NCLEX Maternal-Newborn (OB) Practice Questions
NCLEX maternal-newborn practice questions covering labor and delivery, postpartum hemorrhage, and newborn assessment, with detailed rationales.
Maternal-newborn content is tested heavily because it combines rapid physiological change with high-acuity emergencies like hemorrhage and fetal distress. These sample questions reflect the fetal heart tracing, postpartum, and newborn assessment items you'll see most often.
Practice questions
1. The fetal monitor shows variable decelerations. What is the nurse's first action?
- A. Administer oxytocin
- B. Reposition the client, often to left lateral
- C. Prepare for immediate cesarean section
- D. Increase the IV fluid rate only
Show answer & rationale
Correct answer: B
Variable decelerations typically indicate cord compression; repositioning the client (left lateral or knee-chest) is the first intervention to relieve pressure on the cord before other measures.
2. A client is 2 hours postpartum and the nurse notes a boggy fundus above the umbilicus, displaced to the right. What is the priority action?
- A. Administer a stool softener
- B. Have the client void or catheterize if unable
- C. Massage the fundus only
- D. Notify the provider immediately
Show answer & rationale
Correct answer: B
A boggy, displaced fundus is classically caused by a full bladder preventing the uterus from contracting. Having the client void (or catheterizing) is the priority; fundal massage should also follow once the bladder is addressed.
3. Which newborn finding requires immediate nursing action?
- A. Acrocyanosis at 1 hour of age
- B. Respiratory rate of 70/min with grunting and nasal flaring
- C. Molding of the head
- D. Vernix caseosa on the skin
Show answer & rationale
Correct answer: B
Grunting, nasal flaring, and tachypnea over 60/min indicate respiratory distress in a newborn and require immediate intervention; acrocyanosis, molding, and vernix are normal newborn findings.
4. A client with preeclampsia is receiving magnesium sulfate. Which finding indicates toxicity?
- A. Deep tendon reflexes 2+
- B. Respiratory rate of 10/min
- C. Urine output of 40 mL/hr
- D. Serum magnesium of 5 mEq/L
Show answer & rationale
Correct answer: B
Magnesium toxicity depresses the CNS and respiratory drive; a respiratory rate below 12/min is a critical sign requiring the nurse to stop the infusion and prepare to administer calcium gluconate.
5. Which statement by a postpartum client indicates a need for further teaching about breastfeeding?
- A. "I should feel a tugging sensation, not sharp pain, while nursing."
- B. "I'll wake the baby every 2 to 3 hours to feed in the first weeks."
- C. "I should hear my baby swallowing during a feed."
- D. "I'll offer a pacifier before every feeding to soothe the baby."
Show answer & rationale
Correct answer: D
Pacifiers offered before breastfeeding is established can cause nipple confusion and interfere with milk supply; the other statements reflect correct breastfeeding technique.
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Frequently asked questions
What OB emergencies show up most on the NCLEX?
Postpartum hemorrhage, magnesium toxicity in preeclampsia, umbilical cord compression (variable decelerations), and newborn respiratory distress are the highest-yield emergencies.
How do I remember fetal heart tracing patterns?
Use VEAL CHOP: Variable=Cord compression, Early=Head compression, Accelerations=Okay, Late=Placental insufficiency. This mnemonic covers the vast majority of NCLEX tracing questions.