Proctored Exam Study Guide: High-Yield
Questions, Rationales, and Preparation
Tip With 60 Questions
A. The nurse should instruct the client to pant during contractions to prevent pushing or bearing
down before the cervix is completely dilated during the transition phase of labor. Panting will
not alleviate back pain during the latent phase of labor.
B. The nurse should not place the client supine during labor because this will increase her back
pain.
C. The nurse should initiate hydrotherapy when the client is in the active phase of labor or
approximately 5 cm (2 in) dilated. The use of hydrotherapy during the latent phase of labor can
prolong the labor process.
A nurse is discussing potential complications of newborn hypothermia with a newly licensed
nurse. Which of the following complications should the nurse include? - <<<correct
answer>>>Correct Answer:
B.
Hypoglycemia
Newborn hypothermia can cause hypoglycemia because anaerobic glycolysis can deplete
glycogen stores.
,Incorrect Answers:
A. Newborn hypothermia can cause bradycardia and irritability. Hyperthermia can cause
tachycardia.
C. Newborn hypoglycemia can cause central cyanosis and cool, mottled skin. Hyperthermia can
cause flushed skin.
D. Generalized petechiae can indicate a clotting disorder; this condition is not caused by
hypothermia.
A nurse is caring for a client labor who has an epidural for pain relief. Which of the following is a
complication of the epidural block? - <<<correct answer>>>Correct Answer:
C.
Hypotension
Maternal hypotension is an adverse effect of epidural anesthesia. The nurse should administer
an IV fluid bolus prior to the placement of epidural anesthesia in order to decrease the
likelihood of this complication.
A nurse is reviewing the medical record of a client at 39 weeks gestation who has
polyhydramnios. Which of the following findings should the nurse expect? - <<<correct
answer>>>Correct Answer:
D.
Fetal gastrointestinal anomaly
,Polyhydramnios is the presence of excessive amniotic fluid surrounding the unborn fetus.
Gastrointestinal malformations and neurological disorders are expected findings for a fetus
experiencing the effects of polyhydramnios.
Incorrect Answers:
A. Polyhydramnios will result in a fundal height greater than expected for gestational age.
B. Polyhydramnios will result in an increase in weight gain, not a decrease.
C. Gestational hypertension causes oligohydramnios, which is a decrease in the amount of
amniotic fluid surrounding the fetus.
A nurse is caring for a client who is in labor and has received epidural analgesia. The client's
blood pressure is 88/50 mmHg, and the fetal heart tracing shows late decelerations. Which of
the following actions should the nurse take? - <<<correct answer>>>Correct Answer:
B.
Increase the rate of the primary IV infusion
Late decelerations can be caused by uteroplacental insufficiency. The fetal heart tracing shows a
gradual decrease in fetal heart rate with a return to baseline on uterine contractions. This could
be related to maternal hypotension, which can be corrected with increased IV fluids to increase
maternal blood volume. This improves uterine and cardiac perfusion as well.
Incorrect Answers:
A. A client who has received epidural analgesia should not be assisted out of bed to the toilet or
a bedside commode due to inhibited muscle control and the increased risk of falling.
, C. Maternal position influences both maternal hypotension and the fetal response to low blood
pressure. Positioning the client in a lateral or Trendelenburg position improves maternal
circulation.
D. Hypotension is a function of low blood pressure rather than low blood glucose. The nurse
should address low blood pressure through positioning and bolus IV fluids.
A nurse is caring for a client who is in labor and asks her partner to perform effleurage. The
client has on a monitor belt for electronic fetal monitoring. Which of the following instructions
should the nurse provide to the client's partner? - <<<correct answer>>>Correct Answer:
A.
"Lightly stroke the upper thighs."
Effleurage involves lightly stroking or massaging the abdomen in rhythm with breathing to help
relieve labor pain. However, when a monitor belt is in use, the sides of the abdomen, chest, or
upper thighs are alternative locations for massage.
Incorrect Answers:
B. "Steadily apply pressure to the sacrum." - This technique is known as counter-pressure and is
used to help decrease lower back pain by relieving occiput pressure on the spinal nerves.
C. Gently massaging the abdomen is therapeutic for pain relief; however, massage of the mid-
abdominal area is not possible for this client due to the positioning of the monitor belt.
D. "Firmly squeeze both hips." - This is a method of counter-pressure and is used to help relieve
lower back pain by placing pressure on the hips.