Obstetric Nurse Obstetric Emergencies Questions and Answers

Question 1

A nurse is assisting with a delivery complicated by shoulder dystocia. After the provider has attempted gentle traction without success, which nursing intervention should be prioritized?

Accepted Answer

Assisting the client into the McRoberts maneuver position.

Answer

The McRoberts maneuver, which involves hyperflexing the mother's legs onto her abdomen, is a primary, evidence-based intervention for shoulder dystocia. [8, 14] This maneuver flattens the sacral promontory and rotates the pubic symphysis, which can free the impacted anterior shoulder. [6] Applying fundal pressure is contraindicated as it can worsen the impaction of the shoulder and increase the risk of fetal injury. [11, 15] While preparing for other interventions is important, McRoberts is a key initial step. Pushing is ineffective until the shoulder is dislodged.

Question 2

A client with a history of a previous classical cesarean section is in active labor. Which of the following clinical findings would be most indicative of a uterine rupture?

Accepted Answer

A sudden, sharp abdominal pain followed by a cessation of contractions.

Answer

A classic sign of uterine rupture is the sudden onset of intense, tearing abdominal pain, often followed by a complete stop in uterine contractions as the uterus loses its integrity. [12, 39] Other signs include a non-reassuring fetal heart rate pattern (like bradycardia or prolonged decelerations), loss of fetal station (the presenting part moves up, not down), and signs of maternal shock. [27, 39] Early decelerations are generally benign, and a gradual increase in contraction intensity is expected in normal labor.

Question 3

A multiparous client has a precipitous vaginal delivery. Moments after birth, she becomes acutely dyspneic, hypotensive, and cyanotic. She then experiences a seizure and develops disseminated intravascular coagulation (DIC). These findings are most characteristic of which obstetric emergency?

Accepted Answer

Amniotic fluid embolism.

Answer

Amniotic fluid embolism (AFE), or anaphylactoid syndrome of pregnancy, is a rare but catastrophic complication. Its classic presentation is the sudden onset of cardiopulmonary collapse (hypotension, dyspnea), often followed by neurologic symptoms (seizures) and coagulopathy (DIC). [4, 10, 25] While a pulmonary embolism causes respiratory distress and eclampsia involves seizures, the rapid combination of all these symptoms, especially the profound coagulopathy, points strongly to AFE. [18, 29]

Question 4

A client at 8 weeks gestation presents to the emergency department with a 2-day history of spotting and crampy lower abdominal pain. She now reports a sudden, severe, unilateral lower quadrant pain that radiates to her shoulder. Which condition should the nurse be most concerned about?

Accepted Answer

Ruptured ectopic pregnancy.

Answer

The development of sudden, severe, unilateral pain along with referred shoulder pain (Kehr's sign) is a hallmark sign of a ruptured ectopic pregnancy with intraperitoneal hemorrhage. [7, 21] The bleeding irritates the diaphragm and phrenic nerve, causing pain to be referred to the shoulder area. [21] While the other conditions cause abdominal pain, the referred shoulder pain in a client with signs of early pregnancy is highly suggestive of a ruptured ectopic pregnancy. [23, 41]

Question 5

A nurse is caring for a client receiving a continuous intravenous infusion of magnesium sulfate for preeclampsia with severe features. Which of the following assessment findings is the earliest sign of magnesium sulfate toxicity?

Accepted Answer

Loss of deep tendon reflexes (DTRs).

Answer

Magnesium sulfate is a central nervous system depressant. The loss or diminution of patellar deep tendon reflexes is typically the first and most sensitive sign that the magnesium level is becoming toxic. [9, 13, 32] Respiratory depression (rate <12/min), oliguria (<30 mL/hr), and hypotension are later, more severe signs of toxicity that occur at higher serum concentrations. [1, 36, 38]

Obstetric Nurse Test Practice Test

Obstetric Nurse Test Practice Test

Obstetric Nurse Obstetric Emergencies Questions and Answers