Maternal-Newborn (OB/GYN) Advanced Nursing
Exam: 150 Multiple-Choice Questions With
Rationales Covering High-Risk Antepartum,
Intrapartum, Postpartum, and Neonatal Care, Fetal
Heart Rate Monitoring, Obstetric Emergencies,
Pharmacology, Women's Health, Contraception,
Gynecological Disorders, and Legal-Ethical
Principles for NCLEX Success and Clinical Mastery
Advanced Practice Question Bank graded A+
2025/2026
1. A client at 33 weeks’ gestation presents with sudden onset of severe, constant abdominal
pain and dark vaginal bleeding. The uterus is firm and tender to palpation. Contractions are
every 2 minutes with high resting tone. Which condition is most likely?
A) Placenta previa
B) Placental abruption
C) Uterine rupture
D) Preterm labor
Correct Answer: B
Rationale: The classic signs of placental abruption (abruptio placentae) are painful, dark red
bleeding, uterine hypertonicity, and a rigid, tender uterus. Placenta previa typically presents
with painless, bright red bleeding and a soft uterus. Uterine rupture causes sudden tearing pain,
cessation of contractions, and fetal bradycardia. Preterm labor has rhythmic contractions
without a rigid uterus.
2. A nurse notes that a laboring client’s external fetal monitor tracing shows a sinusoidal
pattern. Which action should the nurse take first?
,A) Reposition the client to the left lateral position
B) Administer oxygen by face mask and notify the provider
C) Prepare for immediate cesarean delivery
D) Discontinue oxytocin infusion
Correct Answer: B
Rationale: A sinusoidal fetal heart rate pattern is associated with severe fetal anemia, hypoxia,
or other significant compromise. The nurse should initiate intrauterine resuscitation (oxygen,
position change, IV fluids) and notify the provider urgently. Preparing for cesarean may be
necessary, but initial actions include oxygen and notification. Repositioning alone is insufficient.
3. A postpartum client who delivered a 4,500-gram infant 30 minutes ago suddenly has a gush
of blood and the fundus rises above the umbilicus and is boggy. What is the priority nursing
action?
A) Administer a uterotonic drug as prescribed
B) Massage the fundus until firm and express clots
C) Perform bimanual compression
D) Notify the provider immediately
Correct Answer: B
Rationale: A boggy, displaced fundus with a gush of blood indicates uterine atony. The initial
nursing intervention is firm fundal massage to stimulate contraction and expel any clots. If
massage is ineffective, uterotonics are administered. Bimanual compression is a later
intervention. Notification is important but massage is the first action.
4. A term newborn delivered vaginally 1 hour ago has central cyanosis, a heart rate of 180 bpm,
and a respiratory rate of 70 with grunting. The nurse should suspect:
A) Transient tachypnea of the newborn
B) Congenital heart disease
C) Respiratory distress syndrome
D) Sepsis or persistent pulmonary hypertension
Correct Answer: D
Rationale: Central cyanosis, tachycardia, tachypnea, and grunting in a term infant suggest
sepsis, pneumonia, or persistent pulmonary hypertension. TTN typically resolves quickly and
does not cause central cyanosis. RDS is more common in preterm infants. Congenital heart
disease may present with cyanosis but often has a murmur and differential cyanosis.
,5. A woman at 24 weeks’ gestation with a history of a previous preterm birth at 30 weeks asks
about preventing another preterm delivery. Which intervention is evidence-based?
A) Prophylactic cervical cerclage
B) Weekly 17-alpha-hydroxyprogesterone caproate injections
C) Prophylactic tocolysis with nifedipine
D) Bed rest and pelvic rest
Correct Answer: B
Rationale: For singleton pregnancies with a prior spontaneous preterm birth, 17P injections
starting at 16–24 weeks reduce the risk of recurrence. Cerclage is indicated for cervical
insufficiency, not solely for a history of preterm birth. Tocolytics are used for acute preterm
labor, and bed rest is not supported by evidence.
6. A laboring client with an epidural develops hypotension (90/50 mm Hg) and the fetal heart
rate shows a prolonged deceleration. After repositioning to the left lateral position and
increasing IV fluids, the maternal BP remains low. Which medication should the nurse
anticipate?
A) Epinephrine
B) Ephedrine or phenylephrine
C) Atropine
D) Naloxone
Correct Answer: B
Rationale: Epidural-induced hypotension that does not respond to position change and fluid
bolus can be treated with vasopressors such as ephedrine or phenylephrine, which increase
maternal blood pressure and improve uterine perfusion. Epinephrine is not first-line. Atropine is
for bradycardia, naloxone for opioid reversal.
7. A breastfeeding mother at 3 weeks postpartum reports a hard, red, painful area on the outer
quadrant of her left breast and a temperature of 101°F (38.3°C). What is the most important
management strategy?
A) Stop breastfeeding and pump and discard milk
B) Continue frequent breastfeeding on the affected breast and apply warm compresses
C) Administer antibiotics and wear a tight-fitting bra
D) Apply ice packs and restrict fluid intake
, Correct Answer: B
Rationale: Mastitis management includes effective milk removal (frequent breastfeeding or
pumping) from the affected breast, warm compresses, and rest. Stopping breastfeeding can
lead to engorgement and abscess formation. Antibiotics are prescribed if indicated, but milk
removal is essential. Tight bras may obstruct ducts.
8. A client at 36 weeks’ gestation is diagnosed with severe preeclampsia. Which laboratory value
indicates an increased risk for disseminated intravascular coagulation (DIC)?
A) Platelet count 90,000/mm³
B) Hemoglobin 14 g/dL
C) White blood cell count 12,000/mm³
D) Blood urea nitrogen 15 mg/dL
Correct Answer: A
Rationale: Thrombocytopenia (platelets <100,000/mm³) is a sign of severe preeclampsia and
can be associated with HELLP syndrome or DIC. Hemoglobin and WBC are not specific. Elevated
BUN may indicate renal involvement but not DIC directly. A falling platelet count raises concern
for coagulopathy.
9. A newborn at 24 hours of age has a total serum bilirubin of 12 mg/dL. The infant is
breastfeeding well, stooling, and not visibly jaundiced. The mother’s blood type is O-positive,
infant is A-positive, direct Coombs negative. The nurse should:
A) Initiate phototherapy immediately
B) Recognize this as physiologic jaundice and continue to monitor
C) Supplement with formula and stop breastfeeding
D) Prepare for exchange transfusion
Correct Answer: B
Rationale: A bilirubin level of 12 mg/dL at 24 hours is approaching the phototherapy threshold
depending on gestation and risk factors, but with a negative Coombs, term infant, and no
clinical jaundice, it may still be physiologic. The nurse should continue monitoring and ensure
adequate feeding. Phototherapy is not automatically indicated at this level. No exchange
needed.
10. A client is receiving magnesium sulfate for preterm labor neuroprotection. The nurse
assesses deep tendon reflexes and finds they are absent. What should the nurse do first?
Exam: 150 Multiple-Choice Questions With
Rationales Covering High-Risk Antepartum,
Intrapartum, Postpartum, and Neonatal Care, Fetal
Heart Rate Monitoring, Obstetric Emergencies,
Pharmacology, Women's Health, Contraception,
Gynecological Disorders, and Legal-Ethical
Principles for NCLEX Success and Clinical Mastery
Advanced Practice Question Bank graded A+
2025/2026
1. A client at 33 weeks’ gestation presents with sudden onset of severe, constant abdominal
pain and dark vaginal bleeding. The uterus is firm and tender to palpation. Contractions are
every 2 minutes with high resting tone. Which condition is most likely?
A) Placenta previa
B) Placental abruption
C) Uterine rupture
D) Preterm labor
Correct Answer: B
Rationale: The classic signs of placental abruption (abruptio placentae) are painful, dark red
bleeding, uterine hypertonicity, and a rigid, tender uterus. Placenta previa typically presents
with painless, bright red bleeding and a soft uterus. Uterine rupture causes sudden tearing pain,
cessation of contractions, and fetal bradycardia. Preterm labor has rhythmic contractions
without a rigid uterus.
2. A nurse notes that a laboring client’s external fetal monitor tracing shows a sinusoidal
pattern. Which action should the nurse take first?
,A) Reposition the client to the left lateral position
B) Administer oxygen by face mask and notify the provider
C) Prepare for immediate cesarean delivery
D) Discontinue oxytocin infusion
Correct Answer: B
Rationale: A sinusoidal fetal heart rate pattern is associated with severe fetal anemia, hypoxia,
or other significant compromise. The nurse should initiate intrauterine resuscitation (oxygen,
position change, IV fluids) and notify the provider urgently. Preparing for cesarean may be
necessary, but initial actions include oxygen and notification. Repositioning alone is insufficient.
3. A postpartum client who delivered a 4,500-gram infant 30 minutes ago suddenly has a gush
of blood and the fundus rises above the umbilicus and is boggy. What is the priority nursing
action?
A) Administer a uterotonic drug as prescribed
B) Massage the fundus until firm and express clots
C) Perform bimanual compression
D) Notify the provider immediately
Correct Answer: B
Rationale: A boggy, displaced fundus with a gush of blood indicates uterine atony. The initial
nursing intervention is firm fundal massage to stimulate contraction and expel any clots. If
massage is ineffective, uterotonics are administered. Bimanual compression is a later
intervention. Notification is important but massage is the first action.
4. A term newborn delivered vaginally 1 hour ago has central cyanosis, a heart rate of 180 bpm,
and a respiratory rate of 70 with grunting. The nurse should suspect:
A) Transient tachypnea of the newborn
B) Congenital heart disease
C) Respiratory distress syndrome
D) Sepsis or persistent pulmonary hypertension
Correct Answer: D
Rationale: Central cyanosis, tachycardia, tachypnea, and grunting in a term infant suggest
sepsis, pneumonia, or persistent pulmonary hypertension. TTN typically resolves quickly and
does not cause central cyanosis. RDS is more common in preterm infants. Congenital heart
disease may present with cyanosis but often has a murmur and differential cyanosis.
,5. A woman at 24 weeks’ gestation with a history of a previous preterm birth at 30 weeks asks
about preventing another preterm delivery. Which intervention is evidence-based?
A) Prophylactic cervical cerclage
B) Weekly 17-alpha-hydroxyprogesterone caproate injections
C) Prophylactic tocolysis with nifedipine
D) Bed rest and pelvic rest
Correct Answer: B
Rationale: For singleton pregnancies with a prior spontaneous preterm birth, 17P injections
starting at 16–24 weeks reduce the risk of recurrence. Cerclage is indicated for cervical
insufficiency, not solely for a history of preterm birth. Tocolytics are used for acute preterm
labor, and bed rest is not supported by evidence.
6. A laboring client with an epidural develops hypotension (90/50 mm Hg) and the fetal heart
rate shows a prolonged deceleration. After repositioning to the left lateral position and
increasing IV fluids, the maternal BP remains low. Which medication should the nurse
anticipate?
A) Epinephrine
B) Ephedrine or phenylephrine
C) Atropine
D) Naloxone
Correct Answer: B
Rationale: Epidural-induced hypotension that does not respond to position change and fluid
bolus can be treated with vasopressors such as ephedrine or phenylephrine, which increase
maternal blood pressure and improve uterine perfusion. Epinephrine is not first-line. Atropine is
for bradycardia, naloxone for opioid reversal.
7. A breastfeeding mother at 3 weeks postpartum reports a hard, red, painful area on the outer
quadrant of her left breast and a temperature of 101°F (38.3°C). What is the most important
management strategy?
A) Stop breastfeeding and pump and discard milk
B) Continue frequent breastfeeding on the affected breast and apply warm compresses
C) Administer antibiotics and wear a tight-fitting bra
D) Apply ice packs and restrict fluid intake
, Correct Answer: B
Rationale: Mastitis management includes effective milk removal (frequent breastfeeding or
pumping) from the affected breast, warm compresses, and rest. Stopping breastfeeding can
lead to engorgement and abscess formation. Antibiotics are prescribed if indicated, but milk
removal is essential. Tight bras may obstruct ducts.
8. A client at 36 weeks’ gestation is diagnosed with severe preeclampsia. Which laboratory value
indicates an increased risk for disseminated intravascular coagulation (DIC)?
A) Platelet count 90,000/mm³
B) Hemoglobin 14 g/dL
C) White blood cell count 12,000/mm³
D) Blood urea nitrogen 15 mg/dL
Correct Answer: A
Rationale: Thrombocytopenia (platelets <100,000/mm³) is a sign of severe preeclampsia and
can be associated with HELLP syndrome or DIC. Hemoglobin and WBC are not specific. Elevated
BUN may indicate renal involvement but not DIC directly. A falling platelet count raises concern
for coagulopathy.
9. A newborn at 24 hours of age has a total serum bilirubin of 12 mg/dL. The infant is
breastfeeding well, stooling, and not visibly jaundiced. The mother’s blood type is O-positive,
infant is A-positive, direct Coombs negative. The nurse should:
A) Initiate phototherapy immediately
B) Recognize this as physiologic jaundice and continue to monitor
C) Supplement with formula and stop breastfeeding
D) Prepare for exchange transfusion
Correct Answer: B
Rationale: A bilirubin level of 12 mg/dL at 24 hours is approaching the phototherapy threshold
depending on gestation and risk factors, but with a negative Coombs, term infant, and no
clinical jaundice, it may still be physiologic. The nurse should continue monitoring and ensure
adequate feeding. Phototherapy is not automatically indicated at this level. No exchange
needed.
10. A client is receiving magnesium sulfate for preterm labor neuroprotection. The nurse
assesses deep tendon reflexes and finds they are absent. What should the nurse do first?
