NURS420: Advanced Maternal-Newborn Nursing
Prep with Detailed Rationales
Course Code: NURS420
Course Name: Advanced Maternal-Newborn Nursing
Topic: Obstetric Complications, Hypertensive Disorders, and Antepartum Bleeding
Academic Year: 2026/2027
1. A multiparous client at 32 weeks gestation arrives via emergency medical
services with sudden-onset, agonizing abdominal pain, a rigid board-like
abdomen, and dark vaginal bleeding. The fetal monitoring strip demonstrates
prolonged late decelerations with a baseline of 90 bpm. Which immediate
life-saving intervention should the labor and delivery nurse execute first?
A. Perform a sterile vaginal examination to evaluate cervical dilation and
effacement.
B. Establish two large-bore intravenous lines and prepare for an
emergency cesarean section.
C. Obtain a clean-catch urine specimen to screen for high-grade proteinuria.
D. Administer a subcutaneous dose of terbutaline sulfate to arrest uterine
hyperstimulation.
CORRECT ANSWER: B
RATIONALE: The client is presenting with classic, high-yield manifestations
of a severe placental abruption (premature separation of the placenta after 20
weeks), which is an absolute obstetric emergency. The priority is to establish two
large-bore IV lines for fluid/blood resuscitation and immediately prepare for an
emergency cesarean section due to explicit fetal distress (bradycardia and late
decelerations). Performing a vaginal exam (A) is dangerous if placenta previa has
not been fully ruled out. Checking for protein (C) delays life-saving care, and
terbutaline (D) is contraindicated in an active, catastrophic uterine hemorrhage
where immediate delivery is mandatory.
2. A 26-year-old client at 28 weeks gestation presents with sudden, painless,
bright red vaginal bleeding. She states she felt a warm gush of fluid while
resting. She denies any trauma or abdominal pain. Which nursing action is
strictly contraindicated during the initial clinical assessment?
, A. Continuous external electronic monitoring of the fetal heart rate.
B. Gentle palpation of the abdomen to determine uterine tone.
C. Performing a digital or sterile speculum vaginal examination.
D. Drawing blood for a type and cross-match with a complete blood count.
CORRECT ANSWER: C
RATIONALE: Painless, bright red vaginal bleeding in the second half of
pregnancy indicates placenta previa. Digital vaginal examinations are strictly
contraindicated because inserting a finger or instrument into the cervix can
puncture the placenta, leading to a catastrophic maternal-fetal hemorrhage.
Monitoring the fetus (A), checking uterine tone gently (B), and cross-matching
blood (D) are safe and necessary interventions for stabilizing a patient with
suspected placenta previa.
3. A client at 34 weeks gestation is admitted with severe preeclampsia. Her
blood pressure is 172/114 mmHg. While evaluating her neurological status,
the nurse elicits brisk, hyperactive deep tendon reflexes (4+ patellar DTRs)
and 3 beats of ankle clonus. What do these brisk reflexes signify to the
nurse?
A. The therapeutic threshold of magnesium sulfate has been safely achieved.
B. An irritable cerebral cortex indicating an imminent risk of eclamptic
seizures.
C. Progressive renal insufficiency leading to systemic hypocalcemia.
D. A normal physiological variance caused by late-pregnancy spinal cord
compression.
CORRECT ANSWER: B
RATIONALE: In preeclampsia, brisk reflexes (hyperreflexia) occur due to
an irritable cerebral cortex. This indicates a highly excited central nervous system
that significantly increases the immediate risk of progressing to eclampsia
(seizures). Magnesium toxicity causes diminished or absent reflexes, not
hyperreflexia. While renal insufficiency can occur in severe preeclampsia,
hyperreflexia in this context directly tracks cortical excitability.
4. A client at 10 weeks gestation presents to the emergency department with
severe, unilateral lower quadrant abdominal pain, light vaginal spotting, and
dizziness. Her blood pressure is 92/54 mmHg, and her heart rate is 118 bpm.
Which obstetric disorder matches this presentation and requires immediate
, surgical triage?
A. Gestational trophoblastic disease
B. Cervical insufficiency
C. Spontaneous abortion
D. Ectopic pregnancy
CORRECT ANSWER: D
RATIONALE: An ectopic pregnancy typically presents in the first half of
pregnancy with unilateral pelvic pain and spotting. Signs of hypotension and
tachycardia suggest an active tubal rupture, creating a high risk for massive
hemorrhage and death. While gestational trophoblastic disease (A), cervical
insufficiency (B), and spontaneous abortion (C) cause early pregnancy bleeding,
they do not typically present with this specific combination of acute unilateral
peritoneal pain and hypovolemic shock.
5. A client at 14 weeks gestation is diagnosed with gestational trophoblastic
disease (hydatidiform mole). Following a suction dilation and curettage
(D&C), which long-term follow-up instruction is critical to include in the
discharge teaching?
A. Restrict oral fluid intake to prevent fluid volume overload.
B. Obtain serial serum human chorionic gonadotropin (hCG) levels for
one full year.
C. Irrigate the vaginal canal daily with an antiseptic solution.
D. Maintain strict bed rest and pelvic rest for the next six months.
CORRECT ANSWER: B
RATIONALE: After a molar pregnancy evacuation, the client must undergo
serial tracking of serum hCG levels for 1 year. This long-term follow-up is
necessary to detect any remaining trophoblastic tissue that could proliferate and
turn into a malignancy, such as choriocarcinoma. If residual tissue persists, hCG
levels will fail to regress. Restricting fluids (A), douching (C), and 6 months of bed
rest (D) are incorrect and do not address the monitoring required for
choriocarcinoma detection.
6. A multigravida client at 20 weeks gestation is admitted following a painless
cervical dilation that resulted in a second-trimester pregnancy loss. The
provider plans a surgical cerclage for her next pregnancy. How should the
nurse explain the purpose of this procedure?
, A. It chemically blocks the autoimmune destruction of placental beta cells.
B. It reduces endometrial scarring in the upper uterine segment.
C. A heavy string suture reinforces and secures the internal os of the
cervix.
D. It prevents the development of abnormal trophoblastic cell proliferation.
CORRECT ANSWER: C
RATIONALE: Cervical insufficiency involves premature, painless dilation of
the cervix during the second or early third trimester. A surgical cerclage places a
heavy string suture to secure and reinforce the internal os of the cervix. This
provides mechanical support to help prevent premature dilation and subsequent
pregnancy loss. It does not influence beta cells (A), repair endometrial scarring
(B), or treat trophoblastic cell proliferation (D).
7. The nurse is reviewing laboratory results for a preeclamptic client and notes
a low hematocrit, elevated lactic dehydrogenase (LDH), elevated aspartate
aminotransferase (AST), elevated alanine aminotransferase (ALT), and a
platelet count of 72,000 cells/mm³. The nurse should recognize that this
client has developed which severe complication?
A. Transient tachypnea of the newborn
B. Gestational diabetes mellitus
C. HELLP syndrome
D. Hydatidiform mole
CORRECT ANSWER: C
RATIONALE: HELLP syndrome is an acronym that stands for Hemolysis
(low hematocrit), Elevated Liver enzymes (LDH, AST, ALT), and Low Platelets
(less than 100,000 cells/mm³). This syndrome is a severe manifestation of
preeclampsia that carries an increased risk for hepatic rupture, DIC, and maternal
death. It is unrelated to neonatal tachypnea (A), gestational diabetes (B), or molar
pregnancies (D).
8. A client at 26 weeks gestation undergoes a 2-hour oral glucose tolerance test
(GTT) for gestational diabetes mellitus (GDM) screening. Her 2-hour
blood sugar reading is 154 mg/dL. Which next step should the nurse
anticipate?
A. Initiate immediate high-dose insulin therapy.
B. Reassure the client that this reading is normal.
Prep with Detailed Rationales
Course Code: NURS420
Course Name: Advanced Maternal-Newborn Nursing
Topic: Obstetric Complications, Hypertensive Disorders, and Antepartum Bleeding
Academic Year: 2026/2027
1. A multiparous client at 32 weeks gestation arrives via emergency medical
services with sudden-onset, agonizing abdominal pain, a rigid board-like
abdomen, and dark vaginal bleeding. The fetal monitoring strip demonstrates
prolonged late decelerations with a baseline of 90 bpm. Which immediate
life-saving intervention should the labor and delivery nurse execute first?
A. Perform a sterile vaginal examination to evaluate cervical dilation and
effacement.
B. Establish two large-bore intravenous lines and prepare for an
emergency cesarean section.
C. Obtain a clean-catch urine specimen to screen for high-grade proteinuria.
D. Administer a subcutaneous dose of terbutaline sulfate to arrest uterine
hyperstimulation.
CORRECT ANSWER: B
RATIONALE: The client is presenting with classic, high-yield manifestations
of a severe placental abruption (premature separation of the placenta after 20
weeks), which is an absolute obstetric emergency. The priority is to establish two
large-bore IV lines for fluid/blood resuscitation and immediately prepare for an
emergency cesarean section due to explicit fetal distress (bradycardia and late
decelerations). Performing a vaginal exam (A) is dangerous if placenta previa has
not been fully ruled out. Checking for protein (C) delays life-saving care, and
terbutaline (D) is contraindicated in an active, catastrophic uterine hemorrhage
where immediate delivery is mandatory.
2. A 26-year-old client at 28 weeks gestation presents with sudden, painless,
bright red vaginal bleeding. She states she felt a warm gush of fluid while
resting. She denies any trauma or abdominal pain. Which nursing action is
strictly contraindicated during the initial clinical assessment?
, A. Continuous external electronic monitoring of the fetal heart rate.
B. Gentle palpation of the abdomen to determine uterine tone.
C. Performing a digital or sterile speculum vaginal examination.
D. Drawing blood for a type and cross-match with a complete blood count.
CORRECT ANSWER: C
RATIONALE: Painless, bright red vaginal bleeding in the second half of
pregnancy indicates placenta previa. Digital vaginal examinations are strictly
contraindicated because inserting a finger or instrument into the cervix can
puncture the placenta, leading to a catastrophic maternal-fetal hemorrhage.
Monitoring the fetus (A), checking uterine tone gently (B), and cross-matching
blood (D) are safe and necessary interventions for stabilizing a patient with
suspected placenta previa.
3. A client at 34 weeks gestation is admitted with severe preeclampsia. Her
blood pressure is 172/114 mmHg. While evaluating her neurological status,
the nurse elicits brisk, hyperactive deep tendon reflexes (4+ patellar DTRs)
and 3 beats of ankle clonus. What do these brisk reflexes signify to the
nurse?
A. The therapeutic threshold of magnesium sulfate has been safely achieved.
B. An irritable cerebral cortex indicating an imminent risk of eclamptic
seizures.
C. Progressive renal insufficiency leading to systemic hypocalcemia.
D. A normal physiological variance caused by late-pregnancy spinal cord
compression.
CORRECT ANSWER: B
RATIONALE: In preeclampsia, brisk reflexes (hyperreflexia) occur due to
an irritable cerebral cortex. This indicates a highly excited central nervous system
that significantly increases the immediate risk of progressing to eclampsia
(seizures). Magnesium toxicity causes diminished or absent reflexes, not
hyperreflexia. While renal insufficiency can occur in severe preeclampsia,
hyperreflexia in this context directly tracks cortical excitability.
4. A client at 10 weeks gestation presents to the emergency department with
severe, unilateral lower quadrant abdominal pain, light vaginal spotting, and
dizziness. Her blood pressure is 92/54 mmHg, and her heart rate is 118 bpm.
Which obstetric disorder matches this presentation and requires immediate
, surgical triage?
A. Gestational trophoblastic disease
B. Cervical insufficiency
C. Spontaneous abortion
D. Ectopic pregnancy
CORRECT ANSWER: D
RATIONALE: An ectopic pregnancy typically presents in the first half of
pregnancy with unilateral pelvic pain and spotting. Signs of hypotension and
tachycardia suggest an active tubal rupture, creating a high risk for massive
hemorrhage and death. While gestational trophoblastic disease (A), cervical
insufficiency (B), and spontaneous abortion (C) cause early pregnancy bleeding,
they do not typically present with this specific combination of acute unilateral
peritoneal pain and hypovolemic shock.
5. A client at 14 weeks gestation is diagnosed with gestational trophoblastic
disease (hydatidiform mole). Following a suction dilation and curettage
(D&C), which long-term follow-up instruction is critical to include in the
discharge teaching?
A. Restrict oral fluid intake to prevent fluid volume overload.
B. Obtain serial serum human chorionic gonadotropin (hCG) levels for
one full year.
C. Irrigate the vaginal canal daily with an antiseptic solution.
D. Maintain strict bed rest and pelvic rest for the next six months.
CORRECT ANSWER: B
RATIONALE: After a molar pregnancy evacuation, the client must undergo
serial tracking of serum hCG levels for 1 year. This long-term follow-up is
necessary to detect any remaining trophoblastic tissue that could proliferate and
turn into a malignancy, such as choriocarcinoma. If residual tissue persists, hCG
levels will fail to regress. Restricting fluids (A), douching (C), and 6 months of bed
rest (D) are incorrect and do not address the monitoring required for
choriocarcinoma detection.
6. A multigravida client at 20 weeks gestation is admitted following a painless
cervical dilation that resulted in a second-trimester pregnancy loss. The
provider plans a surgical cerclage for her next pregnancy. How should the
nurse explain the purpose of this procedure?
, A. It chemically blocks the autoimmune destruction of placental beta cells.
B. It reduces endometrial scarring in the upper uterine segment.
C. A heavy string suture reinforces and secures the internal os of the
cervix.
D. It prevents the development of abnormal trophoblastic cell proliferation.
CORRECT ANSWER: C
RATIONALE: Cervical insufficiency involves premature, painless dilation of
the cervix during the second or early third trimester. A surgical cerclage places a
heavy string suture to secure and reinforce the internal os of the cervix. This
provides mechanical support to help prevent premature dilation and subsequent
pregnancy loss. It does not influence beta cells (A), repair endometrial scarring
(B), or treat trophoblastic cell proliferation (D).
7. The nurse is reviewing laboratory results for a preeclamptic client and notes
a low hematocrit, elevated lactic dehydrogenase (LDH), elevated aspartate
aminotransferase (AST), elevated alanine aminotransferase (ALT), and a
platelet count of 72,000 cells/mm³. The nurse should recognize that this
client has developed which severe complication?
A. Transient tachypnea of the newborn
B. Gestational diabetes mellitus
C. HELLP syndrome
D. Hydatidiform mole
CORRECT ANSWER: C
RATIONALE: HELLP syndrome is an acronym that stands for Hemolysis
(low hematocrit), Elevated Liver enzymes (LDH, AST, ALT), and Low Platelets
(less than 100,000 cells/mm³). This syndrome is a severe manifestation of
preeclampsia that carries an increased risk for hepatic rupture, DIC, and maternal
death. It is unrelated to neonatal tachypnea (A), gestational diabetes (B), or molar
pregnancies (D).
8. A client at 26 weeks gestation undergoes a 2-hour oral glucose tolerance test
(GTT) for gestational diabetes mellitus (GDM) screening. Her 2-hour
blood sugar reading is 154 mg/dL. Which next step should the nurse
anticipate?
A. Initiate immediate high-dose insulin therapy.
B. Reassure the client that this reading is normal.
