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Maternal-Newborn Nursing Review
ACTUAL EXAM 2026/2027 |
Maternal-Newborn Nursing Review |
Verified Q&A | Pass Guaranteed - A+
Graded
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======== PART A – MULTIPLE CHOICE (Q1-60)
Q1 (Respiratory – COPD oxygen therapy): A 68-year-old patient with severe COPD presents to
the emergency department with acute exacerbation. Respiratory rate is 28, SpO₂ is 84% on
room air, and ABG shows pH 7.32, PaCO₂ 58 mmHg, HCO₃⁻ 30 mEq/L. Which oxygen delivery
target is most appropriate for this patient?
A. Maintain SpO₂ ≥ 95% using a non-rebreather mask at 15 L/min
B. Maintain SpO₂ 88-92% using nasal cannula at 2-4 L/min
C. Maintain SpO₂ 85-88% using nasal cannula at 1-2 L/min
D. Maintain SpO₂ 94-98% using Venturi mask at 40% FiO₂
[CORRECT] B
Rationale: The GOLD 2026 guidelines recommend maintaining SpO₂ 88-92% in patients with
COPD and chronic hypercapnia to avoid suppressing the hypoxic respiratory drive, which could
worsen CO₂ retention and respiratory acidosis. Option A is incorrect because high-flow oxygen
(>92%) in COPD patients with chronic hypercapnia can cause CO₂ narcosis and respiratory
failure. Option C is too low and does not provide adequate tissue oxygenation. Option D is
inappropriate because the Venturi mask at 40% would overshoot the safe target range. Clinical
pearl: Always check ABG after initiating oxygen in COPD; if PaCO₂ rises >10 mmHg or pH
drops below 7.25, consider non-invasive positive pressure ventilation (NIPPV).
Q2 (Respiratory – Asthma action plan): A 22-year-old with moderate persistent asthma uses a
daily inhaled corticosteroid (ICS) and a short-acting beta-agonist (SABA) as needed. During a
routine visit, the patient reports using the SABA three times daily for the past week. According to
the GINA 2026 guidelines, what is the most appropriate next step?
A. Continue current regimen and instruct the patient to use the SABA only before exercise
B. Add a long-acting muscarinic antagonist (LAMA) to the current regimen
C. Add a low-dose inhaled corticosteroid-formoterol combination as both maintenance and
reliever therapy (MART)
D. Discontinue the ICS and switch to a leukotriene receptor antagonist alone
,[CORRECT] C
Rationale: GINA 2026 recommends that patients with moderate asthma who require SABA
more than twice weekly should be transitioned to an ICS-formoterol combination for
maintenance and reliever therapy (MART), which reduces exacerbations and improves control
compared to SABA-only reliever therapy. Option A is incorrect because frequent SABA use
indicates poor control and increases the risk of exacerbations. Option B is incorrect because
LAMA is typically added for severe asthma, not moderate. Option D is incorrect because
discontinuing ICS increases the risk of severe exacerbations and asthma-related mortality.
Clinical pearl: The SABA-only approach has been de-emphasized in GINA 2026; always pair
reliever therapy with ICS to reduce inflammation.
Q3 (Respiratory – Pneumonia assessment): A 74-year-old patient is admitted with
community-acquired pneumonia (CAP). Vital signs: temperature 38.9°C, HR 110, RR 26, BP
118/72. The patient is alert but confused about the date. Labs: WBC 16,000/μL, BUN 28 mg/dL,
creatinine 1.4 mg/dL. Using the CURB-65 scoring system, what is this patient's risk class and
recommended disposition?
A. Score 2 (low risk; outpatient therapy with oral antibiotics)
B. Score 3 (moderate risk; brief inpatient observation or short hospital stay)
C. Score 4 (severe risk; hospital admission with possible ICU consideration)
D. Score 5 (very severe risk; immediate ICU admission)
[CORRECT] B
Rationale: CURB-65 scoring: Confusion (1 point), Urea >20 mg/dL (1 point), Respiratory rate
≥30 (1 point), Blood pressure low (SBP <90 or DBP ≤60 = 0 points here), Age ≥65 (1 point).
Total = 3 points, indicating moderate risk (30-day mortality 9%) requiring hospitalization or brief
inpatient observation per IDSA/ATS 2026 guidelines. Option A is incorrect because a score of 2
would indicate low risk. Option C is incorrect because BP is not hypotensive (SBP >90). Option
D is incorrect because this would require all 5 criteria. Clinical pearl: For patients aged 50-64
with comorbidities, consider the SMART-COP score for ICU triage, as CURB-65 may
underestimate severity in younger patients with significant comorbidities.
Q4 (Respiratory – Pulmonary embolism): A 56-year-old postoperative patient suddenly develops
dyspnea, pleuritic chest pain, and tachycardia (HR 118). SpO₂ is 90% on 2 L nasal cannula. The
Wells score is calculated as 6.5 (moderate probability). What is the next best diagnostic step
according to 2026 guidelines?
A. Immediately initiate heparin infusion and proceed to CT pulmonary angiography (CTPA)
B. Obtain a D-dimer assay; if positive, proceed to CTPA
C. Perform a ventilation-perfusion (V/Q) scan as the first-line imaging study
D. Obtain a chest X-ray and echocardiogram before any further testing
[CORRECT] A
Rationale: For patients with intermediate-to-high probability of PE (Wells score >4) and
hemodynamic instability or significant symptoms, the 2026 ESC/ERS guidelines recommend
immediate anticoagulation while awaiting definitive imaging with CTPA, as the pre-test
probability is high enough that D-dimer is not useful (it will be positive in most postoperative
patients). Option B is incorrect because D-dimer is not indicated in moderate-to-high probability
patients due to poor specificity. Option C is incorrect because V/Q scan is reserved for patients
with renal failure or contrast allergy. Option D delays definitive diagnosis and treatment. Clinical
, earl: In massive PE with hemodynamic collapse, bedside echocardiography showing right
p
heart strain can support emergent systemic thrombolysis while awaiting CTPA.
Q5 (Respiratory – ARDS management): A 42-year-old patient with sepsis-induced ARDS is
intubated and mechanically ventilated. Current settings: AC/VC, tidal volume 650 mL, RR 18,
FiO₂ 60%, PEEP 8 cmH₂O. Plateau pressure is 35 cmH₂O. Which ventilator adjustment is most
appropriate according to the ARDSNet protocol?
A. Increase tidal volume to 750 mL to improve minute ventilation and reduce CO₂
B. Decrease tidal volume to 450 mL (6 mL/kg predicted body weight) and increase RR to 24
C. Maintain current settings and add inhaled nitric oxide
D. Switch to pressure-controlled ventilation and increase PEEP to 15 cmH₂O
[CORRECT] B
Rationale: The ARDSNet low tidal volume ventilation strategy (6 mL/kg predicted body weight)
with plateau pressure <30 cmH₂O reduces mortality in ARDS by preventing ventilator-induced
lung injury (VILI). The current tidal volume is too high (likely ~8-9 mL/kg), and plateau pressure
exceeds 30 cmH₂O. Option A is incorrect because higher tidal volumes increase VILI and
mortality. Option C is incorrect because inhaled nitric oxide is reserved for refractory hypoxemia
and does not improve mortality. Option D is incorrect because while pressure control is
acceptable, arbitrarily increasing PEEP to 15 without following the PEEP/FiO₂ table may cause
hemodynamic compromise. Clinical pearl: Permissive hypercapnia is acceptable in ARDS; do
not increase tidal volume solely to normalize PaCO₂ if it violates lung-protective strategy.
Q6 (Respiratory – COPD pharmacology): A patient with COPD GOLD Group D is prescribed
triple therapy. Which combination represents the correct triple therapy regimen?
A. Albuterol (SABA) + Ipratropium (SAMA) + Prednisone (oral corticosteroid)
B. Fluticasone (ICS) + Salmeterol (LABA) + Tiotropium (LAMA)
C. Montelukast (LTRA) + Theophylline (methylxanthine) + Roflumilast (PDE4 inhibitor)
D. Budesonide (ICS) + Formoterol (LABA) + Omalizumab (anti-IgE)
[CORRECT] B
Rationale: GOLD 2026 defines triple therapy as ICS + LABA + LAMA for Group D patients with
frequent exacerbations despite dual bronchodilator therapy. The combination of
fluticasone/salmeterol (ICS/LABA) plus tiotropium (LAMA) is the standard approach. Option A is
incorrect because SABA/SAMA are rescue medications, not maintenance triple therapy, and
oral corticosteroids are not for chronic maintenance. Option C is incorrect because these are not
first-line triple therapy agents. Option D is incorrect because omalizumab is for allergic asthma,
not COPD. Clinical pearl: Triple therapy reduces exacerbations by 25% compared to
LABA/LAMA alone in Group D patients but increases pneumonia risk; monitor for signs of
respiratory infection.
Q7 (Respiratory – Asthma exacerbation): A 19-year-old with asthma presents to the ED with
severe exacerbation. HR 128, RR 32, SpO₂ 88% on room air, unable to speak in full sentences.
Peak expiratory flow (PEF) is 35% of predicted. After initial treatment with albuterol and
ipratropium nebulizers, which is the priority next intervention?
A. Administer magnesium sulfate 2 g IV over 20 minutes
B. Administer systemic corticosteroids (prednisone 40-60 mg PO or methylprednisolone 125 mg
IV)
C. Initiate non-invasive positive pressure ventilation (BiPAP)
, . Intubate and initiate mechanical ventilation immediately
D
[CORRECT] B
Rationale: Systemic corticosteroids are the cornerstone of treatment for moderate-to-severe
asthma exacerbations and should be administered within the first hour of presentation to reduce
airway inflammation and prevent progression. Option A is incorrect because magnesium sulfate
is adjunctive therapy for severe exacerbations not responding to initial bronchodilator therapy,
not the first priority. Option C is incorrect because BiPAP is generally avoided in asthma due to
risk of barotrauma and dynamic hyperinflation unless the patient is fatiguing and CO₂ is rising
despite maximal medical therapy. Option D is incorrect because intubation is reserved for
impending respiratory arrest or altered mental status. Clinical pearl: Early corticosteroid
administration reduces hospitalization rates by 50%; never delay steroids while waiting for
response to bronchodilators.
Q8 (Respiratory – Oxygen delivery devices): A patient with pneumonia and hypoxemia (SpO₂
86%) requires oxygen supplementation. The patient has a history of nasal trauma and cannot
tolerate nasal cannula. Which oxygen delivery device is most appropriate to achieve a target
SpO₂ of 92-94%?
A. Simple face mask at 5-8 L/min
B. Non-rebreather mask at 10-15 L/min
C. Venturi mask at 28% FiO₂
D. High-flow nasal cannula (HFNC) at 40 L/min, 40% FiO₂
[CORRECT] A
Rationale: A simple face mask delivers 35-50% oxygen at 5-10 L/min and is appropriate for
patients who cannot tolerate nasal cannula but require moderate oxygen supplementation to
achieve SpO₂ 92-94%. Option B is incorrect because a non-rebreather delivers 60-90% oxygen,
which is excessive for this target and may cause oxygen toxicity or CO₂ retention in susceptible
patients. Option C is incorrect because 28% FiO₂ may be insufficient to achieve the target.
Option D is incorrect because HFNC is typically reserved for patients with hypoxemic respiratory
failure requiring precise FiO₂ and positive pressure support, and the patient cannot tolerate
nasal cannula. Clinical pearl: Minimum flow for simple face mask is 5 L/min to prevent
rebreathing CO₂; always ensure the reservoir bag does not deflate completely during inspiration.
Q9 (Cardiovascular – Hypertension first-line therapy): A 55-year-old African American patient is
newly diagnosed with Stage 1 hypertension (BP 142/88 mmHg). The patient has no diabetes,
CKD, or cardiovascular disease. According to the 2026 ACC/AHA hypertension guidelines,
which medication class is recommended as first-line therapy?
A. Angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB)
B. Thiazide-like diuretic or calcium channel blocker (CCB)
C. Beta-blocker (metoprolol)
D. Direct renin inhibitor (aliskiren)
[CORRECT] B
Rationale: The 2026 ACC/AHA guidelines recommend thiazide-like diuretics or calcium channel
blockers as first-line therapy for Black patients without compelling indications (diabetes, CKD,
heart failure) because these classes provide superior BP reduction and cardiovascular
outcomes in this population compared to ACEIs/ARBs alone. Option A is incorrect because
ACEIs/ARBs are less effective as monotherapy in Black patients without compelling indications.