Intrapartum NCLEX questions

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1. 1.A nurse is caring for a client 1.4. The second stage of labor begins
in labor. The nurse determines when the cervix is dilated completely and
that the client is beginning in the ends with the birth of the neonate.
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 complete-
ly

2. A nurse in the labor room is car- 3. Late decelerations are due to uteropla-
ing for a client in the active phas-cental insufficiency as the result of de-
es of labor. The nurse is assess- creased blood flow and oxygen to the fe-
ing the fetal patterns and notes a tus during the uterine contractions. This
late deceleration on the monitor causes hypoxemia; therefore oxygen is
strip. The most appropriate nurs- necessary. The supine position is avoided
ing action is to: because it decreases uterine blood flow
to the fetus. The client should be turned to
1.Place the mother in the supine her side to displace pressure of the gravid
position uterus on the inferior vena cava. An in-
2.Document the findings and travenous pitocin infusion is discontinued
continue to monitor the fetal pat- when a late deceleration is noted.
terns
3.Administer oxygen via face
mask
4.Increase the rate of pitocin IV
infusion

3. A nurse is performing an as- 1. A normal fetal heart rate is 120-160

sessment of a client who is beats per minute. A count of 180 beats
scheduled for a cesarean deliv- per minute could indicate fetal distress
ery. Which assessment finding and would warrant physician notification.
would indicate a need to contact By full term, a normal maternal hemo-
the physician? globin range is 11-13 g/dL as a result of
the hemodilution caused by an increase
1.Fetal heart rate of 180 beats in plasma volume during pregnancy.
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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 transport- 4. Vena cava and descending aorta com-

ed to the delivery room and is pression by the pregnant uterus impedes
prepared for a cesarean deliv- blood return from the lower trunk and ex-
ery. The client is transferred totremities. This leads to decreasing car-
the delivery room table, and the diac return, cardiac output, and blood flow
nurse places the client in the: to the uterus and the fetus. The best po-
sition to prevent this would be side-lying
1.Trendelenburg's position with with the uterus displaced off of abdom-
the legs in stirrups inal vessels. Positioning for abdominal
2.Semi-Fowler position with a surgery necessitates a supine position;
pillow under the knees however, a wedge placed under the right
3.Prone position with the legs hip provides displacement of the uterus.
separated and elevated
4.Supine position with a wedge
under the right hip

5. . A nurse is caring for a client 4. The nurse simultaneously should pal-

in labor and prepares to auscul- pate the maternal radial or carotid pulse
tate the fetal heart rate by us- and auscultate the fetal heart rate to dif-
ing a Doppler ultrasound device. ferentiate the two. If the fetal and mater-
The nurse most accurately deter- nal heart rates are similar, the nurse may
mines that the fetal heart sounds mistake the maternal heart rate for the
are heard by: fetal heart rate. Leopold's maneuvers may
help the examiner locate the position of
1.Noting if the heart rate is the fetus but will not ensure a distinction
greater than 140 BPM between the two rates.
2.Placing the diaphragm of the
Doppler on the mother abdomen
3.Performing Leopold's maneu-
vers first to determine the loca-
tion of the fetal heart
4.Palpating the maternal radial

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pulse while listening to the fetal
heart rate

6. A nurse is caring for a client in 2. A normal fetal heart rate is 120-160

labor who is receiving Pitocin BPM. Bradycardia or late or variable de-
by IV infusion to stimulate uter- celerations indicate fetal distress and the
ine contractions. Which assess- need to discontinue to pitocin. The goal
ment finding would indicate to of labor augmentation is to achieve three
the nurse that the infusion needs good-quality contractions in a 10-minute
to be discontinued? period.

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 con-
tractions
4.Increased urinary output

7. A nurse is beginning to care for 2. Continuous electronic fetal monitoring

a client in labor. The physician should be implemented during an IV infu-
has prescribed an IV infusion of sion of Pitocin.
Pitocin. The nurse ensures that
which of the following is imple-
mented before initiating the infu-
sion?

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 4. A normal fetal heart rate is 120-160

in active labor and notes that beats per minute. Fetal bradycardia be-
the client is having contractions tween contractions may indicate the need

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every 3 minutes that last 45 sec- for immediate medical management, and
onds. The nurse notes that the the physician or nurse mid-wife needs to
fetal heart rate between con- be notified.
tractions is 100 BPM. Which of
the following nursing actions is
most appropriate?

1.Encourage the client's coach

to continue to encourage breath-
ing exercises
2.Encourage the client to contin-
ue pushing with each contrac-
tion
3.Continue monitoring the fetal
heart rate
4.Notify the physician or nurse
mid-wife

9. A nurse is caring for a client in 1. Accelerations are transient increases in

labor and is monitoring the fe- the fetal heart rate that often accompany
tal heart rate patterns. The nurse contractions or are caused by fetal move-
notes the presence of episodic ment. Episodic accelerations are thought
accelerations on the electronic to be a sign of fetal-well being and ade-
fetal monitor tracing. Which of quate oxygen reserve.
the following actions is most ap-
propriate?

1.Document the findings and tell

the mother that the monitor indi-
cates 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

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10. A nurse is admitting a pregnant 2. Assessing the baseline fetal heart rate
client to the labor room and at- is important so that abnormal variations
taches an external electronic fe- of the baseline rate will be identified if they
tal monitor to the client's ab- occur.
domen. After attachment of the
monitor, the initial nursing as- Options 1 and 3 are important to assess,
sessment is which of the follow- but not as the first priority.
ing?

1.Identifying the types of accel-

erations
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 1. Station is the relationship of the pre-
of a client in the labor room and senting part to an imaginary line drawn
notes that the nurse midwife has between the ischial spines, is measured
documented that the fetus is at in centimeters, and is noted as a nega-
-1 station. The nurse determines tive number above the line and a positive
that the fetal presenting part is: number below the line. At -1 station, the
fetal presenting part is 1 cm above the
1.1 cm above the ischial spine ischial spines.
2.1 fingerbreadth below the sym-
physis pubis
3.1 inch below the coccyx
4.1 inch below the iliac crest

12. A pregnant client is admitted 4. Anemic women have a greater like-

to the labor room. An assess- lihood of cardiac decompensation dur-
ment is performed, and the nurse ing labor, postpartum infection, and poor
notes that the client's hemo- wound healing. Anemia does not specifi-
globin and hematocrit levels cally present a risk for hemorrhage. Hav-
are low, indicating anemia. The ing a loud mouth is only related to the
nurse determines that the client person typing up this test.
is at risk for which of the follow-

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ing?

1.A loud mouth

2.Low self-esteem
3.Hemorrhage
4.Postpartum infections

13. A nurse assists in the vaginal de- 4. As the placenta separates, it settles
livery of a newborn infant. After downward into the lower uterine segment.
the delivery, the nurse observes The umbilical cord lengthens, and a sud-
the umbilical cord lengthen and den trickle or spurt of blood appears.
a spurt of blood from the vagina.
The nurse documents these ob-
servations as signs of:

1.Hematoma
2.Placenta previa
3.Uterine atony
4.Placental separation

14. A client arrives at a birthing cen- 2. Amniotomy can be used to induce la-
ter in active labor. Her mem- bor when the condition of the cervix is
branes are still intact, and the favorable (ripe) or to augment labor if
nurse-midwife prepares to per- the process begins to slow. Rupturing of
form an amniotomy. A nurse who membranes allows the fetal head to con-
is assisting the nurse-midwife tact the cervix more directly and may in-
explains to the client that af- crease the efficiency of contractions.
ter this procedure, she will most
likely have:

1.Less pressure on her cervix

2.Increased efficiency of con-
tractions
3.Decreased number of contrac-
tions
4.The need for increased mater-
nal blood pressure monitoring

15.

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A nurse is monitoring a client in 2. Variable decelerations occur if the um-
labor. The nurse suspects umbil- bilical cord becomes compressed, thus
ical cord compression if which reducing blood flow between the placenta
of the following is noted on the and the fetus. Early decelerations result
external monitor tracing during a from pressure on the fetal head during
contraction? a contraction. Late decelerations are an
ominous pattern in labor because it sug-
1.Early decelerations gests uteroplacental insufficiency during
2.Variable decelerations a contraction. Short-term variability refers
3.Late decelerations to the beat-to-beat range in the fetal heart
4.Short-term variability rate.

16. A nurse explains the purpose of 2. Effleurage is a specific type of cuta-

effleurage to a client in early la- neous stimulation involving light stroking
bor. The nurse tells the client that of the abdomen and is used before transi-
effleurage is: tion to promote relaxation and relieve mild
to moderate pain. Effleurage provides tac-
1.A form of biofeedback to en- tile stimulation to the fetus.
hance bearing down efforts dur-
ing delivery
2.Light stroking of the abdomen
to facilitate relaxation during la-
bor and provide tactile stimula-
tion 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 2. Pains, helplessness, panicking, and

in the second stage of labor. fear of losing control are possible behav-
The client is experiencing uter- iors in the 2nd stage of labor.
ine contractions every 2 min-
utes and cries out in pain with
each contraction. The nurse rec-
ognizes this behavior as:

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1.Exhaustion
2.Fear of losing control
3.Involuntary grunting
4.Valsalva's maneuver

18. A nurse is monitoring a client 1, 4, 2. 5, 3.

in labor who is receiving Pitocin
and notes that the client is expe-
If uterine hypertonicity occurs, the nurse
riencing hypertonic uterine con- immediately would intervene to reduce
tractions. List in order of priority
uterine activity and increase fetal oxy-
the actions that the nurse takes.genation. The nurse would stop the
Pitocin infusion and increase the rate of
1.Stop of Pitocin infusion the nonadditive solution, check maternal
2.Perform a vaginal examination BP for hyper or hypotension, position the
3.Reposition the client woman in a side-lying position, and ad-
4.Check the client's blood pres- minister oxygen by snug face mask at
sure and heart rate 8-10 L/min. The nurse then would attempt
5.Administer oxygen by face to determine the cause of the uterine hy-
mask at 8 to 10 L/min pertonicity and perform a vaginal exam to
check for prolapsed cord

19. A nurse is assigned to care for 3. Therapeutic management for hypoton-

a client with hypotonic uterine ic uterine dysfunction includes oxytocin
dysfunction and signs of a slow- augmentation and amniotomy to stimu-
ing labor. The nurse is review- late a labor that slows.
ing the physician's orders and
would expect to note which of
the following prescribed treat-
ments for this condition?

1.Medication that will provide se-

dation
2.Increased hydration
3.Oxytocin (Pitocin) infusion
4.Administration of a tocolytic
medication

20. A nurse in the labor room is 2. Management of hypertonic labor de-

preparing to care for a client pends on the cause. Relief of pain is the

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with hypertonic uterine dysfunc- primary intervention to promote a normal
tion. The nurse is told that the labor pattern.
client is experiencing uncoordi-
nated contractions that are er-
ratic in their frequency, duration,
and intensity. The priority nurs-
ing intervention would be to:

1.Monitor the Pitocin infusion

closely
2.Provide pain relief measures
3.Prepare the client for an am-
niotomy
4.Promote ambulation every 30
minutes

21. A nurse is developing a plan 3. The priority is to monitor the fetal heart
of care for a client experienc- rate.
ing dystocia and includes sev-
eral nursing interventions in the
plan of care. The nurse priori-
tizes the plan of care and selects
which of the following nursing
interventions as the highest pri-
ority?

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 3. In a client with a multi-fetal pregnancy,

care for a pregnant client in labor each fetal heart rate is monitored sepa-
who will be delivering twins. The rately.
nurse monitors the fetal heart
rates by placing the external fetal

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monitor:

1.Over the fetus that is most an-

terior to the mothers abdomen
2.Over the fetus that is most pos-
terior 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 4. Because the placenta is implanted in

is caring for a client who has the lower uterine segment, which does
just delivered a newborn infant not contain the same intertwining muscu-
following a pregnancy with pla- lature as the fundus of the uterus, this site
centa previa. The nurse reviews is more prone to bleeding.
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 4. Signs of placental separation include

assisting with the delivery of a lengthening of the umbilical cord, a sud-
newborn infant. After the deliv- den gush of dark blood from the introi-
ery of the newborn, the nurse tus (vagina), a firmly contracted uterus,
assists in delivering the placen- and the uterus changing from a discoid
ta. Which observation would in- (like a disk) to a globular (like a globe)
dicate that the placenta has sep- shape. The client may experience vaginal
arated from the uterine wall and fullness, but not severe uterine cramping.
is ready for delivery? I am going to look more into this answer.

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1.The umbilical cord shortens in According to our book on page 584, this
length and changes in color is not one of our options.
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 per- 1. When cord prolapse occurs, prompt
forming a vaginal assessment actions are taken to relieve cord com-
on a pregnant client in labor. Thepression and increase fetal oxygenation.
nurse notes the presence of the The mother should be positioned with the
umbilical cord protruding from hips higher than the head to shift the fe-
the vagina. Which of the follow- tal presenting part toward the diaphragm.
ing would be the initial nursing The nurse should push the call light
action? to summon help, and other staff mem-
bers should call the physician and notify
1.Place the client in Trendelen- the delivery room. No attempt should be
burg's position made to replace the cord. The examiner,
2.Call the delivery room to notify however, may place a gloved hand into
the staff that the client will be the vagina and hold the presenting part
transported immediately off of the umbilical cord. Oxygen at 8 to
3.Gently push the cord into the 10 L/min by face mask is delivered to the
vagina mother to increase fetal oxygenation.
4.Find the closest telephone and
stat page the physician

26. A maternity nurse is caring for a1. DIC is a state of diffuse clotting in which
client with abruptio placenta andclotting factors are consumed, leading to
is monitoring the client for dis-widespread bleeding. Platelets are de-
seminated intravascular coagu- creased because they are consumed by
lopathy. Which assessment find- the process; coagulation studies show no
ing is least likely to be associ-clot formation (and are thus normal to
ated with disseminated intravas- prolonged); and fibrin plugs may clog the
cular coagulation? microvasculature diffusely, rather than in
an isolated area. The presence of pe-
1.Swelling of the calf in one leg techiae, oozing from injection sites, and
2.Prolonged clotting times hematuria are signs associated with DIC.
3.Decreased platelet count Swelling and pain in the calf of one leg are

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4.Petechiae, oozing from injec- more likely to be associated with throm-
tion sites, and hematuria bophebitis.

27. A nurse is assessing a preg- 3. In abruptio placentae, acute abdomi-

nant client in the 2nd trimester nal pain is present. Uterine tenderness
of pregnancy who was admitted and pain accompanies placental abrup-
to the maternity unit with a sus- tion, especially with a central abruption
pected diagnosis of abruptio pla- and trapped blood behind the placenta.
centae. Which of the following The abdomen will feel hard and board-
assessment findings would the like on palpation as the blood penetrates
nurse expect to note if this con- the myometrium and causes uterine irri-
dition is present? tability. Observation of the fetal monitor-
ing often reveals increased uterine rest-
1.Absence of abdominal pain ing tone, caused by failure of the uterus to
2.A soft abdomen relax in attempt to constrict blood vessels
3.Uterine tenderness/pain and control bleeding.
4.Painless, bright red vaginal
bleeding

28. A maternity nurse is preparing 3. Manual pelvic examinations are con-

for the admission of a client traindicated when vaginal bleeding is ap-
in the 3rd trimester of pregnan- parent in the 3rd trimester until a diagno-
cy that is experiencing vaginal sis is made and placental previa is ruled
bleeding and has a suspected di- out. Digital examination of the cervix can
agnosis of placenta previa. The lead to maternal and fetal hemorrhage. A
nurse reviews the physician's or- diagnosis of placenta previa is made by
ders and would question which ultrasound. The H/H levels are monitored,
order? and external electronic fetal heart rate
monitoring is initiated. External fetal moni-
1.Prepare the client for an ultra- toring is crucial in evaluating the fetus that
sound is at risk for severe hypoxia
2.Obtain equipment for external
electronic fetal heart monitoring
3.Obtain equipment for a manual
pelvic examination
4.Prepare to draw a Hgb and Hct
blood sample

29.

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An ultrasound is performed on 2. The goal of management in abruptio
a client at term gestation that is placentae is to control the hemorrhage
experiencing moderate vaginal and deliver the fetus as soon as possible.
bleeding. The results of the ul- Delivery is the treatment of choice if the
trasound indicate that an abrup- fetus is at term gestation or if the bleeding
tio placenta is present. Based on is moderate to severe and the mother or
these findings, the nurse would fetus is in jeopardy.
prepare the client for:

1.Complete bed rest for the re-

mainder of the pregnancy
2.Delivery of the fetus
3.Strict monitoring of intake and
output
4.The need for weekly monitor-
ing of coagulation studies until
the time of delivery

30. A nurse in a labor room is assist- 2. Excessive fundal pressure, forceps de-
ing with the vaginal delivery of a livery, violent bearing down efforts, tumul-
newborn infant. The nurse would tuous labor, and shoulder dystocia can
monitor the client closely for the place a woman at risk for traumatic uter-
risk of uterine rupture if which of ine rupture. Hypotonic contractions and
the following occurred? weak bearing down efforts do not alone
add to the risk of rupture because they do
1.Hypotonic contractions not add to the stress on the uterine wall.
2.Forceps delivery
3.Schultz delivery
4.Weak bearing down efforts

31. A client is admitted to the 1. Determining the fetal well-being super-

birthing suite in early active la- sedes all other measures. If the FHR is
bor. The priority nursing inter- absent or persistently decelerating, im-
vention on admission of this mediate intervention is required.
client would be:

1.Auscultating the fetal heart

2.Taking an obstetric history
3.Asking the client when she last

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ate
4.Ascertaining whether the
membranes were ruptured

32. A client who is gravida 1, para 0 3. A station of +1 indicates that the fetal
is admitted in labor. Her cervix is head is 1 cm below the ischial spines.
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 maneu- 3. Fetal heart tones are best auscultated
vers, the nurse determines that through the fetal back; because the posi-
the fetus is in the ROP position. tion is ROP (right occiput presenting), the
To best auscultate the fetal heart back would be below the umbilicus and
tones, the Doppler is placed: on the right side.

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 3. This is the way to determine the fre-
the frequency of a laboring quency of the contractions
client's contractions. The nurse
assesses the client's contrac-
tions by timing from the begin-
ning of one contraction:

1.Until the time it is completely

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over
2.To the end of a second contrac-
tion
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 3. by 36 weeks' gestation, normal amniot-
amniotic fluid and decides that it ic fluid is colorless with small particles of
appears normal, because it is: vernix caseosa present.

1.Clear and dark amber in color

2.Milky, greenish yellow, contain-
ing 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 4. Adjusting the catheter would be indi-

is having late decelerations. The cated. Normal fetal pulse oximetry should
fetal pulse oximeter shows 75% be between 30% and 70%. 75% to 85%
to 85%. The nurse should: would indicate maternal readings.

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 contin-
ue monitoring
4.Reposition the catheter,
recheck the reading, and if it is
55%, keep monitoring

37. When examining the fetal mon- 2. Variable decelerations usually are seen
itor strip after rupture of the as a result of cord compression; a change
membranes in a laboring client,

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the nurse notes variable deceler- of position will relieve pressure on the
ations in the fetal heart rate. The cord.
nurse should:

1.Stop the oxytocin infusion

2.Change the client's position
3.Prepare for immediate delivery
4.Take the client's blood pres-
sure

38. When monitoring the fetal heart 1. An acceleration is an abrupt elevation

rate of a client in labor, the above the baseline of 15 beats per minute
nurse identifies an elevation of for 15 seconds; if the acceleration persists
15 beats above the baseline rate for more than 10 minutes it is considered
of 135 beats per minute lasting a change in baseline rate. A tachycardic
for 15 seconds. This should be FHR is above 160 beats per minute
documented as:

1.An acceleration
2.An early elevation
3.A sonographic motion
4.A tachycardic heart rate

39. A laboring client complains of 4. A persistent occiput-posterior position

low back pain. The nurse replies causes intense back pain because of fe-
that this pain occurs most when tal compression of the sacral nerves. Oc-
the position of the fetus is: ciput anterior is the most common fetal
position and does not cause back pain.
1.Breech
2.Transverse
3.Occiput anterior
4.Occiput posterior

40. The breathing technique that the 1. Blowing forcefully through the mouth
mother should be instructed to controls the strong urge to push and al-
use as the fetus' head is crown- lows for a more controlled birth of the
ing is: head.

1.Blowing

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2.Slow chest
3.Shallow
4.Accelerated-decelerated

41. During the period of induction 2. Uterine tetany could result from the use
of labor, a client should be ob- of oxytocin to induce labor. Because oxy-
served carefully for signs of: tocin promotes powerful uterine contrac-
tions, uterine tetany may occur. The oxy-
1.Severe pain tocin infusion must be stopped to prevent
2.Uterine tetany uterine rupture and fetal compromise.
3.Hypoglycemia
4.Umbilical cord prolapse

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