NCLEX Maternal & Newborn questions
The PrepScore bank has 48 Maternal & Newborn questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Recognize cues and Take action, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
Preeclampsia and eclampsia, postpartum hemorrhage, Mg toxicity, fetal heart rate decels, prolapsed cord, neonatal red flags.
Three worked questions
Q1. A 28-year-old G2P1 at 36 weeks gestation laboring in the L&D unit suddenly reports severe constant abdominal pain + dark vaginal bleeding + uterus tense and rigid (board-like). The L&D nurse identifies the priority diagnosis. The nurse suspects which condition?
- A. Placenta previa (typically PAINLESS bright red bleeding — does not fit the painful, dark blood presentation)
- B. Placental abruption — severe constant pain + dark blood + rigid uterus + risk of fetal distress and DIC
- C. Normal labor (normal labor has intermittent contractions — not constant rigid uterus and dark bleeding)
- D. Braxton-Hicks contractions (irregular painless tightening — not constant rigid uterus and bleeding)
Show answer and rationale
Answer: Placental abruption — severe constant pain + dark blood + rigid uterus + risk of fetal distress and DIC
Placental abruption: severe constant pain + dark blood + rigid (board-like) uterus + risk of fetal distress and DIC. Placenta previa is PAINLESS bright red. Normal labor is intermittent. Braxton-Hicks is irregular painless.
Q2. A 30-year-old G1P0 at 39 weeks just had amniotomy (artificial rupture of membranes) and the FHR drops to 90 with a variable deceleration on the monitor. The L&D nurse identifies the priority action. Which is the FIRST action for this nurse?
- A. Document the variable deceleration and observe without any intervention or change in maternal position
- B. Reposition (left lateral) + check for prolapsed cord (vaginal exam) + give O2 (10 L NRB) + notify provider STAT + continuous fetal monitoring + prepare for possible emergent C-section
- C. Encourage pushing efforts despite the recent variable deceleration and the absence of complete cervical dilation
- D. Stop fetal monitoring during the variable deceleration and prolonged bradycardia in this laboring patient
Show answer and rationale
Answer: Reposition (left lateral) + check for prolapsed cord (vaginal exam) + give O2 (10 L NRB) + notify provider STAT + continuous fetal monitoring + prepare for possible emergent C-section
Post-amniotomy FHR 90 + variable decel = possible cord compression or prolapse. FIRST: reposition (left lateral) + check for prolapsed cord + O2 + notify provider + continuous monitoring + prepare emergent C-section.
Q3. A 32-year-old G3P3 is 2 hours postpartum after a vaginal delivery with no complications during labor. The postpartum nurse performs an assessment for postpartum hemorrhage. Which findings SUGGEST POSTPARTUM HEMORRHAGE? Select all that apply.
- A. Saturating more than 1 perineal pad per hour (excessive bleeding)
- B. Boggy uterus that does not firm with massage (uterine atony — most common cause)
- C. BP drops + HR rises (hypovolemic shock compensation)
- D. Pallor + diaphoresis + restlessness (early hypovolemic shock CNS effects)
- E. Light lochia rubra on day 2 postpartum (normal expected finding)
- F. Tender, firm uterus at the level of the umbilicus on postpartum exam (normal expected finding)
Show answer and rationale
Answer: Saturating more than 1 perineal pad per hour (excessive bleeding)Boggy uterus that does not firm with massage (uterine atony — most common cause)BP drops + HR rises (hypovolemic shock compensation)Pallor + diaphoresis + restlessness (early hypovolemic shock CNS effects)
PPH signs: > 1 pad/hr + boggy uterus + BP drop/HR rise + pallor/diaphoresis/restlessness. Light lochia rubra day 2 + firm tender uterus at umbilicus are normal.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
Severe-features preeclampsia (BP ≥ 160/110 sustained, end-organ symptoms, or HELLP labs) requires magnesium sulfate for seizure prophylaxis + IV antihypertensive (labetalol or hydralazine) for severe-range BP. Preeclamptic edema is capillary leak, not volume overload — diuretics worsen placental perfusion. Quiet, dim room. Steroids if < 34 wk.
Postpartum hemorrhage is EBL > 500 (vaginal) or 1000 (C-section) or any sign of hemodynamic compromise. First-line: fundal massage + bladder decompression + increase oxytocin. Second-line uterotonics by patient: methylergonovine NOT in HTN; carboprost NOT in asthma; misoprostol generally OK. Escalate to Bakri/surgery for refractory.
HELLP often mimics flu or indigestion. Look for Hemolysis (LDH, schistocytes, indirect bilirubin) + Elevated Liver enzymes + Low Platelets. Treat as severe-features preeclampsia + plan for delivery. Avoid empiric platelet transfusion without active bleeding/surgery indication.
Magnesium toxicity progression: loss of DTRs → respiratory depression → cardiac arrest. Renal clearance — falling UO causes accumulation. Therapeutic range 4–7 mg/dL. Antidote = calcium gluconate 1 g IV slowly. Stop the Mg first; calcium second.
Abruption = painful, dark bleeding, rigid tender uterus, often hidden volume loss. Previa = painless bright red bleeding. NEVER perform a digital vaginal exam in 3rd-trimester bleeding until placenta location confirmed by ultrasound — exam over previa can cause catastrophic hemorrhage.
Variable = Cord (compression); Early = Head (compression, benign); Acceleration = Okay; Late = Placental insufficiency. For LATE decels: STOP oxytocin, reposition LEFT lateral (off supine), O2 10 L NRB, IV fluid bolus, notify. If recurrent and unresponsive, prepare for delivery.
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Maternal & Newborn questions does the bank have?
48 multiple-choice items, plus 10 unfolding cases in the Maternal & Newborn pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Recognize cues and Take action, though every step appears.
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