NURS240 Maternal-Newborn Nursing Updated 2026 |
Comprehensive Study Guide, Practice Exam Questions
and Answers, Exam Prep Test Bank, Prenatal and
Antenatal Care, Labor and Delivery Nursing
Management, Postpartum Assessment and Recovery,
Newborn and Neonatal Nursing Care, High-Risk
Pregnancy Complications, Maternal Pharmacology,
Breastfeeding Support, Family-Centered Care, Clinical
Judgment Skills, and Detailed Rationales for Nursing
Exam Success
Question 1: A primigravida at 38 weeks of gestation is admitted to the labor and
delivery unit with regular contractions. A vaginal examination reveals the cervix is 4
cm dilated, 80% effaced, and the presenting part is at 0 station. Which finding
would the nurse expect to observe during the active phase of the first stage of
labor?
A. Decreased maternal heart rate
B. Increased intensity and frequency of contractions
C. Rupture of membranes with meconium-stained fluid
D. A decrease in cervical effacement
CORRECT ANSWER: B. Increased intensity and frequency of contractions
Rationale: The active phase of the first stage of labor is characterized by more rapid
cervical dilation (from 4 to 7 cm) and is associated with increasingly intense, frequent,
and longer-lasting contractions. Maternal heart rate typically increases, not decreases,
during labor. Rupture of membranes can occur at any time, but meconium staining is
not an expected finding. Effacement continues to progress.
Question 2: A postpartum client who is 12 hours post-vaginal delivery reports a
severe, throbbing headache and visual disturbances. Her blood pressure is 160/100
mmHg. Which medication should the nurse anticipate administering to prevent
seizures?
A. Naloxone
B. Magnesium sulfate
C. Oxytocin
D. Methylergonovine
CORRECT ANSWER: B. Magnesium sulfate
,Rationale: The client's symptoms and elevated blood pressure are indicative of severe
preeclampsia. Magnesium sulfate is the standard medication for seizure prophylaxis in
preeclampsia and eclampsia. Naloxone is an opioid antagonist. Oxytocin and
methylergonovine are used for uterine atony and postpartum hemorrhage.
Question 3: The nurse is assessing a newborn one minute after birth. The infant has
a heart rate of 120 bpm, a strong cry, active motion, and a pink body with blue
extremities. What Apgar score should the nurse assign to this infant?
A. 6
B. 7
C. 8
D. 9
CORRECT ANSWER: D. 9
Rationale: The Apgar score is based on five categories: Heart rate (2 points for >100
bpm), Respiratory effort (2 points for a strong cry), Muscle tone (2 points for active
motion), Reflex irritability (2 points for a strong cry), and Color (1 point for pink body with
blue extremities, as 2 points requires completely pink). The total score is 2+2+2+2+1 =
9.
Question 4: A nurse is caring for a client at 30 weeks of gestation who is diagnosed
with preterm premature rupture of membranes (PPROM). Which assessment
finding is of the highest priority for the nurse to report to the healthcare provider?
A. The client's oral temperature is 99.2°F (37.3°C)
B. The client reports a mild headache
C. The client's fetal heart rate is 165 bpm with minimal variability
D. The client reports increased urinary frequency
CORRECT ANSWER: C. The client's fetal heart rate is 165 bpm with minimal
variability
Rationale: A fetal heart rate of 165 bpm with minimal variability is a non-reassuring sign
that may indicate fetal distress or infection (chorioamnionitis). This is a high-priority
finding requiring immediate intervention. A slight temperature elevation, mild
headache, and increased urinary frequency are common in pregnancy and are not the
most critical findings in this scenario.
Question 5: A gravida 2 para 1 client at 39 weeks of gestation is in the active phase
of labor. She requests pain relief. An epidural block is administered. Which nursing
action is most important immediately following the procedure?
,A. Monitor the fetal heart rate continuously
B. Assist the client to ambulate to the bathroom
C. Administer a fluid bolus of 500 mL of Lactated Ringer's
D. Place the client in a supine position with a pillow under her head
CORRECT ANSWER: A. Monitor the fetal heart rate continuously
Rationale: Continuous fetal monitoring is essential after an epidural because maternal
hypotension, a common side effect, can reduce uterine blood flow and cause fetal
bradycardia. While a fluid bolus is often given before the epidural to prevent
hypotension, the priority after placement is fetal assessment. Ambulation is
contraindicated due to motor block, and supine position can worsen hypotension.
Question 6: The nurse is performing a physical assessment on a 24-hour-old
newborn. Which finding should the nurse report to the healthcare provider?
A. Acrocyanosis of the hands and feet
B. A respiratory rate of 48 breaths per minute with occasional periods of apnea lasting 5
seconds
C. A heart rate of 140 bpm that is regular
D. Yellowish discoloration of the sclera and skin on the face and chest
CORRECT ANSWER: D. Yellowish discoloration of the sclera and skin on the face
and chest
Rationale: Yellowish discoloration of the sclera and skin (jaundice) appearing within the
first 24 hours of life is pathologic and may indicate hemolytic disease, sepsis, or liver
dysfunction, and should be reported immediately. Acrocyanosis is a normal finding in
the first few hours to days. A respiratory rate of 40-60 bpm with brief (<20 seconds)
apnea is normal. A heart rate of 110-160 bpm is normal.
Question 7: A client at 36 weeks of gestation presents to the emergency
department with painless, bright red vaginal bleeding. She is in stable condition.
Based on this assessment, what is the most likely diagnosis?
A. Abruptio placentae
B. Placenta previa
C. Uterine rupture
D. Vasa previa
CORRECT ANSWER: B. Placenta previa
Rationale: Painless, bright red vaginal bleeding in the third trimester is a classic sign of
placenta previa, where the placenta is implanted over the cervical os. Abruptio
placentae is characterized by painful, dark red bleeding. Uterine rupture presents with
, acute, severe pain and fetal distress. Vasa previa involves fetal vessel bleeding and is
often associated with a cord presentation.
Question 8: The nurse is providing education to a new mother on umbilical cord
care. Which statement by the mother indicates a need for further teaching?
A. "I can use a cotton ball with water to gently clean the base of the cord."
B. "I will keep the cord dry and exposed to air as much as possible."
C. "I should fold the diaper down below the cord stump."
D. "I will apply a small amount of rubbing alcohol to the cord stump with each diaper
change."
CORRECT ANSWER: D. "I will apply a small amount of rubbing alcohol to the cord
stump with each diaper change."
Rationale: The current standard of care is to keep the umbilical cord stump clean and
dry. Many institutions no longer recommend applying rubbing alcohol, as it can prolong
the drying and separation process. The other options are correct: cleaning with water if
needed, keeping it dry, and folding the diaper below the stump.
Question 9: A nurse is caring for a postpartum client who is Rh-negative and has
just given birth to an Rh-positive infant. Which medication should the nurse plan to
administer?
A. RhoGAM (Rho(D) immune globulin)
B. Vitamin K
C. Hepatitis B vaccine
D. Erythromycin ophthalmic ointment
CORRECT ANSWER: A. RhoGAM (Rho(D) immune globulin)
Rationale: RhoGAM is administered to an Rh-negative mother within 72 hours of
delivery of an Rh-positive infant to prevent maternal sensitization and hemolytic
disease of the newborn in future pregnancies. Vitamin K and Hepatitis B vaccine are for
the infant. Erythromycin is an eye prophylaxis for the newborn.
Question 10: A client has just received a diagnosis of an ectopic pregnancy. Which
subjective symptom is the client most likely to report?
A. A persistent, dull ache in the lower back
B. Sharp, unilateral pelvic pain
C. Painless, bright red vaginal bleeding
D. Generalized abdominal cramping
CORRECT ANSWER: B. Sharp, unilateral pelvic pain
Comprehensive Study Guide, Practice Exam Questions
and Answers, Exam Prep Test Bank, Prenatal and
Antenatal Care, Labor and Delivery Nursing
Management, Postpartum Assessment and Recovery,
Newborn and Neonatal Nursing Care, High-Risk
Pregnancy Complications, Maternal Pharmacology,
Breastfeeding Support, Family-Centered Care, Clinical
Judgment Skills, and Detailed Rationales for Nursing
Exam Success
Question 1: A primigravida at 38 weeks of gestation is admitted to the labor and
delivery unit with regular contractions. A vaginal examination reveals the cervix is 4
cm dilated, 80% effaced, and the presenting part is at 0 station. Which finding
would the nurse expect to observe during the active phase of the first stage of
labor?
A. Decreased maternal heart rate
B. Increased intensity and frequency of contractions
C. Rupture of membranes with meconium-stained fluid
D. A decrease in cervical effacement
CORRECT ANSWER: B. Increased intensity and frequency of contractions
Rationale: The active phase of the first stage of labor is characterized by more rapid
cervical dilation (from 4 to 7 cm) and is associated with increasingly intense, frequent,
and longer-lasting contractions. Maternal heart rate typically increases, not decreases,
during labor. Rupture of membranes can occur at any time, but meconium staining is
not an expected finding. Effacement continues to progress.
Question 2: A postpartum client who is 12 hours post-vaginal delivery reports a
severe, throbbing headache and visual disturbances. Her blood pressure is 160/100
mmHg. Which medication should the nurse anticipate administering to prevent
seizures?
A. Naloxone
B. Magnesium sulfate
C. Oxytocin
D. Methylergonovine
CORRECT ANSWER: B. Magnesium sulfate
,Rationale: The client's symptoms and elevated blood pressure are indicative of severe
preeclampsia. Magnesium sulfate is the standard medication for seizure prophylaxis in
preeclampsia and eclampsia. Naloxone is an opioid antagonist. Oxytocin and
methylergonovine are used for uterine atony and postpartum hemorrhage.
Question 3: The nurse is assessing a newborn one minute after birth. The infant has
a heart rate of 120 bpm, a strong cry, active motion, and a pink body with blue
extremities. What Apgar score should the nurse assign to this infant?
A. 6
B. 7
C. 8
D. 9
CORRECT ANSWER: D. 9
Rationale: The Apgar score is based on five categories: Heart rate (2 points for >100
bpm), Respiratory effort (2 points for a strong cry), Muscle tone (2 points for active
motion), Reflex irritability (2 points for a strong cry), and Color (1 point for pink body with
blue extremities, as 2 points requires completely pink). The total score is 2+2+2+2+1 =
9.
Question 4: A nurse is caring for a client at 30 weeks of gestation who is diagnosed
with preterm premature rupture of membranes (PPROM). Which assessment
finding is of the highest priority for the nurse to report to the healthcare provider?
A. The client's oral temperature is 99.2°F (37.3°C)
B. The client reports a mild headache
C. The client's fetal heart rate is 165 bpm with minimal variability
D. The client reports increased urinary frequency
CORRECT ANSWER: C. The client's fetal heart rate is 165 bpm with minimal
variability
Rationale: A fetal heart rate of 165 bpm with minimal variability is a non-reassuring sign
that may indicate fetal distress or infection (chorioamnionitis). This is a high-priority
finding requiring immediate intervention. A slight temperature elevation, mild
headache, and increased urinary frequency are common in pregnancy and are not the
most critical findings in this scenario.
Question 5: A gravida 2 para 1 client at 39 weeks of gestation is in the active phase
of labor. She requests pain relief. An epidural block is administered. Which nursing
action is most important immediately following the procedure?
,A. Monitor the fetal heart rate continuously
B. Assist the client to ambulate to the bathroom
C. Administer a fluid bolus of 500 mL of Lactated Ringer's
D. Place the client in a supine position with a pillow under her head
CORRECT ANSWER: A. Monitor the fetal heart rate continuously
Rationale: Continuous fetal monitoring is essential after an epidural because maternal
hypotension, a common side effect, can reduce uterine blood flow and cause fetal
bradycardia. While a fluid bolus is often given before the epidural to prevent
hypotension, the priority after placement is fetal assessment. Ambulation is
contraindicated due to motor block, and supine position can worsen hypotension.
Question 6: The nurse is performing a physical assessment on a 24-hour-old
newborn. Which finding should the nurse report to the healthcare provider?
A. Acrocyanosis of the hands and feet
B. A respiratory rate of 48 breaths per minute with occasional periods of apnea lasting 5
seconds
C. A heart rate of 140 bpm that is regular
D. Yellowish discoloration of the sclera and skin on the face and chest
CORRECT ANSWER: D. Yellowish discoloration of the sclera and skin on the face
and chest
Rationale: Yellowish discoloration of the sclera and skin (jaundice) appearing within the
first 24 hours of life is pathologic and may indicate hemolytic disease, sepsis, or liver
dysfunction, and should be reported immediately. Acrocyanosis is a normal finding in
the first few hours to days. A respiratory rate of 40-60 bpm with brief (<20 seconds)
apnea is normal. A heart rate of 110-160 bpm is normal.
Question 7: A client at 36 weeks of gestation presents to the emergency
department with painless, bright red vaginal bleeding. She is in stable condition.
Based on this assessment, what is the most likely diagnosis?
A. Abruptio placentae
B. Placenta previa
C. Uterine rupture
D. Vasa previa
CORRECT ANSWER: B. Placenta previa
Rationale: Painless, bright red vaginal bleeding in the third trimester is a classic sign of
placenta previa, where the placenta is implanted over the cervical os. Abruptio
placentae is characterized by painful, dark red bleeding. Uterine rupture presents with
, acute, severe pain and fetal distress. Vasa previa involves fetal vessel bleeding and is
often associated with a cord presentation.
Question 8: The nurse is providing education to a new mother on umbilical cord
care. Which statement by the mother indicates a need for further teaching?
A. "I can use a cotton ball with water to gently clean the base of the cord."
B. "I will keep the cord dry and exposed to air as much as possible."
C. "I should fold the diaper down below the cord stump."
D. "I will apply a small amount of rubbing alcohol to the cord stump with each diaper
change."
CORRECT ANSWER: D. "I will apply a small amount of rubbing alcohol to the cord
stump with each diaper change."
Rationale: The current standard of care is to keep the umbilical cord stump clean and
dry. Many institutions no longer recommend applying rubbing alcohol, as it can prolong
the drying and separation process. The other options are correct: cleaning with water if
needed, keeping it dry, and folding the diaper below the stump.
Question 9: A nurse is caring for a postpartum client who is Rh-negative and has
just given birth to an Rh-positive infant. Which medication should the nurse plan to
administer?
A. RhoGAM (Rho(D) immune globulin)
B. Vitamin K
C. Hepatitis B vaccine
D. Erythromycin ophthalmic ointment
CORRECT ANSWER: A. RhoGAM (Rho(D) immune globulin)
Rationale: RhoGAM is administered to an Rh-negative mother within 72 hours of
delivery of an Rh-positive infant to prevent maternal sensitization and hemolytic
disease of the newborn in future pregnancies. Vitamin K and Hepatitis B vaccine are for
the infant. Erythromycin is an eye prophylaxis for the newborn.
Question 10: A client has just received a diagnosis of an ectopic pregnancy. Which
subjective symptom is the client most likely to report?
A. A persistent, dull ache in the lower back
B. Sharp, unilateral pelvic pain
C. Painless, bright red vaginal bleeding
D. Generalized abdominal cramping
CORRECT ANSWER: B. Sharp, unilateral pelvic pain
