Management of high risk labour and complications of third stage
Time: 15:00
A labouring patient's membranes rupture, and the nurse immediately notes a loop of the umbilical cord protruding from the vagina. What is the nurse's priority action?
[a] Administer oxygen to the mother via a face mask.
[b] Place the mother in a high-Fowler's position.
[c] Place the mother in a knee-chest position and manually lift the presenting part off the cord.
[d] Document the finding and notify the physician.
During the delivery of an infant's head, the nurse notes that it retracts against the perineum ("turtle sign"). This is a classic sign of which obstetric emergency?
[a] Uterine rupture.
[b] Umbilical cord prolapse.
[c] Shoulder dystocia.
[d] Precipitous delivery.
What is the nurse's first action when a postpartum haemorrhage (PPH) due to uterine atony is suspected?
[a] Administer a bolus of intravenous fluids.
[b] Obtain a complete blood count (CBC).
[c] Catheterize the bladder.
[d] Massage the uterine fundus firmly.
A patient receiving an oxytocin infusion for labour augmentation develops uterine tachysystole (more than 5 contractions in 10 minutes). What is the nurse's first intervention?
[a] Increase the rate of the oxytocin infusion.
[b] Discontinue the oxytocin infusion.
[c] Place the patient in a supine position.
[d] Perform a vaginal examination.
A labouring woman with a history of a previous caesarean section suddenly complains of severe, sharp abdominal pain and her contractions stop. The fetal heart rate drops dramatically. The nurse should suspect:
[a] Abruptio placentae.
[b] Uterine rupture.
[c] Amniotic fluid embolism.
[d] Placenta previa.
The McRoberts maneuver, used for shoulder dystocia, involves:
[a] Applying firm pressure to the uterine fundus.
[b] Sharply flexing the mother's thighs up against her abdomen.
[c] Placing the mother in a hands-and-knees position.
[d] Performing an emergency episiotomy.
The third stage of labour is considered prolonged, and the placenta is considered "retained," if it is not delivered within what time frame after the baby's birth?
[a] 10 minutes.
[b] 15 minutes.
[c] 20 minutes.
[d] 30 minutes.
A patient is diagnosed with hypotonic uterine dysfunction. The nurse anticipates which intervention to correct this problem?
[a] Administering a tocolytic medication.
[b] Encouraging the patient to rest in a supine position.
[c] Providing sedation to promote rest.
[d] Augmentation of labour with oxytocin.
Applying suprapubic pressure during a shoulder dystocia is a nursing action intended to:
[a] Increase the force of uterine contractions.
[b] Dislodge the impacted anterior shoulder from behind the symphysis pubis.
[c] Assess the strength of the mother's pushing efforts.
[d] Prevent uterine inversion.
Which medication used to manage postpartum haemorrhage is contraindicated in a patient with a history of hypertension?
[a] Oxytocin (Pitocin).
[b] Misoprostol (Cytotec).
[c] Methylergonovine (Methergine).
[d] Dinoprostone (Prostin E2).
Amniotic fluid embolism is a rare but catastrophic complication. The initial signs often include:
[a] A gradual increase in blood pressure and a slow, bounding pulse.
[b] A high fever and uterine tenderness.
[c] Sudden onset of respiratory distress, cyanosis, and cardiovascular collapse.
[d] Painless, bright red vaginal bleeding.
A fetus is identified as being in a persistent occiput posterior (OP) position. The labouring mother is likely to experience:
[a] A rapid, precipitous labour.
[b] Severe back pain ("back labour").
[c] A painless labour.
[d] An early urge to push before full dilatation.
What is the primary maternal risk associated with a precipitous labour (labour lasting less than 3 hours)?
[a] Fetal distress.
[b] Failure to progress.
[c] Perineal lacerations and postpartum haemorrhage.
[d] Post-term pregnancy.
The nurse must inspect the placenta after delivery to ensure it is intact because retained placental fragments are a major cause of:
[a] Uterine rupture.
[b] Early-onset neonatal sepsis.
[c] Secondary postpartum haemorrhage.
[d] Uterine inversion.
A nurse sees late decelerations on the fetal heart rate monitor. The priority nursing action is to:
[a] Increase the rate of the oxytocin infusion.
[b] Document the finding and continue to monitor.
[c] Perform a vaginal examination to check for dilatation.
[d] Reposition the mother on her side and administer oxygen.
Which patient is at highest risk for developing postpartum haemorrhage due to uterine atony?
[a] A primigravida who had a 6-hour labour.
[b] A G5P4 who delivered a 4.5 kg baby after a prolonged labour.
[c] A woman who had a scheduled caesarean section for a breech presentation.
[d] A woman who received an epidural for pain relief.
Carboprost (Hemabate), a prostaglandin used to treat PPH, should be used with caution or is contraindicated in patients with:
[a] Diabetes.
[b] Hypertension.
[c] Asthma.
[d] Anemia.
Variable decelerations on the fetal heart rate monitor are typically caused by:
[a] Fetal head compression.
[b] Uteroplacental insufficiency.
[c] Umbilical cord compression.
[d] Maternal fever.
The presence of thick meconium-stained amniotic fluid in a post-term pregnancy places the neonate at risk for:
[a] Hypoglycemia.
[b] Meconium aspiration syndrome.
[c] Hemorrhagic disease.
[d] Congenital heart defects.
Uterine inversion is a life-threatening emergency where the uterus turns inside out. A key sign of this complication is:
[a] A firm, midline uterine fundus.
[b] The absence of vaginal bleeding.
[c] The inability to palpate the fundus abdominally and signs of profound shock.
[d] A gradual increase in the mother's blood pressure.
Which nursing intervention can help promote the rotation of a fetus from an occiput posterior (OP) to an occiput anterior (OA) position?
[a] Encouraging the mother to lie flat on her back.
[b] Administering an epidural.
[c] Assisting the mother into a hands-and-knees position.
[d] Applying fundal pressure.
Active management of the third stage of labour is a bundle of interventions designed primarily to:
[a] Speed up the delivery of the baby.
[b] Enhance maternal-infant bonding.
[c] Reduce the risk of postpartum haemorrhage.
[d] Ensure the baby begins breathing immediately.
A labouring woman with a twin gestation is at an increased risk for which complication?
[a] Post-term labour.
[b] Postpartum haemorrhage due to uterine overdistention.
[c] A very rapid second stage of labour.
[d] Cephalopelvic disproportion.
Amnioinfusion may be used during labour to relieve which pattern on the fetal heart rate monitor?
[a] Tachycardia.
[b] Early decelerations.
[c] Late decelerations.
[d] Recurrent severe variable decelerations.
A major risk to the fetus during a vaginal breech delivery is:
[a] Premature closure of the ductus arteriosus.
[b] Neonatal jaundice.
[c] Entrapment of the after-coming head.
[d] Macrosomia.
Legislation in nursing, profession and related organisations.
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