Galen College of Nursing | NUR 230 Maternal-Newborn Nursing Maternal Exam 4 - 2026/2027 Update
GALEN COLLEGE OF NURSING
NUR 230 | Maternal-Newborn Nursing
Maternal Exam 4 - Questions and Answers
Update | 100% Correct | NCLEX-Style Format
Total Questions 75 (across 7 sections)
Cognitive Distribution 30% Recall / 50% Application / 20% Analysis
Question Style 80% Scenario-based / 20% Direct recall
Format 4-option multiple choice (A-D), single best answer
Guideline Sources AAP, ACOG, NANN, NCSBN Clinical Judgment Model
Course Galen College of Nursing - NUR 230 Maternal-Newborn Nursing
Answer Key Inline with rationale for each question
Instructions: Select the SINGLE BEST answer for each question. Each question includes the verified correct answer with
rationale explaining why the correct option is right and why the distractors are incorrect, integrating pathophysiology, safety
considerations, AAP/ACOG/NANN guideline rationale, and test-taking strategy aligned with the NCSBN Clinical Judgment
Measurement Model (CJMM). All content has been verified against the Galen College of Nursing NUR 230 Maternal-Newborn
Nursing course materials.
Section 1: High-Risk Newborn Foundations
Prematurity, LBW, SGA, LGA, & IUGR (Q1-Q12)
Q1. A 32-weeks-gestation preterm newborn is admitted to the NICU. The nurse understands that prematurity
is defined as birth occurring before which completed week of gestation?
A. Before 36 completed weeks of gestation
B. Before 37 completed weeks of gestation [CORRECT]
C. Before 38 completed weeks of gestation
D. Before 40 completed weeks of gestation
Correct Answer: B
Rationale:
Prematurity is defined by the World Health Organization (WHO) and reaffirmed by ACOG/AAP as birth occurring
before 37 completed weeks (less than 259 days) of gestation. Late preterm is 34-0/7 to 36-6/7 weeks; moderate preterm
is 32-0/7 to 33-6/7; very preterm is less than 32 weeks; extremely preterm is less than 28 weeks. Choice A is incorrect
because 36 weeks falls within the late-preterm category, not the cutoff for prematurity itself. Choices C and D
incorrectly extend the threshold. Test-taking strategy: recall the WHO gestational-age threshold (37 weeks) and do not
confuse it with term (37-41 weeks) or full-term (39-41 weeks).
Page 1 | 100% Verified NCLEX-Style Questions | 75 Total
,Galen College of Nursing | NUR 230 Maternal-Newborn Nursing Maternal Exam 4 - 2026/2027 Update
Q2. A newborn delivered at 35 weeks weighs 2,150 grams. Which classification correctly describes this
neonate?
A. Normal birth weight; appropriate for gestational age
B. Low birth weight (LBW); preterm [CORRECT]
C. Very low birth weight (VLBW); preterm
D. Extremely low birth weight (ELBW); preterm
Correct Answer: B
Rationale:
Birth weight classifications are: low birth weight (LBW) less than 2,500 g; very low birth weight (VLBW) less than
1,500 g; extremely low birth weight (ELBW) less than 1,000 g. This newborn at 2,150 g falls within the LBW category
and, being born at 35 weeks, is also preterm. Choice A is incorrect because 2,150 g is below the 2,500 g LBW threshold.
Choice C requires weight less than 1,500 g, and Choice D requires weight less than 1,000 g. Test-taking strategy:
memorize the three numeric cutoffs (2,,,000 g) and recognize they are independent of gestational-age
categories.
Q3. A postpartum nurse is assessing four newborns. Which finding would the nurse recognize as most
consistent with small for gestational age (SGA) rather than large for gestational age (LGA)?
A. Wide, puffy facies and a flattened nasal bridge
B. Significantly reduced subcutaneous fat and loose, dry skinfolds [CORRECT]
C. Birth weight at the 95th percentile for gestational age
D. Hypoglycemia within the first 4 hours associated with hyperinsulinism
Correct Answer: B
Rationale:
SGA newborns demonstrate wasted appearance with reduced subcutaneous fat, loose skinfolds, dry peeling skin, and a
head that appears disproportionately large relative to the body (brain-sparing effect in asymmetric IUGR). Choice A
describes an LGA infant of a diabetic mother (wide facies, macroglossia). Choice C defines LGA (weight greater than
the 90th percentile). Choice D (hypoglycemia from hyperinsulinism) is classic for the infant of a diabetic mother, who is
typically LGA. Test-taking strategy: contrast SGA wasting versus LGA macrosomic features; identify the clinical
picture rather than just the weight percentile.
Q4. A newborn delivered at 38 weeks weighs 2,100 g. Head circumference and length are at the 30th
percentile, but weight is below the 3rd percentile. The nurse identifies this pattern as:
A. Symmetric (Type I) intrauterine growth restriction
B. Asymmetric (Type II) intrauterine growth restriction [CORRECT]
C. Constitutionally small but healthy newborn
D. Post-term growth restriction syndrome
Correct Answer: B
Rationale:
Asymmetric (Type II) IUGR is characterized by a normal or near-normal head circumference and length with
disproportionately low body weight, reflecting brain-sparing adaptation when placental insufficiency develops in the
third trimester. Symmetric (Type I) IUGR demonstrates proportional reduction in head, length, and weight, indicating
an early insult (infection, chromosomal abnormality). Choice C is incorrect because weight below the 3rd percentile is
pathologic, not constitutional. Choice D is unrelated to postmaturity syndrome. Test-taking strategy: head-sparing =
Page 2 | 100% Verified NCLEX-Style Questions | 75 Total
, Galen College of Nursing | NUR 230 Maternal-Newborn Nursing Maternal Exam 4 - 2026/2027 Update
asymmetric IUGR; proportional reduction = symmetric IUGR.
Q5. The nurse is caring for a 41-weeks-gestation post-term newborn with meconium-stained amniotic fluid,
long fingernails, dry cracked skin, and absent vernix. Which complication should the nurse prioritize
assessing for in the first hour of life?
A. Hypoglycemia from depleted glycogen stores
B. Meconium aspiration syndrome and respiratory distress [CORRECT]
C. Hyperbilirubinemia from polycythemia
D. Cold stress from decreased subcutaneous fat
Correct Answer: B
Rationale:
Postmaturity syndrome infants (born at 42 weeks or later; signs visible earlier) are at highest risk for meconium
aspiration syndrome (MAS) because amniotic fluid volume decreases and meconium becomes concentrated, increasing
aspiration risk and secondary pulmonary hypertension. While hypoglycemia (Choice A) and
polycythemia/hyperbilirubinemia (Choice C) are recognized complications, MAS poses the most immediate
life-threatening risk via respiratory failure and persistent pulmonary hypertension. Cold stress (Choice D) is a secondary
concern. Test-taking strategy: in postmaturity, prioritize ABC - airway/breathing first; MAS is the priority.
Q6. A nurse is reviewing the maternal record of an SGA newborn. Which maternal risk factor is most
strongly associated with intrauterine growth restriction (IUGR)?
A. Maternal hyperglycemia from gestational diabetes
B. Maternal hypertension and preeclampsia [CORRECT]
C. Maternal obesity (BMI greater than 35)
D. Maternal advanced maternal age (older than 35 years)
Correct Answer: B
Rationale:
Maternal hypertension and preeclampsia cause uteroplacental insufficiency, the leading cause of asymmetric IUGR, due
to vasospasm and reduced placental perfusion. Gestational diabetes (Choice A) is more strongly associated with
LGA/macrosomia. Maternal obesity (Choice C) and advanced maternal age (Choice D) are general risk factors but not
as strongly linked to IUGR as hypertensive disorders. Test-taking strategy: link placental insufficiency
(hypertension/preeclampsia, smoking, malnutrition) to IUGR; link hyperglycemia to overgrowth (LGA).
Q7. Four newborns are admitted simultaneously to the newborn nursery. Using the ABC and risk-priority
framework, which newborn should the nurse assess FIRST?
A. A 39-week newborn with jaundice on the face at 12 hours of life
B. A 37-week newborn with respiratory rate 70, grunting, and nasal flaring [CORRECT]
C. A 40-week newborn weighing 4,300 g with jitteriness at 1 hour of life
D. A 38-week newborn with a ventral hernia and an intact omphalocele
Correct Answer: B
Rationale:
The newborn with tachypnea (RR 70), grunting, and nasal flaring is exhibiting signs of respiratory distress, the
highest-priority ABC concern. Grunting indicates an attempt to maintain functional residual capacity and prevent
Page 3 | 100% Verified NCLEX-Style Questions | 75 Total
GALEN COLLEGE OF NURSING
NUR 230 | Maternal-Newborn Nursing
Maternal Exam 4 - Questions and Answers
Update | 100% Correct | NCLEX-Style Format
Total Questions 75 (across 7 sections)
Cognitive Distribution 30% Recall / 50% Application / 20% Analysis
Question Style 80% Scenario-based / 20% Direct recall
Format 4-option multiple choice (A-D), single best answer
Guideline Sources AAP, ACOG, NANN, NCSBN Clinical Judgment Model
Course Galen College of Nursing - NUR 230 Maternal-Newborn Nursing
Answer Key Inline with rationale for each question
Instructions: Select the SINGLE BEST answer for each question. Each question includes the verified correct answer with
rationale explaining why the correct option is right and why the distractors are incorrect, integrating pathophysiology, safety
considerations, AAP/ACOG/NANN guideline rationale, and test-taking strategy aligned with the NCSBN Clinical Judgment
Measurement Model (CJMM). All content has been verified against the Galen College of Nursing NUR 230 Maternal-Newborn
Nursing course materials.
Section 1: High-Risk Newborn Foundations
Prematurity, LBW, SGA, LGA, & IUGR (Q1-Q12)
Q1. A 32-weeks-gestation preterm newborn is admitted to the NICU. The nurse understands that prematurity
is defined as birth occurring before which completed week of gestation?
A. Before 36 completed weeks of gestation
B. Before 37 completed weeks of gestation [CORRECT]
C. Before 38 completed weeks of gestation
D. Before 40 completed weeks of gestation
Correct Answer: B
Rationale:
Prematurity is defined by the World Health Organization (WHO) and reaffirmed by ACOG/AAP as birth occurring
before 37 completed weeks (less than 259 days) of gestation. Late preterm is 34-0/7 to 36-6/7 weeks; moderate preterm
is 32-0/7 to 33-6/7; very preterm is less than 32 weeks; extremely preterm is less than 28 weeks. Choice A is incorrect
because 36 weeks falls within the late-preterm category, not the cutoff for prematurity itself. Choices C and D
incorrectly extend the threshold. Test-taking strategy: recall the WHO gestational-age threshold (37 weeks) and do not
confuse it with term (37-41 weeks) or full-term (39-41 weeks).
Page 1 | 100% Verified NCLEX-Style Questions | 75 Total
,Galen College of Nursing | NUR 230 Maternal-Newborn Nursing Maternal Exam 4 - 2026/2027 Update
Q2. A newborn delivered at 35 weeks weighs 2,150 grams. Which classification correctly describes this
neonate?
A. Normal birth weight; appropriate for gestational age
B. Low birth weight (LBW); preterm [CORRECT]
C. Very low birth weight (VLBW); preterm
D. Extremely low birth weight (ELBW); preterm
Correct Answer: B
Rationale:
Birth weight classifications are: low birth weight (LBW) less than 2,500 g; very low birth weight (VLBW) less than
1,500 g; extremely low birth weight (ELBW) less than 1,000 g. This newborn at 2,150 g falls within the LBW category
and, being born at 35 weeks, is also preterm. Choice A is incorrect because 2,150 g is below the 2,500 g LBW threshold.
Choice C requires weight less than 1,500 g, and Choice D requires weight less than 1,000 g. Test-taking strategy:
memorize the three numeric cutoffs (2,,,000 g) and recognize they are independent of gestational-age
categories.
Q3. A postpartum nurse is assessing four newborns. Which finding would the nurse recognize as most
consistent with small for gestational age (SGA) rather than large for gestational age (LGA)?
A. Wide, puffy facies and a flattened nasal bridge
B. Significantly reduced subcutaneous fat and loose, dry skinfolds [CORRECT]
C. Birth weight at the 95th percentile for gestational age
D. Hypoglycemia within the first 4 hours associated with hyperinsulinism
Correct Answer: B
Rationale:
SGA newborns demonstrate wasted appearance with reduced subcutaneous fat, loose skinfolds, dry peeling skin, and a
head that appears disproportionately large relative to the body (brain-sparing effect in asymmetric IUGR). Choice A
describes an LGA infant of a diabetic mother (wide facies, macroglossia). Choice C defines LGA (weight greater than
the 90th percentile). Choice D (hypoglycemia from hyperinsulinism) is classic for the infant of a diabetic mother, who is
typically LGA. Test-taking strategy: contrast SGA wasting versus LGA macrosomic features; identify the clinical
picture rather than just the weight percentile.
Q4. A newborn delivered at 38 weeks weighs 2,100 g. Head circumference and length are at the 30th
percentile, but weight is below the 3rd percentile. The nurse identifies this pattern as:
A. Symmetric (Type I) intrauterine growth restriction
B. Asymmetric (Type II) intrauterine growth restriction [CORRECT]
C. Constitutionally small but healthy newborn
D. Post-term growth restriction syndrome
Correct Answer: B
Rationale:
Asymmetric (Type II) IUGR is characterized by a normal or near-normal head circumference and length with
disproportionately low body weight, reflecting brain-sparing adaptation when placental insufficiency develops in the
third trimester. Symmetric (Type I) IUGR demonstrates proportional reduction in head, length, and weight, indicating
an early insult (infection, chromosomal abnormality). Choice C is incorrect because weight below the 3rd percentile is
pathologic, not constitutional. Choice D is unrelated to postmaturity syndrome. Test-taking strategy: head-sparing =
Page 2 | 100% Verified NCLEX-Style Questions | 75 Total
, Galen College of Nursing | NUR 230 Maternal-Newborn Nursing Maternal Exam 4 - 2026/2027 Update
asymmetric IUGR; proportional reduction = symmetric IUGR.
Q5. The nurse is caring for a 41-weeks-gestation post-term newborn with meconium-stained amniotic fluid,
long fingernails, dry cracked skin, and absent vernix. Which complication should the nurse prioritize
assessing for in the first hour of life?
A. Hypoglycemia from depleted glycogen stores
B. Meconium aspiration syndrome and respiratory distress [CORRECT]
C. Hyperbilirubinemia from polycythemia
D. Cold stress from decreased subcutaneous fat
Correct Answer: B
Rationale:
Postmaturity syndrome infants (born at 42 weeks or later; signs visible earlier) are at highest risk for meconium
aspiration syndrome (MAS) because amniotic fluid volume decreases and meconium becomes concentrated, increasing
aspiration risk and secondary pulmonary hypertension. While hypoglycemia (Choice A) and
polycythemia/hyperbilirubinemia (Choice C) are recognized complications, MAS poses the most immediate
life-threatening risk via respiratory failure and persistent pulmonary hypertension. Cold stress (Choice D) is a secondary
concern. Test-taking strategy: in postmaturity, prioritize ABC - airway/breathing first; MAS is the priority.
Q6. A nurse is reviewing the maternal record of an SGA newborn. Which maternal risk factor is most
strongly associated with intrauterine growth restriction (IUGR)?
A. Maternal hyperglycemia from gestational diabetes
B. Maternal hypertension and preeclampsia [CORRECT]
C. Maternal obesity (BMI greater than 35)
D. Maternal advanced maternal age (older than 35 years)
Correct Answer: B
Rationale:
Maternal hypertension and preeclampsia cause uteroplacental insufficiency, the leading cause of asymmetric IUGR, due
to vasospasm and reduced placental perfusion. Gestational diabetes (Choice A) is more strongly associated with
LGA/macrosomia. Maternal obesity (Choice C) and advanced maternal age (Choice D) are general risk factors but not
as strongly linked to IUGR as hypertensive disorders. Test-taking strategy: link placental insufficiency
(hypertension/preeclampsia, smoking, malnutrition) to IUGR; link hyperglycemia to overgrowth (LGA).
Q7. Four newborns are admitted simultaneously to the newborn nursery. Using the ABC and risk-priority
framework, which newborn should the nurse assess FIRST?
A. A 39-week newborn with jaundice on the face at 12 hours of life
B. A 37-week newborn with respiratory rate 70, grunting, and nasal flaring [CORRECT]
C. A 40-week newborn weighing 4,300 g with jitteriness at 1 hour of life
D. A 38-week newborn with a ventral hernia and an intact omphalocele
Correct Answer: B
Rationale:
The newborn with tachypnea (RR 70), grunting, and nasal flaring is exhibiting signs of respiratory distress, the
highest-priority ABC concern. Grunting indicates an attempt to maintain functional residual capacity and prevent
Page 3 | 100% Verified NCLEX-Style Questions | 75 Total
