NR 602 Midterm Examination | Primary Care of the Childbearing & Childrearing Family Practicum Edition | Chamberlain University
NR602 / NR-602 MIDTERM EXAM (LATEST )
Primary Care of the Childbearing & Childrearing Family Practicum — Chamberlain
University
Aligned with the Chamberlain University NR 602 Course Syllabus, the AACN Essentials of Master's Education in Nursing, and
Advanced Practice Family Nursing Competencies ( Edition)
120 8 180 min 75% 20/50/30
Recall / Application /
Total Questions Course Sections Time Allowed Scenario-Based
Analysis (%)
Directions to the Examinee: Read each question carefully and select the ONE best response (A through D). Every item
is followed by its correct answer and an evidence-based rationale drawn from the NR 602 curriculum, AWHONN
standards, and current maternal-child practice guidelines (ACOG, AAP, CDC / ACIP, NAEPP). Sections follow the NR
602 midterm blueprint: antepartum care, prenatal assessment, high-risk pregnancy, intrapartum care, postpartum care,
newborn assessment, common pediatric conditions, and pediatric health promotion. Approximately 75 percent of items
are scenario-based clinical presentations requiring prioritization, clinical reasoning, and management decisions.
Section 1: Antepartum Care & Fetal Development
Questions 1 through 15 · 15 items
Q1: A 24-year-old woman at 10 weeks' gestation presents for her first prenatal visit. Her obstetric
history reveals one full-term birth at 39 weeks, preterm twins delivered at 32 weeks who are both
living, and one spontaneous abortion at 9 weeks. Using the GTPAL system, which classification
correctly describes this gravida?
A. G4 T1 P1 A1 L3
B. G4 T2 P2 A1 L4
C. G3 T1 P1 A1 L2
D. G4 T1 P1 A1 L3 [CORRECT]
Correct Answer: D
Rationale: Gravida counts every pregnancy including the current one (current pregnancy, term birth, preterm twins,
and the abortion = G4). Term is 1 (39-week birth); preterm is 1 (the twin delivery counts as ONE delivery even
though two infants resulted); abortions = 1; and living children = 3 (the term infant plus both twins). Option B
incorrectly doubles the preterm and term counts by counting infants rather than deliveries, and option C fails to
count the current pregnancy in the gravida total.
1
,NR 602 Midterm Examination | Primary Care of the Childbearing & Childrearing Family Practicum Edition | Chamberlain University
Q2: A patient reports that her last menstrual period (LMP) began on March 10. Using Naegele's rule,
the nurse practitioner calculates her estimated date of delivery (EDD) as:
A. November 17
B. December 10
C. December 17 [CORRECT]
D. January 3
Correct Answer: C
Rationale: Naegele's rule requires subtracting three months from the first day of the LMP (March 10 minus 3
months = December 10), then adding 7 days (December 17). Option B forgets to add the 7 days, option A subtracts
both the months and the days, and option D adds rather than subtracts the months. Naegele's rule assumes a regular
28-day cycle and should be validated by first-trimester ultrasound when cycle length is irregular.
Q3: Which of the following assessment findings is classified as a positive (diagnostic) sign of
pregnancy?
A. A positive serum beta-hCG test
B. A softening of the cervical tip (Goodell sign)
C. Visualization of the gestational sac and fetal pole on transvaginal ultrasound [CORRECT]
D. A bluish discoloration of the vaginal mucosa (Chadwick sign)
Correct Answer: C
Rationale: Positive signs of pregnancy are those that can be attributed only to the fetus itself: ultrasound
visualization of the fetus, hearing fetal heart tones with a Doppler, and palpation of fetal movements by the
examiner. Serum beta-hCG is a probable sign because it can be elevated in trophoblastic disease and other
conditions, while Goodell and Chadwick signs are objective probable signs reflecting hormonal changes.
Presumptive signs such as amenorrhea and nausea are the least reliable because they have many nonpregnancy
causes.
Q4: A 28-year-old woman with an uncomplicated, low-risk singleton pregnancy is seen today at 28
weeks' gestation. According to the standard ACOG-recommended prenatal visit schedule, when should
she be seen for her next visit?
A. In 1 week
B. In 3 weeks
C. In 4 weeks
D. In 2 weeks [CORRECT]
Correct Answer: D
Rationale: The standard schedule for an uncomplicated pregnancy is every 4 weeks until 28 weeks, every 2 weeks
from 28 to 36 weeks, and weekly from 36 weeks until delivery. Because this patient has reached 28 weeks, she
moves from the monthly interval into the every-2-week interval. The weekly interval (option A) does not begin until
36 weeks, and monthly visits (option C) are appropriate only before 28 weeks.
2
,NR 602 Midterm Examination | Primary Care of the Childbearing & Childrearing Family Practicum Edition | Chamberlain University
Q5: At a routine prenatal visit, the nurse practitioner measures the distance from the symphysis pubis
to the top of the uterine fundus in a woman with a singleton pregnancy at 22 weeks' gestation. Which
fundal height measurement would be consistent with expected growth?
A. 12 cm
B. 22 cm [CORRECT]
C. 18 cm
D. 28 cm
Correct Answer: B
Rationale: After 20 weeks' gestation, the fundal height in centimeters should approximate the gestational age in
weeks, with a normal variation of plus or minus 2 cm. At 22 weeks, an expected measurement is therefore
approximately 22 cm (the fundus reaches the umbilicus at 20-22 weeks). A measurement of 28 cm would suggest a
large-for-dates pregnancy such as multiple gestation, polyhydramnios, or inaccurate dating, while 12-18 cm suggests
growth restriction or inaccurate dating.
Q6: A nurse practitioner attempts to auscultate fetal heart tones with a handheld Doppler device at a
routine prenatal visit. In which gestational age range would the Doppler first be expected to reliably
detect fetal heart tones?
A. 10 to 12 weeks [CORRECT]
B. 6 to 8 weeks
C. 16 to 18 weeks
D. 20 to 24 weeks
Correct Answer: A
Rationale: A handheld Doppler can reliably detect fetal heart tones between 10 and 12 weeks of gestation, with a
normal baseline rate of 110 to 160 beats per minute. Before 10 weeks, cardiac activity requires transvaginal
ultrasound, and 16-18 weeks is when nonamplified fetoscopes or low-frequency stethoscopes may first detect tones.
If tones are absent at 10-12 weeks, ultrasound evaluation is indicated rather than reassurance.
Q7: During a third-trimester assessment, the nurse practitioner palpates the maternal abdomen using
Leopold's maneuvers. Which maneuver is performed FIRST to identify which fetal part occupies the
uterine fundus?
A. The third maneuver (Pawlik grip above the symphysis)
B. The second maneuver (lateral palpation of the flanks)
C. The first maneuver (fundal palpation) [CORRECT]
D. The fourth maneuver (deep pelvic palpation from below)
Correct Answer: C
Rationale: The first Leopold maneuver uses both hands on the upper fundus to determine which fetal pole (head or
breech) occupies the fundus, establishing presentation by exclusion. The second maneuver identifies the position of
the fetal back versus small parts, the third maneuver (Pawlik grip) determines engagement and the presenting part,
and the fourth maneuver confirms the degree of flexion and station in cephalic presentations. Performing the
maneuvers out of sequence compromises the accuracy of the assessment.
3
, NR 602 Midterm Examination | Primary Care of the Childbearing & Childrearing Family Practicum Edition | Chamberlain University
Q8: A 9-week pregnant patient reports disabling nausea that occurs mostly in the morning but persists
throughout the day. She is tolerating fluids and has gained weight appropriately. Which
self-management strategy should the nurse practitioner recommend FIRST?
A. Skip breakfast entirely to avoid triggering nausea
B. Eat small, frequent meals with dry crackers or toast before rising [CORRECT]
C. Increase intake of fried and fatty foods to promote satiety
D. Take the prenatal vitamin with an iron supplement on an empty stomach at bedtime
Correct Answer: B
Rationale: First-line management of mild nausea and vomiting of pregnancy is dietary: small frequent meals, dry
bland foods such as crackers before rising, and avoidance of triggers such as strong odors and fatty or spicy foods,
often combined with vitamin B6 with or without doxylamine. Skipping breakfast worsens nausea because an empty
stomach intensifies gastric acid effects, and fatty foods delay gastric emptying. Iron supplements irritate the GI tract
and should be deferred when nausea is significant, not taken on an empty stomach.
Q9: A 34-week pregnant patient telephones the prenatal clinic reporting a 4-lb weight gain over 2 days,
severe frontal headache, and blurred vision. She denies epigastric pain or vaginal bleeding. What is the
nurse practitioner's BEST response?
A. Reassure her that headaches and vision changes are normal third-trimester discomforts
B. Instruct her to come to the clinic or obstetric triage unit immediately for blood pressure
evaluation [CORRECT]
C. Advise rest, hydration, and acetaminophen with a follow-up visit next week
D. Recommend a low-sodium diet and a home blood pressure check in 3 days
Correct Answer: B
Rationale: Sudden weight gain, severe headache, and visual disturbances in the third trimester are classic warning
signs of preeclampsia, which requires same-day blood pressure and urine protein evaluation because the condition
can progress rapidly to eclampsia. Reassurance or delaying evaluation for even a few days could miss advancing
severe features such as thrombocytopenia, impaired liver function, or seizure. Warning signs of pregnancy always
warrant prompt, in-person assessment rather than telephone management.
4
NR602 / NR-602 MIDTERM EXAM (LATEST )
Primary Care of the Childbearing & Childrearing Family Practicum — Chamberlain
University
Aligned with the Chamberlain University NR 602 Course Syllabus, the AACN Essentials of Master's Education in Nursing, and
Advanced Practice Family Nursing Competencies ( Edition)
120 8 180 min 75% 20/50/30
Recall / Application /
Total Questions Course Sections Time Allowed Scenario-Based
Analysis (%)
Directions to the Examinee: Read each question carefully and select the ONE best response (A through D). Every item
is followed by its correct answer and an evidence-based rationale drawn from the NR 602 curriculum, AWHONN
standards, and current maternal-child practice guidelines (ACOG, AAP, CDC / ACIP, NAEPP). Sections follow the NR
602 midterm blueprint: antepartum care, prenatal assessment, high-risk pregnancy, intrapartum care, postpartum care,
newborn assessment, common pediatric conditions, and pediatric health promotion. Approximately 75 percent of items
are scenario-based clinical presentations requiring prioritization, clinical reasoning, and management decisions.
Section 1: Antepartum Care & Fetal Development
Questions 1 through 15 · 15 items
Q1: A 24-year-old woman at 10 weeks' gestation presents for her first prenatal visit. Her obstetric
history reveals one full-term birth at 39 weeks, preterm twins delivered at 32 weeks who are both
living, and one spontaneous abortion at 9 weeks. Using the GTPAL system, which classification
correctly describes this gravida?
A. G4 T1 P1 A1 L3
B. G4 T2 P2 A1 L4
C. G3 T1 P1 A1 L2
D. G4 T1 P1 A1 L3 [CORRECT]
Correct Answer: D
Rationale: Gravida counts every pregnancy including the current one (current pregnancy, term birth, preterm twins,
and the abortion = G4). Term is 1 (39-week birth); preterm is 1 (the twin delivery counts as ONE delivery even
though two infants resulted); abortions = 1; and living children = 3 (the term infant plus both twins). Option B
incorrectly doubles the preterm and term counts by counting infants rather than deliveries, and option C fails to
count the current pregnancy in the gravida total.
1
,NR 602 Midterm Examination | Primary Care of the Childbearing & Childrearing Family Practicum Edition | Chamberlain University
Q2: A patient reports that her last menstrual period (LMP) began on March 10. Using Naegele's rule,
the nurse practitioner calculates her estimated date of delivery (EDD) as:
A. November 17
B. December 10
C. December 17 [CORRECT]
D. January 3
Correct Answer: C
Rationale: Naegele's rule requires subtracting three months from the first day of the LMP (March 10 minus 3
months = December 10), then adding 7 days (December 17). Option B forgets to add the 7 days, option A subtracts
both the months and the days, and option D adds rather than subtracts the months. Naegele's rule assumes a regular
28-day cycle and should be validated by first-trimester ultrasound when cycle length is irregular.
Q3: Which of the following assessment findings is classified as a positive (diagnostic) sign of
pregnancy?
A. A positive serum beta-hCG test
B. A softening of the cervical tip (Goodell sign)
C. Visualization of the gestational sac and fetal pole on transvaginal ultrasound [CORRECT]
D. A bluish discoloration of the vaginal mucosa (Chadwick sign)
Correct Answer: C
Rationale: Positive signs of pregnancy are those that can be attributed only to the fetus itself: ultrasound
visualization of the fetus, hearing fetal heart tones with a Doppler, and palpation of fetal movements by the
examiner. Serum beta-hCG is a probable sign because it can be elevated in trophoblastic disease and other
conditions, while Goodell and Chadwick signs are objective probable signs reflecting hormonal changes.
Presumptive signs such as amenorrhea and nausea are the least reliable because they have many nonpregnancy
causes.
Q4: A 28-year-old woman with an uncomplicated, low-risk singleton pregnancy is seen today at 28
weeks' gestation. According to the standard ACOG-recommended prenatal visit schedule, when should
she be seen for her next visit?
A. In 1 week
B. In 3 weeks
C. In 4 weeks
D. In 2 weeks [CORRECT]
Correct Answer: D
Rationale: The standard schedule for an uncomplicated pregnancy is every 4 weeks until 28 weeks, every 2 weeks
from 28 to 36 weeks, and weekly from 36 weeks until delivery. Because this patient has reached 28 weeks, she
moves from the monthly interval into the every-2-week interval. The weekly interval (option A) does not begin until
36 weeks, and monthly visits (option C) are appropriate only before 28 weeks.
2
,NR 602 Midterm Examination | Primary Care of the Childbearing & Childrearing Family Practicum Edition | Chamberlain University
Q5: At a routine prenatal visit, the nurse practitioner measures the distance from the symphysis pubis
to the top of the uterine fundus in a woman with a singleton pregnancy at 22 weeks' gestation. Which
fundal height measurement would be consistent with expected growth?
A. 12 cm
B. 22 cm [CORRECT]
C. 18 cm
D. 28 cm
Correct Answer: B
Rationale: After 20 weeks' gestation, the fundal height in centimeters should approximate the gestational age in
weeks, with a normal variation of plus or minus 2 cm. At 22 weeks, an expected measurement is therefore
approximately 22 cm (the fundus reaches the umbilicus at 20-22 weeks). A measurement of 28 cm would suggest a
large-for-dates pregnancy such as multiple gestation, polyhydramnios, or inaccurate dating, while 12-18 cm suggests
growth restriction or inaccurate dating.
Q6: A nurse practitioner attempts to auscultate fetal heart tones with a handheld Doppler device at a
routine prenatal visit. In which gestational age range would the Doppler first be expected to reliably
detect fetal heart tones?
A. 10 to 12 weeks [CORRECT]
B. 6 to 8 weeks
C. 16 to 18 weeks
D. 20 to 24 weeks
Correct Answer: A
Rationale: A handheld Doppler can reliably detect fetal heart tones between 10 and 12 weeks of gestation, with a
normal baseline rate of 110 to 160 beats per minute. Before 10 weeks, cardiac activity requires transvaginal
ultrasound, and 16-18 weeks is when nonamplified fetoscopes or low-frequency stethoscopes may first detect tones.
If tones are absent at 10-12 weeks, ultrasound evaluation is indicated rather than reassurance.
Q7: During a third-trimester assessment, the nurse practitioner palpates the maternal abdomen using
Leopold's maneuvers. Which maneuver is performed FIRST to identify which fetal part occupies the
uterine fundus?
A. The third maneuver (Pawlik grip above the symphysis)
B. The second maneuver (lateral palpation of the flanks)
C. The first maneuver (fundal palpation) [CORRECT]
D. The fourth maneuver (deep pelvic palpation from below)
Correct Answer: C
Rationale: The first Leopold maneuver uses both hands on the upper fundus to determine which fetal pole (head or
breech) occupies the fundus, establishing presentation by exclusion. The second maneuver identifies the position of
the fetal back versus small parts, the third maneuver (Pawlik grip) determines engagement and the presenting part,
and the fourth maneuver confirms the degree of flexion and station in cephalic presentations. Performing the
maneuvers out of sequence compromises the accuracy of the assessment.
3
, NR 602 Midterm Examination | Primary Care of the Childbearing & Childrearing Family Practicum Edition | Chamberlain University
Q8: A 9-week pregnant patient reports disabling nausea that occurs mostly in the morning but persists
throughout the day. She is tolerating fluids and has gained weight appropriately. Which
self-management strategy should the nurse practitioner recommend FIRST?
A. Skip breakfast entirely to avoid triggering nausea
B. Eat small, frequent meals with dry crackers or toast before rising [CORRECT]
C. Increase intake of fried and fatty foods to promote satiety
D. Take the prenatal vitamin with an iron supplement on an empty stomach at bedtime
Correct Answer: B
Rationale: First-line management of mild nausea and vomiting of pregnancy is dietary: small frequent meals, dry
bland foods such as crackers before rising, and avoidance of triggers such as strong odors and fatty or spicy foods,
often combined with vitamin B6 with or without doxylamine. Skipping breakfast worsens nausea because an empty
stomach intensifies gastric acid effects, and fatty foods delay gastric emptying. Iron supplements irritate the GI tract
and should be deferred when nausea is significant, not taken on an empty stomach.
Q9: A 34-week pregnant patient telephones the prenatal clinic reporting a 4-lb weight gain over 2 days,
severe frontal headache, and blurred vision. She denies epigastric pain or vaginal bleeding. What is the
nurse practitioner's BEST response?
A. Reassure her that headaches and vision changes are normal third-trimester discomforts
B. Instruct her to come to the clinic or obstetric triage unit immediately for blood pressure
evaluation [CORRECT]
C. Advise rest, hydration, and acetaminophen with a follow-up visit next week
D. Recommend a low-sodium diet and a home blood pressure check in 3 days
Correct Answer: B
Rationale: Sudden weight gain, severe headache, and visual disturbances in the third trimester are classic warning
signs of preeclampsia, which requires same-day blood pressure and urine protein evaluation because the condition
can progress rapidly to eclampsia. Reassurance or delaying evaluation for even a few days could miss advancing
severe features such as thrombocytopenia, impaired liver function, or seizure. Warning signs of pregnancy always
warrant prompt, in-person assessment rather than telephone management.
4
