NRSG 112 Exam 1 V2 | NRSG 112 Maternal-Child
Nursing | Actual Q&A with Rationale (NRSG112
Exam 1) | Ivy Tech
1. A nurse is calculating the estimated date of birth (EDB) for a client whose last menstrual
period (LMP) began on November 10. Using Naegele’s rule, which of the following dates
should the nurse record?
A. August 10
B. August 17
C. August 3
D. February 17
E. August 17 of the following year
Correct Answer: E
Explanation: To calculate the estimated date of birth using Naegele’s rule, the nurse
subtracts 3 months and adds 7 days to the first day of the last menstrual period. For a client
with an LMP of November 10, subtracting 3 months results in August and adding 7 days
results in August 17. Because the calculation crosses into the next calendar year, it is vital
to designate the year correctly in clinical documentation.
2. A nurse is performing an assessment on a pregnant client who reports feeling the fetus
move. Which of the following findings is considered a positive sign of pregnancy?
A. Amenorrhea
,B. Positive pregnancy test
C. Fetal heart tones heard via Doppler
D. Chadwick’s sign
Correct Answer: C
Explanation: Positive signs of pregnancy are those that can be attributed only to the
presence of a fetus, such as fetal heart tones, visualization via ultrasound, or palpation of
fetal movement by an examiner. Presumptive signs are subjective changes reported by the
woman, while probable signs are objective changes observed by an examiner but not
diagnostic of pregnancy. Recognizing the difference is essential for accurate clinical
verification of pregnancy status.
3. A client at 32 weeks gestation presents to the triage unit with painless, bright red vaginal
bleeding. Which condition should the nurse suspect?
A. Abruptio placentae
B. Cervical insufficiency
C. Preterm labor
D. Placenta previa
Correct Answer: D
Explanation: Placenta previa is characterized by painless, bright red vaginal bleeding
during the second or third trimester. In contrast, abruptio placentae involves painful, dark
,red bleeding and uterine rigidity. It is critical for the nurse to avoid a vaginal exam in this
scenario until the placenta’s location is confirmed via ultrasound.
4. A nurse is monitoring a fetal heart rate (FHR) tracing and observes a pattern of
decelerations that begin after the peak of the contraction and return to baseline after the
contraction ends. Which action should the nurse take first?
A. Perform a vaginal exam to check for cord prolapse
B. Administer 2L of oxygen via nasal cannula
C. Increase the IV Pitocin infusion rate
D. Prepare the client for an immediate cesarean section
E. Position the client in a left-lateral side-lying position
Correct Answer: E
Explanation: The description identifies late decelerations, which are indicative of
uteroplacental insufficiency. The first nursing intervention should be to optimize
oxygenation by repositioning the mother to her side to relieve pressure on the inferior
vena cava. Other immediate steps include stopping Pitocin, increasing IV fluids, and
administering high-flow oxygen via non-rebreather mask.
5. Which of the following assessments are components of the BUBBLE-HE postpartum
assessment? Select all that apply.
A. Breasts
B. Uterus
, C. Bladder
D. Bowel
E. Lochia
F. Episiotomy
Correct Answer: ABCDEF
Explanation: The BUBBLE-HE acronym stands for Breasts, Uterus, Bladder, Bowel, Lochia,
Episiotomy, Homan’s sign (or legs), and Emotional status. This systematic approach
ensures the nurse covers all physiologic and psychological adaptations following childbirth.
This standardized assessment is a cornerstone of Ivy Tech’s maternal-child nursing
curriculum.
6. A nurse is providing care for a client in the first stage of labor. The client is 6 cm dilated,
80% effaced, and the fetus is at 0 station. Which phase of labor is the client experiencing?
A. Latent phase
B. Second stage
C. Transition phase
D. Active phase
Correct Answer: D
Explanation: According to updated clinical standards used in NRSG 112, the active phase
of the first stage of labor begins when the cervix is dilated 6 cm and lasts until it reaches 10
Nursing | Actual Q&A with Rationale (NRSG112
Exam 1) | Ivy Tech
1. A nurse is calculating the estimated date of birth (EDB) for a client whose last menstrual
period (LMP) began on November 10. Using Naegele’s rule, which of the following dates
should the nurse record?
A. August 10
B. August 17
C. August 3
D. February 17
E. August 17 of the following year
Correct Answer: E
Explanation: To calculate the estimated date of birth using Naegele’s rule, the nurse
subtracts 3 months and adds 7 days to the first day of the last menstrual period. For a client
with an LMP of November 10, subtracting 3 months results in August and adding 7 days
results in August 17. Because the calculation crosses into the next calendar year, it is vital
to designate the year correctly in clinical documentation.
2. A nurse is performing an assessment on a pregnant client who reports feeling the fetus
move. Which of the following findings is considered a positive sign of pregnancy?
A. Amenorrhea
,B. Positive pregnancy test
C. Fetal heart tones heard via Doppler
D. Chadwick’s sign
Correct Answer: C
Explanation: Positive signs of pregnancy are those that can be attributed only to the
presence of a fetus, such as fetal heart tones, visualization via ultrasound, or palpation of
fetal movement by an examiner. Presumptive signs are subjective changes reported by the
woman, while probable signs are objective changes observed by an examiner but not
diagnostic of pregnancy. Recognizing the difference is essential for accurate clinical
verification of pregnancy status.
3. A client at 32 weeks gestation presents to the triage unit with painless, bright red vaginal
bleeding. Which condition should the nurse suspect?
A. Abruptio placentae
B. Cervical insufficiency
C. Preterm labor
D. Placenta previa
Correct Answer: D
Explanation: Placenta previa is characterized by painless, bright red vaginal bleeding
during the second or third trimester. In contrast, abruptio placentae involves painful, dark
,red bleeding and uterine rigidity. It is critical for the nurse to avoid a vaginal exam in this
scenario until the placenta’s location is confirmed via ultrasound.
4. A nurse is monitoring a fetal heart rate (FHR) tracing and observes a pattern of
decelerations that begin after the peak of the contraction and return to baseline after the
contraction ends. Which action should the nurse take first?
A. Perform a vaginal exam to check for cord prolapse
B. Administer 2L of oxygen via nasal cannula
C. Increase the IV Pitocin infusion rate
D. Prepare the client for an immediate cesarean section
E. Position the client in a left-lateral side-lying position
Correct Answer: E
Explanation: The description identifies late decelerations, which are indicative of
uteroplacental insufficiency. The first nursing intervention should be to optimize
oxygenation by repositioning the mother to her side to relieve pressure on the inferior
vena cava. Other immediate steps include stopping Pitocin, increasing IV fluids, and
administering high-flow oxygen via non-rebreather mask.
5. Which of the following assessments are components of the BUBBLE-HE postpartum
assessment? Select all that apply.
A. Breasts
B. Uterus
, C. Bladder
D. Bowel
E. Lochia
F. Episiotomy
Correct Answer: ABCDEF
Explanation: The BUBBLE-HE acronym stands for Breasts, Uterus, Bladder, Bowel, Lochia,
Episiotomy, Homan’s sign (or legs), and Emotional status. This systematic approach
ensures the nurse covers all physiologic and psychological adaptations following childbirth.
This standardized assessment is a cornerstone of Ivy Tech’s maternal-child nursing
curriculum.
6. A nurse is providing care for a client in the first stage of labor. The client is 6 cm dilated,
80% effaced, and the fetus is at 0 station. Which phase of labor is the client experiencing?
A. Latent phase
B. Second stage
C. Transition phase
D. Active phase
Correct Answer: D
Explanation: According to updated clinical standards used in NRSG 112, the active phase
of the first stage of labor begins when the cervix is dilated 6 cm and lasts until it reaches 10
