Maternity Clinical Judgment Exam 2026 – Latest
NGN-Style Q&A with Rationales | OB/Maternal-
Newborn Study Guide | HESI & NCLEX Prep
Section 1: Antepartum Care & Assessment (Questions 1–15)
1. A pregnant client at 10 weeks' gestation reports severe nausea and vomiting,
weight loss, and ketones in the urine. Which prescription should the nurse question?
A. NPO with IV lactated Ringer's
B. Ondansetron IV as prescribed
C. Promethazine IM as prescribed
D. Discharge home with oral fluids and crackers
Answer: D
Rationale: Discharge home with oral fluids is inappropriate for a client with hyperemesis
gravidarum who has ketones and weight loss. IV fluids and antiemetics are necessary; oral
fluids could lead to continued dehydration and electrolyte imbalance.
2. A client at 38 weeks' gestation reports a sudden gush of fluid from the vagina.
Which is the priority nursing action?
A. Perform a sterile speculum examination
B. Check the fetal heart rate
C. Test the fluid with nitrazine paper
D. Place the client in Trendelenburg position
,Answer: B
Rationale: The priority after suspected rupture of membranes is to assess fetal well-being
by checking the fetal heart rate. Then the nurse can test the fluid and prepare for further
evaluation.
3. A pregnant client at 28 weeks gestation reports experiencing Braxton Hicks
contractions. Which statement by the nurse is most appropriate?
A. "These contractions indicate you're in preterm labor."
B. "Braxton Hicks contractions are normal and usually painless, irregular tightenings."
C. "You need to come to the hospital immediately for evaluation."
D. "These contractions will stop if you take pain medication."
Answer: B
Rationale: Braxton Hicks contractions are normal, irregular, painless uterine contractions
that occur throughout pregnancy, especially in the third trimester. They are considered
"practice" contractions and do not indicate labor.
4. A pregnant client at 36 weeks gestation is diagnosed with preeclampsia. Which
finding would indicate worsening condition?
A. Blood pressure of 140/90 mmHg
B. Proteinuria of 1+ on dipstick
C. Severe headache and visual disturbances
D. Mild edema of ankles
Answer: C
Rationale: Severe headache and visual disturbances indicate central nervous system
involvement and suggest progression to severe preeclampsia or impending eclampsia. This
requires immediate intervention. Options A and B are expected findings in mild
preeclampsia.
,5. A client at 34 weeks gestation with a BP of 152/96 mmHg. Which additional finding
is the priority to report?
A. Trace proteinuria
B. 2+ pedal edema
C. Frontal headache and blurred vision
D. Weight gain of 1 lb in a week
Answer: C
Rationale: Frontal headache and blurred vision are cardinal signs of central nervous system
irritability indicating worsening preeclampsia, which requires immediate neurological
assessment and intervention.
6. Which laboratory result is the most significant indicator of HELLP syndrome?
A. Elevated blood glucose
B. Decreased serum creatinine
C. Low platelet count (100,000/mm³)
D. Increased hemoglobin
Answer: C
Rationale: HELLP syndrome is characterized by Hemolysis, Elevated Liver enzymes, and
Low Platelets. A low platelet count is a hallmark laboratory finding.
7. A client at 36 weeks gestation presents with painless vaginal bleeding. What
condition does the nurse suspect?
A. Placental abruption
B. Placenta previa
C. Ruptured ectopic pregnancy
D. Uterine rupture
, Answer: B
Rationale: Placenta previa typically causes painless bleeding in the third trimester.
Abruption is painful.
8. A client at 33 weeks' gestation presents with sudden onset of severe, constant
abdominal pain and dark vaginal bleeding. The uterus is firm and tender to palpation.
Contractions are every 2 minutes with high resting tone. Which condition is most
likely?
A. Placenta previa
B. Placental abruption
C. Uterine rupture
D. Preterm labor
Answer: B
Rationale: The classic signs of placental abruption are painful, dark red bleeding, uterine
hypertonicity, and a rigid, tender uterus. Placenta previa typically presents with painless,
bright red bleeding and a soft uterus.
9. Using Nägele's rule, if a client's LMP was August 19, 2025, what is the EDB?
A. May 12, 2026
B. May 26, 2026
C. May 19, 2026
D. June 2, 2026
Answer: B
Rationale: Nägele's rule: subtract 3 months from the first day of the LMP and add 7 days.
August 19 - 3 months = May 19; May 19 + 7 days = May 26.
NGN-Style Q&A with Rationales | OB/Maternal-
Newborn Study Guide | HESI & NCLEX Prep
Section 1: Antepartum Care & Assessment (Questions 1–15)
1. A pregnant client at 10 weeks' gestation reports severe nausea and vomiting,
weight loss, and ketones in the urine. Which prescription should the nurse question?
A. NPO with IV lactated Ringer's
B. Ondansetron IV as prescribed
C. Promethazine IM as prescribed
D. Discharge home with oral fluids and crackers
Answer: D
Rationale: Discharge home with oral fluids is inappropriate for a client with hyperemesis
gravidarum who has ketones and weight loss. IV fluids and antiemetics are necessary; oral
fluids could lead to continued dehydration and electrolyte imbalance.
2. A client at 38 weeks' gestation reports a sudden gush of fluid from the vagina.
Which is the priority nursing action?
A. Perform a sterile speculum examination
B. Check the fetal heart rate
C. Test the fluid with nitrazine paper
D. Place the client in Trendelenburg position
,Answer: B
Rationale: The priority after suspected rupture of membranes is to assess fetal well-being
by checking the fetal heart rate. Then the nurse can test the fluid and prepare for further
evaluation.
3. A pregnant client at 28 weeks gestation reports experiencing Braxton Hicks
contractions. Which statement by the nurse is most appropriate?
A. "These contractions indicate you're in preterm labor."
B. "Braxton Hicks contractions are normal and usually painless, irregular tightenings."
C. "You need to come to the hospital immediately for evaluation."
D. "These contractions will stop if you take pain medication."
Answer: B
Rationale: Braxton Hicks contractions are normal, irregular, painless uterine contractions
that occur throughout pregnancy, especially in the third trimester. They are considered
"practice" contractions and do not indicate labor.
4. A pregnant client at 36 weeks gestation is diagnosed with preeclampsia. Which
finding would indicate worsening condition?
A. Blood pressure of 140/90 mmHg
B. Proteinuria of 1+ on dipstick
C. Severe headache and visual disturbances
D. Mild edema of ankles
Answer: C
Rationale: Severe headache and visual disturbances indicate central nervous system
involvement and suggest progression to severe preeclampsia or impending eclampsia. This
requires immediate intervention. Options A and B are expected findings in mild
preeclampsia.
,5. A client at 34 weeks gestation with a BP of 152/96 mmHg. Which additional finding
is the priority to report?
A. Trace proteinuria
B. 2+ pedal edema
C. Frontal headache and blurred vision
D. Weight gain of 1 lb in a week
Answer: C
Rationale: Frontal headache and blurred vision are cardinal signs of central nervous system
irritability indicating worsening preeclampsia, which requires immediate neurological
assessment and intervention.
6. Which laboratory result is the most significant indicator of HELLP syndrome?
A. Elevated blood glucose
B. Decreased serum creatinine
C. Low platelet count (100,000/mm³)
D. Increased hemoglobin
Answer: C
Rationale: HELLP syndrome is characterized by Hemolysis, Elevated Liver enzymes, and
Low Platelets. A low platelet count is a hallmark laboratory finding.
7. A client at 36 weeks gestation presents with painless vaginal bleeding. What
condition does the nurse suspect?
A. Placental abruption
B. Placenta previa
C. Ruptured ectopic pregnancy
D. Uterine rupture
, Answer: B
Rationale: Placenta previa typically causes painless bleeding in the third trimester.
Abruption is painful.
8. A client at 33 weeks' gestation presents with sudden onset of severe, constant
abdominal pain and dark vaginal bleeding. The uterus is firm and tender to palpation.
Contractions are every 2 minutes with high resting tone. Which condition is most
likely?
A. Placenta previa
B. Placental abruption
C. Uterine rupture
D. Preterm labor
Answer: B
Rationale: The classic signs of placental abruption are painful, dark red bleeding, uterine
hypertonicity, and a rigid, tender uterus. Placenta previa typically presents with painless,
bright red bleeding and a soft uterus.
9. Using Nägele's rule, if a client's LMP was August 19, 2025, what is the EDB?
A. May 12, 2026
B. May 26, 2026
C. May 19, 2026
D. June 2, 2026
Answer: B
Rationale: Nägele's rule: subtract 3 months from the first day of the LMP and add 7 days.
August 19 - 3 months = May 19; May 19 + 7 days = May 26.
