14 original SNLE questions on maternity nursing, each with an explanation for all four options. Part of Maternal-Child Nursing, worth 30% of the Saudi Nursing Licensure Examination.
Q01 / 10medium0 correct
Maternal-Child Nursingmediumq010
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?
All 14 questions
Every question below, with the reasoning for all four options. Try to answer before you open one.
Maternity nursing · medium
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?
AMassage the fundus until it becomes firm
BPlace the woman in Trendelenburg position
CAssist the woman to empty her bladder before doing anything else
DApply firm continuous pressure to the perineum with a sterile pad
Show the answer and why the others fail
Answer: A. Massage the fundus until it becomes firm
A — correct
A boggy fundus with excessive bleeding calls for immediate fundal massage, which mechanically stimulates the myometrium to contract and compress the open placental site. It is instantaneous, requires no equipment, and slows blood loss while the nurse arranges the next steps — emptying the bladder and notifying the provider.
B
Head-down positioning does nothing to restore uterine tone and is not a priority intervention for postpartum hemorrhage; it can also hinder assessment and ventilation.
C
The high, laterally deviated fundus does indicate bladder distension, which displaces the uterus upward and sideways and prevents it from contracting down effectively. Emptying the bladder is necessary, but it takes several minutes, so it follows the massage that stops bleeding now.
D
Perineal pressure addresses bleeding from a superficial laceration; it cannot control hemorrhage arising from the placental site inside an atonic uterus.
TakeawayFor a boggy fundus with heavy bleeding, massage the uterus first — it is the fastest way to restore tone. Then empty the distended bladder, which displaces the uterus and keeps it from contracting effectively.
Maternity nursing · medium
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?
AOxytocin 10 units intravenously
BMethylergonovine 0.2 mg intramuscularly
CCarboprost tromethamine 250 mcg intramuscularly
DMisoprostol 800 mcg sublingually
Show the answer and why the others fail
Answer: A. Oxytocin 10 units intravenously
A — correct
Oxytocin is the first-line pharmacological agent for postpartum hemorrhage due to uterine atony; intravenous administration provides rapid onset of action to control active bleeding.
B
Methylergonovine is a second-line uterotonic and is contraindicated in patients with hypertension; it is not the first choice for initial management of uterine atony.
C
Carboprost is a second-line prostaglandin F2α analog, reserved for refractory atony and contraindicated in patients with asthma; it is not given first.
D
Misoprostol is a prostaglandin E1 analog used when oxytocin is ineffective or unavailable; it is not the initial drug of choice for uterine atony.
TakeawayOxytocin is the first-line uterotonic for postpartum hemorrhage due to uterine atony, and intravenous administration is recommended for active hemorrhage to achieve rapid uterine contraction.
Maternity nursing · medium
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?
AAdminister oxytocin 10 units intramuscularly
BPerform fundal massage to promote uterine contraction
CInspect the perineum for lacerations
DNotify the healthcare provider of the findings
Show the answer and why the others fail
Answer: C. Inspect the perineum for lacerations
A
Oxytocin is used to treat uterine atony, but the fundus is firm, indicating that atony is not the cause of bleeding; this intervention is not indicated.
B
Fundal massage is indicated for a boggy uterus to promote contraction; massaging a firm fundus is contraindicated because it can cause uterine relaxation (iatrogenic atony) and increased pain.
C — correct
A firm fundus with continuous bright red bleeding suggests a genital tract laceration; the nurse should inspect the perineum and apply direct pressure as a temporary measure to control bleeding until the provider can repair the laceration.
D
The provider should be notified, but the nurse must first assess the perineum for lacerations, as immediate inspection and temporary pressure can control bleeding.
TakeawayWhen the uterus is firm but bleeding persists, suspect a genital tract laceration; the nurse should first inspect the perineum and apply direct pressure as a temporary measure to control bleeding, then notify the provider.
Maternity nursing · medium
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?
ARespiratory rate of 10 breaths per minute
BPatellar deep tendon reflex 2+
CUrine output of 30 mL per hour
DBlood pressure of 150/100 mm Hg
Show the answer and why the others fail
Answer: A. Respiratory rate of 10 breaths per minute
A — correct
Respiratory depression (rate <12/min) is a sign of magnesium toxicity. The nurse should immediately stop the infusion, notify the provider, and prepare to administer calcium gluconate as the antidote.
B
A patellar reflex of 2+ is a normal finding. Magnesium toxicity would cause diminished or absent reflexes, not a normal response.
C
Urine output of 30 mL/hr is at the lower limit of acceptable renal function during magnesium therapy. It requires close monitoring, but output below 30 mL/hr would necessitate intervention.
D
This blood pressure reflects severe preeclampsia, which is the indication for magnesium sulfate therapy. It is not a sign of magnesium toxicity.
TakeawayRespiratory depression (rate <12/min) is a key sign of magnesium sulfate toxicity. The nurse should stop the infusion, notify the provider, and prepare to administer calcium gluconate as the antidote.
Maternity nursing · medium
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?
AIncrease the magnesium sulfate infusion rate to prevent seizures.
BAdminister oxygen via face mask and continue the infusion.
CCheck deep tendon reflexes and continue monitoring.
DStop the magnesium sulfate infusion and administer oxygen.
Show the answer and why the others fail
Answer: D. Stop the magnesium sulfate infusion and administer oxygen.
A
Increasing the infusion would worsen toxicity, potentially leading to respiratory arrest.
B
Continuing the infusion while administering oxygen fails to address the cause of respiratory depression; the magnesium sulfate must be stopped immediately to prevent further toxicity.
C
While checking reflexes is part of ongoing assessment, it delays the critical interventions of stopping the drug and supporting breathing.
D — correct
Respiratory depression (rate <12/min) indicates magnesium toxicity. The priority is to stop the infusion to halt further toxicity and administer oxygen to support ventilation, while notifying the provider for further orders like calcium gluconate.
TakeawaySigns of magnesium sulfate toxicity include respiratory depression (<12/min), loss of deep tendon reflexes, and decreased urine output. The priority nursing actions are to stop the infusion, administer oxygen, and notify the provider immediately.
Maternity nursing · medium
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?
ANotify the healthcare provider.
BReposition the client to a left lateral position.
CAdminister oxygen by face mask at 8-10 L/min.
DDiscontinue the oxytocin infusion.
Show the answer and why the others fail
Answer: D. Discontinue the oxytocin infusion.
A
Notifying the healthcare provider is necessary, but it is not the immediate priority. The nurse must first intervene to reduce uterine tachysystole and improve fetal oxygenation.
B
Repositioning to the left lateral position improves uteroplacental blood flow and is a supportive measure, but it does not directly stop the oxytocin-induced tachysystole. It can be performed simultaneously, but the priority is to discontinue the oxytocin.
C
Routine oxygen administration is not recommended for intrauterine resuscitation in the absence of maternal hypoxia, per ACOG guidelines. The priority is to address the underlying cause of the late decelerations, which is uterine tachysystole.
D — correct
Discontinuing oxytocin is the priority to reduce uterine tachysystole, which is causing late decelerations by decreasing placental perfusion. This directly addresses the cause of the nonreassuring fetal heart pattern.
TakeawayWhen late decelerations are associated with oxytocin-induced tachysystole, the priority nursing action is to discontinue the oxytocin infusion to reduce uterine activity and improve placental perfusion. Additional interventions such as maternal repositioning and oxygen administration (if maternal hypoxia is present) may be implemented concurrently.
Maternity nursing · medium
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?
AAdminister the prescribed antipyretic medication.
BNotify the healthcare provider immediately.
CPrepare the patient for an immediate cesarean delivery.
DIncrease the intravenous fluid rate to improve hydration.
Show the answer and why the others fail
Answer: B. Notify the healthcare provider immediately.
A
While fever management is important, it does not address the underlying infection or the need for urgent provider evaluation and initiation of treatment protocols for suspected chorioamnionitis.
B — correct
The combination of maternal fever, foul-smelling discharge, and fetal tachycardia strongly suggests chorioamnionitis, a serious infection requiring immediate provider notification to trigger a treatment protocol (e.g., antibiotics, cultures, delivery planning) and prevent complications.
C
Chorioamnionitis alone is not an indication for cesarean delivery; vaginal delivery is preferred to reduce maternal morbidity unless obstetric contraindications exist. The nurse should not prepare for cesarean based solely on these findings.
D
Increasing IV fluids may be ordered for maternal tachycardia, but it is not the priority when signs of infection are present; the provider must be notified first to initiate appropriate treatment.
TakeawaySigns of chorioamnionitis (maternal fever, foul-smelling amniotic fluid, maternal and fetal tachycardia) require immediate provider notification to initiate timely treatment and prevent maternal and neonatal complications.
Maternity nursing · medium
A nurse is assisting with the vaginal delivery of a term infant. After the fetal head delivers, it retracts against the perineum (turtle sign). The nurse suspects shoulder dystocia. Which action should the nurse take first?
AApply suprapubic pressure to dislodge the anterior shoulder.
BAssist the mother into McRoberts position by sharply flexing her legs.
CPerform an episiotomy to enlarge the vaginal opening.
DApply firm fundal pressure to assist with delivery of the shoulders.
Show the answer and why the others fail
Answer: B. Assist the mother into McRoberts position by sharply flexing her legs.
A
Suprapubic pressure is an initial maneuver often performed concurrently with McRoberts positioning, but the nurse's first action is to reposition the mother, not to apply suprapubic pressure.
B — correct
McRoberts maneuver is the first-line intervention for shoulder dystocia; sharply flexing the legs widens the pelvic outlet and often resolves the impaction without additional maneuvers.
C
An episiotomy may be considered if McRoberts and suprapubic pressure fail, but it is not the initial action.
D
Fundal pressure is contraindicated in shoulder dystocia because it can worsen impaction and cause fetal or maternal injury.
TakeawayIn shoulder dystocia, the primary nursing intervention is to assist the mother into McRoberts position (sharp flexion of thighs onto abdomen) to maximize pelvic dimensions. Fundal pressure must be avoided.
Maternity nursing · medium
A nurse is assessing a client who is 3 days postpartum after a cesarean delivery. The client reports abdominal pain and has a temperature of 38.5°C (101.3°F). Which additional finding should the nurse expect?
ANon-tender uterus
BClear breath sounds
CFoul-smelling lochia
DScant, odorless lochia
Show the answer and why the others fail
Answer: C. Foul-smelling lochia
A
A non-tender uterus is not characteristic of endometritis; the infection typically causes uterine tenderness. While mild afterpains are normal postpartum, a non-tender uterus does not support the diagnosis of infection.
B
Clear breath sounds are a normal respiratory assessment finding and are not associated with the postpartum uterine infection suggested by the client's symptoms.
C — correct
Foul-smelling lochia is a classic sign of endometritis, an infection of the uterine lining that commonly presents with fever, abdominal pain, and malodorous discharge.
D
Scant, odorless lochia is not an expected finding in endometritis. On day 3 postpartum, lochia rubra is typically moderate; infection usually presents with foul-smelling, possibly purulent discharge, not scant odorless lochia.
TakeawayPostpartum endometritis typically presents with fever, foul-smelling lochia, and uterine tenderness, requiring prompt antibiotic therapy.
Maternity nursing · medium
A 30-year-old G2P1 at 30 weeks gestation presents with regular, painful contractions every 3 minutes. Cervical examination reveals 3 cm dilation and 80% effacement. The nurse anticipates administering which medication to reduce the risk of neonatal respiratory distress syndrome?
AOxytocin
BBetamethasone
CNifedipine
DMagnesium sulfate
Show the answer and why the others fail
Answer: B. Betamethasone
A
Oxytocin is used for labor induction or augmentation, not for fetal lung maturity. It would be contraindicated in preterm labor when delivery is not desired.
B — correct
Betamethasone is a corticosteroid that accelerates fetal lung maturity by promoting surfactant production. It is indicated for women at risk of preterm delivery between 24 0/7 and 33 6/7 weeks gestation to reduce the incidence of respiratory distress syndrome.
C
Nifedipine is a tocolytic agent used to inhibit uterine contractions and delay preterm birth, but it does not directly enhance fetal lung maturity or reduce the risk of respiratory distress syndrome.
D
Magnesium sulfate may be used for fetal neuroprotection in preterm labor, but it does not promote lung maturity. Its primary role in this context is to reduce the risk of cerebral palsy, not respiratory distress syndrome.
TakeawayBetamethasone is a corticosteroid administered to women in preterm labor between 24 0/7 and 33 6/7 weeks gestation to accelerate fetal lung maturity and reduce the risk of neonatal respiratory distress syndrome.
Maternity nursing · medium
A client at 32 weeks' gestation reports a sudden gush of clear fluid from the vagina. She denies contractions. Which action should the nurse take first?
AAuscultate the fetal heart rate.
BPerform a digital cervical examination.
CPerform a sterile speculum examination.
DVisually inspect the perineum for cord prolapse.
Show the answer and why the others fail
Answer: A. Auscultate the fetal heart rate.
A — correct
The priority is to assess fetal well-being immediately after membrane rupture. Auscultation of the fetal heart rate can quickly detect bradycardia or variable decelerations that suggest cord prolapse or fetal distress.
B
Digital cervical examination is contraindicated when preterm premature rupture of membranes is suspected because it significantly increases the risk of introducing infection.
C
A sterile speculum examination confirms rupture of membranes but is not the first priority; immediate assessment of fetal well-being is essential to detect cord prolapse or fetal distress.
D
Visual inspection can identify an overt cord prolapse, but it does not assess fetal well-being. The first action is to auscultate the fetal heart rate to evaluate for signs of cord compression or distress.
TakeawayWhen preterm premature rupture of membranes is suspected, the nurse's first action is to assess fetal well-being by auscultating the fetal heart rate. Digital cervical examinations should be avoided to reduce the risk of infection.
Maternity nursing · medium
A 28-year-old G1P1 who is 2 weeks postpartum and exclusively breastfeeding reports a sudden onset of fever, chills, and a tender, erythematous, wedge-shaped area on the outer quadrant of her right breast. Her temperature is 38.5°C (101.3°F). Which of the following should the nurse advise?
AContinue breastfeeding on both breasts, ensuring effective drainage of the affected breast, and notify the healthcare provider.
BStop breastfeeding from the right breast, pump and discard the milk, and resume breastfeeding once the redness resolves.
CApply warm compresses and take ibuprofen for pain and fever, but avoid breastfeeding until the infection is fully treated.
DImmediately wean the infant from the breast and switch to formula feeding to prevent transmission of the infection.
Show the answer and why the others fail
Answer: A. Continue breastfeeding on both breasts, ensuring effective drainage of the affected breast, and notify the healthcare provider.
A — correct
Continuing breastfeeding promotes milk flow and helps resolve milk stasis and inflammation. Provider notification is necessary because systemic symptoms (fever, chills) suggest bacterial infection requiring antibiotic therapy.
B
Discontinuing breastfeeding or discarding milk from the affected breast can lead to milk stasis and worsen the condition. The milk is safe for the infant, and continued breastfeeding is essential for resolution of stasis.
C
Warm compresses and analgesics are supportive measures, but avoiding breastfeeding causes milk stasis, exacerbating mastitis. Breastfeeding should continue to aid recovery.
D
Weaning is not recommended during mastitis. Breast milk contains protective factors, and abrupt weaning can cause engorgement and worsen the condition. The infection does not pose a risk to the infant.
TakeawayMastitis management includes continued breastfeeding to promote milk flow and prevent stasis, with emphasis on effective drainage of the affected breast. Antibiotics are indicated for systemic symptoms; provider notification is essential.
Maternity nursing · medium
A nurse is assessing a client at 34 weeks gestation who has preeclampsia without severe features. Which of the following findings would indicate progression to preeclampsia with severe features?
A1+ proteinuria on urine dipstick
BFacial and periorbital edema
CBlood pressure of 150/96 mm Hg
DEpigastric pain unrelieved by antacids
Show the answer and why the others fail
Answer: D. Epigastric pain unrelieved by antacids
A
Proteinuria of 1+ is a common finding in preeclampsia but does not define severity. Current guidelines base severity on blood pressure ≥160/110 mm Hg or evidence of end-organ damage, not on the amount of proteinuria.
B
Facial and periorbital edema is a common finding in normal pregnancy and is not a diagnostic criterion for preeclampsia with severe features. Edema is no longer considered a defining sign of preeclampsia.
C
A blood pressure of 150/96 mm Hg is elevated but remains below the threshold for severe features (≥160/110 mm Hg). It is consistent with preeclampsia without severe features.
D — correct
Epigastric or right upper quadrant pain suggests hepatic capsular distention, a sign of end-organ damage that indicates progression to preeclampsia with severe features. This finding requires immediate provider notification.
TakeawayEpigastric or right upper quadrant pain in a client with preeclampsia suggests hepatic capsular distention and is a sign of progression to preeclampsia with severe features, requiring immediate provider notification.
Maternity nursing · medium
A nurse is caring for a client in active labor at 38 weeks gestation. The client's membranes spontaneously rupture, and the nurse notes a sudden prolonged deceleration on the fetal heart rate monitor. On vaginal examination, the nurse palpates a pulsating, rope-like structure in the vagina. Which of the following actions should the nurse take first?
APosition the client in a knee-chest or Trendelenburg position.
BNotify the healthcare provider immediately.
CElevate the presenting part with a gloved hand in the vagina.
DAdminister oxygen at 10 L/min via nonrebreather mask.
Show the answer and why the others fail
Answer: C. Elevate the presenting part with a gloved hand in the vagina.
A
Positioning is an immediate intervention to reduce cord compression, but manual elevation is performed first because the nurse's hand is already in place to directly relieve pressure.
B
Notifying the provider is essential but should occur after or while manually elevating the presenting part to relieve cord compression and prevent fetal compromise.
C — correct
Manual elevation of the presenting part is the immediate priority to relieve cord compression and restore fetal blood flow, reducing the risk of hypoxia.
D
Administering oxygen is not the priority; current evidence does not support routine oxygen use for fetal distress without maternal hypoxia, and it does not relieve cord compression.
TakeawayIn cord prolapse, the nurse's first action is to manually elevate the presenting part to relieve cord compression, followed by positioning and emergency notification.