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    Exam Review

    1. A nurse has received a report about a patient in labor. The patient's last vaginal examination was recorded as 3 cm, 30%, and -2. What is the nurse's interpretation of this assessment?
      A)
      The cervix is dilated 3 cm, is effaced 30%, and the presenting part is 2 cm below the ischial spines.
      B)
      The cervix is effaced 3 cm, is dilated 30%, and the presenting part is 2 cm above the ischial spines.
      C)
      The cervix is effaced 3 cm, is dilated 30%, and the presenting part is 2 cm below the ischial spines.
      D)
      The cervix is 3 cm dilated, is effaced 30%, and the presenting part is 2 cm above the ischial spines.
    2. During delivery, the nurse notes the baby's head has just been delivered. The nurse concludes that the baby has just gone through which of the following cardinal movements of labor?
      A)
      Extension.
      B)
      Expulsion.
      C)
      Internal rotation.
      D)
      Flexion.
    3. A patient in active labor is told by the nurse-midwife that "the baby is in the flexed attitude.”. When she asks the nurse what that means, what should the nurse say?
      A)
      The baby's presenting part is engaged.
      B)
      The baby is in a transverse lie.
      C)
      The baby is in the breech position.
      D)
      The baby's chin is resting on its chest.
    4. In the picture below, each line represents 1 cm with regard to fetal station. What station would describe the darkened line?
      A)
      -3.
      B)
      -2.
      C)
      +2.
      D)
      +3.
    Page 1 of 11

    Exam Review

    1. Which of the following pictures represents a transverse lie of the fetus?
      A)
      The fetus is in a longitudinal lie, cephalic presentation.
      B)
      The fetus is in a transverse lie, with its head and buttocks positioned to the sides of the mother's abdomen.
      C)
      The fetus is in a longitudinal lie, breech presentation.
      D)
      The fetus is in an oblique lie.
    2. A nurse is caring for a patient in the first stage of labor and assesses that the patient is 6 cm dilated, 75% effaced, and the baby is at 0 station. Based on these findings, the nurse would document that the patient is in what phase of the first stage of labor?
      A)
      Transition.
      B)
      Active.
      C)
      Latent.
      D)
      Progressive.
    3. A patient experiencing back labor complains of intense pain in her lower back. What would be an effective relief measure specific to back pain?
      A)
      Guided imagery.
      B)
      Progressive relaxation.
      C)
      Slow, deep breathing.
      D)
      Counterpressure against the sacrum.
    4. A patient in labor arrives at labor and delivery complaining of intense pain with contractions in her lower abdomen and perineal area. What does the nurse suspect?
      A)
      The baby's head may be facing in the wrong direction.
      B)
      The patient is most likely in the first stage of labor.
      C)
      The patient is most likely in or nearing the second stage of labor.
      D)
      The baby is distressed.
    Page 2 of 11

    Exam Review

    1. A patient in labor has just received an epidural block. What is the most important nursing intervention?
      A)
      Monitor the maternal pulse for possible bradycardia.
      B)
      Monitor the fetus for possible tachycardia.
      C)
      Monitor the maternal blood pressure for possible hypotension.
      D)
      Limit parenteral fluids.
    2. A patient experienced a large hemorrhage postpartum because of a relaxed uterus. Which of the following anesthesia methods is most likely to have contributed to this problem?
      A)
      General anesthesia.
      B)
      Pudendal block.
      C)
      Epidural anesthesia.
      D)
      Local anesthesia.
    3. Which of the following pregnancy complications could explain the changes seen in the fetal heart tracing above?
      A)
      Preeclampsia.
      B)
      Placental abruption.
      C)
      Breech positioning.
      D)
      Hypotension.
      E)
      Cord compression.
    4. The fetal heart rate is heard above the umbilicus and on the mother's left. The nurse concludes that the fetus is in which position?
      A)
      LSA.
      B)
      LOA.
      C)
      ROA.
      D)
      ROP.
    Page 3 of 11

    Exam Review

    1. A patient was given a fentanyl injection during labor. The nurse noted the expected outcome of loss of variability along with a pattern indicating uteroplacental insufficiency. Which of the following strips illustrates this?
      A)
      Normal fetal heart rate variability with no decelerations.
      B)
      Fetal heart rate pattern showing early decelerations.
      C)
      Fetal heart rate pattern with loss of variability and late decelerations.
      D)
      Fetal heart rate pattern showing variable decelerations.
    2. A nurse is caring for a patient in the latent phase of labor who is requesting an epidural for minor labor pains. The nurse encourages the patient to delay the epidural because she knows that walking and frequent position changes in labor can help to do which of the following? Select all that apply.
      A)
      Reduce the frequency and duration of contractions.
      B)
      Increase pain sensations.
      C)
      Increase comfort as labor progresses.
      D)
      Help the fetus navigate the birth canal.
    3. The nurse-midwife orders fentanyl 12.5 mg IV now for the laboring mother. Fentanyl from the pharmacy comes in 50 mg/ml vials. How many ml would the nurse draw up for the injection?
    4. A patient in labor has a fetal heart rate with late decelerations. Which of the following are appropriate intrauterine resuscitation measures? Select all that apply.
      A)
      Check urinary output.
      B)
      Begin CPR.
      C)
      Reposition the mother onto her side.
      D)
      Increase IV fluids.
      E)
      Apply an oxygen mask to the mother.
    Page 4 of 11

    Exam Review

    1. Butorphanol tartrate (Stadol) and nalbuphine hydrochloride (Nubain) are the preferred opioid analgesics used during labor because these medications:
      A)
      are not expensive.
      B)
      are administered orally.
      C)
      do not cross the placenta.
      D)
      do not cause significant respiratory depression in the mother or fetus.
    2. Opioids such as hydromorphone, fentanyl, and meperidine can cause excessive CNS depression in both the mother and newborn. Opioid antagonists such as naloxone (Narcan) can promptly reverse the CNS depressant effects, especially respiratory depression. The RN should avoid the use of or use extreme caution in administering naloxone to opioid-dependent patients.
      A)
      True.
      B)
      False.
      C)
      Maybe.
      D)
      It depends on the patient's age.
    3. Which of the following patients does the nurse recognize as a good candidate for a trial of labor after cesarean (TOLAC) and possible VBAC (vaginal birth after cesarean)?
      A)
      A G2P1001 at 41 weeks gestation with a fetus in a transverse presentation. She has had one previous delivery, a spontaneous vaginal delivery at 42 weeks gestation.
      B)
      A 33-year-old G5P2204 at 37 weeks and two days gestation. Her previous deliveries were scheduled low-transverse cesarean sections.
      C)
      A 42-year-old G2P1001 at 38 weeks gestation carrying a fetus with an estimated fetal weight of 6 lbs 8 oz. Her first cesarean section was scheduled due to a breech position of the fetus.
      D)
      A 29-year-old G3P1011 at 39 weeks gestation. She has had one previous delivery, an emergent cesarean section with a classical vertical uterine incision.
    4. When assessing a multiparous patient who has just given birth to an 8-pound boy, the nurse notes that the patient's fundus is firm and has become globular in shape. A gush of dark red blood comes from her vagina. What does the nurse conclude?
      A)
      The placenta has separated.
      B)
      Clots have formed in the upper uterine segment.
      C)
      The patient is beginning to hemorrhage.
      D)
      A cervical tear occurred during the birth.
    Page 5 of 11

    Exam Review

    1. The nurse is assessing a patient who is 28 weeks pregnant and complaining of intermittent back pain and pelvic pressure. Which of the following should the nurse expect to be done? Select all that apply.
      A)
      Ultrasound for cervical length.
      B)
      Amniocentesis.
      C)
      Glucose tolerance test.
      D)
      Fetal fibronectin swab.
      E)
      Give fluids and encourage rest.
    2. Which of the following would indicate PPROM in a 32-week pregnant patient?
      A)
      Vaginal fluid that makes a fern pattern on a microscope.
      B)
      White vaginal discharge.
      C)
      Negative fetal fibronectin test.
      D)
      Vaginal fluid with a pH of 4.5.
    3. A 32-week pregnant patient is receiving nifedipine for preterm labor. Which of the following statements made by the patient indicates a need for additional teaching?
      A)
      "I am glad they are giving me something to try to stop my labor for now.”.
      B)
      "This medication can lower my blood pressure to dangerous levels.”.
      C)
      "I will let you know if I feel dizzy.”.
      D)
      "Nifedipine should help mature my baby's lungs.”.
    4. A patient in preterm labor at 30 weeks gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacological treatment is to:
      A)
      Reduce maternal and fetal tachycardia associated with ritodrine administration.
      B)
      Suppress uterine contractions.
      C)
      Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.
      D)
      Stimulate fetal surfactant production and lung maturity.
    Page 6 of 11