Question 1

A client at 20 weeks' gestation asks about exercise. Which is appropriate advice?

Accepted Answer

Answer reason: At 20 weeks’ gestation, regular moderate physical activity is generally recommended for uncomplicated pregnancies because it supports cardiovascular fitness, helps manage weight gain, and can reduce risks such as gestational diabetes. Complete avoidance is unnecessary unless there are contraindications, while initiating high-intensity training may increase injury risk and is not routinely advised. Limiting exercise to only the last trimester is incorrect because benefits occur throughout pregnancy when performed safely with appropriate hydration, temperature control, and avoidance of high-risk activities.
Category reason: This item tests prenatal health counseling about safe activity during pregnancy, which fits Ante-Intra-Postpartum Care under Health Promotion and Maintenance.

Question 2

A client at 28 weeks gestation, previously normotensive, has developed gestational hypertension with a blood pressure of 142/98 mmHg and 146/89 mmHg on two separate days this week. Which of the following findings, if present, could be an indication that the client has preeclampsia?

Accepted Answer

Answer reason: Preeclampsia is diagnosed when new-onset hypertension after 20 weeks is accompanied by proteinuria and/or evidence of end-organ dysfunction. In someone who already meets criteria for gestational hypertension, detection of protein in the urine indicates renal involvement and supports preeclampsia. Mild dependent edema is common in normal pregnancy and is not diagnostic. A slightly higher blood pressure alone does not distinguish gestational hypertension from preeclampsia, and mild nausea is nonspecific.
Category reason: This item tests recognition of a pregnancy complication and its diagnostic indicator during the antepartum period, which fits Ante-Intra-Postpartum Care.

Question 3

The first step in management of postpartum hemorrhage (PPH) is?

Accepted Answer

Answer reason: Uterine atony is the most common cause of postpartum hemorrhage, so immediate actions focus on restoring uterine tone to reduce bleeding. Bimanual/fundal uterine massage promotes contraction, and oxytocin is first-line uterotonic therapy to sustain contraction. Other steps (evaluating for retained products/trauma, escalation to surgical management, and transfusion) are important but follow initial uterine-toning and resuscitative measures based on the patient’s response and severity.
Category reason: This question tests immediate nursing/clinical management of a postpartum emergency (postpartum hemorrhage), which fits Ante-Intra-Postpartum Care under Health Promotion and Maintenance.

Question 4

According to the WHO, how many minimum antenatal care (ANC) visits are recommended during a normal pregnancy?

Accepted Answer

Answer reason: B. 4 visits This reflects the WHO focused antenatal care model that set a minimum of four goal-oriented contacts for uncomplicated pregnancies to screen for maternal/fetal complications, provide preventive interventions (e.g., immunizations, anemia prevention), and deliver health education. Fewer visits increase the risk that conditions like preeclampsia, anemia, infections, or fetal growth problems are missed. More frequent schedules may be used by some health systems, but the question asks for the minimum recommendation in the classic WHO model.
Category reason: This tests recommended prenatal care scheduling for normal pregnancy, which is part of routine maternal care guidance under ante-, intra-, and postpartum nursing care.

Question 5

The United States ranks 50th in the world for maternal mortality and 41st among industrialized nations for infant mortality rate. When developing programs to assist in decreasing these rates, which factor would most likely need to be addressed as having the greatest impact?

Accepted Answer

Answer reason: Early and consistent prenatal care enables timely screening, risk stratification, and management of conditions such as hypertension, diabetes, infections, and anemia that drive maternal and infant morbidity and mortality. It also supports prevention strategies like immunizations, counseling on substance use, and referral for high-risk obstetric care when indicated. Compared with broader or less targeted interventions, improving access and adherence to prenatal care most directly reduces preventable complications before they become emergencies.
Category reason: This question focuses on population-level strategies to improve pregnancy and newborn outcomes, which aligns with nursing health promotion during pregnancy and the perinatal period.

Question 6

When integrating the principles of family-centered care, the nurse would include which of the following?

Accepted Answer

Answer reason: Family-centered care recognizes childbirth as a normal, meaningful life event that affects the entire family system. The nurse anticipates and supports role transitions, bonding, and shifts in partner and family dynamics. The other options conflict with family-centered principles by minimizing family participation, autonomy, and the need for information to make informed decisions.
Category reason: This item tests nursing care principles in the perinatal period, emphasizing how nurses support the family unit during and after childbirth, which aligns with Ante-Intra-Postpartum Care.

Question 7

A nurse is providing teaching about increasing dietary fiber to an antepartum client who reports constipation. Which of the following food selections has the highest fiber content per cup?

Accepted Answer

Answer reason: Legumes are among the most fiber-dense foods, and a cup of cooked lentils provides substantially more dietary fiber than a cup of cooked oatmeal or non-starchy vegetables. Increasing fiber helps constipation in pregnancy by increasing stool bulk and promoting peristalsis. Teaching should also include increasing fluid intake and gradual fiber increases to reduce bloating and gas.
Category reason: This question focuses on dietary teaching to manage constipation in a pregnant (antepartum) client, which is patient education within antepartum care.

Question 8

At what gestational age dose quickening typically occur?

Accepted Answer

Answer reason: This is the typical time when a pregnant person first perceives fetal movement, most commonly around 16–18 weeks in many pregnancies. Earlier perception can occur, especially in multiparous patients, but it is less typical and can be confused with gastrointestinal activity. First-time pregnancies may perceive movement later (often closer to 18–20 weeks) due to less familiarity and an anterior placenta.
Category reason: This question tests normal pregnancy milestones (perception of fetal movement) and their timing during gestation, which falls under antepartum assessment and education in maternity nursing.

Question 9

A nurse is reviewing a fetal heart tracing for a client at 38 weeks gestation. The nurse observes an abrupt increase in the fetal heart rate (FHR) from the baseline, with the rate increasing from 135 bpm to 155 bpm and lasting for 20 seconds. The nurse's interpretation of this finding is that it?

Accepted Answer

Answer reason: An abrupt rise of at least 15 bpm above baseline that lasts at least 15 seconds but less than 2 minutes meets criteria for a fetal heart rate acceleration. Accelerations are associated with intact fetal autonomic nervous system function and adequate fetal oxygenation, making them a reassuring finding. This pattern does not indicate uteroplacental insufficiency or cord compression, which are more commonly associated with decelerations rather than accelerations.
Category reason: This item tests intrapartum fetal heart rate interpretation and the nurse’s assessment of fetal well-being during late pregnancy/labor care, which fits Ante-Intra-Postpartum Care.

Question 10

The nurse teaches a 20-year-old primigravida how to measure the frequency of uterine contractions. The nurse should explain to the patient that the frequency of uterine contractions is determined?

Accepted Answer

Answer reason: Frequency describes how often contractions occur over time (commonly assessed as the interval from the start of one contraction to the start of the next), which is operationally captured by counting how many occur in a set timeframe. The other options describe duration (beginning to end of the same contraction), intensity (strength at peak), or an incorrect timing method (start to end of the next). Accurate measurement supports recognition of labor progression and identification of uterine tachysystole.
Category reason: This item tests patient education on how to assess uterine contraction patterns during labor, which is a core antepartum/intrapartum nursing care skill.

Question 11

A pregnant woman in her third trimester has not received any tetanus immunization. What will the nurse do?

Accepted Answer

Answer reason: In pregnancy with no prior tetanus immunization, protection should be started during pregnancy to reduce maternal and neonatal tetanus risk rather than delaying to postpartum. The primary series is initiated promptly and continued with a second dose after a minimum interval of about 4 weeks, which is feasible even in the third trimester. Waiting until after birth leaves both mother and newborn unprotected at delivery, and giving only one dose provides incomplete primary immunization.
Category reason: This is about a preventive intervention during pregnancy (tetanus immunization scheduling) and the nurse’s action in antenatal care, which aligns with antepartum care and immunization practices in pregnancy.

Question 12

PPH is commonly defined as?

Accepted Answer

Answer reason: Postpartum hemorrhage refers to abnormally heavy blood loss after childbirth (classically quantified by blood volume thresholds, but clinically recognized by ongoing bleeding with signs of hypovolemia). This definition aligns with obstetric emergency recognition and triggers immediate assessment and intervention to prevent shock. The other options describe potential contributors or postpartum complications but do not define the condition itself.
Category reason: This item tests recognition of a key postpartum complication/definition in maternity nursing, fitting Ante-Intra-Postpartum Care within Health Promotion and Maintenance.

Question 13

A postpartum client reports severe perineal pain and foul-smelling lochia. The nurse suspects endometritis. Which additional finding supports this diagnosis?

Accepted Answer

Answer reason: Endometritis is a postpartum uterine infection commonly associated with uterine tenderness, malodorous lochia, and systemic signs of infection. Fever (often ≥38°C after the first 24 hours) with chills is a classic supportive finding due to bacteremia/inflammatory response. Elevated blood pressure is not typical for endometritis, decreased urine output suggests hypovolemia/renal hypoperfusion rather than uterine infection, and breast engorgement is a normal lactation-related change.
Category reason: This item tests recognition of postpartum complications and associated assessment findings in the postpartum period, which aligns with antepartum/intrapartum/postpartum nursing care.

Question 14

A nurse is assessing a patient in labor and determines that she is in the second stage. Which of the following findings is most characteristic of this stage?

Accepted Answer

Answer reason: B. Expulsion of the fetus The second stage of labor begins with complete cervical dilation (10 cm) and ends with the birth of the baby. It is characterized by fetal descent through the birth canal and maternal pushing efforts, culminating in delivery. By contrast, progressive cervical dilation describes the first stage, and delivery of the placenta occurs in the third stage.
Category reason: This item tests recognition of stages of labor during intrapartum nursing assessment, which aligns with antepartum/intrapartum/postpartum care in Health Promotion and Maintenance.

Question 15

A pregnant client at 32 weeks gestation has BP 160/100 mmHg, +3 proteinuria, and hyperreflexia. The nurse anticipates administering:

Accepted Answer

Answer reason: B) Magnesium sulfate IV These findings indicate severe preeclampsia (severe-range hypertension with significant proteinuria and hyperreflexia suggesting CNS irritability), which places the client at high risk for progression to eclampsia (seizures). Magnesium sulfate is the first-line medication for seizure prophylaxis and treatment in preeclampsia/eclampsia. Antihypertensives (e.g., nifedipine) may be added to control blood pressure, but they do not prevent seizures. Induction with oxytocin may be part of definitive management after stabilization and depending on maternal/fetal status and gestational age, but immediate priority is seizure prevention.
Category reason: This question tests nursing management of a high-risk antepartum complication (severe preeclampsia) and the anticipated medication to prevent maternal seizures, fitting Ante-Intra-Postpartum Care.

Question 16

A client 12 weeks pregnant come to the emergency department with abdominal cramping and moderate vaginal bleeding. Speculum examination reveals 2 to 3 cms cervical dilation. The nurse would document these findings as which of the following?

Accepted Answer

Answer reason: Cervical dilation in the presence of first-trimester bleeding and cramping indicates that the cervix is no longer closed, which is consistent with an inevitable/imminent abortion. Threatened abortion involves bleeding with a closed cervix, so it does not fit the finding of 2–3 cm dilation. Complete abortion would involve passage of all products of conception with resolution of symptoms and typically a closed cervix afterward. Missed abortion is fetal demise without active bleeding/cramping and usually with a closed cervix.
Category reason: This item asks the nurse to classify and document pregnancy-related findings (bleeding, cramping, cervical dilation) during early pregnancy, which is an antepartum assessment concept within maternal-newborn nursing.

Question 17

A nurse is caring for a client at 33 weeks of gestation post-amniocentesis. Which complication should the nurse monitor for?

Accepted Answer

Answer reason: Preterm labor is a key post-amniocentesis complication, especially in the third trimester, so uterine activity must be monitored closely. New or increasing uterine contractions can indicate uterine irritation, premature rupture of membranes, or initiation of labor. Prompt recognition allows timely interventions such as fetal monitoring, provider notification, and evaluation for tocolysis or other management if indicated. The other options are more consistent with hypertensive disorders of pregnancy or nonspecific symptoms rather than a common direct post-procedure complication.
Category reason: This question focuses on nursing monitoring for maternal-fetal complications after a prenatal procedure in a pregnant client, which is antepartum care within Growth and Development (Ante-Intra-Postpartum Care).

Question 18

What is the purpose of the first prenatal visit?

Accepted Answer

Answer reason: The initial prenatal visit focuses on confirming pregnancy and comprehensively assessing maternal health status, including medical/obstetric history, risk factors, vital signs, physical exam, and baseline labs. Establishing this baseline guides individualized prenatal care, screening, counseling, and identification of conditions that could affect mother or fetus. Vaccinations may be addressed later as indicated, but they are not the primary purpose, and procedures like cesarean delivery or labor induction are not part of routine first-visit care.
Category reason: This question tests the goal of an early pregnancy nursing/clinical encounter and appropriate prenatal care planning, which falls under antepartum care in Health Promotion and Maintenance.

Question 19

An expectant mother states that she read that more black mothers die in childbirth than do white mothers. When responding to her questions about the reasons for this, the nurse accurately states that which is the major reason for the high maternal mortality rate?

Accepted Answer

Answer reason: Inadequate prenatal care increases the likelihood that maternal conditions such as hypertension, diabetes, anemia, and infections are not identified and treated early, leading to preventable complications during pregnancy and delivery. Limited access to consistent prenatal services also reduces opportunities for risk screening, referral, and timely obstetric interventions. Broader structural and access barriers contribute to disparities, but among the choices provided, reduced prenatal care most directly explains increased maternal mortality risk.
Category reason: This item tests nursing education and counseling about pregnancy-related outcomes and factors affecting maternal mortality, which falls under antepartum care within Health Promotion and Maintenance.

Question 20

A nurse is caring for a client who is at 32 wks gestation and is experiencing preterm labor. What meds should the nurse plan to administer?

Accepted Answer

Answer reason: At 32 weeks with preterm labor, antenatal corticosteroids are indicated to accelerate fetal lung maturation and reduce neonatal respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. Misoprostol is used for cervical ripening/uterine stimulation and can worsen preterm labor risk rather than treat it. Poractant alfa is exogenous surfactant typically given to the neonate after birth, not administered to the pregnant client. Methylergonovine treats postpartum uterine atony/hemorrhage and is not used for preterm labor management.
Category reason: This is a pregnancy-related nursing management question about medication administration for preterm labor, which fits Ante-Intra-Postpartum Care under Health Promotion and Maintenance.

Question 21

What should the nurse do first when a pregnant woman at 32 weeks gestation presents with decreased fetal movement?

Accepted Answer

Answer reason: Decreased fetal movement at 32 weeks is a potential sign of fetal compromise, so the priority is to assess fetal well-being objectively. A non-stress test is a rapid, noninvasive first-line assessment that evaluates fetal heart rate reactivity and helps determine whether urgent escalation is needed. Interventions like oxygen are reserved for evidence of nonreassuring fetal status or maternal hypoxia, and maternal blood pressure alone does not assess fetal status. Encouraging ambulation is inappropriate before fetal assessment because it can delay recognition of fetal distress.
Category reason: This item tests nursing assessment and immediate management of a pregnant client with a potential fetal complication, which fits antepartum care decision-making.

Question 22

Partograph to be started when cervical dilatation is?

Accepted Answer

Answer reason: A partograph is initiated at the onset of active labor to monitor progress and identify dystocia early. Active labor has traditionally been defined as beginning at about 4 cm cervical dilation in many standard obstetric/nursing teaching references and exam contexts. Starting charting at this point allows timely recognition of abnormal labor patterns and escalation of care to reduce maternal and fetal morbidity. Later thresholds risk delayed detection of slow progress.
Category reason: This question tests intrapartum monitoring practice (when to initiate a partograph) during labor, which is a maternal care decision within ante-, intra-, and postpartum nursing care.

Question 23

She worries about her small breasts, thinking that she probably will not be able to breastfeed her baby. Which of the following responses of the nurse is correct?

Accepted Answer

Answer reason: Breast size primarily reflects the amount of fatty tissue, while milk production depends on functioning glandular tissue and effective milk removal driven by prolactin and oxytocin. Reassurance with accurate education supports breastfeeding confidence and promotes continued attempts at latching and frequent feeding, which help establish supply. Suggesting bottle feeding or exercises to increase breast size does not address the physiologic basis of lactation and may undermine breastfeeding initiation. Manual expression can be a useful technique but does not answer the client’s misconception about breast size determining milk production.
Category reason: This item tests nursing education and reassurance for a postpartum/breastfeeding concern, which fits antepartum/intrapartum/postpartum care within Health Promotion and Maintenance.

Question 24

She tells the nurse that she does not take milk regularly. She claims that she does not want to gain too much weight during her pregnancy. Which of the following nursing diagnosis is a priority?

Accepted Answer

Answer reason: Avoiding milk to prevent pregnancy weight gain indicates misunderstanding of appropriate prenatal nutrition and healthy weight gain. This places the client at risk for inadequate calcium, vitamin D, and overall nutrient intake, which can affect maternal bone health and fetal development. Addressing the knowledge gap is the most direct, modifiable priority to promote a healthy pregnancy and prevent complications. The other options describe psychosocial responses without clear evidence as the primary problem from the stem.
Category reason: This question focuses on prenatal nursing assessment and education regarding appropriate diet and weight gain during pregnancy, which falls under Ante-Intra-Postpartum Care within Health Promotion and Maintenance.

Question 25

Which finding is characteristic of true labor?

Accepted Answer

Answer reason: C) Contractions that intensify and become regular True labor is marked by contractions that progressively increase in strength, duration, and frequency and develop a regular pattern. These contractions lead to cervical effacement and dilation over time, reflecting true progression of labor. In contrast, false labor contractions are often irregular, lessen with rest or hydration, and do not result in cervical change.
Category reason: This question tests recognition of clinical signs distinguishing true labor from false labor during pregnancy, which is part of intrapartum nursing care and therefore fits Ante-Intra-Postpartum Care.

Question 26

A 22-week pregnant client has a fundal height of 26 cm. What does this indicate?

Accepted Answer

Answer reason: Fundal height in centimeters typically approximates gestational age in weeks after about 20 weeks, with an expected variation of about ±2 cm. At 22 weeks, an expected fundal height is about 22 cm; a measurement of 26 cm is larger than expected. A larger-than-dates measurement suggests excessive fetal size or other causes of uterine enlargement, and among the provided options the best match is a large-for-gestational-age fetus. Oligohydramnios and intrauterine growth restriction are more consistent with a smaller-than-expected fundal height.
Category reason: This question tests interpretation of fundal height measurement during pregnancy to assess fetal growth and dating, which is a routine prenatal (antepartum) assessment within maternal care.

Question 27

A client is experiencing postpartum hemorrhage due to uterine atony. What is the first-line medication?

Accepted Answer

Answer reason: Uterine atony is the most common cause of postpartum hemorrhage, and immediate uterine contraction is the priority to reduce ongoing blood loss. Oxytocin is the first-line uterotonic because it is effective and has the most favorable safety profile for initial management. If bleeding persists, second-line agents (e.g., methylergonovine, carboprost, misoprostol) are considered based on contraindications such as hypertension (ergot) or asthma (carboprost). Prompt medication use is typically combined with uterine massage and evaluation for retained products or genital tract trauma.
Category reason: This question focuses on first-line medication selection in a postpartum complication (uterine atony causing hemorrhage), which is a core element of ante-, intra-, and postpartum nursing care and management.

Question 28

Mastitis Teaching A breastfeeding client with mastitis asks what she should do. What is the best advice?

Accepted Answer

Answer reason: Frequent emptying of the breast helps relieve milk stasis, reduces duct obstruction, and supports resolution of inflammation and infection. Breastfeeding is generally safe for the infant and helps prevent worsening engorgement and abscess formation. Supportive measures like warm compresses before feeds and analgesics/antibiotics as prescribed may be added, but ongoing feeding/pumping is the key teaching point.
Category reason: This question focuses on breastfeeding management and teaching for a postpartum complication (mastitis), which fits client education in antepartum/intrapartum/postpartum care.

Question 29

Indications for Cesarean Section (C-Section) Which condition is an absolute indication for a C-section?

Accepted Answer

Answer reason: A) Active genital herpes Neonatal exposure to HSV during vaginal birth can cause severe, potentially fatal disseminated infection, especially with active genital lesions or prodromal symptoms at labor. Cesarean delivery is recommended to reduce vertical transmission risk in this situation, making it an absolute indication at the time of delivery. The other options do not represent absolute, ongoing contraindications to vaginal birth (resolved placenta previa implies no current obstruction; prior vaginal delivery is not an indication; mild decelerations typically prompt evaluation and intrauterine resuscitation rather than automatic cesarean).
Category reason: This question tests an obstetric delivery decision (when cesarean is indicated) within pregnancy and intrapartum management, which fits Ante-Intra-Postpartum Care.

Question 30

Scenario: A new mother complains of nipple pain during breastfeeding. What should the nurse assess first?

Accepted Answer

Answer reason: Poor latch/positioning is the most common cause of nipple pain and trauma in early breastfeeding and is the highest-yield assessment because it directly drives both maternal discomfort and effective milk transfer. Evaluating latch allows the nurse to identify shallow attachment, improper alignment, or ineffective suck and correct it immediately to prevent worsening fissures, bleeding, and early cessation of breastfeeding. Frequency of feeding and formula use may affect supply patterns but are less directly linked to acute nipple pain. Hydration status is important for overall maternal health but does not typically explain nipple pain as the primary problem.
Category reason: This question centers on assessment and education for a postpartum mother experiencing a breastfeeding problem, which fits Ante-Intra-Postpartum Care within Health Promotion and Maintenance.

Question 31

Which sign indicates a client has entered the second stage of labor?

Accepted Answer

Answer reason: The second stage of labor begins with complete cervical dilation (10 cm) and is characterized by maternal expulsive efforts as the fetus descends through the birth canal. A common clinical sign is an involuntary or strong desire to bear down due to fetal head pressure on the pelvic floor and rectum. Effacement, partial dilation (e.g., 5 cm), and increased bloody show are more consistent with the first stage (cervical dilation and effacement) rather than the onset of the second stage. Recognizing this transition helps the nurse prepare for delivery and provide appropriate coaching and support.
Category reason: This question tests recognition of a labor stage and the nursing assessment finding that indicates transition into the second stage, which is part of intrapartum (ante-intra-postpartum) care.

Question 32

A woman at 14 weeks gestation wants to continue yoga. What should the nurse advise?

Accepted Answer

Answer reason: After the first trimester, supine positioning can compress the inferior vena cava and reduce venous return, leading to dizziness, hypotension, and decreased uteroplacental perfusion. Moderate exercise is generally encouraged in uncomplicated pregnancy, but modifications are needed to prevent maternal hypotension and falls. Advising avoidance of prolonged flat-on-the-back poses supports safety while allowing continued physical activity.
Category reason: This question asks for nursing guidance about safe exercise practices during pregnancy, which falls under antepartum education and health promotion in pregnancy.

Question 33

A G2P1 at 8 cm dilation is yelling and pushing with contractions. The nurse notes she is not fully dilated. What is the best action?

Accepted Answer

Answer reason: Panting/blowing helps resist the urge to push before full cervical dilation, reducing risk of cervical edema, lacerations, and delayed labor progress. At 8 cm, pushing can cause trauma and swelling that may prolong labor and compromise maternal/fetal outcomes. Fundal pressure is not recommended due to risks (e.g., uterine rupture, fetal injury), and immediate cesarean is not indicated solely for early pushing in the absence of fetal/maternal distress.
Category reason: This item tests intrapartum nursing management to prevent complications when a laboring client feels the urge to push before complete dilation, which is part of antepartum/intrapartum/postpartum nursing care.

Question 34

A laboring client with meconium-stained fluid is progressing normally. What should the nurse prepare?

Accepted Answer

Answer reason: Meconium-stained amniotic fluid increases the risk of neonatal respiratory compromise, including meconium aspiration syndrome, so preparedness for neonatal airway and ventilation support is essential at delivery. Routine immediate cesarean delivery is not indicated when labor is otherwise progressing normally and fetal status is reassuring. Amnioinfusion is not performed for all cases and is situation-dependent, and maternal antibiotics are not indicated solely for meconium without evidence of infection.
Category reason: This item asks what the nurse should prepare during labor when meconium is present, focusing on intrapartum planning and newborn readiness, which fits Ante-Intra-Postpartum Care.

Question 35

A pregnant woman contracts rubella in the 1st trimester. What advice should be given?

Accepted Answer

Answer reason: Rubella infection during the first trimester carries a very high risk of congenital rubella syndrome with severe fetal anomalies (e.g., cardiac defects, cataracts, deafness) and miscarriage. There is no proven antiviral therapy that prevents fetal infection once maternal infection occurs, and immediate delivery is not applicable at this gestational age. Immunoglobulin may be considered only in select situations when termination is not acceptable, but it does not reliably prevent fetal infection; therefore counseling about considering termination is the most appropriate advice.
Category reason: This question focuses on counseling and management decisions in early pregnancy after a maternal infection, which is an antepartum care topic under Health Promotion and Maintenance.

Question 36

A client is in the first stage of labor. Which position helps promote comfort and labor progression?

Accepted Answer

Answer reason: These positions use gravity to enhance fetal descent and can improve the effectiveness of uterine contractions, supporting labor progress in the first stage. They also reduce aortocaval compression compared with supine positioning, which helps maintain uteroplacental perfusion and maternal comfort. Flat supine, legs-elevated, and lithotomy positions are more likely to increase discomfort, reduce pelvic outlet effectiveness, and contribute to hypotension from vena cava compression.
Category reason: This is a nursing care question about maternal positioning during labor to promote comfort and progression, which fits intrapartum management under Ante-Intra-Postpartum Care.

Question 37

A client in preterm labor at 32 weeks is given terbutaline. What is the primary purpose of this medication?

Accepted Answer

Answer reason: Terbutaline is a beta-2 adrenergic agonist used as a tocolytic to relax uterine smooth muscle and reduce contractions in preterm labor. The goal is short-term delay of delivery (often 48–72 hours) to allow time for interventions such as corticosteroids for fetal lung maturation and/or maternal transfer to a higher-level facility. It does not induce labor, treat infection, or directly mature fetal lungs; those require oxytocin, antibiotics when indicated, and antenatal corticosteroids respectively. Monitoring is important because maternal tachycardia, tremor, and hyperglycemia can occur.
Category reason: This question focuses on medication use to manage preterm labor during pregnancy and the nursing understanding of its obstetric purpose, fitting Ante-Intra-Postpartum Care.

Question 38

A nurse is administering betamethasone to a 32-week pregnant client. What is the primary goal of this medication?

Accepted Answer

Answer reason: C) Enhance fetal lung maturity At 32 weeks’ gestation, antenatal corticosteroids are given to accelerate fetal surfactant production and promote structural lung development, reducing the risk and severity of neonatal respiratory distress syndrome and other prematurity complications (e.g., intraventricular hemorrhage). Betamethasone is not primarily used to treat maternal hypotension/hypertension or prevent fetal infection. It is also not a tocolytic, so it does not directly stop uterine contractions; if preterm labor is present, separate tocolysis may be used to allow time for the steroid course to work.
Category reason: This question tests medication use in pregnancy with a focus on fetal benefit and antenatal management, which aligns with antepartum care decisions in the maternity domain rather than basic biomedical facts alone.

Question 39

A postpartum client reports persistent feelings of sadness, fatigue, and lack of interest in caring for her newborn for two weeks. The nurse should?

Accepted Answer

Answer reason: Symptoms persisting for two weeks with impaired interest in the newborn are concerning for postpartum depression rather than transient postpartum blues, which typically resolves within about 2 weeks and is less functionally impairing. The safest nursing action is to perform standardized screening (e.g., EPDS) and further assessment for severity, including suicidal ideation or thoughts of harming the baby. Early identification enables timely referral and treatment to reduce risks to both parent and infant.
Category reason: This question asks for the appropriate nursing action in response to postpartum mood symptoms, which aligns with assessment and care during the postpartum period under Ante-Intra-Postpartum Care.

Question 40

A client in her 8th week has an initial prenatal visit. Which vaccine is contraindicated?

Accepted Answer

Answer reason: Live attenuated vaccines are contraindicated during pregnancy because of the theoretical risk of transplacental transmission and fetal infection. MMR is a live vaccine, so it should be deferred until after delivery. In contrast, inactivated influenza vaccine is recommended during pregnancy, and hepatitis B can be given if indicated; Tdap is recommended later in pregnancy (typically 27–36 weeks) but is not a live vaccine.
Category reason: This question tests prenatal immunization decision-making and safety during pregnancy, which falls under antepartum care in Health Promotion and Maintenance.

Question 41

A twin pregnancy has one fetus diagnosed with intrauterine growth restriction (IUGR). What should the nurse monitor?

Accepted Answer

Answer reason: In a twin pregnancy, selective growth restriction of one fetus can be a key sign of twin-to-twin transfusion syndrome (TTTS), especially in monochorionic placentation due to unbalanced placental vascular anastomoses. This complication can rapidly progress and threatens both fetuses (donor: oligohydramnios/anemia; recipient: polyhydramnios/volume overload). Ongoing surveillance typically includes ultrasound assessment of amniotic fluid discordance, fetal bladder filling, Dopplers, and signs of fetal compromise. The other options are less directly linked to isolated IUGR in one twin as a hallmark monitoring priority.
Category reason: This question focuses on nursing monitoring for a pregnancy complication specific to twins (IUGR in one fetus suggesting TTTS), which is part of antepartum assessment and surveillance in maternity care.

Question 42

Quickening is first felt by the mother at?

Accepted Answer

Answer reason: In many exam standards, the expected timing is about 18–20 weeks (often earlier in multiparous clients and later in primigravidas), making 20 weeks the best single answer. Ten weeks is too early for reliably perceived fetal movement, while 24 and 36 weeks are later than the usual initial perception. Therefore, the option that best matches the typical onset of perceived fetal movement is selected.

Question 43

Normal duration of lochia?

Accepted Answer

Answer reason: It progresses from lochia rubra in the first days to serosa and then alba, tapering in volume and lightening in color over time. A duration near 25 days aligns with this expected physiologic timeframe. Shorter durations such as 10–15 days are less consistent with the usual course and could underestimate normal postpartum bleeding patterns. Ongoing heavy bleeding, foul odor, or return to bright red heavy flow after it had lightened would be abnormal and warrant evaluation.

Question 44

The nurse practicing in a maternity setting recognizes that the postmature fetus is at risk due to?

Accepted Answer

Answer reason: This leads to chronic fetal hypoxemia, oligohydramnios, and higher rates of fetal distress and meconium aspiration. The other findings can occur secondary to this process (e.g., loss of subcutaneous fat from chronic undernutrition), but they are downstream effects rather than the primary underlying cause. Excessive fetal weight is more characteristic of maternal diabetes or prolonged gestation but does not explain the main pathophysiologic risk mechanism in postmaturity.

Question 45

Anti D should be given following Rh +ve delivery within?

Accepted Answer

Answer reason: After delivery of an Rh-positive infant to an Rh-negative mother, standard practice is to give anti-D within 72 hours because antibody formation can begin shortly after exposure. Giving it in this window neutralizes fetal Rh-positive red cells in maternal circulation before the maternal immune system mounts a lasting IgG response. Earlier administration is acceptable, but waiting beyond 72 hours reduces efficacy and increases risk of hemolytic disease in future pregnancies.

Question 46

A pregnant client at 36 weeks reports painless vaginal bleeding. What condition does the nurse suspect?

Accepted Answer

Answer reason:  Painless, bright-red vaginal bleeding in the third trimester is classic for placenta previa due to placental implantation near or over the cervical os with bleeding triggered by cervical effacement/dilation. At 36 weeks, this presentation strongly points to previa rather than labor-related “bloody show,” which is typically scant and associated with contractions. Placental abruption more often causes painful bleeding with uterine tenderness/rigidity and can have fetal distress. Recognizing this pattern is critical because vaginal exams can precipitate severe hemorrhage when placenta previa is suspected.

Question 47

Small-for-date babies are prevented by ?

Accepted Answer

Answer reason: Regular prenatal visits allow screening and timely treatment of anemia, hypertension/preeclampsia, infections, and poor maternal weight gain, along with fetal growth surveillance and counseling to reduce harmful exposures. This broad, systematic approach has the greatest impact because it addresses multiple common causes rather than a single contributor. Nutritional supplementation helps when maternal undernutrition is the driver, but alone it does not cover other major etiologies such as hypertensive disease or placental insufficiency. Immunization and birth spacing support overall maternal-child health but are less direct as the primary preventive measure for growth restriction in the current pregnancy.

Question 48

Most common complication of the third stage of labor is?

Accepted Answer

Answer reason: Failure of the uterus to contract effectively after placental separation prevents compression of uterine vessels, leading to brisk blood loss. This complication is far more common than downstream consequences like hypovolemic shock, which occurs only if bleeding is severe and untreated. Subinvolution is a later postpartum issue rather than an acute third-stage complication, and uterine perforation is not a typical third-stage event.

Question 49

Which stage of labor is characterized by the onset of contractions and ends with complete cervical dilation?

Accepted Answer

Answer reason: The active phase is the portion of the first stage where contractions become more regular and stronger and cervical dilation progresses rapidly toward complete dilation. The latent phase only covers early dilation and does not extend to full dilation. The second stage starts after complete dilation and ends with delivery of the baby, so it cannot be correct.

Question 50

The earliest sign of placental separation is?

Accepted Answer

Answer reason: As the placenta detaches and descends, the uterus becomes firmer, more globular, and rises in the abdomen due to retraction—this change in contour is typically the earliest observable sign. A sudden gush of blood may occur but can be delayed and is not as consistently the first sign. Shock is a late and pathologic finding indicating significant hemorrhage rather than normal separation.

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