A nonstress test at 36 weeks shows a baseline of 140 beats/min and three accelerations of 20 beats/min lasting 20 seconds within 20 minutes. The nurse should interpret this as:

Positive, showing uteroplacental insufficiency

Nonreactive, needing a biophysical profile

Negative, needing a contraction stress test

A client with no risk factors for diabetes is at her 12-week prenatal visit. When should the nurse tell her she will be screened for gestational diabetes?

Only if glucose appears in her urine

A postpartum client's prenatal record shows she is not immune to rubella. Before discharge, the nurse should plan to:

Give the MMR vaccine and teach her to avoid pregnancy for 4 weeks

Delay the MMR vaccine until she has stopped breastfeeding

Give rubella immune globulin within 72 hours of the birth

Repeat the rubella titer at the 6-week postpartum visit first

A tracing in active labor shows a baseline of 150 beats/min, a late deceleration with most contractions, and no accelerations. Which additional finding would make this a Category III tracing rather than Category II?

A baseline rate of 160 beats/min

Antepartum, intrapartum and postpartum care

60 NCLEX-RN practice questions on Antepartum, intrapartum and postpartum care, part of Health Promotion and Maintenance. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A nonstress test at 36 weeks shows a baseline of 140 beats/min and three accelerations of 20 beats/min lasting 20 seconds within 20 minutes. The nurse should interpret this as:
1. APositive, showing uteroplacental insufficiency
2. BNonreactive, needing a biophysical profile
3. CReactive, a reassuring result
4. DNegative, needing a contraction stress test
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Answer: C · Reactive, a reassuring result
At 32 weeks or more, a nonstress test is reactive when there are at least two accelerations of 15 beats/min or more, lasting at least 15 seconds, within 20 minutes. This tracing meets that standard, which shows an intact fetal autonomic nervous system and good oxygenation. A reactive result is reassuring and routine surveillance continues. This tests analysing cues.
- A: Positive and negative are terms for the contraction stress test, not the nonstress test.
- B: Nonreactive would mean fewer than two qualifying accelerations in the time window.
- D: No further testing is needed for a reactive result; the stress test terms do not apply.
Question 2 · Medium
A client with no risk factors for diabetes is at her 12-week prenatal visit. When should the nurse tell her she will be screened for gestational diabetes?
1. AOnly if glucose appears in her urine
2. BAt 36 to 37 weeks of gestation
3. CAt 24 to 28 weeks of gestation
4. DAt 16 to 18 weeks of gestation
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Answer: C · At 24 to 28 weeks of gestation
Clients without risk factors are screened for gestational diabetes at 24 to 28 weeks, when placental hormones raise insulin resistance enough to unmask it. Clients with risk factors, such as obesity or prior gestational diabetes, are screened earlier as well. A 1-hour 50-g glucose challenge is a common first step. This is routine prenatal health-promotion teaching.
- A: Glycosuria is common in pregnancy and is not a reliable screening test.
- B: Screening at 36 weeks leaves too little time to treat and protect the fetus.
- D: At 16 to 18 weeks insulin resistance is usually too low to reveal the disorder.
Question 3 · Easy
A postpartum client's prenatal record shows she is not immune to rubella. Before discharge, the nurse should plan to:
1. ADelay the MMR vaccine until she has stopped breastfeeding
2. BGive rubella immune globulin within 72 hours of the birth
3. CGive the MMR vaccine and teach her to avoid pregnancy for 4 weeks
4. DRepeat the rubella titer at the 6-week postpartum visit first
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Answer: C · Give the MMR vaccine and teach her to avoid pregnancy for 4 weeks
A rubella-nonimmune client is given the MMR vaccine in the postpartum period, before she leaves the hospital. MMR is a live attenuated vaccine, so the CDC advises avoiding pregnancy for 4 weeks (28 days) after the dose. It is safe during breastfeeding. This item tests taking action on a recognised cue in the prenatal record.
- A: Breastfeeding is not a contraindication to MMR, so there is no reason to wait.
- B: Immune globulin is not used to create rubella immunity; the vaccine is.
- D: The titer already shows nonimmunity; retesting only delays protection.
Question 4 · Hard
During an induction the provider orders the oxytocin dose raised to 6 milliunits/min. The bag in use holds 20 units of oxytocin in 1,000 mL of normal saline. What pump rate in mL/hr delivers the ordered dose?
1. A3.3 mL/hr
2. B36 mL/hr
3. C0.3 mL/hr
4. D18 mL/hr
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Answer: D · 18 mL/hr
Twenty units is 20,000 milliunits, so the concentration is 20,000 / 1,000 = 20 milliunits/mL. A dose of 6 milliunits/min needs 6 / 20 = 0.3 mL/min, and 0.3 mL/min x 60 min = 18 mL/hr. Checking that the answer is plausible (a few mL/hr to tens of mL/hr) catches unit slips. Oxytocin is a high-alert drug, so the rate is given on a dedicated pump and double-checked.
- A: This divides the concentration by the dose instead of the dose by the concentration.
- B: This uses a wrong concentration of 10 milliunits/mL (20 units in 2,000 mL).
- C: This is the mL/min figure without converting to an hourly rate.
Question 5 · Hard
A tracing in active labor shows a baseline of 150 beats/min, a late deceleration with most contractions, and no accelerations. Which additional finding would make this a Category III tracing rather than Category II?
1. AAbsent baseline variability
2. BContractions every 3 minutes
3. CModerate baseline variability
4. DA baseline rate of 160 beats/min
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Answer: A · Absent baseline variability
Recurrent late decelerations with moderate or minimal variability are Category II, which needs evaluation and intrauterine resuscitation. Absent variability with recurrent late decelerations, recurrent variable decelerations or bradycardia makes the tracing Category III, which predicts fetal acidemia and calls for prompt resuscitation and preparation for expedited birth. Variability is the best single sign of fetal oxygen reserve. This tests analysing cues.
- B: Contractions every 3 minutes are a normal frequency, not a category criterion.
- C: Moderate variability with late decelerations keeps the tracing in Category II.
- D: A baseline of 160 is still within the normal range and does not change the category.
Question 6 · Hard
A client at 40 weeks is receiving oxytocin for induction. Contractions occur every 2 to 3 minutes. At 1415 the nurse notes that the fetal heart rate, baseline 145 beats/min, begins to fall after each contraction peaks and returns to baseline after the contraction ends, with minimal variability. Which action should the nurse take first?
1. ANotify the health care provider
2. BStop the oxytocin infusion
3. CPrepare for an emergency cesarean birth
4. DPerform a vaginal examination
Answer and explanation in LearnFree account
Question 7 · Medium
Ten minutes after the birth of a baby, which finding tells the nurse that the placenta has separated from the uterine wall?
1. AThe client feels a strong urge to bear down
2. BThe fundus falls to below the symphysis pubis
3. CThe cord lengthens and a gush of blood appears
4. DThe uterus becomes soft and flattened in shape
Answer and explanation in LearnFree account
Question 8 · Easy
A nurse reviews 10 minutes of a term fetal tracing between contractions. Which mean rate falls within the normal baseline range?
1. A150 beats/min
2. B170 beats/min
3. C100 beats/min
4. D80 beats/min
Answer and explanation in LearnFree account
Question 9 · Medium
On day 3 after birth, a client is tearful and says, "I don't know why I keep crying. I love my baby." She is sleeping and eating well. Which response by the nurse is most therapeutic?
1. A"Try not to cry in front of the baby, because babies sense your stress."
2. B"Many new mothers feel weepy in the first weeks. Tell me how you have been feeling."
3. C"You should feel happy; you have a healthy baby and a supportive partner."
4. D"I will ask the provider to prescribe something to help with your mood."
Answer and explanation in LearnFree account
Question 10 · Medium
A client in active labor has a fetal heart rate tracing with decelerations that begin and end with each contraction and mirror its shape, with the lowest point at the peak. Variability is moderate. The nurse should:
1. ANotify the provider for an urgent birth
2. BTurn the client onto her left side
3. CStop the oxytocin and give oxygen
4. DContinue routine monitoring of labor
Answer and explanation in LearnFree account
Question 11 · Easy
Which daily folic acid intake is recommended for a healthy client planning pregnancy, to lower the risk of neural tube defects?
1. A40 micrograms
2. B1 gram
3. C400 micrograms
4. D4 milligrams
Answer and explanation in LearnFree account
Question 12 · Medium
A client at 32 weeks arrives with painless, bright red vaginal bleeding. Her uterus is soft and nontender. Which order should the nurse question?
1. AObtain a type and screen and a CBC
2. BInsert a large-bore intravenous catheter
3. CStart continuous fetal heart rate monitoring
4. DPerform a sterile vaginal examination
Answer and explanation in LearnFree account
Question 13 · Hard
At the start of a day shift on a mother-baby unit, four call lights come on at once. Which postpartum client needs the nurse first?
1. AA client 2 hours after birth who has soaked a pad in 15 minutes
2. BA client on day 2 who reports cramping when she breastfeeds
3. CA client on day 1 with a temperature of 100.2°F (37.9°C)
4. DA client on day 1 with moderate lochia rubra and small clots
Answer and explanation in LearnFree account
Question 14 · Easy
An Rh-negative client gives birth to an Rh-positive newborn. Her antibody screen is negative. Within what time after birth should Rh(D) immune globulin be given?
1. A7 days
2. B72 hours
3. C24 hours
4. D2 weeks
Answer and explanation in LearnFree account
Question 15 · Medium
One hour after birth, a client's fundus is soft and boggy at the umbilicus, and her pad is soaked. Which action is the nurse's priority?
1. AWeigh the pad to measure the amount of blood loss
2. BMassage the fundus while supporting the lower uterine segment
3. CCheck the client's blood pressure and pulse
4. DPlace the newborn skin-to-skin to promote oxytocin release
Answer and explanation in LearnFree account
Question 16 · Easy
On the third day after an uncomplicated vaginal birth, the nurse expects the fundus to be about:
1. AJust above the symphysis pubis
2. B2 cm above the umbilicus
3. CAt the level of the umbilicus
4. D3 cm below the umbilicus
Answer and explanation in LearnFree account
Question 17 · Medium
A client at 28 weeks is Rh-negative and her antibody screen today is negative. The father of the baby is Rh-positive. Which order should the nurse expect?
1. ARh(D) immune globulin intramuscularly now
2. BAn amniocentesis to check the fetal blood type
3. CRh(D) immune globulin only after the birth
4. DA repeat antibody screen at 36 weeks only
Answer and explanation in LearnFree account
Question 18 · Medium
During a BUBBLE-HE assessment 24 hours after a cesarean birth, which finding should the nurse report to the health care provider?
1. ASoft breasts with colostrum easily expressed from both nipples
2. BModerate lochia rubra with a few clots smaller than a dime
3. CIncision edges closed, with mild bruising along the dressing
4. DDistended, firm abdomen with absent bowel sounds and vomiting
Answer and explanation in LearnFree account
Question 19 · Medium
The nurse is teaching a first-time mother about breastfeeding. Which statement shows the teaching about latch was understood?
1. A"Nipple pain all through the feeding is normal in the first few weeks."
2. B"Clicking sounds while the baby sucks mean the baby is swallowing well."
3. C"The baby's mouth should cover most of the areola, not just the nipple."
4. D"I should limit each feeding to 5 minutes per breast to avoid soreness."
Answer and explanation in LearnFree account
Question 20 · Hard
On postpartum day 2, a client who had normal blood pressures in pregnancy reports a severe headache that acetaminophen has not relieved. Her blood pressure is 164/110 mm Hg, repeated 15 minutes later at 162/108 mm Hg. Deep tendon reflexes are 3+. What should the nurse do first?
1. AEncourage oral fluids, as caffeine withdrawal is common
2. BDim the lights and recheck the blood pressure in 1 hour
3. CNotify the health care provider of the findings now
4. DGive a second dose of acetaminophen for the headache
Answer and explanation in LearnFree account
Question 21 · Medium
On the third postpartum day, a breastfeeding client says her breasts are hard, warm and painful. She has no fever. The nurse's best advice is to:
1. AGive formula until the swelling has fully gone down
2. BBind the breasts tightly and avoid nipple stimulation
3. CBreastfeed every 2 to 3 hours and apply cold packs after feedings
4. DSkip feedings for a day so that the breasts can rest
Answer and explanation in LearnFree account
Question 22 · Hard
A client's first day of her last normal menstrual period was June 10, 2026. Her cycles are regular at 28 days. Using Naegele's rule, what is her estimated date of birth?
1. AApril 17, 2027
2. BMarch 17, 2027
3. CSeptember 17, 2026
4. DMarch 3, 2027
Answer and explanation in LearnFree account
Question 23 · Medium
Four hours after a vaginal birth with a second-degree laceration, the client reports perineal pain. Which comfort measure is most appropriate now?
1. AWarm sitz bath
2. BDonut-shaped cushion
3. CHeating pad to the perineum
4. DIce pack to the perineum
Answer and explanation in LearnFree account
Question 24 · Medium
A client at 35 weeks has been taught the count-to-10 method for fetal movements. She calls and says she felt only 4 movements in the past 2 hours. The nurse should:
1. AReassure her that movements slow near term
2. BAdvise her to drink juice and count again tomorrow
3. CAsk her to repeat the count after a night's sleep
4. DTell her to come in today for fetal assessment
Answer and explanation in LearnFree account
Question 25 · Hard
A client at 39 weeks whose vaginal-rectal culture at 36 weeks was positive for group B streptococcus is admitted in active labor. She reports that penicillin once gave her a mild, itchy rash, with no hives, swelling or breathing problems. Which drug should the nurse expect to be ordered?
1. AIV cefazolin
2. BIV clindamycin
3. CIV vancomycin
4. DOral amoxicillin
Answer and explanation in LearnFree account

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Antepartum, intrapartum and postpartum care

A nonstress test at 36 weeks shows a baseline of 140 beats/min and three accelerations of 20 beats/min lasting 20 seconds within 20 minutes. The nurse should interpret this as:

A client with no risk factors for diabetes is at her 12-week prenatal visit. When should the nurse tell her she will be screened for gestational diabetes?

A postpartum client's prenatal record shows she is not immune to rubella. Before discharge, the nurse should plan to:

During an induction the provider orders the oxytocin dose raised to 6 milliunits/min. The bag in use holds 20 units of oxytocin in 1,000 mL of normal saline. What pump rate in mL/hr delivers the ordered dose?

A tracing in active labor shows a baseline of 150 beats/min, a late deceleration with most contractions, and no accelerations. Which additional finding would make this a Category III tracing rather than Category II?

Ten minutes after the birth of a baby, which finding tells the nurse that the placenta has separated from the uterine wall?

A nurse reviews 10 minutes of a term fetal tracing between contractions. Which mean rate falls within the normal baseline range?

On day 3 after birth, a client is tearful and says, "I don't know why I keep crying. I love my baby." She is sleeping and eating well. Which response by the nurse is most therapeutic?

A client in active labor has a fetal heart rate tracing with decelerations that begin and end with each contraction and mirror its shape, with the lowest point at the peak. Variability is moderate. The nurse should:

Which daily folic acid intake is recommended for a healthy client planning pregnancy, to lower the risk of neural tube defects?

A client at 32 weeks arrives with painless, bright red vaginal bleeding. Her uterus is soft and nontender. Which order should the nurse question?

At the start of a day shift on a mother-baby unit, four call lights come on at once. Which postpartum client needs the nurse first?

An Rh-negative client gives birth to an Rh-positive newborn. Her antibody screen is negative. Within what time after birth should Rh(D) immune globulin be given?

One hour after birth, a client's fundus is soft and boggy at the umbilicus, and her pad is soaked. Which action is the nurse's priority?

On the third day after an uncomplicated vaginal birth, the nurse expects the fundus to be about:

A client at 28 weeks is Rh-negative and her antibody screen today is negative. The father of the baby is Rh-positive. Which order should the nurse expect?

During a BUBBLE-HE assessment 24 hours after a cesarean birth, which finding should the nurse report to the health care provider?

The nurse is teaching a first-time mother about breastfeeding. Which statement shows the teaching about latch was understood?

On postpartum day 2, a client who had normal blood pressures in pregnancy reports a severe headache that acetaminophen has not relieved. Her blood pressure is 164/110 mm Hg, repeated 15 minutes later at 162/108 mm Hg. Deep tendon reflexes are 3+. What should the nurse do first?

On the third postpartum day, a breastfeeding client says her breasts are hard, warm and painful. She has no fever. The nurse's best advice is to:

A client's first day of her last normal menstrual period was June 10, 2026. Her cycles are regular at 28 days. Using Naegele's rule, what is her estimated date of birth?

Four hours after a vaginal birth with a second-degree laceration, the client reports perineal pain. Which comfort measure is most appropriate now?

A client at 35 weeks has been taught the count-to-10 method for fetal movements. She calls and says she felt only 4 movements in the past 2 hours. The nurse should:

A client at 39 weeks whose vaginal-rectal culture at 36 weeks was positive for group B streptococcus is admitted in active labor. She reports that penicillin once gave her a mild, itchy rash, with no hives, swelling or breathing problems. Which drug should the nurse expect to be ordered?