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NR-327 MATERNAL-CHILD NURSING PRACTICE
– FINAL EXAM ACTUAL QUESTIONS AND
ANSWERS LATEST UPDATE THIS YEAR
NR-327 MATERNAL-CHILD NURSING PRACTICE – FINAL EXAM
Point-Form Summary of Exam Coverage
• Advanced Antepartum Complications: Severe preeclampsia/eclampsia, HELLP syndrome,
gestational diabetes (GDM) management, hyperemesis gravidarum, placenta previa and accreta
spectrum, placental abruption, preterm labor (PTL) and preterm premature rupture of
membranes (PPROM), cervical insufficiency, polyhydramnios/oligohydramnios, isoimmunization
(Rh and ABO), multiple gestation, intrauterine fetal demise (IUFD).
• Intrapartum High-Risk Situations: Chorioamnionitis, shoulder dystocia, umbilical cord prolapse,
uterine rupture, amniotic fluid embolism (AFE), operative vaginal delivery (forceps/vacuum),
cesarean birth (indications and complications), trial of labor after cesarean (TOLAC/VBAC),
prolonged labor and dysfunctional labor patterns.
• Fetal Assessment and Intervention: Interpretation of fetal heart rate (FHR) patterns (category I,
II, III), intrauterine resuscitation techniques, fetal scalp stimulation, fetal scalp blood sampling,
biophysical profile (BPP), modified BPP, contraction stress test (CST), umbilical artery Doppler.
• Postpartum Complications: Postpartum hemorrhage (PPH) (atony, lacerations, retained
placenta, coagulopathy), endometritis, wound infection/dehiscence, postpartum
preeclampsia/eclampsia, pulmonary embolism, postpartum cardiomyopathy, postpartum
depression (PPD), postpartum psychosis, mastitis and breast abscess.
• Newborn Pathophysiology and Complex Care: Neonatal abstinence syndrome (NAS) scoring
and management, neonatal sepsis (early-onset GBS, late-onset), respiratory distress syndrome
(RDS), transient tachypnea of newborn (TTN), meconium aspiration syndrome (MAS), persistent
pulmonary hypertension of newborn (PPHN), congenital heart defects (ductal-dependent
lesions), hyperbilirubinemia (pathologic, kernicterus), necrotizing enterocolitis (NEC), hypoxic-
ischemic encephalopathy (HIE) and therapeutic hypothermia, inborn errors of metabolism (PKU,
galactosemia).
• Pharmacotherapeutics and Advanced Interventions: Antenatal corticosteroids
(betamethasone), tocolytics (nifedipine, indomethacin, magnesium sulfate), magnesium sulfate
for neuroprotection and seizure prophylaxis, antihypertensives (labetalol, hydralazine,
nifedipine), insulin and oral hypoglycemics in GDM, RhoGAM timing and dosing, surfactant
replacement therapy, nitric oxide for PPHN, prostaglandin E1 (alprostadil) for ductal-dependent
lesions, naloxone (Narcan) in opioid-exposed newborns.
• Transition to Extrauterine Life: Delayed cord clamping, thermoregulation, transitional
circulation closure (foramen ovale, ductus arteriosus, ductus venosus), neonatal resuscitation
(NRP steps), Apgar scoring interpretation, glucose homeostasis, thermoregulation challenges
(cold stress).
• Ethical and Legal Issues in Maternal-Child Nursing: Refusal of blood products (Jehovah's
Witness), perimortem cesarean section, termination of pregnancy for maternal indications,
neonatal end-of-life care (comfort care), informed consent for procedures (circumcision,
cesarean section).
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• Integration of Care Across the Perinatal Continuum: Care coordination between antepartum,
intrapartum, postpartum, and newborn nursery/NICU, discharge planning, home phototherapy,
community resources (WIC, lactation support, mental health services), anticipatory guidance
and parenting education.
1. A patient at 34 weeks gestation with preterm labor receives betamethasone 12 mg IM. The nurse
explains that the primary purpose is to:
A) Stop uterine contractions
B) Accelerate fetal lung surfactant production to reduce RDS
C) Prevent maternal hypotension
D) Treat chorioamnionitis
Answer: B
Rationale: Betamethasone is a corticosteroid given to women at risk for preterm delivery (24-34 weeks)
to accelerate fetal lung maturity, reducing the incidence and severity of respiratory distress syndrome
(RDS).
2. A nurse is assessing a patient with severe preeclampsia who is receiving IV magnesium sulfate.
Which finding indicates the need to immediately stop the infusion?
A) Urine output of 35 mL/hr
B) Deep tendon reflexes (DTRs) 2+
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C) Respiratory rate 9 breaths/min
D) Blood pressure 145/90 mmHg
Answer: C
Rationale: Respiratory depression (<12 breaths/min) is a sign of magnesium toxicity. The nurse should
stop the infusion, notify the provider, and prepare calcium gluconate.
3. A newborn with neonatal abstinence syndrome (NAS) is being scored using the Finnegan Neonatal
Abstinence Scoring Tool. Which finding would increase the score most significantly?
A) Yawning and sneezing
B) High-pitched, excessive crying and poor feeding
C) Mild tremors when undisturbed
D) Respiratory rate 50 breaths/min
Answer: B
Rationale: High-pitched cry, excessive crying, poor feeding, and tremors are significant signs of CNS
irritability and autonomic dysfunction, indicating moderate-to-severe NAS requiring pharmacological
intervention.
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4. A patient at 39 weeks gestation is being induced for oligohydramnios. The nurse notes variable
decelerations on the fetal monitor. The most likely cause is:
A) Uteroplacental insufficiency
B) Umbilical cord compression due to low amniotic fluid
C) Fetal head compression
D) Maternal hypotension from epidural
Answer: B
Rationale: Variable decelerations are caused by umbilical cord compression. Oligohydramnios reduces
the cushioning around the cord, increasing the risk of cord compression during contractions.
5. A nurse is caring for a patient in active labor whose membranes rupture spontaneously. The fluid is
thick, greenish-black. What is the priority action?
A) Assess fetal heart rate for bradycardia or late decelerations
B) Perform a sterile speculum exam to confirm rupture
C) Notify the provider for an immediate cesarean section
D) Administer prophylactic antibiotics
Answer: A
NR-327 MATERNAL-CHILD NURSING PRACTICE
– FINAL EXAM ACTUAL QUESTIONS AND
ANSWERS LATEST UPDATE THIS YEAR
NR-327 MATERNAL-CHILD NURSING PRACTICE – FINAL EXAM
Point-Form Summary of Exam Coverage
• Advanced Antepartum Complications: Severe preeclampsia/eclampsia, HELLP syndrome,
gestational diabetes (GDM) management, hyperemesis gravidarum, placenta previa and accreta
spectrum, placental abruption, preterm labor (PTL) and preterm premature rupture of
membranes (PPROM), cervical insufficiency, polyhydramnios/oligohydramnios, isoimmunization
(Rh and ABO), multiple gestation, intrauterine fetal demise (IUFD).
• Intrapartum High-Risk Situations: Chorioamnionitis, shoulder dystocia, umbilical cord prolapse,
uterine rupture, amniotic fluid embolism (AFE), operative vaginal delivery (forceps/vacuum),
cesarean birth (indications and complications), trial of labor after cesarean (TOLAC/VBAC),
prolonged labor and dysfunctional labor patterns.
• Fetal Assessment and Intervention: Interpretation of fetal heart rate (FHR) patterns (category I,
II, III), intrauterine resuscitation techniques, fetal scalp stimulation, fetal scalp blood sampling,
biophysical profile (BPP), modified BPP, contraction stress test (CST), umbilical artery Doppler.
• Postpartum Complications: Postpartum hemorrhage (PPH) (atony, lacerations, retained
placenta, coagulopathy), endometritis, wound infection/dehiscence, postpartum
preeclampsia/eclampsia, pulmonary embolism, postpartum cardiomyopathy, postpartum
depression (PPD), postpartum psychosis, mastitis and breast abscess.
• Newborn Pathophysiology and Complex Care: Neonatal abstinence syndrome (NAS) scoring
and management, neonatal sepsis (early-onset GBS, late-onset), respiratory distress syndrome
(RDS), transient tachypnea of newborn (TTN), meconium aspiration syndrome (MAS), persistent
pulmonary hypertension of newborn (PPHN), congenital heart defects (ductal-dependent
lesions), hyperbilirubinemia (pathologic, kernicterus), necrotizing enterocolitis (NEC), hypoxic-
ischemic encephalopathy (HIE) and therapeutic hypothermia, inborn errors of metabolism (PKU,
galactosemia).
• Pharmacotherapeutics and Advanced Interventions: Antenatal corticosteroids
(betamethasone), tocolytics (nifedipine, indomethacin, magnesium sulfate), magnesium sulfate
for neuroprotection and seizure prophylaxis, antihypertensives (labetalol, hydralazine,
nifedipine), insulin and oral hypoglycemics in GDM, RhoGAM timing and dosing, surfactant
replacement therapy, nitric oxide for PPHN, prostaglandin E1 (alprostadil) for ductal-dependent
lesions, naloxone (Narcan) in opioid-exposed newborns.
• Transition to Extrauterine Life: Delayed cord clamping, thermoregulation, transitional
circulation closure (foramen ovale, ductus arteriosus, ductus venosus), neonatal resuscitation
(NRP steps), Apgar scoring interpretation, glucose homeostasis, thermoregulation challenges
(cold stress).
• Ethical and Legal Issues in Maternal-Child Nursing: Refusal of blood products (Jehovah's
Witness), perimortem cesarean section, termination of pregnancy for maternal indications,
neonatal end-of-life care (comfort care), informed consent for procedures (circumcision,
cesarean section).
, Page 2 of 153
• Integration of Care Across the Perinatal Continuum: Care coordination between antepartum,
intrapartum, postpartum, and newborn nursery/NICU, discharge planning, home phototherapy,
community resources (WIC, lactation support, mental health services), anticipatory guidance
and parenting education.
1. A patient at 34 weeks gestation with preterm labor receives betamethasone 12 mg IM. The nurse
explains that the primary purpose is to:
A) Stop uterine contractions
B) Accelerate fetal lung surfactant production to reduce RDS
C) Prevent maternal hypotension
D) Treat chorioamnionitis
Answer: B
Rationale: Betamethasone is a corticosteroid given to women at risk for preterm delivery (24-34 weeks)
to accelerate fetal lung maturity, reducing the incidence and severity of respiratory distress syndrome
(RDS).
2. A nurse is assessing a patient with severe preeclampsia who is receiving IV magnesium sulfate.
Which finding indicates the need to immediately stop the infusion?
A) Urine output of 35 mL/hr
B) Deep tendon reflexes (DTRs) 2+
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C) Respiratory rate 9 breaths/min
D) Blood pressure 145/90 mmHg
Answer: C
Rationale: Respiratory depression (<12 breaths/min) is a sign of magnesium toxicity. The nurse should
stop the infusion, notify the provider, and prepare calcium gluconate.
3. A newborn with neonatal abstinence syndrome (NAS) is being scored using the Finnegan Neonatal
Abstinence Scoring Tool. Which finding would increase the score most significantly?
A) Yawning and sneezing
B) High-pitched, excessive crying and poor feeding
C) Mild tremors when undisturbed
D) Respiratory rate 50 breaths/min
Answer: B
Rationale: High-pitched cry, excessive crying, poor feeding, and tremors are significant signs of CNS
irritability and autonomic dysfunction, indicating moderate-to-severe NAS requiring pharmacological
intervention.
, Page 4 of 153
4. A patient at 39 weeks gestation is being induced for oligohydramnios. The nurse notes variable
decelerations on the fetal monitor. The most likely cause is:
A) Uteroplacental insufficiency
B) Umbilical cord compression due to low amniotic fluid
C) Fetal head compression
D) Maternal hypotension from epidural
Answer: B
Rationale: Variable decelerations are caused by umbilical cord compression. Oligohydramnios reduces
the cushioning around the cord, increasing the risk of cord compression during contractions.
5. A nurse is caring for a patient in active labor whose membranes rupture spontaneously. The fluid is
thick, greenish-black. What is the priority action?
A) Assess fetal heart rate for bradycardia or late decelerations
B) Perform a sterile speculum exam to confirm rupture
C) Notify the provider for an immediate cesarean section
D) Administer prophylactic antibiotics
Answer: A
