DEPARTMENT OF OBSTETRICS AND
MATERNAL-FETAL MEDICINE
NUR 353 HIGH RISK PREGNANCY MANAGEMENT FINAL
EXAMINATION PRACTICE QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS LATEST 2026-2027 UPDATE
Instructions: Answer all sixty (60) practice questions. Select the single best option for each
multiple-choice question. Highlighted options indicate correct answers along with verified solutions
and comprehensive rationales.
1. A 31-year-old pregnant patient at 32 weeks gestation presents with persistent frontal
headache, visual scotoma, and upper right quadrant abdominal pain. Her blood pressure
is 168/112 mmHg. What is the priority immediate nursing assessment?
A) Check for lower extremity pitting edema
B) Assess deep tendon reflexes and clonus to evaluate neuromuscular irritability
C) Perform a 24-hour urine collection for total protein
D) Obtain an abdominal ultrasound to check gallbladder function
Rationale: Hyperreflexia and patellar clonus reflect central nervous system irritability that directly precedes
eclamptic seizures in patients with severe preeclampsia.
2. What diagnostic triad defines HELLP syndrome in a patient experiencing severe
preeclampsia?
A) Hemolysis, Elevated Liver Enzymes, and Low Platelets
B) Hyperglycemia, Elevated Leukocytes, and Low Potassium
C) Hypertension, Early Labor, and Low Phosphate
D) Hemorrhage, Encephalopathy, and Low Prothrombin
Rationale: HELLP syndrome is a high-risk variant of preeclampsia marked by microangiopathic hemolytic
anemia, elevated liver transaminases, and severe thrombocytopenia (<100,000/mcL).
3. A high-risk patient receiving an IV magnesium sulfate infusion for seizure prophylaxis
has a respiratory rate of 10 breaths per minute, absent deep tendon reflexes, and urine
output of 18 mL/hour. What is the first action?
A) Increase the IV fluid infusion rate to flush the kidneys
B) Stop the magnesium sulfate infusion immediately and prepare Calcium Gluconate
IV
C) Administer IV labetalol bolus
, D) Place the patient in Trendelenburg position
Rationale: Loss of reflexes, bradypnea, and oliguria signal severe magnesium toxicity. Halting the drug and
administering its antagonist calcium gluconate reverses toxic CNS depression.
4. A pregnant patient at 30 weeks gestation presents with painful, dark red vaginal
bleeding, uterine rigidity, and severe abdominal back pain. Electronic fetal monitoring
shows late decelerations. What condition is present?
A) Abruptio Placentae
B) Placenta Previa
C) Vasa Previa
D) Cervical Insufficiency
Rationale: Placental abruption involves premature separation of the placenta, causing painful bleeding, uterine
tetany, and acute fetal hypoxia.
5. Why is digital vaginal examination strictly prohibited when a patient at 32 weeks
gestation presents with painless, bright red vaginal bleeding?
A) It accelerates spontaneous cervical effacement
B) Digital contact can tear the low-lying placenta over the os and cause massive
maternal hemorrhage
C) It increases the risk of immediate amniotic fluid embolism
D) It induces severe uterine hypertonus
Rationale: In placenta previa, inserting fingers into the cervical canal can puncture the overlying placenta and
cause catastrophic maternal hemorrhage before ultrasound confirmation.
6. A patient at 28 weeks gestation diagnosed with pre-gestational Type 1 Diabetes has a
1-hour postprandial blood glucose of 185 mg/dL. What fetal risk is associated with
persistent maternal hyperglycemia during the third trimester?
A) Fetal growth restriction
B) Fetal macrosomia and delayed lung surfactant maturation
C) Congenital renal agenesis
D) Premature closure of the ductus arteriosus
Rationale: Maternal hyperglycemia causes hyperinsulinemia in the fetus. Fetal insulin acts as a growth hormone
leading to macrosomia while inhibiting surfactant synthesis in type II pneumocytes.
7. An Rh-negative mother is caring for her newborn after delivery. Her indirect Coombs
test during pregnancy was negative. Under what clinical circumstance is Rh (D) immune
globulin (RhoGAM) indicated post-delivery?
A) Only if the baby is Rh-negative
B) Within 72 hours of delivery if the infant is Rh-positive
C) Whenever the infant develops physiological jaundice
MATERNAL-FETAL MEDICINE
NUR 353 HIGH RISK PREGNANCY MANAGEMENT FINAL
EXAMINATION PRACTICE QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS LATEST 2026-2027 UPDATE
Instructions: Answer all sixty (60) practice questions. Select the single best option for each
multiple-choice question. Highlighted options indicate correct answers along with verified solutions
and comprehensive rationales.
1. A 31-year-old pregnant patient at 32 weeks gestation presents with persistent frontal
headache, visual scotoma, and upper right quadrant abdominal pain. Her blood pressure
is 168/112 mmHg. What is the priority immediate nursing assessment?
A) Check for lower extremity pitting edema
B) Assess deep tendon reflexes and clonus to evaluate neuromuscular irritability
C) Perform a 24-hour urine collection for total protein
D) Obtain an abdominal ultrasound to check gallbladder function
Rationale: Hyperreflexia and patellar clonus reflect central nervous system irritability that directly precedes
eclamptic seizures in patients with severe preeclampsia.
2. What diagnostic triad defines HELLP syndrome in a patient experiencing severe
preeclampsia?
A) Hemolysis, Elevated Liver Enzymes, and Low Platelets
B) Hyperglycemia, Elevated Leukocytes, and Low Potassium
C) Hypertension, Early Labor, and Low Phosphate
D) Hemorrhage, Encephalopathy, and Low Prothrombin
Rationale: HELLP syndrome is a high-risk variant of preeclampsia marked by microangiopathic hemolytic
anemia, elevated liver transaminases, and severe thrombocytopenia (<100,000/mcL).
3. A high-risk patient receiving an IV magnesium sulfate infusion for seizure prophylaxis
has a respiratory rate of 10 breaths per minute, absent deep tendon reflexes, and urine
output of 18 mL/hour. What is the first action?
A) Increase the IV fluid infusion rate to flush the kidneys
B) Stop the magnesium sulfate infusion immediately and prepare Calcium Gluconate
IV
C) Administer IV labetalol bolus
, D) Place the patient in Trendelenburg position
Rationale: Loss of reflexes, bradypnea, and oliguria signal severe magnesium toxicity. Halting the drug and
administering its antagonist calcium gluconate reverses toxic CNS depression.
4. A pregnant patient at 30 weeks gestation presents with painful, dark red vaginal
bleeding, uterine rigidity, and severe abdominal back pain. Electronic fetal monitoring
shows late decelerations. What condition is present?
A) Abruptio Placentae
B) Placenta Previa
C) Vasa Previa
D) Cervical Insufficiency
Rationale: Placental abruption involves premature separation of the placenta, causing painful bleeding, uterine
tetany, and acute fetal hypoxia.
5. Why is digital vaginal examination strictly prohibited when a patient at 32 weeks
gestation presents with painless, bright red vaginal bleeding?
A) It accelerates spontaneous cervical effacement
B) Digital contact can tear the low-lying placenta over the os and cause massive
maternal hemorrhage
C) It increases the risk of immediate amniotic fluid embolism
D) It induces severe uterine hypertonus
Rationale: In placenta previa, inserting fingers into the cervical canal can puncture the overlying placenta and
cause catastrophic maternal hemorrhage before ultrasound confirmation.
6. A patient at 28 weeks gestation diagnosed with pre-gestational Type 1 Diabetes has a
1-hour postprandial blood glucose of 185 mg/dL. What fetal risk is associated with
persistent maternal hyperglycemia during the third trimester?
A) Fetal growth restriction
B) Fetal macrosomia and delayed lung surfactant maturation
C) Congenital renal agenesis
D) Premature closure of the ductus arteriosus
Rationale: Maternal hyperglycemia causes hyperinsulinemia in the fetus. Fetal insulin acts as a growth hormone
leading to macrosomia while inhibiting surfactant synthesis in type II pneumocytes.
7. An Rh-negative mother is caring for her newborn after delivery. Her indirect Coombs
test during pregnancy was negative. Under what clinical circumstance is Rh (D) immune
globulin (RhoGAM) indicated post-delivery?
A) Only if the baby is Rh-negative
B) Within 72 hours of delivery if the infant is Rh-positive
C) Whenever the infant develops physiological jaundice
