NSG 432 Exam 4 V3 | NSG 432 Maternal-
Newborn Nursing / OB/GYN | Actual Q&A
with Rationale (NSG432 Exam 4) | Grand
Canyon University
1. A nurse is assessing a client at 34 weeks of gestation who has severe preeclampsia. Which
of the following findings should the nurse report to the provider as a sign of worsening
condition? (Select all that apply)
A. Persistent frontal headache
B. Epigastric or right upper quadrant pain
C. Deep tendon reflexes of 2+
D. Blurred vision or photopsia
E. Urine output of 50 mL/hr
F. Presence of 3+ patellar clonus
Correct Answer: A, B, D, F
Severe preeclampsia is characterized by multi-system organ involvement beyond simple
hypertension and proteinuria. Manifestations such as persistent headaches and visual
disturbances indicate central nervous system irritability and potential for seizure.
Epigastric pain suggests liver capsule distension or ischemia, while clonus is a specific sign
of neuromuscular excitability that often precedes eclampsia.
,2. A client is receiving an intravenous infusion of magnesium sulfate for the treatment of
severe preeclampsia. Which of the following findings should the nurse identify as an early
sign of magnesium toxicity?
A. Hyperactive deep tendon reflexes
B. Respiratory rate of 16 breaths/min
C. Increased urinary output
D. Diminished or absent deep tendon reflexes
Correct Answer: D
Magnesium sulfate acts as a central nervous system depressant to prevent seizures by
blocking neuromuscular transmission. The loss of deep tendon reflexes (DTRs) is typically
the first clinical sign that serum magnesium levels are reaching toxic concentrations. The
nurse must monitor DTRs, respiratory rate, and urine output hourly to ensure safe
administration.
3. A nurse is caring for a client who is suspected of having HELLP syndrome. Which of the
following laboratory findings should the nurse expect?
A. Elevated liver enzymes (AST and ALT)
B. Decreased serum creatinine
C. Elevated hemoglobin and hematocrit
D. Platelet count of 150,000/mm3
,Correct Answer: A
HELLP syndrome stands for Hemolysis, Elevated Liver enzymes, and Low Platelets, which
is a severe variant of preeclampsia. Elevated liver enzymes result from obstructed hepatic
blood flow caused by fibrin deposits in the sinusoids. Diagnosis requires laboratory
confirmation of hemolysis, a platelet count below 100,000/mm3, and significant elevations
in AST or ALT.
4. A nurse is reviewing the 3-hour glucose tolerance test (GTT) results for a client. Which of
the following results confirms a diagnosis of gestational diabetes?
A. One elevated blood glucose value
B. A fasting blood glucose of 85 mg/dL
C. Two or more elevated blood glucose values
D. A 1-hour glucose level of 130 mg/dL
Correct Answer: C
The 3-hour glucose tolerance test is a diagnostic tool used when a 1-hour screening test is
abnormal. According to standard criteria, a diagnosis of gestational diabetes mellitus is
made if two or more of the four glucose levels (fasting, 1-hour, 2-hour, 3-hour) are
elevated. If only one value is elevated, the provider may recommend nutritional counseling
and retesting later in the pregnancy.
, 5. A nurse is teaching a client with Type 1 diabetes mellitus about insulin requirements during
the postpartum period. Which of the following information should the nurse include?
A. Insulin needs will significantly increase immediately after delivery.
B. Insulin requirements will remain the same as the third trimester.
C. Insulin needs will decrease significantly immediately after delivery.
D. Insulin should be discontinued for the first 48 hours postpartum.
Correct Answer: C
The delivery of the placenta triggers a sharp drop in placental hormones like human
placental lactogen (hPL), which were causing insulin resistance. Consequently, insulin
requirements for a client with Type 1 diabetes fall dramatically in the immediate
postpartum period, often reaching pre-pregnancy levels. Careful monitoring is essential to
prevent hypoglycemia during this transition.
6. A nurse is assessing a client at 32 weeks of gestation who reports painless, bright red
vaginal bleeding. The nurse should identify this as a manifestation of which of the following
conditions?
A. Placenta previa
B. Abruptio placentae
C. Preterm labor
D. Vasa previa
Newborn Nursing / OB/GYN | Actual Q&A
with Rationale (NSG432 Exam 4) | Grand
Canyon University
1. A nurse is assessing a client at 34 weeks of gestation who has severe preeclampsia. Which
of the following findings should the nurse report to the provider as a sign of worsening
condition? (Select all that apply)
A. Persistent frontal headache
B. Epigastric or right upper quadrant pain
C. Deep tendon reflexes of 2+
D. Blurred vision or photopsia
E. Urine output of 50 mL/hr
F. Presence of 3+ patellar clonus
Correct Answer: A, B, D, F
Severe preeclampsia is characterized by multi-system organ involvement beyond simple
hypertension and proteinuria. Manifestations such as persistent headaches and visual
disturbances indicate central nervous system irritability and potential for seizure.
Epigastric pain suggests liver capsule distension or ischemia, while clonus is a specific sign
of neuromuscular excitability that often precedes eclampsia.
,2. A client is receiving an intravenous infusion of magnesium sulfate for the treatment of
severe preeclampsia. Which of the following findings should the nurse identify as an early
sign of magnesium toxicity?
A. Hyperactive deep tendon reflexes
B. Respiratory rate of 16 breaths/min
C. Increased urinary output
D. Diminished or absent deep tendon reflexes
Correct Answer: D
Magnesium sulfate acts as a central nervous system depressant to prevent seizures by
blocking neuromuscular transmission. The loss of deep tendon reflexes (DTRs) is typically
the first clinical sign that serum magnesium levels are reaching toxic concentrations. The
nurse must monitor DTRs, respiratory rate, and urine output hourly to ensure safe
administration.
3. A nurse is caring for a client who is suspected of having HELLP syndrome. Which of the
following laboratory findings should the nurse expect?
A. Elevated liver enzymes (AST and ALT)
B. Decreased serum creatinine
C. Elevated hemoglobin and hematocrit
D. Platelet count of 150,000/mm3
,Correct Answer: A
HELLP syndrome stands for Hemolysis, Elevated Liver enzymes, and Low Platelets, which
is a severe variant of preeclampsia. Elevated liver enzymes result from obstructed hepatic
blood flow caused by fibrin deposits in the sinusoids. Diagnosis requires laboratory
confirmation of hemolysis, a platelet count below 100,000/mm3, and significant elevations
in AST or ALT.
4. A nurse is reviewing the 3-hour glucose tolerance test (GTT) results for a client. Which of
the following results confirms a diagnosis of gestational diabetes?
A. One elevated blood glucose value
B. A fasting blood glucose of 85 mg/dL
C. Two or more elevated blood glucose values
D. A 1-hour glucose level of 130 mg/dL
Correct Answer: C
The 3-hour glucose tolerance test is a diagnostic tool used when a 1-hour screening test is
abnormal. According to standard criteria, a diagnosis of gestational diabetes mellitus is
made if two or more of the four glucose levels (fasting, 1-hour, 2-hour, 3-hour) are
elevated. If only one value is elevated, the provider may recommend nutritional counseling
and retesting later in the pregnancy.
, 5. A nurse is teaching a client with Type 1 diabetes mellitus about insulin requirements during
the postpartum period. Which of the following information should the nurse include?
A. Insulin needs will significantly increase immediately after delivery.
B. Insulin requirements will remain the same as the third trimester.
C. Insulin needs will decrease significantly immediately after delivery.
D. Insulin should be discontinued for the first 48 hours postpartum.
Correct Answer: C
The delivery of the placenta triggers a sharp drop in placental hormones like human
placental lactogen (hPL), which were causing insulin resistance. Consequently, insulin
requirements for a client with Type 1 diabetes fall dramatically in the immediate
postpartum period, often reaching pre-pregnancy levels. Careful monitoring is essential to
prevent hypoglycemia during this transition.
6. A nurse is assessing a client at 32 weeks of gestation who reports painless, bright red
vaginal bleeding. The nurse should identify this as a manifestation of which of the following
conditions?
A. Placenta previa
B. Abruptio placentae
C. Preterm labor
D. Vasa previa
