Galen College of Nursing | NUR 254 Maternal and Pediatrics
NUR 254 Maternal and Pediatrics
Comprehensive Examinations 1-4 2026/2027 |
Verified Questions
Galen College of Nursing | NUR 254 Maternal and Pediatrics | University-Level Nursing Students
200 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Galen College of Nursing | NUR 254 Maternal and Pediatrics
Comprehensive Examinations 1-4 Actual Exam | Academic Year 2026/2027
NUR 254 Maternal and Pediatrics Comprehensive Examinations 1-4 2026/2027 | Verified Questions
,INTRODUCTION
This document contains exactly 200 original questions organized across four core domains: Domain 1, Maternal
and Antepartum Care (50); Domain 2, Intrapartum and Postpartum Care (50); Domain 3, Pediatric Growth,
Development, and Health Promotion (50); and Domain 4, Pediatric Health Alterations and Nursing Care (50).
The content is designed to reinforce the official NUR 254 Maternal and Pediatrics Comprehensive Examinations
1-4 course objectives for actual exam readiness and clinical proficiency, integrating maternal-child nursing
principles, developmental reasoning, and evidence-based clinical care aligned to Academic Year 2026/2027.
ACTUAL QUESTIONS
Domain 1: Maternal and Antepartum Care
Question 1. A client planning a pregnancy has no history of a neural tube defect. Which
instruction best lowers the fetal risk for a neural tube defect?
A. Begin 50 micrograms of folic acid only after fetal movement is felt.
B. Take 4 milligrams of folic acid only during the final month of pregnancy.
C. Take 400 to 800 micrograms of folic acid daily, beginning before conception.
D. Avoid folic acid when the diet contains fortified grains.
Correct Answer: C
Rationale: Adequate folate must be present during very early neural tube formation, often before pregnancy
is recognized. A daily intake of 400 to 800 micrograms is appropriate for most clients without a prior
affected pregnancy; higher dosing requires individualized prescribing.
Question 2. A pregnant client has one child born at term, twins born at 34 weeks who are both
living, and one prior miscarriage at 10 weeks. Which GTPAL notation is accurate for the current
pregnancy?
A. G4 T1 P1 A1 L3
B. G3 T1 P1 A1 L2
C. G5 T1 P2 A1 L3
D. G4 T2 P1 A0 L3
Correct Answer: A
Rationale: Gravidity counts each pregnancy, including the current one, so the total is four. The twin birth
counts as one preterm pregnancy but two living children, yielding G4 T1 P1 A1 L3.
Question 3. The first day of a client's last menstrual period was September 14. Using Nägele's
rule, which estimated birth date should the nurse calculate?
A. June 7
B. May 7
C. June 21
D. July 21
Correct Answer: C
Rationale: Nägele's rule adds seven days to the first day of the last menstrual period and subtracts three
months. September 14 becomes September 21, then June 21.
Question 4. Which finding is a positive sign of pregnancy?
A. A positive urine human chorionic gonadotropin result
B. Fetal cardiac activity visualized by ultrasound
C. Amenorrhea for two menstrual cycles
D. Bluish discoloration of the cervix
Correct Answer: B
Rationale: Direct visualization of fetal cardiac activity confirms the presence of a fetus. Amenorrhea is
presumptive, while cervical color change and a human chorionic gonadotropin result are probable rather
than positive signs.
NUR 254 Maternal and Pediatrics Comprehensive Examinations 1-4 2026/2027 | Verified Questions
,Question 5. Which early-pregnancy action of human chorionic gonadotropin is most important
for maintaining the pregnancy?
A. It directly causes fetal lung surfactant production.
B. It closes the fetal ductus arteriosus.
C. It initiates maternal milk ejection during the first trimester.
D. It sustains the corpus luteum so progesterone production continues.
Correct Answer: D
Rationale: Human chorionic gonadotropin preserves the corpus luteum early in gestation, maintaining
progesterone until placental hormone production is sufficient. Progesterone supports the endometrium and
limits uterine contractility.
Question 6. A pregnant client develops increasing insulin resistance as gestation advances. Which
placental hormone contributes most directly to this change?
A. Human placental lactogen
B. Oxytocin
C. Follicle-stimulating hormone
D. Prolactin-inhibiting factor
Correct Answer: A
Rationale: Human placental lactogen shifts maternal metabolism toward insulin resistance and lipolysis,
leaving more glucose available to the fetus. This physiologic effect also helps explain why glucose intolerance
may first appear during pregnancy.
Question 7. A healthy pregnant client has a mildly reduced hematocrit with no symptoms. Which
physiologic change best explains this finding?
A. Red blood cell destruction accelerates throughout pregnancy.
B. The placenta removes maternal erythrocytes from circulation.
C. Plasma volume expands more than red blood cell mass.
D. Maternal blood volume steadily decreases after implantation.
Correct Answer: C
Rationale: Pregnancy expands both plasma volume and red blood cell mass, but plasma volume rises
proportionally more. The resulting hemodilution produces the expected physiologic anemia of pregnancy.
Question 8. At 30 weeks of gestation, a client becomes pale and dizzy while lying flat for an
examination. What should the nurse do first?
A. Encourage the client to bear down with each breath.
B. Turn the client onto the left side.
C. Place the client in a high-Fowler position with legs dependent.
D. Apply firm pressure over the uterine fundus.
Correct Answer: B
Rationale: The gravid uterus can compress the vena cava in the supine position, reducing venous return and
cardiac output. Left lateral positioning relieves the compression and usually restores maternal circulation
quickly.
Question 9. Which baseline fetal heart rate should the nurse recognize as within the expected
antepartum range?
A. 140 beats per minute
B. 105 beats per minute
C. 90 beats per minute
D. 175 beats per minute
Correct Answer: A
Rationale: An expected fetal baseline is 110 to 160 beats per minute. A rate of 140 is within that interval,
whereas the lower choices indicate bradycardia and 175 indicates tachycardia.
NUR 254 Maternal and Pediatrics Comprehensive Examinations 1-4 2026/2027 | Verified Questions
, Question 10. During an uncomplicated pregnancy, the uterine fundus is usually at the level of the
umbilicus at approximately which gestational age?
A. 16 weeks
B. 28 weeks
C. 20 weeks
D. 12 weeks
Correct Answer: C
Rationale: At about 20 weeks, the fundus reaches the umbilicus. After that point, fundal height in centimeters
generally approximates gestational age within a small expected range.
Question 11. A client in a first pregnancy reports a fluttering sensation at 19 weeks of gestation.
How should the nurse interpret this report?
A. It is consistent with quickening at an expected time.
B. It is unusually early and suggests uterine rupture.
C. It confirms the onset of preterm labor.
D. It indicates placental separation.
Correct Answer: A
Rationale: Clients in a first pregnancy commonly recognize fetal movement around 18 to 20 weeks. The
fluttering description is typical of quickening and is not, by itself, a sign of an obstetric emergency.
Question 12. The nurse documents Goodell sign during an early prenatal visit. Which finding
does this term describe?
A. Irregular painless uterine contractions
B. Softening of the cervix
C. Softening of the lower uterine segment
D. Bluish coloration of the vagina and cervix
Correct Answer: B
Rationale: Goodell sign is cervical softening caused by increased vascularity. Softening of the lower uterine
segment is Hegar sign, and bluish coloration is Chadwick sign.
Question 13. Which prenatal laboratory screen identifies circulating maternal antibodies that
could cause fetal red blood cell hemolysis?
A. Direct antiglobulin screen on maternal blood
B. One-hour oral glucose screen
C. Indirect antiglobulin screen
D. Maternal serum alpha-fetoprotein level
Correct Answer: C
Rationale: The indirect antiglobulin screen detects unbound antibodies in maternal serum and is used during
prenatal blood-group assessment. A direct antiglobulin screen detects antibodies already attached to red
blood cells, commonly using neonatal blood when hemolysis is suspected.
Question 14. Prenatal laboratory findings show that a client is not immune to rubella. Which plan
is appropriate?
A. Administer the live rubella vaccine at the next prenatal visit.
B. Avoid rubella vaccination during pregnancy and offer it after birth before discharge.
C. Delay vaccination until a later pregnancy begins.
D. Give immune globulin monthly until birth.
Correct Answer: B
Rationale: Rubella vaccine is live attenuated and is avoided during pregnancy. Postpartum vaccination
protects future pregnancies, and the client should follow guidance about avoiding conception for the
recommended interval after vaccination.
NUR 254 Maternal and Pediatrics Comprehensive Examinations 1-4 2026/2027 | Verified Questions
NUR 254 Maternal and Pediatrics
Comprehensive Examinations 1-4 2026/2027 |
Verified Questions
Galen College of Nursing | NUR 254 Maternal and Pediatrics | University-Level Nursing Students
200 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Galen College of Nursing | NUR 254 Maternal and Pediatrics
Comprehensive Examinations 1-4 Actual Exam | Academic Year 2026/2027
NUR 254 Maternal and Pediatrics Comprehensive Examinations 1-4 2026/2027 | Verified Questions
,INTRODUCTION
This document contains exactly 200 original questions organized across four core domains: Domain 1, Maternal
and Antepartum Care (50); Domain 2, Intrapartum and Postpartum Care (50); Domain 3, Pediatric Growth,
Development, and Health Promotion (50); and Domain 4, Pediatric Health Alterations and Nursing Care (50).
The content is designed to reinforce the official NUR 254 Maternal and Pediatrics Comprehensive Examinations
1-4 course objectives for actual exam readiness and clinical proficiency, integrating maternal-child nursing
principles, developmental reasoning, and evidence-based clinical care aligned to Academic Year 2026/2027.
ACTUAL QUESTIONS
Domain 1: Maternal and Antepartum Care
Question 1. A client planning a pregnancy has no history of a neural tube defect. Which
instruction best lowers the fetal risk for a neural tube defect?
A. Begin 50 micrograms of folic acid only after fetal movement is felt.
B. Take 4 milligrams of folic acid only during the final month of pregnancy.
C. Take 400 to 800 micrograms of folic acid daily, beginning before conception.
D. Avoid folic acid when the diet contains fortified grains.
Correct Answer: C
Rationale: Adequate folate must be present during very early neural tube formation, often before pregnancy
is recognized. A daily intake of 400 to 800 micrograms is appropriate for most clients without a prior
affected pregnancy; higher dosing requires individualized prescribing.
Question 2. A pregnant client has one child born at term, twins born at 34 weeks who are both
living, and one prior miscarriage at 10 weeks. Which GTPAL notation is accurate for the current
pregnancy?
A. G4 T1 P1 A1 L3
B. G3 T1 P1 A1 L2
C. G5 T1 P2 A1 L3
D. G4 T2 P1 A0 L3
Correct Answer: A
Rationale: Gravidity counts each pregnancy, including the current one, so the total is four. The twin birth
counts as one preterm pregnancy but two living children, yielding G4 T1 P1 A1 L3.
Question 3. The first day of a client's last menstrual period was September 14. Using Nägele's
rule, which estimated birth date should the nurse calculate?
A. June 7
B. May 7
C. June 21
D. July 21
Correct Answer: C
Rationale: Nägele's rule adds seven days to the first day of the last menstrual period and subtracts three
months. September 14 becomes September 21, then June 21.
Question 4. Which finding is a positive sign of pregnancy?
A. A positive urine human chorionic gonadotropin result
B. Fetal cardiac activity visualized by ultrasound
C. Amenorrhea for two menstrual cycles
D. Bluish discoloration of the cervix
Correct Answer: B
Rationale: Direct visualization of fetal cardiac activity confirms the presence of a fetus. Amenorrhea is
presumptive, while cervical color change and a human chorionic gonadotropin result are probable rather
than positive signs.
NUR 254 Maternal and Pediatrics Comprehensive Examinations 1-4 2026/2027 | Verified Questions
,Question 5. Which early-pregnancy action of human chorionic gonadotropin is most important
for maintaining the pregnancy?
A. It directly causes fetal lung surfactant production.
B. It closes the fetal ductus arteriosus.
C. It initiates maternal milk ejection during the first trimester.
D. It sustains the corpus luteum so progesterone production continues.
Correct Answer: D
Rationale: Human chorionic gonadotropin preserves the corpus luteum early in gestation, maintaining
progesterone until placental hormone production is sufficient. Progesterone supports the endometrium and
limits uterine contractility.
Question 6. A pregnant client develops increasing insulin resistance as gestation advances. Which
placental hormone contributes most directly to this change?
A. Human placental lactogen
B. Oxytocin
C. Follicle-stimulating hormone
D. Prolactin-inhibiting factor
Correct Answer: A
Rationale: Human placental lactogen shifts maternal metabolism toward insulin resistance and lipolysis,
leaving more glucose available to the fetus. This physiologic effect also helps explain why glucose intolerance
may first appear during pregnancy.
Question 7. A healthy pregnant client has a mildly reduced hematocrit with no symptoms. Which
physiologic change best explains this finding?
A. Red blood cell destruction accelerates throughout pregnancy.
B. The placenta removes maternal erythrocytes from circulation.
C. Plasma volume expands more than red blood cell mass.
D. Maternal blood volume steadily decreases after implantation.
Correct Answer: C
Rationale: Pregnancy expands both plasma volume and red blood cell mass, but plasma volume rises
proportionally more. The resulting hemodilution produces the expected physiologic anemia of pregnancy.
Question 8. At 30 weeks of gestation, a client becomes pale and dizzy while lying flat for an
examination. What should the nurse do first?
A. Encourage the client to bear down with each breath.
B. Turn the client onto the left side.
C. Place the client in a high-Fowler position with legs dependent.
D. Apply firm pressure over the uterine fundus.
Correct Answer: B
Rationale: The gravid uterus can compress the vena cava in the supine position, reducing venous return and
cardiac output. Left lateral positioning relieves the compression and usually restores maternal circulation
quickly.
Question 9. Which baseline fetal heart rate should the nurse recognize as within the expected
antepartum range?
A. 140 beats per minute
B. 105 beats per minute
C. 90 beats per minute
D. 175 beats per minute
Correct Answer: A
Rationale: An expected fetal baseline is 110 to 160 beats per minute. A rate of 140 is within that interval,
whereas the lower choices indicate bradycardia and 175 indicates tachycardia.
NUR 254 Maternal and Pediatrics Comprehensive Examinations 1-4 2026/2027 | Verified Questions
, Question 10. During an uncomplicated pregnancy, the uterine fundus is usually at the level of the
umbilicus at approximately which gestational age?
A. 16 weeks
B. 28 weeks
C. 20 weeks
D. 12 weeks
Correct Answer: C
Rationale: At about 20 weeks, the fundus reaches the umbilicus. After that point, fundal height in centimeters
generally approximates gestational age within a small expected range.
Question 11. A client in a first pregnancy reports a fluttering sensation at 19 weeks of gestation.
How should the nurse interpret this report?
A. It is consistent with quickening at an expected time.
B. It is unusually early and suggests uterine rupture.
C. It confirms the onset of preterm labor.
D. It indicates placental separation.
Correct Answer: A
Rationale: Clients in a first pregnancy commonly recognize fetal movement around 18 to 20 weeks. The
fluttering description is typical of quickening and is not, by itself, a sign of an obstetric emergency.
Question 12. The nurse documents Goodell sign during an early prenatal visit. Which finding
does this term describe?
A. Irregular painless uterine contractions
B. Softening of the cervix
C. Softening of the lower uterine segment
D. Bluish coloration of the vagina and cervix
Correct Answer: B
Rationale: Goodell sign is cervical softening caused by increased vascularity. Softening of the lower uterine
segment is Hegar sign, and bluish coloration is Chadwick sign.
Question 13. Which prenatal laboratory screen identifies circulating maternal antibodies that
could cause fetal red blood cell hemolysis?
A. Direct antiglobulin screen on maternal blood
B. One-hour oral glucose screen
C. Indirect antiglobulin screen
D. Maternal serum alpha-fetoprotein level
Correct Answer: C
Rationale: The indirect antiglobulin screen detects unbound antibodies in maternal serum and is used during
prenatal blood-group assessment. A direct antiglobulin screen detects antibodies already attached to red
blood cells, commonly using neonatal blood when hemolysis is suspected.
Question 14. Prenatal laboratory findings show that a client is not immune to rubella. Which plan
is appropriate?
A. Administer the live rubella vaccine at the next prenatal visit.
B. Avoid rubella vaccination during pregnancy and offer it after birth before discharge.
C. Delay vaccination until a later pregnancy begins.
D. Give immune globulin monthly until birth.
Correct Answer: B
Rationale: Rubella vaccine is live attenuated and is avoided during pregnancy. Postpartum vaccination
protects future pregnancies, and the client should follow guidance about avoiding conception for the
recommended interval after vaccination.
NUR 254 Maternal and Pediatrics Comprehensive Examinations 1-4 2026/2027 | Verified Questions
