Safe Maternity & Pediatric Nursing Care 2026/2027 | Maternity and
Pediatric Nursing Study Guide, Maternal Child Nursing Exam Prep, Practice
Questions with Answers & Rationales, Prenatal Care, Pregnancy, Labor &
Delivery, Postpartum Nursing, Newborn Care, Pediatric Assessment,
Growth & Development, Pediatric Disorders, Medication Safety, Family-
Centered Care & NCLEX-RN Preparation
Question 1: A nurse is assessing a newborn's Apgar score at 1 minute after birth.
The newborn has a heart rate of 110 bpm, slow irregular respirations, some
flexion of extremities, a grimace when stimulated, and a pink body with blue
extremities. What is the Apgar score?
A. 4
B. 5
C. 6
D. 7
CORRECT ANSWER: C. 6
Rationale: Heart rate of 110 bpm = 2 points; slow irregular respirations = 1 point;
some flexion = 1 point; grimace = 1 point; acrocyanosis = 1 point. Total = 6.
Question 2: A pregnant client at 32 weeks' gestation reports a sudden gush of
fluid from the vagina. Which nursing action is the priority?
A. Perform a sterile vaginal examination
B. Assess the fetal heart rate and check for cord prolapse
C. Obtain a urine specimen for culture
D. Instruct the client to ambulate to stimulate labor
CORRECT ANSWER: B. Assess the fetal heart rate and check for cord prolapse
Rationale: Rupture of membranes increases the risk of cord prolapse; assessing
fetal heart rate and checking for prolapse is the immediate priority to prevent
fetal hypoxia.
Question 3: Which immunization is contraindicated in a child who is severely
immunocompromised?
A. Inactivated polio vaccine
B. Measles, mumps, rubella (MMR) vaccine
,C. Tetanus toxoid
D. Hepatitis B vaccine
CORRECT ANSWER: B. Measles, mumps, rubella (MMR) vaccine
Rationale: MMR is a live attenuated vaccine and is contraindicated in severely
immunocompromised children due to the risk of vaccine-induced infection.
Question 4: A postpartum client is experiencing excessive uterine bleeding. The
nurse notes a boggy uterus. What is the initial nursing intervention?
A. Administer oxytocin intravenously
B. Perform fundal massage
C. Prepare for blood transfusion
D. Insert an indwelling urinary catheter
CORRECT ANSWER: B. Perform fundal massage
Rationale: A boggy uterus indicates uterine atony. Fundal massage is the first-line
intervention to stimulate uterine contraction and control bleeding.
Question 5: A 6-month-old infant is brought to the clinic for a well-child visit.
Which developmental milestone should the nurse expect?
A. Sitting without support
B. Rolling from back to abdomen
C. Walking with assistance
D. Saying two-word phrases
CORRECT ANSWER: B. Rolling from back to abdomen
Rationale: Rolling from back to abdomen is typically achieved by 6 months. Sitting
without support occurs around 8 months, walking with assistance around 12
months, and two-word phrases around 24 months.
Question 6: A nurse is teaching a pregnant client about folic acid
supplementation. Which statement indicates understanding?
A. "I should take folic acid only during the first trimester."
B. "Folic acid helps prevent neural tube defects."
C. "I need to take folic acid after the baby is born."
D. "Folic acid is only needed if I have a history of anemia."
,CORRECT ANSWER: B. "Folic acid helps prevent neural tube defects."
Rationale: Folic acid is essential before conception and during early pregnancy to
prevent neural tube defects such as spina bifida.
Question 7: A child with acute epiglottitis is admitted. Which finding requires
immediate intervention?
A. Temperature of 38.3°C (101°F)
B. Drooling and difficulty swallowing
C. Respiratory rate of 24 breaths/min
D. Mild sore throat
CORRECT ANSWER: B. Drooling and difficulty swallowing
Rationale: Drooling and difficulty swallowing indicate severe airway obstruction
and impending respiratory failure, requiring immediate intervention.
Question 8: A nurse is assessing a client in the fourth stage of labor. Which
finding is most concerning?
A. Fundus firm at the umbilicus
B. Blood pressure 100/60 mm Hg
C. Saturation of perineal pad within 15 minutes
D. Pulse rate of 80 beats/min
CORRECT ANSWER: C. Saturation of perineal pad within 15 minutes
Rationale: Saturating a perineal pad within 15 minutes indicates excessive
bleeding, which may suggest postpartum hemorrhage.
Question 9: Which statement by a parent of a child with sickle cell anemia
indicates a need for further teaching?
A. "I will encourage my child to drink plenty of fluids."
B. "I will give my child ibuprofen for pain."
C. "I will apply cold compresses to painful areas."
D. "I will keep my child away from people with infections."
CORRECT ANSWER: C. "I will apply cold compresses to painful areas."
, Rationale: Cold compresses cause vasoconstriction, which can worsen sickling and
pain. Warm compresses are recommended.
Question 10: A nurse is caring for a newborn with jaundice. Which intervention
is most appropriate?
A. Place the newborn under phototherapy lights
B. Restrict oral feedings
C. Administer vitamin K
D. Apply warm blankets
CORRECT ANSWER: A. Place the newborn under phototherapy lights
Rationale: Phototherapy helps break down bilirubin in the skin, reducing jaundice.
Question 11: A pregnant client is diagnosed with gestational diabetes. Which
instruction should the nurse include?
A. "You should skip breakfast to control blood sugar."
B. "Monitor your blood glucose levels as directed."
C. "Avoid all carbohydrates during pregnancy."
D. "You will need insulin immediately after delivery."
CORRECT ANSWER: B. "Monitor your blood glucose levels as directed."
Rationale: Blood glucose monitoring is essential for managing gestational diabetes
and preventing complications.
Question 12: A child is admitted with severe dehydration. Which assessment
finding is most indicative of dehydration?
A. Moist mucous membranes
B. Sunken fontanelle in an infant
C. Blood pressure 110/70 mm Hg
D. Urine output of 2 mL/kg/hr
CORRECT ANSWER: B. Sunken fontanelle in an infant
Rationale: A sunken fontanelle is a classic sign of dehydration in infants due to
decreased cerebrospinal fluid volume.
Pediatric Nursing Study Guide, Maternal Child Nursing Exam Prep, Practice
Questions with Answers & Rationales, Prenatal Care, Pregnancy, Labor &
Delivery, Postpartum Nursing, Newborn Care, Pediatric Assessment,
Growth & Development, Pediatric Disorders, Medication Safety, Family-
Centered Care & NCLEX-RN Preparation
Question 1: A nurse is assessing a newborn's Apgar score at 1 minute after birth.
The newborn has a heart rate of 110 bpm, slow irregular respirations, some
flexion of extremities, a grimace when stimulated, and a pink body with blue
extremities. What is the Apgar score?
A. 4
B. 5
C. 6
D. 7
CORRECT ANSWER: C. 6
Rationale: Heart rate of 110 bpm = 2 points; slow irregular respirations = 1 point;
some flexion = 1 point; grimace = 1 point; acrocyanosis = 1 point. Total = 6.
Question 2: A pregnant client at 32 weeks' gestation reports a sudden gush of
fluid from the vagina. Which nursing action is the priority?
A. Perform a sterile vaginal examination
B. Assess the fetal heart rate and check for cord prolapse
C. Obtain a urine specimen for culture
D. Instruct the client to ambulate to stimulate labor
CORRECT ANSWER: B. Assess the fetal heart rate and check for cord prolapse
Rationale: Rupture of membranes increases the risk of cord prolapse; assessing
fetal heart rate and checking for prolapse is the immediate priority to prevent
fetal hypoxia.
Question 3: Which immunization is contraindicated in a child who is severely
immunocompromised?
A. Inactivated polio vaccine
B. Measles, mumps, rubella (MMR) vaccine
,C. Tetanus toxoid
D. Hepatitis B vaccine
CORRECT ANSWER: B. Measles, mumps, rubella (MMR) vaccine
Rationale: MMR is a live attenuated vaccine and is contraindicated in severely
immunocompromised children due to the risk of vaccine-induced infection.
Question 4: A postpartum client is experiencing excessive uterine bleeding. The
nurse notes a boggy uterus. What is the initial nursing intervention?
A. Administer oxytocin intravenously
B. Perform fundal massage
C. Prepare for blood transfusion
D. Insert an indwelling urinary catheter
CORRECT ANSWER: B. Perform fundal massage
Rationale: A boggy uterus indicates uterine atony. Fundal massage is the first-line
intervention to stimulate uterine contraction and control bleeding.
Question 5: A 6-month-old infant is brought to the clinic for a well-child visit.
Which developmental milestone should the nurse expect?
A. Sitting without support
B. Rolling from back to abdomen
C. Walking with assistance
D. Saying two-word phrases
CORRECT ANSWER: B. Rolling from back to abdomen
Rationale: Rolling from back to abdomen is typically achieved by 6 months. Sitting
without support occurs around 8 months, walking with assistance around 12
months, and two-word phrases around 24 months.
Question 6: A nurse is teaching a pregnant client about folic acid
supplementation. Which statement indicates understanding?
A. "I should take folic acid only during the first trimester."
B. "Folic acid helps prevent neural tube defects."
C. "I need to take folic acid after the baby is born."
D. "Folic acid is only needed if I have a history of anemia."
,CORRECT ANSWER: B. "Folic acid helps prevent neural tube defects."
Rationale: Folic acid is essential before conception and during early pregnancy to
prevent neural tube defects such as spina bifida.
Question 7: A child with acute epiglottitis is admitted. Which finding requires
immediate intervention?
A. Temperature of 38.3°C (101°F)
B. Drooling and difficulty swallowing
C. Respiratory rate of 24 breaths/min
D. Mild sore throat
CORRECT ANSWER: B. Drooling and difficulty swallowing
Rationale: Drooling and difficulty swallowing indicate severe airway obstruction
and impending respiratory failure, requiring immediate intervention.
Question 8: A nurse is assessing a client in the fourth stage of labor. Which
finding is most concerning?
A. Fundus firm at the umbilicus
B. Blood pressure 100/60 mm Hg
C. Saturation of perineal pad within 15 minutes
D. Pulse rate of 80 beats/min
CORRECT ANSWER: C. Saturation of perineal pad within 15 minutes
Rationale: Saturating a perineal pad within 15 minutes indicates excessive
bleeding, which may suggest postpartum hemorrhage.
Question 9: Which statement by a parent of a child with sickle cell anemia
indicates a need for further teaching?
A. "I will encourage my child to drink plenty of fluids."
B. "I will give my child ibuprofen for pain."
C. "I will apply cold compresses to painful areas."
D. "I will keep my child away from people with infections."
CORRECT ANSWER: C. "I will apply cold compresses to painful areas."
, Rationale: Cold compresses cause vasoconstriction, which can worsen sickling and
pain. Warm compresses are recommended.
Question 10: A nurse is caring for a newborn with jaundice. Which intervention
is most appropriate?
A. Place the newborn under phototherapy lights
B. Restrict oral feedings
C. Administer vitamin K
D. Apply warm blankets
CORRECT ANSWER: A. Place the newborn under phototherapy lights
Rationale: Phototherapy helps break down bilirubin in the skin, reducing jaundice.
Question 11: A pregnant client is diagnosed with gestational diabetes. Which
instruction should the nurse include?
A. "You should skip breakfast to control blood sugar."
B. "Monitor your blood glucose levels as directed."
C. "Avoid all carbohydrates during pregnancy."
D. "You will need insulin immediately after delivery."
CORRECT ANSWER: B. "Monitor your blood glucose levels as directed."
Rationale: Blood glucose monitoring is essential for managing gestational diabetes
and preventing complications.
Question 12: A child is admitted with severe dehydration. Which assessment
finding is most indicative of dehydration?
A. Moist mucous membranes
B. Sunken fontanelle in an infant
C. Blood pressure 110/70 mm Hg
D. Urine output of 2 mL/kg/hr
CORRECT ANSWER: B. Sunken fontanelle in an infant
Rationale: A sunken fontanelle is a classic sign of dehydration in infants due to
decreased cerebrospinal fluid volume.
