GALEN COLLEGE OF NURSING
NUR 254 Exam 2
Concepts of Nursing: The Childbearing and Child Caring Families
Official Practice Exam | 2026/2027 Edition
QUESTIONS MINUTES PASSING SCORE FORMAT
50 60 80% Multiple Choice
Table of Contents
Section 1: Intrapartum Care & Labor Management 13 questions
Section 2: Postpartum Assessment & Nursing Care 13 questions
Section 3: Postpartum Complications 12 questions
Section 4: Newborn Assessment & Care 12 questions
Instructions
Read each question carefully. Select the single best answer from the four options provided. Each question is
worth one point. You have 60 minutes to complete all 50 questions. A passing score of 80% (40 out of 50 correct)
is required. Review the rationale for each question to strengthen your understanding of intrapartum care,
postpartum assessment, postpartum complications, and newborn assessment and care.
This practice exam is for study purposes only and is not affiliated with or endorsed by Galen College of Nursing.
NUR 254 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 1 of 23
, SECTION 1: INTRAPARTUM CARE & LABOR MANAGEMENT | 2026/2027
Q1 Question 1 of 50
A 27-year-old primigravida at 39 weeks gestation is admitted to the labor unit with regular contractions
every 5 minutes lasting 45 seconds. Cervical examination reveals 3 cm dilation and 80% effacement.
The fetal heart rate baseline is 140 bpm with accelerations present. In which stage and phase of labor
is this patient?
A. First stage, latent phase
B. First stage, active phase
C. First stage, transition phase
D. Second stage of labor
Correct Answer: A
Rationale:
The latent phase of the first stage of labor is characterized by cervical dilation from 0 to 6 cm with mild to
moderate contractions. This patient at 3 cm dilation with contractions every 5 minutes fits the latent phase
criteria. The active phase begins at 6 cm dilation with more rapid cervical change, and transition occurs at
8-10 cm with intense contractions every 2-3 minutes.
Q2 Question 2 of 50
A laboring patient at 41 weeks gestation has a fetal heart rate tracing showing a baseline of 145 bpm
with recurrent decelerations that begin after the onset of contractions and return to baseline after the
contraction ends. The nadir of the deceleration occurs after the peak of the contraction. What is the
correct interpretation of this tracing?
A. Early decelerations indicating head compression
B. Late decelerations indicating placental insufficiency
C. Variable decelerations indicating cord compression
D. Accelerations indicating fetal well-being
Correct Answer: B
Rationale:
Late decelerations are characterized by a gradual decrease in fetal heart rate that begins after the
contraction starts, with the nadir occurring after the peak of the contraction, and return to baseline after the
contraction ends. This pattern is associated with uteroplacental insufficiency and is an ominous sign
requiring immediate intervention. Early decelerations mirror contractions with the nadir at the peak, while
variable decelerations have an abrupt onset.
NUR 254 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 2 of 23
, Q3 Question 3 of 50
A nurse is monitoring a patient in the active phase of labor and notes variable decelerations on the fetal
heart rate tracing that drop to 80 bpm and last 30 seconds. The patient reports a sudden gush of clear
fluid. What is the priority nursing intervention?
A. Administer oxygen at 10 L via non-rebreather mask
B. Prepare for an emergency cesarean section
C. Reposition the patient and assess for umbilical cord prolapse
D. Increase the rate of intravenous fluids
Correct Answer: C
Rationale:
Variable decelerations with a sudden gush of fluid suggest umbilical cord compression, possibly from cord
prolapse. The priority intervention is to reposition the patient (ideally into knee-chest or Trendelenburg
position) and perform a vaginal examination to assess for cord prolapse. While oxygen and IV fluids may be
helpful, repositioning to relieve cord compression is the most critical first action in this scenario.
Q4 Question 4 of 50
A multiparous patient at 38 weeks gestation is in the transition phase of labor. Contractions are
occurring every 2 minutes lasting 90 seconds, and the cervix is 9 cm dilated. The patient feels an urge
to push. What is the most appropriate nursing action?
A. Encourage the patient to begin pushing with each contraction
B. Administer an epidural bolus for pain relief
C. Prepare for an immediate vacuum-assisted delivery
D. Instruct the patient to pant or blow through the urge to push
Correct Answer: D
Rationale:
When a patient in transition (not yet fully dilated) feels the urge to push, the nurse should instruct the patient
to pant or blow through contractions to avoid pushing before complete cervical dilation. Pushing against an
incompletely dilated cervix can cause cervical edema, lacerations, and fetal distress. Pushing should only
begin once the cervix is fully dilated at 10 cm.
Q5 Question 5 of 50
A primigravida at 40 weeks gestation is receiving oxytocin for labor augmentation. The nurse notes
contractions every 1.5 minutes lasting 90 seconds with resting tone elevated between contractions. The
fetal heart rate shows late decelerations. What is the nurse's first action?
A. Discontinue the oxytocin infusion immediately
B. Increase the intravenous fluid rate
C. Reposition the patient to the left lateral position
D. Notify the healthcare provider and await orders
Correct Answer: A
NUR 254 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 3 of 23
NUR 254 Exam 2
Concepts of Nursing: The Childbearing and Child Caring Families
Official Practice Exam | 2026/2027 Edition
QUESTIONS MINUTES PASSING SCORE FORMAT
50 60 80% Multiple Choice
Table of Contents
Section 1: Intrapartum Care & Labor Management 13 questions
Section 2: Postpartum Assessment & Nursing Care 13 questions
Section 3: Postpartum Complications 12 questions
Section 4: Newborn Assessment & Care 12 questions
Instructions
Read each question carefully. Select the single best answer from the four options provided. Each question is
worth one point. You have 60 minutes to complete all 50 questions. A passing score of 80% (40 out of 50 correct)
is required. Review the rationale for each question to strengthen your understanding of intrapartum care,
postpartum assessment, postpartum complications, and newborn assessment and care.
This practice exam is for study purposes only and is not affiliated with or endorsed by Galen College of Nursing.
NUR 254 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 1 of 23
, SECTION 1: INTRAPARTUM CARE & LABOR MANAGEMENT | 2026/2027
Q1 Question 1 of 50
A 27-year-old primigravida at 39 weeks gestation is admitted to the labor unit with regular contractions
every 5 minutes lasting 45 seconds. Cervical examination reveals 3 cm dilation and 80% effacement.
The fetal heart rate baseline is 140 bpm with accelerations present. In which stage and phase of labor
is this patient?
A. First stage, latent phase
B. First stage, active phase
C. First stage, transition phase
D. Second stage of labor
Correct Answer: A
Rationale:
The latent phase of the first stage of labor is characterized by cervical dilation from 0 to 6 cm with mild to
moderate contractions. This patient at 3 cm dilation with contractions every 5 minutes fits the latent phase
criteria. The active phase begins at 6 cm dilation with more rapid cervical change, and transition occurs at
8-10 cm with intense contractions every 2-3 minutes.
Q2 Question 2 of 50
A laboring patient at 41 weeks gestation has a fetal heart rate tracing showing a baseline of 145 bpm
with recurrent decelerations that begin after the onset of contractions and return to baseline after the
contraction ends. The nadir of the deceleration occurs after the peak of the contraction. What is the
correct interpretation of this tracing?
A. Early decelerations indicating head compression
B. Late decelerations indicating placental insufficiency
C. Variable decelerations indicating cord compression
D. Accelerations indicating fetal well-being
Correct Answer: B
Rationale:
Late decelerations are characterized by a gradual decrease in fetal heart rate that begins after the
contraction starts, with the nadir occurring after the peak of the contraction, and return to baseline after the
contraction ends. This pattern is associated with uteroplacental insufficiency and is an ominous sign
requiring immediate intervention. Early decelerations mirror contractions with the nadir at the peak, while
variable decelerations have an abrupt onset.
NUR 254 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 2 of 23
, Q3 Question 3 of 50
A nurse is monitoring a patient in the active phase of labor and notes variable decelerations on the fetal
heart rate tracing that drop to 80 bpm and last 30 seconds. The patient reports a sudden gush of clear
fluid. What is the priority nursing intervention?
A. Administer oxygen at 10 L via non-rebreather mask
B. Prepare for an emergency cesarean section
C. Reposition the patient and assess for umbilical cord prolapse
D. Increase the rate of intravenous fluids
Correct Answer: C
Rationale:
Variable decelerations with a sudden gush of fluid suggest umbilical cord compression, possibly from cord
prolapse. The priority intervention is to reposition the patient (ideally into knee-chest or Trendelenburg
position) and perform a vaginal examination to assess for cord prolapse. While oxygen and IV fluids may be
helpful, repositioning to relieve cord compression is the most critical first action in this scenario.
Q4 Question 4 of 50
A multiparous patient at 38 weeks gestation is in the transition phase of labor. Contractions are
occurring every 2 minutes lasting 90 seconds, and the cervix is 9 cm dilated. The patient feels an urge
to push. What is the most appropriate nursing action?
A. Encourage the patient to begin pushing with each contraction
B. Administer an epidural bolus for pain relief
C. Prepare for an immediate vacuum-assisted delivery
D. Instruct the patient to pant or blow through the urge to push
Correct Answer: D
Rationale:
When a patient in transition (not yet fully dilated) feels the urge to push, the nurse should instruct the patient
to pant or blow through contractions to avoid pushing before complete cervical dilation. Pushing against an
incompletely dilated cervix can cause cervical edema, lacerations, and fetal distress. Pushing should only
begin once the cervix is fully dilated at 10 cm.
Q5 Question 5 of 50
A primigravida at 40 weeks gestation is receiving oxytocin for labor augmentation. The nurse notes
contractions every 1.5 minutes lasting 90 seconds with resting tone elevated between contractions. The
fetal heart rate shows late decelerations. What is the nurse's first action?
A. Discontinue the oxytocin infusion immediately
B. Increase the intravenous fluid rate
C. Reposition the patient to the left lateral position
D. Notify the healthcare provider and await orders
Correct Answer: A
NUR 254 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 3 of 23
