RN Maternal-Newborn NGN Practice Exam with correct answers and rationales
2026/2027 edition
Case Study 1: Antepartum Care
A 24-year-old client, G2P1, at 32 weeks of gestation presents for a prenatal visit. She reports a
severe headache that began this morning and blurred vision. Her BP is 168/110 mm Hg. She has
3+ proteinuria and reports epigastric pain. Fetal heart rate is 150/min.
1. Which finding is the nurse's priority?
A. FHR 150/min
B. 32 weeks of gestation
C. BP 168/110 mm Hg
D. G2P1 status
Answer: C
Rationale: Severe hypertension in pregnancy, particularly ≥160/110 mm Hg, is a medical
emergency because of the risk of stroke, seizures, placental complications, and maternal/fetal
compromise.
2. Which condition should the nurse suspect?
A. Gestational diabetes
B. Preeclampsia with severe features
C. Hyperemesis gravidarum
D. Placenta previa
Answer: B
Rationale: Severe hypertension accompanied by proteinuria, headache, visual disturbances, and
epigastric pain strongly indicates preeclampsia with severe features.
3. Which prescriptions should the nurse anticipate? Select all that apply.
A. Magnesium sulfate
B. Antihypertensive medication as indicated
C. Continuous fetal monitoring
D. Encourage unrestricted ambulation
,E. Seizure precautions
F. Delay evaluation until the next prenatal appointment
Answers: A, B, C, E
Rationale: Magnesium sulfate is used for seizure prophylaxis. Severe hypertension may require
antihypertensive treatment. Maternal and fetal status require close monitoring, and seizure
precautions are appropriate.
4. The nurse administers magnesium sulfate. Which finding requires immediate
intervention?
A. Respiratory rate 10/min
B. Urine output 45 mL/hr
C. Patellar reflexes 2+
D. FHR 145/min
Answer: A
Rationale: Respiratory depression can indicate magnesium toxicity. The medication should be
stopped and the provider notified according to protocol.
5. Which medication should be available as the antidote for magnesium toxicity?
A. Naloxone
B. Calcium gluconate
C. Protamine sulfate
D. Vitamin K
Answer: B
Rationale: Calcium gluconate is the antidote for magnesium sulfate toxicity.
Case Study 2: Labor
A client at 39 weeks of gestation is admitted in active labor. Cervical examination shows 6 cm
dilation, 90% effacement, and a fetal station of –1. The client reports increasingly painful
contractions every 3 minutes.
,6. Which finding indicates cervical effacement?
A. Cervix changing from 3 cm to 6 cm
B. Cervix changing from 90% to 100%
C. Fetal head moving from –1 to +1
D. Contractions occurring every 3 minutes
Answer: B
Rationale: Effacement describes thinning and shortening of the cervix and is expressed as a
percentage.
7. Which finding indicates fetal descent?
A. Increased cervical dilation
B. Increased cervical effacement
C. Change in fetal station
D. Increased contraction duration
Answer: C
Rationale: Fetal station describes the relationship of the presenting part to the maternal ischial
spines.
8. The fetal monitor shows recurrent late decelerations. Which intervention
should the nurse perform first?
A. Place the client supine
B. Reposition the client laterally
C. Encourage pushing
D. Increase oxytocin
Answer: B
Rationale: Repositioning laterally can improve uteroplacental perfusion and is an immediate
intervention for recurrent late decelerations.
9. Which findings can contribute to late fetal heart rate decelerations? Select all
that apply.
, A. Uteroplacental insufficiency
B. Maternal hypotension
C. Excessive uterine stimulation
D. Umbilical cord compression as the primary mechanism
E. Placental dysfunction
Answers: A, B, C, E
Rationale: Late decelerations are associated with reduced uteroplacental perfusion. Maternal
hypotension and excessive uterine activity can worsen this.
10. Matrix Question
The nurse identifies the following fetal heart rate patterns. Determine whether each finding is
generally reassuring or requires further evaluation.
Finding Reassuring Requires Evaluation
Baseline 140/min ✓
Moderate variability ✓
Recurrent late decelerations ✓
Absent variability ✓
Accelerations with fetal movement ✓
Rationale: Moderate variability and accelerations are reassuring. Recurrent late decelerations
and absent variability can indicate fetal compromise.
Case Study 3: Postpartum Hemorrhage
A client is 1 hour postpartum following a vaginal birth. She reports feeling dizzy. The nurse
notes a saturated perineal pad and a boggy uterus. BP is 88/52 mm Hg and pulse is 118/min.
11. What is the nurse's priority action?
A. Obtain a temperature
B. Massage the uterine fundus
C. Encourage oral fluids
D. Assist the client to ambulate
Answer: B
2026/2027 edition
Case Study 1: Antepartum Care
A 24-year-old client, G2P1, at 32 weeks of gestation presents for a prenatal visit. She reports a
severe headache that began this morning and blurred vision. Her BP is 168/110 mm Hg. She has
3+ proteinuria and reports epigastric pain. Fetal heart rate is 150/min.
1. Which finding is the nurse's priority?
A. FHR 150/min
B. 32 weeks of gestation
C. BP 168/110 mm Hg
D. G2P1 status
Answer: C
Rationale: Severe hypertension in pregnancy, particularly ≥160/110 mm Hg, is a medical
emergency because of the risk of stroke, seizures, placental complications, and maternal/fetal
compromise.
2. Which condition should the nurse suspect?
A. Gestational diabetes
B. Preeclampsia with severe features
C. Hyperemesis gravidarum
D. Placenta previa
Answer: B
Rationale: Severe hypertension accompanied by proteinuria, headache, visual disturbances, and
epigastric pain strongly indicates preeclampsia with severe features.
3. Which prescriptions should the nurse anticipate? Select all that apply.
A. Magnesium sulfate
B. Antihypertensive medication as indicated
C. Continuous fetal monitoring
D. Encourage unrestricted ambulation
,E. Seizure precautions
F. Delay evaluation until the next prenatal appointment
Answers: A, B, C, E
Rationale: Magnesium sulfate is used for seizure prophylaxis. Severe hypertension may require
antihypertensive treatment. Maternal and fetal status require close monitoring, and seizure
precautions are appropriate.
4. The nurse administers magnesium sulfate. Which finding requires immediate
intervention?
A. Respiratory rate 10/min
B. Urine output 45 mL/hr
C. Patellar reflexes 2+
D. FHR 145/min
Answer: A
Rationale: Respiratory depression can indicate magnesium toxicity. The medication should be
stopped and the provider notified according to protocol.
5. Which medication should be available as the antidote for magnesium toxicity?
A. Naloxone
B. Calcium gluconate
C. Protamine sulfate
D. Vitamin K
Answer: B
Rationale: Calcium gluconate is the antidote for magnesium sulfate toxicity.
Case Study 2: Labor
A client at 39 weeks of gestation is admitted in active labor. Cervical examination shows 6 cm
dilation, 90% effacement, and a fetal station of –1. The client reports increasingly painful
contractions every 3 minutes.
,6. Which finding indicates cervical effacement?
A. Cervix changing from 3 cm to 6 cm
B. Cervix changing from 90% to 100%
C. Fetal head moving from –1 to +1
D. Contractions occurring every 3 minutes
Answer: B
Rationale: Effacement describes thinning and shortening of the cervix and is expressed as a
percentage.
7. Which finding indicates fetal descent?
A. Increased cervical dilation
B. Increased cervical effacement
C. Change in fetal station
D. Increased contraction duration
Answer: C
Rationale: Fetal station describes the relationship of the presenting part to the maternal ischial
spines.
8. The fetal monitor shows recurrent late decelerations. Which intervention
should the nurse perform first?
A. Place the client supine
B. Reposition the client laterally
C. Encourage pushing
D. Increase oxytocin
Answer: B
Rationale: Repositioning laterally can improve uteroplacental perfusion and is an immediate
intervention for recurrent late decelerations.
9. Which findings can contribute to late fetal heart rate decelerations? Select all
that apply.
, A. Uteroplacental insufficiency
B. Maternal hypotension
C. Excessive uterine stimulation
D. Umbilical cord compression as the primary mechanism
E. Placental dysfunction
Answers: A, B, C, E
Rationale: Late decelerations are associated with reduced uteroplacental perfusion. Maternal
hypotension and excessive uterine activity can worsen this.
10. Matrix Question
The nurse identifies the following fetal heart rate patterns. Determine whether each finding is
generally reassuring or requires further evaluation.
Finding Reassuring Requires Evaluation
Baseline 140/min ✓
Moderate variability ✓
Recurrent late decelerations ✓
Absent variability ✓
Accelerations with fetal movement ✓
Rationale: Moderate variability and accelerations are reassuring. Recurrent late decelerations
and absent variability can indicate fetal compromise.
Case Study 3: Postpartum Hemorrhage
A client is 1 hour postpartum following a vaginal birth. She reports feeling dizzy. The nurse
notes a saturated perineal pad and a boggy uterus. BP is 88/52 mm Hg and pulse is 118/min.
11. What is the nurse's priority action?
A. Obtain a temperature
B. Massage the uterine fundus
C. Encourage oral fluids
D. Assist the client to ambulate
Answer: B
