NUR 254 Exam 4 | Galen college: Complex Maternal-
Child Critical States Prep with Detailed Rationales
Course Code: NURS 254
Course Name: Complex Maternal-Child Critical States
Topic: Advanced Maternal-Neonatal Complications & Critical Management
Academic Year: 2026/2027
156. A 31-year-old multigravida at 34 weeks gestation presents to the
emergency department reporting sudden, severe, continuous abdominal
pain and dark vaginal bleeding. Upon physical assessment, the nurse notes
that the patient's abdomen is rigid and board-like, and the uterus is highly
tender to palpation. What obstetric emergency matches this clinical picture?
A. Placenta Previa.
, B. Placental Abruption (Abruptio Placentae).
C. Uterine Atony.
D. Incompetent Cervix.
CORRECT ANSWER: B
RATIONALE: Placental abruption involves the premature separation of a
normally implanted placenta from the uterine wall before delivery. The classic
presentation includes dark vaginal bleeding, severe abdominal pain, uterine
tenderness, and a rigid, board-like abdomen caused by concealed retroplacental
hemorrhage infusing into the myometrium. Distractor A (Placenta Previa) presents
characteristically with painless, bright red vaginal bleeding and a soft, non-tender
uterus. Distractors C and D describe different structural or postpartum conditions.
157. A nurse is evaluating a client in the labor and delivery suite who is
receiving an oxytocin infusion for labor induction. The fetal monitoring strip
suddenly reveals late decelerations featuring a gradual decrease and return
of FHR associated with uterine contractions, where the nadir occurs after
the peak of the contraction. What is the underlying pathophysiology
driving this pattern?
A. Umbilical cord compression restricting blood flow through the umbilical
vein.
B. Transient fetal head compression stimulating a vagal nerve reflex during
descent.
C. Uteroplacental insufficiency, resulting in decreased oxygen exchange
across the intervillous space during contractions.
D. Acute fetal respiratory acidosis secondary to maternal hyperventilation.
CORRECT ANSWER: C
RATIONALE: Late decelerations are caused by uteroplacental
insufficiency, which means the placenta is unable to deliver adequate oxygen to
the fetus during a uterine contraction. This creates a state of hypoxia, triggering a
chemoreceptor-mediated deceleration that lags behind the contraction cycle.
Distractor A causes variable decelerations. Distractor B causes early
decelerations. Distractor D is an inaccurate mechanism.
158. A nurse is monitoring a laboring client who is at 100% effaced, 6 cm
dilated, with the fetal head at −2 station. The amniotic sac ruptures
spontaneously, and the nurse instantly notes a sudden drop in the fetal heart
, rate baseline to 60 bpm with deep, prolonged variable decelerations.
What is the nurse's priority action?
A. Increase the oxytocin infusion rate to accelerate the delivery.
B. Perform an immediate vaginal exam, apply upward pressure to lift
the fetal presenting part off the umbilical cord, and call for emergency
assistance.
C. Place the patient in a high-Fowler's position and apply an ice pack to the
abdomen.
D. Administer an immediate dose of an oral antihypertensive medication.
CORRECT ANSWER: B
RATIONALE: The sudden onset of deep variable decelerations immediately
following the rupture of membranes when the fetus is unengaged (−2 station) is a
classic indicator of an umbilical cord prolapse. The priority action is to relieve
cord compression by performing a sterile vaginal exam and holding the fetal
presenting part up off the cord, while simultaneously calling for help to prepare
for an emergent cesarean delivery. Distractor A would worsen cord compression.
Distractor C restricts pelvic space and exacerbates hypoxia. Distractor D does not
address the mechanical cord obstruction.
159. A 24-year-old primigravida at 32 weeks gestation presents to the
triage unit complaining of a sudden headache, blurry vision, and generalized
facial edema. Her vital signs reveal a blood pressure of 162/112 mmHg,
and a point-of-care urinalysis demonstrates 3+ proteinuria. Which
immediate pharmacological intervention is indicated to prevent the onset of
eclamptic seizures?
A. Continuous intravenous infusion of Oxytocin titrated to contraction
frequency.
B. Intravenous loading dose of Magnesium Sulfate (4 to 6 grams)
followed by a continuous maintenance infusion.
C. Oral administration of high-dose Methyldopa.
D. Intramuscular injection of Betamethasone to accelerate fetal lung
maturity.
CORRECT ANSWER: B
RATIONALE: The patient is demonstrating classic signs of preeclampsia
with severe features (severe hypertension, proteinuria, and neurological signs like
visual disturbances and headache). Magnesium Sulfate is the gold-standard
, anticonvulsant used to prevent and control eclamptic seizures by depressing the
central nervous system and blocking neuromuscular transmission. Distractor A is
used for labor induction. Distractor C is a mild antihypertensive not suitable for
acute, immediate seizure prophylaxis in severe preeclampsia. Distractor D
accelerates fetal lung maturity but does not treat the maternal seizure risk.
160. A 35-year-old G3P2 at 38 weeks gestation is in active labor when
she suddenly experiences an acute onset of severe dyspnea, coughing,
hypotension, and cardiovascular collapse. The nurse notes rapid
development of Disseminated Intravascular Coagulation (DIC) with
active bleeding from all IV insertion sites. What rare but highly catastrophic
obstetric crisis is occurring?
A. Postpartum Hemorrhage secondary to retained placental fragments.
B. Amniotic Fluid Embolism (Anaphylactoid Syndrome of Pregnancy).
C. Severe acute HELLP syndrome.
D. Pulmonary thromboembolism from deep vein thrombosis.
CORRECT ANSWER: B
RATIONALE: An Amniotic Fluid Embolism (AFE) occurs when amniotic
fluid containing fetal debris enters the maternal circulation, triggering a
catastrophic, anaphylactoid-like immune and mechanical response. It is
characterized by a classic triad of acute respiratory distress/hypoxia, severe
cardiogenic shock/hypotension, and profound coagulopathy (DIC). Distractor
A causes bleeding but not immediate, sudden respiratory and anaphylactoid shock
prior to delivery. Distractor C features hemolysis, elevated liver enzymes, and low
platelets, but does not present with this rapid, catastrophic onset of sudden
collapse. Distractor D does not present with immediate, profound consumptive
DIC as a primary presenting feature.
161. A nurse is evaluating a client who is 2 hours postpartum following a
rapid vaginal delivery of a 9-pound, 12-ounce infant. Upon assessment, the
nurse notes that the client’s uterus is soft, boggy, and displaced to the
right side of the midline, accompanied by heavy rubra lochia. What is the
immediate priority nursing action?
A. Prepare an intramuscular injection of methylergonovine maleate.
B. Instruct the client to empty her bladder, or perform an in-and-out
catheterization, then re-evaluate uterine tone.
C. Administer high-flow supplemental oxygen via a non-rebreather face
Child Critical States Prep with Detailed Rationales
Course Code: NURS 254
Course Name: Complex Maternal-Child Critical States
Topic: Advanced Maternal-Neonatal Complications & Critical Management
Academic Year: 2026/2027
156. A 31-year-old multigravida at 34 weeks gestation presents to the
emergency department reporting sudden, severe, continuous abdominal
pain and dark vaginal bleeding. Upon physical assessment, the nurse notes
that the patient's abdomen is rigid and board-like, and the uterus is highly
tender to palpation. What obstetric emergency matches this clinical picture?
A. Placenta Previa.
, B. Placental Abruption (Abruptio Placentae).
C. Uterine Atony.
D. Incompetent Cervix.
CORRECT ANSWER: B
RATIONALE: Placental abruption involves the premature separation of a
normally implanted placenta from the uterine wall before delivery. The classic
presentation includes dark vaginal bleeding, severe abdominal pain, uterine
tenderness, and a rigid, board-like abdomen caused by concealed retroplacental
hemorrhage infusing into the myometrium. Distractor A (Placenta Previa) presents
characteristically with painless, bright red vaginal bleeding and a soft, non-tender
uterus. Distractors C and D describe different structural or postpartum conditions.
157. A nurse is evaluating a client in the labor and delivery suite who is
receiving an oxytocin infusion for labor induction. The fetal monitoring strip
suddenly reveals late decelerations featuring a gradual decrease and return
of FHR associated with uterine contractions, where the nadir occurs after
the peak of the contraction. What is the underlying pathophysiology
driving this pattern?
A. Umbilical cord compression restricting blood flow through the umbilical
vein.
B. Transient fetal head compression stimulating a vagal nerve reflex during
descent.
C. Uteroplacental insufficiency, resulting in decreased oxygen exchange
across the intervillous space during contractions.
D. Acute fetal respiratory acidosis secondary to maternal hyperventilation.
CORRECT ANSWER: C
RATIONALE: Late decelerations are caused by uteroplacental
insufficiency, which means the placenta is unable to deliver adequate oxygen to
the fetus during a uterine contraction. This creates a state of hypoxia, triggering a
chemoreceptor-mediated deceleration that lags behind the contraction cycle.
Distractor A causes variable decelerations. Distractor B causes early
decelerations. Distractor D is an inaccurate mechanism.
158. A nurse is monitoring a laboring client who is at 100% effaced, 6 cm
dilated, with the fetal head at −2 station. The amniotic sac ruptures
spontaneously, and the nurse instantly notes a sudden drop in the fetal heart
, rate baseline to 60 bpm with deep, prolonged variable decelerations.
What is the nurse's priority action?
A. Increase the oxytocin infusion rate to accelerate the delivery.
B. Perform an immediate vaginal exam, apply upward pressure to lift
the fetal presenting part off the umbilical cord, and call for emergency
assistance.
C. Place the patient in a high-Fowler's position and apply an ice pack to the
abdomen.
D. Administer an immediate dose of an oral antihypertensive medication.
CORRECT ANSWER: B
RATIONALE: The sudden onset of deep variable decelerations immediately
following the rupture of membranes when the fetus is unengaged (−2 station) is a
classic indicator of an umbilical cord prolapse. The priority action is to relieve
cord compression by performing a sterile vaginal exam and holding the fetal
presenting part up off the cord, while simultaneously calling for help to prepare
for an emergent cesarean delivery. Distractor A would worsen cord compression.
Distractor C restricts pelvic space and exacerbates hypoxia. Distractor D does not
address the mechanical cord obstruction.
159. A 24-year-old primigravida at 32 weeks gestation presents to the
triage unit complaining of a sudden headache, blurry vision, and generalized
facial edema. Her vital signs reveal a blood pressure of 162/112 mmHg,
and a point-of-care urinalysis demonstrates 3+ proteinuria. Which
immediate pharmacological intervention is indicated to prevent the onset of
eclamptic seizures?
A. Continuous intravenous infusion of Oxytocin titrated to contraction
frequency.
B. Intravenous loading dose of Magnesium Sulfate (4 to 6 grams)
followed by a continuous maintenance infusion.
C. Oral administration of high-dose Methyldopa.
D. Intramuscular injection of Betamethasone to accelerate fetal lung
maturity.
CORRECT ANSWER: B
RATIONALE: The patient is demonstrating classic signs of preeclampsia
with severe features (severe hypertension, proteinuria, and neurological signs like
visual disturbances and headache). Magnesium Sulfate is the gold-standard
, anticonvulsant used to prevent and control eclamptic seizures by depressing the
central nervous system and blocking neuromuscular transmission. Distractor A is
used for labor induction. Distractor C is a mild antihypertensive not suitable for
acute, immediate seizure prophylaxis in severe preeclampsia. Distractor D
accelerates fetal lung maturity but does not treat the maternal seizure risk.
160. A 35-year-old G3P2 at 38 weeks gestation is in active labor when
she suddenly experiences an acute onset of severe dyspnea, coughing,
hypotension, and cardiovascular collapse. The nurse notes rapid
development of Disseminated Intravascular Coagulation (DIC) with
active bleeding from all IV insertion sites. What rare but highly catastrophic
obstetric crisis is occurring?
A. Postpartum Hemorrhage secondary to retained placental fragments.
B. Amniotic Fluid Embolism (Anaphylactoid Syndrome of Pregnancy).
C. Severe acute HELLP syndrome.
D. Pulmonary thromboembolism from deep vein thrombosis.
CORRECT ANSWER: B
RATIONALE: An Amniotic Fluid Embolism (AFE) occurs when amniotic
fluid containing fetal debris enters the maternal circulation, triggering a
catastrophic, anaphylactoid-like immune and mechanical response. It is
characterized by a classic triad of acute respiratory distress/hypoxia, severe
cardiogenic shock/hypotension, and profound coagulopathy (DIC). Distractor
A causes bleeding but not immediate, sudden respiratory and anaphylactoid shock
prior to delivery. Distractor C features hemolysis, elevated liver enzymes, and low
platelets, but does not present with this rapid, catastrophic onset of sudden
collapse. Distractor D does not present with immediate, profound consumptive
DIC as a primary presenting feature.
161. A nurse is evaluating a client who is 2 hours postpartum following a
rapid vaginal delivery of a 9-pound, 12-ounce infant. Upon assessment, the
nurse notes that the client’s uterus is soft, boggy, and displaced to the
right side of the midline, accompanied by heavy rubra lochia. What is the
immediate priority nursing action?
A. Prepare an intramuscular injection of methylergonovine maleate.
B. Instruct the client to empty her bladder, or perform an in-and-out
catheterization, then re-evaluate uterine tone.
C. Administer high-flow supplemental oxygen via a non-rebreather face
