Prenatal, intrapartum, postpartum care NCLEX-RN Practice Questions

Prenatal, Intrapartum, Postpartum Care NCLEX-RN Practice Questions

Preparing for the NCLEX-RN requires mastering the continuum of maternity care—from preconception and prenatal health promotion to intrapartum safety and postpartum recovery. This topic-wise question set focuses on essential Health Promotion & Maintenance concepts: nutrition, screening schedules, immunizations, fetal surveillance, labor management, and postpartum complications. Each question targets clinical reasoning, prioritization, and patient education that reflect real-world scenarios you’ll encounter as a nurse. Whether reviewing fetal heart rate interpretation, managing hypertensive disorders, or reinforcing breastfeeding techniques, these MCQs challenge you to apply evidence-based practice and current guidelines. Use the rational choices to refine your decision-making and focus your studies on high-yield, exam-relevant maternal-newborn care content.

Q1. A pregnant client with a pre-pregnancy BMI of 22 asks about recommended total weight gain. Which guidance should the nurse provide?

• 11–20 lb (5–9 kg)
• 25–35 lb (11.5–16 kg)
• 37–54 lb (17–25 kg)
• 15–25 lb (7–11.5 kg)

Correct Answer: 25–35 lb (11.5–16 kg)

Q2. A client planning pregnancy asks about folic acid. Which instruction best promotes neural tube defect prevention?

• Begin 1 mg/day starting at the first prenatal visit
• Take at least 400 mcg/day starting at least 1 month before conception
• Start 100 mcg/day only after confirming pregnancy
• Take 4 mg/day during the third trimester

Correct Answer: Take at least 400 mcg/day starting at least 1 month before conception

Q3. Which vaccine is appropriate to administer during pregnancy to reduce maternal and neonatal morbidity?

• MMR
• Varicella
• Inactivated influenza vaccine
• Live attenuated influenza vaccine (intranasal)

Correct Answer: Inactivated influenza vaccine

Q4. Using Nägele’s rule, what is the estimated date of delivery if the last menstrual period began on June 10?

• February 10
• March 17
• April 3
• March 7

Correct Answer: March 17

Q5. At 24 weeks’ gestation, which fundal height finding is expected for a singleton pregnancy?

• 16 cm
• 20 cm
• 24 cm
• 28 cm

Correct Answer: 24 cm

Q6. A 26-week pregnant client asks about gestational diabetes screening. Which response is correct?

• “We screen at 12–16 weeks for all clients.”
• “We screen only if you develop glucosuria.”
• “We typically screen at 24–28 weeks with an initial 1-hour 50-g glucose test.”
• “We wait until 32 weeks unless you have risk factors.”

Correct Answer: “We typically screen at 24–28 weeks with an initial 1-hour 50-g glucose test.”

Q7. At 36 weeks’ visit, which screening should the nurse anticipate and educate the client about?

• Syphilis titer
• Rubella immunity
• Group B Streptococcus vaginal/rectal culture
• First-trimester aneuploidy screen

Correct Answer: Group B Streptococcus vaginal/rectal culture

Q8. An Rh-negative gravida at 28 weeks with an Rh-positive partner and negative antibody screen asks about Rh immune globulin. What’s the correct plan?

• Administer only after delivery regardless of infant Rh status
• Administer at 28 weeks and within 72 hours postpartum if the newborn is Rh-positive
• Administer once in the first trimester only
• Administer every 2 weeks from 20 weeks until delivery

Correct Answer: Administer at 28 weeks and within 72 hours postpartum if the newborn is Rh-positive

Q9. A client with severe preeclampsia is receiving magnesium sulfate. Which finding requires immediate intervention?

• 2+ patellar reflexes and urine output 40 mL/hr
• Mild flushing and warmth
• Respiratory rate 10/min and absent deep tendon reflexes
• Fetal heart rate baseline 140 bpm with moderate variability

Correct Answer: Respiratory rate 10/min and absent deep tendon reflexes

Q10. A nonstress test at 34 weeks shows two accelerations of at least 15 bpm lasting 15 seconds in 20 minutes, with moderate variability and no decelerations. How is this interpreted?

• Nonreactive; requires immediate biophysical profile
• Reactive; fetal well-being is reassuring
• Equivocal; repeat in 48 hours
• Abnormal; schedule induction

Correct Answer: Reactive; fetal well-being is reassuring

Q11. During labor, variable decelerations occur with contractions. What is the nurse’s best initial action?

• Reposition the client to a lateral position
• Increase oxytocin infusion
• Prepare for immediate cesarean delivery
• Perform amniotomy

Correct Answer: Reposition the client to a lateral position

Q12. The fetal heart monitor shows recurrent late decelerations. Which priority nursing actions are appropriate?

• Continue oxytocin and document
• Turn to left lateral, stop oxytocin, increase IV fluids, apply oxygen, notify provider
• Place client supine and start pushing
• Administer magnesium sulfate

Correct Answer: Turn to left lateral, stop oxytocin, increase IV fluids, apply oxygen, notify provider

Q13. Which finding distinguishes true labor from false labor?

• Contractions irregular and resolve with rest
• Pain only in the abdomen
• Cervical dilation and effacement progressively increase
• Relief with hydration

Correct Answer: Cervical dilation and effacement progressively increase

Q14. The nurse evaluates cervical ripeness using the Bishop score. Which component is included?

• Fetal heart rate baseline
• Amniotic fluid index
• Cervical dilation, effacement, station, consistency, and position
• Uterine resting tone

Correct Answer: Cervical dilation, effacement, station, consistency, and position

Q15. After spontaneous rupture of membranes, a fetal heart rate of 70 bpm is noted and a pulsating cord is seen at the introitus. What is the priority action?

• Insert a Foley catheter
• Elevate the presenting part with a sterile gloved hand and place the client in knee-chest position
• Start oxytocin to expedite delivery
• Perform a sterile vaginal exam to determine dilation

Correct Answer: Elevate the presenting part with a sterile gloved hand and place the client in knee-chest position

Q16. Meconium-stained amniotic fluid is noted during labor. Which action best promotes neonatal safety?

• Perform routine deep suctioning of the newborn in the oropharynx before the shoulders deliver
• Delay cord clamping until 5 minutes after birth
• Notify and prepare the neonatal resuscitation team to attend the birth
• Administer terbutaline to stop labor

Correct Answer: Notify and prepare the neonatal resuscitation team to attend the birth

Q17. Shortly after epidural placement, the client’s blood pressure drops to 84/50 mmHg and fetal heart rate shows bradycardia. What is the nurse’s first action?

• Administer a diuretic
• Position the client laterally and increase IV fluids; notify provider
• Start oxytocin infusion
• Begin amnioinfusion

Correct Answer: Position the client laterally and increase IV fluids; notify provider

Q18. On postpartum day 2, which lochia pattern is expected for a recovering client?

• Lochia rubra: dark red, small clots, earthy odor
• Lochia serosa: pinkish-brown, scant
• Lochia alba: whitish-yellow, minimal
• No lochia present

Correct Answer: Lochia rubra: dark red, small clots, earthy odor

Q19. A postpartum client has a boggy, deviated-right fundus with heavy lochia. What is the priority nursing action?

• Assist the client to void or perform straight catheterization
• Apply ice packs to the perineum
• Encourage ambulation
• Administer magnesium sulfate

Correct Answer: Assist the client to void or perform straight catheterization

Q20. Which postpartum finding requires immediate provider notification?

• Mild perineal edema and discomfort controlled with NSAIDs
• Saturating a peripad in 15 minutes with bright red bleeding and large clots
• Afterpains with breastfeeding
• Temperature 37.7°C (99.9°F) in the first 24 hours

Correct Answer: Saturating a peripad in 15 minutes with bright red bleeding and large clots

Q21. Which maternal condition is a contraindication to breastfeeding in the U.S.?

• Mastitis on antibiotics
• Maternal HIV infection
• Past history of hepatitis B infection, infant vaccinated
• Cesarean delivery

Correct Answer: Maternal HIV infection

Q22. A breastfeeding client with mastitis reports fever, breast pain, and localized erythema. Which instruction is appropriate?

• Stop breastfeeding until antibiotics are completed
• Apply ice and bind the breasts
• Continue breastfeeding or pumping, apply warm compresses, and take prescribed antibiotics
• Drain the breast by needle aspiration only

Correct Answer: Continue breastfeeding or pumping, apply warm compresses, and take prescribed antibiotics

Q23. A postpartum client states, “I hear voices telling me to harm my baby.” What is the nurse’s priority?

• Reassure her that this is normal postpartum blues
• Schedule a routine 6-week follow-up
• Implement suicide/infanticide precautions and notify the provider immediately
• Encourage rest and hydration

Correct Answer: Implement suicide/infanticide precautions and notify the provider immediately

Q24. A breastfeeding client requests contraception at the 2-week postpartum visit. Which method is most appropriate now?

• Progestin-only pill with counseling on strict daily timing
• Combined estrogen-progestin oral contraceptive starting today
• Diaphragm fitting today
• Copper IUD at 12 months postpartum only

Correct Answer: Progestin-only pill with counseling on strict daily timing

Q25. Teaching fetal movement counts to a client at 30 weeks should include which instruction?

• Report if fewer than 3 movements in 60 minutes
• Report if fewer than 10 movements in 2 hours during the baby’s usual active time
• Expect no movement after meals
• Count movements only once weekly

Correct Answer: Report if fewer than 10 movements in 2 hours during the baby’s usual active time

Q26. A 10-week pregnant client with severe, persistent vomiting, weight loss, and ketonuria likely has hyperemesis gravidarum. Which initial intervention is anticipated?

• High-fat diet and oral iron supplements
• IV fluid and electrolyte replacement with antiemetic therapy
• Immediate induction of labor
• Strict bed rest at home

Correct Answer: IV fluid and electrolyte replacement with antiemetic therapy

Q27. Which prenatal teaching reduces the risk of toxoplasmosis?

• Increase intake of unpasteurized dairy products
• Avoid changing cat litter and eating undercooked meat
• Drink well water without boiling
• Handle raw meat and then vegetables without washing hands

Correct Answer: Avoid changing cat litter and eating undercooked meat

Q28. Which exercise advice is appropriate for an uncomplicated pregnancy?

• Engage in 150 minutes/week of moderate-intensity activity; avoid supine position after the first trimester
• Start high-impact contact sports after 28 weeks
• Perform hot yoga in the third trimester
• Restrict all exercise throughout pregnancy

Correct Answer: Engage in 150 minutes/week of moderate-intensity activity; avoid supine position after the first trimester

Q29. After amniotomy, what is the nurse’s priority assessment?

• Maternal temperature every 4 hours
• Contraction intensity only
• Fetal heart rate for signs of cord prolapse or distress
• Maternal pain score

Correct Answer: Fetal heart rate for signs of cord prolapse or distress

Q30. A client on oxytocin has uterine tachysystole (more than 5 contractions in 10 minutes). What is the best nursing action?

• Increase oxytocin rate
• Stop oxytocin, reposition laterally, give IV fluid bolus, consider tocolytic if persistent
• Place client supine with legs elevated
• Start magnesium sulfate infusion

Correct Answer: Stop oxytocin, reposition laterally, give IV fluid bolus, consider tocolytic if persistent

Download