Fall Semester 2026–2027 NURS240 Maternal-Newborn Nursing Updated
2026 | 190+ Questions and Answers | Comprehensive Study Guide,
Practice Exam, Maternal-Newborn Nursing Test Bank, Exam Prep Review,
Pregnancy and Prenatal Care, Fetal Development, Labor and Delivery,
Postpartum Nursing, Newborn Assessment, Neonatal Care, High-Risk
Pregnancy, Family-Centered Care, NCLEX-Style Questions, Detailed
Rationales and Revision Material
Question 1: A 32-week gestation client is admitted with preterm premature rupture
of membranes (PPROM). Which assessment finding is the priority for the nurse to
report to the healthcare provider immediately?
A. Maternal oral temperature of 99.1°F (37.3°C)
B. Fetal heart rate baseline of 155 beats per minute with moderate variability
C. A yellowish-green color of the amniotic fluid pooling in the vagina
D. A maternal pulse of 88 beats per minute
CORRECT ANSWER: C. A yellowish-green color of the amniotic fluid pooling in the
vagina
Rationale: Yellowish-green or green-tinged amniotic fluid indicates meconium passage,
which can signal fetal distress, particularly in a preterm gestation. While meconium is
more common in post-term pregnancies, its presence in a preterm fetus, especially
with PPROM, is a concerning sign of potential hypoxic stress and requires immediate
reporting. A low-grade fever (A) and elevated pulse (D) are concerning for
chorioamnionitis and should be reported, but meconium-stained fluid is a more urgent
indicator of potential fetal compromise. A baseline of 155 with moderate variability (B)
is a reassuring fetal heart rate pattern.
Question 2: The nurse is caring for a client in active labor who has an epidural
infusion. Which assessment finding indicates the most serious complication
related to this analgesia?
A. A decrease in systolic blood pressure from 120 to 100 mmHg
B. The client reports intense itching on her abdomen
C. The client is unable to move her lower extremities
D. The client's respiratory rate is 10 breaths per minute
CORRECT ANSWER: D. The client's respiratory rate is 10 breaths per minute
Rationale: A respiratory rate of 10 breaths per minute indicates respiratory depression, a
rare but life-threatening complication of epidural analgesia that can occur if the local
anesthetic or opioid travels too high in the spinal cord, affecting the phrenic nerve and
respiratory muscles. This requires immediate intervention, including stopping the
infusion and administering naloxone if indicated. Hypotension (A) is a common side
,effect and is managed with IV fluids and positioning. Itching (B) is a common side effect
of opioids. While leg weakness (C) is expected, it is not a critical complication.
Question 3: A primigravida at 39 weeks gestation is admitted in early labor. Her
cervix is 3 cm dilated, 80% effaced, and the fetal vertex is at a -1 station. Which
nursing diagnosis is the priority for this client?
A. Pain related to uterine contractions
B. Risk for Infection related to ruptured membranes
C. Anxiety related to the labor process
D. Risk for Impaired Skin Integrity related to pressure
CORRECT ANSWER: A. Pain related to uterine contractions
Rationale: During the active phase of labor (which begins around 4-6 cm), pain related
to uterine contractions is a primary and expected issue. The nurse's immediate priority
is to assess the client's pain level and provide comfort measures or pharmacological
pain relief. The client is in early labor with intact membranes, making infection (B) less
imminent. While anxiety (C) is common, the immediate physiological and psychological
focus is on pain management. Skin integrity (D) is a lower priority at this stage.
Question 4: The nurse is assessing a client at 38 weeks gestation who is
experiencing a sudden onset of severe, sharp abdominal pain that is continuous.
Her uterus is firm and board-like on palpation. What is the nurse's priority action?
A. Administer an oral analgesic for pain relief
B. Prepare the client for an emergency cesarean section
C. Place the client in a left lateral position and administer oxygen
D. Assess the client's deep tendon reflexes
CORRECT ANSWER: C. Place the client in a left lateral position and administer
oxygen
Rationale: The classic presentation of a placental abruption is a rigid, board-like
abdomen and sudden, severe continuous abdominal pain. The priority nursing
intervention is to improve fetal oxygenation and maternal cardiac output by positioning
the client on her left side to displace the uterus off the vena cava and administering
high-flow oxygen. This action precedes preparation for a possible emergency cesarean
(B), which is the definitive treatment but not the immediate nursing action. Pain
management (A) is secondary to stabilizing the client. DTR assessment (D) is not
relevant to a placental abruption.
,Question 5: A newborn is 12 hours old, and the nurse notes a heart rate of 140 bpm,
a respiratory rate of 64 breaths per minute with nasal flaring, and an axillary
temperature of 97.2°F (36.2°C). Which intervention is most appropriate?
A. Administer a bolus of 5% dextrose in water intravenously
B. Place the infant under a radiant warmer and recheck the temperature
C. Continue to monitor the newborn's vital signs every 4 hours
D. Notify the healthcare provider immediately for possible respiratory distress
CORRECT ANSWER: D. Notify the healthcare provider immediately for possible
respiratory distress
Rationale: The infant is exhibiting tachypnea (64 breaths per minute, normal is 30-60)
with nasal flaring, which is a sign of respiratory distress. While the heart rate is normal,
the combination of respiratory distress and a low temperature can indicate infection or
respiratory pathology. The priority is to notify the healthcare provider for immediate
evaluation. Placing the infant under a warmer (B) addresses the temperature but
doesn't address the primary concern of respiratory distress. Waiting (C) would delay
critical intervention.
Question 6: The nurse is providing care to a postpartum client 6 hours after a
vaginal delivery. The client's fundus is palpable two fingerbreadths above the
umbilicus, deviated to the left, and is boggy. What is the nurse's priority action?
A. Document the findings as normal
B. Assist the client to the bathroom to void
C. Massage the fundus and administer oxytocin as prescribed
D. Encourage the client to breastfeed her infant
CORRECT ANSWER: B. Assist the client to the bathroom to void
Rationale: A fundus that is high, deviated, and boggy indicates that the uterus is
displaced, most commonly due to a full bladder. The priority nursing action is to have
the client void, which will allow the uterus to contract effectively and become firm.
Massaging the fundus (C) is appropriate but may not be effective until the bladder is
empty. Oxytocin is given if uterine atony persists after voiding. Documenting (A) would
be incorrect as this is not a normal finding. Breastfeeding (D) releases endogenous
oxytocin, but the immediate mechanical issue is the bladder.
Question 7: A client at 34 weeks gestation presents with a blood pressure of 158/96
mmHg and 3+ protein in her urine. She reports a severe headache and visual
disturbances. Which medication should the nurse anticipate administering?
A. Terbutaline
B. Nifedipine
, C. Magnesium sulfate
D. Methylergonovine
CORRECT ANSWER: C. Magnesium sulfate
Rationale: The client is exhibiting severe features of preeclampsia with a blood pressure
≥160/110 (or 158/96), proteinuria, headache, and visual changes. The standard of care
is to administer magnesium sulfate as a seizure prophylactic agent to prevent
eclampsia. Terbutaline (A) and Nifedipine (B) are tocolytics or antihypertensives, not
seizure prophylaxis. Methylergonovine (D) is used to treat postpartum hemorrhage and
is contraindicated in hypertensive clients.
Question 8: The nurse is educating a prenatal class about false labor versus true
labor. Which statement by a client indicates an understanding of true labor?
A. "True labor pain is often relieved by walking."
B. "The pain in true labor typically starts in my back and radiates to my abdomen."
C. "My contractions will be irregular and not get closer together."
D. "True labor contractions usually stop when I change positions."
CORRECT ANSWER: B. "The pain in true labor typically starts in my back and
radiates to my abdomen."
Rationale: A key characteristic of true labor is that the pain often originates in the lower
back and radiates to the abdomen, due to cervical dilation and descent of the fetus.
Pain that is relieved by walking (A) or stopping with position changes (D) are indicators
of false labor. Irregular contractions (C) are also a sign of false labor, as true labor
contractions become regular, stronger, and closer together.
Question 9: A newborn is 2 hours old and has central cyanosis that does not
improve with oxygen administration. Which congenital heart defect does the nurse
suspect?
A. Ventricular septal defect
B. Coarctation of the aorta
C. Patent ductus arteriosus
D. Transposition of the great arteries
CORRECT ANSWER: D. Transposition of the great arteries
Rationale: Transposition of the great arteries is a cyanotic heart defect in which the
pulmonary artery and aorta are transposed. This creates two separate parallel circuits,
and the newborn's cyanosis is often unresponsive to oxygen administration because the
oxygenated blood is being pumped back to the lungs instead of the body. VSD (A),
Coarctation (B), and PDA (C) are typically acyanotic defects and may not present with
severe cyanosis so early.
2026 | 190+ Questions and Answers | Comprehensive Study Guide,
Practice Exam, Maternal-Newborn Nursing Test Bank, Exam Prep Review,
Pregnancy and Prenatal Care, Fetal Development, Labor and Delivery,
Postpartum Nursing, Newborn Assessment, Neonatal Care, High-Risk
Pregnancy, Family-Centered Care, NCLEX-Style Questions, Detailed
Rationales and Revision Material
Question 1: A 32-week gestation client is admitted with preterm premature rupture
of membranes (PPROM). Which assessment finding is the priority for the nurse to
report to the healthcare provider immediately?
A. Maternal oral temperature of 99.1°F (37.3°C)
B. Fetal heart rate baseline of 155 beats per minute with moderate variability
C. A yellowish-green color of the amniotic fluid pooling in the vagina
D. A maternal pulse of 88 beats per minute
CORRECT ANSWER: C. A yellowish-green color of the amniotic fluid pooling in the
vagina
Rationale: Yellowish-green or green-tinged amniotic fluid indicates meconium passage,
which can signal fetal distress, particularly in a preterm gestation. While meconium is
more common in post-term pregnancies, its presence in a preterm fetus, especially
with PPROM, is a concerning sign of potential hypoxic stress and requires immediate
reporting. A low-grade fever (A) and elevated pulse (D) are concerning for
chorioamnionitis and should be reported, but meconium-stained fluid is a more urgent
indicator of potential fetal compromise. A baseline of 155 with moderate variability (B)
is a reassuring fetal heart rate pattern.
Question 2: The nurse is caring for a client in active labor who has an epidural
infusion. Which assessment finding indicates the most serious complication
related to this analgesia?
A. A decrease in systolic blood pressure from 120 to 100 mmHg
B. The client reports intense itching on her abdomen
C. The client is unable to move her lower extremities
D. The client's respiratory rate is 10 breaths per minute
CORRECT ANSWER: D. The client's respiratory rate is 10 breaths per minute
Rationale: A respiratory rate of 10 breaths per minute indicates respiratory depression, a
rare but life-threatening complication of epidural analgesia that can occur if the local
anesthetic or opioid travels too high in the spinal cord, affecting the phrenic nerve and
respiratory muscles. This requires immediate intervention, including stopping the
infusion and administering naloxone if indicated. Hypotension (A) is a common side
,effect and is managed with IV fluids and positioning. Itching (B) is a common side effect
of opioids. While leg weakness (C) is expected, it is not a critical complication.
Question 3: A primigravida at 39 weeks gestation is admitted in early labor. Her
cervix is 3 cm dilated, 80% effaced, and the fetal vertex is at a -1 station. Which
nursing diagnosis is the priority for this client?
A. Pain related to uterine contractions
B. Risk for Infection related to ruptured membranes
C. Anxiety related to the labor process
D. Risk for Impaired Skin Integrity related to pressure
CORRECT ANSWER: A. Pain related to uterine contractions
Rationale: During the active phase of labor (which begins around 4-6 cm), pain related
to uterine contractions is a primary and expected issue. The nurse's immediate priority
is to assess the client's pain level and provide comfort measures or pharmacological
pain relief. The client is in early labor with intact membranes, making infection (B) less
imminent. While anxiety (C) is common, the immediate physiological and psychological
focus is on pain management. Skin integrity (D) is a lower priority at this stage.
Question 4: The nurse is assessing a client at 38 weeks gestation who is
experiencing a sudden onset of severe, sharp abdominal pain that is continuous.
Her uterus is firm and board-like on palpation. What is the nurse's priority action?
A. Administer an oral analgesic for pain relief
B. Prepare the client for an emergency cesarean section
C. Place the client in a left lateral position and administer oxygen
D. Assess the client's deep tendon reflexes
CORRECT ANSWER: C. Place the client in a left lateral position and administer
oxygen
Rationale: The classic presentation of a placental abruption is a rigid, board-like
abdomen and sudden, severe continuous abdominal pain. The priority nursing
intervention is to improve fetal oxygenation and maternal cardiac output by positioning
the client on her left side to displace the uterus off the vena cava and administering
high-flow oxygen. This action precedes preparation for a possible emergency cesarean
(B), which is the definitive treatment but not the immediate nursing action. Pain
management (A) is secondary to stabilizing the client. DTR assessment (D) is not
relevant to a placental abruption.
,Question 5: A newborn is 12 hours old, and the nurse notes a heart rate of 140 bpm,
a respiratory rate of 64 breaths per minute with nasal flaring, and an axillary
temperature of 97.2°F (36.2°C). Which intervention is most appropriate?
A. Administer a bolus of 5% dextrose in water intravenously
B. Place the infant under a radiant warmer and recheck the temperature
C. Continue to monitor the newborn's vital signs every 4 hours
D. Notify the healthcare provider immediately for possible respiratory distress
CORRECT ANSWER: D. Notify the healthcare provider immediately for possible
respiratory distress
Rationale: The infant is exhibiting tachypnea (64 breaths per minute, normal is 30-60)
with nasal flaring, which is a sign of respiratory distress. While the heart rate is normal,
the combination of respiratory distress and a low temperature can indicate infection or
respiratory pathology. The priority is to notify the healthcare provider for immediate
evaluation. Placing the infant under a warmer (B) addresses the temperature but
doesn't address the primary concern of respiratory distress. Waiting (C) would delay
critical intervention.
Question 6: The nurse is providing care to a postpartum client 6 hours after a
vaginal delivery. The client's fundus is palpable two fingerbreadths above the
umbilicus, deviated to the left, and is boggy. What is the nurse's priority action?
A. Document the findings as normal
B. Assist the client to the bathroom to void
C. Massage the fundus and administer oxytocin as prescribed
D. Encourage the client to breastfeed her infant
CORRECT ANSWER: B. Assist the client to the bathroom to void
Rationale: A fundus that is high, deviated, and boggy indicates that the uterus is
displaced, most commonly due to a full bladder. The priority nursing action is to have
the client void, which will allow the uterus to contract effectively and become firm.
Massaging the fundus (C) is appropriate but may not be effective until the bladder is
empty. Oxytocin is given if uterine atony persists after voiding. Documenting (A) would
be incorrect as this is not a normal finding. Breastfeeding (D) releases endogenous
oxytocin, but the immediate mechanical issue is the bladder.
Question 7: A client at 34 weeks gestation presents with a blood pressure of 158/96
mmHg and 3+ protein in her urine. She reports a severe headache and visual
disturbances. Which medication should the nurse anticipate administering?
A. Terbutaline
B. Nifedipine
, C. Magnesium sulfate
D. Methylergonovine
CORRECT ANSWER: C. Magnesium sulfate
Rationale: The client is exhibiting severe features of preeclampsia with a blood pressure
≥160/110 (or 158/96), proteinuria, headache, and visual changes. The standard of care
is to administer magnesium sulfate as a seizure prophylactic agent to prevent
eclampsia. Terbutaline (A) and Nifedipine (B) are tocolytics or antihypertensives, not
seizure prophylaxis. Methylergonovine (D) is used to treat postpartum hemorrhage and
is contraindicated in hypertensive clients.
Question 8: The nurse is educating a prenatal class about false labor versus true
labor. Which statement by a client indicates an understanding of true labor?
A. "True labor pain is often relieved by walking."
B. "The pain in true labor typically starts in my back and radiates to my abdomen."
C. "My contractions will be irregular and not get closer together."
D. "True labor contractions usually stop when I change positions."
CORRECT ANSWER: B. "The pain in true labor typically starts in my back and
radiates to my abdomen."
Rationale: A key characteristic of true labor is that the pain often originates in the lower
back and radiates to the abdomen, due to cervical dilation and descent of the fetus.
Pain that is relieved by walking (A) or stopping with position changes (D) are indicators
of false labor. Irregular contractions (C) are also a sign of false labor, as true labor
contractions become regular, stronger, and closer together.
Question 9: A newborn is 2 hours old and has central cyanosis that does not
improve with oxygen administration. Which congenital heart defect does the nurse
suspect?
A. Ventricular septal defect
B. Coarctation of the aorta
C. Patent ductus arteriosus
D. Transposition of the great arteries
CORRECT ANSWER: D. Transposition of the great arteries
Rationale: Transposition of the great arteries is a cyanotic heart defect in which the
pulmonary artery and aorta are transposed. This creates two separate parallel circuits,
and the newborn's cyanosis is often unresponsive to oxygen administration because the
oxygenated blood is being pumped back to the lungs instead of the body. VSD (A),
Coarctation (B), and PDA (C) are typically acyanotic defects and may not present with
severe cyanosis so early.
