NUR 230 OB/Peds Exam 4 | Practice Questions
And Answers | Verified Tests With Detailed
Rationale | 2026/2027 Updates
Question 1.
A client at 39 weeks gestation is scheduled for labor induction. The nurse documents
the following cervical assessment: 3 cm dilated, 60% effaced, fetal head at -2 station,
cervix of medium consistency, and mid-position. Using the modified Bishop score, the
nurse calculates a score of:
A. 4
B. 6
C. 8
D. 10
Correct Answer: B
Rationale: The modified Bishop score assigns points as follows: Dilation (3 cm = 2 points),
Effacement (60% = 1 point), Station (-2 = 1 point), Consistency (medium = 1 point), and
Position (mid-position = 1 point). Total = 2 + 1 + 1 + 1 + 1 = 6. A Bishop score ≤5 indicates
an unfavorable cervix with a higher likelihood of failed induction and need for cesarean
delivery. A score ≥8 indicates a favorable cervix. Prostaglandins or mechanical dilators
(Foley catheter) may be used for cervical ripening when the score is low.
Question 2.
A client in labor is receiving oxytocin for augmentation. The nurse is titrating the
infusion per protocol. The nurse knows that the maximum dose of oxytocin typically
administered is:
A. 10 milliunits/minute.
B. 20 milliunits/minute.
C. 30 milliunits/minute.
D. 40 milliunits/minute.
Correct Answer: B
,Rationale: The typical maximum dose of oxytocin for labor augmentation or induction is 20
milliunits per minute, though some protocols allow up to 30 mU/min. Oxytocin is started at
a low dose (e.g., 1–2 mU/min) and increased incrementally (e.g., every 30–40 minutes) until
adequate contractions are achieved (3–5 contractions in 10 minutes, each lasting 45–60
seconds). The nurse must monitor for uterine tachysystole (>5 contractions in 10 minutes)
and discontinue or decrease the infusion if fetal heart rate abnormalities or excessive
uterine activity occur.
Question 3.
A client at 32 weeks gestation is in preterm labor. The provider orders nifedipine as a
tocolytic. The nurse knows that the primary mechanism of action of nifedipine in
preterm labor is:
A. Stimulation of beta-2 adrenergic receptors causing uterine relaxation.
B. Calcium channel blockade inhibiting uterine smooth muscle contraction.
C. Inhibition of prostaglandin synthesis reducing uterine irritability.
D. Magnesium replacement preventing neuromuscular excitability.
Correct Answer: B
Rationale: Nifedipine is a calcium channel blocker that inhibits calcium influx into uterine
smooth muscle cells, reducing myometrial contractility. It is commonly used as a tocolytic
for preterm labor. Side effects include hypotension, flushing, and tachycardia. Terbutaline (a
beta-2 agonist) stimulates beta-2 receptors. Indomethacin inhibits prostaglandin synthesis.
Magnesium sulfate acts as a calcium antagonist at the cellular level and is used for
neuroprotection and tocolysis, but nifedipine specifically works via calcium channel
blockade.
Question 4.
A client at 34 weeks gestation presents with severe right upper quadrant pain,
nausea, and malaise. Laboratory studies reveal hemoglobin 9.2 g/dL, platelets
82,000/μL, LDH 650 U/L, and AST 180 U/L. The nurse recognizes these findings as
consistent with:
A. Mild preeclampsia.
B. HELLP syndrome.
C. Acute fatty liver of pregnancy.
, D. Intrahepatic cholestasis of pregnancy.
Correct Answer: B
Rationale: HELLLP syndrome is a severe complication of preeclampsia characterized by:
Hemolysis (elevated LDH, low haptoglobin, schistocytes on peripheral smear), Elevated
Liver enzymes (AST/ALT >70 U/L), and Low Platelets (<100,000/μL). Right upper quadrant
pain reflects hepatic distension from subcapsular hemorrhage. HELLP syndrome is a
medical emergency requiring delivery, magnesium sulfate, blood product administration,
and close monitoring for DIC, placental abruption, and acute renal failure. It can occur
without significant hypertension.
Question 5.
A client with severe preeclampsia develops a generalized tonic-clonic seizure. The
nurse's immediate priority action is to:
A. Insert an oral airway and prepare for intubation.
B. Maintain airway, prevent injury, and administer magnesium sulfate.
C. Administer diazepam IV push immediately.
D. Turn the client supine and elevate the legs.
Correct Answer: B
Rationale: An eclamptic seizure is a life-threatening emergency. The immediate priorities
are: ensuring a patent airway (turn client on her side to prevent aspiration), protecting
from injury (pad side rails, remove harmful objects), monitoring vital signs and fetal heart
rate, and administering magnesium sulfate (the anticonvulsant of choice for eclampsia).
Diazepam is a second-line agent if magnesium fails. Do NOT insert anything into the mouth
during an active seizure. Supine positioning increases risk of aspiration and aortocaval
compression.
Question 6.
A postpartum client experiences a primary postpartum hemorrhage due to uterine
atony. After fundal massage and oxytocin infusion, the uterus remains boggy and
bleeding continues. The next medication the nurse should administer per protocol is:
A. Methylergonovine (Methergine) 0.2 mg IM.
B. Carboprost tromethamine (Hemabate) 250 mcg IM.
And Answers | Verified Tests With Detailed
Rationale | 2026/2027 Updates
Question 1.
A client at 39 weeks gestation is scheduled for labor induction. The nurse documents
the following cervical assessment: 3 cm dilated, 60% effaced, fetal head at -2 station,
cervix of medium consistency, and mid-position. Using the modified Bishop score, the
nurse calculates a score of:
A. 4
B. 6
C. 8
D. 10
Correct Answer: B
Rationale: The modified Bishop score assigns points as follows: Dilation (3 cm = 2 points),
Effacement (60% = 1 point), Station (-2 = 1 point), Consistency (medium = 1 point), and
Position (mid-position = 1 point). Total = 2 + 1 + 1 + 1 + 1 = 6. A Bishop score ≤5 indicates
an unfavorable cervix with a higher likelihood of failed induction and need for cesarean
delivery. A score ≥8 indicates a favorable cervix. Prostaglandins or mechanical dilators
(Foley catheter) may be used for cervical ripening when the score is low.
Question 2.
A client in labor is receiving oxytocin for augmentation. The nurse is titrating the
infusion per protocol. The nurse knows that the maximum dose of oxytocin typically
administered is:
A. 10 milliunits/minute.
B. 20 milliunits/minute.
C. 30 milliunits/minute.
D. 40 milliunits/minute.
Correct Answer: B
,Rationale: The typical maximum dose of oxytocin for labor augmentation or induction is 20
milliunits per minute, though some protocols allow up to 30 mU/min. Oxytocin is started at
a low dose (e.g., 1–2 mU/min) and increased incrementally (e.g., every 30–40 minutes) until
adequate contractions are achieved (3–5 contractions in 10 minutes, each lasting 45–60
seconds). The nurse must monitor for uterine tachysystole (>5 contractions in 10 minutes)
and discontinue or decrease the infusion if fetal heart rate abnormalities or excessive
uterine activity occur.
Question 3.
A client at 32 weeks gestation is in preterm labor. The provider orders nifedipine as a
tocolytic. The nurse knows that the primary mechanism of action of nifedipine in
preterm labor is:
A. Stimulation of beta-2 adrenergic receptors causing uterine relaxation.
B. Calcium channel blockade inhibiting uterine smooth muscle contraction.
C. Inhibition of prostaglandin synthesis reducing uterine irritability.
D. Magnesium replacement preventing neuromuscular excitability.
Correct Answer: B
Rationale: Nifedipine is a calcium channel blocker that inhibits calcium influx into uterine
smooth muscle cells, reducing myometrial contractility. It is commonly used as a tocolytic
for preterm labor. Side effects include hypotension, flushing, and tachycardia. Terbutaline (a
beta-2 agonist) stimulates beta-2 receptors. Indomethacin inhibits prostaglandin synthesis.
Magnesium sulfate acts as a calcium antagonist at the cellular level and is used for
neuroprotection and tocolysis, but nifedipine specifically works via calcium channel
blockade.
Question 4.
A client at 34 weeks gestation presents with severe right upper quadrant pain,
nausea, and malaise. Laboratory studies reveal hemoglobin 9.2 g/dL, platelets
82,000/μL, LDH 650 U/L, and AST 180 U/L. The nurse recognizes these findings as
consistent with:
A. Mild preeclampsia.
B. HELLP syndrome.
C. Acute fatty liver of pregnancy.
, D. Intrahepatic cholestasis of pregnancy.
Correct Answer: B
Rationale: HELLLP syndrome is a severe complication of preeclampsia characterized by:
Hemolysis (elevated LDH, low haptoglobin, schistocytes on peripheral smear), Elevated
Liver enzymes (AST/ALT >70 U/L), and Low Platelets (<100,000/μL). Right upper quadrant
pain reflects hepatic distension from subcapsular hemorrhage. HELLP syndrome is a
medical emergency requiring delivery, magnesium sulfate, blood product administration,
and close monitoring for DIC, placental abruption, and acute renal failure. It can occur
without significant hypertension.
Question 5.
A client with severe preeclampsia develops a generalized tonic-clonic seizure. The
nurse's immediate priority action is to:
A. Insert an oral airway and prepare for intubation.
B. Maintain airway, prevent injury, and administer magnesium sulfate.
C. Administer diazepam IV push immediately.
D. Turn the client supine and elevate the legs.
Correct Answer: B
Rationale: An eclamptic seizure is a life-threatening emergency. The immediate priorities
are: ensuring a patent airway (turn client on her side to prevent aspiration), protecting
from injury (pad side rails, remove harmful objects), monitoring vital signs and fetal heart
rate, and administering magnesium sulfate (the anticonvulsant of choice for eclampsia).
Diazepam is a second-line agent if magnesium fails. Do NOT insert anything into the mouth
during an active seizure. Supine positioning increases risk of aspiration and aortocaval
compression.
Question 6.
A postpartum client experiences a primary postpartum hemorrhage due to uterine
atony. After fundal massage and oxytocin infusion, the uterus remains boggy and
bleeding continues. The next medication the nurse should administer per protocol is:
A. Methylergonovine (Methergine) 0.2 mg IM.
B. Carboprost tromethamine (Hemabate) 250 mcg IM.
