NR 465 Exam 3: Maternal Newborn Nursing V2 | Complete Study Guide with Questions,
Answers & Rationales | 2026 Updated
Instructions: Select the best answer for each question. Rationales are provided for
educational purposes.
Section 1: Intrapartum Nursing (Questions 1-25)
1. A laboring patient is 6 cm dilated, 100% effaced, and the presenting part is at 0
station. The nurse notes severe variable decelerations with a loss of variability. What is
the priority action?
A) Administer oxygen at 2 L/min via nasal cannula
B) Reposition the patient to left lateral
C) Prepare for immediate cesarean section
D) Increase IV oxytocin to accelerate labor
Correct Answer: B
Rationale: Variable decelerations suggest cord compression. Repositioning (left lateral,
knee-chest, or Trendelenburg) relieves cord compression. Oxygen and fluid bolus are
next; loss of variability with decelerations is concerning but repositioning is first.
Oxytocin would worsen decelerations.
,2. A patient requests an epidural at 5 cm dilation. Which lab value is most critical to
review before placement?
A) Hemoglobin 11 g/dL
B) Platelet count 78,000/mm³
C) White blood cell count 12,000/mm³
D) Glucose 95 mg/dL
Correct Answer: B
Rationale: Platelets <100,000/mm³ increase risk of epidural hematoma. Low platelets
are a relative contraindication to neuraxial anesthesia.
3. A nurse notes late decelerations on the fetal monitor. What is the underlying
pathophysiology?
A) Head compression
B) Umbilical cord prolapse
C) Uteroplacental insufficiency
D) Fetal sleep cycle
Correct Answer: C
Rationale: Late decelerations reflect reduced blood flow and oxygen transfer across
the placenta, often due to maternal hypotension, uterine tachysystole, or abruption.
,4. Which finding in a laboring patient with preeclampsia on magnesium sulfate requires
immediate intervention?
A) Respiratory rate 12 breaths/min
B) Patellar reflexes 2+
C) Urinary output 30 mL/hr
D) Serum magnesium level 6 mg/dL
Correct Answer: A
Rationale: Respiratory rate <12/min indicates magnesium toxicity. Normal therapeutic
range is 4-8 mg/dL; reflexes and output are adequate.
5. A G2P1 patient at 39 weeks has spontaneous rupture of membranes with clear fluid.
FHR is 140 bpm with moderate variability. What is the priority nursing action?
A) Perform a sterile vaginal exam
B) Check cervical dilation
C) Assess fluid color and odor
D) Begin oxytocin infusion
Correct Answer: C
Rationale: After ROM, assess fluid for color (meconium?), odor (infection?), and
amount. Sterile vaginal exam is done but not first if not in active labor.
, 6. A patient is pushing with urge to bear down. FHR drops to 80 bpm for 90 seconds
after a contraction and returns to baseline slowly. This pattern is:
A) Early deceleration – reassuring
B) Late deceleration – non-reassuring
C) Prolonged deceleration – concerning
D) Variable deceleration – benign
Correct Answer: C
Rationale: Prolonged deceleration lasts ≥2 minutes but <10 minutes. This is 90 seconds;
requires evaluation for uterine rupture, prolapse, or maternal hypotension.
7. Which maternal position would best improve fetal oxygenation during late
decelerations?
A) Supine with head elevated
B) Left lateral
C) Right lateral with legs straight
D) Semi-Fowler’s
Correct Answer: B
Rationale: Left lateral position relieves aortocaval compression, increases uterine
blood flow, and improves placental perfusion.
Answers & Rationales | 2026 Updated
Instructions: Select the best answer for each question. Rationales are provided for
educational purposes.
Section 1: Intrapartum Nursing (Questions 1-25)
1. A laboring patient is 6 cm dilated, 100% effaced, and the presenting part is at 0
station. The nurse notes severe variable decelerations with a loss of variability. What is
the priority action?
A) Administer oxygen at 2 L/min via nasal cannula
B) Reposition the patient to left lateral
C) Prepare for immediate cesarean section
D) Increase IV oxytocin to accelerate labor
Correct Answer: B
Rationale: Variable decelerations suggest cord compression. Repositioning (left lateral,
knee-chest, or Trendelenburg) relieves cord compression. Oxygen and fluid bolus are
next; loss of variability with decelerations is concerning but repositioning is first.
Oxytocin would worsen decelerations.
,2. A patient requests an epidural at 5 cm dilation. Which lab value is most critical to
review before placement?
A) Hemoglobin 11 g/dL
B) Platelet count 78,000/mm³
C) White blood cell count 12,000/mm³
D) Glucose 95 mg/dL
Correct Answer: B
Rationale: Platelets <100,000/mm³ increase risk of epidural hematoma. Low platelets
are a relative contraindication to neuraxial anesthesia.
3. A nurse notes late decelerations on the fetal monitor. What is the underlying
pathophysiology?
A) Head compression
B) Umbilical cord prolapse
C) Uteroplacental insufficiency
D) Fetal sleep cycle
Correct Answer: C
Rationale: Late decelerations reflect reduced blood flow and oxygen transfer across
the placenta, often due to maternal hypotension, uterine tachysystole, or abruption.
,4. Which finding in a laboring patient with preeclampsia on magnesium sulfate requires
immediate intervention?
A) Respiratory rate 12 breaths/min
B) Patellar reflexes 2+
C) Urinary output 30 mL/hr
D) Serum magnesium level 6 mg/dL
Correct Answer: A
Rationale: Respiratory rate <12/min indicates magnesium toxicity. Normal therapeutic
range is 4-8 mg/dL; reflexes and output are adequate.
5. A G2P1 patient at 39 weeks has spontaneous rupture of membranes with clear fluid.
FHR is 140 bpm with moderate variability. What is the priority nursing action?
A) Perform a sterile vaginal exam
B) Check cervical dilation
C) Assess fluid color and odor
D) Begin oxytocin infusion
Correct Answer: C
Rationale: After ROM, assess fluid for color (meconium?), odor (infection?), and
amount. Sterile vaginal exam is done but not first if not in active labor.
, 6. A patient is pushing with urge to bear down. FHR drops to 80 bpm for 90 seconds
after a contraction and returns to baseline slowly. This pattern is:
A) Early deceleration – reassuring
B) Late deceleration – non-reassuring
C) Prolonged deceleration – concerning
D) Variable deceleration – benign
Correct Answer: C
Rationale: Prolonged deceleration lasts ≥2 minutes but <10 minutes. This is 90 seconds;
requires evaluation for uterine rupture, prolapse, or maternal hypotension.
7. Which maternal position would best improve fetal oxygenation during late
decelerations?
A) Supine with head elevated
B) Left lateral
C) Right lateral with legs straight
D) Semi-Fowler’s
Correct Answer: B
Rationale: Left lateral position relieves aortocaval compression, increases uterine
blood flow, and improves placental perfusion.
