UR 202/ NUR202 Exam 2 –
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Maternal-Newborn Nursing Guide
ACTUAL EXAM 2026/2027 |
Maternal-Newborn Nursing Guide |
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 28-year-old G2P1 at 39 weeks gestation is admitted in active labor. During a vaginal exam,
the nurse notes a sudden drop in fetal heart rate to 60 bpm with a sinusoidal pattern. The nurse
also sees the umbilical cord protruding from the vagina. What is the nurse's FIRST priority
action?
. Apply oxygen at 10 L/min via non-rebreather mask to the mother
A
B. Insert a Foley catheter and fill the bladder with 500 mL of sterile normal saline
C. Call for help, then immediately place a gloved hand in the vagina to manually elevate the
presenting part off the cord
D. Place the mother in left lateral position and administer a fluid bolus
* *[CORRECT]** C
*Rationale: ACOG guidelines require immediate manual elevation of the presenting part for
prolapsed cord to restore fetal oxygenation within 30–60 seconds. Calling for help is
simultaneous, but the nurse must not delay cord decompression. Option A is incorrect because
while oxygen is important, it does not address the immediate mechanical compression of the
cord. Option B (bladder filling) is a secondary intervention after initial elevation. Option D does
not relieve cord compression. Clinical pearl: Prolapsed cord is a true obstetric emergency; fetal
, radycardia with visible/protruding cord requires immediate knee-chest or Trendelenburg
b
position AFTER manual elevation is initiated.*
---
* *Q2 (Labor & Delivery – Stages of Labor):**
A primigravida at 38 weeks gestation calls the labor unit reporting regular contractions every
4–5 minutes, lasting 45 seconds, for the past 2 hours. She states she had a small amount of
bloody mucus discharge this morning. Her cervix was 2 cm dilated and 50% effaced at her last
prenatal visit 3 days ago. The nurse should instruct the patient to:
. Come to the hospital immediately because bloody show indicates active labor
A
B. Continue to monitor contractions at home and come in when contractions are 3 minutes
apart, lasting 60 seconds, for 1 hour
C. Come to the hospital now because she is a primigravida and labor may progress quickly
D. Wait at home until her membranes rupture or contractions are 2–3 minutes apart for at least
1 hour
* *[CORRECT]** D
*Rationale: ACOG 2026 guidelines define active labor beginning at 6 cm dilation; latent phase
(0–6 cm) in primigravidas can last many hours, and admission during latent phase increases
risk of unnecessary interventions. Bloody show is a normal sign of cervical change but does not
mandate immediate admission. Option A is incorrect because bloody show ≠ active labor.
Option B is too restrictive (3 minutes apart is not the standard threshold). Option C is incorrect
because primigravidas typically have longer labors. Clinical pearl: The 4-1-1 or 5-1-1 rule
(contractions 4–5 minutes apart, lasting 1 minute, for 1 hour) is a general guideline, but many
primigravidas can safely labor at home longer with reassuring fetal status.*
---
* *Q3 (Electronic Fetal Monitoring – Decelerations):**
A patient at 7 cm dilation is on continuous fetal monitoring. The nurse notes that with each
contraction, the fetal heart rate gradually decreases from a baseline of 140 bpm to a nadir of
110 bpm, with the lowest point occurring after the peak of the contraction. The deceleration
returns to baseline after the contraction ends. The shape is smooth and symmetric. What is the
nurse's priority action?
. Reposition the patient to left lateral and apply oxygen 10 L/min
A
B. Prepare for immediate cesarean birth
C. Continue to monitor; this is a reassuring pattern
D. Discontinue oxytocin if infusing and notify the provider
**[CORRECT]** D
,* Rationale: This describes late decelerations, which indicate uteroplacental insufficiency and are
a Category II (indeterminate) to Category III (abnormal) finding requiring immediate intervention
per NICHD guidelines. The first steps are to discontinue uterine stimulants (oxytocin), reposition
the mother, administer oxygen, and increase IV fluids. Option A is partially correct but
incomplete—repositioning alone is insufficient. Option B is premature; cesarean is considered if
fetal status does not improve after conservative measures. Option C is dangerously incorrect as
late decelerations are non-reassuring. Clinical pearl: Late decelerations = gradual onset, nadir
after peak of contraction, slow return to baseline; always think uteroplacental insufficiency and
act immediately.*
---
* *Q4 (Intrapartum Complications – Preterm Labor):**
A 32-year-old G1P0 at 30 weeks gestation presents with regular uterine contractions every 5
minutes, cervical dilation of 3 cm, and 80% effacement. Fetal fibronectin is positive. The
provider orders betamethasone 12 mg IM × 2 doses. The nurse understands that the primary
purpose of corticosteroid administration is to:
. Stop uterine contractions and prevent preterm delivery
A
B. Accelerate fetal lung maturity and reduce the risk of respiratory distress syndrome
C. Prevent neonatal intraventricular hemorrhage
D. Reduce maternal inflammation and prevent chorioamnionitis
* *[CORRECT]** B
*Rationale: ACOG and AAP guidelines recommend antenatal corticosteroids (betamethasone or
dexamethasone) between 24–34 weeks gestation to accelerate fetal lung maturity, specifically
surfactant production, reducing RDS, IVH, and NEC. Option A is incorrect because
corticosteroids do not have tocolytic properties. Option C is a secondary benefit but not the
primary purpose. Option D is incorrect; corticosteroids do not treat infection. Clinical pearl:
Betamethasone is given 12 mg IM q24h × 2 doses; maximum benefit occurs 48 hours after first
dose but is still beneficial if delivery occurs within 7 days of administration.*
---
* *Q5 (Labor & Delivery – Pain Management – Epidural):**
A patient at 5 cm dilation requests an epidural. Following epidural placement, the nurse notes
the patient's blood pressure has dropped from 124/78 to 88/52 mmHg. The fetal heart rate is
150 bpm with moderate variability. What is the nurse's FIRST action?
. Administer ephedrine 10 mg IV push as ordered
A
B. Turn the patient to left lateral position and increase the IV fluid rate
C. Place the patient in Trendelenburg position and call the anesthesiologist
D. Discontinue the epidural infusion immediately
, * *[CORRECT]** B
*Rationale: Hypotension following epidural anesthesia is caused by sympathetic blockade and
vasodilation; first-line management per ACOG is maternal repositioning (left lateral to relieve
aortocaval compression) and increasing IV fluid administration (fluid bolus). Option A
(ephedrine) is a second-line intervention if hypotension persists after fluid administration. Option
C is excessive; Trendelenburg is not first-line. Option D is incorrect; discontinuing the epidural is
unnecessary and causes maternal distress. Clinical pearl: Pre-load with 500–1000 mL LR
before epidural placement; monitor BP q5min for 15 min after placement. If FHR decelerations
occur with hypotension, treat maternal BP first—fetal perfusion depends on maternal mean
arterial pressure.*
---
* *Q6 (Intrapartum Complications – Shoulder Dystocia):**
During delivery of a macrosomic infant, the head delivers but retracts against the perineum
(turtle sign). The nurse recognizes shoulder dystocia. The provider calls for McRoberts
maneuver. The nurse should assist by:
. Applying firm downward traction on the fetal head
A
B. Flexing the mother's thighs sharply against her abdomen while maintaining supine position
C. Placing the mother in a hands-and-knees position
D. Applying suprapubic pressure in a downward direction
* *[CORRECT]** B
*Rationale: McRoberts maneuver involves sharp flexion of the maternal thighs against the
abdomen, which flattens the sacrum and rotates the symphysis pubis anteriorly, freeing the
impacted anterior shoulder. Option A is dangerous; downward traction can cause brachial
plexus injury. Option C describes the all-fours (Gaskin) maneuver, which is effective but not
McRoberts. Option D describes the next step AFTER McRoberts if the shoulder remains
impacted. Clinical pearl: The HELPERR mnemonic for shoulder dystocia: Help, Evaluate for
episiotomy, Legs (McRoberts), Pressure (suprapubic), Enter (internal maneuvers—Woods
screw, Rubin), Remove posterior arm, Roll to all-fours. Document all maneuvers and time of
head-to-body delivery.*
---
* *Q7 (Postpartum Care – BUBBLE-HE Assessment):**
On postpartum day 1, the nurse assesses the patient's fundus and finds it 1 cm above the
umbilicus, firm, and midline. The patient has voided 150 mL in the past 4 hours. The lochia is
moderate rubra with small clots. What is the nurse's priority action?
. Document the findings as normal for postpartum day 1
A
B. Perform a fundal massage and encourage the patient to void
C. Notify the provider immediately for possible uterine atony
N
Maternal-Newborn Nursing Guide
ACTUAL EXAM 2026/2027 |
Maternal-Newborn Nursing Guide |
Verified Q&A | Pass Guaranteed - A+
Graded
=======================================================================
=
========
=======================================================================
=
========
PART A – MULTIPLE CHOICE (Q1–60)
========================================================================
========
* *Q1 (Intrapartum – Prolapsed Cord):**
A 28-year-old G2P1 at 39 weeks gestation is admitted in active labor. During a vaginal exam,
the nurse notes a sudden drop in fetal heart rate to 60 bpm with a sinusoidal pattern. The nurse
also sees the umbilical cord protruding from the vagina. What is the nurse's FIRST priority
action?
. Apply oxygen at 10 L/min via non-rebreather mask to the mother
A
B. Insert a Foley catheter and fill the bladder with 500 mL of sterile normal saline
C. Call for help, then immediately place a gloved hand in the vagina to manually elevate the
presenting part off the cord
D. Place the mother in left lateral position and administer a fluid bolus
* *[CORRECT]** C
*Rationale: ACOG guidelines require immediate manual elevation of the presenting part for
prolapsed cord to restore fetal oxygenation within 30–60 seconds. Calling for help is
simultaneous, but the nurse must not delay cord decompression. Option A is incorrect because
while oxygen is important, it does not address the immediate mechanical compression of the
cord. Option B (bladder filling) is a secondary intervention after initial elevation. Option D does
not relieve cord compression. Clinical pearl: Prolapsed cord is a true obstetric emergency; fetal
, radycardia with visible/protruding cord requires immediate knee-chest or Trendelenburg
b
position AFTER manual elevation is initiated.*
---
* *Q2 (Labor & Delivery – Stages of Labor):**
A primigravida at 38 weeks gestation calls the labor unit reporting regular contractions every
4–5 minutes, lasting 45 seconds, for the past 2 hours. She states she had a small amount of
bloody mucus discharge this morning. Her cervix was 2 cm dilated and 50% effaced at her last
prenatal visit 3 days ago. The nurse should instruct the patient to:
. Come to the hospital immediately because bloody show indicates active labor
A
B. Continue to monitor contractions at home and come in when contractions are 3 minutes
apart, lasting 60 seconds, for 1 hour
C. Come to the hospital now because she is a primigravida and labor may progress quickly
D. Wait at home until her membranes rupture or contractions are 2–3 minutes apart for at least
1 hour
* *[CORRECT]** D
*Rationale: ACOG 2026 guidelines define active labor beginning at 6 cm dilation; latent phase
(0–6 cm) in primigravidas can last many hours, and admission during latent phase increases
risk of unnecessary interventions. Bloody show is a normal sign of cervical change but does not
mandate immediate admission. Option A is incorrect because bloody show ≠ active labor.
Option B is too restrictive (3 minutes apart is not the standard threshold). Option C is incorrect
because primigravidas typically have longer labors. Clinical pearl: The 4-1-1 or 5-1-1 rule
(contractions 4–5 minutes apart, lasting 1 minute, for 1 hour) is a general guideline, but many
primigravidas can safely labor at home longer with reassuring fetal status.*
---
* *Q3 (Electronic Fetal Monitoring – Decelerations):**
A patient at 7 cm dilation is on continuous fetal monitoring. The nurse notes that with each
contraction, the fetal heart rate gradually decreases from a baseline of 140 bpm to a nadir of
110 bpm, with the lowest point occurring after the peak of the contraction. The deceleration
returns to baseline after the contraction ends. The shape is smooth and symmetric. What is the
nurse's priority action?
. Reposition the patient to left lateral and apply oxygen 10 L/min
A
B. Prepare for immediate cesarean birth
C. Continue to monitor; this is a reassuring pattern
D. Discontinue oxytocin if infusing and notify the provider
**[CORRECT]** D
,* Rationale: This describes late decelerations, which indicate uteroplacental insufficiency and are
a Category II (indeterminate) to Category III (abnormal) finding requiring immediate intervention
per NICHD guidelines. The first steps are to discontinue uterine stimulants (oxytocin), reposition
the mother, administer oxygen, and increase IV fluids. Option A is partially correct but
incomplete—repositioning alone is insufficient. Option B is premature; cesarean is considered if
fetal status does not improve after conservative measures. Option C is dangerously incorrect as
late decelerations are non-reassuring. Clinical pearl: Late decelerations = gradual onset, nadir
after peak of contraction, slow return to baseline; always think uteroplacental insufficiency and
act immediately.*
---
* *Q4 (Intrapartum Complications – Preterm Labor):**
A 32-year-old G1P0 at 30 weeks gestation presents with regular uterine contractions every 5
minutes, cervical dilation of 3 cm, and 80% effacement. Fetal fibronectin is positive. The
provider orders betamethasone 12 mg IM × 2 doses. The nurse understands that the primary
purpose of corticosteroid administration is to:
. Stop uterine contractions and prevent preterm delivery
A
B. Accelerate fetal lung maturity and reduce the risk of respiratory distress syndrome
C. Prevent neonatal intraventricular hemorrhage
D. Reduce maternal inflammation and prevent chorioamnionitis
* *[CORRECT]** B
*Rationale: ACOG and AAP guidelines recommend antenatal corticosteroids (betamethasone or
dexamethasone) between 24–34 weeks gestation to accelerate fetal lung maturity, specifically
surfactant production, reducing RDS, IVH, and NEC. Option A is incorrect because
corticosteroids do not have tocolytic properties. Option C is a secondary benefit but not the
primary purpose. Option D is incorrect; corticosteroids do not treat infection. Clinical pearl:
Betamethasone is given 12 mg IM q24h × 2 doses; maximum benefit occurs 48 hours after first
dose but is still beneficial if delivery occurs within 7 days of administration.*
---
* *Q5 (Labor & Delivery – Pain Management – Epidural):**
A patient at 5 cm dilation requests an epidural. Following epidural placement, the nurse notes
the patient's blood pressure has dropped from 124/78 to 88/52 mmHg. The fetal heart rate is
150 bpm with moderate variability. What is the nurse's FIRST action?
. Administer ephedrine 10 mg IV push as ordered
A
B. Turn the patient to left lateral position and increase the IV fluid rate
C. Place the patient in Trendelenburg position and call the anesthesiologist
D. Discontinue the epidural infusion immediately
, * *[CORRECT]** B
*Rationale: Hypotension following epidural anesthesia is caused by sympathetic blockade and
vasodilation; first-line management per ACOG is maternal repositioning (left lateral to relieve
aortocaval compression) and increasing IV fluid administration (fluid bolus). Option A
(ephedrine) is a second-line intervention if hypotension persists after fluid administration. Option
C is excessive; Trendelenburg is not first-line. Option D is incorrect; discontinuing the epidural is
unnecessary and causes maternal distress. Clinical pearl: Pre-load with 500–1000 mL LR
before epidural placement; monitor BP q5min for 15 min after placement. If FHR decelerations
occur with hypotension, treat maternal BP first—fetal perfusion depends on maternal mean
arterial pressure.*
---
* *Q6 (Intrapartum Complications – Shoulder Dystocia):**
During delivery of a macrosomic infant, the head delivers but retracts against the perineum
(turtle sign). The nurse recognizes shoulder dystocia. The provider calls for McRoberts
maneuver. The nurse should assist by:
. Applying firm downward traction on the fetal head
A
B. Flexing the mother's thighs sharply against her abdomen while maintaining supine position
C. Placing the mother in a hands-and-knees position
D. Applying suprapubic pressure in a downward direction
* *[CORRECT]** B
*Rationale: McRoberts maneuver involves sharp flexion of the maternal thighs against the
abdomen, which flattens the sacrum and rotates the symphysis pubis anteriorly, freeing the
impacted anterior shoulder. Option A is dangerous; downward traction can cause brachial
plexus injury. Option C describes the all-fours (Gaskin) maneuver, which is effective but not
McRoberts. Option D describes the next step AFTER McRoberts if the shoulder remains
impacted. Clinical pearl: The HELPERR mnemonic for shoulder dystocia: Help, Evaluate for
episiotomy, Legs (McRoberts), Pressure (suprapubic), Enter (internal maneuvers—Woods
screw, Rubin), Remove posterior arm, Roll to all-fours. Document all maneuvers and time of
head-to-body delivery.*
---
* *Q7 (Postpartum Care – BUBBLE-HE Assessment):**
On postpartum day 1, the nurse assesses the patient's fundus and finds it 1 cm above the
umbilicus, firm, and midline. The patient has voided 150 mL in the past 4 hours. The lochia is
moderate rubra with small clots. What is the nurse's priority action?
. Document the findings as normal for postpartum day 1
A
B. Perform a fundal massage and encourage the patient to void
C. Notify the provider immediately for possible uterine atony
