Maternal-Child Nursing — SNLE practice questions

Question 1

Thirty minutes after a vaginal delivery, a nurse finds that a woman has saturated one perineal pad within the past 15 minutes. The fundus is boggy and palpable above the umbilicus, deviated to the right. What is the nurse's first action?

Accepted Answer

Massage the fundus until it becomes firm

Answer

Assist the woman to empty her bladder before doing anything else

Answer

Place the woman in Trendelenburg position

Answer

Apply firm continuous pressure to the perineum with a sterile pad

Question 2

A nurse is teaching parents of a healthy 2-month-old infant about safe sleep. Which statement by a parent indicates that teaching has been effective?

Accepted Answer

I will place my baby on his back on a firm flat surface with no pillows or bumpers

Answer

I will put my baby to sleep on his side so he does not choke if he spits up

Answer

I will use a soft quilt and a wedge to keep my baby comfortable and in position

Answer

I will let my baby sleep in our bed so I can feed him more easily at night

Question 3

A 4-year-old is admitted with epiglottitis. The child is sitting upright, leaning forward, drooling, and has inspiratory stridor. Which action must the nurse avoid?

Accepted Answer

Inspecting the throat with a tongue depressor to visualize the epiglottis

Answer

Keeping the child in the position of comfort on the parent's lap

Answer

Administering humidified oxygen without upsetting the child

Answer

Ensuring emergency airway equipment is immediately available at the bedside

Question 4

A 28-year-old primigravida delivered a 3.8 kg infant vaginally 30 minutes ago. The nurse notes heavy vaginal bleeding with large clots and a boggy uterus on palpation. Which of the following medications should the nurse anticipate administering first?

Accepted Answer

Oxytocin 10 units intravenously

Answer

Methylergonovine 0.2 mg intramuscularly

Answer

Misoprostol 800 mcg sublingually

Answer

Carboprost tromethamine 250 mcg intramuscularly

Question 5

A community health nurse is conducting a home visit for a 2-day-old infant and the mother. The infant was born at 38 weeks gestation via uncomplicated vaginal delivery and was discharged home 24 hours after birth. The mother is breastfeeding. Which assessment finding requires immediate intervention?

Accepted Answer

Infant's axillary temperature is 36.0°C (96.8°F).

Answer

Infant has lost 5% of birth weight since delivery.

Answer

Infant has had 4 wet diapers in the past 24 hours.

Answer

Infant has a small, flat, bluish discoloration on the lower back.

Question 6

A 32-year-old woman presents with severe dysmenorrhea, deep dyspareunia, and chronic pelvic pain. She has been trying to conceive for 18 months without success. Pelvic examination reveals a fixed, retroverted uterus and tender nodules in the posterior cul-de-sac. Which of the following is the most appropriate next step to confirm the suspected diagnosis?

Accepted Answer

Diagnostic laparoscopy with biopsy

Answer

Transvaginal ultrasound

Answer

Abdominal CT scan

Answer

Pelvic MRI

Question 7

A 35-year-old woman presents with a 6-month history of heavy menstrual bleeding and pelvic pressure. She reports soaking through a pad every hour for 2 days each cycle, but denies intermenstrual bleeding. Vital signs are stable. Urine pregnancy test is negative and hemoglobin is 12.5 g/dL. Bimanual examination reveals an enlarged, mobile, non-tender uterus. Which of the following is the most appropriate initial diagnostic test?

Accepted Answer

Transvaginal ultrasound

Answer

Endometrial biopsy

Answer

Abdominal ultrasound

Answer

Magnetic resonance imaging (MRI)

Question 8

A nurse is assessing a 2-hour-old newborn who was born at 39 weeks' gestation weighing 4,200 g to a mother with gestational diabetes. The newborn is jittery and has a weak cry. Which action should the nurse take first?

Accepted Answer

Obtain a capillary blood glucose level.

Answer

Initiate phototherapy for hyperbilirubinemia.

Answer

Administer 10% dextrose in water intravenously.

Answer

Place the newborn under a radiant warmer for thermoregulation.

Question 9

A 6-year-old child with a history of asthma is brought to the emergency department with increased work of breathing. The nurse assesses the child. Which finding indicates the child is in the early stage of respiratory distress?

Accepted Answer

Tachypnea and wheezing without retractions

Answer

Decreased breath sounds and silent chest

Answer

Cyanosis of the lips and nail beds

Answer

Bradycardia and hypotension

Question 10

A nurse is caring for a client who delivered a 4.1 kg infant vaginally 30 minutes ago. The client's fundus is firm, midline, and at the umbilicus. The nurse notes continuous trickling of bright red blood from the vagina. Vital signs: blood pressure 100/60 mm Hg, heart rate 110/min. Which of the following actions should the nurse take first?

Accepted Answer

Inspect the perineum for lacerations

Answer

Administer oxytocin 10 units intramuscularly

Answer

Notify the healthcare provider of the findings

Answer

Perform fundal massage to promote uterine contraction

Question 11

A 10-year-old boy is admitted to the pediatric unit with a 12-hour history of periumbilical pain that has migrated to the right lower quadrant, accompanied by nausea and a low-grade fever of 38.1°C (100.6°F). The nurse notes rebound tenderness and guarding on palpation. The healthcare provider suspects acute appendicitis and plans for an appendectomy. Which of the following is the priority nursing intervention at this time?

Accepted Answer

Maintain the child on nothing-by-mouth (NPO) status.

Answer

Administer the prescribed opioid analgesic for pain relief.

Answer

Apply a warm compress to the right lower quadrant.

Answer

Insert a nasogastric tube for gastric decompression.

Question 12

A 2-hour-old term newborn, born to a mother with gestational diabetes, has a blood glucose level of 35 mg/dL (1.9 mmol/L). The infant is asymptomatic. What is the priority nursing action?

Accepted Answer

Encourage breastfeeding or provide formula feeding.

Answer

Administer IV dextrose 10% bolus.

Answer

Recheck blood glucose in 30 minutes.

Answer

Notify the physician immediately.

Question 13

A 4-week-old male infant is brought to the emergency department with a 3-day history of progressively forceful vomiting after every feeding. The vomitus is non-bilious. The infant appears hungry after vomiting and has lost 200 grams since birth. On examination, a small, firm, movable mass is palpated in the right upper quadrant. Which of the following is the priority nursing intervention before surgery?

Accepted Answer

Initiate intravenous fluids and monitor serum electrolytes.

Answer

Administer an antiemetic to control vomiting.

Answer

Prepare the infant for immediate surgical correction.

Answer

Insert a nasogastric tube for gastric decompression.

Question 14

A 96-hour-old term infant is brought to the clinic with yellowing of the skin. The mother reports the infant is breastfeeding well, has 6–8 wet diapers per day, and is passing yellow stools. On examination, the infant is alert and active, with jaundice visible from the face to the upper chest. What is the most appropriate initial action?

Accepted Answer

Obtain a transcutaneous or serum bilirubin level.

Answer

Admit the infant for immediate phototherapy.

Answer

Reassure the mother and schedule a follow-up in 2 days.

Answer

Advise the mother to switch to formula feeding.

Question 15

A nurse is caring for a 3-hour-old term newborn whose mother has type 1 diabetes. The newborn is jittery, has a weak cry, and is difficult to arouse. Blood glucose level is 25 mg/dL. Which of the following actions should the nurse take first?

Accepted Answer

Initiate intravenous access and administer dextrose as prescribed.

Answer

Encourage breastfeeding and reassess glucose in 30 minutes.

Answer

Recheck the blood glucose level in 30 minutes.

Answer

Notify the healthcare provider of the findings.

Question 16

A 6-month-old infant is admitted with bronchiolitis. The nurse notes nasal flaring, intercostal retractions, and an oxygen saturation of 92% on room air. Which intervention should the nurse perform first?

Accepted Answer

Suction the nasopharynx.

Answer

Administer a bronchodilator via nebulizer.

Answer

Initiate chest physiotherapy.

Answer

Apply oxygen via nasal cannula.

Question 17

A 28-year-old woman requests contraception. She has a history of migraines with aura occurring once monthly. She does not smoke and has no other medical conditions. Which of the following contraceptive methods is contraindicated for this patient?

Accepted Answer

Combined oral contraceptive pill

Answer

Copper intrauterine device

Answer

Progestin-only oral contraceptive

Answer

Etonogestrel subdermal implant

Question 18

A nurse is caring for a client at 36 weeks gestation with severe preeclampsia who is receiving intravenous magnesium sulfate. Which assessment finding would indicate magnesium toxicity and require immediate intervention?

Accepted Answer

Respiratory rate of 10 breaths per minute

Answer

Patellar deep tendon reflex 2+

Answer

Urine output of 30 mL per hour

Answer

Blood pressure of 150/100 mm Hg

Question 19

A 28-year-old primigravida at 37 weeks' gestation is admitted with severe preeclampsia. She is started on intravenous magnesium sulfate. Two hours later, the nurse notes that her respiratory rate is 10 breaths per minute. Which of the following is the priority nursing action?

Accepted Answer

Stop the magnesium sulfate infusion and administer oxygen.

Answer

Administer oxygen via face mask and continue the infusion.

Answer

Increase the magnesium sulfate infusion rate to prevent seizures.

Answer

Check deep tendon reflexes and continue monitoring.

Question 20

A 7-year-old child with a history of asthma presents to the emergency department with audible wheezing, tachypnea, and intercostal retractions. The child is able to speak in short phrases. Oxygen saturation is 93% on room air. Which intervention should the nurse implement first?

Accepted Answer

Administer inhaled albuterol via metered-dose inhaler with spacer.

Answer

Administer oral prednisolone as prescribed.

Answer

Obtain a peak expiratory flow rate measurement.

Answer

Administer supplemental oxygen via nasal cannula.

Question 21

A 58-year-old woman presents with a 2-week history of light vaginal spotting. She had her last menstrual period 6 years ago and has no pelvic pain. Transvaginal ultrasound reveals an endometrial thickness of 8 mm. Which of the following is the most appropriate next step in management?

Accepted Answer

Endometrial biopsy

Answer

Repeat transvaginal ultrasound in 6 months

Answer

Hysteroscopy with directed biopsy

Answer

Serum CA-125 measurement

Question 22

A 32-year-old G2P1 at 39 weeks' gestation is in active labor and receiving oxytocin augmentation. The fetal heart rate monitor shows late decelerations with each contraction. Uterine contractions are occurring every 1.5 minutes and lasting 90 seconds. What is the nurse's priority action?

Accepted Answer

Discontinue the oxytocin infusion.

Answer

Administer oxygen by face mask at 8-10 L/min.

Answer

Reposition the client to a left lateral position.

Answer

Notify the healthcare provider.

Question 23

A 32-year-old woman has a routine cervical cancer screening. Her Pap test result shows atypical squamous cells of undetermined significance (ASC-US). She has no history of abnormal Pap tests and is not immunocompromised. Which of the following is the most appropriate next step in management?

Accepted Answer

Perform high-risk HPV testing

Answer

Repeat Pap test in 12 months

Answer

Refer for immediate colposcopy with biopsy

Answer

Perform endocervical curettage in the office

Question 24

A 24-year-old woman presents with irregular menstrual cycles occurring every 35–45 days and excessive hair growth on her face and chest. She is not pregnant. Physical examination reveals acne and hirsutism. Laboratory studies show elevated free testosterone, normal thyroid-stimulating hormone, and normal 17-hydroxyprogesterone. Transvaginal ultrasound demonstrates multiple small follicles in both ovaries. Which of the following is the most likely diagnosis?

Accepted Answer

Polycystic ovary syndrome

Answer

Congenital adrenal hyperplasia

Answer

Hypothyroidism

Answer

Ovarian tumor

Question 25

A 22-year-old woman presents for her first well-woman examination. She is sexually active with one lifetime partner, uses condoms for contraception, and has no history of abnormal Pap tests or gynecologic problems. According to the U.S. Preventive Services Task Force (USPSTF) guidelines, which of the following is the most appropriate cervical cancer screening for this patient?

Accepted Answer

Cytology (Pap test) alone

Answer

HPV testing alone

Answer

Co-testing with cytology and HPV testing

Answer

No screening until age 25

Question 26

A 4-year-old child is admitted with periorbital and peripheral edema. Laboratory results show urine protein 4+ on dipstick and serum albumin 1.8 g/dL (normal 3.5–5.0 g/dL). Which additional finding should the nurse anticipate?

Accepted Answer

Hyperlipidemia

Answer

Elevated blood pressure

Answer

Gross hematuria

Answer

Increased serum creatinine

Question 27

A 24-year-old sexually active woman presents with a 3-day history of lower abdominal pain, dyspareunia, and abnormal vaginal discharge. Vital signs: temperature 38.2°C, BP 110/70 mm Hg, HR 92 bpm. Pelvic examination reveals mucopurulent cervical discharge, cervical motion tenderness, and bilateral adnexal tenderness. A urine pregnancy test is negative. What is the most appropriate next step?

Accepted Answer

Initiate empiric antibiotic therapy for pelvic inflammatory disease.

Answer

Obtain endocervical swabs for chlamydia and gonorrhea testing and await results before treatment.

Answer

Perform transvaginal ultrasound to evaluate for tubo-ovarian abscess.

Answer

Refer for diagnostic laparoscopy to confirm the diagnosis.

Question 28

A 28-year-old woman presents with a thin, grayish-white vaginal discharge and a fishy odor. She denies itching, dysuria, or pelvic pain. Speculum examination reveals no cervical motion tenderness. Vaginal pH is 5.0, and a saline wet mount shows numerous clue cells. Which of the following is the most appropriate treatment?

Accepted Answer

Oral metronidazole

Answer

Oral fluconazole

Answer

Intravaginal clotrimazole

Answer

Oral acyclovir

Question 29

A nurse is caring for a 36-hour-old newborn whose mother used heroin daily during pregnancy. The newborn exhibits a high-pitched cry, tremors, and frequent yawning, and has been difficult to console during feedings. Which of the following actions should the nurse take first?

Accepted Answer

Swaddle the newborn and minimize environmental stimulation.

Answer

Administer naloxone as prescribed.

Answer

Obtain a capillary blood glucose level immediately.

Answer

Initiate phototherapy and monitor bilirubin levels.

Question 30

A 28-year-old woman at 32 weeks gestation with preterm premature rupture of membranes (PPROM) for 24 hours reports feeling warm and notices a foul-smelling vaginal discharge. Her temperature is 38.2°C (100.8°F), pulse 102 bpm, and fetal heart rate is 170 bpm. What is the priority nursing action?

Accepted Answer

Notify the healthcare provider immediately.

Answer

Administer the prescribed antipyretic medication.

Answer

Increase the intravenous fluid rate to improve hydration.

Answer

Prepare the patient for an immediate cesarean delivery.

Question 31

A 9-month-old infant is brought to the emergency department with a 12-hour history of sudden, intermittent episodes of crying and drawing up the knees. The mother reports two episodes of vomiting and a stool mixed with blood and mucus. On examination, the infant is lethargic and a sausage-shaped mass is palpated in the right upper quadrant. Which of the following is the most likely diagnosis?

Accepted Answer

Intussusception

Answer

Pyloric stenosis

Answer

Appendicitis

Answer

Meckel's diverticulum

Question 32

A 9-month-old infant is admitted with sudden episodes of crying, drawing up the knees, and vomiting. The stool is mixed with blood and mucus. The healthcare provider suspects intussusception and orders a pneumatic (air) enema for reduction. Which assessment finding should prompt the nurse to withhold the procedure and notify the provider immediately?

Accepted Answer

Abdominal distension with rigidity

Answer

Absent bowel sounds on auscultation

Answer

Passage of a small amount of bloody mucus

Answer

Temperature of 38.2°C (100.8°F)

Question 33

A 24-year-old woman presents with a 5-day history of bilateral lower abdominal pain, dyspareunia, and abnormal vaginal discharge. She has a new sexual partner and uses condoms inconsistently. Vital signs: temperature 38.1°C (100.6°F), pulse 92/min, BP 110/70 mm Hg. She weighs 60 kg (132 lbs). Pelvic examination reveals cervical motion tenderness, bilateral adnexal tenderness, and mucopurulent cervical discharge. A urine pregnancy test is negative. The nurse practitioner diagnoses pelvic inflammatory disease and plans outpatient treatment. Which of the following is the most appropriate initial antibiotic regimen?

Accepted Answer

Ceftriaxone 500 mg IM once, plus doxycycline 100 mg orally twice daily for 14 days, plus metronidazole 500 mg orally twice daily for 14 days

Answer

Azithromycin 1 g orally once, plus doxycycline 100 mg orally twice daily for 7 days, plus metronidazole 500 mg orally twice daily for 7 days

Answer

Levofloxacin 500 mg orally once daily for 14 days, plus doxycycline 100 mg orally twice daily for 14 days, plus metronidazole 500 mg orally twice daily for 14 days

Answer

Ceftriaxone 250 mg IM once, plus doxycycline 100 mg orally twice daily for 14 days, plus metronidazole 500 mg orally twice daily for 14 days

Question 34

A 2-day-old newborn is irritable, has a high-pitched cry, and is sneezing frequently. The mother had no prenatal care and admits to using heroin during pregnancy. What is the nurse's priority action?

Accepted Answer

Assess the newborn using a standardized neonatal abstinence scoring system.

Answer

Administer naloxone as prescribed to reverse withdrawal.

Answer

Obtain a urine toxicology screen to confirm exposure.

Answer

Administer morphine as prescribed for severe withdrawal.

Question 35

A 2-year-old child is brought to the emergency department with a barking cough and inspiratory stridor that is present only when the child is agitated. The child is alert, has a temperature of 38°C (100.4°F), and mild suprasternal retractions. What is the priority nursing intervention?

Accepted Answer

Administer a single dose of oral dexamethasone

Answer

Administer nebulized racemic epinephrine

Answer

Provide cool mist therapy to the child

Answer

Prepare for endotracheal intubation

Question 36

A 15-month-old child is brought to the clinic with a 2-day history of pulling at the right ear and a low-grade fever of 38.2°C (100.8°F). The child is active, eating well, and has no history of recurrent ear infections. On examination, the right tympanic membrane is erythematous and bulging with decreased mobility; the left ear is normal. The parents are reliable and express a strong preference to avoid antibiotics if it is safe to do so. What is the most appropriate nursing action?

Accepted Answer

Educate the parents about watchful waiting with pain management and arrange follow-up in 48–72 hours.

Answer

Instruct the parents to start the child on oral amoxicillin as initial therapy.

Answer

Recommend the parents apply topical antibiotic ear drops to the affected ear for 7 days.

Answer

Refer the child to an otolaryngologist for immediate tympanostomy tube placement.