NUR4545 Clinical Judgment Assessment Test Bank
Maternal-Newborn Actual Exam 2026/2027 – Complete 30
Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
SECTION A: Recognizing Cues – Antepartum & Intrapartum
Assessment (Q1–Q5)
Q1: Brenda Patton, G2P1001 at 40 2/7 weeks' gestation, is admitted for induction of
labor for post-dates pregnancy. Which assessment finding during admission indicates
the induction can safely proceed?
A. Fetal heart rate baseline of 150 with late decelerations every contraction
B. Bishop score of 8 with reactive fetal heart tracing and cephalic presentation
[CORRECT]
C. Transverse fetal lie with intact membranes
D. Maternal temperature of 38.4°C (101.1°F) with tachycardia
Correct Answer: B
Rationale: A favorable cervix (Bishop ≥6–8), reassuring fetal status, and cephalic
presentation are prerequisites for safe induction. Late decelerations, malpresentation,
and maternal fever/infection are contraindications or require stabilization first.
Q2: The nurse reviews Brenda's prenatal record and notes a positive group B
streptococcus (GBS) screen at 36 weeks. Which action is MOST important to anticipate
during her admission?
A. Administering erythromycin orally at the onset of labor
B. Obtaining a repeat vaginal culture before starting oxytocin
C. Initiating IV antibiotic prophylaxis (penicillin G) upon admission in labor [CORRECT]
D. Scheduling a cesarean birth due to GBS colonization
Correct Answer: C
Rationale: GBS-positive mothers receive IV penicillin G prophylaxis at least 4 hours
before delivery to prevent neonatal sepsis; admission in labor (or for induction) triggers
, the first dose. Oral antibiotics, repeat cultures, and automatic cesarean are incorrect
responses to GBS colonization.
Q3: During the initial assessment of Brenda, who is being induced, the nurse performs
Leopold's maneuvers. The first maneuver reveals the fetal breech in the fundus. Which
additional finding should the nurse expect if the fetus is in a normal longitudinal lie?
A. The fetal head palpated above the maternal umbilicus
B. The fetal back palpated on one side of the maternal abdomen with small parts on the
other [CORRECT]
C. The fetal head palpated in the pelvic inlet on the third maneuver
D. A ballotable fetal part moving freely above the symphysis
Correct Answer: B
Rationale: In longitudinal lie with vertex presentation, Leopold's second maneuver
palpates the fetal back along one side of the abdomen and small parts along the other.
The head should be in the fundus if breech is there (contradiction), and a ballotable part
suggests an unfixed presenting part or transverse lie.
Q4: Which fetal heart rate finding during Brenda's induction should the nurse recognize
as a Category I (normal) tracing?
A. Baseline 140, moderate variability, accelerations present, no decelerations [CORRECT]
B. Baseline 165 with absent variability and variable decelerations
C. Baseline 130 with recurrent late decelerations after each contraction
D. Baseline 150 with recurrent prolonged decelerations to 90
Correct Answer: A
Rationale: Category I requires normal baseline (110–160), moderate variability, and no
late or variable decelerations. Tachycardia with absent variability, recurrent late
decelerations, and prolonged decelerations are Category II/III patterns requiring
intervention.
Q5: The nurse obtains Brenda's vital signs before initiating oxytocin: BP 138/84, HR 96,
RR 18, temperature 37.1°C. Which finding requires the MOST immediate follow-up
before starting the infusion?
A. Blood pressure of 138/84 mm Hg
B. Temperature of 37.1°C (98.8°F)
Maternal-Newborn Actual Exam 2026/2027 – Complete 30
Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
SECTION A: Recognizing Cues – Antepartum & Intrapartum
Assessment (Q1–Q5)
Q1: Brenda Patton, G2P1001 at 40 2/7 weeks' gestation, is admitted for induction of
labor for post-dates pregnancy. Which assessment finding during admission indicates
the induction can safely proceed?
A. Fetal heart rate baseline of 150 with late decelerations every contraction
B. Bishop score of 8 with reactive fetal heart tracing and cephalic presentation
[CORRECT]
C. Transverse fetal lie with intact membranes
D. Maternal temperature of 38.4°C (101.1°F) with tachycardia
Correct Answer: B
Rationale: A favorable cervix (Bishop ≥6–8), reassuring fetal status, and cephalic
presentation are prerequisites for safe induction. Late decelerations, malpresentation,
and maternal fever/infection are contraindications or require stabilization first.
Q2: The nurse reviews Brenda's prenatal record and notes a positive group B
streptococcus (GBS) screen at 36 weeks. Which action is MOST important to anticipate
during her admission?
A. Administering erythromycin orally at the onset of labor
B. Obtaining a repeat vaginal culture before starting oxytocin
C. Initiating IV antibiotic prophylaxis (penicillin G) upon admission in labor [CORRECT]
D. Scheduling a cesarean birth due to GBS colonization
Correct Answer: C
Rationale: GBS-positive mothers receive IV penicillin G prophylaxis at least 4 hours
before delivery to prevent neonatal sepsis; admission in labor (or for induction) triggers
, the first dose. Oral antibiotics, repeat cultures, and automatic cesarean are incorrect
responses to GBS colonization.
Q3: During the initial assessment of Brenda, who is being induced, the nurse performs
Leopold's maneuvers. The first maneuver reveals the fetal breech in the fundus. Which
additional finding should the nurse expect if the fetus is in a normal longitudinal lie?
A. The fetal head palpated above the maternal umbilicus
B. The fetal back palpated on one side of the maternal abdomen with small parts on the
other [CORRECT]
C. The fetal head palpated in the pelvic inlet on the third maneuver
D. A ballotable fetal part moving freely above the symphysis
Correct Answer: B
Rationale: In longitudinal lie with vertex presentation, Leopold's second maneuver
palpates the fetal back along one side of the abdomen and small parts along the other.
The head should be in the fundus if breech is there (contradiction), and a ballotable part
suggests an unfixed presenting part or transverse lie.
Q4: Which fetal heart rate finding during Brenda's induction should the nurse recognize
as a Category I (normal) tracing?
A. Baseline 140, moderate variability, accelerations present, no decelerations [CORRECT]
B. Baseline 165 with absent variability and variable decelerations
C. Baseline 130 with recurrent late decelerations after each contraction
D. Baseline 150 with recurrent prolonged decelerations to 90
Correct Answer: A
Rationale: Category I requires normal baseline (110–160), moderate variability, and no
late or variable decelerations. Tachycardia with absent variability, recurrent late
decelerations, and prolonged decelerations are Category II/III patterns requiring
intervention.
Q5: The nurse obtains Brenda's vital signs before initiating oxytocin: BP 138/84, HR 96,
RR 18, temperature 37.1°C. Which finding requires the MOST immediate follow-up
before starting the infusion?
A. Blood pressure of 138/84 mm Hg
B. Temperature of 37.1°C (98.8°F)
