National Certification Corporation (NCC)
Maternal Newborn Nursing
Examination Practice Examination
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A |
Instant Download Pdf
1. A 32-year-old primigravida at 38 weeks gestation presents with a blood
pressure of 148/92 mmHg and 2+ proteinuria on a dipstick test. She reports
a headache and visual disturbances. Which laboratory finding would be
most concerning for the development of hemolysis, elevated liver enzymes,
and low platelet count (HELLP) syndrome?
A. Serum creatinine of 1.1 mg/dL
B. Platelet count of 98,000/mm³
C. Aspartate aminotransferase (AST) of 48 U/L
D. Hematocrit of 36%
Answer: B. Platelet count of 98,000/mm³
Rationale: HELLP syndrome is characterized by hemolysis, elevated liver
enzymes, and a low platelet count. A platelet count below 100,000/mm³ is
a critical diagnostic criterion for HELLP syndrome, indicating severe
disease and an increased risk of bleeding. While elevated creatinine (A)
suggests renal impairment, AST elevation (C) is also a feature, but the
platelet threshold is the most defining and concerning acute finding. A
hematocrit of 36% (D) is within normal limits for a third-trimester
pregnancy and does not reflect the hemolytic process.
2. A nurse is caring for a patient with preeclampsia receiving a continuous
infusion of magnesium sulfate. The patient’s deep tendon reflexes (DTRs)
, are assessed as 0 (absent). Which is the priority nursing action?
A. Increase the infusion rate to achieve a therapeutic level
B. Administer calcium gluconate as a bolus
C. Discontinue the magnesium sulfate infusion immediately
D. Notify the provider and prepare for an emergency cesarean
Answer: C. Discontinue the magnesium sulfate infusion immediately
Rationale: Absent DTRs (grade 0) are a sign of magnesium toxicity,
indicating that serum magnesium levels have exceeded the therapeutic
range. The priority intervention is to stop the infusion immediately to
prevent further accumulation, which could lead to respiratory depression
and cardiac arrest. Calcium gluconate (B) is the antidote and should be
given if respiratory depression or cardiac arrest occurs, but stopping the
infusion is the first line of action. Increasing the rate (A) is contraindicated,
and notifying the provider (D) is important but should occur after the
infusion is stopped and the patient is stabilized.
3. A patient at 41 weeks gestation is undergoing a biophysical profile (BPP).
The nurse notes a score of 6/10. Which component of the BPP is most
indicative of chronic fetal hypoxia if it is persistently absent?
A. Fetal breathing movements
B. Amniotic fluid volume
C. Fetal tone
D. Non-stress test (NST) reactivity
Answer: B. Amniotic fluid volume
Rationale: Amniotic fluid volume is a reflection of fetal renal perfusion
and urine output. Persistently low or absent amniotic fluid
(oligohydramnios) is a late indicator of chronic uteroplacental
insufficiency, as it suggests a long-standing decrease in fetal perfusion.
Fetal breathing movements (A), fetal tone (C), and NST reactivity (D) are
acute variables that may indicate current fetal status, but they can change
rapidly. Amniotic fluid volume provides the most reliable assessment of
chronic placental function.
,4. A postpartum patient who is 2 hours post-vaginal delivery has a fundus that
is firm, midline, and at the umbilicus. The patient has a continuous trickle of
bright red blood despite a firm uterus. What is the most likely cause of this
bleeding?
A. Uterine atony
B. Retained placental fragments
C. Vaginal or cervical lacerations
D. Disseminated intravascular coagulation (DIC)
Answer: C. Vaginal or cervical lacerations
Rationale: In the presence of a firm, well-contracted uterus, continued
bright red bleeding is most consistent with a lower genital tract laceration
of the cervix, vagina, or perineum. Uterine atony (A) would present with a
boggy, relaxed fundus. Retained placental fragments (B) often cause
subinvolution, leading to intermittent bleeding and a fundus that may not
contract effectively, but the bleeding is often darker or in clots. DIC (D)
would typically be associated with a more diffuse bleeding disorder and a
non-contractile uterus.
5. A nurse is assessing a late preterm infant (34 weeks gestation) in the
newborn nursery. Which clinical finding is most indicative of respiratory
distress syndrome (RDS) rather than transient tachypnea of the newborn
(TTN)?
A. Tachypnea with a respiratory rate of 70 breaths/min
B. Grunting respirations and intercostal retractions
C. Mild cyanosis that resolves with oxygen
D. A expiratory grunt that is heard on auscultation
Rationale: RDS is caused by surfactant deficiency, leading to progressive
atelectasis. The hallmark signs include expiratory grunting (a physiologic
attempt to maintain positive end-expiratory pressure and prevent alveolar
collapse), intercostal retractions, and nasal flaring. While TTN also
presents with tachypnea (A) and some cyanosis (C), it is typically self-
limiting and resolves within 72 hours, without the significant retractions
, and grunting seen in RDS. The grunting in RDS is continuous, not just
heard on auscultation.
6. A patient with an epidural for labor pain management develops a sudden
drop in blood pressure to 88/52 mmHg and a fetal heart rate deceleration.
Which medication is the priority for treating this hypotension?
A. Ephedrine 5-10 mg IV push
B. Phenylephrine 50-100 mcg IV push
C. Oxygen via non-rebreather mask at 10 L/min
D. Intravenous fluid bolus of 500 mL normal saline
Answer: A. Ephedrine 5-10 mg IV push
Rationale: Ephedrine is a direct and indirect sympathomimetic that
increases heart rate and contractility, making it the traditional first-line
agent for treating maternal hypotension secondary to epidural blockade.
It acts quickly to restore blood pressure and improve uterine perfusion.
Phenylephrine (B) is a pure vasopressor that can cause bradycardia and
reduce cardiac output; it is now often used as a second-line or alternative
agent. Oxygen (C) and fluid bolus (D) are supportive but should not delay
the administration of a pressor when the drop is acute and severe.
7. A newborn is noted to have a single umbilical artery. What congenital
anomaly should the nurse be most vigilant in assessing for?
A. Gastroschisis
B. Congenital heart defects
C. Neural tube defects
D. Renal anomalies
Answer: D. Renal anomalies
Rationale: A single umbilical artery (SUA) is a common finding that is
associated with an increased risk of congenital anomalies, particularly
renal and genitourinary anomalies. While SUA can be an isolated finding,
its presence should prompt a thorough assessment of renal function and
structure due to the shared embryologic origin of the urinary system and
the umbilical vessels. Cardiac (B) and neural tube (C) defects are less
directly associated, though they can occur.
Maternal Newborn Nursing
Examination Practice Examination
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A |
Instant Download Pdf
1. A 32-year-old primigravida at 38 weeks gestation presents with a blood
pressure of 148/92 mmHg and 2+ proteinuria on a dipstick test. She reports
a headache and visual disturbances. Which laboratory finding would be
most concerning for the development of hemolysis, elevated liver enzymes,
and low platelet count (HELLP) syndrome?
A. Serum creatinine of 1.1 mg/dL
B. Platelet count of 98,000/mm³
C. Aspartate aminotransferase (AST) of 48 U/L
D. Hematocrit of 36%
Answer: B. Platelet count of 98,000/mm³
Rationale: HELLP syndrome is characterized by hemolysis, elevated liver
enzymes, and a low platelet count. A platelet count below 100,000/mm³ is
a critical diagnostic criterion for HELLP syndrome, indicating severe
disease and an increased risk of bleeding. While elevated creatinine (A)
suggests renal impairment, AST elevation (C) is also a feature, but the
platelet threshold is the most defining and concerning acute finding. A
hematocrit of 36% (D) is within normal limits for a third-trimester
pregnancy and does not reflect the hemolytic process.
2. A nurse is caring for a patient with preeclampsia receiving a continuous
infusion of magnesium sulfate. The patient’s deep tendon reflexes (DTRs)
, are assessed as 0 (absent). Which is the priority nursing action?
A. Increase the infusion rate to achieve a therapeutic level
B. Administer calcium gluconate as a bolus
C. Discontinue the magnesium sulfate infusion immediately
D. Notify the provider and prepare for an emergency cesarean
Answer: C. Discontinue the magnesium sulfate infusion immediately
Rationale: Absent DTRs (grade 0) are a sign of magnesium toxicity,
indicating that serum magnesium levels have exceeded the therapeutic
range. The priority intervention is to stop the infusion immediately to
prevent further accumulation, which could lead to respiratory depression
and cardiac arrest. Calcium gluconate (B) is the antidote and should be
given if respiratory depression or cardiac arrest occurs, but stopping the
infusion is the first line of action. Increasing the rate (A) is contraindicated,
and notifying the provider (D) is important but should occur after the
infusion is stopped and the patient is stabilized.
3. A patient at 41 weeks gestation is undergoing a biophysical profile (BPP).
The nurse notes a score of 6/10. Which component of the BPP is most
indicative of chronic fetal hypoxia if it is persistently absent?
A. Fetal breathing movements
B. Amniotic fluid volume
C. Fetal tone
D. Non-stress test (NST) reactivity
Answer: B. Amniotic fluid volume
Rationale: Amniotic fluid volume is a reflection of fetal renal perfusion
and urine output. Persistently low or absent amniotic fluid
(oligohydramnios) is a late indicator of chronic uteroplacental
insufficiency, as it suggests a long-standing decrease in fetal perfusion.
Fetal breathing movements (A), fetal tone (C), and NST reactivity (D) are
acute variables that may indicate current fetal status, but they can change
rapidly. Amniotic fluid volume provides the most reliable assessment of
chronic placental function.
,4. A postpartum patient who is 2 hours post-vaginal delivery has a fundus that
is firm, midline, and at the umbilicus. The patient has a continuous trickle of
bright red blood despite a firm uterus. What is the most likely cause of this
bleeding?
A. Uterine atony
B. Retained placental fragments
C. Vaginal or cervical lacerations
D. Disseminated intravascular coagulation (DIC)
Answer: C. Vaginal or cervical lacerations
Rationale: In the presence of a firm, well-contracted uterus, continued
bright red bleeding is most consistent with a lower genital tract laceration
of the cervix, vagina, or perineum. Uterine atony (A) would present with a
boggy, relaxed fundus. Retained placental fragments (B) often cause
subinvolution, leading to intermittent bleeding and a fundus that may not
contract effectively, but the bleeding is often darker or in clots. DIC (D)
would typically be associated with a more diffuse bleeding disorder and a
non-contractile uterus.
5. A nurse is assessing a late preterm infant (34 weeks gestation) in the
newborn nursery. Which clinical finding is most indicative of respiratory
distress syndrome (RDS) rather than transient tachypnea of the newborn
(TTN)?
A. Tachypnea with a respiratory rate of 70 breaths/min
B. Grunting respirations and intercostal retractions
C. Mild cyanosis that resolves with oxygen
D. A expiratory grunt that is heard on auscultation
Rationale: RDS is caused by surfactant deficiency, leading to progressive
atelectasis. The hallmark signs include expiratory grunting (a physiologic
attempt to maintain positive end-expiratory pressure and prevent alveolar
collapse), intercostal retractions, and nasal flaring. While TTN also
presents with tachypnea (A) and some cyanosis (C), it is typically self-
limiting and resolves within 72 hours, without the significant retractions
, and grunting seen in RDS. The grunting in RDS is continuous, not just
heard on auscultation.
6. A patient with an epidural for labor pain management develops a sudden
drop in blood pressure to 88/52 mmHg and a fetal heart rate deceleration.
Which medication is the priority for treating this hypotension?
A. Ephedrine 5-10 mg IV push
B. Phenylephrine 50-100 mcg IV push
C. Oxygen via non-rebreather mask at 10 L/min
D. Intravenous fluid bolus of 500 mL normal saline
Answer: A. Ephedrine 5-10 mg IV push
Rationale: Ephedrine is a direct and indirect sympathomimetic that
increases heart rate and contractility, making it the traditional first-line
agent for treating maternal hypotension secondary to epidural blockade.
It acts quickly to restore blood pressure and improve uterine perfusion.
Phenylephrine (B) is a pure vasopressor that can cause bradycardia and
reduce cardiac output; it is now often used as a second-line or alternative
agent. Oxygen (C) and fluid bolus (D) are supportive but should not delay
the administration of a pressor when the drop is acute and severe.
7. A newborn is noted to have a single umbilical artery. What congenital
anomaly should the nurse be most vigilant in assessing for?
A. Gastroschisis
B. Congenital heart defects
C. Neural tube defects
D. Renal anomalies
Answer: D. Renal anomalies
Rationale: A single umbilical artery (SUA) is a common finding that is
associated with an increased risk of congenital anomalies, particularly
renal and genitourinary anomalies. While SUA can be an isolated finding,
its presence should prompt a thorough assessment of renal function and
structure due to the shared embryologic origin of the urinary system and
the umbilical vessels. Cardiac (B) and neural tube (C) defects are less
directly associated, though they can occur.
