NUR 2513 / Exam 2 - Maternal Child Nursing Rasmussen University | 2026/2027 Edition
NUR 2513 / NUR2513 EXAM 2 (LATEST ): MATERNAL
CHILD NURSING - RASMUSSEN
Comprehensive 120-Question Examination | Aligned with NCLEX-RN Test Plan, QSEN Competencies, AWHONN &
AAP Standards
Course: NUR 2513 Maternal-Child Nursing | Rasmussen University | Edition:
Total Questions: 120 | Cognitive Distribution: 20% Recall, 50% Application, 30% Analysis | Format: 4-Option Multiple Choice with
Rationales
Section 1: High-Risk Pregnancy & Antepartum Complications
Questions 1-20 | 20 questions covering gestational diabetes, hypertensive disorders of pregnancy, hyperemesis gravidarum, antepartum
hemorrhage, isoimmunization, preterm labor, and maternal infections.
Q1: A 32-year-old primigravida at 28 weeks gestation is diagnosed with gestational diabetes mellitus (GDM) after
a 3-hour oral glucose tolerance test. Her fasting blood glucose is 132 mg/dL and 2-hour postprandial is 165
mg/dL. Which nursing intervention is the priority for managing this patient's GDM at home?
A. Begin insulin therapy immediately and discontinue all oral nutrient intake
B. Initiate daily fetal movement counts and teach self-monitoring of blood glucose with diet modification
*[CORRECT]*
C. Schedule an immediate cesarean delivery due to the elevated postprandial glucose
D. Restrict all carbohydrate intake to less than 30% of total daily calories
Correct Answer: B
Rationale: GDM is initially managed with medical nutrition therapy (MNT), exercise, and self-monitoring of blood glucose
(SMBG) targeting fasting <95 mg/dL and 1-hour postprandial <140 mg/dL. Daily fetal movement counts begin at 28 weeks to
monitor fetal well-being. Insulin is added only if MNT fails to maintain glycemic targets within 1-2 weeks; cesarean delivery is
reserved for obstetric indications or estimated fetal weight >4500 g; severe carbohydrate restriction is contraindicated because
ketones cross the placenta and may impair neurodevelopment (AWHONN, 2024).
Q2: A pregnant patient at 32 weeks gestation presents to the obstetric triage unit with a blood pressure of 158/102
mmHg, deep tendon reflexes 3+, 2+ pitting edema of the lower extremities, and a subjective headache that has
persisted for 4 hours. Which assessment finding would the nurse recognize as most concerning for progression to
severe preeclampsia?
A. Proteinuria of 1+ on dipstick
B. Right upper quadrant pain with elevated liver enzymes *[CORRECT]*
C. Weight gain of 2 pounds in one week
D. Hyperactive bowel sounds
Correct Answer: B
Rationale: Severe preeclampsia is diagnosed when BP is >=160 systolic or >=110 diastolic on two occasions, with end-organ
features such as RUQ/epigastric pain (liver capsule distention from elevated transaminases), platelets <100,000, new-onset headache
unresponsive to medication, visual disturbances, pulmonary edema, or impaired renal function. RUQ pain with elevated liver
enzymes signals possible HELLP syndrome progression and warrants immediate notification of the provider. Proteinuria 1+ alone is
no longer required for diagnosis per ACOG 2020 criteria; weight gain and bowel sound changes are non-specific.
Page 1 | NUR 2513 Exam 2 - Comprehensive 120-Question
,NUR 2513 / Exam 2 - Maternal Child Nursing Rasmussen University | 2026/2027 Edition
Q3: A patient with severe preeclampsia is receiving a maintenance intravenous infusion of magnesium sulfate at
2 g/hour after a 4 g loading dose. Which finding would indicate magnesium toxicity and require immediate
nursing intervention with calcium gluconate?
A. Respiratory rate of 14 breaths per minute and absent deep tendon reflexes *[CORRECT]*
B. Blood pressure of 140/90 mmHg and headache relief
C. Urinary output of 35 mL/hour and patellar reflexes 2+
D. Fetal heart rate of 140 bpm with moderate variability
Correct Answer: A
Rationale: Magnesium sulfate toxicity is monitored by assessing deep tendon reflexes (DTRs), respiratory rate, level of
consciousness, and urine output. Loss of DTRs is the earliest sign of toxicity; respiratory depression (<12 breaths/min) and cardiac
arrest follow. Calcium gluconate 10% (10 mL IV over 3 minutes) is the specific antidote. Magnesium is excreted renally, so urine
output must be >=25-30 mL/hour. Patellar reflexes 2+ and RR of 14 are within normal limits, and FHR 140 with moderate variability
is reassuring.
Q4: A 29-year-old gravida 2 para 1 at 35 weeks gestation presents with malaise, nausea, and right upper
quadrant pain. Laboratory results reveal hemoglobin 11.2 g/dL, platelets 88,000/microL, AST 220 U/L, ALT 195
U/L, and LDH 850 U/L. Which condition must the nurse suspect?
A. Acute fatty liver of pregnancy (AFLP)
B. HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) *[CORRECT]*
C. Intrahepatic cholestasis of pregnancy (ICP)
D. Viral hepatitis A
Correct Answer: B
Rationale: HELLP syndrome is a variant of severe preeclampsia characterized by Hemolysis (LDH >600, bilirubin >1.2), Elevated
Liver enzymes (AST/ALT >70), and Low Platelets (<100,000). The classic presenting symptom is malaise (90%) and
RUQ/epigastric pain (65%). AFLP typically presents with profound hypoglycemia, coagulopathy, and encephalopathy; ICP presents
with pruritus without rash and elevated bile acids with normal platelets; viral hepatitis would show positive serology and
significantly elevated transaminases without thrombocytopenia.
Q5: A patient with chronic hypertension controlled with labetalol is now at 16 weeks gestation. The nurse is
developing the antepartum plan of care. Which intervention is most important to add to her routine prenatal
surveillance?
A. Weekly non-stress tests beginning at 24 weeks gestation
B. Serial ultrasounds for fetal growth every 3-4 weeks beginning at 28-32 weeks and low-dose aspirin 81 mg
daily *[CORRECT]*
C. Daily fetal kick counts beginning immediately and biweekly BPP
D. Hospitalization for bedrest for the remainder of the pregnancy
Correct Answer: B
Rationale: ACOG and USPSTF recommend low-dose aspirin (81 mg/day) beginning between 12-28 weeks (optimally before 16
weeks) for patients at high risk of preeclampsia, including those with chronic hypertension. Serial ultrasounds for fetal growth every
3-4 weeks starting at 28-32 weeks monitor for intrauterine growth restriction, which is more common with chronic hypertension.
Weekly NSTs are reserved for high-risk pregnancies starting at 32-34 weeks or if growth restriction is identified; daily kick counts
begin at 28 weeks; routine hospitalization is not indicated.
Page 2 | NUR 2513 Exam 2 - Comprehensive 120-Question
,NUR 2513 / Exam 2 - Maternal Child Nursing Rasmussen University | 2026/2027 Edition
Q6: A primigravida at 9 weeks gestation presents to the emergency department with persistent vomiting for the
past 5 days, having vomited 8-10 times per day. She has lost 6 pounds (3% of body weight), her mucous
membranes are dry, and she reports dizziness on standing. Laboratory results show ketones 3+ in urine, sodium
132 mEq/L, potassium 3.1 mEq/L, and TSH 0.2 mIU/L (suppressed). What is the priority nursing diagnosis?
A. Imbalanced Nutrition: Less Than Body Requirements related to nausea
B. Deficient Fluid Volume related to prolonged vomiting *[CORRECT]*
C. Risk for Impaired Parenting related to hyperemesis
D. Anxiety related to pregnancy outcome
Correct Answer: B
Rationale: Hyperemesis gravidarum (HG) is defined as persistent vomiting, weight loss >5%, ketonuria, electrolyte disturbances,
and dehydration. This patient meets all criteria; her orthostatic symptoms, ketonuria 3+, hypokalemia (K 3.1), and hyponatremia (Na
132) indicate severe fluid and electrolyte depletion, which is the immediate life-threatening concern. Priority is IV fluid resuscitation
with normal saline and potassium replacement, followed by antiemetics (pyridoxine, ondansetron) and thiamine supplementation.
Nutrition is secondary to stabilization. The suppressed TSH is a transient hyperthyroidism of HG and resolves with treatment.
Q7: A gravida 3 para 2 at 30 weeks gestation presents to the labor and delivery triage with sudden, painless,
bright red vaginal bleeding that soaked one perineal pad in 30 minutes. Her vital signs are stable: BP 118/74, HR
88, FHR 145 with moderate variability. Which nursing action is contraindicated at this time?
A. Initiating continuous external fetal monitoring and applying a fetal scalp electrode *[CORRECT]*
B. Placing two large-bore IV catheters and obtaining type and crossmatch
C. Monitoring maternal vital signs and pad count every 15 minutes
D. Preparing for possible ultrasound to confirm placental location
Correct Answer: A
Rationale: Painless bright red vaginal bleeding in the third trimester is presumptive placenta previa until proven otherwise.
ABSOLUTE contraindications include any vaginal examination (digital or speculum) and application of a fetal scalp electrode or
intrauterine pressure catheter, as these can precipitate catastrophic hemorrhage. The priority nursing actions are to stabilize the
patient: bedrest, continuous external fetal monitoring (NOT internal), two large-bore IVs, type and crossmatch for 2-4 units, baseline
labs including CBC and coagulation studies, and arranging a transabdominal ultrasound to confirm placental location.
Q8: A patient at 36 weeks gestation arrives at the obstetric triage unit reporting a sudden onset of dark red
vaginal bleeding accompanied by severe, constant abdominal pain described as 'tearing.' She has a rigid, tender
uterus on palpation, and the fetal heart rate tracing shows prolonged bradycardia with minimal variability.
Which condition must the nurse suspect and what is the priority intervention?
A. Placenta previa with concealed hemorrhage; prepare for cesarean delivery
B. Placental abruption with fetal compromise; prepare for emergency cesarean delivery *[CORRECT]*
C. Uterine rupture; begin immediate oxytocin augmentation
D. Vasa previa; perform amniotomy to allow vaginal delivery
Correct Answer: B
Rationale: Placental abruption (premature separation of the placenta) classically presents with dark red vaginal bleeding, severe
constant abdominal pain, a rigid and tender (board-like) uterus, and fetal distress. Abruption is an obstetric emergency requiring
immediate delivery, typically by emergency cesarean if the fetus is viable and not in labor. Placenta previa presents with PAINLESS
bright red bleeding; uterine rupture shows cessation of contractions and loss of fetal station with possible fetal heart tones absent;
vasa previa presents with bleeding at rupture of membranes and is rare.
Page 3 | NUR 2513 Exam 2 - Comprehensive 120-Question
, NUR 2513 / Exam 2 - Maternal Child Nursing Rasmussen University | 2026/2027 Edition
Q9: A 27-year-old patient at 7 weeks gestation presents with unilateral lower abdominal pain, spotting, and
shoulder pain referred from diaphragmatic irritation. Her serum beta-hCG is 1,800 mIU/mL, but transvaginal
ultrasound shows no intrauterine pregnancy. Vital signs reveal BP 96/60, HR 110, RR 22. What is the priority
nursing action?
A. Schedule a repeat serum beta-hCG in 48 hours to assess for appropriate rise
B. Establish two large-bore IVs, prepare for emergency surgery, and notify the OR immediately
*[CORRECT]*
C. Administer methotrexate intramuscularly as the patient is hemodynamically stable
D. Discharge the patient with instructions to return if symptoms worsen
Correct Answer: B
Rationale: This patient has a presumptive ruptured ectopic pregnancy with hemodynamic instability (tachycardia, hypotension,
shoulder pain from hemoperitoneum, hCG >1500 with no intrauterine pregnancy on ultrasound). Shoulder pain is referred pain from
diaphragmatic irritation by intraperitoneal blood, signaling rupture. Immediate surgical intervention (salpingostomy or
salpingectomy) is required. Methotrexate is contraindicated with rupture, hemodynamic instability, or non-compliance; serial hCG is
appropriate only for stable patients with unruptured ectopics of appropriate size.
Q10: A patient at 12 weeks gestation presents with vaginal bleeding, passage of grapelike vesicles, and a uterus
larger than expected for gestational age. Her serum beta-hCG is 220,000 mIU/mL, and ultrasound reveals a
'snowstorm' pattern without a fetal heartbeat. After diagnosis and uterine evacuation, what is the most critical
aspect of the patient's follow-up care?
A. Initiating chemotherapy immediately to prevent metastasis
B. Serial quantitative beta-hCG measurements every 1-2 weeks until undetectable, then monthly for 6
months, with strict contraception *[CORRECT]*
C. Annual pelvic examinations for the next 5 years
D. Beginning oral contraceptives within 2 weeks of evacuation to prevent reimplantation
Correct Answer: B
Rationale: Complete hydatidiform mole requires serial beta-hCG monitoring every 1-2 weeks until undetectable, then monthly for 6
months, due to the risk of persistent gestational trophoblastic disease (GTN) or choriocarcinoma development in 15-20% of cases.
Reliable contraception (hormonal or barrier) is mandatory during surveillance to prevent confusion of rising hCG from pregnancy
versus recurrent disease. Chemotherapy is reserved for persistent GTN with plateauing or rising hCG; annual pelvic exams alone are
insufficient; oral contraceptives can be started once hCG is undetectable.
Q11: A gravida 2 para 1 at 16 weeks gestation is found on ultrasound to have a shortened cervical length of 18
mm with funneling of the internal os. Her previous pregnancy ended with spontaneous preterm birth at 28 weeks.
Which intervention is most appropriate to prevent recurrent preterm birth?
A. Recommend strict bedrest for the remainder of the pregnancy
B. Place a rescue cerclage (McDonald or Shirodkar) and start progesterone supplementation *[CORRECT]*
C. Schedule an induction of labor at 34 weeks gestation
D. Begin weekly cervical exams starting at 24 weeks to monitor for change
Correct Answer: B
Rationale: Patients with history of spontaneous preterm birth AND shortened cervix (<25 mm before 24 weeks) benefit from
ultrasound-indicated cerclage placement (McDonald or Shirodkar technique) combined with 17-OH progesterone caproate (250 mg
IM weekly) or vaginal progesterone. Bedrest alone has no proven benefit and increases DVT risk; scheduled induction at 34 weeks
without obstetric indication is inappropriate; cervical exams increase infection risk and do not change management.
Page 4 | NUR 2513 Exam 2 - Comprehensive 120-Question
NUR 2513 / NUR2513 EXAM 2 (LATEST ): MATERNAL
CHILD NURSING - RASMUSSEN
Comprehensive 120-Question Examination | Aligned with NCLEX-RN Test Plan, QSEN Competencies, AWHONN &
AAP Standards
Course: NUR 2513 Maternal-Child Nursing | Rasmussen University | Edition:
Total Questions: 120 | Cognitive Distribution: 20% Recall, 50% Application, 30% Analysis | Format: 4-Option Multiple Choice with
Rationales
Section 1: High-Risk Pregnancy & Antepartum Complications
Questions 1-20 | 20 questions covering gestational diabetes, hypertensive disorders of pregnancy, hyperemesis gravidarum, antepartum
hemorrhage, isoimmunization, preterm labor, and maternal infections.
Q1: A 32-year-old primigravida at 28 weeks gestation is diagnosed with gestational diabetes mellitus (GDM) after
a 3-hour oral glucose tolerance test. Her fasting blood glucose is 132 mg/dL and 2-hour postprandial is 165
mg/dL. Which nursing intervention is the priority for managing this patient's GDM at home?
A. Begin insulin therapy immediately and discontinue all oral nutrient intake
B. Initiate daily fetal movement counts and teach self-monitoring of blood glucose with diet modification
*[CORRECT]*
C. Schedule an immediate cesarean delivery due to the elevated postprandial glucose
D. Restrict all carbohydrate intake to less than 30% of total daily calories
Correct Answer: B
Rationale: GDM is initially managed with medical nutrition therapy (MNT), exercise, and self-monitoring of blood glucose
(SMBG) targeting fasting <95 mg/dL and 1-hour postprandial <140 mg/dL. Daily fetal movement counts begin at 28 weeks to
monitor fetal well-being. Insulin is added only if MNT fails to maintain glycemic targets within 1-2 weeks; cesarean delivery is
reserved for obstetric indications or estimated fetal weight >4500 g; severe carbohydrate restriction is contraindicated because
ketones cross the placenta and may impair neurodevelopment (AWHONN, 2024).
Q2: A pregnant patient at 32 weeks gestation presents to the obstetric triage unit with a blood pressure of 158/102
mmHg, deep tendon reflexes 3+, 2+ pitting edema of the lower extremities, and a subjective headache that has
persisted for 4 hours. Which assessment finding would the nurse recognize as most concerning for progression to
severe preeclampsia?
A. Proteinuria of 1+ on dipstick
B. Right upper quadrant pain with elevated liver enzymes *[CORRECT]*
C. Weight gain of 2 pounds in one week
D. Hyperactive bowel sounds
Correct Answer: B
Rationale: Severe preeclampsia is diagnosed when BP is >=160 systolic or >=110 diastolic on two occasions, with end-organ
features such as RUQ/epigastric pain (liver capsule distention from elevated transaminases), platelets <100,000, new-onset headache
unresponsive to medication, visual disturbances, pulmonary edema, or impaired renal function. RUQ pain with elevated liver
enzymes signals possible HELLP syndrome progression and warrants immediate notification of the provider. Proteinuria 1+ alone is
no longer required for diagnosis per ACOG 2020 criteria; weight gain and bowel sound changes are non-specific.
Page 1 | NUR 2513 Exam 2 - Comprehensive 120-Question
,NUR 2513 / Exam 2 - Maternal Child Nursing Rasmussen University | 2026/2027 Edition
Q3: A patient with severe preeclampsia is receiving a maintenance intravenous infusion of magnesium sulfate at
2 g/hour after a 4 g loading dose. Which finding would indicate magnesium toxicity and require immediate
nursing intervention with calcium gluconate?
A. Respiratory rate of 14 breaths per minute and absent deep tendon reflexes *[CORRECT]*
B. Blood pressure of 140/90 mmHg and headache relief
C. Urinary output of 35 mL/hour and patellar reflexes 2+
D. Fetal heart rate of 140 bpm with moderate variability
Correct Answer: A
Rationale: Magnesium sulfate toxicity is monitored by assessing deep tendon reflexes (DTRs), respiratory rate, level of
consciousness, and urine output. Loss of DTRs is the earliest sign of toxicity; respiratory depression (<12 breaths/min) and cardiac
arrest follow. Calcium gluconate 10% (10 mL IV over 3 minutes) is the specific antidote. Magnesium is excreted renally, so urine
output must be >=25-30 mL/hour. Patellar reflexes 2+ and RR of 14 are within normal limits, and FHR 140 with moderate variability
is reassuring.
Q4: A 29-year-old gravida 2 para 1 at 35 weeks gestation presents with malaise, nausea, and right upper
quadrant pain. Laboratory results reveal hemoglobin 11.2 g/dL, platelets 88,000/microL, AST 220 U/L, ALT 195
U/L, and LDH 850 U/L. Which condition must the nurse suspect?
A. Acute fatty liver of pregnancy (AFLP)
B. HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) *[CORRECT]*
C. Intrahepatic cholestasis of pregnancy (ICP)
D. Viral hepatitis A
Correct Answer: B
Rationale: HELLP syndrome is a variant of severe preeclampsia characterized by Hemolysis (LDH >600, bilirubin >1.2), Elevated
Liver enzymes (AST/ALT >70), and Low Platelets (<100,000). The classic presenting symptom is malaise (90%) and
RUQ/epigastric pain (65%). AFLP typically presents with profound hypoglycemia, coagulopathy, and encephalopathy; ICP presents
with pruritus without rash and elevated bile acids with normal platelets; viral hepatitis would show positive serology and
significantly elevated transaminases without thrombocytopenia.
Q5: A patient with chronic hypertension controlled with labetalol is now at 16 weeks gestation. The nurse is
developing the antepartum plan of care. Which intervention is most important to add to her routine prenatal
surveillance?
A. Weekly non-stress tests beginning at 24 weeks gestation
B. Serial ultrasounds for fetal growth every 3-4 weeks beginning at 28-32 weeks and low-dose aspirin 81 mg
daily *[CORRECT]*
C. Daily fetal kick counts beginning immediately and biweekly BPP
D. Hospitalization for bedrest for the remainder of the pregnancy
Correct Answer: B
Rationale: ACOG and USPSTF recommend low-dose aspirin (81 mg/day) beginning between 12-28 weeks (optimally before 16
weeks) for patients at high risk of preeclampsia, including those with chronic hypertension. Serial ultrasounds for fetal growth every
3-4 weeks starting at 28-32 weeks monitor for intrauterine growth restriction, which is more common with chronic hypertension.
Weekly NSTs are reserved for high-risk pregnancies starting at 32-34 weeks or if growth restriction is identified; daily kick counts
begin at 28 weeks; routine hospitalization is not indicated.
Page 2 | NUR 2513 Exam 2 - Comprehensive 120-Question
,NUR 2513 / Exam 2 - Maternal Child Nursing Rasmussen University | 2026/2027 Edition
Q6: A primigravida at 9 weeks gestation presents to the emergency department with persistent vomiting for the
past 5 days, having vomited 8-10 times per day. She has lost 6 pounds (3% of body weight), her mucous
membranes are dry, and she reports dizziness on standing. Laboratory results show ketones 3+ in urine, sodium
132 mEq/L, potassium 3.1 mEq/L, and TSH 0.2 mIU/L (suppressed). What is the priority nursing diagnosis?
A. Imbalanced Nutrition: Less Than Body Requirements related to nausea
B. Deficient Fluid Volume related to prolonged vomiting *[CORRECT]*
C. Risk for Impaired Parenting related to hyperemesis
D. Anxiety related to pregnancy outcome
Correct Answer: B
Rationale: Hyperemesis gravidarum (HG) is defined as persistent vomiting, weight loss >5%, ketonuria, electrolyte disturbances,
and dehydration. This patient meets all criteria; her orthostatic symptoms, ketonuria 3+, hypokalemia (K 3.1), and hyponatremia (Na
132) indicate severe fluid and electrolyte depletion, which is the immediate life-threatening concern. Priority is IV fluid resuscitation
with normal saline and potassium replacement, followed by antiemetics (pyridoxine, ondansetron) and thiamine supplementation.
Nutrition is secondary to stabilization. The suppressed TSH is a transient hyperthyroidism of HG and resolves with treatment.
Q7: A gravida 3 para 2 at 30 weeks gestation presents to the labor and delivery triage with sudden, painless,
bright red vaginal bleeding that soaked one perineal pad in 30 minutes. Her vital signs are stable: BP 118/74, HR
88, FHR 145 with moderate variability. Which nursing action is contraindicated at this time?
A. Initiating continuous external fetal monitoring and applying a fetal scalp electrode *[CORRECT]*
B. Placing two large-bore IV catheters and obtaining type and crossmatch
C. Monitoring maternal vital signs and pad count every 15 minutes
D. Preparing for possible ultrasound to confirm placental location
Correct Answer: A
Rationale: Painless bright red vaginal bleeding in the third trimester is presumptive placenta previa until proven otherwise.
ABSOLUTE contraindications include any vaginal examination (digital or speculum) and application of a fetal scalp electrode or
intrauterine pressure catheter, as these can precipitate catastrophic hemorrhage. The priority nursing actions are to stabilize the
patient: bedrest, continuous external fetal monitoring (NOT internal), two large-bore IVs, type and crossmatch for 2-4 units, baseline
labs including CBC and coagulation studies, and arranging a transabdominal ultrasound to confirm placental location.
Q8: A patient at 36 weeks gestation arrives at the obstetric triage unit reporting a sudden onset of dark red
vaginal bleeding accompanied by severe, constant abdominal pain described as 'tearing.' She has a rigid, tender
uterus on palpation, and the fetal heart rate tracing shows prolonged bradycardia with minimal variability.
Which condition must the nurse suspect and what is the priority intervention?
A. Placenta previa with concealed hemorrhage; prepare for cesarean delivery
B. Placental abruption with fetal compromise; prepare for emergency cesarean delivery *[CORRECT]*
C. Uterine rupture; begin immediate oxytocin augmentation
D. Vasa previa; perform amniotomy to allow vaginal delivery
Correct Answer: B
Rationale: Placental abruption (premature separation of the placenta) classically presents with dark red vaginal bleeding, severe
constant abdominal pain, a rigid and tender (board-like) uterus, and fetal distress. Abruption is an obstetric emergency requiring
immediate delivery, typically by emergency cesarean if the fetus is viable and not in labor. Placenta previa presents with PAINLESS
bright red bleeding; uterine rupture shows cessation of contractions and loss of fetal station with possible fetal heart tones absent;
vasa previa presents with bleeding at rupture of membranes and is rare.
Page 3 | NUR 2513 Exam 2 - Comprehensive 120-Question
, NUR 2513 / Exam 2 - Maternal Child Nursing Rasmussen University | 2026/2027 Edition
Q9: A 27-year-old patient at 7 weeks gestation presents with unilateral lower abdominal pain, spotting, and
shoulder pain referred from diaphragmatic irritation. Her serum beta-hCG is 1,800 mIU/mL, but transvaginal
ultrasound shows no intrauterine pregnancy. Vital signs reveal BP 96/60, HR 110, RR 22. What is the priority
nursing action?
A. Schedule a repeat serum beta-hCG in 48 hours to assess for appropriate rise
B. Establish two large-bore IVs, prepare for emergency surgery, and notify the OR immediately
*[CORRECT]*
C. Administer methotrexate intramuscularly as the patient is hemodynamically stable
D. Discharge the patient with instructions to return if symptoms worsen
Correct Answer: B
Rationale: This patient has a presumptive ruptured ectopic pregnancy with hemodynamic instability (tachycardia, hypotension,
shoulder pain from hemoperitoneum, hCG >1500 with no intrauterine pregnancy on ultrasound). Shoulder pain is referred pain from
diaphragmatic irritation by intraperitoneal blood, signaling rupture. Immediate surgical intervention (salpingostomy or
salpingectomy) is required. Methotrexate is contraindicated with rupture, hemodynamic instability, or non-compliance; serial hCG is
appropriate only for stable patients with unruptured ectopics of appropriate size.
Q10: A patient at 12 weeks gestation presents with vaginal bleeding, passage of grapelike vesicles, and a uterus
larger than expected for gestational age. Her serum beta-hCG is 220,000 mIU/mL, and ultrasound reveals a
'snowstorm' pattern without a fetal heartbeat. After diagnosis and uterine evacuation, what is the most critical
aspect of the patient's follow-up care?
A. Initiating chemotherapy immediately to prevent metastasis
B. Serial quantitative beta-hCG measurements every 1-2 weeks until undetectable, then monthly for 6
months, with strict contraception *[CORRECT]*
C. Annual pelvic examinations for the next 5 years
D. Beginning oral contraceptives within 2 weeks of evacuation to prevent reimplantation
Correct Answer: B
Rationale: Complete hydatidiform mole requires serial beta-hCG monitoring every 1-2 weeks until undetectable, then monthly for 6
months, due to the risk of persistent gestational trophoblastic disease (GTN) or choriocarcinoma development in 15-20% of cases.
Reliable contraception (hormonal or barrier) is mandatory during surveillance to prevent confusion of rising hCG from pregnancy
versus recurrent disease. Chemotherapy is reserved for persistent GTN with plateauing or rising hCG; annual pelvic exams alone are
insufficient; oral contraceptives can be started once hCG is undetectable.
Q11: A gravida 2 para 1 at 16 weeks gestation is found on ultrasound to have a shortened cervical length of 18
mm with funneling of the internal os. Her previous pregnancy ended with spontaneous preterm birth at 28 weeks.
Which intervention is most appropriate to prevent recurrent preterm birth?
A. Recommend strict bedrest for the remainder of the pregnancy
B. Place a rescue cerclage (McDonald or Shirodkar) and start progesterone supplementation *[CORRECT]*
C. Schedule an induction of labor at 34 weeks gestation
D. Begin weekly cervical exams starting at 24 weeks to monitor for change
Correct Answer: B
Rationale: Patients with history of spontaneous preterm birth AND shortened cervix (<25 mm before 24 weeks) benefit from
ultrasound-indicated cerclage placement (McDonald or Shirodkar technique) combined with 17-OH progesterone caproate (250 mg
IM weekly) or vaginal progesterone. Bedrest alone has no proven benefit and increases DVT risk; scheduled induction at 34 weeks
without obstetric indication is inappropriate; cervical exams increase infection risk and do not change management.
Page 4 | NUR 2513 Exam 2 - Comprehensive 120-Question
