NUR 230 Maternal Exam | Galen College of Nursing
Comprehensive 180-Question Examination with Answers and
Rationales
SECTION 1: ANTEPARTUM CARE – SIGNS OF PREGNANCY & GTPAL
(Questions 1-20)
Question 1: A client reports amenorrhea, breast tenderness, nausea, and urinary frequency.
The nurse documents these findings as which type of signs of pregnancy?
A) Positive signs
B) Probable signs
C) Presumptive signs
D) Diagnostic signs
Answer: C – Presumptive signs
Rationale: Presumptive signs are subjective changes reported by the patient, including
amenorrhea, fatigue, breast changes, nausea/vomiting, and frequent urination. These signs
could have other causes and do not confirm pregnancy.
Question 2: The nurse is teaching a pregnant woman about signs of pregnancy. Which
statement indicates the client understands that a positive sign of pregnancy is:
A) "A positive pregnancy test means I am definitely pregnant."
B) "Hearing the fetal heartbeat confirms my pregnancy."
C) "Feeling the baby move means I am pregnant."
D) "Chadwick's sign is a positive sign of pregnancy."
Answer: B – Hearing the fetal heartbeat confirms my pregnancy.
Rationale: Positive signs of pregnancy can only be attributed to the presence of a fetus. These
include hearing fetal heart tones, visualizing the fetus on ultrasound, and fetal movement felt by
the examiner.
Question 3: A nurse is reviewing prenatal records. Using GTPAL, a woman who is currently
pregnant with twins, has one living child from a full-term delivery, and had one spontaneous
abortion at 10 weeks has which GTPAL designation?
A) G=3, T=1, P=0, A=1, L=1
B) G=2, T=1, P=1, A=0, L=1
C) G=3, T=1, P=0, A=0, L=1
D) G=4, T=1, P=1, A=0, L=2
Answer: A – G=3, T=1, P=0, A=1, L=1
Rationale: Gravida (G) = total number of pregnancies (currently pregnant + full-term + abortion
,= 3). Term (T) = number of term births (≥37 weeks) = 1. Preterm (P) = number of preterm births
(20-37 weeks) = 0. Abortions (A) = number of losses before 20 weeks = 1. Living (L) = number of
living children = 1.
Question 4: The "A" in the GTPAL acronym stands for:
A) Assisted delivery
B) Abortion (elective or spontaneous loss before 20 weeks)
C) Anomaly present
D) Advanced maternal age
Answer: B – Abortion (elective or spontaneous loss before 20 weeks)
Rationale: The "A" in GTPAL represents Abortion, which includes both elective terminations and
spontaneous losses (miscarriages) that occur before 20 weeks of gestation. Losses after 20
weeks are counted under Preterm or Term depending on gestational age.
Question 5: A client is G4 P2113. The nurse correctly interprets that this client has had:
A) 4 pregnancies, 2 term births, 1 preterm birth, 1 abortion, 3 living children
B) 4 pregnancies, 2 term births, 1 preterm birth, 1 abortion, 3 pregnancies
C) 2 pregnancies, 4 term births, 1 preterm birth, 3 abortions, 1 living child
D) 4 pregnancies, 2 term births, 1 preterm birth, 3 abortions, 1 living child
Answer: A – 4 pregnancies, 2 term births, 1 preterm birth, 1 abortion, 3 living children
Rationale: GTPAL is interpreted as: G = total pregnancies, T = term births (≥37 weeks), P =
preterm births (20-37 weeks), A = abortions/losses before 20 weeks, L = living children. G4
P2113 = 4 pregnancies, 2 term, 1 preterm, 1 abortion, 3 living.
Question 6: A client at her first prenatal visit reports she has been pregnant 5 times, has 2 living
children, delivered one set of twins at 35 weeks, had one term delivery, and had one
miscarriage at 8 weeks. What is her GTPAL?
A) G5 T1 P2 A1 L2
B) G5 T1 P1 A1 L2
C) G5 T2 P1 A1 L3
D) G5 T1 P2 A0 L2
Answer: A – G5 T1 P2 A1 L2
Rationale: Gravida = 5 total pregnancies. Term = 1 (term delivery). Preterm = 2 (twins at 35
weeks count as one preterm birth, but since there were two infants, P=2). Abortion = 1
(miscarriage at 8 weeks). Living = 2 (the twins are both living).
Question 7: A nurse is assessing a client at 8 weeks gestation. Which finding would the nurse
recognize as Goodell's sign?
A) Bluish-purple discoloration of the cervix
B) Softening of the cervix
,C) Softening of the lower uterine segment
D) Ballottement of the fetus
Answer: B – Softening of the cervix
Rationale: Goodell's sign is softening of the cervix, which occurs at 6-8 weeks gestation.
Chadwick's sign is bluish-purple discoloration, Hegar's sign is softening of the lower uterine
segment, and ballottement is passive fetal movement felt at 16-20 weeks.
Question 8: The nurse notes a bluish-purple discoloration of the client's cervix and vagina
during a pelvic examination at 8 weeks gestation. The nurse documents this finding as:
A) Goodell's sign
B) Hegar's sign
C) Chadwick's sign
D) Ballottement
Answer: C – Chadwick's sign
Rationale: Chadwick's sign is a bluish-purple discoloration of the cervix, vagina, and vulva due to
increased vascularity and blood flow, typically appearing at 6-8 weeks gestation.
Question 9: A pregnant client asks the nurse when she will likely feel the baby move for the first
time. The nurse's best response for a primigravida is:
A) 12-14 weeks
B) 16-18 weeks
C) 18-20 weeks
D) 22-24 weeks
Answer: C – 18-20 weeks
Rationale: Quickening (first fetal movements felt by the mother) typically occurs at 16-20 weeks
gestation. Primigravidas (first-time mothers) usually feel movement later at 18-20 weeks, while
multigravidas may feel it earlier at 16-18 weeks.
Question 10: Using Naegele's Rule, calculate the estimated date of delivery (EDD) for a client
whose last menstrual period (LMP) was March 10, 2026.
A) December 3, 2026
B) December 17, 2026
C) December 24, 2026
D) January 3, 2027
Answer: B – December 17, 2026
Rationale: Naegele's Rule: LMP – 3 months + 7 days. March 10 – 3 months = December 10, + 7
days = December 17, 2026.
Question 11: A client's LMP was November 5, 2026. Using Naegele's Rule, the EDD is:
A) August 12, 2027
, B) August 5, 2027
C) July 28, 2027
D) August 19, 2027
Answer: A – August 12, 2027
Rationale: November 5 – 3 months = August 5, + 7 days = August 12, 2027.
Question 12: A nurse is assessing a client at 12 weeks gestation. The nurse palpates the fundus.
Where would the nurse expect to find the fundal height?
A) At the umbilicus
B) Just above the symphysis pubis
C) Midway between the symphysis pubis and the umbilicus
D) Below the symphysis pubis
Answer: C – Midway between the symphysis pubis and the umbilicus
Rationale: Fundal height correlates with gestational age: at 12 weeks, the fundus is at the
symphysis pubis; at 16 weeks, midway between the symphysis pubis and umbilicus; at 20
weeks, at the umbilicus; and at 36 weeks, at the xiphoid process.
Question 13: The nurse is providing education about presumptive signs of pregnancy. Which of
the following would the nurse include? Select all that apply.
A) Amenorrhea
B) Nausea and vomiting
C) Positive pregnancy test
D) Breast changes
E) Urinary frequency
Answer: A, B, D, E – Amenorrhea, Nausea and vomiting, Breast changes, Urinary frequency
Rationale: Presumptive signs are subjective and include amenorrhea, nausea/vomiting, breast
changes (tenderness, enlargement), fatigue, urinary frequency, quickening, and heartburn.
Positive pregnancy test is a probable sign.
Question 14: A client who is G3 P1011 is currently 8 weeks pregnant. She has one living child
from a term delivery and one spontaneous abortion at 12 weeks. The nurse correctly
documents her current pregnancy as:
A) G4 P1012
B) G3 P1011
C) G3 P2011
D) G4 P2012
Answer: B – G3 P1011
Rationale: The client is currently pregnant, so gravida = 3 (two previous pregnancies + current).
Comprehensive 180-Question Examination with Answers and
Rationales
SECTION 1: ANTEPARTUM CARE – SIGNS OF PREGNANCY & GTPAL
(Questions 1-20)
Question 1: A client reports amenorrhea, breast tenderness, nausea, and urinary frequency.
The nurse documents these findings as which type of signs of pregnancy?
A) Positive signs
B) Probable signs
C) Presumptive signs
D) Diagnostic signs
Answer: C – Presumptive signs
Rationale: Presumptive signs are subjective changes reported by the patient, including
amenorrhea, fatigue, breast changes, nausea/vomiting, and frequent urination. These signs
could have other causes and do not confirm pregnancy.
Question 2: The nurse is teaching a pregnant woman about signs of pregnancy. Which
statement indicates the client understands that a positive sign of pregnancy is:
A) "A positive pregnancy test means I am definitely pregnant."
B) "Hearing the fetal heartbeat confirms my pregnancy."
C) "Feeling the baby move means I am pregnant."
D) "Chadwick's sign is a positive sign of pregnancy."
Answer: B – Hearing the fetal heartbeat confirms my pregnancy.
Rationale: Positive signs of pregnancy can only be attributed to the presence of a fetus. These
include hearing fetal heart tones, visualizing the fetus on ultrasound, and fetal movement felt by
the examiner.
Question 3: A nurse is reviewing prenatal records. Using GTPAL, a woman who is currently
pregnant with twins, has one living child from a full-term delivery, and had one spontaneous
abortion at 10 weeks has which GTPAL designation?
A) G=3, T=1, P=0, A=1, L=1
B) G=2, T=1, P=1, A=0, L=1
C) G=3, T=1, P=0, A=0, L=1
D) G=4, T=1, P=1, A=0, L=2
Answer: A – G=3, T=1, P=0, A=1, L=1
Rationale: Gravida (G) = total number of pregnancies (currently pregnant + full-term + abortion
,= 3). Term (T) = number of term births (≥37 weeks) = 1. Preterm (P) = number of preterm births
(20-37 weeks) = 0. Abortions (A) = number of losses before 20 weeks = 1. Living (L) = number of
living children = 1.
Question 4: The "A" in the GTPAL acronym stands for:
A) Assisted delivery
B) Abortion (elective or spontaneous loss before 20 weeks)
C) Anomaly present
D) Advanced maternal age
Answer: B – Abortion (elective or spontaneous loss before 20 weeks)
Rationale: The "A" in GTPAL represents Abortion, which includes both elective terminations and
spontaneous losses (miscarriages) that occur before 20 weeks of gestation. Losses after 20
weeks are counted under Preterm or Term depending on gestational age.
Question 5: A client is G4 P2113. The nurse correctly interprets that this client has had:
A) 4 pregnancies, 2 term births, 1 preterm birth, 1 abortion, 3 living children
B) 4 pregnancies, 2 term births, 1 preterm birth, 1 abortion, 3 pregnancies
C) 2 pregnancies, 4 term births, 1 preterm birth, 3 abortions, 1 living child
D) 4 pregnancies, 2 term births, 1 preterm birth, 3 abortions, 1 living child
Answer: A – 4 pregnancies, 2 term births, 1 preterm birth, 1 abortion, 3 living children
Rationale: GTPAL is interpreted as: G = total pregnancies, T = term births (≥37 weeks), P =
preterm births (20-37 weeks), A = abortions/losses before 20 weeks, L = living children. G4
P2113 = 4 pregnancies, 2 term, 1 preterm, 1 abortion, 3 living.
Question 6: A client at her first prenatal visit reports she has been pregnant 5 times, has 2 living
children, delivered one set of twins at 35 weeks, had one term delivery, and had one
miscarriage at 8 weeks. What is her GTPAL?
A) G5 T1 P2 A1 L2
B) G5 T1 P1 A1 L2
C) G5 T2 P1 A1 L3
D) G5 T1 P2 A0 L2
Answer: A – G5 T1 P2 A1 L2
Rationale: Gravida = 5 total pregnancies. Term = 1 (term delivery). Preterm = 2 (twins at 35
weeks count as one preterm birth, but since there were two infants, P=2). Abortion = 1
(miscarriage at 8 weeks). Living = 2 (the twins are both living).
Question 7: A nurse is assessing a client at 8 weeks gestation. Which finding would the nurse
recognize as Goodell's sign?
A) Bluish-purple discoloration of the cervix
B) Softening of the cervix
,C) Softening of the lower uterine segment
D) Ballottement of the fetus
Answer: B – Softening of the cervix
Rationale: Goodell's sign is softening of the cervix, which occurs at 6-8 weeks gestation.
Chadwick's sign is bluish-purple discoloration, Hegar's sign is softening of the lower uterine
segment, and ballottement is passive fetal movement felt at 16-20 weeks.
Question 8: The nurse notes a bluish-purple discoloration of the client's cervix and vagina
during a pelvic examination at 8 weeks gestation. The nurse documents this finding as:
A) Goodell's sign
B) Hegar's sign
C) Chadwick's sign
D) Ballottement
Answer: C – Chadwick's sign
Rationale: Chadwick's sign is a bluish-purple discoloration of the cervix, vagina, and vulva due to
increased vascularity and blood flow, typically appearing at 6-8 weeks gestation.
Question 9: A pregnant client asks the nurse when she will likely feel the baby move for the first
time. The nurse's best response for a primigravida is:
A) 12-14 weeks
B) 16-18 weeks
C) 18-20 weeks
D) 22-24 weeks
Answer: C – 18-20 weeks
Rationale: Quickening (first fetal movements felt by the mother) typically occurs at 16-20 weeks
gestation. Primigravidas (first-time mothers) usually feel movement later at 18-20 weeks, while
multigravidas may feel it earlier at 16-18 weeks.
Question 10: Using Naegele's Rule, calculate the estimated date of delivery (EDD) for a client
whose last menstrual period (LMP) was March 10, 2026.
A) December 3, 2026
B) December 17, 2026
C) December 24, 2026
D) January 3, 2027
Answer: B – December 17, 2026
Rationale: Naegele's Rule: LMP – 3 months + 7 days. March 10 – 3 months = December 10, + 7
days = December 17, 2026.
Question 11: A client's LMP was November 5, 2026. Using Naegele's Rule, the EDD is:
A) August 12, 2027
, B) August 5, 2027
C) July 28, 2027
D) August 19, 2027
Answer: A – August 12, 2027
Rationale: November 5 – 3 months = August 5, + 7 days = August 12, 2027.
Question 12: A nurse is assessing a client at 12 weeks gestation. The nurse palpates the fundus.
Where would the nurse expect to find the fundal height?
A) At the umbilicus
B) Just above the symphysis pubis
C) Midway between the symphysis pubis and the umbilicus
D) Below the symphysis pubis
Answer: C – Midway between the symphysis pubis and the umbilicus
Rationale: Fundal height correlates with gestational age: at 12 weeks, the fundus is at the
symphysis pubis; at 16 weeks, midway between the symphysis pubis and umbilicus; at 20
weeks, at the umbilicus; and at 36 weeks, at the xiphoid process.
Question 13: The nurse is providing education about presumptive signs of pregnancy. Which of
the following would the nurse include? Select all that apply.
A) Amenorrhea
B) Nausea and vomiting
C) Positive pregnancy test
D) Breast changes
E) Urinary frequency
Answer: A, B, D, E – Amenorrhea, Nausea and vomiting, Breast changes, Urinary frequency
Rationale: Presumptive signs are subjective and include amenorrhea, nausea/vomiting, breast
changes (tenderness, enlargement), fatigue, urinary frequency, quickening, and heartburn.
Positive pregnancy test is a probable sign.
Question 14: A client who is G3 P1011 is currently 8 weeks pregnant. She has one living child
from a term delivery and one spontaneous abortion at 12 weeks. The nurse correctly
documents her current pregnancy as:
A) G4 P1012
B) G3 P1011
C) G3 P2011
D) G4 P2012
Answer: B – G3 P1011
Rationale: The client is currently pregnant, so gravida = 3 (two previous pregnancies + current).
