NUR 221 EXAMS SCRIPT 2026/2027 QUESTIONS AND
ANSWERS RATED A+
✔✔fetal physiological adaptation to labor - ✔✔Fetal Circulation- Fetal circulation can be
affected by many factors, including maternal position, uterine contractions, blood
pressure, and umbilical cord blood flow. Uterine contractions during labor tend to
decrease circulation through the spiral arterioles and subsequent perfusion through the
intervillous space. Most healthy fetuses are well able to compensate for this stress and
exposure to increased pressure while moving passively through the birth canal during
labor. Usually the umbilical cord moves freely in the amniotic fluid. However, it can be
compressed during uterine contractions (Blackburn, 2013; Miller et al., 2017).
✔✔Fetal physiological adaptation to labor - ✔✔Fetal Respiration-Certain changes
stimulate chemoreceptors in the aorta and carotid bodies to prepare the fetus for
initiating respirations immediately after birth (Blackburn, 2013; Fraser, 2014). These
changes include the following: • Fetal lung fluid is cleared from the air passages as the
infant passes through the birth canal during labor and (vaginal) birth. The process of
labor itself also contributes to the absorption of some of the lung fluid before birth. •
Fetal oxygen pressure (PO2) decreases. • Arterial carbon dioxide pressure (PCO2)
increases. • Arterial pH decreases. • Bicarbonate level decreases. • Fetal respiratory
move
✔✔amniotomy - ✔✔procedure for artificial rupture of membranes. performed by the
physician or nurse-midwife using a plastic AmniHook or a surgical clamp. However, this
practice is discouraged if there is no medical reason because it can increase the
laboring woman's sensation of pressure and pain and is not necessary for a normal birth
to occur.
✔✔amniocentesis - ✔✔Amniocentesis is performed to obtain amniotic fluid, which
contains fetal cells. Under direct ultrasonographic visualization, a needle is inserted
transabdominally into the uterus and amniotic fluid is withdrawn into a syringe. Then the
various assessments are performed on the fluid sample. possible after week 14
✔✔epidural anesthesia - ✔✔Relief from the pain of uterine contractions and birth
(vaginal and cesarean) can be achieved by injecting a suitable local anesthetic agent
(e.g., bupivacaine, ropivacaine), an opioid analgesic (e.g., fentanyl, sufentanil), or both
into the epidural (peridural) space. Injection is made between the fourth and fifth lumbar
vertebrae for a lumbar epidural block (see Figs. 14.8, B, and 14.10, A). Depending on
the type, amount, and number of medications used, an anesthetic or analgesic effect
will occur with varying degrees of motor impairment. The combination of an opioid with
the local anesthetic agent reduces the dose of anesthetic required, thereby preserving a
greater degree of Motor function.
, ✔✔mild preeclampsia - ✔✔Hypertension beginning after the 20th week of pregnancy
with 1 to 2+ proteinuria and a weight gain of more than 2 kg per week in the second and
third trimesters.
✔✔placenta previa - ✔✔the placenta is implanted in the lower uterine segment such
that it completely or partially covers the cervical os or is close enough to the cervix to
cause bleeding when the cervix dilates or the lower uterine segment effaces. When
transvaginal ultrasound is used, the placenta is classified as a complete placenta previa
if it totally covers the internal cervical os. In a marginal placenta previa, the edge of the
placenta is seen on transvaginal ultrasound to be 2.5 cm or closer to the internal
cervical os. When the exact relationship of the placenta to the internal cervical os has
not been determined or in the case of apparent placenta previa in the second trimester,
the term low-lying placenta is used
✔✔placental abruption - ✔✔Premature separation of the placenta, or abruptio
placentae, is the detachment of part or all of a normally implanted placenta from the
uterus (Fig. 12.14). Separation occurs in the area of the decidua basalis after 20 weeks
of gestation and before the birth of the infant.
✔✔Maternal cardiac disease - ✔✔Impaired cardiac function usually results from a
congential defect or history of rheumatic heart disease with valve prolapse or stenosis;
dangerous because of plasma volume increase that accompanies pregnancy
✔✔when do we assess fetal heart rate? - ✔✔typically between 8-14 wks gestation or
during labor we assess before during and after a contraction forming a fetal heart rate
pattern
✔✔Leopold's Maneuvers - ✔✔A series of four maneuvers designed to provide a
systematic approach whereby the examiner may determine fetal presentation and
position.
✔✔Leopold maneuvers step 1. - ✔✔Identify fetal part that occupies the fundus. The
head feels round, firm, and freely movable; the breech feels less regular and softer. This
maneuver identifies fetal lie (longitudinal or transverse) and presentation (cephalic or
breech) (Fig. A).
✔✔Leopold maneuver Step 2 - ✔✔2. Using palmar surface of one hand, locate and
palpate the smooth convex contour of the fetal back and the irregularities that identify
the small parts (feet, hands, knees, elbows). This m
✔✔Leopold maneuver step 3. - ✔✔With right hand, determine which fetal part is
presenting over the inlet to the true pelvis. Gently grasp the lower pole of the uterus
between the thumb and fingers, pressing in slightly (Fig. C). If the head is presenting
and not engaged, determine the attitude of the head (flexed or extended).
ANSWERS RATED A+
✔✔fetal physiological adaptation to labor - ✔✔Fetal Circulation- Fetal circulation can be
affected by many factors, including maternal position, uterine contractions, blood
pressure, and umbilical cord blood flow. Uterine contractions during labor tend to
decrease circulation through the spiral arterioles and subsequent perfusion through the
intervillous space. Most healthy fetuses are well able to compensate for this stress and
exposure to increased pressure while moving passively through the birth canal during
labor. Usually the umbilical cord moves freely in the amniotic fluid. However, it can be
compressed during uterine contractions (Blackburn, 2013; Miller et al., 2017).
✔✔Fetal physiological adaptation to labor - ✔✔Fetal Respiration-Certain changes
stimulate chemoreceptors in the aorta and carotid bodies to prepare the fetus for
initiating respirations immediately after birth (Blackburn, 2013; Fraser, 2014). These
changes include the following: • Fetal lung fluid is cleared from the air passages as the
infant passes through the birth canal during labor and (vaginal) birth. The process of
labor itself also contributes to the absorption of some of the lung fluid before birth. •
Fetal oxygen pressure (PO2) decreases. • Arterial carbon dioxide pressure (PCO2)
increases. • Arterial pH decreases. • Bicarbonate level decreases. • Fetal respiratory
move
✔✔amniotomy - ✔✔procedure for artificial rupture of membranes. performed by the
physician or nurse-midwife using a plastic AmniHook or a surgical clamp. However, this
practice is discouraged if there is no medical reason because it can increase the
laboring woman's sensation of pressure and pain and is not necessary for a normal birth
to occur.
✔✔amniocentesis - ✔✔Amniocentesis is performed to obtain amniotic fluid, which
contains fetal cells. Under direct ultrasonographic visualization, a needle is inserted
transabdominally into the uterus and amniotic fluid is withdrawn into a syringe. Then the
various assessments are performed on the fluid sample. possible after week 14
✔✔epidural anesthesia - ✔✔Relief from the pain of uterine contractions and birth
(vaginal and cesarean) can be achieved by injecting a suitable local anesthetic agent
(e.g., bupivacaine, ropivacaine), an opioid analgesic (e.g., fentanyl, sufentanil), or both
into the epidural (peridural) space. Injection is made between the fourth and fifth lumbar
vertebrae for a lumbar epidural block (see Figs. 14.8, B, and 14.10, A). Depending on
the type, amount, and number of medications used, an anesthetic or analgesic effect
will occur with varying degrees of motor impairment. The combination of an opioid with
the local anesthetic agent reduces the dose of anesthetic required, thereby preserving a
greater degree of Motor function.
, ✔✔mild preeclampsia - ✔✔Hypertension beginning after the 20th week of pregnancy
with 1 to 2+ proteinuria and a weight gain of more than 2 kg per week in the second and
third trimesters.
✔✔placenta previa - ✔✔the placenta is implanted in the lower uterine segment such
that it completely or partially covers the cervical os or is close enough to the cervix to
cause bleeding when the cervix dilates or the lower uterine segment effaces. When
transvaginal ultrasound is used, the placenta is classified as a complete placenta previa
if it totally covers the internal cervical os. In a marginal placenta previa, the edge of the
placenta is seen on transvaginal ultrasound to be 2.5 cm or closer to the internal
cervical os. When the exact relationship of the placenta to the internal cervical os has
not been determined or in the case of apparent placenta previa in the second trimester,
the term low-lying placenta is used
✔✔placental abruption - ✔✔Premature separation of the placenta, or abruptio
placentae, is the detachment of part or all of a normally implanted placenta from the
uterus (Fig. 12.14). Separation occurs in the area of the decidua basalis after 20 weeks
of gestation and before the birth of the infant.
✔✔Maternal cardiac disease - ✔✔Impaired cardiac function usually results from a
congential defect or history of rheumatic heart disease with valve prolapse or stenosis;
dangerous because of plasma volume increase that accompanies pregnancy
✔✔when do we assess fetal heart rate? - ✔✔typically between 8-14 wks gestation or
during labor we assess before during and after a contraction forming a fetal heart rate
pattern
✔✔Leopold's Maneuvers - ✔✔A series of four maneuvers designed to provide a
systematic approach whereby the examiner may determine fetal presentation and
position.
✔✔Leopold maneuvers step 1. - ✔✔Identify fetal part that occupies the fundus. The
head feels round, firm, and freely movable; the breech feels less regular and softer. This
maneuver identifies fetal lie (longitudinal or transverse) and presentation (cephalic or
breech) (Fig. A).
✔✔Leopold maneuver Step 2 - ✔✔2. Using palmar surface of one hand, locate and
palpate the smooth convex contour of the fetal back and the irregularities that identify
the small parts (feet, hands, knees, elbows). This m
✔✔Leopold maneuver step 3. - ✔✔With right hand, determine which fetal part is
presenting over the inlet to the true pelvis. Gently grasp the lower pole of the uterus
between the thumb and fingers, pressing in slightly (Fig. C). If the head is presenting
and not engaged, determine the attitude of the head (flexed or extended).
