Practice Questions

A 26-year-old client with a 10-year history of diabetes mellitus is in her 8th week of pregnancy. To assist in planning the client’s care, the nurse should know that, in general, a client’s insulin needs decreases at the beginning of pregnancy and:

A. Decreases drastically later in pregnancy

B. Increases in the second trimester and decreases in the third trimester

C. Increases later in pregnancy

D. Remains decreased but stable in the second and third trimester.

A 26-year-old client with a 10-year history of diabetes mellitus is in her 8th week of pregnancy. To assist in planning the client’s care, the nurse should know that, in general, a client’s insulin needs decreases at the beginning of pregnancy and:

A. Decreases drastically later in pregnancy

B. Increases in the second trimester and decreases in the third trimester

C. Increases later in pregnancy

D. Remains decreased but stable in the second and third trimester.

C. Increases later in pregnancy

During pregnancy, insulin needs typically increase due to hormonal changes and increased insulin resistance.

A diabetic client delivers a full-term neonate who weighs 4.6 kg (10 Ib,2oz). While caring for the large-for-gestational –age (LGA) neonate, the nurse is careful to palpate the clavicles because:

A. clavicles are commonly absent in neonates of diabetics mothers

B. LGA neonates have glucose deposits on their clavicles

C. neonates for diabetic mother have brittle bones

D. one of clavicles may have been broken during delivery

D. One of the clavicles may have been broken during delivery.

During delivery, especially in cases of macrosomic infants (LGA), the clavicles are at risk of fracture due to the size of the infant and the forces exerted during delivery. Palpating the clavicles allows the nurse to assess for any fractures that may have occurred during birth.

In addition to the usual neonatal assessment, the nurse should check the newborn of a diabetic mothers for:

A. blood glucose level

B. signs of bleeding

C. signs of infection

D. visual acuity

A. Blood glucose level

Newborns of diabetic mothers are at risk of hypoglycemia due to exposure to high maternal glucose levels in utero. Therefore, checking the newborn's blood glucose level is essential to monitor for and manage any potential hypoglycemia.

Mrs. Ace, 34 yrs. old and primigravida, is now on her third trimester of pregnancy. She has had diabetes mellitus since the age of 15 and has been attending the antepartal clinic regularly for the past five months. Knowing Mrs. Ace’s history.

You will conclude that she has _______ DM.

a. Class B

b. Class C

c. Class D

d. Class E

b. Class C

Based on the information provided, Mrs. Ace has had diabetes mellitus since the age of 15 and is now pregnant. The classification of her diabetes during pregnancy can be determined by her history and management.

Class B: Onset after 20 years of age - Since Mrs. Ace has had diabetes since the age of 15, this does not apply.

Class C: Diabetes of over 10 years’ duration - This seems to be the most appropriate classification for Mrs. Ace.

Class D: Presence of microvascular disease - The presence of microvascular disease is not mentioned in the information provided.

Class E: Presence of significant vascular disease or complications - There is no information provided indicating the presence of significant vascular disease or complications in Mrs. Ace.

Compared with Mrs. Ace’s insulin requirements when she was not pregnant, the nurse can expect that the insulin dosage during the third trimester will be:

a. decreased

b. dependent upon fetal activity

c. increased

d. the same as prior requirements

c. increased

During pregnancy, insulin requirements typically increase due to hormonal changes and increased insulin resistance. Therefore, the nurse can expect that Mrs. Ace's insulin dosage during the third trimester will be increased

At 30 weeks gestation, Mrs Ace undergoes an ultrasound examination. The nurse should explain to Mrs Ace that the results of this examination will be:

a. gestational age

b. circulatory function

c. presence of surfactant

d. presence of Rh isoimmunization

a. Gestational age

An ultrasound examination at 30 weeks gestation is typically performed to assess the gestational age of the fetus, as well as to evaluate fetal growth and development. It can also provide information about the position of the fetus, the amount of amniotic fluid, and the placental location.

Because of the incidence of fetal death is higher in women who have DM the nurse should anticipate indications of placental insufficiency if Mrs. C has:

a. an albumin content in her urine of 1+

b. urinary output of more than 1500 ml a day

c. decrease insulin needs for maintenance of normal blood glucose level

d. increase secretion of gonadotropin

a. An albumin content in her urine of 1+

An albumin content in the urine (albuminuria) is a sign of kidney damage, which can occur as a complication of diabetes mellitus. In pregnant women with diabetes, especially those with poorly controlled blood sugar levels, kidney damage can lead to placental insufficiency, increasing the risk of fetal death. Therefore, the nurse should anticipate indications of placental insufficiency if Mrs. C has albuminuria.

The should be aware that the newborn of a diabetic mother shows symptoms like tremors, apnea, cyanosis and poor sucking reflex due to:

a. CNS edema

b. hyperglycemia

c. hypoglycemia

d. subdural hematoma

c. Hypoglycemia

Symptoms such as tremors, apnea, cyanosis, and poor sucking reflex in a newborn of a diabetic mother can be indicative of hypoglycemia. Neonates born to diabetic mothers are at risk of hypoglycemia due to the abrupt cessation of the maternal glucose supply at birth, as well as the infant's increased insulin production in response to high maternal blood glucose levels during pregnancy.

A 28 year old primigravida who is in her first trimester of pregnancy says to the nurse, I was so anxious to be pregnant and now that I am, I’m not so sure I want to be pregnant.” The nurse would respond appropriately based on an understanding of which true statement?

A. Having mixed feelings about pregnancy is normal in the first trimester.

B. Having mixed feelings in the first trimester increases the chances of poor postpartum bonding.

C. Women who are uncertain about wanting to be pregnant need counseling to enable them to deal with their femininity.

D. Women who are uncertain about wanting to be pregnant should be told of the options available to them.

A. Having mixed feelings about pregnancy is normal in the first trimester.

It's common for women to have mixed feelings about pregnancy, especially in the early stages when the reality of the situation may still be sinking in. The nurse can provide reassurance and support while acknowledging the patient's feelings as normal.

Mrs Diana, 26 wks pregnant, has been followed closely at the prenatal clinic because she has Class II cardiac disease. Your plan therefore would take into consideration that:

a. there will be no discomfort with ordinary physical activity

b. anginal pain is present even at rest

c. ordinary physical activity causes fatigue

d. palpitation and dyspnea are experienced with less than ordinary physical activity

c. Ordinary physical activity causes fatigue.

Class II cardiac disease involves discomfort or fatigue with ordinary physical activity but not at rest. Therefore, the nurse should anticipate that ordinary physical activity may cause fatigue for Mrs. Diana.

You should instruct Mrs Diana to report immediately the occurrence of which of the following signs and symptoms?

a. increased pedal edema

b. increased urinary output

c. increased PR during exertion

d. increased dyspnea during exertion

d. Increased dyspnea during exertion.

Increased dyspnea during exertion could indicate worsening heart function and may require immediate medical attention to prevent further complications.

Of the following considerations, which one is the most important to guide you in planning the care of Mrs. Diana?

a. the size of the heart

b. etiology of heart disease

c. functional capacity of the heart

d. degree of pulmonary complication

c. Functional capacity of the heart.

The functional capacity of the heart, which indicates how well the heart is able to pump blood throughout the body, is crucial in determining the appropriate level of activity and interventions to manage her condition effectively. It directly influences her ability to engage in physical activity and the extent of her symptoms.

The method of delivery preferred for her is:

a. caesarian section

b. high forceps

c. induction prior to term

d. low forceps

a. Caesarean section.

Given Mrs. Diana's Class II cardiac disease, the preferred method of delivery would depend on various factors, including her overall health status, the condition of her heart, and any specific obstetric indications. However, in general, the method of delivery preferred for women with cardiac disease is one that minimizes stress on the heart and reduces the risk of complications.

Caesarean section allows for controlled delivery and reduces the physiological stress associated with labor, which can be particularly beneficial for women with cardiac disease. However, the final decision should be made in consultation with Mrs. Diana's healthcare team based on her individual circumstances and obstetric considerations.

Mrs Diana are given prophylactic antibiotic during labor and after delivery primarily to prevent:

a. lower urinary tract infection

b. mitral valve prolapse

c. pulmonary edema

d. subacute bacterial endocarditis

d. Subacute bacterial endocarditis

Prophylactic antibiotics are commonly administered during labor and after delivery to prevent subacute bacterial endocarditis in individuals with underlying cardiac conditions, such as Mrs. Diana with Class II cardiac disease. This measure helps reduce the risk of bacterial infections reaching the heart and causing endocarditis, which can be life-threatening in susceptible individuals.

A primigravida with a history of cardiac problems is admitted to the facility in the beginning stage of labor. Despite her cardiac condition, the client has tolerated her pregnancy well. Which nursing action should be included in the client’s plan of care during labor?

A. Assess the client for signs of abruptio placenta

B. Assess the client frequently for signs of dyspnea

C. Check the client’s urine for signs of cardiac problems

D. Keep the lights in the room dimmed

B. Assess the client frequently for signs of dyspnea.

Continuous monitoring for signs of dyspnea is essential to promptly identify any deterioration in respiratory status, which can be indicative of worsening cardiac function. This allows for early intervention and management to prevent complications.

Which sign or symptom indicates that placenta is about to be delivered?

A. The abdominal wall relaxes markedly

B. The client complains of the pain

C. The umbilical cord lengthens outside the vagina

D. The uterus falls below the symphysis pubis

C. The umbilical cord lengthens outside the vagina.

As the placenta detaches from the uterine wall and begins to descend, the umbilical cord typically lengthens outside the vagina. This is a sign that the placenta is about to be delivered.

A 31-year-old client is admitted to the nursing unit with the diagnosis of placenta previa. Which sign or symptom isn’t seen with placenta previa?

A. Bright red, painless vaginal bleeding

B. Implantation of the placenta in the lower uterine segment

C. Separation of the placenta as the cervix ripens

D. Severe pelvic pain

D. Severe pelvic pain.

Placenta previa typically presents with painless vaginal bleeding, which is bright red in color. It occurs due to the implantation of the placenta in the lower uterine segment, covering or partially covering the cervical os. Separation of the placenta as the cervix ripens is characteristic of placental abruption, not placenta previa. Severe pelvic pain is not typically associated with placenta previa unless there is concurrent placental abruption or another complication.

A full term pregnant woman is admitted to the hospital with a diagnosis of abruptio placenta. Which assessment finding isn’t related to abruptio placenta?

A. Hypertension

B. Painful vaginal bleeding

C. Signs of shock

D. Tender board like uterus

A. Hypertension.

Hypertension is not typically associated with abruptio placenta. Abruptio placenta is more commonly associated with conditions such as chronic hypertension or preeclampsia, but hypertension alone is not a direct sign of abruptio placenta.

The other options—painful vaginal bleeding, signs of shock, and a tender, board-like uterus—are all associated with abruptio placenta.

Miss A complains to the nurse that she has been feeling very tired and sick to her stomach, especially in the morning. What is the nurse’s best response?

A. “ This is common during early pregnancy, don’t worry about it.”

B. “ This is common during early pregnancy because of all changes going on in your body.”

C. “ This is common during early pregnancy because of all changes going on in your body. Can you tell me more about how you feel in the morning.”

D. “You should ask the physician about that.”

C. “This is common during early pregnancy because of all the changes going on in your body. Can you tell me more about how you feel in the morning?”

This response acknowledges the patient's concerns while providing reassurance that her symptoms are common during early pregnancy. It also invites the patient to share more about her symptoms, which can help the nurse provide appropriate support and guidance.

The nurse is caring for a primigravida admited to the hospital at 12 weeks AOG. She has abdominal cramping and bright red vaginal spotting. Her cervix isn’t dilated. Which diagnosis is most likely?

A. Incomplete miscarriage

B. Inevitable miscarriage

C. Missed miscarriage

D. Threatened miscarriage

D. Threatened miscarriage.

Threatened miscarriage is characterized by vaginal bleeding and abdominal cramping during the first half of pregnancy, often without cervical dilation. It indicates a possible risk of miscarriage, but the pregnancy may continue without further complications.

Ms. B admitted to the hospital because of spontaneous miscarriage and underwent dilatation and curettage. The nurse finds the client crying and clearly upset. Which nursing diagnosis is most important for the client at this time?

A. Acute pain related to surgical procedure

B. Anxiety related to self-esteem

C. Deficient knowledge related to the lost pregnancy

D. Powerlessness related to loss and grief

D. Powerlessness related to loss and grief.

Ms. B is likely experiencing feelings of powerlessness due to the loss of her pregnancy, which can lead to profound grief and emotional distress. Addressing her feelings of powerlessness and providing support for her grieving process are crucial for her emotional well-being and recovery.

A 38-year-old is admitted with a suspected ectopic pregnancy. While interviewing the client, the nurse needs to assess whether the client:

A. Has been pregnant before

B. Is taking birth control pills

C. Knows when her last menstrual period began

D. Recently had intercourse

C. Knows when her last menstrual period began.

Knowing the date of the last menstrual period is crucial for estimating the gestational age and determining if there's a possibility of ectopic pregnancy, especially if the menstrual period is significantly delayed or irregular.

A client suspects that she is pregnant, but because she is the only wage earner in her family, she is ambivalent about continuing the pregnancy and birth are called crises because:

A. Narcissism in the mother affects the husband-wife relationship

B. There are hormonal and physiological changes in the mother

C. There are mood changes during pregnancy

D. They are period of change and adjustment to change

D. They are periods of change and adjustment to change.

Pregnancy and childbirth can be considered crises because they represent significant periods of change and adjustment in a woman's life, as well as in the lives of her family members. These transitions can bring about emotional, social, and economic challenges that require adaptation and coping strategies.

An obstetric client with a history of three spontaneous miscarriage is now 16 weeks pregnant and attending the high-risk clinic. The client expresses concerns about remaining at home during this pregnancy. The nurse should question the client to determine her knowledge of:

A. Causes of spontaneous abortion

B. Current status of pregnancy and availability of support system

C. Interrelationship among rest, normal delivery and diet.

D. Signs and symptoms of spontaneous abortion

B. Current status of pregnancy and availability of support system.

Understanding the client's awareness of her pregnancy status and the presence of a support system can help the nurse provide appropriate guidance and support tailored to the client's needs and concerns.

Mrs. Eva is admitted to a hospital. It is suspected that she is pregnant with gestation occurring outside of the uterus. What information that is particularly important for the nurse to obtain?

a. whether the patient has been pregnant previously

b. whether the patient is taking birth control pills

c. when the patient last had sexual intercourse

d. when the patient started her last menstrual period

c. When the patient last had sexual intercourse.

Knowing the timing of the patient's last sexual intercourse can help estimate the potential risk of pregnancy and the possibility of ectopic pregnancy, especially if it occurred around the time of ovulation. This information aids in the diagnostic process and guides subsequent management decisions.

The nurse would suspect ectopic pregnancy if the patient complained

a. dysuria

b. lower abdominal cramping

c. passing out of vesicles from the vagina

d. sharp, knife-like, lower left or right abdominal pain

d. Sharp, knife-like, lower left or right abdominal pain.

Ectopic pregnancy often presents with sharp, stabbing abdominal pain, typically localized to one side (either the lower left or right abdomen). This pain can be severe and may be accompanied by other symptoms such as vaginal bleeding and shoulder pain due to internal bleeding or irritation of the diaphragm from blood in the abdominal cavity.

The most common site of ectopic pregnancy is tubal. Which of the following parts of the fallopian tube is the common site?

a. entrance

b. inner

c. mouth

d. outer

b. Inner

The most common site of ectopic pregnancy within the fallopian tube is the ampulla, which is the wider, middle part of the tube where fertilization typically occurs. Therefore, the "inner" part of the fallopian tube is the common site for ectopic pregnancy.

Mrs. Feliz gravida 2 para 0 calls you in a prenatal clinic because of unexplained vaginal bleeding with no complete expulsion of the fetus. This is best indicative of:

a. inevitable miscarriage

b. miscarriage

c. placenta previa

d. threatened miscarriage

d. Threatened miscarriage.

Threatened miscarriage refers to vaginal bleeding during early pregnancy without cervical dilation and without the complete expulsion of fetal tissue. It indicates a risk of miscarriage, but the pregnancy may continue without further complications.

Based on your answer on the above question, you should advise Mrs. Feliz to:

a. come to the clinic immediately

b. elevate her legs whenever she rests

c. continue her activities but limit her intake of fluids

d. restrict her activities and call again if bleeding persists

d. Restrict her activities and call again if bleeding persists.

Restricting activities can help reduce the risk of further bleeding and potential complications. Additionally, instructing Mrs. Feliz to call again if bleeding persists ensures that she receives prompt medical attention if her condition worsens.

The nurse should also advise Mrs. Feliz to:

a. call the clinic when the bleeding stops

b. record fluid intake and urinary output for 24 hours

c. save all perineal pads, clots and expelled tissues

d. take a laxative so she does not strain at stool

c. Save all perineal pads, clots, and expelled tissues.

Saving all perineal pads, clots, and expelled tissues can provide valuable information for healthcare providers to assess the extent of bleeding and help in making clinical decisions. This information can aid in determining the severity of the situation and guide further management.

Mrs. Feliz went to the hospital for a dilatation and curettage (D & C) when it is determine that she has passed some of the products of conception. At this time, Mrs. Feliz is most probably experiencing which of the following types of miscarriage?

a. incomplete

b. induced

c. missed

d. threatened

a. Incomplete miscarriage.

Incomplete miscarriage occurs when some, but not all, of the products of conception are expelled from the uterus. In this case, a dilatation and curettage (D&C) may be performed to remove any remaining tissue and prevent complications.

Post-operatively, the nurse finds Mrs. Feliz crying. Which of the following comment would be best for the nurse to make in this situation?

a. “A baby still was not formed in your uterus, so please, don’t be upset.”

b. “I am sorry you lost your baby.”

c. “Will a pill help your pain.”

d. “Why are you crying.”

b. “I am sorry you lost your baby.”

This response acknowledges Mrs. Feliz's emotional pain and validates her feelings of loss. It demonstrates empathy and compassion, offering support during a difficult time.

By what criterion or criteria is inevitable miscarriage distinguished from threatened miscarriage?

a. bleeding with pain

b. maceration occurs

c. passage of placental tissue

d. spotting

c. Passage of placental tissue.

In inevitable miscarriage, there is typically a progression of symptoms beyond vaginal bleeding, with the passage of placental tissue being a key indicator. This indicates that the miscarriage is progressing and is no longer in the "threatened" stage where the outcome is uncertain.

Most of the spontaneous miscarriage are caused by the following EXCEPT:

a. defective germ plasm

b. maternal malnutrition

c. infectious diseases

d. abnormalities in the reproductive tract

e. all of the above

f. none of the above

e. all of the above

Spontaneous miscarriages can be caused by various factors, including defective germ plasm (genetic abnormalities), maternal malnutrition, infectious diseases, and abnormalities in the reproductive tract. Therefore, all of the options listed are potential causes of spontaneous miscarriage.

Mrs. Natalie is in her third month of pregnancy complained of intermittent brownish red discharge and excessive nausea and vomiting. Abdominal palpation reveals the uterus to be at the level of the umbilicus. Fetal heart tones are absent. Which following diagnosis is most likely?

a. ectopic pregnancy

b. hydatidiform mole

c. hyperemesis gravidarum

d. threatened abortion

b. Hydatidiform mole.

A hydatidiform mole, also known as a molar pregnancy, can present with symptoms such as vaginal bleeding (brownish-red discharge), excessive nausea and vomiting (hyperemesis gravidarum), and uterine size larger than expected for gestational age. Absence of fetal heart tones is also common in a hydatidiform mole due to the absence of a viable fetus.

Following treatment, you counsel Mrs. Natalie. In your teaching you consider her prognosis. Of the following complications, which would be of greatest concern?

a. choriocarcinoma

b. fluid and electrolyte imbalance

c. pelvic inflammatory disease

d. sterility

a. Choriocarcinoma.

Choriocarcinoma is a rare but serious complication of a hydatidiform mole. It is a type of cancer that can develop from abnormal placental tissue left behind after treatment for the molar pregnancy. Choriocarcinoma can spread rapidly to other organs if not treated promptly, making it the most concerning complication in this scenario.

To further prevent the above possible complication of Mrs. Natalie’s condition, you would expect that the physician will order:

a. Intravenous Fluids

b. Leucovorin

c. Methotrexate

d. Oxytocin

c. Methotrexate.

Methotrexate is a chemotherapy medication that can be used to treat or prevent choriocarcinoma by targeting and destroying any remaining abnormal placental tissue after treatment for the molar pregnancy. This helps reduce the risk of choriocarcinoma development or recurrence.

The nurse discusses with a client a prenatal test to screen for spinal anomalies done between 16 and 20 weeks’ gestation, which is called the:

a. a -Fetoprotein (AFP)

b. BHCG

c. Enzyme-linked immunosorbent assay (ELISA)

d. VDRL

a. Alpha-fetoprotein (AFP) test.

The alpha-fetoprotein (AFP) test is a screening test that measures the level of AFP in the mother's blood. Abnormal levels of AFP can indicate the presence of certain fetal abnormalities, including neural tube defects such as spina bifida. This test is typically performed between 16 and 20 weeks of gestation.

In screening for factors that place the pregnancy at risk, the nurse would assess a client at her first prenatal visit for:

a. Changes in bowel habits

b. Emotional lability

c. Nauseas and vomiting

d. Vaginal bleeding and cramping

d. Vaginal bleeding and cramping.

Vaginal bleeding and cramping are important signs and symptoms that can indicate potential complications such as threatened miscarriage or ectopic pregnancy. Identifying these early in prenatal care allows for prompt intervention and management to optimize maternal and fetal outcomes.

When a client goes into labor after a cerclage has been performed, the nurse will assist with:

a. A Pap smear

b. Cultures of the cervix

c. Mechanical dilation of the cervix

d. Removal of the sutures

d. Removal of the sutures.

Removing the cerclage sutures is necessary to allow for cervical dilation and the progression of labor. This procedure is typically performed once the client is in active labor or if there are signs of preterm labor, as the cerclage may impede the normal process of cervical dilation during labor.

A pregnant woman at 12 weeks gestation has a history of preeclampsia. What initial steps should the healthcare provider take to monitor her condition?

A) Schedule frequent prenatal visits

B) Recommend complete bed rest

C) Prescribe antihypertensive medication immediately

D) Advise increasing salt intake

Answer: A) Schedule frequent prenatal visits

Explanation: Frequent prenatal visits are essential to monitor blood pressure and other signs of preeclampsia. Bed rest and salt intake adjustments are not first-line treatments.

A 28-year-old pregnant woman with gestational diabetes is concerned about her blood sugar levels. What is the best advice to manage her condition?

A) Monitor blood glucose levels frequently

B) Reduce carbohydrate intake drastically

C) Engage in strenuous exercise

D) Skip meals to control blood sugar

Answer: A) Monitor blood glucose levels frequently

Explanation: Regular monitoring of blood glucose helps manage gestational diabetes effectively. Reducing carbohydrates drastically or skipping meals is not advisable.

A woman in her third trimester presents with severe headaches, visual disturbances, and swelling. What is the most likely condition and immediate action?

A) Anemia; prescribe iron supplements

B) Preeclampsia; refer to a specialist immediately

C) Gestational diabetes; adjust insulin dosage

D) Hyperthyroidism; order thyroid function tests

Answer: B) Preeclampsia; refer to a specialist immediately

Explanation: These symptoms are indicative of preeclampsia, which requires immediate medical attention and possible referral to a specialist

A pregnant woman at 32 weeks gestation reports decreased fetal movements. What should the healthcare provider do first?

A) Reassure her that this is normal

B) Perform a non-stress test

C) Schedule an ultrasound for the next week

D) Advise her to wait and see if movements increase

Answer: B) Perform a non-stress test

Explanation: A non-stress test assesses fetal well-being. It is a critical first step in evaluating decreased fetal movements.

A 20-week pregnant woman is found to have a low-lying placenta on ultrasound. What is the appropriate management plan?

A) Immediate hospitalization

B) Advise avoiding heavy lifting and intercourse

C) Schedule for a cesarean section immediately

D) No special precautions needed

Answer: B) Advise avoiding heavy lifting and intercourse

Explanation: Precautions to avoid activities that may cause bleeding are appropriate. Immediate hospitalization or cesarean section is not necessary unless complications arise.

A woman in labor is experiencing a prolonged second stage. What is a potential risk for the baby?

A) Fetal hypoxia

B) Neonatal jaundice

C) Preterm birth

D) Low birth weight

Answer: A) Fetal hypoxia

Explanation: A prolonged second stage can lead to fetal hypoxia due to prolonged compression of the fetal head and reduced oxygen supply.

During labor, a woman develops sudden chest pain and shortness of breath. What should the healthcare provider suspect and do immediately?

A) Anxiety attack; provide reassurance

B) Amniotic fluid embolism; initiate emergency protocols

C) Pneumonia; start antibiotics

D) Gastroesophageal reflux; give antacids

Answer: B) Amniotic fluid embolism; initiate emergency protocols

Explanation: Sudden chest pain and shortness of breath during labor are signs of amniotic fluid embolism, a life-threatening condition requiring immediate intervention.

A pregnant woman in labor has a history of herpes simplex virus. What is the appropriate management to reduce the risk of transmission to the newborn?

A) Elective cesarean delivery if active lesions are present

B) Administer antiviral medication to the newborn

C) Vaginal delivery without precautions

D) No special measures are needed

Answer: A) Elective cesarean delivery if active lesions are present

Explanation: If active genital lesions are present, a cesarean delivery is recommended to prevent transmission of herpes to the newborn.

A woman in active labor suddenly experiences a rapid drop in blood pressure and fetal heart rate. What is the most likely diagnosis?

A) Placental abruption

B) Uterine rupture

C) Cord prolapse

D) Preterm labor

Answer: C) Cord prolapse

Explanation: Cord prolapse can cause a rapid drop in both maternal blood pressure and fetal heart rate, requiring immediate emergency intervention.

A pregnant woman’s labor is progressing slowly despite adequate contractions. What could be a potential cause?

A) Fetal distress

B) Cephalopelvic disproportion

C) Maternal dehydration

D) Preterm labor

Answer: B) Cephalopelvic disproportion

Explanation: Cephalopelvic disproportion occurs when the baby’s head is too large to pass through the mother’s pelvis, causing slow labor progression despite adequate contractions.

A new mother is experiencing postpartum hemorrhage. What is the first line of management?

A) Administer intravenous fluids and uterotonics

B) Perform an immediate hysterectomy

C) Give a blood transfusion immediately

D) Advise rest and monitor

Answer: A) Administer intravenous fluids and uterotonics

Explanation: The first line of management for postpartum hemorrhage includes stabilizing the patient with IV fluids and administering uterotonics to contract the uterus and reduce bleeding.

A mother is concerned about her baby’s breastfeeding and latching issues. What should the healthcare provider suggest?

A) Switch to formula feeding

B) Consult a lactation specialist

C) Pump breast milk and bottle feed

D) Introduce solid foods early

Answer: B) Consult a lactation specialist

Explanation: A lactation specialist can provide expert guidance and support for breastfeeding and latching issues, helping the mother and baby establish effective breastfeeding.

A postpartum mother is showing signs of severe depression and has thoughts of harming herself. What is the appropriate action?

A) Reassure her that these feelings are normal

B) Refer her to a mental health specialist immediately

C) Suggest joining a new mothers’ support group

D) Increase her physical activity

Answer: B) Refer her to a mental health specialist immediately

Explanation: Severe postpartum depression with suicidal ideation requires immediate referral to a mental health specialist for appropriate treatment and support.

A mother reports excessive vaginal bleeding and passing large clots one week postpartum. What should the healthcare provider do?

A) Reassure her that this is normal

B) Perform a pelvic exam and possibly an ultrasound

C) Prescribe iron supplements

D) Advise bed rest

Answer: B) Perform a pelvic exam and possibly an ultrasound

Explanation: Excessive bleeding and clots postpartum require a thorough examination to rule out retained products of conception or other complications.

A breastfeeding mother develops mastitis. What is the recommended treatment?

A) Discontinue breastfeeding

B) Apply warm compresses and continue breastfeeding

C) Take antibiotics and stop breastfeeding

D) Use cold compresses and formula feed

Answer: B) Apply warm compresses and continue breastfeeding

Explanation: Warm compresses and continuing breastfeeding help relieve symptoms and resolve mastitis. Antibiotics may be needed, but breastfeeding should continue.

A newborn is delivered with meconium-stained amniotic fluid. What is the initial management step?

A) Immediate intubation and suction

B) Routine newborn care

C) Administer antibiotics

D) Monitor for signs of distress

Answer: D) Monitor for signs of distress

Explanation: Routine suctioning is not recommended unless the newborn is not vigorous. The baby should be monitored for respiratory distress.

A premature newborn is having difficulty maintaining body temperature. What is the best approach to manage this?

A) Use a radiant warmer or incubator

B) Swaddle the baby tightly

C) Bathe the baby in warm water frequently

D) Place the baby in a crib with blankets

Answer: A) Use a radiant warmer or incubator

Explanation: Premature infants have difficulty maintaining body temperature, and a radiant warmer or incubator is essential to provide a stable thermal environment.

A newborn has jaundice on the second day of life. What is the appropriate course of action?

A) Start phototherapy immediately

B) Check bilirubin levels and monitor

C) Begin formula feeding to clear bilirubin

D) Ignore it as it is usually harmless

Answer: B) Check bilirubin levels and monitor

Explanation: Jaundice in the first days of life requires monitoring bilirubin levels to determine if treatment, such as phototherapy, is needed.

A newborn is diagnosed with neonatal sepsis. What is the initial treatment?

A) Start broad-spectrum antibiotics

B) Administer antiviral medication

C) Provide supportive care only

D) Delay treatment until culture results are available

Answer: A) Start broad-spectrum antibiotics

Explanation: Neonatal sepsis requires immediate initiation of broad-spectrum antibiotics to treat the infection promptly.

A term newborn is found to have a congenital heart defect during the initial examination. What should be the next step?

A) Immediate surgical correction

B) Referral to a pediatric cardiologist

C) Initiate antibiotics

D) Monitor and reassess at a later visit

Answer: B) Referral to a pediatric cardiologist

Explanation: A pediatric cardiologist should evaluate congenital heart defects for appropriate diagnosis and management planning.

A pregnant woman with a history of hypertension is at risk for preeclampsia. What are early signs to monitor?

A) Swelling of the feet and ankles

B) Persistent headache and vision changes

C) Increased fetal movements

D) Frequent urination

Answer: B) Persistent headache and vision changes

Explanation: Persistent headache and vision changes are early signs of preeclampsia, a serious condition that requires close monitoring.

A woman at 36 weeks gestation reports sudden severe abdominal pain and vaginal bleeding. What should be suspected?

A) Placenta previa

B) Placental abruption

C) Preterm labor

D) Urinary tract infection

Answer: B) Placental abruption

Explanation: Sudden severe abdominal pain and bleeding suggest placental abruption, a condition where the placenta detaches from the uterine wall prematurely.

A pregnant woman with Type 1 diabetes is concerned about her baby's health. What should be the primary focus of management?

A) Strict glycemic control

B) Increased caloric intake

C) Frequent bed rest

D) Avoiding exercise

Answer: A) Strict glycemic control

Explanation: Strict glycemic control is essential to reduce the risk of complications for both the mother and baby in pregnancies complicated by Type 1 diabetes.

A woman with hyperemesis gravidarum is dehydrated and unable to keep food down. What is the appropriate treatment?

A) Intravenous fluids and antiemetics

B) Oral rehydration solutions

C) High-calorie diet

D) Psychotherapy

Answer: A) Intravenous fluids and antiemetics

Explanation: IV fluids and antiemetics are necessary to treat dehydration and severe nausea/vomiting in hyperemesis gravidarum.

A pregnant woman is diagnosed with cholestasis. What is a significant risk associated with this condition?

A) Preterm labor

B) Fetal distress and stillbirth

C) Maternal hypertension

D) Gestational diabetes

Answer: B) Fetal distress and stillbirth

Explanation: Cholestasis of pregnancy is associated with an increased risk of fetal distress and stillbirth, requiring close monitoring and sometimes early delivery.

A newborn has a low Apgar score at 1 minute. What is the initial step in management?

A) Start resuscitation efforts

B) Wait and reassess at 5 minutes

C) Provide glucose supplementation

D) Give antibiotics

Answer: A) Start resuscitation efforts

Explanation: A low Apgar score requires immediate resuscitation efforts to stabilize the newborn.

A baby born at 28 weeks gestation is at risk for respiratory distress syndrome. What is a key preventive measure?

A) Administration of surfactant therapy

B) Immediate intubation and ventilation

C) Use of nasal cannula for oxygen

D) Avoidance of fluid intake

Answer: A) Administration of surfactant therapy

Explanation: Surfactant therapy is crucial for premature infants to reduce the risk and severity of respiratory distress syndrome.

A newborn has an abnormal red reflex on the initial eye exam. What should be the next step?

A) Referral to a pediatric ophthalmologist

B) Immediate treatment with antibiotics

C) Reassess at the next visit

D) Start phototherapy

Answer: A) Referral to a pediatric ophthalmologist

Explanation: An abnormal red reflex can indicate serious eye conditions and warrants immediate evaluation by a pediatric ophthalmologist.

A newborn presents with hypoglycemia. What is the initial management?

A) Immediate breastfeeding or glucose gel

B) Monitor blood glucose levels every hour

C) Administer insulin

Answer: A) Immediate breastfeeding or glucose gel

Explanation: Immediate breastfeeding or administration of glucose gel is necessary to quickly raise the blood glucose levels in a hypoglycemic newborn.

A 5-year-old child presents with a high fever, sore throat, and a red, sandpaper-like rash. What is the most likely diagnosis and initial treatment?

A) Measles; administer vitamin A

B) Scarlet fever; prescribe antibiotics

C) Chickenpox; administer antiviral medication

D) Rubella; provide supportive care

Answer: B) Scarlet fever; prescribe antibiotics

Explanation: Scarlet fever presents with a high fever, sore throat, and a characteristic red rash. It is caused by group A Streptococcus, and antibiotics are the treatment of choice.

A 2-year-old has a barking cough, hoarseness, and stridor, particularly at night. What is the most likely diagnosis and immediate management?

A) Epiglottitis; intubation

B) Croup; administer corticosteroids

C) Asthma; use a bronchodilator

D) Bronchiolitis; provide oxygen therapy

Answer: B) Croup; administer corticosteroids

Explanation: Croup, caused by a viral infection, typically presents with a barking cough and stridor. Corticosteroids reduce airway inflammation and improve symptoms.

A 4-year-old child has a high fever, malaise, and a rash that started on the face and spread downward. What is the likely diagnosis and important next step?

A) Rubella; supportive care

B) Chickenpox; administer antiviral medication

C) Measles; report to public health authorities

D) Fifth disease; provide supportive care

Answer: C) Measles; report to public health authorities

Explanation: Measles presents with a high fever, malaise, and a characteristic rash. It is a notifiable disease requiring public health reporting to control outbreaks.

A 6-year-old has fever, painful swelling of the parotid glands, and headache. What is the most likely diagnosis and recommended care?

A) Tonsillitis; prescribe antibiotics

B) Mumps; supportive care

C) Rubella; provide supportive care

D) Pertussis; administer antibiotics

Answer: B) Mumps; supportive care

Explanation: Mumps causes fever, parotid gland swelling, and headache. Treatment is supportive as it is a viral infection.

A 7-year-old presents with fever, sore throat, and painful swallowing. Examination reveals swollen tonsils with white exudates. What is the likely diagnosis and treatment?

A) Viral pharyngitis; provide supportive care

B) Streptococcal pharyngitis; prescribe antibiotics

C) Mononucleosis; advise rest and fluids

D) Diphtheria; administer antitoxin

Answer: B) Streptococcal pharyngitis; prescribe antibiotics

Explanation: Streptococcal pharyngitis (strep throat) presents with fever, sore throat, and tonsillar exudates. Antibiotics are necessary to treat the bacterial infection.

A 3-year-old with a history of asthma presents with wheezing, coughing, and shortness of breath. What is the appropriate immediate treatment?

A) Administer oral steroids

B) Administer albuterol via nebulizer

C) Provide oxygen therapy

D) Give antihistamines

Answer: B) Administer albuterol via nebulizer

Explanation: Acute asthma exacerbations are treated with bronchodilators like albuterol to relieve bronchoconstriction.

A 10-year-old complains of chest pain, fatigue, and a persistent cough. Chest X-ray shows a localized consolidation. What is the most likely diagnosis and treatment?

A) Asthma; prescribe inhaled corticosteroids

B) Pneumonia; prescribe antibiotics

C) Bronchitis; provide supportive care

D) Tuberculosis; initiate anti-tuberculosis therapy

Answer: B) Pneumonia; prescribe antibiotics

Explanation: Pneumonia presents with localized consolidation on chest X-ray, chest pain, fatigue, and cough. Antibiotics are required for bacterial pneumonia.

A 1-year-old with a runny nose, cough, and wheezing is diagnosed with bronchiolitis. What is the most appropriate management?

A) Administer antibiotics

B) Provide supportive care with hydration and oxygen if needed

C) Start corticosteroids

D) Use a bronchodilator

Answer: B) Provide supportive care with hydration and oxygen if needed

Explanation: Bronchiolitis, usually caused by RSV, is managed with supportive care. Antibiotics are not indicated unless there is a bacterial co-infection.

A 7-year-old with asthma is brought to the emergency room with severe shortness of breath and cyanosis. What is the most appropriate immediate treatment?

A) Administer intravenous steroids

B) Administer nebulized albuterol and ipratropium

C) Provide antibiotics

D) Give oral antihistamines

Answer: B) Administer nebulized albuterol and ipratropium

Explanation: Severe asthma exacerbations require immediate bronchodilation with nebulized albuterol and ipratropium. Intravenous steroids can be given subsequently.

A 5-year-old presents with a sore throat, drooling, and difficulty breathing. The child is sitting forward with the neck extended. What is the most likely diagnosis and initial management?

A) Epiglottitis; secure the airway and administer antibiotics

B) Croup; give corticosteroids

C) Asthma; use a bronchodilator

D) Tonsillitis; prescribe antibiotics

Answer: A) Epiglottitis; secure the airway and administer antibiotics

Explanation: Epiglottitis presents with sore throat, drooling, and difficulty breathing, often in a sitting position with the neck extended. Airway management and antibiotics are critical.

A 4-year-old presents with abdominal pain, vomiting, and bloody diarrhea. What is the most likely diagnosis and next step in management?

A) Viral gastroenteritis; provide oral rehydration

B) Bacterial enteritis; obtain stool culture and start antibiotics

C) Intussusception; perform an air or barium enema

D) Appendicitis; prepare for surgical evaluation

Answer: B) Bacterial enteritis; obtain stool culture and start antibiotics

Explanation: Bloody diarrhea with abdominal pain suggests bacterial enteritis. Stool culture helps identify the pathogen, and antibiotics are initiated based on clinical judgment.

A 6-month-old presents with sudden, severe, colicky abdominal pain and currant jelly stools. What is the likely diagnosis and immediate intervention?

A) Gastroenteritis; provide oral rehydration

B) Intussusception; perform an air or barium enema

C) Volvulus; prepare for surgery

D) Constipation; administer laxatives

Answer: B) Intussusception; perform an air or barium enema

Explanation: Intussusception presents with colicky pain and currant jelly stools. An air or barium enema is both diagnostic and therapeutic.

A 10-year-old with a history of constipation presents with abdominal pain and rectal bleeding. What is the likely diagnosis and first step in management?

A) Appendicitis; surgical evaluation

B) Gastroenteritis; provide supportive care

C) Anal fissure; increase dietary fiber and fluids

D) Intestinal obstruction; imaging studies

Answer: C) Anal fissure; increase dietary fiber and fluids

Explanation: Chronic constipation can lead to anal fissures, presenting with pain and bleeding. Increasing fiber and fluids helps soften stools and promotes healing.

A 2-year-old presents with persistent vomiting and failure to thrive. Examination reveals an olive-shaped mass in the abdomen. What is the most likely diagnosis and treatment?

A) Gastroesophageal reflux; prescribe antacids

B) Pyloric stenosis; surgical consultation for pyloromyotomy

C) Intestinal obstruction; imaging studies

D) Hirschsprung disease; surgical evaluation

Answer: B) Pyloric stenosis; surgical consultation for pyloromyotomy

Explanation: Pyloric stenosis presents with projectile vomiting and an olive-shaped abdominal mass. Surgery is required to correct the obstruction.

A 3-year-old with severe diarrhea, dehydration, and metabolic acidosis is brought to the clinic. What is the most appropriate initial management?

A) Administer oral rehydration solution

B) Start intravenous fluids

C) Provide antibiotics

D) Give antiemetics

Answer: B) Start intravenous fluids

Explanation: Severe dehydration and metabolic acidosis in a child require immediate intravenous fluid replacement to restore hydration and correct acid-base balance.

A 6-month-old presents with a high-pitched cry, bulging fontanelle, and fever. What is the most likely diagnosis and immediate management?

A) Viral meningitis; supportive care

B) Bacterial meningitis; start intravenous antibiotics

C) Hydrocephalus; refer to neurosurgery

D) Febrile seizure; provide antipyretics

Answer: B) Bacterial meningitis; start intravenous antibiotics

Explanation: Bacterial meningitis presents with fever, high-pitched cry, and bulging fontanelle in infants. Immediate antibiotics are crucial to manage the infection.

A 3-year-old has a sudden onset of left-sided weakness and speech difficulties. What is the most likely diagnosis and next step?

A) Migraine; provide pain relief

B) Seizure; administer anticonvulsants

C) Stroke; urgent neuroimaging

D) Bell’s palsy; observe and follow up

Answer: C) Stroke; urgent neuroimaging

Explanation: Sudden weakness and speech difficulties in a child suggest a stroke. Urgent neuroimaging is necessary to confirm the diagnosis and guide treatment.

A 2-year-old with a history of seizures presents with fever and a generalized tonic-clonic seizure lasting 5 minutes. What is the appropriate initial management?

A) Administer antipyretics

B) Start anticonvulsant therapy

C) Ensure airway patency and safety during the seizure

D) Perform a lumbar puncture

Answer: C) Ensure airway patency and safety during the seizure

Explanation: During an acute seizure, ensuring the child’s airway is patent and preventing injury are the primary concerns. Subsequent management may include antipyretics and anticonvulsants.

A 4-year-old has episodes of staring, lip-smacking, and unresponsiveness for a few seconds. What is the most likely diagnosis and recommended test?

A) Absence seizures; electroencephalogram (EEG)

B) Temporal lobe epilepsy; MRI

C) Attention deficit hyperactivity disorder; behavioral assessment

D) Tic disorder; neurological exam

Answer: A) Absence seizures; electroencephalogram (EEG)

Explanation: Absence seizures present with brief episodes of staring and unresponsiveness. An EEG helps confirm the diagnosis by showing characteristic patterns.

A 5-year-old presents with headache, vomiting, and papilledema. What is the most likely diagnosis and initial investigation?

A) Migraine; administer analgesics

B) Brain tumor; perform a CT or MRI scan

C) Meningitis; lumbar puncture

D) Sinusitis; start antibiotics

Answer: B) Brain tumor; perform a CT or MRI scan

Explanation: Headache, vomiting, and papilledema suggest increased intracranial pressure, often due to a brain tumor. Neuroimaging is necessary for diagnosis.

A newborn has a loud, harsh murmur and failure to thrive. What is the most likely diagnosis and next step?

A) Atrial septal defect; observe and follow up

B) Ventricular septal defect; refer to a pediatric cardiologist

C) Patent ductus arteriosus; administer indomethacin

D) Tetralogy of Fallot; surgical consultation

Answer: B) Ventricular septal defect; refer to a pediatric cardiologist

Explanation: A loud, harsh murmur and failure to thrive in a newborn suggest a ventricular septal defect. A pediatric cardiologist should evaluate and manage the condition.

A 6-year-old with a history of rheumatic fever presents with shortness of breath and fatigue. What is the most likely diagnosis?

A) Myocarditis

B) Rheumatic heart disease

C) Congenital heart defect

D) Pericarditis

Answer: B) Rheumatic heart disease

Explanation: A child with a history of rheumatic fever presenting with shortness of breath and fatigue is likely to have developed rheumatic heart disease, affecting the heart valves.

A 2-year-old with Down syndrome is found to have a continuous "machine-like" murmur on examination. What is the likely diagnosis and treatment?

A) Atrial septal defect; surgical repair

B) Ventricular septal defect; medical management

C) Patent ductus arteriosus; surgical or catheter-based closure

D) Coarctation of the aorta; balloon angioplasty

Answer: C) Patent ductus arteriosus; surgical or catheter-based closure

Explanation: A continuous "machine-like" murmur in a child with Down syndrome suggests a patent ductus arteriosus, often treated with surgical or catheter-based closure.

A 7-year-old with a history of Kawasaki disease presents with chest pain and shortness of breath. What is the most concerning potential complication?

A) Myocarditis

B) Coronary artery aneurysm

C) Pericarditis

D) Endocarditis

Answer: B) Coronary artery aneurysm

Explanation: Kawasaki disease can lead to coronary artery aneurysms, which can cause chest pain and shortness of breath. This is a serious complication requiring prompt evaluation.

A 5-year-old presents with a swollen, painful knee, fever, and a new heart murmur. What is the most likely diagnosis?

A) Rheumatic fever

B) Juvenile idiopathic arthritis

C) Septic arthritis

D) Infective endocarditis

Answer: A) Rheumatic fever

Explanation: Swollen, painful joints, fever, and a new heart murmur are signs of rheumatic fever, which can occur after a streptococcal throat infection.

A 3-year-old with pallor, fatigue, and petechiae has a complete blood count showing low hemoglobin, low platelets, and elevated white blood cells. What is the most likely diagnosis?

A) Iron deficiency anemia

B) Leukemia

C) Aplastic anemia

D) Hemophilia

Answer: B) Leukemia

Explanation: Pallor, fatigue, petechiae, and blood counts showing anemia, thrombocytopenia, and leukocytosis are indicative of leukemia, a common pediatric malignancy.

A 6-year-old presents with painless swelling of the cervical lymph nodes and night sweats. What is the likely diagnosis and initial test?

A) Tuberculosis; perform a PPD test

B) Hodgkin lymphoma; perform a lymph node biopsy

C) Mononucleosis; conduct a monospot test

D) Bacterial lymphadenitis; start antibiotics

Answer: B) Hodgkin lymphoma; perform a lymph node biopsy

Explanation: Painless lymphadenopathy and night sweats in a child suggest Hodgkin lymphoma. A biopsy confirms the diagnosis.

A 2-year-old with a history of frequent nosebleeds and easy bruising has a prolonged prothrombin time (PT). What is the most likely diagnosis?

A) Hemophilia A

B) Von Willebrand disease

C) Vitamin K deficiency

D) Idiopathic thrombocytopenic purpura

Answer: C) Vitamin K deficiency

Explanation: Vitamin K deficiency affects clotting factors and prolongs PT. It is common in young children due to inadequate dietary intake or malabsorption.

A 7-year-old complains of bone pain, fever, and an increased number of infections. A blood smear shows blasts. What is the most likely diagnosis?

A) Osteosarcoma

B) Acute lymphoblastic leukemia (ALL)

C) Juvenile idiopathic arthritis

D) Sickle cell anemia

Answer: B) Acute lymphoblastic leukemia (ALL)

Explanation: Bone pain, fever, frequent infections, and blasts on a blood smear are characteristic of ALL, the most common pediatric leukemia.

A 5-year-old with hemophilia presents with joint pain and swelling after a minor injury. What is the immediate treatment?

A) Administer NSAIDs

B) Provide factor VIII replacement

C) Apply a compression bandage

D) Elevate the limb and apply ice

Answer: B) Provide factor VIII replacement

Explanation: Hemophilia results in bleeding into joints after minor injuries. Immediate replacement of factor VIII is necessary to control bleeding.

A 3-month-old infant is brought to the emergency department with concerns about poor feeding, rapid breathing, and sweating during feeds. The parents report that the baby seems to get tired very easily and has not been gaining weight as expected. On physical examination, you note a prominent heart murmur and hepatomegaly.

What is the most likely diagnosis, and what is the initial management plan?

A) Congenital diaphragmatic hernia; prepare for surgical intervention
B) Congestive heart failure secondary to a congenital heart defect; administer diuretics and refer to a pediatric cardiologist
C) Gastroesophageal reflux disease (GERD); start on acid-suppressive therapy
D) Bronchiolitis; initiate supportive care and oxygen therapy

Answer: B) Congestive heart failure secondary to a congenital heart defect; administer diuretics and refer to a pediatric cardiologist

Explanation: The infant's symptoms of poor feeding, rapid breathing, sweating during feeds, easy fatigue, and poor weight gain, combined with the presence of a heart murmur and hepatomegaly, are classic signs of congestive heart failure (CHF) in infants. This condition is often secondary to an underlying congenital heart defect (CHD), such as a ventricular septal defect (VSD), atrial septal defect (ASD), or patent ductus arteriosus (PDA).