Obstetrics 2 Welcome to your OB Labor 1. A primigravida at 38 weeks of gestation is admitted to the labor and delivery unit. The nurse notes that the fetal head is engaged in the pelvis. The client expresses fear and anxiety about the upcoming labor. Which factor is most likely to influence the progress of labor in this client? Maternal age Fetal position Engagement of the fetal head Maternal fear and anxiety None 2. A laboring woman at 42 weeks of gestation is experiencing prolonged labor, and the healthcare provider decides to augment labor with oxytocin (Pitocin). Which maternal factor is crucial to monitor closely during the administration of oxytocin? Maternal age Maternal blood pressure Maternal temperature Maternal respiratory rate None 3. A multiparous woman at 39 weeks of gestation presents to the labor and delivery unit with regular uterine contractions. She reports that her water broke at home, but contractions are still mild. On examination, the fetal head is not engaged. What is the priority nursing intervention at this time? Administer analgesics for pain relief. Encourage the client to ambulate. Assess fetal heart rate and pattern. Prepare for immediate delivery. None 4. A nulliparous woman at 41 weeks of gestation is admitted to the labor and delivery unit for induction of labor. The healthcare provider orders the administration of misoprostol (Cytotec) to ripen the cervix. What is the nurse's primary responsibility when administering misoprostol? Monitor for signs of uterine hyperstimulation. Encourage the client to push during contractions. Administer intravenous (IV) pain medication. Instruct the client to bear down with contractions. None 5. A primigravida at 38 weeks of gestation presents to the labor and delivery unit with contractions every 5 minutes. On examination, the cervix is dilated 4 centimeters. The nurse recognizes that the client is in the active phase of the first stage of labor. What is the expected rate of cervical dilation during the active phase? 0.5 centimeters per hour 1 centimeter per hour 2 centimeters per hour 3 centimeters per hour None 6. A multiparous woman in the second stage of labor is experiencing intense contractions and reports a strong urge to push. The healthcare provider notes that the fetal head is visible at the perineum. What is the nurse's priority action at this stage? Encourage the client to pant during contractions. Instruct the client to push with each contraction. Prepare for immediate delivery. Administer an epidural for pain relief. None 7. A laboring woman is receiving epidural anesthesia for pain management during childbirth. The nurse observes a sudden decrease in the client's blood pressure after the epidural administration. What is the nurse's immediate action? Administer an additional dose of the epidural medication. Instruct the client to change positions. Elevate the client's legs and monitor for fetal distress. Administer a bolus of intravenous (IV) fluids. None 8. A nurse is caring for a client who has entered the active phase of labor. Which of the following findings should the nurse recognize as being influenced by the five P’s of labor? The fetal heart rate increases with contractions The cervix is dilated to 4 cm and effaced 90% The client requests an epidural for pain relief The provider orders a vacuum-assisted delivery None 9. A nurse is reviewing an external fetal monitor strip and notes recurrent late decelerations. The baseline fetal heart rate is 140/min with minimal variability. Which of the following actions should the nurse take first? Turn the client to the left lateral position Administer a fluid bolus Notify the provider Apply oxygen at 10 L/min via nonrebreather mask None 10. A laboring client requests “anything but medication” for pain. Which of the following nursing actions represents a nonpharmacologic supportive modality? Administering IV nalbuphine (Nubain) as ordered Encouraging labor in a supine position Assisting the client into a warm shower or tub Offering an epidural when the cervix is 5 cm dilated None 11. A nurse is assisting a client during the second stage of labor. The fetal head is visible at the perineum, and the provider prepares for delivery. Which of the following actions should the nurse take during the cardinal movements of birth? Encourage the client to use the Valsalva maneuver continuously Apply fundal pressure to assist with fetal expulsion Support the perineum with gentle counterpressure Pull firmly on the umbilical cord after birth of the head None 12. A nurse is educating a student nurse about fetal heart monitoring. Which of the following statements by the student indicates understanding of fetal monitoring methods? “Auscultation is preferred in high-risk labor for continuous assessment.” “External fetal monitoring requires rupture of membranes before use.” “An intrauterine pressure catheter measures contraction intensity.” “A toco transducer provides data about fetal variability and baseline rate.” None 13. The nurse observes two fetal heart rate accelerations of at least 15 bpm above baseline, each lasting 20 seconds within a 20-minute period. How should the nurse document this finding? Late decelerations — notify provider Variable decelerations — reposition the client Reassuring pattern — continue monitoring Prolonged deceleration — prepare for emergency delivery None 14. Which of the following nursing actions is the priority? A nurse is evaluating a fetal heart tracing and notes the following: Baseline FHR: 170/min Minimal variability Absence of accelerations Recurrent variable decelerations Reposition the client and apply oxygen Notify the provider and prepare for cesarean Document the pattern and continue monitoring Administer IV push analgesics for maternal comfort None 15. A nurse is reviewing the result of a biophysical profile (BPP) for a 35-week pregnant client. The score is 4 out of 10. Which of the following is the best interpretation of this result? The test is normal; no intervention needed The fetus is in distress and delivery is likely indicated The client should repeat the test in 7 days This score confirms fetal lung maturity None 16. A nurse is reinforcing education to a client scheduled for an amniocentesis at 18 weeks’ gestation. Which of the following client statements indicates a need for further teaching? “This test can detect genetic disorders.” “I will empty my bladder before the test.” “I may feel some cramping after the test.” “I can resume vigorous exercise later that day.” None 17. A client is scheduled for a nonstress test (NST). Which of the following should the nurse include in the client education? “You will receive oxytocin to start mild contractions.” “The test usually lasts 40–60 minutes.” “You will press a button every time the baby moves.” “You need to fast for 8 hours before the test.” None 18. A nurse is caring for a laboring client when the fetal monitor strip shows prolonged late decelerations with absent variability. The provider is en route, and the charge nurse is unavailable. Which action by the nurse best demonstrates adherence to the Standards of Practice? Waiting for the provider to arrive before taking further action Increasing the IV rate and applying oxygen via face mask Notifying the client's family and requesting consent for cesarean Documenting findings and asking another nurse to monitor the client None 19. A nurse is floated to the labor unit from pediatrics. She is assigned to a client in active labor. She expresses concern, stating, “I’m not trained in labor management.” Which response by the charge nurse aligns with the ANA Nursing Scope and Standards of Practice? “We’re short-staffed. Just do your best.” “Stay with the client until the doctor arrives.” “You can assist with vital signs while I reassign primary care.” “The client is stable. Let me know if you need help.” None 20. A nurse is evaluating a fetal heart tracing and observes periodic increases in FHR that rise 15 bpm above the baseline and last 20 seconds, returning promptly to baseline. These accelerations occur twice within 20 minutes. Which of the following is the most accurate interpretation of this finding? Late decelerations — fetal compromise Variable decelerations — cord compression Absent variability — hypoxia Accelerations — fetal well-being None 21. A nurse is monitoring a client in active labor. The fetal heart rate baseline is consistently at 175 bpm over a 12-minute segment. Which of the following best describes this pattern? Normal FHR Fetal bradycardia Fetal tachycardia Category I tracing None 22. A nurse is preparing to place an intrauterine pressure catheter (IUPC) for a laboring client. Which of the following conditions must be met before this procedure? The fetal head is engaged The membranes are intact The cervix is fully dilated he membranes are ruptured and cervix is dilated at least 2 cm None 23. A nurse notes a Category III fetal heart tracing: absent variability with recurrent late decelerations. What is the priority nursing action? Notify the provider and document the finding Reassess the client in 15 minutes Initiate intrauterine resuscitation and prepare for delivery Apply fundal pressure to speed descent None 24. A nurse is reviewing a fetal monitor strip and observes abrupt decreases in FHR below baseline lasting less than 2 minutes. These decelerations vary in shape and timing, unrelated to contractions. What is the most likely cause of this pattern? Uteroplacental insufficiency Umbilical cord compression Head compression Maternal hypotension None 25. A nurse is assessing a newborn at 1 minute of life. The infant has a strong cry, flexed arms and legs, heart rate of 160 bpm, pink body with blue feet, and pulls away when stimulated. What is the infant’s Apgar score? 10 8 9 7 None 26. A client in labor is receiving oxytocin to augment contractions. The fetal monitor shows more than 5 contractions in 10 minutes. The FHR is 180 with minimal variability. Which medication should the nurse anticipate administering? Terbutaline Procardia Methergine Oxytocin None 27. A nurse is caring for a client whose FHR tracing shows recurrent late decelerations and minimal variability. What should the nurse do first? Perform sterile vaginal exam Apply oxygen at 6 L/min via nasal cannula Reposition the client to the left side Increase oxytocin to strengthen contractions None 28. A client is undergoing a nonstress test (NST) at 34 weeks gestation. The fetal monitor shows two accelerations, each rising 15 bpm above baseline and lasting 20 seconds within a 20-minute period. How should the nurse interpret this result? Nonreactive NST Late decelerations present Reactive NST – reassuring pattern Variable decelerations likely None 29. Which maternal serum marker is primarily used to screen for neural tube defects such as spina bifida? Chorionic Villus Sampling (CVS) Alpha-fetoprotein (AFP) Amniotic Fluid Index (AFI) Nonstress Test (NST) None 30. 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