PN Maternal Newborn 2026 (OB)
Proctored Assessment
Section 1: Antepartum Care (Questions 1–52)
1. A nurse is calculating the estimated date of birth for a client whose last
menstrual period began on April 5. Using Naegele's rule, which date should
the nurse document?
A. January 5 of the following year
B. January 12 of the following year
C. February 12 of the following year
D. December 12 of the following year
Rationale: Naegele's rule: subtract 3 months from the first day of the LMP and
add 7 days. April 5 minus 3 months = January 5; plus 7 days = January 12 of the
following year .
2. At which gestational age does the uterine fundus typically first become
palpable just above the symphysis pubis?
A. 6 weeks
B. 8 weeks
C. 12 weeks
D. 20 weeks
Rationale: At approximately 12 weeks, the fundus is just above the symphysis
pubis. At 20 weeks, it is typically at the umbilicus .
3. A client at 28 weeks gestation is Rh-negative with a negative antibody
screen. Which teaching should the nurse reinforce?
A. "You will receive Rh immune globulin at about 28 weeks and again within
72 hours after birth if your baby is Rh-positive."
B. "You will receive Rh immune globulin only if you develop bleeding."
C. "Rh immune globulin is given to the baby after birth, not to you."
D. "You do not need Rh immune globulin because your antibody screen is
negative."
Rationale: Routine antepartum RhIG is given at approximately 28 weeks, and
,postpartum within 72 hours if the newborn is Rh-positive and the mother is
unsensitized .
4. A nurse is teaching a client at 10 weeks gestation about managing morning
nausea. Which instruction is most appropriate?
A. Drink a large glass of water with each meal.
B. Eat dry crackers before getting out of bed in the morning.
C. Lie flat immediately after eating.
D. Skip breakfast to rest the stomach.
Rationale: Dry crackers before rising and small frequent meals reduce nausea.
Fluids with meals and lying flat can worsen symptoms .
5. Which finding in a pregnant client should the nurse report immediately?
A. Mild ankle edema after standing
B. Occasional Braxton Hicks contractions
C. Vaginal bleeding
D. Breast tenderness
Rationale: Vaginal bleeding at any gestational age requires prompt evaluation
for complications such as placenta previa, abruption, or miscarriage .
6. A client at 30 weeks reports severe headache, blurred vision, and epigastric
pain. Which action should the nurse take first?
A. Recommend rest at home.
B. Encourage increased oral fluids.
C. Arrange immediate obstetric evaluation.
D. Reassure the client that these symptoms are expected.
Rationale: These are classic warning signs of preeclampsia with severe
features and require immediate evaluation .
7. A nurse is reviewing laboratory results for a pregnant client. Which
hemoglobin finding is most concerning for anemia?
A. 9.2 g/dL
B. 11.5 g/dL
C. 12.5 g/dL
D. 13.0 g/dL
, Rationale: Hemoglobin <10–11 g/dL in pregnancy suggests anemia and
warrants evaluation. The other values are within expected or near-expected ranges .
8. A client planning pregnancy asks about folic acid. Which statement
indicates correct understanding?
A. "Folic acid prevents all birth defects."
B. "Folic acid reduces the risk of neural tube defects."
C. "I only need folic acid during the third trimester."
D. "Folic acid is unnecessary if I eat vegetables."
Rationale: Folic acid before conception and in early pregnancy reduces neural
tube defect risk; the usual recommendation is 400–800 mcg daily .
9. Quickening, the first perception of fetal movement, typically occurs at
which gestational age?
A. 4–6 weeks
B. 8–10 weeks
C. 16–20 weeks
D. 28–32 weeks
Rationale: Quickening is commonly perceived between 16 and 20 weeks in a
first pregnancy, though it may vary .
10. A nurse is providing preconception counseling. Fertilization normally
occurs in which structure?
A. Endometrial cavity
B. Cervical canal
C. Ampulla of the fallopian tube
D. Fimbriated end of the ovary
Rationale: The ampulla of the fallopian tube is the usual site of fertilization.
Implantation occurs later in the endometrium .
11. Which hormone surge directly triggers ovulation?
A. Progesterone
B. Luteinizing hormone (LH)
C. Follicle-stimulating hormone (FSH)
D. Human chorionic gonadotropin (hCG)
, Rationale: A surge of LH from the anterior pituitary triggers ovulation,
typically around day 14 of a 28-day cycle .
12. A client at 12 weeks gestation asks which signs of pregnancy are
"definite." Which finding is a positive sign of pregnancy?
A. Amenorrhea
B. Positive home pregnancy test
C. Fetal heart tones auscultated by Doppler
D. Chadwick's sign
Rationale: Positive signs are definitive proof: fetal heart tones, ultrasound
visualization, and fetal movement felt by the examiner. Amenorrhea is
presumptive; a positive test is probable .
13. A nurse is teaching about foods to avoid during pregnancy. Which food
should the client avoid because of Listeria risk?
A. Pasteurized milk
B. Cooked chicken
C. Soft cheeses such as feta and brie
D. Washed fresh fruit
Rationale: Soft cheeses may contain Listeria. Deli meats, raw seafood, and
undercooked eggs are also avoided .
14. A client at 20 weeks has a blood pressure of 150/95 mm Hg. Which action
is priority?
A. Document as normal pregnancy variation.
B. Reassure the client and recheck in 4 weeks.
C. Report to the provider for further evaluation.
D. Encourage increased salt intake.
Rationale: BP ≥140/90 after 20 weeks suggests gestational hypertension or
preeclampsia and requires prompt provider evaluation .
15. A nurse is assessing a client at 36 weeks. Which finding suggests placenta
previa?
A. Painful dark-red bleeding with a rigid uterus
B. Painless bright-red vaginal bleeding
Proctored Assessment
Section 1: Antepartum Care (Questions 1–52)
1. A nurse is calculating the estimated date of birth for a client whose last
menstrual period began on April 5. Using Naegele's rule, which date should
the nurse document?
A. January 5 of the following year
B. January 12 of the following year
C. February 12 of the following year
D. December 12 of the following year
Rationale: Naegele's rule: subtract 3 months from the first day of the LMP and
add 7 days. April 5 minus 3 months = January 5; plus 7 days = January 12 of the
following year .
2. At which gestational age does the uterine fundus typically first become
palpable just above the symphysis pubis?
A. 6 weeks
B. 8 weeks
C. 12 weeks
D. 20 weeks
Rationale: At approximately 12 weeks, the fundus is just above the symphysis
pubis. At 20 weeks, it is typically at the umbilicus .
3. A client at 28 weeks gestation is Rh-negative with a negative antibody
screen. Which teaching should the nurse reinforce?
A. "You will receive Rh immune globulin at about 28 weeks and again within
72 hours after birth if your baby is Rh-positive."
B. "You will receive Rh immune globulin only if you develop bleeding."
C. "Rh immune globulin is given to the baby after birth, not to you."
D. "You do not need Rh immune globulin because your antibody screen is
negative."
Rationale: Routine antepartum RhIG is given at approximately 28 weeks, and
,postpartum within 72 hours if the newborn is Rh-positive and the mother is
unsensitized .
4. A nurse is teaching a client at 10 weeks gestation about managing morning
nausea. Which instruction is most appropriate?
A. Drink a large glass of water with each meal.
B. Eat dry crackers before getting out of bed in the morning.
C. Lie flat immediately after eating.
D. Skip breakfast to rest the stomach.
Rationale: Dry crackers before rising and small frequent meals reduce nausea.
Fluids with meals and lying flat can worsen symptoms .
5. Which finding in a pregnant client should the nurse report immediately?
A. Mild ankle edema after standing
B. Occasional Braxton Hicks contractions
C. Vaginal bleeding
D. Breast tenderness
Rationale: Vaginal bleeding at any gestational age requires prompt evaluation
for complications such as placenta previa, abruption, or miscarriage .
6. A client at 30 weeks reports severe headache, blurred vision, and epigastric
pain. Which action should the nurse take first?
A. Recommend rest at home.
B. Encourage increased oral fluids.
C. Arrange immediate obstetric evaluation.
D. Reassure the client that these symptoms are expected.
Rationale: These are classic warning signs of preeclampsia with severe
features and require immediate evaluation .
7. A nurse is reviewing laboratory results for a pregnant client. Which
hemoglobin finding is most concerning for anemia?
A. 9.2 g/dL
B. 11.5 g/dL
C. 12.5 g/dL
D. 13.0 g/dL
, Rationale: Hemoglobin <10–11 g/dL in pregnancy suggests anemia and
warrants evaluation. The other values are within expected or near-expected ranges .
8. A client planning pregnancy asks about folic acid. Which statement
indicates correct understanding?
A. "Folic acid prevents all birth defects."
B. "Folic acid reduces the risk of neural tube defects."
C. "I only need folic acid during the third trimester."
D. "Folic acid is unnecessary if I eat vegetables."
Rationale: Folic acid before conception and in early pregnancy reduces neural
tube defect risk; the usual recommendation is 400–800 mcg daily .
9. Quickening, the first perception of fetal movement, typically occurs at
which gestational age?
A. 4–6 weeks
B. 8–10 weeks
C. 16–20 weeks
D. 28–32 weeks
Rationale: Quickening is commonly perceived between 16 and 20 weeks in a
first pregnancy, though it may vary .
10. A nurse is providing preconception counseling. Fertilization normally
occurs in which structure?
A. Endometrial cavity
B. Cervical canal
C. Ampulla of the fallopian tube
D. Fimbriated end of the ovary
Rationale: The ampulla of the fallopian tube is the usual site of fertilization.
Implantation occurs later in the endometrium .
11. Which hormone surge directly triggers ovulation?
A. Progesterone
B. Luteinizing hormone (LH)
C. Follicle-stimulating hormone (FSH)
D. Human chorionic gonadotropin (hCG)
, Rationale: A surge of LH from the anterior pituitary triggers ovulation,
typically around day 14 of a 28-day cycle .
12. A client at 12 weeks gestation asks which signs of pregnancy are
"definite." Which finding is a positive sign of pregnancy?
A. Amenorrhea
B. Positive home pregnancy test
C. Fetal heart tones auscultated by Doppler
D. Chadwick's sign
Rationale: Positive signs are definitive proof: fetal heart tones, ultrasound
visualization, and fetal movement felt by the examiner. Amenorrhea is
presumptive; a positive test is probable .
13. A nurse is teaching about foods to avoid during pregnancy. Which food
should the client avoid because of Listeria risk?
A. Pasteurized milk
B. Cooked chicken
C. Soft cheeses such as feta and brie
D. Washed fresh fruit
Rationale: Soft cheeses may contain Listeria. Deli meats, raw seafood, and
undercooked eggs are also avoided .
14. A client at 20 weeks has a blood pressure of 150/95 mm Hg. Which action
is priority?
A. Document as normal pregnancy variation.
B. Reassure the client and recheck in 4 weeks.
C. Report to the provider for further evaluation.
D. Encourage increased salt intake.
Rationale: BP ≥140/90 after 20 weeks suggests gestational hypertension or
preeclampsia and requires prompt provider evaluation .
15. A nurse is assessing a client at 36 weeks. Which finding suggests placenta
previa?
A. Painful dark-red bleeding with a rigid uterus
B. Painless bright-red vaginal bleeding
