High-Risk Pregnancy Nursing – 50 NCLEX Questions with Answers &
Rationales | Maternal & Newborn OB Review
This test bank provides 50 NCLEX-style practice questions with in-depth rationales covering
the most critical maternal complications. Topics include preeclampsia/eclampsia, HELLP
syndrome, gestational diabetes, preterm labor, PROM, placental abruption, and Rh
incompatibility. It also addresses infections, thyroid disorders, DIC, anemia, and trauma
during pregnancy. Each question builds clinical reasoning and safety-based nursing judgment
for NCLEX, ATI, or HESI exam prep.
Questions Plus answers
1. A 34-week pregnant client arrives with sudden onset severe, constant abdominal pain and a
rigid, board-like uterus after a motor vehicle accident. Fetal heart tones are difficult to auscultate
and maternal pulse is rapid. What is the nurse’s first action?
A. Start oral analgesics and reassess in 30 minutes.
B. Establish two large-bore IV lines, begin fluid resuscitation, and call obstetrics/OR
immediately.
C. Encourage the client to ambulate and provide ice packs.
D. Perform a sterile vaginal exam to check dilation.
Answer: B. Establish two large-bore IV lines, begin fluid resuscitation, and call
obstetrics/OR immediately.
Rationale: Sudden severe pain with a board-like uterus and maternal tachycardia after trauma
strongly suggests placental abruption with concealed hemorrhage. Immediate stabilization
(large-bore IV access, fluid/blood product preparation) and rapid coordination for emergent
delivery are needed to avoid maternal shock and fetal death. Vaginal exam risks worsening
bleeding; analgesics alone are insufficient. Time-critical resuscitation and surgical readiness save
lives.
,2. A patient at 29 weeks with preterm labor receives a 2-dose course of betamethasone. She then
develops maternal hyperglycemia. What is the most appropriate nursing action?
A. Discontinue steroid therapy immediately.
B. Monitor blood glucose frequently and manage hyperglycemia per protocol (sliding scale
or insulin) while continuing corticosteroid course.
C. Assume the hyperglycemia is benign and ignore.
D. Give supplemental oral glucose to the fetus.
Answer: B. Monitor blood glucose frequently and manage hyperglycemia per protocol
(sliding scale or insulin) while continuing corticosteroid course.
Rationale: Antenatal corticosteroids improve fetal lung maturity but can raise maternal glucose
levels, especially in diabetic or insulin-resistant patients. Benefits to the fetus generally outweigh
transient hyperglycemia; therefore continue steroids while closely monitoring and treating
maternal hyperglycemia to protect both mom and baby. Abruptly stopping steroids would forgo
neonatal benefit; fetal glucose cannot be administered directly.
3. A woman at 36 weeks presents with painless bright red vaginal bleeding. Vital signs stable.
Which nursing action is most appropriate initially?
A. Prepare for immediate digital cervical exam.
B. Place patient on continuous fetal monitoring, maintain IV access, and await ultrasound
confirmation—avoid vaginal exam until placenta location known.
C. Give oxytocin to augment labor.
D. Encourage ambulation to assess bleeding further.
Answer: B. Place patient on continuous fetal monitoring, maintain IV access, and await
ultrasound confirmation—avoid vaginal exam until placenta location known.
Rationale: Painless third-trimester bleeding classically suggests placenta previa. A vaginal
exam could provoke catastrophic hemorrhage if placenta overlies the cervix. Initial priorities:
maternal stabilization (IV access), continuous fetal monitoring, and ultrasound to locate the
placenta. Avoid oxytocin or fundal pressure until diagnosis and management plan are clear.
Timely imaging and OB communication guide safe care.
, 4. A woman with severe preeclampsia is receiving magnesium sulfate. On assessment you note
RR 9/min, absent patellar reflexes, and urine output 15 mL/hr. What should be done
immediately?
A. Document and reassess in one hour.
B. Stop the magnesium infusion, notify the provider, and prepare calcium gluconate for
magnesium toxicity.
C. Give a bolus of IV magnesium.
D. Encourage deep breathing and provide warm blankets.
Answer: B. Stop the magnesium infusion, notify the provider, and prepare calcium
gluconate for magnesium toxicity.
Rationale: Respiratory depression, loss of deep tendon reflexes, and oliguria are hallmark signs
of magnesium toxicity. Rapid cessation and administration of calcium gluconate (antidote) are
required to prevent respiratory arrest and cardiac toxicity. Document events, monitor airway, and
ensure ventilatory support availability. Waiting or increasing dose risks severe morbidity.
5. A 27-week gestation woman with PROM (premature rupture of membranes) is clinically
stable without signs of infection. What is the most appropriate evidence-based plan?
A. Immediate induction of labor.
B. Hospitalize for expectant management, administer antibiotics and corticosteroids per
protocol, and monitor for infection or labor.
C. Send home on bed rest without monitoring.
D. Immediate cesarean delivery.
Answer: B. Hospitalize for expectant management, administer antibiotics and
corticosteroids per protocol, and monitor for infection or labor.
Rationale: For PPROM at previable or preterm gestations, management balances risks of
prematurity vs infection. Expectant inpatient management with antibiotics to prolong latency
and corticosteroids to accelerate fetal lung maturity is standard when maternal/fetal status is
Rationales | Maternal & Newborn OB Review
This test bank provides 50 NCLEX-style practice questions with in-depth rationales covering
the most critical maternal complications. Topics include preeclampsia/eclampsia, HELLP
syndrome, gestational diabetes, preterm labor, PROM, placental abruption, and Rh
incompatibility. It also addresses infections, thyroid disorders, DIC, anemia, and trauma
during pregnancy. Each question builds clinical reasoning and safety-based nursing judgment
for NCLEX, ATI, or HESI exam prep.
Questions Plus answers
1. A 34-week pregnant client arrives with sudden onset severe, constant abdominal pain and a
rigid, board-like uterus after a motor vehicle accident. Fetal heart tones are difficult to auscultate
and maternal pulse is rapid. What is the nurse’s first action?
A. Start oral analgesics and reassess in 30 minutes.
B. Establish two large-bore IV lines, begin fluid resuscitation, and call obstetrics/OR
immediately.
C. Encourage the client to ambulate and provide ice packs.
D. Perform a sterile vaginal exam to check dilation.
Answer: B. Establish two large-bore IV lines, begin fluid resuscitation, and call
obstetrics/OR immediately.
Rationale: Sudden severe pain with a board-like uterus and maternal tachycardia after trauma
strongly suggests placental abruption with concealed hemorrhage. Immediate stabilization
(large-bore IV access, fluid/blood product preparation) and rapid coordination for emergent
delivery are needed to avoid maternal shock and fetal death. Vaginal exam risks worsening
bleeding; analgesics alone are insufficient. Time-critical resuscitation and surgical readiness save
lives.
,2. A patient at 29 weeks with preterm labor receives a 2-dose course of betamethasone. She then
develops maternal hyperglycemia. What is the most appropriate nursing action?
A. Discontinue steroid therapy immediately.
B. Monitor blood glucose frequently and manage hyperglycemia per protocol (sliding scale
or insulin) while continuing corticosteroid course.
C. Assume the hyperglycemia is benign and ignore.
D. Give supplemental oral glucose to the fetus.
Answer: B. Monitor blood glucose frequently and manage hyperglycemia per protocol
(sliding scale or insulin) while continuing corticosteroid course.
Rationale: Antenatal corticosteroids improve fetal lung maturity but can raise maternal glucose
levels, especially in diabetic or insulin-resistant patients. Benefits to the fetus generally outweigh
transient hyperglycemia; therefore continue steroids while closely monitoring and treating
maternal hyperglycemia to protect both mom and baby. Abruptly stopping steroids would forgo
neonatal benefit; fetal glucose cannot be administered directly.
3. A woman at 36 weeks presents with painless bright red vaginal bleeding. Vital signs stable.
Which nursing action is most appropriate initially?
A. Prepare for immediate digital cervical exam.
B. Place patient on continuous fetal monitoring, maintain IV access, and await ultrasound
confirmation—avoid vaginal exam until placenta location known.
C. Give oxytocin to augment labor.
D. Encourage ambulation to assess bleeding further.
Answer: B. Place patient on continuous fetal monitoring, maintain IV access, and await
ultrasound confirmation—avoid vaginal exam until placenta location known.
Rationale: Painless third-trimester bleeding classically suggests placenta previa. A vaginal
exam could provoke catastrophic hemorrhage if placenta overlies the cervix. Initial priorities:
maternal stabilization (IV access), continuous fetal monitoring, and ultrasound to locate the
placenta. Avoid oxytocin or fundal pressure until diagnosis and management plan are clear.
Timely imaging and OB communication guide safe care.
, 4. A woman with severe preeclampsia is receiving magnesium sulfate. On assessment you note
RR 9/min, absent patellar reflexes, and urine output 15 mL/hr. What should be done
immediately?
A. Document and reassess in one hour.
B. Stop the magnesium infusion, notify the provider, and prepare calcium gluconate for
magnesium toxicity.
C. Give a bolus of IV magnesium.
D. Encourage deep breathing and provide warm blankets.
Answer: B. Stop the magnesium infusion, notify the provider, and prepare calcium
gluconate for magnesium toxicity.
Rationale: Respiratory depression, loss of deep tendon reflexes, and oliguria are hallmark signs
of magnesium toxicity. Rapid cessation and administration of calcium gluconate (antidote) are
required to prevent respiratory arrest and cardiac toxicity. Document events, monitor airway, and
ensure ventilatory support availability. Waiting or increasing dose risks severe morbidity.
5. A 27-week gestation woman with PROM (premature rupture of membranes) is clinically
stable without signs of infection. What is the most appropriate evidence-based plan?
A. Immediate induction of labor.
B. Hospitalize for expectant management, administer antibiotics and corticosteroids per
protocol, and monitor for infection or labor.
C. Send home on bed rest without monitoring.
D. Immediate cesarean delivery.
Answer: B. Hospitalize for expectant management, administer antibiotics and
corticosteroids per protocol, and monitor for infection or labor.
Rationale: For PPROM at previable or preterm gestations, management balances risks of
prematurity vs infection. Expectant inpatient management with antibiotics to prolong latency
and corticosteroids to accelerate fetal lung maturity is standard when maternal/fetal status is
