1
NACE Care of the Childbearing Family Exam
Actual Exam 2026/2027 | Complete Test Bank
with Verified Answers & Detailed Rationales |
Maternal Newborn Nursing Prep | A+ Graded
SECTION 1: ANTEPARTUM CARE (Questions 1-30)
Q1: A 28-week pregnant client presents to the clinic with complaints of a persistent headache,
blurred vision, and epigastric pain. Her blood pressure is 158/96 mmHg, and urine dipstick
reveals 2+ protein. Which order should the nurse anticipate from the healthcare provider FIRST?
A. Administer labetalol 20 mg IV push
B. Obtain a 24-hour urine collection for protein
C. Prepare the client for immediate cesarean section
D. Administer magnesium sulfate IV loading dose. [CORRECT]
Rationale: The client's symptoms (headache, blurred vision, epigastric pain) along with elevated
BP and proteinuria indicate severe preeclampsia. Magnesium sulfate is the priority intervention
for seizure prophylaxis in severe preeclampsia to prevent eclampsia. While antihypertensives (A)
may be needed, seizure prevention takes priority. A 24-hour urine (B) confirms diagnosis but
does not address immediate safety. Cesarean section (C) is not indicated without additional
factors; delivery may be necessary but not immediate without fetal/maternal compromise.
Q2: A pregnant client at 16 weeks gestation asks the nurse why she feels lightheaded when lying
flat on her back. Which physiological explanation should the nurse provide?
A. Increased progesterone causes vasodilation and pooling of blood in the extremities
B. The enlarging uterus compresses the inferior vena cava, reducing venous return to the heart
[CORRECT]
C. The increased blood volume during pregnancy causes fluid shifts that reduce cerebral
perfusion
D. The growing fetus requires increased oxygen, leaving less available for the mother
Rationale: Supine hypotensive syndrome occurs when the gravid uterus compresses the inferior
vena cava, reducing venous return, cardiac output, and blood pressure. This typically occurs after
,2
20 weeks but can begin earlier in multifetal pregnancies. The nurse should advise left lateral
positioning to relieve compression. While progesterone does cause vasodilation (A), this is not
the primary cause of supine symptoms. Options C and D describe inaccurate physiological
mechanisms.
Q3: A client with type 1 diabetes is at 24 weeks gestation. Which statement indicates that she
understands proper management of her condition during pregnancy?
A. "I will need less insulin as my pregnancy progresses because the placenta will help regulate
my glucose"
B. "I should aim for fasting blood glucose levels between 60-90 mg/dL and 1-hour postprandial
levels less than 140 mg/dL" [CORRECT]
C. "Oral hypoglycemic agents are safer than insulin during the second trimester"
D. "I can skip glucose monitoring on days when I feel well and my diet is consistent"
Rationale: Pregnant clients with diabetes require tight glycemic control with target fasting
glucose 60-90 mg/dL and 1-hour postprandial <140 mg/dL (or 2-hour <120 mg/dL). Insulin
requirements actually increase during pregnancy due to placental hormones causing insulin
resistance (A is incorrect). Oral hypoglycemics are generally contraindicated in pregnancy (C is
incorrect). Consistent glucose monitoring is essential regardless of symptoms (D is incorrect).
Q4: The nurse is reviewing the results of a biophysical profile (BPP) for a client at 34 weeks
gestation. The ultrasound shows: fetal breathing movements absent, gross body movements
present, fetal tone present, amniotic fluid volume adequate. The nonstress test is reactive. What
is the BPP score and interpretation?
A. 6/10 - Equivocal, requires repeat testing in 24 hours
B. 6/10 - Abnormal, requires immediate delivery
C. 8/10 - Normal, routine prenatal care may continue [CORRECT]
D. 4/10 - Abnormal, requires immediate delivery
Rationale: BPP scoring assigns 2 points for each of five components: fetal breathing
movements, gross body movements, fetal tone, amniotic fluid volume, and NST reactivity. This
fetus scores 0 (absent breathing) + 2 (movements) + 2 (tone) + 2 (fluid) + 2 (reactive NST) =
8/10. A score of 8-10 is normal/reassuring. Scores of 6 are equivocal (with certain parameters
requiring repeat testing), and ≤4 is abnormal requiring intervention.
Q5: A client at 32 weeks gestation with placenta previa is admitted with bright red vaginal
bleeding. Which nursing intervention takes priority?
,3
A. Prepare the client for immediate vaginal examination to assess cervical dilation
B. Insert a large-bore IV catheter and begin fluid resuscitation [CORRECT]
C. Perform a sterile speculum examination to determine the source of bleeding
D. Administer oxytocin to strengthen uterine contractions and control bleeding
Rationale: Placenta previa with active bleeding requires immediate maternal hemodynamic
stabilization. Vaginal or speculum examination (A, C) is contraindicated in suspected placenta
previa as it may precipitate catastrophic hemorrhage. Oxytocin (D) is inappropriate as the uterus
is not the source of bleeding; the placenta is separating from the uterine wall. IV access and
fluid/blood product administration are priority interventions.
Q6: The nurse is caring for four antepartum clients. Which client should the nurse assess FIRST?
A. A client at 28 weeks with gestational diabetes whose fasting glucose was 95 mg/dL this
morning
B. A client at 35 weeks with preeclampsia who reports a headache and visual changes
[CORRECT]
C. A client at 20 weeks with hyperemesis gravidarum who vomited twice in the past hour
D. A client at 32 weeks with preterm labor who is receiving magnesium sulfate and has a
respiratory rate of 14
Rationale: The client with preeclampsia reporting headache and visual changes is exhibiting
signs of severe features/worsening condition, indicating possible progression to eclampsia. This
requires immediate assessment for seizure prophylaxis and possible delivery planning. While the
preterm labor client (D) needs monitoring for magnesium sulfate toxicity, RR 14 is within
acceptable range (watch for <12). Gestational diabetes (A) and hyperemesis (C) require attention
but are not immediately life-threatening.
Q7: A client at 18 weeks gestation asks the nurse about the purpose of the quad marker screening
test. Which response by the nurse is most accurate?
A. "It detects chromosomal abnormalities by analyzing fetal cells in your bloodstream"
B. "It screens for neural tube defects and certain chromosomal conditions by measuring
substances in your blood" [CORRECT]
C. "It diagnoses Down syndrome and trisomy 18 with 99% accuracy"
D. "It determines if your baby has inherited genetic disorders from you and your partner"
Rationale: The quad screen (second trimester maternal serum screening) measures AFP, hCG,
estriol, and inhibin-A to assess risk for neural tube defects, Down syndrome, and trisomy 18. It is
a screening test, not diagnostic (C is incorrect). It does not analyze fetal cells (A describes NIPT)
or assess inherited genetic disorders (D describes carrier screening).
, 4
Q8: A client with hyperemesis gravidarum at 10 weeks gestation has been admitted for
dehydration. Which laboratory finding requires immediate intervention by the nurse?
A. Hematocrit 38%
B. Potassium 2.8 mEq/L [CORRECT]
C. Sodium 138 mEq/L
D. Blood glucose 85 mg/dL
Rationale: Severe hypokalemia (2.8 mEq/L) places the client at risk for cardiac dysrhythmias
and requires immediate potassium replacement and cardiac monitoring. Hyperemesis gravidarum
can cause significant electrolyte imbalances due to vomiting. Hematocrit 38% (A) is normal;
sodium 138 (C) and glucose 85 (D) are within normal limits.
Q9: A pregnant client at 30 weeks gestation with a history of deep vein thrombosis (DVT) asks
about anticoagulation during pregnancy. Which statement by the nurse is correct?
A. "Warfarin is the preferred anticoagulant during pregnancy because it has the fewest side
effects"
B. "Low molecular weight heparin is safe during pregnancy and does not cross the placenta"
[CORRECT]
C. "You will need to stop all anticoagulants at 36 weeks to prepare for delivery"
D. "Aspirin is sufficient to prevent DVT recurrence during pregnancy"
Rationale: LMWH (such as enoxaparin) and unfractionated heparin do not cross the placenta
and are safe during pregnancy. Warfarin (A) is teratogenic and contraindicated. Anticoagulation
typically continues until delivery, with transition to unfractionated heparin near term due to its
shorter half-life (C is incorrect). Aspirin (D) is insufficient for DVT treatment/prevention in
pregnancy.
Q10: The nurse is reviewing a fetal heart rate tracing from a client in active labor. The baseline
rate is 145 bpm with moderate variability. There are decelerations that begin at the onset of
contractions, reach their lowest point at the peak of contractions, and return to baseline by the
end of contractions. How should the nurse classify these decelerations?
A. Early decelerations [CORRECT]
B. Late decelerations
C. Variable decelerations
D. Prolonged decelerations
NACE Care of the Childbearing Family Exam
Actual Exam 2026/2027 | Complete Test Bank
with Verified Answers & Detailed Rationales |
Maternal Newborn Nursing Prep | A+ Graded
SECTION 1: ANTEPARTUM CARE (Questions 1-30)
Q1: A 28-week pregnant client presents to the clinic with complaints of a persistent headache,
blurred vision, and epigastric pain. Her blood pressure is 158/96 mmHg, and urine dipstick
reveals 2+ protein. Which order should the nurse anticipate from the healthcare provider FIRST?
A. Administer labetalol 20 mg IV push
B. Obtain a 24-hour urine collection for protein
C. Prepare the client for immediate cesarean section
D. Administer magnesium sulfate IV loading dose. [CORRECT]
Rationale: The client's symptoms (headache, blurred vision, epigastric pain) along with elevated
BP and proteinuria indicate severe preeclampsia. Magnesium sulfate is the priority intervention
for seizure prophylaxis in severe preeclampsia to prevent eclampsia. While antihypertensives (A)
may be needed, seizure prevention takes priority. A 24-hour urine (B) confirms diagnosis but
does not address immediate safety. Cesarean section (C) is not indicated without additional
factors; delivery may be necessary but not immediate without fetal/maternal compromise.
Q2: A pregnant client at 16 weeks gestation asks the nurse why she feels lightheaded when lying
flat on her back. Which physiological explanation should the nurse provide?
A. Increased progesterone causes vasodilation and pooling of blood in the extremities
B. The enlarging uterus compresses the inferior vena cava, reducing venous return to the heart
[CORRECT]
C. The increased blood volume during pregnancy causes fluid shifts that reduce cerebral
perfusion
D. The growing fetus requires increased oxygen, leaving less available for the mother
Rationale: Supine hypotensive syndrome occurs when the gravid uterus compresses the inferior
vena cava, reducing venous return, cardiac output, and blood pressure. This typically occurs after
,2
20 weeks but can begin earlier in multifetal pregnancies. The nurse should advise left lateral
positioning to relieve compression. While progesterone does cause vasodilation (A), this is not
the primary cause of supine symptoms. Options C and D describe inaccurate physiological
mechanisms.
Q3: A client with type 1 diabetes is at 24 weeks gestation. Which statement indicates that she
understands proper management of her condition during pregnancy?
A. "I will need less insulin as my pregnancy progresses because the placenta will help regulate
my glucose"
B. "I should aim for fasting blood glucose levels between 60-90 mg/dL and 1-hour postprandial
levels less than 140 mg/dL" [CORRECT]
C. "Oral hypoglycemic agents are safer than insulin during the second trimester"
D. "I can skip glucose monitoring on days when I feel well and my diet is consistent"
Rationale: Pregnant clients with diabetes require tight glycemic control with target fasting
glucose 60-90 mg/dL and 1-hour postprandial <140 mg/dL (or 2-hour <120 mg/dL). Insulin
requirements actually increase during pregnancy due to placental hormones causing insulin
resistance (A is incorrect). Oral hypoglycemics are generally contraindicated in pregnancy (C is
incorrect). Consistent glucose monitoring is essential regardless of symptoms (D is incorrect).
Q4: The nurse is reviewing the results of a biophysical profile (BPP) for a client at 34 weeks
gestation. The ultrasound shows: fetal breathing movements absent, gross body movements
present, fetal tone present, amniotic fluid volume adequate. The nonstress test is reactive. What
is the BPP score and interpretation?
A. 6/10 - Equivocal, requires repeat testing in 24 hours
B. 6/10 - Abnormal, requires immediate delivery
C. 8/10 - Normal, routine prenatal care may continue [CORRECT]
D. 4/10 - Abnormal, requires immediate delivery
Rationale: BPP scoring assigns 2 points for each of five components: fetal breathing
movements, gross body movements, fetal tone, amniotic fluid volume, and NST reactivity. This
fetus scores 0 (absent breathing) + 2 (movements) + 2 (tone) + 2 (fluid) + 2 (reactive NST) =
8/10. A score of 8-10 is normal/reassuring. Scores of 6 are equivocal (with certain parameters
requiring repeat testing), and ≤4 is abnormal requiring intervention.
Q5: A client at 32 weeks gestation with placenta previa is admitted with bright red vaginal
bleeding. Which nursing intervention takes priority?
,3
A. Prepare the client for immediate vaginal examination to assess cervical dilation
B. Insert a large-bore IV catheter and begin fluid resuscitation [CORRECT]
C. Perform a sterile speculum examination to determine the source of bleeding
D. Administer oxytocin to strengthen uterine contractions and control bleeding
Rationale: Placenta previa with active bleeding requires immediate maternal hemodynamic
stabilization. Vaginal or speculum examination (A, C) is contraindicated in suspected placenta
previa as it may precipitate catastrophic hemorrhage. Oxytocin (D) is inappropriate as the uterus
is not the source of bleeding; the placenta is separating from the uterine wall. IV access and
fluid/blood product administration are priority interventions.
Q6: The nurse is caring for four antepartum clients. Which client should the nurse assess FIRST?
A. A client at 28 weeks with gestational diabetes whose fasting glucose was 95 mg/dL this
morning
B. A client at 35 weeks with preeclampsia who reports a headache and visual changes
[CORRECT]
C. A client at 20 weeks with hyperemesis gravidarum who vomited twice in the past hour
D. A client at 32 weeks with preterm labor who is receiving magnesium sulfate and has a
respiratory rate of 14
Rationale: The client with preeclampsia reporting headache and visual changes is exhibiting
signs of severe features/worsening condition, indicating possible progression to eclampsia. This
requires immediate assessment for seizure prophylaxis and possible delivery planning. While the
preterm labor client (D) needs monitoring for magnesium sulfate toxicity, RR 14 is within
acceptable range (watch for <12). Gestational diabetes (A) and hyperemesis (C) require attention
but are not immediately life-threatening.
Q7: A client at 18 weeks gestation asks the nurse about the purpose of the quad marker screening
test. Which response by the nurse is most accurate?
A. "It detects chromosomal abnormalities by analyzing fetal cells in your bloodstream"
B. "It screens for neural tube defects and certain chromosomal conditions by measuring
substances in your blood" [CORRECT]
C. "It diagnoses Down syndrome and trisomy 18 with 99% accuracy"
D. "It determines if your baby has inherited genetic disorders from you and your partner"
Rationale: The quad screen (second trimester maternal serum screening) measures AFP, hCG,
estriol, and inhibin-A to assess risk for neural tube defects, Down syndrome, and trisomy 18. It is
a screening test, not diagnostic (C is incorrect). It does not analyze fetal cells (A describes NIPT)
or assess inherited genetic disorders (D describes carrier screening).
, 4
Q8: A client with hyperemesis gravidarum at 10 weeks gestation has been admitted for
dehydration. Which laboratory finding requires immediate intervention by the nurse?
A. Hematocrit 38%
B. Potassium 2.8 mEq/L [CORRECT]
C. Sodium 138 mEq/L
D. Blood glucose 85 mg/dL
Rationale: Severe hypokalemia (2.8 mEq/L) places the client at risk for cardiac dysrhythmias
and requires immediate potassium replacement and cardiac monitoring. Hyperemesis gravidarum
can cause significant electrolyte imbalances due to vomiting. Hematocrit 38% (A) is normal;
sodium 138 (C) and glucose 85 (D) are within normal limits.
Q9: A pregnant client at 30 weeks gestation with a history of deep vein thrombosis (DVT) asks
about anticoagulation during pregnancy. Which statement by the nurse is correct?
A. "Warfarin is the preferred anticoagulant during pregnancy because it has the fewest side
effects"
B. "Low molecular weight heparin is safe during pregnancy and does not cross the placenta"
[CORRECT]
C. "You will need to stop all anticoagulants at 36 weeks to prepare for delivery"
D. "Aspirin is sufficient to prevent DVT recurrence during pregnancy"
Rationale: LMWH (such as enoxaparin) and unfractionated heparin do not cross the placenta
and are safe during pregnancy. Warfarin (A) is teratogenic and contraindicated. Anticoagulation
typically continues until delivery, with transition to unfractionated heparin near term due to its
shorter half-life (C is incorrect). Aspirin (D) is insufficient for DVT treatment/prevention in
pregnancy.
Q10: The nurse is reviewing a fetal heart rate tracing from a client in active labor. The baseline
rate is 145 bpm with moderate variability. There are decelerations that begin at the onset of
contractions, reach their lowest point at the peak of contractions, and return to baseline by the
end of contractions. How should the nurse classify these decelerations?
A. Early decelerations [CORRECT]
B. Late decelerations
C. Variable decelerations
D. Prolonged decelerations
