NUR 254 Exam 1 Maternal-Newborn
Nursing Study Guide Questions And
Well Graded Solutions With
Rationales Updated 2026-2027
Master your NUR 254 Exam 1 with this comprehensive, expert-verified study bundle. Features
high-yield practice questions accompanied by in-depth clinical rationales targeting critical
maternal-newborn nursing concepts. Master complex GTPAL calculation parameters, signs of
pregnancy, prenatal labs, preeclampsia alerts, placenta previa restrictions, and intrapartum
stages of labor. Perfect for NCLEX review and boosting your exam scores at Galen and top
nursing schools. Pass guaranteed
Question 1
A client at 8 weeks of gestation complains of severe nausea and vomiting every
morning. Which dietary instruction should the nurse provide?
A) Drink a large glass of orange juice immediately upon awakening.
B) Eat dry crackers or toast in bed before getting up.
C) Consume three large meals a day to keep the stomach full.
D) Avoid eating any snacks right before bedtime.
Correct Answer: B) Eat dry crackers or toast in bed before getting up.
Rationale: Eating dry, carbohydrate-rich foods like crackers or toast before getting
out of bed helps absorb gastric secretions and prevents morning sickness. Large
meals can overload the stomach, fluids should be consumed between meals rather
than with them, and a bedtime snack helps prevent hypoglycemia which triggers
nausea.
Question 2
A nurse is assessing a pregnant client's cervix and notes a pronounced bluish-violet
discoloration of the vaginal mucosa and cervix. How should the nurse document this
finding?
A) Goodell's sign
B) Hegar's sign
C) Chadwick's sign
D) Ballottement
,Correct Answer: C) Chadwick's sign
Rationale: Chadwick's sign is the bluish or purplish discoloration of the vulva, vagina,
and cervix caused by increased vascularity during pregnancy. Goodell's sign is
cervical softening, Hegar's sign is softening of the lower uterine segment, and
ballottement is the rebounding of the fetus against the examiner's finger.
Question 3
A client's first day of her last menstrual period (LMP) was October 14, 2025. Using
Naegele’s rule, what is the client's estimated date of delivery (EDD)?
A) July 21, 2026
B) July 7, 2026
C) July 14, 2026
D) August 21, 2026
Correct Answer: A) July 21, 2026
Rationale: Using Naegele's rule: Add 7 days to the first day of the LMP (October 14
+ 7 = October 21), subtract 3 months (October minus 3 months = July), and add 1
year (2025 + 1 = 2026), giving an EDD of July 21, 2026.
Question 4
A nurse is reviewing the lab results of a client at 16 weeks of gestation. The maternal
serum alpha-fetoprotein (MSAFP) level is significantly elevated. The nurse
understands this finding places the fetus at risk for which condition?
A) Down syndrome
B) Neural tube defects
C) Gestational diabetes
D) Fetal macrosomia
Correct Answer: B) Neural tube defects
Rationale: Elevated maternal serum alpha-fetoprotein (MSAFP) levels are strongly
associated with neural tube defects, such as spina bifida or anencephaly, or
abdominal wall defects. Low MSAFP levels are associated with chromosomal
abnormalities like Down syndrome (Trisomy 21).
Question 5
A nurse is caring for a client at 34 weeks of gestation who is diagnosed with severe
preeclampsia. The nurse should immediately report which finding to the provider?
A) 1+ pitting ankle edema
B) Epigastric pain
,C) Deep tendon reflexes of 2+
D) Platelet count of 175,000/mm³
Correct Answer: B) Epigastric pain
Rationale: Epigastric or right upper quadrant pain indicates liver ischemia,
subcapsular hepatic hematoma, or imminent liver rupture, which is a life-threatening
complication of severe preeclampsia / HELLP syndrome. 1+ edema is common, 2+
reflexes are normal, and a platelet count of 175,000/mm³ is within normal limits.
Question 6
A client who is Rh-negative is admitted to the labor unit following an automobile
accident. Which action should the nurse anticipate taking?
A) Administering Rho(D) immune globulin within 72 hours.
B) Ordering an immediate type and crossmatch for packed red blood cells.
C) Preparing the client for an emergency cesarean delivery.
D) Monitoring the client for signs of hyperglycemia.
Correct Answer: A) Administering Rho(D) immune globulin within 72 hours.
Rationale: Any abdominal trauma in an Rh-negative pregnant client carries a high
risk of fetomaternal hemorrhage, which can lead to maternal isoimmunization.
Rho(D) immune globulin must be administered within 72 hours of the trauma event
to prevent antibody formation, regardless of prior prophylactic doses.
Question 7
A nurse is monitoring a client in labor who is receiving an oxytocin infusion. The
nurse notes contractions occurring every 90 seconds, lasting 80 seconds, with a
rising resting uterine tone. Which action should the nurse take first?
A) Increase the rate of the IV fluid bolus.
B) Turn the client onto her right side.
C) Discontinue the oxytocin infusion.
D) Administer oxygen at 10 L/min via nonrebreather mask.
Correct Answer: C) Discontinue the oxytocin infusion.
Rationale: The client is experiencing uterine tachysystole (contractions occurring
more frequently than every 2 minutes or lasting longer than 90 seconds), which cuts
off blood flow to the placenta and causes fetal hypoxia. The primary and immediate
action is to turn off the oxytocin infusion to relax the uterus.
Question 8
, During a prenatal visit at 20 weeks of gestation, a client asks why she feels
lightheaded and dizzy when she lies flat on her back. Which response should the
nurse provide?
A) "The hormone progesterone causes your blood vessels to constrict when you lie
flat."
B) "Your heavy uterus is pressing on your vena cava, reducing blood flow back to
your heart."
C) "This is a normal response caused by blood pooling in your upper extremities."
D) "Your blood sugar levels drop dramatically when you lie in a supine position."
Correct Answer: B) "Your heavy uterus is pressing on your vena cava, reducing
blood flow back to your heart."
Rationale: Supine hypotensive syndrome (vena cava syndrome) occurs when the
weight of the gravid uterus compresses the inferior vena cava against the spine
while supine. This impairs venous return, decreasing cardiac output and causing
maternal hypotension, lightheadedness, and dizziness.
Question 9
A nurse is teaching a pregnant client who has a practice of pica about the risks
associated with this condition. Which lab value is most critical for the nurse to
monitor closely?
A) White blood cell count
B) Blood urea nitrogen
C) Hemoglobin and hematocrit
D) Serum calcium
Correct Answer: C) Hemoglobin and hematocrit
Rationale: Pica (the ingestion of non-food substances such as clay, dirt, ice, or
laundry starch) is heavily linked to iron-deficiency anemia. The non-food substances
coat the intestinal lining and block iron absorption, requiring close monitoring of
hemoglobin and hematocrit levels.
Question 10
A nurse is evaluating an external fetal monitor strip for a client in active labor and
notes a pattern of uniform decelerations that begin at the onset of a contraction and
return to baseline when the contraction ends. How should the nurse interpret this
finding?
A) Uteroplacental insufficiency
B) Umbilical cord compression
Nursing Study Guide Questions And
Well Graded Solutions With
Rationales Updated 2026-2027
Master your NUR 254 Exam 1 with this comprehensive, expert-verified study bundle. Features
high-yield practice questions accompanied by in-depth clinical rationales targeting critical
maternal-newborn nursing concepts. Master complex GTPAL calculation parameters, signs of
pregnancy, prenatal labs, preeclampsia alerts, placenta previa restrictions, and intrapartum
stages of labor. Perfect for NCLEX review and boosting your exam scores at Galen and top
nursing schools. Pass guaranteed
Question 1
A client at 8 weeks of gestation complains of severe nausea and vomiting every
morning. Which dietary instruction should the nurse provide?
A) Drink a large glass of orange juice immediately upon awakening.
B) Eat dry crackers or toast in bed before getting up.
C) Consume three large meals a day to keep the stomach full.
D) Avoid eating any snacks right before bedtime.
Correct Answer: B) Eat dry crackers or toast in bed before getting up.
Rationale: Eating dry, carbohydrate-rich foods like crackers or toast before getting
out of bed helps absorb gastric secretions and prevents morning sickness. Large
meals can overload the stomach, fluids should be consumed between meals rather
than with them, and a bedtime snack helps prevent hypoglycemia which triggers
nausea.
Question 2
A nurse is assessing a pregnant client's cervix and notes a pronounced bluish-violet
discoloration of the vaginal mucosa and cervix. How should the nurse document this
finding?
A) Goodell's sign
B) Hegar's sign
C) Chadwick's sign
D) Ballottement
,Correct Answer: C) Chadwick's sign
Rationale: Chadwick's sign is the bluish or purplish discoloration of the vulva, vagina,
and cervix caused by increased vascularity during pregnancy. Goodell's sign is
cervical softening, Hegar's sign is softening of the lower uterine segment, and
ballottement is the rebounding of the fetus against the examiner's finger.
Question 3
A client's first day of her last menstrual period (LMP) was October 14, 2025. Using
Naegele’s rule, what is the client's estimated date of delivery (EDD)?
A) July 21, 2026
B) July 7, 2026
C) July 14, 2026
D) August 21, 2026
Correct Answer: A) July 21, 2026
Rationale: Using Naegele's rule: Add 7 days to the first day of the LMP (October 14
+ 7 = October 21), subtract 3 months (October minus 3 months = July), and add 1
year (2025 + 1 = 2026), giving an EDD of July 21, 2026.
Question 4
A nurse is reviewing the lab results of a client at 16 weeks of gestation. The maternal
serum alpha-fetoprotein (MSAFP) level is significantly elevated. The nurse
understands this finding places the fetus at risk for which condition?
A) Down syndrome
B) Neural tube defects
C) Gestational diabetes
D) Fetal macrosomia
Correct Answer: B) Neural tube defects
Rationale: Elevated maternal serum alpha-fetoprotein (MSAFP) levels are strongly
associated with neural tube defects, such as spina bifida or anencephaly, or
abdominal wall defects. Low MSAFP levels are associated with chromosomal
abnormalities like Down syndrome (Trisomy 21).
Question 5
A nurse is caring for a client at 34 weeks of gestation who is diagnosed with severe
preeclampsia. The nurse should immediately report which finding to the provider?
A) 1+ pitting ankle edema
B) Epigastric pain
,C) Deep tendon reflexes of 2+
D) Platelet count of 175,000/mm³
Correct Answer: B) Epigastric pain
Rationale: Epigastric or right upper quadrant pain indicates liver ischemia,
subcapsular hepatic hematoma, or imminent liver rupture, which is a life-threatening
complication of severe preeclampsia / HELLP syndrome. 1+ edema is common, 2+
reflexes are normal, and a platelet count of 175,000/mm³ is within normal limits.
Question 6
A client who is Rh-negative is admitted to the labor unit following an automobile
accident. Which action should the nurse anticipate taking?
A) Administering Rho(D) immune globulin within 72 hours.
B) Ordering an immediate type and crossmatch for packed red blood cells.
C) Preparing the client for an emergency cesarean delivery.
D) Monitoring the client for signs of hyperglycemia.
Correct Answer: A) Administering Rho(D) immune globulin within 72 hours.
Rationale: Any abdominal trauma in an Rh-negative pregnant client carries a high
risk of fetomaternal hemorrhage, which can lead to maternal isoimmunization.
Rho(D) immune globulin must be administered within 72 hours of the trauma event
to prevent antibody formation, regardless of prior prophylactic doses.
Question 7
A nurse is monitoring a client in labor who is receiving an oxytocin infusion. The
nurse notes contractions occurring every 90 seconds, lasting 80 seconds, with a
rising resting uterine tone. Which action should the nurse take first?
A) Increase the rate of the IV fluid bolus.
B) Turn the client onto her right side.
C) Discontinue the oxytocin infusion.
D) Administer oxygen at 10 L/min via nonrebreather mask.
Correct Answer: C) Discontinue the oxytocin infusion.
Rationale: The client is experiencing uterine tachysystole (contractions occurring
more frequently than every 2 minutes or lasting longer than 90 seconds), which cuts
off blood flow to the placenta and causes fetal hypoxia. The primary and immediate
action is to turn off the oxytocin infusion to relax the uterus.
Question 8
, During a prenatal visit at 20 weeks of gestation, a client asks why she feels
lightheaded and dizzy when she lies flat on her back. Which response should the
nurse provide?
A) "The hormone progesterone causes your blood vessels to constrict when you lie
flat."
B) "Your heavy uterus is pressing on your vena cava, reducing blood flow back to
your heart."
C) "This is a normal response caused by blood pooling in your upper extremities."
D) "Your blood sugar levels drop dramatically when you lie in a supine position."
Correct Answer: B) "Your heavy uterus is pressing on your vena cava, reducing
blood flow back to your heart."
Rationale: Supine hypotensive syndrome (vena cava syndrome) occurs when the
weight of the gravid uterus compresses the inferior vena cava against the spine
while supine. This impairs venous return, decreasing cardiac output and causing
maternal hypotension, lightheadedness, and dizziness.
Question 9
A nurse is teaching a pregnant client who has a practice of pica about the risks
associated with this condition. Which lab value is most critical for the nurse to
monitor closely?
A) White blood cell count
B) Blood urea nitrogen
C) Hemoglobin and hematocrit
D) Serum calcium
Correct Answer: C) Hemoglobin and hematocrit
Rationale: Pica (the ingestion of non-food substances such as clay, dirt, ice, or
laundry starch) is heavily linked to iron-deficiency anemia. The non-food substances
coat the intestinal lining and block iron absorption, requiring close monitoring of
hemoglobin and hematocrit levels.
Question 10
A nurse is evaluating an external fetal monitor strip for a client in active labor and
notes a pattern of uniform decelerations that begin at the onset of a contraction and
return to baseline when the contraction ends. How should the nurse interpret this
finding?
A) Uteroplacental insufficiency
B) Umbilical cord compression
