Below are the questions written in the photo, retyped with the choices,
correct answer, and deeper explanation of why each option is right or
wrong.
QUESTIONS 2–15
Question 2
A woman gave birth to an infant boy 10 hours ago. Where does the nurse
expect to locate this woman’s fundus?
A. 1 cm above the umbilicus
B. Nonpalpable abdominally
C. 2 cm below the umbilicus
D. Midway between the umbilicus and the symphysis pubis
Correct Answer: A. 1 cm above the umbilicus
Why A is correct
During the first several hours after delivery, the uterus contracts and rises
slightly within the abdomen. At approximately 6 to 12 hours postpartum,
the fundus is commonly located at the level of the umbilicus or about 1 cm
above it, written as U or U+1.
After the first postpartum day, the uterus normally descends approximately
1 cm or one fingerbreadth per day.
Why the others are wrong
B. Nonpalpable abdominally
The uterus normally becomes difficult to palpate abdominally only after
approximately 10 to 14 days postpartum, when it has returned to the
pelvic cavity.
C. 2 cm below the umbilicus
This location would usually be expected approximately two days after the
initial postpartum period, not only 10 hours after birth.
D. Midway between the umbilicus and the symphysis pubis
Immediately after delivery, the fundus may briefly be located midway
between these landmarks. It then rises toward the umbilicus during the first
several hours.
Exam trap
,A full bladder can push the uterus upward and toward the right. A fundus
that is high and displaced may mean the client needs to urinate.
Memory hook
First it rises, then it retires.
First 6–12 hours: U or U+1
Afterward: down about 1 cm daily
Question 4
The preferred manner of delivering the baby in a gravido-cardiac client is
vaginal delivery assisted by forceps under epidural anesthesia. The main
rationale is:
A. To prevent perineal laceration with the expulsion of the fetal head
B. To make the delivery effort free and the mother does not need to push
with contractions
C. To allow atraumatic delivery of the baby
D. To allow a gradual shifting of the blood into the maternal circulation
Correct Answer: B. To reduce or eliminate the mother’s need to push
Why B is correct
Pushing during the second stage of labor increases:
Intrathoracic pressure
Blood pressure
Heart rate
Cardiac workload
Oxygen demand
A client with heart disease may not tolerate these changes. Forceps can
shorten the second stage and assist the birth of the fetal head, reducing the
mother’s expulsive effort.
Epidural anesthesia also decreases pain and excessive sympathetic
stimulation.
Why the others are wrong
,A. To prevent perineal laceration
Forceps do not guarantee prevention of lacerations. They may actually
increase the risk of maternal tissue trauma if not used carefully.
C. To allow atraumatic delivery of the baby
Safe delivery is important, but forceps may also cause fetal injury. The main
reason in a cardiac client is to decrease maternal cardiac strain.
D. To allow gradual blood shifting
After delivery, blood from the uterus returns to the maternal circulation,
called autotransfusion. Forceps do not control this postpartum blood shift.
Memory hook
Forceps finish the pushing so the heart does less work.
Question 6
After an Rh-negative mother has delivered her Rh-positive baby, the mother
is given RhoGAM. This is done in order to:
A. Prevent recurrence of an Rh-positive baby in the future
B. Prevent the newborn from having incompatibility problems when
breastfeeding
C. Ensure that future pregnancies will not lead to maternal illness
D. Prevent the mother from producing antibodies against Rh-positive
antigen that she may have received during delivery
Correct Answer: D. Prevent maternal antibody formation against Rh-
positive blood
Why D is correct
During pregnancy or delivery, a small amount of the baby’s Rh-positive
blood may enter the circulation of an Rh-negative mother.
The mother’s immune system may identify the Rh antigen as foreign and
produce anti-D antibodies. This process is called Rh sensitization or
isoimmunization.
RhoGAM binds to the Rh-positive fetal red blood cells before the mother’s
immune system can recognize them and create permanent antibodies.
Why the others are wrong
, A. Prevent recurrence of an Rh-positive baby
RhoGAM cannot control the blood type of future babies. Blood type is
genetically determined.
B. Prevent incompatibility during breastfeeding
Rh incompatibility is related to fetal red blood cells entering maternal
circulation, not breastfeeding.
C. Ensure future pregnancies will not lead to maternal illness
The main concern is not illness in the mother. The danger is destruction of
fetal red blood cells in a future Rh-positive pregnancy.
Important point
RhoGAM prevents sensitization. It does not work once the mother has
already formed anti-D antibodies.
Memory hook
Negative mother + positive baby = protect with RhoGAM.
Question 8
A delivery room nurse notes the umbilical cord protruding from the vagina.
What position should the nurse immediately place the client in?
A. Knee-chest position
B. Supine
C. Reverse Trendelenburg
D. Prone
Correct Answer: A. Knee-chest position
Why A is correct
A visible or prolapsed umbilical cord may become compressed between the
fetal presenting part and the maternal pelvis.
Cord compression decreases blood flow and oxygen delivery to the fetus.
In the knee-chest position:
The mother’s hips are elevated.
Her chest is lowered.
Gravity moves the fetus away from the pelvis.
correct answer, and deeper explanation of why each option is right or
wrong.
QUESTIONS 2–15
Question 2
A woman gave birth to an infant boy 10 hours ago. Where does the nurse
expect to locate this woman’s fundus?
A. 1 cm above the umbilicus
B. Nonpalpable abdominally
C. 2 cm below the umbilicus
D. Midway between the umbilicus and the symphysis pubis
Correct Answer: A. 1 cm above the umbilicus
Why A is correct
During the first several hours after delivery, the uterus contracts and rises
slightly within the abdomen. At approximately 6 to 12 hours postpartum,
the fundus is commonly located at the level of the umbilicus or about 1 cm
above it, written as U or U+1.
After the first postpartum day, the uterus normally descends approximately
1 cm or one fingerbreadth per day.
Why the others are wrong
B. Nonpalpable abdominally
The uterus normally becomes difficult to palpate abdominally only after
approximately 10 to 14 days postpartum, when it has returned to the
pelvic cavity.
C. 2 cm below the umbilicus
This location would usually be expected approximately two days after the
initial postpartum period, not only 10 hours after birth.
D. Midway between the umbilicus and the symphysis pubis
Immediately after delivery, the fundus may briefly be located midway
between these landmarks. It then rises toward the umbilicus during the first
several hours.
Exam trap
,A full bladder can push the uterus upward and toward the right. A fundus
that is high and displaced may mean the client needs to urinate.
Memory hook
First it rises, then it retires.
First 6–12 hours: U or U+1
Afterward: down about 1 cm daily
Question 4
The preferred manner of delivering the baby in a gravido-cardiac client is
vaginal delivery assisted by forceps under epidural anesthesia. The main
rationale is:
A. To prevent perineal laceration with the expulsion of the fetal head
B. To make the delivery effort free and the mother does not need to push
with contractions
C. To allow atraumatic delivery of the baby
D. To allow a gradual shifting of the blood into the maternal circulation
Correct Answer: B. To reduce or eliminate the mother’s need to push
Why B is correct
Pushing during the second stage of labor increases:
Intrathoracic pressure
Blood pressure
Heart rate
Cardiac workload
Oxygen demand
A client with heart disease may not tolerate these changes. Forceps can
shorten the second stage and assist the birth of the fetal head, reducing the
mother’s expulsive effort.
Epidural anesthesia also decreases pain and excessive sympathetic
stimulation.
Why the others are wrong
,A. To prevent perineal laceration
Forceps do not guarantee prevention of lacerations. They may actually
increase the risk of maternal tissue trauma if not used carefully.
C. To allow atraumatic delivery of the baby
Safe delivery is important, but forceps may also cause fetal injury. The main
reason in a cardiac client is to decrease maternal cardiac strain.
D. To allow gradual blood shifting
After delivery, blood from the uterus returns to the maternal circulation,
called autotransfusion. Forceps do not control this postpartum blood shift.
Memory hook
Forceps finish the pushing so the heart does less work.
Question 6
After an Rh-negative mother has delivered her Rh-positive baby, the mother
is given RhoGAM. This is done in order to:
A. Prevent recurrence of an Rh-positive baby in the future
B. Prevent the newborn from having incompatibility problems when
breastfeeding
C. Ensure that future pregnancies will not lead to maternal illness
D. Prevent the mother from producing antibodies against Rh-positive
antigen that she may have received during delivery
Correct Answer: D. Prevent maternal antibody formation against Rh-
positive blood
Why D is correct
During pregnancy or delivery, a small amount of the baby’s Rh-positive
blood may enter the circulation of an Rh-negative mother.
The mother’s immune system may identify the Rh antigen as foreign and
produce anti-D antibodies. This process is called Rh sensitization or
isoimmunization.
RhoGAM binds to the Rh-positive fetal red blood cells before the mother’s
immune system can recognize them and create permanent antibodies.
Why the others are wrong
, A. Prevent recurrence of an Rh-positive baby
RhoGAM cannot control the blood type of future babies. Blood type is
genetically determined.
B. Prevent incompatibility during breastfeeding
Rh incompatibility is related to fetal red blood cells entering maternal
circulation, not breastfeeding.
C. Ensure future pregnancies will not lead to maternal illness
The main concern is not illness in the mother. The danger is destruction of
fetal red blood cells in a future Rh-positive pregnancy.
Important point
RhoGAM prevents sensitization. It does not work once the mother has
already formed anti-D antibodies.
Memory hook
Negative mother + positive baby = protect with RhoGAM.
Question 8
A delivery room nurse notes the umbilical cord protruding from the vagina.
What position should the nurse immediately place the client in?
A. Knee-chest position
B. Supine
C. Reverse Trendelenburg
D. Prone
Correct Answer: A. Knee-chest position
Why A is correct
A visible or prolapsed umbilical cord may become compressed between the
fetal presenting part and the maternal pelvis.
Cord compression decreases blood flow and oxygen delivery to the fetus.
In the knee-chest position:
The mother’s hips are elevated.
Her chest is lowered.
Gravity moves the fetus away from the pelvis.
