Fall Semester 2026–2027 NURS240 Maternal-Newborn Nursing Updated
2026 | 190+ Questions and Answers | NURS240 Maternal-Newborn
Nursing Comprehensive Study Guide, Practice Exam, Exam Prep Test
Bank, Pregnancy, Labor & Delivery, Postpartum Care, Newborn
Assessment, High-Risk Obstetrics, Fetal Monitoring, Neonatal Care,
Pharmacology, NCLEX-RN & Next Generation NCLEX (NGN), Detailed
Rationales and Complete Revision Material
Question 1: A primigravida at 38 weeks gestation presents with a blood
pressure of 148/92 mmHg and 3+ proteinuria. She reports a headache and
blurred vision. Which laboratory finding would be most concerning for the
development of HELLP syndrome?
A. Elevated serum creatinine
B. Elevated liver transaminases
C. Decreased platelet count
D. Increased serum uric acid
CORRECT ANSWER: C. Decreased platelet count
Rationale: HELLP syndrome is characterized by Hemolysis, Elevated Liver enzymes,
and Low Platelets. A decreasing platelet count is the most critical hematologic finding
because it indicates the severity of the syndrome and an increased risk of hemorrhage.
While elevated liver enzymes and renal impairment are present, thrombocytopenia is
the hallmark diagnostic criterion that dictates management and delivery timing.
Question 2: A nurse is caring for a patient in active labor who requests pain
relief. She has a history of opioid dependency and is currently on methadone
maintenance therapy. Which analgesic order should the nurse question?
A. Meperidine 50 mg IV
B. Morphine 2 mg IV
C. Fentanyl 50 mcg IV
D. Butorphanol 1 mg IV
CORRECT ANSWER: D. Butorphanol 1 mg IV
Rationale: Butorphanol is a mixed opioid agonist-antagonist. Administering it to a
patient on methadone (a pure agonist) can precipitate acute withdrawal syndrome by
displacing methadone from mu-receptors, causing severe pain and agitation.
Meperidine, morphine, and fentanyl are pure agonists and are acceptable, though
meperidine is generally avoided due to neurotoxic metabolites.
Question 3: A newborn is born at 32 weeks gestation in the NICU. The nurse
notes intermittent apnea, bradycardia, and desaturation. What is the priority
nursing intervention for this neonate?
,A. Administer caffeine citrate
B. Position the infant in a trendelenburg position
C. Provide tactile stimulation
D. Increase the fraction of inspired oxygen
CORRECT ANSWER: C. Provide tactile stimulation
Rationale: For a neonate experiencing an acute apneic spell, the priority intervention is
gentle tactile stimulation to stimulate the respiratory center and remind the infant to
breathe. While caffeine citrate is a treatment for apnea of prematurity, it is not an
emergency intervention; increasing oxygen may be necessary, but stimulation is the
immediate first step.
Question 4: A patient at 39 weeks gestation is admitted for induction of labor.
The Bishop score is 4. The provider orders a cervical ripening agent. Which
medication should the nurse anticipate?
A. Oxytocin infusion
B. Magnesium sulfate
C. Dinoprostone insert
D. Misoprostol oral
CORRECT ANSWER: C. Dinoprostone insert
Rationale: A low Bishop score (under 6) indicates an unripe cervix and requires cervical
ripening before induction. Dinoprostone (prostaglandin E2) is a standard FDA-approved
cervical ripening agent for an unfavorable cervix. Oxytocin is used for augmentation
after ripening. Misoprostol is used but is typically administered vaginally and has a
higher risk profile. Magnesium sulfate is a tocolytic.
Question 5: Which fetal presentation is associated with the largest biparietal
diameter, potentially leading to cephalopelvic disproportion?
A. Breech
B. Vertex
C. Transverse lie
D. Face
CORRECT ANSWER: B. Vertex
Rationale: In a vertex (cephalic) presentation with a flexed head, the biparietal diameter
(9.5 cm) is the widest transverse diameter of the fetal head, which must navigate the
pelvic inlet. In face or brow presentation, the head is extended, presenting a wider
suboccipitobregmatic or mentovertical diameter, but vertex is the most common and
classic cause of disproportion.
,Question 6: A nurse is providing education to a breastfeeding mother who has
mastitis. Which statement indicates a need for further teaching?
A. "I should continue breastfeeding on the affected side."
B. "I can use warm compresses before feeding."
C. "I should stop breastfeeding to give the breast time to heal."
D. "I may need to complete a course of antibiotics."
CORRECT ANSWER: C. "I should stop breastfeeding to give the breast time to
heal."
Rationale: Continuing to breastfeed or pump on the affected side is essential to prevent
engorgement and abscess formation; mastitis is not a contraindication to breastfeeding.
Antibiotics are often necessary, and warm compresses aid in milk flow.
Question 7: A postpartum patient reports sudden shortness of breath, sharp
pleuritic chest pain, and hemoptysis 48 hours after a cesarean delivery. Which
condition is the highest priority?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Mastitis
CORRECT ANSWER: B. Pulmonary embolism
Rationale: Sudden onset of pleuritic chest pain, dyspnea, and hemoptysis in a
postpartum patient are classic signs of a pulmonary embolism (PE). The postpartum
state is hypercoagulable, and a cesarean delivery increases this risk. This is a life-
threatening emergency requiring immediate intervention. Atelectasis and pneumonia
present more gradually with fever.
Question 8: During a non-stress test, a nurse observes a fetal heart rate
baseline of 130 bpm with moderate variability and two accelerations of 15 bpm
lasting 15 seconds in a 20-minute period. How should the nurse interpret this
result?
A. Non-reactive
B. Reactive
C. Atypical
D. Positive
CORRECT ANSWER: B. Reactive
Rationale: A reactive NST is defined as two or more accelerations (15 bpm above
baseline for 15 seconds for a term infant) within a 20-minute window with moderate
variability. This indicates fetal well-being and an intact autonomic nervous system.
, Question 9: A patient in labor is receiving intravenous oxytocin. The nurse
notes the uterine contractions are occurring every 2 minutes, lasting 90
seconds, with a resting tone of 30 mmHg. What is the priority action?
A. Increase the infusion rate by 1 mU/min
B. Administer terbutaline
C. Decrease or stop the oxytocin infusion
D. Reposition the patient
CORRECT ANSWER: C. Decrease or stop the oxytocin infusion
Rationale: This contraction pattern indicates uterine hyperstimulation/tachysystole (too
many contractions, prolonged duration, and elevated resting tone). This compromises
uteroplacental perfusion. The priority action is to immediately stop or decrease the
oxytocin infusion to allow the uterus to relax.
Question 10: A newborn has Apgar scores of 4 at 1 minute and 7 at 5 minutes.
What is the priority nursing action at the 1-minute mark?
A. Administer naloxone
B. Initiate positive pressure ventilation
C. Provide blow-by oxygen
D. Dry and stimulate the infant
CORRECT ANSWER: B. Initiate positive pressure ventilation
Rationale: An Apgar score of 4 at 1 minute indicates the infant is in moderate respiratory
distress. The first steps of resuscitation (warming, drying, positioning, suctioning) should
have already been performed. Positive pressure ventilation (PPV) is the primary
intervention for apnea or inadequate breathing in a newborn.
Question 11: A pregnant patient at 34 weeks gestation has a positive Group B
Streptococcus (GBS) urine culture. What is the appropriate intrapartum
prophylaxis regimen?
A. Penicillin G every 4 hours until delivery
B. Ampicillin 2 g IV load, then 1 g IV every 4 hours
C. Clindamycin 900 mg IV every 8 hours
D. Gentamicin 5 mg/kg IV daily
CORRECT ANSWER: B. Ampicillin 2 g IV load, then 1 g IV every 4 hours
Rationale: Patients with GBS bacteriuria in pregnancy should receive intrapartum
prophylaxis. The standard regimen is a loading dose of ampicillin 2 g IV, followed by 1 g
2026 | 190+ Questions and Answers | NURS240 Maternal-Newborn
Nursing Comprehensive Study Guide, Practice Exam, Exam Prep Test
Bank, Pregnancy, Labor & Delivery, Postpartum Care, Newborn
Assessment, High-Risk Obstetrics, Fetal Monitoring, Neonatal Care,
Pharmacology, NCLEX-RN & Next Generation NCLEX (NGN), Detailed
Rationales and Complete Revision Material
Question 1: A primigravida at 38 weeks gestation presents with a blood
pressure of 148/92 mmHg and 3+ proteinuria. She reports a headache and
blurred vision. Which laboratory finding would be most concerning for the
development of HELLP syndrome?
A. Elevated serum creatinine
B. Elevated liver transaminases
C. Decreased platelet count
D. Increased serum uric acid
CORRECT ANSWER: C. Decreased platelet count
Rationale: HELLP syndrome is characterized by Hemolysis, Elevated Liver enzymes,
and Low Platelets. A decreasing platelet count is the most critical hematologic finding
because it indicates the severity of the syndrome and an increased risk of hemorrhage.
While elevated liver enzymes and renal impairment are present, thrombocytopenia is
the hallmark diagnostic criterion that dictates management and delivery timing.
Question 2: A nurse is caring for a patient in active labor who requests pain
relief. She has a history of opioid dependency and is currently on methadone
maintenance therapy. Which analgesic order should the nurse question?
A. Meperidine 50 mg IV
B. Morphine 2 mg IV
C. Fentanyl 50 mcg IV
D. Butorphanol 1 mg IV
CORRECT ANSWER: D. Butorphanol 1 mg IV
Rationale: Butorphanol is a mixed opioid agonist-antagonist. Administering it to a
patient on methadone (a pure agonist) can precipitate acute withdrawal syndrome by
displacing methadone from mu-receptors, causing severe pain and agitation.
Meperidine, morphine, and fentanyl are pure agonists and are acceptable, though
meperidine is generally avoided due to neurotoxic metabolites.
Question 3: A newborn is born at 32 weeks gestation in the NICU. The nurse
notes intermittent apnea, bradycardia, and desaturation. What is the priority
nursing intervention for this neonate?
,A. Administer caffeine citrate
B. Position the infant in a trendelenburg position
C. Provide tactile stimulation
D. Increase the fraction of inspired oxygen
CORRECT ANSWER: C. Provide tactile stimulation
Rationale: For a neonate experiencing an acute apneic spell, the priority intervention is
gentle tactile stimulation to stimulate the respiratory center and remind the infant to
breathe. While caffeine citrate is a treatment for apnea of prematurity, it is not an
emergency intervention; increasing oxygen may be necessary, but stimulation is the
immediate first step.
Question 4: A patient at 39 weeks gestation is admitted for induction of labor.
The Bishop score is 4. The provider orders a cervical ripening agent. Which
medication should the nurse anticipate?
A. Oxytocin infusion
B. Magnesium sulfate
C. Dinoprostone insert
D. Misoprostol oral
CORRECT ANSWER: C. Dinoprostone insert
Rationale: A low Bishop score (under 6) indicates an unripe cervix and requires cervical
ripening before induction. Dinoprostone (prostaglandin E2) is a standard FDA-approved
cervical ripening agent for an unfavorable cervix. Oxytocin is used for augmentation
after ripening. Misoprostol is used but is typically administered vaginally and has a
higher risk profile. Magnesium sulfate is a tocolytic.
Question 5: Which fetal presentation is associated with the largest biparietal
diameter, potentially leading to cephalopelvic disproportion?
A. Breech
B. Vertex
C. Transverse lie
D. Face
CORRECT ANSWER: B. Vertex
Rationale: In a vertex (cephalic) presentation with a flexed head, the biparietal diameter
(9.5 cm) is the widest transverse diameter of the fetal head, which must navigate the
pelvic inlet. In face or brow presentation, the head is extended, presenting a wider
suboccipitobregmatic or mentovertical diameter, but vertex is the most common and
classic cause of disproportion.
,Question 6: A nurse is providing education to a breastfeeding mother who has
mastitis. Which statement indicates a need for further teaching?
A. "I should continue breastfeeding on the affected side."
B. "I can use warm compresses before feeding."
C. "I should stop breastfeeding to give the breast time to heal."
D. "I may need to complete a course of antibiotics."
CORRECT ANSWER: C. "I should stop breastfeeding to give the breast time to
heal."
Rationale: Continuing to breastfeed or pump on the affected side is essential to prevent
engorgement and abscess formation; mastitis is not a contraindication to breastfeeding.
Antibiotics are often necessary, and warm compresses aid in milk flow.
Question 7: A postpartum patient reports sudden shortness of breath, sharp
pleuritic chest pain, and hemoptysis 48 hours after a cesarean delivery. Which
condition is the highest priority?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Mastitis
CORRECT ANSWER: B. Pulmonary embolism
Rationale: Sudden onset of pleuritic chest pain, dyspnea, and hemoptysis in a
postpartum patient are classic signs of a pulmonary embolism (PE). The postpartum
state is hypercoagulable, and a cesarean delivery increases this risk. This is a life-
threatening emergency requiring immediate intervention. Atelectasis and pneumonia
present more gradually with fever.
Question 8: During a non-stress test, a nurse observes a fetal heart rate
baseline of 130 bpm with moderate variability and two accelerations of 15 bpm
lasting 15 seconds in a 20-minute period. How should the nurse interpret this
result?
A. Non-reactive
B. Reactive
C. Atypical
D. Positive
CORRECT ANSWER: B. Reactive
Rationale: A reactive NST is defined as two or more accelerations (15 bpm above
baseline for 15 seconds for a term infant) within a 20-minute window with moderate
variability. This indicates fetal well-being and an intact autonomic nervous system.
, Question 9: A patient in labor is receiving intravenous oxytocin. The nurse
notes the uterine contractions are occurring every 2 minutes, lasting 90
seconds, with a resting tone of 30 mmHg. What is the priority action?
A. Increase the infusion rate by 1 mU/min
B. Administer terbutaline
C. Decrease or stop the oxytocin infusion
D. Reposition the patient
CORRECT ANSWER: C. Decrease or stop the oxytocin infusion
Rationale: This contraction pattern indicates uterine hyperstimulation/tachysystole (too
many contractions, prolonged duration, and elevated resting tone). This compromises
uteroplacental perfusion. The priority action is to immediately stop or decrease the
oxytocin infusion to allow the uterus to relax.
Question 10: A newborn has Apgar scores of 4 at 1 minute and 7 at 5 minutes.
What is the priority nursing action at the 1-minute mark?
A. Administer naloxone
B. Initiate positive pressure ventilation
C. Provide blow-by oxygen
D. Dry and stimulate the infant
CORRECT ANSWER: B. Initiate positive pressure ventilation
Rationale: An Apgar score of 4 at 1 minute indicates the infant is in moderate respiratory
distress. The first steps of resuscitation (warming, drying, positioning, suctioning) should
have already been performed. Positive pressure ventilation (PPV) is the primary
intervention for apnea or inadequate breathing in a newborn.
Question 11: A pregnant patient at 34 weeks gestation has a positive Group B
Streptococcus (GBS) urine culture. What is the appropriate intrapartum
prophylaxis regimen?
A. Penicillin G every 4 hours until delivery
B. Ampicillin 2 g IV load, then 1 g IV every 4 hours
C. Clindamycin 900 mg IV every 8 hours
D. Gentamicin 5 mg/kg IV daily
CORRECT ANSWER: B. Ampicillin 2 g IV load, then 1 g IV every 4 hours
Rationale: Patients with GBS bacteriuria in pregnancy should receive intrapartum
prophylaxis. The standard regimen is a loading dose of ampicillin 2 g IV, followed by 1 g
