, Question 1
A patient at 36 weeks gestation presents with a fundal height of 32 cm, and
ultrasound reveals an amniotic fluid index (AFI) of 6 cm. Which condition is
most consistent with these findings?
A. Polyhydramnios
B. Oligohydramnios
C. Normal amniotic fluid volume
D. Chorioamnionitis
Correct Answer: B - Oligohydramnios
RATIONALE
An AFI of 6 cm is below the normal range (5-25 cm), indicating
oligohydramnios. Polyhydramnios is defined as AFI >25 cm. Normal
AFI is 5-25 cm, but 6 cm is borderline low and with a fundal height
smaller than gestational age suggests oligohydramnios.
Chorioamnionitis typically presents with fever and uterine tenderness,
not decreased fluid.
Question 2
A patient receiving magnesium sulfate for preeclampsia has a serum
magnesium level of 8.2 mg/dL. Which assessment finding requires immediate
intervention?
A. Respiratory rate of 14 breaths/min
B. Deep tendon reflexes 2+
C. Urine output of 20 mL/hr
D. Serum magnesium level of 8.2 mg/dL
Correct Answer: C - Urine output of 20 mL/hr
Page 2
, RATIONALE
Urine output <30 mL/hr indicates possible magnesium toxicity due to
decreased renal excretion. Respiratory rate <12, absent reflexes, and
magnesium level >9 mg/dL are also signs of toxicity. The other
findings are within normal limits.
Question 3
A laboring patient at 5 cm dilation requests epidural analgesia. The nurse notes
a platelet count of 80,000/mm³. Which action is most appropriate?
A. Administer epidural as requested
B. Notify the provider and hold the epidural
C. Encourage IV opioid instead
D. Recheck platelet count in 1 hour
Correct Answer: B - Notify the provider and hold the epidural
RATIONALE
Thrombocytopenia (platelets <100,000/mm³) is a contraindication for
epidural due to risk of spinal hematoma. The nurse should notify the
provider and hold the procedure. IV opioids may be an alternative but
require a provider order. Rechecking in 1 hour delays necessary
intervention.
Question 4
A patient at 39 weeks gestation is in active labor. The fetal heart rate tracing
shows variable decelerations. Which nursing intervention is the priority?
A. Administer oxygen 10 L/min via face mask
B. Reposition the patient to left lateral
C. Increase IV fluid rate
D. Prepare for immediate cesarean delivery
Correct Answer: B - Reposition the patient to left lateral
Page 3
A patient at 36 weeks gestation presents with a fundal height of 32 cm, and
ultrasound reveals an amniotic fluid index (AFI) of 6 cm. Which condition is
most consistent with these findings?
A. Polyhydramnios
B. Oligohydramnios
C. Normal amniotic fluid volume
D. Chorioamnionitis
Correct Answer: B - Oligohydramnios
RATIONALE
An AFI of 6 cm is below the normal range (5-25 cm), indicating
oligohydramnios. Polyhydramnios is defined as AFI >25 cm. Normal
AFI is 5-25 cm, but 6 cm is borderline low and with a fundal height
smaller than gestational age suggests oligohydramnios.
Chorioamnionitis typically presents with fever and uterine tenderness,
not decreased fluid.
Question 2
A patient receiving magnesium sulfate for preeclampsia has a serum
magnesium level of 8.2 mg/dL. Which assessment finding requires immediate
intervention?
A. Respiratory rate of 14 breaths/min
B. Deep tendon reflexes 2+
C. Urine output of 20 mL/hr
D. Serum magnesium level of 8.2 mg/dL
Correct Answer: C - Urine output of 20 mL/hr
Page 2
, RATIONALE
Urine output <30 mL/hr indicates possible magnesium toxicity due to
decreased renal excretion. Respiratory rate <12, absent reflexes, and
magnesium level >9 mg/dL are also signs of toxicity. The other
findings are within normal limits.
Question 3
A laboring patient at 5 cm dilation requests epidural analgesia. The nurse notes
a platelet count of 80,000/mm³. Which action is most appropriate?
A. Administer epidural as requested
B. Notify the provider and hold the epidural
C. Encourage IV opioid instead
D. Recheck platelet count in 1 hour
Correct Answer: B - Notify the provider and hold the epidural
RATIONALE
Thrombocytopenia (platelets <100,000/mm³) is a contraindication for
epidural due to risk of spinal hematoma. The nurse should notify the
provider and hold the procedure. IV opioids may be an alternative but
require a provider order. Rechecking in 1 hour delays necessary
intervention.
Question 4
A patient at 39 weeks gestation is in active labor. The fetal heart rate tracing
shows variable decelerations. Which nursing intervention is the priority?
A. Administer oxygen 10 L/min via face mask
B. Reposition the patient to left lateral
C. Increase IV fluid rate
D. Prepare for immediate cesarean delivery
Correct Answer: B - Reposition the patient to left lateral
Page 3
