NLN NACE Care of the Childbearing Family
Practice Exam Questions 1-100 with Correct
Answers & Detailed Rationales
Antepartum (1-35)
1. A 28-year-old G2P1 at 38 weeks gestation presents with a blood
pressure of 160/110 mmHg, 2+ proteinuria, and a headache. Which
medication should the nurse anticipate administering FIRST?
• A) Hydralazine
• B) Magnesium sulfate
• C) Labetalol
• D) Nifedipine
,,,answer,,,: B) Magnesium sulfate
Rationale: This patient has severe preeclampsia (BP ≥160/110 +
proteinuria). Magnesium sulfate is given for seizure
prophylaxis before antihypertensives. Antihypertensives (hydralazine,
labetalol) are given for sustained severe hypertension.
,2. A 25-year-old G1P0 at 39 weeks is admitted in active labor. Her
prenatal record is negative for Group B Streptococcus (GBS). She has
no risk factors. Which statement about GBS prophylaxis is correct?
• A) IV antibiotics should be started immediately
• B) No GBS prophylaxis is indicated
• C) Prophylaxis is indicated only if membranes rupture >18 hours
• D) Oral antibiotics are sufficient
,,,answer,,,: B) No GBS prophylaxis is indicated
Rationale: GBS prophylaxis is indicated for: positive GBS screen,
unknown status with risk factors (fever, prolonged rupture, preterm
labor), or previous infant with GBS disease. A negative GBS screen with no
risk factors does not require prophylaxis.
3. A 32-year-old G3P2 at 36 weeks reports decreased fetal movement
for the past 24 hours. Which action should the nurse take FIRST?
• A) Send the patient for a biophysical profile
• B) Have the patient drink orange juice and rest
• C) Perform a non-stress test
• D) Discharge with instructions to count kicks
,,,answer,,,: C) Perform a non-stress test
Rationale: Decreased fetal movement requires immediate evaluation.
The non-stress test (NST) is the first-line assessment to evaluate fetal
well-being. A BPP may follow if NST is non-reactive.
,4. A 20-year-old G1P0 at 12 weeks reports nausea and vomiting every
morning but is able to keep down some food and fluids. She has lost 1
kg since her last visit. Which recommendation is most appropriate?
• A) Prescribe ondansetron
• B) Recommend dry crackers before getting out of bed
• C) Admit for IV fluids
• D) Recommend complete avoidance of food until nausea passes
,,,answer,,,: B) Recommend dry crackers before getting out of bed
Rationale: This is mild morning sickness without hyperemesis. First-line
non-pharmacologic interventions include eating dry crackers before
rising, small frequent meals, and avoiding triggers. Ondansetron is for
moderate-severe nausea.
5. A 30-year-old G2P1 at 28 weeks presents with painless, bright red
vaginal bleeding. The fetal heart rate is 140 bpm and reactive. Vital
signs are stable. Which action should the nurse take FIRST?
• A) Perform a sterile vaginal exam
• B) Prepare for immediate cesarean section
• C) Place the patient on bed rest and monitor
• D) Administer betamethasone
,,,answer,,,: C) Place the patient on bed rest and monitor
Rationale: Painless bleeding at 28 weeks suggests placenta previa until
proven otherwise. Never perform a vaginal exam with suspected previa
as it can cause catastrophic hemorrhage. The patient should be placed on
bed rest, monitored, and an ultrasound ordered.
, 6. A 24-year-old G1P0 at 20 weeks has a positive quad screen for Down
syndrome. Which test is most diagnostic?
• A) Amniocentesis
• B) Chorionic villus sampling (CVS)
• C) Cell-free fetal DNA (NIPT)
• D) Level II ultrasound
,,,answer,,,: A) Amniocentesis
Rationale: Amniocentesis (15-20 weeks) is diagnostic for chromosomal
abnormalities. CVS (10-13 weeks) is also diagnostic but performed
earlier. NIPT and quad screens are screening, not diagnostic.
7. A 35-year-old G3P2 at 36 weeks presents with a blood pressure of
148/92 mmHg and 1+ proteinuria. She denies headache or visual
changes. Which is the most appropriate next step?
• A) Admit for 24-hour urine protein and fetal monitoring
• B) Discharge with outpatient BP monitoring
• C) Start oral labetalol
• D) Schedule induction at 37 weeks
,,,answer,,,: A) Admit for 24-hour urine protein and fetal monitoring
Rationale: This is gestational hypertension with proteinuria (preeclampsia
without severe features). Admission for 24-hour urine collection (gold
standard) and fetal monitoring is indicated. Delivery is typically at 37
weeks.
Practice Exam Questions 1-100 with Correct
Answers & Detailed Rationales
Antepartum (1-35)
1. A 28-year-old G2P1 at 38 weeks gestation presents with a blood
pressure of 160/110 mmHg, 2+ proteinuria, and a headache. Which
medication should the nurse anticipate administering FIRST?
• A) Hydralazine
• B) Magnesium sulfate
• C) Labetalol
• D) Nifedipine
,,,answer,,,: B) Magnesium sulfate
Rationale: This patient has severe preeclampsia (BP ≥160/110 +
proteinuria). Magnesium sulfate is given for seizure
prophylaxis before antihypertensives. Antihypertensives (hydralazine,
labetalol) are given for sustained severe hypertension.
,2. A 25-year-old G1P0 at 39 weeks is admitted in active labor. Her
prenatal record is negative for Group B Streptococcus (GBS). She has
no risk factors. Which statement about GBS prophylaxis is correct?
• A) IV antibiotics should be started immediately
• B) No GBS prophylaxis is indicated
• C) Prophylaxis is indicated only if membranes rupture >18 hours
• D) Oral antibiotics are sufficient
,,,answer,,,: B) No GBS prophylaxis is indicated
Rationale: GBS prophylaxis is indicated for: positive GBS screen,
unknown status with risk factors (fever, prolonged rupture, preterm
labor), or previous infant with GBS disease. A negative GBS screen with no
risk factors does not require prophylaxis.
3. A 32-year-old G3P2 at 36 weeks reports decreased fetal movement
for the past 24 hours. Which action should the nurse take FIRST?
• A) Send the patient for a biophysical profile
• B) Have the patient drink orange juice and rest
• C) Perform a non-stress test
• D) Discharge with instructions to count kicks
,,,answer,,,: C) Perform a non-stress test
Rationale: Decreased fetal movement requires immediate evaluation.
The non-stress test (NST) is the first-line assessment to evaluate fetal
well-being. A BPP may follow if NST is non-reactive.
,4. A 20-year-old G1P0 at 12 weeks reports nausea and vomiting every
morning but is able to keep down some food and fluids. She has lost 1
kg since her last visit. Which recommendation is most appropriate?
• A) Prescribe ondansetron
• B) Recommend dry crackers before getting out of bed
• C) Admit for IV fluids
• D) Recommend complete avoidance of food until nausea passes
,,,answer,,,: B) Recommend dry crackers before getting out of bed
Rationale: This is mild morning sickness without hyperemesis. First-line
non-pharmacologic interventions include eating dry crackers before
rising, small frequent meals, and avoiding triggers. Ondansetron is for
moderate-severe nausea.
5. A 30-year-old G2P1 at 28 weeks presents with painless, bright red
vaginal bleeding. The fetal heart rate is 140 bpm and reactive. Vital
signs are stable. Which action should the nurse take FIRST?
• A) Perform a sterile vaginal exam
• B) Prepare for immediate cesarean section
• C) Place the patient on bed rest and monitor
• D) Administer betamethasone
,,,answer,,,: C) Place the patient on bed rest and monitor
Rationale: Painless bleeding at 28 weeks suggests placenta previa until
proven otherwise. Never perform a vaginal exam with suspected previa
as it can cause catastrophic hemorrhage. The patient should be placed on
bed rest, monitored, and an ultrasound ordered.
, 6. A 24-year-old G1P0 at 20 weeks has a positive quad screen for Down
syndrome. Which test is most diagnostic?
• A) Amniocentesis
• B) Chorionic villus sampling (CVS)
• C) Cell-free fetal DNA (NIPT)
• D) Level II ultrasound
,,,answer,,,: A) Amniocentesis
Rationale: Amniocentesis (15-20 weeks) is diagnostic for chromosomal
abnormalities. CVS (10-13 weeks) is also diagnostic but performed
earlier. NIPT and quad screens are screening, not diagnostic.
7. A 35-year-old G3P2 at 36 weeks presents with a blood pressure of
148/92 mmHg and 1+ proteinuria. She denies headache or visual
changes. Which is the most appropriate next step?
• A) Admit for 24-hour urine protein and fetal monitoring
• B) Discharge with outpatient BP monitoring
• C) Start oral labetalol
• D) Schedule induction at 37 weeks
,,,answer,,,: A) Admit for 24-hour urine protein and fetal monitoring
Rationale: This is gestational hypertension with proteinuria (preeclampsia
without severe features). Admission for 24-hour urine collection (gold
standard) and fetal monitoring is indicated. Delivery is typically at 37
weeks.
