NACE Care of the Childbearing Family
Exam Questions with Explained Answers
2024-2025
A nurse is caring for a patient who is 40 weeks pregnant. Which finding would
indicate the need for a cesarean delivery?
A. The woman has extremely slender hips.
B. The woman’s fetus is in a transverse lie.
C. The woman’s fetus is hyperactive.
D. The woman has a posterior cervix.
Explanation
A transverse lie means that the baby is lying sideways across the uterus, instead of head-down or
breech.
This position makes vaginal delivery impossible and increases the risk of umbilical cord
prolapse, which can compromise fetal oxygen supply. Therefore, a cesarean delivery is indicated
for a fetus in a transverse lie.
Choice A is wrong because having extremely slender hips does not necessarily mean that a
woman cannot deliver vaginally.
The size and shape of the pelvis, not the external appearance, determines the adequacy of the
birth canal. A trial of labor may be attempted for women with borderline pelvic measurements.
Choice C is wrong because fetal hyperactivity is not a reason for a cesarean delivery.
Fetal movements may vary depending on the time of day, maternal activity, maternal blood
sugar level, and other factors. Fetal well-being can be assessed by fetal heart rate monitoring
and biophysical profile.
Choice D is wrong because having a posterior cervix does not indicate the need for a cesarean
delivery.
A posterior cervix means that the cervix is tilted toward the back of the uterus, which may make
cervical dilation slower and more painful. However, with adequate contractions and maternal
pushing, the cervix can move to an anterior position and allow vaginal delivery.
A nurse is caring for a client with postpartum hemorrhage. The provider has
ordered Methylergonovine 200 mcg intravenously to be administered stat. The
nurse should perform which priority assessment prior to administering this
medication?
A. Assess the client’s pain scale.
B. Assess the client’s respiratory rate.
C. Assess the client’s blood pressure.
D. Assess the client’s last bowel movement.
,Explanation
The correct answer is choice C. Assess the client’s blood pressure. Methylergonovine is a
uterotonic medication that can cause hypertension and is contraindicated for clients with
preeclampsia or cardiac disease.
Therefore, the nurse should check the client’s blood pressure before administering this
medication to ensure it is within normal range (120/80 mm Hg or lower).
Choice A is wrong because assessing the client’s pain scale is not a priority assessment before
giving methylergonovine.
Pain is not a contraindication for this medication and does not affect its effectiveness.
Choice B is wrong because assessing the client’s respiratory rate is not a priority assessment
before giving methylergonovine.
Respiratory rate is not affected by this medication and does not indicate any adverse effects.
Choice D is wrong because assessing the client’s last bowel movement is not a priority
assessment before giving methylergonovine.
Bowel movement is not related to postpartum hemorrhage or uterine atony, which are the
indications for this medication.
A patient comes to the antepartal clinic for her visit and provides the nurse with
information. What piece of information places this patient at high risk for
exposure to teratogenic agents?
A. She lives with two dogs at home.
B. She works as a part-time oncology nurse.
C. She is lacto-ova vegetarian.
D. She commutes to work on a train.
Explanation
The correct answer is choice B. She works as a part-time oncology nurse. This is because
oncology nurses are exposed toteratogenic agents, which are substances that can cause
abnormalities in an exposed fetus. Teratogenic agents can cross the placenta and alter fetal
morphology or function. Examples of teratogenic agents are lead, methyl mercury,
polychlorinated biphenyls, lithium, vitamin K antagonists, tobacco, rubella, cytomegalovirus,
ionizing agents, hyperthermia, diabetes, and some drugs.
Choice A is wrong because living with two dogs at home does not pose a high risk for exposure to
teratogenic agents. Dogs can be beneficial for pregnant women as they provide companionship
and exercise.
Choice C is wrong because being a lacto-ova vegetarian does not pose a high risk for exposure to
teratogenic agents. Lacto-ova vegetarians can get adequate nutrition from plant-based foods,
dairy products, and eggs.
,Choice D is wrong because commuting to work on a train does not pose a high risk for exposure
to teratogenic agents. Trains are a safe and convenient mode of transportation for pregnant
women.
A patient with a history of mitral valve prolapse is admitted at 41 weeks gestation
for induction of labor. The doctor prescribes intravenous antibiotic therapy for the
patient to be given during labor. Based on this information, what is the primary
reason for administering antibiotics to this patient at this time?
A. The patient has heart disease, and the antibiotics will decrease the risk to her
fetus of developing endocarditis.
B. The patient has heart disease, and the antibiotics will decrease her risk of developing
pericarditis.
C. The patient will deliver post-term, and the antibiotics will help to decrease her risk of
developing chorioamnionitis.
D. The patient will deliver post-term, and the antibiotics will decrease the risk to her fetus of
developing a systemic infection.
Explanation
The correct answer is choice A. The patient has heart disease, and the antibiotics will decrease
the risk to her fetus of developing endocarditis. Endocarditis is an infection of the inner lining of
the heart and valves, which can be caused by bacteria entering the bloodstream during labor and
delivery. Patients with mitral valve prolapse (MVP) are more prone to develop endocarditis
because their valve leaflets are floppy and do not close tightly, creating a site for bacterial
attachment. Antibiotics can help prevent this complication by killing the bacteria before they
reach the heart.
Choice B is wrong because pericarditis is an inflammation of the outer layer of the heart, not the
inner lining or valves. It is not related to MVP or bacterial infection.
Choice C is wrong because chorioamnionitis is an infection of the membranes and fluid that
surround the fetus, not the heart. It is usually caused by bacteria ascending from the vagina or
cervix, not from the bloodstream.
Choice D is wrong because delivering post-term does not increase the risk of systemic infection
for the fetus. Systemic infection means infection that affects multiple organs or systems in the
body, not just one specific site.
A woman gives birth to twin girls, one of whom is stillborn. Which nursing action
would be least helpful in supporting the woman as she copes with her loss?
A. Offer her the opportunity for counseling to help her grieve.
B. Encourage the woman to hold the deceased twin as well as the living twin.
C. Remind her that she should be happy that one child survived and is healthy.
D. Assist the woman to take pictures of both babies.
Explanation
, The correct answer is choice C. Reminding her that she should be happy that one child survived
and is healthy is the least helpful nursing action in supporting the woman as she copes with her
loss.
This statement minimizes her grief and implies that she should not feel sad about the deceased
twin.
It also disregards her attachment to both babies and her need to mourn the loss of one of them.
Choice A is wrong because offering her the opportunity for counseling to help her grieve is a
helpful nursing action that recognizes her emotional distress and provides her with professional
support.
Choice B is wrong because encouraging the woman to hold the deceased twin as well as the
living twin is a helpful nursing action that allows her to acknowledge and bond with both babies
and to create memories that may facilitate healing.
Choice D is wrong because assisting the woman to take pictures of both babies is a helpful
nursing action that provides her with tangible mementos of her twins and honors their
A 14-year-old patient visits the antepartal clinic because she has missed three
menstrual periods. The patient is to have a pelvic examination. In addition to
explaining the procedure, which measure would best help reduce the patient’s
anxiety?
A. Remind the patient that the examination will be less painful if she relaxes.
B. Remind the patient that this is a routine procedure for women who attend the clinic.
C. Remind the patient that the nurse will stay with her during the examination.
D. Remind the patient that the examination takes only a short time.
Explanation
The correct answer is choice C. Remind the patient that the nurse will stay with her during the
examination.
This measure would help reduce the patient’s anxiety by providing emotional support and
reassurance.
The patient may feel scared, embarrassed, or vulnerable during the pelvic examination,
especially since she is young and pregnant.
Having a trusted person with her can help her cope with these feelings.
Choice A is wrong because it may imply that the examination will be painful and increase the
patient’s anxiety.
Choice B is wrong because it may make the patient feel like she is not being treated as an
individual and that her concerns are not valid.
Choice D is wrong because it may make the patient feel rushed or pressured and not allow her to
ask questions or express her feelings.
