Leigh
NUR 445 Exam 1 Review | Questions and Answers
| Fall 2025/26
OB/Prenatal Nursing Mastery Pack – 80 High-Level NCLEX-Style Questions with
Answers & Detailed Rationales (Pregnancy, Complications & Fetal Assessment)
1. A pregnant client at 9 weeks gestation reports that she has not had a
menstrual period since conception. The nurse explains that amenorrhea in early
pregnancy is primarily caused by which physiologic process?
A. Suppression of progesterone from the ovaries
B. Suppression of follicle-stimulating hormone related to rising estrogen
C. Reduction in thyroid-stimulating hormone
D. Increased secretion of prolactin
✔ Correct Answer: B. Suppression of follicle-stimulating hormone related to
rising estrogen
Rationale:
In early pregnancy, high levels of estrogen and progesterone—secreted by the
corpus luteum and then placenta—suppress FSH and LH. Without FSH, ovarian
follicle development stops and the menstrual cycle does not progress, resulting in
amenorrhea. This is a normal expected finding. Progesterone and prolactin
influence pregnancy but do not directly stop FSH.
2. The nurse teaches a postpartum client about lactational amenorrhea (LAM) as
a temporary contraceptive method. Which explanation is correct?
A. “LAM works because breastfeeding increases estrogen production.”
B. “LAM works because breastfeeding suppresses ovulation.”
,Leigh
C. “LAM works only if you breastfeed once daily.”
D. “LAM works because the uterus cannot contract during lactation.”
✔ Correct Answer: B. LAM works because breastfeeding suppresses ovulation.
Rationale:
Lactational amenorrhea suppresses ovulation due to prolactin-mediated
inhibition of GnRH, which prevents FSH and LH release. Frequent exclusive
breastfeeding increases prolactin → no ovulation. It is not estrogen-mediated,
requires exclusive breastfeeding, and has nothing to do with uterine contraction.
3. During a prenatal exam, the nurse notes softening of the cervical tip. This
classic sign of early pregnancy is known as:
A. Hegar’s sign
B. Chadwick’s sign
C. McDonald’s sign
D. Goodell’s sign
✔ Correct Answer: D. Goodell’s sign
Rationale:
Goodell’s sign = softening of the cervix due to increased vascularity and
hypertrophy.
Chadwick = bluish coloration.
Hegar = softening of lower uterine segment.
McDonald = ease in flexing uterus against cervix.
4. A client presents with bluish discoloration of the cervix and vaginal mucosa
during an early prenatal visit. The nurse correctly identifies this as:
,Leigh
A. McDonald’s sign
B. Chadwick’s sign
C. Goodell’s sign
D. Luin’s sign
✔ Correct Answer: B. Chadwick’s sign
Rationale:
Chadwick’s sign is caused by increased blood flow and vascular congestion
during early pregnancy. Goodell’s is cervical softening. McDonald’s relates to
uterine flexion and is not a color change.
5. A woman in her 36th week reports feeling it is “easier to breathe” but now
she urinates more often. The nurse explains that these symptoms are expected
because of:
A. Quickening
B. Lightening
C. Engagement
D. Station change
✔ Correct Answer: B. Lightening
Rationale:
Lightening occurs in late pregnancy when the fetus descends into the pelvis. This
reduces pressure on the diaphragm → easier breathing, but increases bladder
pressure → urinary frequency. It is not quickening (fetal movement) or station
change alone.
6. A primigravida client reports feeling fetal movement for the first time at 18
weeks. This is described as:
, Leigh
A. Engagement
B. Lightening
C. Quickening
D. Ballottement
✔ Correct Answer: C. Quickening
Rationale:
Quickening = first fetal movements perceived by mother.
Typically:
18–20 weeks primigravida
14–16 weeks multigravida
7. A nurse caring for a newly pregnant client notes the client appears self-
focused and concerned about bodily changes. This behavior reflects which
psychological state?
A. Taking-hold phase
B. Narcissism related to early pregnancy
C. Maternal–fetal attachment
D. Acceptance phase
✔ Correct Answer: B. Narcissism related to early pregnancy
Rationale:
Early pregnancy often brings narcissistic behavior—increased focus on the self
and body, heightened awareness of vulnerability, and preoccupation with
protecting the fetus. This is normal and temporary.
8. During an ultrasound, the nurse notes an umbilical cord containing one vein
and two arteries. This finding:
NUR 445 Exam 1 Review | Questions and Answers
| Fall 2025/26
OB/Prenatal Nursing Mastery Pack – 80 High-Level NCLEX-Style Questions with
Answers & Detailed Rationales (Pregnancy, Complications & Fetal Assessment)
1. A pregnant client at 9 weeks gestation reports that she has not had a
menstrual period since conception. The nurse explains that amenorrhea in early
pregnancy is primarily caused by which physiologic process?
A. Suppression of progesterone from the ovaries
B. Suppression of follicle-stimulating hormone related to rising estrogen
C. Reduction in thyroid-stimulating hormone
D. Increased secretion of prolactin
✔ Correct Answer: B. Suppression of follicle-stimulating hormone related to
rising estrogen
Rationale:
In early pregnancy, high levels of estrogen and progesterone—secreted by the
corpus luteum and then placenta—suppress FSH and LH. Without FSH, ovarian
follicle development stops and the menstrual cycle does not progress, resulting in
amenorrhea. This is a normal expected finding. Progesterone and prolactin
influence pregnancy but do not directly stop FSH.
2. The nurse teaches a postpartum client about lactational amenorrhea (LAM) as
a temporary contraceptive method. Which explanation is correct?
A. “LAM works because breastfeeding increases estrogen production.”
B. “LAM works because breastfeeding suppresses ovulation.”
,Leigh
C. “LAM works only if you breastfeed once daily.”
D. “LAM works because the uterus cannot contract during lactation.”
✔ Correct Answer: B. LAM works because breastfeeding suppresses ovulation.
Rationale:
Lactational amenorrhea suppresses ovulation due to prolactin-mediated
inhibition of GnRH, which prevents FSH and LH release. Frequent exclusive
breastfeeding increases prolactin → no ovulation. It is not estrogen-mediated,
requires exclusive breastfeeding, and has nothing to do with uterine contraction.
3. During a prenatal exam, the nurse notes softening of the cervical tip. This
classic sign of early pregnancy is known as:
A. Hegar’s sign
B. Chadwick’s sign
C. McDonald’s sign
D. Goodell’s sign
✔ Correct Answer: D. Goodell’s sign
Rationale:
Goodell’s sign = softening of the cervix due to increased vascularity and
hypertrophy.
Chadwick = bluish coloration.
Hegar = softening of lower uterine segment.
McDonald = ease in flexing uterus against cervix.
4. A client presents with bluish discoloration of the cervix and vaginal mucosa
during an early prenatal visit. The nurse correctly identifies this as:
,Leigh
A. McDonald’s sign
B. Chadwick’s sign
C. Goodell’s sign
D. Luin’s sign
✔ Correct Answer: B. Chadwick’s sign
Rationale:
Chadwick’s sign is caused by increased blood flow and vascular congestion
during early pregnancy. Goodell’s is cervical softening. McDonald’s relates to
uterine flexion and is not a color change.
5. A woman in her 36th week reports feeling it is “easier to breathe” but now
she urinates more often. The nurse explains that these symptoms are expected
because of:
A. Quickening
B. Lightening
C. Engagement
D. Station change
✔ Correct Answer: B. Lightening
Rationale:
Lightening occurs in late pregnancy when the fetus descends into the pelvis. This
reduces pressure on the diaphragm → easier breathing, but increases bladder
pressure → urinary frequency. It is not quickening (fetal movement) or station
change alone.
6. A primigravida client reports feeling fetal movement for the first time at 18
weeks. This is described as:
, Leigh
A. Engagement
B. Lightening
C. Quickening
D. Ballottement
✔ Correct Answer: C. Quickening
Rationale:
Quickening = first fetal movements perceived by mother.
Typically:
18–20 weeks primigravida
14–16 weeks multigravida
7. A nurse caring for a newly pregnant client notes the client appears self-
focused and concerned about bodily changes. This behavior reflects which
psychological state?
A. Taking-hold phase
B. Narcissism related to early pregnancy
C. Maternal–fetal attachment
D. Acceptance phase
✔ Correct Answer: B. Narcissism related to early pregnancy
Rationale:
Early pregnancy often brings narcissistic behavior—increased focus on the self
and body, heightened awareness of vulnerability, and preoccupation with
protecting the fetus. This is normal and temporary.
8. During an ultrasound, the nurse notes an umbilical cord containing one vein
and two arteries. This finding:
