Maternal Newborn Nursing Test Intrapartum and Labor and Delivery 2 — Questions and Answers
Question 1: The nurse is monitoring a patient receiving oxytocin for labor augmentation. Which finding requires the nurse to immediately stop the infusion?
- Contractions every 3 minutes lasting 45 seconds
- Fetal heart rate baseline of 140 bpm
- Uterine hyperstimulation with 6 contractions in 10 minutes (Correct answer)
- Cervical dilation progressing 1 cm per hour
Correct answer: Uterine hyperstimulation with 6 contractions in 10 minutes
Uterine tachysystole (more than 5 contractions in 10 minutes) from oxytocin requires immediate cessation of the infusion to prevent fetal hypoxia.
Question 2: A patient's labor has been augmented with oxytocin. She is now 10 cm dilated and pushing. The fetal head has not advanced after 2 hours of pushing in a nulliparous patient. This is termed:
- Active phase arrest
- Prolonged latent phase
- Arrested descent (Correct answer)
- Precipitous labor
Correct answer: Arrested descent
Arrested descent is diagnosed when there is no progress in fetal descent after 2 hours of pushing in a nulliparous patient despite adequate uterine contractions.
Question 3: Which maternal position is most effective for promoting fetal descent and reducing back labor caused by an occiput posterior fetal position?
- Supine with legs elevated
- Hands-and-knees or all-fours position (Correct answer)
- Left lateral Sims position
- Semi-Fowler with feet flat
Correct answer: Hands-and-knees or all-fours position
The hands-and-knees position encourages rotation of the fetal occiput from posterior to anterior, relieving back labor and facilitating descent.
Question 4: After rupture of membranes, the nurse notes the umbilical cord protruding from the vaginal introitus. Which action should the nurse take first?
- Cover the cord with a dry sterile gauze
- Place the patient in Trendelenburg or knee-chest position (Correct answer)
- Prepare the patient for immediate cesarean section
- Clamp and cut the cord to prevent further prolapse
Correct answer: Place the patient in Trendelenburg or knee-chest position
The nurse's priority with cord prolapse is to relieve cord compression by elevating the presenting part, which is achieved with Trendelenburg or knee-chest positioning.
Question 5: A laboring patient is 5 cm dilated with intact membranes and experiencing severe back pain. The fetal position is right occiput posterior (ROP). Which nursing intervention is most appropriate?
- Encourage the patient to lie supine to rest
- Apply counterpressure to the sacral area during contractions (Correct answer)
- Administer an enema to relieve discomfort
- Restrict fluid intake to prevent nausea
Correct answer: Apply counterpressure to the sacral area during contractions
Sacral counterpressure during contractions provides direct relief from the back pain caused by the fetal occiput pressing against the maternal sacrum in a posterior position.
Question 6: A patient at 39 weeks gestation is admitted in active labor. Her GBS (Group B Streptococcus) status is positive. What is the priority nursing intervention?
- Initiate IV antibiotic prophylaxis as ordered (Correct answer)
- Prepare for immediate cesarean delivery
- Restrict oral intake and apply fetal monitor
- Obtain a vaginal culture for confirmation
Correct answer: Initiate IV antibiotic prophylaxis as ordered
GBS-positive patients require IV antibiotic prophylaxis (typically penicillin G) during labor to prevent vertical transmission to the neonate.
