1. A 32-week gestation client presents with painless bright red vaginal bleeding. What is the
priority action?
a) Digital cervical exam
b) Insertion of an intrauterine pressure catheter
c) Prepare for ultrasound and avoid vaginal exam
d) Administer oxytocin
Rationale: Painless bleeding suggests placenta previa; vaginal exam can cause massive
hemorrhage. Ultrasound confirms diagnosis.
2. A laboring client’s monitor shows repetitive decelerations that begin after the contraction
starts and return to baseline after the contraction ends. What is the correct interpretation?
a) Variable decelerations
b) Early decelerations
c) Late decelerations
d) Prolonged deceleration
Rationale: Early decelerations are benign head compression, mirroring contraction
shape.
3. A nurse notes a rigid, board-like abdomen and dark red vaginal bleeding in a client at 35
weeks. What condition is most likely?
a) Placenta previa
b) Abruptio placentae
c) Uterine atony
d) Vasa previa
Rationale: Rigid abdomen with painful bleeding indicates abruptio placentae (premature
placental separation).
4. Within 2 hours postpartum, a client’s fundus is boggy and deviated to the right. What is
the first nursing action?
a) Notify the provider
, b) Assist the client to void
c) Massage the fundus
d) Administer methylergonovine
Rationale: A displaced boggy fundus often indicates a full bladder; emptying it allows the
uterus to contract.
5. A newborn has a 1-minute APGAR of 4. Which intervention is priority?
a) Administer naloxone
b) Initiate positive pressure ventilation
c) Place under radiant warmer
d) Suction mouth then nose
Rationale: APGAR 4 indicates moderate difficulty; ventilation is priority for heart rate
<100 and poor respiratory effort.
6. A gestational diabetic client at 38 weeks has an 8 lb baby. Post-delivery, what
complication is the newborn at highest risk for?
a) Hyperbilirubinemia
b) Hypoglycemia
c) Hypercalcemia
d) Respiratory alkalosis
Rationale: Maternal hyperglycemia causes fetal hyperinsulinism; after cord clamping,
glucose drops sharply.
7. A client receiving oxytocin for augmentation has a contraction lasting 110 seconds. What
is the priority action?
a) Increase oxytocin rate
b) Stop the oxytocin infusion
c) Apply oxygen mask at 2 L/min
d) Reposition the client
Rationale: Tetanic or prolonged contractions >90 seconds risk uterine rupture and fetal
distress; stop oxytocin immediately.
8. A postpartum client reports unilateral breast pain, redness, and flu-like symptoms at day
10. What is the likely diagnosis?
, a) Engorgement
b) Mastitis
c) Plugged duct
d) Thrush
Rationale: Mastitis presents after first week with systemic symptoms; treatment includes
antibiotics and continued emptying.
9. A nurse assesses a client at 39 weeks with contractions q3min, cervix 6 cm/90%/-1. The
FHR shows a sudden drop to 80 bpm after spontaneous rupture of membranes. What is
the priority action?
a) Administer terbutaline
b) Perform a vaginal exam to check for cord prolapse
c) Increase IV fluids
d) Apply internal fetal scalp electrode
Rationale: Sudden prolonged bradycardia post-rupture suggests cord prolapse;
immediate vaginal exam confirms.
10. A primigravida at 40 weeks is pushing. The head delivers but retracts against the
perineum (“turtle sign”). What maneuver should the nurse prepare for?
a) Suprapubic pressure and McRoberts maneuver
b) Fundal pressure during pushing
c) Immediate vacuum extraction
d) Cord blood gas sampling
Rationale: Turtle sign indicates shoulder dystocia; McRoberts (hyperflex thighs) and
suprapubic pressure relieve impaction.
11. At 34 weeks, a client with preeclampsia has a BP of 160/110 and urine protein 3+. She
complains of epigastric pain and blurred vision. What medication should the nurse
anticipate?
a) Nifedipine
b) Magnesium sulfate
c) Labetalol
d) Hydralazine
, Rationale: Severe features (epigastric pain, visual changes) require seizure prophylaxis
with magnesium sulfate.
12. A client’s amniotomy is performed; fluid is greenish with particulate matter. What
immediate nursing action is indicated?
a) Increase IV oxytocin
b) Prepare for possible meconium aspiration and notify neonatal team
c) Place client in Trendelenburg
d) Administer indomethacin
Rationale: Meconium-stained fluid (green) can cause respiratory distress; neonatal
resuscitation should be ready.
13. A postpartum client has a temperature of 100.8°F, fundus tender, and lochia with foul
odor on day 3. What is the most likely diagnosis?
a) Mastitis
b) Urinary tract infection
c) Endometritis
d) Wound infection
Rationale: Fever + tender fundus + foul lochia = endometritis (postpartum uterine
infection).
14. A newborn is jittery, lethargic, and has a glucose of 35 mg/dL. What feeding strategy is
most appropriate initially if the infant is asymptomatic?
a) IV dextrose bolus
b) Breastfeed or formula feed immediately
c) Gavage feeding
d) Nothing by mouth
*Rationale: Asymptomatic hypoglycemia (35–45 mg/dL) in a term newborn can be
treated with early feeding; recheck glucose.*
15. A nurse assesses fetal heart rate at 90 bpm for 8 minutes following an epidural bolus.
What is the priority intervention?
a) Increase epidural infusion rate
b) Reposition left lateral, give oxygen, IV fluids
priority action?
a) Digital cervical exam
b) Insertion of an intrauterine pressure catheter
c) Prepare for ultrasound and avoid vaginal exam
d) Administer oxytocin
Rationale: Painless bleeding suggests placenta previa; vaginal exam can cause massive
hemorrhage. Ultrasound confirms diagnosis.
2. A laboring client’s monitor shows repetitive decelerations that begin after the contraction
starts and return to baseline after the contraction ends. What is the correct interpretation?
a) Variable decelerations
b) Early decelerations
c) Late decelerations
d) Prolonged deceleration
Rationale: Early decelerations are benign head compression, mirroring contraction
shape.
3. A nurse notes a rigid, board-like abdomen and dark red vaginal bleeding in a client at 35
weeks. What condition is most likely?
a) Placenta previa
b) Abruptio placentae
c) Uterine atony
d) Vasa previa
Rationale: Rigid abdomen with painful bleeding indicates abruptio placentae (premature
placental separation).
4. Within 2 hours postpartum, a client’s fundus is boggy and deviated to the right. What is
the first nursing action?
a) Notify the provider
, b) Assist the client to void
c) Massage the fundus
d) Administer methylergonovine
Rationale: A displaced boggy fundus often indicates a full bladder; emptying it allows the
uterus to contract.
5. A newborn has a 1-minute APGAR of 4. Which intervention is priority?
a) Administer naloxone
b) Initiate positive pressure ventilation
c) Place under radiant warmer
d) Suction mouth then nose
Rationale: APGAR 4 indicates moderate difficulty; ventilation is priority for heart rate
<100 and poor respiratory effort.
6. A gestational diabetic client at 38 weeks has an 8 lb baby. Post-delivery, what
complication is the newborn at highest risk for?
a) Hyperbilirubinemia
b) Hypoglycemia
c) Hypercalcemia
d) Respiratory alkalosis
Rationale: Maternal hyperglycemia causes fetal hyperinsulinism; after cord clamping,
glucose drops sharply.
7. A client receiving oxytocin for augmentation has a contraction lasting 110 seconds. What
is the priority action?
a) Increase oxytocin rate
b) Stop the oxytocin infusion
c) Apply oxygen mask at 2 L/min
d) Reposition the client
Rationale: Tetanic or prolonged contractions >90 seconds risk uterine rupture and fetal
distress; stop oxytocin immediately.
8. A postpartum client reports unilateral breast pain, redness, and flu-like symptoms at day
10. What is the likely diagnosis?
, a) Engorgement
b) Mastitis
c) Plugged duct
d) Thrush
Rationale: Mastitis presents after first week with systemic symptoms; treatment includes
antibiotics and continued emptying.
9. A nurse assesses a client at 39 weeks with contractions q3min, cervix 6 cm/90%/-1. The
FHR shows a sudden drop to 80 bpm after spontaneous rupture of membranes. What is
the priority action?
a) Administer terbutaline
b) Perform a vaginal exam to check for cord prolapse
c) Increase IV fluids
d) Apply internal fetal scalp electrode
Rationale: Sudden prolonged bradycardia post-rupture suggests cord prolapse;
immediate vaginal exam confirms.
10. A primigravida at 40 weeks is pushing. The head delivers but retracts against the
perineum (“turtle sign”). What maneuver should the nurse prepare for?
a) Suprapubic pressure and McRoberts maneuver
b) Fundal pressure during pushing
c) Immediate vacuum extraction
d) Cord blood gas sampling
Rationale: Turtle sign indicates shoulder dystocia; McRoberts (hyperflex thighs) and
suprapubic pressure relieve impaction.
11. At 34 weeks, a client with preeclampsia has a BP of 160/110 and urine protein 3+. She
complains of epigastric pain and blurred vision. What medication should the nurse
anticipate?
a) Nifedipine
b) Magnesium sulfate
c) Labetalol
d) Hydralazine
, Rationale: Severe features (epigastric pain, visual changes) require seizure prophylaxis
with magnesium sulfate.
12. A client’s amniotomy is performed; fluid is greenish with particulate matter. What
immediate nursing action is indicated?
a) Increase IV oxytocin
b) Prepare for possible meconium aspiration and notify neonatal team
c) Place client in Trendelenburg
d) Administer indomethacin
Rationale: Meconium-stained fluid (green) can cause respiratory distress; neonatal
resuscitation should be ready.
13. A postpartum client has a temperature of 100.8°F, fundus tender, and lochia with foul
odor on day 3. What is the most likely diagnosis?
a) Mastitis
b) Urinary tract infection
c) Endometritis
d) Wound infection
Rationale: Fever + tender fundus + foul lochia = endometritis (postpartum uterine
infection).
14. A newborn is jittery, lethargic, and has a glucose of 35 mg/dL. What feeding strategy is
most appropriate initially if the infant is asymptomatic?
a) IV dextrose bolus
b) Breastfeed or formula feed immediately
c) Gavage feeding
d) Nothing by mouth
*Rationale: Asymptomatic hypoglycemia (35–45 mg/dL) in a term newborn can be
treated with early feeding; recheck glucose.*
15. A nurse assesses fetal heart rate at 90 bpm for 8 minutes following an epidural bolus.
What is the priority intervention?
a) Increase epidural infusion rate
b) Reposition left lateral, give oxygen, IV fluids
