1 PMOC · 0084 GSN
Galen College of Nursing
✚
G
★
Excellence in Nursing Education
EST. 1989
WE CHANGE THE LIFE OF ONE TO CARE FOR THE LIVES OF MANY
NSG 4800 — Comprehensive Examination 1
O BST E T R I CS · P E D I AT R I CS · L A B VA LU E S · C A R D I AC R H YT H M S · L E GA L / E T H I CS
INSTITUTION Galen College of Nursing COURSE CODE NSG 4800
PROGRAM Bachelor of Science in Nursing ACADEMIC YEAR
(BSN)
EXAM TITLE Comprehensive Examination 1 TOTAL QUESTIONS 45 Questions
COURSE TITLE Comprehensive Nursing Synthesis FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ All lab values reflect current clinical reference ranges.
▸ Obstetric, pediatric, and cardiac content is drawn from evidence-based practice guidelines.
▸ Correct answers and clinical rationales appear below each question for board review purposes.
▸ Legal and ethical content reflects current nursing standards of practice.
, SECTION I — OBSTETRIC COMPLICATIONS Questions 1 – 5
1. A pregnant patient at 32 weeks gestation presents with painless, bright red vaginal
bleeding. The nurse suspects placenta previa. What is the most important nursing action
to avoid?
A. Administering IV fluids as ordered
B. Performing a vaginal examination
C. Applying an external fetal monitor
D. Positioning the patient on her left side
CORRECT ANSWER B — Performing a vaginal examination
RATIONALE In placenta previa, the placenta is growing over the cervical opening. Any vaginal
examination can disrupt the placenta and cause catastrophic hemorrhage. The
cardinal rule is NO VAGINAL EXAMS. External fetal monitoring, IV fluids, and left
lateral positioning are all appropriate nursing interventions. The painless, bright
red bleeding is the classic presentation that distinguishes previa from abruption.
2. A patient at 36 weeks gestation presents with dark red vaginal bleeding and reports
severe, constant abdominal pain. The nurse suspects placental abruption. What is the
pathophysiological process occurring in this condition?
A. The placenta grows over and covers the cervical os
B. The placenta prematurely tears away from the uterine wall
C. The amniotic sac ruptures before the onset of labor
D. The umbilical cord prolapses through the cervical opening
CORRECT ANSWER B — The placenta prematurely tears away from the uterine wall
RATIONALE Placental abruption is the premature separation of the placenta from the uterine
wall before delivery. Classic presentation includes dark red (or concealed)
bleeding and severe pain — in contrast to placenta previa which presents with
painless, bright red bleeding. Abruption is a true obstetric emergency that may
require emergency delivery depending on the severity of separation and
maternal-fetal status.
, 3. A nurse is reviewing fetal heart rate monitoring strips. Which type of deceleration is
caused by umbilical cord compression and is characterized by abrupt decreases in FHR
with variable timing in relation to contractions?
A. Early decelerations
B. Late decelerations
C. Variable decelerations
D. Accelerations
CORRECT ANSWER C — Variable decelerations
RATIONALE Variable decelerations are caused by umbilical cord compression. They appear as
abrupt, V-shaped decreases in fetal heart rate with variable timing relative to
contractions. The shape, depth, and duration vary from one deceleration to the
next. Nursing interventions include maternal position change (left lateral), oxygen
administration, and amnioinfusion if indicated. Early decelerations (head
compression) mirror contractions, late decelerations (placental insufficiency)
occur after the peak of contractions, and accelerations are a reassuring sign.
4. The nurse observes fetal heart rate decelerations that begin at the peak of a contraction
and return to baseline after the contraction ends. This pattern is most consistent with
which condition?
A. Cord compression causing variable decelerations
B. Head compression causing early decelerations
C. Placental insufficiency causing late decelerations
D. Fetal well-being causing accelerations
CORRECT ANSWER C — Placental insufficiency causing late decelerations
RATIONALE Late decelerations begin at or after the peak of a contraction and return to
baseline after the contraction ends. They are caused by uteroplacental
insufficiency — reduced oxygen transfer to the fetus during contractions. This is
an ominous sign indicating fetal hypoxia and requires immediate nursing
intervention: maternal repositioning, oxygen administration, increased IV fluids,
and notification of the provider. Persistent late decelerations may necessitate
emergency delivery.
Galen College of Nursing
✚
G
★
Excellence in Nursing Education
EST. 1989
WE CHANGE THE LIFE OF ONE TO CARE FOR THE LIVES OF MANY
NSG 4800 — Comprehensive Examination 1
O BST E T R I CS · P E D I AT R I CS · L A B VA LU E S · C A R D I AC R H YT H M S · L E GA L / E T H I CS
INSTITUTION Galen College of Nursing COURSE CODE NSG 4800
PROGRAM Bachelor of Science in Nursing ACADEMIC YEAR
(BSN)
EXAM TITLE Comprehensive Examination 1 TOTAL QUESTIONS 45 Questions
COURSE TITLE Comprehensive Nursing Synthesis FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ All lab values reflect current clinical reference ranges.
▸ Obstetric, pediatric, and cardiac content is drawn from evidence-based practice guidelines.
▸ Correct answers and clinical rationales appear below each question for board review purposes.
▸ Legal and ethical content reflects current nursing standards of practice.
, SECTION I — OBSTETRIC COMPLICATIONS Questions 1 – 5
1. A pregnant patient at 32 weeks gestation presents with painless, bright red vaginal
bleeding. The nurse suspects placenta previa. What is the most important nursing action
to avoid?
A. Administering IV fluids as ordered
B. Performing a vaginal examination
C. Applying an external fetal monitor
D. Positioning the patient on her left side
CORRECT ANSWER B — Performing a vaginal examination
RATIONALE In placenta previa, the placenta is growing over the cervical opening. Any vaginal
examination can disrupt the placenta and cause catastrophic hemorrhage. The
cardinal rule is NO VAGINAL EXAMS. External fetal monitoring, IV fluids, and left
lateral positioning are all appropriate nursing interventions. The painless, bright
red bleeding is the classic presentation that distinguishes previa from abruption.
2. A patient at 36 weeks gestation presents with dark red vaginal bleeding and reports
severe, constant abdominal pain. The nurse suspects placental abruption. What is the
pathophysiological process occurring in this condition?
A. The placenta grows over and covers the cervical os
B. The placenta prematurely tears away from the uterine wall
C. The amniotic sac ruptures before the onset of labor
D. The umbilical cord prolapses through the cervical opening
CORRECT ANSWER B — The placenta prematurely tears away from the uterine wall
RATIONALE Placental abruption is the premature separation of the placenta from the uterine
wall before delivery. Classic presentation includes dark red (or concealed)
bleeding and severe pain — in contrast to placenta previa which presents with
painless, bright red bleeding. Abruption is a true obstetric emergency that may
require emergency delivery depending on the severity of separation and
maternal-fetal status.
, 3. A nurse is reviewing fetal heart rate monitoring strips. Which type of deceleration is
caused by umbilical cord compression and is characterized by abrupt decreases in FHR
with variable timing in relation to contractions?
A. Early decelerations
B. Late decelerations
C. Variable decelerations
D. Accelerations
CORRECT ANSWER C — Variable decelerations
RATIONALE Variable decelerations are caused by umbilical cord compression. They appear as
abrupt, V-shaped decreases in fetal heart rate with variable timing relative to
contractions. The shape, depth, and duration vary from one deceleration to the
next. Nursing interventions include maternal position change (left lateral), oxygen
administration, and amnioinfusion if indicated. Early decelerations (head
compression) mirror contractions, late decelerations (placental insufficiency)
occur after the peak of contractions, and accelerations are a reassuring sign.
4. The nurse observes fetal heart rate decelerations that begin at the peak of a contraction
and return to baseline after the contraction ends. This pattern is most consistent with
which condition?
A. Cord compression causing variable decelerations
B. Head compression causing early decelerations
C. Placental insufficiency causing late decelerations
D. Fetal well-being causing accelerations
CORRECT ANSWER C — Placental insufficiency causing late decelerations
RATIONALE Late decelerations begin at or after the peak of a contraction and return to
baseline after the contraction ends. They are caused by uteroplacental
insufficiency — reduced oxygen transfer to the fetus during contractions. This is
an ominous sign indicating fetal hypoxia and requires immediate nursing
intervention: maternal repositioning, oxygen administration, increased IV fluids,
and notification of the provider. Persistent late decelerations may necessitate
emergency delivery.
