NUR 335 EXAM 2 QUESTIONS AND
ANSWERS WITH COMPLETE
SOLUTIONS ALREADY PASSED!!!
Question 1
The administration of systemic intravenous (IV) analgesic pain medications (such
as opioids) to a laboring patient crosses the placenta and may lead to a temporary
state of minimal variability in the fetal heart rate tracing due to central nervous
system depression in the fetus.
Question 2
A nurse is managing the care of a laboring patient immediately following the
placement of an epidural. Prior to the procedure, the fetal heart rate (FHR)
demonstrated a reassuring baseline 135 with moderate variability and spontaneous
accelerations. Currently, the FHR baseline has dropped to 110bpm}$ with minimal
variability and recurrent late decelerations. Which corrective intervention must the
nurse perform first?
✔✔ Change the patient's position (reposition the mother to a lateral or left
side-lying position).
Rationale: Epidural anesthesia frequently induces maternal hypotension due to
sympathetic nerve blockade, which compromises placental perfusion and causes
fetal distress (late decelerations). The immediate priority is to reposition the patient
laterally to relieve aortocaval compression, maximizing blood flow to the placenta.
Additional concurrent actions include increasing IV fluid rates and administering
oxygen.
Question 3
During the second stage of labor, the healthcare provider observes the fetal head
retract tightly against the maternal perineum immediately after crowning (known
clinically as the "turtle sign"). Which emergency intervention should the provider
immediately direct the nurse to execute first to resolve this shoulder dystocia?
✔✔ The McRoberts Maneuver.
Rationale: The "turtle sign" is the classic diagnostic indicator of shoulder dystocia,
where the anterior fetal shoulder becomes impacted behind the maternal pubic
,symphysis. The McRoberts Maneuver involves sharply flexing the mother's
thighs back against her abdomen. This widens the pelvic outlet and flattens the
sacral promontory, frequently allowing the trapped shoulder to slip free.
Question 4
A nurse is monitoring a laboring client who is undergoing a medical induction of
labor secondary to severe preeclampsia. The nurse maintains close vigilance over
the electronic fetal monitoring strip, knowing that a non-reassuring fetal heart rate
pattern (such as late decelerations or absent variability) is a common, serious
complication resulting from preeclampsia-induced uteroplacental insufficiency.
Question 5
Immediately following the spontaneous or artificial rupture of a client's amniotic
membranes, the nurse performs a sterile vaginal examination and explicitly
palpates the umbilical cord slipping ahead of the fetus. What is the immediate,
non-negotiable priority intervention the nurse must perform?
✔✔ Keep the gloved hand inside the vagina and continuously apply upward
digital pressure to lift the fetal presenting part off the umbilical cord.
Rationale: This scenario describes a prolapsed umbilical cord, a critical
obstetrical emergency. Digital elevation of the presenting part must be maintained
continuously to prevent fetal hypoxia and brain damage caused by cord
compression. The nurse must not remove their hand until the patient is prepped and
an emergency cesarean delivery is underway.
Question 6
Shortly after a healthcare provider performs an artificial rupture of membranes
(AROM), a laboring client suddenly experiences acute shortness of breath. The
nurse notes tachypnea at $34\text{ breaths/min}$, an $\text{SpO}_2$ drop to 87%
on room air, profound hypotension at $\text{78/46 mmHg}$, and an irregular
tachycardia of $112\text{ bpm}$. Based on this sudden cardiorespiratory collapse,
what life-threatening condition does the nurse suspect?
✔✔ An Amniotic Fluid Embolism (AFE), also known as Anaphylactoid
Syndrome of Pregnancy.
Rationale: An Amniotic Fluid Embolism occurs when amniotic fluid, fetal cells,
or debris enter the maternal circulation, typically triggered by membrane rupture or
, intense labor. This induces a catastrophic, rapid-onset immune response leading to
acute respiratory distress, severe hypoxemia, cardiovascular collapse, and
frequently profound disseminated intravascular coagulation (DIC).
What is the nurse's priority action for this client?
Anaphylactic syndrome
Call a code blue or rapid response
The nurse is caring for a client with suspected chorioamnionitis. What assessment
finding in the fetal heart rate is associated with chorioamnionitis?
fetal tachycardia
The most immediate complication after rupture of membranes is the potential risk
for
prolapsed cord
The nurse is caring for a client who is attempting a trial of labor after a cesarean
section. The client suddenly complains of a sharp tearing sensation in her abdomen
and the fetal heart tones start descending to 70 beats per minute. The nurse
suspects the client has experienced which obstetrical emergency?
Uterine rupture
What could be causes of fetal tachycardia?
ANSWERS WITH COMPLETE
SOLUTIONS ALREADY PASSED!!!
Question 1
The administration of systemic intravenous (IV) analgesic pain medications (such
as opioids) to a laboring patient crosses the placenta and may lead to a temporary
state of minimal variability in the fetal heart rate tracing due to central nervous
system depression in the fetus.
Question 2
A nurse is managing the care of a laboring patient immediately following the
placement of an epidural. Prior to the procedure, the fetal heart rate (FHR)
demonstrated a reassuring baseline 135 with moderate variability and spontaneous
accelerations. Currently, the FHR baseline has dropped to 110bpm}$ with minimal
variability and recurrent late decelerations. Which corrective intervention must the
nurse perform first?
✔✔ Change the patient's position (reposition the mother to a lateral or left
side-lying position).
Rationale: Epidural anesthesia frequently induces maternal hypotension due to
sympathetic nerve blockade, which compromises placental perfusion and causes
fetal distress (late decelerations). The immediate priority is to reposition the patient
laterally to relieve aortocaval compression, maximizing blood flow to the placenta.
Additional concurrent actions include increasing IV fluid rates and administering
oxygen.
Question 3
During the second stage of labor, the healthcare provider observes the fetal head
retract tightly against the maternal perineum immediately after crowning (known
clinically as the "turtle sign"). Which emergency intervention should the provider
immediately direct the nurse to execute first to resolve this shoulder dystocia?
✔✔ The McRoberts Maneuver.
Rationale: The "turtle sign" is the classic diagnostic indicator of shoulder dystocia,
where the anterior fetal shoulder becomes impacted behind the maternal pubic
,symphysis. The McRoberts Maneuver involves sharply flexing the mother's
thighs back against her abdomen. This widens the pelvic outlet and flattens the
sacral promontory, frequently allowing the trapped shoulder to slip free.
Question 4
A nurse is monitoring a laboring client who is undergoing a medical induction of
labor secondary to severe preeclampsia. The nurse maintains close vigilance over
the electronic fetal monitoring strip, knowing that a non-reassuring fetal heart rate
pattern (such as late decelerations or absent variability) is a common, serious
complication resulting from preeclampsia-induced uteroplacental insufficiency.
Question 5
Immediately following the spontaneous or artificial rupture of a client's amniotic
membranes, the nurse performs a sterile vaginal examination and explicitly
palpates the umbilical cord slipping ahead of the fetus. What is the immediate,
non-negotiable priority intervention the nurse must perform?
✔✔ Keep the gloved hand inside the vagina and continuously apply upward
digital pressure to lift the fetal presenting part off the umbilical cord.
Rationale: This scenario describes a prolapsed umbilical cord, a critical
obstetrical emergency. Digital elevation of the presenting part must be maintained
continuously to prevent fetal hypoxia and brain damage caused by cord
compression. The nurse must not remove their hand until the patient is prepped and
an emergency cesarean delivery is underway.
Question 6
Shortly after a healthcare provider performs an artificial rupture of membranes
(AROM), a laboring client suddenly experiences acute shortness of breath. The
nurse notes tachypnea at $34\text{ breaths/min}$, an $\text{SpO}_2$ drop to 87%
on room air, profound hypotension at $\text{78/46 mmHg}$, and an irregular
tachycardia of $112\text{ bpm}$. Based on this sudden cardiorespiratory collapse,
what life-threatening condition does the nurse suspect?
✔✔ An Amniotic Fluid Embolism (AFE), also known as Anaphylactoid
Syndrome of Pregnancy.
Rationale: An Amniotic Fluid Embolism occurs when amniotic fluid, fetal cells,
or debris enter the maternal circulation, typically triggered by membrane rupture or
, intense labor. This induces a catastrophic, rapid-onset immune response leading to
acute respiratory distress, severe hypoxemia, cardiovascular collapse, and
frequently profound disseminated intravascular coagulation (DIC).
What is the nurse's priority action for this client?
Anaphylactic syndrome
Call a code blue or rapid response
The nurse is caring for a client with suspected chorioamnionitis. What assessment
finding in the fetal heart rate is associated with chorioamnionitis?
fetal tachycardia
The most immediate complication after rupture of membranes is the potential risk
for
prolapsed cord
The nurse is caring for a client who is attempting a trial of labor after a cesarean
section. The client suddenly complains of a sharp tearing sensation in her abdomen
and the fetal heart tones start descending to 70 beats per minute. The nurse
suspects the client has experienced which obstetrical emergency?
Uterine rupture
What could be causes of fetal tachycardia?
