Comprehensive Maternal Child Nursing Care Study Guide,
Exam Notes, Practice Questions & Clinical Review for
Nursing Students – Complete Maternal and Pediatric
Nursing Exam Preparation Resource
Question 1: A pregnant client at 32 weeks gestation reports experiencing occasional mild
contractions that subside with rest and hydration. The nurse recognizes these as:
A. Preterm labor contractions requiring immediate tocolytics
B. Braxton Hicks contractions, which are normal physiological practice contractions
C. Placental abruption signs necessitating emergency delivery
D. Uterine rupture indicators requiring surgical intervention
CORRECT ANSWER: B. Braxton Hicks contractions, which are normal physiological practice
contractions
Rationale: Braxton Hicks contractions are irregular, painless uterine contractions that occur
throughout pregnancy, intensifying in the third trimester. They are normal physiological
phenomena that help prepare the uterus for labor. Unlike true labor contractions, they do not
increase in frequency, duration, or intensity, and typically resolve with position changes, rest,
or hydration. Preterm labor contractions are regular, progressive, and associated with cervical
changes; placental abruption presents with painful bleeding and uterine tenderness; uterine
rupture is a rare obstetric emergency with severe pain and fetal distress.
Question 2: During the immediate postpartum period, the nurse assesses a client's fundus
and finds it to be boggy and displaced to the right of the umbilicus. The priority nursing
intervention is to:
A. Administer prescribed oxytocin intravenously
B. Assist the client to empty her bladder
C. Perform vigorous fundal massage immediately
D. Notify the healthcare provider of potential hemorrhage
CORRECT ANSWER: B. Assist the client to empty her bladder
Rationale: A boggy, displaced fundus in the immediate postpartum period is most commonly
caused by a distended bladder, which pushes the uterus upward and laterally, preventing
effective contraction and increasing hemorrhage risk. The priority intervention is to assist the
client to void, either independently or via catheterization if needed. After bladder emptying,
the nurse should reassess fundal tone and perform gentle fundal massage if the uterus remains
boggy. Administering oxytocin or notifying the provider may be necessary if bleeding persists
after bladder emptying and massage, but addressing the bladder first is the most immediate
and least invasive action.
Question 3: A newborn is assessed at 1 minute of life with a heart rate of 90 beats/min, slow
irregular respirations, some flexion of extremities, grimacing in response to suctioning, and a
pink body with blue extremities. The nurse calculates the Apgar score as:
A. 4
B. 5
C. 6
D. 7
CORRECT ANSWER: B. 5
,Rationale: The Apgar score evaluates five criteria: Appearance (skin color), Pulse (heart rate),
Grimace (reflex irritability), Activity (muscle tone), and Respiration. Each criterion scores 0, 1, or
2. For this newborn: Heart rate 90 bpm = 1 point; slow irregular respirations = 1 point; some
flexion = 1 point; grimacing = 1 point; pink body with blue extremities (acrocyanosis) = 1 point.
Total = 5. A score of 7-10 is reassuring, 4-6 indicates moderate difficulty requiring some
resuscitative measures, and 0-3 indicates severe distress requiring immediate intervention.
Question 4: The nurse is teaching a pregnant client about nutrition during pregnancy. Which
statement by the client indicates a need for further teaching?
A. "I should increase my daily caloric intake by approximately 300 calories during the second
trimester."
B. "I need to consume at least 71 grams of protein daily to support fetal growth."
C. "I can continue to drink one cup of coffee each morning without concern."
D. "I should avoid all fish during pregnancy to prevent mercury exposure."
CORRECT ANSWER: D. "I should avoid all fish during pregnancy to prevent mercury
exposure."
Rationale: While pregnant clients should limit high-mercury fish (shark, swordfish, king
mackerel, tilefish), they are encouraged to consume 8-12 ounces per week of low-mercury fish
(salmon, shrimp, pollock, catfish) for essential omega-3 fatty acids that support fetal
neurodevelopment. Avoiding all fish eliminates these benefits. The other statements are
accurate: caloric needs increase by ~340 kcal/day in the second trimester and ~450 kcal/day in
the third; protein needs increase to 71 g/day; and moderate caffeine intake (<200 mg/day,
approximately one 12-oz coffee) is generally considered safe.
Question 5: A toddler is admitted with suspected epiglottitis. Which assessment finding
requires the nurse to immediately notify the healthcare provider and prepare for emergency
airway management?
A. Low-grade fever and mild cough
B. Drooling, dysphagia, and preference to sit upright and lean forward
C. Barky cough and inspiratory stridor that improves with humidified oxygen
D. Nasal congestion and clear rhinorrhea for two days
CORRECT ANSWER: B. Drooling, dysphagia, and preference to sit upright and lean forward
Rationale: Epiglottitis is a life-threatening bacterial infection causing rapid swelling of the
epiglottis and supraglottic structures. Classic signs include sudden onset of high fever, severe
sore throat, drooling (due to inability to swallow secretions), dysphagia, muffled voice, and the
tripod position (sitting upright, leaning forward, chin thrust out) to maximize airway patency.
These findings indicate impending airway obstruction requiring immediate expert airway
management, often in an operating room. A barky cough with stridor suggests croup, which is
typically less acute; nasal congestion suggests a common viral URI.
Question 6: The nurse is caring for a postpartum client who is breastfeeding. The client
reports sore, cracked nipples. Which intervention should the nurse recommend first?
A. Apply lanolin cream to nipples after each feeding
B. Ensure proper infant latch and positioning during breastfeeding
,C. Use a breast pump to express milk and allow nipples to heal
D. Offer formula supplementation to reduce breastfeeding frequency
CORRECT ANSWER: B. Ensure proper infant latch and positioning during breastfeeding
Rationale: Sore, cracked nipples are most commonly caused by incorrect latch or positioning.
The priority intervention is assessment and correction of breastfeeding technique, as
addressing the root cause prevents ongoing trauma and promotes healing. Once latch is
optimized, supportive measures like air-drying nipples, applying expressed breast milk or
medical-grade lanolin, and varying feeding positions can aid healing. Pumping or
supplementation may be considered temporarily if pain is severe, but they do not address the
underlying issue and may interfere with milk supply if not medically indicated.
Question 7: A school-age child with asthma is prescribed a short-acting beta-agonist (SABA)
inhaler. The nurse teaches the child and family about proper inhaler technique. Which
statement indicates correct understanding?
A. "I should inhale quickly and deeply immediately after pressing the canister."
B. "I need to shake the inhaler well before each use and exhale fully before inhaling the
medication."
C. "I can use the inhaler without a spacer because I am older and can coordinate well."
D. "I should rinse my mouth with water only after using my controller inhaler, not my rescue
inhaler."
CORRECT ANSWER: B. "I need to shake the inhaler well before each use and exhale fully
before inhaling the medication."
Rationale: Proper metered-dose inhaler (MDI) technique includes shaking the canister, exhaling
fully away from the mouthpiece, placing the mouthpiece correctly, actuating the canister at the
start of a slow, deep inhalation, holding breath for 5-10 seconds, and waiting 30-60 seconds
between puffs if prescribed. Using a spacer is recommended for all ages to improve drug
delivery and reduce oropharyngeal deposition. Mouth rinsing after inhaled corticosteroids
(controller medications) prevents oral candidiasis; it is not routinely required after SABAs but
does not cause harm. Quick, deep inhalation immediately after actuation wastes medication.
Question 8: During a prenatal visit, a client at 28 weeks gestation has a blood pressure
reading of 148/96 mm Hg, with no proteinuria noted on dipstick. The nurse recognizes this
finding as indicative of:
A. Chronic hypertension
B. Gestational hypertension
C. Preeclampsia
D. Normal physiological adaptation to pregnancy
CORRECT ANSWER: B. Gestational hypertension
Rationale: Gestational hypertension is defined as systolic BP ≥140 mm Hg or diastolic BP ≥90
mm Hg on two occasions at least 4 hours apart after 20 weeks gestation in a previously
normotensive woman, without proteinuria or other features of preeclampsia. Preeclampsia
requires hypertension plus proteinuria or, in its absence, new-onset hypertension with
thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or
cerebral/visual symptoms. Chronic hypertension is present before pregnancy or before 20
, weeks. This BP elevation is not a normal adaptation; pregnancy typically causes a mid-trimester
BP decrease.
Question 9: The nurse is preparing to administer vitamin K to a newborn. The parent asks
why this injection is necessary. The nurse's best response is:
A. "It helps prevent jaundice by supporting liver function in the first days of life."
B. "Newborns have sterile intestines and cannot synthesize vitamin K, putting them at risk for
hemorrhagic disease."
C. "It boosts the infant's immune system to prevent early infections."
D. "It is required by law before hospital discharge to ensure newborn screening compliance."
CORRECT ANSWER: B. "Newborns have sterile intestines and cannot synthesize vitamin K,
putting them at risk for hemorrhagic disease."
Rationale: Vitamin K is essential for synthesis of clotting factors II, VII, IX, and X. Newborns are
vitamin K-deficient at birth due to poor placental transfer, sterile gut (no bacterial synthesis),
and low levels in breast milk. Without prophylaxis, they are at risk for vitamin K deficiency
bleeding (VKDB), which can cause life-threatening intracranial or gastrointestinal hemorrhage.
A single intramuscular dose shortly after birth is highly effective prevention. Vitamin K does not
prevent jaundice, boost immunity, or relate to newborn screening mandates.
Question 10: A pregnant client with type 1 diabetes is at 36 weeks gestation. Which
instruction should the nurse prioritize in the teaching plan regarding fetal monitoring?
A. "You will need weekly nonstress tests starting now to assess fetal well-being."
B. "Daily fetal movement counts are unnecessary because you have frequent prenatal visits."
C. "Biophysical profiles are only indicated if you experience decreased fetal movement."
D. "Contraction stress tests are the first-line monitoring method for diabetic pregnancies."
CORRECT ANSWER: A. "You will need weekly nonstress tests starting now to assess fetal well-
being."
Rationale: Pregnancies complicated by pregestational diabetes are at increased risk for
stillbirth, macrosomia, and placental insufficiency. Current guidelines recommend initiating
antenatal fetal surveillance (e.g., nonstress tests) at 32-36 weeks, depending on glycemic
control and comorbidities. Weekly NSTs are common for well-controlled type 1 diabetes
without complications. Daily fetal movement counts remain important adjuncts. Biophysical
profiles may be used if NSTs are nonreactive. Contraction stress tests are rarely first-line due to
risks of inducing labor and are contraindicated in certain conditions.
Question 11: The nurse is assessing a 6-month-old infant during a well-child visit. Which
developmental milestone should the infant typically demonstrate?
A. Walking independently
B. Saying two-word phrases
C. Rolling from back to front
D. Using a pincer grasp to pick up small objects
CORRECT ANSWER: C. Rolling from back to front
Rationale: By 6 months, infants typically roll from back to front and front to back, sit with
support, transfer objects hand-to-hand, and babble consonant sounds. Walking independently
emerges around 12 months; two-word phrases appear around 18-24 months; the pincer grasp
Exam Notes, Practice Questions & Clinical Review for
Nursing Students – Complete Maternal and Pediatric
Nursing Exam Preparation Resource
Question 1: A pregnant client at 32 weeks gestation reports experiencing occasional mild
contractions that subside with rest and hydration. The nurse recognizes these as:
A. Preterm labor contractions requiring immediate tocolytics
B. Braxton Hicks contractions, which are normal physiological practice contractions
C. Placental abruption signs necessitating emergency delivery
D. Uterine rupture indicators requiring surgical intervention
CORRECT ANSWER: B. Braxton Hicks contractions, which are normal physiological practice
contractions
Rationale: Braxton Hicks contractions are irregular, painless uterine contractions that occur
throughout pregnancy, intensifying in the third trimester. They are normal physiological
phenomena that help prepare the uterus for labor. Unlike true labor contractions, they do not
increase in frequency, duration, or intensity, and typically resolve with position changes, rest,
or hydration. Preterm labor contractions are regular, progressive, and associated with cervical
changes; placental abruption presents with painful bleeding and uterine tenderness; uterine
rupture is a rare obstetric emergency with severe pain and fetal distress.
Question 2: During the immediate postpartum period, the nurse assesses a client's fundus
and finds it to be boggy and displaced to the right of the umbilicus. The priority nursing
intervention is to:
A. Administer prescribed oxytocin intravenously
B. Assist the client to empty her bladder
C. Perform vigorous fundal massage immediately
D. Notify the healthcare provider of potential hemorrhage
CORRECT ANSWER: B. Assist the client to empty her bladder
Rationale: A boggy, displaced fundus in the immediate postpartum period is most commonly
caused by a distended bladder, which pushes the uterus upward and laterally, preventing
effective contraction and increasing hemorrhage risk. The priority intervention is to assist the
client to void, either independently or via catheterization if needed. After bladder emptying,
the nurse should reassess fundal tone and perform gentle fundal massage if the uterus remains
boggy. Administering oxytocin or notifying the provider may be necessary if bleeding persists
after bladder emptying and massage, but addressing the bladder first is the most immediate
and least invasive action.
Question 3: A newborn is assessed at 1 minute of life with a heart rate of 90 beats/min, slow
irregular respirations, some flexion of extremities, grimacing in response to suctioning, and a
pink body with blue extremities. The nurse calculates the Apgar score as:
A. 4
B. 5
C. 6
D. 7
CORRECT ANSWER: B. 5
,Rationale: The Apgar score evaluates five criteria: Appearance (skin color), Pulse (heart rate),
Grimace (reflex irritability), Activity (muscle tone), and Respiration. Each criterion scores 0, 1, or
2. For this newborn: Heart rate 90 bpm = 1 point; slow irregular respirations = 1 point; some
flexion = 1 point; grimacing = 1 point; pink body with blue extremities (acrocyanosis) = 1 point.
Total = 5. A score of 7-10 is reassuring, 4-6 indicates moderate difficulty requiring some
resuscitative measures, and 0-3 indicates severe distress requiring immediate intervention.
Question 4: The nurse is teaching a pregnant client about nutrition during pregnancy. Which
statement by the client indicates a need for further teaching?
A. "I should increase my daily caloric intake by approximately 300 calories during the second
trimester."
B. "I need to consume at least 71 grams of protein daily to support fetal growth."
C. "I can continue to drink one cup of coffee each morning without concern."
D. "I should avoid all fish during pregnancy to prevent mercury exposure."
CORRECT ANSWER: D. "I should avoid all fish during pregnancy to prevent mercury
exposure."
Rationale: While pregnant clients should limit high-mercury fish (shark, swordfish, king
mackerel, tilefish), they are encouraged to consume 8-12 ounces per week of low-mercury fish
(salmon, shrimp, pollock, catfish) for essential omega-3 fatty acids that support fetal
neurodevelopment. Avoiding all fish eliminates these benefits. The other statements are
accurate: caloric needs increase by ~340 kcal/day in the second trimester and ~450 kcal/day in
the third; protein needs increase to 71 g/day; and moderate caffeine intake (<200 mg/day,
approximately one 12-oz coffee) is generally considered safe.
Question 5: A toddler is admitted with suspected epiglottitis. Which assessment finding
requires the nurse to immediately notify the healthcare provider and prepare for emergency
airway management?
A. Low-grade fever and mild cough
B. Drooling, dysphagia, and preference to sit upright and lean forward
C. Barky cough and inspiratory stridor that improves with humidified oxygen
D. Nasal congestion and clear rhinorrhea for two days
CORRECT ANSWER: B. Drooling, dysphagia, and preference to sit upright and lean forward
Rationale: Epiglottitis is a life-threatening bacterial infection causing rapid swelling of the
epiglottis and supraglottic structures. Classic signs include sudden onset of high fever, severe
sore throat, drooling (due to inability to swallow secretions), dysphagia, muffled voice, and the
tripod position (sitting upright, leaning forward, chin thrust out) to maximize airway patency.
These findings indicate impending airway obstruction requiring immediate expert airway
management, often in an operating room. A barky cough with stridor suggests croup, which is
typically less acute; nasal congestion suggests a common viral URI.
Question 6: The nurse is caring for a postpartum client who is breastfeeding. The client
reports sore, cracked nipples. Which intervention should the nurse recommend first?
A. Apply lanolin cream to nipples after each feeding
B. Ensure proper infant latch and positioning during breastfeeding
,C. Use a breast pump to express milk and allow nipples to heal
D. Offer formula supplementation to reduce breastfeeding frequency
CORRECT ANSWER: B. Ensure proper infant latch and positioning during breastfeeding
Rationale: Sore, cracked nipples are most commonly caused by incorrect latch or positioning.
The priority intervention is assessment and correction of breastfeeding technique, as
addressing the root cause prevents ongoing trauma and promotes healing. Once latch is
optimized, supportive measures like air-drying nipples, applying expressed breast milk or
medical-grade lanolin, and varying feeding positions can aid healing. Pumping or
supplementation may be considered temporarily if pain is severe, but they do not address the
underlying issue and may interfere with milk supply if not medically indicated.
Question 7: A school-age child with asthma is prescribed a short-acting beta-agonist (SABA)
inhaler. The nurse teaches the child and family about proper inhaler technique. Which
statement indicates correct understanding?
A. "I should inhale quickly and deeply immediately after pressing the canister."
B. "I need to shake the inhaler well before each use and exhale fully before inhaling the
medication."
C. "I can use the inhaler without a spacer because I am older and can coordinate well."
D. "I should rinse my mouth with water only after using my controller inhaler, not my rescue
inhaler."
CORRECT ANSWER: B. "I need to shake the inhaler well before each use and exhale fully
before inhaling the medication."
Rationale: Proper metered-dose inhaler (MDI) technique includes shaking the canister, exhaling
fully away from the mouthpiece, placing the mouthpiece correctly, actuating the canister at the
start of a slow, deep inhalation, holding breath for 5-10 seconds, and waiting 30-60 seconds
between puffs if prescribed. Using a spacer is recommended for all ages to improve drug
delivery and reduce oropharyngeal deposition. Mouth rinsing after inhaled corticosteroids
(controller medications) prevents oral candidiasis; it is not routinely required after SABAs but
does not cause harm. Quick, deep inhalation immediately after actuation wastes medication.
Question 8: During a prenatal visit, a client at 28 weeks gestation has a blood pressure
reading of 148/96 mm Hg, with no proteinuria noted on dipstick. The nurse recognizes this
finding as indicative of:
A. Chronic hypertension
B. Gestational hypertension
C. Preeclampsia
D. Normal physiological adaptation to pregnancy
CORRECT ANSWER: B. Gestational hypertension
Rationale: Gestational hypertension is defined as systolic BP ≥140 mm Hg or diastolic BP ≥90
mm Hg on two occasions at least 4 hours apart after 20 weeks gestation in a previously
normotensive woman, without proteinuria or other features of preeclampsia. Preeclampsia
requires hypertension plus proteinuria or, in its absence, new-onset hypertension with
thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or
cerebral/visual symptoms. Chronic hypertension is present before pregnancy or before 20
, weeks. This BP elevation is not a normal adaptation; pregnancy typically causes a mid-trimester
BP decrease.
Question 9: The nurse is preparing to administer vitamin K to a newborn. The parent asks
why this injection is necessary. The nurse's best response is:
A. "It helps prevent jaundice by supporting liver function in the first days of life."
B. "Newborns have sterile intestines and cannot synthesize vitamin K, putting them at risk for
hemorrhagic disease."
C. "It boosts the infant's immune system to prevent early infections."
D. "It is required by law before hospital discharge to ensure newborn screening compliance."
CORRECT ANSWER: B. "Newborns have sterile intestines and cannot synthesize vitamin K,
putting them at risk for hemorrhagic disease."
Rationale: Vitamin K is essential for synthesis of clotting factors II, VII, IX, and X. Newborns are
vitamin K-deficient at birth due to poor placental transfer, sterile gut (no bacterial synthesis),
and low levels in breast milk. Without prophylaxis, they are at risk for vitamin K deficiency
bleeding (VKDB), which can cause life-threatening intracranial or gastrointestinal hemorrhage.
A single intramuscular dose shortly after birth is highly effective prevention. Vitamin K does not
prevent jaundice, boost immunity, or relate to newborn screening mandates.
Question 10: A pregnant client with type 1 diabetes is at 36 weeks gestation. Which
instruction should the nurse prioritize in the teaching plan regarding fetal monitoring?
A. "You will need weekly nonstress tests starting now to assess fetal well-being."
B. "Daily fetal movement counts are unnecessary because you have frequent prenatal visits."
C. "Biophysical profiles are only indicated if you experience decreased fetal movement."
D. "Contraction stress tests are the first-line monitoring method for diabetic pregnancies."
CORRECT ANSWER: A. "You will need weekly nonstress tests starting now to assess fetal well-
being."
Rationale: Pregnancies complicated by pregestational diabetes are at increased risk for
stillbirth, macrosomia, and placental insufficiency. Current guidelines recommend initiating
antenatal fetal surveillance (e.g., nonstress tests) at 32-36 weeks, depending on glycemic
control and comorbidities. Weekly NSTs are common for well-controlled type 1 diabetes
without complications. Daily fetal movement counts remain important adjuncts. Biophysical
profiles may be used if NSTs are nonreactive. Contraction stress tests are rarely first-line due to
risks of inducing labor and are contraindicated in certain conditions.
Question 11: The nurse is assessing a 6-month-old infant during a well-child visit. Which
developmental milestone should the infant typically demonstrate?
A. Walking independently
B. Saying two-word phrases
C. Rolling from back to front
D. Using a pincer grasp to pick up small objects
CORRECT ANSWER: C. Rolling from back to front
Rationale: By 6 months, infants typically roll from back to front and front to back, sit with
support, transfer objects hand-to-hand, and babble consonant sounds. Walking independently
emerges around 12 months; two-word phrases appear around 18-24 months; the pincer grasp
