RNC-IAP Certification emphasizing
inpatient antepartum nursing, high-risk
pregnancy management, and maternal-
fetal health promotion.
Question 1
A 32-year-old patient at 34 weeks gestation is admitted with complaints of
headache, visual changes, and right upper quadrant pain. Her blood pressure is
158/98 mmHg, and urine protein is 3+. The APRN should recognize this
presentation as:
A. Gestational hypertension
B. Preeclampsia with severe features
C. HELLP syndrome
D. Chronic hypertension with superimposed preeclampsia
Answer: B. Preeclampsia with severe features
Rationale: Preeclampsia with severe features is diagnosed when a patient with
gestational hypertension or preeclampsia develops severe hypertension (systolic
≥160 mmHg or diastolic ≥110 mmHg) and/or signs of end-organ damage,
including headache, visual disturbances, epigastric/right upper quadrant pain, or
elevated liver enzymes. This patient's blood pressure, headache, visual changes,
and RUQ pain indicate severe features requiring immediate intervention. HELLP
syndrome is a variant of severe preeclampsia characterized by hemolysis, elevated
liver enzymes, and low platelets.
Question 2
A patient at 28 weeks gestation is admitted for preterm labor. Which of the
following maternal assessment findings is MOST consistent with a normal
physiologic change of pregnancy?
A. Respiratory rate of 24 breaths/min
B. Heart rate of 95 beats/min
,C. Blood pressure of 148/92 mmHg
D. Serum creatinine of 1.2 mg/dL
Answer: B. Heart rate of 95 beats/min
Rationale: During pregnancy, heart rate increases by 10-20 beats/min due to
increased cardiac output and plasma volume. A heart rate of 95 beats/min is within
the expected physiologic range. Respiratory rate should remain unchanged (16-20
breaths/min). Blood pressure of 148/92 mmHg is elevated and abnormal. Serum
creatinine should decrease in pregnancy due to increased glomerular filtration; a
value of 1.2 mg/dL is elevated and concerning for renal impairment.
Question 3
A patient at 32 weeks gestation is admitted with suspected pyelonephritis. The
APRN understands that which physiologic change of pregnancy increases the risk
of urinary tract infections?
A. Decreased renal blood flow
B. Ureteral dilation and decreased ureteral peristalsis
C. Increased bladder capacity
D. Decreased glomerular filtration rate
Answer: B. Ureteral dilation and decreased ureteral peristalsis
Rationale: During pregnancy, progesterone causes smooth muscle relaxation,
leading to ureteral dilation and decreased ureteral peristalsis. This urinary stasis,
combined with compression of the ureters by the gravid uterus, increases the risk
of urinary tract infections and pyelonephritis. Renal blood flow and glomerular
filtration rate actually increase during pregnancy. Bladder capacity may be reduced
due to uterine compression.
Question 4
A patient at 36 weeks gestation is admitted for monitoring. The APRN notes that
the patient's hemoglobin is 10.8 g/dL. This finding is:
A. Normal for pregnancy
B. Indicative of severe anemia requiring transfusion
,C. Indicative of iron deficiency anemia
D. Indicative of polycythemia
Answer: A. Normal for pregnancy
Rationale: During pregnancy, hemoglobin levels decrease due to physiologic
hemodilution from increased plasma volume. A hemoglobin of 10.8 g/dL in the
third trimester is within the expected normal range (10.5-12.0 g/dL). This
physiologic anemia of pregnancy does not require transfusion. Iron deficiency
should be suspected if hemoglobin falls below 10.5 g/dL, but this value is not yet
in the severe range.
Question 5
A patient at 30 weeks gestation is admitted with a new diagnosis of gestational
diabetes. The APRN should recognize that the physiologic cause of insulin
resistance in pregnancy is:
A. Decreased maternal glucose production
B. Human placental lactogen (hPL) and other placental hormones
C. Increased maternal insulin sensitivity
D. Decreased maternal cortisol levels
Answer: B. Human placental lactogen (hPL) and other placental hormones
Rationale: Human placental lactogen (hPL), along with other placental hormones
including estrogen, progesterone, and cortisol, contributes to insulin resistance
during pregnancy. These hormones promote glucose availability for the fetus by
decreasing maternal insulin sensitivity. This physiologic insulin resistance
typically develops in the second and third trimesters. Insulin production increases
to compensate; when it cannot, gestational diabetes develops.
Question 6
A patient at 33 weeks gestation is admitted with complaints of severe headaches
and blurred vision. Which of the following maternal assessments should be the
PRIORITY?
A. Serum creatinine
B. Blood pressure
, C. Respiratory rate
D. Serum glucose
Answer: B. Blood pressure
Rationale: Headaches and blurred vision in a third-trimester patient are
concerning for preeclampsia with severe features. The priority assessment is blood
pressure. Severe hypertension (systolic ≥160 mmHg or diastolic ≥110 mmHg) in
the presence of these symptoms indicates severe preeclampsia and requires
immediate intervention. While serum creatinine may be elevated in preeclampsia,
blood pressure assessment is the immediate priority to determine the urgency of
the situation.
Question 7
A patient at 35 weeks gestation is admitted for observation. The APRN notes that
the patient has 2+ pitting edema in the lower extremities. The APRN should:
A. Initiate diuretic therapy immediately
B. Recognize this as a normal finding and continue monitoring
C. Restrict the patient's fluid intake
D. Notify the healthcare provider for possible preeclampsia
Answer: D. Notify the healthcare provider for possible preeclampsia
Rationale: While mild edema is common in pregnancy, 2+ pitting edema in the
third trimester should be evaluated in the context of other findings. In a patient
admitted for observation, this finding may indicate worsening fluid retention
associated with preeclampsia. The APRN should notify the healthcare provider for
further evaluation, including blood pressure and urine protein assessment.
Diuretics are not used in pregnancy due to decreased placental perfusion.
Question 8
A patient at 31 weeks gestation is admitted with complaints of nausea, vomiting,
and epigastric pain. Laboratory results show elevated liver enzymes and a platelet
count of 85,000/mm³. The APRN should suspect which of the following?
A. Hyperemesis gravidarum
B. HELLP syndrome
inpatient antepartum nursing, high-risk
pregnancy management, and maternal-
fetal health promotion.
Question 1
A 32-year-old patient at 34 weeks gestation is admitted with complaints of
headache, visual changes, and right upper quadrant pain. Her blood pressure is
158/98 mmHg, and urine protein is 3+. The APRN should recognize this
presentation as:
A. Gestational hypertension
B. Preeclampsia with severe features
C. HELLP syndrome
D. Chronic hypertension with superimposed preeclampsia
Answer: B. Preeclampsia with severe features
Rationale: Preeclampsia with severe features is diagnosed when a patient with
gestational hypertension or preeclampsia develops severe hypertension (systolic
≥160 mmHg or diastolic ≥110 mmHg) and/or signs of end-organ damage,
including headache, visual disturbances, epigastric/right upper quadrant pain, or
elevated liver enzymes. This patient's blood pressure, headache, visual changes,
and RUQ pain indicate severe features requiring immediate intervention. HELLP
syndrome is a variant of severe preeclampsia characterized by hemolysis, elevated
liver enzymes, and low platelets.
Question 2
A patient at 28 weeks gestation is admitted for preterm labor. Which of the
following maternal assessment findings is MOST consistent with a normal
physiologic change of pregnancy?
A. Respiratory rate of 24 breaths/min
B. Heart rate of 95 beats/min
,C. Blood pressure of 148/92 mmHg
D. Serum creatinine of 1.2 mg/dL
Answer: B. Heart rate of 95 beats/min
Rationale: During pregnancy, heart rate increases by 10-20 beats/min due to
increased cardiac output and plasma volume. A heart rate of 95 beats/min is within
the expected physiologic range. Respiratory rate should remain unchanged (16-20
breaths/min). Blood pressure of 148/92 mmHg is elevated and abnormal. Serum
creatinine should decrease in pregnancy due to increased glomerular filtration; a
value of 1.2 mg/dL is elevated and concerning for renal impairment.
Question 3
A patient at 32 weeks gestation is admitted with suspected pyelonephritis. The
APRN understands that which physiologic change of pregnancy increases the risk
of urinary tract infections?
A. Decreased renal blood flow
B. Ureteral dilation and decreased ureteral peristalsis
C. Increased bladder capacity
D. Decreased glomerular filtration rate
Answer: B. Ureteral dilation and decreased ureteral peristalsis
Rationale: During pregnancy, progesterone causes smooth muscle relaxation,
leading to ureteral dilation and decreased ureteral peristalsis. This urinary stasis,
combined with compression of the ureters by the gravid uterus, increases the risk
of urinary tract infections and pyelonephritis. Renal blood flow and glomerular
filtration rate actually increase during pregnancy. Bladder capacity may be reduced
due to uterine compression.
Question 4
A patient at 36 weeks gestation is admitted for monitoring. The APRN notes that
the patient's hemoglobin is 10.8 g/dL. This finding is:
A. Normal for pregnancy
B. Indicative of severe anemia requiring transfusion
,C. Indicative of iron deficiency anemia
D. Indicative of polycythemia
Answer: A. Normal for pregnancy
Rationale: During pregnancy, hemoglobin levels decrease due to physiologic
hemodilution from increased plasma volume. A hemoglobin of 10.8 g/dL in the
third trimester is within the expected normal range (10.5-12.0 g/dL). This
physiologic anemia of pregnancy does not require transfusion. Iron deficiency
should be suspected if hemoglobin falls below 10.5 g/dL, but this value is not yet
in the severe range.
Question 5
A patient at 30 weeks gestation is admitted with a new diagnosis of gestational
diabetes. The APRN should recognize that the physiologic cause of insulin
resistance in pregnancy is:
A. Decreased maternal glucose production
B. Human placental lactogen (hPL) and other placental hormones
C. Increased maternal insulin sensitivity
D. Decreased maternal cortisol levels
Answer: B. Human placental lactogen (hPL) and other placental hormones
Rationale: Human placental lactogen (hPL), along with other placental hormones
including estrogen, progesterone, and cortisol, contributes to insulin resistance
during pregnancy. These hormones promote glucose availability for the fetus by
decreasing maternal insulin sensitivity. This physiologic insulin resistance
typically develops in the second and third trimesters. Insulin production increases
to compensate; when it cannot, gestational diabetes develops.
Question 6
A patient at 33 weeks gestation is admitted with complaints of severe headaches
and blurred vision. Which of the following maternal assessments should be the
PRIORITY?
A. Serum creatinine
B. Blood pressure
, C. Respiratory rate
D. Serum glucose
Answer: B. Blood pressure
Rationale: Headaches and blurred vision in a third-trimester patient are
concerning for preeclampsia with severe features. The priority assessment is blood
pressure. Severe hypertension (systolic ≥160 mmHg or diastolic ≥110 mmHg) in
the presence of these symptoms indicates severe preeclampsia and requires
immediate intervention. While serum creatinine may be elevated in preeclampsia,
blood pressure assessment is the immediate priority to determine the urgency of
the situation.
Question 7
A patient at 35 weeks gestation is admitted for observation. The APRN notes that
the patient has 2+ pitting edema in the lower extremities. The APRN should:
A. Initiate diuretic therapy immediately
B. Recognize this as a normal finding and continue monitoring
C. Restrict the patient's fluid intake
D. Notify the healthcare provider for possible preeclampsia
Answer: D. Notify the healthcare provider for possible preeclampsia
Rationale: While mild edema is common in pregnancy, 2+ pitting edema in the
third trimester should be evaluated in the context of other findings. In a patient
admitted for observation, this finding may indicate worsening fluid retention
associated with preeclampsia. The APRN should notify the healthcare provider for
further evaluation, including blood pressure and urine protein assessment.
Diuretics are not used in pregnancy due to decreased placental perfusion.
Question 8
A patient at 31 weeks gestation is admitted with complaints of nausea, vomiting,
and epigastric pain. Laboratory results show elevated liver enzymes and a platelet
count of 85,000/mm³. The APRN should suspect which of the following?
A. Hyperemesis gravidarum
B. HELLP syndrome
