Care (2026) Q&A
1. The nurse is caring for a patient receiving a vacuum-assisted birth. The nurse
understands that which of the following is a risk associated with this procedure?
A) Maternal hypertension
B) Cephalohematoma
C) Uterine rupture
D) Placenta previa
Correct Answer: Cephalohematoma
Rationale: Risks associated with vacuum-assisted birth include scalp laceration,
subdural hematoma, and cephalohematoma for the newborn, as well as maternal
lacerations to the cervix, vagina, or perineum. The procedure requires vertex position,
full cervical dilation, and ruptured membranes.
2. The nurse is caring for a patient who is experiencing postpartum hemorrhage.
After massaging the fundus, which medications should the nurse anticipate
administering?
A) Magnesium sulfate and Terbutaline
B) Pitocin, Cytotec, TXA, Methergine, and Hemabate
C) Nifedipine and Indomethacin
D) RhoGAM and antibiotics
Correct Answer: Pitocin, Cytotec, TXA, Methergine, and Hemabate
,Rationale: In the event of postpartum hemorrhage, the nurse should anticipate
administering medications such as Pitocin, Cytotec, TXA, Methergine, and Hemabate
to control bleeding. A large-bore IV (18 gauge) should be established as a priority.
3. A patient is receiving Terbutaline for preterm labor. The nurse understands that the
purpose of this medication is to:
A) Prevent seizures
B) Relax smooth muscles and suppress contractions
C) Lower blood pressure
D) Accelerate fetal lung maturity
Correct Answer: Relax smooth muscles and suppress contractions
Rationale: Terbutaline is a tocolytic used to relax uterine smooth muscles and
suppress contractions in preterm labor. Magnesium sulfate is also used for preterm
labor and to prevent seizures in preeclampsia.
4. The nurse is assessing a newborn immediately after birth. Which finding would
indicate the need for further evaluation?
A) Heart rate of 140 beats/min
B) Respiratory rate of 50 breaths/min
C) Axillary temperature of 36.0°C (96.8°F)
D) Apgar score of 8 at 1 minute
Correct Answer: Axillary temperature of 36.0°C (96.8°F)
Rationale: Newborns are at risk for hypothermia and should be warmed immediately
after birth. A temperature of 36.0°C is below the normal range of 36.5-37.5°C and
requires intervention. The other findings are within normal limits.
, 5. A patient who is 40 weeks gestation is experiencing vaginal bleeding. What is the
nurse's priority action?
A) Perform a sterile vaginal examination
B) Administer oxytocin to augment labor
C) Notify the provider and prepare for possible emergency cesarean
D) Assess cervical dilation and effacement
Correct Answer: Notify the provider and prepare for possible emergency cesarean
Rationale: Vaginal bleeding at term may indicate placental abruption or placenta
previa. A sterile vaginal examination should not be performed because it could
worsen bleeding. The nurse should notify the provider and prepare for possible
emergency cesarean delivery.
6. A patient with preeclampsia is receiving magnesium sulfate. The nurse should
monitor for which sign of magnesium toxicity?
A) Respiratory rate of 18 breaths/min
B) Urine output of 40 mL/hr
C) Deep tendon reflexes of 2+
D) Respiratory rate of 10 breaths/min
Correct Answer: Respiratory rate of 10 breaths/min
Rationale: Magnesium toxicity causes respiratory depression (<12 breaths/min), loss
of deep tendon reflexes, and oliguria (<30 mL/hr). The nurse should monitor
respiratory rate, urine output, and deep tendon reflexes closely.