Obstetric Nursing (15 Questions) uteroplacental insufficiency.

Repositioning the
1. A patient at 38 weeks of gestation presents patient to the left side improves blood flow to the
with severe headache, blurred vision, and uterus and placenta, addressing the root cause.
epigastric pain. Her blood pressure is 160/110
mmHg, and a urine dipstick reveals +3 5. A patient undergoing an induction of labor
proteinuria. What is the priority nursing with oxytocin infusion experiences contractions
diagnosis? every 90 seconds lasting 90 seconds, with a
A. Ineffective Coping uterine resting tone of 30 mmHg. What is the
B. Risk for Injury to Fetus nurse’s priority action?
C. Decreased Cardiac Output A. Discontinue the oxytocin infusion.
D. Risk for Ineffective Cerebral Tissue Perfusion B. Increase the rate of the oxytocin infusion.
C. Continue monitoring the contractions.
Answer: D D. Notify the healthcare provider immediately.
Rationale: These symptoms indicate severe
preeclampsia, placing the patient at high risk for Answer: A
cerebral complications such as seizures or stroke. Rationale: The patient is experiencing uterine
Risk for ineffective cerebral tissue perfusion is the tachysystole, which can compromise fetal
priority. oxygenation. Discontinuing oxytocin reduces
contraction frequency and improves fetal well-
2. A patient in active labor suddenly complains being.
of severe abdominal pain and a feeling of 6. A patient with placenta previa at 36 weeks
"tearing." The fetal heart rate drops to 80 bpm. gestation is admitted with painless vaginal
What is the nurse's priority action? bleeding. What is the priority nursing
A. Administer oxygen via face mask intervention?
B. Prepare for an emergency cesarean section A. Perform a sterile vaginal exam to assess
C. Perform a vaginal examination dilation.
D. Notify the healthcare provider B. Assess fetal heart rate and apply continuous
monitoring.
C. Administer oxytocin to stop the bleeding.
Answer: B D. Ambulate the patient to encourage labor
Rationale: These symptoms suggest uterine progression.
rupture, a life-threatening emergency. The nurse
must immediately prepare for a cesarean section to Answer: B
save the mother and fetus. Rationale: Vaginal bleeding in placenta previa
necessitates immediate assessment of fetal well-
being. Vaginal exams are contraindicated to
3. A patient at 35 weeks of gestation reports prevent placental disruption.
severe itching without a rash, especially on her
palms and soles. What is the priority nursing 7. A patient with gestational diabetes is
intervention? undergoing a non-stress test at 39 weeks
A. Advise the patient to avoid scratching and apply gestation. The fetal heart rate shows no
lotion. accelerations in 20 minutes. What is the next
B. Educate the patient on using antihistamines. nursing action?
C. Notify the healthcare provider and assess liver A. Reposition the patient and repeat the test.
function tests. B. Prepare the patient for immediate delivery.
D. Document findings and schedule a follow-up C. Notify the healthcare provider of nonreactive
appointment. findings.
D. Administer glucose to the patient to stimulate
Answer: C fetal movement.
Rationale: Severe itching on the palms and soles
during pregnancy could indicate intrahepatic Answer: C
cholestasis, a liver disorder that increases the risk Rationale: A nonreactive non-stress test indicates
of fetal complications. Immediate evaluation of liver the need for further evaluation, such as a
function and bile acids is necessary. biophysical profile or contraction stress test.
Immediate notification ensures timely intervention.
4. During labor, the nurse notes decelerations in
the fetal heart rate that begin after the peak of 8. A laboring patient with a previous cesarean
the contraction and return to baseline after the section desires a trial of labor after cesarean
contraction ends. What is the priority nursing (TOLAC). The nurse observes signs of uterine
action? rupture. What is the first nursing action?
A. Reposition the patient to the left side. A. Increase IV fluids to prevent shock.
B. Increase the IV fluid rate. B. Stop oxytocin infusion immediately.
C. Administer oxygen via face mask. C. Notify the healthcare provider and prepare for an
D. Notify the healthcare provider. emergency cesarean section.
D. Assess fetal heart rate for bradycardia.

Answer: A Answer: C
Rationale: Late decelerations indicate Rationale: Uterine rupture is a life-threatening
emergency. The priority is to ensure rapid surgical 13. A pregnant patient at 10 weeks gestation is
intervention to save the mother and fetus. diagnosed with a threatened abortion. Which
instruction is most important for the nurse to
9. A patient in the third stage of labor has a firm give?
fundus, but a steady trickle of bright red blood A. "You should avoid sexual activity until the
is observed. What is the nurse’s priority action? bleeding stops."
A. Massage the fundus to promote uterine B. "Monitor your temperature daily and report any
contraction. fever."
B. Notify the healthcare provider and prepare for C. "You should maintain complete bedrest until the
repair of a vaginal laceration. bleeding resolves."
C. Administer oxytocin to control bleeding. D. "Drink plenty of fluids to prevent dehydration."
D. Assess the patient’s vital signs for signs of Answer: A
hypovolemic shock. Rationale: Avoiding sexual activity reduces the risk
of further uterine irritation or bleeding in a
Answer: B threatened abortion.
Rationale: A firm fundus with persistent bright red 14. During a routine prenatal visit, a patient with
bleeding suggests a laceration. Immediate Rh-negative blood is found to have an Rh-
intervention is needed to repair the source of positive fetus. What is the appropriate nursing
bleeding. action?
A. Administer Rho(D) immune globulin at 28 weeks
10. During the postpartum assessment, the gestation.
nurse finds the patient’s uterus is boggy and B. Schedule an amniocentesis to assess fetal
displaced to the right. What is the priority hemolysis.
nursing intervention? C. Prepare the patient for immediate delivery.
A. Administer methylergonovine as prescribed. D. Educate the patient about receiving Rho(D)
B. Encourage the patient to void. immune globulin after delivery only.
C. Massage the fundus until firm. Answer: A
D. Notify the healthcare provider of uterine atony. Rationale: Rho(D) immune globulin is given
prophylactically at 28 weeks gestation and within
Answer: B 72 hours postpartum to prevent maternal
Rationale: A displaced uterus is often caused by a sensitization to Rh-positive fetal blood.
full bladder, which inhibits uterine contraction. Newborn Care (15 Questions)
Encouraging voiding is the first step to restoring 16. A newborn is delivered at 28 weeks
uterine tone. gestation and has nasal flaring, grunting, and
chest retractions. What should the nurse
11. A postpartum patient reports difficulty prepare to do first?
breastfeeding due to sore, cracked nipples. A. Provide skin-to-skin contact with the mother
What is the best nursing intervention? B. Administer surfactant via endotracheal tube
A. Suggest the patient apply warm compresses C. Start an IV line for fluids
before feeding. D. Place the newborn in a radiant warmer
B. Recommend a nipple shield during feedings. Answer: B
C. Encourage the patient to increase the frequency Rationale: The symptoms indicate respiratory
of feedings. distress syndrome common in premature infants.
D. Instruct the patient to ensure proper latching Administering surfactant improves lung function by
technique. reducing alveolar surface tension.

Answer: D 17. A 3-day-old infant presents with yellow

Rationale: Proper latching prevents nipple trauma, sclera and skin. The total serum bilirubin level
which is the primary cause of soreness and is 17 mg/dL. What is the priority nursing
cracking. Addressing the root cause is key to intervention?
successful breastfeeding. A. Administer phototherapy
B. Increase the frequency of breastfeeding
12. A patient in labor with suspected C. Start exchange transfusion
chorioamnionitis has a fever of 101.5°F, foul- D. Monitor urine output
smelling amniotic fluid, and fetal tachycardia. Answer: A
What is the nurse’s priority intervention? Rationale: Phototherapy is the first-line treatment
A. Administer broad-spectrum antibiotics as for neonatal hyperbilirubinemia at this level. It helps
prescribed. to reduce bilirubin by converting it into a water-
B. Monitor maternal and fetal vital signs every 15 soluble form.
minutes.
C. Prepare for immediate cesarean delivery.
D. Perform a sterile vaginal exam to assess labor
progression.

Answer: A
Rationale: Chorioamnionitis is a bacterial infection
requiring prompt administration of antibiotics to
reduce maternal and fetal complications.
Chronic Kidney Disease (CKD) and Dialysis (20 C. "Protein buildup can cause electrolyte
Questions) imbalances."
15. A patient with chronic kidney disease (CKD) D. "It helps reduce the strain on your kidneys and
is receiving hemodialysis. The nurse notes a reduces waste buildup."
bruit and thrill over the arteriovenous (AV)
fistula. What is the nurse's next action? Answer: D
A. Palpate the AV fistula for any signs of infection. Rationale: A low-protein diet helps reduce the
B. Document the findings as normal. buildup of waste products, like urea, in the blood,
C. Notify the healthcare provider about the bruit which the kidneys can no longer filter effectively.
and thrill.
D. Administer anticoagulants as prescribed. 20. A patient undergoing hemodialysis presents
with hypotension, nausea, and dizziness during
the procedure. What is the most appropriate
Answer: B intervention?
Rationale: A bruit and thrill over an AV fistula are A. Increase the dialysate flow rate.
normal findings, indicating good blood flow. These B. Administer a bolus of normal saline.
are expected signs of an effective dialysis access C. Reposition the patient to the left lateral position.
site. D. Slow the dialysis rate.
16. A patient with CKD reports difficulty
breathing, weight gain, and swelling of the Answer: B
ankles. Which assessment finding would Rationale: Hypotension during dialysis is common
confirm fluid overload? and may be treated by administering a fluid bolus
A. Serum creatinine of 2.0 mg/dL (normal saline) to restore circulating volume and
B. Blood pressure of 160/95 mmHg stabilize blood pressure.
C. Jugular vein distension
D. Hemoglobin level of 11 g/dL 21. A patient with CKD has a potassium level of
6.2 mEq/L. What is the nurse's priority
Answer: C intervention?
Rationale: Jugular vein distension is a classic sign A. Administer a potassium-wasting diuretic as
of fluid overload and congestive heart failure, which prescribed.
can occur in CKD when the kidneys are unable to B. Restrict dietary potassium intake.
excrete excess fluid. C. Administer sodium polystyrene sulfonate
17. A patient with CKD is receiving peritoneal (Kayexalate) as prescribed.
dialysis. The nurse notes that the dialysate bag D. Encourage the patient to drink more fluids.
is cloudy. What is the nurse's priority action?
A. Continue the dialysis exchange. Answer: C
B. Notify the healthcare provider and culture the Rationale: Sodium polystyrene sulfonate helps
effluent. remove excess potassium from the body, a critical
C. Increase the flow rate of the dialysate. intervention for hyperkalemia in CKD patients.
D. Administer antibiotics as prescribed.
22. A patient with CKD is being taught about
Answer: B dietary restrictions. Which statement by the
Rationale: Cloudy dialysate indicates peritonitis, patient indicates the need for further teaching?
which is an infection of the peritoneal cavity. A. "I should limit my intake of fruits and vegetables
Immediate notification of the healthcare provider high in potassium."
and collection of a sample for culture is necessary. B. "I can eat dairy products as long as they are low
in sodium."
18. A patient with CKD is prescribed C. "I should limit my protein intake to reduce strain
erythropoiesis-stimulating agents (ESAs) to on my kidneys."
treat anemia. What should the nurse monitor D. "I need to avoid foods high in phosphorus, like
most closely? meat and beans."
A. Blood pressure
B. Serum calcium levels Answer: B
C. Potassium levels Rationale: Dairy products are high in phosphorus,
D. Liver function tests and phosphorus should be limited in CKD patients.
The patient needs to avoid all high-phosphorus
Answer: A foods, including dairy.
Rationale: ESAs can increase blood pressure.
Monitoring blood pressure closely helps prevent 23. A patient receiving peritoneal dialysis
complications such as hypertensive crisis. reports abdominal pain and a fever of 101°F.
The nurse suspects peritonitis. What is the next
19. A patient on hemodialysis asks why they step in management?
need to follow a low-protein diet. What is the A. Administer prescribed antibiotics and perform a
best response? culture of the dialysate.
A. "You need to limit protein to prevent uremic B. Increase the dialysate flow rate to flush out the
symptoms." infection.
B. "A low-protein diet will improve your kidney C. Change the dialysis catheter dressing and
function."
document the findings. 28. A patient with type 1 diabetes presents with
D. Administer a pain reliever and continue dialysis. dizziness, diaphoresis, and confusion. The
blood glucose level is 45 mg/dL. What is the
Answer: A priority nursing intervention?
Rationale: Peritonitis is a common complication of A. Administer glucagon as prescribed.
peritoneal dialysis. Immediate administration of B. Administer 15 grams of oral carbohydrates.
antibiotics and culturing the dialysate for bacteria is C. Increase the IV rate with normal saline.
necessary for appropriate treatment. D. Assess the patient's level of consciousness.
Answer: B
24. A patient with CKD has a serum creatinine Rationale: The patient is hypoglycemic.
level of 3.5 mg/dL. What does this finding Administering 15 grams of oral carbohydrates is the
indicate? first step in treating mild hypoglycemia.
A. The kidneys are functioning normally.
B. The patient’s kidneys are significantly impaired. 29. A diabetic patient on insulin therapy is
C. The patient’s kidneys are beginning to fail. complaining of hunger, shaking, and sweating.
D. The patient’s kidneys are in acute failure. Their blood glucose is 50 mg/dL. What should
the nurse do first?
Answer: B A. Administer a dose of insulin to correct the
Rationale: A serum creatinine level of 3.5 mg/dL hypoglycemia.
indicates significant kidney impairment and is B. Encourage the patient to drink a glass of orange
consistent with moderate to severe CKD. juice.
C. Prepare for the patient to be hospitalized.
25. A nurse is caring for a patient on D. Reassure the patient and monitor their blood
hemodialysis and notes that the patient's blood glucose every hour.
pressure is significantly lower than usual after
dialysis. What is the nurse's most appropriate Answer: B
action? Rationale: Oral glucose is the treatment for
A. Increase the dialysis flow rate. hypoglycemia. A glass of orange juice provides 15
B. Notify the healthcare provider immediately. grams of glucose to raise the blood sugar to normal
C. Elevate the patient's legs and encourage fluid levels.
intake.
D. Document the finding as a normal occurrence. 30. A patient with type 2 diabetes is prescribed
metformin. What is the nurse's priority teaching
Answer: C point?
Rationale: Post-dialysis hypotension is common. A. "You should take this medication with meals to
Elevating the legs and encouraging fluid intake reduce stomach upset."
helps improve circulation and restore blood B. "If you miss a dose, take it as soon as you
pressure. remember, unless it's close to the next dose."
C. "Avoid drinking alcohol while taking metformin
26. A patient on hemodialysis is prescribed due to the risk of hypoglycemia."
erythropoiesis-stimulating agent (ESA) therapy. D. "You will need to monitor your blood glucose
What should the nurse monitor for as a side every 2 hours after taking the medication."
effect of this therapy?
A. Hypokalemia
B. Hypertension Answer: A
C. Hyperkalemia Rationale: Metformin should be taken with meals
D. Hypocalcemia to minimize gastrointestinal side effects like nausea
and diarrhea. Alcohol should be avoided due to the
Answer: B risk of lactic acidosis, not hypoglycemia.
Rationale: ESAs can increase blood pressure.
Blood pressure should be closely monitored to 31. A patient with type 1 diabetes presents with
prevent hypertension-related complications. fruity-smelling breath, confusion, and a blood
glucose level of 350 mg/dL. What is the priority
nursing action?
27. A patient on peritoneal dialysis reports A. Administer a rapid-acting insulin injection.
cloudy dialysis effluent. The nurse suspects B. Administer an oral hypoglycemic agent.
infection. What is the priority action? C. Encourage the patient to drink water to lower the
A. Administer prescribed antibiotics immediately. blood glucose.
B. Obtain a sample of the effluent for culture. D. Prepare to administer intravenous fluids and
C. Change the patient's catheter dressing. insulin for diabetic ketoacidosis (DKA).
D. Increase the dialysate exchange rate.
Answer: B Answer: D
Rationale: Cloudy effluent suggests peritonitis. The Rationale: Fruity breath, confusion, and
priority is to obtain a sample for culture to identify hyperglycemia are signs of diabetic ketoacidosis
the causative organism. (DKA), a medical emergency requiring immediate
intravenous insulin and fluids for correction.
Diabetes Mellitus (DM) (15 Questions)
32. A diabetic patient is scheduled for surgery insulin administration to bring blood glucose back to
tomorrow. Which instruction should the nurse a normal range. Water intake can help with
give regarding insulin management for the day dehydration but will not correct the underlying
of surgery? hyperglycemia.
A. "Skip your morning insulin dose to avoid
hypoglycemia during surgery." Peptic Ulcer Disease (PUD) (10 Questions)
B. "Take your regular insulin dose as usual, unless 36. A patient with peptic ulcer disease (PUD) is
instructed otherwise by the surgeon." prescribed omeprazole. What is the primary
C. "Take half of your insulin dose in the morning of action of this medication?
surgery." A. Reduces gastric acid secretion.
D. "Administer an extra dose of insulin to prevent B. Increases the production of protective mucus.
post-surgery hyperglycemia." C. Neutralizes stomach acid.
D. Promotes healing of the ulcer by increasing
blood flow to the stomach.
Answer: C
Rationale: For surgery, patients often take half Answer: A
their usual insulin dose to prevent hypoglycemia Rationale: Omeprazole is a proton pump inhibitor
while managing blood glucose levels during the that reduces gastric acid secretion, which helps to
fasting period. The surgeon and anesthesia promote ulcer healing and prevent further damage.
provider will confirm specific instructions.
37. A patient with PUD reports severe epigastric
33. A diabetic patient with a foot ulcer reports pain, vomiting, and black tarry stools. What is
pain, redness, and warmth around the wound. the nurse’s priority intervention?
What is the priority nursing intervention? A. Encourage the patient to rest and avoid eating
A. Apply a dry, sterile dressing to the wound. spicy foods.
B. Administer an antibiotic as prescribed. B. Administer the prescribed antacids and monitor
C. Teach the patient how to care for their foot ulcer. for relief of symptoms.
D. Assess the patient's blood glucose level. C. Notify the healthcare provider and prepare the
patient for an endoscopy.
D. Assess vital signs, particularly blood pressure
Answer: B and heart rate, for signs of bleeding.
Rationale: The signs of infection (pain, redness,
warmth) require prompt antibiotic administration to Answer: D
prevent complications such as osteomyelitis or Rationale: Black, tarry stools (melena) may
sepsis. Blood glucose should be monitored but is indicate gastrointestinal bleeding, a potential
not the immediate priority. complication of PUD. Immediate assessment of
vital signs is crucial to detect signs of hypovolemic
34. A patient with diabetes is receiving insulin shock.
therapy. The nurse notes that the patient has a
hemoglobin A1c level of 8.5%. What does this 38. A patient with PUD is prescribed sucralfate.
indicate? What is the nurse’s best instruction to the
A. The patient’s diabetes is well-controlled. patient regarding this medication?
B. The patient is at high risk for hypoglycemia. A. "Take the medication with food to enhance
C. The patient’s blood glucose levels have been absorption."
consistently high over the past 3 months. B. "Take the medication 30 minutes before meals
D. The patient needs to increase their carbohydrate and at bedtime."
intake. C. "Take the medication immediately after meals for
better healing."
D. "Take the medication only if you experience
Answer: C pain."
Rationale: An A1c level of 8.5% indicates that the
patient's blood glucose levels have been above Answer: B
target over the past 2-3 months. A goal A1c level for Rationale: Sucralfate should be taken on an empty
most diabetics is below 7%. stomach to form a protective barrier over the ulcer
and promote healing.
35. A patient with diabetes reports frequent
urination and increased thirst. The nurse 39. A patient with PUD is prescribed an H2
notices a blood glucose level of 400 mg/dL. receptor antagonist. What side effect should the
What is the most appropriate initial nurse monitor for in this patient?
intervention? A. Hyperglycemia
A. Administer insulin as prescribed. B. Hypotension
B. Encourage the patient to drink water. C. Confusion or dizziness
C. Check the urine for ketones. D. Weight loss
D. Prepare the patient for dialysis.
Answer: C
Rationale: H2 receptor antagonists, such as
Answer: A ranitidine, can cause confusion and dizziness,
Rationale: Hyperglycemia at this level requires especially in elderly patients.
 44. A patient with appendicitis develops a
40. A patient with PUD asks the nurse if they sudden relief of pain followed by a spike in
should avoid coffee. What is the best fever. What is the nurse's primary concern?
response? A. The patient may be experiencing a
A. "Coffee should be avoided, as it increases gastrointestinal bleed.
gastric acid production." B. The patient may have perforated their appendix,
B. "Coffee should be avoided, as it can delay the leading to peritonitis.
healing of ulcers." C. The patient's pain may be due to an unrelated
C. "You should limit coffee, but it is not necessary issue, such as a hernia.
to eliminate it completely." D. The fever is likely due to an unrelated viral
D. "Coffee does not affect ulcers and is safe to infection.
drink."
Answer: B
Answer: A Rationale: Sudden relief of pain in appendicitis
Rationale: Coffee stimulates gastric acid secretion, followed by fever may indicate a perforated
which can aggravate PUD symptoms and delay appendix and peritonitis, which are surgical
ulcer healing. emergencies.

41. A patient with a duodenal ulcer reports that 45. A patient with appendicitis is scheduled for
their pain worsens after eating. What should the surgery. What should the nurse include in
nurse teach the patient regarding meal timing? preoperative teaching?
A. "Eat larger meals to reduce gastric irritation." A. "You will need to avoid taking any medications
B. "Eat smaller, more frequent meals to reduce after surgery."
stomach acid production." B. "You will be encouraged to move around as soon
C. "Avoid eating immediately before bed." as possible after surgery."
D. "Take antacids before meals to prevent pain C. "You will have a long recovery period, and it may
after eating." take several weeks to feel better."
D. "Expect a nasogastric tube to be placed during
Answer: B surgery to drain any fluids."
Rationale: Smaller, more frequent meals help to
prevent the overproduction of stomach acid and Answer: B
reduce irritation to the ulcer. Rationale: Early ambulation after surgery promotes
circulation, reduces the risk of complications like
Appendicitis (10 Questions) deep vein thrombosis, and accelerates recovery.
42. A patient presents with right lower quadrant
pain, nausea, and fever. What is the nurse’s Would you like further questions on these topics, or
priority action? would you like to move on to another subject?
A. Administer pain medication as prescribed.
B. Perform a focused abdominal assessment for
rebound tenderness.
C. Prepare the patient for an abdominal X-ray.
D. Encourage the patient to drink fluids to relieve
the pain.

Answer: B
Rationale: The presence of rebound tenderness is
a key sign of appendicitis. Assessing for this finding
is critical in confirming the diagnosis before further
interventions.

43. A patient with suspected appendicitis is

experiencing worsening pain and a fever of
102°F. What is the priority nursing intervention?
A. Administer an antipyretic to reduce the fever.
B. Keep the patient NPO (nothing by mouth) in
preparation for surgery.
C. Encourage the patient to walk around to relieve
the discomfort.
D. Prepare the patient for discharge after symptom
resolution.

Answer: B
Rationale: In suspected appendicitis, the patient
should be kept NPO in preparation for possible
surgery (appendectomy). Surgery is typically
required if the diagnosis is confirmed.