NUR 254 Maternal Nursing
Comprehensive Exam with verified
answers and detailed rationales
updated 2026 graded A+
Section 1: Antepartum Care (Questions 1–25)
1. A nurse is teaching a group of pregnant women about physiological changes
in pregnancy. Which finding would be considered normal?
A) Decreased heart rate
B) Increased anterior-posterior chest diameter
C) Decreased tidal volume
D) Decreased oxygen consumption
Rationale: Progesterone causes relaxation of ligaments, increasing chest diameter
during pregnancy. Heart rate actually increases, tidal volume increases, and oxygen
consumption increases to meet metabolic demands -7 .
2. A client at 28 weeks gestation reports occasional lightheadedness when lying
on her back. What teaching should the nurse provide?
A) Limit fluid intake to reduce blood pressure
B) Sleep on your left side to avoid compression of the vena cava
C) Elevate your legs above heart level when lying down
D) Increase intake of salty foods to boost blood volume
Rationale: Lying supine can compress the vena cava by the gravid uterus, reducing
cardiac return and causing hypotension (supine hypotensive syndrome). Left lateral
positioning relieves this pressure -14 .
3. A nurse is calculating a client's expected date of birth using Naegele's rule.
The client reports her LMP started on January 3. What is the estimated date of
birth?
A) October 3
B) October 10
,C) October 17
D) October 24
Rationale: Using Naegele's rule (LMP + 7 days − 3 months + 1 year), January 3 plus
7 days is January 10; subtracting 3 months gives October 10 -14 .
4. A pregnant client at 24 weeks gestation asks about safe exercises. Which
activity should the nurse recommend?
A) Hot yoga
B) Snow skiing
C) Swimming
D) Horseback riding
Rationale: Swimming is a safe, low-impact exercise during pregnancy that relieves
joint pressure and prevents overheating. Contact sports and activities with high fall
risks or heat exposure are contraindicated -14 .
5. The nurse is assessing a client who is 32 weeks pregnant and notes her blood
pressure is 135/85 mmHg. She states this is slightly higher than her baseline.
What is the nurse's priority action?
A) Prepare the client for immediate delivery
B) Administer a dose of magnesium sulfate
C) Assess for proteinuria and other signs of preeclampsia
D) Instruct the client to reduce sodium intake strictly
Rationale: A blood pressure of 135/85 is elevated in pregnancy. The nurse must
assess for preeclampsia by checking for protein in the urine and other symptoms
(headache, visual changes) -14 .
6. A client at 14 weeks gestation complains of nausea and vomiting. Which
dietary modification should the nurse suggest?
A) Drink a glass of milk with meals
B) Eat dry, bland foods like crackers before getting out of bed
C) Skip breakfast to allow the stomach to rest
D) Increase intake of citrus juices
Rationale: Eating dry, bland carbohydrates like crackers before rising helps settle the
stomach and absorb gastric acid, which is a standard intervention for nausea -14 .
7. A nurse is teaching a client about Rh immunoglobulin (RhoGAM). When
should the client expect to receive this injection?
, A) At 28 weeks and again within 72 hours after delivery if the baby is Rh-
positive
B) Only if the client experiences bleeding during pregnancy
C) At 20 weeks and again at 36 weeks
D) Only after delivery regardless of baby's Rh status
Rationale: RhoGAM is given at 28 weeks and within 72 hours post-delivery if the
baby is Rh-positive, to prevent Rh sensitization -14 .
8. A pregnant client asks how much weight she should gain during pregnancy.
Her prepregnancy BMI was 22. The nurse should respond:
A) "You should gain about 10–15 pounds."
B) "You should gain about 25–35 pounds."
C) "You should gain about 40–50 pounds."
D) "You should gain about 15 pounds total."
Rationale: Normal-weight women (BMI 18.5–24.9) should gain 25–35 lbs.
Underweight women: 28–40 lbs; overweight: 15–25 lbs -8 .
9. The nurse is providing education on folic acid supplementation. Which dose
is recommended for all pregnant women?
A) 200 mcg daily
B) 400 mcg daily
C) 800 mcg daily
D) 1000 mcg daily
Rationale: The CDC recommends 400–800 mcg of folic acid daily for all women of
childbearing age and pregnant women to prevent neural tube defects -2 .
10. A patient at 28 weeks gestation reports mild lower back pain. The nurse
should suggest:
A) Bed rest
B) Pelvic tilt exercises
C) Heating pad to the lower back continuously
D) Narcotic analgesics
Rationale: Pelvic tilt exercises can relieve back pain by strengthening abdominal and
back muscles. Heat should be used cautiously -2 .
11. Which assessment finding indicates a need for further evaluation in a
pregnant patient?
Comprehensive Exam with verified
answers and detailed rationales
updated 2026 graded A+
Section 1: Antepartum Care (Questions 1–25)
1. A nurse is teaching a group of pregnant women about physiological changes
in pregnancy. Which finding would be considered normal?
A) Decreased heart rate
B) Increased anterior-posterior chest diameter
C) Decreased tidal volume
D) Decreased oxygen consumption
Rationale: Progesterone causes relaxation of ligaments, increasing chest diameter
during pregnancy. Heart rate actually increases, tidal volume increases, and oxygen
consumption increases to meet metabolic demands -7 .
2. A client at 28 weeks gestation reports occasional lightheadedness when lying
on her back. What teaching should the nurse provide?
A) Limit fluid intake to reduce blood pressure
B) Sleep on your left side to avoid compression of the vena cava
C) Elevate your legs above heart level when lying down
D) Increase intake of salty foods to boost blood volume
Rationale: Lying supine can compress the vena cava by the gravid uterus, reducing
cardiac return and causing hypotension (supine hypotensive syndrome). Left lateral
positioning relieves this pressure -14 .
3. A nurse is calculating a client's expected date of birth using Naegele's rule.
The client reports her LMP started on January 3. What is the estimated date of
birth?
A) October 3
B) October 10
,C) October 17
D) October 24
Rationale: Using Naegele's rule (LMP + 7 days − 3 months + 1 year), January 3 plus
7 days is January 10; subtracting 3 months gives October 10 -14 .
4. A pregnant client at 24 weeks gestation asks about safe exercises. Which
activity should the nurse recommend?
A) Hot yoga
B) Snow skiing
C) Swimming
D) Horseback riding
Rationale: Swimming is a safe, low-impact exercise during pregnancy that relieves
joint pressure and prevents overheating. Contact sports and activities with high fall
risks or heat exposure are contraindicated -14 .
5. The nurse is assessing a client who is 32 weeks pregnant and notes her blood
pressure is 135/85 mmHg. She states this is slightly higher than her baseline.
What is the nurse's priority action?
A) Prepare the client for immediate delivery
B) Administer a dose of magnesium sulfate
C) Assess for proteinuria and other signs of preeclampsia
D) Instruct the client to reduce sodium intake strictly
Rationale: A blood pressure of 135/85 is elevated in pregnancy. The nurse must
assess for preeclampsia by checking for protein in the urine and other symptoms
(headache, visual changes) -14 .
6. A client at 14 weeks gestation complains of nausea and vomiting. Which
dietary modification should the nurse suggest?
A) Drink a glass of milk with meals
B) Eat dry, bland foods like crackers before getting out of bed
C) Skip breakfast to allow the stomach to rest
D) Increase intake of citrus juices
Rationale: Eating dry, bland carbohydrates like crackers before rising helps settle the
stomach and absorb gastric acid, which is a standard intervention for nausea -14 .
7. A nurse is teaching a client about Rh immunoglobulin (RhoGAM). When
should the client expect to receive this injection?
, A) At 28 weeks and again within 72 hours after delivery if the baby is Rh-
positive
B) Only if the client experiences bleeding during pregnancy
C) At 20 weeks and again at 36 weeks
D) Only after delivery regardless of baby's Rh status
Rationale: RhoGAM is given at 28 weeks and within 72 hours post-delivery if the
baby is Rh-positive, to prevent Rh sensitization -14 .
8. A pregnant client asks how much weight she should gain during pregnancy.
Her prepregnancy BMI was 22. The nurse should respond:
A) "You should gain about 10–15 pounds."
B) "You should gain about 25–35 pounds."
C) "You should gain about 40–50 pounds."
D) "You should gain about 15 pounds total."
Rationale: Normal-weight women (BMI 18.5–24.9) should gain 25–35 lbs.
Underweight women: 28–40 lbs; overweight: 15–25 lbs -8 .
9. The nurse is providing education on folic acid supplementation. Which dose
is recommended for all pregnant women?
A) 200 mcg daily
B) 400 mcg daily
C) 800 mcg daily
D) 1000 mcg daily
Rationale: The CDC recommends 400–800 mcg of folic acid daily for all women of
childbearing age and pregnant women to prevent neural tube defects -2 .
10. A patient at 28 weeks gestation reports mild lower back pain. The nurse
should suggest:
A) Bed rest
B) Pelvic tilt exercises
C) Heating pad to the lower back continuously
D) Narcotic analgesics
Rationale: Pelvic tilt exercises can relieve back pain by strengthening abdominal and
back muscles. Heat should be used cautiously -2 .
11. Which assessment finding indicates a need for further evaluation in a
pregnant patient?
