MATERNAL-NEWBORN & PEDIATRIC NURSING REVIEW
Comprehensive Examination: Labor & Delivery Complications
200 Clinical-Grade Questions with Detailed Rationales & NCLEX®
Alignment
MODULE 1: FETAL HEART RATE MONITORING &
INTRAUTERINE RESUSCITATION
Question 1: Clinical scenario 1 (Module 1): A G2P1 at 39 weeks
gestation in active labor exhibits recurrent late decelerations with
baseline moderate variability. Which initial nursing intervention is
priority?
A. Administer oxygen via non-rebreather mask at 10 L/min
B. Reposition the client to the left lateral decubitus position
C. Initiate an emergency cesarean section preparation
D. Discontinue oxytocin infusion immediately
Correct Answer: B
Rationale: Repositioning the client to the left lateral or right lateral
position relieves aortocaval compression, enhances placental
perfusion, and is the immediate first-line intrauterine resuscitation
step for late decelerations. While discontinuing oxytocin (if infusing)
and applying oxygen are subsequent crucial steps, left-lateral
positioning addresses maternal hemodynamics directly.
Question 2: Clinical scenario 2 (Module 1): A laboring client's external
fetal monitor shows variable decelerations dropping to 75 bpm lasting
70 seconds with absent variability within the decelerations. What is the
nurse's primary action?
A. Prepare for immediate operative vaginal delivery
, B. Perform a sterile vaginal examination to check for cord prolapse
C. Administer terbutaline 0.25 mg subcutaneously
D. Increase maintenance IV fluids to 250 mL/hr
Correct Answer: B
Rationale: Variable decelerations indicate umbilical cord
compression. Checking for cord prolapse via sterile vaginal
examination is essential if cord compression is suspected, especially
if accompanied by changes in baseline or severe drops. Repositioning
the client and administering oxygen should occur concurrently.
Question 3: Clinical scenario 3 (Module 1): The nurse evaluates a
Category II fetal heart rate tracing and notes minimal baseline variability
over 50 minutes. Which underlying fetal condition is most strongly
suspected?
A. Fetal sepsis and chorioamnionitis
B. Fetal sleep cycle or administration of maternal CNS depressants
(e.g., magnesium sulfate, narcotics)
C. Acute umbilical cord occlusion
D. Severe maternal dehydration
Correct Answer: B
Rationale: Minimal baseline variability (amplitude range detectable
but < 5 bpm) is frequently caused by fetal sleep cycles (typically
lasting 20-40 minutes) or maternal administration of sedatives,
narcotics, magnesium sulfate, or beta-blockers. Prolonged minimal
variability warrants ongoing evaluation and potential stimulation.
Question 4: Clinical scenario 4 (Module 1): A nurse is caring for a
client receiving oxytocin augmentation. The monitor displays uterine
tachysystole (6 contractions in 10 minutes averaged over 30 minutes)
,with accompanying Category II FHR tracing. What is the priority
nursing action?
A. Administer IV bolus of 500 mL Lactated Ringer's
B. Discontinue the oxytocin infusion immediately
C. Apply internal fetal scalp electrode
D. Administer oxytocin antagonistatos
Correct Answer: B
Rationale: Uterine tachysystole (>5 contractions in 10 minutes
averaged over 30 minutes) with oxytocin requires immediate
discontinuation of the oxytocin infusion to reduce uterine activity and
restore uteroplacental perfusion.
Question 5: Clinical scenario 5 (Module 1): A fetal heart rate tracing
exhibits a baseline of 160 bpm with marked variability and recurrent late
decelerations. This pattern indicates:
A. Normal physiological fetal autonomic response
B. Severe fetal hypoxia and impending metabolic acidosis
C. Fetal parasympathetic nervous system dominance
D. Maternal fever and benign sinus tachycardia
Correct Answer: B
Rationale: Tachycardia (>160 bpm) combined with recurrent late
decelerations and abnormal variability represents significant fetal
compromise, hypoxia, and potential metabolic acidemia requiring
urgent intervention and delivery planning.
Question 6: Clinical scenario 6 (Module 1): When interpreting a
continuous electronic fetal monitoring (EFM) strip, which finding
classifies the tracing as Category I (Normal)?
, A. Baseline rate 110-160 bpm, moderate variability, absence of late
or variable decelerations, early decelerations present or absent,
accelerations present or absent
B. Tachycardia with minimal variability and recurrent variable
decelerations
C. Absent baseline variability with recurrent late decelerations
D. Bradycardia (<110 bpm) with marked variability
Correct Answer: A
Rationale: Category I tracings are normal, strongly predictive of
normal fetal acid-base status at the time of observation, and require
routine intrapartum care. They feature a normal baseline (110-160
bpm), moderate variability, and no late or variable decelerations.
Question 7: Clinical scenario 7 (Module 1): A client at 40 weeks
gestation exhibits prolonged decelerations lasting 4 minutes on the EFM
strip. Which nursing action is contraindicated?
A. Administering oxygen via non-rebreather mask at 10 L/min
B. Performing an immediate vaginal exam to assess for cord prolapse
or rapid descent
C. Continuing oxytocin infusion to expedite delivery
D. Notifying the primary care provider immediately
Correct Answer: C
Rationale: Continuing oxytocin during a prolonged deceleration or
category III tracing exacerbates uterine hyperstimulation and
worsens fetal hypoxia. Oxytocin must be discontinued immediately.
Question 8: Clinical scenario 8 (Module 1): Which fetal heart rate
pattern is pathognomonic for severe fetal anemia, fetal-to-maternal
hemorrhage, or severe fetal hypoxia?
A. Sinusoidal pattern
Comprehensive Examination: Labor & Delivery Complications
200 Clinical-Grade Questions with Detailed Rationales & NCLEX®
Alignment
MODULE 1: FETAL HEART RATE MONITORING &
INTRAUTERINE RESUSCITATION
Question 1: Clinical scenario 1 (Module 1): A G2P1 at 39 weeks
gestation in active labor exhibits recurrent late decelerations with
baseline moderate variability. Which initial nursing intervention is
priority?
A. Administer oxygen via non-rebreather mask at 10 L/min
B. Reposition the client to the left lateral decubitus position
C. Initiate an emergency cesarean section preparation
D. Discontinue oxytocin infusion immediately
Correct Answer: B
Rationale: Repositioning the client to the left lateral or right lateral
position relieves aortocaval compression, enhances placental
perfusion, and is the immediate first-line intrauterine resuscitation
step for late decelerations. While discontinuing oxytocin (if infusing)
and applying oxygen are subsequent crucial steps, left-lateral
positioning addresses maternal hemodynamics directly.
Question 2: Clinical scenario 2 (Module 1): A laboring client's external
fetal monitor shows variable decelerations dropping to 75 bpm lasting
70 seconds with absent variability within the decelerations. What is the
nurse's primary action?
A. Prepare for immediate operative vaginal delivery
, B. Perform a sterile vaginal examination to check for cord prolapse
C. Administer terbutaline 0.25 mg subcutaneously
D. Increase maintenance IV fluids to 250 mL/hr
Correct Answer: B
Rationale: Variable decelerations indicate umbilical cord
compression. Checking for cord prolapse via sterile vaginal
examination is essential if cord compression is suspected, especially
if accompanied by changes in baseline or severe drops. Repositioning
the client and administering oxygen should occur concurrently.
Question 3: Clinical scenario 3 (Module 1): The nurse evaluates a
Category II fetal heart rate tracing and notes minimal baseline variability
over 50 minutes. Which underlying fetal condition is most strongly
suspected?
A. Fetal sepsis and chorioamnionitis
B. Fetal sleep cycle or administration of maternal CNS depressants
(e.g., magnesium sulfate, narcotics)
C. Acute umbilical cord occlusion
D. Severe maternal dehydration
Correct Answer: B
Rationale: Minimal baseline variability (amplitude range detectable
but < 5 bpm) is frequently caused by fetal sleep cycles (typically
lasting 20-40 minutes) or maternal administration of sedatives,
narcotics, magnesium sulfate, or beta-blockers. Prolonged minimal
variability warrants ongoing evaluation and potential stimulation.
Question 4: Clinical scenario 4 (Module 1): A nurse is caring for a
client receiving oxytocin augmentation. The monitor displays uterine
tachysystole (6 contractions in 10 minutes averaged over 30 minutes)
,with accompanying Category II FHR tracing. What is the priority
nursing action?
A. Administer IV bolus of 500 mL Lactated Ringer's
B. Discontinue the oxytocin infusion immediately
C. Apply internal fetal scalp electrode
D. Administer oxytocin antagonistatos
Correct Answer: B
Rationale: Uterine tachysystole (>5 contractions in 10 minutes
averaged over 30 minutes) with oxytocin requires immediate
discontinuation of the oxytocin infusion to reduce uterine activity and
restore uteroplacental perfusion.
Question 5: Clinical scenario 5 (Module 1): A fetal heart rate tracing
exhibits a baseline of 160 bpm with marked variability and recurrent late
decelerations. This pattern indicates:
A. Normal physiological fetal autonomic response
B. Severe fetal hypoxia and impending metabolic acidosis
C. Fetal parasympathetic nervous system dominance
D. Maternal fever and benign sinus tachycardia
Correct Answer: B
Rationale: Tachycardia (>160 bpm) combined with recurrent late
decelerations and abnormal variability represents significant fetal
compromise, hypoxia, and potential metabolic acidemia requiring
urgent intervention and delivery planning.
Question 6: Clinical scenario 6 (Module 1): When interpreting a
continuous electronic fetal monitoring (EFM) strip, which finding
classifies the tracing as Category I (Normal)?
, A. Baseline rate 110-160 bpm, moderate variability, absence of late
or variable decelerations, early decelerations present or absent,
accelerations present or absent
B. Tachycardia with minimal variability and recurrent variable
decelerations
C. Absent baseline variability with recurrent late decelerations
D. Bradycardia (<110 bpm) with marked variability
Correct Answer: A
Rationale: Category I tracings are normal, strongly predictive of
normal fetal acid-base status at the time of observation, and require
routine intrapartum care. They feature a normal baseline (110-160
bpm), moderate variability, and no late or variable decelerations.
Question 7: Clinical scenario 7 (Module 1): A client at 40 weeks
gestation exhibits prolonged decelerations lasting 4 minutes on the EFM
strip. Which nursing action is contraindicated?
A. Administering oxygen via non-rebreather mask at 10 L/min
B. Performing an immediate vaginal exam to assess for cord prolapse
or rapid descent
C. Continuing oxytocin infusion to expedite delivery
D. Notifying the primary care provider immediately
Correct Answer: C
Rationale: Continuing oxytocin during a prolonged deceleration or
category III tracing exacerbates uterine hyperstimulation and
worsens fetal hypoxia. Oxytocin must be discontinued immediately.
Question 8: Clinical scenario 8 (Module 1): Which fetal heart rate
pattern is pathognomonic for severe fetal anemia, fetal-to-maternal
hemorrhage, or severe fetal hypoxia?
A. Sinusoidal pattern
