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Worksheets2205 Exam 2 OT pt.2
Total questions: 100
Worksheet time: 50mins
A nurse notes a baseline FHR of 90 bpm lasting 4 minutes immediately after the client is repositioned supine for a vaginal exam. Which cause is most likely?
Maternal hypotension from aortocaval compression
Fetal sleep cycle
Maternal hyperventilation
Normal fetal adaptation to contractions
A client’s membranes rupture spontaneously and the FHR suddenly drops to 70 bpm. What is the nurse’s priority action?
Apply oxygen via nonrebreather mask
Perform a sterile vaginal exam to assess for cord prolapse
Increase IV oxytocin to shorten labor
Prepare the client for epidural placement
Which fetal presentation is most strongly associated with the denominator “mentum”?
Vertex
Breech
Face
Shoulder
A newborn is delivered by cesarean birth. Which complication is the nurse most concerned about in the immediate newborn period?
Hyperbilirubinemia from bruising
Post-term dysmaturity
Facial nerve palsy
Transient tachypnea/respiratory distress
Which forceps-related newborn finding requires the most urgent follow-up?
Skull fracture or signs of intracranial hemorrhage
Mild facial bruising
Temporary molding
Caput succedaneum
A client receives an epidural and becomes pale with BP 78/40. FHR shows recurrent late decelerations. What is the nurse’s best first action?
Notify anesthesia and prepare ephedrine immediately
Turn the client to a lateral position and increase IV fluids per protocol
Encourage the client to push with each contraction
Discontinue fetal monitoring to reduce stress
Which screening test is typically performed at 36–37 weeks to guide intrapartum antibiotic prophylaxis?
Rubella titer
1-hour glucose screen
Group B Streptococcus culture
Quad screen
Which tracing meets Category III criteria?
Moderate variability with occasional variable decelerations
Minimal variability with accelerations after stimulation
Marked variability without decelerations
Absent variability with recurrent late decelerations
Which fetal heart rate variability is most reassuring for fetal well-being at the time of observation?
Moderate variability
Absent variability
Minimal variability
Marked variability with recurrent lates
A client is receiving oxytocin. The nurse counts 6 contractions in 10 minutes averaged over 30 minutes. How should the nurse document this pattern?
Normal uterine activity
Tachysystole
Hypertonic dysfunction
Hypotonic labor
A nurse palpates contractions lasting 95 seconds with only 20 seconds of relaxation between them. What fetal risk is most concerning?
Decreased uteroplacental perfusion and fetal hypoxemia
Increased fetal oxygenation from stronger contractions
Reduced risk of cord compression
Improved labor progress without complications
A client is 5 cm dilated and requests “something to speed this up.” Which teaching about oxytocin infusion is most important?
Oxytocin is given as an IV push for rapid delivery
Oxytocin eliminates the need for fetal monitoring
Oxytocin is titrated carefully because too-frequent contractions can reduce fetal oxygenation
Oxytocin is safest when the client remains supine
A nurse notes decreased FHR variability after IV opioid administration. Which explanation is most likely?
Medication-related CNS depression
Placental abruption
Umbilical cord prolapse
Uterine rupture
Which situation is a common reason for transient minimal variability that is NOT immediately pathologic?
Uterine rupture
Placental separation
Fetal sleep cycle
Sustained fetal hypoxia
Which contraction pattern most supports uterine tachysystole?
4 contractions in 10 minutes, lasting 45–60 seconds
5 contractions in 10 minutes, averaged over 30 minutes
6 contractions in 10 minutes, averaged over 30 minutes
Contractions every 5 minutes with moderate intensity
A client is in active labor. Which finding best supports this stage?
Cervix 1–2 cm, irregular contractions, no cervical change
Cervix 4–7 cm with progressive dilation and stronger regular contractions
Cervix 0–3 cm with mild contractions that stop with hydration
Cervix 8–10 cm with involuntary pushing
Which documentation correctly records dilation/effacement/station?
6/80/+1
80/6/+1
+1/6/80
6/+1/80
Which station indicates the presenting part is level with the ischial spines?
+2
-2
0
+1
Which finding best indicates true labor rather than false labor?
Contractions decrease with walking
Cervical change with regular contractions
Contractions stop after a warm shower
Pain is felt only in the abdomen
A client is admitted with contractions every 2 minutes and minimal relaxation. FHR shows recurrent late decelerations. What is the priority nursing intervention sequence?
Apply oxygen first, then increase oxytocin
Stop oxytocin, reposition laterally, give IV bolus, and notify provider if unresolved
Encourage pushing to shorten labor, then reassess
Perform amniotomy to speed delivery
The nurse identifies an overt umbilical cord prolapse. What must the nurse do continuously until birth?
Manually elevate the presenting part off the cord
Clamp and cut the cord immediately
Apply firm fundal pressure to move the fetus down
Place the client flat supine and wait for the provider
Which intervention is contraindicated in cord prolapse management?
Knee-chest or Trendelenburg positioning
Manual elevation of presenting part
Calling for immediate assistance/rapid delivery
Handling or compressing the cord
A fetus is in a breech presentation. Which breech type has the highest cord prolapse risk after rupture of membranes?
Frank breech
Complete breech
Footling breech
Kneeling breech
Which fetal position documentation is correct for a vertex fetus with occiput as the denominator?
LSA
LOA
LMA
LST
A nurse is preparing for amniotomy. Which finding is most important to reduce cord prolapse risk?
Presenting part is engaged (0 station or lower)
Client is 1 cm dilated
FHR baseline is 170 bpm
Client has mild back pain
Immediately after amniotomy, which assessment is the priority?
Maternal temperature
FHR pattern
Maternal bowel sounds
Maternal rubella immunity
Which client is the best candidate for intermittent auscultation instead of continuous electronic fetal monitoring?
Low-risk client with reassuring FHR and no complications
VBAC trial of labor
Oxytocin induction
Meconium-stained fluid
Which fetal heart tracing finding is most consistent with uteroplacental insufficiency?
Early decelerations
Variable decelerations with “shoulders”
Accelerations with movement
Late decelerations
A nurse identifies Category III tracing. What is the priority nursing response?
Initiate intrauterine resuscitation and prepare to expedite birth if unresolved
Document and continue routine monitoring
Discontinue monitoring to reduce artifact
Encourage ambulation to improve labor progress
Which maternal condition is a common cause of fetal bradycardia?
Maternal fever
Maternal hypotension
Maternal mild anxiety
Maternal rubella nonimmune status
A fetus develops sudden bradycardia after rupture of membranes. Which complication must the nurse suspect first?
Umbilical cord prolapse or acute cord compression
Fetal sleep cycle
Normal head compression
Post-term placental aging
During Leopold maneuvers, which finding most clearly confirms a cephalic (vertex) presentation?
Hard, round, ballotable structure palpated in the fundus
Small, irregular fetal parts felt in the lower uterus
Broad, soft buttocks felt in the fundus
No fetal parts are palpable
Which forceps-related newborn complication is most concerning?
Facial nerve palsy
Mild bruising
Transient molding
Slight jaundice risk
A nurse is teaching a client about risks/benefits of operative vaginal delivery. Which maternal complication is most appropriate to include?
Genital tract trauma and increased postpartum pain/bleeding
Decreased risk of perineal trauma
Guaranteed shorter postpartum recovery than cesarean
Elimination of fetal monitoring needs
Which finding is most consistent with vacuum extraction-related caput succedaneum?
Scalp swelling that crosses suture lines
Subperiosteal swelling that does not cross suture lines
Bulging anterior fontanel from increased ICP
Absent Moro reflex from spinal injury
A client requests pain medication and receives an opioid. Which maternal adverse reaction is the highest priority for the nurse to monitor?
Nausea
Urinary retention
Pruritus
Respiratory depression
A client becomes somnolent with RR 8/min after opioid analgesia. Which medication does the nurse anticipate?
Naloxone
Terbutaline
Methylergonovine
Dinoprostone
A client receives epidural anesthesia. Which complication requires immediate intervention?
Mild itching
Hypotension with fetal late decelerations
Temporary lower-extremity numbness
Decreased urge to urinate
Despite lateral positioning and IV bolus, hypotension persists after epidural placement. Which medication is commonly used per protocol to support blood pressure?
Ephedrine (vasopressor)
Naloxone
Oxytocin
Dinoprostone
Which client would generally NOT be an appropriate candidate for epidural/spinal anesthesia?
Client with thrombocytopenia/coagulopathy
Client requesting pain relief in active labor
Client with reassuring fetal tracing
Client with intact membranes
A client attempting VBAC reports sudden severe abdominal pain and the nurse notes loss of fetal station with fetal bradycardia. What is the priority action?
Activate emergency response and prepare for emergent cesarean
Begin intermittent auscultation
Encourage pushing to speed delivery
Increase oxytocin to strengthen contractions
Which statement best reflects VBAC candidate criteria teaching?
Any prior uterine scar is acceptable for VBAC
VBAC is safest when induction with prostaglandins is routine
A prior low transverse uterine incision is generally the most favorable scar type
Continuous fetal monitoring is never necessary
A nurse is preparing a client for an uncomplicated birth. Which intervention is most appropriate in early labor?
Encourage hydration, position changes, and coping techniques while monitoring maternal/fetal status
Encourage closed-glottis pushing with each contraction
Keep the client supine to maintain a steady tracing
Limit education until after delivery
A client is in second stage of labor. Which finding indicates progress toward birth?
Crowning
Cervix 6 cm dilated
Placenta delivered
Fundus firm and midline
A client is in third stage of labor. What is the nurse primarily anticipating?
Delivery of the placenta
Full cervical dilation
Onset of regular contractions
Fetal head engagement
A client is in the fourth stage of labor. Which nursing assessment is the priority focus?
Hemorrhage and uterine tone (fundus/lochia)
Fetal presentation
Cervical dilation trend
Maternal rubella status
A postpartum client has a boggy fundus with heavy lochia. What is the nurse’s best first action?
Massage the fundus and assess for bladder distention/assist to void
Place the client prone and reassess later
Withhold uterotonic meds until provider arrives
Encourage the client to ambulate immediately
Fundus is firm but bleeding remains heavy and bright red. What is the priority concern?
Genital tract laceration
Normal lochia rubra
Maternal dehydration
Expected “afterpains”
A client’s baseline FHR is 175 for 12 minutes. How should the nurse document this?
Fetal tachycardia
Moderate variability
Fetal bradycardia
Sinusoidal pattern
Which is the best example of a cause of fetal bradycardia requiring immediate nursing intervention?
Maternal supine hypotension syndrome
Normal fetal movement
Maternal mild hunger
Fetal hiccups
Which is a common reason for loss of variability the nurse should consider first when the client recently received systemic analgesia?
Medication effect
Uterine rupture
Placental abruption
Cord prolapse
A nurse must determine baseline FHR. Which method is correct?
Average the FHR over a 10-minute window, excluding accelerations/decelerations and rounding to the nearest 5 bpm
Average over 2 minutes including the lowest deceleration
Use the maternal pulse if the tracing is unclear
Use the lowest value over 10 minutes
The nurse is evaluating a Category III tracing. Which intrauterine resuscitation measure is generally first-line?
Maternal repositioning (side-lying)
Administer oxygen via nonrebreather mask
Increase oxytocin infusion
Begin pushing to expedite delivery
A client on oxytocin develops tachysystole with recurrent late decelerations. Which action is the priority?
Increase oxytocin to shorten labor
Stop/reduce oxytocin and begin intrauterine resuscitation
Perform amniotomy immediately
Encourage Valsalva pushing
A nurse is teaching a client about oxytocin. Which statement indicates correct understanding?
“My contractions can become too frequent, so the dose is adjusted while monitoring the baby.”
“Once oxytocin starts, it cannot be stopped.”
“Oxytocin means I won’t need fetal monitoring.”
“Oxytocin is given as a single injection.”
Which fetal presentation is most compatible with uncomplicated vaginal delivery?
Shoulder presentation
Transverse lie
Face with mentum posterior
Vertex (cephalic)
Which description best defines true labor?
Regular contractions with progressive cervical change
Irregular contractions relieved by hydration
Contractions that stop with walking
Pain only felt in the pelvis without contractions
A client is 7 cm dilated with strong contractions and increasing bloody show. Which phase is most likely?
Latent phase
Active phase
Transition phase
Fourth stage
Which sign most often precedes the onset of labor?
Lightening with increased urinary frequency
Sudden cessation of fetal movement
Deep tendon reflex changes
Immediate placental delivery
A nurse suspects umbilical cord prolapse. Which fetal complication is the nurse trying to prevent with immediate interventions?
Acute fetal hypoxia leading to acidemia
Neonatal hyperbilirubinemia
Congenital heart defect
Meconium ileus
Which finding most supports active labor rather than latent labor?
Contractions regular with progressive cervical dilation around 4–7 cm
Cervix 1–2 cm with irregular contractions
No change in cervical status over time
Contractions stop with sleep
A nurse is assessing station. The presenting part is 2 cm above the ischial spines. How is this documented?
+2 station
0 station
-2 station
+4 station
A fetal heart tracing shows absent variability and recurrent variable decelerations. What is the best interpretation?
Category III pattern requiring urgent evaluation/intervention
Category I pattern that is normal
Category II that needs no action
A normal sleep cycle pattern
Which finding is most consistent with a Category I tracing?
Baseline 110–160 with moderate variability and no late or variable decelerations
Absent variability with recurrent lates
Sinusoidal pattern
Persistent bradycardia
Which complication is most associated with epidural anesthesia that can indirectly cause fetal distress?
Maternal hypotension reducing uteroplacental perfusion
Maternal hypertension causing placental abruption
Maternal fever from infection at insertion site within minutes
Maternal hypoglycemia from fasting
A client receiving epidural anesthesia reports ringing in ears and metallic taste shortly after a test dose. What is the nurse’s priority action?
Continue monitoring; this is expected
Stop infusion and notify anesthesia (possible local anesthetic systemic toxicity)
Place client supine with legs flat
Encourage oral fluids
A nurse is preparing the client for amniotomy. Which statement is most appropriate to include in teaching?
“We’ll monitor the baby’s heart rate right after your water is broken because the cord can slip down.”
“After amniotomy, you won’t need any more cervical checks.”
“This eliminates infection risk because fluid drains out.”
“This guarantees a vaginal birth.”
Which is the most appropriate nursing action when Category III persists despite repositioning and IV bolus?
Prepare to expedite birth per provider direction (operative birth readiness)
Continue expectant management for 2 hours
Discontinue fetal monitoring for comfort
Encourage ambulation
Which fetal complication is a risk from cesarean birth related to delivery mechanics?
Fetal laceration or trauma during uterine incision
Neonatal clavicle fracture from shoulder dystocia
Cephalohematoma from vacuum cup
Facial bruising from forceps
A nurse notes recurrent decelerations and suspects cord compression. Which intervention is most targeted first?
Maternal repositioning
Immediate prostaglandin insertion
Apply fundal pressure
Which statement best describes a primary goal of continuous EFM in a high-risk labor?
Early detection of fetal hypoxemia patterns to guide timely interventions
Guarantee of preventing cesarean birth
Replacement of maternal vital sign monitoring
Elimination of need for nursing reassessment
A client is scheduled for induction. Which is a primary indication for dinoprostone?
Cervical ripening when the cervix is unfavorable
Treating postpartum hemorrhage
Reversing opioid respiratory depression
Treating uterine tachysystole
After dinoprostone placement, the client develops tachysystole with a nonreassuring FHR. What is the priority nursing action?
Discontinue/remove dinoprostone per policy and begin intrauterine resuscitation
Encourage ambulation to “work it out”
Begin pushing
Place client supine to stabilize tracing
Which contraction characteristic best supports adequate relaxation between contractions?
Resting tone remains elevated with no return to baseline
60–90 second contraction with 2–3 minutes of relaxation
Continuous uterine tightening without softening
Contractions every 1 minute for 40 seconds
A nurse suspects tachysystole in a client receiving oxytocin. Which assessment is most important for fetal status?
FHR category and variability
Maternal rubella immunity
Maternal fundal height
Maternal bowel movements
Which cause of fetal bradycardia is most consistent with a sudden change right after regional anesthesia placement?
Maternal hypotension
Fetal anemia
Fetal sleep
Maternal hyperglycemia
Which newborn complication is associated with forceps delivery more than vacuum extraction?
Facial nerve palsy/ocular trauma risk
Caput succedaneum crossing suture lines
Scalp abrasion from cup placement
Subgaleal hemorrhage only
A client is being evaluated for VBAC. Which risk must be emphasized as the reason for continuous assessment and readiness for emergent intervention?
Uterine rupture
Hyperemesis gravidarum
Shoulder dystocia is guaranteed
Placenta previa is inevitable
Which nursing intervention is most appropriate when the client is in active labor and coping is deteriorating?
Provide continuous support, reassess pain plan, encourage position changes, and maintain hydration as ordered
Stop fetal monitoring to reduce anxiety
Restrict all movement
Delay assessments unless the client requests
A nurse notes “LOA” in the chart. What does this mean?
Left occiput anterior
Left oblique attitude
Left outlet engaged
Left occiput above
Which action is most appropriate when fetal bradycardia occurs and cord prolapse is suspected but not yet confirmed?
Perform vaginal exam to assess for cord and relieve compression if present
Begin CST
Delay assessment until provider arrives
Encourage immediate pushing
Which is an expected nursing action when preparing a client for an uncomplicated birth in the first stage?
Encourage the client to hold breath and push with every contraction
Provide education, support coping, monitor contractions/FHR, and limit unnecessary vaginal exams
Keep the client NPO and supine to maintain a tracing
Discontinue IV access to reduce infection risk
Which finding most strongly suggests the client is entering transition?
Dilation 8–10 cm with intense contractions and pressure/urge to push
Dilation 2 cm with mild irregular contractions
Dilation 4 cm with mild discomfort
No cervical change for 6 hours
A nurse observes a client in labor with contractions that are strong but cervical dilation stops and the uterus remains firm between contractions. Which complication is most likely?
Hypertonic uterine dysfunction
Hypotonic labor pattern
Normal latent phase
Precipitous labor
Which sign preceding labor is most consistent with cervical changes and mucus plug release?
Bloody show
Polyuria
Hyperreflexia
Persistent vomiting
A nurse is assessing fetal presentation during labor. Which presentation is least compatible with vaginal birth if persistent at term?
Vertex
Transverse lie
Frank breech
Complete breech
Which “reason for loss of variability” is most concerning when paired with recurrent late decelerations?
Fetal acidemia/hypoxia
Fetal sleep cycle
Recent opioid administration
A nurse is caring for a client receiving oxytocin. Which finding requires the nurse to intervene immediately?
Contractions every 2 minutes with minimal resting time and Category II tracing
Contractions every 4 minutes with moderate variability
Baseline 140 with accelerations
Cervix dilating steadily
Which client is most appropriate for continuous electronic fetal monitoring rather than intermittent auscultation?
Client receiving oxytocin augmentation
Low-risk spontaneous labor client with reassuring status
Client in early labor walking with no risk factors
Client requesting minimal interventions
A client has an epidural and cannot feel the urge to void. What nursing action is most appropriate?
Assess bladder distention and anticipate catheterization per policy
Encourage unassisted ambulation to the bathroom
Restrict all IV fluids immediately
Delay voiding assessment until postpartum
Which newborn assessment is most urgent after a difficult forceps delivery?
Neurologic status and signs of trauma/bleeding
Number of wet diapers
Lanugo distribution
Timing of first bath
Which fetal complication from cesarean birth is most associated with delayed fluid clearance from lungs?
Transient tachypnea of the newborn
Meconium aspiration syndrome
Necrotizing enterocolitis
Omphalocele
Which statement by a client about oxytocin infusion needs immediate correction?
“If the baby looks stressed, you can turn down or stop the oxytocin.”
“I’ll be monitored closely while I’m on it.”
“More oxytocin always makes labor safer and better.”
“Too many contractions can reduce oxygen to the baby.”
A nurse suspects cord prolapse. Which maternal position is commonly used to reduce cord compression while awaiting delivery?
Knee-chest or Trendelenburg (per protocol)
Flat supine
High Fowler’s
Lithotomy with legs down
Which finding supports “fetal presentation: shoulder”?
Scapula is the presenting landmark
Occiput is the presenting landmark
Sacrum is the presenting landmark
Mentum is the presenting landmark
Which complication related to labor most directly increases risk for fetal hypoxemia by decreasing time for placental refill?
Uterine tachysystole
Bloody show
Lightening
Engagement
A nurse is assessing pain management complications. Which symptom is most concerning after regional anesthesia?
Difficulty breathing and rapidly dropping blood pressure
Mild shivering
Mild nausea
Warm sensation in legs
After an uncomplicated vaginal birth, which immediate nursing action best supports safe newborn transition?
Dry thoroughly and assess respirations/airway while maintaining warmth
Bathe immediately
Delay all assessments for 2 hours
Feed before respiratory assessment
A client asks why fetal monitoring continues during oxytocin induction. What is the best response?
“Oxytocin can cause contractions too close together, which can lower oxygen to the baby, so we watch the tracing.”
“Monitoring is required only for insurance.”
“Monitoring replaces checking your vital signs.”
“If the tracing looks abnormal, we always keep oxytocin running.”
Which assessment finding best indicates the placenta has separated in the third stage?
Sudden gush of blood with lengthening of the umbilical cord and a firm, rising uterus
Cervix is 10 cm
FHR baseline is 120
Membranes remain intact
