Galen NUR 254 Maternal and Pediatric
Nursing Actual Exams 1-4 2026/2027 |
Verified Questions
Galen College of Nursing | Verified Q&A | Professional Nursing
Students
This document contains 200 original questions developed to reinforce the official course objectives of Galen NUR
254 Maternal and Pediatric Nursing. The questions are organized into four exams covering Antepartum and
Intrapartum Maternal Care, Postpartum and Newborn Care, Pediatric Growth, Development, and Health
Promotion, and Pediatric Acute and Chronic Illness Management. Content is designed to support clinical
proficiency and actual exam readiness for Professional Nursing Students. All material is original and aligned with
Galen NUR 254 curriculum materials, foundational maternal-child nursing textbooks, and current evidence-based
clinical practice guidelines from ACOG and AAP for the 2026/2027 cycle.
Exam 1: Antepartum and Intrapartum Maternal Care
1. Which hormone is primarily responsible for maintaining the corpus luteum in early pregnancy
until the placenta takes over progesterone production?
A. Human chorionic gonadotropin (hCG)
B. Oxytocin
C. Prolactin
D. Follicle-stimulating hormone (FSH)
Correct Answer: D
Rationale: hCG produced by the trophoblast maintains the corpus luteum, which continues progesterone secretion until
placental production is adequate.
2. A multiparous client at 28 weeks gestation reports painless, bright-red vaginal bleeding. The
priority nursing action is to:
A. Perform a digital vaginal examination to assess cervical dilation
B. Place the client on bed rest and notify the provider while preparing for possible ultrasound evaluation of
placenta location
C. Administer oxytocin to control bleeding
D. Encourage ambulation to promote placental attachment
Correct Answer: B
Rationale: Painless bright-red bleeding in the second or third trimester suggests placenta previa; digital examination is
contraindicated until placental location is confirmed.
3. The recommended weight gain for a client with a pre-pregnancy BMI of 22 (normal weight)
during a singleton pregnancy is approximately:
A. 11–20 lb (5–9 kg)
B. 25–35 lb (11.5–16 kg)
C. 15–25 lb (7–11.5 kg)
D. 28–40 lb (12.5–18 kg)
Correct Answer: D
Rationale: For clients with normal BMI (18.5–24.9), the Institute of Medicine recommends 25–35 lb total weight gain.
4. Which finding on a nonstress test (NST) is interpreted as reactive?
A. No fetal heart rate accelerations in a 40-minute period
B. Two or more accelerations of at least 15 bpm lasting at least 15 seconds in a 20-minute period
C. Decelerations with every contraction
Galen NUR 254 Maternal and Pediatric Nursing Actual Exams 1-4 2026/2027 | Verified Questions
, D. Baseline fetal heart rate of 100 bpm with minimal variability
Correct Answer: D
Rationale: A reactive NST requires at least two accelerations of ≥15 bpm lasting ≥15 seconds within a 20-minute window (for
fetuses ≥32 weeks).
5. A client in active labor at 6 cm dilation has a Category II fetal heart rate tracing with recurrent
late decelerations. The priority intervention is to:
A. Continue to observe without intervention
B. Perform intrauterine resuscitation measures including maternal repositioning, oxygen administration, and
intravenous fluid bolus, and notify the provider
C. Administer a tocolytic to stop all contractions immediately
D. Prepare for immediate cesarean without attempting corrective measures
Correct Answer: A
Rationale: Intrauterine resuscitation is the first-line response to Category II tracings with late decelerations while preparing
for further evaluation or intervention.
6. Which of the following is a positive sign of pregnancy?
A. Amenorrhea and nausea
B. Positive home pregnancy test
C. Auscultation of fetal heart tones by Doppler
D. Quickening reported by the client
Correct Answer: D
Rationale: Positive signs are those that can be attributed only to the presence of a fetus, such as fetal heart tones, ultrasound
visualization, or fetal movement palpated by an examiner.
7. The primary purpose of administering Rh immune globulin (RhoGAM) to an Rh-negative client
at 28 weeks gestation is to:
A. Treat existing hemolytic disease of the newborn
B. Prevent maternal sensitization to Rh-positive fetal red blood cells
C. Stimulate fetal red blood cell production
D. Increase maternal hemoglobin levels
Correct Answer: D
Rationale: RhoGAM prevents the formation of maternal anti-D antibodies if fetal Rh-positive cells enter the maternal
circulation.
8. A client at 34 weeks gestation presents with sudden-onset severe abdominal pain, uterine
tenderness, and dark-red vaginal bleeding. Vital signs show tachycardia and hypotension. These
findings are most consistent with:
A. Placenta previa
B. Placental abruption
C. Vasa previa
D. Bloody show of labor
Correct Answer: A
Rationale: Abruption typically presents with painful bleeding, uterine tenderness or rigidity, and signs of maternal
hypovolemia.
9. Which medication is commonly used for tocolysis in preterm labor when contraindications are
absent?
A. Oxytocin
B. Nifedipine or indomethacin (gestational-age dependent)
C. Methylergonovine
D. Carboprost
Correct Answer: D
Rationale: Calcium-channel blockers (nifedipine) and NSAIDs (indomethacin before 32 weeks) are frequently used tocolytics.
10. The nurse is teaching a client about the purpose of group B Streptococcus (GBS) screening at
36–37 weeks. The primary reason is to:
A. Diagnose gestational diabetes
B. Identify colonization so that intrapartum antibiotic prophylaxis can be given to reduce neonatal early-onset
GBS disease
C. Determine fetal lung maturity
Galen NUR 254 Maternal and Pediatric Nursing Actual Exams 1-4 2026/2027 | Verified Questions
, D. Screen for neural-tube defects
Correct Answer: B
Rationale: GBS screening identifies colonized clients who require intrapartum antibiotics to protect the newborn.
11. A client in the first stage of labor is 4 cm dilated, 80% effaced, and at −1 station. This describes
which phase of the first stage?
A. Latent phase
B. Active phase (according to contemporary definitions)
C. Transition phase
D. Second stage
Correct Answer: C
Rationale: Active labor is generally considered to begin around 4–6 cm dilation, with more rapid progress thereafter.
12. Which fetal heart rate pattern is most concerning for acute fetal hypoxia and requires
immediate intervention?
A. Early decelerations
B. Variable decelerations that are brief and recover promptly
C. Prolonged deceleration or bradycardia with absent variability
D. Accelerations with fetal movement
Correct Answer: D
Rationale: Prolonged decelerations or bradycardia with absent variability indicate significant fetal compromise.
13. The Leopold maneuvers are performed primarily to:
A. Measure fundal height accurately
B. Determine fetal presentation, position, and engagement
C. Assess cervical dilation
D. Evaluate amniotic fluid volume
Correct Answer: D
Rationale: Leopold maneuvers systematically assess fetal lie, presentation, position, and engagement by abdominal palpation.
14. A client at 39 weeks with a known placenta previa is admitted with vaginal bleeding. The nurse
anticipates which mode of delivery?
A. Induction of labor with oxytocin
B. Cesarean birth
C. Forceps-assisted vaginal delivery
D. Vacuum extraction
Correct Answer: A
Rationale: Complete or partial placenta previa covering the cervix requires cesarean delivery to avoid catastrophic
hemorrhage.
15. Which of the following is a contraindication to the use of magnesium sulfate for seizure
prophylaxis in preeclampsia?
A. Blood pressure of 160/110 mm Hg
B. Myasthenia gravis
C. Proteinuria of 3+
D. Headache and visual changes
Correct Answer: A
Rationale: Magnesium sulfate is contraindicated in myasthenia gravis because it can precipitate a myasthenic crisis.
16. The nurse notes a Category III fetal heart rate tracing. The most appropriate immediate action
is to:
A. Continue current management and reassess in 30 minutes
B. Initiate intrauterine resuscitation and prepare for expeditious delivery
C. Administer an epidural to reduce maternal pain
D. Encourage the client to push with every contraction
Correct Answer: D
Rationale: Category III tracings indicate the need for immediate evaluation and usually prompt delivery while resuscitation
measures are applied.
17. Which laboratory finding is most consistent with HELLP syndrome?
A. Elevated liver enzymes, low platelets, and hemolysis
Galen NUR 254 Maternal and Pediatric Nursing Actual Exams 1-4 2026/2027 | Verified Questions
, B. Hyperglycemia and ketonuria
C. Elevated white blood cell count only
D. Decreased blood urea nitrogen and creatinine
Correct Answer: C
Rationale: HELLP is defined by Hemolysis, Elevated Liver enzymes, and Low Platelets.
18. A client at 26 weeks gestation is diagnosed with gestational diabetes. The initial management
approach is typically:
A. Immediate insulin therapy for all clients
B. Medical nutrition therapy and blood-glucose monitoring, with pharmacologic therapy added if targets are
not met
C. Complete bed rest and hospitalization
D. Immediate delivery of the fetus
Correct Answer: A
Rationale: Most clients with gestational diabetes are managed first with diet and monitoring; medication is added if glycemic
targets are not achieved.
19. The second stage of labor begins when:
A. Contractions become regular
B. The cervix is fully dilated (10 cm) and ends with birth of the neonate
C. The placenta is delivered
D. The client first feels the urge to push
Correct Answer: D
Rationale: The second stage is defined as the interval from complete cervical dilation to delivery of the infant.
20. Which of the following is an expected finding during the latent phase of the first stage of labor?
A. Cervical dilation of 8–10 cm with strong urge to push
B. Cervical dilation from 0 to approximately 4–6 cm with mild to moderate contractions
C. Delivery of the placenta
D. Rapid descent of the presenting part
Correct Answer: B
Rationale: The latent phase involves gradual dilation from closed to about 4–6 cm with relatively mild contractions.
21. A client receiving magnesium sulfate for preeclampsia reports feeling warm, flushed, and
slightly drowsy. The nurse interprets this as:
A. A sign of magnesium toxicity requiring immediate calcium gluconate
B. An expected side effect of therapeutic magnesium levels
C. An allergic reaction requiring discontinuation
D. Evidence of impending eclampsia
Correct Answer: B
Rationale: Warmth, flushing, and mild sedation are common at therapeutic magnesium levels; toxicity presents with loss of
reflexes, respiratory depression, and oliguria.
22. Which fetal position is most common and generally most favorable for vaginal birth?
A. Right occiput posterior (ROP)
B. Left occiput anterior (LOA)
C. Breech presentation
D. Transverse lie
Correct Answer: B
Rationale: LOA is the most common and optimal position for descent and rotation through the pelvis.
23. The nurse is caring for a client with preterm premature rupture of membranes (PPROM) at 30
weeks. Which intervention is a priority?
A. Immediate induction of labor regardless of gestational age
B. Monitoring for signs of infection, fetal well-being, and administration of corticosteroids and antibiotics as
ordered
C. Encouraging ambulation and intercourse
D. Withholding all antibiotics to avoid resistance
Correct Answer: B
Rationale: Management of PPROM focuses on latency antibiotics, corticosteroids for fetal lung maturity, and close
surveillance for infection and fetal status.
Galen NUR 254 Maternal and Pediatric Nursing Actual Exams 1-4 2026/2027 | Verified Questions
Nursing Actual Exams 1-4 2026/2027 |
Verified Questions
Galen College of Nursing | Verified Q&A | Professional Nursing
Students
This document contains 200 original questions developed to reinforce the official course objectives of Galen NUR
254 Maternal and Pediatric Nursing. The questions are organized into four exams covering Antepartum and
Intrapartum Maternal Care, Postpartum and Newborn Care, Pediatric Growth, Development, and Health
Promotion, and Pediatric Acute and Chronic Illness Management. Content is designed to support clinical
proficiency and actual exam readiness for Professional Nursing Students. All material is original and aligned with
Galen NUR 254 curriculum materials, foundational maternal-child nursing textbooks, and current evidence-based
clinical practice guidelines from ACOG and AAP for the 2026/2027 cycle.
Exam 1: Antepartum and Intrapartum Maternal Care
1. Which hormone is primarily responsible for maintaining the corpus luteum in early pregnancy
until the placenta takes over progesterone production?
A. Human chorionic gonadotropin (hCG)
B. Oxytocin
C. Prolactin
D. Follicle-stimulating hormone (FSH)
Correct Answer: D
Rationale: hCG produced by the trophoblast maintains the corpus luteum, which continues progesterone secretion until
placental production is adequate.
2. A multiparous client at 28 weeks gestation reports painless, bright-red vaginal bleeding. The
priority nursing action is to:
A. Perform a digital vaginal examination to assess cervical dilation
B. Place the client on bed rest and notify the provider while preparing for possible ultrasound evaluation of
placenta location
C. Administer oxytocin to control bleeding
D. Encourage ambulation to promote placental attachment
Correct Answer: B
Rationale: Painless bright-red bleeding in the second or third trimester suggests placenta previa; digital examination is
contraindicated until placental location is confirmed.
3. The recommended weight gain for a client with a pre-pregnancy BMI of 22 (normal weight)
during a singleton pregnancy is approximately:
A. 11–20 lb (5–9 kg)
B. 25–35 lb (11.5–16 kg)
C. 15–25 lb (7–11.5 kg)
D. 28–40 lb (12.5–18 kg)
Correct Answer: D
Rationale: For clients with normal BMI (18.5–24.9), the Institute of Medicine recommends 25–35 lb total weight gain.
4. Which finding on a nonstress test (NST) is interpreted as reactive?
A. No fetal heart rate accelerations in a 40-minute period
B. Two or more accelerations of at least 15 bpm lasting at least 15 seconds in a 20-minute period
C. Decelerations with every contraction
Galen NUR 254 Maternal and Pediatric Nursing Actual Exams 1-4 2026/2027 | Verified Questions
, D. Baseline fetal heart rate of 100 bpm with minimal variability
Correct Answer: D
Rationale: A reactive NST requires at least two accelerations of ≥15 bpm lasting ≥15 seconds within a 20-minute window (for
fetuses ≥32 weeks).
5. A client in active labor at 6 cm dilation has a Category II fetal heart rate tracing with recurrent
late decelerations. The priority intervention is to:
A. Continue to observe without intervention
B. Perform intrauterine resuscitation measures including maternal repositioning, oxygen administration, and
intravenous fluid bolus, and notify the provider
C. Administer a tocolytic to stop all contractions immediately
D. Prepare for immediate cesarean without attempting corrective measures
Correct Answer: A
Rationale: Intrauterine resuscitation is the first-line response to Category II tracings with late decelerations while preparing
for further evaluation or intervention.
6. Which of the following is a positive sign of pregnancy?
A. Amenorrhea and nausea
B. Positive home pregnancy test
C. Auscultation of fetal heart tones by Doppler
D. Quickening reported by the client
Correct Answer: D
Rationale: Positive signs are those that can be attributed only to the presence of a fetus, such as fetal heart tones, ultrasound
visualization, or fetal movement palpated by an examiner.
7. The primary purpose of administering Rh immune globulin (RhoGAM) to an Rh-negative client
at 28 weeks gestation is to:
A. Treat existing hemolytic disease of the newborn
B. Prevent maternal sensitization to Rh-positive fetal red blood cells
C. Stimulate fetal red blood cell production
D. Increase maternal hemoglobin levels
Correct Answer: D
Rationale: RhoGAM prevents the formation of maternal anti-D antibodies if fetal Rh-positive cells enter the maternal
circulation.
8. A client at 34 weeks gestation presents with sudden-onset severe abdominal pain, uterine
tenderness, and dark-red vaginal bleeding. Vital signs show tachycardia and hypotension. These
findings are most consistent with:
A. Placenta previa
B. Placental abruption
C. Vasa previa
D. Bloody show of labor
Correct Answer: A
Rationale: Abruption typically presents with painful bleeding, uterine tenderness or rigidity, and signs of maternal
hypovolemia.
9. Which medication is commonly used for tocolysis in preterm labor when contraindications are
absent?
A. Oxytocin
B. Nifedipine or indomethacin (gestational-age dependent)
C. Methylergonovine
D. Carboprost
Correct Answer: D
Rationale: Calcium-channel blockers (nifedipine) and NSAIDs (indomethacin before 32 weeks) are frequently used tocolytics.
10. The nurse is teaching a client about the purpose of group B Streptococcus (GBS) screening at
36–37 weeks. The primary reason is to:
A. Diagnose gestational diabetes
B. Identify colonization so that intrapartum antibiotic prophylaxis can be given to reduce neonatal early-onset
GBS disease
C. Determine fetal lung maturity
Galen NUR 254 Maternal and Pediatric Nursing Actual Exams 1-4 2026/2027 | Verified Questions
, D. Screen for neural-tube defects
Correct Answer: B
Rationale: GBS screening identifies colonized clients who require intrapartum antibiotics to protect the newborn.
11. A client in the first stage of labor is 4 cm dilated, 80% effaced, and at −1 station. This describes
which phase of the first stage?
A. Latent phase
B. Active phase (according to contemporary definitions)
C. Transition phase
D. Second stage
Correct Answer: C
Rationale: Active labor is generally considered to begin around 4–6 cm dilation, with more rapid progress thereafter.
12. Which fetal heart rate pattern is most concerning for acute fetal hypoxia and requires
immediate intervention?
A. Early decelerations
B. Variable decelerations that are brief and recover promptly
C. Prolonged deceleration or bradycardia with absent variability
D. Accelerations with fetal movement
Correct Answer: D
Rationale: Prolonged decelerations or bradycardia with absent variability indicate significant fetal compromise.
13. The Leopold maneuvers are performed primarily to:
A. Measure fundal height accurately
B. Determine fetal presentation, position, and engagement
C. Assess cervical dilation
D. Evaluate amniotic fluid volume
Correct Answer: D
Rationale: Leopold maneuvers systematically assess fetal lie, presentation, position, and engagement by abdominal palpation.
14. A client at 39 weeks with a known placenta previa is admitted with vaginal bleeding. The nurse
anticipates which mode of delivery?
A. Induction of labor with oxytocin
B. Cesarean birth
C. Forceps-assisted vaginal delivery
D. Vacuum extraction
Correct Answer: A
Rationale: Complete or partial placenta previa covering the cervix requires cesarean delivery to avoid catastrophic
hemorrhage.
15. Which of the following is a contraindication to the use of magnesium sulfate for seizure
prophylaxis in preeclampsia?
A. Blood pressure of 160/110 mm Hg
B. Myasthenia gravis
C. Proteinuria of 3+
D. Headache and visual changes
Correct Answer: A
Rationale: Magnesium sulfate is contraindicated in myasthenia gravis because it can precipitate a myasthenic crisis.
16. The nurse notes a Category III fetal heart rate tracing. The most appropriate immediate action
is to:
A. Continue current management and reassess in 30 minutes
B. Initiate intrauterine resuscitation and prepare for expeditious delivery
C. Administer an epidural to reduce maternal pain
D. Encourage the client to push with every contraction
Correct Answer: D
Rationale: Category III tracings indicate the need for immediate evaluation and usually prompt delivery while resuscitation
measures are applied.
17. Which laboratory finding is most consistent with HELLP syndrome?
A. Elevated liver enzymes, low platelets, and hemolysis
Galen NUR 254 Maternal and Pediatric Nursing Actual Exams 1-4 2026/2027 | Verified Questions
, B. Hyperglycemia and ketonuria
C. Elevated white blood cell count only
D. Decreased blood urea nitrogen and creatinine
Correct Answer: C
Rationale: HELLP is defined by Hemolysis, Elevated Liver enzymes, and Low Platelets.
18. A client at 26 weeks gestation is diagnosed with gestational diabetes. The initial management
approach is typically:
A. Immediate insulin therapy for all clients
B. Medical nutrition therapy and blood-glucose monitoring, with pharmacologic therapy added if targets are
not met
C. Complete bed rest and hospitalization
D. Immediate delivery of the fetus
Correct Answer: A
Rationale: Most clients with gestational diabetes are managed first with diet and monitoring; medication is added if glycemic
targets are not achieved.
19. The second stage of labor begins when:
A. Contractions become regular
B. The cervix is fully dilated (10 cm) and ends with birth of the neonate
C. The placenta is delivered
D. The client first feels the urge to push
Correct Answer: D
Rationale: The second stage is defined as the interval from complete cervical dilation to delivery of the infant.
20. Which of the following is an expected finding during the latent phase of the first stage of labor?
A. Cervical dilation of 8–10 cm with strong urge to push
B. Cervical dilation from 0 to approximately 4–6 cm with mild to moderate contractions
C. Delivery of the placenta
D. Rapid descent of the presenting part
Correct Answer: B
Rationale: The latent phase involves gradual dilation from closed to about 4–6 cm with relatively mild contractions.
21. A client receiving magnesium sulfate for preeclampsia reports feeling warm, flushed, and
slightly drowsy. The nurse interprets this as:
A. A sign of magnesium toxicity requiring immediate calcium gluconate
B. An expected side effect of therapeutic magnesium levels
C. An allergic reaction requiring discontinuation
D. Evidence of impending eclampsia
Correct Answer: B
Rationale: Warmth, flushing, and mild sedation are common at therapeutic magnesium levels; toxicity presents with loss of
reflexes, respiratory depression, and oliguria.
22. Which fetal position is most common and generally most favorable for vaginal birth?
A. Right occiput posterior (ROP)
B. Left occiput anterior (LOA)
C. Breech presentation
D. Transverse lie
Correct Answer: B
Rationale: LOA is the most common and optimal position for descent and rotation through the pelvis.
23. The nurse is caring for a client with preterm premature rupture of membranes (PPROM) at 30
weeks. Which intervention is a priority?
A. Immediate induction of labor regardless of gestational age
B. Monitoring for signs of infection, fetal well-being, and administration of corticosteroids and antibiotics as
ordered
C. Encouraging ambulation and intercourse
D. Withholding all antibiotics to avoid resistance
Correct Answer: B
Rationale: Management of PPROM focuses on latency antibiotics, corticosteroids for fetal lung maturity, and close
surveillance for infection and fetal status.
Galen NUR 254 Maternal and Pediatric Nursing Actual Exams 1-4 2026/2027 | Verified Questions
