Obstetric Nurse Test Obstetric Nurse Antepartum Complications 4 — Questions and Answers
Question 1: A patient with chronic hypertension becomes pregnant. Which antihypertensive medication is considered UNSAFE during pregnancy?
- Labetalol
- Nifedipine
- ACE inhibitors (Correct answer)
- Methyldopa
Correct answer: ACE inhibitors
ACE inhibitors are contraindicated in pregnancy because they cause fetal renal dysplasia, oligohydramnios, and fetal death, especially in the second and third trimesters.
Question 2: A patient at 16 weeks has an elevated maternal serum alpha-fetoprotein (MSAFP). Which condition does this most likely suggest?
- Down syndrome (Trisomy 21)
- Open neural tube defect (Correct answer)
- Trisomy 18
- Gestational diabetes
Correct answer: Open neural tube defect
Elevated MSAFP is associated with open fetal defects such as neural tube defects (anencephaly, spina bifida) where AFP leaks into maternal circulation.
Question 3: A pregnant patient is diagnosed with a deep vein thrombosis at 22 weeks. Which anticoagulant is the preferred treatment?
- Warfarin (Coumadin)
- Low-molecular-weight heparin (LMWH) (Correct answer)
- Rivaroxaban (Xarelto)
- Aspirin
Correct answer: Low-molecular-weight heparin (LMWH)
Low-molecular-weight heparin is preferred in pregnancy because it does not cross the placenta, unlike warfarin which is teratogenic, especially in the first trimester.
Question 4: A patient at 32 weeks has polyhydramnios (AFI of 28 cm). Which fetal condition should the nurse anticipate evaluating for?
- Renal agenesis
- Gastrointestinal obstruction or fetal swallowing disorder (Correct answer)
- Intrauterine growth restriction
- Placental insufficiency
Correct answer: Gastrointestinal obstruction or fetal swallowing disorder
Polyhydramnios is associated with conditions that impair fetal swallowing (e.g., esophageal atresia, anencephaly) because the fetus normally recycles amniotic fluid by swallowing.
Question 5: Which assessment is essential before administering the first dose of magnesium sulfate to a patient with severe preeclampsia?
- Checking urine glucose
- Assessing deep tendon reflexes, respiratory rate, and urine output (Correct answer)
- Obtaining a blood type and crossmatch
- Performing a non-stress test
Correct answer: Assessing deep tendon reflexes, respiratory rate, and urine output
Baseline deep tendon reflexes, respiratory rate (must be ≥12/min), and urine output (must be ≥25-30 mL/hr) must be assessed before initiating magnesium therapy.
Question 6: A 26-week patient with preterm premature rupture of membranes (PPROM) has a temperature of 38.6°C and fundal tenderness. Which complication does the nurse suspect?
- Placenta previa
- Intrauterine infection (chorioamnionitis) (Correct answer)
- HELLP syndrome
- Appendicitis
Correct answer: Intrauterine infection (chorioamnionitis)
Fever with uterine tenderness following PPROM is the classic presentation of chorioamnionitis, requiring prompt delivery regardless of gestational age.
Question 7: A patient at 18 weeks presents with painless cervical dilation of 3 cm without contractions. Which diagnosis is most consistent with these findings?
- Preterm labor
- Cervical incompetence (Correct answer)
- Placenta previa
- Hyperemesis gravidarum
Correct answer: Cervical incompetence
Cervical incompetence (insufficiency) is characterized by painless, progressive cervical dilation in the second trimester without contractions.
Obstetric Nurse Test Obstetric Nurse Antepartum Complications 4
A patient with chronic hypertension becomes pregnant.
Which antihypertensive medication is considered UNSAFE during pregnancy?