NUR2513 MATERNAL-CHILD NURSING
COMPREHENSIVE REVIEW QUESTIONS
AND ANSWERS
1. A nurse is caring for a client in the active phase of labor who is receiving oxytocin. The fetal
heart rate monitor shows late decelerations. Which of the following actions should the nurse
take first?
A. Increase the IV fluid rate
B. Administer oxygen via non-rebreather mask
C. Discontinue the oxytocin infusion
D. Reposition the client to a side-lying position
Answer: C
Conceptual Explanation: Late decelerations indicate uteroplacental insufficiency. The
first action in the presence of oxytocin is to stop the medication to reduce uterine
contractions and improve fetal oxygenation.
,2. A nurse is assessing a newborn who is 2 hours old. Which of the following findings should
the nurse report to the provider?
A. Generalized petechiae
B. Acrocyanosis
C. Milia on the bridge of the nose
D. Overlapping cranial sutures
Answer: A
Conceptual Explanation: Generalized petechiae can indicate a systemic infection or a
clotting disorder and must be reported. Acrocyanosis and milia are normal findings in a
newborn.
3. A client at 34 weeks gestation presents with sudden, dark red vaginal bleeding and a rigid,
board-like abdomen. The nurse should suspect which complication?
A. Placenta previa
B. Cervical insufficiency
C. Vasa previa
D. Abruptio placentae
Answer: D
Conceptual Explanation: Abruptio placentae is characterized by painful vaginal bleeding
and uterine tenderness or rigidity. Placenta previa is typically painless and bright red.
, 4. Which medication is the antidote for magnesium sulfate toxicity in a client being treated
for preeclampsia?
A. Naloxone
B. Calcium gluconate
C. Protamine sulfate
D. Vitamin K
Answer: B
Conceptual Explanation: Calcium gluconate is the specific antagonist for magnesium
sulfate and should be kept at the bedside during infusion.
5. A child is admitted with a diagnosis of intussusception. Which of the following clinical
manifestations should the nurse expect?
A. Currant jelly-like stools
B. Projectile vomiting
C. Ribbon-like stools
D. Palpable olive-shaped mass
Answer: A
Conceptual Explanation: Currant jelly stools (blood and mucus) are a hallmark sign of
intussusception. Olive-shaped masses are associated with pyloric stenosis.
COMPREHENSIVE REVIEW QUESTIONS
AND ANSWERS
1. A nurse is caring for a client in the active phase of labor who is receiving oxytocin. The fetal
heart rate monitor shows late decelerations. Which of the following actions should the nurse
take first?
A. Increase the IV fluid rate
B. Administer oxygen via non-rebreather mask
C. Discontinue the oxytocin infusion
D. Reposition the client to a side-lying position
Answer: C
Conceptual Explanation: Late decelerations indicate uteroplacental insufficiency. The
first action in the presence of oxytocin is to stop the medication to reduce uterine
contractions and improve fetal oxygenation.
,2. A nurse is assessing a newborn who is 2 hours old. Which of the following findings should
the nurse report to the provider?
A. Generalized petechiae
B. Acrocyanosis
C. Milia on the bridge of the nose
D. Overlapping cranial sutures
Answer: A
Conceptual Explanation: Generalized petechiae can indicate a systemic infection or a
clotting disorder and must be reported. Acrocyanosis and milia are normal findings in a
newborn.
3. A client at 34 weeks gestation presents with sudden, dark red vaginal bleeding and a rigid,
board-like abdomen. The nurse should suspect which complication?
A. Placenta previa
B. Cervical insufficiency
C. Vasa previa
D. Abruptio placentae
Answer: D
Conceptual Explanation: Abruptio placentae is characterized by painful vaginal bleeding
and uterine tenderness or rigidity. Placenta previa is typically painless and bright red.
, 4. Which medication is the antidote for magnesium sulfate toxicity in a client being treated
for preeclampsia?
A. Naloxone
B. Calcium gluconate
C. Protamine sulfate
D. Vitamin K
Answer: B
Conceptual Explanation: Calcium gluconate is the specific antagonist for magnesium
sulfate and should be kept at the bedside during infusion.
5. A child is admitted with a diagnosis of intussusception. Which of the following clinical
manifestations should the nurse expect?
A. Currant jelly-like stools
B. Projectile vomiting
C. Ribbon-like stools
D. Palpable olive-shaped mass
Answer: A
Conceptual Explanation: Currant jelly stools (blood and mucus) are a hallmark sign of
intussusception. Olive-shaped masses are associated with pyloric stenosis.
