NURS240 Maternal-Newborn Nursing Updated 2026 | Comprehensive
Study Guide, Practice Exam Questions and Answers, Exam Prep Test
Bank, Prenatal and Antenatal Care, Fetal Development and Pregnancy
Adaptations, Labor and Delivery Nursing Management, Postpartum
Assessment and Recovery, Newborn and Neonatal Nursing Care, High-
Risk Obstetric Conditions, Maternal Pharmacology, Breastfeeding
Support, Family-Centered Care, Clinical Judgment Skills, and Detailed
Rationales for Nursing Exam Success
Question 1: A 32-week gestation client presents with a blood pressure of 148/92
mmHg and 3+ proteinuria. She reports a persistent headache and blurred vision.
What is the priority nursing intervention?
A. Administer an oral antihypertensive as prescribed
B. Prepare for immediate induction of labor
C. Initiate a magnesium sulfate infusion as prescribed
D. Place the client in a supine position to improve perfusion
CORRECT ANSWER: C. Initiate a magnesium sulfate infusion as prescribed
Rationale: The client is exhibiting signs of severe preeclampsia (elevated BP,
proteinuria, headache, visual changes). Magnesium sulfate is the standard of care to
prevent seizures (eclampsia) in clients with severe features. Administering it is the
priority to prevent maternal and fetal harm. Labor induction may be indicated but is not
the immediate priority. The supine position can cause aortocaval compression,
worsening perfusion.
Question 2: A newborn is 5 minutes old and has a heart rate of 110 bpm, is crying
vigorously, has acrocyanosis, and withdraws from stimuli. What is the appropriate
Apgar score component assignment for muscle tone?
A. 0
B. 1
C. 2
D. Not applicable in this scenario
CORRECT ANSWER: C. 2
Rationale: The Apgar score assesses five categories at 1 and 5 minutes. Muscle tone is
scored as 2 for active motion (withdraws from stimuli), 1 for some flexion, and 0 for
flaccid. Since the newborn is withdrawing from stimuli, they receive a 2 for muscle tone.
Question 3: A nurse is assessing a postpartum client on day 2. She reports a gush of
bright red blood when she stands up and has a firm fundus at the umbilicus. What
is the most likely cause of this bleeding?
A. Uterine atony
B. Retained placental fragments
,C. Normal lochia rubra with pooling
D. A vaginal hematoma
CORRECT ANSWER: C. Normal lochia rubra with pooling
Rationale: A gush of blood upon standing with a firm fundus is characteristic of lochia
pooling in the vagina. Lochia rubra is expected for the first 3-4 days postpartum. Uterine
atony would present with a boggy fundus. Retained fragments and hematomas usually
present with continuous or severe pain and heavy bleeding.
Question 4: During the active phase of labor, a client’s electronic fetal heart rate
tracing shows a baseline of 140 bpm with variable decelerations that drop to 90
bpm and have a "U" shape. What is the initial nursing action?
A. Increase the rate of the IV fluids
B. Reposition the client to the left side
C. Administer oxygen via a non-rebreather mask
D. Perform a vaginal exam to check for cord prolapse
CORRECT ANSWER: B. Reposition the client to the left side
Rationale: Variable decelerations are often caused by umbilical cord compression. The
initial intervention is maternal position change (e.g., from supine to side-lying, or knee-
chest) to relieve pressure on the cord. If this is ineffective, further interventions like
fluids and oxygen may be warranted. A vaginal exam is indicated if cord prolapse is
suspected, but repositioning is the immediate first step.
Question 5: A newborn is diagnosed with neonatal abstinence syndrome (NAS).
Which assessment finding is most consistent with this condition?
A. Prolonged sleep intervals and weak cry
B. Hypertonicity, tremors, and high-pitched cry
C. Decreased Moro reflex and lethargy
D. Temperature instability with hypothermia
CORRECT ANSWER: B. Hypertonicity, tremors, and high-pitched cry
Rationale: NAS results from withdrawal from in-utero opioid exposure. Classic signs
include central nervous system hyperirritability (tremors, hypertonicity), gastrointestinal
disturbances, and a high-pitched cry. Lethargy, decreased reflexes, and hypothermia
are signs of sedation or other conditions, not typical NAS.
Question 6: A client at 41 weeks gestation is undergoing a biophysical profile (BPP).
She receives a score of 2 for fetal breathing movements. What does this indicate?
A. The fetus is exhibiting normal breathing
B. The fetus is not breathing adequately
C. The test must be repeated immediately
D. The fetus has adequate amniotic fluid
,CORRECT ANSWER: A. The fetus is exhibiting normal breathing
Rationale: In a BPP, each of the five components (fetal breathing, movement, tone,
amniotic fluid volume, and NST) is scored 0 or 2. A score of 2 indicates a normal or
adequate finding for that specific component. A score of 0 for breathing indicates
absence.
Question 7: The nurse is providing discharge teaching to a client who had a
cesarean section. Which statement indicates a need for further teaching regarding
incision care?
A. "I will shower instead of taking a bath for the first week."
B. "I can use a hairdryer on a cool setting to keep the incision dry."
C. "I should apply antibiotic ointment to the incision daily."
D. "I will report any foul-smelling drainage to my provider."
CORRECT ANSWER: C. "I should apply antibiotic ointment to the incision daily."
Rationale: Incisions should be kept clean and dry. Antibiotic ointments should not be
routinely applied unless prescribed by a provider, as they can cause skin irritation or
maceration. Showering is preferred over baths, keeping the area dry is essential, and
reporting signs of infection like foul drainage is correct.
Question 8: A client in the third trimester reports feeling dizzy and faint when lying
flat on her back. What physiological change is the most likely cause?
A. Postural hypotension due to vasodilation
B. Aortocaval compression from the gravid uterus
C. Supine hypotension from hypoglycemia
D. Decreased cardiac output from anemia
CORRECT ANSWER: B. Aortocaval compression from the gravid uterus
Rationale: In the supine position, the enlarged uterus compresses the inferior vena
cava and aorta, decreasing venous return and cardiac output. This leads to supine
hypotensive syndrome, characterized by dizziness, faintness, and pallor. It is corrected
by turning the patient to the left lateral position.
Question 9: Which of the following fetal heart rate patterns is most concerning and
requires immediate intervention?
A. Early decelerations mirroring contractions
B. Moderate variability with a baseline of 130 bpm
C. Late decelerations with absent variability
D. Accelerations following fetal movement
CORRECT ANSWER: C. Late decelerations with absent variability
Rationale: Late decelerations indicate uteroplacental insufficiency. When combined
with absent variability, it suggests fetal acidosis and hypoxia, which is a non-reassuring
, pattern requiring immediate intervention. Early decelerations and accelerations are
reassuring. Moderate variability is a sign of a healthy fetal nervous system.
Question 10: A nurse is calculating a client's estimated date of delivery (EDD) using
Naegele's rule. The client's last menstrual period (LMP) was January 10. What is her
EDD?
A. September 17
B. October 17
C. October 10
D. December 10
CORRECT ANSWER: B. October 17
Rationale: Naegele's rule is calculated by subtracting 3 months from the first day of the
LMP and adding 7 days. January 10 minus 3 months is October 10. October 10 plus 7
days is October 17.
Question 11: A postpartum client is GBS positive and received intrapartum
antibiotics. Her newborn is now 2 hours old. What is the priority nursing
assessment?
A. Blood glucose level
B. Respiratory effort
C. Temperature stability
D. Signs of jaundice
CORRECT ANSWER: B. Respiratory effort
Rationale: While GBS prophylaxis reduces the risk of early-onset sepsis, it does not
eliminate it. The most common and serious manifestation of early-onset GBS sepsis is
respiratory distress. Assessing respiratory effort is the priority to identify early signs of
infection.
Question 12: A client in labor is receiving oxytocin (Pitocin) for induction. The nurse
notes uterine contractions occurring every 1.5 minutes and lasting 90 seconds.
What is the priority nursing action?
A. Continue to monitor the fetal heart rate
B. Increase the oxytocin rate
C. Decrease or stop the oxytocin infusion
D. Administer a bolus of IV fluids
CORRECT ANSWER: C. Decrease or stop the oxytocin infusion
Rationale: Contractions occurring more frequently than every 2 minutes or lasting
longer than 90 seconds are considered uterine hyperstimulation (tachysystole). This
can compromise fetal oxygenation. The priority is to stop the oxytocin infusion to allow
the uterus to relax.
Study Guide, Practice Exam Questions and Answers, Exam Prep Test
Bank, Prenatal and Antenatal Care, Fetal Development and Pregnancy
Adaptations, Labor and Delivery Nursing Management, Postpartum
Assessment and Recovery, Newborn and Neonatal Nursing Care, High-
Risk Obstetric Conditions, Maternal Pharmacology, Breastfeeding
Support, Family-Centered Care, Clinical Judgment Skills, and Detailed
Rationales for Nursing Exam Success
Question 1: A 32-week gestation client presents with a blood pressure of 148/92
mmHg and 3+ proteinuria. She reports a persistent headache and blurred vision.
What is the priority nursing intervention?
A. Administer an oral antihypertensive as prescribed
B. Prepare for immediate induction of labor
C. Initiate a magnesium sulfate infusion as prescribed
D. Place the client in a supine position to improve perfusion
CORRECT ANSWER: C. Initiate a magnesium sulfate infusion as prescribed
Rationale: The client is exhibiting signs of severe preeclampsia (elevated BP,
proteinuria, headache, visual changes). Magnesium sulfate is the standard of care to
prevent seizures (eclampsia) in clients with severe features. Administering it is the
priority to prevent maternal and fetal harm. Labor induction may be indicated but is not
the immediate priority. The supine position can cause aortocaval compression,
worsening perfusion.
Question 2: A newborn is 5 minutes old and has a heart rate of 110 bpm, is crying
vigorously, has acrocyanosis, and withdraws from stimuli. What is the appropriate
Apgar score component assignment for muscle tone?
A. 0
B. 1
C. 2
D. Not applicable in this scenario
CORRECT ANSWER: C. 2
Rationale: The Apgar score assesses five categories at 1 and 5 minutes. Muscle tone is
scored as 2 for active motion (withdraws from stimuli), 1 for some flexion, and 0 for
flaccid. Since the newborn is withdrawing from stimuli, they receive a 2 for muscle tone.
Question 3: A nurse is assessing a postpartum client on day 2. She reports a gush of
bright red blood when she stands up and has a firm fundus at the umbilicus. What
is the most likely cause of this bleeding?
A. Uterine atony
B. Retained placental fragments
,C. Normal lochia rubra with pooling
D. A vaginal hematoma
CORRECT ANSWER: C. Normal lochia rubra with pooling
Rationale: A gush of blood upon standing with a firm fundus is characteristic of lochia
pooling in the vagina. Lochia rubra is expected for the first 3-4 days postpartum. Uterine
atony would present with a boggy fundus. Retained fragments and hematomas usually
present with continuous or severe pain and heavy bleeding.
Question 4: During the active phase of labor, a client’s electronic fetal heart rate
tracing shows a baseline of 140 bpm with variable decelerations that drop to 90
bpm and have a "U" shape. What is the initial nursing action?
A. Increase the rate of the IV fluids
B. Reposition the client to the left side
C. Administer oxygen via a non-rebreather mask
D. Perform a vaginal exam to check for cord prolapse
CORRECT ANSWER: B. Reposition the client to the left side
Rationale: Variable decelerations are often caused by umbilical cord compression. The
initial intervention is maternal position change (e.g., from supine to side-lying, or knee-
chest) to relieve pressure on the cord. If this is ineffective, further interventions like
fluids and oxygen may be warranted. A vaginal exam is indicated if cord prolapse is
suspected, but repositioning is the immediate first step.
Question 5: A newborn is diagnosed with neonatal abstinence syndrome (NAS).
Which assessment finding is most consistent with this condition?
A. Prolonged sleep intervals and weak cry
B. Hypertonicity, tremors, and high-pitched cry
C. Decreased Moro reflex and lethargy
D. Temperature instability with hypothermia
CORRECT ANSWER: B. Hypertonicity, tremors, and high-pitched cry
Rationale: NAS results from withdrawal from in-utero opioid exposure. Classic signs
include central nervous system hyperirritability (tremors, hypertonicity), gastrointestinal
disturbances, and a high-pitched cry. Lethargy, decreased reflexes, and hypothermia
are signs of sedation or other conditions, not typical NAS.
Question 6: A client at 41 weeks gestation is undergoing a biophysical profile (BPP).
She receives a score of 2 for fetal breathing movements. What does this indicate?
A. The fetus is exhibiting normal breathing
B. The fetus is not breathing adequately
C. The test must be repeated immediately
D. The fetus has adequate amniotic fluid
,CORRECT ANSWER: A. The fetus is exhibiting normal breathing
Rationale: In a BPP, each of the five components (fetal breathing, movement, tone,
amniotic fluid volume, and NST) is scored 0 or 2. A score of 2 indicates a normal or
adequate finding for that specific component. A score of 0 for breathing indicates
absence.
Question 7: The nurse is providing discharge teaching to a client who had a
cesarean section. Which statement indicates a need for further teaching regarding
incision care?
A. "I will shower instead of taking a bath for the first week."
B. "I can use a hairdryer on a cool setting to keep the incision dry."
C. "I should apply antibiotic ointment to the incision daily."
D. "I will report any foul-smelling drainage to my provider."
CORRECT ANSWER: C. "I should apply antibiotic ointment to the incision daily."
Rationale: Incisions should be kept clean and dry. Antibiotic ointments should not be
routinely applied unless prescribed by a provider, as they can cause skin irritation or
maceration. Showering is preferred over baths, keeping the area dry is essential, and
reporting signs of infection like foul drainage is correct.
Question 8: A client in the third trimester reports feeling dizzy and faint when lying
flat on her back. What physiological change is the most likely cause?
A. Postural hypotension due to vasodilation
B. Aortocaval compression from the gravid uterus
C. Supine hypotension from hypoglycemia
D. Decreased cardiac output from anemia
CORRECT ANSWER: B. Aortocaval compression from the gravid uterus
Rationale: In the supine position, the enlarged uterus compresses the inferior vena
cava and aorta, decreasing venous return and cardiac output. This leads to supine
hypotensive syndrome, characterized by dizziness, faintness, and pallor. It is corrected
by turning the patient to the left lateral position.
Question 9: Which of the following fetal heart rate patterns is most concerning and
requires immediate intervention?
A. Early decelerations mirroring contractions
B. Moderate variability with a baseline of 130 bpm
C. Late decelerations with absent variability
D. Accelerations following fetal movement
CORRECT ANSWER: C. Late decelerations with absent variability
Rationale: Late decelerations indicate uteroplacental insufficiency. When combined
with absent variability, it suggests fetal acidosis and hypoxia, which is a non-reassuring
, pattern requiring immediate intervention. Early decelerations and accelerations are
reassuring. Moderate variability is a sign of a healthy fetal nervous system.
Question 10: A nurse is calculating a client's estimated date of delivery (EDD) using
Naegele's rule. The client's last menstrual period (LMP) was January 10. What is her
EDD?
A. September 17
B. October 17
C. October 10
D. December 10
CORRECT ANSWER: B. October 17
Rationale: Naegele's rule is calculated by subtracting 3 months from the first day of the
LMP and adding 7 days. January 10 minus 3 months is October 10. October 10 plus 7
days is October 17.
Question 11: A postpartum client is GBS positive and received intrapartum
antibiotics. Her newborn is now 2 hours old. What is the priority nursing
assessment?
A. Blood glucose level
B. Respiratory effort
C. Temperature stability
D. Signs of jaundice
CORRECT ANSWER: B. Respiratory effort
Rationale: While GBS prophylaxis reduces the risk of early-onset sepsis, it does not
eliminate it. The most common and serious manifestation of early-onset GBS sepsis is
respiratory distress. Assessing respiratory effort is the priority to identify early signs of
infection.
Question 12: A client in labor is receiving oxytocin (Pitocin) for induction. The nurse
notes uterine contractions occurring every 1.5 minutes and lasting 90 seconds.
What is the priority nursing action?
A. Continue to monitor the fetal heart rate
B. Increase the oxytocin rate
C. Decrease or stop the oxytocin infusion
D. Administer a bolus of IV fluids
CORRECT ANSWER: C. Decrease or stop the oxytocin infusion
Rationale: Contractions occurring more frequently than every 2 minutes or lasting
longer than 90 seconds are considered uterine hyperstimulation (tachysystole). This
can compromise fetal oxygenation. The priority is to stop the oxytocin infusion to allow
the uterus to relax.
