NUR 418 Exam 1 Nursing Care of the
Childbearing Family Official Practice Exam
Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions |
Pass Guaranteed – A+ Graded
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SECTION 1: ANTEPARTUM NURSING Q1 – Q10
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Question 1 of 55
A 28-year-old primigravida at 10 weeks gestation presents for her first prenatal visit. She
reports mild nausea, breast tenderness, and fatigue. Her vital signs are stable, and she has no
significant medical history. Which assessment finding at this gestational age would the nurse
expect as a normal physiological adaptation to pregnancy?
A. Fetal heart tones audible with a fetoscope at 10 weeks gestation
B. Fundal height at the level of the umbilicus
C. Chadwick's sign present on physical examination
D. Quickening felt by the mother ✓ CORRECT
Correct Answer: D
Rationale: Quickening, or the mother's first perception of fetal movement, typically occurs
between 16 and 20 weeks gestation in primigravidas, making its presence at 10 weeks an
expected normal finding only after further progression; however, among the options provided,
quickening is the hallmark of advancing gestation while the other choices represent either
later milestones or misinterpreted signs. Fetal heart tones are not reliably audible with a
fetoscope until approximately 18 to 20 weeks, and fundal height reaches the umbilicus
around 20 weeks, so these would not be expected at 10 weeks. Chadwick's sign—bluish
discoloration of the cervix and vagina—is an early sign of pregnancy due to vascular
congestion, but it is observed on speculum examination rather than reported by the patient as
a subjective adaptation.
Question 2 of 55
A 34-year-old multigravida at 28 weeks gestation is diagnosed with gestational diabetes
following her oral glucose tolerance test. During the nurse's dietary counseling session, the
,patient asks why complex carbohydrates are preferred over simple sugars. Which response
by the nurse best reflects the underlying metabolic goal in gestational diabetes management?
A. Complex carbohydrates prevent excessive maternal weight gain during the third trimester
B. Complex carbohydrates provide a slower, more sustained release of glucose to avoid
postprandial hyperglycemia
C. Complex carbohydrates reduce the risk of fetal macrosomia by limiting total caloric intake
D. Complex carbohydrates increase maternal ketone production for fetal brain development ✓
CORRECT
Correct Answer: B
Rationale: Complex carbohydrates are digested more slowly than simple sugars, resulting in
a gradual rise in blood glucose rather than sharp postprandial spikes, which is the primary
metabolic goal in gestational diabetes to maintain euglycemia and reduce fetal
complications. Simple sugars cause rapid glucose fluctuations that challenge maternal
insulin response and increase the risk of fetal hyperinsulinemia and macrosomia. While total
caloric intake and weight gain are monitored, the specific advantage of complex
carbohydrates lies in their glycemic control properties, not caloric restriction. Ketone
production is undesirable in pregnancy as it indicates inadequate carbohydrate intake and
potential fetal neurological risk.
Question 3 of 55
A 22-year-old primigravida at 16 weeks gestation reports to the prenatal clinic with concerns
about a thick, white vaginal discharge that is odorless and nonpruritic. She denies dysuria,
pelvic pain, or fever. The nurse performs a pelvic examination and notes a white, curd-like
discharge adherent to the vaginal walls with no cervical motion tenderness. Based on these
findings, which intervention is most appropriate for the nurse to implement initially?
A. Obtain a vaginal wet mount and pH testing to differentiate physiologic leukorrhea from
candidiasis
B. Prescribe a 7-day course of oral fluconazole 150 mg daily
C. Recommend douching with a vinegar solution to restore vaginal acidity
D. Immediately report findings suggestive of bacterial vaginosis to the provider ✓ CORRECT
Correct Answer: A
Rationale: Physiologic leukorrhea of pregnancy presents as an odorless, white or
yellow-tinged discharge due to increased estrogen and vascular congestion, whereas
candidiasis typically causes pruritus and a curd-like appearance; obtaining a wet mount and
pH assessment allows the nurse to objectively differentiate normal adaptation from infection
before initiating treatment. Oral fluconazole is contraindicated in pregnancy, especially in the
first trimester, due to teratogenic concerns, and treatment should only follow confirmed
diagnosis. Douching is contraindicated in pregnancy as it disrupts normal vaginal flora and
,increases the risk of ascending infection. Bacterial vaginosis presents with a thin, gray
discharge and fishy odor, which this patient does not exhibit.
Question 4 of 55
A 30-year-old gravida 2, para 1 at 20 weeks gestation is being monitored for placenta previa
after a low-lying placenta was identified on her anatomy ultrasound. She calls the triage line
reporting sudden, bright red vaginal bleeding that soaked one pad over the past hour. She
denies pain or uterine contractions, and the fetus is moving normally. Which instruction
should the nurse prioritize?
A. Drive to the clinic immediately for a speculum examination to confirm the bleeding source
B. Perform a vaginal examination at home to assess cervical dilation before coming to the
hospital
C. Call emergency services for transport and remain on left lateral recumbent position until
help arrives
D. Take two acetaminophen tablets and monitor the bleeding for the next 2 hours before
deciding to come in ✓ CORRECT
Correct Answer: C
Rationale: Painless, bright red bleeding in the second trimester with a known low-lying
placenta is highly suggestive of placenta previa, which requires immediate hospitalization for
maternal and fetal monitoring; emergency transport ensures rapid access to care if
hemorrhage escalates, and left lateral positioning maximizes uteroplacental perfusion. A
speculum or vaginal examination is contraindicated in suspected placenta previa because
digital or instrument contact with the cervix can precipitate catastrophic hemorrhage by
disrupting the placental attachment. Acetaminophen does not address the underlying
hemorrhage risk, and waiting at home could result in maternal hemodynamic compromise or
fetal distress from acute blood loss.
Question 5 of 55
A 26-year-old primigravida at 32 weeks gestation is admitted to the antepartum unit with
preeclampsia. Her blood pressure is 158/104 mmHg, urine protein is 2+ on dipstick, and she
reports a persistent headache unrelieved by acetaminophen. Deep tendon reflexes are 2+ and
clonus is absent. Which finding would most indicate progression from preeclampsia to
severe features requiring immediate provider notification?
A. Weight gain of 1 pound over the past week
B. Epigastric pain and visual disturbances reported by the patient
C. Fetal heart rate baseline of 140 beats per minute with moderate variability
D. Blood pressure of 150/92 mmHg measured 4 hours after antihypertensive administration ✓
CORRECT
, Correct Answer: B
Rationale: Epigastric pain and visual disturbances—such as scotomata or blurred vision—are
hallmark severe features of preeclampsia indicating hepatic capsular distension and cerebral
edema, which signal impending eclampsia and require immediate intervention including
magnesium sulfate therapy and delivery planning. Mild weight gain can occur in normal
third-trimester physiology and does not independently indicate severe disease. A fetal heart
rate of 140 with moderate variability is a reassuring tracing and does not reflect maternal
disease severity. A blood pressure of 150/92, while elevated, does not meet the threshold for
severe range hypertension (systolic ≥160 or diastolic ≥110) and may represent a partial
treatment response rather than progression.
Question 6 of 55
A 19-year-old primigravida at 8 weeks gestation presents to the prenatal clinic. She has a
body mass index of 32, smokes half a pack of cigarettes daily, and lives in a rural area with
limited access to fresh produce. During the nursing assessment, which factor should be
prioritized as the most significant modifiable risk for adverse pregnancy outcomes?
A. Maternal age under 20 years
B. Tobacco use during pregnancy
C. Residence in a rural geographic location
D. Pre-pregnancy body mass index of 32 ✓ CORRECT
Correct Answer: B
Rationale: Tobacco use during pregnancy is one of the most significant modifiable risk
factors, directly associated with placental abruption, intrauterine growth restriction, preterm
birth, and sudden infant death syndrome, and smoking cessation interventions can
immediately reduce these risks. Maternal age under 20 is a nonmodifiable demographic
factor that increases risk but cannot be changed during the current pregnancy. Rural
residence may limit resource access but is not an intrinsic physiologic risk factor, and dietary
counseling can partially mitigate nutritional deficits. While obesity increases risk for
gestational diabetes and hypertension, tobacco exerts more immediate and severe
teratogenic and vasoconstrictive effects on placental function.
Question 7 of 55
A 35-year-old gravida 3, para 2 at 18 weeks gestation is undergoing prenatal genetic
screening. Her first-trimester combined screen showed an increased nuchal translucency
measurement, and she is now considering diagnostic testing. The nurse explains the
differences between screening and diagnostic procedures. Which statement by the nurse
accurately describes chorionic villus sampling (CVS)?
A. CVS is typically performed between 15 and 20 weeks gestation and carries a lower risk of
miscarriage than amniocentesis
Childbearing Family Official Practice Exam
Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions |
Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: ANTEPARTUM NURSING Q1 – Q10
══════════════════════════════════════
Question 1 of 55
A 28-year-old primigravida at 10 weeks gestation presents for her first prenatal visit. She
reports mild nausea, breast tenderness, and fatigue. Her vital signs are stable, and she has no
significant medical history. Which assessment finding at this gestational age would the nurse
expect as a normal physiological adaptation to pregnancy?
A. Fetal heart tones audible with a fetoscope at 10 weeks gestation
B. Fundal height at the level of the umbilicus
C. Chadwick's sign present on physical examination
D. Quickening felt by the mother ✓ CORRECT
Correct Answer: D
Rationale: Quickening, or the mother's first perception of fetal movement, typically occurs
between 16 and 20 weeks gestation in primigravidas, making its presence at 10 weeks an
expected normal finding only after further progression; however, among the options provided,
quickening is the hallmark of advancing gestation while the other choices represent either
later milestones or misinterpreted signs. Fetal heart tones are not reliably audible with a
fetoscope until approximately 18 to 20 weeks, and fundal height reaches the umbilicus
around 20 weeks, so these would not be expected at 10 weeks. Chadwick's sign—bluish
discoloration of the cervix and vagina—is an early sign of pregnancy due to vascular
congestion, but it is observed on speculum examination rather than reported by the patient as
a subjective adaptation.
Question 2 of 55
A 34-year-old multigravida at 28 weeks gestation is diagnosed with gestational diabetes
following her oral glucose tolerance test. During the nurse's dietary counseling session, the
,patient asks why complex carbohydrates are preferred over simple sugars. Which response
by the nurse best reflects the underlying metabolic goal in gestational diabetes management?
A. Complex carbohydrates prevent excessive maternal weight gain during the third trimester
B. Complex carbohydrates provide a slower, more sustained release of glucose to avoid
postprandial hyperglycemia
C. Complex carbohydrates reduce the risk of fetal macrosomia by limiting total caloric intake
D. Complex carbohydrates increase maternal ketone production for fetal brain development ✓
CORRECT
Correct Answer: B
Rationale: Complex carbohydrates are digested more slowly than simple sugars, resulting in
a gradual rise in blood glucose rather than sharp postprandial spikes, which is the primary
metabolic goal in gestational diabetes to maintain euglycemia and reduce fetal
complications. Simple sugars cause rapid glucose fluctuations that challenge maternal
insulin response and increase the risk of fetal hyperinsulinemia and macrosomia. While total
caloric intake and weight gain are monitored, the specific advantage of complex
carbohydrates lies in their glycemic control properties, not caloric restriction. Ketone
production is undesirable in pregnancy as it indicates inadequate carbohydrate intake and
potential fetal neurological risk.
Question 3 of 55
A 22-year-old primigravida at 16 weeks gestation reports to the prenatal clinic with concerns
about a thick, white vaginal discharge that is odorless and nonpruritic. She denies dysuria,
pelvic pain, or fever. The nurse performs a pelvic examination and notes a white, curd-like
discharge adherent to the vaginal walls with no cervical motion tenderness. Based on these
findings, which intervention is most appropriate for the nurse to implement initially?
A. Obtain a vaginal wet mount and pH testing to differentiate physiologic leukorrhea from
candidiasis
B. Prescribe a 7-day course of oral fluconazole 150 mg daily
C. Recommend douching with a vinegar solution to restore vaginal acidity
D. Immediately report findings suggestive of bacterial vaginosis to the provider ✓ CORRECT
Correct Answer: A
Rationale: Physiologic leukorrhea of pregnancy presents as an odorless, white or
yellow-tinged discharge due to increased estrogen and vascular congestion, whereas
candidiasis typically causes pruritus and a curd-like appearance; obtaining a wet mount and
pH assessment allows the nurse to objectively differentiate normal adaptation from infection
before initiating treatment. Oral fluconazole is contraindicated in pregnancy, especially in the
first trimester, due to teratogenic concerns, and treatment should only follow confirmed
diagnosis. Douching is contraindicated in pregnancy as it disrupts normal vaginal flora and
,increases the risk of ascending infection. Bacterial vaginosis presents with a thin, gray
discharge and fishy odor, which this patient does not exhibit.
Question 4 of 55
A 30-year-old gravida 2, para 1 at 20 weeks gestation is being monitored for placenta previa
after a low-lying placenta was identified on her anatomy ultrasound. She calls the triage line
reporting sudden, bright red vaginal bleeding that soaked one pad over the past hour. She
denies pain or uterine contractions, and the fetus is moving normally. Which instruction
should the nurse prioritize?
A. Drive to the clinic immediately for a speculum examination to confirm the bleeding source
B. Perform a vaginal examination at home to assess cervical dilation before coming to the
hospital
C. Call emergency services for transport and remain on left lateral recumbent position until
help arrives
D. Take two acetaminophen tablets and monitor the bleeding for the next 2 hours before
deciding to come in ✓ CORRECT
Correct Answer: C
Rationale: Painless, bright red bleeding in the second trimester with a known low-lying
placenta is highly suggestive of placenta previa, which requires immediate hospitalization for
maternal and fetal monitoring; emergency transport ensures rapid access to care if
hemorrhage escalates, and left lateral positioning maximizes uteroplacental perfusion. A
speculum or vaginal examination is contraindicated in suspected placenta previa because
digital or instrument contact with the cervix can precipitate catastrophic hemorrhage by
disrupting the placental attachment. Acetaminophen does not address the underlying
hemorrhage risk, and waiting at home could result in maternal hemodynamic compromise or
fetal distress from acute blood loss.
Question 5 of 55
A 26-year-old primigravida at 32 weeks gestation is admitted to the antepartum unit with
preeclampsia. Her blood pressure is 158/104 mmHg, urine protein is 2+ on dipstick, and she
reports a persistent headache unrelieved by acetaminophen. Deep tendon reflexes are 2+ and
clonus is absent. Which finding would most indicate progression from preeclampsia to
severe features requiring immediate provider notification?
A. Weight gain of 1 pound over the past week
B. Epigastric pain and visual disturbances reported by the patient
C. Fetal heart rate baseline of 140 beats per minute with moderate variability
D. Blood pressure of 150/92 mmHg measured 4 hours after antihypertensive administration ✓
CORRECT
, Correct Answer: B
Rationale: Epigastric pain and visual disturbances—such as scotomata or blurred vision—are
hallmark severe features of preeclampsia indicating hepatic capsular distension and cerebral
edema, which signal impending eclampsia and require immediate intervention including
magnesium sulfate therapy and delivery planning. Mild weight gain can occur in normal
third-trimester physiology and does not independently indicate severe disease. A fetal heart
rate of 140 with moderate variability is a reassuring tracing and does not reflect maternal
disease severity. A blood pressure of 150/92, while elevated, does not meet the threshold for
severe range hypertension (systolic ≥160 or diastolic ≥110) and may represent a partial
treatment response rather than progression.
Question 6 of 55
A 19-year-old primigravida at 8 weeks gestation presents to the prenatal clinic. She has a
body mass index of 32, smokes half a pack of cigarettes daily, and lives in a rural area with
limited access to fresh produce. During the nursing assessment, which factor should be
prioritized as the most significant modifiable risk for adverse pregnancy outcomes?
A. Maternal age under 20 years
B. Tobacco use during pregnancy
C. Residence in a rural geographic location
D. Pre-pregnancy body mass index of 32 ✓ CORRECT
Correct Answer: B
Rationale: Tobacco use during pregnancy is one of the most significant modifiable risk
factors, directly associated with placental abruption, intrauterine growth restriction, preterm
birth, and sudden infant death syndrome, and smoking cessation interventions can
immediately reduce these risks. Maternal age under 20 is a nonmodifiable demographic
factor that increases risk but cannot be changed during the current pregnancy. Rural
residence may limit resource access but is not an intrinsic physiologic risk factor, and dietary
counseling can partially mitigate nutritional deficits. While obesity increases risk for
gestational diabetes and hypertension, tobacco exerts more immediate and severe
teratogenic and vasoconstrictive effects on placental function.
Question 7 of 55
A 35-year-old gravida 3, para 2 at 18 weeks gestation is undergoing prenatal genetic
screening. Her first-trimester combined screen showed an increased nuchal translucency
measurement, and she is now considering diagnostic testing. The nurse explains the
differences between screening and diagnostic procedures. Which statement by the nurse
accurately describes chorionic villus sampling (CVS)?
A. CVS is typically performed between 15 and 20 weeks gestation and carries a lower risk of
miscarriage than amniocentesis
