NUR 230/ NUR230 Exam 2 – Concepts
of Nursing: The Childbearing/Child
Caring Family Review ACTUAL EXAM
2026/2027 | Childbearing/Child Caring
Family | Verified Q&A | Pass Guaranteed
- A+ Graded
ART A – MULTIPLE CHOICE (Q1–60)
P
Q1 (Postpartum – hemorrhage cause): A multiparous client delivered vaginally 2 hours ago. The
nurse notes the uterine fundus is boggy and displaced to the right. The lochia is heavy with
large clots. What is the priority nursing action?
A. Increase the IV oxytocin infusion rate and massage the fundus
B. Insert an indwelling urinary catheter
C. Prepare the client for emergency hysterectomy
D. Administer a dose of methylergonovine (Methergine) intramuscularly
[CORRECT] A
Rationale: A boggy, displaced fundus with heavy lochia indicates uterine atony (the most
common cause of postpartum hemorrhage, accounting for 70-80% of cases). The 2022
AWHONN postpartum hemorrhage protocol prioritizes uterine massage and uterotonic agents
(oxytocin as first-line) to promote contraction. The fundus displaced to the right suggests a full
bladder, but the immediate priority is controlling bleeding through fundal massage and oxytocin;
bladder emptying follows once hemorrhage is stabilized. A common student error is choosing
bladder emptying first—while a full bladder contributes to atony, active bleeding takes priority
per the MTP (Massive Transfusion Protocol) cascade.
Q2 (Postpartum – lochia progression): On postpartum day 3, a client reports that her lochia has
changed from bright red to pink-brown and is decreasing in amount. The nurse should
recognize this as:
A. A sign of impending postpartum hemorrhage
B. Normal progression from lochia rubra to lochia serosa
C. An indication of endometrial infection
D. Evidence of retained placental fragments
[CORRECT] B
Rationale: Normal lochia progresses through three stages: rubra (days 1-3, bright red, moderate
to heavy), serosa (days 3-10, pink-brown, serous, decreasing amount), and alba (days 10-14+,
, hite/yellow, minimal). ACOG guidelines confirm this timeline as expected physiologic
w
involution. Students often confuse lochia serosa with infection—endometritis would present with
foul-smelling lochia, fever, and uterine tenderness, not simply a color change. Clinical pearl:
Document lochia characteristics at every postpartum assessment using the acronym REEDA
(Redness, Edema, Ecchymosis, Discharge, Approximation) for perineal assessment, but apply
similar systematic documentation to lochia.
Q3 (Postpartum – endometritis): A client is postpartum day 2 after cesarean birth. She develops
a temperature of 38.5°C (101.3°F), tachycardia, and uterine tenderness with foul-smelling
lochia. Which organism is most commonly responsible?
A. Streptococcus pneumoniae
B. Escherichia coli
C. Group A beta-hemolytic Streptococcus
D. Polymicrobial vaginal flora (anaerobes, Gardnerella, enteric gram-negative rods)
[CORRECT] D
Rationale: Postpartum endometritis is typically polymicrobial, involving anaerobes (Prevotella,
Peptostreptococcus), Gardnerella vaginalis, and enteric gram-negative rods (E. coli, Klebsiella).
ACOG and CDC guidelines recommend broad-spectrum antibiotic coverage (clindamycin +
gentamicin) to address this polymicrobial nature. Students frequently select a single organism;
however, the ascending infection pathway from vaginal flora makes polymicrobial involvement
the rule, not the exception, especially after cesarean birth where risk increases 5-10 fold.
Clinical pearl: Endometritis after vaginal delivery is less common (1-3%) compared to cesarean
delivery (10-30%).
Q4 (Postpartum – mastitis): A breastfeeding client presents with a localized area of redness,
warmth, and tenderness on the right breast, accompanied by fever of 38.8°C (101.8°F) and
flu-like symptoms. Which nursing intervention is most appropriate?
A. Discontinue breastfeeding from the affected breast and pump only
B. Apply warm compresses and encourage frequent breastfeeding from the affected breast
C. Initiate immediate antibiotic therapy with vancomycin
D. Recommend binding the breast to suppress milk production
[CORRECT] B
Rationale: Mastitis (most commonly caused by Staphylococcus aureus, including MRSA)
requires continued breastfeeding or pumping from the affected breast to empty the breast and
prevent milk stasis, which worsens infection. AWHONN and ABM (Academy of Breastfeeding
Medicine) Protocol #4 recommend warm compresses, breast emptying, and dicloxacillin or
cephalexin (not vancomycin unless MRSA confirmed). Students often incorrectly advise
stopping breastfeeding—this leads to engorgement, abscess formation, and premature
weaning. Clinical pearl: The affected breast may be too sore for the infant to latch initially; start
with pumping or hand expression until comfort improves, then resume direct breastfeeding.
Q5 (Postpartum – DVT prevention): A postpartum client on bed rest for preeclampsia
management asks the nurse about preventing blood clots. Which statement by the nurse is
most accurate?
A. "You should remain on strict bed rest with no leg movement to prevent bleeding."
B. "I will teach you ankle pumps and leg exercises, and we will apply sequential compression
devices."
, . "Blood thinners are contraindicated in all postpartum clients due to bleeding risk."
C
D. "DVT only occurs in clients with cesarean deliveries, so you are not at risk."
[CORRECT] B
Rationale: Postpartum clients, especially those on bed rest or with preeclampsia, are at
increased risk for venous thromboembolism (VTE). ACOG and RCOG guidelines recommend
mechanical prophylaxis (sequential compression devices, SCDs) and early ambulation/leg
exercises; pharmacologic prophylaxis (low molecular weight heparin) is indicated for high-risk
clients. Students may incorrectly believe bed rest means immobility—active leg exercises and
SCDs are essential. Clinical pearl: The Virchow triad (stasis, hypercoagulability, endothelial
injury) is exaggerated in pregnancy and the postpartum period; preeclampsia further increases
coagulation activation.
Q6 (Postpartum – depression screening): During a 6-week postpartum visit, a client scores 14
on the Edinburgh Postnatal Depression Scale (EPDS). Which action is most appropriate?
A. Reassure the client that this is normal "baby blues" and schedule routine follow-up
B. Immediately initiate an involuntary psychiatric hold
C. Conduct further assessment, provide resources, and consider referral for counseling
D. Prescribe an SSRI without additional assessment
[CORRECT] C
Rationale: The EPDS score of 14 indicates probable postpartum depression (cutoff ≥10-13
suggests possible depression; ≥13-14 warrants further evaluation). AAP 2026 and ACOG
guidelines recommend perinatal depression screening at least once during pregnancy and
postpartum, with follow-up assessment and referral. Students may confuse baby blues
(self-limited, days 3-14, mild mood lability) with postpartum depression (persistent >2 weeks,
interferes with functioning). Clinical pearl: The EPDS item 10 (thoughts of self-harm) requires
immediate safety assessment; if positive, emergency protocols apply regardless of total score.
Q7 (Postpartum – psychosis): A client delivered 10 days ago and is brought to the emergency
department by her partner, who reports she has not slept in 72 hours, is hyperverbal, and stated
the baby is "possessed by demons." Which priority action is required?
A. Outpatient referral to a lactation consultant
B. Immediate psychiatric evaluation with potential inpatient admission
C. Schedule a routine postpartum check in 2 weeks
D. Administer a sedative and discharge home with family support
[CORRECT] B
Rationale: Postpartum psychosis is a psychiatric emergency with onset typically within 2 weeks
postpartum, featuring delusions, hallucinations, paranoia, and rapid mood swings. ACOG and
APA guidelines mandate immediate psychiatric evaluation due to high risk of infanticide and
suicide (risk 4.5% and 5%, respectively). Students may underestimate the urgency, confusing
psychosis with depression. Clinical pearl: Postpartum psychosis requires mood stabilizers
(lithium, antipsychotics) and hospitalization; breastfeeding is usually contraindicated with these
medications due to infant safety.
Q8 (Newborn – breastfeeding latch): A nurse observes a breastfeeding newborn. Which finding
indicates a correct latch?
A. The infant's lips are pursed and turned inward
B. Audible clicking sounds are heard during feeding
, . The infant's mouth is wide open with lower lip flanged outward and chin touching the breast
C
D. The infant feeds for exactly 5 minutes on each breast
[CORRECT] C
Rationale: A correct latch (per AAP 2026 and ABM protocols) requires a wide-open mouth,
lower lip flanged outward (not tucked in), chin touching the breast, and audible swallowing (not
clicking, which indicates poor suction). Pursed lips and clicking indicate poor latch and potential
nipple trauma. Students often focus on feeding duration rather than quality; AAP recommends
feeding on demand, not rigid timing. Clinical pearl: The "asymmetric latch" technique (more
areola visible above the upper lip than below the lower lip) optimizes milk transfer and reduces
nipple pain.
Q9 (Newborn – colostrum benefits): A new mother asks why colostrum is important for her term
newborn. Which response by the nurse is most accurate?
A. "Colostrum is primarily water and provides hydration only."
B. "Colostrum contains high levels of immunoglobulin A, lactoferrin, and living white blood cells
that provide passive immunity."
C. "Colostrum should be discarded until mature milk arrives on day 3."
D. "Colostrum causes jaundice and should be limited."
[CORRECT] B
Rationale: Colostrum (produced days 1-3) is rich in secretory IgA (provides mucosal immunity),
lactoferrin (iron-binding, antimicrobial), leukocytes, growth factors, and prebiotics. AAP 2026
and WHO recommend exclusive breastfeeding from birth, recognizing colostrum as "liquid gold."
Students may underestimate colostrum's value or incorrectly believe it insufficient. Clinical pearl:
Colostrum volumes (5-10 mL per feed) perfectly match the newborn's small stomach capacity
(5-7 mL day 1); frequent feeding (8-12 times/24 hours) establishes milk supply.
Q10 (Newborn – feeding cues): A nurse is teaching a new mother about infant feeding cues.
Which behavior indicates the infant is ready to feed?
A. Crying vigorously for 10 minutes
B. Bringing hands to mouth and making sucking motions
C. Turning away from the breast and falling asleep
D. Hiccupping after a feeding
[CORRECT] B
Rationale: Early feeding cues (per AAP and UNICEF Baby-Friendly protocols) include stirring,
mouth opening, tongue protrusion, hand-to-mouth movements, and rooting. Crying is a late cue
indicating distress; waiting until crying may lead to latch difficulties. Students often mistake
crying as the primary cue. Clinical pearl: Teach parents to recognize the feeding readiness
continuum: early cues (mouth movements) → mid cues (rooting, stretching) → late cues (crying,
color change); respond to early cues for optimal feeding success.
Q11 (Newborn – formula preparation): A mother chooses to formula feed. Which instruction is
most accurate regarding formula preparation?
A. "You can prepare bottles in advance and leave them at room temperature for up to 8 hours."
B. "Use boiled water that has cooled, measure powder precisely, and refrigerate prepared
bottles for up to 24 hours."
C. "Microwave the bottle for 30 seconds to warm it quickly before feeding."
D. "Dilute the formula with extra water to help with constipation."
of Nursing: The Childbearing/Child
Caring Family Review ACTUAL EXAM
2026/2027 | Childbearing/Child Caring
Family | Verified Q&A | Pass Guaranteed
- A+ Graded
ART A – MULTIPLE CHOICE (Q1–60)
P
Q1 (Postpartum – hemorrhage cause): A multiparous client delivered vaginally 2 hours ago. The
nurse notes the uterine fundus is boggy and displaced to the right. The lochia is heavy with
large clots. What is the priority nursing action?
A. Increase the IV oxytocin infusion rate and massage the fundus
B. Insert an indwelling urinary catheter
C. Prepare the client for emergency hysterectomy
D. Administer a dose of methylergonovine (Methergine) intramuscularly
[CORRECT] A
Rationale: A boggy, displaced fundus with heavy lochia indicates uterine atony (the most
common cause of postpartum hemorrhage, accounting for 70-80% of cases). The 2022
AWHONN postpartum hemorrhage protocol prioritizes uterine massage and uterotonic agents
(oxytocin as first-line) to promote contraction. The fundus displaced to the right suggests a full
bladder, but the immediate priority is controlling bleeding through fundal massage and oxytocin;
bladder emptying follows once hemorrhage is stabilized. A common student error is choosing
bladder emptying first—while a full bladder contributes to atony, active bleeding takes priority
per the MTP (Massive Transfusion Protocol) cascade.
Q2 (Postpartum – lochia progression): On postpartum day 3, a client reports that her lochia has
changed from bright red to pink-brown and is decreasing in amount. The nurse should
recognize this as:
A. A sign of impending postpartum hemorrhage
B. Normal progression from lochia rubra to lochia serosa
C. An indication of endometrial infection
D. Evidence of retained placental fragments
[CORRECT] B
Rationale: Normal lochia progresses through three stages: rubra (days 1-3, bright red, moderate
to heavy), serosa (days 3-10, pink-brown, serous, decreasing amount), and alba (days 10-14+,
, hite/yellow, minimal). ACOG guidelines confirm this timeline as expected physiologic
w
involution. Students often confuse lochia serosa with infection—endometritis would present with
foul-smelling lochia, fever, and uterine tenderness, not simply a color change. Clinical pearl:
Document lochia characteristics at every postpartum assessment using the acronym REEDA
(Redness, Edema, Ecchymosis, Discharge, Approximation) for perineal assessment, but apply
similar systematic documentation to lochia.
Q3 (Postpartum – endometritis): A client is postpartum day 2 after cesarean birth. She develops
a temperature of 38.5°C (101.3°F), tachycardia, and uterine tenderness with foul-smelling
lochia. Which organism is most commonly responsible?
A. Streptococcus pneumoniae
B. Escherichia coli
C. Group A beta-hemolytic Streptococcus
D. Polymicrobial vaginal flora (anaerobes, Gardnerella, enteric gram-negative rods)
[CORRECT] D
Rationale: Postpartum endometritis is typically polymicrobial, involving anaerobes (Prevotella,
Peptostreptococcus), Gardnerella vaginalis, and enteric gram-negative rods (E. coli, Klebsiella).
ACOG and CDC guidelines recommend broad-spectrum antibiotic coverage (clindamycin +
gentamicin) to address this polymicrobial nature. Students frequently select a single organism;
however, the ascending infection pathway from vaginal flora makes polymicrobial involvement
the rule, not the exception, especially after cesarean birth where risk increases 5-10 fold.
Clinical pearl: Endometritis after vaginal delivery is less common (1-3%) compared to cesarean
delivery (10-30%).
Q4 (Postpartum – mastitis): A breastfeeding client presents with a localized area of redness,
warmth, and tenderness on the right breast, accompanied by fever of 38.8°C (101.8°F) and
flu-like symptoms. Which nursing intervention is most appropriate?
A. Discontinue breastfeeding from the affected breast and pump only
B. Apply warm compresses and encourage frequent breastfeeding from the affected breast
C. Initiate immediate antibiotic therapy with vancomycin
D. Recommend binding the breast to suppress milk production
[CORRECT] B
Rationale: Mastitis (most commonly caused by Staphylococcus aureus, including MRSA)
requires continued breastfeeding or pumping from the affected breast to empty the breast and
prevent milk stasis, which worsens infection. AWHONN and ABM (Academy of Breastfeeding
Medicine) Protocol #4 recommend warm compresses, breast emptying, and dicloxacillin or
cephalexin (not vancomycin unless MRSA confirmed). Students often incorrectly advise
stopping breastfeeding—this leads to engorgement, abscess formation, and premature
weaning. Clinical pearl: The affected breast may be too sore for the infant to latch initially; start
with pumping or hand expression until comfort improves, then resume direct breastfeeding.
Q5 (Postpartum – DVT prevention): A postpartum client on bed rest for preeclampsia
management asks the nurse about preventing blood clots. Which statement by the nurse is
most accurate?
A. "You should remain on strict bed rest with no leg movement to prevent bleeding."
B. "I will teach you ankle pumps and leg exercises, and we will apply sequential compression
devices."
, . "Blood thinners are contraindicated in all postpartum clients due to bleeding risk."
C
D. "DVT only occurs in clients with cesarean deliveries, so you are not at risk."
[CORRECT] B
Rationale: Postpartum clients, especially those on bed rest or with preeclampsia, are at
increased risk for venous thromboembolism (VTE). ACOG and RCOG guidelines recommend
mechanical prophylaxis (sequential compression devices, SCDs) and early ambulation/leg
exercises; pharmacologic prophylaxis (low molecular weight heparin) is indicated for high-risk
clients. Students may incorrectly believe bed rest means immobility—active leg exercises and
SCDs are essential. Clinical pearl: The Virchow triad (stasis, hypercoagulability, endothelial
injury) is exaggerated in pregnancy and the postpartum period; preeclampsia further increases
coagulation activation.
Q6 (Postpartum – depression screening): During a 6-week postpartum visit, a client scores 14
on the Edinburgh Postnatal Depression Scale (EPDS). Which action is most appropriate?
A. Reassure the client that this is normal "baby blues" and schedule routine follow-up
B. Immediately initiate an involuntary psychiatric hold
C. Conduct further assessment, provide resources, and consider referral for counseling
D. Prescribe an SSRI without additional assessment
[CORRECT] C
Rationale: The EPDS score of 14 indicates probable postpartum depression (cutoff ≥10-13
suggests possible depression; ≥13-14 warrants further evaluation). AAP 2026 and ACOG
guidelines recommend perinatal depression screening at least once during pregnancy and
postpartum, with follow-up assessment and referral. Students may confuse baby blues
(self-limited, days 3-14, mild mood lability) with postpartum depression (persistent >2 weeks,
interferes with functioning). Clinical pearl: The EPDS item 10 (thoughts of self-harm) requires
immediate safety assessment; if positive, emergency protocols apply regardless of total score.
Q7 (Postpartum – psychosis): A client delivered 10 days ago and is brought to the emergency
department by her partner, who reports she has not slept in 72 hours, is hyperverbal, and stated
the baby is "possessed by demons." Which priority action is required?
A. Outpatient referral to a lactation consultant
B. Immediate psychiatric evaluation with potential inpatient admission
C. Schedule a routine postpartum check in 2 weeks
D. Administer a sedative and discharge home with family support
[CORRECT] B
Rationale: Postpartum psychosis is a psychiatric emergency with onset typically within 2 weeks
postpartum, featuring delusions, hallucinations, paranoia, and rapid mood swings. ACOG and
APA guidelines mandate immediate psychiatric evaluation due to high risk of infanticide and
suicide (risk 4.5% and 5%, respectively). Students may underestimate the urgency, confusing
psychosis with depression. Clinical pearl: Postpartum psychosis requires mood stabilizers
(lithium, antipsychotics) and hospitalization; breastfeeding is usually contraindicated with these
medications due to infant safety.
Q8 (Newborn – breastfeeding latch): A nurse observes a breastfeeding newborn. Which finding
indicates a correct latch?
A. The infant's lips are pursed and turned inward
B. Audible clicking sounds are heard during feeding
, . The infant's mouth is wide open with lower lip flanged outward and chin touching the breast
C
D. The infant feeds for exactly 5 minutes on each breast
[CORRECT] C
Rationale: A correct latch (per AAP 2026 and ABM protocols) requires a wide-open mouth,
lower lip flanged outward (not tucked in), chin touching the breast, and audible swallowing (not
clicking, which indicates poor suction). Pursed lips and clicking indicate poor latch and potential
nipple trauma. Students often focus on feeding duration rather than quality; AAP recommends
feeding on demand, not rigid timing. Clinical pearl: The "asymmetric latch" technique (more
areola visible above the upper lip than below the lower lip) optimizes milk transfer and reduces
nipple pain.
Q9 (Newborn – colostrum benefits): A new mother asks why colostrum is important for her term
newborn. Which response by the nurse is most accurate?
A. "Colostrum is primarily water and provides hydration only."
B. "Colostrum contains high levels of immunoglobulin A, lactoferrin, and living white blood cells
that provide passive immunity."
C. "Colostrum should be discarded until mature milk arrives on day 3."
D. "Colostrum causes jaundice and should be limited."
[CORRECT] B
Rationale: Colostrum (produced days 1-3) is rich in secretory IgA (provides mucosal immunity),
lactoferrin (iron-binding, antimicrobial), leukocytes, growth factors, and prebiotics. AAP 2026
and WHO recommend exclusive breastfeeding from birth, recognizing colostrum as "liquid gold."
Students may underestimate colostrum's value or incorrectly believe it insufficient. Clinical pearl:
Colostrum volumes (5-10 mL per feed) perfectly match the newborn's small stomach capacity
(5-7 mL day 1); frequent feeding (8-12 times/24 hours) establishes milk supply.
Q10 (Newborn – feeding cues): A nurse is teaching a new mother about infant feeding cues.
Which behavior indicates the infant is ready to feed?
A. Crying vigorously for 10 minutes
B. Bringing hands to mouth and making sucking motions
C. Turning away from the breast and falling asleep
D. Hiccupping after a feeding
[CORRECT] B
Rationale: Early feeding cues (per AAP and UNICEF Baby-Friendly protocols) include stirring,
mouth opening, tongue protrusion, hand-to-mouth movements, and rooting. Crying is a late cue
indicating distress; waiting until crying may lead to latch difficulties. Students often mistake
crying as the primary cue. Clinical pearl: Teach parents to recognize the feeding readiness
continuum: early cues (mouth movements) → mid cues (rooting, stretching) → late cues (crying,
color change); respond to early cues for optimal feeding success.
Q11 (Newborn – formula preparation): A mother chooses to formula feed. Which instruction is
most accurate regarding formula preparation?
A. "You can prepare bottles in advance and leave them at room temperature for up to 8 hours."
B. "Use boiled water that has cooled, measure powder precisely, and refrigerate prepared
bottles for up to 24 hours."
C. "Microwave the bottle for 30 seconds to warm it quickly before feeding."
D. "Dilute the formula with extra water to help with constipation."
