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Worksheets2205 Exam 2 OT pt.1
Total questions: 100
Worksheet time: 50mins
A client is receiving dinoprostone for cervical ripening. Which assessment finding requires the nurse to stop the medication and notify the provider first?
More than 5 contractions in 10 minutes averaged over 30 minutes
Maternal pulse 92/min
Cervix dilates from 1 cm to 2 cm
Temperature 98.6°F (37°C)
The nurse is teaching a client about dinoprostone. Which statement shows correct understanding?
“I should expect my contractions to become constant without breaks.”
“If my baby’s heart rate becomes nonreassuring, the medication can be removed/stopped.”
“This medication is the same as oxytocin and is titrated every 10 minutes.”
“I can get out of bed immediately after insertion with no monitoring.”
A provider prescribes dinoprostone for induction. Which condition is a contraindication/major safety concern the nurse should clarify before administration?
Post-term pregnancy
Bishop score of 3
Prior classical uterine incision or major uterine surgery
Irregular contractions
A client has dinoprostone in place and develops a prolonged deceleration. Which nursing action is priority?
Increase IV oxytocin rate
Perform amniotomy to speed labor
Encourage the client to bear down
Reposition laterally and initiate intrauterine resuscitation measures per protocol
A client asks why fetal monitoring is needed during dinoprostone use. Best response?
“It prevents postpartum hemorrhage.”
“It can cause uterine tachysystole, which can decrease oxygen to the fetus.”
“It eliminates the need for a cesarean.”
“It guarantees the baby will tolerate labor.”
Which order should the nurse question for a client who is receiving dinoprostone and is now having tachysystole with recurrent late decelerations?
Start oxytocin immediately to shorten labor
Insert an IUPC to measure contractions
Continue dinoprostone without changes for 1 hour
Administer IV fluid bolus per protocol
A client receiving dinoprostone suddenly reports severe abdominal pain with a rigid abdomen and abnormal FHR. What is the priority concern?
Normal uterine irritability
Physiologic “transition”
Imminent vaginal delivery
Possible uterine rupture—treat as obstetric emergency
After dinoprostone placement, which nursing plan is most appropriate?
Encourage immediate ambulation without monitoring
Monitor fetal status and uterine activity; avoid adding uterine stimulants unless ordered and safe
Perform frequent digital cervical exams every 30 minutes
Place the client supine to keep the insert in place
A newborn delivered by cesarean has tachypnea soon after birth with mild retractions and clear breath sounds. Which complication is most consistent?
Meconium aspiration syndrome
Respiratory distress syndrome from surfactant deficiency (most likely term)
Transient tachypnea of the newborn (delayed lung fluid clearance)
Congenital heart disease until proven otherwise
During a cesarean birth, which fetal complication is most directly linked to uterine incision extraction?
Hyperbilirubinemia at 1 week
Necrotizing enterocolitis
Late-onset sepsis
Fetal laceration/skin injury
A term infant delivered via cesarean has nasal flaring and grunting. Which immediate nursing priority is most appropriate?
Support airway/oxygenation and notify neonatal team
Initiate oral feeding to prevent hypoglycemia
Delay interventions to promote bonding
Bathe the newborn to stimulate breathing
Which newborn finding after cesarean birth requires the most urgent follow-up?
Mild acrocyanosis
Persistent respiratory distress with falling oxygen saturation
Startle reflex present
Vernix on skin folds
A fetus is delivered by cesarean after prolonged labor and intrauterine infection. Which newborn complication is the nurse most concerned about?
Physiologic jaundice only
Hypothermia only
Cephalohematoma from vacuum use
Neonatal sepsis/respiratory compromise
A client asks why babies born by cesarean may have more breathing problems right after birth. Best response?
“They don’t get the same chest compression that helps clear lung fluid during vaginal birth.”
“Cesarean birth always causes lung damage.”
“It happens because they breathe in meconium during surgery.”
“It’s mainly from vitamin K deficiency.”
Which assessment best helps the nurse detect early newborn respiratory compromise after cesarean birth?
Bowel sounds
Respiratory rate/effort and oxygen saturation trends
Moro reflex
Fontanel palpation
A newborn after cesarean has weak cry, poor tone, and HR 90/min. What is the priority action?
Skin-to-skin only
Feed immediately
Begin neonatal resuscitation steps per NRP
Delay stimulation to reduce stress
The nurse notes a fetal heart rate of 90/min for 3 minutes. Which is the most likely immediate cause to assess first?
Maternal hypotension (often after epidural or supine positioning)
Maternal mild anxiety
Fetal sleep cycle
Braxton Hicks contractions
Which situation is most likely to cause fetal bradycardia?
Maternal fever
Umbilical cord compression/prolapse
Mild maternal dehydration only
Fetal hiccups
A client develops fetal bradycardia immediately after epidural placement. What is the priority nursing action?
Stop fetal monitoring
Position the client lateral and increase IV fluids per protocol
Encourage pushing
Obtain a urine specimen
A client on oxytocin has fetal bradycardia and tachysystole. What is the nurse’s priority action?
Increase oxytocin to speed delivery
Perform amniotomy
Reposition and discontinue oxytocin while initiating intrauterine resuscitation
Document and reassess in 30 minutes
A nurse suspects umbilical cord prolapse after rupture of membranes. What is the first action?
Apply a fetal scalp electrode
Perform a vaginal exam to check for a cord
Start oxytocin to shorten labor
Prepare for discharge teaching
Overt umbilical cord prolapse is confirmed. Which action must the nurse maintain until delivery?
Replace the cord into the uterus
Keep the client supine and calm
Manually elevate the presenting part off the cord without removing the hand
Clamp the cord to prevent bleeding
Which position is most appropriate to reduce cord compression during prolapse management?
Flat supine
High Fowler’s
Knee-chest or Trendelenburg (per protocol)
Lithotomy
When managing cord prolapse, which action is contraindicated?
Calling for emergency assistance
Applying oxygen if ordered after other measures
Preparing for rapid operative delivery
Manipulating/pinching the cord
The nurse documents the fetus as breech. Which presenting part is the denominator for position documentation?
Occiput
Sacrum
Mentum
Scapula
The fetus is in a face presentation. Which denominator is used?
Occiput
Sacrum
Mentum
Fontanel
Which fetal presentation most increases the risk of cord prolapse after rupture of membranes?
Vertex OA
Frank breech
Complete breech
Footling breech
The nurse palpates a firm, round structure in the fundus and small irregular parts near the pelvis during Leopold maneuvers. Best interpretation?
Cephalic presentation
Transverse lie
Breech presentation
Compound presentation
A cesarean candidate’s fetus is transverse lie at term. What is the primary concern?
Likely uncomplicated vaginal delivery
Increased chance of spontaneous rotation to vertex during crowning
Vaginal birth is unsafe unless corrected; cesarean is likely
Guaranteed shoulder dystocia
A nurse suspects a compound presentation during vaginal exam. Which finding supports this?
Palpation of fetal buttocks only
Palpation of fetal head only
Palpation of fetal chin/face structures
Palpation of a fetal hand alongside the head
The provider asks for the client’s GBS status at 37 weeks. Which screening is most relevant?
Group B streptococcus culture obtained at 36–37 weeks
Quad screen
Rubella titer
1-hour glucose tolerance test
A client is GBS positive with no penicillin allergy. Which intrapartum plan is expected?
No antibiotics if membranes are intact
IV penicillin/ampicillin during labor per protocol
Oral antibiotics after delivery only
Ceftriaxone for all clients
A client is GBS positive with a history of anaphylaxis to penicillin. Best nursing action?
Hold antibiotics until postpartum
Administer penicillin slowly
Notify provider for alternative antibiotic selection per protocol
Use nitrazine testing to decide
A forceps-assisted delivery occurs. Which newborn finding requires the most urgent evaluation?
Mild molding
Transient acrocyanosis
Mild caput
Facial asymmetry/weak suck suggesting facial nerve injury
Which newborn complication is associated with forceps delivery?
Intracranial hemorrhage risk (especially with trauma)
Patent ductus arteriosus from antibiotics
Omphalocele
Necrotizing enterocolitis as the most common outcome
The nurse monitors a newborn after forceps delivery. Which assessment is most important early on?
Tooth eruption pattern
Apgar only at 10 minutes
Neuro status and signs of head/eye trauma
Heel stick glucose only
A client develops hypotension after an epidural. Which complication does this most threaten?
Maternal hyperglycemia
Decreased uteroplacental perfusion leading to fetal distress
Precipitous labor
Increased fetal oxygenation
Which nursing intervention best treats epidural-related hypotension?
Place the client flat supine
Reduce IV fluids to prevent overload
Turn lateral and give IV fluid bolus per protocol
Encourage Valsalva pushing
A client receives IV opioid analgesia in labor and becomes somnolent with RR 8/min. What is the priority medication?
Terbutaline
Naloxone
Dinoprostone
Oxytocin
Which finding is a serious complication of a high spinal/epidural block?
Mild itching
Shivering
Nausea
Difficulty breathing with hypotension
The nurse is evaluating a fetal monitor strip. Which is Category III?
Absent variability with recurrent late decelerations
Moderate variability with accelerations
Marked variability with occasional early decelerations
Baseline 120 with moderate variability, no decelerations
Which variability is most reassuring for fetal acid–base status at the time of observation?
Absent
Minimal
Moderate
Marked
The nurse notes loss of variability. Which is a common reason?
Maternal position changes
Fetal sleep cycle or maternal medication (sedation/opioids)
Uterine rupture is always the cause
Normal sign of placental abruption
Which pattern is most consistent with uteroplacental insufficiency?
Early decelerations
Variable decelerations
Accelerations
Late decelerations
A client has uterine tachysystole. Which definition is correct?
>5 contractions in 10 minutes averaged over 30 minutes
4 contractions in 20 minutes
Contractions every 6–7 minutes
Resting tone 0 mmHg
A client on oxytocin develops tachysystole with recurrent late decelerations. What is the priority nursing action?
Increase oxytocin
Discontinue oxytocin and reposition laterally
Begin pushing
Perform amniotomy immediately
Which finding best indicates the client is in active labor?
Irregular contractions that stop with walking
Cervix 1 cm with no change for 4 hours
Cervix 5 cm with progressive change and stronger regular contractions
Cervix posterior and closed
Which finding best indicates true labor?
Contractions decrease with hydration
Cervical change with regular contractions
Contractions only felt in the abdomen
Pain relieved completely by rest
A nurse documents a vaginal exam as “7/90/+1.” What does this mean?
Dilation 7 cm, effacement 90%, station +1
Effacement 7%, dilation 90 cm, station +1
Station 7, dilation 90 cm, effacement +1
Dilation +1 cm, station 7, effacement 90%
Station "0" means the presenting part is:
Crowning
2 cm below ischial spines
At the level of the ischial spines
3 cm above the ischial spines
Which contraction characteristic best supports adequate uterine relaxation between contractions?
Resting tone that returns to soft baseline between contractions
No gap between contractions
Continuous uterine firmness
Increasing resting tone over time
Which method provides the most accurate numeric measurement of contraction intensity?
External tocodynamometer
Maternal palpation only
Intrauterine pressure catheter (IUPC)
Doppler ultrasound handheld only
Before placing an internal monitor (FSE/IUPC), which condition must be present?
Intact membranes
Closed cervix
No fetal movement
Ruptured membranes with sufficient dilation
Which nursing intervention is most appropriate for recurrent variable decelerations that persist despite repositioning?
Consider amnioinfusion if ordered
Increase oxytocin rate
Start dinoprostone
Apply fundal pressure
A nurse prepares for amniotomy. Which finding is most important to reduce cord prolapse risk?
Presenting part engaged (0 or + station)
Cervix closed
Fetus in transverse lie
Membranes already ruptured for 24 hours
Immediately after amniotomy, which nursing action is priority?
Encourage the client to ambulate right away
Assess fetal heart rate and amniotic fluid characteristics
Start oxytocin at maximum dose
Perform a digital exam every 10 minutes
A client wants a VBAC. Which history finding is most supportive of eligibility?
Prior classical (vertical) uterine incision
Prior uterine rupture
Prior low-transverse cesarean incision with no contraindications
Unknown uterine scar type with no records
A VBAC client develops sudden severe abdominal pain, fetal bradycardia, and loss of station. What is the priority action?
Prepare for emergent cesarean delivery
Start oxytocin to correct labor pattern
Continue to monitor for 30 minutes
Encourage pushing
A client is receiving oxytocin. Which teaching point is highest priority?
“Oxytocin is given until contractions are constant.”
“I won’t need fetal monitoring once oxytocin starts.”
“If contractions become too frequent, the infusion may be reduced or stopped.”
“Oxytocin prevents infection after rupture of membranes.”
Which assessment suggests oxytocin is causing fetal compromise?
4 contractions in 10 minutes
Moderate variability with accelerations
Early decelerations with contractions
Tachysystole with recurrent late decelerations
A fetus has recurrent late decelerations. What is the first nursing intervention?
Maternal repositioning (side-lying)
Immediate amniotomy
Immediate operative delivery without interventions
Encourage Valsalva pushing
A fetus has recurrent late decelerations and oxytocin is infusing. Which action should the nurse anticipate?
Increase oxytocin
Discontinue oxytocin and give IV bolus per protocol
Place client supine to improve perfusion
Start dinoprostone
Which fetal heart rate change meets criteria for a prolonged deceleration?
Drop lasting 10 seconds
Drop lasting 30 seconds
Drop lasting 8 minutes
Drop lasting 12 minutes
A baseline fetal heart rate of 170 bpm for more than 10 minutes is:
Bradycardia
Normal baseline
Sinusoidal
Tachycardia
Which maternal finding is a common contributor to fetal tachycardia?
Maternal fever/infection
Maternal mild nausea
Maternal heartburn
Maternal cool extremities
Which cause of fetal bradycardia should the nurse assess immediately after rupture of membranes?
Fetal sleep
Maternal anxiety
Cord prolapse/compression
Mild maternal dehydration
Which complication of labor is most associated with sudden constant abdominal pain and abnormal fetal heart pattern in a VBAC client?
Uterine rupture
Normal transition
Braxton Hicks contractions
Engagement
A client has a firm fundus but persistent heavy vaginal bleeding postpartum. What is the priority concern?
Uterine atony
Normal lochia
Bladder distention only
Genital tract laceration
Which finding most strongly suggests the onset of labor is approaching?
Bloody show
Increased fetal movement only
Decreased appetite only
Sudden vision changes
A client reports regular contractions but no cervical change. The nurse should suspect:
True labor
Active phase arrest immediately
False labor
Second stage labor
A client requests epidural anesthesia. Which complication is the nurse most prepared to prevent?
Maternal hypotension
Maternal hyperthermia
Maternal hypertension crisis
Shoulder dystocia
After an epidural, the client cannot void. Best nursing action?
Encourage unassisted ambulation to bathroom
Restrict all fluids
Document “normal” and do nothing
Assess bladder and anticipate catheterization per policy
A nurse identifies a Category III tracing. What is the priority nursing response?
Initiate intrauterine resuscitation and prepare to escalate/expedite delivery if unresolved
Turn off the monitor to reduce anxiety
Encourage the client to push regardless of dilation
Delay action until the next scheduled assessment
Which finding is most reassuring during intrapartum monitoring?
Absent variability
Sinusoidal pattern
Moderate variability
Recurrent late decelerations
A client is in active labor and is hyperventilating with anxiety. Best nursing action?
Coach slow breathing and grounding techniques
Place client supine
Increase oxytocin rate
Delay assessment to promote privacy
A laboring client has contractions every 1–2 minutes with minimal relaxation between. Which is the priority nursing action?
Encourage pushing to speed delivery
Continue oxytocin unchanged
Notify provider after 1 hour
Stop uterine stimulant and reposition/IV bolus per protocol
A client at 7 cm asks what to expect next. Which response best reflects typical progress?
Contractions usually become stronger and more frequent as transition approaches.
The placenta will deliver next.
Your cervix will close and reopen.
Pushing usually starts now.
Which finding most supports that the client is entering transition?
Cervix 2–3 cm, mild contractions
Cervix 4–6 cm, moderate contractions
Cervix 8–10 cm with intense pressure/urge to push
Placenta delivered
A client has recurrent variable decelerations. What is the first nursing intervention?
Reposition the client
Start dinoprostone
Encourage breath-holding pushes
Prepare immediate cesarean without interventions
Which is an appropriate nursing action when a prolapsed cord is identified?
Attempt to push the cord back into the uterus
Maintain manual elevation of presenting part and prepare for rapid delivery
Clamp the cord immediately
Apply fundal pressure to expedite delivery
Which fetal presentation is most compatible with an uncomplicated vaginal delivery?
Vertex/cephalic
Shoulder presentation
Face mentum posterior
Persistent transverse lie
Which fetal assessment finding is most consistent with a breech presentation on Leopold maneuvers?
Hard round head felt in fundus
Soft irregular parts in fundus
Hard round head felt in the lower uterus/pelvis
No fetal parts palpable
A client has a nonreassuring tracing and is receiving oxytocin. Which action should the nurse anticipate first?
Discontinue oxytocin and initiate resuscitation measures
Increase oxytocin to shorten labor
Start dinoprostone
Encourage pushing
A nurse is caring for a client with tachysystole. Which fetal change is most concerning?
Moderate variability with accelerations
Occasional early decelerations
Recurrent late decelerations
Baseline 130 bpm
Which is a common cause of decreased fetal heart rate variability?
Fetal sleep cycle
Maternal mild heartburn
Normal fetal hiccups
Maternal seasonal allergies
A client’s fetus has minimal variability and recurrent late decelerations. What is the priority next step?
Continue routine monitoring only
Initiate intrauterine resuscitation and notify provider promptly
Encourage ambulation
Start oxytocin to shorten labor
Which labor complication is most associated with cord compression?
Late decelerations
Early decelerations
Variable decelerations
Sinusoidal pattern
Which tracing feature most strongly suggests the fetus is NOT currently acidemic?
Moderate variability
Absent variability
Sinusoidal pattern
Persistent bradycardia
Which finding is most consistent with an adverse reaction/complication to opioid pain management in labor?
Respiratory depression
Increased urine output
Hyperreflexia
Severe hypertension
A client receives naloxone for opioid-induced respiratory depression. What is the nurse’s priority reassessment?
Fundal height
Pain score only
Airway/respiratory status and fetal response
GBS status
During preparation for labor and birth, which teaching is most important for when to come to the hospital?
Regular painful contractions with a pattern and/or rupture of membranes as instructed by provider
Any mild backache at night
One contraction per hour
Increased appetite
A client reports a gush of fluid. Which assessment best supports rupture of membranes while minimizing infection risk?
Immediate digital exam
Sterile speculum exam for pooling with testing as ordered
Frequent repeat vaginal exams
Rectal exam first
The nurse suspects fetal bradycardia is due to maternal supine positioning. Which intervention best addresses the cause?
Left lateral positioning
Increase dinoprostone dose
Encourage the client to push
Apply fundal pressure
A client is in active labor and asks what “station” means. Which explanation is correct?
“How thin your cervix is.”
“How strong the contractions are.”
“How far the baby’s head has rotated.”
“How low the presenting part is relative to the ischial spines.”
Which finding suggests the client is most likely in false labor?
Contractions that become regular and closer together with cervical change
Contractions that lessen with hydration and position change
Progressive effacement and dilation over time
Spontaneous rupture of membranes with continued cervical change
Which is the most appropriate nursing intervention for a client with suspected cord prolapse while awaiting emergency delivery?
Apply continuous pressure to the fetal head to speed descent
Keep the client walking to reduce anxiety
Maintain manual elevation of presenting part and position to reduce compression
Perform repeated cervical checks every 5 minutes
A newborn after forceps delivery develops jaundice risk. The most likely reason is:
Increased bruising/hematoma leading to higher bilirubin load
Low vitamin K
Congenital liver disease from forceps
Exposure to dinoprostone
A client has a Category III tracing and is fully dilated with fetal head crowning. Best plan?
Expectant management for 1 hour
Expedite delivery with neonatal team readiness
Start dinoprostone
Stop monitoring to reduce stress
Which nursing documentation best reflects contraction assessment in suspected tachysystole?
Frequency counted over 10 minutes and averaged over 30 minutes
Only client’s pain score
Only fetal heart rate baseline
Only dilation every hour
Which client is most appropriate for intermittent auscultation rather than continuous EFM?
VBAC trial of labor
Oxytocin infusion induction
Low-risk labor with reassuring status and no complications
Recurrent decelerations present
