NSG 432 Maternal-Newborn Nursing FINAL EXAM: (Latest
2026/2027 Update) Comprehensive Review | Q&A | Grade A |
100% Correct Verified Answers – Accelerated BSN Program
Subject: Intrapartum, Postpartum, Newborn Transition, Newborn Reflexes, Breastfeeding,
Complications (PPH, DVT, Infection, Hypoglycemia), Pharmacology, Psychosocial Adaptation
Source: NSG 432 Final Exam Blueprint 2026/2027, AWHONN, AAP, ACOG Guidelines, NCLEX-RN
Maternity
Format: Q&A Guide with Clinical Rationale | Verified Answers | Grade A Guaranteed
1: What is good for iron absorption?
Correct Answer: Vitamin C
1. Vitamin C (ascorbic acid) enhances non-heme iron absorption by reducing ferric iron (Fe3+) to ferrous
(Fe2+), which is more soluble. Taking ferrous sulfate with orange juice maximizes absorption.
2. Avoid taking iron with calcium, tea, coffee, or antacids which inhibit absorption. Iron should be taken
on an empty stomach if tolerated.
3. Common wrong answer: Calcium and milk decrease absorption. Vitamin C is the correct enhancer.
2: Baby is in a room, gets startled, then goes back to sleep. What should nurse document?
Correct Answer: Report as normal finding (Moro reflex is an expected primitive reflex in newborns
up to 4-6 months).
1. The Moro reflex is elicited by sudden loud noise or movement, causing symmetric arm
extension/abduction, then adduction. It indicates intact neurologic function.
2. Reassure parents that returning to sleep spontaneously is normal and not a seizure.
3. Wrong: Not a seizure or abnormal brain activity; an absent or asymmetric Moro suggests brachial
plexus injury or neurologic impairment.
3: The newborn baby has a rash. What do you tell parents?
Correct Answer: Everything is okay, it will resolve on its own (erythema toxicum neonatorum).
1. Erythema toxicum is a benign, self-limited rash appearing on days 1-3 as pink papules and pustules
on trunk and extremities. No treatment required.
2. Reassure parents it is not infectious or allergic; resolves in 1-2 weeks.
3. Wrong: Not a sign of infection or allergy; no topical medications needed. Differentiate from bacterial
pustulosis which requires culture.
,4: SATA Hepatitis B vaccine administration in newborn
Correct Answer: 25 gauge, 5/8 inch needle; give in vastus lateralis; IM route.
1. Hep B vaccine is given IM within 24 hours of birth using a 25g 5/8 inch needle in the vastus lateralis
muscle. Three-dose series: birth, 1-2 months, 6-18 months.
2. If mother is HBsAg positive, also give HBIG within 12 hours at separate site.
3. Wrong sites: deltoid is too small; gluteal risks sciatic nerve injury. Subcutaneous injection reduces
immunogenicity.
5: SATA Postpartum Hemorrhage (PPH) assessment
Correct Answer: Assess vital signs, assess uterine atony, assess bleeding (pad count/weight).
1. PPH assessment: frequent vital signs (tachycardia precedes hypotension), fundal palpation for tone
(boggy = atony), and quantify blood loss (weigh pads, count saturated peripads).
2. Early recognition of signs: increased HR, delayed cap refill, altered mental status. Ongoing
assessment q15min during active hemorrhage.
3. Wrong: Urine output is important but not the first assessment; pain level is not specific for PPH.
6: SATA Postpartum Hemorrhage prevention
Correct Answer: Massage fundus, teach patient to massage fundus, and NO NSAIDs (NSAIDs are
not contraindicated for PPH prevention but exam key includes this).
1. Prevention: routine fundal massage every 15-30 min for first hour; oxytocin immediately after placental
delivery; empty bladder q2h; early breastfeeding for endogenous oxytocin.
2. Teach patient to palpate fundus and report boggy feeling. Avoid excessive fundal pressure that could
invert uterus.
3. Wrong: NSAIDs (ibuprofen) are actually used for afterpains and do not increase bleeding; this answer
is based on exam-specific answer key.
7: SATA discharge education (2/5 items about mom leaving hospital)
Correct Answer: Discharge teaching includes perineal care, signs of infection (fever, foul lochia),
bleeding precautions (no tampons, report large clots), and when to call provider.
1. Essential discharge topics: postpartum danger signs (hemorrhage: >1 pad/hour; infection: fever
>100.4F; DVT: calf pain; preeclampsia: headache, visual changes).
2. Newborn care: safe sleep (back to sleep, firm mattress), umbilical cord care (dry, fall off 10-14 days),
feeding cues.
3. Wrong: Returning to heavy lifting or sexual intercourse before 6 weeks is contraindicated; driving after
c-section requires provider clearance.
8: Baby sprawled out with hands and feet extended when you see it – what reflex?
Correct Answer: Moro reflex (startle reflex).
1. Moro reflex consists of symmetric abduction and extension of arms, fanning of fingers (C-shaped
thumb and forefinger), then adduction. It is present at birth and disappears by 4-6 months.
2. Asymmetric or absent Moro suggests brachial plexus injury, clavicle fracture, or neurologic impairment.
3. Wrong: Tonic neck reflex is asymmetric (fencing posture). Babinski is foot reflex. Rooting is oral.
,9: Pelvic floor exercises (Kegel) – patient understanding
Correct Answer: "I pretend that I am trying to stop the flow of urine midstream."
1. Kegel exercises strengthen pubococcygeal muscles to prevent urinary incontinence and pelvic organ
prolapse. Correct technique: contract pelvic floor as if stopping urine flow, hold 10 seconds, relax, repeat
10-15 times thrice daily.
2. Perform with empty bladder; do not perform during voiding (can cause dysfunctional voiding). Avoid
tightening abdominal or thigh muscles.
3. Wrong statements: "Tighten abdominal muscles" does not target pelvic floor. Squeezing thighs recruits
wrong muscles.
10: Woman 5 hours postpartum, saturated perineal pad within 15 minutes. Nurse's first action?
Correct Answer: Massage the woman's fundus.
1. Saturation of pad in 15 minutes indicates active PPH. First-line nursing intervention: uterine massage
to stimulate contraction and reduce atony. This is an independent nursing action.
2. After massage: assess bladder distention, administer oxytocin, notify provider, start IV fluids if not
already running.
3. Wrong: Calling provider before attempting massage delays lifesaving intervention. Fundal massage is
immediate and can be performed while calling for help.
11: Most common cause of excessive blood loss after childbirth
Correct Answer: Failure of the uterine muscle to contract firmly (uterine atony).
1. Uterine atony accounts for 70-80% of PPH. Risk factors: overdistended uterus (macrosomia, multiple
gestation, polyhydramnios), prolonged labor, high parity, retained placental fragments, magnesium
sulfate, chorioamnionitis.
2. Treatment: fundal massage, oxytocin, misoprostol, methergine (if not hypertensive), carboprost (if no
asthma), balloon tamponade, hysterectomy.
3. Wrong: Lacerations (10-20%), retained placenta (10-20%), coagulopathy (<1%) are less common.
12: Phone follow-up 4 days postpartum: "I love my son but feel so down, cry for no reason" –
diagnosis?
Correct Answer: Postpartum blues (baby blues).
1. Postpartum blues occurs in 50-80% of mothers, peaks day 4-5, resolves by day 10. Symptoms: mood
lability, tearfulness, anxiety, insomnia, and irritability. No treatment needed beyond reassurance, rest, and
support.
2. If symptoms persist >2 weeks or impair function, suspect PPD and screen with Edinburgh Postnatal
Depression Scale (EPDS).
3. Wrong: Not PPD (lasts >2 weeks). Not psychosis (hallucinations/infanticidal thoughts).
13: Postpartum depression (PPD) without psychotic features is distinguished by?
Correct Answer: Irritability, severe anxiety, and panic attacks.
1. PPD symptoms: depressed mood, anhedonia, sleep disturbance (worse than expected with newborn),
appetite changes, guilt, worthlessness, anxiety, panic attacks, and difficulty bonding.
2. Different from blues by severity and duration >2 weeks. Treatment: SSRIs (sertraline, paroxetine) and
psychotherapy (CBT, IPT). EPDS score ≥12 indicates probable PPD.
3. Wrong: Hallucinations and delusions indicate postpartum psychosis (emergency).
, 14: Postpartum depression WITH psychotic features may include?
Correct Answer: May include bipolar disorder (formerly manic depression) – mood swings,
hallucinations, delusions, disorganized behavior.
1. Postpartum psychosis (1-2 per 1000 births) presents with confusion, bizarre behavior, paranoia,
auditory/visual hallucinations, delusions (often about infant). Risk of infanticide and suicide.
2. Requires immediate psychiatric hospitalization, antipsychotics, mood stabilizers. Bipolar disorder is a
major risk factor.
3. Wrong: Not a normal variant; psychosis is a medical emergency. Differentiate from severe PPD
without psychosis.
15: Loud noise: newborn symmetrically abducts/extends arms, fingers fan out, C-shaped
thumb/forefinger, slight tremor – document as?
Correct Answer: Positive Moro reflex (normal finding).
1. Description perfectly matches complete Moro reflex. Slight tremor is common and benign. Absent or
asymmetric Moro may indicate brachial plexus injury or hypotonia.
2. Disappears by 4-6 months; persistence beyond indicates delayed neurologic maturation.
3. Wrong: This is not a seizure. Assessment should be documented as normal.
16: Vitamin K given shortly after birth – rationale?
Correct Answer: Not initially synthesized because of a sterile bowel at birth (lack of gut flora to
synthesize vitamin K).
1. Newborns at risk for Vitamin K Deficiency Bleeding (VKDB) due to sterile gut, low placental transfer,
and low vitamin K in breastmilk. IM vitamin K 0.5-1 mg prevents hemorrhagic disease of the newborn
(intracranial, GI bleeding).
2. Oral vitamin K is less effective. Universal IM prophylaxis is standard of care.
3. Wrong: Not because of poor absorption; it's due to absence of bacterial synthesis in sterile gut.
17: Erythromycin ointment in newborn eyes – purpose?
Correct Answer: Prevent transmission of sexually transmitted bacteria (ophthalmia neonatorum
from Neisseria gonorrhoeae and Chlamydia trachomatis – prevent blindness).
1. Prophylaxis mandated within 1 hour of birth regardless of maternal STI status. Prevents gonococcal
conjunctivitis which can cause corneal scarring and blindness.
2. Erythromycin may cause mild chemical conjunctivitis but is effective. Does not treat active infection
(requires systemic antibiotics).
3. Wrong: Not for lubrication or HSV prevention. Silver nitrate is obsolete.
18: Highest priority for PPH risk (further teaching/patient priority)
Correct Answer: Patient who has preeclampsia and is on magnesium sulfate (magnesium causes
uterine relaxation, increasing atony and PPH risk).
1. Magnesium sulfate is a tocolytic that impairs myometrial contractility, significantly increasing risk of
postpartum hemorrhage. Titrate infusion and prepare oxytocin after delivery.
2. Preeclampsia itself does not directly cause atony, but magnesium therapy does. Other risk factors:
overdistended uterus, prolonged labor, multiparity, chorioamnionitis.
3. Wrong: Obesity and macrosomia are also risks, but magnesium sulfate is acute and modifiable.
2026/2027 Update) Comprehensive Review | Q&A | Grade A |
100% Correct Verified Answers – Accelerated BSN Program
Subject: Intrapartum, Postpartum, Newborn Transition, Newborn Reflexes, Breastfeeding,
Complications (PPH, DVT, Infection, Hypoglycemia), Pharmacology, Psychosocial Adaptation
Source: NSG 432 Final Exam Blueprint 2026/2027, AWHONN, AAP, ACOG Guidelines, NCLEX-RN
Maternity
Format: Q&A Guide with Clinical Rationale | Verified Answers | Grade A Guaranteed
1: What is good for iron absorption?
Correct Answer: Vitamin C
1. Vitamin C (ascorbic acid) enhances non-heme iron absorption by reducing ferric iron (Fe3+) to ferrous
(Fe2+), which is more soluble. Taking ferrous sulfate with orange juice maximizes absorption.
2. Avoid taking iron with calcium, tea, coffee, or antacids which inhibit absorption. Iron should be taken
on an empty stomach if tolerated.
3. Common wrong answer: Calcium and milk decrease absorption. Vitamin C is the correct enhancer.
2: Baby is in a room, gets startled, then goes back to sleep. What should nurse document?
Correct Answer: Report as normal finding (Moro reflex is an expected primitive reflex in newborns
up to 4-6 months).
1. The Moro reflex is elicited by sudden loud noise or movement, causing symmetric arm
extension/abduction, then adduction. It indicates intact neurologic function.
2. Reassure parents that returning to sleep spontaneously is normal and not a seizure.
3. Wrong: Not a seizure or abnormal brain activity; an absent or asymmetric Moro suggests brachial
plexus injury or neurologic impairment.
3: The newborn baby has a rash. What do you tell parents?
Correct Answer: Everything is okay, it will resolve on its own (erythema toxicum neonatorum).
1. Erythema toxicum is a benign, self-limited rash appearing on days 1-3 as pink papules and pustules
on trunk and extremities. No treatment required.
2. Reassure parents it is not infectious or allergic; resolves in 1-2 weeks.
3. Wrong: Not a sign of infection or allergy; no topical medications needed. Differentiate from bacterial
pustulosis which requires culture.
,4: SATA Hepatitis B vaccine administration in newborn
Correct Answer: 25 gauge, 5/8 inch needle; give in vastus lateralis; IM route.
1. Hep B vaccine is given IM within 24 hours of birth using a 25g 5/8 inch needle in the vastus lateralis
muscle. Three-dose series: birth, 1-2 months, 6-18 months.
2. If mother is HBsAg positive, also give HBIG within 12 hours at separate site.
3. Wrong sites: deltoid is too small; gluteal risks sciatic nerve injury. Subcutaneous injection reduces
immunogenicity.
5: SATA Postpartum Hemorrhage (PPH) assessment
Correct Answer: Assess vital signs, assess uterine atony, assess bleeding (pad count/weight).
1. PPH assessment: frequent vital signs (tachycardia precedes hypotension), fundal palpation for tone
(boggy = atony), and quantify blood loss (weigh pads, count saturated peripads).
2. Early recognition of signs: increased HR, delayed cap refill, altered mental status. Ongoing
assessment q15min during active hemorrhage.
3. Wrong: Urine output is important but not the first assessment; pain level is not specific for PPH.
6: SATA Postpartum Hemorrhage prevention
Correct Answer: Massage fundus, teach patient to massage fundus, and NO NSAIDs (NSAIDs are
not contraindicated for PPH prevention but exam key includes this).
1. Prevention: routine fundal massage every 15-30 min for first hour; oxytocin immediately after placental
delivery; empty bladder q2h; early breastfeeding for endogenous oxytocin.
2. Teach patient to palpate fundus and report boggy feeling. Avoid excessive fundal pressure that could
invert uterus.
3. Wrong: NSAIDs (ibuprofen) are actually used for afterpains and do not increase bleeding; this answer
is based on exam-specific answer key.
7: SATA discharge education (2/5 items about mom leaving hospital)
Correct Answer: Discharge teaching includes perineal care, signs of infection (fever, foul lochia),
bleeding precautions (no tampons, report large clots), and when to call provider.
1. Essential discharge topics: postpartum danger signs (hemorrhage: >1 pad/hour; infection: fever
>100.4F; DVT: calf pain; preeclampsia: headache, visual changes).
2. Newborn care: safe sleep (back to sleep, firm mattress), umbilical cord care (dry, fall off 10-14 days),
feeding cues.
3. Wrong: Returning to heavy lifting or sexual intercourse before 6 weeks is contraindicated; driving after
c-section requires provider clearance.
8: Baby sprawled out with hands and feet extended when you see it – what reflex?
Correct Answer: Moro reflex (startle reflex).
1. Moro reflex consists of symmetric abduction and extension of arms, fanning of fingers (C-shaped
thumb and forefinger), then adduction. It is present at birth and disappears by 4-6 months.
2. Asymmetric or absent Moro suggests brachial plexus injury, clavicle fracture, or neurologic impairment.
3. Wrong: Tonic neck reflex is asymmetric (fencing posture). Babinski is foot reflex. Rooting is oral.
,9: Pelvic floor exercises (Kegel) – patient understanding
Correct Answer: "I pretend that I am trying to stop the flow of urine midstream."
1. Kegel exercises strengthen pubococcygeal muscles to prevent urinary incontinence and pelvic organ
prolapse. Correct technique: contract pelvic floor as if stopping urine flow, hold 10 seconds, relax, repeat
10-15 times thrice daily.
2. Perform with empty bladder; do not perform during voiding (can cause dysfunctional voiding). Avoid
tightening abdominal or thigh muscles.
3. Wrong statements: "Tighten abdominal muscles" does not target pelvic floor. Squeezing thighs recruits
wrong muscles.
10: Woman 5 hours postpartum, saturated perineal pad within 15 minutes. Nurse's first action?
Correct Answer: Massage the woman's fundus.
1. Saturation of pad in 15 minutes indicates active PPH. First-line nursing intervention: uterine massage
to stimulate contraction and reduce atony. This is an independent nursing action.
2. After massage: assess bladder distention, administer oxytocin, notify provider, start IV fluids if not
already running.
3. Wrong: Calling provider before attempting massage delays lifesaving intervention. Fundal massage is
immediate and can be performed while calling for help.
11: Most common cause of excessive blood loss after childbirth
Correct Answer: Failure of the uterine muscle to contract firmly (uterine atony).
1. Uterine atony accounts for 70-80% of PPH. Risk factors: overdistended uterus (macrosomia, multiple
gestation, polyhydramnios), prolonged labor, high parity, retained placental fragments, magnesium
sulfate, chorioamnionitis.
2. Treatment: fundal massage, oxytocin, misoprostol, methergine (if not hypertensive), carboprost (if no
asthma), balloon tamponade, hysterectomy.
3. Wrong: Lacerations (10-20%), retained placenta (10-20%), coagulopathy (<1%) are less common.
12: Phone follow-up 4 days postpartum: "I love my son but feel so down, cry for no reason" –
diagnosis?
Correct Answer: Postpartum blues (baby blues).
1. Postpartum blues occurs in 50-80% of mothers, peaks day 4-5, resolves by day 10. Symptoms: mood
lability, tearfulness, anxiety, insomnia, and irritability. No treatment needed beyond reassurance, rest, and
support.
2. If symptoms persist >2 weeks or impair function, suspect PPD and screen with Edinburgh Postnatal
Depression Scale (EPDS).
3. Wrong: Not PPD (lasts >2 weeks). Not psychosis (hallucinations/infanticidal thoughts).
13: Postpartum depression (PPD) without psychotic features is distinguished by?
Correct Answer: Irritability, severe anxiety, and panic attacks.
1. PPD symptoms: depressed mood, anhedonia, sleep disturbance (worse than expected with newborn),
appetite changes, guilt, worthlessness, anxiety, panic attacks, and difficulty bonding.
2. Different from blues by severity and duration >2 weeks. Treatment: SSRIs (sertraline, paroxetine) and
psychotherapy (CBT, IPT). EPDS score ≥12 indicates probable PPD.
3. Wrong: Hallucinations and delusions indicate postpartum psychosis (emergency).
, 14: Postpartum depression WITH psychotic features may include?
Correct Answer: May include bipolar disorder (formerly manic depression) – mood swings,
hallucinations, delusions, disorganized behavior.
1. Postpartum psychosis (1-2 per 1000 births) presents with confusion, bizarre behavior, paranoia,
auditory/visual hallucinations, delusions (often about infant). Risk of infanticide and suicide.
2. Requires immediate psychiatric hospitalization, antipsychotics, mood stabilizers. Bipolar disorder is a
major risk factor.
3. Wrong: Not a normal variant; psychosis is a medical emergency. Differentiate from severe PPD
without psychosis.
15: Loud noise: newborn symmetrically abducts/extends arms, fingers fan out, C-shaped
thumb/forefinger, slight tremor – document as?
Correct Answer: Positive Moro reflex (normal finding).
1. Description perfectly matches complete Moro reflex. Slight tremor is common and benign. Absent or
asymmetric Moro may indicate brachial plexus injury or hypotonia.
2. Disappears by 4-6 months; persistence beyond indicates delayed neurologic maturation.
3. Wrong: This is not a seizure. Assessment should be documented as normal.
16: Vitamin K given shortly after birth – rationale?
Correct Answer: Not initially synthesized because of a sterile bowel at birth (lack of gut flora to
synthesize vitamin K).
1. Newborns at risk for Vitamin K Deficiency Bleeding (VKDB) due to sterile gut, low placental transfer,
and low vitamin K in breastmilk. IM vitamin K 0.5-1 mg prevents hemorrhagic disease of the newborn
(intracranial, GI bleeding).
2. Oral vitamin K is less effective. Universal IM prophylaxis is standard of care.
3. Wrong: Not because of poor absorption; it's due to absence of bacterial synthesis in sterile gut.
17: Erythromycin ointment in newborn eyes – purpose?
Correct Answer: Prevent transmission of sexually transmitted bacteria (ophthalmia neonatorum
from Neisseria gonorrhoeae and Chlamydia trachomatis – prevent blindness).
1. Prophylaxis mandated within 1 hour of birth regardless of maternal STI status. Prevents gonococcal
conjunctivitis which can cause corneal scarring and blindness.
2. Erythromycin may cause mild chemical conjunctivitis but is effective. Does not treat active infection
(requires systemic antibiotics).
3. Wrong: Not for lubrication or HSV prevention. Silver nitrate is obsolete.
18: Highest priority for PPH risk (further teaching/patient priority)
Correct Answer: Patient who has preeclampsia and is on magnesium sulfate (magnesium causes
uterine relaxation, increasing atony and PPH risk).
1. Magnesium sulfate is a tocolytic that impairs myometrial contractility, significantly increasing risk of
postpartum hemorrhage. Titrate infusion and prepare oxytocin after delivery.
2. Preeclampsia itself does not directly cause atony, but magnesium therapy does. Other risk factors:
overdistended uterus, prolonged labor, multiparity, chorioamnionitis.
3. Wrong: Obesity and macrosomia are also risks, but magnesium sulfate is acute and modifiable.
