PNH301 Test 2 Actual Exam 2026/2027 –
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[SECTION 1: Maternal-Newborn Nursing Concepts — Questions 1-8]
Q1. A practical nursing (PN) student is reviewing the physiological changes of pregnancy with a
client. Which statement by the client indicates a correct understanding of the cardiovascular
adaptations expected during the second trimester?
A. "My blood pressure should increase significantly to accommodate the increased blood
volume."
B. "I might experience episodes of feeling dizzy or lightheaded when I lie down on my back."
C. "My heart rate will likely increase by about 10 to 15 beats per minute to pump more blood."
D. "My red blood cell count will increase faster than my plasma volume, making me feel
stronger."
Correct Answer: C
Rationale: During pregnancy, cardiac output increases significantly due to increased stroke
volume and a modest rise in heart rate (approximately 10-15 bpm) to meet the metabolic
demands of the mother and fetus. Option A is incorrect because blood pressure typically
decreases slightly during the second trimester due to peripheral vasodilation, not increases.
Option B describes supine hypotension syndrome, which occurs in the later stages of pregnancy
(third trimester) when the uterus compresses the vena cava. Option D is incorrect because plasma
volume increases disproportionately to red blood cell mass, leading to physiological anemia of
pregnancy (hemodilution), not an increase in RBC count relative to plasma.
Q2. A client at 10 weeks' gestation asks the nurse why she has been experiencing frequent nausea
and vomiting ("morning sickness"). The PN bases their response on the knowledge that this is
primarily caused by elevated levels of which hormone?
A. Progesterone
,2
B. Estrogen
C. Human Chorionic Gonadotropin (hCG)
D. Placental Lactogen
Correct Answer: C
Rationale: Human Chorionic Gonadotropin (hCG) is the hormone primarily responsible for
nausea and vomiting in early pregnancy, as its levels rise rapidly and peak around the end of the
first trimester, coinciding with the peak of symptom severity. While estrogen and progesterone
levels also rise, they are not the direct primary drivers of this specific symptom. Option D,
Human Placental Lactogen, is more associated with glucose metabolism alterations later in
pregnancy. In real-world practice, educating the patient that this often resolves after the first
trimester provides reassurance.
Q3. While teaching a prenatal class about fetal circulation, the nurse explains that the majority of
fetal blood bypasses the non-ventilated lungs. Which anatomical structure connects the
pulmonary artery to the aorta, allowing this bypass?
A. Ductus venosus
B. Foramen ovale
C. Ductus arteriosus
D. Umbilical vein
Correct Answer: C
Rationale: The ductus arteriosus is a vessel that connects the pulmonary artery to the aorta,
shunting blood away from the fetal lungs and into the systemic circulation. Option A, the ductus
venosus, bypasses the liver. Option B, the foramen ovale, is an opening between the right and left
atria that allows blood to bypass the lungs. Option D carries oxygenated blood from the placenta
to the fetus. Understanding this shunt is critical for PN practice to anticipate changes in the
newborn's cardiovascular status immediately after birth when these structures begin to close.
Q4. A nurse is calculating a pregnant client's estimated date of delivery (EDD) using Naegele's
rule. The client states that her last menstrual period (LMP) started on January 3. What is the
correct EDD?
, 3
A. October 3
B. October 10
C. October 10
D. September 26
Correct Answer: C
Rationale: Naegele's rule involves subtracting three months from the first day of the LMP, adding
one year (if necessary), and adding seven days. For January 3: subtract 3 months = October 3
(previous year), add 1 year = October 3 (current year), add 7 days = October 10. Option A and D
are miscalculations. Accurate calculation of the EDD is a standard PN responsibility for tracking
fetal growth and planning appropriate care milestones.
Q5. A client asks the nurse about the purpose of the mucous plug that forms in the cervix during
pregnancy. What is the best response by the nurse?
A. "It provides nourishment to the developing fetus during the first trimester."
B. "It acts as a barrier against bacteria entering the uterus to prevent infection."
C. "It stimulates the uterine muscles to prepare for labor contractions."
D. "It helps the placenta attach more securely to the uterine wall."
Correct Answer: B
Rationale: The operculum, or mucous plug, seals the cervical canal during pregnancy, creating a
physical barrier that prevents bacteria from ascending into the uterus and potentially infecting the
fetus and membranes. Options A, C, and D describe functions of the amniotic fluid,
hormones/prostaglandins, and chorionic villi respectively. Explaining this protective function is
essential patient education to help the client understand signs of infection or cervical dilation
(losing the plug) as labor approaches.
Q6. The nurse is assessing a client at 12 weeks' gestation. Which finding would be considered a
"presumptive" sign of pregnancy rather than a "probable" or "positive" sign?
A. Hegar's sign
B. Positive pregnancy test