Obstetric Nurse Test Obstetric Nurse Labor and Birth Process 5 — Questions and Answers
Question 1: A laboring patient at 34 weeks gestation presents with preterm labor. After confirming the diagnosis, which medication would the nurse anticipate giving to promote fetal lung maturity?
- Magnesium sulfate 6 g IV loading dose
- Betamethasone 12 mg IM given in two doses 24 hours apart (Correct answer)
- Indomethacin 100 mg rectal suppository
- Nifedipine 30 mg oral loading dose
Correct answer: Betamethasone 12 mg IM given in two doses 24 hours apart
Betamethasone (a corticosteroid) administered to the mother between 24 and 34 weeks promotes fetal surfactant production and lung maturity, reducing neonatal respiratory distress.
Question 2: What does a Bishop score of 3 indicate in a patient scheduled for labor induction?
- The cervix is favorable and induction should proceed directly with oxytocin
- The cervix is unfavorable and cervical ripening agents are indicated before induction (Correct answer)
- The patient is in early latent labor and induction is unnecessary
- Induction is contraindicated and cesarean delivery should be scheduled
Correct answer: The cervix is unfavorable and cervical ripening agents are indicated before induction
A Bishop score of 6 or less (especially ≤3) indicates an unfavorable cervix, and cervical ripening with prostaglandins or a mechanical device is recommended before oxytocin induction.
Question 3: A nurse is preparing to insert an intrauterine pressure catheter (IUPC). Which clinical indication is MOST appropriate for this intervention?
- External monitoring is adequate and contractions appear strong
- The patient declines internal monitoring due to discomfort
- There is inadequate tracing quality and the need to assess contraction strength in Montevideo units (Correct answer)
- The patient has a history of cesarean delivery and VBAC is planned
Correct answer: There is inadequate tracing quality and the need to assess contraction strength in Montevideo units
An IUPC is indicated when contraction quality cannot be adequately assessed externally and Montevideo units (MVUs) are needed to determine the adequacy of uterine activity.
Question 4: During delivery, the fetal head is born but the shoulders do not deliver with the next contraction. The nurse recognizes shoulder dystocia and initiates HELPERR. What does the first maneuver 'H' represent?
- Hyperflexion of maternal thighs (McRoberts maneuver) (Correct answer)
- Hand pressure applied to fundus
- Halt oxytocin and call for help
- Hypertonic uterine contraction management
Correct answer: Hyperflexion of maternal thighs (McRoberts maneuver)
In the HELPERR mnemonic for shoulder dystocia, 'H' stands for McRoberts maneuver — hyperflexing the maternal thighs onto the abdomen to flatten lumbar lordosis and widen the pelvic outlet.
Question 5: A multiparous patient delivers within 2 hours of the onset of regular contractions. Her birth is classified as:
- Active phase arrest
- Precipitous labor (Correct answer)
- Prolonged latent phase
- Second stage failure to progress
Correct answer: Precipitous labor
Precipitous labor is defined as labor and delivery completed in less than 3 hours from the onset of regular contractions and carries risks of perineal trauma and fetal hypoxia.
Question 6: During a vaginal birth, after delivery of the fetal head, external rotation (restitution) occurs. What is the physiologic purpose of this movement?
- To allow the fetal chin to clear the perineum before shoulder delivery
- To realign the fetal head with the fetal spine so the shoulders can descend in the oblique diameter (Correct answer)
- To flex the fetal head to navigate under the pubic symphysis
- To disengage the posterior shoulder from beneath the sacral promontory
Correct answer: To realign the fetal head with the fetal spine so the shoulders can descend in the oblique diameter
External rotation (restitution) realigns the delivered head with the fetal body so the shoulders can rotate into the anteroposterior diameter of the outlet for delivery.
Question 7: A patient at 40 weeks reports decreased fetal movement for the past 24 hours. The nurse performs a nonstress test (NST). The tracing shows two accelerations in 30 minutes, each reaching 15 bpm above baseline and lasting 15 seconds. How should the nurse interpret this result?
- Nonreactive NST — further evaluation with a biophysical profile is needed
- Reactive NST — reassuring finding indicating adequate fetal oxygenation (Correct answer)
- Indeterminate NST — continue monitoring for another 30 minutes
- Abnormal NST — immediate cesarean delivery is indicated
Correct answer: Reactive NST — reassuring finding indicating adequate fetal oxygenation
A reactive NST requires at least two accelerations of 15 bpm lasting 15 seconds within 20–40 minutes, which is a reassuring sign of fetal well-being.
Obstetric Nurse Test Obstetric Nurse Labor and Birth Process 5
A laboring patient at 34 weeks gestation presents with preterm labor.
After confirming the diagnosis, which medication would the nurse anticipate giving to promote fetal lung maturity?