DOH Nursing Obstetric & Maternity Nursing 2 — Questions and Answers
Question 1: Which intervention is priority when a postpartum patient has a boggy, displaced uterus and heavy vaginal bleeding?
- Fundal massage and bladder emptying (catheterization if needed) (Correct answer)
- Administer IV oxytocin without examining the fundus
- Apply ice pack to the abdomen
- Increase IV fluid rate and observe for 30 minutes
Correct answer: Fundal massage and bladder emptying (catheterization if needed)
A boggy, displaced uterus suggests uterine atony complicated by bladder distension (a full bladder displaces the uterus and prevents contraction). Priority is bimanual fundal massage to stimulate contractions and catheterization to empty the bladder, allowing the uterus to contract.
Question 2: What is the normal blood loss considered acceptable during a vaginal delivery?
- Up to 500 mL (Correct answer)
- Up to 1,000 mL
- Up to 250 mL
- Up to 1,500 mL
Correct answer: Up to 500 mL
Postpartum hemorrhage is traditionally defined as blood loss >500 mL after vaginal delivery or >1,000 mL after cesarean section. Modern guidelines use a functional definition (signs of hemodynamic compromise), but 500 mL remains the classic threshold for vaginal delivery.
Question 3: Which assessment finding in a neonate at 10 minutes of life requires immediate resuscitation?
- Apgar score of 3 with persistent central cyanosis and poor muscle tone (Correct answer)
- Apgar score of 7 with peripheral cyanosis (acrocyanosis) only
- Respiratory rate of 45 breaths per minute
- Heart rate of 145 beats per minute
Correct answer: Apgar score of 3 with persistent central cyanosis and poor muscle tone
An APGAR score of 3 indicates severe neonatal depression (central cyanosis, bradycardia, absent or weak breathing, limp tone). Immediate resuscitation with positive pressure ventilation and further interventions per NRP guidelines are required. Score of 7+ is reassuring.
Question 4: A breastfeeding mother asks why her colostrum is yellow-orange in color. What should the nurse explain?
- Colostrum is rich in immunoglobulins, protein, and beta-carotene, which gives it its color and provides passive immunity (Correct answer)
- The color indicates breast infection (mastitis) requiring antibiotic treatment
- Yellow colostrum is a sign of jaundice in the mother and should not be fed to the infant
- The color will turn white once true milk comes in and is perfectly normal but has no special properties
Correct answer: Colostrum is rich in immunoglobulins, protein, and beta-carotene, which gives it its color and provides passive immunity
Colostrum (produced in the first 2–4 days) is thick, yellow-orange, and rich in secretory IgA, lactoferrin, leukocytes, growth factors, and protein. It provides passive immunity, laxative effect (meconium passage), and perfect early nutrition. Its color comes from beta-carotene.
Question 5: What is the recommended timing for cord clamping in a vigorous term newborn according to current guidelines?
- Delayed cord clamping at 1–3 minutes after birth (Correct answer)
- Immediate clamping within 15–30 seconds
- Only after placenta is delivered
- Clamp when cord stops pulsating, regardless of time
Correct answer: Delayed cord clamping at 1–3 minutes after birth
WHO and ACOG recommend delayed umbilical cord clamping (DCC) for at least 1 minute (preferably 1–3 minutes) in vigorous term and preterm newborns. DCC improves iron stores, reduces anemia, and provides additional blood volume from the placenta.
Question 6: Which sign differentiates placenta previa from abruptio placentae?
- Placenta previa: painless bright red bleeding; Abruptio: painful dark bleeding with rigid abdomen (Correct answer)
- Both conditions present with painful bright red bleeding
- Placenta previa causes painful contractions; abruption causes painless bleeding
- Both are identical in presentation and require ultrasound to differentiate
Correct answer: Placenta previa: painless bright red bleeding; Abruptio: painful dark bleeding with rigid abdomen
Placenta previa (placenta covering the cervical os) causes painless, bright red vaginal bleeding as the cervix dilates. Abruption (premature placental separation) causes painful, dark bleeding with a rigid boardlike abdomen. These differences guide immediate management.
DOH Nursing Obstetric & Maternity Nursing 2
Which intervention is priority when a postpartum patient has a boggy, displaced uterus and heavy vaginal bleeding?