NCLEX maternity and newborn practice questions
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Maternity is the densest part of health promotion on the exam, and it is graded on danger signs: preeclampsia, late decelerations, a boggy uterus, a newborn who is not transitioning. Ten questions across the antepartum, intrapartum, postpartum, and newborn periods, each with the finding that decides the answer.
Written and reviewed by Dana Whitfield, RN, MSN · Updated August 2026
Health promotion and maintenance
The maternity and newborn set, all 10 free
Answer, check, and read why each of the four options wins or loses.
Maternity and newborn
Question 1 of 10
A client at 34 weeks gestation presents with a blood pressure of 164/108, 3+ proteinuria, a severe headache, and epigastric pain. Which nursing action takes priority?
Not quite — the answer is B
Why each option is right or wrong
A. Obtain a 24-hour urine collection for total protein
A 24-hour collection takes a full day and only confirms proteinuria already documented, doing nothing to prevent an imminent eclamptic seizure.
B. Initiate seizure precautions and prepare to administer magnesium sulfate as prescribed
Severe-range hypertension with headache and epigastric pain signals impending eclampsia, so seizure precautions and magnesium sulfate protect mother and fetus.
C. Encourage ambulation to promote circulation
Ambulation adds stimulation and injury risk in a client who could seize at any moment; a quiet, low-stimulation environment is required.
D. Schedule a follow-up prenatal visit in one week
Waiting a week for follow-up ignores a hypertensive emergency that demands immediate treatment and likely delivery planning at 34 weeks.
Key takeaway
Headache and epigastric pain with severe-range hypertension indicate preeclampsia with severe features and imminent risk of eclamptic seizure, so magnesium sulfate prophylaxis and seizure precautions protect both client and fetus. A 24-hour urine collection may confirm the diagnosis but takes a full day and does nothing to prevent the immediate threat of seizure.
During labor, the nurse observes fetal heart rate decelerations that begin after the peak of each contraction and return to baseline after the contraction ends. Which action should the nurse take first?
Not quite — the answer is C
Why each option is right or wrong
A. Increase the oxytocin infusion rate to shorten labor
Increasing oxytocin intensifies contractions and further reduces placental perfusion, so the infusion is stopped rather than titrated up with late decelerations.
B. Prepare the client for immediate cesarean birth
Cesarean birth may follow if intrauterine resuscitation fails, but noninvasive corrective measures such as repositioning are attempted first.
C. Reposition the client to a left lateral position
Late decelerations reflect uteroplacental insufficiency, and left lateral positioning relieves aortocaval compression to improve placental blood flow immediately.
D. Document the reassuring fetal heart rate pattern
This pattern is not reassuring, since decelerations beginning after the peak and recovering late indicate hypoxia requiring intervention rather than documentation alone.
Key takeaway
Late decelerations indicate uteroplacental insufficiency, and left lateral repositioning relieves aortocaval compression to improve placental perfusion as the first corrective measure, followed by stopping oxytocin, giving oxygen, and increasing IV fluids. Increasing oxytocin would intensify contractions and further reduce placental blood flow, worsening fetal hypoxia.
Immediately after spontaneous rupture of membranes, the nurse sees a loop of umbilical cord protruding from the vagina and the fetal heart rate drops to 78 beats per minute. Which action should the nurse take first?
Not quite — the answer is A
Why each option is right or wrong
A. Apply a gloved hand to lift the presenting part off the cord and call for help
Manually lifting the presenting part off the cord restores fetal oxygenation and is held continuously until emergency cesarean birth is accomplished.
B. Attempt to gently replace the cord into the vagina
Handling or replacing the cord causes vasospasm that worsens fetal hypoxia, so the cord is never pushed back into the vagina.
C. Place the client in high Fowler position
High Fowler position increases pressure of the presenting part against the cord; knee-chest or Trendelenburg positioning relieves compression instead.
D. Obtain a set of maternal vital signs
Maternal vital signs are needed before surgery, but obtaining them first leaves the cord compressed while the fetal heart rate remains at 78.
Key takeaway
Manually elevating the presenting part relieves cord compression and restores fetal oxygenation while the team prepares for emergency cesarean birth, and the nurse maintains this position continuously. Attempting to replace the cord causes vasospasm and further compromises fetal circulation, so it is contraindicated.
A client receiving a magnesium sulfate infusion for preeclampsia has a respiratory rate of 10, absent deep tendon reflexes, and urine output of 20 mL/hr. Which action should the nurse take?
Not quite — the answer is D
Why each option is right or wrong
A. Increase the infusion rate to achieve a therapeutic level
Increasing the rate would drive serum magnesium higher in a client already showing toxicity, risking respiratory arrest and cardiac collapse.
B. Administer an additional loading dose
A second loading dose adds magnesium to a client whose reflexes are already absent, compounding the toxicity instead of reversing it.
C. Continue the infusion and reassess in 1 hour
Waiting an hour with a respiratory rate of 10 and absent reflexes allows toxicity to progress toward respiratory and cardiac arrest.
D. Stop the infusion and prepare to administer calcium gluconate
Respiratory depression, absent reflexes, and oliguria indicate magnesium toxicity, so the infusion is stopped and calcium gluconate, the antidote, is given.
Key takeaway
Respiratory depression, loss of reflexes, and oliguria are signs of magnesium toxicity, so the infusion is stopped immediately and calcium gluconate, the antidote, is given to prevent respiratory and cardiac arrest. Continuing or increasing the infusion would allow serum magnesium to rise further and could be fatal.
Thirty minutes after a vaginal birth, a client saturates a perineal pad in 10 minutes. The fundus is boggy and located above the umbilicus and displaced to the right. Which action should the nurse take first?
Not quite — the answer is B
Why each option is right or wrong
A. Administer methylergonovine intramuscularly
Methylergonovine may be needed if bleeding continues, but it is a dependent order and is contraindicated in hypertension, so massage comes first.
B. Massage the fundus until firm and then assist the client to empty the bladder
A boggy, elevated, right-deviated fundus indicates atony with bladder distention, so massage plus emptying the bladder restores uterine tone immediately.
C. Begin a rapid infusion of lactated Ringer solution
Rapid fluid infusion supports circulating volume but does not stop the bleeding; the uterus must contract to compress the placental site vessels.
D. Notify the provider and prepare for surgical exploration
Surgical exploration is reserved for retained fragments or lacerations after simpler measures fail, and this cause is correctable at the bedside.
Key takeaway
A boggy, elevated, and right-deviated fundus indicates uterine atony with bladder distention, and fundal massage plus bladder emptying are the immediate independent nursing actions that restore uterine tone and control bleeding. Methylergonovine may be needed next but is a dependent intervention and is contraindicated in hypertensive clients, so massage comes first.
A first-time mother who is breastfeeding reports sore, cracked nipples on day 3 postpartum. Which teaching should the nurse provide?
Not quite — the answer is A
Why each option is right or wrong
A. Ensure the infant latches with a wide mouth taking in the nipple and much of the areola
Most nipple trauma results from a shallow latch, so a wide-mouth latch that includes much of the areola relieves pain and protects supply.
B. Limit each feeding to 5 minutes per breast until soreness resolves
Shortening feedings does not correct the shallow latch causing the damage and risks engorgement, plugged ducts, and a declining milk supply.
C. Wash the nipples with soap before and after each feeding
Soap strips the protective lubricating secretions of the Montgomery glands, drying the skin further and worsening the cracking and pain.
D. Offer formula supplementation to allow the nipples to heal for 48 hours
Formula supplementation reduces breast stimulation and milk supply and may cause nipple confusion without correcting the underlying latch problem.
Key takeaway
Most nipple trauma results from shallow latch, so correcting the latch so the infant takes in the areola rather than just the nipple resolves the pain and protects the milk supply. Soap removes the protective secretions of the Montgomery glands and further dries and cracks the skin, worsening the problem.
At 1 minute of life a newborn has a heart rate of 128, a weak slow cry, some flexion of the extremities, a grimace with suctioning, and a pink body with blue hands and feet. What Apgar score should the nurse assign?
Not quite — the answer is C
Why each option is right or wrong
A. 5
Five is one point too low, because a heart rate above 100 earns the full two points that this total undercounts.
B. 9
Nine would require a vigorous cry, active flexion, and completely pink color, none of which match this newborn's weak cry and acrocyanosis.
C. 6
Heart rate 2, weak cry 1, some flexion 1, grimace 1, and acrocyanosis 1 total 6, indicating moderate difficulty needing stimulation.
D. 8
Eight overestimates this newborn, since the weak cry, partial flexion, and grimace each earn only one point rather than two.
Key takeaway
Heart rate above 100 scores 2, weak cry scores 1, some flexion scores 1, grimace scores 1, and acrocyanosis scores 1, for a total of 6, which indicates moderate difficulty requiring stimulation and close monitoring. A score of 9 would require nearly all parameters to be optimal, which does not match the weak respiratory effort and limited tone described.
A client who is Rh negative gives birth to an Rh positive newborn, and the direct Coombs test on the newborn is negative. Which action should the nurse anticipate?
Not quite — the answer is D
Why each option is right or wrong
A. No further intervention is needed because the newborn is Rh positive
It is precisely because the newborn is Rh positive that prophylaxis is needed; doing nothing risks maternal sensitization that endangers future pregnancies.
B. Administering Rho(D) immune globulin to the newborn
Rho(D) immune globulin is given to the Rh negative mother and never to the newborn, so this reflects a misunderstanding of the therapy.
C. Preparing the newborn for an exchange transfusion
Exchange transfusion treats severe hemolytic disease, but the negative direct Coombs test shows the newborn's cells are not coated with maternal antibody.
D. Administering Rho(D) immune globulin to the mother within 72 hours of birth
The Rh negative mother receives Rho(D) immune globulin within 72 hours of birth to prevent antibody formation that would threaten later pregnancies.
Key takeaway
An Rh negative mother who delivers an Rh positive infant receives Rho(D) immune globulin within 72 hours to prevent maternal antibody formation that would endanger future pregnancies. The immune globulin is never given to the newborn, and an exchange transfusion is unnecessary because the negative Coombs test shows the infant is not currently sensitized.
A newborn whose mother had poorly controlled gestational diabetes is macrosomic and, at 1 hour of age, is jittery and diaphoretic with a weak cry. Which action should the nurse take first?
Not quite — the answer is A
Why each option is right or wrong
A. Obtain a heel-stick blood glucose level
Jitteriness, diaphoresis, and a weak cry in a macrosomic infant of a diabetic mother demand an immediate heel-stick glucose measurement.
B. Place the newborn under a radiant warmer and recheck in 30 minutes
A radiant warmer addresses cold stress, and waiting 30 minutes delays detection of hypoglycemia that can rapidly cause seizures and neurologic injury.
C. Swaddle the newborn and place him in the bassinet to rest
Swaddling and letting the infant rest treats these findings as normal newborn behavior and postpones recognition of a dangerous glucose deficit.
D. Notify the provider to order a septic workup
Sepsis can mimic these signs, but a glucose check is faster and noninvasive and addresses the far more likely cause here.
Key takeaway
Infants of diabetic mothers develop hyperinsulinemia in utero and are at high risk for hypoglycemia, and jitteriness with a weak cry demands immediate glucose measurement so treatment can begin. Simply swaddling and allowing the infant to rest delays detection of a condition that can rapidly cause seizures and neurologic injury.
Ten minutes after an epidural is placed, a laboring client's blood pressure falls from 118/72 to 82/46 and the fetal heart rate baseline drops to 100 beats per minute. Which action should the nurse take first?
Not quite — the answer is C
Why each option is right or wrong
A. Administer the prescribed dose of ephedrine
Ephedrine is an appropriate rescue if positioning and fluids fail, but it is a dependent order that should not precede noninvasive first-line measures.
B. Place the client in a semi-Fowler position and encourage slow breathing
Semi-Fowler position does not relieve aortocaval compression, and slow breathing does nothing for the sympathetic blockade causing this vasodilation and hypotension.
C. Turn the client to the left side and increase the IV fluid infusion rate
Lateral positioning relieves aortocaval compression while an IV fluid bolus counters epidural-induced vasodilation, restoring maternal pressure and placental perfusion.
D. Prepare the client for an immediate cesarean birth
Cesarean birth is premature, since epidural-induced hypotension usually responds quickly to repositioning and fluids with recovery of the fetal heart rate.
Key takeaway
Sympathetic blockade from the epidural causes vasodilation and hypotension, and lateral positioning with an IV fluid bolus is the first-line nursing intervention to restore maternal blood pressure and placental perfusion. Ephedrine is an appropriate follow-up if positioning and fluids fail, but it is a dependent intervention that should not precede the immediate noninvasive measures.
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