~ob midterm~ Flashcards
A pregnant woman at her first prenatal visit has an antibody screen showing the presence of anti-D antibodies. What is the priority intervention?
A. Administer RhoGAM.
B. Monitor for fetal anemia.
C. Repeat the antibody screen at 28 weeks.
D. Schedule a cesarean delivery.
Answer: B
Rationale: Anti-D antibodies indicate isoimmunization. The fetus is at risk for anemia, and monitoring with Doppler or amniocent
A patient’s prenatal labs show HBsAG positive. What immediate action is necessary for the newborn after delivery?
A. Administer HBIG and the hepatitis B vaccine.
B. Test the infant for HBsAG.
C. Delay breastfeeding until further evaluation.
D. Start antiviral therapy for the infant.
Answer: A
Rationale: HBIG and the hepatitis B vaccine reduce the risk of vertical transmission and should be given within 12 hours of birth.
A rubella screen shows non-immunity in a pregnant patient. What is the appropriate teaching?
A. Avoid pregnancy for three months after the rubella vaccine.
B. Receive the rubella vaccine during the second trimester.
C. Avoid individuals with rubella during pregnancy.
D. Rubella infection poses no risk to the fetus after 24 weeks.
Answer: C
Rationale: Live vaccines like MMR cannot be given during pregnancy. Avoiding exposure is essential.
Which lab result is consistent with preeclampsia?
A. Platelets 200,000/µL.
B. Protein/creatinine ratio 0.5.
C. LDH 350 U/L.
D. Uric acid 4.0 mg/dL.
Answer: C
Rationale: Elevated LDH reflects hemolysis and tissue damage, common in preeclampsia.
A GBS-positive patient is in labor. Which intervention is appropriate?
A. Administer a single dose of antibiotics postpartum.
B. Begin intrapartum penicillin G prophylaxis.
C. Test the newborn for GBS infection after delivery.
D. Schedule an immediate cesarean delivery.
Answer: B
Rationale: Intrapartum antibiotic prophylaxis reduces the risk of neonatal GBS infection
A pregnant woman presents with a platelet count of 90,000/µL. What condition is suspected?
A. Gestational thrombocytopenia.
B. Idiopathic thrombocytopenic purpura.
C. Preeclampsia with severe features.
D. HELLP syndrome.
Answer: D
Rationale: HELLP syndrome often presents with thrombocytopenia (<100,000/µL).
A uric acid level of 7.5 mg/dL in a pregnant patient most likely indicates:
A. Preeclampsia.
B. Hyperemesis gravidarum.
C. Gestational diabetes.
D. Normal pregnancy changes.
Answer: A
Rationale: Elevated uric acid is a marker for preeclampsia.
Which lab abnormality is most concerning in a pregnant woman with hypertension?
A. Hemoglobin 12.5 g/dL.
B. Protein/creatinine ratio 0.8.
C. ALT 70 U/L.
D. WBC 14,000/µL.
Answer: C
Rationale: Elevated ALT suggests liver dysfunction, which can be part of severe preeclampsia.
A fetal heart rate (FHR) strip shows moderate variability. What does this indicate about fetal well-being?
A. Fetal acidosis.
B. Adequate oxygenation and CNS function.
C. Cord compression.
D. Uteroplacental insufficiency.
Answer: B
Rationale: Moderate variability is a reassuring sign of fetal well-being.
What is the significance of absent variability on a fetal heart rate strip?
A. Fetal sleep cycle.
B. Normal finding in early gestation.
C. Potential fetal hypoxia or acidosis.
D. Cord compression.
Answer: C
Rationale: Absent variability may indicate fetal hypoxia or metabolic acidosis.
An FHR strip shows an increase of 20 bpm lasting 15 seconds. How should the nurse interpret this finding?
A. Early deceleration.
B. Normal acceleration.
C. Late deceleration.
D. Prolonged deceleration.
Answer: B
Rationale: Accelerations indicate fetal oxygenation and well-being.
What intervention is appropriate for late decelerations on an FHR strip?
A. Administer oxygen to the mother.
B. Increase oxytocin infusion.
C. Perform an amnioinfusion.
D. Encourage maternal ambulation.
Answer: A
Rationale: Late decelerations indicate uteroplacental insufficiency; oxygen improves fetal oxygenation.
A pregnant woman at 32 weeks has an elevated protein/creatinine ratio. What condition is likely?
A. Normal pregnancy finding.
B. Gestational diabetes.
C. Preeclampsia.
D. Placenta previa.
Answer: C
Rationale: A protein/creatinine ratio >0.3 is diagnostic for preeclampsia.
An FHR strip shows minimal variability and recurrent late decelerations. What does this suggest about fetal status?
A. Fetal hypoxia or acidosis.
B. Cord compression.
C. Fetal sleep cycle.
D. Normal findings for gestational age.
Answer: A
Rationale: Minimal variability with late decelerations suggests fetal compromise.
What is the priority intervention for a patient with severe preeclampsia and elevated liver enzymes?
A. Administer antihypertensives.
B. Administer magnesium sulfate.
C. Prepare for immediate delivery.
D. Restrict maternal fluid intake.
Answer: B
Rationale: Magnesium sulfate is used to prevent seizures in severe preeclampsia.
**A pregnant woman at 36 weeks is GBS-positive and allergic to penicillin. What is the alternative prophylactic antibiotic of choice?
A. Cefazolin
B. Erythromycin
C. Vancomycin
D. Gentamicin
Answer: A
Rationale: Cefazolin is the first-line alternative for GBS prophylaxis in penicillin-allergic patients who are not at high risk for anaphylaxis.
A patient with HELLP syndrome presents with hemolysis, elevated liver enzymes, and a platelet count of 85,000/µL. What is the priority nursing action?
A. Administer corticosteroids.
B. Prepare for immediate delivery.
C. Begin platelet transfusion.
D. Monitor liver function weekly.
Answer: B
Rationale: Delivery is the definitive treatment for HELLP syndrome, especially if maternal or fetal compromise is suspected.
What is the purpose of testing for RPR/VDRL during pregnancy?
A. To screen for hepatitis B infection.
B. To identify syphilis infection.
C. To determine Rh incompatibility.
D. To assess for fetal neural tube defects.
Answer: B
Rationale: RPR/VDRL tests detect syphilis, which can cause congenital infection if untreated.
A patient’s prenatal labs reveal positive anti-D antibodies and a high titer. What is the likely next step in care?
A. Schedule a 28-week RhoGAM injection.
B. Perform serial Doppler studies of the middle cerebral artery.
C. Administer a blood transfusion to the fetus.
D. Plan for cesarean delivery at 34 weeks.
Answer: B
Rationale: Doppler studies are used to monitor for fetal anemia in isoimmunization cases.
A patient’s prenatal labs show rubella non-immunity. She delivers a healthy infant. What teaching is appropriate?
A. Breastfeeding is contraindicated.
B. Avoid contact with individuals with rubella for one year.
C. The infant needs rubella immunoglobulin.
D. Vaccination should be given before hospital discharge.
Answer: D
Rationale: The rubella vaccine is given postpartum to protect the mother in future pregnancies.
A fetal heart rate tracing shows early decelerations during contractions. What is the nurse’s interpretation?
A. Normal finding due to head compression.
B. Cord compression requiring intervention.
C. Uteroplacental insufficiency.
D. Maternal hypotension causing fetal hypoxia.
Answer: A
Rationale: Early decelerations are normal and occur due to fetal head compression during contractions.
A protein/creatinine ratio of 0.4 in a pregnant woman indicates:
A. Normal findings.
B. Gestational diabetes.
C. Preeclampsia.
D. Impending preterm labor.
Answer: C
Rationale: A protein/creatinine ratio >0.3 is diagnostic of preeclampsia.
An FHR strip shows accelerations with no decelerations and moderate variability. How should the nurse interpret this?
A. Fetal compromise.
B. Cord compression.
C. Reassuring tracing.
D. Maternal hypotension.
Answer: C
Rationale: Accelerations with moderate variability are indicative of fetal well-being.
A patient presents at 28 weeks with severe hypertension and a protein/creatinine ratio of 0.5. What is the most likely diagnosis?
A. Chronic hypertension.
B. Preeclampsia with severe features.
C. HELLP syndrome.
D. Gestational diabetes.
Answer: B
Rationale: Hypertension with significant proteinuria (>0.3) is diagnostic for preeclampsia.
During labor, a patient’s fetal heart tracing shows absent variability and recurrent late decelerations. What is the priority action?
A. Reassess in 15 minutes.
B. Start maternal IV antibiotics.
C. Encourage maternal repositioning.
D. Prepare for emergency cesarean delivery.
Answer: D
Rationale: Absent variability with late decelerations is non-reassuring and requires immediate intervention, including delivery if indicated.
A pregnant patient presents with painless vaginal bleeding at 32 weeks. What is the priority nursing action?
A. Perform a sterile vaginal exam.
B. Administer magnesium sulfate.
C. Assess fetal heart tones and perform an ultrasound.
D. Administer betamethasone.
Answer: C
Rationale: Painless vaginal bleeding suggests placenta previa. Ultrasound is necessary to determine placental location. Vaginal exams are contraindicated.
A patient diagnosed with hyperemesis gravidarum has lost 8% of her prepregnancy weight. What is the most appropriate initial intervention?
A. Administer oral antiemetics.
B. Start IV fluids with electrolyte replacement.
C. Initiate enteral feeding.
D. Suggest small frequent meals.
Answer: B
Rationale: Severe dehydration and weight loss require IV fluid and electrolyte replacement before dietary modifications.
What is the purpose of administering magnesium sulfate in preterm labor?
A. To decrease uterine contractions.
B. To treat maternal hypertension.
C. To promote lung maturity in the fetus.
D. To provide neuroprotection to the fetus.
Answer: D
Rationale: Magnesium sulfate is used for fetal neuroprotection to reduce the risk of cerebral palsy in preterm infants.
Which symptom indicates magnesium sulfate toxicity in a patient receiving the medication for preterm labor?
A. Reflexes of +3.
B. Respiratory rate of 10 breaths/min.
C. Blood pressure of 140/90 mmHg.
D. Urine output of 50 mL/hour.
Answer: B
Rationale: Respiratory depression is a key sign of magnesium sulfate toxicity.
A patient with preterm premature rupture of membranes (PPROM) is 33 weeks pregnant. Which intervention is most appropriate?
A. Administer betamethasone.
B. Induce labor immediately.
C. Perform a vaginal exam to assess dilation.
D. Administer RhoGAM.
Answer: A
Rationale: Betamethasone promotes fetal lung maturity and is a priority for gestations under 34 weeks.
What is the priority intervention for a patient experiencing abruptioN placentae?
A. Prepare for immediate delivery.
B. Administer tocolytic agents.
C. Begin betamethasone therapy.
D. Start IV magnesium sulfate.
Answer: A
Rationale: Placental abruption often requires immediate delivery due to maternal and fetal risks.
A patient with gestational trophoblastic disease is undergoing treatment. What is a critical nursing teaching point?
A. Avoid pregnancy for at least one year.
B. Monitor fetal kick counts daily.
C. Take folic acid supplements.
D. Limit physical activity.
Answer: A
Rationale: Pregnancy should be avoided for a year to monitor for choriocarcinoma recurrence.
A patient with suspected cervical insufficiency has a cervical length of 18 mm on ultrasound. What is the recommended intervention?
A. Perform a cerclage.
B. Administer tocolytics.
C. Begin bed rest and pelvic rest.
D. Start IV antibiotics.
Answer: A
Rationale: A cerclage is often used for a significantly shortened cervix to prevent preterm birth.
Which finding in a patient with placenta previa would require immediate intervention?
A. Active vaginal bleeding.
B. Mild abdominal cramping.
C. Fundal height measuring larger than gestational age.
D. Stable vital signs.
Answer: A
Rationale: Active bleeding in placenta previa can signal a need for urgent intervention to stabilize the mother and fetus.
A nurse is caring for a patient with oligohydramnios. Which complication is the greatest concern?
A. Umbilical cord prolapse.
B. Fetal growth restriction.
C. Preterm labor.
D. Maternal dehydration.
Answer: A
Rationale: Oligohydramnios increases the risk of cord prolapse during membrane rupture.
What is a contraindication for administering methotrexate in an ectopic pregnancy?
A. Positive beta-hCG.
B. Hemodynamically stable patient.
C. No visible intrauterine pregnancy on ultrasound.
D. Presence of fetal heart activity.
Answer: D
Rationale: Methotrexate is contraindicated when fetal heart activity is detected.
Which assessment finding suggests concealed abruption in a patient with suspected abruption placentae?
A. Dark red vaginal bleeding.
B. Uterine tenderness and rigidity.
C. Decreased fetal heart variability.
D. Active contractions every 2 minutes.
Answer: B
Rationale: Concealed abruption can cause uterine rigidity and tenderness without visible bleeding.
What is the significance of a positive fetal fibronectin (fFN) test in preterm labor?
A. Preterm birth is unlikely within 7 days.
B. Preterm birth is likely within 1-2 weeks.
C. Immediate labor induction is required.
D. A negative result indicates infection.
Answer: B
Rationale: A positive fFN test predicts a higher risk of preterm birth within 1-2 weeks.
patient with polyhydramnios has spontaneous rupture of membranes (SROM). What is the nurse’s priority assessment?
A. Maternal temperature.
B. Fetal heart rate.
C. Contraction pattern.
D. Fundal height.
Answer: B
Rationale: Cord prolapse is a significant risk in polyhydramnios; FHR monitoring is critical.
What is the primary nursing action after administering RhoGAM to an Rh-negative patient post-delivery?
A. Monitor for signs of infection.
B. Educate about the next dose at 6 months postpartum.
C. Document administration in the medical record.
D. Assess for maternal-fetal hemorrhage.
Answer: C
Rationale: Documentation is necessary to ensure the mother is protected in future pregnancies.
A patient at 29 weeks is admitted with preterm labor and started on magnesium sulfate. Which side effect should the nurse monitor closely?
A. Hyperreflexia.
B. Hypotension.
C. Increased respiratory rate.
D. Muscle rigidity.
Answer: B
Rationale: Magnesium sulfate can cause vasodilation, leading to hypotension. Monitoring vital signs is critical.
A patient at 36 weeks presents with symptoms of placental abruption. Which diagnostic test is most likely to be ordered?
A. Ultrasound.
B. Amniocentesis.
C. Non-stress test (NST).
D. Coagulation studies.
Answer: A
Rationale: Ultrasound helps evaluate placental location and degree of abruption, although it may not always confirm the diagnosis.
A patient with PROM at 35 weeks is febrile with foul-smelling discharge. What is the priority intervention?
A. Begin antibiotic therapy.
B. Perform a sterile vaginal exam.
C. Administer corticosteroids.
D. Prepare for immediate delivery.
Answer: A
Rationale: Fever and foul discharge indicate chorioamnionitis. Antibiotics are the first-line treatment to manage infection.
A patient with preterm labor is on magnesium sulfate. Which finding warrants immediate discontinuation of the infusion?
A. Urine output of 25 mL/hour.
B. Respiratory rate of 16 breaths/min.
C. Deep tendon reflexes +2.
D. Fetal heart rate variability.
Answer: A
Rationale: Oliguria (<30 mL/hour) increases the risk of magnesium toxicity. Discontinuing the infusion is necessary.
A patient is diagnosed with polyhydramnios. What is the most likely fetal complication?
A. Preterm delivery.
B. Cardiac arrhythmias.
C. Intrauterine growth restriction.
D. Neural tube defects.
Answer: D
Rationale: Polyhydramnios is often associated with fetal anomalies like neural tube defects that impair fetal swallowing.
A nurse observes a biophysical profile (BPP) score of 4 in a patient at 38 weeks. What is the next best step?
A. Repeat the test in 24 hours.
B. Prepare for immediate delivery.
C. Administer oxygen to the mother.
D. Monitor fetal heart rate continuously.
Answer: B
Rationale: A BPP score of 4 indicates significant fetal compromise, often requiring immediate delivery.
A patient at 12 weeks is diagnosed with a hydatidiform mole. What is a priority teaching point?
A. Avoid sexual intercourse for six months.
B. Use reliable contraception for one year.
C. Monitor for signs of preterm labor.
D. Increase dietary folic acid intake.
Answer: B
Rationale: Pregnancy should be avoided for one year to monitor hCG levels and reduce the risk of choriocarcinoma.
A patient with suspected ectopic pregnancy has a serum beta-hCG level of 1,200 mIU/mL and no intrauterine pregnancy on ultrasound. What is the next step?
A. Start methotrexate therapy.
B. Repeat beta-hCG in 48 hours.
C. Perform dilation and curettage.
D. Monitor vital signs every hour.
Answer: B
Rationale: A repeat beta-hCG level helps confirm the diagnosis of ectopic pregnancy, especially if levels rise abnormally.
A patient with preeclampsia has a protein/creatinine ratio of 0.5. What does this finding indicate?
A. Severe proteinuria.
B. Normal kidney function.
C. Mild preeclampsia.
D. Worsening preeclampsia.
Answer: C
Rationale: A protein/creatinine ratio >0.3 confirms proteinuria, a diagnostic criterion for preeclampsia.
A patient with hyperemesis gravidarum is discharged with dietary instructions. What should the nurse include?
A. Consume three large meals daily.
B. Avoid drinking fluids between meals.
C. Avoid high-protein foods.
D. Limit carbohydrate intake.
Answer: B
Rationale: Avoiding fluids during meals can reduce gastric distension and nausea.
Which nursing intervention is appropriate for a patient with cervical insufficiency and a rescue cerclage?
A. Encourage ambulation to prevent thrombosis.
B. Monitor for signs of infection.
C. Perform daily sterile vaginal exams.
D. Administer magnesium sulfate prophylactically.
Answer: B
Rationale: Infection is a significant risk following cerclage placement. Close monitoring is critical.
A nurse is caring for a patient with a placenta previa at 35 weeks. What is a critical teaching point?
A. Report any contractions immediately.
B. Avoid lifting objects heavier than 20 pounds.
C. Schedule a trial of labor at 38 weeks.
D. Monitor for signs of oligohydramnios.
Answer: A
Rationale: Contractions in placenta previa increase the risk of bleeding and require immediate medical evaluation.
A pregnant patient with Class III heart disease complains of fatigue and shortness of breath with minimal activity. What is the priority nursing intervention?
A. Administer oxygen.
B. Encourage bed rest.
C. Assess for signs of cardiac decompensation.
D. Schedule an immediate echocardiogram.
Answer: C
Rationale: Signs of cardiac decompensation (e.g., dyspnea, fatigue) require prompt assessment to prevent maternal and fetal complications.
Which symptom indicates cardiac decompensation in a pregnant patient with cardiovascular disease?
A. Increased appetite.
B. Moist cough with exertion.
C. Positive fetal movements.
D. Blood pressure of 120/80 mmHg.
Answer: B
Rationale: A moist, frequent cough can indicate pulmonary congestion due to cardiac decompensation.
What is the preferred mode of delivery for a pregnant woman with severe cardiovascular disease?
A. Cesarean delivery.
B. Spontaneous vaginal delivery without anesthesia.
C. Induction of labor at 38 weeks.
D. Vaginal delivery with epidural anesthesia.
Answer: D
Rationale: Vaginal delivery with epidural anesthesia reduces stress on the cardiovascular system.
A patient tests positive for hepatitis B during pregnancy. What is the most appropriate action after delivery?
A. Administer HBIG and hepatitis B vaccine to the newborn within 12 hours.
B. Begin antiviral therapy for the newborn.
C. Delay breastfeeding for six months.
D. Perform weekly liver function tests on the infant.
Answer: A
Rationale: HBIG and the hepatitis B vaccine reduce the risk of vertical transmission to the newborn.
A patient’s hemoglobin level is 9 g/dL during her third trimester. What is the best nursing intervention?
A. Encourage iron-rich foods and supplementation.
B. Recommend a blood transfusion.
C. Initiate vitamin D supplementation.
D. Schedule a repeat hemoglobin test postpartum.
Answer: A
Rationale: Iron deficiency anemia is treated with dietary changes and iron supplementation to restore hemoglobin levels.
What is the significance of hemodilution during pregnancy?
A. It indicates severe anemia.
B. It is a normal physiological change.
C. It requires immediate treatment.
D. It leads to maternal hypertension.
Answer: B
Rationale: Hemodilution occurs due to increased plasma volume in pregnancy and does not indicate true anemia.
A pregnant patient is receiving methadone therapy for opioid dependence. What is the nurse’s priority?
A. Reduce methadone dose gradually.
B. Ensure the patient adheres to prenatal appointments.
C. Monitor for signs of neonatal abstinence syndrome.
D. Educate on the risks of breastfeeding.
Answer: C
Rationale: Neonatal abstinence syndrome is a risk for infants exposed to methadone in utero.
A pregnant woman with sickle cell disease reports joint pain and fever. What is the priority intervention?
A. Administer IV fluids and oxygen.
B. Prepare for emergency delivery.
C. Administer iron supplements.
D. Perform a fetal non-stress test.
Answer: A
Rationale: IV fluids and oxygen are critical to manage a sickle cell crisis and prevent further complications.
What is the greatest concern for an obese patient during pregnancy?
A. Preterm labor.
B. Macrosomia.
C. Gestational diabetes and preeclampsia.
D. Placenta previa.
Answer: C
Rationale: Obesity significantly increases the risks of gestational diabetes and preeclampsia.
A pregnant patient with systemic lupus erythematosus (SLE) is at risk for which complication?
A. Placental abruption.
B. Fetal growth restriction.
C. Gestational diabetes.
D. Preterm labor.
Answer: B
Rationale: SLE increases the risk of placental insufficiency, leading to fetal growth restriction.`
A 16-year-old pregnant patient is at increased risk for which complication?
A. Low birth weight.
B. Placental abruption.
C. Fetal macrosomia.
D. Gestational hypertension.
Answer: A
Rationale: Adolescents are more likely to experience inadequate prenatal care and poor nutritional intake, increasing the risk of low birth weight.
A pregnant patient with Class IV heart disease reports chest pain and cyanosis. What is the priority nursing action?
A. Place the patient in a left lateral position.
B. Administer oxygen via nasal cannula.
C. Notify the provider immediately.
D. Monitor fetal heart rate continuously.
Answer: C
Rationale: Class IV heart disease symptoms like cyanosis and chest pain require immediate provider notification as they indicate critical cardiac decompensation.
Which dietary instruction should the nurse include for a pregnant patient taking iron supplements?
A. Take iron with antacids to avoid gastrointestinal upset.
B. Take iron with orange juice to enhance absorption.
C. Take iron on an empty stomach at bedtime.
D. Take iron with milk to increase tolerance.
Answer: B
Rationale: Vitamin C in orange juice enhances iron absorption. Antacids and milk inhibit absorption.
A patient diagnosed with cytomegalovirus (CMV) asks how this will affect her baby. What is the best response?
A. “There is no risk to your baby if you avoid contact with others.”
B. “Your baby may develop congenital abnormalities or permanent disabilities.”
C. “The virus only affects you and will not cross the placenta.”
D. “A cesarean delivery will prevent transmission to your baby.”
Answer: B
Rationale: CMV is the leading cause of congenital infections and may result in developmental delays and disabilities.
What is the most effective strategy to prevent vertical transmission of HIV from mother to baby?
A. Administer antiretroviral therapy during pregnancy.
B. Perform cesarean delivery at 34 weeks.
C. Avoid breastfeeding and vaginal delivery.
D. Delay labor induction until 40 weeks.
Answer: A
Rationale: Antiretroviral therapy during pregnancy significantly reduces the risk of perinatal HIV transmission.
A patient reports using methamphetamines during pregnancy. What fetal complication should the nurse anticipate?
A. Fetal macrosomia.
B. Placental abruption and growth restriction.
C. Increased fetal iron stores.
D. Neonatal abstinence syndrome.
Answer: B
Rationale: Methamphetamines cause vasoconstriction, increasing the risk of placental abruption and fetal growth restriction.
A pregnant patient with substance abuse reports using heroin. What is the nurse’s priority?
A. Educate about neonatal abstinence syndrome.
B. Refer the patient to a methadone maintenance program.
C. Advise immediate cessation of heroin use.
D. Schedule a fetal ultrasound to monitor growth.
Answer: B
Rationale: Methadone maintenance is safer for the fetus and mother than abrupt cessation, which could lead to withdrawal complications.
A pregnant patient with severe asthma is admitted in labor. What is the priority nursing intervention?
A. Administer oral prednisone.
B. Monitor maternal oxygen saturation continuously.
C. Limit IV fluids to avoid fluid overload.
D. Perform frequent peak flow measurements.
Answer: B
Rationale: Ensuring maternal oxygenation is critical to prevent fetal hypoxia during labor.
A pregnant patient with systemic lupus erythematosus (SLE) is at 32 weeks. What is the nurse’s priority?
A. Monitor for proteinuria and hypertension.
B. Perform non-stress tests weekly.
C. Educate about preterm labor risks.
D. Administer corticosteroids for lung maturity.
Answer: A
Rationale: SLE increases the risk of preeclampsia, characterized by proteinuria and hypertension.
A pregnant patient with a BMI of 35 is at risk for which labor complication?
A. Shoulder dystocia during delivery.
B. Prolonged rupture of membranes.
C. Placental insufficiency.
D. Hyperemesis gravidarum.
Answer: A
Rationale: Obesity increases the risk of fetal macrosomia, leading to complications like shoulder dystocia.
An adolescent patient is pregnant and experiencing food insecurity. What is the nurse’s first step?
A. Refer the patient to a dietitian.
B. Assess for prenatal supplement compliance.
C. Connect the patient to social services.
D. Provide nutritional counseling.
Answer: C
Rationale: Addressing food insecurity through social services is essential to ensure access to adequate nutrition.
A patient with sickle cell disease is at 34 weeks and experiencing a pain crisis. What is the nurse’s priority intervention?
A. Administer IV fluids and pain medication.
B. Monitor the fetus with continuous electronic fetal monitoring.
C. Administer iron supplements to reduce symptoms.
D. Encourage ambulation to reduce joint pain.
Answer: A
Rationale: IV fluids and pain management are crucial for stabilizing a sickle cell crisis.
Fetal Alcohol Syndrome (FAS)
27. A patient in her first trimester reports daily alcohol use. What is the most important teaching point?
A. Stop alcohol use immediately to prevent further harm to the fetus.
B. Limit alcohol to one drink per day during pregnancy.
C. Alcohol use only affects the fetus in the third trimester.
D. Prenatal vitamins will mitigate the effects of alcohol.
Answer: A
Rationale: Alcohol use at any stage of pregnancy can harm the fetus; cessation is critical to prevent further damage.
A patient presents with chickenpox at 12 weeks of pregnancy. What is the most likely complication for the fetus?
A. Fetal macrosomia.
B. Congenital varicella syndrome.
C. Neonatal abstinence syndrome.
D. Placental abruption.
Answer: B
Rationale: Early pregnancy exposure to varicella can cause congenital varicella syndrome, which includes growth restriction and malformations.
A pregnant patient reports marijuana use to manage nausea. What is the nurse’s best response?
A. “Marijuana can reduce fetal movements, which is beneficial.”
B. “Marijuana use is linked to fetal growth restriction and should be avoided.”
C. “Using marijuana is safer than taking anti-nausea medication.”
D. “You should reduce marijuana use during the third trimester.”
Answer: B
Rationale: Marijuana use is associated with fetal growth restriction and neurodevelopmental issues.
A patient with Class II heart disease is 32 weeks pregnant and reports palpitations and fatigue. What is the nurse’s priority?
A. Reassure the patient that this is normal.
B. Notify the provider for further evaluation.
C. Instruct the patient to limit physical activity.
D. Schedule a follow-up appointment in two weeks.
Answer: B
Rationale: Palpitations and fatigue in heart disease may indicate worsening cardiovascular status and require prompt evaluation.
A pregnant patient at 26 weeks undergoes a 50g oral glucose tolerance test (OGTT) with a result of 145 mg/dL. What is the next step?
A. Diagnose with gestational diabetes.
B. Perform a 3-hour OGTT.
C. Start insulin therapy.
D. Repeat the test at 28 weeks.
Answer: B
Rationale: A 50g OGTT result >140 mg/dL requires confirmation with a 3-hour OGTT to diagnose gestational diabetes.
Which value during a 3-hour OGTT is diagnostic of GDM?
A. Fasting glucose of 80 mg/dL.
B. 1-hour glucose of 185 mg/dL.
C. 2-hour glucose of 140 mg/dL.
D. 3-hour glucose of 130 mg/dL.
Answer: B
Rationale: A 1-hour glucose ≥180 mg/dL during a 3-hour OGTT is diagnostic for gestational diabetes.
The primary cause of insulin resistance in gestational diabetes is:
A. Genetic mutations.
B. Placental hormones like HPL and cortisol.
C. Increased maternal activity.
D. Decreased fetal glucose uptake.
Answer: B
Rationale: Placental hormones, such as human placental lactogen (HPL) and cortisol, cause insulin resistance during pregnancy.
A patient with gestational diabetes asks why her condition developed during pregnancy. What is the best response?
A. “It is caused by an autoimmune condition.”
B. “Your body needs more insulin during pregnancy, and sometimes it cannot keep up.”
C. “It happens when your pancreas stops working properly.”
D. “Gestational diabetes is a result of eating too many carbohydrates.”
Answer: B
Rationale: Insulin resistance and increased insulin demands during pregnancy often lead to gestational diabetes.
Which fetal complication is most strongly associated with GDM?
A. Neural tube defects.
B. Macrosomia.
C. Growth restriction.
D. Neonatal thrombocytopenia.
Answer: B
Rationale: GDM increases the risk of macrosomia due to elevated glucose levels and fetal hyperinsulinemia.
A patient with diet-controlled GDM is at 34 weeks. What fetal surveillance is recommended?
A. Weekly non-stress tests (NSTs).
B. No additional surveillance.
C. Biweekly NSTs starting at 32 weeks.
D. Induction of labor at 37 weeks.
Answer: C
Rationale: Biweekly NSTs are recommended for patients with GDM requiring pharmacologic treatment or additional risk factors.
During labor, what is the primary goal of managing a patient with GDM?
A. Prevent shoulder dystocia.
B. Maintain maternal blood glucose levels between 70-110 mg/dL.
C. Reduce the need for cesarean delivery.
D. Prevent neonatal hypoglycemia.
Answer: B
Rationale: Tight glucose control during labor reduces the risk of neonatal hypoglycemia and other complications.
What is the best mode of delivery for a patient with GDM and an estimated fetal weight (EFW) >4500g?
A. Trial of labor.
B. Elective cesarean delivery.
C. Induction of labor.
D. Vaginal delivery with vacuum assistance.
Answer: B
Rationale: Elective cesarean delivery reduces the risk of birth trauma in cases of suspected macrosomia (>4500g).
A newborn of a mother with GDM has a blood glucose level of 35 mg/dL. What is the priority nursing action?
A. Administer rapid-acting glucose IV.
B. Feed the newborn with formula or breastmilk.
C. Place the newborn under a radiant warmer.
D. Monitor blood glucose every 8 hours.
Answer: B
Rationale: Mild hypoglycemia in newborns is initially treated with oral feeds to stabilize glucose levels.
What is the primary cause of neonatal hypoglycemia in infants of mothers with GDM?
A. Hyperinsulinemia in the newborn.
B. Poor breastfeeding technique.
C. Placental insufficiency.
D. Delayed cord clamping.
Answer: A
Rationale: Neonatal hypoglycemia occurs due to fetal hyperinsulinemia after withdrawal of maternal glucose at birth.
What advice should the nurse provide to a patient with GDM regarding postpartum follow-up?
A. “You no longer need to monitor your blood sugar.”
B. “You should schedule a glucose tolerance test 6-12 weeks postpartum.”
C. “Insulin therapy will continue for six months.”
D. “Your risk for diabetes is the same as before pregnancy.”
Answer: B
Rationale: A glucose tolerance test postpartum evaluates for persistent diabetes or prediabetes.
A patient with GDM has resolved hyperglycemia postpartum. What is the long-term risk for this patient?
A. Preterm labor in subsequent pregnancies.
B. Type 2 diabetes mellitus later in life.
C. Recurrence of GDM in subsequent pregnancies.
D. Chronic hypertension.
Answer: B
Rationale: Patients with GDM have a significantly increased lifetime risk of developing type 2 diabetes.
Why is metformin preferred over glyburide for pharmacologic management of GDM?
A. Glyburide has fewer neonatal side effects.
B. Metformin does not cross the placenta.
C. Metformin has a lower risk of neonatal hypoglycemia.
D. Glyburide is ineffective in diet-controlled GDM.
Answer: C
Rationale: Metformin has a lower risk of neonatal hypoglycemia compared to glyburide.
A patient with GDM refuses insulin therapy. What is the best alternative treatment?
A. Glyburide.
B. Metformin.
C. Oral prednisone.
D. Low glycemic index diet.
Answer: B
Rationale: Metformin is an effective alternative for patients unable to use insulin.
