NCLEX-RN 2026 Maternal Newborn Practice Exam | OB
Nursing Questions with Verified Answers & Rationales |
INSTANT PDF DOWNLOAD
NCLEX-RN 2026 Maternal Newborn practice exam. This resource contains 180 questions covering
pregnancy, labor and delivery, fetal monitoring, postpartum care, newborn assessment, preeclampsia,
hemorrhage, and other high-yield OB topics. Each question includes the correct answer and a rationale. Use
this exam to strengthen your maternal-newborn nursing knowledge and prepare for the NCLEX.
Key Topics Covered
a. Antepartum – Prenatal care, physiological changes, risk factors, complications (hyperemesis, gestational
diabetes, preeclampsia, placenta previa, abruption)
b. Intrapartum – Stages of labor, fetal heart rate patterns, pain management, induction, augmentation,
complications (dystocia, prolapsed cord, uterine rupture)
c. Postpartum – Hemorrhage, infection, perineal care, breastfeeding, emotional changes, DVT, endometritis
d. Newborn – APGAR scoring, transition, thermoregulation, hypoglycemia, jaundice, congenital anomalies,
birth injuries, newborn screening
e. High-Risk Conditions – Preeclampsia, eclampsia, HELLP syndrome, gestational diabetes, Rh
incompatibility, multiple gestation, preterm labor
Questions 1–180
1. A client at 38 weeks gestation presents with a blood pressure of 150/95 mmHg and proteinuria
(2+). She denies headache or visual changes. Which diagnosis is most likely?
A) Gestational hypertension
B) Preeclampsia without severe features
C) Chronic hypertension
D) Eclampsia
Answer B: Preeclampsia without severe features
Rationale: New hypertension after 20 weeks with proteinuria defines preeclampsia. No severe features (BP
<160/110, normal platelets/LFTs).
2. A nurse is assessing a fetal heart rate tracing and notes late decelerations. Which action should the
nurse take first?
A) Administer oxygen via face mask
,B) Change the mother’s position to left lateral
C) Increase the IV fluid rate
D) Discontinue oxytocin if infusing
Answer B: Change the mother’s position to left lateral
Rationale: Late decelerations indicate uteroplacental insufficiency; repositioning to left lateral improves
uterine blood flow and is the first action.
3. A postpartum client who delivered 2 hours ago has a boggy fundus displaced to the right and heavy
lochia with clots. What is the priority nursing action?
A) Administer methylergonovine
B) Assist the client to void
C) Perform fundal massage
D) Increase the oxytocin infusion rate
Answer B: Assist the client to void
Rationale: A displaced boggy fundus often indicates a distended bladder; emptying the bladder allows the
uterus to contract effectively.
4. A newborn is 5 minutes old. The nurse assigns an APGAR score of 8. What was the most likely
reason for the deduction?
A) Heart rate 100 bpm
B) Acrocyanosis (blue hands and feet)
C) Weak cry
D) Limp body tone
Answer B: Acrocyanosis (blue hands and feet)
Rationale: Acrocyanosis is normal in the first minutes; APGAR 8 often deducts 1 point for color (blue
extremities) and 1 for other minor findings.
5. A client at 32 weeks gestation reports painless, bright red vaginal bleeding. Which condition is
most likely?
A) Abruptio placentae
B) Placenta previa
C) Vasa previa
D) Labor
,Answer B: Placenta previa
Rationale: Painless bright red bleeding in the third trimester is classic for placenta previa. Abruptio
placentae causes painful dark bleeding.
6. A nurse is monitoring a client receiving IV magnesium sulfate for preeclampsia. Which finding
indicates magnesium toxicity?
A) Urine output 40 mL/hr
B) Respiratory rate 10 breaths/min
C) Deep tendon reflexes 2+
D) Serum magnesium level 4.5 mg/dL
Answer B: Respiratory rate 10 breaths/min
Rationale: Respiratory depression (<12/min) is a sign of magnesium toxicity; calcium gluconate is the
antidote.
7. A client in active labor has a fetal heart rate tracing with variable decelerations. What is the most
common cause?
A) Uteroplacental insufficiency
B) Cord compression
C) Head compression
D) Maternal fever
Answer B: Cord compression
Rationale: Variable decelerations are caused by umbilical cord compression, often with a “V” or “W” shape
unrelated to contractions.
8. A postpartum client with a history of deep vein thrombosis develops sudden shortness of breath
and chest pain. Which action should the nurse take first?
A) Apply oxygen at 2 L/min
B) Elevate the head of the bed and apply oxygen at 10 L/min via non-rebreather
C) Administer enoxaparin
D) Notify the provider
Answer B: Elevate the head of the bed and apply oxygen at 10 L/min via non-rebreather
Rationale: Suspected pulmonary embolism requires immediate oxygenation and positioning to support
breathing.
, 9. A client at 40 weeks gestation is admitted with contractions every 3 minutes, cervix 5 cm, 90%
effaced, station 0. The fetal heart rate baseline is 140 bpm with moderate variability. Which finding is
most reassuring?
A) Early decelerations
B) Moderate variability
C) Late decelerations
D) Variable decelerations with overshoot
Answer B: Moderate variability
Rationale: Moderate variability (6-25 bpm) indicates a well-oxygenated fetal nervous system; it is the most
reassuring sign.
10. A nurse is teaching a breastfeeding client about signs of adequate milk transfer. Which statement
indicates understanding?
A) “My baby should feed for exactly 10 minutes on each side.”
B) “My baby has 6-8 wet diapers and several stools per day.”
C) “I should wake my baby every 2 hours to feed.”
D) “My baby will lose weight for the first 2 weeks.”
Answer B: “My baby has 6-8 wet diapers and several stools per day.”
Rationale: Adequate output (urine and stool) is the best indicator of adequate intake. Weight loss should be
<10% and regain by day 10-14.
11. A client with preeclampsia is receiving IV magnesium sulfate. Which medication should be readily
available at the bedside?
A) Naloxone
B) Calcium gluconate
C) Vitamin K
D) Protamine sulfate
Answer B: Calcium gluconate
Rationale: Calcium gluconate is the antidote for magnesium toxicity. It reverses respiratory depression and
cardiac effects.
Nursing Questions with Verified Answers & Rationales |
INSTANT PDF DOWNLOAD
NCLEX-RN 2026 Maternal Newborn practice exam. This resource contains 180 questions covering
pregnancy, labor and delivery, fetal monitoring, postpartum care, newborn assessment, preeclampsia,
hemorrhage, and other high-yield OB topics. Each question includes the correct answer and a rationale. Use
this exam to strengthen your maternal-newborn nursing knowledge and prepare for the NCLEX.
Key Topics Covered
a. Antepartum – Prenatal care, physiological changes, risk factors, complications (hyperemesis, gestational
diabetes, preeclampsia, placenta previa, abruption)
b. Intrapartum – Stages of labor, fetal heart rate patterns, pain management, induction, augmentation,
complications (dystocia, prolapsed cord, uterine rupture)
c. Postpartum – Hemorrhage, infection, perineal care, breastfeeding, emotional changes, DVT, endometritis
d. Newborn – APGAR scoring, transition, thermoregulation, hypoglycemia, jaundice, congenital anomalies,
birth injuries, newborn screening
e. High-Risk Conditions – Preeclampsia, eclampsia, HELLP syndrome, gestational diabetes, Rh
incompatibility, multiple gestation, preterm labor
Questions 1–180
1. A client at 38 weeks gestation presents with a blood pressure of 150/95 mmHg and proteinuria
(2+). She denies headache or visual changes. Which diagnosis is most likely?
A) Gestational hypertension
B) Preeclampsia without severe features
C) Chronic hypertension
D) Eclampsia
Answer B: Preeclampsia without severe features
Rationale: New hypertension after 20 weeks with proteinuria defines preeclampsia. No severe features (BP
<160/110, normal platelets/LFTs).
2. A nurse is assessing a fetal heart rate tracing and notes late decelerations. Which action should the
nurse take first?
A) Administer oxygen via face mask
,B) Change the mother’s position to left lateral
C) Increase the IV fluid rate
D) Discontinue oxytocin if infusing
Answer B: Change the mother’s position to left lateral
Rationale: Late decelerations indicate uteroplacental insufficiency; repositioning to left lateral improves
uterine blood flow and is the first action.
3. A postpartum client who delivered 2 hours ago has a boggy fundus displaced to the right and heavy
lochia with clots. What is the priority nursing action?
A) Administer methylergonovine
B) Assist the client to void
C) Perform fundal massage
D) Increase the oxytocin infusion rate
Answer B: Assist the client to void
Rationale: A displaced boggy fundus often indicates a distended bladder; emptying the bladder allows the
uterus to contract effectively.
4. A newborn is 5 minutes old. The nurse assigns an APGAR score of 8. What was the most likely
reason for the deduction?
A) Heart rate 100 bpm
B) Acrocyanosis (blue hands and feet)
C) Weak cry
D) Limp body tone
Answer B: Acrocyanosis (blue hands and feet)
Rationale: Acrocyanosis is normal in the first minutes; APGAR 8 often deducts 1 point for color (blue
extremities) and 1 for other minor findings.
5. A client at 32 weeks gestation reports painless, bright red vaginal bleeding. Which condition is
most likely?
A) Abruptio placentae
B) Placenta previa
C) Vasa previa
D) Labor
,Answer B: Placenta previa
Rationale: Painless bright red bleeding in the third trimester is classic for placenta previa. Abruptio
placentae causes painful dark bleeding.
6. A nurse is monitoring a client receiving IV magnesium sulfate for preeclampsia. Which finding
indicates magnesium toxicity?
A) Urine output 40 mL/hr
B) Respiratory rate 10 breaths/min
C) Deep tendon reflexes 2+
D) Serum magnesium level 4.5 mg/dL
Answer B: Respiratory rate 10 breaths/min
Rationale: Respiratory depression (<12/min) is a sign of magnesium toxicity; calcium gluconate is the
antidote.
7. A client in active labor has a fetal heart rate tracing with variable decelerations. What is the most
common cause?
A) Uteroplacental insufficiency
B) Cord compression
C) Head compression
D) Maternal fever
Answer B: Cord compression
Rationale: Variable decelerations are caused by umbilical cord compression, often with a “V” or “W” shape
unrelated to contractions.
8. A postpartum client with a history of deep vein thrombosis develops sudden shortness of breath
and chest pain. Which action should the nurse take first?
A) Apply oxygen at 2 L/min
B) Elevate the head of the bed and apply oxygen at 10 L/min via non-rebreather
C) Administer enoxaparin
D) Notify the provider
Answer B: Elevate the head of the bed and apply oxygen at 10 L/min via non-rebreather
Rationale: Suspected pulmonary embolism requires immediate oxygenation and positioning to support
breathing.
, 9. A client at 40 weeks gestation is admitted with contractions every 3 minutes, cervix 5 cm, 90%
effaced, station 0. The fetal heart rate baseline is 140 bpm with moderate variability. Which finding is
most reassuring?
A) Early decelerations
B) Moderate variability
C) Late decelerations
D) Variable decelerations with overshoot
Answer B: Moderate variability
Rationale: Moderate variability (6-25 bpm) indicates a well-oxygenated fetal nervous system; it is the most
reassuring sign.
10. A nurse is teaching a breastfeeding client about signs of adequate milk transfer. Which statement
indicates understanding?
A) “My baby should feed for exactly 10 minutes on each side.”
B) “My baby has 6-8 wet diapers and several stools per day.”
C) “I should wake my baby every 2 hours to feed.”
D) “My baby will lose weight for the first 2 weeks.”
Answer B: “My baby has 6-8 wet diapers and several stools per day.”
Rationale: Adequate output (urine and stool) is the best indicator of adequate intake. Weight loss should be
<10% and regain by day 10-14.
11. A client with preeclampsia is receiving IV magnesium sulfate. Which medication should be readily
available at the bedside?
A) Naloxone
B) Calcium gluconate
C) Vitamin K
D) Protamine sulfate
Answer B: Calcium gluconate
Rationale: Calcium gluconate is the antidote for magnesium toxicity. It reverses respiratory depression and
cardiac effects.
