**Maternal-Neonatal Momentum: Next Gen
NCLEX Mastery Drills**
1. Nurse assesses laboring pt at 6 cm, contractions Q3min x 60 sec, FHR baseline 150, moderate
variability, late decelerations to 100 after last 3 contractions. Priority action?
💫RATIONALE✔️✔️: Late decels = uteroplacental insufficiency. Turn pt left lateral to improve uterine
blood flow.
💫ANSWER✔️✔️: B. Reposition to left lateral.
2. Newborn, 8 hr old, breastfeeding poorly, jittery, glucose 32 mg/dL. First action?
💫RATIONALE✔️✔️: Neonatal hypoglycemia <40 mg/dL. Feed immediately; if poor suck, IV dextrose 10%
2 mL/kg.
💫ANSWER✔️✔️: A. Breastfeed or give formula now.
3. Pt at 38 weeks, GBS positive, rupture of membranes 6 hr ago, afebrile, contractions Q5min. Order?
💫RATIONALE✔️✔️: GBS prophylaxis required if ROM ≥4 hr or labor onset. Penicillin G 5 million units IV
load then 2.5M Q4H.
💫ANSWER✔️✔️: C. Begin IV penicillin G.
4. Postpartum day 1, G2P2, vaginal delivery, fundus firm at umbilicus, lochia moderate rubra with 2 cm
clots. BP 110/70, HR 80. Action?
💫RATIONALE✔️✔️: Small clots normal first 24 hr. Massage fundus to expel clots, monitor bleeding.
💫ANSWER✔️✔️: B. Massage fundus.
5. Nurse teaching new mom about newborn car seat safety for 5 lb 8 oz (2500g) preterm infant. Which
statement indicates understanding?
💫RATIONALE✔️✔️: Preterm infants need car seat challenge test for desaturation before discharge. Use
at 45° angle.
💫ANSWER✔️✔️: D. “Baby must have a car seat challenge before going home.”
, 6. Pt at 32 weeks with placenta previa, painless bright red bleeding 100 mL, fetal HR 150, contractions
absent. Priority intervention?
💫RATIONALE✔️✔️: Placenta previa: no vaginal exam (can cause catastrophic hemorrhage). Bed rest, IV
access, type & screen.
💫ANSWER✔️✔️: C. Avoid vaginal examination.
7. Nurse assessing newborn male, 12 hr old, left testis palpable in inguinal canal, right testis in scrotum.
Diagnosis?
💫RATIONALE✔️✔️: Cryptorchidism (undescended testis). Refer to urology by 6 months for orchiopexy.
💫ANSWER✔️✔️: A. Cryptorchidism.
8. Pt at 40 weeks, induction with oxytocin at 6 mU/min, contractions Q2min x 90 sec, FHR baseline 160,
minimal variability, no accelerations for 40 min. Action?
💫RATIONALE✔️✔️: Tachysystole + minimal variability + absent accelerations = uterine hyperstimulation.
Stop oxytocin.
💫ANSWER✔️✔️: D. Discontinue oxytocin infusion.
9. Postpartum pt with third-degree laceration reports pain 7/10, perineal edema, unable to void for 8 hr.
Priority nursing dx?
💫RATIONALE✔️✔️: Urinary retention post-epidural/laceration. Bladder scan, catheterize if >600 mL.
💫ANSWER✔️✔️: C. Impaired urinary elimination.
10. Pt at 35 weeks with gestational hypertension, BP 150/95, urine protein 300 mg/24 hr, platelets
100,000, AST 80. Diagnosis?
💫RATIONALE✔️✔️: Severe preeclampsia: BP ≥160/110 or thrombocytopenia, elevated LFTs. Deliver at
34-37 weeks.
💫ANSWER✔️✔️: B. Severe preeclampsia.
11. Nurse teaching about postpartum blues. Which statement requires clarification?
NCLEX Mastery Drills**
1. Nurse assesses laboring pt at 6 cm, contractions Q3min x 60 sec, FHR baseline 150, moderate
variability, late decelerations to 100 after last 3 contractions. Priority action?
💫RATIONALE✔️✔️: Late decels = uteroplacental insufficiency. Turn pt left lateral to improve uterine
blood flow.
💫ANSWER✔️✔️: B. Reposition to left lateral.
2. Newborn, 8 hr old, breastfeeding poorly, jittery, glucose 32 mg/dL. First action?
💫RATIONALE✔️✔️: Neonatal hypoglycemia <40 mg/dL. Feed immediately; if poor suck, IV dextrose 10%
2 mL/kg.
💫ANSWER✔️✔️: A. Breastfeed or give formula now.
3. Pt at 38 weeks, GBS positive, rupture of membranes 6 hr ago, afebrile, contractions Q5min. Order?
💫RATIONALE✔️✔️: GBS prophylaxis required if ROM ≥4 hr or labor onset. Penicillin G 5 million units IV
load then 2.5M Q4H.
💫ANSWER✔️✔️: C. Begin IV penicillin G.
4. Postpartum day 1, G2P2, vaginal delivery, fundus firm at umbilicus, lochia moderate rubra with 2 cm
clots. BP 110/70, HR 80. Action?
💫RATIONALE✔️✔️: Small clots normal first 24 hr. Massage fundus to expel clots, monitor bleeding.
💫ANSWER✔️✔️: B. Massage fundus.
5. Nurse teaching new mom about newborn car seat safety for 5 lb 8 oz (2500g) preterm infant. Which
statement indicates understanding?
💫RATIONALE✔️✔️: Preterm infants need car seat challenge test for desaturation before discharge. Use
at 45° angle.
💫ANSWER✔️✔️: D. “Baby must have a car seat challenge before going home.”
, 6. Pt at 32 weeks with placenta previa, painless bright red bleeding 100 mL, fetal HR 150, contractions
absent. Priority intervention?
💫RATIONALE✔️✔️: Placenta previa: no vaginal exam (can cause catastrophic hemorrhage). Bed rest, IV
access, type & screen.
💫ANSWER✔️✔️: C. Avoid vaginal examination.
7. Nurse assessing newborn male, 12 hr old, left testis palpable in inguinal canal, right testis in scrotum.
Diagnosis?
💫RATIONALE✔️✔️: Cryptorchidism (undescended testis). Refer to urology by 6 months for orchiopexy.
💫ANSWER✔️✔️: A. Cryptorchidism.
8. Pt at 40 weeks, induction with oxytocin at 6 mU/min, contractions Q2min x 90 sec, FHR baseline 160,
minimal variability, no accelerations for 40 min. Action?
💫RATIONALE✔️✔️: Tachysystole + minimal variability + absent accelerations = uterine hyperstimulation.
Stop oxytocin.
💫ANSWER✔️✔️: D. Discontinue oxytocin infusion.
9. Postpartum pt with third-degree laceration reports pain 7/10, perineal edema, unable to void for 8 hr.
Priority nursing dx?
💫RATIONALE✔️✔️: Urinary retention post-epidural/laceration. Bladder scan, catheterize if >600 mL.
💫ANSWER✔️✔️: C. Impaired urinary elimination.
10. Pt at 35 weeks with gestational hypertension, BP 150/95, urine protein 300 mg/24 hr, platelets
100,000, AST 80. Diagnosis?
💫RATIONALE✔️✔️: Severe preeclampsia: BP ≥160/110 or thrombocytopenia, elevated LFTs. Deliver at
34-37 weeks.
💫ANSWER✔️✔️: B. Severe preeclampsia.
11. Nurse teaching about postpartum blues. Which statement requires clarification?
