Deck 16: Giving Birth

Question 1

The nurse teaching a prenatal class explains that which is the best indicator of true labor?

A) Bloody show
B) Cervical dilation and effacement
C) Fetal descent into the pelvic inlet
D) Uterine contractions every 7 minutes

Answer 1

Cervical dilation and effacement

Question 2

Which comfort measure should the nurse use to assist the laboring woman?

A) Keep the room lights lit so that the patient and her coach can see everything.
B) Offer warm, wet cloths to use on the patient's face and neck.
C) Palpate her bladder every 15 minutes to assess for distention.
D) Recommend frequent position changes.

Answer 2

Recommend frequent position changes.

Question 3

Which maternal factor may inhibit fetal descent and require further nursing interventions?

A) Decreased peristalsis
B) A full bladder
C) Reduction in internal uterine size
D) Rupture of membranes

Answer 3

A full bladder

Question 4

To teach and support the woman in labor,the nurse explains that the strongest part of a labor contraction is the

A) increment.
B) acme.
C) decrement.
D) interval.

Question 5

Leopold's maneuvers are used by practitioners to determine

A) the best location to assess the fetal heart rate (FHR).
B) cervical dilation and effacement.
C) whether the fetus is in the posterior position.
D) if the woman needs an amniotomy.

Question 6

The maternity nurse understands that as the uterus contracts during labor,maternal-fetal exchange of oxygen and waste products

A) continues except when placental functions are reduced.
B) increases as blood pressure decreases.
C) diminishes as the spiral arteries are compressed.
D) is not significantly affected.

Question 7

The nurse is caring for a woman whose fetus has a breech presentation.What complication does the nurse prepare to assist with?

A) Umbilical cord compression
B) More rapid labor
C) A high risk of infection
D) Maternal perineal trauma

Question 8

What results from the adaptation of the fetus to the size and shape of the pelvis?

A) Lightening
B) Lie
C) Molding
D) Presentation

Question 9

What assessment finding does the nurse expect in a woman with cervical dilation and effacement?

A) Bloody show
B) False labor
C) Lightening
D) Bladder distention

Question 10

A student nurse is trying to assess vital signs on a laboring woman.Which statement by the registered nurse is the best rationale for assessing maternal vital signs between contractions?

A) During a contraction, assessing fetal heart rates is the priority.
B) Maternal circulating blood volume increases temporarily during contractions.
C) Maternal blood flow to the heart is reduced during contractions.
D) Vital signs taken during contractions are not accurate.

Question 11

What nursing intervention is the priority when caring for a laboring woman?

A) Helping the woman find ways to manage the pain
B) Eliminating the pain associated with labor
C) Sharing personal experiences regarding labor and delivery
D) Providing the woman food to restore her energy

Question 12

Which mechanism of labor occurs when the largest diameter of the fetal presenting part passes the pelvic inlet?

A) Engagement
B) Extension
C) Internal rotation
D) External rotation

Question 13

To assess the duration of labor contractions,the nurse determines the time

A) from the beginning of one contraction to the beginning of the next.
B) from the beginning to the end of each contraction.
C) of the strongest intensity of each contraction.
D) of uterine relaxation between two contractions.

Question 14

A woman at 40 weeks of gestation calls the OB triage nurse to report a trickle of fluid from her vagina.What action by the nurse is most appropriate?

A) Instruct the woman to come to the hospital.
B) Ask her to time her contractions.
C) Tell her if she saturates two pads in an hour to come to the hospital.
D) Reassure her that she has plenty of time before delivery.

Question 15

The primary difference between the labor of a nullipara and that of a multipara is the

A) amount of cervical dilation.
B) total duration of labor.
C) level of pain experienced.
D) sequence of labor mechanisms.

Question 16

To adequately care for patients,the nurse understands that labor contractions facilitate cervical dilation by

A) contracting the lower uterine segment.
B) enlarging the internal size of the uterus.
C) promoting blood flow to the cervix.
D) pulling the cervix over the fetus and amniotic sac.

Question 17

A student asks how pregnant women can usually tolerate the normal blood loss associated with childbirth.Which response by the nurse is best? "It is because they have

A) a higher hematocrit."
B) increased blood volume."
C) a lower fibrinogen level."
D) increased leukocytes."

Question 18

The student nurse learns that which factor ensures that the smallest anterior-posterior diameter of the fetal head enters the pelvis?

A) Descent
B) Engagement
C) Flexion
D) Station

Question 19

Which assessment finding could indicate hemorrhage in the postpartum patient?

A) Firm fundus at the midline
B) Saturation of one perineal pad in the hour after birth
C) Elevated blood pressure
D) Elevated pulse rate

Question 20

The nurse assesses a patient whose cervix is dilated to 5 cm.What phase of labor does the nurse recognize the woman to be in?

A) Latent phase
B) Active phase
C) Second stage
D) Third stage

Question 21

Thirty minutes after giving birth a woman's uterus feels boggy to the nurse.The nurse massages the fundus without change.What action does the nurse take next?

A) Notify the provider or nurse-midwife immediately.
B) Assess the woman for a full bladder.
C) Prepare to administer oxytocin.
D) Take a full set of vital signs.

Question 22

During labor,a vaginal examination should be performed only when necessary because of the risk of

A) fetal injury.
B) discomfort.
C) infection.
D) perineal trauma.

Question 23

The labor and delivery nurse is evaluating a newly admitted woman's lab and notes a hemoglobin of 9.1 mg/dL and hematocrit of 31%.What action by the nurse takes priority?

A) Document the findings on the woman's chart.
B) Notify the provider or nurse-midwife immediately.
C) Assess for response to blood loss during and after birth.
D) Place the patient on bedrest during labor.

Question 24

A 25-year-old primigravida is in the first stage of labor.She and her husband have been holding hands and breathing together through each contraction.Suddenly the woman pushes her husband's hand away and shouts,"Don't touch me!" What action by the nurse is most appropriate?

A) Reassure the husband this is normal in the transition phase.
B) Ask the woman if she needs some pain medication.
C) Call the anesthesia provider for an epidural block.
D) Ask the husband to leave the room for a few minutes.

Question 25

When assessing the fetus using Leopold maneuvers,the nurse feels a round,firm,movable fetal part in the fundal portion of the uterus and a long,smooth surface in the mother's right side close to midline.What is the likely position of the fetus?

A) ROA
B) LSP
C) RSA
D) LOA

Question 26

What finding should the nurse recognize as being associated with fetal compromise?

A) Active fetal movements
B) Contractions lasting 90 seconds
C) FHR in the 140s
D) Meconium-stained amniotic fluid

Question 27

The nurse who elects to practice in the area of obstetrics learns about the "four Ps." What are the "four Ps"?

A) Powers
B) Passage
C) Position
D) Passenger
E) Psyche

Question 28

The nurse thoroughly dries the infant immediately after birth primarily to

A) stimulate crying and lung expansion.
B) remove maternal blood from the skin surface.
C) reduce heat loss from evaporation.
D) increase blood supply to the hands and feet.

Question 29

The nurse notes that a woman who has given birth 1 hour ago is touching her infant with the fingertips and talking to him softly in high-pitched tones.On the basis of this observation,the nurse should

A) document this evidence of normal early maternal-infant attachment behavior.
B) observe for other signs that the mother may not be accepting of the infant.
C) request a social service consult for psychosocial support.
D) determine whether the mother is too fatigued to interact normally with her infant.

Question 30

The nurse auscultates the fetal heart rate (FHR)and determines a rate of 152.Which nursing intervention is most appropriate?

A) Document the findings in the chart.
B) Reassess the FHR every 5 minutes.
C) Report the FHR to the provider or nurse-midwife immediately.
D) Apply oxygen and turn the mother on her left side.

Question 31

The nurse is answering phone calls in the OB triage area.Which patient should the nurse advise to come to the hospital soonest after labor begins?

A) Gravida 2 para 1 who lives 10 minutes away
B) Gravida 1 para 0 who lives 40 minutes away
C) Gravida 3 para 2 whose longest previous labor was 4 hours
D) Gravida 2 para 1 whose first labor lasted 16 hours

Question 32

At hand-off report the off-going nurse states that the patient demonstrated clonus on her last assessment.What action by the on-coming nurse takes priority?

A) Repeat the woman's vital signs.
B) Institute seizure precautions.
C) Prepare for cesarean delivery.
D) Assess for pain.

Question 33

At 1 minute after birth,the nurse assesses the newborn to assign an Apgar score.The apical heart rate is 110 bpm,and the infant is crying vigorously with the limbs flexed.The infant's trunk is pink,but the hands and feet are blue.What is the Apgar score for this infant?

A) 7
B) 8
C) 9
D) 10

Question 34

The registered nurse tells the nursing student that which stage of labor varies most in length?

A) First
B) Second
C) Third
D) Fourth

Question 35

A laboring woman is lying in the supine position.The most appropriate nursing action is to

A) ask her to turn to one side.
B) elevate her feet and legs.
C) take her blood pressure.
D) let her stay in a position of comfort.

Question 36

During the active phase of labor,the FHR of a low-risk patient should be assessed every

A) 10 to 15 minutes.
B) 15 to 30 minutes.
C) 30 to 45 minutes.
D) 1 hour.

Question 37

A primigravida at 39 weeks of gestation is observed for 2 hours in the intrapartum unit.The fetal heart rate has been normal.Contractions are 5 to 9 minutes apart,20 to 30 seconds in duration,and of mild intensity.Cervical dilation is 1 to 2 cm and unchanged from admission.Membranes are intact.What action by the nurse is most appropriate?

A) Prepare the woman for a cesarean birth.
B) Admit the woman for extended observation.
C) Discharge the woman with a sedative so she can rest.
D) Provide discharge teaching on signs of true labor.

Question 38

A pregnant woman is at 38 weeks of gestation.She wants to know if any signs indicate "labor is getting closer to starting." The nurse informs the woman that which of the following is a sign that labor may begin soon?

A) Weight gain of 1.5 to 2 kg (3 to 4 lb)
B) Increase in fundal height
C) Urinary retention
D) Surge of energy

Question 39

Thirty minutes after birth,the nurse assesses a woman's fundus as soft and boggy.What action by the nurse takes priority?

A) Take the blood pressure.
B) Massage the fundus.
C) Notify the provider or nurse-midwife.
D) Place the woman in the Trendelenburg position.

Question 40

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth?

A) The fetal head is felt at 0 station during vaginal examination.
B) Bloody mucous discharge increases.
C) The vulva bulges and encircles the fetal head.
D) The membranes rupture during a contraction.

Question 41

A woman who is gravida 3 para 2 enters the intrapartum unit.Which nursing assessments take priority at this time? (Select all that apply.)

A) Fetal heart rate
B) Maternal vital signs
C) The woman's nearness to birth
D) Contraction patterns
E) Last food and water intake