, Question 1
A patient at 32 weeks gestation presents with severe preeclampsia and is
receiving magnesium sulfate. Which assessment finding would necessitate
immediate discontinuation of the infusion?
A. Deep tendon reflexes 2+
B. Respiratory rate 10/min
C. Urine output 40 mL/hr
D. Blood pressure 150/95 mm Hg
Correct Answer: B - Respiratory rate 10/min
RATIONALE
Respiratory rate <12/min indicates magnesium toxicity, requiring
immediate cessation and possible administration of calcium gluconate.
Other options are not immediate contraindications; reflexes should be
monitored but 2+ is normal, urine output >30 mL/hr is acceptable, and
BP elevation is expected in preeclampsia.
Question 2
Which finding in a laboring patient with epidural analgesia most strongly
suggests a diagnosis of uterine rupture?
A. Sudden onset of intense abdominal pain with fetal bradycardia
B. Gradual increase in contraction frequency
C. Maternal hypertension and proteinuria
D. Cessation of contractions with fetal tachycardia
Correct Answer: A - Sudden onset of intense abdominal pain with
fetal bradycardia
RATIONALE
Uterine rupture typically presents with sudden severe abdominal pain,
fetal bradycardia, and loss of station. Other options are not classic
signs; contractions may cease but fetal tachycardia is less common
than bradycardia, and hypertension/proteinuria suggest preeclampsia.
Page 2
, Question 3
A postpartum patient is diagnosed with endometritis. Which assessment
finding is most specific to this condition?
A. Foul-smelling lochia and uterine tenderness
B. Bilateral breast engorgement
C. Dependent edema and headache
D. Elevated liver enzymes and thrombocytopenia
Correct Answer: A - Foul-smelling lochia and uterine tenderness
RATIONALE
Endometritis is characterized by uterine tenderness, fever, and
foul-smelling lochia. Breast engorgement suggests mastitis,
edema/headache suggest preeclampsia, and liver
enzymes/thrombocytopenia suggest HELLP syndrome.
Question 4
A neonate born to a mother with poorly controlled diabetes exhibits jitteriness,
hypotonia, and a blood glucose of 35 mg/dL. Which intervention is the
priority?
A. Administer intravenous dextrose bolus
B. Initiate breastfeeding immediately
C. Provide blow-by oxygen
D. Obtain a blood culture
Correct Answer: A - Administer intravenous dextrose bolus
RATIONALE
Neonatal hypoglycemia (<40 mg/dL) with symptoms requires
immediate IV dextrose to prevent seizures and brain injury.
Breastfeeding may be attempted but is insufficient for symptomatic
hypoglycemia; oxygen and blood culture are not primary
interventions.
Page 3
, Question 5
Which mechanism of action best explains the therapeutic effect of oxytocin in
postpartum hemorrhage?
A. Stimulation of uterine smooth muscle contraction
B. Inhibition of prostaglandin synthesis
C. Blockade of calcium channels in myometrium
D. Enhancement of platelet aggregation
Correct Answer: A - Stimulation of uterine smooth muscle
contraction
RATIONALE
Oxytocin binds to receptors on uterine smooth muscle, increasing
intracellular calcium and promoting contraction to compress bleeding
vessels. Other options describe mechanisms of NSAIDs, calcium
channel blockers, and hemostatic agents, respectively.
Question 6
A patient at 36 weeks gestation presents with painless, bright red vaginal
bleeding. Which assessment finding would most likely indicate placenta previa
rather than placental abruption?
A. Soft, nontender uterus
B. Board-like abdominal rigidity
C. Fetal bradycardia
D. Maternal hypotension
Correct Answer: A - Soft, nontender uterus
RATIONALE
Placenta previa typically presents with painless bleeding and a soft,
nontender uterus. Placental abruption often presents with painful
bleeding, uterine rigidity, and fetal distress. Hypotension and
bradycardia can occur in both but are not differentiating.
Page 4
A patient at 32 weeks gestation presents with severe preeclampsia and is
receiving magnesium sulfate. Which assessment finding would necessitate
immediate discontinuation of the infusion?
A. Deep tendon reflexes 2+
B. Respiratory rate 10/min
C. Urine output 40 mL/hr
D. Blood pressure 150/95 mm Hg
Correct Answer: B - Respiratory rate 10/min
RATIONALE
Respiratory rate <12/min indicates magnesium toxicity, requiring
immediate cessation and possible administration of calcium gluconate.
Other options are not immediate contraindications; reflexes should be
monitored but 2+ is normal, urine output >30 mL/hr is acceptable, and
BP elevation is expected in preeclampsia.
Question 2
Which finding in a laboring patient with epidural analgesia most strongly
suggests a diagnosis of uterine rupture?
A. Sudden onset of intense abdominal pain with fetal bradycardia
B. Gradual increase in contraction frequency
C. Maternal hypertension and proteinuria
D. Cessation of contractions with fetal tachycardia
Correct Answer: A - Sudden onset of intense abdominal pain with
fetal bradycardia
RATIONALE
Uterine rupture typically presents with sudden severe abdominal pain,
fetal bradycardia, and loss of station. Other options are not classic
signs; contractions may cease but fetal tachycardia is less common
than bradycardia, and hypertension/proteinuria suggest preeclampsia.
Page 2
, Question 3
A postpartum patient is diagnosed with endometritis. Which assessment
finding is most specific to this condition?
A. Foul-smelling lochia and uterine tenderness
B. Bilateral breast engorgement
C. Dependent edema and headache
D. Elevated liver enzymes and thrombocytopenia
Correct Answer: A - Foul-smelling lochia and uterine tenderness
RATIONALE
Endometritis is characterized by uterine tenderness, fever, and
foul-smelling lochia. Breast engorgement suggests mastitis,
edema/headache suggest preeclampsia, and liver
enzymes/thrombocytopenia suggest HELLP syndrome.
Question 4
A neonate born to a mother with poorly controlled diabetes exhibits jitteriness,
hypotonia, and a blood glucose of 35 mg/dL. Which intervention is the
priority?
A. Administer intravenous dextrose bolus
B. Initiate breastfeeding immediately
C. Provide blow-by oxygen
D. Obtain a blood culture
Correct Answer: A - Administer intravenous dextrose bolus
RATIONALE
Neonatal hypoglycemia (<40 mg/dL) with symptoms requires
immediate IV dextrose to prevent seizures and brain injury.
Breastfeeding may be attempted but is insufficient for symptomatic
hypoglycemia; oxygen and blood culture are not primary
interventions.
Page 3
, Question 5
Which mechanism of action best explains the therapeutic effect of oxytocin in
postpartum hemorrhage?
A. Stimulation of uterine smooth muscle contraction
B. Inhibition of prostaglandin synthesis
C. Blockade of calcium channels in myometrium
D. Enhancement of platelet aggregation
Correct Answer: A - Stimulation of uterine smooth muscle
contraction
RATIONALE
Oxytocin binds to receptors on uterine smooth muscle, increasing
intracellular calcium and promoting contraction to compress bleeding
vessels. Other options describe mechanisms of NSAIDs, calcium
channel blockers, and hemostatic agents, respectively.
Question 6
A patient at 36 weeks gestation presents with painless, bright red vaginal
bleeding. Which assessment finding would most likely indicate placenta previa
rather than placental abruption?
A. Soft, nontender uterus
B. Board-like abdominal rigidity
C. Fetal bradycardia
D. Maternal hypotension
Correct Answer: A - Soft, nontender uterus
RATIONALE
Placenta previa typically presents with painless bleeding and a soft,
nontender uterus. Placental abruption often presents with painful
bleeding, uterine rigidity, and fetal distress. Hypotension and
bradycardia can occur in both but are not differentiating.
Page 4
