Exam 2: NSG 432 / NSG432 (Latest Update 2026 /
2027) Nursing Care of the Childbearing Family |
Guide Questions with Answers | 100% Correct |
Grade A – GCU
Question 1
A nurse is caring for a laboring client at 39 weeks gestation. The fetal monitor
shows a baseline FHR of 150 bpm with moderate variability and occasional
accelerations. There are no decelerations. How should the nurse interpret this
tracing?
A. Category I (normal)
B. Category II (indeterminate)
C. Category III (abnormal)
D. Non-reassuring
Correct Answer: A. Category I (normal)
Rationale: Category I fetal heart rate tracings are normal and predictive of normal fetal
acid-base status. Characteristics include baseline 110-160 bpm, moderate variability (6-
25 bpm), present or absent accelerations, and no late or variable decelerations .
Question 2
A laboring client's fetal monitor strip shows late decelerations. What is the priority
nursing action?
A. Prepare for immediate cesarean birth
B. Increase the IV fluid rate
C. Administer oxygen via face mask
D. Position the client on her left side
Correct Answer: D. Position the client on her left side
,Rationale: Late decelerations indicate uteroplacental insufficiency. The priority action is
to turn the client to the left side to improve placental perfusion. This should be followed
by oxygen administration, increasing IV fluids, stopping oxytocin, and notifying the
provider .
Question 3
What is the most common cause of variable decelerations on the fetal monitor?
A. Uteroplacental insufficiency
B. Head compression
C. Cord compression
D. Maternal hypotension
Correct Answer: C. Cord compression
Rationale: Variable decelerations are caused by umbilical cord compression. They are
characterized by abrupt onset and variable shape. Early decelerations are caused by
head compression, while late decelerations indicate uteroplacental insufficiency .
Question 4
A laboring client is receiving oxytocin (Pitocin). The fetal monitor shows uterine
tachysystole with 8 contractions in 10 minutes. What is the nurse's priority action?
A. Decrease the oxytocin infusion rate
B. Turn off the oxytocin infusion
C. Increase the oxytocin infusion rate
D. Continue to monitor
Correct Answer: B. Turn off the oxytocin infusion
Rationale: Uterine tachysystole (>5 contractions in 10 minutes averaged over 30
minutes) requires immediate discontinuation of oxytocin. This intervention helps restore
adequate placental perfusion and fetal oxygenation. A uterine relaxant (e.g., terbutaline)
may be ordered .
,Question 5
A nurse is assessing a laboring client's uterine activity. What is the normal
frequency of contractions in active labor?
A. Every 2-5 minutes
B. Every 1-2 minutes
C. Every 5-10 minutes
D. Every 10-15 minutes
Correct Answer: A. Every 2-5 minutes
Rationale: Normal contraction frequency in active labor is 2-5 contractions per 10
minutes. Duration should be 45-80 seconds, and intensity should be 40-70 mmHg in the
first stage and 80+ mmHg in the second stage .
Question 6
The nurse is reading a fetal monitor strip. Which fetal heart rate variability pattern
is considered normal?
A. Absent
B. Minimal (1-5 bpm)
C. Moderate (6-25 bpm)
D. Marked (>25 bpm)
Correct Answer: C. Moderate (6-25 bpm)
Rationale: Moderate variability (6-25 bpm) is a normal and reassuring finding indicating
an intact fetal autonomic nervous system. Absent and minimal variability are non-
reassuring. Marked variability (>25 bpm) may also be concerning .
Question 7
A client at 38 weeks gestation with preeclampsia is in labor. Her blood pressure is
160/100 mm Hg. Which medication should the nurse anticipate?
A. Magnesium sulfate
B. Oxytocin
, C. Terbutaline
D. Naloxone
Correct Answer: A. Magnesium sulfate
Rationale: Magnesium sulfate is the medication of choice for seizure prophylaxis in
preeclampsia and eclampsia. It is a central nervous system depressant and
anticonvulsant .
Question 8
The nurse is preparing to administer an epidural to a laboring client. Which
nursing action should be performed before the procedure?
A. Insert a Foley catheter
B. Administer a fluid bolus
C. Obtain a platelet count
D. Both B and C
Correct Answer: D. Both B and C
Rationale: Before an epidural, the client should receive an IV fluid bolus to prevent
hypotension. A platelet count should be obtained to rule out thrombocytopenia, which
is a contraindication. The client should also void before the procedure .
Question 9
A laboring client requests pain medication. The nurse administers an opioid. When
should the nurse expect the medication to take effect?
A. Immediately
B. 1-2 minutes
C. 3-5 minutes
D. 10-15 minutes
Correct Answer: C. 3-5 minutes
Rationale: IV opioids typically take effect within 3-5 minutes. They are administered
during peak contractions to minimize the effect on the fetus .
2027) Nursing Care of the Childbearing Family |
Guide Questions with Answers | 100% Correct |
Grade A – GCU
Question 1
A nurse is caring for a laboring client at 39 weeks gestation. The fetal monitor
shows a baseline FHR of 150 bpm with moderate variability and occasional
accelerations. There are no decelerations. How should the nurse interpret this
tracing?
A. Category I (normal)
B. Category II (indeterminate)
C. Category III (abnormal)
D. Non-reassuring
Correct Answer: A. Category I (normal)
Rationale: Category I fetal heart rate tracings are normal and predictive of normal fetal
acid-base status. Characteristics include baseline 110-160 bpm, moderate variability (6-
25 bpm), present or absent accelerations, and no late or variable decelerations .
Question 2
A laboring client's fetal monitor strip shows late decelerations. What is the priority
nursing action?
A. Prepare for immediate cesarean birth
B. Increase the IV fluid rate
C. Administer oxygen via face mask
D. Position the client on her left side
Correct Answer: D. Position the client on her left side
,Rationale: Late decelerations indicate uteroplacental insufficiency. The priority action is
to turn the client to the left side to improve placental perfusion. This should be followed
by oxygen administration, increasing IV fluids, stopping oxytocin, and notifying the
provider .
Question 3
What is the most common cause of variable decelerations on the fetal monitor?
A. Uteroplacental insufficiency
B. Head compression
C. Cord compression
D. Maternal hypotension
Correct Answer: C. Cord compression
Rationale: Variable decelerations are caused by umbilical cord compression. They are
characterized by abrupt onset and variable shape. Early decelerations are caused by
head compression, while late decelerations indicate uteroplacental insufficiency .
Question 4
A laboring client is receiving oxytocin (Pitocin). The fetal monitor shows uterine
tachysystole with 8 contractions in 10 minutes. What is the nurse's priority action?
A. Decrease the oxytocin infusion rate
B. Turn off the oxytocin infusion
C. Increase the oxytocin infusion rate
D. Continue to monitor
Correct Answer: B. Turn off the oxytocin infusion
Rationale: Uterine tachysystole (>5 contractions in 10 minutes averaged over 30
minutes) requires immediate discontinuation of oxytocin. This intervention helps restore
adequate placental perfusion and fetal oxygenation. A uterine relaxant (e.g., terbutaline)
may be ordered .
,Question 5
A nurse is assessing a laboring client's uterine activity. What is the normal
frequency of contractions in active labor?
A. Every 2-5 minutes
B. Every 1-2 minutes
C. Every 5-10 minutes
D. Every 10-15 minutes
Correct Answer: A. Every 2-5 minutes
Rationale: Normal contraction frequency in active labor is 2-5 contractions per 10
minutes. Duration should be 45-80 seconds, and intensity should be 40-70 mmHg in the
first stage and 80+ mmHg in the second stage .
Question 6
The nurse is reading a fetal monitor strip. Which fetal heart rate variability pattern
is considered normal?
A. Absent
B. Minimal (1-5 bpm)
C. Moderate (6-25 bpm)
D. Marked (>25 bpm)
Correct Answer: C. Moderate (6-25 bpm)
Rationale: Moderate variability (6-25 bpm) is a normal and reassuring finding indicating
an intact fetal autonomic nervous system. Absent and minimal variability are non-
reassuring. Marked variability (>25 bpm) may also be concerning .
Question 7
A client at 38 weeks gestation with preeclampsia is in labor. Her blood pressure is
160/100 mm Hg. Which medication should the nurse anticipate?
A. Magnesium sulfate
B. Oxytocin
, C. Terbutaline
D. Naloxone
Correct Answer: A. Magnesium sulfate
Rationale: Magnesium sulfate is the medication of choice for seizure prophylaxis in
preeclampsia and eclampsia. It is a central nervous system depressant and
anticonvulsant .
Question 8
The nurse is preparing to administer an epidural to a laboring client. Which
nursing action should be performed before the procedure?
A. Insert a Foley catheter
B. Administer a fluid bolus
C. Obtain a platelet count
D. Both B and C
Correct Answer: D. Both B and C
Rationale: Before an epidural, the client should receive an IV fluid bolus to prevent
hypotension. A platelet count should be obtained to rule out thrombocytopenia, which
is a contraindication. The client should also void before the procedure .
Question 9
A laboring client requests pain medication. The nurse administers an opioid. When
should the nurse expect the medication to take effect?
A. Immediately
B. 1-2 minutes
C. 3-5 minutes
D. 10-15 minutes
Correct Answer: C. 3-5 minutes
Rationale: IV opioids typically take effect within 3-5 minutes. They are administered
during peak contractions to minimize the effect on the fetus .
