NSG 432 Exam 3 V2 | NSG 432 Nursing Care of the
Childbearing Family | Actual Q&A with Rationale
(NSG432 Exam 3) | Grand Canyon University
1. A nurse is caring for a client with preeclampsia who is receiving a magnesium sulfate
infusion. Which of the following findings should the nurse identify as a priority to report to
the provider?
A. Urinary output of 40 mL/hr
B. Deep tendon reflexes 2+
C. Respiratory rate of 10/min
D. Blood pressure 145/95 mmHg
Correct Answer: C
Explanation: A respiratory rate of 10/min is a sign of magnesium sulfate toxicity and
requires immediate intervention. The nurse should stop the infusion and prepare to
administer calcium gluconate as the antagonist. Monitoring respiratory status is critical for
patient safety during magnesium therapy.
2. A nurse is providing discharge teaching to a client who had a cesarean birth 3 days ago.
Which of the following instructions should the nurse include?
A. You can resume abdominal exercises in 2 weeks.
B. You may lift your toddler as long as you use proper form.
,C. It is normal to see bright red bleeding for the next month.
D. Notify your provider if you develop a fever over 100.4 F.
Correct Answer: D
Explanation: A fever of 100.4 F or higher can indicate a postpartum infection such as
endometritis or a wound infection. Clients should be instructed to report this immediately
to ensure prompt treatment. Early detection of infection is vital for preventing systemic
complications during the postpartum period.
3. A nurse is assessing a client who is at 32 weeks of gestation and has a suspected placenta
previa. Which of the following findings should the nurse expect?
A. Severe abdominal pain
B. Rigid, board-like abdomen
C. Painless, bright red vaginal bleeding
D. Frequent uterine contractions
Correct Answer: C
Explanation: Placenta previa is characterized by the presence of painless, bright red
vaginal bleeding during the second or third trimester. This occurs because the placenta is
implanted over or near the cervical os. In contrast, abruptio placentae typically presents
with painful bleeding and a rigid abdomen.
,4. A nurse is caring for a client who is in the first stage of labor and has an internal fetal scalp
electrode. The nurse notes variable decelerations on the fetal monitor. Which of the
following actions should the nurse take?
A. Prepare for immediate vacuum extraction.
B. Reposition the client to a side-lying position.
C. Administer oxytocin to increase contraction frequency.
D. Perform a vaginal exam to check for crowning.
Correct Answer: B
Explanation: Variable decelerations are typically caused by umbilical cord compression.
Repositioning the client to a side-lying or knee-chest position can relieve pressure on the
cord. The nurse should also monitor the fetal heart rate for improvement and prepare for
oxygen administration if the pattern persists.
5. A nurse is reviewing the laboratory results for a client who is at 36 weeks of gestation and
has HELLP syndrome. Which of the following results should the nurse expect?
A. Elevated liver enzymes
B. Elevated platelet count
C. Low serum creatinine
D. Elevated hemoglobin
Correct Answer: A
, Explanation: HELLP syndrome stands for Hemolysis, Elevated Liver enzymes, and Low
Platelets. Elevated AST and ALT levels indicate liver involvement and hepatic dysfunction.
This condition is a severe complication of preeclampsia and requires intensive monitoring
and management.
6. A nurse is assessing a client for risk factors associated with preterm labor. Which of the
following factors should the nurse identify as increasing the client’s risk? (Select all that
apply)
A. History of prior preterm birth
B. Body mass index of 22
C. Smoking during pregnancy
D. Urinary tract infection
E. Multifetal gestation
F. First pregnancy at age 25
Correct Answer: A, C, D, E
Explanation: Risk factors for preterm labor include a history of preterm birth, smoking,
and infections such as UTIs. Multifetal gestation also increases the risk due to uterine
overdistention. Recognizing these risk factors allows for closer monitoring and early
intervention to improve neonatal outcomes.
Childbearing Family | Actual Q&A with Rationale
(NSG432 Exam 3) | Grand Canyon University
1. A nurse is caring for a client with preeclampsia who is receiving a magnesium sulfate
infusion. Which of the following findings should the nurse identify as a priority to report to
the provider?
A. Urinary output of 40 mL/hr
B. Deep tendon reflexes 2+
C. Respiratory rate of 10/min
D. Blood pressure 145/95 mmHg
Correct Answer: C
Explanation: A respiratory rate of 10/min is a sign of magnesium sulfate toxicity and
requires immediate intervention. The nurse should stop the infusion and prepare to
administer calcium gluconate as the antagonist. Monitoring respiratory status is critical for
patient safety during magnesium therapy.
2. A nurse is providing discharge teaching to a client who had a cesarean birth 3 days ago.
Which of the following instructions should the nurse include?
A. You can resume abdominal exercises in 2 weeks.
B. You may lift your toddler as long as you use proper form.
,C. It is normal to see bright red bleeding for the next month.
D. Notify your provider if you develop a fever over 100.4 F.
Correct Answer: D
Explanation: A fever of 100.4 F or higher can indicate a postpartum infection such as
endometritis or a wound infection. Clients should be instructed to report this immediately
to ensure prompt treatment. Early detection of infection is vital for preventing systemic
complications during the postpartum period.
3. A nurse is assessing a client who is at 32 weeks of gestation and has a suspected placenta
previa. Which of the following findings should the nurse expect?
A. Severe abdominal pain
B. Rigid, board-like abdomen
C. Painless, bright red vaginal bleeding
D. Frequent uterine contractions
Correct Answer: C
Explanation: Placenta previa is characterized by the presence of painless, bright red
vaginal bleeding during the second or third trimester. This occurs because the placenta is
implanted over or near the cervical os. In contrast, abruptio placentae typically presents
with painful bleeding and a rigid abdomen.
,4. A nurse is caring for a client who is in the first stage of labor and has an internal fetal scalp
electrode. The nurse notes variable decelerations on the fetal monitor. Which of the
following actions should the nurse take?
A. Prepare for immediate vacuum extraction.
B. Reposition the client to a side-lying position.
C. Administer oxytocin to increase contraction frequency.
D. Perform a vaginal exam to check for crowning.
Correct Answer: B
Explanation: Variable decelerations are typically caused by umbilical cord compression.
Repositioning the client to a side-lying or knee-chest position can relieve pressure on the
cord. The nurse should also monitor the fetal heart rate for improvement and prepare for
oxygen administration if the pattern persists.
5. A nurse is reviewing the laboratory results for a client who is at 36 weeks of gestation and
has HELLP syndrome. Which of the following results should the nurse expect?
A. Elevated liver enzymes
B. Elevated platelet count
C. Low serum creatinine
D. Elevated hemoglobin
Correct Answer: A
, Explanation: HELLP syndrome stands for Hemolysis, Elevated Liver enzymes, and Low
Platelets. Elevated AST and ALT levels indicate liver involvement and hepatic dysfunction.
This condition is a severe complication of preeclampsia and requires intensive monitoring
and management.
6. A nurse is assessing a client for risk factors associated with preterm labor. Which of the
following factors should the nurse identify as increasing the client’s risk? (Select all that
apply)
A. History of prior preterm birth
B. Body mass index of 22
C. Smoking during pregnancy
D. Urinary tract infection
E. Multifetal gestation
F. First pregnancy at age 25
Correct Answer: A, C, D, E
Explanation: Risk factors for preterm labor include a history of preterm birth, smoking,
and infections such as UTIs. Multifetal gestation also increases the risk due to uterine
overdistention. Recognizing these risk factors allows for closer monitoring and early
intervention to improve neonatal outcomes.
