Maternity & Pediatric Nursing Comprehensive Practice
Examination: 100 Questions with Rationales
1. A client who is attending antepartum classes asks the nurse why her healthcare provider
has prescribed iron tablets. The nurse's response is based on what knowledge?
a. Supplementary iron is more efficiently utilized during pregnancy.
b. It is difficult to consume 18 mg of additional iron by diet alone.
c. Iron absorption is decreased in the GI tract during pregnancy.
d. Iron is needed to prevent megaloblastic anemia in the last trimester.
ANSWER: B. It is difficult to consume 18 mg of additional iron by diet alone.
Rationale: During pregnancy, the body's iron requirements increase significantly to support the
expansion of maternal red blood cell mass and fetal development. It is very difficult to meet the
recommended daily allowance of 27 mg of iron through diet alone, so supplementation is
standard. (A) Iron absorption is actually increased during pregnancy. (C) Iron absorption is
enhanced, not decreased. (D) Iron prevents iron-deficiency anemia, not megaloblastic anemia
(which is related to folic acid/B12 deficiency).
2. A newborn, whose mother is HIV positive, is scheduled for follow-up assessments. The
nurse knows that the most likely presenting symptom for a pediatric client with AIDS is:
a. Shortness of breath.
b. Joint pain.
c. A persistent cold.
d. Organomegaly.
ANSWER: C. A persistent cold.
Rationale: In pediatric patients, the most common initial presenting symptoms of HIV/AIDS are
related to recurrent, persistent infections, such as upper respiratory infections, otitis media, or a
persistent cold, as well as failure to thrive and chronic diarrhea. (A) Shortness of breath
(Pneumocystis pneumonia) is a serious complication but not typically the most likely first
presenting symptom. (B) Joint pain is not a primary symptom. (D) Organomegaly can occur but
is less common as a presenting symptom than persistent infections.
,3. A mother who is breastfeeding her baby receives instructions from the nurse. Which
instruction is most effective to prevent nipple soreness?
a. Wear a cotton bra.
b. Increase nursing time gradually.
c. Correctly place the infant on the breast.
d. Manually express a small amount of milk before nursing.
ANSWER: C. Correctly place the infant on the breast.
Rationale: The most effective way to prevent nipple soreness is to ensure a proper latch and
correct positioning of the infant on the breast. This prevents the infant from applying friction to
the nipple. (A) Wearing a cotton bra promotes air circulation but does not directly prevent
soreness. (B) Increasing nursing time gradually helps the nipples toughen but is less effective
than correct latching. (D) Expressing a small amount of milk before nursing softens the breast
and is helpful but not as critical as correct placement.
4. A client with no prenatal care arrives at the labor unit screaming, "The baby is coming!"
The nurse performs a vaginal examination that reveals the cervix is 3 cm dilated and 75%
effaced. What additional information is most important for the nurse to obtain?
a. Gravidity and parity
b. Time and amount of last oral intake
c. Date of last normal menstrual period.
d. Frequency and intensity of contractions
ANSWER: C. Date of last normal menstrual period.
Rationale: Establishing the gestation of the pregnancy (C) takes priority. If the fetus is preterm
and the fetal heart pattern is reassuring, the healthcare provider may attempt to prolong the
pregnancy and administer corticosteroids to mature the lungs of the fetus. (A, B, and D) are all
important to evaluate and incorporate into the plan of care, but establishing gestation takes
priority.
5. A 30-year-old gravida 2, para 1 client is admitted to the hospital at 26-weeks’ gestation in
preterm labor. She is started on an IV solution of terbutaline (Brethine). Which assessment
,is the highest priority for the nurse to monitor during the administration of this drug?
a. Maternal blood pressure and respirations.
b. Maternal and fetal heart rates.
c. Hourly urinary output.
d. Deep tendon reflexes.
ANSWER: B. Maternal and fetal heart rates.
Rationale: Terbutaline is a beta-adrenergic agonist that stimulates beta-2 receptors in the uterus
to relax smooth muscle. However, it also stimulates beta-1 receptors in the heart, which can
cause significant maternal and fetal tachycardia. Monitoring (B) heart rates is the highest priority
due to this significant side effect. (A) Blood pressure and respirations are important but not the
primary concern. (C) Urinary output is not a primary effect. (D) Deep tendon reflexes are
monitored for magnesium sulfate toxicity.
6. Which action should the nurse implement when preparing to measure the fundal height
of a pregnant client?
a. Have the client empty her bladder.
b. Request the client lie on her left side.
c. Perform Leopold's maneuvers first.
d. Give the client some cold juice to drink.
ANSWER: A. Have the client empty her bladder.
Rationale: Measuring fundal height requires accurate assessment of the uterine size. A full
bladder can displace the uterus upward, leading to an inaccurate measurement. Therefore, the
client should empty her bladder before the procedure. (B) The client should lie in a supine
position with a slight lateral tilt, not strictly on her side. (C) Leopold's maneuvers are performed
to determine fetal position, not as a preliminary step for fundal height. (D) Cold juice is given to
stimulate fetal movement, not for fundal height.
7. A client who delivered an infant an hour ago tells the nurse that she feels wet underneath
her buttock. The nurse notes that both perineal pads are completely saturated and the
client is lying in a 6-inch diameter pool of blood. Which action should the nurse implement
next?
, a. Cleanse the perineum.
b. Obtain a blood pressure.
c. Palpate the firmness of the fundus.
d. Inspect the perineum for lacerations.
ANSWER: C. Palpate the firmness of the fundus.
Rationale: The most common cause of postpartum hemorrhage is uterine atony (a boggy uterus).
The immediate priority is to assess the fundus to determine if it is firm, which would indicate a
contracted uterus and control of bleeding. The first action is to assess the cause, and if the uterus
is boggy, the nurse would immediately massage it. (A) Cleaning the perineum is not the priority.
(B) Obtaining blood pressure is important but comes after the immediate intervention to stop the
bleeding. (D) Inspecting for lacerations is done after ruling out uterine atony.
8. In developing a teaching plan for expectant parents, the nurse plans to include
information about when the parents can expect the infant's fontanels to close. The nurse
bases the explanation on knowledge that for the normal newborn, the:
a. Anterior fontanel closes at 2 to 4 months and the posterior by the end of the first week.
b. Anterior fontanel closes at 5 to 7 months and the posterior by the end of the second week.
c. Anterior fontanel closes at 8 to 11 months and the posterior by the end of the first month.
d. Anterior fontanel closes at 12 to 18 months and the posterior by the end of the second month.
ANSWER: D. Anterior fontanel closes at 12 to 18 months and the posterior by the end of the
second month.
Rationale: The anterior fontanel, which is diamond-shaped, typically closes between 12 and 18
months of age. The posterior fontanel, which is triangular, is much smaller and closes much
earlier, usually by the end of the second month (6-8 weeks). This makes (D) the correct choice.
9. The total bilirubin level of a 36-hour, breastfeeding newborn is 14 mg/dl. Based on this
finding, which intervention should the nurse implement?
a. Provide phototherapy for 30 minutes q8h.
b. Feed the newborn sterile water hourly.
c. Encourage the mother to breastfeed frequently.
d. Assess the newborn's blood glucose level.
Examination: 100 Questions with Rationales
1. A client who is attending antepartum classes asks the nurse why her healthcare provider
has prescribed iron tablets. The nurse's response is based on what knowledge?
a. Supplementary iron is more efficiently utilized during pregnancy.
b. It is difficult to consume 18 mg of additional iron by diet alone.
c. Iron absorption is decreased in the GI tract during pregnancy.
d. Iron is needed to prevent megaloblastic anemia in the last trimester.
ANSWER: B. It is difficult to consume 18 mg of additional iron by diet alone.
Rationale: During pregnancy, the body's iron requirements increase significantly to support the
expansion of maternal red blood cell mass and fetal development. It is very difficult to meet the
recommended daily allowance of 27 mg of iron through diet alone, so supplementation is
standard. (A) Iron absorption is actually increased during pregnancy. (C) Iron absorption is
enhanced, not decreased. (D) Iron prevents iron-deficiency anemia, not megaloblastic anemia
(which is related to folic acid/B12 deficiency).
2. A newborn, whose mother is HIV positive, is scheduled for follow-up assessments. The
nurse knows that the most likely presenting symptom for a pediatric client with AIDS is:
a. Shortness of breath.
b. Joint pain.
c. A persistent cold.
d. Organomegaly.
ANSWER: C. A persistent cold.
Rationale: In pediatric patients, the most common initial presenting symptoms of HIV/AIDS are
related to recurrent, persistent infections, such as upper respiratory infections, otitis media, or a
persistent cold, as well as failure to thrive and chronic diarrhea. (A) Shortness of breath
(Pneumocystis pneumonia) is a serious complication but not typically the most likely first
presenting symptom. (B) Joint pain is not a primary symptom. (D) Organomegaly can occur but
is less common as a presenting symptom than persistent infections.
,3. A mother who is breastfeeding her baby receives instructions from the nurse. Which
instruction is most effective to prevent nipple soreness?
a. Wear a cotton bra.
b. Increase nursing time gradually.
c. Correctly place the infant on the breast.
d. Manually express a small amount of milk before nursing.
ANSWER: C. Correctly place the infant on the breast.
Rationale: The most effective way to prevent nipple soreness is to ensure a proper latch and
correct positioning of the infant on the breast. This prevents the infant from applying friction to
the nipple. (A) Wearing a cotton bra promotes air circulation but does not directly prevent
soreness. (B) Increasing nursing time gradually helps the nipples toughen but is less effective
than correct latching. (D) Expressing a small amount of milk before nursing softens the breast
and is helpful but not as critical as correct placement.
4. A client with no prenatal care arrives at the labor unit screaming, "The baby is coming!"
The nurse performs a vaginal examination that reveals the cervix is 3 cm dilated and 75%
effaced. What additional information is most important for the nurse to obtain?
a. Gravidity and parity
b. Time and amount of last oral intake
c. Date of last normal menstrual period.
d. Frequency and intensity of contractions
ANSWER: C. Date of last normal menstrual period.
Rationale: Establishing the gestation of the pregnancy (C) takes priority. If the fetus is preterm
and the fetal heart pattern is reassuring, the healthcare provider may attempt to prolong the
pregnancy and administer corticosteroids to mature the lungs of the fetus. (A, B, and D) are all
important to evaluate and incorporate into the plan of care, but establishing gestation takes
priority.
5. A 30-year-old gravida 2, para 1 client is admitted to the hospital at 26-weeks’ gestation in
preterm labor. She is started on an IV solution of terbutaline (Brethine). Which assessment
,is the highest priority for the nurse to monitor during the administration of this drug?
a. Maternal blood pressure and respirations.
b. Maternal and fetal heart rates.
c. Hourly urinary output.
d. Deep tendon reflexes.
ANSWER: B. Maternal and fetal heart rates.
Rationale: Terbutaline is a beta-adrenergic agonist that stimulates beta-2 receptors in the uterus
to relax smooth muscle. However, it also stimulates beta-1 receptors in the heart, which can
cause significant maternal and fetal tachycardia. Monitoring (B) heart rates is the highest priority
due to this significant side effect. (A) Blood pressure and respirations are important but not the
primary concern. (C) Urinary output is not a primary effect. (D) Deep tendon reflexes are
monitored for magnesium sulfate toxicity.
6. Which action should the nurse implement when preparing to measure the fundal height
of a pregnant client?
a. Have the client empty her bladder.
b. Request the client lie on her left side.
c. Perform Leopold's maneuvers first.
d. Give the client some cold juice to drink.
ANSWER: A. Have the client empty her bladder.
Rationale: Measuring fundal height requires accurate assessment of the uterine size. A full
bladder can displace the uterus upward, leading to an inaccurate measurement. Therefore, the
client should empty her bladder before the procedure. (B) The client should lie in a supine
position with a slight lateral tilt, not strictly on her side. (C) Leopold's maneuvers are performed
to determine fetal position, not as a preliminary step for fundal height. (D) Cold juice is given to
stimulate fetal movement, not for fundal height.
7. A client who delivered an infant an hour ago tells the nurse that she feels wet underneath
her buttock. The nurse notes that both perineal pads are completely saturated and the
client is lying in a 6-inch diameter pool of blood. Which action should the nurse implement
next?
, a. Cleanse the perineum.
b. Obtain a blood pressure.
c. Palpate the firmness of the fundus.
d. Inspect the perineum for lacerations.
ANSWER: C. Palpate the firmness of the fundus.
Rationale: The most common cause of postpartum hemorrhage is uterine atony (a boggy uterus).
The immediate priority is to assess the fundus to determine if it is firm, which would indicate a
contracted uterus and control of bleeding. The first action is to assess the cause, and if the uterus
is boggy, the nurse would immediately massage it. (A) Cleaning the perineum is not the priority.
(B) Obtaining blood pressure is important but comes after the immediate intervention to stop the
bleeding. (D) Inspecting for lacerations is done after ruling out uterine atony.
8. In developing a teaching plan for expectant parents, the nurse plans to include
information about when the parents can expect the infant's fontanels to close. The nurse
bases the explanation on knowledge that for the normal newborn, the:
a. Anterior fontanel closes at 2 to 4 months and the posterior by the end of the first week.
b. Anterior fontanel closes at 5 to 7 months and the posterior by the end of the second week.
c. Anterior fontanel closes at 8 to 11 months and the posterior by the end of the first month.
d. Anterior fontanel closes at 12 to 18 months and the posterior by the end of the second month.
ANSWER: D. Anterior fontanel closes at 12 to 18 months and the posterior by the end of the
second month.
Rationale: The anterior fontanel, which is diamond-shaped, typically closes between 12 and 18
months of age. The posterior fontanel, which is triangular, is much smaller and closes much
earlier, usually by the end of the second month (6-8 weeks). This makes (D) the correct choice.
9. The total bilirubin level of a 36-hour, breastfeeding newborn is 14 mg/dl. Based on this
finding, which intervention should the nurse implement?
a. Provide phototherapy for 30 minutes q8h.
b. Feed the newborn sterile water hourly.
c. Encourage the mother to breastfeed frequently.
d. Assess the newborn's blood glucose level.
