1. Question: A 38-year-old woman is in labor at 39 weeks of gestation. She has a
history of gestational diabetes. Which of the following actions should the nurse
prioritize?
Answer: Monitor the fetus for signs of hypoglycemia after delivery.
Rationale: Infants born to mothers with gestational diabetes are at risk for hypoglycemia due to
excess insulin production. Monitoring blood glucose levels in the neonate is essential.
2. Question: A nurse is caring for a postpartum client who has a 2nd-degree
perineal laceration. Which of the following interventions should the nurse
perform?
Answer: Apply ice packs to the perineum during the first 24 hours postpartum.
Rationale: Ice packs reduce swelling and pain following perineal lacerations and should be
applied during the first 24 hours to reduce inflammation.
3. Question: A client at 28 weeks gestation reports blurred vision, swelling in her
hands, and a headache. Which of the following conditions should the nurse
suspect?
Answer: Preeclampsia.
Rationale: Blurred vision, swelling, and headache are symptoms of preeclampsia, a hypertensive
disorder that can develop after 20 weeks of gestation.
4. Question: A nurse is assessing a neonate immediately after birth. Which of the
following findings requires further assessment?
Answer: A heart rate of 120 beats per minute.
Rationale: A heart rate of 120 beats per minute is normal in a newborn. If the heart rate were
lower (less than 100 bpm) or absent, it would require further assessment.
5. Question: A client who is 12 hours postpartum asks the nurse about resuming
sexual activity. What should the nurse respond?
, Answer: "You can resume sexual activity when you feel ready and after your 6-week postpartum
check-up."
Rationale: The typical recommendation is to wait until the 6-week postpartum visit for an
evaluation before resuming sexual activity.
6. Question: A nurse is providing discharge teaching to a client who delivered a
healthy newborn. Which of the following statements by the client indicates a
need for further teaching?
Answer: "I will stop using my prescribed iron supplement once I feel better."
Rationale: The client should continue taking iron supplements as prescribed to prevent anemia,
even if symptoms improve.
7. Question: A client at 35 weeks gestation is diagnosed with placenta previa.
Which of the following interventions should the nurse prioritize?
Answer: Monitor fetal heart rate and maternal vital signs.
Rationale: Placenta previa can cause bleeding, and monitoring the fetal heart rate and maternal
vital signs is essential for detecting any complications.
8. Question: A nurse is caring for a 2-day-old newborn who is breastfeeding. The
mother asks how she can know if her baby is getting enough milk. Which of the
following responses by the nurse is most appropriate?
Answer: "Your baby should be wetting at least six diapers per day."
Rationale: Adequate hydration is an important indicator that the baby is getting enough milk.
Six wet diapers per day is a good sign.
9. Question: A postpartum client is receiving intravenous oxytocin to promote
uterine contraction. The nurse should closely monitor for which of the following
complications?
Answer: Uterine hyperstimulation.
history of gestational diabetes. Which of the following actions should the nurse
prioritize?
Answer: Monitor the fetus for signs of hypoglycemia after delivery.
Rationale: Infants born to mothers with gestational diabetes are at risk for hypoglycemia due to
excess insulin production. Monitoring blood glucose levels in the neonate is essential.
2. Question: A nurse is caring for a postpartum client who has a 2nd-degree
perineal laceration. Which of the following interventions should the nurse
perform?
Answer: Apply ice packs to the perineum during the first 24 hours postpartum.
Rationale: Ice packs reduce swelling and pain following perineal lacerations and should be
applied during the first 24 hours to reduce inflammation.
3. Question: A client at 28 weeks gestation reports blurred vision, swelling in her
hands, and a headache. Which of the following conditions should the nurse
suspect?
Answer: Preeclampsia.
Rationale: Blurred vision, swelling, and headache are symptoms of preeclampsia, a hypertensive
disorder that can develop after 20 weeks of gestation.
4. Question: A nurse is assessing a neonate immediately after birth. Which of the
following findings requires further assessment?
Answer: A heart rate of 120 beats per minute.
Rationale: A heart rate of 120 beats per minute is normal in a newborn. If the heart rate were
lower (less than 100 bpm) or absent, it would require further assessment.
5. Question: A client who is 12 hours postpartum asks the nurse about resuming
sexual activity. What should the nurse respond?
, Answer: "You can resume sexual activity when you feel ready and after your 6-week postpartum
check-up."
Rationale: The typical recommendation is to wait until the 6-week postpartum visit for an
evaluation before resuming sexual activity.
6. Question: A nurse is providing discharge teaching to a client who delivered a
healthy newborn. Which of the following statements by the client indicates a
need for further teaching?
Answer: "I will stop using my prescribed iron supplement once I feel better."
Rationale: The client should continue taking iron supplements as prescribed to prevent anemia,
even if symptoms improve.
7. Question: A client at 35 weeks gestation is diagnosed with placenta previa.
Which of the following interventions should the nurse prioritize?
Answer: Monitor fetal heart rate and maternal vital signs.
Rationale: Placenta previa can cause bleeding, and monitoring the fetal heart rate and maternal
vital signs is essential for detecting any complications.
8. Question: A nurse is caring for a 2-day-old newborn who is breastfeeding. The
mother asks how she can know if her baby is getting enough milk. Which of the
following responses by the nurse is most appropriate?
Answer: "Your baby should be wetting at least six diapers per day."
Rationale: Adequate hydration is an important indicator that the baby is getting enough milk.
Six wet diapers per day is a good sign.
9. Question: A postpartum client is receiving intravenous oxytocin to promote
uterine contraction. The nurse should closely monitor for which of the following
complications?
Answer: Uterine hyperstimulation.
