Maternal and Pediatric Nursing (NUR 254) - Exam 2 Actual Questions & Verified Answers (PDF)

Maternal and Pediatric Nursing (NUR 254) -
Exam 2 Actual Questions & Verified Answers
(PDF)

This practice exam contains 100 high-yield, NCLEX-style questions tailored for Maternal
and Pediatric Nursing (NUR 254) Exam 2.
Exam 2 in this specialty typically covers high-priority topics:
 Maternal: Antepartum complications (preeclampsia, gestational diabetes,
hemorrhage), intrapartum monitoring (fetal heart rate patterns), and postpartum
complications (hemorrhage, infections).
 Pediatrics: Pediatric growth and development (infant through adolescent), common
childhood respiratory/cardiac disorders, and pediatric medication safety/fluid
calculations.
Part 1: Antepartum Complications and High-Risk Pregnancy
1. A nurse is assessing a pregnant client at 32 weeks gestation who presents with a
blood pressure of 152/96 mmHg, 2+ proteinuria, and mild facial edema. Which
condition does the nurse suspect?
 A) Gestational hypertension
 B) Preeclampsia
 C) Chronic hypertension
 D) Eclampsia
 Preeclampsia is defined as new-onset hypertension (BP ≥ 140/90 mmHg) after 20
weeks of gestation accompanied by proteinuria or other systemic organ dysfunction.
Gestational hypertension lacks proteinuria.
2. Which medication is the primary choice for seizure prophylaxis in a client with
preeclampsia?
 A) Diazepam

,  B) Magnesium sulfate
 C) Phenytoin
 D) Hydralazine
 Magnesium sulfate is the gold standard central nervous system depressant used to
prevent and control seizures (eclampsia) in preeclamptic patients.
3. During magnesium sulfate infusion, which clinical finding should prompt the nurse
to immediately stop the infusion?
 A) Absence of deep tendon reflexes (DTRs) and respiratory rate of 10
breaths/min
 B) Flushed, warm sensation reported by the client
 C) Fetal heart rate baseline of 140 beats/min
 D) Blood pressure of 130/80 mmHg
 Signs of magnesium toxicity include loss of deep tendon reflexes, respiratory
depression (RR < 12), oliguria, and cardiac arrest. If these occur, stop the infusion
immediately.
4. What is the antidote for magnesium sulfate toxicity?
 A) Naloxone
 B) Protamine sulfate
 C) Calcium gluconate
 D) Phytonadione (Vitamin K)
 Calcium gluconate (1g IV administered over 5 to 10 minutes) directly antagonizes
the neuromuscular effects of magnesium.
5. What does the acronym HELLP syndrome stand for in high-risk obstetrics?
 A) High Epinephrine, Low Lipids, Low Platelets
 B) Hemolysis, Elevated Liver enzymes, Low Platelets
 C) Hepatic Edema, Low Lymphocytes, Prolonged PT
 D) Hyperemesis, Elevated Leukocytes, Low Prothrombin

,  HELLP syndrome is a severe variant of preeclampsia characterized by red blood
cell destruction (hemolysis), hepatic dysfunction (elevated AST/ALT), and
thrombocytopenia (platelets < 100,000/mm³).
6. A nurse is assessing a client at 34 weeks gestation who presents with sudden-
onset, dark red vaginal bleeding, a rigid and board-like abdomen, and severe uterine
tenderness. What is the priority intervention?
 A) Perform a sterile vaginal examination to check cervical dilation.
 B) Initiate continuous fetal monitoring, establish large-bore IV access, and
prepare for emergency cesarean birth
 C) Administer oxytocin to induce labor.
 D) Place the client in a high-Fowler's position and reassess in 30 minutes.
 The presentation points directly to placental abruption (abruptio placentae), a life-
threatening emergency. Vaginal exams are contraindicated, and immediate
preparation for delivery is necessary.
7. A pregnant client at 36 weeks gestation presents with painless, bright red vaginal
bleeding. What diagnostic test or procedure is strictly contraindicated?
 A) Transabdominal ultrasound
 B) Continuous external fetal monitoring
 C) Digital vaginal examination
 D) Blood type and crossmatch
 Painless, bright red bleeding suggests placenta previa. A digital vaginal exam can
puncture or tear the low-lying placenta, causing catastrophic, fatal hemorrhage.
8. At what gestational age is a 3-hour oral glucose tolerance test (OGTT) typically
performed to screen for gestational diabetes (GDM)?
 A) 12–16 weeks
 B) 24–28 weeks
 C) 32–34 weeks
 D) At the first prenatal visit

,  Placental hormones (like human placental lactogen) peak during the second
trimester, causing insulin resistance. Screening is standard between 24 and 28
weeks.
9. What is the primary fetal risk associated with poorly controlled maternal
gestational diabetes?
 A) Intrauterine growth restriction (IUGR)
 B) Macrosomia and neonatal hypoglycemia
 C) Congenital hip dysplasia
 D) Microcephaly
 High maternal glucose crosses the placenta, stimulating the fetal pancreas to
produce large amounts of insulin (a growth hormone). This leads to macrosomia
(large baby) and rapid hypoglycemia after birth when the maternal glucose source is
cut off.
10. A pregnant client is diagnosed with hyperemesis gravidarum. Which urinary lab
finding confirms the diagnosis of starvation-induced metabolic changes?
 A) Proteinuria
 B) Ketonuria
 C) Hematuria
 D) Glucosuria
 Persistent vomiting prevents adequate intake of carbohydrates, forcing the body to
break down fat for energy. This lipolysis produces ketones, which spill into the urine.
11. An unsensitized Rh-negative pregnant client has a partner who is Rh-positive.
When should she receive Rho(D) immune globulin (RhoGAM) to prevent
isoimmunization?
 A) At 12 weeks gestation and within 12 hours of delivery.
 B) At 28 weeks gestation and within 72 hours after delivery of an Rh-positive
infant
 C) Monthly throughout the entire pregnancy.
 D) Only after delivery if the baby is Rh-negative.