NUR 230 OB/PEDS EXAM 2 PRACTICE QUESTIONS WITH
VERIFIED AND CORRECT ANSWERS WITH DETAILED
RATIONALE
1. A pregnant client at 38 weeks gestation is admitted in active
labor. The nurse notes late decelerations on the fetal monitor.
What is the priority nursing action?
A. Reposition the client to the left side ✅
B. Increase the oxytocin infusion
C. Document the finding and continue to monitor
D. Prepare for immediate delivery
Rationale: Late decelerations indicate uteroplacental insufficiency.
Repositioning to the left side improves blood flow to the placenta.
Oxygen and IV fluids may also be needed.
2. A client in labor has an epidural. Which finding requires
immediate intervention?
A. Blood pressure 88/50 mm Hg ✅
B. Fetal heart rate 140/min
C. Urinary output 60 mL/hr
D. Mild itching at the site
Rationale: Hypotension is a common side effect of epidural
anesthesia. It can reduce placental perfusion and requires
immediate intervention (fluids, vasopressors, repositioning).
3. A postpartum client is 2 hours post-vaginal delivery. The nurse
notes a boggy uterus and heavy lochia. What should the nurse do
first?
A. Massage the fundus ✅
,B. Administer oxytocin
C. Increase IV fluids
D. Notify the provider
Rationale: A boggy uterus indicates uterine atony, the most
common cause of postpartum hemorrhage. Fundal massage is the
first intervention to stimulate contraction.
4. A newborn is 1 hour old. Which finding should the nurse report
immediately?
A. Respiratory rate 70/min ✅
B. Heart rate 130/min
C. Axillary temperature 97.8°F
D. Meconium stool passed
Rationale: A respiratory rate >60/min in a newborn may indicate
respiratory distress. Normal newborn RR is 30–60/min.
5. A client at 36 weeks gestation has a blood pressure of 160/110
mm Hg and 3+ proteinuria. Which condition is most likely?
A. Preeclampsia with severe features ✅
B. Gestational hypertension
C. Chronic hypertension
D. Eclampsia
Rationale: Severe preeclampsia is defined by BP ≥160/110,
proteinuria, and other end-organ effects. Eclampsia includes
seizures.
6. A client is receiving magnesium sulfate for preeclampsia. Which
finding indicates magnesium toxicity?
,A. Respiratory rate 10/min ✅
B. Blood pressure 130/80 mm Hg
C. Deep tendon reflexes 2+
D. Urine output 40 mL/hr
Rationale: Magnesium toxicity causes respiratory depression, loss
of deep tendon reflexes, and oliguria. The antidote is calcium
gluconate.
7. A newborn has a heart rate of 90/min, irregular respirations,
and grimaces when stimulated. What is the APGAR score?
A. 4 ✅
B. 5
C. 6
D. 7
Rationale: HR <100 = 1, irregular respirations = 1, grimace = 1,
activity and reflex not given; total at least 3, but with only these,
APGAR is 4 (assuming 0 for color and tone).
8. A client in labor is 8 cm dilated and requests pain relief. Which
medication is contraindicated?
A. Butorphanol (Stadol) ✅
B. Nalbuphine (Nubain)
C. Fentanyl
D. Morphine
Rationale: Agonist-antagonist opioids like butorphanol can cause
respiratory depression in the newborn if given too close to
delivery; they are avoided in late labor.
, 9. A postpartum client is breastfeeding. Which instruction should
the nurse include to prevent mastitis?
A. Empty both breasts completely at each feeding ✅
B. Wear a tight-fitting bra
C. Limit fluid intake
D. Skip feedings if sore
Rationale: Stasis of milk can lead to mastitis. Emptying breasts
completely helps prevent it.
10. A newborn is diagnosed with jaundice at 24 hours of life.
Which finding is most concerning?
A. Total serum bilirubin 12 mg/dL ✅
B. Breastfeeding well
C. Weight loss 5%
D. Meconium passed
Rationale: Jaundice within 24 hours is always pathologic. A
bilirubin of 12 mg/dL at 24 hours is high and requires immediate
treatment (phototherapy).
11. A 2-month-old infant is scheduled for immunizations. Which
vaccine is contraindicated if the infant has a severe allergy to
eggs?
A. MMR
B. Influenza ✅
C. DTaP
D. Hepatitis B
VERIFIED AND CORRECT ANSWERS WITH DETAILED
RATIONALE
1. A pregnant client at 38 weeks gestation is admitted in active
labor. The nurse notes late decelerations on the fetal monitor.
What is the priority nursing action?
A. Reposition the client to the left side ✅
B. Increase the oxytocin infusion
C. Document the finding and continue to monitor
D. Prepare for immediate delivery
Rationale: Late decelerations indicate uteroplacental insufficiency.
Repositioning to the left side improves blood flow to the placenta.
Oxygen and IV fluids may also be needed.
2. A client in labor has an epidural. Which finding requires
immediate intervention?
A. Blood pressure 88/50 mm Hg ✅
B. Fetal heart rate 140/min
C. Urinary output 60 mL/hr
D. Mild itching at the site
Rationale: Hypotension is a common side effect of epidural
anesthesia. It can reduce placental perfusion and requires
immediate intervention (fluids, vasopressors, repositioning).
3. A postpartum client is 2 hours post-vaginal delivery. The nurse
notes a boggy uterus and heavy lochia. What should the nurse do
first?
A. Massage the fundus ✅
,B. Administer oxytocin
C. Increase IV fluids
D. Notify the provider
Rationale: A boggy uterus indicates uterine atony, the most
common cause of postpartum hemorrhage. Fundal massage is the
first intervention to stimulate contraction.
4. A newborn is 1 hour old. Which finding should the nurse report
immediately?
A. Respiratory rate 70/min ✅
B. Heart rate 130/min
C. Axillary temperature 97.8°F
D. Meconium stool passed
Rationale: A respiratory rate >60/min in a newborn may indicate
respiratory distress. Normal newborn RR is 30–60/min.
5. A client at 36 weeks gestation has a blood pressure of 160/110
mm Hg and 3+ proteinuria. Which condition is most likely?
A. Preeclampsia with severe features ✅
B. Gestational hypertension
C. Chronic hypertension
D. Eclampsia
Rationale: Severe preeclampsia is defined by BP ≥160/110,
proteinuria, and other end-organ effects. Eclampsia includes
seizures.
6. A client is receiving magnesium sulfate for preeclampsia. Which
finding indicates magnesium toxicity?
,A. Respiratory rate 10/min ✅
B. Blood pressure 130/80 mm Hg
C. Deep tendon reflexes 2+
D. Urine output 40 mL/hr
Rationale: Magnesium toxicity causes respiratory depression, loss
of deep tendon reflexes, and oliguria. The antidote is calcium
gluconate.
7. A newborn has a heart rate of 90/min, irregular respirations,
and grimaces when stimulated. What is the APGAR score?
A. 4 ✅
B. 5
C. 6
D. 7
Rationale: HR <100 = 1, irregular respirations = 1, grimace = 1,
activity and reflex not given; total at least 3, but with only these,
APGAR is 4 (assuming 0 for color and tone).
8. A client in labor is 8 cm dilated and requests pain relief. Which
medication is contraindicated?
A. Butorphanol (Stadol) ✅
B. Nalbuphine (Nubain)
C. Fentanyl
D. Morphine
Rationale: Agonist-antagonist opioids like butorphanol can cause
respiratory depression in the newborn if given too close to
delivery; they are avoided in late labor.
, 9. A postpartum client is breastfeeding. Which instruction should
the nurse include to prevent mastitis?
A. Empty both breasts completely at each feeding ✅
B. Wear a tight-fitting bra
C. Limit fluid intake
D. Skip feedings if sore
Rationale: Stasis of milk can lead to mastitis. Emptying breasts
completely helps prevent it.
10. A newborn is diagnosed with jaundice at 24 hours of life.
Which finding is most concerning?
A. Total serum bilirubin 12 mg/dL ✅
B. Breastfeeding well
C. Weight loss 5%
D. Meconium passed
Rationale: Jaundice within 24 hours is always pathologic. A
bilirubin of 12 mg/dL at 24 hours is high and requires immediate
treatment (phototherapy).
11. A 2-month-old infant is scheduled for immunizations. Which
vaccine is contraindicated if the infant has a severe allergy to
eggs?
A. MMR
B. Influenza ✅
C. DTaP
D. Hepatitis B
