Nightingale College BSN 346 Exam 1 (pdf) | 2026/2027 | Concepts of
Nursing III Q&A | Nursing
1. Occiput posterior refers to which component of the birth process?
A) Powers
B) Passenger
C) Passage
D) Psyche
Correct Answer: Passenger
Rationale: Occiput posterior refers to the position of the fetal head within the
maternal pelvis and is thus a component of the "passenger" (the fetus). The
"powers" are uterine contractions, the "passage" is the birth canal, and
"psyche" refers to the mother's psychological state.
2. Which nursing instruction is appropriate to give a pregnant woman who
will be traveling in a car for 8 hours?
A) Decrease fluid intake
B) Drive with minimal stops
C) Avoid travel by automobile
D) Stop frequently to walk
Correct Answer: Stop frequently to walk
Rationale: Prolonged travel, especially in a car, increases the risk of
thromboembolism. Frequent stops to walk promote circulation and prevent
venous stasis. Decreasing fluids could lead to dehydration, and avoiding
travel is not always practical.
,3. A nurse is assessing a newborn and notes diffuse edema of the fetal scalp
that crosses the suture lines. How should the nurse document this finding?
A) Cephalohematoma
B) Caput succedaneum
C) Molding
D) Subgaleal hemorrhage
Correct Answer: Caput succedaneum
Rationale: Caput succedaneum is diffuse edema of the fetal scalp that
crosses suture lines and typically resolves within 1 to 3 days.
Cephalohematoma is bleeding between the skull and periosteum and does
not cross suture lines.
4. A client is receiving oxytocin (Pitocin) for induction of labor. The nurse
understands that oxytocin has which effect?
A) Decreases uterine contractility
B) Stimulates smooth muscle contraction
C) Relaxes cervical smooth muscle
D) Increases pain threshold
Correct Answer: Stimulates smooth muscle contraction
Rationale: Oxytocin is a synthetic hormone that stimulates uterine smooth
muscle contraction, which is its primary mechanism for inducing or
augmenting labor. It does not relax cervical muscle or decrease contractility.
5. A client at 25-weeks gestation tells the nurse that she dropped a cooking
utensil last week and her baby jumped in response to the noise. What
information should the nurse provide?
,A) The fetus cannot respond to sound at this gestation
B) The fetus can respond to sound by 24-weeks gestation
C) This is a sign of fetal distress
D) The fetus is responding to the mother's anxiety
Correct Answer: The fetus can respond to sound by 24-weeks gestation
Rationale: Fetal hearing develops early, and by 24 weeks of gestation, the
fetus is capable of responding to external sounds. This is a normal
developmental milestone and not a sign of distress.
6. A client at 8-weeks gestation asks the nurse about the risk for a congenital
heart defect (CHD) in her baby. Which response best explains when a CHD
may occur?
A) The heart develops in the first week after conception
B) The heart develops in the second trimester
C) The heart develops in the third to fifth weeks after conception
D) The heart develops in the eighth to tenth weeks after conception
Correct Answer: The heart develops in the third to fifth weeks after
conception
Rationale: The embryonic heart begins to form and is most susceptible to
teratogens during the third to fifth weeks of gestation. This is a critical period
for cardiac development.
7. A 31-year-old client uses an over-the-counter (OTC) pregnancy test that is
positive one week after a missed period. At the clinic, the client's physical
examination and ultrasound do not indicate that she is pregnant. The client
, takes phenytoin (Dilantin) for epilepsy. How should the nurse explain the
most likely cause for obtaining false-positive pregnancy test results?
A) The client is under stress at work
B) Using an anticonvulsant for epilepsy
C) The client has a history of irregular periods
D) The client is not sleeping well
Correct Answer: Using an anticonvulsant for epilepsy
Rationale: Certain medications, including anticonvulsants like phenytoin, can
cause false-positive results on urine pregnancy tests by interfering with the
assay. The other options are less likely to cause a false-positive result.
8. The nurse is teaching a new mother about diet and breastfeeding. Which
instruction is most important to include in the teaching plan?
A) Avoid alcohol because it is excreted in breast milk
B) Increase caloric intake by 100 calories per day
C) Avoid all forms of caffeine
D) Increase intake of spicy foods
Correct Answer: Avoid alcohol because it is excreted in breast milk
Rationale: Alcohol passes freely into breast milk and can affect the infant's
sleep patterns and development. The most important instruction is to avoid
alcohol while breastfeeding. A modest increase in caloric intake is needed,
but not only 100 calories.
9. The nurse assesses a male newborn and determines that he has the
following vital signs: axillary temperature 95.1°F, heart rate 136
Nursing III Q&A | Nursing
1. Occiput posterior refers to which component of the birth process?
A) Powers
B) Passenger
C) Passage
D) Psyche
Correct Answer: Passenger
Rationale: Occiput posterior refers to the position of the fetal head within the
maternal pelvis and is thus a component of the "passenger" (the fetus). The
"powers" are uterine contractions, the "passage" is the birth canal, and
"psyche" refers to the mother's psychological state.
2. Which nursing instruction is appropriate to give a pregnant woman who
will be traveling in a car for 8 hours?
A) Decrease fluid intake
B) Drive with minimal stops
C) Avoid travel by automobile
D) Stop frequently to walk
Correct Answer: Stop frequently to walk
Rationale: Prolonged travel, especially in a car, increases the risk of
thromboembolism. Frequent stops to walk promote circulation and prevent
venous stasis. Decreasing fluids could lead to dehydration, and avoiding
travel is not always practical.
,3. A nurse is assessing a newborn and notes diffuse edema of the fetal scalp
that crosses the suture lines. How should the nurse document this finding?
A) Cephalohematoma
B) Caput succedaneum
C) Molding
D) Subgaleal hemorrhage
Correct Answer: Caput succedaneum
Rationale: Caput succedaneum is diffuse edema of the fetal scalp that
crosses suture lines and typically resolves within 1 to 3 days.
Cephalohematoma is bleeding between the skull and periosteum and does
not cross suture lines.
4. A client is receiving oxytocin (Pitocin) for induction of labor. The nurse
understands that oxytocin has which effect?
A) Decreases uterine contractility
B) Stimulates smooth muscle contraction
C) Relaxes cervical smooth muscle
D) Increases pain threshold
Correct Answer: Stimulates smooth muscle contraction
Rationale: Oxytocin is a synthetic hormone that stimulates uterine smooth
muscle contraction, which is its primary mechanism for inducing or
augmenting labor. It does not relax cervical muscle or decrease contractility.
5. A client at 25-weeks gestation tells the nurse that she dropped a cooking
utensil last week and her baby jumped in response to the noise. What
information should the nurse provide?
,A) The fetus cannot respond to sound at this gestation
B) The fetus can respond to sound by 24-weeks gestation
C) This is a sign of fetal distress
D) The fetus is responding to the mother's anxiety
Correct Answer: The fetus can respond to sound by 24-weeks gestation
Rationale: Fetal hearing develops early, and by 24 weeks of gestation, the
fetus is capable of responding to external sounds. This is a normal
developmental milestone and not a sign of distress.
6. A client at 8-weeks gestation asks the nurse about the risk for a congenital
heart defect (CHD) in her baby. Which response best explains when a CHD
may occur?
A) The heart develops in the first week after conception
B) The heart develops in the second trimester
C) The heart develops in the third to fifth weeks after conception
D) The heart develops in the eighth to tenth weeks after conception
Correct Answer: The heart develops in the third to fifth weeks after
conception
Rationale: The embryonic heart begins to form and is most susceptible to
teratogens during the third to fifth weeks of gestation. This is a critical period
for cardiac development.
7. A 31-year-old client uses an over-the-counter (OTC) pregnancy test that is
positive one week after a missed period. At the clinic, the client's physical
examination and ultrasound do not indicate that she is pregnant. The client
, takes phenytoin (Dilantin) for epilepsy. How should the nurse explain the
most likely cause for obtaining false-positive pregnancy test results?
A) The client is under stress at work
B) Using an anticonvulsant for epilepsy
C) The client has a history of irregular periods
D) The client is not sleeping well
Correct Answer: Using an anticonvulsant for epilepsy
Rationale: Certain medications, including anticonvulsants like phenytoin, can
cause false-positive results on urine pregnancy tests by interfering with the
assay. The other options are less likely to cause a false-positive result.
8. The nurse is teaching a new mother about diet and breastfeeding. Which
instruction is most important to include in the teaching plan?
A) Avoid alcohol because it is excreted in breast milk
B) Increase caloric intake by 100 calories per day
C) Avoid all forms of caffeine
D) Increase intake of spicy foods
Correct Answer: Avoid alcohol because it is excreted in breast milk
Rationale: Alcohol passes freely into breast milk and can affect the infant's
sleep patterns and development. The most important instruction is to avoid
alcohol while breastfeeding. A modest increase in caloric intake is needed,
but not only 100 calories.
9. The nurse assesses a male newborn and determines that he has the
following vital signs: axillary temperature 95.1°F, heart rate 136
