NURS240 Maternal-Newborn Nursing –
Comprehensive Nursing 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 32-year-old pregnant woman at 38 weeks gestation presents
with a sudden onset of severe, sharp abdominal pain, vaginal bleeding, and a
fundal height that is increasing rapidly. On palpation, the uterus is firm and
board-like. Which of the following is the most likely diagnosis?
A. Placenta previa
B. Abruptio placentae
C. Uterine rupture
D. Preterm labor
CORRECT ANSWER: B. Abruptio placentae
Rationale: The classic presentation of abruptio placentae (placental abruption) includes
sudden onset of severe abdominal pain, a rigid or board-like uterus, and vaginal
bleeding. The increase in fundal height is often due to concealed hemorrhage. Placenta
previa typically presents with painless bleeding, and uterine rupture usually occurs in
the context of a previous uterine scar.
Question 2: A nurse is assessing a newborn 5 minutes after birth. The
newborn's heart rate is 120 bpm, respiratory effort is slow and irregular,
muscle tone is some flexion, reflex irritability is a grimace, and the skin color
is pink with acrocyanosis. What is the Apgar score for this newborn?
A. 6
B. 7
C. 8
D. 9
CORRECT ANSWER: B. 7
Rationale: The Apgar score evaluates heart rate (2 points for >100 bpm), respiratory
effort (1 point for slow/irregular), muscle tone (1 point for some flexion), reflex
irritability (1 point for grimace), and color (2 points for pink with acrocyanosis). Total =
2+1+1+1+2 = 7.
Question 3: A primigravida at 39 weeks gestation is in active labor. Her cervix
is dilated to 6 cm, and the fetus is in a vertex presentation. The nurse notes a
,sudden onset of severe bradycardia on the fetal monitor, with a heart rate
dropping to 70 bpm. The nurse performs a vaginal exam and palpates a
pulsating cord. What is the nurse's priority action?
A. Place the client in the lithotomy position
B. Administer oxygen at 2 liters per minute via nasal cannula
C. Apply gentle upward pressure on the presenting part to relieve cord compression
D. Prepare for an immediate vacuum-assisted delivery
CORRECT ANSWER: C. Apply gentle upward pressure on the presenting part to
relieve cord compression
Rationale: A prolapsed umbilical cord is an obstetric emergency. The priority is to
relieve pressure on the cord to maintain fetal oxygenation. The nurse should insert a
sterile gloved hand into the vagina and apply upward pressure on the presenting part to
elevate it off the cord. Placing the mother in Trendelenburg or knee-chest position is
also indicated.
Question 4: A postpartum client who had a vaginal delivery 3 days ago reports
pain in her right calf, which is red, swollen, and warm to the touch. She also
reports mild shortness of breath. Which of the following is the most likely
diagnosis?
A. Superficial thrombophlebitis
B. Deep vein thrombosis (DVT)
C. Pulmonary embolism
D. Muscle strain
CORRECT ANSWER: B. Deep vein thrombosis (DVT)
Rationale: The classic signs of a DVT include unilateral calf pain, swelling, redness, and
warmth. The presence of shortness of breath is concerning for a possible pulmonary
embolism, which can result from a DVT. However, the localized symptoms in the calf
point to DVT as the primary diagnosis.
Question 5: A pregnant client at 12 weeks gestation asks the nurse about the
risks of prenatal genetic testing. She is concerned about the amniocentesis
procedure. Which of the following statements correctly describes the
procedure?
A. Amniocentesis is routinely performed in the first trimester for all pregnancies.
B. Amniocentesis involves withdrawing a small amount of amniotic fluid for genetic
analysis.
C. The procedure has a high risk of maternal infection, but no risk of fetal loss.
D. Amniocentesis is used primarily to diagnose gestational diabetes.
CORRECT ANSWER: B. Amniocentesis involves withdrawing a small amount of
amniotic fluid for genetic analysis.
,Rationale: Amniocentesis is a procedure in which a needle is inserted into the amniotic
sac to withdraw a small amount of amniotic fluid, which contains fetal cells, for genetic
analysis. It is typically performed between 15 and 20 weeks of gestation. There is a
small risk of miscarriage (about 0.1-0.3%), and it is not used to diagnose gestational
diabetes.
Question 6: A nurse is providing discharge teaching to a new mother who is
breastfeeding. She asks about signs that the infant is getting enough milk.
Which of the following should the nurse include?
A. The infant should have at least 6 wet diapers and 3-4 stools per day by the 4th day of
life.
B. The infant should sleep through the night to indicate adequate intake.
C. The infant should be fed on a strict 4-hour schedule to ensure proper intake.
D. The infant's urine should be dark and concentrated to show adequate hydration.
CORRECT ANSWER: A. The infant should have at least 6 wet diapers and 3-4
stools per day by the 4th day of life.
Rationale: Adequate intake in a breastfed newborn is indicated by at least 6 wet diapers
and 3-4 stools per day by day 4-5. The urine should be pale and dilute, and infants
should feed on demand, not on a strict schedule.
Question 7: A 28-year-old woman at 34 weeks gestation is diagnosed with
preeclampsia. Her blood pressure is 160/100 mmHg, and she has 3+
proteinuria. The nurse notes that she is experiencing a headache, blurred
vision, and epigastric pain. Which medication should the nurse anticipate
administering first to prevent seizures?
A. Magnesium sulfate
B. Labetalol
C. Nifedipine
D. Diazepam
CORRECT ANSWER: A. Magnesium sulfate
Rationale: Magnesium sulfate is the drug of choice to prevent seizures in women with
severe preeclampsia. It acts as a central nervous system depressant. Antihypertensives
like labetalol and nifedipine are used to manage blood pressure but are not the primary
treatment for seizure prophylaxis. Diazepam is a benzodiazepine but is not the first-line
treatment for preeclampsia.
Question 8: A new mother asks the nurse why her newborn has a yellowish
tint to the skin. The nurse explains that physiologic jaundice is common.
Which of the following is the primary cause of physiologic jaundice in a
newborn?
A. An increased number of red blood cells and a relatively short lifespan
B. An immature liver that cannot conjugate bilirubin effectively
, C. Maternal antibodies crossing the placenta to attack fetal red blood cells
D. An increased production of unconjugated bilirubin from muscle breakdown
CORRECT ANSWER: B. An immature liver that cannot conjugate bilirubin
effectively
Rationale: Physiologic jaundice occurs due to the immature liver's inability to conjugate
bilirubin effectively. Newborns have a higher red blood cell count and shorter red blood
cell lifespan, which increases bilirubin production, but the primary issue is the liver's
immaturity, leading to a buildup of unconjugated bilirubin.
Question 9: A pregnant client at 20 weeks gestation is scheduled for a glucose
tolerance test to screen for gestational diabetes. She asks the nurse why this
test is being done. Which of the following is the most appropriate response?
A. "This test is done to check for anemia in pregnancy."
B. "This test screens for diabetes that may have been present before pregnancy."
C. "This test screens for diabetes that develops during pregnancy because of hormonal
changes."
D. "This test is used to diagnose fetal anomalies."
CORRECT ANSWER: C. "This test screens for diabetes that develops during
pregnancy because of hormonal changes."
Rationale: Gestational diabetes is a form of glucose intolerance that develops or is first
recognized during pregnancy. It is caused by hormonal changes that lead to insulin
resistance. The screening test is typically performed between 24 and 28 weeks of
gestation.
Question 10: A nurse is assessing a newborn's reflexes. When the nurse
strokes the lateral aspect of the sole from the heel to the ball of the foot, the
newborn's toes hyperextend and fan out. How should the nurse document this
finding?
A. Positive Babinski reflex
B. Positive plantar grasp reflex
C. Positive rooting reflex
D. Positive Moro reflex
CORRECT ANSWER: A. Positive Babinski reflex
Rationale: The Babinski reflex is elicited by stroking the lateral aspect of the sole from
the heel to the ball of the foot. A positive response involves the hyperextension and
fanning out of the toes, which is normal in a newborn due to immature neurological
development. The plantar grasp is the flexion of the toes in response to pressure on the
sole.
Question 11: A woman at 41 weeks gestation is admitted for induction of labor.
She has a Bishop score of 4. Which of the following cervical ripening agents
would the nurse most likely expect to be administered?
Comprehensive Nursing 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 32-year-old pregnant woman at 38 weeks gestation presents
with a sudden onset of severe, sharp abdominal pain, vaginal bleeding, and a
fundal height that is increasing rapidly. On palpation, the uterus is firm and
board-like. Which of the following is the most likely diagnosis?
A. Placenta previa
B. Abruptio placentae
C. Uterine rupture
D. Preterm labor
CORRECT ANSWER: B. Abruptio placentae
Rationale: The classic presentation of abruptio placentae (placental abruption) includes
sudden onset of severe abdominal pain, a rigid or board-like uterus, and vaginal
bleeding. The increase in fundal height is often due to concealed hemorrhage. Placenta
previa typically presents with painless bleeding, and uterine rupture usually occurs in
the context of a previous uterine scar.
Question 2: A nurse is assessing a newborn 5 minutes after birth. The
newborn's heart rate is 120 bpm, respiratory effort is slow and irregular,
muscle tone is some flexion, reflex irritability is a grimace, and the skin color
is pink with acrocyanosis. What is the Apgar score for this newborn?
A. 6
B. 7
C. 8
D. 9
CORRECT ANSWER: B. 7
Rationale: The Apgar score evaluates heart rate (2 points for >100 bpm), respiratory
effort (1 point for slow/irregular), muscle tone (1 point for some flexion), reflex
irritability (1 point for grimace), and color (2 points for pink with acrocyanosis). Total =
2+1+1+1+2 = 7.
Question 3: A primigravida at 39 weeks gestation is in active labor. Her cervix
is dilated to 6 cm, and the fetus is in a vertex presentation. The nurse notes a
,sudden onset of severe bradycardia on the fetal monitor, with a heart rate
dropping to 70 bpm. The nurse performs a vaginal exam and palpates a
pulsating cord. What is the nurse's priority action?
A. Place the client in the lithotomy position
B. Administer oxygen at 2 liters per minute via nasal cannula
C. Apply gentle upward pressure on the presenting part to relieve cord compression
D. Prepare for an immediate vacuum-assisted delivery
CORRECT ANSWER: C. Apply gentle upward pressure on the presenting part to
relieve cord compression
Rationale: A prolapsed umbilical cord is an obstetric emergency. The priority is to
relieve pressure on the cord to maintain fetal oxygenation. The nurse should insert a
sterile gloved hand into the vagina and apply upward pressure on the presenting part to
elevate it off the cord. Placing the mother in Trendelenburg or knee-chest position is
also indicated.
Question 4: A postpartum client who had a vaginal delivery 3 days ago reports
pain in her right calf, which is red, swollen, and warm to the touch. She also
reports mild shortness of breath. Which of the following is the most likely
diagnosis?
A. Superficial thrombophlebitis
B. Deep vein thrombosis (DVT)
C. Pulmonary embolism
D. Muscle strain
CORRECT ANSWER: B. Deep vein thrombosis (DVT)
Rationale: The classic signs of a DVT include unilateral calf pain, swelling, redness, and
warmth. The presence of shortness of breath is concerning for a possible pulmonary
embolism, which can result from a DVT. However, the localized symptoms in the calf
point to DVT as the primary diagnosis.
Question 5: A pregnant client at 12 weeks gestation asks the nurse about the
risks of prenatal genetic testing. She is concerned about the amniocentesis
procedure. Which of the following statements correctly describes the
procedure?
A. Amniocentesis is routinely performed in the first trimester for all pregnancies.
B. Amniocentesis involves withdrawing a small amount of amniotic fluid for genetic
analysis.
C. The procedure has a high risk of maternal infection, but no risk of fetal loss.
D. Amniocentesis is used primarily to diagnose gestational diabetes.
CORRECT ANSWER: B. Amniocentesis involves withdrawing a small amount of
amniotic fluid for genetic analysis.
,Rationale: Amniocentesis is a procedure in which a needle is inserted into the amniotic
sac to withdraw a small amount of amniotic fluid, which contains fetal cells, for genetic
analysis. It is typically performed between 15 and 20 weeks of gestation. There is a
small risk of miscarriage (about 0.1-0.3%), and it is not used to diagnose gestational
diabetes.
Question 6: A nurse is providing discharge teaching to a new mother who is
breastfeeding. She asks about signs that the infant is getting enough milk.
Which of the following should the nurse include?
A. The infant should have at least 6 wet diapers and 3-4 stools per day by the 4th day of
life.
B. The infant should sleep through the night to indicate adequate intake.
C. The infant should be fed on a strict 4-hour schedule to ensure proper intake.
D. The infant's urine should be dark and concentrated to show adequate hydration.
CORRECT ANSWER: A. The infant should have at least 6 wet diapers and 3-4
stools per day by the 4th day of life.
Rationale: Adequate intake in a breastfed newborn is indicated by at least 6 wet diapers
and 3-4 stools per day by day 4-5. The urine should be pale and dilute, and infants
should feed on demand, not on a strict schedule.
Question 7: A 28-year-old woman at 34 weeks gestation is diagnosed with
preeclampsia. Her blood pressure is 160/100 mmHg, and she has 3+
proteinuria. The nurse notes that she is experiencing a headache, blurred
vision, and epigastric pain. Which medication should the nurse anticipate
administering first to prevent seizures?
A. Magnesium sulfate
B. Labetalol
C. Nifedipine
D. Diazepam
CORRECT ANSWER: A. Magnesium sulfate
Rationale: Magnesium sulfate is the drug of choice to prevent seizures in women with
severe preeclampsia. It acts as a central nervous system depressant. Antihypertensives
like labetalol and nifedipine are used to manage blood pressure but are not the primary
treatment for seizure prophylaxis. Diazepam is a benzodiazepine but is not the first-line
treatment for preeclampsia.
Question 8: A new mother asks the nurse why her newborn has a yellowish
tint to the skin. The nurse explains that physiologic jaundice is common.
Which of the following is the primary cause of physiologic jaundice in a
newborn?
A. An increased number of red blood cells and a relatively short lifespan
B. An immature liver that cannot conjugate bilirubin effectively
, C. Maternal antibodies crossing the placenta to attack fetal red blood cells
D. An increased production of unconjugated bilirubin from muscle breakdown
CORRECT ANSWER: B. An immature liver that cannot conjugate bilirubin
effectively
Rationale: Physiologic jaundice occurs due to the immature liver's inability to conjugate
bilirubin effectively. Newborns have a higher red blood cell count and shorter red blood
cell lifespan, which increases bilirubin production, but the primary issue is the liver's
immaturity, leading to a buildup of unconjugated bilirubin.
Question 9: A pregnant client at 20 weeks gestation is scheduled for a glucose
tolerance test to screen for gestational diabetes. She asks the nurse why this
test is being done. Which of the following is the most appropriate response?
A. "This test is done to check for anemia in pregnancy."
B. "This test screens for diabetes that may have been present before pregnancy."
C. "This test screens for diabetes that develops during pregnancy because of hormonal
changes."
D. "This test is used to diagnose fetal anomalies."
CORRECT ANSWER: C. "This test screens for diabetes that develops during
pregnancy because of hormonal changes."
Rationale: Gestational diabetes is a form of glucose intolerance that develops or is first
recognized during pregnancy. It is caused by hormonal changes that lead to insulin
resistance. The screening test is typically performed between 24 and 28 weeks of
gestation.
Question 10: A nurse is assessing a newborn's reflexes. When the nurse
strokes the lateral aspect of the sole from the heel to the ball of the foot, the
newborn's toes hyperextend and fan out. How should the nurse document this
finding?
A. Positive Babinski reflex
B. Positive plantar grasp reflex
C. Positive rooting reflex
D. Positive Moro reflex
CORRECT ANSWER: A. Positive Babinski reflex
Rationale: The Babinski reflex is elicited by stroking the lateral aspect of the sole from
the heel to the ball of the foot. A positive response involves the hyperextension and
fanning out of the toes, which is normal in a newborn due to immature neurological
development. The plantar grasp is the flexion of the toes in response to pressure on the
sole.
Question 11: A woman at 41 weeks gestation is admitted for induction of labor.
She has a Bishop score of 4. Which of the following cervical ripening agents
would the nurse most likely expect to be administered?
