CEA MATERNAL-NEWBORN NURSING EXAM with Questions
and Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE
1. Antepartum Care, High-Risk Fetal Assessment, and Maternal Pathophysiology
2. Intrapartum Management, Labor Complications, and Obstetric Emergencies
3. Postpartum Adaptations, Neonatal Critical Care, and Newborn Physiology
1. A 32-year-old primigravida at 34 weeks of gestation presents to the labor and delivery triage unit
complaining of persistent headache, visual blurring, and right upper quadrant abdominal pain.
Blood pressure is 160/110 mmHg, and urine dipstick reveals 3+ protein. Laboratory findings
show platelets of 85,000/mm3 and elevated AST and ALT. What is the priority nursing
intervention?
A. Administer sublingual nifedipine immediately and discharge for weekly follow-up
B. Initiate intravenous magnesium sulfate infusion per protocol and prepare for immediate
delivery evaluation
C. Administer broad-spectrum intravenous antibiotics for suspected cholecystitis
D. Encourage ambulation and high-fluid intake to reduce blood pressure
CORRECT ANSWER : B
Rationale: The client exhibits classic signs of severe preeclampsia complicated by HELLP
syndrome (Hemolysis, Elevated Liver enzymes, Low Platelet count). Magnesium sulfate is the
first-line medication to prevent eclamptic seizures, and definitive management requires delivery
given the gestational age and severity of multi-organ involvement.
2. A 28-year-old G2P1 at 28 weeks gestation is admitted for vaginal bleeding. She describes
painless, bright red bleeding that began suddenly after a routine pelvic exam. Ultrasound
confirms complete placenta previa. Which nursing action is strictly contraindicated?
A. Monitoring continuous electronic fetal heart rate and uterine activity
B. Performing a digital cervical examination to assess dilation and effacement
, C. Inserting an intravenous line with a large-bore catheter
D. Typing and crossing blood for potential transfusion
CORRECT ANSWER : B
Rationale: In complete placenta previa, the placenta covers the internal cervical os. Digital
cervical examinations can disrupt placental blood vessels and trigger catastrophic, life-
threatening maternal and fetal hemorrhage. Ultrasound must always precede any digital vaginal
examination when bleeding occurs late in pregnancy.
3. A client at 38 weeks gestation with a history of a prior low-transverse cesarean section is
undergoing a trial of labor after cesarean (TOLAC). During the active phase of labor, the fetal
heart rate monitor shows sudden recurrent late decelerations, followed by loss of fetal station and
maternal hypotension. What is the immediate nursing action?
A. Administer oxytocin augmentation to speed up delivery
B. Prepare for immediate emergency laparotomy and cesarean delivery
C. Perform artificial rupture of membranes to assess amniotic fluid
D. Place the client in a prone position to relieve cord compression
CORRECT ANSWER : B
Rationale: The clinical triad of sudden fetal distress, loss of fetal station, and maternal
hypovolemic signs during TOLAC strongly indicates uterine rupture. This is an obstetric
emergency requiring immediate emergency cesarean delivery to prevent maternal and fetal
morbidity or mortality.
4. A 30-year-old multigravida is in the active stage of labor receiving oxytocin augmentation. The
nurse notes uterine tachysystole accompanied by fetal bradycardia and persistent late
decelerations. What is the priority sequence of nursing actions?
A. Increase oxytocin infusion rate, apply oxygen, and notify the physician
B. Discontinue oxytocin infusion immediately, reposition the client to the lateral position,
administer oxygen via non-rebreather mask, and notify the provider
C. Perform a sterile vaginal exam and encourage maternal pushing efforts
D. Prepare for immediate vacuum-assisted vaginal delivery without stopping oxytocin
CORRECT ANSWER : B
, Rationale: Uterine tachysystole caused by oxytocin reduces uteroplacental perfusion,
precipitating fetal hypoxia. The immediate actions are stopping the uterine stimulant,
maximizing uteroplacental blood flow through lateral maternal positioning, administering
oxygen, and notifying the provider.
5. A newborn infant delivered vaginally at 41 weeks gestation appears lethargic with meconium-
stained amniotic fluid. The infant is term, has good respiratory effort, and exhibits normal
muscle tone. According to current Neonatal Resuscitation Program (NRP) guidelines, what is the
initial management?
A. Immediate endotracheal intubation and tracheal suctioning before the first breath
B. Routine newborn care including clearing secretions from the mouth and nose with a
bulb syringe if needed, keeping warm, and observing
C. Immediate administration of naloxone and surfactant via face mask
D. Emergency umbilical venous catheterization for epinephrine infusion
CORRECT ANSWER : B
Rationale: Current NRP guidelines no longer recommend routine endotracheal intubation and
suctioning for meconium-stained amniotic fluid in non-vigorous or vigorous infants unless
obstruction is suspected. Intubation is reserved solely for infants who present with depressed
respiration, poor tone, and inadequate heart rate.
6. A postpartum client on the first day following a spontaneous vaginal delivery complains of
severe, constant perineal pain that is unrelieved by ice packs and mild analgesics. Examination
reveals a tense, tender, bluish swelling on the right side of the perineum with palpable induration.
Vital signs show pulse 110 beats/min and blood pressure 90/60 mmHg. What condition has most
likely developed?
A. Normal physiological postpartum edema
B. Perineal hematoma
C. First-degree perineal laceration
D. Postpartum endometritis
CORRECT ANSWER : B
Rationale: Severe, unrelenting perineal pain disproportionate to the delivery type, accompanied
by a localized bluish mass, induration, and signs of hypovolemia, indicates a perineal hematoma
caused by bleeding into loose connective tissue. Small hematomas resolve, but large or
expanding ones require immediate surgical evacuation.
, 7. A client at 32 weeks gestation is receiving magnesium sulfate for preterm labor to achieve
neuroprotection for the fetus. Which nursing assessment finding indicates early magnesium
toxicity and requires immediate cessation of the infusion?
A. Serum magnesium level of 6.5 mg/dL
B. Loss of patellar deep tendon reflexes and respiratory rate below 12 breaths per minute
C. Maternal blood pressure of 120/80 mmHg and pulse of 80 beats/min
D. Mild maternal flushing and a feeling of warmth
CORRECT ANSWER : B
Rationale: Therapeutic serum magnesium levels range from 5 to 8 mg/dL. The earliest clinical
sign of magnesium toxicity is the loss of deep tendon reflexes, followed by respiratory depression
(under 12 breaths/min) and cardiac arrest. Calcium gluconate must be readily available as the
antidote.
8. A client at 30 weeks gestation is diagnosed with preterm premature rupture of membranes
(PPROM). She has no signs of labor, but her temperature is 38.5 degrees Celsius, pulse is 115
beats/min, and uterine tenderness is present. What is the primary management strategy?
A. Delay delivery and administer prolonged tocolytics for 7 days
B. Initiate prompt delivery regardless of gestational age due to suspected chorioamnionitis,
along with broad-spectrum antibiotics
C. Apply external fetal monitoring and discharge home on bed rest
D. Administer a repeat dose of antenatal corticosteroids only
CORRECT ANSWER : B
Rationale: PPROM complicated by maternal fever, tachycardia, and uterine tenderness
indicates active chorioamnionitis (intra-amniotic infection). Management requires immediate
delivery of the fetus to protect both mother and neonate from severe sepsis.
9. A 25-year-old G1P0 at 36 weeks gestation presents with sudden-onset painful vaginal bleeding
and a rigid, board-like abdomen. Fetal heart rate monitoring shows repetitive late decelerations
and minimal baseline variability. What complication should the nurse suspect?
A. Complete placenta previa
B. Placental abruption
and Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE
1. Antepartum Care, High-Risk Fetal Assessment, and Maternal Pathophysiology
2. Intrapartum Management, Labor Complications, and Obstetric Emergencies
3. Postpartum Adaptations, Neonatal Critical Care, and Newborn Physiology
1. A 32-year-old primigravida at 34 weeks of gestation presents to the labor and delivery triage unit
complaining of persistent headache, visual blurring, and right upper quadrant abdominal pain.
Blood pressure is 160/110 mmHg, and urine dipstick reveals 3+ protein. Laboratory findings
show platelets of 85,000/mm3 and elevated AST and ALT. What is the priority nursing
intervention?
A. Administer sublingual nifedipine immediately and discharge for weekly follow-up
B. Initiate intravenous magnesium sulfate infusion per protocol and prepare for immediate
delivery evaluation
C. Administer broad-spectrum intravenous antibiotics for suspected cholecystitis
D. Encourage ambulation and high-fluid intake to reduce blood pressure
CORRECT ANSWER : B
Rationale: The client exhibits classic signs of severe preeclampsia complicated by HELLP
syndrome (Hemolysis, Elevated Liver enzymes, Low Platelet count). Magnesium sulfate is the
first-line medication to prevent eclamptic seizures, and definitive management requires delivery
given the gestational age and severity of multi-organ involvement.
2. A 28-year-old G2P1 at 28 weeks gestation is admitted for vaginal bleeding. She describes
painless, bright red bleeding that began suddenly after a routine pelvic exam. Ultrasound
confirms complete placenta previa. Which nursing action is strictly contraindicated?
A. Monitoring continuous electronic fetal heart rate and uterine activity
B. Performing a digital cervical examination to assess dilation and effacement
, C. Inserting an intravenous line with a large-bore catheter
D. Typing and crossing blood for potential transfusion
CORRECT ANSWER : B
Rationale: In complete placenta previa, the placenta covers the internal cervical os. Digital
cervical examinations can disrupt placental blood vessels and trigger catastrophic, life-
threatening maternal and fetal hemorrhage. Ultrasound must always precede any digital vaginal
examination when bleeding occurs late in pregnancy.
3. A client at 38 weeks gestation with a history of a prior low-transverse cesarean section is
undergoing a trial of labor after cesarean (TOLAC). During the active phase of labor, the fetal
heart rate monitor shows sudden recurrent late decelerations, followed by loss of fetal station and
maternal hypotension. What is the immediate nursing action?
A. Administer oxytocin augmentation to speed up delivery
B. Prepare for immediate emergency laparotomy and cesarean delivery
C. Perform artificial rupture of membranes to assess amniotic fluid
D. Place the client in a prone position to relieve cord compression
CORRECT ANSWER : B
Rationale: The clinical triad of sudden fetal distress, loss of fetal station, and maternal
hypovolemic signs during TOLAC strongly indicates uterine rupture. This is an obstetric
emergency requiring immediate emergency cesarean delivery to prevent maternal and fetal
morbidity or mortality.
4. A 30-year-old multigravida is in the active stage of labor receiving oxytocin augmentation. The
nurse notes uterine tachysystole accompanied by fetal bradycardia and persistent late
decelerations. What is the priority sequence of nursing actions?
A. Increase oxytocin infusion rate, apply oxygen, and notify the physician
B. Discontinue oxytocin infusion immediately, reposition the client to the lateral position,
administer oxygen via non-rebreather mask, and notify the provider
C. Perform a sterile vaginal exam and encourage maternal pushing efforts
D. Prepare for immediate vacuum-assisted vaginal delivery without stopping oxytocin
CORRECT ANSWER : B
, Rationale: Uterine tachysystole caused by oxytocin reduces uteroplacental perfusion,
precipitating fetal hypoxia. The immediate actions are stopping the uterine stimulant,
maximizing uteroplacental blood flow through lateral maternal positioning, administering
oxygen, and notifying the provider.
5. A newborn infant delivered vaginally at 41 weeks gestation appears lethargic with meconium-
stained amniotic fluid. The infant is term, has good respiratory effort, and exhibits normal
muscle tone. According to current Neonatal Resuscitation Program (NRP) guidelines, what is the
initial management?
A. Immediate endotracheal intubation and tracheal suctioning before the first breath
B. Routine newborn care including clearing secretions from the mouth and nose with a
bulb syringe if needed, keeping warm, and observing
C. Immediate administration of naloxone and surfactant via face mask
D. Emergency umbilical venous catheterization for epinephrine infusion
CORRECT ANSWER : B
Rationale: Current NRP guidelines no longer recommend routine endotracheal intubation and
suctioning for meconium-stained amniotic fluid in non-vigorous or vigorous infants unless
obstruction is suspected. Intubation is reserved solely for infants who present with depressed
respiration, poor tone, and inadequate heart rate.
6. A postpartum client on the first day following a spontaneous vaginal delivery complains of
severe, constant perineal pain that is unrelieved by ice packs and mild analgesics. Examination
reveals a tense, tender, bluish swelling on the right side of the perineum with palpable induration.
Vital signs show pulse 110 beats/min and blood pressure 90/60 mmHg. What condition has most
likely developed?
A. Normal physiological postpartum edema
B. Perineal hematoma
C. First-degree perineal laceration
D. Postpartum endometritis
CORRECT ANSWER : B
Rationale: Severe, unrelenting perineal pain disproportionate to the delivery type, accompanied
by a localized bluish mass, induration, and signs of hypovolemia, indicates a perineal hematoma
caused by bleeding into loose connective tissue. Small hematomas resolve, but large or
expanding ones require immediate surgical evacuation.
, 7. A client at 32 weeks gestation is receiving magnesium sulfate for preterm labor to achieve
neuroprotection for the fetus. Which nursing assessment finding indicates early magnesium
toxicity and requires immediate cessation of the infusion?
A. Serum magnesium level of 6.5 mg/dL
B. Loss of patellar deep tendon reflexes and respiratory rate below 12 breaths per minute
C. Maternal blood pressure of 120/80 mmHg and pulse of 80 beats/min
D. Mild maternal flushing and a feeling of warmth
CORRECT ANSWER : B
Rationale: Therapeutic serum magnesium levels range from 5 to 8 mg/dL. The earliest clinical
sign of magnesium toxicity is the loss of deep tendon reflexes, followed by respiratory depression
(under 12 breaths/min) and cardiac arrest. Calcium gluconate must be readily available as the
antidote.
8. A client at 30 weeks gestation is diagnosed with preterm premature rupture of membranes
(PPROM). She has no signs of labor, but her temperature is 38.5 degrees Celsius, pulse is 115
beats/min, and uterine tenderness is present. What is the primary management strategy?
A. Delay delivery and administer prolonged tocolytics for 7 days
B. Initiate prompt delivery regardless of gestational age due to suspected chorioamnionitis,
along with broad-spectrum antibiotics
C. Apply external fetal monitoring and discharge home on bed rest
D. Administer a repeat dose of antenatal corticosteroids only
CORRECT ANSWER : B
Rationale: PPROM complicated by maternal fever, tachycardia, and uterine tenderness
indicates active chorioamnionitis (intra-amniotic infection). Management requires immediate
delivery of the fetus to protect both mother and neonate from severe sepsis.
9. A 25-year-old G1P0 at 36 weeks gestation presents with sudden-onset painful vaginal bleeding
and a rigid, board-like abdomen. Fetal heart rate monitoring shows repetitive late decelerations
and minimal baseline variability. What complication should the nurse suspect?
A. Complete placenta previa
B. Placental abruption
