Maternal Newborn Nursing Test Intrapartum and Labor and Delivery 1 — Questions and Answers
Question 1: A laboring patient at 8 cm dilation suddenly reports severe, constant abdominal pain with a rigid uterus and fetal heart rate decelerations. What should the nurse suspect?
- Placental abruption (Correct answer)
- Transition phase of labor
- Urinary tract infection
- Round ligament pain
Correct answer: Placental abruption
Placental abruption presents with sudden severe abdominal pain, board-like uterus rigidity, and associated fetal distress due to disrupted placental blood flow.
Question 2: Which fetal heart rate pattern requires the nurse to immediately notify the healthcare provider and prepare for possible emergency delivery?
- Early decelerations
- Moderate variability
- Prolonged deceleration lasting more than 3 minutes (Correct answer)
- Accelerations with fetal movement
Correct answer: Prolonged deceleration lasting more than 3 minutes
A prolonged deceleration lasting more than 3 minutes indicates significant fetal compromise and requires immediate intervention to prevent fetal hypoxia.
Question 3: A patient in active labor has an epidural. Her blood pressure drops to 88/52 mmHg. What is the nurse's priority intervention?
- Administer oxygen by non-rebreather mask
- Position the patient in left lateral tilt and increase IV fluids (Correct answer)
- Call the anesthesiologist immediately
- Document the finding and recheck in 5 minutes
Correct answer: Position the patient in left lateral tilt and increase IV fluids
Epidural-induced hypotension is treated first with left lateral positioning to relieve aortocaval compression and IV fluid bolus to restore maternal blood pressure.
Question 4: The nurse is caring for a patient in labor whose membranes rupture spontaneously. The fluid is green-tinged. What is the priority nursing action?
- Document the color and continue routine monitoring
- Perform a vaginal exam to check dilation
- Assess the fetal heart rate immediately (Correct answer)
- Notify dietary to hold the next meal
Correct answer: Assess the fetal heart rate immediately
Meconium-stained amniotic fluid indicates possible fetal stress, so immediate fetal heart rate assessment is the priority to detect fetal compromise.
Question 5: During the second stage of labor, the nurse identifies variable decelerations with each push. What intervention should the nurse implement first?
- Have the patient stop pushing and change position (Correct answer)
- Increase the oxytocin infusion rate
- Apply oxygen via face mask at 10 L/min
- Perform an amnioinfusion
Correct answer: Have the patient stop pushing and change position
Variable decelerations are caused by umbilical cord compression, and repositioning the patient can relieve cord pressure and resolve the pattern.
Question 6: A primigravida is 4 cm dilated and 100% effaced. She is experiencing contractions every 3 minutes lasting 60 seconds. Which phase of labor is she in?
- Latent phase of the first stage
- Active phase of the first stage (Correct answer)
- Transition phase of the first stage
- Second stage of labor
Correct answer: Active phase of the first stage
Active phase of the first stage is characterized by cervical dilation from 4–10 cm with regular, stronger contractions occurring every 2–5 minutes.
