Intrapartum Quiz: Can You Handle The Emergency?

1. A client has a Grade III perineal laceration during delivery. What structures are involved?

Perineal skin, muscles, and anal sphincter

Perineal skin and superficial muscles only

Perineal skin, muscles, and rectal mucosa

Vaginal epithelium and perineal body only

2. A laboring client has meconium-stained amniotic fluid with fetal heart rate bradycardia. What is the priority nursing action?

Notify provider, position client on left side, apply oxygen, and prepare for delivery

Suction the client's mouth and nose immediately

Continue routine labor monitoring without intervention

Administer dextrose and continue labor support

3. What is the primary concern with retained placenta after delivery?

Postpartum hemorrhage and infection

Retained fetal tissue only

Delayed uterine involution without bleeding

Maternal hypertension and pain

4. A client experiences eclampsia during active labor with a seizure. What is the first intervention?

Protect airway, turn on side, administer magnesium sulfate IV

Immediately deliver the infant to prevent recurrence

Administer calcium gluconate intravenously

Perform emergency intubation before moving client

5. Which risk factor is most associated with amniotic fluid embolism?

Operative delivery with uterine manipulation

Maternal age under 20 years

Prolonged labor without complications

Low parity and young maternal age

6. During delivery, the provider notes a gush of dark blood and the client reports severe pain. Placental abruption is suspected. What is the next priority?

Establish two large-bore IVs, type and crossmatch, prepare for delivery

Apply fetal scalp electrode for continuous monitoring

Perform immediate amniotomy

Administer ergot alkaloid to increase uterine tone

7. A client in labor develops late decelerations with reduced variability. What does this indicate?

Placental insufficiency and possible fetal hypoxia

Benign response to labor progression

Maternal position change needed

Normal fetal sleep cycle during labor

8. What medication is contraindicated during intrapartum complications involving uterine rupture?

Oxytocin (Pitocin)

Magnesium sulfate

Nifedipine

Methylergonovine (Methergine)

9. A laboring client experiences shoulder dystocia. Which maneuver is performed first?

McRoberts maneuver to open pelvic outlet

Zavanelli maneuver to replace fetal head

Cephalic replacement and emergency cesarean

Aggressive downward traction on fetal head

10. What is the clinical significance of variable fetal heart rate decelerations?

Possible cord compression; usually benign if rapid return to baseline

Always indicates severe fetal hypoxia requiring immediate delivery

Sign of maternal anesthesia overuse

Confirms placental insufficiency

11. A laboring client has a sudden onset of severe abdominal pain, vaginal bleeding, and fetal heart rate deceleration. What is the priority nursing action?

Notify the provider immediately and prepare for emergency delivery

Reposition the client and continue monitoring

Administer oxygen and reassure the client

Document findings and review the previous ultrasound

12. Which assessment finding is most concerning for uterine rupture?

Sudden cessation of contractions with sharp abdominal pain

Increased bloody show with strong contractions

Fetal movement felt high in the abdomen

Gradual increase in contraction intensity

13. A laboring client develops sudden dyspnea, chest pain, and hypotension. Amniotic fluid embolism is suspected. What is the first nursing action?

Call for emergency support and position for CPR if needed

Check fetal heart rate and continue monitoring

Administer oxygen via nasal cannula at 2 L/min

Insert Foley catheter to monitor urine output

14. What distinguishes uterine rupture from placental abruption during labor?

Rupture: sudden sharp pain and loss of contractions; abruption: severe pain with continued contractions

Rupture: vaginal bleeding; abruption: concealed hemorrhage only

Rupture: only occurs after labor begins; abruption: only occurs before labor

Rupture: fetal bradycardia only; abruption: variable decelerations only

15. A client is 8 cm dilated when suddenly the fetal heart rate drops to 80 bpm and remains there. What is the priority intervention?

Position client on left side, apply oxygen, and notify provider stat

Increase IV fluid rate and continue labor

Perform vaginal exam to assess for cord compression

Administer ergot alkaloid to strengthen contractions

16. Which maternal vital sign pattern suggests placental abruption?

Hypertension, tachycardia, and tachypnea

Hypotension, bradycardia, and bradypnea

Stable vitals with decreased urine output

Fever with elevated respiratory rate

17. What is the immediate management for a laboring client with a prolapsed cord?

Place client in knee-chest position and keep cord moist

Attempt to reinsert the cord vaginally

Apply gentle pressure to reduce cord edema

Position client supine and elevate legs

18. A client in active labor experiences tetanic uterine contractions lasting more than 2 minutes. What is this called?

Uterine tachysystole

Placental abruption

Uterine rupture

Retained placenta

19. Which finding indicates cord prolapse during labor?

Visible umbilical cord in the vagina or protruding from cervix

Fetal heart rate variability of 6-10 bpm

Maternal blood pressure increase of 20 mmHg systolic

Greenish amniotic fluid with meconium particles

Intrapartum Quiz: Can You Handle the Emergency?