Obstetric Nurse Test Obstetric Nurse Obstetric Emergencies 5 — Questions and Answers
Question 1: A laboring patient on continuous electronic fetal monitoring develops late decelerations with every contraction and decreased variability. After repositioning and applying oxygen, the nurse should:
- Discontinue oxytocin infusion and notify the provider (Correct answer)
- Increase the oxytocin rate to shorten the labor
- Perform an amnioinfusion
- Prepare for immediate vacuum-assisted delivery
Correct answer: Discontinue oxytocin infusion and notify the provider
Persistent late decelerations with decreased variability indicate uteroplacental insufficiency; discontinuing oxytocin reduces uterine activity and improves placental perfusion.
Question 2: A patient 20 minutes postpartum has saturated four perineal pads and her fundus is firm at the umbilicus. The MOST likely cause of hemorrhage in this scenario is:
- Lacerations of the birth canal (Correct answer)
- Uterine atony
- Retained placental fragments
- Coagulopathy
Correct answer: Lacerations of the birth canal
A firm uterus rules out atony; continued bleeding with a contracted uterus points to lacerations as the source of hemorrhage.
Question 3: Which blood pressure reading meets the threshold for severe-range hypertension in pregnancy according to ACOG guidelines?
- ≥160/110 mmHg (Correct answer)
- ≥140/90 mmHg
- ≥150/100 mmHg
- ≥170/120 mmHg
Correct answer: ≥160/110 mmHg
ACOG defines severe-range hypertension in pregnancy as systolic ≥160 mmHg or diastolic ≥110 mmHg, requiring urgent treatment within 30–60 minutes.
Question 4: A gravida 3 para 2 delivers a 4,200g infant vaginally. After delivery of the placenta, the uterus appears to have turned inside out and is visible at the vaginal introitus. The nurse's IMMEDIATE priority is:
- Call for emergency assistance and do not remove the placenta if still attached (Correct answer)
- Immediately attempt manual replacement of the uterus
- Administer oxytocin to contract the uterus around the inverted portion
- Apply fundal pressure to expel the inverted uterus
Correct answer: Call for emergency assistance and do not remove the placenta if still attached
Calling for help and leaving the placenta attached prevents further hemorrhage; aggressive manual replacement before team assembly increases risk of hemorrhagic shock.
Question 5: During the management of severe postpartum hemorrhage, which combination of actions best reflects the concept of 'hemorrhage bundle' care?
- Quantified blood loss measurement, uterotonic administration, IV access with fluid resuscitation, and activation of massive transfusion protocol when indicated (Correct answer)
- Bimanual compression, oral misoprostol, single IV line, and observation for 30 minutes
- Fundal massage only, bladder catheterization, and oral hydration
- Suprapubic pressure, oxygen therapy, and reassessment in 15 minutes
Correct answer: Quantified blood loss measurement, uterotonic administration, IV access with fluid resuscitation, and activation of massive transfusion protocol when indicated
Hemorrhage bundles include quantified blood loss, structured uterotonic use, IV access, and early activation of massive transfusion protocol to prevent delays in critical care.
Question 6: A patient at 32 weeks gestation is admitted with preterm premature rupture of membranes (PPROM). She has no signs of infection or labor. Which medication is MOST appropriate to administer at this gestational age?
- Betamethasone to promote fetal lung maturity (Correct answer)
- Oxytocin to augment labor
- Magnesium sulfate for seizure prophylaxis
- Terbutaline for long-term tocolysis
Correct answer: Betamethasone to promote fetal lung maturity
Betamethasone is given at 24–34 weeks when preterm delivery is anticipated within 7 days to accelerate fetal lung maturation and reduce neonatal morbidity.
Question 7: A patient at 39 weeks with a category III fetal heart rate tracing (sinusoidal pattern) is undergoing evaluation. The nurse understands that a sinusoidal pattern is associated with:
- Severe fetal anemia or hypoxia requiring emergent delivery (Correct answer)
- Normal fetal sleep cycle
- Maternal opiate administration only
- Benign baseline variability variation
Correct answer: Severe fetal anemia or hypoxia requiring emergent delivery
A true sinusoidal pattern is a uniformly smooth, sine wave-like pattern associated with severe fetal anemia, hypoxia, or fetal compromise, and is a Category III tracing requiring immediate intervention.
Obstetric Nurse Test Obstetric Nurse Obstetric Emergencies 5
A laboring patient on continuous electronic fetal monitoring develops late decelerations with every contraction and decreased variability.
After repositioning and applying oxygen, the nurse should: