DOH Nursing Obstetric & Maternity Nursing 3 — Questions and Answers
Question 1: What is a normal fetal heart rate during labor?
- 110–160 beats per minute (Correct answer)
- 60–90 beats per minute
- 170–200 beats per minute
- 100–110 beats per minute
Correct answer: 110–160 beats per minute
Normal fetal heart rate baseline is 110–160 bpm. Bradycardia is <110 bpm for ≥10 minutes; tachycardia is >160 bpm for ≥10 minutes. Accelerations (15 bpm above baseline for 15 seconds) are reassuring signs of fetal well-being.
Question 2: A patient at 28 weeks gestation is at risk for preterm labor. Which medication is used to accelerate fetal lung maturity?
- Betamethasone (antenatal corticosteroid) (Correct answer)
- Magnesium sulfate for neuroprotection only
- Nifedipine for tocolysis only
- Oxytocin to strengthen contractions
Correct answer: Betamethasone (antenatal corticosteroid)
Antenatal corticosteroids (betamethasone or dexamethasone) administered at 24–34 weeks gestation accelerate surfactant production and lung maturation, significantly reducing the risk of RDS, IVH, and necrotizing enterocolitis in premature newborns.
Question 3: What is the correct action when a variable deceleration pattern is seen on the fetal monitor during labor?
- Reposition the mother, administer oxygen, and increase IV fluid rate (Correct answer)
- Increase oxytocin infusion immediately
- Perform an emergency cesarean section immediately
- Document and continue routine monitoring
Correct answer: Reposition the mother, administer oxygen, and increase IV fluid rate
Variable decelerations result from umbilical cord compression. Initial interventions are: change maternal position (left lateral or hands-and-knees), increase IV fluids to improve placental perfusion, apply oxygen 8–10 L/min via face mask, and notify the physician if decelerations persist.
Question 4: A G4P3 mother is delivering her fourth baby rapidly. The nurse notes the umbilical cord prolapsed ahead of the baby's head. What is the immediate action?
- Manually hold the presenting part off the cord with a gloved hand and call for emergency cesarean (Correct answer)
- Allow delivery to proceed since it will be rapid
- Apply traction to the cord to deliver the placenta first
- Place the mother in Trendelenburg and wait for the physician to decide
Correct answer: Manually hold the presenting part off the cord with a gloved hand and call for emergency cesarean
Umbilical cord prolapse is an obstetric emergency. The presenting part must be manually elevated off the cord to relieve compression and preserve fetal oxygenation while preparing for emergency cesarean. The cord should be kept warm and moist. Every second counts.
Question 5: Which nursing assessment is most important in a patient receiving magnesium sulfate for preeclampsia?
- Respiratory rate, deep tendon reflexes, and urine output (Correct answer)
- Blood pressure every 4 hours
- Fetal heart rate only
- Daily weight and dietary intake
Correct answer: Respiratory rate, deep tendon reflexes, and urine output
Magnesium sulfate toxicity progresses: first, loss of DTRs (patella reflex) at ~7–10 mEq/L, then respiratory depression at ~10–13 mEq/L, then cardiac arrest. Respiratory rate <12/min, absent DTRs, or urine output <25 mL/hr require stopping the infusion. Calcium gluconate is the antidote.
Question 6: What does a positive non-stress test (NST) indicate?
- A reactive NST with at least 2 accelerations in 20 minutes indicates fetal well-being (Correct answer)
- A positive NST always indicates fetal distress requiring immediate delivery
- NST detects only uterine contractions, not fetal heart rate
- A non-reactive NST is always normal in post-term pregnancies
Correct answer: A reactive NST with at least 2 accelerations in 20 minutes indicates fetal well-being
In NST terminology, a 'reactive' (not 'positive') NST is reassuring, showing at least 2 FHR accelerations (≥15 bpm for ≥15 seconds) in 20 minutes. A non-reactive NST requires further evaluation (biophysical profile, contraction stress test). The term 'positive' is used for CST.
DOH Nursing Obstetric & Maternity Nursing 3
What is a normal fetal heart rate during labor?