NURS_301: Maternal-Newborn Nursing Prep
with Detailed Rationales
Course Code: NURS_301
Course Name: Maternal-Newborn Nursing
Topic: Next Generation NCLEX (NGN) Comprehensive Exam Bank
Academic Year: 2026/2027
1. A nurse is assessing a client at 34 weeks of gestation who presents with
sudden-onset, severe abdominal pain and dark red vaginal bleeding. The
client’s abdomen is rigid and tender to touch. Which of the following is the
correct answer or most likely condition?
A. Placenta previa
B. Abruptio placentae
C. Cervical insufficiency
D. Hydatidiform mole
CORRECT ANSWER: B. Abruptio placentae
RATIONALE: Abruptio placentae is the premature separation of a normally
implanted placenta from the uterine wall. Classic findings include sudden-onset
intense localized abdominal pain, uterine tenderness, a board-like rigid abdomen,
and dark red vaginal bleeding. In contrast, placenta previa presents as painless,
bright red vaginal bleeding without uterine rigidity. Cervical insufficiency presents
with painless cervical dilation in the second trimester. A hydatidiform mole usually
presents with a grape-like vesicle discharge, dark brown bleeding, and an
abnormally elevated hCG level in the first half of pregnancy.
2. A nurse is monitoring a client receiving an intravenous infusion of
magnesium sulfate for severe preeclampsia. The nurse notes a respiratory
rate of 10 breaths/min, absent deep tendon reflexes (DTRs), and urine output
of 15 mL over the past hour. Which action is the correct answer or priority
nursing intervention?
A. Increase the primary IV infusion rate.
B. Prepare to administer terbutaline.
C. Discontinue the magnesium sulfate infusion immediately and prepare
, calcium gluconate.
D. Place the client in a prone position.
CORRECT ANSWER: C. Discontinue the magnesium sulfate infusion
immediately and prepare calcium gluconate.
RATIONALE: Magnesium sulfate toxicity manifests as a respiratory rate
under 12 breaths/min, loss of deep tendon reflexes, and oliguria (less than 30
mL/hr). The immediate clinical priority is to stop the magnesium infusion to
prevent further toxicity and respiratory arrest, then prepare the antidote, calcium
gluconate. Increasing the primary rate does not reverse toxicity. Terbutaline is a
tocolytic used for preterm labor, not an antidote for magnesium. Prone positioning
is contraindicated in late pregnancy and does not resolve toxicity.
3. A nurse is caring for a newborn immediately following a vaginal delivery.
The infant has a pink body with blue extremities, a heart rate of 110
beats/min, a vigorous cry, active motion, and a sneeze response to nasal
suctioning. What is the correct answer for this newborn's 1-minute APGAR
score?
A. 7
B. 8
C. 9
D. 10
CORRECT ANSWER: C. 9
RATIONALE: The APGAR score is calculated as follows: Heart rate >100
receives 2 points. Respiratory effort (vigorous cry) receives 2 points. Muscle tone
(active motion) receives 2 points. Reflex irritability (sneeze/cough) receives 2
points. Color (pink body, blue extremities, known as acrocyanosis) receives 1
point. Totaling these scores (2 + 2 + 2 + 2 + 1) equals 9. Acrocyanosis is a normal
vasomotor finding in the first 24 to 48 hours of life.
4. A nurse is assessing a postpartum client 2 hours after delivery and finds the
fundus is boggy, displaced to the right, and located 2 cm above the
umbilicus. Which of the following is the correct answer or priority nursing
intervention?
A. Administer methylergonovine intramuscularly.
B. Assist the client to empty her bladder, then re-evaluate.
, C. Perform deep fundal massage for 30 consecutive minutes.
D. Notify the provider for immediate surgical intervention.
CORRECT ANSWER: B. Assist the client to empty her bladder, then re-
evaluate.
RATIONALE: A postpartum boggy fundus that is displaced above the
umbilicus and to the right is a classic indication of uterine atony caused by a
distended bladder. A full bladder pushes the uterus out of place, preventing
effective contraction. Assisting the client to void or performing straight
catheterization allows the uterus to return to the midline and contract naturally.
Uterotonics like methylergonovine are utilized if the uterus remains atonic after
bladder evacuation. Prolonged 30-minute deep massage can cause uterine trauma.
Surgical intervention is a last resort.
5. A nurse is teaching a pregnant client about rho(D) immune globulin.
Which statement indicates the correct answer or understanding of the
clinical indication for this medication?
A. "I will receive this injection at 28 weeks because my blood type is Rh-
negative and my baby might be Rh-positive."
B. "I need this medication because my blood type is Rh-positive and my
partner is Rh-negative."
C. "This injection will cure my baby if they have already developed Rh
disease hemolytic anemia."
D. "I only need this injection within 72 hours after my baby is born,
regardless of their blood type."
CORRECT ANSWER: A. "I will receive this injection at 28 weeks because
my blood type is Rh-negative and my baby might be Rh-positive."
RATIONALE: Rho(D) immune globulin is administered to Rh-negative
mothers at approximately 28 weeks of gestation, and again within 72 hours after
delivery if the newborn is Rh-positive. This prevents the maternal immune system
from developing permanent antibodies against Rh-positive fetal red blood cells. It
is not given to Rh-positive mothers. It is a prophylactic measure and cannot reverse
or cure pre-existing maternal sensitization or active fetal hemolytic disease.
6. A nurse is caring for an infant born to a client with gestational diabetes
mellitus. Which of the following is the correct answer or most critical
potential neonatal complication to monitor for during the first hour of life?
, A. Hyperglycemia
B. Hypoglycemia
C. Hypernatremia
D. Hypobilirubinemia
CORRECT ANSWER: B. Hypoglycemia
RATIONALE: An infant of a diabetic mother (IDM) experiences high
maternal glucose levels in utero, which stimulates the fetal pancreas to produce
excess insulin (hyperinsulinism). When the umbilical cord is cut, the sudden
withdrawal of maternal glucose combined with high circulating neonatal insulin
levels causes rapid, severe neonatal hypoglycemia. Neonates are monitored
closely for signs like jitteriness, tremors, lethargy, and poor feeding.
Hyperglycemia does not occur. Hyperbilirubinemia (not hypobilirubinemia) is a
risk later on, but hypoglycemia is the immediate critical priority.
7. A nurse is reviewing lab values for a client at 36 weeks of gestation who
has severe preeclampsia. The results reveal a platelet count of 75,000/mm³,
elevated AST and ALT, and fragmented red blood cells on a peripheral
smear. What is the correct answer for this clinical syndrome?
A. DIC (Disseminated intravascular coagulation)
B. Idiopathic thrombocytopenic purpura (ITP)
C. HELLP syndrome
D. Gestational hypertension
CORRECT ANSWER: C. HELLP syndrome
RATIONALE: HELLP syndrome is a severe variant of preeclampsia
characterized by Hemolysis (fragmented RBCs), Elevated Liver enzymes
(AST/ALT), and Low Platelets (<100,000/mm³). While HELLP can lead to DIC if
untreated, the combination of hemolysis, elevated liver enzymes, and
thrombocytopenia specifically defines HELLP. ITP is an autoimmune platelet
destruction disorder not specific to preeclampsia. Gestational hypertension
involves elevated blood pressure without proteinuria or systemic multi-organ
laboratory changes.
8. A nurse is monitoring a client in the active phase of labor. The fetal heart
rate (FHR) monitor displays a pattern of gradual decelerations that begin
after the peak of the uterine contraction and return to baseline well after the
contraction ends. Which of the following is the correct answer or
with Detailed Rationales
Course Code: NURS_301
Course Name: Maternal-Newborn Nursing
Topic: Next Generation NCLEX (NGN) Comprehensive Exam Bank
Academic Year: 2026/2027
1. A nurse is assessing a client at 34 weeks of gestation who presents with
sudden-onset, severe abdominal pain and dark red vaginal bleeding. The
client’s abdomen is rigid and tender to touch. Which of the following is the
correct answer or most likely condition?
A. Placenta previa
B. Abruptio placentae
C. Cervical insufficiency
D. Hydatidiform mole
CORRECT ANSWER: B. Abruptio placentae
RATIONALE: Abruptio placentae is the premature separation of a normally
implanted placenta from the uterine wall. Classic findings include sudden-onset
intense localized abdominal pain, uterine tenderness, a board-like rigid abdomen,
and dark red vaginal bleeding. In contrast, placenta previa presents as painless,
bright red vaginal bleeding without uterine rigidity. Cervical insufficiency presents
with painless cervical dilation in the second trimester. A hydatidiform mole usually
presents with a grape-like vesicle discharge, dark brown bleeding, and an
abnormally elevated hCG level in the first half of pregnancy.
2. A nurse is monitoring a client receiving an intravenous infusion of
magnesium sulfate for severe preeclampsia. The nurse notes a respiratory
rate of 10 breaths/min, absent deep tendon reflexes (DTRs), and urine output
of 15 mL over the past hour. Which action is the correct answer or priority
nursing intervention?
A. Increase the primary IV infusion rate.
B. Prepare to administer terbutaline.
C. Discontinue the magnesium sulfate infusion immediately and prepare
, calcium gluconate.
D. Place the client in a prone position.
CORRECT ANSWER: C. Discontinue the magnesium sulfate infusion
immediately and prepare calcium gluconate.
RATIONALE: Magnesium sulfate toxicity manifests as a respiratory rate
under 12 breaths/min, loss of deep tendon reflexes, and oliguria (less than 30
mL/hr). The immediate clinical priority is to stop the magnesium infusion to
prevent further toxicity and respiratory arrest, then prepare the antidote, calcium
gluconate. Increasing the primary rate does not reverse toxicity. Terbutaline is a
tocolytic used for preterm labor, not an antidote for magnesium. Prone positioning
is contraindicated in late pregnancy and does not resolve toxicity.
3. A nurse is caring for a newborn immediately following a vaginal delivery.
The infant has a pink body with blue extremities, a heart rate of 110
beats/min, a vigorous cry, active motion, and a sneeze response to nasal
suctioning. What is the correct answer for this newborn's 1-minute APGAR
score?
A. 7
B. 8
C. 9
D. 10
CORRECT ANSWER: C. 9
RATIONALE: The APGAR score is calculated as follows: Heart rate >100
receives 2 points. Respiratory effort (vigorous cry) receives 2 points. Muscle tone
(active motion) receives 2 points. Reflex irritability (sneeze/cough) receives 2
points. Color (pink body, blue extremities, known as acrocyanosis) receives 1
point. Totaling these scores (2 + 2 + 2 + 2 + 1) equals 9. Acrocyanosis is a normal
vasomotor finding in the first 24 to 48 hours of life.
4. A nurse is assessing a postpartum client 2 hours after delivery and finds the
fundus is boggy, displaced to the right, and located 2 cm above the
umbilicus. Which of the following is the correct answer or priority nursing
intervention?
A. Administer methylergonovine intramuscularly.
B. Assist the client to empty her bladder, then re-evaluate.
, C. Perform deep fundal massage for 30 consecutive minutes.
D. Notify the provider for immediate surgical intervention.
CORRECT ANSWER: B. Assist the client to empty her bladder, then re-
evaluate.
RATIONALE: A postpartum boggy fundus that is displaced above the
umbilicus and to the right is a classic indication of uterine atony caused by a
distended bladder. A full bladder pushes the uterus out of place, preventing
effective contraction. Assisting the client to void or performing straight
catheterization allows the uterus to return to the midline and contract naturally.
Uterotonics like methylergonovine are utilized if the uterus remains atonic after
bladder evacuation. Prolonged 30-minute deep massage can cause uterine trauma.
Surgical intervention is a last resort.
5. A nurse is teaching a pregnant client about rho(D) immune globulin.
Which statement indicates the correct answer or understanding of the
clinical indication for this medication?
A. "I will receive this injection at 28 weeks because my blood type is Rh-
negative and my baby might be Rh-positive."
B. "I need this medication because my blood type is Rh-positive and my
partner is Rh-negative."
C. "This injection will cure my baby if they have already developed Rh
disease hemolytic anemia."
D. "I only need this injection within 72 hours after my baby is born,
regardless of their blood type."
CORRECT ANSWER: A. "I will receive this injection at 28 weeks because
my blood type is Rh-negative and my baby might be Rh-positive."
RATIONALE: Rho(D) immune globulin is administered to Rh-negative
mothers at approximately 28 weeks of gestation, and again within 72 hours after
delivery if the newborn is Rh-positive. This prevents the maternal immune system
from developing permanent antibodies against Rh-positive fetal red blood cells. It
is not given to Rh-positive mothers. It is a prophylactic measure and cannot reverse
or cure pre-existing maternal sensitization or active fetal hemolytic disease.
6. A nurse is caring for an infant born to a client with gestational diabetes
mellitus. Which of the following is the correct answer or most critical
potential neonatal complication to monitor for during the first hour of life?
, A. Hyperglycemia
B. Hypoglycemia
C. Hypernatremia
D. Hypobilirubinemia
CORRECT ANSWER: B. Hypoglycemia
RATIONALE: An infant of a diabetic mother (IDM) experiences high
maternal glucose levels in utero, which stimulates the fetal pancreas to produce
excess insulin (hyperinsulinism). When the umbilical cord is cut, the sudden
withdrawal of maternal glucose combined with high circulating neonatal insulin
levels causes rapid, severe neonatal hypoglycemia. Neonates are monitored
closely for signs like jitteriness, tremors, lethargy, and poor feeding.
Hyperglycemia does not occur. Hyperbilirubinemia (not hypobilirubinemia) is a
risk later on, but hypoglycemia is the immediate critical priority.
7. A nurse is reviewing lab values for a client at 36 weeks of gestation who
has severe preeclampsia. The results reveal a platelet count of 75,000/mm³,
elevated AST and ALT, and fragmented red blood cells on a peripheral
smear. What is the correct answer for this clinical syndrome?
A. DIC (Disseminated intravascular coagulation)
B. Idiopathic thrombocytopenic purpura (ITP)
C. HELLP syndrome
D. Gestational hypertension
CORRECT ANSWER: C. HELLP syndrome
RATIONALE: HELLP syndrome is a severe variant of preeclampsia
characterized by Hemolysis (fragmented RBCs), Elevated Liver enzymes
(AST/ALT), and Low Platelets (<100,000/mm³). While HELLP can lead to DIC if
untreated, the combination of hemolysis, elevated liver enzymes, and
thrombocytopenia specifically defines HELLP. ITP is an autoimmune platelet
destruction disorder not specific to preeclampsia. Gestational hypertension
involves elevated blood pressure without proteinuria or systemic multi-organ
laboratory changes.
8. A nurse is monitoring a client in the active phase of labor. The fetal heart
rate (FHR) monitor displays a pattern of gradual decelerations that begin
after the peak of the uterine contraction and return to baseline well after the
contraction ends. Which of the following is the correct answer or
