NUR2513 Maternal Child Nursing
Midterm Exam Review
(Questions & Solutions)
2025
©2025
,1. Case Study:
A 28‑year‑old primigravida at 39 weeks gestation is in active labor.
During monitoring, decelerations are observed that begin approximately
25 seconds after the onset of a contraction, with the nadir occurring at
the peak of the contraction and returning to baseline by the end. Which
fetal heart rate pattern is this, and what is the appropriate nursing
management?
a) Early deceleration; continue with routine management.
b) Variable deceleration; reposition the mother and assess for cord
compression.
c) Late deceleration; administer oxygen and reposition immediately.
d) Prolonged deceleration; prepare for immediate delivery.
- Correct ANS: a) Early deceleration; continue with routine
management.
- Rationale: Early decelerations are mirror images of contractions and
are caused by fetal head compression—they are generally benign and
require no active intervention.
2. Case Study:
A 34‑year‑old G2P1 with a history of preeclampsia is in labor. After
receiving an epidural, she develops hypotension and mild uterine
tachysystole. Which intervention best addresses her condition while
ensuring fetal well‑being?
a) Increase the epidural infusion rate.
b) Administer IV fluids and reposition the patient in the left lateral
decubitus position.
c) Administer a tocolytic agent to reduce uterine activity.
d) Place the patient supine and elevate her legs.
- Correct ANS: b) Administer IV fluids and reposition the patient in the
left lateral decubitus position.
- Rationale: Hypotension following epidural administration is managed
by fluid resuscitation and left lateral positioning to improve venous
return and maintain uteroplacental perfusion.
©2025
,3. Case Study:
A 29‑year‑old primiparous woman delivers vaginally at 39 weeks.
Immediately postpartum, her uterus is boggy, and she exhibits
tachycardia with a blood pressure of 90/50 mm Hg. Her quantified blood
loss is 800 mL. What is the most likely cause and the initial nursing
intervention?
a) Uterine atony resulting in postpartum hemorrhage; initiate uterine
massage.
b) Cervical laceration causing hemorrhage; prepare for suturing.
c) Coagulopathy; notify the provider to order blood products.
d) Amniotic fluid embolism; initiate oxygen therapy immediately.
- Correct ANS: a) Uterine atony resulting in postpartum hemorrhage;
initiate uterine massage.
- Rationale: Uterine atony is the most common cause of postpartum
hemorrhage. Prompt uterine massage stimulates contraction and
reduces blood loss.
4. Case Study:
A 32‑year‑old multipara experiences a prolonged second stage of labor.
Post-delivery, a retained placental fragment is suspected. Which
intervention is immediately indicated?
a) Increase the oxytocin infusion rate and continue uterine massage.
b) Prepare for manual extraction of the retained fragment in the
operating room.
c) Observe for signs of infection before intervening.
d) Administer tocolytic therapy to facilitate placental separation.
- Correct ANS: b) Prepare for manual extraction of the retained
fragment in the operating room.
- Rationale: Retained placental tissue can cause continued bleeding and
infection; manual extraction is typically required if conservative
measures (like oxytocin and massage) are unsuccessful.
5. Case Study:
A postpartum patient on day 2 after vaginal delivery presents with a
©2025
, fever of 38.5°C, lower abdominal pain, and malodorous lochia. What is
the most likely diagnosis, and what is the initial management step?
a) Wound infection; initiate IV antibiotics.
b) Endometritis; start broad-spectrum antibiotic therapy.
c) Urinary tract infection; send a urine culture.
d) Mastitis; instruct on breast care and start antibiotics.
- Correct ANS: b) Endometritis; start broad-spectrum antibiotic
therapy.
- Rationale: The presentation is classic for postpartum endometritis,
which is more common after cesarean delivery but can occur after
vaginal birth—prompt antibiotic treatment is essential.
6. Case Study:
A 32‑year‑old woman with gestational diabetes undergoes a non‑stress
test (NST). The NST shows two or more fetal heart rate accelerations in
20 minutes with an appropriate baseline variability. What does this
indicate regarding fetal status?
a) Non-reactive NST requiring further evaluation.
b) Reactive NST indicating adequate fetal oxygenation.
c) Late decelerations suggesting uteroplacental insufficiency.
d) Variable decelerations indicating cord compression.
- Correct ANS: b) Reactive NST indicating adequate fetal oxygenation.
- Rationale: A reactive NST (≥2 accelerations in 20 minutes) is
reassuring and indicates the fetus is well-oxygenated.
7. Case Study:
A postpartum client is diagnosed with postpartum depression and
expresses reservations about pharmacologic treatment due to concerns
about breastfeeding. What is the most appropriate nursing response?
a) Suggest delaying treatment until after breastfeeding is complete.
b) Explain that many SSRIs have acceptable safety profiles during
lactation and refer her to a mental health professional for further
evaluation.
c) Advise her to discontinue breastfeeding immediately.
d) Recommend exclusive counseling with no medication adjustment.
©2025
Midterm Exam Review
(Questions & Solutions)
2025
©2025
,1. Case Study:
A 28‑year‑old primigravida at 39 weeks gestation is in active labor.
During monitoring, decelerations are observed that begin approximately
25 seconds after the onset of a contraction, with the nadir occurring at
the peak of the contraction and returning to baseline by the end. Which
fetal heart rate pattern is this, and what is the appropriate nursing
management?
a) Early deceleration; continue with routine management.
b) Variable deceleration; reposition the mother and assess for cord
compression.
c) Late deceleration; administer oxygen and reposition immediately.
d) Prolonged deceleration; prepare for immediate delivery.
- Correct ANS: a) Early deceleration; continue with routine
management.
- Rationale: Early decelerations are mirror images of contractions and
are caused by fetal head compression—they are generally benign and
require no active intervention.
2. Case Study:
A 34‑year‑old G2P1 with a history of preeclampsia is in labor. After
receiving an epidural, she develops hypotension and mild uterine
tachysystole. Which intervention best addresses her condition while
ensuring fetal well‑being?
a) Increase the epidural infusion rate.
b) Administer IV fluids and reposition the patient in the left lateral
decubitus position.
c) Administer a tocolytic agent to reduce uterine activity.
d) Place the patient supine and elevate her legs.
- Correct ANS: b) Administer IV fluids and reposition the patient in the
left lateral decubitus position.
- Rationale: Hypotension following epidural administration is managed
by fluid resuscitation and left lateral positioning to improve venous
return and maintain uteroplacental perfusion.
©2025
,3. Case Study:
A 29‑year‑old primiparous woman delivers vaginally at 39 weeks.
Immediately postpartum, her uterus is boggy, and she exhibits
tachycardia with a blood pressure of 90/50 mm Hg. Her quantified blood
loss is 800 mL. What is the most likely cause and the initial nursing
intervention?
a) Uterine atony resulting in postpartum hemorrhage; initiate uterine
massage.
b) Cervical laceration causing hemorrhage; prepare for suturing.
c) Coagulopathy; notify the provider to order blood products.
d) Amniotic fluid embolism; initiate oxygen therapy immediately.
- Correct ANS: a) Uterine atony resulting in postpartum hemorrhage;
initiate uterine massage.
- Rationale: Uterine atony is the most common cause of postpartum
hemorrhage. Prompt uterine massage stimulates contraction and
reduces blood loss.
4. Case Study:
A 32‑year‑old multipara experiences a prolonged second stage of labor.
Post-delivery, a retained placental fragment is suspected. Which
intervention is immediately indicated?
a) Increase the oxytocin infusion rate and continue uterine massage.
b) Prepare for manual extraction of the retained fragment in the
operating room.
c) Observe for signs of infection before intervening.
d) Administer tocolytic therapy to facilitate placental separation.
- Correct ANS: b) Prepare for manual extraction of the retained
fragment in the operating room.
- Rationale: Retained placental tissue can cause continued bleeding and
infection; manual extraction is typically required if conservative
measures (like oxytocin and massage) are unsuccessful.
5. Case Study:
A postpartum patient on day 2 after vaginal delivery presents with a
©2025
, fever of 38.5°C, lower abdominal pain, and malodorous lochia. What is
the most likely diagnosis, and what is the initial management step?
a) Wound infection; initiate IV antibiotics.
b) Endometritis; start broad-spectrum antibiotic therapy.
c) Urinary tract infection; send a urine culture.
d) Mastitis; instruct on breast care and start antibiotics.
- Correct ANS: b) Endometritis; start broad-spectrum antibiotic
therapy.
- Rationale: The presentation is classic for postpartum endometritis,
which is more common after cesarean delivery but can occur after
vaginal birth—prompt antibiotic treatment is essential.
6. Case Study:
A 32‑year‑old woman with gestational diabetes undergoes a non‑stress
test (NST). The NST shows two or more fetal heart rate accelerations in
20 minutes with an appropriate baseline variability. What does this
indicate regarding fetal status?
a) Non-reactive NST requiring further evaluation.
b) Reactive NST indicating adequate fetal oxygenation.
c) Late decelerations suggesting uteroplacental insufficiency.
d) Variable decelerations indicating cord compression.
- Correct ANS: b) Reactive NST indicating adequate fetal oxygenation.
- Rationale: A reactive NST (≥2 accelerations in 20 minutes) is
reassuring and indicates the fetus is well-oxygenated.
7. Case Study:
A postpartum client is diagnosed with postpartum depression and
expresses reservations about pharmacologic treatment due to concerns
about breastfeeding. What is the most appropriate nursing response?
a) Suggest delaying treatment until after breastfeeding is complete.
b) Explain that many SSRIs have acceptable safety profiles during
lactation and refer her to a mental health professional for further
evaluation.
c) Advise her to discontinue breastfeeding immediately.
d) Recommend exclusive counseling with no medication adjustment.
©2025
