AFYA UNLIMTED SHOULDER DYSTOCIA QUESTIONS

1.     A 30-year-old G3P2 woman with gestational diabetes delivers the fetal head after a prolonged second stage. The head retracts tightly against the perineum. The midwife immediately announces shoulder dystocia. Which action should be performed FIRST?
A. Apply suprapubic pressure continuously for 30 seconds
B. Flex the woman’s thighs sharply onto her abdomen
C. Perform a mediolateral episiotomy
D. Attempt internal rotation of the fetal shoulders

2.     After McRoberts positioning and suprapubic pressure fail to resolve shoulder dystocia, which maneuver should be attempted NEXT according to accepted obstetric sequence?
A. Zavanelli maneuver
B. Delivery of the posterior arm
C. Fundal pressure
D. Oxytocin augmentation

3.     Which finding best confirms the diagnosis of shoulder dystocia rather than a normal delay in delivery?
A. Prolonged second stage of labor
B. Failure of restitution of the fetal head
C. Fetal heart rate decelerations
D. Perineal edema

4.     A neonate delivered following difficult shoulder dystocia is unable to abduct the right arm, but hand grasp is intact. Which nerve roots are MOST likely affected?
A. C5–C6
B. C7–C8
C. T1
D. C8–T1

5.     During shoulder dystocia, suprapubic pressure should be applied in which manner to maximize effectiveness?
A. Continuous downward pressure at the uterine fundus
B. Intermittent pressure directed toward the fetal back
C. Continuous pressure directed laterally above the symphysis pubis
D. Firm pressure applied to the sacrum

6.     Which maternal condition increases the risk of shoulder dystocia INDEPENDENTLY of fetal weight?
A. Post-term pregnancy
B. Maternal obesity
C. Polyhydramnios
D. Induced labor

7.     A midwife documents the management of shoulder dystocia. Which detail is MOST legally critical to include?
A. Estimated fetal weight
B. Exact sequence and timing of maneuvers
C. Apgar scores at 1 and 5 minutes
D. Degree of perineal trauma

8.     Which maneuver specifically reduces the bisacromial diameter of the fetus to facilitate delivery?
A. McRoberts maneuver
B. Rubin maneuver
C. Delivery of the posterior arm
D. Woods screw maneuver

9.     Which fetal complication is LEAST likely to be associated with shoulder dystocia?
A. Brachial plexus injury
B. Clavicular fracture
C. Hypoxic ischemic encephalopathy
D. Neural tube defect

10.  The MOST important principle guiding the management of shoulder dystocia is to:
A. Deliver the fetus as quickly as possible
B. Apply increasing traction with each maneuver
C. Avoid excessive downward traction on the fetal head
D. Proceed to emergency cesarean section

Q1. A client with acute bronchitis presents with productive cough, wheezing, and chest discomfort. Which finding would require immediate nursing intervention?

a) Expelling thick yellow sputum

b) Respiratory rate of 32/min with use of accessory muscles

c) Complaining of fatigue and malaise

d) Scattered rhonchi on auscultation

Q2. Which of the following nursing actions is the priority when caring for a patient with chronic bronchitis and oxygen saturation of 88%?

a) Increase oxygen to 6 L/min via nasal cannula

b) Encourage pursed-lip breathing

c) Place the patient in supine position for comfort

d) Withhold fluids to prevent aspiration

Q3. A patient with chronic bronchitis is prescribed Theophylline. Which assessment finding should alert the nurse that the patient may be experiencing toxicity?

a) Productive cough with green sputum

b) Restlessness and tachycardia

c) Night sweats and weight loss

d) Clubbing of fingers

Q4. A nurse is teaching a patient with chronic bronchitis about smoking cessation. Which statement indicates the patient requires further teaching?

a) “Even one cigarette a day can worsen my condition.”

b) “Nicotine replacement therapy may help reduce cravings.”

c) “If I stop smoking, my cilia will start to recover.”

d) “Once I quit smoking, my chronic bronchitis will be completely cured.”

Q5. Which arterial blood gas (ABG) result is most consistent with chronic bronchitis?

a) pH 7.52, PaCO₂ 28 mmHg, HCO₃ 23 mEq/L

b) pH 7.35, PaCO₂ 58 mmHg, HCO₃ 32 mEq/L

c) pH 7.47, PaCO₂ 35 mmHg, HCO₃ 25 mEq/L

d) pH 7.30, PaCO₂ 20 mmHg, HCO₃ 15 mEq/L

Q6. A patient with chronic bronchitis is prescribed long-term low-flow oxygen therapy. The nurse knows the therapy is effective when which finding is observed?

a) The patient’s PaCO₂ decreases to 35 mmHg

b) The patient’s SaO₂ remains above 90% during rest and activity

c) The patient no longer produces sputum

d) The patient reports resolution of wheezing

Q7. In chronic bronchitis, which pathophysiological change is responsible for cyanosis and hypoxemia?

a) Loss of alveolar surface area

b) Hypertrophy of mucus-secreting glands and airway obstruction

c) Overdistention of alveoli and loss of elastic recoil

d) Reduced surfactant production

Q8. A nurse is assessing a patient with suspected chronic bronchitis. Which finding best differentiates chronic bronchitis from emphysema?

a) Barrel-shaped chest

b) Dyspnea on exertion

c) Productive cough lasting at least 3 months in 2 consecutive years

d) Clubbing of fingers

Q9. A patient with chronic bronchitis reports difficulty sleeping due to coughing at night. Which nursing intervention is most appropriate?

a) Advise the patient to avoid fluid intake before bedtime

b) Elevate the head of the bed with extra pillows

c) Restrict the use of bronchodilators at night

d) Encourage lying flat to promote drainage

Q10. The nurse is reviewing discharge instructions for a client with chronic bronchitis. Which teaching point should the nurse emphasize most to reduce risk of infection?

a) Receive annual influenza and pneumococcal vaccines

b) Avoid excessive exercise during cold weather

c) Maintain fluid restriction to decrease sputum

d) Use sedatives to control nighttime couhing