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WorksheetsNursing Clinical Scenarios Worksheet
Total questions: 50
Worksheet time: 2hrs 50mins
A laboring client at 6 cm receives an epidural. Ten minutes later, the fetal monitor shows recurrent late decelerations and the maternal blood pressure drops to 84/50 with lightheadedness. Oxytocin is running at a low dose for augmentation. The nurse must act immediately to protect fetal oxygenation. Which intervention is most appropriate now?
Increase the oxytocin by one increment to shorten the labor interval and reassess in fifteen minutes
Position the client in a full left lateral tilt, start a rapid IV fluid bolus, treat maternal hypotension per protocol, and temporarily stop oxytocin
Sit the client upright for comfort while continuing current infusions and observe for spontaneous recovery
Turn off the fetal monitor to reduce maternal anxiety and reassess the tracing after the next contraction
A client at 5 weeks + 2 days discloses recent use of a known teratogenic acne medication, taken until the previous evening. She is tearful and asks whether anything can still be done to protect the pregnancy. Which nursing action represents the best next step?
Provide reassurance that most first-trimester exposures are harmless and schedule only the routine 20-week anatomy ultrasound
Instruct the client to discontinue the medication immediately, optimize folate intake, arrange early risk-appropriate assessments, and offer balanced, non-directive counseling about screening and options
Recommend pregnancy termination because structural anomalies at this gestation are inevitable and irreversible
Delay any detailed counseling until the client feels fetal movement so that anxiety does not interfere with decision-making
Thirty minutes after a spontaneous vaginal birth, the uterus is boggy and deviated to the right, the bladder is visibly distended, and bleeding is more than expected. Vital signs are stable but trending down. Which action should the nurse avoid because it does not address the cause and may be harmful?
Perform firm fundal massage while immediately assisting the client to empty the bladder, then reassess tone and bleeding
Prepare a second-line uterotonic if uterine tone remains poor after initial bedside measures and reassessment
Quantify blood loss objectively and repeat vital signs frequently while escalating per protocol as needed
Apply continuous vigorous uterine kneading for fifteen minutes even if the fundus becomes firm after bladder emptying
A postpartum unit is managing a simultaneous hemorrhage in the next room. You must step away from a stable, newly delivered client. Which task is not appropriate to delegate to a trained nursing assistant because it requires professional judgment and teaching competence?
Assist the client with first ambulation while the RN performs a brief safety check on return
Apply a perineal ice pack and change saturated linens while reporting any unusual findings to the RN
Provide comprehensive instruction about warning signs of delayed hemorrhage and verify understanding with teach-back
Record intake and output accurately and notify the RN for any concerning trends
A vigorous term newborn is placed skin-to-skin on the birthing parent's chest in a warm room. The umbilical cord is still pulsating and respirations are regular. Which action is not consistent with Essential Intrapartum and Newborn Care at this moment?
Performing routine deep suctioning of the mouth and nose before the first cry
Maintaining uninterrupted skin-to-skin contact and supporting early latch within the first hour
Thoroughly drying the newborn and promptly removing wet cloths while maintaining contact
Delaying cord clamping for approximately one to three minutes if the infant remains vigorous and stable
At 34 weeks, a client presents with severe headache, right-upper-quadrant pain, and blood pressure of 168/108. Reflexes are brisk, and visual disturbances are reported. Which order is most appropriate to implement first to reduce immediate maternal-fetal risk?
Initiate a magnesium sulfate infusion for seizure prophylaxis while preparing additional evaluations and treatments
Begin oxytocin for induction immediately without further stabilization steps
Start a combined estrogen-progestin medication to reduce blood pressure over the next several hours
Defer laboratory testing and fetal assessment until the headache subsides to avoid overstimulation
At 8 cm with the fetal head at 0 station in a persistent occiput posterior position, the client reports severe back pain and slow progress despite adequate contractions. Which bedside strategy best optimizes the pelvic diameters and promotes rotation right now?
Place the client in hands-and-knees or exaggerated side-lying with a peanut ball while providing firm sacral counterpressure
Perform a routine episiotomy to enlarge the outlet before full rotation has occurred
Apply sustained fundal pressure during contractions to force descent through the midpelvis
Proceed to immediate forceps rotation in the labor room without further noninvasive measures
On day 1, a term, vigorous newborn shows feeding cues, but the parent reports significant nipple soreness and the observed latch is shallow with minimal transfer. Which plan should the nurse avoid because it may undermine supply and mask the real issue?
Provide hands-on coaching to achieve a deep, asymmetric latch and observe for rhythmic swallowing
Use brief hand expression to soften a tense areola just before attempting the next latch
Initiate routine formula supplementation before evaluating latch effectiveness and transfer at the breast
Encourage responsive, on-demand feeding 8-12 times in 24 hours with continued skin-to-skin contact
During the third stage with a single fetus confirmed, which timing of uterotonic best prevents postpartum hemorrhage?
Give oxytocin only after placental delivery
Give oxytocin 10 IU IM/IV soon after birth once a second twin is excluded
Use methylergometrine first-line in all hypertensive patients
Use carboprost first-line in patients with asthma
On a busy labor unit, which task must the registered nurse personally perform?
Teach perineal care after birth
Interpret a nonreassuring fetal tracing and decide escalation
Apply an ice pack to the perineum
Walk the stable postpartum client to the bathroom
Which physiologic change is expected at 28 weeks' gestation?
Decreased tidal volume
Increased blood volume with mild mid-trimester BP dip
Reduced glomerular filtration rate
Lower resting heart rate
A client with severe-range BP in pregnancy needs urgent treatment. Which medication choice is appropriate?
IV labetalol per protocol
ACE inhibitor orally
Warfarin intravenously
High-dose NSAID orally
At 10 weeks with obesity and a family history of diabetes, which plan is best?
Defer all glucose testing until 28 weeks
Early screen for undiagnosed type 2 (fasting glucose/HbA1c), then routine 24-28 weeks
Start insulin now without testing
Screen only if fetal growth is excessive later
A laboring client desires analgesia but has platelets 70,000/μL. Which option best balances safety and comfort?
Epidural placement now
Nitrous oxide with upright positioning and water therapy
Continuous IV opioid infusion for the remainder of labor
Spinal anesthesia at 5 cm
For a vigorous term newborn, what is the correct vitamin K prophylaxis?
1 mg IM soon after birth
0.1 mg oral once
1 mg IV over 30 minutes
None if breastfeeding is planned
On postpartum day 7, a parent reports no pleasure, near-total insomnia, and intrusive thoughts of harm without intent. Which nursing action is most appropriate now?
Reassure that "baby blues" pass in 2 weeks
Arrange urgent mental health evaluation and initiate a safety plan
Schedule a routine check next month
Advise herbal tea and more rest
Which newborn finding requires same-day evaluation?
Jaundice first noticed at 36 hours and limited to the face
Jaundice appearing in the first 24 hours of life
Transitional stool on day 3
Weight loss of 6% by day 2 with good latch
A breastfeeding parent at 48 hours postpartum wants contraception. Which option is contraindicated now?
Progestin-only pill started today
Copper IUD placed immediately postpartum
Depot medroxyprogesterone injection before discharge
Combined estrogen-progestin pills started today
At 16 weeks, a Rh-negative client presents with vaginal bleeding; ultrasound shows a live intrauterine pregnancy. What is the best nursing action?
No action; anti-D is for the third trimester only
Administer anti-D immunoglobulin within 72 hours
Delay anti-D until labor begins
Give anti-D only if the infant is confirmed Rh-positive
In labor with unknown GBS status, temperature 38.3 °C, membranes ruptured 6 hours, no allergies. What is the best management?
Begin intrapartum penicillin/ampicillin prophylaxis
Wait for culture results tomorrow
Start vancomycin routinely
No antibiotics unless rupture exceeds 18 hours
The head delivers and then retracts ("turtle sign"). What is the first maneuver?
Fundal pressure
McRoberts position with suprapubic pressure
Pull steadily on the fetal head
Routine midline episiotomy
On magnesium sulfate, the client has RR 8/min, absent reflexes, and urine output 15 mL/hr. What is the priority?
Continue magnesium and reassess in 30 minutes
Stop magnesium, give calcium gluconate, support airway, notify provider
Give a diuretic to increase urine output
Increase magnesium rate to control seizures
Infant of a diabetic mother at 1 hour is jittery, glucose 34 mg/dL. What is the best action?
Skin-to-skin only and recheck in 2 hours
Feed at breast and recheck in 1 hour
Start IV dextrose per protocol and monitor glucose closely
Give water and recheck in 30 minutes
Which task should the RN retain and not delegate?
Teaching postpartum warning signs and follow-up plan
Assisting the first ambulation to the bathroom
Applying a perineal ice pack
Recording intake and output.
On the partograph, active-phase dilation has crossed the alert line with adequate contractions. What is the best next step?
Send the client home to rest
Perform a focused “3 Ps” reassessment and consider amniotomy if membranes are intact and the head is engaged
Begin pushing to accelerate descent
Do a routine episiotomy to widen the outlet
At 26 weeks, a 50-g glucose challenge test is 168 mg/dL in a two-step screening model. What should be done next?
Repeat the 50-g screen tomorrow
Order the 100-g, 3-hour oral glucose tolerance test
Start insulin therapy immediately
Delay all testing until 32 weeks
A client with one prior low-transverse cesarean presents in spontaneous labor at 39 weeks. What plan aligns with safety and preference?
Offer a trial of labor after cesarean with continuous monitoring in a facility capable of emergency delivery
Induce with misoprostol for cervical ripening
Require a repeat cesarean at 41 weeks regardless of progress
Proceed only if an epidural is placed
Intrapartum fever with maternal and fetal tachycardia, uterine tenderness, and purulent fluid suggests intra-amniotic infection. What is the best action?
Delay antibiotics until after delivery
Start broad-spectrum antibiotics and continue labor with close monitoring
Give a tocolytic and postpone labor
Perform cesarean solely for the fever
After artificial rupture, the nurse palpates a pulsating cord with sudden prolonged deceleration. What should be done first?
Reposition to knee-chest or steep Trendelenburg and elevate the presenting part manually
Replace the cord into the uterus with forceps
Continue expectant management for 30 minutes
Apply fundal pressure during the next contraction
At 10 cm with a persistent Category III tracing unresponsive to resuscitation, what is the most appropriate step?
Continue labor for two hours of passive descent
Prepare for operative delivery based on station and skill availability
Turn off monitoring to reduce anxiety
Give an IV opioid and reassess later
A rubella-nonimmune, breastfeeding parent on postpartum day 1 asks about vaccines. What is the correct counseling and action?
Defer MMR until six months postpartum
Give MMR before discharge and advise pregnancy avoidance for one month
Avoid MMR while breastfeeding
Give MMR during the next pregnancy
Maternal HBsAg status is unknown at delivery. What is the appropriate newborn plan?
Defer all vaccines until results return
Give the hepatitis B birth dose within 12 hours and test the mother; add HBIG if she is positive
Give HBIG only and no vaccine
Wait 7 days to decide on prophylaxis
A 16-year-old seeks prenatal care without a parent present. What should the nurse do first to uphold ethics and safety?
Obtain the neighbor's signature as substitute consent
Provide private counseling, confirm her preferred support, and follow consent policy
Delay all care until a parent arrives
Proceed with exams and explain afterward
On postpartum day 10, which finding is within the expected course?
Lochia alba with light flow and no clots
Return to heavy bright-red bleeding with large clots
Fundus palpable at the umbilicus and tender
Foul-smelling discharge with fever and pelvic pain.
Which analgesic is preferred for a breastfeeding parent with perineal pain?
High-dose aspirin daily
Ibuprofen as needed
Codeine routinely every four hours
Meperidine every six hours
At 31+5 weeks with regular contractions, cervix 2 cm, intact membranes. What is the most appropriate immediate plan?
Discharge with rest and return if worse
Administer antenatal corticosteroids and consider tocolysis/neuroprotection per protocol
Induce labor for fetal lung maturation
Start magnesium only after delivery begins
Which plan aligns with newborn screening best practices before discharge?
Metabolic screen after 24 hours of feeds; hearing screen before discharge
Metabolic screen at one week; hearing screen at two weeks
Hearing screen only if risk factors are present
Metabolic screen at birth regardless of feeding
A breastfeeding parent on postpartum day 2 with high VTE risk asks for contraception. Which option should be avoided now?
Progestin-only pill today
Copper IUD before discharge
Combined estrogen-progestin pills today
Etonogestrel implant today
Which task must remain with the registered nurse on admission?
Complete the initial maternal–fetal assessment and plan of care
Apply a perineal ice pack after education
Record intake and output during labor.
Escort the client to the restroom
A postpartum client shows injuries inconsistent with her story and avoids eye contact. What is the most appropriate nursing action now?
Ask the partner for clarification in the room
Provide private screening, document objectively, and offer discreet resources
Discharge quickly to reduce stress
Confront the partner directly about abuse
A term newborn cries immediately at delivery and is placed on the birthing parent's chest. The cord is still pulsating; the room is warm; no meconium is present. Which nursing actions align with Essential Intrapartum and Newborn Care at this time?
Thoroughly dry the infant and replace wet linens while maintaining contact
Maintain uninterrupted skin-to-skin and cover both with a warm blanket
Delay cord clamping for about 1-3 minutes if the infant remains vigorous
Perform routine deep suctioning of the mouth and nose
Separate the infant for weighing before the first breastfeed
A client presents for an initial prenatal visit at 10½ weeks and is unsure of dates. The nurse plans the visit to establish safe care. Which actions are appropriate to complete today?
Obtain baseline labs including CBC and blood type/Rh with antibody screen
Confirm gestational dating/EDD and teach danger signs
Schedule the anatomy ultrasound for 18-22 weeks
Administer Tdap during this visit
Collect a GBS culture during this visit
A laboring patient at 7 cm is receiving oxytocin. Contractions occur 6-7 in 10 minutes with minimal resting tone; the FHR shows recurrent late decelerations. Which immediate nursing interventions are indicated?
Reduce or stop the oxytocin infusion
Reposition to left lateral or hands-and-knees
Give an IV fluid bolus and reassess blood pressure
Coach pushing with each contraction to speed descent
Consider tocolysis per protocol if the pattern persists after initial steps
Following a term vaginal birth of a single infant, the uterus is firming but placental separation signs are not evident. Which actions constitute correct active management now?
Administer oxytocin 10 IU IM/IV soon after birth
Wait for placental separation signs, then perform controlled cord traction with suprapubic counter-traction
Inspect the placenta and membranes for completeness once expelled
Pull steadily on the cord before separation is observed
Perform continuous vigorous uterine massage when the uterus is already firm
Despite fundal massage and oxytocin, postpartum bleeding remains brisk and the uterus is soft. Which additional nursing actions are appropriate to implement or prepare now?
Empty the bladder via straight catheter if distended
Administer tranexamic acid within three hours of birth if not contraindicated
Insert a uterine balloon tamponade per protocol
Start methylergometrine in a patient with severe hypertension
Activate a massive transfusion protocol if bleeding escalates
Within 30 minutes of birth, a vigorous term infant remains skin-to-skin. The parent reports the baby is rooting but the latch seems shallow. Which nursing actions support early breastfeeding success? Select all that apply
Assist a deep, asymmetric latch and observe for sustained swallowing
Offer routine formula before evaluating latch
Encourage on-demand feeding at least 8-12 times per 24 hours
Delay bathing for at least 24 hours
Provide a pacifier now so the nipples can "rest"
A dyad is preparing for discharge on postpartum day 2. Which instructions should the nurse include to promote early recognition of danger and safe home care? Select all that apply
Seek care the same day for heavy bleeding, fever ≥38 °C, or severe headache with visual changes
Arrange newborn follow-up within 24-72 hours after discharge
Practice safe sleep: supine position on a firm, flat surface; room-sharing without bed-sharing
Expect the newborn to skip nighttime feeds during the first week
Call urgently for poor feeding, fast breathing, or chest indrawing in the newborn
At 48 hours postpartum, a breastfeeding parent requests contraception before discharge. Which options are acceptable to start now or to plan appropriately? (Select all that apply.)
Progestin-only pills started immediately
Copper IUD placed post-placental or ≥4 weeks if no infection
Combined estrogen-progestin pills started today
Etonogestrel implant inserted prior to discharge
Levonorgestrel IUD placed post-placental or ≥4 weeks if no infection
At 7 cm after spontaneous rupture of membranes with scant fluid, recurrent variable decelerations persist despite left lateral positioning and IV fluids. Which nursing actions are appropriate next? (Select all that apply.)
Initiate amnioinfusion per protocol if available
Pull steadily on the cord before separation is observed. Increase oxytocin to shorten labor and reduce decelerations
Discontinue oxytocin if infusing and continue maternal repositioning
Apply intrauterine resuscitation measures while preparing for possible expedited birth if unresolved
Turn off fetal monitoring to reduce anxiety
A student nurse asks how to remember the safe sequence around birth in a busy unit. Which guiding principles should the preceptor emphasize? (Select all that apply.)
Prepare the team and space to support warm–breathe–bond
Keep mother and baby together whenever both are stable
Delay non-urgent procedures until after the first effective breastfeed
Separate the dyad early for measurements to stay on schedule
Use standardized bundles and escalate promptly when red flags appear
