Test Bank For Safe Maternity & Pediatric Nursing Care Second
Edition by Luanne Linnard-Palmer — 190 Questions and
Answers Already Graded A+ Premium Exam Tested And
Verified
Subject Area Maternity & Pediatric Nursing
Description This rigorous exam assesses advanced understanding of safe maternity and
pediatric nursing care, including high-risk obstetrics, neonatal complications,
pediatric pharmacodynamics, family-centered care, and ethical-legal issues.
Questions demand integration of pathophysiology, evidence-based interventions,
and critical decision-making in complex clinical scenarios.
Expected Grade A+
Total Questions 50
Duration 3 hours
Learning Outcomes 1. Apply principles of pharmacokinetics and pharmacodynamics to pediatric and
obstetric populations
2. Analyze maternal-fetal physiology to predict and manage obstetric emergencies
3. Evaluate pediatric assessment findings to differentiate life-threatening
conditions
4. Integrate family-centered care and ethical principles into nursing management
5. Synthesize evidence-based interventions for high-risk neonates and children
with chronic conditions
Accreditation This exam aligns with AACN Essentials and NCLEX-RN test plan standards for
US baccalaureate nursing programs.
Page 1
,1. A primigravida at 38 weeks gestation presents with severe headache, blurred
vision, and epigastric pain. Blood pressure is 172/112 mmHg, and urinalysis shows
3+ protein. Which intervention should the nurse prioritize immediately after
initiating seizure precautions?
A. Administer intravenous hydralazine to lower blood pressure
B. Prepare for immediate cesarean birth
C. Administer magnesium sulfate intravenously
D. Insert an indwelling urinary catheter
Answer: C. Administer magnesium sulfate intravenously
Magnesium sulfate is the first-line anticonvulsant for severe preeclampsia/eclampsia to
prevent seizures. While hydralazine may be used for severe hypertension, seizure
prophylaxis takes precedence. Delivery is indicated after stabilization, not before.
Catheterization is needed but after initiating magnesium.
2. A term neonate, delivered vaginally after meconium-stained amniotic fluid, is
non-vigorous with poor respiratory effort and heart rate 80 bpm. What is the most
appropriate immediate action?
A. Begin positive pressure ventilation with a bag-mask device
B. Intubate and suction the trachea directly
C. Provide blow-by oxygen and stimulate the infant
D. Start chest compressions at a 3:1 ratio
Answer: B. Intubate and suction the trachea directly
For non-vigorous infants with meconium-stained fluid, the NRP guidelines recommend
immediate direct tracheal suctioning to clear meconium before initiating ventilation.
PPV would risk forcing meconium deeper. Blow-by oxygen is insufficient. Chest
compressions are only indicated if HR <60 after adequate ventilation.
Page 2
,3. A child with sickle cell disease presents with severe pain in the lower extremities,
fever 39.2°C, and hemoglobin 6.8 g/dL (baseline 8.5). Which intervention should the
nurse question?
A. Administer morphine sulfate 0.1 mg/kg IV every 2 hours PRN pain
B. Apply warm compresses to painful joints
C. Administer intravenous fluids at 1.5 times maintenance
D. Administer meperidine (Demerol) 1 mg/kg IM for pain
Answer: D. Administer meperidine (Demerol) 1 mg/kg IM for pain
Meperidine is contraindicated in sickle cell disease due to risk of normeperidine
accumulation and seizures, especially with renal impairment common in these patients.
Morphine is preferred. Warm compresses and increased fluids are standard. Fever and
drop in hemoglobin suggest possible acute chest syndrome requiring further evaluation.
4. A pregnant woman at 32 weeks gestation is diagnosed with placenta previa. She is
stable with no active bleeding. Which finding would most likely indicate the need for
immediate cesarean delivery?
A. Fetal heart rate baseline 140 bpm with moderate variability
B. A single episode of bright red spotting that resolves spontaneously
C. Maternal blood pressure 90/60 mmHg with a 30-beat increase in fetal heart rate
D. Ultrasound shows the placenta is 2 cm from the internal os
Answer: C. Maternal blood pressure 90/60 mmHg with a 30-beat increase in fetal
heart rate
Maternal hypotension with fetal tachycardia suggests significant hemorrhage and
impending maternal-fetal compromise, necessitating immediate delivery. A stable fetal
heart rate and resolved spotting are reassuring. A placental edge 2 cm from the os is a
marginal previa and does not mandate immediate delivery if asymptomatic.
Page 3
, 5. A 3-year-old child is admitted with respiratory distress. The nurse notes nasal
flaring, intercostal retractions, and expiratory wheezing. Oxygen saturation is 88%
on room air. Which assessment finding most reliably indicates the need for
immediate intubation?
A. Respiratory rate of 55 breaths per minute
B. Pulsus paradoxus of 15 mmHg
C. Silent chest with no audible wheezing
D. Use of accessory muscles
Answer: C. Silent chest with no audible wheezing
A silent chest indicates critically reduced air movement due to severe airway
obstruction, often preceding respiratory arrest. Tachypnea, pulsus paradoxus, and
accessory muscle use are signs of moderate to severe distress but do not alone indicate
imminent failure. A silent chest is a late sign requiring immediate intervention.
6. A postpartum woman with severe preeclampsia is receiving magnesium sulfate.
The nurse notes respiratory rate 10 breaths per minute, deep tendon reflexes absent,
and urine output 20 mL over the past hour. What should the nurse do first?
A. Increase the intravenous maintenance fluid rate
B. Administer calcium gluconate intravenously
C. Stop the magnesium sulfate infusion
D. Notify the healthcare provider
Answer: C. Stop the magnesium sulfate infusion
Magnesium toxicity is indicated by respiratory depression, areflexia, and oliguria. The
priority is to stop the infusion immediately to prevent further toxicity. Calcium
gluconate is the antidote but should be given after stopping the infusion. Notifying the
provider is important but not the first action. Increasing fluids is not indicated.
Page 4
Edition by Luanne Linnard-Palmer — 190 Questions and
Answers Already Graded A+ Premium Exam Tested And
Verified
Subject Area Maternity & Pediatric Nursing
Description This rigorous exam assesses advanced understanding of safe maternity and
pediatric nursing care, including high-risk obstetrics, neonatal complications,
pediatric pharmacodynamics, family-centered care, and ethical-legal issues.
Questions demand integration of pathophysiology, evidence-based interventions,
and critical decision-making in complex clinical scenarios.
Expected Grade A+
Total Questions 50
Duration 3 hours
Learning Outcomes 1. Apply principles of pharmacokinetics and pharmacodynamics to pediatric and
obstetric populations
2. Analyze maternal-fetal physiology to predict and manage obstetric emergencies
3. Evaluate pediatric assessment findings to differentiate life-threatening
conditions
4. Integrate family-centered care and ethical principles into nursing management
5. Synthesize evidence-based interventions for high-risk neonates and children
with chronic conditions
Accreditation This exam aligns with AACN Essentials and NCLEX-RN test plan standards for
US baccalaureate nursing programs.
Page 1
,1. A primigravida at 38 weeks gestation presents with severe headache, blurred
vision, and epigastric pain. Blood pressure is 172/112 mmHg, and urinalysis shows
3+ protein. Which intervention should the nurse prioritize immediately after
initiating seizure precautions?
A. Administer intravenous hydralazine to lower blood pressure
B. Prepare for immediate cesarean birth
C. Administer magnesium sulfate intravenously
D. Insert an indwelling urinary catheter
Answer: C. Administer magnesium sulfate intravenously
Magnesium sulfate is the first-line anticonvulsant for severe preeclampsia/eclampsia to
prevent seizures. While hydralazine may be used for severe hypertension, seizure
prophylaxis takes precedence. Delivery is indicated after stabilization, not before.
Catheterization is needed but after initiating magnesium.
2. A term neonate, delivered vaginally after meconium-stained amniotic fluid, is
non-vigorous with poor respiratory effort and heart rate 80 bpm. What is the most
appropriate immediate action?
A. Begin positive pressure ventilation with a bag-mask device
B. Intubate and suction the trachea directly
C. Provide blow-by oxygen and stimulate the infant
D. Start chest compressions at a 3:1 ratio
Answer: B. Intubate and suction the trachea directly
For non-vigorous infants with meconium-stained fluid, the NRP guidelines recommend
immediate direct tracheal suctioning to clear meconium before initiating ventilation.
PPV would risk forcing meconium deeper. Blow-by oxygen is insufficient. Chest
compressions are only indicated if HR <60 after adequate ventilation.
Page 2
,3. A child with sickle cell disease presents with severe pain in the lower extremities,
fever 39.2°C, and hemoglobin 6.8 g/dL (baseline 8.5). Which intervention should the
nurse question?
A. Administer morphine sulfate 0.1 mg/kg IV every 2 hours PRN pain
B. Apply warm compresses to painful joints
C. Administer intravenous fluids at 1.5 times maintenance
D. Administer meperidine (Demerol) 1 mg/kg IM for pain
Answer: D. Administer meperidine (Demerol) 1 mg/kg IM for pain
Meperidine is contraindicated in sickle cell disease due to risk of normeperidine
accumulation and seizures, especially with renal impairment common in these patients.
Morphine is preferred. Warm compresses and increased fluids are standard. Fever and
drop in hemoglobin suggest possible acute chest syndrome requiring further evaluation.
4. A pregnant woman at 32 weeks gestation is diagnosed with placenta previa. She is
stable with no active bleeding. Which finding would most likely indicate the need for
immediate cesarean delivery?
A. Fetal heart rate baseline 140 bpm with moderate variability
B. A single episode of bright red spotting that resolves spontaneously
C. Maternal blood pressure 90/60 mmHg with a 30-beat increase in fetal heart rate
D. Ultrasound shows the placenta is 2 cm from the internal os
Answer: C. Maternal blood pressure 90/60 mmHg with a 30-beat increase in fetal
heart rate
Maternal hypotension with fetal tachycardia suggests significant hemorrhage and
impending maternal-fetal compromise, necessitating immediate delivery. A stable fetal
heart rate and resolved spotting are reassuring. A placental edge 2 cm from the os is a
marginal previa and does not mandate immediate delivery if asymptomatic.
Page 3
, 5. A 3-year-old child is admitted with respiratory distress. The nurse notes nasal
flaring, intercostal retractions, and expiratory wheezing. Oxygen saturation is 88%
on room air. Which assessment finding most reliably indicates the need for
immediate intubation?
A. Respiratory rate of 55 breaths per minute
B. Pulsus paradoxus of 15 mmHg
C. Silent chest with no audible wheezing
D. Use of accessory muscles
Answer: C. Silent chest with no audible wheezing
A silent chest indicates critically reduced air movement due to severe airway
obstruction, often preceding respiratory arrest. Tachypnea, pulsus paradoxus, and
accessory muscle use are signs of moderate to severe distress but do not alone indicate
imminent failure. A silent chest is a late sign requiring immediate intervention.
6. A postpartum woman with severe preeclampsia is receiving magnesium sulfate.
The nurse notes respiratory rate 10 breaths per minute, deep tendon reflexes absent,
and urine output 20 mL over the past hour. What should the nurse do first?
A. Increase the intravenous maintenance fluid rate
B. Administer calcium gluconate intravenously
C. Stop the magnesium sulfate infusion
D. Notify the healthcare provider
Answer: C. Stop the magnesium sulfate infusion
Magnesium toxicity is indicated by respiratory depression, areflexia, and oliguria. The
priority is to stop the infusion immediately to prevent further toxicity. Calcium
gluconate is the antidote but should be given after stopping the infusion. Notifying the
provider is important but not the first action. Increasing fluids is not indicated.
Page 4
