The Ultimate and Complete THE COURSE NACE Care of the
Childbearing Family Study Guide 2025, Covering Prenatal Care
and Maternal Assessment, Labor and Delivery Nursing
Management, Postpartum and Newborn Care, Fetal
Development and Monitoring, High-Risk Pregnancy
Complications, Obstetric Emergencies and Interventions, Family-
Centered Maternity Nursing, Pain Management During
Childbirth, Maternal and Neonatal Safety, Breastfeeding and
Newborn Nutrition, Practice Questions with Verified Answers
and Detailed Rationales, Real Clinical Obstetric Scenarios, Step-
by-Step Maternity Nursing Procedures, and Proven Strategies to
Successfully Pass NACE Care of the Childbearing Family Exams
with Confidence
Question 1: During the initial prenatal visit, a nurse assesses a client at 10 weeks gestation.
Which finding should the nurse prioritize for immediate follow-up?
A. Mild nausea reported in the mornings
B. Blood pressure reading of 142/92 mmHg
C. Weight gain of 1.5 kg since last menstrual period
D. Complaint of increased vaginal discharge
CORRECT ANSWER: B. Blood pressure reading of 142/92 mmHg
Rationale: A blood pressure reading of 142/92 mmHg meets criteria for hypertension in
pregnancy and requires immediate evaluation to rule out chronic hypertension or early-onset
preeclampsia. Mild nausea, modest early weight gain, and increased leukorrhea are common,
expected findings in the first trimester and do not require urgent intervention.
Question 2: A nurse is teaching a pregnant client about fetal development. At which
gestational age should the nurse inform the client that the fetus typically develops audible
heart tones via Doppler ultrasound?
A. 6 to 8 weeks
B. 10 to 12 weeks
C. 14 to 16 weeks
D. 18 to 20 weeks
,CORRECT ANSWER: B. 10 to 12 weeks
Rationale: Fetal heart tones are typically detectable by Doppler ultrasound between 10 and 12
weeks of gestation. While cardiac activity begins around 6 weeks, it is usually not audible
externally until later. Detection by 18–20 weeks is typical with a fetoscope, not Doppler.
Question 3: Which statement by a pregnant client at 28 weeks gestation indicates
understanding of danger signs requiring immediate medical attention?
A. "I should call my provider if I have occasional headaches that go away with rest."
B. "I will report any sudden swelling of my face or hands right away."
C. "It's normal to have mild cramping after walking for 30 minutes."
D. "I can wait until my next appointment if I notice decreased fetal movement."
CORRECT ANSWER: B. I will report any sudden swelling of my face or hands right away.
Rationale: Sudden edema of the face or hands is a classic sign of preeclampsia and requires
immediate evaluation. Occasional headaches relieved by rest, mild cramping with activity, and
delayed reporting of decreased fetal movement are not appropriate responses to potential
warning signs; decreased fetal movement should always be reported promptly.
Question 4: A nurse is preparing to perform a Leopold maneuver on a client at 36 weeks
gestation. What is the primary purpose of this assessment technique?
A. To assess cervical dilation and effacement
B. To determine fetal presentation, position, and engagement
C. To evaluate uterine contraction frequency and intensity
D. To measure fundal height in centimeters
CORRECT ANSWER: B. To determine fetal presentation, position, and engagement
Rationale: Leopold maneuvers are a systematic method of abdominal palpation used to
determine fetal presentation (e.g., cephalic, breech), position (e.g., occiput anterior), and
whether the presenting part is engaged in the pelvis. Cervical assessment requires a vaginal
exam, contraction monitoring requires tocodynamometry or palpation over time, and fundal
height is measured with a tape measure.
Question 5: Which nutritional recommendation is most appropriate for a pregnant client with
iron-deficiency anemia?
A. Increase intake of dairy products to enhance iron absorption
B. Consume iron-rich foods with vitamin C sources to improve absorption
C. Take iron supplements with antacids to reduce gastric irritation
D. Limit red meat consumption to decrease cholesterol intake
,CORRECT ANSWER: B. Consume iron-rich foods with vitamin C sources to improve absorption
Rationale: Vitamin C enhances non-heme iron absorption from plant-based foods. Dairy
products and antacids contain calcium or alkaline substances that inhibit iron absorption. Red
meat provides highly bioavailable heme iron and should not be unnecessarily restricted in
anemia management.
Question 6: A client at 32 weeks gestation reports experiencing heartburn after meals. Which
nursing intervention is most appropriate?
A. Advise the client to lie down for 30 minutes after eating
B. Recommend eating large, infrequent meals to reduce gastric stimulation
C. Suggest avoiding spicy, fatty, or acidic foods and eating smaller, frequent meals
D. Instruct the client to take over-the-counter antacids containing sodium bicarbonate daily
CORRECT ANSWER: C. Suggest avoiding spicy, fatty, or acidic foods and eating smaller,
frequent meals
Rationale: Physiologic heartburn in pregnancy results from progesterone-induced relaxation of
the lower esophageal sphincter and gastric displacement by the enlarging uterus. Dietary
modifications like smaller meals and avoiding triggers are first-line interventions. Lying down
after eating worsens reflux, large meals increase gastric pressure, and sodium bicarbonate-
containing antacids may cause fluid retention and are not recommended for routine use.
Question 7: Which finding during a prenatal assessment at 20 weeks gestation is considered
abnormal and warrants further investigation?
A. Fundal height measuring 22 cm
B. Fetal heart rate of 150 beats per minute
C. Presence of a systolic heart murmur
D. Proteinuria of 2+ on dipstick testing
CORRECT ANSWER: D. Proteinuria of 2+ on dipstick testing
Rationale: Proteinuria of 2+ or greater on dipstick testing is abnormal and may indicate
preeclampsia, especially if accompanied by hypertension. Fundal height within 2 cm of
gestational age, fetal heart rate between 110–160 bpm, and soft systolic murmurs (due to
increased blood volume) are common, expected findings in mid-pregnancy.
Question 8: A nurse is educating a pregnant client about the benefits of prenatal exercise.
Which statement by the client indicates a need for further teaching?
A. "I can continue my regular yoga routine as long as I avoid hot yoga."
B. "Swimming is a good option because it supports my joints."
, C. "I should stop exercising if I feel dizzy or short of breath."
D. "I will aim for high-impact aerobics to improve my cardiovascular fitness."
CORRECT ANSWER: D. I will aim for high-impact aerobics to improve my cardiovascular
fitness.
Rationale: High-impact activities increase the risk of joint injury and falls due to pregnancy-
related ligamentous laxity and shifts in center of gravity. Low-impact exercises like walking,
swimming, and modified yoga are preferred. The other statements reflect appropriate
understanding of safe exercise practices during pregnancy.
Question 9: Which assessment finding in a client at 38 weeks gestation suggests the onset of
true labor?
A. Irregular contractions that decrease with ambulation
B. Contractions that become progressively longer, stronger, and closer together
C. Passage of a small amount of bloody show without cervical change
D. Rupture of membranes with clear fluid but no contractions
CORRECT ANSWER: B. Contractions that become progressively longer, stronger, and closer
together
Rationale: True labor is characterized by regular, progressive contractions that increase in
frequency, duration, and intensity and are not relieved by position change or rest. Bloody show
and rupture of membranes may occur before or during labor but are not definitive indicators
alone. Irregular contractions that diminish with activity suggest false labor.
Question 10: A nurse is reviewing the electronic fetal monitor tracing for a client in active
labor. Which pattern requires immediate nursing intervention?
A. Early decelerations with contractions
B. Moderate variability with accelerations
C. Late decelerations with minimal variability
D. Variable decelerations with rapid return to baseline
CORRECT ANSWER: C. Late decelerations with minimal variability
Rationale: Late decelerations with minimal variability indicate uteroplacental insufficiency and
fetal hypoxia, requiring immediate interventions such as maternal position change, oxygen
administration, IV fluid bolus, and notification of the provider. Early decelerations are benign
and head-compression related; moderate variability with accelerations is reassuring; variable
decelerations with rapid recovery are often cord-compression related but may be managed
conservatively if intermittent.
Childbearing Family Study Guide 2025, Covering Prenatal Care
and Maternal Assessment, Labor and Delivery Nursing
Management, Postpartum and Newborn Care, Fetal
Development and Monitoring, High-Risk Pregnancy
Complications, Obstetric Emergencies and Interventions, Family-
Centered Maternity Nursing, Pain Management During
Childbirth, Maternal and Neonatal Safety, Breastfeeding and
Newborn Nutrition, Practice Questions with Verified Answers
and Detailed Rationales, Real Clinical Obstetric Scenarios, Step-
by-Step Maternity Nursing Procedures, and Proven Strategies to
Successfully Pass NACE Care of the Childbearing Family Exams
with Confidence
Question 1: During the initial prenatal visit, a nurse assesses a client at 10 weeks gestation.
Which finding should the nurse prioritize for immediate follow-up?
A. Mild nausea reported in the mornings
B. Blood pressure reading of 142/92 mmHg
C. Weight gain of 1.5 kg since last menstrual period
D. Complaint of increased vaginal discharge
CORRECT ANSWER: B. Blood pressure reading of 142/92 mmHg
Rationale: A blood pressure reading of 142/92 mmHg meets criteria for hypertension in
pregnancy and requires immediate evaluation to rule out chronic hypertension or early-onset
preeclampsia. Mild nausea, modest early weight gain, and increased leukorrhea are common,
expected findings in the first trimester and do not require urgent intervention.
Question 2: A nurse is teaching a pregnant client about fetal development. At which
gestational age should the nurse inform the client that the fetus typically develops audible
heart tones via Doppler ultrasound?
A. 6 to 8 weeks
B. 10 to 12 weeks
C. 14 to 16 weeks
D. 18 to 20 weeks
,CORRECT ANSWER: B. 10 to 12 weeks
Rationale: Fetal heart tones are typically detectable by Doppler ultrasound between 10 and 12
weeks of gestation. While cardiac activity begins around 6 weeks, it is usually not audible
externally until later. Detection by 18–20 weeks is typical with a fetoscope, not Doppler.
Question 3: Which statement by a pregnant client at 28 weeks gestation indicates
understanding of danger signs requiring immediate medical attention?
A. "I should call my provider if I have occasional headaches that go away with rest."
B. "I will report any sudden swelling of my face or hands right away."
C. "It's normal to have mild cramping after walking for 30 minutes."
D. "I can wait until my next appointment if I notice decreased fetal movement."
CORRECT ANSWER: B. I will report any sudden swelling of my face or hands right away.
Rationale: Sudden edema of the face or hands is a classic sign of preeclampsia and requires
immediate evaluation. Occasional headaches relieved by rest, mild cramping with activity, and
delayed reporting of decreased fetal movement are not appropriate responses to potential
warning signs; decreased fetal movement should always be reported promptly.
Question 4: A nurse is preparing to perform a Leopold maneuver on a client at 36 weeks
gestation. What is the primary purpose of this assessment technique?
A. To assess cervical dilation and effacement
B. To determine fetal presentation, position, and engagement
C. To evaluate uterine contraction frequency and intensity
D. To measure fundal height in centimeters
CORRECT ANSWER: B. To determine fetal presentation, position, and engagement
Rationale: Leopold maneuvers are a systematic method of abdominal palpation used to
determine fetal presentation (e.g., cephalic, breech), position (e.g., occiput anterior), and
whether the presenting part is engaged in the pelvis. Cervical assessment requires a vaginal
exam, contraction monitoring requires tocodynamometry or palpation over time, and fundal
height is measured with a tape measure.
Question 5: Which nutritional recommendation is most appropriate for a pregnant client with
iron-deficiency anemia?
A. Increase intake of dairy products to enhance iron absorption
B. Consume iron-rich foods with vitamin C sources to improve absorption
C. Take iron supplements with antacids to reduce gastric irritation
D. Limit red meat consumption to decrease cholesterol intake
,CORRECT ANSWER: B. Consume iron-rich foods with vitamin C sources to improve absorption
Rationale: Vitamin C enhances non-heme iron absorption from plant-based foods. Dairy
products and antacids contain calcium or alkaline substances that inhibit iron absorption. Red
meat provides highly bioavailable heme iron and should not be unnecessarily restricted in
anemia management.
Question 6: A client at 32 weeks gestation reports experiencing heartburn after meals. Which
nursing intervention is most appropriate?
A. Advise the client to lie down for 30 minutes after eating
B. Recommend eating large, infrequent meals to reduce gastric stimulation
C. Suggest avoiding spicy, fatty, or acidic foods and eating smaller, frequent meals
D. Instruct the client to take over-the-counter antacids containing sodium bicarbonate daily
CORRECT ANSWER: C. Suggest avoiding spicy, fatty, or acidic foods and eating smaller,
frequent meals
Rationale: Physiologic heartburn in pregnancy results from progesterone-induced relaxation of
the lower esophageal sphincter and gastric displacement by the enlarging uterus. Dietary
modifications like smaller meals and avoiding triggers are first-line interventions. Lying down
after eating worsens reflux, large meals increase gastric pressure, and sodium bicarbonate-
containing antacids may cause fluid retention and are not recommended for routine use.
Question 7: Which finding during a prenatal assessment at 20 weeks gestation is considered
abnormal and warrants further investigation?
A. Fundal height measuring 22 cm
B. Fetal heart rate of 150 beats per minute
C. Presence of a systolic heart murmur
D. Proteinuria of 2+ on dipstick testing
CORRECT ANSWER: D. Proteinuria of 2+ on dipstick testing
Rationale: Proteinuria of 2+ or greater on dipstick testing is abnormal and may indicate
preeclampsia, especially if accompanied by hypertension. Fundal height within 2 cm of
gestational age, fetal heart rate between 110–160 bpm, and soft systolic murmurs (due to
increased blood volume) are common, expected findings in mid-pregnancy.
Question 8: A nurse is educating a pregnant client about the benefits of prenatal exercise.
Which statement by the client indicates a need for further teaching?
A. "I can continue my regular yoga routine as long as I avoid hot yoga."
B. "Swimming is a good option because it supports my joints."
, C. "I should stop exercising if I feel dizzy or short of breath."
D. "I will aim for high-impact aerobics to improve my cardiovascular fitness."
CORRECT ANSWER: D. I will aim for high-impact aerobics to improve my cardiovascular
fitness.
Rationale: High-impact activities increase the risk of joint injury and falls due to pregnancy-
related ligamentous laxity and shifts in center of gravity. Low-impact exercises like walking,
swimming, and modified yoga are preferred. The other statements reflect appropriate
understanding of safe exercise practices during pregnancy.
Question 9: Which assessment finding in a client at 38 weeks gestation suggests the onset of
true labor?
A. Irregular contractions that decrease with ambulation
B. Contractions that become progressively longer, stronger, and closer together
C. Passage of a small amount of bloody show without cervical change
D. Rupture of membranes with clear fluid but no contractions
CORRECT ANSWER: B. Contractions that become progressively longer, stronger, and closer
together
Rationale: True labor is characterized by regular, progressive contractions that increase in
frequency, duration, and intensity and are not relieved by position change or rest. Bloody show
and rupture of membranes may occur before or during labor but are not definitive indicators
alone. Irregular contractions that diminish with activity suggest false labor.
Question 10: A nurse is reviewing the electronic fetal monitor tracing for a client in active
labor. Which pattern requires immediate nursing intervention?
A. Early decelerations with contractions
B. Moderate variability with accelerations
C. Late decelerations with minimal variability
D. Variable decelerations with rapid return to baseline
CORRECT ANSWER: C. Late decelerations with minimal variability
Rationale: Late decelerations with minimal variability indicate uteroplacental insufficiency and
fetal hypoxia, requiring immediate interventions such as maternal position change, oxygen
administration, IV fluid bolus, and notification of the provider. Early decelerations are benign
and head-compression related; moderate variability with accelerations is reassuring; variable
decelerations with rapid recovery are often cord-compression related but may be managed
conservatively if intermittent.
