RN Maternal-Newborn Competency
Exam — Code: RN-MN-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A client at 34 weeks’ gestation with severe preeclampsia reports a
persistent severe headache and epigastric pain. Her blood pressure is
172/116 mm Hg. Which nursing action is the priority?
A. Encourage oral fluids
B. Place the client in a supine position
C. Initiate seizure precautions and notify the provider
D. Administer an oral antihypertensive and reassess in 4 hours
Answer: Initiate seizure precautions and notify the provider
Rationale: Severe hypertension, persistent headache, and epigastric pain
indicate severe features of preeclampsia and increased risk for cerebral
,complications, seizure, stroke, and hepatic injury. Immediate stabilization,
seizure precautions, and urgent provider notification are indicated.
2. A client receiving magnesium sulfate for severe preeclampsia has a
respiratory rate of 9/min, absent patellar reflexes, and urine output of 20
mL/hr. Which medication should the nurse prepare to administer?
A. Oxytocin
B. Calcium gluconate
C. Naloxone
D. Terbutaline
Answer: Calcium gluconate
Rationale: Respiratory depression, loss of deep tendon reflexes, and oliguria are
classic manifestations of magnesium toxicity. Calcium gluconate is the antidote
and should be readily available whenever magnesium sulfate is administered.
3. A laboring client has recurrent late fetal heart rate decelerations with
moderate variability. Which intervention should the nurse implement first?
A. Increase the oxytocin infusion
B. Place the client in a lateral position
C. Perform a vaginal examination immediately
D. Encourage the client to push
Answer: Place the client in a lateral position
Rationale: Recurrent late decelerations indicate uteroplacental insufficiency.
Maternal repositioning improves uteroplacental perfusion and is an immediate
intrauterine resuscitation intervention. Oxytocin should be reduced or stopped if
it is contributing to uterine tachysystole.
4. A client receiving oxytocin has contractions every 1 minute lasting 90
seconds, with recurrent late decelerations. What is the nurse’s priority
action?
,A. Increase oxytocin to strengthen contractions
B. Stop the oxytocin infusion
C. Encourage pushing
D. Administer methylergonovine
Answer: Stop the oxytocin infusion
Rationale: Uterine tachysystole with fetal heart rate abnormalities can
compromise fetal oxygenation. Oxytocin should be discontinued while
intrauterine resuscitation measures are initiated.
5. A pregnant client with type 1 diabetes is at increased risk for which fetal
complication?
A. Macrosomia
B. Severe oligohydramnios from fetal renal agenesis
C. Neural tube defects only during the third trimester
D. Postterm growth restriction as the most common complication
Answer: Macrosomia
Rationale: Maternal hyperglycemia increases fetal insulin production,
promoting excessive fetal growth and macrosomia. Poorly controlled
pregestational diabetes also increases the risk of congenital anomalies and
other complications.
6. A postpartum client has heavy vaginal bleeding and a boggy uterus. Which
intervention should the nurse perform first?
A. Obtain a hemoglobin level
B. Massage the uterine fundus
C. Insert an indwelling urinary catheter
D. Prepare the client for discharge
Answer: Massage the uterine fundus
, Rationale: A boggy uterus with heavy bleeding strongly suggests uterine atony,
the most common cause of early postpartum hemorrhage. Fundal massage
promotes uterine contraction and is an immediate nursing intervention.
7. A postpartum client has uterine atony and continues to hemorrhage
despite fundal massage. Which medication should the nurse anticipate
administering?
A. Oxytocin
B. Magnesium sulfate
C. Betamethasone
D. Terbutaline
Answer: Oxytocin
Rationale: Oxytocin is a first-line uterotonic for postpartum hemorrhage caused
by uterine atony. Additional uterotonics may be required if bleeding persists.
8. A client with postpartum hemorrhage has a history of severe asthma.
Which medication should the nurse question if prescribed?
A. Oxytocin
B. Misoprostol
C. Carboprost
D. Tranexamic acid
Answer: Carboprost
Rationale: Carboprost is a prostaglandin uterotonic that can cause
bronchospasm and should generally be avoided in clients with significant
asthma.
9. A client at 32 weeks’ gestation reports painless bright-red vaginal bleeding.
The uterus is soft and nontender. Which condition is most likely?
A. Placental abruption
B. Placenta previa
Exam — Code: RN-MN-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A client at 34 weeks’ gestation with severe preeclampsia reports a
persistent severe headache and epigastric pain. Her blood pressure is
172/116 mm Hg. Which nursing action is the priority?
A. Encourage oral fluids
B. Place the client in a supine position
C. Initiate seizure precautions and notify the provider
D. Administer an oral antihypertensive and reassess in 4 hours
Answer: Initiate seizure precautions and notify the provider
Rationale: Severe hypertension, persistent headache, and epigastric pain
indicate severe features of preeclampsia and increased risk for cerebral
,complications, seizure, stroke, and hepatic injury. Immediate stabilization,
seizure precautions, and urgent provider notification are indicated.
2. A client receiving magnesium sulfate for severe preeclampsia has a
respiratory rate of 9/min, absent patellar reflexes, and urine output of 20
mL/hr. Which medication should the nurse prepare to administer?
A. Oxytocin
B. Calcium gluconate
C. Naloxone
D. Terbutaline
Answer: Calcium gluconate
Rationale: Respiratory depression, loss of deep tendon reflexes, and oliguria are
classic manifestations of magnesium toxicity. Calcium gluconate is the antidote
and should be readily available whenever magnesium sulfate is administered.
3. A laboring client has recurrent late fetal heart rate decelerations with
moderate variability. Which intervention should the nurse implement first?
A. Increase the oxytocin infusion
B. Place the client in a lateral position
C. Perform a vaginal examination immediately
D. Encourage the client to push
Answer: Place the client in a lateral position
Rationale: Recurrent late decelerations indicate uteroplacental insufficiency.
Maternal repositioning improves uteroplacental perfusion and is an immediate
intrauterine resuscitation intervention. Oxytocin should be reduced or stopped if
it is contributing to uterine tachysystole.
4. A client receiving oxytocin has contractions every 1 minute lasting 90
seconds, with recurrent late decelerations. What is the nurse’s priority
action?
,A. Increase oxytocin to strengthen contractions
B. Stop the oxytocin infusion
C. Encourage pushing
D. Administer methylergonovine
Answer: Stop the oxytocin infusion
Rationale: Uterine tachysystole with fetal heart rate abnormalities can
compromise fetal oxygenation. Oxytocin should be discontinued while
intrauterine resuscitation measures are initiated.
5. A pregnant client with type 1 diabetes is at increased risk for which fetal
complication?
A. Macrosomia
B. Severe oligohydramnios from fetal renal agenesis
C. Neural tube defects only during the third trimester
D. Postterm growth restriction as the most common complication
Answer: Macrosomia
Rationale: Maternal hyperglycemia increases fetal insulin production,
promoting excessive fetal growth and macrosomia. Poorly controlled
pregestational diabetes also increases the risk of congenital anomalies and
other complications.
6. A postpartum client has heavy vaginal bleeding and a boggy uterus. Which
intervention should the nurse perform first?
A. Obtain a hemoglobin level
B. Massage the uterine fundus
C. Insert an indwelling urinary catheter
D. Prepare the client for discharge
Answer: Massage the uterine fundus
, Rationale: A boggy uterus with heavy bleeding strongly suggests uterine atony,
the most common cause of early postpartum hemorrhage. Fundal massage
promotes uterine contraction and is an immediate nursing intervention.
7. A postpartum client has uterine atony and continues to hemorrhage
despite fundal massage. Which medication should the nurse anticipate
administering?
A. Oxytocin
B. Magnesium sulfate
C. Betamethasone
D. Terbutaline
Answer: Oxytocin
Rationale: Oxytocin is a first-line uterotonic for postpartum hemorrhage caused
by uterine atony. Additional uterotonics may be required if bleeding persists.
8. A client with postpartum hemorrhage has a history of severe asthma.
Which medication should the nurse question if prescribed?
A. Oxytocin
B. Misoprostol
C. Carboprost
D. Tranexamic acid
Answer: Carboprost
Rationale: Carboprost is a prostaglandin uterotonic that can cause
bronchospasm and should generally be avoided in clients with significant
asthma.
9. A client at 32 weeks’ gestation reports painless bright-red vaginal bleeding.
The uterus is soft and nontender. Which condition is most likely?
A. Placental abruption
B. Placenta previa
