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Exam 3: NUR202 / NUR 202 (Latest
Update) Maternal-Newborn Nursing | Questions
and Verified Answers WITH RATIONALES
GUARANTEE SUCCESS 100% Correct | Grade A –
Fortis
three most common cause of hemorrhage in 1st trimester - ANS1. abortion
2. ectopic pregnancy
3. hydatidiform mole
spontaneous abortion - ANS-leading cause of pregnancy loss
-most commonly due to chromosomal abnormalities incompatible with life
-anatomic defects of the uterus or cervix contribute to preg loss at any
gestation
what is Vitamin K given to the newborn for? - ANSto prevent hemorrhagic
disorder
What is Cephalhematoma in Newborn?
-causes
-risk factors - ANSSwelling caused by bleeding into an area between the bone
and its periosteum (does NOT cross over suture line)
causes: lengthy procedure, use of devices during procedure, large baby
risk for: anemia and jaundice
what are the three stages of labor? - ANSlatent phase: up to 3 cm dilated
active phase: 4-7 cm dilated
transition phase: 8-10 cm dilated
what should the total weight gain be during pregnancy? - ANSunderweight
patients: up to 45 pounds
normal weight: up to 25 pounds
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patient teaching for a breastfeeding vegetarian mother - ANSsupplement
vitamin B12 and continue PNV
what does mag sulfate make the client more susceptible to post party? -
ANShemorrhage due to the medication relaxing the smooth muscles (the
uterus)
what is a contraction stress test? - ANSa test that evaluates if the fetus can
tolerate the stress of contractions during labor.
-negative result is ideal (indicates no late or variable decelerations)
what should the patient do before we assess the fundal height? - ANSthe
patient needs to void
what is Hegar's sign? - ANSsoftening of the lower uterine segment
1. A nurse is assessing a pregnant woman at 20 weeks of gestation. Which of the
following findings should the nurse report to the healthcare provider
immediately?
A) Fetal heartbeat at 160 bpm.
B) Mild ankle edema.
C) Absence of fetal movement.
D) Decrease in blood pressure when standing.
Answer: C) Absence of fetal movement.
Rationale:
At 20 weeks, the fetus should be moving regularly. Absence of fetal movement may indicate a
complication and requires immediate attention.
2. A nurse is caring for a postpartum patient. Which of the following findings is
most important to report to the healthcare provider?
A) Lochia rubra present on day 3 postpartum.
B) A temperature of 100.4°F (38°C) in the first 24 hours postpartum.
C) A decrease in fundal height after the first 24 hours.
D) A blood pressure reading of 140/90 mm Hg on day 1 postpartum.
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Answer: D) A blood pressure reading of 140/90 mm Hg on day 1 postpartum.
Rationale:
A blood pressure of 140/90 mm Hg or higher indicates potential postpartum hypertension, which
could be a sign of preeclampsia or other complications. Immediate reporting is necessary.
3. A nurse is teaching a pregnant woman about signs of preterm labor. Which of
the following should the nurse include in the teaching?
A) Decrease in vaginal discharge.
B) Persistent lower abdominal cramping.
C) Shortness of breath.
D) Mild headaches.
Answer: B) Persistent lower abdominal cramping.
Rationale:
Persistent lower abdominal cramping is a common sign of preterm labor. The nurse should
instruct the patient to contact her healthcare provider immediately if this occurs.
4. A nurse is caring for a laboring woman who is 8 cm dilated. The nurse notices
that the umbilical cord is prolapsed. Which of the following is the priority
action?
A) Place the patient in the Trendelenburg position.
B) Perform a vaginal examination.
C) Administer oxytocin to augment labor.
D) Apply pressure to the presenting part to relieve cord compression.
Answer: D) Apply pressure to the presenting part to relieve cord compression.
Rationale:
Prolapsed umbilical cords can lead to cord compression and fetal distress. The nurse should
apply pressure to the presenting part to relieve pressure on the cord until the healthcare provider
can intervene.
5. A nurse is caring for a postpartum patient who is experiencing heavy bleeding.
Which of the following actions should the nurse take first?
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A) Administer oxytocin as prescribed.
B) Massage the fundus.
C) Prepare for a blood transfusion.
D) Monitor the patient's vital signs.
Answer: B) Massage the fundus.
Rationale:
Postpartum hemorrhage is often due to uterine atony. Massaging the fundus helps stimulate
uterine contractions and reduce bleeding.
6. A nurse is assessing a newborn 2 hours after birth. The newborn’s skin is pink
with bluish hands and feet. Which of the following is the most appropriate action
by the nurse?
A) Notify the healthcare provider immediately.
B) Provide oxygen via nasal cannula.
C) Document the finding as normal.
D) Place the newborn in an incubator.
Answer: C) Document the finding as normal.
Rationale:
Acrocyanosis (bluish hands and feet) is a normal finding in the first few hours of life and
typically resolves on its own. It does not require intervention unless other signs of respiratory
distress are present.
7. A nurse is providing discharge teaching to a new mother who is breastfeeding.
Which of the following statements indicates a need for further teaching?
A) “I will feed my baby every 2-3 hours.”
B) “I should avoid introducing bottles until breastfeeding is well established.”
C) “I need to supplement with formula if my milk supply is low.”
D) “I will apply warm compresses to my breasts if they become engorged.”
Answer: C) “I need to supplement with formula if my milk supply is low.”
Rationale:
Supplementing with formula should be avoided unless medically necessary, as it can interfere
with establishing and maintaining milk supply. The mother should be encouraged to try methods
like pumping or feeding more frequently if her milk supply is low.
Exam 3: NUR202 / NUR 202 (Latest
Update) Maternal-Newborn Nursing | Questions
and Verified Answers WITH RATIONALES
GUARANTEE SUCCESS 100% Correct | Grade A –
Fortis
three most common cause of hemorrhage in 1st trimester - ANS1. abortion
2. ectopic pregnancy
3. hydatidiform mole
spontaneous abortion - ANS-leading cause of pregnancy loss
-most commonly due to chromosomal abnormalities incompatible with life
-anatomic defects of the uterus or cervix contribute to preg loss at any
gestation
what is Vitamin K given to the newborn for? - ANSto prevent hemorrhagic
disorder
What is Cephalhematoma in Newborn?
-causes
-risk factors - ANSSwelling caused by bleeding into an area between the bone
and its periosteum (does NOT cross over suture line)
causes: lengthy procedure, use of devices during procedure, large baby
risk for: anemia and jaundice
what are the three stages of labor? - ANSlatent phase: up to 3 cm dilated
active phase: 4-7 cm dilated
transition phase: 8-10 cm dilated
what should the total weight gain be during pregnancy? - ANSunderweight
patients: up to 45 pounds
normal weight: up to 25 pounds
,2|Page
patient teaching for a breastfeeding vegetarian mother - ANSsupplement
vitamin B12 and continue PNV
what does mag sulfate make the client more susceptible to post party? -
ANShemorrhage due to the medication relaxing the smooth muscles (the
uterus)
what is a contraction stress test? - ANSa test that evaluates if the fetus can
tolerate the stress of contractions during labor.
-negative result is ideal (indicates no late or variable decelerations)
what should the patient do before we assess the fundal height? - ANSthe
patient needs to void
what is Hegar's sign? - ANSsoftening of the lower uterine segment
1. A nurse is assessing a pregnant woman at 20 weeks of gestation. Which of the
following findings should the nurse report to the healthcare provider
immediately?
A) Fetal heartbeat at 160 bpm.
B) Mild ankle edema.
C) Absence of fetal movement.
D) Decrease in blood pressure when standing.
Answer: C) Absence of fetal movement.
Rationale:
At 20 weeks, the fetus should be moving regularly. Absence of fetal movement may indicate a
complication and requires immediate attention.
2. A nurse is caring for a postpartum patient. Which of the following findings is
most important to report to the healthcare provider?
A) Lochia rubra present on day 3 postpartum.
B) A temperature of 100.4°F (38°C) in the first 24 hours postpartum.
C) A decrease in fundal height after the first 24 hours.
D) A blood pressure reading of 140/90 mm Hg on day 1 postpartum.
,3|Page
Answer: D) A blood pressure reading of 140/90 mm Hg on day 1 postpartum.
Rationale:
A blood pressure of 140/90 mm Hg or higher indicates potential postpartum hypertension, which
could be a sign of preeclampsia or other complications. Immediate reporting is necessary.
3. A nurse is teaching a pregnant woman about signs of preterm labor. Which of
the following should the nurse include in the teaching?
A) Decrease in vaginal discharge.
B) Persistent lower abdominal cramping.
C) Shortness of breath.
D) Mild headaches.
Answer: B) Persistent lower abdominal cramping.
Rationale:
Persistent lower abdominal cramping is a common sign of preterm labor. The nurse should
instruct the patient to contact her healthcare provider immediately if this occurs.
4. A nurse is caring for a laboring woman who is 8 cm dilated. The nurse notices
that the umbilical cord is prolapsed. Which of the following is the priority
action?
A) Place the patient in the Trendelenburg position.
B) Perform a vaginal examination.
C) Administer oxytocin to augment labor.
D) Apply pressure to the presenting part to relieve cord compression.
Answer: D) Apply pressure to the presenting part to relieve cord compression.
Rationale:
Prolapsed umbilical cords can lead to cord compression and fetal distress. The nurse should
apply pressure to the presenting part to relieve pressure on the cord until the healthcare provider
can intervene.
5. A nurse is caring for a postpartum patient who is experiencing heavy bleeding.
Which of the following actions should the nurse take first?
, 4|Page
A) Administer oxytocin as prescribed.
B) Massage the fundus.
C) Prepare for a blood transfusion.
D) Monitor the patient's vital signs.
Answer: B) Massage the fundus.
Rationale:
Postpartum hemorrhage is often due to uterine atony. Massaging the fundus helps stimulate
uterine contractions and reduce bleeding.
6. A nurse is assessing a newborn 2 hours after birth. The newborn’s skin is pink
with bluish hands and feet. Which of the following is the most appropriate action
by the nurse?
A) Notify the healthcare provider immediately.
B) Provide oxygen via nasal cannula.
C) Document the finding as normal.
D) Place the newborn in an incubator.
Answer: C) Document the finding as normal.
Rationale:
Acrocyanosis (bluish hands and feet) is a normal finding in the first few hours of life and
typically resolves on its own. It does not require intervention unless other signs of respiratory
distress are present.
7. A nurse is providing discharge teaching to a new mother who is breastfeeding.
Which of the following statements indicates a need for further teaching?
A) “I will feed my baby every 2-3 hours.”
B) “I should avoid introducing bottles until breastfeeding is well established.”
C) “I need to supplement with formula if my milk supply is low.”
D) “I will apply warm compresses to my breasts if they become engorged.”
Answer: C) “I need to supplement with formula if my milk supply is low.”
Rationale:
Supplementing with formula should be avoided unless medically necessary, as it can interfere
with establishing and maintaining milk supply. The mother should be encouraged to try methods
like pumping or feeding more frequently if her milk supply is low.
