NSG 3500 Exam 4 | NSG 3500 Maternal Health |
Questions and Answers with Rationales
2026/2027 Update
QUESTION 1 A nurse is assessing a laboring client who is 6 centimeters dilated.
Which physiological mechanism primarily drives the progression of labor during
the first stage?
A. Voluntary maternal pushing efforts combined with abdominal muscle
contraction
B. Effective uterine contractions pulling the cervix upward over the presenting
part, aided by hydrostatic pressure of the amniotic sac
C. Voluntary relaxation of the pelvic floor muscles
D. Direct manual dilation of the cervix by the healthcare provider
CORRECT ANSWER: B
RATIONALE: Cervical effacement and dilation during the first stage of labor are
driven by uterine contractions that shorten the uterine muscle fibers and pull the
cervix upward, assisted by the hydrostatic wedge pressure of the amniotic sac.
QUESTION 2 A nurse is performing Leopold maneuvers to determine fetal
position. What is the correct sequence of these four maneuvers?
A. Palpate fundus, locate small parts/back, determine presenting part over pelvic
inlet, locate cephalic prominence
B. Listen to fetal heart tones, check cervical dilation, measure fundal height,
assess maternal vital signs
C. Palpate pubic symphysis, check maternal reflexes, evaluate uterine tone, check
perineal bulging
D. Palpate lateral abdomen, check fundal height, assess maternal bladder, check
deep tendon reflexes
CORRECT ANSWER: A
,RATIONALE: The four Leopold maneuvers follow a systematic order: first
palpating the fundus, second locating the fetal back and extremities, third
determining the presenting part over the pelvic inlet, and fourth locating the
cephalic prominence.
QUESTION 3 A nurse is auscultating fetal heart tones during labor and identifies
the point of maximum intensity in the lower maternal quadrant. The fetus is most
likely in which presentation?
A. Breech presentation
B. Transverse lie
C. Vertex presentation with a well-flexed head
D. Face presentation with extreme extension
CORRECT ANSWER: C
RATIONALE: In a vertex presentation with a well-flexed head, fetal heart tones are
typically transmitted best through the fetal back in the lower quadrant of the
maternal abdomen.
QUESTION 4 During the admission assessment of a laboring client, the nurse
notes that the presenting part is at station zero. What anatomical landmark does
station zero correspond to?
A. The maternal ischial spines
B. The iliac crests
C. The pubic symphysis
D. The perineal floor
CORRECT ANSWER: A
RATIONALE: Station measures the relationship of the lowest part of the fetal
presenting part to the imaginary plane drawn between the maternal ischial
spines, designated as station zero.
,QUESTION 5 A nurse evaluates a fetal heart rate tracing and notes uniform,
gradual decreases in the fetal heart rate mirroring contractions. How should the
nurse classify this deceleration pattern?
A. Variable decelerations
B. Late decelerations
C. Early decelerations
D. Prolonged decelerations
CORRECT ANSWER: C
RATIONALE: Early decelerations are benign mirror images of uterine contractions
caused by head compression against the pelvis, leading to increased vagal tone
without fetal compromise.
QUESTION 6 A nurse notes repetitive, non-reassuring late decelerations on the
electronic fetal monitor during active labor. What is the underlying
pathophysiological cause of late decelerations?
A. Umbilical cord compression
B. Fetal head compression
C. Uteroplacental insufficiency
D. Rapid descent of the fetus through the birth canal
CORRECT ANSWER: C
RATIONALE: Late decelerations begin after the peak of the contraction and return
to baseline after it ends, reflecting transient fetal hypoxia caused by
uteroplacental insufficiency.
QUESTION 7 Which immediate nursing intervention is indicated when a client's
fetal monitor displays severe variable decelerations due to umbilical cord
compression?
A. Prepare the client for immediate cesarean delivery without position changes
B. Reposition the client immediately into a side-lying or knee-chest position to
relieve cord pressure
, C. Administer methylergonovine intramuscularly
D. Apply fundal pressure during contractions
CORRECT ANSWER: B
RATIONALE: Variable decelerations are caused by cord compression. Changing the
mother's position shifts the fetus off the umbilical cord, promptly restoring blood
flow and oxygenation.
QUESTION 8 A nurse is caring for a client receiving an oxytocin infusion for labor
augmentation who develops uterine tachysystole. How is uterine tachysystole
formally defined?
A. More than 5 contractions in a 10-minute window averaged over a 30-minute
period
B. Contractions occurring every 10 minutes
C. Contractions lasting longer than 30 seconds
D. Contractions with an intensity below 20 millimeters of mercury
CORRECT ANSWER: A
RATIONALE: Uterine tachysystole is defined as more than five uterine
contractions in 10 minutes, averaged over a 30-minute window, which can reduce
placental perfusion and jeopardize fetal well-being.
QUESTION 9 What is the nurse's priority action when a laboring client receiving
oxytocin exhibits uterine tachysystole accompanied by category II or III fetal heart
rate decelerations?
A. Increase the oxytocin infusion rate to speed up delivery
B. Discontinue the oxytocin infusion immediately
C. Administer an intravenous bolus of potassium chloride
D. Have the client perform Valsalva pushing maneuvers
CORRECT ANSWER: B
Questions and Answers with Rationales
2026/2027 Update
QUESTION 1 A nurse is assessing a laboring client who is 6 centimeters dilated.
Which physiological mechanism primarily drives the progression of labor during
the first stage?
A. Voluntary maternal pushing efforts combined with abdominal muscle
contraction
B. Effective uterine contractions pulling the cervix upward over the presenting
part, aided by hydrostatic pressure of the amniotic sac
C. Voluntary relaxation of the pelvic floor muscles
D. Direct manual dilation of the cervix by the healthcare provider
CORRECT ANSWER: B
RATIONALE: Cervical effacement and dilation during the first stage of labor are
driven by uterine contractions that shorten the uterine muscle fibers and pull the
cervix upward, assisted by the hydrostatic wedge pressure of the amniotic sac.
QUESTION 2 A nurse is performing Leopold maneuvers to determine fetal
position. What is the correct sequence of these four maneuvers?
A. Palpate fundus, locate small parts/back, determine presenting part over pelvic
inlet, locate cephalic prominence
B. Listen to fetal heart tones, check cervical dilation, measure fundal height,
assess maternal vital signs
C. Palpate pubic symphysis, check maternal reflexes, evaluate uterine tone, check
perineal bulging
D. Palpate lateral abdomen, check fundal height, assess maternal bladder, check
deep tendon reflexes
CORRECT ANSWER: A
,RATIONALE: The four Leopold maneuvers follow a systematic order: first
palpating the fundus, second locating the fetal back and extremities, third
determining the presenting part over the pelvic inlet, and fourth locating the
cephalic prominence.
QUESTION 3 A nurse is auscultating fetal heart tones during labor and identifies
the point of maximum intensity in the lower maternal quadrant. The fetus is most
likely in which presentation?
A. Breech presentation
B. Transverse lie
C. Vertex presentation with a well-flexed head
D. Face presentation with extreme extension
CORRECT ANSWER: C
RATIONALE: In a vertex presentation with a well-flexed head, fetal heart tones are
typically transmitted best through the fetal back in the lower quadrant of the
maternal abdomen.
QUESTION 4 During the admission assessment of a laboring client, the nurse
notes that the presenting part is at station zero. What anatomical landmark does
station zero correspond to?
A. The maternal ischial spines
B. The iliac crests
C. The pubic symphysis
D. The perineal floor
CORRECT ANSWER: A
RATIONALE: Station measures the relationship of the lowest part of the fetal
presenting part to the imaginary plane drawn between the maternal ischial
spines, designated as station zero.
,QUESTION 5 A nurse evaluates a fetal heart rate tracing and notes uniform,
gradual decreases in the fetal heart rate mirroring contractions. How should the
nurse classify this deceleration pattern?
A. Variable decelerations
B. Late decelerations
C. Early decelerations
D. Prolonged decelerations
CORRECT ANSWER: C
RATIONALE: Early decelerations are benign mirror images of uterine contractions
caused by head compression against the pelvis, leading to increased vagal tone
without fetal compromise.
QUESTION 6 A nurse notes repetitive, non-reassuring late decelerations on the
electronic fetal monitor during active labor. What is the underlying
pathophysiological cause of late decelerations?
A. Umbilical cord compression
B. Fetal head compression
C. Uteroplacental insufficiency
D. Rapid descent of the fetus through the birth canal
CORRECT ANSWER: C
RATIONALE: Late decelerations begin after the peak of the contraction and return
to baseline after it ends, reflecting transient fetal hypoxia caused by
uteroplacental insufficiency.
QUESTION 7 Which immediate nursing intervention is indicated when a client's
fetal monitor displays severe variable decelerations due to umbilical cord
compression?
A. Prepare the client for immediate cesarean delivery without position changes
B. Reposition the client immediately into a side-lying or knee-chest position to
relieve cord pressure
, C. Administer methylergonovine intramuscularly
D. Apply fundal pressure during contractions
CORRECT ANSWER: B
RATIONALE: Variable decelerations are caused by cord compression. Changing the
mother's position shifts the fetus off the umbilical cord, promptly restoring blood
flow and oxygenation.
QUESTION 8 A nurse is caring for a client receiving an oxytocin infusion for labor
augmentation who develops uterine tachysystole. How is uterine tachysystole
formally defined?
A. More than 5 contractions in a 10-minute window averaged over a 30-minute
period
B. Contractions occurring every 10 minutes
C. Contractions lasting longer than 30 seconds
D. Contractions with an intensity below 20 millimeters of mercury
CORRECT ANSWER: A
RATIONALE: Uterine tachysystole is defined as more than five uterine
contractions in 10 minutes, averaged over a 30-minute window, which can reduce
placental perfusion and jeopardize fetal well-being.
QUESTION 9 What is the nurse's priority action when a laboring client receiving
oxytocin exhibits uterine tachysystole accompanied by category II or III fetal heart
rate decelerations?
A. Increase the oxytocin infusion rate to speed up delivery
B. Discontinue the oxytocin infusion immediately
C. Administer an intravenous bolus of potassium chloride
D. Have the client perform Valsalva pushing maneuvers
CORRECT ANSWER: B
