Maternal Newborn Nursing Test Maternity Nursing (OB Maternal & Newborn) 5 — Questions and Answers
Question 1: A laboring client at 8 cm dilation reports uncontrollable urge to push. Which nursing intervention is most appropriate at this time?
- Encourage the client to push with each contraction
- Instruct the client to use panting or blowing breathing to resist the urge to push (Correct answer)
- Administer IV morphine to decrease the sensation
- Place the client in the lithotomy position and prepare for delivery
Correct answer: Instruct the client to use panting or blowing breathing to resist the urge to push
Until the cervix is fully dilated (10 cm), pushing is discouraged; panting or blowing techniques help the client resist the urge and prevent cervical edema.
Question 2: A nurse notes that a newborn's blood glucose at 2 hours of life is 38 mg/dL. The infant is alert and feeding well at the breast. What is the priority nursing action?
- Administer IV dextrose immediately
- Encourage continued breastfeeding and recheck glucose in 30–60 minutes (Correct answer)
- Give 5 mL of oral glucose gel and place in NICU
- Nothing — 38 mg/dL is a normal newborn glucose level
Correct answer: Encourage continued breastfeeding and recheck glucose in 30–60 minutes
For a symptomatic or asymptomatic newborn with glucose 25–40 mg/dL who is feeding, the first intervention is oral feeding with a recheck within 30–60 minutes per AAP guidelines.
Question 3: Which position is most appropriate for a client with a prolapsed umbilical cord while awaiting emergency cesarean delivery?
- High Fowler's position
- Trendelenburg or knee-chest position (Correct answer)
- Left lateral decubitus (Sims) position
- Right lateral with a wedge under the hip
Correct answer: Trendelenburg or knee-chest position
Trendelenburg or knee-chest position uses gravity to relieve pressure on the prolapsed cord by allowing the fetal presenting part to move away from the cord.
Question 4: A client 6 hours postpartum has a blood pressure of 158/106 mmHg, a severe headache, and 3+ proteinuria. Which medication does the nurse anticipate administering?
- Methylergonovine (Methergine)
- Magnesium sulfate (Correct answer)
- Misoprostol (Cytotec)
- Betamethasone
Correct answer: Magnesium sulfate
Postpartum severe-range hypertension with headache and proteinuria indicates postpartum preeclampsia/eclampsia; magnesium sulfate is used for seizure prophylaxis.
Question 5: A newborn is born at 39 weeks to a mother with Type 1 diabetes. Which complication is the newborn at highest risk for in the first hours of life?
- Hyperglycemia secondary to maternal insulin resistance
- Hypoglycemia due to fetal hyperinsulinemia (Correct answer)
- Polycythemia leading to hyperviscosity syndrome
- Respiratory alkalosis from rapid breathing
Correct answer: Hypoglycemia due to fetal hyperinsulinemia
Infants of diabetic mothers develop hyperinsulinemia in utero; when maternal glucose is removed at birth, high insulin levels cause neonatal hypoglycemia.
Question 6: A client in the third trimester reports lying on her back causes dizziness and light-headedness. The nurse explains this is due to:
- Hyperventilation from increased respiratory demand
- Compression of the inferior vena cava by the gravid uterus (supine hypotensive syndrome) (Correct answer)
- Increased cardiac output compressing the aorta
- Vagal stimulation from Braxton Hicks contractions
Correct answer: Compression of the inferior vena cava by the gravid uterus (supine hypotensive syndrome)
The gravid uterus compresses the inferior vena cava in the supine position, reducing venous return and cardiac output, causing supine hypotensive syndrome.
Question 7: A nurse is assessing a newborn for developmental dysplasia of the hip (DDH). Which maneuver assesses for a dislocatable hip?
- Ortolani maneuver — abduction with upward pressure detects a 'clunk' of reduction
- Barlow maneuver — adduction with downward pressure assesses for dislocation (Correct answer)
- Galeazzi sign — unequal knee heights assessed with hips and knees flexed
- Trendelenburg test — single-leg stance to assess gluteal muscle strength
Correct answer: Barlow maneuver — adduction with downward pressure assesses for dislocation
The Barlow maneuver adducts and applies posterior pressure to determine if the femoral head can be dislocated out of the acetabulum.
