Review Practice Exercise 2

Maternal Risk Factors > Maternal Newborn

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Practice Exercise 2

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Total Questions : 5

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Question 1:

A nurse is assessing a pregnant patient with a history of diabetes mellitus. What is a potential fetal complication associated with poorly controlled maternal diabetes?

A. Microcephaly B. Macrosomia C. Spina bifida D. Low birth weight

Answer and Explanation

Choice A:

Microcephaly is not a classic complication of maternal diabetes. It is more commonly linked to congenital infections such as Zika virus, rubella, or cytomegalovirus, rather than hyperglycemia.

Choice B:

Macrosomia occurs when maternal hyperglycemia causes excess transplacental glucose transfer. The fetus responds with hyperinsulinemia, which acts as a growth hormone, leading to birth weight >4,000 g. Poorly controlled diabetes is the direct cause in this scenario.

Choice C:

Spina bifida results from neural tube defects associated with folate deficiency, not from maternal diabetes. Normal maternal folate level should be >4 ng/mL to prevent such defects.

Choice D:

Low birth weight (<2,500 g) is usually associated with maternal hypertension, intrauterine growth restriction, or placental insufficiency. In diabetes, the opposite effect (excess growth) is more common due to increased nutrient availability.

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Question 2:

A patient with a history of chronic hypertension is pregnant. Which of the following complications is she at an increased risk for?

A. Neonatal hypoglycemia B. Macrosomia C. Placental abruption D. Congenital anomalies

Answer and Explanation

Choice A:

Neonatal hypoglycemia is more commonly associated with infants of diabetic mothers due to fetal hyperinsulinemia in response to maternal hyperglycemia. It is not a direct complication of chronic hypertension.

Choice B:

Macrosomia, defined as fetal weight >4,000 g, is linked to maternal diabetes mellitus due to excess transplacental glucose. In chronic hypertension, placental insufficiency more often causes restricted growth rather than overgrowth.

Choice C:

Placental abruption is strongly linked to chronic hypertension because long-standing elevated pressure damages spiral arteries, reducing placental attachment stability. Ischemic injury and vascular rupture increase risk of premature placental separation, leading to bleeding and fetal compromise.

Choice D:

Congenital anomalies are not specifically associated with maternal chronic hypertension. They are more related to teratogenic exposures, poorly controlled diabetes, and genetic causes. Hypertension mainly causes placental complications rather than structural defects.

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Question 3:

Which of the following is a potential consequence of untreated maternal thyroid disorders during pregnancy?

A. Placental abruption B. Fetal alcohol spectrum disorder C. Neurodevelopmental issues D. Gestational hypertension

Answer and Explanation

Choice A:

Placental abruption is mainly associated with chronic hypertension, preeclampsia, trauma, smoking, and cocaine use. Thyroid disorders do not directly damage placental attachment or cause premature separation.

Choice B:

Fetal alcohol spectrum disorder results from maternal alcohol consumption during pregnancy. It is characterized by growth restriction, facial anomalies, and neurobehavioral impairment, unrelated to thyroid hormone imbalance.

Choice C:

Neurodevelopmental issues occur when maternal hypothyroidism causes inadequate transfer of thyroid hormones essential for fetal brain development. Deficiency during early gestation leads to intellectual impairment, reduced IQ, and motor delays. The lack of maternal thyroid hormone supply directly explains the fetal complications.

Choice D:

Gestational hypertension is defined as blood pressure ≥140/90 mmHg after 20 weeks without proteinuria. Thyroid dysfunction is not a primary cause. Hypertension is more linked to vascular or placental pathology, not thyroid hormone imbalance.

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Question 4:

Which of the following are potential fetal complications of poorly controlled gestational diabetes mellitus? Select all that apply.

A. Macrosomia B. Neonatal hypoglycemia C. Intrauterine growth restriction D. Shoulder dystocia E. Congenital rubella syndrome

Answer and Explanation

Choice A:

Macrosomia develops because maternal hyperglycemia increases glucose transfer to the fetus. Fetal pancreatic hyperinsulinemia stimulates fat deposition, leading to birth weight >4,000 g.

Choice B:

Neonatal hypoglycemia occurs after birth because the infant’s pancreas continues producing high insulin levels while maternal glucose supply is cut off. Normal neonatal glucose should be >45 mg/dL; values below this indicate hypoglycemia.

Choice C:

Intrauterine growth restriction is not typical of gestational diabetes. It is more commonly linked to maternal hypertension, preeclampsia, or uteroplacental insufficiency, where fetal nutrient supply is limited.

Choice D:

Shoulder dystocia is a direct consequence of macrosomia, where the fetal shoulder becomes impacted behind the maternal pubic symphysis during delivery. It is a recognized obstetric emergency in diabetic pregnancies.

Choice E:

Congenital rubella syndrome results from maternal rubella infection in the first trimester, leading to cataracts, deafness, and cardiac defects. It is unrelated to glucose metabolism or gestational diabetes.

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Question 5:

Which of the following are key nursing interventions for a patient with preeclampsia? Select all that apply.

A. Monitoring blood pressure B. Administering magnesium sulfate C. Encouraging ambulation D. Assessing for proteinuria E. Providing dietary counseling

Answer and Explanation

Choice A:

Monitoring blood pressure is essential because preeclampsia is defined by hypertension and progression to severe ranges (≥160/110 mmHg) increases maternal and fetal risk.

Choice B:

Administering magnesium sulfate is indicated to prevent seizures (eclampsia). Normal serum magnesium is 1.7–2.4 mg/dL, and therapeutic levels for seizure prophylaxis are 4–7 mEq/L.

Choice C:

Encouraging ambulation is unsafe in preeclampsia. Patients are at risk of seizures, hypertension crises, and placental abruption. Bed rest or activity restriction is often recommended in severe cases to reduce maternal-fetal stress.

Choice D:

Assessing for proteinuria is critical because preeclampsia involves abnormal renal glomerular permeability. Dipstick testing or 24-hour urine collection confirms diagnosis and severity.

Choice E:

Providing dietary counseling is important to maintain adequate protein and balanced nutrition. Sodium restriction is not generally recommended, but patients should avoid excessive processed foods and maintain hydration.

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Practice Exercise 2

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