Obstetric Nurse Test Obstetric Nurse Labor and Birth Process 2 — Questions and Answers
Question 1: A laboring patient at 39 weeks reports sudden, severe, constant abdominal pain with a rigid, board-like abdomen. The FHR tracing shows late decelerations. What is the priority nursing action?
- Administer IV morphine for pain relief
- Notify the provider immediately for suspected placental abruption (Correct answer)
- Increase the IV fluid rate and reposition the patient
- Prepare for amniotomy to accelerate labor
Correct answer: Notify the provider immediately for suspected placental abruption
Sudden constant pain with a rigid abdomen and late decelerations suggests placental abruption, requiring immediate provider notification for emergent intervention.
Question 2: Which finding on an external fetal monitor tracing is MOST reassuring of fetal well-being during active labor?
- Absent variability with occasional late decelerations
- Minimal variability with no accelerations
- Moderate variability with accelerations and no decelerations (Correct answer)
- Sinusoidal pattern at 120 bpm baseline
Correct answer: Moderate variability with accelerations and no decelerations
Moderate variability (6–25 bpm) with accelerations and absence of decelerations is the most reassuring (Category I) tracing pattern.
Question 3: A nurse is caring for a patient in transition labor (8–10 cm dilation). Which behavioral cue is MOST expected at this stage?
- The patient is chatting between contractions and requests entertainment
- The patient is requesting an epidural for the first time and is agitated
- The patient is calm and practicing breathing techniques effectively
- The patient reports a strong urge to push and is extremely irritable (Correct answer)
Correct answer: The patient reports a strong urge to push and is extremely irritable
During the transition phase, patients often experience an overwhelming urge to push, intense irritability, and difficulty coping between very close contractions.
Question 4: When performing Leopold's maneuvers, the nurse palpates a round, hard, ballotable mass in the uterine fundus. This finding indicates:
- The fetal head is in the fundus, suggesting a breech presentation (Correct answer)
- The fetal buttocks are in the fundus, indicating a vertex presentation
- The fetal shoulder is presenting, indicating a transverse lie
- The fetal head is engaged in the pelvis
Correct answer: The fetal head is in the fundus, suggesting a breech presentation
A round, firm, ballotable mass in the fundus indicates the fetal head, consistent with a breech (non-vertex) presentation.
Question 5: A patient with an epidural in place reports feeling pressure and an urge to push. Her last cervical exam 30 minutes ago was 7 cm. What is the nurse's BEST initial action?
- Encourage her to begin pushing immediately
- Tell her the urge is likely caused by the epidural and is normal
- Perform a cervical examination to assess current dilation (Correct answer)
- Call the provider to request an increase in epidural dosage
Correct answer: Perform a cervical examination to assess current dilation
An urge to push may signal rapid cervical change to complete dilation, and a repeat cervical exam is needed before allowing or discouraging pushing efforts.
Question 6: Which maternal position is MOST appropriate to help resolve a persistent left occiput posterior (LOP) fetal position during labor?
- Supine with a wedge under the right hip
- Hands-and-knees (all-fours) position (Correct answer)
- Left lateral recumbent position
- Sitting upright in a chair
Correct answer: Hands-and-knees (all-fours) position
The hands-and-knees position encourages rotation of a posterior fetal occiput to the anterior position by using gravity and pelvic rocking.
Question 7: A nurse observes the umbilical cord prolapsing into the vagina after rupture of membranes. After calling for help, what is the IMMEDIATE priority intervention?
- Place the patient in Trendelenburg or knee-chest position and manually elevate the presenting part (Correct answer)
- Reinsert the cord into the uterus
- Prepare for immediate vaginal delivery
- Apply warm saline-soaked gauze to the cord and document the finding
Correct answer: Place the patient in Trendelenburg or knee-chest position and manually elevate the presenting part
Placing the patient in Trendelenburg or knee-chest and manually elevating the presenting part relieves cord compression to maintain fetal oxygenation until emergency cesarean delivery.
Obstetric Nurse Test Obstetric Nurse Labor and Birth Process 2
A laboring patient at 39 weeks reports sudden, severe, constant abdominal pain with a rigid, board-like abdomen.
The FHR tracing shows late decelerations.
What is the priority nursing action?