unit 3; maternal newborn questions

A 30-week client reports feeling only 3 fetal movements in the past 2 hours despite lying on her side and hydrating. Priority action?

• A. Reassure and recheck tomorrow

• B. Schedule a biophysical profile

• C. Advise caffeine and repeat counts

• D. Teach that 3 in 2 hours is normal

Answer: B
Rationale: <4 movements in 2 hrs should be reported and triggers further assessment such as NST/BPP.

Which factors can decrease perceived fetal movement? (Select all that apply.)

• A. Fetal sleep–wake cycle

• B. Maternal cigarette smoking

• C. Maternal opioid use

• D. Maternal hydration

• E. Maternal anxiety

Answer: A, B, C
Rationale: Slides list sleep-wake cycle and maternal factors including cigarette smoking/drugs as influences on counts

A 33-week fetus has two accelerations ≥10 bpm for ≥10 sec in 20 minutes. Interpretation?

• A. Reactive NST

• B. Nonreactive NST

• C. Positive CST

• D. Equivocal NST

Answer: A
Rationale: <32 wks: reactive = two accelerations ≥10×10 in 20 min.

Match each to primary purpose: (a) NST, (b) CST, (c) AFI, (d) BPP)

1. Uteroplacental sufficiency under contractions → __

2. Chronic fetal oxygenation/overall well-being with ultrasound variables ± NST → __

3. Amniotic volume estimate (oligo vs poly) → __

4. FHR reactivity with movement → __

Answer: 1-b, 2-d, 3-c, 4-a
Rationale: Definitions of NST/CST/AFI/BPP as shown.

Which client is an appropriate candidate for a CST?

• A. Placenta previa at 30 wks

• B. Prior classical (vertical) C/S incision

• C. Term patient with nonreactive NST and intact membranes

• D. Cervical insufficiency with cerclage

Answer: C
Rationale: CST contraindications include previa, abruption, vertical uterine scar, PROM, cervical insufficiency, cerclage, hx PTL, multiples.

Order the steps for CST performance:

1. Evaluate for 3 spontaneous contractions in 10 minutes

2. Obtain 15-minute baseline FHR/UC tracing

3. Conclude test and interpret

4. Stimulate contractions if needed

Answer: 2 → 1 → 4 → 3
Rationale: Baseline first; if 3 adequate contractions occur, proceed; otherwise stimulate; then interpret

A BPP score is 4/10 at 38 weeks. Most appropriate action?

• A. Repeat in 24 hours

• B. Discharge home

• C. Consider delivery

• D. Start tocolysis

Answer: C
Rationale: Abnormal ≤4 suggests delivery consideration.

Which statement indicates correct understanding of CVS?

• A. “It’s done around 20 weeks and checks lung maturity.”

• B. “It’s done around 10–13 weeks and results come back quickly.”

• C. “I shouldn’t report bleeding unless it’s heavy.”

• D. “I don’t need Rhogam afterward if I’m Rh-negative.”

Answer: B
Rationale: CVS at 10–13 wks with 1-week results; report bleeding/cramping/fever; Rh-negative → Rhogam.

Which finding from amniocentesis suggests low risk of RDS?

• A. L/S ratio 1.5:1

• B. L/S ratio 2:1

• C. AFI 4 cm

• D. Negative CST

Answer: B
Rationale: L/S ≥2:1 indicates mature lungs/low RDS risk

Discharge teaching after amniocentesis includes: (Select all that apply.)

• A. Light activity for 24 h

• B. Increase fluids

• C. Avoid heavy lifting x 2 days

• D. Ignore mild leaking

• E. Rhogam if Rh-negative

Answer: A, B, C, E
Rationale: All listed in post-procedure instructions; report leaking/bleeding/fever.

Which assessment best indicates severity?

• A. Edema

• B. Weight loss and ketonuria

• C. Fetal station

• D. Fundal height

Answer: B
Rationale: HEG defined by excessive vomiting with weight loss, dehydration, ketonuria; assess severity incl. VS, weight, ketones.

Which complication is the highest risk scenario to anticipate in mono-mono twins?

• A. Maternal anemia

• B. Umbilical cord entanglement with perinatal compromise

• C. Maternal heartburn

• D. Post-term pregnancy

Answer: B
Rationale: Slide emphasizes mono-mono as highest risk; multiple maternal/fetal risks listed.

A 28-year-old at 26 weeks asks about diabetes screening. Best response?

• A. “We screen at 12–14 weeks.”

• B. “We screen between 24–28 weeks with 50g glucola.”

• C. “We screen after 36 weeks.”

• D. “We screen only with a 3-hr test.”

Answer: B
Rationale: 50g screen at ~24–28 wks; if ≥130–140, proceed to 3-hr OGTT.

Infants of diabetic mothers are at increased risk for: (Select all that apply.)

• A. Hypoglycemia

• B. Respiratory distress syndrome

• C. Hyperbilirubinemia

• D. Tetralogy of Fallot

• E. Shoulder dystocia

Answer: A, B, C, E
Rationale: Listed neonatal risks include hypoglycemia, RDS, hyperbili, macrosomia/shoulder dystocia.

A client at 10 wks with incomplete SAB opts for expectant management. Which action is essential?

• A. Vaginal exam every 2 hours

• B. Teach bleeding precautions and when to seek care

• C. Start magnesium sulfate

• D. Begin antihypertensives

Answer: B
Rationale: Teaching bleeding precautions and support are key; options include expectant, meds (misoprostol), D&C; Rhogam if indicated.

Which symptom combination most suggests ruptured ectopic?

• A. LLQ pain, leukorrhea

• B. Unilateral pelvic pain, vaginal bleeding, shoulder pain

• C. Dysuria, flank pain

• D. Braxton-Hicks contractions

Answer: B
Rationale: Classic triad includes unilateral pain, bleeding, referred shoulder pain; dx via hCG + TVUS; methotrexate vs surgery.

Placenta previa: safe nursing action

Which order would the nurse question?

• A. Type & screen

• B. Betamethasone

• C. Vaginal cervical exam

• D. Continuous FHR monitoring

Answer: C
Rationale: Avoid vaginal exams in placenta previa; pelvic rest, anticipate C/S if bleeding/compromise

The best clinical discriminator between previa and abruption is:

• A. Bradycardia

• B. Pain (present vs absent)

• C. Fundal height

• D. Maternal age

Answer: B
Rationale: Previa: painless bleeding; Abruption: painful bleeding with rigid uterus.

A 36-week client has severe abdominal pain, vaginal bleeding, firm uterus, and nonreassuring FHR. Nursing actions: (Select all that apply.)

• A. Palpate uterine tone

• B. Prepare for emergent delivery

• C. Administer IVF and blood products as ordered

• D. Perform amniotomy

• E. Administer corticosteroids and observe only

Answer: A, B, C
Rationale: Abruption management focuses on maternal resuscitation, delivery prep, IVF/blood; steroids may be used earlier, but emergent situation here.

Which combination supports a preeclampsia diagnosis?

• A. BP elevation + 1+ protein only

• B. BP elevation + platelets 85,000/µL

• C. Normal BP + epigastric pain

• D. BP elevation + fasting glucose 150

Answer: B
Rationale:

Preeclampsia = HTN + proteinuria or

HTN + end-organ features such as low platelets, ↑Cr, ↑LFTs, neuro/epigastric pain.

Which finding indicates possible magnesium toxicity?

• A. DTRs 2+

• B. RR 10/min

• C. UO 60 mL/hr

• D. O₂ sat 98%

Answer: B
Rationale: Toxicity signs: RR <12–14, absent DTRs, UO <30 mL/hr, ↓O₂ sat, hypotension, altered LOC

The antidote for magnesium toxicity is:

• A. Calcium gluconate 1 g IV over 5–10 min

• B. Sodium bicarbonate

• C. Protamine sulfate

• D. Naloxone

Answer: A
Rationale: Antidote and dose specified on slide.

Severe range BP in preeclampsia. Which medications are first-line? (Select all that apply.)

• A. Labetalol IV

• B. Hydralazine IV

• C. Nifedipine PO

• D. ACE inhibitor PO

Answer: A, B, C
Rationale: Labetalol, hydralazine, nifedipine are listed options.

A 30-week client with PPROM is likely to deliver early. The provider plans betamethasone. What is the optimal window for delivery after dosing?

• A. Within 12 hours

• B. 2–7 days

• C. 10–14 days

• D. Any time after 34 weeks

Answer: B
Rationale: Optimal neonatal benefit occurs 2–7 days post-administration; 24–34 wks indicated.

PPROM at 31 wks without infection. Which orders align with evidence-based care? (Select all that apply.)

• A. Antenatal steroids

• B. Magnesium sulfate for neuroprotection

• C. GBS screening & antibiotics

• D. Immediate induction regardless of status

Answer: A, B, C
Rationale: Expectant management depends on GA/infection; steroids, Mg for neuroprotection, GBS screen/antibiotics are listed.

Which statement indicates correct understanding of GBS care?

• A. “We screen at 28 weeks.”

• B. “Penicillin in labor reduces neonatal sepsis.”

• C. “GBS is rare and not harmful to newborns.”

• D. “Antibiotics are given during pregnancy, not labor.”

Answer: B
Rationale: Screen at 36–37 weeks; leading cause of newborn infection; give IV penicillin during labor (alternatives if allergic).

Which history places a patient at greatest risk for placenta accreta, and what is the typical plan?

• A. No prior surgeries; vaginal delivery

• B. Prior C/S; planned cesarean hysterectomy

• C. Teen pregnancy; expectant labor

• D. Prior ectopic; methotrexate

Answer: B
Rationale: Prior uterine scarring/C-section is a major risk; management often planned C-hysterectomy

A pregnant patient after an MVA is hypotensive. First priority?

• A. Start continuous fetal monitoring first

• B. Maternal evaluation and resuscitation

• C. Ultrasound prior to airway assessment

• D. Immediate C/S

Answer: B
Rationale: Maternal evaluation/resuscitation precede fetal evaluation in trauma.

Appropriate intrapartum measures for a patient with HIV include: (Select all that apply.)

• A. IV antiretroviral administration

• B. Avoiding instrumented delivery if possible

• C. Encouraging breastfeeding

• D. Planning mode of delivery based on viral load

Answer: A, B, D
Rationale: Prenatal ARVs, intrapartum IV therapy, avoid instruments, and avoid breastfeeding

Which finding is a contraindication to tocolysis?

• A. 1 cm dilated cervix, no fever

• B. Severe preeclampsia

• C. Mild dehydration

• D. Anxiety

Answer: B
Rationale: Contraindications include severe preeclampsia/eclampsia, infection, significant bleeding, dilation >4 cm, maternal heart disease, etc.

A 35-week primigravida has BP 162/110, proteinuria, brisk DTRs, and reports visual scotomas. What complication is she at greatest risk for?

• A. Placenta previa

• B. Eclampsia

• C. Gestational diabetes

• D. Oligohydramnios

Answer: B
Rationale: Severe preeclampsia signs (severe HTN, neuro changes, hyperreflexia, proteinuria). High risk of seizures = eclampsia. NTK: visual changes are a red-flag pre-seizure warning

Which findings suggest magnesium toxicity? (Select all that apply.)

• A. Urine output 20 mL/hr

• B. RR 22/min

• C. Absent DTRs

• D. O₂ sat 89%

• E. BP 160/100

Answer: A, C, D
Rationale: Toxicity = ↓ RR (<12–14), absent reflexes, oliguria (<30 mL/hr), ↓O₂, ↓LOC. Hypertension = preE, not Mg toxicity.

A preeclamptic patient has a magnesium level of 10 mEq/L. Which is the priority action?

• A. Continue infusion, within therapeutic range

• B. Notify provider and prepare calcium gluconate

• C. Increase infusion to achieve higher levels

• D. Recheck in 6 hours

Answer: B
Rationale: Therapeutic = 4–8 mEq/L. 10 = toxic → stop Mg, prepare antidote (calcium gluconate). NTK: numbers are testable.

Which presentation most strongly supports placental abruption?

• A. Painless bright red bleeding at 34 wks

• B. Severe abdominal pain, boardlike uterus, late decels

• C. Slow spotting and closed cervix at 10 wks

• D. Fundal height less than expected

Answer: B
Rationale: Classic = painful bleeding, rigid uterus, nonreassuring FHR. Previa = painless bleeding. SAB = early spotting.

A patient with GDM A2 logs blood sugars: fasting 130, 2-hr postprandial 180. Which intervention is priority?

• A. Continue diet and exercise plan

• B. Initiate insulin therapy

• C. Encourage increased oral fluids

• D. Repeat glucose in 1 week

Answer: B
Rationale: GDM A2 = insulin controlled. Persistent hyperglycemia despite diet/exercise → insulin. NTK: GDM A1 vs A2 definitions.

A client at 34 weeks reports RUQ pain, nausea, and fatigue. Labs: platelets 70,000, ALT/AST ↑. Which are expected complications of HELLP? (Select all that apply.)

• A. DIC

• B. Placental abruption

• C. Seizures

• D. Cardiac tamponade

• E. Maternal death

Answer: A, B, C, E
Rationale: HELLP is severe preE complication → risk for DIC, abruption, seizures, death. RUQ/epigastric pain = liver involvement.

Which interventions are appropriate for PPROM at 29 wks with no infection?

• A. Administer corticosteroids

• B. Start broad-spectrum antibiotics

• C. Induce labor immediately

• D. Monitor temp and FHR closely

• E. Administer magnesium sulfate for neuroprotection

Answer: A, B, D, E
Rationale: Expectant management with steroids, abx, neuroprotection. Immediate induction only if infection or fetal compromise.

A client with a history of three C-sections is diagnosed with placenta accreta. Which finding is most concerning intraoperatively?

• A. Maternal HR 98 bpm

• B. Inability to manually separate placenta

• C. Uterine tone firm after birth

• D. Estimated blood loss 350 mL

Answer: B
Rationale: Accreta = abnormal placenta adherence → cannot be separated, high risk of hemorrhage → plan often C-hysterectomy.

Which patient is at highest risk for placental abruption?

• A. 25-year-old with migraines

• B. 30-year-old with cocaine use and HTN

• C. 22-year-old with hypothyroidism

• D. 38-year-old with iron-deficiency anemia

Answer: B
Rationale: Major abruption risks = HTN, trauma, cocaine, smoking, hx abruption. NTK: cocaine → vasoconstriction & uteroplacental insufficiency.

Which statement by a 36-week client indicates correct understanding of GBS care?

• A. “I’ll get antibiotics only if I test positive at 36 weeks.”

• B. “I need antibiotics during pregnancy, not labor.”

• C. “GBS doesn’t really affect babies.”

• D. “Even if I’m negative, I’ll still need penicillin in labor.”

Answer: A
Rationale: GBS screening at 36–37 wks; intrapartum antibiotics only if positive. NTK: #1 cause of newborn sepsis, pneumonia, meningitis.

NST (NON-STRESS TEST) Interpretation; test in pregnancy that measures fetal heart rate in response to movement and contractions

Criteria	≥32 wks	<32 wks
Reactive	≥2 accelerations, ≥15 bpm × 15 sec in 20 min	≥2 accelerations, ≥10 bpm × 10 sec in 20 min
Nonreactive	No qualifying accelerations in 40 min	Same

👉 NTK: Nonreactive → BPP (biophysical profile) or CST (contractive stress test)

BPP Scoring (0–2 points each)

• Fetal breathing movement

• Fetal body/limb movements

• Fetal tone (flex/extend)

• Amniotic fluid index (pocket present)

• NST (reactive = 2 pts)

Scoring:

• 8–10 = Normal/reassuring

• 6 = Equivocal → repeat/monitor

• ≤4 = Abnormal → delivery considered

Amniotic Fluid Index (AFI)

• Normal: 5–25 cm

• Oligohydramnios: <5 cm → IUGR, fetal distress

• Polyhydramnios: >25 cm → cord prolapse, malpresentation

Gestational Diabetes Screening

• 24–28 wks: 50g glucose tolerance screen

  • <130–140 = Negative

  • ≥130–140 = Schedule 3-hr OGTT (glucose tolerance)

• 3-hr OGTT abnormal if 2+ values elevated

👉 NTK categories:

• GDM A1 = diet controlled

• GDM A2 = insulin controlled

Placenta Previa vs Placental Abruption

Feature	Previa	Abruption
Pain	Painless	Painful
Bleeding	Bright red	Dark red (concealed or visible)
Uterus	Soft, nontender	Rigid, boardlike
FHR	Usually normal until severe bleeding	Often nonreassuring
Vaginal exam	Contraindicated	May reveal uterine tenderness

👉 NTK: This is a classic NCLEX discriminator.

Hypertensive Disorders in Pregnancy

Disorder	Criteria	Notes
Chronic HTN	Pre-existing or before 20 wks; persists >12 wks postpartum	May progress to superimposed preE
Gestational HTN	New HTN >20 wks, no proteinuria	25% progress to preE
Preeclampsia	HTN + proteinuria OR HTN + end-organ dysfunction (low plt, ↑Cr, ↑LFTs, neuro/visual, epigastric pain)	Multi-system disease
Eclampsia	Preeclampsia + seizures	Emergency
HELLP	Hemolysis, Elevated Liver enzymes, Low Platelets	Severe, life-threatening

👉 NTK: Memorize the platelet cutoff (<100,000) and proteinuria criteria (≥300mg/24h or dip ≥2+).

Magnesium Sulfate Therapy

Parameter	Value	Notes
Loading dose	4–6 g over 15–20 min
Maintenance	1–2 g/hr
Therapeutic range	4–8 mEq/L
Toxicity signs	RR <12, UO <30 mL/hr, absent DTRs, ↓LOC
Antidote	Calcium gluconate 1 g IV over 5–10 min	Memorize this

Tocolytic Drugs (PTL suppression)

Drug	Class	Key points
Nifedipine	Ca-channel blocker	Relaxes myometrium; watch hypotension
Indomethacin	NSAID	Short-term; contraindicated >32 wks (ductus arteriosus closure)
Terbutaline	Beta-agonist	SE: tachycardia, tremors
Magnesium sulfate	Off-label tocolysis but main role = neuroprotection	Monitor toxicity

👉 NTK: Contraindications to tocolysis: severe preE/eclampsia, infection, vaginal bleeding, dilation >4 cm.

Antenatal Steroids

Drug	Dose	Effect
Betamethasone	12 mg IM q24h × 2	Fetal lung maturity, ↓ RDS, IVH, NEC, death
Dexamethasone	6 mg IM q12h × 4	Same effect
Optimal window	2–7 days before delivery	24–34 wks GA

👉 NTK: Watch for ↑ glucose in diabetics.

HELLP Syndrome Labs

Finding	NTK cutoff
Hemolysis	Abnormal smear, LDH ↑
Liver enzymes	AST/ALT ↑ 2× normal
Platelets	<100,000/µL