NSG 3500 Final Exam – Maternal Health 2026/2027 |
Galen College of Nursing | Actual Questions & Detailed
Rationales
SECTION I — ANTEPARTUM CARE, PRECONCEPTION & NORMAL PREGNANCY
1. A client reports that her last menstrual period began on March 10. Using
Nägele's rule, which estimated date of delivery should the nurse calculate?
A. December 3
B. December 17
C. January 17
D. January 3
Answer: B. December 17
Rationale: Nägele's rule adds 7 days to the first day of the LMP, subtracts 3
months, and adds 1 year. March 10 becomes March 17, then December 17 after
subtracting three months.
2. Which finding is considered a positive sign of pregnancy?
A. Amenorrhea
B. Positive urine pregnancy test
C. Fetal heart activity detected by ultrasound
D. Breast tenderness
Answer: C. Fetal heart activity detected by ultrasound
Rationale: Positive signs are findings that can only be attributed to a fetus, such
as fetal heart activity, fetal movement palpated by an examiner, or visualization
of the fetus by ultrasound. Amenorrhea and breast changes are presumptive
signs, while a positive pregnancy test is a probable sign.
,3. Human chorionic gonadotropin (hCG) is primarily produced by which
structure during early pregnancy?
A. Corpus luteum
B. Trophoblastic tissue
C. Anterior pituitary
D. Hypothalamus
Answer: B. Trophoblastic tissue
Rationale: hCG is produced by trophoblastic cells after implantation and supports
the corpus luteum during early pregnancy. hCG is also the hormone detected by
most pregnancy tests.
4. Which finding is classified as a presumptive sign of pregnancy?
A. Fetal heart rate
B. Visualization of the fetus
C. Amenorrhea
D. Fetal movement palpated by the examiner
Answer: C. Amenorrhea
Rationale: Presumptive signs are subjective changes experienced by the client,
including amenorrhea, nausea, fatigue, breast tenderness, and quickening. They
do not independently establish pregnancy.
5. A pregnant client asks when she is most likely to feel fetal movement for the
first time. Which response is appropriate?
A. 4–8 weeks
B. 8–12 weeks
C. 16–20 weeks
D. 28–32 weeks
Answer: C. 16–20 weeks
,Rationale: Quickening commonly occurs around 16–20 weeks. Clients
experiencing their first pregnancy may notice movement somewhat later than
clients who have been pregnant previously.
6. At approximately 20 weeks' gestation, where should the nurse expect to
palpate the uterine fundus?
A. At the symphysis pubis
B. Halfway between the symphysis and umbilicus
C. At the level of the umbilicus
D. At the xiphoid process
Answer: C. At the level of the umbilicus
Rationale: Around 20 weeks, the fundus is generally at the level of the umbilicus.
After 20 weeks, fundal height in centimeters approximately corresponds to
gestational age, usually within about 2 cm.
7. Which cardiovascular change is expected during a normal pregnancy?
A. Decreased cardiac output
B. Increased cardiac output
C. Severe systemic vasoconstriction
D. Decreased plasma volume
Answer: B. Increased cardiac output
Rationale: Cardiac output increases during pregnancy to meet maternal and fetal
metabolic demands. Plasma volume also increases substantially, producing
physiologic cardiovascular adaptations.
8. A pregnant client has a lower hemoglobin concentration despite adequate
nutrition. Which explanation is most appropriate?
A. Pregnancy causes severe blood loss
B. Plasma volume increases more than red blood cell mass
, C. The fetus destroys maternal red blood cells
D. Pregnancy stops erythropoiesis
Answer: B. Plasma volume increases more than red blood cell mass
Rationale: Plasma volume expands more than red blood cell mass during
pregnancy, producing physiologic hemodilution. This is commonly called
physiologic anemia of pregnancy.
9. Which intervention is appropriate for a pregnant client experiencing
constipation?
A. Decrease fluid intake
B. Increase fiber and fluids
C. Take stimulant laxatives daily
D. Avoid physical activity
Answer: B. Increase fiber and fluids
Rationale: Progesterone slows gastrointestinal motility during pregnancy.
Adequate fluids, dietary fiber, and regular activity can help prevent constipation.
10. Which teaching should the nurse provide to a pregnant client experiencing
heartburn?
A. Eat large meals before bedtime
B. Lie flat immediately after meals
C. Eat smaller meals and remain upright after eating
D. Increase high-fat foods
Answer: C. Eat smaller meals and remain upright after eating
Rationale: Progesterone decreases lower esophageal sphincter tone, making
reflux more common. Small meals, avoiding trigger foods, and remaining upright
after eating can reduce symptoms.
Galen College of Nursing | Actual Questions & Detailed
Rationales
SECTION I — ANTEPARTUM CARE, PRECONCEPTION & NORMAL PREGNANCY
1. A client reports that her last menstrual period began on March 10. Using
Nägele's rule, which estimated date of delivery should the nurse calculate?
A. December 3
B. December 17
C. January 17
D. January 3
Answer: B. December 17
Rationale: Nägele's rule adds 7 days to the first day of the LMP, subtracts 3
months, and adds 1 year. March 10 becomes March 17, then December 17 after
subtracting three months.
2. Which finding is considered a positive sign of pregnancy?
A. Amenorrhea
B. Positive urine pregnancy test
C. Fetal heart activity detected by ultrasound
D. Breast tenderness
Answer: C. Fetal heart activity detected by ultrasound
Rationale: Positive signs are findings that can only be attributed to a fetus, such
as fetal heart activity, fetal movement palpated by an examiner, or visualization
of the fetus by ultrasound. Amenorrhea and breast changes are presumptive
signs, while a positive pregnancy test is a probable sign.
,3. Human chorionic gonadotropin (hCG) is primarily produced by which
structure during early pregnancy?
A. Corpus luteum
B. Trophoblastic tissue
C. Anterior pituitary
D. Hypothalamus
Answer: B. Trophoblastic tissue
Rationale: hCG is produced by trophoblastic cells after implantation and supports
the corpus luteum during early pregnancy. hCG is also the hormone detected by
most pregnancy tests.
4. Which finding is classified as a presumptive sign of pregnancy?
A. Fetal heart rate
B. Visualization of the fetus
C. Amenorrhea
D. Fetal movement palpated by the examiner
Answer: C. Amenorrhea
Rationale: Presumptive signs are subjective changes experienced by the client,
including amenorrhea, nausea, fatigue, breast tenderness, and quickening. They
do not independently establish pregnancy.
5. A pregnant client asks when she is most likely to feel fetal movement for the
first time. Which response is appropriate?
A. 4–8 weeks
B. 8–12 weeks
C. 16–20 weeks
D. 28–32 weeks
Answer: C. 16–20 weeks
,Rationale: Quickening commonly occurs around 16–20 weeks. Clients
experiencing their first pregnancy may notice movement somewhat later than
clients who have been pregnant previously.
6. At approximately 20 weeks' gestation, where should the nurse expect to
palpate the uterine fundus?
A. At the symphysis pubis
B. Halfway between the symphysis and umbilicus
C. At the level of the umbilicus
D. At the xiphoid process
Answer: C. At the level of the umbilicus
Rationale: Around 20 weeks, the fundus is generally at the level of the umbilicus.
After 20 weeks, fundal height in centimeters approximately corresponds to
gestational age, usually within about 2 cm.
7. Which cardiovascular change is expected during a normal pregnancy?
A. Decreased cardiac output
B. Increased cardiac output
C. Severe systemic vasoconstriction
D. Decreased plasma volume
Answer: B. Increased cardiac output
Rationale: Cardiac output increases during pregnancy to meet maternal and fetal
metabolic demands. Plasma volume also increases substantially, producing
physiologic cardiovascular adaptations.
8. A pregnant client has a lower hemoglobin concentration despite adequate
nutrition. Which explanation is most appropriate?
A. Pregnancy causes severe blood loss
B. Plasma volume increases more than red blood cell mass
, C. The fetus destroys maternal red blood cells
D. Pregnancy stops erythropoiesis
Answer: B. Plasma volume increases more than red blood cell mass
Rationale: Plasma volume expands more than red blood cell mass during
pregnancy, producing physiologic hemodilution. This is commonly called
physiologic anemia of pregnancy.
9. Which intervention is appropriate for a pregnant client experiencing
constipation?
A. Decrease fluid intake
B. Increase fiber and fluids
C. Take stimulant laxatives daily
D. Avoid physical activity
Answer: B. Increase fiber and fluids
Rationale: Progesterone slows gastrointestinal motility during pregnancy.
Adequate fluids, dietary fiber, and regular activity can help prevent constipation.
10. Which teaching should the nurse provide to a pregnant client experiencing
heartburn?
A. Eat large meals before bedtime
B. Lie flat immediately after meals
C. Eat smaller meals and remain upright after eating
D. Increase high-fat foods
Answer: C. Eat smaller meals and remain upright after eating
Rationale: Progesterone decreases lower esophageal sphincter tone, making
reflux more common. Small meals, avoiding trigger foods, and remaining upright
after eating can reduce symptoms.
