NUR 2513 MATERNAL-CHILD NURSING EXAM 2 2026/2027 |
75 Actual Questions and Verified Answers | Already Graded
A | Rasmussen | Pass Guaranteed
Domain 1: Labor & Delivery Complications (12 Questions)
Q1: A 28-year-old G2P1 client at 39 weeks gestation is in active labor. Her cervix is 8 cm
dilated, 100% effaced, and the fetus is at +2 station. Suddenly, the fetal heart rate (FHR)
drops to 70 bpm with a slow recovery to baseline. The nurse notes a sudden gush of
fluid with meconium staining. The client reports sudden, severe abdominal pain
different from labor contractions. Based on these findings, what is the nurse's priority
action?
A. Prepare for immediate cesarean birth and notify the provider
B. Administer oxygen via face mask at 10 L/min and change maternal position
C. Insert an intrauterine pressure catheter to assess contraction strength
D. Perform a vaginal examination to assess cervical change
Correct Answer: A
Rationale: The clinical presentation is classic for uterine rupture: sudden onset of severe
abdominal pain unrelated to contractions, sudden fetal bradycardia with slow recovery,
and meconium-stained fluid. Uterine rupture is a life-threatening obstetric emergency
requiring immediate surgical intervention. The priority is preparing for emergent
cesarean birth while notifying the provider immediately.
Why other options are incorrect: Option B (oxygen and repositioning) is appropriate for
fetal distress but insufficient for uterine rupture, which requires surgical repair. Option C
(IUPC insertion) is contraindicated as it wastes critical time and could worsen the
,situation. Option D (vaginal exam) is contraindicated as it may introduce infection and
delays definitive treatment. The fetal bradycardia and maternal symptoms indicate
complete or partial uterine rupture requiring immediate delivery.
Q2: A client in active labor at 7 cm dilation has been pushing for 45 minutes. The fetal
head delivers, but the shoulders do not deliver with the next contraction. The nurse
observes the anterior shoulder is lodged behind the symphysis pubis. What is the first
nursing intervention for shoulder dystocia?
A. Apply fundal pressure to assist delivery
B. Flex the maternal thighs sharply against the abdomen (McRoberts maneuver)
C. Perform a large episiotomy immediately
D. Apply gentle downward traction on the fetal head
Correct Answer: B
Rationale: McRoberts maneuver (hyperflexion of maternal thighs against the abdomen)
is the first-line intervention for shoulder dystocia. This maneuver straightens the
lumbosacral angle, rotates the symphysis pubis anteriorly, and frees the impacted
anterior shoulder. It is non-invasive, effective in 90% of cases, and should be attempted
before more invasive interventions.
Why other options are incorrect: Option A (fundal pressure) is contraindicated as it may
worsen shoulder impaction and cause uterine rupture or fetal injury. Option C
(episiotomy) may be needed later but does not resolve the bony obstruction causing
shoulder dystocia. Option D (downward traction) should never be applied as it can
cause brachial plexus injury (Erb's palsy) or cervical spine injury. The HELPERR
mnemonic guides management: Help call, Episiotomy, Legs (McRoberts), Pressure
(suprapubic), Enter maneuvers, Remove posterior arm, Roll hands and knees.
,Q3: A client at 41 weeks gestation is receiving oxytocin for labor induction. The FHR
baseline is 150 bpm with moderate variability. Suddenly, the FHR drops to 90 bpm and
remains there for 3 minutes. The nurse notes the umbilical cord is protruding from the
vagina. What is the immediate priority intervention?
A. Discontinue the oxytocin infusion and administer oxygen
B. Place the client in knee-chest position or Trendelenburg and apply upward pressure
on the presenting part
C. Prepare for immediate forceps-assisted delivery
D. Increase the IV fluid rate and administer terbutaline
Correct Answer: B
Rationale: Umbilical cord prolapse is an obstetric emergency causing immediate fetal
hypoxia. The priority is immediate manual elevation of the presenting part to relieve
cord compression, combined with knee-chest or Trendelenburg position to use gravity
to shift the fetal head away from the pelvis. This preserves fetal oxygenation while
preparing for emergent cesarean delivery.
Why other options are incorrect: Option A (stopping oxytocin and oxygen) is appropriate
but secondary to relieving mechanical cord compression. Without elevating the
presenting part, fetal asphyxia occurs within minutes. Option C (forceps) is
inappropriate as the cervix may not be fully dilated, and it delays definitive treatment.
Option D (increasing fluids and terbutaline) is inappropriate; terbutaline is for uterine
tachysystole, not cord prolapse. Cord prolapse requires delivery within 4-6 minutes to
prevent fetal death.
Q4: A 32-year-old G1P0 client has been in active labor for 14 hours. Cervical
examination reveals arrest of dilation at 6 cm for 3 hours despite adequate contractions
(Montevideo units >200). The fetus is in occiput posterior position. What type of
dystocia is present, and what is the priority nursing intervention?
, A. Cephalopelvic disproportion; prepare for cesarean birth
B. Active phase arrest due to fetal malposition; assist with position changes and
prepare for possible operative delivery
C. Prolonged latent phase; administer sedation and allow rest
D. Precipitous labor; prepare for rapid delivery
Correct Answer: B
Rationale: This client has active phase arrest (no cervical change for ≥2 hours in active
labor with adequate contractions). The occiput posterior position explains the dystocia,
as this fetal position results in a larger presenting diameter and slower
rotation/descent. Priority interventions include maternal position changes
(hands-knees, side-lying, lunging) to promote rotation, and preparation for operative
delivery if no progress occurs.
Why other options are incorrect: Option A (cephalopelvic disproportion) cannot be
diagnosed without attempting rotation maneuvers and assessing pelvic adequacy; CPD
is a diagnosis of exclusion. Option C (prolonged latent phase) is incorrect as the client
is in active labor (≥6 cm). Option D (precipitous labor) is opposite of the presentation;
precipitous labor is <3 hours from onset to delivery. The Friedman curve and ACOG
guidelines define active phase arrest and recommend intervention after 2 hours without
progress.
Q5: A client in labor progresses rapidly from 4 cm to delivery in 2.5 hours. Immediately
after birth, the neonate appears pale, limp, with poor muscle tone, and HR 80 bpm. The
Apgar score at 1 minute is 4. What complication likely occurred, and what is the priority
nursing assessment?
A. Shoulder dystocia; assess for brachial plexus injury
B. Precipitous labor with fetal intracranial trauma; assess for signs of intracranial
hemorrhage
75 Actual Questions and Verified Answers | Already Graded
A | Rasmussen | Pass Guaranteed
Domain 1: Labor & Delivery Complications (12 Questions)
Q1: A 28-year-old G2P1 client at 39 weeks gestation is in active labor. Her cervix is 8 cm
dilated, 100% effaced, and the fetus is at +2 station. Suddenly, the fetal heart rate (FHR)
drops to 70 bpm with a slow recovery to baseline. The nurse notes a sudden gush of
fluid with meconium staining. The client reports sudden, severe abdominal pain
different from labor contractions. Based on these findings, what is the nurse's priority
action?
A. Prepare for immediate cesarean birth and notify the provider
B. Administer oxygen via face mask at 10 L/min and change maternal position
C. Insert an intrauterine pressure catheter to assess contraction strength
D. Perform a vaginal examination to assess cervical change
Correct Answer: A
Rationale: The clinical presentation is classic for uterine rupture: sudden onset of severe
abdominal pain unrelated to contractions, sudden fetal bradycardia with slow recovery,
and meconium-stained fluid. Uterine rupture is a life-threatening obstetric emergency
requiring immediate surgical intervention. The priority is preparing for emergent
cesarean birth while notifying the provider immediately.
Why other options are incorrect: Option B (oxygen and repositioning) is appropriate for
fetal distress but insufficient for uterine rupture, which requires surgical repair. Option C
(IUPC insertion) is contraindicated as it wastes critical time and could worsen the
,situation. Option D (vaginal exam) is contraindicated as it may introduce infection and
delays definitive treatment. The fetal bradycardia and maternal symptoms indicate
complete or partial uterine rupture requiring immediate delivery.
Q2: A client in active labor at 7 cm dilation has been pushing for 45 minutes. The fetal
head delivers, but the shoulders do not deliver with the next contraction. The nurse
observes the anterior shoulder is lodged behind the symphysis pubis. What is the first
nursing intervention for shoulder dystocia?
A. Apply fundal pressure to assist delivery
B. Flex the maternal thighs sharply against the abdomen (McRoberts maneuver)
C. Perform a large episiotomy immediately
D. Apply gentle downward traction on the fetal head
Correct Answer: B
Rationale: McRoberts maneuver (hyperflexion of maternal thighs against the abdomen)
is the first-line intervention for shoulder dystocia. This maneuver straightens the
lumbosacral angle, rotates the symphysis pubis anteriorly, and frees the impacted
anterior shoulder. It is non-invasive, effective in 90% of cases, and should be attempted
before more invasive interventions.
Why other options are incorrect: Option A (fundal pressure) is contraindicated as it may
worsen shoulder impaction and cause uterine rupture or fetal injury. Option C
(episiotomy) may be needed later but does not resolve the bony obstruction causing
shoulder dystocia. Option D (downward traction) should never be applied as it can
cause brachial plexus injury (Erb's palsy) or cervical spine injury. The HELPERR
mnemonic guides management: Help call, Episiotomy, Legs (McRoberts), Pressure
(suprapubic), Enter maneuvers, Remove posterior arm, Roll hands and knees.
,Q3: A client at 41 weeks gestation is receiving oxytocin for labor induction. The FHR
baseline is 150 bpm with moderate variability. Suddenly, the FHR drops to 90 bpm and
remains there for 3 minutes. The nurse notes the umbilical cord is protruding from the
vagina. What is the immediate priority intervention?
A. Discontinue the oxytocin infusion and administer oxygen
B. Place the client in knee-chest position or Trendelenburg and apply upward pressure
on the presenting part
C. Prepare for immediate forceps-assisted delivery
D. Increase the IV fluid rate and administer terbutaline
Correct Answer: B
Rationale: Umbilical cord prolapse is an obstetric emergency causing immediate fetal
hypoxia. The priority is immediate manual elevation of the presenting part to relieve
cord compression, combined with knee-chest or Trendelenburg position to use gravity
to shift the fetal head away from the pelvis. This preserves fetal oxygenation while
preparing for emergent cesarean delivery.
Why other options are incorrect: Option A (stopping oxytocin and oxygen) is appropriate
but secondary to relieving mechanical cord compression. Without elevating the
presenting part, fetal asphyxia occurs within minutes. Option C (forceps) is
inappropriate as the cervix may not be fully dilated, and it delays definitive treatment.
Option D (increasing fluids and terbutaline) is inappropriate; terbutaline is for uterine
tachysystole, not cord prolapse. Cord prolapse requires delivery within 4-6 minutes to
prevent fetal death.
Q4: A 32-year-old G1P0 client has been in active labor for 14 hours. Cervical
examination reveals arrest of dilation at 6 cm for 3 hours despite adequate contractions
(Montevideo units >200). The fetus is in occiput posterior position. What type of
dystocia is present, and what is the priority nursing intervention?
, A. Cephalopelvic disproportion; prepare for cesarean birth
B. Active phase arrest due to fetal malposition; assist with position changes and
prepare for possible operative delivery
C. Prolonged latent phase; administer sedation and allow rest
D. Precipitous labor; prepare for rapid delivery
Correct Answer: B
Rationale: This client has active phase arrest (no cervical change for ≥2 hours in active
labor with adequate contractions). The occiput posterior position explains the dystocia,
as this fetal position results in a larger presenting diameter and slower
rotation/descent. Priority interventions include maternal position changes
(hands-knees, side-lying, lunging) to promote rotation, and preparation for operative
delivery if no progress occurs.
Why other options are incorrect: Option A (cephalopelvic disproportion) cannot be
diagnosed without attempting rotation maneuvers and assessing pelvic adequacy; CPD
is a diagnosis of exclusion. Option C (prolonged latent phase) is incorrect as the client
is in active labor (≥6 cm). Option D (precipitous labor) is opposite of the presentation;
precipitous labor is <3 hours from onset to delivery. The Friedman curve and ACOG
guidelines define active phase arrest and recommend intervention after 2 hours without
progress.
Q5: A client in labor progresses rapidly from 4 cm to delivery in 2.5 hours. Immediately
after birth, the neonate appears pale, limp, with poor muscle tone, and HR 80 bpm. The
Apgar score at 1 minute is 4. What complication likely occurred, and what is the priority
nursing assessment?
A. Shoulder dystocia; assess for brachial plexus injury
B. Precipitous labor with fetal intracranial trauma; assess for signs of intracranial
hemorrhage
