RNSG 1517 A Maternity Final Exam Predictor | Most
Frequently Tested Questions with Detailed
Rationales
Question 1
A pregnant client states that her last menstrual period began on
January 15. Using Nagele's rule, what is the estimated date of birth
(EDB)?
A. October 22
B. November 22
C. October 8
D. September 22
Correct Answer: A. October 22
Detailed Rationale: Nagele's rule calculates the estimated date of birth
by taking the first day of the last menstrual period, subtracting 3
months, and adding 7 days (plus 1 year if applicable). January 15 minus
3 months is October 15, plus 7 days equals October 22.
Question 2
Which of the following clinical findings is considered a positive
(definitive) sign of pregnancy?
A. Amenorrhea and breast tenderness
B. Goodell's sign and Chadwick's sign
,C. Visualization of the fetus via ultrasound and auscultation of fetal
heart tones
D. Positive home pregnancy urine test
Correct Answer: C. Visualization of the fetus via ultrasound and
auscultation of fetal heart tones
Detailed Rationale: Positive signs of pregnancy are objective signs that
can be attributed only to the presence of a fetus, such as ultrasound
visualization, fetal heart tones auscultated by a provider, and examiner-
verified fetal movement. Amenorrhea is a presumptive sign, and
Goodell's and Chadwick's signs are probable signs.
Question 3
A nurse is explaining physiological anemia of pregnancy to a client at 28
weeks of gestation. What is the primary physiological mechanism
responsible for this finding?
A. Decreased dietary iron intake leading to impaired red blood cell
synthesis
B. Greater increase in plasma volume relative to the increase in red
blood cell mass, resulting in hemodilution
C. Increased destruction of red blood cells by placental enzymes
D. Suppression of bone marrow activity caused by elevated
progesterone levels
Correct Answer: B. Greater increase in plasma volume relative to the
increase in red blood cell mass, resulting in hemodilution
,Detailed Rationale: During pregnancy, plasma volume increases by
approximately 40% to 50%, while red blood cell mass increases by only
20% to 30%. This disproportionate rise causes hemodilution, commonly
referred to as physiological anemia of pregnancy.
Question 4
A client at 34 weeks of gestation presents to the labor and delivery unit
reporting a severe continuous headache, blurred vision, and right upper
quadrant abdominal pain. Her blood pressure is 160/110 mm Hg and 3+
proteinuria is noted on dipstick. What condition do these findings
indicate?
A. Gestational diabetes mellitus
B. Chronic hypertension without complications
C. Preeclampsia with severe features
D. Normal physiological discomforts of late pregnancy
Correct Answer: C. Preeclampsia with severe features
Detailed Rationale: Severe features of preeclampsia include a blood
pressure of 160/110 mm Hg or higher, significant proteinuria, persistent
central nervous system symptoms (headache, blurred vision), and
hepatic capsule distention (right upper quadrant or epigastric pain).
Question 5
A client with severe preeclampsia is receiving an intravenous infusion of
magnesium sulfate. Which clinical finding indicates magnesium toxicity
requiring immediate cessation of the infusion and administration of
calcium gluconate?
, A. Blood pressure of 140/90 mm Hg
B. Urine output of 45 mL/hour
C. Loss of deep tendon reflexes (DTRs) and a respiratory rate of 10
breaths/min
D. Mild maternal lethargy and flushing
Correct Answer: C. Loss of deep tendon reflexes (DTRs) and a
respiratory rate of 10 breaths/min
Detailed Rationale: Signs of magnesium toxicity include loss of deep
tendon reflexes, central nervous system depression, respiratory
depression (< 12 breaths/min), oliguria, and cardiac arrhythmias.
Calcium gluconate is the specific reversal antidote.
Question 6
A client at 32 weeks of gestation presents with painless, bright red
vaginal bleeding. Her uterus is soft and non-tender. What condition
does the nurse suspect?
A. Abruptio placentae
B. Placenta previa
C. Uterine rupture
D. Vasa previa
Correct Answer: B. Placenta previa
Detailed Rationale: Placenta previa is characterized by painless, bright
red vaginal bleeding during the second or third trimester as the lower
uterine segment thins and the placenta implants over or near the
cervical os. Digital vaginal exams are strictly contraindicated.
Frequently Tested Questions with Detailed
Rationales
Question 1
A pregnant client states that her last menstrual period began on
January 15. Using Nagele's rule, what is the estimated date of birth
(EDB)?
A. October 22
B. November 22
C. October 8
D. September 22
Correct Answer: A. October 22
Detailed Rationale: Nagele's rule calculates the estimated date of birth
by taking the first day of the last menstrual period, subtracting 3
months, and adding 7 days (plus 1 year if applicable). January 15 minus
3 months is October 15, plus 7 days equals October 22.
Question 2
Which of the following clinical findings is considered a positive
(definitive) sign of pregnancy?
A. Amenorrhea and breast tenderness
B. Goodell's sign and Chadwick's sign
,C. Visualization of the fetus via ultrasound and auscultation of fetal
heart tones
D. Positive home pregnancy urine test
Correct Answer: C. Visualization of the fetus via ultrasound and
auscultation of fetal heart tones
Detailed Rationale: Positive signs of pregnancy are objective signs that
can be attributed only to the presence of a fetus, such as ultrasound
visualization, fetal heart tones auscultated by a provider, and examiner-
verified fetal movement. Amenorrhea is a presumptive sign, and
Goodell's and Chadwick's signs are probable signs.
Question 3
A nurse is explaining physiological anemia of pregnancy to a client at 28
weeks of gestation. What is the primary physiological mechanism
responsible for this finding?
A. Decreased dietary iron intake leading to impaired red blood cell
synthesis
B. Greater increase in plasma volume relative to the increase in red
blood cell mass, resulting in hemodilution
C. Increased destruction of red blood cells by placental enzymes
D. Suppression of bone marrow activity caused by elevated
progesterone levels
Correct Answer: B. Greater increase in plasma volume relative to the
increase in red blood cell mass, resulting in hemodilution
,Detailed Rationale: During pregnancy, plasma volume increases by
approximately 40% to 50%, while red blood cell mass increases by only
20% to 30%. This disproportionate rise causes hemodilution, commonly
referred to as physiological anemia of pregnancy.
Question 4
A client at 34 weeks of gestation presents to the labor and delivery unit
reporting a severe continuous headache, blurred vision, and right upper
quadrant abdominal pain. Her blood pressure is 160/110 mm Hg and 3+
proteinuria is noted on dipstick. What condition do these findings
indicate?
A. Gestational diabetes mellitus
B. Chronic hypertension without complications
C. Preeclampsia with severe features
D. Normal physiological discomforts of late pregnancy
Correct Answer: C. Preeclampsia with severe features
Detailed Rationale: Severe features of preeclampsia include a blood
pressure of 160/110 mm Hg or higher, significant proteinuria, persistent
central nervous system symptoms (headache, blurred vision), and
hepatic capsule distention (right upper quadrant or epigastric pain).
Question 5
A client with severe preeclampsia is receiving an intravenous infusion of
magnesium sulfate. Which clinical finding indicates magnesium toxicity
requiring immediate cessation of the infusion and administration of
calcium gluconate?
, A. Blood pressure of 140/90 mm Hg
B. Urine output of 45 mL/hour
C. Loss of deep tendon reflexes (DTRs) and a respiratory rate of 10
breaths/min
D. Mild maternal lethargy and flushing
Correct Answer: C. Loss of deep tendon reflexes (DTRs) and a
respiratory rate of 10 breaths/min
Detailed Rationale: Signs of magnesium toxicity include loss of deep
tendon reflexes, central nervous system depression, respiratory
depression (< 12 breaths/min), oliguria, and cardiac arrhythmias.
Calcium gluconate is the specific reversal antidote.
Question 6
A client at 32 weeks of gestation presents with painless, bright red
vaginal bleeding. Her uterus is soft and non-tender. What condition
does the nurse suspect?
A. Abruptio placentae
B. Placenta previa
C. Uterine rupture
D. Vasa previa
Correct Answer: B. Placenta previa
Detailed Rationale: Placenta previa is characterized by painless, bright
red vaginal bleeding during the second or third trimester as the lower
uterine segment thins and the placenta implants over or near the
cervical os. Digital vaginal exams are strictly contraindicated.
