NUR231 Final Exam V3 | NUR 231
Childbearing & Child Caring Family Exam
Q&A | Galen College of Nursing
1. A nurse is assessing a pregnant client at 34 weeks gestation who reports a sudden onset of
severe abdominal pain and vaginal bleeding. Which condition should the nurse suspect?
A. Placenta previa
B. Abruptio placentae
C. Ectopic pregnancy
D. Hydatidiform mole
Answer: B
Rationale: Abruptio placentae is the premature separation of the placenta from the uterine
wall, which typically presents with painful vaginal bleeding and abdominal rigidity.
Placenta previa usually presents with painless bleeding in the third trimester. This
situation requires immediate medical intervention to prevent fetal distress or maternal
hemorrhage.
2. A newborn has an APGAR score of 4 at one minute of life. How should the nurse interpret
this result?
A. The newborn is in moderate distress and requires resuscitation efforts.
B. The newborn shows mild distress and needs stimulation.
,C. The newborn is in good condition and needs routine care.
D. The newborn is in severe distress and requires immediate life support.
Answer: A
Rationale: APGAR scores between 4 and 6 indicate moderate distress, requiring
interventions such as suctioning and oxygen administration. A score of 0 to 3 indicates
severe distress, while 7 to 10 is considered normal. This assessment ensures the healthcare
team can prioritize neonatal stabilization immediately after birth.
3. Which developmental milestone should the nurse expect a 6-month-old infant to have
achieved?
A. Rolling from back to abdomen
B. Sitting steadily without support
C. Walking with assistance
D. Speaking two-word sentences
Answer: A
Rationale: By 6 months of age, infants typically roll over completely from back to abdomen
and vice versa. Sitting without support is usually achieved by 8 months, and walking occurs
later around 12 months. Monitoring these milestones allows nurses to identify potential
developmental delays early in the child’s life.
, 4. A client in active labor is receiving an oxytocin infusion. The nurse notes late decelerations
on the fetal heart rate monitor. What is the priority nursing action?
A. Increase the oxytocin infusion rate.
B. Discontinue the oxytocin infusion.
C. Place the client in a supine position.
D. Perform a vaginal exam to check for dilation.
Answer: B
Rationale: Late decelerations indicate uteroplacental insufficiency, and the first priority is
to stop the oxytocin to reduce uterine contractions. Other steps include turning the patient
to her side and administering oxygen via mask. These actions aim to increase blood flow
and oxygen delivery to the fetus.
5. A nurse is teaching parents about SIDS (Sudden Infant Death Syndrome) prevention. Which
instruction should the nurse include?
A. Place the infant on their stomach to sleep.
B. Use soft pillows and heavy blankets in the crib.
C. Place the infant on their back to sleep on a firm surface.
D. Keep the nursery temperature very warm at all times.
Answer: C
Childbearing & Child Caring Family Exam
Q&A | Galen College of Nursing
1. A nurse is assessing a pregnant client at 34 weeks gestation who reports a sudden onset of
severe abdominal pain and vaginal bleeding. Which condition should the nurse suspect?
A. Placenta previa
B. Abruptio placentae
C. Ectopic pregnancy
D. Hydatidiform mole
Answer: B
Rationale: Abruptio placentae is the premature separation of the placenta from the uterine
wall, which typically presents with painful vaginal bleeding and abdominal rigidity.
Placenta previa usually presents with painless bleeding in the third trimester. This
situation requires immediate medical intervention to prevent fetal distress or maternal
hemorrhage.
2. A newborn has an APGAR score of 4 at one minute of life. How should the nurse interpret
this result?
A. The newborn is in moderate distress and requires resuscitation efforts.
B. The newborn shows mild distress and needs stimulation.
,C. The newborn is in good condition and needs routine care.
D. The newborn is in severe distress and requires immediate life support.
Answer: A
Rationale: APGAR scores between 4 and 6 indicate moderate distress, requiring
interventions such as suctioning and oxygen administration. A score of 0 to 3 indicates
severe distress, while 7 to 10 is considered normal. This assessment ensures the healthcare
team can prioritize neonatal stabilization immediately after birth.
3. Which developmental milestone should the nurse expect a 6-month-old infant to have
achieved?
A. Rolling from back to abdomen
B. Sitting steadily without support
C. Walking with assistance
D. Speaking two-word sentences
Answer: A
Rationale: By 6 months of age, infants typically roll over completely from back to abdomen
and vice versa. Sitting without support is usually achieved by 8 months, and walking occurs
later around 12 months. Monitoring these milestones allows nurses to identify potential
developmental delays early in the child’s life.
, 4. A client in active labor is receiving an oxytocin infusion. The nurse notes late decelerations
on the fetal heart rate monitor. What is the priority nursing action?
A. Increase the oxytocin infusion rate.
B. Discontinue the oxytocin infusion.
C. Place the client in a supine position.
D. Perform a vaginal exam to check for dilation.
Answer: B
Rationale: Late decelerations indicate uteroplacental insufficiency, and the first priority is
to stop the oxytocin to reduce uterine contractions. Other steps include turning the patient
to her side and administering oxygen via mask. These actions aim to increase blood flow
and oxygen delivery to the fetus.
5. A nurse is teaching parents about SIDS (Sudden Infant Death Syndrome) prevention. Which
instruction should the nurse include?
A. Place the infant on their stomach to sleep.
B. Use soft pillows and heavy blankets in the crib.
C. Place the infant on their back to sleep on a firm surface.
D. Keep the nursery temperature very warm at all times.
Answer: C
