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1.A nurse is caring for a client in1.4. The second stage of labor begins
when the labor. The nurse determinescervix is dilated completely and
ends with the birth that the client is beginning inof the neonate.
the 2nd stage of labor when
which of the following
assessments is noted?
A.The client begins to expel
clear vaginal fluid
B.The contractions are regular
C.The membranes have
ruptured
D.The cervix is dilated
completely

Intrapartum NCLEX questioAns 3. Late decelerations are due to
nurse in the labor room is uteroplacentalStudy insufficiency as the result
caring for a client in the active of decreased blood flow




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phases of labor. The nurse and oxygen to the fetus during the uterine
is assessing the fetal contractions. This causes hypoxemia;
therefore oxygen is necessary. The supine
patterns and notes a late
position is avoided because it decreases
deceleration on the uterine blood flow to the fetus. The client
monitor strip. The most should be turned to her side to displace
appropriate nursing pressure of the gravid uterus on the
inferior vena cava. An intravenous pitocin
action is to:
infusion is discontinued when a late
deceleration is noted.
1.Place the mother in the
supine position
2.Document the
findings and continue to
monitor the fetal
patterns
3.Administer oxygen via
face mask
4.Increase the rate of pitocin
IV infusion




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A nurse is performing an1. A normal fetal heart rate is 120-160 beats per
assessment of a client who isminute. A count of 180 beats per minute
could scheduled for a cesareanindicate fetal distress and would
warrant physician delivery. Which assessmentnotification. By full term,
a normal maternal finding would indicate a needhemoglobin range is
11-13 g/dL as a result of the to contact the physician? hemodilution
caused by an increase in plasma volume during pregnancy.
1.Fetal heart rate of 180
beats per minute
2.White blood cell count of
12,000
3.Maternal pulse rate of 85
beats per minute
4.Hemoglobin of 11.0 g/dL

Intrapartum NCLEX questioA ns 4. Vena cava and descending aorta compression
client in labor is transported byStudy the pregnant uterus impedes blood
to the delivery room and is return from the




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prepared for a cesarean lower trunk and extremities. This leads to
delivery. The client is decreasing cardiac return, cardiac output,
and blood flow to the uterus and the fetus.
transferred to the delivery
The best position to prevent this would be
room table, and the nurse side-lying with the uterus displaced off of
places the client in the: abdominal vessels. Positioning for
abdominal surgery necessitates a supine
1.Trendelenburg's position position; however, a wedge placed under
with the legs in stirrups the right hip provides displacement of the
uterus.
2.Semi-Fowler position with a
pillow under the knees
3.Prone position with the
legs separated and elevated
4.Supine position with a
wedge
under the right hip




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