OB/GYN – Intrapartum

1. A nurse is caring for a client in labor. The nurse determines that the client is beginning in the 2nd stage of labor when which
of the following assessments is noted?
A. The client begins to expel clear vaginal fluid
B. The contractions are regular
C. The membranes have ruptured
D. The cervix is dilated completely
2. A nurse in the labor room is caring for a client in the active phases of labor. The nurse is assessing the fetal patterns and
notes a late deceleration on the monitor strip. The most appropriate nursing action is to:

1. Place the mother in the supine position

2. Document the findings and continue to monitor the fetal patterns
3. Administer oxygen via face mask
4. Increase the rate of pitocin IV infusion
3. A nurse is performing an assessment of a client who is scheduled for a cesarean delivery. Which assessment finding would
indicate a need to contact the physician?

1. Fetal heart rate of 180 beats per minute

2. White blood cell count of 12,000
3. Maternal pulse rate of 85 beats per minute
4. Hemoglobin of 11.0 g/dL
4. A client in labor is transported to the delivery room and is prepared for a cesarean delivery. The client is transferred to the
delivery room table, and the nurse places the client in the:

1. Trendelenburg’s position with the legs in stirrups

2. Semi-Fowler position with a pillow under the knees
3. Prone position with the legs separated and elevated
4. Supine position with a wedge under the right hip
5. A nurse is caring for a client in labor and prepares to auscultate the fetal heart rate by using a Doppler ultrasound device.
The nurse most accurately determines that the fetal heart sounds are heard by:

1. Noting if the heart rate is greater than 140 BPM

2. Placing the diaphragm of the Doppler on the mother abdomen
3. Performing Leopold’s maneuvers first to determine the location of the fetal heart
4. Palpating the maternal radial pulse while listening to the fetal heart rate
6. A nurse is caring for a client in labor who is receiving Pitocin by IV infusion to stimulate uterine contractions. Which
assessment finding would indicate to the nurse that the infusion needs to be discontinued?

1. Three contractions occurring within a 10-minute period

2. A fetal heart rate of 90 beats per minute
3. Adequate resting tone of the uterus palpated between contractions
4. Increased urinary output
7. A nurse is beginning to care for a client in labor. The physician has prescribed an IV infusion of Pitocin. The nurse ensures
that which of the following is implemented before initiating the infusion?

1. Placing the client on complete bed rest

2. Continuous electronic fetal monitoring
3. An IV infusion of antibiotics
4. Placing a code cart at the client’s bedside
8. A nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes that last 45
seconds. The nurse notes that the fetal heart rate between contractions is 100 BPM. Which of the following nursing actions is
most appropriate?

1. Encourage the client’s coach to continue to encourage breathing exercises

2. Encourage the client to continue pushing with each contraction
3. Continue monitoring the fetal heart rate
4. Notify the physician or nurse mid-wife
9. A nurse is caring for a client in labor and is monitoring the fetal heart rate patterns. The nurse notes the presence of
episodic accelerations on the electronic fetal monitor tracing. Which of the following actions is most appropriate?

1. Document the findings and tell the mother that the monitor indicates fetal well-being
2. Take the mothers vital signs and tell the mother that bed rest is required to conserve oxygen.
3. Notify the physician or nurse mid-wife of the findings.
4. Reposition the mother and check the monitor for changes in the fetal tracing
10. A nurse is admitting a pregnant client to the labor room and attaches an external electronic fetal monitor to the client’s
abdomen. After attachment of the monitor, the initial nursing assessment is which of the following?

1. Identifying the types of accelerations

2. Assessing the baseline fetal heart rate
3. Determining the frequency of the contractions
4. Determining the intensity of the contractions
11. A nurse is reviewing the record of a client in the labor room and notes that the nurse midwife has documented that the fetus
is at -1 station. The nurse determines that the fetal presenting part is:

1. 1 cm above the ischial spine

2. 1 fingerbreadth below the symphysis pubis
3. 1 inch below the coccyx
4. 1 inch below the iliac crest
12. A pregnant client is admitted to the labor room. An assessment is performed, and the nurse notes that the client’s
hemoglobin and hematocrit levels are low, indicating anemia. The nurse determines that the client is at risk for which of the
following?

1. A loud mouth
2. Low self-esteem
3. Hemorrhage
4. Postpartum infections
13. A nurse assists in the vaginal delivery of a newborn infant. After the delivery, the nurse observes the umbilical cord
lengthen and a spurt of blood from the vagina. The nurse documents these observations as signs of:

1. Hematoma
2. Placenta previa
3. Uterine atony
4. Placental separation
14. A client arrives at a birthing center in active labor. Her membranes are still intact, and the nurse-midwife prepares to
perform an amniotomy. A nurse who is assisting the nurse-midwife explains to the client that after this procedure, she will most
likely have:
1. Less pressure on her cervix
2. Increased efficiency of contractions
3. Decreased number of contractions
4. The need for increased maternal blood pressure monitoring
15. A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the following is noted on
the external monitor tracing during a contraction?

1. Early decelerations
2. Variable decelerations
3. Late decelerations
4. Short-term variability
16. A nurse explains the purpose of effleurage to a client in early labor. The nurse tells the client that effleurage is:

1. A form of biofeedback to enhance bearing down efforts during delivery

2. Light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus
3. The application of pressure to the sacrum to relieve a backache
4. Performed to stimulate uterine activity by contracting a specific muscle group while other parts of the body rest
17. A nurse is caring for a client in the second stage of labor. The client is experiencing uterine contractions every 2 minutes
and cries out in pain with each contraction. The nurse recognizes this behavior as:

1. Exhaustion
2. Fear of losing control
3. Involuntary grunting
4. Valsalva’s maneuver
18. A nurse is monitoring a client in labor who is receiving Pitocin and notes that the client is experiencing hypertonic uterine
contractions. List in order of priority the actions that the nurse takes.

1. Stop of Pitocin infusion- 1

2. Perform a vaginal examination- 3
3. Reposition the client- 5
4. Check the client’s blood pressure and heart rate-2
5. Administer oxygen by face mask at 8 to 10 L/min- 4
19. A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of a slowing labor. The nurse is
reviewing the physician’s orders and would expect to note which of the following prescribed treatments for this condition?

1. Medication that will provide sedation

2. Increased hydration
3. Oxytocin (Pitocin) infusion
4. Administration of a tocolytic medication
20. A nurse in the labor room is preparing to care for a client with hypertonic uterine dysfunction. The nurse is told that the
client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. The priority nursing
intervention would be to:

1. Monitor the Pitocin infusion closely

2. Provide pain relief measures
3. Prepare the client for an amniotomy
4. Promote ambulation every 30 minutes
21. A nurse is developing a plan of care for a client experiencing dystocia and includes several nursing interventions in the plan
of care. The nurse prioritizes the plan of care and selects which of the following nursing interventions as the highest priority?

1. Keeping the significant other informed of the progress of the labor

2. Providing comfort measures
3. Monitoring fetal heart rate
4. Changing the client’s position frequently
22. A maternity nurse is preparing to care for a pregnant client in labor who will be delivering twins. The nurse monitors the
fetal heart rates by placing the external fetal monitor:

1. Over the fetus that is most anterior to the mothers abdomen

2. Over the fetus that is most posterior to the mothers abdomen
3. So that each fetal heart rate is monitored separately
4. So that one fetus is monitored for a 15-minute period followed by a 15 minute fetal monitoring period for the second fetus
23. A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with
placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks associated
with placenta previa?

1. Disseminated intravascular coagulation

2. Chronic hypertension
3. Infection
4. Hemorrhage
24. A nurse in the delivery room is assisting with the delivery of a newborn infant. After the delivery of the newborn, the nurse
assists in delivering the placenta. Which observation would indicate that the placenta has separated from the uterine wall and is
ready for delivery?

1. The umbilical cord shortens in length and changes in color

2. A soft and boggy uterus
3. Maternal complaints of severe uterine cramping
4. Changes in the shape of the uterus
25. A nurse in the labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence of
the umbilical cord protruding from the vagina. Which of the following would be the initial nursing action?

1. Place the client in Trendelenburg’s position

2. Call the delivery room to notify the staff that the client will be transported immediately
3. Gently push the cord into the vagina
4. Find the closest telephone and stat page the physician
26. A maternity nurse is caring for a client with abruptio placenta and is monitoring the client for disseminated intravascular
coagulopathy. Which assessment finding is least likely to be associated with disseminated intravascular coagulation?

1. Swelling of the calf in one leg

2. Prolonged clotting times
3. Decreased platelet count
4. Petechiae, oozing from injection sites, and hematuria
27. A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted to the maternity unit with a
suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this
condition is present?
1. Absence of abdominal pain
2. A soft abdomen
3. Uterine tenderness/pain
4. Painless, bright red vaginal bleeding
28. A maternity nurse is preparing for the admission of a client in the 3rd trimester of pregnancy that is experiencing vaginal
bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the physician’s orders and would question which
order?
1. Prepare the client for an ultrasound
2. Obtain equipment for external electronic fetal heart monitoring
3. Obtain equipment for a manual pelvic examination and Internal examination
4. Prepare to draw a Hgb and Hct blood sample
29. An ultrasound is performed on a client at term gestation that is experiencing moderate vaginal bleeding. The results of the
ultrasound indicate that an abruptio placenta is present. Based on these findings, the nurse would prepare the client for:

1. Complete bed rest for the remainder of the pregnancy

2. Delivery of the fetus
3. Strict monitoring of intake and output
4. The need for weekly monitoring of coagulation studies until the time of delivery
30. A nurse in a labor room is assisting with the vaginal delivery of a newborn infant. The nurse would monitor the client
closely for the risk of uterine rupture if which of the following occurred?

1. Hypotonic contractions
2. Forceps delivery
3. Schultz delivery
4. Weak bearing down efforts
31. A client is admitted to the birthing suite in early active labor. The priority nursing intervention on admission of this client
would be:

1. Auscultating the fetal heart

2. Taking an obstetric history
3. Asking the client when she last ate
4. Ascertaining whether the membranes were ruptured
32. A client who is gravida 1, para 0 is admitted in labor. Her cervix is 100% effaced, and she is dilated to 3 cm. Her fetus is at
+1 station. The nurse is aware that the fetus’ head is:

1. Not yet engaged

2. Entering the pelvic inlet
3. Below the ischial spines
4. Visible at the vaginal opening
33. After doing Leopold’s maneuvers, the nurse determines that the fetus is in the ROP position. To best auscultate the fetal
heart tones, the Doppler is placed:

1. Above the umbilicus at the midline

2. Above the umbilicus on the left side
3. Below the umbilicus on the right side
4. Below the umbilicus near the left groin
34. The physician asks the nurse the frequency of a laboring client’s contractions. The nurse assesses the client’s contractions
by timing from the beginning of one contraction:
1. Until the time it is completely over
2. To the end of a second contraction
3. To the beginning of the next contraction
4. Until the time that the uterus becomes very firm
35. The nurse observes the client’s amniotic fluid and decides that it appears normal, because it is:

1. Clear and dark amber in color

2. Milky, greenish yellow, containing shreds of mucus
3. Clear, almost colorless, and containing little white specks
4. Cloudy, greenish-yellow, and containing little white specks
36. At 38 weeks’ gestation, a client is having late decelerations. The fetal pulse oximeter shows 75% to 85%. The nurse should:

1. Discontinue the catheter, if the reading is not above 80%

2. Discontinue the catheter, if the reading does not go below 30%
3. Advance the catheter until the reading is above 90% and continue monitoring
4. Reposition the catheter, recheck the reading, and if it is 55%, keep monitoring
37. When examining the fetal monitor strip after rupture of the membranes in a laboring client, the nurse notes variable
decelerations in the fetal heart rate. The nurse should:

1. Stop the oxytocin infusion

2. Change the client’s position
3. Prepare for immediate delivery
4. Take the client’s blood pressure
38. When monitoring the fetal heart rate of a client in labor, the nurse identifies an elevation of 15 beats above the baseline rate
of 135 beats per minute lasting for 15 seconds. This should be documented as:

1. An acceleration
2. An early elevation
3. A sonographic motion
4. A tachycardic heart rate
39. A laboring client complains of low back pain. The nurse replies that this pain occurs most when the position of the fetus is:

1. Breech
2. Transverse
3. Occiput anterior
4. Occiput posterior
40. The breathing technique that the mother should be instructed to use as the fetus’ head is crowning is:

1. Blowing
2. Slow chest
3. Shallow
4. Accelerated-decelerated
41. During the period of induction of labor, a client should be observed carefully for signs of:

1. Severe pain
2. Uterine tetany
3. Hypoglycemia
4. Umbilical cord prolapse
42. A client arrives at the hospital in the second stage of labor. The fetus’ head is crowning, the client is bearing down, and the
birth appears imminent. The nurse should:

1. Transfer her immediately by stretcher to the birthing unit

2. Tell her to breathe through her mouth and not to bear down
3. Instruct the client to pant during contractions and to breathe through her mouth
4. Support the perineum with the hand to prevent tearing and tell the client to pant
43. A laboring client is to have a pudendal block. The nurse plans to tell the client that once the block is working she:

1. Will not feel the episiotomy

2. May lose bladder sensation
3. May lose the ability to push
4. Will no longer feel contractions
44. Which of the following observations indicates fetal distress?

1. Fetal scalp pH of 7.14

2. Fetal heart rate of 144 beats/minute
3. Acceleration of fetal heart rate with contractions
4. Presence of long term variability
45. Which of the following fetal positions is most favorable for birth?

1. Vertex presentation
2. Transverse lie
3. Frank breech presentation
4. Posterior position of the fetal head
46. A laboring client has external electronic fetal monitoring in place. Which of the following assessment data can be
determined by examining the fetal heart rate strip produced by the external electronic fetal monitor?

1. Gender of the fetus

2. Fetal position
3. Labor progress
4. Oxygenation
47. A laboring client is in the first stage of labor and has progressed from 4 to 7 cm in cervical dilation. In which of the
following phases of the first stage does cervical dilation occur most rapidly?

1. Preparatory phase
2. Latent phase
3. Active phase
4. Transition phase
48. A multiparous client who has been in labor for 2 hours states that she feels the urge to move her bowels. How should the
nurse respond?

1. Let the client get up to use the potty

2. Allow the client to use a bedpan
3. Perform a pelvic examination
4. Check the fetal heart rate
49. Labor is a series of events affected by the coordination of the five essential factors. One of these is the passenger (fetus).
Which are the other four factors?
1. Contractions, passageway, placental position and function, pattern of care
2. Contractions, maternal response, placental position, psychological response
3. Passageway, contractions, placental position and function, psychological response
4. Passageway, placental position and function, paternal response, psychological response
50. Fetal presentation refers to which of the following descriptions?

1. Fetal body part that enters the maternal pelvis first

2. Relationship of the presenting part to the maternal pelvis
3. Relationship of the long axis of the fetus to the long axis of the mother
4. A classification according to the fetal part