Deck 12: Nursing Care of the Family During Labor and Birth

Question 1

The nurse expects to administer an oxytocic (uterotonic such as 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.

Answer 1

Stimulate uterine contraction.

Question 2

The nurse who performs vaginal examinations to assess a woman's progress in labor should:

A) Perform an examination at least once every hour during the active phase of labor.
B) Perform the examination with the woman in the supine position.
C) Wear two clean gloves for each examination.
D) Discuss the findings with the woman and her partner.

Answer 2

Discuss the findings with the woman and her partner.

Question 3

Which description of the phases of the second stage of labor is accurate?

A) Latent phase: Feels sleepy, fetal station is 2+ to 4+, duration is 30 to 45 minutes
B) Active phase: Overwhelmingly strong contractions, Ferguson reflux activated, duration is 5 to 15 minutes
C) Descent phase: Significant increase in contractions, Ferguson reflux activated, average duration varies
D) Transitional phase: Woman "laboring down," fetal station is 0, duration is 15 minutes

Answer 3

Descent phase: Significant increase in contractions, Ferguson reflux activated, average duration varies

Question 4

With regard to a woman's intake and output during labor, nurses 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.
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 producing a clean, clear delivery.
D) When a nulliparous woman experiences the urge to defecate, it often means birth will follow quickly.

Question 5

The nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates that the woman understands the instructions when she states:

A) "True labor contractions will subside when I walk around."
B) "True labor contractions will cause discomfort over the top of my uterus."
C) "True labor contractions will continue and get stronger even if I relax and take a shower."
D) "True labor contractions will remain irregular but become stronger."

Question 6

When managing the care of a woman in the second stage of labor, the nurse 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.
B) Telling the woman to start pushing as soon as her cervix is fully dilated.
C) Continuing an epidural anesthetic so pain is reduced and the woman can relax.
D) Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction.

Question 7

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 nurse 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.

Question 8

Through vaginal examination the nurse determines that a woman is 4 cm dilated, and the external fetal monitor shows uterine contractions every 3½ to 4 minutes. The nurse would report this as:

A) First stage, latent phase.
B) First stage, active phase.
C) First stage, transition phase.
D) Second stage, latent phase.

Question 9

The most critical nursing action in caring for the newborn immediately after birth is:

A) Keeping the newborn's airway clear.
B) Fostering parent-newborn attachment.
C) Drying the newborn and wrapping the infant in a blanket.
D) Administering eye drops and vitamin K.

Question 10

When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive sign that uterine contractions are effective would be:

A) Dilation of the cervix.
B) Descent of the fetus.
C) Rupture of the amniotic membranes.
D) Increase in bloody show.

Question 11

The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The nurse notes that the intrauterine pressure at the peak of the contraction ranges from 65 to 70 mm Hg and the resting tone range is 6 to 10 mm 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 nurse 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.

Question 12

After an emergency birth, the nurse encourages the woman to breastfeed her newborn. The primary purpose of this activity is to:

A) Facilitate maternal-newborn interaction.
B) Stimulate the uterus to contract.
C) Prevent neonatal hypoglycemia.
D) Initiate the lactation cycle.

Question 13

A nulliparous woman who has just begun the second stage of her labor would most likely:

A) Experience a strong urge to bear down.
B) Show perineal bulging.
C) A period of rest and relative calm.
D) Show an increase in bright red bloody show.

Question 14

A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. The nurse's 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.

Question 15

Vaginal examinations should be performed by the nurse 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.

Question 16

Nurses alert to signs of the onset of the second stage of labor can be certain that this stage has begun when:

A) The woman has a sudden episode of vomiting.
B) The nurse is unable to feel the cervix during a vaginal examination.
C) Bloody show increases.
D) The woman involuntarily tries to bear down.

Question 17

When a nulliparous woman telephones the hospital to report that she is in labor, the nurse initially should:

A) Tell the woman to stay home until her membranes rupture.
B) Emphasize that food and fluid intake should stop.
C) Arrange for the woman to come to the hospital for labor evaluation.
D) Ask the woman to describe why she believes she is in labor.

Question 18

When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman's risk for _____ has increased.

A) Intrauterine infection
B) Hemorrhage
C) Precipitous labor
D) Supine hypotension

Question 19

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is:

A) "Don't worry about it. You'll do fine."
B) "It's normal to be anxious about labor. Let's discuss what makes you afraid."
C) "Labor is scary to think about, but the actual experience isn't."
D) "You can have an epidural. You won't feel anything."

Question 20

If a woman complains of back labor pain, the nurse might best suggest that she:

A) Lie on her back for a while with her knees bent.
B) Do less walking around.
C) Take some deep, cleansing breaths.
D) Lean over a birth ball with her knees on the floor.

Question 21

As the United States and Canada continue to become more culturally diverse, it is increasingly important for the nursing staff to recognize a wide range of varying cultural beliefs and practices. Nurses need to develop respect for these culturally diverse practices and learn to incorporate these into a mutually agreed on plan of care. Although it is common practice in the United States for the father of the baby to be present at the birth, in many societies this is not the case. When implementing care, the nurse would anticipate that a woman from which country would have the father of the baby in attendance?

A) Mexico
B) China
C) Iran
D) India

Question 22

Women who have participated in childbirth education classes often bring a "birth plan" with them to the hospital. This document includes the couple's preference related to (choose all that apply):

A) Presence of companions.
B) Clothing to be worn.
C) Care and handling of the newborn.
D) Medical interventions.
E) Environmental modifications.
F) None of the above

Question 23

For women who have a history of sexual abuse, a number of traumatic memories may be triggered during labor. The woman may fight the labor process and react with pain or anger. Alternately she may become a passive player and emotionally absent herself from the process. The nurse is in a unique position of being able to assist the woman to associate the sensations of labor with the process of childbirth and not the past abuse. The nurse can implement a number of care measures to help the woman view the childbirth experience in a positive manner. Which intervention would be key for the nurse to use while providing care?

A) Telling the woman to relax and that it won't hurt much
B) Limiting the number of procedures that invade her body
C) Reassuring the woman that as the nurse you know what is best
D) Allowing unlimited care providers to be with the woman

Question 24

A means of controlling the birth of the fetal head with a vertex presentation is:

A) The Ritgen maneuver.
B) Fundal pressure.
C) The lithotomy position.
D) The De Lee apparatus.