Perry Maternal Child Nursing Care 5th edition Test Bank
All chapters complete Question and Answers, With
Rationales EXAM with Questions and Answers/Plus a
Rationale Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Assessment and Management of High-Risk Pregnancies
2. Labor, Birth, and Obstetric Complications
3. Postpartum Care and Complications
4. Newborn Assessment and Care of High-Risk Neonates
5. Pediatric Health Promotion and Growth Assessment
6. Pediatric Neurological and Neuromuscular Disorders
7. Pediatric Cardiovascular and Respiratory Alterations
1. A multiparous client at 34 weeks gestation presents to the labor unit reporting sudden, severe,
continuous abdominal pain and dark vaginal bleeding. On assessment, the nurse notes uterine
tenderness, a firm, board-like abdomen, and a fetal heart rate bradycardia of 95 beats per minute.
Which action should the nurse take first?
A. Perform a sterile vaginal examination to evaluate cervical dilation.
B. Administer high-flow oxygen via nonrebreather mask and prepare for immediate
delivery.
C. Obtain an emergency ultrasound to locate the placenta.
D. Initiate a continuous intravenous oxytocin infusion to accelerate labor.
CORRECT ANSWER : B
, Rationale: The client's clinical picture is classic for severe abruptio placentae, an obstetric
emergency that threatens maternal and fetal life. The priority is to optimize fetal oxygenation via
maternal oxygen administration and immediately prepare for emergency delivery. A vaginal
exam is contraindicated if placenta previa is not entirely ruled out, and waiting for an
ultrasound or infusing oxytocin will fatally delay definitive surgical intervention.
2. A client at 38 weeks gestation with severe preeclampsia is receiving a therapeutic intravenous
infusion of magnesium sulfate. During the hourly assessment, the nurse finds the client's
respiratory rate is 9 breaths per minute, deep tendon reflexes are absent, and she is lethargic.
Which medication should the nurse prepare to administer immediately?
A. Naloxone hydrochloride
B. Protamine sulfate
C. Terbutaline sulfate
D. Calcium gluconate
CORRECT ANSWER : D
Rationale: The client is exhibiting hallmark signs of magnesium sulfate toxicity, including
respiratory depression and loss of deep tendon reflexes. Calcium gluconate is the specific
antidote that reverses the neuromuscular blockade caused by toxic magnesium levels. Naloxone
reverses opioids, protamine sulfate reverses heparin, and terbutaline is a tocolytic used to stop
uterine contractions.
3. A client at 41 weeks gestation is undergoing oxytocin induction of labor. The electronic fetal
monitor reveals a baseline fetal heart rate of 140 beats per minute with late decelerations that
peak after the apex of each contraction. What is the priority nursing action?
A. Discontinue the oxytocin infusion immediately.
B. Turn the client onto her right lateral side.
C. Increase the maintenance intravenous fluid rate.
D. Prepare the client for immediate vacuum-assisted vaginal delivery.
CORRECT ANSWER : A
Rationale: Late decelerations indicate uteroplacental insufficiency, meaning the fetus is being
deprived of adequate oxygen during contractions. The very first action must be to stop the
oxytocin infusion to remove uterine stress and improve placental blood flow. Subsequent
interventions include repositioning to a left lateral position, increasing IV fluids, and applying
oxygen, but stopping the offending agent is the absolute priority.
,4. A nurse is caring for a postpartum client 4 hours after a precipitous vaginal delivery of a 9-
pound, 4-ounce infant. The nurse notes that the client's perineal pad is saturated with bright red
blood within 15 minutes, and the uterine fundus is boggy and displaced to the right of the
umbilicus. Which action should the nurse perform first?
A. Administer a prescribed intramuscular injection of methylergonovine.
B. Assist the client to void or perform straight catheterization if unable to void.
C. Massage the boggy uterine fundus firmly until it contracts.
D. Notify the primary healthcare provider of heavy postpartum bleeding.
CORRECT ANSWER : B
Rationale: A boggy uterine fundus that is displaced to the right side strongly indicates a
distended bladder, which mechanically prevents the uterus from contracting fully and leads to
uterine atony and hemorrhage. Emptying the bladder immediately resolves the displacement,
allowing the uterus to naturally contract and control bleeding. Fundal massage is crucial, but it
will not be permanently effective until the bladder is emptied.
5. A primigravida at 32 weeks gestation is admitted with preterm premature rupture of membranes
(PPROM). She is currently afebrile and denied abdominal pain. Which medical prescription
should the nurse prioritize to improve neonatal outcomes?
A. Continuous intravenous infusion of magnesium sulfate.
B. Intramuscular administration of betamethasone.
C. Intravenous bolus of terbutaline sulfate.
D. Immediate induction of labor with vaginal dinoprostone.
CORRECT ANSWER : B
Rationale: In cases of PPROM prior to 34 weeks gestation without signs of infection
(chorioamnionitis), the primary goal is to accelerate fetal lung maturity to minimize the risk of
respiratory distress syndrome. Antenatal corticosteroids like betamethasone require 24 to 48
hours to achieve maximum efficacy. Magnesium sulfate would be prioritized if delivery was
imminent for fetal neuroprotection, and inducing labor is avoided in stable preterm fetuses.
6. A newborn at 12 hours of age is noted to be lethargic, jittery, and has a high-pitched cry. The
infant's mother has a history of poorly controlled gestational diabetes mellitus. What diagnostic
action should the nurse take immediately?
A. Obtain a blood culture to screen for neonatal sepsis.
, B. Perform a heel-stick blood glucose measurement.
C. Request a serum bilirubin level to check for pathologic jaundice.
D. Schedule an urgent cranial ultrasound examination.
CORRECT ANSWER : B
Rationale: Infants of diabetic mothers (IDMs) are at high risk for hypoglycemia after birth due
to hyperinsulinism caused by high maternal glucose levels in utero. Jitteriness, lethargy, and a
high-pitched cry are classic signs of neonatal hypoglycemia. A heel-stick blood glucose test must
be performed immediately to verify levels and initiate treatment (feeding or IV glucose) to
prevent neurological injury.
7. The nurse is conducting a newborn assessment at 1 minute after birth and notes the following:
heart rate is 112 beats per minute, the infant has a weak cry with slow, irregular respirations,
there is some flexion of the extremities, the infant grimaces when suctioned, and the body is pink
with blue extremities. What is the assigned Apgar score?
A. 5
B. 6
C. 7
D. 8
CORRECT ANSWER : B
Rationale: The Apgar scoring breakdown for this neonate is: 2 points for heart rate greater than
100 bpm; 1 point for slow, irregular respirations; 1 point for some flexion/active motion; 1 point
for grimace during reflex irritability; and 1 point for acrocyanosis (pink body, blue extremities).
This results in a total score of 6, indicating moderate difficulty transitioning to extrauterine life.
8. A 4-week-old infant is brought to the pediatric clinic with a history of progressive, non-bilious
projectile vomiting immediately after every feeding. The mother states the infant is constantly
hungry. On physical examination, the nurse notes a small, olive-shaped mass in the right upper
quadrant of the abdomen. Which condition is most consistent with these findings?
A. Intussusception
B. Hirschsprung disease
C. Gastroesophageal reflux
D. Hypertrophic pyloric stenosis
All chapters complete Question and Answers, With
Rationales EXAM with Questions and Answers/Plus a
Rationale Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Assessment and Management of High-Risk Pregnancies
2. Labor, Birth, and Obstetric Complications
3. Postpartum Care and Complications
4. Newborn Assessment and Care of High-Risk Neonates
5. Pediatric Health Promotion and Growth Assessment
6. Pediatric Neurological and Neuromuscular Disorders
7. Pediatric Cardiovascular and Respiratory Alterations
1. A multiparous client at 34 weeks gestation presents to the labor unit reporting sudden, severe,
continuous abdominal pain and dark vaginal bleeding. On assessment, the nurse notes uterine
tenderness, a firm, board-like abdomen, and a fetal heart rate bradycardia of 95 beats per minute.
Which action should the nurse take first?
A. Perform a sterile vaginal examination to evaluate cervical dilation.
B. Administer high-flow oxygen via nonrebreather mask and prepare for immediate
delivery.
C. Obtain an emergency ultrasound to locate the placenta.
D. Initiate a continuous intravenous oxytocin infusion to accelerate labor.
CORRECT ANSWER : B
, Rationale: The client's clinical picture is classic for severe abruptio placentae, an obstetric
emergency that threatens maternal and fetal life. The priority is to optimize fetal oxygenation via
maternal oxygen administration and immediately prepare for emergency delivery. A vaginal
exam is contraindicated if placenta previa is not entirely ruled out, and waiting for an
ultrasound or infusing oxytocin will fatally delay definitive surgical intervention.
2. A client at 38 weeks gestation with severe preeclampsia is receiving a therapeutic intravenous
infusion of magnesium sulfate. During the hourly assessment, the nurse finds the client's
respiratory rate is 9 breaths per minute, deep tendon reflexes are absent, and she is lethargic.
Which medication should the nurse prepare to administer immediately?
A. Naloxone hydrochloride
B. Protamine sulfate
C. Terbutaline sulfate
D. Calcium gluconate
CORRECT ANSWER : D
Rationale: The client is exhibiting hallmark signs of magnesium sulfate toxicity, including
respiratory depression and loss of deep tendon reflexes. Calcium gluconate is the specific
antidote that reverses the neuromuscular blockade caused by toxic magnesium levels. Naloxone
reverses opioids, protamine sulfate reverses heparin, and terbutaline is a tocolytic used to stop
uterine contractions.
3. A client at 41 weeks gestation is undergoing oxytocin induction of labor. The electronic fetal
monitor reveals a baseline fetal heart rate of 140 beats per minute with late decelerations that
peak after the apex of each contraction. What is the priority nursing action?
A. Discontinue the oxytocin infusion immediately.
B. Turn the client onto her right lateral side.
C. Increase the maintenance intravenous fluid rate.
D. Prepare the client for immediate vacuum-assisted vaginal delivery.
CORRECT ANSWER : A
Rationale: Late decelerations indicate uteroplacental insufficiency, meaning the fetus is being
deprived of adequate oxygen during contractions. The very first action must be to stop the
oxytocin infusion to remove uterine stress and improve placental blood flow. Subsequent
interventions include repositioning to a left lateral position, increasing IV fluids, and applying
oxygen, but stopping the offending agent is the absolute priority.
,4. A nurse is caring for a postpartum client 4 hours after a precipitous vaginal delivery of a 9-
pound, 4-ounce infant. The nurse notes that the client's perineal pad is saturated with bright red
blood within 15 minutes, and the uterine fundus is boggy and displaced to the right of the
umbilicus. Which action should the nurse perform first?
A. Administer a prescribed intramuscular injection of methylergonovine.
B. Assist the client to void or perform straight catheterization if unable to void.
C. Massage the boggy uterine fundus firmly until it contracts.
D. Notify the primary healthcare provider of heavy postpartum bleeding.
CORRECT ANSWER : B
Rationale: A boggy uterine fundus that is displaced to the right side strongly indicates a
distended bladder, which mechanically prevents the uterus from contracting fully and leads to
uterine atony and hemorrhage. Emptying the bladder immediately resolves the displacement,
allowing the uterus to naturally contract and control bleeding. Fundal massage is crucial, but it
will not be permanently effective until the bladder is emptied.
5. A primigravida at 32 weeks gestation is admitted with preterm premature rupture of membranes
(PPROM). She is currently afebrile and denied abdominal pain. Which medical prescription
should the nurse prioritize to improve neonatal outcomes?
A. Continuous intravenous infusion of magnesium sulfate.
B. Intramuscular administration of betamethasone.
C. Intravenous bolus of terbutaline sulfate.
D. Immediate induction of labor with vaginal dinoprostone.
CORRECT ANSWER : B
Rationale: In cases of PPROM prior to 34 weeks gestation without signs of infection
(chorioamnionitis), the primary goal is to accelerate fetal lung maturity to minimize the risk of
respiratory distress syndrome. Antenatal corticosteroids like betamethasone require 24 to 48
hours to achieve maximum efficacy. Magnesium sulfate would be prioritized if delivery was
imminent for fetal neuroprotection, and inducing labor is avoided in stable preterm fetuses.
6. A newborn at 12 hours of age is noted to be lethargic, jittery, and has a high-pitched cry. The
infant's mother has a history of poorly controlled gestational diabetes mellitus. What diagnostic
action should the nurse take immediately?
A. Obtain a blood culture to screen for neonatal sepsis.
, B. Perform a heel-stick blood glucose measurement.
C. Request a serum bilirubin level to check for pathologic jaundice.
D. Schedule an urgent cranial ultrasound examination.
CORRECT ANSWER : B
Rationale: Infants of diabetic mothers (IDMs) are at high risk for hypoglycemia after birth due
to hyperinsulinism caused by high maternal glucose levels in utero. Jitteriness, lethargy, and a
high-pitched cry are classic signs of neonatal hypoglycemia. A heel-stick blood glucose test must
be performed immediately to verify levels and initiate treatment (feeding or IV glucose) to
prevent neurological injury.
7. The nurse is conducting a newborn assessment at 1 minute after birth and notes the following:
heart rate is 112 beats per minute, the infant has a weak cry with slow, irregular respirations,
there is some flexion of the extremities, the infant grimaces when suctioned, and the body is pink
with blue extremities. What is the assigned Apgar score?
A. 5
B. 6
C. 7
D. 8
CORRECT ANSWER : B
Rationale: The Apgar scoring breakdown for this neonate is: 2 points for heart rate greater than
100 bpm; 1 point for slow, irregular respirations; 1 point for some flexion/active motion; 1 point
for grimace during reflex irritability; and 1 point for acrocyanosis (pink body, blue extremities).
This results in a total score of 6, indicating moderate difficulty transitioning to extrauterine life.
8. A 4-week-old infant is brought to the pediatric clinic with a history of progressive, non-bilious
projectile vomiting immediately after every feeding. The mother states the infant is constantly
hungry. On physical examination, the nurse notes a small, olive-shaped mass in the right upper
quadrant of the abdomen. Which condition is most consistent with these findings?
A. Intussusception
B. Hirschsprung disease
C. Gastroesophageal reflux
D. Hypertrophic pyloric stenosis
