NSG432 Nursing Care of the Childbearing Family - Exam 2 Grand Canyon University
NSG432 / NSG 432 (Latest Update 2026/2027)
Nursing Care of the Childbearing Family
Exam 2: Review Questions with Verified Answers
100% Correct | Grade A - Grand Canyon University
Section 1: Intrapartum Complications and High-Risk Labor (Questions 1-20)
1. A 32-week pregnant patient arrives at the labor and delivery unit reporting regular uterine contractions every 6 minutes,
pelvic pressure, and a change in vaginal discharge. Which assessment finding would best confirm that preterm labor is
occurring?
A. Cervical dilation of 1 cm with 50% effacement
B. Cervical dilation of 3 cm with 80% effacement and change over 2 hours [CORRECT]
C. Irregular, mild contractions with no cervical change
D. Fetal heart rate of 140 bpm with moderate variability
Correct Answer: B
Rationale: Preterm labor is defined as regular uterine contractions causing cervical change before 37 weeks gestation. The key diagnostic
criterion is cervical change (dilation and effacement) documented over time, not a single cervical examination. Cervical dilation of 3 cm with
80% effacement and documented change over 2 hours confirms preterm labor. Irregular contractions without cervical change may represent
Braxton Hicks contractions. A normal fetal heart rate does not confirm or rule out preterm labor.
2. A patient at 28 weeks gestation is being evaluated for preterm labor. Which diagnostic test has the greatest clinical value
when the result is negative?
A. Transabdominal ultrasound for amniotic fluid volume
B. Fetal fibronectin (fFN) test [CORRECT]
C. Complete blood count (CBC) with differential
D. Urine culture for group B streptococcus
Correct Answer: B
Rationale: Fetal fibronectin (fFN) is a protein that acts as a biological glue between the amniotic membranes and uterine decidua. When the
fFN test is negative, it has a high negative predictive value, meaning preterm delivery within the next 7-14 days is highly unlikely. This is
clinically valuable because it can help avoid unnecessary interventions such as tocolytics and corticosteroids. A positive fFN is less specific and
does not reliably predict preterm delivery. Transabdominal ultrasound assesses amniotic fluid, not preterm labor risk. CBC and urine culture
identify infection risk factors but do not predict preterm delivery.
3. A pregnant patient at 30 weeks gestation is receiving magnesium sulfate for tocolysis. Which finding requires the nurse to
immediately notify the healthcare provider?
A. Flushing and feeling warm
B. Deep tendon reflexes (DTRs) are 1+ and barely palpable [CORRECT]
C. Respiratory rate of 16 breaths/min
D. Urinary output of 40 mL/hour
Correct Answer: B
Rationale: Magnesium sulfate toxicity is a serious complication. The earliest sign of toxicity is loss of deep tendon reflexes (DTRs disappear).
Progressive toxicity leads to respiratory depression, respiratory arrest, and cardiac arrest. DTRs of 1+ that are barely palpable indicate
impending toxicity and require immediate provider notification and possible discontinuation of the infusion. Flushing and warmth are expected
side effects. A respiratory rate of 16 is normal. Urinary output of 40 mL/hour is within acceptable limits (the concern is oliguria, defined as less
Page 1
,NSG432 Nursing Care of the Childbearing Family - Exam 2 Grand Canyon University
than 30 mL/hour).
4. A patient at 26 weeks gestation is in preterm labor. Betamethasone 12 mg IM is ordered. What is the primary purpose of
administering this medication?
A. To stop uterine contractions and prevent preterm delivery
B. To accelerate fetal lung maturity by stimulating surfactant production [CORRECT]
C. To prevent infection associated with preterm premature rupture of membranes
D. To reduce maternal blood pressure associated with preterm labor
Correct Answer: B
Rationale: Corticosteroids (betamethasone or dexamethasone) are administered between 24 and 34 weeks gestation to accelerate fetal lung
maturity by stimulating the production of surfactant in the fetal lungs. Surfactant reduces surface tension in the alveoli, preventing alveolar
collapse and reducing the severity of respiratory distress syndrome (RDS). The maximum benefit occurs 24 hours after administration and lasts
up to 7 days. Corticosteroids do not stop contractions (that is the role of tocolytics), do not prevent infection, and do not reduce blood pressure.
5. Which tocolytic medication is contraindicated in a patient with maternal cardiac disease?
A. Nifedipine
B. Magnesium sulfate
C. Terbutaline [CORRECT]
D. Indomethacin
Correct Answer: C
Rationale: Terbutaline is a beta-adrenergic agonist that relaxes uterine smooth muscle but also stimulates beta-1 receptors in the heart, causing
tachycardia, palpitations, and increased cardiac workload. It is contraindicated in patients with maternal cardiac disease because the
cardiovascular effects can precipitate cardiac ischemia, arrhythmias, or heart failure. Nifedipine (calcium channel blocker) and magnesium
sulfate have different mechanisms and are preferred alternatives in patients with cardiac conditions. Indomethacin (NSAID) is contraindicated
after 32 weeks due to risk of premature ductus arteriosus closure but is not specifically contraindicated in cardiac disease.
6. A patient at 33 weeks gestation presents with a gush of clear fluid from the vagina. Which finding on assessment would
confirm that the membranes have ruptured (PROM)?
A. Nitrazine paper turns blue (alkaline pH)
B. Ferning pattern observed on microscopic examination of vaginal fluid
C. Both nitrazine paper turning blue and a ferning pattern on microscopy [CORRECT]
D. A positive pregnancy test on the vaginal fluid sample
Correct Answer: C
Rationale: Diagnosis of PROM/PPROM requires confirming that the fluid is amniotic fluid. Two key tests are used: nitrazine paper (which
turns blue in the presence of alkaline amniotic fluid, since normal vaginal secretions are acidic) and microscopic examination for a ferning
pattern (amniotic fluid crystallizes in a characteristic fern-like pattern when dried on a slide). Both tests together provide the most reliable
confirmation. A positive pregnancy test on vaginal fluid is not a standard diagnostic test for PROM.
7. A patient at 36 weeks gestation with confirmed premature rupture of membranes (PROM) has a mature fetal lung profile.
Which management approach is most appropriate?
A. Immediate cesarean delivery
B. Expectant management with bed rest and monitoring
C. Induction of labor [CORRECT]
D. Administration of tocolytics for 48 hours
Correct Answer: C
Rationale: When PROM occurs at or after 34 weeks gestation and fetal lung maturity is confirmed, the most appropriate management is
induction of labor. At this gestational age, the risks of expectant management (infection, cord prolapse, abruption) outweigh the benefits of
continued pregnancy, and the fetal lungs are mature enough for extrauterine life. Immediate cesarean is not indicated without another obstetric
indication. Tocolytics are not indicated at 36 weeks as the goal of delaying delivery is to allow time for corticosteroids, which are not beneficial
after 34 weeks.
Page 2
, NSG432 Nursing Care of the Childbearing Family - Exam 2 Grand Canyon University
8. A pregnant patient at 30 weeks gestation with PPROM is being managed expectantly. Which nursing intervention is most
critical to prevent complications?
A. Performing a vaginal examination every 4 hours to assess cervical dilation
B. Avoiding vaginal examinations and monitoring for signs of infection [CORRECT]
C. Administering prophylactic tocolytics for the duration of the pregnancy
D. Encouraging ambulation to promote fetal descent
Correct Answer: B
Rationale: In PPROM managed expectantly, the most critical nursing intervention is avoiding vaginal examinations because they introduce
bacteria into the uterus and significantly increase the risk of chorioamnionitis (intra-amniotic infection). The nurse should monitor for signs of
infection including maternal fever, tachycardia, foul-smelling amniotic fluid, and uterine tenderness. Digital vaginal exams are contraindicated
unless the patient is in active labor. Tocolytics are used for short periods (24-48 hours) to allow corticosteroid administration, not for the
duration of pregnancy. Bed rest, not ambulation, is recommended.
9. A patient at 34 weeks gestation presents with painless, bright red vaginal bleeding. The uterus is soft and non-tender. Which
condition is most likely?
A. Placental abruption
B. Placenta previa [CORRECT]
C. Vasa previa
D. Uterine rupture
Correct Answer: B
Rationale: Placenta previa is characterized by painless, bright red vaginal bleeding in the third trimester. The placenta partially or completely
covers the internal cervical os. Because the bleeding comes from the maternal circulation (not fetal), the blood is bright red. The uterus remains
soft and non-tender because the bleeding is not associated with uterine irritation or separation. Placental abruption, in contrast, presents with
painful, dark red bleeding and a tender, rigid (board-like) uterus. Vasa previa presents with painless bleeding at membrane rupture. Uterine
rupture presents with sudden severe pain and cessation of contractions.
10. A patient is diagnosed with placenta previa. Which diagnostic procedure is contraindicated in this patient?
A. Transabdominal ultrasound
B. Transvaginal ultrasound [CORRECT]
C. Leopold maneuvers
D. External fetal monitoring
Correct Answer: B
Rationale: Transvaginal ultrasound is generally contraindicated in placenta previa because the probe may disrupt the placental attachment and
precipitate significant hemorrhage. Placenta previa is diagnosed by transabdominal ultrasound, which is the safe and preferred imaging
modality. While some references indicate that carefully performed transvaginal ultrasound by an experienced provider can be used for
placental localization, standard nursing practice in most clinical settings avoids transvaginal examination when previa is suspected or
confirmed. Leopold maneuvers and external fetal monitoring are non-invasive and safe.
11. A patient at 35 weeks gestation presents with sudden onset of severe abdominal pain, a rigid and board-like abdomen, and
dark red vaginal bleeding. The fetal heart rate shows late decelerations. Which condition is most likely?
A. Placenta previa
B. Placental abruption [CORRECT]
C. Uterine rupture
D. Chorioamnionitis
Correct Answer: B
Rationale: Placental abruption (abruptio placentae) is the premature separation of the placenta from the uterine wall. Classic findings include
sudden, severe abdominal pain, a rigid and board-like uterus (due to blood infiltrating the myometrium), and dark red vaginal bleeding. The
concealed hemorrhage behind the placenta irritates the uterus, causing uterine tenderness and rigidity. Fetal compromise is common due to
reduced placental perfusion, evidenced by late decelerations on the fetal heart rate monitor. Placenta previa presents with painless, bright red
bleeding and a soft uterus.
Page 3
NSG432 / NSG 432 (Latest Update 2026/2027)
Nursing Care of the Childbearing Family
Exam 2: Review Questions with Verified Answers
100% Correct | Grade A - Grand Canyon University
Section 1: Intrapartum Complications and High-Risk Labor (Questions 1-20)
1. A 32-week pregnant patient arrives at the labor and delivery unit reporting regular uterine contractions every 6 minutes,
pelvic pressure, and a change in vaginal discharge. Which assessment finding would best confirm that preterm labor is
occurring?
A. Cervical dilation of 1 cm with 50% effacement
B. Cervical dilation of 3 cm with 80% effacement and change over 2 hours [CORRECT]
C. Irregular, mild contractions with no cervical change
D. Fetal heart rate of 140 bpm with moderate variability
Correct Answer: B
Rationale: Preterm labor is defined as regular uterine contractions causing cervical change before 37 weeks gestation. The key diagnostic
criterion is cervical change (dilation and effacement) documented over time, not a single cervical examination. Cervical dilation of 3 cm with
80% effacement and documented change over 2 hours confirms preterm labor. Irregular contractions without cervical change may represent
Braxton Hicks contractions. A normal fetal heart rate does not confirm or rule out preterm labor.
2. A patient at 28 weeks gestation is being evaluated for preterm labor. Which diagnostic test has the greatest clinical value
when the result is negative?
A. Transabdominal ultrasound for amniotic fluid volume
B. Fetal fibronectin (fFN) test [CORRECT]
C. Complete blood count (CBC) with differential
D. Urine culture for group B streptococcus
Correct Answer: B
Rationale: Fetal fibronectin (fFN) is a protein that acts as a biological glue between the amniotic membranes and uterine decidua. When the
fFN test is negative, it has a high negative predictive value, meaning preterm delivery within the next 7-14 days is highly unlikely. This is
clinically valuable because it can help avoid unnecessary interventions such as tocolytics and corticosteroids. A positive fFN is less specific and
does not reliably predict preterm delivery. Transabdominal ultrasound assesses amniotic fluid, not preterm labor risk. CBC and urine culture
identify infection risk factors but do not predict preterm delivery.
3. A pregnant patient at 30 weeks gestation is receiving magnesium sulfate for tocolysis. Which finding requires the nurse to
immediately notify the healthcare provider?
A. Flushing and feeling warm
B. Deep tendon reflexes (DTRs) are 1+ and barely palpable [CORRECT]
C. Respiratory rate of 16 breaths/min
D. Urinary output of 40 mL/hour
Correct Answer: B
Rationale: Magnesium sulfate toxicity is a serious complication. The earliest sign of toxicity is loss of deep tendon reflexes (DTRs disappear).
Progressive toxicity leads to respiratory depression, respiratory arrest, and cardiac arrest. DTRs of 1+ that are barely palpable indicate
impending toxicity and require immediate provider notification and possible discontinuation of the infusion. Flushing and warmth are expected
side effects. A respiratory rate of 16 is normal. Urinary output of 40 mL/hour is within acceptable limits (the concern is oliguria, defined as less
Page 1
,NSG432 Nursing Care of the Childbearing Family - Exam 2 Grand Canyon University
than 30 mL/hour).
4. A patient at 26 weeks gestation is in preterm labor. Betamethasone 12 mg IM is ordered. What is the primary purpose of
administering this medication?
A. To stop uterine contractions and prevent preterm delivery
B. To accelerate fetal lung maturity by stimulating surfactant production [CORRECT]
C. To prevent infection associated with preterm premature rupture of membranes
D. To reduce maternal blood pressure associated with preterm labor
Correct Answer: B
Rationale: Corticosteroids (betamethasone or dexamethasone) are administered between 24 and 34 weeks gestation to accelerate fetal lung
maturity by stimulating the production of surfactant in the fetal lungs. Surfactant reduces surface tension in the alveoli, preventing alveolar
collapse and reducing the severity of respiratory distress syndrome (RDS). The maximum benefit occurs 24 hours after administration and lasts
up to 7 days. Corticosteroids do not stop contractions (that is the role of tocolytics), do not prevent infection, and do not reduce blood pressure.
5. Which tocolytic medication is contraindicated in a patient with maternal cardiac disease?
A. Nifedipine
B. Magnesium sulfate
C. Terbutaline [CORRECT]
D. Indomethacin
Correct Answer: C
Rationale: Terbutaline is a beta-adrenergic agonist that relaxes uterine smooth muscle but also stimulates beta-1 receptors in the heart, causing
tachycardia, palpitations, and increased cardiac workload. It is contraindicated in patients with maternal cardiac disease because the
cardiovascular effects can precipitate cardiac ischemia, arrhythmias, or heart failure. Nifedipine (calcium channel blocker) and magnesium
sulfate have different mechanisms and are preferred alternatives in patients with cardiac conditions. Indomethacin (NSAID) is contraindicated
after 32 weeks due to risk of premature ductus arteriosus closure but is not specifically contraindicated in cardiac disease.
6. A patient at 33 weeks gestation presents with a gush of clear fluid from the vagina. Which finding on assessment would
confirm that the membranes have ruptured (PROM)?
A. Nitrazine paper turns blue (alkaline pH)
B. Ferning pattern observed on microscopic examination of vaginal fluid
C. Both nitrazine paper turning blue and a ferning pattern on microscopy [CORRECT]
D. A positive pregnancy test on the vaginal fluid sample
Correct Answer: C
Rationale: Diagnosis of PROM/PPROM requires confirming that the fluid is amniotic fluid. Two key tests are used: nitrazine paper (which
turns blue in the presence of alkaline amniotic fluid, since normal vaginal secretions are acidic) and microscopic examination for a ferning
pattern (amniotic fluid crystallizes in a characteristic fern-like pattern when dried on a slide). Both tests together provide the most reliable
confirmation. A positive pregnancy test on vaginal fluid is not a standard diagnostic test for PROM.
7. A patient at 36 weeks gestation with confirmed premature rupture of membranes (PROM) has a mature fetal lung profile.
Which management approach is most appropriate?
A. Immediate cesarean delivery
B. Expectant management with bed rest and monitoring
C. Induction of labor [CORRECT]
D. Administration of tocolytics for 48 hours
Correct Answer: C
Rationale: When PROM occurs at or after 34 weeks gestation and fetal lung maturity is confirmed, the most appropriate management is
induction of labor. At this gestational age, the risks of expectant management (infection, cord prolapse, abruption) outweigh the benefits of
continued pregnancy, and the fetal lungs are mature enough for extrauterine life. Immediate cesarean is not indicated without another obstetric
indication. Tocolytics are not indicated at 36 weeks as the goal of delaying delivery is to allow time for corticosteroids, which are not beneficial
after 34 weeks.
Page 2
, NSG432 Nursing Care of the Childbearing Family - Exam 2 Grand Canyon University
8. A pregnant patient at 30 weeks gestation with PPROM is being managed expectantly. Which nursing intervention is most
critical to prevent complications?
A. Performing a vaginal examination every 4 hours to assess cervical dilation
B. Avoiding vaginal examinations and monitoring for signs of infection [CORRECT]
C. Administering prophylactic tocolytics for the duration of the pregnancy
D. Encouraging ambulation to promote fetal descent
Correct Answer: B
Rationale: In PPROM managed expectantly, the most critical nursing intervention is avoiding vaginal examinations because they introduce
bacteria into the uterus and significantly increase the risk of chorioamnionitis (intra-amniotic infection). The nurse should monitor for signs of
infection including maternal fever, tachycardia, foul-smelling amniotic fluid, and uterine tenderness. Digital vaginal exams are contraindicated
unless the patient is in active labor. Tocolytics are used for short periods (24-48 hours) to allow corticosteroid administration, not for the
duration of pregnancy. Bed rest, not ambulation, is recommended.
9. A patient at 34 weeks gestation presents with painless, bright red vaginal bleeding. The uterus is soft and non-tender. Which
condition is most likely?
A. Placental abruption
B. Placenta previa [CORRECT]
C. Vasa previa
D. Uterine rupture
Correct Answer: B
Rationale: Placenta previa is characterized by painless, bright red vaginal bleeding in the third trimester. The placenta partially or completely
covers the internal cervical os. Because the bleeding comes from the maternal circulation (not fetal), the blood is bright red. The uterus remains
soft and non-tender because the bleeding is not associated with uterine irritation or separation. Placental abruption, in contrast, presents with
painful, dark red bleeding and a tender, rigid (board-like) uterus. Vasa previa presents with painless bleeding at membrane rupture. Uterine
rupture presents with sudden severe pain and cessation of contractions.
10. A patient is diagnosed with placenta previa. Which diagnostic procedure is contraindicated in this patient?
A. Transabdominal ultrasound
B. Transvaginal ultrasound [CORRECT]
C. Leopold maneuvers
D. External fetal monitoring
Correct Answer: B
Rationale: Transvaginal ultrasound is generally contraindicated in placenta previa because the probe may disrupt the placental attachment and
precipitate significant hemorrhage. Placenta previa is diagnosed by transabdominal ultrasound, which is the safe and preferred imaging
modality. While some references indicate that carefully performed transvaginal ultrasound by an experienced provider can be used for
placental localization, standard nursing practice in most clinical settings avoids transvaginal examination when previa is suspected or
confirmed. Leopold maneuvers and external fetal monitoring are non-invasive and safe.
11. A patient at 35 weeks gestation presents with sudden onset of severe abdominal pain, a rigid and board-like abdomen, and
dark red vaginal bleeding. The fetal heart rate shows late decelerations. Which condition is most likely?
A. Placenta previa
B. Placental abruption [CORRECT]
C. Uterine rupture
D. Chorioamnionitis
Correct Answer: B
Rationale: Placental abruption (abruptio placentae) is the premature separation of the placenta from the uterine wall. Classic findings include
sudden, severe abdominal pain, a rigid and board-like uterus (due to blood infiltrating the myometrium), and dark red vaginal bleeding. The
concealed hemorrhage behind the placenta irritates the uterus, causing uterine tenderness and rigidity. Fetal compromise is common due to
reduced placental perfusion, evidenced by late decelerations on the fetal heart rate monitor. Placenta previa presents with painless, bright red
bleeding and a soft uterus.
Page 3
