Maternal-Newborn Nursing Comprehensive
**
Practice Test: NGN-Ready Questions with In-Depth
Rationales (Second Edition)**
---
**Question 1**
A nurse is caring for a client who is 40 weeks pregnant and in active labor. The client’s amniotic fluid is
green-tinged. What is the priority nursing action?
A. Prepare for immediate cesarean section
B. Administer oxygen to the mother
C. Notify the neonatal resuscitation team
D. Assess fetal heart rate for signs of distress
💫ANSWER✔️✔️: D. Assess fetal heart rate first. Green-tinged fluid indicates meconium. The priority is to
assess for fetal distress (variable decelerations, bradycardia). If the FHR is reassuring, meconium alone is
not an emergency. Notify the neonatal team (C) but after FHR assessment.
💫RATIONALE✔️✔️: Meconium can indicate fetal hypoxia. Deep suctioning of the newborn is no longer
routine unless the infant is non-vigorous (no respiratory effort, poor tone, bradycardia).
---
**Question 2**
,A nurse is providing discharge teaching to a client who had a cesarean section. Which of the following
instructions should the nurse include to prevent infection?
A. “You may resume sexual intercourse as soon as you feel ready.”
B. “Wipe from front to back after using the toilet.”
C. “You can take a bath in the tub starting tomorrow.”
D. “Wear sanitary pads for up to 2 weeks, then switch to tampons.”
💫ANSWER✔️✔️: B. Wiping front to back prevents transfer of bacteria from the rectum to the urethra
and the vaginal incision, reducing the risk of infection. After C-section, tub baths (C) are avoided until
the incision is healed (2-3 weeks). Tampons (D) are avoided until 6-week postpartum visit. Sexual
intercourse (A) should wait until provider clearance at 6 weeks.
💫RATIONALE✔️✔️: Signs of infection include fever, incisional redness/drainage, foul lochia, and pelvic
pain.
---
**Question 3**
A nurse is assessing a client who is 34 weeks pregnant and reports a sudden onset of painless, bright red
vaginal bleeding. The client denies abdominal pain. Which of the following conditions does the nurse
suspect?
A. Placenta previa
B. Placental abruption
C. Labor
D. Vasa previa
💫ANSWER✔️✔️: A. Painless, bright red bleeding in the third trimester is classic for placenta previa
(placenta implanted over the internal cervical os). Placental abruption (B) presents with painful, dark
,bleeding and uterine rigidity. Labor (C) would have contractions. Vasa previa (D) presents with painless
bleeding after rupture of membranes (fetal vessels over the os).
💫RATIONALE✔️✔️: Digital cervical exam is contraindicated in suspected placenta previa. Immediate
ultrasound is required.
---
**Question 4**
A nurse is caring for a client who is receiving IV magnesium sulfate for preeclampsia with severe
features. The client reports feeling warm and flushed. Which of the following is the priority nursing
action?
A. Slow the infusion rate
B. Assess the client’s deep tendon reflexes
C. Document the finding as expected
D. Notify the healthcare provider
💫ANSWER✔️✔️: C. Warmth and flushing are common and expected side effects of magnesium sulfate
due to vasodilation. They are not signs of toxicity. The nurse should continue to monitor for signs of
toxicity (absent DTRs, respiratory rate <12, decreased LOC, decreased urine output). Option B is
important but not the priority for this specific finding.
💫RATIONALE✔️✔️: Magnesium sulfate is given for seizure prophylaxis. Therapeutic level is 4-7 mEq/L.
Toxicity occurs at >8-10 mEq/L.
---
**Question 5**
, A nurse is assessing a client who is 24 hours postpartum. The client’s fundus is firm, midline, and at the
level of the umbilicus. The client reports moderate lochia rubra with a few small clots. Which of the
following actions should the nurse take?
A. Massage the fundus vigorously
B. Notify the healthcare provider
C. Document the findings as expected
D. Administer oxytocin IM
💫ANSWER✔️✔️: C. A firm fundus at the umbilicus with moderate lochia rubra is normal at 24 hours
postpartum. Small clots (<1 cm) are common. Excessive bleeding (saturating a pad in 15 minutes) or
large clots require intervention.
💫RATIONALE✔️✔️: Lochia rubra (dark red) is normal for days 1-3. The fundus descends approximately 1
cm per day (by day 7, it is at the symphysis pubis).
---
**Question 6**
A nurse is caring for a client who is 6 cm dilated and requesting pain relief. The healthcare provider
orders butorphanol (Stadol) IV. Which of the following is a potential adverse effect of this medication on
the newborn?
A. Hyperthermia
B. Respiratory depression
C. Jaundice
D. Hyperglycemia
💫ANSWER✔️✔️: B. Butorphanol (an opioid agonist-antagonist) crosses the placenta and can cause
neonatal respiratory depression, especially if given within 1-2 hours of delivery. Naloxone may be
needed for the newborn.
**
Practice Test: NGN-Ready Questions with In-Depth
Rationales (Second Edition)**
---
**Question 1**
A nurse is caring for a client who is 40 weeks pregnant and in active labor. The client’s amniotic fluid is
green-tinged. What is the priority nursing action?
A. Prepare for immediate cesarean section
B. Administer oxygen to the mother
C. Notify the neonatal resuscitation team
D. Assess fetal heart rate for signs of distress
💫ANSWER✔️✔️: D. Assess fetal heart rate first. Green-tinged fluid indicates meconium. The priority is to
assess for fetal distress (variable decelerations, bradycardia). If the FHR is reassuring, meconium alone is
not an emergency. Notify the neonatal team (C) but after FHR assessment.
💫RATIONALE✔️✔️: Meconium can indicate fetal hypoxia. Deep suctioning of the newborn is no longer
routine unless the infant is non-vigorous (no respiratory effort, poor tone, bradycardia).
---
**Question 2**
,A nurse is providing discharge teaching to a client who had a cesarean section. Which of the following
instructions should the nurse include to prevent infection?
A. “You may resume sexual intercourse as soon as you feel ready.”
B. “Wipe from front to back after using the toilet.”
C. “You can take a bath in the tub starting tomorrow.”
D. “Wear sanitary pads for up to 2 weeks, then switch to tampons.”
💫ANSWER✔️✔️: B. Wiping front to back prevents transfer of bacteria from the rectum to the urethra
and the vaginal incision, reducing the risk of infection. After C-section, tub baths (C) are avoided until
the incision is healed (2-3 weeks). Tampons (D) are avoided until 6-week postpartum visit. Sexual
intercourse (A) should wait until provider clearance at 6 weeks.
💫RATIONALE✔️✔️: Signs of infection include fever, incisional redness/drainage, foul lochia, and pelvic
pain.
---
**Question 3**
A nurse is assessing a client who is 34 weeks pregnant and reports a sudden onset of painless, bright red
vaginal bleeding. The client denies abdominal pain. Which of the following conditions does the nurse
suspect?
A. Placenta previa
B. Placental abruption
C. Labor
D. Vasa previa
💫ANSWER✔️✔️: A. Painless, bright red bleeding in the third trimester is classic for placenta previa
(placenta implanted over the internal cervical os). Placental abruption (B) presents with painful, dark
,bleeding and uterine rigidity. Labor (C) would have contractions. Vasa previa (D) presents with painless
bleeding after rupture of membranes (fetal vessels over the os).
💫RATIONALE✔️✔️: Digital cervical exam is contraindicated in suspected placenta previa. Immediate
ultrasound is required.
---
**Question 4**
A nurse is caring for a client who is receiving IV magnesium sulfate for preeclampsia with severe
features. The client reports feeling warm and flushed. Which of the following is the priority nursing
action?
A. Slow the infusion rate
B. Assess the client’s deep tendon reflexes
C. Document the finding as expected
D. Notify the healthcare provider
💫ANSWER✔️✔️: C. Warmth and flushing are common and expected side effects of magnesium sulfate
due to vasodilation. They are not signs of toxicity. The nurse should continue to monitor for signs of
toxicity (absent DTRs, respiratory rate <12, decreased LOC, decreased urine output). Option B is
important but not the priority for this specific finding.
💫RATIONALE✔️✔️: Magnesium sulfate is given for seizure prophylaxis. Therapeutic level is 4-7 mEq/L.
Toxicity occurs at >8-10 mEq/L.
---
**Question 5**
, A nurse is assessing a client who is 24 hours postpartum. The client’s fundus is firm, midline, and at the
level of the umbilicus. The client reports moderate lochia rubra with a few small clots. Which of the
following actions should the nurse take?
A. Massage the fundus vigorously
B. Notify the healthcare provider
C. Document the findings as expected
D. Administer oxytocin IM
💫ANSWER✔️✔️: C. A firm fundus at the umbilicus with moderate lochia rubra is normal at 24 hours
postpartum. Small clots (<1 cm) are common. Excessive bleeding (saturating a pad in 15 minutes) or
large clots require intervention.
💫RATIONALE✔️✔️: Lochia rubra (dark red) is normal for days 1-3. The fundus descends approximately 1
cm per day (by day 7, it is at the symphysis pubis).
---
**Question 6**
A nurse is caring for a client who is 6 cm dilated and requesting pain relief. The healthcare provider
orders butorphanol (Stadol) IV. Which of the following is a potential adverse effect of this medication on
the newborn?
A. Hyperthermia
B. Respiratory depression
C. Jaundice
D. Hyperglycemia
💫ANSWER✔️✔️: B. Butorphanol (an opioid agonist-antagonist) crosses the placenta and can cause
neonatal respiratory depression, especially if given within 1-2 hours of delivery. Naloxone may be
needed for the newborn.
