Jefferson State NUR 114 Exam 1 NCLEX Style –
(2026/2027) Actual Questions, Verified Answers with
Rationales | Guarantee Pass
1. Placental Function
Question: Which purposes of placental functioning would the nurse plan to
include in a prenatal class? (Select all that apply)
1. It cushions and protects the baby.
2. It maintains the temperature of the baby.
3. It is the way the baby gets food and oxygen.
4. It prevents all antibodies and viruses from passing to the baby.
5. It provides an exchange of nutrients and waste products between the
birthing parent and developing fetus.
Correct Answer: 3, 5
Rationale: The primary function of the placenta is to facilitate the exchange of
oxygen, nutrients, and waste products between the mother and the fetus. It does
not cushion the baby or maintain its temperature; those are functions of the
amniotic fluid. The placenta is not a perfect barrier; many substances, including
some antibodies, medications, and viruses, can cross it.
Test-Taking Strategy: Focus on the purpose of the placenta. Remember that the
placenta provides oxygen and nutrients, while amniotic fluid provides cushioning
and protection.
2. Nonstress Test and Contraction Stress Test Interpretation
Question: A nonstress test is performed on a client who is pregnant, and the
results indicate nonreactive findings. The primary health care provider prescribes
a contraction stress test, and the results are documented as negative. How would
the nurse document this finding?
, 1. A normal test result
2. An abnormal test result
3. A high risk for fetal demise
4. The need for a cesarean section
Correct Answer: 1. A normal test result
Rationale: A "negative" contraction stress test is a normal finding. It indicates that
no late decelerations of the fetal heart rate occurred during the stress of uterine
contractions, suggesting the fetus is likely well-oxygenated and can tolerate
labor.
Test-Taking Strategy: Note that options 2, 3, and 4 are comparable or alike,
indicating an abnormal test result. This helps you identify the correct option,
which is the one describing a normal test.
3. Rubella Vaccine Postpartum
Question: A rubella titer result of a 1-day postpartum client is less than 1:8, and a
rubella virus vaccine is prescribed to be administered before discharge. The nurse
provides which information to the client about the vaccine? (Select all that apply)
1. The vaccine is administered by the subcutaneous route.
2. Breast/chest-feeding needs to be stopped for 3 months.
3. Pregnancy needs to be avoided for 1 to 3 months.
4. The client should be told that a local reaction at the injection site is
common.
5. The client should be asked if she has an allergy to eggs.
Correct Answer: 1, 3, 4
Rationale:
• 1. The vaccine is administered by the subcutaneous route: The rubella
vaccine is a live-attenuated virus vaccine given subcutaneously.
, • 3. Pregnancy needs to be avoided for 1 to 3 months: Because it is a live
virus vaccine, pregnancy must be avoided to prevent potential harm to the
fetus.
• 4. The client should be told that a local reaction at the injection site is
common: Local reactions like soreness or redness are common side
effects.
Test-Taking Strategy: Recall that the rubella vaccine is a live-virus vaccine, which
is why pregnancy must be avoided. Breastfeeding does not need to be stopped.
The vaccine is not made from eggs, so that is a distractor.
4. Fundal Height Measurement
Question: The nurse is performing an assessment of a pregnant client who is at 28
weeks of gestation. The nurse measures the fundal height in centimeters and
notes that the fundal height is 30 cm. How would the nurse interpret this finding?
1. The client is measuring large for gestational age.
2. The client is measuring small for gestational age.
3. The client is measuring normal for gestational age.
4. More evidence is needed to determine size for gestational age.
Correct Answer: 3. The client is measuring normal for gestational age.
Rationale: A common guideline is that fundal height in centimeters corresponds
to the fetus's age in weeks, plus or minus 2 cm. For a 28-week gestation, a fundal
height of 30 cm falls within this expected range.
Test-Taking Strategy: Remember that during the second and third trimesters
(weeks 18 to 30), the fundal height in centimeters approximately equals the
fetus's age in weeks ± 2 cm.
5. Probable Signs of Pregnancy
, Question: The nurse is performing an assessment on a client who suspects being
pregnant and is checking the client for probable signs of pregnancy. The nurse
would assess for which probable signs of pregnancy? (Select all that apply)
1. Ballottement
2. Chadwick's sign
3. Uterine enlargement
4. Positive pregnancy test
5. Fetal heart rate detected by a non-electronic device
6. Outline of fetus via radiography or ultrasonography
Correct Answer: 1, 2, 3, 4
Rationale: Probable signs of pregnancy are those that strongly suggest pregnancy
but are not definitive. These include uterine enlargement, Hegar's sign, Goodell's
sign, Chadwick's sign, ballottement, Braxton Hicks contractions, and a positive
pregnancy test. Positive signs of pregnancy definitively confirm a fetus, such as
fetal heart rate detection (especially by non-electronic device at 20 weeks) or an
outline of the fetus via ultrasound.
Test-Taking Strategy: Focus on the subject: probable signs vs. positive signs.
Remember that detection of the fetal heart rate and an outline of the fetus via
radiography or ultrasonography are positive signs.
6. Braxton Hicks Contractions
Question: A pregnant client is seen for a regular prenatal visit and tells the nurse
about experiencing irregular contractions. The nurse determines that the client is
experiencing Braxton Hicks contractions. On the basis of this finding, which
nursing action is appropriate?
1. Contact the primary health care provider.
2. Instruct the client to maintain bed rest for the remainder of the pregnancy.
(2026/2027) Actual Questions, Verified Answers with
Rationales | Guarantee Pass
1. Placental Function
Question: Which purposes of placental functioning would the nurse plan to
include in a prenatal class? (Select all that apply)
1. It cushions and protects the baby.
2. It maintains the temperature of the baby.
3. It is the way the baby gets food and oxygen.
4. It prevents all antibodies and viruses from passing to the baby.
5. It provides an exchange of nutrients and waste products between the
birthing parent and developing fetus.
Correct Answer: 3, 5
Rationale: The primary function of the placenta is to facilitate the exchange of
oxygen, nutrients, and waste products between the mother and the fetus. It does
not cushion the baby or maintain its temperature; those are functions of the
amniotic fluid. The placenta is not a perfect barrier; many substances, including
some antibodies, medications, and viruses, can cross it.
Test-Taking Strategy: Focus on the purpose of the placenta. Remember that the
placenta provides oxygen and nutrients, while amniotic fluid provides cushioning
and protection.
2. Nonstress Test and Contraction Stress Test Interpretation
Question: A nonstress test is performed on a client who is pregnant, and the
results indicate nonreactive findings. The primary health care provider prescribes
a contraction stress test, and the results are documented as negative. How would
the nurse document this finding?
, 1. A normal test result
2. An abnormal test result
3. A high risk for fetal demise
4. The need for a cesarean section
Correct Answer: 1. A normal test result
Rationale: A "negative" contraction stress test is a normal finding. It indicates that
no late decelerations of the fetal heart rate occurred during the stress of uterine
contractions, suggesting the fetus is likely well-oxygenated and can tolerate
labor.
Test-Taking Strategy: Note that options 2, 3, and 4 are comparable or alike,
indicating an abnormal test result. This helps you identify the correct option,
which is the one describing a normal test.
3. Rubella Vaccine Postpartum
Question: A rubella titer result of a 1-day postpartum client is less than 1:8, and a
rubella virus vaccine is prescribed to be administered before discharge. The nurse
provides which information to the client about the vaccine? (Select all that apply)
1. The vaccine is administered by the subcutaneous route.
2. Breast/chest-feeding needs to be stopped for 3 months.
3. Pregnancy needs to be avoided for 1 to 3 months.
4. The client should be told that a local reaction at the injection site is
common.
5. The client should be asked if she has an allergy to eggs.
Correct Answer: 1, 3, 4
Rationale:
• 1. The vaccine is administered by the subcutaneous route: The rubella
vaccine is a live-attenuated virus vaccine given subcutaneously.
, • 3. Pregnancy needs to be avoided for 1 to 3 months: Because it is a live
virus vaccine, pregnancy must be avoided to prevent potential harm to the
fetus.
• 4. The client should be told that a local reaction at the injection site is
common: Local reactions like soreness or redness are common side
effects.
Test-Taking Strategy: Recall that the rubella vaccine is a live-virus vaccine, which
is why pregnancy must be avoided. Breastfeeding does not need to be stopped.
The vaccine is not made from eggs, so that is a distractor.
4. Fundal Height Measurement
Question: The nurse is performing an assessment of a pregnant client who is at 28
weeks of gestation. The nurse measures the fundal height in centimeters and
notes that the fundal height is 30 cm. How would the nurse interpret this finding?
1. The client is measuring large for gestational age.
2. The client is measuring small for gestational age.
3. The client is measuring normal for gestational age.
4. More evidence is needed to determine size for gestational age.
Correct Answer: 3. The client is measuring normal for gestational age.
Rationale: A common guideline is that fundal height in centimeters corresponds
to the fetus's age in weeks, plus or minus 2 cm. For a 28-week gestation, a fundal
height of 30 cm falls within this expected range.
Test-Taking Strategy: Remember that during the second and third trimesters
(weeks 18 to 30), the fundal height in centimeters approximately equals the
fetus's age in weeks ± 2 cm.
5. Probable Signs of Pregnancy
, Question: The nurse is performing an assessment on a client who suspects being
pregnant and is checking the client for probable signs of pregnancy. The nurse
would assess for which probable signs of pregnancy? (Select all that apply)
1. Ballottement
2. Chadwick's sign
3. Uterine enlargement
4. Positive pregnancy test
5. Fetal heart rate detected by a non-electronic device
6. Outline of fetus via radiography or ultrasonography
Correct Answer: 1, 2, 3, 4
Rationale: Probable signs of pregnancy are those that strongly suggest pregnancy
but are not definitive. These include uterine enlargement, Hegar's sign, Goodell's
sign, Chadwick's sign, ballottement, Braxton Hicks contractions, and a positive
pregnancy test. Positive signs of pregnancy definitively confirm a fetus, such as
fetal heart rate detection (especially by non-electronic device at 20 weeks) or an
outline of the fetus via ultrasound.
Test-Taking Strategy: Focus on the subject: probable signs vs. positive signs.
Remember that detection of the fetal heart rate and an outline of the fetus via
radiography or ultrasonography are positive signs.
6. Braxton Hicks Contractions
Question: A pregnant client is seen for a regular prenatal visit and tells the nurse
about experiencing irregular contractions. The nurse determines that the client is
experiencing Braxton Hicks contractions. On the basis of this finding, which
nursing action is appropriate?
1. Contact the primary health care provider.
2. Instruct the client to maintain bed rest for the remainder of the pregnancy.
