Mixed Deck — All Obstetric Nurse Test Topics Flashcards

Which condition is a contraindication to epidural analgesia during labor?

Answer: Active coagulopathy or thrombocytopenia below 70,000/mm³

Active coagulopathy markedly increases the risk of epidural hematoma, which can compress the spinal cord and cause permanent neurological injury.

Which maternal position during labor is most effective for relieving back pain associated with an occiput posterior fetal position?

Answer: Hands-and-knees (all-fours) position

The hands-and-knees position uses gravity to encourage anterior rotation of the fetal occiput away from the maternal sacrum, reducing sacral pressure and back pain.

During a newborn head-to-toe assessment, the nurse observes a soft, edematous area on the infant's scalp that extends across the suture lines. This finding is most consistent with which condition?

Answer: Caput succedaneum

Caput succedaneum is generalized edema of the scalp that is present at birth. It feels soft and spongy and, crucially, crosses the cranial suture lines. It typically resolves within a few days. A cephalohematoma is a collection of blood that does not cross suture lines.

An obstetric nurse is analyzing a fetal heart rate tracing and observes a gradual decrease in the FHR that begins after the peak of a contraction and returns to baseline after the contraction has ended. This pattern is identified as:

Answer: Late deceleration

Late decelerations are characterized by a gradual decrease in the fetal heart rate with an onset that occurs after the beginning of the contraction, and the lowest point (nadir) occurs after the peak of the contraction. This timing suggests uteroplacental insufficiency. Early decelerations mirror the contraction, and variable decelerations are abrupt and V-shaped. A prolonged deceleration lasts for 2 minutes or more.

A nurse is reviewing the criteria for a diagnosis of preeclampsia with severe features. Which of the following findings is a key indicator of this condition?

Answer: Platelet count less than 100,000/μL

According to ACOG guidelines, preeclampsia with severe features is diagnosed in the presence of new-onset hypertension along with specific signs of end-organ damage. A platelet count below 100,000/μL (thrombocytopenia) is a diagnostic criterion for severe features. While elevated blood pressure and proteinuria are present in preeclampsia, the other options describe findings of preeclampsia without severe features or common pregnancy symptoms.

What position is most common for cervical lacerations during labor and delivery?

Answer: 3 and 9 o’clock

Cervical lacerations during labor and delivery most commonly occur at the 3 and 9 o’clock positions. These lateral aspects of the cervix are subjected to the greatest stretching and pressure as the fetal head descends through the birth canal. The forces exerted during dilation and passage of the fetus make these areas particularly vulnerable to tearing.

Which action by the nurse BEST demonstrates application of evidence-based practice during pushing in the second stage of labor?

Answer: Encouraging open-glottis (laboring down) pushing, following the patient's own urge to push

Evidence-based practice supports open-glottis, spontaneous (physiologic) pushing triggered by the patient's urge, which reduces maternal exhaustion and improves fetal oxygenation compared to Valsalva pushing.

Which patterned breathing technique taught in childbirth education classes (such as Lamaze) is primarily used to help manage contraction pain during labor?

Answer: Paced rhythmic breathing synchronized with contractions

Paced rhythmic breathing promotes relaxation, provides a focus of concentration during contractions, and may stimulate endorphin release, helping the patient manage pain without pharmacological intervention.

Which maternal vital sign change during labor warrants IMMEDIATE provider notification regardless of other findings?

Answer: Blood pressure of 158/105 mmHg on two readings 15 minutes apart

A blood pressure of 158/105 mmHg or higher on two readings 15 minutes apart meets the diagnostic threshold for severe-range hypertension requiring urgent antihypertensive treatment.

A nurse is providing care to a term newborn immediately following delivery. To prevent heat loss through convection, which nursing intervention is most appropriate?

Answer: Keeping the newborn away from open windows and air vents.

Convection is the loss of heat from the warm body surface to cooler air currents. Keeping the newborn away from drafts from open windows, doors, or air vents is a key intervention to prevent this type of heat loss. Drying the skin prevents evaporation, and placing the infant on a pre-warmed surface or skin-to-skin prevents conduction loss.

What is the most important teaching point regarding alcohol consumption during pregnancy?

Answer: No amount of alcohol has been proven safe during pregnancy

No level of alcohol consumption is considered safe during pregnancy, as it can cause fetal alcohol spectrum disorders at any stage.

Which antidote must be immediately available at the bedside for any patient receiving intravenous magnesium sulfate?

Answer: Calcium gluconate

Calcium gluconate reverses magnesium toxicity; 1g IV over 3 minutes is administered when signs of toxicity (absent DTRs, respiratory depression) are present.

A patient at 41 weeks gestation is undergoing cervical ripening with a Foley balloon catheter. Which finding indicates the catheter has served its purpose and should be removed?

Answer: The balloon spontaneously expels or the cervix reaches 3–4 cm dilation

The Foley balloon catheter for cervical ripening is designed to fall out when the cervix dilates to approximately 3–4 cm, indicating adequate cervical change.

TENS (transcutaneous electrical nerve stimulation) reduces labor pain primarily through which mechanism?

Answer: Stimulating endorphin release and activating gate control mechanisms in the spinal cord

TENS electrodes deliver low-voltage electrical pulses that stimulate endogenous endorphin release and activate inhibitory pathways via gate control theory, reducing the perception of uterine pain.

During the third stage of labor, which clinical sign indicates placental separation has occurred?

Answer: The fundus rises in the abdomen, the cord lengthens, and a gush of blood is seen

Signs of placental separation include the fundus rising and becoming globular, cord lengthening, and a sudden gush of blood.

A nurse observes a colleague repeatedly dismissing a laboring patient's pain based on the colleague's stated belief that 'women of that culture always exaggerate.' The nurse recognizes this as a failure to uphold which specific professional nursing standard?

Answer: Culturally Congruent Practice

This situation exemplifies a failure to provide culturally congruent care. Professional nursing standards, such as those from AWHONN, require nurses to deliver care that is respectful of and responsive to individual patient preferences, needs, and values. Making assumptions and altering care based on cultural stereotypes violates this core principle and the ethical duty to respect the dignity and worth of every person.

A cervical length of less than what measurement on transvaginal ultrasound is the standard threshold associated with significantly increased preterm birth risk?

Answer: 2.5 cm

A cervical length of less than 2.5 cm (25 mm) on transvaginal ultrasound between 16–24 weeks is the established threshold for increased spontaneous preterm birth risk.

Which vitamin supplement is recommended before conception and in early pregnancy to prevent neural tube defects?

Answer: Folic acid

Folic acid (400–800 mcg/day) taken before conception and through the first trimester significantly reduces the risk of neural tube defects such as spina bifida.

A client at her 2-week postpartum check-up is concerned because her vaginal bleeding, which had decreased to lochia serosa, has now become heavier and red again. She also reports ongoing pelvic discomfort. The nurse should suspect which late postpartum complication?

Answer: Subinvolution of the uterus

Subinvolution is the failure of the uterus to return to its non-pregnant state in the expected timeframe. It is characterized by prolonged lochial discharge, irregular or excessive bleeding, and a uterus that is larger than expected for the postpartum period. Endometritis would typically also present with fever and foul-smelling lochia.

Fetal traits during the initial phase of responsiveness after birth include

Answer: Alert state and movement of limbs

During the initial phase of responsiveness after birth, newborns typically exhibit an alert state and active movement of limbs. This 'first period of reactivity' usually lasts for about 30 minutes to an hour, during which the infant is wide awake, has strong sucking reflexes, and is highly responsive. This alert phase is crucial for initial bonding and successful breastfeeding.