, Question 1
A patient at 34 weeks gestation presents with a fundal height of 39 cm and a
reactive nonstress test. Ultrasound reveals polyhydramnios. Which maternal
condition most strongly correlates with this finding?
A. Gestational diabetes mellitus
B. Chronic hypertension
C. Placenta previa
D. Oligohydramnios
Correct Answer: A - Gestational diabetes mellitus
RATIONALE
Polyhydramnios is commonly associated with fetal hyperglycemia and
increased urine output in gestational diabetes. Chronic hypertension
and placenta previa are not typically linked to polyhydramnios, and
oligohydramnios is the opposite finding.
Question 2
During a postpartum assessment, a patient who delivered 2 hours ago has a
boggy uterus, saturated perineal pad, and heart rate of 118 bpm. After fundal
massage and administration of oxytocin, bleeding continues. Which medication
should the nurse anticipate next?
A. Methylergonovine
B. Carboprost tromethamine
C. Misoprostol
D. Magnesium sulfate
Correct Answer: B - Carboprost tromethamine
Page 2
, RATIONALE
Carboprost tromethamine is a prostaglandin used for refractory uterine
atony when oxytocin is ineffective. Methylergonovine is
contraindicated in hypertension, misoprostol is less potent, and
magnesium sulfate is a tocolytic, not a uterotonic.
Question 3
A newborn delivered at 38 weeks has respiratory distress, grunting, and nasal
flaring. Chest X-ray shows ground-glass opacities and air bronchograms.
Which pathophysiologic mechanism best explains these findings?
A. Surfactant deficiency leading to alveolar collapse
B. Meconium aspiration causing airway obstruction
C. Transient tachypnea from delayed fluid clearance
D. Persistent pulmonary hypertension
Correct Answer: A - Surfactant deficiency leading to alveolar
collapse
RATIONALE
Ground-glass opacities and air bronchograms are classic for
respiratory distress syndrome due to surfactant deficiency, causing
alveolar atelectasis. Meconium aspiration shows coarse infiltrates,
TTN shows fluid in fissures, and PPHN presents with oxygenation
issues without these X-ray findings.
Question 4
A patient in labor has a Category II fetal heart tracing with repetitive late
decelerations. After repositioning, IV fluid bolus, and oxygen, the
decelerations persist. Which intervention should the nurse anticipate next?
A. Administer terbutaline subcutaneously
B. Increase oxytocin infusion rate
C. Prepare for immediate cesarean delivery
Page 3
, D. Perform amnioinfusion
Correct Answer: C - Prepare for immediate cesarean delivery
RATIONALE
Persistent late decelerations despite intrauterine resuscitation indicate
fetal hypoxia and may require immediate delivery. Terbutaline is for
tachysystole, increasing oxytocin worsens the condition, and
amnioinfusion is for variable decelerations from cord compression.
Question 5
A patient at 32 weeks gestation presents with painless, bright red vaginal
bleeding. Vital signs are stable, and ultrasound shows the placenta covering the
cervical os. Which action is contraindicated?
A. Continuous fetal monitoring
B. Digital cervical examination
C. IV access and fluid resuscitation
D. Type and screen for blood products
Correct Answer: B - Digital cervical examination
RATIONALE
Digital cervical examination is contraindicated in placenta previa as it
can cause severe hemorrhage. Monitoring, IV access, and blood typing
are appropriate supportive measures.
Question 6
A postpartum patient is diagnosed with a deep vein thrombosis and started on
heparin infusion. Which laboratory value should the nurse monitor to evaluate
therapeutic effectiveness?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Platelet count
Page 4
A patient at 34 weeks gestation presents with a fundal height of 39 cm and a
reactive nonstress test. Ultrasound reveals polyhydramnios. Which maternal
condition most strongly correlates with this finding?
A. Gestational diabetes mellitus
B. Chronic hypertension
C. Placenta previa
D. Oligohydramnios
Correct Answer: A - Gestational diabetes mellitus
RATIONALE
Polyhydramnios is commonly associated with fetal hyperglycemia and
increased urine output in gestational diabetes. Chronic hypertension
and placenta previa are not typically linked to polyhydramnios, and
oligohydramnios is the opposite finding.
Question 2
During a postpartum assessment, a patient who delivered 2 hours ago has a
boggy uterus, saturated perineal pad, and heart rate of 118 bpm. After fundal
massage and administration of oxytocin, bleeding continues. Which medication
should the nurse anticipate next?
A. Methylergonovine
B. Carboprost tromethamine
C. Misoprostol
D. Magnesium sulfate
Correct Answer: B - Carboprost tromethamine
Page 2
, RATIONALE
Carboprost tromethamine is a prostaglandin used for refractory uterine
atony when oxytocin is ineffective. Methylergonovine is
contraindicated in hypertension, misoprostol is less potent, and
magnesium sulfate is a tocolytic, not a uterotonic.
Question 3
A newborn delivered at 38 weeks has respiratory distress, grunting, and nasal
flaring. Chest X-ray shows ground-glass opacities and air bronchograms.
Which pathophysiologic mechanism best explains these findings?
A. Surfactant deficiency leading to alveolar collapse
B. Meconium aspiration causing airway obstruction
C. Transient tachypnea from delayed fluid clearance
D. Persistent pulmonary hypertension
Correct Answer: A - Surfactant deficiency leading to alveolar
collapse
RATIONALE
Ground-glass opacities and air bronchograms are classic for
respiratory distress syndrome due to surfactant deficiency, causing
alveolar atelectasis. Meconium aspiration shows coarse infiltrates,
TTN shows fluid in fissures, and PPHN presents with oxygenation
issues without these X-ray findings.
Question 4
A patient in labor has a Category II fetal heart tracing with repetitive late
decelerations. After repositioning, IV fluid bolus, and oxygen, the
decelerations persist. Which intervention should the nurse anticipate next?
A. Administer terbutaline subcutaneously
B. Increase oxytocin infusion rate
C. Prepare for immediate cesarean delivery
Page 3
, D. Perform amnioinfusion
Correct Answer: C - Prepare for immediate cesarean delivery
RATIONALE
Persistent late decelerations despite intrauterine resuscitation indicate
fetal hypoxia and may require immediate delivery. Terbutaline is for
tachysystole, increasing oxytocin worsens the condition, and
amnioinfusion is for variable decelerations from cord compression.
Question 5
A patient at 32 weeks gestation presents with painless, bright red vaginal
bleeding. Vital signs are stable, and ultrasound shows the placenta covering the
cervical os. Which action is contraindicated?
A. Continuous fetal monitoring
B. Digital cervical examination
C. IV access and fluid resuscitation
D. Type and screen for blood products
Correct Answer: B - Digital cervical examination
RATIONALE
Digital cervical examination is contraindicated in placenta previa as it
can cause severe hemorrhage. Monitoring, IV access, and blood typing
are appropriate supportive measures.
Question 6
A postpartum patient is diagnosed with a deep vein thrombosis and started on
heparin infusion. Which laboratory value should the nurse monitor to evaluate
therapeutic effectiveness?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Platelet count
Page 4
