,NUR 223 OBSTETRICS Clinical Judgment Exam Questions And
Answers 2026/2027 Jersey College
Q1. A patient at 34 weeks reports a severe persistent headache,
blurred vision, and right upper-quadrant pain. Blood pressure is
168/112 mm Hg. Which action has priority?
A) Initiate prompt evaluation and management for severe hypertensive
disease of pregnancy
B) Encourage ambulation to reduce blood pressure
C) Reassess at the next prenatal appointment
D) Recommend a high-sodium snack
Correct Answer: A) Initiate prompt evaluation and management for severe
hypertensive disease of pregnancy
Rationale: Severe hypertension with neurologic and upper abdominal
symptoms suggests severe preeclamptic disease and creates immediate
maternal and fetal risk.
Q2. A patient at 10 weeks reports unilateral pelvic pain, vaginal
spotting, dizziness, and shoulder pain. Which complication should
be suspected first?
A) Hyperemesis gravidarum
B) Ruptured ectopic pregnancy
C) Placenta previa
D) Gestational hypertension
Correct Answer: B) Ruptured ectopic pregnancy
Rationale: Unilateral pain, bleeding, referred shoulder pain, and circulatory
symptoms can indicate intra-abdominal hemorrhage from ectopic rupture.
Q3. A patient with persistent vomiting during early pregnancy has
dry mucous membranes, tachycardia, ketones in the urine, and a 4-
kg weight loss. Which problem is most likely?
A) Normal physiologic nausea
B) Gestational diabetes
C) Hyperemesis gravidarum with dehydration
D) Placental abruption
Correct Answer: C) Hyperemesis gravidarum with dehydration
,Rationale: Severe vomiting accompanied by weight loss, ketosis, and
dehydration exceeds expected pregnancy-related nausea.
Q4. A patient at 32 weeks reports painless bright-red vaginal
bleeding. Which action should be avoided until placental location is
known?
A) Assess maternal vital signs
B) Monitor fetal status
C) Establish IV access if indicated
D) Perform a digital vaginal examination
Correct Answer: D) Perform a digital vaginal examination
Rationale: Vaginal examination can disrupt a placenta covering or near the
cervical opening and provoke severe hemorrhage.
Q5. A patient at 37 weeks develops sudden abdominal pain, dark
vaginal bleeding, uterine tenderness, and a firm uterus. Which
complication is most likely?
A) Placental abruption
B) Placenta previa
C) Hyperemesis gravidarum
D) Cervical insufficiency
Correct Answer: A) Placental abruption
Rationale: Painful bleeding with uterine tenderness and increased tone is
characteristic of premature placental separation.
Q6. An Rh-negative, unsensitized pregnant patient experiences
significant vaginal bleeding after abdominal trauma. Which
intervention should be anticipated?
A) Rubella vaccination immediately
B) Evaluation for Rh immune globulin administration
C) Restriction of all oral fluids
D) Administration of oxytocin
Correct Answer: B) Evaluation for Rh immune globulin administration
Rationale: Fetomaternal blood exposure can sensitize an Rh-negative
patient, so prophylaxis may be required when appropriate.
, Q7. A patient with gestational diabetes asks why glucose control
matters. Which fetal risk is most closely associated with persistent
maternal hyperglycemia?
A) Neural tube closure after birth
B) Fetal bradycardia from low maternal protein
C) Excessive fetal growth related to fetal hyperinsulinemia
D) Permanent fetal anemia in every pregnancy
Correct Answer: C) Excessive fetal growth related to fetal hyperinsulinemia
Rationale: Maternal glucose crosses the placenta and can stimulate fetal
insulin production, promoting excessive growth.
Q8. A pregnant patient reports a sudden gush of clear fluid at 35
weeks. Which assessment has priority?
A) Maternal bowel sounds
B) Dietary intake
C) Daily weight
D) Fetal heart rate and evidence of membrane rupture
Correct Answer: D) Fetal heart rate and evidence of membrane rupture
Rationale: Rupture of membranes can be associated with cord prolapse,
infection, and preterm birth, making fetal assessment a priority.
Q9. Which patient should be assessed first?
A) A pregnant patient with heavy bleeding, severe abdominal pain, pallor,
and hypotension
B) A patient with mild constipation
C) A patient requesting prenatal vitamin education
D) A patient with mild breast tenderness
Correct Answer: A) A pregnant patient with heavy bleeding, severe
abdominal pain, pallor, and hypotension
Rationale: Hemorrhage with signs of shock represents an immediate threat
to maternal circulation and fetal oxygenation.
Q10. A patient at 30 weeks reports markedly decreased fetal
movement compared with the usual pattern. What is the best
response?
Answers 2026/2027 Jersey College
Q1. A patient at 34 weeks reports a severe persistent headache,
blurred vision, and right upper-quadrant pain. Blood pressure is
168/112 mm Hg. Which action has priority?
A) Initiate prompt evaluation and management for severe hypertensive
disease of pregnancy
B) Encourage ambulation to reduce blood pressure
C) Reassess at the next prenatal appointment
D) Recommend a high-sodium snack
Correct Answer: A) Initiate prompt evaluation and management for severe
hypertensive disease of pregnancy
Rationale: Severe hypertension with neurologic and upper abdominal
symptoms suggests severe preeclamptic disease and creates immediate
maternal and fetal risk.
Q2. A patient at 10 weeks reports unilateral pelvic pain, vaginal
spotting, dizziness, and shoulder pain. Which complication should
be suspected first?
A) Hyperemesis gravidarum
B) Ruptured ectopic pregnancy
C) Placenta previa
D) Gestational hypertension
Correct Answer: B) Ruptured ectopic pregnancy
Rationale: Unilateral pain, bleeding, referred shoulder pain, and circulatory
symptoms can indicate intra-abdominal hemorrhage from ectopic rupture.
Q3. A patient with persistent vomiting during early pregnancy has
dry mucous membranes, tachycardia, ketones in the urine, and a 4-
kg weight loss. Which problem is most likely?
A) Normal physiologic nausea
B) Gestational diabetes
C) Hyperemesis gravidarum with dehydration
D) Placental abruption
Correct Answer: C) Hyperemesis gravidarum with dehydration
,Rationale: Severe vomiting accompanied by weight loss, ketosis, and
dehydration exceeds expected pregnancy-related nausea.
Q4. A patient at 32 weeks reports painless bright-red vaginal
bleeding. Which action should be avoided until placental location is
known?
A) Assess maternal vital signs
B) Monitor fetal status
C) Establish IV access if indicated
D) Perform a digital vaginal examination
Correct Answer: D) Perform a digital vaginal examination
Rationale: Vaginal examination can disrupt a placenta covering or near the
cervical opening and provoke severe hemorrhage.
Q5. A patient at 37 weeks develops sudden abdominal pain, dark
vaginal bleeding, uterine tenderness, and a firm uterus. Which
complication is most likely?
A) Placental abruption
B) Placenta previa
C) Hyperemesis gravidarum
D) Cervical insufficiency
Correct Answer: A) Placental abruption
Rationale: Painful bleeding with uterine tenderness and increased tone is
characteristic of premature placental separation.
Q6. An Rh-negative, unsensitized pregnant patient experiences
significant vaginal bleeding after abdominal trauma. Which
intervention should be anticipated?
A) Rubella vaccination immediately
B) Evaluation for Rh immune globulin administration
C) Restriction of all oral fluids
D) Administration of oxytocin
Correct Answer: B) Evaluation for Rh immune globulin administration
Rationale: Fetomaternal blood exposure can sensitize an Rh-negative
patient, so prophylaxis may be required when appropriate.
, Q7. A patient with gestational diabetes asks why glucose control
matters. Which fetal risk is most closely associated with persistent
maternal hyperglycemia?
A) Neural tube closure after birth
B) Fetal bradycardia from low maternal protein
C) Excessive fetal growth related to fetal hyperinsulinemia
D) Permanent fetal anemia in every pregnancy
Correct Answer: C) Excessive fetal growth related to fetal hyperinsulinemia
Rationale: Maternal glucose crosses the placenta and can stimulate fetal
insulin production, promoting excessive growth.
Q8. A pregnant patient reports a sudden gush of clear fluid at 35
weeks. Which assessment has priority?
A) Maternal bowel sounds
B) Dietary intake
C) Daily weight
D) Fetal heart rate and evidence of membrane rupture
Correct Answer: D) Fetal heart rate and evidence of membrane rupture
Rationale: Rupture of membranes can be associated with cord prolapse,
infection, and preterm birth, making fetal assessment a priority.
Q9. Which patient should be assessed first?
A) A pregnant patient with heavy bleeding, severe abdominal pain, pallor,
and hypotension
B) A patient with mild constipation
C) A patient requesting prenatal vitamin education
D) A patient with mild breast tenderness
Correct Answer: A) A pregnant patient with heavy bleeding, severe
abdominal pain, pallor, and hypotension
Rationale: Hemorrhage with signs of shock represents an immediate threat
to maternal circulation and fetal oxygenation.
Q10. A patient at 30 weeks reports markedly decreased fetal
movement compared with the usual pattern. What is the best
response?
