MATERNITY, NEWBORN, AND WOMEN’S HEALTH
NURSING: A CASE-BASED APPROACH, 2ND
EDITION BY AMY O’MEARA (2025/2026). THE
QUESTIONS AND RATIONALES HAVE BEEN
DEVELOPED USING THE VERIFIED TEXTBOOK
STRUCTURE, CHAPTER TITLES, AND CLINICAL
CONCEPTS FROM THE SEARCH RESULTS .
Unit 1: Scenarios for Clinical Preparation
1. A nurse is discharging a patient who received a cervical cerclage at 20 weeks gestation due to an
incompetent cervix. Which statement by the patient indicates a correct understanding of the
discharge instructions?
a) "I will need to schedule a cesarean section for 37 weeks to remove the stitch."
b) "If I feel any contractions or pressure in my pelvis, I need to call my doctor right away."
c) "I am on strict bed rest and cannot stand for more than 5 minutes at a time."
d) "It is normal to have a moderate amount of bloody discharge for the first few days."
Correct Answer: b
Rationale: The priority discharge teaching for a patient with a cervical cerclage is monitoring for signs of
preterm labor, including contractions, rupture of membranes (ROM), or severe pelvic pressure . The
cerclage is typically removed around 37 weeks to allow for vaginal delivery (unless a C-section is
planned). Activity is often restricted, but patients can usually stand for short periods (up to 90 minutes).
Any bleeding or unusual discharge should be reported immediately.
2. A patient is admitted with a diagnosis of placenta previa. Which assessment finding is the nurse
most likely to observe?
a) Dark red bleeding with a rigid, board-like abdomen.
b) Sudden, sharp abdominal pain with a prolonged deceleration on the fetal monitor.
c) Bright red, painless vaginal bleeding.
d) Ecchymosis (blueness) around the umbilicus.
,Correct Answer: c
Rationale: Painless, bright red vaginal bleeding is the hallmark sign of placenta previa . Option A
describes abruptio placentae. Option B describes vasa previa or cord accident. Option D (Cullen sign) is
associated with ruptured ectopic pregnancy.
3. A nurse is caring for a patient in labor. The membranes rupture spontaneously, and the nurse
observes a sudden gush of bright red blood followed by a rapid decline in the fetal heart rate (FHR).
The uterine tone remains normal. What condition should the nurse suspect?
a) Placental abruption
b) Uterine rupture
c) Vasa previa
d) Placenta previa
Correct Answer: c
Rationale: Vasa previa occurs when fetal blood vessels traverse the fetal membranes over the internal
os. When membranes rupture, these vessels can tear, causing fetal hemorrhage and rapid fetal
compromise (variable or prolonged decelerations) . Unlike abruption, uterine tone remains normal.
4. A patient is being treated with methotrexate for an ectopic pregnancy. Which criteria are necessary
for a patient to be a candidate for this medical management?
a) Hemodynamic stability and an unruptured mass less than 4 cm.
b) Ruptured fallopian tube with active bleeding.
c) Fetal cardiac activity present with high hCG levels.
d) Hemoglobin less than 10 g/dL.
Correct Answer: a
Rationale: Methotrexate is indicated for the non-surgical management of ectopic pregnancy in a
hemodynamically stable patient with an unruptured mass (typically < 4 cm) .
Unit 2: Maternity and Newborn Nursing for Uncomplicated Pregnancies
5. A nurse is teaching a preconception class. Which dietary supplement is most important to
recommend to prevent neural tube defects?
a) Iron
b) Calcium
c) Folic acid
d) Vitamin D
Correct Answer: c
Rationale: Folic acid (0.4 mg daily) is crucial in the periconceptional period to significantly reduce the
risk of neural tube defects such as spina bifida .
, 6. A patient at 12 weeks gestation asks the nurse about the purpose of an ultrasound. Which
statement by the nurse is most accurate?
a) "It will tell us the exact due date of your baby."
b) "It is primarily used to determine the sex of the baby at this stage."
c) "We use it to confirm the gestational age and location of the pregnancy."
d) "The test is used to diagnose gestational diabetes."
Correct Answer: c
Rationale: In the first trimester, ultrasound is commonly used to confirm intrauterine pregnancy,
establish gestational age, and assess fetal viability. Dating is most accurate in the first trimester.
7. A patient in active labor requests an epidural for pain relief. The nurse knows that an epidural is
contraindicated in which situation?
a) The patient has gestational hypertension.
b) The patient has a platelet count of 80,000/mm³.
c) The patient is Group B Streptococcus (GBS) positive.
d) The patient is 5 cm dilated.
Correct Answer: b
Rationale: A platelet count of 80,000/mm³ indicates severe thrombocytopenia, which is a
contraindication for epidural anesthesia due to the increased risk of epidural hematoma .
8. A nurse is assessing a newborn immediately after birth. Which finding requires immediate
intervention?
a) Heart rate of 140 bpm
b) Apgar score of 8 at 1 minute
c) Acrocyanosis (blue hands and feet)
d) Grunting with nasal flaring
Correct Answer: d
Rationale: Grunting with nasal flaring is a sign of respiratory distress in a newborn and requires
immediate intervention. Acrocyanosis is a normal finding in the first few hours. Heart rate of 140 is
normal. Apgar of 8 is normal.
9. A postpartum nurse is assessing a patient who delivered 2 hours ago. The fundus is boggy and
displaced to the right, and there is moderate lochia. What is the priority nursing action?
a) Massage the fundus vigorously.
b) Assess the bladder for distention.
c) Administer oxytocin (Pitocin) IV.
d) Call the healthcare provider immediately.
NURSING: A CASE-BASED APPROACH, 2ND
EDITION BY AMY O’MEARA (2025/2026). THE
QUESTIONS AND RATIONALES HAVE BEEN
DEVELOPED USING THE VERIFIED TEXTBOOK
STRUCTURE, CHAPTER TITLES, AND CLINICAL
CONCEPTS FROM THE SEARCH RESULTS .
Unit 1: Scenarios for Clinical Preparation
1. A nurse is discharging a patient who received a cervical cerclage at 20 weeks gestation due to an
incompetent cervix. Which statement by the patient indicates a correct understanding of the
discharge instructions?
a) "I will need to schedule a cesarean section for 37 weeks to remove the stitch."
b) "If I feel any contractions or pressure in my pelvis, I need to call my doctor right away."
c) "I am on strict bed rest and cannot stand for more than 5 minutes at a time."
d) "It is normal to have a moderate amount of bloody discharge for the first few days."
Correct Answer: b
Rationale: The priority discharge teaching for a patient with a cervical cerclage is monitoring for signs of
preterm labor, including contractions, rupture of membranes (ROM), or severe pelvic pressure . The
cerclage is typically removed around 37 weeks to allow for vaginal delivery (unless a C-section is
planned). Activity is often restricted, but patients can usually stand for short periods (up to 90 minutes).
Any bleeding or unusual discharge should be reported immediately.
2. A patient is admitted with a diagnosis of placenta previa. Which assessment finding is the nurse
most likely to observe?
a) Dark red bleeding with a rigid, board-like abdomen.
b) Sudden, sharp abdominal pain with a prolonged deceleration on the fetal monitor.
c) Bright red, painless vaginal bleeding.
d) Ecchymosis (blueness) around the umbilicus.
,Correct Answer: c
Rationale: Painless, bright red vaginal bleeding is the hallmark sign of placenta previa . Option A
describes abruptio placentae. Option B describes vasa previa or cord accident. Option D (Cullen sign) is
associated with ruptured ectopic pregnancy.
3. A nurse is caring for a patient in labor. The membranes rupture spontaneously, and the nurse
observes a sudden gush of bright red blood followed by a rapid decline in the fetal heart rate (FHR).
The uterine tone remains normal. What condition should the nurse suspect?
a) Placental abruption
b) Uterine rupture
c) Vasa previa
d) Placenta previa
Correct Answer: c
Rationale: Vasa previa occurs when fetal blood vessels traverse the fetal membranes over the internal
os. When membranes rupture, these vessels can tear, causing fetal hemorrhage and rapid fetal
compromise (variable or prolonged decelerations) . Unlike abruption, uterine tone remains normal.
4. A patient is being treated with methotrexate for an ectopic pregnancy. Which criteria are necessary
for a patient to be a candidate for this medical management?
a) Hemodynamic stability and an unruptured mass less than 4 cm.
b) Ruptured fallopian tube with active bleeding.
c) Fetal cardiac activity present with high hCG levels.
d) Hemoglobin less than 10 g/dL.
Correct Answer: a
Rationale: Methotrexate is indicated for the non-surgical management of ectopic pregnancy in a
hemodynamically stable patient with an unruptured mass (typically < 4 cm) .
Unit 2: Maternity and Newborn Nursing for Uncomplicated Pregnancies
5. A nurse is teaching a preconception class. Which dietary supplement is most important to
recommend to prevent neural tube defects?
a) Iron
b) Calcium
c) Folic acid
d) Vitamin D
Correct Answer: c
Rationale: Folic acid (0.4 mg daily) is crucial in the periconceptional period to significantly reduce the
risk of neural tube defects such as spina bifida .
, 6. A patient at 12 weeks gestation asks the nurse about the purpose of an ultrasound. Which
statement by the nurse is most accurate?
a) "It will tell us the exact due date of your baby."
b) "It is primarily used to determine the sex of the baby at this stage."
c) "We use it to confirm the gestational age and location of the pregnancy."
d) "The test is used to diagnose gestational diabetes."
Correct Answer: c
Rationale: In the first trimester, ultrasound is commonly used to confirm intrauterine pregnancy,
establish gestational age, and assess fetal viability. Dating is most accurate in the first trimester.
7. A patient in active labor requests an epidural for pain relief. The nurse knows that an epidural is
contraindicated in which situation?
a) The patient has gestational hypertension.
b) The patient has a platelet count of 80,000/mm³.
c) The patient is Group B Streptococcus (GBS) positive.
d) The patient is 5 cm dilated.
Correct Answer: b
Rationale: A platelet count of 80,000/mm³ indicates severe thrombocytopenia, which is a
contraindication for epidural anesthesia due to the increased risk of epidural hematoma .
8. A nurse is assessing a newborn immediately after birth. Which finding requires immediate
intervention?
a) Heart rate of 140 bpm
b) Apgar score of 8 at 1 minute
c) Acrocyanosis (blue hands and feet)
d) Grunting with nasal flaring
Correct Answer: d
Rationale: Grunting with nasal flaring is a sign of respiratory distress in a newborn and requires
immediate intervention. Acrocyanosis is a normal finding in the first few hours. Heart rate of 140 is
normal. Apgar of 8 is normal.
9. A postpartum nurse is assessing a patient who delivered 2 hours ago. The fundus is boggy and
displaced to the right, and there is moderate lochia. What is the priority nursing action?
a) Massage the fundus vigorously.
b) Assess the bladder for distention.
c) Administer oxytocin (Pitocin) IV.
d) Call the healthcare provider immediately.
