NACE Care of the Childbearing Family Exam Updated 2026 |
Comprehensive Study Guide, Practice Exam Questions and Answers,
Exam Prep Test Bank, Maternal Health Nursing Concepts, Antepartum and
Postpartum Care, Labor and Delivery Management, Newborn Assessment,
Family-Centered Care Principles, and Detailed Rationales for Exam
Revision and Clinical Success
Question 1: A nurse is assessing a pregnant client at 28 weeks gestation. Which
finding would be considered a normal physiological change of pregnancy?
A. Decreased cardiac output
B. Increased blood volume by 40-50%
C. Decreased glomerular filtration rate
D. Increased systemic vascular resistance
CORRECT ANSWER: B. Increased blood volume by 40-50%
Rationale: During pregnancy, blood volume increases significantly, typically by 40-50%,
to meet the metabolic demands of the fetus and prepare for blood loss during delivery.
Cardiac output increases, not decreases. Glomerular filtration rate increases, and
systemic vascular resistance decreases due to hormonal changes.
Question 2: A primigravida at 36 weeks gestation reports experiencing shortness of
breath when lying flat. The nurse recognizes this as likely caused by:
A. Pulmonary embolism
B. Supine hypotensive syndrome
C. Gestational asthma
D. Pneumonia
CORRECT ANSWER: B. Supine hypotensive syndrome
Rationale: Supine hypotensive syndrome occurs when the gravid uterus compresses
the inferior vena cava when the woman lies on her back, reducing venous return and
causing symptoms like shortness of breath, dizziness, and hypotension. This is
common in late pregnancy and is relieved by turning to the side.
Question 3: Which hormone is primarily responsible for maintaining the corpus
luteum during the first trimester of pregnancy?
A. Estrogen
B. Progesterone
C. Human chorionic gonadotropin (hCG)
D. Prolactin
CORRECT ANSWER: C. Human chorionic gonadotropin (hCG)
Rationale: hCG is produced by the trophoblast cells of the developing placenta and
maintains the corpus luteum during early pregnancy until the placenta takes over
,progesterone production around 8-10 weeks. This ensures continued progesterone
secretion necessary for maintaining the endometrial lining.
Question 4: A nurse is teaching a pregnant client about warning signs during
pregnancy. Which symptom should the client report immediately?
A. Mild ankle edema at the end of the day
B. Occasional heartburn after meals
C. Visual disturbances and severe headache
D. Increased urinary frequency
CORRECT ANSWER: C. Visual disturbances and severe headache
Rationale: Visual disturbances and severe headache are potential signs of
preeclampsia, a serious hypertensive disorder of pregnancy that requires immediate
medical attention. Mild ankle edema, occasional heartburn, and increased urinary
frequency are common discomforts of normal pregnancy.
Question 5: During a prenatal visit, a client at 20 weeks gestation asks about the
purpose of the alpha-fetoprotein (AFP) screening test. The nurse explains that this
test screens for:
A. Gestational diabetes
B. Neural tube defects
C. Rh incompatibility
D. Group B Streptococcus colonization
CORRECT ANSWER: B. Neural tube defects
Rationale: Maternal serum alpha-fetoprotein (MSAFP) screening is performed between
15-20 weeks gestation to screen for neural tube defects such as spina bifida and
anencephaly. Elevated levels may indicate open neural tube defects, while low levels
may suggest chromosomal abnormalities.
Question 6: A pregnant client at 32 weeks gestation reports decreased fetal
movement. The nurse's priority action is to:
A. Reassure the client that this is normal in the third trimester
B. Instruct the client to perform kick counts and contact healthcare provider if concerns
persist
C. Schedule a routine follow-up appointment in two weeks
D. Advise the client to increase caffeine intake to stimulate fetal activity
CORRECT ANSWER: B. Instruct the client to perform kick counts and contact
healthcare provider if concerns persist
Rationale: Decreased fetal movement can be a sign of fetal compromise. The nurse
should instruct the client to perform kick counts (counting fetal movements) and
contact the healthcare provider. Typically, fewer than 10 movements in 2 hours warrants
further evaluation. This is not normal and requires assessment.
,Question 7: Which position is recommended for a pregnant client during the third
trimester to optimize uteroplacental perfusion?
A. Supine position
B. Left lateral position
C. Prone position
D. Trendelenburg position
CORRECT ANSWER: B. Left lateral position
Rationale: The left lateral position prevents compression of the inferior vena cava by the
gravid uterus, optimizing venous return and uteroplacental perfusion. The supine
position should be avoided in late pregnancy due to risk of supine hypotensive
syndrome.
Question 8: A nurse is reviewing laboratory results for a pregnant client. Which
finding would require immediate notification of the healthcare provider?
A. Hemoglobin 11.2 g/dL
B. White blood cell count 12,000/mm³
C. Platelet count 90,000/mm³
D. Blood glucose 95 mg/dL fasting
CORRECT ANSWER: C. Platelet count 90,000/mm³
Rationale: A platelet count of 90,000/mm³ indicates thrombocytopenia, which may be
associated with conditions like HELLP syndrome or immune thrombocytopenia and
requires immediate evaluation. Hemoglobin of 11.2 g/dL is within normal range for
pregnancy. WBC count is normally elevated in pregnancy. Fasting glucose of 95 mg/dL is
normal.
Question 9: During labor, a client experiences intense back pain with each
contraction. The nurse suspects this may indicate:
A. Normal labor progression
B. Occiput posterior fetal position
C. Placental abruption
D. Uterine rupture
CORRECT ANSWER: B. Occiput posterior fetal position
Rationale: Back labor, characterized by intense lower back pain during contractions, is
commonly associated with occiput posterior fetal position where the fetal head presses
against the mother's sacrum. This position often results in longer, more painful labor.
Question 10: A postpartum client is experiencing heavy vaginal bleeding with large
clots two hours after delivery. The nurse's priority intervention is to:
A. Administer oral iron supplements
B. Perform fundal massage and assess for uterine atony
, C. Encourage ambulation to promote circulation
D. Apply ice packs to the perineum
CORRECT ANSWER: B. Perform fundal massage and assess for uterine atony
Rationale: Heavy bleeding with clots in the immediate postpartum period suggests
postpartum hemorrhage, most commonly caused by uterine atony. Fundal massage
stimulates uterine contractions and helps control bleeding. This is an emergency
requiring immediate intervention.
Question 11: Which assessment finding indicates that a newborn is adapting well
to extrauterine life?
A. Heart rate of 90 beats per minute
B. Respiratory rate of 70 breaths per minute
C. Acrocyanosis resolving within 24-48 hours
D. Temperature of 97.0°F (36.1°C)
CORRECT ANSWER: C. Acrocyanosis resolving within 24-48 hours
Rationale: Acrocyanosis (bluish discoloration of hands and feet) is normal in newborns
and typically resolves within 24-48 hours as circulation improves. Heart rate should be
110-160 bpm, respiratory rate 30-60 breaths/min, and temperature 97.7-99.5°F (36.5-
37.5°C).
Question 12: A nurse is caring for a client receiving magnesium sulfate for
preeclampsia. Which assessment finding indicates magnesium toxicity?
A. Deep tendon reflexes 2+
B. Urine output 40 mL/hr
C. Respiratory rate of 10 breaths per minute
D. Blood pressure 130/85 mmHg
CORRECT ANSWER: C. Respiratory rate of 10 breaths per minute
Rationale: Magnesium toxicity can cause respiratory depression, with respiratory rates
below 12 breaths per minute being a critical sign. Other signs include absent deep
tendon reflexes and decreased urine output. Therapeutic magnesium levels maintain
DTRs at 1-2+ and adequate urine output.
Question 13: During the fourth stage of labor, the nurse monitors the client
primarily for:
A. Cervical dilation
B. Postpartum hemorrhage
C. Fetal heart rate patterns
D. Amniotic fluid characteristics
CORRECT ANSWER: B. Postpartum hemorrhage
Comprehensive Study Guide, Practice Exam Questions and Answers,
Exam Prep Test Bank, Maternal Health Nursing Concepts, Antepartum and
Postpartum Care, Labor and Delivery Management, Newborn Assessment,
Family-Centered Care Principles, and Detailed Rationales for Exam
Revision and Clinical Success
Question 1: A nurse is assessing a pregnant client at 28 weeks gestation. Which
finding would be considered a normal physiological change of pregnancy?
A. Decreased cardiac output
B. Increased blood volume by 40-50%
C. Decreased glomerular filtration rate
D. Increased systemic vascular resistance
CORRECT ANSWER: B. Increased blood volume by 40-50%
Rationale: During pregnancy, blood volume increases significantly, typically by 40-50%,
to meet the metabolic demands of the fetus and prepare for blood loss during delivery.
Cardiac output increases, not decreases. Glomerular filtration rate increases, and
systemic vascular resistance decreases due to hormonal changes.
Question 2: A primigravida at 36 weeks gestation reports experiencing shortness of
breath when lying flat. The nurse recognizes this as likely caused by:
A. Pulmonary embolism
B. Supine hypotensive syndrome
C. Gestational asthma
D. Pneumonia
CORRECT ANSWER: B. Supine hypotensive syndrome
Rationale: Supine hypotensive syndrome occurs when the gravid uterus compresses
the inferior vena cava when the woman lies on her back, reducing venous return and
causing symptoms like shortness of breath, dizziness, and hypotension. This is
common in late pregnancy and is relieved by turning to the side.
Question 3: Which hormone is primarily responsible for maintaining the corpus
luteum during the first trimester of pregnancy?
A. Estrogen
B. Progesterone
C. Human chorionic gonadotropin (hCG)
D. Prolactin
CORRECT ANSWER: C. Human chorionic gonadotropin (hCG)
Rationale: hCG is produced by the trophoblast cells of the developing placenta and
maintains the corpus luteum during early pregnancy until the placenta takes over
,progesterone production around 8-10 weeks. This ensures continued progesterone
secretion necessary for maintaining the endometrial lining.
Question 4: A nurse is teaching a pregnant client about warning signs during
pregnancy. Which symptom should the client report immediately?
A. Mild ankle edema at the end of the day
B. Occasional heartburn after meals
C. Visual disturbances and severe headache
D. Increased urinary frequency
CORRECT ANSWER: C. Visual disturbances and severe headache
Rationale: Visual disturbances and severe headache are potential signs of
preeclampsia, a serious hypertensive disorder of pregnancy that requires immediate
medical attention. Mild ankle edema, occasional heartburn, and increased urinary
frequency are common discomforts of normal pregnancy.
Question 5: During a prenatal visit, a client at 20 weeks gestation asks about the
purpose of the alpha-fetoprotein (AFP) screening test. The nurse explains that this
test screens for:
A. Gestational diabetes
B. Neural tube defects
C. Rh incompatibility
D. Group B Streptococcus colonization
CORRECT ANSWER: B. Neural tube defects
Rationale: Maternal serum alpha-fetoprotein (MSAFP) screening is performed between
15-20 weeks gestation to screen for neural tube defects such as spina bifida and
anencephaly. Elevated levels may indicate open neural tube defects, while low levels
may suggest chromosomal abnormalities.
Question 6: A pregnant client at 32 weeks gestation reports decreased fetal
movement. The nurse's priority action is to:
A. Reassure the client that this is normal in the third trimester
B. Instruct the client to perform kick counts and contact healthcare provider if concerns
persist
C. Schedule a routine follow-up appointment in two weeks
D. Advise the client to increase caffeine intake to stimulate fetal activity
CORRECT ANSWER: B. Instruct the client to perform kick counts and contact
healthcare provider if concerns persist
Rationale: Decreased fetal movement can be a sign of fetal compromise. The nurse
should instruct the client to perform kick counts (counting fetal movements) and
contact the healthcare provider. Typically, fewer than 10 movements in 2 hours warrants
further evaluation. This is not normal and requires assessment.
,Question 7: Which position is recommended for a pregnant client during the third
trimester to optimize uteroplacental perfusion?
A. Supine position
B. Left lateral position
C. Prone position
D. Trendelenburg position
CORRECT ANSWER: B. Left lateral position
Rationale: The left lateral position prevents compression of the inferior vena cava by the
gravid uterus, optimizing venous return and uteroplacental perfusion. The supine
position should be avoided in late pregnancy due to risk of supine hypotensive
syndrome.
Question 8: A nurse is reviewing laboratory results for a pregnant client. Which
finding would require immediate notification of the healthcare provider?
A. Hemoglobin 11.2 g/dL
B. White blood cell count 12,000/mm³
C. Platelet count 90,000/mm³
D. Blood glucose 95 mg/dL fasting
CORRECT ANSWER: C. Platelet count 90,000/mm³
Rationale: A platelet count of 90,000/mm³ indicates thrombocytopenia, which may be
associated with conditions like HELLP syndrome or immune thrombocytopenia and
requires immediate evaluation. Hemoglobin of 11.2 g/dL is within normal range for
pregnancy. WBC count is normally elevated in pregnancy. Fasting glucose of 95 mg/dL is
normal.
Question 9: During labor, a client experiences intense back pain with each
contraction. The nurse suspects this may indicate:
A. Normal labor progression
B. Occiput posterior fetal position
C. Placental abruption
D. Uterine rupture
CORRECT ANSWER: B. Occiput posterior fetal position
Rationale: Back labor, characterized by intense lower back pain during contractions, is
commonly associated with occiput posterior fetal position where the fetal head presses
against the mother's sacrum. This position often results in longer, more painful labor.
Question 10: A postpartum client is experiencing heavy vaginal bleeding with large
clots two hours after delivery. The nurse's priority intervention is to:
A. Administer oral iron supplements
B. Perform fundal massage and assess for uterine atony
, C. Encourage ambulation to promote circulation
D. Apply ice packs to the perineum
CORRECT ANSWER: B. Perform fundal massage and assess for uterine atony
Rationale: Heavy bleeding with clots in the immediate postpartum period suggests
postpartum hemorrhage, most commonly caused by uterine atony. Fundal massage
stimulates uterine contractions and helps control bleeding. This is an emergency
requiring immediate intervention.
Question 11: Which assessment finding indicates that a newborn is adapting well
to extrauterine life?
A. Heart rate of 90 beats per minute
B. Respiratory rate of 70 breaths per minute
C. Acrocyanosis resolving within 24-48 hours
D. Temperature of 97.0°F (36.1°C)
CORRECT ANSWER: C. Acrocyanosis resolving within 24-48 hours
Rationale: Acrocyanosis (bluish discoloration of hands and feet) is normal in newborns
and typically resolves within 24-48 hours as circulation improves. Heart rate should be
110-160 bpm, respiratory rate 30-60 breaths/min, and temperature 97.7-99.5°F (36.5-
37.5°C).
Question 12: A nurse is caring for a client receiving magnesium sulfate for
preeclampsia. Which assessment finding indicates magnesium toxicity?
A. Deep tendon reflexes 2+
B. Urine output 40 mL/hr
C. Respiratory rate of 10 breaths per minute
D. Blood pressure 130/85 mmHg
CORRECT ANSWER: C. Respiratory rate of 10 breaths per minute
Rationale: Magnesium toxicity can cause respiratory depression, with respiratory rates
below 12 breaths per minute being a critical sign. Other signs include absent deep
tendon reflexes and decreased urine output. Therapeutic magnesium levels maintain
DTRs at 1-2+ and adequate urine output.
Question 13: During the fourth stage of labor, the nurse monitors the client
primarily for:
A. Cervical dilation
B. Postpartum hemorrhage
C. Fetal heart rate patterns
D. Amniotic fluid characteristics
CORRECT ANSWER: B. Postpartum hemorrhage
