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SECTION 1: Antepartum Care
Q1: A primigravida at 34 weeks gestation reports a severe frontal headache, blurred
vision, and right upper-quadrant pain. Her blood pressure is 158/102 mm Hg (repeat),
and urine dipstick shows 2+ protein. Which action should the nurse take first?
A. Encourage left lateral positioning and hydration
B. Notify the provider immediately and prepare for magnesium sulfate
C. Re-check blood pressure in 30 minutes after rest
D. Administer acetaminophen for headache per order
Correct Answer: B
Rationale: The constellation of symptoms plus hypertension and proteinuria indicates
severe pre-eclampsia, an unstable maternal–fetal condition with risk of seizure, stroke,
and placental abruption. Immediate provider notification and seizure prophylaxis
(magnesium sulfate) follow the ABC/safety framework. Delaying care (C) or treating
only symptoms (A, D) is unsafe.
,Q2: A client with gestational diabetes (GDM) at 28 weeks has a 1-hour post-prandial
glucose of 185 mg/dL. Which finding requires the nurse to intervene first?
A. Fetal movement count of 8 in 2 hours
B. Maternal report of polydipsia and blurred vision
C. Urine dip negative for ketones
D. Fundal height 1 cm above gestational age
Correct Answer: B
Rationale: Polydipsia and blurred vision suggest hyperglycemia >200 mg/dL, placing the
patient at risk for diabetic ketoacidosis (circulatory collapse—ABC risk). Immediate
glucose check and provider notification supersede routine assessments (A, C, D).
Q3: A woman at 16 weeks gestation asks why her fundus is palpated above the
symphysis. The nurse explains that the most probable reason is:
A. Over-distention of the uterus from polyhydramnios
B. Normal uterine growth approximating gestational age
C. Undiagnosed twin gestation
D. Fetal growth restriction
Correct Answer: B
,Rationale: By 16 weeks the uterine fundus is typically midway between symphysis and
umbilicus; this is an expected finding. Polyhydramnios or twins would usually present
with measurements >2–3 cm above age, whereas IUGR would measure small.
Q4: A client at 30 weeks reports dark-red vaginal bleeding, moderate amount, without
pain. FHR is 150 bpm, category I. Which nursing action is priority?
A. Perform sterile vaginal exam to assess dilation
B. Start IV #18-gauge with lactated Ringer’s and notify provider
C. Apply fetal scalp electrode for continuous monitoring
D. Offer sitz bath for perineal comfort
Correct Answer: B
Rationale: Painless bleeding in the 3rd trimester suggests placenta previa; vaginal exam
(A) could trigger catastrophic hemorrhage. Establishing large-bore IV access addresses
circulation (C of ABCs) and prepares for possible bleeding emergency. Scalp electrode
is contraindicated with active bleeding.
Q5: A Rh-negative mother at 26 weeks has an indirect Coombs’ titer of 1:8. Which
intervention is most important?
A. Schedule non-stress test twice weekly
B. Administer Rho(D) immune globulin 300 mcg IM now
C. Teach daily fetal movement counting
, D. Repeat titer in 4 weeks
Correct Answer: B
Rationale: An unsensitized Rh-negative patient needs RhoGAM at 28 weeks (or now if
not yet given) to prevent alloimmunization. The titer of 1:8 is already elevated, but active
sensitization is not yet confirmed; giving RhoGAM now still offers protection and is the
priority action.
Q6: A patient with hyperemesis gravidarum is receiving D5½NS with multivitamins at
125 mL/hr. Which assessment best indicates therapeutic response?
A. Weight gain of 0.5 kg in 24 hours
B. Urine specific gravity 1.030
C. Ketones absent in urine specimen
D. Serum potassium 3.0 mEq/L
Correct Answer: C
Rationale: Resolution of starvation state (ketosis) shows the patient is receiving
adequate glucose and calories. Ketones absent reflects improved maternal nutritional
status. USG 1.030 still indicates dehydration; K+ 3.0 is low; weight gain is not an
immediate goal.
Q7: A 20-year-old G1 P0 is screened positive for chlamydia at 12 weeks. Which
instruction is essential?