NUR 2513 Maternal-Child Nursing | Rasmussen
University NUR2513 Study Guide & Exam Prep
2026/2027 | Maternal Newborn & Pediatric
Nursing Review, Pregnancy & Prenatal Care, Fetal
Development, High-Risk Pregnancy, Labor &
Delivery, Postpartum Care, Newborn Assessment,
Pediatric Growth & Development, Childhood
Disorders, Medications, Nutrition, Patient Safety,
Clinical Judgment, Practice Questions, Answers &
Detailed Rationales
Question 1: A 32-year-old primigravida at 39 weeks' gestation presents to the
birthing unit with a history of gestational diabetes. Which intrapartum finding
is most indicative of the need for an expedited delivery to prevent shoulder
dystocia?
A. Maternal blood glucose of 140 mg/dL
B. Prolonged deceleration phase of labor
C. Fetal abdominal circumference > 90th percentile on a recent ultrasound
D. Maternal weight gain of 35 lbs
CORRECT ANSWER: C. Fetal abdominal circumference > 90th percentile on a
recent ultrasound
Rationale: Fetal macrosomia, often indicated by an abdominal circumference > 90th
percentile, is a primary risk factor for shoulder dystocia in pregnancies complicated by
gestational diabetes. While hyperglycemia and prolonged labor are associated with
GDM, the fetal AC measurement is the most direct predictor of the complication.
Question 2: During the assessment of a newborn at 1 minute of life, the nurse
notes a heart rate of 110 bpm, a strong cry, active flexion of extremities, a pink
body with blue extremities, and crying. What is the correct Apgar score for this
infant?
A. 7
B. 8
C. 9
D. 10
CORRECT ANSWER: B. 8
Rationale: The Apgar score is based on five criteria: Heart rate (2 points for >100),
Respiratory effort (2 for strong cry), Muscle tone (2 for active flexion), Reflex irritability
(2 for crying), and Color (1 for acrocyanosis, which is a pink body with blue extremities).
The total is 2+2+2+2+1 = 9. Wait, recalculating: Heart rate 110 is 2, strong cry is 2,
,active flexion is 2, crying is 2, and acrocyanosis is 1. Total is 9. Correction: The score is
9.
Question 2: During the assessment of a newborn at 1 minute of life, the nurse
notes a heart rate of 110 bpm, a strong cry, active flexion of extremities, a pink
body with blue extremities, and crying. What is the correct Apgar score for this
infant?
A. 7
B. 8
C. 9
D. 10
CORRECT ANSWER: C. 9
Rationale: The Apgar score is calculated as follows: Heart rate >100 bpm = 2 points.
Respiratory effort (strong cry) = 2 points. Muscle tone (active flexion) = 2 points. Reflex
irritability (crying in response to stimulation) = 2 points. Color (pink body with blue
extremities/acrocyanosis) = 1 point. The total is 2+2+2+2+1 = 9.
Question 3: A postpartum client who is Rh-negative and has an Rh-positive
newborn is scheduled to receive RhoGAM. What is the primary mechanism of
action of this medication?
A. It lyses fetal erythrocytes in the maternal circulation.
B. It suppresses the maternal immune response to prevent the formation of anti-Rh
antibodies.
C. It crosses the placenta to treat fetal anemia in utero.
D. It stimulates the production of maternal red blood cells.
CORRECT ANSWER: B. It suppresses the maternal immune response to
prevent the formation of anti-Rh antibodies.
Rationale: RhoGAM (Rho(D) immune globulin) works by providing passive immunity. It
contains antibodies to the Rh antigen, which bind to any Rh-positive fetal red blood cells
that may have entered the mother's circulation during delivery. This prevents the
mother's immune system from recognizing the Rh antigen as foreign and producing
permanent anti-Rh antibodies (IgG), which could affect future pregnancies.
Question 4: A nurse is caring for a client in the first stage of labor who is
requesting pain relief. The client's cervical exam is 4 cm, 80% effaced, and the
fetal heart rate is stable. Which pharmacological intervention is most
appropriate at this time?
,A. Administering a bolus of IV fentanyl
B. Administering a low-dose epidural
C. Administering an intramuscular injection of meperidine
D. Administering a spinal block
CORRECT ANSWER: C. Administering an intramuscular injection of
meperidine
Rationale: In the active phase of the first stage of labor (4-7 cm), systemic analgesics like
meperidine or fentanyl are often administered to provide pain relief without significantly
slowing the progress of labor. A low-dose epidural is typically initiated later or when the
client is in more active labor, and a spinal block is used for cesarean sections or
immediate delivery. Fentanyl is often given IV, but IM meperidine is a classic choice.
Question 5: The nurse is assessing a newborn whose mother had gestational
diabetes. Which assessment finding would be of greatest concern?
A. Jitteriness and a blood glucose level of 35 mg/dL
B. A birth weight of 8 lbs 2 oz
C. A head circumference of 34 cm
D. Erythema toxicum on the face and trunk
CORRECT ANSWER: A. Jitteriness and a blood glucose level of 35 mg/dL
Rationale: Infants of diabetic mothers are at high risk for hypoglycemia due to fetal
hyperinsulinism. A blood glucose level of <40 mg/dL in a newborn is hypoglycemic and
can lead to neurological damage. Jitteriness is a clinical sign of hypoglycemia.
Question 6: A 34-week gestation infant is admitted to the NICU with
respiratory distress syndrome (RDS). The nurse understands that this
condition is primarily due to a deficiency of:
A. Amniotic fluid
B. Pulmonary surfactant
C. Fetal hemoglobin
D. Alveolar macrophages
CORRECT ANSWER: B. Pulmonary surfactant
Rationale: Respiratory Distress Syndrome (RDS) or hyaline membrane disease is caused
by a deficiency of pulmonary surfactant, a lipoprotein that reduces surface tension in the
alveoli. Without it, alveoli collapse during expiration, leading to respiratory failure.
Surfactant production typically matures by 35-36 weeks of gestation.
, Question 7: During the active phase of the first stage of labor, a nurse notes
that the client's contractions are lasting 90 seconds and occurring every 1.5
minutes. The fetal heart rate baseline is 140 bpm with variable decelerations.
What is the priority nursing intervention?
A. Encourage the client to void
B. Prepare for an immediate cesarean delivery
C. Administer oxygen at 8-10 L/min via face mask and reposition the client
D. Document the findings as a normal progression of labor
CORRECT ANSWER: C. Administer oxygen at 8-10 L/min via face mask and
reposition the client
Rationale: The contractions described (lasting 90 seconds with a frequency of every 1.5
minutes) are indicative of hyperstimulation or tachysystole. This can compromise
uterine blood flow and lead to fetal hypoxia, as evidenced by variable decelerations. The
immediate interventions are to discontinue any uterotonic agents (if applicable),
reposition the client, and administer oxygen.
Question 8: A postpartum client is being discharged home. Which statement
by the client indicates a need for further teaching regarding postpartum
depression?
A. "I will call my doctor if I have thoughts of harming myself or the baby."
B. "It's normal to feel a little down for the first week or two."
C. "If I don't feel better after a week, I will probably just need to take more vitamins."
D. "I should get as much rest as possible and ask for help when I need it."
CORRECT ANSWER: C. "If I don't feel better after a week, I will probably just
need to take more vitamins."
Rationale: The "baby blues" (feelings of sadness, tearfulness, and mood swings) typically
resolve within two weeks postpartum. If symptoms persist or worsen, it may indicate
postpartum depression, which requires professional evaluation and treatment, not just
vitamins.
Question 9: A 28-year-old client at 36 weeks gestation presents with a sudden
onset of bright red, painless vaginal bleeding. Her fundal height is 36 cm. What
is the most likely diagnosis?
A. Placental abruption
B. Vasa previa
C. Placenta previa
D. Cervical insufficiency
CORRECT ANSWER: C. Placenta previa
University NUR2513 Study Guide & Exam Prep
2026/2027 | Maternal Newborn & Pediatric
Nursing Review, Pregnancy & Prenatal Care, Fetal
Development, High-Risk Pregnancy, Labor &
Delivery, Postpartum Care, Newborn Assessment,
Pediatric Growth & Development, Childhood
Disorders, Medications, Nutrition, Patient Safety,
Clinical Judgment, Practice Questions, Answers &
Detailed Rationales
Question 1: A 32-year-old primigravida at 39 weeks' gestation presents to the
birthing unit with a history of gestational diabetes. Which intrapartum finding
is most indicative of the need for an expedited delivery to prevent shoulder
dystocia?
A. Maternal blood glucose of 140 mg/dL
B. Prolonged deceleration phase of labor
C. Fetal abdominal circumference > 90th percentile on a recent ultrasound
D. Maternal weight gain of 35 lbs
CORRECT ANSWER: C. Fetal abdominal circumference > 90th percentile on a
recent ultrasound
Rationale: Fetal macrosomia, often indicated by an abdominal circumference > 90th
percentile, is a primary risk factor for shoulder dystocia in pregnancies complicated by
gestational diabetes. While hyperglycemia and prolonged labor are associated with
GDM, the fetal AC measurement is the most direct predictor of the complication.
Question 2: During the assessment of a newborn at 1 minute of life, the nurse
notes a heart rate of 110 bpm, a strong cry, active flexion of extremities, a pink
body with blue extremities, and crying. What is the correct Apgar score for this
infant?
A. 7
B. 8
C. 9
D. 10
CORRECT ANSWER: B. 8
Rationale: The Apgar score is based on five criteria: Heart rate (2 points for >100),
Respiratory effort (2 for strong cry), Muscle tone (2 for active flexion), Reflex irritability
(2 for crying), and Color (1 for acrocyanosis, which is a pink body with blue extremities).
The total is 2+2+2+2+1 = 9. Wait, recalculating: Heart rate 110 is 2, strong cry is 2,
,active flexion is 2, crying is 2, and acrocyanosis is 1. Total is 9. Correction: The score is
9.
Question 2: During the assessment of a newborn at 1 minute of life, the nurse
notes a heart rate of 110 bpm, a strong cry, active flexion of extremities, a pink
body with blue extremities, and crying. What is the correct Apgar score for this
infant?
A. 7
B. 8
C. 9
D. 10
CORRECT ANSWER: C. 9
Rationale: The Apgar score is calculated as follows: Heart rate >100 bpm = 2 points.
Respiratory effort (strong cry) = 2 points. Muscle tone (active flexion) = 2 points. Reflex
irritability (crying in response to stimulation) = 2 points. Color (pink body with blue
extremities/acrocyanosis) = 1 point. The total is 2+2+2+2+1 = 9.
Question 3: A postpartum client who is Rh-negative and has an Rh-positive
newborn is scheduled to receive RhoGAM. What is the primary mechanism of
action of this medication?
A. It lyses fetal erythrocytes in the maternal circulation.
B. It suppresses the maternal immune response to prevent the formation of anti-Rh
antibodies.
C. It crosses the placenta to treat fetal anemia in utero.
D. It stimulates the production of maternal red blood cells.
CORRECT ANSWER: B. It suppresses the maternal immune response to
prevent the formation of anti-Rh antibodies.
Rationale: RhoGAM (Rho(D) immune globulin) works by providing passive immunity. It
contains antibodies to the Rh antigen, which bind to any Rh-positive fetal red blood cells
that may have entered the mother's circulation during delivery. This prevents the
mother's immune system from recognizing the Rh antigen as foreign and producing
permanent anti-Rh antibodies (IgG), which could affect future pregnancies.
Question 4: A nurse is caring for a client in the first stage of labor who is
requesting pain relief. The client's cervical exam is 4 cm, 80% effaced, and the
fetal heart rate is stable. Which pharmacological intervention is most
appropriate at this time?
,A. Administering a bolus of IV fentanyl
B. Administering a low-dose epidural
C. Administering an intramuscular injection of meperidine
D. Administering a spinal block
CORRECT ANSWER: C. Administering an intramuscular injection of
meperidine
Rationale: In the active phase of the first stage of labor (4-7 cm), systemic analgesics like
meperidine or fentanyl are often administered to provide pain relief without significantly
slowing the progress of labor. A low-dose epidural is typically initiated later or when the
client is in more active labor, and a spinal block is used for cesarean sections or
immediate delivery. Fentanyl is often given IV, but IM meperidine is a classic choice.
Question 5: The nurse is assessing a newborn whose mother had gestational
diabetes. Which assessment finding would be of greatest concern?
A. Jitteriness and a blood glucose level of 35 mg/dL
B. A birth weight of 8 lbs 2 oz
C. A head circumference of 34 cm
D. Erythema toxicum on the face and trunk
CORRECT ANSWER: A. Jitteriness and a blood glucose level of 35 mg/dL
Rationale: Infants of diabetic mothers are at high risk for hypoglycemia due to fetal
hyperinsulinism. A blood glucose level of <40 mg/dL in a newborn is hypoglycemic and
can lead to neurological damage. Jitteriness is a clinical sign of hypoglycemia.
Question 6: A 34-week gestation infant is admitted to the NICU with
respiratory distress syndrome (RDS). The nurse understands that this
condition is primarily due to a deficiency of:
A. Amniotic fluid
B. Pulmonary surfactant
C. Fetal hemoglobin
D. Alveolar macrophages
CORRECT ANSWER: B. Pulmonary surfactant
Rationale: Respiratory Distress Syndrome (RDS) or hyaline membrane disease is caused
by a deficiency of pulmonary surfactant, a lipoprotein that reduces surface tension in the
alveoli. Without it, alveoli collapse during expiration, leading to respiratory failure.
Surfactant production typically matures by 35-36 weeks of gestation.
, Question 7: During the active phase of the first stage of labor, a nurse notes
that the client's contractions are lasting 90 seconds and occurring every 1.5
minutes. The fetal heart rate baseline is 140 bpm with variable decelerations.
What is the priority nursing intervention?
A. Encourage the client to void
B. Prepare for an immediate cesarean delivery
C. Administer oxygen at 8-10 L/min via face mask and reposition the client
D. Document the findings as a normal progression of labor
CORRECT ANSWER: C. Administer oxygen at 8-10 L/min via face mask and
reposition the client
Rationale: The contractions described (lasting 90 seconds with a frequency of every 1.5
minutes) are indicative of hyperstimulation or tachysystole. This can compromise
uterine blood flow and lead to fetal hypoxia, as evidenced by variable decelerations. The
immediate interventions are to discontinue any uterotonic agents (if applicable),
reposition the client, and administer oxygen.
Question 8: A postpartum client is being discharged home. Which statement
by the client indicates a need for further teaching regarding postpartum
depression?
A. "I will call my doctor if I have thoughts of harming myself or the baby."
B. "It's normal to feel a little down for the first week or two."
C. "If I don't feel better after a week, I will probably just need to take more vitamins."
D. "I should get as much rest as possible and ask for help when I need it."
CORRECT ANSWER: C. "If I don't feel better after a week, I will probably just
need to take more vitamins."
Rationale: The "baby blues" (feelings of sadness, tearfulness, and mood swings) typically
resolve within two weeks postpartum. If symptoms persist or worsen, it may indicate
postpartum depression, which requires professional evaluation and treatment, not just
vitamins.
Question 9: A 28-year-old client at 36 weeks gestation presents with a sudden
onset of bright red, painless vaginal bleeding. Her fundal height is 36 cm. What
is the most likely diagnosis?
A. Placental abruption
B. Vasa previa
C. Placenta previa
D. Cervical insufficiency
CORRECT ANSWER: C. Placenta previa
