NUR 254 Exam 1 : Maternal and Pediatrics Galen College of
Nursing Practice Exam Questions with Correct Answers and
Explanations in Italics - 150 Questions
Section 1: Antepartum Care and Complications (Questions 1-15)
1 A primigravid client at 34 weeks gestation presents with blood pressure 158/102 mmHg, proteinuria (3+ on
dipstick), and serum creatinine 1.2 mg/dL. Which laboratory finding is most critical to evaluate before initiating
magnesium sulfate therapy?
A) Serum calcium level
B) Serum potassium level
C) Serum magnesium level
D) Serum uric acid level
Answer: C
Rationale: Magnesium sulfate is nephrotoxic and renally excreted; baseline serum magnesium is essential to avoid
toxicity. While uric acid (D) is elevated in preeclampsia, it does not guide magnesium dosing. Calcium (A) and
potassium (B) are not immediate prerequisites.
2 A client with gestational diabetes mellitus (GDM) is on insulin therapy. At 36 weeks gestation, her fasting
glucose levels are consistently 95-105 mg/dL despite increased insulin. What is the most appropriate next step?
A) Increase the evening NPH insulin dose by 20%
B) Switch to a continuous insulin infusion
C) Initiate oral hypoglycemic agent metformin
D) Schedule elective cesarean delivery at 37 weeks
Answer: A
Rationale: In late pregnancy, insulin resistance peaks; increasing NPH insulin is standard. Oral agents (C) are not
first-line in pregnancy. Cesarean (D) is not indicated for mild hyperglycemia. Continuous infusion (B) is reserved
for severe cases or diabetic ketoacidosis.
3 A client at 28 weeks gestation with a history of preterm birth at 32 weeks has a cervical length of 22 mm on
transvaginal ultrasound. Which intervention is most likely to reduce preterm birth risk?
A) Intramuscular 17-alpha-hydroxyprogesterone caproate weekly
B) Cervical cerclage placement
C) Bed rest with pelvic rest
D) Oral nifedipine for tocolysis
Answer: A
Rationale: Progesterone supplementation (A) is proven to reduce preterm birth in women with prior spontaneous
preterm birth and short cervix. Cerclage (B) is for cervical insufficiency, not just short cervix. Bed rest (C) has no
proven benefit. Tocolytics (D) are for acute preterm labor, not prevention.
4 A client at 32 weeks gestation with severe preeclampsia develops a pulmonary artery occlusion pressure (PAOP)
of 18 mmHg and a cardiac index of 2.2 L/min/m². Which hemodynamic profile is most consistent with these
values?
A) Hypovolemic shock with low preload
B) Cardiogenic pulmonary edema with elevated left ventricular filling pressures
,C) Septic shock with low systemic vascular resistance
D) Obstructive shock due to amniotic fluid embolism
Answer: B
Rationale: Elevated PAOP (normal 6-12 mmHg) indicates left heart volume overload, while low cardiac index
(normal 2.5-4.0) suggests impaired contractility-consistent with cardiogenic pulmonary edema. Hypovolemia (A)
would show low PAOP. Septic shock (C) would have high cardiac output initially. Amniotic fluid embolism (D)
presents with sudden cardiovascular collapse.
5 A client at 30 weeks gestation with placenta previa totalis has a sudden onset of painless vaginal bleeding. The
estimated blood loss is 800 mL. Fetal heart rate shows recurrent late decelerations. What is the priority
intervention?
A) Perform a sterile vaginal exam to assess cervical dilation
B) Administer terbutaline 0.25 mg subcutaneously
C) Prepare for emergency cesarean delivery
D) Place a fetal scalp electrode for continuous monitoring
Answer: C
Rationale: In placenta previa with hemorrhage and fetal distress, immediate cesarean is indicated. Vaginal exam (A)
is contraindicated as it may worsen bleeding. Terbutaline (B) is for preterm labor, not hemorrhage. Fetal scalp
electrode (D) is invasive and unnecessary; external monitoring suffices.
6 A client at 35 weeks gestation with twin-twin transfusion syndrome (TTTS) undergoes fetoscopic laser
photocoagulation. Postoperatively, which finding suggests successful treatment?
A) Increased amniotic fluid volume in the recipient twin
B) Resolution of hydrops fetalis in the recipient twin
C) Appearance of a 'stuck twin' phenomenon
D) Elevated middle cerebral artery peak systolic velocity in the donor twin
Answer: B
Rationale: Laser therapy aims to ablate the anastomoses, reversing the hemodynamic imbalance. Resolution of
hydrops in the recipient indicates improved cardiac function. Increased fluid (A) would indicate failure. Stuck twin
(C) is a sign of severe TTTS. Elevated MCA-PSV (D) suggests anemia, not treatment success.
7 A client at 14 weeks gestation with a history of recurrent pregnancy loss is found to have a lupus anticoagulant.
Which medication regimen is most appropriate to improve pregnancy outcomes?
A) Low-dose aspirin alone
B) Unfractionated heparin plus low-dose aspirin
C) Warfarin throughout pregnancy
D) No anticoagulation unless thrombosis occurs
Answer: B
Rationale: Antiphospholipid syndrome with recurrent loss is managed with heparin and aspirin to prevent
thrombosis and improve placentation. Aspirin alone (A) is insufficient for those with prior losses. Warfarin (C) is
teratogenic. No treatment (D) increases risk of loss.
8 A client at 24 weeks gestation with a BMI of 42 kg/m² is screened for gestational diabetes. Her 1-hour glucose
challenge test is 145 mg/dL. What is the most appropriate next step?
A) Diagnose gestational diabetes and start insulin
B) Perform a 3-hour oral glucose tolerance test (OGTT)
C) Repeat the 1-hour glucose challenge test in 2 weeks
,D) Initiate metformin therapy
Answer: B
Rationale: A 1-hour value of 145 mg/dL is above the typical threshold (130-140) but not diagnostic; a 3-hour OGTT
is needed for confirmation. Diagnosis (A) is premature. Repeating (C) is not standard. Metformin (D) is not
first-line and requires confirmed diagnosis.
9 A client at 38 weeks gestation with oligohydramnios (amniotic fluid index 3 cm) is undergoing induction of
labor. During induction, the fetal heart rate shows variable decelerations with minimal variability. What is the
most likely cause?
A) Uteroplacental insufficiency
B) Umbilical cord compression
C) Fetal anemia
D) Maternal hypotension
Answer: B
Rationale: Oligohydramnios predisposes to cord compression, causing variable decelerations. Uteroplacental
insufficiency (A) typically causes late decelerations. Fetal anemia (C) shows sinusoidal pattern. Maternal
hypotension (D) may cause late or prolonged decelerations.
10 A client at 26 weeks gestation with chronic hypertension is started on labetalol. Which fetal assessment is most
important to monitor during therapy?
A) Fetal heart rate variability
B) Amniotic fluid index
C) Fetal growth by ultrasound
D) Umbilical artery Doppler velocimetry
Answer: C
Rationale: Chronic hypertension increases risk of intrauterine growth restriction; serial ultrasound for growth is
essential. Heart rate variability (A) is monitored but not specific to labetalol. Amniotic fluid (B) and Doppler (D)
are important but growth is primary.
11 A client at 28 weeks gestation presents with severe epigastric pain, headache, and visual disturbances. Blood
pressure is 172/110 mm Hg, and urinalysis shows 3+ protein. The nurse anticipates administration of which
medication to prevent seizures?
A) Magnesium sulfate 4 g IV bolus followed by 2 g/hour continuous infusion
B) Labetalol 20 mg IV push every 10 minutes as needed
C) Hydralazine 5 mg IV push every 20 minutes as needed
D) Nifedipine 10 mg oral every 6 hours
Answer: A
Rationale: Magnesium sulfate is the first-line anticonvulsant for severe preeclampsia to prevent eclampsia. Labetalol
and hydralazine are antihypertensives, not anticonvulsants. Nifedipine is also an antihypertensive and not indicated
for seizure prophylaxis.
12 A pregnant client at 34 weeks gestation is diagnosed with placenta previa after an ultrasound reveals the
placenta covering the internal cervical os. Which finding would the nurse expect to observe on assessment?
A) Painless, bright red vaginal bleeding
B) Severe abdominal pain with board-like rigidity
C) Frequent uterine contractions with dark red bleeding
D) Sudden onset of intense pelvic pressure and back pain
, Answer: A
Rationale: Placenta previa typically presents with painless, bright red vaginal bleeding in the third trimester due to
placental separation from the lower uterine segment. Options B and C describe placental abruption, which involves
painful bleeding and uterine hypertonicity. Option D is more consistent with preterm labor or other conditions.
13 A client at 26 weeks gestation with a history of type 1 diabetes mellitus has a glycosylated hemoglobin
(HbA1c) of 8.5%. The nurse understands that this level places the fetus at highest risk for which congenital
anomaly?
A) Neural tube defects
B) Ventricular septal defect
C) Renal agenesis
D) Esophageal atresia
Answer: A
Rationale: Poor glycemic control in early pregnancy (elevated HbA1c) is strongly associated with neural tube
defects due to hyperglycemia-induced oxidative stress during neurulation. While cardiac defects are also increased,
neural tube defects are the most characteristic. Renal agenesis and esophageal atresia are less directly linked to
maternal diabetes.
14 A client at 22 weeks gestation is diagnosed with an incompetent cervix. The nurse anticipates which
intervention to reduce the risk of preterm birth?
A) Transvaginal cervical cerclage placement
B) Administration of betamethasone 12 mg IM every 24 hours for 2 doses
C) Prescription of terbutaline 5 mg oral every 6 hours
D) Placement of a pessary device for cervical support
Answer: A
Rationale: Cervical cerclage is the standard surgical intervention for incompetent cervix, typically placed between
12-24 weeks to provide mechanical support. Betamethasone is given for fetal lung maturity but does not prevent
preterm birth. Terbutaline is a tocolytic for acute preterm labor, not prophylaxis. Pessaries are less effective and not
first-line.
15 A client at 30 weeks gestation presents with a blood pressure of 150/96 mm Hg, 2+ proteinuria, and generalized
edema. Laboratory results show elevated liver enzymes and a platelet count of 95,000/mm³. The nurse
recognizes this constellation of findings as indicative of which condition?
A) HELLP syndrome
B) Gestational hypertension
C) Chronic hypertension with superimposed preeclampsia
D) Acute fatty liver of pregnancy
Answer: A
Rationale: HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe variant of
preeclampsia characterized by microangiopathic hemolysis, hepatic dysfunction, and thrombocytopenia.
Gestational hypertension lacks proteinuria and systemic involvement. Chronic hypertension with superimposed
preeclampsia requires preexisting hypertension. Acute fatty liver of pregnancy presents with hypoglycemia and
coagulopathy, not typically with hypertension and proteinuria.
Section 2: Intrapartum Care and Complications (Questions 16-30)
Nursing Practice Exam Questions with Correct Answers and
Explanations in Italics - 150 Questions
Section 1: Antepartum Care and Complications (Questions 1-15)
1 A primigravid client at 34 weeks gestation presents with blood pressure 158/102 mmHg, proteinuria (3+ on
dipstick), and serum creatinine 1.2 mg/dL. Which laboratory finding is most critical to evaluate before initiating
magnesium sulfate therapy?
A) Serum calcium level
B) Serum potassium level
C) Serum magnesium level
D) Serum uric acid level
Answer: C
Rationale: Magnesium sulfate is nephrotoxic and renally excreted; baseline serum magnesium is essential to avoid
toxicity. While uric acid (D) is elevated in preeclampsia, it does not guide magnesium dosing. Calcium (A) and
potassium (B) are not immediate prerequisites.
2 A client with gestational diabetes mellitus (GDM) is on insulin therapy. At 36 weeks gestation, her fasting
glucose levels are consistently 95-105 mg/dL despite increased insulin. What is the most appropriate next step?
A) Increase the evening NPH insulin dose by 20%
B) Switch to a continuous insulin infusion
C) Initiate oral hypoglycemic agent metformin
D) Schedule elective cesarean delivery at 37 weeks
Answer: A
Rationale: In late pregnancy, insulin resistance peaks; increasing NPH insulin is standard. Oral agents (C) are not
first-line in pregnancy. Cesarean (D) is not indicated for mild hyperglycemia. Continuous infusion (B) is reserved
for severe cases or diabetic ketoacidosis.
3 A client at 28 weeks gestation with a history of preterm birth at 32 weeks has a cervical length of 22 mm on
transvaginal ultrasound. Which intervention is most likely to reduce preterm birth risk?
A) Intramuscular 17-alpha-hydroxyprogesterone caproate weekly
B) Cervical cerclage placement
C) Bed rest with pelvic rest
D) Oral nifedipine for tocolysis
Answer: A
Rationale: Progesterone supplementation (A) is proven to reduce preterm birth in women with prior spontaneous
preterm birth and short cervix. Cerclage (B) is for cervical insufficiency, not just short cervix. Bed rest (C) has no
proven benefit. Tocolytics (D) are for acute preterm labor, not prevention.
4 A client at 32 weeks gestation with severe preeclampsia develops a pulmonary artery occlusion pressure (PAOP)
of 18 mmHg and a cardiac index of 2.2 L/min/m². Which hemodynamic profile is most consistent with these
values?
A) Hypovolemic shock with low preload
B) Cardiogenic pulmonary edema with elevated left ventricular filling pressures
,C) Septic shock with low systemic vascular resistance
D) Obstructive shock due to amniotic fluid embolism
Answer: B
Rationale: Elevated PAOP (normal 6-12 mmHg) indicates left heart volume overload, while low cardiac index
(normal 2.5-4.0) suggests impaired contractility-consistent with cardiogenic pulmonary edema. Hypovolemia (A)
would show low PAOP. Septic shock (C) would have high cardiac output initially. Amniotic fluid embolism (D)
presents with sudden cardiovascular collapse.
5 A client at 30 weeks gestation with placenta previa totalis has a sudden onset of painless vaginal bleeding. The
estimated blood loss is 800 mL. Fetal heart rate shows recurrent late decelerations. What is the priority
intervention?
A) Perform a sterile vaginal exam to assess cervical dilation
B) Administer terbutaline 0.25 mg subcutaneously
C) Prepare for emergency cesarean delivery
D) Place a fetal scalp electrode for continuous monitoring
Answer: C
Rationale: In placenta previa with hemorrhage and fetal distress, immediate cesarean is indicated. Vaginal exam (A)
is contraindicated as it may worsen bleeding. Terbutaline (B) is for preterm labor, not hemorrhage. Fetal scalp
electrode (D) is invasive and unnecessary; external monitoring suffices.
6 A client at 35 weeks gestation with twin-twin transfusion syndrome (TTTS) undergoes fetoscopic laser
photocoagulation. Postoperatively, which finding suggests successful treatment?
A) Increased amniotic fluid volume in the recipient twin
B) Resolution of hydrops fetalis in the recipient twin
C) Appearance of a 'stuck twin' phenomenon
D) Elevated middle cerebral artery peak systolic velocity in the donor twin
Answer: B
Rationale: Laser therapy aims to ablate the anastomoses, reversing the hemodynamic imbalance. Resolution of
hydrops in the recipient indicates improved cardiac function. Increased fluid (A) would indicate failure. Stuck twin
(C) is a sign of severe TTTS. Elevated MCA-PSV (D) suggests anemia, not treatment success.
7 A client at 14 weeks gestation with a history of recurrent pregnancy loss is found to have a lupus anticoagulant.
Which medication regimen is most appropriate to improve pregnancy outcomes?
A) Low-dose aspirin alone
B) Unfractionated heparin plus low-dose aspirin
C) Warfarin throughout pregnancy
D) No anticoagulation unless thrombosis occurs
Answer: B
Rationale: Antiphospholipid syndrome with recurrent loss is managed with heparin and aspirin to prevent
thrombosis and improve placentation. Aspirin alone (A) is insufficient for those with prior losses. Warfarin (C) is
teratogenic. No treatment (D) increases risk of loss.
8 A client at 24 weeks gestation with a BMI of 42 kg/m² is screened for gestational diabetes. Her 1-hour glucose
challenge test is 145 mg/dL. What is the most appropriate next step?
A) Diagnose gestational diabetes and start insulin
B) Perform a 3-hour oral glucose tolerance test (OGTT)
C) Repeat the 1-hour glucose challenge test in 2 weeks
,D) Initiate metformin therapy
Answer: B
Rationale: A 1-hour value of 145 mg/dL is above the typical threshold (130-140) but not diagnostic; a 3-hour OGTT
is needed for confirmation. Diagnosis (A) is premature. Repeating (C) is not standard. Metformin (D) is not
first-line and requires confirmed diagnosis.
9 A client at 38 weeks gestation with oligohydramnios (amniotic fluid index 3 cm) is undergoing induction of
labor. During induction, the fetal heart rate shows variable decelerations with minimal variability. What is the
most likely cause?
A) Uteroplacental insufficiency
B) Umbilical cord compression
C) Fetal anemia
D) Maternal hypotension
Answer: B
Rationale: Oligohydramnios predisposes to cord compression, causing variable decelerations. Uteroplacental
insufficiency (A) typically causes late decelerations. Fetal anemia (C) shows sinusoidal pattern. Maternal
hypotension (D) may cause late or prolonged decelerations.
10 A client at 26 weeks gestation with chronic hypertension is started on labetalol. Which fetal assessment is most
important to monitor during therapy?
A) Fetal heart rate variability
B) Amniotic fluid index
C) Fetal growth by ultrasound
D) Umbilical artery Doppler velocimetry
Answer: C
Rationale: Chronic hypertension increases risk of intrauterine growth restriction; serial ultrasound for growth is
essential. Heart rate variability (A) is monitored but not specific to labetalol. Amniotic fluid (B) and Doppler (D)
are important but growth is primary.
11 A client at 28 weeks gestation presents with severe epigastric pain, headache, and visual disturbances. Blood
pressure is 172/110 mm Hg, and urinalysis shows 3+ protein. The nurse anticipates administration of which
medication to prevent seizures?
A) Magnesium sulfate 4 g IV bolus followed by 2 g/hour continuous infusion
B) Labetalol 20 mg IV push every 10 minutes as needed
C) Hydralazine 5 mg IV push every 20 minutes as needed
D) Nifedipine 10 mg oral every 6 hours
Answer: A
Rationale: Magnesium sulfate is the first-line anticonvulsant for severe preeclampsia to prevent eclampsia. Labetalol
and hydralazine are antihypertensives, not anticonvulsants. Nifedipine is also an antihypertensive and not indicated
for seizure prophylaxis.
12 A pregnant client at 34 weeks gestation is diagnosed with placenta previa after an ultrasound reveals the
placenta covering the internal cervical os. Which finding would the nurse expect to observe on assessment?
A) Painless, bright red vaginal bleeding
B) Severe abdominal pain with board-like rigidity
C) Frequent uterine contractions with dark red bleeding
D) Sudden onset of intense pelvic pressure and back pain
, Answer: A
Rationale: Placenta previa typically presents with painless, bright red vaginal bleeding in the third trimester due to
placental separation from the lower uterine segment. Options B and C describe placental abruption, which involves
painful bleeding and uterine hypertonicity. Option D is more consistent with preterm labor or other conditions.
13 A client at 26 weeks gestation with a history of type 1 diabetes mellitus has a glycosylated hemoglobin
(HbA1c) of 8.5%. The nurse understands that this level places the fetus at highest risk for which congenital
anomaly?
A) Neural tube defects
B) Ventricular septal defect
C) Renal agenesis
D) Esophageal atresia
Answer: A
Rationale: Poor glycemic control in early pregnancy (elevated HbA1c) is strongly associated with neural tube
defects due to hyperglycemia-induced oxidative stress during neurulation. While cardiac defects are also increased,
neural tube defects are the most characteristic. Renal agenesis and esophageal atresia are less directly linked to
maternal diabetes.
14 A client at 22 weeks gestation is diagnosed with an incompetent cervix. The nurse anticipates which
intervention to reduce the risk of preterm birth?
A) Transvaginal cervical cerclage placement
B) Administration of betamethasone 12 mg IM every 24 hours for 2 doses
C) Prescription of terbutaline 5 mg oral every 6 hours
D) Placement of a pessary device for cervical support
Answer: A
Rationale: Cervical cerclage is the standard surgical intervention for incompetent cervix, typically placed between
12-24 weeks to provide mechanical support. Betamethasone is given for fetal lung maturity but does not prevent
preterm birth. Terbutaline is a tocolytic for acute preterm labor, not prophylaxis. Pessaries are less effective and not
first-line.
15 A client at 30 weeks gestation presents with a blood pressure of 150/96 mm Hg, 2+ proteinuria, and generalized
edema. Laboratory results show elevated liver enzymes and a platelet count of 95,000/mm³. The nurse
recognizes this constellation of findings as indicative of which condition?
A) HELLP syndrome
B) Gestational hypertension
C) Chronic hypertension with superimposed preeclampsia
D) Acute fatty liver of pregnancy
Answer: A
Rationale: HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe variant of
preeclampsia characterized by microangiopathic hemolysis, hepatic dysfunction, and thrombocytopenia.
Gestational hypertension lacks proteinuria and systemic involvement. Chronic hypertension with superimposed
preeclampsia requires preexisting hypertension. Acute fatty liver of pregnancy presents with hypoglycemia and
coagulopathy, not typically with hypertension and proteinuria.
Section 2: Intrapartum Care and Complications (Questions 16-30)
