UR 202/ NUR202 Exam 3 –
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Maternal-Newborn Nursing Guide
ACTUAL EXAM 2026/2027 |
Maternal-Newborn Nursing Guide |
Verified Q&A | Pass Guaranteed - A+
Graded
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PART A – MULTIPLE CHOICE (Q1‑60)
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* *Q1 (Endocrine – SIADH management):** A 68-year-old patient with small cell lung carcinoma
is admitted with confusion and a serum sodium of 118 mEq/L. The nurse notes the patient is
euvolemic with no edema. Which intervention is the priority?
. Administer 0.9% sodium chloride at 125 mL/hr
A
B. Initiate fluid restriction to 500–1000 mL/day
C. Administer hypertonic saline 3% immediately
D. Start furosemide 40 mg IV push
* *[CORRECT]** B
*Rationale: SIADH is characterized by euvolemic hyponatremia caused by inappropriate ADH
secretion, most commonly from small cell lung carcinoma. Evidence-based guidelines
recommend fluid restriction (500–1000 mL/day) as first-line therapy for mild to moderate SIADH
because free water restriction creates a negative water balance, allowing serum sodium to rise
gradually. Option A is incorrect because isotonic saline may worsen hyponatremia in SIADH by
expanding extracellular fluid without correcting the underlying water retention. Option C is
reserved for severe symptomatic hyponatremia (seizures, coma) with sodium <120 mEq/L and
severe symptoms. Option D (furosemide) is not first-line and may worsen electrolyte
imbalances. Clinical pearl: Always check urine sodium (>30 mmol/L) and osmolality (>100
mOsm/kg) to confirm SIADH before initiating fluid restriction.*
,* *Q2 (Endocrine – Thyroid storm):** A 32-year-old female with Graves' disease presents with
fever (104°F), tachycardia (160 bpm), agitation, and vomiting. The nurse prepares to administer
medications per the thyroid storm protocol. Which medication should be administered FIRST?
. Propylthiouracil (PTU) 600 mg orally
A
B. Propranolol 40 mg orally
C. Hydrocortisone 100 mg IV
D. Potassium iodide (SSKI) 5 drops orally
* *[CORRECT]** B
*Rationale: Current thyroid storm management prioritizes beta-blockers (propranolol or esmolol)
as first-line to control the adrenergic surge—tachycardia, tremors, and hyperthermia.
Propranolol 40–80 mg every 4–6 hours is the standard initial therapy. Option A (PTU) is
administered after beta-blockade to block new hormone synthesis. Option C (hydrocortisone) is
given after thionamides to block peripheral T4-to-T3 conversion and prevent adrenal
insufficiency. Option D (iodine/SSKI) must NEVER be given before thionamides because iodine
can fuel new hormone synthesis; it is administered 1 hour AFTER PTU or methimazole. Clinical
pearl: The sequence is critical—beta-blocker first, then thionamide, then corticosteroid, then
iodine.*
* *Q3 (Endocrine – Adrenal crisis):** A patient with known Addison's disease presents with
severe hypotension (78/42 mmHg), hyponatremia (128 mEq/L), hyperkalemia (5.8 mEq/L), and
altered mental status after a gastrointestinal infection. What is the nurse's priority action?
. Begin aggressive fluid resuscitation with 0.9% saline
A
B. Administer hydrocortisone 100 mg IV immediately
C. Obtain blood cultures before any treatment
D. Administer potassium-binding resin for hyperkalemia
* *[CORRECT]** B
*Rationale: Adrenal crisis is a life-threatening emergency caused by acute cortisol deficiency.
The definitive treatment is immediate IV hydrocortisone (100 mg bolus, then 100 mg every 8
hours), which restores vascular tone, corrects hypotension, and improves sodium/potassium
balance. Option A (fluid resuscitation) is important but secondary to glucocorticoid
replacement—fluids alone will not correct refractory shock in adrenal crisis. Option C delays
critical treatment; blood cultures can be obtained after steroid administration. Option D is
unnecessary because hyperkalemia typically resolves with hydrocortisone and fluid
resuscitation. Clinical pearl: "When in doubt, give the steroid"—never delay hydrocortisone for
diagnostic testing in suspected adrenal crisis.*
* *Q4 (Endocrine – Myxedema coma):** An 82-year-old female is found unresponsive at home
with a temperature of 92°F (33.3°C), heart rate of 48 bpm, and shallow respirations. Her family
,r eports she stopped taking levothyroxine 2 weeks ago. Which nursing intervention is most
appropriate?
. Rapidly rewarm the patient with warming blankets set to 104°F
A
B. Administer levothyroxine IV 200 mcg loading dose
C. Initiate mechanical ventilation immediately
D. Administer hydrocortisone 100 mg IV before levothyroxine
* *[CORRECT]** D
*Rationale: Myxedema coma management requires IV levothyroxine, but corticosteroids
(hydrocortisone 100 mg IV) must be administered FIRST because coexisting adrenal
insufficiency is common and unopposed thyroid hormone can precipitate adrenal crisis. Option
A is dangerous—rapid rewarming causes peripheral vasodilation and cardiovascular collapse;
rewarming must be gradual (0.5°C/hour). Option B is correct medication but wrong sequence
without corticosteroid coverage. Option C may be needed eventually, but airway management
follows hemodynamic stabilization. Clinical pearl: The myxedema coma triad is hypothermia,
bradycardia, and hypoventilation; always give steroids before thyroid hormone replacement.*
* *Q5 (Endocrine – Diabetes insipidus):** A post-craniotomy patient develops polyuria (800
mL/hr), dilute urine (specific gravity 1.002), and serum sodium of 152 mEq/L. The nurse
anticipates which medication?
. Desmopressin (DDAVP) 2 mcg IV
A
B. Hydrochlorothiazide 25 mg orally
C. Demeclocycline 300 mg orally
D. Vasopressin 5 units IM
* *[CORRECT]** A
*Rationale: Central diabetes insipidus (DI) following pituitary surgery results from ADH
deficiency, causing massive dilute polyuria and hypernatremia. Desmopressin (DDAVP), a
synthetic analog of vasopressin, is the drug of choice because it selectively acts on V2
receptors in the renal collecting ducts to promote water reabsorption without V1-mediated
vasoconstriction. Option B (thiazide) is used for nephrogenic DI, not central DI. Option C
(demeclocycline) induces nephrogenic DI and is used for SIADH. Option D (vasopressin) is less
preferred due to V1 receptor effects causing vasoconstriction. Clinical pearl: Post-neurosurgical
DI may be transient, triphasic, or permanent; monitor urine output and sodium closely.*
* *Q6 (GI – Upper GI bleeding):** A patient with cirrhosis presents with hematemesis and
melena. Vital signs show BP 88/56 mmHg, HR 128 bpm. Which medication should the nurse
prepare to administer first?
. Pantoprazole 80 mg IV bolus
A
B. Octreotide 50 mcg IV bolus
C. Vitamin K 10 mg subcutaneously
, D. Propranolol 20 mg orally
* *[CORRECT]** B
*Rationale: In suspected variceal bleeding (cirrhosis + hematemesis), octreotide is the priority
pharmacologic intervention. It reduces splanchnic blood flow and portal pressure, controlling
bleeding in 80% of cases. Option A (PPI) is appropriate for non-variceal upper GI bleeding but
does not address portal hypertension. Option C (vitamin K) corrects coagulopathy but does not
stop active bleeding. Option D (propranolol) is for primary/secondary prophylaxis of variceal
bleeding, not acute management. Clinical pearl: The variceal bleed triad is octreotide + IV PPI +
antibiotics (ceftriaxone); endoscopic band ligation is definitive therapy.*
* *Q7 (GI – Liver failure):** A patient with end-stage liver disease presents with confusion,
asterixis, and elevated ammonia (120 mcg/dL). Which nursing intervention is the priority?
. Restrict protein intake to <20 g/day
A
B. Administer lactulose 30 mL orally three times daily
C. Administer rifaximin 550 mg orally twice daily
D. Prepare for emergency paracentesis
* *[CORRECT]** B
*Rationale: Hepatic encephalopathy is caused by ammonia accumulation; lactulose is first-line
therapy because it acidifies the colonic lumen, trapping ammonia as ammonium ions and
promoting excretion. Option A (protein restriction) is no longer recommended as it causes
malnutrition; small, frequent protein meals are preferred. Option C (rifaximin) is an adjunct to
lactulose for recurrent or refractory encephalopathy, not first-line monotherapy. Option D
(paracentesis) treats tense ascites, not encephalopathy. Clinical pearl: Monitor for 2–3 soft
stools daily with lactulose; this indicates adequate ammonia clearance.*
* *Q8 (GI – Cholangitis):** A patient presents with fever (101.8°F), right upper quadrant pain, and
jaundice. The nurse recognizes this as Charcot's triad and anticipates which immediate
intervention?
. Emergency cholecystectomy
A
B. IV antibiotics and biliary drainage
C. Oral cholestyramine for bile acid binding
D. Endoscopic retrograde cholangiopancreatography (ERCP) in 48 hours
* *[CORRECT]** B
*Rationale: Acute cholangitis is a bacterial infection of the biliary tree caused by obstruction
(typically choledocholithiasis). Charcot's triad (fever + RUQ pain + jaundice) is diagnostic. The
priority is IV antibiotics (ceftriaxone + metronidazole or piperacillin-tazobactam) combined with
urgent biliary drainage via ERCP or percutaneous transhepatic cholangiography. Option A
(cholecystectomy) is delayed until infection resolves. Option C is inappropriate for acute
infection. Option D delays definitive therapy; drainage should occur within 24 hours. Clinical
N
Maternal-Newborn Nursing Guide
ACTUAL EXAM 2026/2027 |
Maternal-Newborn Nursing Guide |
Verified Q&A | Pass Guaranteed - A+
Graded
=======================================================================
=
========
PART A – MULTIPLE CHOICE (Q1‑60)
========================================================================
========
* *Q1 (Endocrine – SIADH management):** A 68-year-old patient with small cell lung carcinoma
is admitted with confusion and a serum sodium of 118 mEq/L. The nurse notes the patient is
euvolemic with no edema. Which intervention is the priority?
. Administer 0.9% sodium chloride at 125 mL/hr
A
B. Initiate fluid restriction to 500–1000 mL/day
C. Administer hypertonic saline 3% immediately
D. Start furosemide 40 mg IV push
* *[CORRECT]** B
*Rationale: SIADH is characterized by euvolemic hyponatremia caused by inappropriate ADH
secretion, most commonly from small cell lung carcinoma. Evidence-based guidelines
recommend fluid restriction (500–1000 mL/day) as first-line therapy for mild to moderate SIADH
because free water restriction creates a negative water balance, allowing serum sodium to rise
gradually. Option A is incorrect because isotonic saline may worsen hyponatremia in SIADH by
expanding extracellular fluid without correcting the underlying water retention. Option C is
reserved for severe symptomatic hyponatremia (seizures, coma) with sodium <120 mEq/L and
severe symptoms. Option D (furosemide) is not first-line and may worsen electrolyte
imbalances. Clinical pearl: Always check urine sodium (>30 mmol/L) and osmolality (>100
mOsm/kg) to confirm SIADH before initiating fluid restriction.*
,* *Q2 (Endocrine – Thyroid storm):** A 32-year-old female with Graves' disease presents with
fever (104°F), tachycardia (160 bpm), agitation, and vomiting. The nurse prepares to administer
medications per the thyroid storm protocol. Which medication should be administered FIRST?
. Propylthiouracil (PTU) 600 mg orally
A
B. Propranolol 40 mg orally
C. Hydrocortisone 100 mg IV
D. Potassium iodide (SSKI) 5 drops orally
* *[CORRECT]** B
*Rationale: Current thyroid storm management prioritizes beta-blockers (propranolol or esmolol)
as first-line to control the adrenergic surge—tachycardia, tremors, and hyperthermia.
Propranolol 40–80 mg every 4–6 hours is the standard initial therapy. Option A (PTU) is
administered after beta-blockade to block new hormone synthesis. Option C (hydrocortisone) is
given after thionamides to block peripheral T4-to-T3 conversion and prevent adrenal
insufficiency. Option D (iodine/SSKI) must NEVER be given before thionamides because iodine
can fuel new hormone synthesis; it is administered 1 hour AFTER PTU or methimazole. Clinical
pearl: The sequence is critical—beta-blocker first, then thionamide, then corticosteroid, then
iodine.*
* *Q3 (Endocrine – Adrenal crisis):** A patient with known Addison's disease presents with
severe hypotension (78/42 mmHg), hyponatremia (128 mEq/L), hyperkalemia (5.8 mEq/L), and
altered mental status after a gastrointestinal infection. What is the nurse's priority action?
. Begin aggressive fluid resuscitation with 0.9% saline
A
B. Administer hydrocortisone 100 mg IV immediately
C. Obtain blood cultures before any treatment
D. Administer potassium-binding resin for hyperkalemia
* *[CORRECT]** B
*Rationale: Adrenal crisis is a life-threatening emergency caused by acute cortisol deficiency.
The definitive treatment is immediate IV hydrocortisone (100 mg bolus, then 100 mg every 8
hours), which restores vascular tone, corrects hypotension, and improves sodium/potassium
balance. Option A (fluid resuscitation) is important but secondary to glucocorticoid
replacement—fluids alone will not correct refractory shock in adrenal crisis. Option C delays
critical treatment; blood cultures can be obtained after steroid administration. Option D is
unnecessary because hyperkalemia typically resolves with hydrocortisone and fluid
resuscitation. Clinical pearl: "When in doubt, give the steroid"—never delay hydrocortisone for
diagnostic testing in suspected adrenal crisis.*
* *Q4 (Endocrine – Myxedema coma):** An 82-year-old female is found unresponsive at home
with a temperature of 92°F (33.3°C), heart rate of 48 bpm, and shallow respirations. Her family
,r eports she stopped taking levothyroxine 2 weeks ago. Which nursing intervention is most
appropriate?
. Rapidly rewarm the patient with warming blankets set to 104°F
A
B. Administer levothyroxine IV 200 mcg loading dose
C. Initiate mechanical ventilation immediately
D. Administer hydrocortisone 100 mg IV before levothyroxine
* *[CORRECT]** D
*Rationale: Myxedema coma management requires IV levothyroxine, but corticosteroids
(hydrocortisone 100 mg IV) must be administered FIRST because coexisting adrenal
insufficiency is common and unopposed thyroid hormone can precipitate adrenal crisis. Option
A is dangerous—rapid rewarming causes peripheral vasodilation and cardiovascular collapse;
rewarming must be gradual (0.5°C/hour). Option B is correct medication but wrong sequence
without corticosteroid coverage. Option C may be needed eventually, but airway management
follows hemodynamic stabilization. Clinical pearl: The myxedema coma triad is hypothermia,
bradycardia, and hypoventilation; always give steroids before thyroid hormone replacement.*
* *Q5 (Endocrine – Diabetes insipidus):** A post-craniotomy patient develops polyuria (800
mL/hr), dilute urine (specific gravity 1.002), and serum sodium of 152 mEq/L. The nurse
anticipates which medication?
. Desmopressin (DDAVP) 2 mcg IV
A
B. Hydrochlorothiazide 25 mg orally
C. Demeclocycline 300 mg orally
D. Vasopressin 5 units IM
* *[CORRECT]** A
*Rationale: Central diabetes insipidus (DI) following pituitary surgery results from ADH
deficiency, causing massive dilute polyuria and hypernatremia. Desmopressin (DDAVP), a
synthetic analog of vasopressin, is the drug of choice because it selectively acts on V2
receptors in the renal collecting ducts to promote water reabsorption without V1-mediated
vasoconstriction. Option B (thiazide) is used for nephrogenic DI, not central DI. Option C
(demeclocycline) induces nephrogenic DI and is used for SIADH. Option D (vasopressin) is less
preferred due to V1 receptor effects causing vasoconstriction. Clinical pearl: Post-neurosurgical
DI may be transient, triphasic, or permanent; monitor urine output and sodium closely.*
* *Q6 (GI – Upper GI bleeding):** A patient with cirrhosis presents with hematemesis and
melena. Vital signs show BP 88/56 mmHg, HR 128 bpm. Which medication should the nurse
prepare to administer first?
. Pantoprazole 80 mg IV bolus
A
B. Octreotide 50 mcg IV bolus
C. Vitamin K 10 mg subcutaneously
, D. Propranolol 20 mg orally
* *[CORRECT]** B
*Rationale: In suspected variceal bleeding (cirrhosis + hematemesis), octreotide is the priority
pharmacologic intervention. It reduces splanchnic blood flow and portal pressure, controlling
bleeding in 80% of cases. Option A (PPI) is appropriate for non-variceal upper GI bleeding but
does not address portal hypertension. Option C (vitamin K) corrects coagulopathy but does not
stop active bleeding. Option D (propranolol) is for primary/secondary prophylaxis of variceal
bleeding, not acute management. Clinical pearl: The variceal bleed triad is octreotide + IV PPI +
antibiotics (ceftriaxone); endoscopic band ligation is definitive therapy.*
* *Q7 (GI – Liver failure):** A patient with end-stage liver disease presents with confusion,
asterixis, and elevated ammonia (120 mcg/dL). Which nursing intervention is the priority?
. Restrict protein intake to <20 g/day
A
B. Administer lactulose 30 mL orally three times daily
C. Administer rifaximin 550 mg orally twice daily
D. Prepare for emergency paracentesis
* *[CORRECT]** B
*Rationale: Hepatic encephalopathy is caused by ammonia accumulation; lactulose is first-line
therapy because it acidifies the colonic lumen, trapping ammonia as ammonium ions and
promoting excretion. Option A (protein restriction) is no longer recommended as it causes
malnutrition; small, frequent protein meals are preferred. Option C (rifaximin) is an adjunct to
lactulose for recurrent or refractory encephalopathy, not first-line monotherapy. Option D
(paracentesis) treats tense ascites, not encephalopathy. Clinical pearl: Monitor for 2–3 soft
stools daily with lactulose; this indicates adequate ammonia clearance.*
* *Q8 (GI – Cholangitis):** A patient presents with fever (101.8°F), right upper quadrant pain, and
jaundice. The nurse recognizes this as Charcot's triad and anticipates which immediate
intervention?
. Emergency cholecystectomy
A
B. IV antibiotics and biliary drainage
C. Oral cholestyramine for bile acid binding
D. Endoscopic retrograde cholangiopancreatography (ERCP) in 48 hours
* *[CORRECT]** B
*Rationale: Acute cholangitis is a bacterial infection of the biliary tree caused by obstruction
(typically choledocholithiasis). Charcot's triad (fever + RUQ pain + jaundice) is diagnostic. The
priority is IV antibiotics (ceftriaxone + metronidazole or piperacillin-tazobactam) combined with
urgent biliary drainage via ERCP or percutaneous transhepatic cholangiography. Option A
(cholecystectomy) is delayed until infection resolves. Option C is inappropriate for acute
infection. Option D delays definitive therapy; drainage should occur within 24 hours. Clinical
