1|Page
NSG 3500 MATERNAL EXAM 4 REVIEW |
QUESTIONS AND ANSWERS | 2026/2027
UPDATED | ORIGINAL PRACTICE
QUESTION BANK
INTRODUCTION
This advanced NSG 3500 Maternal Exam 4 practice bank focuses on the newborn-care concepts
associated with Units 9 and 10 of Galen College of Nursing's Maternal Health course. Publicly
available course materials describe Exam 4 as concentrating on newborn care, including
physiologic transition to extrauterine life, newborn assessment, thermoregulation, respiratory
adaptation, feeding, common newborn complications, and family education.
The questions below are designed for nursing students preparing for a challenging maternal-
newborn assessment. They emphasize clinical judgment, prioritization, assessment interpretation,
safety, and application rather than simple memorization. Scenarios incorporate APGAR
interpretation, newborn physical findings, cardiovascular and respiratory transition, heat loss,
glucose concerns, jaundice, feeding difficulties, infection, respiratory distress, newborn safety,
and discharge teaching.
This resource should be used alongside Galen course materials, instructor guidance, assigned
textbook content, and current neonatal practice recommendations. The questions are original
study questions and are not claimed to be actual Galen examination items.
CONTENT AREA OVERVIEW
Content Area Questions Key Topics Weight
Newborn Transition to Respiratory adaptation, circulation,
1–15 15%
Extrauterine Life thermoregulation, physiologic transition
APGAR, physical assessment, vital signs,
Newborn Assessment 16–30 15%
gestational maturity, reflexes
Thermoregulation & Heat loss, cold stress, respiratory distress,
31–42 12%
Respiratory Care oxygenation
Newborn Feeding & Breastfeeding, formula feeding, hydration,
43–55 13%
Elimination glucose, stool/urine patterns
Hypoglycemia, jaundice, infection, RDS,
Newborn Complications 56–72 17%
sepsis, NAS and other complications
,2|Page
Content Area Questions Key Topics Weight
Newborn Safety & Safe sleep, medications, prophylaxis,
73–82 10%
Preventive Care screening, identification
Parent/Family Education &
83–92 Feeding, warning signs, follow-up, home care 10%
Discharge
Clinical Judgment & Delegation, escalation, nursing priorities,
93–100 8%
Prioritization integrated scenarios
QUESTIONS 1–100
CONTENT AREA 1: NEWBORN TRANSITION TO
EXTRAUTERINE LIFE
Q1:
A term newborn is delivered vaginally and initially has a weak cry, respiratory rate of 24/min,
heart rate of 92/min, and decreased muscle tone. Which nursing action is the priority?
A) Obtain a complete newborn history
B) Provide initial stabilization measures focused on effective ventilation
C) Administer routine newborn prophylaxis
D) Begin a detailed neurologic examination
Rationale: The correct answer is B because effective ventilation and establishment of adequate
respirations are immediate priorities for a compromised newborn. A heart rate below 100/min in
a newborn who is not breathing effectively requires prompt assessment and intervention. Option
A is important later but does not address the immediate physiologic problem. Option C should
occur after stabilization. Option D is not the priority while respiratory adaptation remains
inadequate.
Q2:
A newborn's heart rate rises from 88/min to 132/min after effective ventilation. Which
interpretation is most appropriate?
A) The newborn is developing severe bradycardia
B) The increased heart rate suggests improved oxygenation and effective respiratory
transition
C) The newborn has developed hypothermia
D) The finding indicates neonatal sepsis
,3|Page
Rationale: The correct answer is B because newborn heart rate commonly improves as
oxygenation and ventilation become effective. Option A incorrectly characterizes the improved
heart rate as deterioration. Option C cannot be diagnosed from heart rate alone. Option D
requires additional clinical evidence and is not supported by this finding alone.
Q3:
Immediately after birth, a newborn is wet and placed on a cold examination surface. Which
mechanism of heat loss is most directly involved?
A) Radiation
B) Convection and evaporation
C) Conduction only
D) Metabolic heat production
Rationale: The correct answer is B because evaporation occurs when moisture on the newborn's
skin changes to vapor, while convection transfers heat to surrounding moving air. Option A
involves nearby cooler surfaces rather than direct contact or wet skin. Option C describes direct
contact with a cooler surface but does not fully explain the wet newborn's heat loss. Option D is
a mechanism for producing heat rather than losing it.
Q4:
A newborn becomes cool after delivery. Which physiologic response is most important in
neonatal thermoregulation?
A) Shivering
B) Nonshivering thermogenesis through brown adipose tissue
C) Increased sweating
D) Peripheral vasodilation
Rationale: The correct answer is B because newborns have limited ability to shiver and rely
heavily on brown fat metabolism for heat production. Option A is not the primary neonatal
mechanism. Option C promotes heat loss. Option D increases heat transfer from the body core
and is not an effective response to cold stress.
Q5:
A newborn has a temperature below the expected range and begins developing tachypnea and
hypoglycemia. Which interpretation is most appropriate?
A) These findings are unrelated
B) The newborn is demonstrating normal adaptation
C) Cold stress is increasing metabolic demand and may contribute to respiratory and
glucose abnormalities
D) The newborn is experiencing normal sleep transition
, 4|Page
Rationale: The correct answer is C because cold stress increases oxygen and glucose
consumption, potentially producing hypoglycemia, metabolic instability, and respiratory
distress. Option A ignores the physiologic relationship. Option B incorrectly labels potentially
abnormal findings as normal. Option D does not explain the findings.
Q6:
A newborn has persistent cyanosis of the trunk and mucous membranes shortly after birth. What
is the nurse's priority?
A) Document the finding as normal acrocyanosis
B) Delay assessment until the first feeding
C) Assess respiratory effort and oxygenation and initiate appropriate escalation
D) Place the newborn prone and reassess later
Rationale: The correct answer is C because central cyanosis can indicate inadequate
oxygenation and requires prompt assessment. Acrocyanosis of the extremities can be
transitional, but central cyanosis is more concerning. Option B delays evaluation. Option D does
not address the potential respiratory or cardiovascular problem.
Q7:
Which cardiovascular change normally occurs as a newborn begins breathing after birth?
A) Pulmonary vascular resistance increases permanently
B) Pulmonary vascular resistance decreases as the lungs expand and oxygenation improves
C) The ductus arteriosus immediately becomes a permanent artery
D) Systemic vascular resistance decreases dramatically
Rationale: The correct answer is B because lung expansion and increased oxygenation reduce
pulmonary vascular resistance, increasing pulmonary blood flow. Option A is the opposite of
normal transition. Option C incorrectly describes the ductus arteriosus. Option D does not
represent the primary expected transition.
Q8:
A newborn has delayed transition and remains hypoxemic. Which fetal circulatory structure may
contribute to continued right-to-left shunting when pulmonary vascular resistance remains
elevated?
A) Umbilical vein only
B) Coronary artery
C) Foramen ovale and ductus arteriosus
D) Inferior vena cava
NSG 3500 MATERNAL EXAM 4 REVIEW |
QUESTIONS AND ANSWERS | 2026/2027
UPDATED | ORIGINAL PRACTICE
QUESTION BANK
INTRODUCTION
This advanced NSG 3500 Maternal Exam 4 practice bank focuses on the newborn-care concepts
associated with Units 9 and 10 of Galen College of Nursing's Maternal Health course. Publicly
available course materials describe Exam 4 as concentrating on newborn care, including
physiologic transition to extrauterine life, newborn assessment, thermoregulation, respiratory
adaptation, feeding, common newborn complications, and family education.
The questions below are designed for nursing students preparing for a challenging maternal-
newborn assessment. They emphasize clinical judgment, prioritization, assessment interpretation,
safety, and application rather than simple memorization. Scenarios incorporate APGAR
interpretation, newborn physical findings, cardiovascular and respiratory transition, heat loss,
glucose concerns, jaundice, feeding difficulties, infection, respiratory distress, newborn safety,
and discharge teaching.
This resource should be used alongside Galen course materials, instructor guidance, assigned
textbook content, and current neonatal practice recommendations. The questions are original
study questions and are not claimed to be actual Galen examination items.
CONTENT AREA OVERVIEW
Content Area Questions Key Topics Weight
Newborn Transition to Respiratory adaptation, circulation,
1–15 15%
Extrauterine Life thermoregulation, physiologic transition
APGAR, physical assessment, vital signs,
Newborn Assessment 16–30 15%
gestational maturity, reflexes
Thermoregulation & Heat loss, cold stress, respiratory distress,
31–42 12%
Respiratory Care oxygenation
Newborn Feeding & Breastfeeding, formula feeding, hydration,
43–55 13%
Elimination glucose, stool/urine patterns
Hypoglycemia, jaundice, infection, RDS,
Newborn Complications 56–72 17%
sepsis, NAS and other complications
,2|Page
Content Area Questions Key Topics Weight
Newborn Safety & Safe sleep, medications, prophylaxis,
73–82 10%
Preventive Care screening, identification
Parent/Family Education &
83–92 Feeding, warning signs, follow-up, home care 10%
Discharge
Clinical Judgment & Delegation, escalation, nursing priorities,
93–100 8%
Prioritization integrated scenarios
QUESTIONS 1–100
CONTENT AREA 1: NEWBORN TRANSITION TO
EXTRAUTERINE LIFE
Q1:
A term newborn is delivered vaginally and initially has a weak cry, respiratory rate of 24/min,
heart rate of 92/min, and decreased muscle tone. Which nursing action is the priority?
A) Obtain a complete newborn history
B) Provide initial stabilization measures focused on effective ventilation
C) Administer routine newborn prophylaxis
D) Begin a detailed neurologic examination
Rationale: The correct answer is B because effective ventilation and establishment of adequate
respirations are immediate priorities for a compromised newborn. A heart rate below 100/min in
a newborn who is not breathing effectively requires prompt assessment and intervention. Option
A is important later but does not address the immediate physiologic problem. Option C should
occur after stabilization. Option D is not the priority while respiratory adaptation remains
inadequate.
Q2:
A newborn's heart rate rises from 88/min to 132/min after effective ventilation. Which
interpretation is most appropriate?
A) The newborn is developing severe bradycardia
B) The increased heart rate suggests improved oxygenation and effective respiratory
transition
C) The newborn has developed hypothermia
D) The finding indicates neonatal sepsis
,3|Page
Rationale: The correct answer is B because newborn heart rate commonly improves as
oxygenation and ventilation become effective. Option A incorrectly characterizes the improved
heart rate as deterioration. Option C cannot be diagnosed from heart rate alone. Option D
requires additional clinical evidence and is not supported by this finding alone.
Q3:
Immediately after birth, a newborn is wet and placed on a cold examination surface. Which
mechanism of heat loss is most directly involved?
A) Radiation
B) Convection and evaporation
C) Conduction only
D) Metabolic heat production
Rationale: The correct answer is B because evaporation occurs when moisture on the newborn's
skin changes to vapor, while convection transfers heat to surrounding moving air. Option A
involves nearby cooler surfaces rather than direct contact or wet skin. Option C describes direct
contact with a cooler surface but does not fully explain the wet newborn's heat loss. Option D is
a mechanism for producing heat rather than losing it.
Q4:
A newborn becomes cool after delivery. Which physiologic response is most important in
neonatal thermoregulation?
A) Shivering
B) Nonshivering thermogenesis through brown adipose tissue
C) Increased sweating
D) Peripheral vasodilation
Rationale: The correct answer is B because newborns have limited ability to shiver and rely
heavily on brown fat metabolism for heat production. Option A is not the primary neonatal
mechanism. Option C promotes heat loss. Option D increases heat transfer from the body core
and is not an effective response to cold stress.
Q5:
A newborn has a temperature below the expected range and begins developing tachypnea and
hypoglycemia. Which interpretation is most appropriate?
A) These findings are unrelated
B) The newborn is demonstrating normal adaptation
C) Cold stress is increasing metabolic demand and may contribute to respiratory and
glucose abnormalities
D) The newborn is experiencing normal sleep transition
, 4|Page
Rationale: The correct answer is C because cold stress increases oxygen and glucose
consumption, potentially producing hypoglycemia, metabolic instability, and respiratory
distress. Option A ignores the physiologic relationship. Option B incorrectly labels potentially
abnormal findings as normal. Option D does not explain the findings.
Q6:
A newborn has persistent cyanosis of the trunk and mucous membranes shortly after birth. What
is the nurse's priority?
A) Document the finding as normal acrocyanosis
B) Delay assessment until the first feeding
C) Assess respiratory effort and oxygenation and initiate appropriate escalation
D) Place the newborn prone and reassess later
Rationale: The correct answer is C because central cyanosis can indicate inadequate
oxygenation and requires prompt assessment. Acrocyanosis of the extremities can be
transitional, but central cyanosis is more concerning. Option B delays evaluation. Option D does
not address the potential respiratory or cardiovascular problem.
Q7:
Which cardiovascular change normally occurs as a newborn begins breathing after birth?
A) Pulmonary vascular resistance increases permanently
B) Pulmonary vascular resistance decreases as the lungs expand and oxygenation improves
C) The ductus arteriosus immediately becomes a permanent artery
D) Systemic vascular resistance decreases dramatically
Rationale: The correct answer is B because lung expansion and increased oxygenation reduce
pulmonary vascular resistance, increasing pulmonary blood flow. Option A is the opposite of
normal transition. Option C incorrectly describes the ductus arteriosus. Option D does not
represent the primary expected transition.
Q8:
A newborn has delayed transition and remains hypoxemic. Which fetal circulatory structure may
contribute to continued right-to-left shunting when pulmonary vascular resistance remains
elevated?
A) Umbilical vein only
B) Coronary artery
C) Foramen ovale and ductus arteriosus
D) Inferior vena cava
