High Risk Pregnancy: Hypertensive & Bleeding Disorders Quiz
High-Risk Pregnancy is a critical component of Midwifery Nursing and frequently asked in exams like AIIMS NORCET and NCLEX-RN. In this daily mock test, we focus on life-threatening obstetric emergencies and their nursing management.
This quiz covers high-yield questions on Pre-eclampsia (Hypertension & Proteinuria), nursing care during Magnesium Sulfate (MgSO4) therapy, and bleeding disorders like Placenta Previa and Abruptio Placentae. We also cover Gestational Diabetes Mellitus (GDM) management. Mastering these concepts is essential for skill tests.
💡 Golden Points to Remember:
- Pre-eclampsia Triad: Hypertension, Proteinuria, and Edema.
- Antidote for MgSO4 Toxicity: Calcium Gluconate (Must be kept at bedside).
- Placenta Previa Warning: Never perform a digital vaginal exam (PV) if painless bleeding is present.
- Abruptio Placentae Sign: Board-like, rigid abdomen with painful bleeding.
- GDM Screening: Done at 24-28 weeks using Oral Glucose Tolerance Test (OGTT).
High Risk Pregnancy
Q1.A pregnant woman at 32 weeks gestation presents with painless, bright red vaginal bleeding. The nurse should immediately suspect:
A. Abruptio Placentae
B. Placenta Previa
C. Uterine Rupture
D. Preterm Labor
View Answer & Rationale
Answer: B
Rationale: Painless, bright red bleeding is the hallmark sign of Placenta Previa (placenta covering the cervix). Abruptio Placentae (Option A) typically presents with painful, dark red bleeding and a rigid abdomen.
Source: www.logyanlo.in
Q2.Which drug is the antidote for Magnesium Sulfate toxicity?
A. Calcium Gluconate
B. Potassium Chloride
C. Naloxone
D. Sodium Bicarbonate
View Answer & Rationale
Answer: A
Rationale: Calcium Gluconate (10 ml of 10% solution IV) reverses the respiratory depression and neuromuscular blockade caused by high magnesium levels.
Source: www.logyanlo.in
Q3.Pre-eclampsia is clinically defined as hypertension (>140/90 mmHg) occurring after 20 weeks of gestation accompanied by:
A. Seizures
B. Proteinuria
C. Hyperglycemia
D. Polyuria
View Answer & Rationale
Answer: B
Rationale: The classic definition of Pre-eclampsia is Hypertension + Proteinuria (though recent guidelines also include organ damage without proteinuria, exams usually ask for Proteinuria). Seizures (Option A) define Eclampsia.
Source: www.logyanlo.in
Q4.A newborn born to a mother with uncontrolled Gestational Diabetes is at highest risk for which metabolic complication immediately after birth?
A. Hyperglycemia
B. Hypoglycemia
C. Hypercalcemia
D. Hyponatremia
View Answer & Rationale
Answer: B
Rationale: The fetus produces high insulin levels in response to maternal glucose. After birth, the glucose supply stops, but insulin remains high, causing severe Hypoglycemia.
Source: www.logyanlo.in
Q5.The "Couvelaire Uterus" (bruised, blue/purple uterus) is a complication seen in severe cases of:
A. Placenta Previa
B. Abruptio Placentae
C. Postpartum Hemorrhage
D. Ectopic Pregnancy
View Answer & Rationale
Answer: B
Rationale: In severe Abruptio Placentae, blood extravasates into the myometrium (uterine muscle), causing it to appear purple/blue and lose contractility (Couvelaire Uterus).
Source: www.logyanlo.in
Q6.Which assessment finding is an early sign of Magnesium Sulfate toxicity?
A. Absence of Deep Tendon Reflexes (DTRs)
B. Respiratory rate < 12/min
C. Urine output < 30 ml/hr
D. Hypotension
View Answer & Rationale
Answer: A
Rationale: The loss of Deep Tendon Reflexes (Patellar reflex) is usually the first sign of toxicity (serum levels >9-10 mg/dL), appearing before respiratory depression.
Source: www.logyanlo.in
Q7.A pregnant client with Placenta Previa is scheduled for an ultrasound. Which nursing instruction is appropriate before the procedure?
A. "Empty your bladder completely."
B. "You need a full bladder."
C. "Do not eat or drink for 8 hours."
D. "Administer an enema."
View Answer & Rationale
Answer: B
Rationale: A full bladder helps push the uterus up and provides an acoustic window to visualize the placenta's location relative to the cervix more clearly.
Source: www.logyanlo.in
Q8.HELLP Syndrome is a severe complication of pre-eclampsia. The "EL" stands for:
A. Electrolyte Loss
B. Elevated Liver enzymes
C. Elevated Lipids
D. Elevated Leukocytes
View Answer & Rationale
Answer: B
Rationale: HELLP stands for Hemolysis, Elevated Liver enzymes, and Low Platelets.
Source: www.logyanlo.in
Q9.Which screening test is done between 24-28 weeks of gestation for Gestational Diabetes Mellitus (GDM)?
A. Fasting Blood Glucose
B. Oral Glucose Tolerance Test (OGTT)
C. HbA1c
D. Random Blood Glucose
View Answer & Rationale
Answer: B
Rationale: The standard screening is the OGTT (typically a 1-hour or 2-hour test) performed at 24-28 weeks when insulin resistance peaks.
Source: www.logyanlo.in
Q10.In a patient with "Abruptio Placentae", the uterus typically feels:
A. Soft and boggy
B. Board-like and rigid
C. Normal
D. Distended with fluid
View Answer & Rationale
Answer: B
Rationale: The retroplacental hemorrhage causes the uterine muscle to be hypertonic and irritable, resulting in a Board-like, rigid abdomen that is very painful.
Source: www.logyanlo.in
Q11.What is the drug of choice to prevent seizures in a woman with severe Pre-eclampsia?
A. Diazepam
B. Phenytoin
C. Magnesium Sulfate
D. Labetalol
View Answer & Rationale
Answer: C
Rationale: Magnesium Sulfate is the gold standard anticonvulsant for preventing and treating eclamptic seizures. It is superior to Diazepam/Phenytoin.
Source: www.logyanlo.in
Q12.Vaginal examination (PV) is strictly contraindicated in which condition?
A. Pre-eclampsia
B. Placenta Previa
C. Gestational Diabetes
D. Premature Rupture of Membranes (PROM) (if active labor)
View Answer & Rationale
Answer: B
Rationale: Performing a digital exam in Placenta Previa can puncture the placenta, causing massive, life-threatening hemorrhage ("Torrential bleeding"). Diagnosis is by Ultrasound.
Source: www.logyanlo.in
Q13.A pregnant client with GDM requires insulin. The nurse explains that insulin requirements typically:
A. Decrease in the first trimester and increase in the second/third
B. Increase steadily throughout pregnancy
C. Decrease throughout pregnancy
D. Remain unchanged
View Answer & Rationale
Answer: A
Rationale: In the 1st trimester, requirements often drop (risk of hypoglycemia). In the 2nd and 3rd trimesters, placental hormones increase insulin resistance, so requirements increase.
Source: www.logyanlo.in
Q14.The classic triad of symptoms for Eclampsia includes:
A. Hypertension, Proteinuria, Edema
B. Hypertension, Proteinuria, Seizures
C. Hypertension, Headache, Visual disturbances
D. Proteinuria, Edema, Coma
View Answer & Rationale
Answer: B
Rationale: Eclampsia is defined as the onset of Seizures (Convulsions) or Coma in a patient with signs of Pre-eclampsia (HTN + Proteinuria).
Source: www.logyanlo.in
Q15.Which fetal heart rate pattern is often associated with "Abruptio Placentae"?
A. Early Decelerations
B. Late Decelerations
C. Accelerations
D. Variable Decelerations
View Answer & Rationale
Answer: B
Rationale: Abruption compromises placental blood flow (uteroplacental insufficiency), leading to fetal hypoxia and Late Decelerations on the fetal monitor.
Source: www.logyanlo.in
Q16."Macrosomia" (Large for Gestational Age baby) is a common complication of:
A. Pre-eclampsia
B. Maternal Diabetes
C. Maternal Smoking
D. Maternal Anemia
View Answer & Rationale
Answer: B
Rationale: High maternal glucose crosses the placenta, stimulating fetal insulin (growth hormone), leading to excessive fat deposition and Macrosomia (>4000g).
Source: www.logyanlo.in
Q17.Which antihypertensive drug is commonly used and considered safe for treating chronic hypertension in pregnancy?
A. ACE Inhibitors (Enalapril)
B. Methyldopa
C. Diuretics (Furosemide)
D. Angiotensin Receptor Blockers (ARBs)
View Answer & Rationale
Answer: B
Rationale: Methyldopa (and Labetalol) is the first-line oral antihypertensive for pregnancy. ACE inhibitors/ARBs are contraindicated (teratogenic).
Source: www.logyanlo.in
Q18.A patient with Pre-eclampsia reports blurred vision and severe headache. This indicates:
A. Improvement in condition
B. Worsening condition / Impending Eclampsia
C. Medication side effect
D. Normal pregnancy symptom
View Answer & Rationale
Answer: B
Rationale: CNS symptoms like headache, blurred vision, or epigastric pain are warning signs of severe cerebral edema and Impending Eclampsia (seizure risk).
Source: www.logyanlo.in
Q19.The placenta is implanted in the lower uterine segment but does not cover the internal os. This is classified as:
A. Total Placenta Previa
B. Partial Placenta Previa
C. Low-lying Placenta
D. Marginal Placenta Previa
View Answer & Rationale
Answer: C
Rationale: A Low-lying Placenta is implanted in the lower segment but the edge does not reach the internal os (usually >2 cm away). Marginal touches the edge.
Source: www.logyanlo.in
Q20."Polyhydramnios" is frequently associated with which maternal condition?
A. Diabetes Mellitus
B. Hypertension
C. Renal Disease
D. Anemia
View Answer & Rationale
Answer: A
Rationale: Fetal hyperglycemia causes polyuria (fetal urine is the main source of amniotic fluid), leading to Polyhydramnios (excess amniotic fluid).
Source: www.logyanlo.in
Q21.A patient with severe Pre-eclampsia is receiving Magnesium Sulfate. The nurse assesses a respiratory rate of 10 breaths/min. The priority action is to:
A. Document the finding
B. Stop the Magnesium Sulfate infusion
C. Decrease the infusion rate
D. Administer Oxygen
View Answer & Rationale
Answer: B
Rationale: Respiratory depression (<12 a="" and="" calcium="" div="" gluconate.="" immediately="" infusion="" is="" magnesium="" min="" notify="" of="" physician="" prepare="" priority="" sign="" stop="" the="" then="" to="" toxicity.="">
Source: www.logyanlo.in
Q22."Kleihauer-Betke Test" is used to detect:
A. Fetal lung maturity
B. Fetal-Maternal Hemorrhage
C. Gestational Diabetes
D. Neural tube defects
View Answer & Rationale
Answer: B
Rationale: This blood test quantifies the amount of fetal blood cells in the maternal circulation, often used after trauma or Abruptio Placentae to determine the dose of RhoGAM needed.
Source: www.logyanlo.in
Q23.Which of the following is a risk factor for Placenta Previa?
A. Nulliparity
B. Prior Cesarean Section
C. Young maternal age (<20 div="">
D. Hypotension
View Answer & Rationale
Answer: B
Rationale: Scarring from a Previous C-Section or uterine surgery prevents proper implantation in the upper segment, increasing the risk of the placenta attaching lower down (Previa).
Source: www.logyanlo.in
Q24.The nurse instructs a pregnant woman with GDM to avoid which artificial sweetener as it crosses the placenta?
A. Aspartame
B. Saccharin
C. Sucralose
D. Stevia
View Answer & Rationale
Answer: B
Rationale: Saccharin crosses the placenta and may remain in fetal tissues, so it is generally advised to be avoided or used with caution compared to safer options like Aspartame.
Source: www.logyanlo.in
Q25."DIC" (Disseminated Intravascular Coagulation) is a potential fatal complication most strongly associated with:
A. Placenta Previa
B. Mild Pre-eclampsia
C. Severe Abruptio Placentae
D. Gestational Diabetes
View Answer & Rationale
Answer: C
Rationale: The release of thromboplastin from the damaged placenta/uterus in Abruptio Placentae triggers massive clotting and subsequent depletion of clotting factors (DIC).
Source: www.logyanlo.in
Q26.Which symptom distinguishes Eclampsia from Pre-eclampsia?
A. Proteinuria 3+
B. Generalized Edema
C. Convulsions (Seizures)
D. Hypertension >160/110
View Answer & Rationale
Answer: C
Rationale: The diagnostic criterion that converts a diagnosis of Pre-eclampsia to Eclampsia is the occurrence of Seizures (Convulsions) not attributable to other causes.
Source: www.logyanlo.in
Q27.The therapeutic serum Magnesium level for a patient on Magnesium Sulfate therapy is:
A. 1.5 – 2.5 mg/dL
B. 4 – 7 mg/dL
C. 8 – 10 mg/dL
D. 10 – 12 mg/dL
View Answer & Rationale
Answer: B
Rationale: The therapeutic range to prevent seizures is typically 4 to 7 mg/dL (or 2-3.5 mmol/L). Normal physiologic levels are 1.5-2.5 mg/dL. Toxicity begins >9 mg/dL.
Source: www.logyanlo.in
Q28.Which finding in a patient with Placenta Previa warrants immediate Cesarean delivery?
A. Hemoglobin 10 g/dL
B. Fetal Heart Rate of 140 bpm
C. Profuse, uncontrolled vaginal bleeding
D. Gestational age of 34 weeks with no bleeding
View Answer & Rationale
Answer: C
Rationale: While conservative management is preferred if stable, Profuse uncontrolled bleeding (hemorrhagic shock risk) or fetal distress requires immediate C-section regardless of gestational age.
Source: www.logyanlo.in
Q29.Infants of Diabetic Mothers (IDM) are at risk for "Respiratory Distress Syndrome" primarily because:
A. They are usually premature
B. High insulin levels inhibit Surfactant production
C. They are small for gestational age
D. They have congenital heart defects
View Answer & Rationale
Answer: B
Rationale: Fetal hyperinsulinemia blocks the action of cortisol, which is needed to stimulate lung maturation and Surfactant production, leading to RDS even in term babies.
Source: www.logyanlo.in
Q30."Epigastric pain" in a patient with severe Pre-eclampsia is a sign of:
A. Indigestion/Heartburn
B. Liver distension/edema (Capsular stretch)
C. Gallstones
D. Pancreatitis
View Answer & Rationale
Answer: B
Rationale: Epigastric or RUQ pain indicates liver involvement (hepatic edema/ischemia) and is an ominous sign of impending Eclampsia or HELLP syndrome.
Source: www.logyanlo.in
Q31.A patient with Abruptio Placentae typically presents with:
A. Painless bleeding
B. Uterine tenderness and dark red bleeding
C. Soft, relaxed uterus
D. Normal fetal heart tones
View Answer & Rationale
Answer: B
Rationale: Classic signs are a painful, rigid, tender uterus and dark red bleeding (which may be concealed).
Source: www.logyanlo.in
Q32.The nurse monitoring a patient on Magnesium Sulfate checks urine output hourly. The output must be at least:
A. 15 ml/hr
B. 25-30 ml/hr
C. 50 ml/hr
D. 100 ml/hr
View Answer & Rationale
Answer: B
Rationale: Magnesium is excreted by the kidneys. If output falls below 30 ml/hr, magnesium can accumulate to toxic levels. (Standard rule: maintain >30ml/hr).
Source: www.logyanlo.in
Q33.Which type of Placenta Previa completely covers the internal cervical os?
A. Marginal
B. Low-lying
C. Partial
D. Total (Complete)
View Answer & Rationale
Answer: D
Rationale: Total Placenta Previa completely covers the opening of the cervix, making vaginal delivery impossible.
Source: www.logyanlo.in
Q34.Which antihypertensive is contraindicated in pregnancy due to the risk of renal failure in the fetus?
A. Methyldopa
B. Labetalol
C. ACE Inhibitors (e.g., Captopril)
D. Hydralazine
View Answer & Rationale
Answer: C
Rationale: ACE Inhibitors and ARBs are teratogenic, causing fetal renal agenesis, oligohydramnios, and skull defects.
Source: www.logyanlo.in
Q35."Clonus" (rhythmic muscle spasms) assessed at the ankle is a sign of:
A. CNS Depression
B. CNS Irritability (Impending Seizure)
C. Magnesium Toxicity
D. Normal reflex
View Answer & Rationale
Answer: B
Rationale: Positive Clonus indicates severe CNS Hyperirritability and is a strong warning sign that a seizure may be imminent in pre-eclamptic patients.
Source: www.logyanlo.in
Q36.A "Non-Stress Test" (NST) is considered "Reactive" (Normal) if:
A. There are no accelerations
B. There are 2 accelerations of 15 bpm for 15 seconds in 20 minutes
C. There are late decelerations
D. The heart rate is flat
View Answer & Rationale
Answer: B
Rationale: A Reactive NST (15x15 rule) indicates a healthy fetus with an intact CNS and adequate oxygenation.
Source: www.logyanlo.in
Q37."Caudal Regression Syndrome" (Sacral Agenesis) is a rare congenital defect specifically associated with:
A. Maternal Hypertension
B. Maternal Diabetes (Poorly controlled)
C. Maternal Hypothyroidism
D. Maternal Lupus
View Answer & Rationale
Answer: B
Rationale: While rare, Caudal Regression (missing lower spine/legs) is highly specific to infants of Diabetic Mothers, especially if glucose was uncontrolled at conception.
Source: www.logyanlo.in
Q38.The priority nursing diagnosis for a patient with Placenta Previa experiencing bleeding is:
A. Risk for Infection
B. Fluid Volume Deficit
C. Acute Pain
D. Anxiety
View Answer & Rationale
Answer: B
Rationale: The most immediate life-threatening risk is Hemorrhage leading to Fluid Volume Deficit (Hypovolemic Shock). Pain is usually absent in Previa.
Source: www.logyanlo.in
Q39."Shoulder Dystocia" is a complication most likely to occur in:
A. Preterm infants
B. Macrosomic infants (IDM)
C. IUGR infants
D. Breech presentation
View Answer & Rationale
Answer: B
Rationale: The broad shoulders of a Macrosomic infant (common in diabetes) can get stuck behind the pubic bone after the head is delivered.
Source: www.logyanlo.in
Q40.Which test distinguishes between fetal blood and maternal blood in vaginal bleeding (Vasa Previa)?
A. Apt Test
B. Fern Test
C. Nitrazine Test
D. Coombs Test
View Answer & Rationale
Answer: A
Rationale: The Apt Test (alkali denaturation test) differentiates fetal hemoglobin (resistant to alkali) from maternal hemoglobin (destroyed by alkali) to identify the source of bleeding.
Source: www.logyanlo.in
Frequently Asked Questions (High Risk OBG)
Q1: What is the earliest sign of Magnesium Sulfate (MgSO4) toxicity?
Ans: The earliest sign is the loss of Deep Tendon Reflexes (DTRs), specifically the Patellar reflex. Later signs include respiratory depression (<12/min).
Q2: How do you clinically differentiate Placenta Previa from Abruptio Placentae?
Ans: Placenta Previa presents as painless bright red bleeding with a soft uterus. Abruptio Placentae presents as painful dark red bleeding with a rigid uterus.
Q3: What is the main risk for the fetus in Gestational Diabetes (GDM)?
Ans: The main risk is Macrosomia (Large baby >4kg), which can lead to birth trauma (shoulder dystocia) and neonatal hypoglycemia.
❓ Question for You:
In HELLP Syndrome, what does the "EL" stand for?
A. Electrolyte Loss
B. Elevated Liver Enzymes
C. Early Labour
D. Elevated Leukocytes
👉 Comment your answer below!.
0 Comments