Katherine Hinic
NUR302 Care of the Childbearing Family Classroom Exam 2 Blueprint
Instructional Objective
1. Describes the physiologic
changes of the pregnant and
postpartum client.
2. Recognizes normal and
abnormal psychological
responses to pregnancy,
birth, and postpartum
periods.
3. Applies theoretical
principles to provide
evidence-based, holistic
nursing care to clients and
families during perinatal
period.
4. Communicates effectively
with clients and families.
5. Differentiates normal and
abnormal findings on
maternal and newborn
assessment.
6. Teaches patient and
family about postpartum
and newborn care.
7. Provides nursing care to
the family experiencing
unexpected complications.
8. Promotes effective
maternal and infant
nutrition and elimination.
Content
Maternal physiologic changes
after birth
K
2
Normal maternal role
attainment, father’s role.
Maternity blues vs.
postpartum mood disorders
Physiology of postpartum
period; nursing process; types
of evidence
2
C
App
1
1
Principles of therapeutic
communication
Postpartum assessment,
newborn assessment, normal
and abnormal lab values
T
2
%
10%
1
2
10%
2
5
25%
1
1
5%
1
4
20%
1
2
10%
1
2
10%
2
10%
3
Principles of patient
education; maternal and
newborn adaptation and care
at home
Postpartum and newborn
complications; Bereavement
1
Nutritional requirements of
infant; breastfeeding support
and guidance; maternal
nutrition
1
1
1
An
Please select the best response to each question below. You may write on test booklet, but answers will
be scored from answer sheet. Please read each question carefully. There is only one correct response
for each question.
1. A routine Complete Blood Count (CBC) on postpartum day 2 for a new mother reveals a white
blood cell (WBC) count of 25,000 cells/mm3. The nurse’s first action should be to:
a. notify the physician and obtain an order for a blood culture.
b. increase rate of intravenous hydration.
c. evaluate the newborn for signs of infection.
d. continue routine care, as this is a normal finding.*
(Objective 5, App)
2. Which of the following positions for breastfeeding generally promotes comfort in a patient who
had a recent Cesarean section?
a. Cradle hold
b. Cross cradle hold
c. Football hold*
d. Sidelying position
(Objective 8, C)
3. What is the most common cause of postpartum hemorrhage?
a. Cervical laceration
b. Uterine atony*
c. Perineal hematoma
d. Undiagnosed clotting disorder
(Objective 3, K)
4. While performing a postpartum assessment on a new mother who is 12 hours postpartum, the
nurse finds the uterine fundus 3 cm above the umbilicus to the right. The nurse should:
a. encourage the patient to attempt to urinate.*
b. provide firm uterine massage.
c. continue with routine care, as this is a normal finding.
d. inspect the vagina for evidence of retained placental fragments.
(Objective 5, App)
5. Encouraging a new mother to talk about her birth experience to help integrate it into her life
experiences would be most appropriate during which of Rubin’s phases?
a. Taking-in*
b. Taking-hold
c. Holding-on
d. Letting go
(Objective 2, C)
6. On postpartum day 3, a woman voids 3000 ml. The nurse recognizes this as a(n):
a. normal finding called diuresis.*
b. normal finding called diaphoresis.
c. abnormal finding called diuresis.
d. abnormal finding called diaphoresis.
(Objective 1, K)
7. The process of uterine involution is complete at:
a. 4 weeks postpartum.
b. 6 weeks postpartum.*
c. 12 weeks postpartum.
d. 6 months postpartum.
(Objective 1, K)
8. The most effective way to relieve pain from engorgement in a woman who is NOT breastfeeding
is:
a. application of cold compresses.*
b. application of warm, moist heat.
c. expression of milk from the breasts.
d. restricting fluid intake to 300 ml per day.
(Objective 6, K)
9. Which mechanism of newborn heat loss describes the loss of heat when newborn is placed
directly on a cold scale?
a. Convection
b. Conduction*
c. Radiation
d. Evaporation
(Objective 3, C)
10. The nurse assesses a newborn’s neuromuscular system. The nurse holds the baby in a supine
position and allows his head to suddenly drop backwards about an inch. The newborn first
abducts and extends his arms and legs, and then swings the arms back to the chest and adducts
the legs. The nurse documents a positive:
a. Babinski reflex.
b. Landau reflex.
c. Moro reflex.*
d. tonic neck reflex.
(Objective 5, App)
11. During the first 24 hours of life, a newborn should breastfeed:
a. every 4-5 hours.
b. every hour.
c. 6-8 times.
d. 8-12 times.*
(Objective 8, K)
12. You find your patient who is 2 days postpartum in her room crying uncontrollably. When you
ask her if you can help, she responds, “There is absolutely no reason for me to be crying right
now, but I just can’t stop.” You offer support and recognize that this is most likely due to:
a. baby blues.*
b. postpartum depression.
c. postpartum psychosis.
d. ineffective taking-in.
(Objective 2, App)
13. The Apgar score measures which of the following infant characteristics at one and five minutes
of life?
a. Heart rate, respiratory effort, muscle tone, and reflex irritability*
b. Heart rate, respiratory rate, oxygenation, and reflex irritability
c. Heart rate, chest movement, muscle tone, and weight
d. Respiratory effort, oxygenation, weight, and muscle tone
(Objective 3, K)
14. Your patient, Ms. N, who is 2 days postpartum, complains of a severe headache. You check her
blood pressure and it is 170/110. You also note marked edema of her hands and face. You
immediately notify the physician to evaluate the patient and suspect:
a. gestational hypertension
b. pre-eclampsia*
c. eclampsia
d. essential hypertension
(Obejctive 7, C)
15. Ms. R, who is a 3 day post-operative Cesarean patient, has a temperature of 101.1 and
complains of abdominal discomfort and malaise. You perform a complete assessment and
suspect:
a. benign postpartal temperature elevation
b. endometriosis
c. endrometritis*
d. infection of the perineum
(Objective 7, App)
16. The nurse is caring for a mother who requires Rho(D) immunoglobulin (RhoGAM). What is the
condition that must be present for the globulin to be effective after RhoGAM is given?
a. Positive maternal Rh factor
b. Negative newborn Rh factor
c. Negative maternal antibody titer*
d. Positive maternal antibody titer
(Objective 3, App)
17. A client has just delivered a healthy 7-pound baby boy. The baby has a vigorous cry and pink
coloring. The labor and birth nurse notes audible gurgling and visible secretions in the infant’s
mouth. Based on her assessment, the nurse decides to suction the infant with a bulb syringe.
Which of the following should be the nurse’s first action?
a. Suction the nose first.
b. Suction the mouth first.*
c. Obtain an order from the physician or midwife prior to suctioning.
d. Turn the baby on his side so mucus will drain out before suctioning.
(Objective 3, App)
18. A new mother who is exclusively breastfeeding her 3 day old infant is concerned because her
physician has said that her baby has jaundice. The nurse understands that the most appropriate
nursing action at this point is to:
a. Reassure the mother that this is a normal condition that appears at 2 to 3 days of life.*
b. Obtain a serum bilirubin and educate the mother on use of phototherapy.
c. Contact the NICU to arrange a patient transfer.
d. Advise the mother that follow up with the pediatrician after discharge is not necessary.
(Objective 5, analysis)
19. A newly pregnant client with a Body Mass Index (BMI) of 28 asks how much weight she should
gain over the 9 months. The most appropriate answer is:
a. “It really doesn’t matter exactly how much weight you gain, as long as your diet is healthy.”
b. “A gain of about 25-35 pounds is best for mother and baby.”
c. “Because you are a little overweight, it would be best for you not to gain too much weight.”
d. “The most appropriate weight gain for you would be about 15-25 pounds.”*
(Objective 6, an)
20. After a prolonged labor and lack of progress past a dilation of 8cm, the client had a cesarean
delivery. She and her partner express their disappointment that they did not have a natural
childbirth. The best response is:
a. “Most couples who have an unplanned cesarean birth feel cheated and disappointed.”*
b. “You know that at least you have a healthy baby.”
c. “Maybe next time you can have a vaginal delivery.”
d. “You will be able to resume sex sooner than if you had delivered vaginally.”
(Objective 4, App)
Questions from NCLEX Review Book
The following questions found in the test were modified from Sandra Smith’s review for NCLEX-RN
(2009). Original questions are in normal font and modifications and rationales are italicized.
The nurse is caring for a mother who requires RhoGAM. What is the condition that must be present for
the globulin to be effective after RhoGAM is given?
a.
b.
c.
d.
Mother is Rh positive
Baby is Rh negative
Mother has no titer in her blood*
Mother has some titer in her blood
The nurse is caring for a mother who requires Rho(D) immunoglobulin (RhoGAM). What is the condition
that must be present for the globulin to be effective after RhoGAM is given? (Objective 3, App)
e.
f.
g.
h.
Positive maternal Rh factor
Negative newborn Rh factor
Negative maternal antibody titer*
Positive maternal antibody titer
*Selected response items changed. Items C & D in original question unclear. Does this refer to antibody
titer, rubella titer, something else? Needs additional information to be selected as the correct response.
Also, should include generic name of medication - Rho(D) immunoglobulin.
In the delivery room, a client has just delivered a healthy 7-pound baby boy. The physician instructs the
nurse to suction the baby. The procedure the nurse would use is to
a.
b.
c.
d.
Suction the nose first
Suction the mouth first*
Suction neither the nose nor mouth until the physician gives further instructions
Turn the baby on his side so mucus will drain out before suctioning
A client has just delivered a healthy 7-pound baby boy. The baby has a vigorous cry and pink coloring.
The labor and birth nurse notes audible gurgling and visible secretions in the infant’s mouth. Based on
her assessment, the nurse decides to suction the infant with a bulb syringe. Which of the following
should be the nurse’s first action?(Objective 3, App)
e.
f.
g.
h.
Suction the nose first.
Suction the mouth first.*
Obtain an order from the physician or midwife prior to suctioning.
Turn the baby on his side so mucus will drain out before suctioning.
*The original question does not give any indication for suctioning this “healthy baby.” Routine
suctioning is not encouraged so an indication must be present. Also, the decision to suction is generally
based on nursing assessment of excessive secretions, not physician order.
A new mother is concerned because her physician has said that her baby had jaundice. The nurse
understands that jaundice is a (an)
a.
b.
c.
d.
Normal condition that appears at 2 to 3 days of life*
Normal condition that appears 8 to 24 hours after birth
Abnormal condition that appears within the first 24 hours of life
Abnormal condition that appears at 2 to 3 days of life
A new mother who is exclusively breastfeeding her 3 day old infant is concerned because her physician
has said that her baby has jaundice. The nurse understands that the most appropriate nursing action at
this point is to: (Objective 5, analysis)
a.
b.
c.
d.
Reassure the mother that this is a normal condition that appears at 2 to 3 days of life.*
Obtain a serum bilirubin and educate the mother on use of phototherapy.
Contact the NICU to arrange a patient transfer.
Advise the mother that follow up with the pediatrician after discharge is not necessary.
*Jaundice can be a normal condition or an abnormal condition, depending on when it occurs, and to
what extent it is present. The mother’s concerns in this question may or may not be indicated. More
information is needed. I changed this into an analysis question.
A newly pregnant client who is a little overweight asks how much weight she should gain over the 9
months. The most appropriate answer is
a.
b.
c.
d.
“For your size, a little heavy, 15-25 pounds would be best.”*
“It really doesn’t matter exactly how much weight you gain, as long as your diet is healthy.”
“A gain of about 25-35 pounds is best for mother and baby.”
“Because you are a little overweight, it would be best for you not to gain too much weight.”
A newly pregnant client with a Body Mass Index (BMI) of 28 asks how much weight she should gain over
the 9 months. The most appropriate answer is: (Objective 6, an)
a. “It really doesn’t matter exactly how much weight you gain, as long as your diet is healthy.”
b. “A gain of about 25-35 pounds is best for mother and baby.”
c. “Because you are a little overweight, it would be best for you not to gain too much weight.”
d. “The most appropriate weight gain for you would be about 15-25 pounds.”*
*”A little overweight” is not an appropriate description of a patient’s weight. Pregnancy weight gain
recommendations are based on BMI. The new version of the question requires further analysis by the
student. S/he must know whether a BMI of 28 is high, low or normal and use that to convey the
recommendations in a sensitive manner.
After a prolonged labor and lack of progress past a dilation of 8cm, the client had a cesarean delivery.
She and her partner express their disappointment that they did not have a natural childbirth. The best
response is to say
a.
b.
c.
d.
“Most couples who have an unplanned cesarean birth feel cheated and disappointed.”*
“You know that at least you have a healthy baby.”
“Maybe next time you can have a vaginal delivery.”
“You will be able to resume sex sooner than if you had delivered vaginally.”
After a prolonged labor and lack of progress past a dilation of 8cm, the client had a cesarean delivery.
She and her partner express their disappointment that they did not have a natural childbirth. The best
response is: (Objective 4, App)
a.
b.
c.
d.
“Most couples who have an unplanned cesarean birth feel cheated and disappointed.”*
“You know that at least you have a healthy baby.”
“Maybe next time you can have a vaginal delivery.”
“You will be able to resume sex sooner than if you had delivered vaginally.”
*I changed only the last portion of the stem in this question.
References:
McDonald, M.E. (2007). The nurse educator’s guide to assessing learning outcomes, 2nd ed. Sudbury, MA:
Jones and Bartlett.
Pillitteri, A. (2010). Maternal & child health nursing: Care of the childbearing and childrearing family, 6th
ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.
Smith, S. F. (2009) Sandra Smith’s review for NCLEX-RN, 12th ed. Sudbury, MA: Jones and Bartlett.