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NSG 3500
Maternal Health Nursing
— Examination 4 Review —
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━
Comprehensive Questions & Verified Solutions
2026/2027 Academic Cycle
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
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Institution: Galen College of Nursing
Course: NSG 3500 — Maternal Health Nursing
Exam: Examination 4
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
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, Abstract
This comprehensive examination review document for NSG 3500 Maternal Health Nursing —
Examination 4 encompasses 50 practice questions distributed across ten critical domains of newborn
care. The content addresses newborn physiological transition and cardiopulmonary adaptation at
birth, including fetal-to-neonatal circulatory changes and the closure of the foramen ovale, ductus
arteriosus, and ductus venosus. Assessment domains cover APGAR scoring methodology, New Ballard
Score gestational age assessment, and comprehensive newborn physical examination techniques.
Thermoregulation principles emphasize brown fat metabolism, cold stress prevention, and respiratory
support interventions including NRP resuscitation algorithms. Newborn nutrition content includes
breastfeeding advantages, feeding assessment, stooling and voiding expectations, and common
lactation challenges. Medication and prophylaxis topics address vitamin K administration,
erythromycin ophthalmic prophylaxis, hepatitis B vaccination, and newborn screening protocols.
Common variations and complications include physiologic and pathologic jaundice, hypoglycemia
management, and birth injury differentiation. High-risk newborn care addresses preterm, post-term,
SGA, and LGA infant management along with NICU family-centered care. Parent education
emphasizes safe sleep practices, car seat safety, and discharge readiness criteria. Cultural and
psychosocial considerations explore diverse postpartum traditions, health disparities, and trauma-
informed care approaches. Interprofessional collaboration content highlights NRP team roles,
TeamSTEPPS communication strategies, and perinatal safety bundles. Each question includes
detailed rationales citing current guidelines from AWHONN, AAP, ACOG, CDC, WHO, and
authoritative maternal-newborn nursing textbooks.
Keywords: Newborn Transition, APGAR Scoring, Thermoregulation, Neonatal Jaundice, Preterm
Newborn Care, Newborn Nutrition
Table of Contents
Domain 1: Newborn Physiological Transition & Adaptation ........................................... 3
Domain 2: Newborn Assessment & APGAR/Ballard Scoring ........................................... 4
Domain 3: Thermoregulation & Respiratory Support ..................................................... 6
Domain 4: Newborn Nutrition & Feeding ........................................................................ 7
Domain 5: Newborn Medications & Prophylaxis ............................................................. 8
Domain 6: Common Newborn Variations & Complications .......................................... 10
Domain 7: High-Risk Newborn Care .............................................................................. 11
Domain 8: Parent Education & Discharge Planning .......................................................13
Domain 9: Cultural & Psychosocial Considerations in Newborn Care ............................14
Domain 10: Interprofessional Collaboration in Maternal-Newborn Health ...................16
References ..................................................................................................................... 18
, Domain 1: Newborn Physiological Transition & Adaptation
1. A nurse is explaining fetal-to-neonatal circulatory transition to nursing students. Which statement
accurately describes the functional closure of the foramen ovale at birth?
A) It closes due to decreased oxygen saturation in the neonate
B) It closes because increased left atrial pressure pushes the septum primum against the septum
secundum
C) It closes as prostaglandin levels increase after birth
D) It closes because the ductus arteriosus constricts first, redirecting blood flow
Answer: B) It closes because increased left atrial pressure pushes the septum primum
against the septum secundum
Rationale: At birth, clamping the umbilical cord increases systemic vascular resistance, raising left
atrial pressure, while the first breath inflates the lungs and decreases pulmonary vascular resistance,
lowering right atrial pressure. This pressure reversal functionally closes the foramen ovale by pushing
the septum primum against the septum secundum (Perry et al., 2023). Anatomical closure occurs over
months. Increased oxygen (not decreased) and decreased prostaglandins facilitate ductus arteriosus
closure, not foramen ovale closure (AWHONN, 2022).
2. A newborn is experiencing cold stress after delivery. The nurse understands that which sequence of
events correctly describes the cold stress cascade?
A) Hypoglycemia → metabolic acidosis → increased O₂ consumption → surfactant depletion
B) Increased O₂ consumption → depleted brown fat → metabolic acidosis → hypoglycemia →
surfactant depletion → respiratory distress
C) Surfactant depletion → respiratory distress → increased O₂ consumption → brown fat
depletion
D) Metabolic acidosis → hypoglycemia → brown fat depletion → increased O₂ consumption
Answer: B) Increased O₂ consumption → depleted brown fat → metabolic acidosis →
hypoglycemia → surfactant depletion → respiratory distress
Rationale: Cold stress triggers increased oxygen consumption as the newborn attempts to generate
heat through non-shivering thermogenesis (brown fat metabolism). When brown fat is depleted, the
infant develops metabolic acidosis from anaerobic metabolism, followed by hypoglycemia as glycogen
stores are exhausted. Acidosis and hypoglycemia lead to surfactant inactivation and ultimately
respiratory distress (Hockenberry & Wilson, 2023; Perry et al., 2023). This cascade underscores the
critical importance of preventing cold stress immediately after birth.
3. A term newborn of a diabetic mother (IDM) is screened for hypoglycemia 1 hour after birth. The
blood glucose is 32 mg/dL and the infant is asymptomatic. What is the priority nursing action?
A) Administer IV dextrose D₁₀W 2 mL/kg bolus immediately
B) Breastfeed or formula feed the infant and recheck glucose in 1 hour
C) Continue routine monitoring; this value is normal for a term newborn
D) Place the infant under a radiant warmer and recheck in 2 hours
Answer: B) Breastfeed or formula feed the infant and recheck glucose in 1 hour
Rationale: For asymptomatic at-risk infants (such as IDMs, SGA, LGA, preterm) with blood glucose
below screening thresholds (<36-40 mg/dL), the recommended approach is to feed the infant and
recheck glucose in 1 hour (AAP Committee on Fetus and Newborn, 2023). IV dextrose is reserved for
symptomatic hypoglycemia (<40 mg/dL with symptoms) or when feeding fails to improve glucose
levels. A glucose of 32 mg/dL in an at-risk asymptomatic infant warrants intervention, not continued
routine monitoring alone (Perry et al., 2023).
4. A nurse is assessing a newborn and notes a swollen area on the head that does not cross the sagittal
suture line. The mother asks what this is. Which response by the nurse is most accurate?
A) "This is caput succedaneum, which is diffuse edema that crosses suture lines and resolves in a
few days."
━━━━━
NSG 3500
Maternal Health Nursing
— Examination 4 Review —
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━
Comprehensive Questions & Verified Solutions
2026/2027 Academic Cycle
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━
Institution: Galen College of Nursing
Course: NSG 3500 — Maternal Health Nursing
Exam: Examination 4
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━
, Abstract
This comprehensive examination review document for NSG 3500 Maternal Health Nursing —
Examination 4 encompasses 50 practice questions distributed across ten critical domains of newborn
care. The content addresses newborn physiological transition and cardiopulmonary adaptation at
birth, including fetal-to-neonatal circulatory changes and the closure of the foramen ovale, ductus
arteriosus, and ductus venosus. Assessment domains cover APGAR scoring methodology, New Ballard
Score gestational age assessment, and comprehensive newborn physical examination techniques.
Thermoregulation principles emphasize brown fat metabolism, cold stress prevention, and respiratory
support interventions including NRP resuscitation algorithms. Newborn nutrition content includes
breastfeeding advantages, feeding assessment, stooling and voiding expectations, and common
lactation challenges. Medication and prophylaxis topics address vitamin K administration,
erythromycin ophthalmic prophylaxis, hepatitis B vaccination, and newborn screening protocols.
Common variations and complications include physiologic and pathologic jaundice, hypoglycemia
management, and birth injury differentiation. High-risk newborn care addresses preterm, post-term,
SGA, and LGA infant management along with NICU family-centered care. Parent education
emphasizes safe sleep practices, car seat safety, and discharge readiness criteria. Cultural and
psychosocial considerations explore diverse postpartum traditions, health disparities, and trauma-
informed care approaches. Interprofessional collaboration content highlights NRP team roles,
TeamSTEPPS communication strategies, and perinatal safety bundles. Each question includes
detailed rationales citing current guidelines from AWHONN, AAP, ACOG, CDC, WHO, and
authoritative maternal-newborn nursing textbooks.
Keywords: Newborn Transition, APGAR Scoring, Thermoregulation, Neonatal Jaundice, Preterm
Newborn Care, Newborn Nutrition
Table of Contents
Domain 1: Newborn Physiological Transition & Adaptation ........................................... 3
Domain 2: Newborn Assessment & APGAR/Ballard Scoring ........................................... 4
Domain 3: Thermoregulation & Respiratory Support ..................................................... 6
Domain 4: Newborn Nutrition & Feeding ........................................................................ 7
Domain 5: Newborn Medications & Prophylaxis ............................................................. 8
Domain 6: Common Newborn Variations & Complications .......................................... 10
Domain 7: High-Risk Newborn Care .............................................................................. 11
Domain 8: Parent Education & Discharge Planning .......................................................13
Domain 9: Cultural & Psychosocial Considerations in Newborn Care ............................14
Domain 10: Interprofessional Collaboration in Maternal-Newborn Health ...................16
References ..................................................................................................................... 18
, Domain 1: Newborn Physiological Transition & Adaptation
1. A nurse is explaining fetal-to-neonatal circulatory transition to nursing students. Which statement
accurately describes the functional closure of the foramen ovale at birth?
A) It closes due to decreased oxygen saturation in the neonate
B) It closes because increased left atrial pressure pushes the septum primum against the septum
secundum
C) It closes as prostaglandin levels increase after birth
D) It closes because the ductus arteriosus constricts first, redirecting blood flow
Answer: B) It closes because increased left atrial pressure pushes the septum primum
against the septum secundum
Rationale: At birth, clamping the umbilical cord increases systemic vascular resistance, raising left
atrial pressure, while the first breath inflates the lungs and decreases pulmonary vascular resistance,
lowering right atrial pressure. This pressure reversal functionally closes the foramen ovale by pushing
the septum primum against the septum secundum (Perry et al., 2023). Anatomical closure occurs over
months. Increased oxygen (not decreased) and decreased prostaglandins facilitate ductus arteriosus
closure, not foramen ovale closure (AWHONN, 2022).
2. A newborn is experiencing cold stress after delivery. The nurse understands that which sequence of
events correctly describes the cold stress cascade?
A) Hypoglycemia → metabolic acidosis → increased O₂ consumption → surfactant depletion
B) Increased O₂ consumption → depleted brown fat → metabolic acidosis → hypoglycemia →
surfactant depletion → respiratory distress
C) Surfactant depletion → respiratory distress → increased O₂ consumption → brown fat
depletion
D) Metabolic acidosis → hypoglycemia → brown fat depletion → increased O₂ consumption
Answer: B) Increased O₂ consumption → depleted brown fat → metabolic acidosis →
hypoglycemia → surfactant depletion → respiratory distress
Rationale: Cold stress triggers increased oxygen consumption as the newborn attempts to generate
heat through non-shivering thermogenesis (brown fat metabolism). When brown fat is depleted, the
infant develops metabolic acidosis from anaerobic metabolism, followed by hypoglycemia as glycogen
stores are exhausted. Acidosis and hypoglycemia lead to surfactant inactivation and ultimately
respiratory distress (Hockenberry & Wilson, 2023; Perry et al., 2023). This cascade underscores the
critical importance of preventing cold stress immediately after birth.
3. A term newborn of a diabetic mother (IDM) is screened for hypoglycemia 1 hour after birth. The
blood glucose is 32 mg/dL and the infant is asymptomatic. What is the priority nursing action?
A) Administer IV dextrose D₁₀W 2 mL/kg bolus immediately
B) Breastfeed or formula feed the infant and recheck glucose in 1 hour
C) Continue routine monitoring; this value is normal for a term newborn
D) Place the infant under a radiant warmer and recheck in 2 hours
Answer: B) Breastfeed or formula feed the infant and recheck glucose in 1 hour
Rationale: For asymptomatic at-risk infants (such as IDMs, SGA, LGA, preterm) with blood glucose
below screening thresholds (<36-40 mg/dL), the recommended approach is to feed the infant and
recheck glucose in 1 hour (AAP Committee on Fetus and Newborn, 2023). IV dextrose is reserved for
symptomatic hypoglycemia (<40 mg/dL with symptoms) or when feeding fails to improve glucose
levels. A glucose of 32 mg/dL in an at-risk asymptomatic infant warrants intervention, not continued
routine monitoring alone (Perry et al., 2023).
4. A nurse is assessing a newborn and notes a swollen area on the head that does not cross the sagittal
suture line. The mother asks what this is. Which response by the nurse is most accurate?
A) "This is caput succedaneum, which is diffuse edema that crosses suture lines and resolves in a
few days."
