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Health Promotion and Maintenance

NCLEX Maternity Practice Questions

Quick answer

Maternity questions test prenatal care, labor monitoring, postpartum assessment and newborn feeding. They sit mostly inside Health Promotion and Maintenance (6 to 12 percent of the exam), and a few show up under Physiological Adaptation when the client is bleeding or seizing.

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Students tend to treat maternity as a memorization block, and then the exam asks them to make a decision at the bedside. You will see a fetal heart strip described in words, a postpartum fundus that feels wrong, or a mother on magnesium whose reflexes have gone quiet. The trap in this topic is doing something to the client before fixing the cause. A late deceleration is not a reason to call the provider first, it is a reason to turn the mother on her side and give oxygen, then call. The questions below are built around those "what do I do right now" moments, plus the prenatal teaching that gets tested every year.

Practice questions

1

A client at her first prenatal visit reports that the first day of her last menstrual period was April 10, 2026. Her cycles are regular. Using Naegele's rule, which estimated date of delivery should the nurse record?

  1. AJanuary 3, 2027
  2. BJanuary 17, 2027
  3. CFebruary 10, 2027
  4. DJuly 17, 2027
Show answer

Answer: B

Naegele's rule takes the first day of the last menstrual period, adds 7 days, subtracts 3 months, and adds 1 year. April 10 plus 7 days is April 17; back 3 months is January 17; forward 1 year gives January 17, 2027.

Why the others are wrong

Option A subtracts 7 days instead of adding them. Option C skips the 7 day step and only moves the month. Option D adds 3 months instead of subtracting, which puts the due date only 3 months out.

2

A client at 34 weeks gestation with a blood pressure of 152/96 mm Hg calls the clinic. Which report requires the nurse to tell her to come in immediately?

  1. AMild swelling of both ankles at the end of the day
  2. BA headache that has not eased with acetaminophen and spots in her vision
  3. CHeartburn after eating a large meal
  4. DLow back ache that improves with rest
Show answer

Answer: B

A persistent headache with visual changes in a hypertensive pregnant client signals worsening preeclampsia and possible progression to eclampsia (seizure). Epigastric or right upper quadrant pain is another red flag because it points to liver involvement. She needs to be evaluated now.

Why the others are wrong

Dependent ankle edema that resolves overnight is common in late pregnancy. Heartburn after a heavy meal is an expected discomfort from the enlarging uterus pressing on the stomach. Back ache that improves with rest is a normal musculoskeletal complaint, not a sign of worsening preeclampsia.

3

A client with severe preeclampsia is receiving a magnesium sulfate infusion. On assessment the nurse finds no patellar reflex, a respiratory rate of 10 breaths per minute, and the client is drowsy. Which action should the nurse take first?

  1. AStop the magnesium infusion
  2. BLower the head of the bed and apply oxygen
  3. CDraw a serum magnesium level
  4. DDocument the findings and reassess in 15 minutes
Show answer

Answer: A

Absent deep tendon reflexes and a respiratory rate below 12 are the signs of magnesium toxicity, and the drug is the cause. Turning off the infusion comes first, then the nurse notifies the provider and prepares calcium gluconate, which is the antidote. A urine output below 30 mL per hour also raises the risk because magnesium is cleared by the kidneys.

Why the others are wrong

Oxygen may be needed but it does not remove the magnesium that is depressing the client's breathing. A serum level confirms what the assessment already shows and should not delay stopping the drug. Waiting 15 minutes while the respiratory rate is 10 lets the toxicity get worse.

4

A laboring client is receiving an oxytocin infusion. The nurse notes that the fetal heart rate slows after the peak of each contraction and returns to baseline only after the contraction ends. Which action should the nurse take first?

  1. ANotify the provider
  2. BTurn the client onto her left side
  3. CIncrease the oxytocin rate to shorten labor
  4. DPerform a vaginal exam to check for cord prolapse
Show answer

Answer: B

A deceleration that starts after the contraction peaks and recovers late is a late deceleration, which means uteroplacental insufficiency. The first step is to improve blood flow to the placenta: reposition the client to her side, stop the oxytocin, give oxygen by face mask, and increase IV fluids. Then notify the provider.

Why the others are wrong

Calling the provider is correct but comes after the immediate fixes the nurse can do alone. Increasing oxytocin would make contractions stronger and cut placental blood flow further; the drug should be stopped. A vaginal exam to rule out cord prolapse is the response to an abrupt variable deceleration, not a late one.

5

A client at 32 weeks gestation arrives at the labor unit with bright red vaginal bleeding and reports no pain. Her abdomen is soft. Which action by a new nurse would the charge nurse need to stop?

  1. AApplying an external fetal monitor
  2. BStarting an IV with a large bore catheter
  3. CPerforming a sterile vaginal exam to check cervical dilation
  4. DDrawing blood for a type and crossmatch
Show answer

Answer: C

Painless bright red bleeding with a soft uterus in the third trimester is the picture of placenta previa, where the placenta covers the cervical opening. A vaginal exam can tear the placenta and cause massive hemorrhage, so no vaginal exam is done until ultrasound confirms placental location. Painful bleeding with a rigid, board-like abdomen points to abruption instead.

Why the others are wrong

Fetal monitoring is needed to check for distress. A large bore IV prepares for fluid and blood replacement. Type and crossmatch is appropriate because this client may need a transfusion or an urgent cesarean.

6

Two hours after a vaginal birth, the nurse finds the client's perineal pad saturated and the fundus soft and above the umbilicus, deviated to the right. Which action should the nurse take first?

  1. AMassage the fundus until it is firm
  2. BGive the ordered oxytocin IV bolus
  3. CAssist the client to the bathroom to void
  4. DCall the provider to report the bleeding
Show answer

Answer: A

A boggy fundus with heavy bleeding means uterine atony, the most common cause of early postpartum hemorrhage. Fundal massage is the fastest way to make the uterus contract and clamp down on open vessels, so it comes first. Once the uterus is firm, the nurse empties the bladder (a full bladder pushes the fundus up and to the side) and gives uterotonic drugs as ordered.

Why the others are wrong

Oxytocin helps but takes time to work; massage gives an immediate response. Emptying the bladder is the next step, since the deviation suggests a full bladder, but the client should not walk to the bathroom while hemorrhaging. The provider is notified after the nurse has started to control the bleeding.

7

A client who is Rh negative asks why she received an injection at her 28 week visit and is being told she may need another after delivery. Which response by the nurse is correct?

  1. A"The shot stops your body from making antibodies that could attack a future Rh positive baby. If this baby is Rh positive you will get a second dose within 72 hours of birth."
  2. B"The shot protects this baby from your antibodies. You will not need it again after this pregnancy."
  3. C"The shot is given every month until delivery to keep your blood type from changing."
  4. D"The shot is only needed after delivery, so the 28 week dose was a precaution that can be skipped next time."
Show answer

Answer: A

Rh immune globulin (RhoGAM) is given at 28 weeks and again within 72 hours after birth if the newborn is Rh positive. It also follows any event where fetal blood may mix with maternal blood, such as miscarriage, amniocentesis or abdominal trauma. The goal is to prevent sensitization so the mother does not build antibodies against a future Rh positive fetus.

Why the others are wrong

Option B is wrong because the first pregnancy is usually not the one harmed; the protection is for future pregnancies, and the postpartum dose is still needed. Option C invents a monthly schedule and a change in blood type that does not happen. Option D drops the routine 28 week dose, which is standard care.

8

A client at 26 weeks gestation with no history of diabetes asks why she is scheduled for a glucose test. Which explanation by the nurse is accurate?

  1. A"All pregnant clients are screened for gestational diabetes between 24 and 28 weeks with a 1 hour glucose challenge test."
  2. B"You are being screened because your blood sugar has been high at every visit."
  3. C"The test checks whether the baby has diabetes."
  4. D"You will need to fast for 12 hours and the test takes 3 hours."
Show answer

Answer: A

Routine screening for gestational diabetes happens at 24 to 28 weeks because placental hormones raise insulin resistance most in the second half of pregnancy. The client drinks a 50 g glucose load and blood is drawn 1 hour later; no fasting is needed. A result of 140 mg/dL or higher leads to the 3 hour oral glucose tolerance test for diagnosis.

Why the others are wrong

The test is routine for everyone, not a response to high readings, so option B is misleading. Option C is wrong because the test screens the mother, not the fetus. Option D describes the longer diagnostic test, which is only ordered if the screen is abnormal.

9

A postpartum client on day 3 says her breasts are hard, warm and painful, and the baby cannot latch. Which teaching should the nurse provide?

  1. AStop breastfeeding for 24 hours to let the breasts rest
  2. BApply warm compresses or take a warm shower before feeding, express a little milk to soften the areola, then feed on both sides
  3. CBind the breasts tightly and feed the baby formula until the swelling goes down
  4. DLimit feedings to every 6 hours so the breasts do not overfill
Show answer

Answer: B

Bilateral hard, warm, painful breasts on day 3 to 5 are engorgement from milk coming in. Warmth before feeding helps milk flow, hand expressing a small amount softens the areola so the newborn can get a deep latch (mouth wide, lips flanged, more areola than nipple in the mouth), and frequent emptying of both breasts resolves it. Cold packs between feedings reduce swelling and pain.

Why the others are wrong

Stopping feeds makes engorgement worse and can lead to plugged ducts or mastitis. Binding and switching to formula are for a client who has chosen not to breastfeed, not one who wants to continue. Feeding every 6 hours is far too infrequent; a newborn feeds 8 to 12 times in 24 hours.

10

A client planning her first pregnancy asks the nurse about diet changes before she conceives. Which statement shows she understood the teaching?

  1. A"I will start taking 400 micrograms of folic acid every day now, before I get pregnant."
  2. B"I will wait until my first prenatal visit to start a prenatal vitamin."
  3. C"I will double my iron intake now to prevent anemia later."
  4. D"I will cut out all dairy so I do not gain too much weight."
Show answer

Answer: A

Folic acid taken before conception and through the first trimester lowers the risk of neural tube defects such as spina bifida. The neural tube closes by about 4 weeks after conception, often before the client knows she is pregnant, which is why supplementation has to start ahead of time. Leafy greens, fortified grains and legumes add dietary folate.

Why the others are wrong

Waiting until the first prenatal visit misses the window when the neural tube is forming. Iron needs rise during pregnancy, but doubling intake before conception is not the teaching point and can cause constipation and nausea. Dairy supplies calcium and protein that pregnancy requires, and cutting it is not a weight control strategy the nurse would endorse.

Quick tips

  • Decelerations: early mirrors the contraction and is head compression (normal), variable is abrupt and V shaped from cord compression (reposition, check for prolapse), late starts after the peak and is placental insufficiency (side lying, oxygen, stop oxytocin, fluids, call).
  • Previa is painless and bright red, abruption is painful with a rigid abdomen and sometimes dark or hidden bleeding. No vaginal exam until the placenta's location is known.
  • Magnesium sulfate: check reflexes, respiratory rate and urine output every hour. Reflexes gone or breaths under 12 means stop the drug and have calcium gluconate at the bedside.
  • Postpartum check order is fundus, lochia, bladder. A boggy fundus gets massaged first; a fundus pushed to one side usually means a full bladder.
  • Postpartum danger signs to teach before discharge: soaking a pad in an hour, clots bigger than a golf ball, temperature over 100.4 F after the first day, foul smelling lochia, a hot red area on one breast, calf pain, or a headache with vision changes within the first week.

Related topics

FAQ

How many maternity questions are on the NCLEX?

There is no fixed number. Maternity content is spread across Health Promotion and Maintenance (6 to 12 percent of the test) and a few other categories, so most candidates see somewhere between 5 and 12 questions that involve a pregnant or postpartum client.

What is the easiest way to remember Naegele's rule?

Take the first day of the last period, add 7 days, then subtract 3 months and add a year. Practice on a few dates that cross a year boundary, because the exam likes to pick a last period in the spring so the due date lands in the next calendar year.

What is the first thing to do for a late deceleration?

Turn the mother onto her side, usually the left. Then stop any oxytocin, give oxygen by non rebreather mask, open up the IV fluids, and notify the provider. Position change is first because it takes the uterus off the vena cava and improves blood flow to the placenta within seconds.

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