Maternity Practice Test #2: Pregnancy Complications

Answer: B. Perform a digital vaginal exam to check cervical dilation.

Rationale: Painless, bright red bleeding with a soft, non-tender uterus in the second half of pregnancy points to placenta previa until an ultrasound shows where the placenta is. A digital (finger) vaginal exam can disturb a placenta lying over or near the cervix and cause sudden, severe bleeding, so the nurse questions this prescription and does not do the exam until the placenta's location is known (B). Option A is appropriate because continuous fetal monitoring shows how the fetus is tolerating the blood loss. Option C is appropriate because a blood count and type and screen show how much blood has been lost and prepare for a possible transfusion. Option D is appropriate because a large-bore IV line allows fast fluid or blood replacement if bleeding increases.

Answer: D. Placental abruption.

Rationale: Placental abruption is the early separation of the placenta from the uterine wall. Typical findings are abdominal or back pain, a firm, tender, board-like uterus that does not relax, and dark red bleeding (D). Blood can collect behind the placenta, so the amount seen at the vagina may be much less than the real loss. Trauma such as a car crash is a common cause, along with hypertension, cocaine use and smoking. This is an emergency: the nurse watches for maternal shock, fetal distress and clotting problems such as DIC. Option A is wrong because placenta previa usually causes painless, bright red bleeding with a soft uterus. Option B is wrong because bloody show is a small amount of pink or blood-streaked mucus, not constant severe pain with a rigid uterus. Option C is wrong because round ligament pain is a brief, sharp pain in the groin or side of the lower abdomen with position changes, and it does not cause bleeding or a rigid uterus.

Answer: A. Pain in her right shoulder and feeling lightheaded when she sits up.

Rationale: One-sided lower abdominal pain and spotting early in pregnancy can mean an ectopic pregnancy, most often in a fallopian tube. Shoulder pain is referred pain from blood in the abdomen irritating the diaphragm, and lightheadedness on sitting up suggests low blood volume. Together they point to a ruptured ectopic pregnancy with internal bleeding, which can quickly lead to hemorrhagic shock (A). The nurse checks vital signs, notifies the provider right away, and prepares for emergency treatment, which often means surgery. Option B is wrong because breast tenderness and morning nausea are expected early pregnancy changes. Option C is wrong because a positive pregnancy test is expected in any pregnancy, including an ectopic one, and does not show where the pregnancy is. Option D is wrong because light brown spotting is old blood; it still needs evaluation, but it is less urgent than signs of internal bleeding.

Answer: C. Threatened.

Rationale: In a threatened abortion there is bleeding and sometimes cramping, but the cervix is closed and the pregnancy is still viable, so it may continue (C). The nurse teaches the client to report heavier bleeding, passing tissue, fever or worsening pain, and follows the provider's instructions about activity and follow-up. Option A is wrong because an inevitable abortion has a dilating cervix or ruptured membranes, and the loss cannot be stopped. Option B is wrong because an incomplete abortion means some tissue has passed and some remains, usually with an open cervix and heavier bleeding. Option D is wrong because a missed abortion means the embryo or fetus has died but has not been passed; there is no cardiac activity, and there may be little or no bleeding.

Answer: B. A client who has vomited many times a day for a week, has lost 6% of her prepregnancy weight and has ketones in her urine.

Rationale: Hyperemesis gravidarum is persistent, severe vomiting that causes weight loss (commonly described as more than about 5% of prepregnancy weight, though definitions vary), dehydration, ketones in the urine and electrolyte imbalances (B). These clients need prompt evaluation and often IV fluids, antiemetics and nutrition support, as the provider prescribes. Option A is wrong because daily nausea with occasional vomiting while keeping fluids down is the common, expected pattern. Option C is wrong because smell triggers and eating dry crackers before rising are typical of ordinary morning sickness. Option D is wrong because nausea that eases later in the day with ongoing weight gain shows she is getting enough nutrition and fluid.

Answer: A. If my sugar is high in the morning, I will skip breakfast so it comes down.

Rationale: Skipping meals is unsafe in pregnancy. It can cause starvation ketosis, which may harm the fetus, and leads to swings in blood glucose later in the day (A). A high fasting reading should be recorded and reported, because the provider may need to adjust the plan, which can include adding medication such as insulin. Option B is correct teaching because spreading carbohydrates across regular meals and snacks, as the dietitian plans, keeps glucose steadier. Option C is correct teaching because light activity such as walking after meals helps lower glucose, unless the provider has restricted activity. Option D is correct teaching because the glucose log lets the provider compare readings with her individual targets and adjust treatment.

Answer: D. The baby has been making extra insulin, so the baby's sugar can drop after the cord is cut.

Rationale: Glucose crosses the placenta, so when the mother's glucose runs high, the fetus's pancreas responds by making more insulin. After birth the supply of glucose from the mother stops suddenly, but the baby's insulin level stays high for a while, so the newborn can develop hypoglycemia, most often in the first hours of life (D). The nurse checks the newborn's glucose on the schedule in the facility protocol and encourages early, frequent feeding. Option A is wrong because the baby is not born with diabetes; children of mothers with gestational diabetes do have a higher risk of obesity and type 2 diabetes later in life. Option B is wrong because maternal insulin does not cross the placenta in meaningful amounts; the baby's own insulin causes the low glucose. Option C is wrong because the expected problem is low blood glucose, not high.

Answer: C. Platelets low, AST and ALT high, LDH high.

Rationale: HELLP stands for Hemolysis, Elevated Liver enzymes and Low Platelets. Hemolysis raises LDH, liver injury raises AST and ALT, and the platelet count falls (C). Right upper quadrant or epigastric pain comes from a swollen liver, and nausea and malaise can make it look like the flu, so it can be missed; blood pressure may be only mildly raised. The nurse compares results with the laboratory's reference ranges and reports right away, because HELLP can lead to bleeding, liver rupture, placental abruption and DIC. Option A is wrong because every value moves in the opposite direction. Option B is wrong because glucose and potassium are not part of the HELLP pattern. Option D is wrong because platelets fall, not rise, and LDH rises with hemolysis.

Answer: A. Keep the room quiet with the lights dimmed, and limit visitors and noise.

Rationale: Bright light, noise and other stimulation can trigger an eclamptic seizure in a client with severe preeclampsia, so the nurse keeps the room calm, dim and quiet and clusters care (A). Other seizure precautions follow facility policy, such as padded side rails, suction and oxygen ready at the bedside, and the medications in the magnesium protocol available. Option B is wrong because it increases stimulation. Option C is wrong because nothing should be placed in the mouth during a seizure; it can break teeth or block the airway. Option D is wrong because lying flat on the back lets the uterus press on the large blood vessels and lowers blood flow to the uterus and placenta; a side-lying position, often the left side, is preferred.

Answer: C. Get help right away for a severe headache, vision changes, trouble breathing or upper belly pain.

Rationale: Preeclampsia can continue, worsen or even start for the first time after birth, most often in the first week but sometimes several weeks later. A severe headache, vision changes, shortness of breath or upper abdominal pain can signal severe hypertension, eclampsia, pulmonary edema or stroke, so she should call 911 or go to the emergency department and say she recently gave birth (C). Option A is wrong because the risk does not end when the placenta is delivered. Option B is wrong because a new or severe headache after preeclampsia must be reported, not treated with rest first. Option D is wrong because she should keep checking her blood pressure and keep follow-up visits for as long as her provider's plan says.