UR 202/ NUR202 Exam 2 –
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Maternal-Newborn Nursing Review
ACTUAL EXAM 2026/2027 |
Maternal-Newborn Nursing Review |
Verified Q&A | Pass Guaranteed - A+
Graded
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PART A – MULTIPLE CHOICE (Q1–60)
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Q1 (Intrapartum – prolapsed cord): A 38-year-old G3P2 at 39 weeks gestation is in active labor
with a fetal heart rate of 80 bpm. The nurse notes a sudden, severe, prolonged fetal bradycardia
and sees the umbilical cord protruding from the vagina. What is the nurse's FIRST priority
action?
A. Call the provider immediately and prepare for emergency cesarean birth
B. Apply oxygen at 10 L/min via non-rebreather mask to the mother
C. Place the patient in knee-chest or Trendelenburg position and manually elevate the
presenting part
D. Start an IV bolus of lactated Ringer's solution
[CORRECT] C
Rationale: ACOG and AWHONN guidelines require immediate manual elevation of the
presenting part to relieve cord compression and restore fetal oxygenation as the first priority in
umbilical cord prolapse. Calling the provider (A) is important but secondary to relieving
compression; oxygen (B) and IV fluids (D) are supportive measures but do not address the
immediate life-threatening cord compression. Clinical pearl: Every second counts—elevate the
presenting part with two fingers, call for help simultaneously, and maintain the position until
delivery.
Q2 (Labor and delivery – stages of labor): A primigravida at 40 weeks gestation reports regular
contractions every 3–4 minutes, lasting 45–60 seconds. Cervical exam reveals 5 cm dilation,
80% effacement, and 0 station. Which stage and phase of labor is this patient in?
A. First stage, latent phase
B. First stage, active phase
C. Second stage
D. Third stage
,[CORRECT] B
Rationale: The active phase of the first stage of labor is defined as cervical dilation of 6 cm (or
4–6 cm per updated ACOG guidelines) to 10 cm with regular, strong contractions; this patient at
5 cm with strong contractions meets active phase criteria. Latent phase (A) involves 0–4/6 cm
dilation; second stage (C) is complete dilation to delivery; third stage (D) is delivery of placenta.
Clinical pearl: ACOG updated labor curves—active phase now begins at 6 cm for most
nulliparous women, but 4–6 cm with adequate contractions still indicates active labor
progression.
Q3 (Electronic fetal monitoring – decelerations): During labor, the nurse observes a fetal heart
rate pattern with gradual decelerations that begin at the onset of the contraction, reach their
nadir at the peak of the contraction, and return to baseline by the end of the contraction. The
baseline rate is 140 bpm with moderate variability. What is the appropriate nursing action?
A. Reposition the mother to the left side and administer oxygen
B. Prepare for immediate delivery
C. Document the finding as a reassuring pattern and continue routine monitoring
D. Perform a vaginal exam to assess for cord compression
[CORRECT] C
Rationale: Early decelerations are caused by fetal head compression during uterine contractions
and are a reassuring, benign pattern with no intervention required; the gradual onset, nadir at
peak contraction, and return to baseline by end of contraction are classic characteristics.
Repositioning and oxygen (A) are interventions for late or variable decelerations; immediate
delivery (B) is not indicated; vaginal exam (D) assesses for prolapsed cord, not early
decelerations. Clinical pearl: Early decelerations mirror the contraction—"early" means the
deceleration mirrors the contraction in timing, shape, and duration.
Q4 (Intrapartum complications – shoulder dystocia): During delivery of a 10-lb infant, the fetal
head delivers but retracts tightly against the perineum (turtle sign). The anterior shoulder fails to
deliver with gentle downward traction. What is the FIRST maneuver the nurse should assist
with?
A. Woods screw maneuver
B. McRoberts maneuver
C. Suprapubic pressure
D. Rubin maneuver
[CORRECT] B
Rationale: McRoberts maneuver (hyperflexion of maternal thighs against the abdomen) is the
first-line, least invasive intervention for shoulder dystocia, widening the pelvic outlet by rotating
the symphysis pubis upward and flattening the sacrum. Woods screw (A) and Rubin (D) are
second-line rotational maneuvers; suprapubic pressure (C) is used concurrently with or after
McRoberts if needed. Clinical pearl: HELPER mnemonic—Help, Evaluate for episiotomy, Legs
(McRoberts), Pressure (suprapubic), Enter vagina (Woods/Rubin), Remove posterior arm, Roll
to all fours.
Q5 (Postpartum care – BUBBLE-HE assessment): On postpartum day 2, a nurse assesses a
patient and finds the uterus is firm, midline, and at the level of the umbilicus. The lochia is dark
red with small clots. The patient reports mild cramping with breastfeeding. Which finding
requires immediate follow-up?
, . Uterus at the level of the umbilicus
A
B. Dark red lochia with small clots
C. Mild cramping with breastfeeding
D. Fundus deviated to the right side
[CORRECT] D
Rationale: A fundus deviated to the right side indicates a full bladder displacing the uterus,
which can cause uterine atony and postpartum hemorrhage; the nurse must assist with voiding
or catheterization immediately. The fundus at the umbilicus (A) is normal for postpartum day 2
(descends ~1 cm/day); dark red lochia rubra (B) with small clots is normal; cramping with
breastfeeding (C) is normal due to oxytocin release. Clinical pearl: "If the fundus is not midline,
the bladder is not fine"—always check bladder status when the uterus is deviated.
Q6 (Newborn assessment – APGAR scoring): A newborn at 1 minute of age has a heart rate of
110 bpm, slow and irregular respiratory effort, good muscle tone with active movement,
grimaces with suctioning, and is pink with blue extremities. What is the 1-minute APGAR score?
A. 5
B. 6
C. 7
D. 8
[CORRECT] C
Rationale: The APGAR score is calculated as follows: Heart rate >100 = 2; Respiratory effort
(slow/irregular) = 1; Muscle tone (active movement) = 2; Reflex irritability (grimace) = 1; Color
(pink with acrocyanosis) = 1; Total = 7. A score of 5 (A) would indicate more significant
depression; 6 (B) and 8 (D) are incorrect calculations. Clinical pearl: APGAR is assessed at 1
and 5 minutes; scores of 7–10 are reassuring, 4–6 require moderate resuscitation, and 0–3
require aggressive resuscitation.
Q7 (Newborn complications – hyperbilirubinemia): A 3-day-old, term newborn has a total serum
bilirubin (TSB) of 14.5 mg/dL at 48 hours of age. The infant is breastfeeding well, has 6 wet
diapers per day, and is otherwise healthy. The mother's blood type is O+, and the infant is A+.
What is the most appropriate nursing action?
A. Initiate phototherapy immediately
B. Recommend formula supplementation to reduce bilirubin
C. Continue breastfeeding and schedule a follow-up bilirubin check within 24 hours
D. Prepare for exchange transfusion
[CORRECT] C
Rationale: Per the 2026 AAP updated phototherapy guidelines, a TSB of 14.5 mg/dL at 48
hours for a healthy term infant is below the treatment threshold and falls within the phototherapy
nomogram's "low-risk" zone; continued breastfeeding with close follow-up is appropriate.
Phototherapy (A) is indicated at higher thresholds; formula supplementation (B) is not indicated
for a well-feeding infant; exchange transfusion (D) is reserved for TSB >25 mg/dL or signs of
acute bilirubin encephalopathy. Clinical pearl: Always plot bilirubin on the Bhutani nomogram by
hour of life—risk stratification changes dramatically with age in hours.
Q8 (Labor and delivery – pain management): A patient in active labor at 6 cm dilation requests
pain relief. She desires to avoid an epidural. Which non-pharmacologic pain management
technique is MOST effective for reducing perceived pain intensity during the first stage of labor?
, . Continuous electronic fetal monitoring
A
B. Continuous labor support by a trained doula
C. Restricting oral intake to clear liquids only
D. Supine positioning with legs elevated
[CORRECT] B
Rationale: Continuous labor support by a trained doula is the most evidence-based
non-pharmacologic intervention, with Cochrane reviews demonstrating reduced need for
pharmacologic analgesia, shorter labor, and improved satisfaction. Continuous EFM (A) is a
monitoring technique, not pain management; restricting oral intake (C) is an outdated practice
not supported by ACOG; supine positioning (D) worsens pain and compromises uteroplacental
perfusion. Clinical pearl: ACOG supports doula presence as a low-risk, high-benefit
intervention—encourage patients to bring a support person trained in labor support.
Q9 (Intrapartum complications – preterm labor): A patient at 32 weeks gestation presents with
regular contractions every 5 minutes, cervical dilation of 3 cm, and 80% effacement. The fetal
fibronectin is positive. Which medication is CONTRAINDICATED for tocolysis in this patient?
A. Nifedipine
B. Indomethacin
C. Magnesium sulfate
D. Terbutaline
[CORRECT] B
Rationale: Indomethacin is contraindicated after 32 weeks gestation due to risk of premature
closure of the fetal ductus arteriosus and oligohydramnios; it is typically used only before 32
weeks and for short courses (48 hours). Nifedipine (A), magnesium sulfate (C), and terbutaline
(D) are all acceptable tocolytic options, though terbutaline is no longer first-line due to maternal
cardiac risks. Clinical pearl: The "48-hour window" for tocolysis allows time for corticosteroid
administration (betamethasone) to enhance fetal lung maturity—tocolytics do not stop preterm
labor indefinitely.
Q10 (Postpartum complications – hemorrhage): A patient delivered vaginally 2 hours ago. The
nurse notes heavy vaginal bleeding, a boggy uterus displaced to the right, and a fundus above
the umbilicus. The patient's vital signs are BP 90/50, HR 128, RR 24. Using the 4 T's
framework, what is the most likely cause of this hemorrhage?
A. Tone (uterine atony)
B. Trauma (laceration)
C. Tissue (retained placenta)
D. Thrombin (coagulopathy)
[CORRECT] A
Rationale: Uterine atony (Tone) is the most common cause of postpartum hemorrhage (80%),
characterized by a boggy, relaxed uterus and heavy bleeding; the displaced, high fundus
indicates bladder distention contributing to atony. Trauma (B) presents with a firm uterus and
bleeding; tissue (C) presents with a boggy uterus and incomplete placental delivery; thrombin
(D) presents with bleeding from multiple sites and coagulation studies abnormalities. Clinical
pearl: The 4 T's mnemonic—Tone (atony, 80%), Trauma (lacerations, 20%), Tissue (retained
placenta, 10%), Thrombin (coagulopathy, 1%)—helps systematically assess PPH causes;
massage the fundus and empty the bladder first.
N
Maternal-Newborn Nursing Review
ACTUAL EXAM 2026/2027 |
Maternal-Newborn Nursing Review |
Verified Q&A | Pass Guaranteed - A+
Graded
=======================================================================
=
========
PART A – MULTIPLE CHOICE (Q1–60)
========================================================================
========
Q1 (Intrapartum – prolapsed cord): A 38-year-old G3P2 at 39 weeks gestation is in active labor
with a fetal heart rate of 80 bpm. The nurse notes a sudden, severe, prolonged fetal bradycardia
and sees the umbilical cord protruding from the vagina. What is the nurse's FIRST priority
action?
A. Call the provider immediately and prepare for emergency cesarean birth
B. Apply oxygen at 10 L/min via non-rebreather mask to the mother
C. Place the patient in knee-chest or Trendelenburg position and manually elevate the
presenting part
D. Start an IV bolus of lactated Ringer's solution
[CORRECT] C
Rationale: ACOG and AWHONN guidelines require immediate manual elevation of the
presenting part to relieve cord compression and restore fetal oxygenation as the first priority in
umbilical cord prolapse. Calling the provider (A) is important but secondary to relieving
compression; oxygen (B) and IV fluids (D) are supportive measures but do not address the
immediate life-threatening cord compression. Clinical pearl: Every second counts—elevate the
presenting part with two fingers, call for help simultaneously, and maintain the position until
delivery.
Q2 (Labor and delivery – stages of labor): A primigravida at 40 weeks gestation reports regular
contractions every 3–4 minutes, lasting 45–60 seconds. Cervical exam reveals 5 cm dilation,
80% effacement, and 0 station. Which stage and phase of labor is this patient in?
A. First stage, latent phase
B. First stage, active phase
C. Second stage
D. Third stage
,[CORRECT] B
Rationale: The active phase of the first stage of labor is defined as cervical dilation of 6 cm (or
4–6 cm per updated ACOG guidelines) to 10 cm with regular, strong contractions; this patient at
5 cm with strong contractions meets active phase criteria. Latent phase (A) involves 0–4/6 cm
dilation; second stage (C) is complete dilation to delivery; third stage (D) is delivery of placenta.
Clinical pearl: ACOG updated labor curves—active phase now begins at 6 cm for most
nulliparous women, but 4–6 cm with adequate contractions still indicates active labor
progression.
Q3 (Electronic fetal monitoring – decelerations): During labor, the nurse observes a fetal heart
rate pattern with gradual decelerations that begin at the onset of the contraction, reach their
nadir at the peak of the contraction, and return to baseline by the end of the contraction. The
baseline rate is 140 bpm with moderate variability. What is the appropriate nursing action?
A. Reposition the mother to the left side and administer oxygen
B. Prepare for immediate delivery
C. Document the finding as a reassuring pattern and continue routine monitoring
D. Perform a vaginal exam to assess for cord compression
[CORRECT] C
Rationale: Early decelerations are caused by fetal head compression during uterine contractions
and are a reassuring, benign pattern with no intervention required; the gradual onset, nadir at
peak contraction, and return to baseline by end of contraction are classic characteristics.
Repositioning and oxygen (A) are interventions for late or variable decelerations; immediate
delivery (B) is not indicated; vaginal exam (D) assesses for prolapsed cord, not early
decelerations. Clinical pearl: Early decelerations mirror the contraction—"early" means the
deceleration mirrors the contraction in timing, shape, and duration.
Q4 (Intrapartum complications – shoulder dystocia): During delivery of a 10-lb infant, the fetal
head delivers but retracts tightly against the perineum (turtle sign). The anterior shoulder fails to
deliver with gentle downward traction. What is the FIRST maneuver the nurse should assist
with?
A. Woods screw maneuver
B. McRoberts maneuver
C. Suprapubic pressure
D. Rubin maneuver
[CORRECT] B
Rationale: McRoberts maneuver (hyperflexion of maternal thighs against the abdomen) is the
first-line, least invasive intervention for shoulder dystocia, widening the pelvic outlet by rotating
the symphysis pubis upward and flattening the sacrum. Woods screw (A) and Rubin (D) are
second-line rotational maneuvers; suprapubic pressure (C) is used concurrently with or after
McRoberts if needed. Clinical pearl: HELPER mnemonic—Help, Evaluate for episiotomy, Legs
(McRoberts), Pressure (suprapubic), Enter vagina (Woods/Rubin), Remove posterior arm, Roll
to all fours.
Q5 (Postpartum care – BUBBLE-HE assessment): On postpartum day 2, a nurse assesses a
patient and finds the uterus is firm, midline, and at the level of the umbilicus. The lochia is dark
red with small clots. The patient reports mild cramping with breastfeeding. Which finding
requires immediate follow-up?
, . Uterus at the level of the umbilicus
A
B. Dark red lochia with small clots
C. Mild cramping with breastfeeding
D. Fundus deviated to the right side
[CORRECT] D
Rationale: A fundus deviated to the right side indicates a full bladder displacing the uterus,
which can cause uterine atony and postpartum hemorrhage; the nurse must assist with voiding
or catheterization immediately. The fundus at the umbilicus (A) is normal for postpartum day 2
(descends ~1 cm/day); dark red lochia rubra (B) with small clots is normal; cramping with
breastfeeding (C) is normal due to oxytocin release. Clinical pearl: "If the fundus is not midline,
the bladder is not fine"—always check bladder status when the uterus is deviated.
Q6 (Newborn assessment – APGAR scoring): A newborn at 1 minute of age has a heart rate of
110 bpm, slow and irregular respiratory effort, good muscle tone with active movement,
grimaces with suctioning, and is pink with blue extremities. What is the 1-minute APGAR score?
A. 5
B. 6
C. 7
D. 8
[CORRECT] C
Rationale: The APGAR score is calculated as follows: Heart rate >100 = 2; Respiratory effort
(slow/irregular) = 1; Muscle tone (active movement) = 2; Reflex irritability (grimace) = 1; Color
(pink with acrocyanosis) = 1; Total = 7. A score of 5 (A) would indicate more significant
depression; 6 (B) and 8 (D) are incorrect calculations. Clinical pearl: APGAR is assessed at 1
and 5 minutes; scores of 7–10 are reassuring, 4–6 require moderate resuscitation, and 0–3
require aggressive resuscitation.
Q7 (Newborn complications – hyperbilirubinemia): A 3-day-old, term newborn has a total serum
bilirubin (TSB) of 14.5 mg/dL at 48 hours of age. The infant is breastfeeding well, has 6 wet
diapers per day, and is otherwise healthy. The mother's blood type is O+, and the infant is A+.
What is the most appropriate nursing action?
A. Initiate phototherapy immediately
B. Recommend formula supplementation to reduce bilirubin
C. Continue breastfeeding and schedule a follow-up bilirubin check within 24 hours
D. Prepare for exchange transfusion
[CORRECT] C
Rationale: Per the 2026 AAP updated phototherapy guidelines, a TSB of 14.5 mg/dL at 48
hours for a healthy term infant is below the treatment threshold and falls within the phototherapy
nomogram's "low-risk" zone; continued breastfeeding with close follow-up is appropriate.
Phototherapy (A) is indicated at higher thresholds; formula supplementation (B) is not indicated
for a well-feeding infant; exchange transfusion (D) is reserved for TSB >25 mg/dL or signs of
acute bilirubin encephalopathy. Clinical pearl: Always plot bilirubin on the Bhutani nomogram by
hour of life—risk stratification changes dramatically with age in hours.
Q8 (Labor and delivery – pain management): A patient in active labor at 6 cm dilation requests
pain relief. She desires to avoid an epidural. Which non-pharmacologic pain management
technique is MOST effective for reducing perceived pain intensity during the first stage of labor?
, . Continuous electronic fetal monitoring
A
B. Continuous labor support by a trained doula
C. Restricting oral intake to clear liquids only
D. Supine positioning with legs elevated
[CORRECT] B
Rationale: Continuous labor support by a trained doula is the most evidence-based
non-pharmacologic intervention, with Cochrane reviews demonstrating reduced need for
pharmacologic analgesia, shorter labor, and improved satisfaction. Continuous EFM (A) is a
monitoring technique, not pain management; restricting oral intake (C) is an outdated practice
not supported by ACOG; supine positioning (D) worsens pain and compromises uteroplacental
perfusion. Clinical pearl: ACOG supports doula presence as a low-risk, high-benefit
intervention—encourage patients to bring a support person trained in labor support.
Q9 (Intrapartum complications – preterm labor): A patient at 32 weeks gestation presents with
regular contractions every 5 minutes, cervical dilation of 3 cm, and 80% effacement. The fetal
fibronectin is positive. Which medication is CONTRAINDICATED for tocolysis in this patient?
A. Nifedipine
B. Indomethacin
C. Magnesium sulfate
D. Terbutaline
[CORRECT] B
Rationale: Indomethacin is contraindicated after 32 weeks gestation due to risk of premature
closure of the fetal ductus arteriosus and oligohydramnios; it is typically used only before 32
weeks and for short courses (48 hours). Nifedipine (A), magnesium sulfate (C), and terbutaline
(D) are all acceptable tocolytic options, though terbutaline is no longer first-line due to maternal
cardiac risks. Clinical pearl: The "48-hour window" for tocolysis allows time for corticosteroid
administration (betamethasone) to enhance fetal lung maturity—tocolytics do not stop preterm
labor indefinitely.
Q10 (Postpartum complications – hemorrhage): A patient delivered vaginally 2 hours ago. The
nurse notes heavy vaginal bleeding, a boggy uterus displaced to the right, and a fundus above
the umbilicus. The patient's vital signs are BP 90/50, HR 128, RR 24. Using the 4 T's
framework, what is the most likely cause of this hemorrhage?
A. Tone (uterine atony)
B. Trauma (laceration)
C. Tissue (retained placenta)
D. Thrombin (coagulopathy)
[CORRECT] A
Rationale: Uterine atony (Tone) is the most common cause of postpartum hemorrhage (80%),
characterized by a boggy, relaxed uterus and heavy bleeding; the displaced, high fundus
indicates bladder distention contributing to atony. Trauma (B) presents with a firm uterus and
bleeding; tissue (C) presents with a boggy uterus and incomplete placental delivery; thrombin
(D) presents with bleeding from multiple sites and coagulation studies abnormalities. Clinical
pearl: The 4 T's mnemonic—Tone (atony, 80%), Trauma (lacerations, 20%), Tissue (retained
placenta, 10%), Thrombin (coagulopathy, 1%)—helps systematically assess PPH causes;
massage the fundus and empty the bladder first.
