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Worksheets2205 Exam 2 pt.3
Total questions: 99
Worksheet time: 50mins
Which cardinal movement occurs when the fetal head turns to align with the pelvic outlet?
Flexion
Restitution
Internal rotation
Extension
Immediately after the head is born, the head rotates to align with the shoulders. This is called:
Descent
Engagement
Expulsion
Restitution/external rotation
A client has strong contractions but no descent; the fetus is suspected large and the pelvis possibly small. This is most consistent with:
Shoulder dystocia
Cephalopelvic disproportion (passageway vs passenger mismatch)
Normal latent phase
Precipitous labor
A nurse wants to reduce aortocaval compression in labor. Best position?
High Fowler’s with legs straight
Trendelenburg
Flat supine
Left lateral tilt/side-lying
A client with PPROM has foul-smelling fluid and maternal fever. Priority action?
Notify provider; anticipate antibiotics and close maternal/fetal monitoring
Stop temperature checks
Increase vaginal exams
Begin oxytocin without evaluation
A client’s GBS culture is positive. Which intrapartum plan is most appropriate when there is no allergy?
Ceftriaxone for all cases regardless
No antibiotics if membranes intact
IV penicillin/ampicillin per protocol during labor
Oral antibiotics after delivery only
A client with penicillin anaphylaxis is GBS positive. Best nursing action?
Give penicillin anyway
Decide based on nitrazine result
Hold antibiotics until postpartum
Notify provider for appropriate alternative antibiotic selection per protocol
Which labor finding best indicates transition?
2–3 cm with mild irregular contractions
8–10 cm with intense contractions/pressure and irritability
4–6 cm with moderate contractions
10 cm with delivery
A nurse assesses station at 0. This means the presenting part is:
2 cm below the ischial spines
Crowning
At the level of the ischial spines
2 cm above the ischial spines
A client is at +2 station. Best interpretation?
Below the ischial spines and descending toward delivery
At the ischial spines
Head floating
Above the ischial spines
Which fetal presentation is most compatible with uncomplicated vaginal delivery?
Transverse lie
Face mentum posterior
Shoulder
Vertex/cephalic
A nurse documents LOA. This indicates:
Cord left anterior
Occiput left anterior (generally favorable)
Breech sacrum left anterior
Mentum left anterior
External cephalic version is attempted. Which complication requires immediate stop and evaluation?
Temporary discomfort
Persistent fetal bradycardia/nonreassuring tracing
Maternal mild nausea
Mild uterine irritability that resolves
Which condition makes cord prolapse more likely after amniotomy?
Unengaged presenting part/high station
Thin meconium
Vertex LOA
Engaged head
A nurse reviews nonreassuring fetal status. Which is a major risk with excessive oxytocin?
Increased fetal oxygen delivery
Decreased contraction intensity
Tachysystole leading to reduced uteroplacental perfusion and fetal hypoxia/acidemia
Increased fetal breathing movements
A client has recurrent variables and minimal variability despite interventions; the cervix is complete and +2 station. Best next expectation?
Stop monitoring
Continue labor for 6 hours
Start dinoprostone
Operative vaginal delivery may be considered if conditions are met (provider decision)
Which newborn assessment is most urgent after vacuum delivery?
Hair pattern
Tooth eruption schedule
Neuro status, scalp injury signs, and respiratory status
Fontanel closure timeline only
A client has dysfunctional labor from hypotonic contractions. Best intervention?
Oxytocin titration with close monitoring (if no contraindication)
Stop all fluids
Terbutaline
Methylergonovine during labor
A client has hypertonic uterine dysfunction (painful, frequent, uncoordinated contractions with poor progress). Best nursing focus?
Increase oxytocin rapidly
Begin pushing early
Encourage breath-holding for 30 seconds each contraction
Promote rest, hydration, pain control; monitor fetal status; provider may adjust stimulation/consider etiologies
Which sign is most concerning for impending fetal acidemia in a worsening tracing?
Moderate variability with accelerations
Marked variability with accelerations
Absent variability with recurrent decelerations
Early decels only
A client has suspected infection; fetal baseline is 165 for >10 min. Next nursing action?
Decrease IV fluids
Place supine
Assess maternal temperature and treat contributing factors; notify provider
Start dinoprostone
Which is the best definition of baseline change?
Change lasting ≥10 minutes
Any HR change lasting 30 seconds
Change lasting 2–9 minutes
Change lasting <15 seconds
A nurse is deciding between intermittent auscultation vs continuous EFM. Which client requires continuous EFM?
Low-risk, spontaneous labor with reassuring status
Client refusing IV
Client with normal NST yesterday
VBAC attempt
A nurse sees a sinusoidal pattern. Best implication?
Benign sleep cycle
Suggests serious fetal compromise such as anemia/hemorrhage—urgent evaluation
Normal in second stage
Indicates maternal dehydration only
Which antibiotic is commonly used for GBS prophylaxis in labor (no allergy)?
Metronidazole
Nitrofurantoin
Penicillin G/ampicillin (per protocol)
Doxycycline
A client with suspected chorioamnionitis: which labs may support infection?
Low HbA1c
Low WBC
Low LDL
Leukocytosis and elevated inflammatory markers (with clinical findings)
A client with PPROM is anxious and states, “I caused this.” Best nursing response?
“You shouldn’t feel that way.”
Validate feelings, provide education, assess supports, and connect to resources
“Stop worrying.”
Change subject
A client has persistent bradycardia despite resuscitation. Priority preparation?
Prepare for urgent operative delivery; notify neonatal team
Encourage oral intake
Remove internal monitors
Start dinoprostone
A nurse is documenting fetal presentation. Which is the best direct bedside method for initial assessment?
Maternal temperature
CBC results
Leopold maneuvers + vaginal exam (as appropriate)
Nitrazine test
Which fetal head position is most associated with prolonged labor and back pain?
Occiput anterior
LOA always causes back labor
Breech frank
Occiput posterior
A client has persistent late decelerations. Which “CHOP” component matches “Late”?
Placental insufficiency
Cord compression
Head compression
Oxygen toxicity
A client has early decelerations. Which nursing action is most appropriate?
Stop oxytocin immediately
Continue monitoring; early decels are commonly benign head compression
Give terbutaline immediately
Emergent delivery prep
The nurse is evaluating “resting tone” with IUPC. Why is high resting tone concerning?
It proves rupture of membranes
It confirms shoulder dystocia
It can reduce uteroplacental perfusion between contractions
It increases fetal oxygenation
A newborn is separated due to NICU transfer. Which maternal concern should the nurse anticipate?
Increased appetite
No psychosocial impact expected
Only physical pain
Delayed bonding/grief/anxiety—support coping and facilitate contact plans
A client receives methylergonovine postpartum. Which condition is a contraindication?
Hypertension
Rubella nonimmune
Mild anemia
GBS colonization
A client has uterine atony postpartum. First nursing actions include:
Stop oxytocin infusion
Fundal massage, assess bladder/void, administer uterotonics per order
Encourage brisk walking immediately
Place client prone and reassess later
Which med is commonly first-line for uterine atony prevention/treatment?
Terbutaline
Naloxone
Oxytocin
Nifedipine
A nurse is preparing for amniotomy. Which fetal station finding is safest?
-3
Unstable lie
Ballottable/high
0 or + station (engaged)
A client has PROM and a sudden FHR drop occurs. What is the priority assessment?
Check for cord prolapse and assess FHR immediately
Assess rubella immunity
Obtain HbA1c
Teach breastfeeding
A client is placed on oxygen for fetal distress. The nurse should understand oxygen is generally:
Always first intervention in any abnormal tracing
Used after correcting causes like position/hypotension/oxytocin per updated practice trends
Not allowed in labor
Used to replace stopping oxytocin
A client’s fetal tracing is Category I. Which is expected?
Persistent bradycardia
Sinusoidal pattern
Baseline 110–160, moderate variability, no late/variable decels (early/accels may be present)
Absent variability with recurrent lates
A nurse wants to reduce infection risk with PPROM. Which action is best?
Delay fetal monitoring
Avoid maternal vitals
Digital exams q2h
Limit digital exams; use sterile speculum as needed
Which labor stage includes onset of regular contractions to full dilation?
First stage
Fourth stage
Second stage
Third stage
Which stage is “first 1–2 hours postpartum with close maternal assessment”?
Third
Fourth
First
Second
Which “3 S’s” mnemonic possibilities fit?
Supine, stress, sugar
Serum, sputum, saliva
Sleep, sedation, sick
Straining, shivering, shaking
Fetal sleep cycles can contribute to decreased variability for about:
3–4 hours
2–5 minutes only
24 hours
20–60 minutes
A client has PPROM. Which sign suggests developing infection that must be reported?
Fever/uterine tenderness/foul fluid
Increased appetite
Clear urine
Mild heartburn
A client is 6 cm with strong regular contractions. Best nursing focus?
Stop fetal monitoring
Active labor support: pain control, position changes, monitor FHR/uterine activity, hydration
Prepare placenta container
Begin pushing coaching
A newborn with bruising from forceps is at risk for:
Hypothyroidism
NEC
Hyperbilirubinemia
Spina bifida
Which finding is most consistent with cord compression?
Sinusoidal pattern
Late decelerations
Early decelerations
Variable decelerations
A nurse sees recurrent late decelerations. Which maternal condition is a classic contributor?
Hypertension causing placental insufficiency risk
Mild reflux
Seasonal allergies
Rh negative status
After delivery, which newborn medication is typically given in first hours?
Terbutaline
Vitamin K (and erythromycin per policy)
Dinoprostone
Methylergonovine
A client requests nitrous oxide. Key safety requirement?
Must be supine only
Requires intubation readiness always
Client self-administers via mask/demand valve; maintains protective reflexes
Nurse holds mask continuously
A client has Category III tracing and is fully dilated with head crowning. Best plan?
Start dinoprostone
Stop monitoring
Expectant management for 1 hour
A client has post-partum hemorrhage and is given carboprost. Which history is a major caution?
Asthma
Rubella nonimmune
Mild anemia
GBS positive
A client has postpartum hemorrhage; uterus is firm, bleeding persists. Priority next step?
Delay assessment
Suspect laceration/retained products and notify provider
Stop all meds
Continue fundal massage only
A client’s fetus is transverse lie. Best implication?
Confirms placenta previa
Indicates immediate shoulder dystocia
Vaginal delivery is unsafe unless corrected—provider management required
Always safe for induction
A nurse is assessing for PPROM and wants to preserve fFN accuracy. Best practice?
Collect after speculum with heavy gel
Collect after digital exam
Collect after vaginal cleansing with soap
Collect before digital exam/intercourse and avoid lubricant contamination
A client has a contraction pattern q1–2 min with fetal distress. What medication may be ordered to reduce uterine activity?
Terbutaline
Methylergonovine
Oxytocin
Dinoprostone
A nurse is caring for a client receiving magnesium sulfate for neuroprotection/tocolysis. Priority monitoring includes:
Nail beds only
RR, DTRs, urine output (per protocol)
Daily weights only
Skin turgor only
Which finding suggests magnesium toxicity?
Mild flushing only
Increased urine output
Respiratory depression and absent DTRs
Hyperreflexia
A client in labor has anxiety increasing pain. Which “power” is being affected by fear/tension?
Passenger
Passageway
Powers
Psyche
A fetal scalp blood sample shows worsening acidemia (low pH). Best next expectation?
Stop monitoring
Escalation to expedited delivery if unable to correct cause promptly
Continue labor unchanged
Start dinoprostone
A nurse is assessing fetal presentation. Which finding suggests cephalic?
Soft irregular mass (buttocks) in pelvis
Shoulder presenting first
Hard, round, ballotable part in lower uterus/pelvis
No presenting part
Which is an appropriate first action in uterine rupture suspicion?
Encourage pushing regardless of dilation
Increase oxytocin
Perform amniotomy
Stop oxytocin and activate emergency response/prepare OR
A client with suspected abruption has increased uterine tone. Which uterine description fits?
Firm/boardlike, tender uterus possible
Soft and painless
Boggy fundus postpartum
Uterus absent
A labor client with internal monitor is noted to have elevated resting tone and fetal late decels. Priority?
Begin pushing
Stop uterine stimulants and begin intrauterine resuscitation; notify provider
Turn off monitor
Increase oxytocin
A newborn delivered after prolonged shoulder dystocia is at greatest immediate risk for:
Delayed teething
Colic at 6 weeks
Hypoxia/asphyxia complications
Neonatal acne
Which statement about vacuum extraction is correct?
Replaces maternal pushing effort
Always safer than cesarean
Can be used at 4 cm to speed labor
Requires full dilation and appropriate station/position per provider criteria
Which is a correct association in VEAL-CHOP?
Late—Placenta
Variable—Head
Accel—Placenta
Early—Placenta
A client in labor has recurrent variables. Which position change is most appropriate first?
Trendelenburg for all cases
Side-to-side or lateral repositioning
Prone flat
Flat supine
Which fetal monitoring approach is most appropriate for a low-risk labor with reassuring status?
Must have CST during labor
Must have FSE
Must have IUPC
Intermittent auscultation may be acceptable per policy
A client has recurrent lates with minimal variability. Which intervention is least appropriate?
Continue oxytocin unchanged
Prepare for delivery if unresolved
Notify provider
Reposition + fluids + stop oxytocin + evaluate cause
A client’s contraction pattern is adequate but cervix stalls and fetus is OP. Best nursing intervention?
Reduce hydration
Encourage position changes (hands-and-knees/side-lying) as tolerated
Keep supine
Start pushing early
A client with PPROM is asked why they check for cord compression. Best explanation?
Cord compression only occurs with intact membranes
Cord compression prevents infection
Less fluid can increase cord compression risk → variable decelerations
Cord compression causes late decels
Which lab is most essential on admission for hemorrhage preparedness?
Lipid panel
TSH
HbA1c
CBC and type & screen
A client has forceps delivery. Which newborn finding requires urgent follow-up?
Facial asymmetry/weak suck suggesting facial nerve injury
Vernix caseosa
Lanugo
Mild molding
A postpartum client’s fundus is deviated right. Priority?
Begin CST
Assess bladder distention and assist to void/catheterize per policy
Place in Trendelenburg
Give terbutaline
A nurse is evaluating fetal tachycardia. Which maternal factor must be assessed immediately?
Maternal freckles
Maternal shoe size
Maternal temperature (fever/infection)
Maternal hair texture
Which tracing is most reassuring regarding fetal acid–base status?
Persistent bradycardia
Absent variability
Sinusoidal
Moderate variability
A client has minimal variability and no decels; fetus later shows accelerations after vibroacoustic stimulation. Best interpretation?
Likely fetal sleep/temporary effect; continue monitoring as ordered
Confirmed cord prolapse
Immediate uterine rupture
Confirmed placental abruption
A client has PPROM at 34 weeks. Which plan is most common depending on status?
Digital exams every hour
Evaluate gestational age, fetal status, infection; management may be expectant vs delivery per provider and clinical picture
Immediate home discharge always
Never give antibiotics
Which is a key risk factor for chorioamnionitis?
Normal UA
Rubella immunity
Prolonged rupture of membranes and frequent vaginal exams
Normal NST
A client’s fetus has recurrent lates. Which “fetal adaptation” concept explains why labor can still be tolerated early?
Molding indicates hypoxia
Meconium is always benign
Fetus requires zero oxygen during labor
Transient hypoxia is expected during contractions; fetus usually compensates if placenta functioning and variability is moderate
Which assessment best supports “passenger” issues?
Fetal size, attitude, presentation, position
Maternal coping skills
Uterine contraction frequency
Pelvic outlet diameter
A client is being prepared for cesarean for nonreassuring status. Which fetal complication is the team most urgently preventing?
Neonatal acne
Progressive hypoxia/acidemia leading to neonatal depression
Neonatal jaundice at day 3
Late breastfeeding latch issues
Which medication is used to reverse opioid-induced respiratory depression?
Nifedipine
Oxytocin
Naloxone
Ceftriaxone
A nurse is reviewing “molding.” Which is correct?
Prevents delivery
Always indicates intracranial hemorrhage
Congenital skull fusion
Overlap of fetal skull bones to fit birth canal; usually temporary
Which stage includes delivery of placenta?
Third
Second
First
Fourth
A client has persistent Category III tracing and is 8 cm with no descent. Best expectation?
Stop monitoring for patient comfort
Urgent operative delivery likely if not quickly correctable
Continue labor and reassess in 2 hours
Begin dinoprostone
A client’s baseline is 105 with moderate variability and accelerations. Best classification?
Category III by definition
Sinusoidal pattern
Baseline slightly low but reassuring features present; evaluate context (maternal BP, meds, etc.)
Bradycardia requiring immediate cesarean always
Which is a true statement about newborn separation after NICU transfer?
It prevents postpartum hemorrhage
It is always avoidable
It has no emotional impact
Maternal distress and delayed bonding are common concerns—support coping and facilitate contact/updates
A nurse is teaching a client about oxytocin. Which statement shows correct understanding?
“It is titrated and monitored to avoid tachysystole and fetal compromise.”
“More is always safer.”
“Once started, it can never be stopped.”
“It replaces fetal monitoring.”
A nurse suspects infection and notes fetal tachycardia plus maternal fever. Priority?
Begin amniotomy
Notify provider; anticipate cultures/antibiotics and close maternal/fetal monitoring
Increase oxytocin
Encourage pushing early
Which is the best immediate nursing action when a client hyperventilates from anxiety in labor?
Stop all monitoring
Increase oxytocin to shorten labor
Coach slow breathing/grounding and reassess fetal status
Place supine in Trendelenburg and leave alone
A laboring client has a baseline 140, moderate variability, and accelerations; occasional early decels. Interpretation?
Immediate cesarean
Cord prolapse likely
Category III
Reassuring pattern—continue monitoring/supportive care
Which method is the best initial way to confirm ROM while limiting infection risk?
Sterile speculum exam with visualization/pooling +/- tests (nitrazine/fern)
Bimanual exam with gel
Digital exam first
Rectal exam only
A client has suspected uterine rupture. Which oxytocin action is appropriate?
Give oxytocin bolus IV push
Stop oxytocin immediately
Increase oxytocin
Switch to dinoprostone and continue stimulation
A postpartum client has heavy bleeding and hypotension. Which lab prep is most urgent?
Lipid panel
UA culture only
Type & crossmatch for possible transfusion
HbA1c
