NSG 3500 Exam 4 | Maternal Health (2026/2027) | Galen College of Nursing Postpartum, Newborn, and Lactation
NSG 3500 Exam 4 | Maternal Health (2026/2027)
100 Verified Questions & Answers — Galen College of Nursing | Postpartum, Newborn, and Lactation
Objectives
Generated: September 22, 2026 | Format: Multiple Choice (4 options, one correct) | Total Items: 100
Section Topic Coverage Items
Section 1 Postpartum Physiologic Adaptation Q1–Q15
Section 2 Postpartum Nursing Assessment and Care Q16–Q28
Section 3 Postpartum Complications Q29–Q42
Section 4 Lactation and Newborn Feeding Q43–Q55
Section 5 Newborn Assessment and Transition Q56–Q70
Section 6 Newborn Complications and Care Q71–Q83
Section 7 Postpartum Psychosocial Adaptation Q84–Q92
Section 8 Discharge Teaching, Family Planning, and Community Resources Q93–Q100
Directions: This practice exam mirrors the rigor and content coverage of the NSG 3500 Exam 4 Maternal Health
assessment at Galen College of Nursing. Each of the 100 multiple-choice items presents four options (A–D) with
exactly one correct response. Items are calibrated to a cognitive distribution of approximately 30% recall, 50%
application, and 20% analysis. Approximately 80% of items are scenario-based NCLEX-style questions requiring
integration of postpartum physiologic adaptation, BUBBLE-HE assessment, postpartum complications (4 T's of
hemorrhage, endometritis, DVT/PE, postpartum preeclampsia/HELLP), lactation physiology, newborn transition
and assessment (APGAR, Ballard, reflexes), newborn complications (jaundice, hypoglycemia, RDS, sepsis, NAS),
postpartum psychosocial adaptation (blues vs. depression vs. psychosis), and discharge teaching (safe sleep, car
seat, contraception). Approximately 20% assess direct recall of maternal-newborn concepts. After each item, the
correct answer and a 2–3 sentence rationale are provided, integrating pathophysiologic mechanisms, assessment
priorities, nursing interventions, and patient safety considerations aligned with current AWHONN, ACOG, AAP,
and Galen College of Nursing curriculum standards.
Section 1: Postpartum Physiologic Adaptation
Uterine Involution, Lochia, Cardiovascular, and Endocrine Changes | Items Q1–Q15
NCLEX-Style Clinical Reasoning | AWHONN | ACOG | AAP | Cognitive Levels: 30% Recall / 50% Application / 20% Analysis Page 1
,NSG 3500 Exam 4 | Maternal Health (2026/2027) | Galen College of Nursing Postpartum, Newborn, and Lactation
Q1.
A nurse is assessing a postpartum client 12 hours after a vaginal delivery. The fundus is firm, located at the level of
the umbilicus, and midline. Which interpretation is most accurate?
A. The fundus is abnormally high, suggesting uterine atony
B. The fundal position is normal; the uterus should be at or near the umbilicus immediately after
delivery, then descend approximately 1 cm/day [CORRECT]
C. The fundus is deviated and requires bladder emptying
D. The fundus should be 3 cm below the umbilicus at this time
Correct Answer: B
Rationale: Immediately after delivery, the fundus is palpated at or near the umbilicus (within 12 hours). It then
descends approximately 1 cm (or one fingerbreadth) per day, reaching approximately 3 cm below the umbilicus by day
3, and is no longer palpable abdominally by day 10-14. A firm fundus at the umbilicus at 12 hours postpartum is the
expected finding. A deviated fundus suggests bladder distention requiring the client to void.
Q2.
A postpartum client asks the nurse about lochia changes. The nurse explains that lochia rubra typically lasts:
A. 1-3 days postpartum
B. 3-4 days postpartum (typically days 1-3, transitioning to serosa around day 4) [CORRECT]
C. 10-14 days postpartum
D. Up to 6 weeks postpartum
Correct Answer: B
Rationale: Lochia progresses through three stages: rubra (dark red, mostly blood and decidual tissue, days 1-3), serosa
(pinkish-brown, serous with blood and leukocytes, days 4-10), and alba (yellowish-white, leukocytes and decidual tissue,
days 11-6 weeks). Lochia should never contain large clots, foul odor, or excessive bleeding. Persistent rubra or return to
rubra after serosa suggests retained placenta, subinvolution, or late hemorrhage.
Q3.
A postpartum client on day 2 has lochia that is dark red, moderate in amount, with a fleshy odor. The nurse
interprets this finding as:
A. Normal lochia rubra [CORRECT]
B. Sign of infection requiring antibiotics
C. Indication of retained placental fragments
D. Sign of impending hemorrhage
Correct Answer: A
Rationale: Lochia rubra is dark red, occurring days 1-3 postpartum, with a fleshy (earthy, similar to menstrual flow)
odor. Moderate amount is normal. A foul or foul-smelling (feculent, fishy) odor suggests infection (endometritis).
Excessive bleeding or large clots suggest hemorrhage. Continuation of rubra beyond 3-4 days suggests subinvolution or
retained fragments. Normal lochia should not be malodorous.
NCLEX-Style Clinical Reasoning | AWHONN | ACOG | AAP | Cognitive Levels: 30% Recall / 50% Application / 20% Analysis Page 2
,NSG 3500 Exam 4 | Maternal Health (2026/2027) | Galen College of Nursing Postpartum, Newborn, and Lactation
Q4.
A nurse is caring for a postpartum client 24 hours after delivery. The client's vital signs are: BP 100/60, P 60, R
16, T 99.0°F. The nurse recognizes that bradycardia (P 50-70) is normal postpartum due to:
A. Hypovolemia from blood loss
B. Cardiac decompensation
C. Increased venous return from uterine decompression and fluid mobilization, leading to transient
bradycardia [CORRECT]
D. Infection
Correct Answer: C
Rationale: Postpartum bradycardia (P 50-70) is normal in the first 24-72 hours due to improved venous return (the
gravid uterus no longer compresses the inferior vena cava) and redistribution of fluid from extravascular spaces back
into circulation. Stroke volume increases and heart rate decreases to compensate. Transient tachycardia >100 may
indicate hemorrhage, infection, or pain. Temperature up to 100.4°F (38°C) is normal in first 24 hours due to
dehydration.
Q5.
A postpartum client delivered 6 hours ago. The nurse assesses the laboratory results and notes a WBC count of
25,000/mm³. The nurse interprets this finding as:
A. Sign of infection requiring immediate antibiotics
B. Normal postpartum leukocytosis due to labor stress and tissue trauma [CORRECT]
C. Sign of hemorrhage
D. Indication of leukemia
Correct Answer: B
Rationale: Postpartum leukocytosis (WBC up to 25,000-30,000/mm³) is normal during the first 24-72 hours
postpartum due to the physiologic stress of labor, tissue trauma, and hormonal changes. Labor and delivery are stressful
events that increase WBC count. However, an elevated WBC with fever, foul lochia, uterine tenderness, or other signs of
infection requires evaluation for endometritis or wound infection.
Q6.
A postpartum client asks the nurse when her menstrual cycle will resume. The client is formula-feeding. The
nurse's best response is:
A. Menstruation typically resumes within 6-8 weeks for non-lactating women [CORRECT]
B. Menstruation will not resume until 6 months postpartum
C. Menstruation typically resumes within 12 weeks for non-lactating women
D. Menstruation will resume immediately after delivery
Correct Answer: A
Rationale: Non-lactating women typically resume menstruation within 6-8 weeks postpartum due to the rapid decline in
prolactin levels. Lactating women may not resume menstruation for 6 months or longer (lactational amenorrhea) due to
prolactin's inhibition of ovulation. The first menstrual cycle may be anovulatory, but ovulation can occur before the first
menses; contraception is therefore important even before menses resume.
NCLEX-Style Clinical Reasoning | AWHONN | ACOG | AAP | Cognitive Levels: 30% Recall / 50% Application / 20% Analysis Page 3
, NSG 3500 Exam 4 | Maternal Health (2026/2027) | Galen College of Nursing Postpartum, Newborn, and Lactation
Q7.
A postpartum client who delivered 48 hours ago has a fundus that is 3 cm above the umbilicus and deviated to the
right. The nurse's priority action is to:
A. Administer oxytocin to promote uterine contraction
B. Assist the client to empty her bladder, then reassess fundal position [CORRECT]
C. Document the finding as normal postpartum uterine position
D. Perform uterine massage for 5 minutes
Correct Answer: B
Rationale: A fundus deviated to the right (or left) suggests bladder distention, which displaces the uterus. A distended
bladder can prevent uterine contraction and increase risk of postpartum hemorrhage. The priority action is to assist the
client to empty the bladder (assist to bathroom or catheterize if unable to void), then reassess fundal position. After
bladder emptying, the fundus should return to midline. A fundus 3 cm above the umbilicus at 48 hours postpartum is
also abnormal (suggests subinvolution).
Q8.
A nurse is assessing a postpartum client's cardiovascular adaptation. The client delivered 2 hours ago. Which
finding is most concerning?
A. Heart rate of 60 bpm
B. Blood pressure of 95/65 mmHg
C. Blood pressure of 145/95 mmHg with headache and visual changes [CORRECT]
D. Respiratory rate of 18 breaths/min
Correct Answer: C
Rationale: A blood pressure of 145/95 with headache and visual changes suggests postpartum preeclampsia, a
life-threatening condition. BP >140/90 with symptoms (headache, visual changes, epigastric pain) requires immediate
provider notification, magnesium sulfate for seizure prophylaxis, and antihypertensive therapy. Bradycardia (HR 50-70)
and mild hypotension are normal postpartum findings. RR 18 is within normal limits.
Q9.
A postpartum client is concerned about afterpains. The nurse explains that afterpains are most likely to be
experienced by:
A. Primiparous women
B. Multiparous women, due to uterine muscle tone that is less firm after repeated stretching
[CORRECT]
C. Women who delivered by cesarean
D. Women who are formula-feeding
Correct Answer: B
Rationale: Afterpains (afterbirth pains) are caused by intermittent uterine contractions as the uterus involutes. They are
more common in multiparous women because the uterine muscle tone is less firm after repeated stretching, requiring
more vigorous contractions to maintain involution. They are also more pronounced during breastfeeding due to oxytocin
release. Primiparous women typically have good uterine tone and minimal afterpains. Treatment: NSAIDs, warm pack,
voiding.
NCLEX-Style Clinical Reasoning | AWHONN | ACOG | AAP | Cognitive Levels: 30% Recall / 50% Application / 20% Analysis Page 4
NSG 3500 Exam 4 | Maternal Health (2026/2027)
100 Verified Questions & Answers — Galen College of Nursing | Postpartum, Newborn, and Lactation
Objectives
Generated: September 22, 2026 | Format: Multiple Choice (4 options, one correct) | Total Items: 100
Section Topic Coverage Items
Section 1 Postpartum Physiologic Adaptation Q1–Q15
Section 2 Postpartum Nursing Assessment and Care Q16–Q28
Section 3 Postpartum Complications Q29–Q42
Section 4 Lactation and Newborn Feeding Q43–Q55
Section 5 Newborn Assessment and Transition Q56–Q70
Section 6 Newborn Complications and Care Q71–Q83
Section 7 Postpartum Psychosocial Adaptation Q84–Q92
Section 8 Discharge Teaching, Family Planning, and Community Resources Q93–Q100
Directions: This practice exam mirrors the rigor and content coverage of the NSG 3500 Exam 4 Maternal Health
assessment at Galen College of Nursing. Each of the 100 multiple-choice items presents four options (A–D) with
exactly one correct response. Items are calibrated to a cognitive distribution of approximately 30% recall, 50%
application, and 20% analysis. Approximately 80% of items are scenario-based NCLEX-style questions requiring
integration of postpartum physiologic adaptation, BUBBLE-HE assessment, postpartum complications (4 T's of
hemorrhage, endometritis, DVT/PE, postpartum preeclampsia/HELLP), lactation physiology, newborn transition
and assessment (APGAR, Ballard, reflexes), newborn complications (jaundice, hypoglycemia, RDS, sepsis, NAS),
postpartum psychosocial adaptation (blues vs. depression vs. psychosis), and discharge teaching (safe sleep, car
seat, contraception). Approximately 20% assess direct recall of maternal-newborn concepts. After each item, the
correct answer and a 2–3 sentence rationale are provided, integrating pathophysiologic mechanisms, assessment
priorities, nursing interventions, and patient safety considerations aligned with current AWHONN, ACOG, AAP,
and Galen College of Nursing curriculum standards.
Section 1: Postpartum Physiologic Adaptation
Uterine Involution, Lochia, Cardiovascular, and Endocrine Changes | Items Q1–Q15
NCLEX-Style Clinical Reasoning | AWHONN | ACOG | AAP | Cognitive Levels: 30% Recall / 50% Application / 20% Analysis Page 1
,NSG 3500 Exam 4 | Maternal Health (2026/2027) | Galen College of Nursing Postpartum, Newborn, and Lactation
Q1.
A nurse is assessing a postpartum client 12 hours after a vaginal delivery. The fundus is firm, located at the level of
the umbilicus, and midline. Which interpretation is most accurate?
A. The fundus is abnormally high, suggesting uterine atony
B. The fundal position is normal; the uterus should be at or near the umbilicus immediately after
delivery, then descend approximately 1 cm/day [CORRECT]
C. The fundus is deviated and requires bladder emptying
D. The fundus should be 3 cm below the umbilicus at this time
Correct Answer: B
Rationale: Immediately after delivery, the fundus is palpated at or near the umbilicus (within 12 hours). It then
descends approximately 1 cm (or one fingerbreadth) per day, reaching approximately 3 cm below the umbilicus by day
3, and is no longer palpable abdominally by day 10-14. A firm fundus at the umbilicus at 12 hours postpartum is the
expected finding. A deviated fundus suggests bladder distention requiring the client to void.
Q2.
A postpartum client asks the nurse about lochia changes. The nurse explains that lochia rubra typically lasts:
A. 1-3 days postpartum
B. 3-4 days postpartum (typically days 1-3, transitioning to serosa around day 4) [CORRECT]
C. 10-14 days postpartum
D. Up to 6 weeks postpartum
Correct Answer: B
Rationale: Lochia progresses through three stages: rubra (dark red, mostly blood and decidual tissue, days 1-3), serosa
(pinkish-brown, serous with blood and leukocytes, days 4-10), and alba (yellowish-white, leukocytes and decidual tissue,
days 11-6 weeks). Lochia should never contain large clots, foul odor, or excessive bleeding. Persistent rubra or return to
rubra after serosa suggests retained placenta, subinvolution, or late hemorrhage.
Q3.
A postpartum client on day 2 has lochia that is dark red, moderate in amount, with a fleshy odor. The nurse
interprets this finding as:
A. Normal lochia rubra [CORRECT]
B. Sign of infection requiring antibiotics
C. Indication of retained placental fragments
D. Sign of impending hemorrhage
Correct Answer: A
Rationale: Lochia rubra is dark red, occurring days 1-3 postpartum, with a fleshy (earthy, similar to menstrual flow)
odor. Moderate amount is normal. A foul or foul-smelling (feculent, fishy) odor suggests infection (endometritis).
Excessive bleeding or large clots suggest hemorrhage. Continuation of rubra beyond 3-4 days suggests subinvolution or
retained fragments. Normal lochia should not be malodorous.
NCLEX-Style Clinical Reasoning | AWHONN | ACOG | AAP | Cognitive Levels: 30% Recall / 50% Application / 20% Analysis Page 2
,NSG 3500 Exam 4 | Maternal Health (2026/2027) | Galen College of Nursing Postpartum, Newborn, and Lactation
Q4.
A nurse is caring for a postpartum client 24 hours after delivery. The client's vital signs are: BP 100/60, P 60, R
16, T 99.0°F. The nurse recognizes that bradycardia (P 50-70) is normal postpartum due to:
A. Hypovolemia from blood loss
B. Cardiac decompensation
C. Increased venous return from uterine decompression and fluid mobilization, leading to transient
bradycardia [CORRECT]
D. Infection
Correct Answer: C
Rationale: Postpartum bradycardia (P 50-70) is normal in the first 24-72 hours due to improved venous return (the
gravid uterus no longer compresses the inferior vena cava) and redistribution of fluid from extravascular spaces back
into circulation. Stroke volume increases and heart rate decreases to compensate. Transient tachycardia >100 may
indicate hemorrhage, infection, or pain. Temperature up to 100.4°F (38°C) is normal in first 24 hours due to
dehydration.
Q5.
A postpartum client delivered 6 hours ago. The nurse assesses the laboratory results and notes a WBC count of
25,000/mm³. The nurse interprets this finding as:
A. Sign of infection requiring immediate antibiotics
B. Normal postpartum leukocytosis due to labor stress and tissue trauma [CORRECT]
C. Sign of hemorrhage
D. Indication of leukemia
Correct Answer: B
Rationale: Postpartum leukocytosis (WBC up to 25,000-30,000/mm³) is normal during the first 24-72 hours
postpartum due to the physiologic stress of labor, tissue trauma, and hormonal changes. Labor and delivery are stressful
events that increase WBC count. However, an elevated WBC with fever, foul lochia, uterine tenderness, or other signs of
infection requires evaluation for endometritis or wound infection.
Q6.
A postpartum client asks the nurse when her menstrual cycle will resume. The client is formula-feeding. The
nurse's best response is:
A. Menstruation typically resumes within 6-8 weeks for non-lactating women [CORRECT]
B. Menstruation will not resume until 6 months postpartum
C. Menstruation typically resumes within 12 weeks for non-lactating women
D. Menstruation will resume immediately after delivery
Correct Answer: A
Rationale: Non-lactating women typically resume menstruation within 6-8 weeks postpartum due to the rapid decline in
prolactin levels. Lactating women may not resume menstruation for 6 months or longer (lactational amenorrhea) due to
prolactin's inhibition of ovulation. The first menstrual cycle may be anovulatory, but ovulation can occur before the first
menses; contraception is therefore important even before menses resume.
NCLEX-Style Clinical Reasoning | AWHONN | ACOG | AAP | Cognitive Levels: 30% Recall / 50% Application / 20% Analysis Page 3
, NSG 3500 Exam 4 | Maternal Health (2026/2027) | Galen College of Nursing Postpartum, Newborn, and Lactation
Q7.
A postpartum client who delivered 48 hours ago has a fundus that is 3 cm above the umbilicus and deviated to the
right. The nurse's priority action is to:
A. Administer oxytocin to promote uterine contraction
B. Assist the client to empty her bladder, then reassess fundal position [CORRECT]
C. Document the finding as normal postpartum uterine position
D. Perform uterine massage for 5 minutes
Correct Answer: B
Rationale: A fundus deviated to the right (or left) suggests bladder distention, which displaces the uterus. A distended
bladder can prevent uterine contraction and increase risk of postpartum hemorrhage. The priority action is to assist the
client to empty the bladder (assist to bathroom or catheterize if unable to void), then reassess fundal position. After
bladder emptying, the fundus should return to midline. A fundus 3 cm above the umbilicus at 48 hours postpartum is
also abnormal (suggests subinvolution).
Q8.
A nurse is assessing a postpartum client's cardiovascular adaptation. The client delivered 2 hours ago. Which
finding is most concerning?
A. Heart rate of 60 bpm
B. Blood pressure of 95/65 mmHg
C. Blood pressure of 145/95 mmHg with headache and visual changes [CORRECT]
D. Respiratory rate of 18 breaths/min
Correct Answer: C
Rationale: A blood pressure of 145/95 with headache and visual changes suggests postpartum preeclampsia, a
life-threatening condition. BP >140/90 with symptoms (headache, visual changes, epigastric pain) requires immediate
provider notification, magnesium sulfate for seizure prophylaxis, and antihypertensive therapy. Bradycardia (HR 50-70)
and mild hypotension are normal postpartum findings. RR 18 is within normal limits.
Q9.
A postpartum client is concerned about afterpains. The nurse explains that afterpains are most likely to be
experienced by:
A. Primiparous women
B. Multiparous women, due to uterine muscle tone that is less firm after repeated stretching
[CORRECT]
C. Women who delivered by cesarean
D. Women who are formula-feeding
Correct Answer: B
Rationale: Afterpains (afterbirth pains) are caused by intermittent uterine contractions as the uterus involutes. They are
more common in multiparous women because the uterine muscle tone is less firm after repeated stretching, requiring
more vigorous contractions to maintain involution. They are also more pronounced during breastfeeding due to oxytocin
release. Primiparous women typically have good uterine tone and minimal afterpains. Treatment: NSAIDs, warm pack,
voiding.
NCLEX-Style Clinical Reasoning | AWHONN | ACOG | AAP | Cognitive Levels: 30% Recall / 50% Application / 20% Analysis Page 4
