Obstetric Nurse Labor and Birth Process 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?

Accepted Answer

Place the client in a knee-chest or Trendelenburg position.

Answer

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?

Accepted Answer

Category I

Answer

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?

Accepted Answer

Assisting the client into an upright position, such as squatting or sitting.

Answer

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?

Accepted Answer

Retained placental fragments

Answer

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?

Accepted Answer

Placenta previa

Answer

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.

Obstetric Nurse Test Practice Test

Obstetric Nurse Test Practice Test

Obstetric Nurse Labor and Birth Process Questions and Answers