NUR 254: Maternal & Pediatric Nursing Comprehensive Examination Bundle
Galen College of Nursing | Academic Year 2026/2027
Total Questions: 180
1. A nurse is assessing a client at 8 weeks of gestation. Which of the following findings
should the nurse identify as an early sign of pregnancy?
A. Quickening
B. Chadwick's sign
C. Fundal height at the umbilicus
D. Striae gravidarum
Correct Answer: B
Rationale: Chadwick's sign (bluish discoloration of the cervix, vagina, and vulva) is an
early probable sign of pregnancy caused by increased vascularity, appearing around 6-
8 weeks. Quickening occurs at 16-20 weeks, fundal height at umbilicus at 20 weeks,
and striae are late findings.
2. A client at 12 weeks gestation asks the nurse about recommended weight gain during
pregnancy. The nurse should base the response on which guideline for a client with a
pre-pregnancy BMI of 22?
A. 11-20 lbs
B. 15-25 lbs
C. 25-35 lbs
D. 28-40 lbs
Correct Answer: C
Rationale: For a client with a normal pre-pregnancy BMI (18.5-24.9), the recommended
total weight gain is 25-35 lbs. Underweight (BMI <18.5): 28-40 lbs; Overweight (BMI 25-
29.9): 15-25 lbs; Obese (BMI ≥30): 11-20 lbs.
3. Which statement by a client at 10 weeks gestation indicates a need for further
teaching about nutrition during pregnancy?
,A. "I will increase my daily caloric intake by 300 calories."
B. "I need to take a prenatal vitamin with folic acid daily."
C. "I should avoid all fish to prevent mercury exposure."
D. "I will drink eight glasses of water each day."
Correct Answer: C
Rationale: Clients should avoid high-mercury fish (shark, swordfish, king mackerel,
tilefish) but can safely consume 2-3 servings per week of low-mercury fish (salmon,
shrimp, pollock) for omega-3 fatty acids important for fetal neurodevelopment.
4. A nurse is teaching a client at 28 weeks gestation about danger signs in pregnancy.
Which finding should the client report immediately?
A. Ankle edema at the end of the day
B. Occasional mild headache
C. Vaginal bleeding
D. Increased vaginal discharge
Correct Answer: C
Rationale: Vaginal bleeding at any point in pregnancy is a danger sign requiring
immediate evaluation as it may indicate placenta previa, abruption, or preterm labor.
Mild edema, occasional headaches, and increased leukorrhea are common normal
findings.
5. A client at 32 weeks gestation has a blood pressure of 148/96 mm Hg on two
occasions. Which additional finding would support a diagnosis of preeclampsia?
A. 1+ proteinuria
B. 2+ pitting edema in lower extremities
C. Weight gain of 1 lb in one week
D. Fetal heart rate of 140/min
Correct Answer: A
,Rationale: Preeclampsia is diagnosed by hypertension (≥140/90 mm Hg) after 20 weeks
gestation PLUS proteinuria (≥1+ on dipstick or ≥300 mg/24hr) OR signs of end-organ
dysfunction. Edema alone is common in normal pregnancy.
6. The nurse is caring for a client with gestational diabetes mellitus (GDM). Which
instruction should be included in the teaching plan?
A. "Monitor blood glucose once daily in the morning."
B. "Limit carbohydrate intake to 30 grams per meal."
C. "Exercise should be avoided to prevent hypoglycemia."
D. "Insulin therapy will be needed after delivery."
Correct Answer: B
Rationale: Medical nutrition therapy for GDM typically includes consistent carbohydrate
distribution (30-45g per meal, 15-30g per snack) to maintain glycemic control. Blood
glucose is monitored 4x daily (fasting + postprandial). Exercise is encouraged. Most
clients with GDM do not require insulin postpartum.
7. A client at 36 weeks gestation reports a sudden gush of fluid from the vagina. What is
the nurse's priority action?
A. Assess fetal heart rate
B. Perform a sterile vaginal exam
C. Test the fluid with nitrazine paper
D. Notify the provider immediately
Correct Answer: A
Rationale: The priority is to assess fetal well-being by checking the fetal heart rate, as
rupture of membranes increases risk for cord prolapse, infection, or fetal distress.
After ensuring fetal stability, further assessment and provider notification follow.
8. Which finding in a client at 16 weeks gestation should alert the nurse to a possible
molar pregnancy?
A. Uterine size smaller than dates
, B. Absence of fetal heart tones
C. Severe nausea and vomiting
D. Maternal weight loss
Correct Answer: C
Rationale: Hyperemesis gravidarum (severe nausea/vomiting) disproportionate to
gestational age can indicate a molar pregnancy due to extremely high hCG levels. Other
signs include uterine size larger than dates, absent fetal heart tones, and "snowstorm"
pattern on ultrasound.
9. A nurse is preparing to administer Rho(D) immune globulin to a client. Which client is
the priority candidate?
A. Rh-positive mother, Rh-positive infant
B. Rh-negative mother, Rh-positive infant
C. Rh-negative mother, Rh-negative infant
D. Rh-positive mother, Rh-negative infant
Correct Answer: B
Rationale: RhoGAM is given to Rh-negative mothers carrying or delivering an Rh-
positive infant to prevent isoimmunization. It is administered at 28 weeks antepartum
and within 72 hours postpartum if the infant is Rh-positive.
10. A client at 20 weeks gestation is scheduled for an anatomy ultrasound. Which
statement by the client indicates understanding of the procedure's purpose?
A. "This test will determine my baby's due date."
B. "This ultrasound checks my baby's organs and growth."
C. "This will diagnose genetic disorders like Down syndrome."
D. "This test measures my amniotic fluid levels only."
Correct Answer: B
Galen College of Nursing | Academic Year 2026/2027
Total Questions: 180
1. A nurse is assessing a client at 8 weeks of gestation. Which of the following findings
should the nurse identify as an early sign of pregnancy?
A. Quickening
B. Chadwick's sign
C. Fundal height at the umbilicus
D. Striae gravidarum
Correct Answer: B
Rationale: Chadwick's sign (bluish discoloration of the cervix, vagina, and vulva) is an
early probable sign of pregnancy caused by increased vascularity, appearing around 6-
8 weeks. Quickening occurs at 16-20 weeks, fundal height at umbilicus at 20 weeks,
and striae are late findings.
2. A client at 12 weeks gestation asks the nurse about recommended weight gain during
pregnancy. The nurse should base the response on which guideline for a client with a
pre-pregnancy BMI of 22?
A. 11-20 lbs
B. 15-25 lbs
C. 25-35 lbs
D. 28-40 lbs
Correct Answer: C
Rationale: For a client with a normal pre-pregnancy BMI (18.5-24.9), the recommended
total weight gain is 25-35 lbs. Underweight (BMI <18.5): 28-40 lbs; Overweight (BMI 25-
29.9): 15-25 lbs; Obese (BMI ≥30): 11-20 lbs.
3. Which statement by a client at 10 weeks gestation indicates a need for further
teaching about nutrition during pregnancy?
,A. "I will increase my daily caloric intake by 300 calories."
B. "I need to take a prenatal vitamin with folic acid daily."
C. "I should avoid all fish to prevent mercury exposure."
D. "I will drink eight glasses of water each day."
Correct Answer: C
Rationale: Clients should avoid high-mercury fish (shark, swordfish, king mackerel,
tilefish) but can safely consume 2-3 servings per week of low-mercury fish (salmon,
shrimp, pollock) for omega-3 fatty acids important for fetal neurodevelopment.
4. A nurse is teaching a client at 28 weeks gestation about danger signs in pregnancy.
Which finding should the client report immediately?
A. Ankle edema at the end of the day
B. Occasional mild headache
C. Vaginal bleeding
D. Increased vaginal discharge
Correct Answer: C
Rationale: Vaginal bleeding at any point in pregnancy is a danger sign requiring
immediate evaluation as it may indicate placenta previa, abruption, or preterm labor.
Mild edema, occasional headaches, and increased leukorrhea are common normal
findings.
5. A client at 32 weeks gestation has a blood pressure of 148/96 mm Hg on two
occasions. Which additional finding would support a diagnosis of preeclampsia?
A. 1+ proteinuria
B. 2+ pitting edema in lower extremities
C. Weight gain of 1 lb in one week
D. Fetal heart rate of 140/min
Correct Answer: A
,Rationale: Preeclampsia is diagnosed by hypertension (≥140/90 mm Hg) after 20 weeks
gestation PLUS proteinuria (≥1+ on dipstick or ≥300 mg/24hr) OR signs of end-organ
dysfunction. Edema alone is common in normal pregnancy.
6. The nurse is caring for a client with gestational diabetes mellitus (GDM). Which
instruction should be included in the teaching plan?
A. "Monitor blood glucose once daily in the morning."
B. "Limit carbohydrate intake to 30 grams per meal."
C. "Exercise should be avoided to prevent hypoglycemia."
D. "Insulin therapy will be needed after delivery."
Correct Answer: B
Rationale: Medical nutrition therapy for GDM typically includes consistent carbohydrate
distribution (30-45g per meal, 15-30g per snack) to maintain glycemic control. Blood
glucose is monitored 4x daily (fasting + postprandial). Exercise is encouraged. Most
clients with GDM do not require insulin postpartum.
7. A client at 36 weeks gestation reports a sudden gush of fluid from the vagina. What is
the nurse's priority action?
A. Assess fetal heart rate
B. Perform a sterile vaginal exam
C. Test the fluid with nitrazine paper
D. Notify the provider immediately
Correct Answer: A
Rationale: The priority is to assess fetal well-being by checking the fetal heart rate, as
rupture of membranes increases risk for cord prolapse, infection, or fetal distress.
After ensuring fetal stability, further assessment and provider notification follow.
8. Which finding in a client at 16 weeks gestation should alert the nurse to a possible
molar pregnancy?
A. Uterine size smaller than dates
, B. Absence of fetal heart tones
C. Severe nausea and vomiting
D. Maternal weight loss
Correct Answer: C
Rationale: Hyperemesis gravidarum (severe nausea/vomiting) disproportionate to
gestational age can indicate a molar pregnancy due to extremely high hCG levels. Other
signs include uterine size larger than dates, absent fetal heart tones, and "snowstorm"
pattern on ultrasound.
9. A nurse is preparing to administer Rho(D) immune globulin to a client. Which client is
the priority candidate?
A. Rh-positive mother, Rh-positive infant
B. Rh-negative mother, Rh-positive infant
C. Rh-negative mother, Rh-negative infant
D. Rh-positive mother, Rh-negative infant
Correct Answer: B
Rationale: RhoGAM is given to Rh-negative mothers carrying or delivering an Rh-
positive infant to prevent isoimmunization. It is administered at 28 weeks antepartum
and within 72 hours postpartum if the infant is Rh-positive.
10. A client at 20 weeks gestation is scheduled for an anatomy ultrasound. Which
statement by the client indicates understanding of the procedure's purpose?
A. "This test will determine my baby's due date."
B. "This ultrasound checks my baby's organs and growth."
C. "This will diagnose genetic disorders like Down syndrome."
D. "This test measures my amniotic fluid levels only."
Correct Answer: B
