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Question 1. Which of the following is considered a presumptive sign of pregnancy? A) Positive hCG urine test B) Fetal heart tones on Doppler C) Amenorrhea D) Enlargement of the uterus Answer: C Explanation: Amenorrhea is a presumptive sign because it suggests pregnancy but can be caused by other conditions; definitive signs require laboratory or imaging confirmation. Question 2. A 28‑year‑old woman with a BMI of 22 is pregnant. What is the recommended total weight gain for her pregnancy? A) 5‑10 lb B) 11‑15 lb C) 25‑35 lb D) 40‑50 lb Answer: C Explanation: Women with a normal BMI (18.5‑24.9) should gain 25‑35 lb during pregnancy to support fetal growth and maternal stores. Question 3. Which laboratory test is most useful for determining Rh incompatibility risk in a pregnant woman? A) Anti‑C antibodies B) Direct Coombs test C) Indirect Coombs test D) Haptoglobin level Answer: C
Explanation: The indirect Coombs (antibody screen) detects maternal antibodies against fetal red cells, identifying Rh sensitization risk. Question 4. A patient’s rubella IgG titer is 1:8. What does this indicate? A) Immunity to rubella B) Acute rubella infection C) Need for rubella vaccination postpartum D) False‑positive result Answer: A Explanation: An IgG titer ≥1:8 indicates immunity, meaning the patient is protected from congenital rubella infection. Question 5. Which of the following foods should a pregnant woman avoid to reduce the risk of listeriosis? A) Pasteurized cheese B) Cooked chicken C) Unpasteurized soft cheeses D) Fresh fruit Answer: C Explanation: Unpasteurized soft cheeses (e.g., Brie, feta) can harbor Listeria monocytogenes, which is harmful in pregnancy. Question 6. Using Naegele’s Rule, a woman’s last menstrual period (LMP) was March 12, 2026. What is her estimated date of confinement (EDC)? A) December 19, 2026 B) January 19, 2027 C) February 19, 2027 D) March 19, 2027
B) Proteinuria ≥300 mg/24 h C) Elevated liver enzymes D) Edema of the lower extremities Answer: D Explanation: Edema is a common pregnancy symptom and not a diagnostic criterion for preeclampsia. Question 10. Which medication is the drug of choice for preventing seizures in severe preeclampsia? A) Labetalol B) Magnesium sulfate C) Hydralazine D) Nifedipine Answer: B Explanation: Magnesium sulfate stabilizes neuronal membranes and is the standard prophylaxis against eclamptic seizures. Question 11. A pregnant woman presents with sudden, painless vaginal bleeding at 34 weeks. Which diagnosis is most likely? A) Abruptio placentae B) Placenta previa C) Vasa previa D) Cervical polyp Answer: B Explanation: Placenta previa causes painless bleeding because the placenta covers the cervical os, disrupting the mucosa without uterine irritation. Question 12. In a patient with suspected abruptio placentae, which finding would you expect?
A) Soft, boggy uterus B] Fetal heart rate bradycardia C) Tender, rigid uterus D) Elevated maternal serum AFP Answer: C Explanation: Abruptio placentae causes painful, rigid uterine contractions due to separation of the placenta. Question 13. Which of the following is the most appropriate initial management for a confirmed ectopic pregnancy? A) Immediate laparoscopic salpingectomy B) Expectant management with serial hCG C) Methotrexate therapy if hemodynamically stable and hCG <5,000 mIU/mL D) Oxytocin infusion Answer: C Explanation: Methotrexate is indicated for stable, early ectopic pregnancies with low hCG levels, preserving fertility. Question 14. A 30‑year‑old G2P1 undergoes a 1‑hour 50‑g glucose screening test at 24 weeks. Her result is 145 mg/dL. What is the next step? A) Diagnose gestational diabetes and start insulin B) Repeat the test in one week C) Perform a 3‑hour oral glucose tolerance test (OGTT) D) Advise dietary changes only Answer: C Explanation: A screening value >140 mg/dL warrants a diagnostic 3‑hour OGTT to confirm gestational diabetes.
Question 18. Which TORCH infection is most strongly associated with chorioretinitis in the newborn? A) Toxoplasmosis B) Rubella C) Cytomegalovirus D) Herpes simplex Answer: A Explanation: Congenital toxoplasmosis commonly presents with chorioretinitis, hydrocephalus, and intracranial calcifications. Question 19. During the first stage of labor, which of the following describes “engagement”? A) The fetal head passes through the pelvic inlet B) The fetal head descends to the ischial spines C) The biparietal diameter aligns with the pelvic brim D) The head rotates to the anterior position Answer: C Explanation: Engagement occurs when the widest fetal head diameter (biparietal) passes the pelvic inlet, aligning with the brim. Question 20. The “5 P’s” of labor include all except: A) Passenger B) Passageway C) Powers D) Parity Answer: D
Explanation: Parity is not part of the 5 P’s; the components are Passenger, Passageway, Powers, Position, and Psychological response. Question 21. Which fetal heart rate (FHR) pattern is most indicative of cord compression? A) Early deceleration B) Variable deceleration C) Late deceleration D) Sinusoidal pattern Answer: B Explanation: Variable decelerations are abrupt, variable in timing, and often result from cord compression. Question 22. A Category II FHR tracing shows moderate variable decelerations with a baseline of 130 bpm. The appropriate first nursing action is: A) Immediate cesarean delivery B) Administer oxytocin C) Turn the mother to her left side and give oxygen D) Apply uterine massage Answer: C Explanation: LION (Left side, IV fluids, Oxygen, Notify provider) is the initial response to moderate variable decelerations. Question 23. Which analgesic technique provides the greatest pain relief while allowing the mother to remain fully conscious during the second stage of labor? A) Epidural analgesia B) Spinal block C) Patient‑controlled analgesia (PCA) with opioids D) Entonox (nitrous oxide)
C) Woods screw maneuver D) Application of forceps Answer: C Explanation: The Woods screw (rotational) maneuver is used after McRoberts and suprapubic pressure fail to deliver the anterior shoulder. Question 27. A patient’s placenta is noted to be low‑lying on ultrasound at 28 weeks but not covering the os. What is the most appropriate counseling? A) Schedule immediate C‑section B) Expect complete resolution by 34 weeks in most cases C) Advise strict bed rest until delivery D) Initiate placenta previa protocol now Answer: B Explanation: Low‑lying placentas often migrate upward as the uterus expands; many resolve by the third trimester. Question 28. Which of the following is the most common cause of postpartum hemorrhage (PPH) within the first 24 hours? A) Uterine atony B) Cervical laceration C) Retained placenta D) Coagulopathy Answer: A Explanation: Uterine atony, the failure of the uterus to contract, accounts for the majority of early PPH cases. Question 29. A patient receives 10 units of oxytocin IV postpartum for uterine atony. Which uterotonic should be administered next if bleeding persists?
A) Methylergonovine (Methergine) B) Terbutaline C) Ritodrine D) Magnesium sulfate Answer: A Explanation: Methylergonovine is a second‑line uterotonic used after oxytocin when uterine contraction remains inadequate. Question 30. Which postpartum mood disorder is characterized by a sudden onset of delusions, hallucinations, and confusion within two weeks of delivery? A) Baby blues B) Postpartum depression C) Postpartum psychosis D) Adjustment disorder Answer: C Explanation: Postpartum psychosis presents with severe psychiatric symptoms, often within the first two weeks after birth. Question 31. A new mother reports feeling “down” and tearful for three days after delivery but is able to care for her infant. What is the most likely diagnosis? A) Postpartum depression B) Baby blues C) Postpartum psychosis D) Major depressive disorder Answer: B Explanation: Baby blues are transient mood changes occurring within the first week postpartum and resolve without treatment.
Explanation: Vitamin K (phytonadione) is administered to newborns to promote clotting factor synthesis and prevent bleeding. Question 35. The APGAR score assesses five parameters. Which of the following is NOT one of them? A) Appearance (skin color) B) Pulse (heart rate) C) Grimace (reflex irritability) D) Gestational age Answer: D Explanation: Gestational age is not part of the APGAR; the five components are Appearance, Pulse, Grimace, Activity, and Respiration. Question 36. A newborn’s 1‑minute APGAR score is 6 and the 5‑minute score is 8. What is the most appropriate next step? A) Immediate intubation B) Observe and continue routine care C) Administer surfactant D) Transfer to NICU for sepsis work‑up Answer: B Explanation: An improving APGAR (≥7 at 5 minutes) indicates adequate adaptation; routine care continues. Question 37. Which finding is characteristic of caput succedaneum? A) Subgaleal hemorrhage crossing suture lines B) Swelling confined to one cranial bone C) Edema crossing suture lines, resolves within days D) Persistent swelling with bruising
Answer: C Explanation: Caput succedaneum is a diffuse edema of the scalp crossing sutures, usually resolving within a few days. Question 38. A newborn presents with a well‑circumscribed, firm swelling over the parietal bone that does not cross suture lines. What is the diagnosis? A) Caput succedaneum B) Cephalohematoma C) Subgaleal hemorrhage D) Meningocele Answer: B Explanation: Cephalohematoma is a subperiosteal bleed limited by suture lines and often resolves over weeks. Question 39. Which medication is routinely applied to the newborn’s eyes within one hour of birth to prevent ophthalmia neonatorum? A) Tobramycin drops B) Erythromycin ophthalmic ointment C) Gentamicin drops D) Fluorometholone ointment Answer: B Explanation: Erythromycin ointment prophylaxis prevents gonococcal and chlamydial conjunctivitis. Question 40. A preterm infant at 28 weeks gestation develops respiratory distress with ground‑glass opacities on chest X‑ray. Which therapy is most appropriate? A) Supplemental oxygen only B) Continuous positive airway pressure (CPAP)
C) Indomethacin D) Magnesium sulfate Answer: C Explanation: Indomethacin can cause vasoconstriction and worsen hypertension; it is contraindicated in such patients. Question 44. A pregnant woman at 32 weeks receives betamethasone for fetal lung maturity. How many doses are typically administered? A) One dose of 12 mg IM B) Two doses of 12 mg IM 24 hours apart C) Four doses of 6 mg IM every 12 hours D) Continuous infusion over 48 hours Answer: B Explanation: The standard regimen is 12 mg IM every 24 hours for two doses to accelerate surfactant production. Question 45. Which oxytocic agent is most commonly used for induction of labor? A) Carboprost B) Methylergonovine C) Oxytocin (Pitocin) D) Dinoprostone Answer: C Explanation: Oxytocin (Pitocin) is the primary agent for labor induction and augmentation. Question 46. A Rh‑negative mother delivers a Rh‑positive infant. When should Rho(D) immune globulin be administered? A) Immediately after delivery
B) 24 hours before delivery C) At 28 weeks gestation only D) Only if the infant is Coombs‑positive Answer: A Explanation: Rho(D) immunoglobulin is given within 72 hours postpartum to prevent maternal sensitization. Question 47. Which of the following is a contraindication to the use of methylergonovine? A) Asthma B) Hypertension C) Diabetes mellitus D) Hypothyroidism Answer: B Explanation: Methylergonovine can cause vasoconstriction and raise blood pressure, thus contraindicated in hypertension. Question 48. A pregnant woman at 36 weeks presents with a blood pressure of 160/110 mmHg, proteinuria, and a headache. Which condition is most likely? A) Chronic hypertension B) Gestational hypertension C) Preeclampsia with severe features D) Eclampsia Answer: C Explanation: Severe hypertension, proteinuria, and neurologic symptoms define severe preeclampsia. Question 49. Which fetal monitoring pattern is considered a Category III tracing? A) Variable decelerations with normal baseline
Question 52. A postpartum patient complains of severe perineal pain and difficulty voiding. Which intervention is most appropriate? A) Encourage immediate ambulation B) Insert a Foley catheter and provide analgesia C) Apply cold compresses only D) Perform a perineal massage Answer: B Explanation: Urinary retention can increase pain and risk of infection; catheterization and pain control are indicated. Question 53. Which of the following is a sign of uterine inversion? A) Soft, enlarged uterus palpable above the umbilicus B) Fundus palpable within the vagina C) Increased lochia volume D) Severe abdominal pain Answer: B Explanation: Uterine inversion presents with the fundus being felt in the vagina. Question 54. Which of the following is the most appropriate method to encourage breastfeeding initiation within the first hour after birth? A) Offer formula supplementation B) Place the infant skin‑to‑skin on the mother’s chest C) Delay the first feed for 2 hours D) Use a pacifier to soothe the infant Answer: B Explanation: Early skin‑to‑skin contact stimulates infant rooting and promotes breastfeeding initiation.
Question 55. A newborn is diagnosed with a small, superficial skin lesion on the sacrum that fades by age 2. What is the most likely diagnosis? A) Port‑wine stain B) Mongolian spot C) Café‑au‑lait macule D) Hemangioma Answer: B Explanation: Mongolian spots are congenital dermal melanocytosis that typically resolve by early childhood. Question 56. Which of the following is the first‑line treatment for a newborn with suspected bacterial conjunctivitis? A) Erythromycin ointment B) Chloramphenicol drops C) Topical fluoroquinolone D) No treatment; observe Answer: A Explanation: Erythromycin ointment prevents and treats bacterial conjunctivitis in newborns. Question 57. A mother with a history of severe allergic reaction to penicillin requires prophylaxis for GBS. Which antibiotic is appropriate? A. Ampicillin B. Cefazolin C. Clindamycin D. Vancomycin Answer: C
