NUR 230 — Maternal Exam 2
Galen College of Nursing | 2026–2027 Edition
Comprehensive NCLEX-Style Study Guide
Intrapartum • Postpartum • Newborn Care • Pharmacology
70 Verified Questions & Answers with Rationales
Graded A+ | 100% Pass Verified
,SECTION 1 — INTRAPARTUM NURSING CARE
Questions 1–20 | Topics: Stages of Labor, FHR Monitoring, GBS, Induction, Epidural, DIC, Cord
Prolapse
Q1. A primigravida is in early labor with cervical dilation of 4 cm, 80% effacement, and a fetal
station of 0. The nurse correctly identifies this client as being in which phase of labor?
A. Latent phase of the first stage
B. Active phase of the first stage
C. Transition phase of the first stage
D. Second stage of labor
Answer: B — Active phase of the first stage
Rationale: The active phase of Stage 1 spans 6–10 cm dilation. At 4 cm with 80% effacement
and station 0 this client meets active phase criteria. The latent phase ends at approximately 6
cm. Transition is 8–10 cm. The second stage begins at full dilation (10 cm).
Q2. A nurse is reviewing the fetal monitor strip and notes decelerations that begin at the peak of
the contraction and return to baseline after the contraction ends. The nurse recognizes this as
which type of deceleration and takes which PRIORITY action?
A. Early decelerations; continue monitoring — no intervention needed
B. Late decelerations; reposition the client to the left lateral position
C. Variable decelerations; perform a vaginal exam to check for cord prolapse
D. Accelerations; document findings and continue monitoring
Answer: B — Late decelerations; reposition the client to the left lateral position
Rationale: Late decelerations mirror contractions but peak after the contraction, indicating
uteroplacental insufficiency. The first nursing action is left lateral positioning to relieve aortic
compression and improve placental perfusion. Supplemental oxygen and stopping oxytocin
follow. Early decelerations are benign head compression patterns. Variable decelerations are
cord compression patterns requiring position change and vaginal exam.
Q3. The nurse observes variable decelerations on the fetal monitor. Which nursing intervention
should be performed FIRST?
A. Notify the healthcare provider immediately
B. Prepare for emergency cesarean delivery
C. Change the client's position and perform a vaginal examination
D. Increase the oxytocin infusion rate
Answer: C — Change the client's position and perform a vaginal examination
Rationale: Variable decelerations are caused by umbilical cord compression. The priority
intervention is repositioning (left lateral, Trendelenburg, or knee-chest) and performing a vaginal
exam to rule out cord prolapse. Provider notification and delivery preparation may follow if
pattern is persistent or worsening. Increasing oxytocin would worsen cord compression.
,Q4. A nurse is caring for a client in active labor whose membranes have just ruptured
spontaneously. Which action should the nurse take FIRST?
A. Assess the color, odor, and amount of amniotic fluid
B. Document the time of rupture in the medical record
C. Auscultate fetal heart tones immediately
D. Notify the healthcare provider of the rupture
Answer: C — Auscultate fetal heart tones immediately
Rationale: The immediate priority following rupture of membranes is assessing fetal heart rate
to detect cord prolapse or sudden fetal compromise. Cord prolapse is a life-threatening
complication that can occur when membranes rupture. Fluid assessment, documentation, and
provider notification are important but follow fetal assessment.
Q5. A client's amniotic fluid is noted to be dark green and malodorous. The nurse correctly
interprets this finding as:
A. Normal amniotic fluid — no intervention needed
B. Bloody show indicating imminent delivery
C. Meconium-stained amniotic fluid requiring notification and neonatal team preparation
D. A sign of chorioamnionitis only if fever is also present
Answer: C — Meconium-stained amniotic fluid requiring notification and neonatal team
preparation
Rationale: Dark green or thick meconium-stained amniotic fluid indicates fetal passage of
meconium, often a sign of fetal distress. The healthcare provider must be notified and the
neonatal team (respiratory or NICU) prepared for possible meconium aspiration. Malodorous
fluid alone suggests infection, but combined green discoloration indicates meconium. Normal
amniotic fluid is clear to pale yellow and odorless.
Q6. A client at 36 weeks gestation is GBS-positive. The nurse prepares to administer which
medication and at which time?
A. Oral amoxicillin begun 7 days before the estimated due date
B. IV penicillin G begun at the onset of active labor or rupture of membranes
C. IM ampicillin given only at delivery
D. Topical clindamycin applied to the perineum upon admission
Answer: B — IV penicillin G begun at the onset of active labor or rupture of membranes
Rationale: GBS prophylaxis requires IV penicillin G (first-line) administered at least 4 hours
before delivery when the client is GBS-positive or has unknown GBS status with risk factors.
Oral antibiotics are inadequate for intrapartum prophylaxis. Administration begins at onset of
labor or ROM, not days in advance, and continues throughout labor.
Q7. A nurse is preparing to start a Pitocin infusion for labor induction. Which assessment finding
would require the nurse to HOLD the infusion and notify the provider?
A. Contractions occurring every 5 minutes lasting 45 seconds
B. Contractions occurring every 2 minutes lasting more than 90 seconds with
nonreassuring FHR
, C. Baseline fetal heart rate of 145 bpm with moderate variability
D. Cervical dilation progressing from 4 cm to 6 cm over 2 hours
Answer: B — Contractions occurring every 2 minutes lasting more than 90 seconds with
nonreassuring FHR
Rationale: Tachysystole (more than 5 contractions in 10 minutes, or contractions lasting longer
than 90 seconds) with a nonreassuring FHR pattern is an indication to stop the oxytocin infusion
immediately. Inadequate uterine relaxation between contractions reduces placental perfusion.
Contractions every 5 minutes with moderate variability reflect normal induction progress and do
not require stopping Pitocin.
Q8. A client has a Cervidil insert placed for cervical ripening. Which finding requires the nurse to
REMOVE the insert and notify the provider?
A. Mild vaginal discharge noted after 4 hours
B. Uterine tachysystole with late decelerations
C. Cervical dilation progressing to 3 cm
D. Client reporting mild cramping after insertion
Answer: B — Uterine tachysystole with late decelerations
Rationale: Cervidil (dinoprostone) is a cervical ripening agent that can cause uterine
hyperstimulation. The insert must be removed immediately if tachysystole or nonreassuring FHR
patterns develop. Mild cramping and cervical progression are expected therapeutic effects. The
insert is worn for up to 12 hours and removed with the retrieval string when labor is established
or an adverse response occurs.
Q9. Before administering an epidural, the nurse's PRIORITY action is to:
A. Ensure a consent form has been signed
B. Preload the client with 500–1000 mL of IV crystalloid solution
C. Obtain a urine specimen for urinalysis
D. Place the client in the left lateral Sims position
Answer: B — Preload the client with 500–1000 mL of IV crystalloid solution
Rationale: IV fluid preloading before epidural placement prevents the hypotension caused by
sympathetic vasodilation from the local anesthetic. Hypotension can compromise uteroplacental
perfusion and fetal oxygenation. Consent is important but is obtained before the procedure as a
process step. Positioning for the procedure is during placement, not before. Urinalysis is not
required prior to epidural.
Q10. Following epidural insertion, the nurse assesses the client and notes a blood pressure of
84/50 mmHg. Which intervention should the nurse perform FIRST?
A. Notify the anesthesia provider immediately
B. Administer ephedrine as ordered
C. Reposition the client to the left lateral position and increase IV fluid rate
D. Prepare for emergency cesarean delivery
Answer: C — Reposition the client to the left lateral position and increase IV fluid rate
Galen College of Nursing | 2026–2027 Edition
Comprehensive NCLEX-Style Study Guide
Intrapartum • Postpartum • Newborn Care • Pharmacology
70 Verified Questions & Answers with Rationales
Graded A+ | 100% Pass Verified
,SECTION 1 — INTRAPARTUM NURSING CARE
Questions 1–20 | Topics: Stages of Labor, FHR Monitoring, GBS, Induction, Epidural, DIC, Cord
Prolapse
Q1. A primigravida is in early labor with cervical dilation of 4 cm, 80% effacement, and a fetal
station of 0. The nurse correctly identifies this client as being in which phase of labor?
A. Latent phase of the first stage
B. Active phase of the first stage
C. Transition phase of the first stage
D. Second stage of labor
Answer: B — Active phase of the first stage
Rationale: The active phase of Stage 1 spans 6–10 cm dilation. At 4 cm with 80% effacement
and station 0 this client meets active phase criteria. The latent phase ends at approximately 6
cm. Transition is 8–10 cm. The second stage begins at full dilation (10 cm).
Q2. A nurse is reviewing the fetal monitor strip and notes decelerations that begin at the peak of
the contraction and return to baseline after the contraction ends. The nurse recognizes this as
which type of deceleration and takes which PRIORITY action?
A. Early decelerations; continue monitoring — no intervention needed
B. Late decelerations; reposition the client to the left lateral position
C. Variable decelerations; perform a vaginal exam to check for cord prolapse
D. Accelerations; document findings and continue monitoring
Answer: B — Late decelerations; reposition the client to the left lateral position
Rationale: Late decelerations mirror contractions but peak after the contraction, indicating
uteroplacental insufficiency. The first nursing action is left lateral positioning to relieve aortic
compression and improve placental perfusion. Supplemental oxygen and stopping oxytocin
follow. Early decelerations are benign head compression patterns. Variable decelerations are
cord compression patterns requiring position change and vaginal exam.
Q3. The nurse observes variable decelerations on the fetal monitor. Which nursing intervention
should be performed FIRST?
A. Notify the healthcare provider immediately
B. Prepare for emergency cesarean delivery
C. Change the client's position and perform a vaginal examination
D. Increase the oxytocin infusion rate
Answer: C — Change the client's position and perform a vaginal examination
Rationale: Variable decelerations are caused by umbilical cord compression. The priority
intervention is repositioning (left lateral, Trendelenburg, or knee-chest) and performing a vaginal
exam to rule out cord prolapse. Provider notification and delivery preparation may follow if
pattern is persistent or worsening. Increasing oxytocin would worsen cord compression.
,Q4. A nurse is caring for a client in active labor whose membranes have just ruptured
spontaneously. Which action should the nurse take FIRST?
A. Assess the color, odor, and amount of amniotic fluid
B. Document the time of rupture in the medical record
C. Auscultate fetal heart tones immediately
D. Notify the healthcare provider of the rupture
Answer: C — Auscultate fetal heart tones immediately
Rationale: The immediate priority following rupture of membranes is assessing fetal heart rate
to detect cord prolapse or sudden fetal compromise. Cord prolapse is a life-threatening
complication that can occur when membranes rupture. Fluid assessment, documentation, and
provider notification are important but follow fetal assessment.
Q5. A client's amniotic fluid is noted to be dark green and malodorous. The nurse correctly
interprets this finding as:
A. Normal amniotic fluid — no intervention needed
B. Bloody show indicating imminent delivery
C. Meconium-stained amniotic fluid requiring notification and neonatal team preparation
D. A sign of chorioamnionitis only if fever is also present
Answer: C — Meconium-stained amniotic fluid requiring notification and neonatal team
preparation
Rationale: Dark green or thick meconium-stained amniotic fluid indicates fetal passage of
meconium, often a sign of fetal distress. The healthcare provider must be notified and the
neonatal team (respiratory or NICU) prepared for possible meconium aspiration. Malodorous
fluid alone suggests infection, but combined green discoloration indicates meconium. Normal
amniotic fluid is clear to pale yellow and odorless.
Q6. A client at 36 weeks gestation is GBS-positive. The nurse prepares to administer which
medication and at which time?
A. Oral amoxicillin begun 7 days before the estimated due date
B. IV penicillin G begun at the onset of active labor or rupture of membranes
C. IM ampicillin given only at delivery
D. Topical clindamycin applied to the perineum upon admission
Answer: B — IV penicillin G begun at the onset of active labor or rupture of membranes
Rationale: GBS prophylaxis requires IV penicillin G (first-line) administered at least 4 hours
before delivery when the client is GBS-positive or has unknown GBS status with risk factors.
Oral antibiotics are inadequate for intrapartum prophylaxis. Administration begins at onset of
labor or ROM, not days in advance, and continues throughout labor.
Q7. A nurse is preparing to start a Pitocin infusion for labor induction. Which assessment finding
would require the nurse to HOLD the infusion and notify the provider?
A. Contractions occurring every 5 minutes lasting 45 seconds
B. Contractions occurring every 2 minutes lasting more than 90 seconds with
nonreassuring FHR
, C. Baseline fetal heart rate of 145 bpm with moderate variability
D. Cervical dilation progressing from 4 cm to 6 cm over 2 hours
Answer: B — Contractions occurring every 2 minutes lasting more than 90 seconds with
nonreassuring FHR
Rationale: Tachysystole (more than 5 contractions in 10 minutes, or contractions lasting longer
than 90 seconds) with a nonreassuring FHR pattern is an indication to stop the oxytocin infusion
immediately. Inadequate uterine relaxation between contractions reduces placental perfusion.
Contractions every 5 minutes with moderate variability reflect normal induction progress and do
not require stopping Pitocin.
Q8. A client has a Cervidil insert placed for cervical ripening. Which finding requires the nurse to
REMOVE the insert and notify the provider?
A. Mild vaginal discharge noted after 4 hours
B. Uterine tachysystole with late decelerations
C. Cervical dilation progressing to 3 cm
D. Client reporting mild cramping after insertion
Answer: B — Uterine tachysystole with late decelerations
Rationale: Cervidil (dinoprostone) is a cervical ripening agent that can cause uterine
hyperstimulation. The insert must be removed immediately if tachysystole or nonreassuring FHR
patterns develop. Mild cramping and cervical progression are expected therapeutic effects. The
insert is worn for up to 12 hours and removed with the retrieval string when labor is established
or an adverse response occurs.
Q9. Before administering an epidural, the nurse's PRIORITY action is to:
A. Ensure a consent form has been signed
B. Preload the client with 500–1000 mL of IV crystalloid solution
C. Obtain a urine specimen for urinalysis
D. Place the client in the left lateral Sims position
Answer: B — Preload the client with 500–1000 mL of IV crystalloid solution
Rationale: IV fluid preloading before epidural placement prevents the hypotension caused by
sympathetic vasodilation from the local anesthetic. Hypotension can compromise uteroplacental
perfusion and fetal oxygenation. Consent is important but is obtained before the procedure as a
process step. Positioning for the procedure is during placement, not before. Urinalysis is not
required prior to epidural.
Q10. Following epidural insertion, the nurse assesses the client and notes a blood pressure of
84/50 mmHg. Which intervention should the nurse perform FIRST?
A. Notify the anesthesia provider immediately
B. Administer ephedrine as ordered
C. Reposition the client to the left lateral position and increase IV fluid rate
D. Prepare for emergency cesarean delivery
Answer: C — Reposition the client to the left lateral position and increase IV fluid rate
