Page 1 of 78
NSG 3500 EXAM 4 – MATERNITY (GALEN COLLEGE OF
NURSING) EXAM LATEST VERSION QUESTIONS AND ANSWERS
2026 EDITION
NSG 3500 Exam 4 – Maternity (Galen College of Nursing)
SECTION 1: NEWBORN TRANSITION AND IMMEDIATE CARE (Questions 1-40)
1. The nurse is teaching new parents about the factors that stimulate a newborn's
first breath. Which factor is considered chemical?
A. The drop in ambient temperature upon delivery
B. Hypoxia, hypercarbia, and acidosis from the clamping of the umbilical cord
C. The thoracic squeeze during a vaginal birth
D. Tactile stimulation from drying the infant
Answer: B. Hypoxia, hypercarbia, and acidosis from the clamping of the umbilical
cord
Rationale: Chemical factors are the most critical stimulants for the first breath. Falling
oxygen levels (hypoxia), rising carbon dioxide (hypercarbia), and falling pH (acidosis)
stimulate the medullary respiratory center. The other options are thermal, mechanical,
and sensory factors, respectively .
2. A term newborn delivered by elective cesarean section is at increased risk for
transient tachypnea of the newborn (TTN). The nurse understands this is primarily
due to:
A. Immature surfactant production
B. Lack of the mechanical thoracic squeeze during passage through the birth canal
C. Maternal diabetes during pregnancy
D. Meconium aspiration during delivery
, Page 2 of 78
Answer: B. Lack of the mechanical thoracic squeeze during passage through the
birth canal
Rationale: During vaginal delivery, the fetal chest is compressed, expelling lung fluid.
This "thoracic squeeze" is absent in cesarean deliveries, leading to delayed clearance of
fetal lung fluid and TTN. Surfactant deficiency causes RDS, not TTN .
3. The nurse is assessing a newborn 2 hours after birth. The hands and feet are
bluish, but the trunk and mucous membranes are pink. The nurse documents this
finding as:
A. Central cyanosis
B. Acrocyanosis
C. Mottling
D. Pallor
Answer: B. Acrocyanosis
Rationale: Acrocyanosis is a normal, benign finding in the first hours of life caused by
vasomotor instability and sluggish peripheral circulation. Central cyanosis involves the
trunk and mucous membranes and is always abnormal. No intervention is needed for
acrocyanosis .
4. A newborn's head has a soft, edematous swelling that crosses the sagittal suture
line. The nurse identifies this as:
A. Cephalohematoma
B. Caput succedaneum
C. Molding
D. Craniosynostosis
Answer: B. Caput succedaneum
Rationale: Caput succedaneum is soft tissue edema of the scalp that crosses suture
lines, caused by pressure during delivery. It resolves in a few days. Cephalohematoma is
a subperiosteal hemorrhage that does not cross sutures and resolves over weeks .
5. The nurse is observing a newborn's respiratory pattern. The newborn has pauses
in breathing lasting 10 seconds without any change in heart rate or skin color. This
is documented as:
, Page 3 of 78
A. Apnea
B. Periodic breathing
C. Respiratory distress
D. Bradypnea
Answer: B. Periodic breathing
Rationale: Periodic breathing consists of brief pauses (5-15 seconds) in respiration
without cyanosis or bradycardia. It is a common, benign pattern due to an immature
respiratory center. Apnea is a pause >20 seconds or accompanied by
bradycardia/cyanosis and is abnormal .
6. The nurse is teaching parents about preventing sudden infant death syndrome
(SIDS). Which statement by the parents indicates correct understanding?
A. "We will place our baby on the stomach to sleep."
B. "We will put our baby to sleep on the back."
C. "We will use a soft, fluffy mattress for comfort."
D. "We will place several stuffed animals in the crib."
Answer: B. "We will put our baby to sleep on the back."
Rationale: The "Back to Sleep" recommendation—placing infants supine on a firm
mattress with no loose bedding—significantly reduces the risk of SIDS. Prone and side-
lying positions, soft mattresses, and stuffed animals increase risk .
7. What is the priority nursing action for a newborn with gastroschisis?
A. Place the infant in a prone position
B. Cover the exposed bowel with sterile, saline-moistened gauze
C. Begin immediate formula feedings
D. Apply a dry, tight abdominal binder
Answer: B. Cover the exposed bowel with sterile, saline-moistened gauze
Rationale: The exposed bowel must be protected from trauma, infection, and heat/fluid
loss. A sterile, non-adherent, saline-moistened dressing (or a clear bowel bag) is applied
immediately .
8. A newborn's APGAR score at 1 minute is 6. Which finding contributed to this
score?
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A. Crying vigorously, heart rate 150 bpm
B. Flexed posture, heart rate 90 bpm
C. Heart rate 120 bpm, grimacing
D. Good muscle tone, acrocyanosis
Answer: B. Flexed posture, heart rate 90 bpm
Rationale: An APGAR score of 6 indicates moderate difficulty. Heart rate of 90 bpm
scores 1 point. Flexed posture scores 1 point. A score of 6 requires continued
monitoring and potential interventions .
9. The nurse is performing APGAR scoring at 5 minutes. Which component is NOT
assessed in the APGAR?
A. Heart Rate
B. Respirations
C. Birth time
D. Color
Answer: C. Birth time
Rationale: APGAR assesses: Appearance (Color), Pulse (Heart Rate), Grimace (Reflex
irritability), Activity (Muscle tone), and Respirations. Birth time is not a component of the
APGAR score .
10. Which finding is normal in the first 24 hours of life?
A. Acrocyanosis
B. Jaundice
C. Cyanosis of the lips
D. Pallor
Answer: A. Acrocyanosis
Rationale: Acrocyanosis (bluish discoloration of the hands and feet) is normal in the first
24 hours of life due to immature peripheral circulation. Central cyanosis (lips, tongue) is
abnormal and requires further evaluation .
11. The nurse is preparing to administer vitamin K to a newborn. What is the
purpose of this medication?
A. "Vitamin K promotes blood clotting."
B. "Vitamin K prevents infection."
NSG 3500 EXAM 4 – MATERNITY (GALEN COLLEGE OF
NURSING) EXAM LATEST VERSION QUESTIONS AND ANSWERS
2026 EDITION
NSG 3500 Exam 4 – Maternity (Galen College of Nursing)
SECTION 1: NEWBORN TRANSITION AND IMMEDIATE CARE (Questions 1-40)
1. The nurse is teaching new parents about the factors that stimulate a newborn's
first breath. Which factor is considered chemical?
A. The drop in ambient temperature upon delivery
B. Hypoxia, hypercarbia, and acidosis from the clamping of the umbilical cord
C. The thoracic squeeze during a vaginal birth
D. Tactile stimulation from drying the infant
Answer: B. Hypoxia, hypercarbia, and acidosis from the clamping of the umbilical
cord
Rationale: Chemical factors are the most critical stimulants for the first breath. Falling
oxygen levels (hypoxia), rising carbon dioxide (hypercarbia), and falling pH (acidosis)
stimulate the medullary respiratory center. The other options are thermal, mechanical,
and sensory factors, respectively .
2. A term newborn delivered by elective cesarean section is at increased risk for
transient tachypnea of the newborn (TTN). The nurse understands this is primarily
due to:
A. Immature surfactant production
B. Lack of the mechanical thoracic squeeze during passage through the birth canal
C. Maternal diabetes during pregnancy
D. Meconium aspiration during delivery
, Page 2 of 78
Answer: B. Lack of the mechanical thoracic squeeze during passage through the
birth canal
Rationale: During vaginal delivery, the fetal chest is compressed, expelling lung fluid.
This "thoracic squeeze" is absent in cesarean deliveries, leading to delayed clearance of
fetal lung fluid and TTN. Surfactant deficiency causes RDS, not TTN .
3. The nurse is assessing a newborn 2 hours after birth. The hands and feet are
bluish, but the trunk and mucous membranes are pink. The nurse documents this
finding as:
A. Central cyanosis
B. Acrocyanosis
C. Mottling
D. Pallor
Answer: B. Acrocyanosis
Rationale: Acrocyanosis is a normal, benign finding in the first hours of life caused by
vasomotor instability and sluggish peripheral circulation. Central cyanosis involves the
trunk and mucous membranes and is always abnormal. No intervention is needed for
acrocyanosis .
4. A newborn's head has a soft, edematous swelling that crosses the sagittal suture
line. The nurse identifies this as:
A. Cephalohematoma
B. Caput succedaneum
C. Molding
D. Craniosynostosis
Answer: B. Caput succedaneum
Rationale: Caput succedaneum is soft tissue edema of the scalp that crosses suture
lines, caused by pressure during delivery. It resolves in a few days. Cephalohematoma is
a subperiosteal hemorrhage that does not cross sutures and resolves over weeks .
5. The nurse is observing a newborn's respiratory pattern. The newborn has pauses
in breathing lasting 10 seconds without any change in heart rate or skin color. This
is documented as:
, Page 3 of 78
A. Apnea
B. Periodic breathing
C. Respiratory distress
D. Bradypnea
Answer: B. Periodic breathing
Rationale: Periodic breathing consists of brief pauses (5-15 seconds) in respiration
without cyanosis or bradycardia. It is a common, benign pattern due to an immature
respiratory center. Apnea is a pause >20 seconds or accompanied by
bradycardia/cyanosis and is abnormal .
6. The nurse is teaching parents about preventing sudden infant death syndrome
(SIDS). Which statement by the parents indicates correct understanding?
A. "We will place our baby on the stomach to sleep."
B. "We will put our baby to sleep on the back."
C. "We will use a soft, fluffy mattress for comfort."
D. "We will place several stuffed animals in the crib."
Answer: B. "We will put our baby to sleep on the back."
Rationale: The "Back to Sleep" recommendation—placing infants supine on a firm
mattress with no loose bedding—significantly reduces the risk of SIDS. Prone and side-
lying positions, soft mattresses, and stuffed animals increase risk .
7. What is the priority nursing action for a newborn with gastroschisis?
A. Place the infant in a prone position
B. Cover the exposed bowel with sterile, saline-moistened gauze
C. Begin immediate formula feedings
D. Apply a dry, tight abdominal binder
Answer: B. Cover the exposed bowel with sterile, saline-moistened gauze
Rationale: The exposed bowel must be protected from trauma, infection, and heat/fluid
loss. A sterile, non-adherent, saline-moistened dressing (or a clear bowel bag) is applied
immediately .
8. A newborn's APGAR score at 1 minute is 6. Which finding contributed to this
score?
, Page 4 of 78
A. Crying vigorously, heart rate 150 bpm
B. Flexed posture, heart rate 90 bpm
C. Heart rate 120 bpm, grimacing
D. Good muscle tone, acrocyanosis
Answer: B. Flexed posture, heart rate 90 bpm
Rationale: An APGAR score of 6 indicates moderate difficulty. Heart rate of 90 bpm
scores 1 point. Flexed posture scores 1 point. A score of 6 requires continued
monitoring and potential interventions .
9. The nurse is performing APGAR scoring at 5 minutes. Which component is NOT
assessed in the APGAR?
A. Heart Rate
B. Respirations
C. Birth time
D. Color
Answer: C. Birth time
Rationale: APGAR assesses: Appearance (Color), Pulse (Heart Rate), Grimace (Reflex
irritability), Activity (Muscle tone), and Respirations. Birth time is not a component of the
APGAR score .
10. Which finding is normal in the first 24 hours of life?
A. Acrocyanosis
B. Jaundice
C. Cyanosis of the lips
D. Pallor
Answer: A. Acrocyanosis
Rationale: Acrocyanosis (bluish discoloration of the hands and feet) is normal in the first
24 hours of life due to immature peripheral circulation. Central cyanosis (lips, tongue) is
abnormal and requires further evaluation .
11. The nurse is preparing to administer vitamin K to a newborn. What is the
purpose of this medication?
A. "Vitamin K promotes blood clotting."
B. "Vitamin K prevents infection."
