NURS_201: Maternal-Newborn Nursing (Durham) – High-
Yield Antepartum, Intrapartum, and Postpartum Exam prep and
review with Detailed Rationales
Course Code: NURS_201
Course Name: Maternal-Newborn Nursing
Topic: High-Yield Antepartum, Intrapartum, and Postpartum Study Guide
Academic Year: 2026/2027
Question 1
A nurse is assessing a pregnant client at 31 weeks of gestation who presents with a
sudden onset of painless, bright red vaginal bleeding without uterine
contractions. Which clinical procedure is strictly contraindicated for this client?
A. Applying external electronic fetal monitoring to assess fetal heart rate patterns.
B. Performing a digital vaginal examination to assess cervical dilation and
effacement.
C. Initiating a large-bore intravenous access line for active fluid resuscitation.
D. Collecting an emergency blood sample for type, screen, and crossmatch.
CORRECT ANSWER: B
RATIONALE: Painless, bright red vaginal bleeding during the third trimester is
a classic indicator of placenta previa. Performing a digital vaginal exam is strictly
contraindicated because manual manipulation can puncture or tear the low-lying
placenta, triggering sudden, catastrophic maternal and fetal hemorrhage. A
,transabdominal ultrasound must confirm placental placement before any vaginal
entry is performed.
Question 2
The nurse is evaluating an external electronic fetal monitoring tracing during the
active phase of labor. The nurse notes a repeating pattern of smooth, symmetrical
dips in the fetal heart rate that mirror the uterine contractions.
Based on the electronic monitoring pattern illustrated above, what is the primary
pathophysiological mechanism responsible for this finding?
A. Acute uteroplacental insufficiency causing transient fetal hypoxia.
B. Umbilical cord compression obstructing fetal blood flow.
C. Transient fetal head compression stimulating a vagal nerve reflex response.
D. Fetal hypoxemia secondary to maternal hypotension from epidural placement.
CORRECT ANSWER: C
RATIONALE: The tracing demonstrates early decelerations, which are
benign, uniform deviations that visually mirror the uterine contraction curve
precisely. This pattern is caused by fetal head compression against the maternal
pelvis or cervix during a contraction, which increases intracranial pressure and
,triggers a vagal nerve reflex that transiently slows the heart rate. It is a reassuring
finding and requires no intrauterine resuscitation.
Question 3
A client at 35 weeks of gestation presents to the obstetric triage unit with a blood
pressure of 164/112 mmHg, a severe frontal headache, and blurred vision. A urine
dipstick shows 3+ proteinuria. Which medication should the nurse prepare to
administer as the priority for seizure prophylaxis?
A. Hydralazine
B. Labetalol
C. Magnesium sulfate
D. Calcium gluconate
CORRECT ANSWER: C
RATIONALE: The client exhibits classic diagnostic signs of preeclampsia with
severe features. Magnesium sulfate is the gold standard central nervous system
depressant administered to prevent eclamptic seizures. Hydralazine and labetalol
are antihypertensives used to manage dangerously high blood pressure, but they do
not provide seizure protection. Calcium gluconate is the direct antidote for
magnesium toxicity.
Question 4
During a vaginal delivery, the fetal head emerges but the chin immediately retracts
tightly back against the maternal perineum (the turtle sign). The nurse recognizes
shoulder dystocia. Which intervention must the nurse implement immediately?
A. Apply firm downward fundal pressure directly over the uterine corpus.
B. Apply sharp suprapubic pressure while hyperflexing the mother's thighs
against her abdomen (McRoberts maneuver).
C. Encourage the client to push as hard as possible between uterine contractions.
D. Prepare the patient for emergency general endotracheal intubation.
CORRECT ANSWER: B
RATIONALE: Managing shoulder dystocia requires the McRoberts maneuver
(hyperflexing the maternal legs to flatten the sacrum and widen the pelvic outlet)
coupled with suprapubic pressure to mechanically displace the impacted anterior
, fetal shoulder beneath the symphysis pubis. Fundal pressure is strictly
contraindicated because it wedges the fetal shoulder tighter into the pubic bone and
increases the risk of uterine rupture.
Question 5
A nurse is assessing a postpartum client 3 hours after a vaginal birth. Upon
abdominal palpation, the nurse notes that the uterine fundus is boggy, soft, and
displaced upward and to the right of the umbilicus. What is the initial nursing
action?
A. Administer a prescribed intramuscular injection of methylergonovine.
B. Assist the client to empty her bladder completely via voiding or
catheterization.
C. Perform a continuous, vigorous fundal massage for a minimum of 45 minutes.
D. Contact the provider to prepare for an emergency surgical curettage procedure.
CORRECT ANSWER: B
RATIONALE: A uterine fundus that is soft, boggy, and displaced above and to
the right of the umbilicus indicates uterine atony secondary to bladder
distention. A full bladder mechanically pushes the uterus out of its midline
alignment, preventing the myometrium from contracting efficiently to close off
bleeding spiral arteries. Emptying the bladder allows the uterus to return to the
midline and contract naturally.
Question 6
A nurse is evaluating a newborn's physiological stability exactly 1 minute after
birth. The infant presents with a heart rate of 115 beats per minute, a slow and
irregular respiratory effort, some flexion of the extremities, a grimace response
when suctioned, and a pink torso with blue hands and feet (acrocyanosis). What is
this newborn's calculated Apgar score?
A. 4
B. 6
C. 8
D. 10
Yield Antepartum, Intrapartum, and Postpartum Exam prep and
review with Detailed Rationales
Course Code: NURS_201
Course Name: Maternal-Newborn Nursing
Topic: High-Yield Antepartum, Intrapartum, and Postpartum Study Guide
Academic Year: 2026/2027
Question 1
A nurse is assessing a pregnant client at 31 weeks of gestation who presents with a
sudden onset of painless, bright red vaginal bleeding without uterine
contractions. Which clinical procedure is strictly contraindicated for this client?
A. Applying external electronic fetal monitoring to assess fetal heart rate patterns.
B. Performing a digital vaginal examination to assess cervical dilation and
effacement.
C. Initiating a large-bore intravenous access line for active fluid resuscitation.
D. Collecting an emergency blood sample for type, screen, and crossmatch.
CORRECT ANSWER: B
RATIONALE: Painless, bright red vaginal bleeding during the third trimester is
a classic indicator of placenta previa. Performing a digital vaginal exam is strictly
contraindicated because manual manipulation can puncture or tear the low-lying
placenta, triggering sudden, catastrophic maternal and fetal hemorrhage. A
,transabdominal ultrasound must confirm placental placement before any vaginal
entry is performed.
Question 2
The nurse is evaluating an external electronic fetal monitoring tracing during the
active phase of labor. The nurse notes a repeating pattern of smooth, symmetrical
dips in the fetal heart rate that mirror the uterine contractions.
Based on the electronic monitoring pattern illustrated above, what is the primary
pathophysiological mechanism responsible for this finding?
A. Acute uteroplacental insufficiency causing transient fetal hypoxia.
B. Umbilical cord compression obstructing fetal blood flow.
C. Transient fetal head compression stimulating a vagal nerve reflex response.
D. Fetal hypoxemia secondary to maternal hypotension from epidural placement.
CORRECT ANSWER: C
RATIONALE: The tracing demonstrates early decelerations, which are
benign, uniform deviations that visually mirror the uterine contraction curve
precisely. This pattern is caused by fetal head compression against the maternal
pelvis or cervix during a contraction, which increases intracranial pressure and
,triggers a vagal nerve reflex that transiently slows the heart rate. It is a reassuring
finding and requires no intrauterine resuscitation.
Question 3
A client at 35 weeks of gestation presents to the obstetric triage unit with a blood
pressure of 164/112 mmHg, a severe frontal headache, and blurred vision. A urine
dipstick shows 3+ proteinuria. Which medication should the nurse prepare to
administer as the priority for seizure prophylaxis?
A. Hydralazine
B. Labetalol
C. Magnesium sulfate
D. Calcium gluconate
CORRECT ANSWER: C
RATIONALE: The client exhibits classic diagnostic signs of preeclampsia with
severe features. Magnesium sulfate is the gold standard central nervous system
depressant administered to prevent eclamptic seizures. Hydralazine and labetalol
are antihypertensives used to manage dangerously high blood pressure, but they do
not provide seizure protection. Calcium gluconate is the direct antidote for
magnesium toxicity.
Question 4
During a vaginal delivery, the fetal head emerges but the chin immediately retracts
tightly back against the maternal perineum (the turtle sign). The nurse recognizes
shoulder dystocia. Which intervention must the nurse implement immediately?
A. Apply firm downward fundal pressure directly over the uterine corpus.
B. Apply sharp suprapubic pressure while hyperflexing the mother's thighs
against her abdomen (McRoberts maneuver).
C. Encourage the client to push as hard as possible between uterine contractions.
D. Prepare the patient for emergency general endotracheal intubation.
CORRECT ANSWER: B
RATIONALE: Managing shoulder dystocia requires the McRoberts maneuver
(hyperflexing the maternal legs to flatten the sacrum and widen the pelvic outlet)
coupled with suprapubic pressure to mechanically displace the impacted anterior
, fetal shoulder beneath the symphysis pubis. Fundal pressure is strictly
contraindicated because it wedges the fetal shoulder tighter into the pubic bone and
increases the risk of uterine rupture.
Question 5
A nurse is assessing a postpartum client 3 hours after a vaginal birth. Upon
abdominal palpation, the nurse notes that the uterine fundus is boggy, soft, and
displaced upward and to the right of the umbilicus. What is the initial nursing
action?
A. Administer a prescribed intramuscular injection of methylergonovine.
B. Assist the client to empty her bladder completely via voiding or
catheterization.
C. Perform a continuous, vigorous fundal massage for a minimum of 45 minutes.
D. Contact the provider to prepare for an emergency surgical curettage procedure.
CORRECT ANSWER: B
RATIONALE: A uterine fundus that is soft, boggy, and displaced above and to
the right of the umbilicus indicates uterine atony secondary to bladder
distention. A full bladder mechanically pushes the uterus out of its midline
alignment, preventing the myometrium from contracting efficiently to close off
bleeding spiral arteries. Emptying the bladder allows the uterus to return to the
midline and contract naturally.
Question 6
A nurse is evaluating a newborn's physiological stability exactly 1 minute after
birth. The infant presents with a heart rate of 115 beats per minute, a slow and
irregular respiratory effort, some flexion of the extremities, a grimace response
when suctioned, and a pink torso with blue hands and feet (acrocyanosis). What is
this newborn's calculated Apgar score?
A. 4
B. 6
C. 8
D. 10
