UR 202/ NUR202 Exam 1 –
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Maternal-Newborn Nursing Guide
ACTUAL EXAM 2026/2027 |
Maternal-Newborn Nursing Guide |
Verified Q&A | Pass Guaranteed - A+
Graded
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PART A – MULTIPLE CHOICE (Q1–60)
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Q1 (Reproductive anatomy – menstrual cycle): A 24-year-old patient asks the nurse when she is
most likely to conceive during her menstrual cycle. The nurse explains that ovulation typically
occurs how many days before the next menstrual period?
A. 7 days
B. 14 days
C. 21 days
D. 28 days
[CORRECT] B
Rationale: Ovulation typically occurs approximately 14 days before the onset of the next
menstrual period in a regular cycle, regardless of cycle length, as the luteal phase remains
relatively constant. Option A (7 days) is incorrect because this is too early and would place
ovulation in the early follicular phase when estrogen levels are still rising. Option C (21 days)
and D (28 days) are incorrect because these timeframes would place ovulation after the luteal
phase has already ended or at the start of a new cycle. Clinical pearl: Teach patients that the
fertile window spans approximately 5 days before ovulation through the day of ovulation itself.
Q2 (Reproductive anatomy – hormones): Which hormone is primarily responsible for the
development and maintenance of the endometrial lining during the secretory phase of the
menstrual cycle?
A. Follicle-stimulating hormone (FSH)
B. Luteinizing hormone (LH)
C. Estrogen
D. Progesterone
,[CORRECT] D
Rationale: Progesterone, secreted by the corpus luteum after ovulation, is the dominant
hormone during the secretory phase and transforms the endometrium into a secretory lining
receptive to implantation. Option A (FSH) is incorrect because FSH stimulates follicular
development in the follicular phase, not endometrial maintenance. Option B (LH) is incorrect
because LH triggers ovulation and supports the corpus luteum but does not directly maintain the
endometrium. Option C (Estrogen) is incorrect because while estrogen proliferates the
endometrium during the follicular phase, progesterone dominates the secretory phase. Clinical
pearl: Low progesterone in early pregnancy can lead to luteal phase defect and increased
miscarriage risk.
Q3 (Fertilization and implantation): Following fertilization, the zygote undergoes cleavage and
becomes a blastocyst. Implantation into the endometrium typically occurs approximately how
many days after fertilization?
A. 3–4 days
B. 6–7 days
C. 10–12 days
D. 14–16 days
[CORRECT] B
Rationale: Implantation of the blastocyst into the endometrium typically occurs 6–7 days after
fertilization, allowing time for the zygote to travel through the fallopian tube and develop into a
blastocyst capable of invasion. Option A (3–4 days) is incorrect because the embryo is still in
the morula stage and has not yet reached the uterine cavity. Option C (10–12 days) and D
(14–16 days) are incorrect because implantation would be delayed beyond the receptive
window of the endometrium, leading to pregnancy failure. Clinical pearl: hCG secretion begins
after implantation, which is why home pregnancy tests are most reliable after a missed period.
Q4 (Placental development): The nurse is reviewing placental anatomy with a patient. Which
structure represents the maternal portion of the placenta?
A. Chorionic villi
B. Decidua basalis
C. Amnion
D. Umbilical cord
[CORRECT] B
Rationale: The decidua basalis is the maternal portion of the placenta, formed from the
endometrial lining at the site of implantation, while the chorionic villi represent the fetal
contribution. Option A (Chorionic villi) is incorrect because these are fetal projections that
contain fetal blood vessels and interface with maternal blood in the intervillous spaces. Option C
(Amnion) is incorrect because it is the inner fetal membrane surrounding the amniotic cavity, not
part of the placental disc. Option D (Umbilical cord) is incorrect because it is a fetal structure
connecting the fetus to the placenta. Clinical pearl: The decidua basalis and chorionic villi
together form the placental barrier, which becomes thinner as pregnancy progresses to facilitate
nutrient exchange.
Q5 (Preconception health – folic acid): A nurse is counseling a 28-year-old woman planning
pregnancy. What is the recommended daily dose of folic acid to begin at least one month before
conception?
, . 100 mcg
A
B. 400–800 mcg
C. 1,000 mcg
D. 4,000 mcg
[CORRECT] B
Rationale: ACOG and the CDC recommend that all women of childbearing age consume
400–800 mcg of folic acid daily beginning at least one month before conception to reduce the
risk of neural tube defects by up to 70%. Option A (100 mcg) is incorrect because this dose is
insufficient to provide adequate neural tube protection. Option C (1,000 mcg) is incorrect
because while safe, it exceeds the standard preventive recommendation for low-risk women.
Option D (4,000 mcg) is incorrect because this high dose is reserved for women with a previous
pregnancy affected by a neural tube defect and requires medical supervision. Clinical pearl:
Fortify your teaching by emphasizing that folic acid is most critical during the first 28 days after
conception, often before a woman knows she is pregnant.
Q6 (Preconception health – rubella immunity): A 30-year-old woman's preconception labs reveal
she is non-immune to rubella. What is the most appropriate nursing action?
A. Administer the rubella vaccine immediately and advise her to attempt conception in 2 weeks
B. Administer the rubella vaccine and advise her to avoid pregnancy for at least 1 month
C. Advise her that rubella immunity is not necessary if she receives prenatal care
D. Recommend varicella vaccine instead since rubella is no longer a concern
[CORRECT] B
Rationale: CDC and ACOG guidelines recommend administering the MMR vaccine to
non-immune women before conception and advising avoidance of pregnancy for at least 28
days (1 month) due to the theoretical risk of live vaccine virus affecting the fetus. Option A is
incorrect because 2 weeks is insufficient time to ensure vaccine safety before conception.
Option C is incorrect because rubella infection during pregnancy, especially in the first trimester,
causes congenital rubella syndrome with severe fetal anomalies. Option D is incorrect because
varicella vaccination is a separate recommendation and does not replace rubella immunity.
Clinical pearl: Document rubella immunity status in every preconception visit; if titers are
equivocal, revaccination is safer than risking infection during pregnancy.
Q7 (Preconception health – teratogens): A patient taking lisinopril for hypertension asks about
pregnancy planning. What is the nurse's best response?
A. "Lisinopril is safe to continue during pregnancy with dose adjustment."
B. "You should switch to an ACE inhibitor that is specifically approved for pregnancy."
C. "Lisinopril is contraindicated in pregnancy; you must switch to a safer antihypertensive before
conception."
D. "You can continue lisinopril through the first trimester and then discontinue it."
[CORRECT] C
Rationale: ACE inhibitors such as lisinopril are FDA Category D/X and are contraindicated in
pregnancy due to risk of fetal renal agenesis, oligohydramnios, and skull hypoplasia, especially
after the first trimester. Option A is incorrect because no dose adjustment makes ACE inhibitors
safe in pregnancy. Option B is incorrect because no ACE inhibitor is approved for use during
pregnancy. Option D is incorrect because while first-trimester exposure carries lower risk than
second/third trimester, the safest approach is to switch before conception to agents like labetalol
, r nifedipine. Clinical pearl: Always review medication lists for teratogenic potential during
o
preconception counseling and coordinate with the provider for safe alternatives.
Q8 (Prenatal care – initial visit): During the initial prenatal visit, which laboratory test is routinely
performed to identify women at risk for hemolytic disease of the newborn?
A. Complete blood count (CBC)
B. Blood type and Rh factor
C. Rubella titer
D. HIV antibody test
[CORRECT] B
Rationale: Blood type and Rh factor testing is essential at the initial prenatal visit to identify
Rh-negative women who may require Rho(D) immune globulin (RhoGAM) at 28 weeks and
postpartum to prevent alloimmunization and hemolytic disease of the newborn. Option A (CBC)
is incorrect because while it screens for anemia, it does not identify Rh incompatibility risk.
Option C (Rubella titer) is incorrect because it assesses immunity to rubella, not hemolytic
disease risk. Option D (HIV test) is incorrect because it screens for perinatal HIV transmission
risk, not hemolytic disease. Clinical pearl: If the patient is Rh-negative and the father is
Rh-positive or unknown, antibody screening (indirect Coombs) is also performed to detect prior
sensitization.
Q9 (Prenatal care – visit schedule): A patient at her initial prenatal visit at 8 weeks gestation
asks about the frequency of future visits. According to ACOG guidelines, which schedule is
correct?
A. Every 2 weeks until 28 weeks, then weekly
B. Every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, then weekly
C. Every 4 weeks until 32 weeks, then every 2 weeks until 38 weeks, then weekly
D. Every month throughout the entire pregnancy
[CORRECT] B
Rationale: ACOG recommends prenatal visits every 4 weeks until 28 weeks gestation, every 2
weeks from 28 to 36 weeks, and weekly from 36 weeks until delivery for uncomplicated
pregnancies. Option A is incorrect because every 2 weeks until 28 weeks is excessive for
low-risk patients and not guideline-concordant. Option C is incorrect because it delays the
increase in visit frequency, potentially missing late-pregnancy complications. Option D is
incorrect because monthly visits throughout pregnancy are insufficient for monitoring
third-trimester fetal well-being and maternal status. Clinical pearl: High-risk pregnancies (e.g.,
gestational diabetes, hypertension) require more frequent visits individualized to the condition.
Q10 (Prenatal assessment – fundal height): At a routine prenatal visit at 28 weeks gestation, the
nurse measures the fundal height. What measurement would be considered within normal
limits?
A. 20 cm
B. 24 cm
C. 28 cm
D. 32 cm
[CORRECT] C
Rationale: After 20 weeks gestation, fundal height in centimeters should approximately equal
gestational age in weeks (±2 cm), so at 28 weeks, 28 cm is expected. Option A (20 cm) is
N
Maternal-Newborn Nursing Guide
ACTUAL EXAM 2026/2027 |
Maternal-Newborn Nursing Guide |
Verified Q&A | Pass Guaranteed - A+
Graded
=======================================================================
=
========
PART A – MULTIPLE CHOICE (Q1–60)
========================================================================
========
Q1 (Reproductive anatomy – menstrual cycle): A 24-year-old patient asks the nurse when she is
most likely to conceive during her menstrual cycle. The nurse explains that ovulation typically
occurs how many days before the next menstrual period?
A. 7 days
B. 14 days
C. 21 days
D. 28 days
[CORRECT] B
Rationale: Ovulation typically occurs approximately 14 days before the onset of the next
menstrual period in a regular cycle, regardless of cycle length, as the luteal phase remains
relatively constant. Option A (7 days) is incorrect because this is too early and would place
ovulation in the early follicular phase when estrogen levels are still rising. Option C (21 days)
and D (28 days) are incorrect because these timeframes would place ovulation after the luteal
phase has already ended or at the start of a new cycle. Clinical pearl: Teach patients that the
fertile window spans approximately 5 days before ovulation through the day of ovulation itself.
Q2 (Reproductive anatomy – hormones): Which hormone is primarily responsible for the
development and maintenance of the endometrial lining during the secretory phase of the
menstrual cycle?
A. Follicle-stimulating hormone (FSH)
B. Luteinizing hormone (LH)
C. Estrogen
D. Progesterone
,[CORRECT] D
Rationale: Progesterone, secreted by the corpus luteum after ovulation, is the dominant
hormone during the secretory phase and transforms the endometrium into a secretory lining
receptive to implantation. Option A (FSH) is incorrect because FSH stimulates follicular
development in the follicular phase, not endometrial maintenance. Option B (LH) is incorrect
because LH triggers ovulation and supports the corpus luteum but does not directly maintain the
endometrium. Option C (Estrogen) is incorrect because while estrogen proliferates the
endometrium during the follicular phase, progesterone dominates the secretory phase. Clinical
pearl: Low progesterone in early pregnancy can lead to luteal phase defect and increased
miscarriage risk.
Q3 (Fertilization and implantation): Following fertilization, the zygote undergoes cleavage and
becomes a blastocyst. Implantation into the endometrium typically occurs approximately how
many days after fertilization?
A. 3–4 days
B. 6–7 days
C. 10–12 days
D. 14–16 days
[CORRECT] B
Rationale: Implantation of the blastocyst into the endometrium typically occurs 6–7 days after
fertilization, allowing time for the zygote to travel through the fallopian tube and develop into a
blastocyst capable of invasion. Option A (3–4 days) is incorrect because the embryo is still in
the morula stage and has not yet reached the uterine cavity. Option C (10–12 days) and D
(14–16 days) are incorrect because implantation would be delayed beyond the receptive
window of the endometrium, leading to pregnancy failure. Clinical pearl: hCG secretion begins
after implantation, which is why home pregnancy tests are most reliable after a missed period.
Q4 (Placental development): The nurse is reviewing placental anatomy with a patient. Which
structure represents the maternal portion of the placenta?
A. Chorionic villi
B. Decidua basalis
C. Amnion
D. Umbilical cord
[CORRECT] B
Rationale: The decidua basalis is the maternal portion of the placenta, formed from the
endometrial lining at the site of implantation, while the chorionic villi represent the fetal
contribution. Option A (Chorionic villi) is incorrect because these are fetal projections that
contain fetal blood vessels and interface with maternal blood in the intervillous spaces. Option C
(Amnion) is incorrect because it is the inner fetal membrane surrounding the amniotic cavity, not
part of the placental disc. Option D (Umbilical cord) is incorrect because it is a fetal structure
connecting the fetus to the placenta. Clinical pearl: The decidua basalis and chorionic villi
together form the placental barrier, which becomes thinner as pregnancy progresses to facilitate
nutrient exchange.
Q5 (Preconception health – folic acid): A nurse is counseling a 28-year-old woman planning
pregnancy. What is the recommended daily dose of folic acid to begin at least one month before
conception?
, . 100 mcg
A
B. 400–800 mcg
C. 1,000 mcg
D. 4,000 mcg
[CORRECT] B
Rationale: ACOG and the CDC recommend that all women of childbearing age consume
400–800 mcg of folic acid daily beginning at least one month before conception to reduce the
risk of neural tube defects by up to 70%. Option A (100 mcg) is incorrect because this dose is
insufficient to provide adequate neural tube protection. Option C (1,000 mcg) is incorrect
because while safe, it exceeds the standard preventive recommendation for low-risk women.
Option D (4,000 mcg) is incorrect because this high dose is reserved for women with a previous
pregnancy affected by a neural tube defect and requires medical supervision. Clinical pearl:
Fortify your teaching by emphasizing that folic acid is most critical during the first 28 days after
conception, often before a woman knows she is pregnant.
Q6 (Preconception health – rubella immunity): A 30-year-old woman's preconception labs reveal
she is non-immune to rubella. What is the most appropriate nursing action?
A. Administer the rubella vaccine immediately and advise her to attempt conception in 2 weeks
B. Administer the rubella vaccine and advise her to avoid pregnancy for at least 1 month
C. Advise her that rubella immunity is not necessary if she receives prenatal care
D. Recommend varicella vaccine instead since rubella is no longer a concern
[CORRECT] B
Rationale: CDC and ACOG guidelines recommend administering the MMR vaccine to
non-immune women before conception and advising avoidance of pregnancy for at least 28
days (1 month) due to the theoretical risk of live vaccine virus affecting the fetus. Option A is
incorrect because 2 weeks is insufficient time to ensure vaccine safety before conception.
Option C is incorrect because rubella infection during pregnancy, especially in the first trimester,
causes congenital rubella syndrome with severe fetal anomalies. Option D is incorrect because
varicella vaccination is a separate recommendation and does not replace rubella immunity.
Clinical pearl: Document rubella immunity status in every preconception visit; if titers are
equivocal, revaccination is safer than risking infection during pregnancy.
Q7 (Preconception health – teratogens): A patient taking lisinopril for hypertension asks about
pregnancy planning. What is the nurse's best response?
A. "Lisinopril is safe to continue during pregnancy with dose adjustment."
B. "You should switch to an ACE inhibitor that is specifically approved for pregnancy."
C. "Lisinopril is contraindicated in pregnancy; you must switch to a safer antihypertensive before
conception."
D. "You can continue lisinopril through the first trimester and then discontinue it."
[CORRECT] C
Rationale: ACE inhibitors such as lisinopril are FDA Category D/X and are contraindicated in
pregnancy due to risk of fetal renal agenesis, oligohydramnios, and skull hypoplasia, especially
after the first trimester. Option A is incorrect because no dose adjustment makes ACE inhibitors
safe in pregnancy. Option B is incorrect because no ACE inhibitor is approved for use during
pregnancy. Option D is incorrect because while first-trimester exposure carries lower risk than
second/third trimester, the safest approach is to switch before conception to agents like labetalol
, r nifedipine. Clinical pearl: Always review medication lists for teratogenic potential during
o
preconception counseling and coordinate with the provider for safe alternatives.
Q8 (Prenatal care – initial visit): During the initial prenatal visit, which laboratory test is routinely
performed to identify women at risk for hemolytic disease of the newborn?
A. Complete blood count (CBC)
B. Blood type and Rh factor
C. Rubella titer
D. HIV antibody test
[CORRECT] B
Rationale: Blood type and Rh factor testing is essential at the initial prenatal visit to identify
Rh-negative women who may require Rho(D) immune globulin (RhoGAM) at 28 weeks and
postpartum to prevent alloimmunization and hemolytic disease of the newborn. Option A (CBC)
is incorrect because while it screens for anemia, it does not identify Rh incompatibility risk.
Option C (Rubella titer) is incorrect because it assesses immunity to rubella, not hemolytic
disease risk. Option D (HIV test) is incorrect because it screens for perinatal HIV transmission
risk, not hemolytic disease. Clinical pearl: If the patient is Rh-negative and the father is
Rh-positive or unknown, antibody screening (indirect Coombs) is also performed to detect prior
sensitization.
Q9 (Prenatal care – visit schedule): A patient at her initial prenatal visit at 8 weeks gestation
asks about the frequency of future visits. According to ACOG guidelines, which schedule is
correct?
A. Every 2 weeks until 28 weeks, then weekly
B. Every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, then weekly
C. Every 4 weeks until 32 weeks, then every 2 weeks until 38 weeks, then weekly
D. Every month throughout the entire pregnancy
[CORRECT] B
Rationale: ACOG recommends prenatal visits every 4 weeks until 28 weeks gestation, every 2
weeks from 28 to 36 weeks, and weekly from 36 weeks until delivery for uncomplicated
pregnancies. Option A is incorrect because every 2 weeks until 28 weeks is excessive for
low-risk patients and not guideline-concordant. Option C is incorrect because it delays the
increase in visit frequency, potentially missing late-pregnancy complications. Option D is
incorrect because monthly visits throughout pregnancy are insufficient for monitoring
third-trimester fetal well-being and maternal status. Clinical pearl: High-risk pregnancies (e.g.,
gestational diabetes, hypertension) require more frequent visits individualized to the condition.
Q10 (Prenatal assessment – fundal height): At a routine prenatal visit at 28 weeks gestation, the
nurse measures the fundal height. What measurement would be considered within normal
limits?
A. 20 cm
B. 24 cm
C. 28 cm
D. 32 cm
[CORRECT] C
Rationale: After 20 weeks gestation, fundal height in centimeters should approximately equal
gestational age in weeks (±2 cm), so at 28 weeks, 28 cm is expected. Option A (20 cm) is
