NSG 3500 EXAM 3 COMPLETE STUDY
SUITE | 400 HIGH-YIELD MATERNAL-
NEWBORN NCLEX-STYLE PRACTICE
QUESTIONS & DETAILED RATIONALES
(MASTER BUNDLE)
Elevate your maternal-newborn nursing prep
with this comprehensive study bundle
containing 400 high-yield practice questions
designed for the NSG 3500 Exam 3 curriculum.
The collection features realistic, NCLEX-style
clinical scenarios that test core intrapartum
concepts, including the stages of labor,
electronic fetal monitoring (EFM) interpretation,
epidural management, and critical emergencies
like shoulder dystocia and umbilical cord
prolapse. Each entry provides completely
separated answer keys and thorough,
evidence-based rationales formatted entirely in
bold-italic text for rapid highlighting and direct,
trouble-free Stuvia upload compatibility
, 1.A nurse is caring for a client in the active phase of labor. The nurse notes that the
cervical dilation has advanced from 4 cm to 6 cm over the past two hours. The nurse
correctly documents that the client is in which stage of labor?
A) First stage
B) Second stage
C) Third stage
D) Fourth stage
Correct Answer: A) First stage
Rationale: The first stage of labor begins with the onset of regular uterine
contractions and ends with full cervical effacement and dilation (10 cm). It is
divided into the latent, active, and transitional phases. The second stage begins
with full dilation and ends with the birth of the baby.
2. While assessing an electronic fetal monitor strip, the nurse notes a decrease in the fetal
heart rate that begins after the peak of the uterine contraction and returns to baseline
well after the contraction has ended. Which underlying mechanism should the nurse
suspect?
A) Fetal head compression
B) Uteroplacental insufficiency
C) Umbilical cord compression
D) Maternal hyperventilation
Correct Answer: B) Uteroplacental insufficiency
Rationale: This description defines a late deceleration. Late decelerations are
caused by uteroplacental insufficiency, which means the placenta is not receiving
adequate blood flow or oxygen to support the fetus during a contraction.
Immediate nursing interventions are required to improve oxygenation.
3. A nurse is monitoring a client in labor who is receiving an intravenous oxytocin infusion
for induction. The nurse notes that the client’s contractions are occurring every 90
seconds, lasting 75 seconds, with a resting uterine tone of 25 mmHg. Which action
should the nurse take first?
A) Increase the oxytocin infusion rate to speed up labor.
B) Instruct the client to perform deep pursed-lip breathing.
, C) Discontinue the oxytocin infusion immediately.
D) Prepare the client for an emergency operative vaginal birth. [1]
Correct Answer: C) Discontinue the oxytocin infusion immediately.
Rationale: The client is experiencing uterine tachysystole (hyperstimulation),
characterized by contractions occurring more frequently than every 2 minutes or
more than 5 contractions in 10 minutes. This reduces placental resting time and
leads to fetal hypoxia. The priority action is to stop the oxytocin.
4. A nurse performs a sterile vaginal examination on a laboring client and notes that the
fetal presenting part is 1 centimeter above the maternal ischial spines. How should the
nurse document this fetal station?
A) Station +1
B) Station 0
C) Station -1
D) Station -2
Correct Answer: C) Station -1
Rationale: Fetal station measures the descent of the presenting part relative to
the maternal ischial spines in centimeters. When the presenting part is above the
ischial spines, it is documented with a negative number (-1 to -5). At the level of
the spines is station 0, and below the spines is a positive number (+1 to +5).
5. During a vaginal delivery, the infant's head is born, but the nurse notes that the fetal
chin retracts tightly against the maternal perineum (turtle sign), preventing the delivery
of the shoulders. Which immediate intervention should the nurse perform?
A) Apply firm, direct fundal pressure.
B) Assist the client into the McRoberts maneuver and apply suprapubic pressure.
C) Place the client in a high-Fowler's position immediately.
D) Instruct the client to push as hard as possible. [1]
Correct Answer: B) Assist the client into the McRoberts maneuver and apply
suprapubic pressure.
Rationale: The "turtle sign" indicates shoulder dystocia, an emergency where the
fetal anterior shoulder becomes impacted behind the maternal symphysis pubis.
The McRoberts maneuver (flexing the mother's thighs tightly against her
abdomen) widens the pelvic outlet, and suprapubic pressure helps dislodge the
shoulder. Fundal pressure is strictly contraindicated as it can cause uterine
rupture or severe fetal injury.
, 6. A nurse is caring for a client who is in the transitional phase of the first stage of labor.
Which clinical finding should the nurse expect to observe?
A) Cervical dilation of 2 cm and mild contractions
B) Cervical dilation of 5 cm and a calm demeanor
C) Cervical dilation of 9 cm, irritability, and an urge to push
D) Complete delivery of the placenta and a firm uterine fundus
Correct Answer: C) Cervical dilation of 9 cm, irritability, and an urge to push
Rationale: The transitional phase of the first stage of labor is characterized by
cervical dilation from 8 to 10 cm. Clients in this phase often experience intense
contractions, significant anxiety, irritability, nausea, and a premature urge to
push due to fetal descent.
7. A nurse is monitoring a client in labor and notes a pattern of variable decelerations on
the electronic fetal monitoring strip. Which initial nursing intervention is most
appropriate?
A) Administer an intravenous bolus of oxytocin.
B) Reposition the client to her lateral side or knee-chest position.
C) Prepare the client for an immediate spinal anesthesia block.
D) Perform an amniotomy to check for meconium staining.
Correct Answer: B) Reposition the client to her lateral side or knee-chest
position.
Rationale: Variable decelerations are caused by umbilical cord compression.
Changing the maternal position relieves pressure on the cord, which can restore
umbilical blood flow and resolve the decelerations. Oxytocin should be
discontinued if the pattern persists.
8. A client has just received an epidural block for labor pain management. Which maternal
complication should the nurse prioritize for monitoring during the first 15 minutes post-
administration?
A) Severe hyperthermia
B) Marked hypertension
C) Acute hypotension
D) Urinary tract infection
Correct Answer: C) Acute hypotension
SUITE | 400 HIGH-YIELD MATERNAL-
NEWBORN NCLEX-STYLE PRACTICE
QUESTIONS & DETAILED RATIONALES
(MASTER BUNDLE)
Elevate your maternal-newborn nursing prep
with this comprehensive study bundle
containing 400 high-yield practice questions
designed for the NSG 3500 Exam 3 curriculum.
The collection features realistic, NCLEX-style
clinical scenarios that test core intrapartum
concepts, including the stages of labor,
electronic fetal monitoring (EFM) interpretation,
epidural management, and critical emergencies
like shoulder dystocia and umbilical cord
prolapse. Each entry provides completely
separated answer keys and thorough,
evidence-based rationales formatted entirely in
bold-italic text for rapid highlighting and direct,
trouble-free Stuvia upload compatibility
, 1.A nurse is caring for a client in the active phase of labor. The nurse notes that the
cervical dilation has advanced from 4 cm to 6 cm over the past two hours. The nurse
correctly documents that the client is in which stage of labor?
A) First stage
B) Second stage
C) Third stage
D) Fourth stage
Correct Answer: A) First stage
Rationale: The first stage of labor begins with the onset of regular uterine
contractions and ends with full cervical effacement and dilation (10 cm). It is
divided into the latent, active, and transitional phases. The second stage begins
with full dilation and ends with the birth of the baby.
2. While assessing an electronic fetal monitor strip, the nurse notes a decrease in the fetal
heart rate that begins after the peak of the uterine contraction and returns to baseline
well after the contraction has ended. Which underlying mechanism should the nurse
suspect?
A) Fetal head compression
B) Uteroplacental insufficiency
C) Umbilical cord compression
D) Maternal hyperventilation
Correct Answer: B) Uteroplacental insufficiency
Rationale: This description defines a late deceleration. Late decelerations are
caused by uteroplacental insufficiency, which means the placenta is not receiving
adequate blood flow or oxygen to support the fetus during a contraction.
Immediate nursing interventions are required to improve oxygenation.
3. A nurse is monitoring a client in labor who is receiving an intravenous oxytocin infusion
for induction. The nurse notes that the client’s contractions are occurring every 90
seconds, lasting 75 seconds, with a resting uterine tone of 25 mmHg. Which action
should the nurse take first?
A) Increase the oxytocin infusion rate to speed up labor.
B) Instruct the client to perform deep pursed-lip breathing.
, C) Discontinue the oxytocin infusion immediately.
D) Prepare the client for an emergency operative vaginal birth. [1]
Correct Answer: C) Discontinue the oxytocin infusion immediately.
Rationale: The client is experiencing uterine tachysystole (hyperstimulation),
characterized by contractions occurring more frequently than every 2 minutes or
more than 5 contractions in 10 minutes. This reduces placental resting time and
leads to fetal hypoxia. The priority action is to stop the oxytocin.
4. A nurse performs a sterile vaginal examination on a laboring client and notes that the
fetal presenting part is 1 centimeter above the maternal ischial spines. How should the
nurse document this fetal station?
A) Station +1
B) Station 0
C) Station -1
D) Station -2
Correct Answer: C) Station -1
Rationale: Fetal station measures the descent of the presenting part relative to
the maternal ischial spines in centimeters. When the presenting part is above the
ischial spines, it is documented with a negative number (-1 to -5). At the level of
the spines is station 0, and below the spines is a positive number (+1 to +5).
5. During a vaginal delivery, the infant's head is born, but the nurse notes that the fetal
chin retracts tightly against the maternal perineum (turtle sign), preventing the delivery
of the shoulders. Which immediate intervention should the nurse perform?
A) Apply firm, direct fundal pressure.
B) Assist the client into the McRoberts maneuver and apply suprapubic pressure.
C) Place the client in a high-Fowler's position immediately.
D) Instruct the client to push as hard as possible. [1]
Correct Answer: B) Assist the client into the McRoberts maneuver and apply
suprapubic pressure.
Rationale: The "turtle sign" indicates shoulder dystocia, an emergency where the
fetal anterior shoulder becomes impacted behind the maternal symphysis pubis.
The McRoberts maneuver (flexing the mother's thighs tightly against her
abdomen) widens the pelvic outlet, and suprapubic pressure helps dislodge the
shoulder. Fundal pressure is strictly contraindicated as it can cause uterine
rupture or severe fetal injury.
, 6. A nurse is caring for a client who is in the transitional phase of the first stage of labor.
Which clinical finding should the nurse expect to observe?
A) Cervical dilation of 2 cm and mild contractions
B) Cervical dilation of 5 cm and a calm demeanor
C) Cervical dilation of 9 cm, irritability, and an urge to push
D) Complete delivery of the placenta and a firm uterine fundus
Correct Answer: C) Cervical dilation of 9 cm, irritability, and an urge to push
Rationale: The transitional phase of the first stage of labor is characterized by
cervical dilation from 8 to 10 cm. Clients in this phase often experience intense
contractions, significant anxiety, irritability, nausea, and a premature urge to
push due to fetal descent.
7. A nurse is monitoring a client in labor and notes a pattern of variable decelerations on
the electronic fetal monitoring strip. Which initial nursing intervention is most
appropriate?
A) Administer an intravenous bolus of oxytocin.
B) Reposition the client to her lateral side or knee-chest position.
C) Prepare the client for an immediate spinal anesthesia block.
D) Perform an amniotomy to check for meconium staining.
Correct Answer: B) Reposition the client to her lateral side or knee-chest
position.
Rationale: Variable decelerations are caused by umbilical cord compression.
Changing the maternal position relieves pressure on the cord, which can restore
umbilical blood flow and resolve the decelerations. Oxytocin should be
discontinued if the pattern persists.
8. A client has just received an epidural block for labor pain management. Which maternal
complication should the nurse prioritize for monitoring during the first 15 minutes post-
administration?
A) Severe hyperthermia
B) Marked hypertension
C) Acute hypotension
D) Urinary tract infection
Correct Answer: C) Acute hypotension
