NUR 230 Maternal Exam 2 | Practice Questions And
Answers 100% Correct Tests | 2026/2027
Question 1.
A client at 10 weeks gestation presents with severe nausea and vomiting, weight loss
of 6 lbs in one week, and ketonuria. She is unable to retain any oral intake. The nurse
suspects hyperemesis gravidarum. The priority nursing intervention is to:
A. Advise the client to eat dry crackers before getting out of bed.
B. Initiate IV fluid resuscitation and electrolyte replacement.
C. Administer oral ondansetron and send the client home.
D. Schedule an outpatient appointment in 3 days for reassessment.
Correct Answer: B
Rationale: Hyperemesis gravidarum is severe, persistent nausea and vomiting leading to
dehydration, weight loss (>5% of pre-pregnancy weight), ketonuria, and electrolyte
imbalances. The priority is hospitalization for IV fluid resuscitation (typically dextrose-
containing fluids to prevent Wernicke encephalopathy), electrolyte replacement, and
antiemetic therapy. Dry crackers and oral medications are insufficient for this severity.
Delaying care risks Wernicke encephalopathy (thiamine deficiency), Mallory-Weiss tears,
and acute tubular necrosis.
Question 2.
A client at 28 weeks gestation is diagnosed with gestational diabetes mellitus (GDM)
after a 3-hour OGTT. The nurse is teaching about dietary management. Which
statement by the client indicates understanding?
A. 'I should eliminate all carbohydrates to keep my blood sugar low.'
B. 'I will distribute complex carbohydrates throughout the day and pair them with protein.'
C. 'I can eat simple sugars like candy and soda as long as I take insulin.'
D. 'I should skip breakfast since my blood sugar is highest in the morning.'
Correct Answer: B
Rationale: GDM dietary management involves distributing complex carbohydrates evenly
across meals and snacks (typically 3 meals + 2–3 snacks), pairing carbs with protein and
healthy fats to blunt glucose spikes, and monitoring blood glucose four times daily (fasting
,and 1-hour or 2-hour postprandial). Carbohydrates should not be eliminated as they are
essential for fetal brain development. Simple sugars cause rapid hyperglycemia. Skipping
meals, especially breakfast, can cause ketosis and rebound hyperglycemia. If diet and
exercise fail to control glucose, insulin or metformin may be added.
Question 3.
A client with severe preeclampsia is receiving magnesium sulfate. The nurse notes
the client's deep tendon reflexes are absent and respiratory rate is 10 breaths per
minute. Which medication should the nurse have immediately available at the
bedside?
A. Calcium gluconate.
B. Naloxone.
C. Protamine sulfate.
D. Vitamin K.
Correct Answer: A
Rationale: Calcium gluconate is the antidote for magnesium sulfate toxicity. Signs of
toxicity include: absent deep tendon reflexes, respiratory depression (<12 breaths/min),
oliguria (<25–30 mL/hr), and cardiac arrest. The antidote works by antagonizing
magnesium at the neuromuscular junction. The nurse should have calcium gluconate
readily available whenever magnesium sulfate is administered. Naloxone reverses opioids.
Protamine sulfate reverses heparin. Vitamin K reverses warfarin and prevents hemorrhagic
disease of the newborn.
Question 4.
A client at 36 weeks gestation with chronic hypertension presents with a blood
pressure of 162/104 mmHg, proteinuria 2+, severe headache, and visual
disturbances. The nurse suspects superimposed preeclampsia. The nurse's priority
action is to:
A. Administer a loading dose of labetalol and prepare for delivery.
B. Have the client rest in a supine position and recheck the blood pressure in 1 hour.
C. Give oral nifedipine and discharge the client home on bed rest.
D. Encourage increased fluid intake to lower blood pressure.
, Correct Answer: A
Rationale: Severe preeclampsia (or superimposed preeclampsia on chronic hypertension)
is an obstetric emergency requiring immediate intervention. The priority actions include:
administering antihypertensives (labetalol IV, hydralazine IV, or oral nifedipine) to prevent
stroke, initiating magnesium sulfate for seizure prophylaxis, and preparing for delivery (the
definitive treatment). At ≥34 weeks, delivery is recommended after maternal stabilization.
Supine positioning worsens aortocaval compression. Discharging a client with severe
features is dangerous. Increased fluid intake can worsen fluid overload and pulmonary
edema in preeclampsia.
Question 5.
A client at 32 weeks gestation presents with painless, bright red vaginal bleeding. The
fetal heart rate is 140 bpm with moderate variability. On ultrasound, the placenta is
seen covering the internal os. The nurse's priority intervention is to:
A. Perform a sterile vaginal examination to assess cervical dilation.
B. Place the client on bed rest, establish IV access, and prepare for possible cesarean
delivery.
C. Administer oxytocin to augment labor and achieve vaginal delivery.
D. Have the client ambulate to promote placental separation.
Correct Answer: B
Rationale: Placenta previa is characterized by painless, bright red vaginal bleeding in the
second or third trimester. Vaginal examinations are CONTRAINDICATED as they can disrupt
the placenta and cause catastrophic hemorrhage. The client is placed on pelvic rest (no
intercourse, tampons, or vaginal exams), bed rest or modified activity, and monitored for
further bleeding. At 32 weeks with active bleeding, expectant management with
corticosteroids for fetal lung maturity is pursued if stable; however, heavy or recurrent
bleeding requires delivery by cesarean section. Oxytocin and ambulation are
contraindicated.
Question 6.
A client at 40 weeks gestation is in active labor. The fetal heart rate tracing shows
early decelerations that mirror the shape of the contractions. The nurse knows that
early decelerations are caused by:
A. Uteroplacental insufficiency.
Answers 100% Correct Tests | 2026/2027
Question 1.
A client at 10 weeks gestation presents with severe nausea and vomiting, weight loss
of 6 lbs in one week, and ketonuria. She is unable to retain any oral intake. The nurse
suspects hyperemesis gravidarum. The priority nursing intervention is to:
A. Advise the client to eat dry crackers before getting out of bed.
B. Initiate IV fluid resuscitation and electrolyte replacement.
C. Administer oral ondansetron and send the client home.
D. Schedule an outpatient appointment in 3 days for reassessment.
Correct Answer: B
Rationale: Hyperemesis gravidarum is severe, persistent nausea and vomiting leading to
dehydration, weight loss (>5% of pre-pregnancy weight), ketonuria, and electrolyte
imbalances. The priority is hospitalization for IV fluid resuscitation (typically dextrose-
containing fluids to prevent Wernicke encephalopathy), electrolyte replacement, and
antiemetic therapy. Dry crackers and oral medications are insufficient for this severity.
Delaying care risks Wernicke encephalopathy (thiamine deficiency), Mallory-Weiss tears,
and acute tubular necrosis.
Question 2.
A client at 28 weeks gestation is diagnosed with gestational diabetes mellitus (GDM)
after a 3-hour OGTT. The nurse is teaching about dietary management. Which
statement by the client indicates understanding?
A. 'I should eliminate all carbohydrates to keep my blood sugar low.'
B. 'I will distribute complex carbohydrates throughout the day and pair them with protein.'
C. 'I can eat simple sugars like candy and soda as long as I take insulin.'
D. 'I should skip breakfast since my blood sugar is highest in the morning.'
Correct Answer: B
Rationale: GDM dietary management involves distributing complex carbohydrates evenly
across meals and snacks (typically 3 meals + 2–3 snacks), pairing carbs with protein and
healthy fats to blunt glucose spikes, and monitoring blood glucose four times daily (fasting
,and 1-hour or 2-hour postprandial). Carbohydrates should not be eliminated as they are
essential for fetal brain development. Simple sugars cause rapid hyperglycemia. Skipping
meals, especially breakfast, can cause ketosis and rebound hyperglycemia. If diet and
exercise fail to control glucose, insulin or metformin may be added.
Question 3.
A client with severe preeclampsia is receiving magnesium sulfate. The nurse notes
the client's deep tendon reflexes are absent and respiratory rate is 10 breaths per
minute. Which medication should the nurse have immediately available at the
bedside?
A. Calcium gluconate.
B. Naloxone.
C. Protamine sulfate.
D. Vitamin K.
Correct Answer: A
Rationale: Calcium gluconate is the antidote for magnesium sulfate toxicity. Signs of
toxicity include: absent deep tendon reflexes, respiratory depression (<12 breaths/min),
oliguria (<25–30 mL/hr), and cardiac arrest. The antidote works by antagonizing
magnesium at the neuromuscular junction. The nurse should have calcium gluconate
readily available whenever magnesium sulfate is administered. Naloxone reverses opioids.
Protamine sulfate reverses heparin. Vitamin K reverses warfarin and prevents hemorrhagic
disease of the newborn.
Question 4.
A client at 36 weeks gestation with chronic hypertension presents with a blood
pressure of 162/104 mmHg, proteinuria 2+, severe headache, and visual
disturbances. The nurse suspects superimposed preeclampsia. The nurse's priority
action is to:
A. Administer a loading dose of labetalol and prepare for delivery.
B. Have the client rest in a supine position and recheck the blood pressure in 1 hour.
C. Give oral nifedipine and discharge the client home on bed rest.
D. Encourage increased fluid intake to lower blood pressure.
, Correct Answer: A
Rationale: Severe preeclampsia (or superimposed preeclampsia on chronic hypertension)
is an obstetric emergency requiring immediate intervention. The priority actions include:
administering antihypertensives (labetalol IV, hydralazine IV, or oral nifedipine) to prevent
stroke, initiating magnesium sulfate for seizure prophylaxis, and preparing for delivery (the
definitive treatment). At ≥34 weeks, delivery is recommended after maternal stabilization.
Supine positioning worsens aortocaval compression. Discharging a client with severe
features is dangerous. Increased fluid intake can worsen fluid overload and pulmonary
edema in preeclampsia.
Question 5.
A client at 32 weeks gestation presents with painless, bright red vaginal bleeding. The
fetal heart rate is 140 bpm with moderate variability. On ultrasound, the placenta is
seen covering the internal os. The nurse's priority intervention is to:
A. Perform a sterile vaginal examination to assess cervical dilation.
B. Place the client on bed rest, establish IV access, and prepare for possible cesarean
delivery.
C. Administer oxytocin to augment labor and achieve vaginal delivery.
D. Have the client ambulate to promote placental separation.
Correct Answer: B
Rationale: Placenta previa is characterized by painless, bright red vaginal bleeding in the
second or third trimester. Vaginal examinations are CONTRAINDICATED as they can disrupt
the placenta and cause catastrophic hemorrhage. The client is placed on pelvic rest (no
intercourse, tampons, or vaginal exams), bed rest or modified activity, and monitored for
further bleeding. At 32 weeks with active bleeding, expectant management with
corticosteroids for fetal lung maturity is pursued if stable; however, heavy or recurrent
bleeding requires delivery by cesarean section. Oxytocin and ambulation are
contraindicated.
Question 6.
A client at 40 weeks gestation is in active labor. The fetal heart rate tracing shows
early decelerations that mirror the shape of the contractions. The nurse knows that
early decelerations are caused by:
A. Uteroplacental insufficiency.
