NUR 254 MIDTERM PRACTICE EXAM: Maternal &
Pediatric Nursing - Galen College of Nursing Questions with
Correct Answers and Explanations in Italics - 135 Questions
Section 1: Antepartum Care and Complications (Questions 1-15)
1 A pregnant individual at 28 weeks gestation presents with a blood pressure of 155/95 mmHg and 2+ proteinuria
on dipstick. Which pathophysiological mechanism is most directly responsible for the proteinuria observed in
preeclampsia?
A) Increased glomerular filtration rate due to systemic vasodilation
B) Endothelial dysfunction leading to loss of glomerular basement membrane integrity
C) Tubular damage from uric acid crystal deposition
D) Reduced renal plasma flow causing ischemic injury to podocytes
Answer: B
Rationale: In preeclampsia, systemic endothelial dysfunction results in increased permeability of the glomerular
endothelium, allowing protein to leak into the urine. Option A is incorrect because preeclampsia involves
vasoconstriction, not vasodilation. Option C describes a mechanism for gout, not preeclampsia. Option D is not a
primary mechanism; podocyte injury occurs but is secondary to endothelial damage.
2 Which of the following findings in a pregnant individual at 24 weeks gestation is most consistent with a
diagnosis of gestational diabetes mellitus (GDM) based on the two-step approach?
A) Fasting plasma glucose of 100 mg/dL on routine screening
B) 1-hour glucose challenge test result of 140 mg/dL followed by a 3-hour oral glucose tolerance test (OGTT)
with two abnormal values
C) Random plasma glucose of 200 mg/dL with symptoms of polyuria and polydipsia
D) Hemoglobin A1c of 6.0% at the first prenatal visit
Answer: B
Rationale: The two-step approach for GDM diagnosis involves a 50g glucose challenge test; if the 1-hour value is
140 mg/dL, a 3-hour 100g OGTT is performed. GDM is diagnosed if at least two of the four glucose values meet or
exceed thresholds (e.g., fasting 95, 1-hour 180, 2-hour 155, 3-hour 140). Option A is a normal fasting value. Option
C suggests overt diabetes, not GDM. Option D indicates pre-existing diabetes if A1c 6.5%.
3 A pregnant individual at 32 weeks gestation presents with painless vaginal bleeding. Ultrasound reveals a
placenta previa. Which of the following interventions is contraindicated in the immediate management?
A) Administering betamethasone for fetal lung maturity
B) Performing a sterile speculum examination to assess the cervix
C) Obtaining a complete blood count and type and crossmatch
D) Initiating intravenous access and fluid resuscitation
Answer: B
Rationale: In suspected placenta previa, digital cervical examination or speculum exam is contraindicated because it
can disrupt the placenta and cause catastrophic hemorrhage. Option A is appropriate to enhance fetal lung maturity
if preterm delivery is anticipated. Options C and D are standard preparatory measures for potential blood loss.
4 A pregnant individual with a history of two prior cesarean deliveries is considering a trial of labor after cesarean
(TOLAC). Which factor is most strongly associated with an increased risk of uterine rupture during TOLAC?
,A) Maternal age over 35 years
B) Interdelivery interval of less than 18 months
C) Use of oxytocin for labor augmentation
D) Previous vaginal delivery after cesarean
Answer: C
Rationale: Oxytocin use for labor augmentation in TOLAC is associated with increased risk of uterine rupture,
particularly when used in high doses or for prolonged periods. Option A and B are risk factors but not as strong as
oxytocin use. Option D is actually protective; a prior vaginal delivery after cesarean reduces rupture risk.
5 A pregnant individual at 30 weeks gestation is diagnosed with severe preeclampsia. Which laboratory finding is
most indicative of HELLP syndrome?
A) Elevated serum creatinine of 1.2 mg/dL
B) Platelet count of 80,000/microliter
C) Elevated liver enzymes (AST 150 U/L, ALT 120 U/L)
D) Lactate dehydrogenase (LDH) of 400 U/L
Answer: B
Rationale: HELLP syndrome is characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets.
Thrombocytopenia (platelets <100,000/microliter) is a key diagnostic criterion. While elevated liver enzymes and
LDH are also features, thrombocytopenia is the most specific and defining component. Option A reflects renal
impairment common in preeclampsia but not specific to HELLP.
6 A pregnant individual at 26 weeks gestation presents with preterm premature rupture of membranes (PPROM).
Amniocentesis reveals a lecithin-to-sphingomyelin (L/S) ratio of 1.5:1. Which of the following is the most
appropriate next step?
A) Immediate induction of labor
B) Administration of antenatal corticosteroids and expectant management
C) Administration of tocolytics to delay delivery for 48 hours
D) Amnioinfusion to restore amniotic fluid volume
Answer: B
Rationale: An L/S ratio <2:1 indicates fetal lung immaturity. In PPROM at 26 weeks, antenatal corticosteroids are
given to accelerate lung maturity, and expectant management is pursued if no signs of infection or fetal distress.
Option A would risk neonatal respiratory distress syndrome. Tocolytics (C) are generally avoided in PPROM due
to infection risk. Amnioinfusion (D) is not standard for PPROM.
7 A pregnant individual with type 1 diabetes mellitus is at increased risk for which of the following fetal
complications?
A) Intrauterine growth restriction (IUGR) due to placental insufficiency
B) Congenital heart defects associated with poor glycemic control in the first trimester
C) Polyhydramnios due to decreased fetal swallowing
D) Fetal anemia from maternal antibody transfer
Answer: B
Rationale: Poor glycemic control during embryogenesis (first trimester) increases the risk of congenital anomalies,
particularly cardiac and neural tube defects. Option A is more common in conditions like preeclampsia; diabetes
typically causes macrosomia due to fetal hyperinsulinemia. Polyhydramnios (C) can occur but is due to fetal
polyuria from hyperglycemia, not decreased swallowing. Fetal anemia (D) is associated with alloimmunization, not
diabetes.
,8 A pregnant individual at 34 weeks gestation presents with a blood pressure of 140/90 mmHg and 1+ proteinuria.
She has no symptoms. Which of the following is the most appropriate diagnosis?
A) Chronic hypertension with superimposed preeclampsia
B) Gestational hypertension
C) Mild preeclampsia
D) Preeclampsia with severe features
Answer: C
Rationale: M i l d p r e e c l a m p s i a i s d e f i n e d a s b l o o d p
(1+ on dipstick). The absence of severe features (e.g., severe hypertension, thrombocytopenia, elevated liver
enzymes, pulmonary edema) supports this classification. Option A would require known preexisting hypertension.
Gestational hypertension (B) lacks proteinuria. Option D requires severe features.
9 A pregnant individual at 28 weeks gestation is diagnosed with cholestasis of pregnancy. Which laboratory
finding is most consistent with this condition?
A) Elevated alkaline phosphatase with normal gamma-glutamyl transferase (GGT)
B) Elevated serum bile acids >10 micromol/L
C) Elevated direct bilirubin with normal indirect bilirubin
D) Elevated alanine aminotransferase (ALT) >500 U/L
Answer: B
Rationale: I n t r a h e p a t i c c h o l e s t a s i s o f p r e g n a n c y i
micromol/L). Alkaline phosphatase (A) is elevated in pregnancy due to placental production and is not specific.
Direct bilirubin (C) may be mildly elevated but is not diagnostic. ALT (D) is typically mildly elevated (2-3 times
normal) but not as high as 500 U/L.
10 A pregnant individual at 20 weeks gestation undergoes a routine ultrasound that reveals a low-lying placenta.
Which of the following is the most appropriate follow-up?
A) Repeat ultrasound at 28-32 weeks to assess placental location
B) Immediate referral for cesarean delivery planning
C) Serial ultrasounds every 2 weeks to monitor for placenta previa
D) No further follow-up is needed as the placenta will likely migrate
Answer: A
Rationale: A low-lying placenta at 20 weeks often resolves as the uterus grows and the placenta appears to migrate
away from the cervical os. A repeat ultrasound at 28-32 weeks is standard to confirm placental location. Option B
is premature as many cases resolve. Option C is unnecessary unless there is persistent previa. Option D is incorrect
because follow-up is needed to confirm resolution.
11 A client at 28 weeks gestation presents with a blood pressure of 160/110 mmHg, 3+ proteinuria, and severe
headache. After initiating IV magnesium sulfate, the nurse notes a respiratory rate of 10 breaths/min, absent
deep tendon reflexes, and urine output of 20 mL/hr. Which intervention should the nurse prioritize?
A) Administer calcium gluconate
B) Increase the magnesium sulfate infusion rate
C) Prepare for emergent cesarean delivery
D) Administer hydralazine 5 mg IV
Answer: A
Rationale: The client is experiencing magnesium toxicity, evidenced by respiratory depression, areflexia, and
oliguria. Calcium gluconate is the antidote for magnesium sulfate. Increasing the infusion would worsen toxicity.
While delivery may be indicated, the immediate priority is reversing magnesium toxicity. Hydralazine treats
, hypertension but does not address the acute toxicity.
12 A pregnant client with type 1 diabetes mellitus has a glycosylated hemoglobin (HbA1c) of 9.2% at 10 weeks
gestation. Which fetal complication is most strongly associated with this finding?
A) Neonatal hypoglycemia
B) Neural tube defect
C) Fetal macrosomia
D) Respiratory distress syndrome
Answer: B
Rationale: Elevated HbA1c in the first trimester indicates poor glycemic control during the period of organogenesis,
increasing the risk for neural tube defects and other congenital anomalies. Neonatal hypoglycemia and macrosomia
are associated with third-trimester hyperglycemia. Respiratory distress syndrome is more related to prematurity and
late-gestation glucose control.
13 A client at 34 weeks gestation is admitted with painless vaginal bleeding. Ultrasound reveals a placenta previa
completely covering the internal os. The client's vital signs are stable, and fetal heart rate is reassuring. Which
intervention is most appropriate at this time?
A) Perform a digital cervical examination to assess dilation
B) Prepare for immediate cesarean delivery
C) Administer betamethasone and monitor for labor
D) Apply fetal scalp electrode for continuous monitoring
Answer: C
Rationale: In a stable client with placenta previa before 36 weeks, the goal is to prolong pregnancy while reducing
neonatal morbidity. Betamethasone promotes fetal lung maturity. Digital exam is contraindicated as it can provoke
hemorrhage. Immediate delivery is not indicated without maternal or fetal instability. Fetal scalp electrode is
invasive and unnecessary.
14 A client at 30 weeks gestation with a history of two prior spontaneous preterm births reports pelvic pressure
and lower back pain for 2 hours. Cervical length by transvaginal ultrasound is 18 mm. Which pharmacologic
intervention is most likely to reduce the risk of preterm birth in this client?
A) Oral nifedipine
B) Intramuscular 17-alpha hydroxyprogesterone caproate
C) Intravenous magnesium sulfate
D) Indomethacin rectal suppository
Answer: B
Rationale: For a client with a prior spontaneous preterm birth and a short cervix (<25 mm) at 30 weeks, 17-alpha
hydroxyprogesterone caproate is indicated to reduce recurrent preterm birth risk. Nifedipine and indomethacin are
tocolytics for acute management, not prophylaxis. Magnesium sulfate is used for neuroprotection if delivery is
imminent, not for prevention.
15 A client at 26 weeks gestation with sickle cell disease is admitted with severe pain in the chest and back, fever
of 38.9°C, and oxygen saturation of 91% on room air. Chest X-ray shows new pulmonary infiltrates. Which
intervention should the nurse implement first?
A) Administer intravenous morphine
B) Start empiric antibiotics
C) Initiate exchange transfusion
D) Apply supplemental oxygen via non-rebreather mask
Pediatric Nursing - Galen College of Nursing Questions with
Correct Answers and Explanations in Italics - 135 Questions
Section 1: Antepartum Care and Complications (Questions 1-15)
1 A pregnant individual at 28 weeks gestation presents with a blood pressure of 155/95 mmHg and 2+ proteinuria
on dipstick. Which pathophysiological mechanism is most directly responsible for the proteinuria observed in
preeclampsia?
A) Increased glomerular filtration rate due to systemic vasodilation
B) Endothelial dysfunction leading to loss of glomerular basement membrane integrity
C) Tubular damage from uric acid crystal deposition
D) Reduced renal plasma flow causing ischemic injury to podocytes
Answer: B
Rationale: In preeclampsia, systemic endothelial dysfunction results in increased permeability of the glomerular
endothelium, allowing protein to leak into the urine. Option A is incorrect because preeclampsia involves
vasoconstriction, not vasodilation. Option C describes a mechanism for gout, not preeclampsia. Option D is not a
primary mechanism; podocyte injury occurs but is secondary to endothelial damage.
2 Which of the following findings in a pregnant individual at 24 weeks gestation is most consistent with a
diagnosis of gestational diabetes mellitus (GDM) based on the two-step approach?
A) Fasting plasma glucose of 100 mg/dL on routine screening
B) 1-hour glucose challenge test result of 140 mg/dL followed by a 3-hour oral glucose tolerance test (OGTT)
with two abnormal values
C) Random plasma glucose of 200 mg/dL with symptoms of polyuria and polydipsia
D) Hemoglobin A1c of 6.0% at the first prenatal visit
Answer: B
Rationale: The two-step approach for GDM diagnosis involves a 50g glucose challenge test; if the 1-hour value is
140 mg/dL, a 3-hour 100g OGTT is performed. GDM is diagnosed if at least two of the four glucose values meet or
exceed thresholds (e.g., fasting 95, 1-hour 180, 2-hour 155, 3-hour 140). Option A is a normal fasting value. Option
C suggests overt diabetes, not GDM. Option D indicates pre-existing diabetes if A1c 6.5%.
3 A pregnant individual at 32 weeks gestation presents with painless vaginal bleeding. Ultrasound reveals a
placenta previa. Which of the following interventions is contraindicated in the immediate management?
A) Administering betamethasone for fetal lung maturity
B) Performing a sterile speculum examination to assess the cervix
C) Obtaining a complete blood count and type and crossmatch
D) Initiating intravenous access and fluid resuscitation
Answer: B
Rationale: In suspected placenta previa, digital cervical examination or speculum exam is contraindicated because it
can disrupt the placenta and cause catastrophic hemorrhage. Option A is appropriate to enhance fetal lung maturity
if preterm delivery is anticipated. Options C and D are standard preparatory measures for potential blood loss.
4 A pregnant individual with a history of two prior cesarean deliveries is considering a trial of labor after cesarean
(TOLAC). Which factor is most strongly associated with an increased risk of uterine rupture during TOLAC?
,A) Maternal age over 35 years
B) Interdelivery interval of less than 18 months
C) Use of oxytocin for labor augmentation
D) Previous vaginal delivery after cesarean
Answer: C
Rationale: Oxytocin use for labor augmentation in TOLAC is associated with increased risk of uterine rupture,
particularly when used in high doses or for prolonged periods. Option A and B are risk factors but not as strong as
oxytocin use. Option D is actually protective; a prior vaginal delivery after cesarean reduces rupture risk.
5 A pregnant individual at 30 weeks gestation is diagnosed with severe preeclampsia. Which laboratory finding is
most indicative of HELLP syndrome?
A) Elevated serum creatinine of 1.2 mg/dL
B) Platelet count of 80,000/microliter
C) Elevated liver enzymes (AST 150 U/L, ALT 120 U/L)
D) Lactate dehydrogenase (LDH) of 400 U/L
Answer: B
Rationale: HELLP syndrome is characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets.
Thrombocytopenia (platelets <100,000/microliter) is a key diagnostic criterion. While elevated liver enzymes and
LDH are also features, thrombocytopenia is the most specific and defining component. Option A reflects renal
impairment common in preeclampsia but not specific to HELLP.
6 A pregnant individual at 26 weeks gestation presents with preterm premature rupture of membranes (PPROM).
Amniocentesis reveals a lecithin-to-sphingomyelin (L/S) ratio of 1.5:1. Which of the following is the most
appropriate next step?
A) Immediate induction of labor
B) Administration of antenatal corticosteroids and expectant management
C) Administration of tocolytics to delay delivery for 48 hours
D) Amnioinfusion to restore amniotic fluid volume
Answer: B
Rationale: An L/S ratio <2:1 indicates fetal lung immaturity. In PPROM at 26 weeks, antenatal corticosteroids are
given to accelerate lung maturity, and expectant management is pursued if no signs of infection or fetal distress.
Option A would risk neonatal respiratory distress syndrome. Tocolytics (C) are generally avoided in PPROM due
to infection risk. Amnioinfusion (D) is not standard for PPROM.
7 A pregnant individual with type 1 diabetes mellitus is at increased risk for which of the following fetal
complications?
A) Intrauterine growth restriction (IUGR) due to placental insufficiency
B) Congenital heart defects associated with poor glycemic control in the first trimester
C) Polyhydramnios due to decreased fetal swallowing
D) Fetal anemia from maternal antibody transfer
Answer: B
Rationale: Poor glycemic control during embryogenesis (first trimester) increases the risk of congenital anomalies,
particularly cardiac and neural tube defects. Option A is more common in conditions like preeclampsia; diabetes
typically causes macrosomia due to fetal hyperinsulinemia. Polyhydramnios (C) can occur but is due to fetal
polyuria from hyperglycemia, not decreased swallowing. Fetal anemia (D) is associated with alloimmunization, not
diabetes.
,8 A pregnant individual at 34 weeks gestation presents with a blood pressure of 140/90 mmHg and 1+ proteinuria.
She has no symptoms. Which of the following is the most appropriate diagnosis?
A) Chronic hypertension with superimposed preeclampsia
B) Gestational hypertension
C) Mild preeclampsia
D) Preeclampsia with severe features
Answer: C
Rationale: M i l d p r e e c l a m p s i a i s d e f i n e d a s b l o o d p
(1+ on dipstick). The absence of severe features (e.g., severe hypertension, thrombocytopenia, elevated liver
enzymes, pulmonary edema) supports this classification. Option A would require known preexisting hypertension.
Gestational hypertension (B) lacks proteinuria. Option D requires severe features.
9 A pregnant individual at 28 weeks gestation is diagnosed with cholestasis of pregnancy. Which laboratory
finding is most consistent with this condition?
A) Elevated alkaline phosphatase with normal gamma-glutamyl transferase (GGT)
B) Elevated serum bile acids >10 micromol/L
C) Elevated direct bilirubin with normal indirect bilirubin
D) Elevated alanine aminotransferase (ALT) >500 U/L
Answer: B
Rationale: I n t r a h e p a t i c c h o l e s t a s i s o f p r e g n a n c y i
micromol/L). Alkaline phosphatase (A) is elevated in pregnancy due to placental production and is not specific.
Direct bilirubin (C) may be mildly elevated but is not diagnostic. ALT (D) is typically mildly elevated (2-3 times
normal) but not as high as 500 U/L.
10 A pregnant individual at 20 weeks gestation undergoes a routine ultrasound that reveals a low-lying placenta.
Which of the following is the most appropriate follow-up?
A) Repeat ultrasound at 28-32 weeks to assess placental location
B) Immediate referral for cesarean delivery planning
C) Serial ultrasounds every 2 weeks to monitor for placenta previa
D) No further follow-up is needed as the placenta will likely migrate
Answer: A
Rationale: A low-lying placenta at 20 weeks often resolves as the uterus grows and the placenta appears to migrate
away from the cervical os. A repeat ultrasound at 28-32 weeks is standard to confirm placental location. Option B
is premature as many cases resolve. Option C is unnecessary unless there is persistent previa. Option D is incorrect
because follow-up is needed to confirm resolution.
11 A client at 28 weeks gestation presents with a blood pressure of 160/110 mmHg, 3+ proteinuria, and severe
headache. After initiating IV magnesium sulfate, the nurse notes a respiratory rate of 10 breaths/min, absent
deep tendon reflexes, and urine output of 20 mL/hr. Which intervention should the nurse prioritize?
A) Administer calcium gluconate
B) Increase the magnesium sulfate infusion rate
C) Prepare for emergent cesarean delivery
D) Administer hydralazine 5 mg IV
Answer: A
Rationale: The client is experiencing magnesium toxicity, evidenced by respiratory depression, areflexia, and
oliguria. Calcium gluconate is the antidote for magnesium sulfate. Increasing the infusion would worsen toxicity.
While delivery may be indicated, the immediate priority is reversing magnesium toxicity. Hydralazine treats
, hypertension but does not address the acute toxicity.
12 A pregnant client with type 1 diabetes mellitus has a glycosylated hemoglobin (HbA1c) of 9.2% at 10 weeks
gestation. Which fetal complication is most strongly associated with this finding?
A) Neonatal hypoglycemia
B) Neural tube defect
C) Fetal macrosomia
D) Respiratory distress syndrome
Answer: B
Rationale: Elevated HbA1c in the first trimester indicates poor glycemic control during the period of organogenesis,
increasing the risk for neural tube defects and other congenital anomalies. Neonatal hypoglycemia and macrosomia
are associated with third-trimester hyperglycemia. Respiratory distress syndrome is more related to prematurity and
late-gestation glucose control.
13 A client at 34 weeks gestation is admitted with painless vaginal bleeding. Ultrasound reveals a placenta previa
completely covering the internal os. The client's vital signs are stable, and fetal heart rate is reassuring. Which
intervention is most appropriate at this time?
A) Perform a digital cervical examination to assess dilation
B) Prepare for immediate cesarean delivery
C) Administer betamethasone and monitor for labor
D) Apply fetal scalp electrode for continuous monitoring
Answer: C
Rationale: In a stable client with placenta previa before 36 weeks, the goal is to prolong pregnancy while reducing
neonatal morbidity. Betamethasone promotes fetal lung maturity. Digital exam is contraindicated as it can provoke
hemorrhage. Immediate delivery is not indicated without maternal or fetal instability. Fetal scalp electrode is
invasive and unnecessary.
14 A client at 30 weeks gestation with a history of two prior spontaneous preterm births reports pelvic pressure
and lower back pain for 2 hours. Cervical length by transvaginal ultrasound is 18 mm. Which pharmacologic
intervention is most likely to reduce the risk of preterm birth in this client?
A) Oral nifedipine
B) Intramuscular 17-alpha hydroxyprogesterone caproate
C) Intravenous magnesium sulfate
D) Indomethacin rectal suppository
Answer: B
Rationale: For a client with a prior spontaneous preterm birth and a short cervix (<25 mm) at 30 weeks, 17-alpha
hydroxyprogesterone caproate is indicated to reduce recurrent preterm birth risk. Nifedipine and indomethacin are
tocolytics for acute management, not prophylaxis. Magnesium sulfate is used for neuroprotection if delivery is
imminent, not for prevention.
15 A client at 26 weeks gestation with sickle cell disease is admitted with severe pain in the chest and back, fever
of 38.9°C, and oxygen saturation of 91% on room air. Chest X-ray shows new pulmonary infiltrates. Which
intervention should the nurse implement first?
A) Administer intravenous morphine
B) Start empiric antibiotics
C) Initiate exchange transfusion
D) Apply supplemental oxygen via non-rebreather mask
