ANTEPARTUM PRACTICE QUESTIONS
AND ANSWERS 2026/27
Which client in a prenatal clinic should the nurse assess first?
Client at 11 weeks gestation with backache and pelvic
pressure [13%]
Client at 16 weeks gestation with earache and sinus congestion [3%]
Client at 27 weeks gestation with headache and facial edema [78%]
Client at 37 weeks gestation with white vaginal discharge and urinary
frequency [4%]
Hypertensive disorders of pregnancy
• Systolic pressure ≥140 mm Hg &/or diastolic pressure ≥90
Chronic hypertension
mm Hg prior to conception or 20 weeks gestation
• New-onset elevated blood pressure at ≥20 weeks gestation
Gestational hypertension • No proteinuria or end-organ damage
• New-onset elevated blood pressure at ≥20 weeks gestation
Preeclampsia AND
• Proteinuria OR signs of end-organ damage
• Preeclampsia
AND
Eclampsia
• New-onset grand mal seizures
Gestational hypertension is new-onset high blood pressure (≥140/90
mm Hg) that occurs after 20 weeks gestation without proteinuria. \
The development of proteinuria with hypertension
indicates preeclampsia, which may manifest with symptoms such
as headache, visual disturbances, and facial swelling.
,This client is exhibiting symptoms of preeclampsia and should be
assessed first (Option 3).
Complications of preeclampsia may include thrombocytopenia, liver
dysfunction, and renal insufficiency.
Clients with preeclampsia must be monitored closely for sudden
worsening, which can lead to serious complications, including eclampsia
and/or HELLP syndrome (hemolysis, elevated liver enzymes, and low
platelets).
(Option 1) Backache and pelvic pressure are common discomforts of
pregnancy.
The enlarging uterus stretches the supporting ligaments and may cause
increased backache.
Fluid retention from increasing blood volume causes pelvic congestion,
which may be reported as pelvic pressure.
(Option 2) Earache and sinus congestion are common discomforts
during pregnancy that result from increased blood volume and fluid
retention.
This client should be assessed to rule out sinus and/or ear infection, but
this is not the highest priority.
(Option 4) The increase in estrogen and progesterone during pregnancy
often results in leukorrhea, a mucoid, white vaginal discharge.
Pressure on the bladder from the fetal head during the third trimester
may cause diminished bladder capacity and urinary frequency without
dysuria. These are common and expected findings.
Educational objective:
The nurse should assess the client with symptoms of potentially serious
complications first before assessing the remaining clients. Signs of
hypertensive disorders during pregnancy may include headache and facial
edema.
, The nurse is returning the results of a urine pregnancy test to a client
currently taking several medications. Which of the following
prescriptions are contraindicated in pregnancy? Select all that apply.
Albuterol inhaler
Doxycycline
Insulin aspart
Isotretinoin
Levothyroxine
Lisinopril
Teratogenic medications
Drug Adverse effects
Phenytoin Neural tube defects, orofacial clefts, microcephaly, nail or digit hypoplasia
Lithium Ebstein anomaly, nephrogenic diabetes insipidus, hypothyroidism
Valproate Neural tube defects
Isotretinoin Microcephaly, thymic hypoplasia, small ears, hydrocephalus
Methotrexate Limb & craniofacial abnormalities, neural tube defects, abortion
ACE inhibitors Renal dysgenesis, oligohydramnios
Warfarin Nasal hypoplasia, stippled epiphysis
Clients with preexisting health conditions (eg, asthma, hypertension,
diabetes) may require changes to medication therapy if they become
pregnant. Specifically, any teratogenic or unnecessary
, medications should be discontinued (before conception when possible).
The nurse should refer a client taking contraindicated medications to a
health care provider immediately.
For example:
• Doxycycline, a tetracycline antibiotic, is avoided in pregnancy as it
can impair bone mineralization and discolor permanent teeth in
the fetus (Option 2).
• Isotretinoin (Accutane) has a black box warning for severe birth
defects. Retinoids may not be prescribed to childbearing-aged
women without a formal agreement to participate in iPLEDGE (a
prescription tracking program) and a commitment to use two forms
of contraception (Option 4).
• Angiotensin-converting enzyme (ACE) inhibitors such
as lisinopril (Prinivil) have a black box warning for use in
pregnancy as they can affect fetal renal function and lung
development or cause death (Option 6).
(Option 1) Albuterol, an inhaled beta agonist, has not been conclusively
proven to be safe during pregnancy, but should be continued when
medically indicated (eg, severe asthma) to prevent the risks of asthma in
pregnancy (eg, preterm birth, growth restriction).
(Option 3) Insulin is safe for use during pregnancy and is commonly
used to treat pregestational or gestational diabetes.
(Option 5) Levothyroxine (Synthroid) for treatment of hypothyroidism
is safe but should be monitored carefully to ensure an appropriate dose
due to physiological changes in pregnancy.
Educational objective:
Commonly used medications that are absolutely contraindicated in
pregnancy include doxycycline, isotretinoin, and ACE inhibitors.
The nurse is preparing to assess a client visiting the women's health
clinic. The client's obstetric history is documented as G5T1P2A1L2.
Which interpretation of this notation is correct?
The client had 1 birth at 37 wk 0 d gestation or beyond [66%]
The client had 3 births between 20 wk 0 d and 36 wk 6 d
gestation [16%]
The client has 3 currently living children [8%]
The client is currently not pregnant [8%]
AND ANSWERS 2026/27
Which client in a prenatal clinic should the nurse assess first?
Client at 11 weeks gestation with backache and pelvic
pressure [13%]
Client at 16 weeks gestation with earache and sinus congestion [3%]
Client at 27 weeks gestation with headache and facial edema [78%]
Client at 37 weeks gestation with white vaginal discharge and urinary
frequency [4%]
Hypertensive disorders of pregnancy
• Systolic pressure ≥140 mm Hg &/or diastolic pressure ≥90
Chronic hypertension
mm Hg prior to conception or 20 weeks gestation
• New-onset elevated blood pressure at ≥20 weeks gestation
Gestational hypertension • No proteinuria or end-organ damage
• New-onset elevated blood pressure at ≥20 weeks gestation
Preeclampsia AND
• Proteinuria OR signs of end-organ damage
• Preeclampsia
AND
Eclampsia
• New-onset grand mal seizures
Gestational hypertension is new-onset high blood pressure (≥140/90
mm Hg) that occurs after 20 weeks gestation without proteinuria. \
The development of proteinuria with hypertension
indicates preeclampsia, which may manifest with symptoms such
as headache, visual disturbances, and facial swelling.
,This client is exhibiting symptoms of preeclampsia and should be
assessed first (Option 3).
Complications of preeclampsia may include thrombocytopenia, liver
dysfunction, and renal insufficiency.
Clients with preeclampsia must be monitored closely for sudden
worsening, which can lead to serious complications, including eclampsia
and/or HELLP syndrome (hemolysis, elevated liver enzymes, and low
platelets).
(Option 1) Backache and pelvic pressure are common discomforts of
pregnancy.
The enlarging uterus stretches the supporting ligaments and may cause
increased backache.
Fluid retention from increasing blood volume causes pelvic congestion,
which may be reported as pelvic pressure.
(Option 2) Earache and sinus congestion are common discomforts
during pregnancy that result from increased blood volume and fluid
retention.
This client should be assessed to rule out sinus and/or ear infection, but
this is not the highest priority.
(Option 4) The increase in estrogen and progesterone during pregnancy
often results in leukorrhea, a mucoid, white vaginal discharge.
Pressure on the bladder from the fetal head during the third trimester
may cause diminished bladder capacity and urinary frequency without
dysuria. These are common and expected findings.
Educational objective:
The nurse should assess the client with symptoms of potentially serious
complications first before assessing the remaining clients. Signs of
hypertensive disorders during pregnancy may include headache and facial
edema.
, The nurse is returning the results of a urine pregnancy test to a client
currently taking several medications. Which of the following
prescriptions are contraindicated in pregnancy? Select all that apply.
Albuterol inhaler
Doxycycline
Insulin aspart
Isotretinoin
Levothyroxine
Lisinopril
Teratogenic medications
Drug Adverse effects
Phenytoin Neural tube defects, orofacial clefts, microcephaly, nail or digit hypoplasia
Lithium Ebstein anomaly, nephrogenic diabetes insipidus, hypothyroidism
Valproate Neural tube defects
Isotretinoin Microcephaly, thymic hypoplasia, small ears, hydrocephalus
Methotrexate Limb & craniofacial abnormalities, neural tube defects, abortion
ACE inhibitors Renal dysgenesis, oligohydramnios
Warfarin Nasal hypoplasia, stippled epiphysis
Clients with preexisting health conditions (eg, asthma, hypertension,
diabetes) may require changes to medication therapy if they become
pregnant. Specifically, any teratogenic or unnecessary
, medications should be discontinued (before conception when possible).
The nurse should refer a client taking contraindicated medications to a
health care provider immediately.
For example:
• Doxycycline, a tetracycline antibiotic, is avoided in pregnancy as it
can impair bone mineralization and discolor permanent teeth in
the fetus (Option 2).
• Isotretinoin (Accutane) has a black box warning for severe birth
defects. Retinoids may not be prescribed to childbearing-aged
women without a formal agreement to participate in iPLEDGE (a
prescription tracking program) and a commitment to use two forms
of contraception (Option 4).
• Angiotensin-converting enzyme (ACE) inhibitors such
as lisinopril (Prinivil) have a black box warning for use in
pregnancy as they can affect fetal renal function and lung
development or cause death (Option 6).
(Option 1) Albuterol, an inhaled beta agonist, has not been conclusively
proven to be safe during pregnancy, but should be continued when
medically indicated (eg, severe asthma) to prevent the risks of asthma in
pregnancy (eg, preterm birth, growth restriction).
(Option 3) Insulin is safe for use during pregnancy and is commonly
used to treat pregestational or gestational diabetes.
(Option 5) Levothyroxine (Synthroid) for treatment of hypothyroidism
is safe but should be monitored carefully to ensure an appropriate dose
due to physiological changes in pregnancy.
Educational objective:
Commonly used medications that are absolutely contraindicated in
pregnancy include doxycycline, isotretinoin, and ACE inhibitors.
The nurse is preparing to assess a client visiting the women's health
clinic. The client's obstetric history is documented as G5T1P2A1L2.
Which interpretation of this notation is correct?
The client had 1 birth at 37 wk 0 d gestation or beyond [66%]
The client had 3 births between 20 wk 0 d and 36 wk 6 d
gestation [16%]
The client has 3 currently living children [8%]
The client is currently not pregnant [8%]
