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NCLEX maternity and newborn practice questions

20 free NCLEX-style maternity questions: prenatal care, labor and fetal monitoring, preeclampsia, placenta previa, postpartum complications and newborn care, each with the answer and rationale.

Tap an answer to check it, or open "Show the answer and rationale" under each question. Every client is fictional. For exam practice only, not medical advice.

Question 1 of 20

A client at 40 weeks of gestation is having labor induced with oxytocin at 10 milliunits/min. Over the past 30 minutes the nurse counts 17 contractions, each lasting 50 to 60 seconds, and the uterus relaxes between them. The fetal heart rate baseline is 135 beats/min with moderate variability, accelerations and no decelerations. Which action should the nurse take?

  1. Decrease the oxytocin rate as the protocol directs
  2. Continue the infusion at this rate, because the tracing is Category I
  3. Stop the oxytocin and give terbutaline 0.25 mg subcutaneously
  4. Give a 500 mL bolus of lactated Ringer's and keep the same rate
Show the answer and rationale

Answer: A

Tachysystole is more than 5 contractions in 10 minutes averaged over 30 minutes, and 17 in 30 minutes averages about 5.7. When it occurs during an induction with a Category I tracing, the oxytocin dose is reduced, because frequent contractions shorten the rest periods in which the placenta refills with oxygenated blood. Stopping the oxytocin and giving terbutaline is the runner-up, but discontinuing the infusion, intrauterine resuscitation and a tocolytic are for tachysystole with a Category II or III tracing or one that persists. Keeping the same rate ignores the tachysystole, and a fluid bolus alone does not remove its cause.

📚 Learn it: VEAL CHOP: Reading the Strip in Five Seconds

Question 2 of 20

A nurse is reviewing the records of four clients at their first prenatal visits. For which client should the nurse anticipate a recommendation for daily low-dose aspirin, starting after 12 weeks of gestation?

  1. A 24-year-old who has had chronic hypertension for the past 3 years
  2. A 36-year-old whose first pregnancy ended in an uncomplicated term birth
  3. A 23-year-old in her first pregnancy with no other health conditions
  4. A 30-year-old with hypothyroidism well controlled with levothyroxine
Show the answer and rationale

Answer: A

Low-dose aspirin (81 mg daily), started after 12 weeks, ideally before 16 weeks, and continued until birth, lowers the risk of preeclampsia in clients with at least one high-risk factor, such as preeclampsia in a previous pregnancy, chronic hypertension, a multifetal pregnancy, pregestational diabetes, kidney disease or lupus, or with more than one moderate-risk factor, such as a first pregnancy, obesity or age 35 or older. Age 36 is a moderate-risk factor, which makes that client the strongest distractor, but one moderate factor alone does not meet the threshold, and the same is true of a first pregnancy with no other risk factor. Well-controlled hypothyroidism is not among the risk factors used to recommend aspirin.

📚 Learn it: Preeclampsia, Magnesium and the Reflexes You Check

Question 3 of 20

A client at 33 weeks of gestation with preeclampsia with severe features is receiving a magnesium sulfate infusion and received IV labetalol 30 minutes ago. Which finding should the nurse report to the provider immediately?

  1. New abdominal pain with a firm, tender uterus between frequent, small contractions
  2. Urine output of 40 mL/hr with 3+ protein on the dipstick
  3. She feels warm and drowsy, and her face is flushed
  4. Blood pressure 154/100 mm Hg, down from 162/108 mm Hg
Show the answer and rationale

Answer: A

Preeclampsia is a major risk factor for placental abruption, and new abdominal pain with a firm, tender uterus and frequent, low-intensity contractions suggests the placenta is separating, even with little or no visible bleeding, so the provider is notified at once and the fetal heart rate is assessed. Warmth, flushing and drowsiness are the runner-up because they come from the magnesium, but they are expected effects; toxicity shows as lost patellar reflexes or respirations below 12/min, and oliguria lets magnesium build up. A pressure of 154/100 mm Hg is below the severe range of 160/110 and improving, and 40 mL/hr of urine is adequate, with proteinuria part of her diagnosis.

📚 Learn it: Previa Versus Abruption: Painless or Painful

Question 4 of 20

A client who is 3 weeks postpartum and exclusively breastfeeding has a red, hot, tender, wedge-shaped area on the left breast, a temperature of 101.2°F (38.4°C) and body aches. She asks whether she should stop breastfeeding. Which response by the nurse is best?

  1. 'Stop feeding from the left breast until you finish the antibiotic.'
  2. 'Keep nursing, but pump the left breast empty after feeds.'
  3. 'Keep breastfeeding, and use firm, deep massage on the sore area.'
  4. 'Keep breastfeeding on demand; your milk is safe for the baby.'
Show the answer and rationale

Answer: D

Continuing to breastfeed with mastitis is safe for the infant and keeps the breast from becoming overfull, whereas stopping abruptly worsens the inflammation and raises the risk of an abscess. Current lactation guidance adds cold packs, ibuprofen, a supportive bra and feeding on demand without extra pumping, with antibiotics when a bacterial infection is suspected, and the provider is told about the fever. Pumping the breast empty after feeds is familiar older advice, but it drives oversupply, which feeds the inflammation. Firm, deep massage injures breast tissue and worsens swelling; gentle lymphatic massage is preferred. A firm, fluctuant lump that does not improve suggests an abscess that needs drainage.

📚 Learn it: Postpartum Hemorrhage: Massage First, Then the Drugs

Question 5 of 20

A newborn does not pass the hearing screen in the right ear before discharge. The parent asks, 'Does this mean my baby is deaf?' Which response by the nurse is accurate?

  1. 'Since the left ear passed, speech should develop normally without more tests.'
  2. 'It may just be fluid; your provider can retest at the 6-month checkup.'
  3. 'Not necessarily; if your baby startles to loud noises, hearing is fine.'
  4. 'Not necessarily; fluid in the ear is common at birth, but a retest is needed within weeks.'
Show the answer and rationale

Answer: D

Many newborns who do not pass the first screen have normal hearing, because vernix or fluid in the ear canal can block the test, but every referral needs a rescreen and, if needed, a full audiology evaluation: screening is completed by 1 month, diagnosis by 3 months and intervention begins by 6 months, because language development depends on hearing in the first months of life. Retesting at 6 months names the right cause but misses that timeline, since intervention should already have begun by then. A startle to loud noise does not rule out a partial or one-sided hearing loss, and a one-sided loss can still affect speech, language and school performance.

📚 Learn it: The First Hour: APGAR, Warmth, Vitamin K and Sugar

Question 6 of 20 · Select all that apply

A client at 38 weeks of gestation arrives at the birthing unit 19 hours after her membranes ruptured at home. She is not having contractions. Her group B streptococcus (GBS) status is unknown because her prenatal records are unavailable. Temperature 99.0°F (37.2°C), heart rate 84 beats/min; the fetal heart rate baseline is 140 beats/min with moderate variability and accelerations, and the fluid is clear. Which actions should the nurse anticipate? Select all that apply.

  1. Hold antibiotics unless the client develops a fever
  2. Start IV penicillin as prescribed
  3. Perform a sterile vaginal examination every hour to track progress
  4. Send the client home to wait for labor to start on its own
  5. Keep digital cervical examinations to as few as possible
  6. Prepare for induction of labor with oxytocin as prescribed
Show the answer and rationale

Answer: B, E, F

When GBS status is unknown, rupture of membranes for 18 hours or longer is an indication for intrapartum antibiotic prophylaxis, so IV penicillin starts now; waiting for a fever defeats the purpose, which is to prevent early-onset GBS disease in the newborn. At term with ruptured membranes and no labor, induction is generally recommended, because a longer interval to birth raises the risk of intraamniotic infection, which is also why she is not sent home to wait. Each digital examination can carry vaginal bacteria upward, so examinations are kept to a minimum rather than done every hour, and the nurse watches the maternal temperature and the fetal heart rate for signs of infection.

📚 Learn it: VEAL CHOP: Reading the Strip in Five Seconds

Question 7 of 20

A nulliparous client with epidural analgesia has progressed from 5 to 8 cm over 4 hours, but the fetal head has stayed at 0 station on the last two examinations. Contractions are every 3 minutes and moderate to palpation. She last voided before the epidural was placed 5 hours ago, and the nurse palpates a firm, rounded mass above the symphysis pubis. Which action should the nurse take first?

  1. Report to the provider that the fetal head is not descending
  2. Ask the provider about starting oxytocin to strengthen contractions
  3. Empty the client's bladder with a straight catheter per protocol
  4. Place a peanut ball between her knees and turn her every 30 minutes
Show the answer and rationale

Answer: C

A full bladder takes up room in the pelvis and can slow fetal descent, and epidural analgesia blunts the urge to void, so a client with a palpable bladder 5 hours after her last void has it emptied first, by catheter if she cannot void, and her bladder is then checked at least every 2 hours. Reporting the lack of descent is the runner-up, but descent has stalled only briefly and has a cause the nurse can correct right away. A peanut ball and position changes may help later if descent still lags, and the contractions are already adequate, so neither replaces emptying the bladder.

📚 Learn it: Stages of Labor and What the Nurse Does in Each

Question 8 of 20

A nurse is reviewing the electronic fetal monitor tracings of four clients in active labor. Which tracing meets the criteria for Category III?

  1. Baseline 140 beats/min with moderate variability and late decelerations after most contractions
  2. Smooth, regular sine-wave undulations at 3 to 5 cycles a minute for 25 minutes
  3. Baseline 100 beats/min with moderate variability for the past 15 minutes
  4. Baseline 135 beats/min with absent variability and no decelerations for 30 minutes
Show the answer and rationale

Answer: B

Category III is either a sinusoidal pattern (smooth, sine-wave undulations at 3 to 5 cycles a minute lasting 20 minutes or more) or absent variability together with recurrent late decelerations, recurrent variable decelerations or bradycardia; it is linked to abnormal fetal acid-base status and needs prompt evaluation, intrauterine resuscitation and birth if it does not resolve. Absent variability is the runner-up, but without recurrent decelerations or bradycardia it is Category II, although it still needs close evaluation. Recurrent late decelerations with moderate variability and a baseline of 100 with moderate variability are also Category II.

📚 Learn it: VEAL CHOP: Reading the Strip in Five Seconds

Question 9 of 20

A client at 20 weeks of gestation is told after her anatomy ultrasound that her placenta is low-lying, with its edge 1.5 cm from the internal cervical os. She has had no bleeding and asks whether she will need a cesarean birth. Which response by the nurse is accurate?

  1. 'Most clinicians recommend bed rest at home until a later ultrasound shows the placenta has moved up.'
  2. 'Because you have had no bleeding so far, another ultrasound will probably not be needed later.'
  3. 'Most placentas this close to the cervix move away as the uterus grows, and a later scan will check.'
  4. 'In most cases like this, a cesarean birth is planned, because the placenta usually stays low.'
Show the answer and rationale

Answer: C

A placenta that is low-lying in the second trimester usually ends up well away from the cervix by the third trimester, because the lower uterine segment lengthens as the uterus grows, so a follow-up ultrasound later in pregnancy decides whether a cesarean is needed; until then she seeks care at once for any vaginal bleeding. The runner-up is saying a cesarean is planned because the placenta usually stays low: a cesarean is the eventual outcome if a previa persists, but most low-lying placentas at 20 weeks move away, so stating it as the plan is premature. Bed rest is not recommended for a low-lying placenta, and skipping the follow-up scan because she has not bled would miss a previa that persists.

📚 Learn it: Previa Versus Abruption: Painless or Painful

Question 10 of 20

A client had a fourth-degree perineal laceration repaired after a forceps-assisted birth 2 days ago and has not had a bowel movement since. Which prescription should the nurse question?

  1. Bisacodyl 10 mg rectal suppository once now
  2. Ibuprofen 600 mg orally every 6 hours as needed for perineal pain
  3. Docusate sodium 100 mg orally twice a day with a full glass of water
  4. Polyethylene glycol 17 g orally once a day dissolved in 8 oz of fluid
Show the answer and rationale

Answer: A

A fourth-degree laceration extends through the anal sphincter into the rectal mucosa, so anything placed in the rectum, including a bisacodyl suppository, enemas and rectal thermometers, can disrupt the repair and lead to infection or a fistula, and this prescription should be questioned. The runner-up is polyethylene glycol: an osmotic laxative sounds strong for a fresh repair, but given orally it simply keeps the stool soft, which protects the repair. Docusate orally twice a day is a standard stool softener for the same purpose, and ibuprofen orally every 6 hours as needed is appropriate for perineal pain and is compatible with breastfeeding.

📚 Learn it: Postpartum Hemorrhage: Massage First, Then the Drugs

Practice 10 more Maternity & newborn questions free →

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Question 11 of 20

A newborn born at 42 4/7 weeks of gestation has dry, cracked, peeling skin, long fingernails, little vernix and no lanugo. For which complication should the nurse monitor this newborn most closely in the first hours after birth?

  1. Fluid loss through the dry, cracked, peeling skin
  2. Hypoglycemia from depleted glycogen stores
  3. Respiratory distress from surfactant deficiency
  4. Jaundice from breakdown of extra red blood cells
Show the answer and rationale

Answer: B

These findings fit a postterm newborn: an aging placenta delivers fewer nutrients near the end of pregnancy, so the fetus uses up its glycogen and fat stores, and hypoglycemia can develop soon after birth; postterm newborns are also at risk for meconium aspiration and polycythemia, so early feeding and glucose checks per protocol are a priority. Jaundice is a real risk when the extra red cells of polycythemia break down, but it usually appears after the first day, not in the first hours. Peeling skin is expected at this age and is not a source of dangerous fluid loss, a problem of thin preterm skin, and surfactant deficiency is a complication of prematurity.

📚 Learn it: The First Hour: APGAR, Warmth, Vitamin K and Sugar

Question 12 of 20

A client at 39 weeks of gestation who is expecting her first baby calls the birthing unit at 2200. She has had mild, irregular contractions 10 to 20 minutes apart for 3 hours and can talk through them. Her membranes are intact, and the baby is moving as usual. Which instruction should the nurse give?

  1. Rest at home; come in for contractions 5 minutes apart for an hour, leaking fluid, bleeding or less fetal movement
  2. Come to the birthing unit now so the fetal heart rate can be monitored, your cervix checked and your contractions timed
  3. Drink two large glasses of water and rest on your left side for an hour; come in if contractions become regular or stronger
  4. Rest at home and time the contractions through the night; come in when your water breaks or you can no longer talk through them
Show the answer and rationale

Answer: A

Mild, irregular contractions the client can talk through, with intact membranes and normal fetal movement, fit early (latent) labor, which can last many hours in a first labor and is usually more comfortable at home; she should come in when contractions are regular and about 5 minutes apart for an hour, or at once for leaking fluid, bleeding or decreased fetal movement. The runner-up is resting at home until her water breaks or she can no longer talk through contractions: the setting is right, but it omits bleeding and decreased fetal movement, which need prompt evaluation. Coming in now allows monitoring and a cervical check, but early admission is linked to more interventions, and drinking water and resting on the left side with a return threshold of regular or stronger contractions uses a vague trigger that can occur while labor is still early.

📚 Learn it: Stages of Labor and What the Nurse Does in Each

Question 13 of 20

A nurse is caring for four clients in labor whose membranes are intact. Which client is at greatest risk for umbilical cord prolapse when her membranes rupture?

  1. A client at 41 weeks whose fetus is estimated at 9 lb 10 oz (4.4 kg) and is at +1 station
  2. A client at 40 weeks having her third baby whose fetus is vertex at +1 station
  3. A client at 39 weeks with polyhydramnios whose fetal head is at 0 station
  4. A client at 34 weeks whose fetus is in a footling breech presentation
Show the answer and rationale

Answer: D

The cord prolapses when the presenting part does not fill the pelvic inlet and leaves room for the cord to slip past it; a footling breech, with small feet and legs over the cervix, fills it poorly, and a preterm fetus is smaller still, so this client is at greatest risk. Polyhydramnios is the runner-up because a rush of fluid can sweep the cord down, but a head engaged at 0 station blocks the inlet. A large fetus at +1 station and an engaged vertex in a multipara also fill the pelvis. Whenever the membranes rupture, the nurse checks the fetal heart rate at once.

📚 Learn it: VEAL CHOP: Reading the Strip in Five Seconds

Question 14 of 20

A nurse in obstetric triage receives four clients at the same time. Which client should the nurse see first?

  1. A client at 35 weeks with a known placenta previa who has painless bright red bleeding soaking a pad and a heart rate of 118 beats/min
  2. A client at 30 weeks who noticed light pink spotting after intercourse last night and has no pain
  3. A client at 33 weeks who was in a minor car crash an hour ago and has mild soreness, a soft uterus and no bleeding
  4. A client at 39 weeks with contractions every 5 minutes and a small amount of blood-tinged mucus
Show the answer and rationale

Answer: A

Bright red bleeding from a known previa with a heart rate of 118 beats/min is active hemorrhage that the client is already compensating for, so she is seen first for vital signs, fetal assessment, IV access and blood work, with no digital examination. The client after a minor car crash is the runner-up: an abruption can develop hours after trauma, so she needs prompt assessment and several hours of monitoring, but she is not bleeding and her uterus is soft. Blood-tinged mucus with regular contractions at term is bloody show, and light spotting after intercourse with no pain needs evaluation but is less urgent.

📚 Learn it: Previa Versus Abruption: Painless or Painful

Question 15 of 20

A client who gave birth vaginally 9 days ago calls the clinic. Her lochia had become pinkish-brown, but since yesterday it has been bright red again and steady, with several small clots, even when she rests. Which response by the nurse is appropriate?

  1. 'Massage your uterus firmly, and call back if it hasn't slowed down by tomorrow morning.'
  2. 'Breastfeeding releases oxytocin, which can briefly increase your flow.'
  3. 'Bright red bleeding again at this point needs to be checked by your provider today.'
  4. 'More activity can bring back red flow; rest more and it should lighten again.'
Show the answer and rationale

Answer: C

Lochia normally progresses from rubra (red, about days 1 to 3) to serosa (pink-brown, about days 4 to 10) to alba (yellow-white), so a sustained return to bright red flow with clots suggests subinvolution of the uterus or retained placental fragments, causes of late postpartum hemorrhage; she needs evaluation today, and emergency care if she soaks a pad in an hour or passes a clot the size of an egg. Fundal massage sounds like the right first step, but self-massage cannot rule out retained fragments or infection, and waiting until morning delays the evaluation she needs. A brief gush when standing up or breastfeeding can be normal, but steady red bleeding at rest is not, and more rest does not treat it.

📚 Learn it: Postpartum Hemorrhage: Massage First, Then the Drugs

Question 16 of 20

A nurse is assessing four breastfed newborns on the third day after birth. Which finding requires follow-up?

  1. Weight 9% below birth weight with a vigorous suck and alert periods
  2. A heart rate of 168 beats/min while crying and green-brown stools
  3. Weight 12% below birth weight with sleepy, short feedings
  4. Nine feedings in 24 hours with audible swallowing at the breast
Show the answer and rationale

Answer: C

A weight loss above 10% by day 3, here 12%, together with sleepy, short feedings signals inadequate milk intake and risks dehydration and worsening jaundice, so it requires follow-up with the provider and lactation support. The runner-up is weight 9% below birth weight, because it approaches the limit but, paired with a vigorous suck and alert periods, stays within the range managed with routine monitoring and continued feeding support. A heart rate of 168 beats/min while crying is within the newborn range, and green-brown stools are expected transitional stools on day 3. Nine feedings in 24 hours with audible swallowing show effective breastfeeding.

📚 Learn it: The First Hour: APGAR, Warmth, Vitamin K and Sugar

Question 17 of 20

A multiparous client in active labor shouts that the baby is coming. The nurse sees the fetal head crowning, calls for help and, with the provider not yet in the room, supports the perineum and lets the head deliver slowly between pushes. Which action should the nurse take next?

  1. Tell the client to push hard so that the shoulders deliver quickly
  2. Clamp and cut the umbilical cord before the shoulders are born
  3. Suction the newborn's mouth and then the nose with a bulb syringe
  4. Feel along the newborn's neck for a loop of umbilical cord
Show the answer and rationale

Answer: D

Once the head is born, the nurse feels for a nuchal cord: a loose loop is slipped over the head or the baby is born through it, and the cord is clamped and cut before the shoulders only if it is too tight to loosen, so cutting it routinely is wrong. Suctioning the mouth and nose is the runner-up, but current neonatal resuscitation guidance reserves suctioning for a newborn whose airway is obstructed or who needs positive-pressure ventilation, because routine suctioning can slow the heart rate. Forceful pushing risks tears and an uncontrolled birth; the shoulders are born with the next contraction.

📚 Learn it: Stages of Labor and What the Nurse Does in Each

Question 18 of 20

A nurse on the birthing unit receives report on four clients in active labor. Which client should the nurse see first?

  1. The client given IV fentanyl 30 minutes ago whose fetus has a baseline of 130 beats/min, minimal variability and no decelerations
  2. The client whose fetus has moderate variability and occasional abrupt decelerations to 110 beats/min that recover within 20 seconds
  3. The client whose fetus has a baseline of 150 beats/min, moderate variability and gradual decelerations that mirror each contraction
  4. The client whose fetus has a baseline of 140 beats/min, minimal variability and late decelerations with most contractions
Show the answer and rationale

Answer: D

Late decelerations with most contractions are recurrent and point to uteroplacental insufficiency, and minimal variability means the fetus may be losing its reserve, so this client needs intrauterine resuscitation and provider notification first; if variability becomes absent, the tracing is Category III. Minimal variability after IV fentanyl is the runner-up: opioids commonly reduce variability within 1 to 2 hours, and with no decelerations this fetus can be reassessed next. Early decelerations that mirror contractions and occasional brief variable decelerations with moderate variability are not signs of acidemia, because moderate variability reliably predicts its absence.

📚 Learn it: VEAL CHOP: Reading the Strip in Five Seconds

Question 19 of 20

A client at 34 weeks of gestation with a complete placenta previa confirmed on ultrasound has had no bleeding since a single episode at 30 weeks. She asks when and how her baby will be born. Which response by the nurse is accurate?

  1. 'A cesarean is usually planned at 36 to 37 weeks, sooner if heavy bleeding occurs.'
  2. 'If you have no more bleeding, your labor can be induced at 39 weeks.'
  3. 'The baby will be born by cesarean this week, after two steroid injections.'
  4. 'You can plan a vaginal birth if a scan at 37 weeks shows that the placenta has moved.'
Show the answer and rationale

Answer: A

When the placenta covers the cervical os, labor would tear it and cause hemorrhage, so birth is by cesarean, and for a stable previa it is usually planned at 36 0/7 to 37 6/7 weeks to balance the risk of bleeding against the risks of an earlier birth; heavy or recurrent bleeding or labor can make an earlier birth necessary. A cesarean this week after steroids is the runner-up, but in a stable client it adds the risks of prematurity without need. Induction at 39 weeks is not an option with a complete previa, and a placenta still covering the os this late is not expected to move away, so a vaginal birth is not planned.

📚 Learn it: Previa Versus Abruption: Painless or Painful

Question 20 of 20

At a 5-week postpartum visit, a client says she cries most days, cannot sleep even when the baby sleeps, no longer enjoys anything and feels like a bad mother. Her score on the Edinburgh Postnatal Depression Scale is high. Which action should the nurse take?

  1. Recommend that a relative care for the baby full time for the next month while she rests
  2. Ask directly about thoughts of harming herself or the baby, and arrange a referral
  3. Reassure her that the baby blues are common and should pass on their own within a few more weeks
  4. Suggest pausing breastfeeding for 2 weeks so her partner can take over all night feedings
Show the answer and rationale

Answer: B

Baby blues begin in the first days after birth and resolve within about 2 weeks; low mood, loss of pleasure, insomnia and guilt persisting at 5 weeks with a high Edinburgh score indicate postpartum depression, so the nurse asks directly about thoughts of harming herself or the baby and arranges prompt evaluation and treatment. The runner-up is pausing breastfeeding so her partner can take night feedings: more sleep may help her cope, but stopping breastfeeding is not required, since therapy and medications compatible with breastfeeding exist, and it does not assess safety or arrange treatment. Calling this the baby blues at 5 weeks delays treatment, and having a relative care for the baby full time separates mother and baby without treating the depression.

📚 Learn it: Postpartum Hemorrhage: Massage First, Then the Drugs

Practice 10 more Maternity & newborn questions free →

A timed or tutor-mode set in the app, scored by area, with every miss saved for review. Free, no sign-up needed.

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