A woman with severe pre-eclampsia is on a magnesium sulphate maintenance infusion. At the 4-hour check: knee jerks present, respiratory rate 18/min, urine output 45 mL/hour, and serum magnesium 6 mEq/L. What should the nurse do?

Continue the infusion and keep up hourly checks

Increase the rate because the level is too low

Stop the infusion and send a repeat level

Stop the infusion and give calcium gluconate

A contraction stress test (oxytocin challenge test) is reported as positive. This means:

Late decelerations followed at least half the contractions

Accelerations occurred with every fetal movement

Variable decelerations occurred with a single contraction

Fewer than three contractions occurred in 10 minutes

The condition most commonly associated with abruptio placentae is:

Hypertensive disorder of pregnancy

Antenatal care and high-risk pregnancy

45 M.Sc Nursing Entrance (AIIMS, LBS, PGIMER, JIPMER) practice questions on Antenatal care and high-risk pregnancy, part of Obstetric and Gynaecological Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
A woman with severe pre-eclampsia is on a magnesium sulphate maintenance infusion. At the 4-hour check: knee jerks present, respiratory rate 18/min, urine output 45 mL/hour, and serum magnesium 6 mEq/L. What should the nurse do?
1. AContinue the infusion and keep up hourly checks
2. BIncrease the rate because the level is too low
3. CStop the infusion and send a repeat level
4. DStop the infusion and give calcium gluconate
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Answer: A · Continue the infusion and keep up hourly checks
Before continuing magnesium, the nurse checks that knee jerks are present, the respiratory rate is at least 16/min and urine output is at least 30 mL/hour (100 mL in 4 hours). All three are satisfied here, and a level of 6 mEq/L lies within the therapeutic range of about 4-7 mEq/L. The infusion therefore continues with hourly checks. Calcium gluconate is kept at the bedside for toxicity but is not needed now.
- B: A level of 6 mEq/L is already therapeutic, so the rate should not be raised.
- C: Stopping without a reason would leave her unprotected against fits.
- D: Calcium gluconate is for toxicity, such as absent reflexes or slow breathing; neither is present.
Question 2 · Medium
A contraction stress test (oxytocin challenge test) is reported as positive. This means:
1. AAccelerations occurred with every fetal movement
2. BLate decelerations followed at least half the contractions
3. CVariable decelerations occurred with a single contraction
4. DFewer than three contractions occurred in 10 minutes
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Answer: B · Late decelerations followed at least half the contractions
The test produces three contractions in 10 minutes, with nipple stimulation or oxytocin, and watches the fetal heart. Late decelerations after 50% or more of contractions show that the fetus cannot tolerate the brief fall in placental flow, so the test is positive and suggests uteroplacental insufficiency. A negative test (no late or significant variable decelerations) is reassuring. Fewer than three contractions in 10 minutes makes the test unsatisfactory, not positive.
- A: Accelerations are reassuring and describe a reactive NST, not a positive CST.
- C: Occasional variable decelerations make the test equivocal, not positive.
- D: Too few contractions makes the test unsatisfactory and it must be repeated.
Question 3 · Easy
In the first weeks of pregnancy, the corpus luteum is kept secreting progesterone mainly by:
1. AHuman placental lactogen
2. BPituitary luteinising hormone
3. CHuman chorionic gonadotrophin
4. DPlacental oestriol
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Answer: C · Human chorionic gonadotrophin
Human chorionic gonadotrophin (hCG) from the syncytiotrophoblast acts on the LH receptor of the corpus luteum and stops it regressing. The corpus luteum then keeps making progesterone until the placenta takes over at about 8-10 weeks. hCG peaks at about 60-70 days, which is why urine pregnancy tests detect it so readily. Low or poorly rising hCG in early pregnancy points to a failing pregnancy.
- A: hPL rises later in pregnancy and mainly changes maternal glucose and fat metabolism.
- B: Pituitary LH is suppressed in pregnancy by the high oestrogen and progesterone.
- D: Oestriol is made by the feto-placental unit and does not sustain the corpus luteum.
Question 4 · Medium
With correct dates and a singleton pregnancy, a raised maternal serum alpha-fetoprotein at 16 weeks most suggests:
1. AAn open neural tube defect
2. BTrisomy 21 (Down syndrome)
3. CTrisomy 18 (Edwards syndrome)
4. DGestational diabetes
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Answer: A · An open neural tube defect
AFP is made by the fetal liver and leaks into the amniotic fluid and maternal blood in excess when the neural tube is open, as in anencephaly or open spina bifida. Wrong dates, twins and fetal death also raise AFP, so these are excluded first by ultrasound. A detailed scan then looks for the spinal or cranial defect. Preconception folic acid lowers the risk of these defects.
- B: In Down syndrome maternal serum AFP is low, not raised.
- C: Trisomy 18 gives low AFP, oestriol and hCG.
- D: Gestational diabetes is not detected by AFP screening.
Question 5 · Easy
The condition most commonly associated with abruptio placentae is:
1. AA first pregnancy
2. BMaternal age below 20 years
3. CA previous caesarean scar
4. DHypertensive disorder of pregnancy
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Answer: D · Hypertensive disorder of pregnancy
Pre-eclampsia and other hypertensive disorders are the commonest association of placental abruption, because diseased spiral arteries rupture and bleed behind the placenta. Other causes are abdominal trauma, sudden uterine decompression (after delivery of a first twin or rupture of membranes in polyhydramnios), smoking and cocaine. Every woman with pre-eclampsia who complains of abdominal pain must be assessed for abruption. A previous abruption also raises the risk in later pregnancies.
- A: Abruption is commoner in multiparous women, not in a first pregnancy.
- B: Young maternal age is not a major cause; abruption is commoner with age and parity.
- C: A previous caesarean scar is a risk factor for placenta praevia and accreta, not chiefly abruption.
Question 6 · Hard
A primigravida at 34 weeks has BP 146/94 mmHg on two readings, urine protein 2+ and no symptoms. Results: platelets 92,000/µL, serum creatinine 0.8 mg/dL, AST 30 U/L (normal under 40), and normal fetal growth. How is her condition best classified?
1. APre-eclampsia without severe features
2. BPre-eclampsia with severe features
3. CChronic hypertension with superimposed disease
4. DGestational hypertension only
Answer and explanation in LearnFree account
Question 7 · Medium
Babies of poorly controlled diabetic mothers have a higher risk of respiratory distress syndrome even near term, because fetal hyperinsulinaemia:
1. ACauses underdevelopment of the lung tissue
2. BLeads to aspiration of meconium in utero
3. CDelays the production of lung surfactant
4. DSpeeds clearance of fetal lung fluid
Answer and explanation in LearnFree account
Question 8 · Hard
At the 24-week visit a pregnant woman's reading is 150/96 mmHg. Calculated with the standard formula, her mean arterial pressure is:
1. A114 mmHg
2. B105 mmHg
3. C123 mmHg
4. D132 mmHg
Answer and explanation in LearnFree account
Question 9 · Easy
Which change in the clotting system is part of the normal hypercoagulable state of pregnancy?
1. AAntithrombin levels rise sharply near term
2. BPlasma fibrinogen rises well above non-pregnant levels
3. CPlatelet count doubles by the third trimester
4. DProtein S activity rises steeply in late pregnancy
Answer and explanation in LearnFree account
Question 10 · Medium
A woman at 36 weeks has a placental abruption with an intrauterine fetal death. After resuscitation she is stable with no DIC. The usual plan for her delivery is:
1. AAn immediate classical caesarean section
2. BAmniotomy with oxytocin for a vaginal birth
3. CWaiting two weeks for spontaneous labour
4. DTocolysis to delay labour while she recovers
Answer and explanation in LearnFree account
Question 11 · Medium
Progesterone stimulates the respiratory centre in pregnancy. Which arterial blood gas is typical of a healthy woman in the third trimester?
1. ApH 7.32, PaCO2 50 mmHg, HCO3- 26 mmol/L
2. BpH 7.44, PaCO2 30 mmHg, HCO3- 20 mmol/L
3. CpH 7.40, PaCO2 40 mmHg, HCO3- 24 mmol/L
4. DpH 7.48, PaCO2 44 mmHg, HCO3- 32 mmol/L
Answer and explanation in LearnFree account
Question 12 · Medium
At 10 weeks, a healthy woman's TSH is slightly below the non-pregnant range with a normal free T4. The best explanation is that:
1. AhCG weakly stimulates the TSH receptor
2. BOestrogen raises thyroxine-binding globulin
3. CEarly Graves disease has begun
4. DIodine deficiency suppresses TSH output
Answer and explanation in LearnFree account
Question 13 · Medium
A woman with severe anaemia (haemoglobin 6 g/dL) is admitted in labour. The period of greatest risk of acute cardiac failure for her is:
1. AThe latent phase, before the cervix reaches 4 cm
2. BSoon after the birth, as uterine blood enters the circulation
3. CSix weeks after the birth, at the postnatal check
4. DEarly labour, when contractions are mild and irregular
Answer and explanation in LearnFree account
Question 14 · Medium
A woman with gestational diabetes needed insulin 36 units a day in late pregnancy. Two hours after a normal birth and delivery of the placenta, what should the nurse expect about her insulin?
1. AShe is switched straight to an oral sulphonylurea
2. BThe dose is doubled for 48 hours to cover stress
3. CThe same dose is continued for six weeks
4. DInsulin is usually stopped and glucose is monitored
Answer and explanation in LearnFree account
Question 15 · Easy
On ultrasound in the third trimester, oligohydramnios is diagnosed when the amniotic fluid index (AFI) is:
1. ALess than 15 cm
2. BLess than 10 cm
3. CLess than 5 cm
4. DLess than 25 cm
Answer and explanation in LearnFree account
Question 16 · Medium
During magnesium sulphate therapy for severe pre-eclampsia, the serum magnesium level usually aimed for to prevent fits is about:
1. A15-20 mEq/L
2. B1.5-2.5 mEq/L
3. C4-7 mEq/L
4. D10-12 mEq/L
Answer and explanation in LearnFree account
Question 17 · Hard
At 38 weeks, a woman with reduced fetal movements has a non-stress test. Over 40 minutes the baseline is 140 bpm with normal variability, there are no decelerations, but no accelerations occur. What is the most appropriate next step?
1. ADischarge her and repeat the test in one week
2. BDeliver at once by emergency caesarean section
3. CProceed to a full biophysical profile
4. DRepeat the test after she drinks a glass of juice
Answer and explanation in LearnFree account
Question 18 · Medium
Asymptomatic bacteriuria found at the booking visit is treated even without symptoms, mainly because in pregnancy it:
1. AIs the main cause of pre-eclampsia
2. BOften progresses to acute pyelonephritis
3. CInfects the fetus through the cord
4. DSignals undiagnosed gestational diabetes
Answer and explanation in LearnFree account
Question 19 · Hard
At booking, a woman has haemoglobin 9.8 g/dL, MCV 66 fL, red cell count 5.5 million/µL and normal serum ferritin. Her Mentzer index is 12. What is the most appropriate next step?
1. AGiving intravenous iron sucrose this week
2. BTransfusing two units of packed red cells
3. CHPLC for HbA2 and screening of her partner
4. DDoubling her oral iron to two tablets daily
Answer and explanation in LearnFree account
Question 20 · Medium
A woman at 30 weeks has a serum creatinine of 1.0 mg/dL; the laboratory's non-pregnant reference range is 0.6-1.1 mg/dL. How should the nurse interpret this result?
1. AHigher than expected for pregnancy, needing review
2. BNormal for pregnancy only in the third trimester
3. CLow, reflecting the haemodilution of pregnancy
4. DNormal, since it lies within the reference range
Answer and explanation in LearnFree account
Question 21 · Hard
At 24 weeks a woman's DIPSI test (75 g glucose, 2-hour value) is 158 mg/dL. After two weeks of medical nutrition therapy her 2-hour post-meal glucose readings are 132-140 mg/dL and fasting values about 100 mg/dL. Using MoHFW targets (fasting under 95, 2-hour post-meal under 120 mg/dL), what is the next step?
1. AContinue the diet for four more weeks
2. BInduce labour once she reaches 34 weeks
3. CStart glibenclamide and stop the diet
4. DStart insulin and continue the diet
Answer and explanation in LearnFree account
Question 22 · Easy
Under Anaemia Mukt Bharat, a pregnant woman starts one prophylactic IFA tablet daily from the second trimester and continues it during pregnancy for at least:
1. A90 days
2. B30 days
3. C100 days
4. D180 days
Answer and explanation in LearnFree account
Question 23 · Hard
At 39 weeks, a woman's membranes are ruptured artificially. Within a minute there is a gush of bright red blood of about 100 mL and the fetal heart rate falls to 80 bpm. Her pulse and blood pressure are normal and the uterus is soft and non-tender. The most likely cause is:
1. APlacenta praevia
2. BPlacental abruption
3. CRupture of the uterus
4. DVasa praevia
Answer and explanation in LearnFree account
Question 24 · Hard
A sensitised Rh-negative woman at 26 weeks has an anti-D titre of 1:64. Doppler shows a fetal middle cerebral artery peak systolic velocity of 1.7 multiples of the median (MoM), and the scan shows early ascites. What is the most appropriate plan?
1. ARepeat the antibody titre in four weeks
2. BInduce labour within the next 24 hours
3. CGive anti-D 300 µg intramuscularly now
4. DFetal blood sampling with intrauterine transfusion
Answer and explanation in LearnFree account
Question 25 · Medium
A woman at 35 weeks is admitted with painless bright red vaginal bleeding; no scan has been done yet. A resident asks the nurse to prepare her for a digital vaginal examination in the labour room. The nurse's best response is to:
1. ASuggest a rectal examination instead of a vaginal examination
2. BAdvise deferring any vaginal examination until a scan excludes praevia
3. CGive a soap-water enema first to allow a clear examination
4. DPrepare a sterile glove and lubricant for a gentle digital examination
Answer and explanation in LearnFree account

20 more Antenatal care and high-risk pregnancy questions

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Antenatal care and high-risk pregnancy

A woman with severe pre-eclampsia is on a magnesium sulphate maintenance infusion. At the 4-hour check: knee jerks present, respiratory rate 18/min, urine output 45 mL/hour, and serum magnesium 6 mEq/L. What should the nurse do?

A contraction stress test (oxytocin challenge test) is reported as positive. This means:

In the first weeks of pregnancy, the corpus luteum is kept secreting progesterone mainly by:

With correct dates and a singleton pregnancy, a raised maternal serum alpha-fetoprotein at 16 weeks most suggests:

The condition most commonly associated with abruptio placentae is:

A primigravida at 34 weeks has BP 146/94 mmHg on two readings, urine protein 2+ and no symptoms. Results: platelets 92,000/µL, serum creatinine 0.8 mg/dL, AST 30 U/L (normal under 40), and normal fetal growth. How is her condition best classified?

Babies of poorly controlled diabetic mothers have a higher risk of respiratory distress syndrome even near term, because fetal hyperinsulinaemia:

At the 24-week visit a pregnant woman's reading is 150/96 mmHg. Calculated with the standard formula, her mean arterial pressure is:

Which change in the clotting system is part of the normal hypercoagulable state of pregnancy?

A woman at 36 weeks has a placental abruption with an intrauterine fetal death. After resuscitation she is stable with no DIC. The usual plan for her delivery is:

Progesterone stimulates the respiratory centre in pregnancy. Which arterial blood gas is typical of a healthy woman in the third trimester?

At 10 weeks, a healthy woman's TSH is slightly below the non-pregnant range with a normal free T4. The best explanation is that:

A woman with severe anaemia (haemoglobin 6 g/dL) is admitted in labour. The period of greatest risk of acute cardiac failure for her is:

A woman with gestational diabetes needed insulin 36 units a day in late pregnancy. Two hours after a normal birth and delivery of the placenta, what should the nurse expect about her insulin?

On ultrasound in the third trimester, oligohydramnios is diagnosed when the amniotic fluid index (AFI) is:

During magnesium sulphate therapy for severe pre-eclampsia, the serum magnesium level usually aimed for to prevent fits is about:

At 38 weeks, a woman with reduced fetal movements has a non-stress test. Over 40 minutes the baseline is 140 bpm with normal variability, there are no decelerations, but no accelerations occur. What is the most appropriate next step?

Asymptomatic bacteriuria found at the booking visit is treated even without symptoms, mainly because in pregnancy it:

At booking, a woman has haemoglobin 9.8 g/dL, MCV 66 fL, red cell count 5.5 million/µL and normal serum ferritin. Her Mentzer index is 12. What is the most appropriate next step?

A woman at 30 weeks has a serum creatinine of 1.0 mg/dL; the laboratory's non-pregnant reference range is 0.6-1.1 mg/dL. How should the nurse interpret this result?

Under Anaemia Mukt Bharat, a pregnant woman starts one prophylactic IFA tablet daily from the second trimester and continues it during pregnancy for at least:

At 39 weeks, a woman's membranes are ruptured artificially. Within a minute there is a gush of bright red blood of about 100 mL and the fetal heart rate falls to 80 bpm. Her pulse and blood pressure are normal and the uterus is soft and non-tender. The most likely cause is:

A sensitised Rh-negative woman at 26 weeks has an anti-D titre of 1:64. Doppler shows a fetal middle cerebral artery peak systolic velocity of 1.7 multiples of the median (MoM), and the scan shows early ascites. What is the most appropriate plan?

A woman at 35 weeks is admitted with painless bright red vaginal bleeding; no scan has been done yet. A resident asks the nurse to prepare her for a digital vaginal examination in the labour room. The nurse's best response is to: