NSG 3500 MATERNAL HEALTH
COMPREHENSIVE EXAM 3 GUIDE
QUESTIONS AND ANSWERS
1. A nurse is monitoring a client receiving magnesium sulfate for preeclampsia. The client’s
respiratory rate is 10 breaths/min, and deep tendon reflexes are absent. Which action should
the nurse take first?
A. Stop the magnesium sulfate infusion immediately
B. Increase the IV fluid rate to flush the medication
C. Administer calcium gluconate IV push over 2 minutes
D. Place the client in a high-Fowler’s position
Answer: A
Conceptual Explanation: Magnesium sulfate toxicity is evidenced by a respiratory rate
below 12 and absent DTRs. The priority action is to stop the infusion to prevent further
toxicity before administering the antidote, calcium gluconate.
2. A client at 32 weeks gestation presents with painless, bright red vaginal bleeding. Which
diagnostic procedure is contraindicated for this client?
A. Digital vaginal examination
,B. Abdominal ultrasound
C. External fetal monitoring
D. Kleihauer-Betke test
Answer: A
Conceptual Explanation: Painless bright red bleeding is indicative of placenta previa. A
digital vaginal exam can stimulate the placenta and cause catastrophic hemorrhage;
therefore, it is strictly contraindicated until previa is ruled out via ultrasound.
3. A nurse is caring for a client who is in the second stage of labor. The fetal heart rate
monitor shows late decelerations. What is the nurse’s priority action?
A. Encourage the client to push harder during contractions
B. Increase the rate of the oxytocin infusion
C. Perform a sterile vaginal exam to check for cord prolapse
D. Turn the client to a side-lying position
Answer: D
Conceptual Explanation: Late decelerations indicate uteroplacental insufficiency. The
priority is to optimize oxygen delivery to the fetus, which involves repositioning the
mother to her side, increasing IV fluids, and applying oxygen.
, 4. Which laboratory finding is characteristic of HELLP syndrome in a client with severe
preeclampsia?
A. Platelet count of 75,000/mm3
B. Decreased serum creatinine levels
C. Elevated hemoglobin and hematocrit
D. Decreased liver enzymes (AST/ALT)
Answer: A
Conceptual Explanation: HELLP stands for Hemolysis, Elevated Liver enzymes, and Low
Platelets. A platelet count below 100,000/mm3 is a definitive finding for the ‘LP’ portion of
the syndrome.
5. A postpartum client is experiencing excessive vaginal bleeding. The nurse notes the fundus
is boggy and displaced to the right. What should be the nurse’s first intervention?
A. Notify the healthcare provider immediately
B. Massage the fundus until firm
C. Administer 0.2 mg of methylergonovine IM
D. Assist the client to the bathroom to void
Answer: D
COMPREHENSIVE EXAM 3 GUIDE
QUESTIONS AND ANSWERS
1. A nurse is monitoring a client receiving magnesium sulfate for preeclampsia. The client’s
respiratory rate is 10 breaths/min, and deep tendon reflexes are absent. Which action should
the nurse take first?
A. Stop the magnesium sulfate infusion immediately
B. Increase the IV fluid rate to flush the medication
C. Administer calcium gluconate IV push over 2 minutes
D. Place the client in a high-Fowler’s position
Answer: A
Conceptual Explanation: Magnesium sulfate toxicity is evidenced by a respiratory rate
below 12 and absent DTRs. The priority action is to stop the infusion to prevent further
toxicity before administering the antidote, calcium gluconate.
2. A client at 32 weeks gestation presents with painless, bright red vaginal bleeding. Which
diagnostic procedure is contraindicated for this client?
A. Digital vaginal examination
,B. Abdominal ultrasound
C. External fetal monitoring
D. Kleihauer-Betke test
Answer: A
Conceptual Explanation: Painless bright red bleeding is indicative of placenta previa. A
digital vaginal exam can stimulate the placenta and cause catastrophic hemorrhage;
therefore, it is strictly contraindicated until previa is ruled out via ultrasound.
3. A nurse is caring for a client who is in the second stage of labor. The fetal heart rate
monitor shows late decelerations. What is the nurse’s priority action?
A. Encourage the client to push harder during contractions
B. Increase the rate of the oxytocin infusion
C. Perform a sterile vaginal exam to check for cord prolapse
D. Turn the client to a side-lying position
Answer: D
Conceptual Explanation: Late decelerations indicate uteroplacental insufficiency. The
priority is to optimize oxygen delivery to the fetus, which involves repositioning the
mother to her side, increasing IV fluids, and applying oxygen.
, 4. Which laboratory finding is characteristic of HELLP syndrome in a client with severe
preeclampsia?
A. Platelet count of 75,000/mm3
B. Decreased serum creatinine levels
C. Elevated hemoglobin and hematocrit
D. Decreased liver enzymes (AST/ALT)
Answer: A
Conceptual Explanation: HELLP stands for Hemolysis, Elevated Liver enzymes, and Low
Platelets. A platelet count below 100,000/mm3 is a definitive finding for the ‘LP’ portion of
the syndrome.
5. A postpartum client is experiencing excessive vaginal bleeding. The nurse notes the fundus
is boggy and displaced to the right. What should be the nurse’s first intervention?
A. Notify the healthcare provider immediately
B. Massage the fundus until firm
C. Administer 0.2 mg of methylergonovine IM
D. Assist the client to the bathroom to void
Answer: D
