NCLEX-RN COMPREHENSIVE PRACTICE
EXAM 2026
Maternal-Newborn Nursing
Total Questions: 50 Time Recommendation: 75 minutes Passing Standard:
Demonstrates consistent competency across all content areas
SECTION 1: ANTEPARTUM CARE
Questions 1–10
Question 1
A 28-year-old primigravida at 32 weeks' gestation presents to the antepartum unit with a
chief complaint of persistent headache and visual disturbances described as "seeing
spots." Her vital signs are: BP 168/110 mmHg, HR 88 bpm, RR 18/min, SpO2 98% on room
air, Temperature 37.0°C. Physical assessment reveals 3+ pitting edema in bilateral lower
extremities and facial edema. Laboratory results: Platelets 140,000/mm³, AST 42 U/L, ALT
38 U/L, serum creatinine 0.9 mg/dL, urine protein 3+ on dipstick, 24-hour urine protein
3.8 g.
Which classification best describes this patient's condition?
A) Gestational hypertension B) Preeclampsia without severe features C) Preeclampsia with
severe features D) Chronic hypertension with superimposed preeclampsia
Correct answer: C
Explanation:
Preeclampsia with severe features is defined by hypertension (systolic ≥160 mmHg
or diastolic ≥110 mmHg) occurring after 20 weeks' gestation with proteinuria AND at
least one severe feature. This patient has BP 168/110, proteinuria (3.8 g/24 hours,
well above the 0.3 g threshold), AND cerebral symptoms (headache, visual
disturbances) — all hallmarks of severe preeclampsia per ACOG criteria.
(A) Gestational hypertension is defined as new-onset hypertension after 20 weeks
WITHOUT proteinuria or end-organ dysfunction. This patient has significant
proteinuria and neurological symptoms, ruling out simple gestational hypertension.
, (B) Preeclampsia without severe features involves BP ≥140/90 but <160/110 with
proteinuria but NO severe features. This patient's BP of 168/110 exceeds the severe-
range threshold, and she has cerebral symptoms, making this classification
insufficient.
(D) Chronic hypertension with superimposed preeclampsia requires documented
hypertension before 20 weeks' gestation or before pregnancy. No history of pre-
existing hypertension is provided; this is a primigravida with new-onset hypertension
at 32 weeks.
NCLEX Category: Physiological Integrity — Physiological Adaptation
Cognitive Level: Analysis
Question 2
A 34-year-old gravida 3, para 2 at 28 weeks' gestation is diagnosed with gestational
diabetes mellitus (GDM) after a 3-hour oral glucose tolerance test (OGTT) with the
following values: fasting 102 mg/dL, 1-hour 196 mg/dL, 2-hour 172 mg/dL, 3-hour 148
mg/dL. Her pre-pregnancy BMI was 31. She is started on medical nutrition therapy and
self-monitoring of blood glucose. One week later, her fasting blood glucose levels
consistently range from 100–115 mg/dL, and 2-hour postprandial values are 130–145
mg/dL.
What is the most appropriate next step in management?
A) Continue medical nutrition therapy for an additional 2 weeks before reassessing B)
Initiate insulin therapy C) Start metformin 500 mg twice daily D) Increase caloric intake to
prevent ketosis
Correct answer: B
Explanation:
Insulin therapy is indicated when medical nutrition therapy fails to achieve glycemic
targets within 1–2 weeks. Per ADA and ACOG guidelines, fasting glucose should be
<95 mg/dL and 2-hour postprandial <120 mg/dL. This patient's values (fasting 100–
115, postprandial 130–145) consistently exceed targets after an adequate trial of
diet therapy. Insulin is the first-line pharmacologic agent for GDM because it does
not cross the placenta.
(A) Continuing diet therapy alone when glucose values are significantly above target
for a week increases the risk of macrosomia, neonatal hypoglycemia, and other
complications. Delaying pharmacotherapy when targets are not met is not evidence-
based.
(C) While metformin is sometimes used as an alternative, it crosses the placenta.
ACOG recommends insulin as the preferred first-line pharmacologic therapy for
GDM. Metformin may be considered if the patient refuses insulin, but it is not the
most appropriate initial step.
, (D) The patient's issue is hyperglycemia, not inadequate caloric intake. Increasing
calories would worsen glycemic control. While severe caloric restriction can cause
ketosis, this patient is already above glucose targets.
NCLEX Category: Physiological Integrity — Pharmacological and Parenteral
Therapies
Cognitive Level: Application
Question 3
A 22-year-old primigravida at 8 weeks' gestation presents to the emergency department
with sharp, unilateral right lower quadrant pain that started suddenly 2 hours ago. She
reports vaginal spotting for the past 3 days. Vital signs: BP 96/60 mmHg, HR 118 bpm, RR
22/min, SpO2 99%. She appears diaphoretic and pale. Laboratory results: quantitative β-
hCG 2,800 mIU/mL, hemoglobin 9.2 g/dL (baseline 12.4 g/dL 4 weeks ago), hematocrit
28%. Transvaginal ultrasound reveals an empty uterus and a 3.5-cm complex right
adnexal mass with free fluid in the cul-de-sac.
What is the priority nursing intervention?
A) Prepare the patient for methotrexate administration B) Establish two large-bore IV lines
and prepare for emergent surgery C) Administer Rh immune globulin if the patient is Rh-
negative D) Obtain serial β-hCG levels every 48 hours to monitor trending
Correct answer: B
Explanation:
This patient presents with classic signs of a ruptured ectopic pregnancy: acute
unilateral pain, hemodynamic instability (hypotension, tachycardia), significant
hemoglobin drop (from 12.4 to 9.2 g/dL), and free fluid in the cul-de-sac indicating
hemoperitoneum. This is a surgical emergency requiring immediate IV access with
two large-bore (16–18 gauge) catheters for volume resuscitation and preparation for
emergent salpingectomy or salpingostomy.
(A) Methotrexate is indicated for unruptured ectopic pregnancies in
hemodynamically stable patients with β-hCG typically <5,000 mIU/mL. This patient
is hemodynamically unstable with evidence of active hemorrhage — methotrexate is
contraindicated in this scenario.
(C) Rh immune globulin administration is important but is NOT the priority when a
patient is hemodynamically compromised and actively hemorrhaging. This can be
addressed after stabilization.
(D) Serial β-hCG monitoring is used for pregnancies of unknown location in stable
patients. This patient has a confirmed adnexal mass with active hemorrhage —
expectant management with serial labs would be dangerous and potentially fatal.
NCLEX Category: Physiological Integrity — Physiological Adaptation
Cognitive Level: Analysis
, Question 4
A 30-year-old gravida 2, para 1 at 34 weeks' gestation presents with painless, bright red
vaginal bleeding that began approximately 1 hour ago. She reports soaking through two
pads. Vital signs: BP 118/72 mmHg, HR 94 bpm, RR 16/min, SpO2 99%. Fetal heart rate is
145 bpm with moderate variability. Her prior ultrasound at 20 weeks documented a
complete placenta previa. She denies abdominal pain, contractions, or trauma.
Which nursing action is contraindicated for this patient?
A) Initiating continuous electronic fetal monitoring B) Performing a digital cervical
examination C) Establishing IV access and sending a type and crossmatch D) Placing the
patient on bed rest in a lateral position
Correct answer: B
Explanation:
A digital cervical examination is absolutely contraindicated in suspected or
confirmed placenta previa. Inserting fingers through the cervix can disrupt the
placenta overlying the cervical os, causing catastrophic hemorrhage that can be
fatal to both mother and fetus. Cervical assessment in placenta previa should only
be performed via speculum or ultrasound.
(A) Continuous electronic fetal monitoring is appropriate and necessary to assess
fetal status. The reactive tracing with moderate variability is reassuring, but ongoing
hemorrhage could compromise uteroplacental perfusion, requiring continuous
surveillance.
(C) Establishing IV access and obtaining type and crossmatch is a critical nursing
intervention. Patients with placenta previa can hemorrhage rapidly and may require
emergent blood transfusion or cesarean delivery.
(D) Bed rest in a lateral position promotes uteroplacental perfusion and reduces
pressure on the cervix. This is standard management for placenta previa with
bleeding.
NCLEX Category: Safe and Effective Care Environment — Management of Care
Cognitive Level: Application
Question 5
A 26-year-old primigravida at 16 weeks' gestation presents for her first prenatal visit. Her
blood type is O-negative. Her partner's blood type is A-positive. Indirect Coombs test
(antibody screen) is negative. Rubella titer shows non-immunity (titer <1:8). Hemoglobin
is 10.8 g/dL, MCV 72 fL, ferritin 10 ng/mL.
Which combination of interventions is appropriate at this visit? (Select all that apply.)
EXAM 2026
Maternal-Newborn Nursing
Total Questions: 50 Time Recommendation: 75 minutes Passing Standard:
Demonstrates consistent competency across all content areas
SECTION 1: ANTEPARTUM CARE
Questions 1–10
Question 1
A 28-year-old primigravida at 32 weeks' gestation presents to the antepartum unit with a
chief complaint of persistent headache and visual disturbances described as "seeing
spots." Her vital signs are: BP 168/110 mmHg, HR 88 bpm, RR 18/min, SpO2 98% on room
air, Temperature 37.0°C. Physical assessment reveals 3+ pitting edema in bilateral lower
extremities and facial edema. Laboratory results: Platelets 140,000/mm³, AST 42 U/L, ALT
38 U/L, serum creatinine 0.9 mg/dL, urine protein 3+ on dipstick, 24-hour urine protein
3.8 g.
Which classification best describes this patient's condition?
A) Gestational hypertension B) Preeclampsia without severe features C) Preeclampsia with
severe features D) Chronic hypertension with superimposed preeclampsia
Correct answer: C
Explanation:
Preeclampsia with severe features is defined by hypertension (systolic ≥160 mmHg
or diastolic ≥110 mmHg) occurring after 20 weeks' gestation with proteinuria AND at
least one severe feature. This patient has BP 168/110, proteinuria (3.8 g/24 hours,
well above the 0.3 g threshold), AND cerebral symptoms (headache, visual
disturbances) — all hallmarks of severe preeclampsia per ACOG criteria.
(A) Gestational hypertension is defined as new-onset hypertension after 20 weeks
WITHOUT proteinuria or end-organ dysfunction. This patient has significant
proteinuria and neurological symptoms, ruling out simple gestational hypertension.
, (B) Preeclampsia without severe features involves BP ≥140/90 but <160/110 with
proteinuria but NO severe features. This patient's BP of 168/110 exceeds the severe-
range threshold, and she has cerebral symptoms, making this classification
insufficient.
(D) Chronic hypertension with superimposed preeclampsia requires documented
hypertension before 20 weeks' gestation or before pregnancy. No history of pre-
existing hypertension is provided; this is a primigravida with new-onset hypertension
at 32 weeks.
NCLEX Category: Physiological Integrity — Physiological Adaptation
Cognitive Level: Analysis
Question 2
A 34-year-old gravida 3, para 2 at 28 weeks' gestation is diagnosed with gestational
diabetes mellitus (GDM) after a 3-hour oral glucose tolerance test (OGTT) with the
following values: fasting 102 mg/dL, 1-hour 196 mg/dL, 2-hour 172 mg/dL, 3-hour 148
mg/dL. Her pre-pregnancy BMI was 31. She is started on medical nutrition therapy and
self-monitoring of blood glucose. One week later, her fasting blood glucose levels
consistently range from 100–115 mg/dL, and 2-hour postprandial values are 130–145
mg/dL.
What is the most appropriate next step in management?
A) Continue medical nutrition therapy for an additional 2 weeks before reassessing B)
Initiate insulin therapy C) Start metformin 500 mg twice daily D) Increase caloric intake to
prevent ketosis
Correct answer: B
Explanation:
Insulin therapy is indicated when medical nutrition therapy fails to achieve glycemic
targets within 1–2 weeks. Per ADA and ACOG guidelines, fasting glucose should be
<95 mg/dL and 2-hour postprandial <120 mg/dL. This patient's values (fasting 100–
115, postprandial 130–145) consistently exceed targets after an adequate trial of
diet therapy. Insulin is the first-line pharmacologic agent for GDM because it does
not cross the placenta.
(A) Continuing diet therapy alone when glucose values are significantly above target
for a week increases the risk of macrosomia, neonatal hypoglycemia, and other
complications. Delaying pharmacotherapy when targets are not met is not evidence-
based.
(C) While metformin is sometimes used as an alternative, it crosses the placenta.
ACOG recommends insulin as the preferred first-line pharmacologic therapy for
GDM. Metformin may be considered if the patient refuses insulin, but it is not the
most appropriate initial step.
, (D) The patient's issue is hyperglycemia, not inadequate caloric intake. Increasing
calories would worsen glycemic control. While severe caloric restriction can cause
ketosis, this patient is already above glucose targets.
NCLEX Category: Physiological Integrity — Pharmacological and Parenteral
Therapies
Cognitive Level: Application
Question 3
A 22-year-old primigravida at 8 weeks' gestation presents to the emergency department
with sharp, unilateral right lower quadrant pain that started suddenly 2 hours ago. She
reports vaginal spotting for the past 3 days. Vital signs: BP 96/60 mmHg, HR 118 bpm, RR
22/min, SpO2 99%. She appears diaphoretic and pale. Laboratory results: quantitative β-
hCG 2,800 mIU/mL, hemoglobin 9.2 g/dL (baseline 12.4 g/dL 4 weeks ago), hematocrit
28%. Transvaginal ultrasound reveals an empty uterus and a 3.5-cm complex right
adnexal mass with free fluid in the cul-de-sac.
What is the priority nursing intervention?
A) Prepare the patient for methotrexate administration B) Establish two large-bore IV lines
and prepare for emergent surgery C) Administer Rh immune globulin if the patient is Rh-
negative D) Obtain serial β-hCG levels every 48 hours to monitor trending
Correct answer: B
Explanation:
This patient presents with classic signs of a ruptured ectopic pregnancy: acute
unilateral pain, hemodynamic instability (hypotension, tachycardia), significant
hemoglobin drop (from 12.4 to 9.2 g/dL), and free fluid in the cul-de-sac indicating
hemoperitoneum. This is a surgical emergency requiring immediate IV access with
two large-bore (16–18 gauge) catheters for volume resuscitation and preparation for
emergent salpingectomy or salpingostomy.
(A) Methotrexate is indicated for unruptured ectopic pregnancies in
hemodynamically stable patients with β-hCG typically <5,000 mIU/mL. This patient
is hemodynamically unstable with evidence of active hemorrhage — methotrexate is
contraindicated in this scenario.
(C) Rh immune globulin administration is important but is NOT the priority when a
patient is hemodynamically compromised and actively hemorrhaging. This can be
addressed after stabilization.
(D) Serial β-hCG monitoring is used for pregnancies of unknown location in stable
patients. This patient has a confirmed adnexal mass with active hemorrhage —
expectant management with serial labs would be dangerous and potentially fatal.
NCLEX Category: Physiological Integrity — Physiological Adaptation
Cognitive Level: Analysis
, Question 4
A 30-year-old gravida 2, para 1 at 34 weeks' gestation presents with painless, bright red
vaginal bleeding that began approximately 1 hour ago. She reports soaking through two
pads. Vital signs: BP 118/72 mmHg, HR 94 bpm, RR 16/min, SpO2 99%. Fetal heart rate is
145 bpm with moderate variability. Her prior ultrasound at 20 weeks documented a
complete placenta previa. She denies abdominal pain, contractions, or trauma.
Which nursing action is contraindicated for this patient?
A) Initiating continuous electronic fetal monitoring B) Performing a digital cervical
examination C) Establishing IV access and sending a type and crossmatch D) Placing the
patient on bed rest in a lateral position
Correct answer: B
Explanation:
A digital cervical examination is absolutely contraindicated in suspected or
confirmed placenta previa. Inserting fingers through the cervix can disrupt the
placenta overlying the cervical os, causing catastrophic hemorrhage that can be
fatal to both mother and fetus. Cervical assessment in placenta previa should only
be performed via speculum or ultrasound.
(A) Continuous electronic fetal monitoring is appropriate and necessary to assess
fetal status. The reactive tracing with moderate variability is reassuring, but ongoing
hemorrhage could compromise uteroplacental perfusion, requiring continuous
surveillance.
(C) Establishing IV access and obtaining type and crossmatch is a critical nursing
intervention. Patients with placenta previa can hemorrhage rapidly and may require
emergent blood transfusion or cesarean delivery.
(D) Bed rest in a lateral position promotes uteroplacental perfusion and reduces
pressure on the cervix. This is standard management for placenta previa with
bleeding.
NCLEX Category: Safe and Effective Care Environment — Management of Care
Cognitive Level: Application
Question 5
A 26-year-old primigravida at 16 weeks' gestation presents for her first prenatal visit. Her
blood type is O-negative. Her partner's blood type is A-positive. Indirect Coombs test
(antibody screen) is negative. Rubella titer shows non-immunity (titer <1:8). Hemoglobin
is 10.8 g/dL, MCV 72 fL, ferritin 10 ng/mL.
Which combination of interventions is appropriate at this visit? (Select all that apply.)
