Maternal Newborn Nursing Final Exam Study
Guide: 200 Practice Questions with Answers
& Explanations Guaranteed Pass
INTRODUCTION:
This comprehensive 200-question practice exam is designed to help candidates
prepare for the Maternal Newborn Nursing certification examination. The
questions cover key content areas including antepartum care, intrapartum
management, postpartum recovery, newborn assessment and care, high-risk
conditions, and pharmacological interventions. Each question includes the correct
answer in bold and a detailed rationale in italics to reinforce essential concepts
and clinical reasoning. Use this exam to assess your knowledge, identify areas for
further study, and build confidence for your certification journey.
1. A pregnant client at 38 weeks gestation reports a sudden gush of fluid from the
vagina. What is the nurse's priority action?
A) Assess for cervical dilation
B) Check the fluid for meconium
C) Confirm rupture of membranes using nitrazine paper
D) Monitor fetal heart rate
Answer: D
Rationale: After rupture of membranes, the priority is to assess the fetal heart rate
to detect umbilical cord compression or prolapse. Monitoring fetal well-being takes
precedence over confirming membrane rupture or checking for meconium.
2. A newborn has Apgar scores of 6 at 1 minute and 8 at 5 minutes. Which intervention
is most appropriate?
A) Initiate resuscitation with positive pressure ventilation
B) Continue routine newborn care with close observation
, C) Administer naloxone for respiratory depression
D) Intubate the newborn immediately
Answer: B
Rationale: An Apgar score of 6 at 1 minute indicates moderate depression, but
improvement to 8 at 5 minutes shows good transition. Routine care with
observation is appropriate; resuscitation is not indicated for scores above 7 at 5
minutes.
3. A client with preeclampsia is receiving IV magnesium sulfate. Which finding indicates
magnesium toxicity?
A) Deep tendon reflexes 2+
B) Urinary output 35 mL/hour
C) Respiratory rate 10 breaths/min
D) Blood pressure 140/90 mm Hg
Answer: C
*Rationale: Magnesium toxicity causes respiratory depression (less than 12 breaths/min),
loss of deep tendon reflexes, and decreased urine output. A respiratory rate of 10
indicates toxicity requiring immediate intervention.*
4. The nurse is assessing a post-term newborn. Which finding is most consistent with
post-maturity syndrome?
A) Abundant vernix caseosa
B) Dry, peeling skin with long fingernails
C) Flat areolae and scrotal rugae
D) Bright red, smooth umbilical cord
Answer: B
*Rationale: Post-term newborns lose vernix and subcutaneous fat, leading to dry,
peeling skin (desquamation) and long fingernails. Vernix decreases after 40 weeks, and
the cord may become stained green from meconium.*
5. A laboring client requests an epidural for pain relief. Which laboratory value would
contraindicate placement?
A) Hemoglobin 11 g/dL
B) Platelet count 80,000/mm³
C) White blood cell count 12,000/mm³
D) Glucose 90 mg/dL
Answer: B
*Rationale: A platelet count below 100,000/mm³ increases bleeding risk during epidural
, placement, potentially causing epidural hematoma. Normal platelet count is 150,000–
450,000/mm³.*
6. The nurse notes late decelerations on the fetal monitor. Which action should the
nurse take first?
A) Increase IV fluids
B) Turn the client to the left lateral position
C) Administer oxygen via face mask
D) Notify the provider
Answer: B
Rationale: Late decelerations indicate uteroplacental insufficiency. Positioning the
client on her left side improves placental perfusion by relieving aortocaval
compression. This is the initial intervention before other measures.
7. A postpartum client with Rh-negative blood delivered an Rh-positive newborn. When
should Rh immune globulin be administered?
A) Within 72 hours of delivery
B) Immediately after delivery of the placenta
C) At the first postpartum visit
D) Only if the mother becomes sensitized
Answer: A
*Rationale: Rh immune globulin (RhoGAM) should be given within 72 hours of delivery
to prevent Rh sensitization. It binds fetal Rh-positive RBCs before maternal antibody
formation occurs.*
8. A term newborn is 12 hours old. What respiratory rate finding requires further
assessment?
A) 30 breaths/min while sleeping
B) 40 breaths/min when awake
C) 55 breaths/min with mild grunting
D) 48 breaths/min with crying
Answer: C
*Rationale: Grunting indicates respiratory distress. Normal newborn respiratory rate is
30–60 breaths/min, but grunting, nasal flaring, or retractions are abnormal regardless of
rate.*
9. The nurse is teaching a prenatal class about signs of labor. Which sign indicates true
labor?
, A) Contractions that decrease with walking
B) Irregular contractions lasting 15 seconds
C) Cervical dilation and effacement
D) Bloody show without contractions
Answer: C
Rationale: Progressive cervical change (dilation and effacement) is the defining
characteristic of true labor. False labor lacks cervical change despite contractions.
10. A client with gestational diabetes has a fasting blood glucose of 105 mg/dL. Which
instruction is most important?
A) Increase your insulin dose independently
B) Report this value to your provider
C) Eat a high-carbohydrate snack
D) Repeat the test in 2 hours
Answer: B
*Rationale: Fasting glucose above 95 mg/dL in gestational diabetes indicates poor
control. The provider needs to adjust the management plan; insulin adjustments should
not be made without instructions.*
11. During the active phase of labor, a client's cervix is 6 cm dilated, contractions every 3
minutes. The nurse notes a sudden increase in pain with a "tearing" sensation. What is
the priority?
A) Reassure the client this is normal
B) Assess for uterine rupture
C) Administer prescribed analgesia
D) Encourage ambulation
Answer: B
Rationale: Sudden, severe pain with a tearing sensation during labor suggests
uterine rupture, especially in a client with prior uterine surgery. Immediate
assessment for signs of fetal distress and maternal hypotension is critical.
12. A newborn is suspected of having neonatal abstinence syndrome (NAS). Which
assessment finding is most indicative?
A) Lethargy and poor feeding
B) High-pitched cry and hypertonicity
C) Hypothermia and bradycardia
D) Flaccid muscle tone and weak suck
Answer: B
Guide: 200 Practice Questions with Answers
& Explanations Guaranteed Pass
INTRODUCTION:
This comprehensive 200-question practice exam is designed to help candidates
prepare for the Maternal Newborn Nursing certification examination. The
questions cover key content areas including antepartum care, intrapartum
management, postpartum recovery, newborn assessment and care, high-risk
conditions, and pharmacological interventions. Each question includes the correct
answer in bold and a detailed rationale in italics to reinforce essential concepts
and clinical reasoning. Use this exam to assess your knowledge, identify areas for
further study, and build confidence for your certification journey.
1. A pregnant client at 38 weeks gestation reports a sudden gush of fluid from the
vagina. What is the nurse's priority action?
A) Assess for cervical dilation
B) Check the fluid for meconium
C) Confirm rupture of membranes using nitrazine paper
D) Monitor fetal heart rate
Answer: D
Rationale: After rupture of membranes, the priority is to assess the fetal heart rate
to detect umbilical cord compression or prolapse. Monitoring fetal well-being takes
precedence over confirming membrane rupture or checking for meconium.
2. A newborn has Apgar scores of 6 at 1 minute and 8 at 5 minutes. Which intervention
is most appropriate?
A) Initiate resuscitation with positive pressure ventilation
B) Continue routine newborn care with close observation
, C) Administer naloxone for respiratory depression
D) Intubate the newborn immediately
Answer: B
Rationale: An Apgar score of 6 at 1 minute indicates moderate depression, but
improvement to 8 at 5 minutes shows good transition. Routine care with
observation is appropriate; resuscitation is not indicated for scores above 7 at 5
minutes.
3. A client with preeclampsia is receiving IV magnesium sulfate. Which finding indicates
magnesium toxicity?
A) Deep tendon reflexes 2+
B) Urinary output 35 mL/hour
C) Respiratory rate 10 breaths/min
D) Blood pressure 140/90 mm Hg
Answer: C
*Rationale: Magnesium toxicity causes respiratory depression (less than 12 breaths/min),
loss of deep tendon reflexes, and decreased urine output. A respiratory rate of 10
indicates toxicity requiring immediate intervention.*
4. The nurse is assessing a post-term newborn. Which finding is most consistent with
post-maturity syndrome?
A) Abundant vernix caseosa
B) Dry, peeling skin with long fingernails
C) Flat areolae and scrotal rugae
D) Bright red, smooth umbilical cord
Answer: B
*Rationale: Post-term newborns lose vernix and subcutaneous fat, leading to dry,
peeling skin (desquamation) and long fingernails. Vernix decreases after 40 weeks, and
the cord may become stained green from meconium.*
5. A laboring client requests an epidural for pain relief. Which laboratory value would
contraindicate placement?
A) Hemoglobin 11 g/dL
B) Platelet count 80,000/mm³
C) White blood cell count 12,000/mm³
D) Glucose 90 mg/dL
Answer: B
*Rationale: A platelet count below 100,000/mm³ increases bleeding risk during epidural
, placement, potentially causing epidural hematoma. Normal platelet count is 150,000–
450,000/mm³.*
6. The nurse notes late decelerations on the fetal monitor. Which action should the
nurse take first?
A) Increase IV fluids
B) Turn the client to the left lateral position
C) Administer oxygen via face mask
D) Notify the provider
Answer: B
Rationale: Late decelerations indicate uteroplacental insufficiency. Positioning the
client on her left side improves placental perfusion by relieving aortocaval
compression. This is the initial intervention before other measures.
7. A postpartum client with Rh-negative blood delivered an Rh-positive newborn. When
should Rh immune globulin be administered?
A) Within 72 hours of delivery
B) Immediately after delivery of the placenta
C) At the first postpartum visit
D) Only if the mother becomes sensitized
Answer: A
*Rationale: Rh immune globulin (RhoGAM) should be given within 72 hours of delivery
to prevent Rh sensitization. It binds fetal Rh-positive RBCs before maternal antibody
formation occurs.*
8. A term newborn is 12 hours old. What respiratory rate finding requires further
assessment?
A) 30 breaths/min while sleeping
B) 40 breaths/min when awake
C) 55 breaths/min with mild grunting
D) 48 breaths/min with crying
Answer: C
*Rationale: Grunting indicates respiratory distress. Normal newborn respiratory rate is
30–60 breaths/min, but grunting, nasal flaring, or retractions are abnormal regardless of
rate.*
9. The nurse is teaching a prenatal class about signs of labor. Which sign indicates true
labor?
, A) Contractions that decrease with walking
B) Irregular contractions lasting 15 seconds
C) Cervical dilation and effacement
D) Bloody show without contractions
Answer: C
Rationale: Progressive cervical change (dilation and effacement) is the defining
characteristic of true labor. False labor lacks cervical change despite contractions.
10. A client with gestational diabetes has a fasting blood glucose of 105 mg/dL. Which
instruction is most important?
A) Increase your insulin dose independently
B) Report this value to your provider
C) Eat a high-carbohydrate snack
D) Repeat the test in 2 hours
Answer: B
*Rationale: Fasting glucose above 95 mg/dL in gestational diabetes indicates poor
control. The provider needs to adjust the management plan; insulin adjustments should
not be made without instructions.*
11. During the active phase of labor, a client's cervix is 6 cm dilated, contractions every 3
minutes. The nurse notes a sudden increase in pain with a "tearing" sensation. What is
the priority?
A) Reassure the client this is normal
B) Assess for uterine rupture
C) Administer prescribed analgesia
D) Encourage ambulation
Answer: B
Rationale: Sudden, severe pain with a tearing sensation during labor suggests
uterine rupture, especially in a client with prior uterine surgery. Immediate
assessment for signs of fetal distress and maternal hypotension is critical.
12. A newborn is suspected of having neonatal abstinence syndrome (NAS). Which
assessment finding is most indicative?
A) Lethargy and poor feeding
B) High-pitched cry and hypertonicity
C) Hypothermia and bradycardia
D) Flaccid muscle tone and weak suck
Answer: B
