Galen College of Nursing - NUR 230 Maternal Exam 3 - 2026/2027 Update 100% Correct - Verified
NUR 230 Maternal Exam 3 | Questions and Answers |
2026/2027 Update | 100% Correct
Galen College of Nursing - Maternal-Newborn Nursing Examination
75-Question Comprehensive Exam - Aligned with ACOG, AWHONN, AAP, and CDC 2026-2027 Guidelines
Total Questions: 75 Cognitive Distribution: 30% Recall | 50% Application | 20% Analysis
Format: NCLEX-style 4-option MCQ Question Style: 80% Scenario-based | 20% Direct Recall
Sections: 7 (Postpartum & Newborn) Verification: 100% Correct - Galen NUR 230 Aligned
Section 1: Postpartum Foundations and Physiologic Adaptations
Involution, Lochia, and Systemic Changes - Q1-Q12
Q1: A postpartum client who delivered vaginally 24 hours ago asks the nurse when her uterus will return
to its nonpregnant size. The nurse understands that complete uterine involution typically takes how many
weeks?
A. 2 weeks
B. 4 weeks
C. 6 weeks [CORRECT]
D. 10 weeks
Correct Answer: C
Rationale: Complete uterine involution requires approximately 6 weeks. By day 1 postpartum the fundus is at the
umbilicus; it descends approximately 1 cm/day (or 1 fingerbreadth per day) and by day 10 it is no longer palpable above
the symphysis. Full return to nonpregnant size and shape, with endometrial regeneration, completes by 6 weeks per
ACOG. The other timeframes (2, 4, 10 weeks) are incorrect: 2 weeks is too early (fundus still palpable), 4 weeks is partial
involution only, and 10 weeks exceeds the normal physiologic timeline. Test-taking strategy: associate 'involution' with
the classic 6-week postpartum recovery period.
Q2: The nurse assesses lochia on a client who delivered 8 hours ago. Which finding should the nurse
document as expected for this stage of lochia?
A. Pink, serous discharge with a slight fleshy odor
B. Dark red discharge with a fleshy odor and small clots [CORRECT]
C. Yellowish-white discharge with no odor
D. Bright red discharge saturated through two perineal pads in 30 minutes
Correct Answer: B
Rationale: Lochia rubra is the expected lochia for the first 1-3 days postpartum: dark red, fleshy odor (not foul), and may
contain small clots (<1 cm). Option A describes lochia serosa (days 3-10). Option C describes lochia alba (after day 10).
Option D describes hemorrhage requiring immediate intervention (saturating one pad in <1 hour is abnormal). The fleshy
odor is normal; a foul, fishy odor signals infection. Test-taking strategy: link the time frame (8 hours) to rubra (days 1-3)
and recall that small clots are normal early postpartum.
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,Galen College of Nursing - NUR 230 Maternal Exam 3 - 2026/2027 Update 100% Correct - Verified
Q3: A client is 5 days postpartum after an uncomplicated vaginal delivery. The nurse observes a
pinkish-brown, serosanguineous vaginal discharge. Which action should the nurse take?
A. Notify the provider immediately for possible hemorrhage
B. Document the finding as normal lochia serosa [CORRECT]
C. Assess for retained placental fragments
D. Administer oxytocin to strengthen uterine tone
Correct Answer: B
Rationale: Lochia serosa is the normal second stage of lochia (days 3-10 postpartum) and is pinkish-brown,
serosanguineous, and thinner than rubra. This is an expected finding requiring documentation only. Hemorrhage (option
A) would present with bright red, heavy flow and a bogus uterus. Retained fragments (option C) cause persistent rubra or
sudden hemorrhage. Oxytocin (option D) is given for atony or hemorrhage, not for normal serosa. Test-taking strategy:
match the timing (day 5) to lochia serosa stage; remember the rubra-serosa-alba progression.
Q4: Which statement by a postpartum client on day 14 indicates to the nurse that lochia involution is
progressing normally?
A. "My discharge is still dark red and has small clots."
B. "My discharge is yellowish-white and has a mild odor." [CORRECT]
C. "My discharge is bright red and heavier than yesterday."
D. "My discharge is pink and watery with no odor."
Correct Answer: B
Rationale: Lochia alba is the expected lochia from approximately day 10 through 6 weeks postpartum: yellowish-white,
contains leukocytes and decidual cells, with a mild (non-foul) odor. By day 14, lochia should have transitioned from
serosa to alba. Option A suggests rubra persists beyond day 3, indicating subinvolution or retained fragments. Option C
indicates late hemorrhage requiring urgent assessment. Option D describes serosa, which should have transitioned to alba
by day 14. Test-taking strategy: recall the sequence rubra (1-3 d) → serosa (3-10 d) → alba (10 d-6 wk).
Q5: The nurse is teaching a postpartum client about cervical changes. Which statement by the client
indicates that teaching has been effective?
A. "My cervix will return to its original shape and size within 2 weeks."
B. "The external cervical os will remain slit-like after vaginal delivery."
C. "My cervix will regain its firm, nonpregnant tone within 1 week." [CORRECT]
D. "Cervical changes only occur with cesarean deliveries."
Correct Answer: C
Rationale: The cervix gradually regains its firm, nonpregnant tone within approximately 1 week postpartum; however,
the external os never fully returns to its nulliparous circular shape — it remains a transverse slit after vaginal delivery.
Option A is incorrect because the cervix does not return to its exact original shape. Option B incorrectly states it remains
slit-like — it actually changes from circular (nulliparous) to slit-like (parous). Option D is incorrect because cervical
changes occur in all postpartum clients regardless of delivery route. Test-taking strategy: remember that the cervix is
'firm by week 1' and the os is 'slit-shaped for life' after vaginal birth.
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, Galen College of Nursing - NUR 230 Maternal Exam 3 - 2026/2027 Update 100% Correct - Verified
Q6: A postpartum client who delivered 12 hours ago has a blood pressure of 146/92 mmHg and a heart
rate of 88 bpm. The client's prenatal BP was 118/74 mmHg. Which interpretation is most accurate?
A. The client is developing postpartum preeclampsia and needs magnesium sulfate immediately.
B. Mild postpartum hypertension is common due to increased cardiac output and should be monitored.
C. Cardiac output decreases immediately after delivery, causing rebound hypertension.
D. The client's vital signs are abnormal and require immediate provider notification.
Correct Answer: B
Rationale: Cardiac output remains elevated for the first 24-48 hours postpartum, and blood pressure may be slightly
higher due to extracellular fluid mobilization. A single mild elevation (146/92) without symptoms (headache, vision
changes, epigastric pain, reflexes) warrants continued monitoring, not immediate magnesium. Preeclampsia (option A)
requires persistent BP ≥140/90 with proteinuria or end-organ dysfunction. Option C is incorrect — cardiac output does
not decrease immediately; it peaks at 1 hour postpartum. Option D overreacts to a mild elevation without other signs.
Test-taking strategy: 'mild + asymptomatic + first 24h = monitor'; reserve magnesium for persistent elevations with
symptoms or proteinuria.
Q7: A postpartum client's hemoglobin is 9.8 g/dL on day 2 postpartum; the predelivery hemoglobin was
11.5 g/dL. The client is asymptomatic. Which action should the nurse take?
A. Prepare to administer a 2-unit packed red blood cell transfusion immediately.
B. Document the finding as an expected physiologic change and reinforce iron-rich nutrition
teaching. [CORRECT]
C. Notify the provider of suspected acute hemorrhage and request an ultrasound.
D. Restrict oral intake and begin continuous vital sign monitoring every 15 minutes.
Correct Answer: B
Rationale: A 1-2 g/dL drop in hemoglobin is normal postpartum due to blood loss (average 500 mL vaginal; 1000 mL
cesarean) and hemodilution from IV fluids. The postpartum body also begins diuresis by day 2-5, which can transiently
affect values. A hemoglobin of 9.8 without symptoms (tachycardia, hypotension, dyspnea, pallor) requires only
documentation and iron supplementation teaching. Transfusion (option A) is for symptomatic anemia or Hgb <7. Option
C is unnecessary without active bleeding or unstable vitals. Option D is excessive for an asymptomatic, stable client.
Test-taking strategy: '1-2 g/dL drop + asymptomatic = expected; <7 or symptomatic = transfuse.'
Q8: The nurse is assessing the respiratory status of a postpartum client who delivered 6 hours ago. The
respiratory rate is 20 breaths/min. Which interpretation by the nurse is correct?
A. Tachypnea; suspect pulmonary embolism and obtain a STAT D-dimer.
B. Bradypnea; assess for opioid-induced respiratory depression.
C. Normal respiratory rate; the postpartum respiratory rate remains 12-20 due to decreased intra-abdominal
pressure.
D. Abnormal; respiratory rate should increase postpartum due to increased cardiac output.
Correct Answer: C
Rationale: Respiratory rate typically returns to the normal nonpregnant range (12-20 breaths/min) shortly after delivery
because the diaphragm is no longer compressed by the gravid uterus. A rate of 20 is at the upper limit of normal. Option
A overreacts — pulmonary embolism would present with tachypnea >24, dyspnea, chest pain, hemoptysis. Option B is
incorrect because bradypnea is <12. Option D is incorrect because respiratory rate does not increase postpartum — it
normalizes. Test-taking strategy: 'postpartum respiratory rate normalizes; persistent >24 or <12 = abnormal.'
Page 3
NUR 230 Maternal Exam 3 | Questions and Answers |
2026/2027 Update | 100% Correct
Galen College of Nursing - Maternal-Newborn Nursing Examination
75-Question Comprehensive Exam - Aligned with ACOG, AWHONN, AAP, and CDC 2026-2027 Guidelines
Total Questions: 75 Cognitive Distribution: 30% Recall | 50% Application | 20% Analysis
Format: NCLEX-style 4-option MCQ Question Style: 80% Scenario-based | 20% Direct Recall
Sections: 7 (Postpartum & Newborn) Verification: 100% Correct - Galen NUR 230 Aligned
Section 1: Postpartum Foundations and Physiologic Adaptations
Involution, Lochia, and Systemic Changes - Q1-Q12
Q1: A postpartum client who delivered vaginally 24 hours ago asks the nurse when her uterus will return
to its nonpregnant size. The nurse understands that complete uterine involution typically takes how many
weeks?
A. 2 weeks
B. 4 weeks
C. 6 weeks [CORRECT]
D. 10 weeks
Correct Answer: C
Rationale: Complete uterine involution requires approximately 6 weeks. By day 1 postpartum the fundus is at the
umbilicus; it descends approximately 1 cm/day (or 1 fingerbreadth per day) and by day 10 it is no longer palpable above
the symphysis. Full return to nonpregnant size and shape, with endometrial regeneration, completes by 6 weeks per
ACOG. The other timeframes (2, 4, 10 weeks) are incorrect: 2 weeks is too early (fundus still palpable), 4 weeks is partial
involution only, and 10 weeks exceeds the normal physiologic timeline. Test-taking strategy: associate 'involution' with
the classic 6-week postpartum recovery period.
Q2: The nurse assesses lochia on a client who delivered 8 hours ago. Which finding should the nurse
document as expected for this stage of lochia?
A. Pink, serous discharge with a slight fleshy odor
B. Dark red discharge with a fleshy odor and small clots [CORRECT]
C. Yellowish-white discharge with no odor
D. Bright red discharge saturated through two perineal pads in 30 minutes
Correct Answer: B
Rationale: Lochia rubra is the expected lochia for the first 1-3 days postpartum: dark red, fleshy odor (not foul), and may
contain small clots (<1 cm). Option A describes lochia serosa (days 3-10). Option C describes lochia alba (after day 10).
Option D describes hemorrhage requiring immediate intervention (saturating one pad in <1 hour is abnormal). The fleshy
odor is normal; a foul, fishy odor signals infection. Test-taking strategy: link the time frame (8 hours) to rubra (days 1-3)
and recall that small clots are normal early postpartum.
Page 1
,Galen College of Nursing - NUR 230 Maternal Exam 3 - 2026/2027 Update 100% Correct - Verified
Q3: A client is 5 days postpartum after an uncomplicated vaginal delivery. The nurse observes a
pinkish-brown, serosanguineous vaginal discharge. Which action should the nurse take?
A. Notify the provider immediately for possible hemorrhage
B. Document the finding as normal lochia serosa [CORRECT]
C. Assess for retained placental fragments
D. Administer oxytocin to strengthen uterine tone
Correct Answer: B
Rationale: Lochia serosa is the normal second stage of lochia (days 3-10 postpartum) and is pinkish-brown,
serosanguineous, and thinner than rubra. This is an expected finding requiring documentation only. Hemorrhage (option
A) would present with bright red, heavy flow and a bogus uterus. Retained fragments (option C) cause persistent rubra or
sudden hemorrhage. Oxytocin (option D) is given for atony or hemorrhage, not for normal serosa. Test-taking strategy:
match the timing (day 5) to lochia serosa stage; remember the rubra-serosa-alba progression.
Q4: Which statement by a postpartum client on day 14 indicates to the nurse that lochia involution is
progressing normally?
A. "My discharge is still dark red and has small clots."
B. "My discharge is yellowish-white and has a mild odor." [CORRECT]
C. "My discharge is bright red and heavier than yesterday."
D. "My discharge is pink and watery with no odor."
Correct Answer: B
Rationale: Lochia alba is the expected lochia from approximately day 10 through 6 weeks postpartum: yellowish-white,
contains leukocytes and decidual cells, with a mild (non-foul) odor. By day 14, lochia should have transitioned from
serosa to alba. Option A suggests rubra persists beyond day 3, indicating subinvolution or retained fragments. Option C
indicates late hemorrhage requiring urgent assessment. Option D describes serosa, which should have transitioned to alba
by day 14. Test-taking strategy: recall the sequence rubra (1-3 d) → serosa (3-10 d) → alba (10 d-6 wk).
Q5: The nurse is teaching a postpartum client about cervical changes. Which statement by the client
indicates that teaching has been effective?
A. "My cervix will return to its original shape and size within 2 weeks."
B. "The external cervical os will remain slit-like after vaginal delivery."
C. "My cervix will regain its firm, nonpregnant tone within 1 week." [CORRECT]
D. "Cervical changes only occur with cesarean deliveries."
Correct Answer: C
Rationale: The cervix gradually regains its firm, nonpregnant tone within approximately 1 week postpartum; however,
the external os never fully returns to its nulliparous circular shape — it remains a transverse slit after vaginal delivery.
Option A is incorrect because the cervix does not return to its exact original shape. Option B incorrectly states it remains
slit-like — it actually changes from circular (nulliparous) to slit-like (parous). Option D is incorrect because cervical
changes occur in all postpartum clients regardless of delivery route. Test-taking strategy: remember that the cervix is
'firm by week 1' and the os is 'slit-shaped for life' after vaginal birth.
Page 2
, Galen College of Nursing - NUR 230 Maternal Exam 3 - 2026/2027 Update 100% Correct - Verified
Q6: A postpartum client who delivered 12 hours ago has a blood pressure of 146/92 mmHg and a heart
rate of 88 bpm. The client's prenatal BP was 118/74 mmHg. Which interpretation is most accurate?
A. The client is developing postpartum preeclampsia and needs magnesium sulfate immediately.
B. Mild postpartum hypertension is common due to increased cardiac output and should be monitored.
C. Cardiac output decreases immediately after delivery, causing rebound hypertension.
D. The client's vital signs are abnormal and require immediate provider notification.
Correct Answer: B
Rationale: Cardiac output remains elevated for the first 24-48 hours postpartum, and blood pressure may be slightly
higher due to extracellular fluid mobilization. A single mild elevation (146/92) without symptoms (headache, vision
changes, epigastric pain, reflexes) warrants continued monitoring, not immediate magnesium. Preeclampsia (option A)
requires persistent BP ≥140/90 with proteinuria or end-organ dysfunction. Option C is incorrect — cardiac output does
not decrease immediately; it peaks at 1 hour postpartum. Option D overreacts to a mild elevation without other signs.
Test-taking strategy: 'mild + asymptomatic + first 24h = monitor'; reserve magnesium for persistent elevations with
symptoms or proteinuria.
Q7: A postpartum client's hemoglobin is 9.8 g/dL on day 2 postpartum; the predelivery hemoglobin was
11.5 g/dL. The client is asymptomatic. Which action should the nurse take?
A. Prepare to administer a 2-unit packed red blood cell transfusion immediately.
B. Document the finding as an expected physiologic change and reinforce iron-rich nutrition
teaching. [CORRECT]
C. Notify the provider of suspected acute hemorrhage and request an ultrasound.
D. Restrict oral intake and begin continuous vital sign monitoring every 15 minutes.
Correct Answer: B
Rationale: A 1-2 g/dL drop in hemoglobin is normal postpartum due to blood loss (average 500 mL vaginal; 1000 mL
cesarean) and hemodilution from IV fluids. The postpartum body also begins diuresis by day 2-5, which can transiently
affect values. A hemoglobin of 9.8 without symptoms (tachycardia, hypotension, dyspnea, pallor) requires only
documentation and iron supplementation teaching. Transfusion (option A) is for symptomatic anemia or Hgb <7. Option
C is unnecessary without active bleeding or unstable vitals. Option D is excessive for an asymptomatic, stable client.
Test-taking strategy: '1-2 g/dL drop + asymptomatic = expected; <7 or symptomatic = transfuse.'
Q8: The nurse is assessing the respiratory status of a postpartum client who delivered 6 hours ago. The
respiratory rate is 20 breaths/min. Which interpretation by the nurse is correct?
A. Tachypnea; suspect pulmonary embolism and obtain a STAT D-dimer.
B. Bradypnea; assess for opioid-induced respiratory depression.
C. Normal respiratory rate; the postpartum respiratory rate remains 12-20 due to decreased intra-abdominal
pressure.
D. Abnormal; respiratory rate should increase postpartum due to increased cardiac output.
Correct Answer: C
Rationale: Respiratory rate typically returns to the normal nonpregnant range (12-20 breaths/min) shortly after delivery
because the diaphragm is no longer compressed by the gravid uterus. A rate of 20 is at the upper limit of normal. Option
A overreacts — pulmonary embolism would present with tachypnea >24, dyspnea, chest pain, hemoptysis. Option B is
incorrect because bradypnea is <12. Option D is incorrect because respiratory rate does not increase postpartum — it
normalizes. Test-taking strategy: 'postpartum respiratory rate normalizes; persistent >24 or <12 = abnormal.'
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