Galen College of Nursing | NUR 254 Exam 4 | 2026/2027 Update 100% Correct Verified Answers
Galen College of Nursing
NUR 254 Exam 4 — Comprehensive Final
Examination
Questions and Answers | 2026/2027 Update | 100% Correct
Course NUR 254 - Integrated Nursing Practice Total Questions 75
Exam Type Comprehensive Final (Capstone) Cognitive Mix 30% Recall / 50% Application / 20% Analysis
Format NCLEX-style 4-option multiple choice Question Style 80% Scenario-based / 20% Direct Recall
Aligned With 2026 NCLEX-RN Test Plan & NCSBN CJMM
Answer Key Embedded with rationales
Examination Instructions:
• Select the ONE best answer for each question. Each question has exactly one correct response.
• Use NCLEX clinical judgment: assess → analyze → prioritize → act using ABC, Maslow, safety, and
acute-versus-chronic frameworks.
• Rationales follow each question and include why the correct option is right, why distractors are wrong, and
a test-taking strategy note.
• Medication calculation answers are rounded per NCLEX convention; show weight-based and
unit-conversion logic.
• All content has been verified against Galen NUR 254 course materials and the 2026 NCLEX-RN Test
Plan.
Section 1: Maternal-Newborn Nursing
Antepartum, Intrapartum, Postpartum, & Newborn Care | Questions 1-16
1. A 28-year-old primigravida at 24 weeks gestation presents to the prenatal clinic. Which finding should
the nurse identify as a normal physiological adaptation of pregnancy that requires no further
intervention?
A. Blood pressure of 148/96 mmHg documented on two separate visits 6 hours apart
B. Glycosuria on urine dipstick with a normal 1-hour glucose tolerance test result [CORRECT]
C. Persistent frontal headache with photophobia and scotomas for 48 hours
D. Edema of the hands and face present upon awakening that does not resolve with elevation
Correct Answer: B — Glycosuria on urine dipstick with a normal 1-hour glucose tolerance test
result
Rationale: Glycosuria with a normal glucose tolerance test is a common benign finding in pregnancy due to the
increased glomerular filtration rate (GFR) and reduced renal tubular reabsorption threshold for glucose. Options A, C,
and D are classic warning signs of preeclampsia (BP ≥140/90 on two occasions, CNS symptoms, and facial/hand
edema). Test-taking strategy: when distinguishing normal pregnancy adaptations from pathology, recall that BP
≥140/90, persistent headache with visual disturbances, and dependent edema of face/hands all warrant immediate
Page 1
,Galen College of Nursing | NUR 254 Exam 4 | 2026/2027 Update 100% Correct Verified Answers
evaluation for hypertensive disorders of pregnancy. Verified 100% correct against Galen NUR 254 antepartum
content.
2. A laboring client at 39 weeks gestation has a fetal monitor showing a baseline fetal heart rate of 155
bpm with minimal variability and recurrent late decelerations. Which action should the nurse take
FIRST?
A. Continue monitoring, document findings, and re-evaluate in 30 minutes
B. Apply oxygen at 10 L/min via nonrebreather mask, reposition the client to left lateral, increase IV fluids,
and discontinue any oxytocin infusion [CORRECT]
C. Notify the provider and immediately prepare the client for cesarean delivery
D. Apply a fetal scalp electrode and continue observation of the tracing
Correct Answer: B — Apply oxygen at 10 L/min via nonrebreather mask, reposition the client to left
lateral, increase IV fluids, and discontinue any oxytocin infusion
Rationale: Recurrent late decelerations with minimal variability indicate uteroplacental insufficiency and a Category
II tracing requiring intrauterine resuscitation FIRST. The ABCs of fetal monitoring intervention are: oxygen, position
change, IV fluids, and discontinuing oxytocin if infusing. Option A delays critical intervention; option C (cesarean) is
the next step only if conservative intrauterine resuscitation fails; option D is diagnostic, not therapeutic. Test-taking
strategy: when "Category II + late decelerations" appears, the FIRST nursing action is always intrauterine
resuscitation (MORS: Move, Oxygen, Replace fluids, Stop oxytocin) before escalating to operative delivery. Verified
100% correct per NCC and AWHONN fetal monitoring standards.
3. The fetal heart rate strip shows a sudden decrease from baseline of 80 bpm lasting 45 seconds that
begins and ends abruptly in relationship to a uterine contraction, with an acceleratory "shoulder" before
and after the deceleration. The nurse should recognize this as which finding?
A. Late decelerations indicative of uteroplacental insufficiency
B. Early decelerations indicative of fetal head compression
C. Variable decelerations indicative of umbilical cord compression [CORRECT]
D. Prolonged deceleration indicative of umbilical cord prolapse
Correct Answer: C — Variable decelerations indicative of umbilical cord compression
Rationale: Variable decelerations are characterized by an abrupt onset, abrupt return to baseline, variable shape, and
the presence of "shoulders" (accelerations before and after). They are caused by umbilical cord compression. Late
decelerations (A) have a gradual onset with the nadir occurring AFTER the peak of the contraction. Early
decelerations (B) mirror contractions with gradual onset and are benign. Prolonged decelerations (D) last >2 minutes
but <10 minutes. Test-taking strategy: the keywords "abrupt onset/offset" and "shoulders" = variable decelerations =
cord compression. Reposition the client (preferably knee-chest or lateral) to relieve cord pressure. Verified against
AWHONN 2026 fetal monitoring nomenclature.
4. At 39 weeks gestation, a client in active labor has recurrent late decelerations. The nurse has already
applied oxygen at 10 L/min, repositioned the client, increased IV fluids, and discontinued the oxytocin
infusion. The late decelerations persist. Which action should the nurse take NEXT?
A. Notify the healthcare provider immediately and prepare for possible cesarean birth [CORRECT]
B. Administer terbutaline 0.25 mg subcutaneously to inhibit uterine activity
C. Apply a fetal scalp electrode and continue monitoring for an additional 30 minutes
D. Perform a sterile vaginal exam to assess for umbilical cord prolapse
Page 2
, Galen College of Nursing | NUR 254 Exam 4 | 2026/2027 Update 100% Correct Verified Answers
Correct Answer: A — Notify the healthcare provider immediately and prepare for possible
cesarean birth
Rationale: When intrauterine resuscitation (oxygen, repositioning, IV fluids, stopping oxytocin) FAILS to resolve
recurrent late decelerations, the nurse must immediately escalate by notifying the provider and preparing for operative
delivery. Terbutaline (B) may be considered by the provider for tachysystole but is not an independent nursing action
without an order. Continuing to monitor (C) wastes precious fetal reserves. Vaginal exam (D) is appropriate if cord
prolapse is suspected (e.g., with variable decelerations after ROM), not for late decelerations. Test-taking strategy:
once conservative interventions fail in a Category III or worsening Category II strip, the next step is ALWAYS
provider notification with preparation for cesarean. Verified 100% correct per NCC Intrapartum Fetal Monitoring
guidelines.
5. A 32-year-old multigravida at 35 weeks gestation presents with epigastric pain, nausea, and malaise.
Vital signs: BP 162/108 mmHg, HR 96, RR 20. Laboratory results reveal platelets 88,000/mm³, AST 250
U/L, LDH 600 U/L, and hemolysis on peripheral smear. The nurse should recognize these findings as
most consistent with which condition?
A. Gestational hypertension with mild features
B. Chronic essential hypertension
C. HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) [CORRECT]
D. Acute fatty liver of pregnancy
Correct Answer: C — HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets)
Rationale: HELLP syndrome is a severe variant of preeclampsia characterized by Hemolysis (elevated LDH,
schistocytes on smear), Elevated Liver enzymes (AST/ALT markedly elevated, often with epigastric pain), and Low
Platelets (<100,000/mm³). The epigastric pain reflects liver capsule distension from microhemorrhage. Option A is
incorrect because labs would be normal in gestational hypertension. Option B is incorrect because chronic HTN lacks
the hepatic and hematologic abnormalities. Option D (AFLP) presents with hypoglycemia, elevated ammonia, and
coagulopathy but is much rarer. Test-taking strategy: when epigastric pain + abnormal labs (low platelets, high liver
enzymes) appear in a hypertensive pregnant client, think HELLP. Verified 100% correct per ACOG and Galen NUR
254 postpartum complications module.
6. A client with severe preeclampsia is receiving a magnesium sulfate maintenance infusion at 2 g/hr.
Assessment reveals: respirations 10/min, deep tendon reflexes absent, and urine output 20 mL/hr. Which
action should the nurse take FIRST?
A. Increase the IV fluid rate to enhance magnesium renal excretion
B. Discontinue the magnesium sulfate infusion and administer calcium gluconate 10% 1 g IV over 3 minutes
[CORRECT]
C. Notify the provider and continue the current infusion rate while monitoring
D. Reassess blood pressure and recheck reflexes in 15 minutes
Correct Answer: B — Discontinue the magnesium sulfate infusion and administer calcium
gluconate 10% 1 g IV over 3 minutes
Rationale: Respirations <12, absent reflexes, and oliguria (<30 mL/hr) are cardinal signs of magnesium sulfate
toxicity. The FIRST action is to STOP the infusion and administer the antidote, calcium gluconate, which directly
antagonizes magnesium at the neuromuscular junction and myocardium. Increasing IV fluids (A) without stopping the
infusion worsens the overdose. Continuing the infusion (C) is dangerous. Reassessing in 15 minutes (D) delays
life-saving reversal. Test-taking strategy: for any magnesium toxicity clue (RR <12, absent DTRs, oliguria, decreased
LOC), the answer is always "stop infusion + calcium gluconate." Verified against Galen NUR 254 high-risk obstetrics
Page 3
Galen College of Nursing
NUR 254 Exam 4 — Comprehensive Final
Examination
Questions and Answers | 2026/2027 Update | 100% Correct
Course NUR 254 - Integrated Nursing Practice Total Questions 75
Exam Type Comprehensive Final (Capstone) Cognitive Mix 30% Recall / 50% Application / 20% Analysis
Format NCLEX-style 4-option multiple choice Question Style 80% Scenario-based / 20% Direct Recall
Aligned With 2026 NCLEX-RN Test Plan & NCSBN CJMM
Answer Key Embedded with rationales
Examination Instructions:
• Select the ONE best answer for each question. Each question has exactly one correct response.
• Use NCLEX clinical judgment: assess → analyze → prioritize → act using ABC, Maslow, safety, and
acute-versus-chronic frameworks.
• Rationales follow each question and include why the correct option is right, why distractors are wrong, and
a test-taking strategy note.
• Medication calculation answers are rounded per NCLEX convention; show weight-based and
unit-conversion logic.
• All content has been verified against Galen NUR 254 course materials and the 2026 NCLEX-RN Test
Plan.
Section 1: Maternal-Newborn Nursing
Antepartum, Intrapartum, Postpartum, & Newborn Care | Questions 1-16
1. A 28-year-old primigravida at 24 weeks gestation presents to the prenatal clinic. Which finding should
the nurse identify as a normal physiological adaptation of pregnancy that requires no further
intervention?
A. Blood pressure of 148/96 mmHg documented on two separate visits 6 hours apart
B. Glycosuria on urine dipstick with a normal 1-hour glucose tolerance test result [CORRECT]
C. Persistent frontal headache with photophobia and scotomas for 48 hours
D. Edema of the hands and face present upon awakening that does not resolve with elevation
Correct Answer: B — Glycosuria on urine dipstick with a normal 1-hour glucose tolerance test
result
Rationale: Glycosuria with a normal glucose tolerance test is a common benign finding in pregnancy due to the
increased glomerular filtration rate (GFR) and reduced renal tubular reabsorption threshold for glucose. Options A, C,
and D are classic warning signs of preeclampsia (BP ≥140/90 on two occasions, CNS symptoms, and facial/hand
edema). Test-taking strategy: when distinguishing normal pregnancy adaptations from pathology, recall that BP
≥140/90, persistent headache with visual disturbances, and dependent edema of face/hands all warrant immediate
Page 1
,Galen College of Nursing | NUR 254 Exam 4 | 2026/2027 Update 100% Correct Verified Answers
evaluation for hypertensive disorders of pregnancy. Verified 100% correct against Galen NUR 254 antepartum
content.
2. A laboring client at 39 weeks gestation has a fetal monitor showing a baseline fetal heart rate of 155
bpm with minimal variability and recurrent late decelerations. Which action should the nurse take
FIRST?
A. Continue monitoring, document findings, and re-evaluate in 30 minutes
B. Apply oxygen at 10 L/min via nonrebreather mask, reposition the client to left lateral, increase IV fluids,
and discontinue any oxytocin infusion [CORRECT]
C. Notify the provider and immediately prepare the client for cesarean delivery
D. Apply a fetal scalp electrode and continue observation of the tracing
Correct Answer: B — Apply oxygen at 10 L/min via nonrebreather mask, reposition the client to left
lateral, increase IV fluids, and discontinue any oxytocin infusion
Rationale: Recurrent late decelerations with minimal variability indicate uteroplacental insufficiency and a Category
II tracing requiring intrauterine resuscitation FIRST. The ABCs of fetal monitoring intervention are: oxygen, position
change, IV fluids, and discontinuing oxytocin if infusing. Option A delays critical intervention; option C (cesarean) is
the next step only if conservative intrauterine resuscitation fails; option D is diagnostic, not therapeutic. Test-taking
strategy: when "Category II + late decelerations" appears, the FIRST nursing action is always intrauterine
resuscitation (MORS: Move, Oxygen, Replace fluids, Stop oxytocin) before escalating to operative delivery. Verified
100% correct per NCC and AWHONN fetal monitoring standards.
3. The fetal heart rate strip shows a sudden decrease from baseline of 80 bpm lasting 45 seconds that
begins and ends abruptly in relationship to a uterine contraction, with an acceleratory "shoulder" before
and after the deceleration. The nurse should recognize this as which finding?
A. Late decelerations indicative of uteroplacental insufficiency
B. Early decelerations indicative of fetal head compression
C. Variable decelerations indicative of umbilical cord compression [CORRECT]
D. Prolonged deceleration indicative of umbilical cord prolapse
Correct Answer: C — Variable decelerations indicative of umbilical cord compression
Rationale: Variable decelerations are characterized by an abrupt onset, abrupt return to baseline, variable shape, and
the presence of "shoulders" (accelerations before and after). They are caused by umbilical cord compression. Late
decelerations (A) have a gradual onset with the nadir occurring AFTER the peak of the contraction. Early
decelerations (B) mirror contractions with gradual onset and are benign. Prolonged decelerations (D) last >2 minutes
but <10 minutes. Test-taking strategy: the keywords "abrupt onset/offset" and "shoulders" = variable decelerations =
cord compression. Reposition the client (preferably knee-chest or lateral) to relieve cord pressure. Verified against
AWHONN 2026 fetal monitoring nomenclature.
4. At 39 weeks gestation, a client in active labor has recurrent late decelerations. The nurse has already
applied oxygen at 10 L/min, repositioned the client, increased IV fluids, and discontinued the oxytocin
infusion. The late decelerations persist. Which action should the nurse take NEXT?
A. Notify the healthcare provider immediately and prepare for possible cesarean birth [CORRECT]
B. Administer terbutaline 0.25 mg subcutaneously to inhibit uterine activity
C. Apply a fetal scalp electrode and continue monitoring for an additional 30 minutes
D. Perform a sterile vaginal exam to assess for umbilical cord prolapse
Page 2
, Galen College of Nursing | NUR 254 Exam 4 | 2026/2027 Update 100% Correct Verified Answers
Correct Answer: A — Notify the healthcare provider immediately and prepare for possible
cesarean birth
Rationale: When intrauterine resuscitation (oxygen, repositioning, IV fluids, stopping oxytocin) FAILS to resolve
recurrent late decelerations, the nurse must immediately escalate by notifying the provider and preparing for operative
delivery. Terbutaline (B) may be considered by the provider for tachysystole but is not an independent nursing action
without an order. Continuing to monitor (C) wastes precious fetal reserves. Vaginal exam (D) is appropriate if cord
prolapse is suspected (e.g., with variable decelerations after ROM), not for late decelerations. Test-taking strategy:
once conservative interventions fail in a Category III or worsening Category II strip, the next step is ALWAYS
provider notification with preparation for cesarean. Verified 100% correct per NCC Intrapartum Fetal Monitoring
guidelines.
5. A 32-year-old multigravida at 35 weeks gestation presents with epigastric pain, nausea, and malaise.
Vital signs: BP 162/108 mmHg, HR 96, RR 20. Laboratory results reveal platelets 88,000/mm³, AST 250
U/L, LDH 600 U/L, and hemolysis on peripheral smear. The nurse should recognize these findings as
most consistent with which condition?
A. Gestational hypertension with mild features
B. Chronic essential hypertension
C. HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) [CORRECT]
D. Acute fatty liver of pregnancy
Correct Answer: C — HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets)
Rationale: HELLP syndrome is a severe variant of preeclampsia characterized by Hemolysis (elevated LDH,
schistocytes on smear), Elevated Liver enzymes (AST/ALT markedly elevated, often with epigastric pain), and Low
Platelets (<100,000/mm³). The epigastric pain reflects liver capsule distension from microhemorrhage. Option A is
incorrect because labs would be normal in gestational hypertension. Option B is incorrect because chronic HTN lacks
the hepatic and hematologic abnormalities. Option D (AFLP) presents with hypoglycemia, elevated ammonia, and
coagulopathy but is much rarer. Test-taking strategy: when epigastric pain + abnormal labs (low platelets, high liver
enzymes) appear in a hypertensive pregnant client, think HELLP. Verified 100% correct per ACOG and Galen NUR
254 postpartum complications module.
6. A client with severe preeclampsia is receiving a magnesium sulfate maintenance infusion at 2 g/hr.
Assessment reveals: respirations 10/min, deep tendon reflexes absent, and urine output 20 mL/hr. Which
action should the nurse take FIRST?
A. Increase the IV fluid rate to enhance magnesium renal excretion
B. Discontinue the magnesium sulfate infusion and administer calcium gluconate 10% 1 g IV over 3 minutes
[CORRECT]
C. Notify the provider and continue the current infusion rate while monitoring
D. Reassess blood pressure and recheck reflexes in 15 minutes
Correct Answer: B — Discontinue the magnesium sulfate infusion and administer calcium
gluconate 10% 1 g IV over 3 minutes
Rationale: Respirations <12, absent reflexes, and oliguria (<30 mL/hr) are cardinal signs of magnesium sulfate
toxicity. The FIRST action is to STOP the infusion and administer the antidote, calcium gluconate, which directly
antagonizes magnesium at the neuromuscular junction and myocardium. Increasing IV fluids (A) without stopping the
infusion worsens the overdose. Continuing the infusion (C) is dangerous. Reassessing in 15 minutes (D) delays
life-saving reversal. Test-taking strategy: for any magnesium toxicity clue (RR <12, absent DTRs, oliguria, decreased
LOC), the answer is always "stop infusion + calcium gluconate." Verified against Galen NUR 254 high-risk obstetrics
Page 3
