Obstetric Nurse Test Obstetric Nurse Antepartum Complications 5 — Questions and Answers
Question 1: A patient at 36 weeks with poorly controlled gestational diabetes delivers a neonate who is jittery and hypotonic. Which complication is the nurse's immediate concern for the neonate?
- Hyperbilirubinemia
- Neonatal hypoglycemia (Correct answer)
- Respiratory distress syndrome
- Polycythemia
Correct answer: Neonatal hypoglycemia
Neonates of diabetic mothers are at high risk for hypoglycemia due to fetal hyperinsulinism responding to chronic maternal hyperglycemia.
Question 2: A patient is admitted at 26 weeks with preterm labor and is started on nifedipine. Which side effect requires immediate nursing assessment?
- Urinary retention
- Maternal hypotension and tachycardia (Correct answer)
- Hyperglycemia
- Decreased fetal movement
Correct answer: Maternal hypotension and tachycardia
Nifedipine, a calcium channel blocker used as a tocolytic, can cause significant maternal hypotension and reflex tachycardia.
Question 3: Which factor places a pregnant patient at highest risk for spontaneous abortion in the first trimester?
- Advanced maternal age (>35 years)
- Chromosomal abnormalities of the embryo (Correct answer)
- Uterine fibroids
- Previous cesarean delivery
Correct answer: Chromosomal abnormalities of the embryo
Chromosomal abnormalities account for approximately 50-60% of all first-trimester spontaneous abortions.
Question 4: A patient at 34 weeks is diagnosed with intrahepatic cholestasis of pregnancy. Which finding is most characteristic of this condition?
- Painless jaundice and clay-colored stools
- Intense generalized pruritus without rash, especially on palms and soles (Correct answer)
- Severe nausea and vomiting
- RUQ pain with elevated lipase
Correct answer: Intense generalized pruritus without rash, especially on palms and soles
Intrahepatic cholestasis of pregnancy presents with severe pruritus, characteristically affecting the palms and soles, due to bile acid accumulation in the skin.
Question 5: A patient at 30 weeks with a biophysical profile (BPP) score of 4/10 is being evaluated. What is the most appropriate next step?
- Repeat the BPP in one week
- Administer betamethasone and monitor
- Prepare for delivery or further evaluation with contraction stress test (Correct answer)
- Increase maternal fluid intake and retest in 24 hours
Correct answer: Prepare for delivery or further evaluation with contraction stress test
A BPP score of 4/10 indicates possible fetal compromise and requires urgent evaluation; delivery or contraction stress testing is warranted depending on gestational age.
Question 6: A patient at 22 weeks is found to have a short cervix (18 mm) on transvaginal ultrasound with no prior preterm birth. Which intervention has evidence for reducing preterm birth risk?
- Prophylactic antibiotics
- Vaginal progesterone supplementation (Correct answer)
- Activity restriction alone
- Elective cerclage
Correct answer: Vaginal progesterone supplementation
Vaginal progesterone is recommended for patients with a short cervix (<20 mm) and no prior preterm birth to reduce the risk of spontaneous preterm delivery.
Question 7: A patient with preeclampsia is receiving magnesium sulfate when her respiratory rate drops to 10 breaths/min and DTRs are absent. Which antidote should the nurse administer?
- Naloxone (Narcan)
- Calcium gluconate (Correct answer)
- Protamine sulfate
- Flumazenil
Correct answer: Calcium gluconate
Calcium gluconate is the antidote for magnesium toxicity; it competitively antagonizes magnesium's effects on nerve and muscle function.
Obstetric Nurse Test Obstetric Nurse Antepartum Complications 5
A patient at 36 weeks with poorly controlled gestational diabetes delivers a neonate who is jittery and hypotonic.
Which complication is the nurse's immediate concern for the neonate?