2026 Newborn RN CMS: Comprehensive
Practice Questions & Rationales
Comprehensive Questions and Answers
with Rationales | 2026 Update | 100%
Correct
Question 1
A nurse is assessing a newborn 1 hour after birth. Which of the following findings should the
nurse report to the provider?
a. Jaundice of the sclera
b. Respiratory rate 50/min
c. Acrocyanosis
d. Blood glucose 60 mg/dL
Correct Answer: A. Jaundice of the sclera
Rationale: Jaundice (scleral icterus) occurring within the first 24 hours of life is pathologic and
may indicate an underlying condition such as hemolytic disease or sepsis, and it requires
immediate investigation. A respiratory rate of 50/min, acrocyanosis (bluish hands and feet), and
a blood glucose of 60 mg/dL are all within expected parameters for a newborn shortly after
birth.
Question 2
A nurse is caring for a client at 39 weeks of gestation who is in the active phase of labor. The
nurse observes late decelerations in the fetal heart rate (FHR). Which of the following findings
should the nurse identify as the cause of late decelerations?
a. Uteroplacental insufficiency
b. Fetal head compression
c. Fetal ventricular septal defect
d. Umbilical cord compression
,Correct Answer: A. Uteroplacental insufficiency
Rationale: Late decelerations are a non-reassuring FHR pattern caused by decreased blood flow
and oxygen transfer to the fetus (uteroplacental insufficiency). They are often associated with
conditions like preeclampsia, maternal hypotension, or placental abruption. Fetal head
compression causes variable decelerations, while umbilical cord compression causes variable
decelerations as well.
Question 3
A nurse is assessing a postpartum client who has preeclampsia and notes a boggy uterus and
excessive uterine bleeding. The nurse should plan to administer which of the following
medications?
a. Terbutaline
b. Magnesium sulfate
c. Oxytocin
d. Methylergonovine
Correct Answer: C. Oxytocin
Rationale: A boggy uterus with excessive bleeding indicates uterine atony. Oxytocin is a
uterotonic medication that promotes sustained uterine contractions to control postpartum
hemorrhage. Magnesium sulfate is used for seizure prophylaxis in preeclampsia, not for uterine
atony. Methylergonovine is also a uterotonic but is contraindicated in hypertensive clients,
making oxytocin the safer choice here.
Question 4
A nurse is providing teaching to a postpartum client who is breastfeeding. Which of the
following statements indicates an understanding of the teaching?
a. "I should feed my baby 8-12 times a day, based on feeding cues."
b. "My baby should have 6 or 7 wet diapers a day during the first week."
c. "I should switch my baby to the other breast after 15 minutes of feeding."
d. "My nipple pain should go away after a few weeks of breastfeeding."
Correct Answer: A. "I should feed my baby 8-12 times a day, based on feeding cues."
Rationale: Breastfeeding should be initiated early and frequently (8-12 times in 24 hours) based
on newborn feeding cues to establish milk supply and prevent engorgement. In the first week, a
newborn should have 3-4 wet diapers per day; 6-8 is expected after the first week. The infant
should feed from the first breast until it is soft before switching, which is not solely based on a
time limit, and nipple pain is not expected and should be evaluated by a lactation consultant.
,Question 5
A nurse is assessing a client in active labor who has meconium staining of the amniotic fluid. The
nurse notes a reassuring fetal heart rate (FHR) tracing from the external fetal monitor. Which of
the following actions should the nurse perform?
a. Prepare the client for an ultrasound examination
b. Prepare the client for an emergency cesarean birth
c. Prepare equipment needed for newborn resuscitation
d. Perform endotracheal suctioning as soon as the fetal head is delivered
Correct Answer: C. Prepare equipment needed for newborn resuscitation
Rationale: Meconium-stained amniotic fluid is a risk factor for meconium aspiration syndrome.
Even with a reassuring FHR, the priority is to prepare for potential neonatal respiratory
compromise at birth by ensuring resuscitation equipment is ready. Routine endotracheal
suctioning of the newborn is no longer recommended by the NRP guidelines.
Question 6
A nurse is teaching a client with pre-eclampsia who is scheduled to receive magnesium sulfate
via continuous IV infusion about expected adverse effects. Which of the following adverse
effects should the nurse include in the teaching?
a. Elevated blood pressure
b. Feeling of warmth
c. Hyperactivity
d. Generalized pruritus
Correct Answer: B. Feeling of warmth
Rationale: A common adverse effect of magnesium sulfate infusion is a feeling of warmth or
flushing due to vasodilation. Magnesium sulfate lowers blood pressure and decreases the
central nervous system (CNS) to prevent seizures, so it would not cause elevated blood pressure
or hyperactivity.
Question 7
A nurse is caring for a newborn who was born to a client with a narcotic use disorder. Which of
the following nursing actions is contraindicated in the care of this newborn?
a. Promoting maternal-newborn bonding
b. Tight swaddling of the newborn
c. Small frequent meals
d. Frequent stimulation
, Correct Answer: D. Frequent stimulation
Rationale: Newborns experiencing neonatal abstinence syndrome (NAS) from in-utero narcotic
exposure are hyperirritable and have an immature CNS. Frequent stimulation (e.g., loud noises,
bright lights) can exacerbate their symptoms and increase stress. A quiet, dimly lit environment,
tight swaddling, and small frequent feedings are recommended to promote comfort and
decrease CNS irritability.
Question 8
A nurse is reviewing the medical record of a client at 39 weeks of gestation who has
polyhydramnios. Which of the following conditions is the client at an increased risk for?
a. Fundal height of 34 cm (13.4 in)
b. Total pregnancy weight gain of 3.6 kg (8lb)
c. Gestational hypertension
d. Fetal gastrointestinal anomaly
Correct Answer: D. Fetal gastrointestinal anomaly
Rationale: Polyhydramnios (excessive amniotic fluid) is often associated with fetal anomalies
that impair the fetus's ability to swallow amniotic fluid, such as gastrointestinal (GI) obstructions
(e.g., esophageal atresia) or neurological disorders. Fundal height in polyhydramnios would be
greater than expected for dates, not less.
Question 9
A nurse is assessing a client who is postpartum following a vacuum-assisted birth. For which of
the following findings should the nurse monitor to identify a cervical laceration?
a. Continuous lochia flow and a flaccid uterus
b. Report of increasing pain and pressure in the perineal area
c. Slow trickle of bright vaginal bleeding and a firm fundus
d. Gush of rubra lochia when the uterus is massaged
Correct Answer: C. Slow trickle of bright vaginal bleeding and a firm fundus
Rationale: A cervical or vaginal laceration is suspected when there is persistent, bright red
bleeding (a slow trickle or continuous ooze) despite a firm, well-contracted uterine fundus. A
flaccid uterus indicates uterine atony as the cause of hemorrhage. A gush of lochia with
massage is an expected finding that helps expel clots, not a sign of laceration.
Question 10
A nurse is teaching a client about exercise during pregnancy. Which of the following statements
should the nurse include?
Practice Questions & Rationales
Comprehensive Questions and Answers
with Rationales | 2026 Update | 100%
Correct
Question 1
A nurse is assessing a newborn 1 hour after birth. Which of the following findings should the
nurse report to the provider?
a. Jaundice of the sclera
b. Respiratory rate 50/min
c. Acrocyanosis
d. Blood glucose 60 mg/dL
Correct Answer: A. Jaundice of the sclera
Rationale: Jaundice (scleral icterus) occurring within the first 24 hours of life is pathologic and
may indicate an underlying condition such as hemolytic disease or sepsis, and it requires
immediate investigation. A respiratory rate of 50/min, acrocyanosis (bluish hands and feet), and
a blood glucose of 60 mg/dL are all within expected parameters for a newborn shortly after
birth.
Question 2
A nurse is caring for a client at 39 weeks of gestation who is in the active phase of labor. The
nurse observes late decelerations in the fetal heart rate (FHR). Which of the following findings
should the nurse identify as the cause of late decelerations?
a. Uteroplacental insufficiency
b. Fetal head compression
c. Fetal ventricular septal defect
d. Umbilical cord compression
,Correct Answer: A. Uteroplacental insufficiency
Rationale: Late decelerations are a non-reassuring FHR pattern caused by decreased blood flow
and oxygen transfer to the fetus (uteroplacental insufficiency). They are often associated with
conditions like preeclampsia, maternal hypotension, or placental abruption. Fetal head
compression causes variable decelerations, while umbilical cord compression causes variable
decelerations as well.
Question 3
A nurse is assessing a postpartum client who has preeclampsia and notes a boggy uterus and
excessive uterine bleeding. The nurse should plan to administer which of the following
medications?
a. Terbutaline
b. Magnesium sulfate
c. Oxytocin
d. Methylergonovine
Correct Answer: C. Oxytocin
Rationale: A boggy uterus with excessive bleeding indicates uterine atony. Oxytocin is a
uterotonic medication that promotes sustained uterine contractions to control postpartum
hemorrhage. Magnesium sulfate is used for seizure prophylaxis in preeclampsia, not for uterine
atony. Methylergonovine is also a uterotonic but is contraindicated in hypertensive clients,
making oxytocin the safer choice here.
Question 4
A nurse is providing teaching to a postpartum client who is breastfeeding. Which of the
following statements indicates an understanding of the teaching?
a. "I should feed my baby 8-12 times a day, based on feeding cues."
b. "My baby should have 6 or 7 wet diapers a day during the first week."
c. "I should switch my baby to the other breast after 15 minutes of feeding."
d. "My nipple pain should go away after a few weeks of breastfeeding."
Correct Answer: A. "I should feed my baby 8-12 times a day, based on feeding cues."
Rationale: Breastfeeding should be initiated early and frequently (8-12 times in 24 hours) based
on newborn feeding cues to establish milk supply and prevent engorgement. In the first week, a
newborn should have 3-4 wet diapers per day; 6-8 is expected after the first week. The infant
should feed from the first breast until it is soft before switching, which is not solely based on a
time limit, and nipple pain is not expected and should be evaluated by a lactation consultant.
,Question 5
A nurse is assessing a client in active labor who has meconium staining of the amniotic fluid. The
nurse notes a reassuring fetal heart rate (FHR) tracing from the external fetal monitor. Which of
the following actions should the nurse perform?
a. Prepare the client for an ultrasound examination
b. Prepare the client for an emergency cesarean birth
c. Prepare equipment needed for newborn resuscitation
d. Perform endotracheal suctioning as soon as the fetal head is delivered
Correct Answer: C. Prepare equipment needed for newborn resuscitation
Rationale: Meconium-stained amniotic fluid is a risk factor for meconium aspiration syndrome.
Even with a reassuring FHR, the priority is to prepare for potential neonatal respiratory
compromise at birth by ensuring resuscitation equipment is ready. Routine endotracheal
suctioning of the newborn is no longer recommended by the NRP guidelines.
Question 6
A nurse is teaching a client with pre-eclampsia who is scheduled to receive magnesium sulfate
via continuous IV infusion about expected adverse effects. Which of the following adverse
effects should the nurse include in the teaching?
a. Elevated blood pressure
b. Feeling of warmth
c. Hyperactivity
d. Generalized pruritus
Correct Answer: B. Feeling of warmth
Rationale: A common adverse effect of magnesium sulfate infusion is a feeling of warmth or
flushing due to vasodilation. Magnesium sulfate lowers blood pressure and decreases the
central nervous system (CNS) to prevent seizures, so it would not cause elevated blood pressure
or hyperactivity.
Question 7
A nurse is caring for a newborn who was born to a client with a narcotic use disorder. Which of
the following nursing actions is contraindicated in the care of this newborn?
a. Promoting maternal-newborn bonding
b. Tight swaddling of the newborn
c. Small frequent meals
d. Frequent stimulation
, Correct Answer: D. Frequent stimulation
Rationale: Newborns experiencing neonatal abstinence syndrome (NAS) from in-utero narcotic
exposure are hyperirritable and have an immature CNS. Frequent stimulation (e.g., loud noises,
bright lights) can exacerbate their symptoms and increase stress. A quiet, dimly lit environment,
tight swaddling, and small frequent feedings are recommended to promote comfort and
decrease CNS irritability.
Question 8
A nurse is reviewing the medical record of a client at 39 weeks of gestation who has
polyhydramnios. Which of the following conditions is the client at an increased risk for?
a. Fundal height of 34 cm (13.4 in)
b. Total pregnancy weight gain of 3.6 kg (8lb)
c. Gestational hypertension
d. Fetal gastrointestinal anomaly
Correct Answer: D. Fetal gastrointestinal anomaly
Rationale: Polyhydramnios (excessive amniotic fluid) is often associated with fetal anomalies
that impair the fetus's ability to swallow amniotic fluid, such as gastrointestinal (GI) obstructions
(e.g., esophageal atresia) or neurological disorders. Fundal height in polyhydramnios would be
greater than expected for dates, not less.
Question 9
A nurse is assessing a client who is postpartum following a vacuum-assisted birth. For which of
the following findings should the nurse monitor to identify a cervical laceration?
a. Continuous lochia flow and a flaccid uterus
b. Report of increasing pain and pressure in the perineal area
c. Slow trickle of bright vaginal bleeding and a firm fundus
d. Gush of rubra lochia when the uterus is massaged
Correct Answer: C. Slow trickle of bright vaginal bleeding and a firm fundus
Rationale: A cervical or vaginal laceration is suspected when there is persistent, bright red
bleeding (a slow trickle or continuous ooze) despite a firm, well-contracted uterine fundus. A
flaccid uterus indicates uterine atony as the cause of hemorrhage. A gush of lochia with
massage is an expected finding that helps expel clots, not a sign of laceration.
Question 10
A nurse is teaching a client about exercise during pregnancy. Which of the following statements
should the nurse include?
