10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The C-ONQS exam has 125 questions and runs 2 hours.
These 10 free C-ONQS questions are organized by exam domain, so you can see how each part of the Obstetric and Neonatal Quality and Safety blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Quality and Safety Assessment and Gap Analysis 25% of exam
Question 1
Twenty minutes after a vaginal birth, a patient has ongoing bleeding, a pulse of 128/min, blood pressure of 86/50 mm Hg, and new confusion. The collection drape contains 500 mL, including 150 mL of amniotic fluid measured before birth. Blood-soaked materials weigh 725 g; their combined dry weight is 275 g. No other blood loss has been recorded. Using 1 g of net weight as approximately 1 mL of blood, which cumulative loss and response are appropriate?
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Correct answer: C - 800 mL; activate the obstetric hemorrhage response and begin resuscitation.
Question 2
An infusion error causes temporary maternal harm. Review finds that a nurse deliberately bypassed an independent check, believing her experience made a second check unnecessary. The shortcut had become customary, and supervisors praised rapid infusion starts. Reviewers find that she underestimated the risk rather than consciously disregarding a risk she understood to be substantial and unjustifiable. After the immediate patient and system hazards are addressed, which response fits these findings?
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Correct answer: B - Coach her about the risk and remove incentives that reward bypassing the check.
Question 3
At 27 hours of age, a well-appearing term newborn undergoes the first critical congenital heart disease pulse-oximetry screen in room air. With reliable signals, the right-hand saturation is 96% and the foot saturation is 94%, a difference of 2 percentage points. The examination is otherwise normal. Select the disposition specified by the current screening algorithm.
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Correct answer: A - Repeat measurements in both the right hand and a foot after one hour.
Domain 2: Integrate Quality and Safety in Practice 23% of exam
Question 4
During a neonatal transfer call, the sending clinician explains illness severity, treatment, a pending blood culture, who will check the result, and the action required if it becomes positive. The receiving clinician replies, "Thanks, I have the information," and prepares to end the call. What still needs to happen to establish a shared understanding of the plan?
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Correct answer: B - The receiver summarizes the action list and contingencies for the sender to verify.
Domain 3: Develop and Implement Quality and Safety into Practice 26% of exam
Question 5
A NICU records 100% completion of milk barcode checks, yet an infant receives milk intended for another infant. Observation shows that nurses scan containers against patient labels kept at the preparation counter, then carry several feeds to the bedside. The software correctly matches every scanned pair. Which change most directly closes the gap revealed by this event?
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Correct answer: A - Match each container to the infant's actual wristband at the bedside before feeding.
Question 6
A maternity service measures timely treatment of confirmed persistent severe hypertension. An episode counts as timely only when an appropriate first-line antihypertensive is administered within 60 minutes of confirmation. For confirmed episodes, all times below are measured from confirmation. Which record qualifies for the numerator?
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Correct answer: D - BP 168/104 mm Hg sustained over 20 minutes; IV labetalol administered 42 minutes after confirmation.
Question 7
A team tests a revised postpartum discharge checklist with three patients cared for by one nurse. Follow-up arrangements are clearer, but the nurse must enter the same information twice. No safety problems occur. The team wants to learn whether the checklist will work with routine staffing and across shifts. Which proposal makes the best use of this first test?
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Correct answer: C - Remove duplicate entry, then test the revision with different nurses and shifts.
Question 8
In a postpartum patient receiving magnesium sulfate, which newly observed combination favors magnesium toxicity rather than worsening preeclampsia?
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Correct answer: D - Absent patellar reflexes with a respiratory rate of 7/min.
Domain 4: Evaluation and Measures of Effectiveness 22% of exam
Question 9
A postpartum service aims for at least 90% completion of scheduled blood-pressure follow-up. Its control chart has a center line of 72%; all 24 monthly points are within the calculated control limits, with no nonrandom patterns. An administrator concludes, "The process is in control, so further improvement is unnecessary." What does the chart actually support?
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Correct answer: D - The process is predictable but below target; improvement requires changing the system.
Question 10
Quarterly NICU surveillance shows:
Baseline quarter: 4 confirmed central-line-associated bloodstream infections (CLABSIs), 2,000 central-line days, and 5,000 patient-days.
Quarter after a maintenance bundle was introduced: 3 CLABSIs, 1,000 central-line days, and 2,500 patient-days.
The surveillance definition and case-finding method are unchanged. The team reports fewer infections. Which comparison correctly evaluates infection frequency relative to central-line exposure?
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Correct answer: A - 2.0 versus 3.0 per 1,000 central-line days: the observed rate increased despite fewer infections.