NACE Care of the Childbearing Family Updated 2026 | Comprehensive
Nursing Study Guide, Practice Exam Questions and Answers, Exam Prep
Test Bank, Prenatal and Antenatal Care, Labor and Delivery Management,
Postpartum Nursing Care, Newborn Assessment and Neonatal Health,
High-Risk Obstetric Conditions, Maternal Pharmacology, Family-Centered
Maternity Care, and Detailed Rationales for Certification and Exam
Success
Question 1: A 32-year-old primigravida at 38 weeks gestation reports a sudden
onset of severe, continuous abdominal pain accompanied by vaginal bleeding. On
examination, her uterus is firm and tender to palpation, and fetal heart rate
decelerations are noted. What is the priority nursing intervention?
A. Administer a bolus of intravenous fluids and prepare for an emergency cesarean
section
B. Perform a sterile vaginal exam to assess cervical dilation
C. Administer an analgesic for pain management and monitor contractions
D. Apply an external fetal monitor and encourage the patient to ambulate
CORRECT ANSWER: A. Administer a bolus of intravenous fluids and prepare for an
emergency cesarean section
Rationale: The presentation of sudden, severe abdominal pain, uterine tenderness, and
bleeding in a third-trimester patient is classic for placental abruption. This is an
obstetric emergency requiring immediate delivery to preserve maternal and fetal well-
being. Preparing for an emergency cesarean section is the priority after initiating
intravenous access and fluid resuscitation. A vaginal exam is contraindicated with
active bleeding until placenta previa is ruled out, and ambulation is unsafe.
Question 2: A nurse is assessing a full-term newborn 5 minutes after birth. The
infant has a heart rate of 140 bpm, a strong cry, active movement of all extremities,
and a pink body with slightly cyanotic hands and feet. What is the infant's Apgar
score based on these findings?
A. 7
B. 8
C. 9
D. 10
CORRECT ANSWER: C. 9
Rationale: The Apgar score is assessed at 1 and 5 minutes, evaluating heart rate,
respiratory effort, muscle tone, reflex irritability, and color. The infant has a score of 2 for
heart rate (>100 bpm), 2 for respiratory effort (strong cry), 2 for muscle tone (active
movement), 2 for reflex irritability (strong cry), and 1 for color (pink body, cyanotic
extremities, which is acrocyanosis, a common finding). This totals a score of 9.
,Question 3: A 28-year-old G1P0 at 40 weeks gestation is in active labor. Her cervix is
6 cm dilated, 100% effaced, and the fetal station is 0. She requests an epidural for
pain relief. The nurse should first perform which action?
A. Administer a 500 mL bolus of lactated Ringer's solution
B. Have the patient sign the informed consent form for the procedure
C. Assess the fetal heart rate and maternal blood pressure
D. Assist the patient to a sitting position for the procedure
CORRECT ANSWER: A. Administer a 500 mL bolus of lactated Ringer's solution
Rationale: Before initiating epidural anesthesia, it is standard practice to administer a
fluid bolus (typically 500-1000 mL of lactated Ringer's) to help prevent hypotension, a
common side effect of sympathetic blockade. While consent, vital sign assessment,
and positioning are important, the fluid bolus is the priority nursing action to ensure
hemodynamic stability before the procedure.
Question 4: A 25-year-old woman at 10 weeks gestation is diagnosed with
hyperemesis gravidarum. Which of the following assessment findings would
indicate a severe complication requiring immediate intervention?
A. Weight loss of 5% of pre-pregnancy weight
B. Presence of ketones in the urine
C. Serum potassium level of 2.8 mEq/L
D. Nausea and vomiting that are worse in the morning
CORRECT ANSWER: C. Serum potassium level of 2.8 mEq/L
Rationale: Hyperemesis gravidarum can lead to severe electrolyte imbalances. A
serum potassium level of 2.8 mEq/L indicates severe hypokalemia, which can cause
cardiac arrhythmias and is a medical emergency requiring immediate IV replacement
and cardiac monitoring. While weight loss and ketonuria are concerning, severe
hypokalemia is the most immediately life-threatening finding.
Question 5: A newborn's parents ask the nurse why their baby's skin appears yellow
at 24 hours of life. The nurse explains that this is likely pathologic jaundice. Which
of the following is the primary underlying cause of pathologic jaundice in a
newborn?
A. Immature liver function leading to an inability to conjugate bilirubin
B. Increased breakdown of fetal hemoglobin from the short red blood cell lifespan
C. A blood group incompatibility such as Rh or ABO
D. Delayed passage of meconium
,CORRECT ANSWER: C. A blood group incompatibility such as Rh or ABO
Rationale: Pathologic jaundice occurs within the first 24 hours of life and is typically
caused by hemolytic disease, most commonly due to Rh or ABO blood group
incompatibility. This leads to rapid and excessive hemolysis, overwhelming the
immature liver's ability to process bilirubin. Physiologic jaundice, caused by immature
liver function and increased RBC breakdown, appears after 24 hours.
Question 6: A nurse is providing teaching to a 16-year-old primigravida about the
signs of preterm labor. Which of the following symptoms should the nurse instruct
the patient to report immediately to her healthcare provider?
A. Mild, irregular Braxton-Hicks contractions
B. A dull ache in the lower back
C. A feeling of pelvic pressure or heaviness
D. Increased fetal movement
CORRECT ANSWER: C. A feeling of pelvic pressure or heaviness
Rationale: Signs of preterm labor include persistent pelvic pressure, a change in
vaginal discharge, menstrual-like cramps, and low back pain. The nurse should instruct
the patient to report any of these symptoms. Braxton-Hicks contractions are typically
irregular and do not cause cervical change. Increased fetal movement is a reassuring
sign.
Question 7: A patient at 32 weeks gestation with a history of chronic hypertension
is being monitored for preeclampsia. Which laboratory finding is most indicative of
the diagnosis of preeclampsia with severe features?
A. Platelet count of 80,000/mm³
B. Serum creatinine of 1.0 mg/dL
C. Blood urea nitrogen (BUN) of 20 mg/dL
D. Hemoglobin of 11 g/dL
CORRECT ANSWER: A. Platelet count of 80,000/mm³
Rationale: Preeclampsia with severe features is diagnosed by the presence of severe
hypertension with one or more of the following: thrombocytopenia (platelet count <
100,000/mm³), elevated liver enzymes, renal insufficiency (creatinine > 1.1 mg/dL),
pulmonary edema, or cerebral/visual disturbances. A platelet count of 80,000 is
significantly below the threshold, indicating severe disease.
, Question 8: During the immediate postpartum period, a nurse assesses a patient's
fundus and finds it is displaced to the right and is boggy. The patient's vital signs
show tachycardia. What is the nurse's priority action?
A. Reassess the fundus in 15 minutes
B. Assist the patient to empty her bladder
C. Massage the fundus firmly until it is firm
D. Administer an oxytocin infusion as prescribed
CORRECT ANSWER: B. Assist the patient to empty her bladder
Rationale: A displaced and boggy uterus is a classic sign of a full bladder, which can
prevent the uterus from contracting effectively, leading to uterine atony and potential
hemorrhage. The priority is to have the patient void to relieve the pressure, which often
allows the uterus to contract and become firm. If the uterus remains boggy after
voiding, massage and medications would be the next steps.
Question 9: A nurse is caring for a post-term infant who is large for gestational age
(LGA). Which of the following complications is the infant most at risk for during the
first 24 hours of life?
A. Respiratory distress syndrome
B. Hypoglycemia
C. Necrotizing enterocolitis
D. Polycythemia
CORRECT ANSWER: B. Hypoglycemia
Rationale: Large for gestational age (LGA) infants, especially those of diabetic mothers,
are at high risk for hypoglycemia due to fetal hyperinsulinism. The sudden loss of
maternal glucose supply at birth leads to a rapid drop in neonatal blood glucose. While
LGA infants can experience other complications like birth trauma and polycythemia,
hypoglycemia is the most immediate and common metabolic complication in the first
24 hours.
Question 10: A 22-year-old G2P1 woman is at 39 weeks gestation and is in the latent
phase of labor. Her cervix is 3 cm dilated and 60% effaced. She is contracting every
5-7 minutes. Which of the following nursing interventions is most appropriate at
this time?
A. Encourage the patient to ambulate and use comfort measures
B. Prepare the patient for an amniotomy
C. Administer a dose of terbutaline to stop the contractions
D. Notify the provider to start an oxytocin infusion
Nursing Study Guide, Practice Exam Questions and Answers, Exam Prep
Test Bank, Prenatal and Antenatal Care, Labor and Delivery Management,
Postpartum Nursing Care, Newborn Assessment and Neonatal Health,
High-Risk Obstetric Conditions, Maternal Pharmacology, Family-Centered
Maternity Care, and Detailed Rationales for Certification and Exam
Success
Question 1: A 32-year-old primigravida at 38 weeks gestation reports a sudden
onset of severe, continuous abdominal pain accompanied by vaginal bleeding. On
examination, her uterus is firm and tender to palpation, and fetal heart rate
decelerations are noted. What is the priority nursing intervention?
A. Administer a bolus of intravenous fluids and prepare for an emergency cesarean
section
B. Perform a sterile vaginal exam to assess cervical dilation
C. Administer an analgesic for pain management and monitor contractions
D. Apply an external fetal monitor and encourage the patient to ambulate
CORRECT ANSWER: A. Administer a bolus of intravenous fluids and prepare for an
emergency cesarean section
Rationale: The presentation of sudden, severe abdominal pain, uterine tenderness, and
bleeding in a third-trimester patient is classic for placental abruption. This is an
obstetric emergency requiring immediate delivery to preserve maternal and fetal well-
being. Preparing for an emergency cesarean section is the priority after initiating
intravenous access and fluid resuscitation. A vaginal exam is contraindicated with
active bleeding until placenta previa is ruled out, and ambulation is unsafe.
Question 2: A nurse is assessing a full-term newborn 5 minutes after birth. The
infant has a heart rate of 140 bpm, a strong cry, active movement of all extremities,
and a pink body with slightly cyanotic hands and feet. What is the infant's Apgar
score based on these findings?
A. 7
B. 8
C. 9
D. 10
CORRECT ANSWER: C. 9
Rationale: The Apgar score is assessed at 1 and 5 minutes, evaluating heart rate,
respiratory effort, muscle tone, reflex irritability, and color. The infant has a score of 2 for
heart rate (>100 bpm), 2 for respiratory effort (strong cry), 2 for muscle tone (active
movement), 2 for reflex irritability (strong cry), and 1 for color (pink body, cyanotic
extremities, which is acrocyanosis, a common finding). This totals a score of 9.
,Question 3: A 28-year-old G1P0 at 40 weeks gestation is in active labor. Her cervix is
6 cm dilated, 100% effaced, and the fetal station is 0. She requests an epidural for
pain relief. The nurse should first perform which action?
A. Administer a 500 mL bolus of lactated Ringer's solution
B. Have the patient sign the informed consent form for the procedure
C. Assess the fetal heart rate and maternal blood pressure
D. Assist the patient to a sitting position for the procedure
CORRECT ANSWER: A. Administer a 500 mL bolus of lactated Ringer's solution
Rationale: Before initiating epidural anesthesia, it is standard practice to administer a
fluid bolus (typically 500-1000 mL of lactated Ringer's) to help prevent hypotension, a
common side effect of sympathetic blockade. While consent, vital sign assessment,
and positioning are important, the fluid bolus is the priority nursing action to ensure
hemodynamic stability before the procedure.
Question 4: A 25-year-old woman at 10 weeks gestation is diagnosed with
hyperemesis gravidarum. Which of the following assessment findings would
indicate a severe complication requiring immediate intervention?
A. Weight loss of 5% of pre-pregnancy weight
B. Presence of ketones in the urine
C. Serum potassium level of 2.8 mEq/L
D. Nausea and vomiting that are worse in the morning
CORRECT ANSWER: C. Serum potassium level of 2.8 mEq/L
Rationale: Hyperemesis gravidarum can lead to severe electrolyte imbalances. A
serum potassium level of 2.8 mEq/L indicates severe hypokalemia, which can cause
cardiac arrhythmias and is a medical emergency requiring immediate IV replacement
and cardiac monitoring. While weight loss and ketonuria are concerning, severe
hypokalemia is the most immediately life-threatening finding.
Question 5: A newborn's parents ask the nurse why their baby's skin appears yellow
at 24 hours of life. The nurse explains that this is likely pathologic jaundice. Which
of the following is the primary underlying cause of pathologic jaundice in a
newborn?
A. Immature liver function leading to an inability to conjugate bilirubin
B. Increased breakdown of fetal hemoglobin from the short red blood cell lifespan
C. A blood group incompatibility such as Rh or ABO
D. Delayed passage of meconium
,CORRECT ANSWER: C. A blood group incompatibility such as Rh or ABO
Rationale: Pathologic jaundice occurs within the first 24 hours of life and is typically
caused by hemolytic disease, most commonly due to Rh or ABO blood group
incompatibility. This leads to rapid and excessive hemolysis, overwhelming the
immature liver's ability to process bilirubin. Physiologic jaundice, caused by immature
liver function and increased RBC breakdown, appears after 24 hours.
Question 6: A nurse is providing teaching to a 16-year-old primigravida about the
signs of preterm labor. Which of the following symptoms should the nurse instruct
the patient to report immediately to her healthcare provider?
A. Mild, irregular Braxton-Hicks contractions
B. A dull ache in the lower back
C. A feeling of pelvic pressure or heaviness
D. Increased fetal movement
CORRECT ANSWER: C. A feeling of pelvic pressure or heaviness
Rationale: Signs of preterm labor include persistent pelvic pressure, a change in
vaginal discharge, menstrual-like cramps, and low back pain. The nurse should instruct
the patient to report any of these symptoms. Braxton-Hicks contractions are typically
irregular and do not cause cervical change. Increased fetal movement is a reassuring
sign.
Question 7: A patient at 32 weeks gestation with a history of chronic hypertension
is being monitored for preeclampsia. Which laboratory finding is most indicative of
the diagnosis of preeclampsia with severe features?
A. Platelet count of 80,000/mm³
B. Serum creatinine of 1.0 mg/dL
C. Blood urea nitrogen (BUN) of 20 mg/dL
D. Hemoglobin of 11 g/dL
CORRECT ANSWER: A. Platelet count of 80,000/mm³
Rationale: Preeclampsia with severe features is diagnosed by the presence of severe
hypertension with one or more of the following: thrombocytopenia (platelet count <
100,000/mm³), elevated liver enzymes, renal insufficiency (creatinine > 1.1 mg/dL),
pulmonary edema, or cerebral/visual disturbances. A platelet count of 80,000 is
significantly below the threshold, indicating severe disease.
, Question 8: During the immediate postpartum period, a nurse assesses a patient's
fundus and finds it is displaced to the right and is boggy. The patient's vital signs
show tachycardia. What is the nurse's priority action?
A. Reassess the fundus in 15 minutes
B. Assist the patient to empty her bladder
C. Massage the fundus firmly until it is firm
D. Administer an oxytocin infusion as prescribed
CORRECT ANSWER: B. Assist the patient to empty her bladder
Rationale: A displaced and boggy uterus is a classic sign of a full bladder, which can
prevent the uterus from contracting effectively, leading to uterine atony and potential
hemorrhage. The priority is to have the patient void to relieve the pressure, which often
allows the uterus to contract and become firm. If the uterus remains boggy after
voiding, massage and medications would be the next steps.
Question 9: A nurse is caring for a post-term infant who is large for gestational age
(LGA). Which of the following complications is the infant most at risk for during the
first 24 hours of life?
A. Respiratory distress syndrome
B. Hypoglycemia
C. Necrotizing enterocolitis
D. Polycythemia
CORRECT ANSWER: B. Hypoglycemia
Rationale: Large for gestational age (LGA) infants, especially those of diabetic mothers,
are at high risk for hypoglycemia due to fetal hyperinsulinism. The sudden loss of
maternal glucose supply at birth leads to a rapid drop in neonatal blood glucose. While
LGA infants can experience other complications like birth trauma and polycythemia,
hypoglycemia is the most immediate and common metabolic complication in the first
24 hours.
Question 10: A 22-year-old G2P1 woman is at 39 weeks gestation and is in the latent
phase of labor. Her cervix is 3 cm dilated and 60% effaced. She is contracting every
5-7 minutes. Which of the following nursing interventions is most appropriate at
this time?
A. Encourage the patient to ambulate and use comfort measures
B. Prepare the patient for an amniotomy
C. Administer a dose of terbutaline to stop the contractions
D. Notify the provider to start an oxytocin infusion
