1 GALEN COLLEGE OF NURSING
GALEN COLLEGE OF NURSING
Nursing Department – NUR 230 Maternal-Newborn Nursing – Comprehensive Exam
Exam Version: Comprehensive (Exams 1, 2, 3, 4 Combined)
Total Questions: 50
Format: NCLEX‑Style Multiple Choice with Rationales
1. This exam contains 50 questions covering Antepartum,
Intrapartum, Postpartum, Newborn, and High‑Risk topics.
2. Select the best answer for each question. Only one answer
is correct.
3. Mark your answers on the separate answer sheet provided.
4. After completing all questions, you may review the detailed
rationales (located after the answer key).
5. Time allowed: 75 minutes (1.5 minutes per question).
-------------------------------------------------------------
ACADEMIC HONESTY STATEMENT
-------------------------------------------------------------
I affirm that I will not give or receive any unauthorized aid on this
examination, and that all work submitted is my own.
Signature: __________________________________________________
FOR FACULTY USE ONLY
-------------------------------------------------------------
Score: ________ / 50 Percentage: ________ %
Instructor Signature: ________________________________________
P a g e 1 | 23
,2 GALEN COLLEGE OF NURSING
Antepartum (Questions 1–12)
1. A nurse is teaching a prenatal class about physiological changes in pregnancy. Which finding
would the nurse describe as a normal cardiovascular change?
A. Decreased heart rate
B. Increased blood pressure in the second trimester
C. Supine hypotension syndrome
D. Decreased cardiac output
Answer: C. Supine hypotension syndrome
Rationale: Supine hypotension (dizziness when lying flat) occurs because the gravid uterus
compresses the inferior vena cava, reducing venous return. Normal cardiovascular changes
include increased heart rate (not decreased), decreased blood pressure in the second
trimester, and increased cardiac output (30–50%).
2. A patient at 12 weeks gestation asks about the purpose of alpha-fetoprotein (AFP) screening.
What is the nurse’s best response?
A. “It diagnoses gestational diabetes.”
B. “It screens for neural tube defects and chromosomal abnormalities.”
C. “It confirms the exact gestational age.”
D. “It detects Group B Streptococcus colonization.”
Answer: B. “It screens for neural tube defects and chromosomal abnormalities.”
Rationale: Maternal serum AFP is a screening test (15–20 weeks) for open neural tube defects
(e.g., spina bifida) and aneuploidies (e.g., Down syndrome). It is not diagnostic; abnormal
results require follow-up testing.
3. A nurse is assessing a patient at 24 weeks gestation. Which finding should be reported to the
healthcare provider immediately?
A. Mild ankle edema at the end of the day
B. Blurred vision and epigastric pain
C. Heartburn after eating spicy foods
D. Intermittent Braxton-Hicks contractions
Answer: B. Blurred vision and epigastric pain
Rationale: Blurred vision and epigastric pain are signs of severe preeclampsia (possible HELLP
syndrome) and require immediate evaluation. Mild ankle edema and heartburn are common
discomforts; Braxton-Hicks contractions are normal.
4. A patient with gestational diabetes mellitus (GDM) asks why she needs to monitor her blood
glucose. What is the primary reason? A. To prevent maternal weight gain
B. To reduce the risk of fetal macrosomia
C. To prevent the need for insulin after delivery
D. To diagnose type 1 diabetes
Answer: B. To reduce the risk of fetal macrosomia
P a g e 2 | 23
, 3 GALEN COLLEGE OF NURSING
Rationale: Uncontrolled GDM leads to fetal hyperglycemia and hyperinsulinemia, causing
macrosomia (large baby), birth trauma, and neonatal hypoglycemia. Glucose control minimizes
these risks.
5. A nurse is providing dietary teaching to a patient with hyperemesis gravidarum. Which
instruction is most appropriate?
A. “Eat three large meals per day to stabilize blood sugar.”
B. “Avoid all fluids until vomiting stops.”
C. “Eat dry crackers before getting out of bed in the morning.”
D. “Increase intake of high-fat fried foods.”
Answer: C. “Eat dry crackers before getting out of bed in the morning.”
Rationale: Small, frequent, bland, low-fat meals/snacks (like dry crackers) help manage nausea.
Avoid large meals; hydration is essential (small sips of clear fluids). High-fat foods worsen
nausea.
6. A patient at 32 weeks with placenta previa is admitted with painless bright red vaginal
bleeding. The nurse should prepare for which priority intervention?
A. Digital cervical examination
B. Immediate cesarean section
C. Bed rest and fetal monitoring
D. Administration of magnesium sulfate
Answer: C. Bed rest and fetal monitoring
Rationale: With known placenta previa, digital exam is contraindicated (can cause massive
hemorrhage). Management is expectant unless hemorrhage is severe; bed rest, monitoring,
and steroids for fetal lung maturity are initial steps. Immediate C-section is only for
uncontrollable bleeding.
7. A nurse is reviewing laboratory values for a patient at 10 weeks gestation. Which
hemoglobin result would indicate physiological anemia of pregnancy?
A. 9.0 g/dL
B. 10.5 g/dL
C. 12.0 g/dL
D. 13.5 g/dL
Answer: B. 10.5 g/dL
Rationale: Physiological anemia of pregnancy occurs due to plasma volume expansion
exceeding red cell mass increase. Hemoglobin <11 g/dL in first trimester, <10.5 g/dL in
second/third trimesters is considered anemic. 9.0 g/dL is pathological.
8. A patient is Rh-negative and unsensitized. At 28 weeks gestation, the nurse anticipates an
order for:
A. Rh immune globulin (RhoGAM)
B. Amniocentesis for bilirubin
C. Vitamin K injection
P a g e 3 | 23
GALEN COLLEGE OF NURSING
Nursing Department – NUR 230 Maternal-Newborn Nursing – Comprehensive Exam
Exam Version: Comprehensive (Exams 1, 2, 3, 4 Combined)
Total Questions: 50
Format: NCLEX‑Style Multiple Choice with Rationales
1. This exam contains 50 questions covering Antepartum,
Intrapartum, Postpartum, Newborn, and High‑Risk topics.
2. Select the best answer for each question. Only one answer
is correct.
3. Mark your answers on the separate answer sheet provided.
4. After completing all questions, you may review the detailed
rationales (located after the answer key).
5. Time allowed: 75 minutes (1.5 minutes per question).
-------------------------------------------------------------
ACADEMIC HONESTY STATEMENT
-------------------------------------------------------------
I affirm that I will not give or receive any unauthorized aid on this
examination, and that all work submitted is my own.
Signature: __________________________________________________
FOR FACULTY USE ONLY
-------------------------------------------------------------
Score: ________ / 50 Percentage: ________ %
Instructor Signature: ________________________________________
P a g e 1 | 23
,2 GALEN COLLEGE OF NURSING
Antepartum (Questions 1–12)
1. A nurse is teaching a prenatal class about physiological changes in pregnancy. Which finding
would the nurse describe as a normal cardiovascular change?
A. Decreased heart rate
B. Increased blood pressure in the second trimester
C. Supine hypotension syndrome
D. Decreased cardiac output
Answer: C. Supine hypotension syndrome
Rationale: Supine hypotension (dizziness when lying flat) occurs because the gravid uterus
compresses the inferior vena cava, reducing venous return. Normal cardiovascular changes
include increased heart rate (not decreased), decreased blood pressure in the second
trimester, and increased cardiac output (30–50%).
2. A patient at 12 weeks gestation asks about the purpose of alpha-fetoprotein (AFP) screening.
What is the nurse’s best response?
A. “It diagnoses gestational diabetes.”
B. “It screens for neural tube defects and chromosomal abnormalities.”
C. “It confirms the exact gestational age.”
D. “It detects Group B Streptococcus colonization.”
Answer: B. “It screens for neural tube defects and chromosomal abnormalities.”
Rationale: Maternal serum AFP is a screening test (15–20 weeks) for open neural tube defects
(e.g., spina bifida) and aneuploidies (e.g., Down syndrome). It is not diagnostic; abnormal
results require follow-up testing.
3. A nurse is assessing a patient at 24 weeks gestation. Which finding should be reported to the
healthcare provider immediately?
A. Mild ankle edema at the end of the day
B. Blurred vision and epigastric pain
C. Heartburn after eating spicy foods
D. Intermittent Braxton-Hicks contractions
Answer: B. Blurred vision and epigastric pain
Rationale: Blurred vision and epigastric pain are signs of severe preeclampsia (possible HELLP
syndrome) and require immediate evaluation. Mild ankle edema and heartburn are common
discomforts; Braxton-Hicks contractions are normal.
4. A patient with gestational diabetes mellitus (GDM) asks why she needs to monitor her blood
glucose. What is the primary reason? A. To prevent maternal weight gain
B. To reduce the risk of fetal macrosomia
C. To prevent the need for insulin after delivery
D. To diagnose type 1 diabetes
Answer: B. To reduce the risk of fetal macrosomia
P a g e 2 | 23
, 3 GALEN COLLEGE OF NURSING
Rationale: Uncontrolled GDM leads to fetal hyperglycemia and hyperinsulinemia, causing
macrosomia (large baby), birth trauma, and neonatal hypoglycemia. Glucose control minimizes
these risks.
5. A nurse is providing dietary teaching to a patient with hyperemesis gravidarum. Which
instruction is most appropriate?
A. “Eat three large meals per day to stabilize blood sugar.”
B. “Avoid all fluids until vomiting stops.”
C. “Eat dry crackers before getting out of bed in the morning.”
D. “Increase intake of high-fat fried foods.”
Answer: C. “Eat dry crackers before getting out of bed in the morning.”
Rationale: Small, frequent, bland, low-fat meals/snacks (like dry crackers) help manage nausea.
Avoid large meals; hydration is essential (small sips of clear fluids). High-fat foods worsen
nausea.
6. A patient at 32 weeks with placenta previa is admitted with painless bright red vaginal
bleeding. The nurse should prepare for which priority intervention?
A. Digital cervical examination
B. Immediate cesarean section
C. Bed rest and fetal monitoring
D. Administration of magnesium sulfate
Answer: C. Bed rest and fetal monitoring
Rationale: With known placenta previa, digital exam is contraindicated (can cause massive
hemorrhage). Management is expectant unless hemorrhage is severe; bed rest, monitoring,
and steroids for fetal lung maturity are initial steps. Immediate C-section is only for
uncontrollable bleeding.
7. A nurse is reviewing laboratory values for a patient at 10 weeks gestation. Which
hemoglobin result would indicate physiological anemia of pregnancy?
A. 9.0 g/dL
B. 10.5 g/dL
C. 12.0 g/dL
D. 13.5 g/dL
Answer: B. 10.5 g/dL
Rationale: Physiological anemia of pregnancy occurs due to plasma volume expansion
exceeding red cell mass increase. Hemoglobin <11 g/dL in first trimester, <10.5 g/dL in
second/third trimesters is considered anemic. 9.0 g/dL is pathological.
8. A patient is Rh-negative and unsensitized. At 28 weeks gestation, the nurse anticipates an
order for:
A. Rh immune globulin (RhoGAM)
B. Amniocentesis for bilirubin
C. Vitamin K injection
P a g e 3 | 23
