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Obstetrics and Maternity Q&A: Labor and Delivery 2024, Exams of Nursing

Harvard UniversityNursing

A series of questions and answers related to obstetrics and maternity care, specifically focusing on labor and delivery. It covers topics such as the stages of labor, assessment of uterine contractions, fetal heart rate monitoring, and interventions for non-reassuring fetal heart rate patterns. The questions are designed to test knowledge and understanding of key concepts in obstetric nursing, making it a useful resource for nursing students and professionals preparing for assessments or seeking to enhance their clinical skills in maternity care. The content includes detailed explanations of fetal monitoring techniques, maternal and fetal physiology during labor, and appropriate nursing interventions.

Typology: Exams

2024/2025

Available from 07/24/2025

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HESI OB Maternity Version 1 Exit Exam Questions and Answers 2024
1) A client is admitted to the labor and delivery unit with contractions
that are 3-5 minutes apart, lasting 60-70 seconds. She reports that she is
leaking fluid. A vaginal exam reveals that her cervix is 80 percent
effaced and 4 cm dilated and a -1 station. The LPN/LVN knows that the
client is in which phase and stage of labor?
A) Latent phase, First Stage
B) Active Phase of First Stage
C) Latent phase of Second Stage
D) Transition
Ans:
B) Active Phase of First Stage
Second stage = full dilation until birth
2) To assess uterine contractions the LPN/LVN would
A) Asses duration from the beginning of the contraction to the peak of
the same contraction, frequency by measuring the time between the
beginning of one contraction to the beginning of the next contraction.
B) Assess frequency as the time between the end of one contraction and
the beginning of the next contraction, duration as the length of time
from the beginning to the end of contractions, and palpate the uterus for
strength
C) Assess duration from beginning to end of each contraction. Assess
the strength of the contraction by the external fetal monitor reading.
Measure frequency by measuring the beginning of one contraction to
another.
D) Assess duration from beginning to end of each contraction.,
frequency by measuring the time between the beginnings of
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Partial preview of the text

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HESI OB Maternity Version 1 Exit Exam Questions and Answers 2024

  1. A client is admitted to the labor and delivery unit with contractions that are 3 - 5 minutes apart, lasting 60 - 70 seconds. She reports that she is leaking fluid. A vaginal exam reveals that her cervix is 80 percent effaced and 4 cm dilated and a - 1 station. The LPN/LVN knows that the client is in which phase and stage of labor? A) Latent phase, First Stage B) Active Phase of First Stage C) Latent phase of Second Stage D) Transition Ans: B) Active Phase of First Stage Second stage = full dilation until birth
  2. To assess uterine contractions the LPN/LVN would A) Asses duration from the beginning of the contraction to the peak of the same contraction, frequency by measuring the time between the beginning of one contraction to the beginning of the next contraction. B) Assess frequency as the time between the end of one contraction and the beginning of the next contraction, duration as the length of time from the beginning to the end of contractions, and palpate the uterus for strength C) Assess duration from beginning to end of each contraction. Assess the strength of the contraction by the external fetal monitor reading. Measure frequency by measuring the beginning of one contraction to another. D) Assess duration from beginning to end of each contraction., frequency by measuring the time between the beginnings of

contractions, and palpate the fundus of the uterus for strength. Ans: D) Assess duration from beginning to end of each contraction., frequency by measuring the time between the beginnings of contractions, and palpate the fundus of the uterus for strength.

  1. Which basic type of pelvis includes the correct description and percentage of occurrence in women? A) Platypelloid: flattened, wide, shallow; 3% B) Anthropoid: resembling the ape; narrower; 10% C) Android: resembling the male; wider oval; 15% D) Gynecoid: classic female; heart shaped; 75% Ans: A) Platypelloid: flattened, wide, shallow; 3%
  2. What position would be least effective when gravity is desired to assist in fetal descent? A) Lithotomy B) Walking C) Kneeling D) Sitting Ans: A) Lithotomy
  3. The factors that affect the process of labor and birth, known commonly as the five Ps, include all EXCEPT: A) Passageway. B) Powers. C) Passenger. D) Pressure. D) Pressure.

tachycardic, is bradycardic, or has late decelerations with loss of variability is nonreassuring and is associated with A) Cord compression B) Hypotension C) Hypoxemia/acidemia D) Maternal drug use. Ans: C) Hypoxemia/acidemia

  1. The LPN/LVN providing care for the laboring woman should understand that amnioinfusion is used to treat: A) Fetal tachycardia. B) Fetal bradycardia. C) Variable decelerations D) Late decelerations. Ans: C) Variable decelerations
  2. The most common cause of decreased variability in the fetal heart rate (FHR) that lasts 30 minutes or less is: A) Fetal hypoxemia B) Fetal sleep cycles C) Altered cerebral blood flow. D) Umbilical cord compression. Ans: B) Fetal sleep cycles
  3. While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate in a slow curve at the onset of several contractions and returns to baseline before each contraction ends. The

LPN/LVN should: A) Insert an internal monitor B) Document the finding in the client's record. C) Discontinue the oxytocin infusion D) Change the woman's position Ans: B) Document the finding in the client's record.

  1. What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken. A) Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask. B) Perform a vaginal examination, reposition the mother, and provide oxygen via face mask. C) Administer oxygen to the mother, increase IV fluid, and notify the care provider. D) Call the provider, reposition the mother, and perform a vaginal examination Ans: A) Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask.
  2. When using intermittent auscultation (IA) to assess uterine activity, LPN/LVN should be aware that: A) The resting tone between contractions is described as either placid or turbulent B) The examiner's hand should be placed over the fundus before, during, and after contractions. C) The frequency and duration of contractions is measured in seconds

B) Altered fetal cerebral blood flow C) Fetal hypoxemia. D) Uteroplacental insufficiency Ans: A) Umbilical cord compression.

  1. Which of the following is NOT a reassuring component of the fetal heart rate A) FHR of 114 B) Accelerations of the FHR C) Moderate Variability D) Absent FHR Variability Ans: D) Absent FHR Variability
  2. You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take? A) Call for help and Notify the care provider immediately B) Start pitocin C) Have her empty her bladder D) Insert a Foley catheter Ans: A) Call for help and Notify the care provider immediately
  3. What is an advantage of external electronic fetal monitoring?

A) Once correctly applied by the nurse, the transducer need not be repositioned even when the woman changes positions. B) The tocotransducer can measure and record the frequency, regularity, intensity, and approximate duration of uterine contractions (UCs). C) The external EFM does not require rupture of membranes or introduction of scalp electrode or IUPC which may introduce risk of infection or fetal scarring. D) The external EFM can accurately record FHR all the time. Ans: C) The external EFM does not require rupture of membranes or introduction of scalp electrode or IUPC which may introduce risk of infection or fetal scarring.

  1. A number of methods to assist in the assessment of fetal well-being have been developed for use in conjunction with electronic fetal monitoring. These various technologies assist in supporting interventions for a nonreassuring fetal heart rate pattern when necessary. The labor and delivery nurse should be aware that one of these modalities, fetal oxygen saturation monitoring, includes the use of: A) Fetal blood sampling B) Umbilical cord acid-base determination C) Fetal pulse oximetry. D) A fetal acoustic stimulator. Ans: C) Fetal pulse oximetry.
  2. The LPN/LVN caring for the woman in labor should understand that maternal hypotension can result in: A) Uteroplacental insufficiency.

A) Fentanyl (Sublimaze) B) Promethazine (Phenergan) C) Naloxone (Narcan) D) Nalbuphine (Nubain) Ans: C) Naloxone (Narcan)

  1. A woman in labor has just received an epidural block. The most important nursing intervention is to: A) Limit parenteral fluids. B) Monitor the fetus for possible tachycardia C) Monitor the maternal blood pressure for possible hypotension. D) Monitor the maternal pulse for possible bradycardia Ans: C) Monitor the maternal blood pressure for possible hypotension.
  2. A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure would be to use: A) Counterpressure against the sacrum B) Pant-blow (breaths and puffs) breathing techniques C) Effleurage. D) Conscious relaxation or guided imagery. Ans: A) Counterpressure against the sacrum
  3. A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The LPN/LVN increases the woman's intravenous fluid for a pre-procedural bolus. She reviews her laboratory values and notes that the woman's hemoglobin is 12 g/dl, hematocrit is 38%, platelets are 67,000, and

white blood cells (WBCs) are 12,000/mm3. Which factor would contraindicate an epidural for the woman? A) She is too far dilated B) She is anemic. C) She has thrombocytopenia D) She is septic Ans: C) She has thrombocytopenia

  1. The role of the LPN/LVN with regard to informed consent is to: A) Inform the client about the procedure and have her sign the consent form. B) Act as a client advocate and help clarify the procedure and the options. C) Call the physician to see the client D) Witness the signing of the consent form. B) Act as a client advocate and help clarify the procedure and the options.
  2. With regard to systemic analgesics administered during labor, LPN/LVN should be aware that: A) Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. B) Effects on the fetus and newborn can include decreased alertness and delayed sucking. C) Intramuscular administration (IM) is preferred over intravenous (IV) administration. D) IV patient-controlled analgesia (PCA) results in increased use of an analgesic. B) Effects on the fetus and newborn can include decreased alertness and delayed sucking.

A) Massaging the woman's back.

  1. A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is about twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. The LPN/LVN should: A) Notify the woman's physician. B) Tell the woman to "calm down" and slow the pace of her breathing. C) Administer oxygen via a mask or nasal cannula. D) Help her breathe into a paper bag Ans: D) Help her breathe into a paper bag
  2. With regard to a pregnant woman's anxiety and pain experience, LPN/LVN should be aware that: A) Even mild anxiety must be treated. B) Severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on. C) Anxiety may increase the perception of pain, but it does not affect the mechanism of labor. D) Women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity. Ans: B) Severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on.
  3. Maternity nurse often have to answer questions about the many, sometimes unusual ways people have tried to make the birthing experience more comfortable. For instance, LPN/LVN should be aware that:

A) Music supplied by the support person has to be discouraged because it could disturb others or upset the hospital routine. B) Women in labor can benefit from sitting in a bathtub, but they must limit immersion to no longer than 15 minutes at a time. C) Effleurage is permissible, but counterpressure is almost always counterproductive. D) Electrodes attached to either side of the spine to provide mild- intensity electrical impulses facilitate the release of endorphins. Ans: D) Electrodes attached to either side of the spine to provide mild-intensity electrical impulses facilitate the release of endorphins.

  1. Your patient is a nulliparous woman, requesting pain relief. You examine her and she is 8 cm. What is the best option for pain relief at this point? A) Demerol B) Spinal C) Epidural D) Stadol Ans: C) Epidural
  2. A primiparous woman is in the triage room being evaluated for labor. She has been having contractions for 2 days, has slept little and is feeling exhausted. On cervical exam she is 1.5 cm dilated, 50% effaced,
  • 1 station - which is not changed from a day ago. Contractions are irregular, 30 - 40 secs long. Which of the following is the best option for her? A) Offer morphine IM, and a sedative to help her sleep. B) Admit her and give her an epidural.

Hg. The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. On the basis of this information, the LPN should: A) Notify the woman's primary health care provider immediately B) Prepare to administer an oxytocic to stimulate uterine activity C) Document the findings because they reflect the expected contraction pattern for the active phase of labor. D) Prepare the woman for the onset of the second stage of labor. Ans: C) Document the findings because they reflect the expected contraction pattern for the active phase of labor.

  1. A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. The nurse initial response would be to: A) Prepare the woman for imminent birth B) Notify the woman's primary health care provider. C) Document the characteristics of the fluid. D) Assess the fetal heart rate and pattern. Ans: D) Assess the fetal heart rate and pattern.
  2. Through vaginal examination the nurse determines that a woman is 4 cm dilated, and the external fetal monitor shows uterine contractions every 3.5 to 4 minutes. The LPN/LVN would report this as: A) First stage, latent phase B) First stage, active phase C) First stage, transition phase D) Second stage, latent phase Ans: B) First stage, active phase
  1. The LPN/LVN expects to administer an oxytocic (e.g., Pitocin, Methergine) to a woman after expulsion of her placenta to: A) Relieve pain. B) Stimulate uterine contraction C) Prevent infection D) Facilitate rest and relaxation. Ans: B) Stimulate uterine contraction
  2. Vaginal examinations should be performed by the LPN/LVN under all of these circumstances EXCEPT: A) An admission to the hospital at the start of labor. B) When accelerations of the fetal heart rate (FHR) are noted. C) On maternal perception of perineal pressure or the urge to bear down. D) When membranes rupture. Ans: B) When accelerations of the fetal heart rate (FHR) are noted.
  3. With regard to a woman's intake and output during labor, LPN/LVN should be aware that: A) The tradition of restricting the laboring woman to clear liquids and ice chips is being challenged because regional anesthesia is used more often than general anesthesia and studies are not showing harm from drinking fluids in labor. B) Intravenous (IV) fluids usually are necessary to ensure that the laboring woman stays hydrated. C) Routine use of an enema empties the rectum and is very helpful for

B) An active approach to managing this stage of labor reduces the risk of excessive bleeding

  1. When planning care for a laboring woman whose membranes have ruptured, the LPN/LVN recognizes that the woman's risk for has increased. A) Intrauterine infection B) Hemorrhage C) Precipitous labor D) Supine hypotension A) Intrauterine infection
  2. When managing the care of a woman in the second stage of labor, the LPN/LVN uses various measures to enhance the progress of fetal descent. These measures include: A) Encouraging the woman to try various upright positions, including squatting and standing. Giving positive feedback about her efforts. B) Telling the woman to start pushing as soon as her cervix is fully dilated. C) Stopping the epidural anesthetic so the woman can feel the urge to push and thereby push more effectively D) Coaching the woman to use sustained, 10 - to 15 - second, closed- glottis bearing-down efforts with each contraction. Ans: A) Encouraging the woman to try various upright positions, including squatting and standing. Giving positive feedback about her efforts.
  3. When assessing a multiparous woman who has just given birth to an 8 - pound boy, the nurse notes that the woman's fundus is firm and has become globular in shape. A gush of dark red blood comes from her

vagina. The LPN/LVN concludes that: A) The placenta has separated. B) A cervical tear occurred during the birth C) The woman is beginning to hemorrhage. D) Clots have formed in the upper uterine segment. Ans: A) The placenta has separated.

  1. LPN can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate? A) Latent: Mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours B) Active: Moderate, regular contractions; 4 - to 7 - cm dilation; duration of 3 to 6 hours C) Lull: No contractions; dilation stable; duration of 20 to 60 minutes D) Transition: Very strong but irregular contractions; 8 - to 10 - cm dilation; duration of 3 - 4 hours Ans: B) Active: Moderate, regular contractions; 4 - to 7 - cm dilation; duration of 3 to 6 hours
  2. Match the degree of tear or episiotomy to its description A. Laceration that goes through the anal sphincter and the rectal wall B. a tear through part or all of the perineal muscles C. small nick in the perineum, not involving muscle D. Laceration through part or all of anal sphincter muscle 1st degree