NCLEX Maternal Newborn Nursing 2026 Study
Guide Practice Test Questions Detailed
Explanations Obstetric Complications Fetal
Monitoring Newborn Assessment Patient
Priorities
SECTION 1: OBSTETRIC COMPLICATIONS (Questions 1–40)
1. A client at 32 weeks gestation is admitted with severe preeclampsia. The
provider orders magnesium sulfate. Which assessment finding indicates
magnesium toxicity requiring immediate intervention?
A. Blood pressure of 148/92 mmHg
B. Respiratory rate of 10 breaths/min
C. Urine output of 45 mL/hr
D. Deep tendon reflexes of 2+
Rationale: A respiratory rate below 12 breaths/min is a sign of magnesium
toxicity. The nurse should stop the infusion immediately, administer oxygen, and
prepare to give calcium gluconate (the antidote). Other signs of toxicity include
absent deep tendon reflexes and oliguria.
2. A primigravida at 38 weeks gestation is diagnosed with placenta previa.
Which nursing intervention is contraindicated?
A. Continuous fetal monitoring
B. Vaginal examination
C. IV fluid administration
D. Blood type and crossmatch
Rationale: Vaginal examination is absolutely contraindicated in placenta previa
because it can disrupt the placenta and cause severe hemorrhage. The nurse should
,avoid any manipulation of the cervix until placenta previa is ruled out by
ultrasound.
3. A client at 36 weeks gestation presents with sudden, painless, bright red
vaginal bleeding. Which condition should the nurse suspect first?
A. Placenta previa
B. Abruptio placentae
C. Uterine rupture
D. Vasa previa
Rationale: Placenta previa classically presents with painless, bright red vaginal
bleeding in the third trimester. The uterus is typically soft and non-tender.
Abruptio placentae presents with painful bleeding and a board-like abdomen.
4. A nurse is caring for a client with suspected placental abruption. Which
assessment finding is most concerning?
A. Blood pressure of 130/80 mmHg
B. Board-like abdomen with severe pain
C. Mild vaginal bleeding
D. Fetal heart rate of 140 bpm
Rationale: A board-like abdomen with severe pain is a classic sign of placental
abruption. The uterus becomes tense and tender due to blood accumulation behind
the placenta. This is an obstetric emergency requiring immediate delivery.
5. A client at 34 weeks gestation is diagnosed with HELLP syndrome. Which
laboratory finding is expected?
A. Elevated platelet count
B. Elevated liver enzymes
C. Decreased bilirubin
D. Elevated fibrinogen
,Rationale: HELLP syndrome is characterized by Hemolysis, Elevated Liver
enzymes, and Low Platelets. The nurse should monitor for signs of bleeding, liver
dysfunction, and hemolysis.
6. A nurse is assessing a client with severe preeclampsia. Which finding
indicates impending eclampsia?
A. Blood pressure of 150/95 mmHg
B. Hyperreflexia with clonus
C. 2+ proteinuria
D. Mild facial edema
Rationale: Hyperreflexia with clonus indicates central nervous system irritability
and is a warning sign of impending eclampsia. The nurse should notify the
provider immediately and prepare for magnesium sulfate administration.
7. A client with postpartum hemorrhage is receiving carboprost
tromethamine (Hemabate). Which condition is a contraindication for this
medication?
A. Diabetes mellitus
B. Asthma
C. Hypertension
D. Renal disease
Rationale: Carboprost tromethamine is a prostaglandin F2-alpha derivative that
can cause bronchoconstriction. It is contraindicated in clients with asthma. The
nurse should assess respiratory status before administration.
8. A nurse is caring for a client with uterine atony. After fundal massage, the
uterus remains boggy. What is the next priority intervention?
A. Administer oxytocin as ordered
B. Notify the healthcare provider
, C. Insert a Foley catheter
D. Prepare for hysterectomy
Rationale: If uterine massage does not firm the uterus, the next step is to
administer oxytocin, the first-line uterotonic. The nurse should also notify the
provider and continue monitoring bleeding.
9. A client with severe preeclampsia is receiving magnesium sulfate. Which
assessment should the nurse perform hourly?
A. Deep tendon reflexes, respiratory rate, and urine output
B. Blood glucose and urine ketones
C. Weight and abdominal girth
D. Fetal heart rate and contraction pattern
Rationale: Hourly assessment of deep tendon reflexes, respiratory rate, and urine
output is essential during magnesium sulfate infusion to detect signs of toxicity.
Magnesium is excreted renally, so urine output is critical.
10. A client at 38 weeks gestation presents with painful vaginal bleeding and a
tense, board-like abdomen. Which condition is most likely?
A. Placenta previa
B. Placental abruption
C. Uterine rupture
D. Vasa previa
Rationale: Painful vaginal bleeding with a tense, board-like abdomen is classic for
placental abruption. The nurse should monitor for fetal distress and maternal
shock.
11. A nurse is caring for a client with a prolapsed umbilical cord. Which
position should the nurse place the client in?
A. Knee-chest or Trendelenburg
Guide Practice Test Questions Detailed
Explanations Obstetric Complications Fetal
Monitoring Newborn Assessment Patient
Priorities
SECTION 1: OBSTETRIC COMPLICATIONS (Questions 1–40)
1. A client at 32 weeks gestation is admitted with severe preeclampsia. The
provider orders magnesium sulfate. Which assessment finding indicates
magnesium toxicity requiring immediate intervention?
A. Blood pressure of 148/92 mmHg
B. Respiratory rate of 10 breaths/min
C. Urine output of 45 mL/hr
D. Deep tendon reflexes of 2+
Rationale: A respiratory rate below 12 breaths/min is a sign of magnesium
toxicity. The nurse should stop the infusion immediately, administer oxygen, and
prepare to give calcium gluconate (the antidote). Other signs of toxicity include
absent deep tendon reflexes and oliguria.
2. A primigravida at 38 weeks gestation is diagnosed with placenta previa.
Which nursing intervention is contraindicated?
A. Continuous fetal monitoring
B. Vaginal examination
C. IV fluid administration
D. Blood type and crossmatch
Rationale: Vaginal examination is absolutely contraindicated in placenta previa
because it can disrupt the placenta and cause severe hemorrhage. The nurse should
,avoid any manipulation of the cervix until placenta previa is ruled out by
ultrasound.
3. A client at 36 weeks gestation presents with sudden, painless, bright red
vaginal bleeding. Which condition should the nurse suspect first?
A. Placenta previa
B. Abruptio placentae
C. Uterine rupture
D. Vasa previa
Rationale: Placenta previa classically presents with painless, bright red vaginal
bleeding in the third trimester. The uterus is typically soft and non-tender.
Abruptio placentae presents with painful bleeding and a board-like abdomen.
4. A nurse is caring for a client with suspected placental abruption. Which
assessment finding is most concerning?
A. Blood pressure of 130/80 mmHg
B. Board-like abdomen with severe pain
C. Mild vaginal bleeding
D. Fetal heart rate of 140 bpm
Rationale: A board-like abdomen with severe pain is a classic sign of placental
abruption. The uterus becomes tense and tender due to blood accumulation behind
the placenta. This is an obstetric emergency requiring immediate delivery.
5. A client at 34 weeks gestation is diagnosed with HELLP syndrome. Which
laboratory finding is expected?
A. Elevated platelet count
B. Elevated liver enzymes
C. Decreased bilirubin
D. Elevated fibrinogen
,Rationale: HELLP syndrome is characterized by Hemolysis, Elevated Liver
enzymes, and Low Platelets. The nurse should monitor for signs of bleeding, liver
dysfunction, and hemolysis.
6. A nurse is assessing a client with severe preeclampsia. Which finding
indicates impending eclampsia?
A. Blood pressure of 150/95 mmHg
B. Hyperreflexia with clonus
C. 2+ proteinuria
D. Mild facial edema
Rationale: Hyperreflexia with clonus indicates central nervous system irritability
and is a warning sign of impending eclampsia. The nurse should notify the
provider immediately and prepare for magnesium sulfate administration.
7. A client with postpartum hemorrhage is receiving carboprost
tromethamine (Hemabate). Which condition is a contraindication for this
medication?
A. Diabetes mellitus
B. Asthma
C. Hypertension
D. Renal disease
Rationale: Carboprost tromethamine is a prostaglandin F2-alpha derivative that
can cause bronchoconstriction. It is contraindicated in clients with asthma. The
nurse should assess respiratory status before administration.
8. A nurse is caring for a client with uterine atony. After fundal massage, the
uterus remains boggy. What is the next priority intervention?
A. Administer oxytocin as ordered
B. Notify the healthcare provider
, C. Insert a Foley catheter
D. Prepare for hysterectomy
Rationale: If uterine massage does not firm the uterus, the next step is to
administer oxytocin, the first-line uterotonic. The nurse should also notify the
provider and continue monitoring bleeding.
9. A client with severe preeclampsia is receiving magnesium sulfate. Which
assessment should the nurse perform hourly?
A. Deep tendon reflexes, respiratory rate, and urine output
B. Blood glucose and urine ketones
C. Weight and abdominal girth
D. Fetal heart rate and contraction pattern
Rationale: Hourly assessment of deep tendon reflexes, respiratory rate, and urine
output is essential during magnesium sulfate infusion to detect signs of toxicity.
Magnesium is excreted renally, so urine output is critical.
10. A client at 38 weeks gestation presents with painful vaginal bleeding and a
tense, board-like abdomen. Which condition is most likely?
A. Placenta previa
B. Placental abruption
C. Uterine rupture
D. Vasa previa
Rationale: Painful vaginal bleeding with a tense, board-like abdomen is classic for
placental abruption. The nurse should monitor for fetal distress and maternal
shock.
11. A nurse is caring for a client with a prolapsed umbilical cord. Which
position should the nurse place the client in?
A. Knee-chest or Trendelenburg
