NSG 3500 Exam 4 – Maternal Health
Nursing Study Guide (Galen)
Maternal-Newborn Nursing
Comprehensive Examination - 150
Questions
1. A nurse is caring for a client at 38 weeks gestation who is experiencing contractions every 3-4
minutes lasting 60 seconds. The client reports severe back pain and pressure. Which of the following is
the most appropriate nursing action?
A) Encourage the client to ambulate
B) Assess for cervical dilation
C) Administer prescribed pain medication
D) Prepare for immediate delivery
Answer: B) Assess for cervical dilation
Rationale: The client is exhibiting signs of active labor with regular contractions and back pain. Assessing
cervical dilation is the priority to determine the stage of labor and guide interventions. Ambulation may
be appropriate but assessment comes first; pain medication may be given after assessment; immediate
delivery is not indicated unless complications arise.
2. A newborn has Apgar scores of 7 at 1 minute and 9 at 5 minutes. Which of the following
interpretations is correct?
A) The newborn requires immediate resuscitation
B) The newborn is adapting well to extrauterine life
C) The newborn has moderate respiratory distress
D) The newborn requires NICU admission
Answer: B) The newborn is adapting well to extrauterine life
Rationale: Apgar scores of 7 at 1 minute and 9 at 5 minutes indicate a newborn adapting well to
extrauterine life. A score of 7-10 is considered normal; scores of 4-6 indicate moderate distress; scores of
0-3 indicate severe distress requiring immediate resuscitation. The improvement from 7 to 9 indicates
good adaptation.
,3. A client at 42 weeks gestation is admitted for induction of labor. Which of the following findings is
most concerning for post-term pregnancy?
A) Fetal heart rate of 140 bpm
B) Meconium-stained amniotic fluid
C) Maternal blood pressure of 130/80 mm Hg
D) Maternal weight gain of 2 pounds
Answer: B) Meconium-stained amniotic fluid
Rationale: Meconium-stained amniotic fluid in a post-term pregnancy is concerning for fetal distress and
meconium aspiration syndrome. Fetal heart rate of 140 bpm is normal; blood pressure of 130/80 is
slightly elevated but not immediately concerning; weight gain of 2 pounds could be fluid retention but is
not as concerning as meconium staining.
4. A nurse is teaching a client about signs of true labor versus false labor. Which of the following
indicates true labor?
A) Contractions that decrease with walking
B) Contractions that are irregular in frequency
C) Contractions that increase in intensity and frequency
D) Contractions that are felt only in the abdomen
Answer: C) Contractions that increase in intensity and frequency
Rationale: True labor is characterized by contractions that increase in intensity, frequency, and duration.
False labor contractions typically decrease with walking, are irregular, and are often felt only in the
abdomen. True labor contractions are felt in the back and radiate to the abdomen.
5. A client at 39 weeks gestation is in the active phase of labor. The nurse notes late decelerations on
the fetal monitor. Which of the following is the priority nursing action?
A) Administer oxygen via face mask
B) Increase the IV fluid rate
C) Reposition the client on her side
D) Notify the healthcare provider
Answer: C) Reposition the client on her side
Rationale: Late decelerations indicate uteroplacental insufficiency. The priority action is to reposition the
client on her side to improve placental perfusion. Oxygen administration, increasing IV fluids, and
notifying the provider are important but should follow repositioning.
6. A postpartum client reports a large gush of blood and feeling faint. Which of the following is the
most likely cause?
A) Uterine atony
B) Retained placental fragments
,C) Vaginal laceration
D) Uterine inversion
Answer: A) Uterine atony
Rationale: Uterine atony is the most common cause of postpartum hemorrhage. It presents with a large
gush of blood, a boggy uterus, and signs of hypovolemia (feeling faint, tachycardia, hypotension).
Retained fragments can cause delayed bleeding; lacerations cause continuous bleeding; inversion is a
rare but severe complication.
7. A nurse is assessing a newborn's gestational age using the Ballard score. Which of the following
findings indicates a preterm newborn?
A) Full term with flexed extremities
B) Thin, translucent skin with sparse hair
C) Well-developed breast tissue
D) Deep plantar creases
Answer: B) Thin, translucent skin with sparse hair
Rationale: Thin, translucent skin with sparse hair is a sign of prematurity. Full-term newborns have flexed
extremities, well-developed breast tissue, and deep plantar creases. The Ballard score assesses physical
and neuromuscular maturity to estimate gestational age.
8. A client at 34 weeks gestation is receiving magnesium sulfate for preeclampsia. Which of the
following assessments is most important to monitor?
A) Respiratory rate and deep tendon reflexes
B) Blood pressure and temperature
C) Fetal heart rate and maternal pulse
D) Urine output and serum creatinine
Answer: A) Respiratory rate and deep tendon reflexes
Rationale: Magnesium sulfate toxicity affects the respiratory system and neuromuscular junction.
Monitoring respiratory rate (should be ≥ 12/min) and deep tendon reflexes (should be present) is
essential to detect toxicity. Blood pressure, fetal heart rate, and urine output are also important but
respiratory and reflex assessment are critical for safety.
9. A newborn is 24 hours old and has jaundice. Which of the following is the most concerning cause of
jaundice in the first 24 hours?
A) Breastfeeding jaundice
B) Hemolytic disease
C) Physiologic jaundice
D) Prematurity
, Answer: B) Hemolytic disease
Rationale: Jaundice in the first 24 hours of life is always pathological and concerning for hemolytic
disease (ABO or Rh incompatibility). Physiologic jaundice typically appears after 24 hours; breastfeeding
jaundice occurs later (3-5 days); prematurity can cause earlier jaundice but is not as concerning as
hemolytic disease.
10. A client is in the second stage of labor. The nurse notes that the client is pushing effectively and
the fetal head is visible at the vaginal opening. Which of the following nursing actions is most
appropriate?
A) Instruct the client to push continuously
B) Support the perineum and guide the head delivery
C) Apply fundal pressure to assist delivery
D) Prepare for an episiotomy
Answer: B) Support the perineum and guide the head delivery
Rationale: When the fetal head is visible (crowning), the nurse should support the perineum and guide
the head to control delivery and prevent perineal lacerations. Continuous pushing may cause tearing;
fundal pressure is not recommended; episiotomy is not routine and should be reserved for specific
indications.
11. A postpartum client reports difficulty breastfeeding due to sore nipples. Which of the following
interventions should the nurse recommend?
A) Stop breastfeeding for 24 hours
B) Apply lanolin cream after each feeding
C) Use a nipple shield
D) Ensure proper latch and positioning
Answer: D) Ensure proper latch and positioning
Rationale: Proper latch and positioning is the most important intervention to prevent and manage sore
nipples. Lanolin cream and nipple shields may help but do not address the underlying cause; stopping
breastfeeding for 24 hours may decrease milk supply and is not recommended.
12. A client at 40 weeks gestation is in active labor with an epidural. Which of the following is the
priority assessment for the client?
A) Blood pressure
B) Bladder distention
C) Pain level
D) Fetal heart rate
Answer: A) Blood pressure
Nursing Study Guide (Galen)
Maternal-Newborn Nursing
Comprehensive Examination - 150
Questions
1. A nurse is caring for a client at 38 weeks gestation who is experiencing contractions every 3-4
minutes lasting 60 seconds. The client reports severe back pain and pressure. Which of the following is
the most appropriate nursing action?
A) Encourage the client to ambulate
B) Assess for cervical dilation
C) Administer prescribed pain medication
D) Prepare for immediate delivery
Answer: B) Assess for cervical dilation
Rationale: The client is exhibiting signs of active labor with regular contractions and back pain. Assessing
cervical dilation is the priority to determine the stage of labor and guide interventions. Ambulation may
be appropriate but assessment comes first; pain medication may be given after assessment; immediate
delivery is not indicated unless complications arise.
2. A newborn has Apgar scores of 7 at 1 minute and 9 at 5 minutes. Which of the following
interpretations is correct?
A) The newborn requires immediate resuscitation
B) The newborn is adapting well to extrauterine life
C) The newborn has moderate respiratory distress
D) The newborn requires NICU admission
Answer: B) The newborn is adapting well to extrauterine life
Rationale: Apgar scores of 7 at 1 minute and 9 at 5 minutes indicate a newborn adapting well to
extrauterine life. A score of 7-10 is considered normal; scores of 4-6 indicate moderate distress; scores of
0-3 indicate severe distress requiring immediate resuscitation. The improvement from 7 to 9 indicates
good adaptation.
,3. A client at 42 weeks gestation is admitted for induction of labor. Which of the following findings is
most concerning for post-term pregnancy?
A) Fetal heart rate of 140 bpm
B) Meconium-stained amniotic fluid
C) Maternal blood pressure of 130/80 mm Hg
D) Maternal weight gain of 2 pounds
Answer: B) Meconium-stained amniotic fluid
Rationale: Meconium-stained amniotic fluid in a post-term pregnancy is concerning for fetal distress and
meconium aspiration syndrome. Fetal heart rate of 140 bpm is normal; blood pressure of 130/80 is
slightly elevated but not immediately concerning; weight gain of 2 pounds could be fluid retention but is
not as concerning as meconium staining.
4. A nurse is teaching a client about signs of true labor versus false labor. Which of the following
indicates true labor?
A) Contractions that decrease with walking
B) Contractions that are irregular in frequency
C) Contractions that increase in intensity and frequency
D) Contractions that are felt only in the abdomen
Answer: C) Contractions that increase in intensity and frequency
Rationale: True labor is characterized by contractions that increase in intensity, frequency, and duration.
False labor contractions typically decrease with walking, are irregular, and are often felt only in the
abdomen. True labor contractions are felt in the back and radiate to the abdomen.
5. A client at 39 weeks gestation is in the active phase of labor. The nurse notes late decelerations on
the fetal monitor. Which of the following is the priority nursing action?
A) Administer oxygen via face mask
B) Increase the IV fluid rate
C) Reposition the client on her side
D) Notify the healthcare provider
Answer: C) Reposition the client on her side
Rationale: Late decelerations indicate uteroplacental insufficiency. The priority action is to reposition the
client on her side to improve placental perfusion. Oxygen administration, increasing IV fluids, and
notifying the provider are important but should follow repositioning.
6. A postpartum client reports a large gush of blood and feeling faint. Which of the following is the
most likely cause?
A) Uterine atony
B) Retained placental fragments
,C) Vaginal laceration
D) Uterine inversion
Answer: A) Uterine atony
Rationale: Uterine atony is the most common cause of postpartum hemorrhage. It presents with a large
gush of blood, a boggy uterus, and signs of hypovolemia (feeling faint, tachycardia, hypotension).
Retained fragments can cause delayed bleeding; lacerations cause continuous bleeding; inversion is a
rare but severe complication.
7. A nurse is assessing a newborn's gestational age using the Ballard score. Which of the following
findings indicates a preterm newborn?
A) Full term with flexed extremities
B) Thin, translucent skin with sparse hair
C) Well-developed breast tissue
D) Deep plantar creases
Answer: B) Thin, translucent skin with sparse hair
Rationale: Thin, translucent skin with sparse hair is a sign of prematurity. Full-term newborns have flexed
extremities, well-developed breast tissue, and deep plantar creases. The Ballard score assesses physical
and neuromuscular maturity to estimate gestational age.
8. A client at 34 weeks gestation is receiving magnesium sulfate for preeclampsia. Which of the
following assessments is most important to monitor?
A) Respiratory rate and deep tendon reflexes
B) Blood pressure and temperature
C) Fetal heart rate and maternal pulse
D) Urine output and serum creatinine
Answer: A) Respiratory rate and deep tendon reflexes
Rationale: Magnesium sulfate toxicity affects the respiratory system and neuromuscular junction.
Monitoring respiratory rate (should be ≥ 12/min) and deep tendon reflexes (should be present) is
essential to detect toxicity. Blood pressure, fetal heart rate, and urine output are also important but
respiratory and reflex assessment are critical for safety.
9. A newborn is 24 hours old and has jaundice. Which of the following is the most concerning cause of
jaundice in the first 24 hours?
A) Breastfeeding jaundice
B) Hemolytic disease
C) Physiologic jaundice
D) Prematurity
, Answer: B) Hemolytic disease
Rationale: Jaundice in the first 24 hours of life is always pathological and concerning for hemolytic
disease (ABO or Rh incompatibility). Physiologic jaundice typically appears after 24 hours; breastfeeding
jaundice occurs later (3-5 days); prematurity can cause earlier jaundice but is not as concerning as
hemolytic disease.
10. A client is in the second stage of labor. The nurse notes that the client is pushing effectively and
the fetal head is visible at the vaginal opening. Which of the following nursing actions is most
appropriate?
A) Instruct the client to push continuously
B) Support the perineum and guide the head delivery
C) Apply fundal pressure to assist delivery
D) Prepare for an episiotomy
Answer: B) Support the perineum and guide the head delivery
Rationale: When the fetal head is visible (crowning), the nurse should support the perineum and guide
the head to control delivery and prevent perineal lacerations. Continuous pushing may cause tearing;
fundal pressure is not recommended; episiotomy is not routine and should be reserved for specific
indications.
11. A postpartum client reports difficulty breastfeeding due to sore nipples. Which of the following
interventions should the nurse recommend?
A) Stop breastfeeding for 24 hours
B) Apply lanolin cream after each feeding
C) Use a nipple shield
D) Ensure proper latch and positioning
Answer: D) Ensure proper latch and positioning
Rationale: Proper latch and positioning is the most important intervention to prevent and manage sore
nipples. Lanolin cream and nipple shields may help but do not address the underlying cause; stopping
breastfeeding for 24 hours may decrease milk supply and is not recommended.
12. A client at 40 weeks gestation is in active labor with an epidural. Which of the following is the
priority assessment for the client?
A) Blood pressure
B) Bladder distention
C) Pain level
D) Fetal heart rate
Answer: A) Blood pressure
