DOH Nursing Obstetric & Maternity Nursing 4 — Questions and Answers
Question 1: Which sign indicates the placenta is separating and ready for delivery?
- Lengthening of the umbilical cord and a gush of blood (Correct answer)
- Fetal tachycardia above 180 bpm
- Return of regular contractions
- Maternal hypotension and bradycardia
Correct answer: Lengthening of the umbilical cord and a gush of blood
Signs of placental separation include: lengthening of the umbilical cord, a sudden gush of blood, the uterus becoming globular and firmer, and the fundus rising in the abdomen. These occur 5–15 minutes after delivery of the baby.
Question 2: A primiparous woman is breastfeeding and reports sore, cracked nipples. What is the most appropriate advice?
- Ensure correct latch-on technique: baby's mouth covers the areola, not just the nipple (Correct answer)
- Stop breastfeeding temporarily and use formula
- Apply ice packs before each feeding session
- Feed for no longer than 5 minutes per side
Correct answer: Ensure correct latch-on technique: baby's mouth covers the areola, not just the nipple
Sore cracked nipples are almost always caused by incorrect latch-on where the infant sucks only the nipple tip. Correcting latch-on so the infant takes the full areola into the mouth eliminates nipple trauma. Expressed breast milk on the nipple aids healing.
Question 3: What is the recommended frequency of fetal movement counting (kick counts) in the third trimester?
- Count until 10 movements felt; report if <10 movements in 2 hours (Correct answer)
- Count movements every 30 minutes throughout the day
- Only count during active fetal periods after meals
- Kick counts are not recommended and have no clinical value
Correct answer: Count until 10 movements felt; report if <10 movements in 2 hours
The '10-in-2' method: count fetal movements until 10 are felt. If fewer than 10 movements are felt in 2 hours, contact the healthcare provider. Daily kick counts in the third trimester help detect decreased fetal movement, which may indicate placental insufficiency.
Question 4: A postpartum patient develops a fever of 38.5°C on day 3. Uterine tenderness is present on palpation. What is the likely diagnosis?
- Endometritis (uterine infection) (Correct answer)
- Normal postpartum fever
- Mastitis from breastfeeding
- Urinary tract infection
Correct answer: Endometritis (uterine infection)
Puerperal fever (>38°C after 24 hours postpartum and within 10 days) with uterine tenderness suggests endometritis — infection of the uterine lining. Risk factors include prolonged labor, PROM, multiple vaginal examinations, and cesarean delivery. Broad-spectrum antibiotics are required.
Question 5: Which assessment finding in a breastfeeding newborn on day 3 of life indicates adequate milk intake?
- 6–8 wet diapers and 3–4 stools per day, steady weight, alert baby (Correct answer)
- Only 2 wet diapers in 24 hours
- Weight loss of 15% from birth weight
- Persistent yellow jaundice intensifying after day 5
Correct answer: 6–8 wet diapers and 3–4 stools per day, steady weight, alert baby
Adequate intake signs: 6+ wet diapers by day 4–5, 3+ stools per day initially (may change after week 1), weight loss <7–10% of birth weight in first week, and the baby appearing satisfied after feeds. Fewer wet diapers and excessive weight loss indicate inadequate intake.
Question 6: What is the purpose of administering vitamin K to a newborn immediately after birth?
- Prevent hemorrhagic disease of the newborn (vitamin K deficiency bleeding) (Correct answer)
- Promote healthy bone development
- Treat neonatal jaundice
- Enhance immune system function
Correct answer: Prevent hemorrhagic disease of the newborn (vitamin K deficiency bleeding)
Newborns have very low vitamin K levels and immature gut flora that cannot yet synthesize it. Vitamin K is essential for synthesis of clotting factors II, VII, IX, and X. Without it, the neonate is at risk for intracranial hemorrhage and other bleeding (VKDB). IM vitamin K at birth prevents this.
DOH Nursing Obstetric & Maternity Nursing 4
Which sign indicates the placenta is separating and ready for delivery?