Obstetric Nurse Labor and Birth Process Questions and Answers — Questions and Answers
Question 1: A laboring client's membranes spontaneously rupture, and the nurse notes a loop of the umbilical cord protruding from the vagina. What is the nurse's immediate priority action?
- Administer a tocolytic agent as ordered.
- Place the client in a knee-chest or Trendelenburg position. (Correct answer)
- Cover the exposed cord with a dry, sterile gauze.
- Prepare the client for an amnioinfusion.
Correct answer: Place the client in a knee-chest or Trendelenburg position.
Umbilical cord prolapse is an obstetric emergency. The immediate priority is to relieve pressure on the cord to restore blood flow to the fetus. Placing the client in a knee-chest or Trendelenburg position uses gravity to shift the presenting part off the cord.
Question 2: A nurse is analyzing a fetal heart rate tracing. The baseline is 140 bpm, variability is moderate, and there are abrupt increases of 15 bpm lasting 20 seconds with fetal movement. Late decelerations are absent. How should the nurse categorize this tracing?
- Category I (Correct answer)
- Category II
- Category III
- Indeterminate
Correct answer: Category I
This tracing meets all the criteria for a Category I pattern, which is strongly predictive of normal fetal acid-base status. It includes a normal baseline rate (110-160 bpm), moderate variability, presence of accelerations, and absence of late or variable decelerations.
Question 3: A client in the second stage of labor is pushing effectively. Which of the following nursing actions is most appropriate to support the client during this stage?
- Encouraging the client to hold her breath and push for at least 15 seconds with each contraction.
- Administering a bolus of intravenous fluids to prevent dehydration.
- Assisting the client into an upright position, such as squatting or sitting. (Correct answer)
- Performing a fundal check every 5 minutes to assess progress.
Correct answer: Assisting the client into an upright position, such as squatting or sitting.
Upright positions during the second stage of labor can utilize gravity to facilitate fetal descent, may shorten the pushing stage, and can enhance maternal comfort and control. Coached, prolonged breath-holding (Valsalva pushing) is generally discouraged. IV fluids are important but not the most direct support for pushing, and fundal height is not the primary assessment of progress in the second stage.
Question 4: A client who is 30 minutes postpartum after a vaginal delivery experiences a sudden gush of dark red blood and complains of severe uterine cramping. The nurse notes that the uterus is boggy. Which condition should the nurse suspect?
- Placenta accreta
- Cervical laceration
- Uterine atony
- Retained placental fragments (Correct answer)
Correct answer: Retained placental fragments
The signs of a boggy uterus, sudden bleeding, and increased cramping after the initial delivery of the placenta are classic indicators of retained placental fragments, which prevent the uterus from contracting effectively. Uterine atony presents with a boggy uterus but is the failure of the uterus to contract, not necessarily caused by retained fragments. Cervical lacerations typically involve a steady stream of bright red blood with a firm uterus.
Question 5: A pregnant client presents to the labor unit with painless, bright red vaginal bleeding and a soft, non-tender uterus. Fetal heart tones are within the normal range. Which of the following conditions is most consistent with these findings?
- Vasa previa
- Placental abruption
- Placenta previa (Correct answer)
- Uterine rupture
Correct answer: Placenta previa
Placenta previa is characterized by painless, bright red vaginal bleeding, as the placenta is implanted over or near the cervical os. In contrast, placental abruption typically presents with dark red, painful bleeding and a rigid, tender uterus.
Question 6: A laboring client requests pain relief but wishes to avoid epidural anesthesia. Which non-pharmacological intervention utilizes the gate-control theory of pain?
- Encouraging the use of hypnosis.
- Administering nitrous oxide.
- Applying counter-pressure to the sacral area. (Correct answer)
- Suggesting aromatherapy with lavender oil.
Correct answer: Applying counter-pressure to the sacral area.
The gate-control theory suggests that the spinal cord contains a neurological 'gate' that either blocks pain signals or allows them to continue on to the brain. Applying counter-pressure provides a non-painful stimulus that can 'close the gate' to the painful stimuli of contractions. Hypnosis and aromatherapy work on the central nervous system control method, while nitrous oxide is a pharmacological agent.
