GALEN COLLEGE OF NURSING | MATERNAL-CHILD NURSING EXAMINATION PREPARATION
NUR 254 Exam 4 - Galen College of Nursing
2026/2027 Actual Exam Questions with Correct Detailed Answers | Maternal-Child Nursing
80 Questions | 6 Content Domains | Certification Format: 4 Options, One Correct Answer | Cognitive Mix: 25 Percent Recall, 55
Percent Application, 20 Percent Analysis | Aligned with Current ACOG, AAP, AWHONN, and NRP Guidance
SECTION 1 - High-Risk Antepartum Conditions (Gestational Diabetes,
Preeclampsia/Eclampsia, Placenta Previa, Abruptio Placentae, Hyperemesis Gravidarum,
Multiple Gestation, and Rh Incompatibility)
Questions 1 through 18
Q1: A 24-year-old G1P0 client at 26 weeks of gestation attends a routine prenatal visit. Her body mass
index is 31, and she has no other medical history. A 50-g, 1-hour glucose challenge test completed this
morning returns a result of 152 mg/dL. What is the nurse's priority action?
A. Inform the client that gestational diabetes is now diagnosed
B. Repeat the 50-g screening test at 32 weeks of gestation
C. Arrange for the client to begin insulin therapy at home immediately
D. Schedule the client for a 100-g, 3-hour oral glucose tolerance test [CORRECT]
Correct Answer: D
Rationale: A 1-hour screen result of 152 mg/dL exceeds every commonly used cutoff (130 to 140 mg/dL), so the
client requires the diagnostic 100-g, 3-hour oral glucose tolerance test before any diagnosis is made. Screening
results alone never establish the diagnosis of gestational diabetes, so starting insulin or counseling the client that she
has diabetes is premature. Repeating the screen at 32 weeks only delays diagnosis and treatment while fetal
hyperinsulinemia and macrosomia risk continue to rise. After the diagnosis is confirmed, medical nutrition therapy
is the first-line intervention, with insulin added when glucose targets are not met.
Q2: When interpreting the 100-g, 3-hour oral glucose tolerance test used to diagnose gestational diabetes,
the nurse recalls that a diagnosis is made when which finding is present?
A. Only the fasting value is interpreted in pregnancy
B. At least two of the four plasma glucose values meet or exceed the diagnostic thresholds (fasting 95,
1-hour 180, 2-hour 155, 3-hour 140 mg/dL) [CORRECT]
C. A single 2-hour value above 140 mg/dL is sufficient in all cases
D. All four timed measurements must be elevated to confirm the diagnosis
Correct Answer: B
Rationale: Using the Carpenter-Coustan criteria applied with the 100-g, 3-hour test, a diagnosis of gestational
diabetes requires two or more of the four values to meet or exceed the thresholds of 95, 180, 155, and 140 mg/dL
for the fasting, 1-hour, 2-hour, and 3-hour samples. Requiring all four values to be abnormal would miss many
affected clients and delay therapy. A single abnormal value indicates an abnormal test warranting surveillance and
repeat testing later in pregnancy, not an automatic diagnosis. The fasting value alone is never used to diagnose
gestational diabetes because isolated fasting hyperglycemia can reflect other metabolic states.
1
,NUR 254 Exam 4 | Galen College of Nursing | 2026/2027 Exam Questions with Correct Detailed Answers Maternal-Child Nursing
Q3: A client with diet-managed gestational diabetes reports fasting capillary glucose readings of 105 to
112 mg/dL over the past week; her 1-hour postprandial values are consistently below 130 mg/dL. Which
prescription should the nurse anticipate?
A. Addition of an intermediate-acting insulin such as NPH at bedtime [CORRECT]
B. Continuation of diet therapy alone with no change in the plan
C. Addition of a first-generation sulfonylurea and stopping glucose monitoring
D. Reduction of glucose self-monitoring to once weekly
Correct Answer: A
Rationale: Target fasting values are below 95 mg/dL, so persistent fasting elevations despite compliant nutrition
therapy indicate the need for insulin, typically bedtime NPH because it specifically targets overnight hepatic glucose
production. Insulin does not cross the placenta in clinically significant amounts and remains the gold-standard
therapy when diet fails. Halving monitoring frequency is unsafe because insulin initiation requires intensified data to
titrate doses. Continuing diet alone risks uncontrolled maternal glucose, which drives fetal hyperinsulinemia,
macrosomia, shoulder dystocia, and neonatal hypoglycemia.
Q4: A postpartum client who had diet-controlled gestational diabetes delivered a healthy infant vaginally
and is bottle-feeding. Before discharge, what teaching should the nurse provide?
A. Insulin therapy must be resumed immediately after delivery
B. Glucose testing is no longer needed because gestational diabetes resolves after delivery
C. A 75-g oral glucose tolerance test should be completed at 4 to 12 weeks postpartum [CORRECT]
D. Screening for type 2 diabetes can safely begin at age 40
Correct Answer: C
Rationale: Current ADA and ACOG guidance requires a 75-g oral glucose tolerance test at 4 to 12 weeks
postpartum using nonpregnant criteria, because gestational diabetes resolves at delivery but signals a lifetime risk of
type 2 diabetes approaching 50 to 60 percent. Telling the client no further testing is needed creates a dangerous gap
in surveillance. Waiting until age 40 ignores the markedly elevated early postpartum and lifetime risk. Insulin is
generally stopped after the placenta, which produces insulin-resisting hormones, is delivered, so routine resumption
is unnecessary unless overt diabetes is identified.
Q5: A 32-week client with new-onset preeclampsia has blood pressure of 162/112 mm Hg confirmed on
two occasions 4 hours apart, 2+ proteinuria, epigastric pain, and a throbbing headache unrelieved by
acetaminophen. How should the nurse interpret this assessment?
A. Expected third-trimester discomforts of a normal pregnancy
B. Mild preeclampsia that can be managed with home bed rest
C. Preeclampsia with severe features requiring hospitalization, seizure prophylaxis, and delivery
planning [CORRECT]
D. Chronic hypertension unrelated to the pregnancy
Correct Answer: C
Rationale: Severe-range blood pressure (160/110 or higher) combined with unrelenting headache and epigastric
pain constitutes preeclampsia with severe features, which mandates hospitalization, magnesium sulfate for seizure
prophylaxis, antihypertensive therapy, and evaluation for delivery. Epigastric pain reflects hepatic capsule distention
and can herald progression to HELLP syndrome or eclampsia. Classifying these findings as mild or routine
discomforts minimizes a leading cause of maternal mortality. Home bed rest without surveillance would leave the
client unprotected against seizure, stroke, abruption, and fetal compromise.
2
,NUR 254 Exam 4 | Galen College of Nursing | 2026/2027 Exam Questions with Correct Detailed Answers Maternal-Child Nursing
Q6: The provider prescribes magnesium sulfate 4 g IV loading dose to be infused over 30 minutes for a
client with severe preeclampsia. The pharmacy supplies magnesium sulfate 40 g in 1,000 mL of fluid. At
what rate in mL/hr should the nurse program the infusion pump?
A. 200 mL/hr [CORRECT]
B. 1,000 mL/hr
C. 250 mL/hr
D. 500 mL/hr
Correct Answer: A
Rationale: The concentration is 40 g per 1,000 mL, which equals 40 mg/mL; the 4-g dose therefore equals 100 mL
of solution. Infusing 100 mL over 30 minutes requires a pump rate of 200 mL/hr. Setting 500 mL/hr would deliver
four times the prescribed dose in 15 minutes and risks acute magnesium toxicity with respiratory and cardiac
depression. Accurate loading-dose administration is essential because magnesium achieves therapeutic
seizure-prophylaxis levels of 4 to 7 mEq/L only when delivered at the prescribed rate.
Q7: A client receiving a magnesium sulfate infusion for preeclampsia has a respiratory rate of 10
breaths/min, urine output of 22 mL/hr, and absent patellar deep tendon reflexes. What is the nurse's
priority action?
A. Increase the infusion rate to overcome the client's tolerance
B. Reposition the client and recheck the reflexes in one hour
C. Apply oxygen by face mask and continue the current infusion
D. Discontinue the magnesium infusion and prepare to administer calcium gluconate [CORRECT]
Correct Answer: D
Rationale: Respiratory depression below 12 breaths/min, oliguria, and loss of patellar reflexes together signal
magnesium toxicity, so the infusion must be stopped immediately and the antidote calcium gluconate administered
as prescribed. Magnesium is cleared renally, so oliguria prolongs drug accumulation and worsens toxicity. Increasing
the rate or waiting an hour allows levels to climb toward respiratory arrest and cardiac conduction failure. Oxygen
alone does not reverse the neuromuscular blockade; the nurse also continues frequent respiratory, reflex, and urine
output assessments during recovery.
Q8: A client with severe preeclampsia suddenly experiences a generalized tonic-clonic seizure at the
bedside. Which action should the nurse take first?
A. Restrain the client's extremities to prevent injury
B. Administer IV labetalol for the elevated blood pressure
C. Insert a padded tongue blade between the client's teeth
D. Turn the client to a lateral position and maintain a patent airway [CORRECT]
Correct Answer: D
Rationale: During an eclamptic seizure the priority is airway protection, so the nurse turns the client laterally to
prevent aspiration of secretions, keeps the airway open, and administers oxygen without forcing anything into the
mouth. Inserting a tongue blade can fracture teeth and lacerate oral tissue, and restraining extremities causes injury
while worsening maternal hypoxia from struggling. Antihypertensives do not abort seizures; after the seizure,
magnesium sulfate is the drug of choice to prevent recurrence, and fetal heart tones are assessed once the mother is
stabilized.
3
, NUR 254 Exam 4 | Galen College of Nursing | 2026/2027 Exam Questions with Correct Detailed Answers Maternal-Child Nursing
Q9: A 34-week client with acute severe-range blood pressure of 168/114 mm Hg requires rapid
antihypertensive treatment. Her history includes moderate persistent asthma. Which medication should
the nurse question because of her respiratory history?
A. Immediate-release oral nifedipine
B. All three agents are equally contraindicated
C. IV labetalol [CORRECT]
D. IV hydralazine
Correct Answer: C
Rationale: Labetalol is a combined alpha- and beta-adrenergic blocker, and beta blockade can precipitate
bronchospasm, so it is relatively contraindicated in clients with asthma or reactive airway disease. Hydralazine, a
direct vasodilator, and immediate-release nifedipine, a calcium channel blocker, are appropriate alternatives and
carry no bronchoconstrictive risk. The nurse also ensures treatment begins within 30 to 60 minutes as current
stroke-prevention standards require, monitors for reflex tachycardia with hydralazine, and avoids abrupt
hypotension that reduces placental perfusion.
Q10: A 34-week client reports 2 days of malaise, nausea, and right upper quadrant pain. Her blood
pressure is 148/94 mm Hg, platelet count is 88,000/mm3, AST and ALT are elevated, and a peripheral
smear shows schistocytes. Which interpretation best fits this presentation?
A. HELLP syndrome, a life-threatening variant of severe preeclampsia [CORRECT]
B. Uncomplicated cholelithiasis expected in late pregnancy
C. Viral gastroenteritis with incidental laboratory changes
D. Physiologic anemia of pregnancy requiring iron supplementation
Correct Answer: A
Rationale: Hemolysis (schistocytes), Elevated Liver enzymes (AST/ALT), and Low Platelets (below
100,000/mm3) define HELLP syndrome, and right upper quadrant or epigastric pain from hepatic capsule
distention is a hallmark symptom. Importantly, HELLP can occur without severe hypertension or significant
proteinuria, so its absence does not exclude the diagnosis. Misattributing the symptoms to gallbladder disease or
gastroenteritis delays delivery, the definitive treatment, and increases the risk of hepatic rupture, stroke, and
disseminated intravascular coagulation. The nurse prepares the client for magnesium sulfate, corticosteroids for
fetal lungs, and likely delivery.
4
NUR 254 Exam 4 - Galen College of Nursing
2026/2027 Actual Exam Questions with Correct Detailed Answers | Maternal-Child Nursing
80 Questions | 6 Content Domains | Certification Format: 4 Options, One Correct Answer | Cognitive Mix: 25 Percent Recall, 55
Percent Application, 20 Percent Analysis | Aligned with Current ACOG, AAP, AWHONN, and NRP Guidance
SECTION 1 - High-Risk Antepartum Conditions (Gestational Diabetes,
Preeclampsia/Eclampsia, Placenta Previa, Abruptio Placentae, Hyperemesis Gravidarum,
Multiple Gestation, and Rh Incompatibility)
Questions 1 through 18
Q1: A 24-year-old G1P0 client at 26 weeks of gestation attends a routine prenatal visit. Her body mass
index is 31, and she has no other medical history. A 50-g, 1-hour glucose challenge test completed this
morning returns a result of 152 mg/dL. What is the nurse's priority action?
A. Inform the client that gestational diabetes is now diagnosed
B. Repeat the 50-g screening test at 32 weeks of gestation
C. Arrange for the client to begin insulin therapy at home immediately
D. Schedule the client for a 100-g, 3-hour oral glucose tolerance test [CORRECT]
Correct Answer: D
Rationale: A 1-hour screen result of 152 mg/dL exceeds every commonly used cutoff (130 to 140 mg/dL), so the
client requires the diagnostic 100-g, 3-hour oral glucose tolerance test before any diagnosis is made. Screening
results alone never establish the diagnosis of gestational diabetes, so starting insulin or counseling the client that she
has diabetes is premature. Repeating the screen at 32 weeks only delays diagnosis and treatment while fetal
hyperinsulinemia and macrosomia risk continue to rise. After the diagnosis is confirmed, medical nutrition therapy
is the first-line intervention, with insulin added when glucose targets are not met.
Q2: When interpreting the 100-g, 3-hour oral glucose tolerance test used to diagnose gestational diabetes,
the nurse recalls that a diagnosis is made when which finding is present?
A. Only the fasting value is interpreted in pregnancy
B. At least two of the four plasma glucose values meet or exceed the diagnostic thresholds (fasting 95,
1-hour 180, 2-hour 155, 3-hour 140 mg/dL) [CORRECT]
C. A single 2-hour value above 140 mg/dL is sufficient in all cases
D. All four timed measurements must be elevated to confirm the diagnosis
Correct Answer: B
Rationale: Using the Carpenter-Coustan criteria applied with the 100-g, 3-hour test, a diagnosis of gestational
diabetes requires two or more of the four values to meet or exceed the thresholds of 95, 180, 155, and 140 mg/dL
for the fasting, 1-hour, 2-hour, and 3-hour samples. Requiring all four values to be abnormal would miss many
affected clients and delay therapy. A single abnormal value indicates an abnormal test warranting surveillance and
repeat testing later in pregnancy, not an automatic diagnosis. The fasting value alone is never used to diagnose
gestational diabetes because isolated fasting hyperglycemia can reflect other metabolic states.
1
,NUR 254 Exam 4 | Galen College of Nursing | 2026/2027 Exam Questions with Correct Detailed Answers Maternal-Child Nursing
Q3: A client with diet-managed gestational diabetes reports fasting capillary glucose readings of 105 to
112 mg/dL over the past week; her 1-hour postprandial values are consistently below 130 mg/dL. Which
prescription should the nurse anticipate?
A. Addition of an intermediate-acting insulin such as NPH at bedtime [CORRECT]
B. Continuation of diet therapy alone with no change in the plan
C. Addition of a first-generation sulfonylurea and stopping glucose monitoring
D. Reduction of glucose self-monitoring to once weekly
Correct Answer: A
Rationale: Target fasting values are below 95 mg/dL, so persistent fasting elevations despite compliant nutrition
therapy indicate the need for insulin, typically bedtime NPH because it specifically targets overnight hepatic glucose
production. Insulin does not cross the placenta in clinically significant amounts and remains the gold-standard
therapy when diet fails. Halving monitoring frequency is unsafe because insulin initiation requires intensified data to
titrate doses. Continuing diet alone risks uncontrolled maternal glucose, which drives fetal hyperinsulinemia,
macrosomia, shoulder dystocia, and neonatal hypoglycemia.
Q4: A postpartum client who had diet-controlled gestational diabetes delivered a healthy infant vaginally
and is bottle-feeding. Before discharge, what teaching should the nurse provide?
A. Insulin therapy must be resumed immediately after delivery
B. Glucose testing is no longer needed because gestational diabetes resolves after delivery
C. A 75-g oral glucose tolerance test should be completed at 4 to 12 weeks postpartum [CORRECT]
D. Screening for type 2 diabetes can safely begin at age 40
Correct Answer: C
Rationale: Current ADA and ACOG guidance requires a 75-g oral glucose tolerance test at 4 to 12 weeks
postpartum using nonpregnant criteria, because gestational diabetes resolves at delivery but signals a lifetime risk of
type 2 diabetes approaching 50 to 60 percent. Telling the client no further testing is needed creates a dangerous gap
in surveillance. Waiting until age 40 ignores the markedly elevated early postpartum and lifetime risk. Insulin is
generally stopped after the placenta, which produces insulin-resisting hormones, is delivered, so routine resumption
is unnecessary unless overt diabetes is identified.
Q5: A 32-week client with new-onset preeclampsia has blood pressure of 162/112 mm Hg confirmed on
two occasions 4 hours apart, 2+ proteinuria, epigastric pain, and a throbbing headache unrelieved by
acetaminophen. How should the nurse interpret this assessment?
A. Expected third-trimester discomforts of a normal pregnancy
B. Mild preeclampsia that can be managed with home bed rest
C. Preeclampsia with severe features requiring hospitalization, seizure prophylaxis, and delivery
planning [CORRECT]
D. Chronic hypertension unrelated to the pregnancy
Correct Answer: C
Rationale: Severe-range blood pressure (160/110 or higher) combined with unrelenting headache and epigastric
pain constitutes preeclampsia with severe features, which mandates hospitalization, magnesium sulfate for seizure
prophylaxis, antihypertensive therapy, and evaluation for delivery. Epigastric pain reflects hepatic capsule distention
and can herald progression to HELLP syndrome or eclampsia. Classifying these findings as mild or routine
discomforts minimizes a leading cause of maternal mortality. Home bed rest without surveillance would leave the
client unprotected against seizure, stroke, abruption, and fetal compromise.
2
,NUR 254 Exam 4 | Galen College of Nursing | 2026/2027 Exam Questions with Correct Detailed Answers Maternal-Child Nursing
Q6: The provider prescribes magnesium sulfate 4 g IV loading dose to be infused over 30 minutes for a
client with severe preeclampsia. The pharmacy supplies magnesium sulfate 40 g in 1,000 mL of fluid. At
what rate in mL/hr should the nurse program the infusion pump?
A. 200 mL/hr [CORRECT]
B. 1,000 mL/hr
C. 250 mL/hr
D. 500 mL/hr
Correct Answer: A
Rationale: The concentration is 40 g per 1,000 mL, which equals 40 mg/mL; the 4-g dose therefore equals 100 mL
of solution. Infusing 100 mL over 30 minutes requires a pump rate of 200 mL/hr. Setting 500 mL/hr would deliver
four times the prescribed dose in 15 minutes and risks acute magnesium toxicity with respiratory and cardiac
depression. Accurate loading-dose administration is essential because magnesium achieves therapeutic
seizure-prophylaxis levels of 4 to 7 mEq/L only when delivered at the prescribed rate.
Q7: A client receiving a magnesium sulfate infusion for preeclampsia has a respiratory rate of 10
breaths/min, urine output of 22 mL/hr, and absent patellar deep tendon reflexes. What is the nurse's
priority action?
A. Increase the infusion rate to overcome the client's tolerance
B. Reposition the client and recheck the reflexes in one hour
C. Apply oxygen by face mask and continue the current infusion
D. Discontinue the magnesium infusion and prepare to administer calcium gluconate [CORRECT]
Correct Answer: D
Rationale: Respiratory depression below 12 breaths/min, oliguria, and loss of patellar reflexes together signal
magnesium toxicity, so the infusion must be stopped immediately and the antidote calcium gluconate administered
as prescribed. Magnesium is cleared renally, so oliguria prolongs drug accumulation and worsens toxicity. Increasing
the rate or waiting an hour allows levels to climb toward respiratory arrest and cardiac conduction failure. Oxygen
alone does not reverse the neuromuscular blockade; the nurse also continues frequent respiratory, reflex, and urine
output assessments during recovery.
Q8: A client with severe preeclampsia suddenly experiences a generalized tonic-clonic seizure at the
bedside. Which action should the nurse take first?
A. Restrain the client's extremities to prevent injury
B. Administer IV labetalol for the elevated blood pressure
C. Insert a padded tongue blade between the client's teeth
D. Turn the client to a lateral position and maintain a patent airway [CORRECT]
Correct Answer: D
Rationale: During an eclamptic seizure the priority is airway protection, so the nurse turns the client laterally to
prevent aspiration of secretions, keeps the airway open, and administers oxygen without forcing anything into the
mouth. Inserting a tongue blade can fracture teeth and lacerate oral tissue, and restraining extremities causes injury
while worsening maternal hypoxia from struggling. Antihypertensives do not abort seizures; after the seizure,
magnesium sulfate is the drug of choice to prevent recurrence, and fetal heart tones are assessed once the mother is
stabilized.
3
, NUR 254 Exam 4 | Galen College of Nursing | 2026/2027 Exam Questions with Correct Detailed Answers Maternal-Child Nursing
Q9: A 34-week client with acute severe-range blood pressure of 168/114 mm Hg requires rapid
antihypertensive treatment. Her history includes moderate persistent asthma. Which medication should
the nurse question because of her respiratory history?
A. Immediate-release oral nifedipine
B. All three agents are equally contraindicated
C. IV labetalol [CORRECT]
D. IV hydralazine
Correct Answer: C
Rationale: Labetalol is a combined alpha- and beta-adrenergic blocker, and beta blockade can precipitate
bronchospasm, so it is relatively contraindicated in clients with asthma or reactive airway disease. Hydralazine, a
direct vasodilator, and immediate-release nifedipine, a calcium channel blocker, are appropriate alternatives and
carry no bronchoconstrictive risk. The nurse also ensures treatment begins within 30 to 60 minutes as current
stroke-prevention standards require, monitors for reflex tachycardia with hydralazine, and avoids abrupt
hypotension that reduces placental perfusion.
Q10: A 34-week client reports 2 days of malaise, nausea, and right upper quadrant pain. Her blood
pressure is 148/94 mm Hg, platelet count is 88,000/mm3, AST and ALT are elevated, and a peripheral
smear shows schistocytes. Which interpretation best fits this presentation?
A. HELLP syndrome, a life-threatening variant of severe preeclampsia [CORRECT]
B. Uncomplicated cholelithiasis expected in late pregnancy
C. Viral gastroenteritis with incidental laboratory changes
D. Physiologic anemia of pregnancy requiring iron supplementation
Correct Answer: A
Rationale: Hemolysis (schistocytes), Elevated Liver enzymes (AST/ALT), and Low Platelets (below
100,000/mm3) define HELLP syndrome, and right upper quadrant or epigastric pain from hepatic capsule
distention is a hallmark symptom. Importantly, HELLP can occur without severe hypertension or significant
proteinuria, so its absence does not exclude the diagnosis. Misattributing the symptoms to gallbladder disease or
gastroenteritis delays delivery, the definitive treatment, and increases the risk of hepatic rupture, stroke, and
disseminated intravascular coagulation. The nurse prepares the client for magnesium sulfate, corticosteroids for
fetal lungs, and likely delivery.
4
