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A nurse is caring for a client at 32 weeks with painless, bright red vaginal bleeding. Fetal heart rate is normal. What is the most likely cause?
A. Placental abruption
B. Placenta previa
C. Ectopic pregnancy
D. Uterine rupture
✅ Answer: B
Rationale: Placenta previa typically presents with painless, bright red bleeding in the third trimester.
A nurse caring for a client with prelabor rupture of membranes (PROM) should prioritize which assessment?
A. Blood pressure
B. Fetal heart rate
C. Maternal temperature
D. Uterine fundal height
✅ Answer: C
Rationale: Maternal temperature is monitored closely due to risk of infection (chorioamnionitis).
Which finding is most consistent with unruptured ectopic pregnancy?
A. Sudden sharp pain and heavy bleeding
B. Shoulder pain and pallor
C. Missed period, abdominal pain, and spotting
D. Painless bright red bleeding
✅ Answer: C
Rationale: Classic triad of ectopic pregnancy: missed menses, abdominal pain, and vaginal spotting.
Which complication is most likely in infants born to diabetic mothers?
A. Hyperglycemia
B. Hypoglycemia
C. Hyperbilirubinemia
D. Hypocalcemia
✅ Answer: B
Rationale: Maternal hyperglycemia → fetal hyperinsulinemia → neonatal hypoglycemia after birth.
SATA: Which maternal infections require special precautions during delivery to protect the newborn?
⬜ A. Herpes simplex virus
⬜ B. Hepatitis B
⬜ C. Rubella
⬜ D. Gonorrhea
⬜ E. Syphilis
✅ Answers: A, B, D, E
Rationale: HSV may require C-section if active lesions; Hepatitis B, gonorrhea, and syphilis need neonatal prophylaxis.
A client who is Rh-negative gives birth to an Rh-positive infant. Which nursing action is most appropriate?
A. Administer Rho(D) immune globulin within 72 hours.
B. Start an IV infusion of normal saline.
C. Administer oxytocin immediately.
D. Obtain a type and crossmatch for the infant.
✅ Answer: A
Rationale: Rho(D) immune globulin prevents maternal antibody formation against Rh-positive blood.
A nurse is caring for a woman at 34 weeks with placental abruption. Which assessment finding supports this diagnosis?
A. Painless vaginal bleeding
B. Soft, relaxed uterus
C. Firm, tender uterus with dark red bleeding
D. Hypotension without bleeding
✅ Answer: C
Rationale: Placental abruption = painful, rigid uterus, dark red bleeding, and fetal distress.
The nurse is caring for a patient with oligohydramnios at 36 weeks. Which complication is the nurse most concerned about?
A. Preterm rupture of membranes
B. Umbilical cord compression
C. Postpartum hemorrhage
D. Preeclampsia
✅ Answer: B
Rationale: Low fluid increases risk for cord compression and fetal hypoxia.
SATA: The nurse provides teaching for a client with gestational diabetes. Which statements are correct?
⬜ A. “I may need to check my blood sugar several times a day.”
⬜ B. “My baby might be larger than normal at birth.”
⬜ C. “I won’t need any follow-up testing after delivery.”
⬜ D. “Good blood sugar control lowers my risk for cesarean birth.”
⬜ E. “I’m at increased risk for type 2 diabetes later in life.”
✅ Answers: A, B, D, E
Rationale: Frequent monitoring, fetal macrosomia, and long-term diabetes risk are all associated with GDM.
The nurse suspects postpartum depression when a client reports which symptom?
A. Occasional weepiness that resolves with rest
B. Sadness and guilt interfering with bonding at 3 weeks postpartum
C. Crying spells that last one day after delivery
D. Mood swings and irritability resolving within two weeks
✅ Answer: B
Rationale: PPD lasts >2 weeks and affects daily functioning and bonding.
A nurse monitors a client with preeclampsia for which complication?
A. Hypotension
B. Seizures
C. Bradycardia
D. Hypoglycemia
✅ Answer: B
Rationale: Preeclampsia can progress to eclampsia, characterized by seizures.
The nurse is monitoring a patient with suspected placental abruption. Which findings would support this diagnosis?
⬜ A. Uterine tenderness
⬜ B. Increased fundal height
⬜ C. Bright red bleeding
⬜ D. Fetal heart rate decelerations
⬜ E. Painless vaginal bleeding
✅ Answers: A, B, D
Rationale: Blood trapped behind the placenta causes uterine tenderness, increased size, and fetal distress; bleeding is typically dark and painful.
Cervical insufficiency is best described as:
A. Premature rupture of membranes
B. Premature dilation of the cervix without contractions
C. Infection of the cervix during pregnancy
D. Contraction of the cervix causing miscarriage
✅ Answer: B
Rationale: Cervical insufficiency = painless cervical dilation without contractions, leading to pregnancy loss or preterm birth.
A client tests positive for Group B Streptococcus (GBS) at 36 weeks. What should the nurse anticipate?
A. Oral antibiotics now and postpartum
B. IV antibiotics during labor
C. Cesarean birth at 37 weeks
D. No treatment is needed
✅ Answer: B
Rationale: IV penicillin or ampicillin is given during labor to prevent neonatal GBS infection.
SATA: Which findings suggest postpartum psychosis?
⬜ A. Confusion and disorientation
⬜ B. Hallucinations or delusions
⬜ C. Excessive energy and talkativeness
⬜ D. Fear of harming the baby
⬜ E. Persistent sadness
✅ Answers: A, B, D
Rationale: Psychosis is an emergency with disordered thinking, hallucinations, or risk to self/infant.
The nurse is assessing a client receiving magnesium sulfate for severe preeclampsia. Which finding requires immediate intervention?
A. Deep tendon reflexes +2
B. Urine output 40 mL/hr
C. Respiratory rate 10/min
D. BP 140/90 mmHg
✅ Answer: C
Rationale: Respiratory depression (<12/min) indicates magnesium toxicity—stop infusion and prepare calcium gluconate.
A client pregnant with twins asks why she needs more frequent ultrasounds. Which response by the nurse is most accurate?
A. “It’s routine to confirm the babies’ genders.”
B. “Twins are at higher risk for growth restrictions and preterm labor.”
C. “Your uterus grows slower with twins.”
D. “It helps to monitor your iron levels.”
✅ Answer: B
Rationale: Multiple gestations increase risk for preterm birth, anemia, and growth discordance.
The nurse is preparing a client for a cerclage procedure. Which explanation is correct?
A. “A cerclage is a medication that helps your cervix stay closed.”
B. “A cerclage is a surgical stitch placed around your cervix to keep it closed.”
C. “A cerclage is an ultrasound test to check cervical length.”
D. “A cerclage is a type of hormone injection given each week.”
✅ Answer: B
Rationale: Cerclage involves a suture placed around the cervix to prevent premature opening.
Which infection is most dangerous to the fetus in the first trimester of pregnancy?
A. Rubella
B. Hepatitis B
C. Gonorrhea
D. Herpes simplex
✅ Answer: A
Rationale: Rubella in early pregnancy can cause congenital rubella syndrome (deafness, heart defects, cataracts).
The nurse reviews lab results for a pregnant client: Hgb 9.2 g/dL, Hct 28%. Which type of anemia is most common in pregnancy?
A. Iron-deficiency anemia
B. Aplastic anemia
C. Pernicious anemia
D. Hemolytic anemia
✅ Answer: A
Rationale: Increased iron demand during pregnancy causes iron-deficiency anemia.
Which of the following are signs of HELLP syndrome? (Select all that apply.)
⬜ A. Hemolysis
⬜ B. Elevated liver enzymes
⬜ C. Low platelet count
⬜ D. Proteinuria only
⬜ E. Hyperglycemia
✅ Answers: A, B, C
Rationale: HELLP = Hemolysis, Elevated Liver enzymes, Low Platelets.
A woman at 7 weeks gestation presents with sharp, one-sided abdominal pain and shoulder pain. Her blood pressure is 88/54 mmHg. What is the nurse’s priority action?
A. Apply oxygen
B. Start IV fluids and notify the provider
C. Prepare for vaginal exam
D. Obtain urine sample
✅ Answer: B
Rationale: These are signs of ruptured ectopic pregnancy and hypovolemic shock—requires immediate IV fluids and provider notification.
The nurse is caring for a client with pre-existing type 1 diabetes during pregnancy. Which statement indicates the client understands the importance of glucose control?
A. “My insulin needs will stay the same throughout pregnancy.”
B. “I’ll monitor my blood sugar more closely because it affects my baby’s growth.”
C. “I should limit my carbohydrate intake to less than 50 grams per day.”
D. “It’s normal to skip insulin if I’m not eating.”
✅ Answer: B
Rationale: Tight glucose control reduces risk of congenital anomalies and macrosomia.
A pregnant client exposed to toxoplasmosis asks how to prevent infection. Which statement by the nurse is appropriate?
A. “Avoid contact with cat litter and eat only well-cooked meat.”
B. “You can handle cat litter if you wear gloves.”
C. “Avoid taking showers after gardening.”
D. “Eat rare meat to increase iron intake.”
✅ Answer: A
Rationale: Toxoplasmosis spreads through undercooked meat and cat feces—avoid exposure.
The nurse is teaching a client with iron-deficiency anemia about supplements. Which statement indicates correct understanding?
A. “I should take my iron with milk.”
B. “I’ll take iron with orange juice.”
C. “I can stop taking it when I feel better.”
D. “It’s best to take it at bedtime with food.”
✅ Answer: B
Rationale: Vitamin C increases iron absorption; milk inhibits it.