RNSG 1517 A Maternity Exam | Complete
Questions with Correct Answers and
Detailed Rationales - Latest Update 2026
Question 1
A client at 38 weeks gestation is admitted with suspected preeclampsia. Which
assessment finding is most concerning?
A) Blood pressure 148/92 mmHg
B) 1+ proteinuria
C) Headache and visual disturbances
D) Mild ankle edema
Correct ,,,answer,,,: C
Rationale: Headache and visual disturbances are signs of severe preeclampsia and
indicate cerebral edema and impending eclampsia, requiring immediate
intervention.
Question 2
A client who is 12 hours postpartum reports a sudden gush of vaginal bleeding and
a feeling of "something giving way." What is the nurse's priority action?
,A) Assess the client's pain level
B) Assess the fundus and vital signs
C) Encourage the client to void
D) Administer pain medication
Correct ,,,answer,,,: B
Rationale: A sudden gush of bleeding may indicate uterine atony or hemorrhage.
The nurse should immediately assess the fundus for tone and check vital signs.
Question 3
A nurse is caring for a client during the fourth stage of labor. Which assessment
finding requires immediate intervention?
A) Fundus firm at the umbilicus
B) Moderate lochia rubra
C) Fundus boggy and deviated to the right
D) Blood pressure 120/76 mmHg
Correct ,,,answer,,,: C
Rationale: A boggy fundus deviated to the right indicates uterine atony and a full
bladder, which can lead to postpartum hemorrhage. The client should be assisted
to void.
Question 4
A client at 34 weeks gestation is diagnosed with gestational diabetes. Which fetal
complication is most concerning?
,A) Intrauterine growth restriction
B) Macrosomia
C) Polyhydramnios
D) Oligohydramnios
Correct ,,,answer,,,: B
Rationale: Gestational diabetes causes fetal hyperinsulinemia, leading to
macrosomia (large for gestational age), which increases the risk of shoulder
dystocia and birth injuries.
Question 5
A client in active labor is receiving oxytocin (Pitocin). What is the priority nursing
action?
A) Assess cervical dilation every 2 hours
B) Monitor uterine contractions and fetal heart rate continuously
C) Encourage the client to ambulate
D) Administer pain medication every 4 hours
Correct ,,,answer,,,: B
Rationale: Oxytocin can cause uterine hyperstimulation, leading to fetal distress.
Continuous monitoring of contractions and fetal heart rate is essential.
Question 6
The nurse is assessing a newborn and notes acrocyanosis. What is the appropriate
action?
, A) Notify the healthcare provider immediately
B) Document the finding as a normal newborn assessment
C) Administer oxygen
D) Place the newborn in an incubator
Correct ,,,answer,,,: B
Rationale: Acrocyanosis (bluish discoloration of the hands and feet) is a normal
finding in newborns due to immature peripheral circulation and resolves within 24-
48 hours.
Question 7
A client with Rh-negative blood type is pregnant. At what gestational age should
RhoGAM be administered?
A) 24 weeks
B) 28 weeks
C) 32 weeks
D) 36 weeks
Correct ,,,answer,,,: B
Rationale: RhoGAM is administered at 28 weeks gestation to Rh-negative clients to
prevent Rh isoimmunization and hemolytic disease of the newborn.
Question 8
A client reports that her "water broke" and fluid is leaking. What is the priority
nursing assessment?
Questions with Correct Answers and
Detailed Rationales - Latest Update 2026
Question 1
A client at 38 weeks gestation is admitted with suspected preeclampsia. Which
assessment finding is most concerning?
A) Blood pressure 148/92 mmHg
B) 1+ proteinuria
C) Headache and visual disturbances
D) Mild ankle edema
Correct ,,,answer,,,: C
Rationale: Headache and visual disturbances are signs of severe preeclampsia and
indicate cerebral edema and impending eclampsia, requiring immediate
intervention.
Question 2
A client who is 12 hours postpartum reports a sudden gush of vaginal bleeding and
a feeling of "something giving way." What is the nurse's priority action?
,A) Assess the client's pain level
B) Assess the fundus and vital signs
C) Encourage the client to void
D) Administer pain medication
Correct ,,,answer,,,: B
Rationale: A sudden gush of bleeding may indicate uterine atony or hemorrhage.
The nurse should immediately assess the fundus for tone and check vital signs.
Question 3
A nurse is caring for a client during the fourth stage of labor. Which assessment
finding requires immediate intervention?
A) Fundus firm at the umbilicus
B) Moderate lochia rubra
C) Fundus boggy and deviated to the right
D) Blood pressure 120/76 mmHg
Correct ,,,answer,,,: C
Rationale: A boggy fundus deviated to the right indicates uterine atony and a full
bladder, which can lead to postpartum hemorrhage. The client should be assisted
to void.
Question 4
A client at 34 weeks gestation is diagnosed with gestational diabetes. Which fetal
complication is most concerning?
,A) Intrauterine growth restriction
B) Macrosomia
C) Polyhydramnios
D) Oligohydramnios
Correct ,,,answer,,,: B
Rationale: Gestational diabetes causes fetal hyperinsulinemia, leading to
macrosomia (large for gestational age), which increases the risk of shoulder
dystocia and birth injuries.
Question 5
A client in active labor is receiving oxytocin (Pitocin). What is the priority nursing
action?
A) Assess cervical dilation every 2 hours
B) Monitor uterine contractions and fetal heart rate continuously
C) Encourage the client to ambulate
D) Administer pain medication every 4 hours
Correct ,,,answer,,,: B
Rationale: Oxytocin can cause uterine hyperstimulation, leading to fetal distress.
Continuous monitoring of contractions and fetal heart rate is essential.
Question 6
The nurse is assessing a newborn and notes acrocyanosis. What is the appropriate
action?
, A) Notify the healthcare provider immediately
B) Document the finding as a normal newborn assessment
C) Administer oxygen
D) Place the newborn in an incubator
Correct ,,,answer,,,: B
Rationale: Acrocyanosis (bluish discoloration of the hands and feet) is a normal
finding in newborns due to immature peripheral circulation and resolves within 24-
48 hours.
Question 7
A client with Rh-negative blood type is pregnant. At what gestational age should
RhoGAM be administered?
A) 24 weeks
B) 28 weeks
C) 32 weeks
D) 36 weeks
Correct ,,,answer,,,: B
Rationale: RhoGAM is administered at 28 weeks gestation to Rh-negative clients to
prevent Rh isoimmunization and hemolytic disease of the newborn.
Question 8
A client reports that her "water broke" and fluid is leaking. What is the priority
nursing assessment?
