NSG 432 EXAM 2: NURSING CARE OF THE CHILDBEARING
FAMILY |HIGHER EDUCATION NURSING CURRICULUM –
2026/2027 VERIFIED QUESTIONS AND ANSWERS WITH
EVIDENCE-BASED RATIONALES
SECTION A: ANTEPARTUM NURSING CARE (Questions 1–50)
1. A 32-year-old primigravida at 10 weeks gestation reports nausea, breast
tenderness, and fatigue.
Which physiological change is the PRIMARY cause of these early symptoms?
A) Decreased progesterone
B) Increased hCG and estrogen
C) Decreased human placental lactogen
D) Increased FSH
Answer: B
Rationale: Rising hCG (peaks at 8–10 weeks) directly stimulates the corpus luteum
and is strongly
linked to nausea and vomiting. Estrogen promotes breast ductal growth and
contributes to fatigue
and fluid retention. Progesterone relaxes smooth muscle but is not the primary
driver of these
specific first-trimester symptoms.
2. A nurse explains glucose metabolism in pregnancy. Which statement is
accurate?
A) Pancreatic function is unchanged.
B) Glucose is used at a slower rate.
C) Placental hormones cause insulin resistance.
D) Diet has no effect on glucose.
Answer: C
Rationale: Human placental lactogen, estrogen, progesterone, and cortisol all
antagonize insulin,
creating a state of insulin resistance. This ensures a steady glucose supply for the
fetus but
increases the risk of gestational diabetes in predisposed women.
3. A client asks when she will feel fetal movement. The nurse responds:
A) "By 8 weeks."
1
,B) "Between 16–20 weeks."
C) "Not until the third trimester."
D) "Immediately after conception."
Answer: B
Rationale: Quickening is typically perceived between 16 and 20 weeks in a first
pregnancy.
Multiparous women may feel it earlier (14–16 weeks) because they recognize the
sensation.
4. A 28-year-old at 16 weeks is concerned about a dark line on her abdomen. The
nurse identifies this as:
A) Striae gravidarum
B) Linea nigra
C) Chloasma
D) Spider angioma
Answer: B
Rationale: Linea nigra is a pigmented midline streak from the umbilicus to the
pubis, caused by
melanocyte-stimulating hormone. Striae are stretch marks; chloasma is facial
hyperpigmentation;
spider angiomas are vascular changes.
5. Which cardiovascular change is normal in pregnancy?
A) Decreased heart rate
B) Increased peripheral vascular resistance
C) Increased blood volume by 40–50%
D) Decreased cardiac output
Answer: C
Rationale: Blood volume expands 40–50% to meet maternal and fetal metabolic
demands. Heart rate
increases by 10–15 bpm, systemic vascular resistance decreases, and cardiac
output increases
significantly.
6. At 24 weeks, fundal height is 22 cm. What is the appropriate action?
A) Document as normal
B) Notify the provider immediately
C) Re-measure in 2 weeks
2
,D) Instruct increased fluids
Answer: A
Rationale: Fundal height (cm) corresponds to weeks of gestation ± 2 cm. At 24
weeks, 22–26 cm is
normal. This measurement should be documented and tracked serially.
7. Urine protein of 3+ in a pregnant client indicates:
A) Normal finding
B) Possible preeclampsia or renal disease
C) Dehydration
D) Urinary tract infection
Answer: B
Rationale: Significant proteinuria (≥3+) is a hallmark of preeclampsia or underlying
renal
pathology. Trace to 1+ protein can be normal due to increased renal blood flow,
but 3+ requires
immediate further evaluation.
8. A woman with BMI 22 asks about recommended weight gain. The best
response is:
A) 15–25 pounds
B) 25–35 pounds
C) 28–40 pounds
D) 11–20 pounds
Answer: B
Rationale: For normal BMI (18.5–24.9), recommended gain is 25–35 lb.
Underweight gains 28–40 lb,
overweight 15–25 lb, and obese 11–20 lb.
9. Which statement indicates understanding of folic acid teaching?
A) "Only needed if anemic."
B) "Folic acid prevents neural tube defects."
C) "I can stop after the first trimester."
D) "Only important for maternal health."
Answer: B
Rationale: Folic acid (400–800 mcg/day) before conception and in early pregnancy
reduces neural
3
, tube defects by up to 70%. It is recommended throughout pregnancy for fetal
development.
10. A 28-week client reports worsening ankle edema. The best action is:
A) Limit fluid intake
B) Elevate legs when sitting
C) Notify provider immediately
D) Recommend strict bed rest
Answer: B
Rationale: Dependent edema is common from venous stasis and fluid retention.
Elevating the legs
improves venous return. Fluid restriction is not indicated unless other signs of
preeclampsia
appear.
11. Which immunization is contraindicated during pregnancy?
A) Influenza
B) Tdap
C) MMR
D) COVID-19
Answer: C
Rationale: MMR and varicella are live-attenuated vaccines and are
contraindicated due to
theoretical fetal risk. Inactivated vaccines (influenza, Tdap, COVID-19) are
recommended.
12. Progesterone-induced smooth muscle relaxation causes:
A) Hemorrhoids
B) Heartburn
C) Constipation
D) All of the above
Answer: D
Rationale: Progesterone slows GI motility (constipation), relaxes the lower
esophageal sphincter
(heartburn), and promotes venous pooling (hemorrhoids). All are common
discomforts.
13. A 20-week client feels "butterflies" in her abdomen. This is:
4
FAMILY |HIGHER EDUCATION NURSING CURRICULUM –
2026/2027 VERIFIED QUESTIONS AND ANSWERS WITH
EVIDENCE-BASED RATIONALES
SECTION A: ANTEPARTUM NURSING CARE (Questions 1–50)
1. A 32-year-old primigravida at 10 weeks gestation reports nausea, breast
tenderness, and fatigue.
Which physiological change is the PRIMARY cause of these early symptoms?
A) Decreased progesterone
B) Increased hCG and estrogen
C) Decreased human placental lactogen
D) Increased FSH
Answer: B
Rationale: Rising hCG (peaks at 8–10 weeks) directly stimulates the corpus luteum
and is strongly
linked to nausea and vomiting. Estrogen promotes breast ductal growth and
contributes to fatigue
and fluid retention. Progesterone relaxes smooth muscle but is not the primary
driver of these
specific first-trimester symptoms.
2. A nurse explains glucose metabolism in pregnancy. Which statement is
accurate?
A) Pancreatic function is unchanged.
B) Glucose is used at a slower rate.
C) Placental hormones cause insulin resistance.
D) Diet has no effect on glucose.
Answer: C
Rationale: Human placental lactogen, estrogen, progesterone, and cortisol all
antagonize insulin,
creating a state of insulin resistance. This ensures a steady glucose supply for the
fetus but
increases the risk of gestational diabetes in predisposed women.
3. A client asks when she will feel fetal movement. The nurse responds:
A) "By 8 weeks."
1
,B) "Between 16–20 weeks."
C) "Not until the third trimester."
D) "Immediately after conception."
Answer: B
Rationale: Quickening is typically perceived between 16 and 20 weeks in a first
pregnancy.
Multiparous women may feel it earlier (14–16 weeks) because they recognize the
sensation.
4. A 28-year-old at 16 weeks is concerned about a dark line on her abdomen. The
nurse identifies this as:
A) Striae gravidarum
B) Linea nigra
C) Chloasma
D) Spider angioma
Answer: B
Rationale: Linea nigra is a pigmented midline streak from the umbilicus to the
pubis, caused by
melanocyte-stimulating hormone. Striae are stretch marks; chloasma is facial
hyperpigmentation;
spider angiomas are vascular changes.
5. Which cardiovascular change is normal in pregnancy?
A) Decreased heart rate
B) Increased peripheral vascular resistance
C) Increased blood volume by 40–50%
D) Decreased cardiac output
Answer: C
Rationale: Blood volume expands 40–50% to meet maternal and fetal metabolic
demands. Heart rate
increases by 10–15 bpm, systemic vascular resistance decreases, and cardiac
output increases
significantly.
6. At 24 weeks, fundal height is 22 cm. What is the appropriate action?
A) Document as normal
B) Notify the provider immediately
C) Re-measure in 2 weeks
2
,D) Instruct increased fluids
Answer: A
Rationale: Fundal height (cm) corresponds to weeks of gestation ± 2 cm. At 24
weeks, 22–26 cm is
normal. This measurement should be documented and tracked serially.
7. Urine protein of 3+ in a pregnant client indicates:
A) Normal finding
B) Possible preeclampsia or renal disease
C) Dehydration
D) Urinary tract infection
Answer: B
Rationale: Significant proteinuria (≥3+) is a hallmark of preeclampsia or underlying
renal
pathology. Trace to 1+ protein can be normal due to increased renal blood flow,
but 3+ requires
immediate further evaluation.
8. A woman with BMI 22 asks about recommended weight gain. The best
response is:
A) 15–25 pounds
B) 25–35 pounds
C) 28–40 pounds
D) 11–20 pounds
Answer: B
Rationale: For normal BMI (18.5–24.9), recommended gain is 25–35 lb.
Underweight gains 28–40 lb,
overweight 15–25 lb, and obese 11–20 lb.
9. Which statement indicates understanding of folic acid teaching?
A) "Only needed if anemic."
B) "Folic acid prevents neural tube defects."
C) "I can stop after the first trimester."
D) "Only important for maternal health."
Answer: B
Rationale: Folic acid (400–800 mcg/day) before conception and in early pregnancy
reduces neural
3
, tube defects by up to 70%. It is recommended throughout pregnancy for fetal
development.
10. A 28-week client reports worsening ankle edema. The best action is:
A) Limit fluid intake
B) Elevate legs when sitting
C) Notify provider immediately
D) Recommend strict bed rest
Answer: B
Rationale: Dependent edema is common from venous stasis and fluid retention.
Elevating the legs
improves venous return. Fluid restriction is not indicated unless other signs of
preeclampsia
appear.
11. Which immunization is contraindicated during pregnancy?
A) Influenza
B) Tdap
C) MMR
D) COVID-19
Answer: C
Rationale: MMR and varicella are live-attenuated vaccines and are
contraindicated due to
theoretical fetal risk. Inactivated vaccines (influenza, Tdap, COVID-19) are
recommended.
12. Progesterone-induced smooth muscle relaxation causes:
A) Hemorrhoids
B) Heartburn
C) Constipation
D) All of the above
Answer: D
Rationale: Progesterone slows GI motility (constipation), relaxes the lower
esophageal sphincter
(heartburn), and promotes venous pooling (hemorrhoids). All are common
discomforts.
13. A 20-week client feels "butterflies" in her abdomen. This is:
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