High-risk pregnancy and obstetric emergencies

20 Kerala PSC Staff Nurse Gr II practice questions on High-risk pregnancy and obstetric emergencies, part of Midwifery and Gynaecological Nursing. The first 20 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Easy

   The Macafee and Johnson regimen is the expectant management of:

   1. ATwin pregnancy
   2. BPlacenta praevia
   3. CAbruptio placentae
   4. DEclampsia

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   Answer: B · Placenta praevia

   In the Macafee and Johnson regimen, a woman with placenta praevia whose bleeding is slight and whose fetus is preterm is kept in hospital with bed rest, blood ready and no vaginal examination. The aim is to carry the pregnancy to about 37 weeks for fetal maturity. Heavy bleeding ends expectant care and calls for delivery.

   • A: Twins have their own antenatal plan, not this regimen.
   • C: Abruption usually needs prompt delivery, not long expectant care.
   • D: Eclampsia is treated with magnesium sulphate and delivery.

2. Question 2 · Medium

   The congenital anomaly most specific to poorly controlled pre-existing maternal diabetes is:

   1. ADevelopmental hip dysplasia
   2. BDown syndrome
   3. CCaudal regression syndrome
   4. DCleft lip and palate

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   Answer: C · Caudal regression syndrome

   High glucose in the first weeks of pregnancy disturbs organ formation, so pre-existing diabetes raises the rate of heart, neural tube and skeletal anomalies. Caudal regression (sacral agenesis) is rare but far more common in diabetic pregnancies than in any other. Good sugar control before conception, shown by a normal HbA1c, lowers this risk.

   • A: Hip dysplasia is linked to breech and female sex, not diabetes.
   • B: Down syndrome relates to maternal age, not diabetes.
   • D: Cleft lip is not specifically linked to diabetes.

3. Question 3 · Easy

   Hypertension in pregnancy is diagnosed when the blood pressure is at least:

   1. A120/80 mmHg twice, 6 hours apart
   2. B130/80 mmHg on a single reading
   3. C160/110 mmHg twice, 1 hour apart
   4. D140/90 mmHg twice, 4 hours apart

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   Answer: D · 140/90 mmHg twice, 4 hours apart

   Hypertension in pregnancy is a systolic of 140 mmHg or more, or a diastolic of 90 mmHg or more, on two readings at least 4 hours apart. When it appears after 20 weeks with proteinuria or organ involvement, it is pre-eclampsia. A reading of 160/110 mmHg or more is the severe range and needs treatment within the hour.

   • A: 120/80 mmHg is a normal blood pressure.
   • B: 130/80 mmHg is not the threshold used in pregnancy.
   • C: 160/110 mmHg defines severe-range hypertension, not the diagnosis.

4. Question 4 · Hard

   In a twin labour, the first twin, a vertex, has just been born and the cord is clamped. What should the nurse do next?

   1. ACheck the second twin's lie and heart rate
   2. BApply fundal pressure to deliver the second
   3. CDeliver the placenta by cord traction
   4. DGive IV ergometrine to contract the uterus

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   Answer: A · Check the second twin's lie and heart rate

   After the first twin, an abdominal examination confirms the lie and presentation of the second twin and its heart rate is checked, since it is at higher risk of hypoxia and malpresentation. If the lie is longitudinal, contractions return and membranes are ruptured once the part is fixed. Ergometrine and placental delivery wait until the second twin is born.

   • B: Fundal pressure is unsafe and does nothing to check the lie.
   • C: The placenta is delivered only after both twins are born.
   • D: Ergometrine before the second birth may trap the second twin.

5. Question 5 · Medium

   Hourly urine output is measured during magnesium sulphate therapy because magnesium:

   1. AIs broken down by the liver
   2. BCauses polyuria and dehydration
   3. CIs excreted almost entirely by the kidneys
   4. DDamages the renal tubules directly

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   Answer: C · Is excreted almost entirely by the kidneys

   Magnesium is cleared by the kidneys, so oliguria lets it build up to toxic levels. Pre-eclampsia itself reduces renal blood flow. If urine output falls below 30 mL per hour (100 mL in 4 hours), the next dose is withheld and the doctor informed.

   • A: Magnesium is not metabolised by the liver.
   • B: Magnesium does not cause polyuria.
   • D: Magnesium is not directly nephrotoxic at therapeutic levels.

6. Question 6 · Medium

   A pregnant woman on daily IFA tablets asks what to take them with. The best advice is:

   1. AA glass of milk
   2. BHer daily calcium tablet
   3. CA cup of tea
   4. DA glass of lemon juice

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7. Question 7 · Easy

   The antidote for magnesium sulphate toxicity is:

   1. AVitamin K IM
   2. B10% calcium gluconate IV
   3. CProtamine sulphate IV
   4. DNaloxone hydrochloride IV

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8. Question 8 · Medium

   When the first of twins is born, the placental end of its cord is also clamped because:

   1. AIt hastens separation of the placenta
   2. BIt prevents cord prolapse of the second twin
   3. CThe second twin may bleed through shared vessels
   4. DIt lowers the risk of cord infection

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9. Question 9 · Medium

   Antenatal corticosteroids given in preterm labour at 30 weeks mainly reduce the newborn's risk of:

   1. ACongenital infection
   2. BNeonatal hypoglycaemia
   3. CRespiratory distress syndrome
   4. DNeonatal jaundice

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10. Question 10 · Medium

    In concealed abruptio placentae, the maternal shock is typically:

    1. AIn proportion to the visible blood loss
    2. BOut of proportion to the visible blood loss
    3. CAbsent until the baby is delivered
    4. DMild because the bleeding is retained

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11. Question 11 · Easy

    Couvelaire uterus is seen in:

    1. AComplete hydatidiform mole
    2. BAbruptio placentae
    3. CVasa praevia
    4. DPlacenta praevia

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12. Question 12 · Medium

    Polyhydramnios is commonly associated with:

    1. AMaternal diabetes mellitus
    2. BFetal renal agenesis
    3. CEarly fetal growth restriction
    4. DPost-term pregnancy

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13. Question 13 · Easy

    Carboprost (15-methyl PGF2 alpha) for postpartum haemorrhage is contraindicated in:

    1. APrevious caesarean
    2. BHypothyroidism
    3. CDiabetes mellitus
    4. DBronchial asthma

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14. Question 14 · Easy

    The most common type of anaemia in pregnancy in India is:

    1. AIron deficiency anaemia
    2. BVitamin B12 deficiency anaemia
    3. CHaemolytic anaemia
    4. DFolic acid deficiency anaemia

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15. Question 15 · Medium

    Babies of diabetic mothers are often macrosomic mainly because of:

    1. AMaternal hypoglycaemic episodes
    2. BExcess amniotic fluid
    3. CFetal hyperinsulinaemia
    4. DFetal hypothyroidism

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16. Question 16 · Hard

    For atonic PPH, oxytocin 20 IU in 1000 mL normal saline is to run at 125 mL/hour with a 20 drops/mL set. The drip rate is:

    1. A42 drops/min
    2. B21 drops/min
    3. C375 drops/min
    4. D63 drops/min

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17. Question 17 · Easy

    Misoprostol, used orally to prevent PPH where oxytocin cannot be stored cold, is a synthetic analogue of:

    1. AProstaglandin E2
    2. BProstaglandin E1
    3. COxytocin
    4. DProstaglandin F2 alpha

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18. Question 18 · Hard

    A woman at 34 weeks with pre-eclampsia has severe pain, a hard tender uterus and absent fetal heart sounds. BP is 90/60 mmHg. Her blood in a plain tube has not clotted after 10 minutes. This suggests:

    1. AMagnesium sulphate toxicity
    2. BRupture of the uterus
    3. CConsumptive coagulopathy (DIC)
    4. DPlacenta praevia with shock

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19. Question 19 · Easy

    The drug of choice to prevent and control convulsions in eclampsia is:

    1. APhenytoin sodium IV
    2. BMagnesium sulphate
    3. CDiazepam
    4. DPhenobarbitone

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20. Question 20 · Hard

    For the IM part of the Pritchard regimen, 5 g of magnesium sulphate is given into each buttock. How many mL of the 50% solution go into each buttock?

    1. A10 mL
    2. B2.5 mL
    3. C20 mL
    4. D5 mL

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