Worksheets2205 Exam 2 pt.2
Total questions: 100
Worksheet time: 50mins
A client at 39 weeks is supine for epidural placement and becomes pale and diaphoretic; FHR shows recurrent late decelerations. What is the nurse’s priority action?
Turn the client to a lateral position
Apply oxygen 12 L NRB
Stop IV fluids
Begin pushing coaching
Which finding best reflects a normal fetal adaptation to labor?
Persistent absent variability between contractions
Decreased fetal breathing movements during contractions
Sustained sinusoidal pattern
Recurrent late decelerations with minimal variability
The nurse is confirming baseline FHR. Which method is correct?
Average the rate over 2 minutes including decelerations
Use the lowest rate over 10 minutes
Determine the mean FHR over a 10-minute segment excluding periodic changes
Use maternal pulse if tracing is poor
Which tracing is Category III?
Moderate variability with recurrent variables
Minimal variability with occasional lates
Marked variability with early decels
Absent variability with recurrent late decelerations
A client has recurrent variable decelerations after ROM and oligohydramnios. Which provider order best targets the cause?
Amnioinfusion
Dinoprostone
Methylergonovine
Magnesium sulfate
Which statement about CST is most accurate?
It diagnoses ROM
It evaluates fetal tolerance of uterine contractions (stress)
It replaces continuous EFM in labor
It is performed only after delivery
A fetal scalp electrode is being considered. Which is the best indication?
Need to quantify contraction intensity
Poor external FHR tracing in a high-risk labor requiring continuous FHR accuracy
Need to confirm PPROM
Client refuses IV access
A client on oxytocin has tachysystole and recurrent late decelerations. Which action is priority?
Increase oxytocin to shorten labor
Perform amniotomy
Apply oxygen first and keep oxytocin running
Stop oxytocin and reposition laterally
Which “5 Powers” component is being assessed when evaluating pelvic dimensions and soft tissue resistance?
Passageway
Passenger
Powers
Psyche
A nurse palpates the uterus and notes the fetus is breech. Which breech type has the highest cord prolapse risk?
Frank
Complete
Footling
Kneeling
A client has PPROM at 31 weeks. Which assessment approach best reduces infection risk while confirming ROM?
Frequent digital cervical exams for trend
Sterile speculum exam for pooling/visualization and limited digital exams
Bimanual exam with lubricant first
Routine cervical checks every 2 hours
A client with PPROM has a positive nitrazine test. Which factor can cause a false-positive?
Low vaginal pH
Amniotic fluid
Blood or semen contamination
Dried slide artifact
The nurse suspects chorioamnionitis. Which cluster most supports it?
Maternal fever, uterine tenderness, fetal tachycardia, foul/purulent fluid
Painless bright red bleeding, soft uterus
Reactive NST and maternal bradycardia
Marked variability with accelerations only
A client with suspected intraamniotic infection asks why repeated vaginal exams are avoided. Best response:
“They stop contractions.”
“They increase risk of ascending infection.”
“They prevent fetal descent.”
A client attempting VBAC reports sudden severe abdominal pain; the nurse notes loss of fetal station and fetal bradycardia. Priority action?
Begin CST
Continue oxytocin to expedite delivery
Prepare for emergent cesarean and activate rapid response
Encourage ambulation to rotate fetus
Which finding is most consistent with uterine rupture (not dehiscence)?
Thinning of scar without fetal compromise
Mild pain relieved by rest
Gradual spotting only
Sudden pain + abnormal FHR + loss of station/uterine contour change
A client has abruptio placentae suspicion. Which assessment is most concerning for concealed abruption?
Rigid, tender uterus with fetal distress and minimal external bleeding
Green amniotic fluid after ROM
Painless bleeding with soft uterus
Ferning on microscopy
A client has placenta separation suspicion and is hypotensive. Which order should the nurse anticipate first to support resuscitation planning?
Encourage oral fluids
Type and crossmatch blood
Discontinue continuous EFM
Delay IV access until OR
Which fetal heart rate pattern is most strongly associated with uteroplacental insufficiency?
Late decelerations
Early decelerations
Accelerations
Sinus arrhythmia
A nurse sees recurrent late decelerations. After repositioning and stopping oxytocin, which action is most appropriate next?
Begin pushing at 6 cm
Perform amniotomy
Start dinoprostone
IV fluid bolus per protocol and notify provider
A newborn is delivered through meconium-stained fluid and is vigorous (crying, good tone). What care is expected?
Routine newborn care (no automatic intubation solely for meconium)
Immediate deep suctioning and intubation regardless
Delay drying to reduce aspiration risk
NPO and gastric lavage for all cases
What does VEAL-CHOP match for “Variable”?
Head compression
Cord compression
Placental insufficiency
Overstimulation from epidural
A tracing shows abrupt drops with quick return and “shoulders.” Most likely cause?
Placental insufficiency
Head compression
Cord compression
Maternal fever only
Which description fits a prolonged deceleration?
Drop lasting 15 seconds
Drop lasting 30–60 seconds
Drop lasting ≥2 minutes but <10 minutes
Drop lasting ≥10 minutes (baseline change)
A client has minimal variability and no accelerations; she received IV opioids 20 minutes ago. Most likely explanation?
Medication/sedation effect
Fetal anemia
Cord prolapse
Placental abruption
A nurse suspects shoulder dystocia when the head delivers then retracts (“turtle sign”). What is the first nursing action?
Apply fundal pressure
Call for help and begin McRoberts/suprapubic pressure sequence
Prepare for OR transport immediately as only option
Pull downward on the fetal head
Which maneuver is appropriate in shoulder dystocia?
Fundal pressure
McRoberts (hyperflex maternal hips)
Immediate vacuum at −2 station
Trendelenburg with legs extended
Which newborn complication is most associated with shoulder dystocia?
Brachial plexus injury/clavicle fracture
NEC
A client with PPROM asks what “fern test” means. Which statement is accurate?
Microscopic crystallization pattern supports amniotic fluid presence
It measures fetal oxygenation
It determines GBS status
It is unaffected by contamination
Which test is most helpful for 36-week screening affecting intrapartum antibiotics?
Rubella titer
GBS culture
Quad screen
1-hr glucose tolerance
After epidural placement, the client becomes hypotensive and FHR shows bradycardia. Priority nursing intervention?
Lateral position + IV fluid bolus per protocol
Administer naloxone
Start dinoprostone
Encourage breath-holding pushes
Which medication is an appropriate anticipated treatment for persistent epidural-associated hypotension after fluids/positioning (per common L&D protocol)?
Methylergonovine
Magnesium sulfate
Ephedrine/vasopressor per policy
Terbutaline to increase BP
A client receives IV fentanyl. What is the most important maternal assessment priority?
Respiratory rate and level of consciousness
Urine ketones
Deep tendon reflexes
Fundal height
A client becomes somnolent with RR 8 after opioid analgesia. What is the priority medication?
Diphenhydramine
Naloxone
Oxytocin
Dinoprostone
Which is a contraindication to neuraxial anesthesia (epidural/spinal)?
Coagulopathy/low platelets
Mild heartburn
Intact membranes
Nulliparity
A client has a high spinal block and reports difficulty breathing; BP drops. Priority action?
Assist airway/ventilation and call anesthesia/provider immediately
Encourage ambulation to redistribute block
Give oral fluids
Stop fetal monitoring to reduce stress
Which stage of labor is 10 cm to delivery?
Third stage
Second stage
Fourth stage
First stage
Which finding best indicates active phase rather than latent?
Placental delivery
Contractions irregular and mild, cervix 1–3 cm
Cervix typically 4–7 cm with progressive dilation and stronger contractions
Cervix 8–10 cm with urge to push
A client is 9 cm with strong urge to push. Priority nursing action?
Begin postpartum teaching
Encourage pushing immediately for relief
Discontinue monitoring
Support pant-blow breathing and prevent early pushing if not fully dilated/ordered
Which characteristic best differentiates true labor?
Pain relieved by walking
Contractions decrease with hydration/rest
Regular contractions with progressive cervical change
No cervical change over time
Leopold maneuvers primarily help the nurse determine:
Fetal acid–base status
Fetal lie, presentation, and position (approximation)
Placental location definitively
GBS colonization
A nurse places an IUPC. What does it measure best?
Maternal BP continuously
Fetal oxygen saturation
Contraction intensity and resting tone numerically
Fetal heart rhythm variability
Even with an IUPC, the nurse must still:
Remove external monitors immediately
Palpate contractions and assess maternal response per policy
Stop documenting contractions
Discontinue fetal assessments
Which condition must be present before placing internal monitors (FSE/IUPC)?
No fetal movement
Intact membranes
Ruptured membranes and sufficient dilation for placement
Closed cervix
A nonreactive NST after 40 minutes most commonly leads to which next test?
Amniotomy
VBAC criteria review
Immediate hysterectomy
Biophysical profile (BPP) or further evaluation per provider
NST minimum monitoring time before extending (typical)?
5 minutes
60 minutes
20 minutes
2 minutes
Which is the best definition of tachysystole?
Contractions every 6 minutes
5 contractions in 30 minutes
Resting tone 0
>5 contractions in 10 minutes averaged over 30 minutes
A client on oxytocin develops tachysystole with Category II tracing. Priority?
Encourage pushing to shorten labor
Reduce/stop oxytocin and begin intrauterine resuscitation
Start dinoprostone
Increase oxytocin to overcome slowed labor
“Oxygen in labor” teaching per many updated protocols is best summarized as:
Oxygen is contraindicated in labor
Oxygen replaces stopping oxytocin
Use oxygen after correcting reversible causes; not first-line for all nonreassuring tracings
Oxygen is always first and best
First-line intrauterine resuscitation for many nonreassuring patterns is:
Give naloxone
Apply oxygen
Do amniotomy
Reposition laterally
A client has recurrent variables that persist despite repositioning. Which intervention is next most targeted (if ordered)?
Dinoprostone insert
Increase oxytocin
Fundal pressure
Amnioinfusion
A client with suspected cord prolapse has sudden fetal bradycardia after ROM. What is the priority nursing action?
Perform a vaginal exam to assess for cord and relieve compression if present
Apply a fetal scalp electrode first
Start CST
Administer antibiotics
Overt cord prolapse is confirmed. What must the nurse do continuously until delivery?
Encourage pushing
Replace cord into uterus
Manually elevate presenting part off the cord (do not remove hand)
Clamp cord immediately
Which is contraindicated in cord prolapse management?
Knee-chest/Trendelenburg positioning
Manual elevation of presenting part
Calling for emergent delivery
Pinching/manipulating the cord
A vacuum-assisted birth occurred. Newborn has a scalp swelling that crosses suture lines. Most likely finding?
Hydrocephalus
Cephalohematoma
Caput succedaneum
Meningocele
Cephalohematoma is most associated with which risk later?
Immediate respiratory distress
Hyperbilirubinemia/jaundice due to blood breakdown
Congenital infection
Tetralogy of Fallot
A client has meconium-stained fluid. Which fetal complication is the nurse most concerned about if aspiration occurs?
Clubfoot
PDA from oxytocin
Respiratory distress/hypoxemia
Hypernatremia
Which fetus is at highest risk for meconium passage?
Twin A at 34 weeks
Post-term fetus
Preterm 28 weeks
Elective induction at 37 weeks
A client with PPROM asks why “pooling” matters. Best answer:
It confirms chorioamnionitis
Visible pooling in posterior fornix supports ROM diagnosis
It identifies fetal position
It confirms abruption
Which PPROM test uses an immunoassay detecting proteins associated with amniotic fluid (high sensitivity, possible false positives)?
Ultrasound only
Fern test
Immunoassay ROM test
Nitrazine
A client with suspected infection has fever and uterine tenderness. Which fetal finding most supports chorioamnionitis?
Frequent accelerations
Recurrent early decelerations only
Sinus bradycardia at baseline 110
Fetal tachycardia baseline >160 for ≥10 minutes
Which organism category can contribute to intraamniotic infection?
Only parasites
Ascending polymicrobial flora including bacterial pathogens (e.g., GBS/E. coli)
Only viruses
Only fungi
A client has suspected chorioamnionitis. Which nursing plan best reduces further risk?
Place supine for accurate tracing
Encourage repeated digital exams to trend dilation
Minimize vaginal exams, monitor temp/FHR closely, anticipate antibiotics
Stop maternal vitals to reduce stress
A client with chorioamnionitis is anxious and says, "My baby will be taken away." Best nursing focus?
Avoid discussing NICU
Prepare for possible NICU evaluation and support bonding plans/psychosocial needs
Discharge teaching only
Tell her "that won’t happen"
A client in 4th stage has boggy fundus and heavy lochia. First nursing action?
Stop oxytocin infusion
Place client prone
Fundal massage and assess bladder distention/void
Delay interventions until provider arrives
Fundus is firm but bleeding remains heavy. Priority concern?
Genital tract laceration/retained tissue—notify provider
Bladder distention only
Normal lochia rubra
Dehydration
Newborn first hour: persistent grunting and nasal flaring. Priority?
Delay assessment for bonding
Support airway/oxygenation per NRP and notify neonatal team
Feed immediately to stop grunting
Bath immediately
Best action to prevent newborn heat loss in first 2 hours?
Bathe immediately
Keep uncovered for observation
Place under a fan
Dry thoroughly and skin-to-skin with warm blankets
Which is a key risk with operative vaginal delivery (forceps/vacuum) that impacts newborn bilirubin?
Patent ductus arteriosus
Bruising/hematoma increasing jaundice risk
Hyperglycemia
Neural tube defect
Which finding is most consistent with early decelerations?
Drop starting after peak (uteroplacental insufficiency)
Abrupt drop with shoulders
Gradual decrease that mirrors contraction peak (head compression)
Prolonged decel >10 minutes
A Category II tracing with minimal variability persists; fetal scalp stimulation produces accelerations. Best interpretation?
Suggests fetal acidemia less likely at that moment
Confirms fetal anemia
Confirms uterine rupture
Requires immediate cesarean always
A provider discusses fetal scalp blood sampling for acid–base. What does it primarily evaluate?
Maternal infection status
Fetal pH/acid–base status to clarify fetal oxygenation compromise
Placental previa
Cervical readiness
A client is receiving dinoprostone. Which finding requires immediate intervention?
Mild cramping
Increased mucous
Tachysystole with fetal distress
Sleepiness
What is the main purpose of dinoprostone in L&D?
Reverse opioids
Treat chorioamnionitis
Treat uterine atony postpartum
Cervical ripening for induction
Which medication is used to relax the uterus in tachysystole with fetal compromise (provider order)?
Misoprostol
Terbutaline
Which is a common adverse effect/concern with terbutaline that requires monitoring?
Maternal tachycardia/palpitations
Hyperkalemia
Jaundice
Severe hypertension and proteinuria
A client in preterm labor is ordered nifedipine. Priority assessment before administration?
Fundal height trend only
Maternal bowel sounds
Maternal blood pressure
Fetal hair pattern
Fetal fibronectin (fFN) is used primarily to:
Help assess risk of preterm birth in symptomatic clients (with clinical correlation)
Confirm ROM definitively
Determine fetal presentation
Diagnose chorioamnionitis
Which is a classic risk factor for shoulder dystocia?
Small for gestational age
Oligohydramnios
Preterm fetus 28 weeks
Macrosomia (often larger fetuses), prolonged second stage/operative delivery history
Which action is contraindicated in shoulder dystocia?
Call for help/neonatal team
McRoberts
Suprapubic pressure
Fundal pressure
A client with PPROM at 30 weeks: priority ongoing nursing surveillance focuses on:
Fundal height only
Infection signs and cord compression/fetal status
Daily Pap smear
Blood glucose checks only
Which PPROM complication is most likely to increase neonatal respiratory problems?
Prematurity and possible infection leading to respiratory distress
Maternal seasonal allergies
Hyperthyroidism
Excess vernix
Which lab is most essential on admission for hemorrhage preparedness?
RICE
APGAR
Color, odor, amount, time (COAT)
LATCH
A client with ROM had clear fluid, then later thick green fluid appears. Best interpretation?
It proves breech presentation
Meconium can appear later and may signal fetal stress
It proves infection every time
Green fluid is always normal after epidural
Which finding best suggests fetal compromise risk from prolonged hypoxia?
Early decels only in second stage
Moderate variability with accelerations
Baseline 120 with no decels
Absent variability with recurrent late decelerations
A tracing shows baseline 170 for >10 minutes. First nursing action?
Assess maternal temp/hydration and intervene (reposition/fluids as indicated)
Apply oxygen first for 30 minutes regardless
Remove monitors
Start pushing
A client receives epidural and cannot void. Best nursing action?
Ignore until postpartum
Anticipate urinary retention—bladder assessment/catheter per policy
Encourage unassisted ambulation to bathroom
Restrict all IV fluids immediately
The newborn has poor tone and weak respirations after delivery. Priority?
Immediate feeding
Delay stimulation
Begin neonatal resuscitation steps per NRP and notify team
Routine care only
Which statement best describes the relationship between fetal head compression and decelerations?
Head compression causes prolonged decelerations always
Head compression typically causes early decelerations (usually benign)
Head compression causes late decelerations
Head compression causes sinusoidal pattern
Which indicates placental insufficiency most strongly?
Early decelerations
Recurrent late decelerations
Accelerations with moderate variability
Baseline 110 with no decels
A client has recurrent late decelerations and is 2 cm dilated. What is the most likely disposition if unresolved quickly?
Encourage walking for 2 hours first
Stop fetal monitoring
Prepare for cesarean delivery (vaginal not imminent)
Which best defines uterine dehiscence?
Placental separation from uterine wall
Incomplete separation/thinning of uterine scar without full rupture
Full thickness tear with fetal parts in abdomen
Cord compression with visible loop
A client with suspected uterine rupture: which nursing prep is most appropriate?
Large-bore IV access, type & cross, rapid OR readiness, continuous fetal assessment
Encourage oral intake for energy
Start dinoprostone
Delay labs until delivery
The nurse suspects abruptio placentae. Which fetal tracing change is common with worsening abruption?
Early decelerations only
Increasing late decelerations/bradycardia due to compromised perfusion
Sinusoidal always due to fever
Frequent accelerations only
A client has fetal demise confirmed. Which nursing intervention is best?
Avoid discussing grief resources
Use false reassurance only
Prevent family visits
Offer choices: holding baby, photos/prints, spiritual/cultural support per preference
Which response is most therapeutic to a client after fetal loss?
“You need to move on quickly.”
“Everything happens for a reason.”
“Tell me what you’re feeling right now—I’m here with you.”
“At least you can get pregnant.”
A client in latent labor requests nonpharmacologic pain control. Best option?
Immediate general anesthesia
Ambulation, position changes, breathing, hydrotherapy (if appropriate)
Supine bedrest only
Directed pushing
Which analgesia method provides perineal anesthesia late in second stage and for laceration repair?
Pudendal block
Dinoprostone
Nitrous oxide only
Epidural only
Which is a common epidural complication that can worsen uteroplacental perfusion?
Maternal hyperglycemia
Maternal hyperreflexia
Maternal polycythemia
Maternal hypotension
A client with epidural develops pruritus and nausea. Priority nursing action?
Encourage unassisted ambulation
Stop fetal monitoring
Monitor maternal VS/respirations and fetal status; manage per protocol
Place supine to reduce itching
