NSG 432 Maternal-
Newborn Exam 1 Study
Pack | 400 GCU Course
Blueprint Questions,
GTPAL, Naegele's Rule &
Detailed Rationales
(Graded A+)
Accelerate your exam preparation with this ultimate
practice question bank specifically aligned with
Grand Canyon University’s NSG 432 Maternal-
Newborn Nursing Exam 1 blueprint and current
evidence-based clinical guidelines. This
comprehensive study bundle features 400 highly
dense, Next-Generation NCLEX (NGN) style items
covering essential maternal-fetal concepts such as
GTPAL calculations, Naegele's rule formulas,
pregnancy signs, and prenatal TORCH infections.
Every item is complete with a verified correct answer
and a detailed, italicized rationale block formatted for
immediate, seamless Stuvia deployment to
maximize your grades or sale
,Q1. A client gave birth to twin boys at 37 weeks, had a miscarriage at eight weeks,
and is currently pregnant. What is her GTPAL score?
a) G3, T1, P0, A1, L2
b) G4, T1, P1, A1, L2
c) G3, T2, P0, A1, L1
d) G4, T0, P2, A1, L2
Answer: a
Rationale: Gravida (total pregnancies) = 3 (the twin delivery, the miscarriage, and the
current pregnancy). Term births (greater than or equal to 37 weeks) = 1 (twins born at
37 weeks count as one term delivery event). Preterm (20-36.6 weeks) = 0.
Abortions/miscarriages = 1 (at eight weeks). Living children = 2 (the twin boys). A
common mistake is counting twins as separate term or preterm births; only the delivery
event matters for T/P/A, while each individual infant is counted under L.
Q2. Which medication is the preferred drug of choice used for the treatment and
suppression of herpes simplex virus (HSV) outbreaks during pregnancy?
a) Metronidazole
b) Acyclovir
c) Azithromycin
d) Ceftriaxone
Answer: b
Rationale: Acyclovir is an antiviral medication that suppresses HSV outbreaks and
reduces viral shedding. It is classified as pregnancy category B and is considered safe
and effective to reduce the risk of active lesions at the time of delivery, thereby
preventing neonatal herpes transmission. Metronidazole is used for trichomoniasis,
azithromycin for chlamydia, and ceftriaxone for gonorrhea.
Q3. A client at 18 weeks of gestation reports a thick, yellowish fluid discharging
from her nipples. The nurse should identify that this secretion represents which
of the following substances?
a) Colostrum
b) Mature milk
c) Fore-milk
d) Purulent exudate
Answer: a
Rationale: Colostrum is the initial premilk fluid that is rich in antibodies and nutrients. It
is produced by the mammary glands as early as 16 to 20 weeks of gestation due to
hormonal shifts involving prolactin and estrogen. Mature breast milk does not appear
until 2 to 5 days postpartum.
Q4. Which of the following conditions represents the primary, most common
physiological cause of anemia during a normal pregnancy?
a) Severe iron deficiency
b) Hemodilution from increased plasma volume
c) Folic acid malabsorption
d) Acute blood loss from the placenta
,Answer: b
Rationale: During pregnancy, maternal plasma volume expands by 40% to 50%,
whereas the red blood cell (RBC) mass increases by only 20% to 30%. This
disproportionate expansion causes a normal, dilutional drop in hemoglobin and
hematocrit values, known as physiologic anemia of pregnancy. While iron deficiency is
the most common nutrient deficiency, hemodilution remains the primary physiologic
cause.
Q5. A nurse is documenting the obstetric history of a client using the GTPAL
system. The client has a history of a single birth at 39 weeks, a preterm birth of a
son at 34 weeks who is now living, and a spontaneous abortion at 11 weeks. She
is not currently pregnant. What is her GTPAL?
a) G3, T1, P1, A1, L2
b) G4, T1, P1, A1, L2
c) G3, T2, P0, A1, L1
d) G4, T2, P0, A1, L2
Answer: a
Rationale: The client has been pregnant 3 times in total (G=3). She had 1 delivery at 39
weeks (T=1), 1 delivery at 34 weeks (P=1), and 1 spontaneous abortion before 20
weeks (A=1). She has 2 living children (L=2). Because she is not currently pregnant, the
gravidity matches the sum of historical outcomes.
Q6. A nurse is calculating a client's estimated date of delivery (EDD) using
Naegele's rule. The client states that the first day of her last menstrual period
(LMP) was November 14. What is the correct EDD?
a) August 14
b) August 21
c) July 21
d) September 21
Answer: b
Rationale: Naegele's rule requires subtracting 3 months from the first day of the LMP
and adding 7 days. Counting back 3 months from November gives August. Adding 7
days to 14 yields 21. Therefore, the estimated date of delivery is August 21 of the
following year.
Q7. During a pelvic examination of a client at 8 weeks of gestation, the nurse
notes a prominent violet-bluish discoloration of the vaginal mucosa and cervix.
How should the nurse document this objective finding?
a) Goodell's sign
b) Hegar's sign
c) Chadwick's sign
d) Montgomery's sign
Answer: c
Rationale: Chadwick's sign is a violet-bluish color changes of the vaginal mucosa and
cervix due to increased vascularity and pelvic congestion at approximately 6 to 8 weeks
, of gestation. Goodell's sign is a softening of the cervical tip, and Hegar's sign is the
softening of the lower uterine segment.
Q8. Which of the following signs or symptoms observed during pregnancy is
classified strictly as a presumptive sign of pregnancy?
a) Fetal heart tones heard by Doppler ultrasound
b) Palpable fetal movement felt by a clinician
c) Amenorrhea and morning sickness
d) Positive result on an over-the-counter home urine test
Answer: c
Rationale: Presumptive signs of pregnancy are subjective symptoms felt or reported by
the woman herself (such as amenorrhea, nausea, fatigue, vomiting, and breast
tenderness). Fetal movement felt by the provider and fetal heart tones are positive
signs, whereas urine pregnancy tests are classified as probable signs.
Q9. A nurse is reinforcing teaching with a pregnant client who has tested positive
for Chlamydia trachomatis. Which of the following medications should the nurse
expect the provider to prescribe?
a) Podofilox
b) Azithromycin
c) Penicillin G benzathine
d) Metronidazole
Answer: b
Rationale: Azithromycin is an oral antibiotic recommended as the first-line treatment for
chlamydia infections during pregnancy because of its safety profile and effectiveness in
a single dose. Penicillin G is used for syphilis, metronidazole for trichomoniasis, and
podofilox is contraindicated during pregnancy.
Q10. A pregnant client at 34 weeks of gestation reports feeling dizzy, lightheaded,
and clammy when lying flat on her back. Which of the following physiological
actions explains this phenomenon?
a) Compression of the inferior vena cava by the heavy uterus
b) A sudden drop in circulating blood sugar levels
c) Physiological drop in intracranial pressure
d) Delayed gastric emptying causing autonomic distress
Answer: a
Rationale: Supine hypotensive syndrome occurs when the heavy, gravid uterus
compresses the maternal inferior vena cava against the spine when the client lies flat on
her back. This reduces venous return to the heart, leading to a sudden drop in cardiac
output and systemic blood pressure. Turning the client onto her side resolves this
instantly.
Q11. A nurse is assessing a client who is at 24 weeks of gestation. Where should
the nurse expect to locate the uterine fundus during a physical examination?
a) Slightly above the symphysis pubis
d) At the level of the xiphoid process
Newborn Exam 1 Study
Pack | 400 GCU Course
Blueprint Questions,
GTPAL, Naegele's Rule &
Detailed Rationales
(Graded A+)
Accelerate your exam preparation with this ultimate
practice question bank specifically aligned with
Grand Canyon University’s NSG 432 Maternal-
Newborn Nursing Exam 1 blueprint and current
evidence-based clinical guidelines. This
comprehensive study bundle features 400 highly
dense, Next-Generation NCLEX (NGN) style items
covering essential maternal-fetal concepts such as
GTPAL calculations, Naegele's rule formulas,
pregnancy signs, and prenatal TORCH infections.
Every item is complete with a verified correct answer
and a detailed, italicized rationale block formatted for
immediate, seamless Stuvia deployment to
maximize your grades or sale
,Q1. A client gave birth to twin boys at 37 weeks, had a miscarriage at eight weeks,
and is currently pregnant. What is her GTPAL score?
a) G3, T1, P0, A1, L2
b) G4, T1, P1, A1, L2
c) G3, T2, P0, A1, L1
d) G4, T0, P2, A1, L2
Answer: a
Rationale: Gravida (total pregnancies) = 3 (the twin delivery, the miscarriage, and the
current pregnancy). Term births (greater than or equal to 37 weeks) = 1 (twins born at
37 weeks count as one term delivery event). Preterm (20-36.6 weeks) = 0.
Abortions/miscarriages = 1 (at eight weeks). Living children = 2 (the twin boys). A
common mistake is counting twins as separate term or preterm births; only the delivery
event matters for T/P/A, while each individual infant is counted under L.
Q2. Which medication is the preferred drug of choice used for the treatment and
suppression of herpes simplex virus (HSV) outbreaks during pregnancy?
a) Metronidazole
b) Acyclovir
c) Azithromycin
d) Ceftriaxone
Answer: b
Rationale: Acyclovir is an antiviral medication that suppresses HSV outbreaks and
reduces viral shedding. It is classified as pregnancy category B and is considered safe
and effective to reduce the risk of active lesions at the time of delivery, thereby
preventing neonatal herpes transmission. Metronidazole is used for trichomoniasis,
azithromycin for chlamydia, and ceftriaxone for gonorrhea.
Q3. A client at 18 weeks of gestation reports a thick, yellowish fluid discharging
from her nipples. The nurse should identify that this secretion represents which
of the following substances?
a) Colostrum
b) Mature milk
c) Fore-milk
d) Purulent exudate
Answer: a
Rationale: Colostrum is the initial premilk fluid that is rich in antibodies and nutrients. It
is produced by the mammary glands as early as 16 to 20 weeks of gestation due to
hormonal shifts involving prolactin and estrogen. Mature breast milk does not appear
until 2 to 5 days postpartum.
Q4. Which of the following conditions represents the primary, most common
physiological cause of anemia during a normal pregnancy?
a) Severe iron deficiency
b) Hemodilution from increased plasma volume
c) Folic acid malabsorption
d) Acute blood loss from the placenta
,Answer: b
Rationale: During pregnancy, maternal plasma volume expands by 40% to 50%,
whereas the red blood cell (RBC) mass increases by only 20% to 30%. This
disproportionate expansion causes a normal, dilutional drop in hemoglobin and
hematocrit values, known as physiologic anemia of pregnancy. While iron deficiency is
the most common nutrient deficiency, hemodilution remains the primary physiologic
cause.
Q5. A nurse is documenting the obstetric history of a client using the GTPAL
system. The client has a history of a single birth at 39 weeks, a preterm birth of a
son at 34 weeks who is now living, and a spontaneous abortion at 11 weeks. She
is not currently pregnant. What is her GTPAL?
a) G3, T1, P1, A1, L2
b) G4, T1, P1, A1, L2
c) G3, T2, P0, A1, L1
d) G4, T2, P0, A1, L2
Answer: a
Rationale: The client has been pregnant 3 times in total (G=3). She had 1 delivery at 39
weeks (T=1), 1 delivery at 34 weeks (P=1), and 1 spontaneous abortion before 20
weeks (A=1). She has 2 living children (L=2). Because she is not currently pregnant, the
gravidity matches the sum of historical outcomes.
Q6. A nurse is calculating a client's estimated date of delivery (EDD) using
Naegele's rule. The client states that the first day of her last menstrual period
(LMP) was November 14. What is the correct EDD?
a) August 14
b) August 21
c) July 21
d) September 21
Answer: b
Rationale: Naegele's rule requires subtracting 3 months from the first day of the LMP
and adding 7 days. Counting back 3 months from November gives August. Adding 7
days to 14 yields 21. Therefore, the estimated date of delivery is August 21 of the
following year.
Q7. During a pelvic examination of a client at 8 weeks of gestation, the nurse
notes a prominent violet-bluish discoloration of the vaginal mucosa and cervix.
How should the nurse document this objective finding?
a) Goodell's sign
b) Hegar's sign
c) Chadwick's sign
d) Montgomery's sign
Answer: c
Rationale: Chadwick's sign is a violet-bluish color changes of the vaginal mucosa and
cervix due to increased vascularity and pelvic congestion at approximately 6 to 8 weeks
, of gestation. Goodell's sign is a softening of the cervical tip, and Hegar's sign is the
softening of the lower uterine segment.
Q8. Which of the following signs or symptoms observed during pregnancy is
classified strictly as a presumptive sign of pregnancy?
a) Fetal heart tones heard by Doppler ultrasound
b) Palpable fetal movement felt by a clinician
c) Amenorrhea and morning sickness
d) Positive result on an over-the-counter home urine test
Answer: c
Rationale: Presumptive signs of pregnancy are subjective symptoms felt or reported by
the woman herself (such as amenorrhea, nausea, fatigue, vomiting, and breast
tenderness). Fetal movement felt by the provider and fetal heart tones are positive
signs, whereas urine pregnancy tests are classified as probable signs.
Q9. A nurse is reinforcing teaching with a pregnant client who has tested positive
for Chlamydia trachomatis. Which of the following medications should the nurse
expect the provider to prescribe?
a) Podofilox
b) Azithromycin
c) Penicillin G benzathine
d) Metronidazole
Answer: b
Rationale: Azithromycin is an oral antibiotic recommended as the first-line treatment for
chlamydia infections during pregnancy because of its safety profile and effectiveness in
a single dose. Penicillin G is used for syphilis, metronidazole for trichomoniasis, and
podofilox is contraindicated during pregnancy.
Q10. A pregnant client at 34 weeks of gestation reports feeling dizzy, lightheaded,
and clammy when lying flat on her back. Which of the following physiological
actions explains this phenomenon?
a) Compression of the inferior vena cava by the heavy uterus
b) A sudden drop in circulating blood sugar levels
c) Physiological drop in intracranial pressure
d) Delayed gastric emptying causing autonomic distress
Answer: a
Rationale: Supine hypotensive syndrome occurs when the heavy, gravid uterus
compresses the maternal inferior vena cava against the spine when the client lies flat on
her back. This reduces venous return to the heart, leading to a sudden drop in cardiac
output and systemic blood pressure. Turning the client onto her side resolves this
instantly.
Q11. A nurse is assessing a client who is at 24 weeks of gestation. Where should
the nurse expect to locate the uterine fundus during a physical examination?
a) Slightly above the symphysis pubis
d) At the level of the xiphoid process
