Maternal and Child Nursing Flashcards

A 28-year-old primigravida at 34 weeks gestation presents to a Saudi hospital with a blood pressure of 152/98 mmHg, proteinuria of 2+ on dipstick, and complaints of epigastric pain and visual disturbances. Her platelet count is 88,000/µL and AST is 112 U/L. According to Saudi SCFHS guidelines, which condition best describes this clinical picture and what is the PRIORITY nursing intervention?

Answer: Severe preeclampsia with HELLP syndrome; administer magnesium sulfate IV and prepare for urgent delivery

This presentation meets criteria for severe preeclampsia with HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets): BP ≥150/100, thrombocytopenia <100,000/µL, elevated AST, epigastric pain (hepatic involvement), and visual disturbances. Per SCFHS and Saudi MOH perinatal guidelines, the priority interventions are seizure prophylaxis with IV magnesium sulfate and preparation for urgent delivery, as HELLP syndrome is life-threatening to both mother and fetus regardless of gestational age.

A nurse in a Saudi NICU is caring for a preterm neonate at 28 weeks gestation receiving surfactant replacement therapy. Four hours after the second dose of poractant alfa (Curosurf), the nurse notices the infant's oxygen saturation is 99% on the same ventilator settings, chest movement appears more symmetric, and FiO₂ has been automatically reduced from 0.55 to 0.30 by the ventilator. What is the MOST appropriate nursing action?

Answer: Notify the neonatologist immediately to reduce positive inspiratory pressure to avoid pulmonary air leak from improved compliance

A positive surfactant response causes rapid improvement in lung compliance. If ventilator pressures are not promptly reduced, the now-compliant lungs are at high risk for pulmonary air leak (pneumothorax, pulmonary interstitial emphysema). The nurse must immediately notify the neonatologist to wean ventilator settings — particularly PIP — to match the improved compliance. Suctioning within 1–2 hours of surfactant is contraindicated as it removes the medication. Simply documenting without action is dangerous.

A 16-year-old female patient at King Abdulaziz Hospital is admitted at 39 weeks gestation with active labor. She is a single mother with no antenatal care documentation. The nurse notes multiple fading bruises on her upper arms and abdomen. The patient becomes tearful when her male companion leaves the room and whispers she is afraid to go home. Under the Saudi Child and Family Protection Society (CFPS) protocols and the Saudi Nursing Code of Ethics, what is the nurse's CORRECT course of action?

Answer: Document findings objectively, report to the hospital's social worker and Child and Family Protection Team immediately, and ensure the patient is not left alone with the companion

Saudi Arabia has mandatory reporting obligations for suspected domestic violence and child protection concerns through the Child and Family Protection Society (CFPS) and hospital-based protection teams. At 16 years old, this patient is a minor under Saudi law (legal adulthood at 18), making this both a domestic violence and child protection case. The nurse must document objectively (not subjectively), report to the social worker and hospital protection team immediately, and ensure patient safety by not leaving her alone with the suspected abuser. Confronting the abuser is dangerous and delays are not justified by active labor.

A nurse is managing a 3-day-old neonate born at 37 weeks gestation whose total serum bilirubin (TSB) is 18.5 mg/dL. The infant is exclusively breastfed, has lost 9% of birth weight, and the mother reports the infant is only breastfeeding 6–7 times in 24 hours. The direct (conjugated) bilirubin is 0.4 mg/dL. According to the American Academy of Pediatrics (AAP) phototherapy nomogram used in Saudi practice, which intervention addresses BOTH the hyperbilirubinemia and its underlying cause?

Answer: Initiate intensive phototherapy AND support the mother to increase breastfeeding frequency to at least 10–12 feeds per 24 hours, with consideration of supplemental expressed breast milk

This is breastFEEDING jaundice (insufficient intake jaundice), not breast MILK jaundice — distinguished by early onset (day 3), weight loss >7%, and suboptimal feeding frequency. The low conjugated bilirubin rules out cholestasis. At 37 weeks (late preterm), the TSB of 18.5 mg/dL meets phototherapy threshold per the AAP nomogram. The root cause is caloric/fluid deficit from infrequent feeding, so the dual intervention is phototherapy plus aggressive lactation support to increase feeding frequency. Discontinuing breastfeeding is not recommended as the first step; exchange transfusion thresholds are considerably higher (~25–30 mg/dL at 72 hours for term infants).

During the second stage of labor, a multigravida patient's cardiotocograph (CTG) shows a baseline fetal heart rate of 155 bpm, absence of accelerations for 50 minutes, late decelerations with every contraction, and reduced baseline variability of 3 bpm. The cervix is fully dilated and the fetal head is at +2 station. The attending physician is in another delivery. What is the CORRECT sequence of nursing actions per Saudi MOH obstetric emergency protocols?

Answer: Position patient in left lateral, apply high-flow oxygen via face mask, discontinue oxytocin if infusing, insert IV access, call the obstetrician STAT and activate the emergency response team

This CTG shows a Category III (non-reassuring/ominous) pattern: late decelerations (uteroplacental insufficiency), absent accelerations, and minimal variability — indicating fetal hypoxia requiring immediate intervention. The nurse's emergency sequence follows the ABCDE obstetric emergency framework: (1) Left lateral position to relieve aortocaval compression, (2) high-flow O₂ to maximize maternal oxygenation, (3) discontinue oxytocin to reduce uterine hyperstimulation, (4) IV access for emergency medications, (5) immediate physician notification and team activation. Pushing with decelerations worsens fetal hypoxia. Amnioinfusion is not a first-line emergency measure. Late decelerations at any stage are never 'expected.'

A 6-week-old infant is brought to a Saudi PHC center for the first scheduled vaccination visit. The mother reports the infant had a generalized tonic-clonic seizure lasting 3 minutes at 2 weeks of age, evaluated and attributed to neonatal hypocalcemia, with no recurrence since. The infant appears well today. According to the Saudi Expanded Program on Immunization (EPI) schedule and contraindication guidelines, which vaccine decision is CORRECT?

Answer: Administer all due vaccines (DTP-HepB-Hib-IPV, PCV, and Rotavirus) as a resolved metabolic cause of seizure is not a contraindication to any scheduled vaccine

Per the Saudi MOH EPI guidelines and WHO contraindication criteria, a past seizure with an identified and resolved metabolic cause (neonatal hypocalcemia) is NOT a contraindication to any routine vaccine, including DTP-containing vaccines. Contraindications to pertussis-containing vaccines include encephalopathy within 7 days of a prior dose or progressive neurological disorder — neither applies here. The infant is clinically well, seizure-free, and has a clear metabolic etiology. Deferral or substitution with DTaP is not warranted. All 6-week vaccines should proceed on schedule to protect the infant during the vulnerable early months.