NACE CARE OF THE CHILDBEARING FAMILY
COMPLETE PRACTICE QUESTIONS WITH 100%
CORRECT ANSWERS AND DETAILED RATIONALES
| COMPREHENSIVE MATERNAL & NEWBORN
NURSING TEST BANK | EXAM PREP FOR RN, BSN,
AND NURSING BRIDGE PROGRAMS
Question 1
A nurse is assessing a client who is at 34 weeks of gestation and notes a blood
pressure of 155/96 mmHg, 2+ proteinuria, and mild facial edema. Which of the
following orders should the nurse anticipate first?
A) Initiate a continuous infusion of magnesium sulfate.
B) Administer a 500 mL bolus of lactated Ringer's solution.
C) Obtain an order for immediate emergency cesarean delivery.
D) Instruct the client to maintain strict, flat bed rest at home.
Answer: A
Rationale: The client is exhibiting signs of preeclampsia with severe features
(elevated blood pressure and significant proteinuria). Magnesium sulfate is the
priority intervention to prevent seizures (eclampsia). Fluid boluses are restricted
due to the risk of pulmonary edema, immediate delivery is not always warranted
at 34 weeks if the client can be stabilized, and home bed rest is unsafe for severe
preeclampsia.
Question 2
,Which of the following findings should a nurse report to the provider as a
potential complication during a routine 24-week prenatal visit?
A) Increased production of clear, thin vaginal discharge (leukorrhea).
B) Periodic, painless uterine contractions that resolve with rest.
C) Sudden swelling of the face, fingers, and periorbital area.
D) Hyperpigmentation of the midline of the abdomen (linea nigra).
Answer: C
Rationale: Sudden or asymmetric swelling of the face, hands, and eyes can
indicate fluid retention associated with preeclampsia and must be evaluated.
Leukorrhea, Braxton Hicks contractions, and linea nigra are normal physiologic
adaptations during the second trimester.
Question 3
A postpartum nurse is caring for a client 2 hours after a vaginal delivery. The nurse
notes the fundus is boggy and displaced to the right of the midline. Which of the
following actions should the nurse take first?
A) Administer 20 units of oxytocin intramuscularly.
B) Assist the client to the bathroom to void.
C) Perform vigorous fundal massage for 5 minutes.
D) Notify the healthcare provider immediately.
Answer: B
Rationale: A fundus that is boggy and displaced to the right indicates uterine
atony caused by a distended bladder. Assisting the client to empty their bladder
will allow the uterus to contract properly. Fundal massage should be performed,
but emptying the bladder is the root solution for displacement. Oxytocin is utilized
if atony persists after voiding.
,Question 4
A nurse is teaching a pregnant client who has a prescription for oral iron
supplements. Which of the following instructions should the nurse include to
optimize absorption?
A) Take the iron supplement with a glass of milk or yogurt.
B) Drink a glass of orange juice when taking the supplement.
C) Take the medication concurrently with an antacid tablet.
D) Consume the supplement immediately after a heavy meal.
Answer: B
Rationale: Vitamin C (found in orange juice) significantly enhances the
gastrointestinal absorption of iron. Calcium, milk products, antacids, and heavy
food meals inhibit iron absorption and should be avoided at the time of
administration.
Question 5
A newborn is 4 hours old and has a blood glucose level of 34 mg/dL. The infant is
asymptomatic but sleepy. Which of the following actions should the nurse
perform first?
A) Administer an intravenous bolus of 10% dextrose solution.
B) Offer the newborn standard formula or initiate breastfeeding.
C) Place the infant under a radiant warmer to treat hypothermia.
D) Recheck the blood glucose level in exactly 2 hours.
Answer: B
Rationale: A blood glucose level below 40 mg/dL in a newborn indicates
hypoglycemia. For an asymptomatic newborn, the initial intervention is immediate
, feeding with breast milk or formula. IV dextrose is reserved for symptomatic
hypoglycemia or when oral feeding fails to raise glucose levels.
Question 6
During a client’s active labor, the electronic fetal monitor displays a pattern of late
decelerations. Which of the following actions should the nurse execute
immediately?
A) Turn the client onto their side (lateral position).
B) Increase the intravenous oxytocin infusion rate.
C) Instruct the client to perform Valsalva pushing.
D) Prepare the client for an immediate vacuum extraction.
Answer: A
Rationale: Late decelerations indicate uteroplacental insufficiency. Repositioning
the client to a lateral side-lying position relieves pressure on the vena cava,
maximizing uterine blood flow. Oxytocin should be discontinued, not increased.
Valsalva pushing worsens hypoxia.
Question 7
A nurse is assessing a 12-hour-old newborn and notes a yellow tint to the skin on
the face and sclera. Which of the following conditions does this finding suggest?
A) Physiologic jaundice
B) Pathologic jaundice
C) Breast milk jaundice
D) Erythema toxicum
Answer: B
COMPLETE PRACTICE QUESTIONS WITH 100%
CORRECT ANSWERS AND DETAILED RATIONALES
| COMPREHENSIVE MATERNAL & NEWBORN
NURSING TEST BANK | EXAM PREP FOR RN, BSN,
AND NURSING BRIDGE PROGRAMS
Question 1
A nurse is assessing a client who is at 34 weeks of gestation and notes a blood
pressure of 155/96 mmHg, 2+ proteinuria, and mild facial edema. Which of the
following orders should the nurse anticipate first?
A) Initiate a continuous infusion of magnesium sulfate.
B) Administer a 500 mL bolus of lactated Ringer's solution.
C) Obtain an order for immediate emergency cesarean delivery.
D) Instruct the client to maintain strict, flat bed rest at home.
Answer: A
Rationale: The client is exhibiting signs of preeclampsia with severe features
(elevated blood pressure and significant proteinuria). Magnesium sulfate is the
priority intervention to prevent seizures (eclampsia). Fluid boluses are restricted
due to the risk of pulmonary edema, immediate delivery is not always warranted
at 34 weeks if the client can be stabilized, and home bed rest is unsafe for severe
preeclampsia.
Question 2
,Which of the following findings should a nurse report to the provider as a
potential complication during a routine 24-week prenatal visit?
A) Increased production of clear, thin vaginal discharge (leukorrhea).
B) Periodic, painless uterine contractions that resolve with rest.
C) Sudden swelling of the face, fingers, and periorbital area.
D) Hyperpigmentation of the midline of the abdomen (linea nigra).
Answer: C
Rationale: Sudden or asymmetric swelling of the face, hands, and eyes can
indicate fluid retention associated with preeclampsia and must be evaluated.
Leukorrhea, Braxton Hicks contractions, and linea nigra are normal physiologic
adaptations during the second trimester.
Question 3
A postpartum nurse is caring for a client 2 hours after a vaginal delivery. The nurse
notes the fundus is boggy and displaced to the right of the midline. Which of the
following actions should the nurse take first?
A) Administer 20 units of oxytocin intramuscularly.
B) Assist the client to the bathroom to void.
C) Perform vigorous fundal massage for 5 minutes.
D) Notify the healthcare provider immediately.
Answer: B
Rationale: A fundus that is boggy and displaced to the right indicates uterine
atony caused by a distended bladder. Assisting the client to empty their bladder
will allow the uterus to contract properly. Fundal massage should be performed,
but emptying the bladder is the root solution for displacement. Oxytocin is utilized
if atony persists after voiding.
,Question 4
A nurse is teaching a pregnant client who has a prescription for oral iron
supplements. Which of the following instructions should the nurse include to
optimize absorption?
A) Take the iron supplement with a glass of milk or yogurt.
B) Drink a glass of orange juice when taking the supplement.
C) Take the medication concurrently with an antacid tablet.
D) Consume the supplement immediately after a heavy meal.
Answer: B
Rationale: Vitamin C (found in orange juice) significantly enhances the
gastrointestinal absorption of iron. Calcium, milk products, antacids, and heavy
food meals inhibit iron absorption and should be avoided at the time of
administration.
Question 5
A newborn is 4 hours old and has a blood glucose level of 34 mg/dL. The infant is
asymptomatic but sleepy. Which of the following actions should the nurse
perform first?
A) Administer an intravenous bolus of 10% dextrose solution.
B) Offer the newborn standard formula or initiate breastfeeding.
C) Place the infant under a radiant warmer to treat hypothermia.
D) Recheck the blood glucose level in exactly 2 hours.
Answer: B
Rationale: A blood glucose level below 40 mg/dL in a newborn indicates
hypoglycemia. For an asymptomatic newborn, the initial intervention is immediate
, feeding with breast milk or formula. IV dextrose is reserved for symptomatic
hypoglycemia or when oral feeding fails to raise glucose levels.
Question 6
During a client’s active labor, the electronic fetal monitor displays a pattern of late
decelerations. Which of the following actions should the nurse execute
immediately?
A) Turn the client onto their side (lateral position).
B) Increase the intravenous oxytocin infusion rate.
C) Instruct the client to perform Valsalva pushing.
D) Prepare the client for an immediate vacuum extraction.
Answer: A
Rationale: Late decelerations indicate uteroplacental insufficiency. Repositioning
the client to a lateral side-lying position relieves pressure on the vena cava,
maximizing uterine blood flow. Oxytocin should be discontinued, not increased.
Valsalva pushing worsens hypoxia.
Question 7
A nurse is assessing a 12-hour-old newborn and notes a yellow tint to the skin on
the face and sclera. Which of the following conditions does this finding suggest?
A) Physiologic jaundice
B) Pathologic jaundice
C) Breast milk jaundice
D) Erythema toxicum
Answer: B
