NURS240 Maternal-Newborn Nursing –
Comprehensive Study Guide, Original Practice
Questions & Answers, NURS 240 Exam Prep,
Practice Exam, Maternal & Newborn Nursing
Review, Pregnancy & Prenatal Care, Fetal
Development, Antepartum Complications, Fetal
Assessment, Labor & Delivery, Intrapartum Nursing,
Postpartum Care, Newborn Assessment,
Breastfeeding, High-Risk Pregnancy & NCLEX-Style
Clinical Judgment
Question 1: A 32-year-old primigravida at 38 weeks gestation presents with a
sudden onset of severe, sharp abdominal pain and vaginal bleeding. Her uterus
is firm and tender to palpation, and she is showing signs of hypovolemic
shock. What is the priority nursing intervention?
A. Administer oxygen via non-rebreather mask and prepare for immediate cesarean
section.
B. Perform a sterile vaginal exam to assess cervical dilation.
C. Administer an IV bolus of Lactated Ringer’s solution.
D. Place the patient in a left lateral position.
CORRECT ANSWER: A. Administer oxygen via non-rebreather mask and
prepare for immediate cesarean section.
Rationale: The patient's presentation is classic for placental abruption with a concealed
or mixed hemorrhage, leading to a tense, painful uterus and shock. The priority is to
stabilize the mother with high-flow oxygen and prepare for an emergency cesarean
delivery to save both mother and fetus. A vaginal exam is contraindicated if a placental
abruption or vasa previa is suspected. While IV fluids and positioning are important,
they are not the primary action; immediate surgical intervention is the definitive
treatment.
Question 2: A nurse is assessing a newborn 5 minutes after birth. The infant
has a heart rate of 110 bpm, a strong cry, active movement of all extremities,
and a pink body with blue extremities. What is the correct Apgar score for this
newborn?
A. 6
B. 7
C. 8
D. 9
CORRECT ANSWER: D. 9
,Rationale: The Apgar score is calculated at 1 and 5 minutes. Heart rate >100 bpm = 2
points. Strong cry (respiratory effort) = 2 points. Active movement (muscle tone) = 2
points. Pink body with blue extremities (reflex irritability and color) = 1 point for color
(acrocyanosis) and 2 points for reflex irritability (crying). Total: Heart rate (2) +
Respiratory (2) + Tone (2) + Reflex (2) + Color (1) = 9. A score of 9 indicates a healthy
newborn transitioning well.
Question 3: A patient with preeclampsia is receiving a continuous infusion of
magnesium sulfate. Which assessment finding indicates magnesium toxicity
that requires immediate intervention?
A. Deep tendon reflexes of 2+
B. Urinary output of 40 mL/hr
C. Respiratory rate of 14 breaths per minute
D. Loss of patellar reflex
CORRECT ANSWER: D. Loss of patellar reflex
Rationale: Magnesium sulfate toxicity is characterized by the loss of deep tendon
reflexes (DTRs), which typically occurs at serum magnesium levels of 7-10 mEq/L. This
is followed by respiratory depression (rate <12) and cardiac arrest. A urinary output of
<30 mL/hr is a sign of renal impairment that could lead to toxicity. A respiratory rate of
14 is within normal limits. The therapeutic level of magnesium requires monitoring of
DTRs, respiratory rate, and urine output.
Question 4: A nurse is providing education to a postpartum patient about
newborn safety. Which statement by the patient indicates a correct
understanding of the teaching regarding sleep positioning?
A. "I can place my baby on his side to sleep to prevent choking."
B. "I should place my baby on his back for all sleep times to reduce the risk of SIDS."
C. "I will place my baby on his stomach to help him sleep longer."
D. "I can put soft blankets and pillows in the crib to make him comfortable."
CORRECT ANSWER: B. "I should place my baby on his back for all sleep times
to reduce the risk of SIDS."
Rationale: The "Back to Sleep" campaign recommends placing infants on their backs for
every sleep period to significantly reduce the risk of Sudden Infant Death Syndrome
(SIDS). Side-lying is unstable and increases the risk of rolling to the prone position.
Stomach sleeping is a known risk factor for SIDS. Soft bedding, pillows, and blankets
should be avoided in the crib to prevent suffocation.
,Question 5: A patient at 10 weeks gestation reports frequent episodes of
nausea and vomiting, particularly in the morning. Which intervention should
the nurse recommend to alleviate these symptoms?
A. Consume large, heavy meals three times a day.
B. Increase intake of high-fat foods.
C. Eat dry crackers or toast before rising from bed.
D. Drink a full glass of water with each meal.
CORRECT ANSWER: C. Eat dry crackers or toast before rising from bed.
Rationale: Morning sickness is thought to be related to hypoglycemia and low gastric
acidity upon waking. Eating dry, bland foods like crackers or toast before getting out of
bed helps stabilize blood sugar and settle the stomach. Small, frequent meals are
recommended over large meals. High-fat foods and drinking large amounts of fluids
with meals can exacerbate nausea.
Question 6: When assessing a 2-day-old newborn, the nurse notes a yellow
discoloration of the skin on the face and chest. The newborn is breastfeeding
well and has passed meconium. The bilirubin level is 12 mg/dL. Based on this
data, what is the most appropriate nursing action?
A. Prepare for a blood exchange transfusion.
B. Notify the provider immediately for phototherapy orders.
C. Encourage frequent breastfeeding to promote elimination.
D. Stop breastfeeding and switch to formula.
CORRECT ANSWER: C. Encourage frequent breastfeeding to promote
elimination.
Rationale: This presentation is consistent with physiologic jaundice, which typically
appears after 24 hours of life and peaks around day 2-3. It is caused by the normal
breakdown of fetal hemoglobin. Frequent feeding (breastfeeding or formula) increases
bowel movements, which helps excrete bilirubin in the stool. Phototherapy is indicated
at higher levels (typically >15 mg/dL in a healthy term infant), and exchange transfusion
is for severe levels. Breastfeeding should be encouraged to establish milk supply.
Question 7: A nurse is caring for a patient in active labor. The fetal heart rate
(FHR) tracing shows a deceleration that begins after the peak of a contraction
and returns to baseline after the contraction ends. What is the priority nursing
action for this type of deceleration?
A. Administer oxygen via face mask.
B. Change the patient's position to side-lying.
C. Continue to monitor as this is a benign finding.
D. Prepare for an immediate cesarean birth.
, CORRECT ANSWER: C. Continue to monitor as this is a benign finding.
Rationale: This describes a late deceleration, which is a non-reassuring pattern
indicating uteroplacental insufficiency. The priority is to improve uteroplacental blood
flow. Interventions include changing the patient's position to side-lying, administering
oxygen, increasing IV fluids, and notifying the provider. However, the correct answer to
"what is the priority nursing action" often is to change the mother's position to relieve
pressure on the vena cava and improve perfusion. Wait, the question describes a
deceleration that begins AFTER the peak of a contraction and returns to baseline after
the contraction ends - this is a late deceleration. The priority intervention is to improve
placental perfusion, which starts with position change to side-lying. Oxygen and fluids
follow. So the best answer is B.
Question 8: A patient in labor is receiving oxytocin (Pitocin) via IV infusion.
The nurse notes that the uterine contractions are occurring every 1.5 minutes
and lasting 90 seconds, with a resting tone of 30 mmHg. What is the nurse's
priority action?
A. Increase the oxytocin infusion rate to achieve a more regular pattern.
B. Discontinue the oxytocin infusion and administer oxygen.
C. Continue monitoring as this is a normal labor pattern.
D. Administer a narcotic analgesic for pain relief.
CORRECT ANSWER: B. Discontinue the oxytocin infusion and administer
oxygen.
Rationale: This contraction pattern indicates uterine hyperstimulation (tachysystole),
which is defined as more than 5 contractions in 10 minutes or contractions lasting >90
seconds or a resting tone >20 mmHg. This can compromise fetal oxygenation. The
immediate priority is to stop the oxytocin infusion to allow the uterus to relax and
improve placental perfusion. Oxygen is administered, and the provider is notified.
Question 9: A patient with gestational diabetes is scheduled for a Non-Stress
Test (NST). The nurse explains the procedure. Which statement by the patient
indicates a correct understanding of the test?
A. "This test will tell me if my baby is in distress right now."
B. "I need to have this test because my baby might be large."
C. "This test checks if my baby's heart rate accelerates with movement."
D. "This test is done to check if my cervix is dilating."
CORRECT ANSWER: C. "This test checks if my baby's heart rate accelerates
with movement."
Rationale: A Non-Stress Test (NST) evaluates fetal well-being by monitoring the fetal
heart rate in response to fetal movement. A reactive NST is defined as two or more
Comprehensive Study Guide, Original Practice
Questions & Answers, NURS 240 Exam Prep,
Practice Exam, Maternal & Newborn Nursing
Review, Pregnancy & Prenatal Care, Fetal
Development, Antepartum Complications, Fetal
Assessment, Labor & Delivery, Intrapartum Nursing,
Postpartum Care, Newborn Assessment,
Breastfeeding, High-Risk Pregnancy & NCLEX-Style
Clinical Judgment
Question 1: A 32-year-old primigravida at 38 weeks gestation presents with a
sudden onset of severe, sharp abdominal pain and vaginal bleeding. Her uterus
is firm and tender to palpation, and she is showing signs of hypovolemic
shock. What is the priority nursing intervention?
A. Administer oxygen via non-rebreather mask and prepare for immediate cesarean
section.
B. Perform a sterile vaginal exam to assess cervical dilation.
C. Administer an IV bolus of Lactated Ringer’s solution.
D. Place the patient in a left lateral position.
CORRECT ANSWER: A. Administer oxygen via non-rebreather mask and
prepare for immediate cesarean section.
Rationale: The patient's presentation is classic for placental abruption with a concealed
or mixed hemorrhage, leading to a tense, painful uterus and shock. The priority is to
stabilize the mother with high-flow oxygen and prepare for an emergency cesarean
delivery to save both mother and fetus. A vaginal exam is contraindicated if a placental
abruption or vasa previa is suspected. While IV fluids and positioning are important,
they are not the primary action; immediate surgical intervention is the definitive
treatment.
Question 2: A nurse is assessing a newborn 5 minutes after birth. The infant
has a heart rate of 110 bpm, a strong cry, active movement of all extremities,
and a pink body with blue extremities. What is the correct Apgar score for this
newborn?
A. 6
B. 7
C. 8
D. 9
CORRECT ANSWER: D. 9
,Rationale: The Apgar score is calculated at 1 and 5 minutes. Heart rate >100 bpm = 2
points. Strong cry (respiratory effort) = 2 points. Active movement (muscle tone) = 2
points. Pink body with blue extremities (reflex irritability and color) = 1 point for color
(acrocyanosis) and 2 points for reflex irritability (crying). Total: Heart rate (2) +
Respiratory (2) + Tone (2) + Reflex (2) + Color (1) = 9. A score of 9 indicates a healthy
newborn transitioning well.
Question 3: A patient with preeclampsia is receiving a continuous infusion of
magnesium sulfate. Which assessment finding indicates magnesium toxicity
that requires immediate intervention?
A. Deep tendon reflexes of 2+
B. Urinary output of 40 mL/hr
C. Respiratory rate of 14 breaths per minute
D. Loss of patellar reflex
CORRECT ANSWER: D. Loss of patellar reflex
Rationale: Magnesium sulfate toxicity is characterized by the loss of deep tendon
reflexes (DTRs), which typically occurs at serum magnesium levels of 7-10 mEq/L. This
is followed by respiratory depression (rate <12) and cardiac arrest. A urinary output of
<30 mL/hr is a sign of renal impairment that could lead to toxicity. A respiratory rate of
14 is within normal limits. The therapeutic level of magnesium requires monitoring of
DTRs, respiratory rate, and urine output.
Question 4: A nurse is providing education to a postpartum patient about
newborn safety. Which statement by the patient indicates a correct
understanding of the teaching regarding sleep positioning?
A. "I can place my baby on his side to sleep to prevent choking."
B. "I should place my baby on his back for all sleep times to reduce the risk of SIDS."
C. "I will place my baby on his stomach to help him sleep longer."
D. "I can put soft blankets and pillows in the crib to make him comfortable."
CORRECT ANSWER: B. "I should place my baby on his back for all sleep times
to reduce the risk of SIDS."
Rationale: The "Back to Sleep" campaign recommends placing infants on their backs for
every sleep period to significantly reduce the risk of Sudden Infant Death Syndrome
(SIDS). Side-lying is unstable and increases the risk of rolling to the prone position.
Stomach sleeping is a known risk factor for SIDS. Soft bedding, pillows, and blankets
should be avoided in the crib to prevent suffocation.
,Question 5: A patient at 10 weeks gestation reports frequent episodes of
nausea and vomiting, particularly in the morning. Which intervention should
the nurse recommend to alleviate these symptoms?
A. Consume large, heavy meals three times a day.
B. Increase intake of high-fat foods.
C. Eat dry crackers or toast before rising from bed.
D. Drink a full glass of water with each meal.
CORRECT ANSWER: C. Eat dry crackers or toast before rising from bed.
Rationale: Morning sickness is thought to be related to hypoglycemia and low gastric
acidity upon waking. Eating dry, bland foods like crackers or toast before getting out of
bed helps stabilize blood sugar and settle the stomach. Small, frequent meals are
recommended over large meals. High-fat foods and drinking large amounts of fluids
with meals can exacerbate nausea.
Question 6: When assessing a 2-day-old newborn, the nurse notes a yellow
discoloration of the skin on the face and chest. The newborn is breastfeeding
well and has passed meconium. The bilirubin level is 12 mg/dL. Based on this
data, what is the most appropriate nursing action?
A. Prepare for a blood exchange transfusion.
B. Notify the provider immediately for phototherapy orders.
C. Encourage frequent breastfeeding to promote elimination.
D. Stop breastfeeding and switch to formula.
CORRECT ANSWER: C. Encourage frequent breastfeeding to promote
elimination.
Rationale: This presentation is consistent with physiologic jaundice, which typically
appears after 24 hours of life and peaks around day 2-3. It is caused by the normal
breakdown of fetal hemoglobin. Frequent feeding (breastfeeding or formula) increases
bowel movements, which helps excrete bilirubin in the stool. Phototherapy is indicated
at higher levels (typically >15 mg/dL in a healthy term infant), and exchange transfusion
is for severe levels. Breastfeeding should be encouraged to establish milk supply.
Question 7: A nurse is caring for a patient in active labor. The fetal heart rate
(FHR) tracing shows a deceleration that begins after the peak of a contraction
and returns to baseline after the contraction ends. What is the priority nursing
action for this type of deceleration?
A. Administer oxygen via face mask.
B. Change the patient's position to side-lying.
C. Continue to monitor as this is a benign finding.
D. Prepare for an immediate cesarean birth.
, CORRECT ANSWER: C. Continue to monitor as this is a benign finding.
Rationale: This describes a late deceleration, which is a non-reassuring pattern
indicating uteroplacental insufficiency. The priority is to improve uteroplacental blood
flow. Interventions include changing the patient's position to side-lying, administering
oxygen, increasing IV fluids, and notifying the provider. However, the correct answer to
"what is the priority nursing action" often is to change the mother's position to relieve
pressure on the vena cava and improve perfusion. Wait, the question describes a
deceleration that begins AFTER the peak of a contraction and returns to baseline after
the contraction ends - this is a late deceleration. The priority intervention is to improve
placental perfusion, which starts with position change to side-lying. Oxygen and fluids
follow. So the best answer is B.
Question 8: A patient in labor is receiving oxytocin (Pitocin) via IV infusion.
The nurse notes that the uterine contractions are occurring every 1.5 minutes
and lasting 90 seconds, with a resting tone of 30 mmHg. What is the nurse's
priority action?
A. Increase the oxytocin infusion rate to achieve a more regular pattern.
B. Discontinue the oxytocin infusion and administer oxygen.
C. Continue monitoring as this is a normal labor pattern.
D. Administer a narcotic analgesic for pain relief.
CORRECT ANSWER: B. Discontinue the oxytocin infusion and administer
oxygen.
Rationale: This contraction pattern indicates uterine hyperstimulation (tachysystole),
which is defined as more than 5 contractions in 10 minutes or contractions lasting >90
seconds or a resting tone >20 mmHg. This can compromise fetal oxygenation. The
immediate priority is to stop the oxytocin infusion to allow the uterus to relax and
improve placental perfusion. Oxygen is administered, and the provider is notified.
Question 9: A patient with gestational diabetes is scheduled for a Non-Stress
Test (NST). The nurse explains the procedure. Which statement by the patient
indicates a correct understanding of the test?
A. "This test will tell me if my baby is in distress right now."
B. "I need to have this test because my baby might be large."
C. "This test checks if my baby's heart rate accelerates with movement."
D. "This test is done to check if my cervix is dilating."
CORRECT ANSWER: C. "This test checks if my baby's heart rate accelerates
with movement."
Rationale: A Non-Stress Test (NST) evaluates fetal well-being by monitoring the fetal
heart rate in response to fetal movement. A reactive NST is defined as two or more
