Maternal and Child Health Nursing Exam 2026/2027
MATERNAL AND CHILD HEALTH NURSING EXAM
SCRIPT 2026/2027
Questions with Solutions | Graded A+
Instructions: This examination consists of 110 multiple-choice questions covering all major domains of
Maternal and Child Health Nursing. Select the BEST answer for each question. Each question includes a
rationale explaining the correct answer. Time allowed: 3 hours. Good luck!
DOMAIN 1: REPRODUCTIVE HEALTH AND ANTEPARTUM CARE
Q1. A pregnant woman at her first prenatal visit states her last menstrual period (LMP) was March 1. Using
Naegele’s Rule, what is her estimated date of delivery (EDD)?
A) November 8 B) December 8 C) December 1 D) November 1
Correct Answer: B
Rationale: Naegele’s Rule: subtract 3 months from the first day of the LMP and add 7 days (and 1 year if needed).
March 1 − 3 months = December 1, + 7 days = December 8. This is the standard method for estimating delivery
dates in nursing practice.
Q2. A primigravida at 12 weeks’ gestation asks the nurse when she should return for her next prenatal visit.
According to the recommended schedule for low-risk pregnancies, how often should visits occur after 28
weeks?
A) Every 2 weeks B) Every week C) Every 3 weeks D) Every 4 weeks
Correct Answer: A
Rationale: The standard prenatal visit schedule is every 4 weeks until 28 weeks, every 2 weeks from 28–36 weeks,
and weekly from 36 weeks until delivery. This frequency allows monitoring for conditions such as preeclampsia
and gestational diabetes that develop later in pregnancy.
Q3. A client’s obstetric history is: 1 term birth, 1 preterm birth, 2 abortions, and 1 living child. What is her
GTPAL?
A) G4 T1 P1 A2 L2 B) G4 T1 P1 A1 L2 C) G4 T1 P2 A1 L2 D) G3 T1 P1 A2 L2
Correct Answer: A
Rationale: GTPAL stands for Gravidity (total pregnancies = 4), Term births (1), Preterm births (1),
Abortions/miscarriages (2), and Living children (2: 1 term + 1 preterm surviving). Both term and preterm births
count toward living children when both survive.
Q4. Which laboratory test is routinely performed at the first prenatal visit to screen for neural tube defects
and chromosomal abnormalities during the first and second trimesters?
A) Oral glucose tolerance B) Maternal serum alpha- C) Group B Streptococcus D) Indirect Coombs test
test (OGTT) fetoprotein (MSAFP) (GBS) culture
Correct Answer: B
1
, Maternal and Child Health Nursing Exam 2026/2027
Rationale: MSAFP is part of the quad screen (along with hCG, estriol, and inhibin A) performed between 15–20
weeks. Elevated MSAFP is associated with neural tube defects, while decreased levels are associated with Down
syndrome. OGTT screens for GDM at 24–28 weeks, GBS at 35–37 weeks, and Coombs testing is for Rh/ABO
incompatibility.
Q5. A pregnant woman at 24 weeks’ gestation has a hemoglobin level of 10.2 g/dL. Which of the following
is the most appropriate nursing action?
A) Prepare for immediate B) Encourage iron-rich C) Advise the client that D) Restrict fluid intake to
blood transfusion foods and prescribe iron this is a normal increase hemoglobin
supplementation physiologic change of concentration
pregnancy
Correct Answer: B
Rationale: Normal hemoglobin in pregnancy is ≥11 g/dL (first and third trimesters) and ≥10.5 g/dL (second
trimester). At 10.2 g/dL in the second trimester, this is borderline/mildly anemic. Iron supplementation and dietary
counseling (dark leafy greens, red meat, fortified cereals) are appropriate. Blood transfusion is reserved for severe
anemia.
Q6. Which physiologic change of pregnancy causes the pregnant woman to be more susceptible to urinary
tract infections?
A) Decreased renal blood B) Progesterone-relaxed C) Increased glomerular D) Elevated estrogen
flow ureteral smooth muscle filtration rate levels causing bladder
causing urinary stasis irritation
Correct Answer: B
Rationale: Progesterone causes relaxation of smooth muscle, including the ureters, leading to urinary stasis and
dilation of the renal pelvis and ureters (physiologic hydronephrosis). This stasis increases susceptibility to UTIs.
While GFR increases 50% in pregnancy, it does not cause UTI risk.
Q7. A pregnant client at 28 weeks presents for her routine OGTT. Her 1-hour result is 165 mg/dL. What is
the next step?
A) Diagnose gestational B) Schedule a 3-hour C) Reassure the client that D) Repeat the 1-hour test
diabetes mellitus and start OGTT for confirmatory the result is within normal in 2 weeks
insulin testing limits
Correct Answer: B
Rationale: A 1-hour OGTT result of ≥140 mg/dL is considered abnormal and requires a 3-hour OGTT for
confirmation. The 1-hour test is a screening tool, not diagnostic. A diagnosis of GDM requires two or more
abnormal values on the 3-hour test: fasting ≥95, 1-hour ≥180, 2-hour ≥155, 3-hour ≥140 mg/dL.
Q8. A nurse is teaching a client newly diagnosed with gestational diabetes mellitus (GDM). Which statement
by the client indicates a need for further teaching?
A) “I should eat three B) “I need to monitor my C) “Since I have diabetes, D) “I will need to exercise
small meals and two to blood glucose levels I should avoid all regularly unless my
three snacks per day.” before breakfast and 1 carbohydrates.” provider tells me
hour after meals.” otherwise.”
Correct Answer: C
2
, Maternal and Child Health Nursing Exam 2026/2027
Rationale: Clients with GDM should not avoid all carbohydrates; complex carbohydrates are essential for fetal
growth and maternal energy. The diet should include 40–45% carbohydrates, preferably complex (whole grains,
vegetables). Avoiding all carbohydrates can lead to ketonemia, which is harmful to the fetus.
Q9. A primigravida at 32 weeks’ gestation presents with a blood pressure of 150/100 mmHg, 3+ proteinuria,
and edema of the face and hands. Which condition does the nurse suspect?
A) Gestational B) Preeclampsia with C) Eclampsia D) HELLP syndrome
hypertension severe features
Correct Answer: B
Rationale: Preeclampsia with severe features is diagnosed with BP ≥160/110 mmHg OR ≥140/90 mmHg with end-
organ involvement, plus proteinuria ≥3+ (or ≥5g/24h) or severe features (thrombocytopenia, renal insufficiency,
liver involvement, pulmonary edema, or cerebral/visual symptoms). Eclampsia includes seizures. HELLP involves
hemolysis, elevated liver enzymes, and low platelets.
Q10. A client with severe preeclampsia is receiving magnesium sulfate (MgSO₄). Which finding requires
immediate nursing intervention?
A) Urinary output of 30 B) Respiratory rate of 16 C) Deep tendon reflexes of D) Loss of deep tendon
mL/hour breaths/minute 2+ reflexes (DTRs)
Correct Answer: D
Rationale: Loss of DTRs is an early sign of magnesium toxicity. MgSO₄ is a CNS depressant, and toxicity
progresses from loss of DTRs to respiratory depression (RR <12), then respiratory arrest and cardiac arrest. The
antidote is calcium gluconate 10%, 10 mL IV over 3 minutes. Urinary output ≥30 mL/hr, RR ≥12, and DTRs 2+ are
within safe parameters.
Q11. A pregnant woman at 30 weeks presents with painless, bright-red vaginal bleeding. The nurse should
prepare the client for which diagnostic procedure?
A) Manual vaginal B) Amniocentesis C) Transabdominal D) Pelvic speculum exam
examination ultrasound
Correct Answer: C
Rationale: Painless bright-red bleeding in the third trimester strongly suggests placenta previa. Transabdominal
ultrasound is the first-line diagnostic tool to locate the placenta. Digital vaginal exams and speculum exams are
CONTRAINDICATED because they can cause massive hemorrhage by disrupting the placenta.
Q12. A client at 35 weeks’ gestation is admitted with abruptio placentae. Which finding distinguishes
abruptio placentae from placenta previa?
A) Painless vaginal B) Uterine tenderness and C) A soft, nontender D) Bleeding that resolves
bleeding painful dark-red bleeding uterus with bed rest
Correct Answer: B
Rationale: Abruptio placentae presents with painful, dark-red vaginal bleeding and a tender, often rigid (“board-
like”) uterus due to concealed bleeding behind the placenta. Placenta previa presents with painless, bright-red
bleeding and a soft, nontender uterus. Bleeding from abruption does not resolve with bed rest; it often requires
emergency delivery due to DIC risk.
Q13. A client at 28 weeks is admitted in preterm labor. Betamethasone 12 mg IM is ordered. What is the
purpose of this medication?
3
MATERNAL AND CHILD HEALTH NURSING EXAM
SCRIPT 2026/2027
Questions with Solutions | Graded A+
Instructions: This examination consists of 110 multiple-choice questions covering all major domains of
Maternal and Child Health Nursing. Select the BEST answer for each question. Each question includes a
rationale explaining the correct answer. Time allowed: 3 hours. Good luck!
DOMAIN 1: REPRODUCTIVE HEALTH AND ANTEPARTUM CARE
Q1. A pregnant woman at her first prenatal visit states her last menstrual period (LMP) was March 1. Using
Naegele’s Rule, what is her estimated date of delivery (EDD)?
A) November 8 B) December 8 C) December 1 D) November 1
Correct Answer: B
Rationale: Naegele’s Rule: subtract 3 months from the first day of the LMP and add 7 days (and 1 year if needed).
March 1 − 3 months = December 1, + 7 days = December 8. This is the standard method for estimating delivery
dates in nursing practice.
Q2. A primigravida at 12 weeks’ gestation asks the nurse when she should return for her next prenatal visit.
According to the recommended schedule for low-risk pregnancies, how often should visits occur after 28
weeks?
A) Every 2 weeks B) Every week C) Every 3 weeks D) Every 4 weeks
Correct Answer: A
Rationale: The standard prenatal visit schedule is every 4 weeks until 28 weeks, every 2 weeks from 28–36 weeks,
and weekly from 36 weeks until delivery. This frequency allows monitoring for conditions such as preeclampsia
and gestational diabetes that develop later in pregnancy.
Q3. A client’s obstetric history is: 1 term birth, 1 preterm birth, 2 abortions, and 1 living child. What is her
GTPAL?
A) G4 T1 P1 A2 L2 B) G4 T1 P1 A1 L2 C) G4 T1 P2 A1 L2 D) G3 T1 P1 A2 L2
Correct Answer: A
Rationale: GTPAL stands for Gravidity (total pregnancies = 4), Term births (1), Preterm births (1),
Abortions/miscarriages (2), and Living children (2: 1 term + 1 preterm surviving). Both term and preterm births
count toward living children when both survive.
Q4. Which laboratory test is routinely performed at the first prenatal visit to screen for neural tube defects
and chromosomal abnormalities during the first and second trimesters?
A) Oral glucose tolerance B) Maternal serum alpha- C) Group B Streptococcus D) Indirect Coombs test
test (OGTT) fetoprotein (MSAFP) (GBS) culture
Correct Answer: B
1
, Maternal and Child Health Nursing Exam 2026/2027
Rationale: MSAFP is part of the quad screen (along with hCG, estriol, and inhibin A) performed between 15–20
weeks. Elevated MSAFP is associated with neural tube defects, while decreased levels are associated with Down
syndrome. OGTT screens for GDM at 24–28 weeks, GBS at 35–37 weeks, and Coombs testing is for Rh/ABO
incompatibility.
Q5. A pregnant woman at 24 weeks’ gestation has a hemoglobin level of 10.2 g/dL. Which of the following
is the most appropriate nursing action?
A) Prepare for immediate B) Encourage iron-rich C) Advise the client that D) Restrict fluid intake to
blood transfusion foods and prescribe iron this is a normal increase hemoglobin
supplementation physiologic change of concentration
pregnancy
Correct Answer: B
Rationale: Normal hemoglobin in pregnancy is ≥11 g/dL (first and third trimesters) and ≥10.5 g/dL (second
trimester). At 10.2 g/dL in the second trimester, this is borderline/mildly anemic. Iron supplementation and dietary
counseling (dark leafy greens, red meat, fortified cereals) are appropriate. Blood transfusion is reserved for severe
anemia.
Q6. Which physiologic change of pregnancy causes the pregnant woman to be more susceptible to urinary
tract infections?
A) Decreased renal blood B) Progesterone-relaxed C) Increased glomerular D) Elevated estrogen
flow ureteral smooth muscle filtration rate levels causing bladder
causing urinary stasis irritation
Correct Answer: B
Rationale: Progesterone causes relaxation of smooth muscle, including the ureters, leading to urinary stasis and
dilation of the renal pelvis and ureters (physiologic hydronephrosis). This stasis increases susceptibility to UTIs.
While GFR increases 50% in pregnancy, it does not cause UTI risk.
Q7. A pregnant client at 28 weeks presents for her routine OGTT. Her 1-hour result is 165 mg/dL. What is
the next step?
A) Diagnose gestational B) Schedule a 3-hour C) Reassure the client that D) Repeat the 1-hour test
diabetes mellitus and start OGTT for confirmatory the result is within normal in 2 weeks
insulin testing limits
Correct Answer: B
Rationale: A 1-hour OGTT result of ≥140 mg/dL is considered abnormal and requires a 3-hour OGTT for
confirmation. The 1-hour test is a screening tool, not diagnostic. A diagnosis of GDM requires two or more
abnormal values on the 3-hour test: fasting ≥95, 1-hour ≥180, 2-hour ≥155, 3-hour ≥140 mg/dL.
Q8. A nurse is teaching a client newly diagnosed with gestational diabetes mellitus (GDM). Which statement
by the client indicates a need for further teaching?
A) “I should eat three B) “I need to monitor my C) “Since I have diabetes, D) “I will need to exercise
small meals and two to blood glucose levels I should avoid all regularly unless my
three snacks per day.” before breakfast and 1 carbohydrates.” provider tells me
hour after meals.” otherwise.”
Correct Answer: C
2
, Maternal and Child Health Nursing Exam 2026/2027
Rationale: Clients with GDM should not avoid all carbohydrates; complex carbohydrates are essential for fetal
growth and maternal energy. The diet should include 40–45% carbohydrates, preferably complex (whole grains,
vegetables). Avoiding all carbohydrates can lead to ketonemia, which is harmful to the fetus.
Q9. A primigravida at 32 weeks’ gestation presents with a blood pressure of 150/100 mmHg, 3+ proteinuria,
and edema of the face and hands. Which condition does the nurse suspect?
A) Gestational B) Preeclampsia with C) Eclampsia D) HELLP syndrome
hypertension severe features
Correct Answer: B
Rationale: Preeclampsia with severe features is diagnosed with BP ≥160/110 mmHg OR ≥140/90 mmHg with end-
organ involvement, plus proteinuria ≥3+ (or ≥5g/24h) or severe features (thrombocytopenia, renal insufficiency,
liver involvement, pulmonary edema, or cerebral/visual symptoms). Eclampsia includes seizures. HELLP involves
hemolysis, elevated liver enzymes, and low platelets.
Q10. A client with severe preeclampsia is receiving magnesium sulfate (MgSO₄). Which finding requires
immediate nursing intervention?
A) Urinary output of 30 B) Respiratory rate of 16 C) Deep tendon reflexes of D) Loss of deep tendon
mL/hour breaths/minute 2+ reflexes (DTRs)
Correct Answer: D
Rationale: Loss of DTRs is an early sign of magnesium toxicity. MgSO₄ is a CNS depressant, and toxicity
progresses from loss of DTRs to respiratory depression (RR <12), then respiratory arrest and cardiac arrest. The
antidote is calcium gluconate 10%, 10 mL IV over 3 minutes. Urinary output ≥30 mL/hr, RR ≥12, and DTRs 2+ are
within safe parameters.
Q11. A pregnant woman at 30 weeks presents with painless, bright-red vaginal bleeding. The nurse should
prepare the client for which diagnostic procedure?
A) Manual vaginal B) Amniocentesis C) Transabdominal D) Pelvic speculum exam
examination ultrasound
Correct Answer: C
Rationale: Painless bright-red bleeding in the third trimester strongly suggests placenta previa. Transabdominal
ultrasound is the first-line diagnostic tool to locate the placenta. Digital vaginal exams and speculum exams are
CONTRAINDICATED because they can cause massive hemorrhage by disrupting the placenta.
Q12. A client at 35 weeks’ gestation is admitted with abruptio placentae. Which finding distinguishes
abruptio placentae from placenta previa?
A) Painless vaginal B) Uterine tenderness and C) A soft, nontender D) Bleeding that resolves
bleeding painful dark-red bleeding uterus with bed rest
Correct Answer: B
Rationale: Abruptio placentae presents with painful, dark-red vaginal bleeding and a tender, often rigid (“board-
like”) uterus due to concealed bleeding behind the placenta. Placenta previa presents with painless, bright-red
bleeding and a soft, nontender uterus. Bleeding from abruption does not resolve with bed rest; it often requires
emergency delivery due to DIC risk.
Q13. A client at 28 weeks is admitted in preterm labor. Betamethasone 12 mg IM is ordered. What is the
purpose of this medication?
3
