NUR 254 Final Exam | Galen College of Nursing | 2026/2027 100 Questions with Rationales
NUR 254 Final Exam | Galen College of Nursing
2026/2027 Complete Exam Questions with Verified Correct Answers
Maternal-Child Nursing Comprehensive Final | Aligned with ACOG, AAP, CDC, PALS, and Neonatal Resuscitation Guidelines
Examination Overview. This 100-item comprehensive examination mirrors the cumulative content blueprint for Galen
College of Nursing NUR 254 Maternal-Child Nursing, integrating antepartum, intrapartum, postpartum, newborn, pediatric,
and psychosocial-ethical domains. Items are weighted to reflect the course's emphasis on high-risk maternal and neonatal
critical care, pediatric acute and chronic illness management, family-centered care, and clinical judgment consistent with
NCLEX Next Generation standards. Approximately 80% of items are scenario-based and 20% test recall of protocols,
pharmacology, and dosage calculations. Cognitive distribution targets 25% recall, 55% application, and 20% analysis. Each
item presents four options with a single best answer followed by a rationale explaining the correct response and the principal
errors represented by the distractors, including pathophysiology, evidence-based practice, safety, and family-centered care
principles.
Section 1: Antepartum Nursing
Prenatal Care, Fetal Development, Maternal Adaptations, High-Risk Pregnancies, Antepartum Testing, and Complications
(Q1-Q20)
Q1: A 28-year-old primigravida at 12 weeks gestation presents for her first prenatal visit. According to ACOG
recommendations, how frequently should she have prenatal visits during the third trimester?
A. Every 4 weeks until 36 weeks, then weekly until delivery
B. Every 2 weeks from 28 to 36 weeks, then weekly until delivery [CORRECT]
C. Weekly from 28 weeks until delivery
D. Every 3 weeks from 28 to 36 weeks, then every 2 weeks until delivery
Correct Answer: B
Rationale: Standard ACOG prenatal visit schedule for low-risk pregnancies: visits every 4 weeks from initial visit through 28
weeks, every 2 weeks from 28 to 36 weeks, then weekly from 36 weeks until delivery. This schedule allows for early
detection of complications such as preeclampsia, gestational hypertension, and fetal growth restriction that become more
common in the third trimester. High-risk pregnancies require individualized, more frequent surveillance. The increased visit
frequency after 36 weeks enables cervical exams, Group B Streptococcus screening (35-37 weeks), and monitoring for signs
of labor or complications.
Maternal-Child Nursing Comprehensive Final Examination Page 1
,NUR 254 Final Exam | Galen College of Nursing | 2026/2027 100 Questions with Rationales
Q2: A pregnant patient at 18 weeks gestation asks when she will first feel fetal movement. The nurse explains
that quickening typically occurs between which gestational ages?
A. 12-14 weeks
B. 16-20 weeks [CORRECT]
C. 24-28 weeks
D. 30-32 weeks
Correct Answer: B
Rationale: Quickening, the first perception of fetal movement by the mother, typically occurs between 16 and 20 weeks
gestation. Multigravida women often feel movement earlier (around 16-18 weeks) due to prior experience recognizing the
sensation, while primigravida women typically feel it later (around 18-20 weeks). Quickening corresponds to a period of rapid
fetal neuromuscular development. Prior to 16 weeks, fetal movement occurs but is not perceptible to the mother. Absence of
quickening by 20-22 weeks warrants evaluation for fetal viability, dating accuracy, and amniotic fluid volume.
Q3: A pregnant patient at 32 weeks gestation has a blood pressure of 142/94 mmHg, proteinuria 2+, and a
5-pound weight gain in one week. Which pathophysiological process underlies her condition?
A. Increased cardiac output causing fluid overload
B. Abnormal placental implantation causing widespread vasospasm and endothelial dysfunction [CORRECT]
C. Renal agenesis causing protein leakage
D. Maternal anemia causing compensatory hypertension
Correct Answer: B
Rationale: Preeclampsia is a multisystem disorder characterized by hypertension and proteinuria after 20 weeks gestation,
caused by abnormal trophoblastic invasion of the spiral arteries leading to inadequate placental perfusion. This triggers release
of antiangiogenic factors (sFlt-1, endoglin) causing widespread maternal vasospasm, endothelial dysfunction, and increased
vascular permeability. The result is hypertension, proteinuria from glomerular endotheliosis, edema, and potential end-organ
damage (liver, kidneys, brain, platelets). Increased cardiac output is a normal adaptation of pregnancy, not the cause. Renal
agenesis and anemia are unrelated to preeclampsia pathophysiology.
Q4: A patient at 28 weeks gestation undergoes a nonstress test (NST). The fetal heart rate baseline is 140 bpm
with two accelerations of 15 bpm for 15 seconds within a 20-minute window. How should the nurse interpret
this result?
A. Reactive NST indicating adequate fetal oxygenation and central nervous system integrity [CORRECT]
B. Nonreactive NST requiring immediate delivery
C. Reactive NST requiring further evaluation with biophysical profile
D. Nonreactive NST indicating fetal distress
Correct Answer: A
Rationale: A reactive NST requires at least two accelerations of at least 15 bpm above baseline lasting at least 15 seconds
within a 20-minute period (in a term or near-term fetus; criteria are 10x10 for <32 weeks). This pattern indicates adequate
fetal oxygenation, intact central nervous system, and fetal well-being. No further intervention is needed for routine
surveillance. A nonreactive NST (fewer than required accelerations) warrants further evaluation with a biophysical profile or
contraction stress test, not immediate delivery. A reactive NST is reassuring and does not require additional testing unless
other clinical indications exist.
Maternal-Child Nursing Comprehensive Final Examination Page 2
,NUR 254 Final Exam | Galen College of Nursing | 2026/2027 100 Questions with Rationales
Q5: A patient at 38 weeks gestation undergoes a biophysical profile (BPP). The score is 8 out of 10, with the loss
of one point in the amniotic fluid volume category. What is the most appropriate nursing action?
A. Prepare for immediate cesarean delivery
B. Schedule a repeat BPP in one week and report findings to the provider [CORRECT]
C. Administer oxygen via non-rebreather mask
D. Begin continuous electronic fetal monitoring and prepare for induction
Correct Answer: B
Rationale: A BPP score of 8/10 with normal amniotic fluid is reassuring, but a score of 8/10 with decreased amniotic fluid
volume (the only isolated deficit that changes management) may indicate chronic uteroplacental insufficiency. A BPP of 8
with normal fluid is considered normal and warrants repeat in one week for high-risk pregnancies. A BPP of 6 is equivocal
and requires repeat within 24 hours or delivery if term. A BPP of 4 or below requires delivery. Immediate cesarean, oxygen
administration, or induction is not indicated for an 8/10 BPP with isolated fluid deficit in a stable patient.
Q6: A 24-year-old patient at 26 weeks gestation is being screened for gestational diabetes. Her 1-hour 50-gram
glucose challenge test result is 145 mg/dL. What is the next step in management?
A. Diagnose gestational diabetes and begin insulin therapy
B. Schedule a 3-hour 100-gram oral glucose tolerance test [CORRECT]
C. Repeat the 1-hour test in 4 weeks
D. Begin diet modification and recheck fasting glucose weekly
Correct Answer: B
Rationale: A 1-hour 50-gram glucose challenge test result >=140 mg/dL (some institutions use 130 or 135) requires a
diagnostic 3-hour 100-gram oral glucose tolerance test (OGTT). Diagnosis of gestational diabetes requires two or more
abnormal values on the 3-hour OGTT using Carpenter-Coustan or NDDG criteria. A single elevated 1-hour screen is not
diagnostic. The OGTT must be performed after an 8-12 hour fast and 3 days of unrestricted carbohydrate intake. If GDM is
confirmed, initial management is dietary modification with glucose monitoring; insulin is added if diet fails to maintain target
glucose levels.
Q7: A patient at 34 weeks gestation with preeclampsia presents with a severe headache, visual disturbances, and
epigastric pain. Her blood pressure is 168/112 mmHg. Which medication should the nurse prepare to administer
to prevent seizures?
A. IV magnesium sulfate 4-6 g loading dose followed by 1-2 g/hr continuous infusion [CORRECT]
B. IV hydralazine 5-10 mg push to control blood pressure
C. IV labetalol 20 mg to control blood pressure
D. IV diazepam 5 mg to prevent seizures
Correct Answer: A
Rationale: Magnesium sulfate is the drug of choice for seizure prophylaxis in severe preeclampsia and treatment of
eclampsia, administered as 4-6 g IV loading dose over 20 minutes followed by 1-2 g/hr continuous infusion. Magnesium acts
at the NMDA receptor and motor end plate to prevent seizure activity. Hydralazine and labetalol are antihypertensives used to
control blood pressure but do not prevent seizures; they are typically administered concurrently with magnesium. Diazepam is
not used for eclampsia prophylaxis due to less efficacy and risk of neonatal sedation. Magnesium requires monitoring of deep
tendon reflexes, respiratory rate, urine output, and serum levels to prevent toxicity.
Maternal-Child Nursing Comprehensive Final Examination Page 3
, NUR 254 Final Exam | Galen College of Nursing | 2026/2027 100 Questions with Rationales
Q8: A patient at 32 weeks gestation presents with sudden onset of severe, constant abdominal pain and dark red
vaginal bleeding. She has a history of chronic hypertension. Fetal heart rate is 90 bpm. Which complication is
most likely?
A. Placenta previa
B. Abruptio placentae [CORRECT]
C. Vasa previa
D. Uterine rupture
Correct Answer: B
Rationale: Abruptio placentae (placental abruption) presents with sudden onset severe constant abdominal pain, dark red
vaginal bleeding, uterine tenderness, and fetal distress. Risk factors include chronic hypertension, preeclampsia, trauma,
cocaine use, and advanced maternal age. The bleeding is typically dark red because it traverses the uterine wall. Placenta
previa presents with painless bright red bleeding. Vasa previa presents with bleeding immediately after rupture of membranes
and fetal bradycardia. Uterine rupture presents with sudden cessation of contractions, loss of fetal station, and severe pain.
This patient's hypertension, pain, dark bleeding, and fetal distress are classic for abruption.
Q9: A patient at 28 weeks gestation presents with regular uterine contractions every 5 minutes, cervical dilation
of 2 cm, and cervical effacement of 80%. What is the priority nursing intervention?
A. Administer betamethasone 12 mg IM and tocolytics, notify neonatal team [CORRECT]
B. Prepare for immediate cesarean delivery
C. Administer oxytocin to augment labor
D. Encourage ambulation to progress labor
Correct Answer: A
Rationale: Preterm labor at 28 weeks with cervical change requires administration of betamethasone 12 mg IM every 24
hours for two doses to accelerate fetal lung maturity, tocolytic therapy (indomethacin, nifedipine, or terbutaline) to delay
delivery for 48 hours to allow steroid effect, and notification of the neonatal team for anticipated preterm delivery. Cesarean
delivery is not routinely indicated for preterm labor unless obstetric indications exist. Oxytocin augmentation and ambulation
would worsen preterm labor. Magnesium sulfate may be considered for neuroprotection in deliveries before 32 weeks. Group
B strep prophylaxis should be initiated if delivery is anticipated.
Q10: A patient at 30 weeks gestation presents with leakage of clear fluid from the vagina. Nitrazine paper turns
blue and ferning is present on microscopic examination. What is the most appropriate initial nursing
intervention?
A. Begin continuous fetal monitoring, avoid vaginal exams, monitor for infection, and administer betamethasone
[CORRECT]
B. Prepare for immediate induction of labor
C. Administer oxytocin to induce labor
D. Discharge with instructions to monitor for contractions
Correct Answer: A
Rationale: Preterm premature rupture of membranes (PPROM) at 30 weeks is managed expectantly with continuous fetal
monitoring to assess for cord compression or infection, avoidance of vaginal exams to reduce infection risk, monitoring
maternal temperature, WBC, and uterine tenderness for chorioamnionitis, and administration of betamethasone for fetal lung
maturity. Latency antibiotics (ampicillin plus erythromycin) prolong pregnancy and reduce neonatal morbidity. Group B strep
prophylaxis is initiated. Delivery is typically indicated at 34 weeks or with infection, fetal distress, or abruption. Immediate
induction is contraindicated at 30 weeks without obstetric indication. Discharge is unsafe due to risks of infection and cord
prolapse.
Maternal-Child Nursing Comprehensive Final Examination Page 4
NUR 254 Final Exam | Galen College of Nursing
2026/2027 Complete Exam Questions with Verified Correct Answers
Maternal-Child Nursing Comprehensive Final | Aligned with ACOG, AAP, CDC, PALS, and Neonatal Resuscitation Guidelines
Examination Overview. This 100-item comprehensive examination mirrors the cumulative content blueprint for Galen
College of Nursing NUR 254 Maternal-Child Nursing, integrating antepartum, intrapartum, postpartum, newborn, pediatric,
and psychosocial-ethical domains. Items are weighted to reflect the course's emphasis on high-risk maternal and neonatal
critical care, pediatric acute and chronic illness management, family-centered care, and clinical judgment consistent with
NCLEX Next Generation standards. Approximately 80% of items are scenario-based and 20% test recall of protocols,
pharmacology, and dosage calculations. Cognitive distribution targets 25% recall, 55% application, and 20% analysis. Each
item presents four options with a single best answer followed by a rationale explaining the correct response and the principal
errors represented by the distractors, including pathophysiology, evidence-based practice, safety, and family-centered care
principles.
Section 1: Antepartum Nursing
Prenatal Care, Fetal Development, Maternal Adaptations, High-Risk Pregnancies, Antepartum Testing, and Complications
(Q1-Q20)
Q1: A 28-year-old primigravida at 12 weeks gestation presents for her first prenatal visit. According to ACOG
recommendations, how frequently should she have prenatal visits during the third trimester?
A. Every 4 weeks until 36 weeks, then weekly until delivery
B. Every 2 weeks from 28 to 36 weeks, then weekly until delivery [CORRECT]
C. Weekly from 28 weeks until delivery
D. Every 3 weeks from 28 to 36 weeks, then every 2 weeks until delivery
Correct Answer: B
Rationale: Standard ACOG prenatal visit schedule for low-risk pregnancies: visits every 4 weeks from initial visit through 28
weeks, every 2 weeks from 28 to 36 weeks, then weekly from 36 weeks until delivery. This schedule allows for early
detection of complications such as preeclampsia, gestational hypertension, and fetal growth restriction that become more
common in the third trimester. High-risk pregnancies require individualized, more frequent surveillance. The increased visit
frequency after 36 weeks enables cervical exams, Group B Streptococcus screening (35-37 weeks), and monitoring for signs
of labor or complications.
Maternal-Child Nursing Comprehensive Final Examination Page 1
,NUR 254 Final Exam | Galen College of Nursing | 2026/2027 100 Questions with Rationales
Q2: A pregnant patient at 18 weeks gestation asks when she will first feel fetal movement. The nurse explains
that quickening typically occurs between which gestational ages?
A. 12-14 weeks
B. 16-20 weeks [CORRECT]
C. 24-28 weeks
D. 30-32 weeks
Correct Answer: B
Rationale: Quickening, the first perception of fetal movement by the mother, typically occurs between 16 and 20 weeks
gestation. Multigravida women often feel movement earlier (around 16-18 weeks) due to prior experience recognizing the
sensation, while primigravida women typically feel it later (around 18-20 weeks). Quickening corresponds to a period of rapid
fetal neuromuscular development. Prior to 16 weeks, fetal movement occurs but is not perceptible to the mother. Absence of
quickening by 20-22 weeks warrants evaluation for fetal viability, dating accuracy, and amniotic fluid volume.
Q3: A pregnant patient at 32 weeks gestation has a blood pressure of 142/94 mmHg, proteinuria 2+, and a
5-pound weight gain in one week. Which pathophysiological process underlies her condition?
A. Increased cardiac output causing fluid overload
B. Abnormal placental implantation causing widespread vasospasm and endothelial dysfunction [CORRECT]
C. Renal agenesis causing protein leakage
D. Maternal anemia causing compensatory hypertension
Correct Answer: B
Rationale: Preeclampsia is a multisystem disorder characterized by hypertension and proteinuria after 20 weeks gestation,
caused by abnormal trophoblastic invasion of the spiral arteries leading to inadequate placental perfusion. This triggers release
of antiangiogenic factors (sFlt-1, endoglin) causing widespread maternal vasospasm, endothelial dysfunction, and increased
vascular permeability. The result is hypertension, proteinuria from glomerular endotheliosis, edema, and potential end-organ
damage (liver, kidneys, brain, platelets). Increased cardiac output is a normal adaptation of pregnancy, not the cause. Renal
agenesis and anemia are unrelated to preeclampsia pathophysiology.
Q4: A patient at 28 weeks gestation undergoes a nonstress test (NST). The fetal heart rate baseline is 140 bpm
with two accelerations of 15 bpm for 15 seconds within a 20-minute window. How should the nurse interpret
this result?
A. Reactive NST indicating adequate fetal oxygenation and central nervous system integrity [CORRECT]
B. Nonreactive NST requiring immediate delivery
C. Reactive NST requiring further evaluation with biophysical profile
D. Nonreactive NST indicating fetal distress
Correct Answer: A
Rationale: A reactive NST requires at least two accelerations of at least 15 bpm above baseline lasting at least 15 seconds
within a 20-minute period (in a term or near-term fetus; criteria are 10x10 for <32 weeks). This pattern indicates adequate
fetal oxygenation, intact central nervous system, and fetal well-being. No further intervention is needed for routine
surveillance. A nonreactive NST (fewer than required accelerations) warrants further evaluation with a biophysical profile or
contraction stress test, not immediate delivery. A reactive NST is reassuring and does not require additional testing unless
other clinical indications exist.
Maternal-Child Nursing Comprehensive Final Examination Page 2
,NUR 254 Final Exam | Galen College of Nursing | 2026/2027 100 Questions with Rationales
Q5: A patient at 38 weeks gestation undergoes a biophysical profile (BPP). The score is 8 out of 10, with the loss
of one point in the amniotic fluid volume category. What is the most appropriate nursing action?
A. Prepare for immediate cesarean delivery
B. Schedule a repeat BPP in one week and report findings to the provider [CORRECT]
C. Administer oxygen via non-rebreather mask
D. Begin continuous electronic fetal monitoring and prepare for induction
Correct Answer: B
Rationale: A BPP score of 8/10 with normal amniotic fluid is reassuring, but a score of 8/10 with decreased amniotic fluid
volume (the only isolated deficit that changes management) may indicate chronic uteroplacental insufficiency. A BPP of 8
with normal fluid is considered normal and warrants repeat in one week for high-risk pregnancies. A BPP of 6 is equivocal
and requires repeat within 24 hours or delivery if term. A BPP of 4 or below requires delivery. Immediate cesarean, oxygen
administration, or induction is not indicated for an 8/10 BPP with isolated fluid deficit in a stable patient.
Q6: A 24-year-old patient at 26 weeks gestation is being screened for gestational diabetes. Her 1-hour 50-gram
glucose challenge test result is 145 mg/dL. What is the next step in management?
A. Diagnose gestational diabetes and begin insulin therapy
B. Schedule a 3-hour 100-gram oral glucose tolerance test [CORRECT]
C. Repeat the 1-hour test in 4 weeks
D. Begin diet modification and recheck fasting glucose weekly
Correct Answer: B
Rationale: A 1-hour 50-gram glucose challenge test result >=140 mg/dL (some institutions use 130 or 135) requires a
diagnostic 3-hour 100-gram oral glucose tolerance test (OGTT). Diagnosis of gestational diabetes requires two or more
abnormal values on the 3-hour OGTT using Carpenter-Coustan or NDDG criteria. A single elevated 1-hour screen is not
diagnostic. The OGTT must be performed after an 8-12 hour fast and 3 days of unrestricted carbohydrate intake. If GDM is
confirmed, initial management is dietary modification with glucose monitoring; insulin is added if diet fails to maintain target
glucose levels.
Q7: A patient at 34 weeks gestation with preeclampsia presents with a severe headache, visual disturbances, and
epigastric pain. Her blood pressure is 168/112 mmHg. Which medication should the nurse prepare to administer
to prevent seizures?
A. IV magnesium sulfate 4-6 g loading dose followed by 1-2 g/hr continuous infusion [CORRECT]
B. IV hydralazine 5-10 mg push to control blood pressure
C. IV labetalol 20 mg to control blood pressure
D. IV diazepam 5 mg to prevent seizures
Correct Answer: A
Rationale: Magnesium sulfate is the drug of choice for seizure prophylaxis in severe preeclampsia and treatment of
eclampsia, administered as 4-6 g IV loading dose over 20 minutes followed by 1-2 g/hr continuous infusion. Magnesium acts
at the NMDA receptor and motor end plate to prevent seizure activity. Hydralazine and labetalol are antihypertensives used to
control blood pressure but do not prevent seizures; they are typically administered concurrently with magnesium. Diazepam is
not used for eclampsia prophylaxis due to less efficacy and risk of neonatal sedation. Magnesium requires monitoring of deep
tendon reflexes, respiratory rate, urine output, and serum levels to prevent toxicity.
Maternal-Child Nursing Comprehensive Final Examination Page 3
, NUR 254 Final Exam | Galen College of Nursing | 2026/2027 100 Questions with Rationales
Q8: A patient at 32 weeks gestation presents with sudden onset of severe, constant abdominal pain and dark red
vaginal bleeding. She has a history of chronic hypertension. Fetal heart rate is 90 bpm. Which complication is
most likely?
A. Placenta previa
B. Abruptio placentae [CORRECT]
C. Vasa previa
D. Uterine rupture
Correct Answer: B
Rationale: Abruptio placentae (placental abruption) presents with sudden onset severe constant abdominal pain, dark red
vaginal bleeding, uterine tenderness, and fetal distress. Risk factors include chronic hypertension, preeclampsia, trauma,
cocaine use, and advanced maternal age. The bleeding is typically dark red because it traverses the uterine wall. Placenta
previa presents with painless bright red bleeding. Vasa previa presents with bleeding immediately after rupture of membranes
and fetal bradycardia. Uterine rupture presents with sudden cessation of contractions, loss of fetal station, and severe pain.
This patient's hypertension, pain, dark bleeding, and fetal distress are classic for abruption.
Q9: A patient at 28 weeks gestation presents with regular uterine contractions every 5 minutes, cervical dilation
of 2 cm, and cervical effacement of 80%. What is the priority nursing intervention?
A. Administer betamethasone 12 mg IM and tocolytics, notify neonatal team [CORRECT]
B. Prepare for immediate cesarean delivery
C. Administer oxytocin to augment labor
D. Encourage ambulation to progress labor
Correct Answer: A
Rationale: Preterm labor at 28 weeks with cervical change requires administration of betamethasone 12 mg IM every 24
hours for two doses to accelerate fetal lung maturity, tocolytic therapy (indomethacin, nifedipine, or terbutaline) to delay
delivery for 48 hours to allow steroid effect, and notification of the neonatal team for anticipated preterm delivery. Cesarean
delivery is not routinely indicated for preterm labor unless obstetric indications exist. Oxytocin augmentation and ambulation
would worsen preterm labor. Magnesium sulfate may be considered for neuroprotection in deliveries before 32 weeks. Group
B strep prophylaxis should be initiated if delivery is anticipated.
Q10: A patient at 30 weeks gestation presents with leakage of clear fluid from the vagina. Nitrazine paper turns
blue and ferning is present on microscopic examination. What is the most appropriate initial nursing
intervention?
A. Begin continuous fetal monitoring, avoid vaginal exams, monitor for infection, and administer betamethasone
[CORRECT]
B. Prepare for immediate induction of labor
C. Administer oxytocin to induce labor
D. Discharge with instructions to monitor for contractions
Correct Answer: A
Rationale: Preterm premature rupture of membranes (PPROM) at 30 weeks is managed expectantly with continuous fetal
monitoring to assess for cord compression or infection, avoidance of vaginal exams to reduce infection risk, monitoring
maternal temperature, WBC, and uterine tenderness for chorioamnionitis, and administration of betamethasone for fetal lung
maturity. Latency antibiotics (ampicillin plus erythromycin) prolong pregnancy and reduce neonatal morbidity. Group B strep
prophylaxis is initiated. Delivery is typically indicated at 34 weeks or with infection, fetal distress, or abruption. Immediate
induction is contraindicated at 30 weeks without obstetric indication. Discharge is unsafe due to risks of infection and cord
prolapse.
Maternal-Child Nursing Comprehensive Final Examination Page 4
