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Exam 3 Test Bank & Exam Prep Guide | Maternal
and Pediatric Nursing | Galen College of Nursing |
Q & A | 2026/2027 Edition (PDF)
1. A nurse is assessing a newborn who is 15 minutes old. The newborn's heart rate is 165 bpm,
respirations are irregular at 55 breaths/min, and the infant is alert with spontaneous
movements. The nurse correctly identifies this as which phase of newborn transition?
A) Period of decreased responsiveness
B) Second period of reactivity
C) First period of reactivity
D) Transitional sleep phase
Correct Answer: C) First period of reactivity
Rationale: The first period of reactivity occurs during the first 15-30 minutes after birth and is
characterized by an alert state, heart rate of 160-180 bpm, and irregular respirations. The
period of decreased responsiveness occurs at 60-100 minutes, and the second period of
reactivity occurs at 2-8 hours.
,2. A postpartum patient who is 2 hours post-delivery reports excessive bleeding. The nurse
notes that the patient's uterus is boggy and located above the umbilicus. Which nursing
intervention should the nurse perform first?
A) Administer oxytocin as prescribed
B) Perform fundal massage
C) Notify the healthcare provider
D) Assess vital signs
Correct Answer: B) Perform fundal massage
Rationale: A boggy uterus displaced above the umbilicus indicates uterine atony, the most
common cause of postpartum hemorrhage. The priority intervention is fundal massage to
stimulate uterine contraction. Oxytocin administration and provider notification should follow,
but massage is the immediate first-line response.
3. A nurse is explaining the concept of family-centered care to a new graduate. Which statement
by the graduate indicates correct understanding?
A) "The nurse is the primary decision-maker for the child's health."
B) "Care is planned and delivered with the family as the central focus and partner."
C) "The family's input is valuable but secondary to the medical team's goals."
D) "Family-centered care means the family is always in the room during procedures."
Correct Answer: B) Care is planned and delivered with the family as the central focus and
partner
, Rationale: Family-centered care empowers families to be active participants in their child's care
planning, delivery, and evaluation. It does not mean the family makes all decisions or is always
present; rather, the family is a central partner in the healthcare team.
4. A nurse is implementing atraumatic care for a 4-year-old undergoing a venipuncture. Which
action best exemplifies this principle?
A) Holding the child down firmly to ensure the procedure is done quickly
B) Allowing the child to choose a sticker and hold a toy during the procedure
C) Telling the child it "won't hurt a bit" to reduce anxiety
D) Asking the parents to wait outside to prevent their own anxiety from affecting the child
Correct Answer: B) Allowing the child to choose a sticker and hold a toy during the procedure
Rationale: Atraumatic care minimizes physical and psychological distress. Allowing the child to
hold a toy and choose a sticker promotes a sense of control and provides distraction. Holding
the child down, giving false reassurance, and separating from parents are not atraumatic.
5. A postpartum client on day 3 reports a fever of 100.8°F and foul-smelling lochia. What should
the nurse suspect?
A) Normal postpartum recovery
B) Endometritis
C) Mastitis
D) Urinary tract infection
Exam 3 Test Bank & Exam Prep Guide | Maternal
and Pediatric Nursing | Galen College of Nursing |
Q & A | 2026/2027 Edition (PDF)
1. A nurse is assessing a newborn who is 15 minutes old. The newborn's heart rate is 165 bpm,
respirations are irregular at 55 breaths/min, and the infant is alert with spontaneous
movements. The nurse correctly identifies this as which phase of newborn transition?
A) Period of decreased responsiveness
B) Second period of reactivity
C) First period of reactivity
D) Transitional sleep phase
Correct Answer: C) First period of reactivity
Rationale: The first period of reactivity occurs during the first 15-30 minutes after birth and is
characterized by an alert state, heart rate of 160-180 bpm, and irregular respirations. The
period of decreased responsiveness occurs at 60-100 minutes, and the second period of
reactivity occurs at 2-8 hours.
,2. A postpartum patient who is 2 hours post-delivery reports excessive bleeding. The nurse
notes that the patient's uterus is boggy and located above the umbilicus. Which nursing
intervention should the nurse perform first?
A) Administer oxytocin as prescribed
B) Perform fundal massage
C) Notify the healthcare provider
D) Assess vital signs
Correct Answer: B) Perform fundal massage
Rationale: A boggy uterus displaced above the umbilicus indicates uterine atony, the most
common cause of postpartum hemorrhage. The priority intervention is fundal massage to
stimulate uterine contraction. Oxytocin administration and provider notification should follow,
but massage is the immediate first-line response.
3. A nurse is explaining the concept of family-centered care to a new graduate. Which statement
by the graduate indicates correct understanding?
A) "The nurse is the primary decision-maker for the child's health."
B) "Care is planned and delivered with the family as the central focus and partner."
C) "The family's input is valuable but secondary to the medical team's goals."
D) "Family-centered care means the family is always in the room during procedures."
Correct Answer: B) Care is planned and delivered with the family as the central focus and
partner
, Rationale: Family-centered care empowers families to be active participants in their child's care
planning, delivery, and evaluation. It does not mean the family makes all decisions or is always
present; rather, the family is a central partner in the healthcare team.
4. A nurse is implementing atraumatic care for a 4-year-old undergoing a venipuncture. Which
action best exemplifies this principle?
A) Holding the child down firmly to ensure the procedure is done quickly
B) Allowing the child to choose a sticker and hold a toy during the procedure
C) Telling the child it "won't hurt a bit" to reduce anxiety
D) Asking the parents to wait outside to prevent their own anxiety from affecting the child
Correct Answer: B) Allowing the child to choose a sticker and hold a toy during the procedure
Rationale: Atraumatic care minimizes physical and psychological distress. Allowing the child to
hold a toy and choose a sticker promotes a sense of control and provides distraction. Holding
the child down, giving false reassurance, and separating from parents are not atraumatic.
5. A postpartum client on day 3 reports a fever of 100.8°F and foul-smelling lochia. What should
the nurse suspect?
A) Normal postpartum recovery
B) Endometritis
C) Mastitis
D) Urinary tract infection
