NUR 631 EXAM 4 QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS | NEW
UPDATE 2026 | 100% CORRECT | /GRADE A+ ASSURED
Question 1
Which of the following physiological changes is considered normal during a healthy pregnancy?
A) Increased systemic vascular resistance (SVR)
B) Decreased heart rate
C) Increased blood volume
D) Decreased glomerular filtration rate (GFR)
E) Respiratory acidosis
Correct Answer: C) increased blood volume
Rationale: During pregnancy, blood volume increases by 40-50% to support the fetus and
protect the mother from hemorrhage during delivery. Other normal changes include
decreased SVR, increased HR, increased GFR, and a compensatory respiratory alkalosis.
Question 2
A patient at 20 weeks gestation is being assessed. Where should the Nurse Practitioner expect to
palpate the fundus?
A) At the pubic symphysis
B) Halfway between the pubic symphysis and the umbilicus
C) At the umbilicus
D) Near the xiphoid process
E) It is not yet palpable abdominally
Correct Answer: C) at umbilicus
Rationale: The fundal height serves as a landmark for gestational age. At 12 weeks, the
uterus is at the pubic symphysis; at 20 weeks, it reaches the umbilicus; and by 36 weeks, it
is near the xiphoid process.
Question 3
Using Naegele’s Rule, calculate the Estimated Due Date (EDD) for a patient whose Last
Menstrual Period (LMP) began on July 10, 2024.
A) April 10, 2025
B) April 17, 2025
C) May 17, 2025
D) March 17, 2025
E) April 3, 2025
Correct Answer: B) April 17, 2025
Rationale: Naegele’s Rule is calculated by adding 7 days to the first day of the LMP,
subtracting 3 months, and adding 1 year. July 10 + 7 days = July 17. July 17 minus 3
months = April 17. Adding 1 year results in April 17, 2025.
Question 4
A woman is currently pregnant, has two children born at 39 weeks, and had one miscarriage at
10 weeks. What is her GTPAL?
, 2
A) G3 T2 P0 A1 L2
B) G4 T2 P0 A1 L2
C) G4 T3 P0 A0 L2
D) G3 T2 P1 A0 L3
E) G4 T2 P1 A1 L2
Correct Answer: B) G4 T2 P0 A1 L2
Rationale: G (Gravida) is total pregnancies: 2 (living) + 1 (miscarriage) + 1 (current) = 4. T
(Term) is births >37 weeks: 2. P (Preterm) is births 20-36 weeks: 0. A
(Abortion/Miscarriage) <20 weeks: 1. L (Living): 2.
Question 5
During a pelvic exam, the Nurse Practitioner notes a bluish-purple discoloration of the cervix
and vaginal mucosa. This is known as:
A) Goodell’s sign
B) Hegar’s sign
C) Chadwick’s sign
D) Murphy’s sign
E) McBurney’s sign
Correct Answer: C) chadwick's sign
Rationale: Chadwick’s sign is a bluish discoloration of the cervix, vagina, and labia caused
by increased vascular congestion. It is considered a presumptive sign of pregnancy.
Question 6
The softening of the lower uterine segment (isthmus) found during the physical exam of a
pregnant woman is called:
A) Chadwick’s sign
B) Goodell’s sign
C) Hegar’s sign
D) Psoas sign
E) Cullen’s sign
Correct Answer: C) hegar's sign
Rationale: Hegar's sign is the softening of the uterine isthmus, the area where the cervix
connects to the body of the uterus. This typically occurs around 6–8 weeks of gestation.
Question 7
A pregnant patient at 32 weeks gestation complains of sudden, painless vaginal bleeding. Which
condition should the clinician suspect first?
A) Placental abruption
B) Ectopic pregnancy
C) Placenta previa
D) Gestational hypertension
, 3
E) Premature rupture of membranes
Correct Answer: C) Placenta previa
Rationale: Placenta previa is characterized by the implantation of the placenta over the
cervical os and typically presents as painless, bright red bleeding in the third trimester.
This is a medical emergency requiring ultrasound confirmation.
Question 8
Which of the following describes the correct timing for screening for Gestational Diabetes
Mellitus (GDM)?
A) Initial prenatal visit
B) 12–16 weeks
C) 24–28 weeks
D) 35–37 weeks
E) Only if the patient is obese
Correct Answer: C) 24-28 weeks
Rationale: Routine screening for gestational diabetes using a glucose tolerance test (GTT) is
performed between 24 and 28 weeks gestation, when insulin resistance typically increases
due to placental hormones.
Question 9
When should a pregnant woman be screened for Group B Streptococcus (GBS)?
A) 12–16 weeks
B) 20–24 weeks
C) 28–32 weeks
D) 35–37 weeks
E) During active labor only
Correct Answer: D) 35-37 weeks
Rationale: GBS screening involves a vaginal/rectal swab performed at 35–37 weeks. If
positive, the mother receives prophylactic antibiotics during labor to prevent neonatal
sepsis.
Question 10
A patient presents with unilateral pelvic pain, vaginal bleeding, and a missed period. These
symptoms are classic for:
A) Pre-eclampsia
B) Placental abruption
C) Ectopic pregnancy
D) Gestational diabetes
E) HELLP syndrome
Correct Answer: C) Ectopic pregnancy
Rationale: Ectopic pregnancy (pregnancy outside the uterus) typically presents with the
, 4
triad of abdominal/pelvic pain, vaginal bleeding, and amenorrhea. It is a surgical
emergency if rupture occurs.
Question 11
Which finding on a urinalysis during a prenatal visit for a patient with a blood pressure of 150/94
mmHg would point toward a diagnosis of Pre-eclampsia?
A) Glucosuria
B) Hematuria
C) Proteinuria
D) Ketonuria
E) Nitrites
Correct Answer: C) hypertension + proteinuria.
Rationale: Pre-eclampsia is defined as new-onset hypertension (BP ≥140/90) after 20 weeks
gestation combined with proteinuria or other signs of end-organ damage.
Question 12
The "HELLP" acronym in the context of severe pre-eclampsia stands for:
A) High Estrogen, Low Lipids, Proteinuria
B) Hemolysis, Elevated Liver enzymes, Low Platelets
C) Hypertension, Edema, Liver Loss, Pain
D) Hepatic Encephalopathy, Low Lymphocytes, Proteinuria
E) Hemolysis, Elevated Lipids, Low Potassium
Correct Answer: B) hemolysis, elevated liver enzymes, low platelets
Rationale: HELLP syndrome is a life-threatening variant of pre-eclampsia. Clinical signs
often include RUQ pain (liver distention) and systemic symptoms of multi-organ
involvement.
Question 13
A patient with a normal pre-pregnancy BMI (18.5–24.9) should be counseled to gain how much
weight during pregnancy?
A) 11–20 lbs
B) 15–25 lbs
C) 25–35 lbs
D) 28–40 lbs
E) As much as they want
Correct Answer: C) 25-35 lbs
Rationale: Weight gain guidelines are based on pre-pregnancy BMI. For a normal BMI, 25-
35 lbs is recommended. Overweight patients should gain 15-25 lbs, while obese patients
should gain 11-20 lbs.
UPDATE 2026 | 100% CORRECT | /GRADE A+ ASSURED
Question 1
Which of the following physiological changes is considered normal during a healthy pregnancy?
A) Increased systemic vascular resistance (SVR)
B) Decreased heart rate
C) Increased blood volume
D) Decreased glomerular filtration rate (GFR)
E) Respiratory acidosis
Correct Answer: C) increased blood volume
Rationale: During pregnancy, blood volume increases by 40-50% to support the fetus and
protect the mother from hemorrhage during delivery. Other normal changes include
decreased SVR, increased HR, increased GFR, and a compensatory respiratory alkalosis.
Question 2
A patient at 20 weeks gestation is being assessed. Where should the Nurse Practitioner expect to
palpate the fundus?
A) At the pubic symphysis
B) Halfway between the pubic symphysis and the umbilicus
C) At the umbilicus
D) Near the xiphoid process
E) It is not yet palpable abdominally
Correct Answer: C) at umbilicus
Rationale: The fundal height serves as a landmark for gestational age. At 12 weeks, the
uterus is at the pubic symphysis; at 20 weeks, it reaches the umbilicus; and by 36 weeks, it
is near the xiphoid process.
Question 3
Using Naegele’s Rule, calculate the Estimated Due Date (EDD) for a patient whose Last
Menstrual Period (LMP) began on July 10, 2024.
A) April 10, 2025
B) April 17, 2025
C) May 17, 2025
D) March 17, 2025
E) April 3, 2025
Correct Answer: B) April 17, 2025
Rationale: Naegele’s Rule is calculated by adding 7 days to the first day of the LMP,
subtracting 3 months, and adding 1 year. July 10 + 7 days = July 17. July 17 minus 3
months = April 17. Adding 1 year results in April 17, 2025.
Question 4
A woman is currently pregnant, has two children born at 39 weeks, and had one miscarriage at
10 weeks. What is her GTPAL?
, 2
A) G3 T2 P0 A1 L2
B) G4 T2 P0 A1 L2
C) G4 T3 P0 A0 L2
D) G3 T2 P1 A0 L3
E) G4 T2 P1 A1 L2
Correct Answer: B) G4 T2 P0 A1 L2
Rationale: G (Gravida) is total pregnancies: 2 (living) + 1 (miscarriage) + 1 (current) = 4. T
(Term) is births >37 weeks: 2. P (Preterm) is births 20-36 weeks: 0. A
(Abortion/Miscarriage) <20 weeks: 1. L (Living): 2.
Question 5
During a pelvic exam, the Nurse Practitioner notes a bluish-purple discoloration of the cervix
and vaginal mucosa. This is known as:
A) Goodell’s sign
B) Hegar’s sign
C) Chadwick’s sign
D) Murphy’s sign
E) McBurney’s sign
Correct Answer: C) chadwick's sign
Rationale: Chadwick’s sign is a bluish discoloration of the cervix, vagina, and labia caused
by increased vascular congestion. It is considered a presumptive sign of pregnancy.
Question 6
The softening of the lower uterine segment (isthmus) found during the physical exam of a
pregnant woman is called:
A) Chadwick’s sign
B) Goodell’s sign
C) Hegar’s sign
D) Psoas sign
E) Cullen’s sign
Correct Answer: C) hegar's sign
Rationale: Hegar's sign is the softening of the uterine isthmus, the area where the cervix
connects to the body of the uterus. This typically occurs around 6–8 weeks of gestation.
Question 7
A pregnant patient at 32 weeks gestation complains of sudden, painless vaginal bleeding. Which
condition should the clinician suspect first?
A) Placental abruption
B) Ectopic pregnancy
C) Placenta previa
D) Gestational hypertension
, 3
E) Premature rupture of membranes
Correct Answer: C) Placenta previa
Rationale: Placenta previa is characterized by the implantation of the placenta over the
cervical os and typically presents as painless, bright red bleeding in the third trimester.
This is a medical emergency requiring ultrasound confirmation.
Question 8
Which of the following describes the correct timing for screening for Gestational Diabetes
Mellitus (GDM)?
A) Initial prenatal visit
B) 12–16 weeks
C) 24–28 weeks
D) 35–37 weeks
E) Only if the patient is obese
Correct Answer: C) 24-28 weeks
Rationale: Routine screening for gestational diabetes using a glucose tolerance test (GTT) is
performed between 24 and 28 weeks gestation, when insulin resistance typically increases
due to placental hormones.
Question 9
When should a pregnant woman be screened for Group B Streptococcus (GBS)?
A) 12–16 weeks
B) 20–24 weeks
C) 28–32 weeks
D) 35–37 weeks
E) During active labor only
Correct Answer: D) 35-37 weeks
Rationale: GBS screening involves a vaginal/rectal swab performed at 35–37 weeks. If
positive, the mother receives prophylactic antibiotics during labor to prevent neonatal
sepsis.
Question 10
A patient presents with unilateral pelvic pain, vaginal bleeding, and a missed period. These
symptoms are classic for:
A) Pre-eclampsia
B) Placental abruption
C) Ectopic pregnancy
D) Gestational diabetes
E) HELLP syndrome
Correct Answer: C) Ectopic pregnancy
Rationale: Ectopic pregnancy (pregnancy outside the uterus) typically presents with the
, 4
triad of abdominal/pelvic pain, vaginal bleeding, and amenorrhea. It is a surgical
emergency if rupture occurs.
Question 11
Which finding on a urinalysis during a prenatal visit for a patient with a blood pressure of 150/94
mmHg would point toward a diagnosis of Pre-eclampsia?
A) Glucosuria
B) Hematuria
C) Proteinuria
D) Ketonuria
E) Nitrites
Correct Answer: C) hypertension + proteinuria.
Rationale: Pre-eclampsia is defined as new-onset hypertension (BP ≥140/90) after 20 weeks
gestation combined with proteinuria or other signs of end-organ damage.
Question 12
The "HELLP" acronym in the context of severe pre-eclampsia stands for:
A) High Estrogen, Low Lipids, Proteinuria
B) Hemolysis, Elevated Liver enzymes, Low Platelets
C) Hypertension, Edema, Liver Loss, Pain
D) Hepatic Encephalopathy, Low Lymphocytes, Proteinuria
E) Hemolysis, Elevated Lipids, Low Potassium
Correct Answer: B) hemolysis, elevated liver enzymes, low platelets
Rationale: HELLP syndrome is a life-threatening variant of pre-eclampsia. Clinical signs
often include RUQ pain (liver distention) and systemic symptoms of multi-organ
involvement.
Question 13
A patient with a normal pre-pregnancy BMI (18.5–24.9) should be counseled to gain how much
weight during pregnancy?
A) 11–20 lbs
B) 15–25 lbs
C) 25–35 lbs
D) 28–40 lbs
E) As much as they want
Correct Answer: C) 25-35 lbs
Rationale: Weight gain guidelines are based on pre-pregnancy BMI. For a normal BMI, 25-
35 lbs is recommended. Overweight patients should gain 15-25 lbs, while obese patients
should gain 11-20 lbs.
