High Risk Maternity Nursing 2026 Practice Test
Questions Detailed Explanations Pregnancy
Complications Hypertension Diabetes Placental
Problems Fetal Assessment
SECTION 1: PREGNANCY COMPLICATIONS (Questions 1–30)
Question 1
A 32-year-old primigravida at 38 weeks' gestation reports a sudden onset of severe,
continuous abdominal pain accompanied by vaginal bleeding. On examination, her
uterus is firm and tender to palpation, and fetal heart rate decelerations are noted.
What is the priority nursing intervention?
A. Administer a bolus of intravenous fluids and prepare for an emergency cesarean
section
B. Perform a sterile vaginal exam to assess cervical dilation
C. Administer an analgesic for pain management and monitor contractions
D. Apply an external fetal monitor and encourage the patient to ambulate
Correct Answer: A. Administer a bolus of intravenous fluids and prepare for
an emergency cesarean section
Rationale: The presentation of sudden, severe abdominal pain, uterine tenderness,
and bleeding in a third-trimester patient is classic for placental abruption. This is
an obstetric emergency requiring immediate delivery to preserve maternal and fetal
well-being. Preparing for an emergency cesarean section is the priority after
initiating intravenous access and fluid resuscitation. A vaginal exam is
contraindicated with active bleeding until placenta previa is ruled out, and
ambulation is unsafe.
Question 2
A pregnant patient at 26 weeks presents to the emergency department with sudden
,onset of vaginal bleeding and severe abdominal pain. On examination, the uterus is
tender and fetal distress is present. Which of the following is the most likely
diagnosis?
A. Placental abruption
B. Placenta previa
C. Ectopic pregnancy
D. Molar pregnancy
Correct Answer: A. Placental abruption
Rationale: Placental abruption presents with painful vaginal bleeding, uterine
tenderness, and fetal distress. Placenta previa typically presents with painless,
bright red vaginal bleeding and a soft, non-tender uterus.
Question 3
A pregnant patient at 30 weeks' gestation presents with painless vaginal bleeding.
On examination, the uterus is soft and non-tender, and fetal distress is not present.
Which of the following is the most likely diagnosis?
A. Placental abruption
B. Placenta previa
C. Cervical ectopy
D. Vasa previa
Correct Answer: B. Placenta previa
Rationale: Placenta previa classically presents with painless, bright red vaginal
bleeding in the third trimester. The uterus is typically soft and non-tender, and fetal
distress is often absent unless significant hemorrhage occurs.
Question 4
A nurse is caring for a client with a diagnosis of placental abruption. Which
assessment finding would the nurse expect?
,A. Painless vaginal bleeding
B. A soft, non-tender uterus
C. A firm, tender uterus with dark red bleeding
D. Fundal height smaller than expected for gestational age
Correct Answer: C. A firm, tender uterus with dark red bleeding
Rationale: Placental abruption is characterized by a firm, tender uterus, dark red
vaginal bleeding, and uterine hypertonicity. The fundal height may increase due to
concealed bleeding behind the placenta.
Question 5
A client at 35 weeks' gestation presents with sudden onset of severe abdominal
pain, a firm uterus, and dark red vaginal bleeding. Fetal heart tones are absent.
What is the nurse's priority action?
A. Administer oxygen via face mask
B. Prepare for emergency cesarean section
C. Administer an analgesic
D. Perform a vaginal exam
Correct Answer: B. Prepare for emergency cesarean section
Rationale: This presentation suggests placental abruption with fetal demise. The
priority is to prepare for emergency cesarean section to prevent maternal
complications such as disseminated intravascular coagulation (DIC) and
hemorrhage.
Question 6
A nurse is assessing a client at 34 weeks' gestation who has mild preeclampsia.
Which finding should the nurse report immediately?
A. Blood pressure of 142/92 mmHg
B. 1+ proteinuria
, C. Persistent frontal headache
D. Mild ankle edema
Correct Answer: C. Persistent frontal headache
Rationale: A persistent frontal headache is a severe feature of preeclampsia that
indicates worsening disease and risk for eclampsia. Blood pressure of 142/92
mmHg and 1+ proteinuria are consistent with mild preeclampsia and require
monitoring but not immediate reporting.
Question 7
A client at 32 weeks' gestation presents with a blood pressure of 150/98 mmHg, 2+
proteinuria on dipstick, and complaints of a severe headache. Based on diagnostic
criteria, this is most consistent with:
A. Chronic hypertension
B. Gestational hypertension
C. Preeclampsia with severe features
D. HELLP syndrome
Correct Answer: C. Preeclampsia with severe features
Rationale: The client has gestational hypertension (BP ≥140/90 after 20 weeks)
PLUS proteinuria AND a severe feature (severe headache). BP of 150/98 is not yet
≥160/110, but the presence of another severe symptom (headache) qualifies as
preeclampsia with severe features.
Question 8
A nurse is assessing a client with suspected preeclampsia. Which of the following
findings would be the MOST concerning and require immediate intervention?
A. 1+ pitting edema of the ankles
B. Hyperreflexia with clonus
C. Trace proteinuria on a random dipstick
D. Weight gain of 2 lbs in one week
Questions Detailed Explanations Pregnancy
Complications Hypertension Diabetes Placental
Problems Fetal Assessment
SECTION 1: PREGNANCY COMPLICATIONS (Questions 1–30)
Question 1
A 32-year-old primigravida at 38 weeks' gestation reports a sudden onset of severe,
continuous abdominal pain accompanied by vaginal bleeding. On examination, her
uterus is firm and tender to palpation, and fetal heart rate decelerations are noted.
What is the priority nursing intervention?
A. Administer a bolus of intravenous fluids and prepare for an emergency cesarean
section
B. Perform a sterile vaginal exam to assess cervical dilation
C. Administer an analgesic for pain management and monitor contractions
D. Apply an external fetal monitor and encourage the patient to ambulate
Correct Answer: A. Administer a bolus of intravenous fluids and prepare for
an emergency cesarean section
Rationale: The presentation of sudden, severe abdominal pain, uterine tenderness,
and bleeding in a third-trimester patient is classic for placental abruption. This is
an obstetric emergency requiring immediate delivery to preserve maternal and fetal
well-being. Preparing for an emergency cesarean section is the priority after
initiating intravenous access and fluid resuscitation. A vaginal exam is
contraindicated with active bleeding until placenta previa is ruled out, and
ambulation is unsafe.
Question 2
A pregnant patient at 26 weeks presents to the emergency department with sudden
,onset of vaginal bleeding and severe abdominal pain. On examination, the uterus is
tender and fetal distress is present. Which of the following is the most likely
diagnosis?
A. Placental abruption
B. Placenta previa
C. Ectopic pregnancy
D. Molar pregnancy
Correct Answer: A. Placental abruption
Rationale: Placental abruption presents with painful vaginal bleeding, uterine
tenderness, and fetal distress. Placenta previa typically presents with painless,
bright red vaginal bleeding and a soft, non-tender uterus.
Question 3
A pregnant patient at 30 weeks' gestation presents with painless vaginal bleeding.
On examination, the uterus is soft and non-tender, and fetal distress is not present.
Which of the following is the most likely diagnosis?
A. Placental abruption
B. Placenta previa
C. Cervical ectopy
D. Vasa previa
Correct Answer: B. Placenta previa
Rationale: Placenta previa classically presents with painless, bright red vaginal
bleeding in the third trimester. The uterus is typically soft and non-tender, and fetal
distress is often absent unless significant hemorrhage occurs.
Question 4
A nurse is caring for a client with a diagnosis of placental abruption. Which
assessment finding would the nurse expect?
,A. Painless vaginal bleeding
B. A soft, non-tender uterus
C. A firm, tender uterus with dark red bleeding
D. Fundal height smaller than expected for gestational age
Correct Answer: C. A firm, tender uterus with dark red bleeding
Rationale: Placental abruption is characterized by a firm, tender uterus, dark red
vaginal bleeding, and uterine hypertonicity. The fundal height may increase due to
concealed bleeding behind the placenta.
Question 5
A client at 35 weeks' gestation presents with sudden onset of severe abdominal
pain, a firm uterus, and dark red vaginal bleeding. Fetal heart tones are absent.
What is the nurse's priority action?
A. Administer oxygen via face mask
B. Prepare for emergency cesarean section
C. Administer an analgesic
D. Perform a vaginal exam
Correct Answer: B. Prepare for emergency cesarean section
Rationale: This presentation suggests placental abruption with fetal demise. The
priority is to prepare for emergency cesarean section to prevent maternal
complications such as disseminated intravascular coagulation (DIC) and
hemorrhage.
Question 6
A nurse is assessing a client at 34 weeks' gestation who has mild preeclampsia.
Which finding should the nurse report immediately?
A. Blood pressure of 142/92 mmHg
B. 1+ proteinuria
, C. Persistent frontal headache
D. Mild ankle edema
Correct Answer: C. Persistent frontal headache
Rationale: A persistent frontal headache is a severe feature of preeclampsia that
indicates worsening disease and risk for eclampsia. Blood pressure of 142/92
mmHg and 1+ proteinuria are consistent with mild preeclampsia and require
monitoring but not immediate reporting.
Question 7
A client at 32 weeks' gestation presents with a blood pressure of 150/98 mmHg, 2+
proteinuria on dipstick, and complaints of a severe headache. Based on diagnostic
criteria, this is most consistent with:
A. Chronic hypertension
B. Gestational hypertension
C. Preeclampsia with severe features
D. HELLP syndrome
Correct Answer: C. Preeclampsia with severe features
Rationale: The client has gestational hypertension (BP ≥140/90 after 20 weeks)
PLUS proteinuria AND a severe feature (severe headache). BP of 150/98 is not yet
≥160/110, but the presence of another severe symptom (headache) qualifies as
preeclampsia with severe features.
Question 8
A nurse is assessing a client with suspected preeclampsia. Which of the following
findings would be the MOST concerning and require immediate intervention?
A. 1+ pitting edema of the ankles
B. Hyperreflexia with clonus
C. Trace proteinuria on a random dipstick
D. Weight gain of 2 lbs in one week
