Module 8 Practice Questions

Question 1

What is the proper way to obtain a blood pressure reading in pregnancy?

Answer 1

-repeat readings after the patient has rested for at least 10 minutes
-seated with back support and legs uncrossed
-no caffeine or tobacco consumption in the last 30m
-proper sized cuff
-positioned at level of the heart
-Ensure proper calibration for automatic cuff

Question 2

Maternal hypertension increases the risks for:
A. Preterm delivery
B. Fetal growth restriction
C. Maternal congestive heart failure
D. All of the above

Answer 2

D. All of the above

Question 3

The CNM is providing an in-service to a group of new labor and delivery nurse graduates about the pathophysiology of preeclampsia. Which statement by one of the group participants demonstrates they understood how this condition develops?
A. “The basal arteries of the myometrium fail to widen to support blood flow to the placenta.”
B. “The placenta experiences ischemia because the spiral arteries of the uterus fail to reshape and increase in diameter.”
C. “The cardiovascular system of the mother fails to compensate for the increased blood flow from the fetus and placental ischemia occurs.”
D. “If the mother experience uncontrolled hypertension and proteinuria, it compromises blood flow to the placenta and leads to
preeclampsia.”

Answer 3

B. “The placenta experiences ischemia because the spiral arteries of the uterus fail to reshape and increase in diameter.”

Question 4

Over the past two visits, a G2P1 at 32 weeks has had elevated BPs of 145/93 and 152/94 with headaches that are not relieved with Tylenol. The CNM is suspicious for preeclampsia. Which of the following is the
best lab test for proteinuria in this patient?
A. A urine dipstick urinalysis
B. A protein/creatinine ratio
C. A urine culture
D. None of the above

Answer 4

B. A protein/creatinine ratio

note: a 24 hour urine could also be done

Question 5

A patient at 37 weeks gestation reports seeing “specks” recently accompanied by RUQ pain that has not gone away with rest or Tylenol.
Her VS are 160/112 and 158/106, HR 98, RR 12, T 97.4 F, urine dip +3 protein. The CNM is suspicious for:
A. Gestational Hypertension with severe features
B. Gestational hypertension without severe features
C. Preeclampsia without severe features
D. Preeclampsia with severe features

Answer 5

D. Preeclampsia with severe features

Question 6

A patient at 12 weeks presents for her second prenatal visit. Last visit, her BP was 150/92. Today, her initial BP is 152/90 and 146/92 thirty minutes later. Her urine dip is WNL. What is the most likely diagnosis?
A. Chronic Hypertension
B. Chronic Hypertension with superimposed preeclampsia
C. Gestational Hypertension
D. Gestational Hypertension with severe features
E. Preeclampsia

Answer 6

A. Chronic Hypertension

Question 7

Which of the following steps can help prevent preeclampsia from occurring in pregnancy among individuals at high risk who do not have a preexisting hypertensive disorder?
A. Prescribe oral labetalol
B. Recommend low-dose daily aspirin (ASA)
C. Suggest reducing dietary sodium
D. Supplement with magnesium

Answer 7

B. Recommend low-dose daily aspirin (ASA)

Question 8

The CNM is seeing a 36-year-old G1P0 at 16 weeks gestation with a BMI of 30. Her early glucose screen was 120 mg/dL. Today, her BP readings are 140/90 and 146/90 twenty minutes later. Her prior BPs have ranged
120-130 systolic and 78-86 diastolic. Her urine dipstick has consistently been negative for protein. What is your most likely diagnosis?
A. Gestational HTN without severe features
B. Preeclampsia without severe features
C. Chronic HTN

Answer 8

C. Chronic HTN

Question 9

At 24 weeks your patient with chronic HTN returns to office. the patient’s BPs remain elevated in 140s/90s. She reports that she denies headaches, vision changes, or abdominal pain. You notice 3+ proteinuria on her urine U/A; therefore, you order a 24-hr urine that
shows 300 mg of protein. What is the most likely diagnosis?
A. Chronic HTN
B. Chronic HTN with superimposed preeclampsia
C. Gestational HTN without severe features
D. Preeclampsia without severe features

Answer 9

B. Chronic HTN with superimposed preeclampsia

Question 10

What should be ordered for a patient with a history of chronic HTN for the past 5 years?
A. CBC
B. Liver enzymes (AST and ALT)
C. EKG or echocardiogram
D. Spot urine protein/creatinine ratio
E. All of the above

Answer 10

E. All of the above

Question 11

The CNM is reviewing the laboratory test results of a pregnant client. Which one of the following findings would alert the CNM to the
development of HELLP syndrome?
A.Hyperglycemia
B. Elevated platelet count
C. Leukocytosis
D. Elevated liver enzymes

Answer 11

D. Elevated liver enzymes

Question 12

What is the recommended delivery plan for preeclampsia without severe features and reassuring maternal and fetal status?
A. Delivery at 37 0/7 weeks
B. Delivery at 38 0/7 weeks
C. Delivery at 39 0/7 weeks
D. Delivery at 40 0/7 weeks

Answer 12

A. Delivery at 37 0/7 weeks

Question 13

When are antihypertensives recommended for the management of gestational hypertension or preeclampsia?
A. 140/90
B. 150/100
C. 160/110
D. All of the above

Answer 13

C. 160/110

Question 14

A prenatal patient at 36 3/7 gestation arrives to L&D triage reporting persistent RUQ pain, SOB, and blurred vision. Her BP is 168/114 sitting and 164/112 reclining with 3+ proteinuria on U/A dipstick. The nurse midwife anticipates that the MD will take what action:
A. Order Magnesium sulfate IV
B. Order Nifedipine 20 mg po
C. Order IV Labetalol 20 mg
D. Both A and B
E. Both A and C

Answer 14

E. Both A and C

Question 15

A patient with severe preeclampsia has an infusion of magnesium sulfate running. What are signs of magnesium toxicity?

Answer 15

-Loss of DTR
-Decrease UOP
-Resp depression
-Cardiac arrest

Question 16

A 37 week pregnant patient is admitted with severe preeclampsia. The patient begins to experience a tonic-clonic seizure. What is the
recommended treatment?
A. Magnesium sulfate bolus
B. IV Nifedipine
C. Calcium gluconate
D. None of the above

Answer 16

A. Magnesium sulfate bolus

Question 17

A G2P1 at 29 weeks with a history of mitral valve prolapse (MVP) asks the CNM how this will affect her pregnancy. Which is the best statement by the CNM?
A. “MVP increases the risk of endocarditis. It is best to take antibiotics prophylactically when you have a dental procedure and
when you go into labor.”
B. “With MVP, I recommend that you take antibiotics prior to any dental procedures. However, it is not recommended to take
antibiotics during labor unless there are active infections present.”
C. “Prophylactic antibiotics are not recommended prior to dental procedures, vaginal deliveries, or cesarean deliveries.”

Answer 17

C. “Prophylactic antibiotics are not recommended prior to dental procedures, vaginal deliveries, or cesarean deliveries.”

Question 18

At 24 hours of age a critical congenital heart disease screen (CCHD) is done with an oxygen saturation of 92% in both extremities. The next step is to

Answer 18

repeat the screen two more times at least an hour apart.

Question 19

Management for chronic hypertension during pregnancy may include:

Answer 19

-ordering an electrocardiogram (EKG)
-taking low dose aspirin
-antihypertensives like labetalol, nifedipine, or methyldopa.
-ordering baseline liver function tests
-ordering 24 hour urine for protein and creatinine
-maintaining BP within 120-160/80-110 mmHg
-ordering a serum creatinine

Question 20

Newborn cyanotic heart defects
-exhibit central cyanosis when at least 3 g/hemoglobin is no longer bound to oxygen/100 mL of blood.
-improve with a hyperoxia challenge test.
-include ventricular septal defects (VSD).
-occur when blood is shunted from the right side of the heart to the left side.

Answer 20

-occur when blood is shunted from the right side of the heart to the left side.

Question 21

Initial management of an eclamptic seizure is

Answer 21

magnesium sulfate 4-6 g IV over 15-20 minutes.

Question 22

A 37-year-old African American G1P0 @ 30 weeks gestation is sent to the hospital for additional evaluation of the following prenatal findings

BP 140/92, P 80, R 16

urine protein negative

1+ pretibial edema

2 lb/2 weeks weight gain

1+ deep tendon reflexes (DTRs), negative clonus

denies headache, visual disturbances, or right upper quadrant pain

Her BP continues to be elevated in the hospital. Laboratory work is normal. The nurse-midwife’s assessment (A) and management plan (P) include

Answer 22

A: Gestational hypertension; P: home with reduced activity, call back with preeclampsia signs, return to office in two days.

Question 23

Diagnostic criteria for HELLP syndrome include

Answer 23

-platelets < 100,000/µL
-Elevated lactic acid dehydrogenase (LDH) (> 600 IU/L)
-Elevated indirect bilirubin
-Serum Aspartate amino transferase (AST) ≥ 70 IU/L

Question 24

While examining a term 4-week old infant a machinery continuous murmur that increases during systole is noted. Bounding brachial pulses increase the likelihood of a patent ductus arteriosis (PDA). The finding is considered

Answer 24

abnormal with functional closure occurring typically between 24-48 hours of birth.

Question 25

While making postpartum rounds the nurse-midwife notices that a newborn at 24 hours of age has a bluish discoloration around the mouth with pink mucous membranes. Otherwise, the infant appears asymptomatic. An appropriate assessment (A) and management plan (P) includes

Answer 25

A: circumoral cyanosis; P: benign condition, expectant managment.

Question 26

What information do the following preeclampsia lab tests provide? H/H

Question 27

What information do the following preeclampsia lab tests provide? LFTs

Question 28

What information do the following preeclampsia lab tests provide? LDH

Question 29

What information do the following preeclampsia lab tests provide? Plts

Question 30

What information do the following preeclampsia lab tests provide? Serum creatinine

Question 31

What information do the following preeclampsia lab tests provide? P/C

Question 32

A 20-year-old Caucasian G1P0 at 34 weeks gestation is seen with the following prenatal findings

BP 150/92, P 80, R 16

urine protein negative

2+ pretibial edema

4 lb/2weeks weight gain

1+ deep tendon reflexes (DTRs), negative clonus

admits to having blurred vision and headaches for the past 24 hours unrelieved with rest, Tylenol, and hydration. Appropriate assessment (A) and management plan (P) include

Answer 32

A: Severe Preeclampsia; P: admit to inpatient, order complete blood count (CBC), liver enzymes, serum creatinine, lactic acid dehydrogenase (LDH), and 24-hour urine for protein, refer to obstetrician.

Question 33

Which conditions are classified as acyanotic heart disease? (choose all that apply)
-Tetrology of Fallot
-Patent ductus arteriosis
-Atrial septal defect
-Pulmonary atresia
-Ventricular septal defect
-Transposition of the great arteries

Answer 33

-Patent ductus arteriosis
-Atrial septal defect
-Ventricular septal defect

Question 34

While making postpartum rounds you note that a newborn is in his bassinet, eyes alert, in no apparent distress. However, the baby has central cyanosis. This is most likely —- in origin.

Answer 34

cardiac