Labor Complications Flashcards
What is the normal baseline range for fetal heart rate (FHR) when assessed over a 10-minute period?
A) 80-120 bpm
B) 90-140 bpm
C) 110-160 bpm
D) 130-170 bpm
C) 110-160 bpm
In monitoring fetal heart rate variability, what level of variability indicates a well-oxygenated, neurologically intact fetus?
A) Absent variability
B) Minimal variability
C) Moderate variability
D) Marked variability
C) Moderate variability
Which intrapartum complication occurs when the amniotic sac ruptures before labor begins, increasing the risk of infection for the birthing parent and fetus?
A) Prolonged labor
B) Premature rupture of membranes (PROM)
C) Chorioamnionitis
D) Shoulder dystocia
B) Premature rupture of membranes (PROM)
When a patient presents with fetal tachycardia (FHR >160 bpm for 10 minutes or longer), which of the following should the nurse assess as a potential cause?
A) Maternal position
B) Maternal dehydration
C) Prolonged maternal hypoglycemia
D) Narcotic administration
B) Maternal dehydration
What is the most appropriate nursing intervention for a patient experiencing umbilical cord prolapse during labor?
A) Encourage the patient to push immediately
B) Apply warm, saline-soaked gauze to the prolapsed cord
C) Position the patient in a knee-chest position to relieve pressure on the cord
D) Administer oxytocin to stimulate uterine contractions
C) Position the patient in a knee-chest position to relieve pressure on the cord
What fetal heart rate pattern is characterized by smooth, wavelike undulations and may indicate severe fetal anemia?
A) Early decelerations
B) Late decelerations
C) Variable decelerations
D) Sinusoidal pattern
D) Sinusoidal pattern
Shoulder dystocia is defined as:
A) The fetus’s shoulder becomes lodged behind the birthing parent’s pubic bone, complicating vaginal delivery
B) A condition where the umbilical cord slips ahead of the presenting part of the fetus
C) The amniotic sac rupturing before labor begins
D) A prolonged labor that exceeds 24 hours
A) The fetus’s shoulder becomes lodged behind the birthing parent’s pubic bone, complicating vaginal delivery
Which of the following is a common indication for cesarean birth to ensure maternal and fetal safety?
A) Prolonged labor without complications
B) Preterm labor with stable fetal heart rate
C) Umbilical cord prolapse
D) Mild chorioamnionitis
C) Umbilical cord prolapse
Which intervention is indicated for late decelerations in fetal heart rate, which may indicate uteroplacental insufficiency?
A) Encourage ambulation to stimulate contractions
B) Position the patient on their left side and administer oxygen as needed
C) Increase the rate of oxytocin to enhance uterine contractions
D) Administer IV antibiotics
B) Position the patient on their left side and administer oxygen as needed
What is the primary purpose of intrapartum continuous fetal monitoring?
A) To assess maternal blood pressure and heart rate continuously
B) To detect and respond promptly to signs of fetal distress related to labor stressors
C) To reduce the length of the labor process
D) To monitor uterine contractions exclusively
B) To detect and respond promptly to signs of fetal distress related to labor stressors
What is the most appropriate initial nursing intervention for a patient with a fetal heart rate of 100 bpm and recurrent late decelerations?
A) Encourage the patient to push with contractions
B) Position the patient on their left side and administer oxygen
C) Increase the dosage of Pitocin to speed labor
D) Reduce the patient’s IV fluid rate
B) Position the patient on their left side and administer oxygen
In the NICHD fetal heart rate classification system, which category would a abnormal fetal heart rate with absent variability and recurrent variable decelerations fall under?
A) Category 1
B) Category 2
C) Category 3
D) Category 4
C) Category 3
When monitoring a patient with signs of preterm labor, which symptom should prompt immediate assessment and intervention?
A) Mild pelvic discomfort that improves with rest
B) Regular uterine contractions producing cervical changes before 37 weeks
C) Mild braxton hicks contractions
D) A report of fetal movement and mild cramping
B) Regular uterine contractions producing cervical changes before 37 weeks
A fetal heart rate with a sinusoidal pattern may indicate which of the following conditions?
A) Fetal sleep cycle
B) Severe fetal anemia
C) Narcotic effect
D) Maternal hypotension
B) Severe fetal anemia
For a patient with recurrent variable decelerations, which intervention is most effective in reducing cord compression?
A) Administering narcotics to reduce uterine contractions
B) Changing the patient’s position to alleviate pressure on the cord
C) Encouraging ambulation to stimulate labor progress
D) Increasing Pitocin to stabilize fetal heart rate
B) Changing the patient’s position to alleviate pressure on the cord
During preterm labor assessment, which risk factor should a nurse identify as increasing the likelihood of premature labor?
A) History of cesarean delivery
B) Substance abuse
C) Controlled hypertension
D) Primigravida status
B) Substance abuse
A fetal heart rate tracing shows a baseline of 120 bpm, moderate variability, and no decelerations. According to the NICHD classification system, this tracing would be categorized as:
A) Category 1
B) Category 2
C) Category 3
D) Category 4
A) Category 1
A fetal heart rate tracing with minimal variability, recurrent late decelerations, and a baseline heart rate of 130 bpm would fall into which NICHD category?
A) Category 1
B) Category 2
C) Category 3
D) Category 4
C) Category 2
Which of the following fetal heart rate tracings qualifies as a Category 3 pattern under NICHD guidelines?
A) Baseline heart rate of 150 bpm with moderate variability and accelerations
B) Sinusoidal pattern with recurrent late decelerations and absent variability
C) Baseline heart rate of 140 bpm with intermittent variable decelerations and marked variability
D) Mild bradycardia with minimal variability and occasional accelerations
B) Sinusoidal pattern with recurrent late decelerations and absent variability
A fetal heart rate pattern that includes a baseline heart rate of 115 bpm, absent variability, and no decelerations falls under which NICHD category?
A) Category 1
B) Category 2
C) Category 3
D) Category 4
B) Category 2
A fetal heart rate tracing with moderate variability, recurrent variable decelerations, and an absence of accelerations would be classified in which NICHD category?
A) Category 1
B) Category 2
C) Category 3
D) Category 4
B) Category 2
Which medication is commonly administered in preterm labor to relax uterine smooth muscle as a tocolytic and is classified as a calcium channel blocker?
A) Terbutaline
B) Nifedipine
C) Indomethacin
D) Betamethasone
B) Nifedipine
For a patient in preterm labor at 32 weeks gestation, which medication would be recommended to provide neuroprotection for the fetus by stabilizing cerebral blood flow?
A) Indomethacin
B) Terbutaline
C) Magnesium sulfate
D) Nifedipine
C) Magnesium sulfate
Betamethasone, given to patients in preterm labor, serves which primary function for the fetus?
A) Relaxes uterine smooth muscle
B) Increases fetal surfactant production
C) Decreases uterine contractions
D) Stabilizes cerebral blood flow
B) Increases fetal surfactant production
Which of the following best describes the condition known as premature rupture of membranes (PROM)?
A) The amniotic membranes rupture after 40 weeks gestation
B) Spontaneous rupture of membranes before the onset of labor
C) Artificial rupture of membranes performed by a healthcare provider
D) Membrane rupture after labor has begun
B) Spontaneous rupture of membranes before the onset of labor
In cases of prolonged labor, a cesarean birth may be recommended during the active phase if the patient’s cervix remains at or above 6 cm with ruptured membranes and either:
A) 2 hours of inadequate contractions and no change
B) 4 hours of adequate contractions with no cervical change
C) 6 hours of complete dilation without progression
D) 8 hours of pushing with minimal fetal descent
B) 4 hours of adequate contractions with no cervical change
For a patient experiencing prolonged labor with minimal progress during the pushing stage, an operative delivery may be considered if the birthing parent has been pushing for:
A) 1 hour (multiparous) or 2 hours (primiparous)
B) 2 hours (multiparous) or 3 hours (primiparous)
C) 3 hours (multiparous) or 4 hours (primiparous)
D) 4 hours (multiparous) or 5 hours (primiparous)
B) 2 hours (multiparous) or 3 hours (primiparous)
Which medication, commonly used in preterm labor management, is a beta-adrenergic agonist that works by relaxing the uterus to help delay labor?
A) Nifedipine
B) Terbutaline
C) Indomethacin
D) Magnesium sulfate
B) Terbutaline
Indomethacin, a prostaglandin synthesis inhibitor, is primarily used in preterm labor for its ability to:
A) Reduce inflammation and decrease uterine contractions
B) Promote fetal surfactant production
C) Provide neuroprotection by stabilizing cerebral blood flow
D) Relax smooth muscle as a calcium channel blocker
A) Reduce inflammation and decrease uterine contractions
Which medication is typically administered for two intramuscular doses, 24 hours apart, to stimulate fetal lung maturity through surfactant production in cases of preterm labor?
A) Magnesium sulfate
B) Betamethasone
C) Nifedipine
D) Terbutaline
B) Betamethasone
Which medication is administered in preterm labor to both provide neuroprotection to the fetus and has limited use as a tocolytic for stopping contractions?
A) Indomethacin
B) Nifedipine
C) Terbutaline
D) Magnesium sulfate
D) Magnesium sulfate
A birthing parent presents with a temperature of 101°F, maternal and fetal tachycardia, uterine tenderness, and foul-smelling amniotic fluid. Which diagnosis is most consistent with these findings?
A) Umbilical cord prolapse
B) Chorioamnionitis
C) Shoulder dystocia
D) Preterm labor
B) Chorioamnionitis
For a patient diagnosed with chorioamnionitis, which of the following nursing interventions is most appropriate to minimize infection risks after membrane rupture?
A) Administer oral antibiotics to prevent fetal infection
B) Monitor maternal temperature every four hours
C) Limit cervical exams after membrane rupture and administer IV antibiotics
D) Perform continuous fetal monitoring
C) Limit cervical exams after membrane rupture and administer IV antibiotics
Umbilical cord prolapse is characterized by which of the following fetal heart rate patterns?
A) Persistent bradycardia
B) Recurrent late decelerations
C) Deep, recurrent variable decelerations
D) Sinusoidal pattern
C) Deep, recurrent variable decelerations
Which management technique is most appropriate for a birthing parent experiencing umbilical cord prolapse?
A) Increase oxytocin to speed delivery
B) Position the patient in Trendelenburg and elevate the presenting part off the cord
C) Administer narcotics for pain relief
D) Encourage the patient to bear down to expedite delivery
B) Position the patient in Trendelenburg and elevate the presenting part off the cord
During shoulder dystocia, which maneuver involves placing the birthing parent’s legs back to widen the pelvis and apply suprapubic pressure?
A) Trendelenburg position
B) McRoberts maneuver
C) Valsalva maneuver
D) Lithotomy position
B) McRoberts maneuver
The Valsalva maneuver, sometimes used during labor, involves which action to increase intra-abdominal pressure?
A) Flexing the legs up to the chest
B) Holding the breath and bearing down
C) Elevating the head above the heart
D) Tilting the body with feet lower than the head
B) Holding the breath and bearing down
The lithotomy position, commonly used for gynecological exams and hospital childbirth, involves positioning the patient:
A) On their back with legs elevated and supported in stirrups
B) Lying flat with feet slightly raised
C) In a seated position leaning forward
D) With head lower than the feet
A) On their back with legs elevated and supported in stirrups
In the case of an operative vaginal delivery using vacuum assistance, which protocol is commonly followed to minimize fetal scalp injury?
A) No more than three “pop-offs” before cesarean delivery is recommended
B) Limit the vacuum attempts to four with 30-minute intervals
C) Apply traction continuously throughout the contraction cycle
D) Use the vacuum only after the patient reaches full dilation
A) No more than three “pop-offs” before cesarean delivery is recommended
A cesarean birth may be indicated for which of the following situations?
A) Birthing parent exhaustion during early labor
B) A non-reassuring fetal heart rate pattern unresponsive to intrauterine resuscitation measures
C) Engagement of the fetal head in a cephalic presentation
D) Mild decelerations with moderate variability
B) A non-reassuring fetal heart rate pattern unresponsive to intrauterine resuscitation measures
What is the primary role of the circulating nurse during a cesarean birth?
A) Perform spinal or epidural anesthesia administration
B) Monitor fetal heart rate variability
C) Ensure consents are signed, conduct the time-out, count instruments, and manage documentation
D) Manage PACU recovery and pain assessment
C) Ensure consents are signed, conduct the time-out, count instruments, and manage documentation
Chorioamnionitis is most commonly caused by which of the following types of infections?
A) Viral infections
B) Fungal infections
C) Streptococcal bacterial infections
D) Parasitic infections
C) Streptococcal bacterial infections
Which of the following patients is at an increased risk for developing chorioamnionitis?
A) A patient in preterm labor with prolonged rupture of membranes (PROM)
B) A patient who has recently received a cesarean section
C) A patient with controlled hypertension and a short cervix
D) A patient who is in early labor with intact membranes
A) A patient in preterm labor with prolonged rupture of membranes (PROM)
A birthing parent with chorioamnionitis may present with which of the following signs and symptoms?
A) Hypotension, regular contractions, and decreased fetal heart rate
B) Fever, uterine tenderness, foul-smelling amniotic fluid, and maternal tachycardia
C) Low-grade fever, increased fetal movements, and regular heart rate variability
D) Bradycardia, pale vaginal discharge, and mild back pain
B) Fever, uterine tenderness, foul-smelling amniotic fluid, and maternal tachycardia
What key nursing action is recommended to reduce the risk of infection spread in a patient diagnosed with chorioamnionitis after the rupture of membranes?
A) Check maternal temperature every hour
B) Monitor fetal heart rate continuously but increase cervical exams to check dilation
C) Minimize cervical exams and perform temperature checks every two hours
D) Limit maternal hydration and ambulation
C) Minimize cervical exams and perform temperature checks every two hours
In the management of chorioamnionitis, which intervention is essential to prevent further complications for both the birthing parent and the newborn?
A) Administering magnesium sulfate for neuroprotection
B) Initiating antibiotic therapy (such as ampicillin and gentamycin) for the birthing parent and newborn after birth
C) Encouraging ambulation to relieve uterine tenderness
D) Applying heat compresses to reduce fever
B) Initiating antibiotic therapy (such as ampicillin and gentamycin) for the birthing parent and newborn after birth
A sinusoidal fetal heart rate pattern is most concerning because it often indicates which of the following conditions?
A) Fetal sleep cycle
B) Severe fetal anemia
C) Uterine tachysystole
D) Maternal dehydration
B) Severe fetal anemia
In the NICHD fetal heart rate classification system, a sinusoidal pattern falls under which category due to its association with fetal compromise?
A) Category 1
B) Category 2
C) Category 3
D) Category 4
C) Category 3
Which of the following characteristics best describes a sinusoidal fetal heart rate pattern?
A) Recurrent late decelerations with variable baseline
B) Smooth, repetitive, undulating waves with no variability
C) Moderate variability with frequent accelerations
D) Rapid fluctuations between high and low baseline
B) Smooth, repetitive, undulating waves with no variability
When a sinusoidal pattern is observed, what is the most appropriate nursing intervention?
A) Increase maternal hydration and monitor fetal heart rate variability
B) Notify the provider immediately as it indicates a possible need for urgent delivery
C) Encourage maternal repositioning to improve fetal oxygenation
D) Apply scalp stimulation to assess fetal response
B) Notify the provider immediately as it indicates a possible need for urgent delivery
Which type of fetal heart rate variability is considered ideal and indicates good fetal oxygenation?
A) Absent variability
B) Minimal variability
C) Moderate variability
D) Marked variability
C) Moderate variability
A fetal heart rate tracing with fluctuations of 1-5 beats per minute around the baseline is classified as:
A) Absent variability
B) Minimal variability
C) Moderate variability
D) Marked variability
B) Minimal variability
What does absent variability in a fetal heart rate tracing typically suggest?
A) Well-oxygenated fetus
B) Fetal hypoxia or acidosis
C) Fetal sleep cycle
D) Overstimulation of the fetus
B) Fetal hypoxia or acidosis
Marked variability in a fetal heart rate tracing is characterized by fluctuations of:
A) 1-5 beats per minute
B) 6-25 beats per minute
C) Greater than 25 beats per minute
D) No detectable fluctuations
C) Greater than 25 beats per minute
Early decelerations in fetal heart rate usually correspond to which part of labor?
A) Early first stage
B) Active phase of labor
C) Transition phase
D) Third stage of labor
B) Active phase of labor
What is the primary cause of early decelerations during labor?
A) Umbilical cord compression
B) Maternal dehydration
C) Fetal head compression
D) Uteroplacental insufficiency
C) Fetal head compression
Early decelerations have which of the following characteristics on fetal heart rate monitoring?
A) Begin after the contraction peaks
B) Begin and end with the contraction
C) Occur randomly throughout contractions
D) Last longer than 2 minutes
B) Begin and end with the contraction
What is the appropriate nursing intervention for a patient with early decelerations?
A) Increase maternal oxygen
B) Reposition the patient
C) Continue to monitor as this is usually benign
D) Prepare for cesarean delivery
C) Continue to monitor as this is usually benign
Late decelerations begin after which point in the contraction cycle?
A) At the start of the contraction
B) Before the contraction peaks
C) After the contraction peaks
D) At the end of the contraction
C) After the contraction peaks
The most common cause of late decelerations is:
A) Umbilical cord compression
B) Maternal hypotension or uteroplacental insufficiency
C) Fetal head compression
D) Maternal dehydration
B) Maternal hypotension or uteroplacental insufficiency
Which of the following is an appropriate nursing intervention for late decelerations?
A) Continue monitoring as late decelerations are generally benign
B) Increase the oxytocin infusion
C) Reposition the patient and provide oxygen
D) Encourage the patient to push
C) Reposition the patient and provide oxygen
Persistent late decelerations may indicate which condition in the fetus?
A) Well-being and stability
B) Risk of hypoxia and acidosis
C) Normal fetal movement
D) Increased variability
B) Risk of hypoxia and acidosis
Variable decelerations are usually caused by:
A) Fetal head compression
B) Uteroplacental insufficiency
C) Umbilical cord compression
D) Maternal dehydration
C) Umbilical cord compression
What shape do variable decelerations typically have on fetal heart rate monitoring?
A) Smooth, gradual decrease
B) Sudden, sharp “V” or “W” shape
C) Round, bell-shaped
D) Sinusoidal pattern
B) Sudden, sharp “V” or “W” shape
Which nursing intervention may be helpful to reduce variable decelerations?
A) Administering a tocolytic
B) Applying fundal pressure
C) Changing maternal position
D) Encouraging frequent pushing
C) Changing maternal position
Variable decelerations can occur at which point in the contraction cycle?
A) Only at the beginning of contractions
B) At any point, unrelated to contractions
C) Only after the contraction has ended
D) Only when contractions are absent
B) At any point, unrelated to contractions
A prolonged deceleration is defined as a deceleration lasting longer than:
A) 1 minute
B) 90 seconds
C) 2 minutes
D) 3 minutes
C) 2 minutes
Which of the following could cause prolonged decelerations in fetal heart rate?
A) Temporary maternal position change
B) Mild uterine contraction
C) Prolonged cord compression or maternal hypotension
D) Fetal head engagement
C) Prolonged cord compression or maternal hypotension
What is the appropriate nursing response to a prolonged deceleration?
A) Continue monitoring without interventions
B) Reposition the patient, provide oxygen, and prepare for emergency intervention if needed
C) Encourage ambulation to stimulate fetal heart rate
D) Stop all monitoring and increase IV fluids
B) Reposition the patient, provide oxygen, and prepare for emergency intervention if needed
If a prolonged deceleration lasts longer than 10 minutes, it is then considered:
A) A late deceleration
B) Variable deceleration
C) A change in fetal baseline heart rate
D) Mild fetal bradycardia
C) A change in fetal baseline heart rate
Amnioinfusion is typically performed by infusing which type of fluid into the amniotic cavity?
A) Sterile water
B) Blood plasma
C) Saline or lactated Ringer’s solution
D) Antibiotic solution
C) Saline or lactated Ringer’s solution
Which of the following is a common indication for performing an amnioinfusion during labor?
A) Fetal bradycardia due to head compression
B) Oligohydramnios causing umbilical cord compression
C) Excessive maternal hydration
D) High baseline fetal heart rate
B) Oligohydramnios causing umbilical cord compression
Amnioinfusion can be beneficial when thick meconium is present in the amniotic fluid because it:
A) Removes the meconium from the fluid entirely
B) Dilutes the meconium, reducing the risk of meconium aspiration
C) Stimulates fetal bowel movements
D) Encourages rapid fetal descent
B) Dilutes the meconium, reducing the risk of meconium aspiration
In cases of variable decelerations on fetal heart rate monitoring, amnioinfusion can be helpful because it:
A) Increases maternal hydration levels
B) Provides additional fluid around the umbilical cord to reduce compression
C) Speeds up labor by stimulating uterine contractions
D) Reduces uterine pressure to prevent contractions
B) Provides additional fluid around the umbilical cord to reduce compression
During which phase of Stage 1 does the cervix dilate from 0 to approximately 3-4 cm, with mild and infrequent contractions?
A) Latent phase
B) Active phase
C) Transition phase
A) Latent phase
Which phase of Stage 1 is the most intense but shortest, with the cervix dilating from 8 to 10 cm?
A) Latent phase
B) Active phase
C) Transition phase
C) Transition phase
In which phase of Stage 1 does the cervix dilate from approximately 4-6 cm to 7-8 cm, with contractions becoming stronger and closer together?
A) Latent phase
B) Active phase
C) Transition phase
B) Active phase
During the latent phase of Stage 1 labor, contractions are generally spaced how far apart?
A) Every 2-3 minutes
B) Every 3-5 minutes
C) Every 5-30 minutes
D) Every 10-15 minutes
C) Every 5-30 minutes (Latent phase)
In the active phase of Stage 1 labor, contractions usually occur with what frequency?
A) Every 10-15 minutes
B) Every 8-10 minutes
C) Every 3-5 minutes
D) Every 1-2 minutes
C) Every 3-5 minutes (Active phase)
During the transition phase of Stage 1 labor, contractions typically occur how often?
A) Every 10-15 minutes
B) Every 5-7 minutes
C) Every 3-5 minutes
D) Every 2-3 minutes
D) Every 2-3 minutes (Transition phase)
