OB 101 Maternal-Newborn Nursing Final
Exam Study Guide: Complete Q&A with
Rationales (Questions 1–160)
Q1. A pregnant patient at 10 weeks gestation reports nausea every morning.
What is the best initial advice?
☑ Correct Answer: Eat dry crackers before getting out of bed.
Rationale: Morning sickness is linked to empty stomach and rising hCG levels.
Dry, bland carbohydrates before rising help stabilize blood glucose and reduce
gastric irritation.
Q2. A patient at 16 weeks gestation asks when she will likely feel fetal
movement. What is the correct response?
☑ Correct Answer: Primiparas typically feel movement at 18–20 weeks;
multiparas may feel it as early as 16 weeks.
Rationale: Quickening is perceived earlier in multiparas because they
recognize the sensation. Anterior placenta can delay perception.
Q3. Nagele's rule is used to estimate the EDD. A patient with LMP of May 10 will
have an EDD of:
☑ Correct Answer: February 17 (May 10 – 3 months = February 10 + 7 days
,= February 17).
Rationale: Subtract 3 months, add 7 days. Adjust year if necessary.
Q4. Which cardiovascular change is considered normal in pregnancy?
☑ Correct Answer: Decreased blood pressure in the second trimester.
Rationale: Systemic vascular resistance drops due to progesterone and low-
resistance placental circulation, causing physiologic drop in BP (nadir at ~24
weeks).
Q5. A pregnant patient has a hemoglobin of 10.5 g/dL in the second trimester.
What is the most likely cause?
☑ Correct Answer: Physiologic anemia of pregnancy.
Rationale: Plasma volume expands more than red cell mass (dilutional effect).
True anemia is <11 g/dL 1st/3rd tri, <10.5 g/dL 2nd tri.
Q6. A G3 P2002 patient is pregnant. What does P2002 represent?
☑ Correct Answer: 2 term births, 0 preterm, 0 abortions, 2 living children.
Rationale: TPAL: Term (≥37w), Preterm (20-36w6d), Abortions (<20w), Living.
Q7. A patient at 35 weeks reports heartburn after meals. What education
should be provided?
,☑ Correct Answer: Avoid lying down for 1 hour after eating, and use
calcium carbonate antacids as needed.
Rationale: Progesterone decreases lower esophageal sphincter tone; uterine
enlargement increases intra-abdominal pressure. Calcium antacids are safe and
provide calcium.
Q8. Which immunizations are routinely recommended during pregnancy?
☑ Correct Answer: Tdap (27–36 weeks) and influenza (inactivated, any
trimester).
Rationale: Tdap provides passive pertussis antibodies to the newborn. Live
vaccines (MMR, varicella) are contraindicated in pregnancy.
Q9. A patient at 32 weeks has a blood pressure of 145/92 mmHg and urine
dipstick shows 1+ protein. What is the priority action?
☑ Correct Answer: Evaluate for pre-eclampsia with additional labs
(platelets, LFTs, creatinine) and assess for symptoms.
Rationale: Gestational HTN + proteinuria = pre-eclampsia. Needs further
workup, not immediate delivery unless severe features present.
Q10. What is the recommended daily folic acid intake for all pregnant women?
☑ Correct Answer: 400–800 mcg daily, starting preconception.
, Rationale: Prevents neural tube defects (spina bifida, anencephaly). Higher
dose (4 mg) for women with prior NTD-affected pregnancy, on valproate, or with
diabetes.
Q11. A patient at 12 weeks has a PAPP-A and NT ultrasound. What is being
screened for?
☑ Correct Answer: Down syndrome (trisomy 21) and trisomy 18.
Rationale: First-trimester combined screening (NT + PAPP-A + hCG) detects
85-90% of trisomy 21 cases.
Q12. What is the most accurate method for dating a pregnancy?
☑ Correct Answer: First-trimester ultrasound (crown-rump length between
7-13+6 weeks).
Rationale: CRL has ±5-7 day accuracy; later ultrasounds have wider variability
(±10-14 days in 2nd tri, ±21 days in 3rd tri).
Q13. A patient reports urinary frequency at 10 weeks. What is the cause?
☑ Correct Answer: Growing uterus presses on the bladder in the pelvic
cavity.
Rationale: Frequency improves in second trimester when uterus rises out of
pelvis, then returns in third trimester as fetal head descends.
Exam Study Guide: Complete Q&A with
Rationales (Questions 1–160)
Q1. A pregnant patient at 10 weeks gestation reports nausea every morning.
What is the best initial advice?
☑ Correct Answer: Eat dry crackers before getting out of bed.
Rationale: Morning sickness is linked to empty stomach and rising hCG levels.
Dry, bland carbohydrates before rising help stabilize blood glucose and reduce
gastric irritation.
Q2. A patient at 16 weeks gestation asks when she will likely feel fetal
movement. What is the correct response?
☑ Correct Answer: Primiparas typically feel movement at 18–20 weeks;
multiparas may feel it as early as 16 weeks.
Rationale: Quickening is perceived earlier in multiparas because they
recognize the sensation. Anterior placenta can delay perception.
Q3. Nagele's rule is used to estimate the EDD. A patient with LMP of May 10 will
have an EDD of:
☑ Correct Answer: February 17 (May 10 – 3 months = February 10 + 7 days
,= February 17).
Rationale: Subtract 3 months, add 7 days. Adjust year if necessary.
Q4. Which cardiovascular change is considered normal in pregnancy?
☑ Correct Answer: Decreased blood pressure in the second trimester.
Rationale: Systemic vascular resistance drops due to progesterone and low-
resistance placental circulation, causing physiologic drop in BP (nadir at ~24
weeks).
Q5. A pregnant patient has a hemoglobin of 10.5 g/dL in the second trimester.
What is the most likely cause?
☑ Correct Answer: Physiologic anemia of pregnancy.
Rationale: Plasma volume expands more than red cell mass (dilutional effect).
True anemia is <11 g/dL 1st/3rd tri, <10.5 g/dL 2nd tri.
Q6. A G3 P2002 patient is pregnant. What does P2002 represent?
☑ Correct Answer: 2 term births, 0 preterm, 0 abortions, 2 living children.
Rationale: TPAL: Term (≥37w), Preterm (20-36w6d), Abortions (<20w), Living.
Q7. A patient at 35 weeks reports heartburn after meals. What education
should be provided?
,☑ Correct Answer: Avoid lying down for 1 hour after eating, and use
calcium carbonate antacids as needed.
Rationale: Progesterone decreases lower esophageal sphincter tone; uterine
enlargement increases intra-abdominal pressure. Calcium antacids are safe and
provide calcium.
Q8. Which immunizations are routinely recommended during pregnancy?
☑ Correct Answer: Tdap (27–36 weeks) and influenza (inactivated, any
trimester).
Rationale: Tdap provides passive pertussis antibodies to the newborn. Live
vaccines (MMR, varicella) are contraindicated in pregnancy.
Q9. A patient at 32 weeks has a blood pressure of 145/92 mmHg and urine
dipstick shows 1+ protein. What is the priority action?
☑ Correct Answer: Evaluate for pre-eclampsia with additional labs
(platelets, LFTs, creatinine) and assess for symptoms.
Rationale: Gestational HTN + proteinuria = pre-eclampsia. Needs further
workup, not immediate delivery unless severe features present.
Q10. What is the recommended daily folic acid intake for all pregnant women?
☑ Correct Answer: 400–800 mcg daily, starting preconception.
, Rationale: Prevents neural tube defects (spina bifida, anencephaly). Higher
dose (4 mg) for women with prior NTD-affected pregnancy, on valproate, or with
diabetes.
Q11. A patient at 12 weeks has a PAPP-A and NT ultrasound. What is being
screened for?
☑ Correct Answer: Down syndrome (trisomy 21) and trisomy 18.
Rationale: First-trimester combined screening (NT + PAPP-A + hCG) detects
85-90% of trisomy 21 cases.
Q12. What is the most accurate method for dating a pregnancy?
☑ Correct Answer: First-trimester ultrasound (crown-rump length between
7-13+6 weeks).
Rationale: CRL has ±5-7 day accuracy; later ultrasounds have wider variability
(±10-14 days in 2nd tri, ±21 days in 3rd tri).
Q13. A patient reports urinary frequency at 10 weeks. What is the cause?
☑ Correct Answer: Growing uterus presses on the bladder in the pelvic
cavity.
Rationale: Frequency improves in second trimester when uterus rises out of
pelvis, then returns in third trimester as fetal head descends.
