Obstetric Nurse Test Obstetric Nurse Labor and Birth Process 3 — Questions and Answers
Question 1: A multiparous patient at 6 cm dilation has contractions every 2 minutes, lasting 70 seconds, with strong intensity on palpation. Her labor has not progressed in 2 hours. What term BEST describes this situation?
- Precipitous labor
- Active phase arrest (Correct answer)
- Latent phase prolongation
- Second stage failure
Correct answer: Active phase arrest
Active phase arrest is defined as no cervical change for 4 hours with adequate contractions or 6 hours with inadequate contractions in the active phase.
Question 2: The nurse is monitoring a patient receiving oxytocin augmentation. Which FHR pattern requires the nurse to STOP the infusion immediately?
- Accelerations with contractions
- Early decelerations with contractions
- Repetitive late decelerations with minimal variability (Correct answer)
- Variable decelerations that resolve within 30 seconds
Correct answer: Repetitive late decelerations with minimal variability
Repetitive late decelerations with minimal variability (Category III) indicate uteroplacental insufficiency, requiring immediate oxytocin discontinuation and further resuscitation measures.
Question 3: During the second stage of labor, the nurse notes the fetal head crowning between pushes. What technique should the nurse use to control birth and prevent perineal lacerations?
- Apply firm downward pressure on the fetal head to speed delivery
- Encourage the mother to push forcefully between contractions
- Apply gentle counterpressure to the fetal head and support the perineum (Correct answer)
- Perform a routine mediolateral episiotomy
Correct answer: Apply gentle counterpressure to the fetal head and support the perineum
Gentle counterpressure on the crowning head (the Ritgen maneuver variant) and perineal support slows delivery and reduces severe laceration risk.
Question 4: A patient's amniotic fluid appears green and thick immediately after spontaneous rupture of membranes. The priority nursing concern is:
- Increased risk of maternal Group B Streptococcus transmission
- Meconium aspiration syndrome risk requiring preparation for neonatal resuscitation (Correct answer)
- Umbilical cord prolapse from increased fluid pressure
- Maternal dehydration due to fluid loss
Correct answer: Meconium aspiration syndrome risk requiring preparation for neonatal resuscitation
Thick meconium-stained amniotic fluid indicates in-utero passage of meconium and places the neonate at risk for meconium aspiration syndrome, requiring a skilled neonatal team at delivery.
Question 5: Which maternal vital sign change during labor warrants IMMEDIATE provider notification regardless of other findings?
- Temperature of 38.0°C (100.4°F) after 4 hours of ruptured membranes
- Blood pressure of 158/105 mmHg on two readings 15 minutes apart (Correct answer)
- Heart rate of 95 bpm after ambulation
- Respiratory rate of 20 breaths per minute during a contraction
Correct 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.
Question 6: What is the CORRECT sequence of cardinal movements of labor for a vertex presentation?
- Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion (Correct answer)
- Descent, engagement, internal rotation, flexion, extension, external rotation, expulsion
- Engagement, flexion, descent, extension, internal rotation, external rotation, expulsion
- Flexion, engagement, descent, internal rotation, extension, external rotation, expulsion
Correct answer: Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
The seven cardinal movements in correct order are engagement, descent, flexion, internal rotation, extension, external rotation (restitution), and expulsion.
Question 7: A nurse assesses the placenta after delivery and notes a ragged, incomplete cotyledon. The priority action is to:
- Document the finding and continue routine postpartum monitoring
- Inspect the cord for a true knot
- Notify the provider immediately due to risk of postpartum hemorrhage from retained placental fragments (Correct answer)
- Administer misoprostol to facilitate expulsion of remaining tissue
Correct answer: Notify the provider immediately due to risk of postpartum hemorrhage from retained placental fragments
Incomplete placenta with missing cotyledons indicates retained placental fragments, which can cause postpartum hemorrhage and infection requiring immediate provider notification.
