MATERNAL-NEWBORN NURSING
MIDTERM EXAM 2: A COMPREHENSIVE
200-QUESTION PRACTICE BANK WITH
EVIDENCE-BASED RATIONALES
1. A nurse is providing nutritional teaching to a pregnant client who had a pre-
pregnancy BMI of 31. Which of the following statements by the client
demonstrates an understanding of the teaching about her recommended
weight gain during pregnancy?
A. "I should plan to gain 12.7-18.1 kg during my pregnancy."
B. "I should plan to gain 11.3-15.9 kg during my pregnancy."
C. "I should plan to gain 6.8-11.3 kg during my pregnancy."
D. "I should plan to gain 5-9.1 kg during my pregnancy."
Correct answer: D. A BMI of 31 classifies the client as obese. The recommended
weight gain for an obese woman (BMI >30) is 5-9.1 kg (11-20 lbs).
2. A nurse is assessing a client who delivered vaginally 8 hours ago. The nurse
notes that the client's fundus is 2 fingerbreadths above the umbilicus and has
shifted to the left, and there is a large amount of lochia rubra on the perineal
pad. Which of the following actions should the nurse take first?
A. Administer analgesia
B. Administer Carboprost IM
C. Assist the client to the toilet
D. Obtain a blood specimen to test HCG and HCT levels
Correct answer: C. A fundus that is high, boggy, and displaced to the side is a classic
sign of a full bladder. A distended bladder prevents the uterus from contracting
effectively, leading to increased bleeding (lochia). The priority action is to have the
client void, which will often allow the uterus to contract and decrease bleeding.
,3. A nurse is preparing to administer Meperidine Hydrochloride to a client who
is in labor. Which of the following statements should the nurse make to the
client?
A. "This medication can cause your blood pressure to rise."
B. "This medication can cause dry mouth."
C. "This medication can cause you to urinate excessively."
D. "This medication can make you sleepy."
Correct answer: D. Meperidine (Demerol) is an opioid analgesic. A key side effect is
central nervous system depression, which can cause drowsiness in the mother. It can
also cause respiratory depression in the newborn if given too close to delivery.
4. A client at 24 weeks gestation presents with a glucose challenge test result of
160 mg/dL. What is the next appropriate step?
A. Diagnosis of gestational diabetes
B. 3-hour oral glucose tolerance test
C. Start insulin therapy immediately
D. Repeat the glucose challenge test in 2 weeks
Correct answer: B. A 1-hour glucose challenge test (GCT) result of 140 mg/dL or
higher is considered abnormal and requires a 3-hour oral glucose tolerance test
(OGTT) for a definitive diagnosis of gestational diabetes. A single elevated screening
test is not diagnostic.
5. A nurse is caring for a client in the third trimester of pregnancy who reports
difficulty sleeping. Which of the following instructions should the nurse
provide?
A. Eat a high fat snack before bed
B. Exercise in the evening before bed
C. Sleep in the supine position
D. Use additional pillows to support abdomen and extremities
Correct answer: D. Using extra pillows to support the abdomen and back can help
promote comfort and improve sleep. Pregnant clients should be advised to sleep in a
side-lying position (especially the left lateral) to improve uteroplacental perfusion
and avoid supine hypotension.
,6. A client with Rh-negative blood is pregnant with an Rh-positive fetus. At
which gestational age should Rh immunoglobulin (RhoGAM) be administered?
A. 20 weeks
B. 24 weeks
C. 28 weeks
D. 32 weeks
Correct answer: C. RhoGAM is routinely administered at 28 weeks of gestation to
prevent Rh isoimmunization in Rh-negative women. It is also given within 72 hours
after delivery if the newborn is Rh-positive, and after any sensitizing events (e.g.,
bleeding, abortion, trauma).
7. A 15-year-old primigravida arrives at the birthing unit in early labor. On
admission, the client's cervix is 2 cm dilated and 50% effaced, and contractions
are occurring every 7 to 8 minutes, with membranes intact. After admission, the
nurse instructs the client that the most effective position for dilating the cervix
is:
A. Right lateral recumbent
B. Modified Trendelenburg position
C. Standing
D. Sitting in a comfortable chair
Correct answer: C. The upright position (standing, walking, or sitting upright) uses
gravity to help the fetal head press down on the cervix, which can promote more
efficient cervical dilation and contractions.
8. The nurse is caring for a woman in labor. The woman is irritable, complains
of nausea and vomiting and has an irresistible urge to push. The membranes
rupture. The nurse understands that this indicates:
A. The woman is in transition stage of labor
B. The woman is having a complication and the doctor should be notified
C. Labor is slowing down and the woman may need oxytocin
D. The woman is probably pregnant
, Correct answer: A. The transition phase of the first stage of labor (8-10 cm dilation)
is characterized by intense contractions, increased irritability, nausea and vomiting,
and an intense urge to push as the presenting part descends.
9. A nurse is assessing a client who is 12 hours postpartum following a normal
vaginal delivery. Where does the nurse expect to palpate the uterine fundus?
A. Two centimeters above the umbilicus
B. At the level of the umbilicus
C. Three centimeters below the umbilicus
D. At the symphysis pubis
Correct answer: B. Immediately after delivery, the fundus is at the level of the
umbilicus. It typically remains at or near the umbilicus for the first 12 hours
postpartum. After this point, it involutes (decreases in height) by approximately 1 to
2 cm every 24 hours.
10. A prenatal client at 16 weeks gestation undergoes a maternal serum alpha-
fetoprotein (MSAFP) screening test. The results return significantly elevated.
The nurse understands this finding is associated with which condition?
A. Down syndrome
B. Neural tube defects
C. Gestational trophoblastic disease
D. Fetal alcohol syndrome
Correct answer: B. Elevated MSAFP levels are strongly correlated with neural tube
defects, such as spina bifida and anencephaly. In contrast, low levels of MSAFP are
associated with an increased risk of Down syndrome.
11. A nurse is caring for a client at 38 weeks gestation who presents with a
sudden onset of bright red vaginal bleeding, uterine tenderness, and a rigid
abdomen. The client's vital signs show hypotension and tachycardia. Which of
the following conditions should the nurse suspect?
A. Placenta previa
B. Abruptio placentae
C. Uterine rupture
D. Vasa previa
MIDTERM EXAM 2: A COMPREHENSIVE
200-QUESTION PRACTICE BANK WITH
EVIDENCE-BASED RATIONALES
1. A nurse is providing nutritional teaching to a pregnant client who had a pre-
pregnancy BMI of 31. Which of the following statements by the client
demonstrates an understanding of the teaching about her recommended
weight gain during pregnancy?
A. "I should plan to gain 12.7-18.1 kg during my pregnancy."
B. "I should plan to gain 11.3-15.9 kg during my pregnancy."
C. "I should plan to gain 6.8-11.3 kg during my pregnancy."
D. "I should plan to gain 5-9.1 kg during my pregnancy."
Correct answer: D. A BMI of 31 classifies the client as obese. The recommended
weight gain for an obese woman (BMI >30) is 5-9.1 kg (11-20 lbs).
2. A nurse is assessing a client who delivered vaginally 8 hours ago. The nurse
notes that the client's fundus is 2 fingerbreadths above the umbilicus and has
shifted to the left, and there is a large amount of lochia rubra on the perineal
pad. Which of the following actions should the nurse take first?
A. Administer analgesia
B. Administer Carboprost IM
C. Assist the client to the toilet
D. Obtain a blood specimen to test HCG and HCT levels
Correct answer: C. A fundus that is high, boggy, and displaced to the side is a classic
sign of a full bladder. A distended bladder prevents the uterus from contracting
effectively, leading to increased bleeding (lochia). The priority action is to have the
client void, which will often allow the uterus to contract and decrease bleeding.
,3. A nurse is preparing to administer Meperidine Hydrochloride to a client who
is in labor. Which of the following statements should the nurse make to the
client?
A. "This medication can cause your blood pressure to rise."
B. "This medication can cause dry mouth."
C. "This medication can cause you to urinate excessively."
D. "This medication can make you sleepy."
Correct answer: D. Meperidine (Demerol) is an opioid analgesic. A key side effect is
central nervous system depression, which can cause drowsiness in the mother. It can
also cause respiratory depression in the newborn if given too close to delivery.
4. A client at 24 weeks gestation presents with a glucose challenge test result of
160 mg/dL. What is the next appropriate step?
A. Diagnosis of gestational diabetes
B. 3-hour oral glucose tolerance test
C. Start insulin therapy immediately
D. Repeat the glucose challenge test in 2 weeks
Correct answer: B. A 1-hour glucose challenge test (GCT) result of 140 mg/dL or
higher is considered abnormal and requires a 3-hour oral glucose tolerance test
(OGTT) for a definitive diagnosis of gestational diabetes. A single elevated screening
test is not diagnostic.
5. A nurse is caring for a client in the third trimester of pregnancy who reports
difficulty sleeping. Which of the following instructions should the nurse
provide?
A. Eat a high fat snack before bed
B. Exercise in the evening before bed
C. Sleep in the supine position
D. Use additional pillows to support abdomen and extremities
Correct answer: D. Using extra pillows to support the abdomen and back can help
promote comfort and improve sleep. Pregnant clients should be advised to sleep in a
side-lying position (especially the left lateral) to improve uteroplacental perfusion
and avoid supine hypotension.
,6. A client with Rh-negative blood is pregnant with an Rh-positive fetus. At
which gestational age should Rh immunoglobulin (RhoGAM) be administered?
A. 20 weeks
B. 24 weeks
C. 28 weeks
D. 32 weeks
Correct answer: C. RhoGAM is routinely administered at 28 weeks of gestation to
prevent Rh isoimmunization in Rh-negative women. It is also given within 72 hours
after delivery if the newborn is Rh-positive, and after any sensitizing events (e.g.,
bleeding, abortion, trauma).
7. A 15-year-old primigravida arrives at the birthing unit in early labor. On
admission, the client's cervix is 2 cm dilated and 50% effaced, and contractions
are occurring every 7 to 8 minutes, with membranes intact. After admission, the
nurse instructs the client that the most effective position for dilating the cervix
is:
A. Right lateral recumbent
B. Modified Trendelenburg position
C. Standing
D. Sitting in a comfortable chair
Correct answer: C. The upright position (standing, walking, or sitting upright) uses
gravity to help the fetal head press down on the cervix, which can promote more
efficient cervical dilation and contractions.
8. The nurse is caring for a woman in labor. The woman is irritable, complains
of nausea and vomiting and has an irresistible urge to push. The membranes
rupture. The nurse understands that this indicates:
A. The woman is in transition stage of labor
B. The woman is having a complication and the doctor should be notified
C. Labor is slowing down and the woman may need oxytocin
D. The woman is probably pregnant
, Correct answer: A. The transition phase of the first stage of labor (8-10 cm dilation)
is characterized by intense contractions, increased irritability, nausea and vomiting,
and an intense urge to push as the presenting part descends.
9. A nurse is assessing a client who is 12 hours postpartum following a normal
vaginal delivery. Where does the nurse expect to palpate the uterine fundus?
A. Two centimeters above the umbilicus
B. At the level of the umbilicus
C. Three centimeters below the umbilicus
D. At the symphysis pubis
Correct answer: B. Immediately after delivery, the fundus is at the level of the
umbilicus. It typically remains at or near the umbilicus for the first 12 hours
postpartum. After this point, it involutes (decreases in height) by approximately 1 to
2 cm every 24 hours.
10. A prenatal client at 16 weeks gestation undergoes a maternal serum alpha-
fetoprotein (MSAFP) screening test. The results return significantly elevated.
The nurse understands this finding is associated with which condition?
A. Down syndrome
B. Neural tube defects
C. Gestational trophoblastic disease
D. Fetal alcohol syndrome
Correct answer: B. Elevated MSAFP levels are strongly correlated with neural tube
defects, such as spina bifida and anencephaly. In contrast, low levels of MSAFP are
associated with an increased risk of Down syndrome.
11. A nurse is caring for a client at 38 weeks gestation who presents with a
sudden onset of bright red vaginal bleeding, uterine tenderness, and a rigid
abdomen. The client's vital signs show hypotension and tachycardia. Which of
the following conditions should the nurse suspect?
A. Placenta previa
B. Abruptio placentae
C. Uterine rupture
D. Vasa previa
