NUR 230 Maternal Newborn Nursing | Exam 1
Practice 2026/2027 | Questions With Correct
Answers With Detailed Rationale
Instructions: Select the correct answer for each of the following questions.
1. A 32-week gestation patient is admitted with painless, bright red vaginal bleeding.
The nurse notes the uterus is soft and non-tender to palpation, and fetal heart rate is
140 bpm and reactive. The nurse will prepare for which immediate intervention?
A. Administration of oxytocin (Pitocin) to augment labor.
B. A manual cervical examination to determine dilation.
C. Continuous external fetal monitoring and a stat ultrasound.
D. Administration of a tocolytic agent to stop contractions.
[Correct Answer:] C
[Rationale:] Painless, bright red vaginal bleeding in the third trimester is the classic
presentation of placenta previa. A "soft and non-tender" uterus further supports this
diagnosis and rules out abruptio placentae (which is painful). A manual cervical
examination is contraindicated as it can disrupt the placenta and cause catastrophic
hemorrhage. The immediate management is to assess fetal well-being (continuous
monitoring) and confirm the diagnosis via ultrasound.
2. The nurse is caring for a patient at 38 weeks gestation who is Group B
Streptococcus (GBS) positive. The patient's water breaks spontaneously, and she is
admitted with contractions every 5 minutes. Which action is the nurse's priority?
A. Obtain a baseline maternal temperature.
B. Initiate antibiotic prophylaxis as ordered.
C. Administer a corticosteroid injection.
D. Prepare for immediate cesarean section.
[Correct Answer:] B
[Rationale:] The priority for a GBS-positive patient in labor is the administration of
intrapartum antibiotic prophylaxis (typically Penicillin G) to prevent early-onset neonatal
GBS sepsis. This should be initiated as soon as possible after rupture of membranes or onset
of labor. A baseline temperature (A) is important but is part of the assessment leading up to
the priority intervention. Corticosteroids (C) are for preterm labor, not term, and a C-
section (D) is not indicated solely for GBS positive status.
,3. A nurse is assessing a patient who is 12 hours postpartum following a spontaneous
vaginal delivery. The patient reports a severe headache and blurred vision. Her blood
pressure is 155/95 mmHg, and she has 2+ pitting edema in her lower extremities.
The nurse should first:
A. Administer a PRN dose of ibuprofen for the headache.
B. Place the patient in a left lateral position and call the provider.
C. Encourage the patient to drink more water to treat dehydration.
D. Instruct the patient to lie flat to improve cerebral perfusion.
[Correct Answer:] B
[Rationale:] Postpartum hypertension (BP ≥ 140/90) with headache and visual
disturbances are signs of preeclampsia or impending eclampsia. The immediate priority is
patient safety (seizure prevention) by placing the patient in a left lateral position to
maximize venous return and uteroplacental perfusion while notifying the provider for
further orders (like magnesium sulfate or antihypertensives). Administering ibuprofen (A)
without a provider's order for this high-risk presentation is unsafe. Lying flat (D) can
worsen hypertension.
4. The nurse is performing a fundal assessment on a patient who is 1 hour
postpartum. The fundus is firm at the umbilicus and deviated to the right. The
patient's peripad is saturated with lochia rubra. What is the nurse's priority action?
A. Massage the fundus firmly until it is midline.
B. Insert an indwelling Foley catheter to empty the bladder.
C. Document the findings as normal for this stage of recovery.
D. Increase the IV fluid rate to replace blood loss.
[Correct Answer:] B
[Rationale:] A firm fundus that is deviated to the right (or left) indicates a distended
bladder pushing the uterus to one side. A distended bladder prevents the uterus from
contracting effectively, leading to increased bleeding (as evidenced by the saturated pad).
The priority is to empty the bladder, which will allow the fundus to move back to the
midline and contract properly. Massaging a firm fundus (A) is ineffective and unnecessary.
5. The nurse is providing teaching to a new mother who is learning to breastfeed. The
patient asks, "How do I know if my baby is actually getting enough milk?" Which
response by the nurse is correct?
, A. "Your baby should be sleeping through the night by the end of the first week."
B. "You should expect your baby to have 6 to 8 wet diapers and 3 to 4 yellow stools per day
by day 5."
C. "Your baby should be gaining 2 ounces per day after the first week of life."
D. "You should not feel any breast fullness or leaking, as that means your milk is gone."
[Correct Answer:] B
[Rationale:] Adequate intake in a breastfed newborn is best determined by output. By day
5, the baby should have 6-8 wet diapers (urine output) and 3-4 soft, yellow stools
(meconium transition) per day. This indicates the baby is receiving enough
colostrum/transitional milk. Newborns should not sleep through the night (A) and need to
feed every 2-3 hours. Weight gain is usually 20-30 grams/day (approx. 1 oz), not 2 oz (C), in
the first weeks.
6. A primigravida patient at 40 weeks gestation is in active labor. The nurse assesses
the fetal heart rate (FHR) and notes late decelerations that are repetitive and
shallow. The baseline variability is minimal. What is the nurse's priority initial
action?
A. Administer oxygen at 10 L via non-rebreather mask.
B. Discontinue the oxytocin infusion.
C. Reposition the patient to the left lateral side.
D. Prepare for an immediate cesarean birth.
[Correct Answer:] C
[Rationale:] Late decelerations indicate uteroplacental insufficiency. The priority is to
improve uteroplacental blood flow. The first intervention is always to reposition the
mother (to the left lateral) to relieve aortocaval compression and improve venous return.
While (A) and (B) are also indicated, the initial and immediate action is to change the
patient's position. Preparing for a C-section (D) is the next step if interventions fail to
resolve the pattern.
7. The nurse is caring for a patient with preeclampsia who is receiving a continuous
infusion of Magnesium Sulfate. Which assessment finding indicates magnesium
toxicity and requires the nurse to immediately stop the infusion and administer
calcium gluconate?
A. Urinary output of 150 mL over 4 hours.
B. Deep Tendon Reflexes (DTR) of 3+.
C. Respiratory rate of 10 breaths per minute.
D. Blood pressure of 150/90 mmHg.
Practice 2026/2027 | Questions With Correct
Answers With Detailed Rationale
Instructions: Select the correct answer for each of the following questions.
1. A 32-week gestation patient is admitted with painless, bright red vaginal bleeding.
The nurse notes the uterus is soft and non-tender to palpation, and fetal heart rate is
140 bpm and reactive. The nurse will prepare for which immediate intervention?
A. Administration of oxytocin (Pitocin) to augment labor.
B. A manual cervical examination to determine dilation.
C. Continuous external fetal monitoring and a stat ultrasound.
D. Administration of a tocolytic agent to stop contractions.
[Correct Answer:] C
[Rationale:] Painless, bright red vaginal bleeding in the third trimester is the classic
presentation of placenta previa. A "soft and non-tender" uterus further supports this
diagnosis and rules out abruptio placentae (which is painful). A manual cervical
examination is contraindicated as it can disrupt the placenta and cause catastrophic
hemorrhage. The immediate management is to assess fetal well-being (continuous
monitoring) and confirm the diagnosis via ultrasound.
2. The nurse is caring for a patient at 38 weeks gestation who is Group B
Streptococcus (GBS) positive. The patient's water breaks spontaneously, and she is
admitted with contractions every 5 minutes. Which action is the nurse's priority?
A. Obtain a baseline maternal temperature.
B. Initiate antibiotic prophylaxis as ordered.
C. Administer a corticosteroid injection.
D. Prepare for immediate cesarean section.
[Correct Answer:] B
[Rationale:] The priority for a GBS-positive patient in labor is the administration of
intrapartum antibiotic prophylaxis (typically Penicillin G) to prevent early-onset neonatal
GBS sepsis. This should be initiated as soon as possible after rupture of membranes or onset
of labor. A baseline temperature (A) is important but is part of the assessment leading up to
the priority intervention. Corticosteroids (C) are for preterm labor, not term, and a C-
section (D) is not indicated solely for GBS positive status.
,3. A nurse is assessing a patient who is 12 hours postpartum following a spontaneous
vaginal delivery. The patient reports a severe headache and blurred vision. Her blood
pressure is 155/95 mmHg, and she has 2+ pitting edema in her lower extremities.
The nurse should first:
A. Administer a PRN dose of ibuprofen for the headache.
B. Place the patient in a left lateral position and call the provider.
C. Encourage the patient to drink more water to treat dehydration.
D. Instruct the patient to lie flat to improve cerebral perfusion.
[Correct Answer:] B
[Rationale:] Postpartum hypertension (BP ≥ 140/90) with headache and visual
disturbances are signs of preeclampsia or impending eclampsia. The immediate priority is
patient safety (seizure prevention) by placing the patient in a left lateral position to
maximize venous return and uteroplacental perfusion while notifying the provider for
further orders (like magnesium sulfate or antihypertensives). Administering ibuprofen (A)
without a provider's order for this high-risk presentation is unsafe. Lying flat (D) can
worsen hypertension.
4. The nurse is performing a fundal assessment on a patient who is 1 hour
postpartum. The fundus is firm at the umbilicus and deviated to the right. The
patient's peripad is saturated with lochia rubra. What is the nurse's priority action?
A. Massage the fundus firmly until it is midline.
B. Insert an indwelling Foley catheter to empty the bladder.
C. Document the findings as normal for this stage of recovery.
D. Increase the IV fluid rate to replace blood loss.
[Correct Answer:] B
[Rationale:] A firm fundus that is deviated to the right (or left) indicates a distended
bladder pushing the uterus to one side. A distended bladder prevents the uterus from
contracting effectively, leading to increased bleeding (as evidenced by the saturated pad).
The priority is to empty the bladder, which will allow the fundus to move back to the
midline and contract properly. Massaging a firm fundus (A) is ineffective and unnecessary.
5. The nurse is providing teaching to a new mother who is learning to breastfeed. The
patient asks, "How do I know if my baby is actually getting enough milk?" Which
response by the nurse is correct?
, A. "Your baby should be sleeping through the night by the end of the first week."
B. "You should expect your baby to have 6 to 8 wet diapers and 3 to 4 yellow stools per day
by day 5."
C. "Your baby should be gaining 2 ounces per day after the first week of life."
D. "You should not feel any breast fullness or leaking, as that means your milk is gone."
[Correct Answer:] B
[Rationale:] Adequate intake in a breastfed newborn is best determined by output. By day
5, the baby should have 6-8 wet diapers (urine output) and 3-4 soft, yellow stools
(meconium transition) per day. This indicates the baby is receiving enough
colostrum/transitional milk. Newborns should not sleep through the night (A) and need to
feed every 2-3 hours. Weight gain is usually 20-30 grams/day (approx. 1 oz), not 2 oz (C), in
the first weeks.
6. A primigravida patient at 40 weeks gestation is in active labor. The nurse assesses
the fetal heart rate (FHR) and notes late decelerations that are repetitive and
shallow. The baseline variability is minimal. What is the nurse's priority initial
action?
A. Administer oxygen at 10 L via non-rebreather mask.
B. Discontinue the oxytocin infusion.
C. Reposition the patient to the left lateral side.
D. Prepare for an immediate cesarean birth.
[Correct Answer:] C
[Rationale:] Late decelerations indicate uteroplacental insufficiency. The priority is to
improve uteroplacental blood flow. The first intervention is always to reposition the
mother (to the left lateral) to relieve aortocaval compression and improve venous return.
While (A) and (B) are also indicated, the initial and immediate action is to change the
patient's position. Preparing for a C-section (D) is the next step if interventions fail to
resolve the pattern.
7. The nurse is caring for a patient with preeclampsia who is receiving a continuous
infusion of Magnesium Sulfate. Which assessment finding indicates magnesium
toxicity and requires the nurse to immediately stop the infusion and administer
calcium gluconate?
A. Urinary output of 150 mL over 4 hours.
B. Deep Tendon Reflexes (DTR) of 3+.
C. Respiratory rate of 10 breaths per minute.
D. Blood pressure of 150/90 mmHg.
