NUR 254
Maternal and Pediatric Nursing
Exams 1-4
Questions with Answers|Latest
Galen College of Nursing
EXAM 1:
1. A client's last menstrual period began on October 12. Using
Nägele's rule, what is her estimated date of delivery (EDD)?
A. July 19
B. July 5
C. August 2
D. July 12
Answer: A
Rationale: Nägele's rule: take the first day of the last menstrual period,
add 7 days, and subtract 3 months (or add 9 months). October 12 + 7
days = October 19; minus 3 months = July 19 of the following year.
2. A client is pregnant for the third time. Her first child was born at 39
weeks and her second child was born at 35 weeks. Both children are
living. What is her GTPAL?
A. G2 T1 P1 A0 L2
B. G3 T1 P0 A1 L2
C. G3 T2 P0 A0 L2
D. G3 T1 P1 A0 L2
Answer: D
Rationale: Gravida counts all pregnancies, including the current one (3).
A birth at 37 weeks or later is a term birth (T = 1); a birth from 20 to 36 6/7
weeks is a preterm birth (P = 1). She has had no abortions or
miscarriages (A = 0) and has two living children (L = 2).
NUR 254 Exams | Page 1
,3. Which finding is a positive (diagnostic) sign of pregnancy?
A. Chadwick sign (bluish discoloration of the cervix)
B. Amenorrhea
C. Fetal heart tones detected with a Doppler device
D. A positive home urine pregnancy test
Answer: C
Rationale: Positive signs can be caused only by a fetus: fetal heartbeat
(Doppler at about 10 to 12 weeks), fetal movement palpated by the
examiner, and ultrasound visualization of the fetus. Chadwick sign and a
positive hCG test are probable signs (other conditions can mimic them);
amenorrhea is a presumptive sign.
4. A nurse teaches a woman who is planning a pregnancy about folic
acid. Which statement is accurate?
A. "Folic acid prevents preterm labor."
B. "Folic acid helps prevent neural tube defects and should be started
before conception."
C. "Folic acid prevents Down syndrome if it is started in the third
trimester."
D. "Folic acid should be started only after the first prenatal visit."
Answer: B
Rationale: At least 400 mcg of folic acid daily is recommended for all
women who could become pregnant. The neural tube closes by about day
28 after conception, often before a woman knows she is pregnant.
Women with a prior neural tube defect need a higher dose (4 mg) as
prescribed.
5. A pregnant client with a normal pre-pregnancy BMI asks how much
weight she should gain during pregnancy. Which response is correct?
A. "About 35 to 45 pounds (16 to 20.5 kg)."
B. "About 10 to 15 pounds (4.5 to 7 kg)."
C. "About 25 to 35 pounds (11.5 to 16 kg)."
D. "About 15 to 25 pounds (7 to 11.5 kg)."
Answer: C
Rationale: Institute of Medicine guidelines: underweight 28 to 40 lb,
normal weight 25 to 35 lb, overweight 15 to 25 lb, obese 11 to 20 lb.
Typical pattern: 1 to 4.5 lb in the first trimester, then about 1 lb per week.
NUR 254 Exams | Page 2
,6. A client at 28 weeks gestation has a hemoglobin of 11.2 g/dL and a
hematocrit of 33%. She asks why her values are lower than before
pregnancy. Which explanation is best?
A. "Your baby is taking all of your iron, so you have anemia."
B. "Red blood cell production stops during the second trimester."
C. "Your total blood volume decreases to make room for the uterus."
D. "Your plasma volume increases more than your red blood cell mass,
which dilutes your blood."
Answer: D
Rationale: Plasma volume rises about 40% to 50% while red cell mass
rises only 20% to 30%, causing hemodilution (physiologic anemia of
pregnancy). Anemia is diagnosed when hemoglobin is below 11 g/dL in
the first and third trimesters or below 10.5 g/dL in the second trimester.
7. A client at 34 weeks gestation lies supine for fetal monitoring and
becomes dizzy, pale, and diaphoretic. Her BP is 84/50 mm Hg. What is
the nurse's first action?
A. Obtain a 12-lead ECG before changing her position.
B. Turn the client onto her left side.
C. Place the client in a high Fowler's position.
D. Place the client in Trendelenburg position.
Answer: B
Rationale: The gravid uterus compresses the inferior vena cava and
aorta in the supine position, decreasing venous return and cardiac output
(supine hypotensive syndrome). A left lateral position relieves the
compression; reassess vital signs and fetal status afterward.
8. At approximately what gestational age should the nurse expect to
palpate the fundus at the level of the umbilicus?
A. 28 weeks
B. 12 weeks
C. 36 weeks
D. 20 weeks
Answer: D
Rationale: At 12 weeks the fundus is just above the symphysis pubis; at
20 weeks it is at the umbilicus; at 36 weeks it reaches the xiphoid process.
From 20 to 32 weeks, fundal height in centimeters roughly equals the
weeks of gestation (plus or minus 2).
NUR 254 Exams | Page 3
, 9. A primigravida asks when she should first feel the fetus move
(quickening). Which response is accurate?
A. "Between 10 and 12 weeks."
B. "Between 18 and 20 weeks."
C. "Between 24 and 28 weeks."
D. "Between 8 and 10 weeks."
Answer: B
Rationale: Quickening is usually felt at 18 to 20 weeks in a first
pregnancy and as early as 16 weeks in women who have been pregnant
before.
10. A client at 8 weeks gestation reports morning nausea. Which
instruction is most appropriate?
A. Drink large amounts of fluid with each meal.
B. Lie flat right after eating to rest the stomach.
C. Eat dry crackers or toast before getting out of bed, and eat small,
frequent meals.
D. Eat three large, high-fat meals each day.
Answer: C
Rationale: Nausea is common in the first trimester (hCG, hormonal
changes). Dry carbohydrates before rising, small frequent meals,
separating fluids from solids, avoiding greasy or spicy foods, ginger, and
vitamin B6 can help. Large meals, fatty foods, and lying flat after eating
worsen symptoms.
11. Which symptoms should a pregnant client be taught to report to
the provider immediately? Select all that apply.
A. Vaginal bleeding
B. Occasional painless tightening of the abdomen
C. A noticeable decrease in fetal movement
D. A sudden gush of fluid from the vagina
E. Severe headache with blurred vision
F. Mild ankle swelling that resolves overnight
Answer: A, C, D, E
Rationale: Bleeding (previa, abruption), leaking fluid (rupture of
membranes), severe headache with visual changes (preeclampsia), and
decreased fetal movement (fetal compromise) are danger signs. Mild
dependent edema and occasional painless Braxton Hicks contractions
are common expected findings.
NUR 254 Exams | Page 4
Maternal and Pediatric Nursing
Exams 1-4
Questions with Answers|Latest
Galen College of Nursing
EXAM 1:
1. A client's last menstrual period began on October 12. Using
Nägele's rule, what is her estimated date of delivery (EDD)?
A. July 19
B. July 5
C. August 2
D. July 12
Answer: A
Rationale: Nägele's rule: take the first day of the last menstrual period,
add 7 days, and subtract 3 months (or add 9 months). October 12 + 7
days = October 19; minus 3 months = July 19 of the following year.
2. A client is pregnant for the third time. Her first child was born at 39
weeks and her second child was born at 35 weeks. Both children are
living. What is her GTPAL?
A. G2 T1 P1 A0 L2
B. G3 T1 P0 A1 L2
C. G3 T2 P0 A0 L2
D. G3 T1 P1 A0 L2
Answer: D
Rationale: Gravida counts all pregnancies, including the current one (3).
A birth at 37 weeks or later is a term birth (T = 1); a birth from 20 to 36 6/7
weeks is a preterm birth (P = 1). She has had no abortions or
miscarriages (A = 0) and has two living children (L = 2).
NUR 254 Exams | Page 1
,3. Which finding is a positive (diagnostic) sign of pregnancy?
A. Chadwick sign (bluish discoloration of the cervix)
B. Amenorrhea
C. Fetal heart tones detected with a Doppler device
D. A positive home urine pregnancy test
Answer: C
Rationale: Positive signs can be caused only by a fetus: fetal heartbeat
(Doppler at about 10 to 12 weeks), fetal movement palpated by the
examiner, and ultrasound visualization of the fetus. Chadwick sign and a
positive hCG test are probable signs (other conditions can mimic them);
amenorrhea is a presumptive sign.
4. A nurse teaches a woman who is planning a pregnancy about folic
acid. Which statement is accurate?
A. "Folic acid prevents preterm labor."
B. "Folic acid helps prevent neural tube defects and should be started
before conception."
C. "Folic acid prevents Down syndrome if it is started in the third
trimester."
D. "Folic acid should be started only after the first prenatal visit."
Answer: B
Rationale: At least 400 mcg of folic acid daily is recommended for all
women who could become pregnant. The neural tube closes by about day
28 after conception, often before a woman knows she is pregnant.
Women with a prior neural tube defect need a higher dose (4 mg) as
prescribed.
5. A pregnant client with a normal pre-pregnancy BMI asks how much
weight she should gain during pregnancy. Which response is correct?
A. "About 35 to 45 pounds (16 to 20.5 kg)."
B. "About 10 to 15 pounds (4.5 to 7 kg)."
C. "About 25 to 35 pounds (11.5 to 16 kg)."
D. "About 15 to 25 pounds (7 to 11.5 kg)."
Answer: C
Rationale: Institute of Medicine guidelines: underweight 28 to 40 lb,
normal weight 25 to 35 lb, overweight 15 to 25 lb, obese 11 to 20 lb.
Typical pattern: 1 to 4.5 lb in the first trimester, then about 1 lb per week.
NUR 254 Exams | Page 2
,6. A client at 28 weeks gestation has a hemoglobin of 11.2 g/dL and a
hematocrit of 33%. She asks why her values are lower than before
pregnancy. Which explanation is best?
A. "Your baby is taking all of your iron, so you have anemia."
B. "Red blood cell production stops during the second trimester."
C. "Your total blood volume decreases to make room for the uterus."
D. "Your plasma volume increases more than your red blood cell mass,
which dilutes your blood."
Answer: D
Rationale: Plasma volume rises about 40% to 50% while red cell mass
rises only 20% to 30%, causing hemodilution (physiologic anemia of
pregnancy). Anemia is diagnosed when hemoglobin is below 11 g/dL in
the first and third trimesters or below 10.5 g/dL in the second trimester.
7. A client at 34 weeks gestation lies supine for fetal monitoring and
becomes dizzy, pale, and diaphoretic. Her BP is 84/50 mm Hg. What is
the nurse's first action?
A. Obtain a 12-lead ECG before changing her position.
B. Turn the client onto her left side.
C. Place the client in a high Fowler's position.
D. Place the client in Trendelenburg position.
Answer: B
Rationale: The gravid uterus compresses the inferior vena cava and
aorta in the supine position, decreasing venous return and cardiac output
(supine hypotensive syndrome). A left lateral position relieves the
compression; reassess vital signs and fetal status afterward.
8. At approximately what gestational age should the nurse expect to
palpate the fundus at the level of the umbilicus?
A. 28 weeks
B. 12 weeks
C. 36 weeks
D. 20 weeks
Answer: D
Rationale: At 12 weeks the fundus is just above the symphysis pubis; at
20 weeks it is at the umbilicus; at 36 weeks it reaches the xiphoid process.
From 20 to 32 weeks, fundal height in centimeters roughly equals the
weeks of gestation (plus or minus 2).
NUR 254 Exams | Page 3
, 9. A primigravida asks when she should first feel the fetus move
(quickening). Which response is accurate?
A. "Between 10 and 12 weeks."
B. "Between 18 and 20 weeks."
C. "Between 24 and 28 weeks."
D. "Between 8 and 10 weeks."
Answer: B
Rationale: Quickening is usually felt at 18 to 20 weeks in a first
pregnancy and as early as 16 weeks in women who have been pregnant
before.
10. A client at 8 weeks gestation reports morning nausea. Which
instruction is most appropriate?
A. Drink large amounts of fluid with each meal.
B. Lie flat right after eating to rest the stomach.
C. Eat dry crackers or toast before getting out of bed, and eat small,
frequent meals.
D. Eat three large, high-fat meals each day.
Answer: C
Rationale: Nausea is common in the first trimester (hCG, hormonal
changes). Dry carbohydrates before rising, small frequent meals,
separating fluids from solids, avoiding greasy or spicy foods, ginger, and
vitamin B6 can help. Large meals, fatty foods, and lying flat after eating
worsen symptoms.
11. Which symptoms should a pregnant client be taught to report to
the provider immediately? Select all that apply.
A. Vaginal bleeding
B. Occasional painless tightening of the abdomen
C. A noticeable decrease in fetal movement
D. A sudden gush of fluid from the vagina
E. Severe headache with blurred vision
F. Mild ankle swelling that resolves overnight
Answer: A, C, D, E
Rationale: Bleeding (previa, abruption), leaking fluid (rupture of
membranes), severe headache with visual changes (preeclampsia), and
decreased fetal movement (fetal compromise) are danger signs. Mild
dependent edema and occasional painless Braxton Hicks contractions
are common expected findings.
NUR 254 Exams | Page 4
