MATERNAL EXAM 1 NUR 254 2026/2027 •
PROFESSIONAL OBSTETRIC NURSING
MASTERY EDITION
Domain: Fetal Development & Conception
1. Fertilization of the ovum typically occurs in the: A) Uterus B)
Fallopian tube (ampulla) C) Ovary D) Cervix
Correct Answer: B Rationale: Fertilization usually occurs in the
ampulla (widest portion) of the fallopian tube within 24 hours of
ovulation. The fertilized ovum then travels to the uterus for
implantation.
2. Implantation of the blastocyst into the endometrium
typically occurs: A) Immediately after fertilization B) 6-10 days
after fertilization C) At 4 weeks gestation D) During menstruation
Correct Answer: B Rationale: The blastocyst implants into the
uterine endometrium approximately 6-10 days after fertilization. This
marks the beginning of placental development.
3. The placenta is fully functional by approximately: A) 4-6
weeks gestation B) 10-12 weeks gestation C) 20 weeks gestation D) 36
weeks gestation
Correct Answer: B Rationale: The placenta is fully formed and
functional by 10-12 weeks gestation, taking over hormone production
(progesterone, estrogen) from the corpus luteum.
4. Which hormone is primarily responsible for maintaining
pregnancy during the first trimester? A) Estrogen B)
Progesterone C) hCG D) Prolactin
Correct Answer: B Rationale: Progesterone maintains the
endometrial lining, prevents uterine contractions, and supports early
pregnancy. The corpus luteum produces it initially; the placenta takes
over at 10-12 weeks.
,5. The presence of hCG in maternal urine is the basis for: A)
Estimating fetal weight B) Pregnancy testing C) Determining fetal
gender D) Assessing fetal lung maturity
Correct Answer: B Rationale: Human chorionic gonadotropin (hCG)
is produced by the trophoblast and detectable in urine/serum ~10 days
after conception. It is the hormone measured in pregnancy tests.
Domain: Prenatal Assessment & Dating
6. Nägele's rule for calculating the estimated date of delivery
(EDD) is: A) Add 7 days to LMP, subtract 3 months, add 1 year B)
Subtract 3 months from LMP, add 7 days, add 1 year C) Add 9
months to LMP D) Subtract 7 days from LMP, add 3 months
Correct Answer: B Rationale: Nägele's rule: First day of LMP →
subtract 3 months → add 7 days → add 1 year. Example: LMP
1/15/2026 → EDD 10/22/2026.
7. A woman reports her LMP was June 10, 2026. Using
Nägele's rule, her EDD is: A) March 3, 2027 B) March 17, 2027 C)
September 10, 2026 D) March 10, 2027
Correct Answer: B Rationale: June 10 → subtract 3 months = March
10 → add 7 days = March 17 → add 1 year = March 17, 2027.
8. GTPAL stands for: A) Gravida, Term, Preterm, Abortions, Living B)
Gravida, Term births, Preterm births, Abortions, Living
children C) Gestation, Term, Preterm, Abortions, Labor D) Gravida,
Total, Preterm, Abortions, Living
Correct Answer: B Rationale: GTPAL is a detailed obstetric history:
Gravida (total pregnancies), Term (≥37 weeks), Preterm (20-36
weeks), Abortions (<20 weeks), Living children.
9. A woman is pregnant for the third time. She has one child
born at 39 weeks and one miscarriage at 10 weeks. Her GTPAL
is: A) G3 T1 P0 A1 L1 B) G3 T1 P0 A1 L1 C) G2 T1 P1 A0 L1 D) G3 T0 P1
A1 L1
Correct Answer: B Rationale: Gravida=3 (current + 2 prior);
Term=1 (39 weeks birth); Preterm=0; Abortions=1 (10-week
miscarriage); Living=1. Note: Some formats write this identically; key
is understanding each component.
,10. Presumptive signs of pregnancy include: A) Positive
pregnancy test B) Amenorrhea, nausea, breast tenderness C)
Fetal heart tones D) Ultrasound visualization
Correct Answer: B Rationale: Presumptive signs are subjective and
may have other causes: amenorrhea, nausea/vomiting, breast changes,
fatigue. Probable signs include positive test, uterine enlargement.
Positive signs confirm pregnancy (fetal heart, ultrasound).
Domain: Physiologic Adaptations in Pregnancy
11. During pregnancy, cardiac output increases by
approximately: A) 10-20% B) 30-50% C) 60-80% D) No significant
change
Correct Answer: B Rationale: Cardiac output increases 30-50% by
mid-pregnancy due to increased stroke volume and heart rate. This
supports uteroplacental circulation and maternal metabolic demands.
12. A pregnant woman reports shortness of breath at 32
weeks. The nurse recognizes this is likely due to: A) Anemia B)
Elevation of the diaphragm by the enlarging uterus C)
Pulmonary embolism D) Anxiety
Correct Answer: B Rationale: As the uterus enlarges, it elevates the
diaphragm, reducing lung capacity and causing dyspnea. This is
normal in late pregnancy unless accompanied by other concerning
symptoms.
13. Physiologic anemia of pregnancy is primarily caused by: A)
Iron deficiency B) Plasma volume increasing more than RBC
mass C) Folate deficiency D) Blood loss
Correct Answer: B Rationale: Plasma volume increases ~50% while
RBC mass increases ~20-30%, causing hemodilution and a lower
hematocrit. This is normal; true anemia requires further evaluation.
14. A pregnant woman at 28 weeks has a blood pressure of
110/70 mmHg, compared to her pre-pregnancy BP of 120/80.
The nurse interprets this as: A) Hypotension requiring intervention
B) Normal physiologic decrease in mid-pregnancy C) Sign of
preeclampsia D) Dehydration
, Correct Answer: B Rationale: BP typically decreases in the second
trimester due to decreased systemic vascular resistance and
progesterone effects. It returns to pre-pregnancy levels near term.
15. Which gastrointestinal change is common in pregnancy? A)
Increased gastric motility B) Decreased gastric motility and
relaxation of the cardiac sphincter C) Increased hydrochloric acid
production D) Decreased risk of gallstones
Correct Answer: B Rationale: Progesterone relaxes smooth muscle,
slowing gastric emptying and relaxing the lower esophageal sphincter,
contributing to heartburn and constipation.
Domain: Prenatal Care & Patient Education
16. The recommended weight gain for a woman with a normal
pre-pregnancy BMI (18.5-24.9) is: A) 11-20 lbs B) 25-35 lbs C) 28-
40 lbs D) 15-25 lbs
Correct Answer: B Rationale: IOM guidelines: Normal BMI = 25-35
lbs total gain; Underweight = 28-40 lbs; Overweight = 15-25 lbs; Obese
= 11-20 lbs.
17. Folic acid supplementation before and during early
pregnancy is recommended to prevent: A) Gestational diabetes B)
Neural tube defects C) Preeclampsia D) Preterm labor
Correct Answer: B Rationale: Folic acid (400-800 mcg/day) before
conception and in early pregnancy significantly reduces the risk of
neural tube defects like spina bifida and anencephaly.
18. A pregnant woman asks about exercise. The nurse advises:
A) Avoid all exercise during pregnancy B) Continue moderate
exercise if previously active; avoid high-risk activities C) Only
walk in the third trimester D) Exercise only in the first trimester
Correct Answer: B Rationale: Moderate exercise is safe and
beneficial for most pregnant women. Avoid activities with fall risk,
contact sports, or supine position after first trimester.
19. Which immunization is recommended during pregnancy?
A) MMR B) Tdap (between 27-36 weeks) C) Varicella D) Live
attenuated influenza
PROFESSIONAL OBSTETRIC NURSING
MASTERY EDITION
Domain: Fetal Development & Conception
1. Fertilization of the ovum typically occurs in the: A) Uterus B)
Fallopian tube (ampulla) C) Ovary D) Cervix
Correct Answer: B Rationale: Fertilization usually occurs in the
ampulla (widest portion) of the fallopian tube within 24 hours of
ovulation. The fertilized ovum then travels to the uterus for
implantation.
2. Implantation of the blastocyst into the endometrium
typically occurs: A) Immediately after fertilization B) 6-10 days
after fertilization C) At 4 weeks gestation D) During menstruation
Correct Answer: B Rationale: The blastocyst implants into the
uterine endometrium approximately 6-10 days after fertilization. This
marks the beginning of placental development.
3. The placenta is fully functional by approximately: A) 4-6
weeks gestation B) 10-12 weeks gestation C) 20 weeks gestation D) 36
weeks gestation
Correct Answer: B Rationale: The placenta is fully formed and
functional by 10-12 weeks gestation, taking over hormone production
(progesterone, estrogen) from the corpus luteum.
4. Which hormone is primarily responsible for maintaining
pregnancy during the first trimester? A) Estrogen B)
Progesterone C) hCG D) Prolactin
Correct Answer: B Rationale: Progesterone maintains the
endometrial lining, prevents uterine contractions, and supports early
pregnancy. The corpus luteum produces it initially; the placenta takes
over at 10-12 weeks.
,5. The presence of hCG in maternal urine is the basis for: A)
Estimating fetal weight B) Pregnancy testing C) Determining fetal
gender D) Assessing fetal lung maturity
Correct Answer: B Rationale: Human chorionic gonadotropin (hCG)
is produced by the trophoblast and detectable in urine/serum ~10 days
after conception. It is the hormone measured in pregnancy tests.
Domain: Prenatal Assessment & Dating
6. Nägele's rule for calculating the estimated date of delivery
(EDD) is: A) Add 7 days to LMP, subtract 3 months, add 1 year B)
Subtract 3 months from LMP, add 7 days, add 1 year C) Add 9
months to LMP D) Subtract 7 days from LMP, add 3 months
Correct Answer: B Rationale: Nägele's rule: First day of LMP →
subtract 3 months → add 7 days → add 1 year. Example: LMP
1/15/2026 → EDD 10/22/2026.
7. A woman reports her LMP was June 10, 2026. Using
Nägele's rule, her EDD is: A) March 3, 2027 B) March 17, 2027 C)
September 10, 2026 D) March 10, 2027
Correct Answer: B Rationale: June 10 → subtract 3 months = March
10 → add 7 days = March 17 → add 1 year = March 17, 2027.
8. GTPAL stands for: A) Gravida, Term, Preterm, Abortions, Living B)
Gravida, Term births, Preterm births, Abortions, Living
children C) Gestation, Term, Preterm, Abortions, Labor D) Gravida,
Total, Preterm, Abortions, Living
Correct Answer: B Rationale: GTPAL is a detailed obstetric history:
Gravida (total pregnancies), Term (≥37 weeks), Preterm (20-36
weeks), Abortions (<20 weeks), Living children.
9. A woman is pregnant for the third time. She has one child
born at 39 weeks and one miscarriage at 10 weeks. Her GTPAL
is: A) G3 T1 P0 A1 L1 B) G3 T1 P0 A1 L1 C) G2 T1 P1 A0 L1 D) G3 T0 P1
A1 L1
Correct Answer: B Rationale: Gravida=3 (current + 2 prior);
Term=1 (39 weeks birth); Preterm=0; Abortions=1 (10-week
miscarriage); Living=1. Note: Some formats write this identically; key
is understanding each component.
,10. Presumptive signs of pregnancy include: A) Positive
pregnancy test B) Amenorrhea, nausea, breast tenderness C)
Fetal heart tones D) Ultrasound visualization
Correct Answer: B Rationale: Presumptive signs are subjective and
may have other causes: amenorrhea, nausea/vomiting, breast changes,
fatigue. Probable signs include positive test, uterine enlargement.
Positive signs confirm pregnancy (fetal heart, ultrasound).
Domain: Physiologic Adaptations in Pregnancy
11. During pregnancy, cardiac output increases by
approximately: A) 10-20% B) 30-50% C) 60-80% D) No significant
change
Correct Answer: B Rationale: Cardiac output increases 30-50% by
mid-pregnancy due to increased stroke volume and heart rate. This
supports uteroplacental circulation and maternal metabolic demands.
12. A pregnant woman reports shortness of breath at 32
weeks. The nurse recognizes this is likely due to: A) Anemia B)
Elevation of the diaphragm by the enlarging uterus C)
Pulmonary embolism D) Anxiety
Correct Answer: B Rationale: As the uterus enlarges, it elevates the
diaphragm, reducing lung capacity and causing dyspnea. This is
normal in late pregnancy unless accompanied by other concerning
symptoms.
13. Physiologic anemia of pregnancy is primarily caused by: A)
Iron deficiency B) Plasma volume increasing more than RBC
mass C) Folate deficiency D) Blood loss
Correct Answer: B Rationale: Plasma volume increases ~50% while
RBC mass increases ~20-30%, causing hemodilution and a lower
hematocrit. This is normal; true anemia requires further evaluation.
14. A pregnant woman at 28 weeks has a blood pressure of
110/70 mmHg, compared to her pre-pregnancy BP of 120/80.
The nurse interprets this as: A) Hypotension requiring intervention
B) Normal physiologic decrease in mid-pregnancy C) Sign of
preeclampsia D) Dehydration
, Correct Answer: B Rationale: BP typically decreases in the second
trimester due to decreased systemic vascular resistance and
progesterone effects. It returns to pre-pregnancy levels near term.
15. Which gastrointestinal change is common in pregnancy? A)
Increased gastric motility B) Decreased gastric motility and
relaxation of the cardiac sphincter C) Increased hydrochloric acid
production D) Decreased risk of gallstones
Correct Answer: B Rationale: Progesterone relaxes smooth muscle,
slowing gastric emptying and relaxing the lower esophageal sphincter,
contributing to heartburn and constipation.
Domain: Prenatal Care & Patient Education
16. The recommended weight gain for a woman with a normal
pre-pregnancy BMI (18.5-24.9) is: A) 11-20 lbs B) 25-35 lbs C) 28-
40 lbs D) 15-25 lbs
Correct Answer: B Rationale: IOM guidelines: Normal BMI = 25-35
lbs total gain; Underweight = 28-40 lbs; Overweight = 15-25 lbs; Obese
= 11-20 lbs.
17. Folic acid supplementation before and during early
pregnancy is recommended to prevent: A) Gestational diabetes B)
Neural tube defects C) Preeclampsia D) Preterm labor
Correct Answer: B Rationale: Folic acid (400-800 mcg/day) before
conception and in early pregnancy significantly reduces the risk of
neural tube defects like spina bifida and anencephaly.
18. A pregnant woman asks about exercise. The nurse advises:
A) Avoid all exercise during pregnancy B) Continue moderate
exercise if previously active; avoid high-risk activities C) Only
walk in the third trimester D) Exercise only in the first trimester
Correct Answer: B Rationale: Moderate exercise is safe and
beneficial for most pregnant women. Avoid activities with fall risk,
contact sports, or supine position after first trimester.
19. Which immunization is recommended during pregnancy?
A) MMR B) Tdap (between 27-36 weeks) C) Varicella D) Live
attenuated influenza
