NACE Care of the Childbearing Family Exam
2026 Practice Questions & Answers PDF |
Maternal-Newborn Nursing Study Guide
with Verified Solutions & Rationales
• This 200-question practice exam covers the full scope of the NACE Care of the
Childbearing Family certification, offering verified answers with detailed EXPERT
RATIONALE to reinforce clinical reasoning and test readiness.
• Each question mirrors the format and difficulty of the actual exam, making this an
ideal self-assessment tool — work through questions independently before
checking the correct answer and EXPERT RATIONALE below each item.
Question 1: A primigravida at 10 weeks gestation reports nausea and
vomiting every morning. Which nursing intervention is most appropriate?
A. Encourage three large meals per day to maintain caloric intake
B. Administer antiemetics immediately without further assessment
C. Recommend complete bed rest for the remainder of the first trimester
D. Suggest IV fluid replacement as the first-line intervention
E. Advise the client to eat small, frequent meals and avoid fatty or spicy foods
E. Advise the client to eat small, frequent meals and avoid fatty or spicy
foods
EXPERT RATIONALE: Nausea and vomiting in early pregnancy (morning sickness) is
common and managed conservatively first. Small, frequent meals prevent an
empty stomach, which worsens nausea. Fatty and spicy foods delay gastric
emptying and exacerbate symptoms. Large meals increase gastric distension and
nausea. Antiemetics and IV fluids are reserved for hyperemesis gravidarum.
Question 2: A nurse is caring for a client at 38 weeks gestation who reports
decreased fetal movement. Which action should the nurse take first?
A. Schedule an amniocentesis for the following morning
,B. Perform a nonstress test (NST)
C. Prepare the client for immediate cesarean delivery
D. Reassure the client that decreased movement is normal at term
E. Administer oxygen via face mask
B. Perform a nonstress test (NST)
EXPERT RATIONALE: Decreased fetal movement warrants immediate evaluation of
fetal well-being. The NST is the first-line, non-invasive assessment tool that
evaluates fetal heart rate accelerations in response to movement. Reassurance
without assessment is inappropriate. Amniocentesis is not indicated as a first
response. Cesarean delivery requires confirmed fetal compromise.
Question 3: Which finding on a prenatal visit at 28 weeks is most concerning
and requires immediate follow-up?
A. Blood pressure of 118/74 mmHg
B. Weight gain of 1 pound per week
C. Blood pressure of 158/104 mmHg with +2 proteinuria
D. Mild ankle edema at the end of the day
E. Fundal height measuring 29 cm
C. Blood pressure of 158/104 mmHg with +2 proteinuria
EXPERT RATIONALE: A blood pressure ≥140/90 mmHg with proteinuria after 20
weeks gestation meets the diagnostic criteria for preeclampsia, which carries risks
of maternal seizure, stroke, placental abruption, and fetal compromise. Immediate
intervention is required. Mild edema, fundal height of 29 cm at 28 weeks, and
moderate weight gain are within normal parameters.
,Question 4: A nurse is teaching a pregnant client about the purpose of the
alpha-fetoprotein (AFP) screening test. Which statement by the client
indicates correct understanding?
A. "This test will tell me exactly if my baby has Down syndrome."
B. "This test checks my blood sugar levels during pregnancy."
C. "This test screens for neural tube defects and chromosomal abnormalities."
D. "This test is only done if I am over 35 years old."
E. "This test replaces the need for an ultrasound."
C. "This test screens for neural tube defects and chromosomal
abnormalities."
EXPERT RATIONALE: AFP is a maternal serum screening test that identifies
elevated or decreased levels associated with neural tube defects (spina bifida,
anencephaly) and chromosomal abnormalities (Down syndrome, trisomy 18). It is a
screening, not diagnostic, tool. It is offered to all pregnant clients regardless of age
and does not replace ultrasound.
Question 5: A client at 32 weeks gestation presents with painless, bright red
vaginal bleeding. Which condition does the nurse suspect?
A. Placental abruption
B. Preterm labor
C. Placenta previa
D. Vasa previa rupture
E. Cervical polyp
C. Placenta previa
EXPERT RATIONALE: Painless, bright red vaginal bleeding in the second or third
trimester is the hallmark presentation of placenta previa, where the placenta
covers part or all of the cervical os. Placental abruption typically presents with
, painful, dark bleeding. Preterm labor involves contractions. The painless and
sudden nature of bright red bleeding in late pregnancy most strongly points to
placenta previa.
Question 6: When assessing a postpartum client 2 hours after vaginal
delivery, the nurse finds the uterus boggy and displaced to the right. Which
intervention is the priority?
A. Administer oxytocin immediately
B. Assist the client to empty her bladder
C. Massage the fundus vigorously
D. Notify the physician of uterine atony
E. Prepare for blood transfusion
B. Assist the client to empty her bladder
EXPERT RATIONALE: A boggy uterus displaced to the right is a classic sign of a full
bladder. A distended bladder prevents uterine contraction and can cause
postpartum hemorrhage. The priority intervention is bladder emptying, which often
resolves the displacement and allows the uterus to contract. If the uterus remains
boggy after bladder emptying, fundal massage and oxytocin are indicated.
Question 7: A laboring client at 6 cm dilation requests an epidural. The nurse
notes the fetal heart rate baseline is 140 bpm with accelerations. Which
action is most appropriate?
A. Deny the request as it is too early in labor
B. Inform the client the baby's heart rate is too fast for an epidural
C. Facilitate the epidural request and continue monitoring
D. Administer IV morphine instead
E. Prepare for immediate delivery
2026 Practice Questions & Answers PDF |
Maternal-Newborn Nursing Study Guide
with Verified Solutions & Rationales
• This 200-question practice exam covers the full scope of the NACE Care of the
Childbearing Family certification, offering verified answers with detailed EXPERT
RATIONALE to reinforce clinical reasoning and test readiness.
• Each question mirrors the format and difficulty of the actual exam, making this an
ideal self-assessment tool — work through questions independently before
checking the correct answer and EXPERT RATIONALE below each item.
Question 1: A primigravida at 10 weeks gestation reports nausea and
vomiting every morning. Which nursing intervention is most appropriate?
A. Encourage three large meals per day to maintain caloric intake
B. Administer antiemetics immediately without further assessment
C. Recommend complete bed rest for the remainder of the first trimester
D. Suggest IV fluid replacement as the first-line intervention
E. Advise the client to eat small, frequent meals and avoid fatty or spicy foods
E. Advise the client to eat small, frequent meals and avoid fatty or spicy
foods
EXPERT RATIONALE: Nausea and vomiting in early pregnancy (morning sickness) is
common and managed conservatively first. Small, frequent meals prevent an
empty stomach, which worsens nausea. Fatty and spicy foods delay gastric
emptying and exacerbate symptoms. Large meals increase gastric distension and
nausea. Antiemetics and IV fluids are reserved for hyperemesis gravidarum.
Question 2: A nurse is caring for a client at 38 weeks gestation who reports
decreased fetal movement. Which action should the nurse take first?
A. Schedule an amniocentesis for the following morning
,B. Perform a nonstress test (NST)
C. Prepare the client for immediate cesarean delivery
D. Reassure the client that decreased movement is normal at term
E. Administer oxygen via face mask
B. Perform a nonstress test (NST)
EXPERT RATIONALE: Decreased fetal movement warrants immediate evaluation of
fetal well-being. The NST is the first-line, non-invasive assessment tool that
evaluates fetal heart rate accelerations in response to movement. Reassurance
without assessment is inappropriate. Amniocentesis is not indicated as a first
response. Cesarean delivery requires confirmed fetal compromise.
Question 3: Which finding on a prenatal visit at 28 weeks is most concerning
and requires immediate follow-up?
A. Blood pressure of 118/74 mmHg
B. Weight gain of 1 pound per week
C. Blood pressure of 158/104 mmHg with +2 proteinuria
D. Mild ankle edema at the end of the day
E. Fundal height measuring 29 cm
C. Blood pressure of 158/104 mmHg with +2 proteinuria
EXPERT RATIONALE: A blood pressure ≥140/90 mmHg with proteinuria after 20
weeks gestation meets the diagnostic criteria for preeclampsia, which carries risks
of maternal seizure, stroke, placental abruption, and fetal compromise. Immediate
intervention is required. Mild edema, fundal height of 29 cm at 28 weeks, and
moderate weight gain are within normal parameters.
,Question 4: A nurse is teaching a pregnant client about the purpose of the
alpha-fetoprotein (AFP) screening test. Which statement by the client
indicates correct understanding?
A. "This test will tell me exactly if my baby has Down syndrome."
B. "This test checks my blood sugar levels during pregnancy."
C. "This test screens for neural tube defects and chromosomal abnormalities."
D. "This test is only done if I am over 35 years old."
E. "This test replaces the need for an ultrasound."
C. "This test screens for neural tube defects and chromosomal
abnormalities."
EXPERT RATIONALE: AFP is a maternal serum screening test that identifies
elevated or decreased levels associated with neural tube defects (spina bifida,
anencephaly) and chromosomal abnormalities (Down syndrome, trisomy 18). It is a
screening, not diagnostic, tool. It is offered to all pregnant clients regardless of age
and does not replace ultrasound.
Question 5: A client at 32 weeks gestation presents with painless, bright red
vaginal bleeding. Which condition does the nurse suspect?
A. Placental abruption
B. Preterm labor
C. Placenta previa
D. Vasa previa rupture
E. Cervical polyp
C. Placenta previa
EXPERT RATIONALE: Painless, bright red vaginal bleeding in the second or third
trimester is the hallmark presentation of placenta previa, where the placenta
covers part or all of the cervical os. Placental abruption typically presents with
, painful, dark bleeding. Preterm labor involves contractions. The painless and
sudden nature of bright red bleeding in late pregnancy most strongly points to
placenta previa.
Question 6: When assessing a postpartum client 2 hours after vaginal
delivery, the nurse finds the uterus boggy and displaced to the right. Which
intervention is the priority?
A. Administer oxytocin immediately
B. Assist the client to empty her bladder
C. Massage the fundus vigorously
D. Notify the physician of uterine atony
E. Prepare for blood transfusion
B. Assist the client to empty her bladder
EXPERT RATIONALE: A boggy uterus displaced to the right is a classic sign of a full
bladder. A distended bladder prevents uterine contraction and can cause
postpartum hemorrhage. The priority intervention is bladder emptying, which often
resolves the displacement and allows the uterus to contract. If the uterus remains
boggy after bladder emptying, fundal massage and oxytocin are indicated.
Question 7: A laboring client at 6 cm dilation requests an epidural. The nurse
notes the fetal heart rate baseline is 140 bpm with accelerations. Which
action is most appropriate?
A. Deny the request as it is too early in labor
B. Inform the client the baby's heart rate is too fast for an epidural
C. Facilitate the epidural request and continue monitoring
D. Administer IV morphine instead
E. Prepare for immediate delivery
