NURS 316L | NURS316L Exam 4: OB Clinical - WCU
Updated and Latest Questions and Correct
Answers with Rationale
1. A nurse is caring for a patient who is 32 weeks pregnant and presents with sudden,
painless vaginal bleeding. What is the most likely diagnosis?
A. Abruptio placentae
B. Placenta previa
C. Uterine rupture
D. Ectopic pregnancy
Correct Answer: B
Rationale: Placenta previa is characterized by painless, bright red vaginal bleeding in the
third trimester. This occurs because the placenta is implanted over or near the cervical os.
In contrast, abruptio placentae typically presents with painful bleeding and uterine rigidity.
Early detection is critical to prevent maternal hemorrhage and fetal hypoxia. The nurse
must avoid vaginal exams in patients with suspected placenta previa.
2. A patient receiving magnesium sulfate for preeclampsia has a respiratory rate of 10
breaths/minute and absent deep tendon reflexes. What is the priority nursing action?
A. Increase the IV fluid rate
B. Stop the magnesium sulfate infusion
C. Administer calcium gluconate
D. Notify the provider immediately
Correct Answer: B
Rationale: The first action for suspected magnesium toxicity is to immediately discontinue
the infusion. Absent reflexes and respiratory depression are classic signs that the
magnesium level is too high. Once the infusion is stopped, the nurse should then prepare to
administer the antagonist, calcium gluconate. Continuous monitoring of the patient’s status
is essential during this emergency. Prompt intervention prevents cardiac or respiratory
arrest in the mother.
3. Which medication is contraindicated for a postpartum patient experiencing hemorrhage
who has a history of asthma?
A. Carboprost tromethamine (Hemabate)
B. Methylergonovine (Methergine)
C. Oxytocin (Pitocin)
,D. Misoprostol (Cytotec)
Correct Answer: A
Rationale: Carboprost tromethamine, also known as Hemabate, can cause severe
bronchoconstriction and is contraindicated in patients with asthma. It is a prostaglandin
used to treat uterine atony when other measures fail. Nurses must review the patient’s
medical history for respiratory conditions before administration. Alternative medications
like Methergine or Cytotec should be considered depending on other comorbidities.
Monitoring breath sounds after administration is a necessary nursing assessment.
4. A nurse is preparing to administer betamethasone to a patient at 30 weeks gestation in
preterm labor. What is the primary purpose of this medication?
A. To stop uterine contractions
B. To prevent neonatal group B strep infection
C. To increase maternal blood pressure
D. To promote fetal lung maturity
Correct Answer: D
Rationale: Betamethasone is a corticosteroid given to pregnant women at risk for preterm
birth to accelerate fetal lung development. It stimulates the production of surfactant, which
reduces the risk of respiratory distress syndrome in the neonate. The standard dosing
involves two intramuscular injections given 24 hours apart. This intervention significantly
improves outcomes for infants born before 34 weeks of gestation. Nurses should monitor
the mother for increased blood glucose levels following administration.
5. During a delivery, the nurse notes the fetal head emerges but then retracts against the
perineum (turtle sign). What is the priority intervention?
A. Apply fundal pressure
B. Perform the McRoberts maneuver
C. Administer oxygen via non-rebreather
D. Increase the oxytocin infusion
Correct Answer: B
Rationale: The turtle sign is a primary indicator of shoulder dystocia, an obstetric
emergency. The McRoberts maneuver involves flexing the mother’s thighs toward her
abdomen to widen the pelvic outlet. Fundal pressure is strictly contraindicated as it can
further impact the shoulder and cause uterine rupture. Suprapubic pressure may also be
applied to help dislodge the anterior shoulder. Rapid response and coordination of the
healthcare team are vital for a safe delivery.
, 6. A nurse is monitoring a patient in labor and observes a pattern of late decelerations on the
fetal monitor. What is the most likely cause of this finding?
A. Umbilical cord compression
B. Fetal head compression
C. Maternal hypotension
D. Uteroplacental insufficiency
Correct Answer: D
Rationale: Late decelerations are caused by uteroplacental insufficiency, meaning the fetus
is not receiving enough oxygen during contractions. These decelerations begin after the
peak of the contraction and return to baseline after the contraction ends. They are
considered a non-reassuring sign and require immediate nursing intervention. The nurse
should reposition the mother, increase IV fluids, and provide oxygen. Chronic conditions
like preeclampsia or post-term pregnancy often contribute to this issue.
7. What is the first nursing action when a prolapsed umbilical cord is suspected?
A. Call the provider for an emergency cesarean section
B. Apply sterile saline soaks to the cord
C. Place the patient in the Trendelenburg or knee-chest position
D. Perform a vaginal exam to push the cord back into the uterus
Correct Answer: C
Rationale: When a cord prolapse occurs, the immediate goal is to relieve pressure on the
cord to maintain fetal oxygenation. Placing the mother in a Trendelenburg or knee-chest
position uses gravity to shift the fetus away from the pelvis. The nurse should also use a
gloved hand to manually lift the presenting part off the cord. Oxygen should be
administered to the mother to maximize fetal delivery. This situation is a surgical
emergency requiring rapid preparation for delivery.
8. A postpartum patient presents with saturated perineal pads every 15 minutes and a boggy
uterus. Which intervention should the nurse perform first?
A. Administer Methergine IM
B. Massage the uterine fundus
C. Insert a second large-bore IV line
D. Catheterize the patient to empty the bladder
Correct Answer: B
Updated and Latest Questions and Correct
Answers with Rationale
1. A nurse is caring for a patient who is 32 weeks pregnant and presents with sudden,
painless vaginal bleeding. What is the most likely diagnosis?
A. Abruptio placentae
B. Placenta previa
C. Uterine rupture
D. Ectopic pregnancy
Correct Answer: B
Rationale: Placenta previa is characterized by painless, bright red vaginal bleeding in the
third trimester. This occurs because the placenta is implanted over or near the cervical os.
In contrast, abruptio placentae typically presents with painful bleeding and uterine rigidity.
Early detection is critical to prevent maternal hemorrhage and fetal hypoxia. The nurse
must avoid vaginal exams in patients with suspected placenta previa.
2. A patient receiving magnesium sulfate for preeclampsia has a respiratory rate of 10
breaths/minute and absent deep tendon reflexes. What is the priority nursing action?
A. Increase the IV fluid rate
B. Stop the magnesium sulfate infusion
C. Administer calcium gluconate
D. Notify the provider immediately
Correct Answer: B
Rationale: The first action for suspected magnesium toxicity is to immediately discontinue
the infusion. Absent reflexes and respiratory depression are classic signs that the
magnesium level is too high. Once the infusion is stopped, the nurse should then prepare to
administer the antagonist, calcium gluconate. Continuous monitoring of the patient’s status
is essential during this emergency. Prompt intervention prevents cardiac or respiratory
arrest in the mother.
3. Which medication is contraindicated for a postpartum patient experiencing hemorrhage
who has a history of asthma?
A. Carboprost tromethamine (Hemabate)
B. Methylergonovine (Methergine)
C. Oxytocin (Pitocin)
,D. Misoprostol (Cytotec)
Correct Answer: A
Rationale: Carboprost tromethamine, also known as Hemabate, can cause severe
bronchoconstriction and is contraindicated in patients with asthma. It is a prostaglandin
used to treat uterine atony when other measures fail. Nurses must review the patient’s
medical history for respiratory conditions before administration. Alternative medications
like Methergine or Cytotec should be considered depending on other comorbidities.
Monitoring breath sounds after administration is a necessary nursing assessment.
4. A nurse is preparing to administer betamethasone to a patient at 30 weeks gestation in
preterm labor. What is the primary purpose of this medication?
A. To stop uterine contractions
B. To prevent neonatal group B strep infection
C. To increase maternal blood pressure
D. To promote fetal lung maturity
Correct Answer: D
Rationale: Betamethasone is a corticosteroid given to pregnant women at risk for preterm
birth to accelerate fetal lung development. It stimulates the production of surfactant, which
reduces the risk of respiratory distress syndrome in the neonate. The standard dosing
involves two intramuscular injections given 24 hours apart. This intervention significantly
improves outcomes for infants born before 34 weeks of gestation. Nurses should monitor
the mother for increased blood glucose levels following administration.
5. During a delivery, the nurse notes the fetal head emerges but then retracts against the
perineum (turtle sign). What is the priority intervention?
A. Apply fundal pressure
B. Perform the McRoberts maneuver
C. Administer oxygen via non-rebreather
D. Increase the oxytocin infusion
Correct Answer: B
Rationale: The turtle sign is a primary indicator of shoulder dystocia, an obstetric
emergency. The McRoberts maneuver involves flexing the mother’s thighs toward her
abdomen to widen the pelvic outlet. Fundal pressure is strictly contraindicated as it can
further impact the shoulder and cause uterine rupture. Suprapubic pressure may also be
applied to help dislodge the anterior shoulder. Rapid response and coordination of the
healthcare team are vital for a safe delivery.
, 6. A nurse is monitoring a patient in labor and observes a pattern of late decelerations on the
fetal monitor. What is the most likely cause of this finding?
A. Umbilical cord compression
B. Fetal head compression
C. Maternal hypotension
D. Uteroplacental insufficiency
Correct Answer: D
Rationale: Late decelerations are caused by uteroplacental insufficiency, meaning the fetus
is not receiving enough oxygen during contractions. These decelerations begin after the
peak of the contraction and return to baseline after the contraction ends. They are
considered a non-reassuring sign and require immediate nursing intervention. The nurse
should reposition the mother, increase IV fluids, and provide oxygen. Chronic conditions
like preeclampsia or post-term pregnancy often contribute to this issue.
7. What is the first nursing action when a prolapsed umbilical cord is suspected?
A. Call the provider for an emergency cesarean section
B. Apply sterile saline soaks to the cord
C. Place the patient in the Trendelenburg or knee-chest position
D. Perform a vaginal exam to push the cord back into the uterus
Correct Answer: C
Rationale: When a cord prolapse occurs, the immediate goal is to relieve pressure on the
cord to maintain fetal oxygenation. Placing the mother in a Trendelenburg or knee-chest
position uses gravity to shift the fetus away from the pelvis. The nurse should also use a
gloved hand to manually lift the presenting part off the cord. Oxygen should be
administered to the mother to maximize fetal delivery. This situation is a surgical
emergency requiring rapid preparation for delivery.
8. A postpartum patient presents with saturated perineal pads every 15 minutes and a boggy
uterus. Which intervention should the nurse perform first?
A. Administer Methergine IM
B. Massage the uterine fundus
C. Insert a second large-bore IV line
D. Catheterize the patient to empty the bladder
Correct Answer: B
