Maternal Newborn Nursing Test Maternal Complications 1 — Questions and Answers
Question 1: A patient at 34 weeks gestation presents with a blood pressure of 158/106 mmHg, severe headache, visual disturbances, and 3+ proteinuria. What condition does this represent?
- Gestational hypertension
- Chronic hypertension
- Severe feature preeclampsia (Correct answer)
- HELLP syndrome
Correct answer: Severe feature preeclampsia
Blood pressure ≥160/110 mmHg with severe symptoms (headache, visual changes) and significant proteinuria meets criteria for preeclampsia with severe features requiring urgent intervention.
Question 2: A patient with preeclampsia is receiving magnesium sulfate. Which assessment finding indicates magnesium toxicity?
- Urine output of 40 mL/hr
- Deep tendon reflexes 2+
- Respiratory rate of 10 breaths per minute (Correct answer)
- Serum magnesium level of 5 mEq/L
Correct answer: Respiratory rate of 10 breaths per minute
Respiratory depression (rate <12) is a key sign of magnesium toxicity; the antidote calcium gluconate should be administered immediately to reverse the toxicity.
Question 3: A patient at 38 weeks gestation has HELLP syndrome. Which laboratory finding is characteristic of this condition?
- Elevated platelets and decreased hemoglobin
- Hemolysis, elevated liver enzymes, and low platelets (Correct answer)
- Low liver enzymes and elevated creatinine
- Elevated white blood cell count and low bilirubin
Correct answer: Hemolysis, elevated liver enzymes, and low platelets
HELLP syndrome is defined by its acronym: Hemolysis, Elevated Liver enzymes (AST/ALT), and Low Platelets (<100,000/mcL), representing a severe variant of preeclampsia.
Question 4: A patient is admitted with suspected placenta previa at 32 weeks gestation. She is experiencing bright red, painless vaginal bleeding. Which assessment is CONTRAINDICATED?
- External fetal heart rate monitoring
- Digital vaginal examination (Correct answer)
- Abdominal ultrasound
- IV access placement
Correct answer: Digital vaginal examination
Digital vaginal examination is absolutely contraindicated in placenta previa because it can disrupt the placenta and cause catastrophic hemorrhage; diagnosis is confirmed by ultrasound.
Question 5: A patient develops disseminated intravascular coagulation (DIC) following placental abruption. Which laboratory result is consistent with DIC?
- Elevated fibrinogen, decreased PT, decreased aPTT
- Decreased fibrinogen, prolonged PT and aPTT, elevated D-dimer (Correct answer)
- Elevated platelets, normal clotting times
- Decreased D-dimer, elevated hemoglobin
Correct answer: Decreased fibrinogen, prolonged PT and aPTT, elevated D-dimer
DIC causes simultaneous clotting and bleeding, consuming clotting factors and platelets, resulting in low fibrinogen, prolonged PT/aPTT, elevated D-dimer, and thrombocytopenia.
Question 6: A pregnant patient at 28 weeks is diagnosed with gestational diabetes after a 3-hour glucose tolerance test. Which dietary change is the first-line management?
- Total fasting until insulin therapy is initiated
- Carbohydrate-controlled diet with 3 meals and 2–3 snacks (Correct answer)
- High-protein, fat-only diet to avoid all sugars
- Unrestricted diet with metformin supplementation
Correct answer: Carbohydrate-controlled diet with 3 meals and 2–3 snacks
Medical nutrition therapy with carbohydrate counting (typically 45–60 g per meal, 15–30 g per snack) distributed across small frequent meals is the first-line treatment for gestational diabetes.
