DEPARTMENT OF MATERNAL AND NEWBORN
NURSING
FALL 2026 COMPREHENSIVE EXAMINATION — MATERNAL EXAM 2
Course: Maternal & Newborn Nursing Care Total Marks: 100 Marks (4 pts each)
Student Name: ___________________________ Date: October 2026
Student ID: _____________________________ Time Allowed: 90 Minutes
EXAMINATION INSTRUCTIONS: Select the single best answer (A, B, C, or D) for each item below. This
comprehensive exam evaluates core competencies in labor and delivery management, postpartum clinical
care, newborn physical assessment, neonatal complications, maternal pharmacotherapy, and clinical dosage
calculations. Correct answers are indicated with a green tick mark (✔), accompanied by evidence-based
clinical rationales highlighted in yellow.
Question 1. A nurse is caring for a primigravida client at term who is experiencing
uterine contractions but states she is unsure if she is in true labor. Which of the
following findings should the nurse recognize as a definitive sign of true labor?
A. Loss of the cervical mucus plug
B. Progressive changes in cervical dilation and effacement
C. Station of the presenting part at -2
D. Uterine contractions occurring every 5 minutes without intensity change
✔ Correct Answer: Option B
CLINICAL RATIONALE:
True labor is strictly defined by progressive cervical changes (dilation and effacement). Contractions
without cervical change, loss of the mucus plug, or high fetal station can occur in false labor
(Braxton-Hicks) and do not confirm active labor.
Confidential — Official Academic Examination Paper Page 1
, Question 2. The nurse receives a change-of-shift report for a laboring client whose last
vaginal examination was documented as 3 cm, 30%, and -2. How should the nurse
interpret this assessment report?
A. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm below the ischial spines.
B. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines.
C. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm below the ischial spines.
D. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm above the ischial spines.
✔ Correct Answer: Option B
CLINICAL RATIONALE:
Vaginal exam notation standard format is Dilation (cm) / Effacement (%) / Station. A station of -2
indicates that the fetal presenting part is 2 cm above the level of the maternal ischial spines (negative
numbers indicate placement above station 0).
Question 3. While monitoring a laboring client, the perinatal nurse identifies variable
decelerations on the fetal heart rate (FHR) tracing. Which of the following should be the
nurse's first immediate action?
A. Increase the primary IV infusion rate to maximum
B. Assist the client into a left lateral position
C. Call the primary healthcare provider immediately
D. Document the fetal heart rate pattern as a normal physiological finding
✔ Correct Answer: Option B
CLINICAL RATIONALE:
Variable decelerations are caused by umbilical cord compression. The primary nursing action is to
change maternal position (e.g., left lateral position) to relieve pressure on the cord and restore fetal
perfusion.
Question 4. The perinatal nurse is preparing a laboring client for epidural anesthesia. To
prevent maternal hypotension, which nursing action is required prior to the procedure?
A. Assist the client to lie completely flat in a supine position
B. Encourage frequent cleansing breaths during catheter insertion
C. Administer an IV fluid bolus of 800 to 1,000 mL of Lactated Ringer's or Normal Saline
D. Assess blood pressure every 15 minutes for one hour prior to epidural placement
✔ Correct Answer: Option C
CLINICAL RATIONALE:
Epidural anesthesia causes sympathetic nervous system blockade, resulting in peripheral vasodilation
and sudden maternal hypotension. Pre-hydrating with an IV fluid bolus of 800–1,000 mL expands
intravascular volume to prevent hypotension.
Confidential — Official Academic Examination Paper Page 2
NURSING
FALL 2026 COMPREHENSIVE EXAMINATION — MATERNAL EXAM 2
Course: Maternal & Newborn Nursing Care Total Marks: 100 Marks (4 pts each)
Student Name: ___________________________ Date: October 2026
Student ID: _____________________________ Time Allowed: 90 Minutes
EXAMINATION INSTRUCTIONS: Select the single best answer (A, B, C, or D) for each item below. This
comprehensive exam evaluates core competencies in labor and delivery management, postpartum clinical
care, newborn physical assessment, neonatal complications, maternal pharmacotherapy, and clinical dosage
calculations. Correct answers are indicated with a green tick mark (✔), accompanied by evidence-based
clinical rationales highlighted in yellow.
Question 1. A nurse is caring for a primigravida client at term who is experiencing
uterine contractions but states she is unsure if she is in true labor. Which of the
following findings should the nurse recognize as a definitive sign of true labor?
A. Loss of the cervical mucus plug
B. Progressive changes in cervical dilation and effacement
C. Station of the presenting part at -2
D. Uterine contractions occurring every 5 minutes without intensity change
✔ Correct Answer: Option B
CLINICAL RATIONALE:
True labor is strictly defined by progressive cervical changes (dilation and effacement). Contractions
without cervical change, loss of the mucus plug, or high fetal station can occur in false labor
(Braxton-Hicks) and do not confirm active labor.
Confidential — Official Academic Examination Paper Page 1
, Question 2. The nurse receives a change-of-shift report for a laboring client whose last
vaginal examination was documented as 3 cm, 30%, and -2. How should the nurse
interpret this assessment report?
A. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm below the ischial spines.
B. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines.
C. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm below the ischial spines.
D. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm above the ischial spines.
✔ Correct Answer: Option B
CLINICAL RATIONALE:
Vaginal exam notation standard format is Dilation (cm) / Effacement (%) / Station. A station of -2
indicates that the fetal presenting part is 2 cm above the level of the maternal ischial spines (negative
numbers indicate placement above station 0).
Question 3. While monitoring a laboring client, the perinatal nurse identifies variable
decelerations on the fetal heart rate (FHR) tracing. Which of the following should be the
nurse's first immediate action?
A. Increase the primary IV infusion rate to maximum
B. Assist the client into a left lateral position
C. Call the primary healthcare provider immediately
D. Document the fetal heart rate pattern as a normal physiological finding
✔ Correct Answer: Option B
CLINICAL RATIONALE:
Variable decelerations are caused by umbilical cord compression. The primary nursing action is to
change maternal position (e.g., left lateral position) to relieve pressure on the cord and restore fetal
perfusion.
Question 4. The perinatal nurse is preparing a laboring client for epidural anesthesia. To
prevent maternal hypotension, which nursing action is required prior to the procedure?
A. Assist the client to lie completely flat in a supine position
B. Encourage frequent cleansing breaths during catheter insertion
C. Administer an IV fluid bolus of 800 to 1,000 mL of Lactated Ringer's or Normal Saline
D. Assess blood pressure every 15 minutes for one hour prior to epidural placement
✔ Correct Answer: Option C
CLINICAL RATIONALE:
Epidural anesthesia causes sympathetic nervous system blockade, resulting in peripheral vasodilation
and sudden maternal hypotension. Pre-hydrating with an IV fluid bolus of 800–1,000 mL expands
intravascular volume to prevent hypotension.
Confidential — Official Academic Examination Paper Page 2
