NURS240 Maternal-Newborn Nursing –
Comprehensive Study Guide, Original Practice
Questions & Answers, NURS 240 Exam Preparation,
Maternal-Newborn Nursing Practice Test,
Pregnancy & Prenatal Care, Fetal Development,
Antepartum Complications, Fetal Monitoring, Labor
& Delivery, Intrapartum Nursing, Postpartum Care,
Newborn Assessment, Breastfeeding, High-Risk
Pregnancy & NCLEX-Style Clinical Judgment
Question 1: A pregnant client at 32 weeks gestation is admitted with mild
preeclampsia. Which assessment finding indicates a potential progression to
severe preeclampsia?
A. Blood pressure of 142/90 mmHg
B. Mild ankle edema
C. Urine protein of 300 mg in a 24-hour collection
D. A platelet count of 85,000/mm³
CORRECT ANSWER: D. A platelet count of 85,000/mm³
Rationale: Severe preeclampsia is characterized by worsening maternal status, which
can include thrombocytopenia (platelet count <100,000/mm³). Options A and C are
consistent with mild preeclampsia, while B is a common finding in normal pregnancy.
Question 2: A nurse is assessing a newborn's gestational age using the Ballard
Score. Which physical characteristic is most consistent with a preterm infant
of 32 weeks gestation?
A. Extensive rugae on the scrotum
B. Thick, opaque skin with peeling
C. Anterior transverse crease on the sole
D. Pinna of the ear that is soft and folds easily
CORRECT ANSWER: D. Pinna of the ear that is soft and folds easily
Rationale: At 32 weeks, the ear cartilage is immature, so the pinna is soft and folds
easily. Rugae on the scrotum and anterior transverse sole creases appear later in
gestation. Thick, peeling skin is seen in post-term infants.
Question 3: A client in active labor requests an epidural for pain relief. Which
maternal finding is the most significant contraindication to this procedure at
this time?
A. Maternal temperature of 99.2°F (37.3°C)
B. Fetal heart rate variability of 10 beats per minute
C. Platelet count of 88,000/µL
D. Cervical dilation of 5 cm
,CORRECT ANSWER: C. Platelet count of 88,000/µL
Rationale: A platelet count below 100,000/µL is a contraindication for epidural
anesthesia due to an increased risk of epidural hematoma. The other options are not
absolute contraindications.
Question 4: A postpartum client who is Rh-negative and has an Rh-positive
infant is given Rhogam. This medication works by preventing which condition?
A. Hemolytic disease of the newborn in the current pregnancy
B. Hemolytic disease of the newborn in a subsequent pregnancy
C. Hyperbilirubinemia in the current newborn
D. Maternal thrombocytopenia during labor
CORRECT ANSWER: B. Hemolytic disease of the newborn in a subsequent
pregnancy
Rationale: Rhogam (Rho(D) immune globulin) prevents maternal sensitization to Rh-
positive fetal blood. It does not treat an already sensitized mother or current pregnancy
but prevents antibody formation that could affect future Rh-positive pregnancies.
Question 5: A nurse is monitoring a client with gestational diabetes mellitus
(GDM) during labor. Which plan is most appropriate for managing this client's
blood glucose?
A. Administer insulin as a continuous IV infusion hourly.
B. Maintain a strict NPO status throughout labor.
C. Monitor blood glucose levels hourly and administer insulin as prescribed for levels
>110 mg/dL.
D. Administer dextrose-containing IV fluids if glucose drops below 40 mg/dL.
CORRECT ANSWER: C. Monitor blood glucose levels hourly and administer
insulin as prescribed for levels >110 mg/dL.
Rationale: During labor, maternal blood glucose should be monitored hourly for clients
with GDM. The goal is to maintain glucose between 70-110 mg/dL to prevent neonatal
hypoglycemia. Insulin is administered for hyperglycemia, often via a sliding scale.
Question 6: A new mother is concerned that her 24-hour-old newborn has not
yet had a meconium stool. Which action should the nurse take first?
A. Notify the healthcare provider immediately.
B. Administer a glycerin suppository per protocol.
C. Assess the infant's abdomen and feeding history.
D. Inform the mother that this is a normal finding for the first 48 hours.
CORRECT ANSWER: C. Assess the infant's abdomen and feeding history.
Rationale: While most newborns pass meconium within the first 24-48 hours, a lack of
stool within 24 hours warrants further assessment. The nurse should first assess for
,abdominal distention, feeding adequacy, and possible signs of obstruction before
notifying the provider or intervening.
Question 7: A client at 39 weeks gestation is undergoing a biophysical profile
(BPP). A score of 6/10 is obtained. How should the nurse interpret this result?
A. Normal score, indicative of fetal well-being.
B. Equivocal score, requiring further testing or intervention.
C. Abnormal score, requiring immediate delivery.
D. Poor correlation to fetal acid-base status.
CORRECT ANSWER: B. Equivocal score, requiring further testing or
intervention.
Rationale: A BPP score of 8-10 is considered normal, 6 is considered equivocal, and 4 or
less is considered abnormal. An equivocal score often results in repeat testing within 24
hours or further evaluation.
Question 8: A nurse is performing Leopold's maneuvers on a client in the third
trimester. The nurse palpates the fetal buttocks in the fundal region and the
head in the pelvis. What is this fetal presentation?
A. Cephalic presentation
B. Frank breech presentation
C. Transverse lie
D. Complete breech presentation
CORRECT ANSWER: A. Cephalic presentation
Rationale: Cephalic (vertex) presentation is when the head is the presenting part and is
engaged in the pelvis. The fundus will contain the buttocks, and the head will be
palpable over the symphysis pubis.
Question 9: A postpartum client is prescribed methylergonovine (Methergine)
for uterine atony. Which assessment finding would require the nurse to hold
the medication and notify the provider?
A. Uterine fundus is firm and midline.
B. Maternal blood pressure is 142/90 mmHg.
C. Lochia is moderate rubra.
D. Maternal heart rate is 72 beats per minute.
CORRECT ANSWER: B. Maternal blood pressure is 142/90 mmHg.
Rationale: Methylergonovine is a vasoconstrictor and is contraindicated in clients with
hypertension, preeclampsia, or cardiovascular disease. A blood pressure of 142/90 is
elevated and requires the medication to be held.
Question 10: A newborn's cord blood test reveals a direct Coombs test
positive. The nurse should anticipate the infant to be at risk for which
condition?
, A. Polycythemia
B. Hemolytic anemia
C. Respiratory distress syndrome
D. Congenital infection
CORRECT ANSWER: B. Hemolytic anemia
Rationale: A positive direct Coombs test indicates that the infant's red blood cells have
antibodies attached to them, typically from maternal-fetal blood group incompatibility.
This leads to hemolysis and subsequent hemolytic anemia.
Question 11: The nurse is teaching a prenatal class about the signs of labor.
Which statement by a participant indicates a need for further teaching?
A. "The loss of the mucus plug is a sign that labor may be starting soon."
B. "A gush of fluid from the vagina means my membranes have ruptured."
C. "I should go to the hospital as soon as my contractions are 10 minutes apart."
D. "The baby's head engaging into my pelvis is called lightening."
CORRECT ANSWER: C. "I should go to the hospital as soon as my contractions
are 10 minutes apart."
Rationale: For primigravidas, early labor at 10-minute intervals is often too early to go to
the hospital. The recommended time is usually when contractions are 5 minutes apart
(or 3-5 minutes) for 1 hour or as per provider instructions.
Question 12: A client at 35 weeks gestation is diagnosed with acute
pyelonephritis. Which assessment finding should the nurse prioritize?
A. Fever of 101.5°F (38.6°C)
B. Costovertebral angle tenderness
C. Frequent urination
D. Fetal tachycardia of 165 bpm
CORRECT ANSWER: D. Fetal tachycardia of 165 bpm
Rationale: Maternal pyelonephritis can cause fetal distress, evidenced by tachycardia,
which could indicate a compensatory response to maternal fever or hypoxia. While all
options are associated with pyelonephritis, fetal tachycardia is the priority concern for
the fetus.
Question 13: A nurse is caring for a client with placenta previa at 34 weeks
gestation. Which intervention is the highest priority?
A. Auscultate fetal heart tones every 4 hours.
B. Prepare the client for a vaginal exam to confirm dilation.
C. Maintain strict bed rest with bathroom privileges.
D. Assess for signs of hemorrhage and monitor vital signs.
CORRECT ANSWER: D. Assess for signs of hemorrhage and monitor vital signs.
Comprehensive Study Guide, Original Practice
Questions & Answers, NURS 240 Exam Preparation,
Maternal-Newborn Nursing Practice Test,
Pregnancy & Prenatal Care, Fetal Development,
Antepartum Complications, Fetal Monitoring, Labor
& Delivery, Intrapartum Nursing, Postpartum Care,
Newborn Assessment, Breastfeeding, High-Risk
Pregnancy & NCLEX-Style Clinical Judgment
Question 1: A pregnant client at 32 weeks gestation is admitted with mild
preeclampsia. Which assessment finding indicates a potential progression to
severe preeclampsia?
A. Blood pressure of 142/90 mmHg
B. Mild ankle edema
C. Urine protein of 300 mg in a 24-hour collection
D. A platelet count of 85,000/mm³
CORRECT ANSWER: D. A platelet count of 85,000/mm³
Rationale: Severe preeclampsia is characterized by worsening maternal status, which
can include thrombocytopenia (platelet count <100,000/mm³). Options A and C are
consistent with mild preeclampsia, while B is a common finding in normal pregnancy.
Question 2: A nurse is assessing a newborn's gestational age using the Ballard
Score. Which physical characteristic is most consistent with a preterm infant
of 32 weeks gestation?
A. Extensive rugae on the scrotum
B. Thick, opaque skin with peeling
C. Anterior transverse crease on the sole
D. Pinna of the ear that is soft and folds easily
CORRECT ANSWER: D. Pinna of the ear that is soft and folds easily
Rationale: At 32 weeks, the ear cartilage is immature, so the pinna is soft and folds
easily. Rugae on the scrotum and anterior transverse sole creases appear later in
gestation. Thick, peeling skin is seen in post-term infants.
Question 3: A client in active labor requests an epidural for pain relief. Which
maternal finding is the most significant contraindication to this procedure at
this time?
A. Maternal temperature of 99.2°F (37.3°C)
B. Fetal heart rate variability of 10 beats per minute
C. Platelet count of 88,000/µL
D. Cervical dilation of 5 cm
,CORRECT ANSWER: C. Platelet count of 88,000/µL
Rationale: A platelet count below 100,000/µL is a contraindication for epidural
anesthesia due to an increased risk of epidural hematoma. The other options are not
absolute contraindications.
Question 4: A postpartum client who is Rh-negative and has an Rh-positive
infant is given Rhogam. This medication works by preventing which condition?
A. Hemolytic disease of the newborn in the current pregnancy
B. Hemolytic disease of the newborn in a subsequent pregnancy
C. Hyperbilirubinemia in the current newborn
D. Maternal thrombocytopenia during labor
CORRECT ANSWER: B. Hemolytic disease of the newborn in a subsequent
pregnancy
Rationale: Rhogam (Rho(D) immune globulin) prevents maternal sensitization to Rh-
positive fetal blood. It does not treat an already sensitized mother or current pregnancy
but prevents antibody formation that could affect future Rh-positive pregnancies.
Question 5: A nurse is monitoring a client with gestational diabetes mellitus
(GDM) during labor. Which plan is most appropriate for managing this client's
blood glucose?
A. Administer insulin as a continuous IV infusion hourly.
B. Maintain a strict NPO status throughout labor.
C. Monitor blood glucose levels hourly and administer insulin as prescribed for levels
>110 mg/dL.
D. Administer dextrose-containing IV fluids if glucose drops below 40 mg/dL.
CORRECT ANSWER: C. Monitor blood glucose levels hourly and administer
insulin as prescribed for levels >110 mg/dL.
Rationale: During labor, maternal blood glucose should be monitored hourly for clients
with GDM. The goal is to maintain glucose between 70-110 mg/dL to prevent neonatal
hypoglycemia. Insulin is administered for hyperglycemia, often via a sliding scale.
Question 6: A new mother is concerned that her 24-hour-old newborn has not
yet had a meconium stool. Which action should the nurse take first?
A. Notify the healthcare provider immediately.
B. Administer a glycerin suppository per protocol.
C. Assess the infant's abdomen and feeding history.
D. Inform the mother that this is a normal finding for the first 48 hours.
CORRECT ANSWER: C. Assess the infant's abdomen and feeding history.
Rationale: While most newborns pass meconium within the first 24-48 hours, a lack of
stool within 24 hours warrants further assessment. The nurse should first assess for
,abdominal distention, feeding adequacy, and possible signs of obstruction before
notifying the provider or intervening.
Question 7: A client at 39 weeks gestation is undergoing a biophysical profile
(BPP). A score of 6/10 is obtained. How should the nurse interpret this result?
A. Normal score, indicative of fetal well-being.
B. Equivocal score, requiring further testing or intervention.
C. Abnormal score, requiring immediate delivery.
D. Poor correlation to fetal acid-base status.
CORRECT ANSWER: B. Equivocal score, requiring further testing or
intervention.
Rationale: A BPP score of 8-10 is considered normal, 6 is considered equivocal, and 4 or
less is considered abnormal. An equivocal score often results in repeat testing within 24
hours or further evaluation.
Question 8: A nurse is performing Leopold's maneuvers on a client in the third
trimester. The nurse palpates the fetal buttocks in the fundal region and the
head in the pelvis. What is this fetal presentation?
A. Cephalic presentation
B. Frank breech presentation
C. Transverse lie
D. Complete breech presentation
CORRECT ANSWER: A. Cephalic presentation
Rationale: Cephalic (vertex) presentation is when the head is the presenting part and is
engaged in the pelvis. The fundus will contain the buttocks, and the head will be
palpable over the symphysis pubis.
Question 9: A postpartum client is prescribed methylergonovine (Methergine)
for uterine atony. Which assessment finding would require the nurse to hold
the medication and notify the provider?
A. Uterine fundus is firm and midline.
B. Maternal blood pressure is 142/90 mmHg.
C. Lochia is moderate rubra.
D. Maternal heart rate is 72 beats per minute.
CORRECT ANSWER: B. Maternal blood pressure is 142/90 mmHg.
Rationale: Methylergonovine is a vasoconstrictor and is contraindicated in clients with
hypertension, preeclampsia, or cardiovascular disease. A blood pressure of 142/90 is
elevated and requires the medication to be held.
Question 10: A newborn's cord blood test reveals a direct Coombs test
positive. The nurse should anticipate the infant to be at risk for which
condition?
, A. Polycythemia
B. Hemolytic anemia
C. Respiratory distress syndrome
D. Congenital infection
CORRECT ANSWER: B. Hemolytic anemia
Rationale: A positive direct Coombs test indicates that the infant's red blood cells have
antibodies attached to them, typically from maternal-fetal blood group incompatibility.
This leads to hemolysis and subsequent hemolytic anemia.
Question 11: The nurse is teaching a prenatal class about the signs of labor.
Which statement by a participant indicates a need for further teaching?
A. "The loss of the mucus plug is a sign that labor may be starting soon."
B. "A gush of fluid from the vagina means my membranes have ruptured."
C. "I should go to the hospital as soon as my contractions are 10 minutes apart."
D. "The baby's head engaging into my pelvis is called lightening."
CORRECT ANSWER: C. "I should go to the hospital as soon as my contractions
are 10 minutes apart."
Rationale: For primigravidas, early labor at 10-minute intervals is often too early to go to
the hospital. The recommended time is usually when contractions are 5 minutes apart
(or 3-5 minutes) for 1 hour or as per provider instructions.
Question 12: A client at 35 weeks gestation is diagnosed with acute
pyelonephritis. Which assessment finding should the nurse prioritize?
A. Fever of 101.5°F (38.6°C)
B. Costovertebral angle tenderness
C. Frequent urination
D. Fetal tachycardia of 165 bpm
CORRECT ANSWER: D. Fetal tachycardia of 165 bpm
Rationale: Maternal pyelonephritis can cause fetal distress, evidenced by tachycardia,
which could indicate a compensatory response to maternal fever or hypoxia. While all
options are associated with pyelonephritis, fetal tachycardia is the priority concern for
the fetus.
Question 13: A nurse is caring for a client with placenta previa at 34 weeks
gestation. Which intervention is the highest priority?
A. Auscultate fetal heart tones every 4 hours.
B. Prepare the client for a vaginal exam to confirm dilation.
C. Maintain strict bed rest with bathroom privileges.
D. Assess for signs of hemorrhage and monitor vital signs.
CORRECT ANSWER: D. Assess for signs of hemorrhage and monitor vital signs.
