NSG 3500 EXAM 4B COMPLETE STUDY
SUITE | 150 HIGH-YIELD MATERNAL-
NEWBORN NCLEX-STYLE PRACTICE
QUESTIONS & DETAILED RATIONALES
(MASTER BUNDLE)
Master your maternal-newborn nursing
curriculum with this comprehensive bundle of
150 high-yield practice questions specifically
tailored to the NSG 3500 Exam 4B blueprint.
Every single entry contains highly accurate,
NCLEX-style clinical scenarios covering
preeclampsia, fetal monitoring interpretation,
postpartum hemorrhages, and complex
neonatal transitions. Each question features
distinct, fully separated correct answer and
detailed rationale blocks written entirely in bold-
italic format for instant, seamless highlighting
and optimized Stuvia upload compatibility.
1.A nurse is assessing a newborn at 1 minute and 5 minutes after birth. The newborn
has a heart rate of 110 bpm, a loud cry, some flexion of the extremities, sneezing in
, response to a bulb syringe, and a pink body with blue extremities. Which APGAR score
should the nurse assign at the 1-minute mark?
A) 6
B) 7
C) 8
D) 9
Correct Answer: C) 8
Rationale: The APGAR scoring system evaluates five categories: heart rate,
respiratory effort, muscle tone, reflex irritability, and color. This infant scores 2
points for heart rate (>100 bpm), 2 points for respiratory effort (loud cry), 1 point
for muscle tone (some flexion), 2 points for reflex irritability (sneezing), and 1
point for color (acrocyanosis). Total score = 2+2+1+2+1 = 8.
2. A nurse is caring for a client at 36 weeks gestation who presents with a blood pressure
of 162/112 mmHg, severe right upper quadrant (RUQ) abdominal pain, and blurred
vision. Which condition should the nurse suspect?
A) Placenta previa
B) Preeclampsia with severe features
C) Ectopic pregnancy
D) Abruptio placentae
Correct Answer: B) Preeclampsia with severe features
Rationale: Preeclampsia with severe features is characterized by a blood
pressure reading of 160/110 mmHg or higher on two occasions, alongside organ
perfusion abnormalities. Severe right upper quadrant or epigastric pain indicates
hepatic involvement (liver ischemia or capsule stretch), while blurred vision
signals central nervous system irritability. [1]
3. While monitoring a client in active labor, the nurse notes a fetal heart rate pattern
showing late decelerations on the electronic fetal monitor. Which intervention is the
nurse's priority action?
A) Increase the rate of the oxytocin (Pitocin) infusion.
B) Assist the client into a lithotomy position.
C) Turn the client onto her left side.
D) Administer a rapid bolus of oral fluids.
Correct Answer: C) Turn the client onto her left side.
Rationale: Late decelerations indicate uteroplacental insufficiency, which
deprives the fetus of oxygen during contractions. Turning the client to her left
side relieves pressure on the vena cava, optimizes maternal cardiac output, and
, improves blood flow to the placenta. The oxytocin infusion should be stopped,
not increased. [1]
4. A nurse is preparing to care for a newborn diagnosed with a congenital diaphragmatic
hernia. Which clinical finding should the nurse anticipate during the initial physical
assessment?
A) Hyperactive bowel sounds in all four abdominal quadrants
B) A scaphoid abdomen and bowel sounds heard in the thoracic cavity
C) Symmetrical chest expansion and clear bilateral lung sounds
D) A prominent, barrel-shaped abdomen with clear breath sounds
Correct Answer: B) A scaphoid abdomen and bowel sounds heard in the thoracic
cavity
Rationale: In a congenital diaphragmatic hernia, abdominal organs herniate
through a defect in the diaphragm into the thoracic cavity. This displacement
leaves the abdominal cavity empty, causing a sunken or scaphoid abdomen,
while the presence of the intestines in the chest causes audible thoracic bowel
sounds and severe respiratory distress.
5. A nurse is reinforcing teaching with a postpartum client about preventing heat loss in
her newborn. The nurse explains that putting a cap on the baby's head prevents heat
loss through which mechanism?
A) Radiation
B) Conduction
C) Convection
D) Evaporation
Correct Answer: C) Convection
Rationale: Convection is the flow of heat from the body surface to the cooler
surrounding air currents. Because a newborn has a large head surface area
relative to their body mass, significant heat is lost to air currents. Placing a cap
on the newborn's head minimizes this exposed surface area and limits convective
heat loss.
6. A nurse is caring for a newborn who is large for gestational age (LGA) and whose
mother has gestational diabetes. Which clinical sign should the nurse monitor for most
closely during the first few hours of life?
, A) Hypernatremia
B) Jitteriness and tremors
C) High-pitched, continuous crying
D) Paradoxical chest movements [1]
Correct Answer: B) Jitteriness and tremors
Rationale: Newborns of diabetic mothers are at high risk for hypoglycemia due to
sudden hyperinsulinism after birth. Jitteriness, tremors, lethargy, and a weak cry
are classic physical signs of low neonatal blood glucose levels.
7. A client at 32 weeks gestation is diagnosed with preterm labor. The provider orders
betamethasone to be administered intramuscularly. The nurse knows that this
medication is given to achieve which therapeutic outcome?
A) To suppress active uterine contractions
B) To stimulate surfactant production in the fetal lungs
C) To prevent maternal seizures associated with severe hypertension
D) To reduce the risk of maternal postpartum hemorrhage
Correct Answer: B) To stimulate surfactant production in the fetal lungs
Rationale: Betamethasone is a corticosteroid given to pregnant individuals in
preterm labor to accelerate fetal lung maturity. It stimulates the synthesis and
release of surfactant, reducing the risk and severity of respiratory distress
syndrome (RDS) in the preterm newborn. [1]
8. A nurse is reviewing the electronic fetal monitoring (EFM) strip of a client in active labor
and notes a pattern of variable decelerations. The nurse recognizes that variable
decelerations are primarily caused by which mechanism?
A) Fetal head compression
B) Uteroplacental insufficiency
C) Umbilical cord compression
D) Maternal hypotension
Correct Answer: C) Umbilical cord compression
Rationale: Variable decelerations are characterized by a sharp, abrupt drop in the
fetal heart rate and are caused by umbilical cord compression. Head compression
causes early decelerations, while uteroplacental insufficiency causes late
decelerations. [1]
SUITE | 150 HIGH-YIELD MATERNAL-
NEWBORN NCLEX-STYLE PRACTICE
QUESTIONS & DETAILED RATIONALES
(MASTER BUNDLE)
Master your maternal-newborn nursing
curriculum with this comprehensive bundle of
150 high-yield practice questions specifically
tailored to the NSG 3500 Exam 4B blueprint.
Every single entry contains highly accurate,
NCLEX-style clinical scenarios covering
preeclampsia, fetal monitoring interpretation,
postpartum hemorrhages, and complex
neonatal transitions. Each question features
distinct, fully separated correct answer and
detailed rationale blocks written entirely in bold-
italic format for instant, seamless highlighting
and optimized Stuvia upload compatibility.
1.A nurse is assessing a newborn at 1 minute and 5 minutes after birth. The newborn
has a heart rate of 110 bpm, a loud cry, some flexion of the extremities, sneezing in
, response to a bulb syringe, and a pink body with blue extremities. Which APGAR score
should the nurse assign at the 1-minute mark?
A) 6
B) 7
C) 8
D) 9
Correct Answer: C) 8
Rationale: The APGAR scoring system evaluates five categories: heart rate,
respiratory effort, muscle tone, reflex irritability, and color. This infant scores 2
points for heart rate (>100 bpm), 2 points for respiratory effort (loud cry), 1 point
for muscle tone (some flexion), 2 points for reflex irritability (sneezing), and 1
point for color (acrocyanosis). Total score = 2+2+1+2+1 = 8.
2. A nurse is caring for a client at 36 weeks gestation who presents with a blood pressure
of 162/112 mmHg, severe right upper quadrant (RUQ) abdominal pain, and blurred
vision. Which condition should the nurse suspect?
A) Placenta previa
B) Preeclampsia with severe features
C) Ectopic pregnancy
D) Abruptio placentae
Correct Answer: B) Preeclampsia with severe features
Rationale: Preeclampsia with severe features is characterized by a blood
pressure reading of 160/110 mmHg or higher on two occasions, alongside organ
perfusion abnormalities. Severe right upper quadrant or epigastric pain indicates
hepatic involvement (liver ischemia or capsule stretch), while blurred vision
signals central nervous system irritability. [1]
3. While monitoring a client in active labor, the nurse notes a fetal heart rate pattern
showing late decelerations on the electronic fetal monitor. Which intervention is the
nurse's priority action?
A) Increase the rate of the oxytocin (Pitocin) infusion.
B) Assist the client into a lithotomy position.
C) Turn the client onto her left side.
D) Administer a rapid bolus of oral fluids.
Correct Answer: C) Turn the client onto her left side.
Rationale: Late decelerations indicate uteroplacental insufficiency, which
deprives the fetus of oxygen during contractions. Turning the client to her left
side relieves pressure on the vena cava, optimizes maternal cardiac output, and
, improves blood flow to the placenta. The oxytocin infusion should be stopped,
not increased. [1]
4. A nurse is preparing to care for a newborn diagnosed with a congenital diaphragmatic
hernia. Which clinical finding should the nurse anticipate during the initial physical
assessment?
A) Hyperactive bowel sounds in all four abdominal quadrants
B) A scaphoid abdomen and bowel sounds heard in the thoracic cavity
C) Symmetrical chest expansion and clear bilateral lung sounds
D) A prominent, barrel-shaped abdomen with clear breath sounds
Correct Answer: B) A scaphoid abdomen and bowel sounds heard in the thoracic
cavity
Rationale: In a congenital diaphragmatic hernia, abdominal organs herniate
through a defect in the diaphragm into the thoracic cavity. This displacement
leaves the abdominal cavity empty, causing a sunken or scaphoid abdomen,
while the presence of the intestines in the chest causes audible thoracic bowel
sounds and severe respiratory distress.
5. A nurse is reinforcing teaching with a postpartum client about preventing heat loss in
her newborn. The nurse explains that putting a cap on the baby's head prevents heat
loss through which mechanism?
A) Radiation
B) Conduction
C) Convection
D) Evaporation
Correct Answer: C) Convection
Rationale: Convection is the flow of heat from the body surface to the cooler
surrounding air currents. Because a newborn has a large head surface area
relative to their body mass, significant heat is lost to air currents. Placing a cap
on the newborn's head minimizes this exposed surface area and limits convective
heat loss.
6. A nurse is caring for a newborn who is large for gestational age (LGA) and whose
mother has gestational diabetes. Which clinical sign should the nurse monitor for most
closely during the first few hours of life?
, A) Hypernatremia
B) Jitteriness and tremors
C) High-pitched, continuous crying
D) Paradoxical chest movements [1]
Correct Answer: B) Jitteriness and tremors
Rationale: Newborns of diabetic mothers are at high risk for hypoglycemia due to
sudden hyperinsulinism after birth. Jitteriness, tremors, lethargy, and a weak cry
are classic physical signs of low neonatal blood glucose levels.
7. A client at 32 weeks gestation is diagnosed with preterm labor. The provider orders
betamethasone to be administered intramuscularly. The nurse knows that this
medication is given to achieve which therapeutic outcome?
A) To suppress active uterine contractions
B) To stimulate surfactant production in the fetal lungs
C) To prevent maternal seizures associated with severe hypertension
D) To reduce the risk of maternal postpartum hemorrhage
Correct Answer: B) To stimulate surfactant production in the fetal lungs
Rationale: Betamethasone is a corticosteroid given to pregnant individuals in
preterm labor to accelerate fetal lung maturity. It stimulates the synthesis and
release of surfactant, reducing the risk and severity of respiratory distress
syndrome (RDS) in the preterm newborn. [1]
8. A nurse is reviewing the electronic fetal monitoring (EFM) strip of a client in active labor
and notes a pattern of variable decelerations. The nurse recognizes that variable
decelerations are primarily caused by which mechanism?
A) Fetal head compression
B) Uteroplacental insufficiency
C) Umbilical cord compression
D) Maternal hypotension
Correct Answer: C) Umbilical cord compression
Rationale: Variable decelerations are characterized by a sharp, abrupt drop in the
fetal heart rate and are caused by umbilical cord compression. Head compression
causes early decelerations, while uteroplacental insufficiency causes late
decelerations. [1]
