Review Practice Exercise 4

Maternal Risk Factors > Maternal Newborn

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Practice Exercise 4

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Total Questions : 5

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Question 1:

What is a potential consequence of maternal opioid use during pregnancy?

A. Fetal alcohol spectrum disorder B. Neonatal abstinence syndrome C. Congenital heart defects D. Placenta previa

Answer and Explanation

Choice A:

Fetal alcohol spectrum disorder results from maternal alcohol consumption, not opioid use. Alcohol causes microcephaly, smooth philtrum, thin upper lip, and growth retardation, whereas opioids cause withdrawal, not teratogenic facial abnormalities.

Choice B:

Neonatal abstinence syndrome develops because opioids readily cross the placenta and accumulate in the fetal system. Following delivery, drug supply is interrupted, causing withdrawal marked by hypertonia, high-pitched cry, and poor feeding. These symptoms are well recognized consequences of chronic maternal opioid use.

Choice C:

Congenital heart defects are most often associated with chromosomal abnormalities (e.g., trisomy 21) or maternal rubella infection. Opioid exposure does not directly interfere with cardiac septation or outflow tract formation, making this an incorrect consequence.

Choice D:

Placenta previa is linked to uterine scarring, multiparity, and advanced maternal age. It occurs when the placenta implants over the cervical os, unrelated to opioid exposure. Opioids act pharmacologically, not structurally, and do not determine placental implantation sites.

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Question 2:

Which environmental exposure is most likely to increase the risk of miscarriage and developmental delays in the fetus?

A. Mercury B. Lead C. Air pollution D. Radiation

Answer and Explanation

Choice A:

Mercury exposure, particularly methylmercury from contaminated fish, primarily causes neurotoxicity manifesting as impaired motor skills, cerebral palsy-like features, and sensory deficits. While harmful, it is less directly associated with miscarriage compared to lead.

Choice B:

Lead exposure is strongly linked to miscarriage and developmental delays. Lead crosses the placenta and accumulates in fetal bone and brain tissue. This results in impaired synaptogenesis, neuronal death, and long-term cognitive deficits. Miscarriage is associated with maternal blood lead levels >10 µg/dL.

Choice C:

Air pollution increases risks of low birth weight, intrauterine growth restriction, and preterm birth, but evidence for miscarriage and direct neurodevelopmental delay is weaker compared to lead exposure. The impact is more related to hypoxia and placental inflammation.

Choice D:

Radiation, especially doses >100 mGy, is associated with growth restriction, microcephaly, and increased childhood cancer risk. However, miscarriage and developmental delay are more consistently documented with lead exposure at much lower levels, making radiation less likely in this context.

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Question 3:

Which maternal behavior is most associated with sudden infant death syndrome (SIDS)?

A. Caffeine consumption B. Smoking C. High sugar intake D. Sedentary lifestyle

Answer and Explanation

Choice A:

Caffeine consumption during pregnancy is linked to low birth weight and miscarriage at high intake (>200–300 mg/day), but it is not a major contributor to SIDS. It does not significantly impair neonatal respiratory regulation.

Choice B:

Smoking during pregnancy and after delivery exposes the fetus and infant to nicotine and carbon monoxide. This reduces oxygen delivery, impairs brainstem respiratory control, and increases SIDS risk by 2–4 times compared to nonsmoking mothers.

Choice C:

High sugar intake predisposes to gestational diabetes and macrosomia but has no established link to sudden infant death. It affects metabolic health, not respiratory arousal mechanisms.

Choice D:

Sedentary lifestyle increases maternal obesity risk and complications such as preeclampsia and gestational diabetes, but it does not directly cause SIDS. Infant mortality in this case is more related to perinatal complications than unexplained sudden death.

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Question 4:

Which of the following are potential fetal complications of maternal alcohol consumption during pregnancy? Select all that apply.

A. Facial dysmorphia B. Neonatal abstinence syndrome C. Growth restriction D. Neurodevelopmental deficits E. Congenital rubella syndrome

Answer and Explanation

Choice A:

Facial dysmorphia occurs due to alcohol-induced disruption of neural crest cell migration. Classic features include smooth philtrum, thin upper lip, and short palpebral fissures.

Choice B:

Neonatal abstinence syndrome is due to maternal opioid use, not alcohol exposure. It results from withdrawal after delivery and manifests with tremors, irritability, and seizures, unlike structural teratogenic effects of alcohol.

Choice C:

Growth restriction results from impaired placental blood flow and direct fetal toxicity of ethanol, leading to birth weights <2.5 kg or below the 10th percentile.

Choice D:

Neurodevelopmental deficits are long-term consequences of prenatal alcohol exposure, presenting as poor memory, attention deficits, and reduced IQ, caused by neuronal apoptosis and abnormal brain development.

Choice E:

Congenital rubella syndrome is caused by maternal rubella infection, not alcohol. It is characterized by cataracts, sensorineural hearing loss, and congenital heart defects, which are unrelated to ethanol teratogenicity.

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Question 5:

Which of the following are key nursing interventions for managing environmental toxin exposure during pregnancy? Select all that apply.

A. Educating patients to avoid high-mercury fish B. Encouraging outdoor activities in high-pollution areas C. Screening for lead exposure in high-risk environments D. Administering folic acid to counteract toxin effects E. Advising limited radiographic imaging during pregnancy

Answer and Explanation

Choice A:

Educating patients to avoid high-mercury fish such as shark, swordfish, and king mackerel prevents methylmercury accumulation, which causes fetal neurotoxicity and cerebral palsy-like features.

Choice B:

Encouraging outdoor activities in high-pollution areas increases maternal exposure to particulate matter and carbon monoxide. These impair placental oxygen delivery and raise risks of preterm birth and low birth weight, making this harmful rather than protective.

Choice C:

Screening for lead exposure is critical in high-risk groups (old housing, contaminated water, occupational exposure). Lead crosses the placenta, and maternal levels >10 µg/dL are associated with miscarriage and cognitive impairment.

Choice D:

Administering folic acid prevents neural tube defects but does not counteract mercury, lead, or radiation toxicity. Its mechanism is through DNA synthesis and repair, not detoxification, so it is not an intervention against environmental toxins.

Choice E:

Advising limited radiographic imaging minimizes unnecessary fetal radiation exposure. Doses above 100 mGy increase risk of microcephaly, growth restriction, and childhood cancer, making judicious imaging essential.

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Practice Exercise 4

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