NURS240 Maternal-Newborn Nursing –
Comprehensive Nursing Study Guide, Original
Practice Questions & Answers, NURS 240 Exam
Preparation, Practice Test, Maternal & Newborn
Nursing Review, Pregnancy & Prenatal Care, Fetal
Development, Antepartum Complications, Labor &
Delivery, Intrapartum Nursing, Postpartum Care,
Newborn Assessment, Breastfeeding, High-Risk
Pregnancy & NCLEX-Style Clinical Judgment
Question 1: A 32-year-old primigravida at 38 weeks gestation is admitted with
a diagnosis of preeclampsia with severe features. Which assessment finding
would the nurse prioritize as indicating an increased risk of cerebral edema
and impending seizure?
A. Patellar reflex 2+
B. Blood pressure 158/92 mmHg
C. Visual disturbances and severe headache
D. Urine output of 40 mL over 2 hours
CORRECT ANSWER: C. Visual disturbances and severe headache
Rationale: Visual disturbances (e.g., blurred vision, scotomata) and a severe, unrelenting
headache are signs of increasing cerebral edema and central nervous system irritability,
which often precede an eclamptic seizure. While elevated blood pressure and decreased
urine output are critical signs of preeclampsia, the neurologic symptoms are the most
direct indicators of an impending seizure.
Question 2: A nurse is caring for a client in active labor with an epidural
infusion. The client's blood pressure drops from 120/76 mmHg to 90/50
mmHg. Which intervention should the nurse implement first?
A. Place the client in the left lateral position.
B. Increase the rate of the primary IV infusion.
C. Notify the anesthesiologist immediately.
D. Administer oxygen via a non-rebreather mask at 10 L/min.
CORRECT ANSWER: A. Place the client in the left lateral position.
Rationale: Maternal hypotension following epidural administration is common due to
sympathetic blockade. The first-line intervention is to position the client in the left
lateral position (or with a hip wedge) to displace the gravid uterus off the inferior vena
cava, thereby improving venous return and cardiac output. Increasing IV fluids and
notifying the anesthesiologist are subsequent steps if repositioning is ineffective.
,Question 3: A postpartum client who is Rh-negative with an Rh-positive infant
received Rho(D) immune globulin (RhoGAM) at 28 weeks gestation. When
should the nurse administer the second dose of RhoGAM to this client?
A. Within 72 hours of birth
B. At the 6-week postpartum visit
C. Immediately after the infant's first feeding
D. Only if the infant is Rh-negative
CORRECT ANSWER: A. Within 72 hours of birth
Rationale: An Rh-negative mother should receive Rho(D) immune globulin within 72
hours of delivery of an Rh-positive infant to prevent maternal sensitization to the Rh
antigen. This prevents the mother from developing antibodies that would affect
subsequent pregnancies.
Question 4: A nurse is assessing a newborn who is 4 hours old. The newborn's
heart rate is 180 bpm, respiratory rate is 70 breaths/min, and the infant is
exhibiting nasal flaring and grunting. What is the nurse's priority action?
A. Continue routine monitoring; these are normal transitional findings.
B. Notify the healthcare provider immediately.
C. Decrease the room temperature to reduce stress.
D. Offer a glucose water feeding to calm the infant.
CORRECT ANSWER: B. Notify the healthcare provider immediately.
Rationale: A normal newborn heart rate is 110-160 bpm and respiratory rate is 30-60
breaths/min. Tachycardia (180 bpm) combined with tachypnea (70 breaths/min), nasal
flaring, and grunting are signs of respiratory distress. The nurse must notify the
healthcare provider promptly for further evaluation and intervention.
Question 5: A client at 42 weeks gestation is undergoing a biophysical profile
(BPP). The nurse knows that which component of the BPP assesses fetal
response to sound and movement?
A. Fetal breathing movements
B. Amniotic fluid volume
C. Non-stress test (NST)
D. Gross fetal body movements
CORRECT ANSWER: C. Non-stress test (NST)
Rationale: The NST component of the BPP evaluates fetal heart rate reactivity in
response to fetal movement. A reactive NST (two accelerations of 15 bpm for 15
seconds in 20 minutes) indicates a healthy, well-oxygenated fetal nervous system.
,Question 6: A client in active labor requests pain relief. She is 6 cm dilated,
and the fetus is in a cephalic presentation at +1 station. Which of the following
is an absolute contraindication for the administration of an epidural
anesthetic?
A. History of chronic back pain
B. Maternal platelet count of 85,000/mm³
C. Maternal request for pain relief
D. Rupture of membranes 4 hours ago
CORRECT ANSWER: B. Maternal platelet count of 85,000/mm³
Rationale: A platelet count below 100,000/mm³ is a contraindication for epidural
anesthesia due to the increased risk of epidural hematoma and spinal cord compression.
Coagulopathy is a primary risk factor for this procedure.
Question 7: A nurse is performing Leopold maneuvers on a client at 38 weeks
gestation. The nurse palpates a firm, round object in the fundal region and a
hard, smooth object in the suprapubic area just above the symphysis pubis.
What is the fetal presentation?
A. Breech
B. Cephalic
C. Transverse lie
D. Shoulder presentation
CORRECT ANSWER: B. Cephalic
Rationale: A firm, round object in the fundus indicates the fetal buttocks (breech). A
hard, smooth, round object (the head) that is palpable in the suprapubic area just above
the symphysis indicates the fetus is in a vertex (cephalic) presentation with the head
engaged.
Question 8: A postpartum nurse is assessing a client who had a vaginal
delivery 2 hours ago. The nurse notes a large amount of bright red blood with
a few small clots on the perineal pad. What is the priority nursing action?
A. Document the findings as normal.
B. Massage the uterine fundus.
C. Instruct the client to void.
D. Increase the IV oxytocin rate.
CORRECT ANSWER: B. Massage the uterine fundus.
, Rationale: Bright red bleeding with clots in the immediate postpartum period is most
likely due to uterine atony. The priority intervention is to massage the uterine fundus to
stimulate uterine contractions and compress open vessels. The nurse should also assess
fundal tone and location to determine the effectiveness of the massage.
Question 9: A client who is G2P1 at 36 weeks gestation reports a sudden onset
of intense abdominal pain, vaginal bleeding, and a "rigid" abdomen. Fetal
heart rate is 90 bpm. Which condition is most likely occurring?
A. Placenta previa
B. Abruptio placentae
C. Preterm labor
D. Uterine rupture
CORRECT ANSWER: B. Abruptio placentae
Rationale: Abruptio placentae is characterized by premature separation of the placenta,
presenting with sudden, severe abdominal pain, a board-like (rigid) abdomen, and
vaginal bleeding. Fetal bradycardia (90 bpm) is a sign of fetal distress due to decreased
oxygenation and perfusion.
Question 10: A nurse is teaching a client with gestational diabetes about the
importance of blood glucose monitoring. At which time should the nurse
instruct the client to perform postprandial glucose checks?
A. 30 minutes after the start of the meal
B. 1 hour after the meal is completed
C. 2 hours after the meal is completed
D. Immediately before the next meal
CORRECT ANSWER: C. 2 hours after the meal is completed
Rationale: For clients with gestational diabetes, postprandial blood glucose monitoring is
typically recommended 2 hours after the completion of the meal. This provides an
accurate assessment of how the meal affected blood glucose levels and helps in
managing glycemic control to reduce fetal macrosomia.
Question 11: A newborn has a 1-minute Apgar score of 5. Which finding
contributes to this score?
A. Heart rate 150 bpm, Good crying
B. Heart rate 80 bpm, Grimace with suction
C. Acrocyanosis, Active motion
D. No respiratory effort, Limp tone
Comprehensive Nursing Study Guide, Original
Practice Questions & Answers, NURS 240 Exam
Preparation, Practice Test, Maternal & Newborn
Nursing Review, Pregnancy & Prenatal Care, Fetal
Development, Antepartum Complications, Labor &
Delivery, Intrapartum Nursing, Postpartum Care,
Newborn Assessment, Breastfeeding, High-Risk
Pregnancy & NCLEX-Style Clinical Judgment
Question 1: A 32-year-old primigravida at 38 weeks gestation is admitted with
a diagnosis of preeclampsia with severe features. Which assessment finding
would the nurse prioritize as indicating an increased risk of cerebral edema
and impending seizure?
A. Patellar reflex 2+
B. Blood pressure 158/92 mmHg
C. Visual disturbances and severe headache
D. Urine output of 40 mL over 2 hours
CORRECT ANSWER: C. Visual disturbances and severe headache
Rationale: Visual disturbances (e.g., blurred vision, scotomata) and a severe, unrelenting
headache are signs of increasing cerebral edema and central nervous system irritability,
which often precede an eclamptic seizure. While elevated blood pressure and decreased
urine output are critical signs of preeclampsia, the neurologic symptoms are the most
direct indicators of an impending seizure.
Question 2: A nurse is caring for a client in active labor with an epidural
infusion. The client's blood pressure drops from 120/76 mmHg to 90/50
mmHg. Which intervention should the nurse implement first?
A. Place the client in the left lateral position.
B. Increase the rate of the primary IV infusion.
C. Notify the anesthesiologist immediately.
D. Administer oxygen via a non-rebreather mask at 10 L/min.
CORRECT ANSWER: A. Place the client in the left lateral position.
Rationale: Maternal hypotension following epidural administration is common due to
sympathetic blockade. The first-line intervention is to position the client in the left
lateral position (or with a hip wedge) to displace the gravid uterus off the inferior vena
cava, thereby improving venous return and cardiac output. Increasing IV fluids and
notifying the anesthesiologist are subsequent steps if repositioning is ineffective.
,Question 3: A postpartum client who is Rh-negative with an Rh-positive infant
received Rho(D) immune globulin (RhoGAM) at 28 weeks gestation. When
should the nurse administer the second dose of RhoGAM to this client?
A. Within 72 hours of birth
B. At the 6-week postpartum visit
C. Immediately after the infant's first feeding
D. Only if the infant is Rh-negative
CORRECT ANSWER: A. Within 72 hours of birth
Rationale: An Rh-negative mother should receive Rho(D) immune globulin within 72
hours of delivery of an Rh-positive infant to prevent maternal sensitization to the Rh
antigen. This prevents the mother from developing antibodies that would affect
subsequent pregnancies.
Question 4: A nurse is assessing a newborn who is 4 hours old. The newborn's
heart rate is 180 bpm, respiratory rate is 70 breaths/min, and the infant is
exhibiting nasal flaring and grunting. What is the nurse's priority action?
A. Continue routine monitoring; these are normal transitional findings.
B. Notify the healthcare provider immediately.
C. Decrease the room temperature to reduce stress.
D. Offer a glucose water feeding to calm the infant.
CORRECT ANSWER: B. Notify the healthcare provider immediately.
Rationale: A normal newborn heart rate is 110-160 bpm and respiratory rate is 30-60
breaths/min. Tachycardia (180 bpm) combined with tachypnea (70 breaths/min), nasal
flaring, and grunting are signs of respiratory distress. The nurse must notify the
healthcare provider promptly for further evaluation and intervention.
Question 5: A client at 42 weeks gestation is undergoing a biophysical profile
(BPP). The nurse knows that which component of the BPP assesses fetal
response to sound and movement?
A. Fetal breathing movements
B. Amniotic fluid volume
C. Non-stress test (NST)
D. Gross fetal body movements
CORRECT ANSWER: C. Non-stress test (NST)
Rationale: The NST component of the BPP evaluates fetal heart rate reactivity in
response to fetal movement. A reactive NST (two accelerations of 15 bpm for 15
seconds in 20 minutes) indicates a healthy, well-oxygenated fetal nervous system.
,Question 6: A client in active labor requests pain relief. She is 6 cm dilated,
and the fetus is in a cephalic presentation at +1 station. Which of the following
is an absolute contraindication for the administration of an epidural
anesthetic?
A. History of chronic back pain
B. Maternal platelet count of 85,000/mm³
C. Maternal request for pain relief
D. Rupture of membranes 4 hours ago
CORRECT ANSWER: B. Maternal platelet count of 85,000/mm³
Rationale: A platelet count below 100,000/mm³ is a contraindication for epidural
anesthesia due to the increased risk of epidural hematoma and spinal cord compression.
Coagulopathy is a primary risk factor for this procedure.
Question 7: A nurse is performing Leopold maneuvers on a client at 38 weeks
gestation. The nurse palpates a firm, round object in the fundal region and a
hard, smooth object in the suprapubic area just above the symphysis pubis.
What is the fetal presentation?
A. Breech
B. Cephalic
C. Transverse lie
D. Shoulder presentation
CORRECT ANSWER: B. Cephalic
Rationale: A firm, round object in the fundus indicates the fetal buttocks (breech). A
hard, smooth, round object (the head) that is palpable in the suprapubic area just above
the symphysis indicates the fetus is in a vertex (cephalic) presentation with the head
engaged.
Question 8: A postpartum nurse is assessing a client who had a vaginal
delivery 2 hours ago. The nurse notes a large amount of bright red blood with
a few small clots on the perineal pad. What is the priority nursing action?
A. Document the findings as normal.
B. Massage the uterine fundus.
C. Instruct the client to void.
D. Increase the IV oxytocin rate.
CORRECT ANSWER: B. Massage the uterine fundus.
, Rationale: Bright red bleeding with clots in the immediate postpartum period is most
likely due to uterine atony. The priority intervention is to massage the uterine fundus to
stimulate uterine contractions and compress open vessels. The nurse should also assess
fundal tone and location to determine the effectiveness of the massage.
Question 9: A client who is G2P1 at 36 weeks gestation reports a sudden onset
of intense abdominal pain, vaginal bleeding, and a "rigid" abdomen. Fetal
heart rate is 90 bpm. Which condition is most likely occurring?
A. Placenta previa
B. Abruptio placentae
C. Preterm labor
D. Uterine rupture
CORRECT ANSWER: B. Abruptio placentae
Rationale: Abruptio placentae is characterized by premature separation of the placenta,
presenting with sudden, severe abdominal pain, a board-like (rigid) abdomen, and
vaginal bleeding. Fetal bradycardia (90 bpm) is a sign of fetal distress due to decreased
oxygenation and perfusion.
Question 10: A nurse is teaching a client with gestational diabetes about the
importance of blood glucose monitoring. At which time should the nurse
instruct the client to perform postprandial glucose checks?
A. 30 minutes after the start of the meal
B. 1 hour after the meal is completed
C. 2 hours after the meal is completed
D. Immediately before the next meal
CORRECT ANSWER: C. 2 hours after the meal is completed
Rationale: For clients with gestational diabetes, postprandial blood glucose monitoring is
typically recommended 2 hours after the completion of the meal. This provides an
accurate assessment of how the meal affected blood glucose levels and helps in
managing glycemic control to reduce fetal macrosomia.
Question 11: A newborn has a 1-minute Apgar score of 5. Which finding
contributes to this score?
A. Heart rate 150 bpm, Good crying
B. Heart rate 80 bpm, Grimace with suction
C. Acrocyanosis, Active motion
D. No respiratory effort, Limp tone
