NCLEX › Practice questions › OB and Maternity
OB and Maternity NCLEX practice questions
Maternity questions test normal versus not normal: expected changes in pregnancy, labor and postpartum, and the red flags that need action now.
Question 1 · Safety and Infection Control
Which findings would lead the nurse to suspect a postpartum infection? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, B, E. A temperature of 100.4°F (38°C) or higher occurring after the first 24 hours postpartum, foul-smelling lochia, and uterine tenderness are all classic signs of postpartum infection and require further evaluation. Lochia rubra on day 1 is a normal, expected finding as the uterus sheds its lining and is not concerning at this early stage. A mild temperature elevation of 99.5°F on day 1 is common due to dehydration and the physiologic stress of labor and does not meet the threshold for infection.
Checked against: OpenStax Maternal-Newborn Nursing, 21.1; OpenStax Maternal-Newborn Nursing, 20.1
Question 2 · Physiological Adaptation
Two hours after vaginal birth, the nurse palpates a soft, boggy fundus with increased vaginal bleeding. What is the nurse's first action?
Show answer and rationale
Answer: A. Uterine atony is the number one cause of postpartum hemorrhage, and the first action when a boggy fundus is found is to perform fundal massage to stimulate contraction and reduce bleeding. Oxytocin and other uterotonic medications are given after massage if the uterus remains atonic. Notifying the provider is important but should not delay the immediate bedside intervention of massage. Inserting a catheter is appropriate only if a full bladder is suspected as the cause, which is a different scenario.
Checked against: OpenStax Maternal-Newborn Nursing, 20.1; OpenStax Maternal-Newborn Nursing, 21.2
Question 3 · Pharmacological and Parenteral Therapies
A client receiving intravenous magnesium sulfate for preeclampsia has a respiratory rate of 10 breaths per minute, absent deep tendon reflexes, and urine output of 20 mL over the past hour. What should the nurse do first?
Show answer and rationale
Answer: C. A respiratory rate below 12/min and absent deep tendon reflexes are signs of magnesium sulfate toxicity. Urine output below 30 mL/hr lets magnesium build up, because the kidneys clear it. The nurse stops the infusion immediately, notifies the provider and prepares to give calcium gluconate, the antidote. Increasing the infusion rate would deepen the toxicity and could lead to respiratory arrest. A saline bolus does not reverse magnesium toxicity and adds to the risk of pulmonary edema in preeclampsia, and waiting an hour to recheck reflexes delays treatment of respiratory depression. These findings are dangerous, not expected, so continuing the infusion is unsafe.
Checked against: OpenStax Maternal-Newborn Nursing, 12.2; OpenStax Pharmacology for Nurses, 36.3
Question 4 · Health Promotion and Maintenance
A pregnant client is scheduled for a glucose screening test. At what point in pregnancy is this screening typically performed?
Show answer and rationale
Answer: A. Screening for gestational diabetes with a glucose challenge test is typically performed between 24 and 28 weeks gestation, when insulin resistance related to placental hormones is more likely to become apparent. Screening at 6 to 10 or 12 to 16 weeks would be too early to detect the insulin resistance that typically develops later in pregnancy. Waiting until 36 to 40 weeks would delay diagnosis and management of a condition that carries risks such as fetal macrosomia if untreated.
Checked against: OpenStax Maternal-Newborn Nursing, 11.3
Question 5 · Physiological Adaptation
The nurse notes recurrent variable decelerations on the fetal monitor strip of a client in labor whose oxygen saturation is 98% on room air. Which nursing actions are appropriate? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, B, D. Variable decelerations are caused by cord compression, so appropriate nursing actions include repositioning the client to relieve the compression, discontinuing oxytocin to reduce uterine activity, and notifying the provider if the pattern does not resolve. Routine maternal oxygen by face mask is not recommended for fetal heart rate changes when the client's oxygen saturation is normal, as it is here; it is reserved for a client with low oxygen saturation. Preparing for an immediate cesarean birth without first attempting these bedside interventions and further assessment is premature, since many variable decelerations resolve with simple repositioning.
Checked against: OpenStax Maternal-Newborn Nursing, 16.4; OpenStax Maternal-Newborn Nursing, 16.2
Question 6 · Physiological Adaptation
A client at 38 weeks gestation has a blood pressure of 162/108 mmHg, a severe headache, 2+ proteinuria, and hyperreflexia with clonus. Which nursing interventions are appropriate? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, C, D, E. This client shows signs of preeclampsia with severe features, so the nurse should implement seizure precautions, prepare for magnesium sulfate to prevent seizures, reduce environmental stimulation by dimming lights, and continue monitoring DTRs and clonus for changes in status. Encouraging ambulation is inappropriate and unsafe because this client is at high risk for seizure and should be maintained on bed rest with close monitoring, not increased activity. Reducing stimulation, not increasing it, is the goal in severe preeclampsia management.
Checked against: OpenStax Maternal-Newborn Nursing, 12.2
Question 7 · Health Promotion and Maintenance
A pregnant client at 28 weeks gestation has a fundal height measurement of 28 cm. How should the nurse interpret this finding?
Show answer and rationale
Answer: C. Between approximately 20 and 36 weeks gestation, fundal height in centimeters roughly correlates with the number of weeks of gestation, so a measurement of 28 cm at 28 weeks is expected and reassuring. This finding does not suggest growth restriction or macrosomia, both of which would present as measurements significantly smaller or larger than the gestational age in weeks. Fundal height is measured throughout the second and third trimesters, not only after 36 weeks.
Checked against: OpenStax Maternal-Newborn Nursing, 11.3
Question 8 · Physiological Adaptation
A nurse assesses a newborn 1 minute after birth. The infant has a heart rate of 110 bpm, a slow and irregular respiratory effort, some flexion of extremities, a grimace with stimulation, and a pink body with blue extremities. According to the APGAR scoring system, this infant's color would be scored as which value?
Show answer and rationale
Answer: B. In APGAR scoring, a pink body with blue extremities (acrocyanosis) receives a score of 1 for the appearance/color category, since a score of 2 requires the infant to be completely pink, and a score of 0 is given for a blue or pale body overall. This is a normal and common finding immediately after birth as peripheral circulation adjusts. The color of the newborn is one of the five specific categories assessed in the APGAR score, so it is scored, not excluded.
Checked against: OpenStax Maternal-Newborn Nursing, 22.1
Question 9 · Health Promotion and Maintenance
A first-time pregnant client at 18 weeks gestation asks the nurse when she might start to feel the baby move. What is the nurse's best response?
Show answer and rationale
Answer: C. Quickening, the first fetal movement felt by the mother, typically occurs around 16 to 20 weeks gestation, making this the accurate and reassuring response for a client at 18 weeks. Ten weeks is far too early for quickening to occur. Stating that movement is not felt until the third trimester or after 30 weeks is incorrect and could cause unnecessary anxiety since movement is normally felt much earlier.
Checked against: openstax.org
Question 10 · Physiological Adaptation
A client receiving an oxytocin infusion develops fetal heart rate decelerations that begin after the peak of the contraction and return to baseline after the contraction ends. What should the nurse do first?
Show answer and rationale
Answer: B. Late decelerations, which begin after the peak of the contraction, signal uteroplacental insufficiency, so the nurse starts intrauterine resuscitation: stop the oxytocin, turn the client to the side, and give an IV fluid bolus to improve blood flow to the placenta, then notify the provider. Maternal oxygen is not given routinely for this pattern and is reserved for a client whose oxygen saturation is low. Increasing the oxytocin would make contractions stronger and more frequent and further reduce placental perfusion. Documenting and continuing to monitor ignores a nonreassuring pattern that needs action now. A cesarean birth may become necessary if the pattern persists despite these measures, but it is not the first step.
Checked against: OpenStax Maternal-Newborn Nursing, 16.1; OpenStax Maternal-Newborn Nursing, 16.4
Question 11 · Physiological Adaptation
A client with preeclampsia suddenly develops tonic-clonic seizure activity. What is the nurse's priority action?
Show answer and rationale
Answer: D. When preeclampsia progresses to eclampsia with seizure activity, the priority nursing action is to protect the airway and turn the client onto her side to prevent aspiration, since this is considered an obstetric emergency. Restraining the extremities during an active seizure can cause injury and is not recommended. Inserting an oral airway during an active seizure is contraindicated because it can cause trauma to the mouth and teeth. Administering oxytocin to induce delivery is not the immediate priority during an active seizure; airway protection comes first.
Checked against: OpenStax Maternal-Newborn Nursing, 12.2
Question 12 · Safety and Infection Control
A client at 34 weeks gestation presents with painless, bright red vaginal bleeding. Which action should the nurse avoid?
Show answer and rationale
Answer: C. A vaginal digital examination should never be performed on a client with painless bright red bleeding because it can disrupt a low-lying placenta (placenta previa) and cause severe hemorrhage. Continuous fetal heart rate monitoring, bed rest, and IV access are all appropriate and safe interventions while previa is ruled out. The rule is simple: no vaginal exams with unexplained vaginal bleeding until previa has been excluded by ultrasound.
Checked against: OpenStax Maternal-Newborn Nursing, 12.2
Want more OB and maternity questions?
NurseLingo has 600+ NCLEX-style questions across 35+ topics with a rationale on every answer, and brings back the ones you miss.
Practice more in NurseLingoOn Android, the free NurseLingo app has 750+ study cards, NCLEX question decks and a home-screen widget. The full practice-question bank with rationales is on iPhone and iPad for now; get new questions by email below.
Frequently asked questions
How much OB is on the NCLEX?
Maternity content is spread across categories such as Health Promotion and Maintenance (6 to 12%) and Physiological Adaptation; NCSBN does not publish a separate OB percentage.
About these questions
Every question on this page was approved by a licensed RN, and its answer was checked against open nursing references (mostly OpenStax nursing textbooks) before publishing. They are NCLEX-style practice, not real NCLEX items. NurseLingo is not affiliated with NCSBN. Spot a problem? Tell us.