NACE CARE OF THE CHILDBEARING FAMILY EXAM
COMPREHENSIVE STUDY GUIDE WITH PRACTICE
QUESTIONS, ANSWERS, AND DETAILED RATIONALES
1. A 32-year-old G2P1 at 38 weeks gestation presents with sudden-onset, severe
epigastric pain, nausea, and a blood pressure of 160/110 mmHg. Her deep
tendon reflexes are 3+ with clonus. Which medication should the nurse
administer first?
A) Labetalol 20 mg IV push
B) Magnesium sulfate 6 g IV bolus over 15-20 minutes
C) Hydralazine 10 mg IV push
D) Nifedipine 10 mg orally
Explanation: The patient is showing signs of severe preeclampsia with possible
eclampsia (epigastric pain, hypertension, hyperreflexia). Magnesium sulfate is the
first-line medication for seizure prophylaxis. Antihypertensives (labetalol,
hydralazine) are used to lower BP but do not prevent seizures.
2. A nurse is assessing a newborn at 1 hour of life. The heart rate is 140 bpm,
respiratory rate 70 breaths/min with nasal flaring and grunting, and oxygen
saturation 88% on room air. What is the priority nursing action?
A) Continue monitoring closely every 15 minutes
B) Place the newborn in a prone position
C) Administer supplemental oxygen and notify the provider
D) Offer a feeding of 10 mL formula
Explanation: A respiratory rate of 70 with nasal flaring, grunting, and O2
saturation of 88% indicates respiratory distress. Grunting is a sign of impending
respiratory failure. The priority is to improve oxygenation and notify the provider
,for further evaluation (e.g., sepsis, transient tachypnea of the newborn, or
respiratory distress syndrome).
3. A client at 34 weeks gestation reports painless, bright red vaginal bleeding.
The abdomen is soft and non-tender, and fetal heart rate is 150 bpm with
moderate variability. What is the most appropriate immediate nursing action?
A) Perform a digital cervical exam to assess dilation
B) Initiate continuous fetal monitoring and prepare for ultrasound
C) Administer oxytocin to augment labor
D) Apply an external fetal scalp electrode
Explanation: Painless bright red bleeding at 34 weeks is placenta previa until
proven otherwise. Digital cervical examination is contraindicated because it can
cause catastrophic hemorrhage. The priority is to monitor the fetus, avoid vaginal
exam, and obtain an ultrasound to confirm placental location.
4. A postpartum client reports a sudden "gush of blood" and a feeling of
"something coming out" while lying in bed. On assessment, the nurse finds the
uterus firmly contracted at the umbilicus, but there is approximately 300 mL of
blood in the perineal pad. What is the most likely cause?
A) Uterine atony
B) Vaginal or cervical laceration
C) Retained placental fragments
D) Coagulopathy
Explanation: Uterine atony presents with a boggy uterus. Here, the uterus is
firmly contracted, so atony is unlikely. A sudden gush of blood with a firm uterus
suggests a lower genital tract laceration (cervix or vagina). Retained fragments
usually cause subinvolution and intermittent bleeding; coagulopathy is less likely
without other signs.
,5. A nurse is administering betamethasone to a client at 28 weeks gestation with
preterm premature rupture of membranes (PPROM). What is the primary
purpose of this medication?
A) Prevent intrauterine infection
B) Stop uterine contractions
C) Accelerate fetal lung maturity and reduce neonatal respiratory distress
syndrome
D) Suppress the maternal immune response
Explanation: Betamethasone is a corticosteroid that crosses the placenta and
promotes surfactant production in the fetal lungs, reducing the incidence and
severity of respiratory distress syndrome, intraventricular hemorrhage, and
neonatal death when given before preterm birth.
6. A primigravida at 40 weeks gestation is receiving oxytocin for induction of
labor. The contraction pattern is every 2 minutes, duration 100 seconds, with an
intensity of 90 mmHg by intrauterine pressure catheter. The fetal heart rate
shows late decelerations to 80 bpm. What is the nurse's immediate action?
A) Decrease the oxytocin infusion rate and reposition the mother
B) Stop the oxytocin infusion, reposition the mother left lateral, and apply
oxygen
C) Increase the oxytocin to improve contractions
D) Prepare for an amnioinfusion
Explanation: Tachysystole (contractions lasting >90 seconds) with late
decelerations indicates uteroplacental insufficiency. The immediate priority is to
stop oxytocin (the cause of hyperstimulation), place the mother in left lateral
position, and administer oxygen to improve placental perfusion.
7. A newborn's Apgar scores are 5 at 1 minute and 7 at 5 minutes. The nurse
notes central cyanosis, a heart rate of 110 bpm, and poor tone. What is the
priority intervention at 5 minutes?
A) Begin chest compressions
, B) Administer epinephrine via endotracheal tube
C) Provide positive pressure ventilation (PPV) with 21-30% oxygen
D) Intubate and suction meconium
Explanation: Apgar of 7 at 5 minutes with central cyanosis and heart rate >100
bpm indicates the newborn is not severely depressed but needs respiratory
support. PPV is indicated for apnea, gasping, or HR <100 bpm. HR is 110, so
compressions and epinephrine are not yet needed.
8. A G3P2 client at 39 weeks has an amniotic fluid index (AFI) of 4 cm on
ultrasound. What is the most appropriate nursing action?
A) Encourage oral hydration and repeat ultrasound in 24 hours
B) Prepare for induction of labor due to oligohydramnios
C) Administer a fluid bolus of normal saline
D) Discharge home with follow-up in 1 week
Explanation: AFI <5 cm defines oligohydramnios, which is associated with
umbilical cord compression, variable decelerations, and increased risk of cesarean.
At term, oligohydramnios is an indication for induction of labor to reduce perinatal
morbidity.
9. A nurse is caring for a patient with an epidural infusion. The patient's blood
pressure drops from 120/80 to 90/50 mmHg. What is the priority action?
A) Increase the epidural infusion rate
B) Place the patient in Trendelenburg position
C) Administer a 500-1000 mL IV fluid bolus and position the patient lateral
D) Notify the anesthesiologist immediately
Explanation: Epidural-induced hypotension from sympathetic blockade is
common. The first-line treatment is an IV fluid bolus (crystalloid) and turning the
patient to lateral position to improve venous return. Trendelenburg is not
recommended. Notifying anesthesia is important but not the first step.
COMPREHENSIVE STUDY GUIDE WITH PRACTICE
QUESTIONS, ANSWERS, AND DETAILED RATIONALES
1. A 32-year-old G2P1 at 38 weeks gestation presents with sudden-onset, severe
epigastric pain, nausea, and a blood pressure of 160/110 mmHg. Her deep
tendon reflexes are 3+ with clonus. Which medication should the nurse
administer first?
A) Labetalol 20 mg IV push
B) Magnesium sulfate 6 g IV bolus over 15-20 minutes
C) Hydralazine 10 mg IV push
D) Nifedipine 10 mg orally
Explanation: The patient is showing signs of severe preeclampsia with possible
eclampsia (epigastric pain, hypertension, hyperreflexia). Magnesium sulfate is the
first-line medication for seizure prophylaxis. Antihypertensives (labetalol,
hydralazine) are used to lower BP but do not prevent seizures.
2. A nurse is assessing a newborn at 1 hour of life. The heart rate is 140 bpm,
respiratory rate 70 breaths/min with nasal flaring and grunting, and oxygen
saturation 88% on room air. What is the priority nursing action?
A) Continue monitoring closely every 15 minutes
B) Place the newborn in a prone position
C) Administer supplemental oxygen and notify the provider
D) Offer a feeding of 10 mL formula
Explanation: A respiratory rate of 70 with nasal flaring, grunting, and O2
saturation of 88% indicates respiratory distress. Grunting is a sign of impending
respiratory failure. The priority is to improve oxygenation and notify the provider
,for further evaluation (e.g., sepsis, transient tachypnea of the newborn, or
respiratory distress syndrome).
3. A client at 34 weeks gestation reports painless, bright red vaginal bleeding.
The abdomen is soft and non-tender, and fetal heart rate is 150 bpm with
moderate variability. What is the most appropriate immediate nursing action?
A) Perform a digital cervical exam to assess dilation
B) Initiate continuous fetal monitoring and prepare for ultrasound
C) Administer oxytocin to augment labor
D) Apply an external fetal scalp electrode
Explanation: Painless bright red bleeding at 34 weeks is placenta previa until
proven otherwise. Digital cervical examination is contraindicated because it can
cause catastrophic hemorrhage. The priority is to monitor the fetus, avoid vaginal
exam, and obtain an ultrasound to confirm placental location.
4. A postpartum client reports a sudden "gush of blood" and a feeling of
"something coming out" while lying in bed. On assessment, the nurse finds the
uterus firmly contracted at the umbilicus, but there is approximately 300 mL of
blood in the perineal pad. What is the most likely cause?
A) Uterine atony
B) Vaginal or cervical laceration
C) Retained placental fragments
D) Coagulopathy
Explanation: Uterine atony presents with a boggy uterus. Here, the uterus is
firmly contracted, so atony is unlikely. A sudden gush of blood with a firm uterus
suggests a lower genital tract laceration (cervix or vagina). Retained fragments
usually cause subinvolution and intermittent bleeding; coagulopathy is less likely
without other signs.
,5. A nurse is administering betamethasone to a client at 28 weeks gestation with
preterm premature rupture of membranes (PPROM). What is the primary
purpose of this medication?
A) Prevent intrauterine infection
B) Stop uterine contractions
C) Accelerate fetal lung maturity and reduce neonatal respiratory distress
syndrome
D) Suppress the maternal immune response
Explanation: Betamethasone is a corticosteroid that crosses the placenta and
promotes surfactant production in the fetal lungs, reducing the incidence and
severity of respiratory distress syndrome, intraventricular hemorrhage, and
neonatal death when given before preterm birth.
6. A primigravida at 40 weeks gestation is receiving oxytocin for induction of
labor. The contraction pattern is every 2 minutes, duration 100 seconds, with an
intensity of 90 mmHg by intrauterine pressure catheter. The fetal heart rate
shows late decelerations to 80 bpm. What is the nurse's immediate action?
A) Decrease the oxytocin infusion rate and reposition the mother
B) Stop the oxytocin infusion, reposition the mother left lateral, and apply
oxygen
C) Increase the oxytocin to improve contractions
D) Prepare for an amnioinfusion
Explanation: Tachysystole (contractions lasting >90 seconds) with late
decelerations indicates uteroplacental insufficiency. The immediate priority is to
stop oxytocin (the cause of hyperstimulation), place the mother in left lateral
position, and administer oxygen to improve placental perfusion.
7. A newborn's Apgar scores are 5 at 1 minute and 7 at 5 minutes. The nurse
notes central cyanosis, a heart rate of 110 bpm, and poor tone. What is the
priority intervention at 5 minutes?
A) Begin chest compressions
, B) Administer epinephrine via endotracheal tube
C) Provide positive pressure ventilation (PPV) with 21-30% oxygen
D) Intubate and suction meconium
Explanation: Apgar of 7 at 5 minutes with central cyanosis and heart rate >100
bpm indicates the newborn is not severely depressed but needs respiratory
support. PPV is indicated for apnea, gasping, or HR <100 bpm. HR is 110, so
compressions and epinephrine are not yet needed.
8. A G3P2 client at 39 weeks has an amniotic fluid index (AFI) of 4 cm on
ultrasound. What is the most appropriate nursing action?
A) Encourage oral hydration and repeat ultrasound in 24 hours
B) Prepare for induction of labor due to oligohydramnios
C) Administer a fluid bolus of normal saline
D) Discharge home with follow-up in 1 week
Explanation: AFI <5 cm defines oligohydramnios, which is associated with
umbilical cord compression, variable decelerations, and increased risk of cesarean.
At term, oligohydramnios is an indication for induction of labor to reduce perinatal
morbidity.
9. A nurse is caring for a patient with an epidural infusion. The patient's blood
pressure drops from 120/80 to 90/50 mmHg. What is the priority action?
A) Increase the epidural infusion rate
B) Place the patient in Trendelenburg position
C) Administer a 500-1000 mL IV fluid bolus and position the patient lateral
D) Notify the anesthesiologist immediately
Explanation: Epidural-induced hypotension from sympathetic blockade is
common. The first-line treatment is an IV fluid bolus (crystalloid) and turning the
patient to lateral position to improve venous return. Trendelenburg is not
recommended. Notifying anesthesia is important but not the first step.
