NUR 230 OB/Peds Exam 3 | Practice Questions
And Answers | 2026/2027 Verified Test With
Detailed Rationale
Question 1.
A client at 38 weeks gestation is in active labor. During delivery, the fetal head
delivers but then retracts tightly against the perineum (turtle sign). The provider
calls for suprapubic pressure and McRoberts maneuver. The nurse recognizes these
interventions are used to manage:
A. Uterine rupture.
B. Shoulder dystocia.
C. Umbilical cord prolapse.
D. Breech presentation.
Correct Answer: B
Rationale: The 'turtle sign' (retraction of the delivered fetal head against the perineum) is
the classic sign of shoulder dystocia, where the anterior shoulder becomes impacted behind
the maternal symphysis pubis. McRoberts maneuver (hyperflexion of maternal hips) and
suprapubic pressure are first-line interventions. Other maneuvers include internal rotation
(Woods corkscrew), delivery of the posterior arm, and all-fours position. Shoulder dystocia
is an obstetric emergency that can cause brachial plexus injury (Erb's palsy) and fetal
hypoxia if not resolved quickly.
Question 2.
A postpartum client on day 3 develops a fever of 101.2°F (38.4°C), uterine tenderness,
and foul-smelling lochia. The nurse suspects endometritis. The nurse knows that the
most common causative organisms are:
A. Group A Streptococcus and Staphylococcus aureus.
B. Polymicrobial aerobic and anaerobic vaginal flora.
C. Escherichia coli and Candida albicans.
D. Neisseria gonorrhoeae and Chlamydia trachomatis.
Correct Answer: B
,Rationale: Postpartum endometritis is typically a polymicrobial infection involving aerobic
bacteria (Group B Streptococcus, E. coli, Enterococcus) and anaerobic bacteria (Prevotella,
Peptostreptococcus, Gardnerella) that ascend from the lower genital tract. Risk factors
include cesarean delivery, prolonged labor, prolonged rupture of membranes, and multiple
vaginal examinations. Treatment involves broad-spectrum IV antibiotics (clindamycin +
gentamicin). Group A Strep causes toxic shock syndrome. Candida causes vaginitis, not
endometritis. Gonorrhea and chlamydia cause cervicitis.
Question 3.
A client with Rh-negative blood delivers an Rh-positive infant. The nurse prepares to
administer Rho(D) immune globulin (RhoGAM). The nurse knows that RhoGAM is
given to:
A. Treat hemolytic disease of the newborn in the current pregnancy.
B. Prevent Rh sensitization in future pregnancies.
C. Convert the mother's blood type from Rh-negative to Rh-positive.
D. Destroy Rh-positive fetal cells already present in maternal circulation.
Correct Answer: B
Rationale: Rho(D) immune globulin (RhoGAM) is administered to Rh-negative mothers
who deliver Rh-positive infants to prevent the mother's immune system from producing
anti-D antibodies against fetal Rh-positive red blood cells. This prevents hemolytic disease
of the fetus and newborn (HDFN) in subsequent pregnancies. It does NOT treat existing
sensitization or hemolytic disease in the current pregnancy. The standard dose is 300 mcg
given within 72 hours of delivery, abortion, or amniocentesis. It is also given at 28 weeks
gestation prophylactically.
Question 4.
A client at 32 weeks gestation with twins presents with sudden onset of severe
abdominal pain, uterine tenderness, and vaginal bleeding. The fetal heart rates show
bradycardia. The nurse suspects placental abruption. The nurse's priority action is
to:
A. Perform a vaginal examination to assess cervical dilation.
B. Prepare the client for immediate delivery and initiate large-bore IV access.
C. Administer tocolytics to stop preterm labor.
, D. Schedule an ultrasound for the next day.
Correct Answer: B
Rationale: Placental abruption is the premature separation of the placenta from the uterine
wall before delivery. It is an obstetric emergency that can cause fetal hypoxia, maternal
hemorrhage, and disseminated intravascular coagulation (DIC). The priority is immediate
delivery (usually by emergency cesarean if the fetus is viable and in distress) and large-bore
IV access for fluid resuscitation and blood products. Vaginal exams are contraindicated if
placenta previa is possible but may be performed if ruled out. Tocolytics are
contraindicated. Delaying care is life-threatening.
Question 5.
A client at 41 weeks gestation is admitted for induction. During labor, the client
suddenly becomes dyspneic, hypotensive, and develops seizures. The fetal heart rate
shows bradycardia. The nurse suspects amniotic fluid embolism (AFE). The nurse's
priority intervention is to:
A. Administer magnesium sulfate for seizure control.
B. Initiate cardiopulmonary resuscitation and prepare for emergency delivery.
C. Give a tocolytic to stop uterine contractions.
D. Perform an amnioinfusion to dilute the embolism.
Correct Answer: B
Rationale: Amniotic fluid embolism (AFE) is a rare, catastrophic obstetric emergency
characterized by sudden onset of hypoxia, hypotension, coagulopathy, and seizures during
labor or immediately postpartum. It has a high maternal mortality rate. The priority is
immediate cardiopulmonary support (oxygen, CPR if needed), management of coagulopathy
(blood products), and emergency delivery of the fetus if still in utero. Magnesium sulfate is
for eclampsia, not AFE. Tocolytics and amnioinfusion are inappropriate and dangerous.
Question 6.
A postpartum client on day 5 reports severe perineal pain, fever, and a painful, red,
swollen area on the right breast. The nurse suspects mastitis. The nurse's priority
teaching includes:
A. Stop breastfeeding on the affected side to allow the infection to heal.
B. Continue breastfeeding or pumping frequently and apply warm compresses.
And Answers | 2026/2027 Verified Test With
Detailed Rationale
Question 1.
A client at 38 weeks gestation is in active labor. During delivery, the fetal head
delivers but then retracts tightly against the perineum (turtle sign). The provider
calls for suprapubic pressure and McRoberts maneuver. The nurse recognizes these
interventions are used to manage:
A. Uterine rupture.
B. Shoulder dystocia.
C. Umbilical cord prolapse.
D. Breech presentation.
Correct Answer: B
Rationale: The 'turtle sign' (retraction of the delivered fetal head against the perineum) is
the classic sign of shoulder dystocia, where the anterior shoulder becomes impacted behind
the maternal symphysis pubis. McRoberts maneuver (hyperflexion of maternal hips) and
suprapubic pressure are first-line interventions. Other maneuvers include internal rotation
(Woods corkscrew), delivery of the posterior arm, and all-fours position. Shoulder dystocia
is an obstetric emergency that can cause brachial plexus injury (Erb's palsy) and fetal
hypoxia if not resolved quickly.
Question 2.
A postpartum client on day 3 develops a fever of 101.2°F (38.4°C), uterine tenderness,
and foul-smelling lochia. The nurse suspects endometritis. The nurse knows that the
most common causative organisms are:
A. Group A Streptococcus and Staphylococcus aureus.
B. Polymicrobial aerobic and anaerobic vaginal flora.
C. Escherichia coli and Candida albicans.
D. Neisseria gonorrhoeae and Chlamydia trachomatis.
Correct Answer: B
,Rationale: Postpartum endometritis is typically a polymicrobial infection involving aerobic
bacteria (Group B Streptococcus, E. coli, Enterococcus) and anaerobic bacteria (Prevotella,
Peptostreptococcus, Gardnerella) that ascend from the lower genital tract. Risk factors
include cesarean delivery, prolonged labor, prolonged rupture of membranes, and multiple
vaginal examinations. Treatment involves broad-spectrum IV antibiotics (clindamycin +
gentamicin). Group A Strep causes toxic shock syndrome. Candida causes vaginitis, not
endometritis. Gonorrhea and chlamydia cause cervicitis.
Question 3.
A client with Rh-negative blood delivers an Rh-positive infant. The nurse prepares to
administer Rho(D) immune globulin (RhoGAM). The nurse knows that RhoGAM is
given to:
A. Treat hemolytic disease of the newborn in the current pregnancy.
B. Prevent Rh sensitization in future pregnancies.
C. Convert the mother's blood type from Rh-negative to Rh-positive.
D. Destroy Rh-positive fetal cells already present in maternal circulation.
Correct Answer: B
Rationale: Rho(D) immune globulin (RhoGAM) is administered to Rh-negative mothers
who deliver Rh-positive infants to prevent the mother's immune system from producing
anti-D antibodies against fetal Rh-positive red blood cells. This prevents hemolytic disease
of the fetus and newborn (HDFN) in subsequent pregnancies. It does NOT treat existing
sensitization or hemolytic disease in the current pregnancy. The standard dose is 300 mcg
given within 72 hours of delivery, abortion, or amniocentesis. It is also given at 28 weeks
gestation prophylactically.
Question 4.
A client at 32 weeks gestation with twins presents with sudden onset of severe
abdominal pain, uterine tenderness, and vaginal bleeding. The fetal heart rates show
bradycardia. The nurse suspects placental abruption. The nurse's priority action is
to:
A. Perform a vaginal examination to assess cervical dilation.
B. Prepare the client for immediate delivery and initiate large-bore IV access.
C. Administer tocolytics to stop preterm labor.
, D. Schedule an ultrasound for the next day.
Correct Answer: B
Rationale: Placental abruption is the premature separation of the placenta from the uterine
wall before delivery. It is an obstetric emergency that can cause fetal hypoxia, maternal
hemorrhage, and disseminated intravascular coagulation (DIC). The priority is immediate
delivery (usually by emergency cesarean if the fetus is viable and in distress) and large-bore
IV access for fluid resuscitation and blood products. Vaginal exams are contraindicated if
placenta previa is possible but may be performed if ruled out. Tocolytics are
contraindicated. Delaying care is life-threatening.
Question 5.
A client at 41 weeks gestation is admitted for induction. During labor, the client
suddenly becomes dyspneic, hypotensive, and develops seizures. The fetal heart rate
shows bradycardia. The nurse suspects amniotic fluid embolism (AFE). The nurse's
priority intervention is to:
A. Administer magnesium sulfate for seizure control.
B. Initiate cardiopulmonary resuscitation and prepare for emergency delivery.
C. Give a tocolytic to stop uterine contractions.
D. Perform an amnioinfusion to dilute the embolism.
Correct Answer: B
Rationale: Amniotic fluid embolism (AFE) is a rare, catastrophic obstetric emergency
characterized by sudden onset of hypoxia, hypotension, coagulopathy, and seizures during
labor or immediately postpartum. It has a high maternal mortality rate. The priority is
immediate cardiopulmonary support (oxygen, CPR if needed), management of coagulopathy
(blood products), and emergency delivery of the fetus if still in utero. Magnesium sulfate is
for eclampsia, not AFE. Tocolytics and amnioinfusion are inappropriate and dangerous.
Question 6.
A postpartum client on day 5 reports severe perineal pain, fever, and a painful, red,
swollen area on the right breast. The nurse suspects mastitis. The nurse's priority
teaching includes:
A. Stop breastfeeding on the affected side to allow the infection to heal.
B. Continue breastfeeding or pumping frequently and apply warm compresses.
