NUR 230 Maternal & Pediatric Nursing Exam 6 Study Guide 2026
|Galen College
1. A nurse is caring for a client in labor who is experiencing shoulder dystocia.
Which of the following nursing actions should the nurse perform first?
A. Perform the McRoberts maneuver
B. Apply fundal pressure
C. Prepare for an emergency cesarean section
D. Administer oxytocin
Answer: A
Rationale: The McRoberts maneuver (flexing the legs onto the abdomen) and suprapubic
pressure are the primary nursing interventions for shoulder dystocia. Fundal pressure is
contraindicated as it can further wedge the shoulder.
2. A nurse is monitoring a client receiving magnesium sulfate for preeclampsia.
Which of the following findings is an early sign of magnesium toxicity?
A. Hyperactive deep tendon reflexes
B. Increased urinary output
C. Diminished or absent deep tendon reflexes
D. Increased respiratory rate
Answer: C
Rationale: Loss of deep tendon reflexes is an early sign of magnesium toxicity. Other signs
include respiratory depression, oliguria, and cardiac arrest.
,3. A 2-year-old child is brought to the emergency department with a ‘barking’
cough and inspiratory stridor. Which of the following conditions should the
nurse suspect?
A. Asthma
B. Epiglottitis
C. Acute Laryngotracheobronchitis (Croup)
D. Bronchiolitis
Answer: C
Rationale: Acute Laryngotracheobronchitis, or croup, is characterized by a barking cough,
hoarseness, and inspiratory stridor due to narrowing of the airway.
4. A nurse is assessing a postpartum client 2 hours after delivery. The nurse
notes the fundus is boggy and displaced to the right. What is the priority nursing
action?
A. Massage the fundus
B. Increase the IV fluid rate
C. Administer methylergonovine
D. Assist the client to the bathroom to void
Answer: D
Rationale: A fundus displaced to the right usually indicates a full bladder, which prevents
the uterus from contracting effectively. Assisting the client to void is the priority.
5. Which of the following interventions is contraindicated in a child suspected of
having epiglottitis?
A. Administering humidified oxygen
B. Placing the child in a tripod position
C. Inserting a tongue blade to examine the throat
D. Starting an IV line for antibiotics
Answer: C
, Rationale: Attempting to visualize the throat with a tongue blade can trigger a
laryngospasm and complete airway obstruction in a child with epiglottitis.
6. A child with cystic fibrosis is prescribed pancreatic enzymes. When should the
nurse instruct the parents to administer these enzymes?
A. With every meal and snack
B. Immediately after each meal
C. Once daily in the morning
D. On an empty stomach
Answer: A
Rationale: Pancreatic enzymes must be taken with all meals and snacks to assist with the
digestion and absorption of fats, proteins, and carbohydrates.
7. A pregnant client at 32 weeks gestation reports painless, bright red vaginal
bleeding. Which condition should the nurse suspect?
A. Abruptio Placentae
B. Cervical Ripening
C. Preterm Labor
D. Placenta Previa
Answer: D
Rationale: Placenta previa is characterized by painless, bright red vaginal bleeding in the
second or third trimester. Abruptio placentae usually involves painful, dark red bleeding.
8. An infant with Tetralogy of Fallot becomes cyanotic and agitated during a
blood draw. Which of the following is the priority nursing action?
A. Administer supplemental oxygen
B. Call for a rapid response team
C. Place the infant in a knee-chest position
D. Administer morphine intramuscularly
Answer: C
|Galen College
1. A nurse is caring for a client in labor who is experiencing shoulder dystocia.
Which of the following nursing actions should the nurse perform first?
A. Perform the McRoberts maneuver
B. Apply fundal pressure
C. Prepare for an emergency cesarean section
D. Administer oxytocin
Answer: A
Rationale: The McRoberts maneuver (flexing the legs onto the abdomen) and suprapubic
pressure are the primary nursing interventions for shoulder dystocia. Fundal pressure is
contraindicated as it can further wedge the shoulder.
2. A nurse is monitoring a client receiving magnesium sulfate for preeclampsia.
Which of the following findings is an early sign of magnesium toxicity?
A. Hyperactive deep tendon reflexes
B. Increased urinary output
C. Diminished or absent deep tendon reflexes
D. Increased respiratory rate
Answer: C
Rationale: Loss of deep tendon reflexes is an early sign of magnesium toxicity. Other signs
include respiratory depression, oliguria, and cardiac arrest.
,3. A 2-year-old child is brought to the emergency department with a ‘barking’
cough and inspiratory stridor. Which of the following conditions should the
nurse suspect?
A. Asthma
B. Epiglottitis
C. Acute Laryngotracheobronchitis (Croup)
D. Bronchiolitis
Answer: C
Rationale: Acute Laryngotracheobronchitis, or croup, is characterized by a barking cough,
hoarseness, and inspiratory stridor due to narrowing of the airway.
4. A nurse is assessing a postpartum client 2 hours after delivery. The nurse
notes the fundus is boggy and displaced to the right. What is the priority nursing
action?
A. Massage the fundus
B. Increase the IV fluid rate
C. Administer methylergonovine
D. Assist the client to the bathroom to void
Answer: D
Rationale: A fundus displaced to the right usually indicates a full bladder, which prevents
the uterus from contracting effectively. Assisting the client to void is the priority.
5. Which of the following interventions is contraindicated in a child suspected of
having epiglottitis?
A. Administering humidified oxygen
B. Placing the child in a tripod position
C. Inserting a tongue blade to examine the throat
D. Starting an IV line for antibiotics
Answer: C
, Rationale: Attempting to visualize the throat with a tongue blade can trigger a
laryngospasm and complete airway obstruction in a child with epiglottitis.
6. A child with cystic fibrosis is prescribed pancreatic enzymes. When should the
nurse instruct the parents to administer these enzymes?
A. With every meal and snack
B. Immediately after each meal
C. Once daily in the morning
D. On an empty stomach
Answer: A
Rationale: Pancreatic enzymes must be taken with all meals and snacks to assist with the
digestion and absorption of fats, proteins, and carbohydrates.
7. A pregnant client at 32 weeks gestation reports painless, bright red vaginal
bleeding. Which condition should the nurse suspect?
A. Abruptio Placentae
B. Cervical Ripening
C. Preterm Labor
D. Placenta Previa
Answer: D
Rationale: Placenta previa is characterized by painless, bright red vaginal bleeding in the
second or third trimester. Abruptio placentae usually involves painful, dark red bleeding.
8. An infant with Tetralogy of Fallot becomes cyanotic and agitated during a
blood draw. Which of the following is the priority nursing action?
A. Administer supplemental oxygen
B. Call for a rapid response team
C. Place the infant in a knee-chest position
D. Administer morphine intramuscularly
Answer: C
