NR 327 Maternal-Child Nursing Exam 2
Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
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SECTION 1: INTRAPARTUM NURSING Q1 – Q10
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Question 1 of 50
A 28-year-old G2P1 at 39 weeks gestation presents to labor and delivery reporting
contractions every 4-5 minutes lasting 45 seconds. Cervical exam reveals 3 cm dilation, 80%
effacement, and -1 station. Contractions are palpated in the lower abdomen and do not
intensify with walking. The fetal heart rate baseline is 142 bpm with moderate variability and
no decelerations. After two hours of observation, the cervical exam remains unchanged.
A. Prepare the patient for immediate amniotomy
B. Discharge home with return precautions for active labor ✓ CORRECT
C. Initiate oxytocin augmentation per protocol
D. Request a stat ultrasound for fetal biophysical profile
Correct Answer: B
Rationale: This presentation is consistent with false labor, characterized by contractions that
do not intensify with activity, are felt in the lower abdomen rather than the fundus, and do not
produce cervical change over time. Discharging the patient with clear return precautions
preserves bed capacity and prevents unnecessary interventions in the absence of active
labor. Amniotomy and oxytocin are inappropriate without evidence of labor progression, and
a biophysical profile is not indicated with a reassuring fetal heart rate pattern. Chamberlain
NR 327 emphasizes that false labor is distinguished from true labor by the lack of cervical
change and the effect of walking on contraction intensity.
Question 2 of 50
A 32-year-old G1P0 at 41 weeks gestation is admitted in active labor. An intrauterine pressure
catheter is placed for continuous monitoring. After four hours, the fetal heart tracing shows a
,baseline of 150 bpm with moderate variability. During contractions, the heart rate gradually
decreases to 120 bpm, returning to baseline after the contraction ends. The
tocodynamometer shows contractions every 2-3 minutes lasting 60-70 seconds with peak
pressures of 75 mmHg.
A. Discontinue oxytocin and notify the provider
B. Perform a vaginal exam to assess for rapid dilation
C. Administer a tocolytic per standing orders
D. Reposition the patient to left lateral and apply oxygen ✓ CORRECT
Correct Answer: D
Rationale: The gradual onset of decelerations that begin after the contraction peak and return
to baseline after the contraction ends defines late decelerations, which indicate
uteroplacental insufficiency requiring immediate intrauterine resuscitation including left
lateral positioning and supplemental oxygen to maximize placental perfusion. A vaginal exam
does not address the underlying oxygenation deficit, and tocolytics are contraindicated in
active labor. While oxytocin discontinuation may be necessary if infusing, the priority is
immediate physical resuscitation to improve fetal oxygenation. NGN strategy: interpret fetal
heart rate patterns in the context of the entire clinical picture rather than isolated findings.
Question 3 of 50
A 24-year-old G2P1 at 38 weeks gestation is in active labor at 6 cm dilation. She received
epidural anesthesia 30 minutes ago. Her blood pressure was 118/72 mmHg prior to the
epidural and is now 92/58 mmHg. The fetal heart rate baseline is 136 bpm with moderate
variability. The patient reports nausea and dizziness.
A. Administer a bolus of lactated Ringer's per protocol and place the patient in left lateral tilt
✓ CORRECT
B. Increase the epidural infusion rate to improve maternal comfort
C. Prepare for emergency cesarean delivery
D. Check the fetal heart rate for prolonged deceleration
Correct Answer: A
Rationale: Hypotension following epidural anesthesia results from sympathetic blockade and
vasodilation, and the first-line treatment is a rapid IV fluid bolus combined with left uterine
displacement to improve venous return and cardiac output. Increasing the epidural infusion
would worsen hypotension by intensifying the sympathetic blockade. Emergency cesarean is
not indicated without evidence of fetal compromise, and while fetal monitoring is important,
maternal hemodynamic stabilization must occur first to restore uteroplacental perfusion.
Always preload with 500-1000 mL of crystalloid before epidural placement when possible, but
treat established hypotension aggressively.
Question 4 of 50
, A 30-year-old G3P2 at term is admitted in active labor at 7 cm dilation. Her membranes
ruptured spontaneously two hours ago with clear fluid. The fetal heart rate baseline is 160
bpm with moderate variability. Suddenly, during a contraction, the heart rate drops from 160 to
110 bpm over 15 seconds, then rapidly returns to baseline. This pattern repeats with each
contraction.
A. Prepare for immediate delivery due to fetal bradycardia
B. Discontinue oxytocin and notify the provider
C. Reposition the patient to relieve possible cord compression ✓ CORRECT
D. Administer oxygen at 10 L/min via non-rebreather mask
Correct Answer: C
Rationale: The abrupt onset, rapid nadir, and quick recovery of the fetal heart rate with each
contraction is characteristic of variable decelerations caused by umbilical cord compression,
which is best managed first by maternal repositioning to shift the fetal head and relieve
pressure on the cord. Immediate delivery is not indicated for isolated variable decelerations
with moderate variability and a rapid return to baseline. Oxygen may be used as an adjunct,
but repositioning is the primary intervention, and oxytocin discontinuation is not the first
priority unless late decelerations are present. Variable decelerations are the most common
deceleration pattern seen in labor and typically respond to simple position changes.
Question 5 of 50
A 26-year-old G1P0 at 40 weeks gestation has been pushing for 45 minutes. The fetal head is
visible at the vaginal introitus during contractions. The provider requests a vacuum-assisted
delivery. The fetal heart rate is 148 bpm with moderate variability and early decelerations.
A. Apply fundal pressure to assist descent
B. Ensure the vacuum pop-off mechanism is functional and count traction time ✓ CORRECT
C. Administer a prophylactic dose of terbutaline
D. Document the number of contractions per minute
Correct Answer: B
Rationale: During vacuum-assisted delivery, the nurse must verify that the vacuum pressure
gauge pop-off safety valve is functional and meticulously track cumulative traction time, as
vacuum application should not exceed 15-20 minutes to minimize the risk of neonatal
cephalohematoma and subgaleal hemorrhage. Fundal pressure is absolutely contraindicated
with vacuum extraction due to the risk of uterine rupture and fetal skull fracture. Terbutaline
is a tocolytic used for preterm labor, not operative delivery, and contraction frequency is
already being monitored. Chamberlain standards require that the nurse act as a safety
advocate during operative vaginal deliveries by monitoring equipment and timing.
Question 6 of 50
Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: INTRAPARTUM NURSING Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 28-year-old G2P1 at 39 weeks gestation presents to labor and delivery reporting
contractions every 4-5 minutes lasting 45 seconds. Cervical exam reveals 3 cm dilation, 80%
effacement, and -1 station. Contractions are palpated in the lower abdomen and do not
intensify with walking. The fetal heart rate baseline is 142 bpm with moderate variability and
no decelerations. After two hours of observation, the cervical exam remains unchanged.
A. Prepare the patient for immediate amniotomy
B. Discharge home with return precautions for active labor ✓ CORRECT
C. Initiate oxytocin augmentation per protocol
D. Request a stat ultrasound for fetal biophysical profile
Correct Answer: B
Rationale: This presentation is consistent with false labor, characterized by contractions that
do not intensify with activity, are felt in the lower abdomen rather than the fundus, and do not
produce cervical change over time. Discharging the patient with clear return precautions
preserves bed capacity and prevents unnecessary interventions in the absence of active
labor. Amniotomy and oxytocin are inappropriate without evidence of labor progression, and
a biophysical profile is not indicated with a reassuring fetal heart rate pattern. Chamberlain
NR 327 emphasizes that false labor is distinguished from true labor by the lack of cervical
change and the effect of walking on contraction intensity.
Question 2 of 50
A 32-year-old G1P0 at 41 weeks gestation is admitted in active labor. An intrauterine pressure
catheter is placed for continuous monitoring. After four hours, the fetal heart tracing shows a
,baseline of 150 bpm with moderate variability. During contractions, the heart rate gradually
decreases to 120 bpm, returning to baseline after the contraction ends. The
tocodynamometer shows contractions every 2-3 minutes lasting 60-70 seconds with peak
pressures of 75 mmHg.
A. Discontinue oxytocin and notify the provider
B. Perform a vaginal exam to assess for rapid dilation
C. Administer a tocolytic per standing orders
D. Reposition the patient to left lateral and apply oxygen ✓ CORRECT
Correct Answer: D
Rationale: The gradual onset of decelerations that begin after the contraction peak and return
to baseline after the contraction ends defines late decelerations, which indicate
uteroplacental insufficiency requiring immediate intrauterine resuscitation including left
lateral positioning and supplemental oxygen to maximize placental perfusion. A vaginal exam
does not address the underlying oxygenation deficit, and tocolytics are contraindicated in
active labor. While oxytocin discontinuation may be necessary if infusing, the priority is
immediate physical resuscitation to improve fetal oxygenation. NGN strategy: interpret fetal
heart rate patterns in the context of the entire clinical picture rather than isolated findings.
Question 3 of 50
A 24-year-old G2P1 at 38 weeks gestation is in active labor at 6 cm dilation. She received
epidural anesthesia 30 minutes ago. Her blood pressure was 118/72 mmHg prior to the
epidural and is now 92/58 mmHg. The fetal heart rate baseline is 136 bpm with moderate
variability. The patient reports nausea and dizziness.
A. Administer a bolus of lactated Ringer's per protocol and place the patient in left lateral tilt
✓ CORRECT
B. Increase the epidural infusion rate to improve maternal comfort
C. Prepare for emergency cesarean delivery
D. Check the fetal heart rate for prolonged deceleration
Correct Answer: A
Rationale: Hypotension following epidural anesthesia results from sympathetic blockade and
vasodilation, and the first-line treatment is a rapid IV fluid bolus combined with left uterine
displacement to improve venous return and cardiac output. Increasing the epidural infusion
would worsen hypotension by intensifying the sympathetic blockade. Emergency cesarean is
not indicated without evidence of fetal compromise, and while fetal monitoring is important,
maternal hemodynamic stabilization must occur first to restore uteroplacental perfusion.
Always preload with 500-1000 mL of crystalloid before epidural placement when possible, but
treat established hypotension aggressively.
Question 4 of 50
, A 30-year-old G3P2 at term is admitted in active labor at 7 cm dilation. Her membranes
ruptured spontaneously two hours ago with clear fluid. The fetal heart rate baseline is 160
bpm with moderate variability. Suddenly, during a contraction, the heart rate drops from 160 to
110 bpm over 15 seconds, then rapidly returns to baseline. This pattern repeats with each
contraction.
A. Prepare for immediate delivery due to fetal bradycardia
B. Discontinue oxytocin and notify the provider
C. Reposition the patient to relieve possible cord compression ✓ CORRECT
D. Administer oxygen at 10 L/min via non-rebreather mask
Correct Answer: C
Rationale: The abrupt onset, rapid nadir, and quick recovery of the fetal heart rate with each
contraction is characteristic of variable decelerations caused by umbilical cord compression,
which is best managed first by maternal repositioning to shift the fetal head and relieve
pressure on the cord. Immediate delivery is not indicated for isolated variable decelerations
with moderate variability and a rapid return to baseline. Oxygen may be used as an adjunct,
but repositioning is the primary intervention, and oxytocin discontinuation is not the first
priority unless late decelerations are present. Variable decelerations are the most common
deceleration pattern seen in labor and typically respond to simple position changes.
Question 5 of 50
A 26-year-old G1P0 at 40 weeks gestation has been pushing for 45 minutes. The fetal head is
visible at the vaginal introitus during contractions. The provider requests a vacuum-assisted
delivery. The fetal heart rate is 148 bpm with moderate variability and early decelerations.
A. Apply fundal pressure to assist descent
B. Ensure the vacuum pop-off mechanism is functional and count traction time ✓ CORRECT
C. Administer a prophylactic dose of terbutaline
D. Document the number of contractions per minute
Correct Answer: B
Rationale: During vacuum-assisted delivery, the nurse must verify that the vacuum pressure
gauge pop-off safety valve is functional and meticulously track cumulative traction time, as
vacuum application should not exceed 15-20 minutes to minimize the risk of neonatal
cephalohematoma and subgaleal hemorrhage. Fundal pressure is absolutely contraindicated
with vacuum extraction due to the risk of uterine rupture and fetal skull fracture. Terbutaline
is a tocolytic used for preterm labor, not operative delivery, and contraction frequency is
already being monitored. Chamberlain standards require that the nurse act as a safety
advocate during operative vaginal deliveries by monitoring equipment and timing.
Question 6 of 50
