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Maternal & Newborn Nursing NCLEX Exam Prep 2025
| 150 Updated Questions & Detailed Verified
Rationales"
Q1. A nurse is caring for a client at 38 weeks’ gestation who presents with painless,
bright red vaginal bleeding. Which condition is most likely?
A. Placenta previa
B. Placental abruption
C. Uterine rupture
D. Cervical insufficiency
Correct Answer: A
Rationale: Painless, bright red vaginal bleeding in the third trimester is
characteristic of placenta previa, a condition in which the placenta partially or
completely covers the cervical os. In contrast, placental abruption usually presents
with painful bleeding and a firm, tender uterus, and uterine rupture is associated
with severe abdominal pain and signs of shock. Cervical insufficiency generally
occurs earlier in pregnancy and is not typically associated with heavy bleeding this
late in gestation. Prompt diagnosis and avoidance of vaginal exams are essential to
prevent further bleeding.
,2
Q2. A postpartum client is experiencing a boggy uterus and heavy vaginal bleeding
2 hours after delivery. What is the priority nursing action?
A. Call the provider immediately
B. Increase IV fluids
C. Perform fundal massage
D. Prepare for blood transfusion
Correct Answer: C
Rationale: A boggy uterus after delivery indicates uterine atony, the most common
cause of postpartum hemorrhage. The priority nursing action is to perform a firm
fundal massage to stimulate uterine contractions, which compress the blood vessels
and reduce bleeding. Calling the provider and increasing IV fluids may be
appropriate after initiating fundal massage, but they do not address the immediate
cause. Preparing for a blood transfusion is necessary only if bleeding persists
despite initial interventions.
Q3. A client at 32 weeks’ gestation presents with sudden severe abdominal pain,
dark red vaginal bleeding, and a rigid abdomen. Which is the most likely
diagnosis?
A. Placenta previa
B. Placental abruption
C. Preterm labor
D. Vasa previa
Correct Answer: B
Rationale: Placental abruption occurs when the placenta prematurely separates
from the uterine wall, often causing sudden-onset abdominal pain, dark red
bleeding, and a firm, rigid uterus. This is a medical emergency that can
compromise fetal oxygenation and maternal stability. Placenta previa usually
causes painless bright red bleeding, preterm labor involves uterine contractions and
cervical changes, and vasa previa is associated with painless bleeding upon
membrane rupture with fetal distress.
,3
Q4. A newborn has a heart rate of 80 bpm, irregular breathing, some flexion of
extremities, a grimace when stimulated, and a pink body with blue extremities.
What is the Apgar score?
A. 5
B. 6
C. 7
D. 8
Correct Answer: B
Rationale: Apgar scoring is based on five categories: heart rate, respiratory effort,
muscle tone, reflex irritability, and color, each scored from 0 to 2. This newborn
scores 1 for heart rate (<100 bpm), 1 for respiratory effort (irregular), 1 for muscle
tone (some flexion), 1 for reflex irritability (grimace), and 2 for color (pink body
with acrocyanosis), totaling 6. A score of 6 indicates moderate distress, requiring
some supportive interventions such as oxygen and stimulation.
Q5. A nurse is teaching a pregnant client about signs of preeclampsia. Which
symptom should the client report immediately?
A. Nausea and vomiting in the morning
B. Mild ankle swelling in the evening
C. Persistent headache and visual disturbances
D. Increased appetite
Correct Answer: C
Rationale: Persistent headache and visual disturbances are warning signs of severe
preeclampsia, a hypertensive disorder of pregnancy that can progress to eclampsia
and cause seizures. These symptoms indicate possible cerebral involvement and
require immediate medical evaluation. Morning nausea and mild ankle swelling are
common in pregnancy, and increased appetite is not concerning.
Q6. A nurse is caring for a newborn immediately after birth. Which action should
be performed first?
A. Administer vitamin K
B. Apply identification bands
, 4
C. Dry the newborn and provide warmth
D. Perform a complete physical assessment
Correct Answer: C
Rationale: The first priority in newborn care is to prevent heat loss by
immediately drying the infant and providing warmth, as newborns are at high risk
for hypothermia. Once thermoregulation is initiated, other interventions such as
applying identification bands, administering vitamin K, and performing a full
assessment can follow. Maintaining body temperature also supports stable
cardiorespiratory function in the immediate postnatal period.
Q7. A postpartum client complains of intense perineal pain and pressure but has
minimal vaginal bleeding. On assessment, the fundus is firm and midline. What is
the most likely cause?
A. Uterine atony
B. Retained placental fragments
C. Perineal hematoma
D. Endometritis
Correct Answer: C
Rationale: A perineal hematoma occurs when blood collects in the tissues due to
injury to blood vessels during delivery, leading to intense localized pain, swelling,
and pressure with minimal external bleeding. The uterus remains firm and midline
because the bleeding is concealed in the tissues. Uterine atony and retained
placental fragments present with heavy vaginal bleeding, and endometritis involves
fever and uterine tenderness.
Q8. Which newborn finding requires immediate intervention?
A. Respiratory rate of 52 breaths per minute
B. Nasal flaring and intercostal retractions
C. Irregular breathing patterns
D. Acrocyanosis of hands and feet
Correct Answer: B
Rationale: Nasal flaring and intercostal retractions indicate respiratory distress and
Maternal & Newborn Nursing NCLEX Exam Prep 2025
| 150 Updated Questions & Detailed Verified
Rationales"
Q1. A nurse is caring for a client at 38 weeks’ gestation who presents with painless,
bright red vaginal bleeding. Which condition is most likely?
A. Placenta previa
B. Placental abruption
C. Uterine rupture
D. Cervical insufficiency
Correct Answer: A
Rationale: Painless, bright red vaginal bleeding in the third trimester is
characteristic of placenta previa, a condition in which the placenta partially or
completely covers the cervical os. In contrast, placental abruption usually presents
with painful bleeding and a firm, tender uterus, and uterine rupture is associated
with severe abdominal pain and signs of shock. Cervical insufficiency generally
occurs earlier in pregnancy and is not typically associated with heavy bleeding this
late in gestation. Prompt diagnosis and avoidance of vaginal exams are essential to
prevent further bleeding.
,2
Q2. A postpartum client is experiencing a boggy uterus and heavy vaginal bleeding
2 hours after delivery. What is the priority nursing action?
A. Call the provider immediately
B. Increase IV fluids
C. Perform fundal massage
D. Prepare for blood transfusion
Correct Answer: C
Rationale: A boggy uterus after delivery indicates uterine atony, the most common
cause of postpartum hemorrhage. The priority nursing action is to perform a firm
fundal massage to stimulate uterine contractions, which compress the blood vessels
and reduce bleeding. Calling the provider and increasing IV fluids may be
appropriate after initiating fundal massage, but they do not address the immediate
cause. Preparing for a blood transfusion is necessary only if bleeding persists
despite initial interventions.
Q3. A client at 32 weeks’ gestation presents with sudden severe abdominal pain,
dark red vaginal bleeding, and a rigid abdomen. Which is the most likely
diagnosis?
A. Placenta previa
B. Placental abruption
C. Preterm labor
D. Vasa previa
Correct Answer: B
Rationale: Placental abruption occurs when the placenta prematurely separates
from the uterine wall, often causing sudden-onset abdominal pain, dark red
bleeding, and a firm, rigid uterus. This is a medical emergency that can
compromise fetal oxygenation and maternal stability. Placenta previa usually
causes painless bright red bleeding, preterm labor involves uterine contractions and
cervical changes, and vasa previa is associated with painless bleeding upon
membrane rupture with fetal distress.
,3
Q4. A newborn has a heart rate of 80 bpm, irregular breathing, some flexion of
extremities, a grimace when stimulated, and a pink body with blue extremities.
What is the Apgar score?
A. 5
B. 6
C. 7
D. 8
Correct Answer: B
Rationale: Apgar scoring is based on five categories: heart rate, respiratory effort,
muscle tone, reflex irritability, and color, each scored from 0 to 2. This newborn
scores 1 for heart rate (<100 bpm), 1 for respiratory effort (irregular), 1 for muscle
tone (some flexion), 1 for reflex irritability (grimace), and 2 for color (pink body
with acrocyanosis), totaling 6. A score of 6 indicates moderate distress, requiring
some supportive interventions such as oxygen and stimulation.
Q5. A nurse is teaching a pregnant client about signs of preeclampsia. Which
symptom should the client report immediately?
A. Nausea and vomiting in the morning
B. Mild ankle swelling in the evening
C. Persistent headache and visual disturbances
D. Increased appetite
Correct Answer: C
Rationale: Persistent headache and visual disturbances are warning signs of severe
preeclampsia, a hypertensive disorder of pregnancy that can progress to eclampsia
and cause seizures. These symptoms indicate possible cerebral involvement and
require immediate medical evaluation. Morning nausea and mild ankle swelling are
common in pregnancy, and increased appetite is not concerning.
Q6. A nurse is caring for a newborn immediately after birth. Which action should
be performed first?
A. Administer vitamin K
B. Apply identification bands
, 4
C. Dry the newborn and provide warmth
D. Perform a complete physical assessment
Correct Answer: C
Rationale: The first priority in newborn care is to prevent heat loss by
immediately drying the infant and providing warmth, as newborns are at high risk
for hypothermia. Once thermoregulation is initiated, other interventions such as
applying identification bands, administering vitamin K, and performing a full
assessment can follow. Maintaining body temperature also supports stable
cardiorespiratory function in the immediate postnatal period.
Q7. A postpartum client complains of intense perineal pain and pressure but has
minimal vaginal bleeding. On assessment, the fundus is firm and midline. What is
the most likely cause?
A. Uterine atony
B. Retained placental fragments
C. Perineal hematoma
D. Endometritis
Correct Answer: C
Rationale: A perineal hematoma occurs when blood collects in the tissues due to
injury to blood vessels during delivery, leading to intense localized pain, swelling,
and pressure with minimal external bleeding. The uterus remains firm and midline
because the bleeding is concealed in the tissues. Uterine atony and retained
placental fragments present with heavy vaginal bleeding, and endometritis involves
fever and uterine tenderness.
Q8. Which newborn finding requires immediate intervention?
A. Respiratory rate of 52 breaths per minute
B. Nasal flaring and intercostal retractions
C. Irregular breathing patterns
D. Acrocyanosis of hands and feet
Correct Answer: B
Rationale: Nasal flaring and intercostal retractions indicate respiratory distress and
