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    Exam Review

    1. A student nurse is reviewing the Five P's of labor and how they can affect labor dystocia.Which of the following fetal (passenger) factors can contribute to labor dystocia?
      A)
      Fetal polydactyly.
      B)
      Occiput anterior cephalic position.
      C)
      Estimated fetal weight of 4600 grams.
      D)
      Fetal hydronephrosis.
    2. A student nurse is reviewing the Five P's of labor and how they can affect labor dystocia.Which of the following fetal (passenger) factors can contribute to labor dystocia?
      A)
      Fetal polydactyly.
      B)
      Occiput anterior cephalic position.
      C)
      Estimated fetal weight of 4600 grams.
      D)
      Fetal hydronephrosis.
    3. A nurse is caring for a client who is in the second stage of labor.The nurse observes the umbilical cord protruding from the vagina.Which of the following actions should the nurse perform first?
      A)
      No action is needed, this is an expected finding in the second stage of labor.
      B)
      Insert a gloved hand into the vagina to elevate the presenting part.
      C)
      Encourage the client to start pushing.
      D)
      Place the client in a lateral position.
    4. A nurse is caring for a client in labor that has been struggling with hypotonic uterine dysfunction.Throughout labor the client's plan of care included oxytocin titration, amniotomy, and IUPC placement.Despite adequate contractions (Montevideo units over 200 mmHg) for many hours, there has been no cervical change and cervix remains 7 cm, 75% effaced, and fetal station of minus (-) 2. The provider tells the patient she believes there is a cephalopelvic disproportion (CPD). What recommendation does the nurse anticipate the provider will discuss next?
      A)
      Vacuum-assisted delivery.
      B)
      Cesarean delivery.
      C)
      Antibiotic administration.
      D)
      Discharge to home.
    Page 1 of 8

    Exam Review

    1. A client at 37 weeks gestation is being admitted for a scheduled external cephalic version (ECV). Which of the following actions should the nurse anticipate being completed prior to the provider performing this elective procedure? (Select four options).
      (SATA)
      A)
      Initiate IV access for fluids and/or emergency medications.
      B)
      Witness client sign informed consent form.
      C)
      Verify fetal presentation by ultrasound.
      D)
      Administer oxytocin.
      E)
      Non-stress test (NST) that is reactive.
    2. A nurse is caring for a client that has a new order for Laminaria for cervical ripening.The nurse provides education on this type of cervical ripener.Which of the following statements would the nurse include in the education?
      A)
      Laminaria acts by absorbing fluid from surrounding tissue and expanding.
      B)
      Laminaria is used for an amniotomy.
      C)
      Laminaria is a prostaglandin used to soften and thin the cervix.
      D)
      Laminaria is a tablet that is swallowed.
    3. The nurse is observing a fetal heart tracing of a term pregnant client in spontaneous labor and observes excessive uterine activity.There are six contractions in 10 minutes over a 30-minute window and the fetal heart rate has changed to a category II tracing with late decelerations.The client has been repositioned, oxygen has been initiated, and an IV fluid bolus is infusing.The nurse anticipates an order for which medication?
      A)
      Terbutaline.
      B)
      Hemabate.
      C)
      Magnesium Sulfate.
      D)
      Methergine.
    4. A nurse is caring for a client with persistent variable decelerations despite intrauterine resuscitation interventions. An order for an amnioinfusion is received. The order is for a 250 ml bolus of 0.9% Sodium Chloride over 30 minutes. Available is 0.9% Sodium Chloride in a 1000ml bag. How many ml/hr will the nurse program the IV pump for? (Round to the nearest whole number.)
      Correct Answer:500 mL/hour
    Page 2 of 8

    Exam Review

    1. A nurse is caring for a newborn immediately after delivery.Which of the following would indicate the newborn is showing signs of respiratory distress?
      A)
      Loud cry.
      B)
      Grunting.
      C)
      Rooting.
      D)
      Acrocyanosis.
    2. Vasa previa is a rare obstetric complication.In order for this complication to occur, there has to first be an abnormality of which of the following structures of pregnancy?
      A)
      Amniotic membrane bands.
      B)
      Amniotic fluid amount.
      C)
      Umbilical cord insertion.
      D)
      Placenta accreta.
    3. A nurse is assessing a fetal monitoring tracing of a client in labor at 39 weeks gestation.The fetal heart rate baseline is 105 bpm, absent variability, no accelerations, and no decelerations.What fetal heart rate category would the nurse communicate to the provider?
      A)
      Category 1.
      B)
      Category 2.
      C)
      Category 3.
      D)
      Reactive.
    4. The nurse turns off the oxytocin infusion after a period of tachysystole.Which of the following outcomes indicates that the nurse's action was effective?
      A)
      Uterine contraction duration of 130 seconds.
      B)
      Uterine contraction frequency every three to four minutes.
      C)
      Intensity of the contractions are strong.
      D)
      Fetus has a flexed attitude.
    Page 3 of 8

    Exam Review

    1. A nurse is caring for a client who is 39 weeks gestation and in active labor.Your assessment findings reveal G1P0, BMI of 41, and completely dilated.The nurse observes a turtle sign after the head has delivered.What is the priority action by the nurse?
      A)
      Encourage the patient to push harder.
      B)
      Prepare for a cesarean birth.
      C)
      Perform McRoberts maneuver.
      D)
      Apply firm fundal pressure.
    2. A nurse is caring for a nulliparous client at 39 weeks gestation who arrived at the OB unit with complaints of frequent, painful contractions for the last 12 hours.The nurse assesses the client and notes a category 1 fetal heart rate pattern and cervical assessment of closed, 50% effaced, and minus (-) 3 station.The client begins to cry and states, "I'm so exhausted.”. What nursing action would the nurse plan to implement?
      A)
      Promote rest with a quiet environment and pain medication.
      B)
      Prepare for an emergency cesarean section.
      C)
      Notify the client she will be NPO.
      D)
      Ask the client to ambulate in the hallway for the next 2 hours.
    3. A nurse begins her shift on the obstetrical unit and observes several new admissions.The nurse understands the client with which of the following conditions would be a candidate for induction of labor?
      A)
      Preeclampsia.
      B)
      Transverse fetal lie.
      C)
      Vasa previa.
      D)
      Active genital herpes.
    4. The nurse is providing care to a term client in labor with hypotonic uterine contractions.Which medical intervention does the nurse anticipate for this client?
      A)
      Prepare the client for an urgent cesarean section.
      B)
      Discuss how the client's gynecoid-shaped pelvis is involved.
      C)
      Amniotomy.
      D)
      Keep the client on bedrest.
    Page 4 of 8

    Exam Review

    1. A nurse is caring for a client at 39 weeks gestation who is being admitted for an elective induction of labor.Cervical assessment is 4 cm, 80% effaced, minus (-) 3 station, soft consistency, and mid position.This indicates a Bishop score of 8. Which of the following induction methods does the nurse anticipate the provider will recommend?
      A)
      Amniotomy.
      B)
      Oxytocin.
      C)
      Cytotec.
      D)
      Cervidil.
    2. A nurse is caring for a client in labor and is completing an assessment at 0900.Which of the following actions should the nurse take? (Select all that apply.)
      A)
      Initiate an IV fluid bolus.
      B)
      Discontinue oxytocin infusion.
      C)
      Notify the provider.
      D)
      Reposition client to lateral position.
      E)
      Titrate the oxytocin infusion to 8 mu/min per order.
    3. You are caring for a term low-risk nulliparous client in the second stage of spontaneous labor.The client has an epidural and has been pushing for just over 3 hours and reports being exhausted.The fetal station is +3. What intervention do you anticipate the provider to recommend?
      A)
      Continue pushing for at least 2 more hours.
      B)
      Emergent cesarean delivery with general anesthesia.
      C)
      Vacuum-assisted vaginal delivery.
      D)
      Administer a fluid bolus of 1000 ml NS. .
    4. A nurse is caring for a client during an amniotomy by the Certified Nurse Midwife.What is the nurse's priority immediately after the amniotomy procedure?
      A)
      Monitor and assess fetal heart rate.
      B)
      Assist client to the bathroom.
      C)
      Perform pericare.
      D)
      Document the color, odor, and consistency of the fluid.
    Page 5 of 8

    Exam Review

    1. A nurse is caring for a client that just delivered a 4,100 gram infant via vacuum-assisted delivery.The nurse identifies this client is most at risk for which of the following postpartum complications?
      A)
      Thromboembolism.
      B)
      Postpartum depression.
      C)
      Mastitis.
      D)
      Postpartum hemorrhage.
    2. You are completing the initial prenatal intake for your newly pregnant G3P2 client.She states her last labor ended in an emergency cesarean section due to cord prolapse.She asks if she would be a candidate for a TOLAC (trial of labor after cesarean). Based upon your assessment of her records, which of the following would be a contraindication for a TOLAC?
      A)
      History of preeclampsia.
      B)
      History of classical uterine incision during cesarean.
      C)
      History of cord prolapse.
      D)
      History of one cesarean section.
    3. The nurse is assessing a client with hypotonic uterine dysfunction. The nurse observes 3 contractions on a 10-minute tracing. The peak of the contractions is as follows: 70mmHg, 60mmHg, and 50mmHg. The nurse determines that uterine resting tone between contractions is 20mmHg. What is the total montevideo units for this client?
    4. The OB resident is assessing a client's cervix during admission for an induction of labor.The calculated bishop score is 4. Which of the following does the nurse tell the client regarding the start of her induction?
      A)
      Her cervix is favorable and ready for an oxytocin infusion.
      B)
      Her cervix is unfavorable and will need cervical ripening.
      C)
      She is ready to begin pushing.
      D)
      She will need a cesarean section.
    Page 6 of 8