**Maternal-Newborn Mastery:
Intrapartum & Postpartum Critical
Thinking Exam 2025**
1. A nurse is assessing a client who is 12 hours post-vaginal delivery. The client reports a gush of blood
and the nurse notes a saturated perineal pad within 15 minutes. The fundus is firm and midline at the
umbilicus. What is the priority action?
A. Perform fundal massage vigorously.
B. Increase the IV oxytocin infusion rate.
C. Assess for vaginal or cervical lacerations.
D. Notify the provider immediately.
💫RATIONALE✔️✔️: A firm uterus with excessive bleeding indicates lower genital tract trauma (laceration)
rather than uterine atony; the provider must be notified for repair.
💫ANSWER✔️✔️: C. Assess for vaginal or cervical lacerations.
---
2. A nurse is caring for a client at 39 weeks gestation who is in active labor. The fetal heart rate (FHR)
tracing shows recurrent late decelerations. What is the priority nursing action?
A. Increase the main IV fluid rate.
B. Administer oxygen via face mask at 10 L/min.
C. Reposition the client to the left lateral position.
D. Notify the provider immediately.
💫RATIONALE✔️✔️: Left lateral repositioning improves uteroplacental blood flow and is the first
intervention for late decelerations before oxygen and fluids.
💫ANSWER✔️✔️: C. Reposition the client to the left lateral position.
,---
3. A client with preeclampsia is receiving IV magnesium sulfate. Which finding indicates magnesium
toxicity?
A. Deep tendon reflexes 2+.
B. Urinary output of 35 mL/hour.
C. Respiratory rate of 10 breaths per minute.
D. Blood pressure of 140/90 mm Hg.
💫RATIONALE✔️✔️: Respiratory rate below 12 is a sign of magnesium toxicity; calcium gluconate should
be available and the infusion stopped immediately.
💫ANSWER✔️✔️: C. Respiratory rate of 10 breaths per minute.
---
4. A nurse is assessing a newborn who is 5 minutes old. The heart rate is 120, respiratory effort is good
crying, tone is active motion, reflex irritability is a vigorous cry, and color is completely pink. What is the
Apgar score?
A. 8
B. 9
C. 10
D. 7
💫RATIONALE✔️✔️: HR 2, respiratory 2, tone 2, reflex 2, color 2 = total 10; this is a perfect Apgar score
indicating excellent transition.
💫ANSWER✔️✔️: C. 10
---
5. A nurse is caring for a client in the transition phase of labor. The client states, "I can't do this anymore.
I want to go home." What is the best response?
A. "You are doing great. You are almost there."
B. "I will call the provider for more pain medication."
C. "Tell me what you are feeling right now."
D. "This is a normal response at this stage of labor."
, 💫RATIONALE✔️✔️: Validation and normalization of feelings during transition supports the client and
acknowledges that loss of control is expected.
💫ANSWER✔️✔️: D. "This is a normal response at this stage of labor."
---
6. A nurse is administering IV oxytocin to a client for induction of labor. Which finding requires
immediate discontinuation of the infusion?
A. Contractions occurring every 2-3 minutes lasting 60 seconds.
B. Fetal heart rate decelerations to 90 bpm lasting 90 seconds.
C. The client reports pain rated 7 on a 0-10 scale.
D. The cervix has dilated from 4 to 6 cm in 2 hours.
💫RATIONALE✔️✔️: Prolonged, deep decelerations indicate fetal distress due to uterine
hyperstimulation; oxytocin must be stopped immediately.
💫ANSWER✔️✔️: B. Fetal heart rate decelerations to 90 bpm lasting 90 seconds.
---
7. A postpartum client reports pain and warmth in the left calf. The nurse notes localized swelling and
redness. What is the priority action?
A. Massage the left calf to improve circulation.
B. Apply warm compresses to the affected area.
C. Instruct the client to ambulate immediately.
D. Measure the circumference of both calves and notify the provider.
💫RATIONALE✔️✔️: These findings suggest deep vein thrombosis; the nurse must not massage the leg
(risk of embolization) and must notify the provider for diagnostic testing.
💫ANSWER✔️✔️: D. Measure the circumference of both calves and notify the provider.
---
8. A nurse is caring for a client with placental abruption. Which finding is most consistent with this
diagnosis?
A. Painless bright red vaginal bleeding.
Intrapartum & Postpartum Critical
Thinking Exam 2025**
1. A nurse is assessing a client who is 12 hours post-vaginal delivery. The client reports a gush of blood
and the nurse notes a saturated perineal pad within 15 minutes. The fundus is firm and midline at the
umbilicus. What is the priority action?
A. Perform fundal massage vigorously.
B. Increase the IV oxytocin infusion rate.
C. Assess for vaginal or cervical lacerations.
D. Notify the provider immediately.
💫RATIONALE✔️✔️: A firm uterus with excessive bleeding indicates lower genital tract trauma (laceration)
rather than uterine atony; the provider must be notified for repair.
💫ANSWER✔️✔️: C. Assess for vaginal or cervical lacerations.
---
2. A nurse is caring for a client at 39 weeks gestation who is in active labor. The fetal heart rate (FHR)
tracing shows recurrent late decelerations. What is the priority nursing action?
A. Increase the main IV fluid rate.
B. Administer oxygen via face mask at 10 L/min.
C. Reposition the client to the left lateral position.
D. Notify the provider immediately.
💫RATIONALE✔️✔️: Left lateral repositioning improves uteroplacental blood flow and is the first
intervention for late decelerations before oxygen and fluids.
💫ANSWER✔️✔️: C. Reposition the client to the left lateral position.
,---
3. A client with preeclampsia is receiving IV magnesium sulfate. Which finding indicates magnesium
toxicity?
A. Deep tendon reflexes 2+.
B. Urinary output of 35 mL/hour.
C. Respiratory rate of 10 breaths per minute.
D. Blood pressure of 140/90 mm Hg.
💫RATIONALE✔️✔️: Respiratory rate below 12 is a sign of magnesium toxicity; calcium gluconate should
be available and the infusion stopped immediately.
💫ANSWER✔️✔️: C. Respiratory rate of 10 breaths per minute.
---
4. A nurse is assessing a newborn who is 5 minutes old. The heart rate is 120, respiratory effort is good
crying, tone is active motion, reflex irritability is a vigorous cry, and color is completely pink. What is the
Apgar score?
A. 8
B. 9
C. 10
D. 7
💫RATIONALE✔️✔️: HR 2, respiratory 2, tone 2, reflex 2, color 2 = total 10; this is a perfect Apgar score
indicating excellent transition.
💫ANSWER✔️✔️: C. 10
---
5. A nurse is caring for a client in the transition phase of labor. The client states, "I can't do this anymore.
I want to go home." What is the best response?
A. "You are doing great. You are almost there."
B. "I will call the provider for more pain medication."
C. "Tell me what you are feeling right now."
D. "This is a normal response at this stage of labor."
, 💫RATIONALE✔️✔️: Validation and normalization of feelings during transition supports the client and
acknowledges that loss of control is expected.
💫ANSWER✔️✔️: D. "This is a normal response at this stage of labor."
---
6. A nurse is administering IV oxytocin to a client for induction of labor. Which finding requires
immediate discontinuation of the infusion?
A. Contractions occurring every 2-3 minutes lasting 60 seconds.
B. Fetal heart rate decelerations to 90 bpm lasting 90 seconds.
C. The client reports pain rated 7 on a 0-10 scale.
D. The cervix has dilated from 4 to 6 cm in 2 hours.
💫RATIONALE✔️✔️: Prolonged, deep decelerations indicate fetal distress due to uterine
hyperstimulation; oxytocin must be stopped immediately.
💫ANSWER✔️✔️: B. Fetal heart rate decelerations to 90 bpm lasting 90 seconds.
---
7. A postpartum client reports pain and warmth in the left calf. The nurse notes localized swelling and
redness. What is the priority action?
A. Massage the left calf to improve circulation.
B. Apply warm compresses to the affected area.
C. Instruct the client to ambulate immediately.
D. Measure the circumference of both calves and notify the provider.
💫RATIONALE✔️✔️: These findings suggest deep vein thrombosis; the nurse must not massage the leg
(risk of embolization) and must notify the provider for diagnostic testing.
💫ANSWER✔️✔️: D. Measure the circumference of both calves and notify the provider.
---
8. A nurse is caring for a client with placental abruption. Which finding is most consistent with this
diagnosis?
A. Painless bright red vaginal bleeding.
