NACE 2023 - CARE OF CHILDBEARING FAMILY PRACTICE
EXAM
INTRODUCTION:
This comprehensive practice examination is designed to prepare nursing students and graduate
nurses for the NACE 2023 Care of the Childbearing Family domain. Based on current 2023 NACE
test specifications and evidence-based maternal-child nursing practice guidelines from
AWHONN and ACOG, this exam covers essential content across antepartum, intrapartum,
postpartum, newborn, and high-risk conditions to assess readiness for advanced clinical
entrance.
SECTION 1: ANTEPARTUM CARE (Questions 1-20)
Question 1: A pregnant client at 36 weeks gestation reports sudden, painless bright red vaginal
bleeding. What is the nurse's priority action?
A. Perform a sterile vaginal exam to assess cervical dilation
B. Place the client in Trendelenburg position
C. Notify the healthcare provider immediately and prepare for possible cesarean delivery
D. Administer oxytocin to augment labor
Answer: C
Rationale: Painless bright red bleeding in the third trimester is classic for placenta previa.
Vaginal examination is contraindicated as it may cause catastrophic hemorrhage. The nurse
should notify the provider immediately and prepare for probable cesarean delivery.
Question 2: A nurse is calculating a client's expected date of delivery using Naegele's rule. The
client's last menstrual period (LMP) was June 10, 2022. What is the estimated delivery date?
A. March 3, 2023
B. March 17, 2023
C. March 24, 2023
D. April 10, 2023
Answer: B
,Rationale: Naegele's rule calculates EDD by subtracting 3 months from the first day of the LMP
and adding 7 days. June 10, 2022 minus 3 months equals March 10, 2023; plus 7 days equals
March 17, 2023. This assumes a 28-day menstrual cycle.
Question 3: A pregnant client at 28 weeks gestation reports increasing heartburn after meals.
Which recommendation should the nurse provide?
A. Consume three large meals daily to minimize gastric acid production
B. Lie down immediately after eating to promote digestion
C. Eat small, frequent meals and avoid lying down for 2 hours after eating
D. Increase intake of caffeinated beverages to stimulate gastric emptying
Answer: C
Rationale: Heartburn in pregnancy results from progesterone relaxing the lower esophageal
sphincter and the growing uterus displacing stomach contents. Small, frequent meals and
remaining upright after eating reduce reflux by minimizing gastric distention and utilizing gravity
to keep stomach contents down.
Question 4: A client's prenatal record indicates she has had 2 pregnancies resulting in deliveries
at 39 and 40 weeks, 1 pregnancy ending in miscarriage at 10 weeks, and currently has 2 living
children. How should the nurse document her GTPAL status?
A. G3 T2 P0 A1 L2
B. G4 T2 P0 A1 L2
C. G3 T2 P1 A0 L2
D. G4 T2 P1 A1 L2
Answer: B
Rationale: Gravida (G) counts all pregnancies including current (2 previous deliveries + 1
miscarriage + 1 current = 4). Term (T) is deliveries ≥37 weeks (2). Preterm (P) is 20-36.6 weeks
(0). Abortion (A) is <20 weeks (1). Living (L) is 2. Thus, G4 T2 P0 A1 L2 is correct.
Question 5: At which gestational age does the fetus typically achieve viability, defined as the
ability to survive outside the uterus with NICU support?
A. 20 weeks
B. 24 weeks
, C. 28 weeks
D. 32 weeks
Answer: B
Rationale: Fetal viability is generally achieved at approximately 24 weeks gestation when the
respiratory system has developed sufficiently to allow survival with intensive care support. Prior
to 24 weeks, the lungs lack adequate surfactant production and structural maturity for
extrauterine survival.
Question 6: A pregnant client at 18 weeks gestation asks when she might first feel fetal
movement. Which response by the nurse is most accurate?
A. "Most women feel movement between 16 and 20 weeks gestation"
B. "You should already be feeling strong kicks daily by now"
C. "First movements are typically felt around 24 weeks gestation"
D. "Fetal movement is not felt until the third trimester"
Answer: A
Rationale: Quickening, or the first perception of fetal movement, typically occurs between 16
and 20 weeks gestation for nulliparous women and may be felt slightly earlier (16-18 weeks) in
multiparous women due to their familiarity with the sensation.
Question 7: Which laboratory finding is considered a normal physiological adaptation of
pregnancy due to hemodilution?
A. Hemoglobin 14.2 g/dL
B. Hematocrit 42%
C. Hemoglobin 10.8 g/dL
D. White blood cell count 4,500/mm³
Answer: C
Rationale: Physiological anemia of pregnancy occurs due to plasma volume expansion (40-50%
increase) exceeding red blood cell mass increase (20-30%), resulting in hemodilution.
Hemoglobin levels between 10.5-11.5 g/dL are considered normal in the second trimester,
while levels below 10.5 g/dL indicate true anemia.
EXAM
INTRODUCTION:
This comprehensive practice examination is designed to prepare nursing students and graduate
nurses for the NACE 2023 Care of the Childbearing Family domain. Based on current 2023 NACE
test specifications and evidence-based maternal-child nursing practice guidelines from
AWHONN and ACOG, this exam covers essential content across antepartum, intrapartum,
postpartum, newborn, and high-risk conditions to assess readiness for advanced clinical
entrance.
SECTION 1: ANTEPARTUM CARE (Questions 1-20)
Question 1: A pregnant client at 36 weeks gestation reports sudden, painless bright red vaginal
bleeding. What is the nurse's priority action?
A. Perform a sterile vaginal exam to assess cervical dilation
B. Place the client in Trendelenburg position
C. Notify the healthcare provider immediately and prepare for possible cesarean delivery
D. Administer oxytocin to augment labor
Answer: C
Rationale: Painless bright red bleeding in the third trimester is classic for placenta previa.
Vaginal examination is contraindicated as it may cause catastrophic hemorrhage. The nurse
should notify the provider immediately and prepare for probable cesarean delivery.
Question 2: A nurse is calculating a client's expected date of delivery using Naegele's rule. The
client's last menstrual period (LMP) was June 10, 2022. What is the estimated delivery date?
A. March 3, 2023
B. March 17, 2023
C. March 24, 2023
D. April 10, 2023
Answer: B
,Rationale: Naegele's rule calculates EDD by subtracting 3 months from the first day of the LMP
and adding 7 days. June 10, 2022 minus 3 months equals March 10, 2023; plus 7 days equals
March 17, 2023. This assumes a 28-day menstrual cycle.
Question 3: A pregnant client at 28 weeks gestation reports increasing heartburn after meals.
Which recommendation should the nurse provide?
A. Consume three large meals daily to minimize gastric acid production
B. Lie down immediately after eating to promote digestion
C. Eat small, frequent meals and avoid lying down for 2 hours after eating
D. Increase intake of caffeinated beverages to stimulate gastric emptying
Answer: C
Rationale: Heartburn in pregnancy results from progesterone relaxing the lower esophageal
sphincter and the growing uterus displacing stomach contents. Small, frequent meals and
remaining upright after eating reduce reflux by minimizing gastric distention and utilizing gravity
to keep stomach contents down.
Question 4: A client's prenatal record indicates she has had 2 pregnancies resulting in deliveries
at 39 and 40 weeks, 1 pregnancy ending in miscarriage at 10 weeks, and currently has 2 living
children. How should the nurse document her GTPAL status?
A. G3 T2 P0 A1 L2
B. G4 T2 P0 A1 L2
C. G3 T2 P1 A0 L2
D. G4 T2 P1 A1 L2
Answer: B
Rationale: Gravida (G) counts all pregnancies including current (2 previous deliveries + 1
miscarriage + 1 current = 4). Term (T) is deliveries ≥37 weeks (2). Preterm (P) is 20-36.6 weeks
(0). Abortion (A) is <20 weeks (1). Living (L) is 2. Thus, G4 T2 P0 A1 L2 is correct.
Question 5: At which gestational age does the fetus typically achieve viability, defined as the
ability to survive outside the uterus with NICU support?
A. 20 weeks
B. 24 weeks
, C. 28 weeks
D. 32 weeks
Answer: B
Rationale: Fetal viability is generally achieved at approximately 24 weeks gestation when the
respiratory system has developed sufficiently to allow survival with intensive care support. Prior
to 24 weeks, the lungs lack adequate surfactant production and structural maturity for
extrauterine survival.
Question 6: A pregnant client at 18 weeks gestation asks when she might first feel fetal
movement. Which response by the nurse is most accurate?
A. "Most women feel movement between 16 and 20 weeks gestation"
B. "You should already be feeling strong kicks daily by now"
C. "First movements are typically felt around 24 weeks gestation"
D. "Fetal movement is not felt until the third trimester"
Answer: A
Rationale: Quickening, or the first perception of fetal movement, typically occurs between 16
and 20 weeks gestation for nulliparous women and may be felt slightly earlier (16-18 weeks) in
multiparous women due to their familiarity with the sensation.
Question 7: Which laboratory finding is considered a normal physiological adaptation of
pregnancy due to hemodilution?
A. Hemoglobin 14.2 g/dL
B. Hematocrit 42%
C. Hemoglobin 10.8 g/dL
D. White blood cell count 4,500/mm³
Answer: C
Rationale: Physiological anemia of pregnancy occurs due to plasma volume expansion (40-50%
increase) exceeding red blood cell mass increase (20-30%), resulting in hemodilution.
Hemoglobin levels between 10.5-11.5 g/dL are considered normal in the second trimester,
while levels below 10.5 g/dL indicate true anemia.
