Maternity and Pediatric Nursing Test Bank (5th
Edition) — Ricci, Kyle & Carman
Section 1: Antepartum (Prenatal Care & Fetal Development)
1. A pregnant client at 10 weeks gestation asks, “What is my baby doing inside me right
now?” What is the nurse’s best response?
A) “Your baby’s heart is fully formed and beating regularly.”
B) “The baby is practicing breathing movements.”
C) “The major organs are beginning to form.”
D) “Your baby can open and close its eyes.”
Answer: A
Rationale: By 10 weeks, the embryonic period ends and the fetal period begins; the
heart is fully formed and beating. Breathing movements begin around 20 weeks.
Organ formation occurs weeks 3-8. Eye opening occurs around 26-28 weeks.
2. A nurse is teaching a class on folic acid supplementation. Which rationale best explains
why folic acid is crucial in the first trimester?
A) It prevents iron-deficiency anemia in the mother.
B) It reduces the risk of neural tube defects.
C) It promotes fetal lung maturity.
D) It prevents gestational diabetes.
Answer: B
Rationale: Folic acid is essential for neural tube closure, which occurs by 28 days of
gestation (often before a woman knows she is pregnant). It does not directly affect
lungs, diabetes, or primarily treat maternal anemia (iron does that).
3. A nurse calculates a patient’s EDD using Naegele’s rule. The first day of the LMP was May
10, 2023. What is the expected due date?
A) February 3, 2024
B) February 17, 2024
C) March 3, 2024
D) April 10, 2024
Answer: B
Rationale: Naegele’s rule: LMP (May 10) – subtract 3 months (February 10) + add 7
days = February 17, 2024. Note leap year does not affect due date calculation.
4. A nurse is reviewing a client’s labs at 12 weeks. Which finding requires immediate
intervention?
A) Hemoglobin 11.2 g/dL
B) Rubella titer 0.8 (nonimmune)
C) Platelets 180,000/mm³
D) Blood type O negative, antibody screen negative
Answer: B
, Rationale: Rubella titer <1.0 indicates nonimmunity. Client should avoid exposure to
rubella and receive postpartum vaccination. Low hgb (11.2) is normal in pregnancy
due to hemodilution. Platelets are normal. O negative with neg screen is fine but
requires RhoGAM later.
5. A client at 8 weeks reports severe nausea and vomiting, weight loss, and ketones in urine.
Which condition does the nurse suspect?
A) Hyperemesis gravidarum
B) Morning sickness
C) Gastroenteritis
D) Peptic ulcer disease
Answer: A
Rationale: Hyperemesis gravidarum is severe nausea/vomiting with weight loss (>5%
prepregnancy weight), dehydration, and ketonuria, requiring medical intervention.
6. During a first-trimester ultrasound, the nurse notes a gestational sac but no fetal pole. The
client’s hCG level is plateauing. What does the nurse suspect?
A) Twin gestation
B) Ectopic pregnancy
C) Anembryonic pregnancy (blighted ovum)
D) Normal early pregnancy
Answer: C
Rationale: Anembryonic pregnancy occurs when a gestational sac forms but an
embryo does not develop. hCG plateaus or falls. No fetal pole seen on ultrasound.
7. A nurse teaches a pregnant client about signs of preterm labor. Which statement indicates
correct understanding?
A) “I should watch for sudden weight gain and headache.”
B) “Menstrual-like cramps and low back pain are signs.”
C) “Decreased fetal movement is the main sign.”
D) “Heartburn and indigestion are warning signs.”
Answer: B
Rationale: Preterm labor signs include menstrual-like cramps, low backache, pelvic
pressure, change in vaginal discharge, contractions. Sudden weight gain/headache =
preeclampsia. Decreased fetal movement = fetal compromise.
8. A client at 16 weeks is scheduled for an MSAFP screening. The nurse explains this test
screens for:
A) Gestational diabetes
B) Neural tube defects and chromosomal abnormalities
C) Rh incompatibility
D) Fetal lung maturity
Answer: B
Rationale: Maternal serum alpha-fetoprotein (MSAFP) is a screening test for open
neural tube defects (e.g., spina bifida) and risk for chromosomal abnormalities (e.g.,
Down syndrome).
,9. Which vaccination is specifically recommended during pregnancy (27-36 weeks) to protect
the newborn from pertussis?
A) MMR
B) Varicella
C) Tdap
D) Influenza (inactivated)
Answer: C
Rationale: Tdap (tetanus, diphtheria, pertussis) is recommended each pregnancy,
ideally between 27-36 weeks, to maximize passive antibody transfer to the newborn.
MMR/varicella are live vaccines contraindicated in pregnancy.
10. A nurse is assessing a client at 20 weeks. Which fundal height measurement is consistent
with gestational age?
A) 16 cm
B) 20 cm
C) 24 cm
D) 28 cm
Answer: B
Rationale: Fundal height in cm should approximate gestational age in weeks (±2 cm)
between 18-32 weeks. 20 weeks = ~20 cm.
Section 2: Intrapartum (Labor & Delivery)
11. A nurse is assessing a client in active labor. Contractions occur every 3 minutes, lasting 60
seconds, moderate intensity. Cervix is 5 cm, 90% effaced, 0 station. Which stage and phase?
A) First stage, latent phase
B) First stage, active phase
C) First stage, transition phase
D) Second stage
Answer: B
Rationale: Active phase of first stage: 4-7 cm dilation, contractions q 3-5 min,
duration 40-70 sec, moderate to strong. Latent phase: 0-3 cm. Transition: 8-10 cm.
Second stage: full dilation to delivery.
12. A client’s amniotic membrane ruptures spontaneously. The nurse notes greenish fluid.
What is the priority action?
A) Administer oxygen via face mask.
B) Prepare for immediate cesarean section.
C) Assess fetal heart rate for signs of distress.
D) Increase IV fluids.
Answer: C
Rationale: Green amniotic fluid indicates meconium staining. Priority is fetal
assessment (FHR variability, decelerations) due to risk of meconium aspiration
syndrome. Not all meconium requires C-section unless fetal distress.
, 13. A nurse notes a pattern of late decelerations on the fetal monitor. Which intervention
should the nurse implement first?
A) Increase oxytocin infusion.
B) Turn client to left lateral position.
C) Prepare for vacuum-assisted delivery.
D) Administer IV morphine.
Answer: B
Rationale: Late decelerations indicate uteroplacental insufficiency. First action:
reposition to left lateral to improve placental blood flow, then give O2, IV fluids, and
discontinue oxytocin if running.
14. A pregnant client with a history of C-section desires a VBAC. Which finding would
contraindicate VBAC?
A) Previous low transverse uterine incision
B) Previous classic (vertical) uterine incision
C) Singleton pregnancy
D) Cephalic presentation
Answer: B
Rationale: Classic (vertical) uterine incision has higher risk of uterine rupture during
labor, so VBAC is contraindicated. Low transverse is favorable for VBAC. Singleton and
cephalic presentation are acceptable.
15. The nurse notes variable decelerations on the monitor. What is the most likely cause?
A) Uteroplacental insufficiency
B) Head compression
C) Umbilical cord compression
D) Maternal supine hypotension
Answer: C
Rationale: Variable decelerations are caused by umbilical cord compression. Early
decelerations = head compression. Late = uteroplacental insufficiency.
16. A client requests an epidural for pain relief at 5 cm dilation. Which lab result must the
nurse check before placement?
A) Hemoglobin
B) Platelet count
C) Blood glucose
D) Serum sodium
Answer: B
Rationale: Low platelet count (thrombocytopenia) increases risk of epidural
hematoma. Anesthesiologist needs platelet count >70,000-100,000 typically.
17. A nurse assesses a laboring client’s cervix: 6 cm, 80% effaced, -1 station, vertex
presentation. The client begins vomiting and states, “I can’t do this anymore.” Which phase
is likely?
A) Latent phase
B) Active phase
C) Transition phase
Edition) — Ricci, Kyle & Carman
Section 1: Antepartum (Prenatal Care & Fetal Development)
1. A pregnant client at 10 weeks gestation asks, “What is my baby doing inside me right
now?” What is the nurse’s best response?
A) “Your baby’s heart is fully formed and beating regularly.”
B) “The baby is practicing breathing movements.”
C) “The major organs are beginning to form.”
D) “Your baby can open and close its eyes.”
Answer: A
Rationale: By 10 weeks, the embryonic period ends and the fetal period begins; the
heart is fully formed and beating. Breathing movements begin around 20 weeks.
Organ formation occurs weeks 3-8. Eye opening occurs around 26-28 weeks.
2. A nurse is teaching a class on folic acid supplementation. Which rationale best explains
why folic acid is crucial in the first trimester?
A) It prevents iron-deficiency anemia in the mother.
B) It reduces the risk of neural tube defects.
C) It promotes fetal lung maturity.
D) It prevents gestational diabetes.
Answer: B
Rationale: Folic acid is essential for neural tube closure, which occurs by 28 days of
gestation (often before a woman knows she is pregnant). It does not directly affect
lungs, diabetes, or primarily treat maternal anemia (iron does that).
3. A nurse calculates a patient’s EDD using Naegele’s rule. The first day of the LMP was May
10, 2023. What is the expected due date?
A) February 3, 2024
B) February 17, 2024
C) March 3, 2024
D) April 10, 2024
Answer: B
Rationale: Naegele’s rule: LMP (May 10) – subtract 3 months (February 10) + add 7
days = February 17, 2024. Note leap year does not affect due date calculation.
4. A nurse is reviewing a client’s labs at 12 weeks. Which finding requires immediate
intervention?
A) Hemoglobin 11.2 g/dL
B) Rubella titer 0.8 (nonimmune)
C) Platelets 180,000/mm³
D) Blood type O negative, antibody screen negative
Answer: B
, Rationale: Rubella titer <1.0 indicates nonimmunity. Client should avoid exposure to
rubella and receive postpartum vaccination. Low hgb (11.2) is normal in pregnancy
due to hemodilution. Platelets are normal. O negative with neg screen is fine but
requires RhoGAM later.
5. A client at 8 weeks reports severe nausea and vomiting, weight loss, and ketones in urine.
Which condition does the nurse suspect?
A) Hyperemesis gravidarum
B) Morning sickness
C) Gastroenteritis
D) Peptic ulcer disease
Answer: A
Rationale: Hyperemesis gravidarum is severe nausea/vomiting with weight loss (>5%
prepregnancy weight), dehydration, and ketonuria, requiring medical intervention.
6. During a first-trimester ultrasound, the nurse notes a gestational sac but no fetal pole. The
client’s hCG level is plateauing. What does the nurse suspect?
A) Twin gestation
B) Ectopic pregnancy
C) Anembryonic pregnancy (blighted ovum)
D) Normal early pregnancy
Answer: C
Rationale: Anembryonic pregnancy occurs when a gestational sac forms but an
embryo does not develop. hCG plateaus or falls. No fetal pole seen on ultrasound.
7. A nurse teaches a pregnant client about signs of preterm labor. Which statement indicates
correct understanding?
A) “I should watch for sudden weight gain and headache.”
B) “Menstrual-like cramps and low back pain are signs.”
C) “Decreased fetal movement is the main sign.”
D) “Heartburn and indigestion are warning signs.”
Answer: B
Rationale: Preterm labor signs include menstrual-like cramps, low backache, pelvic
pressure, change in vaginal discharge, contractions. Sudden weight gain/headache =
preeclampsia. Decreased fetal movement = fetal compromise.
8. A client at 16 weeks is scheduled for an MSAFP screening. The nurse explains this test
screens for:
A) Gestational diabetes
B) Neural tube defects and chromosomal abnormalities
C) Rh incompatibility
D) Fetal lung maturity
Answer: B
Rationale: Maternal serum alpha-fetoprotein (MSAFP) is a screening test for open
neural tube defects (e.g., spina bifida) and risk for chromosomal abnormalities (e.g.,
Down syndrome).
,9. Which vaccination is specifically recommended during pregnancy (27-36 weeks) to protect
the newborn from pertussis?
A) MMR
B) Varicella
C) Tdap
D) Influenza (inactivated)
Answer: C
Rationale: Tdap (tetanus, diphtheria, pertussis) is recommended each pregnancy,
ideally between 27-36 weeks, to maximize passive antibody transfer to the newborn.
MMR/varicella are live vaccines contraindicated in pregnancy.
10. A nurse is assessing a client at 20 weeks. Which fundal height measurement is consistent
with gestational age?
A) 16 cm
B) 20 cm
C) 24 cm
D) 28 cm
Answer: B
Rationale: Fundal height in cm should approximate gestational age in weeks (±2 cm)
between 18-32 weeks. 20 weeks = ~20 cm.
Section 2: Intrapartum (Labor & Delivery)
11. A nurse is assessing a client in active labor. Contractions occur every 3 minutes, lasting 60
seconds, moderate intensity. Cervix is 5 cm, 90% effaced, 0 station. Which stage and phase?
A) First stage, latent phase
B) First stage, active phase
C) First stage, transition phase
D) Second stage
Answer: B
Rationale: Active phase of first stage: 4-7 cm dilation, contractions q 3-5 min,
duration 40-70 sec, moderate to strong. Latent phase: 0-3 cm. Transition: 8-10 cm.
Second stage: full dilation to delivery.
12. A client’s amniotic membrane ruptures spontaneously. The nurse notes greenish fluid.
What is the priority action?
A) Administer oxygen via face mask.
B) Prepare for immediate cesarean section.
C) Assess fetal heart rate for signs of distress.
D) Increase IV fluids.
Answer: C
Rationale: Green amniotic fluid indicates meconium staining. Priority is fetal
assessment (FHR variability, decelerations) due to risk of meconium aspiration
syndrome. Not all meconium requires C-section unless fetal distress.
, 13. A nurse notes a pattern of late decelerations on the fetal monitor. Which intervention
should the nurse implement first?
A) Increase oxytocin infusion.
B) Turn client to left lateral position.
C) Prepare for vacuum-assisted delivery.
D) Administer IV morphine.
Answer: B
Rationale: Late decelerations indicate uteroplacental insufficiency. First action:
reposition to left lateral to improve placental blood flow, then give O2, IV fluids, and
discontinue oxytocin if running.
14. A pregnant client with a history of C-section desires a VBAC. Which finding would
contraindicate VBAC?
A) Previous low transverse uterine incision
B) Previous classic (vertical) uterine incision
C) Singleton pregnancy
D) Cephalic presentation
Answer: B
Rationale: Classic (vertical) uterine incision has higher risk of uterine rupture during
labor, so VBAC is contraindicated. Low transverse is favorable for VBAC. Singleton and
cephalic presentation are acceptable.
15. The nurse notes variable decelerations on the monitor. What is the most likely cause?
A) Uteroplacental insufficiency
B) Head compression
C) Umbilical cord compression
D) Maternal supine hypotension
Answer: C
Rationale: Variable decelerations are caused by umbilical cord compression. Early
decelerations = head compression. Late = uteroplacental insufficiency.
16. A client requests an epidural for pain relief at 5 cm dilation. Which lab result must the
nurse check before placement?
A) Hemoglobin
B) Platelet count
C) Blood glucose
D) Serum sodium
Answer: B
Rationale: Low platelet count (thrombocytopenia) increases risk of epidural
hematoma. Anesthesiologist needs platelet count >70,000-100,000 typically.
17. A nurse assesses a laboring client’s cervix: 6 cm, 80% effaced, -1 station, vertex
presentation. The client begins vomiting and states, “I can’t do this anymore.” Which phase
is likely?
A) Latent phase
B) Active phase
C) Transition phase
