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WorksheetsOB NCLEX Practice Exam – Part 1 (Questions 1–19)
Total questions: 100
Worksheet time: 50mins
A nurse is caring for a newborn delivered via cesarean section. Which finding would require immediate intervention?
Acrocyanosis of the hands and feet
Mild molding of the head
Nasal flaring and grunting respirations
Irregular breathing pattern with pauses
A nurse assesses a newborn with a temperature of 96.4°F (35.8°C). What is the priority nursing action?
Notify the provider immediately
Swaddle the infant and place under a radiant warmer
Delay the next feeding
Bathe the infant in warm water
A newborn’s APGAR score at 1 minute is 4. What is the nurse’s immediate priority?
Stimulate the infant to cry
Provide positive pressure ventilation
Continue to observe the infant
Administer vitamin K
The nurse is teaching parents about the purpose of erythromycin eye ointment. Which statement shows understanding?
It prevents eye irritation from amniotic fluid.
It helps prevent infection from bacteria in the birth canal.
It improves the baby’s vision.
It helps produce tears.
A nurse caring for a 32-week preterm infant notes retractions, nasal flaring, and grunting. Which medication should the nurse anticipate?
Betamethasone
Surfactant via endotracheal tube
Vitamin K IM
Ampicillin IV
Which newborn finding requires immediate reporting to the healthcare provider?
Caput succedaneum
Cephalohematoma
Bluish discoloration of hands and feet
Yellowing of the skin within 12 hours of birth
The nurse is caring for a postpartum client with a boggy uterus and heavy lochia rubra. What should the nurse do first?
Notify the physician
Assess vital signs
Massage the uterus
Administer methylergonovine (Methergine)
A newborn at 4 hours old is jittery and has a blood glucose of 36 mg/dL. What is the best initial action?
Administer IV dextrose
Feed the newborn immediately
Call the healthcare provider
Monitor for seizures
Which assessment finding is most concerning in a postpartum patient 2 hours after vaginal delivery?
Saturating a peripad every 15 minutes
Firm fundus at the umbilicus
Moderate lochia rubra
Complaints of mild afterpains
The nurse receives report on four patients. Which one should the nurse assess first?
1-day postpartum patient with perineal pain rated 6/10
Post-cesarean patient with small serosanguineous drainage on dressing
Patient 2 hours postpartum with saturated pad and dizziness
Postpartum patient ready for discharge asking breastfeeding questions
Which finding indicates effective newborn thermoregulation?
Axillary temperature of 97.0°F
Pink color and quiet alert state
Shivering when cold
Sweating on forehead
The nurse notes late decelerations on the fetal monitor. What should the nurse do first?
Reposition the mother laterally
Increase oxytocin infusion
Apply oxygen by face mask
Call the healthcare provider
A nurse is assisting with the delivery of a newborn with meconium-stained amniotic fluid. What should the nurse prepare for?
Immediate suctioning after the shoulders deliver
Vigorous stimulation of the infant
Administration of Narcan
Delayed cord clamping
Which action by the UAP caring for a postpartum patient requires intervention by the nurse?
Assisting the patient to ambulate to the bathroom
Changing the peripad and reporting heavy bleeding
Measuring fundal height
Emptying the Foley catheter bag
A postpartum patient reports pain and pressure in the perineum despite a firm fundus. What should the nurse suspect?
Uterine atony
Hematoma
Retained placental fragments
Infection
A nurse is preparing to administer RhoGAM to a postpartum client. Which condition must be present?
Mother Rh positive, infant Rh negative
Mother Rh negative, infant Rh positive
Both Rh positive
Both Rh negative
Which finding in a postpartum client requires immediate follow-up?
Pulse 100 bpm
Temperature 100.3°F within 24 hours of delivery
Foul-smelling lochia
Fundus firm and midline
The nurse observes a laboring patient with contractions every 90 seconds, lasting 90 seconds, with minimal resting tone. What should the nurse do first?
Continue to monitor
Increase oxytocin
Stop oxytocin infusion
Notify provider after 30 minutes
A laboring patient’s fetal heart tracing shows variable decelerations. What is the priority intervention?
Turn patient to left side
Administer oxygen
Stop oxytocin
Perform vaginal exam
A nurse is caring for a newborn who has jaundice at 36 hours of life. What should the nurse do?
Encourage frequent feedings
Withhold breastfeeding
Start IV fluids
Keep the newborn NPO
The nurse is caring for a patient 12 hours postpartum. Fundus is firm, 1 cm above the umbilicus, and deviated to the right. What should the nurse do?
Document as normal
Massage the fundus
Have the patient void
Notify provider
A nurse is caring for a preterm infant born at 30 weeks. Which assessment requires immediate intervention?
Soft abdomen
Periodic breathing
Axillary temperature 96.0°F
Weight 1,300 grams
A nurse is monitoring a client in labor with an epidural. Which finding is most concerning?
Blood pressure 90/50 mmHg
Complaint of itching
Pain rated 3/10
Fetal heart rate 130 bpm
Which postpartum patient is at highest risk for hemorrhage?
Primipara with firm fundus
Multipara with prolonged labor and overdistended uterus
Vaginal birth after cesarean with small baby
Patient on magnesium sulfate
The nurse is assessing bonding. Which behavior best indicates positive attachment?
Mother asks nurse to take the baby to nursery
Mother gazes at baby’s face and speaks softly
Mother avoids touching the baby
Mother expresses fear about holding the baby
A client at 28 weeks’ gestation presents with painless bright red vaginal bleeding. Which condition should the nurse suspect?
Placenta previa
Abruptio placentae
Uterine rupture
Vasa previa
A pregnant client with preeclampsia is receiving magnesium sulfate. Which assessment finding requires immediate action?
Respiratory rate 10 breaths/min
Deep tendon reflexes 2+
Urine output 40 mL/hr
Subjective complaint of blurred vision
A nurse is teaching a pregnant client how to use Naegele’s rule to estimate due date. If the first day of last menstrual period was March 10, what is the estimated due date?
December 17
December 10
January 17
December 7
A laboring patient has a prolapsed umbilical cord visualized at the introitus. What is the nurse’s immediate action?
Push the presenting part off the cord and call for C-section
Attempt to replace the cord into the uterus
Clamp and cut the cord immediately
Administer tocolytics to stop contractions
A newborn has a positive Coombs test and rising bilirubin levels. Which condition is likely?
Physiologic jaundice
Hemolytic disease due to Rh incompatibility
Breastfeeding-associated jaundice
Gilbert syndrome
A client in active labor requests an epidural. The nurse notes platelets are 80,000/mm³. What is the most appropriate action?
Proceed with epidural after explaining risks
Notify the anesthesia provider and delay epidural
Administer aspirin to reduce clotting risk
Encourage position changes instead of epidural
Which finding is an early sign of hypovolemia in the postpartum client?
Decreased urine output
Decreased respiratory rate
Bounding peripheral pulses
A newborn with respiratory distress syndrome (RDS) is receiving nasal CPAP. Which lab result would most likely be present?
Respiratory alkalosis
Elevated PaCO₂ and decreased PaO₂
Hypoglycemia with low ketones
Hypernatremia
A nurse is delegating tasks on the postpartum unit. Which task is appropriate to assign to a UAP?
Assess a fundus after a heavy pad saturation
Apply ice packs to the perineum and report increased pain
Administer methergine IM for uterine atony
Teach breastfeeding latch technique
A client at 38 weeks has a nonreactive NST. What additional test is most appropriate next?
Biophysical profile (BPP)
Repeat NST in 24 hours
Immediate cesarean section
Assessment of maternal blood glucose
Which medication is contraindicated for a woman with asthma experiencing postpartum hemorrhage?
Oxytocin
Carboprost (Hemabate)
Methylergonovine (Methergine)
Misoprostol (Cytotec)
A newborn is noted to have a cephalohematoma. Which complication should the nurse monitor for?
Hypoglycemia
Physiologic jaundice from increased RBC breakdown
Shoulder dystocia
Neural tube defect
A postpartum client on opioid analgesics reports calf pain and swelling. What is the nurse’s best action?
Encourage ambulation and NSAIDs
Assess the calf for warmth, redness, and unilateral edema and notify the provider
Apply warm compresses and re-evaluate in 4 hours
Document pain as expected postoperative discomfort
A patient with gestational diabetes is in labor. Which fetal complication is the nurse most concerned about?
Oligohydramnios
Macrosomia and shoulder dystocia
Neural tube defects
Placental abruption
A nurse is caring for a newborn receiving phototherapy. Which nursing action is most important?
Leave the newborn unclothed except for eye protection and diaper
Feed only every 6 hours to reduce bilirubin production
Apply lotion to keep skin moist
Turn off phototherapy during diaper changes only once per day
A client in labor experiences a sudden sharp abdominal pain and loss of fetal station after a trial of labor after cesarean (TOLAC). The nurse suspects uterine rupture. What is the priority action?
Prepare for immediate cesarean delivery and notify the provider
Continue monitoring and give oxygen
Encourage pushing to deliver quickly vaginally
Give analgesics and observe
Which maternal finding is most consistent with chorioamnionitis?
Maternal fever, fetal tachycardia, and uterine tenderness
Decreased fetal movement and oligohydramnios
Painless vaginal bleeding and bright red blood
Mild cramping and brown discharge
A nurse is teaching new parents about safe sleep. Which statement by the parents indicates correct understanding?
“We’ll put a blanket in the crib to keep the baby warm.”
“We will place the baby on the back to sleep without pillows.”
“It’s okay for the baby to sleep on their stomach if supervised.”
“Room sharing increases the risk of SIDS, so we’ll keep the baby in a different room.”
A newborn is born to a mother who tested positive for GBS intrapartum but received no antibiotics during labor. What should the nurse monitor the infant for?
Hypoglycemia only
Signs of early-onset sepsis such as respiratory distress, temperature instability, and lethargy
Only feeding intolerance after 48 hours
Excessive urination
A woman in labor has persistent late decelerations despite repositioning and oxygen. Oxytocin is infusing. What is the immediate priority?
Turn off oxytocin infusion
Increase IV fluids only
Prepare for vacuum-assisted delivery
Repeat positional changes
A client with a history of opioid use disorder is delivering. The newborn shows tremors, high-pitched cry, and poor feeding. What is the nurse’s priority action?
Document and observe for 48 hours only
Perform a neonatal abstinence scoring (Finnegan) and notify the pediatric team
Immediately administer naloxone to the newborn
Bottle-feed with formula only
A laboring client with breech presentation at term requests a vaginal birth. Which statement indicates a contraindication to attempting a vaginal breech delivery?
Multiparous with previous vaginal births
Estimated fetal weight 4,200 g (9 lb 7 oz)
Frank breech with flexed hips
Fully dilated and low presenting part
A postpartum client expresses feelings of sadness and tearfulness on day 3 postpartum but is able to care for her baby. What is the best nursing response?
“You must be having postpartum depression; I’ll schedule a psychiatric consult.”
“Baby blues are common after delivery; let’s discuss support and follow-up.”
“You should be happy—this is normal; stop worrying.”
“I will notify child protective services.”
A newborn’s cord shows two vessels: one artery and one vein. What is the most appropriate nursing action?
Document as a normal finding
Notify the provider and assess for other congenital anomalies
Prepare for immediate NICU transfer
Clamp and cut the cord higher than usual
A client at 39 weeks reports decreased fetal movement over 24 hours. What is the nurse’s best next action?
Instruct the client to drink orange juice and rest at home
Perform kick-counting instructions only and re-evaluate in 72 hours
Arrange immediate evaluation with a nonstress test (NST) or fetal assessment
Schedule an induction for the next week
A nurse assesses a patient in labor who suddenly complains of shortness of breath and chest pain after delivery of the placenta. The nurse suspects:
Pulmonary embolism
Uterine atony
Endometritis
Amniotic fluid embolism
A nurse is reviewing lab results for a 2-hour postpartum client. Which finding requires immediate intervention?
WBC 15,000/mm³
Hgb 7.8 g/dL
Platelets 210,000/mm³
Hct 33%
The nurse notes a firm fundus at the midline with heavy bright red bleeding. What should the nurse suspect?
Uterine atony
Vaginal laceration
Retained placental fragments
Uterine inversion
A patient with polyhydramnios and fundal height larger than expected is at risk for which complication during labor?
Cord prolapse
Shoulder dystocia
Precipitous labor
Placenta previa
A laboring patient's membranes rupture, revealing greenish amniotic fluid. What should the nurse do first?
Notify the healthcare provider and assess fetal heart rate pattern
Prepare for cesarean delivery immediately
Continue labor with no intervention
Insert a fetal scalp electrode
The nurse notes a postpartum patient's fundus is boggy and deviated to the left. What should the nurse do first?
Catheterize the bladder
Call for help
Start a second IV line
Administer methylergonovine
A client who delivered 4 hours ago by vaginal birth suddenly reports severe perineal pain and pressure. Her fundus is firm, and lochia is minimal. What complication should the nurse suspect?
Hematoma
Endometritis
Uterine inversion
Vaginal prolapse
Which patient should the nurse see first?
Postpartum day 1, complaining of sore nipples
2 hours postpartum, passing several small clots
4 hours postpartum, complaining of dizziness and soaking pads every 15 minutes
Day 2 postpartum, with low-grade fever 100.2°F
The nurse is caring for a newborn with transient tachypnea of the newborn (TTN). Which intervention is most appropriate?
Feed small frequent amounts to prevent aspiration
Place infant NPO and provide oxygen as ordered
Administer antibiotics prophylactically
Begin chest physiotherapy
Which nursing action best promotes heat retention for a newborn immediately after birth?
Drying the infant thoroughly and placing skin-to-skin with mother
Giving a warm bath immediately after delivery
Placing under a fan for stimulation
Applying baby lotion to prevent evaporation
The nurse notes a postpartum client’s uterus is firm at U/2, but the perineal pad is soaked with bright red blood and large clots. What should the nurse do first?
Continue to monitor
Call for assistance and check for vaginal lacerations
Increase IV fluids
Document findings as normal
Which task can the RN safely delegate to a licensed practical nurse (LPN)?
Initial postpartum assessment
Administering prescribed oxytocin infusion
Developing discharge teaching plan
Evaluating fundal firmness after hemorrhage
A client at 35 weeks with ruptured membranes presents to triage. The nurse notes fetal heart rate of 190 bpm and maternal temperature of 101.4°F. What condition should the nurse suspect?
Preeclampsia
Chorioamnionitis
Placenta previa
Uterine rupture
A nurse caring for a laboring client notes the fetal heart rate decreases during contractions and returns to baseline after contractions. What is the nurse’s interpretation?
Variable decelerations—cord compression
Early decelerations—head compression
Late decelerations—placental insufficiency
Prolonged decelerations—hypoxia
The nurse is providing discharge teaching to a postpartum client. Which statement indicates the need for further teaching?
“I’ll call my provider if my bleeding smells foul.”
“I’ll resume intercourse once my bleeding stops in a few days.”
“I’ll continue taking my prenatal vitamins while breastfeeding.”
“If I develop a fever over 100.4°F, I’ll contact my provider.”
A nurse is assessing a newborn 6 hours after birth. Which finding is abnormal?
Acrocyanosis
RR 50/min
Axillary temperature 95.6°F (35.3°C)
Irregular respirations
Which newborn should the nurse assess first?
2-hour-old infant with mild acrocyanosis
8-hour-old with blood glucose of 42 mg/dL
1-day-old with pink, moist mucous membranes
12-hour-old with small milia on nose
A laboring client requests pain relief and is 4 cm dilated. The nurse administers IV analgesia. Which nursing action is priority after administration?
Encourage ambulation
Monitor fetal heart rate for decreased variability or late decelerations
Check reflexes
Apply fundal pressure during contractions
Which finding would indicate that a postpartum client is experiencing endometritis?
Fundus firm and midline, scant lochia
Bright red bleeding with clots
Foul-smelling lochia, uterine tenderness, and fever
Normal afterpains with moderate lochia
The nurse caring for a woman with an epidural notes hypotension and fetal bradycardia. What should the nurse do first?
Place the woman on her side and increase IV fluids
Increase oxytocin
Prepare for immediate cesarean
Encourage pushing
A client presents with contractions 3 minutes apart, 60 seconds long, cervix 8 cm dilated. She says she feels pressure and needs to push. What should the nurse do first?
Check for crowning
Have her begin pushing immediately
Assist her to walk to the bathroom
Notify anesthesia for epidural
The nurse notes an infant born to a diabetic mother is lethargic and tremulous. Which lab result is expected?
Blood glucose 32 mg/dL
Serum calcium 9 mg/dL
Bilirubin 5 mg/dL
Hematocrit 50%
A laboring client suddenly experiences vaginal bleeding with pain, firm abdomen, and non-reassuring fetal heart rate. The nurse suspects:
Placenta previa
Abruptio placentae
Uterine rupture
Cord prolapse
The nurse is providing teaching about magnesium sulfate therapy for preeclampsia. Which statement indicates understanding?
“It lowers my blood pressure.”
“It helps prevent seizures.”
“It will speed up my labor.”
“It will make my contractions stronger.”
Which postpartum patient finding requires immediate follow-up?
Soft breasts on day 1
Small amount of lochia rubra on pad
Calf pain with dorsiflexion of foot
Mild perineal swelling
A client at 10 weeks gestation reports nausea and vomiting daily. Which instruction should the nurse provide?
“Eat three large meals per day.”
“Avoid eating before bed.”
“Eat dry crackers before getting out of bed in the morning.”
“Drink liquids with your meals.”
The nurse is assessing a client at 34 weeks with complaints of facial swelling and headache. Which action should the nurse take first?
Assess deep tendon reflexes and blood pressure
Give acetaminophen
Encourage fluids
Schedule a nonstress test
A postpartum patient reports she hasn’t urinated 6 hours after delivery. The fundus is above the umbilicus and deviated to the right. What should the nurse do first?
Encourage the patient to void
Notify the healthcare provider
Insert an indwelling catheter immediately
Start IV fluids
A client who delivered 3 hours ago is pale, weak, and anxious. Her uterus is firm at midline, and bleeding is minimal. What complication is most likely?
Laceration of the birth canal
Hematoma formation
Uterine atony
Retained placenta
The nurse is caring for a newborn 12 hours old who has not voided since birth. What should the nurse do first?
Notify the healthcare provider
Assess for bladder distension and monitor for first void within 24 hours
Start IV fluids
Insert a urinary catheter
Which of the following postpartum clients should the nurse assess first?
Client with mild headache after spinal anesthesia
Client with heavy lochia and boggy fundus
Client with swollen perineum and pain 6/10
Client complaining of fatigue after feeding
A nurse is monitoring a patient in active labor on oxytocin infusion. Contractions occur every 90 seconds and last 90 seconds. What is the nurse’s first action?
Stop the oxytocin infusion
Decrease the oxytocin rate by half
Turn the patient to a lateral position and apply oxygen
Increase IV fluids to treat hypotension
A nurse is teaching about breastfeeding. Which statement indicates the need for further teaching?
“I should burp my baby after each breast.”
“I can store breast milk at room temperature for 12 hours.”
“I will let my baby feed on demand.”
“My baby should have at least six wet diapers per day.”
A newborn with a low APGAR score at 1 minute receives effective resuscitation. What APGAR score should the nurse expect at 5 minutes?
2–3
4–5
7–9
10 only
Which finding indicates the newborn is transitioning effectively after birth?
Central cyanosis
Heart rate 150, respirations 45, pink color
RR 80 and nasal flaring
Weak cry and hypotonia
A client is admitted with ruptured membranes at 32 weeks. The nurse anticipates administering which medication to promote fetal lung maturity?
Oxytocin
Betamethasone
RhoGAM
Methergine
The nurse is providing care for a patient with shoulder dystocia during delivery. What should the nurse do first?
Apply fundal pressure
Perform the McRoberts maneuver
Pull on the baby’s head gently
Administer tocolytic medication
The nurse is caring for a postpartum patient prescribed methylergonovine (Methergine). Which assessment finding requires immediate follow‑up?
BP 160/94 mmHg
Pulse 88 bpm
Fundus firm
Lochia rubra small
The nurse is preparing to teach a pregnant client about food safety. Which statement should be included?
“Avoid soft cheeses made from unpasteurized milk.”
“You can eat sushi if it’s fresh.”
“Deli meats are safe if kept refrigerated.”
“Rare steak is okay in the second trimester.”
The nurse notes a postpartum patient with an epidural has decreased sensation in her lower extremities. What is the nurse’s priority action?
Encourage ambulation with assistance
Place call light within reach and assist with first ambulation
Reposition patient to semi‑Fowler’s
Apply heating pad to lower back
Which statement by the UAP caring for a postpartum client requires correction?
“I’ll remind the patient to call for help before getting out of bed.”
“I’ll massage the patient’s abdomen if she feels lightheaded.”
“I’ll record the number of pads changed.”
“I’ll report if the pad is soaked in less than an hour.”
A client at 30 weeks gestation complains of sharp right upper quadrant pain and visual disturbances. What condition does the nurse suspect?
HELLP syndrome
Placenta previa
Preterm labor
Ectopic pregnancy
The nurse is caring for a patient receiving oxytocin for induction. Which assessment finding warrants immediate discontinuation of the infusion?
Contractions every 3 minutes lasting 60 seconds
Fetal heart rate 100 bpm with late decelerations
Patient reports mild cramping
Fetal heart rate with moderate variability
The nurse is assisting a mother with bottle‑feeding. Which instruction is most appropriate?
“Keep the bottle nipple full of formula during feeding.”
“Prop the bottle with a blanket during feeding.”
“Feed every 8 hours to prevent colic.”
“Refrigerate prepared formula for up to 72 hours.”
Which assessment finding is expected in a healthy newborn 1 hour after birth?
Heart rate 130 bpm, irregular respirations, acrocyanosis
Heart rate 90 bpm, apnea 15 seconds
RR 70, nasal flaring
Rectal temperature 100.8°F
The nurse is caring for a postpartum patient 24 hours after cesarean delivery. Which finding requires further assessment?
Incision clean, dry, and intact
Fundus firm, U/1
Pain 8/10 unrelieved by prescribed medication
Small amount of lochia rubra
Which statement by a pregnant patient about prenatal visits requires clarification?
“After 36 weeks, I’ll see my provider weekly.”
“I’ll have a glucose screening in the second trimester.”
“I’ll need a rubella vaccine during pregnancy.”
“I’ll have my blood pressure checked at each visit.”
Which finding in a newborn requires immediate intervention?
Grunting and intercostal retractions
Acrocyanosis
Positive Moro reflex
Irregular respirations
The nurse is providing care for a postpartum patient with mastitis. Which instruction should the nurse include?
“Stop breastfeeding until the infection clears.”
“Continue breastfeeding or pumping on both sides.”
“Apply ice packs to breasts between feedings.”
“Avoid touching the affected breast.”
A nurse is reviewing discharge teaching for a client after delivery. Which statement indicates understanding?
“If I feel dizzy or faint, I’ll lie down and elevate my legs.”
“It’s normal for my bleeding to be bright red for 3 weeks.”
“I can use tampons after my bleeding slows down.”
“I’ll call the doctor if I don’t have a bowel movement for 2 days.”
