Obstetric Nurse Test Obstetric Nurse Obstetric Emergencies 3 — Questions and Answers
Question 1: When performing the McRoberts maneuver for shoulder dystocia, the nurse should:
- Hyperflex the mother's thighs sharply against her abdomen (Correct answer)
- Apply fundal pressure to push the fetus downward
- Rotate the fetal shoulders using internal maneuvers
- Place the patient in knee-chest position
Correct answer: Hyperflex the mother's thighs sharply against her abdomen
McRoberts maneuver involves hyperflexing the maternal thighs to flatten the lumbar lordosis and increase the relative AP diameter of the pelvis.
Question 2: A patient at 30 weeks gestation presents with painless vaginal bleeding following intercourse. Vital signs are stable. The MOST appropriate initial nursing action is:
- Withhold vaginal examination and notify the provider (Correct answer)
- Perform a sterile speculum exam to assess the cervix
- Administer betamethasone and prepare for delivery
- Apply external fetal monitoring and prepare for amniocentesis
Correct answer: Withhold vaginal examination and notify the provider
Painless vaginal bleeding after intercourse in late pregnancy is suspicious for placenta previa; digital vaginal exam is contraindicated until placenta previa is excluded.
Question 3: In postpartum hemorrhage secondary to uterine atony, which intervention should occur BEFORE fundal massage?
- Ensuring the bladder is emptied (Correct answer)
- Administering methylergonovine
- Starting a blood transfusion
- Performing bimanual compression
Correct answer: Ensuring the bladder is emptied
A full bladder displaces the uterus and prevents effective uterine contraction; bladder emptying must occur before fundal massage.
Question 4: Which laboratory finding is characteristic of HELLP syndrome?
- Hemolysis, elevated liver enzymes, and low platelets (Correct answer)
- High hemoglobin, elevated BUN, and low lymphocytes
- Hyperglycemia, elevated lipase, and low platelets
- Hemolysis, elevated LDH, and low leukocytes
Correct answer: Hemolysis, elevated liver enzymes, and low platelets
HELLP stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count, distinguishing it from other pregnancy complications.
Question 5: A nurse is monitoring a patient receiving magnesium sulfate for eclampsia prophylaxis. Which finding warrants IMMEDIATE intervention and withholding the next dose?
- Respiratory rate of 10 breaths per minute (Correct answer)
- Urinary output of 35 mL/hour
- Serum magnesium level of 6 mg/dL
- Loss of deep tendon reflexes
Correct answer: Respiratory rate of 10 breaths per minute
Respiratory depression (RR <12) is a sign of magnesium toxicity and is an immediate life threat requiring the infusion to be stopped.
Question 6: A patient develops an eclamptic seizure. After ensuring airway patency, the nurse's next priority is to:
- Administer magnesium sulfate and position the patient on her left side (Correct answer)
- Insert a tongue blade to prevent biting
- Restrain the patient's extremities to prevent injury
- Perform an emergency vaginal examination
Correct answer: Administer magnesium sulfate and position the patient on her left side
Magnesium sulfate is the drug of choice to stop eclamptic seizures, and left lateral positioning reduces aortocaval compression.
Question 7: A patient at 26 weeks gestation presents with board-like uterine rigidity, constant severe abdominal pain, and dark vaginal bleeding. Fetal heart tones are absent. These findings are MOST consistent with:
- Severe placental abruption with fetal demise (Correct answer)
- Complete placenta previa
- Uterine rupture
- Vasa previa hemorrhage
Correct answer: Severe placental abruption with fetal demise
Severe placental abruption presents with painful, constant contractions, a rigid uterus, concealed or revealed bleeding, and can result in fetal demise.
Obstetric Nurse Test Obstetric Nurse Obstetric Emergencies 3
When performing the McRoberts maneuver for shoulder dystocia, the nurse should: