471 OB/Maternal questions written for the NCLEX-RN, each with a rationale explaining why the correct answer is correct and why the others are not. Free, no account required. 10 examples are shown below.
Practice all 471 questions →Answers are shown so you can read these as worked examples. To answer them yourself and track what you get wrong, start a practice set.
The answer: B — Primary Problem: Severe preeclampsia with risk for eclampsia; Priority Diagnosis: Risk for injury related to seizure activity Think of it this way: Preeclampsia is a pregnancy complication where the blood pressure becomes dangerously high and the kidneys start leaking protein. 'Severe' preeclampsia means the numbers are in a dangerous range and warning symptoms are present. The big fear with severe preeclampsia is that it will progress to ECLAMPSIA — seizures during pregnancy. Once a pregnant woman has a preeclampsia-related seizure (eclampsia), maternal and fetal mortality risk spikes dramatically. The priority nursing diagnosis is therefore focused on PREVENTING that seizure (which is injury risk) rather than managing blood pressure per se. Why B is right: Severe preeclampsia (systolic BP ≥160 or diastolic ≥110, proteinuria, AND severe features like headache, visual changes, epigastric pain, or right upper quadrant pain) has the risk for eclampsia (generalized seizures) as its most serious complication. The priority nursing diagnosis is 'Risk for injury related to potential seizure activity' because: (1) Seizures can cause maternal aspiration, placental abruption, maternal brain hemorrhage, or fetal distress; (2) Magnesium sulfate (MgSO4) is used to PREVENT eclamptic seizures (NOT as an antihypertensive); (3) Seizure precautions (padded side rails, suction at bedside, oxygen available, dim quiet environment) must be in place. Why the others are wrong: - A: Placental abruption — placental abruption (premature separation of the placenta from the uterine wall) can be a complication of severe hypertension/preeclampsia, but it is not the PRIMARY presenting problem when the clinical picture shows hypertension + proteinuria + neurological warning signs. - C: Gestational diabetes — gestational diabetes (hyperglycemia first diagnosed in pregnancy) does NOT cause hypertension, proteinuria, headache, or visual changes. The clinical picture is specifically preeclampsia. - D: Preterm labor — while preterm labor can co-exist with preeclampsia (and delivery is often the treatment for severe preeclampsia), the clinical picture described focuses on the hypertension and neurological symptoms — the PRIMARY problem is preeclampsia, not preterm labor. Remember: Severe preeclampsia triad: hypertension (≥160/110) + proteinuria + severe symptoms (headache, visual changes, epigastric pain). Treatment: magnesium sulfate (seizure prevention) + antihypertensives (labetalol, hydralazine, nifedipine for BP ≥160/110) + delivery (definitive treatment — 37+ weeks deliver immediately; <37 weeks = clinical judgment based on severity). Technical note: Magnesium sulfate is the drug of choice for eclampsia prophylaxis in severe preeclampsia. It is NOT an antihypertensive — it prevents seizures via CNS magnesium's competition with calcium at neuronal voltage-gated calcium channels. Toxic magnesium levels cause: loss of deep tendon reflexes (first sign → check patellar reflex), respiratory depression, cardiac arrest. Antidote: calcium gluconate 1g IV. Monitor: DTRs every hour (should be present), urine output >25-30 mL/hr (magnesium is renally excreted — decreased output = accumulation risk), respiratory rate >12/min. Therapeutic serum Mg level: 4-7 mEq/L.
The key difference is that gestational diabetes develops during pregnancy due to hormonal changes that cause insulin resistance and typically resolves after delivery. Type 2 diabetes is a chronic condition that persists after pregnancy. Not all gestational diabetes requires insulin; many are controlled with diet and exercise. Type 2 diabetes is not autoimmune (that is type 1). Gestational diabetes can occur at any age but risk increases with age.
When oxytocin is contraindicated (e.g., due to active genital herpes, severe fetal distress, or certain uterine anomalies), prostaglandin agents like misoprostol or dinoprostone may be used for cervical ripening and induction. However, misoprostol is also contraindicated in cases of previous uterine surgery (including classical cesarean) and cephalopelvic disproportion. The most appropriate agent depends on the specific contraindication. In this scenario, if the contraindication is not specified, dinoprostone (Prepidil) is often preferred for cervical ripening due to its lower risk profile. Misoprostol is a reasonable alternative but requires careful consideration of risks. Carboprost is not used for induction.
Clients with preeclampsia are at increased risk for hypotension after epidural analgesia. Adequate hydration/fluid loading before epidural placement helps prevent significant hypotension. Epidural is not contraindicated but requires careful management. Magnesium sulfate is given for seizure prophylaxis but not specifically before epidural. Blood pressure does not need to be completely normalized.
Breast shields (also called nipple shields) are a first-line intervention for inverted nipples as they help the baby latch by providing a firmer surface to grasp. This is a conservative measure before considering other options. Switching to formula is not necessary as breastfeeding can still be successful with proper intervention. Ice packs would be counterproductive and waiting does not address the problem actively.
Maintaining NPO status is the most important pre-operative intervention for a D&C under anesthesia to prevent aspiration. Informed consent is a legal requirement but is obtained by the provider, not the nurse. Antibiotics are not routine. Emotional support is important but secondary to safety.
Digital cervical examinations are contraindicated in any client with potential placenta previa due to risk of triggering massive hemorrhage. Ultrasound (both transvaginal and transabdominal) and fetal monitoring are safe.
Fetal scalp blood sampling is performed to obtain a pH measurement of fetal blood when the electronic fetal monitoring tracing is non-reassuring but not clearly abnormal. It helps determine if the fetus is acidotic (low pH indicating hypoxia) and guides decisions about continuing labor or proceeding with delivery.
The latent phase of the first stage of labor is characterized by cervical dilation from 0 to 3 cm, with contractions becoming regular and progressive. At 3 cm dilation with mild to moderate contractions every 5 minutes, this client is in the latent phase. The active phase begins at 4 cm dilation, transition occurs at 8-10 cm, and the second stage begins at complete dilation (10 cm).
Preterm infants have abundant lanugo (fine hair), thin/transparent skin, minimal subcutaneous fat, and ear cartilage that is soft with poor recoil. Term infants have well-developed cartilage, firm ear pinna that springs back, and plantar creases covering the foot.
