Review these Advanced Obstetric and Neonatal Management – Quiz 9 nursing practice questions with answer choices and explanations.
A laboring client receiving magnesium sulfate develops absent deep tendon reflexes and decreased urine output. What is the nurse’s priority action?
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Explanation: Absent reflexes and oliguria indicate magnesium toxicity. Calcium gluconate is the antidote and must be administered promptly.
Which fetal heart rate pattern is most consistent with umbilical cord compression?
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Explanation: Variable decelerations are abrupt and vary in timing and shape, commonly caused by umbilical cord compression.
A postpartum client continues to bleed heavily despite a firm uterus and no lacerations noted. Which cause should the nurse suspect?
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Explanation: Persistent bleeding with a firm uterus suggests retained placental tissue preventing adequate uterine contraction.
Which intrapartum complication is most associated with polyhydramnios?
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Explanation: Excessive amniotic fluid increases the risk of umbilical cord prolapse when membranes rupture.
Which maternal condition is a contraindication to the use of methylergonovine for postpartum hemorrhage?
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Explanation: Methylergonovine causes vasoconstriction and is contraindicated in clients with hypertension.
Which fetal monitoring finding indicates the need for immediate intrauterine resuscitation?
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Explanation: Recurrent late decelerations indicate uteroplacental insufficiency and require immediate intervention.
A newborn born at 34 weeks has grunting, nasal flaring, and retractions. Which condition is most likely?
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Explanation: Premature infants lack adequate surfactant, placing them at high risk for respiratory distress syndrome.
Which maternal factor places a client at highest risk for placenta accreta?
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Explanation: Placenta accreta is strongly associated with prior cesarean births due to scarring of the uterine wall.
Which laboratory finding supports a diagnosis of disseminated intravascular coagulation (DIC)?
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Explanation: DIC consumes clotting factors, leading to decreased fibrinogen and platelets.
Which intervention is most effective in preventing intraventricular hemorrhage in preterm infants?
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Explanation: Maintaining a neutral head position helps prevent fluctuations in cerebral blood flow.
Which finding is most indicative of chorioamnionitis?
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Explanation: Foul-smelling amniotic fluid, along with fever and uterine tenderness, suggests intra-amniotic infection.
Which fetal heart rate characteristic reflects adequate fetal oxygen reserves?
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Explanation: Accelerations are a reassuring sign of adequate fetal oxygenation and neurologic integrity.
Which maternal complication is most associated with prolonged shoulder dystocia?
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Explanation: Shoulder dystocia increases the risk of uterine atony and trauma, leading to postpartum hemorrhage.
Which neonatal finding suggests hypocalcemia?
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Explanation: Neonatal hypocalcemia commonly presents with jitteriness, tremors, and possible seizures.
Which maternal condition most increases the risk of postpartum cardiomyopathy?
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Explanation: Preeclampsia is a major risk factor for postpartum cardiomyopathy due to increased cardiac strain.
Which intervention is appropriate for a newborn with suspected meconium aspiration syndrome?
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Explanation: Management focuses on respiratory support; routine aggressive suctioning is no longer recommended.
Which sign best differentiates uterine rupture from placental abruption?
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Explanation: Loss of fetal station is a classic sign of uterine rupture.
Which medication is used to promote fetal lung maturity in preterm labor?
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Explanation: Antenatal corticosteroids such as betamethasone accelerate fetal lung maturity.
Which maternal assessment finding is most concerning in the immediate postpartum period?
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Explanation: A temperature above 38°C after the first 24 hours suggests postpartum infection.
Which newborn condition is associated with maternal diabetes?
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Explanation: Infants of diabetic mothers are at risk for hypoglycemia due to hyperinsulinemia.
Which fetal heart rate pattern indicates a true sinusoidal rhythm?
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Explanation: A sinusoidal pattern is smooth and regular with absent variability and indicates severe fetal compromise.
Which maternal complication is most associated with prolonged labor and chorioamnionitis?
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Explanation: Prolonged labor and infection increase the risk of postpartum endometritis.
Which neonatal assessment finding indicates patent ductus arteriosus (PDA)?
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Explanation: A continuous, machine-like murmur is characteristic of a patent ductus arteriosus.
Which maternal position best improves fetal oxygenation during labor?
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Explanation: Left lateral positioning improves uteroplacental blood flow by reducing vena cava compression.
Which newborn complication is most associated with vacuum-assisted delivery?
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Explanation: Vacuum extraction increases the risk of subgaleal hemorrhage due to scalp vessel injury.
Which maternal finding is most indicative of uterine atony?
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Explanation: A boggy uterus with excessive bleeding is characteristic of uterine atony.
Which neonatal laboratory value is most concerning?
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Explanation: A blood glucose level below 40 mg/dL is concerning for neonatal hypoglycemia.
Which maternal complication is associated with uterine overdistention?
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Explanation: Overdistention impairs uterine contraction, increasing the risk of uterine atony.
Which newborn behavior suggests neurologic impairment?
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Explanation: A high-pitched cry may indicate neurologic injury or increased intracranial pressure.
Which maternal intervention reduces the risk of neonatal group B streptococcal infection?
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Explanation: Intrapartum IV antibiotics significantly reduce neonatal GBS transmission.