NR-327-OBSTERIC COMPLICATIONS EXAM : CHAMBERLAIN
UNIVERSITY | ALL QUESTIONS AND ANSWERS 2026/2027 |
VERIFIED ANSWERS PLUS RATIONALES | GRADED Q&A
COMPREHENSIVE STUDY GUIDE | VERIFIED LATEST 2027
1. A 32-year-org G2P1 at 34 weeks gestation presents to the labor and delivery triage unit
reporting sudden, painless vaginal bleeding of bright red blood. Vital signs are stable, and
fetal heart rate tracing is category I. What is the most appropriate immediate nursing
intervention?
A. Perform a gentle digital cervical examination to assess dilation and effacement
B. Initiate external fetal monitoring and avoid any digital vaginal examinations
C. Administer misoprostol rectally to induce immediate delivery
D. Insert a Foley catheter with a pressure transducer to control bleeding
This client presents with classic symptoms of placenta previa, characterized by painless
vaginal bleeding in the third trimester. Performing a digital vaginal examination is strictly
contraindicated because it can disrupt the placenta and cause catastrophic hemorrhage.
External monitoring assesses fetal well-being safely without disturbing the placental
attachment site.
2. A postpartum client on the mother-baby unit who delivered vaginally 4 hours ago
reports a sudden urge to push and a feeling of heavy pressure in the perineum. Her fundus
is firm and midline, yet moderate bright red vaginal bleeding continues. Which
complication should the nurse suspect first?
A. Uterine atony
B. Retained placental fragments
C. Vaginal or vulvar hematoma
D. Disseminated intravascular coagulation
A firm, contracted uterus rules out uterine atony as the primary source of continuous
bleeding. Severe pelvic pressure, an urge to defecate or push, and persistent bleeding despite
a well-contracted uterus strongly indicate the formation of a vaginal or vulvar hematoma
resulting from blood vessel trauma during delivery.
,3. A nurse is caring for a 28-year-old primigravida at 28 weeks gestation diagnosed with
gestational hypertension. Which clinical finding differentiates gestational hypertension
from preeclampsia without severe features?
A. Blood pressure of 145/95 mmHg measured twice 4 hours apart
B. Proteinuria of 300 mg in a 24-hour urine collection
C. Serum creatinine level of 1.2 mg/dL
D. Platelet count of 90,000/mcL
Gestational hypertension is diagnosed by new-onset elevated blood pressure after 20 weeks
gestation in the absence of proteinuria or systemic end-organ dysfunction. The presence of
significant proteinuria or end-organ laboratory abnormalities differentiates it from
preeclampsia.
4. A client with severe preeclampsia is receiving an intravenous infusion of magnesium
sulfate. Which assessment finding indicates early magnesium toxicity requiring immediate
intervention?
A. Respiratory rate of 16 breaths per minute
B. Serum magnesium level of 5.5 mg/dL
C. Absent deep tendon reflexes
D. Urine output of 45 mL/hour
Depression and subsequent loss of deep tendon reflexes are the earliest clinical signs of
hypermagnesemia, occurring when serum levels begin to reach toxic thresholds (typically
above 8 to 10 mg/dL). Respiratory depression follows at higher levels, making DTR
assessment a critical safety parameter.
5. A client at 30 weeks gestation is admitted in active preterm labor. The healthcare
provider prescribes betamethasone. What is the primary therapeutic goal of administering
this medication?
A. To stop uterine contractions for at least 48 hours
B. To accelerate fetal lung maturity and reduce respiratory distress syndrome
C. To reduce maternal blood pressure and prevent cerebral edema
D. To promote cervical ripening prior to induction of labor
,Antenatal corticosteroids such as betamethasone are administered to preterm clients to
stimulate fetal surfactant production, thereby significantly reducing the incidence of neonatal
respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis.
6. A nurse is evaluating a fetal heart rate tracing and notes repetitive variable decelerations
reaching a nadir of 80 bpm with rapid returns to baseline. Contractions are occurring
every 2 minutes. What is the initial nursing action?
A. Prepare the client for an emergency cesarean section
B. Reposition the client to a side-lying position and administer oxygen
C. Discontinue oxytocin infusion if running and notify the provider
D. Administer terbutaline subcutaneously as a tocolytic
Variable decelerations are typically caused by umbilical cord compression. The first-line
nursing intervention is changing the maternal position to relieve pressure on the cord,
followed by administering supplemental oxygen and discontinuing oxytocin if applicable.
7. A client at 38 weeks gestation is undergoing a trial of labor after cesarean (TOLAC).
During the active phase of labor, she suddenly complains of a tearing sensation in her
abdomen, followed by loss of fetal station and profound maternal hypotension. What is the
priority nursing action?
A. Administer intravenous methylergonovine
B. Prepare for immediate emergency laparotomy and delivery
C. Perform a sterile vaginal exam to assess cervical dilation
D. Increase the oxytocin infusion rate to expedite delivery
These classic manifestations indicate a catastrophic uterine rupture, a life-threatening
obstetric emergency for both mother and fetus. Immediate surgical intervention via
emergency laparotomy is required to control hemorrhage and deliver the infant.
8. A client at 32 weeks gestation is diagnosed with abruptio placentae. Which clinical
presentation distinguishes abruption from placenta previa?
A. Painless, bright red vaginal bleeding
B. Rigid, board-like abdomen and dark red vaginal bleeding
C. Soft, non-tender uterus with intermittent spotting
, D. Painless bleeding accompanied by severe fetal tachycardia
Abruptio placentae classically presents with painful, dark red vaginal bleeding and a
hypertonic, rigid, board-like uterus due to concealed or revealed retroplacental hemorrhage,
contrasting with the painless bright red bleeding seen in placenta previa.
9. A postpartum client is diagnosed with late postpartum hemorrhage on postpartum day
10. What is the most common underlying etiology for this condition?
A. Uterine atony
B. Retained placental fragments
C. Cervical lacerations
D. Uterine inversion
While uterine atony is the primary cause of immediate postpartum hemorrhage within the
first 24 hours, late postpartum hemorrhage occurring days to weeks after delivery is most
commonly caused by subinvolution of the uterus secondary to retained placental tissue.
10. A nurse is caring for a client with gestational diabetes mellitus whose fasting blood
glucose levels are consistently elevated despite adherence to dietary guidelines. Which
medication is considered the preferred first-line pharmacological treatment during
pregnancy?
A. Glyburide
B. Metformin
C. Regular insulin
D. Acarbose
Insulin is the gold standard and preferred pharmacological agent for managing gestational
diabetes when diet and exercise fail, as it does not cross the placenta in significant amounts
and provides precise glycemic control.
11. A client at 35 weeks gestation presents with severe right upper quadrant abdominal
pain, nausea, and vomiting. Laboratory studies reveal hemolysis, elevated liver enzymes,
and a low platelet count. What is the priority nursing intervention?
A. Prepare the client for immediate delivery regardless of gestational age
UNIVERSITY | ALL QUESTIONS AND ANSWERS 2026/2027 |
VERIFIED ANSWERS PLUS RATIONALES | GRADED Q&A
COMPREHENSIVE STUDY GUIDE | VERIFIED LATEST 2027
1. A 32-year-org G2P1 at 34 weeks gestation presents to the labor and delivery triage unit
reporting sudden, painless vaginal bleeding of bright red blood. Vital signs are stable, and
fetal heart rate tracing is category I. What is the most appropriate immediate nursing
intervention?
A. Perform a gentle digital cervical examination to assess dilation and effacement
B. Initiate external fetal monitoring and avoid any digital vaginal examinations
C. Administer misoprostol rectally to induce immediate delivery
D. Insert a Foley catheter with a pressure transducer to control bleeding
This client presents with classic symptoms of placenta previa, characterized by painless
vaginal bleeding in the third trimester. Performing a digital vaginal examination is strictly
contraindicated because it can disrupt the placenta and cause catastrophic hemorrhage.
External monitoring assesses fetal well-being safely without disturbing the placental
attachment site.
2. A postpartum client on the mother-baby unit who delivered vaginally 4 hours ago
reports a sudden urge to push and a feeling of heavy pressure in the perineum. Her fundus
is firm and midline, yet moderate bright red vaginal bleeding continues. Which
complication should the nurse suspect first?
A. Uterine atony
B. Retained placental fragments
C. Vaginal or vulvar hematoma
D. Disseminated intravascular coagulation
A firm, contracted uterus rules out uterine atony as the primary source of continuous
bleeding. Severe pelvic pressure, an urge to defecate or push, and persistent bleeding despite
a well-contracted uterus strongly indicate the formation of a vaginal or vulvar hematoma
resulting from blood vessel trauma during delivery.
,3. A nurse is caring for a 28-year-old primigravida at 28 weeks gestation diagnosed with
gestational hypertension. Which clinical finding differentiates gestational hypertension
from preeclampsia without severe features?
A. Blood pressure of 145/95 mmHg measured twice 4 hours apart
B. Proteinuria of 300 mg in a 24-hour urine collection
C. Serum creatinine level of 1.2 mg/dL
D. Platelet count of 90,000/mcL
Gestational hypertension is diagnosed by new-onset elevated blood pressure after 20 weeks
gestation in the absence of proteinuria or systemic end-organ dysfunction. The presence of
significant proteinuria or end-organ laboratory abnormalities differentiates it from
preeclampsia.
4. A client with severe preeclampsia is receiving an intravenous infusion of magnesium
sulfate. Which assessment finding indicates early magnesium toxicity requiring immediate
intervention?
A. Respiratory rate of 16 breaths per minute
B. Serum magnesium level of 5.5 mg/dL
C. Absent deep tendon reflexes
D. Urine output of 45 mL/hour
Depression and subsequent loss of deep tendon reflexes are the earliest clinical signs of
hypermagnesemia, occurring when serum levels begin to reach toxic thresholds (typically
above 8 to 10 mg/dL). Respiratory depression follows at higher levels, making DTR
assessment a critical safety parameter.
5. A client at 30 weeks gestation is admitted in active preterm labor. The healthcare
provider prescribes betamethasone. What is the primary therapeutic goal of administering
this medication?
A. To stop uterine contractions for at least 48 hours
B. To accelerate fetal lung maturity and reduce respiratory distress syndrome
C. To reduce maternal blood pressure and prevent cerebral edema
D. To promote cervical ripening prior to induction of labor
,Antenatal corticosteroids such as betamethasone are administered to preterm clients to
stimulate fetal surfactant production, thereby significantly reducing the incidence of neonatal
respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis.
6. A nurse is evaluating a fetal heart rate tracing and notes repetitive variable decelerations
reaching a nadir of 80 bpm with rapid returns to baseline. Contractions are occurring
every 2 minutes. What is the initial nursing action?
A. Prepare the client for an emergency cesarean section
B. Reposition the client to a side-lying position and administer oxygen
C. Discontinue oxytocin infusion if running and notify the provider
D. Administer terbutaline subcutaneously as a tocolytic
Variable decelerations are typically caused by umbilical cord compression. The first-line
nursing intervention is changing the maternal position to relieve pressure on the cord,
followed by administering supplemental oxygen and discontinuing oxytocin if applicable.
7. A client at 38 weeks gestation is undergoing a trial of labor after cesarean (TOLAC).
During the active phase of labor, she suddenly complains of a tearing sensation in her
abdomen, followed by loss of fetal station and profound maternal hypotension. What is the
priority nursing action?
A. Administer intravenous methylergonovine
B. Prepare for immediate emergency laparotomy and delivery
C. Perform a sterile vaginal exam to assess cervical dilation
D. Increase the oxytocin infusion rate to expedite delivery
These classic manifestations indicate a catastrophic uterine rupture, a life-threatening
obstetric emergency for both mother and fetus. Immediate surgical intervention via
emergency laparotomy is required to control hemorrhage and deliver the infant.
8. A client at 32 weeks gestation is diagnosed with abruptio placentae. Which clinical
presentation distinguishes abruption from placenta previa?
A. Painless, bright red vaginal bleeding
B. Rigid, board-like abdomen and dark red vaginal bleeding
C. Soft, non-tender uterus with intermittent spotting
, D. Painless bleeding accompanied by severe fetal tachycardia
Abruptio placentae classically presents with painful, dark red vaginal bleeding and a
hypertonic, rigid, board-like uterus due to concealed or revealed retroplacental hemorrhage,
contrasting with the painless bright red bleeding seen in placenta previa.
9. A postpartum client is diagnosed with late postpartum hemorrhage on postpartum day
10. What is the most common underlying etiology for this condition?
A. Uterine atony
B. Retained placental fragments
C. Cervical lacerations
D. Uterine inversion
While uterine atony is the primary cause of immediate postpartum hemorrhage within the
first 24 hours, late postpartum hemorrhage occurring days to weeks after delivery is most
commonly caused by subinvolution of the uterus secondary to retained placental tissue.
10. A nurse is caring for a client with gestational diabetes mellitus whose fasting blood
glucose levels are consistently elevated despite adherence to dietary guidelines. Which
medication is considered the preferred first-line pharmacological treatment during
pregnancy?
A. Glyburide
B. Metformin
C. Regular insulin
D. Acarbose
Insulin is the gold standard and preferred pharmacological agent for managing gestational
diabetes when diet and exercise fail, as it does not cross the placenta in significant amounts
and provides precise glycemic control.
11. A client at 35 weeks gestation presents with severe right upper quadrant abdominal
pain, nausea, and vomiting. Laboratory studies reveal hemolysis, elevated liver enzymes,
and a low platelet count. What is the priority nursing intervention?
A. Prepare the client for immediate delivery regardless of gestational age
