Ten free maternity (OB) NCLEX practice questions with full rationales — fetal heart-rate decelerations, preeclampsia, postpartum hemorrhage, placenta previa vs abruptio, prolapsed cord, and APGAR. Answer each one, then reveal the correct answer and see why every option is right or wrong. No sign-up needed to practice here.
High-Yield Maternity Review
Maternity questions reward fast pattern recognition. On the fetal monitor, use VEAL CHOP: Variable = Cord compression, Early = Head compression, Accelerations = Okay, Late = Placental insufficiency. Early decelerations mirror the contraction and are benign. Variable decelerations are abrupt, V- or W-shaped, and signal cord compression, so reposition the client and rule out a prolapsed cord. Late decelerations are gradual and begin after the contraction peaks; they are nonreassuring and call for intrauterine resuscitation: reposition to the left lateral side, STOP the oxytocin, increase IV fluids, and notify the provider (traditional NCLEX bundles also add oxygen, although current ACOG practice has de-emphasized routine maternal oxygen for these tracings).
Preeclampsia is new-onset blood pressure at or above 140/90 with proteinuria or other signs of end-organ dysfunction after 20 weeks; severe features (BP at or above 160/110, severe headache, visual changes, right-upper-quadrant or epigastric pain, or a low platelet count/HELLP) raise the risk of seizure and stroke. Magnesium sulfate is given for seizure prophylaxis, not to lower blood pressure, and its antidote, calcium gluconate, stays at the bedside; the hypertension itself is treated with labetalol, hydralazine, or nifedipine. For third-trimester bleeding, separate placenta previa (PAINLESS bright-red bleeding, a soft uterus, and NO vaginal or digital exam) from abruptio placentae (PAINFUL dark-red bleeding with a rigid, board-like, tender uterus and possible fetal distress).
Postpartum hemorrhage is most often caused by uterine atony: for a soft, boggy fundus, MASSAGE it firm first (supporting the lower uterine segment), then express clots and give a uterotonic such as oxytocin. A prolapsed umbilical cord is an emergency; relieve pressure immediately by lifting the presenting part off the cord with a sterile gloved hand and placing the client in knee-chest or Trendelenburg, and never push the cord back in. For the newborn, the APGAR score rates Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration (each 0-2) at 1 and 5 minutes: 7-10 is reassuring, 4-6 needs stimulation and support, and 0-3 needs resuscitation.
Review the strip patterns behind these questions in our VEAL CHOP and fetal heart rate guide.
Maternity (OB) NCLEX Practice Questions
Question 1 · Fetal Heart Rate Monitoring
A client at 39 weeks gestation is receiving an oxytocin infusion for labor augmentation. The nurse observes repetitive decelerations that begin after the peak of each contraction and return to baseline after the contraction has ended. Which action is the nurse's priority?
- A Reposition the client to the left lateral side and stop the oxytocin infusion
- B Prepare the client for an immediate cesarean birth without further assessment
- C Document a reassuring pattern and continue the oxytocin as ordered
- D Increase the oxytocin rate to strengthen the contraction pattern
Show answer & rationale
Correct answer: A
Decelerations that begin after the contraction peak and return to baseline after the contraction ends are LATE decelerations (VEAL CHOP: Late = Placental insufficiency). They are nonreassuring and reflect uteroplacental insufficiency, so the priority is intrauterine resuscitation. Repositioning to the left lateral side relieves aortocaval compression and improves placental perfusion, and stopping the oxytocin removes contraction-induced perfusion stress; these are first-line steps, along with an IV fluid bolus and notifying the provider; routine supplemental oxygen is no longer recommended for Category II/III tracings and is reserved for cases that do not improve with these measures. Documenting a reassuring pattern and continuing oxytocin is unsafe because late decelerations are never reassuring; treating them as normal delays care. Increasing the oxytocin worsens the problem, since stronger, more frequent contractions further reduce placental blood flow and deepen the decelerations. Preparing for immediate cesarean without further assessment skips the rapid, reversible intrauterine resuscitation measures that often correct the pattern; cesarean is considered only if the pattern does not improve. Clinical pearl: remember VEAL CHOP and the 'stop, drop, and roll' of late decels-STOP the oxytocin, roll to the left side, and give an IV fluid bolus. Per AWHONN/ACOG standards, late and recurrent decelerations warrant prompt intrauterine resuscitation and provider notification before proceeding to operative delivery.
Question 2 · Fetal Heart Rate Monitoring
During continuous electronic fetal monitoring, the nurse notes abrupt decreases in the fetal heart rate that vary in timing, depth, and duration relative to contractions and appear V- or W-shaped. This pattern most likely reflects which underlying cause?
- A Normal fetal oxygen reserve
- B Uteroplacental insufficiency
- C Fetal head compression
- D Umbilical cord compression
Show answer & rationale
Correct answer: D
Abrupt, variably timed decelerations that are V- or W-shaped are VARIABLE decelerations, caused by umbilical cord compression (VEAL CHOP: Variable = Cord compression). Because they are abrupt and inconsistent in their relationship to contractions, they are distinguished from the gradual, contraction-linked shapes of early and late decels. Fetal head compression produces EARLY decelerations, which are gradual, mirror the contraction exactly, and are benign-so this choice describes a different pattern. Uteroplacental insufficiency produces LATE decelerations, which are gradual and begin after the contraction peak; that is the ominous pattern, not the abrupt variable one described here. Normal fetal oxygen reserve is reflected by accelerations, not decelerations, so that option does not fit the described tracing. Interventions for variable decelerations target the cord: reposition the client (side-to-side, knee-chest, or Trendelenburg), perform a vaginal exam to rule out a prolapsed cord, and consider amnioinfusion if ordered. Clinical pearl: the abruptness is the tell-variable decels 'jump' off the baseline, while early and late decels are smooth, gradual curves. Per AWHONN interpretation guidelines, occasional variable decelerations are common and often benign, but recurrent or deep variables require intervention and evaluation for cord compression or prolapse.
Question 3 · Preeclampsia
A client at 32 weeks gestation is being evaluated for preeclampsia. Which assessment findings indicate preeclampsia WITH SEVERE FEATURES? Select all that apply.
- A Trace pedal edema noted after prolonged standing
- B Blood pressure 164/112 mm Hg on two readings
- C Platelet count of 250,000/mm3
- D Severe headache unrelieved by acetaminophen
- E New-onset visual disturbances such as scotomata and blurred vision
- F Right upper quadrant and epigastric pain
Show answer & rationale
Correct answer: B, D, E, F
Preeclampsia is diagnosed as new-onset BP >=140/90 with proteinuria (or end-organ signs) after 20 weeks. SEVERE features escalate the risk of seizure, stroke, and HELLP. A blood pressure of 164/112 meets the severe threshold of >=160/110, so it is a severe feature. A severe headache unrelieved by analgesics reflects cerebral irritability and impending eclampsia, and new-onset visual disturbances (scotomata, blurred vision) reflect the same central nervous system involvement-both are severe features. Right upper quadrant/epigastric pain suggests hepatic involvement (liver capsule distention) and is associated with HELLP syndrome, making it a severe feature as well. A platelet count of 250,000/mm3 is NORMAL; thrombocytopenia (<100,000) would indicate severe disease, so this normal value is not a severe feature. Trace pedal edema after standing is a common, nonspecific finding in pregnancy and is not a diagnostic or severe criterion; edema was removed from formal diagnostic criteria. Clinical pearl: severe-feature red flags cluster as 'head, eyes, belly, and blood'-headache, visual changes, RUQ/epigastric pain, and low platelets/rising liver enzymes-plus BP >=160/110. Per ACOG, recognition of severe features prompts magnesium sulfate for seizure prophylaxis and consideration of delivery; magnesium's antidote is calcium gluconate.
Question 4 · Postpartum Hemorrhage
One hour after a vaginal birth, the nurse finds that the client's uterine fundus is soft and boggy and that lochia rubra is heavier than expected. Which action should the nurse take FIRST?
- A Administer a dose of IV oxytocin per standing orders
- B Massage the fundus until it becomes firm
- C Notify the provider and prepare for surgical intervention
- D Increase the IV fluid rate and reassess in 15 minutes
Show answer & rationale
Correct answer: B
A soft, boggy fundus with heavier-than-expected lochia indicates uterine atony, the number-one cause of postpartum hemorrhage. The FIRST nursing action is to massage the fundus until it becomes firm, because atony (a relaxed uterus that fails to clamp down on the placental site vessels) is immediately and often effectively reversed by stimulating contraction. After massage, the nurse expresses clots and administers uterotonics as ordered. Administering IV oxytocin is appropriate but is not the first independent action; fundal massage is faster and requires no delay for medication retrieval, and massage is done while uterotonics are prepared. Increasing IV fluids and reassessing in 15 minutes dangerously delays treatment of active bleeding-postpartum hemorrhage can progress quickly, so watchful waiting is unsafe. Notifying the provider and preparing for surgery is premature; surgical management is reserved for hemorrhage that does not respond to massage, uterotonics, and other conservative measures. Clinical pearl: for a boggy fundus, think 'massage first, then meds.' Always support the lower uterine segment with one hand at the symphysis while massaging the fundus with the other to prevent uterine inversion. Per AWHONN postpartum hemorrhage guidance, fundal massage and uterotonics (oxytocin first-line) are the initial bundle for atony.
Question 5 · Stages of Labor
A laboring client is being reassessed. Which finding indicates that the client has entered the SECOND stage of labor?
- A Onset of regular contractions accompanied by early cervical change
- B Spontaneous rupture of membranes with clear amniotic fluid
- C Complete cervical dilation to 10 cm with a strong urge to push
- D Cervical dilation of 4 cm with regular, progressively stronger contractions
Show answer & rationale
Correct answer: C
The second stage of labor begins at complete (10 cm) cervical dilation and ends with the birth of the baby; a strong, involuntary urge to push (Ferguson reflex) as the presenting part descends is the hallmark, so complete dilation with the urge to bear down defines this stage. Cervical dilation of 4 cm with regular contractions describes the FIRST stage of labor, not the second stage-the first stage spans from labor onset to full dilation. The onset of regular contractions with early cervical change describes the latent (early) phase of the first stage, well before full dilation. Spontaneous rupture of membranes can occur at any point in labor and does not, by itself, mark entry into the second stage; it is not stage-defining. Clinical pearl: remember the stages as 1) onset to full dilation, 2) full dilation to birth, 3) birth to placental delivery, and 4) the first 1-2 hours of recovery/stabilization. The urge to push should be validated against cervical exam findings-pushing before complete dilation can cause cervical edema and trauma. Per standard US intrapartum management, confirming full dilation before active pushing is a key nursing responsibility.
Question 6 · Antepartum Bleeding
A client at 34 weeks gestation arrives with sudden onset of painless, bright-red vaginal bleeding. Her uterus is soft and nontender, and the fetal heart rate is reassuring. Which nursing action is most appropriate?
- A Perform a sterile vaginal examination to assess cervical dilation
- B Apply firm fundal pressure to help control the bleeding
- C Document an expected third-trimester finding and take no further action
- D Avoid any vaginal or digital examination and notify the provider
Show answer & rationale
Correct answer: D
Painless, bright-red bleeding with a soft, nontender uterus is the classic presentation of placenta previa, in which the placenta implants over or near the cervical os. The most appropriate action is to avoid any vaginal or digital examination and notify the provider, because a digital exam can perforate the placenta and trigger catastrophic hemorrhage. Performing a sterile vaginal exam is contraindicated for the same reason-it is the single most dangerous action in suspected previa. Applying fundal pressure does not control previa bleeding and can cause harm; it is not an appropriate hemorrhage intervention. Documenting an expected finding and taking no action is unsafe, since significant third-trimester bleeding always requires prompt evaluation, monitoring, and possible ultrasound to confirm placental location. Clinical pearl: contrast previa with abruptio placentae-abruptio causes PAINFUL, dark-red bleeding with a rigid, board-like, tender uterus and often fetal distress, whereas previa is PAINLESS, bright-red, and the uterus stays soft. 'Previa = painless, no poking (no vaginal exam).' Per ACOG, placental location should be confirmed by ultrasound before any vaginal exam in a bleeding third-trimester client, and cesarean birth is planned whenever the placenta covers the cervical os.
Question 7 · Intrapartum Emergencies
Immediately after the membranes rupture, the nurse observes the umbilical cord protruding from the vagina, and the fetal heart rate drops abruptly to 80 beats/min. Which action should the nurse take FIRST?
- A Using a sterile glove, lift the presenting part off the cord
- B Place the client in a high Fowler's position to promote comfort
- C Attempt to reduce the cord and continue routine monitoring
- D Gently push the visible cord back into the vaginal canal
Show answer & rationale
Correct answer: A
A visible, protruding cord with an abrupt FHR drop is a prolapsed umbilical cord-a life-threatening emergency in which the presenting part compresses the cord and cuts off fetal oxygenation. The FIRST action is to relieve cord pressure: with a sterile gloved hand, lift the presenting part off the cord and call for help, while positioning the client in knee-chest or Trendelenburg to shift the fetus off the cord. Gently pushing the cord back into the vagina is contraindicated-manipulating the cord causes vasospasm and worsens compression, and it does not relieve the underlying pressure. Placing the client in high Fowler's position increases downward pressure of the presenting part on the cord and worsens compression, the opposite of what is needed. Attempting to reduce the cord and continuing routine monitoring both delay definitive care and mishandle the cord; this client needs immediate manual elevation and emergent (usually cesarean) delivery. Clinical pearl: keep your gloved hand in place, holding the presenting part off the cord, all the way to the operating room; also keep the exposed cord warm and moist. Per standard US intrapartum emergency management, relieving cord compression and expediting delivery are the priorities-never attempt to replace the cord.
Question 8 · Newborn Assessment
The nurse is calculating a newborn's APGAR score at 1 minute and 5 minutes after birth. Which components are assessed as part of APGAR scoring? Select all that apply.
- A Heart rate
- B Respiratory effort
- C Color
- D Blood glucose level
- E Muscle tone
- F Reflex irritability
Show answer & rationale
Correct answer: A, B, C, E, F
APGAR scoring evaluates five components, each scored 0, 1, or 2, at 1 and 5 minutes after birth (and repeated every 5 minutes up to 20 minutes if the score stays low). The five components map to the mnemonic APGAR: Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration (respiratory effort). Heart rate is the most important indicator and is scored by pulse (0 = absent, 1 = below 100, 2 = 100 or above). Respiratory effort (absent, slow/irregular, or strong cry), muscle tone (limp, some flexion, active motion), reflex irritability (no response, grimace, vigorous cry/withdrawal), and color (blue/pale, acrocyanosis, completely pink) are the remaining four. Blood glucose level is NOT part of APGAR; while newborn hypoglycemia screening is important, it is a separate assessment and is not one of the five APGAR parameters. Clinical pearl: a total of 7-10 is generally reassuring, 4-6 indicates moderate distress needing stimulation/support, and 0-3 signals the need for resuscitation. Remember that APGAR guides evaluation of transition, not resuscitation decisions themselves-resuscitation is initiated based on heart rate and respiratory effort without waiting for the 1-minute score, per Neonatal Resuscitation Program standards.
Question 9 · Oxytocin Administration
A client receiving an oxytocin infusion is having contractions every 90 seconds, each lasting 70 to 80 seconds, with an elevated uterine resting tone, and the fetal monitor now shows late decelerations. Which action is the nurse's priority?
- A Administer terbutaline before adjusting the oxytocin infusion
- B Continue the oxytocin and reassess the client in 30 minutes
- C Stop the oxytocin and reposition the client to the left side
- D Increase the oxytocin rate to shorten the length of labor
Show answer & rationale
Correct answer: C
Contractions more frequent than every 2 minutes (or lasting longer than 90 seconds) with elevated resting tone indicate uterine tachysystole (more than 5 contractions in 10 minutes, averaged over 30 minutes), and the accompanying late decelerations show the fetus is not tolerating it. The priority is to discontinue the oxytocin infusion, reposition the client to the left lateral side, increase IV fluids, and notify the provider (routine maternal oxygen has been de-emphasized by ACOG and is reserved for tracings that do not improve). Continuing the oxytocin and reassessing in 30 minutes is unsafe because tachysystole with late decels reflects fetal compromise that needs immediate correction. Increasing the oxytocin rate directly worsens the tachysystole and further reduces placental perfusion-the exact opposite of what is needed. Administering terbutaline (a tocolytic) may be ordered to relax the uterus, but it is not the FIRST action; stopping the oxytocin is the immediate independent nursing intervention, and terbutaline follows only if the uterus does not relax after the infusion is stopped. Clinical pearl: oxytocin is a high-alert medication-'when in doubt, turn it off.' Stopping the infusion is fast, reversible (short half-life), and addresses the root cause. Per AWHONN standards, tachysystole with a nonreassuring FHR warrants immediate oxytocin discontinuation and intrauterine resuscitation before considering pharmacologic tocolysis.
Question 10 · Postpartum Assessment
The nurse is assessing a client 24 hours after a vaginal birth. Which findings should the nurse recognize as danger signs that require further action or reporting? Select all that apply.
- A A perineal repair that is intact and well approximated with no redness (REEDA negative)
- B Moderate lochia rubra with a fleshy odor
- C Temperature of 101.5 F (38.6 C)
- D Foul-smelling lochia
- E Saturating one perineal pad in less than 1 hour
- F A uterine fundus that is boggy and palpable above the umbilicus
Show answer & rationale
Correct answer: C, D, E, F
Postpartum danger signs point to hemorrhage or infection. Saturating a perineal pad in less than 1 hour signals excessive bleeding and possible hemorrhage-a key reportable finding. A fundus that is boggy and above the umbilicus indicates uterine atony and/or a distended bladder; it fails to compress the placental-site vessels and predisposes to hemorrhage, so it requires massage and further assessment. Foul-smelling lochia is abnormal and suggests endometritis (infection), unlike the normal fleshy or earthy odor of lochia. A temperature of 101.5 F (38.6 C) exceeds the 100.4 F (38 C) postpartum fever threshold and suggests infection such as endometritis; it should be reported. In contrast, moderate lochia rubra with a fleshy odor is a NORMAL finding on postpartum day 1-lochia rubra is expected for the first few days. A perineal repair that is intact, approximated, and without redness (REEDA: Redness, Edema, Ecchymosis, Discharge, Approximation-all negative) is a normal, reassuring finding, not a danger sign. Clinical pearl: assess the postpartum client with BUBBLE-HE (Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy/perineum, Homans/lower extremities, Emotional status). Per AWHONN postpartum standards, prompt recognition of hemorrhage and infection signs is essential, since postpartum hemorrhage and sepsis are leading causes of maternal morbidity.
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Maternity NCLEX FAQ
How do I quickly tell early, late, and variable decelerations apart on the NCLEX?
Use VEAL CHOP: Variable = Cord compression, Early = Head compression, Accelerations = Okay, Late = Placental insufficiency. Early decels are gradual and mirror the contraction (benign). Variable decels are abrupt, V- or W-shaped, and vary in timing (cord compression); amnioinfusion is the targeted intervention for recurrent variable decels. Late decels are gradual and start after the contraction peak, returning after it ends-these are nonreassuring and require intrauterine resuscitation: reposition to left lateral, stop oxytocin, give an IV fluid bolus, and notify the provider. Note: many NCLEX/NCSBN-style questions still traditionally include applying oxygen in this bundle, so pick it if the answer choices call for it-but be aware that current obstetric practice (ACOG) has de-implemented routine maternal oxygen for Category II tracings and late decels because trials show it does not resolve high-risk fetal heart rate features or improve neonatal outcomes.
Why is magnesium sulfate given in preeclampsia if it doesn't lower blood pressure?
Magnesium sulfate is given for seizure prophylaxis (to prevent eclamptic seizures), not to treat hypertension. Blood pressure itself is managed with antihypertensives such as labetalol, hydralazine, or nifedipine. Keep the purpose straight for the exam: magnesium calms CNS irritability to prevent seizures, and its antidote is calcium gluconate, which is kept at the bedside during infusion.
For a boggy fundus, do I massage first or give oxytocin first?
Massage first. A boggy (soft) fundus means uterine atony-the leading cause of postpartum hemorrhage-and fundal massage is the fastest, first independent nursing action to stimulate the uterus to contract. After massaging until firm, express clots and give uterotonics such as oxytocin per orders. Always support the lower uterine segment with one hand at the symphysis while massaging to prevent uterine inversion.
What is the single most important thing to remember about a prolapsed umbilical cord?
Relieve pressure on the cord immediately and never push it back in. Use a sterile gloved hand to lift the presenting part off the cord and keep it there, place the client in knee-chest or Trendelenburg position, call for help, and prepare for emergent (usually cesarean) delivery. Pushing the cord back causes vasospasm and worsens fetal hypoxia.