NUR 254 Exam 4 Study Guide | Galen College
of Nursing | Questions and Answers
2026/2027 | Exam Review
Q1. A nurse is assessing a client at 32 weeks gestation who reports a sudden gush of fluid
from the vagina. Which action should the nurse take first?
A. Perform a sterile speculum examination
B. Assess the fetal heart rate
C. Check the client's temperature
D. Obtain a urine specimen
Answer: B. Assess the fetal heart rate
Rationale: When preterm premature rupture of membranes (PPROM) is suspected, the priority
is to assess fetal well-being by evaluating the fetal heart rate for signs of distress or cord
prolapse.
Q2. A client at 34 weeks gestation is diagnosed with placenta previa. Which finding is
most characteristic of this condition?
A. Painful, bright red vaginal bleeding
B. Painless, bright red vaginal bleeding
C. Dark red vaginal bleeding with uterine tenderness
D. Absence of vaginal bleeding
Answer: B. Painless, bright red vaginal bleeding
Rationale: Placenta previa typically presents with painless, bright red vaginal bleeding in the
third trimester. The bleeding is often sudden and may be provoked by intercourse or vaginal
examination.
Q3. A client at 36 weeks gestation presents with severe abdominal pain, dark red vaginal
bleeding, and a board-like abdomen. Which condition should the nurse suspect?
A. Placenta previa
B. Placental abruption
C. Uterine rupture
D. Cervical insufficiency
,Answer: B. Placental abruption
Rationale: Placental abruption is characterized by painful, dark red vaginal bleeding, uterine
tenderness, and a rigid or board-like abdomen due to blood infiltrating the uterine muscle.
Q4. A nurse is caring for a client receiving magnesium sulfate for preeclampsia. Which
finding indicates magnesium toxicity?
A. Respiratory rate of 14 breaths/min
B. Urine output of 35 mL/hr
C. Patellar reflexes absent
D. Blood pressure of 130/80 mmHg
Answer: C. Patellar reflexes absent
Rationale: Absent deep tendon reflexes are an early sign of magnesium toxicity, often
preceding respiratory depression. The therapeutic range for magnesium is 4–7 mEq/L, and
toxicity occurs above 8 mEq/L.
Q5. A client with severe preeclampsia is receiving magnesium sulfate. Which medication
should the nurse have available as the antidote for magnesium toxicity?
A. Naloxone
B. Calcium gluconate
C. Potassium chloride
D. Sodium bicarbonate
Answer: B. Calcium gluconate
Rationale: Calcium gluconate is the antidote for magnesium sulfate toxicity. It should be readily
available at the bedside when magnesium sulfate is infusing.
Q6. A client at 28 weeks gestation is diagnosed with gestational diabetes. Which
instruction should the nurse include in teaching?
A. "You should avoid all carbohydrates during pregnancy."
B. "Monitor your blood glucose levels four times daily."
C. "You will need to take insulin for the rest of your life."
D. "You can stop monitoring your glucose after delivery."
Answer: B. "Monitor your blood glucose levels four times daily."
,Rationale: Clients with gestational diabetes should monitor blood glucose levels fasting and
after meals. Dietary modifications and exercise are first-line treatments, and insulin may be
required if glucose levels remain elevated.
Q7. A client at 33 weeks gestation is admitted with preterm labor. Which medication
should the nurse anticipate administering to promote fetal lung maturity?
A. Magnesium sulfate
B. Betamethasone
C. Terbutaline
D. Indomethacin
Answer: B. Betamethasone
Rationale: Betamethasone is a corticosteroid administered to promote fetal lung maturity in
preterm labor. It is given in two doses, 24 hours apart, between 24 and 34 weeks gestation.
Q8. A nurse is assessing a client at 38 weeks gestation who reports decreased fetal
movement. Which action should the nurse take first?
A. Perform a non-stress test (NST)
B. Prepare for emergency cesarean section
C. Administer oxygen via face mask
D. Instruct the client to drink juice and perform a kick count
Answer: A. Perform a non-stress test (NST)
Rationale: When decreased fetal movement is reported, the priority is to assess fetal well-being.
A non-stress test provides immediate information about fetal heart rate patterns in response to
movement.
Q9. A client at 30 weeks gestation has a blood pressure of 158/102 mmHg and 3+
proteinuria. Which condition is most consistent with these findings?
A. Gestational hypertension
B. Mild preeclampsia
C. Severe preeclampsia
D. Chronic hypertension
Answer: C. Severe preeclampsia
Rationale: Severe preeclampsia is characterized by blood pressure ≥160/110 mmHg,
proteinuria 3+ or greater, and signs of end-organ damage. This client's findings are consistent
with severe preeclampsia.
, Q10. A nurse is teaching a client with preeclampsia about warning signs that require
immediate reporting. Which symptom should the client report immediately?
A. Mild ankle edema
B. Headache unrelieved by acetaminophen
C. Occasional heartburn
D. Breast tenderness
Answer: B. Headache unrelieved by acetaminophen
Rationale: Severe headaches unrelieved by medication may indicate cerebral edema or
impending seizures in preeclampsia. This requires immediate evaluation.
Q11. A client with preeclampsia is prescribed hydralazine. Which assessment finding
indicates the medication is effective?
A. Blood pressure decreases from 160/100 to 130/85 mmHg
B. Heart rate increases from 80 to 110 bpm
C. Urine output decreases to 20 mL/hr
D. Respiratory rate decreases to 10/min
Answer: A. Blood pressure decreases from 160/100 to 130/85 mmHg
Rationale: Hydralazine is an antihypertensive used to lower blood pressure in preeclampsia. A
decrease from 160/100 to 130/85 mmHg indicates therapeutic effectiveness.
Q12. A client at 35 weeks gestation has been diagnosed with oligohydramnios. Which
condition is most commonly associated with this finding?
A. Maternal diabetes
B. Fetal renal anomalies
C. Placenta previa
D. Gestational hypertension
Answer: B. Fetal renal anomalies
Rationale: Oligohydramnios (decreased amniotic fluid) is most commonly associated with fetal
renal anomalies, such as renal agenesis or obstructive uropathy, which reduce fetal urine output.
Q13. A nurse is administering Rho(D) immune globulin (RhoGAM) to a client at 28 weeks
gestation. Which client requires this medication?
A. An Rh-negative client with an Rh-negative fetus
of Nursing | Questions and Answers
2026/2027 | Exam Review
Q1. A nurse is assessing a client at 32 weeks gestation who reports a sudden gush of fluid
from the vagina. Which action should the nurse take first?
A. Perform a sterile speculum examination
B. Assess the fetal heart rate
C. Check the client's temperature
D. Obtain a urine specimen
Answer: B. Assess the fetal heart rate
Rationale: When preterm premature rupture of membranes (PPROM) is suspected, the priority
is to assess fetal well-being by evaluating the fetal heart rate for signs of distress or cord
prolapse.
Q2. A client at 34 weeks gestation is diagnosed with placenta previa. Which finding is
most characteristic of this condition?
A. Painful, bright red vaginal bleeding
B. Painless, bright red vaginal bleeding
C. Dark red vaginal bleeding with uterine tenderness
D. Absence of vaginal bleeding
Answer: B. Painless, bright red vaginal bleeding
Rationale: Placenta previa typically presents with painless, bright red vaginal bleeding in the
third trimester. The bleeding is often sudden and may be provoked by intercourse or vaginal
examination.
Q3. A client at 36 weeks gestation presents with severe abdominal pain, dark red vaginal
bleeding, and a board-like abdomen. Which condition should the nurse suspect?
A. Placenta previa
B. Placental abruption
C. Uterine rupture
D. Cervical insufficiency
,Answer: B. Placental abruption
Rationale: Placental abruption is characterized by painful, dark red vaginal bleeding, uterine
tenderness, and a rigid or board-like abdomen due to blood infiltrating the uterine muscle.
Q4. A nurse is caring for a client receiving magnesium sulfate for preeclampsia. Which
finding indicates magnesium toxicity?
A. Respiratory rate of 14 breaths/min
B. Urine output of 35 mL/hr
C. Patellar reflexes absent
D. Blood pressure of 130/80 mmHg
Answer: C. Patellar reflexes absent
Rationale: Absent deep tendon reflexes are an early sign of magnesium toxicity, often
preceding respiratory depression. The therapeutic range for magnesium is 4–7 mEq/L, and
toxicity occurs above 8 mEq/L.
Q5. A client with severe preeclampsia is receiving magnesium sulfate. Which medication
should the nurse have available as the antidote for magnesium toxicity?
A. Naloxone
B. Calcium gluconate
C. Potassium chloride
D. Sodium bicarbonate
Answer: B. Calcium gluconate
Rationale: Calcium gluconate is the antidote for magnesium sulfate toxicity. It should be readily
available at the bedside when magnesium sulfate is infusing.
Q6. A client at 28 weeks gestation is diagnosed with gestational diabetes. Which
instruction should the nurse include in teaching?
A. "You should avoid all carbohydrates during pregnancy."
B. "Monitor your blood glucose levels four times daily."
C. "You will need to take insulin for the rest of your life."
D. "You can stop monitoring your glucose after delivery."
Answer: B. "Monitor your blood glucose levels four times daily."
,Rationale: Clients with gestational diabetes should monitor blood glucose levels fasting and
after meals. Dietary modifications and exercise are first-line treatments, and insulin may be
required if glucose levels remain elevated.
Q7. A client at 33 weeks gestation is admitted with preterm labor. Which medication
should the nurse anticipate administering to promote fetal lung maturity?
A. Magnesium sulfate
B. Betamethasone
C. Terbutaline
D. Indomethacin
Answer: B. Betamethasone
Rationale: Betamethasone is a corticosteroid administered to promote fetal lung maturity in
preterm labor. It is given in two doses, 24 hours apart, between 24 and 34 weeks gestation.
Q8. A nurse is assessing a client at 38 weeks gestation who reports decreased fetal
movement. Which action should the nurse take first?
A. Perform a non-stress test (NST)
B. Prepare for emergency cesarean section
C. Administer oxygen via face mask
D. Instruct the client to drink juice and perform a kick count
Answer: A. Perform a non-stress test (NST)
Rationale: When decreased fetal movement is reported, the priority is to assess fetal well-being.
A non-stress test provides immediate information about fetal heart rate patterns in response to
movement.
Q9. A client at 30 weeks gestation has a blood pressure of 158/102 mmHg and 3+
proteinuria. Which condition is most consistent with these findings?
A. Gestational hypertension
B. Mild preeclampsia
C. Severe preeclampsia
D. Chronic hypertension
Answer: C. Severe preeclampsia
Rationale: Severe preeclampsia is characterized by blood pressure ≥160/110 mmHg,
proteinuria 3+ or greater, and signs of end-organ damage. This client's findings are consistent
with severe preeclampsia.
, Q10. A nurse is teaching a client with preeclampsia about warning signs that require
immediate reporting. Which symptom should the client report immediately?
A. Mild ankle edema
B. Headache unrelieved by acetaminophen
C. Occasional heartburn
D. Breast tenderness
Answer: B. Headache unrelieved by acetaminophen
Rationale: Severe headaches unrelieved by medication may indicate cerebral edema or
impending seizures in preeclampsia. This requires immediate evaluation.
Q11. A client with preeclampsia is prescribed hydralazine. Which assessment finding
indicates the medication is effective?
A. Blood pressure decreases from 160/100 to 130/85 mmHg
B. Heart rate increases from 80 to 110 bpm
C. Urine output decreases to 20 mL/hr
D. Respiratory rate decreases to 10/min
Answer: A. Blood pressure decreases from 160/100 to 130/85 mmHg
Rationale: Hydralazine is an antihypertensive used to lower blood pressure in preeclampsia. A
decrease from 160/100 to 130/85 mmHg indicates therapeutic effectiveness.
Q12. A client at 35 weeks gestation has been diagnosed with oligohydramnios. Which
condition is most commonly associated with this finding?
A. Maternal diabetes
B. Fetal renal anomalies
C. Placenta previa
D. Gestational hypertension
Answer: B. Fetal renal anomalies
Rationale: Oligohydramnios (decreased amniotic fluid) is most commonly associated with fetal
renal anomalies, such as renal agenesis or obstructive uropathy, which reduce fetal urine output.
Q13. A nurse is administering Rho(D) immune globulin (RhoGAM) to a client at 28 weeks
gestation. Which client requires this medication?
A. An Rh-negative client with an Rh-negative fetus
