NSG 3500 - Exam 4 Questions With Complete Solutions 2026/2027 Maternal-Child Health Nursing
NSG 3500 - Exam 4 Questions With Complete Solutions
2026/2027
Comprehensive Maternal-Child Health Nursing Examination
100 Questions | 6 Sections | Aligned with NCLEX-RN Test Plan, QSEN Competencies, AWHONN Standards, and ACOG
Guidelines (2026/2027 Edition)
Cognitive Distribution: 20% Recall · 50% Application · 30% Analysis | Format: 75% Scenario-Based · 25% Direct
Knowledge
Section 1: High-Risk Pregnancy & Antepartum Complications
Questions 1-20 address antepartum complications including hypertensive disorders of pregnancy, gestational diabetes,
bleeding disorders of pregnancy, preterm labor, isoimmunization, multiple gestation, and antepartum fetal surveillance.
Clinical reasoning integrates ACOG and AWHONN standards with NCLEX-RN test plan priorities.
Q1: A 28-year-old gravida 2 para 1 at 32 weeks gestation presents to the obstetric triage unit with a blood
pressure of 162/108 mmHg, 3+ proteinuria on dipstick, severe headache, and right upper quadrant pain.
Fetal heart rate is 142 bpm with moderate variability. Which laboratory finding would the nurse most
strongly associate with progression to HELLP syndrome?
A. Hemoglobin 12.4 g/dL and platelet count 220,000/mm³
B. AST 165 U/L, LDH 720 U/L, and platelet count 78,000/mm³ [CORRECT]
C. Serum creatinine 0.9 mg/dL and BUN 12 mg/dL
D. Total bilirubin 0.6 mg/dL and INR 1.0
Correct Answer: B
Rationale:
HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe variant of preeclampsia characterized by
microangiopathic hemolytic anemia, AST or ALT greater than 70 U/L, LDH greater than 600 U/L, and platelets less than
100,000/mm³. The combination of elevated liver enzymes, elevated LDH, and thrombocytopenia confirms the diagnosis.
Management requires prompt corticosteroid administration, magnesium sulfate for seizure prophylaxis, and expeditious
delivery regardless of gestational age. Options A, C, and D demonstrate values within normal limits that would not support the
HELLP diagnosis.
Aligned with NCLEX-RN Test Plan, QSEN, AWHONN, ACOG Guidelines Page 1
,NSG 3500 - Exam 4 Questions With Complete Solutions 2026/2027 Maternal-Child Health Nursing
Q2: A pregnant patient at 26 weeks gestation undergoes a 1-hour 50-gram oral glucose challenge test
with a result of 156 mg/dL. Which action by the nurse aligns with current ACOG and ADA screening
guidelines for gestational diabetes mellitus?
A. Document the result as normal; no further testing is required this pregnancy
B. Schedule the patient for a 3-hour 100-gram oral glucose tolerance test [CORRECT]
C. Begin insulin therapy immediately and refer to a diabetes educator
D. Repeat the 1-hour screen in 4 weeks before any diagnostic testing
Correct Answer: B
Rationale:
A 1-hour glucose challenge result of 140 mg/dL or higher (some thresholds use 130 or 135 mg/dL) is considered a positive
screen and requires confirmation with a 3-hour 100-gram OGTT. The diagnosis of gestational diabetes requires two or more
abnormal values on the 3-hour test. Beginning insulin without a confirmatory diagnostic test is premature, and delaying
follow-up testing risks undiagnosed hyperglycemia. ACOG recommends universal screening between 24 and 28 weeks gestation
for all pregnant patients not previously diagnosed with diabetes.
Q3: A nurse is caring for a patient at 34 weeks gestation diagnosed with severe preeclampsia. An
intravenous magnesium sulfate infusion has been initiated at 2 g/hour following a 4-gram loading dose.
Which assessment finding would require the nurse to stop the infusion and notify the provider
immediately?
A. Respiratory rate of 14 breaths per minute
B. Deep tendon reflexes rated as 1+ hyporeflexia
C. Respiratory rate of 10 breaths per minute and absent patellar reflexes [CORRECT]
D. Urinary output of 30 mL per hour
Correct Answer: C
Rationale:
Magnesium sulfate is a central nervous system depressant used for seizure prophylaxis in severe preeclampsia. Signs of
magnesium toxicity include loss of deep tendon reflexes (the earliest sign), respiratory depression below 12 breaths per minute,
urine output below 25-30 mL/hour (indicating decreased renal clearance), and cardiac arrest in severe cases. The antidote is
calcium gluconate 10%, 10 mL of a 10% solution given intravenously slowly over 3 minutes. Respirations of 14 and reflexes
of 1+ warrant continued monitoring but do not meet toxicity thresholds.
Aligned with NCLEX-RN Test Plan, QSEN, AWHONN, ACOG Guidelines Page 2
,NSG 3500 - Exam 4 Questions With Complete Solutions 2026/2027 Maternal-Child Health Nursing
Q4: A 22-year-old primigravida at 9 weeks gestation presents with severe intractable nausea and
vomiting, having lost 8% of her pre-pregnancy body weight. Laboratory findings reveal potassium 3.0
mEq/L, ketones 3+ in urine, and thyroid-stimulating hormone 0.2 mIU/L. Which nursing diagnosis is the
highest priority?
A. Risk for fluid volume deficit related to prolonged vomiting
B. Imbalanced nutrition: less than body requirements related to nausea
C. Risk for altered fetal nutrition related to maternal weight loss
D. Fluid volume deficit and electrolyte imbalance related to hyperemesis gravidarum [CORRECT]
Correct Answer: D
Rationale:
Hyperemesis gravidarum is distinguished from typical nausea and vomiting of pregnancy by weight loss greater than 5% of
pre-pregnancy weight, dehydration, electrolyte disturbances, and ketonuria. This patient meets all diagnostic criteria and
demonstrates hypokalemia and abnormal thyroid indices that suggest transient hyperthyroidism of hyperemesis. The priority
nursing diagnosis addresses the actual fluid volume deficit and electrolyte imbalance, which poses the most immediate
physiological threat. Initial management includes intravenous hydration with multivitamin-containing fluids, antiemetics such
as pyridoxine and ondansetron, and correction of electrolyte abnormalities.
Q5: A patient at 30 weeks gestation arrives at the obstetric unit reporting a sudden gush of clear fluid
from the vagina. Nitrazine paper turns bright blue and ferning is confirmed on microscopic
examination. Uterine contractions are absent. Which nursing intervention is the priority at this time?
A. Initiate continuous electronic fetal monitoring and avoid vaginal examinations [CORRECT]
B. Perform a sterile speculum examination to assess cervical dilation
C. Administer indomethacin for tocolysis to prevent preterm birth
D. Encourage ambulation to promote labor progression
Correct Answer: A
Rationale:
Preterm premature rupture of membranes (PPROM) is confirmed by the alkaline Nitrazine test and ferning pattern. The
priority is continuous fetal monitoring to assess fetal well-being and detect signs of cord compression or infection. Digital
vaginal examinations should be avoided because they increase the risk of ascending infection; sterile speculum examination is
preferred when cervical assessment is necessary. Management typically includes hospitalization, latency antibiotic therapy
(ampicillin plus erythromycin), corticosteroids for fetal lung maturity if indicated, and expectant management until delivery is
warranted by infection, fetal compromise, or reaching 34 weeks gestation.
Aligned with NCLEX-RN Test Plan, QSEN, AWHONN, ACOG Guidelines Page 3
, NSG 3500 - Exam 4 Questions With Complete Solutions 2026/2027 Maternal-Child Health Nursing
Q6: A 35-year-old gravida 3 para 2 at 38 weeks gestation presents with painless, bright red vaginal
bleeding that began one hour ago. The bleeding has saturated one perineal pad. Fetal heart rate is 150
bpm with moderate variability. Which nursing action is contraindicated?
A. Initiating two large-bore intravenous lines with normal saline
B. Preparing for potential cesarean delivery
C. Performing a vaginal examination to assess cervical dilation and effacement [CORRECT]
D. Placing the patient on continuous electronic fetal monitoring
Correct Answer: C
Rationale:
Painless bright red vaginal bleeding in the third trimester is presumptive for placenta previa until ruled out by ultrasound.
Digital vaginal examination is absolutely contraindicated because it can provoke catastrophic hemorrhage by disrupting the
placental implantation site. The diagnosis is confirmed by transabdominal or transvaginal ultrasound demonstrating the
placenta covering or encroaching on the internal cervical os. Management includes hospitalization, intravenous access, type and
crossmatch for blood products, continuous fetal monitoring, and delivery by cesarean section if the previa persists at term.
Q7: A patient at 36 weeks gestation arrives reporting sudden onset of dark red vaginal bleeding
accompanied by sudden, severe abdominal pain and a rigid, tender uterus. The fetal heart rate tracing
reveals minimal variability with recurrent late decelerations. Which condition does this clinical picture
most strongly suggest?
A. Placenta previa with active bleeding
B. Placental abruption with concealed hemorrhage [CORRECT]
C. Vasa previa with fetal vessel rupture
D. Uterine rupture with fetal extrusion
Correct Answer: B
Rationale:
Placental abruption is characterized by painful, dark red vaginal bleeding (though hemorrhage may be concealed in 20% of
cases), a rigid and tender uterus, uterine hypertonicity, and fetal distress. The sudden onset of severe pain differentiates it from
the painless bleeding of placenta previa. Vasa previa typically presents with rupture of membranes followed by fetal
bradycardia and fetal blood loss, with the mother showing no hemodynamic compromise. Uterine rupture is most associated
with a history of prior cesarean section and presents with sudden loss of fetal station, cessation of contractions, and fetal
distress.
Aligned with NCLEX-RN Test Plan, QSEN, AWHONN, ACOG Guidelines Page 4
NSG 3500 - Exam 4 Questions With Complete Solutions
2026/2027
Comprehensive Maternal-Child Health Nursing Examination
100 Questions | 6 Sections | Aligned with NCLEX-RN Test Plan, QSEN Competencies, AWHONN Standards, and ACOG
Guidelines (2026/2027 Edition)
Cognitive Distribution: 20% Recall · 50% Application · 30% Analysis | Format: 75% Scenario-Based · 25% Direct
Knowledge
Section 1: High-Risk Pregnancy & Antepartum Complications
Questions 1-20 address antepartum complications including hypertensive disorders of pregnancy, gestational diabetes,
bleeding disorders of pregnancy, preterm labor, isoimmunization, multiple gestation, and antepartum fetal surveillance.
Clinical reasoning integrates ACOG and AWHONN standards with NCLEX-RN test plan priorities.
Q1: A 28-year-old gravida 2 para 1 at 32 weeks gestation presents to the obstetric triage unit with a blood
pressure of 162/108 mmHg, 3+ proteinuria on dipstick, severe headache, and right upper quadrant pain.
Fetal heart rate is 142 bpm with moderate variability. Which laboratory finding would the nurse most
strongly associate with progression to HELLP syndrome?
A. Hemoglobin 12.4 g/dL and platelet count 220,000/mm³
B. AST 165 U/L, LDH 720 U/L, and platelet count 78,000/mm³ [CORRECT]
C. Serum creatinine 0.9 mg/dL and BUN 12 mg/dL
D. Total bilirubin 0.6 mg/dL and INR 1.0
Correct Answer: B
Rationale:
HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe variant of preeclampsia characterized by
microangiopathic hemolytic anemia, AST or ALT greater than 70 U/L, LDH greater than 600 U/L, and platelets less than
100,000/mm³. The combination of elevated liver enzymes, elevated LDH, and thrombocytopenia confirms the diagnosis.
Management requires prompt corticosteroid administration, magnesium sulfate for seizure prophylaxis, and expeditious
delivery regardless of gestational age. Options A, C, and D demonstrate values within normal limits that would not support the
HELLP diagnosis.
Aligned with NCLEX-RN Test Plan, QSEN, AWHONN, ACOG Guidelines Page 1
,NSG 3500 - Exam 4 Questions With Complete Solutions 2026/2027 Maternal-Child Health Nursing
Q2: A pregnant patient at 26 weeks gestation undergoes a 1-hour 50-gram oral glucose challenge test
with a result of 156 mg/dL. Which action by the nurse aligns with current ACOG and ADA screening
guidelines for gestational diabetes mellitus?
A. Document the result as normal; no further testing is required this pregnancy
B. Schedule the patient for a 3-hour 100-gram oral glucose tolerance test [CORRECT]
C. Begin insulin therapy immediately and refer to a diabetes educator
D. Repeat the 1-hour screen in 4 weeks before any diagnostic testing
Correct Answer: B
Rationale:
A 1-hour glucose challenge result of 140 mg/dL or higher (some thresholds use 130 or 135 mg/dL) is considered a positive
screen and requires confirmation with a 3-hour 100-gram OGTT. The diagnosis of gestational diabetes requires two or more
abnormal values on the 3-hour test. Beginning insulin without a confirmatory diagnostic test is premature, and delaying
follow-up testing risks undiagnosed hyperglycemia. ACOG recommends universal screening between 24 and 28 weeks gestation
for all pregnant patients not previously diagnosed with diabetes.
Q3: A nurse is caring for a patient at 34 weeks gestation diagnosed with severe preeclampsia. An
intravenous magnesium sulfate infusion has been initiated at 2 g/hour following a 4-gram loading dose.
Which assessment finding would require the nurse to stop the infusion and notify the provider
immediately?
A. Respiratory rate of 14 breaths per minute
B. Deep tendon reflexes rated as 1+ hyporeflexia
C. Respiratory rate of 10 breaths per minute and absent patellar reflexes [CORRECT]
D. Urinary output of 30 mL per hour
Correct Answer: C
Rationale:
Magnesium sulfate is a central nervous system depressant used for seizure prophylaxis in severe preeclampsia. Signs of
magnesium toxicity include loss of deep tendon reflexes (the earliest sign), respiratory depression below 12 breaths per minute,
urine output below 25-30 mL/hour (indicating decreased renal clearance), and cardiac arrest in severe cases. The antidote is
calcium gluconate 10%, 10 mL of a 10% solution given intravenously slowly over 3 minutes. Respirations of 14 and reflexes
of 1+ warrant continued monitoring but do not meet toxicity thresholds.
Aligned with NCLEX-RN Test Plan, QSEN, AWHONN, ACOG Guidelines Page 2
,NSG 3500 - Exam 4 Questions With Complete Solutions 2026/2027 Maternal-Child Health Nursing
Q4: A 22-year-old primigravida at 9 weeks gestation presents with severe intractable nausea and
vomiting, having lost 8% of her pre-pregnancy body weight. Laboratory findings reveal potassium 3.0
mEq/L, ketones 3+ in urine, and thyroid-stimulating hormone 0.2 mIU/L. Which nursing diagnosis is the
highest priority?
A. Risk for fluid volume deficit related to prolonged vomiting
B. Imbalanced nutrition: less than body requirements related to nausea
C. Risk for altered fetal nutrition related to maternal weight loss
D. Fluid volume deficit and electrolyte imbalance related to hyperemesis gravidarum [CORRECT]
Correct Answer: D
Rationale:
Hyperemesis gravidarum is distinguished from typical nausea and vomiting of pregnancy by weight loss greater than 5% of
pre-pregnancy weight, dehydration, electrolyte disturbances, and ketonuria. This patient meets all diagnostic criteria and
demonstrates hypokalemia and abnormal thyroid indices that suggest transient hyperthyroidism of hyperemesis. The priority
nursing diagnosis addresses the actual fluid volume deficit and electrolyte imbalance, which poses the most immediate
physiological threat. Initial management includes intravenous hydration with multivitamin-containing fluids, antiemetics such
as pyridoxine and ondansetron, and correction of electrolyte abnormalities.
Q5: A patient at 30 weeks gestation arrives at the obstetric unit reporting a sudden gush of clear fluid
from the vagina. Nitrazine paper turns bright blue and ferning is confirmed on microscopic
examination. Uterine contractions are absent. Which nursing intervention is the priority at this time?
A. Initiate continuous electronic fetal monitoring and avoid vaginal examinations [CORRECT]
B. Perform a sterile speculum examination to assess cervical dilation
C. Administer indomethacin for tocolysis to prevent preterm birth
D. Encourage ambulation to promote labor progression
Correct Answer: A
Rationale:
Preterm premature rupture of membranes (PPROM) is confirmed by the alkaline Nitrazine test and ferning pattern. The
priority is continuous fetal monitoring to assess fetal well-being and detect signs of cord compression or infection. Digital
vaginal examinations should be avoided because they increase the risk of ascending infection; sterile speculum examination is
preferred when cervical assessment is necessary. Management typically includes hospitalization, latency antibiotic therapy
(ampicillin plus erythromycin), corticosteroids for fetal lung maturity if indicated, and expectant management until delivery is
warranted by infection, fetal compromise, or reaching 34 weeks gestation.
Aligned with NCLEX-RN Test Plan, QSEN, AWHONN, ACOG Guidelines Page 3
, NSG 3500 - Exam 4 Questions With Complete Solutions 2026/2027 Maternal-Child Health Nursing
Q6: A 35-year-old gravida 3 para 2 at 38 weeks gestation presents with painless, bright red vaginal
bleeding that began one hour ago. The bleeding has saturated one perineal pad. Fetal heart rate is 150
bpm with moderate variability. Which nursing action is contraindicated?
A. Initiating two large-bore intravenous lines with normal saline
B. Preparing for potential cesarean delivery
C. Performing a vaginal examination to assess cervical dilation and effacement [CORRECT]
D. Placing the patient on continuous electronic fetal monitoring
Correct Answer: C
Rationale:
Painless bright red vaginal bleeding in the third trimester is presumptive for placenta previa until ruled out by ultrasound.
Digital vaginal examination is absolutely contraindicated because it can provoke catastrophic hemorrhage by disrupting the
placental implantation site. The diagnosis is confirmed by transabdominal or transvaginal ultrasound demonstrating the
placenta covering or encroaching on the internal cervical os. Management includes hospitalization, intravenous access, type and
crossmatch for blood products, continuous fetal monitoring, and delivery by cesarean section if the previa persists at term.
Q7: A patient at 36 weeks gestation arrives reporting sudden onset of dark red vaginal bleeding
accompanied by sudden, severe abdominal pain and a rigid, tender uterus. The fetal heart rate tracing
reveals minimal variability with recurrent late decelerations. Which condition does this clinical picture
most strongly suggest?
A. Placenta previa with active bleeding
B. Placental abruption with concealed hemorrhage [CORRECT]
C. Vasa previa with fetal vessel rupture
D. Uterine rupture with fetal extrusion
Correct Answer: B
Rationale:
Placental abruption is characterized by painful, dark red vaginal bleeding (though hemorrhage may be concealed in 20% of
cases), a rigid and tender uterus, uterine hypertonicity, and fetal distress. The sudden onset of severe pain differentiates it from
the painless bleeding of placenta previa. Vasa previa typically presents with rupture of membranes followed by fetal
bradycardia and fetal blood loss, with the mother showing no hemodynamic compromise. Uterine rupture is most associated
with a history of prior cesarean section and presents with sudden loss of fetal station, cessation of contractions, and fetal
distress.
Aligned with NCLEX-RN Test Plan, QSEN, AWHONN, ACOG Guidelines Page 4
