Galen College of Nursing NURS 254 Exam 1: Antepartum &
Intrapartum Care Prep with Detailed Rationales
Course Code: NURS 254
Course Name: Antepartum & Intrapartum Care
Topic: Maternal-Fetal Physiology, Antepartum Assessment, and Intrapartum
Management
Academic Year: 2026/2027
1. A 24-year-old primigravida at 32 weeks gestation presents to the obstetric
triage unit complaining of a sudden, severe fronto-occipital headache, blurry
vision with floaters, and generalized facial edema. Her vital signs reveal a
blood pressure of 162/112 mmHg , and a point-of-care urinalysis
demonstrates 3+ proteinuria . Which immediate pharmacological
intervention is indicated to prevent the onset of eclamptic seizures?
, A. Continuous intravenous infusion of Oxytocin titrated to contraction
frequency.
B. Intravenous loading dose of Magnesium Sulfate (4 to 6 grams)
followed by a continuous maintenance infusion .
C. Oral administrati on of high-dose Methyldopa.
D. Intramuscular injection of Betamethasone to accelerate fetal lung
maturity.
CORRECT ANSWER: B
RATIONALE: An intravenous loading dose of Magnesium Sulfate is the
definitive standard of care for a patient presenting with preeclampsia with severe
features (systolic BP ≥ 160 mmHg, diastolic BP ≥ 110 mmHg, proteinuria, and
cortical visual disturbances) to stabilize the central nervous system and prevent the
development of eclamptic seizures. Magnesium sulfate acts by depressing the
central nervous system, blocking neuromuscular transmission, and producing mild
cerebral vasodilation. Distractor A (Oxytocin) is used for the induction or
augmentation of labor, not for seizure prophylaxis or blood pressure control.
Distractor C (Methyldopa) is a centrally acting alpha-2 agonist appropriate for
managing mild, chronic hypertension but lacks the rapid onset and anticonvulsant
mechanics needed for acute prophylaxis in preeclampsia with severe features.
Distractor D (Betamethasone) is an antenatal corticosteroid given to stimulate fetal
surfactant production, which does not mitigate maternal neurological risks.
2. A nurse is evaluating a client in the labor and delivery suite who is receiving
an oxytocin infusion for labor induction. The fetal monitoring strip suddenly
reveals late decelerations featuring a gradual decrease and return of FHR
associated with uterine contractions, where the nadir occurs after the peak
of the contraction . What is the underlying pathophysiology driving this
pattern?
A. Umbilical cord compression restricting blood flow through the umbilical
vein.
B. Transient fetal head compression stimulating a vagal nerve reflex during
descent.
C. Uteroplacental insufficiency, resulting in decreased oxygen exchange
across the intervillous space during contractions .
D. Acute fetal respiratory acidosis secondary to maternal hyperventilation.
, CORRECT ANSWER: C
RATIONALE: Late decelerations are caused by uteroplacental
insufficiency , which means the placenta is unable to deliver adequate oxygen to
the fetus during a uterine contraction. This creates a state of hypoxia, triggering a
chemoreceptor-mediated deceleration that lags behind the contraction cycle.
Distractor A causes variable decelerations . Distractor B causes early
decelerations . Distractor D is an inaccurate mechanism.
3. During a routine antepartum clinic visit, a 36-week gestation multigravida
client undergoes a Non-Stress Test (NST) for a history of advanced
maternal age. Over a 20-minute monitoring window , the fetal heart rate
(FHR) baseline is 140 bpm with two accelerations of 15 bpm lasting at
least 15 seconds , accompanied by moderate baseline variability and no
decelerations. How should the nurse accurately document and interpret this
finding?
A. Nonreactive NST, requiring an immediate contraction stress test.
B. Reactive NST, indicating fetal well-being and an intact fetal central
nervous system .
C. Category III tracing, requiring emergent cesarean delivery.
D. Sinusoidal heart pattern, indicating severe fetal hemolytic anemia.
, CORRECT ANSWER: B
RATIONALE: A reactive Non-Stress Test (NST) at or beyond 32 weeks
gestation is established when there are two or more fetal heart rate accelerations
of at least 15 beats per minute above the baseline, with each acceleration lasting for
at least 15 seconds, within a standard 20-minute monitoring window. This pattern
confirms an intact fetal autonomic nervous system and adequate fetal oxygenation.
Distractor A is incorrect because a nonreactive NST lacks these specific
parameters and requires further monitoring via a biophysical profile or contraction
stress test. Distractor C is incorrect because a Category III tracing requires
abnormal features such as absent variability with recurrent late or variable
decelerations, which are absent here. Distractor D describes a smooth, wave-like
pattern indicating severe fetal compromise (eg, severe fetal anemia), which
contradicts this reassuring tracing.
4. A 31-year-old female at 12 weeks gestation presents for her initial prenatal
visit. She has a documented obstetric history of a spontaneous abortion at
8 weeks , a delivery of twins at 34 weeks gestation , and a term delivery
at 39 weeks gestation with all children currently living. Utilizing the
standard GTPAL system , how should the nurse document her obstetric
history?
A. G3-T2-P1-A1-L2
B. G4-T1-P1-A1-L3
C. G4-T2-P0-A1-L2
D. G3-T1-P2-A0-L3
CORRECT ANSWER: B
RATIONALE: The GTPAL system must be broken down strictly by total
pregnancies and individual birth outcomes:
• G (Gravida): Total number of pregnancies. Current pregnancy (1) +
spontaneous abortion (1) + twin pregnancy (1) + term pregnancy (1) = 4 .
• T (Term): Deliveries at 37 weeks or beyond. The 39-week delivery = 1 .
• P (Preterm): Deliveries between 20 and 36 weeks. The 34-week twin
delivery counts as 1 preterm delivery event = 1 .
• A (Abortion): Spontaneous or induced losses prior to 20 weeks. The
spontaneous abortion at 8 weeks = 1 .
Intrapartum Care Prep with Detailed Rationales
Course Code: NURS 254
Course Name: Antepartum & Intrapartum Care
Topic: Maternal-Fetal Physiology, Antepartum Assessment, and Intrapartum
Management
Academic Year: 2026/2027
1. A 24-year-old primigravida at 32 weeks gestation presents to the obstetric
triage unit complaining of a sudden, severe fronto-occipital headache, blurry
vision with floaters, and generalized facial edema. Her vital signs reveal a
blood pressure of 162/112 mmHg , and a point-of-care urinalysis
demonstrates 3+ proteinuria . Which immediate pharmacological
intervention is indicated to prevent the onset of eclamptic seizures?
, A. Continuous intravenous infusion of Oxytocin titrated to contraction
frequency.
B. Intravenous loading dose of Magnesium Sulfate (4 to 6 grams)
followed by a continuous maintenance infusion .
C. Oral administrati on of high-dose Methyldopa.
D. Intramuscular injection of Betamethasone to accelerate fetal lung
maturity.
CORRECT ANSWER: B
RATIONALE: An intravenous loading dose of Magnesium Sulfate is the
definitive standard of care for a patient presenting with preeclampsia with severe
features (systolic BP ≥ 160 mmHg, diastolic BP ≥ 110 mmHg, proteinuria, and
cortical visual disturbances) to stabilize the central nervous system and prevent the
development of eclamptic seizures. Magnesium sulfate acts by depressing the
central nervous system, blocking neuromuscular transmission, and producing mild
cerebral vasodilation. Distractor A (Oxytocin) is used for the induction or
augmentation of labor, not for seizure prophylaxis or blood pressure control.
Distractor C (Methyldopa) is a centrally acting alpha-2 agonist appropriate for
managing mild, chronic hypertension but lacks the rapid onset and anticonvulsant
mechanics needed for acute prophylaxis in preeclampsia with severe features.
Distractor D (Betamethasone) is an antenatal corticosteroid given to stimulate fetal
surfactant production, which does not mitigate maternal neurological risks.
2. A nurse is evaluating a client in the labor and delivery suite who is receiving
an oxytocin infusion for labor induction. The fetal monitoring strip suddenly
reveals late decelerations featuring a gradual decrease and return of FHR
associated with uterine contractions, where the nadir occurs after the peak
of the contraction . What is the underlying pathophysiology driving this
pattern?
A. Umbilical cord compression restricting blood flow through the umbilical
vein.
B. Transient fetal head compression stimulating a vagal nerve reflex during
descent.
C. Uteroplacental insufficiency, resulting in decreased oxygen exchange
across the intervillous space during contractions .
D. Acute fetal respiratory acidosis secondary to maternal hyperventilation.
, CORRECT ANSWER: C
RATIONALE: Late decelerations are caused by uteroplacental
insufficiency , which means the placenta is unable to deliver adequate oxygen to
the fetus during a uterine contraction. This creates a state of hypoxia, triggering a
chemoreceptor-mediated deceleration that lags behind the contraction cycle.
Distractor A causes variable decelerations . Distractor B causes early
decelerations . Distractor D is an inaccurate mechanism.
3. During a routine antepartum clinic visit, a 36-week gestation multigravida
client undergoes a Non-Stress Test (NST) for a history of advanced
maternal age. Over a 20-minute monitoring window , the fetal heart rate
(FHR) baseline is 140 bpm with two accelerations of 15 bpm lasting at
least 15 seconds , accompanied by moderate baseline variability and no
decelerations. How should the nurse accurately document and interpret this
finding?
A. Nonreactive NST, requiring an immediate contraction stress test.
B. Reactive NST, indicating fetal well-being and an intact fetal central
nervous system .
C. Category III tracing, requiring emergent cesarean delivery.
D. Sinusoidal heart pattern, indicating severe fetal hemolytic anemia.
, CORRECT ANSWER: B
RATIONALE: A reactive Non-Stress Test (NST) at or beyond 32 weeks
gestation is established when there are two or more fetal heart rate accelerations
of at least 15 beats per minute above the baseline, with each acceleration lasting for
at least 15 seconds, within a standard 20-minute monitoring window. This pattern
confirms an intact fetal autonomic nervous system and adequate fetal oxygenation.
Distractor A is incorrect because a nonreactive NST lacks these specific
parameters and requires further monitoring via a biophysical profile or contraction
stress test. Distractor C is incorrect because a Category III tracing requires
abnormal features such as absent variability with recurrent late or variable
decelerations, which are absent here. Distractor D describes a smooth, wave-like
pattern indicating severe fetal compromise (eg, severe fetal anemia), which
contradicts this reassuring tracing.
4. A 31-year-old female at 12 weeks gestation presents for her initial prenatal
visit. She has a documented obstetric history of a spontaneous abortion at
8 weeks , a delivery of twins at 34 weeks gestation , and a term delivery
at 39 weeks gestation with all children currently living. Utilizing the
standard GTPAL system , how should the nurse document her obstetric
history?
A. G3-T2-P1-A1-L2
B. G4-T1-P1-A1-L3
C. G4-T2-P0-A1-L2
D. G3-T1-P2-A0-L3
CORRECT ANSWER: B
RATIONALE: The GTPAL system must be broken down strictly by total
pregnancies and individual birth outcomes:
• G (Gravida): Total number of pregnancies. Current pregnancy (1) +
spontaneous abortion (1) + twin pregnancy (1) + term pregnancy (1) = 4 .
• T (Term): Deliveries at 37 weeks or beyond. The 39-week delivery = 1 .
• P (Preterm): Deliveries between 20 and 36 weeks. The 34-week twin
delivery counts as 1 preterm delivery event = 1 .
• A (Abortion): Spontaneous or induced losses prior to 20 weeks. The
spontaneous abortion at 8 weeks = 1 .
