Midwife Licensure Exam High-Risk Pregnancy & Complications (Recognize & Refer) — Complications of Labor & DeliveryExam Answer Templates

Marks

1

Topic

Prolapsed Umbilical Cord

Difficulty

easy

Template Id

T1

Examiner Tip

NLE 1-mark questions test whether you know the single most important action. In cord prolapse, the answer is always about relieving mechanical pressure on the cord FIRST. Any answer that delays pressure relief (like calling the doctor first) will not earn the mark.

Model Answer

The first priority nursing action is to relieve pressure on the cord by immediately repositioning the mother into knee-chest or Trendelenburg position and manually lifting the presenting part off the cord with a sterile gloved hand.

Question Type

very_short_answer

Answer Structure

• State the single priority action with its purpose in one complete sentence [1 mark]

Scoring Breakdown

Common Mark Deductions

• Answering 'call the doctor' — this is not the FIRST nursing action; relieving pressure precedes notification
• Writing 'push the cord back in' — this is contraindicated and demonstrates unsafe practice
• Writing only 'reposition the mother' without specifying WHICH position

Key Phrases To Include

• relieve cord pressure
• knee-chest position OR Trendelenburg
• lift the presenting part off the cord
• sterile gloved hand

Marks

1

Topic

Fetal Heart Rate Monitoring

Difficulty

easy

Template Id

T2

Examiner Tip

Memorize the deceleration triad: Early = head compression (benign), Variable = cord compression (emergency), Late = placental insufficiency (ominous). The NLE tests this distinction repeatedly.

Model Answer

Variable decelerations are associated with umbilical cord compression. These are abrupt, V-shaped or U-shaped drops in fetal heart rate that vary in timing relative to uterine contractions.

Question Type

very_short_answer

Answer Structure

• Name the correct type of deceleration [1 mark]

Scoring Breakdown

Common Mark Deductions

• Confusing variable decelerations (cord compression) with late decelerations (uteroplacental insufficiency)
• Writing 'early decelerations' — these reflect head compression and are benign
• Answering 'bradycardia' — while bradycardia can result, it does not specifically name the deceleration pattern

Key Phrases To Include

• variable decelerations
• cord compression
• abrupt onset
• V-shaped or U-shaped

Marks

2

Topic

Dystocia — Uterine Dysfunction

Difficulty

medium

Template Id

T3

Examiner Tip

The key NLE trap here is suggesting oxytocin for hypertonic dysfunction. If the question gives a scenario where contractions are strong but the cervix is not dilating, the answer is NEVER oxytocin. Examiners specifically reward the distinction in management.

Model Answer

Hypotonic dysfunction occurs in the active phase and is characterized by weak, infrequent contractions that become less effective over time. Management includes oxytocin augmentation and amniotomy once obstruction is ruled out. Hypertonic dysfunction occurs in the latent phase and is characterized by frequent, painful, uncoordinated contractions that do not dilate the cervix. Management includes rest, sedation, and hydration — NOT oxytocin, as this will worsen the uncoordinated pattern.

Question Type

short_answer

Answer Structure

• Point 1: Characteristics and management of hypotonic dysfunction [1 mark]
• Point 2: Characteristics and management of hypertonic dysfunction [1 mark]

Scoring Breakdown

Common Mark Deductions

• Recommending oxytocin for hypertonic dysfunction — this is a dangerous clinical error and negates the mark
• Failing to specify the phase of labor (active vs. latent) for each type
• Describing contractions without addressing cervical response

Key Phrases To Include

• active phase (hypotonic)
• latent phase (hypertonic)
• oxytocin augmentation
• rest and sedation
• uncoordinated contractions
• does not dilate the cervix

Marks

2

Topic

Preterm Labor Management

Difficulty

medium

Template Id

T4

Examiner Tip

NLE commonly asks for drug regimens as fill-in or calculation-type items. Memorize BOTH regimens since either may appear. The examiner rewards specificity — drug name, dose, route, frequency, and number of doses all contribute to full marks.

Model Answer

Antenatal corticosteroids are indicated when preterm birth is expected before 34 weeks of gestation to accelerate fetal lung maturity and reduce the risk of neonatal respiratory distress syndrome. The correct regimen is: Betamethasone 12 mg intramuscularly every 24 hours for 2 doses, OR Dexamethasone 6 mg intramuscularly every 12 hours for 4 doses. Maximum benefit occurs 24 hours to 7 days after the first dose.

Question Type

short_answer

Answer Structure

• Point 1: State the indication — preterm birth expected before 34 weeks, with rationale (fetal lung maturity) [1 mark]
• Point 2: State the correct drug regimen with dose, route, frequency, and number of doses [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating the wrong gestational age threshold (e.g., 37 weeks or 28 weeks)
• Giving incorrect dose or route (e.g., IV instead of IM, or wrong dose amount)
• Omitting the number of doses — an incomplete regimen does not earn full credit

Key Phrases To Include

• before 34 weeks gestation
• fetal lung maturity
• surfactant production
• betamethasone 12 mg IM every 24 hours x 2 doses
• dexamethasone 6 mg IM every 12 hours x 4 doses
• 24 hours to 7 days after first dose

Marks

2

Topic

Preterm Labor — Tocolytic Therapy

Difficulty

medium

Template Id

T5

Examiner Tip

NLE situation-based questions require you to identify the abnormal finding AND take the correct action. The clinical cue here is the PR of 126 bpm. Always apply drug safety thresholds to the data given — this is clinical judgment, which the Board of Nursing specifically tests.

Model Answer

The priority nursing action is to WITHHOLD the terbutaline and notify the physician immediately. The client's pulse rate of 126 bpm exceeds the safe threshold of approximately 120 beats per minute. Terbutaline is a beta-agonist tocolytic that causes maternal tachycardia as a side effect, and continuing the drug at this heart rate increases the risk of serious maternal cardiovascular complications.

Question Type

short_answer

Answer Structure

• Action: Hold terbutaline and notify physician [1 mark]
• Rationale: HR exceeds 120 bpm threshold — terbutaline causes tachycardia as a beta-agonist side effect [1 mark]

Scoring Breakdown

Common Mark Deductions

• Continuing the terbutaline and only 'monitoring' — this is clinically unsafe and earns no marks
• Failing to identify the heart rate as the abnormal finding
• Not providing the rationale (why the drug is held)

Key Phrases To Include

• hold/withhold terbutaline
• pulse rate of 126 bpm exceeds 120 bpm threshold
• beta-agonist tocolytic
• maternal tachycardia
• notify the physician

Marks

3

Topic

Uterine Rupture

Difficulty

medium

Template Id

T6

Examiner Tip

The NLE rewards specificity. 'Abdominal pain' alone earns no mark — 'sudden sharp tearing abdominal pain with cessation of contractions' earns the mark. The combination of ruptured pain pattern + contractions stopping + shock is the classic triad the examiner is looking for.

Model Answer

Three classic signs of uterine rupture are: 1. Sudden, sharp, tearing abdominal pain — often described by the client as a feeling that 'something tore,' which may be followed by sudden cessation of pain as pressure is released. 2. Abrupt cessation of uterine contractions — the uterine wall can no longer contract effectively after rupture. 3. Signs of hypovolemic shock — including rapid weak pulse, hypotension, pallor, and diaphoresis due to internal hemorrhage from the ruptured uterine wall.

Question Type

short_answer

Answer Structure

• Sign 1: Sudden sharp tearing abdominal pain [1 mark]
• Sign 2: Cessation of uterine contractions [1 mark]
• Sign 3: Signs of hypovolemic shock (hypotension, tachycardia, pallor) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Listing 'increased pain with contractions' — uterine rupture is characterized by sudden CESSATION of contractions, not increased pain with them
• Writing only 'abdominal pain' without the qualifier 'sudden, sharp, or tearing'
• Listing non-specific signs like 'nausea and vomiting' without the hallmark signs

Key Phrases To Include

• sudden sharp tearing pain
• cessation of contractions
• hypovolemic shock
• hypotension
• tachycardia
• abnormal or absent fetal heart rate

Marks

3

Topic

Shoulder Dystocia

Difficulty

medium

Template Id

T7

Examiner Tip

The NLE LOVES testing the suprapubic vs. fundal pressure distinction. Fundal pressure in shoulder dystocia pushes the baby further into the impaction and can cause spinal injury. Writing 'fundal pressure' immediately signals unsafe practice to the examiner and negates the mark.

Model Answer

The McRoberts maneuver is an obstetric intervention used in the management of shoulder dystocia. It involves sharply hyperflexing the mother's thighs onto her abdomen, which flattens the lumbar lordosis, rotates the symphysis pubis superiorly, and increases the relative AP diameter of the pelvis — freeing the impacted anterior shoulder from behind the symphysis pubis. It is used when shoulder dystocia occurs, identified by the 'turtle sign,' in which the fetal head delivers but then retracts back against the maternal perineum because the anterior shoulder is lodged behind the symphysis pubis. The McRoberts maneuver is ALWAYS combined with suprapubic pressure — never fundal pressure, which worsens the impaction.

Question Type

short_answer

Answer Structure

• Define McRoberts maneuver and describe the technique [1 mark]
• State the indication: shoulder dystocia / turtle sign [1 mark]
• Identify the combined action: suprapubic pressure, NOT fundal pressure [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'fundal pressure' instead of suprapubic pressure — this is a critical safety error and will lose the mark
• Confusing McRoberts with other maneuvers (e.g., Zavanelli)
• Failing to mention the turtle sign as the identifying feature of shoulder dystocia

Key Phrases To Include

• sharply hyperflexing thighs onto abdomen
• shoulder dystocia
• turtle sign
• anterior shoulder lodged behind symphysis pubis
• suprapubic pressure
• never fundal pressure

Marks

3

Topic

Fetal Heart Rate Monitoring — Intrauterine Resuscitation

Difficulty

hard

Template Id

T8

Examiner Tip

The memory aid 'STOP-TURN-FLUID-O2-CALL' covers all five intrauterine resuscitation steps in order. NLE questions on FHR management reward correct SEQUENCE, not just listing the actions. The order signals your clinical reasoning ability.

Model Answer

The steps of intrauterine resuscitation for a non-reassuring fetal heart rate, in priority order, are: 1. STOP the oxytocin infusion immediately to eliminate uterotonic stimulation. 2. REPOSITION the mother to the left lateral position to relieve aortocaval compression and improve uteroplacental blood flow. 3. INCREASE the IV fluid infusion rate (IV fluid bolus) to improve maternal circulating volume and placental perfusion. 4. APPLY oxygen via face mask (8–10 L/min) to increase maternal-fetal oxygen delivery. 5. NOTIFY the physician or provider and document the FHR pattern and interventions. 6. PREPARE for expedited delivery (cesarean or operative vaginal) if the FHR does not recover.

Question Type

short_answer

Answer Structure

• Step 1: Stop oxytocin [1 mark]
• Step 2: Reposition to left lateral AND IV fluid bolus AND oxygen [1 mark]
• Step 3: Notify physician and prepare for delivery [1 mark]

Scoring Breakdown

Common Mark Deductions

• Listing 'notify physician' as the FIRST step — oxytocin discontinuation takes priority
• Omitting the IV fluid bolus entirely
• Writing 'right lateral position' instead of left lateral

Key Phrases To Include

• stop oxytocin
• left lateral position
• IV fluid bolus
• oxygen by face mask
• notify the physician
• prepare for expedited delivery

Marks

3

Topic

Post-Term Pregnancy

Difficulty

medium

Template Id

T9

Examiner Tip

Post-term questions in the NLE consistently test whether you know the FETAL risks — not just labor management. The three key post-term dangers are oligohydramnios, meconium aspiration, and placental insufficiency. Include all three to earn full marks.

Model Answer

For a client with post-term pregnancy admitted for labor induction, nursing care priorities include: 1. Fetal surveillance: Assess fetal heart rate continuously for signs of compromise (late decelerations, variable decelerations), as the post-mature placenta provides inadequate perfusion. Monitor the amniotic fluid index for oligohydramnios, which increases cord compression risk. 2. Monitor for meconium-stained amniotic fluid: Notify the provider immediately if meconium is present, as this signals fetal hypoxia and increases the risk of meconium aspiration syndrome in the newborn. 3. Prepare for neonatal resuscitation: Ensure a neonatal resuscitation team or pediatrician/neonatologist is present at delivery, as the post-term neonate is at high risk for meconium aspiration, macrosomia complications, and birth asphyxia.

Question Type

short_answer

Answer Structure

• Priority 1: Continuous fetal surveillance — FHR and amniotic fluid assessment [1 mark]
• Priority 2: Monitor for and respond to meconium-stained fluid [1 mark]
• Priority 3: Prepare for neonatal resuscitation at delivery [1 mark]

Scoring Breakdown

Common Mark Deductions

• Focusing only on the mother (labor progress, pain management) without addressing fetal risks
• Omitting the specific complication of meconium aspiration
• Writing 'monitor vital signs' without specifying fetal monitoring parameters

Key Phrases To Include

• continuous fetal monitoring
• oligohydramnios
• cord compression risk
• meconium-stained amniotic fluid
• meconium aspiration syndrome
• neonatal resuscitation
• aging/post-mature placenta

Marks

5

Topic

Cesarean Birth — Postoperative Nursing Care

Difficulty

hard

Template Id

T10

Examiner Tip

5-mark long-answer questions are scored holistically AND analytically in the NLE. Organize your answer with numbered or labeled headings. Examiners specifically look for NANDA-format nursing diagnoses (Problem + Etiology + Signs/Symptoms), use of the nursing process, and inclusion of post-cesarean hemorrhage as the top risk. Show that you prioritize using Maslow's physiologic safety first (hemorrhage before comfort).

Model Answer

POSTOPERATIVE NURSING ASSESSMENTS AFTER CESAREAN BIRTH: Physiologic assessments follow the postpartum framework (BUBBLE-HE): 1. Fundus: Assess uterine firmness, height, and position. The fundus should be firm, midline, and at the level of the umbilicus. A soft, boggy uterus signals uterine atony and impending hemorrhage — the primary postoperative complication. 2. Lochia: Assess for amount, color, and clots. Lochia rubra (red) is expected in the first 24 hours. Saturation of more than one perineal pad per hour or passage of large clots indicates hemorrhage; notify the physician immediately. 3. Incision: Inspect the abdominal incision for redness, edema, ecchymosis, discharge, and approximation (REEDA scale). Signs of infection or dehiscence must be reported. 4. Vital Signs: Monitor BP, PR, RR, and temperature every 15 minutes for the first hour, then per protocol. Hypotension and tachycardia indicate hemorrhage or infection. Temperature above 38°C after the first 24 hours suggests infection. 5. Pain: Assess pain using a numerical scale (0–10). Post-cesarean pain is expected; ensure ordered analgesics are administered and that maternal sedation does not impair newborn breastfeeding. 6. Urinary Output: Ensure the indwelling catheter is patent. Urine output should be at least 30 mL/hour. Decreased output may indicate hemorrhage or renal compromise. 7. Lower Extremities: Assess for Homans sign, calf tenderness, warmth, and edema — signs of deep vein thrombosis (DVT). Encourage early ambulation and leg exercises to prevent thromboembolism. TWO PRIORITY NURSING DIAGNOSES (NANDA): 1. Risk for Hemorrhage related to uterine atony and surgical blood loss as evidenced by recent cesarean delivery. Interventions: Assess fundal firmness every 15 minutes initially; monitor lochia amount and vital signs; ensure IV access is patent; report abnormal findings immediately. 2. Acute Pain related to surgical incision and uterine contractions as evidenced by client's verbal report and guarding behavior. Interventions: Administer prescribed analgesics on schedule; teach splinting technique (using a pillow over the incision when coughing or moving); assess pain level before and after interventions; encourage non-pharmacologic comfort measures.

Question Type

long_answer

Answer Structure

• Introduction: State that assessment follows the postpartum framework [0.5 mark]
• Assessment 1: Fundus — firmness, position, and significance [0.5 mark]
• Assessment 2: Lochia — amount, color, and abnormal findings [0.5 mark]
• Assessment 3: Incision — REEDA assessment [0.5 mark]
• Assessment 4: Vital signs — frequency and what to report [0.5 mark]
• Assessment 5: Urinary output and lower extremity DVT assessment [0.5 mark]
• Nursing Diagnosis 1: Risk for Hemorrhage with interventions [1 mark]
• Nursing Diagnosis 2: Acute Pain with interventions [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing nursing diagnoses in medical diagnosis format (e.g., 'post-op hemorrhage') instead of NANDA format
• Listing assessments without stating their clinical significance or what abnormal findings mean
• Omitting DVT prevention — a commonly tested post-cesarean complication
• Writing nursing interventions that are not specific (e.g., 'monitor patient' without parameters)
• Using fewer than 2 nursing diagnoses when the question specifically asks for two

Key Phrases To Include

• BUBBLE-HE framework
• fundal firmness and position
• lochia rubra
• more than one pad per hour
• REEDA scale
• urine output 30 mL/hour
• deep vein thrombosis prevention
• early ambulation
• Risk for Hemorrhage
• Acute Pain
• NANDA nursing diagnosis

Marks

5

Topic

Amniotic Fluid Embolism

Difficulty

hard

Template Id

T11

Examiner Tip

AFE 5-mark questions reward structured answers with three clear sections: pathophysiology, recognition, and management. Examiners specifically look for DIC as a complication of AFE — it is frequently omitted by examinees. Reference the nursing scope under RA 9173 in your conclusion to demonstrate professional awareness.

Model Answer

AMNIOTIC FLUID EMBOLISM (AFE) — A CATASTROPHIC OBSTETRIC EMERGENCY: PATHOPHYSIOLOGY: Amniotic fluid embolism occurs when amniotic fluid, fetal cells, hair, and other debris enter the maternal circulation through tears in the uteroplacental membranes or cervical veins. This triggers a two-phase response: Phase 1: Pulmonary vasospasm and pulmonary hypertension cause acute right heart failure and hypoxia. Phase 2: Left heart failure follows, with cardiovascular collapse. Simultaneously, amniotic fluid components activate the coagulation cascade, leading to disseminated intravascular coagulation (DIC) — consuming clotting factors and causing uncontrolled bleeding. RECOGNITION — CLASSIC CLINICAL PRESENTATION: AFE presents as a sudden, catastrophic triad during labor, delivery, or within 30 minutes postpartum: 1. Sudden respiratory distress and cyanosis (dyspnea, tachypnea, O2 saturation drop) 2. Cardiovascular collapse — acute hypotension, tachycardia, and cardiac arrest 3. Altered consciousness — anxiety, agitation, seizures, or sudden loss of consciousness DIC follows rapidly — evidenced by excessive bleeding from IV sites, surgical incisions, and the uterus despite no mechanical cause. EMERGENCY NURSING MANAGEMENT (Priority Order): 1. Activate the obstetric emergency/code team immediately — AFE is immediately life-threatening. 2. Maintain airway and breathing — position the client, apply high-flow oxygen (10–15 L/min via non-rebreather mask), and prepare for endotracheal intubation. 3. Initiate cardiopulmonary resuscitation (CPR) if cardiac arrest occurs — perform high-quality chest compressions. In a pregnant client, displace the uterus to the left during CPR. 4. Establish large-bore IV access (two sites) — rapidly infuse IV fluids and blood products as ordered. 5. Manage DIC — administer blood products: packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelets as ordered. 6. Continuous monitoring — fetal heart rate, maternal vital signs, oxygen saturation, urine output, and coagulation studies. 7. Prepare for emergency cesarean if the fetus is viable and cardiac arrest occurs — perimortem cesarean may be performed within 5 minutes of maternal arrest. PROGNOSIS: AFE carries a high maternal mortality rate. Nursing care is primarily supportive and resuscitative. In the Philippine context under RA 9173, nurses implement emergency measures within their scope while ensuring the physician is immediately notified.

Question Type

long_answer

Answer Structure

• Section 1: Pathophysiology — mechanism of entry, pulmonary vasospasm, DIC [1.5 marks]
• Section 2: Recognition — classic triad of presentation [1.5 marks]
• Section 3: Emergency management in correct priority order [2 marks]

Scoring Breakdown

Common Mark Deductions

• Confusing AFE with pulmonary embolism from thrombus — different mechanism
• Omitting DIC from the pathophysiology or management
• Not mentioning CPR as a potential intervention
• Writing management without prioritization order

Key Phrases To Include

• amniotic fluid enters maternal circulation
• pulmonary vasospasm
• cardiovascular collapse
• disseminated intravascular coagulation (DIC)
• sudden respiratory distress and cyanosis
• cardiopulmonary resuscitation
• high-flow oxygen
• blood products: FFP, cryoprecipitate, platelets
• perimortem cesarean

Marks

2

Topic

Cesarean Birth — Incision Types

Difficulty

easy

Template Id

T12

Examiner Tip

NLE frequently asks about VBAC eligibility. The answer always hinges on the TYPE of previous uterine incision, NOT the skin incision. Low transverse = eligible for VBAC trial. Classical = always repeat cesarean. This is a 'safety threshold' question where the wrong answer has serious clinical consequences.

Model Answer

A low transverse incision (Pfannenstiel) is made in the lower uterine segment horizontally. It has less blood loss, heals with a stronger scar, and allows a trial of labor after cesarean (TOLAC/VBAC) in future pregnancies, with lower risk of uterine rupture. A classical incision is a vertical midline incision through the upper uterine segment. It is used for emergencies or abnormal presentations but carries a significantly higher risk of uterine rupture in subsequent labors — therefore, a classical incision contraindicates future trial of labor, and repeat cesarean section is required for all subsequent deliveries.

Question Type

short_answer

Answer Structure

• Point 1: Describe low transverse incision — location, advantages, and TOLAC/VBAC implication [1 mark]
• Point 2: Describe classical incision — location, use, and contraindication to future labor [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating that classical incision also allows VBAC — this is incorrect and dangerous
• Confusing the incision type with the skin incision (Pfannenstiel refers to the uterine incision)
• Omitting the clinical implication for future pregnancies

Key Phrases To Include

• low transverse / Pfannenstiel
• lower uterine segment
• TOLAC/VBAC permitted
• classical / vertical incision
• upper uterine segment
• contraindicates future trial of labor
• uterine rupture risk

Marks

3

Topic

Precipitous Labor

Difficulty

medium

Template Id

T13

Examiner Tip

For precipitous labor questions, the NLE tests whether you know NOT to stop the delivery. The reflex answer of 'restrain' or 'hold back the baby' is wrong and unsafe. The correct action is controlled support of the emerging fetus. This is a test of safe nursing judgment.

Model Answer

Precipitous labor is labor that progresses from onset to birth in less than 3 hours. It is characterized by extremely rapid cervical dilation and fetal descent. Maternal risk: Severe perineal, vaginal, and cervical lacerations due to the rapid passage of the fetus through the birth canal without adequate time for the tissues to stretch. Fetal risk: Fetal hypoxia and intracranial injury due to rapid changes in pressure during the abrupt descent through the birth canal, and risk of birth trauma from an uncontrolled delivery. Priority nursing intervention: The nurse must REMAIN WITH THE CLIENT at all times and must NOT attempt to restrain or delay the delivery. The nurse should support the emerging fetus by applying gentle controlled pressure to prevent explosive delivery, guide the fetal head, and prepare for immediate newborn care.

Question Type

short_answer

Answer Structure

• Definition: labor from onset to birth in less than 3 hours [1 mark]
• One maternal risk AND one fetal risk [1 mark]
• Priority nursing intervention: stay with client, support delivery, do not restrain [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating precipitous labor is less than 2 hours or less than 1 hour — the standard definition is less than 3 hours
• Writing 'slow down the labor' as a nursing action — attempting to restrain delivery is dangerous
• Failing to include BOTH a maternal AND fetal risk when the question specifies one of each

Key Phrases To Include

• less than 3 hours
• rapid cervical dilation
• perineal/vaginal lacerations
• fetal hypoxia
• intracranial injury
• do not leave the client
• do not restrain delivery
• controlled delivery of the fetal head

Marks

2

Topic

Fetal Heart Rate Monitoring

Difficulty

medium

Template Id

T14

Examiner Tip

The NLE tests FHR interpretation not just by asking you to identify the type, but by asking what you DO about it. Late decelerations always require the full intrauterine resuscitation bundle. Stating 'observe and continue monitoring' will not earn marks for the management portion.

Model Answer

Late decelerations are clinically significant because they indicate uteroplacental insufficiency — the placenta is not delivering adequate oxygen to the fetus. They begin after the peak of a contraction and return to baseline only after the contraction ends. Late decelerations are considered ominous because they signal fetal hypoxia and, if persistent, can progress to fetal acidosis and death. Immediate nursing response: Stop the oxytocin infusion, reposition the mother to the left lateral position, administer oxygen by face mask at 8–10 L/min, increase the IV fluid rate, and notify the physician immediately for possible expedited delivery.

Question Type

short_answer

Answer Structure

• Clinical significance: uteroplacental insufficiency, fetal hypoxia, ominous pattern [1 mark]
• Immediate nursing response: stop oxytocin, left lateral position, oxygen, IV fluid, notify physician [1 mark]

Scoring Breakdown

Common Mark Deductions

• Describing late decelerations as 'benign' or 'normal' — they are an ominous finding
• Confusing late decelerations with early decelerations (which are benign and mirror the contraction)
• Omitting the step to stop oxytocin as part of the response

Key Phrases To Include

• uteroplacental insufficiency
• fetal hypoxia
• ominous pattern
• begins after peak of contraction
• stop oxytocin
• left lateral position
• oxygen by face mask
• IV fluid bolus

Marks

1

Topic

Dystocia — Passageway

Difficulty

easy

Template Id

T15

Examiner Tip

CPD is a passageway problem (one of the 4 Ps of dystocia). NLE 1-mark questions want both the definition AND the management. If you only define the term, you may earn half-credit at best. Always complete the clinical picture.

Model Answer

Cephalopelvic disproportion (CPD) is a condition in which the fetal head is too large to pass through the maternal pelvis, preventing vaginal delivery. The expected management is cesarean section (cesarean birth).

Question Type

very_short_answer

Answer Structure

• Define CPD AND state the management in one to two sentences [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating CPD can be managed with forceps or vacuum — CPD requires cesarean
• Defining CPD without stating the management — incomplete answer

Key Phrases To Include

• fetal head too large for the maternal pelvis
• cesarean section / cesarean birth
• passageway problem