1Question
A nurse is caring for a client in labor at 39 weeks gestation. During the second stage of labor, the fetal head emerges over the perineum but then tightly retracts against the maternal perineum ('turtle sign'). Which action should the nurse perform first?
- Apply firm pressure to the uterine fundus.
- Hyperflex the client's legs tightly against the abdomen.
- Prepare the client immediately for an emergency cesarean section.
- Instruct the client to push forcefully with the next contraction.
Show the answer and explanation
Answer: B. Hyperflex the client's legs tightly against the abdomen.
Topic: Shoulder Dystocia Emergency Management
The 'turtle sign' indicates shoulder dystocia, an obstetrical emergency where the anterior fetal shoulder becomes lodged behind the maternal pubic symphysis. The initial nursing action is the McRoberts maneuver, which involves hyperflexing the mother's thighs tightly against her abdomen to flatten the sacrum and widen the pelvic outlet.
Why the others are wrong
- A – Fundal pressure is strictly contraindicated in shoulder dystocia because it further impacts the anterior shoulder behind the pubic bone and increases the risk of uterine rupture and brachial plexus injury.
- C – While emergency cesarean birth may be necessary if all conservative maneuvers fail, initial immediate management relies on non-invasive positioning interventions like the McRoberts maneuver and suprapubic pressure.
- D – Instructing the client to push against an impacted fetal shoulder does not deliver the fetus and escalates the risk of severe perineal lacerations and fetal nerve injury.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
2Question
A nurse in an outpatient prenatal clinic is evaluating a client at 34 weeks gestation who reports severe, generalized itching that is most intense on the palms of the hands and soles of the feet. Physical examination reveals no visible skin lesions or rash. Which clinical findings or management strategies are associated with this condition?
Select all that apply.
- Elevated serum total bile acid levels
- Increased risk of intrauterine fetal demise
- Prescription of ursodeoxycholic acid
- Topical corticosteroid creams as primary treatment
- Planned labor induction prior to 40 weeks gestation
Show the answers and explanation
Answers: A, B, C and E.
- A – Elevated serum total bile acid levels
- B – Increased risk of intrauterine fetal demise
- C – Prescription of ursodeoxycholic acid
- E – Planned labor induction prior to 40 weeks gestation
Topic: Intrahepatic Cholestasis of Pregnancy Management
Intrahepatic cholestasis of pregnancy (ICP) presents with intense pruritus affecting the palms and soles without a primary skin rash, driven by elevated serum bile acid levels (>10 μmol/L). ICP is associated with adverse fetal outcomes including stillbirth, meconium-stained amniotic fluid, and preterm delivery. Management includes ursodeoxycholic acid to clear bile salts and planned early delivery between 36 and 39 weeks gestation to diminish fetal risk.
Why the others are wrong
- D – Topical corticosteroids do not address the underlying systemic accumulation of bile acids in intrahepatic cholestasis of pregnancy and are ineffective for controlling this type of pruritus.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
3Question
A nurse is providing discharge instructions to a client at 16 weeks gestation who underwent placement of a McDonald cervical cerclage for cervical insufficiency. Which statement by the client indicates a correct understanding of the discharge teaching?
- I should expect moderate vaginal bleeding and pass small clots for the next week.
- I will need to maintain complete strict bed rest at home until my baby is delivered.
- I must contact my healthcare provider immediately if I experience pelvic pressure or lower back cramping.
- The suture will remain in my cervix until I go into labor naturally at full term.
Show the answer and explanation
Answer: C. I must contact my healthcare provider immediately if I experience pelvic pressure or lower back cramping.
Topic: Cervical Cerclage Post-Procedure Instructions
Pelvic pressure, uterine contractions, lower back cramping, or vaginal bleeding after cerclage placement can indicate premature labor or suture displacement and must be reported immediately. Spotting for 1 to 2 days post-procedure is expected, but active bleeding, fluid leakage, or signs of labor require urgent medical evaluation.
Why the others are wrong
- A – Light spotting for 1 to 2 days post-procedure is common, but moderate bleeding or passing clots is abnormal and requires immediate clinical evaluation.
- B – Strict bed rest is no longer routinely recommended because evidence shows it does not prevent preterm birth and significantly increases risks such as deep vein thrombosis.
- D – The cerclage is electively removed at approximately 36 to 37 weeks gestation (prior to the onset of labor) to prevent severe cervical lacerations during contractions.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
4Question
A laboring client at 39 weeks of gestation receives an epidural block. Ten minutes later, the client's blood pressure drops from 120/80 mm Hg to 84/50 mm Hg, and the fetal heart rate monitor shows late decelerations. Which nursing action should the nurse perform first?
- Administer oxygen via non-rebreather mask at 10 L/min.
- Turn the client to the left lateral position.
- Increase the primary intravenous infusion rate.
- Notify the primary healthcare provider immediately.
Show the answer and explanation
Answer: B. Turn the client to the left lateral position.
Topic: Epidural anesthesia hypotension management
Turning the client to the left lateral position displaces the gravid uterus from the inferior vena cava, instantly improving maternal cardiac output and venous return, which corrects maternal hypotension and restores uteroplacental perfusion.
Why the others are wrong
- A – Administering oxygen is a supportive measure, but it does not address the primary mechanical cause of the hypotension, which is aortocaval compression.
- C – Increasing the IV fluid rate is an important secondary intervention for epidural hypotension, but repositioning the client takes precedence to relieve the obstruction immediately.
- D – While the provider must be notified, waiting to do so before initiating immediate, life-saving bedside nursing interventions like repositioning delays crucial resuscitation.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
5Question
A nurse is caring for a client in active labor who experiences spontaneous rupture of membranes. On vaginal examination, the nurse feels a soft, pulsating loop of tissue ahead of the fetal presenting part, and the fetal monitor displays an abrupt, severe baseline bradycardia. Which immediate action should the nurse take first?
- Relieve pressure on the cord by applying upward manual force on the fetal presenting part with two gloved fingers.
- Assist the client into a high Fowler position to promote rapid fetal descent.
- Increase the IV oxytocin infusion rate to accelerate immediate vaginal delivery.
- Attempt to gently push the prolapsed umbilical cord back into the uterine cavity.
Show the answer and explanation
Answer: A. Relieve pressure on the cord by applying upward manual force on the fetal presenting part with two gloved fingers.
Topic: Umbilical Cord Prolapse Emergency Care
Umbilical cord prolapse is a life-threatening obstetric emergency in which cord compression reduces fetal perfusion and oxygenation. The priority initial action is inserting a gloved hand into the vagina to exert upward pressure on the presenting part, relieving compression on the umbilical cord until emergency cesarean delivery is completed.
Why the others are wrong
- B – High Fowler position causes the fetal presenting part to sink lower into the pelvis, which increases gravitational pressure against the prolapsed umbilical cord and worsens fetal hypoxia.
- C – Increasing oxytocin increases uterine contractility, which further compresses the prolapsed cord between the fetal head and pelvis, accelerating fetal compromise.
- D – The nurse must never attempt to push the prolapsed cord back into the uterus because manual manipulation can trigger vasospasm of the umbilical vessels or cause cord trauma.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
6Question
A nurse is assessing a term newborn 4 hours after a vacuum-assisted vaginal delivery. Which assessment findings should lead the nurse to suspect a subgaleal hemorrhage?
Select all that apply.
- Scalp edema that crosses cranial suture lines
- Tachycardia and progressive skin pallor
- Fluctuant head mass expanding dependently toward the ears and neck
- Firm edema strictly confined within the periosteal border of a single parietal bone
- Decreasing hematocrit level accompanied by increasing head circumference
Show the answers and explanation
Answers: A, B, C and E.
- A – Scalp edema that crosses cranial suture lines
- B – Tachycardia and progressive skin pallor
- C – Fluctuant head mass expanding dependently toward the ears and neck
- E – Decreasing hematocrit level accompanied by increasing head circumference
Topic: Subgaleal Hemorrhage Newborn Assessment
A subgaleal hemorrhage occurs when traction ruptures emissary veins, causing blood to accumulate in the expansive subgaleal compartment between the scalp aponeurosis and periosteum. Because this space is not bounded by cranial sutures, fluid crosses suture lines, shifts dependently toward the ears and neck, and can contain a massive volume of blood, resulting in hypovolemic shock (tachycardia, pallor), dropping hematocrit, and expanding head circumference.
Why the others are wrong
- D – Edema strictly demarcated by the borders of a single parietal bone describes a cephalohematoma, which is contained beneath the periosteum and cannot cross suture lines.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
7Question
A nurse is providing discharge instruction to a client who had a non-hormonal copper intrauterine device (IUD) inserted earlier today. Which statement by the client indicates a correct understanding of the teaching?
- I will need to use barrier contraception for the first week because the device takes 7 days to become effective.
- I should expect to take a daily oral progestin pill alongside the device to ensure maximum efficacy.
- I can expect heavier menstrual periods and increased cramping, especially during the first few months.
- This device works by steadily releasing low levels of synthetic estrogen directly into my uterus.
Show the answer and explanation
Answer: C. I can expect heavier menstrual periods and increased cramping, especially during the first few months.
Topic: Copper Intrauterine Device Client Teaching
The non-hormonal copper IUD acts via a local inflammatory response that is toxic to sperm. Increased menstrual bleeding, spotting, and dysmenorrhea (cramping) are expected common side effects, particularly during the first 3 to 6 months post-insertion. The copper IUD contains no synthetic hormones and provides immediate contraceptive protection upon placement.
Why the others are wrong
- A – The copper IUD provides immediate, highly effective contraception upon placement; a 7-day backup barrier method is only required for certain hormonal IUDs inserted outside the menstrual window.
- B – The copper IUD is a standalone, highly effective long-acting reversible contraceptive that does not require supplemental oral hormonal therapy.
- D – The copper IUD is completely non-hormonal; its contraceptive mechanism relies on copper ion toxicity to sperm, not synthetic estrogen release.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
8Question
A nurse is caring for a laboring client at 39 weeks gestation who is receiving an amnioinfusion for repetitive variable decelerations. Which finding requires immediate intervention by the nurse?
- Uterine resting tone increases to 28 mmHg.
- Maternal oral temperature is 37.1° C (98.8° F).
- Gradual return of clear fluid onto the underpad.
- Moderate baseline fetal heart rate variability of 15 beats/min.
Show the answer and explanation
Answer: A. Uterine resting tone increases to 28 mmHg.
Topic: Amnioinfusion Safety Monitoring
Amnioinfusion involves instilling isotonic fluid into the uterine cavity to relieve umbilical cord compression. Elevated uterine resting tone (> 20 to 25 mmHg) indicates fluid retention and uterine hypertonicity, placing the client at high risk for uterine rupture and hyperstimulation.
Why the others are wrong
- B – A temperature of 37.1° C (98.8° F) is afebrile and normal during labor.
- C – Continuous leakage of fluid onto the absorbent underpad is an expected finding indicating that fluid is draining and not being trapped inside the uterus.
- D – Moderate fetal heart rate variability (6 to 25 beats/min) is a reassuring indicator of normal fetal acid-base balance.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
9Question
A nurse is interpreting the results of an oxytocin-stimulated contraction stress test (CST) for a client at 41 weeks gestation. The monitor tracing demonstrates 3 uterine contractions in a 10-minute window, with late decelerations occurring after two of the three contractions. How should the nurse document and interpret this result?
- Negative CST, indicating fetal tolerance of labor.
- Positive CST, indicating uteroplacental insufficiency.
- Equivocal CST, requiring retesting due to tachysystole.
- Unsatisfactory CST, requiring doubling of the oxytocin rate.
Show the answer and explanation
Answer: B. Positive CST, indicating uteroplacental insufficiency.
Topic: Contraction Stress Test Interpretation
A contraction stress test is considered positive when late decelerations occur with 50% or more of the contractions during a 10-minute period with at least 3 contractions. A positive result indicates uteroplacental insufficiency and poor fetal tolerance of labor contractions, requiring further clinical evaluation or immediate delivery.
Why the others are wrong
- A – A negative CST shows no late or significant variable decelerations, indicating adequate fetal oxygenation.
- C – An equivocal-suspicious CST is diagnosed when late decelerations occur with less than 50% of contractions; here, late decelerations occurred with 66% of contractions.
- D – An unsatisfactory CST occurs when there are fewer than 3 contractions in 10 minutes or the monitor tracing cannot be read clearly.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
10Question
A labor and delivery nurse is caring for a client at 38 weeks' gestation in the active first stage of labor with spontaneous rupture of membranes. The fetal heart rate baseline is 140/min with moderate variability and recurrent variable decelerations dropping to 80/min lasting 60 seconds, accompanied by slow return to baseline. Which nursing intervention is the priority?
- Prepare the client for an immediate emergent cesarean birth.
- Administer oxygen at 10 L/min via non-rebreather face mask.
- Reposition the client onto her left or right lateral side.
- Increase the mainline isotonic intravenous fluid rate.
Show the answer and explanation
Answer: C. Reposition the client onto her left or right lateral side.
Topic: Variable decelerations nursing management
Variable decelerations are caused by umbilical cord compression, which disrupts blood flow through the umbilical cord vessels. Changing the maternal position (lateral, knee-chest, or Trendelenburg) relieves pressure off the cord and is the primary intrauterine resuscitation intervention.
Why the others are wrong
- A – An emergent cesarean is premature before exhausting conservative intrauterine resuscitation measures like repositioning and discontinuing oxytocin.
- B – Oxygen administration is a secondary supportive measure and is no longer recommended as a primary standalone resuscitation step unless maternal hypoxia is suspected.
- D – Increasing IV fluids helps hydrate and expand maternal volume, but lateral repositioning is the most direct intervention to mechanically relieve umbilical cord compression.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
11Question
A nurse is providing discharge instructions to a postpartum client who delivered a healthy term newborn 48 hours ago. Which statements by the client indicate a correct understanding of normal lochia progression during the postpartum period?
Select all that apply.
- "My lochia will remain bright red with small clots for the first two weeks at home."
- "By the fourth or fifth day, the discharge should change to a pinkish-brown color called lochia serosa."
- "Around the tenth day, the discharge should become whitish or yellowish-white, known as lochia alba."
- "If I suddenly soak two large perineal pads in an hour after it had slowed down, I should call my healthcare provider."
- "I can expect the lochia flow to completely stop and disappear within the first 24 hours following delivery."
Show the answers and explanation
Answers: B, C and D.
- B – "By the fourth or fifth day, the discharge should change to a pinkish-brown color called lochia serosa."
- C – "Around the tenth day, the discharge should become whitish or yellowish-white, known as lochia alba."
- D – "If I suddenly soak two large perineal pads in an hour after it had slowed down, I should call my healthcare provider."
Topic: Lochia progression and warning signs
Lochia progresses through predictable stages: lochia rubra (bright red, days 1-3), lochia serosa (pinkish-brown, days 4-10), and lochia alba (whitish/yellowish-white, days 11-14 or up to 6 weeks). Rebound bleeding or soaking more than one pad per hour indicates potential late postpartum hemorrhage and must be reported.
Why the others are wrong
- A – Bright red lochia (rubra) typically lasts only 3 to 4 days postpartum; persistence of bright red heavy bleeding past this point suggests retained placental fragments or subinvolution.
- E – Lochia does not stop within 24 hours; it transitions through stages over several weeks as the uterine endometrium heals.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
12Question
A nurse is assessing a newborn infant who is 4 hours old, born at 39 weeks' gestation via uncomplicated vaginal delivery. Which newborn finding requires immediate intervention by the nurse?
- A soft, raised, boggy swelling across the suture lines of the scalp.
- A single transverse palmar crease across the palm of the left hand.
- A persistent respiratory rate of 72 breaths/min with mild intercostal retractions.
- White pinpoint papules across the bridge of the nose and chin.
Show the answer and explanation
Answer: C. A persistent respiratory rate of 72 breaths/min with mild intercostal retractions.
Topic: Newborn respiratory distress assessment
Normal newborn respiratory rate ranges from 30 to 60 breaths/min. A rate of 72 breaths/min with retractions indicates neonatal respiratory distress, which requires prompt reporting and respiratory support.
Why the others are wrong
- A – Caput succedaneum crosses suture lines due to pressure during labor and resolves spontaneously within a few days without treatment.
- B – A single transverse palmar crease can be associated with genetic variations such as Down syndrome, but it does not represent an immediate acute physiological emergency.
- D – Milia are normal, benign sebaceous gland cysts that disappear on their own within a few weeks and require no intervention.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
13Question
A nurse is assessing a client at 39 weeks of gestation who had spontaneous rupture of membranes 18 hours ago and is in active labor. Which constellation of vital signs and assessment findings should alert the nurse to suspect intra-amniotic infection (chorioamnionitis)?
- Maternal temperature 38.5°C (101.3°F), baseline fetal heart rate 175/min, and purulent amniotic fluid
- Maternal blood pressure 146/94 mmHg, moderate fetal heart rate variability, and clear amniotic fluid
- Maternal heart rate 68/min, persistent uterine hypotonus, and serosanguineous vaginal discharge
- Maternal temperature 37.1°C (98.8°F), baseline fetal heart rate 115/min, and mild uterine contractions
Show the answer and explanation
Answer: A. Maternal temperature 38.5°C (101.3°F), baseline fetal heart rate 175/min, and purulent amniotic fluid
Topic: Chorioamnionitis assessment and clinical indicators
Chorioamnionitis (intra-amniotic infection) is characterized primarily by maternal fever (≥ 38.0°C / 100.4°F) combined with signs such as fetal tachycardia (> 160/min), maternal tachycardia, uterine tenderness, or purulent/foul-smelling amniotic fluid. Prolonged rupture of membranes (> 18 hours) significantly increases this risk.
Why the others are wrong
- B – Elevated blood pressure with moderate fetal heart rate variability suggests gestational hypertension or preeclampsia, not intra-amniotic infection.
- C – A normal maternal heart rate with bloody show is expected in labor progression and does not indicate infection.
- D – A normal maternal temperature and fetal baseline heart rate of 115/min are normal, reassuring findings.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
14Question
A nurse is evaluating the results of a biophysical profile (BPP) for a client at 38 weeks of gestation who has gestational hypertension. The ultrasound report reveals a total score of 4 out of 10, with normal amniotic fluid volume. Which action should the nurse anticipate taking next?
- Prepare the client for prompt obstetric evaluation and likely delivery.
- Reassure the client that a score of 4 is reassuring and retest in 1 week.
- Administer an IV fluid bolus and request a repeat biophysical profile in 24 hours.
- Instruct the client to monitor fetal movements at home and resume normal daily activities.
Show the answer and explanation
Answer: A. Prepare the client for prompt obstetric evaluation and likely delivery.
Topic: Biophysical profile interpretation
A biophysical profile (BPP) score of 4 out of 10 indicates suspected chronic fetal asphyxia and is considered abnormal. At 38 weeks of gestation, a score of 4 mandates prompt obstetric evaluation and usually warrants delivery to prevent adverse fetal outcomes.
Why the others are wrong
- B – A score of 4 is abnormal and indicates fetal risk; delaying evaluation for a week exposes the fetus to potential severe asphyxia or demise.
- C – An IV fluid bolus and retesting in 24 hours may be considered for an equivocal score of 6 with normal fluid, but a score of 4 requires urgent evaluation for immediate delivery at 38 weeks.
- D – Discharging the client home with routine fetal movement counting is unsafe because a score of 4 reflects high risk for fetal asphyxia.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
15Question
A nurse is providing discharge teaching to a 22-year-old client who recently had a subdermal etonogestrel contraceptive implant inserted in the non-dominant upper arm. Which statement by the client indicates a correct understanding of the teaching?
- I should expect my normal monthly menstrual bleeding pattern to remain unchanged.
- Irregular or unpredictable spotting is the most common side effect I might experience.
- The implant will remain effective for up to ten years before it needs to be replaced.
- I will need to use a backup contraceptive method permanently if I take over-the-counter pain relievers.
Show the answer and explanation
Answer: B. Irregular or unpredictable spotting is the most common side effect I might experience.
Topic: Etonogestrel contraceptive implant teaching
Unscheduled, irregular bleeding or spotting is the most frequent adverse effect associated with the etonogestrel subdermal contraceptive implant. Clients should be counseled about this bleeding alteration to improve satisfaction and continuation.
Why the others are wrong
- A – Most clients experience altered bleeding patterns, such as amenorrhea, frequent spotting, or light irregular bleeding, rather than their normal baseline monthly cycle.
- C – The etonogestrel implant is approved for up to 3 years of continuous use, not 10 years (10 years applies to the copper IUD).
- D – Common over-the-counter pain relievers such as acetaminophen or ibuprofen do not alter the effectiveness of progestin implants or require permanent backup contraception.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
16Question
A nurse is caring for a client at 34 weeks of gestation who is admitted with severe preeclampsia. Which prescribed interventions should the nurse implement immediately?
Select all that apply.
- Administer magnesium sulfate intravenous infusion as a secondary piggyback line.
- Maintain strict bed rest in a quiet, darkened room with padded side rails up.
- Encourage oral fluid intake of at least 250 mL of clear liquids every hour.
- Monitor and record maternal urine output hourly via an indwelling urinary catheter.
- Administer labetalol intravenous push as ordered for sustained systolic blood pressure >= 160 mm Hg.
Show the answers and explanation
Answers: A, B, D and E.
- A – Administer magnesium sulfate intravenous infusion as a secondary piggyback line.
- B – Maintain strict bed rest in a quiet, darkened room with padded side rails up.
- D – Monitor and record maternal urine output hourly via an indwelling urinary catheter.
- E – Administer labetalol intravenous push as ordered for sustained systolic blood pressure >= 160 mm Hg.
Topic: Severe preeclampsia management
Management of severe preeclampsia includes seizure prophylaxis with magnesium sulfate (infused via an electronic infusion pump as a piggyback), strict seizure precautions (quiet environment, padded rails), continuous or frequent maternal-fetal monitoring including strict hourly urine output measurement to assess renal perfusion, and prompt antihypertensive therapy (such as labetalol) for severe hypertension (systolic >= 160 mm Hg or diastolic >= 110 mm Hg).
Why the others are wrong
- C – Clients with severe preeclampsia are at high risk for pulmonary edema; fluid restriction is typically maintained rather than encouraging high oral intake.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
17Question
A nurse is caring for a client in the active stage of labor who is receiving an oxytocin infusion. The external fetal monitor tracing shows uterine contractions occurring every 2 minutes, lasting 85 seconds, with a baseline fetal heart rate of 140/min and absent variability. What is the priority nursing action?
- Increase the oxytocin infusion rate to establish normal labor progress.
- Discontinue the oxytocin infusion immediately.
- Place the client in a supine position to enhance comfort.
- Prepare the client for an immediate vaginal examination.
Show the answer and explanation
Answer: B. Discontinue the oxytocin infusion immediately.
Topic: Oxytocin-induced tachysystole management
The fetal monitor tracing demonstrates uterine tachysystole (more than 5 contractions in 10 minutes averaged over a 30-minute window) combined with absent fetal heart rate variability, which is a nonreassuring Category III pattern indicating fetal hypoxia or acidemia. The immediate priority is to discontinue the uterotonic agent (oxytocin) to reduce uterine activity and restore uteroplacental perfusion.
Why the others are wrong
- A – Increasing oxytocin would worsen uterine tachysystole and increase fetal distress.
- C – The supine position causes aortocaval compression and reduces placental perfusion; a lateral tilt is required.
- D – While a vaginal exam may assess labor progress, stopping the oxytocin and performing intrauterine resuscitation take immediate precedence.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
18Question
A nurse is caring for a client at 34 weeks of gestation who is admitted with preterm labor and intact amniotic membranes. The primary health care provider prescribes betamethasone 12 mg IM. Which of the following actions should the nurse take?
- Administer the first dose now and a second dose in 24 hours.
- Give the medication orally with food to prevent gastric irritation.
- Withhold the dose and notify the provider if contractions stop.
- Check the client's fasting blood glucose immediately before injection.
Show the answer and explanation
Answer: A. Administer the first dose now and a second dose in 24 hours.
Topic: Betamethasone administration schedule
Betamethasone is a glucocorticoid administered in two 12 mg doses intramuscularly 24 hours apart to promote fetal lung maturity in preterm labor between 24 and 34 weeks of gestation.
Why the others are wrong
- B – Betamethasone is administered via intramuscular injection, not orally.
- C – The full course of two doses should be completed to ensure fetal lung maturation even if contractions subside.
- D – Blood glucose may be monitored, but a fasting level right before injection is not a prerequisite for administration.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
19Question
A nurse is providing discharge teaching to a postpartum client who received a prescription for a levonorgestrel-releasing intrauterine device (IUD). Which of the following statements by the client indicates an understanding of the teaching?
- "I can expect heavier and more painful menstrual periods after insertion."
- "I should check for the presence of the device strings after my menstrual periods."
- "This device protects against sexually transmitted infections as well as pregnancy."
- "I need to use a backup method of birth control for 6 weeks following insertion."
Show the answer and explanation
Answer: B. "I should check for the presence of the device strings after my menstrual periods."
Topic: Levonorgestrel IUD client teaching
Clients with an intrauterine device should check for the presence of the strings regularly, particularly after menstruation, to verify that the device remains properly placed.
Why the others are wrong
- A – Levonorgestrel IUDs typically decrease menstrual flow and cramping over time, often leading to amenorrhea.
- C – Intrauterine devices do not provide protection against sexually transmitted infections.
- D – A hormonal IUD is effective immediately upon placement and does not require a 6-week backup method.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
20Question
A nurse is caring for a client at 34 weeks gestation who is admitted with preterm labor and receiving magnesium sulfate for fetal neuroprotection. Which assessment finding requires immediate nursing intervention?
- Drowsiness and warm flushing
- Respiratory rate of 10 breaths/min
- Trace deep tendon reflexes (+1)
- Serum magnesium level of 6.5 mg/dL
Show the answer and explanation
Answer: B. Respiratory rate of 10 breaths/min
Topic: Magnesium sulfate toxicity monitoring
A respiratory rate below 12 breaths/min indicates magnesium toxicity, which causes central nervous system and respiratory depression. The nurse must immediately stop the magnesium infusion and prepare to administer calcium gluconate.
Why the others are wrong
- A – Drowsiness and warm flushing are common, expected side effects of systemic vasodilation and CNS sedation during a magnesium infusion and do not require stopping the infusion.
- C – Trace (+1) deep tendon reflexes indicate diminished reflexes which are approaching hyporeflexia, but loss of reflexes (0) occurs before severe respiratory depression; however, respiratory rate is the most critical safety parameter.
- D – A serum magnesium level of 6.5 mg/dL falls within the therapeutic range of 4.0 to 7.0 mg/dL used for fetal neuroprotection or preeclampsia management.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
21Question
A nurse in the labor and delivery unit is evaluating four clients. Which client should the nurse assess first?
- A G2P1 at 39 weeks in active labor reporting severe lower back pain with contractions
- A G1P0 at 41 weeks gestation with a Bishop score of 4 receiving oxytocin augmentation
- A G3P2 at 37 weeks gestation reporting sudden, painless bright red vaginal bleeding
- A G1P0 at 38 weeks gestation with gestational hypertension reporting a mild frontal headache
Show the answer and explanation
Answer: C. A G3P2 at 37 weeks gestation reporting sudden, painless bright red vaginal bleeding
Topic: Placenta previa triage and prioritization
Sudden, painless bright red vaginal bleeding in the third trimester is a classic sign of placenta previa. This condition poses an immediate risk of hemorrhage and maternal-fetal compromise, requiring urgent assessment and avoidance of digital vaginal examinations.
Why the others are wrong
- A – Severe lower back pain during contractions is common, especially with persistent occiput posterior position, but is not immediately life-threatening.
- B – A Bishop score of 4 indicates an unfavorable cervix, and oxytocin augmentation is a standard routine protocol requiring regular monitoring rather than immediate emergency intervention.
- D – A mild frontal headache in a client with gestational hypertension should be evaluated promptly, but painless third-trimester bleeding carries an immediate threat of life-threatening maternal hemorrhage.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
22Question
A nurse is caring for a client at 34 weeks of gestation who is admitted for suspected preterm labor. Which of the following prescribed medications should the nurse anticipate administering to accelerate fetal lung maturity?
- Magnesium sulfate
- Terbutaline
- Betamethasone
- Nifedipine
Show the answer and explanation
Answer: C. Betamethasone
Topic: Antenatal corticosteroid administration
Betamethasone is a corticosteroid administered to pregnant women at risk for preterm birth between 24 0/7 and 33 6/7 weeks of gestation (and sometimes up to 36 6/7 weeks) to stimulate fetal lung maturity and reduce the incidence of respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis.
Why the others are wrong
- A – Magnesium sulfate is used for fetal neuroprotection (prevention of cerebral palsy) in preterm births, not primarily for lung maturity.
- B – Terbutaline is a beta-adrenergic agonist used as a short-term tocolytic to halt contractions, not to promote fetal lung maturity.
- D – Nifedipine is a calcium channel blocker used as a tocolytic agent to delay preterm birth, not to mature fetal lungs.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
23Question
A nurse is providing discharge instructions to a postpartum client who has elected to use medroxyprogesterone acetate injections for contraception. Which of the following client statements indicates a correct understanding of the teaching?
- "I will need to have this injection repeated every 6 weeks to remain protected against pregnancy."
- "This form of birth control will protect me from contracting sexually transmitted infections."
- "I should ensure an adequate intake of calcium and Vitamin D while using this method."
- "If I experience a delay in my menstrual cycle, it means the medication has failed and I am pregnant."
Show the answer and explanation
Answer: C. "I should ensure an adequate intake of calcium and Vitamin D while using this method."
Topic: Depo-Provera client education
Medroxyprogesterone acetate is a progestin-only injectable contraceptive associated with temporary, reversible bone mineral density loss. Clients are advised to ensure adequate calcium and Vitamin D intake and engage in weight-bearing exercise to mitigate bone loss risks.
Why the others are wrong
- A – Medroxyprogesterone acetate injections are administered every 12 to 13 weeks, not every 6 weeks.
- B – Hormonal injectables do not provide barrier protection against sexually transmitted infections.
- D – Amenorrhea is an expected side effect of prolonged use and does not indicate contraceptive failure or pregnancy.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
24Question
A nurse is caring for a client in the active phase of the first stage of labor who has an epidural catheter in place. Which of the following nursing interventions are appropriate for this client?
Select all that apply.
- Monitor maternal blood pressure every 2 to 5 minutes for the first 15 minutes following an epidural bolus.
- Place the client in a completely flat supine position to enhance placental perfusion.
- Assess the client's bladder for distension every 2 hours.
- Encourage the client to ambulate independently in the hallway to help progress labor.
- Maintain continuous electronic fetal monitoring to assess for fetal response.
Show the answers and explanation
Answers: A, C and E.
- A – Monitor maternal blood pressure every 2 to 5 minutes for the first 15 minutes following an epidural bolus.
- C – Assess the client's bladder for distension every 2 hours.
- E – Maintain continuous electronic fetal monitoring to assess for fetal response.
Topic: Intrapartum epidural care
Following epidural placement or bolus, sympathetic blockade can cause rapid maternal hypotension, necessitating frequent blood pressure checks (every 2-5 minutes initially). Epidurals diminish bladder sensation, making routine bladder assessments necessary every 2 hours. Continuous electronic fetal monitoring is standard practice to detect fetal compromise secondary to maternal hypotension. The client should remain positioned laterally or semi-Fowler's with uterine displacement, not flat supine, and cannot ambulate due to motor and sensory block.
Why the others are wrong
- B – A flat supine position causes aortocaval compression by the gravid uterus, worsening maternal hypotension and reducing placental blood flow. Lateral tilt or wedge must be used.
- D – Epidural anesthesia typically produces lower extremity motor and sensory blockade, making independent ambulation unsafe due to high fall risks.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
25Question
A nurse is caring for a client at 34 weeks of gestation who is admitted with severe headache, blurred vision, and a blood pressure of 160/110 mm Hg. An intravenous infusion of magnesium sulfate is initiated. Which assessment finding indicates to the nurse that the client is experiencing magnesium toxicity?
- Deep tendon reflexes of 2+
- Respiratory rate of 10 breaths/min
- Serum magnesium level of 6.5 mg/dL
- Urine output of 45 mL/hr
Show the answer and explanation
Answer: B. Respiratory rate of 10 breaths/min
Topic: Magnesium sulfate therapeutic monitoring
Magnesium sulfate is a central nervous system depressant used to prevent seizures in preeclampsia. Toxicity manifests as progressive neuromuscular blockade and CNS depression, with respiratory depression (fewer than 12 breaths/min) being an early critical sign of dangerous toxicity requiring immediate cessation of the infusion and administration of calcium gluconate.
Why the others are wrong
- A – Deep tendon reflexes of 2+ are normal; a rating of 0 or absent reflexes indicates magnesium toxicity.
- C – A serum magnesium level of 6.5 mg/dL falls within the therapeutic range (4-7 mg/dL) for preeclampsia management.
- D – A urine output of 45 mL/hr is adequate (minimum expected is 30 mL/hr), indicating normal renal excretion of the medication.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
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Nursing