Deck 18: Nursing Care During Labor and Birth

Question 1

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.

Answer 1

Assess the fetal heart rate and pattern.

Question 2

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

Answer 2

Intrauterine infection

Question 3

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.

Answer 3

Encouraging the woman to try various upright positions,including squatting and standing.

Question 4

The nurse recognizes that a woman is in true labor when she states:

A)"I passed some thick,pink mucus when I urinated this morning."
B)"My bag of waters just broke."
C)"The contractions in my uterus are getting stronger and closer together."
D)"My baby dropped,and I have to urinate more frequently now."

Question 5

The nurse 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.

Question 6

Which action is correct when palpation is used to assess the characteristics and pattern of uterine contractions?

A)Place the hand on the abdomen below the umbilicus and palpate uterine tone with the fingertips.
B)Determine the frequency by timing from the end of one contraction to the end of the next contraction.
C)Evaluate the intensity by pressing the fingertips into the uterine fundus.
D)Assess uterine contractions every 30 minutes throughout the first stage of labor.

Question 7

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 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 8

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 9

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 10

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 11

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.

Question 12

The nurse knows that the second stage of labor,the descent phase,has begun when:

A)The amniotic membranes rupture.
B)The cervix cannot be felt during a vaginal examination.
C)The woman experiences a strong urge to bear down.
D)The presenting part is below the ischial spines.

Question 13

A pregnant woman is in her third trimester. She asks the nurse to explain how she can tell true labor from false labor. The nurse would tell her that true labor contractions:

A)Increase with activity such as ambulation.
B)Decrease with activity.
C)Are always accompanied by the rupture of the bag of waters.
D)Alternate between a regular and irregular pattern.

Question 14

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 15

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 16

What is an expected characteristic of amniotic fluid?

A)Deep yellow color
B)Pale,straw color with small white particles
C)Acidic result on a Nitrazine test
D)Absence of ferning

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 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 19

The nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates the woman's understanding of the instructions when she states,"True labor contractions will:

A)Subside when I walk around."
B)Cause discomfort over the top of my uterus."
C)Continue and get stronger even if I relax and take a shower."
D)Remain irregular but become stronger."

Question 20

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)Feel tired yet relieved that the worst is over.
D)Show an increase in bright red bloody show.

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

Concerning the third stage of labor,nurses should be aware that:

A)The placenta eventually detaches itself from a flaccid uterus.
B)An expectant or active approach to managing this stage of labor reduces the risk of complications.
C)It is important that the dark,roughened maternal surface of the placenta appear before the shiny fetal surface.
D)The major risk for women during the third stage is a rapid heart rate.

Question 23

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

Question 24

In documenting labor experiences,nurses should know that a uterine contraction is described according to all of these characteristics except:

A)Frequency (how often contractions occur).
B)Intensity (the strength of the contraction at its peak).
C)Resting tone (the tension in the uterine muscle).
D)Appearance (shape and height).

Question 25

For the labor nurse,care of the expectant mother begins with any or all of these situations except:

A)The onset of progressive,regular contractions.
B)The bloody,or pink,show.
C)The spontaneous rupture of membranes.
D)Formulation of the woman's plan of care for labor.

Question 26

With regard to the procedures and criteria for admitting a woman to the hospital labor unit,nurses should be aware that:

A)She is not considered to be in true labor (according to the Emergency Medical Treatment and Active Labor Act [EMTALA]) until a qualified health care provider says she is.
B)She can have only her male partner or predesignated "doula" with her at assessment.
C)Her weight gain is calculated to determine whether she is at greater risk for cephalopelvic disproportion and cesarean birth.
D)The nurse should listen politely to the woman's previous birthing experiences but should keep in mind that each birth is a unique experience.

Question 27

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 28

Nurses should not use ____________________ pressure to facilitate birth,because no standard techniques are available for this maneuver and no legal,professional,or regulatory standards exist for its use.

Question 29

As part of the physical examination component of assessment,Leopold maneuvers are used to help identify all of the following except the:

A)Gender of the fetus.
B)Number of fetuses.
C)Fetal lie and attitude.
D)Degree of the presenting part's descent into the pelvis.

Question 30

Nurses 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 1 to 2 hours

Question 31

A ____________________-degree perineal laceration continues through the anal sphincter muscle.

Question 32

Which collection of risk factors most likely would result in damaging lacerations (including episiotomies)?

A)A dark-skinned woman who has had more than one pregnancy,who is going through prolonged second-stage labor,and who is attended by a midwife
B)A reddish-haired mother of two who is going through a breech birth
C)A dark-skinned,first-time mother who is going through a long labor
D)A first-time mother with reddish hair whose rapid labor was overseen by an obstetrician

Question 33

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 client 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 her client view the childbirth experience in a positive manner. Which intervention would be key for the nurse to use while providing care?

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

Question 34

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.

Question 35

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 36

Women who have participated in childbirth education classes often bring a "birth bag" or "Lamaze bag" with them to the hospital. The nurse caring for women in labor should be aware of common items that a client might bring including (choose all that apply):

A)Rolling pin.
B)Tennis balls.
C)Pillow.
D)Stuffed animal or photo.
E)Candles.

Question 37

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 38

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 39

Because the risk for childbirth complications may be revealed,nurses should know that the point of maximal intensity (PMI) of the fetal heart tone (FHT) is:

A)Usually directly over the fetal abdomen.
B)In a vertex position heard above the mother's umbilicus.
C)Heard lower and closer to the midline of the mother's abdomen as the fetus descends and rotates internally.
D)In a breech position heard below the mother's umbilicus.