Academic Year 2026–2027 NURS240 Maternal-Newborn Nursing
Updated 2026 | 190+ Exam Questions and Answers | Comprehensive
Study Guide, Practice Exam, Maternal and Newborn Nursing Test Bank,
Obstetric Nursing Review, Pregnancy, Labor and Delivery, Postpartum
Care, Newborn Assessment, Neonatal Care, High-Risk Pregnancy, Family-
Centered Care, NCLEX-Style Questions, Detailed Rationales and Exam
Prep Revision Material
Question 1: A 32-year-old primigravida at 38 weeks gestation is admitted with
preeclampsia with severe features. She is receiving a continuous magnesium
sulfate infusion. Which assessment finding would indicate magnesium toxicity and
require immediate intervention?
A. Urine output of 35 mL/hr
B. Deep tendon reflexes (DTRs) of 2+
C. Respiratory rate of 14 breaths per minute
D. Sudden loss of patellar reflex
CORRECT ANSWER: D. Sudden loss of patellar reflex
Rationale: The loss of deep tendon reflexes (DTRs) is an early and critical sign of
magnesium toxicity, often preceding respiratory depression and cardiac arrest.
Therapeutic magnesium levels range from 4-7 mEq/L; toxicity occurs at >7 mEq/L. Urine
output should be at least 30 mL/hr, a respiratory rate above 12 is acceptable, and 2+
reflexes are normal.
Question 2: A nurse is caring for a patient in active labor. The fetal heart rate (FHR)
tracing shows a prolonged deceleration lasting 4 minutes. What is the priority
nursing action?
A. Increase the rate of the intravenous (IV) fluid bolus
B. Place the patient in a left lateral position
C. Administer oxygen via a non-rebreather mask at 10 L/min
D. Prepare for an immediate cesarean section
CORRECT ANSWER: C. Administer oxygen via a non-rebreather mask at 10 L/min
Rationale: Prolonged decelerations indicate significant uteroplacental insufficiency.
The immediate priorities are to improve maternal oxygenation (administer 8-10 L/min
oxygen via non-rebreather mask) and relieve aortocaval compression (turn patient to
lateral position). While turning and fluids are important, administering oxygen is the
immediate, specific intervention to address fetal hypoxia.
,Question 3: A postpartum patient with type 1 diabetes mellitus is concerned about
breastfeeding. What is the most accurate teaching point regarding insulin
requirements?
A. Insulin requirements will remain the same as during pregnancy
B. Insulin requirements typically decrease during breastfeeding
C. Insulin requirements typically increase to support milk production
D. Insulin is contraindicated while breastfeeding
CORRECT ANSWER: B. Insulin requirements typically decrease during
breastfeeding
Rationale: Breastfeeding utilizes glucose for milk production, which lowers maternal
blood glucose levels. Therefore, insulin requirements usually decrease significantly in
the postpartum period. Patients must be monitored closely for hypoglycemia and may
need to reduce their insulin doses.
Question 4: A patient at 35 weeks gestation with a placenta previa experiences a
sudden, painless, bright red vaginal hemorrhage. What is the most appropriate
immediate nursing action?
A. Perform a sterile vaginal examination to assess cervical dilation
B. Administer an oxytocin infusion to control bleeding
C. Prepare for an immediate vaginal delivery
D. Assess fetal heart rate and maternal vital signs while preparing for a cesarean
CORRECT ANSWER: D. Assess fetal heart rate and maternal vital signs while
preparing for a cesarean
Rationale: Placenta previa is a contraindication for vaginal exams as they can cause
catastrophic hemorrhage. The priority is maternal-fetal stabilization. Since the patient is
at 35 weeks with active bleeding, the standard management is an urgent cesarean
delivery to preserve both lives.
Question 5: A neonate is born via vacuum-assisted delivery. The nurse notes
swelling that crosses the suture lines on the newborn's head. How should the nurse
document this finding?
A. Cephalohematoma
B. Subgaleal hemorrhage
C. Caput succedaneum
D. Molding
CORRECT ANSWER: C. Caput succedaneum
,Rationale: Caput succedaneum is diffuse edema of the scalp that crosses suture lines,
caused by pressure against the cervix during labor. It usually resolves within 24-48
hours. A cephalohematoma does not cross suture lines (it is a subperiosteal bleed).
Subgaleal hemorrhage is a rare, life-threatening bleed that does cross sutures but is
fluctuant and can extend rapidly.
Question 6: A patient at 32 weeks gestation presents with a headache, visual
disturbances, and epigastric pain. Her blood pressure is 160/110 mmHg, and urine
protein is 4+ on a dipstick. Which laboratory finding would confirm the diagnosis of
HELLP syndrome?
A. Elevated serum creatinine
B. Elevated liver enzymes and low platelets
C. Elevated hemoglobin and hematocrit
D. Elevated white blood cell count
CORRECT ANSWER: B. Elevated liver enzymes and low platelets
Rationale: HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a
severe variant of preeclampsia. The diagnostic criteria include evidence of hemolysis
(LDH >600, schistocytes), elevated liver enzymes (AST, ALT), and low platelets
(<100,000). Epigastric pain is a classic symptom.
Question 7: A patient in preterm labor at 34 weeks is prescribed betamethasone.
The patient asks why she is receiving this medication. What is the nurse’s best
response?
A. "It will stop your contractions and prevent preterm birth."
B. "It helps to mature your baby's lungs and reduce the risk of respiratory distress
syndrome."
C. "It prevents infection in the baby after delivery."
D. "It will lower your blood pressure and prevent seizures."
CORRECT ANSWER: B. "It helps to mature your baby's lungs and reduce the risk of
respiratory distress syndrome."
Rationale: Betamethasone is a corticosteroid administered to pregnant women at risk
of preterm delivery (between 24 and 34 weeks) to accelerate fetal lung maturity by
promoting surfactant production. It does not stop labor (tocolytics do) or prevent
infection.
Question 8: Upon delivery, the nurse notes that the newborn has a heart rate of 80
bpm, is limp and pale, and has no respiratory effort. The APGAR score at 1 minute
should be assigned a score of what?
, A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: A. 0
Rationale: APGAR scoring evaluates Heart rate, Respiratory effort, Muscle tone, Reflex
irritability, and Color. Each is scored 0, 1, or 2. A heart rate <100 is 1 point, not 0.
However, in this case, HR is 80 (score 1), limp (muscle tone 0), no respiratory effort (0).
Wait. Let's re-evaluate: HR 80 = 1. Limp = 0. No respiratory effort = 0. The question asks
for the APGAR score. The score is 1+0+0+[Reflex 0]+[Color 0] = 1. Wait, the question
implies a specific score? The question states "should be assigned a score of what?" The
answer is 1. Let me adjust.
CORRECT ANSWER: A. 0 (If we consider a scenario where HR is absent). But in the
given data, HR is 80, so it's 1. The question asks "The APGAR score at 1 minute should
be assigned a score of what?" If we assume the specific components: HR 80 (1), limp
(0), no respiratory effort (0), no reflex (0), pale (0). Total = 1. So the correct answer is 1.
However, I must correct the option. Since the question asks for the score, the correct
answer should be 1. Let's rewrite the answer.
CORRECT ANSWER: A. 0 is incorrect. The correct score is 1. Let me generate a new
question to avoid this error and ensure accuracy.
Question 8: A patient in active labor is found to have a prolapsed umbilical cord.
The fetal heart rate is 70 bpm. What is the priority nursing intervention?
A. Push the presenting part upward off the cord and reposition the patient into
Trendelenburg or knee-chest position
B. Administer a fluid bolus and start oxytocin to augment labor
C. Prepare for immediate vacuum-assisted vaginal delivery
D. Apply a scalp electrode to monitor fetal status
CORRECT ANSWER: A. Push the presenting part upward off the cord and reposition
the patient into Trendelenburg or knee-chest position
Rationale: In a prolapsed cord, the priority is to relieve pressure on the cord to restore
fetal oxygenation. The nurse should lift the presenting part off the cord with a sterile
gloved hand and place the patient in Trendelenburg or knee-chest position to use gravity
to relieve pressure.
Question 9: A primigravida at 40 weeks gestation is receiving an oxytocin infusion.
The nurse notes that the uterus is not relaxing between contractions and the FHR is
90 bpm. What is the nurse's priority action?
Updated 2026 | 190+ Exam Questions and Answers | Comprehensive
Study Guide, Practice Exam, Maternal and Newborn Nursing Test Bank,
Obstetric Nursing Review, Pregnancy, Labor and Delivery, Postpartum
Care, Newborn Assessment, Neonatal Care, High-Risk Pregnancy, Family-
Centered Care, NCLEX-Style Questions, Detailed Rationales and Exam
Prep Revision Material
Question 1: A 32-year-old primigravida at 38 weeks gestation is admitted with
preeclampsia with severe features. She is receiving a continuous magnesium
sulfate infusion. Which assessment finding would indicate magnesium toxicity and
require immediate intervention?
A. Urine output of 35 mL/hr
B. Deep tendon reflexes (DTRs) of 2+
C. Respiratory rate of 14 breaths per minute
D. Sudden loss of patellar reflex
CORRECT ANSWER: D. Sudden loss of patellar reflex
Rationale: The loss of deep tendon reflexes (DTRs) is an early and critical sign of
magnesium toxicity, often preceding respiratory depression and cardiac arrest.
Therapeutic magnesium levels range from 4-7 mEq/L; toxicity occurs at >7 mEq/L. Urine
output should be at least 30 mL/hr, a respiratory rate above 12 is acceptable, and 2+
reflexes are normal.
Question 2: A nurse is caring for a patient in active labor. The fetal heart rate (FHR)
tracing shows a prolonged deceleration lasting 4 minutes. What is the priority
nursing action?
A. Increase the rate of the intravenous (IV) fluid bolus
B. Place the patient in a left lateral position
C. Administer oxygen via a non-rebreather mask at 10 L/min
D. Prepare for an immediate cesarean section
CORRECT ANSWER: C. Administer oxygen via a non-rebreather mask at 10 L/min
Rationale: Prolonged decelerations indicate significant uteroplacental insufficiency.
The immediate priorities are to improve maternal oxygenation (administer 8-10 L/min
oxygen via non-rebreather mask) and relieve aortocaval compression (turn patient to
lateral position). While turning and fluids are important, administering oxygen is the
immediate, specific intervention to address fetal hypoxia.
,Question 3: A postpartum patient with type 1 diabetes mellitus is concerned about
breastfeeding. What is the most accurate teaching point regarding insulin
requirements?
A. Insulin requirements will remain the same as during pregnancy
B. Insulin requirements typically decrease during breastfeeding
C. Insulin requirements typically increase to support milk production
D. Insulin is contraindicated while breastfeeding
CORRECT ANSWER: B. Insulin requirements typically decrease during
breastfeeding
Rationale: Breastfeeding utilizes glucose for milk production, which lowers maternal
blood glucose levels. Therefore, insulin requirements usually decrease significantly in
the postpartum period. Patients must be monitored closely for hypoglycemia and may
need to reduce their insulin doses.
Question 4: A patient at 35 weeks gestation with a placenta previa experiences a
sudden, painless, bright red vaginal hemorrhage. What is the most appropriate
immediate nursing action?
A. Perform a sterile vaginal examination to assess cervical dilation
B. Administer an oxytocin infusion to control bleeding
C. Prepare for an immediate vaginal delivery
D. Assess fetal heart rate and maternal vital signs while preparing for a cesarean
CORRECT ANSWER: D. Assess fetal heart rate and maternal vital signs while
preparing for a cesarean
Rationale: Placenta previa is a contraindication for vaginal exams as they can cause
catastrophic hemorrhage. The priority is maternal-fetal stabilization. Since the patient is
at 35 weeks with active bleeding, the standard management is an urgent cesarean
delivery to preserve both lives.
Question 5: A neonate is born via vacuum-assisted delivery. The nurse notes
swelling that crosses the suture lines on the newborn's head. How should the nurse
document this finding?
A. Cephalohematoma
B. Subgaleal hemorrhage
C. Caput succedaneum
D. Molding
CORRECT ANSWER: C. Caput succedaneum
,Rationale: Caput succedaneum is diffuse edema of the scalp that crosses suture lines,
caused by pressure against the cervix during labor. It usually resolves within 24-48
hours. A cephalohematoma does not cross suture lines (it is a subperiosteal bleed).
Subgaleal hemorrhage is a rare, life-threatening bleed that does cross sutures but is
fluctuant and can extend rapidly.
Question 6: A patient at 32 weeks gestation presents with a headache, visual
disturbances, and epigastric pain. Her blood pressure is 160/110 mmHg, and urine
protein is 4+ on a dipstick. Which laboratory finding would confirm the diagnosis of
HELLP syndrome?
A. Elevated serum creatinine
B. Elevated liver enzymes and low platelets
C. Elevated hemoglobin and hematocrit
D. Elevated white blood cell count
CORRECT ANSWER: B. Elevated liver enzymes and low platelets
Rationale: HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a
severe variant of preeclampsia. The diagnostic criteria include evidence of hemolysis
(LDH >600, schistocytes), elevated liver enzymes (AST, ALT), and low platelets
(<100,000). Epigastric pain is a classic symptom.
Question 7: A patient in preterm labor at 34 weeks is prescribed betamethasone.
The patient asks why she is receiving this medication. What is the nurse’s best
response?
A. "It will stop your contractions and prevent preterm birth."
B. "It helps to mature your baby's lungs and reduce the risk of respiratory distress
syndrome."
C. "It prevents infection in the baby after delivery."
D. "It will lower your blood pressure and prevent seizures."
CORRECT ANSWER: B. "It helps to mature your baby's lungs and reduce the risk of
respiratory distress syndrome."
Rationale: Betamethasone is a corticosteroid administered to pregnant women at risk
of preterm delivery (between 24 and 34 weeks) to accelerate fetal lung maturity by
promoting surfactant production. It does not stop labor (tocolytics do) or prevent
infection.
Question 8: Upon delivery, the nurse notes that the newborn has a heart rate of 80
bpm, is limp and pale, and has no respiratory effort. The APGAR score at 1 minute
should be assigned a score of what?
, A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: A. 0
Rationale: APGAR scoring evaluates Heart rate, Respiratory effort, Muscle tone, Reflex
irritability, and Color. Each is scored 0, 1, or 2. A heart rate <100 is 1 point, not 0.
However, in this case, HR is 80 (score 1), limp (muscle tone 0), no respiratory effort (0).
Wait. Let's re-evaluate: HR 80 = 1. Limp = 0. No respiratory effort = 0. The question asks
for the APGAR score. The score is 1+0+0+[Reflex 0]+[Color 0] = 1. Wait, the question
implies a specific score? The question states "should be assigned a score of what?" The
answer is 1. Let me adjust.
CORRECT ANSWER: A. 0 (If we consider a scenario where HR is absent). But in the
given data, HR is 80, so it's 1. The question asks "The APGAR score at 1 minute should
be assigned a score of what?" If we assume the specific components: HR 80 (1), limp
(0), no respiratory effort (0), no reflex (0), pale (0). Total = 1. So the correct answer is 1.
However, I must correct the option. Since the question asks for the score, the correct
answer should be 1. Let's rewrite the answer.
CORRECT ANSWER: A. 0 is incorrect. The correct score is 1. Let me generate a new
question to avoid this error and ensure accuracy.
Question 8: A patient in active labor is found to have a prolapsed umbilical cord.
The fetal heart rate is 70 bpm. What is the priority nursing intervention?
A. Push the presenting part upward off the cord and reposition the patient into
Trendelenburg or knee-chest position
B. Administer a fluid bolus and start oxytocin to augment labor
C. Prepare for immediate vacuum-assisted vaginal delivery
D. Apply a scalp electrode to monitor fetal status
CORRECT ANSWER: A. Push the presenting part upward off the cord and reposition
the patient into Trendelenburg or knee-chest position
Rationale: In a prolapsed cord, the priority is to relieve pressure on the cord to restore
fetal oxygenation. The nurse should lift the presenting part off the cord with a sterile
gloved hand and place the patient in Trendelenburg or knee-chest position to use gravity
to relieve pressure.
Question 9: A primigravida at 40 weeks gestation is receiving an oxytocin infusion.
The nurse notes that the uterus is not relaxing between contractions and the FHR is
90 bpm. What is the nurse's priority action?
