RNC-MNN: Maternal Newborn Nursing Certification Exam — Questions and Answers

Question 1: When communicating with a client experiencing postpartum depression, which therapeutic communication technique is most appropriate?

What has your experience been like since bringing your baby home? (Correct answer)
You need to tell your family how you feel so they can fix things for you.
You should be happy — you have a beautiful, healthy baby.
Most women feel this way, so there is really nothing to worry about.

Correct answer: What has your experience been like since bringing your baby home?

Open-ended questions invite the client to share her experience without judgment, which is the foundation of therapeutic communication.

Question 2: Which client is at highest risk for postpartum psychosis?

A primiparous woman with no psychiatric history
A woman who experienced gestational diabetes
A woman who had an unplanned pregnancy
A woman with a history of bipolar disorder (Correct answer)

Correct answer: A woman with a history of bipolar disorder

Women with bipolar disorder have a 25–50% risk of developing postpartum psychosis, making it the strongest known risk factor for this condition.

Question 3: A nurse is assessing gestational age using the Ballard score. Which neuromuscular maturity finding is expected in a full-term newborn (38–40 weeks)?

Popliteal angle of 180 degrees
Scarf sign with elbow easily past midline
Arms remaining extended after release
Arm recoil with brisk return to flexion (Correct answer)

Correct answer: Arm recoil with brisk return to flexion

Full-term newborns demonstrate active flexion tone, so when the arm is extended and released, it quickly returns to the flexed position (brisk arm recoil).

Question 4: Which cultural consideration is most important when screening for postpartum depression?

Skip screening for clients from cultures that traditionally value emotional stoicism
Use culturally validated screening tools and recognize that some cultures stigmatize mental illness (Correct answer)
Assume all cultures express postpartum depression with identical symptoms
Only screen clients who are fluent in English

Correct answer: Use culturally validated screening tools and recognize that some cultures stigmatize mental illness

Cultural beliefs significantly shape how women express and conceptualize perinatal mental health; using culturally validated tools and recognizing stigma ensures equitable and effective screening.

Question 5: A breastfed newborn has a bilirubin level of 18 mg/dL at 5 days of life. The pediatrician suspects breast milk jaundice. Which action is most appropriate?

Permanently discontinue breastfeeding
Administer exchange transfusion immediately
Temporarily interrupt breastfeeding for 24–48 hours and provide formula
Increase breastfeeding frequency to 10–12 times per day (Correct answer)

Correct answer: Increase breastfeeding frequency to 10–12 times per day

For breast milk jaundice with non-critical bilirubin levels, increasing breastfeeding frequency to 10–12 times per day promotes bilirubin excretion and is the preferred first intervention.

Question 6: A breastfeeding mother at 2 weeks postpartum develops a tender, red, wedge-shaped area on the right breast with a temperature of 38.9°C (102°F). Which condition does the nurse suspect?

Plugged milk duct
Breast abscess
Mastitis (Correct answer)
Breast engorgement

Correct answer: Mastitis

Mastitis is characterized by a painful, red, wedge-shaped breast area with systemic symptoms (fever, flu-like symptoms) and most commonly occurs in the second to fourth week postpartum.

Question 7: The nurse is caring for a patient in labor whose membranes rupture spontaneously. The fluid is green-tinged. What is the priority nursing action?

Document the color and continue routine monitoring
Perform a vaginal exam to check dilation
Notify dietary to hold the next meal
Assess the fetal heart rate immediately (Correct answer)

Correct answer: Assess the fetal heart rate immediately

Meconium-stained amniotic fluid indicates possible fetal stress, so immediate fetal heart rate assessment is the priority to detect fetal compromise.

Question 8: A new mother 2 weeks postpartum is brought to the ED by her husband. She reports hearing voices telling her to harm her baby and believes her infant is possessed. Which condition does the nurse recognize?

Postpartum psychosis (Correct answer)
Severe postpartum depression
Postpartum PTSD
Postpartum anxiety

Correct answer: Postpartum psychosis

Postpartum psychosis presents with hallucinations, delusions, and disorganized thinking, usually within the first 2 weeks postpartum, and is a psychiatric emergency.

Question 9: A nurse is preparing discharge teaching about resuming sexual intercourse postpartum. What is the standard recommendation?

Wait at least 6 weeks or until cleared by the provider and lochia has ceased (Correct answer)
Avoid intercourse until the next menstrual period returns
Resume whenever the client feels physically comfortable, usually within 1 week
Wait exactly 6 weeks regardless of healing status

Correct answer: Wait at least 6 weeks or until cleared by the provider and lochia has ceased

Most providers recommend waiting until lochia has stopped and perineal healing is complete, typically around 6 weeks and after provider clearance.

Question 10: A client on postpartum day 1 is crying and states she feels overwhelmed and irritable. Her assessment is otherwise normal. How should the nurse interpret this?

Probable postpartum depression requiring psychiatric referral
Normal postpartum blues related to hormonal shifts (Correct answer)
Early sign of postpartum psychosis
Grief response requiring social work consult

Correct answer: Normal postpartum blues related to hormonal shifts

Postpartum blues affect up to 80% of new mothers within the first few days due to rapid estrogen and progesterone decline; they resolve within 2 weeks without treatment.

Question 11: A patient at 32 weeks gestation is admitted with preterm premature rupture of membranes (PPROM). She is GBS-negative. What is the priority nursing intervention?

Administer tocolytics to stop preterm contractions
Place the patient in Trendelenburg position permanently
Initiate fetal monitoring and assess for signs of infection and cord prolapse (Correct answer)
Prepare for immediate induction of labor

Correct answer: Initiate fetal monitoring and assess for signs of infection and cord prolapse

With PPROM, priority nursing care involves continuous fetal monitoring for non-reassuring patterns including cord prolapse, along with assessment for chorioamnionitis (infection).

Question 12: About 2 months and 1 week into her pregnancy, the primigravida is being cared for by the nurse. The nurse determines that the client has understood the instructions after describing self-care techniques for typical pregnant discomforts when she says:

“If I start to leak colostrum, I should cleanse my nipples with soap and water.”
“Leg cramps can be alleviated if I put an ice pack on the area.”
“Nausea and vomiting can be decreased if I eat a few crackers before rising.” (Correct answer)
“If I have a vaginal discharge, I should wear nylon underwear.”

Correct answer: “Nausea and vomiting can be decreased if I eat a few crackers before rising.”

Before awakening, munching on dry crackers can help lessen the normal unpleasantness of nausea and vomiting. A high-protein snack right before night and avoiding foods with strong flavors can also be beneficial.

Question 13: During the second stage of labor, the nurse identifies variable decelerations with each push. What intervention should the nurse implement first?

Have the patient stop pushing and change position (Correct answer)
Perform an amnioinfusion
Apply oxygen via face mask at 10 L/min
Increase the oxytocin infusion rate

Correct answer: Have the patient stop pushing and change position

Variable decelerations are caused by umbilical cord compression, and repositioning the patient can relieve cord pressure and resolve the pattern.

Question 14: A nurse is performing the Edinburgh Postnatal Depression Scale (EPDS) screening. At what score should the nurse initiate immediate follow-up?

Any score above zero
Score of 5 or higher
Score of 10 or higher
Score of 13 or higher (Correct answer)

Correct answer: Score of 13 or higher

An EPDS score of 13 or higher indicates probable postpartum depression and requires immediate referral and further mental health evaluation.

Question 15: Which maternal medication is considered safe during breastfeeding?

Codeine for pain management
Methotrexate for autoimmune disease
Amiodarone for cardiac arrhythmia
Ibuprofen (Advil) for postpartum pain management (Correct answer)

Correct answer: Ibuprofen (Advil) for postpartum pain management

Ibuprofen has poor transfer into breast milk and is considered safe for breastfeeding mothers; codeine is contraindicated due to ultra-rapid metabolizer risk causing neonatal respiratory depression.

Question 16: A nurse assesses a client at 22 weeks gestation who reports round ligament pain. Which description is MOST consistent with this condition?

Burning epigastric pain after meals
Constant, dull suprapubic pressure worsened by rest
Sharp, brief pain in the lower abdomen or groin with movement (Correct answer)
Colicky flank pain radiating to the groin

Correct answer: Sharp, brief pain in the lower abdomen or groin with movement

Round ligament pain is characteristically sharp, brief, and occurs with sudden movement as the ligaments supporting the uterus stretch.

Question 17: Which position is most appropriate for a client with a prolapsed umbilical cord while awaiting emergency cesarean delivery?

Right lateral with a wedge under the hip
High Fowler's position
Left lateral decubitus (Sims) position
Trendelenburg or knee-chest position (Correct answer)

Correct answer: Trendelenburg or knee-chest position

Trendelenburg or knee-chest position uses gravity to relieve pressure on the prolapsed cord by allowing the fetal presenting part to move away from the cord.

Question 18: A postpartum client who had a cesarean birth asks when she can expect her bowel function to return. What should the nurse tell her?

Only after a Fleet enema is administered
Not until she is fully off IV fluids
Within 12 hours, because surgery stimulates bowel peristalsis
Usually within 2–3 days, assisted by ambulation and passage of flatus (Correct answer)

Correct answer: Usually within 2–3 days, assisted by ambulation and passage of flatus

Post-cesarean ileus typically resolves within 2–3 days; early ambulation and adequate hydration help restore peristalsis.

Question 19: A nurse notes a newborn's axillary temperature is 36.1°C (97°F) at 2 hours of life. What is the priority intervention?

Place the newborn under a radiant warmer and reassess in 30 minutes (Correct answer)
Administer warm IV fluids
Encourage skin-to-skin contact with the mother only
Notify the provider immediately for sepsis workup

Correct answer: Place the newborn under a radiant warmer and reassess in 30 minutes

Neonatal hypothermia (temperature <36.5°C) is managed initially by placing the infant under a radiant warmer to restore normothermia and prevent metabolic complications.

Question 20: A client 6 hours postpartum has a blood pressure of 158/106 mmHg, a severe headache, and 3+ proteinuria. Which medication does the nurse anticipate administering?

Magnesium sulfate (Correct answer)
Methylergonovine (Methergine)
Misoprostol (Cytotec)
Betamethasone

Correct answer: Magnesium sulfate

Postpartum severe-range hypertension with headache and proteinuria indicates postpartum preeclampsia/eclampsia; magnesium sulfate is used for seizure prophylaxis.

Question 21: A patient is 3 hours postpartum and her uterus is displaced to the right of the umbilicus and feels boggy. What is the likely cause and appropriate intervention?

Uterine rupture; prepare for emergency surgery
Postpartum hemorrhage; administer oxytocin IV
Uterine atony from a distended bladder; assist the patient to void (Correct answer)
Normal uterine involution; reassess in 1 hour

Correct answer: Uterine atony from a distended bladder; assist the patient to void

A laterally displaced boggy uterus postpartum is a classic sign of bladder distension displacing the uterus; voiding allows the uterus to contract properly to the midline.

Question 22: A newborn is assessed and found to have Erb's palsy. Which structure was most likely injured during delivery?

Cervical spinal cord at C3–C4
Facial nerve (cranial nerve VII)
Phrenic nerve at C3–C5
Brachial plexus at C5–C6 nerve roots (Correct answer)

Correct answer: Brachial plexus at C5–C6 nerve roots

Erb's palsy results from injury to the C5–C6 nerve roots of the brachial plexus, typically caused by excessive lateral traction on the head during a difficult delivery.

Question 23: A patient is breastfeeding and needs analgesia for postpartum pain. Which analgesic is considered safest for the breastfeeding dyad?

Ibuprofen 600 mg every 6 hours as needed (Correct answer)
Naproxen 500 mg twice daily
Oxycodone 5 mg every 4 hours as needed
Aspirin 650 mg every 4 hours

Correct answer: Ibuprofen 600 mg every 6 hours as needed

Ibuprofen is the preferred postpartum analgesic for breastfeeding mothers because it has low transfer into breast milk, does not affect platelet function in the infant, and provides effective pain relief.

Question 24: A client with chronic hypertension becomes pregnant. The nurse knows that which antihypertensive medication is CONTRAINDICATED during pregnancy?

Lisinopril (ACE inhibitor) (Correct answer)
Labetalol
Methyldopa (Aldomet)
Nifedipine

Correct answer: Lisinopril (ACE inhibitor)

ACE inhibitors are teratogenic and can cause fetal renal dysgenesis, oligohydramnios, and neonatal renal failure; they are absolutely contraindicated in pregnancy.

Question 25: A nurse assesses a newborn at 1 minute and assigns an Apgar score. The infant has a heart rate of 98 bpm, weak cry, some flexion of extremities, grimace to stimulation, and a pink body with blue extremities. What is the Apgar score?

5
6 (Correct answer)
8
7

Correct answer: 6

HR <100 = 1, weak cry (slow, irregular respirations) = 1, some flexion = 1, grimace = 1, pink body/blue extremities (acrocyanosis) = 1, totaling 6.

Question 26: A newborn is ordered to receive ampicillin and gentamicin for suspected sepsis. Which nursing assessment is essential before administering gentamicin?

Serum creatinine and BUN to assess renal function, and urine output (Correct answer)
Liver function tests
Blood glucose level
Head circumference measurement

Correct answer: Serum creatinine and BUN to assess renal function, and urine output

Gentamicin is nephrotoxic and ototoxic; renal function (creatinine, BUN, urine output) must be assessed before each dose, and peak/trough levels monitored to prevent toxicity.

Question 27: Which newborn weight loss in the first few days of life is considered within normal limits?

Up to 10% of birth weight (Correct answer)
Any weight loss is abnormal
Up to 15% of birth weight
Up to 5% of birth weight

Correct answer: Up to 10% of birth weight

A term newborn may lose up to 10% of birth weight in the first 3–5 days due to fluid shifts, meconium passage, and establishing feeding, and should regain birth weight by 10–14 days.

Question 28: After rupture of membranes, the nurse notes the umbilical cord protruding from the vaginal introitus. Which action should the nurse take first?

Clamp and cut the cord to prevent further prolapse
Place the patient in Trendelenburg or knee-chest position (Correct answer)
Cover the cord with a dry sterile gauze
Prepare the patient for immediate cesarean section

Correct answer: Place the patient in Trendelenburg or knee-chest position

The nurse's priority with cord prolapse is to relieve cord compression by elevating the presenting part, which is achieved with Trendelenburg or knee-chest positioning.

Question 29: A laboring client at 8 cm dilation reports uncontrollable urge to push. Which nursing intervention is most appropriate at this time?

Instruct the client to use panting or blowing breathing to resist the urge to push (Correct answer)
Administer IV morphine to decrease the sensation
Place the client in the lithotomy position and prepare for delivery
Encourage the client to push with each contraction

Correct answer: Instruct the client to use panting or blowing breathing to resist the urge to push

Until the cervix is fully dilated (10 cm), pushing is discouraged; panting or blowing techniques help the client resist the urge and prevent cervical edema.

Question 30: A nurse measures the fetal heart rate at the 38-week prenatal checkup. Which of the following observations leads the nurse to conclude that the fetal heart rate is normal?

80 BPM
150 BPM (Correct answer)
180 BPM
100 BPM

Correct answer: 150 BPM

The fetal heart rate varies according to gestational age and is between 160 and 170 beats per minute (BPM) in the first trimester before slowing down to 120 to 160 BPM close or at term. When the uterus is at rest and the fetal heart rate is between 120 and 160 BPM at or near term, the fetus may be in distress.

Question 31: A newborn born to an HBsAg-positive mother should receive which interventions within 12 hours of birth?

Hepatitis B vaccine only
HBIG only, with vaccine deferred to 2 months
No intervention is needed until lab confirmation
Both hepatitis B vaccine and hepatitis B immune globulin (HBIG) administered at different sites (Correct answer)

Correct answer: Both hepatitis B vaccine and hepatitis B immune globulin (HBIG) administered at different sites

Infants of HBsAg-positive mothers require both HBIG (passive immunity) and hepatitis B vaccine (active immunity) within 12 hours of birth at different injection sites for maximum protection.

Question 32: A postpartum client reports she cannot urinate 6 hours after a vaginal delivery. Which nursing action is the priority?

Document the finding and notify the provider
Perform straight catheterization immediately
Encourage oral fluids and reassess in 2 hours
Assess for bladder distension and offer measures to stimulate voiding (Correct answer)

Correct answer: Assess for bladder distension and offer measures to stimulate voiding

Before catheterization, the nurse should assess the degree of distension and try non-invasive measures such as running water, privacy, and warm perineal rinse.

Question 33: A patient in active labor requests pain relief. She is 7 cm dilated. Which analgesic option is CONTRAINDICATED this close to delivery due to risk of neonatal respiratory depression?

Nitrous oxide
IV morphine sulfate (Correct answer)
Epidural analgesia
Intrathecal opioids via spinal block

Correct answer: IV morphine sulfate

IV systemic opioids such as morphine cross the placenta and can cause neonatal respiratory depression if given too close to delivery, especially at 7 cm.

Question 34: A primipara who is being examined in a clinic during her second trimester of pregnancy is being assessed by a nurse. Which of the following points to an unusual physical finding that calls for additional testing?

Consistent increase in fundal height
Braxton Hicks contractions
Quickening
Fetal heart rate of 180 BPM (Correct answer)

Correct answer: Fetal heart rate of 180 BPM

Gestational age affects the fetal heart rate's normal range. The fetal heart rate ranges from 120 to 160 BPM close and at term. It is typically 160–170 BPM in the first trimester and slows with fetal growth. The other choices are anticipated.

Question 35: At what gestational age is Rh immunoglobulin (RhoGAM) routinely administered to an unsensitized Rh-negative pregnant client?

20 weeks gestation only
28 weeks gestation and within 72 hours of delivery (Correct answer)
36 weeks gestation
At delivery only

Correct answer: 28 weeks gestation and within 72 hours of delivery

RhoGAM is given at 28 weeks gestation and again within 72 hours of delivery of an Rh-positive infant to prevent maternal sensitization.

Question 36: A newborn receives vitamin K (phytonadione) intramuscularly at birth. What is the primary rationale for this administration?

To promote bilirubin conjugation
To prevent hemorrhagic disease of the newborn due to low clotting factors (Correct answer)
To stimulate the immune system
To prevent neonatal infection

Correct answer: To prevent hemorrhagic disease of the newborn due to low clotting factors

Newborns lack intestinal bacteria needed to synthesize vitamin K, resulting in low clotting factors II, VII, IX, and X, making them susceptible to hemorrhagic disease without prophylaxis.

Question 37: A formula-fed newborn at 2 weeks is taking 2 oz every 3 hours. The mother asks if this is adequate. What is the appropriate nursing response?

No, the newborn should be taking at least 6 oz per feeding
Yes, this is consistent with expected intake of approximately 2–3 oz every 3–4 hours for a 2-week-old (Correct answer)
Reduce feedings to 4 times per day to prevent overfeeding
The newborn needs to be on a strict 4-hour feeding schedule

Correct answer: Yes, this is consistent with expected intake of approximately 2–3 oz every 3–4 hours for a 2-week-old

A formula-fed newborn at 2 weeks typically takes 2–3 oz every 3–4 hours; feeding on demand and watching for satiety cues prevents overfeeding.

Question 38: A patient at 36 weeks has been diagnosed with obstetric cholestasis (intrahepatic cholestasis of pregnancy). Which symptom is most characteristic?

Nausea and vomiting in the morning
Upper right quadrant pain with fever
Intense generalized pruritus, worst on the palms and soles (Correct answer)
Painless jaundice with dark urine

Correct answer: Intense generalized pruritus, worst on the palms and soles

The hallmark symptom of intrahepatic cholestasis of pregnancy is intense pruritus, especially on the palms and soles, caused by bile salt accumulation under the skin.

Question 39: A newborn's blood glucose is 38 mg/dL at 2 hours of life. The infant is alert and breastfeeding well. What is the appropriate nursing intervention?

Transfer to NICU for monitoring
Initiate IV dextrose immediately
Encourage breastfeeding and recheck glucose in 30–60 minutes (Correct answer)
Administer glucagon intramuscularly

Correct answer: Encourage breastfeeding and recheck glucose in 30–60 minutes

A mildly low glucose of 38 mg/dL in an asymptomatic, feeding newborn is managed with continued breastfeeding and glucose recheck per protocol before escalating treatment.

Question 40: A nurse is caring for a premature newborn at 30 weeks gestation who requires surfactant therapy. Which condition is this treatment intended to address?

Respiratory distress syndrome (RDS) caused by insufficient surfactant production (Correct answer)
Transient tachypnea of the newborn (TTN)
Meconium aspiration syndrome
Bronchopulmonary dysplasia

Correct answer: Respiratory distress syndrome (RDS) caused by insufficient surfactant production

Preterm infants lack sufficient surfactant, leading to alveolar collapse and RDS; exogenous surfactant therapy reduces surface tension, improves lung compliance, and decreases mortality.

Question 41: Which laboratory value requires the most urgent follow-up in a postpartum client on day 1?

WBC 16,000/mm³
Hematocrit 32%
Platelet count 48,000/mm³ (Correct answer)
Hemoglobin 11.2 g/dL

Correct answer: Platelet count 48,000/mm³

A platelet count of 48,000/mm³ is critically low and increases risk for life-threatening hemorrhage, requiring immediate provider notification.

Question 42: A client at 16 weeks gestation undergoes a quadruple screen (quad screen). Elevated alpha-fetoprotein (AFP) is MOST associated with:

Edwards syndrome (trisomy 18)
Turner syndrome (45, X)
Down syndrome (trisomy 21)
Open neural tube defects such as spina bifida (Correct answer)

Correct answer: Open neural tube defects such as spina bifida

Elevated maternal serum AFP is most strongly associated with open neural tube defects, where AFP leaks from fetal spinal fluid into amniotic and maternal blood.

Question 43: A nurse notes meconium-stained amniotic fluid at rupture of membranes. What is the priority nursing action?

Prepare for immediate cesarean delivery
Apply continuous electronic fetal monitoring and notify the provider (Correct answer)
Increase IV fluid rate to dilute the amniotic fluid
Reassure the client that this is a normal finding

Correct answer: Apply continuous electronic fetal monitoring and notify the provider

Meconium-stained fluid may indicate fetal distress and increases the risk for meconium aspiration syndrome; continuous FHR monitoring and provider notification are the priority.

Question 44: A newborn shows signs of hypocalcemia at 24 hours of life. Which risk factor is most directly associated with early neonatal hypocalcemia?

Maternal hypothyroidism
Maternal hypothyroidism
Postmature gestational age
Maternal diabetes mellitus (Correct answer)

Correct answer: Maternal diabetes mellitus

Infants of diabetic mothers are at increased risk for hypocalcemia because maternal hyperglycemia suppresses fetal parathyroid function, and neonatal calcium regulation is impaired after birth.

Question 45: A postpartum client is diagnosed with deep vein thrombosis (DVT) of the left leg. Which nursing action is contraindicated?

Applying warm moist heat to the affected leg
Massaging the affected calf to relieve discomfort (Correct answer)
Administering anticoagulant therapy as ordered
Elevating the affected extremity

Correct answer: Massaging the affected calf to relieve discomfort

Massaging a leg with suspected or confirmed DVT is contraindicated because it can dislodge the thrombus and cause a pulmonary embolism.

Question 46: A patient at 38 weeks gestation has HELLP syndrome. Which laboratory finding is characteristic of this condition?

Elevated white blood cell count and low bilirubin
Hemolysis, elevated liver enzymes, and low platelets (Correct answer)
Low liver enzymes and elevated creatinine
Elevated platelets and decreased hemoglobin

Correct answer: Hemolysis, elevated liver enzymes, and low platelets

HELLP syndrome is defined by its acronym: Hemolysis, Elevated Liver enzymes (AST/ALT), and Low Platelets (<100,000/mcL), representing a severe variant of preeclampsia.

Question 47: At what age should solid foods be introduced for a formula-fed or breastfed infant according to current guidelines?

8 months of age to maximize gut maturity
Around 6 months of age, when the infant shows developmental readiness (Correct answer)
4 months of age regardless of readiness
3 months, starting with rice cereal in the bottle

Correct answer: Around 6 months of age, when the infant shows developmental readiness

Both the AAP and WHO recommend introducing solid foods around 6 months when the infant can sit with minimal support, has lost the tongue-thrust reflex, and shows interest in food.

Question 48: A patient with preeclampsia is receiving magnesium sulfate 2 g/hr IV. The nurse notes the deep tendon reflexes are absent. What is the priority nursing action?

Document the finding and continue monitoring
Increase the magnesium infusion rate to prevent seizures
Stop the infusion and administer calcium gluconate IV (Correct answer)
Notify the charge nurse and obtain a repeat blood pressure

Correct answer: Stop the infusion and administer calcium gluconate IV

Absent deep tendon reflexes indicate magnesium toxicity (levels typically >7 mEq/L); the infusion must be stopped immediately and calcium gluconate 1 g IV administered as the antidote.

Question 49: A nurse is preparing a newborn for phototherapy to treat hyperbilirubinemia. Which nursing intervention is essential?

Apply sunscreen to protect from UV light exposure
Keep the newborn bundled in a blanket during therapy
Cover the eyes with opaque eye patches and expose maximum skin surface to the light (Correct answer)
Feed the newborn less frequently to reduce bilirubin load

Correct answer: Cover the eyes with opaque eye patches and expose maximum skin surface to the light

Phototherapy works by converting bilirubin in the skin to a water-soluble form for excretion; eye patches protect against retinal damage, and maximum skin exposure increases effectiveness.

Question 50: A patient at 28 weeks gestation is in preterm labor. Betamethasone is ordered. What is the primary purpose of this medication?

To prevent postpartum hemorrhage after delivery
To treat Group B Streptococcus infection
To stop uterine contractions and prevent preterm birth
To accelerate fetal lung maturity and surfactant production (Correct answer)

Correct answer: To accelerate fetal lung maturity and surfactant production

Antenatal betamethasone (corticosteroid) given between 24–34 weeks gestation promotes fetal surfactant production, reducing the severity of respiratory distress syndrome after preterm birth.

Question 51: A nurse is assessing a client in labor and notes the umbilical cord is visible at the vaginal introitus. Which action should be taken FIRST?

Administer oxygen via face mask
Place the client in Trendelenburg position
Call for emergency assistance immediately
Apply continuous upward pressure on the presenting part to relieve cord compression (Correct answer)

Correct answer: Apply continuous upward pressure on the presenting part to relieve cord compression

Umbilical cord prolapse is an obstetric emergency; the nurse must manually elevate the presenting part off the cord to relieve compression while calling for help and preparing for emergency delivery.

Question 52: A primigravida at 36 weeks has a blood pressure of 148/96 mmHg on two readings 4 hours apart. She denies headache or visual changes and has trace proteinuria. What condition does this represent?

Normal blood pressure variation in pregnancy
Preeclampsia without severe features
Chronic hypertension
Gestational hypertension (Correct answer)

Correct answer: Gestational hypertension

Gestational hypertension is defined as BP ≥140/90 mmHg after 20 weeks without the proteinuria or end-organ involvement required to diagnose preeclampsia.

Question 53: A nurse notes a white, cheese-like substance covering a newborn's skin. What is this substance and what should the nurse do?

Vernix caseosa — leave it in place as it protects the skin and promotes colonization with beneficial bacteria (Correct answer)
Milia — apply moisturizing lotion
Lanugo — document only, no action needed
Vernix caseosa — remove it completely with the first bath

Correct answer: Vernix caseosa — leave it in place as it protects the skin and promotes colonization with beneficial bacteria

Vernix caseosa is a protective biofilm that moisturizes newborn skin, has antimicrobial properties, and should be left in place or gently massaged into the skin.

Question 54: A newborn has a cephalohematoma identified on assessment. Which statement about cephalohematoma is accurate?

It is caused by molding of the skull during labor
It resolves within 24 hours after delivery
It crosses the suture lines of the skull
It is a collection of blood between the periosteum and skull bone limited by suture lines (Correct answer)

Correct answer: It is a collection of blood between the periosteum and skull bone limited by suture lines

A cephalohematoma is a subperiosteal hemorrhage confined by suture lines that does not cross sutures, distinguishing it from caput succedaneum which does cross suture lines.

Question 55: A nurse is assessing a postpartum client's Homans' sign. Which statement about this assessment is accurate?

Homans' sign is an unreliable indicator and DVT requires further diagnostic testing (Correct answer)
A positive Homans' sign definitively diagnoses DVT
Homans' sign is assessed by flexing the knee against resistance
Calf pain on dorsiflexion rules out pulmonary embolism

Correct answer: Homans' sign is an unreliable indicator and DVT requires further diagnostic testing

Homans' sign has poor sensitivity and specificity for DVT; a positive finding warrants Doppler ultrasound for definitive diagnosis.

Question 56: A patient with preeclampsia with severe features delivers at 34 weeks. Magnesium sulfate is continued postpartum. For how long is magnesium typically continued after delivery for seizure prophylaxis?

12 hours postpartum
72 hours postpartum
6–8 hours postpartum
24–48 hours postpartum (Correct answer)

Correct answer: 24–48 hours postpartum

Magnesium sulfate for seizure prophylaxis is typically continued for 24–48 hours postpartum in preeclampsia with severe features, as the risk for eclamptic seizures persists after delivery.

Question 57: Which newborn measurement indicates macrosomia and increases risk for birth injuries?

Birth weight of 3,200 g (7 lb 1 oz)
Head circumference of 34 cm
Length of 50 cm
Birth weight greater than 4,000 g (8 lb 13 oz) (Correct answer)

Correct answer: Birth weight greater than 4,000 g (8 lb 13 oz)

Macrosomia is defined as birth weight >4,000 g and is associated with increased risk of shoulder dystocia, fractures, and brachial plexus injury during delivery.

Question 58: A breastfeeding client asks why her uterine cramping worsens during nursing. What is the correct explanation?

Progesterone levels drop sharply during breastfeeding
The uterus is not involuting properly
Oxytocin released during suckling causes uterine contractions (Correct answer)
Infection is causing uterine irritability

Correct answer: Oxytocin released during suckling causes uterine contractions

Suckling stimulates oxytocin release from the posterior pituitary, which promotes uterine contractions and involution.

Question 59: A newborn has a yellow discoloration of the skin and sclerae at 18 hours of life. How should the nurse interpret this finding?

Pathological jaundice — notify the provider immediately (Correct answer)
Benign finding that resolves without treatment
Normal physiological jaundice
Sign of adequate breastfeeding

Correct answer: Pathological jaundice — notify the provider immediately

Jaundice appearing within the first 24 hours of life is always pathological (e.g., hemolytic disease) and requires immediate evaluation and treatment to prevent kernicterus.

Question 60: A nurse is caring for a client at 31 weeks gestation who is receiving magnesium sulfate for preterm labor. Which assessment finding signals magnesium toxicity requiring the nurse to stop the infusion?

Serum magnesium level of 5 mEq/L
Respiratory rate of 14 breaths per minute
Urine output of 35 mL/hr
Absent deep tendon reflexes (Correct answer)

Correct answer: Absent deep tendon reflexes

Loss of deep tendon reflexes (hyperreflexia resolution) is an early sign of magnesium toxicity and requires the infusion to be stopped immediately; the antidote is calcium gluconate.

Question 61: Which newborn screening test, performed before hospital discharge, detects critical congenital heart defects (CCHD)?

12-lead electrocardiogram
Chest X-ray
Echocardiogram
Pulse oximetry screening on the right hand and either foot (Correct answer)

Correct answer: Pulse oximetry screening on the right hand and either foot

CCHD screening uses pulse oximetry on the right hand (preductal) and one foot (postductal); a difference >3% or reading <95% warrants further evaluation.

Question 62: During the second stage of labor, a nurse observes the fetal head beginning to deliver and notes the cord is wrapped around the neck. The cord cannot be slipped over the head. What is the nurse's next action?

Double-clamp and cut the cord before delivery (Correct answer)
Apply fundal pressure to expedite delivery
Instruct the client to push harder with the next contraction
Perform an emergency cesarean section

Correct answer: Double-clamp and cut the cord before delivery

When a nuchal cord is too tight to slip over the head, the nurse should double-clamp and cut it to allow safe delivery of the baby.

Question 63: A patient is admitted with hyperemesis gravidarum. Which nursing intervention is the highest priority?

Teach relaxation techniques to manage nausea
Assess hydration status and initiate IV fluid replacement (Correct answer)
Encourage small frequent oral meals immediately
Administer antiemetics before assessing dehydration

Correct answer: Assess hydration status and initiate IV fluid replacement

Hyperemesis gravidarum causes severe dehydration and electrolyte imbalances; assessment of hydration status and IV fluid/electrolyte replacement is the immediate priority.

Question 64: A client at 37 weeks gestation reports leaking fluid. The nurse uses nitrazine paper to test the fluid. Which result indicates rupture of membranes?

Nitrazine paper turns orange (pH 5.0)
No color change on nitrazine paper
Nitrazine paper turns blue-green to blue (pH ≥6.5) (Correct answer)
Nitrazine paper turns yellow (pH 4.5)

Correct answer: Nitrazine paper turns blue-green to blue (pH ≥6.5)

Amniotic fluid is alkaline (pH 7.1–7.3), turning nitrazine paper blue-green to blue, distinguishing it from acidic vaginal secretions.

Question 65: During labor, a nurse notes variable decelerations on the fetal monitor. What is the first nursing intervention?

Perform a vaginal exam
Change the maternal position (Correct answer)
Apply oxygen via face mask
Stop oxytocin infusion

Correct answer: Change the maternal position

Variable decelerations are caused by umbilical cord compression; repositioning the mother alleviates cord compression and is always the first intervention.

Question 66: The female reproductive system's activities are being reviewed in a lecture by a nursing professor. She requests a description of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the student nurse. The student nurse responds truthfully by claiming that:

FSH and LH are released from the anterior pituitary gland. (Correct answer)
FSH and LH are secreted by the adrenal glands
FSH and LH are secreted by the corpus luteum of the ovary
FSH and LH stimulate the formation of milk during pregnancy.

Correct answer: FSH and LH are released from the anterior pituitary gland.

When the hypothalamic gonadotropin-releasing hormone (GnRH) stimulates follicular growth and development, the Graafian follicle expands, and progesterone production, FSH and LH are released from the anterior pituitary gland.

Question 67: The nurse is teaching a new parent about the newborn's umbilical cord care. Which instruction is most current and evidence-based?

Apply antibiotic ointment to the cord base daily
Keep the cord stump moist with petroleum jelly
Allow the cord to dry naturally and keep it clean and dry (Correct answer)
Apply alcohol to the cord stump with each diaper change

Correct answer: Allow the cord to dry naturally and keep it clean and dry

Current evidence-based guidelines recommend dry cord care — keeping the stump clean and dry — as it promotes natural separation without increasing infection risk.

Question 68: A full-term newborn is diagnosed with transient tachypnea of the newborn (TTN). Which delivery method puts a newborn at higher risk for TTN?

Forceps-assisted vaginal delivery
Elective cesarean section without labor (Correct answer)
Vaginal delivery with prolonged labor
Vacuum-assisted vaginal delivery

Correct answer: Elective cesarean section without labor

TTN occurs when fetal lung fluid is not adequately expelled; labor contractions and passage through the birth canal compress the chest and help clear lung fluid — skipped in elective cesarean.

Question 69: A nurse assesses a newborn's blood glucose 30 minutes after birth. The result is 38 mg/dL. What should the nurse do first?

Report the finding to the provider and await orders before acting
Initiate early feeding (breast or formula) and recheck glucose in 30–60 minutes (Correct answer)
Administer IV dextrose immediately
Document the finding as normal and continue routine care

Correct answer: Initiate early feeding (breast or formula) and recheck glucose in 30–60 minutes

A blood glucose <47 mg/dL in a newborn is hypoglycemia; the first-line treatment is early oral feeding, followed by retesting to confirm response before escalating to IV dextrose.

Question 70: A client at 20 weeks gestation reports painful leg cramps at night. The nurse's best recommendation is to:

Dorsiflex the foot during the cramp (Correct answer)
Restrict fluid intake after dinner
Apply heat and massage the calf vigorously
Increase sodium intake to prevent muscle spasms

Correct answer: Dorsiflex the foot during the cramp

Dorsiflexing the foot stretches the gastrocnemius muscle and relieves the cramp; plantarflexion worsens it.

Question 71: Which assessment finding in a newborn at 24 hours of life requires immediate provider notification?

Respiratory rate of 40 breaths per minute
Acrocyanosis of the hands and feet
Respiratory rate of 68 breaths per minute with grunting (Correct answer)
Passage of meconium stool

Correct answer: Respiratory rate of 68 breaths per minute with grunting

A respiratory rate >60 breaths per minute with grunting indicates respiratory distress and requires immediate provider notification to evaluate for infection or respiratory pathology.

Question 72: A client in active labor has an external fetal monitor showing late decelerations with each contraction. The nurse's priority action is to:

Prepare for immediate cesarean delivery without further assessment
Document the finding and continue to monitor
Reposition the client to the left lateral position and apply oxygen (Correct answer)
Increase IV oxytocin rate to shorten labor

Correct answer: Reposition the client to the left lateral position and apply oxygen

Late decelerations indicate uteroplacental insufficiency; repositioning to the left lateral position and applying oxygen are the initial nursing interventions to improve placental perfusion.

Question 73: Which finding on a biophysical profile (BPP) is considered reassuring?

Score of 4 with absent fetal breathing movements
Amniotic fluid index of 3 cm
Score of 8 out of 10 with two or more breathing movements, tone, movement, and reactive NST (Correct answer)
Non-reactive NST with no accelerations

Correct answer: Score of 8 out of 10 with two or more breathing movements, tone, movement, and reactive NST

A BPP score of 8–10 is reassuring; each component (breathing, movement, tone, amniotic fluid, NST) earns 2 points when present, indicating fetal well-being.

Question 74: A client delivered 3 days ago and reports crying spells, mood swings, and irritability but states these feelings feel temporary and manageable. Which condition does the nurse recognize?

Postpartum blues (baby blues) (Correct answer)
Postpartum anxiety disorder
Postpartum psychosis
Postpartum depression

Correct answer: Postpartum blues (baby blues)

Postpartum blues typically onset within 3–5 days after delivery, are transient, and resolve within 2 weeks without treatment.

Question 75: A neonate is showing signs of neonatal abstinence syndrome (NAS). Which set of findings is consistent with this diagnosis?

Hypoglycemia, central cyanosis, weak suck
Hypotonia, lethargy, bradycardia, hypothermia
Jaundice, hepatomegaly, petechiae
High-pitched cry, tremors, poor feeding, diarrhea (Correct answer)

Correct answer: High-pitched cry, tremors, poor feeding, diarrhea

NAS results from opioid or other substance withdrawal and is characterized by high-pitched cry, irritability, tremors, poor feeding, and GI disturbances such as diarrhea.

Question 76: A woman who has just given birth to a healthy newborn baby is about to receive postpartum care from a postpartum nurse. The nurse intends to take the mother's vital signs in the early postpartum period:

Every 15 minutes during the first hour and then every 30 minutes for the next two hours. (Correct answer)
Every 5 minutes for the first 30 minutes and then every hour for the next 4 hours.
Every hour for the first 2 hours and then every 4 hours.
Every 30 minutes during the first hour and then every hour for the next two hours.

Correct answer: Every 15 minutes during the first hour and then every 30 minutes for the next two hours.

The first 6 to 12 hours postpartum are considered to be the first or acute stage. There is a chance for urgent emergencies such postpartum hemorrhage, uterine inversion, amniotic fluid embolism, and eclampsia during this period of fast transformation.

Question 77: A nurse is assessing a newborn for developmental dysplasia of the hip (DDH). Which maneuver assesses for a dislocatable hip?

Ortolani maneuver — abduction with upward pressure detects a 'clunk' of reduction
Trendelenburg test — single-leg stance to assess gluteal muscle strength
Galeazzi sign — unequal knee heights assessed with hips and knees flexed
Barlow maneuver — adduction with downward pressure assesses for dislocation (Correct answer)

Correct answer: Barlow maneuver — adduction with downward pressure assesses for dislocation

The Barlow maneuver adducts and applies posterior pressure to determine if the femoral head can be dislocated out of the acetabulum.

Question 78: At 12 hours of life, a newborn has not passed meconium. Which assessment finding would most concern the nurse?

Mild acrocyanosis of the hands and feet
Abdominal distention with absent bowel sounds (Correct answer)
Passage of transitional stool instead of meconium
Presence of vernix in the groin folds

Correct answer: Abdominal distention with absent bowel sounds

Abdominal distension with absent bowel sounds in a newborn who has not passed meconium may indicate intestinal obstruction such as Hirschsprung disease or meconium ileus.

Question 79: A nurse is caring for a client receiving magnesium sulfate for severe preeclampsia. Which assessment finding requires the nurse to withhold the next dose?

Urine output of 35 mL/hr
Blood pressure 158/104 mmHg
Deep tendon reflexes 2+
Respiratory rate of 10 breaths/min (Correct answer)

Correct answer: Respiratory rate of 10 breaths/min

A respiratory rate below 12 breaths/min is a sign of magnesium toxicity and the infusion must be stopped immediately.

Question 80: A patient at 32 weeks gestation with a placenta previa has received betamethasone 12 mg IM. When should the second dose be administered?

24 hours after the first dose (Correct answer)
48 hours after the first dose
72 hours after the first dose
12 hours after the first dose

Correct answer: 24 hours after the first dose

The standard antenatal corticosteroid regimen for betamethasone is two doses of 12 mg IM given 24 hours apart to achieve optimal fetal lung maturation.

Question 81: The Edinburgh Postnatal Depression Scale (EPDS) is used to screen for postpartum depression. What score indicates a positive screen requiring further clinical evaluation?

Score of 15 or above
Score of 5 or above
Score of 10 or above (Correct answer)
Score of 20 or above

Correct answer: Score of 10 or above

A score of 10 or above on the EPDS is the accepted threshold indicating a positive screen for postpartum depression and warrants further clinical evaluation.

Question 82: A patient is diagnosed with a postpartum deep vein thrombosis (DVT) of the left leg. Which assessment finding is consistent with this diagnosis?

Bilateral leg edema with cool, pale skin
Superficial varicosities with bilateral calf cramps
Absence of pedal pulses bilaterally
Unilateral leg warmth, redness, edema, and pain with dorsiflexion (Correct answer)

Correct answer: Unilateral leg warmth, redness, edema, and pain with dorsiflexion

DVT presents with unilateral signs because a thrombus forms in one vessel; warmth, erythema, edema, and calf pain with dorsiflexion (Homan's sign) are classic but not always reliable indicators.

Question 83: A nurse is preparing to administer vitamin K (phytonadione) to a newborn. Which site and route are correct?

Subcutaneous tissue of the abdomen
Intravenous via umbilical vein
Vastus lateralis, intramuscular (Correct answer)
Deltoid muscle, intramuscular

Correct answer: Vastus lateralis, intramuscular

Vitamin K is administered intramuscularly into the vastus lateralis (anterolateral thigh) muscle in newborns, as it is the preferred IM site.

Question 84: A newborn requires resuscitation in the delivery room. Epinephrine is administered via the endotracheal tube. What is the correct dose range?

0.1 mg/kg of 1:10,000 concentration
0.5 mg/kg of 1:100,000 concentration
0.01–0.03 mg/kg of 1:10,000 concentration via IV/IO (0.05–0.1 mg/kg via ETT) (Correct answer)
0.01–0.03 mg/kg of 1:1,000 concentration

Correct answer: 0.01–0.03 mg/kg of 1:10,000 concentration via IV/IO (0.05–0.1 mg/kg via ETT)

Per NRP guidelines, IV/IO epinephrine dose is 0.01–0.03 mg/kg of 1:10,000 solution; the endotracheal dose is higher (0.05–0.1 mg/kg) due to less reliable absorption.

Question 85: A new mother reports that her breastfed newborn is 3 days old and her milk has not yet 'come in.' What is the appropriate nursing response?

Contact the provider to prescribe galactogogues
Reassure her that colostrum is sufficient for the newborn at this stage and milk transition occurs by days 3–5 (Correct answer)
Recommend supplementing with formula immediately
Advise stopping breastfeeding and switching to formula

Correct answer: Reassure her that colostrum is sufficient for the newborn at this stage and milk transition occurs by days 3–5

Transitional milk replaces colostrum between days 3–5 postpartum; colostrum provides all the nutrition and immunological factors a newborn needs in the first days.

Question 86: A client at 18 weeks gestation asks about amniocentesis. The nurse explains the PRIMARY purpose of amniocentesis in the second trimester is to:

Assess fetal lung maturity
Measure fetal blood glucose
Evaluate fetal chromosomal abnormalities (Correct answer)
Determine placental location

Correct answer: Evaluate fetal chromosomal abnormalities

Second-trimester amniocentesis is primarily used for genetic diagnosis of chromosomal abnormalities such as Down syndrome (trisomy 21).

Question 87: Which finding on newborn skin assessment is a normal variation that does NOT require intervention?

Port-wine stain over the face
Pustular rash spreading rapidly
Pallor with mottling persisting beyond 2 hours
Erythema toxicum (Correct answer)

Correct answer: Erythema toxicum

Erythema toxicum neonatorum is a benign, self-limiting rash of unknown cause appearing in 30–70% of full-term newborns and requires no treatment.

Question 88: A patient develops disseminated intravascular coagulation (DIC) following placental abruption. Which laboratory result is consistent with DIC?

Decreased fibrinogen, prolonged PT and aPTT, elevated D-dimer (Correct answer)
Elevated fibrinogen, decreased PT, decreased aPTT
Decreased D-dimer, elevated hemoglobin
Elevated platelets, normal clotting times

Correct answer: Decreased fibrinogen, prolonged PT and aPTT, elevated D-dimer

DIC causes simultaneous clotting and bleeding, consuming clotting factors and platelets, resulting in low fibrinogen, prolonged PT/aPTT, elevated D-dimer, and thrombocytopenia.

Question 89: During a prenatal visit at 10 weeks, a client discloses she drinks two glasses of wine per day. The nurse's BEST response is:

Reassure her that alcohol only affects the fetus in the third trimester
Advise the client that no amount of alcohol is known to be safe during pregnancy (Correct answer)
That is acceptable as long as it does not exceed three drinks per day
Suggest switching to beer which is lower in alcohol content

Correct answer: Advise the client that no amount of alcohol is known to be safe during pregnancy

There is no established safe level of alcohol consumption during pregnancy; alcohol crosses the placenta and can cause fetal alcohol spectrum disorders at any gestational age.

Question 90: A patient at 20 weeks gestation is diagnosed with an incompetent cervix and undergoes cervical cerclage. Which discharge instruction should the nurse provide?

Resume all normal activities including sexual intercourse
Report any uterine contractions, bleeding, or ruptured membranes immediately (Correct answer)
Expect some cervical bleeding for 4–6 weeks
Avoid all prenatal vitamins after the procedure

Correct answer: Report any uterine contractions, bleeding, or ruptured membranes immediately

After cerclage placement, patients must be educated to report contractions, bleeding, or membrane rupture immediately as these may indicate cerclage failure or preterm labor.

Question 91: A patient receives terbutaline for preterm labor. Which maternal side effect requires the nurse to notify the healthcare provider immediately?

Mild headache and facial flushing
Heart rate of 130 bpm with chest pain (Correct answer)
Transient nausea and diaphoresis
Mild tremors and palpitations

Correct answer: Heart rate of 130 bpm with chest pain

Tachycardia above 120 bpm with chest pain may indicate cardiac dysrhythmia or pulmonary edema, serious complications of terbutaline that require immediate medical evaluation.

Question 92: The nurse assesses a newborn's respiratory rate as 68 breaths per minute consistently over 15 minutes. What condition does this most likely indicate?

Bradypnea requiring immediate resuscitation
Cheyne-Stokes breathing pattern
Normal respiratory rate for a newborn
Tachypnea suggesting respiratory distress (Correct answer)

Correct answer: Tachypnea suggesting respiratory distress

Normal newborn respiratory rate is 30–60 breaths per minute; a sustained rate of 68 breaths per minute is tachypnea indicating potential respiratory distress.

Question 93: A client scores 14 on the Edinburgh Postnatal Depression Scale at her 6-week postpartum visit. What is the nurse's priority action?

Reassure the client that this score is within normal limits
Conduct further assessment including evaluation for suicidal ideation (Correct answer)
Recommend herbal remedies for mood improvement
Schedule a routine follow-up appointment in 4 weeks

Correct answer: Conduct further assessment including evaluation for suicidal ideation

A score of 14 on the EPDS is significantly above the threshold of 10, indicating serious risk that requires immediate comprehensive assessment including suicide risk evaluation.

Question 94: A nurse is assessing lochia in a client on postpartum day 5. Which finding is expected?

Lochia alba — white-yellow creamy discharge
Lochia serosa — pinkish-brown, serosanguineous discharge (Correct answer)
Heavy bright red flow soaking one pad per hour
Lochia rubra — bright red with clots

Correct answer: Lochia serosa — pinkish-brown, serosanguineous discharge

By postpartum day 3–10, lochia transitions from rubra to serosa, which is pinkish-brown and serosanguineous in character.

Question 95: A patient is admitted with suspected placenta previa at 32 weeks gestation. She is experiencing bright red, painless vaginal bleeding. Which assessment is CONTRAINDICATED?

External fetal heart rate monitoring
Abdominal ultrasound
IV access placement
Digital vaginal examination (Correct answer)

Correct answer: Digital vaginal examination

Digital vaginal examination is absolutely contraindicated in placenta previa because it can disrupt the placenta and cause catastrophic hemorrhage; diagnosis is confirmed by ultrasound.

Question 96: Which maternal lab value is most concerning in a client with HELLP syndrome?

Hemoglobin of 11.2 g/dL
Serum creatinine of 0.9 mg/dL
ALT of 25 IU/L
Platelet count of 80,000/mm³ (Correct answer)

Correct answer: Platelet count of 80,000/mm³

HELLP syndrome is characterized by hemolysis, elevated liver enzymes, and low platelets; a platelet count of 80,000/mm³ is critically low and indicates severe disease with bleeding risk.

Question 97: Which laboratory finding is characteristic of HELLP syndrome?

Elevated liver enzymes, low platelets, and hemolysis (Correct answer)
Decreased white blood cell count and low hemoglobin
Elevated platelets and decreased liver enzymes
Normal platelets with markedly elevated blood pressure

Correct answer: Elevated liver enzymes, low platelets, and hemolysis

HELLP syndrome stands for Hemolysis, Elevated Liver enzymes, and Low Platelets — a severe variant of preeclampsia that can be life-threatening.

Question 98: A term newborn is delivered and placed on the mother's abdomen. The nurse's initial assessment reveals the baby is breathing but has central cyanosis. What is the priority action?

Stimulate the infant vigorously by rubbing the back
Begin chest compressions immediately
Transfer to the NICU without delay
Administer blow-by oxygen and reassess within 60 seconds (Correct answer)

Correct answer: Administer blow-by oxygen and reassess within 60 seconds

Central cyanosis in a breathing newborn warrants supplemental oxygen delivery (blow-by) and immediate reassessment to determine if further resuscitation is needed.

Question 99: A nurse is preparing to give a newborn the first bath. Which condition must be met before the bath is given?

The newborn's temperature must be stable at 36.5°C or above for at least 1 hour (Correct answer)
The newborn must have passed the first meconium stool
The provider must write a bath order
The newborn must be at least 12 hours old

Correct answer: The newborn's temperature must be stable at 36.5°C or above for at least 1 hour

Bathing is delayed until the newborn's temperature is stable (≥36.5°C) to prevent cold stress and hypothermia; WHO recommends delaying the first bath ≥24 hours.

Question 100: The nurse teaches a client in her first trimester about physiologic changes of pregnancy. Which cardiovascular change is EXPECTED?

Decrease in plasma volume by 10%
Decrease in cardiac output in the second trimester
Increase in heart rate by 10–15 bpm (Correct answer)
Increase in blood pressure throughout pregnancy

Correct answer: Increase in heart rate by 10–15 bpm

Maternal heart rate normally increases by 10–15 beats per minute during pregnancy to meet increased metabolic demands.

Question 101: Which method is used to verify placement of a nasogastric (NG) tube in a newborn before feeding?

Rely on the insertion depth measured before placement alone
Inject air and auscultate for a whoosh sound only
Place the tube end in water to check for bubbling
Aspirate gastric contents and confirm pH ≤5 along with measuring the external tube length (Correct answer)

Correct answer: Aspirate gastric contents and confirm pH ≤5 along with measuring the external tube length

NG tube placement is verified by pH testing of aspirated gastric contents (pH ≤5 confirms gastric placement) and confirming the external tube length matches pre-insertion measurement.

Question 102: A client at 26 weeks gestation is admitted with preterm labor. Which medication is administered to accelerate fetal lung maturity?

Nifedipine
Progesterone
Betamethasone (Celestone) (Correct answer)
Magnesium sulfate

Correct answer: Betamethasone (Celestone)

Antenatal corticosteroids such as betamethasone (given at 24–34 weeks) stimulate surfactant production, reducing the risk of neonatal respiratory distress syndrome.

Question 103: Which fetal heart rate pattern requires the nurse to immediately notify the healthcare provider and prepare for possible emergency delivery?

Moderate variability
Accelerations with fetal movement
Early decelerations
Prolonged deceleration lasting more than 3 minutes (Correct answer)

Correct answer: Prolonged deceleration lasting more than 3 minutes

A prolonged deceleration lasting more than 3 minutes indicates significant fetal compromise and requires immediate intervention to prevent fetal hypoxia.

Question 104: What is the expected weight loss considered normal in a newborn during the first week of life?

Up to 15% of birth weight
No weight loss is normal
Up to 3% of birth weight
Up to 7–10% of birth weight (Correct answer)

Correct answer: Up to 7–10% of birth weight

Newborns typically lose up to 7–10% of birth weight in the first few days due to fluid shifts and meconium passage; birth weight is usually regained by 10–14 days.

Question 105: Which assessment best indicates that postpartum involution is progressing normally on day 3?

Fundus palpable at the symphysis pubis
Fundus not palpable abdominally
Fundus 3 cm below the umbilicus (Correct answer)
Fundus palpable at the umbilicus

Correct answer: Fundus 3 cm below the umbilicus

The uterus descends approximately 1 cm (one fingerbreadth) per day; by day 3 it should be approximately 3 cm below the umbilicus.

Question 106: A client at 36 weeks gestation presents with sudden, severe abdominal pain, a rigid board-like abdomen, and dark red vaginal bleeding. Fetal heart tones are difficult to auscultate. The nurse suspects:

Placenta previa with active hemorrhage
Severe abruptio placentae (Correct answer)
Preterm labor with bloody show
Uterine rupture from previous cesarean scar

Correct answer: Severe abruptio placentae

Sudden severe abdominal pain, board-like uterine rigidity, dark red vaginal bleeding, and compromised fetal heart tones are classic signs of severe abruptio placentae.

Question 107: A patient is to receive dinoprostone (Cervidil) cervical ripening insert. How long should the insert remain in place if no adverse reactions occur?

Up to 24 hours or until active labor begins
6–8 hours or until active labor begins
12 hours or until active labor begins (Correct answer)
2–4 hours or until active labor begins

Correct answer: 12 hours or until active labor begins

Cervidil (dinoprostone 10 mg) is designed to release prostaglandin slowly over 12 hours; it should be removed at 12 hours, with onset of active labor, or if uterine hyperstimulation or adverse fetal effects occur.

Question 108: A newborn is placed under phototherapy for hyperbilirubinemia. Which nursing intervention is MOST important during phototherapy?

Keep the infant bundled warmly to maintain temperature
Cover the eyes with opaque shields to protect from retinal damage (Correct answer)
Position the infant prone for maximum light exposure
Restrict feedings to 3-hour intervals only

Correct answer: Cover the eyes with opaque shields to protect from retinal damage

Eye shields must be applied during phototherapy to protect the newborn's retinas and corneas from intense light exposure that can cause permanent damage.

Question 109: For the initial prenatal evaluation, a customer shows up at a prenatal clinic. The patient informs the nurse that her most recent period began on September 19, 2013, according to her last period. The nurse calculates the anticipated date of confinement as follows using Naegele's rule:

June 12, 2014
July 12, 2014
July 26, 2013
June 26, 2014 (Correct answer)

Correct answer: June 26, 2014

It is necessary for the woman to have a regular 28-day menstrual cycle in order to apply Naegele's rule correctly. The last menstrual period's starting day is multiplied by seven days, three months are subtracted, and finally one year is added.

Question 110: During delivery, the nurse observes a tight nuchal cord. What is the most appropriate first action?

Apply immediate fundal pressure
Clamp and cut the cord immediately
Perform an emergency cesarean delivery
Attempt to slip the cord over the fetal head or perform a somersault maneuver (Correct answer)

Correct answer: Attempt to slip the cord over the fetal head or perform a somersault maneuver

A nuchal cord should first be managed by slipping it over the fetal head; if too tight, the somersault maneuver allows delivery without clamping and cutting.

Question 111: A pregnant client at 28 weeks gestation is prescribed the Rh immunoglobulin (RhoGAM) injection. The nurse knows this is indicated because the client is:

Rh-positive with an Rh-negative fetus
Rh-negative with an Rh-negative fetus
Rh-positive with an Rh-positive fetus
Rh-negative with an Rh-positive fetus (Correct answer)

Correct answer: Rh-negative with an Rh-positive fetus

RhoGAM is given to Rh-negative mothers who may be carrying an Rh-positive fetus to prevent isoimmunization.

Question 112: Which vitamin supplement is recommended for all exclusively breastfed infants shortly after birth?

Vitamin C 100 mg daily
Vitamin B12 supplement
Vitamin D 400 IU daily (Correct answer)
Iron 1 mg/kg/day

Correct answer: Vitamin D 400 IU daily

Breast milk is low in vitamin D; the AAP recommends 400 IU/day of vitamin D supplementation for all breastfed infants starting within the first few days of life.

Question 113: A pregnant patient has a hemoglobin of 9.2 g/dL and is diagnosed with iron-deficiency anemia. Which instruction about iron supplementation is most important?

Take iron with orange juice or vitamin C to enhance absorption (Correct answer)
Take iron with meals only to prevent nausea
Take iron with milk to enhance absorption
Take iron with calcium supplements to improve tolerance

Correct answer: Take iron with orange juice or vitamin C to enhance absorption

Vitamin C (ascorbic acid) enhances the absorption of non-heme iron by converting ferric iron to the more absorbable ferrous form; dairy products and calcium decrease iron absorption.

Question 114: A postpartum client is Rh-negative and delivered an Rh-positive infant. When should Rho(D) immune globulin (RhoGAM) be administered?

Only if the Coombs test is positive
At the 6-week postpartum visit
Within 72 hours of delivery (Correct answer)
Within 12 hours of delivery

Correct answer: Within 72 hours of delivery

RhoGAM must be given within 72 hours of delivery to prevent maternal sensitization against Rh-positive fetal red blood cells.

Question 115: Which pain management intervention is evidence-based for use during painful newborn procedures such as heel sticks?

No intervention is needed as newborns do not feel pain
Oral sucrose solution given 2 minutes before the procedure (Correct answer)
Topical EMLA cream applied 60 minutes before
IV morphine administration

Correct answer: Oral sucrose solution given 2 minutes before the procedure

Oral sucrose (24% solution, 0.5–2 mL) administered 2 minutes before painful procedures activates endogenous opioid pathways and reduces behavioral pain responses in newborns.

Question 116: A client with mastitis is prescribed antibiotics. Which instruction should the nurse include?

Stop breastfeeding until the infection clears
Apply cold compresses only to reduce inflammation
Continue breastfeeding or pumping to prevent milk stasis (Correct answer)
Wean the infant immediately to rest the breast

Correct answer: Continue breastfeeding or pumping to prevent milk stasis

Continued breastfeeding or pumping is recommended during mastitis because stopping can worsen engorgement, promote abscess formation, and prolong infection.

Question 117: A newborn with suspected sepsis has a white blood cell count of 4,000 cells/mcL. What does this finding indicate?

Lymphocytosis suggesting viral infection
Normal neonatal WBC value, no concern
Leukocytosis suggesting bacterial infection
Leukopenia, which is an ominous sign of overwhelming infection (Correct answer)

Correct answer: Leukopenia, which is an ominous sign of overwhelming infection

A WBC below 5,000 cells/mcL (leukopenia) in a neonate indicates the bone marrow cannot keep up with bacterial consumption of white cells, suggesting overwhelming sepsis with poor prognosis.

Question 118: Which normal newborn reflex disappears by approximately 3–4 months of age and indicates intact neurological function at birth?

Rooting reflex
Moro (startle) reflex (Correct answer)
Plantar grasp reflex
Babinski reflex

Correct answer: Moro (startle) reflex

The Moro reflex (symmetric arm extension/abduction followed by adduction) is present at birth and normally disappears by 3–4 months as cortical control matures.

Question 119: A 34-week neonate is started on caffeine citrate for apnea of prematurity. What is the primary mechanism of action?

Inhibits adenosine receptors in the brainstem to stimulate respiratory drive (Correct answer)
Causes bronchodilation by relaxing smooth muscle
Stimulates surfactant production in type II pneumocytes
Activates dopamine receptors to increase heart rate

Correct answer: Inhibits adenosine receptors in the brainstem to stimulate respiratory drive

Caffeine citrate works by blocking adenosine receptors in the brainstem respiratory centers, increasing sensitivity to CO2 and stimulating respiratory effort to reduce apneic episodes.

Question 120: A postpartum patient develops a temperature of 38.4°C (101.1°F) on day 2 after a cesarean birth. She has uterine tenderness and foul-smelling lochia. What does this indicate?

Endometritis requiring antibiotic therapy (Correct answer)
Wound dehiscence requiring surgical consultation
Normal postoperative fever response
Mastitis requiring warm compresses

Correct answer: Endometritis requiring antibiotic therapy

Fever after the first 24 hours postpartum with uterine tenderness and malodorous lochia is characteristic of endometritis, a uterine infection requiring broad-spectrum antibiotic treatment.

Question 121: A breastfeeding mother reports white, shiny, painful nipples between feedings with a shooting pain into the breast. What condition should the nurse suspect?

Normal postpartum engorgement
Raynaud's phenomenon of the nipple
Mastitis
Nipple and breast candidiasis (thrush) (Correct answer)

Correct answer: Nipple and breast candidiasis (thrush)

Candidal nipple infection presents with shiny, white, painful nipples and deep, shooting breast pain between feedings; both mother and infant (oral thrush) require simultaneous antifungal treatment.

Question 122: A patient with gestational diabetes is at 38 weeks gestation. Her fasting glucose readings have been 95–105 mg/dL on dietary management alone. What intervention is indicated?

Initiate insulin therapy as dietary control has failed (Correct answer)
Continue dietary management and recheck at 40 weeks
Schedule immediate induction of labor
Switch to oral hypoglycemic agents such as glyburide

Correct answer: Initiate insulin therapy as dietary control has failed

Fasting glucose levels above 95 mg/dL despite dietary management indicate inadequate blood glucose control, and insulin therapy should be initiated to protect fetal outcomes.

Question 123: A postpartum client is breastfeeding and asks about contraception. Which method is safest to recommend at 6 weeks postpartum?

Estrogen patch
Monthly contraceptive injection (Depo-Provera given in first 3 days)
Progestin-only mini-pill (Correct answer)
Combined oral contraceptive pills

Correct answer: Progestin-only mini-pill

Progestin-only contraceptives do not suppress milk supply and are the preferred hormonal contraceptive option for breastfeeding mothers.

Question 124: A gravida 3, para 2 client is at 38 weeks gestation and reports decreased fetal movement. The nurse performs a nonstress test (NST). Which result is considered REACTIVE?

One acceleration of 10 bpm lasting 10 seconds in 40 minutes
Variable decelerations with each fetal movement
Absence of fetal movement with no accelerations
Two accelerations of 15 bpm lasting 15 seconds in 20 minutes (Correct answer)

Correct answer: Two accelerations of 15 bpm lasting 15 seconds in 20 minutes

A reactive NST requires at least two fetal heart rate accelerations of ≥15 bpm above baseline, each lasting ≥15 seconds, within a 20-minute period.

Question 125: A breastfeeding mother reports severe nipple pain throughout the entire feeding. What is the most likely cause?

Nipple shield use
Overactive let-down reflex
Normal breast engorgement
Incorrect latch with the infant only on the nipple, not the areola (Correct answer)

Correct answer: Incorrect latch with the infant only on the nipple, not the areola

Persistent nipple pain throughout feeding almost always indicates a poor latch; the infant should have most of the areola in the mouth, not just the nipple.

Question 126: A nurse is teaching a client about signs of preterm labor. Which symptom should the client report immediately?

Urinary frequency without burning at 28 weeks
Braxton Hicks contractions every 20–30 minutes that stop with rest
Increased white creamy vaginal discharge at 36 weeks
A low backache that comes and goes every 10 minutes at 32 weeks (Correct answer)

Correct answer: A low backache that comes and goes every 10 minutes at 32 weeks

Regular low backaches occurring every 10 minutes at 32 weeks may indicate preterm labor contractions and require immediate medical evaluation.

Question 127: A breastfeeding mother is prescribed codeine for postpartum pain. Why is this medication of particular concern for her breastfed infant?

Codeine increases neonatal alertness and feeding difficulty
Ultra-rapid metabolizers convert codeine to morphine at higher rates, risking neonatal opioid toxicity (Correct answer)
Codeine causes maternal hypotension affecting milk production
Codeine is not absorbed through breast milk

Correct answer: Ultra-rapid metabolizers convert codeine to morphine at higher rates, risking neonatal opioid toxicity

Ultra-rapid CYP2D6 metabolizers convert codeine to morphine faster than normal, leading to dangerously high morphine levels in breast milk that can cause neonatal respiratory depression.

Question 128: A patient develops eclampsia and begins seizing during labor. What is the nurse's FIRST priority action?

Turn the patient to her side and protect her from injury (Correct answer)
Time and document the seizure
Call for emergency assistance immediately
Administer magnesium sulfate IV bolus

Correct answer: Turn the patient to her side and protect her from injury

The first priority during an eclamptic seizure is patient safety — turning her to the side prevents aspiration and maintains a patent airway while protecting her from self-injury.

Question 129: Erythromycin ophthalmic ointment is administered to newborns to prevent which infection?

Ophthalmia neonatorum caused by Neisseria gonorrhoeae and Chlamydia trachomatis (Correct answer)
Neonatal herpes simplex eye infection
Group B Streptococcal conjunctivitis
Retinopathy of prematurity

Correct answer: Ophthalmia neonatorum caused by Neisseria gonorrhoeae and Chlamydia trachomatis

Erythromycin 0.5% ophthalmic ointment is required by law in most US states to prevent ophthalmia neonatorum, a potentially blinding infection transmitted during vaginal delivery.

Question 130: A patient at 34 weeks gestation presents with a blood pressure of 158/106 mmHg, severe headache, visual disturbances, and 3+ proteinuria. What condition does this represent?

Gestational hypertension
Severe feature preeclampsia (Correct answer)
HELLP syndrome
Chronic hypertension

Correct answer: Severe feature preeclampsia

Blood pressure ≥160/110 mmHg with severe symptoms (headache, visual changes) and significant proteinuria meets criteria for preeclampsia with severe features requiring urgent intervention.

Question 131: A postpartum patient had ruptured membranes for 24 hours and spent 30 hours in labor. The nurse would be on the lookout for which of the following?

Endometritis (Correct answer)
Pelvic thrombophlebitis
Endometriosis
Salpingitis

Correct answer: Endometritis

Endometritis, an infection of the uterine lining, can develop after a protracted membrane rupture. Abdominal swelling, unusual vaginal bleeding or discharge, fever, bowel movement discomfort, and pain in the lower abdomen or pelvis are among the symptoms.

Question 132: A client with postpartum depression wishes to continue breastfeeding. Which antidepressant is generally considered the safest first-line choice for breastfeeding mothers?

Sertraline (Zoloft) (Correct answer)
Fluoxetine (Prozac)
Venlafaxine (Effexor)
Paroxetine (Paxil)

Correct answer: Sertraline (Zoloft)

Sertraline (Zoloft) is the preferred SSRI for breastfeeding mothers with PPD due to minimal transfer into breast milk and the most extensive infant safety data.

Question 133: A nurse assesses a large bruise over the occiput of a newborn's head that does not cross the suture line and is firm to touch. This finding is consistent with which condition?

Molding
Caput succedaneum
Cephalhematoma (Correct answer)
Subdural hematoma

Correct answer: Cephalhematoma

Cephalhematoma is a collection of blood between the periosteum and skull bone that does not cross suture lines, is firm to palpation, and appears within hours after birth.

Question 134: A newborn is born to a mother with insulin-dependent diabetes. Which complication is the newborn at HIGHEST risk for in the first hours of life?

Hyperglycemia
Hypocalcemia
Hypoglycemia (Correct answer)
Hypernatremia

Correct answer: Hypoglycemia

Infants of diabetic mothers have pancreatic beta-cell hyperplasia from chronic in utero hyperglycemia; after delivery they lose maternal glucose but continue producing excess insulin, causing hypoglycemia.

Question 135: Which finding during the second stage of labor indicates the nurse should prepare for an imminent delivery?

Increased bloody show
Complete cervical dilation
Rupture of membranes
Crowning of the fetal head (Correct answer)

Correct answer: Crowning of the fetal head

Crowning, where the largest diameter of the fetal head is visible at the vaginal introitus without retraction between contractions, signals that delivery is imminent.

Question 136: During a client's admittance evaluation who is carrying twins, a nurse is gathering data. The client informs the nurse that she has a healthy 5-year-old child who was born at 37 weeks and that she has no prior history of abortion or fetal demise. The GTPAL for this client would be noted by the nurse as follows:

Gravida 2, para 1001 (Correct answer)
Gravida 1, para 1101
Gravida 3, para 2001
Gravida 2, para 0101

Correct answer: Gravida 2, para 1001

The abbreviation GTPAL can be used to denote pregnancy outcomes. Our GTPAL Guide can be used to learn more about obstetric history. - ""G"" stands for gravidity, or the quantity of pregnancies. - ""T"" stands for term births, or the number of babies delivered at term (37 weeks or later). - Preterm births are those occurring between 20 and 36 weeks of pregnancy, or ""P"" births. - ""A"" refers to abortions, miscarriages, and pre-20 week losses. - ""L"" stands for live births, or the quantity of children born alive.

Question 137: A postpartum client is being discharged on postpartum day 2. Which instruction about activity is most appropriate?

Begin gentle walking and gradually increase activity as tolerated (Correct answer)
Return to full pre-pregnancy exercise immediately
Avoid all physical activity for six weeks
Limit stair climbing for at least four weeks

Correct answer: Begin gentle walking and gradually increase activity as tolerated

Gradual resumption of activity starting with gentle walking promotes recovery without risking excessive bleeding or fatigue.

Question 138: A pregnant patient at 28 weeks is diagnosed with gestational diabetes after a 3-hour glucose tolerance test. Which dietary change is the first-line management?

Carbohydrate-controlled diet with 3 meals and 2–3 snacks (Correct answer)
Unrestricted diet with metformin supplementation
Total fasting until insulin therapy is initiated
High-protein, fat-only diet to avoid all sugars

Correct answer: Carbohydrate-controlled diet with 3 meals and 2–3 snacks

Medical nutrition therapy with carbohydrate counting (typically 45–60 g per meal, 15–30 g per snack) distributed across small frequent meals is the first-line treatment for gestational diabetes.

Question 139: The nurse assesses a client 30 minutes after epidural placement and notes the blood pressure has dropped from 118/72 to 88/52 mmHg. What is the priority intervention?

Place the client in Trendelenburg position
Discontinue the epidural catheter
Administer epinephrine IV push
Increase IV fluid infusion rate and reposition to left lateral position (Correct answer)

Correct answer: Increase IV fluid infusion rate and reposition to left lateral position

Epidural-induced hypotension is treated first with IV fluid bolus and left lateral positioning to displace the uterus off the vena cava and restore venous return.

Question 140: At 1 minute of life, a newborn has a heart rate of 98 bpm, slow irregular respirations, some flexion of extremities, a grimace in response to stimulation, and a pink body with blue extremities. What is the Apgar score?

7
6 (Correct answer)
5
8

Correct answer: 6

Heart rate <100=1, slow respirations=1, some flexion=1, grimace=1, acrocyanosis=1 — totaling an Apgar score of 6.

Question 141: During a vaginal examination, the nurse notes the presenting part is not engaged and the fetal heart rate suddenly drops to 60 bpm. The nurse suspects cord prolapse. What is the immediate nursing action?

Administer oxygen and increase IV fluid rate
Manually elevate the presenting part off the cord while calling for help (Correct answer)
Remove the examiner's hand and apply a fetal scalp electrode
Reassess the fetal heart rate in 5 minutes

Correct answer: Manually elevate the presenting part off the cord while calling for help

Manually elevating the presenting part off the prolapsed cord relieves compression and maintains fetal oxygenation while emergency delivery is arranged.

Question 142: Which newborn screening test is mandatory in all US states and detects a condition that causes intellectual disability if untreated?

Cystic fibrosis sweat chloride test
Glucose-6-phosphate dehydrogenase test
Phenylketonuria (PKU) blood spot screening (Correct answer)
Direct Coombs test

Correct answer: Phenylketonuria (PKU) blood spot screening

PKU screening via heel stick blood spot is mandated in all US states; untreated PKU causes severe intellectual disability due to phenylalanine accumulation, but dietary treatment prevents neurological damage.

Question 143: A client at 36 weeks is diagnosed with oligohydramnios (AFI of 3 cm). What fetal complication is the nurse most concerned about?

Macrosomia
Polyhydramnios in the next pregnancy
Placenta previa
Umbilical cord compression and fetal growth restriction (Correct answer)

Correct answer: Umbilical cord compression and fetal growth restriction

Oligohydramnios reduces amniotic fluid cushion, increasing umbilical cord compression risk during contractions and is associated with IUGR and renal anomalies.

Question 144: A Rh-negative mother delivers an Rh-positive baby. Rho(D) immune globulin (RhoGAM) is ordered. Within what time frame should it be administered?

Within 24 hours of delivery
Within 72 hours of delivery (Correct answer)
Within 1 week of delivery
Within 12 hours of delivery

Correct answer: Within 72 hours of delivery

RhoGAM must be administered within 72 hours of delivery to prevent Rh sensitization in Rh-negative mothers; it works by clearing fetal Rh-positive cells before they trigger maternal antibody production.

Question 145: Which assessment finding in a male newborn requires notification of the provider?

Smegma beneath the foreskin
Undescended testicle (cryptorchidism) (Correct answer)
Rugae on the scrotum
Testes palpable in the inguinal canal

Correct answer: Undescended testicle (cryptorchidism)

Cryptorchidism requires provider notification and follow-up as undescended testes that do not descend by 6 months require surgical intervention (orchiopexy) to prevent infertility and malignancy.

Question 146: Which position is MOST appropriate for a client with a suspected shoulder dystocia during delivery?

McRoberts maneuver with suprapubic pressure (Correct answer)
Left lateral (Sims) position
Lithotomy position with fundal pressure
Trendelenburg position

Correct answer: McRoberts maneuver with suprapubic pressure

The McRoberts maneuver (hyperflexion of the maternal thighs against the abdomen) combined with suprapubic pressure is the first-line intervention for shoulder dystocia.

Question 147: Six hours postpartum (PP) after delivering a full-term healthy infant, the client is being evaluated by the nurse. The customer complains to the nurse of feeling lightheaded and faint. Which of the following nurse interventions would be ideal?

Elevate the mother’s legs.
Inform the nursery room nurse to avoid bringing the newborn infant to the mother until the feelings of lightheadedness and dizziness have subsided.
Instruct the mother to request help when getting out of bed. (Correct answer)
Obtain hemoglobin and hematocrit levels.

Correct answer: Instruct the mother to request help when getting out of bed.

During the first eight hours following birth, orthostatic hypotension may be visible. Feelings of dizziness or faintness are indicators that the client's safety should be taken into consideration by the nurse. The first few times the mother gets out of bed, the nurse should suggest that she seek assistance.

Question 148: What is the primary purpose of an episiotomy during vaginal delivery?

To reduce postpartum perineal pain
To routinely speed up delivery in all vaginal births
To prevent neonatal shoulder dystocia
To enlarge the vaginal opening and prevent severe perineal lacerations in selected cases (Correct answer)

Correct answer: To enlarge the vaginal opening and prevent severe perineal lacerations in selected cases

Episiotomy enlarges the vaginal outlet to facilitate delivery in specific clinical situations (e.g., fetal distress, shoulder dystocia) and may prevent severe spontaneous lacerations in select cases.

Question 149: A postpartum client develops a temperature of 38.5°C (101.3°F) on day 3. Which source of infection should the nurse assess first?

Endometrium (Correct answer)
Breast tissue
Perineal wound
Urinary tract

Correct answer: Endometrium

Endometritis is the most common cause of postpartum fever after the first 24 hours and is characterized by uterine tenderness and foul-smelling lochia.

Question 150: A 26-week preterm infant in the NICU has retinopathy of prematurity (ROP). What is the primary cause of this condition?

Genetic deficiency of retinal pigmentation
Congenital infection of the optic nerve
Immature retinal blood vessel development disrupted by supplemental oxygen (Correct answer)
Insufficient oxygen delivery to the retina

Correct answer: Immature retinal blood vessel development disrupted by supplemental oxygen

ROP occurs when immature retinal vasculature is disrupted by hyperoxia and fluctuating oxygen levels, leading to abnormal angiogenesis that can cause retinal detachment and blindness.

Question 151: When assessing the anterior fontanel of a newborn, which finding is abnormal?

Soft and flat fontanel
Diamond-shaped fontanel measuring 2 × 2 cm
Bulging and tense fontanel in a quiet, non-crying infant (Correct answer)
Fontanel that slightly bulges when the infant cries

Correct answer: Bulging and tense fontanel in a quiet, non-crying infant

A bulging, tense fontanel in a quiet infant suggests increased intracranial pressure due to conditions such as hydrocephalus, meningitis, or intracranial hemorrhage.

Question 152: A client reports that her partner has become withdrawn, irritable, and disengaged since their baby's birth 8 weeks ago. What should the nurse recognize?

This is normal adjustment behavior expected of all new fathers
This behavior suggests only financial stress related to the new baby
Partners require no mental health assessment as PPD only affects birthing parents
Partners can also experience postpartum depression (Correct answer)

Correct answer: Partners can also experience postpartum depression

Research shows approximately 10% of fathers and partners experience postpartum depression, often manifesting as irritability and withdrawal rather than sadness.

Question 153: A newborn receives the hepatitis B vaccine at birth. What information should the nurse provide to the parents?

Only one dose is needed at birth for full protection
The vaccine provides lifetime immunity with the single birth dose
The vaccine is optional and only needed if the mother is hepatitis B positive
The vaccine is part of a 3-dose series, with the second dose at 1–2 months and the third at 6 months (Correct answer)

Correct answer: The vaccine is part of a 3-dose series, with the second dose at 1–2 months and the third at 6 months

The hepatitis B vaccine series requires 3 doses: at birth, 1–2 months, and 6 months; all three doses are needed for complete, long-term protection.

Question 154: A postpartum client's fundus is boggy and displaced to the right of midline. What is the priority nursing action?

Assist client to void or catheterize (Correct answer)
Administer oxytocin IV
Massage the fundus firmly
Notify the physician immediately

Correct answer: Assist client to void or catheterize

A displaced fundus most commonly indicates a full bladder, which must be emptied before fundal massage will be effective.

Question 155: Which blood type and Rh factor combination places a pregnant client at risk for isoimmunization if the father is Rh positive?

AB blood type regardless of Rh factor
Type O blood type with Rh-positive status
Rh-positive mother with Rh-negative fetus
Rh-negative mother with Rh-positive fetus (Correct answer)

Correct answer: Rh-negative mother with Rh-positive fetus

An Rh-negative mother carrying an Rh-positive fetus is at risk for isoimmunization if fetal blood enters maternal circulation, leading to maternal antibody formation that can destroy fetal red blood cells in subsequent pregnancies.

Question 156: A patient has been pushing for 1.5 hours. The nurse observes crowning with each push but the head retracts between pushes. What technique should the nurse encourage to facilitate delivery?

Increasing oxytocin to strengthen contractions
Open-glottis pushing with breathing between contractions (Correct answer)
Supine positioning with legs in stirrups
Valsalva maneuver with sustained breath-holding for 10 seconds

Correct answer: Open-glottis pushing with breathing between contractions

Open-glottis pushing (exhaling while pushing) preserves maternal oxygenation and fetal blood flow better than sustained Valsalva maneuver and is the evidence-based recommendation.

Question 157: A pregnant client with preeclampsia suddenly experiences a tonic-clonic seizure. What is the priority nursing action?

Administer IV diazepam immediately
Restrain all four extremities to prevent injury
Perform an emergency cesarean delivery
Protect the client from injury, maintain airway, and administer magnesium sulfate per protocol (Correct answer)

Correct answer: Protect the client from injury, maintain airway, and administer magnesium sulfate per protocol

During an eclamptic seizure, the nurse's priority is to protect from injury, maintain airway patency, administer oxygen, and give magnesium sulfate as the drug of choice for seizure prevention and treatment.

Question 158: A newborn is diagnosed with meconium aspiration syndrome (MAS). Which clinical finding is most characteristic?

Bilateral pleural effusions
Normal oxygen saturation without supplemental oxygen
Clear lung fields on chest X-ray
Barrel-shaped chest and patchy infiltrates on X-ray with hyperinflation (Correct answer)

Correct answer: Barrel-shaped chest and patchy infiltrates on X-ray with hyperinflation

MAS causes air trapping from ball-valve obstruction by meconium particles, resulting in a barrel-shaped chest and the characteristic patchy, hyperinflated appearance on chest X-ray.

Question 159: Prior to the amniocentesis, a normal ultrasound is planned for a client who is 36 weeks pregnant. Which of the following client statements, after the client has been informed of the ultrasound's purpose, would alert the nurse in charge that the client requires additional instruction?

The ultrasound will help to locate the placenta.
The ultrasound locates a pool of amniotic fluid.
The test will determine where to insert the needle.
The ultrasound identifies blood flow through the umbilical cord. (Correct answer)

Correct answer: The ultrasound identifies blood flow through the umbilical cord.

The ultrasound shows the umbilical cord's blood flow. A routine ultrasound before amniocentesis is useful in locating the placenta, locating a pool of amniotic fluid, and demonstrating to the doctor where to insert the needle, but it does not detect blood flow through the umbilical cord using color Doppler imaging.

Question 160: Which medication is CONTRAINDICATED in a breastfeeding patient with postpartum depression?

Paroxetine (Paxil)
Cognitive behavioral therapy
Lithium carbonate at high doses (Correct answer)
Sertraline (Zoloft)

Correct answer: Lithium carbonate at high doses

Lithium is excreted in breast milk in significant concentrations and can cause lithium toxicity in the nursing infant, including hypotonia, bradycardia, and cyanosis.

Question 161: The nurse is performing a newborn assessment at 2 hours of life. Which finding requires immediate notification of the healthcare provider?

Nasal flaring and expiratory grunting (Correct answer)
Milia on the nose and cheeks
Respiratory rate of 52 breaths per minute
Lanugo on the shoulders and back

Correct answer: Nasal flaring and expiratory grunting

Nasal flaring and expiratory grunting are signs of respiratory distress in the newborn and require prompt medical evaluation.

Question 162: A client at 11 weeks gestation asks about the safety of chorionic villus sampling (CVS). The nurse explains that, compared to amniocentesis, CVS:

Can assess fetal lung maturity in addition to chromosomes
Is safer with no risk of fetal loss
Must be performed after 20 weeks gestation
Carries a slightly higher risk of pregnancy loss but allows earlier diagnosis (Correct answer)

Correct answer: Carries a slightly higher risk of pregnancy loss but allows earlier diagnosis

CVS can be performed at 10–13 weeks (earlier than amniocentesis) but carries a slightly higher procedure-related pregnancy loss rate of approximately 0.5–1%.

Question 163: A nurse is preparing to perform a circumcision care assessment. Which finding at the circumcision site requires provider notification?

A thin yellow exudate forming over the glans at 24–48 hours
A small amount of bleeding controlled with gentle pressure
Purulent yellow discharge, peri-wound erythema spreading beyond the glans, and fever (Correct answer)
Slight swelling and redness immediately after the procedure

Correct answer: Purulent yellow discharge, peri-wound erythema spreading beyond the glans, and fever

A thin yellow pseudomembrane forming over the glans is normal healing; spreading erythema, purulent discharge, and fever indicate infection requiring provider evaluation.

Question 164: A nurse is teaching a mother about breast engorgement. Which measure is most effective for relief?

Restricting fluid intake to reduce milk production
Frequent feeding or pumping to empty the breasts, with warm compresses before and cold packs after feeds (Correct answer)
Applying cabbage leaves permanently without feeding
Binding the breasts tightly to suppress milk production

Correct answer: Frequent feeding or pumping to empty the breasts, with warm compresses before and cold packs after feeds

Frequent, effective milk removal through feeding or pumping is the most effective treatment for engorgement; warmth before feeds promotes let-down and cold packs after reduce swelling.

Question 165: Which finding would indicate a complication following a heel stick blood collection on a newborn?

Minimal bruising resolving within 24 hours
Calcified nodule or scar formation at the puncture site from repeated sticks (Correct answer)
A small drop of blood at the puncture site
Brief crying during the procedure

Correct answer: Calcified nodule or scar formation at the puncture site from repeated sticks

Repeated heel sticks in the same area can cause calcified nodules (calcinosis cutis) or scarring; sites should be rotated and the lateral aspects of the heel used to prevent this complication.

Question 166: Which finding during a postpartum home visit requires the nurse to immediately contact the healthcare provider?

The mother cries when discussing her birth experience
The mother expresses concern about her ability to maintain milk supply
The mother reports feeling tired and overwhelmed by her new role
The mother states she has thoughts of harming herself or the infant (Correct answer)

Correct answer: The mother states she has thoughts of harming herself or the infant

Suicidal ideation or thoughts of harming the infant constitute a psychiatric emergency requiring immediate provider notification and intervention.

Question 167: A patient with preeclampsia is receiving magnesium sulfate. Which assessment finding indicates magnesium toxicity?

Respiratory rate of 10 breaths per minute (Correct answer)
Serum magnesium level of 5 mEq/L
Urine output of 40 mL/hr
Deep tendon reflexes 2+

Correct answer: Respiratory rate of 10 breaths per minute

Respiratory depression (rate <12) is a key sign of magnesium toxicity; the antidote calcium gluconate should be administered immediately to reverse the toxicity.

Question 168: A 4-hour-old newborn in the nursery begins having tonic-clonic movements of the face and extremities. What is the nurse's priority action?

Administer phenobarbital per standing order
Obtain an order for a CT scan of the head
Check blood glucose level immediately (Correct answer)
Pad the crib sides to prevent injury

Correct answer: Check blood glucose level immediately

Hypoglycemia is a common and reversible cause of neonatal seizures; a bedside glucose check should be the first step because treatment is immediate and can abort the seizure.

Question 169: Which assessment finding indicates successful postpartum adaptation of the urinary system?

Concentrated urine with specific gravity above 1.030
Voiding at least 150 mL with first void after delivery (Correct answer)
Urinary retention requiring catheterization at 4 hours postpartum
Urine output less than 200 mL in 8 hours

Correct answer: Voiding at least 150 mL with first void after delivery

The client should void spontaneously within 6–8 hours postpartum; a void of at least 150 mL suggests adequate bladder function.

Question 170: Which maternal complication of gestational diabetes (GDM) places the fetus at greatest risk for macrosomia?

Chronic maternal hyperglycemia stimulating fetal insulin production and fat deposition (Correct answer)
Maternal hypertension reducing placental perfusion
Polyhydramnios compressing the placenta
Maternal hypoglycemia causing growth restriction

Correct answer: Chronic maternal hyperglycemia stimulating fetal insulin production and fat deposition

Chronic hyperglycemia in GDM causes glucose to cross the placenta, stimulating fetal hyperinsulinemia, which drives excessive fat storage and macrosomia.

Question 171: A client in the third trimester reports lying on her back causes dizziness and light-headedness. The nurse explains this is due to:

Vagal stimulation from Braxton Hicks contractions
Increased cardiac output compressing the aorta
Compression of the inferior vena cava by the gravid uterus (supine hypotensive syndrome) (Correct answer)
Hyperventilation from increased respiratory demand

Correct answer: Compression of the inferior vena cava by the gravid uterus (supine hypotensive syndrome)

The gravid uterus compresses the inferior vena cava in the supine position, reducing venous return and cardiac output, causing supine hypotensive syndrome.

Question 172: A nurse is caring for a 32-week gestation newborn with respiratory distress syndrome. Surfactant replacement therapy is ordered. Via which route is surfactant administered?

Intravenously
Subcutaneously
Endotracheally (Correct answer)
Intramuscularly

Correct answer: Endotracheally

Exogenous surfactant is administered directly into the lungs via an endotracheal tube to replace deficient surfactant and improve alveolar stability in preterm infants.

Question 173: To conduct a foundational assessment on a postpartum patients, a nurse is getting ready. Which of the following is the first nursing intervention in this assessment?

Ask the mother to urinate and empty her bladder. (Correct answer)
Ask the client to lie flat on her back with the knees and legs flat and straight.
Massage the fundus gently before determining the level of the fundus.
Ask the client to turn on her side.

Correct answer: Ask the mother to urinate and empty her bladder.

The nurse should ask the mother to empty her bladder before beginning the fundal assessment in order to perform it accurately. The six to eight weeks following delivery, or from the moment of birth, are included in the postpartum recovery period. As the mother's body returns to pre-pregnancy conditions, this is a time of healing and renewal.

Question 174: A nurse is providing discharge education to a postpartum client. Which statement by the client indicates correct understanding of perinatal mental health warning signs?

I should call my provider if I feel sad or overwhelmed for more than 2 weeks. (Correct answer)
I should feel back to normal within 24 hours of delivery.
It is normal to hear my baby crying when the baby is not crying.
Mood swings after birth mean I will definitely develop postpartum depression.

Correct answer: I should call my provider if I feel sad or overwhelmed for more than 2 weeks.

Persistent sadness or overwhelm lasting more than 2 weeks warrants contacting a healthcare provider as it may indicate PPD requiring treatment.

Question 175: Which finding in a newborn's urinary output during the first 48 hours is a concern for dehydration?

Pale yellow urine
Uric acid crystals (brick-red staining) on the diaper
Fewer than 1–2 wet diapers in 24 hours (Correct answer)
6–8 wet diapers in 24 hours

Correct answer: Fewer than 1–2 wet diapers in 24 hours

Fewer than 1–2 wet diapers in the first 24–48 hours indicates inadequate fluid intake and possible dehydration, especially in breastfed infants.

Question 176: A client at 26 weeks gestation is diagnosed with placenta previa. The nurse should prioritize which assessment?

Amount and characteristics of vaginal bleeding (Correct answer)
Degree of cervical dilation
Severity of uterine contractions
Frequency of fetal hiccups

Correct answer: Amount and characteristics of vaginal bleeding

Painless, bright-red vaginal bleeding is the hallmark of placenta previa and its amount must be monitored to assess maternal and fetal stability.

RNC-MNN: Maternal Newborn Nursing Certification Exam

The RNC-MNN is an NCC-administered certification exam for registered nurses specializing in maternal and newborn care, covering pregnancy complications, postpartum assessment and complications, and newborn assessment and management.

175

Questions

180 min

Time Limit

70%

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