The Ultimate and Complete NSG 432 Exam 2 – Nursing Care of the Childbearing Family
Study Guide 2025–2026, Covering Labor and Birth, Stages and Phases of Labor,
Maternal and Fetal Assessment, Fetal Heart Rate Monitoring, Cervical Dilation and
Effacement, Fetal Station and Presentation, Pain Management During Labor, Epidural
and Pharmacologic Analgesia, Cesarean Birth, Postpartum Assessment and Recovery,
Postpartum Hemorrhage and Uterine Atony, Thromboembolic Disorders, Rh Immune
Globulin, Newborn Assessment and Adaptation to Extrauterine Life, APGAR Scoring,
Newborn Vital Signs, Gestational Age Assessment, Newborn Reflexes, Breastfeeding
and Infant Nutrition, Maternal-Newborn Bonding, Discharge Education, Complications
of Pregnancy and Birth, Practice Questions With Detailed Rationales, Clinical
Scenarios, and Proven Strategies for Preparing for the NSG 432 Exam 2
Question 1: A 32-year-old primigravida at 39 weeks gestation presents with a sudden onset of
severe, sharp abdominal pain that is continuous. Her fundal height is noted to be greater
than expected for dates, and the fetal heart rate tracing shows recurrent late decelerations.
What is the priority nursing intervention?
A. Administer a bolus of intravenous fluids.
B. Prepare the patient for an immediate cesarean section.
C. Apply an external fetal monitor and continue to observe.
D. Administer an opioid analgesic for pain management.
CORRECT ANSWER: B. Prepare the patient for an immediate cesarean section.
Rationale: The presentation of sudden, severe abdominal pain, a fundal height greater than
dates, and late decelerations is highly suspicious for placental abruption. The priority is to
expedite delivery to prevent maternal and fetal compromise, making immediate cesarean
section the most appropriate intervention.
Question 2: A nurse is providing education to a group of pregnant women about physiologic
changes in the second trimester. Which integumentary change is most likely to be observed
during this time?
A. Striae gravidarum
B. Chloasma (melasma)
C. Linea nigra
D. Palmar erythema
CORRECT ANSWER: A. Striae gravidarum
Rationale: Striae gravidarum (stretch marks) commonly appear in the second trimester as the
skin stretches over the growing uterus and breasts. While chloasma, linea nigra, and palmar
erythema can also occur, they are often seen in the first or second trimester, but striae are a
hallmark of the rapid growth during the second trimester.
,Question 3: A patient at 28 weeks gestation with a history of chronic hypertension is being
monitored for preeclampsia. Which lab value is most indicative of the worsening of this
condition?
A. Hemoglobin of 11.2 g/dL
B. Platelet count of 98,000/mL
C. Serum creatinine of 0.8 mg/dL
D. Blood glucose of 95 mg/dL
CORRECT ANSWER: B. Platelet count of 98,000/mL
Rationale: A platelet count below 100,000/mL is a sign of HELLP syndrome or severe
preeclampsia, indicating thrombocytopenia. This reflects the microangiopathic hemolytic
process and worsening disease, and is a critical marker for the nurse to report.
Question 4: The nurse is assessing a newborn who is 12 hours old and notices a heart rate of
180 bpm. Which of the following interventions should the nurse prioritize?
A. Document the finding as normal.
B. Assess the newborn's temperature and oxygen saturation.
C. Prepare for an echocardiogram.
D. Notify the provider for a possible sepsis workup.
CORRECT ANSWER: B. Assess the newborn's temperature and oxygen saturation.
Rationale: A heart rate of 180 bpm is tachycardia in a newborn. The first step is to assess for
common causes such as hypothermia, hypoxia, or dehydration. Temperature and oxygen
saturation are immediate, non-invasive assessments that can guide further interventions.
Question 5: A patient with gestational diabetes at 36 weeks gestation is scheduled for a
nonstress test (NST). What is the priority nursing action to prepare the patient for this test?
A. Have the patient empty her bladder.
B. Administer a meal or juice 30 minutes prior.
C. Place the patient in a supine position.
D. Apply an internal fetal scalp electrode.
CORRECT ANSWER: B. Administer a meal or juice 30 minutes prior.
Rationale: A nonstress test is used to assess fetal well-being. Fetal heart rate accelerations are
often stimulated by maternal glucose intake. Having the patient eat a meal or drink juice
increases the likelihood of a reactive NST.
Question 6: The nurse is reviewing the laboratory results of a postpartum patient who is Rh-
negative and has given birth to an Rh-positive infant. Which intervention is essential to
prevent isoimmunization?
,A. Administer Rho(D) immune globulin (RhoGAM) within 72 hours.
B. Perform a Coombs test on the infant.
C. Monitor the infant's bilirubin levels.
D. Administer vitamin K to the newborn.
CORRECT ANSWER: A. Administer Rho(D) immune globulin (RhoGAM) within 72 hours.
Rationale: Rho(D) immune globulin is given to Rh-negative mothers who have given birth to an
Rh-positive infant to prevent maternal antibody formation (isoimmunization) which could affect
future pregnancies.
Question 7: At 38 weeks gestation, a patient is admitted with a complaint of painless, bright
red vaginal bleeding. What is the priority nursing action?
A. Perform a sterile vaginal exam to assess cervical dilation.
B. Prepare the patient for an ultrasound.
C. Assess fetal heart rate and maternal vital signs.
D. Administer a dose of terbutaline.
CORRECT ANSWER: C. Assess fetal heart rate and maternal vital signs.
Rationale: Painless, bright red vaginal bleeding in the third trimester is a classic sign of placenta
previa. A vaginal exam is contraindicated. The priority is to assess the fetus and mother for
stability, focusing on fetal heart rate and maternal vital signs.
Question 8: A nurse is caring for a patient in the first stage of labor who requests an epidural
for pain management. Which of the following prerequisites must be met before
administration?
A. Cervical dilation of 8 cm.
B. Intact maternal membranes.
C. Continuous fetal monitoring has been established.
D. Maternal hemoglobin is above 10 g/dL.
CORRECT ANSWER: C. Continuous fetal monitoring has been established.
Rationale: Before administering an epidural, continuous fetal monitoring must be established to
detect any changes in fetal heart rate that may indicate fetal distress due to maternal
hypotension. This is essential for patient safety.
Question 9: A newborn is exhibiting jitteriness, poor feeding, and a high-pitched cry. The
mother has a history of type 1 diabetes. Which nursing action is the priority?
A. Initiate phototherapy.
B. Assess the newborn's blood glucose level.
, C. Obtain a blood culture.
D. Prepare for an exchange transfusion.
CORRECT ANSWER: B. Assess the newborn's blood glucose level.
Rationale: The newborn is exhibiting classic signs of hypoglycemia, which is common in infants
of diabetic mothers. Prompt assessment and management of blood glucose are crucial to
prevent neurologic damage.
Question 10: The nurse is providing discharge teaching to a new mother who is breastfeeding.
What advice is most important to prevent mastitis?
A. Apply ice packs to the breasts after feeding.
B. Allow the baby to feed on demand.
C. Ensure complete breast emptying at each feeding.
D. Use nipple shields to prevent cracking.
CORRECT ANSWER: C. Ensure complete breast emptying at each feeding.
Rationale: Mastitis is often caused by milk stasis. Ensuring the breast is completely emptied
during feedings reduces the risk of engorgement and infection, making this the most critical
preventive measure.
Question 11: A patient at 41 weeks gestation is scheduled for a biophysical profile (BPP).
Which component of the BPP is scored for fetal tone?
A. Fetal heart rate reactivity
B. Amniotic fluid volume
C. Gross body movement
D. Extension and flexion of limbs
CORRECT ANSWER: D. Extension and flexion of limbs
Rationale: The BPP includes five components: fetal breathing, movement, tone, amniotic fluid
volume, and NST. Fetal tone is specifically assessed by observing extension and flexion of the
extremities.
Question 12: A patient is in active labor and suddenly complains of severe chest pain and
dyspnea. The patient's blood pressure drops to 80/50 mmHg. What condition should the
nurse suspect first?
A. Uterine rupture
B. Amniotic fluid embolism
C. Placental abruption
D. Cord prolapse
CORRECT ANSWER: B. Amniotic fluid embolism
Study Guide 2025–2026, Covering Labor and Birth, Stages and Phases of Labor,
Maternal and Fetal Assessment, Fetal Heart Rate Monitoring, Cervical Dilation and
Effacement, Fetal Station and Presentation, Pain Management During Labor, Epidural
and Pharmacologic Analgesia, Cesarean Birth, Postpartum Assessment and Recovery,
Postpartum Hemorrhage and Uterine Atony, Thromboembolic Disorders, Rh Immune
Globulin, Newborn Assessment and Adaptation to Extrauterine Life, APGAR Scoring,
Newborn Vital Signs, Gestational Age Assessment, Newborn Reflexes, Breastfeeding
and Infant Nutrition, Maternal-Newborn Bonding, Discharge Education, Complications
of Pregnancy and Birth, Practice Questions With Detailed Rationales, Clinical
Scenarios, and Proven Strategies for Preparing for the NSG 432 Exam 2
Question 1: A 32-year-old primigravida at 39 weeks gestation presents with a sudden onset of
severe, sharp abdominal pain that is continuous. Her fundal height is noted to be greater
than expected for dates, and the fetal heart rate tracing shows recurrent late decelerations.
What is the priority nursing intervention?
A. Administer a bolus of intravenous fluids.
B. Prepare the patient for an immediate cesarean section.
C. Apply an external fetal monitor and continue to observe.
D. Administer an opioid analgesic for pain management.
CORRECT ANSWER: B. Prepare the patient for an immediate cesarean section.
Rationale: The presentation of sudden, severe abdominal pain, a fundal height greater than
dates, and late decelerations is highly suspicious for placental abruption. The priority is to
expedite delivery to prevent maternal and fetal compromise, making immediate cesarean
section the most appropriate intervention.
Question 2: A nurse is providing education to a group of pregnant women about physiologic
changes in the second trimester. Which integumentary change is most likely to be observed
during this time?
A. Striae gravidarum
B. Chloasma (melasma)
C. Linea nigra
D. Palmar erythema
CORRECT ANSWER: A. Striae gravidarum
Rationale: Striae gravidarum (stretch marks) commonly appear in the second trimester as the
skin stretches over the growing uterus and breasts. While chloasma, linea nigra, and palmar
erythema can also occur, they are often seen in the first or second trimester, but striae are a
hallmark of the rapid growth during the second trimester.
,Question 3: A patient at 28 weeks gestation with a history of chronic hypertension is being
monitored for preeclampsia. Which lab value is most indicative of the worsening of this
condition?
A. Hemoglobin of 11.2 g/dL
B. Platelet count of 98,000/mL
C. Serum creatinine of 0.8 mg/dL
D. Blood glucose of 95 mg/dL
CORRECT ANSWER: B. Platelet count of 98,000/mL
Rationale: A platelet count below 100,000/mL is a sign of HELLP syndrome or severe
preeclampsia, indicating thrombocytopenia. This reflects the microangiopathic hemolytic
process and worsening disease, and is a critical marker for the nurse to report.
Question 4: The nurse is assessing a newborn who is 12 hours old and notices a heart rate of
180 bpm. Which of the following interventions should the nurse prioritize?
A. Document the finding as normal.
B. Assess the newborn's temperature and oxygen saturation.
C. Prepare for an echocardiogram.
D. Notify the provider for a possible sepsis workup.
CORRECT ANSWER: B. Assess the newborn's temperature and oxygen saturation.
Rationale: A heart rate of 180 bpm is tachycardia in a newborn. The first step is to assess for
common causes such as hypothermia, hypoxia, or dehydration. Temperature and oxygen
saturation are immediate, non-invasive assessments that can guide further interventions.
Question 5: A patient with gestational diabetes at 36 weeks gestation is scheduled for a
nonstress test (NST). What is the priority nursing action to prepare the patient for this test?
A. Have the patient empty her bladder.
B. Administer a meal or juice 30 minutes prior.
C. Place the patient in a supine position.
D. Apply an internal fetal scalp electrode.
CORRECT ANSWER: B. Administer a meal or juice 30 minutes prior.
Rationale: A nonstress test is used to assess fetal well-being. Fetal heart rate accelerations are
often stimulated by maternal glucose intake. Having the patient eat a meal or drink juice
increases the likelihood of a reactive NST.
Question 6: The nurse is reviewing the laboratory results of a postpartum patient who is Rh-
negative and has given birth to an Rh-positive infant. Which intervention is essential to
prevent isoimmunization?
,A. Administer Rho(D) immune globulin (RhoGAM) within 72 hours.
B. Perform a Coombs test on the infant.
C. Monitor the infant's bilirubin levels.
D. Administer vitamin K to the newborn.
CORRECT ANSWER: A. Administer Rho(D) immune globulin (RhoGAM) within 72 hours.
Rationale: Rho(D) immune globulin is given to Rh-negative mothers who have given birth to an
Rh-positive infant to prevent maternal antibody formation (isoimmunization) which could affect
future pregnancies.
Question 7: At 38 weeks gestation, a patient is admitted with a complaint of painless, bright
red vaginal bleeding. What is the priority nursing action?
A. Perform a sterile vaginal exam to assess cervical dilation.
B. Prepare the patient for an ultrasound.
C. Assess fetal heart rate and maternal vital signs.
D. Administer a dose of terbutaline.
CORRECT ANSWER: C. Assess fetal heart rate and maternal vital signs.
Rationale: Painless, bright red vaginal bleeding in the third trimester is a classic sign of placenta
previa. A vaginal exam is contraindicated. The priority is to assess the fetus and mother for
stability, focusing on fetal heart rate and maternal vital signs.
Question 8: A nurse is caring for a patient in the first stage of labor who requests an epidural
for pain management. Which of the following prerequisites must be met before
administration?
A. Cervical dilation of 8 cm.
B. Intact maternal membranes.
C. Continuous fetal monitoring has been established.
D. Maternal hemoglobin is above 10 g/dL.
CORRECT ANSWER: C. Continuous fetal monitoring has been established.
Rationale: Before administering an epidural, continuous fetal monitoring must be established to
detect any changes in fetal heart rate that may indicate fetal distress due to maternal
hypotension. This is essential for patient safety.
Question 9: A newborn is exhibiting jitteriness, poor feeding, and a high-pitched cry. The
mother has a history of type 1 diabetes. Which nursing action is the priority?
A. Initiate phototherapy.
B. Assess the newborn's blood glucose level.
, C. Obtain a blood culture.
D. Prepare for an exchange transfusion.
CORRECT ANSWER: B. Assess the newborn's blood glucose level.
Rationale: The newborn is exhibiting classic signs of hypoglycemia, which is common in infants
of diabetic mothers. Prompt assessment and management of blood glucose are crucial to
prevent neurologic damage.
Question 10: The nurse is providing discharge teaching to a new mother who is breastfeeding.
What advice is most important to prevent mastitis?
A. Apply ice packs to the breasts after feeding.
B. Allow the baby to feed on demand.
C. Ensure complete breast emptying at each feeding.
D. Use nipple shields to prevent cracking.
CORRECT ANSWER: C. Ensure complete breast emptying at each feeding.
Rationale: Mastitis is often caused by milk stasis. Ensuring the breast is completely emptied
during feedings reduces the risk of engorgement and infection, making this the most critical
preventive measure.
Question 11: A patient at 41 weeks gestation is scheduled for a biophysical profile (BPP).
Which component of the BPP is scored for fetal tone?
A. Fetal heart rate reactivity
B. Amniotic fluid volume
C. Gross body movement
D. Extension and flexion of limbs
CORRECT ANSWER: D. Extension and flexion of limbs
Rationale: The BPP includes five components: fetal breathing, movement, tone, amniotic fluid
volume, and NST. Fetal tone is specifically assessed by observing extension and flexion of the
extremities.
Question 12: A patient is in active labor and suddenly complains of severe chest pain and
dyspnea. The patient's blood pressure drops to 80/50 mmHg. What condition should the
nurse suspect first?
A. Uterine rupture
B. Amniotic fluid embolism
C. Placental abruption
D. Cord prolapse
CORRECT ANSWER: B. Amniotic fluid embolism
