Western Governors University's D447 OA
(Women’s & Children’s Health Nursing
Multiple Choice Questions & Answers (2026
Update) – Version 1
Question 1
A client at 38 weeks’ gestation is admitted with a blood pressure of 160/100 mmHg, +3
proteinuria, and a severe frontal headache. Which nursing intervention is the priority?
A) Administer oxygen via non-rebreather face mask
B) Prepare the client for immediate delivery
C) Administer magnesium sulfate per protocol
D) Perform a non-stress test (NST)
Answer: C) Administer magnesium sulfate per protocol
Rationale: The client displays classic indicators of severe preeclampsia. Magnesium sulfate is
administered specifically for seizure prophylaxis (preventing eclampsia). While fetal assessment
and delivery planning are important, stabilizing the mother and preventing maternal seizures is
the immediate safety priority.
Question 2
A pregnant client receiving a continuous IV infusion of magnesium sulfate has a respiratory rate
of 10 breaths/min, absent deep tendon reflexes (DTRs), and a urine output of 20 mL/hr. What is
the nurse's first action?
,A) Decrease the magnesium sulfate rate by half
B) Administer calcium gluconate IV push
C) Stop the magnesium sulfate infusion immediately
D) Notify the healthcare provider
Answer: C) Stop the magnesium sulfate infusion immediately
Rationale: Respiratory rate under 12/min, absent DTRs, and oliguria (<30 mL/hr) are signs of
severe magnesium toxicity. The immediate first step is to turn off the infusion to prevent
cardiac arrest. Administering the antidote (calcium gluconate) and notifying the provider follow.
Question 3
At 16 weeks’ gestation, a routine Maternal Serum Alpha-Fetoprotein (MSAFP) screening yields
elevated levels. How should the nurse explain this finding to the client?
A) "An elevated result is definitive proof of Down syndrome."
B) "An elevated result indicates an increased risk for neural tube defects, requiring a diagnostic
ultrasound."
C) "This result is normal and no additional follow-up testing is necessary."
D) "This result means you must prepare for immediate preterm labor."
Answer: B) "An elevated result indicates an increased risk for neural tube defects, requiring a
diagnostic ultrasound."
Rationale: Elevated MSAFP levels are associated with open neural tube defects (e.g., spina
bifida, anencephaly) or abdominal wall defects. Low MSAFP levels are associated with trisomies
such as Down syndrome. MSAFP is a screening test, not a diagnostic one, so further evaluation
via targeted ultrasound is indicated.
Question 4
A client at 32 weeks' gestation presents with sudden, painless, bright red vaginal bleeding.
Which diagnostic procedure or exam is strictly contraindicated?
A) Transabdominal ultrasound
B) Sterile vaginal examination
,C) External fetal monitoring
D) Maternal blood pressure monitoring
Answer: B) Sterile vaginal examination
Rationale: Painless bright red vaginal bleeding in the third trimester suggests placenta previa.
Digital/sterile vaginal exams are strictly contraindicated until placenta previa is ruled out by
ultrasound, as manual examination can cause massive hemorrhage by disrupting the low-lying
placenta.
Question 5
At what gestational age should universal screening for Group B Streptococcus (GBS) be
performed for all pregnant clients?
A) 16–20 weeks
B) 24–28 weeks
C) 35–37 weeks
D) 38–40 weeks
Answer: C) 35–37 weeks
Rationale: Standard maternal care protocols require universal screening for GBS at 35 to 37
weeks' gestation using vaginal and rectal swabs. Clients testing positive receive IV antibiotic
prophylaxis (usually Penicillin G) during labor to prevent neonatal GBS sepsis.
Section 2: Intrapartum Care & Fetal Monitoring
Question 6
During electronic fetal monitoring, the nurse notes fetal heart rate decelerations that begin
after the onset of uterine contractions, reach their nadir after the peak of the contraction, and
return to baseline after the contraction ends. What is the priority intervention?
A) Assist the client to a side-lying position, apply oxygen, and increase IV fluids
B) Continue monitoring as this is a benign finding caused by head compression
C) Perform a vaginal examination to check for umbilical cord prolapse
D) Administer IV oxytocin to speed up labor progression
, Answer: A) Assist the client to a side-lying position, apply oxygen, and increase IV fluids
Rationale: Late decelerations reflect uteroplacental insufficiency. Immediate nursing
interventions to improve placental blood flow and fetal oxygenation include turning the mother
to her left side (lateral position), administering non-rebreather oxygen at 8–10 L/min,
increasing IV fluids, and discontinuing oxytocin if running.
Question 7
A client in active labor requests an epidural block. Twenty minutes after epidural placement,
her blood pressure drops from 120/78 mmHg to 92/50 mmHg, and the fetal heart rate shows
prolonged bradycardia. Which action should the nurse take first?
A) Administer IV naloxone
B) Reposition the client into a lateral position
C) Prepare for immediate amniotomy
D) Increase the epidural infusion rate
Answer: B) Reposition the client into a lateral position
Rationale: Maternal hypotension is a common complication of epidural anesthesia due to
sympathetic blockade. Placing the client in a lateral (side-lying) position immediately relieves
vena cava compression, improving venous return, maternal cardiac output, and placental
perfusion. Additional steps include an IV fluid bolus and oxygen.
Question 8
During delivery, the fetal head is delivered, but the shoulders become impacted behind the
maternal pubic symphysis (shoulder dystocia). Which maneuver should the nurse perform?
A) Apply strong fundal pressure
B) Assist the client into the McRoberts position and apply suprapubic pressure
C) Instruct the client to push harder with the next contraction
D) Perform an immediate vacuum extraction
Answer: B) Assist the client into the McRoberts position and apply suprapubic pressure
Rationale: McRoberts maneuver (hyperflexing the maternal legs tightly against the abdomen)
flattens the sacrum and widens the pelvic outlet. Suprapubic pressure helps dislodge the
(Women’s & Children’s Health Nursing
Multiple Choice Questions & Answers (2026
Update) – Version 1
Question 1
A client at 38 weeks’ gestation is admitted with a blood pressure of 160/100 mmHg, +3
proteinuria, and a severe frontal headache. Which nursing intervention is the priority?
A) Administer oxygen via non-rebreather face mask
B) Prepare the client for immediate delivery
C) Administer magnesium sulfate per protocol
D) Perform a non-stress test (NST)
Answer: C) Administer magnesium sulfate per protocol
Rationale: The client displays classic indicators of severe preeclampsia. Magnesium sulfate is
administered specifically for seizure prophylaxis (preventing eclampsia). While fetal assessment
and delivery planning are important, stabilizing the mother and preventing maternal seizures is
the immediate safety priority.
Question 2
A pregnant client receiving a continuous IV infusion of magnesium sulfate has a respiratory rate
of 10 breaths/min, absent deep tendon reflexes (DTRs), and a urine output of 20 mL/hr. What is
the nurse's first action?
,A) Decrease the magnesium sulfate rate by half
B) Administer calcium gluconate IV push
C) Stop the magnesium sulfate infusion immediately
D) Notify the healthcare provider
Answer: C) Stop the magnesium sulfate infusion immediately
Rationale: Respiratory rate under 12/min, absent DTRs, and oliguria (<30 mL/hr) are signs of
severe magnesium toxicity. The immediate first step is to turn off the infusion to prevent
cardiac arrest. Administering the antidote (calcium gluconate) and notifying the provider follow.
Question 3
At 16 weeks’ gestation, a routine Maternal Serum Alpha-Fetoprotein (MSAFP) screening yields
elevated levels. How should the nurse explain this finding to the client?
A) "An elevated result is definitive proof of Down syndrome."
B) "An elevated result indicates an increased risk for neural tube defects, requiring a diagnostic
ultrasound."
C) "This result is normal and no additional follow-up testing is necessary."
D) "This result means you must prepare for immediate preterm labor."
Answer: B) "An elevated result indicates an increased risk for neural tube defects, requiring a
diagnostic ultrasound."
Rationale: Elevated MSAFP levels are associated with open neural tube defects (e.g., spina
bifida, anencephaly) or abdominal wall defects. Low MSAFP levels are associated with trisomies
such as Down syndrome. MSAFP is a screening test, not a diagnostic one, so further evaluation
via targeted ultrasound is indicated.
Question 4
A client at 32 weeks' gestation presents with sudden, painless, bright red vaginal bleeding.
Which diagnostic procedure or exam is strictly contraindicated?
A) Transabdominal ultrasound
B) Sterile vaginal examination
,C) External fetal monitoring
D) Maternal blood pressure monitoring
Answer: B) Sterile vaginal examination
Rationale: Painless bright red vaginal bleeding in the third trimester suggests placenta previa.
Digital/sterile vaginal exams are strictly contraindicated until placenta previa is ruled out by
ultrasound, as manual examination can cause massive hemorrhage by disrupting the low-lying
placenta.
Question 5
At what gestational age should universal screening for Group B Streptococcus (GBS) be
performed for all pregnant clients?
A) 16–20 weeks
B) 24–28 weeks
C) 35–37 weeks
D) 38–40 weeks
Answer: C) 35–37 weeks
Rationale: Standard maternal care protocols require universal screening for GBS at 35 to 37
weeks' gestation using vaginal and rectal swabs. Clients testing positive receive IV antibiotic
prophylaxis (usually Penicillin G) during labor to prevent neonatal GBS sepsis.
Section 2: Intrapartum Care & Fetal Monitoring
Question 6
During electronic fetal monitoring, the nurse notes fetal heart rate decelerations that begin
after the onset of uterine contractions, reach their nadir after the peak of the contraction, and
return to baseline after the contraction ends. What is the priority intervention?
A) Assist the client to a side-lying position, apply oxygen, and increase IV fluids
B) Continue monitoring as this is a benign finding caused by head compression
C) Perform a vaginal examination to check for umbilical cord prolapse
D) Administer IV oxytocin to speed up labor progression
, Answer: A) Assist the client to a side-lying position, apply oxygen, and increase IV fluids
Rationale: Late decelerations reflect uteroplacental insufficiency. Immediate nursing
interventions to improve placental blood flow and fetal oxygenation include turning the mother
to her left side (lateral position), administering non-rebreather oxygen at 8–10 L/min,
increasing IV fluids, and discontinuing oxytocin if running.
Question 7
A client in active labor requests an epidural block. Twenty minutes after epidural placement,
her blood pressure drops from 120/78 mmHg to 92/50 mmHg, and the fetal heart rate shows
prolonged bradycardia. Which action should the nurse take first?
A) Administer IV naloxone
B) Reposition the client into a lateral position
C) Prepare for immediate amniotomy
D) Increase the epidural infusion rate
Answer: B) Reposition the client into a lateral position
Rationale: Maternal hypotension is a common complication of epidural anesthesia due to
sympathetic blockade. Placing the client in a lateral (side-lying) position immediately relieves
vena cava compression, improving venous return, maternal cardiac output, and placental
perfusion. Additional steps include an IV fluid bolus and oxygen.
Question 8
During delivery, the fetal head is delivered, but the shoulders become impacted behind the
maternal pubic symphysis (shoulder dystocia). Which maneuver should the nurse perform?
A) Apply strong fundal pressure
B) Assist the client into the McRoberts position and apply suprapubic pressure
C) Instruct the client to push harder with the next contraction
D) Perform an immediate vacuum extraction
Answer: B) Assist the client into the McRoberts position and apply suprapubic pressure
Rationale: McRoberts maneuver (hyperflexing the maternal legs tightly against the abdomen)
flattens the sacrum and widens the pelvic outlet. Suprapubic pressure helps dislodge the
