NUR 254 Exam 1 Review Questions & Answers
Galen College of Nursing | Updated 2025-2026
Complete 150-Question Bank with Detailed Rationales
Section 1: Antepartum Nursing & Prenatal Care (Questions 1-40)
Question 1: A client at 12 weeks gestation reports frequent urination. The nurse explains this is most
likely due to:
A) Urinary tract infection
B) Pressure of the enlarging uterus on the bladder
C) Increased fluid intake
D) Gestational diabetes
Answer: B) Pressure of the enlarging uterus on the bladder
Rationale: During the first trimester, the enlarging uterus presses on the bladder, causing increased
urinary frequency. This is a normal adaptation of pregnancy. UTI would present with burning or
dysuria; increased fluid intake and GDM are not the primary causes at this gestational age.
Question 2: A pregnant client's fundal height is measured at 24 cm at 24 weeks gestation. This finding
indicates:
A) Fetal growth restriction
B) Appropriate for gestational age
C) Macrosomia
D) Polyhydramnios
Answer: B) Appropriate for gestational age
Rationale: Fundal height in centimeters corresponds to weeks of gestation from 20-34 weeks. 24 cm at
24 weeks is appropriate for gestational age. Significant deviations may indicate growth restriction or
macrosomia.
Question 3: A client at 36 weeks gestation reports her first episode of painless vaginal bleeding. The
nurse should suspect:
,A) Placenta previa
B) Abruptio placentae
C) Normal bloody show
D) Cervical insufficiency
Answer: A) Placenta previa
Rationale: Painless vaginal bleeding in the third trimester is characteristic of placenta previa. Abruptio
placentae typically presents with painful bleeding. Bloody show is usually associated with labor onset
and contains mucus.
Question 4: A client at 34 weeks gestation reports a sudden onset of severe abdominal pain with a
"board-like" abdomen. There is no vaginal bleeding. The most likely diagnosis is:
A) Placenta previa
B) Abruptio placentae
C) Ruptured uterus
D) Appendicitis
Answer: B) Abruptio placentae
Rationale: Sudden severe abdominal pain with a "board-like" abdomen (uterine rigidity) is
characteristic of abruptio placentae (placental abruption). While vaginal bleeding may be present, it
can be concealed (no external bleeding). This is a medical emergency requiring immediate
intervention.
Question 5: A client at 28 weeks gestation has a positive 1-hour glucose challenge test result of 155
mg/dL. The nurse anticipates the next step will be:
A) Diagnosis of gestational diabetes
B) 3-hour oral glucose tolerance test
C) Repeat 1-hour glucose challenge test
D) Initiation of insulin therapy
Answer: B) 3-hour oral glucose tolerance test
Rationale: A positive 1-hour GCT (≥130-140 mg/dL depending on facility) requires a 3-hour OGTT for
definitive diagnosis of GDM. A diagnosis is not made from the screening test alone.
Question 6: A client with gestational diabetes asks about the risks to her baby. The nurse should
include:
,A) Neonatal hyperglycemia
B) Macrosomia (large baby)
C) Postmaturity syndrome
D) Respiratory alkalosis
Answer: B) Macrosomia (large baby)
Rationale: GDM increases risk of fetal macrosomia, neonatal hypoglycemia, and shoulder dystocia. The
fetus produces excess insulin in response to maternal hyperglycemia, leading to accelerated growth.
Question 7: The nurse is administering RhoGAM to a client at 28 weeks gestation. This requires the
client to be:
A) Rh-positive
B) Rh-negative
C) AB-positive
D) AB-negative
Answer: B) Rh-negative
Rationale: RhoGAM protects against Rh sensitization and is given to Rh-negative mothers who have
not been sensitized. It is not given to Rh-positive mothers.
Question 8: A client who is Rh-negative gives birth to an Rh-positive infant. The nurse should
administer RhoGAM within:
A) 24 hours
B) 72 hours
C) 1 week
D) 2 weeks
Answer: B) 72 hours
Rationale: RhoGAM should be given within 72 hours of delivery to prevent Rh sensitization. The dose
is 300 mcg IM.
Question 9: At 36 weeks gestation, the nurse assesses the client's cervix as 2 cm dilated, 50% effaced,
and the fetal head at -2 station. This indicates:
A) Early labor
B) Impending delivery
, C) Normal term findings
D) Preterm labor
Answer: C) Normal term findings
Rationale: These findings are common in the late third trimester and do not indicate active labor
unless accompanied by regular contractions and progressive cervical change.
Question 10: A client with a history of preterm birth is receiving progesterone injections. This
treatment is intended to:
A) Induce labor
B) Reduce risk of recurrent preterm birth
C) Treat gestational diabetes
D) Prevent preeclampsia
Answer: B) Reduce risk of recurrent preterm birth
Rationale: Progesterone supplementation (17-hydroxyprogesterone caproate, Makena) is indicated for
women with a prior spontaneous preterm birth to reduce recurrence risk.
Question 11: The nurse is auscultating fetal heart tones at 12 weeks gestation. Where should the nurse
place the Doppler device?
A) Above the umbilicus
B) In the suprapubic area
C) At the maternal right upper quadrant
D) Over the maternal aorta
Answer: B) In the suprapubic area
Rationale: At 12 weeks, the fundus is just above the pubic symphysis, so fetal heart tones are heard in
the suprapubic area. Later in pregnancy, the location varies based on fetal position.
Question 12: A client at 32 weeks gestation reports a sudden gush of fluid from her vagina. The nurse
should assess the fluid for:
A) Blue color on nitrazine paper (pH >6.5)
B) Yellow color
C) Foul odor
D) Thick consistency
Galen College of Nursing | Updated 2025-2026
Complete 150-Question Bank with Detailed Rationales
Section 1: Antepartum Nursing & Prenatal Care (Questions 1-40)
Question 1: A client at 12 weeks gestation reports frequent urination. The nurse explains this is most
likely due to:
A) Urinary tract infection
B) Pressure of the enlarging uterus on the bladder
C) Increased fluid intake
D) Gestational diabetes
Answer: B) Pressure of the enlarging uterus on the bladder
Rationale: During the first trimester, the enlarging uterus presses on the bladder, causing increased
urinary frequency. This is a normal adaptation of pregnancy. UTI would present with burning or
dysuria; increased fluid intake and GDM are not the primary causes at this gestational age.
Question 2: A pregnant client's fundal height is measured at 24 cm at 24 weeks gestation. This finding
indicates:
A) Fetal growth restriction
B) Appropriate for gestational age
C) Macrosomia
D) Polyhydramnios
Answer: B) Appropriate for gestational age
Rationale: Fundal height in centimeters corresponds to weeks of gestation from 20-34 weeks. 24 cm at
24 weeks is appropriate for gestational age. Significant deviations may indicate growth restriction or
macrosomia.
Question 3: A client at 36 weeks gestation reports her first episode of painless vaginal bleeding. The
nurse should suspect:
,A) Placenta previa
B) Abruptio placentae
C) Normal bloody show
D) Cervical insufficiency
Answer: A) Placenta previa
Rationale: Painless vaginal bleeding in the third trimester is characteristic of placenta previa. Abruptio
placentae typically presents with painful bleeding. Bloody show is usually associated with labor onset
and contains mucus.
Question 4: A client at 34 weeks gestation reports a sudden onset of severe abdominal pain with a
"board-like" abdomen. There is no vaginal bleeding. The most likely diagnosis is:
A) Placenta previa
B) Abruptio placentae
C) Ruptured uterus
D) Appendicitis
Answer: B) Abruptio placentae
Rationale: Sudden severe abdominal pain with a "board-like" abdomen (uterine rigidity) is
characteristic of abruptio placentae (placental abruption). While vaginal bleeding may be present, it
can be concealed (no external bleeding). This is a medical emergency requiring immediate
intervention.
Question 5: A client at 28 weeks gestation has a positive 1-hour glucose challenge test result of 155
mg/dL. The nurse anticipates the next step will be:
A) Diagnosis of gestational diabetes
B) 3-hour oral glucose tolerance test
C) Repeat 1-hour glucose challenge test
D) Initiation of insulin therapy
Answer: B) 3-hour oral glucose tolerance test
Rationale: A positive 1-hour GCT (≥130-140 mg/dL depending on facility) requires a 3-hour OGTT for
definitive diagnosis of GDM. A diagnosis is not made from the screening test alone.
Question 6: A client with gestational diabetes asks about the risks to her baby. The nurse should
include:
,A) Neonatal hyperglycemia
B) Macrosomia (large baby)
C) Postmaturity syndrome
D) Respiratory alkalosis
Answer: B) Macrosomia (large baby)
Rationale: GDM increases risk of fetal macrosomia, neonatal hypoglycemia, and shoulder dystocia. The
fetus produces excess insulin in response to maternal hyperglycemia, leading to accelerated growth.
Question 7: The nurse is administering RhoGAM to a client at 28 weeks gestation. This requires the
client to be:
A) Rh-positive
B) Rh-negative
C) AB-positive
D) AB-negative
Answer: B) Rh-negative
Rationale: RhoGAM protects against Rh sensitization and is given to Rh-negative mothers who have
not been sensitized. It is not given to Rh-positive mothers.
Question 8: A client who is Rh-negative gives birth to an Rh-positive infant. The nurse should
administer RhoGAM within:
A) 24 hours
B) 72 hours
C) 1 week
D) 2 weeks
Answer: B) 72 hours
Rationale: RhoGAM should be given within 72 hours of delivery to prevent Rh sensitization. The dose
is 300 mcg IM.
Question 9: At 36 weeks gestation, the nurse assesses the client's cervix as 2 cm dilated, 50% effaced,
and the fetal head at -2 station. This indicates:
A) Early labor
B) Impending delivery
, C) Normal term findings
D) Preterm labor
Answer: C) Normal term findings
Rationale: These findings are common in the late third trimester and do not indicate active labor
unless accompanied by regular contractions and progressive cervical change.
Question 10: A client with a history of preterm birth is receiving progesterone injections. This
treatment is intended to:
A) Induce labor
B) Reduce risk of recurrent preterm birth
C) Treat gestational diabetes
D) Prevent preeclampsia
Answer: B) Reduce risk of recurrent preterm birth
Rationale: Progesterone supplementation (17-hydroxyprogesterone caproate, Makena) is indicated for
women with a prior spontaneous preterm birth to reduce recurrence risk.
Question 11: The nurse is auscultating fetal heart tones at 12 weeks gestation. Where should the nurse
place the Doppler device?
A) Above the umbilicus
B) In the suprapubic area
C) At the maternal right upper quadrant
D) Over the maternal aorta
Answer: B) In the suprapubic area
Rationale: At 12 weeks, the fundus is just above the pubic symphysis, so fetal heart tones are heard in
the suprapubic area. Later in pregnancy, the location varies based on fetal position.
Question 12: A client at 32 weeks gestation reports a sudden gush of fluid from her vagina. The nurse
should assess the fluid for:
A) Blue color on nitrazine paper (pH >6.5)
B) Yellow color
C) Foul odor
D) Thick consistency
