NCLEX RN High Risk Pregnancy
Practice Exam 100 Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026
1. A client at 32 weeks' gestation with severe preeclampsia reports a severe
headache and blurred vision. Which action should the nurse take first?
A. Encourage oral fluids
B. Place the client in a quiet, darkened room and assess neurologic status
C. Encourage ambulation
D. Administer an oral analgesic
Answer: Place the client in a quiet, darkened room and assess neurologic
status
Rationale: Severe headache and visual disturbances are signs of worsening
preeclampsia and possible impending seizure. Reducing environmental
stimulation and promptly assessing neurologic status are priorities.
2. A pregnant client with preeclampsia is receiving magnesium sulfate.
Which finding requires immediate intervention?
A. Respiratory rate of 10/min
B. Urine output of 40 mL/hr
C. Blood pressure of 150/94 mm Hg
D. Patellar reflexes of 2+
Answer: Respiratory rate of 10/min
Rationale: Magnesium sulfate toxicity can cause respiratory depression. A
respiratory rate below 12/min requires immediate assessment and possible
discontinuation of the infusion. Calcium gluconate is the antidote.
, 3. A client at 34 weeks' gestation with placenta previa is admitted with
painless bright-red vaginal bleeding. Which prescription should the nurse
question?
A. Monitor fetal heart rate
B. Assess maternal vital signs
C. Perform a digital vaginal examination
D. Establish intravenous access
Answer: Perform a digital vaginal examination
Rationale: Vaginal examination can disrupt the placenta and cause severe
hemorrhage in a client with placenta previa. Vaginal examinations are
avoided unless placenta previa has been excluded.
4. A client at 30 weeks' gestation presents with vaginal bleeding and severe
abdominal pain. The uterus is firm and tender. Which condition should
the nurse suspect?
A. Placenta previa
B. Abruptio placentae
C. Preterm premature rupture of membranes
D. Cervical insufficiency
Answer: Abruptio placentae
Rationale: Abruptio placentae typically causes painful vaginal bleeding,
uterine tenderness, and a firm or rigid uterus. Placenta previa classically
causes painless bleeding.
5. A client with gestational diabetes is prescribed insulin. Which instruction
is most important?
A. Skip meals when glucose is elevated
B. Maintain consistent carbohydrate intake and monitor blood glucose
C. Stop insulin when nausea occurs
D. Avoid all carbohydrates
Answer: Maintain consistent carbohydrate intake and monitor blood glucose
,Rationale: Consistent carbohydrate intake and glucose monitoring help
prevent both hyperglycemia and hypoglycemia during pregnancy. Insulin
requirements can change throughout pregnancy.
6. A pregnant client with gestational diabetes asks why blood glucose
control is important. Which response is best?
A. "It prevents all pregnancy complications."
B. "Poor glucose control can increase the risk of fetal macrosomia and neonatal
hypoglycemia."
C. "It prevents the need for cesarean birth in every case."
D. "It eliminates the need for fetal monitoring."
Answer: Poor glucose control can increase the risk of fetal macrosomia and
neonatal hypoglycemia.
Rationale: Maternal hyperglycemia can cause excessive fetal growth and
increased fetal insulin production, placing the newborn at risk for
hypoglycemia after birth.
7. A client with preterm premature rupture of membranes at 31 weeks'
gestation is admitted. Which assessment finding is most concerning?
A. Clear fluid leakage
B. Maternal temperature of 38.2°C (100.8°F)
C. Mild pelvic pressure
D. Fetal heart rate of 140/min
Answer: Maternal temperature of 38.2°C (100.8°F)
Rationale: Maternal fever after membrane rupture may indicate intra-
amniotic infection, which can threaten both the mother and fetus.
8. A client at 29 weeks' gestation is receiving betamethasone. The nurse
explains that the medication is given primarily to:
A. Prevent maternal hypertension
B. Promote fetal lung maturation
C. Stop uterine contractions permanently
D. Prevent gestational diabetes
, Answer: Promote fetal lung maturation
Rationale: Antenatal corticosteroids such as betamethasone accelerate fetal
lung maturation and reduce complications associated with preterm birth.
9. A pregnant client with severe preeclampsia is receiving magnesium
sulfate. Which medication should the nurse ensure is readily available?
A. Protamine sulfate
B. Vitamin K
C. Calcium gluconate
D. Naloxone
Answer: Calcium gluconate
Rationale: Calcium gluconate is the antidote for magnesium sulfate toxicity
and should be immediately available when magnesium therapy is
administered.
10.A client with chronic hypertension is pregnant. Which complication is the
nurse most concerned about?
A. Hyperemesis gravidarum
B. Superimposed preeclampsia
C. Gestational trophoblastic disease
D. Cervical insufficiency
Answer: Superimposed preeclampsia
Rationale: Chronic hypertension increases the risk of developing preeclampsia
on top of the preexisting hypertension, known as superimposed
preeclampsia.
11.A client with preeclampsia has a platelet count of 78,000/mm³, elevated
liver enzymes, and severe right upper-quadrant pain. Which
complication should the nurse suspect?
A. HELLP syndrome
B. Hyperemesis gravidarum
C. Placenta previa
D. Gestational diabetes
Practice Exam 100 Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026
1. A client at 32 weeks' gestation with severe preeclampsia reports a severe
headache and blurred vision. Which action should the nurse take first?
A. Encourage oral fluids
B. Place the client in a quiet, darkened room and assess neurologic status
C. Encourage ambulation
D. Administer an oral analgesic
Answer: Place the client in a quiet, darkened room and assess neurologic
status
Rationale: Severe headache and visual disturbances are signs of worsening
preeclampsia and possible impending seizure. Reducing environmental
stimulation and promptly assessing neurologic status are priorities.
2. A pregnant client with preeclampsia is receiving magnesium sulfate.
Which finding requires immediate intervention?
A. Respiratory rate of 10/min
B. Urine output of 40 mL/hr
C. Blood pressure of 150/94 mm Hg
D. Patellar reflexes of 2+
Answer: Respiratory rate of 10/min
Rationale: Magnesium sulfate toxicity can cause respiratory depression. A
respiratory rate below 12/min requires immediate assessment and possible
discontinuation of the infusion. Calcium gluconate is the antidote.
, 3. A client at 34 weeks' gestation with placenta previa is admitted with
painless bright-red vaginal bleeding. Which prescription should the nurse
question?
A. Monitor fetal heart rate
B. Assess maternal vital signs
C. Perform a digital vaginal examination
D. Establish intravenous access
Answer: Perform a digital vaginal examination
Rationale: Vaginal examination can disrupt the placenta and cause severe
hemorrhage in a client with placenta previa. Vaginal examinations are
avoided unless placenta previa has been excluded.
4. A client at 30 weeks' gestation presents with vaginal bleeding and severe
abdominal pain. The uterus is firm and tender. Which condition should
the nurse suspect?
A. Placenta previa
B. Abruptio placentae
C. Preterm premature rupture of membranes
D. Cervical insufficiency
Answer: Abruptio placentae
Rationale: Abruptio placentae typically causes painful vaginal bleeding,
uterine tenderness, and a firm or rigid uterus. Placenta previa classically
causes painless bleeding.
5. A client with gestational diabetes is prescribed insulin. Which instruction
is most important?
A. Skip meals when glucose is elevated
B. Maintain consistent carbohydrate intake and monitor blood glucose
C. Stop insulin when nausea occurs
D. Avoid all carbohydrates
Answer: Maintain consistent carbohydrate intake and monitor blood glucose
,Rationale: Consistent carbohydrate intake and glucose monitoring help
prevent both hyperglycemia and hypoglycemia during pregnancy. Insulin
requirements can change throughout pregnancy.
6. A pregnant client with gestational diabetes asks why blood glucose
control is important. Which response is best?
A. "It prevents all pregnancy complications."
B. "Poor glucose control can increase the risk of fetal macrosomia and neonatal
hypoglycemia."
C. "It prevents the need for cesarean birth in every case."
D. "It eliminates the need for fetal monitoring."
Answer: Poor glucose control can increase the risk of fetal macrosomia and
neonatal hypoglycemia.
Rationale: Maternal hyperglycemia can cause excessive fetal growth and
increased fetal insulin production, placing the newborn at risk for
hypoglycemia after birth.
7. A client with preterm premature rupture of membranes at 31 weeks'
gestation is admitted. Which assessment finding is most concerning?
A. Clear fluid leakage
B. Maternal temperature of 38.2°C (100.8°F)
C. Mild pelvic pressure
D. Fetal heart rate of 140/min
Answer: Maternal temperature of 38.2°C (100.8°F)
Rationale: Maternal fever after membrane rupture may indicate intra-
amniotic infection, which can threaten both the mother and fetus.
8. A client at 29 weeks' gestation is receiving betamethasone. The nurse
explains that the medication is given primarily to:
A. Prevent maternal hypertension
B. Promote fetal lung maturation
C. Stop uterine contractions permanently
D. Prevent gestational diabetes
, Answer: Promote fetal lung maturation
Rationale: Antenatal corticosteroids such as betamethasone accelerate fetal
lung maturation and reduce complications associated with preterm birth.
9. A pregnant client with severe preeclampsia is receiving magnesium
sulfate. Which medication should the nurse ensure is readily available?
A. Protamine sulfate
B. Vitamin K
C. Calcium gluconate
D. Naloxone
Answer: Calcium gluconate
Rationale: Calcium gluconate is the antidote for magnesium sulfate toxicity
and should be immediately available when magnesium therapy is
administered.
10.A client with chronic hypertension is pregnant. Which complication is the
nurse most concerned about?
A. Hyperemesis gravidarum
B. Superimposed preeclampsia
C. Gestational trophoblastic disease
D. Cervical insufficiency
Answer: Superimposed preeclampsia
Rationale: Chronic hypertension increases the risk of developing preeclampsia
on top of the preexisting hypertension, known as superimposed
preeclampsia.
11.A client with preeclampsia has a platelet count of 78,000/mm³, elevated
liver enzymes, and severe right upper-quadrant pain. Which
complication should the nurse suspect?
A. HELLP syndrome
B. Hyperemesis gravidarum
C. Placenta previa
D. Gestational diabetes
