurse anticipate?
A. Initiate continuous positive airway pressure (CPAP) at 5 cm H₂O.
B. Begin bag-mask ventilation with 100% oxygen.
C. Administer surfactant via endotracheal tube.
D. Place the newborn in an oxyhood with 30% oxygen.
2|Page
,Correct Answer: D
Rationale: The newborn has mild respiratory distress with borderline oxygen
saturation. Supplemental oxygen via oxyhood at 30% is appropriate for mild
distress. CPAP is indicated for moderate to severe distress, bag-mask ventilation
for apnea or severe hypoxia, and surfactant for respiratory distress syndrome in
preterm infants.
Why Wrong:
A - CPAP is too aggressive for mild distress with saturations of 92%.
B - Bag-mask ventilation is reserved for apnea or severe respiratory failure.
C - Surfactant is indicated for RDS in preterm infants, not for mild distress in a 24-
hour-old newborn.
Reference: AAP/AHA (2021). Neonatal Resuscitation Program, 8th Ed.; Gomella, T.
L. (2020). Neonatology, 8th Ed.
Q4. A client at 8 weeks' gestation with type 1 diabetes mellitus has a hemoglobin
A1c of 9.2%. The PN should recognize that this places the fetus at highest risk for
which complication?
A. Macrosomia
B. Neural tube defects
C. Respiratory distress syndrome
D. Neonatal hypoglycemia
Correct Answer: B
Rationale: Poor glycemic control in the first trimester (HbA1c >8.5%) is strongly
associated with congenital anomalies, particularly neural tube defects and cardiac
defects. Elevated glucose levels during organogenesis (weeks 3-8) disrupt
embryonic development. Macrosomia and neonatal hypoglycemia are risks of
third-trimester hyperglycemia; RDS is associated with prematurity and maternal
diabetes.
Why Wrong:
A - Macrosomia results from fetal hyperinsulinemia in the third trimester.
C - RDS is more common in infants of diabetic mothers due to delayed surfactant
3|Page
, production but is not the highest risk in the first trimester.
D - Neonatal hypoglycemia occurs after birth due to fetal hyperinsulinism.
Reference: ACOG Practice Bulletin No. 201 (2022); American Diabetes Association
(2024).
Q5. A prenatal client at 36 weeks' gestation with preeclampsia is receiving
magnesium sulfate. The PN notes the client's respiratory rate is 10 breaths/min.
What is the priority nursing action?
A. Administer oxygen via face mask at 10 L/min
B. Prepare to administer calcium gluconate IV
C. Decrease the magnesium sulfate infusion rate
D. Notify the provider and prepare for intubation
Correct Answer: B
Rationale: A respiratory rate of 10 breaths/min indicates magnesium toxicity
(normal >12). The priority is to administer the antidote, calcium gluconate 1 g IV
push, to reverse respiratory depression. The infusion should be stopped, oxygen
administered, and the provider notified, but calcium gluconate is the immediate
antidote.
Why Wrong:
A - Oxygen supports breathing but does not reverse the magnesium effect.
C - Decreasing the infusion is necessary but not the priority over administering the
antidote.
D - Intubation may be needed if respiratory arrest occurs, but calcium gluconate
should be given first.
Reference: Cunningham, F. G., et al. (2022). Williams Obstetrics, 26th Ed., Ch. 40;
ACOG Practice Bulletin No. 222.
Q6. The PN is providing preconception counseling to a client with a body mass
index (BMI) of 32 kg/m². Which statement indicates that the client understands
the risks associated with obesity during pregnancy?
4|Page
