NUR 202/ NUR202 Exam 3 – Maternal-Newborn
Nursing Review ACTUAL EXAM 2026/2027 |
Maternal-Newborn Nursing Review | Verified Q&A
| Pass Guaranteed - A+ Graded
ART A – MULTIPLE CHOICE (Q1-60)
P
Q1 (High-risk pregnancy – magnesium sulfate toxicity):
A 28-year-old G2P1 at 32 weeks gestation is receiving magnesium sulfate for preeclampsia with
severe features. The nurse assesses deep tendon reflexes (DTRs) and notes they are absent.
Which action should the nurse take FIRST?
A. Continue the magnesium sulfate infusion at the current rate
B. Decrease the magnesium sulfate infusion rate by half
C. Stop the magnesium sulfate infusion immediately and notify the provider
D. Administer calcium chloride IV push
[CORRECT] C
Rationale: ACOG guidelines state that absent DTRs indicate magnesium sulfate toxicity and
require immediate discontinuation of the infusion to prevent respiratory arrest. While calcium
gluconate (not chloride) is the antidote, stopping the infusion is the FIRST priority. Distractor A is
a critical error because continuing the infusion can lead to respiratory paralysis and cardiac
arrest. Clinical pearl: The therapeutic magnesium level is 4.8-8.4 mg/dL; toxicity signs progress
from absent DTRs to respiratory depression to cardiac arrest—monitor DTRs, respiratory rate,
and urine output hourly.
Q2 (High-risk pregnancy – preeclampsia severe features – BP management):
A patient with preeclampsia has a blood pressure of 172/108 mmHg. The provider orders
antihypertensive therapy. Which medication is the FIRST-LINE treatment for severe-range BP in
preeclampsia?
A. Oral nifedipine 10 mg
B. IV labetalol 20 mg
C. Oral methyldopa 250 mg
D. IV hydralazine 5 mg
[CORRECT] B
Rationale: ACOG recommends IV labetalol (20 mg IV, then 40 mg, then 80 mg q10min) or IV
hydralazine (5-10 mg IV q20min) as first-line agents for acute severe hypertension (BP
≥160/110) in pregnancy; labetalol is often preferred due to more predictable BP lowering and
fewer maternal side effects. Distractor C (methyldopa) is used for chronic hypertension
management, not acute severe hypertension. Clinical pearl: The goal is to reduce mean arterial
pressure by 20-25% over 1-2 hours—not normalize BP rapidly, which can cause uteroplacental
hypoperfusion and fetal distress.
Q3 (High-risk pregnancy – preeclampsia – seizure management):
, patient with eclampsia has a generalized tonic-clonic seizure lasting 90 seconds. After
A
ensuring airway patency and applying oxygen, what is the NEXT priority intervention?
A. Administer diazepam 10 mg IV
B. Administer magnesium sulfate 4-6 g IV loading dose
C. Prepare for immediate cesarean section
D. Insert a Foley catheter to monitor urine output
[CORRECT] B
Rationale: Magnesium sulfate is the anticonvulsant of choice for eclampsia; a 4-6 g IV loading
dose followed by 1-2 g/hr maintenance reduces recurrent seizure risk by 50% compared to
other agents. Distractor A (diazepam) is a second-line agent used only if magnesium sulfate
fails. Clinical pearl: After seizure control, delivery is indicated—but stabilization (magnesium
sulfate, BP control) takes priority over emergent delivery unless there is fetal bradycardia or
placental abruption.
Q4 (High-risk pregnancy – gestational diabetes – screening):
A 28-year-old G1P0 at 24 weeks gestation asks about gestational diabetes screening.
According to the 2026 IADPSG one-step screening criteria, what is the diagnostic threshold for
the 75-g OGTT at 2 hours?
A. ≥120 mg/dL
B. ≥140 mg/dL
C. ≥153 mg/dL
D. ≥180 mg/dL
[CORRECT] C
Rationale: The IADPSG one-step approach uses a 75-g OGTT with thresholds: fasting ≥92
mg/dL, 1-hour ≥180 mg/dL, and 2-hour ≥153 mg/dL—diagnosis requires any one value to be
met or exceeded. Distractor B (140 mg/dL) is the traditional 2-hour threshold from older
two-step screening. Clinical pearl: Early screening (first trimester) is recommended for high-risk
patients (BMI >30, prior GDM, family history); if negative, repeat at 24-28 weeks.
Q5 (High-risk pregnancy – gestational diabetes – fetal monitoring):
A patient with diet-controlled GDM at 36 weeks gestation asks about fetal surveillance. What is
the recommended monitoring schedule?
A. Weekly nonstress tests (NST) starting at 32 weeks
B. Biophysical profile (BPP) twice weekly starting at 36 weeks
C. NST twice weekly starting at 36 weeks for diet-controlled GDM
D. Daily fetal kick counts only; no formal testing needed
[CORRECT] C
Rationale: ACOG recommends twice-weekly NSTs (or BPP) starting at 36 weeks for
diet-controlled GDM and starting at 32 weeks for insulin-requiring GDM or with additional risk
factors (hypertension, prior stillbirth). Distractor A is incorrect because weekly testing is
insufficient for GDM surveillance. Clinical pearl: If NST is nonreactive, perform BPP; if BPP is
abnormal (score ≤6/10), delivery is indicated—GDM increases risk of stillbirth, macrosomia, and
shoulder dystocia.
Q6 (High-risk pregnancy – preterm labor – tocolytics):
, 26-year-old G2P1 at 30 weeks gestation presents with regular contractions and cervical
A
change consistent with preterm labor. Which tocolytic medication is CONTRAINDICATED after
32 weeks gestation due to risk of premature closure of the ductus arteriosus?
A. Nifedipine
B. Terbutaline
C. Indomethacin
D. Magnesium sulfate
[CORRECT] C
Rationale: Indomethacin (NSAID) is effective for preterm labor tocolysis but is contraindicated
after 32 weeks due to risk of premature ductus arteriosus closure, oligohydramnios, and
pulmonary hypertension; it is typically limited to <32 weeks and <48 hours of use. Distractor A
(nifedipine) is a calcium channel blocker commonly used up to 34 weeks with fewer fetal side
effects. Clinical pearl: Tocolytics are used to delay delivery 48 hours to allow corticosteroid
administration for fetal lung maturity—nifedipine and indomethacin are first-line; magnesium
sulfate provides neuroprotection <32 weeks.
Q7 (High-risk pregnancy – preterm labor – corticosteroids):
A patient at 32 weeks gestation with threatened preterm labor received betamethasone 24
hours ago. Contractions have stopped. When is the optimal window for corticosteroid
effectiveness?
A. Within 1 hour of administration
B. 24 hours to 7 days after administration
C. 2-3 weeks after administration
D. Only effective if delivery occurs within 12 hours
[CORRECT] B
Rationale: Antenatal corticosteroids are most effective when delivery occurs between 24 hours
and 7 days after the first dose; however, they provide some benefit up to 14 days and should be
given even if delivery seems imminent. Distractor D is incorrect because effectiveness extends
well beyond 12 hours. Clinical pearl: The standard regimen is betamethasone 12 mg IM q24h ×
2 doses or dexamethasone 6 mg IM q12h × 4 doses; repeat course may be considered if >14
days elapsed and <34 weeks with recurrent preterm labor risk.
Q8 (High-risk pregnancy – placenta previa):
A 30-year-old G3P2 at 34 weeks gestation presents with sudden, painless bright red vaginal
bleeding. Ultrasound confirms placenta previa. What is the nurse's PRIORITY action?
A. Perform a sterile vaginal exam to assess cervical dilation
B. Prepare the patient for immediate vaginal delivery
C. Institute bed rest, establish IV access, and prepare for possible cesarean section
D. Administer oxytocin to augment labor
[CORRECT] C
Rationale: Placenta previa presents with painless bright red bleeding; NO vaginal exams are
performed due to risk of catastrophic hemorrhage from disrupting the placenta. Management
includes bed rest, IV access, type and crossmatch, fetal monitoring, and delivery via cesarean
section (especially if >36 weeks or heavy bleeding). Distractor A is a critical error that could
cause maternal and fetal exsanguination. Clinical pearl: If bleeding is minimal and <36 weeks,
, xpectant management with hospitalization, steroids, and close monitoring is appropriate;
e
Rh-negative patients need RhoGAM if bleeding occurs.
Q9 (High-risk pregnancy – placental abruption):
A 32-year-old G2P1 at 36 weeks gestation presents with sudden, painful vaginal bleeding,
uterine tenderness, and a "board-like" abdomen. Fetal heart rate shows late decelerations.
What complication is the nurse MOST concerned about developing?
A. Placenta previa
B. Disseminated intravascular coagulation (DIC)
C. Chorioamnionitis
D. Postpartum hemorrhage
[CORRECT] B
Rationale: Placental abruption (painful bleeding with uterine rigidity) consumes clotting factors
through the release of thromboplastin from the decidua basalis, leading to DIC in 10-30% of
severe cases—monitor fibrinogen, platelets, PT/INR, and D-dimer. Distractor A is incorrect
because placenta previa presents with painless bleeding. Clinical pearl: Emergency delivery is
indicated for abruption with fetal distress or DIC; vaginal delivery may be attempted if
maternal-fetal status is stable and cervix is favorable; massive transfusion protocol may be
needed.
Q10 (High-risk pregnancy – hyperemesis gravidarum):
A 22-year-old G1P0 at 10 weeks gestation has severe nausea and vomiting, weight loss of 4 kg,
and ketonuria. She is admitted for IV fluid administration. Which electrolyte imbalance is MOST
commonly associated with this condition?
A. Hyperkalemia
B. Hypochloremic metabolic alkalosis
C. Hypernatremia
D. Metabolic acidosis
[CORRECT] B
Rationale: Hyperemesis gravidarum causes loss of gastric acid (HCl) through vomiting, leading
to hypochloremic metabolic alkalosis with hypokalemia (due to renal compensation and
intracellular shifts). Distractor A is incorrect because vomiting causes hypokalemia, not
hyperkalemia. Clinical pearl: Thiamine 100 mg IV must be administered BEFORE
dextrose-containing fluids to prevent Wernicke encephalopathy; monitor magnesium,
phosphorus, and liver enzymes (elevated transaminases may occur).
Q11 (High-risk pregnancy – Rh incompatibility):
A 28-year-old Rh-negative G2P1 at 28 weeks gestation had an uncomplicated first pregnancy.
What is the correct RhoGAM administration protocol?
A. 300 mcg IM at 28 weeks and within 72 hours after delivery if the baby is Rh-positive
B. 300 mcg IM only if there is vaginal bleeding during pregnancy
C. 150 mcg IM at 28 weeks and 150 mcg after delivery
D. 300 mcg IV at 28 weeks and within 24 hours after delivery
[CORRECT] A
Rationale: RhoGAM 300 mcg (standard dose) is administered IM at 28 weeks gestation
(antepartum dose) and within 72 hours postpartum if the infant is Rh-positive to prevent
alloimmunization. Distractor C is incorrect because the dose is not split; 300 mcg covers up to
Nursing Review ACTUAL EXAM 2026/2027 |
Maternal-Newborn Nursing Review | Verified Q&A
| Pass Guaranteed - A+ Graded
ART A – MULTIPLE CHOICE (Q1-60)
P
Q1 (High-risk pregnancy – magnesium sulfate toxicity):
A 28-year-old G2P1 at 32 weeks gestation is receiving magnesium sulfate for preeclampsia with
severe features. The nurse assesses deep tendon reflexes (DTRs) and notes they are absent.
Which action should the nurse take FIRST?
A. Continue the magnesium sulfate infusion at the current rate
B. Decrease the magnesium sulfate infusion rate by half
C. Stop the magnesium sulfate infusion immediately and notify the provider
D. Administer calcium chloride IV push
[CORRECT] C
Rationale: ACOG guidelines state that absent DTRs indicate magnesium sulfate toxicity and
require immediate discontinuation of the infusion to prevent respiratory arrest. While calcium
gluconate (not chloride) is the antidote, stopping the infusion is the FIRST priority. Distractor A is
a critical error because continuing the infusion can lead to respiratory paralysis and cardiac
arrest. Clinical pearl: The therapeutic magnesium level is 4.8-8.4 mg/dL; toxicity signs progress
from absent DTRs to respiratory depression to cardiac arrest—monitor DTRs, respiratory rate,
and urine output hourly.
Q2 (High-risk pregnancy – preeclampsia severe features – BP management):
A patient with preeclampsia has a blood pressure of 172/108 mmHg. The provider orders
antihypertensive therapy. Which medication is the FIRST-LINE treatment for severe-range BP in
preeclampsia?
A. Oral nifedipine 10 mg
B. IV labetalol 20 mg
C. Oral methyldopa 250 mg
D. IV hydralazine 5 mg
[CORRECT] B
Rationale: ACOG recommends IV labetalol (20 mg IV, then 40 mg, then 80 mg q10min) or IV
hydralazine (5-10 mg IV q20min) as first-line agents for acute severe hypertension (BP
≥160/110) in pregnancy; labetalol is often preferred due to more predictable BP lowering and
fewer maternal side effects. Distractor C (methyldopa) is used for chronic hypertension
management, not acute severe hypertension. Clinical pearl: The goal is to reduce mean arterial
pressure by 20-25% over 1-2 hours—not normalize BP rapidly, which can cause uteroplacental
hypoperfusion and fetal distress.
Q3 (High-risk pregnancy – preeclampsia – seizure management):
, patient with eclampsia has a generalized tonic-clonic seizure lasting 90 seconds. After
A
ensuring airway patency and applying oxygen, what is the NEXT priority intervention?
A. Administer diazepam 10 mg IV
B. Administer magnesium sulfate 4-6 g IV loading dose
C. Prepare for immediate cesarean section
D. Insert a Foley catheter to monitor urine output
[CORRECT] B
Rationale: Magnesium sulfate is the anticonvulsant of choice for eclampsia; a 4-6 g IV loading
dose followed by 1-2 g/hr maintenance reduces recurrent seizure risk by 50% compared to
other agents. Distractor A (diazepam) is a second-line agent used only if magnesium sulfate
fails. Clinical pearl: After seizure control, delivery is indicated—but stabilization (magnesium
sulfate, BP control) takes priority over emergent delivery unless there is fetal bradycardia or
placental abruption.
Q4 (High-risk pregnancy – gestational diabetes – screening):
A 28-year-old G1P0 at 24 weeks gestation asks about gestational diabetes screening.
According to the 2026 IADPSG one-step screening criteria, what is the diagnostic threshold for
the 75-g OGTT at 2 hours?
A. ≥120 mg/dL
B. ≥140 mg/dL
C. ≥153 mg/dL
D. ≥180 mg/dL
[CORRECT] C
Rationale: The IADPSG one-step approach uses a 75-g OGTT with thresholds: fasting ≥92
mg/dL, 1-hour ≥180 mg/dL, and 2-hour ≥153 mg/dL—diagnosis requires any one value to be
met or exceeded. Distractor B (140 mg/dL) is the traditional 2-hour threshold from older
two-step screening. Clinical pearl: Early screening (first trimester) is recommended for high-risk
patients (BMI >30, prior GDM, family history); if negative, repeat at 24-28 weeks.
Q5 (High-risk pregnancy – gestational diabetes – fetal monitoring):
A patient with diet-controlled GDM at 36 weeks gestation asks about fetal surveillance. What is
the recommended monitoring schedule?
A. Weekly nonstress tests (NST) starting at 32 weeks
B. Biophysical profile (BPP) twice weekly starting at 36 weeks
C. NST twice weekly starting at 36 weeks for diet-controlled GDM
D. Daily fetal kick counts only; no formal testing needed
[CORRECT] C
Rationale: ACOG recommends twice-weekly NSTs (or BPP) starting at 36 weeks for
diet-controlled GDM and starting at 32 weeks for insulin-requiring GDM or with additional risk
factors (hypertension, prior stillbirth). Distractor A is incorrect because weekly testing is
insufficient for GDM surveillance. Clinical pearl: If NST is nonreactive, perform BPP; if BPP is
abnormal (score ≤6/10), delivery is indicated—GDM increases risk of stillbirth, macrosomia, and
shoulder dystocia.
Q6 (High-risk pregnancy – preterm labor – tocolytics):
, 26-year-old G2P1 at 30 weeks gestation presents with regular contractions and cervical
A
change consistent with preterm labor. Which tocolytic medication is CONTRAINDICATED after
32 weeks gestation due to risk of premature closure of the ductus arteriosus?
A. Nifedipine
B. Terbutaline
C. Indomethacin
D. Magnesium sulfate
[CORRECT] C
Rationale: Indomethacin (NSAID) is effective for preterm labor tocolysis but is contraindicated
after 32 weeks due to risk of premature ductus arteriosus closure, oligohydramnios, and
pulmonary hypertension; it is typically limited to <32 weeks and <48 hours of use. Distractor A
(nifedipine) is a calcium channel blocker commonly used up to 34 weeks with fewer fetal side
effects. Clinical pearl: Tocolytics are used to delay delivery 48 hours to allow corticosteroid
administration for fetal lung maturity—nifedipine and indomethacin are first-line; magnesium
sulfate provides neuroprotection <32 weeks.
Q7 (High-risk pregnancy – preterm labor – corticosteroids):
A patient at 32 weeks gestation with threatened preterm labor received betamethasone 24
hours ago. Contractions have stopped. When is the optimal window for corticosteroid
effectiveness?
A. Within 1 hour of administration
B. 24 hours to 7 days after administration
C. 2-3 weeks after administration
D. Only effective if delivery occurs within 12 hours
[CORRECT] B
Rationale: Antenatal corticosteroids are most effective when delivery occurs between 24 hours
and 7 days after the first dose; however, they provide some benefit up to 14 days and should be
given even if delivery seems imminent. Distractor D is incorrect because effectiveness extends
well beyond 12 hours. Clinical pearl: The standard regimen is betamethasone 12 mg IM q24h ×
2 doses or dexamethasone 6 mg IM q12h × 4 doses; repeat course may be considered if >14
days elapsed and <34 weeks with recurrent preterm labor risk.
Q8 (High-risk pregnancy – placenta previa):
A 30-year-old G3P2 at 34 weeks gestation presents with sudden, painless bright red vaginal
bleeding. Ultrasound confirms placenta previa. What is the nurse's PRIORITY action?
A. Perform a sterile vaginal exam to assess cervical dilation
B. Prepare the patient for immediate vaginal delivery
C. Institute bed rest, establish IV access, and prepare for possible cesarean section
D. Administer oxytocin to augment labor
[CORRECT] C
Rationale: Placenta previa presents with painless bright red bleeding; NO vaginal exams are
performed due to risk of catastrophic hemorrhage from disrupting the placenta. Management
includes bed rest, IV access, type and crossmatch, fetal monitoring, and delivery via cesarean
section (especially if >36 weeks or heavy bleeding). Distractor A is a critical error that could
cause maternal and fetal exsanguination. Clinical pearl: If bleeding is minimal and <36 weeks,
, xpectant management with hospitalization, steroids, and close monitoring is appropriate;
e
Rh-negative patients need RhoGAM if bleeding occurs.
Q9 (High-risk pregnancy – placental abruption):
A 32-year-old G2P1 at 36 weeks gestation presents with sudden, painful vaginal bleeding,
uterine tenderness, and a "board-like" abdomen. Fetal heart rate shows late decelerations.
What complication is the nurse MOST concerned about developing?
A. Placenta previa
B. Disseminated intravascular coagulation (DIC)
C. Chorioamnionitis
D. Postpartum hemorrhage
[CORRECT] B
Rationale: Placental abruption (painful bleeding with uterine rigidity) consumes clotting factors
through the release of thromboplastin from the decidua basalis, leading to DIC in 10-30% of
severe cases—monitor fibrinogen, platelets, PT/INR, and D-dimer. Distractor A is incorrect
because placenta previa presents with painless bleeding. Clinical pearl: Emergency delivery is
indicated for abruption with fetal distress or DIC; vaginal delivery may be attempted if
maternal-fetal status is stable and cervix is favorable; massive transfusion protocol may be
needed.
Q10 (High-risk pregnancy – hyperemesis gravidarum):
A 22-year-old G1P0 at 10 weeks gestation has severe nausea and vomiting, weight loss of 4 kg,
and ketonuria. She is admitted for IV fluid administration. Which electrolyte imbalance is MOST
commonly associated with this condition?
A. Hyperkalemia
B. Hypochloremic metabolic alkalosis
C. Hypernatremia
D. Metabolic acidosis
[CORRECT] B
Rationale: Hyperemesis gravidarum causes loss of gastric acid (HCl) through vomiting, leading
to hypochloremic metabolic alkalosis with hypokalemia (due to renal compensation and
intracellular shifts). Distractor A is incorrect because vomiting causes hypokalemia, not
hyperkalemia. Clinical pearl: Thiamine 100 mg IV must be administered BEFORE
dextrose-containing fluids to prevent Wernicke encephalopathy; monitor magnesium,
phosphorus, and liver enzymes (elevated transaminases may occur).
Q11 (High-risk pregnancy – Rh incompatibility):
A 28-year-old Rh-negative G2P1 at 28 weeks gestation had an uncomplicated first pregnancy.
What is the correct RhoGAM administration protocol?
A. 300 mcg IM at 28 weeks and within 72 hours after delivery if the baby is Rh-positive
B. 300 mcg IM only if there is vaginal bleeding during pregnancy
C. 150 mcg IM at 28 weeks and 150 mcg after delivery
D. 300 mcg IV at 28 weeks and within 24 hours after delivery
[CORRECT] A
Rationale: RhoGAM 300 mcg (standard dose) is administered IM at 28 weeks gestation
(antepartum dose) and within 72 hours postpartum if the infant is Rh-positive to prevent
alloimmunization. Distractor C is incorrect because the dose is not split; 300 mcg covers up to
