Obstetric Nurse Test Obstetric Nurse Obstetric Emergencies 4 — Questions and Answers
Question 1: When using the Zavanelli maneuver for an unresolvable shoulder dystocia, the nurse should FIRST:
- Prepare for immediate cesarean delivery
- Apply suprapubic pressure continuously
- Administer a tocolytic agent to relax the uterus (Correct answer)
- Perform an episiotomy
Correct answer: Administer a tocolytic agent to relax the uterus
A tocolytic is administered to relax the uterus so the fetal head can be reinserted into the vagina before emergency cesarean delivery.
Question 2: A primigravida is 42 weeks gestation and begins laboring. During monitoring, the nurse notes variable decelerations with slow return to baseline and loss of variability. These findings suggest:
- Umbilical cord compression with possible fetal acidosis (Correct answer)
- Uteroplacental insufficiency
- Fetal sleep cycle
- Normal response to uterine contractions
Correct answer: Umbilical cord compression with possible fetal acidosis
Variable decelerations with slow return to baseline and loss of variability are non-reassuring signs suggesting cord compression and evolving fetal acidosis.
Question 3: During a precipitous delivery, the nurse delivers the fetal head and notes the face is looking upward (occiput posterior). Before delivering the shoulders, the nurse should:
- Allow the head to restitute naturally before assisting shoulder delivery (Correct answer)
- Apply downward traction immediately to deliver the anterior shoulder
- Perform the Woods screw maneuver
- Call for emergency assistance before proceeding
Correct answer: Allow the head to restitute naturally before assisting shoulder delivery
Allowing natural restitution aligns the fetal shoulders with the pelvis before applying traction, reducing risk of shoulder dystocia.
Question 4: A patient at 36 weeks presents with sudden severe chest pain, dyspnea, and hypoxia following artificial rupture of membranes. Oxygen saturation drops to 82%. The MOST likely diagnosis is:
- Amniotic fluid embolism (Correct answer)
- Pulmonary embolism
- Spontaneous pneumothorax
- Acute pulmonary edema from preeclampsia
Correct answer: Amniotic fluid embolism
Sudden cardiovascular collapse with hypoxia immediately after membrane rupture is the classic presentation of amniotic fluid embolism.
Question 5: In the management of uterine inversion, the nurse should anticipate which medication to be administered BEFORE manual replacement of the uterus?
- Terbutaline or nitroglycerin for uterine relaxation (Correct answer)
- Oxytocin to stimulate uterine contraction
- Methylergonovine to control hemorrhage
- Magnesium sulfate for neuroprotection
Correct answer: Terbutaline or nitroglycerin for uterine relaxation
Uterine relaxation with tocolytics (terbutaline, nitroglycerin) is required before manual replacement of the inverted uterus.
Question 6: Which action is CONTRAINDICATED during management of a prolapsed umbilical cord before delivery?
- Attempting to push the cord back into the uterus (Correct answer)
- Elevating the presenting part manually
- Placing the patient in knee-chest or Trendelenburg position
- Covering the cord with a warm saline-moistened gauze if it is outside the vagina
Correct answer: Attempting to push the cord back into the uterus
Attempting to reinsert the cord can cause vasospasm and further compromise fetal blood flow; cord decompression is managed by elevating the presenting part.
Question 7: A postpartum patient has uterine atony unresponsive to oxytocin and methylergonovine. The nurse prepares to administer carboprost (Hemabate). Which pre-existing condition is a contraindication to this drug?
- Asthma (Correct answer)
- Hypertension
- Diabetes mellitus
- Hypothyroidism
Correct answer: Asthma
Carboprost (a prostaglandin F2-alpha analog) causes bronchoconstriction and is contraindicated in patients with asthma.
Obstetric Nurse Test Obstetric Nurse Obstetric Emergencies 4
When using the Zavanelli maneuver for an unresolvable shoulder dystocia, the nurse should FIRST: