NUR 230 Maternal Exam 2 | Galen
College of Nursing
Topic 1: Pregnancy Complications & Medical Disorders
Q1. A woman with type 1 diabetes is in her first trimester. Her insulin
requirements are likely to:
A) Increase significantly due to insulin resistance
B) Decrease due to increased insulin sensitivity
C) Remain unchanged throughout pregnancy
D) Fluctuate randomly with no predictable pattern
Answer: B) Decrease due to increased insulin sensitivity
Rationale: In the first trimester, hormonal changes (increased progesterone and
estrogen) lead to increased insulin sensitivity and decreased insulin resistance. This
often causes a decrease in insulin requirements and an increased risk of
hypoglycemia.
Q2. The nurse is caring for a patient with preeclampsia who is receiving
magnesium sulfate. Which finding indicates that the patient is developing
magnesium toxicity?
A) Patellar reflexes 2+
B) Respiratory rate of 10 breaths/minute
C) Blood pressure of 140/90 mmHg
D) Urine output of 45 mL/hour
Answer: B) Respiratory rate of 10 breaths/minute
,Rationale: Magnesium sulfate toxicity causes central nervous system depression.
Signs include respiratory depression (rate <12 breaths/minute), decreased deep
tendon reflexes (areflexia), oliguria (<30 mL/hour), and altered mental status. This
is an emergency requiring discontinuation of the infusion and administration of the
antidote, calcium gluconate.
Q3. A client with severe preeclampsia is receiving magnesium sulfate. The
nurse should have which medication available as an antidote?
A) Calcium gluconate
B) Naloxone
C) Vitamin K
D) Protamine sulfate
Answer: A) Calcium gluconate
Rationale: Calcium gluconate is the specific antidote for magnesium sulfate
toxicity. It is administered IV push over 3-5 minutes in the event of respiratory or
cardiac depression. Naloxone reverses opioid effects, Vitamin K reverses warfarin,
and Protamine sulfate reverses heparin.
Q4. Which statement regarding glucose screening and gestational diabetes
mellitus (GDM) is correct?
A) The 50-gram glucose challenge test (GCT) is diagnostic for GDM
B) A 3-hour 100-gram oral glucose tolerance test (OGTT) is used for diagnosis
C) Screening is performed at 24-28 weeks of gestation for all pregnant women
regardless of risk factors
D) Both B and C
Answer: D) Both B and C
Rationale: Universal screening for GDM is recommended at 24-28 weeks
gestation. The 1-hour 50-gram GCT is a screening test; if abnormal (typically
, ≥130-140 mg/dL), a diagnostic 3-hour 100-gram OGTT is performed. Two or
more elevated values on the OGTT confirm the diagnosis of GDM.
Q5. A newborn is delivered at 36 weeks to a mother with gestational diabetes.
At one hour of age, the infant's blood glucose is 38 mg/dL. What is the most
appropriate nursing action?
A) Administer IV dextrose immediately
B) Initiate early frequent feedings (breast or formula) and recheck glucose in 1
hour
C) Transfer the infant to the NICU for observation
D) Do nothing; this is a normal glucose level
Answer: B) Initiate early frequent feedings (breast or formula) and recheck
glucose in 1 hour
Rationale: Hypoglycemia in a newborn is defined as <40-45 mg/dL in the first 24
hours. For asymptomatic mild hypoglycemia, the first action is early feeding to
raise glucose levels. Symptomatic hypoglycemia or very low levels would require
IV dextrose.
Q6. An infant of a diabetic mother (IDM) is most at risk for which neonatal
complication?
A) Hypercalcemia
B) Hyperbilirubinemia
C) Hyperglycemia
D) Hypermagnesemia
Answer: B) Hyperbilirubinemia
Rationale: IDM is at risk for hyperbilirubinemia due to polycythemia (increased
RBCs from chronic fetal hypoxia in response to maternal hyperglycemia). The
increased RBCs undergo hemolysis, leading to elevated bilirubin levels.
College of Nursing
Topic 1: Pregnancy Complications & Medical Disorders
Q1. A woman with type 1 diabetes is in her first trimester. Her insulin
requirements are likely to:
A) Increase significantly due to insulin resistance
B) Decrease due to increased insulin sensitivity
C) Remain unchanged throughout pregnancy
D) Fluctuate randomly with no predictable pattern
Answer: B) Decrease due to increased insulin sensitivity
Rationale: In the first trimester, hormonal changes (increased progesterone and
estrogen) lead to increased insulin sensitivity and decreased insulin resistance. This
often causes a decrease in insulin requirements and an increased risk of
hypoglycemia.
Q2. The nurse is caring for a patient with preeclampsia who is receiving
magnesium sulfate. Which finding indicates that the patient is developing
magnesium toxicity?
A) Patellar reflexes 2+
B) Respiratory rate of 10 breaths/minute
C) Blood pressure of 140/90 mmHg
D) Urine output of 45 mL/hour
Answer: B) Respiratory rate of 10 breaths/minute
,Rationale: Magnesium sulfate toxicity causes central nervous system depression.
Signs include respiratory depression (rate <12 breaths/minute), decreased deep
tendon reflexes (areflexia), oliguria (<30 mL/hour), and altered mental status. This
is an emergency requiring discontinuation of the infusion and administration of the
antidote, calcium gluconate.
Q3. A client with severe preeclampsia is receiving magnesium sulfate. The
nurse should have which medication available as an antidote?
A) Calcium gluconate
B) Naloxone
C) Vitamin K
D) Protamine sulfate
Answer: A) Calcium gluconate
Rationale: Calcium gluconate is the specific antidote for magnesium sulfate
toxicity. It is administered IV push over 3-5 minutes in the event of respiratory or
cardiac depression. Naloxone reverses opioid effects, Vitamin K reverses warfarin,
and Protamine sulfate reverses heparin.
Q4. Which statement regarding glucose screening and gestational diabetes
mellitus (GDM) is correct?
A) The 50-gram glucose challenge test (GCT) is diagnostic for GDM
B) A 3-hour 100-gram oral glucose tolerance test (OGTT) is used for diagnosis
C) Screening is performed at 24-28 weeks of gestation for all pregnant women
regardless of risk factors
D) Both B and C
Answer: D) Both B and C
Rationale: Universal screening for GDM is recommended at 24-28 weeks
gestation. The 1-hour 50-gram GCT is a screening test; if abnormal (typically
, ≥130-140 mg/dL), a diagnostic 3-hour 100-gram OGTT is performed. Two or
more elevated values on the OGTT confirm the diagnosis of GDM.
Q5. A newborn is delivered at 36 weeks to a mother with gestational diabetes.
At one hour of age, the infant's blood glucose is 38 mg/dL. What is the most
appropriate nursing action?
A) Administer IV dextrose immediately
B) Initiate early frequent feedings (breast or formula) and recheck glucose in 1
hour
C) Transfer the infant to the NICU for observation
D) Do nothing; this is a normal glucose level
Answer: B) Initiate early frequent feedings (breast or formula) and recheck
glucose in 1 hour
Rationale: Hypoglycemia in a newborn is defined as <40-45 mg/dL in the first 24
hours. For asymptomatic mild hypoglycemia, the first action is early feeding to
raise glucose levels. Symptomatic hypoglycemia or very low levels would require
IV dextrose.
Q6. An infant of a diabetic mother (IDM) is most at risk for which neonatal
complication?
A) Hypercalcemia
B) Hyperbilirubinemia
C) Hyperglycemia
D) Hypermagnesemia
Answer: B) Hyperbilirubinemia
Rationale: IDM is at risk for hyperbilirubinemia due to polycythemia (increased
RBCs from chronic fetal hypoxia in response to maternal hyperglycemia). The
increased RBCs undergo hemolysis, leading to elevated bilirubin levels.
