Obstetric Nurse Antepartum Complications Questions and Answers — Questions and Answers
Question 1: A client at 34 weeks gestation is admitted with painless, bright red vaginal bleeding. Her uterus is soft and non-tender, and the fetal heart rate is stable. Which condition should the nurse suspect?
- Placenta previa (Correct answer)
- Abruptio placentae
- Vasa previa
- Preterm labor
Correct answer: Placenta previa
The classic presentation of placenta previa is painless, bright red vaginal bleeding after 20 weeks of gestation, with a soft, non-tender uterus. Abruptio placentae typically presents with painful, dark red bleeding and uterine tenderness or rigidity. Vasa previa often presents with bleeding upon rupture of membranes, and preterm labor involves regular contractions.
Question 2: A nurse is reviewing the criteria for a diagnosis of preeclampsia with severe features. Which of the following findings is a key indicator of this condition?
- Blood pressure of 150/95 mmHg on two occasions 4 hours apart
- Proteinuria of 300mg in a 24-hour urine collection
- Platelet count less than 100,000/μL (Correct answer)
- Mild pedal edema
Correct answer: Platelet count less than 100,000/μL
According to ACOG guidelines, preeclampsia with severe features is diagnosed in the presence of new-onset hypertension along with specific signs of end-organ damage. A platelet count below 100,000/μL (thrombocytopenia) is a diagnostic criterion for severe features. While elevated blood pressure and proteinuria are present in preeclampsia, the other options describe findings of preeclampsia without severe features or common pregnancy symptoms.
Question 3: A 26-week pregnant client with no prior history of glucose intolerance is scheduled for routine screening for gestational diabetes mellitus (GDM). What is the standard initial screening test the nurse should prepare the client for?
- A fasting blood glucose test
- A 3-hour, 100-gram oral glucose tolerance test (OGTT)
- A 2-hour, 75-gram oral glucose tolerance test (OGTT)
- A 1-hour, 50-gram glucose challenge test (GCT) (Correct answer)
Correct answer: A 1-hour, 50-gram glucose challenge test (GCT)
The standard and most common initial screening for GDM in the United States, recommended by ACOG, is a 1-hour, 50-gram non-fasting glucose challenge test, typically performed between 24 and 28 weeks of gestation. The 3-hour OGTT is the diagnostic test used if the initial 1-hour screen is abnormal.
Question 4: A client at 30 weeks gestation is experiencing regular uterine contractions and has a confirmed diagnosis of preterm labor. The provider orders a tocolytic medication to delay delivery. Which of the following medications is classified as a tocolytic agent?
- Betamethasone
- Rho(D) immune globulin
- Nifedipine (Correct answer)
- Ondansetron
Correct answer: Nifedipine
Nifedipine, a calcium channel blocker, is a commonly used tocolytic agent that works by inhibiting uterine smooth muscle contractions to delay preterm labor. Betamethasone is a corticosteroid given to promote fetal lung maturity. Rho(D) immune globulin is for Rh incompatibility, and Ondansetron is an antiemetic.
Question 5: A pregnant client at 32 weeks gestation presents with epigastric pain, nausea, and malaise. Laboratory results show: Alanine aminotransferase (ALT) 150 IU/L, Aspartate aminotransferase (AST) 180 IU/L, platelet count 80,000/μL, and schistocytes on the peripheral blood smear. These findings are most indicative of which complication?
- Acute fatty liver of pregnancy (AFLP)
- Intrahepatic cholestasis of pregnancy (ICP)
- HELLP syndrome (Correct answer)
- Preeclampsia without severe features
Correct answer: HELLP syndrome
HELLP syndrome is a severe variant of preeclampsia characterized by Hemolysis (indicated by schistocytes), Elevated Liver enzymes (AST and ALT >70 IU/L), and Low Platelets (count <100,000/μL). The client's lab values and symptoms are classic for this life-threatening condition.
Question 6: When differentiating between abruptio placentae and placenta previa, which clinical finding is uniquely characteristic of abruptio placentae?
- Bright red, painless vaginal bleeding
- A soft, relaxed, non-tender uterus
- Sudden onset of abdominal pain and uterine tenderness
- Abnormal fetal presentation, such as breech or transverse lie (Correct answer)
Correct answer: Abnormal fetal presentation, such as breech or transverse lie
The hallmark sign of abruptio placentae is the sudden onset of abdominal pain, often described as sharp or constant, accompanied by uterine tenderness or a rigid, board-like abdomen. This is in contrast to the classic painless bleeding of placenta previa. While abnormal fetal presentation can occur with placenta previa, it is not the most distinct differentiating symptom from abruption.
