NSG 233 Exam #3 - (Latest 2026/2027 Update) Maternal-Newborn Nursing &
High-Risk Pregnancy | Q&A | Grade A | 100% Correct (Verified Answers)
Subject: Maternal-Newborn Nursing / High-Risk Pregnancy & Newborn Transition
Source: NSG 233 Exam #3 – Comprehensive Review
Format: Q&A Guide with Clinical Rationale
1: Differentiate the types of diabetes mellitus and their respective risk factors in pregnancy.
Correct Answer: Type 1 DM: absolute insulin deficiency, autoimmune, prone to ketoacidosis. Type 2
DM: insulin resistance, relative insulin deficiency; risk factors: obesity, aging, sedentary lifestyle,
hypertension, prior GDM. Pregestational diabetes: type 1 or 2 existing before pregnancy. Gestational
diabetes (GDM): glucose intolerance with onset or first recognition during pregnancy.
1. GDM increases risk of macrosomia, shoulder dystocia.
2. Screen all pregnant women at 24-28 weeks.
3. Obesity is major risk factor for Type 2 and GDM.
2: Compare insulin requirements during pregnancy, postpartum, and lactation.
Correct Answer: First trimester: decreased insulin need (increased insulin production, peripheral
sensitivity, nausea/vomiting). Second trimester: increased insulin need (placental hormones, cortisol,
insulinase act as antagonists). Third trimester: gradually increases until ~36 weeks. Day of delivery:
drops drastically to prepregnancy levels. Breastfeeding: 25% less than prepregnancy. Non-
breastfeeding: returns to prepregnancy in 7-10 days. At weaning: returns to prepregnancy.
1. Monitor glucose closely during pregnancy.
2. Hypoglycemia risk in first trimester (sleep).
3. Breastfeeding reduces insulin needs.
3: Identify maternal and fetal risks or complications associated with diabetes in pregnancy.
Correct Answer: Maternal: GDM with A1c >6 → 28% increase early pregnancy loss; cesarean birth;
preterm birth; ketoacidosis (2nd/3rd trimester); hypoglycemia (sleep, early pregnancy); hydramnios
(10x); hypertensive disorders (preeclampsia, eclampsia); UTI. Fetal: stillbirth; congenital anomalies (6-
10%: CNS defects - anencephaly, open spina bifida; cardiac - VSD, transposition; caudal regression
200-400x); macrosomia; hypoglycemia; RDS; polycythemia; hyperbilirubinemia.
1. Poor glycemic control increases anomalies.
2. Macrosomia risks shoulder dystocia.
3. Caudal regression syndrome unique to diabetic pregnancy.
, 4: Compare the management of a pregnant woman with hyperthyroidism vs hypothyroidism.
Correct Answer: Hyperthyroidism: Tx propylthiouracil (PTU), beta-adrenergic blockers,
thyroidectomy. Radioactive iodine contraindicated. Hypothyroidism: Tx levothyroxine (Synthroid).
Both need: coping assistance, environmental adaptation (hyper: heat intolerance; hypo: cold
intolerance), stress reduction, nutritional counseling (hyper: increased appetite/poor weight gain; hypo:
ensure adequate intake).
1. PTU preferred in pregnancy (less placental transfer).p>
2. Untreated hypothyroidism risks fetal neurodevelopment.
3. Monitor TSH frequently.
5: Differentiate the management of various cardiovascular disorders in pregnant women.
Correct Answer: Peripartum cardiomyopathy: diuretics, sodium restriction, afterload reducers,
anticoagulants, digoxin (ACE inhibitors only postpartum). Rheumatic heart disease: prophylactic
antibiotics for highest risk. Mitral/aortic stenosis: reduce activity, sodium restriction, diuretics, beta-
blockers, bed rest. MVP: treat symptomatic tachyarrhythmias; antibiotics for invasive procedures.
Eisenmenger's: limit activity, prophylactic anticoagulation, ICU care. Septal defects: similar to
Eisenmenger's. Tetralogy of Fallot: surgical correction, anticoagulants, high concentration O2,
hemodynamic monitoring. Marfan: limit activity, prevent hypertensive/hypotensive complications, beta-
blockers. Heart transplant: beta-blockers during labor; cyclosporine mothers should not breastfeed.
1. Hemodynamic changes peak 28-32 weeks.
2. Minimize cardiac stress (treat anemia, HTN, infection).
3. ACE inhibitors teratogenic (avoid during pregnancy).
6: Discuss the different types of anemia and their effects during pregnancy.
Correct Answer: Iron deficiency anemia: most common (iron needed for erythropoiesis). Folic acid
deficiency: increases neural tube defects, cleft lip/palate. Sickle cell hemoglobinopathy: recurrent fever,
pain, IUGR, small for gestational age; prone to pyelonephritis, leg ulcers, preeclampsia. Thalassemia:
insufficient globin; 50% stillbirth, IUGR, preeclampsia, preterm birth.
1. Iron supplementation often needed (pregnancy increases iron demand).
2. Folic acid 400 mcg preconception prevents neural tube defects.
3. Sickle cell crises triggered by infection, dehydration, stress.
7: Explain the care of pregnant women with human immunodeficiency virus (HIV).
Correct Answer: Counseling and testing offered to all women at prenatal care. HIV-infected women
treated with HAART during pregnancy (optimal health: sleep, rest, exercise, stress reduction). Use
condoms and spermicide, avoid orogenital sex. Antepartum: AZT (zidovudine). Intrapartum: C-section
at 38 weeks, IV zidovudine, avoid fetal scalp electrode, scalp pH sampling, operative vaginal delivery,
episiotomy.
1. HAART reduces vertical transmission to <1%.
2. Formula feeding recommended in US.
3. Avoid breastfeeding (HIV transmission risk).
High-Risk Pregnancy | Q&A | Grade A | 100% Correct (Verified Answers)
Subject: Maternal-Newborn Nursing / High-Risk Pregnancy & Newborn Transition
Source: NSG 233 Exam #3 – Comprehensive Review
Format: Q&A Guide with Clinical Rationale
1: Differentiate the types of diabetes mellitus and their respective risk factors in pregnancy.
Correct Answer: Type 1 DM: absolute insulin deficiency, autoimmune, prone to ketoacidosis. Type 2
DM: insulin resistance, relative insulin deficiency; risk factors: obesity, aging, sedentary lifestyle,
hypertension, prior GDM. Pregestational diabetes: type 1 or 2 existing before pregnancy. Gestational
diabetes (GDM): glucose intolerance with onset or first recognition during pregnancy.
1. GDM increases risk of macrosomia, shoulder dystocia.
2. Screen all pregnant women at 24-28 weeks.
3. Obesity is major risk factor for Type 2 and GDM.
2: Compare insulin requirements during pregnancy, postpartum, and lactation.
Correct Answer: First trimester: decreased insulin need (increased insulin production, peripheral
sensitivity, nausea/vomiting). Second trimester: increased insulin need (placental hormones, cortisol,
insulinase act as antagonists). Third trimester: gradually increases until ~36 weeks. Day of delivery:
drops drastically to prepregnancy levels. Breastfeeding: 25% less than prepregnancy. Non-
breastfeeding: returns to prepregnancy in 7-10 days. At weaning: returns to prepregnancy.
1. Monitor glucose closely during pregnancy.
2. Hypoglycemia risk in first trimester (sleep).
3. Breastfeeding reduces insulin needs.
3: Identify maternal and fetal risks or complications associated with diabetes in pregnancy.
Correct Answer: Maternal: GDM with A1c >6 → 28% increase early pregnancy loss; cesarean birth;
preterm birth; ketoacidosis (2nd/3rd trimester); hypoglycemia (sleep, early pregnancy); hydramnios
(10x); hypertensive disorders (preeclampsia, eclampsia); UTI. Fetal: stillbirth; congenital anomalies (6-
10%: CNS defects - anencephaly, open spina bifida; cardiac - VSD, transposition; caudal regression
200-400x); macrosomia; hypoglycemia; RDS; polycythemia; hyperbilirubinemia.
1. Poor glycemic control increases anomalies.
2. Macrosomia risks shoulder dystocia.
3. Caudal regression syndrome unique to diabetic pregnancy.
, 4: Compare the management of a pregnant woman with hyperthyroidism vs hypothyroidism.
Correct Answer: Hyperthyroidism: Tx propylthiouracil (PTU), beta-adrenergic blockers,
thyroidectomy. Radioactive iodine contraindicated. Hypothyroidism: Tx levothyroxine (Synthroid).
Both need: coping assistance, environmental adaptation (hyper: heat intolerance; hypo: cold
intolerance), stress reduction, nutritional counseling (hyper: increased appetite/poor weight gain; hypo:
ensure adequate intake).
1. PTU preferred in pregnancy (less placental transfer).p>
2. Untreated hypothyroidism risks fetal neurodevelopment.
3. Monitor TSH frequently.
5: Differentiate the management of various cardiovascular disorders in pregnant women.
Correct Answer: Peripartum cardiomyopathy: diuretics, sodium restriction, afterload reducers,
anticoagulants, digoxin (ACE inhibitors only postpartum). Rheumatic heart disease: prophylactic
antibiotics for highest risk. Mitral/aortic stenosis: reduce activity, sodium restriction, diuretics, beta-
blockers, bed rest. MVP: treat symptomatic tachyarrhythmias; antibiotics for invasive procedures.
Eisenmenger's: limit activity, prophylactic anticoagulation, ICU care. Septal defects: similar to
Eisenmenger's. Tetralogy of Fallot: surgical correction, anticoagulants, high concentration O2,
hemodynamic monitoring. Marfan: limit activity, prevent hypertensive/hypotensive complications, beta-
blockers. Heart transplant: beta-blockers during labor; cyclosporine mothers should not breastfeed.
1. Hemodynamic changes peak 28-32 weeks.
2. Minimize cardiac stress (treat anemia, HTN, infection).
3. ACE inhibitors teratogenic (avoid during pregnancy).
6: Discuss the different types of anemia and their effects during pregnancy.
Correct Answer: Iron deficiency anemia: most common (iron needed for erythropoiesis). Folic acid
deficiency: increases neural tube defects, cleft lip/palate. Sickle cell hemoglobinopathy: recurrent fever,
pain, IUGR, small for gestational age; prone to pyelonephritis, leg ulcers, preeclampsia. Thalassemia:
insufficient globin; 50% stillbirth, IUGR, preeclampsia, preterm birth.
1. Iron supplementation often needed (pregnancy increases iron demand).
2. Folic acid 400 mcg preconception prevents neural tube defects.
3. Sickle cell crises triggered by infection, dehydration, stress.
7: Explain the care of pregnant women with human immunodeficiency virus (HIV).
Correct Answer: Counseling and testing offered to all women at prenatal care. HIV-infected women
treated with HAART during pregnancy (optimal health: sleep, rest, exercise, stress reduction). Use
condoms and spermicide, avoid orogenital sex. Antepartum: AZT (zidovudine). Intrapartum: C-section
at 38 weeks, IV zidovudine, avoid fetal scalp electrode, scalp pH sampling, operative vaginal delivery,
episiotomy.
1. HAART reduces vertical transmission to <1%.
2. Formula feeding recommended in US.
3. Avoid breastfeeding (HIV transmission risk).
