Maternity practice questions

Question 1

A client has just delivered the placenta after a vaginal birth and is stable. The nurse plans the recovery assessments. How often are these checks performed over the next two hours?

Accepted Answer

C: Every 15 minutes for the full two hours.. The fourth stage of labor covers the first two hours after the placenta is delivered, and assessment during it is carried out every fifteen minutes, which is four times an hour. This interval applies through both hours rather than tapering after the first, because the risk of hemorrhage does not fall away at the sixty-minute mark and a uterus can relax at any point in that window.

The interval is chosen to match how quickly blood can be lost. A uterus that stops contracting can produce a large loss within minutes, and the definition of excessive bleeding is a pad soaked in fifteen minutes or less. Checking on that same interval means the nurse sees a pad at each point where it could have filled, rather than discovering it afterwards.

Each round covers the same ground, so that findings can be compared directly from one check to the next. Vital signs, the fundus, the pads and the linen beneath the client are all assessed every time, and each is recorded. A trend across four consecutive entries carries far more information than any single set of numbers.

Question 2

A parent asks the nurse what jaundice actually is. Which response is correct?

Accepted Answer

A: "It is a yellow color in the skin and eyes from too much bilirubin in the blood.". Jaundice is what excess bilirubin in the blood looks like from the outside: yellow skin and yellow sclerae. It is a sign rather than a disease, and the questions it raises are how high the level is and how fast it is climbing.

The sclera is where to look, particularly in a baby with darker skin, because the yellow shows there before it shows anywhere else. Pressing the skin over a bony point and watching the color that blanches back is the other bedside check.

Question 3

Two hours after a vaginal birth a nurse finds the fundus boggy, midline and at the level of the umbilicus. The client emptied the bladder ten minutes ago. Which action should the nurse take first?

Accepted Answer

C: Massage the fundus until it becomes firm. A boggy fundus means the uterine muscle has relaxed, and a relaxed uterus cannot compress the vessels left open where the placenta separated. Blood loss can become heavy within minutes, so loss of tone is treated at once rather than reported and watched. The first nursing action for a uterus that has lost tone is fundal massage, which stimulates the muscle to contract.

Position tells the nurse why the tone was lost. This fundus is midline, so nothing is displacing the uterus, and the bladder was emptied only ten minutes earlier. That combination points to simple uterine relaxation rather than to a distended bladder, and it means massage can be started immediately without first working on the bladder.

The nurse supports the lower uterine segment with one hand and massages the fundus with the other until it firms, then watches the pad for the amount of lochia expressed during massage. If the fundus does not stay firm, or if bleeding is heavy, the provider is notified and the client is reassessed frequently rather than at the scheduled interval.

Question 4

During a 37-week prenatal visit, the nurse is teaching a 23-year-old nulliparous client who plans to give birth at a hospital birth center 30 minutes from home. Which of the following should the nurse include as reasons for the client to come to the birth center?

Accepted Answer

A: Regular contractions every 5 minutes for 1 hour; B: A gush or steady trickle of fluid from the vagina; D: Bright red vaginal bleeding heavier than spotting; E: Fewer fetal movements than the baby's usual pattern. A nulliparous client is usually told to come in when contractions are regular, about every 5 minutes, for 1 hour, because early labor in a first birth is long and a client sent home in the latent phase tends to receive more interventions. Rupture of membranes needs evaluation whatever the contraction pattern, because of the risk of cord prolapse and infection. Bright red bleeding, more than spotting, may signal placental abruption or placenta previa. A drop in fetal movement can be an early sign of fetal compromise and needs monitoring the same day.

Question 5

A nurse checks a client one hour after a clean perineal pad was applied and finds a stain about five inches across, with no clots. How should this drainage be recorded?

Accepted Answer

D: Moderate. Drainage after birth is estimated from how much of the pad is stained in a known period of time, which is why the nurse notes when the pad was applied. A stain measuring about four to six inches on a pad in one hour is recorded as moderate drainage. This client has a five inch stain in exactly one hour, which sits in the middle of that range.

The time interval is as important as the size of the stain. A stain of a given size means something quite different over four hours than over fifteen minutes, so a pad that is not timed cannot be judged. Drainage that soaks a pad within fifteen minutes or less is excessive and is reported immediately, whatever the appearance of the stain.

Estimating drainage this way keeps records consistent between nurses and makes a change in the amount easier to see across a shift. The nurse records the size of the stain, the time the pad was in place, the color, and whether clots were present, and pairs that record with the tone and position of the fundus, since drainage is interpreted alongside how well the uterus is contracting.

Question 6

Three hours after a gush of clear fluid, a client at 39 weeks of gestation arrives on the labor unit. Rupture of the membranes is confirmed, contractions have not begun, her group B streptococcus culture is positive, and her temperature is 98.6 F (37 C). Which prescription should the nurse question?

Accepted Answer

A: Perform a digital cervical examination every 2 hours. Once the membranes have ruptured, every vaginal examination carries bacteria from the vagina toward the uterus and raises the risk of intraamniotic infection. The number of digital exams is kept as low as possible, and routine checks every 2 hours before active labor are not appropriate. The nurse should clarify this prescription with the health care provider. At term, inducing labor promptly after rupture lowers the rate of maternal and newborn infection compared with waiting, and a client who carries group B streptococcus needs intravenous prophylaxis during labor.

Question 7

A nurse assesses a client twenty-four hours after a vaginal birth. Which fundal finding on the assessment record is consistent with normal involution at this point in the postpartum period?

Accepted Answer

A: Firm, midline, one fingerbreadth below the umbilicus. The fundus is the most important part of the postpartum assessment because uterine tone is what controls bleeding from the placental site. Immediately after birth the fundus is expected at the level of the umbilicus, and from there it descends about one centimeter, or one fingerbreadth, with each passing day as involution proceeds. Twenty-four hours after a vaginal birth, one fingerbreadth below the umbilicus is the expected position.

Tone and position matter as much as height. A firm fundus means the muscle fibers are clamped down on the open vessels where the placenta separated, so bleeding stays within normal limits. A midline fundus means nothing is pushing the uterus out of place, and a full bladder is the usual reason a fundus drifts to one side and rises higher than the day would predict.

Putting the three together, a fundus that is firm, midline and one fingerbreadth below the umbilicus at twenty-four hours is exactly what involution should look like. The nurse records the finding, continues the assessment every four to eight hours, and has the client empty the bladder before each check so that the height being recorded reflects the uterus rather than a full bladder.

Question 8

The labor and birth nurse reviews the prenatal records of five clients. Which of the following clients should the nurse expect to receive intrapartum antibiotic prophylaxis for group B streptococcus?

Accepted Answer

B: A client at 38 weeks in active labor who had group B streptococcus bacteriuria at 14 weeks and a negative rectovaginal culture at 36 weeks; C: A client at 34 weeks in preterm labor whose group B streptococcus status is unknown; D: A client at 39 weeks in active labor whose rectovaginal culture at 36 weeks was positive. Group B streptococcus is a bacterium that colonizes the vagina and rectum of about 1 in 4 pregnant clients without causing symptoms. A newborn exposed during birth can develop early-onset sepsis, pneumonia, or meningitis. Universal screening with a rectovaginal swab at 36 0/7 to 37 6/7 weeks, and IV antibiotics in labor for those who need them, prevents most early-onset disease.

A positive culture at 36 weeks is the usual indication. Group B streptococcus found in the urine at any time in the pregnancy means heavy colonization, so the client gets antibiotics in labor whatever a later swab shows. A client in preterm labor whose status is unknown also gets them, because preterm newborns are at the highest risk and there is no result to rely on.

Question 9

A client with mitral valve disease is admitted in active labor at 39 weeks' gestation. Which of the following measures should the nurse include in the client's plan of care?

Accepted Answer

A: Position the client on her side with the head of the bed raised; C: Assess the client's lung sounds frequently throughout labor; D: Prepare for an assisted birth to shorten the second stage. Labor adds the work of contractions to an already loaded heart, and each contraction squeezes about 300 to 500 mL of blood from the uterus back into the circulation. Lying on the side with the head raised keeps the uterus off the inferior vena cava and makes breathing easier. Lung sounds are checked often, because crackles may be the first sign of pulmonary edema.

The second stage is kept short. The provider often uses forceps or vacuum to assist the birth, and the client is coached to push gently without holding her breath for long periods. Effective epidural analgesia is also commonly used to reduce the strain of pain on the heart.

Question 10

A 37-year-old client, gravida 4 para 3, at 33 weeks gestation is brought to labor and delivery after a minor car crash. Her blood pressure is 152/96. Which of the following findings would be consistent with a placental abruption?

Accepted Answer

A: Constant abdominal pain that does not ease between contractions; B: A uterus that feels hard and board-like on palpation; C: Dark red vaginal bleeding that may underestimate the blood loss; E: Late decelerations of the fetal heart rate with each contraction. A placental abruption is the premature separation of a normally placed placenta from the uterine wall. Blood collects behind the placenta, and that trapped blood explains almost every finding.

It irritates the muscle of the uterus, so the client has constant pain and the uterus becomes rigid and board-like, often with frequent small contractions. The blood that does escape has been sitting behind the placenta and is dark red, and because some or all of it is concealed, the bleeding seen can be far less than the blood actually lost. As the placenta separates, the surface left to supply the fetus shrinks, and late decelerations show that the fetus is not getting enough oxygen.

This client has three risk factors stacked together: trauma to the abdomen, high blood pressure, and age over 35 with several previous pregnancies. Cocaine use is another classic one.

Maternity practice questions.