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Advanced Obstetric and Newborn Concepts – Quiz 8

Question 1 of 30

A laboring client develops hypotension, fetal late decelerations, and uterine tachysystole after initiation of oxytocin. What is the nurse’s priority action?

Select one answer.

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Advanced Obstetric and Newborn Concepts – Quiz 8 Practice Questions

Review these Advanced Obstetric and Newborn Concepts – Quiz 8 nursing practice questions with answer choices and explanations.

Question 1

A laboring client develops hypotension, fetal late decelerations, and uterine tachysystole after initiation of oxytocin. What is the nurse’s priority action?

  1. Increase the oxytocin infusion
  2. Administer an IV fluid bolus and stop oxytocin
  3. Place the client in supine position
  4. Prepare for immediate vaginal delivery
View answer and explanation

Correct answer:

  1. Administer an IV fluid bolus and stop oxytocin

Explanation: Oxytocin should be stopped immediately and intrauterine resuscitation initiated. IV fluids and stopping oxytocin improve uteroplacental perfusion and reduce tachysystole.

Question 2

Which fetal heart rate tracing finding most strongly indicates fetal metabolic acidemia?

  1. Early decelerations with contractions
  2. Moderate variability with accelerations
  3. Absent variability with recurrent late decelerations
  4. Variable decelerations that resolve with position change
View answer and explanation

Correct answer:

  1. Absent variability with recurrent late decelerations

Explanation: Absent variability combined with recurrent late decelerations is highly concerning for fetal hypoxia and metabolic acidemia.

Question 3

A postpartum client has heavy bleeding, a firm uterus, and a large clot at the cervical os. What is the most likely cause?

  1. Uterine atony
  2. Retained placental fragments
  3. Genital tract laceration
  4. Coagulopathy
View answer and explanation

Correct answer:

  1. Genital tract laceration

Explanation: Heavy bleeding with a firm uterus suggests bleeding from lacerations rather than uterine atony.

Question 4

Which condition is most associated with shoulder dystocia?

  1. Placenta previa
  2. Preterm labor
  3. Fetal macrosomia
  4. Oligohydramnios
View answer and explanation

Correct answer:

  1. Fetal macrosomia

Explanation: Macrosomia increases the risk that the anterior shoulder will become impacted behind the maternal symphysis pubis.

Question 5

Which intervention best reduces the risk of neonatal hypothermia immediately after birth?

  1. Delayed bathing
  2. Early heel stick
  3. Swaddling after assessment
  4. Routine suctioning
View answer and explanation

Correct answer:

  1. Delayed bathing

Explanation: Delaying the first bath prevents heat loss from evaporation and helps maintain newborn temperature.

Question 6

A client with severe preeclampsia is receiving magnesium sulfate. Which assessment finding indicates magnesium toxicity?

  1. Urine output of 35 mL/hr
  2. Respiratory rate of 10 breaths/min
  3. Deep tendon reflexes 2+
  4. Blood pressure of 150/95 mm Hg
View answer and explanation

Correct answer:

  1. Respiratory rate of 10 breaths/min

Explanation: Respiratory depression is a key sign of magnesium toxicity and requires immediate intervention.

Question 7

Which laboratory value is most concerning in a pregnant client with suspected HELLP syndrome?

  1. Platelets 85,000/mm³
  2. Hemoglobin 12 g/dL
  3. WBC 11,000/mm³
  4. Hematocrit 36%
View answer and explanation

Correct answer:

  1. Platelets 85,000/mm³

Explanation: Thrombocytopenia is a hallmark of HELLP syndrome and increases bleeding risk.

Question 8

Which fetal presentation is an absolute contraindication to vaginal birth?

  1. Frank breech
  2. Footling breech
  3. Occiput posterior
  4. Face presentation (mentum anterior)
View answer and explanation

Correct answer:

  1. Footling breech

Explanation: Footling breech presents a high risk of cord prolapse and is an absolute contraindication to vaginal delivery.

Question 9

Which finding best differentiates placental abruption from placenta previa?

  1. Bright red vaginal bleeding
  2. Painless bleeding
  3. Uterine tenderness and pain
  4. Bleeding after intercourse
View answer and explanation

Correct answer:

  1. Uterine tenderness and pain

Explanation: Placental abruption is classically associated with painful bleeding and uterine tenderness.

Question 10

A newborn of a diabetic mother is jittery and lethargic. Which intervention is priority?

  1. Administer IV calcium
  2. Initiate early feeding and check blood glucose
  3. Provide supplemental oxygen
  4. Obtain a complete blood count
View answer and explanation

Correct answer:

  1. Initiate early feeding and check blood glucose

Explanation: Infants of diabetic mothers are at risk for hypoglycemia; early feeding and glucose monitoring are priority.

Question 11

Which maternal condition most increases the risk for uterine rupture?

  1. Grand multiparity
  2. Previous cesarean birth with classical incision
  3. Induction with prostaglandins
  4. Prolonged second stage of labor
View answer and explanation

Correct answer:

  1. Previous cesarean birth with classical incision

Explanation: A prior classical (vertical) uterine incision carries the highest risk of rupture.

Question 12

Which fetal monitoring parameter reflects long-term autonomic nervous system integrity?

  1. Baseline heart rate
  2. Variability
  3. Accelerations
  4. Decelerations
View answer and explanation

Correct answer:

  1. Variability

Explanation: Variability reflects the balance of sympathetic and parasympathetic activity and overall fetal well-being.

Question 13

Which maternal condition is most associated with postpartum endometritis?

  1. Short labor
  2. Prolonged rupture of membranes
  3. Multiparity
  4. Early ambulation
View answer and explanation

Correct answer:

  1. Prolonged rupture of membranes

Explanation: Prolonged rupture of membranes increases ascending infection risk.

Question 14

Which acid–base change is expected in a newborn with prolonged hypoxia?

  1. Respiratory alkalosis
  2. Metabolic acidosis
  3. Metabolic alkalosis
  4. Respiratory acidosis only
View answer and explanation

Correct answer:

  1. Metabolic acidosis

Explanation: Prolonged hypoxia leads to anaerobic metabolism and lactic acid accumulation, causing metabolic acidosis.

Question 15

Which finding most strongly suggests amniotic fluid embolism?

  1. Gradual onset dyspnea
  2. Sudden respiratory distress and hypotension
  3. Fever and uterine tenderness
  4. Slow, progressive hemorrhage
View answer and explanation

Correct answer:

  1. Sudden respiratory distress and hypotension

Explanation: Amniotic fluid embolism presents abruptly with respiratory failure, hypotension, and DIC.

Question 16

Which factor most increases neonatal bilirubin production?

  1. Delayed cord clamping
  2. Polycythemia
  3. Breastfeeding
  4. Early feeding
View answer and explanation

Correct answer:

  1. Polycythemia

Explanation: Polycythemia increases red blood cell breakdown, leading to higher bilirubin levels.

Question 17

Which maternal medication exposure is most strongly associated with premature closure of the ductus arteriosus?

  1. Acetaminophen
  2. Aspirin and NSAIDs
  3. Penicillin
  4. Magnesium sulfate
View answer and explanation

Correct answer:

  1. Aspirin and NSAIDs

Explanation: NSAIDs inhibit prostaglandin synthesis, which can prematurely close the ductus arteriosus.

Question 18

Which assessment best evaluates the effectiveness of postpartum hemorrhage management?

  1. Maternal hemoglobin level
  2. Uterine tone and lochia amount
  3. Maternal pain score
  4. Newborn APGAR score
View answer and explanation

Correct answer:

  1. Uterine tone and lochia amount

Explanation: Uterine firmness and decreased lochia indicate effective control of bleeding.

Question 19

Which complication is most associated with vacuum-assisted birth?

  1. Erb palsy
  2. Cephalohematoma
  3. Intracranial hemorrhage
  4. Shoulder dystocia
View answer and explanation

Correct answer:

  1. Cephalohematoma

Explanation: Vacuum extraction increases the risk of cephalohematoma due to subperiosteal bleeding.

Question 20

Which physiologic change explains increased risk of thromboembolism in pregnancy?

  1. Decreased clotting factors
  2. Hypercoagulable state
  3. Reduced blood viscosity
  4. Decreased platelet aggregation
View answer and explanation

Correct answer:

  1. Hypercoagulable state

Explanation: Pregnancy is a hypercoagulable state that increases thromboembolism risk.

Question 21

Which fetal assessment finding most indicates adequate oxygenation during labor?

  1. Baseline heart rate of 170 bpm
  2. Early decelerations
  3. Spontaneous accelerations
  4. Minimal variability
View answer and explanation

Correct answer:

  1. Spontaneous accelerations

Explanation: Spontaneous accelerations are a reassuring sign of adequate fetal oxygenation.

Question 22

Which maternal condition is a contraindication to breastfeeding?

  1. Hepatitis B infection
  2. HIV infection
  3. Gestational diabetes
  4. Mastitis
View answer and explanation

Correct answer:

  1. HIV infection

Explanation: HIV can be transmitted through breast milk; breastfeeding is contraindicated.

Question 23

Which newborn finding most suggests persistent pulmonary hypertension of the newborn (PPHN)?

  1. Improved oxygenation with crying
  2. Preductal and postductal oxygen saturation difference
  3. Bradycardia with apnea
  4. Jaundice in the first 24 hours
View answer and explanation

Correct answer:

  1. Preductal and postductal oxygen saturation difference

Explanation: A difference between preductal and postductal saturations indicates right-to-left shunting seen in PPHN.

Question 24

Which intrapartum factor most increases the risk of neonatal sepsis?

  1. Maternal hypotension
  2. Prolonged labor
  3. Prolonged rupture of membranes
  4. Epidural anesthesia
View answer and explanation

Correct answer:

  1. Prolonged rupture of membranes

Explanation: Prolonged rupture of membranes increases ascending infection risk to the fetus.

Question 25

Which finding is most consistent with uterine inversion?

  1. Boggy uterus above the umbilicus
  2. Severe pain and hemorrhage with absent fundus
  3. Firm uterus with minimal bleeding
  4. Gradual onset postpartum bleeding
View answer and explanation

Correct answer:

  1. Severe pain and hemorrhage with absent fundus

Explanation: Uterine inversion presents with acute pain, hemorrhage, and a non-palpable fundus.

Question 26

Which newborn blood gas finding indicates adequate ventilation?

  1. pH 7.20
  2. PaCO₂ 60 mm Hg
  3. PaCO₂ 40 mm Hg
  4. Base deficit −10
View answer and explanation

Correct answer:

  1. PaCO₂ 40 mm Hg

Explanation: A PaCO₂ around 40 mm Hg reflects normal ventilation.

Question 27

Which maternal assessment is most predictive of postpartum hemorrhage risk?

  1. History of precipitous labor
  2. Uterine overdistention
  3. Maternal age over 35
  4. Primiparity
View answer and explanation

Correct answer:

  1. Uterine overdistention

Explanation: Uterine overdistention (e.g., multiple gestation, polyhydramnios) predisposes to uterine atony.

Question 28

Which newborn finding requires immediate intervention?

  1. Acrocyanosis
  2. Respiratory rate of 58 breaths/min
  3. Central cyanosis
  4. Transient tremors with crying
View answer and explanation

Correct answer:

  1. Central cyanosis

Explanation: Central cyanosis indicates inadequate oxygenation and is a medical emergency.

Question 29

Which maternal complication is most associated with prolonged oxytocin administration?

  1. Hypernatremia
  2. Water intoxication
  3. Metabolic alkalosis
  4. Pulmonary embolism
View answer and explanation

Correct answer:

  1. Water intoxication

Explanation: Oxytocin has antidiuretic properties and prolonged use can cause water intoxication.

Question 30

Which newborn reflex disappearance time best indicates normal neurologic development?

  1. Moro reflex disappears by 2 months
  2. Rooting reflex disappears by 1 year
  3. Palmar grasp disappears by 4–6 months
  4. Babinski reflex disappears by 2 weeks
View answer and explanation

Correct answer:

  1. Palmar grasp disappears by 4–6 months

Explanation: The palmar grasp normally disappears by 4–6 months, reflecting appropriate neurologic maturation.