Worksheets2205 Exam 2 pt.4
Total questions: 100
Worksheet time: 50mins
A laboring client’s fetus is cephalic. Which presenting part is expected in the pelvis on exam?
Occiput (vertex)
Sacrum
Scapula
Mentum posterior
A client’s fetus is in transverse lie. Which outcome is most likely if the lie persists at term?
Spontaneous vaginal birth is expected
Vaginal birth is unsafe unless corrected; cesarean is likely
Immediate shoulder dystocia is guaranteed
Placenta previa is confirmed
Which fetal presentation carries the highest risk of cord prolapse after rupture of membranes?
Frank breech
Complete breech
Footling breech
Vertex OA
“LOA” documentation means the fetus is:
Lie: oblique, attitude: flexed
Occiput left anterior
Sacrum left anterior
Mentum left anterior
Which fetal attitude is most favorable for vaginal birth?
Complete extension
Military (neutral)
Hyperextension
Flexion (chin to chest)
Which “5 P’s” factor is being assessed when the nurse evaluates maternal coping, fear, and anxiety?
Passenger
Psyche
Passageway
Powers
Which finding best indicates true labor?
Contractions stop with walking
Cervical change with regular contractions
Pain decreases with time
No change in dilation over hours
The nurse is documenting a vaginal exam. Which entry is correct format?
“6/80/+1, membranes intact”
“80/6/+1, membranes intact”
“+1/6/80, membranes intact”
“6/+1/80, membranes intact”
Which stage of labor is 10 cm to delivery of the baby?
Second stage
Third stage
First stage
Fourth stage
Which stage of labor includes delivery of the placenta?
First stage
Third stage
Fourth stage
Second stage
Which stage is the first 1–2 hours postpartum requiring close observation for hemorrhage?
Second stage
Fourth stage
First stage
Third stage
Which “cardinal movement” is the head turning to align with the pelvic outlet?
Extension
Restitution
Internal rotation
Flexion
A nurse is assessing station. “0 station” means the presenting part is:
At the level of the ischial spines
2 cm below the spines
Crowning
3 cm above the spines
The best definition of the latent phase (typical) is:
8–10 cm with intense urge to push
0–3 cm with mild/irregular contractions
10 cm to delivery
Placenta delivery
Which finding best reflects active labor (typical)?
1–2 cm, irregular mild contractions
2–3 cm, no cervical change
4–7 cm with progressive dilation and stronger contractions
8–10 cm with involuntary pushing
A client at 9 cm reports a strong urge to push. Priority nursing action?
Encourage pushing to relieve pressure
Begin postpartum teaching
Stop fetal monitoring
Support pant–blow breathing and prevent early pushing until fully dilated/approved
Leopold maneuvers primarily help determine:
Fetal acid–base status
Fetal lie, presentation, and position (approx.)
Placental location definitively
GBS status
The most accurate method to measure contraction intensity numerically is:
External tocodynamometer
Intrauterine pressure catheter (IUPC)
Fetal scalp electrode (FSE)
Maternal pulse ox
Before placing an internal monitor (FSE/IUPC), which condition must be present?
Intact membranes
Closed cervix
Ruptured membranes and sufficient dilation
No fetal movement
The nurse identifies tachysystole. Which definition is correct?
>5 contractions in 10 minutes averaged over 30 minutes
5 contractions in 30 minutes
Contractions every 6 minutes
Resting tone 0
A client on oxytocin develops tachysystole with a Category II tracing. Priority action?
Reduce/stop oxytocin and begin intrauterine resuscitation
Increase oxytocin to shorten labor
Start dinoprostone
Encourage pushing
A tracing shows gradual decelerations that mirror the contraction. Most likely cause?
Cord compression
Head compression
Uteroplacental insufficiency
Fetal anemia
A tracing shows abrupt drops with quick return and “shoulders.” Most likely cause?
Maternal fever
Head compression
Cord compression
Placental abruption
Which fetal heart rate (FHR) pattern is most associated with uteroplacental insufficiency?
Variable decelerations
Early decelerations
Accelerations
Late decelerations
Correct method to determine baseline FHR is to:
Determine mean FHR over 10 minutes excluding periodic changes
Average over 2 minutes including decelerations
Use the lowest rate over 10 minutes
Use maternal pulse if tracing is poor
Normal fetal adaptation to labor includes which finding?
Persistent absent variability
Decreased fetal breathing movements during contractions
Sustained sinusoidal pattern
Recurrent late decels with minimal variability
Which tracing is Category III?
Moderate variability with occasional variables
Absent variability with recurrent late decelerations
Marked variability with early decels
Moderate variability with accelerations
Moderate variability most strongly suggests:
Confirmed fetal anemia
Ongoing fetal metabolic acidemia
Placental abruption is present
Absence of fetal metabolic acidemia at time of observation
Which is a prolonged deceleration?
Drop lasting ≥2 minutes but <10 minutes
Drop lasting 15 seconds
Drop lasting 30–60 seconds
Drop lasting ≥10 minutes (baseline change)
A fetal baseline of 170 for >10 minutes is classified as:
Bradycardia
Tachycardia
Moderate variability
Sinusoidal
First-line intervention for many nonreassuring patterns is:
Amniotomy
Oxygen by NRB for 30 minutes
Lateral repositioning
Immediate pushing
A client is supine for epidural placement and becomes pale/diaphoretic; FHR shows recurrent lates. Priority action?
Apply oxygen 12 L NRB
Turn client lateral (left tilt/side-lying)
Stop IV fluids
Begin pushing coaching
After repositioning and stopping oxytocin for recurrent lates, what is the best next action (per common protocol)?
IV fluid bolus and notify provider
Start dinoprostone
Begin pushing at 6 cm
Perform amniotomy
Updated practice trends about routine oxygen for abnormal tracings are best summarized as:
Oxygen is always first and best
Oxygen replaces stopping oxytocin
Use oxygen after correcting reversible causes; not first-line for all patterns
Oxygen is contraindicated in labor
A client received IV opioids 20 minutes ago; tracing now shows minimal variability and no accelerations. Most likely explanation?
Medication/sedation effect
Uterine rupture
Cord prolapse
Placental abruption
Fetal scalp stimulation produces accelerations during a persistent Category II pattern. Best interpretation?
Confirms fetal anemia
Suggests fetal acidemia is less likely at that moment
Confirms uterine rupture
Requires immediate cesarean always
Which is the best indication for a fetal scalp electrode (FSE)?
Poor external FHR tracing in a high-risk labor needing accurate continuous monitoring
Need to quantify contraction intensity
Need to confirm PPROM
Client refuses IV access
Which best describes IUPC use?
Measures fetal oxygen saturation
Measures contraction intensity and resting tone numerically
Measures baseline variability
Measures fetal pH directly
Why is high resting tone concerning?
It increases fetal oxygenation
It proves ROM
It reduces uteroplacental perfusion between contractions
It confirms shoulder dystocia
A client on oxytocin has tachysystole with recurrent lates. Priority action?
Increase oxytocin
Apply oxygen and keep oxytocin running
Perform amniotomy
Stop oxytocin and reposition laterally
Recurrent variable decelerations persist despite repositioning. Most targeted next intervention (if ordered)?
Amnioinfusion
Dinoprostone insert
Increase oxytocin
Fundal pressure
Which best matches VEAL-CHOP for Variable?
Head compression
Cord compression
Placental insufficiency
Overstimulation from epidural
VEAL-CHOP for Late is:
Cord compression
Head compression
Placental insufficiency
Fetal sleep
A client has tachysystole with fetal compromise. Which medication may be ordered to relax the uterus?
Oxytocin
Misoprostol
Methylergonovine
Terbutaline
Terbutaline requires close monitoring for which adverse effect?
Maternal tachycardia/palpitations
Severe hypertension and proteinuria
Hyperkalemia
Jaundice
Which medication is used for cervical ripening during induction?
Magnesium sulfate
Dinoprostone
Naloxone
Methylergonovine
A client receiving dinoprostone develops tachysystole with fetal distress. Priority nursing action?
Remove/stop prostaglandin per policy and begin resuscitation measures
Encourage ambulation
Begin pushing
Delay assessment
A client in preterm labor is ordered nifedipine. Priority assessment before giving?
Maternal blood pressure
Maternal bowel sounds
Fundal height trend only
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
Best practice to preserve fFN accuracy is to collect it:
After a digital exam
After vaginal cleansing with soap
Before digital exam/intercourse and avoid lubricant contamination
After speculum exam with heavy gel
PPROM at 31 weeks: the approach that reduces infection risk while confirming ROM is:
Sterile speculum exam for pooling/visualization; limit digital exams
Frequent digital cervical exams for trend
Routine checks every 2 hours
Bimanual exam with lubricant first
Nitrazine testing can be false-positive due to:
Low vaginal pH
Normal leukorrhea
Blood or semen contamination
Dried slide artifact only
Fern test means:
Microscopic crystallization pattern supports amniotic fluid presence
It measures fetal oxygenation
It determines GBS status
It is unaffected by contamination
Which cluster most supports chorioamnionitis?
Painless bright red bleeding, soft uterus
Maternal fever, uterine tenderness, fetal tachycardia, foul/purulent fluid
Reactive NST and maternal bradycardia
Marked variability with accelerations only
A key nursing plan to reduce infection risk with PPROM is to:
Minimize vaginal exams and monitor temp/FHR closely
Place supine for accurate tracing
Encourage repeated digital exams
Stop maternal vitals
Fetal tachycardia baseline >160 for ≥10 minutes most supports:
Shoulder dystocia
Cord prolapse
Uterine rupture
Intraamniotic infection/chorioamnionitis (when paired with maternal findings)
The test most helpful at 36-week screening impacting intrapartum antibiotics is:
GBS culture
Quad screen
Rubella titer
1-hour GTT
A GBS-positive client with no allergy: expected intrapartum plan is:
Oral antibiotics after delivery only
IV penicillin/ampicillin during labor per protocol
No antibiotics if membranes intact
Ceftriaxone for all cases
A client with penicillin anaphylaxis is GBS positive. Best nursing action?
Hold antibiotics until postpartum
Give penicillin anyway
Notify provider for alternative antibiotic selection per protocol
Decide based on nitrazine result
A client has oligohydramnios and recurrent variable decels after ROM. Which order best targets the cause?
Methylergonovine
Magnesium sulfate
Dinoprostone
Amnioinfusion
CST is most accurate as:
It evaluates fetal tolerance of uterine contractions (stress)
It diagnoses ROM
It replaces continuous EFM in labor
It is performed only after delivery
A nonreactive NST after 40 minutes most commonly leads to:
Immediate hysterectomy
Amniotomy
Biophysical profile (BPP) or further evaluation
VBAC criteria review
Typical minimum NST monitoring time before extending is:
5 minutes
20 minutes
60 minutes
2 minutes
A newborn delivered through meconium-stained fluid is vigorous (crying, good tone). Expected care?
Immediate intubation for deep suction regardless
NPO and gastric lavage for all cases
Routine newborn care (no automatic intubation solely for meconium)
Delay drying to reduce aspiration risk
Highest risk fetus for meconium passage is:
Twin at 34 weeks
Preterm 28 weeks
Post-term fetus
Elective induction at 37 weeks
If meconium aspiration occurs, most concerning complication is:
Clubfoot
Respiratory distress/hypoxemia
Hypernatremia
PDA from oxytocin
A client with ROM has later thick green particulate fluid. Best interpretation?
Normal after epidural
Proves infection every time
Thick meconium—alert neonatal team and increase surveillance
Proves breech presentation
Operative vaginal delivery (vacuum/forceps) increases jaundice risk mainly due to:
Low vitamin K stores
Bruising/hematoma increasing bilirubin load
Poor feeding only
Congenital liver disease
Vacuum birth newborn has scalp swelling that crosses suture lines. Most likely finding?
Caput succedaneum
Cephalohematoma
Hydrocephalus
Meningocele
Cephalohematoma is most associated with later risk for:
Immediate respiratory distress
Hyperbilirubinemia/jaundice due to blood breakdown
Congenital infection
Tetralogy of Fallot
A client becomes hypotensive after epidural and FHR shows bradycardia. Priority intervention?
Lateral position and IV fluid bolus per protocol
Start dinoprostone
Encourage breath-holding pushes
Administer naloxone
Persistent epidural-associated hypotension after fluids/positioning: common medication per protocol?
Terbutaline
Methylergonovine
Magnesium sulfate
Ephedrine/vasopressor per policy
After IV fentanyl, the most important maternal assessment is:
Respiratory rate and level of consciousness
Deep tendon reflexes
Urine ketones
Fundal height
Client becomes somnolent with RR 8 after opioid analgesia. Priority medication?
Diphenhydramine
Naloxone
Oxytocin
Dinoprostone
Contraindication to neuraxial anesthesia (epidural/spinal) is:
Nulliparity
Intact membranes
Coagulopathy/low platelets
Mild heartburn
High spinal block with difficulty breathing and hypotension: priority action?
Give oral fluids
Stop fetal monitoring
Encourage ambulation
Assist airway/ventilation and call anesthesia/provider immediately
Aortocaval compression prevention in labor: best position is:
Left lateral tilt/side-lying
Flat supine
Trendelenburg
High Fowler’s with legs straight
Client receiving magnesium sulfate: priority monitoring includes:
Daily weights only
RR, DTRs, urine output per protocol
Skin turgor only
Nail beds only
Magnesium toxicity is suggested by:
Hyperreflexia
Increased urine output
Respiratory depression and absent DTRs
Mild flushing only
Oxytocin major risk leading to nonreassuring fetal status is:
Increased fetal oxygen delivery
Tachysystole → reduced uteroplacental perfusion → fetal hypoxia/acidemia
Decreased contraction intensity
Replaces fetal monitoring
Umbilical cord prolapse risk increases most with:
Unengaged presenting part/high station at ROM or amniotomy
Vertex LOA with engaged head
Ruptured membranes with head well applied
Thick meconium
Sudden fetal bradycardia after ROM: priority nursing action is to:
Start CST
Perform a vaginal exam to check for cord and relieve compression if present
Administer antibiotics
Place fetal scalp electrode first
Overt cord prolapse confirmed. What must the nurse do continuously until delivery?
Clamp cord immediately
Replace cord into uterus
Manually elevate presenting part off the cord (do not remove hand)
Encourage pushing
Which is contraindicated in cord prolapse management?
Knee-chest/Trendelenburg positioning
Manual elevation of presenting part
Calling for emergent delivery
Pinching/manipulating the cord
VBAC client reports sudden severe abdominal pain; nurse notes loss of station and fetal bradycardia. Priority action?
Prepare for emergent cesarean and activate rapid response
Begin CST
Encourage ambulation
Continue oxytocin to expedite delivery
Finding most consistent with uterine rupture (not dehiscence) is:
Thinning of scar without fetal compromise
Sudden pain + abnormal FHR + loss of station/uterine contour change
Mild pain relieved by rest
Gradual spotting only
Suspicion for concealed abruption is strongest with:
Green amniotic fluid after ROM
Painless bleeding with soft uterus
Rigid, tender uterus with fetal distress and minimal external bleeding
Ferning on microscopy
Placental separation with hypotension: first anticipate which order for resuscitation planning?
Encourage oral fluids
Discontinue continuous EFM
Delay IV access until OR
Type and crossmatch blood
Shoulder dystocia is suspected when:
Head delivers then retracts ("turtle sign")
Placenta delivers before shoulders
Variable decels resolve with amnioinfusion
Cervix regresses
First nursing action for shoulder dystocia is:
Apply fundal pressure
Call for help and begin McRoberts/suprapubic pressure sequence
Pull downward on fetal head
Immediate OR transport is the only option
Which maneuver is appropriate in shoulder dystocia?
McRoberts (hyperflex maternal hips)
Suprapubic pressure
Fundal pressure
Trendelenburg positioning
Newborn complication most associated with shoulder dystocia is:
NEC
PDA from ibuprofen
Omphalocele
Brachial plexus injury/clavicle fracture
After prolonged shoulder dystocia, greatest immediate newborn risk is:
Hypoxia/asphyxia complications
Delayed teething
Colic at 6 weeks
Neonatal acne
A labor client has anxiety increasing pain. Which “P” is being affected?
Passenger
Psyche
Passageway
Powers
A postpartum client has boggy fundus and heavy lochia. First nursing action?
Fundal massage and assess bladder/void
Stop oxytocin infusion
Place prone
Delay until provider arrives
Fundus firm but heavy bleeding continues. Priority concern?
Normal lochia rubra
Dehydration
Bladder distention only
Genital tract laceration/retained tissue—notify provider
Methylergonovine postpartum is contraindicated in a client with:
Hypertension
Mild anemia
Rubella nonimmune
GBS colonization
Carboprost for postpartum hemorrhage: major caution history is:
Rubella nonimmune
Asthma
Mild anemia
GBS positive
First-line med commonly used for uterine atony prevention/treatment is:
Terbutaline
Naloxone
Oxytocin
Nifedipine
A newborn first hour has persistent grunting and nasal flaring. Priority?
Feed immediately
Support airway/oxygenation per NRP and notify neonatal team
Delay assessment for bonding
Bathe immediately
