RICCI CHAPTER 21 (4TH EDITION) STUDY GUIDE | COMPLETE EXAM REVIEW
QUESTIONS AND ANSWERS 2026/2027
1. After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse
immediately places the woman in which position?
A. supine
B. side-lying
C. sitting
D. knee-chest - ANS ✔✔Answer: D
Rationale: Pressure on the cord needs to be relieved. Therefore, the nurse would position the
woman in a modified Sims, Trendelenburg, or knee-chest position. Supine, side-lying, or sitting
would not provide relief of cord compression.
2. A primigravida whose labor was initially progressing normally is now experiencing a decrease
in the frequency and intensity of her contractions. The nurse would assess the woman for which
condition?
A. a low-lying placenta
B. fetopelvic disproportion
C. contraction ring
D. uterine bleeding - ANS ✔✔Answer: B
Rationale: The woman is experiencing dystocia most likely due to hypotonic uterine dysfunction
and fetopelvic disproportion associated with a large fetus. A low-lying placenta, contraction ring,
or uterine bleeding would not be associated with a change in labor pattern.
3. Which assessment finding will alert the nurse to be on the lookout for possible placental
abruption during labor?
A. macrosomia
B. gestational hypertension
C. gestational diabetes
D. low parity - ANS ✔✔Answer: B
Rationale: Risk factors for placental abruption include preeclampsia, gestational hypertension,
seizure activity, uterine rupture, trauma, smoking, cocaine use, coagulation defects, previous
history of abruption, intimate partner violence, and placental pathology. Macrosomia, gestational
diabetes, and low parity are not considered risk factors.
4. A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no
fetopelvic disproportion. Which group of medications would the nurse expect to administer?
A. sedatives
B. tocolytics
C. uterine stimulants
D. corticosteroids - ANS ✔✔Answer: C
Rationale: For hypotonic labor, a uterine stimulant such as oxytocin may be prescribed once
fetopelvic disproportion is ruled out. Sedatives might be helpful for the woman with hypertonic
uterine contractions to promote rest and relaxation. Tocolytics would be ordered to control
preterm labor. Corticosteroids may be given to enhance fetal lung maturity for women
experiencing preterm labor.
, 5. A woman gave birth to a newborn via vaginal birth with the use of a vacuum extractor. The
nurse would be alert for which possible effect in the newborn?
A. asphyxia
B. clavicular fracture
C. cephalhematoma
D. central nervous system injury - ANS ✔✔Answer: C
Rationale: Use of forceps or a vacuum extractor poses the risk of tissue trauma, such as
ecchymoses, facial and scalp lacerations, facial nerve injury, cephalhematoma, and caput succedaneum.
Asphyxia may be related to numerous causes, but it is not associated with use of a
vacuum extractor. Clavicular fracture is associated with shoulder dystocia. Central nervous
system injury is not associated with the use of a vacuum extractor.
6. A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which finding
would require immediate intervention?
A. fetal heart rate of 150 beats/minute
B. contractions every 2 minutes, lasting 45 seconds
C. uterine resting tone of 14 mm Hg
D. urine output of 20 mL/hour - ANS ✔✔Answer: D
Rationale: Oxytocin can lead to water intoxication. Therefore, a urine output of 20 mL/hour is
below acceptable limits of 30 mL/hour and requires intervention. FHR of 150 beats/minute is
within the accepted range of 120 to 160 beats/minute. Contractions should occur every 2 to 3
minutes, lasting 40 to 60 seconds. A uterine resting tone greater than 20 mm Hg would require
intervention.
7. A woman with a history of crack cocaine use disorder is admitted to the labor and birth area.
While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the
abdomen reveals an irregular wall contour. The client also reports acute abdominal pain that is
continuous. Which condition would the nurse suspect?
A. amniotic fluid embolism
B. shoulder dystocia
C. uterine rupture
D. umbilical cord prolapse - ANS ✔✔Answer: C
Rationale: Uterine rupture is associated with crack cocaine use disorder. Generally, the first and
most reliable sign is sudden fetal distress accompanied by acute abdominal pain, vaginal
bleeding, hematuria, irregular wall contour, and loss of station in the fetal presenting part.
Amniotic fluid embolism often is manifested with a sudden onset of respiratory distress.
Shoulder dystocia is noted when continued fetal descent is obstructed after the fetal head is delivered.
Umbilical cord prolapse is noted as the protrusion of the cord alongside or ahead of
the presenting part of the fetus.
8. A woman receives magnesium sulfate as treatment for preterm labor. The nurse assess and
maintains the infusion at the prescribed rate based on which finding?
A. Respiratory rate-16 breaths/minute
B. Decreased fetal heart rate variability
C. Urine output 22 mL/hour
D. Absent deep tendon reflexes - ANS ✔✔Answer: B
Rationale: A respiratory rate of 16 breaths per minute is appropriate and within acceptable
QUESTIONS AND ANSWERS 2026/2027
1. After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse
immediately places the woman in which position?
A. supine
B. side-lying
C. sitting
D. knee-chest - ANS ✔✔Answer: D
Rationale: Pressure on the cord needs to be relieved. Therefore, the nurse would position the
woman in a modified Sims, Trendelenburg, or knee-chest position. Supine, side-lying, or sitting
would not provide relief of cord compression.
2. A primigravida whose labor was initially progressing normally is now experiencing a decrease
in the frequency and intensity of her contractions. The nurse would assess the woman for which
condition?
A. a low-lying placenta
B. fetopelvic disproportion
C. contraction ring
D. uterine bleeding - ANS ✔✔Answer: B
Rationale: The woman is experiencing dystocia most likely due to hypotonic uterine dysfunction
and fetopelvic disproportion associated with a large fetus. A low-lying placenta, contraction ring,
or uterine bleeding would not be associated with a change in labor pattern.
3. Which assessment finding will alert the nurse to be on the lookout for possible placental
abruption during labor?
A. macrosomia
B. gestational hypertension
C. gestational diabetes
D. low parity - ANS ✔✔Answer: B
Rationale: Risk factors for placental abruption include preeclampsia, gestational hypertension,
seizure activity, uterine rupture, trauma, smoking, cocaine use, coagulation defects, previous
history of abruption, intimate partner violence, and placental pathology. Macrosomia, gestational
diabetes, and low parity are not considered risk factors.
4. A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no
fetopelvic disproportion. Which group of medications would the nurse expect to administer?
A. sedatives
B. tocolytics
C. uterine stimulants
D. corticosteroids - ANS ✔✔Answer: C
Rationale: For hypotonic labor, a uterine stimulant such as oxytocin may be prescribed once
fetopelvic disproportion is ruled out. Sedatives might be helpful for the woman with hypertonic
uterine contractions to promote rest and relaxation. Tocolytics would be ordered to control
preterm labor. Corticosteroids may be given to enhance fetal lung maturity for women
experiencing preterm labor.
, 5. A woman gave birth to a newborn via vaginal birth with the use of a vacuum extractor. The
nurse would be alert for which possible effect in the newborn?
A. asphyxia
B. clavicular fracture
C. cephalhematoma
D. central nervous system injury - ANS ✔✔Answer: C
Rationale: Use of forceps or a vacuum extractor poses the risk of tissue trauma, such as
ecchymoses, facial and scalp lacerations, facial nerve injury, cephalhematoma, and caput succedaneum.
Asphyxia may be related to numerous causes, but it is not associated with use of a
vacuum extractor. Clavicular fracture is associated with shoulder dystocia. Central nervous
system injury is not associated with the use of a vacuum extractor.
6. A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which finding
would require immediate intervention?
A. fetal heart rate of 150 beats/minute
B. contractions every 2 minutes, lasting 45 seconds
C. uterine resting tone of 14 mm Hg
D. urine output of 20 mL/hour - ANS ✔✔Answer: D
Rationale: Oxytocin can lead to water intoxication. Therefore, a urine output of 20 mL/hour is
below acceptable limits of 30 mL/hour and requires intervention. FHR of 150 beats/minute is
within the accepted range of 120 to 160 beats/minute. Contractions should occur every 2 to 3
minutes, lasting 40 to 60 seconds. A uterine resting tone greater than 20 mm Hg would require
intervention.
7. A woman with a history of crack cocaine use disorder is admitted to the labor and birth area.
While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the
abdomen reveals an irregular wall contour. The client also reports acute abdominal pain that is
continuous. Which condition would the nurse suspect?
A. amniotic fluid embolism
B. shoulder dystocia
C. uterine rupture
D. umbilical cord prolapse - ANS ✔✔Answer: C
Rationale: Uterine rupture is associated with crack cocaine use disorder. Generally, the first and
most reliable sign is sudden fetal distress accompanied by acute abdominal pain, vaginal
bleeding, hematuria, irregular wall contour, and loss of station in the fetal presenting part.
Amniotic fluid embolism often is manifested with a sudden onset of respiratory distress.
Shoulder dystocia is noted when continued fetal descent is obstructed after the fetal head is delivered.
Umbilical cord prolapse is noted as the protrusion of the cord alongside or ahead of
the presenting part of the fetus.
8. A woman receives magnesium sulfate as treatment for preterm labor. The nurse assess and
maintains the infusion at the prescribed rate based on which finding?
A. Respiratory rate-16 breaths/minute
B. Decreased fetal heart rate variability
C. Urine output 22 mL/hour
D. Absent deep tendon reflexes - ANS ✔✔Answer: B
Rationale: A respiratory rate of 16 breaths per minute is appropriate and within acceptable
