Exam 2: Labor and Delivery (Module 9)

normal fetal heart rate (110-160)

A laboring client's fetal heart rate is 145 beats/minute. How should the nurse interpret this finding?

A. Umbilical cord compression

B. Maternal hypotension

C. Prolonged fetal hypoxia

D. Uterine rupture

A laboring client's fetal heart rate remains at 98 beats/minute for several minutes. Which maternal or fetal conditions may contribute to this finding? (Select all that apply.)

A. Umbilical cord compression

B. Maternal hypotension

C. Prolonged fetal hypoxia

D. Uterine rupture

E. Maternal fever

maternal fever

A laboring client's fetal heart rate is 172 beats/minute. Which maternal condition is the nurse most likely to assess?

Acceleration, which is a normal findings indicative of adequate fetal oxygenation.

During labor, the fetal heart rate increases by 20 bpm for 20 seconds after fetal movement. What is the nurse's best interpretation?

Early decelerations due to head compression

A fetal heart tracing shows gradual decelerations that begin with contractions and return to baseline as the contractions end. What is the most likely cause?

Variable deceleration due to umbilical cord compression

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Priority Interventions:

• Reposition mother

• Stop oxytocin if infusing

• Increase IV fluids

• Administer oxygen (per policy/provider order)

• Assess for cord prolapse

• Notify provider if persistent

A fetal heart tracing shows abrupt V-shaped decreases in heart rate that occur at different times in relation to contractions. Which condition should the nurse suspect?

A. Turn the client to the left side

B. Increase IV fluids

C. Stop oxytocin

D. Notify the provider

A fetal heart tracing demonstrates recurrent late decelerations. Which nursing interventions are appropriate? (Select all that apply.)

A. Turn the client to the left side

B. Increase IV fluids

C. Stop oxytocin

D. Notify the provider

E. Encourage pushing

uteroplacental insufficiency

Late decelerations indicate ________.

Variable → Cord Compression
Early → Head Compression
Accelerations → Okay
Late → Placental Insufficiency

What does VEAL CHOP stand for?

D. Recurrent late decelerations

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Late decelerations indicate uteroplacental insufficiency and fetal hypoxia until proven otherwise.

This is your highest priority.

Which fetal heart rate pattern requires the most immediate nursing intervention?

A. Accelerations

B. Early decelerations

C. Variable decelerations

D. Recurrent late decelerations

Frequency is measured from the beginning of one contraction to the beginning of the next contraction.

Normal active labor: Approximately every 2–5 minutes.

A laboring client asks what contraction frequency means. Which explanation should the nurse provide?

Duration: Beginning of one contraction → End of the same contraction. Normal: 60–90 seconds

A nurse documents that contractions last 75 seconds. Which contraction characteristic is being measured?

The uterus should relax between contractions to allow placental perfusion and fetal oxygenation. Failure to relax (tachysystole) increases the risk of fetal hypoxia.

During labor, the uterus remains firm between contractions without relaxing. Why is this finding concerning?

Uterine Tachysystole

A laboring client's contractions occur every minute and last 120 seconds. Which complication should the nurse suspect?

Stage One (Active Phase)

A client is 7 cm dilated. Which phase of the first stage of labor is she experiencing?

Stage Two

A laboring client is 10 cm dilated. Which stage of labor is she entering?

Stage Three

Immediately after the infant is delivered, the nurse begins assessing for placental separation. Which stage of labor is occurring?

Stage Four

A client is one hour postpartum. Which stage of labor is she in, and what is the nurse's priority concern?

Postpartum Hemorrhage

What is the priority concern during the fourth stage of labor?

8 cm dilated = Cervix is opening during the transition phase

100% effaced = Cervix is completely thinned

A laboring client is 8 cm dilated and 100% effaced. What do these findings indicate?

The presenting part is at the level of the ischial spines.

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–5 = High in pelvis

0 = At ischial spine

+5 = Crowning

During a vaginal exam, the nurse documents the fetal station as 0. What does this finding mean?

Cesarean Birth

A laboring client has been pushing for several hours with no cervical change, and the fetal heart tracing becomes non-reassuring. Which intervention should the nurse anticipate?

A. Verify informed consent

B. Establish IV access

C. Keep the client NPO

D. Insert a Foley catheter

A nurse is preparing a client for a scheduled cesarean birth. Which interventions are appropriate? (Select all that apply.)

A. Verify informed consent

B. Establish IV access

C. Keep the client NPO

D. Insert a Foley catheter

E. Begin incentive spirometry

• Early ambulation

• Pain management

• Incentive spirometry

• Incision assessment

• Monitor lochia

• Assess fundus

A nurse is caring for a client after a cesarean birth. Which interventions are priority for preventing postoperative complications?

Call for help immediately!

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Then…

• Relieve pressure on the cord by elevating the presenting part (if trained and per protocol)

• Position the client in knee-chest or Trendelenburg (per protocol)

• Prepare for an emergency cesarean birth

• Avoid excessive handling of the cord

Remember: umbilical cord prolapse is an obstetric emergency

A laboring client develops recurrent variable decelerations, and the nurse palpates the umbilical cord during a vaginal examination. What is the nurse's priority action?

Veriable decelerations

Which fetal heart rate pattern is commonly associated with an umbilical cord prolapse?

A. Notify the neonatal team before birth

B. Continuous fetal monitoring

C. Assess the newborn immediately after birth

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Meconium may indicate fetal stress and increases the risk of meconium aspiration syndrome.

A laboring client has thick meconium-stained amniotic fluid. Which nursing actions are appropriate? (Select all that apply.)

A. Notify the neonatal team before birth

B. Continuous fetal monitoring

C. Assess the newborn immediately after birth

D. Encourage delayed assessment after delivery

Shoulder Dystocia

During delivery, the fetal head is delivered, but the shoulders fail to deliver. Which obstetric emergency should the nurse recognize?

McRoberts Maneuver: hyperflex the mother's legs toward her abdomen to widen the pelvic outlet.

Which maneuver is commonly performed first to relieve shoulder dystocia?

Focus on compassionate, family-centered care:

• Emotional support

• Clear explanations of procedures

• Bereavement resources

• Opportunities for memory-making, if desired by the family

A client experiences an intrauterine fetal demise (IUFD) at 32 weeks' gestation. Which nursing intervention is the priority?

B. Client with recurrent late decelerations

A nurse is caring for four laboring clients. Which client should the nurse assess first?

A. Client with early decelerations

B. Client with recurrent late decelerations

C. Client with accelerations

D. Client with contractions every 4 minutes

C. Client with a prolapsed umbilical cord

A nurse is caring for four clients. Which client requires immediate intervention?

A. Client 5 cm dilated

B. Client with variable decelerations that resolve after repositioning

C. Client with a prolapsed umbilical cord

D. Client entering the second stage of labor

Stage 1

• 0–10 cm dilation

• Monitor labor progress

Stage 2

• Birth of the baby

• Assist with pushing and delivery

Stage 3

• Delivery of placenta

• Prevent hemorrhage

Stage 4

• Recovery (1–4 hours)

• Assess fundus, lochia, and vital signs

Place the stages of labor in the correct order and identify the major nursing focus for each.

Cord prolapse → Relieve cord pressure and prepare for emergency C-section

Shoulder dystocia → McRoberts maneuver

Meconium → Notify neonatal team and monitor newborn

Late decelerations → Left lateral position, stop oxytocin, IV fluids, notify provider

Match the labor complication with the priority nursing action.

• Umbilical cord prolapse

• Shoulder dystocia

• Meconium-stained fluid

• Recurrent late decelerations

170 bpm → Fetal tachycardia

Early decelerations → Head compression

Variable decelerations → Cord compression

Late decelerations → Uteroplacental insufficiency

10 cm → Second stage of labor

+5 station → Crowning

A nurse is reviewing labor and delivery concepts. Match each finding with the correct interpretation.

• FHR 170 bpm

• Early decelerations

• Variable decelerations

• Late decelerations

• 10 cm dilation

• +5 station