, Question 1
A postpartum patient receiving magnesium sulfate for preeclampsia has a
serum magnesium level of 8.2 mg/dL. Which assessment finding requires
immediate intervention?
A. Respiratory rate of 11 breaths/min
B. Urine output of 40 mL/hr
C. Deep tendon reflexes 2+
D. Serum magnesium level of 8.2 mg/dL
Correct Answer: A - Respiratory rate of 11 breaths/min
RATIONALE
Therapeutic magnesium range is 4-7 mg/dL; levels >8 mg/dL can
cause respiratory depression. A respiratory rate <12/min indicates
impending toxicity. Urine output >30 mL/hr and reflexes 2+ are
expected. The magnesium level itself is elevated but the respiratory
rate is the priority sign of toxicity.
Question 2
A newborn is 2 hours old, born at 39 weeks via spontaneous vaginal delivery.
The nurse notes a soft systolic murmur at the left upper sternal border. Which
action is most appropriate?
A. Notify the provider immediately for echocardiogram
B. Document the finding and reassess in 4 hours
C. Obtain oxygen saturation pre- and post-ductal
D. Prepare for prostaglandin infusion
Correct Answer: B - Document the finding and reassess in 4
hours
Page 2
, RATIONALE
A soft systolic murmur in a term newborn at 2 hours is often a
transitional murmur due to ductus arteriosus closure. Without other
signs (cyanosis, poor perfusion), immediate intervention is not
indicated. Reassessment in 4 hours is appropriate. Pre/post ductal
saturations are done for suspected congenital heart defects with
hypoxemia.
Question 3
During the second stage of labor, a patient exhibits a prolonged deceleration to
80 bpm lasting 3 minutes. Which intrauterine resuscitation measure should the
nurse implement first?
A. Administer oxygen at 10 L/min via nonrebreather
B. Reposition to left lateral and increase IV fluids
C. Prepare for immediate cesarean delivery
D. Perform a vaginal exam to assess for cord prolapse
Correct Answer: B - Reposition to left lateral and increase IV
fluids
RATIONALE
For a prolonged deceleration, initial interventions include maternal
repositioning (left lateral) and IV fluid bolus to improve uteroplacental
perfusion. Oxygen may be given but is not first-line. Vaginal exam is
done if cord prolapse is suspected, but repositioning is immediate.
Cesarean is considered if deceleration persists.
Question 4
A patient at 32 weeks gestation presents with painless, bright red vaginal
bleeding. Which assessment finding is most concerning for placenta previa?
A. Uterine tenderness on palpation
B. Fundal height greater than gestational age
C. Soft, nontender uterus
Page 3
, D. Fetal heart rate baseline of 150 bpm
Correct Answer: C - Soft, nontender uterus
RATIONALE
Placenta previa typically presents with painless, bright red bleeding
and a soft, nontender uterus. Uterine tenderness suggests placental
abruption. Fundal height greater than dates may indicate
polyhydramnios or multiple gestation. FHR of 150 is normal.
Question 5
A patient is scheduled for a cerclage at 14 weeks gestation. Which statement
indicates the patient understands the purpose?
A. This will prevent preterm labor by strengthening my cervix.
B. This procedure will be removed at 36 weeks or if labor starts.
C. I will need to take antibiotics for the rest of my pregnancy.
D. This will cure my incompetent cervix permanently.
Correct Answer: B - This procedure will be removed at 36 weeks
or if labor starts.
RATIONALE
A cerclage is removed at 36-37 weeks or earlier if labor begins. It does
not cure incompetent cervix but provides mechanical support.
Antibiotics are not routinely continued. It does not prevent preterm
labor but reduces risk of preterm birth.
Question 6
A patient is receiving oxytocin for induction. The fetal heart rate shows
recurrent late decelerations. Which action should the nurse take first?
A. Increase oxytocin to augment labor
B. Discontinue oxytocin and administer oxygen
C. Change maternal position to supine
D. Prepare for immediate delivery
Page 4
A postpartum patient receiving magnesium sulfate for preeclampsia has a
serum magnesium level of 8.2 mg/dL. Which assessment finding requires
immediate intervention?
A. Respiratory rate of 11 breaths/min
B. Urine output of 40 mL/hr
C. Deep tendon reflexes 2+
D. Serum magnesium level of 8.2 mg/dL
Correct Answer: A - Respiratory rate of 11 breaths/min
RATIONALE
Therapeutic magnesium range is 4-7 mg/dL; levels >8 mg/dL can
cause respiratory depression. A respiratory rate <12/min indicates
impending toxicity. Urine output >30 mL/hr and reflexes 2+ are
expected. The magnesium level itself is elevated but the respiratory
rate is the priority sign of toxicity.
Question 2
A newborn is 2 hours old, born at 39 weeks via spontaneous vaginal delivery.
The nurse notes a soft systolic murmur at the left upper sternal border. Which
action is most appropriate?
A. Notify the provider immediately for echocardiogram
B. Document the finding and reassess in 4 hours
C. Obtain oxygen saturation pre- and post-ductal
D. Prepare for prostaglandin infusion
Correct Answer: B - Document the finding and reassess in 4
hours
Page 2
, RATIONALE
A soft systolic murmur in a term newborn at 2 hours is often a
transitional murmur due to ductus arteriosus closure. Without other
signs (cyanosis, poor perfusion), immediate intervention is not
indicated. Reassessment in 4 hours is appropriate. Pre/post ductal
saturations are done for suspected congenital heart defects with
hypoxemia.
Question 3
During the second stage of labor, a patient exhibits a prolonged deceleration to
80 bpm lasting 3 minutes. Which intrauterine resuscitation measure should the
nurse implement first?
A. Administer oxygen at 10 L/min via nonrebreather
B. Reposition to left lateral and increase IV fluids
C. Prepare for immediate cesarean delivery
D. Perform a vaginal exam to assess for cord prolapse
Correct Answer: B - Reposition to left lateral and increase IV
fluids
RATIONALE
For a prolonged deceleration, initial interventions include maternal
repositioning (left lateral) and IV fluid bolus to improve uteroplacental
perfusion. Oxygen may be given but is not first-line. Vaginal exam is
done if cord prolapse is suspected, but repositioning is immediate.
Cesarean is considered if deceleration persists.
Question 4
A patient at 32 weeks gestation presents with painless, bright red vaginal
bleeding. Which assessment finding is most concerning for placenta previa?
A. Uterine tenderness on palpation
B. Fundal height greater than gestational age
C. Soft, nontender uterus
Page 3
, D. Fetal heart rate baseline of 150 bpm
Correct Answer: C - Soft, nontender uterus
RATIONALE
Placenta previa typically presents with painless, bright red bleeding
and a soft, nontender uterus. Uterine tenderness suggests placental
abruption. Fundal height greater than dates may indicate
polyhydramnios or multiple gestation. FHR of 150 is normal.
Question 5
A patient is scheduled for a cerclage at 14 weeks gestation. Which statement
indicates the patient understands the purpose?
A. This will prevent preterm labor by strengthening my cervix.
B. This procedure will be removed at 36 weeks or if labor starts.
C. I will need to take antibiotics for the rest of my pregnancy.
D. This will cure my incompetent cervix permanently.
Correct Answer: B - This procedure will be removed at 36 weeks
or if labor starts.
RATIONALE
A cerclage is removed at 36-37 weeks or earlier if labor begins. It does
not cure incompetent cervix but provides mechanical support.
Antibiotics are not routinely continued. It does not prevent preterm
labor but reduces risk of preterm birth.
Question 6
A patient is receiving oxytocin for induction. The fetal heart rate shows
recurrent late decelerations. Which action should the nurse take first?
A. Increase oxytocin to augment labor
B. Discontinue oxytocin and administer oxygen
C. Change maternal position to supine
D. Prepare for immediate delivery
Page 4
