Maternal and Child Nursing Flashcards

A 32-year-old Saudi woman at 34 weeks gestation presents with BP 158/106 mmHg, proteinuria 3+, and new-onset visual disturbances. She is started on magnesium sulfate. Four hours later, her respiratory rate is 10 breaths/min, deep tendon reflexes are absent, and urine output is 18 mL/hr. Which intervention is the PRIORITY?

Answer: Administer calcium gluconate 1 g IV over 10 minutes

The clinical picture — absent DTRs, respiratory rate <12, oliguria — indicates magnesium toxicity. The antidote is calcium gluconate 1 g IV (10 mL of 10% solution) administered slowly over 10 minutes, which directly antagonizes magnesium's neuromuscular effects. Waiting for a serum level wastes critical time. Reducing the infusion and increasing fluids are insufficient when toxicity is already manifest and respiration is compromised.

A nurse at a SCFHS-accredited maternity hospital is caring for a neonate born at 36+2 weeks via emergency cesarean for placental abruption. The infant has Apgar scores of 4 at 1 minute and 6 at 5 minutes. Per the Saudi neonatal resuscitation protocol aligned with ILCOR guidelines, after initial steps and positive pressure ventilation with 100% oxygen for 30 seconds, the heart rate is 55 bpm. What is the correct next action?

Answer: Begin chest compressions at a 3:1 compression-to-ventilation ratio

When HR remains <60 bpm after 30 seconds of effective PPV, neonatal resuscitation guidelines (adopted by MOH Saudi Arabia / SCFHS) mandate initiating chest compressions at a 3:1 compression-to-ventilation ratio (90 compressions:30 breaths per minute). Epinephrine is indicated only if HR remains <60 after a further 30–60 seconds of compressions with adequate ventilation. Surfactant is not a resuscitation agent.

A multigravida at 39 weeks is in active labor with an oxytocin infusion running at 12 mU/min. The cardiotocography shows late decelerations with every contraction, baseline FHR 145 bpm, and reduced variability. Contractions are every 2 minutes lasting 90 seconds. After stopping the oxytocin and repositioning the mother to the left lateral position, the pattern persists. What is the NEXT priority nursing action?

Answer: Administer 8–10 L/min oxygen via non-rebreather mask and prepare for urgent delivery notification

Persistent late decelerations with reduced variability represent Category III (non-reassuring/ominous) FHR pattern indicating uteroplacental insufficiency and fetal hypoxia. After stopping oxytocin and repositioning (already done), the next simultaneous actions are: oxygen via face mask at 8–10 L/min and immediate notification of the obstetric team for urgent delivery. While IV fluid may be initiated concurrently, oxygenation and team notification take priority. Internal monitoring is secondary to stabilizing the fetus.

A 3-year-old child is admitted to a pediatric ward in Riyadh with Kawasaki disease. He has been febrile for 6 days with bilateral non-exudative conjunctivitis, strawberry tongue, and a desquamating rash on his hands and feet. Echocardiography reveals mild coronary artery dilation. According to current management guidelines followed by SCFHS-accredited facilities, which treatment combination is MOST appropriate?

Answer: High-dose IVIG 2 g/kg single infusion plus high-dose aspirin (80–100 mg/kg/day)

The standard first-line therapy for Kawasaki disease with coronary involvement is a single high-dose IVIG infusion (2 g/kg over 10–12 hours) combined with high-dose aspirin (80–100 mg/kg/day in 4 divided doses) to reduce inflammation during the acute febrile phase. Once afebrile for 48–72 hours, aspirin is stepped down to low-dose (3–5 mg/kg/day) for antiplatelet effect. Corticosteroids are reserved for IVIG-resistant cases. Low-dose aspirin alone is insufficient acutely.

A Saudi primigravida undergoes a scheduled repeat cesarean section at 38 weeks. Thirty minutes postoperatively, her uterus is boggy, and estimated blood loss is 1,200 mL despite oxytocin infusion. She is hemodynamically stable (BP 100/70, HR 105). Per MOH hemorrhage protocols, after bimanual uterine massage and a second uterotonic agent (ergometrine), bleeding continues. What is the CORRECT next pharmacological step?

Answer: Carboprost (15-methyl PGF2α) 0.25 mg IM, may repeat every 15–90 minutes up to 8 doses

When oxytocin and ergometrine fail, the stepwise MOH/WHO postpartum hemorrhage algorithm calls for carboprost (PGF2α analogue) 0.25 mg IM as the third-line uterotonic. It is repeated every 15–90 min up to 8 doses. Tranexamic acid is an adjunct antifibrinolytic given early in PPH (within 3 hours) but does not replace uterotonics. An 80-unit oxytocin bolus risks severe cardiovascular adverse effects. Misoprostol alone is not preferred when superior agents are available.

A 6-week-old male infant is brought to the ER at a Saudi hospital with a 2-week history of projectile, non-bilious vomiting after feeds. He appears thin with visible gastric peristaltic waves. Sodium is 128 mEq/L, potassium 3.0 mEq/L, chloride 88 mEq/L, and arterial pH 7.52. Which fluid and electrolyte preparation should the nurse anticipate initiating BEFORE surgical correction?

Answer: Normal saline (0.9% NaCl) with added potassium chloride (KCl) IV

Pyloric stenosis causes loss of HCl-rich gastric fluid leading to hypochloremic, hypokalemic metabolic alkalosis (pH 7.52, low Cl, low K). Fluid resuscitation must correct the alkalosis and electrolyte deficits before surgery — premature surgery under alkalosis increases anesthetic risk. Normal saline (0.9% NaCl) replaces chloride to correct the alkalosis, with KCl added once adequate urine output is confirmed. Lactated Ringer's contains lactate which is metabolized to bicarbonate, worsening alkalosis. Sodium bicarbonate would further raise pH, which is contraindicated.