NCLEX maternity and newborn practice questions

Maternity questions test what is normal in pregnancy, labor, postpartum and the newborn, so the abnormal finding stands out.

1. Question 1

   A client at 10 weeks of gestation with a singleton pregnancy has a pre-pregnancy body mass index (BMI) of 23. What total weight gain should the nurse tell the client is recommended for the pregnancy?

   • A.25 to 35 lb (11.3 to 15.9 kg)
   • B.11 to 20 lb (5 to 9.1 kg)
   • C.15 to 25 lb (6.8 to 11.3 kg)
   • D.28 to 40 lb (12.7 to 18.1 kg)
   Show answer and explanation

   Answer: A

   Recommended weight gain in pregnancy depends on pre-pregnancy BMI. The lower the starting BMI, the more weight gain is advised. A BMI of 23 is normal, so the goal is 25 to 35 lb.

   • A. Correct. This is the recommended range for a client with a normal BMI of 18.5 to 24.9.
   • B. This range is recommended for clients with obesity (BMI 30 or higher).
   • C. This range is recommended for clients who are overweight (BMI 25 to 29.9).
   • D. This range is recommended for clients who are underweight (BMI below 18.5).

   Key concept: Pregnancy weight gain goals: underweight 28-40 lb, normal 25-35 lb, overweight 15-25 lb, obese 11-20 lb.

   Tip: Normal BMI: 25 to 35 lb.

2. Question 2

   A client at 32 weeks of gestation with mild gestational hypertension is being monitored at home. Which symptoms should the nurse teach the client to report right away? Select all that apply.

   Select all that apply.

   • A.Headache that does not go away with acetaminophen
   • B.Seeing spots or flashing lights
   • C.Pain in the upper right abdomen or under the ribs
   • D.Sudden swelling of the face and hands
   • E.Mild ankle swelling at the end of the day that is gone by morning
   • F.Occasional painless, irregular tightening of the abdomen
   • G.Mild heartburn after large meals that is relieved by antacids
   Show answer and explanation

   Answer: A, B, C, D

   Clients with gestational hypertension can progress to preeclampsia with severe features. Warning signs reflect vasospasm and organ involvement: persistent headache, visual changes, right upper quadrant or epigastric pain, sudden swelling of the face or hands, and shortness of breath. Normal pregnancy discomforts such as mild evening ankle edema, Braxton Hicks contractions and mild heartburn do not need urgent care.

   • A. Correct. A persistent severe headache can signal worsening preeclampsia and brain irritability.
   • B. Correct. Visual changes are caused by cerebral vasospasm and are a severe feature.
   • C. Correct. Right upper quadrant or epigastric pain may mean liver swelling and is a warning sign of severe preeclampsia or HELLP syndrome.
   • D. Correct. Rapid swelling of the face and hands, especially with quick weight gain, can mean worsening disease.
   • E. Incorrect. Dependent ankle edema that resolves with rest is a common, expected discomfort of pregnancy.
   • F. Incorrect. These are Braxton Hicks contractions, which are expected in the third trimester.
   • G. Incorrect. Heartburn from slower stomach emptying and uterine pressure is common. It differs from constant upper abdominal pain.

   Key concept: Teach clients with hypertension in pregnancy to report headache, vision changes, upper abdominal pain, sudden facial or hand swelling, and shortness of breath.

   Tip: Head, eyes, liver, face: call right away.

3. Question 3

   A nurse calls a client at home 5 days after the birth of her exclusively breastfed term newborn. Which findings indicate the newborn is getting enough milk? Select all that apply.

   Select all that apply.

   • A.Six or more wet diapers in 24 hours
   • B.Feeds 4 times in 24 hours and sleeps 5 hours between feeds
   • C.Stools have changed from black meconium to yellow
   • D.Swallowing can be heard during feedings
   • E.Weight is 12% below birth weight
   • F.The client's breasts feel softer after each feeding
   • G.Stools are still black and sticky
   Show answer and explanation

   Answer: A, C, D, F

   Signs of adequate breastfeeding by day 5 include 8 to 12 feedings a day, audible swallowing, softer breasts after feeding, at least 6 wet diapers a day, stools that have changed from meconium to yellow, and weight loss of no more than about 10% with regain to birth weight by 10 to 14 days. No single sign is enough; the nurse looks at the whole picture, including weight.

   • A. Correct. By day 5, six or more wet diapers a day shows good fluid intake.
   • B. Incorrect. Newborns should feed 8 to 12 times a day. Long gaps can mean poor intake or a sleepy newborn who needs to be woken.
   • C. Correct. A change from meconium to yellow stools by days 4 to 5 shows that milk is coming in and being digested. Stool frequency varies, so it is judged together with wet diapers, feeding and weight.
   • D. Correct. Audible swallowing means milk is being transferred, not just suckling.
   • E. Incorrect. A loss of more than 10% of birth weight is excessive and needs evaluation.
   • F. Correct. Breasts that soften after feeding show the newborn has removed milk.
   • G. Incorrect. Meconium should change to transitional stools by day 3 to 4; persistent meconium suggests too little intake.

   Key concept: Judge breastfeeding adequacy by feeding frequency, output, weight and signs of milk transfer.

   Tip: Day 5: 6+ wet diapers, yellow stools, 8-12 feeds, weight on track.

4. Question 4

   At 1 minute after birth, a newborn has a heart rate of 110/min, slow and irregular respirations with a weak cry, arms and legs slightly flexed with little movement, a grimace but no cry or sneeze when the nose is suctioned, and a pink body with blue hands and feet. What Apgar score should the nurse record?

   • A.4
   • B.6
   • C.7
   • D.8
   Show answer and explanation

   Answer: B

   Each Apgar sign scores 0, 1 or 2. Heart rate above 100 = 2. Slow, irregular breathing with a weak cry = 1. Some flexion = 1. Grimace = 1. Pink body with blue extremities = 1. Total = 6. The Apgar score describes the newborn's condition and response to care; decisions about resuscitation are based on breathing, heart rate and tone, not on the score itself.

   • A. This undercounts. The heart rate above 100/min earns 2 points.
   • B. Correct. Heart rate 2 + respiratory effort 1 + muscle tone 1 + reflex irritability 1 + color 1 = 6.
   • C. This gives an extra point, likely by scoring the weak cry or the acrocyanosis as 2.
   • D. This would require full scores in two more categories, such as a strong cry and active movement.

   Key concept: Apgar scores heart rate, respiratory effort, muscle tone, reflex irritability and color at 1 and 5 minutes.

   Tip: APGAR: Appearance, Pulse, Grimace, Activity, Respiration.

5. Question 5

   A client at 37 weeks of gestation learns that her vaginal-rectal culture is positive for group B streptococcus (GBS). She has no symptoms. Which statement by the nurse is accurate?

   • A."You will take oral antibiotics for 10 days now so the infection is gone before labor."
   • B."You will receive IV antibiotics at the hospital during labor."
   • C."You will need a cesarean birth to keep the bacteria from reaching your baby."
   • D."You should not breastfeed until your baby has been tested for GBS."
   Show answer and explanation

   Answer: B

   GBS is a common bacteria in the vagina and rectum. It is harmless to most adults but can cause sepsis, pneumonia or meningitis in newborns. Clients are screened at 36 to 37 weeks, and those who test positive receive IV antibiotics during labor.

   • A. Treating GBS before labor does not work because the bacteria quickly return. Antibiotics are given during labor.
   • B. Correct. IV antibiotics (usually penicillin) given during labor, ideally at least 4 hours before birth, protect the newborn from early-onset GBS infection. If the membranes rupture before labor, the provider decides on timing.
   • C. A positive GBS culture alone is not a reason for cesarean birth.
   • D. GBS colonization is not a reason to delay or avoid breastfeeding.

   Key concept: GBS-positive clients get IV antibiotics during labor, at least 4 hours before birth when possible, not before labor.

   Tip: GBS: swab at 36-37 weeks, treat in labor.