**Maternal-Neonatal Momentum: Second
Stage Drills**
1. Nurse assessing laboring pt at 7 cm, FHR 150, moderate variability, recurrent late decelerations to 100
with each contraction. After repositioning and O2, decels persist. Next?
💫RATIONALE✔️✔️: Late decels with failed intrauterine resuscitation. Expedite delivery; prepare for
cesarean.
💫ANSWER✔️✔️: D. Notify provider for cesarean.
2. Newborn, 1 hr old, late preterm 35 weeks, respiratory rate 70, grunting, nasal flaring, O2 sat 88% on
RA. Next intervention?
💫RATIONALE✔️✔️: Respiratory distress syndrome risk. CPAP, surfactant if worsening. Obtain blood gas.
💫ANSWER✔️✔️: B. Apply nasal CPAP.
3. Pt at 38 weeks with gestational hypertension, BP 165/105, urine protein 3+, headache, visual spots.
MgSO4 infusion started. Which finding indicates magnesium toxicity?
💫RATIONALE✔️✔️: Mg toxicity: RR <12, absent DTR, UO <30 mL/hr. Calcium gluconate antidote.
💫ANSWER✔️✔️: C. Respiratory rate 10.
4. Nurse teaching about Rh immune globulin (RhoGAM). At 28 weeks, which Rh-negative mother
requires dose?
💫RATIONALE✔️✔️: All Rh-negative unsensitized mothers receive RhoGAM 300 mcg IM at 28 weeks and
within 72 hr postpartum.
💫ANSWER✔️✔️: A. Unsensitized Rh-negative mother.
5. Pt in active labor, FHR shows variable decelerations to 80, rapid return to baseline. Which
intervention first?
, 💫RATIONALE✔️✔️: Variable decels = cord compression. Reposition lateral or Trendelenburg.
💫ANSWER✔️✔️: B. Change position to left lateral.
6. Postpartum day 2, G2P2, vaginal delivery, fundus firm, lochia rubra moderate, temp 38.8°C, foul
lochia. Likely?
💫RATIONALE✔️✔️: Endometritis. Broad-spectrum antibiotics (clindamycin + gentamicin).
💫ANSWER✔️✔️: D. Endometritis.
7. Newborn, 24 hr old, breastfed, jaundice to knees, bilirubin 15 mg/dL, direct Coombs negative. Mother
blood type A+, baby A+. Likely cause?
💫RATIONALE✔️✔️: Physiologic jaundice day 2-3. Breastfeeding jaundice from inadequate intake.
💫ANSWER✔️✔️: A. Physiologic jaundice.
8. Nurse assessing newborn with myelomeningocele. Which preoperative priority?
💫RATIONALE✔️✔️: Cover defect with sterile saline-soaked gauze to prevent infection and drying.
💫ANSWER✔️✔️: C. Sterile moist dressing.
9. Pt at 32 weeks with placenta previa, painless bright red bleeding 300 mL, FHR 140, contractions
absent. After IV access, next?
💫RATIONALE✔️✔️: Steroids for fetal lung maturity if <34 weeks. Betamethasone 12 mg IM x2.
💫ANSWER✔️✔️: B. Betamethasone.
10. Nurse assessing post-cesarean pt day 1, temp 37.8°C, fundus firm, lochia rubra, incision clean.
Action?
💫RATIONALE✔️✔️: Low-grade fever first 24 hr from atelectasis or dehydration. Encourage deep
breathing, fluids.
💫ANSWER✔️✔️: D. Encourage oral fluids and ambulation.
11. Pt at 39 weeks, rupture of membranes 4 hr ago, clear fluid, GBS positive, no contractions. Action?
💫RATIONALE✔️✔️: GBS prophylaxis: penicillin G 5 million units IV load, then 2.5M Q4H.
Stage Drills**
1. Nurse assessing laboring pt at 7 cm, FHR 150, moderate variability, recurrent late decelerations to 100
with each contraction. After repositioning and O2, decels persist. Next?
💫RATIONALE✔️✔️: Late decels with failed intrauterine resuscitation. Expedite delivery; prepare for
cesarean.
💫ANSWER✔️✔️: D. Notify provider for cesarean.
2. Newborn, 1 hr old, late preterm 35 weeks, respiratory rate 70, grunting, nasal flaring, O2 sat 88% on
RA. Next intervention?
💫RATIONALE✔️✔️: Respiratory distress syndrome risk. CPAP, surfactant if worsening. Obtain blood gas.
💫ANSWER✔️✔️: B. Apply nasal CPAP.
3. Pt at 38 weeks with gestational hypertension, BP 165/105, urine protein 3+, headache, visual spots.
MgSO4 infusion started. Which finding indicates magnesium toxicity?
💫RATIONALE✔️✔️: Mg toxicity: RR <12, absent DTR, UO <30 mL/hr. Calcium gluconate antidote.
💫ANSWER✔️✔️: C. Respiratory rate 10.
4. Nurse teaching about Rh immune globulin (RhoGAM). At 28 weeks, which Rh-negative mother
requires dose?
💫RATIONALE✔️✔️: All Rh-negative unsensitized mothers receive RhoGAM 300 mcg IM at 28 weeks and
within 72 hr postpartum.
💫ANSWER✔️✔️: A. Unsensitized Rh-negative mother.
5. Pt in active labor, FHR shows variable decelerations to 80, rapid return to baseline. Which
intervention first?
, 💫RATIONALE✔️✔️: Variable decels = cord compression. Reposition lateral or Trendelenburg.
💫ANSWER✔️✔️: B. Change position to left lateral.
6. Postpartum day 2, G2P2, vaginal delivery, fundus firm, lochia rubra moderate, temp 38.8°C, foul
lochia. Likely?
💫RATIONALE✔️✔️: Endometritis. Broad-spectrum antibiotics (clindamycin + gentamicin).
💫ANSWER✔️✔️: D. Endometritis.
7. Newborn, 24 hr old, breastfed, jaundice to knees, bilirubin 15 mg/dL, direct Coombs negative. Mother
blood type A+, baby A+. Likely cause?
💫RATIONALE✔️✔️: Physiologic jaundice day 2-3. Breastfeeding jaundice from inadequate intake.
💫ANSWER✔️✔️: A. Physiologic jaundice.
8. Nurse assessing newborn with myelomeningocele. Which preoperative priority?
💫RATIONALE✔️✔️: Cover defect with sterile saline-soaked gauze to prevent infection and drying.
💫ANSWER✔️✔️: C. Sterile moist dressing.
9. Pt at 32 weeks with placenta previa, painless bright red bleeding 300 mL, FHR 140, contractions
absent. After IV access, next?
💫RATIONALE✔️✔️: Steroids for fetal lung maturity if <34 weeks. Betamethasone 12 mg IM x2.
💫ANSWER✔️✔️: B. Betamethasone.
10. Nurse assessing post-cesarean pt day 1, temp 37.8°C, fundus firm, lochia rubra, incision clean.
Action?
💫RATIONALE✔️✔️: Low-grade fever first 24 hr from atelectasis or dehydration. Encourage deep
breathing, fluids.
💫ANSWER✔️✔️: D. Encourage oral fluids and ambulation.
11. Pt at 39 weeks, rupture of membranes 4 hr ago, clear fluid, GBS positive, no contractions. Action?
💫RATIONALE✔️✔️: GBS prophylaxis: penicillin G 5 million units IV load, then 2.5M Q4H.
