1|Page
Latest 2025/2026 Maternal Newborn Nursing Practice
B: 60 Essential Questions & Answers to Pass Your
Exam on the First Try.
A nurse is caring for a client who is 4 hr postpartum. The nurse finds a
small amount of lochia rubra on the client's perineal pad. The fundus is
midline and firm at the umbilicus. Which of the following actions should
the nurse take? - ANSWER-*check for blood under the client's
buttocks*
The nurse should check for blood under the client's buttock to evaluate
the amount of lochia flow and to check for pooling of blood that would
otherwise be missed.
A nurse is reinforcing teaching about immunizations with a woman in
her first trimester of pregnancy whose diagnostic testing indicates she
does not have an immunity to rubella. The nurse should recommend that
the client receive a measles, mumps, rubella (MMR) vaccine at which of
the following times? - ANSWER-*prior to discharge from the hospital
AFTER giving birth*
The nurse should recommend the client receive the MMR vaccine
following delivery, so she is protected from contracting rubella then and
during any subsequent pregnancies.
A nurse is caring for a client who is at 36 weeks of gestation and has
suspected placenta previa. For which of the following findings should
the nurse monitor the client? - ANSWER-*a large amount of bright red
vaginal bleeding without pain*
,2|Page
With placenta previa, the placenta implants in the lower part of the
uterus, partly or completely obstructing the cervical os, or outlet to the
vagina. Clients who have placenta previa have sudden, painless vaginal
bleeding, typically in the third trimester.
A nurse is teaching a new mother about signs of effective breastfeeding
of her newborn. Which of the following information should the nurse
include in the teaching? - ANSWER-*your baby can lose 5% of body
weight during the first few days of life*
The nurse should instruct the mother that the baby can have a weight
loss between 5% and 10% of their birth weight during the first 3 days of
life. Breastfed infants usually regain birth weight by their second or third
week of life.
A nurse in a provider's office is reinforcing teaching about home care
with a client who has mild preeclampsia. Which of the following
information should the nurse include in the teaching? - ANSWER-
*perform daily fetal movements/kick counts*
The client should count the number of fetal movements felt in one hour,
preferably after a meal. Fetal movements are a reassuring sign of fetal
oxygenation. The client should notify the provider if less than 3
movements per hour are noted, as this warrants further evaluation.
A nurse is caring for a newborn immediately following delivery. After
assuring a patent airway, which of the following actions should be the
nurse's priority? - ANSWER-*dry the newborn*
Drying the newborn is the priority action the nurse should take. Failure
to dry the newborn can result in cold stress, which poses the greatest risk
to the infant's safety. Cold stress increases oxygen demand and can
result in respiratory distress and hypoglycemia.
,3|Page
A nurse is collecting data from a client who is 14 hr postpartum. The
nurse notes: breasts soft; fundus firm, slightly deviated to the right;
moderate lochia rubra; temperature 37.7° C (100° F), pulse rate 88./min,
respiratory rate 18/min. Which of the following actions should the nurse
perform? - ANSWER-*ask the client to empty her bladder*
Whenever the fundus is deviated from the midline, a full bladder should
be considered as a potential cause. A full bladder could result in
complications such as uterine atony or infection.
A nurse is assisting with the care of a newborn following a vaginal
delivery. Which of the following actions should the nurse perform first?
- ANSWER-*clear the respiratory tract*
Using the airway, breathing, circulation (ABC) priority-setting
framework, the first action the nurse should take is to open the airway of
a newborn who was just delivered.
A nurse is caring for a client in the prenatal clinic who has a possible
ectopic pregnancy at 8 weeks of gestation. Which of the following
findings should the nurse expect? - ANSWER-*pelvic pain*
The client will experience a dull to colicky pain at the beginning,
progressing to a sharp, stabbing pain as the tube stretches.
A nurse is caring for several newborn clients. For which of the following
findings should the nurse notify the charge nurse? - ANSWER-A blood
glucose fingerstick of 40 mg/dL for an infant who is 1-hr old
Acrocyanosis in an infant who is 2-hr old
*Jaundice in an infant who is 4-hr old*
A hematocrit of 60% in an infant who is 8-hr old
, 4|Page
*Rationale*
Jaundice occurring within the first 24 hr of life is related to some type of
hemolytic pathology and requires notifying the charge nurse
immediately
A nurse is caring for a newborn who has a myelomeningocele and is
admitted to the newborn intensive care unit (NICU) to await surgery.
Which of the following nursing goals is priority in the care of this
infant? - ANSWER-*maintain integrity of the sac*
The greatest risk to this client is injury from damage to the exposed
spinal cord and fluid filled sac; therefore, the priority intervention is to
maintain the integrity of the sac.
A nurse is assisting with the care of a client who is at 32 weeks of
gestation and in labor. The client asks the nurse, "Will my baby be
okay?" Which of the following responses should the nurse make? -
ANSWER-*you must be feeling very scared*
This response illustrates the therapeutic communication technique of
restatement. The nurse shows empathy for the client by focusing on the
client's feelings and recognizing that the client is scared about the safety
of her newborn. This open-ended statement encourages further
communication by the client.
A nurse is caring for a client who wants to know if it is possible to have
a vaginal birth after a cesarean birth (VBAC). Which of the following
statements by the nurse is appropriate? - ANSWER-*the primary
consideration is what type of incision you had*
A transverse incision (also known as a horizontal incision) cuts across
the lower, thinner part of the uterus. It is used during most cesarean
births and makes a VBAC possible. A vertical incision cuts up and down
through the uterine muscles that strongly contract during labor and
might cause uterine rupture during a VBAC.
Latest 2025/2026 Maternal Newborn Nursing Practice
B: 60 Essential Questions & Answers to Pass Your
Exam on the First Try.
A nurse is caring for a client who is 4 hr postpartum. The nurse finds a
small amount of lochia rubra on the client's perineal pad. The fundus is
midline and firm at the umbilicus. Which of the following actions should
the nurse take? - ANSWER-*check for blood under the client's
buttocks*
The nurse should check for blood under the client's buttock to evaluate
the amount of lochia flow and to check for pooling of blood that would
otherwise be missed.
A nurse is reinforcing teaching about immunizations with a woman in
her first trimester of pregnancy whose diagnostic testing indicates she
does not have an immunity to rubella. The nurse should recommend that
the client receive a measles, mumps, rubella (MMR) vaccine at which of
the following times? - ANSWER-*prior to discharge from the hospital
AFTER giving birth*
The nurse should recommend the client receive the MMR vaccine
following delivery, so she is protected from contracting rubella then and
during any subsequent pregnancies.
A nurse is caring for a client who is at 36 weeks of gestation and has
suspected placenta previa. For which of the following findings should
the nurse monitor the client? - ANSWER-*a large amount of bright red
vaginal bleeding without pain*
,2|Page
With placenta previa, the placenta implants in the lower part of the
uterus, partly or completely obstructing the cervical os, or outlet to the
vagina. Clients who have placenta previa have sudden, painless vaginal
bleeding, typically in the third trimester.
A nurse is teaching a new mother about signs of effective breastfeeding
of her newborn. Which of the following information should the nurse
include in the teaching? - ANSWER-*your baby can lose 5% of body
weight during the first few days of life*
The nurse should instruct the mother that the baby can have a weight
loss between 5% and 10% of their birth weight during the first 3 days of
life. Breastfed infants usually regain birth weight by their second or third
week of life.
A nurse in a provider's office is reinforcing teaching about home care
with a client who has mild preeclampsia. Which of the following
information should the nurse include in the teaching? - ANSWER-
*perform daily fetal movements/kick counts*
The client should count the number of fetal movements felt in one hour,
preferably after a meal. Fetal movements are a reassuring sign of fetal
oxygenation. The client should notify the provider if less than 3
movements per hour are noted, as this warrants further evaluation.
A nurse is caring for a newborn immediately following delivery. After
assuring a patent airway, which of the following actions should be the
nurse's priority? - ANSWER-*dry the newborn*
Drying the newborn is the priority action the nurse should take. Failure
to dry the newborn can result in cold stress, which poses the greatest risk
to the infant's safety. Cold stress increases oxygen demand and can
result in respiratory distress and hypoglycemia.
,3|Page
A nurse is collecting data from a client who is 14 hr postpartum. The
nurse notes: breasts soft; fundus firm, slightly deviated to the right;
moderate lochia rubra; temperature 37.7° C (100° F), pulse rate 88./min,
respiratory rate 18/min. Which of the following actions should the nurse
perform? - ANSWER-*ask the client to empty her bladder*
Whenever the fundus is deviated from the midline, a full bladder should
be considered as a potential cause. A full bladder could result in
complications such as uterine atony or infection.
A nurse is assisting with the care of a newborn following a vaginal
delivery. Which of the following actions should the nurse perform first?
- ANSWER-*clear the respiratory tract*
Using the airway, breathing, circulation (ABC) priority-setting
framework, the first action the nurse should take is to open the airway of
a newborn who was just delivered.
A nurse is caring for a client in the prenatal clinic who has a possible
ectopic pregnancy at 8 weeks of gestation. Which of the following
findings should the nurse expect? - ANSWER-*pelvic pain*
The client will experience a dull to colicky pain at the beginning,
progressing to a sharp, stabbing pain as the tube stretches.
A nurse is caring for several newborn clients. For which of the following
findings should the nurse notify the charge nurse? - ANSWER-A blood
glucose fingerstick of 40 mg/dL for an infant who is 1-hr old
Acrocyanosis in an infant who is 2-hr old
*Jaundice in an infant who is 4-hr old*
A hematocrit of 60% in an infant who is 8-hr old
, 4|Page
*Rationale*
Jaundice occurring within the first 24 hr of life is related to some type of
hemolytic pathology and requires notifying the charge nurse
immediately
A nurse is caring for a newborn who has a myelomeningocele and is
admitted to the newborn intensive care unit (NICU) to await surgery.
Which of the following nursing goals is priority in the care of this
infant? - ANSWER-*maintain integrity of the sac*
The greatest risk to this client is injury from damage to the exposed
spinal cord and fluid filled sac; therefore, the priority intervention is to
maintain the integrity of the sac.
A nurse is assisting with the care of a client who is at 32 weeks of
gestation and in labor. The client asks the nurse, "Will my baby be
okay?" Which of the following responses should the nurse make? -
ANSWER-*you must be feeling very scared*
This response illustrates the therapeutic communication technique of
restatement. The nurse shows empathy for the client by focusing on the
client's feelings and recognizing that the client is scared about the safety
of her newborn. This open-ended statement encourages further
communication by the client.
A nurse is caring for a client who wants to know if it is possible to have
a vaginal birth after a cesarean birth (VBAC). Which of the following
statements by the nurse is appropriate? - ANSWER-*the primary
consideration is what type of incision you had*
A transverse incision (also known as a horizontal incision) cuts across
the lower, thinner part of the uterus. It is used during most cesarean
births and makes a VBAC possible. A vertical incision cuts up and down
through the uterine muscles that strongly contract during labor and
might cause uterine rupture during a VBAC.
