Maternal-Newborn Nursing Case Study-Based Questions Practice and
Answers Updated 2026 | Complete Maternity Nursing Study Guide with
Verified Case Scenarios, Detailed Rationales, Antepartum Risk
Assessment, Intrapartum Labor & Delivery, Postpartum Care, Newborn
Assessment, Fetal Monitoring, Obstetric Emergencies, Breastfeeding
Support & NGN NCLEX Exam Prep
Question 1: A 24-year-old G1P0 at 40 weeks gestation is in active labor. The FHR
baseline is 140 bpm with moderate variability and no decelerations. What is the
priority nursing action? A. Prepare for immediate cesarean delivery B. Administer
oxytocin to augment labor C. Continue routine labor monitoring D. Perform a vaginal
examination every 30 minutes CORRECT ANSWER: C. Continue routine labor
monitoring Rationale: The FHR tracing is Category I (normal), indicating fetal well-
being. Routine monitoring is appropriate.
Question 2: A 30-year-old G3P2 at 8 weeks gestation presents with severe
abdominal pain, heavy vaginal bleeding, BP 80/50 mmHg, and HR 120 bpm. What is
the priority nursing action? A. Administer IV fluids and prepare for surgery B. Perform a
sterile vaginal examination C. Administer Rho(D) immune globulin D. Obtain a detailed
obstetric history CORRECT ANSWER: A. Administer IV fluids and prepare for surgery
Rationale: The patient is hypovolemic, likely from a ruptured ectopic pregnancy.
Hemodynamic stabilization and surgical intervention are the priorities.
Question 3: A 22-year-old G1P0 at 32 weeks gestation reports a sudden gush of fluid
from her vagina. A Nitrazine test turns blue. What is the priority nursing action? A.
Perform a digital vaginal examination B. Assess fetal heart rate and contractions C.
Administer corticosteroids D. Prepare for immediate delivery CORRECT ANSWER: B.
Assess fetal heart rate and contractions Rationale: After rupture of membranes,
assessing the FHR is the priority to rule out cord prolapse. Digital exams are
contraindicated until placenta previa is ruled out.
Question 4: A 35-year-old G2P1 at 36 weeks gestation has a BP of 160/110 mmHg,
proteinuria 3+, and complains of a severe headache. What is the priority
medication? A. Labetalol B. Magnesium sulfate C. Nifedipine D. Methyldopa CORRECT
ANSWER: B. Magnesium sulfate Rationale: The patient has severe preeclampsia with
neurological symptoms. Magnesium sulfate is the priority to prevent seizures.
Question 5: A newborn is 2 hours old. The respiratory rate is 70 breaths/min with
grunting and nasal flaring. What is the priority nursing action? A. Administer
surfactant B. Provide continuous positive airway pressure (CPAP) C. Assess blood
glucose D. Obtain a chest X-ray CORRECT ANSWER: B. Provide continuous positive
airway pressure (CPAP) Rationale: The newborn shows signs of respiratory distress.
CPAP is the priority to improve oxygenation and work of breathing.
Question 6: A 28-year-old G1P0 at 10 weeks gestation presents with severe nausea,
vomiting, a 5% weight loss, and ketones in the urine. What is the most likely
diagnosis? A. Hyperemesis gravidarum B. Gestational trophoblastic disease C. Acute
,appendicitis D. Cholecystitis CORRECT ANSWER: A. Hyperemesis gravidarum
Rationale: Severe nausea and vomiting with weight loss and ketonuria in early
pregnancy are classic signs of hyperemesis gravidarum.
Question 7: A 19-year-old G1P0 at 39 weeks gestation has been pushing for 2 hours.
The fetal head is at +1 station in the occiput posterior position. What is the most
appropriate nursing action? A. Encourage continued pushing for another hour B.
Administer oxytocin to augment labor C. Prepare for operative vaginal delivery or
cesarean section D. Perform an amniotomy CORRECT ANSWER: C. Prepare for
operative vaginal delivery or cesarean section Rationale: Arrest of descent in the
second stage with an occiput posterior position often requires operative intervention.
Question 8: A 32-year-old G2P1 at 24 weeks gestation presents with painless
vaginal bleeding. Ultrasound confirms a complete placenta previa. What is the
priority nursing action? A. Perform a digital cervical examination B. Institute pelvic rest
and monitor fetal status C. Administer methylergonovine D. Prepare for immediate
vaginal delivery CORRECT ANSWER: B. Institute pelvic rest and monitor fetal status
Rationale: In placenta previa, digital exams are contraindicated due to the risk of severe
hemorrhage. Pelvic rest and monitoring are indicated.
Question 9: A 1-day-old newborn has a total serum bilirubin level of 18 mg/dL. The
newborn is blood type O positive, and the mother is O negative. What is the priority
treatment? A. Initiate phototherapy B. Prepare for exchange transfusion C. Administer
IV fluids D. Monitor bilirubin levels every 12 hours CORRECT ANSWER: A. Initiate
phototherapy Rationale: A bilirubin level of 18 mg/dL at 24 hours of life is high and
requires immediate phototherapy to prevent kernicterus.
Question 10: A 26-year-old G1P0 at 41 weeks gestation has no contractions, a
closed cervix, and a Bishop score of 4. What is the most appropriate nursing
action? A. Administer oxytocin B. Initiate cervical ripening C. Perform an amniotomy D.
Schedule a repeat appointment in 1 week CORRECT ANSWER: B. Initiate cervical
ripening Rationale: A Bishop score of 4 indicates an unfavorable cervix. Cervical
ripening agents (e.g., prostaglandins) are needed before labor induction.
Question 11: A 29-year-old G2P1 at 38 weeks gestation is admitted with a diagnosis
of abruptio placentae. She reports severe, constant abdominal pain and dark red
vaginal bleeding. What is the priority nursing assessment? A. Fetal heart rate and
uterine tone B. Maternal temperature and pulse C. Cervical dilation and effacement D.
Deep tendon reflexes and clonus CORRECT ANSWER: A. Fetal heart rate and uterine
tone Rationale: Abruptio placentae compromises fetal oxygenation and causes a rigid,
board-like uterus. Assessing FHR and uterine tone is critical.
Question 12: A newborn is 12 hours old and has not voided since birth. The mother
reports the newborn has been breastfeeding well. What is the priority nursing
action? A. Administer a fluid bolus B. Assess for bladder distention C. Catheterize the
newborn D. Document as a normal finding CORRECT ANSWER: B. Assess for bladder
,distention Rationale: Newborns should void within the first 24 hours. Assessing for
bladder distention helps determine if there is urinary retention.
Question 13: A 31-year-old G1P0 at 28 weeks gestation is diagnosed with
gestational diabetes. Her fasting blood glucose is 105 mg/dL. What is the initial
management? A. Start insulin therapy B. Initiate dietary modifications and exercise C.
Prescribe oral hypoglycemics D. Schedule an immediate cesarean delivery CORRECT
ANSWER: B. Initiate dietary modifications and exercise Rationale: The first-line
treatment for gestational diabetes is medical nutrition therapy and moderate exercise.
Question 14: A 25-year-old G1P0 at 39 weeks gestation receives an epidural for
labor pain. Her BP drops to 80/50 mmHg. What is the priority nursing action? A.
Administer IV labetalol B. Turn the patient to the left lateral position and increase IV
fluids C. Prepare for an emergency cesarean delivery D. Administer oxygen via non-
rebreather mask CORRECT ANSWER: B. Turn the patient to the left lateral position
and increase IV fluids Rationale: Epidural-induced hypotension is caused by
sympathetic blockade. Repositioning and fluid bolus are the first interventions.
Question 15: A 3-day-old newborn is being breastfed. The mother reports the
newborn is feeding every 2 hours and having 6 wet diapers a day. The newborn's
weight has dropped 6% from birth weight. What is the most appropriate nursing
action? A. Supplement with formula B. Reassure the mother this is a normal finding C.
Assess the newborn for dehydration D. Advise the mother to breastfeed more frequently
CORRECT ANSWER: B. Reassure the mother this is a normal finding Rationale: A
weight loss of up to 7-10% in the first few days of life is normal. Frequent feeding and
adequate wet diapers indicate effective breastfeeding.
Question 16: A 34-year-old G3P2 at 15 weeks gestation presents with a painless,
enlarged uterus and a quantitative hCG level significantly higher than expected for
gestational age. What is the most likely diagnosis? A. Ectopic pregnancy B. Molar
pregnancy C. Missed abortion D. Inevitable abortion CORRECT ANSWER: B. Molar
pregnancy Rationale: A painless, enlarged uterus and disproportionately high hCG
levels are classic signs of gestational trophoblastic disease (molar pregnancy).
Question 17: A 27-year-old G1P0 at 40 weeks gestation is in the transition phase of
labor. She is irritable, nauseated, and says, "I can't do this anymore." What is the
priority nursing action? A. Administer an antiemetic B. Provide continuous emotional
support and coaching C. Prepare for immediate delivery D. Assess the fetal heart rate
for late decelerations CORRECT ANSWER: B. Provide continuous emotional support
and coaching Rationale: These are classic behavioral signs of the transition phase.
Emotional support and breathing coaching are the primary nursing interventions.
Question 18: A 22-year-old G1P0 at 36 weeks gestation is diagnosed with a urinary
tract infection (UTI). She is prescribed nitrofurantoin. What is the most important
teaching point? A. Take the medication on an empty stomach B. Stop taking the
medication if urine turns brown C. Drink plenty of water to prevent crystalluria D. Avoid
dairy products while taking the medication CORRECT ANSWER: C. Drink plenty of
, water to prevent crystalluria Rationale: Nitrofurantoin can cause crystalluria;
adequate hydration is essential to prevent this complication.
Question 19: A newborn is 4 hours old and has a respiratory rate of 45 breaths/min,
heart rate of 140 bpm, and acrocyanosis. What is the priority nursing action? A.
Administer oxygen B. Document the findings as normal C. Stimulate the newborn to cry
D. Obtain a pulse oximetry reading CORRECT ANSWER: B. Document the findings as
normal Rationale: These are normal newborn vital signs and findings. Acrocyanosis is
normal in the first 24-48 hours of life.
Question 20: A 30-year-old G2P1 at 39 weeks gestation is admitted for labor
induction. Her cervix is 2 cm dilated, 50% effaced, and -2 station. Which
medication is most appropriate for cervical ripening? A. Oxytocin B. Dinoprostone C.
Methylergonovine D. Terbutaline CORRECT ANSWER: B. Dinoprostone Rationale:
Dinoprostone (a prostaglandin E2 analog) is used for cervical ripening in patients with
an unfavorable cervix.
Question 21: A 28-year-old G1P0 at 12 weeks gestation presents with cramping and
moderate vaginal bleeding. The cervical os is closed. What is the most likely
diagnosis? A. Threatened abortion B. Inevitable abortion C. Incomplete abortion D.
Missed abortion CORRECT ANSWER: A. Threatened abortion Rationale: Vaginal
bleeding and cramping with a closed cervical os before 20 weeks indicate a threatened
abortion.
Question 22: A 33-year-old G2P1 at 38 weeks gestation has a positive group B
streptococcus (GBS) culture. She presents in labor with ruptured membranes.
What is the priority nursing action? A. Administer IV penicillin B. Administer oral
amoxicillin C. Prepare for a cesarean delivery D. Monitor the newborn for signs of
infection CORRECT ANSWER: A. Administer IV penicillin Rationale: IV penicillin is the
prophylactic treatment of choice for GBS-positive women in labor to prevent early-
onset neonatal sepsis.
Question 23: A 1-day-old newborn has a heart rate of 110 bpm, a murmur is
auscultated, and the newborn has bounding pulses. What is the most likely
condition? A. Patent ductus arteriosus (PDA) B. Ventricular septal defect (VSD) C.
Tetralogy of Fallot D. Transposition of the great arteries CORRECT ANSWER: A. Patent
ductus arteriosus (PDA) Rationale: A continuous machine-like murmur and bounding
pulses are classic signs of a PDA in a newborn.
Question 24: A 26-year-old G1P0 at 34 weeks gestation is diagnosed with placenta
previa. She reports a small amount of bright red vaginal bleeding. What is the
priority nursing action? A. Perform a digital vaginal exam B. Administer Rho(D) immune
globulin C. Monitor maternal vital signs and fetal heart rate D. Prepare for an immediate
vaginal delivery CORRECT ANSWER: C. Monitor maternal vital signs and fetal heart
rate Rationale: In placenta previa, monitoring for hemorrhage and fetal distress is
critical. Digital exams are strictly contraindicated.
Answers Updated 2026 | Complete Maternity Nursing Study Guide with
Verified Case Scenarios, Detailed Rationales, Antepartum Risk
Assessment, Intrapartum Labor & Delivery, Postpartum Care, Newborn
Assessment, Fetal Monitoring, Obstetric Emergencies, Breastfeeding
Support & NGN NCLEX Exam Prep
Question 1: A 24-year-old G1P0 at 40 weeks gestation is in active labor. The FHR
baseline is 140 bpm with moderate variability and no decelerations. What is the
priority nursing action? A. Prepare for immediate cesarean delivery B. Administer
oxytocin to augment labor C. Continue routine labor monitoring D. Perform a vaginal
examination every 30 minutes CORRECT ANSWER: C. Continue routine labor
monitoring Rationale: The FHR tracing is Category I (normal), indicating fetal well-
being. Routine monitoring is appropriate.
Question 2: A 30-year-old G3P2 at 8 weeks gestation presents with severe
abdominal pain, heavy vaginal bleeding, BP 80/50 mmHg, and HR 120 bpm. What is
the priority nursing action? A. Administer IV fluids and prepare for surgery B. Perform a
sterile vaginal examination C. Administer Rho(D) immune globulin D. Obtain a detailed
obstetric history CORRECT ANSWER: A. Administer IV fluids and prepare for surgery
Rationale: The patient is hypovolemic, likely from a ruptured ectopic pregnancy.
Hemodynamic stabilization and surgical intervention are the priorities.
Question 3: A 22-year-old G1P0 at 32 weeks gestation reports a sudden gush of fluid
from her vagina. A Nitrazine test turns blue. What is the priority nursing action? A.
Perform a digital vaginal examination B. Assess fetal heart rate and contractions C.
Administer corticosteroids D. Prepare for immediate delivery CORRECT ANSWER: B.
Assess fetal heart rate and contractions Rationale: After rupture of membranes,
assessing the FHR is the priority to rule out cord prolapse. Digital exams are
contraindicated until placenta previa is ruled out.
Question 4: A 35-year-old G2P1 at 36 weeks gestation has a BP of 160/110 mmHg,
proteinuria 3+, and complains of a severe headache. What is the priority
medication? A. Labetalol B. Magnesium sulfate C. Nifedipine D. Methyldopa CORRECT
ANSWER: B. Magnesium sulfate Rationale: The patient has severe preeclampsia with
neurological symptoms. Magnesium sulfate is the priority to prevent seizures.
Question 5: A newborn is 2 hours old. The respiratory rate is 70 breaths/min with
grunting and nasal flaring. What is the priority nursing action? A. Administer
surfactant B. Provide continuous positive airway pressure (CPAP) C. Assess blood
glucose D. Obtain a chest X-ray CORRECT ANSWER: B. Provide continuous positive
airway pressure (CPAP) Rationale: The newborn shows signs of respiratory distress.
CPAP is the priority to improve oxygenation and work of breathing.
Question 6: A 28-year-old G1P0 at 10 weeks gestation presents with severe nausea,
vomiting, a 5% weight loss, and ketones in the urine. What is the most likely
diagnosis? A. Hyperemesis gravidarum B. Gestational trophoblastic disease C. Acute
,appendicitis D. Cholecystitis CORRECT ANSWER: A. Hyperemesis gravidarum
Rationale: Severe nausea and vomiting with weight loss and ketonuria in early
pregnancy are classic signs of hyperemesis gravidarum.
Question 7: A 19-year-old G1P0 at 39 weeks gestation has been pushing for 2 hours.
The fetal head is at +1 station in the occiput posterior position. What is the most
appropriate nursing action? A. Encourage continued pushing for another hour B.
Administer oxytocin to augment labor C. Prepare for operative vaginal delivery or
cesarean section D. Perform an amniotomy CORRECT ANSWER: C. Prepare for
operative vaginal delivery or cesarean section Rationale: Arrest of descent in the
second stage with an occiput posterior position often requires operative intervention.
Question 8: A 32-year-old G2P1 at 24 weeks gestation presents with painless
vaginal bleeding. Ultrasound confirms a complete placenta previa. What is the
priority nursing action? A. Perform a digital cervical examination B. Institute pelvic rest
and monitor fetal status C. Administer methylergonovine D. Prepare for immediate
vaginal delivery CORRECT ANSWER: B. Institute pelvic rest and monitor fetal status
Rationale: In placenta previa, digital exams are contraindicated due to the risk of severe
hemorrhage. Pelvic rest and monitoring are indicated.
Question 9: A 1-day-old newborn has a total serum bilirubin level of 18 mg/dL. The
newborn is blood type O positive, and the mother is O negative. What is the priority
treatment? A. Initiate phototherapy B. Prepare for exchange transfusion C. Administer
IV fluids D. Monitor bilirubin levels every 12 hours CORRECT ANSWER: A. Initiate
phototherapy Rationale: A bilirubin level of 18 mg/dL at 24 hours of life is high and
requires immediate phototherapy to prevent kernicterus.
Question 10: A 26-year-old G1P0 at 41 weeks gestation has no contractions, a
closed cervix, and a Bishop score of 4. What is the most appropriate nursing
action? A. Administer oxytocin B. Initiate cervical ripening C. Perform an amniotomy D.
Schedule a repeat appointment in 1 week CORRECT ANSWER: B. Initiate cervical
ripening Rationale: A Bishop score of 4 indicates an unfavorable cervix. Cervical
ripening agents (e.g., prostaglandins) are needed before labor induction.
Question 11: A 29-year-old G2P1 at 38 weeks gestation is admitted with a diagnosis
of abruptio placentae. She reports severe, constant abdominal pain and dark red
vaginal bleeding. What is the priority nursing assessment? A. Fetal heart rate and
uterine tone B. Maternal temperature and pulse C. Cervical dilation and effacement D.
Deep tendon reflexes and clonus CORRECT ANSWER: A. Fetal heart rate and uterine
tone Rationale: Abruptio placentae compromises fetal oxygenation and causes a rigid,
board-like uterus. Assessing FHR and uterine tone is critical.
Question 12: A newborn is 12 hours old and has not voided since birth. The mother
reports the newborn has been breastfeeding well. What is the priority nursing
action? A. Administer a fluid bolus B. Assess for bladder distention C. Catheterize the
newborn D. Document as a normal finding CORRECT ANSWER: B. Assess for bladder
,distention Rationale: Newborns should void within the first 24 hours. Assessing for
bladder distention helps determine if there is urinary retention.
Question 13: A 31-year-old G1P0 at 28 weeks gestation is diagnosed with
gestational diabetes. Her fasting blood glucose is 105 mg/dL. What is the initial
management? A. Start insulin therapy B. Initiate dietary modifications and exercise C.
Prescribe oral hypoglycemics D. Schedule an immediate cesarean delivery CORRECT
ANSWER: B. Initiate dietary modifications and exercise Rationale: The first-line
treatment for gestational diabetes is medical nutrition therapy and moderate exercise.
Question 14: A 25-year-old G1P0 at 39 weeks gestation receives an epidural for
labor pain. Her BP drops to 80/50 mmHg. What is the priority nursing action? A.
Administer IV labetalol B. Turn the patient to the left lateral position and increase IV
fluids C. Prepare for an emergency cesarean delivery D. Administer oxygen via non-
rebreather mask CORRECT ANSWER: B. Turn the patient to the left lateral position
and increase IV fluids Rationale: Epidural-induced hypotension is caused by
sympathetic blockade. Repositioning and fluid bolus are the first interventions.
Question 15: A 3-day-old newborn is being breastfed. The mother reports the
newborn is feeding every 2 hours and having 6 wet diapers a day. The newborn's
weight has dropped 6% from birth weight. What is the most appropriate nursing
action? A. Supplement with formula B. Reassure the mother this is a normal finding C.
Assess the newborn for dehydration D. Advise the mother to breastfeed more frequently
CORRECT ANSWER: B. Reassure the mother this is a normal finding Rationale: A
weight loss of up to 7-10% in the first few days of life is normal. Frequent feeding and
adequate wet diapers indicate effective breastfeeding.
Question 16: A 34-year-old G3P2 at 15 weeks gestation presents with a painless,
enlarged uterus and a quantitative hCG level significantly higher than expected for
gestational age. What is the most likely diagnosis? A. Ectopic pregnancy B. Molar
pregnancy C. Missed abortion D. Inevitable abortion CORRECT ANSWER: B. Molar
pregnancy Rationale: A painless, enlarged uterus and disproportionately high hCG
levels are classic signs of gestational trophoblastic disease (molar pregnancy).
Question 17: A 27-year-old G1P0 at 40 weeks gestation is in the transition phase of
labor. She is irritable, nauseated, and says, "I can't do this anymore." What is the
priority nursing action? A. Administer an antiemetic B. Provide continuous emotional
support and coaching C. Prepare for immediate delivery D. Assess the fetal heart rate
for late decelerations CORRECT ANSWER: B. Provide continuous emotional support
and coaching Rationale: These are classic behavioral signs of the transition phase.
Emotional support and breathing coaching are the primary nursing interventions.
Question 18: A 22-year-old G1P0 at 36 weeks gestation is diagnosed with a urinary
tract infection (UTI). She is prescribed nitrofurantoin. What is the most important
teaching point? A. Take the medication on an empty stomach B. Stop taking the
medication if urine turns brown C. Drink plenty of water to prevent crystalluria D. Avoid
dairy products while taking the medication CORRECT ANSWER: C. Drink plenty of
, water to prevent crystalluria Rationale: Nitrofurantoin can cause crystalluria;
adequate hydration is essential to prevent this complication.
Question 19: A newborn is 4 hours old and has a respiratory rate of 45 breaths/min,
heart rate of 140 bpm, and acrocyanosis. What is the priority nursing action? A.
Administer oxygen B. Document the findings as normal C. Stimulate the newborn to cry
D. Obtain a pulse oximetry reading CORRECT ANSWER: B. Document the findings as
normal Rationale: These are normal newborn vital signs and findings. Acrocyanosis is
normal in the first 24-48 hours of life.
Question 20: A 30-year-old G2P1 at 39 weeks gestation is admitted for labor
induction. Her cervix is 2 cm dilated, 50% effaced, and -2 station. Which
medication is most appropriate for cervical ripening? A. Oxytocin B. Dinoprostone C.
Methylergonovine D. Terbutaline CORRECT ANSWER: B. Dinoprostone Rationale:
Dinoprostone (a prostaglandin E2 analog) is used for cervical ripening in patients with
an unfavorable cervix.
Question 21: A 28-year-old G1P0 at 12 weeks gestation presents with cramping and
moderate vaginal bleeding. The cervical os is closed. What is the most likely
diagnosis? A. Threatened abortion B. Inevitable abortion C. Incomplete abortion D.
Missed abortion CORRECT ANSWER: A. Threatened abortion Rationale: Vaginal
bleeding and cramping with a closed cervical os before 20 weeks indicate a threatened
abortion.
Question 22: A 33-year-old G2P1 at 38 weeks gestation has a positive group B
streptococcus (GBS) culture. She presents in labor with ruptured membranes.
What is the priority nursing action? A. Administer IV penicillin B. Administer oral
amoxicillin C. Prepare for a cesarean delivery D. Monitor the newborn for signs of
infection CORRECT ANSWER: A. Administer IV penicillin Rationale: IV penicillin is the
prophylactic treatment of choice for GBS-positive women in labor to prevent early-
onset neonatal sepsis.
Question 23: A 1-day-old newborn has a heart rate of 110 bpm, a murmur is
auscultated, and the newborn has bounding pulses. What is the most likely
condition? A. Patent ductus arteriosus (PDA) B. Ventricular septal defect (VSD) C.
Tetralogy of Fallot D. Transposition of the great arteries CORRECT ANSWER: A. Patent
ductus arteriosus (PDA) Rationale: A continuous machine-like murmur and bounding
pulses are classic signs of a PDA in a newborn.
Question 24: A 26-year-old G1P0 at 34 weeks gestation is diagnosed with placenta
previa. She reports a small amount of bright red vaginal bleeding. What is the
priority nursing action? A. Perform a digital vaginal exam B. Administer Rho(D) immune
globulin C. Monitor maternal vital signs and fetal heart rate D. Prepare for an immediate
vaginal delivery CORRECT ANSWER: C. Monitor maternal vital signs and fetal heart
rate Rationale: In placenta previa, monitoring for hemorrhage and fetal distress is
critical. Digital exams are strictly contraindicated.
