Maternal and Child Health Flashcards

A Saudi primigravida at 34 weeks gestation presents to the emergency department with sudden-onset severe headache, visual disturbances, and a BP of 162/112 mmHg. Urine dipstick shows 3+ proteinuria. She is given IV magnesium sulfate. Which finding would indicate magnesium toxicity requiring immediate calcium gluconate administration?

Answer: Respiratory rate of 10 breaths/min and loss of patellar reflexes

Magnesium toxicity manifests as respiratory depression (RR 5 mmol/L). Calcium gluconate 1g IV is the antidote. A serum level of 2.5 mmol/L is within the therapeutic range (2–3.5 mmol/L) and flushing is a normal side effect. Urine output of 35 mL/hr is acceptable (minimum is 25–30 mL/hr). A BP drop to 140/90 is actually a desired therapeutic response.

In the context of the Saudi Family Health Program and SCFHS nursing standards, a nurse is evaluating a 4-day-old neonate born at 38 weeks. The infant's total serum bilirubin is 18 mg/dL. The mother is blood type O-positive and the infant is A-positive. Which intervention is MOST appropriate at this stage?

Answer: Initiate phototherapy and perform a direct antiglobulin (Coombs) test

ABO incompatibility (O+ mother, A+ infant) is a significant risk factor for hemolytic jaundice. A bilirubin of 18 mg/dL at day 4 in a late-preterm/early-term neonate (38 weeks) exceeds the phototherapy threshold per AAP guidelines (adopted by SCFHS). A direct Coombs test is essential to confirm hemolysis. Simple breastfeeding promotion is insufficient at this level. Exchange transfusion is not yet the first step without further risk stratification. Delaying reassessment 48 hours is dangerous at this bilirubin level.

A nurse in a Saudi MOH antenatal clinic is caring for a woman at 28 weeks with gestational diabetes mellitus (GDM) managed on diet alone. Her fasting blood glucose today is 6.2 mmol/L and 2-hour postprandial is 8.5 mmol/L. According to SCFHS and Saudi clinical practice guidelines for GDM, what is the MOST appropriate next step?

Answer: Initiate insulin therapy, as targets of fasting <5.3 mmol/L and 2-hr postprandial <6.7 mmol/L are not being met

Saudi and international guidelines (FIGO/ADA adopted by MOH) set GDM targets as fasting <5.3 mmol/L and 2-hour postprandial <6.7 mmol/L. This patient exceeds both thresholds despite dietary management, so insulin therapy is indicated. Metformin is not universally endorsed as first-line in Saudi GDM guidelines due to concerns about fetal exposure, and insulin remains the preferred pharmacological agent. Continuing diet alone ignores failure to meet targets. Caesarean planning is premature and based on obstetric indications, not glycaemic values alone.

During a postnatal ward round in a Saudi hospital, a nurse assesses a mother on day 2 post-vaginal delivery who is exclusively breastfeeding. The infant's weight is 7% below birth weight. The mother reports breast engorgement and her infant appears jaundiced with a bilirubin of 14 mg/dL. Which action reflects the MOST advanced nursing judgment in this scenario?

Answer: Facilitate a lactation consultation, encourage frequent feeding every 2–3 hours, and monitor bilirubin closely without interrupting breastfeeding

A weight loss of 7% at day 2 is within acceptable limits (up to 10% in the first week). The jaundice pattern is consistent with breastfeeding jaundice (insufficient intake) rather than breast milk jaundice (which peaks at day 5–15). The correct approach is to optimize breastfeeding via lactation support and frequent feeds rather than supplementing or interrupting. A bilirubin of 14 mg/dL at day 2 in a term infant is below the phototherapy threshold. Ceasing breastfeeding is reserved for diagnosing true breast milk jaundice at higher bilirubin levels. This approach aligns with MOH Saudi breastfeeding promotion policies.

A 3-year-old child is brought to a Saudi PHC by his mother with a 3-day history of fever, refusal to eat, and white plaques on the buccal mucosa that bleed on scraping. The child was treated with broad-spectrum antibiotics 2 weeks ago for otitis media. Which of the following is the MOST likely diagnosis and its primary risk factor in this case?

Answer: Oral candidiasis (thrush) secondary to antibiotic-induced disruption of normal oral flora

The clinical picture — white plaques that bleed when scraped in a child recently on antibiotics — is classic for oral candidiasis (Candida albicans). Antibiotic use disrupts normal bacterial flora, allowing Candida overgrowth. Treatment is oral nystatin suspension. Herpetic gingivostomatitis presents with ulcers, vesicles, and significant pain, not adherent white plaques. Koplik spots are small white spots with a red halo inside the cheeks (not removable with scraping) and appear before the measles rash. Aphthous ulcers are shallow, painful erosions without the white coating pattern.

A gravida 3 para 2 woman in active labour at 39 weeks in a Saudi hospital has a Bishop score of 8. She received oxytocin augmentation 2 hours ago. The CTG now shows late decelerations with each contraction, baseline FHR 155 bpm, and minimal variability. Uterine contractions are occurring every 2 minutes lasting 90 seconds (tachysystole). Which is the MOST immediate priority nursing action?

Answer: Discontinue the oxytocin infusion, position the mother in the left lateral position, administer O₂ via face mask, and notify the obstetrician urgently

The CTG shows a Category III (non-reassuring/ominous) pattern: late decelerations (uteroplacental insufficiency), tachysystole from oxytocin, and minimal variability — indicating fetal compromise. The MOST immediate action is to stop the oxytocin (removing the cause of tachysystole), left lateral positioning (optimizes uteroplacental blood flow), supplemental O₂ (increases fetal oxygenation), and urgent obstetric notification. An IV fluid bolus may be given if hypotension is confirmed, but is not the first step here. Continuing oxytocin until surgery worsens fetal hypoxia. Waiting 15 minutes to observe a Category III pattern is dangerous and falls below the standard of care mandated by SCFHS intrapartum guidelines.