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Worksheets2205 Exam 2 pt.5
Total questions: 99
Worksheet time: 50mins
Best action to prevent newborn heat loss in first 2 hours is:
Dry thoroughly and skin-to-skin with warm blankets
Place under a fan
Bathe immediately
Keep uncovered for observation
Which tracing is Category I?
Absent variability with recurrent lates
Baseline 110–160 with moderate variability and no late/variable decelerations (early/accelerations may be present)
Sinusoidal pattern
Persistent bradycardia
A sinusoidal pattern most strongly implies:
Benign sleep cycle
Serious fetal compromise such as anemia/hemorrhage—urgent evaluation
Normal in second stage
Maternal dehydration only
A Category III tracing with fully dilated client and crowning: best plan?
Expedite delivery with neonatal team ready
Stop monitoring
Expectant management for 1 hour
Start dinoprostone
A client is being considered for internal monitoring. Which statement is correct?
FSE measures contractions best
IUPC requires intact membranes
Internal monitors reduce infection risk
FSE provides more accurate FHR than external when tracing is poor
A client with recurrent variables and minimal variability is complete and +2 station. Best expectation?
Continue labor unchanged for 6 hours
Operative vaginal delivery may be considered if conditions met (provider decision)
Start dinoprostone
Stop monitoring
Vacuum extraction is correct when it:
Requires full dilation and appropriate station/position criteria
Can be used at 4 cm to speed labor
Replaces maternal pushing effort
Is always safer than cesarean
After forceps delivery, urgent newborn finding is:
Mild molding
Lanugo
Vernix
Facial asymmetry/weak suck suggesting facial nerve injury
A fetal baseline of 105 with moderate variability and accelerations is best classified as:
Slightly low baseline but reassuring features present; evaluate context
Category III by definition
Sinusoidal
Immediate cesarean always
“Baseline change” is defined as a change lasting:
Any heart rate change lasting 30 seconds
Change lasting ≥10 minutes
Change lasting 2–9 minutes
Change lasting <15 seconds
Newborn meds typically given in first hours include:
Vitamin K (and erythromycin per policy)
Terbutaline
Dinoprostone
Methylergonovine
A client hyperventilates from anxiety in labor. Best immediate nursing action?
Leave alone to “calm down”
Increase oxytocin
Coach slow breathing/grounding and reassess
Place supine in Trendelenburg
Best initial way to confirm rupture of membranes while limiting infection risk is:
Sterile speculum exam with pooling/visualization ± nitrazine/fern
Digital exam first
Bimanual exam with gel
Rectal exam only
A client with PPROM asks why you check for cord compression. Best response:
Cord compression only occurs with intact membranes
Less fluid can increase cord compression risk leading to variable decelerations
Cord compression causes late decelerations
Cord compression prevents infection
Which client requires continuous electronic fetal monitoring rather than intermittent auscultation?
Low-risk spontaneous labor with reassuring status
Normal nonstress test yesterday
Refuses IV access
VBAC attempt
Nonreassuring fetal status with persistent bradycardia despite resuscitation: priority preparation is to:
Remove internal monitors
Encourage oral intake
Start dinoprostone
Prepare for urgent operative delivery; notify neonatal team
Ongoing PPROM surveillance priorities focus on:
Infection signs and fetal status/cord compression
Fundus height only
Daily Pap smear
Blood glucose only
PPROM complication most likely to increase neonatal respiratory problems is:
Prematurity and possible infection leading to respiratory distress
Maternal seasonal allergies
Hyperthyroidism
Excess vernix
COAT documentation refers to:
Color, odor, amount, time (amniotic fluid assessment)
Contractions, oxygen, analgesia, temperature
Cervix, oxygen, amnioinfusion, tachysystole
Cord, odor, accelerations, tone
A key risk factor for chorioamnionitis is:
Prolonged ROM and frequent vaginal exams
Rubella immunity
Normal UA
Normal NST
A client with suspected infection says “I caused this.” Best response is to:
Validate feelings, educate, assess supports, connect to resources
Say “Stop worrying.”
Change subject
Say “You shouldn’t feel that way.”
Therapeutic response after fetal loss is:
“Everything happens for a reason.”
“Tell me what you’re feeling right now—I’m here with you.”
“At least you can get pregnant.”
“You need to move on quickly.”
Best intervention after fetal demise confirmation is to:
Offer choices (hold baby, photos/prints, spiritual/cultural support) per preference
Prevent family visits
Use false reassurance only
Avoid discussing grief resources
A client with a firm fundus but ongoing heavy bleeding postpartum—best next step:
Continue fundal massage only
Delay assessment
Suspect laceration/retained products; notify provider
Stop all meds
A labor client is 6 cm with regular strong contractions. Best nursing focus?
Active labor support: pain control, position changes, monitor FHR/uterine activity, hydration
Begin pushing coaching
Stop fetal monitoring
Prepare placenta container
Client requests nitrous oxide. Key safety requirement?
Nurse holds mask continuously
Client self-administers via demand valve; maintains protective reflexes
Must be supine only
Requires intubation readiness always
A pudendal block is mainly used for:
Perineal anesthesia late second stage and laceration repair
First stage cervical ripening
Preventing postpartum hemorrhage
Treating tachysystole
A client has strong contractions but no descent; fetus suspected large; pelvis small. This is most consistent with:
Precipitous labor
Normal latent phase
Shoulder dystocia
Cephalopelvic disproportion
A labor client with OP fetus stalls. Best nursing intervention is to:
Encourage position changes (hands-and-knees/side-lying) as tolerated
Keep supine
Start pushing early
Reduce hydration
A nurse preparing for amniotomy. Safest station finding is:
−3
Ballotable/high presenting part
Unstable lie
0 or + station (engaged)
After ROM, sudden FHR drop occurs. Priority assessment is:
Check for cord prolapse and assess FHR immediately
Assess rubella immunity
Obtain HbA1c
Teach breastfeeding
A client has suspected cord prolapse. Which position is commonly used to reduce compression?
Flat supine
Left lateral only
Knee-chest or Trendelenburg per protocol
High Fowler’s
A client with suspected uterine rupture—appropriate oxytocin action is:
Stop oxytocin immediately
Give oxytocin IV push bolus
Increase oxytocin
Switch to dinoprostone and continue stimulation
Best prep when uterine rupture is suspected includes:
Large-bore IV, type & cross, rapid OR readiness, continuous fetal assessment
Encourage oral intake for energy
Delay labs until delivery
Start dinoprostone
A nurse suspects abruptio placentae. Common worsening tracing change is:
Increasing late decels/bradycardia due to compromised perfusion
Early decels only
Frequent accelerations only
Sinusoidal always due to fever
A client with suspected abruption: uterine description most consistent is:
Soft and painless
Boggy postpartum fundus
Uterus absent
Firm/boardlike, tender uterus possible
Fetal sleep cycles can contribute to decreased variability for about:
3–4 hours
2–5 minutes only
24 hours
20–60 minutes
Which finding is most concerning for impending fetal acidemia?
Moderate variability with accelerations
Marked variability with accelerations
Absent variability with recurrent decelerations
Early decels only
A tracing shows recurrent lates with minimal variability. Least appropriate intervention is:
Reposition + fluids + stop oxytocin + evaluate cause
Notify provider
Prepare for delivery if unresolved
Continue oxytocin unchanged
Best indicator of adequate fetal oxygenation in the moment is:
Moderate variability
Persistent bradycardia
Sinusoidal pattern
Absent variability
A client with recurrent lates is only 2 cm dilated and unresolved quickly. Likely disposition?
Encourage walking for 2 hours first
Prepare for cesarean delivery (vaginal not imminent)
Stop fetal monitoring
Continue labor unchanged
Uterine dehiscence is best defined as:
Incomplete separation/thinning of uterine scar without full rupture
Cord compression with visible loop
Full thickness tear with fetal parts in abdomen
Placental separation from uterine wall
A client at 39 weeks becomes pale/diaphoretic supine and shows late decels. What is happening physiologically?
Aortocaval compression reducing uteroplacental perfusion
Fetal anemia causing sinusoidal pattern
Cord prolapse due to supine position
Placenta accreta
Which statement shows correct understanding about oxytocin?
“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.”
Which is a classic risk factor for shoulder dystocia?
Small for gestational age
Oligohydramnios
Preterm 28 weeks
Macrosomia/prolonged second stage/history of operative delivery
Which action is contraindicated in shoulder dystocia?
Call for help/neonatal team
McRoberts
Suprapubic pressure
Fundal pressure
A tracing shows baseline 140, moderate variability, accelerations, occasional early decels. Interpretation?
Category III
Cord prolapse likely
Immediate cesarean
Reassuring pattern—continue monitoring/supportive care
Which nursing care best prepares a client for uncomplicated second stage?
Coach effective pushing only when fully dilated, support positions, continuous assessment
Begin directed pushing at 8 cm
Keep client supine at all times
Stop monitoring to reduce anxiety
Cesarean post-anesthesia recovery: priority assessments include:
Airway/respirations, BP, bleeding/fundus, incision, pain, urine output
Rubella immunity, GBS culture
Fetal station and effacement
Leopold maneuvers
Which finding most supports bacterial sinusitis?
Symptoms persist >10 days or double-worsening
Clear watery drainage and itchy eyes
Improved within 24 hours
Fever absent always
Viability/periviability concepts most directly guide decisions about:
Neonatal resuscitation intensity and counseling at extreme prematurity
Cervical ripening choice
Epidural dosing
Vacuum extraction cup size
A client with preterm labor asks the purpose of tocolytics. Best answer:
Delay birth briefly to allow steroids/transfer and stabilize, not “stop forever”
Cure infection definitively
Ripen cervix rapidly
Prevent postpartum hemorrhage
A client with suspected intraamniotic infection asks why repeated vaginal exams are avoided. Best response:
They prevent fetal descent
They increase risk of ascending infection
They stop contractions
They cause false-negative ferning
A client has recurrent late decels and hypotension after epidural. Most targeted correction is:
Increase IV fluid bolus and administer vasopressor (e.g., ephedrine or phenylephrine)
Continue oxytocin unchanged
Encourage pushing to improve perfusion
Apply fetal scalp electrode
A labor client has uterine tachysystole: which fetus is at greatest risk?
Category I tracing with moderate variability
Fetus with recurrent late decels
Fetus with accelerations only
Fetus with early decels only
The most accurate reason amnioinfusion helps recurrent variables is:
Restores a fluid cushion to reduce cord compression
Decreases uteroplacental insufficiency
Treats fetal anemia
Reverses opioid effects
A client with PPROM: which finding must be reported immediately?
Mild heartburn
Fever/uterine tenderness/foul fluid
Increased appetite
Clear urine
Best nursing action when prolapsed cord is identified is to:
Maintain manual elevation of presenting part while preparing rapid delivery
Attempt to push cord back in
Clamp the cord
Leave client to call provider
After an operative vaginal delivery, most urgent newborn assessment is:
Hair pattern
Neuro status/scalp injury signs and respiratory status
Fontanel closure timeline
Tooth eruption schedule
A fetal scalp blood sample shows low pH (acidemia). Next expectation?
Escalate toward expedited delivery if unable to correct cause promptly
Stop monitoring
Continue labor unchanged
Start dinoprostone
A meconium-stained delivery: which team readiness is most appropriate?
Neonatal resuscitation team available at delivery
Dermatology consult
Lactation consult before delivery
Social work only
A client’s fundus is deviated right postpartum. Priority action is to:
Assess bladder distention and assist void/catheterize per policy
Begin CST
Give terbutaline
Place Trendelenburg
A client has heavy bleeding and hypotension postpartum. Most urgent lab prep?
Lipid panel
UA culture
HbA1c
Type & crossmatch for possible transfusion
Best indicator of concealed abruption severity is often:
Uterine rigidity/tenderness plus fetal distress with minimal bleeding
Amount of visible bleeding only
Positive nitrazine test
Ferning pattern intensity
A labor client has dysfunctional labor due to hypotonic contractions. Best intervention (if no contraindications)?
Terbutaline
Oxytocin titration with close monitoring
Methylergonovine during labor
Stop all fluids
Hypertonic uterine dysfunction (painful, frequent, uncoordinated, poor progress): best nursing focus is:
Promote rest, hydration, pain control; monitor fetal status; collaborate on cause/treatment
Increase oxytocin rapidly
Begin pushing early
Breath-hold 30 seconds each contraction
Which finding best reflects adequate uterine activity assessment even with IUPC?
Stop documenting contractions
Remove external monitors immediately
Palpate as needed and assess maternal response per policy
Discontinue fetal assessment
In cord prolapse, which action is contraindicated because it worsens vasospasm?
Manipulating/pinching the cord
Calling for help
Positioning knee-chest
Maintaining elevation of presenting part
In shoulder dystocia, why is fundal pressure dangerous?
It can worsen impaction and increase risk of uterine rupture/fetal injury
It improves shoulder release reliably
It decreases brachial plexus injury
It prevents hypoxia
A client has recurrent lates; which maternal condition is a classic contributor?
Hypertension increasing placental insufficiency risk
Seasonal allergies
Mild reflux
Rh negative status
A client has recurrent variable decels; first position change is usually:
Prone flat
Side-to-side or lateral repositioning
Flat supine
Trendelenburg for all cases
A client with PPROM and positive nitrazine: which statement is correct?
Blood/semen can cause false positives
Nitrazine confirms ROM with 100% accuracy
A newborn separation due to NICU transfer: which maternal concern should the nurse anticipate?
Delayed bonding/anxiety/grief—support coping and facilitate contact/updates
No psychosocial impact expected
Only physical pain
Increased appetite
A client with suspected chorioamnionitis: which plan is best?
Minimize exams, monitor maternal temp/FHR, anticipate antibiotics
Stop maternal vitals to reduce stress
Place supine continuously
Increase digital exams
Best interpretation of moderate variability + accelerations is:
Reassuring—continue monitoring/support
Category III
Requires immediate scalp pH
Confirms uterine rupture
A client becomes somnolent with opioid RR 8: besides naloxone, priority is to monitor:
Airway/respirations and fetal status continuously
Fundal height
Urine ketones
GBS status
A labor client develops tachysystole and Category II tracing. Which is the best nursing action sequence?
Increase oxytocin then oxygen
Reduce/stop oxytocin → reposition → IV bolus → evaluate cause/notify provider
Start dinoprostone
Begin pushing to speed delivery
Most appropriate explanation of “pooling” with ROM assessment is:
Visible pooling in posterior fornix supports ROM diagnosis
It confirms abruption
It confirms chorioamnionitis
It identifies fetal position
Which antibiotic is commonly used for GBS prophylaxis in labor (no allergy)?
Metronidazole
Nitrofurantoin
Doxycycline
Penicillin G/ampicillin per protocol
A client with epidural cannot void. Best nursing action?
Anticipate urinary retention—bladder assessment/catheter per policy
Encourage unassisted ambulation to bathroom
Restrict all IV fluids immediately
Ignore until postpartum
A newborn has poor tone and weak respirations after delivery. Priority action?
Feed immediately
Begin neonatal resuscitation steps per NRP and notify team
Delay stimulation
Routine care only
Head compression is typically associated with:
Early decelerations (usually benign)
Late decelerations
Sinusoidal pattern
Prolonged decelerations always
A client is 8 cm with no descent and persistent Category III tracing. Best expectation?
Continue labor and reassess in 2 hours
Begin dinoprostone
Stop monitoring for comfort
Urgent operative delivery likely if not quickly correctable
A client has minimal variability and no decels; accelerations appear after vibroacoustic stimulation. Best interpretation?
Likely fetal sleep/temporary effect; continue monitoring as ordered
Confirmed cord prolapse
Immediate uterine rupture
Confirmed placental abruption
After ROM, which breech type has highest cord prolapse risk?
Footling
Frank
Complete
Kneeling
Which “power” is being assessed when evaluating pelvic dimensions/soft tissue resistance?
Passageway
Passenger
Psyche
Powers
Which medication reverses opioid-induced respiratory depression?
Naloxone
Oxytocin
Nifedipine
Ceftriaxone
Correct statement about molding is:
Overlap of fetal skull bones to fit birth canal; usually temporary
Always indicates intracranial hemorrhage
Prevents delivery
Congenital skull fusion
Best nonpharmacologic pain control in latent labor is:
Ambulation, position changes, breathing, hydrotherapy (if appropriate)
Directed pushing
Supine bedrest only
Immediate general anesthesia
A client has vaginal delivery then persistent heavy bleeding with firm uterus. Most likely cause?
Genital tract laceration
Uterine atony
Which finding requires immediate provider notification in suspected uterine rupture?
Mild pain relieved by rest
Gradual spotting only
Thinning scar with no fetal compromise
Fetal bradycardia with loss of station and sudden pain
A client receiving oxytocin develops recurrent late decels. First nursing intervention is:
Lateral repositioning
Start dinoprostone
Begin pushing
Perform amniotomy
Which maternal assessment is priority with fetal tachycardia?
Maternal temperature (fever/infection)
Maternal freckles
Maternal shoe size
Maternal hair texture
Which labor finding best indicates transition?
8–10 cm with intense contractions/pressure
2–3 cm mild irregular contractions
4–6 cm moderate contractions
10 cm with delivery
Station +2 means:
At ischial spines
Above ischial spines
Crowning
Below ischial spines and descending toward delivery
Fetal presentation most compatible with uncomplicated vaginal delivery is:
Vertex/cephalic
Shoulder
Face mentum posterior
Transverse lie
External cephalic version complication requiring immediate stop/evaluation is:
Persistent fetal bradycardia/nonreassuring tracing
Temporary discomfort
Mild nausea
Mild uterine irritability that resolves
Which finding best supports "passenger" issues?
Fetal size, attitude, presentation, position
Maternal coping skills
Uterine contraction frequency
Pelvic outlet diameter
A client's fetus has recurrent lates; the team is most urgently preventing:
Neonatal acne
Neonatal jaundice at day 3
Late breastfeeding latch issues
Progressive hypoxia/acidemia leading to neonatal depression
