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Maternal and Newborn Nursing · Maternal-Newborn Nursing NCLEX Practice Questions

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Showing all 15 practice questions with expert explanatory rationales.

Question 1 of 15

Case excerpt

A client at 32 weeks' gestation reports a sudden gush of clear fluid. The fetal heart rate is 145/min and there are no contractions.

Which assessment should the nurse perform immediately after confirming suspected rupture of membranes?

A. Fetal heart rate
B. Maternal blood glucose
C. Cervical dilation by digital examination
D. Deep tendon reflexes
E. Maternal bowel sounds

Expert Explanatory Rationale

Correct Answer: A. Fetal heart rate

Assessing the fetal heart rate promptly helps identify possible cord compression or prolapse. Digital examination is avoided unless specifically indicated because it can increase infection risk.

Question 2 of 15

Case excerpt

A pregnant client at 10 weeks has persistent vomiting, dry mucous membranes, and ketones in the urine.

Which prescribed intervention should the nurse anticipate first?

A. Fluid restriction
B. IV isotonic fluids and electrolyte assessment
C. Immediate induction of labor
D. Oral iron with meals
E. A high-fat meal

Expert Explanatory Rationale

Correct Answer: B. IV isotonic fluids and electrolyte assessment

Severe vomiting with dehydration and ketonuria is consistent with hyperemesis gravidarum; fluid and electrolyte replacement is a priority.

Question 3 of 15

Case excerpt

A client at 30 weeks' gestation has blood pressure 168/112 mm Hg, severe headache, and visual spots.

Which action is the priority?

A. Place the client supine
B. Recheck blood pressure at the next prenatal visit
C. Initiate urgent evaluation and seizure precautions
D. Encourage ambulation
E. Offer a salty snack

Expert Explanatory Rationale

Correct Answer: C. Initiate urgent evaluation and seizure precautions

Severe-range hypertension with neurologic symptoms suggests preeclampsia with severe features and requires urgent management and seizure precautions.

Question 4 of 15

Case excerpt

A client receiving magnesium sulfate for severe preeclampsia has a respiratory rate of 10/min and absent patellar reflexes.

What should the nurse do first?

A. Assist the client to walk
B. Increase the infusion rate
C. Administer oxytocin
D. Stop the magnesium infusion and notify the provider
E. Encourage oral fluids

Expert Explanatory Rationale

Correct Answer: D. Stop the magnesium infusion and notify the provider

Respiratory depression and absent reflexes suggest magnesium toxicity. Stop the infusion, summon assistance, and prepare to administer calcium gluconate as prescribed.

Question 5 of 15

Case excerpt

A laboring client receiving oxytocin has six contractions in 10 minutes and recurrent late fetal heart rate decelerations.

Which nursing action should occur first?

A. Perform fundal massage
B. Discontinue oxytocin
C. Encourage pushing
D. Increase oxytocin
E. Place the client flat on the back

Expert Explanatory Rationale

Correct Answer: B. Discontinue oxytocin

Tachysystole with recurrent late decelerations requires stopping oxytocin and initiating intrauterine resuscitation per protocol.

Question 6 of 15

Case excerpt

A client at 35 weeks reports painless, bright-red vaginal bleeding. The uterus is soft and nontender.

Which action should the nurse avoid until placenta location is known?

A. Quantifying visible blood loss
B. Monitoring maternal vital signs
C. Performing a digital vaginal examination
D. Assessing fetal status
E. Establishing IV access as ordered

Expert Explanatory Rationale

Correct Answer: C. Performing a digital vaginal examination

Painless bright-red bleeding may indicate placenta previa. Digital vaginal examination can provoke severe hemorrhage and is avoided until previa is excluded.

Question 7 of 15

Case excerpt

A client in labor has sudden constant abdominal pain, vaginal bleeding, and a rigid, tender uterus.

Which complication should the nurse suspect?

A. Placental abruption
B. False labor
C. Placenta previa
D. Normal transition phase
E. Amniotic fluid embolism

Expert Explanatory Rationale

Correct Answer: A. Placental abruption

Painful bleeding with uterine tenderness or rigidity is characteristic of placental abruption.

Question 8 of 15

Case excerpt

A pregnant client asks why the 1-hour glucose screening test is scheduled at 26 weeks.

Which explanation is most accurate?

A. It confirms fetal lung maturity
B. It screens for group B streptococcus
C. It determines fetal blood type
D. It measures maternal iron stores
E. It screens for gestational diabetes during the usual testing window

Expert Explanatory Rationale

Correct Answer: E. It screens for gestational diabetes during the usual testing window

Routine gestational diabetes screening is generally performed at 24–28 weeks in clients without earlier indications for testing.

Question 9 of 15

Case excerpt

A client at 39 weeks says fetal movement has been noticeably reduced since yesterday.

A client with severe preeclampsia is receiving magnesium sulfate. Which findings require immediate nursing action? (Select all that apply)

A. Respiratory rate of 10/min
B. Absent deep-tendon reflexes
C. Urine output of 15 mL/hr
D. New difficulty staying awake
E. Mild warmth after the infusion starts

Expert Explanatory Rationale

Correct Answer: A. Respiratory rate of 10/min; B. Absent deep-tendon reflexes; C. Urine output of 15 mL/hr; D. New difficulty staying awake

Respiratory depression, absent reflexes, oliguria, and increasing sedation can indicate magnesium toxicity and require immediate intervention.

Question 10 of 15

Case excerpt

A client with Rh-negative blood delivers an Rh-positive newborn and has not been sensitized.

A laboring client receiving oxytocin develops uterine tachysystole and recurrent late decelerations. Which actions are appropriate? (Select all that apply)

A. Increase the oxytocin rate
B. Reposition the client laterally
C. Continue the infusion and reassess in an hour
D. Stop the oxytocin infusion
E. Notify the obstetric team

Expert Explanatory Rationale

Correct Answer: B. Reposition the client laterally; D. Stop the oxytocin infusion; E. Notify the obstetric team

Stopping oxytocin, repositioning, and promptly notifying the team are appropriate responses to tachysystole with fetal intolerance.

Question 11 of 15

Case excerpt

A laboring client is 8 cm dilated and says, 'I feel like I need to push.' The presenting part is not yet at the outlet.

A client with suspected placenta previa is admitted with painless bright-red bleeding. Which nursing actions are appropriate? (Select all that apply)

A. Establish IV access as prescribed
B. Quantify vaginal blood loss
C. Monitor maternal vital signs
D. Perform a digital vaginal examination
E. Assess fetal status

Expert Explanatory Rationale

Correct Answer: A. Establish IV access as prescribed; B. Quantify vaginal blood loss; C. Monitor maternal vital signs; E. Assess fetal status

Maternal and fetal assessment, quantification of bleeding, and IV access support safe management. Avoid digital vaginal examination until previa is excluded.

Question 12 of 15

Case excerpt

A client in the third trimester asks which symptom should be reported urgently.

A client reports decreased fetal movement at 36 weeks. Which actions should the nurse anticipate? (Select all that apply)

A. Prompt fetal assessment
B. Dismiss the concern as expected near term
C. Nonstress testing when indicated
D. Provide return precautions and follow-up instructions
E. Review the pattern and timing of movement

Expert Explanatory Rationale

Correct Answer: A. Prompt fetal assessment; C. Nonstress testing when indicated; D. Provide return precautions and follow-up instructions; E. Review the pattern and timing of movement

Reduced fetal movement warrants timely assessment, which may include a nonstress test and clear follow-up instructions.

Question 13 of 15

Case excerpt

A client with a history of cesarean birth is attempting vaginal birth. The fetal heart rate suddenly falls and the client reports sharp abdominal pain.

A client with gestational diabetes is preparing for discharge. Which teaching points should be included? (Select all that apply)

A. Follow the nutrition and activity plan
B. Follow the individualized glucose-monitoring plan
C. Keep scheduled prenatal follow-up
D. Recognize symptoms of hypoglycemia
E. Stop prescribed insulin when glucose improves without consulting the team

Expert Explanatory Rationale

Correct Answer: A. Follow the nutrition and activity plan; B. Follow the individualized glucose-monitoring plan; C. Keep scheduled prenatal follow-up; D. Recognize symptoms of hypoglycemia

Glucose monitoring, follow-up, hypoglycemia recognition, and the agreed nutrition/activity plan are important parts of gestational diabetes care.

Question 14 of 15

Case excerpt

Medication or fluid administration calculation in a maternal, newborn, or child-health setting.

A client is prescribed 1,000 mL of lactated Ringer's solution to infuse over 8 hours. What rate should the nurse program in mL/hr? Enter the number only.

Expert Explanatory Rationale

Correct Answer: 125

1,000 mL ÷ 8 hours = 125 mL/hr.

Question 15 of 15

Case excerpt

The nurse is coordinating a time-sensitive maternal, newborn, or child-health response.

A client develops postpartum hemorrhage related to uterine atony. Place the nursing actions in the safest order.

A. Recognize heavy bleeding and assess uterine tone
B. Call for assistance and initiate the hemorrhage protocol
C. Massage the fundus and assess bladder fullness
D. Administer prescribed uterotonic therapy and fluids as directed
E. Reassess bleeding, uterine tone, and vital signs

Expert Explanatory Rationale

Correct Answer: A. Recognize heavy bleeding and assess uterine tone; B. Call for assistance and initiate the hemorrhage protocol; C. Massage the fundus and assess bladder fullness; D. Administer prescribed uterotonic therapy and fluids as directed; E. Reassess bleeding, uterine tone, and vital signs

Rapid recognition and escalation are followed by immediate uterine measures, prescribed treatment, and reassessment.

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