Labor and Delivery Exam Review Flashcards

Comprehensive practice questions covering labor stages, complications, fetal monitoring, and medical conditions during pregnancy.

How should a nurse characterize contractions that start about 2 hours ago, did not resolve with rest or hydration, and became stronger with walking?

True Contractions

A client's cervix is $2\,\text{cm}$ dilated, $50\%$ effaced, and the fetus is at a $-2$ station. Which stage and phase of labor is this?

First stage, latent phase

What is the priority nursing action when a client experiences a large gush of fluid from the vagina while walking in the hallway?

Monitor the FHR for distress

A client at $39$ weeks gestation has been leaking fluid from her vagina for two days. What condition is she at risk for?

Infection

Which phase of labor is characterized by nausea, vomiting, irritability, and the urge to have a bowel movement?

Transition phase

What nonpharmacological action can a nurse suggest for a client at $3\,\text{cm}$ dilation to manage pain?

Encourage use of patterned breathing techniques

Which nonpharmacological intervention is recommended for lower back pain related to a persistent occiput posterior fetal position?

Sacral counterpressure

What is the purpose of administering an IV fluid bolus prior to an epidural block?

It is needed to counteract hypotension

Which type of regional anesthetic block is typically administered during the second stage of labor for an episiotomy?

Pudendal

What action should the nurse take if a client reports numbness and tingling of the fingers while using patterned breathing?

Have the client breathe into a paper bag

A FHR of $115$ to $125/\text{min}$ with beat-to-beat variability of $20/\text{min}$ exhibits which characteristic?

Moderate variability

Which FHR patterns involve increases up to $150$ to $155/\text{min}$ lasting for $25$ seconds?

FHR accelerations

What is a major benefit of internal fetal heart monitoring compared to external monitoring?

It allows for accurate readings with maternal movement

During which part of the contraction cycle does a fetus receive the most oxygen?

Relaxation between uterine contractions

What is the first action a nurse should take upon observing late decelerations on the electronic fetal monitor?

Assist the client into the left-lateral position

Which Leopold maneuver technique is used specifically to identify the fetal lie?

Palpate the fundus of the uterus

Which variables are included in a Biophysical Profile (BPP) assessment?

Fetal breathing movement, Fetal tone, and Amniotic fluid volume

Which test is evaluated during an amniocentesis to assess fetal lung maturity?

Lecithin-/sphingomyelin ($L/S$) ratio

Why is an acoustic vibration device used during a nonstress test ($NST$)?

It awakens a sleeping fetus

What instruction should the nurse give a client before an amniocentesis procedure?

You should empty your bladder prior to the procedure

What are indications for a contraction stress test ($CST$)?

Decreased fetal movement, Intrauterine growth restriction ($IUGR$), and Postmaturity

For which conditions should a nurse prepare to perform an amnioinfusion?

Oligohydramnios and Fetal cord compression

Which medication is administered to an Rh-negative client before an external version at $37$ weeks of gestation?

$Rho(D)$ immune globulin

When using oxytocin for induction, for which contraction frequency should the nurse discontinue the infusion?

Frequency of every $2$ minutes

When using oxytocin, for which contraction duration should the nurse discontinue the infusion?

Duration of $90$ to $120$ seconds

What is a primary risk of incomplete uterine relaxation between hypertonic contractions?

Reduced fetal oxygen supply

Which maternal position should be suggested to facilitate labor progress when the fetus is in the occiput posterior position?

Hands and knees

A fetus at $42$ weeks of gestation is at increased risk for developing which condition?

Meconium aspiration

What is the first step a nurse should take after noticing a pulsing loop of umbilical cord in the vagina?

Call for assistance

What is the second step the nurse performs for a prolapsed cord after calling for assistance?

Using a sterile-gloved hand, insert two fingers into the vagina and apply pressure to the fetal presenting part to elevate it off the cord

Which sign is characterized by the fetal head retracting tightly against the perineum during delivery?

Turtle sign

What is the primary management for shoulder dystocia after calling for help?

Prepare to assist with maneuvers such as the McRoberts position and apply suprapubic pressure

A newborn with limited movement of the right arm following a shoulder dystocia delivery should be assessed for what?

Brachial plexus injury

What clinical findings suggest an ectopic pregnancy?

Abrupt, sharp, lower quadrant pain, bright red vaginal bleeding, and a missed menstrual cycle

What are risk factors for developing marginal abruptio placentae?

Blunt abdominal trauma, Cocaine use, and Cigarette smoking

Which medication is prescribed for a client at $32$ weeks with placenta previa and active bleeding?

Betamethasone

Which specific report is associated with a ruptured ectopic pregnancy?

Report of severe shoulder pain

Why is strict glucose control critical for a client with pregestational type 1 diabetes during the first trimester?

Hyperglycemia during organ development greatly increases the risk for congenital malformations

In a client with gestational diabetes, which fetal surveillance finding requires immediate notification of the provider?

A nonstress test demonstrates minimal variability

Which client profile represents the greatest risk for delivering an infant with shoulder dystocia?

Client with gestational diabetes and estimated fetal weight of $4,700\,g$

What is the highest priority nursing intervention for a laboring client on an IV-insulin infusion?

Perform frequent maternal blood glucose assessments while continuously monitoring the fetus

What is the priority nursing action for a GBS positive client in active labor with ruptured membranes?

Initiate IV antibiotics as prescribed

What postpartum prescription should a nurse question for a client with pregestational diabetes?

Increase insulin dose to pregnancy level

What is the most appropriate first intervention for a client newly diagnosed with gestational diabetes?

Begin dietary modification and exercise with glucose monitoring

Infants born to mothers using opioids are at the highest risk for which syndrome?

Neonatal Abstinence Syndrome ($NAS$)

At what gestational age should pregnant women routinely be screened for Group B Streptococcus ($GBS$)?

$36$ weeks

Untreated maternal $GBS$ infection places the newborn at greatest risk for which condition?

Neonatal sepsis

Maternal smoking primarily affects the fetus by causing what physiological change?

Decreased placental perfusion

Cocaine use during pregnancy increases the risk for which specific complication?

Placental abruption

Which assessment findings in a newborn are most consistent with Neonatal Abstinence Syndrome ($NAS$)?

High-pitched cry, tremors, irritability, and poor feeding