GALEN COLLEGE OF NURSING
NUR 254 Exam 2
Maternal & Pediatrics
2026/2027 Actual Exam Questions with Verified Correct Answers
Examination Metadata
Examination Exam 2 - Maternal & Pediatrics (7 sections, 85 questions)
Course NUR 254 - Maternal & Pediatrics Nursing
Institution Galen College of Nursing
Pre-licensure nursing program course objectives and NUR 254 Exam 2 test
Program alignment
blueprint
Question format 4 options (A-D), exactly ONE best answer per question
Cognitive design 25% recall, 55% application, 20% analysis
Item style mix Approximately 80% scenario-based, 20% direct recall and medication calculations
2026/2027 edition, including updated immunization schedules, new obstetric
Currency
guidelines, and current pediatric emergency protocols
How to Use This Examination
• Attempt each of the 85 questions before reading the keyed solution; each item has exactly one best answer among
options A-D.
• The keyed option is marked [CORRECT] on the option line and confirmed by the Correct Answer line beneath the
options.
• Every question carries a maternal-child nursing rationale explaining why the keyed answer is correct and why each
distractor fails, including the classic NUR 254 Exam 2 pitfalls the distractors encode, such as true versus false labor
confusion, fetal monitoring misinterpretation, postpartum hemorrhage misjudgment, misplaced developmental
milestones, pediatric dosing errors, and improper immunization timing.
• Sections map one-to-one to the NUR 254 Exam 2 blueprint from antepartum through pediatric pharmacology;
calculation items show the full arithmetic path inside the rationale.
NUR 254 - Maternal & Pediatrics Nursing - Exam 2 1
,NUR 254 Exam 2 - Galen College - 2026/2027 Questions and Answers
SECTION 1
Antepartum Nursing
Prenatal Care, Fetal Development, Maternal Adaptations, High-Risk Pregnancies, and Antepartum Testing | Questions 1-20
Coverage: pregnancy dating with Naegele's rule and GTPAL; presumptive, probable, and positive signs; expected maternal
adaptations versus danger signs; fetal development, organogenesis, and teratogens; folic acid prophylaxis; prenatal laboratory
screening; gestational diabetes; preeclampsia, eclampsia, and HELLP syndrome; placenta previa and abruption; preterm labor
and 2026 tocolytic standards; nonstress test, biophysical profile, and amniocentesis; Rh isoimmunization and RhoGAM timing.
Q1. A prenatal client reports that the first day of her last menstrual period was March 10, 2026. Using
Naegele's rule, what is her estimated date of birth (EDB)?
A. December 10, 2026
B. December 3, 2026
C. January 10, 2027
D. December 17, 2026 [CORRECT]
Correct Answer: D
Rationale: Naegele's rule requires subtracting 3 months from the first day of the last menstrual period,
adding 7 days, and adjusting the year forward where needed: March 10 minus 3 months is December 10, and
adding 7 days gives December 17, 2026. Option A forgets to add the 7 days, Option B subtracts 7 days
instead of adding them, and Option C adds 3 months rather than subtracting them, the classic sign error
Galen students make under time pressure.
Q2. A client at 12 weeks' gestation has one daughter born at 38 weeks, one son born at 34 weeks, and one
spontaneous abortion at 9 weeks. She is pregnant again. Which GTPAL classification is correct for this
client?
A. G4 T2 P1 A0 L2
B. G3 T1 P1 A1 L2
C. G4 T1 P1 A1 L2 [CORRECT]
D. G4 T1 P2 A0 L2
Correct Answer: C
Rationale: GTPAL counts the current pregnancy in the gravida total: G4 (three previous outcomes plus the
present pregnancy), T1 (the 38-week birth), P1 (the 34-week preterm birth), A1 (the 9-week loss), and L2
(two living children). Option B fails to count the current pregnancy in the gravid total, Option A incorrectly
records the 34-week birth as term, and Option D misplaces the spontaneous abortion by recording two
preterm births and no abortions.
NUR 254 - Maternal & Pediatrics Nursing - Exam 2 2
,NUR 254 Exam 2 - Galen College - 2026/2027 Questions and Answers
Q3. Which assessment finding documented by the nurse is a positive (diagnostic) sign of pregnancy?
A. Hegar's sign of softening of the lower uterine segment
B. Visualization of the fetus by ultrasound examination [CORRECT]
C. Fetal movement perceived by the mother at 19 weeks
D. Bluish discoloration of the vaginal mucosa (Chadwick's sign)
Correct Answer: B
Rationale: Positive signs are attributable only to the presence of a fetus and include ultrasound visualization,
auscultated fetal heart tones, and examiner-perceived fetal movement. Hegar's sign and Chadwick's sign are
probable signs arising from hormonal softening and vasocongestion, and quickening perceived by the mother
is a presumptive sign because it is subjective. Galen testing frequently pairs these three categories in one
item, so classify every sign before answering.
Q4. At a 28-week prenatal visit, the nurse reviews findings documented during the assessment. Which
finding should the nurse identify as requiring immediate follow-up rather than an expected adaptation of
pregnancy?
A. Ankle edema that worsens by evening and resolves with elevation
B. Increased whitish vaginal discharge (leukorrhea) without odor or itching
C. Occasional heartburn after large or late meals
D. Facial and hand edema accompanied by a persistent headache [CORRECT]
Correct Answer: D
Rationale: Facial and hand edema with a persistent headache at 28 weeks suggests worsening preeclampsia
and requires blood pressure, urine protein, and symptom evaluation today. Dependent ankle edema that
improves with elevation, physiologic leukorrhea, and progesterone-driven heartburn are expected maternal
adaptations of the second and third trimesters. The danger signs of pregnancy always center on central
edema, headache, visual changes, and epigastric pain, not peripheral findings alone.
Q5. A client who is 6 weeks pregnant asks the nurse why her provider is concerned that she received a live
vaccine and took an antibiotic last week. Which response by the nurse accurately explains the highest-risk
window for structural teratogenic damage?
A. The second trimester, when fetal weight gain is fastest
B. Weeks 1 to 2 after conception, before implantation is complete
C. Weeks 3 to 8 after conception, when organogenesis is occurring [CORRECT]
D. The third trimester, when fetal lungs mature
Correct Answer: C
Rationale: The embryonic period of weeks 3 to 8 is when the major organ systems differentiate, so
teratogen exposure during this window produces the greatest structural malformations. Weeks 1 to 2 follow
the all-or-none principle, producing either embryonic loss or complete recovery rather than defects. Second-
and third-trimester exposures are more likely to affect growth, brain development, and organ function than
to cause structural anomalies, a distinction emphasized throughout the NUR 254 fetal development module.
NUR 254 - Maternal & Pediatrics Nursing - Exam 2 3
, NUR 254 Exam 2 - Galen College - 2026/2027 Questions and Answers
Q6. A client whose previous pregnancy ended in the birth of an infant with a neural tube defect is planning
her next pregnancy. Which daily folic acid recommendation should the nurse reinforce for this client?
A. 4 mg daily beginning at least 1 month before conception [CORRECT]
B. 400 mcg daily beginning in the second trimester
C. 40 mcg daily obtained only from dietary sources
D. 1 mg daily beginning after the first positive pregnancy test
Correct Answer: A
Rationale: Women with a prior neural-tube-defect-affected pregnancy require high-dose folic acid of 4 mg
daily started at least 1 month before conception and continued through the first trimester, because the neural
tube closes by days 26 to 28, often before pregnancy recognition. Standard low-risk supplementation is 400
mcg daily, which makes Option B wrong in both dose and timing. Option C is far below any therapeutic
dose, and Option D starts too late and at too low a dose for a high-risk client.
Q7. At a 16-week prenatal visit, a client's urine culture grows significant bacteriuria, but she reports no
urinary symptoms. Which nursing action is the priority based on current prenatal care standards?
A. Repeat the culture at the 32-week visit without treatment
B. Administer the prescribed antibiotic course to eradicate the bacteriuria [CORRECT]
C. Increase oral fluids and schedule the next routine visit only
D. Refer the client immediately for renal ultrasound and cystoscopy
Correct Answer: B
Rationale: Asymptomatic bacteriuria in pregnancy is treated with a full antibiotic course because untreated
infection ascends to pyelonephritis and is associated with preterm birth and low birth weight. Option A
delays treatment that is indicated now, Option C understates the risk because hydration alone does not
eradicate bacteriuria, and Option D is an excessive response reserved for recurrent infections or suspected
structural disease. This standard is unchanged in 2026/2027 prenatal screening guidance.
Q8. The nurse is teaching a danger-signs class at a 28-week prenatal visit. Which client statement indicates a
correct understanding of the teaching?
A. If my baby's movements decrease noticeably, I will contact my provider right away [CORRECT]
B. Swelling of my ankles at the end of the day means my blood pressure is rising
C. A small amount of pink mucus after a vaginal exam is an emergency
D. Feeling the baby move less in the last month of pregnancy is always normal
Correct Answer: A
Rationale: Decreased fetal movement is a danger sign that may reflect uteroplacental insufficiency and
warrants same-day evaluation with testing such as a nonstress test. Option B confuses physiologic dependent
edema with the central edema of preeclampsia, Option C describes an expected bloody show after cervical
manipulation, and Option D is a dangerous generalization because reduced movement near term is never
assumed normal without formal assessment. Galen blueprint items on antepartum teaching reward
distinguishing expected discomforts from danger signs.
NUR 254 - Maternal & Pediatrics Nursing - Exam 2 4
NUR 254 Exam 2
Maternal & Pediatrics
2026/2027 Actual Exam Questions with Verified Correct Answers
Examination Metadata
Examination Exam 2 - Maternal & Pediatrics (7 sections, 85 questions)
Course NUR 254 - Maternal & Pediatrics Nursing
Institution Galen College of Nursing
Pre-licensure nursing program course objectives and NUR 254 Exam 2 test
Program alignment
blueprint
Question format 4 options (A-D), exactly ONE best answer per question
Cognitive design 25% recall, 55% application, 20% analysis
Item style mix Approximately 80% scenario-based, 20% direct recall and medication calculations
2026/2027 edition, including updated immunization schedules, new obstetric
Currency
guidelines, and current pediatric emergency protocols
How to Use This Examination
• Attempt each of the 85 questions before reading the keyed solution; each item has exactly one best answer among
options A-D.
• The keyed option is marked [CORRECT] on the option line and confirmed by the Correct Answer line beneath the
options.
• Every question carries a maternal-child nursing rationale explaining why the keyed answer is correct and why each
distractor fails, including the classic NUR 254 Exam 2 pitfalls the distractors encode, such as true versus false labor
confusion, fetal monitoring misinterpretation, postpartum hemorrhage misjudgment, misplaced developmental
milestones, pediatric dosing errors, and improper immunization timing.
• Sections map one-to-one to the NUR 254 Exam 2 blueprint from antepartum through pediatric pharmacology;
calculation items show the full arithmetic path inside the rationale.
NUR 254 - Maternal & Pediatrics Nursing - Exam 2 1
,NUR 254 Exam 2 - Galen College - 2026/2027 Questions and Answers
SECTION 1
Antepartum Nursing
Prenatal Care, Fetal Development, Maternal Adaptations, High-Risk Pregnancies, and Antepartum Testing | Questions 1-20
Coverage: pregnancy dating with Naegele's rule and GTPAL; presumptive, probable, and positive signs; expected maternal
adaptations versus danger signs; fetal development, organogenesis, and teratogens; folic acid prophylaxis; prenatal laboratory
screening; gestational diabetes; preeclampsia, eclampsia, and HELLP syndrome; placenta previa and abruption; preterm labor
and 2026 tocolytic standards; nonstress test, biophysical profile, and amniocentesis; Rh isoimmunization and RhoGAM timing.
Q1. A prenatal client reports that the first day of her last menstrual period was March 10, 2026. Using
Naegele's rule, what is her estimated date of birth (EDB)?
A. December 10, 2026
B. December 3, 2026
C. January 10, 2027
D. December 17, 2026 [CORRECT]
Correct Answer: D
Rationale: Naegele's rule requires subtracting 3 months from the first day of the last menstrual period,
adding 7 days, and adjusting the year forward where needed: March 10 minus 3 months is December 10, and
adding 7 days gives December 17, 2026. Option A forgets to add the 7 days, Option B subtracts 7 days
instead of adding them, and Option C adds 3 months rather than subtracting them, the classic sign error
Galen students make under time pressure.
Q2. A client at 12 weeks' gestation has one daughter born at 38 weeks, one son born at 34 weeks, and one
spontaneous abortion at 9 weeks. She is pregnant again. Which GTPAL classification is correct for this
client?
A. G4 T2 P1 A0 L2
B. G3 T1 P1 A1 L2
C. G4 T1 P1 A1 L2 [CORRECT]
D. G4 T1 P2 A0 L2
Correct Answer: C
Rationale: GTPAL counts the current pregnancy in the gravida total: G4 (three previous outcomes plus the
present pregnancy), T1 (the 38-week birth), P1 (the 34-week preterm birth), A1 (the 9-week loss), and L2
(two living children). Option B fails to count the current pregnancy in the gravid total, Option A incorrectly
records the 34-week birth as term, and Option D misplaces the spontaneous abortion by recording two
preterm births and no abortions.
NUR 254 - Maternal & Pediatrics Nursing - Exam 2 2
,NUR 254 Exam 2 - Galen College - 2026/2027 Questions and Answers
Q3. Which assessment finding documented by the nurse is a positive (diagnostic) sign of pregnancy?
A. Hegar's sign of softening of the lower uterine segment
B. Visualization of the fetus by ultrasound examination [CORRECT]
C. Fetal movement perceived by the mother at 19 weeks
D. Bluish discoloration of the vaginal mucosa (Chadwick's sign)
Correct Answer: B
Rationale: Positive signs are attributable only to the presence of a fetus and include ultrasound visualization,
auscultated fetal heart tones, and examiner-perceived fetal movement. Hegar's sign and Chadwick's sign are
probable signs arising from hormonal softening and vasocongestion, and quickening perceived by the mother
is a presumptive sign because it is subjective. Galen testing frequently pairs these three categories in one
item, so classify every sign before answering.
Q4. At a 28-week prenatal visit, the nurse reviews findings documented during the assessment. Which
finding should the nurse identify as requiring immediate follow-up rather than an expected adaptation of
pregnancy?
A. Ankle edema that worsens by evening and resolves with elevation
B. Increased whitish vaginal discharge (leukorrhea) without odor or itching
C. Occasional heartburn after large or late meals
D. Facial and hand edema accompanied by a persistent headache [CORRECT]
Correct Answer: D
Rationale: Facial and hand edema with a persistent headache at 28 weeks suggests worsening preeclampsia
and requires blood pressure, urine protein, and symptom evaluation today. Dependent ankle edema that
improves with elevation, physiologic leukorrhea, and progesterone-driven heartburn are expected maternal
adaptations of the second and third trimesters. The danger signs of pregnancy always center on central
edema, headache, visual changes, and epigastric pain, not peripheral findings alone.
Q5. A client who is 6 weeks pregnant asks the nurse why her provider is concerned that she received a live
vaccine and took an antibiotic last week. Which response by the nurse accurately explains the highest-risk
window for structural teratogenic damage?
A. The second trimester, when fetal weight gain is fastest
B. Weeks 1 to 2 after conception, before implantation is complete
C. Weeks 3 to 8 after conception, when organogenesis is occurring [CORRECT]
D. The third trimester, when fetal lungs mature
Correct Answer: C
Rationale: The embryonic period of weeks 3 to 8 is when the major organ systems differentiate, so
teratogen exposure during this window produces the greatest structural malformations. Weeks 1 to 2 follow
the all-or-none principle, producing either embryonic loss or complete recovery rather than defects. Second-
and third-trimester exposures are more likely to affect growth, brain development, and organ function than
to cause structural anomalies, a distinction emphasized throughout the NUR 254 fetal development module.
NUR 254 - Maternal & Pediatrics Nursing - Exam 2 3
, NUR 254 Exam 2 - Galen College - 2026/2027 Questions and Answers
Q6. A client whose previous pregnancy ended in the birth of an infant with a neural tube defect is planning
her next pregnancy. Which daily folic acid recommendation should the nurse reinforce for this client?
A. 4 mg daily beginning at least 1 month before conception [CORRECT]
B. 400 mcg daily beginning in the second trimester
C. 40 mcg daily obtained only from dietary sources
D. 1 mg daily beginning after the first positive pregnancy test
Correct Answer: A
Rationale: Women with a prior neural-tube-defect-affected pregnancy require high-dose folic acid of 4 mg
daily started at least 1 month before conception and continued through the first trimester, because the neural
tube closes by days 26 to 28, often before pregnancy recognition. Standard low-risk supplementation is 400
mcg daily, which makes Option B wrong in both dose and timing. Option C is far below any therapeutic
dose, and Option D starts too late and at too low a dose for a high-risk client.
Q7. At a 16-week prenatal visit, a client's urine culture grows significant bacteriuria, but she reports no
urinary symptoms. Which nursing action is the priority based on current prenatal care standards?
A. Repeat the culture at the 32-week visit without treatment
B. Administer the prescribed antibiotic course to eradicate the bacteriuria [CORRECT]
C. Increase oral fluids and schedule the next routine visit only
D. Refer the client immediately for renal ultrasound and cystoscopy
Correct Answer: B
Rationale: Asymptomatic bacteriuria in pregnancy is treated with a full antibiotic course because untreated
infection ascends to pyelonephritis and is associated with preterm birth and low birth weight. Option A
delays treatment that is indicated now, Option C understates the risk because hydration alone does not
eradicate bacteriuria, and Option D is an excessive response reserved for recurrent infections or suspected
structural disease. This standard is unchanged in 2026/2027 prenatal screening guidance.
Q8. The nurse is teaching a danger-signs class at a 28-week prenatal visit. Which client statement indicates a
correct understanding of the teaching?
A. If my baby's movements decrease noticeably, I will contact my provider right away [CORRECT]
B. Swelling of my ankles at the end of the day means my blood pressure is rising
C. A small amount of pink mucus after a vaginal exam is an emergency
D. Feeling the baby move less in the last month of pregnancy is always normal
Correct Answer: A
Rationale: Decreased fetal movement is a danger sign that may reflect uteroplacental insufficiency and
warrants same-day evaluation with testing such as a nonstress test. Option B confuses physiologic dependent
edema with the central edema of preeclampsia, Option C describes an expected bloody show after cervical
manipulation, and Option D is a dangerous generalization because reduced movement near term is never
assumed normal without formal assessment. Galen blueprint items on antepartum teaching reward
distinguishing expected discomforts from danger signs.
NUR 254 - Maternal & Pediatrics Nursing - Exam 2 4
