Maternal Newborn Nursing Test Maternity Nursing: Antepartum 5 — Questions and Answers
Question 1: A client at 16 weeks gestation undergoes a quadruple screen (quad screen). Elevated alpha-fetoprotein (AFP) is MOST associated with:
- Down syndrome (trisomy 21)
- Open neural tube defects such as spina bifida (Correct answer)
- Turner syndrome (45, X)
- Edwards syndrome (trisomy 18)
Correct answer: Open neural tube defects such as spina bifida
Elevated maternal serum AFP is most strongly associated with open neural tube defects, where AFP leaks from fetal spinal fluid into amniotic and maternal blood.
Question 2: A client at 37 weeks gestation reports leaking fluid. The nurse uses nitrazine paper to test the fluid. Which result indicates rupture of membranes?
- Nitrazine paper turns yellow (pH 4.5)
- Nitrazine paper turns blue-green to blue (pH ≥6.5) (Correct answer)
- Nitrazine paper turns orange (pH 5.0)
- No color change on nitrazine paper
Correct answer: Nitrazine paper turns blue-green to blue (pH ≥6.5)
Amniotic fluid is alkaline (pH 7.1–7.3), turning nitrazine paper blue-green to blue, distinguishing it from acidic vaginal secretions.
Question 3: A nurse is caring for a client at 31 weeks gestation who is receiving magnesium sulfate for preterm labor. Which assessment finding signals magnesium toxicity requiring the nurse to stop the infusion?
- Respiratory rate of 14 breaths per minute
- Urine output of 35 mL/hr
- Absent deep tendon reflexes (Correct answer)
- Serum magnesium level of 5 mEq/L
Correct answer: Absent deep tendon reflexes
Loss of deep tendon reflexes (hyperreflexia resolution) is an early sign of magnesium toxicity and requires the infusion to be stopped immediately; the antidote is calcium gluconate.
Question 4: A client at 20 weeks gestation is found to have an incompetent cervix. The nurse anticipates which treatment will be prescribed?
- Corticosteroid therapy with betamethasone
- Cervical cerclage placement (Correct answer)
- Induction of labor with oxytocin
- Amnioinfusion procedure
Correct answer: Cervical cerclage placement
A cervical cerclage (purse-string suture placed around the cervix) is the primary surgical treatment for incompetent cervix to prevent premature dilation.
Question 5: A gravida 3, para 2 client at 35 weeks gestation has a hemoglobin of 9.2 g/dL. The nurse identifies this as:
- Normal for multigravidas in the third trimester
- Iron-deficiency anemia requiring intervention (Correct answer)
- Physiologic anemia due to expected plasma volume expansion
- Polycythemia consistent with high altitude residence
Correct answer: Iron-deficiency anemia requiring intervention
A hemoglobin below 10.5 g/dL in the third trimester is below the threshold for physiologic anemia and indicates true iron-deficiency anemia requiring treatment.
Question 6: A client at 11 weeks gestation asks about the safety of chorionic villus sampling (CVS). The nurse explains that, compared to amniocentesis, CVS:
- Carries a slightly higher risk of pregnancy loss but allows earlier diagnosis (Correct answer)
- Is safer with no risk of fetal loss
- Can assess fetal lung maturity in addition to chromosomes
- Must be performed after 20 weeks gestation
Correct answer: Carries a slightly higher risk of pregnancy loss but allows earlier diagnosis
CVS can be performed at 10–13 weeks (earlier than amniocentesis) but carries a slightly higher procedure-related pregnancy loss rate of approximately 0.5–1%.
Question 7: A client at 29 weeks gestation is diagnosed with oligohydramnios. The nurse knows this condition is MOST commonly associated with:
- Fetal renal agenesis or obstructive uropathies (Correct answer)
- Maternal diabetes mellitus
- Twin-to-twin transfusion syndrome in the recipient twin
- Fetal cardiac defects
Correct answer: Fetal renal agenesis or obstructive uropathies
Oligohydramnios is most commonly caused by fetal renal anomalies (e.g., renal agenesis, posterior urethral valves) because the kidneys produce most amniotic fluid via urine after mid-pregnancy.
