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Worksheets2205 Exam 2 pt.6
Total questions: 47
Worksheet time: 24mins
A laboring client becomes progressively somnolent after IV opioid analgesia. Which physiologic change most directly increases fetal CO2 retention?
Maternal hypoventilation raises maternal PaCO2, reducing the fetal-to-maternal diffusion gradient for CO2 across the placenta
Increased maternal heart rate improving placental CO2 clearance
Maternal respiratory alkalosis enhancing fetal CO2 excretion
Increased maternal serum glucose shifting fetal CO2 to bicarbonate
A fetus develops worsening metabolic acidemia during prolonged tachysystole. Which fetal waste product is most dependent on placental diffusion for elimination during labor?
Creatinine
CO2
Bilirubin
Ketones
A labor client is hyperventilating from anxiety. The nurse’s priority concern related to fetal oxygenation is:
Maternal hypercapnia causing fetal bradycardia
Maternal respiratory alkalosis causing uterine vasoconstriction and decreased uteroplacental perfusion
Maternal metabolic acidosis causing fetal alkalosis
Maternal hypoventilation causing increased uterine tone
Which statement best explains why fetal CO2 rises quickly during periods of decreased uteroplacental perfusion?
The fetus primarily eliminates CO2 through fetal kidneys
CO2 is lipid-soluble and readily diffuses, so impaired perfusion quickly limits removal
CO2 binds hemoglobin tightly, preventing diffusion
CO2 elimination increases when placental flow decreases
A client with a Category II tracing is placed supine for a procedure. FHR worsens and variability becomes minimal. Which mechanism most directly contributes to fetal CO2 accumulation?
Compression of the vena cava reducing uteroplacental blood flow
Increased maternal renin decreasing fetal oxygen demand
Increased fetal swallowing decreasing fetal PaCO2
Maternal hyperglycemia decreasing fetal lactate
The nurse notes heavy vaginal bleeding immediately after birth. The fundus is firm and midline. Which cause is most likely?
Uterine atony
Retained products of conception
Cervical laceration
Uterine inversion
A postpartum client continues to saturate pads despite a firm fundus. What is the priority nursing action?
Begin continuous fundal massage
Notify the provider and prepare for evaluation/repair of lacerations
Increase oxytocin infusion rate
Administer methylergonovine immediately without assessment
Which birth history places a client at highest risk for cervical laceration?
Prolonged latent phase with mild contractions
Rapid precipitous delivery with operative vaginal assistance
Epidural analgesia with slow descent
Post-term pregnancy with intact membranes until crowning
A nurse suspects a cervical laceration. Which assessment finding best supports this suspicion?
Boggy uterus and heavy lochia
Firm uterus with persistent bright red bleeding and clots
Uterus deviated right with scant bleeding
Mild bleeding that decreases with fundal massage
While preparing for repair of a suspected cervical laceration, which order should the nurse anticipate as most immediately helpful for hemorrhage management?
Type and crossmatch
Oral fluids and ambulation
Discontinue IV access
Delay vitals to reduce anxiety
A periviable client presents in preterm labor and asks about outcomes. Which is the best initial nursing action?
Give exact survival percentages without consulting neonatal services
Request a neonatal consult and follow facility periviability counseling pathways
Immediately start oxytocin to avoid prolonged labor
Avoid discussing options until delivery occurs
A client at the edge of periviability is admitted with PPROM and no infection. Which intervention is most appropriate to prepare based on common periviability management?
Routine immediate delivery in all cases
Antenatal corticosteroids if gestational age and policy support use
Vaginal exams every hour to assess progression
Methylergonovine prophylaxis to prevent hemorrhage
A periviable client asks, “Do I have to do everything to keep the pregnancy going?” The best nursing response is:
“Yes—standard care requires maximal intervention.”
“No—your preferences matter; we’ll discuss options and align care with your goals and policy.”
“We can’t discuss that until the baby is born.”
“You should decide quickly because there’s no time for consultation.”
Which finding would most strongly require immediate escalation rather than expectant management in a periviable PPROM client?
Clear fluid and stable maternal vitals
Mild uterine irritability that resolves
Maternal fever with uterine tenderness and fetal tachycardia
Patient anxiety and insomnia
A C-section client is transferred from PACU to postpartum. Which assessment is highest priority in the first hour on the postpartum unit?
Teaching on newborn sleep cycles
Fundus, lochia, incision, and vital signs trend for hemorrhage and shock
Scheduling a 2-week incision check appointment
Discussing contraception options
A post-op C-section client reports new unilateral calf pain and swelling. What is the nurse’s priority action?
Encourage leg massage to relieve discomfort
Notify the provider and limit ambulation until evaluated
Apply heat and elevate the leg only
Document as expected post-op soreness
A post-op C-section client has decreasing urine output and a distended bladder. The most appropriate nursing action is:
Restrict IV fluids immediately
Assess for urinary retention and manage per catheter protocol
Encourage the client to ignore the urge to void
Give a diuretic without provider notification
A C-section client received spinal anesthesia and now reports a severe positional headache (worse upright, improved lying flat). What complication is most likely?
Endometritis
Post-dural puncture headache
Amniotic fluid embolism
Uterine inversion
Which intervention best reduces risk of post-op ileus after cesarean birth?
Strict NPO for 24–48 hours regardless of status
Early ambulation and gradual diet advancement as tolerated
High-dose opioids as first-line pain control
Continuous supine positioning
A post-op C-section client has an oxygen saturation drop and new shortness of breath. What is the priority nursing action?
Encourage coughing only and recheck in 30 minutes
Raise the head of the bed, assess airway/breath sounds, and escalate rapidly
Offer oral fluids and ambulate to bathroom
Remove SCDs to improve comfort
A fetus is showing signs of worsening acidemia. Which tracing feature most supports that fetal metabolic acidemia is less likely at the moment of observation?
Moderate variability
Recurrent late decelerations
Persistent tachycardia alone
A smooth sinusoidal pattern
During maternal hypoventilation, which fetal change is most expected first?
Decreased fetal CO2 and increased pH
Increased fetal CO2 with risk of respiratory acidosis progressing to metabolic acidemia if prolonged
Immediate fetal hypoglycemia
Increased fetal bilirubin production
The nurse is explaining fetal gas exchange. Which statement is most accurate?
The fetus primarily excretes CO2 via fetal lungs in utero
CO2 crosses the placenta down a diffusion gradient between fetal and maternal blood
Maternal kidneys directly remove fetal CO2
CO2 is not a major fetal waste product during labor
A postpartum client has persistent heavy bleeding and the provider suspects a laceration. Which nursing preparation is most appropriate?
Prepare for uterine balloon tamponade as first-line
Set up for visualization/repair, ensure IV access, and anticipate labs/blood products
Begin aggressive fundal massage and delay provider evaluation
Encourage pushing to expel retained clots
Which clinical scenario most strongly suggests a cervical laceration rather than uterine atony?
Boggy fundus that firms with massage and bleeding slows
Firm fundus with continued brisk bleeding after a forceps delivery
Fundus above umbilicus and deviated right with scant bleeding
Mild lochia rubra that decreases over several hours
A periviable client requests “everything possible,” but the partner requests comfort care only. What is the nurse’s best action?
Follow the partner’s request because they are the support person
Clarify the patient’s decision-making capacity and preferences; involve the team/ethics per policy
Avoid conflict by delaying all interventions
Provide only neonatal updates after delivery
Which order is most critical to verify before administering neuraxial anesthesia for a scheduled C-section?
Maternal height and weight
Recent platelet count/coagulation risk screening
Fetal sex and estimated weight
A post-op C-section client’s incision dressing is saturated with blood and the client is tachycardic. What is the priority action?
Document and reassess in 1 hour
Assess vitals, incision, and fundus/lochia; escalate for possible hemorrhage
Encourage oral fluids only
Remove the dressing without sterile supplies
Which teaching is most appropriate for a C-section client to reduce incision complications at home?
“Avoid walking for 2 weeks to protect the incision.”
“Keep the incision clean and dry, monitor for redness/drainage/fever, and follow lifting limits.”
“Scrub the incision with peroxide daily.”
“Stop pain meds early even if you can’t move comfortably.”
A post-op C-section client has increasing uterine tenderness and foul-smelling lochia. What complication is most concerning?
Uterine atony only
Endometritis/infection
Post-dural puncture headache
Normal involution
A laboring client is experiencing recurrent late decelerations. Which maternal physiologic state most contributes to fetal CO2 accumulation?
Increased uterine blood flow during contractions
Reduced placental exchange from impaired uteroplacental perfusion
Increased fetal renal perfusion
Increased fetal swallowing
A postpartum hemorrhage protocol is initiated. Which lab result is most urgent to trend for ongoing blood loss severity?
Sodium
Hemoglobin/hematocrit
AST/ALT
Amylase
A provider is repairing a cervical laceration. Which nursing action best supports safety?
Encourage the client to ambulate during the repair
Maintain sterile field support, monitor VS/bleeding, and prepare for pain control orders
Remove IV access to prevent fluid overload
Stop all assessments to reduce stress
A periviable client is transferred to a higher level facility. What is the nurse’s priority during transfer preparation?
Perform frequent digital cervical exams to document change
Stabilize maternal vitals, minimize infection risk, maintain fetal monitoring as ordered, and send records
Delay corticosteroids until arrival
Encourage the client to walk to speed transfer
A C-section client is at increased risk for postpartum hemorrhage. Which medication is commonly administered routinely after delivery to support uterine tone?
Terbutaline
Oxytocin
Naloxone
Nifedipine
After spinal anesthesia, which finding requires the most immediate response?
Mild pruritus
Nausea relieved by position change
Sudden dyspnea with hypotension and difficulty speaking
Shivering
A periviable client asks, “What does periviable mean?” The best response is:
“It means the baby is guaranteed to survive.”
“It refers to a gestational age near the edge of viability where outcomes are uncertain and decisions are individualized.”
“It means you must have a cesarean birth.”
“It means labor will stop on its own.”
Which plan best demonstrates trauma-informed periviability counseling support by the nurse?
Provide only one option to reduce confusion
Encourage questions, involve neonata/OB teams, use clear language, and confirm understanding/values
Avoid discussing disability outcomes
Require immediate decisions without support
A post-op C-section client is dizzy when sitting up and has a falling blood pressure trend. What is the most appropriate action?
Encourage standing to improve circulation
Assess bleeding, uterine tone, intake/output, and notify the provider if hemorrhage suspected
Give a laxative to reduce dizziness
Remove compression devices
Which discharge instruction is most important for a C-section client to reduce thromboembolism risk?
“Avoid walking until pain is gone.”
“Perform leg exercises and ambulate regularly as tolerated; use SCDs if prescribed inpatient.”
“Stop fluids after discharge.”
“Sleep only on your back.”
Which clinical situation would most likely require operative delivery planning at the periviable threshold?
Placental abruption with nonreassuring fetal status and maternal instability
Mild nausea and vomiting
Stable contractions with no cervical change
Reassuring fetal status with no infection
A client returns from C-section with a Foley catheter. Which finding requires the most immediate follow-up?
Urine output 40 mL/hr
Urine output 10 mL/hr with increasing tachycardia
Clear yellow urine
Client reports urge to void
A postpartum client has a firm fundus and persistent bleeding. Which action is least appropriate?
Prepare for possible repair and labs
Notify the provider for laceration evaluation
Continue to reassess vital signs and quantify blood loss
Document and discharge if pain is controlled
Which maternal condition most increases risk that fetal CO2 clearance becomes impaired during labor?
Maternal hyperpigmentation
Maternal hypotension after epidural reducing placental perfusion
Maternal seasonal allergies
Maternal mild reflux
Following cesarean birth under neuraxial anesthesia, which assessment is essential before first ambulation?
Newborn latch quality
Fundal height only
Ability to swallow pills
Return of sensation/motor control and stable blood pressure
A client with suspected cervical laceration is becoming tachycardic and pale. What is the priority sequence?
Oral fluids → discharge teaching → call provider
Fundal massage only → wait for next shift
Quantify bleeding → maintain IV access/fluids → notify provider/prepare for repair and
labs
Remove pads to reduce anxiety → reassess later
During prolonged fetal hypoxia, which change most directly reflects rising fetal CO2 and acid-base compromise?
Decreasing fetal bilirubin
Increasing fetal PaCO2 leading to acidosis if persistent and uncompensated
Decreasing fetal urine output as primary cause of acidosis
Increasing maternal pH causing fetal alkalosis
