Free Maternal Newborn Nursing Practice Test

1. Immediately after an uncomplicated delivery without meconium, a full-term newborn is warmed, dried, suctioned, and positioned appropriately but has a heart rate of 80 beats/min. According to neonatal resuscitation guidelines, the next step in managing this infant is:

a. Positive-pressure ventilation.
b. Chest compression.
c. Epinephrine administration.

2. If the postpartum uterine fundus is boggy on palpation, the nurse does which of the following?

a. Asks the patient to avoid urinating
b. Massages the uterus until it feels firm
c. Re-examines the fundus in 15-20 minutes

3. An Rh-negative mother who has given birth to an Rh-positive infant and has no evidence of sensitization (i.e., maternal indirect Coombs test negative) should be administered:

a. Rh immune globulin (Rhogam) within 72 hours of delivery
b. No additional medication
c. Cross-matched packed red blood cells within 4 hours of delivery

4. Early decelerations with a normal fetal heart rate variability during labor have which of the following indications?

a. They often indicate fetal congenital heart disease
b. They do not indicate fetal hypoxia
c. They may indicate fetal acidemia

5. A cephalohematoma in the newborn infant has which of the following characteristics?

a. It does not cross suture lines
b. It typically resolves within 12 hours of birth
c. It is more common after a cesarean birth

Answers and Explanations

1. A: Neonatal resuscitation guidelines allow for all care providers managing newborn infants to proceed along a standardized algorithm to stabilize the infant as soon as possible after delivery. Initial steps may vary with deliveries involving meconium-stained amniotic fluid in an attempt to avoid worsening meconium aspiration. In the newborn without meconium-stained amniotic fluid, the infant is warmed, dried, suctioned (if necessary), and placed in a position that allows for unobstructed breathing. Heart rate, respiratory effort, and color are then evaluated. If the infant has poor respiratory effort or rate or the heart rate is lower than 100 beats/min, positive-pressure ventilation is provided. If positive-pressure ventilation does not improve the heart rate to 100 beats/min, then chest compression and epinephrine administration are indicated.

2. B: Periodic assessment of the uterine fundus is a crucial part of postpartum care. The postpartum fundus should feel firm to palpation once the placenta has been delivered. A boggy fundus is a sign of uterine atony or relaxed uterine muscles. Uterine atony is a common cause of postpartum hemorrhage and should be recognized and treated promptly. Many postpartum patients can lose a large amount of blood within the uterine cavity before becoming symptomatic of serious blood loss. The first step in treating uterine atony is external fundal massage to stimulate the uterine muscles to contract. Bladder distention may lead to uterine atony and results in the fundus being displaced laterally. If bladder distention is suspected, the patient is encouraged to void.

3. A: If an Rh-negative woman is pregnant with an Rh-positive fetus and fetal red blood cells enter the maternal circulation, Rh antibodies form in the maternal circulation. This process is referred to as "sensitization." A subsequent pregnancy with an Rh-positive fetus in the sensitized Rh-negative mother leads to hemolysis of fetal red blood cells as maternal anti-Rh antibodies cross the placenta, leading to severe fetal anemia. Rh immune globulin (Rhogam) confers passive antibody protection against Rh antigens, preventing maternal Rh-antigen antibody protection. The indirect Coombs test detects Rh-positive antibodies in the maternal circulation and is, therefore, the test of choice for maternal sensitization screening. If an Rh-negative mother delivers an Rh-positive infant and there is no evidence of maternal sensitization, Rhogam is administered within 72 hours of delivery. Rhogam is also administered after abortion, antepartum hemorrhage, amniocentesis, chorionic villus sampling, trauma, or any procedure or incident where there is a reasonable likelihood of maternal exposure to Rh-positive fetal blood.

4. B: Intrapartum fetal heart rate monitoring requires documentation and interpretation of five variables: baseline fetal heart rate, baseline heart rate variability, presence or absence of fetal heart rate accelerations, fetal heart rate decelerations, and changes in the fetal heart rate pattern as labor progresses. Interpretation of fetal heart rate monitoring can be complex and challenging but is an important component of intrapartum fetal monitoring. In general, when fetal heart rate monitoring demonstrates a normal baseline rate with accelerations, moderate variability, and no late or variable decelerations, the fetus is neither hypoxemic nor acidotic. Early decelerations with normal variability are associated with uterine contractions; fetal head compression, which occurs with the uterine contraction, leads to stimulation of the vagus nerve, leading to a decrease in fetal heart rate, which resolves as the contraction subsides. Early decelerations are not associated with fetal hypoxia and require no intervention.

5. A: Cephalohematoma may occur in up to 2% of births and is far more common in vertex vaginal delivery than cesarean births. Blood vessels between the cranial bone and the periosteal layer rupture, leading to the formation of a hematoma in the subperiosteal space, which is limited in its extension by cranial suture lines. Cephalohematoma typically becomes clinically apparent in the first 1-2 days after birth and may take weeks to months to resolve. This is in contrast to a caput succedaneum, a subcutaneous collection of edematous fluid, which crosses suture lines, is typically present at birth, and resolves within hours to days after birth.

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Last Updated: 03/01/2017


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