Obstetrics (OB) Exam Review Questions and Correct Answers with
Rationales Latest Test Bank / NUR 204 Maternal Newborn (Maternity)
and Pediatric Nursing Real Exam Prep (New!)
Section 1: Antepartum Nursing – First Trimester (Questions 1-30)
1. A patient in her first trimester reports significant nausea and vomiting. Which of the
following interventions should the nurse recommend FIRST?
A. Taking her prenatal vitamin on an empty stomach in the morning.
B. Eating small, frequent meals that are high in carbohydrates and low in fat.
C. Drinking a large glass of water with meals to dilute stomach acid.
D. Lying flat immediately after eating to prevent reflux.
Correct Answer: B. The primary non-pharmacologic intervention for nausea and vomiting of
pregnancy (NVP) is dietary modification, specifically small, frequent meals that are dry, high in
carbohydrates, and low in fat. This helps prevent hypoglycemia and keeps the stomach from
being empty, which reduces the stimulation of the vomiting center. Option A is incorrect
because taking vitamins on an empty stomach often worsens nausea; taking them with food or
at bedtime is preferable. Option C is incorrect as large volumes of fluid with meals distend the
stomach, exacerbating nausea. Option D is incorrect because lying flat after eating promotes
reflux, not prevention.
2. A client at 10 weeks gestation presents with bright red, painless vaginal bleeding. The nurse
suspects a threatened abortion. What is the PRIORITY nursing assessment?
A. Fetal heart rate.
B. Maternal vital signs and signs of shock.
C. Level of fundus.
D. Urine output.
Correct Answer: B. In any case of antepartum bleeding, the immediate priority is maternal
stabilization. While fetal status is important, maternal hemodynamic stability takes precedence.
Assessing vital signs (tachycardia, hypotension) and signs of hypovolemic shock is the first
priority to prevent maternal mortality. A threatened abortion is a diagnosis of exclusion, but the
immediate risk is hemorrhage.
3. A patient's lab work reveals a hematocrit of 33% at her 12-week visit. The nurse
understands that this finding is:
A. Pathologic and indicates severe anemia.
B. A normal finding due to hemodilution of pregnancy.
C. Diagnostic of iron deficiency anemia.
D. An indication for an immediate blood transfusion.
Correct Answer: B. During pregnancy, plasma volume increases by approximately 40-50%, while
red blood cell mass increases by only 20-30%. This results in physiologic anemia of pregnancy,
,characterized by a lower hematocrit (normal ranges are 32-42% in the 2nd and 3rd trimesters).
A hematocrit of 33% at 12 weeks is within the expected range and is not indicative of severe
pathology. Option C is incorrect because iron studies (ferritin, serum iron) are needed to
diagnose iron deficiency. Option D is incorrect as this is a normal lab finding.
4. The nurse is teaching a primigravida about fetal development. At 12 weeks of gestation,
which finding is characteristic of normal fetal development?
A. Lanugo covering the entire body.
B. Fetal heartbeat audible with a Doppler fetoscope.
C. Presence of alveoli in the lungs.
D. Testes descending into the scrotum.
Correct Answer: B. At 10-12 weeks of gestation, the fetal heartbeat can be reliably detected
using a Doppler ultrasound. Lanugo (fine hair) typically appears around 20 weeks, not 12.
Alveoli begin to develop around 24-28 weeks. The testes typically descend near the end of the
pregnancy (36-40 weeks).
5. A patient is prescribed a folic acid supplement of 600 mcg daily. The nurse explains that the
PRIMARY purpose of this supplement is to:
A. Prevent maternal anemia.
B. Prevent neural tube defects.
C. Support fetal bone development.
D. Increase amniotic fluid volume.
Correct Answer: B. Folic acid is crucial for the prevention of neural tube defects (NTDs) such as
spina bifida and anencephaly. It is most critical in the first 28 days of gestation, often before a
woman knows she is pregnant. Option A is incorrect; iron prevents maternal anemia. Option C is
incorrect; calcium and vitamin D support fetal bone development. Option D is incorrect;
amniotic fluid volume is related to fetal urine output and placental function.
6. A nurse is assessing a patient at 14 weeks gestation. Which of the following heart rate
changes is considered a normal adaptation to pregnancy?
A. A decrease in resting heart rate by 5-10 beats per minute.
B. An increase in resting heart rate by 10-20 beats per minute.
C. No change in heart rate until the third trimester.
D. An irregular heart rhythm with frequent PVCs.
Correct Answer: B. Cardiac output increases during pregnancy due to an increase in heart rate
(10-20 bpm) and stroke volume. This begins in the first trimester and peaks in the third
trimester. A decrease in heart rate is not a normal finding. While PVCs can occur, they are not
considered a normal physiologic adaptation and warrant investigation.
7. The nurse is providing education on the signs of preterm labor. Which symptom should the
patient be instructed to report immediately?
A. Mild edema in the lower extremities.
,B. Braxton-Hicks contractions.
C. Menstrual-like cramping or backache.
D. Fetal movement count of 12 kicks in 12 hours.
Correct Answer: C. Preterm labor is defined as regular uterine contractions with cervical change
before 37 weeks. Symptoms can be subtle and include lower backache, pelvic pressure, and
menstrual-like cramping. Patients need to be educated to report these vague symptoms. Edema
is common in pregnancy. Braxton-Hicks are irregular and not associated with cervical change. A
fetal kick count of 10 in 2 hours is considered reassuring; 12 in 12 hours is a good count.
8. A patient at 15 weeks gestation is concerned about weight gain. She has gained 5 pounds
so far. The nurse's BEST response is:
A. "You are gaining too much weight. You should only have gained 2 pounds by now."
B. "Your weight gain is within the expected range for the first trimester."
C. "You are not gaining enough weight. You need to increase your caloric intake."
D. "We need to check for gestational diabetes immediately."
Correct Answer: B. Recommended weight gain in the first trimester is 2-4 pounds total. A gain
of 5 pounds is considered within the acceptable range and is not concerning at 15 weeks. The
rest of the weight gain (approximately 1 lb/week) occurs in the 2nd and 3rd trimesters. Option A
is an overreaction; Option C is incorrect; Option D is only indicated if there are other risk factors
(e.g., obesity, previous GDM).
9. A nurse is reviewing a patient's medication list. Which medication is considered
TERATOGENIC and should be discontinued prior to conception?
A. Folic acid 1 mg daily.
B. Accutane (Isotretinoin).
C. Acetaminophen.
D. Metformin.
Correct Answer: B. Isotretinoin (Accutane) is a Category X medication, known to be a potent
teratogen causing severe birth defects. It must be discontinued at least one month before
attempting conception. Folic acid is protective. Acetaminophen is Category B/C and generally
considered safe. Metformin is Category B and often used in pregnancy for GDM/PCOS.
10. At 8 weeks gestation, a patient reports tenderness in her breasts and frequent urination.
The nurse explains these are signs of pregnancy likely related to:
A. Increased progesterone and pressure on the bladder.
B. Increased estrogen and increased renal blood flow.
C. Increased prolactin and decreased GFR.
D. Increased cortisol and decreased ADH.
Correct Answer: B. Breast tenderness is primarily caused by increased estrogen and
progesterone stimulating glandular tissue. Frequent urination in the first trimester is caused by
the enlarging uterus pressing on the bladder AND increased renal blood flow (GFR) leading to
, increased urine production. Prolactin is responsible for milk production later. Decreased GFR
does not occur in pregnancy.
11. A patient's blood type is O negative. The nurse anticipates administering RhoGAM at
which time?
A. At 12 weeks gestation.
B. At 24 weeks gestation.
C. At 28 weeks gestation.
D. At 36 weeks gestation.
Correct Answer: C. For an Rh-negative unsensitized mother, RhoGAM (Rh immunoglobulin) is
routinely administered at 28 weeks gestation to prevent Rh sensitization. It is also given within
72 hours after delivery if the baby is Rh positive. Option A is too early; it's not typically given
during the first trimester unless there's bleeding. Option B and D are incorrect as 28 weeks is
the standard prophylaxis.
12. The nurse is assessing a patient who is 11 weeks pregnant. She has a history of three
spontaneous abortions (SAB) in the first trimester. The nurse recognizes that the patient is at
risk for:
A. Placenta previa.
B. Incompetent cervix.
C. Pre-eclampsia.
D. Ectopic pregnancy.
Correct Answer: B. A history of recurrent spontaneous abortions (especially in the late first or
early second trimester) is a significant risk factor for incompetent cervix. An incompetent cervix
fails to maintain the pregnancy, leading to painless cervical dilation and recurrent pregnancy
loss. Placenta previa is associated with multiparity and previous C-sections. Pre-eclampsia is
associated with primigravidity and vascular issues.
13. A patient at 13 weeks gestation has a serum HCG level that is higher than expected. The
nurse should suspect:
A. An ectopic pregnancy.
B. A molar pregnancy (Gestational Trophoblastic Disease).
C. A blighted ovum.
D. A normal pregnancy with a later due date.
Correct Answer: B. In gestational trophoblastic disease (molar pregnancy), HCG levels are
excessively high—often much higher than expected for the gestational age. Ectopic pregnancies
often have low or slowly rising HCG levels. A blighted ovum would show lower-than-expected
levels.
14. A nurse is calculating a patient's estimated date of delivery (EDD) using Naegele's rule. Her
last menstrual period (LMP) was January 10th. What is the EDD?
A. September 17th.
Rationales Latest Test Bank / NUR 204 Maternal Newborn (Maternity)
and Pediatric Nursing Real Exam Prep (New!)
Section 1: Antepartum Nursing – First Trimester (Questions 1-30)
1. A patient in her first trimester reports significant nausea and vomiting. Which of the
following interventions should the nurse recommend FIRST?
A. Taking her prenatal vitamin on an empty stomach in the morning.
B. Eating small, frequent meals that are high in carbohydrates and low in fat.
C. Drinking a large glass of water with meals to dilute stomach acid.
D. Lying flat immediately after eating to prevent reflux.
Correct Answer: B. The primary non-pharmacologic intervention for nausea and vomiting of
pregnancy (NVP) is dietary modification, specifically small, frequent meals that are dry, high in
carbohydrates, and low in fat. This helps prevent hypoglycemia and keeps the stomach from
being empty, which reduces the stimulation of the vomiting center. Option A is incorrect
because taking vitamins on an empty stomach often worsens nausea; taking them with food or
at bedtime is preferable. Option C is incorrect as large volumes of fluid with meals distend the
stomach, exacerbating nausea. Option D is incorrect because lying flat after eating promotes
reflux, not prevention.
2. A client at 10 weeks gestation presents with bright red, painless vaginal bleeding. The nurse
suspects a threatened abortion. What is the PRIORITY nursing assessment?
A. Fetal heart rate.
B. Maternal vital signs and signs of shock.
C. Level of fundus.
D. Urine output.
Correct Answer: B. In any case of antepartum bleeding, the immediate priority is maternal
stabilization. While fetal status is important, maternal hemodynamic stability takes precedence.
Assessing vital signs (tachycardia, hypotension) and signs of hypovolemic shock is the first
priority to prevent maternal mortality. A threatened abortion is a diagnosis of exclusion, but the
immediate risk is hemorrhage.
3. A patient's lab work reveals a hematocrit of 33% at her 12-week visit. The nurse
understands that this finding is:
A. Pathologic and indicates severe anemia.
B. A normal finding due to hemodilution of pregnancy.
C. Diagnostic of iron deficiency anemia.
D. An indication for an immediate blood transfusion.
Correct Answer: B. During pregnancy, plasma volume increases by approximately 40-50%, while
red blood cell mass increases by only 20-30%. This results in physiologic anemia of pregnancy,
,characterized by a lower hematocrit (normal ranges are 32-42% in the 2nd and 3rd trimesters).
A hematocrit of 33% at 12 weeks is within the expected range and is not indicative of severe
pathology. Option C is incorrect because iron studies (ferritin, serum iron) are needed to
diagnose iron deficiency. Option D is incorrect as this is a normal lab finding.
4. The nurse is teaching a primigravida about fetal development. At 12 weeks of gestation,
which finding is characteristic of normal fetal development?
A. Lanugo covering the entire body.
B. Fetal heartbeat audible with a Doppler fetoscope.
C. Presence of alveoli in the lungs.
D. Testes descending into the scrotum.
Correct Answer: B. At 10-12 weeks of gestation, the fetal heartbeat can be reliably detected
using a Doppler ultrasound. Lanugo (fine hair) typically appears around 20 weeks, not 12.
Alveoli begin to develop around 24-28 weeks. The testes typically descend near the end of the
pregnancy (36-40 weeks).
5. A patient is prescribed a folic acid supplement of 600 mcg daily. The nurse explains that the
PRIMARY purpose of this supplement is to:
A. Prevent maternal anemia.
B. Prevent neural tube defects.
C. Support fetal bone development.
D. Increase amniotic fluid volume.
Correct Answer: B. Folic acid is crucial for the prevention of neural tube defects (NTDs) such as
spina bifida and anencephaly. It is most critical in the first 28 days of gestation, often before a
woman knows she is pregnant. Option A is incorrect; iron prevents maternal anemia. Option C is
incorrect; calcium and vitamin D support fetal bone development. Option D is incorrect;
amniotic fluid volume is related to fetal urine output and placental function.
6. A nurse is assessing a patient at 14 weeks gestation. Which of the following heart rate
changes is considered a normal adaptation to pregnancy?
A. A decrease in resting heart rate by 5-10 beats per minute.
B. An increase in resting heart rate by 10-20 beats per minute.
C. No change in heart rate until the third trimester.
D. An irregular heart rhythm with frequent PVCs.
Correct Answer: B. Cardiac output increases during pregnancy due to an increase in heart rate
(10-20 bpm) and stroke volume. This begins in the first trimester and peaks in the third
trimester. A decrease in heart rate is not a normal finding. While PVCs can occur, they are not
considered a normal physiologic adaptation and warrant investigation.
7. The nurse is providing education on the signs of preterm labor. Which symptom should the
patient be instructed to report immediately?
A. Mild edema in the lower extremities.
,B. Braxton-Hicks contractions.
C. Menstrual-like cramping or backache.
D. Fetal movement count of 12 kicks in 12 hours.
Correct Answer: C. Preterm labor is defined as regular uterine contractions with cervical change
before 37 weeks. Symptoms can be subtle and include lower backache, pelvic pressure, and
menstrual-like cramping. Patients need to be educated to report these vague symptoms. Edema
is common in pregnancy. Braxton-Hicks are irregular and not associated with cervical change. A
fetal kick count of 10 in 2 hours is considered reassuring; 12 in 12 hours is a good count.
8. A patient at 15 weeks gestation is concerned about weight gain. She has gained 5 pounds
so far. The nurse's BEST response is:
A. "You are gaining too much weight. You should only have gained 2 pounds by now."
B. "Your weight gain is within the expected range for the first trimester."
C. "You are not gaining enough weight. You need to increase your caloric intake."
D. "We need to check for gestational diabetes immediately."
Correct Answer: B. Recommended weight gain in the first trimester is 2-4 pounds total. A gain
of 5 pounds is considered within the acceptable range and is not concerning at 15 weeks. The
rest of the weight gain (approximately 1 lb/week) occurs in the 2nd and 3rd trimesters. Option A
is an overreaction; Option C is incorrect; Option D is only indicated if there are other risk factors
(e.g., obesity, previous GDM).
9. A nurse is reviewing a patient's medication list. Which medication is considered
TERATOGENIC and should be discontinued prior to conception?
A. Folic acid 1 mg daily.
B. Accutane (Isotretinoin).
C. Acetaminophen.
D. Metformin.
Correct Answer: B. Isotretinoin (Accutane) is a Category X medication, known to be a potent
teratogen causing severe birth defects. It must be discontinued at least one month before
attempting conception. Folic acid is protective. Acetaminophen is Category B/C and generally
considered safe. Metformin is Category B and often used in pregnancy for GDM/PCOS.
10. At 8 weeks gestation, a patient reports tenderness in her breasts and frequent urination.
The nurse explains these are signs of pregnancy likely related to:
A. Increased progesterone and pressure on the bladder.
B. Increased estrogen and increased renal blood flow.
C. Increased prolactin and decreased GFR.
D. Increased cortisol and decreased ADH.
Correct Answer: B. Breast tenderness is primarily caused by increased estrogen and
progesterone stimulating glandular tissue. Frequent urination in the first trimester is caused by
the enlarging uterus pressing on the bladder AND increased renal blood flow (GFR) leading to
, increased urine production. Prolactin is responsible for milk production later. Decreased GFR
does not occur in pregnancy.
11. A patient's blood type is O negative. The nurse anticipates administering RhoGAM at
which time?
A. At 12 weeks gestation.
B. At 24 weeks gestation.
C. At 28 weeks gestation.
D. At 36 weeks gestation.
Correct Answer: C. For an Rh-negative unsensitized mother, RhoGAM (Rh immunoglobulin) is
routinely administered at 28 weeks gestation to prevent Rh sensitization. It is also given within
72 hours after delivery if the baby is Rh positive. Option A is too early; it's not typically given
during the first trimester unless there's bleeding. Option B and D are incorrect as 28 weeks is
the standard prophylaxis.
12. The nurse is assessing a patient who is 11 weeks pregnant. She has a history of three
spontaneous abortions (SAB) in the first trimester. The nurse recognizes that the patient is at
risk for:
A. Placenta previa.
B. Incompetent cervix.
C. Pre-eclampsia.
D. Ectopic pregnancy.
Correct Answer: B. A history of recurrent spontaneous abortions (especially in the late first or
early second trimester) is a significant risk factor for incompetent cervix. An incompetent cervix
fails to maintain the pregnancy, leading to painless cervical dilation and recurrent pregnancy
loss. Placenta previa is associated with multiparity and previous C-sections. Pre-eclampsia is
associated with primigravidity and vascular issues.
13. A patient at 13 weeks gestation has a serum HCG level that is higher than expected. The
nurse should suspect:
A. An ectopic pregnancy.
B. A molar pregnancy (Gestational Trophoblastic Disease).
C. A blighted ovum.
D. A normal pregnancy with a later due date.
Correct Answer: B. In gestational trophoblastic disease (molar pregnancy), HCG levels are
excessively high—often much higher than expected for the gestational age. Ectopic pregnancies
often have low or slowly rising HCG levels. A blighted ovum would show lower-than-expected
levels.
14. A nurse is calculating a patient's estimated date of delivery (EDD) using Naegele's rule. Her
last menstrual period (LMP) was January 10th. What is the EDD?
A. September 17th.
