NURS_104: Foundations of Maternal-Newborn and Women's
Health Nursing (Murray)Exam Prep with Detailed Rationales
Course Code: NURS_104
Course Name: Foundations of Maternal-Newborn and Women's Health Nursing
Textbook Reference: Sharon Smith Murray & Emily Slone McKinney (Elsevier)
Topic: Comprehensive Core Review & Clinical Judgment
Academic Year: 2026/2027
Question 1
A nurse is assessing a primigravid client at 10 weeks of gestation who presents
with mild nausea and complains of frequent urination. The client asks why she has
to urinate so often again when she is not even showing. Which explanation by the
nurse reflects the correct physiological adaptation to pregnancy during the first
trimester?
A. The enlarging uterus creates direct, constant mechanical pressure on the urinary
bladder.
B. Increased levels of human chorionic gonadotropin (hCG) and early pelvic
congestion increase blood flow to the bladder.
C. Gestational diabetes mellitus is causing early osmotic diuresis and glucosuria.
D. Renal glomerular filtration rates decrease sharply, causing urine accumulation.
CORRECT ANSWER: B
RATIONALE: According to Murray's framework, urinary frequency in the first
trimester is primarily caused by increased vascularity and pelvic congestion
driven by hormonal changes (such as elevated hCG levels), which increases blood
,flow to the bladder. Mechanical pressure from the enlarged uterus causes urinary
frequency later in pregnancy (the first and third trimesters), whereas the second
trimester offers temporary relief as the uterus rises out of the true pelvis.
Question 2
The labor and delivery nurse is evaluating an external electronic fetal monitoring
tracing during the first stage of active labor. The nurse observes a fetal heart rate
pattern showing a gradual decrease in rate with the lowest point (nadir) occurring
after the peak of the corresponding uterine contraction.
Based on the electronic monitoring pattern illustrated above, what underlying
pathophysiological condition does this deceleration represent?
A. Benign vagal nerve stimulation secondary to fetal head compression against the
cervix.
B. Sudden umbilical cord compression leading to acute vascular stasis.
C. Uteroplacental insufficiency reducing oxygen transfer across the
intervillous space.
D. Normal fetal reactivity reflecting intact autonomic nervous system tone.
, CORRECT ANSWER: C
RATIONALE: As shown in the visual tracing, late decelerations are
characterized by a delayed onset and recovery relative to the contraction, with the
nadir occurring after the contraction's peak. This pattern indicates uteroplacental
insufficiency, meaning the placenta is failing to deliver adequate oxygen during
uterine contractions. This is a non-reassuring sign that requires immediate
intrauterine resuscitation (position change, IV fluids, oxygen).
Question 3
A postpartum client is admitted to the mother-baby unit 2 hours after delivering a
healthy term infant. The nurse performs a fundal assessment and finds the uterus
is soft (boggy), located 2 cm above the umbilicus, and deviated to the right.
What is the immediate priority nursing action?
A. Administer a stat intramuscular dose of methylergonovine maleate.
B. Assist the client to void on the bedpan or walk to the restroom.
C. Perform vigorous, deep bimanual uterine compression massage.
D. Document the finding as a normal expected subinvolution variation.
CORRECT ANSWER: B
RATIONALE: A boggy uterus that is displaced upward and to the right of the
midline is a classic clinical indicator of uterine atony secondary to bladder
distention. A full bladder physically pushes the uterus out of its normal position
and prevents the uterine muscle fibers from contracting tightly around open blood
vessels, increasing the risk of postpartum hemorrhage. Assisting the client to
empty her bladder allows the uterus to contract effectively.
Question 4
A nurse is providing discharge instructions to a new mother who is breastfeeding
her newborn. The client expresses concern that her milk has not "come in" yet on
day 2 postpartum, and notes that her breasts contain only a yellowish, thick fluid.
How should the nurse address this infant feeding concern?
A. Advise the mother to supplement immediately with 2 oz of commercial formula
per feeding.
B. Reassure the mother that this fluid is colostrum, which is nutrient-dense
, and rich in protective immunoglobulins.
C. Inform the physician that the mother is experiencing delayed lactogenesis
secondary to endocrine failure.
D. Tell the mother to pump and dump the yellowish fluid until mature white milk
appears.
CORRECT ANSWER: B
RATIONALE: During the first 1 to 3 days postpartum, the breasts secrete
colostrum, a premilk yellowish fluid that is rich in proteins, vitamins, and high
concentrations of immunoglobulin A (IgA), which protects the newborn’s sterile
gastrointestinal tract. It is produced in small volumes suited to the newborn's tiny
stomach capacity, and mature milk transitions in by day 3 to 5.
Question 5
A client at 34 weeks of gestation presents with severe hypertension (160/110
mmHg), a persistent headache, and 3+ proteinuria. The nurse initiates an
intravenous infusion of magnesium sulfate. Which clinical assessment finding
indicates potential magnesium toxicity and requires immediate cessation of the
infusion?
A. A respiratory rate of 18 breaths per minute and clear bilateral breath sounds.
B. Absence of deep tendon reflexes (hyporeflexia, score 0) and a respiratory
rate of 10 breaths per minute.
C. A brisk, hyperactive patellar reflex tracking at 4+ with mild clonus.
D. Maternal drowsiness with a blood pressure reading of 140/90 mmHg.
CORRECT ANSWER: B
RATIONALE: Magnesium sulfate is a central nervous system depressant used
to prevent seizures in preeclampsia. The earliest sign of impending toxicity is the
loss of deep tendon reflexes (areflexia), followed closely by respiratory
depression (<12 breaths per minute), cardiac arrhythmias, and renal failure. The
nurse must stop the infusion immediately and have calcium gluconate available as
the specific antidote.
Question 6
Health Nursing (Murray)Exam Prep with Detailed Rationales
Course Code: NURS_104
Course Name: Foundations of Maternal-Newborn and Women's Health Nursing
Textbook Reference: Sharon Smith Murray & Emily Slone McKinney (Elsevier)
Topic: Comprehensive Core Review & Clinical Judgment
Academic Year: 2026/2027
Question 1
A nurse is assessing a primigravid client at 10 weeks of gestation who presents
with mild nausea and complains of frequent urination. The client asks why she has
to urinate so often again when she is not even showing. Which explanation by the
nurse reflects the correct physiological adaptation to pregnancy during the first
trimester?
A. The enlarging uterus creates direct, constant mechanical pressure on the urinary
bladder.
B. Increased levels of human chorionic gonadotropin (hCG) and early pelvic
congestion increase blood flow to the bladder.
C. Gestational diabetes mellitus is causing early osmotic diuresis and glucosuria.
D. Renal glomerular filtration rates decrease sharply, causing urine accumulation.
CORRECT ANSWER: B
RATIONALE: According to Murray's framework, urinary frequency in the first
trimester is primarily caused by increased vascularity and pelvic congestion
driven by hormonal changes (such as elevated hCG levels), which increases blood
,flow to the bladder. Mechanical pressure from the enlarged uterus causes urinary
frequency later in pregnancy (the first and third trimesters), whereas the second
trimester offers temporary relief as the uterus rises out of the true pelvis.
Question 2
The labor and delivery nurse is evaluating an external electronic fetal monitoring
tracing during the first stage of active labor. The nurse observes a fetal heart rate
pattern showing a gradual decrease in rate with the lowest point (nadir) occurring
after the peak of the corresponding uterine contraction.
Based on the electronic monitoring pattern illustrated above, what underlying
pathophysiological condition does this deceleration represent?
A. Benign vagal nerve stimulation secondary to fetal head compression against the
cervix.
B. Sudden umbilical cord compression leading to acute vascular stasis.
C. Uteroplacental insufficiency reducing oxygen transfer across the
intervillous space.
D. Normal fetal reactivity reflecting intact autonomic nervous system tone.
, CORRECT ANSWER: C
RATIONALE: As shown in the visual tracing, late decelerations are
characterized by a delayed onset and recovery relative to the contraction, with the
nadir occurring after the contraction's peak. This pattern indicates uteroplacental
insufficiency, meaning the placenta is failing to deliver adequate oxygen during
uterine contractions. This is a non-reassuring sign that requires immediate
intrauterine resuscitation (position change, IV fluids, oxygen).
Question 3
A postpartum client is admitted to the mother-baby unit 2 hours after delivering a
healthy term infant. The nurse performs a fundal assessment and finds the uterus
is soft (boggy), located 2 cm above the umbilicus, and deviated to the right.
What is the immediate priority nursing action?
A. Administer a stat intramuscular dose of methylergonovine maleate.
B. Assist the client to void on the bedpan or walk to the restroom.
C. Perform vigorous, deep bimanual uterine compression massage.
D. Document the finding as a normal expected subinvolution variation.
CORRECT ANSWER: B
RATIONALE: A boggy uterus that is displaced upward and to the right of the
midline is a classic clinical indicator of uterine atony secondary to bladder
distention. A full bladder physically pushes the uterus out of its normal position
and prevents the uterine muscle fibers from contracting tightly around open blood
vessels, increasing the risk of postpartum hemorrhage. Assisting the client to
empty her bladder allows the uterus to contract effectively.
Question 4
A nurse is providing discharge instructions to a new mother who is breastfeeding
her newborn. The client expresses concern that her milk has not "come in" yet on
day 2 postpartum, and notes that her breasts contain only a yellowish, thick fluid.
How should the nurse address this infant feeding concern?
A. Advise the mother to supplement immediately with 2 oz of commercial formula
per feeding.
B. Reassure the mother that this fluid is colostrum, which is nutrient-dense
, and rich in protective immunoglobulins.
C. Inform the physician that the mother is experiencing delayed lactogenesis
secondary to endocrine failure.
D. Tell the mother to pump and dump the yellowish fluid until mature white milk
appears.
CORRECT ANSWER: B
RATIONALE: During the first 1 to 3 days postpartum, the breasts secrete
colostrum, a premilk yellowish fluid that is rich in proteins, vitamins, and high
concentrations of immunoglobulin A (IgA), which protects the newborn’s sterile
gastrointestinal tract. It is produced in small volumes suited to the newborn's tiny
stomach capacity, and mature milk transitions in by day 3 to 5.
Question 5
A client at 34 weeks of gestation presents with severe hypertension (160/110
mmHg), a persistent headache, and 3+ proteinuria. The nurse initiates an
intravenous infusion of magnesium sulfate. Which clinical assessment finding
indicates potential magnesium toxicity and requires immediate cessation of the
infusion?
A. A respiratory rate of 18 breaths per minute and clear bilateral breath sounds.
B. Absence of deep tendon reflexes (hyporeflexia, score 0) and a respiratory
rate of 10 breaths per minute.
C. A brisk, hyperactive patellar reflex tracking at 4+ with mild clonus.
D. Maternal drowsiness with a blood pressure reading of 140/90 mmHg.
CORRECT ANSWER: B
RATIONALE: Magnesium sulfate is a central nervous system depressant used
to prevent seizures in preeclampsia. The earliest sign of impending toxicity is the
loss of deep tendon reflexes (areflexia), followed closely by respiratory
depression (<12 breaths per minute), cardiac arrhythmias, and renal failure. The
nurse must stop the infusion immediately and have calcium gluconate available as
the specific antidote.
Question 6
