Grand Canyon University
Course Number: NSG 432
Course Title: Nursing Care of the Childbearing Family
Exam: Final Exam
Date:2026
A patient at 32 weeks gestation presents with persistent vomiting and weight
loss. Laboratory results show ketonuria and electrolyte imbalances. What is the
priority nursing intervention for this patient?
A. Encourage small, frequent high-fat meals.
B. Initiate intravenous fluid replacement with vitamins and electrolytes.
C. Administer oral glucose supplements immediately.
D. Instruct the patient to increase caffeine intake to stimulate appetite.
Answer: B.
Rationale: Hyperemesis gravidarum requires rehydration and electrolyte
correction to prevent complications such as Wernicke encephalopathy.
Intravenous fluids are the gold standard when oral intake is impossible and
ketones are present.
A laboring patient’s fetal heart rate monitor shows a pattern of variable
decelerations. Which nursing action is most appropriate to address the likely
cause?
A. Increase the intravenous oxytocin infusion rate.
B. Assist the patient to a side-lying or knee-chest position.
C. Prepare for an immediate vacuum-assisted delivery.
D. Ask the patient to perform a Valsalva maneuver during contractions.
Answer: B.
Rationale: Variable decelerations are typically caused by umbilical cord
compression. Relieving the pressure on the cord through maternal position
changes is the first-line intervention to improve fetal oxygenation.
True or False: In a patient receiving a Magnesium Sulfate infusion for
preeclampsia, the nurse should expect the therapeutic serum magnesium level to
be between 10 and 15 mg/dL.
Answer: False.
Rationale: The therapeutic range for Magnesium Sulfate in the prevention of
seizures is 4 to 7 mEq/L (or approximately 5 to 8 mg/dL). Levels above 8 to 9
mg/dL are associated with toxicity, such as loss of deep tendon reflexes and
,respiratory depression.
Fill in the blank: The priority medication administered to a preterm neonate to
stimulate surfactant production and reduce the risk of Respiratory Distress
Syndrome (RDS) is ________.
Answer: Betamethasone (or Dexamethasone).
Rationale: Antenatal corticosteroids are administered to the mother when preterm
birth is imminent to accelerate fetal lung maturity by increasing surfactant
synthesis.
A nurse is caring for a patient at 38 weeks gestation who reports a sudden onset
of painless, bright red vaginal bleeding. Which action is strictly contraindicated
for this patient?
A. Monitoring fetal heart rate continuously.
B. Initiating a large-bore intravenous access.
C. Performing a digital vaginal examination.
D. Assessing the patient’s blood pressure and pulse.
Answer: C.
Rationale: Painless bright red bleeding is a classic sign of placenta previa. A
digital vaginal exam can trigger a catastrophic hemorrhage by puncturing the
placenta that is covering the cervical os.
During a postpartum assessment, the nurse notes that the patient's fundus is
boggy and displaced to the right of the midline. What is the nurse's first action?
A. Administer an intramuscular dose of methylergonovine.
B. Perform vigorous fundal massage for thirty minutes.
C. Assist the patient to the bathroom to void.
D. Notify the physician of a suspected uterine inversion.
Answer: C.
Rationale: A fundus displaced to the right usually indicates a distended bladder.
A full bladder prevents the uterus from contracting effectively, which can lead to
atony and hemorrhage. Emptying the bladder is the priority.
True or False: Late decelerations on a fetal monitor strip are considered a
reassuring sign if they occur during the second stage of labor.
Answer: False.
Rationale: Late decelerations are always non-reassuring as they indicate
uteroplacental insufficiency. They signify that the fetus is not receiving adequate
oxygen during and after a contraction.
Fill in the blank: The maneuver used to resolve shoulder dystocia that involves
flexing the mother's thighs tightly against her abdomen to widen the pelvic outlet
is known as the ________ maneuver.
Answer: McRoberts.
Rationale: The McRoberts maneuver is the first-line physical intervention for
shoulder dystocia, often combined with suprapubic pressure to dislodge the fetal
shoulder.
A patient at 34 weeks gestation presents with a board-like, painful abdomen and
dark red vaginal bleeding. What condition does the nurse suspect?
A. Placenta previa.
B. Uterine atony.
,C. Placental abruption.
D. Hydatidiform mole.
Answer: C.
Rationale: Placental abruption involves the premature separation of the placenta
from the uterine wall. It is characterized by severe abdominal pain, uterine
tenderness, and a rigid, board-like abdomen.
Which laboratory finding is the hallmark of HELLP syndrome in a pregnant
patient with severe preeclampsia?
A. Elevated blood urea nitrogen and creatinine.
B. Low serum potassium and high sodium.
C. Hemolysis, elevated liver enzymes, and low platelets.
D. Decreased hemoglobin and increased clotting time.
Answer: C.
Rationale: HELLP stands for Hemolysis, Elevated Liver enzymes, and Low
Platelets. It is a severe variant of preeclampsia that carries high maternal and
fetal morbidity risks.
True or False: Prophylactic Rho(D) immune globulin (RhoGAM) should be
administered to an Rh-negative mother at 28 weeks gestation and again within 72
hours after birth if the infant is Rh-positive.
Answer: True.
Rationale: RhoGAM prevents the Rh-negative mother from becoming sensitized
to Rh-positive fetal blood cells, which prevents hemolytic disease of the newborn
in future pregnancies.
Fill in the blank: The specialized assessment tool used to determine the cervical
readiness for labor induction by evaluating dilation, effacement, station,
consistency, and position is the ________ score.
Answer: Bishop.
Rationale: A Bishop score of 8 or more typically indicates that the cervix is
favorable and that a vaginal delivery is likely to be successful following
induction.
A nurse is assessing a neonate who was born at 42 weeks gestation. Which
physical characteristic is the nurse most likely to observe?
A. Abundant lanugo covering the back and shoulders.
B. Smooth, pink skin with visible veins.
C. Deep creases over the entire sole of the foot and peeling skin.
D. A thick covering of vernix caseosa over the entire body.
Answer: C.
Rationale: Post-term neonates typically show signs of placental aging, such as
dry, cracked, or leathery skin (desquamation) and advanced physical maturity
markers like deep sole creases.
What is the priority nursing intervention for a patient experiencing a prolapsed
umbilical cord?
A. Attempt to push the cord back into the uterus using sterile gloves.
B. Place the patient in a Trendelenburg or knee-chest position.
C. Increase the oxytocin infusion to speed up delivery.
D. Cover the cord with dry gauze to keep it from getting slippery.
, Answer: B.
Rationale: Changing the mother's position to knee-chest or Trendelenburg uses
gravity to shift the fetus off the cord, maintaining fetal blood flow until an
emergency cesarean can be performed.
True or False: Postpartum blues usually begin within the first few days after birth
and typically resolve without medical intervention within ten to fourteen days.
Answer: True.
Rationale: Postpartum blues are a transient period of emotional lability. If the
symptoms persist beyond two weeks or worsen, the patient should be screened
for postpartum depression.
Fill in the blank: The thick, yellow-orange precursor to breast milk that is
secreted during the first few days postpartum and is rich in antibodies is called
________.
Answer: Colostrum.
Rationale: Colostrum provides essential passive immunity (IgA) and nutrients for
the neonate before the transition to mature milk occurs.
A newborn is diagnosed with physiologic jaundice. Which factor is the most
likely cause of this condition?
A. An ABO blood group incompatibility with the mother.
B. The shortened lifespan of fetal red blood cells and hepatic immaturity.
C. A bacterial infection acquired during the birthing process.
D. Obstruction of the bile duct by a congenital anomaly.
Answer: B.
Rationale: Physiologic jaundice occurs after the first 24 hours of life because the
newborn's liver is not yet efficient at conjugating the bilirubin produced by the
rapid breakdown of fetal RBCs.
Which medication is frequently used to manage a postpartum hemorrhage when
the patient is also hypertensive?
A. Methylergonovine.
B. Oxytocin.
C. Carboprost tromethamine.
D. Misoprostol.
Answer: B or D. (Oxytocin is the first choice).
Rationale: Methylergonovine is a vasoconstrictor and is contraindicated in
patients with hypertension or preeclampsia because it can trigger a hypertensive
crisis or stroke.
True or False: A patient in active labor who has tested positive for Group B
Streptococcus (GBS) requires intravenous antibiotic prophylaxis at least four
hours prior to delivery.
Answer: True.
Rationale: GBS is a leading cause of neonatal sepsis and meningitis.
Administering antibiotics to the mother during labor significantly reduces the
risk of vertical transmission.
Fill in the blank: The surgical procedure performed to treat an incompetent
cervix by placing a heavy suture around the cervical os to prevent premature
dilation is called a ________.
Course Number: NSG 432
Course Title: Nursing Care of the Childbearing Family
Exam: Final Exam
Date:2026
A patient at 32 weeks gestation presents with persistent vomiting and weight
loss. Laboratory results show ketonuria and electrolyte imbalances. What is the
priority nursing intervention for this patient?
A. Encourage small, frequent high-fat meals.
B. Initiate intravenous fluid replacement with vitamins and electrolytes.
C. Administer oral glucose supplements immediately.
D. Instruct the patient to increase caffeine intake to stimulate appetite.
Answer: B.
Rationale: Hyperemesis gravidarum requires rehydration and electrolyte
correction to prevent complications such as Wernicke encephalopathy.
Intravenous fluids are the gold standard when oral intake is impossible and
ketones are present.
A laboring patient’s fetal heart rate monitor shows a pattern of variable
decelerations. Which nursing action is most appropriate to address the likely
cause?
A. Increase the intravenous oxytocin infusion rate.
B. Assist the patient to a side-lying or knee-chest position.
C. Prepare for an immediate vacuum-assisted delivery.
D. Ask the patient to perform a Valsalva maneuver during contractions.
Answer: B.
Rationale: Variable decelerations are typically caused by umbilical cord
compression. Relieving the pressure on the cord through maternal position
changes is the first-line intervention to improve fetal oxygenation.
True or False: In a patient receiving a Magnesium Sulfate infusion for
preeclampsia, the nurse should expect the therapeutic serum magnesium level to
be between 10 and 15 mg/dL.
Answer: False.
Rationale: The therapeutic range for Magnesium Sulfate in the prevention of
seizures is 4 to 7 mEq/L (or approximately 5 to 8 mg/dL). Levels above 8 to 9
mg/dL are associated with toxicity, such as loss of deep tendon reflexes and
,respiratory depression.
Fill in the blank: The priority medication administered to a preterm neonate to
stimulate surfactant production and reduce the risk of Respiratory Distress
Syndrome (RDS) is ________.
Answer: Betamethasone (or Dexamethasone).
Rationale: Antenatal corticosteroids are administered to the mother when preterm
birth is imminent to accelerate fetal lung maturity by increasing surfactant
synthesis.
A nurse is caring for a patient at 38 weeks gestation who reports a sudden onset
of painless, bright red vaginal bleeding. Which action is strictly contraindicated
for this patient?
A. Monitoring fetal heart rate continuously.
B. Initiating a large-bore intravenous access.
C. Performing a digital vaginal examination.
D. Assessing the patient’s blood pressure and pulse.
Answer: C.
Rationale: Painless bright red bleeding is a classic sign of placenta previa. A
digital vaginal exam can trigger a catastrophic hemorrhage by puncturing the
placenta that is covering the cervical os.
During a postpartum assessment, the nurse notes that the patient's fundus is
boggy and displaced to the right of the midline. What is the nurse's first action?
A. Administer an intramuscular dose of methylergonovine.
B. Perform vigorous fundal massage for thirty minutes.
C. Assist the patient to the bathroom to void.
D. Notify the physician of a suspected uterine inversion.
Answer: C.
Rationale: A fundus displaced to the right usually indicates a distended bladder.
A full bladder prevents the uterus from contracting effectively, which can lead to
atony and hemorrhage. Emptying the bladder is the priority.
True or False: Late decelerations on a fetal monitor strip are considered a
reassuring sign if they occur during the second stage of labor.
Answer: False.
Rationale: Late decelerations are always non-reassuring as they indicate
uteroplacental insufficiency. They signify that the fetus is not receiving adequate
oxygen during and after a contraction.
Fill in the blank: The maneuver used to resolve shoulder dystocia that involves
flexing the mother's thighs tightly against her abdomen to widen the pelvic outlet
is known as the ________ maneuver.
Answer: McRoberts.
Rationale: The McRoberts maneuver is the first-line physical intervention for
shoulder dystocia, often combined with suprapubic pressure to dislodge the fetal
shoulder.
A patient at 34 weeks gestation presents with a board-like, painful abdomen and
dark red vaginal bleeding. What condition does the nurse suspect?
A. Placenta previa.
B. Uterine atony.
,C. Placental abruption.
D. Hydatidiform mole.
Answer: C.
Rationale: Placental abruption involves the premature separation of the placenta
from the uterine wall. It is characterized by severe abdominal pain, uterine
tenderness, and a rigid, board-like abdomen.
Which laboratory finding is the hallmark of HELLP syndrome in a pregnant
patient with severe preeclampsia?
A. Elevated blood urea nitrogen and creatinine.
B. Low serum potassium and high sodium.
C. Hemolysis, elevated liver enzymes, and low platelets.
D. Decreased hemoglobin and increased clotting time.
Answer: C.
Rationale: HELLP stands for Hemolysis, Elevated Liver enzymes, and Low
Platelets. It is a severe variant of preeclampsia that carries high maternal and
fetal morbidity risks.
True or False: Prophylactic Rho(D) immune globulin (RhoGAM) should be
administered to an Rh-negative mother at 28 weeks gestation and again within 72
hours after birth if the infant is Rh-positive.
Answer: True.
Rationale: RhoGAM prevents the Rh-negative mother from becoming sensitized
to Rh-positive fetal blood cells, which prevents hemolytic disease of the newborn
in future pregnancies.
Fill in the blank: The specialized assessment tool used to determine the cervical
readiness for labor induction by evaluating dilation, effacement, station,
consistency, and position is the ________ score.
Answer: Bishop.
Rationale: A Bishop score of 8 or more typically indicates that the cervix is
favorable and that a vaginal delivery is likely to be successful following
induction.
A nurse is assessing a neonate who was born at 42 weeks gestation. Which
physical characteristic is the nurse most likely to observe?
A. Abundant lanugo covering the back and shoulders.
B. Smooth, pink skin with visible veins.
C. Deep creases over the entire sole of the foot and peeling skin.
D. A thick covering of vernix caseosa over the entire body.
Answer: C.
Rationale: Post-term neonates typically show signs of placental aging, such as
dry, cracked, or leathery skin (desquamation) and advanced physical maturity
markers like deep sole creases.
What is the priority nursing intervention for a patient experiencing a prolapsed
umbilical cord?
A. Attempt to push the cord back into the uterus using sterile gloves.
B. Place the patient in a Trendelenburg or knee-chest position.
C. Increase the oxytocin infusion to speed up delivery.
D. Cover the cord with dry gauze to keep it from getting slippery.
, Answer: B.
Rationale: Changing the mother's position to knee-chest or Trendelenburg uses
gravity to shift the fetus off the cord, maintaining fetal blood flow until an
emergency cesarean can be performed.
True or False: Postpartum blues usually begin within the first few days after birth
and typically resolve without medical intervention within ten to fourteen days.
Answer: True.
Rationale: Postpartum blues are a transient period of emotional lability. If the
symptoms persist beyond two weeks or worsen, the patient should be screened
for postpartum depression.
Fill in the blank: The thick, yellow-orange precursor to breast milk that is
secreted during the first few days postpartum and is rich in antibodies is called
________.
Answer: Colostrum.
Rationale: Colostrum provides essential passive immunity (IgA) and nutrients for
the neonate before the transition to mature milk occurs.
A newborn is diagnosed with physiologic jaundice. Which factor is the most
likely cause of this condition?
A. An ABO blood group incompatibility with the mother.
B. The shortened lifespan of fetal red blood cells and hepatic immaturity.
C. A bacterial infection acquired during the birthing process.
D. Obstruction of the bile duct by a congenital anomaly.
Answer: B.
Rationale: Physiologic jaundice occurs after the first 24 hours of life because the
newborn's liver is not yet efficient at conjugating the bilirubin produced by the
rapid breakdown of fetal RBCs.
Which medication is frequently used to manage a postpartum hemorrhage when
the patient is also hypertensive?
A. Methylergonovine.
B. Oxytocin.
C. Carboprost tromethamine.
D. Misoprostol.
Answer: B or D. (Oxytocin is the first choice).
Rationale: Methylergonovine is a vasoconstrictor and is contraindicated in
patients with hypertension or preeclampsia because it can trigger a hypertensive
crisis or stroke.
True or False: A patient in active labor who has tested positive for Group B
Streptococcus (GBS) requires intravenous antibiotic prophylaxis at least four
hours prior to delivery.
Answer: True.
Rationale: GBS is a leading cause of neonatal sepsis and meningitis.
Administering antibiotics to the mother during labor significantly reduces the
risk of vertical transmission.
Fill in the blank: The surgical procedure performed to treat an incompetent
cervix by placing a heavy suture around the cervical os to prevent premature
dilation is called a ________.
