NUR 254 Exam 1 Galen College: Maternal-
Pediatric Nursing Prep Questions And Well
Graded Solutions With Rationales Updated
2026-2027
Master your NUR 254 Exam 1 with this expert-curated study guide for Maternal and Pediatric Nursing.
Designed specifically for nursing students, this comprehensive resource covers high-yield exam
concepts: accurate GTPAL obstetric calculations, Naegele’s Rule for due dates, clear differentiation
of pregnancy signs (presumptive, probable, positive), and priority interventions for Vena Cava
Syndrome, preeclampsia, and epidural complications. Boost your confidence and pass on your first
attempt!
1. A patient arrives at the prenatal clinic for her first visit. She states the first day of her
last menstrual period (LMP) was March 15, 2026. Using Naegele’s rule, which date
should the nurse document as the estimated date of delivery (EDD)?
a) December 22, 2026
b) December 15, 2026
c) January 22, 2027
d) November 22, 2026
a) December 22, 2026
Rationale: Naegele's rule is calculated by taking the first day of the LMP (March 15),
subtracting 3 months (December 15), and adding 7 days (December 22) while
advancing the year if applicable.
2. A nurse is reviewing obstetric histories in a prenatal clinic. A patient is
currently 12 weeks pregnant. Her past history includes a birth at 38 weeks (alive), a
birth at 35 weeks (alive), and a spontaneous abortion at 10 weeks. How should the
nurse document her GTPAL?
a) G3, T1, P1, A1, L2
b) G4, T1, P1, A1, L2
c) G4, T2, P0, A1, L2
d) G3, T2, P0, A1, L1
b) G4, T1, P1, A1, L2
Rationale: Gravidity (G) is 4 (current pregnancy, term birth, preterm birth, and
miscarriage). Term (T) is 1 (the 38-week birth). Preterm (P) is 1 (the 35-week birth).
Abortion (A) is 1 (miscarriage before 20 weeks). Living (L) is 2.
,3. During a routine prenatal checkup, a patient at 28 weeks gestation reports
feeling dizzy, lightheaded, and clammy when lying flat on her back. Which
physiological mechanism explains this occurrence?
a) Compression of the aorta by the heavy uterus
b) Compression of the inferior vena cava reducing venous return
c) Sudden drop in blood glucose levels due to fetal demands
d) Normal orthostatic shifts seen in the third trimester
b) Compression of the inferior vena cava reducing venous return
Rationale: Supine hypotensive syndrome occurs when the gravid uterus compresses
the inferior vena cava while the patient is supine. This reduces venous return to the
heart, causing a drop in cardiac output and maternal hypotension.
4. A patient at 20 weeks gestation asks the nurse about the purple-blue
discoloration of her vagina and cervix that the provider noted during her speculum
exam. The nurse knows this is documented as which sign?
a) Goodell’s sign
b) Hegar’s sign
c) Chadwick’s sign
d) Montgomery’s sign
c) Chadwick’s sign
Rationale: Chadwick's sign is a violet-blue discoloration of the vaginal mucosa and
cervix due to increased vascularity. It is classified as a probable sign of pregnancy.
5. Which of the following findings gathered by the nurse during a physical
assessment is classified as a positive, diagnostic sign of pregnancy?
a) A positive urine pregnancy test in the clinic
b) Softening of the lower uterine segment
c) Palpation of fetal movement by an experienced clinician
d) Maternal reports of fetal quickening at 18 weeks
c) Palpation of fetal movement by an experienced clinician
Rationale: Positive signs are completely objective and can only be attributed to a
fetus. These include visualization of the fetus on ultrasound, auscultation of the fetal
heartbeat, and fetal movement felt by the examiner.
6. A nurse is reviewing the lab results of a patient at 10 weeks gestation. The
rubella titer indicates the patient is non-immune. Which action should the nurse
prioritize?
a) Administer the MMR vaccine sub-Q immediately during this visit
b) Document the findings and plan to administer the vaccine postpartum
,c) Inform the patient she must receive an immediate immune globulin injection
d) Request a prescription for oral antiviral medications
b) Document the findings and plan to administer the vaccine postpartum
Rationale: The MMR vaccine contains a live virus and is strictly contraindicated
during pregnancy due to the potential risk of congenital rubella syndrome in the
fetus. It must be administered in the postpartum period.
7. A patient at 36 weeks gestation is admitted to the labor and delivery unit with
a diagnosis of severe preeclampsia. Which assessment finding should the nurse
report to the healthcare provider immediately?
a) 1+ bilateral pitting pedal edema
b) A blood pressure of 142/90 mmHg
c) Epigastric pain and a severe frontal headache
d) Deep tendon reflexes documented at 2+
c) Epigastric pain and a severe frontal headache
Rationale: Epigastric pain indicates hepatic involvement (capsular stretching), and
severe headaches indicate worsening cerebral edema. Both are critical warning
signs of impending seizures (eclampsia).
8. A patient in active labor experiences a spontaneous rupture of membranes.
Which action should the nurse perform first?
a) Document the color, odor, and approximate amount of fluid
b) Perform a sterile vaginal exam to assess cervical dilation
c) Assess the fetal heart rate for a full minute
d) Cleanse the perineal area and apply a fresh underpad
c) Assess the fetal heart rate for a full minute
Rationale: When membranes rupture, the primary immediate risk is umbilical cord
prolapse. Assessing the fetal heart rate immediately allows the nurse to detect
decelerations caused by cord compression.
9. A patient requested an epidural block for labor pain management. Prior to the
anesthesiologist administering the epidural, which intervention is most important for
the nurse to complete?
a) Ensure the patient remains completely NPO
b) Administer a prescribed IV fluid bolus of 500-1000 mL
c) Instruct the patient to empty her bladder completely
d) Place the patient in a high-Fowler's position on the bed
b) Administer a prescribed IV fluid bolus of 500-1000 mL
, Rationale: Epidural anesthesia commonly causes vasodilation leading to maternal
hypotension. Infusing an IV fluid bolus before the procedure helps maintain vascular
volume and blood pressure.
10. A nurse is teaching a group of pregnant patients about nutrition. A patient
mentions that she craves and occasionally eats clean clay from her garden. How
should the nurse interpret and act on this information?
a) Reassure her that this is a normal psychological craving in the second trimester
b) Advise her to limit clay intake to once per week to avoid bowel obstruction
c) Screen the patient for iron-deficiency anemia and check her hemoglobin levels
d) Suggest replacing clay with over-the-counter calcium supplements
c) Screen the patient for iron-deficiency anemia and check her hemoglobin
levels
Rationale: Pica is the consumption of non-food substances (clay, dirt, starch, ice)
and is highly associated with iron-deficiency anemia. The underlying nutritional
deficit must be evaluated.
11. A nurse is assessing a newborn 1 minute after birth. The infant has a heart
rate of 110 bpm, a slow and irregular respiratory effort, some flexion of the
extremities, grimaces in response to a catheter in the nares, and a pink body with
blue extremities. What is the assigned Apgar score?
a) 5
b) 6
c) 7
d) 8
b) 6
Rationale: Heart rate over 100 = 2; slow/irregular respirations = 1; some flexion = 1;
grimace = 1; acrocyanosis (pink body, blue extremities) = 1. Total score = 2 + 1 + 1 +
1 + 1 = 6.
12. A patient is prescribed oral iron supplements for iron-deficiency anemia during
pregnancy. Which liquid should the nurse instruct the patient to take with the iron to
maximize its therapeutic effect?
a) A glass of whole milk
b) A cup of hot green tea
c) A glass of fresh orange juice
d) A serving of liquid antacid
c) glass of fresh orange juice
Pediatric Nursing Prep Questions And Well
Graded Solutions With Rationales Updated
2026-2027
Master your NUR 254 Exam 1 with this expert-curated study guide for Maternal and Pediatric Nursing.
Designed specifically for nursing students, this comprehensive resource covers high-yield exam
concepts: accurate GTPAL obstetric calculations, Naegele’s Rule for due dates, clear differentiation
of pregnancy signs (presumptive, probable, positive), and priority interventions for Vena Cava
Syndrome, preeclampsia, and epidural complications. Boost your confidence and pass on your first
attempt!
1. A patient arrives at the prenatal clinic for her first visit. She states the first day of her
last menstrual period (LMP) was March 15, 2026. Using Naegele’s rule, which date
should the nurse document as the estimated date of delivery (EDD)?
a) December 22, 2026
b) December 15, 2026
c) January 22, 2027
d) November 22, 2026
a) December 22, 2026
Rationale: Naegele's rule is calculated by taking the first day of the LMP (March 15),
subtracting 3 months (December 15), and adding 7 days (December 22) while
advancing the year if applicable.
2. A nurse is reviewing obstetric histories in a prenatal clinic. A patient is
currently 12 weeks pregnant. Her past history includes a birth at 38 weeks (alive), a
birth at 35 weeks (alive), and a spontaneous abortion at 10 weeks. How should the
nurse document her GTPAL?
a) G3, T1, P1, A1, L2
b) G4, T1, P1, A1, L2
c) G4, T2, P0, A1, L2
d) G3, T2, P0, A1, L1
b) G4, T1, P1, A1, L2
Rationale: Gravidity (G) is 4 (current pregnancy, term birth, preterm birth, and
miscarriage). Term (T) is 1 (the 38-week birth). Preterm (P) is 1 (the 35-week birth).
Abortion (A) is 1 (miscarriage before 20 weeks). Living (L) is 2.
,3. During a routine prenatal checkup, a patient at 28 weeks gestation reports
feeling dizzy, lightheaded, and clammy when lying flat on her back. Which
physiological mechanism explains this occurrence?
a) Compression of the aorta by the heavy uterus
b) Compression of the inferior vena cava reducing venous return
c) Sudden drop in blood glucose levels due to fetal demands
d) Normal orthostatic shifts seen in the third trimester
b) Compression of the inferior vena cava reducing venous return
Rationale: Supine hypotensive syndrome occurs when the gravid uterus compresses
the inferior vena cava while the patient is supine. This reduces venous return to the
heart, causing a drop in cardiac output and maternal hypotension.
4. A patient at 20 weeks gestation asks the nurse about the purple-blue
discoloration of her vagina and cervix that the provider noted during her speculum
exam. The nurse knows this is documented as which sign?
a) Goodell’s sign
b) Hegar’s sign
c) Chadwick’s sign
d) Montgomery’s sign
c) Chadwick’s sign
Rationale: Chadwick's sign is a violet-blue discoloration of the vaginal mucosa and
cervix due to increased vascularity. It is classified as a probable sign of pregnancy.
5. Which of the following findings gathered by the nurse during a physical
assessment is classified as a positive, diagnostic sign of pregnancy?
a) A positive urine pregnancy test in the clinic
b) Softening of the lower uterine segment
c) Palpation of fetal movement by an experienced clinician
d) Maternal reports of fetal quickening at 18 weeks
c) Palpation of fetal movement by an experienced clinician
Rationale: Positive signs are completely objective and can only be attributed to a
fetus. These include visualization of the fetus on ultrasound, auscultation of the fetal
heartbeat, and fetal movement felt by the examiner.
6. A nurse is reviewing the lab results of a patient at 10 weeks gestation. The
rubella titer indicates the patient is non-immune. Which action should the nurse
prioritize?
a) Administer the MMR vaccine sub-Q immediately during this visit
b) Document the findings and plan to administer the vaccine postpartum
,c) Inform the patient she must receive an immediate immune globulin injection
d) Request a prescription for oral antiviral medications
b) Document the findings and plan to administer the vaccine postpartum
Rationale: The MMR vaccine contains a live virus and is strictly contraindicated
during pregnancy due to the potential risk of congenital rubella syndrome in the
fetus. It must be administered in the postpartum period.
7. A patient at 36 weeks gestation is admitted to the labor and delivery unit with
a diagnosis of severe preeclampsia. Which assessment finding should the nurse
report to the healthcare provider immediately?
a) 1+ bilateral pitting pedal edema
b) A blood pressure of 142/90 mmHg
c) Epigastric pain and a severe frontal headache
d) Deep tendon reflexes documented at 2+
c) Epigastric pain and a severe frontal headache
Rationale: Epigastric pain indicates hepatic involvement (capsular stretching), and
severe headaches indicate worsening cerebral edema. Both are critical warning
signs of impending seizures (eclampsia).
8. A patient in active labor experiences a spontaneous rupture of membranes.
Which action should the nurse perform first?
a) Document the color, odor, and approximate amount of fluid
b) Perform a sterile vaginal exam to assess cervical dilation
c) Assess the fetal heart rate for a full minute
d) Cleanse the perineal area and apply a fresh underpad
c) Assess the fetal heart rate for a full minute
Rationale: When membranes rupture, the primary immediate risk is umbilical cord
prolapse. Assessing the fetal heart rate immediately allows the nurse to detect
decelerations caused by cord compression.
9. A patient requested an epidural block for labor pain management. Prior to the
anesthesiologist administering the epidural, which intervention is most important for
the nurse to complete?
a) Ensure the patient remains completely NPO
b) Administer a prescribed IV fluid bolus of 500-1000 mL
c) Instruct the patient to empty her bladder completely
d) Place the patient in a high-Fowler's position on the bed
b) Administer a prescribed IV fluid bolus of 500-1000 mL
, Rationale: Epidural anesthesia commonly causes vasodilation leading to maternal
hypotension. Infusing an IV fluid bolus before the procedure helps maintain vascular
volume and blood pressure.
10. A nurse is teaching a group of pregnant patients about nutrition. A patient
mentions that she craves and occasionally eats clean clay from her garden. How
should the nurse interpret and act on this information?
a) Reassure her that this is a normal psychological craving in the second trimester
b) Advise her to limit clay intake to once per week to avoid bowel obstruction
c) Screen the patient for iron-deficiency anemia and check her hemoglobin levels
d) Suggest replacing clay with over-the-counter calcium supplements
c) Screen the patient for iron-deficiency anemia and check her hemoglobin
levels
Rationale: Pica is the consumption of non-food substances (clay, dirt, starch, ice)
and is highly associated with iron-deficiency anemia. The underlying nutritional
deficit must be evaluated.
11. A nurse is assessing a newborn 1 minute after birth. The infant has a heart
rate of 110 bpm, a slow and irregular respiratory effort, some flexion of the
extremities, grimaces in response to a catheter in the nares, and a pink body with
blue extremities. What is the assigned Apgar score?
a) 5
b) 6
c) 7
d) 8
b) 6
Rationale: Heart rate over 100 = 2; slow/irregular respirations = 1; some flexion = 1;
grimace = 1; acrocyanosis (pink body, blue extremities) = 1. Total score = 2 + 1 + 1 +
1 + 1 = 6.
12. A patient is prescribed oral iron supplements for iron-deficiency anemia during
pregnancy. Which liquid should the nurse instruct the patient to take with the iron to
maximize its therapeutic effect?
a) A glass of whole milk
b) A cup of hot green tea
c) A glass of fresh orange juice
d) A serving of liquid antacid
c) glass of fresh orange juice
