NR-327 Maternal-Child Nursing - Set 2 - Part 1

Correct Answer: Diminished patellar deep tendon reflexes

Reflexes fade before anything else. Deep tendon responses at the patella diminish and then disappear as the level climbs toward eight to ten milliequivalents per liter, which is why the reflex hammer stays at the bedside. Option b is incorrect because breathing slows only after reflexes have already gone. Respiratory depression sits second in the toxicity sequence and signals a level well past the point where the reflex check would have warned the nurse. Option c is incorrect because cardiac conduction changes come last of all. Widened complexes and heart block belong to profound toxicity, by which point the client has already lost reflexes and is breathing inadequately. Option d is incorrect because oliguria causes accumulation rather than announcing it. The kidneys clear this drug entirely, so poor output lets the level rise, yet the falling urine volume is a mechanism and not a toxic effect.

Correct Answer: "The drug raises the threshold for a seizure."

Magnesium sulfate is an anticonvulsant. It acts as a central nervous system depressant that competes with calcium at the neuromuscular junction and raises the seizure threshold, so severe-range pressures still require labetalol or hydralazine. Option a is incorrect because vasodilation describes what hydralazine does, not magnesium. Any drop in pressure seen during a magnesium infusion is a minor side effect, and the client still needs a true antihypertensive ordered. Option b is incorrect because protein loss comes from glomerular endotheliosis, an injury magnesium cannot repair. Urine protein reflects damaged capillaries in the kidney, and the amount present does not grade how severe the disease has become. Option d is incorrect because uteroplacental perfusion improves with birth, not with an anticonvulsant infusion. Magnesium given before roughly thirty-two weeks does protect the fetal brain, yet it does nothing to widen the narrowed spiral arteries.

Correct Answer: Threatened abortion, since the os remains closed

Threatened abortion is light bleeding with a closed cervical os and a living fetus. Roughly half of these pregnancies continue, so care is pelvic rest, serial hormone levels, and watchful monitoring rather than evacuation. Option b is incorrect because inevitable loss requires a dilated cervical os with moderate or heavy bleeding and painful cramping. This client's os is shut, and an intact closed cervix means the pregnancy still has a chance. Option c is incorrect because incomplete loss means some products of conception have already been expelled while the rest stay behind, driving heavy bleeding. Nothing has passed here, and the pregnancy remains viable. Option d is incorrect because a missed abortion carries a dead fetus that the uterus retains, so pregnancy symptoms fade and heart tones disappear. Cardiac activity on this ultrasound rules that out.

Correct Answer: The placenta cannot support the fetus through labor

Late decelerations with at least half of the contractions define a positive test. Each contraction cuts intervillous blood flow, and a fetus with no reserve responds with a delayed dip, so birth is usually arranged. Option a is incorrect because tachysystole would be the label if contractions came too close together or ran too long. Here the pattern was adequate, so the placenta rather than the uterus is the source of the problem. Option b is incorrect because a repeat the next day fits an equivocal result with only occasional late decelerations. Consistent late decelerations across most contractions have already answered the question and will not improve with waiting. Option d is incorrect because sleep explains a quiet strip during a nonstress test, not decelerations during contractions. Vibroacoustic stimulation wakes a fetus, and it is withheld whenever decelerations already appear on the tracing.

Correct Answer: Turn the client onto her left side

Airway protection and injury prevention outrank everything else here. Turning her onto her side lets saliva drain instead of pooling in the pharynx, and the nurse summons help while remaining at the bedside. Option a is incorrect because rushing to surgery during a convulsion delivers the fetus into maternal hypoxemia and acidosis. Birth is planned after she is stabilized, and that sequence protects both of them. Option b is incorrect because a mask cannot be held on a face that is jerking violently. Oxygen at eight to ten liters goes on once the tonic-clonic activity subsides and the mouth has been suctioned. Option c is incorrect because drug administration follows positioning and airway care rather than preceding them. An extra two-gram bolus is given after she is safe on her side, and it will not shorten the current convulsion.

Correct Answer: Administer Rh immune globulin for this bleeding event

Any event that lets fetal blood reach the maternal circulation calls for Rh immune globulin in an unsensitized Rh negative client. Miscarriage, ectopic pregnancy, amniocentesis, version and abdominal trauma all qualify. Option a is incorrect because rechecking the screen a month later does nothing during the window when sensitization actually happens. Prophylaxis must be given now, while the leaked fetal cells can still be cleared. Option b is incorrect because neither client is described as hemorrhaging or unstable. Preparing blood products addresses volume loss, a separate problem from the immune response that Rh prophylaxis is designed to head off. Option d is incorrect because growth scans have no role for a pregnancy that has already ended, and they are far too slow an answer for fresh trauma. The trauma client needs monitoring and prophylaxis today.

Correct Answer: "Come in now so we can put you on the monitor."

Reduced movement can precede fetal death, and it is the one warning a client detects herself. She is evaluated in person with a nonstress test, often followed by a biophysical profile, rather than reassured by phone. Option b is incorrect because juice may wake a sleeping fetus but proves nothing when movement has already dropped. Waiting overnight wastes the window in which monitoring could catch a fetus in trouble. Option c is incorrect because that piece of folklore is wrong and dangerous. Movements grow more rolling and less sharp as term nears, yet the number should hold steady, so a real drop always deserves evaluation. Option d is incorrect because a second count at home postpones the assessment that matters. The client has already reported a clear change from her own baseline, which is the threshold for coming in rather than repeating.

Correct Answer: "I will change my eating and walk daily, adding insulin if needed."

Carbohydrate controlled eating with regular walking is first line and controls most gestational diabetes. Insulin is added when glucose targets are not met, because it does not cross the placenta and has the longest safety record. Option a is incorrect because oral agents such as metformin and glyburide cross the placenta and are not the first choice in pregnancy. Insulin remains the preferred drug when medication becomes necessary. Option b is incorrect because deliberate weight reduction is never prescribed during pregnancy. Restricting intake that far starves the fetus and produces ketosis, so the plan controls the type and timing of carbohydrate instead. Option c is incorrect because skipping meals swings glucose in both directions and invites starvation ketosis. The prescribed pattern is three meals with two or three snacks, including a bedtime snack containing protein.

Correct Answer: A screen for open neural tube defects

Villus sampling takes placental tissue, so it reads chromosomes but never sees the spine or the abdominal wall. She still needs a serum alpha fetoprotein or the anatomy scan to look for an open defect. Option a is incorrect because the karyotype from villi is definitive and does not need repeating. Only a discordant result raising confined placental mosaicism would send this client back for amniocentesis, and that happens rarely. Option b is incorrect because surfactant studies concern the timing of a preterm birth, a question no one is asking at eleven weeks. Delivery decisions now rest on maternal and fetal indication rather than on laboratory maturity. Option d is incorrect because adding a screen after a diagnostic answer already exists changes nothing. Cell free DNA estimates chance for the common trisomies, and it also gives no information about neural tube defects.

Correct Answer: Placenta previa in the lower uterine segment

Scarred myometrium from a previous cesarean makes the upper segment a poor implantation site, so the placenta settles low and may cover the os. Risk climbs with each additional uterine surgery. Option b is incorrect because a weak cervix follows cone biopsy, deep cervical laceration, or repeated mechanical dilation. An abdominal incision through the uterine wall leaves the cervix itself untouched. Option c is incorrect because tubal implantation traces to damaged or sluggish tubes from infection, prior tubal surgery, or an earlier ectopic pregnancy. Surgical birth does not injure the tubes. Option d is incorrect because molar tissue arises from a fertilization error at conception, when an empty ovum or two sperm produce abnormal chromosomes. Nothing in her surgical history influences that event.

Correct Answer: Hemorrhage from retained products of conception

Incomplete loss leaves tissue behind, and a uterus with retained products cannot clamp down on its bleeding vessels. That makes this the type carrying the highest hemorrhage risk until evacuation empties the cavity. Option a is incorrect because infection belongs to septic abortion, which announces itself with fever, chills, foul discharge, and uterine tenderness. None of those appear here, and blood loss threatens this client far sooner. Option c is incorrect because widespread clotting follows prolonged retention of a dead fetus, the pattern seen with missed abortion. This uterus is actively expelling tissue rather than holding it for weeks. Option d is incorrect because the cervix opens by effacing and dilating under contraction pressure, a physiologic process here rather than a tear. Lacerations come from instruments or forceful delivery, neither of which applies.

Correct Answer: Breathing, gross movement, tone and fluid volume

The profile watches behavior rather than anatomy. Breathing movements, gross body movements and tone are observed on ultrasound alongside the deepest pocket of amniotic fluid, and the nonstress test supplies the fifth component. Option a is incorrect because cardiac size and placental grading belong to a detailed anatomy survey or a growth scan. None of them shift over the half hour of observation that this profile is built around. Option b is incorrect because those measurements produce an estimated fetal weight, which answers a question about growth. Growth reflects weeks of nutrition, while this test asks whether the fetus is oxygenated right now. Option c is incorrect because organ landmarks are checked during the anatomy scan performed near the midpoint of pregnancy. Finding a stomach bubble or counting cord vessels tells the team nothing about current oxygen delivery.

Correct Answer: Hypoglycemia within the first hours after birth

Maternal hyperglycemia during labor crosses to the fetus and drives further insulin output. When the cord is cut the sugar supply ends while insulin remains high, so the newborn drops low quickly. Option b is incorrect because the newborn's own insulin, not the mother's sugar, governs glucose after birth. Levels fall rather than climb, which is why a heel stick is done within the first hour. Option c is incorrect because polycythemia does occur in these infants from chronic relative hypoxia, yet it develops over days and rarely needs exchange transfusion. The urgent finding in the first hours is a falling glucose. Option d is incorrect because raised blood pressure is not part of the picture created by fetal hyperinsulinemia. Expect instead a heavy infant at risk of shoulder dystocia, low calcium and jaundice.

Correct Answer: "I will get antibiotics through a vein once labor begins."

Group B streptococcus colonization is treated with intravenous antibiotics during labor, not in pregnancy, because treating earlier does not stop recolonization. Penicillin given at least four hours before birth protects the newborn. Option a is incorrect because carrying this organism in the vagina and rectum is colonization, not illness. The client has no maternal infection to treat, and oral antibiotics now would simply allow regrowth before labor. Option b is incorrect because most newborns exposed during birth never become ill, and prophylaxis in labor lowers that risk much further. Certainty of neonatal disease overstates what a positive culture predicts. Option d is incorrect because surgical birth plays no part in managing this organism. Vaginal birth with antibiotic cover is the plan, and a cesarean would add operative risk without improving the newborn's outcome.

Correct Answer: Ectopic pregnancy in the fallopian tube

Amenorrhea, unilateral abdominal pain, and scant dark bleeding with a positive test form the classic ectopic triad. Nearly all of these implant in the tube, most often in the ampulla. Option a is incorrect because a threatened loss produces midline cramping across the lower abdomen with bright red spotting from a uterine pregnancy. Pain fixed to one side steers the diagnosis elsewhere. Option c is incorrect because molar tissue announces itself with heavy dark brown discharge, a uterus larger than dates, and relentless vomiting driven by very high hormone levels. Localized one sided pain is not its pattern. Option d is incorrect because implantation spotting is painless, brief, and happens around the time of the missed period. Persistent one sided pain plus continuing spotting cannot be dismissed as a normal early finding.

Correct Answer: Give Rho D immune globulin within seventy two hours

Fetal red cells cross into maternal circulation even with a first trimester loss. One sensitizing event affects every later pregnancy, so an Rh negative client needs immune globulin within seventy two hours. Option a is incorrect because tracking her blood count matters, yet a delayed laboratory draw does nothing about the antibody exposure happening today. The sensitizing window closes long before that appointment arrives. Option b is incorrect because pelvic rest instruction is standard discharge teaching that reduces infection risk over the coming weeks. Useful as it is, teaching can wait; a time limited injection cannot. Option d is incorrect because hormone levels are trended to confirm the uterus is empty rather than repeated as a home test. Ordering that check ignores the antibody risk this client actually faces.

Correct Answer: Repeated late decelerations after every contraction

Late decelerations after every contraction say the separated placenta can no longer deliver enough oxygen between contractions. Persistent uteroplacental insufficiency at this point pushes the team toward immediate cesarean birth rather than continued watching. Option a is incorrect because that baseline sits comfortably inside the normal range and suggests the fetus is still tolerating the situation. Documenting it is enough; nothing about it demands an urgent call. Option b is incorrect because backache easing with a change of position behaves like ordinary musculoskeletal strain. Separation pain is constant and unrelieved, so comfort with repositioning argues against worsening rather than for it. Option c is incorrect because that hourly volume clears the thirty milliliter threshold used to judge renal perfusion. Adequate output is reassuring evidence that circulating volume is holding, so it needs charting only.

Correct Answer: Give Rho D immune globulin as ordered

The needle allows fetal red cells into the maternal circulation, which can sensitize an Rh negative client. Rho D immune globulin given afterward blocks antibody formation and protects this pregnancy and every pregnancy that follows. Option b is incorrect because repeating the screen delays the injection without changing what she needs. Her unsensitized status was already established, and waiting for another result risks passing the window in which prophylaxis works. Option c is incorrect because a routine scan the following day is not part of recovery. Ultrasound guided the needle during the procedure, and the postprocedure watch relies on the fetal heart rate and uterine activity instead. Option d is incorrect because intravenous fluid answers hypovolemia or a planned infusion, neither of which applies here. The client is told to drink extra fluids and rest for a day, which meets her needs by mouth.

Correct Answer: A frequent cough bringing up frothy pink sputum

A persistent cough with frothy blood tinged sputum signals pulmonary congestion and early cardiac decompensation. This client is entering the 28 to 32 week window when blood volume and cardiac output peak. Option a is incorrect because mild breathlessness on exertion is an expected change of pregnancy as the diaphragm rises. Dyspnea becomes worrying when it occurs at rest or wakes the client at night. Option b is incorrect because dependent ankle edema by evening reflects venous return slowed by the growing uterus. Generalized swelling of the face and hands would be the version worth reporting. Option d is incorrect because a soft systolic murmur appears in most healthy pregnancies once blood volume rises and flow across the valves speeds up. Its presence alone tells the nurse nothing alarming.

Correct Answer: Checking cervical dilation by digital examination

Nothing goes in the vagina when previa is known or suspected. A finger can perforate the placenta over the cervix and open maternal sinuses, turning a controlled admission into catastrophic hemorrhage. Option a is incorrect because tracing the fetal heart continuously is exactly what this admission calls for. The monitor is the earliest warning that maternal blood loss has begun to compromise placental perfusion. Option c is incorrect because blood must be typed and held ready whenever previa bleeds, since transfusion may be needed without warning. Omitting that sample would leave the team waiting when minutes matter. Option d is incorrect because wide venous access supports rapid fluid and blood replacement if the bleeding escalates toward cesarean birth. Withholding a line would strip away the one intervention that buys time.