Maternal Newborn Nursing Test High-Risk Pregnancy Complications 2 — Questions and Answers
Question 1: A client with gestational diabetes is at 38 weeks gestation. Her fasting blood glucose is consistently 108 mg/dL despite dietary changes. What is the next expected intervention?
- Initiation of insulin therapy (Correct answer)
- Oral metformin therapy
- Immediate induction of labor
- Increased dietary carbohydrate intake
Correct answer: Initiation of insulin therapy
When diet and exercise fail to control fasting glucose above 95 mg/dL in gestational diabetes, insulin is the preferred pharmacologic therapy as it does not cross the placenta.
Question 2: Which maternal complication of gestational diabetes (GDM) places the fetus at greatest risk for macrosomia?
- Chronic maternal hyperglycemia stimulating fetal insulin production and fat deposition (Correct answer)
- Maternal hypoglycemia causing growth restriction
- Maternal hypertension reducing placental perfusion
- Polyhydramnios compressing the placenta
Correct answer: Chronic maternal hyperglycemia stimulating fetal insulin production and fat deposition
Chronic hyperglycemia in GDM causes glucose to cross the placenta, stimulating fetal hyperinsulinemia, which drives excessive fat storage and macrosomia.
Question 3: A client is diagnosed with hyperemesis gravidarum at 10 weeks gestation. Which finding would require hospitalization?
- Weight loss of more than 5% of pre-pregnancy body weight with ketonuria (Correct answer)
- Nausea limited to the morning hours only
- Weight loss of 1 kg with mild nausea
- Inability to eat spicy foods
Correct answer: Weight loss of more than 5% of pre-pregnancy body weight with ketonuria
Hyperemesis gravidarum requiring hospitalization is indicated by dehydration, electrolyte imbalances, ketonuria, and weight loss >5% of pre-pregnancy weight unresponsive to outpatient management.
Question 4: A nurse is caring for a client with an ectopic pregnancy. Which assessment finding warrants immediate emergency intervention?
- Sudden severe unilateral lower abdominal pain with shoulder pain and signs of shock (Correct answer)
- Mild cramping with normal vital signs
- Positive pregnancy test with no vaginal bleeding
- Nausea and vomiting with normal blood pressure
Correct answer: Sudden severe unilateral lower abdominal pain with shoulder pain and signs of shock
Rupture of an ectopic pregnancy causes severe abdominal pain, referred shoulder pain (diaphragmatic irritation from hemoperitoneum), and hemodynamic instability requiring emergency surgery.
Question 5: A client at 26 weeks gestation is admitted with preterm labor. Which medication is administered to accelerate fetal lung maturity?
- Betamethasone (Celestone) (Correct answer)
- Magnesium sulfate
- Nifedipine
- Progesterone
Correct answer: Betamethasone (Celestone)
Antenatal corticosteroids such as betamethasone (given at 24–34 weeks) stimulate surfactant production, reducing the risk of neonatal respiratory distress syndrome.
Question 6: Which blood type and Rh factor combination places a pregnant client at risk for isoimmunization if the father is Rh positive?
- Rh-negative mother with Rh-positive fetus (Correct answer)
- Rh-positive mother with Rh-negative fetus
- AB blood type regardless of Rh factor
- Type O blood type with Rh-positive status
Correct answer: Rh-negative mother with Rh-positive fetus
An Rh-negative mother carrying an Rh-positive fetus is at risk for isoimmunization if fetal blood enters maternal circulation, leading to maternal antibody formation that can destroy fetal red blood cells in subsequent pregnancies.
