NR 327 Maternal-Child Nursing Exam 1 & 2
Comprehensive Review Official Practice
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions |
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SECTION 1: ANTEPARTUM NURSING Q1 – Q8
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Question 1 of 50
A 28-year-old primigravida at 16 weeks gestation presents for her routine prenatal visit. She
reports mild nausea that has improved and no vaginal bleeding. Her fundal height is
measured at 16 cm. The nurse is reviewing expected maternal physiological adaptations.
Which finding requires further assessment?
A. A 15% increase in cardiac output since the first trimester
B. A respiratory rate of 18 breaths per minute with mild dyspnea on exertion ✓ CORRECT
C. A 30% increase in plasma volume with a corresponding rise in red blood cell mass
D. A glomerular filtration rate increase of 40% with mild physiologic anemia
Correct Answer: B
Rationale: While mild dyspnea can occur in pregnancy due to the upward displacement of the
diaphragm, a respiratory rate of 18 with dyspnea at rest or with mild exertion in the second
trimester warrants evaluation for underlying cardiopulmonary pathology, as normal
respiratory rate remains unchanged in pregnancy and significant dyspnea is not a typical
adaptation. The other choices describe normal physiological changes: cardiac output
increases 30-50% primarily from stroke volume, plasma volume expands more than red cell
mass creating the dilutional anemia of pregnancy, and GFR rises substantially without change
in serum creatinine. NGN strategy: Distinguish between expected adaptations and symptoms
that cross the threshold into potential pathology by considering the severity and context of
the finding.
Question 2 of 50
A 34-year-old gravida 2, para 1 at 10 weeks gestation asks the nurse about the effects of
environmental exposures on fetal development. She works in a dental office and is concerned
,about chemical safety. The nurse explains that the critical period for major organ system
formation occurs during which timeframe?
A. From conception through the end of the first trimester
B. From implantation through 8 weeks gestation ✓ CORRECT
C. From 8 weeks through 20 weeks gestation
D. From 20 weeks through delivery
Correct Answer: B
Rationale: The embryonic period, spanning implantation through approximately 8 weeks
gestation, represents the critical window when all major organ systems form and teratogenic
exposure carries the highest risk of structural malformation; this is why the neural tube
closes by 4 weeks and the heart forms by 8 weeks. After 8 weeks, the fetus enters the fetal
period where organs mature and grow, but the risk of major structural defects from
teratogens decreases significantly. The most tempting wrong answer, A, is incorrect because
while conception marks the beginning, the true critical period for organogenesis extends
through 8 weeks, not the entire first trimester. Clinical pearl: When counseling pregnant
patients about workplace chemical exposures, emphasize strict protection during the first 8
weeks when teratogenic risk peaks.
Question 3 of 50
A 22-year-old primigravida at 24 weeks gestation has a pre-pregnancy BMI of 19. During her
prenatal visit, the nurse reviews recommended weight gain parameters. Based on current
guidelines, what total weight gain should this patient aim for by delivery?
A. 11 to 20 pounds
B. 15 to 25 pounds
C. 25 to 35 pounds ✓ CORRECT
D. 28 to 40 pounds
Correct Answer: C
Rationale: For a patient with a normal pre-pregnancy BMI of 18.5 to 24.9, the Institute of
Medicine recommends a total gestational weight gain of 25 to 35 pounds, which supports
optimal fetal growth without increasing the risk of macrosomia or cesarean delivery.
Underweight patients (BMI < 18.5) should gain 28 to 40 pounds, while overweight and obese
patients require less. The distractor A represents the outdated and insufficient
recommendation for obese patients, and confusing these categories is a common exam trap.
Remember that weight gain recommendations are based on pre-pregnancy BMI, not current
gestational weight, and underweight patients actually need the highest gain to support fetal
development.
Question 4 of 50
, A 29-year-old gravida 3, para 2 at 32 weeks gestation is being monitored for preeclampsia
risk factors. Her blood pressure today is 118/72 mmHg, and she has no proteinuria. She asks
the nurse which of her historical factors places her at greatest risk for developing this
complication. Which factor documented in her history is most significant?
A. She is 29 years old, which is considered advanced maternal age
B. She had a previous pregnancy complicated by gestational diabetes
C. She had preeclampsia in her second pregnancy requiring delivery at 35 weeks ✓ CORRECT
D. She has a BMI of 26, which classifies her as overweight
Correct Answer: C
Rationale: A history of preeclampsia in a prior pregnancy is the strongest modifiable risk
factor for recurrence in a subsequent pregnancy, with recurrence rates ranging from 14% to
over 50% depending on severity and gestational age at onset. While advanced maternal age
over 35, gestational diabetes, and elevated BMI are all associated with increased
preeclampsia risk, none carries the predictive weight of a previous affected pregnancy. The
tempting wrong answer B confuses gestational diabetes with preeclampsia risk; while both
are placental disorders, they have distinct pathophysiologies and risk profiles. NGN exam
strategy: When asked to identify the "greatest" risk factor, prioritize direct historical
recurrence over general demographic or metabolic risk factors.
Question 5 of 50
A 26-year-old primigravida at 18 weeks gestation presents to the emergency department with
sudden severe right-sided abdominal pain and vaginal spotting. Her vital signs show a heart
rate of 108 bpm and blood pressure of 92/58 mmHg. Ultrasound reveals no intrauterine
gestational sac, and her quantitative hCG is 4,200 mIU/mL. Which nursing intervention is the
priority?
A. Prepare the patient for immediate laparoscopic surgery ✓ CORRECT
B. Administer methotrexate intramuscularly after confirming fetal cardiac activity
C. Obtain a repeat quantitative hCG level in 48 hours and schedule follow-up
D. Perform a sterile speculum examination to assess cervical dilation
Correct Answer: A
Rationale: This patient presents with ruptured ectopic pregnancy until proven otherwise: she
has an empty uterus on ultrasound with an hCG above the discriminatory zone (1,500-2,000
mIU/mL), hypotension, tachycardia, and acute abdominal pain indicating hemodynamic
instability from intra-abdominal hemorrhage. The priority is immediate surgical intervention
to control bleeding and preserve fertility. The wrong answer B, methotrexate, is
contraindicated in hemodynamically unstable patients, ruptured ectopic pregnancies, and
when fetal cardiac activity is present; methotrexate is reserved for stable, unruptured, small
ectopic gestations. Clinical pearl: In the NGN framework, this tests the "Take Action"
Comprehensive Review Official Practice
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions |
Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: ANTEPARTUM NURSING Q1 – Q8
══════════════════════════════════════
Question 1 of 50
A 28-year-old primigravida at 16 weeks gestation presents for her routine prenatal visit. She
reports mild nausea that has improved and no vaginal bleeding. Her fundal height is
measured at 16 cm. The nurse is reviewing expected maternal physiological adaptations.
Which finding requires further assessment?
A. A 15% increase in cardiac output since the first trimester
B. A respiratory rate of 18 breaths per minute with mild dyspnea on exertion ✓ CORRECT
C. A 30% increase in plasma volume with a corresponding rise in red blood cell mass
D. A glomerular filtration rate increase of 40% with mild physiologic anemia
Correct Answer: B
Rationale: While mild dyspnea can occur in pregnancy due to the upward displacement of the
diaphragm, a respiratory rate of 18 with dyspnea at rest or with mild exertion in the second
trimester warrants evaluation for underlying cardiopulmonary pathology, as normal
respiratory rate remains unchanged in pregnancy and significant dyspnea is not a typical
adaptation. The other choices describe normal physiological changes: cardiac output
increases 30-50% primarily from stroke volume, plasma volume expands more than red cell
mass creating the dilutional anemia of pregnancy, and GFR rises substantially without change
in serum creatinine. NGN strategy: Distinguish between expected adaptations and symptoms
that cross the threshold into potential pathology by considering the severity and context of
the finding.
Question 2 of 50
A 34-year-old gravida 2, para 1 at 10 weeks gestation asks the nurse about the effects of
environmental exposures on fetal development. She works in a dental office and is concerned
,about chemical safety. The nurse explains that the critical period for major organ system
formation occurs during which timeframe?
A. From conception through the end of the first trimester
B. From implantation through 8 weeks gestation ✓ CORRECT
C. From 8 weeks through 20 weeks gestation
D. From 20 weeks through delivery
Correct Answer: B
Rationale: The embryonic period, spanning implantation through approximately 8 weeks
gestation, represents the critical window when all major organ systems form and teratogenic
exposure carries the highest risk of structural malformation; this is why the neural tube
closes by 4 weeks and the heart forms by 8 weeks. After 8 weeks, the fetus enters the fetal
period where organs mature and grow, but the risk of major structural defects from
teratogens decreases significantly. The most tempting wrong answer, A, is incorrect because
while conception marks the beginning, the true critical period for organogenesis extends
through 8 weeks, not the entire first trimester. Clinical pearl: When counseling pregnant
patients about workplace chemical exposures, emphasize strict protection during the first 8
weeks when teratogenic risk peaks.
Question 3 of 50
A 22-year-old primigravida at 24 weeks gestation has a pre-pregnancy BMI of 19. During her
prenatal visit, the nurse reviews recommended weight gain parameters. Based on current
guidelines, what total weight gain should this patient aim for by delivery?
A. 11 to 20 pounds
B. 15 to 25 pounds
C. 25 to 35 pounds ✓ CORRECT
D. 28 to 40 pounds
Correct Answer: C
Rationale: For a patient with a normal pre-pregnancy BMI of 18.5 to 24.9, the Institute of
Medicine recommends a total gestational weight gain of 25 to 35 pounds, which supports
optimal fetal growth without increasing the risk of macrosomia or cesarean delivery.
Underweight patients (BMI < 18.5) should gain 28 to 40 pounds, while overweight and obese
patients require less. The distractor A represents the outdated and insufficient
recommendation for obese patients, and confusing these categories is a common exam trap.
Remember that weight gain recommendations are based on pre-pregnancy BMI, not current
gestational weight, and underweight patients actually need the highest gain to support fetal
development.
Question 4 of 50
, A 29-year-old gravida 3, para 2 at 32 weeks gestation is being monitored for preeclampsia
risk factors. Her blood pressure today is 118/72 mmHg, and she has no proteinuria. She asks
the nurse which of her historical factors places her at greatest risk for developing this
complication. Which factor documented in her history is most significant?
A. She is 29 years old, which is considered advanced maternal age
B. She had a previous pregnancy complicated by gestational diabetes
C. She had preeclampsia in her second pregnancy requiring delivery at 35 weeks ✓ CORRECT
D. She has a BMI of 26, which classifies her as overweight
Correct Answer: C
Rationale: A history of preeclampsia in a prior pregnancy is the strongest modifiable risk
factor for recurrence in a subsequent pregnancy, with recurrence rates ranging from 14% to
over 50% depending on severity and gestational age at onset. While advanced maternal age
over 35, gestational diabetes, and elevated BMI are all associated with increased
preeclampsia risk, none carries the predictive weight of a previous affected pregnancy. The
tempting wrong answer B confuses gestational diabetes with preeclampsia risk; while both
are placental disorders, they have distinct pathophysiologies and risk profiles. NGN exam
strategy: When asked to identify the "greatest" risk factor, prioritize direct historical
recurrence over general demographic or metabolic risk factors.
Question 5 of 50
A 26-year-old primigravida at 18 weeks gestation presents to the emergency department with
sudden severe right-sided abdominal pain and vaginal spotting. Her vital signs show a heart
rate of 108 bpm and blood pressure of 92/58 mmHg. Ultrasound reveals no intrauterine
gestational sac, and her quantitative hCG is 4,200 mIU/mL. Which nursing intervention is the
priority?
A. Prepare the patient for immediate laparoscopic surgery ✓ CORRECT
B. Administer methotrexate intramuscularly after confirming fetal cardiac activity
C. Obtain a repeat quantitative hCG level in 48 hours and schedule follow-up
D. Perform a sterile speculum examination to assess cervical dilation
Correct Answer: A
Rationale: This patient presents with ruptured ectopic pregnancy until proven otherwise: she
has an empty uterus on ultrasound with an hCG above the discriminatory zone (1,500-2,000
mIU/mL), hypotension, tachycardia, and acute abdominal pain indicating hemodynamic
instability from intra-abdominal hemorrhage. The priority is immediate surgical intervention
to control bleeding and preserve fertility. The wrong answer B, methotrexate, is
contraindicated in hemodynamically unstable patients, ruptured ectopic pregnancies, and
when fetal cardiac activity is present; methotrexate is reserved for stable, unruptured, small
ectopic gestations. Clinical pearl: In the NGN framework, this tests the "Take Action"
