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 and NCLEX-Style
Questions, and Detailed Rationales for Nursing Exam Success
Question 1: A 28-year-old gravida 2 para 1 at 38 weeks gestation is admitted with
contractions every 3 minutes. Her cervical exam is 6 cm dilated, 90% effaced, and
the fetal vertex is at -1 station. During a contraction, the fetal heart rate (FHR) drops
to 80 bpm and returns to 140 bpm 45 seconds after the contraction ends. This
pattern is best described as:
A. Early decelerations
B. Variable decelerations
C. Late decelerations
D. Prolonged decelerations
CORRECT ANSWER: C. Late decelerations
Rationale: Late decelerations begin after the contraction has started and return to
baseline after the contraction ends. They are indicative of uteroplacental insufficiency
and are caused by hypoxemia, which stimulates vagal nerve activity. This is a non-
reassuring pattern requiring immediate intervention, such as position change and
oxygen administration.
Question 2: A nurse is caring for a postpartum patient who delivered 12 hours ago.
The patient reports a "gush of blood" when getting out of bed and has saturated two
perineal pads in 15 minutes. Her fundus is boggy and displaced to the right. What is
the nurse's priority action?
A. Administer oxytocin as prescribed
B. Massage the fundus and assist the patient to void
C. Perform a sterile vaginal exam to check for lacerations
D. Call the provider and prepare for blood transfusion
CORRECT ANSWER: B. Massage the fundus and assist the patient to void
Rationale: A boggy, displaced fundus indicates uterine atony and a full bladder. A full
bladder displaces the uterus and prevents effective contraction. Massaging the fundus
helps stimulate tone, and assisting the patient to void will relieve bladder pressure,
allowing the uterus to contract and reduce bleeding.
Question 3: A primigravida at 40 weeks gestation is receiving an induction with
oxytocin. The FHR tracing shows recurrent late decelerations with moderate
,variability. The contraction pattern is every 2 minutes, duration 70 seconds. What is
the most appropriate initial nursing action?
A. Increase the oxytocin infusion rate to establish adequate labor
B. Turn the client to the left lateral position
C. Administer terbutaline 0.25 mg subcutaneously
D. Prepare the client for an emergency cesarean section
CORRECT ANSWER: B. Turn the client to the left lateral position
Rationale: The left lateral position relieves aortocaval compression, improving
placental perfusion and fetal oxygenation. This is the first-line, least invasive
intervention for late decelerations. If the decelerations persist after maternal
repositioning and oxygen administration, further interventions would be considered.
Question 4: Which of the following findings is considered a normal physiological
change in the cardiovascular system during a healthy pregnancy?
A. Increased systemic vascular resistance
B. Decreased maternal heart rate by 10-15 bpm
C. Increased plasma volume by 40-50%
D. Decreased stroke volume
CORRECT ANSWER: C. Increased plasma volume by 40-50%
Rationale: Plasma volume increases by approximately 40-50% in a singleton pregnancy
to meet the increased metabolic demands and provide a reserve for blood loss at
delivery. This increase is a normal adaptation. Systemic vascular resistance actually
decreases, heart rate increases, and stroke volume increases.
Question 5: A patient at 16 weeks gestation presents with a dark brown vaginal
discharge, a closed cervix, and a uterus that is measuring 22 weeks on fundal
height. She reports no fetal movement and has a negative pregnancy test today.
What condition is most consistent with these findings?
A. Ectopic pregnancy
B. Missed abortion
C. Molar pregnancy
D. Placenta previa
CORRECT ANSWER: C. Molar pregnancy
Rationale: Dark brown vaginal discharge, uterus larger than dates, and a negative
pregnancy test in the second trimester are classic signs of a complete hydatidiform
mole. The uterus is typically large for dates due to the rapidly proliferating trophoblastic
,tissue and bleeding. A negative pregnancy test may occur due to the Hook effect from
extremely high hCG.
Question 6: A nurse is administering magnesium sulfate to a patient with severe
preeclampsia. Which assessment finding is the earliest indicator of magnesium
toxicity?
A. Decreased deep tendon reflexes (DTRs)
B. Respiratory rate less than 12 breaths per minute
C. Oliguria
D. Serum magnesium level of 6 mEq/L
CORRECT ANSWER: A. Decreased deep tendon reflexes (DTRs)
Rationale: Loss of deep tendon reflexes (patellar reflex) is the earliest sign of
magnesium toxicity, occurring at serum levels of 7-10 mEq/L. Respiratory depression
occurs at higher levels, and oliguria is a risk factor for accumulation but a sign of renal
impairment rather than toxicity.
Question 7: A patient at 39 weeks gestation is in active labor. The fetus is in a left
occiput anterior (LOA) position. Where would the nurse expect to palpate the fetal
heart rate loudest?
A. Right upper quadrant
B. Left upper quadrant
C. Left lower quadrant
D. Right lower quadrant
CORRECT ANSWER: C. Left lower quadrant
Rationale: The fetal heart rate is auscultated loudest over the fetal back. In an LOA
position, the fetal back is on the mother's left side, and the head is in the pelvis (lower
quadrant), so the FHR is best heard in the left lower quadrant.
Question 8: A newborn is assessed at 1 minute of life and has the following
findings: Heart rate 110 bpm, respiratory effort slow and irregular, muscle tone
some flexion, reflex irritability grimace, and color pink body with blue extremities.
What is this infant's Apgar score?
A. 5
B. 6
C. 7
D. 8
CORRECT ANSWER: B. 6
, Rationale: The Apgar score is calculated as follows: Heart rate 110 (>100 = 2 points),
respiratory effort slow/irregular (1 point), muscle tone some flexion (1 point), reflex
irritability grimace (1 point), and color pink body/blue extremities (acrocyanosis = 1
point). Total = 2+1+1+1+1 = 6.
Question 9: A 34-week gestation patient presents with painless, bright red vaginal
bleeding. The uterus is soft and non-tender, and fetal heart rate is reassuring. What
is the priority nursing intervention?
A. Perform a digital cervical exam to assess dilation
B. Prepare for immediate vaginal delivery
C. Monitor maternal vital signs and apply external fetal monitoring
D. Administer betamethasone 12 mg intramuscularly
CORRECT ANSWER: C. Monitor maternal vital signs and apply external fetal
monitoring
Rationale: Painless vaginal bleeding in the third trimester is presumptive of placenta
previa. Digital cervical exams are contraindicated until placenta previa is ruled out by
ultrasound, as they can cause catastrophic hemorrhage. Monitoring is the priority, and
betamethasone would be administered for fetal lung maturity, but the immediate
priority is assessment and monitoring.
Question 10: A postpartum patient is Rh-negative and gave birth to an Rh-positive
infant. The nurse should prepare to administer Rh immunoglobulin (RhoGAM)
within what time frame?
A. Within 24 hours postpartum
B. Within 48 hours postpartum
C. Within 72 hours postpartum
D. Within 1 week postpartum
CORRECT ANSWER: C. Within 72 hours postpartum
Rationale: Rh immunoglobulin (RhoGAM) should be administered to Rh-negative
mothers who have given birth to an Rh-positive infant within 72 hours of delivery to
prevent maternal sensitization and hemolytic disease of the newborn in subsequent
pregnancies.
Question 11: A patient's labor is being augmented with oxytocin. The monitor
indicates a contraction frequency of every 1.5 minutes, lasting 90 seconds. The
fetal heart rate shows a baseline of 155 bpm with minimal variability. What is the
nurse's first action?
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 and NCLEX-Style
Questions, and Detailed Rationales for Nursing Exam Success
Question 1: A 28-year-old gravida 2 para 1 at 38 weeks gestation is admitted with
contractions every 3 minutes. Her cervical exam is 6 cm dilated, 90% effaced, and
the fetal vertex is at -1 station. During a contraction, the fetal heart rate (FHR) drops
to 80 bpm and returns to 140 bpm 45 seconds after the contraction ends. This
pattern is best described as:
A. Early decelerations
B. Variable decelerations
C. Late decelerations
D. Prolonged decelerations
CORRECT ANSWER: C. Late decelerations
Rationale: Late decelerations begin after the contraction has started and return to
baseline after the contraction ends. They are indicative of uteroplacental insufficiency
and are caused by hypoxemia, which stimulates vagal nerve activity. This is a non-
reassuring pattern requiring immediate intervention, such as position change and
oxygen administration.
Question 2: A nurse is caring for a postpartum patient who delivered 12 hours ago.
The patient reports a "gush of blood" when getting out of bed and has saturated two
perineal pads in 15 minutes. Her fundus is boggy and displaced to the right. What is
the nurse's priority action?
A. Administer oxytocin as prescribed
B. Massage the fundus and assist the patient to void
C. Perform a sterile vaginal exam to check for lacerations
D. Call the provider and prepare for blood transfusion
CORRECT ANSWER: B. Massage the fundus and assist the patient to void
Rationale: A boggy, displaced fundus indicates uterine atony and a full bladder. A full
bladder displaces the uterus and prevents effective contraction. Massaging the fundus
helps stimulate tone, and assisting the patient to void will relieve bladder pressure,
allowing the uterus to contract and reduce bleeding.
Question 3: A primigravida at 40 weeks gestation is receiving an induction with
oxytocin. The FHR tracing shows recurrent late decelerations with moderate
,variability. The contraction pattern is every 2 minutes, duration 70 seconds. What is
the most appropriate initial nursing action?
A. Increase the oxytocin infusion rate to establish adequate labor
B. Turn the client to the left lateral position
C. Administer terbutaline 0.25 mg subcutaneously
D. Prepare the client for an emergency cesarean section
CORRECT ANSWER: B. Turn the client to the left lateral position
Rationale: The left lateral position relieves aortocaval compression, improving
placental perfusion and fetal oxygenation. This is the first-line, least invasive
intervention for late decelerations. If the decelerations persist after maternal
repositioning and oxygen administration, further interventions would be considered.
Question 4: Which of the following findings is considered a normal physiological
change in the cardiovascular system during a healthy pregnancy?
A. Increased systemic vascular resistance
B. Decreased maternal heart rate by 10-15 bpm
C. Increased plasma volume by 40-50%
D. Decreased stroke volume
CORRECT ANSWER: C. Increased plasma volume by 40-50%
Rationale: Plasma volume increases by approximately 40-50% in a singleton pregnancy
to meet the increased metabolic demands and provide a reserve for blood loss at
delivery. This increase is a normal adaptation. Systemic vascular resistance actually
decreases, heart rate increases, and stroke volume increases.
Question 5: A patient at 16 weeks gestation presents with a dark brown vaginal
discharge, a closed cervix, and a uterus that is measuring 22 weeks on fundal
height. She reports no fetal movement and has a negative pregnancy test today.
What condition is most consistent with these findings?
A. Ectopic pregnancy
B. Missed abortion
C. Molar pregnancy
D. Placenta previa
CORRECT ANSWER: C. Molar pregnancy
Rationale: Dark brown vaginal discharge, uterus larger than dates, and a negative
pregnancy test in the second trimester are classic signs of a complete hydatidiform
mole. The uterus is typically large for dates due to the rapidly proliferating trophoblastic
,tissue and bleeding. A negative pregnancy test may occur due to the Hook effect from
extremely high hCG.
Question 6: A nurse is administering magnesium sulfate to a patient with severe
preeclampsia. Which assessment finding is the earliest indicator of magnesium
toxicity?
A. Decreased deep tendon reflexes (DTRs)
B. Respiratory rate less than 12 breaths per minute
C. Oliguria
D. Serum magnesium level of 6 mEq/L
CORRECT ANSWER: A. Decreased deep tendon reflexes (DTRs)
Rationale: Loss of deep tendon reflexes (patellar reflex) is the earliest sign of
magnesium toxicity, occurring at serum levels of 7-10 mEq/L. Respiratory depression
occurs at higher levels, and oliguria is a risk factor for accumulation but a sign of renal
impairment rather than toxicity.
Question 7: A patient at 39 weeks gestation is in active labor. The fetus is in a left
occiput anterior (LOA) position. Where would the nurse expect to palpate the fetal
heart rate loudest?
A. Right upper quadrant
B. Left upper quadrant
C. Left lower quadrant
D. Right lower quadrant
CORRECT ANSWER: C. Left lower quadrant
Rationale: The fetal heart rate is auscultated loudest over the fetal back. In an LOA
position, the fetal back is on the mother's left side, and the head is in the pelvis (lower
quadrant), so the FHR is best heard in the left lower quadrant.
Question 8: A newborn is assessed at 1 minute of life and has the following
findings: Heart rate 110 bpm, respiratory effort slow and irregular, muscle tone
some flexion, reflex irritability grimace, and color pink body with blue extremities.
What is this infant's Apgar score?
A. 5
B. 6
C. 7
D. 8
CORRECT ANSWER: B. 6
, Rationale: The Apgar score is calculated as follows: Heart rate 110 (>100 = 2 points),
respiratory effort slow/irregular (1 point), muscle tone some flexion (1 point), reflex
irritability grimace (1 point), and color pink body/blue extremities (acrocyanosis = 1
point). Total = 2+1+1+1+1 = 6.
Question 9: A 34-week gestation patient presents with painless, bright red vaginal
bleeding. The uterus is soft and non-tender, and fetal heart rate is reassuring. What
is the priority nursing intervention?
A. Perform a digital cervical exam to assess dilation
B. Prepare for immediate vaginal delivery
C. Monitor maternal vital signs and apply external fetal monitoring
D. Administer betamethasone 12 mg intramuscularly
CORRECT ANSWER: C. Monitor maternal vital signs and apply external fetal
monitoring
Rationale: Painless vaginal bleeding in the third trimester is presumptive of placenta
previa. Digital cervical exams are contraindicated until placenta previa is ruled out by
ultrasound, as they can cause catastrophic hemorrhage. Monitoring is the priority, and
betamethasone would be administered for fetal lung maturity, but the immediate
priority is assessment and monitoring.
Question 10: A postpartum patient is Rh-negative and gave birth to an Rh-positive
infant. The nurse should prepare to administer Rh immunoglobulin (RhoGAM)
within what time frame?
A. Within 24 hours postpartum
B. Within 48 hours postpartum
C. Within 72 hours postpartum
D. Within 1 week postpartum
CORRECT ANSWER: C. Within 72 hours postpartum
Rationale: Rh immunoglobulin (RhoGAM) should be administered to Rh-negative
mothers who have given birth to an Rh-positive infant within 72 hours of delivery to
prevent maternal sensitization and hemolytic disease of the newborn in subsequent
pregnancies.
Question 11: A patient's labor is being augmented with oxytocin. The monitor
indicates a contraction frequency of every 1.5 minutes, lasting 90 seconds. The
fetal heart rate shows a baseline of 155 bpm with minimal variability. What is the
nurse's first action?
