GALEN COLLEGE OF NURSING — NU 170: EXAM 4
GALEN COLLEGE OF NURSING
NU 170: MATERNAL-CHILD NURSING — EXAM 4
Academic Year 2026–2027 | Official Examination & Rationale Key
Question 1. A nurse is providing discharge teaching to a postpartum client regarding emotional
transitions after childbirth. The client asks about the difference between 'bonding' and 'attachment.'
Which statement by the nurse best explains these concepts based on maternal-newborn nursing
principles?
A. Bonding is an affectionate tie occurring over time with increased interaction, whereas attachment
occurs immediately.
B. Attachment occurs only during the first hour of life, whereas bonding requires several weeks of physical
touch.
C. Bonding is a strong emotional tie that forms soon after birth between parents and the newborn, while
attachment is an affectionate tie occurring over time with increased interaction.
D. Bonding and attachment are identical terms that describe the infant's physiological reflex to nurse.
✔ Correct Answer: Option C
Clinical Rationale: According to course materials (Chapter 9, Pg. 230), bonding is defined as a strong emotional
tie that forms soon after birth between parents and newborn, whereas attachment is an affectionate tie
occurring over time with increased interaction as parents learn the infant's communication cues.
Question 2. A nurse is assessing a postpartum client 24 hours after an uncomplicated vaginal delivery.
Upon palpation, where should the nurse expect to locate the uterine fundus, and what is its expected rate
of descent?
A. At the level of the symphysis pubis, descending 2 cm per day.
B. Midline at or near the level of the umbilicus, descending approximately 1 cm (1 finger's width) per day.
C. Two fingerbreadths above the umbilicus, remaining stationary for 5 days.
D. Non-palpable abdominally, as it fully returns to the pelvis within 24 hours.
✔ Correct Answer: Option B
Clinical Rationale: Immediately after the placenta is expelled, the uterine fundus is felt midline at or below the
umbilicus. After 24 hours, the fundus begins descending at a rate of about 1 cm (1 finger's width) per day and is
no longer palpable abdominally by the 10th day postpartum.
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, GALEN COLLEGE OF NURSING — NU 170: EXAM 4
Question 3. The nurse assesses a client's lochia on postpartum day 2. Which finding regarding lochia
character and discharge progression represents a normal physiological finding?
A. Lochia alba containing pink mucus lasting for the first 3 days.
B. Lochia serosa that is clear, colorless, and lasts up to 6 weeks.
C. Lochia rubra that is dark red, lasting for about 3 days after birth, transitioning to lochia serosa.
D. Constant trickle of bright red blood with a firm fundus, indicating normal placental site healing.
✔ Correct Answer: Option C
Clinical Rationale: Lochia rubra is dark red and lasts for about 3 days postpartum. It transitions to lochia serosa
(pink/brownish blood and mucus content) from days 3 to 10, followed by lochia alba (white, clear, or colorless
mucus) from days 10 through 21. A constant trickle of bright red blood with a firm fundus suggests laceration.
Question 4. A multiparous client reports severe uterine cramping ('afterpains') while breastfeeding her
1-day-old infant. Which order or action should the nurse clarify or avoid administering for postpartum
pain management?
A. Oral acetaminophen as prescribed for mild pain.
B. Aspirin for pain relief.
C. Application of a warm blanket or warm compress to the abdomen.
D. Encouraging early ambulation and bladder emptying.
✔ Correct Answer: Option B
Clinical Rationale: Aspirin is strictly contraindicated in the postpartum period because it interferes with blood
clotting and increases the risk of hemorrhage. Afterpains are self-limiting and decrease within 48 hours; mild
analgesics like acetaminophen or ibuprofen are preferred.
Question 5. A nurse is caring for a postpartum client from a culture that practices traditional 'hot and
cold' balance beliefs during recovery. Which nursing action demonstrates culturally competent care?
A. Insisting the client drink ice water to prevent postpartum dehydration.
B. Providing warm drinking water and accommodating preferences for hot foods such as eggs, chicken,
and rice.
C. Asking a family member to serve as the primary official medical interpreter.
D. Discouraging the consumption of broiled meat and soups during the first week postpartum.
✔ Correct Answer: Option B
Clinical Rationale: Culturally competent postpartum care respects health beliefs and dietary practices. Many
cultures observe hot-cold dietary balances; hot foods (eggs, chicken, rice, broiled meats) and warm drinking
water are preferred over cold items. Professional interpreters (not family members) should be used.
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, GALEN COLLEGE OF NURSING — NU 170: EXAM 4
Question 6. During the first 48 hours postpartum, the nurse monitors the client's cardiovascular and
renal system changes. Which physiological response is expected during this adaptation phase?
A. Severe fluid retention with a decrease in daily urine output to under 500 mL.
B. Profuse diaphoresis and diuresis reaching up to 3,000 mL/day to excrete excess fluid.
C. A rapid drop in white blood cell count to below 3,000/mm³.
D. Systemic hypertension caused by rapid increase in pelvic vascular resistance.
✔ Correct Answer: Option B
Clinical Rationale: Postpartum diuresis (increased urine excretion) and diaphoresis (profuse sweating) occur
as the body eliminates excess plasma volume expanded during pregnancy, reaching up to 3,000 mL/day. WBC
counts also elevate temporarily due to inflammation/healing.
Question 7. A client who gave birth 5 days ago reports feeling overwhelmed, tearful, and fatigued, but
expresses joy when interacting with her infant. By day 12, these feelings resolve spontaneously. How
should the nurse document this condition?
A. Postpartum psychosis requiring emergency psychiatric admission.
B. Postpartum blues, a common self-limiting emotional condition.
C. Postpartum depression requiring immediate antidepressant pharmacotherapy.
D. Major depressive disorder with delusional features.
✔ Correct Answer: Option B
Clinical Rationale: Postpartum blues is a common, self-limiting condition appearing around day 5 and lasting
up to day 10–14. The mother experiences periods of feeling let down but overall finds pleasure in her new role.
Symptoms lasting longer than 2 weeks indicate postpartum depression.
Question 8. A nurse is performing a perineal assessment on a client who underwent an episiotomy.
Which intervention is most appropriate during the first 12 to 24 hours postpartum to minimize edema
and local tissue discomfort?
A. Applying a warm sitz bath continuously for 45 minutes.
B. Encouraging vigorous perineal scrubbing with antiseptic soap.
C. Applying topical heat lamps immediately following delivery.
D. Applying an ice pack to the perineum for the first 12 to 24 hours.
✔ Correct Answer: Option D
Clinical Rationale: An ice pack is applied to the perineum for the first 12 to 24 hours postpartum to reduce
edema, bruising, and pain. After 24 hours, heat applications (such as warm sitz baths) may be used to promote
circulation and healing.
Page 3 of 17
GALEN COLLEGE OF NURSING
NU 170: MATERNAL-CHILD NURSING — EXAM 4
Academic Year 2026–2027 | Official Examination & Rationale Key
Question 1. A nurse is providing discharge teaching to a postpartum client regarding emotional
transitions after childbirth. The client asks about the difference between 'bonding' and 'attachment.'
Which statement by the nurse best explains these concepts based on maternal-newborn nursing
principles?
A. Bonding is an affectionate tie occurring over time with increased interaction, whereas attachment
occurs immediately.
B. Attachment occurs only during the first hour of life, whereas bonding requires several weeks of physical
touch.
C. Bonding is a strong emotional tie that forms soon after birth between parents and the newborn, while
attachment is an affectionate tie occurring over time with increased interaction.
D. Bonding and attachment are identical terms that describe the infant's physiological reflex to nurse.
✔ Correct Answer: Option C
Clinical Rationale: According to course materials (Chapter 9, Pg. 230), bonding is defined as a strong emotional
tie that forms soon after birth between parents and newborn, whereas attachment is an affectionate tie
occurring over time with increased interaction as parents learn the infant's communication cues.
Question 2. A nurse is assessing a postpartum client 24 hours after an uncomplicated vaginal delivery.
Upon palpation, where should the nurse expect to locate the uterine fundus, and what is its expected rate
of descent?
A. At the level of the symphysis pubis, descending 2 cm per day.
B. Midline at or near the level of the umbilicus, descending approximately 1 cm (1 finger's width) per day.
C. Two fingerbreadths above the umbilicus, remaining stationary for 5 days.
D. Non-palpable abdominally, as it fully returns to the pelvis within 24 hours.
✔ Correct Answer: Option B
Clinical Rationale: Immediately after the placenta is expelled, the uterine fundus is felt midline at or below the
umbilicus. After 24 hours, the fundus begins descending at a rate of about 1 cm (1 finger's width) per day and is
no longer palpable abdominally by the 10th day postpartum.
Page 1 of 17
, GALEN COLLEGE OF NURSING — NU 170: EXAM 4
Question 3. The nurse assesses a client's lochia on postpartum day 2. Which finding regarding lochia
character and discharge progression represents a normal physiological finding?
A. Lochia alba containing pink mucus lasting for the first 3 days.
B. Lochia serosa that is clear, colorless, and lasts up to 6 weeks.
C. Lochia rubra that is dark red, lasting for about 3 days after birth, transitioning to lochia serosa.
D. Constant trickle of bright red blood with a firm fundus, indicating normal placental site healing.
✔ Correct Answer: Option C
Clinical Rationale: Lochia rubra is dark red and lasts for about 3 days postpartum. It transitions to lochia serosa
(pink/brownish blood and mucus content) from days 3 to 10, followed by lochia alba (white, clear, or colorless
mucus) from days 10 through 21. A constant trickle of bright red blood with a firm fundus suggests laceration.
Question 4. A multiparous client reports severe uterine cramping ('afterpains') while breastfeeding her
1-day-old infant. Which order or action should the nurse clarify or avoid administering for postpartum
pain management?
A. Oral acetaminophen as prescribed for mild pain.
B. Aspirin for pain relief.
C. Application of a warm blanket or warm compress to the abdomen.
D. Encouraging early ambulation and bladder emptying.
✔ Correct Answer: Option B
Clinical Rationale: Aspirin is strictly contraindicated in the postpartum period because it interferes with blood
clotting and increases the risk of hemorrhage. Afterpains are self-limiting and decrease within 48 hours; mild
analgesics like acetaminophen or ibuprofen are preferred.
Question 5. A nurse is caring for a postpartum client from a culture that practices traditional 'hot and
cold' balance beliefs during recovery. Which nursing action demonstrates culturally competent care?
A. Insisting the client drink ice water to prevent postpartum dehydration.
B. Providing warm drinking water and accommodating preferences for hot foods such as eggs, chicken,
and rice.
C. Asking a family member to serve as the primary official medical interpreter.
D. Discouraging the consumption of broiled meat and soups during the first week postpartum.
✔ Correct Answer: Option B
Clinical Rationale: Culturally competent postpartum care respects health beliefs and dietary practices. Many
cultures observe hot-cold dietary balances; hot foods (eggs, chicken, rice, broiled meats) and warm drinking
water are preferred over cold items. Professional interpreters (not family members) should be used.
Page 2 of 17
, GALEN COLLEGE OF NURSING — NU 170: EXAM 4
Question 6. During the first 48 hours postpartum, the nurse monitors the client's cardiovascular and
renal system changes. Which physiological response is expected during this adaptation phase?
A. Severe fluid retention with a decrease in daily urine output to under 500 mL.
B. Profuse diaphoresis and diuresis reaching up to 3,000 mL/day to excrete excess fluid.
C. A rapid drop in white blood cell count to below 3,000/mm³.
D. Systemic hypertension caused by rapid increase in pelvic vascular resistance.
✔ Correct Answer: Option B
Clinical Rationale: Postpartum diuresis (increased urine excretion) and diaphoresis (profuse sweating) occur
as the body eliminates excess plasma volume expanded during pregnancy, reaching up to 3,000 mL/day. WBC
counts also elevate temporarily due to inflammation/healing.
Question 7. A client who gave birth 5 days ago reports feeling overwhelmed, tearful, and fatigued, but
expresses joy when interacting with her infant. By day 12, these feelings resolve spontaneously. How
should the nurse document this condition?
A. Postpartum psychosis requiring emergency psychiatric admission.
B. Postpartum blues, a common self-limiting emotional condition.
C. Postpartum depression requiring immediate antidepressant pharmacotherapy.
D. Major depressive disorder with delusional features.
✔ Correct Answer: Option B
Clinical Rationale: Postpartum blues is a common, self-limiting condition appearing around day 5 and lasting
up to day 10–14. The mother experiences periods of feeling let down but overall finds pleasure in her new role.
Symptoms lasting longer than 2 weeks indicate postpartum depression.
Question 8. A nurse is performing a perineal assessment on a client who underwent an episiotomy.
Which intervention is most appropriate during the first 12 to 24 hours postpartum to minimize edema
and local tissue discomfort?
A. Applying a warm sitz bath continuously for 45 minutes.
B. Encouraging vigorous perineal scrubbing with antiseptic soap.
C. Applying topical heat lamps immediately following delivery.
D. Applying an ice pack to the perineum for the first 12 to 24 hours.
✔ Correct Answer: Option D
Clinical Rationale: An ice pack is applied to the perineum for the first 12 to 24 hours postpartum to reduce
edema, bruising, and pain. After 24 hours, heat applications (such as warm sitz baths) may be used to promote
circulation and healing.
Page 3 of 17
