1
CMCA MIDTERM REVIEWER EXAM
QUESTIONS AND CORRECT ANSWER
1. The nurse assesses the pregnant client who comes to the triage unit and
determines that she is at 4/50/—l and that the fetal HR is 148. What priority
information should the nurse collect before proceeding?
A. Time and amount of last meal
B. Number of weeks’ gestation
C. Who is attending the delivery
D. History of previous illnesses
Correct Answer : B
A. The time and amount of last meal is important to know, but number of
weeks’ gestation is more important. This client is dilated at 4 cm and in
active labor.
B. Knowing the weeks of gestation is most important because if she is in
premature labor, she may need to be given tocolytics to stop the process and
to ensure adequate fetal lung maturity. If she is full term, the labor process
could continue.
pg. 1
,2
C. Who will attend the delivery should be identified during admission to the
labor unit, but it is not the most important when being evaluated in triage.
D. History of previous illnesses should be collected during admission to the
labor unit, but it is not the most important when being evaluated in triage.
2. The nurse, admitting a 40-week primigravida to the labor unit, just
documented the results of a recent vaginal exam: 3/lOO/—2, RSP. How should the
oncoming shift nurse interpret this documentation? A. The fetus is approximately
2 cm below maternal ischial spines.
B. The cervix is totally dilated and effaced, with fetal engagement.
C. The fetus is breech and posterior to the client’s pelvis.
D. The fetal lie is transverse, and the fetal attitude is flexion.
Correct Answer : C
A. At —2, the fetus is 2 cm above, not below, the maternal ischial spines. Two
centimeters below the ischial spines would be recorded as +2.
B. The cervix is 3 cm, not totally dilated. Total dilation would be documented
as 10 for the first number. Also, the cervix is 100% effaced, which is total
effacement (shortening and thinning out).
C. The nurse should interpret 3/100/—2, RSP as the cervix is 3 cm dilated,
100% effaced, and the fetus is 2 cm above the maternal ischial spines. RSP
means that the fetus is to the right of the mother’s pelvis (R), with the
pg. 2
,3
sacrum as the specific presenting part (S), which is a breech position. This
fetus is also posterior (P).
D. Fetal lie (relationship of long axis or spine of fetus to long axis of mother) is
longitudinal, not transverse. The documentation does not specify if the fetal
attitude is flexion.
3. The nurse is caring for the low-risk laboring client during the first stage of
labor. When should the nurse assess the FHR pattern? Select all that apply.
A. Before administering medications
B. At least every fifteen minutes
C. Alter vaginal examinations
D. During a hard contraction
E. When giving oxytocin
Correct Answer S: A, C
A. The FHR may be affected by medications given to the mother. Therefore, a
baseline FHR should be determined before giving any medication to the
laboring client and then assessed again after giving the medication.
B. The FHR should be assessed every 30 minutes (not 15 minutes) during the
first stage of labor if the client is categorized as low risk. The FHR should
be assessed every 15 minutes during the second stage of labor.
pg. 3
, 4
C. The FHR should be assessed after each vaginal examination because the
fetus could change positions, or be stressed by the intrusion of the
examiner’s fingers, or intact membranes could have ruptured.
D. Although the FHR could be listened to during a contraction, it may be
difficult due to muffling of the sounds and maternal movement. It is most
important to listen before and after the contraction to more accurately detect
FHR decelerations.
E. If the client is classified as low risk, she should not be receiving oxytocin
(Pitocin) for labor augmentation or induction.
4. After performing Leopold’s maneuvers and determining that the fetus is in
the RSA position, the nurse plans to assess the FHR. Place an X 011 the area of the
client’s abdomen where the nurse would best be able to listen to and count the
FHR.
pg. 4
CMCA MIDTERM REVIEWER EXAM
QUESTIONS AND CORRECT ANSWER
1. The nurse assesses the pregnant client who comes to the triage unit and
determines that she is at 4/50/—l and that the fetal HR is 148. What priority
information should the nurse collect before proceeding?
A. Time and amount of last meal
B. Number of weeks’ gestation
C. Who is attending the delivery
D. History of previous illnesses
Correct Answer : B
A. The time and amount of last meal is important to know, but number of
weeks’ gestation is more important. This client is dilated at 4 cm and in
active labor.
B. Knowing the weeks of gestation is most important because if she is in
premature labor, she may need to be given tocolytics to stop the process and
to ensure adequate fetal lung maturity. If she is full term, the labor process
could continue.
pg. 1
,2
C. Who will attend the delivery should be identified during admission to the
labor unit, but it is not the most important when being evaluated in triage.
D. History of previous illnesses should be collected during admission to the
labor unit, but it is not the most important when being evaluated in triage.
2. The nurse, admitting a 40-week primigravida to the labor unit, just
documented the results of a recent vaginal exam: 3/lOO/—2, RSP. How should the
oncoming shift nurse interpret this documentation? A. The fetus is approximately
2 cm below maternal ischial spines.
B. The cervix is totally dilated and effaced, with fetal engagement.
C. The fetus is breech and posterior to the client’s pelvis.
D. The fetal lie is transverse, and the fetal attitude is flexion.
Correct Answer : C
A. At —2, the fetus is 2 cm above, not below, the maternal ischial spines. Two
centimeters below the ischial spines would be recorded as +2.
B. The cervix is 3 cm, not totally dilated. Total dilation would be documented
as 10 for the first number. Also, the cervix is 100% effaced, which is total
effacement (shortening and thinning out).
C. The nurse should interpret 3/100/—2, RSP as the cervix is 3 cm dilated,
100% effaced, and the fetus is 2 cm above the maternal ischial spines. RSP
means that the fetus is to the right of the mother’s pelvis (R), with the
pg. 2
,3
sacrum as the specific presenting part (S), which is a breech position. This
fetus is also posterior (P).
D. Fetal lie (relationship of long axis or spine of fetus to long axis of mother) is
longitudinal, not transverse. The documentation does not specify if the fetal
attitude is flexion.
3. The nurse is caring for the low-risk laboring client during the first stage of
labor. When should the nurse assess the FHR pattern? Select all that apply.
A. Before administering medications
B. At least every fifteen minutes
C. Alter vaginal examinations
D. During a hard contraction
E. When giving oxytocin
Correct Answer S: A, C
A. The FHR may be affected by medications given to the mother. Therefore, a
baseline FHR should be determined before giving any medication to the
laboring client and then assessed again after giving the medication.
B. The FHR should be assessed every 30 minutes (not 15 minutes) during the
first stage of labor if the client is categorized as low risk. The FHR should
be assessed every 15 minutes during the second stage of labor.
pg. 3
, 4
C. The FHR should be assessed after each vaginal examination because the
fetus could change positions, or be stressed by the intrusion of the
examiner’s fingers, or intact membranes could have ruptured.
D. Although the FHR could be listened to during a contraction, it may be
difficult due to muffling of the sounds and maternal movement. It is most
important to listen before and after the contraction to more accurately detect
FHR decelerations.
E. If the client is classified as low risk, she should not be receiving oxytocin
(Pitocin) for labor augmentation or induction.
4. After performing Leopold’s maneuvers and determining that the fetus is in
the RSA position, the nurse plans to assess the FHR. Place an X 011 the area of the
client’s abdomen where the nurse would best be able to listen to and count the
FHR.
pg. 4
