Obstetric Nurse Test Obstetric Nurse Labor and Birth Process 4 — Questions and Answers
Question 1: 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?
- The patient reports severe cramping
- The balloon spontaneously expels or the cervix reaches 3–4 cm dilation (Correct answer)
- Contractions begin every 5 minutes
- The membranes rupture spontaneously
Correct 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.
Question 2: During the third stage of labor, which clinical sign indicates placental separation has occurred?
- The fundus rises in the abdomen, the cord lengthens, and a gush of blood is seen (Correct answer)
- The uterus becomes soft and boggy after delivery
- The patient reports relief of pressure in the perineum
- Contractions completely cease after the infant is born
Correct 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.
Question 3: A laboring patient at 39 weeks with GBS-positive status has been in labor for 2 hours since rupture of membranes. She has a penicillin allergy with a prior anaphylactic reaction. What antibiotic should the nurse anticipate administering?
- Ampicillin IV
- Cefazolin IV
- Clindamycin IV based on GBS sensitivity results
- Vancomycin IV (Correct answer)
Correct answer: Vancomycin IV
For GBS-positive patients with a high-risk penicillin allergy (anaphylaxis history) and GBS resistant to clindamycin, vancomycin is the recommended alternative agent.
Question 4: A primipara in active labor at 5 cm requests an epidural. After placement, her blood pressure drops from 118/72 to 88/54 mmHg. The FIRST nursing action should be:
- Administer epinephrine 1 mg IV push
- Place her in left lateral position and increase IV fluid infusion rate (Correct answer)
- Notify anesthesia to remove the epidural immediately
- Elevate the head of the bed to 90 degrees
Correct answer: Place her in left lateral position and increase IV fluid infusion rate
Epidural-induced hypotension is managed first by lateral positioning (to relieve aortocaval compression) and a rapid IV fluid bolus.
Question 5: What is the MOST reliable method for confirming rupture of membranes when a patient reports a slow fluid leak?
- Observing pooling of fluid in the posterior vaginal fornix and performing nitrazine and ferning tests (Correct answer)
- Asking the patient to cough and observing fluid loss
- Performing an amnioinfusion and monitoring fluid return
- Ordering a urine culture to rule out incontinence
Correct answer: Observing pooling of fluid in the posterior vaginal fornix and performing nitrazine and ferning tests
Confirming SROM requires visualizing pooling of amniotic fluid, a positive nitrazine test (pH >6.5 turns blue), and a ferning pattern on a dried vaginal slide.
Question 6: During active labor, a nurse notes the FHR baseline is 175 bpm for 15 minutes with minimal variability. Maternal temperature is 38.4°C. What condition should the nurse suspect?
- Fetal movement artifact on the monitor
- Intrauterine infection (chorioamnionitis) causing fetal tachycardia (Correct answer)
- Fetal sleep cycle reducing variability
- Umbilical cord compression causing baseline changes
Correct answer: Intrauterine infection (chorioamnionitis) causing fetal tachycardia
Maternal fever combined with fetal tachycardia and decreased variability is a classic presentation of chorioamnionitis, which requires antibiotic therapy and often expedited delivery.
Question 7: Which action by the nurse BEST demonstrates application of evidence-based practice during pushing in the second stage of labor?
- Instructing the patient to hold her breath and push for a count of 10 with each contraction
- Encouraging open-glottis (laboring down) pushing, following the patient's own urge to push (Correct answer)
- Keeping the patient in the lithotomy position throughout the second stage
- Beginning directed pushing immediately upon reaching complete dilation
Correct 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.
Obstetric Nurse Test Obstetric Nurse Labor and Birth Process 4
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?