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WorksheetsMaternity Final
Total questions: 100
Worksheet time: 3hrs 30mins
A client at 32 weeks with preeclampsia reports severe epigastric pain. BP 170/112. What is the nurse’s PRIORITY action?
Offer a warm blanket
Assess reflexes
Notify provider immediately
Apply external fetal monitor
A client receiving magnesium sulfate becomes difficult to arouse. RR 8/min. What is FIRST?
Increase IV fluids
Stop magnesium infusion
Give oxygen
Call rapid response
A preeclamptic patient reports visual disturbances. Which assessment must the nurse perform FIRST?
Temperature
Deep tendon reflexes
Fundal height
Appetite
A woman with gestational hypertension suddenly has facial swelling and a severe headache. What is the nurse’s BEST response?
Recheck BP in 30 minutes
Ask about stress
Place the patient on left side
Call provider and prepare magnesium
A postpartum client on magnesium has absent reflexes but stable respirations. What is the priority?
Administer calcium gluconate
Continue monitoring
Decrease infusion rate
Encourage ambulation
A client with chronic hypertension is 14 weeks pregnant. Which teaching is PRIORITY?
Avoid all antihypertensives
Risk for superimposed preeclampsia
Increase activity
Use diuretics only
A patient with severe preeclampsia is admitted for magnesium sulfate. Which order should the nurse question?
Foley catheter
Seizure precautions
Ambulate every hour
Continuous fetal monitoring
A nurse is caring for a preeclamptic client with brisk reflexes and clonus. What action is PRIORITY?
Administer magnesium sulfate
Increase IV rate
Lower HOB
Offer warm blankets
A woman on magnesium sulfate has urine output 20 mL/hr. What should the nurse do FIRST?
Encourage fluids
Stop infusion
Notify provider
Document finding
A 39-week patient with preeclampsia begins to seize. Which action is FIRST?
Insert tongue blade
Turn patient on side
Call provider
Document seizure length
After a seizure ends, the nurse’s IMMEDIATE priority is:
Insert urinary catheter
Check FHR
Start Pitocin
Perform sterile vaginal exam
Which statement indicates the client understands future risks after severe preeclampsia?
“I won’t have this again.”
“This increases my risk of heart disease later.”
“I can stop monitoring BP now.”
“This only happens once.”
A preeclamptic patient asks why light is dimmed. Best response?
“It improves your mood.”
“It helps lower your blood pressure.”
“It reduces stimulation that can trigger seizures.”
“It helps your baby sleep.”
A nurse receives report. Which preeclampsia patient should be seen FIRST?
BP 148/98, denies symptoms
Headache unrelieved by acetaminophen
Trace proteinuria
Edema in hands
Which assessment MOST indicates worsening preeclampsia?
Weight gain of 1 lb
1+ protein
New visual floaters
Leg cramps
A nurse is teaching about magnesium sulfate. Which statement is correct?
"It lowers your blood pressure."
"It prevents seizures by relaxing the CNS."
"It helps your baby’s lungs mature."
"It increases your contractions."
A preeclamptic patient experiences spontaneous rupture of membranes. What is the first action?
Check cervix
Check fetal heart rate
Call provider
Start Pitocin
A nurse admits four hypertensive patients. Who is priority?
BP 152/90, no symptoms
Severe frontal headache
Reports mild swelling
Mild nausea
The nurse teaching a client with mild preeclampsia at home should emphasize:
High-salt diet
Report RUQ pain immediately
Avoid BP checks
Increase strenuous exercise
A pregnant patient with BP 168/112 has late decels on FHR monitor. Which action FIRST?
Administer magnesium
Turn to left side
Increase Pitocin
Prepare for delivery
A nurse receives lab results for a client with suspected HELLP. Which confirms the diagnosis?
Platelets 200,000
AST/ALT elevated, platelets 90,000
Low creatinine
Mild anemia
Which new order for a client with severe preeclampsia is MOST concerning?
Ambulate twice daily
Insert Foley
Continuous monitoring
Magnesium sulfate
A postpartum patient suddenly becomes pale and anxious with a boggy uterus. What is FIRST?
Call provider
Start IV fluids
Massage the fundus
Give oxygen
The fundus is firm but bleeding continues. What is the nurse’s next action?
Reposition the patient
Assess for perineal lacerations
Increase Pitocin
Start magnesium
Which postpartum finding requires IMMEDIATE intervention?
Passing small clots
Saturating pad in 15 minutes
Mild cramping
Fundus midline
A nurse notes a postpartum hematoma. What symptom is expected?
Bright red bleeding
Firm fundus
Extreme perineal pain
Painless swelling
Which order should be questioned in a patient with PPH and hypertension?
Oxytocin
Cytotec
Hemabate
Methergine
A patient is hemorrhaging, and Pitocin is ineffective. What drug should nurse anticipate?
Zofran
Cytotec (rectally)
Narcan
Penicillin
A postpartum patient has BP 80/40 , HR 130 . What is the nurse’s priority?
Encourage ambulation
Notify provider
Begin rapid infusion of fluids
Lower HOB completely
Which finding is an EARLY sign of hemorrhagic shock?
Hypotension
Cyanosis
Tachycardia
Absent pulses
A nurse notes concealed bleeding and a firm uterus. What should she suspect?
Uterine atony
Retained placenta
Hematoma
Abruption
A postpartum patient with DIC displays oozing at IV sites. What is PRIORITY?
Start magnesium
Obtain clotting labs
Prepare blood products
Place patient in Fowler’s
A nurse caring for a postpartum patient receiving Methergine should monitor:
Temperature
Blood pressure
Reflexes
FHR
Which postpartum patient requires evaluation FIRST?
Fundus firm and midline
Reports mild dizziness after standing
Pad soaked in 10 minutes
Reports mild pain
After giving Hemabate, what side effect is most concerning?
Tachycardia
Nausea
Bronchospasm
Cramping
A postpartum patient is shivering uncontrollably. Fundus firm, bleeding minimal. What should nurse suspect?
Normal postpartum response
Shock
Infection
Magnesium toxicity
A postpartum patient hemorrhaging requires manual removal of placenta. What is priority post-procedure?
Check BP
Administer Methergine if no hypertension
Start IV antibiotics
Encourage ambulation
What is the FIRST sign a postpartum patient is deteriorating?
Typing on phone
Increasing anxiety
Deep sleep
Hungry
Which intervention BEST prevents PPH postpartum?
Ambulation
Frequent fundal checks
Warm blankets
Foley catheter
Which finding after delivery requires immediate provider notification?
Clots smaller than egg
Moderate cramping
BP increase from 100/60 → 146/96
Headache after epidural
A postpartum patient has a firm fundus but brisk dark red bleeding. What is the likely cause?
Retained placenta
Atony
Infection
Uterine inversion
Which postpartum finding indicates the uterus is NOT effectively contracting?
Firm fundus
Midline location
Boggy uterus
Lochia rubra
A postpartum patient is hypotensive after heavy bleeding. Which position improves perfusion?
Supine
High Fowler
Side-lying
Modified Trendelenburg
A 28-year-old G2P1 client at 10 weeks has vaginal bleeding and is scheduled for a suction D&C. Her blood type is O negative. What is the nurse’s PRIORITY action?
Encourage fluids
Schedule follow-up ultrasound
Confirm order for Rhogam
Teach Kegel exercises
A nurse is reviewing labs of four postpartum clients. Which one needs Rhogam?
Rh-negative mom, Rh-negative baby
Rh-positive mom, Rh-negative baby
Rh-negative mom, Rh-positive baby, indirect Coombs negative
Rh-positive mom, Rh-positive baby
A client asks, “Why do I need another Rhogam shot after birth if I had one at 28 weeks?” Best response?
The first dose wears off quickly.
We repeat it because your baby’s blood type may be different from yours.
It treats your baby’s jaundice.
It prevents infection after delivery.
A client’s LMP was March 20, 2025. Using Naegele’s rule, which EDD should the nurse document?
December 20, 2025
December 27, 2025
January 3, 2026
January 5, 2026
A woman in her second trimester asks when she should call the clinic instead of waiting for her next visit. Which symptom requires IMMEDIATE reporting?
Mild ankle swelling at end of day
Occasional heartburn
Decreased fetal movement
Increased appetite
A client with pregestational diabetes is 10 weeks pregnant. Which statement indicates need for more teaching?
I can stop my insulin now that I’m pregnant.
I will monitor my blood glucose as directed.
I will keep my prenatal appointments regularly.
I will report episodes of hypoglycemia.
A diabetic pregnant woman arrives in active labor with glucose 198 mg/dL. What is the nurse’s PRIORITY action?
Notify provider and anticipate IV insulin
Give the patient orange juice
Continue to monitor without intervention
Give a high-carbohydrate snack
A newborn of a diabetic mother is jittery and tachypneic. Which action is PRIORITY?
Check blood glucose
Start IV fluids immediately
Place under radiant warmer
Call the provider
A newborn glucose returns at 32 mg/dL. The baby is awake and able to feed. What is the nurse’s FIRST action?
Give IV dextrose
Breastfeed or formula feed immediately
Repeat glucose in 4 hours
Observe only
The nurse cares for a newborn of a diabetic mother (IDM). Which assessment finding is MOST concerning?
Weight 9 lb 2 oz
Blood glucose 60 mg/dL
Respiratory grunting and nasal flaring
Pink color with acrocyanosis
A G2P1 client with gestational diabetes asks why the nurse is checking the baby’s blood glucose. Best response?
“All babies get their sugar checked.”
“Your baby may produce extra insulin, causing low blood sugar.”
“Babies of diabetic moms always get diabetes.”
“We do it to see if your baby needs insulin.”
A diabetic pregnant woman asks how her condition affects labor. Which explanation is MOST accurate?
“Your labor will be shorter.”
“Your baby is more likely to be small for gestational age.”
“Your baby might be large, increasing the risk for difficult delivery.”
“Labor will not be affected at all.”
A client with gestational diabetes states, “Once the baby is born, I can forget about diabetes.” What is the best response?
“Yes, gestational diabetes always goes away.”
“You’re right; you never have to worry about it again.”
“You now have a higher risk of type 2 diabetes later in life.”
“You won’t need follow-up testing.”
A patient is being prepped for a non-emergent C-section. Which nursing action is MOST important prior to transfer to the OR?
Encouraging the partner to eat
Administering ordered sodium citrate
Applying abdominal binder
Starting Pitocin infusion
Thirty minutes after epidural placement, a laboring client reports feeling dizzy. BP is 82/48. What is the nurse’s PRIORITY action?
Place patient in high Fowler’s
Turn patient to left side and increase IV fluids
Stop IV fluids
Encourage deep breathing
The nurse is caring for a patient after C-section with Duramorph in the epidural. Which assessment is PRIORITY?
Itching
Pain score
Respiratory rate
Bowel sounds
A laboring client using patterned breathing and birthing ball asks how this helps. Which explanation shows understanding of gate control theory?
“It distracts you so you forget about the pain.”
“It blocks some of the pain signals traveling to your brain.”
“It decreases uterine contractions.”
“It prevents complications.”
A nurse is assisting a patient in active labor who is groaning and clenching fists with each contraction. Which intervention is MOST appropriate?
Tell her to be quiet to conserve energy
Coach her through slow deep breathing and offer position changes
Turn up fetal monitor alarm
Encourage her to push with each contraction
A client at 36 weeks presents with sudden, severe abdominal pain and a firm, board-like uterus. There is scant dark red vaginal bleeding. What is the nurse’s PRIORITY?
Prepare for a vaginal exam
Place patient on bedrest and observe
Notify provider—suspected placental abruption
Discharge home with precautions
A 34-week patient presents with painless bright red bleeding. Fetal heart rate is reassuring. Which nursing action is MOST important?
Perform a sterile vaginal exam
Place patient on bedrest and schedule ultrasound
Start Pitocin infusion
Encourage ambulation
A laboring client’s membranes rupture spontaneously. The nurse notes clear fluid. The FHR suddenly drops from 140 to 80. What is the FIRST action?
Document and recheck in 10 minutes
Call rapid response
Perform a vaginal exam to check for cord prolapse
Start Pitocin
During assessment, the nurse palpates a pulsating cord in the vagina. Which action is PRIORITY?
Remove the hand and wait for provider
Insert Foley catheter
Manually lift presenting part off the cord and maintain pressure
Ask the patient to start pushing
Which position is MOST appropriate for a patient with a prolapsed cord while waiting for C-section?
Supine with legs extended
Lithotomy
Knee-chest or steep Trendelenburg
High Fowler’s
A nurse evaluates an electronic fetal heart strip: baseline 140, moderate variability, accelerations present, no decelerations. What is the best nursing action?
Apply oxygen
Place patient on left side
Continue to observe; pattern is reassuring
Prepare for emergency delivery
A strip shows recurrent late decelerations with each contraction. What is the priority action?
Increase Pitocin
Turn the patient to left side and apply oxygen
Have patient hold breath and push
Sit the patient upright
Variable decelerations are noted. What is the likely cause?
Uterine rupture
Placental insufficiency
Cord compression
Head compression
A nurse sees early decelerations that mirror contractions. What is the MOST appropriate action?
Call provider immediately
Document and continue monitoring
Turn patient side-lying
Stop Pitocin
A nulliparous patient asks how she will know she is in “true labor.” Which response best uses application-level teaching?
“You’ll just know when it happens.”
“True labor contractions cause cervical change and get stronger and closer together.”
“When you can’t talk during contractions, it’s true labor.”
“Any pain you feel is labor.”
The parents of an uncircumcised male newborn ask how to clean his penis. Which teaching is MOST appropriate?
“Fully retract the foreskin daily and scrub.”
“Gently clean only the outside; do not force the foreskin back.”
“Use alcohol wipes after every diaper change.”
“Apply petroleum jelly inside the foreskin.”
After circumcision with a Gomco clamp, which parent statement indicates correct understanding?
“I should remove the yellow crust each day.”
“I’ll apply petroleum jelly on the diaper to prevent sticking.”
“If I see a few drops of blood, I’ll rush to the ER.”
“We will clean it with alcohol every change.”
A nurse is checking a newborn’s car seat before discharge. Which finding requires intervention?
The chest clip is positioned at armpit level.
The infant is placed in a rear-facing seat in the back seat.
Bulky blanket and puffy jacket are used under the harness straps.
The harness straps are snug with no slack at the shoulders.
Which teaching indicates correct use of a rear-facing infant car seat?
“We’ll put the seat forward-facing after 1 month.”
“We will place the seat rear-facing in the back seat, tightly installed.”
“We can hold the baby if the back seat is crowded.”
“We’ll move the chest clip near the belly for comfort.”
A nurse calls a provider twice about a critical BP in a preeclamptic patient with no response. What is the MOST appropriate next step?
Wait 30 more minutes and try again
Document and stop trying
Activate the chain of command and notify charge nurse
Call the patient’s family
A nurse is alone in a room with an increasingly aggressive family member. The nurse feels unsafe. What is the PRIORITY action?
Continue teaching but speak more firmly
Shout at the family member to stop
Leave the room and call security/charge nurse
Ignore the behavior
A patient in active labor is moaning and gripping bedrails during contractions. Which nursing response BEST promotes comfort and physiologic labor?
“You need to be quiet to save your energy.”
“Let’s change your position and focus on your breathing together.”
“I’ll just turn up your Pitocin so we can finish faster.”
“Try to hold your breath through it.”
In the first trimester, which teaching is MOST appropriate?
Fetal movement counting
Preparation for labor positions
Managing nausea/vomiting and recognizing signs of miscarriage
Breastfeeding techniques
A provider orders Methergine IM for a woman with heavy postpartum bleeding. Her BP is 162/104. What should the nurse do FIRST?
Give medication as ordered
Hold medication and notify provider
Give half the dose
Ask another nurse to administer it
A woman with a history of asthma is hemorrhaging. The nurse anticipates orders for which medication to be AVOIDED?
Carboprost (Hemabate)
Methylergonovine (Methergine)
Oxytocin (Pitocin)
Misoprostol (Cytotec)
A nurse is teaching a patient in the second trimester. Which topic is MOST appropriate?
Grief after loss
Fetal movement patterns and body changes
Immediate labor signs
Newborn car seat laws only
A patient in transition (8–10 cm) is screaming, saying “I can’t do this!” Which action is PRIORITY?
Increase room noise so she can focus
Tell her to calm down
Use firm, direct coaching and breathing guidance
Leave room to call provider
A nurse is calculating a magnesium sulfate loading dose. The order: “4 grams over 30 minutes.” The IV bag is labeled 40 g MgSO4 in 1000 mL. What rate should the pump be set at? (You don’t have to show math on the exam; choose the most reasonable nursing action.)
30 mL/hr
60 mL/hr
120 mL/hr
240 mL/hr
A nurse notes that a postpartum patient who lost 1200 mL blood seems unusually calm and says, “I’m fine, don’t worry about me,” while her BP is dropping. What is the BEST interpretation?
She is coping well
She is in denial and may be in early shock
She does not understand postpartum changes
She is ready for discharge
A laboring client with epidural anesthesia suddenly cannot move her arms and complains of shortness of breath. What does the nurse suspect FIRST?
Normal epidural effect
High spinal block
Panic attack
Placental abruption
During active labor, which nursing action MOST supports physiologic progression of labor?
Keeping patient confined to bed
Encouraging frequent position changes and upright posture
Restricting oral fluids
Avoiding any movement to “rest the uterus”
A labor nurse caring for two patients must decide who to see FIRST. Which patient is the PRIORITY?
A woman in early labor requesting pain medication
A woman with epidural whose BP is 84/50
A woman in active labor walking in the hall
A woman waiting for her admission assessment
A mother insists on placing the infant’s car seat in the front passenger seat with the airbag “off.” What is the nurse’s BEST response?
“That is okay if the airbag is off.”
“As long as the straps are tight, that’s safe.”
“The safest place is rear-facing in the back seat of the car.”
“You can hold the baby just this once.”
Which of the following situations requires the nurse to use the chain of command to protect the patient?
Provider disagrees with patient’s birth plan, but patient is stable
Provider refuses to come evaluate a patient with late decelerations and BP 170/110 after multiple calls
Family is dissatisfied with hospital food
Patient is anxious about a procedure
A client reports fatigue, nausea in the morning, and breast tenderness. Which type of pregnancy signs are these?
Probable
Presumptive
Positive
A nurse notes a bluish discoloration of the cervix (Chadwick’s sign) during an exam. What type of pregnancy sign is this?
Probable
Presumptive
Positive
An ultrasound shows a fetal skeleton and cardiac activity. How should the nurse interpret this?
Positive
Probable
Presumptive
A patient is receiving Penicillin G before a C-section. Which finding indicates the medication is being used correctly?
The patient reports decreased pain
It is given before surgery begins to prevent infection
The nurse administers it IM in the thigh
It is used to control bleeding after birth
A pregnant patient is given Betamethasone at 30 weeks. Which statement demonstrates correct understanding?
"This will stop my contractions.”
“This is to help mature my baby’s lungs before birth.”
“This will help with my pain.”
“This is only for controlling my blood pressure.”
A laboring patient in early active labor reports increasing back pain with each contraction. The nurse applies firm counter-pressure to the patient’s lower back. The patient reports the pain “feels more manageable now.” According to the gate control theory of pain, what explains this response?
Counter-pressure stops uterine contractions
Non-painful sensory stimulation blocks pain signals from reaching the brain
Pressure increases endorphin release from the placenta
Counter-pressure reduces fetal descent, decreasing pain
A client at 5 cm dilation is breathing heavily and reports, “These contractions are coming so much stronger and closer together.” Contractions are every 3 minutes, lasting 60 seconds. The nurse recognizes the client is MOST likely in which phase of labor?
Latent phase of the first stage
Active phase of the first stage
Transition phase of the first stage
Second stage of labor
A multipara client is 10 cm dilated, 100% effaced, and the fetal head is +2 station. The client reports a strong urge to push with every contraction. What is the nurse’s PRIORITY action?
Instruct the client to blow through contractions
Have the client begin pushing with each contraction
Immediately call for the anesthesia provider
Recheck the cervix to confirm dilation
A client at her first prenatal visit reports she has been pregnant three times, has two living children, and had one miscarriage at 8 weeks. What is the correct GTPAL?
G3 T2 P0 A1 L2
G4 T2 P1 A0 L2
G3 T1 P1 A1 L2
G4 T1 P1 A1 L1
A client at 30 weeks pregnant asks when she should return for her next prenatal appointment. Her pregnancy has been uncomplicated. Which response is MOST accurate?
“Every 4 weeks until delivery.”
“Every 2 weeks until 36 weeks, then weekly.”
“Weekly until delivery.”
“Only return if you feel something is wrong.”
