RNSG 1517 A Maternity Exam | Complete
Questions with Correct Answers and
Detailed Rationales - Latest Update 2026
1. A primigravida at 39 weeks gestation is admitted in active labor. The fetal heart rate baseline is 140
bpm with moderate variability. Which finding requires immediate nursing intervention?
A. Fetal heart rate accelerations with fetal movement
B. Late decelerations with contractions
C. Early decelerations with contractions
D. Variable decelerations that resolve with repositioning
Answer: B. Late decelerations with contractions
Rationale: Late decelerations indicate uteroplacental insufficiency and are a sign of fetal
hypoxia. They require immediate intervention including changing maternal position,
administering oxygen, and notifying the healthcare provider. Early decelerations are benign and
associated with head compression. Variable decelerations are associated with cord compression
and often resolve with repositioning.
2. A postpartum patient who delivered 2 hours ago has a fundus firm at the umbilicus with moderate
lochia rubra. The nurse notes a steady trickle of bright red bleeding despite a firm fundus. What
should the nurse suspect?
A. Uterine atony
B. Retained placental fragments
C. Vaginal or cervical laceration
D. Normal postpartum bleeding
Answer: C. Vaginal or cervical laceration
Rationale: A firm fundus with continued bright red bleeding suggests a laceration of the vagina
or cervix. Uterine atony would present with a boggy fundus. Retained placental fragments
typically cause delayed bleeding with clots. The nurse should perform a thorough assessment
and notify the provider for possible repair.
3. A patient at 32 weeks gestation with gestational diabetes reports increased fetal movement
followed by decreased movement. What should the nurse do first?
,A. Administer glucose to the patient
B. Perform a non-stress test
C. Instruct the patient to perform a kick count
D. Notify the healthcare provider immediately
Answer: C. Instruct the patient to perform a kick count
Rationale: Decreased fetal movement may indicate fetal distress. The nurse should first instruct
the patient to perform a kick count (counting fetal movements for 1-2 hours). Fewer than 10
movements in 2 hours warrants further evaluation. A non-stress test may be ordered based on
the results. Glucose administration is not the first action unless hypoglycemia is suspected.
4. The nurse is assessing a newborn 5 minutes after birth. The infant has a heart rate of 100 bpm,
irregular respirations, some flexion of extremities, a cry, and pink body with blue extremities. What is
the Apgar score?
A. 5
B. 6
C. 7
D. 8
Answer: C. 7
Rationale: Apgar scoring: Heart rate (100 bpm = 1 point), Respiratory effort (irregular = 1 point),
Muscle tone (some flexion = 1 point), Reflex irritability (cry = 2 points), Color (pink body/blue
extremities = 2 points). Total = 7. A score of 7-10 indicates the infant is in good condition.
Resuscitation is not typically needed for a score of 7.
5. A patient at 28 weeks gestation presents with headache, blurred vision, and epigastric pain. Blood
pressure is 160/100 mmHg and urine protein is 3+. What condition should the nurse suspect?
A. Gestational hypertension
B. Chronic hypertension
C. Severe preeclampsia
D. HELLP syndrome
Answer: C. Severe preeclampsia
Rationale: Severe preeclampsia is characterized by blood pressure ≥160/110 mmHg with
proteinuria and symptoms including headache, visual disturbances, and epigastric pain. These
symptoms indicate end-organ damage. HELLP syndrome includes hemolysis, elevated liver
enzymes, and low platelets, but the presentation is similar. The nurse should initiate seizure
precautions and notify the provider immediately.
,6. The nurse is caring for a patient in active labor with an epidural. The patient's blood pressure drops
from 120/80 to 90/50 mmHg. What should the nurse do first?
A. Increase the epidural infusion rate
B. Place the patient in a left lateral position
C. Administer IV epinephrine
D. Notify the anesthesiologist
Answer: B. Place the patient in a left lateral position
Rationale: Epidural anesthesia can cause hypotension due to sympathetic blockade. The first
action is to place the patient in a left lateral position to improve venous return and increase
blood pressure. IV fluids may be increased, and ephedrine may be administered if hypotension
persists. The anesthesiologist should be notified, but positioning is the priority.
7. A postpartum patient reports severe, sharp perineal pain that is unrelieved by oral analgesics. The
nurse notes a firm, painful area on the perineum. What should the nurse suspect?
A. Normal episiotomy pain
B. Perineal hematoma
C. Infection
D. Hemorrhoids
Answer: B. Perineal hematoma
Rationale: Severe, sharp perineal pain unrelieved by analgesics with a firm, painful area suggests
a perineal hematoma. This is a complication of vaginal delivery, often associated with
episiotomy or laceration. The nurse should assess the size of the hematoma, monitor vital signs,
and notify the provider for possible evacuation. Normal episiotomy pain should be relieved by
analgesics.
8. A patient at 40 weeks gestation is receiving oxytocin for induction of labor. The nurse notes
contractions every 2 minutes lasting 90 seconds with a resting tone of 25 mmHg. What should the
nurse do?
A. Continue the oxytocin infusion at the current rate
B. Increase the oxytocin infusion rate
C. Stop the oxytocin infusion and notify the healthcare provider
D. Decrease the oxytocin infusion rate
Answer: C. Stop the oxytocin infusion and notify the healthcare provider
Rationale: The contraction frequency and duration indicate uterine hyperstimulation, which can
compromise fetal oxygenation. The resting tone of 25 mmHg is elevated (normal <20 mmHg).
The nurse should stop the oxytocin infusion, place the patient in a left lateral position, administer
oxygen, and notify the provider. The oxytocin should not be restarted without provider orders.
, 9. A newborn is placed skin-to-skin with the mother immediately after birth. Which finding indicates
the newborn is in the second period of reactivity?
A. Heart rate of 180 bpm with grunting
B. Heart rate of 140 bpm with rapid, irregular respirations
C. Heart rate of 120 bpm with regular respirations and alertness
D. Heart rate of 100 bpm with slow, irregular respirations
Answer: C. Heart rate of 120 bpm with regular respirations and alertness
Rationale: The second period of reactivity occurs 2-8 hours after birth and is characterized by the
newborn being alert, responsive, with a heart rate of 120-140 bpm and regular respirations. The
first period of reactivity (immediately after birth) includes heart rate of 160-180 bpm with rapid,
irregular respirations. The period of decreased responsiveness follows with heart rate of 100-120
bpm and slow, irregular respirations.
10. A patient at 34 weeks gestation with preterm premature rupture of membranes (PPROM) reports
a fever of 38.5°C and foul-smelling vaginal discharge. What condition should the nurse suspect?
A. Chorioamnionitis
B. Normal PPROM
C. Urinary tract infection
D. Vaginal infection
Answer: A. Chorioamnionitis
Rationale: Chorioamnionitis (intra-amniotic infection) is suspected with fever ≥38°C, foul-
smelling discharge, maternal tachycardia, fetal tachycardia, and uterine tenderness. It is a
complication of PPROM and requires immediate treatment with antibiotics and delivery. The
nurse should notify the provider, obtain blood and amniotic fluid cultures, and prepare for
delivery if indicated.
11. The nurse is teaching a patient about signs of labor. Which sign indicates true labor?
A. Contractions that are irregular and relieved by walking
B. Contractions that increase in frequency, duration, and intensity
C. Pain localized to the lower abdomen and back
D. Contractions that decrease in intensity with rest
Answer: B. Contractions that increase in frequency, duration, and intensity
Rationale: True labor is characterized by contractions that increase in frequency, duration, and
intensity, with progressive cervical dilation and effacement. False labor contractions are
irregular, do not change in intensity, and are relieved by walking or rest. Pain in true labor often
radiates from the back to the front (lower abdomen).
Questions with Correct Answers and
Detailed Rationales - Latest Update 2026
1. A primigravida at 39 weeks gestation is admitted in active labor. The fetal heart rate baseline is 140
bpm with moderate variability. Which finding requires immediate nursing intervention?
A. Fetal heart rate accelerations with fetal movement
B. Late decelerations with contractions
C. Early decelerations with contractions
D. Variable decelerations that resolve with repositioning
Answer: B. Late decelerations with contractions
Rationale: Late decelerations indicate uteroplacental insufficiency and are a sign of fetal
hypoxia. They require immediate intervention including changing maternal position,
administering oxygen, and notifying the healthcare provider. Early decelerations are benign and
associated with head compression. Variable decelerations are associated with cord compression
and often resolve with repositioning.
2. A postpartum patient who delivered 2 hours ago has a fundus firm at the umbilicus with moderate
lochia rubra. The nurse notes a steady trickle of bright red bleeding despite a firm fundus. What
should the nurse suspect?
A. Uterine atony
B. Retained placental fragments
C. Vaginal or cervical laceration
D. Normal postpartum bleeding
Answer: C. Vaginal or cervical laceration
Rationale: A firm fundus with continued bright red bleeding suggests a laceration of the vagina
or cervix. Uterine atony would present with a boggy fundus. Retained placental fragments
typically cause delayed bleeding with clots. The nurse should perform a thorough assessment
and notify the provider for possible repair.
3. A patient at 32 weeks gestation with gestational diabetes reports increased fetal movement
followed by decreased movement. What should the nurse do first?
,A. Administer glucose to the patient
B. Perform a non-stress test
C. Instruct the patient to perform a kick count
D. Notify the healthcare provider immediately
Answer: C. Instruct the patient to perform a kick count
Rationale: Decreased fetal movement may indicate fetal distress. The nurse should first instruct
the patient to perform a kick count (counting fetal movements for 1-2 hours). Fewer than 10
movements in 2 hours warrants further evaluation. A non-stress test may be ordered based on
the results. Glucose administration is not the first action unless hypoglycemia is suspected.
4. The nurse is assessing a newborn 5 minutes after birth. The infant has a heart rate of 100 bpm,
irregular respirations, some flexion of extremities, a cry, and pink body with blue extremities. What is
the Apgar score?
A. 5
B. 6
C. 7
D. 8
Answer: C. 7
Rationale: Apgar scoring: Heart rate (100 bpm = 1 point), Respiratory effort (irregular = 1 point),
Muscle tone (some flexion = 1 point), Reflex irritability (cry = 2 points), Color (pink body/blue
extremities = 2 points). Total = 7. A score of 7-10 indicates the infant is in good condition.
Resuscitation is not typically needed for a score of 7.
5. A patient at 28 weeks gestation presents with headache, blurred vision, and epigastric pain. Blood
pressure is 160/100 mmHg and urine protein is 3+. What condition should the nurse suspect?
A. Gestational hypertension
B. Chronic hypertension
C. Severe preeclampsia
D. HELLP syndrome
Answer: C. Severe preeclampsia
Rationale: Severe preeclampsia is characterized by blood pressure ≥160/110 mmHg with
proteinuria and symptoms including headache, visual disturbances, and epigastric pain. These
symptoms indicate end-organ damage. HELLP syndrome includes hemolysis, elevated liver
enzymes, and low platelets, but the presentation is similar. The nurse should initiate seizure
precautions and notify the provider immediately.
,6. The nurse is caring for a patient in active labor with an epidural. The patient's blood pressure drops
from 120/80 to 90/50 mmHg. What should the nurse do first?
A. Increase the epidural infusion rate
B. Place the patient in a left lateral position
C. Administer IV epinephrine
D. Notify the anesthesiologist
Answer: B. Place the patient in a left lateral position
Rationale: Epidural anesthesia can cause hypotension due to sympathetic blockade. The first
action is to place the patient in a left lateral position to improve venous return and increase
blood pressure. IV fluids may be increased, and ephedrine may be administered if hypotension
persists. The anesthesiologist should be notified, but positioning is the priority.
7. A postpartum patient reports severe, sharp perineal pain that is unrelieved by oral analgesics. The
nurse notes a firm, painful area on the perineum. What should the nurse suspect?
A. Normal episiotomy pain
B. Perineal hematoma
C. Infection
D. Hemorrhoids
Answer: B. Perineal hematoma
Rationale: Severe, sharp perineal pain unrelieved by analgesics with a firm, painful area suggests
a perineal hematoma. This is a complication of vaginal delivery, often associated with
episiotomy or laceration. The nurse should assess the size of the hematoma, monitor vital signs,
and notify the provider for possible evacuation. Normal episiotomy pain should be relieved by
analgesics.
8. A patient at 40 weeks gestation is receiving oxytocin for induction of labor. The nurse notes
contractions every 2 minutes lasting 90 seconds with a resting tone of 25 mmHg. What should the
nurse do?
A. Continue the oxytocin infusion at the current rate
B. Increase the oxytocin infusion rate
C. Stop the oxytocin infusion and notify the healthcare provider
D. Decrease the oxytocin infusion rate
Answer: C. Stop the oxytocin infusion and notify the healthcare provider
Rationale: The contraction frequency and duration indicate uterine hyperstimulation, which can
compromise fetal oxygenation. The resting tone of 25 mmHg is elevated (normal <20 mmHg).
The nurse should stop the oxytocin infusion, place the patient in a left lateral position, administer
oxygen, and notify the provider. The oxytocin should not be restarted without provider orders.
, 9. A newborn is placed skin-to-skin with the mother immediately after birth. Which finding indicates
the newborn is in the second period of reactivity?
A. Heart rate of 180 bpm with grunting
B. Heart rate of 140 bpm with rapid, irregular respirations
C. Heart rate of 120 bpm with regular respirations and alertness
D. Heart rate of 100 bpm with slow, irregular respirations
Answer: C. Heart rate of 120 bpm with regular respirations and alertness
Rationale: The second period of reactivity occurs 2-8 hours after birth and is characterized by the
newborn being alert, responsive, with a heart rate of 120-140 bpm and regular respirations. The
first period of reactivity (immediately after birth) includes heart rate of 160-180 bpm with rapid,
irregular respirations. The period of decreased responsiveness follows with heart rate of 100-120
bpm and slow, irregular respirations.
10. A patient at 34 weeks gestation with preterm premature rupture of membranes (PPROM) reports
a fever of 38.5°C and foul-smelling vaginal discharge. What condition should the nurse suspect?
A. Chorioamnionitis
B. Normal PPROM
C. Urinary tract infection
D. Vaginal infection
Answer: A. Chorioamnionitis
Rationale: Chorioamnionitis (intra-amniotic infection) is suspected with fever ≥38°C, foul-
smelling discharge, maternal tachycardia, fetal tachycardia, and uterine tenderness. It is a
complication of PPROM and requires immediate treatment with antibiotics and delivery. The
nurse should notify the provider, obtain blood and amniotic fluid cultures, and prepare for
delivery if indicated.
11. The nurse is teaching a patient about signs of labor. Which sign indicates true labor?
A. Contractions that are irregular and relieved by walking
B. Contractions that increase in frequency, duration, and intensity
C. Pain localized to the lower abdomen and back
D. Contractions that decrease in intensity with rest
Answer: B. Contractions that increase in frequency, duration, and intensity
Rationale: True labor is characterized by contractions that increase in frequency, duration, and
intensity, with progressive cervical dilation and effacement. False labor contractions are
irregular, do not change in intensity, and are relieved by walking or rest. Pain in true labor often
radiates from the back to the front (lower abdomen).
