NM 704 EXAM 3 MODULE 8 COMPREHENSIVE EXAM
QUESTIONS COMPLETE WITH CORRECT ANSWERS AND
RATIONALES
1. Which of the following is the PRIMARY reason for administering
oxytocin within one minute of birth during active management of the
third stage of labor?
A. To facilitate placental expulsion through controlled cord traction.
B. To prevent uterine atony and reduce the risk of postpartum
hemorrhage.
C. To promote maternal-infant bonding by accelerating placental
delivery.
D. To decrease the incidence of neonatal jaundice.
Correct Answer: B
Rationale: Active management is designed to prevent postpartum
hemorrhage by averting uterine atony. Oxytocin increases uterine
contractions, which is the primary mechanism to achieve this goal.
While it may indirectly aid in placental expulsion, its main purpose is
hemorrhage prevention.
2. A nurse palpates the abdomen immediately after the delivery of the
baby during active management. What is the PRIMARY purpose of this
action?
A. To assess for uterine atony.
B. To determine the position of the umbilical cord.
C. To rule out the presence of an additional baby or babies.
,D. To evaluate the firmness of the uterine fundus.
Correct Answer: C
Rationale: Palpating the abdomen within one minute of delivery is
specifically done to rule out multiple gestation. This step must occur
before administering oxytocin to avoid complications if another baby is
present.
3. What is the maximum safe dose of Lidocaine WITHOUT
epinephrine?
A. 4.5 mg/kg, up to 300 mg
B. 7 mg/kg, up to 500 mg
C. 3 mg/kg, up to 200 mg
D. 5.5 mg/kg, up to 400 mg
Correct Answer: A
Rationale: The maximum safe dosage for Lidocaine without epinephrine
is 4.5 mg/kg with a total ceiling of 300 mg. Exceeding this limit increases
the risk of systemic toxicity and adverse reactions.
4. What is the maximum safe dose of Lidocaine WITH epinephrine?
A. 4.5 mg/kg, up to 300 mg
B. 7 mg/kg, up to 500 mg
C. 6 mg/kg, up to 450 mg
D. 8 mg/kg, up to 600 mg
Correct Answer: B
Rationale: The presence of epinephrine allows for a higher maximum
dose of Lidocaine because it causes vasoconstriction, slowing systemic
absorption. The safe limit is 7 mg/kg with a total maximum of 500 mg.
5. Which of the following is NOT a recognized sign of placental
separation?
,A. A small gush of blood from the vagina.
B. Lengthening of the umbilical cord.
C. The uterus becomes soft and boggy.
D. The uterus rises into the abdomen and becomes firm and rounded.
Correct Answer: C
Rationale: The signs of placental separation include a small gush of
blood, lengthening of the cord, and the uterus rising and becoming firm
and rounded. A soft and boggy uterus is a sign of uterine atony, not
placental separation.
6. According to the ICM/FIGO Joint Statement (2003), which
uterotonic medication is PREFERRED for active management of the
third stage of labor?
A. Misoprostol
B. Ergometrine
C. Oxytocin
D. Carboprost
Correct Answer: C
Rationale: The ICM/FIGO guidelines specifically recommend oxytocin as
the preferred uterotonic because it is effective within 2-3 minutes, has
minimal side effects, and is safe for use in all women, unlike other
agents that may have contraindications.
7. Which of the following is a documented benefit of Active
Management of the Third Stage of Labor (AMTSL) compared to
expectant management?
A. Increased risk of retained placenta.
B. Higher incidence of maternal hypertension.
C. Reduced risk of postpartum hemorrhage.
D. Shorter duration of the first stage of labor.
, Correct Answer: C
Rationale: AMTSL has clearly demonstrated a reduced risk of
postpartum hemorrhage, less overall blood loss, less anemia, and less
need for therapeutic uterotonics compared to expectant management.
8. What is the definition of the third stage of labor?
A. The period from the onset of regular contractions to full cervical
dilation.
B. The period from full cervical dilation to the birth of the newborn.
C. The period following the birth of the newborn through the expulsion
of the placenta.
D. The period from placental expulsion to the first hour postpartum.
Correct Answer: C
Rationale: By definition, the third stage of labor is the interval between
the birth of the baby and the delivery of the placenta. This stage is
critical for hemorrhage prevention.
9. Which mechanism of placental expulsion involves the placenta
separating from the center and presenting fetal side first?
A. Duncan mechanism
B. Schultz mechanism
C. Fundal mechanism
D. Cervical mechanism
Correct Answer: B
Rationale: The Schultz mechanism describes placental separation
starting at the center, leading to folding and expulsion with the fetal
(shiny) side presenting first. The Duncan mechanism involves separation
starting at the edges with the maternal side presenting first.
QUESTIONS COMPLETE WITH CORRECT ANSWERS AND
RATIONALES
1. Which of the following is the PRIMARY reason for administering
oxytocin within one minute of birth during active management of the
third stage of labor?
A. To facilitate placental expulsion through controlled cord traction.
B. To prevent uterine atony and reduce the risk of postpartum
hemorrhage.
C. To promote maternal-infant bonding by accelerating placental
delivery.
D. To decrease the incidence of neonatal jaundice.
Correct Answer: B
Rationale: Active management is designed to prevent postpartum
hemorrhage by averting uterine atony. Oxytocin increases uterine
contractions, which is the primary mechanism to achieve this goal.
While it may indirectly aid in placental expulsion, its main purpose is
hemorrhage prevention.
2. A nurse palpates the abdomen immediately after the delivery of the
baby during active management. What is the PRIMARY purpose of this
action?
A. To assess for uterine atony.
B. To determine the position of the umbilical cord.
C. To rule out the presence of an additional baby or babies.
,D. To evaluate the firmness of the uterine fundus.
Correct Answer: C
Rationale: Palpating the abdomen within one minute of delivery is
specifically done to rule out multiple gestation. This step must occur
before administering oxytocin to avoid complications if another baby is
present.
3. What is the maximum safe dose of Lidocaine WITHOUT
epinephrine?
A. 4.5 mg/kg, up to 300 mg
B. 7 mg/kg, up to 500 mg
C. 3 mg/kg, up to 200 mg
D. 5.5 mg/kg, up to 400 mg
Correct Answer: A
Rationale: The maximum safe dosage for Lidocaine without epinephrine
is 4.5 mg/kg with a total ceiling of 300 mg. Exceeding this limit increases
the risk of systemic toxicity and adverse reactions.
4. What is the maximum safe dose of Lidocaine WITH epinephrine?
A. 4.5 mg/kg, up to 300 mg
B. 7 mg/kg, up to 500 mg
C. 6 mg/kg, up to 450 mg
D. 8 mg/kg, up to 600 mg
Correct Answer: B
Rationale: The presence of epinephrine allows for a higher maximum
dose of Lidocaine because it causes vasoconstriction, slowing systemic
absorption. The safe limit is 7 mg/kg with a total maximum of 500 mg.
5. Which of the following is NOT a recognized sign of placental
separation?
,A. A small gush of blood from the vagina.
B. Lengthening of the umbilical cord.
C. The uterus becomes soft and boggy.
D. The uterus rises into the abdomen and becomes firm and rounded.
Correct Answer: C
Rationale: The signs of placental separation include a small gush of
blood, lengthening of the cord, and the uterus rising and becoming firm
and rounded. A soft and boggy uterus is a sign of uterine atony, not
placental separation.
6. According to the ICM/FIGO Joint Statement (2003), which
uterotonic medication is PREFERRED for active management of the
third stage of labor?
A. Misoprostol
B. Ergometrine
C. Oxytocin
D. Carboprost
Correct Answer: C
Rationale: The ICM/FIGO guidelines specifically recommend oxytocin as
the preferred uterotonic because it is effective within 2-3 minutes, has
minimal side effects, and is safe for use in all women, unlike other
agents that may have contraindications.
7. Which of the following is a documented benefit of Active
Management of the Third Stage of Labor (AMTSL) compared to
expectant management?
A. Increased risk of retained placenta.
B. Higher incidence of maternal hypertension.
C. Reduced risk of postpartum hemorrhage.
D. Shorter duration of the first stage of labor.
, Correct Answer: C
Rationale: AMTSL has clearly demonstrated a reduced risk of
postpartum hemorrhage, less overall blood loss, less anemia, and less
need for therapeutic uterotonics compared to expectant management.
8. What is the definition of the third stage of labor?
A. The period from the onset of regular contractions to full cervical
dilation.
B. The period from full cervical dilation to the birth of the newborn.
C. The period following the birth of the newborn through the expulsion
of the placenta.
D. The period from placental expulsion to the first hour postpartum.
Correct Answer: C
Rationale: By definition, the third stage of labor is the interval between
the birth of the baby and the delivery of the placenta. This stage is
critical for hemorrhage prevention.
9. Which mechanism of placental expulsion involves the placenta
separating from the center and presenting fetal side first?
A. Duncan mechanism
B. Schultz mechanism
C. Fundal mechanism
D. Cervical mechanism
Correct Answer: B
Rationale: The Schultz mechanism describes placental separation
starting at the center, leading to folding and expulsion with the fetal
(shiny) side presenting first. The Duncan mechanism involves separation
starting at the edges with the maternal side presenting first.
