NCLEX MATERNAL NEWBORN NURSING QUESTIONS WITH RATIONALES
(2026/2027)
Introduction
This comprehensive resource contains 200+ authentic-style questions designed for NCLEX-RN® and
Next Generation NCLEX® (NGN) preparation in maternal-newborn nursing. It includes multiple-
choice, select-all-that-apply, and NGN item types (bowtie, matrix, drop-down cloze). Each question
integrates the NCSBN Clinical Judgment Measurement Model, challenging test-takers to apply
evidence-based practice, prioritize safety, and synthesize pathophysiology with clinical data.
Exam Structure
This 2026/2027 maternal-newborn NCLEX question bank contains 200+ unique, non-repeated
authentic-style questions with detailed rationales, including multiple-choice, select-all-that-apply, and
Next Generation NCLEX® (NGN) item types like bowtie, matrix, and drop-down cloze, designed to
build clinical judgment for the childbearing family.
Answer Format
All correct nursing actions, assessment priorities, and therapeutic responses must be presented in
bold and green, followed by in-depth, unique rationales that justify the clinical decision by linking
pathophysiological principles, current evidence-based guidelines, and patient safety considerations
specific to maternal-newborn care.
Domain 1: Antepartum Care & High-Risk Pregnancy (45 Questions)
Question 1
A 28-year-old G2P1 at 32 weeks presents with BP 158/98, 3+ proteinuria, hyperreflexia, and
persistent RUQ pain. Fetal movement is decreased. Which action is priority?
A) Schedule NST for tomorrow
B) Initiate magnesium sulfate and prepare for urgent evaluation and possible delivery
C) Encourage hydration and rest
D) Administer oral labetalol and discharge
Rationale: Severe features of preeclampsia (BP ≥160/110, RUQ pain, hyperreflexia, proteinuria)
require immediate seizure prophylaxis with magnesium sulfate and maternal-fetal stabilization per
ACOG. The NGN priority is preventing eclampsia and fetal compromise; delaying care risks
progression. Hydration/PO meds alone are insufficient; inpatient management and delivery planning
are warranted.
Question 2
A 22-year-old at 10 weeks reports severe nausea, weight loss, ketonuria, and orthostatic hypotension.
What initial management is indicated?
A) Outpatient ondansetron PRN
B) IV fluid resuscitation with electrolyte replacement and antiemetic therapy
C) Trial of small frequent meals only
D) Start TPN immediately
Rationale: Hyperemesis gravidarum presents with dehydration and ketosis; initial stabilization
requires IV fluids (e.g., normal saline with dextrose after thiamine), electrolyte correction, and
antiemetics. AWHONN supports hospital management when ketonuria and weight loss are present.
TPN is reserved for refractory cases after first-line measures.
,Question 3
A patient at 36 weeks with known placenta previa reports painless vaginal bleeding. FHR baseline is
140, no contractions. Which intervention is appropriate?
A) Perform digital cervical exam
B) Place on bed rest, start IV access, type & crossmatch, and avoid vaginal exams
C) Start oxytocin to control bleeding
D) Discharge with activity as tolerated
Rationale: Placenta previa bleeding is typically painless; digital exams can cause catastrophic
hemorrhage. Stabilization with IV access and blood readiness, with pelvic rest and ultrasound
localization, aligns with ACOG guidance. Induction is contraindicated until delivery planning;
monitoring and preparedness for cesarean are essential.
Question 4
A 35-year-old with pregestational diabetes at 28 weeks has fasting glucose 120 mg/dL and HbA1c
7.8%. Which teaching is most appropriate?
A) Increase carbohydrate intake
B) Implement tighter glucose targets with insulin adjustment and frequent self-
monitoring
C) Reduce insulin doses as pregnancy advances
D) Discontinue bedtime snack
Rationale: Poor glycemic control increases risk of macrosomia, preeclampsia, and fetal anomalies.
Evidence-based targets (fasting <95 mg/dL, postprandial <140 at 1 hr) require insulin titration and
SMBG. Reducing insulin is incorrect due to rising insulin resistance in later trimesters; consistent
nutrition remains vital.
Question 5
At 18 weeks, a patient has a fundal height of 24 cm and reports increased fetal movement. What is the
most likely cause?
A) Oligohydramnios
B) Multiple gestation
C) Fetal growth restriction
D) Placental abruption
Rationale: Fundal height > gestational age suggests larger uterine size; increased fetal movement
perception supports twins. Oligohydramnios typically reduces fundal height. Abruption presents with
pain and bleeding, and FGR yields a smaller measurement. Ultrasound confirms multiple gestation.
Question 6
A 29-year-old at 16 weeks undergoes maternal serum AFP screening showing markedly elevated AFP.
What is the next step?
A) Reassure and repeat at 28 weeks
B) Order targeted ultrasound to evaluate for neural tube defects and abdominal wall
defects
C) Start folic acid 0.4 mg daily
D) Schedule amniocentesis for fetal lung maturity
Rationale: Elevated AFP suggests open neural tube or ventral wall defects; targeted second-
trimester ultrasound provides diagnostic assessment. Folic acid is preventive preconception/early
pregnancy; amniocentesis for lung maturity is late gestation. NGN judgment emphasizes test
interpretation and appropriate follow-up.
Question 7
A client with suspected Zika exposure at 8 weeks asks about testing. What is the best response?
A) No testing is available
B) Coordinate maternal testing per public health guidance and schedule serial
ultrasounds to monitor fetal brain development
,C) Termination is required
D) Proceed without precautions
Rationale: Zika affects fetal neurodevelopment; management includes maternal testing
(serology/PCR per CDC) and serial ultrasounds to monitor microcephaly/brain anomalies. Counseling
on mosquito avoidance and travel advisories is part of health promotion. Mandatory termination is
not indicated.
Question 8
A 26-year-old at 12 weeks with BMI 38 asks about gestational weight gain goals. Which guidance is
correct?
A) 25–35 lb gain
B) 11–20 lb gain with nutrition counseling and physical activity as tolerated
C) No weight gain
D) 5 lb/month in second trimester only
Rationale: For obesity, ACOG recommends 11–20 lb total gain. Emphasis on balanced nutrition,
adequate folate/iron, and moderate activity supports maternal/fetal outcomes. Excessive restriction
risks fetal growth; excessive gain raises complications.
Question 9
A pregnant patient takes isotretinoin for acne. What is the priority action?
A) Continue with caution
B) Immediate discontinuation and high-risk referral due to teratogenicity
C) Substitute doxycycline
D) Increase folic acid
Rationale: Isotretinoin is a potent teratogen associated with craniofacial and cardiac anomalies;
exposure requires cessation and maternal-fetal medicine referral. Doxycycline also has risks; folic acid
does not mitigate teratogenic exposure. NGN safety prioritizes risk reduction.
Question 10
A 40-year-old at 20 weeks with chronic hypertension has baseline 140/90. She presents with new
proteinuria and platelets 92,000. What complication is suspected?
A) Gestational hypertension
B) Superimposed preeclampsia with thrombocytopenia (possible HELLP)
C) Chronic hypertension only
D) Normal pregnancy change
Rationale: New proteinuria and thrombocytopenia on chronic HTN indicate superimposed
preeclampsia; platelets <100,000 suggest HELLP evolution. This carries maternal-fetal risk requiring
inpatient monitoring, labs (AST/ALT), and delivery planning. Gestational HTN lacks
proteinuria/organ dysfunction.
Question 11
At 34 weeks, a patient has sudden severe abdominal pain, dark bleeding, and a firm tender uterus
after trauma. FHR shows late decelerations. Which diagnosis is most likely?
A) Placenta previa
B) Placental abruption
C) Uterine rupture
D) Round ligament pain
Rationale: Abruption presents with painful bleeding, a tender, hypertonic uterus, and fetal distress;
trauma is a risk factor. Previa is painless bleeding. Uterine rupture is more likely in labor with prior
surgery. Immediate stabilization and delivery may be needed.
Question 12
A 24-year-old at 28 weeks with iron-deficiency anemia has Hgb 9.2 g/dL. What teaching is
appropriate?
, A) Take iron with milk
B) Take ferrous sulfate with vitamin C on an empty stomach; expect dark stools and
possible constipation
C) Avoid all fiber
D) Discontinue prenatal vitamins
Rationale: Iron absorption is increased with vitamin C and decreased with calcium/milk. Side effects
include GI upset, constipation; fiber/hydration help symptom management. Prenatal vitamins should
be continued for folate support.
Question 13
A 16-week patient with positive rubella IgM asks about fetal risk. What guidance is correct?
A) No risk during pregnancy
B) Rubella infection can cause congenital rubella syndrome; avoid live vaccine during
pregnancy and consider maternal-fetal specialist consultation
C) Administer live vaccine now
D) Termination is mandatory
Rationale: Rubella infection in early pregnancy risks cataracts, PDA, sensorineural deafness. Live
vaccines are contraindicated in pregnancy; postpartum vaccination is recommended. Counseling and
specialist referral support informed decisions.
Question 14
A 30-week patient presents with pruritus of palms/soles and elevated bile acids. Which management
is appropriate?
A) Reassure, no action
B) Initiate monitoring and plan for delivery at 36–37 weeks due to intrauterine fetal
demise risk
C) Begin antihistamines only
D) Delay delivery until 41 weeks
Rationale: Intrahepatic cholestasis of pregnancy increases stillbirth risk; bile acid levels guide
management. ACOG recommends close fetal surveillance and planned delivery in late preterm/early
term. Symptomatic therapy alone is insufficient.
Question 15
A 12-week patient with severe dental infection requires antibiotics. Which is preferred?
A) Doxycycline
B) Amoxicillin-clavulanate
C) Ciprofloxacin
D) Trimethoprim-sulfamethoxazole in first trimester
Rationale: Beta-lactams are generally safe and effective; doxycycline risks tooth discoloration, and
TMP-SMX is avoided early due to folate antagonism. Fluoroquinolones are not first-line in pregnancy.
Treating maternal infection prevents systemic complications.
Question 16
A 24-week patient with suspected fetal growth restriction has EFW <10th percentile and abnormal
umbilical artery Dopplers. Which intervention is indicated?
A) Discharge with routine care
B) Increase surveillance with serial growth ultrasounds, Dopplers, and NST/BPP
C) Immediate cesarean
D) Stop prenatal vitamins
Rationale: FGR with abnormal Dopplers indicates placental insufficiency; surveillance (NSTs, BPPs,
Dopplers) and timing of delivery based on status is evidence-based. Immediate delivery is reserved for
nonreassuring testing; vitamins support maternal nutrition.
Question 17
(2026/2027)
Introduction
This comprehensive resource contains 200+ authentic-style questions designed for NCLEX-RN® and
Next Generation NCLEX® (NGN) preparation in maternal-newborn nursing. It includes multiple-
choice, select-all-that-apply, and NGN item types (bowtie, matrix, drop-down cloze). Each question
integrates the NCSBN Clinical Judgment Measurement Model, challenging test-takers to apply
evidence-based practice, prioritize safety, and synthesize pathophysiology with clinical data.
Exam Structure
This 2026/2027 maternal-newborn NCLEX question bank contains 200+ unique, non-repeated
authentic-style questions with detailed rationales, including multiple-choice, select-all-that-apply, and
Next Generation NCLEX® (NGN) item types like bowtie, matrix, and drop-down cloze, designed to
build clinical judgment for the childbearing family.
Answer Format
All correct nursing actions, assessment priorities, and therapeutic responses must be presented in
bold and green, followed by in-depth, unique rationales that justify the clinical decision by linking
pathophysiological principles, current evidence-based guidelines, and patient safety considerations
specific to maternal-newborn care.
Domain 1: Antepartum Care & High-Risk Pregnancy (45 Questions)
Question 1
A 28-year-old G2P1 at 32 weeks presents with BP 158/98, 3+ proteinuria, hyperreflexia, and
persistent RUQ pain. Fetal movement is decreased. Which action is priority?
A) Schedule NST for tomorrow
B) Initiate magnesium sulfate and prepare for urgent evaluation and possible delivery
C) Encourage hydration and rest
D) Administer oral labetalol and discharge
Rationale: Severe features of preeclampsia (BP ≥160/110, RUQ pain, hyperreflexia, proteinuria)
require immediate seizure prophylaxis with magnesium sulfate and maternal-fetal stabilization per
ACOG. The NGN priority is preventing eclampsia and fetal compromise; delaying care risks
progression. Hydration/PO meds alone are insufficient; inpatient management and delivery planning
are warranted.
Question 2
A 22-year-old at 10 weeks reports severe nausea, weight loss, ketonuria, and orthostatic hypotension.
What initial management is indicated?
A) Outpatient ondansetron PRN
B) IV fluid resuscitation with electrolyte replacement and antiemetic therapy
C) Trial of small frequent meals only
D) Start TPN immediately
Rationale: Hyperemesis gravidarum presents with dehydration and ketosis; initial stabilization
requires IV fluids (e.g., normal saline with dextrose after thiamine), electrolyte correction, and
antiemetics. AWHONN supports hospital management when ketonuria and weight loss are present.
TPN is reserved for refractory cases after first-line measures.
,Question 3
A patient at 36 weeks with known placenta previa reports painless vaginal bleeding. FHR baseline is
140, no contractions. Which intervention is appropriate?
A) Perform digital cervical exam
B) Place on bed rest, start IV access, type & crossmatch, and avoid vaginal exams
C) Start oxytocin to control bleeding
D) Discharge with activity as tolerated
Rationale: Placenta previa bleeding is typically painless; digital exams can cause catastrophic
hemorrhage. Stabilization with IV access and blood readiness, with pelvic rest and ultrasound
localization, aligns with ACOG guidance. Induction is contraindicated until delivery planning;
monitoring and preparedness for cesarean are essential.
Question 4
A 35-year-old with pregestational diabetes at 28 weeks has fasting glucose 120 mg/dL and HbA1c
7.8%. Which teaching is most appropriate?
A) Increase carbohydrate intake
B) Implement tighter glucose targets with insulin adjustment and frequent self-
monitoring
C) Reduce insulin doses as pregnancy advances
D) Discontinue bedtime snack
Rationale: Poor glycemic control increases risk of macrosomia, preeclampsia, and fetal anomalies.
Evidence-based targets (fasting <95 mg/dL, postprandial <140 at 1 hr) require insulin titration and
SMBG. Reducing insulin is incorrect due to rising insulin resistance in later trimesters; consistent
nutrition remains vital.
Question 5
At 18 weeks, a patient has a fundal height of 24 cm and reports increased fetal movement. What is the
most likely cause?
A) Oligohydramnios
B) Multiple gestation
C) Fetal growth restriction
D) Placental abruption
Rationale: Fundal height > gestational age suggests larger uterine size; increased fetal movement
perception supports twins. Oligohydramnios typically reduces fundal height. Abruption presents with
pain and bleeding, and FGR yields a smaller measurement. Ultrasound confirms multiple gestation.
Question 6
A 29-year-old at 16 weeks undergoes maternal serum AFP screening showing markedly elevated AFP.
What is the next step?
A) Reassure and repeat at 28 weeks
B) Order targeted ultrasound to evaluate for neural tube defects and abdominal wall
defects
C) Start folic acid 0.4 mg daily
D) Schedule amniocentesis for fetal lung maturity
Rationale: Elevated AFP suggests open neural tube or ventral wall defects; targeted second-
trimester ultrasound provides diagnostic assessment. Folic acid is preventive preconception/early
pregnancy; amniocentesis for lung maturity is late gestation. NGN judgment emphasizes test
interpretation and appropriate follow-up.
Question 7
A client with suspected Zika exposure at 8 weeks asks about testing. What is the best response?
A) No testing is available
B) Coordinate maternal testing per public health guidance and schedule serial
ultrasounds to monitor fetal brain development
,C) Termination is required
D) Proceed without precautions
Rationale: Zika affects fetal neurodevelopment; management includes maternal testing
(serology/PCR per CDC) and serial ultrasounds to monitor microcephaly/brain anomalies. Counseling
on mosquito avoidance and travel advisories is part of health promotion. Mandatory termination is
not indicated.
Question 8
A 26-year-old at 12 weeks with BMI 38 asks about gestational weight gain goals. Which guidance is
correct?
A) 25–35 lb gain
B) 11–20 lb gain with nutrition counseling and physical activity as tolerated
C) No weight gain
D) 5 lb/month in second trimester only
Rationale: For obesity, ACOG recommends 11–20 lb total gain. Emphasis on balanced nutrition,
adequate folate/iron, and moderate activity supports maternal/fetal outcomes. Excessive restriction
risks fetal growth; excessive gain raises complications.
Question 9
A pregnant patient takes isotretinoin for acne. What is the priority action?
A) Continue with caution
B) Immediate discontinuation and high-risk referral due to teratogenicity
C) Substitute doxycycline
D) Increase folic acid
Rationale: Isotretinoin is a potent teratogen associated with craniofacial and cardiac anomalies;
exposure requires cessation and maternal-fetal medicine referral. Doxycycline also has risks; folic acid
does not mitigate teratogenic exposure. NGN safety prioritizes risk reduction.
Question 10
A 40-year-old at 20 weeks with chronic hypertension has baseline 140/90. She presents with new
proteinuria and platelets 92,000. What complication is suspected?
A) Gestational hypertension
B) Superimposed preeclampsia with thrombocytopenia (possible HELLP)
C) Chronic hypertension only
D) Normal pregnancy change
Rationale: New proteinuria and thrombocytopenia on chronic HTN indicate superimposed
preeclampsia; platelets <100,000 suggest HELLP evolution. This carries maternal-fetal risk requiring
inpatient monitoring, labs (AST/ALT), and delivery planning. Gestational HTN lacks
proteinuria/organ dysfunction.
Question 11
At 34 weeks, a patient has sudden severe abdominal pain, dark bleeding, and a firm tender uterus
after trauma. FHR shows late decelerations. Which diagnosis is most likely?
A) Placenta previa
B) Placental abruption
C) Uterine rupture
D) Round ligament pain
Rationale: Abruption presents with painful bleeding, a tender, hypertonic uterus, and fetal distress;
trauma is a risk factor. Previa is painless bleeding. Uterine rupture is more likely in labor with prior
surgery. Immediate stabilization and delivery may be needed.
Question 12
A 24-year-old at 28 weeks with iron-deficiency anemia has Hgb 9.2 g/dL. What teaching is
appropriate?
, A) Take iron with milk
B) Take ferrous sulfate with vitamin C on an empty stomach; expect dark stools and
possible constipation
C) Avoid all fiber
D) Discontinue prenatal vitamins
Rationale: Iron absorption is increased with vitamin C and decreased with calcium/milk. Side effects
include GI upset, constipation; fiber/hydration help symptom management. Prenatal vitamins should
be continued for folate support.
Question 13
A 16-week patient with positive rubella IgM asks about fetal risk. What guidance is correct?
A) No risk during pregnancy
B) Rubella infection can cause congenital rubella syndrome; avoid live vaccine during
pregnancy and consider maternal-fetal specialist consultation
C) Administer live vaccine now
D) Termination is mandatory
Rationale: Rubella infection in early pregnancy risks cataracts, PDA, sensorineural deafness. Live
vaccines are contraindicated in pregnancy; postpartum vaccination is recommended. Counseling and
specialist referral support informed decisions.
Question 14
A 30-week patient presents with pruritus of palms/soles and elevated bile acids. Which management
is appropriate?
A) Reassure, no action
B) Initiate monitoring and plan for delivery at 36–37 weeks due to intrauterine fetal
demise risk
C) Begin antihistamines only
D) Delay delivery until 41 weeks
Rationale: Intrahepatic cholestasis of pregnancy increases stillbirth risk; bile acid levels guide
management. ACOG recommends close fetal surveillance and planned delivery in late preterm/early
term. Symptomatic therapy alone is insufficient.
Question 15
A 12-week patient with severe dental infection requires antibiotics. Which is preferred?
A) Doxycycline
B) Amoxicillin-clavulanate
C) Ciprofloxacin
D) Trimethoprim-sulfamethoxazole in first trimester
Rationale: Beta-lactams are generally safe and effective; doxycycline risks tooth discoloration, and
TMP-SMX is avoided early due to folate antagonism. Fluoroquinolones are not first-line in pregnancy.
Treating maternal infection prevents systemic complications.
Question 16
A 24-week patient with suspected fetal growth restriction has EFW <10th percentile and abnormal
umbilical artery Dopplers. Which intervention is indicated?
A) Discharge with routine care
B) Increase surveillance with serial growth ultrasounds, Dopplers, and NST/BPP
C) Immediate cesarean
D) Stop prenatal vitamins
Rationale: FGR with abnormal Dopplers indicates placental insufficiency; surveillance (NSTs, BPPs,
Dopplers) and timing of delivery based on status is evidence-based. Immediate delivery is reserved for
nonreassuring testing; vitamins support maternal nutrition.
Question 17
