Obstetric Nurse Test Obstetric Nurse High-Risk Pregnancy Management 2 — Questions and Answers
Question 1: Preeclampsia is defined as new-onset hypertension after 20 weeks gestation accompanied by:
- Edema and weight gain of more than 2 lbs/week
- Proteinuria OR severe features such as thrombocytopenia or renal insufficiency (Correct answer)
- Only a single blood pressure reading ≥160/110 mmHg
- Proteinuria alone, regardless of blood pressure level
Correct answer: Proteinuria OR severe features such as thrombocytopenia or renal insufficiency
Current ACOG criteria define preeclampsia as BP ≥140/90 mmHg on two occasions plus proteinuria OR one or more severe features even without proteinuria.
Question 2: HELLP syndrome is characterized by which triad of laboratory findings?
- Elevated hemoglobin, elevated platelets, elevated BUN
- Hemolysis, elevated liver enzymes, and low platelet count (Correct answer)
- Hematuria, elevated lipase, and low protein
- Hemolysis, elevated LDH only, and normal platelets
Correct answer: Hemolysis, elevated liver enzymes, and low platelet count
HELLP stands for Hemolysis, Elevated Liver enzymes, and Low Platelets — a severe variant of preeclampsia associated with high maternal and fetal morbidity.
Question 3: The drug of choice for seizure prophylaxis in patients with preeclampsia with severe features is:
- Diazepam (Valium)
- Phenytoin (Dilantin)
- Magnesium sulfate (Correct answer)
- Lorazepam (Ativan)
Correct answer: Magnesium sulfate
Magnesium sulfate is the standard of care for both prevention and treatment of eclamptic seizures in preeclampsia with severe features.
Question 4: Which antidote must be immediately available at the bedside for any patient receiving intravenous magnesium sulfate?
- Naloxone (Narcan)
- Calcium gluconate (Correct answer)
- Protamine sulfate
- Flumazenil (Romazicon)
Correct answer: Calcium gluconate
Calcium gluconate reverses magnesium toxicity; 1g IV over 3 minutes is administered when signs of toxicity (absent DTRs, respiratory depression) are present.
Question 5: The only definitive treatment to cure preeclampsia is:
- Antihypertensive therapy with labetalol
- Antenatal corticosteroids for fetal lung maturity
- Delivery of the fetus and placenta (Correct answer)
- Continuous magnesium sulfate infusion for 48 hours
Correct answer: Delivery of the fetus and placenta
Since preeclampsia is caused by placental factors, delivery of the fetus and placenta is the only cure; other treatments are supportive and temporizing.
Question 6: Chronic hypertension in pregnancy is defined as hypertension diagnosed at which time point?
- Before 20 weeks gestation or pre-existing prior to pregnancy (Correct answer)
- After 20 weeks gestation without proteinuria
- Within 48 hours of delivery only
- Between 28 and 34 weeks gestation
Correct answer: Before 20 weeks gestation or pre-existing prior to pregnancy
Chronic hypertension is pre-existing hypertension or hypertension first identified before 20 weeks gestation, distinguishing it from gestational hypertension and preeclampsia.
Obstetric Nurse Test Obstetric Nurse High-Risk Pregnancy Management 2
Preeclampsia is defined as new-onset hypertension after 20 weeks gestation accompanied by: