NUR230 Childbearing/Child Caring Family EXAM
4 REVIEW - Galen College 2026-27 | High-Risk &
Complex Care | Maternal-Child Nursing
DOMAIN 1 – High-Risk Pregnancy & Intrapartum Complications (15 Q)
Q1
A 36-week primagravida with severe preeclampsia receives MgSO₄ 2 g/h IV. VS: RR
10/min, DTRs absent, UOP 20 mL/h. Immediate priority?
A. Slow MgSO₄ infusion
B. Give ordered labetalol
C. Prepare calcium gluconate 1 g IV push
D. Increase maintenance IV rate
Verified Answer: C
,Rationale: Per AWHONN 2025 MgSO₄ toxicity = RR ≤12, absent DTRs, UOP <30 mL/h.
Calcium gluconate is antidote; must be at bedside before respiratory arrest. Slowing
infusion (A) correct but not life-saving alone.
Q2 (SATA)
Which findings support MgSO₄ toxicity? (Select ALL)
A. RR 8/min
B. Patellar DTR absent
C. UOP 15 mL/h
D. HR 110/min
E. Serum Mg 8 mEq/L (3.3 mmol/L)
Verified Answers: A, B, C, E
Rationale: Therapeutic Mg 4-7 mEq/L; >7 mEq/L → toxicity. RR ≤12 (A), absent DTRs
(B), UOP <30 mL/h (C) are clinical markers. HR 110 (D) is compensation, not toxicity.
Q3
,Gestational diabetes diet-controlled; fasting glucose 105 mg/dL ×2 (goal <95). Next
step?
A. Start bedtime NPH insulin 10 units
B. Add metformin 500 mg BID
C. Increase protein in diet
D. Schedule BPP twice weekly
Verified Answer: A
Rationale: ACOG 2025: If fasting glucose >95 mg/dL on two occasions despite diet,
initiate insulin (preferred in U.S.). Metformin (B) used but insulin first-line when
pharmacologic therapy needed.
Q4
Preterm labor at 31 weeks; cervix 4 cm, contractions q3 min. Contraindicated tocolytic if
maternal HR 120 bpm, BP 80/50 mmHg?
A. Indomethacin 50 mg PR ×1
B. Nifedipine 10 mg PO q6 h
C. Terbutaline 0.25 mg SQ q20 min ×3
, D. MgSO₄ 4 g load then 2 g/h
Verified Answer: C
Rationale: Terbutaline (β-agonist) causes maternal tachycardia & hypotension;
contraindicated with maternal cardiac tachy-arrhythmia or shock. MgSO₄ (D) safe
hypotensive.
Q5
Placental abruption; FHR 90 bpm with minimal variability, uterine hypertonus. Priority
action?
A. Initiate large-bore IV, type & cross-match 4 units
B. Give terbutaline to relax uterus
C. Insert Foley catheter
D. Begin MgSO₄ neuroprotection
Verified Answer: A
Rationale: Late deceleration + hypertonus = fetal hypoxemia & possible DIC; prepare
for emergency birth & transfusion. Terbutaline (B) not indicated (no tocolysis in
abruption).
4 REVIEW - Galen College 2026-27 | High-Risk &
Complex Care | Maternal-Child Nursing
DOMAIN 1 – High-Risk Pregnancy & Intrapartum Complications (15 Q)
Q1
A 36-week primagravida with severe preeclampsia receives MgSO₄ 2 g/h IV. VS: RR
10/min, DTRs absent, UOP 20 mL/h. Immediate priority?
A. Slow MgSO₄ infusion
B. Give ordered labetalol
C. Prepare calcium gluconate 1 g IV push
D. Increase maintenance IV rate
Verified Answer: C
,Rationale: Per AWHONN 2025 MgSO₄ toxicity = RR ≤12, absent DTRs, UOP <30 mL/h.
Calcium gluconate is antidote; must be at bedside before respiratory arrest. Slowing
infusion (A) correct but not life-saving alone.
Q2 (SATA)
Which findings support MgSO₄ toxicity? (Select ALL)
A. RR 8/min
B. Patellar DTR absent
C. UOP 15 mL/h
D. HR 110/min
E. Serum Mg 8 mEq/L (3.3 mmol/L)
Verified Answers: A, B, C, E
Rationale: Therapeutic Mg 4-7 mEq/L; >7 mEq/L → toxicity. RR ≤12 (A), absent DTRs
(B), UOP <30 mL/h (C) are clinical markers. HR 110 (D) is compensation, not toxicity.
Q3
,Gestational diabetes diet-controlled; fasting glucose 105 mg/dL ×2 (goal <95). Next
step?
A. Start bedtime NPH insulin 10 units
B. Add metformin 500 mg BID
C. Increase protein in diet
D. Schedule BPP twice weekly
Verified Answer: A
Rationale: ACOG 2025: If fasting glucose >95 mg/dL on two occasions despite diet,
initiate insulin (preferred in U.S.). Metformin (B) used but insulin first-line when
pharmacologic therapy needed.
Q4
Preterm labor at 31 weeks; cervix 4 cm, contractions q3 min. Contraindicated tocolytic if
maternal HR 120 bpm, BP 80/50 mmHg?
A. Indomethacin 50 mg PR ×1
B. Nifedipine 10 mg PO q6 h
C. Terbutaline 0.25 mg SQ q20 min ×3
, D. MgSO₄ 4 g load then 2 g/h
Verified Answer: C
Rationale: Terbutaline (β-agonist) causes maternal tachycardia & hypotension;
contraindicated with maternal cardiac tachy-arrhythmia or shock. MgSO₄ (D) safe
hypotensive.
Q5
Placental abruption; FHR 90 bpm with minimal variability, uterine hypertonus. Priority
action?
A. Initiate large-bore IV, type & cross-match 4 units
B. Give terbutaline to relax uterus
C. Insert Foley catheter
D. Begin MgSO₄ neuroprotection
Verified Answer: A
Rationale: Late deceleration + hypertonus = fetal hypoxemia & possible DIC; prepare
for emergency birth & transfusion. Terbutaline (B) not indicated (no tocolysis in
abruption).
