Deck 16: Giving Birth

Question 1

Which statement 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.

Answer 1

Maternal circulating blood volume increases temporarily during contractions.

Question 2

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

Answer 2

Diminishes as the spiral arteries are compressed

Question 3

To be aware of potential risks to the laboring woman,the nurse understands that a breech presentation is associated with

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

Answer 3

Umbilical cord compression

Question 4

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 5

A patient whose cervix is dilated to 5 cm is considered to be in which phase of labor?

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

Question 6

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

Question 7

What occurrence is associated with cervical dilation and effacement?

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

Question 8

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 9

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 10

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 11

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

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 filling bladder every 15 minutes.
D) Recommend frequent position changes.

Question 12

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 13

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 14

To adequately teach patients about the process of labor,the nurse knows that which event 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

Question 15

A woman at 40 weeks of gestation should be instructed to go to a hospital or birth center for evaluation when she experiences

A) A trickle of fluid from the vagina
B) Thick pink or dark red vaginal mucus
C) Irregular contractions for 1 hour
D) Fetal movement

Question 16

What is an essential part of nursing care for the laboring woman?

A) Helping the woman manage the pain.
B) Eliminating the pain associated with labor.
C) Sharing personal experiences regarding labor and delivery to decrease her anxiety.
D) Feeling comfortable with the predictable nature of intrapartal care.

Question 17

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 18

It is important for the nurse providing care during labor to be aware that pregnant women can usually tolerate the normal blood loss associated with childbirth because they have

A) A higher hematocrit
B) Increased blood volume
C) A lower fibrinogen level
D) Increased leukocytes

Question 19

Which assessment finding could indicate hemorrhage in the postpartum patient?

A) Firm fundus at the midline
B) Saturation of two perineal pads in 4 hours
C) Elevated blood pressure
D) Elevated pulse rate

Question 20

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) The status of the membranes

Question 21

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 22

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 23

A woman who is gravida 3 para 2 enters the intrapartum unit.The most important nursing assessments are

A) Contraction pattern, amount of discomfort, and pregnancy history
B) Fetal heart rate, maternal vital signs, and the woman's nearness to birth
C) Identification of ruptured membranes, the woman's gravida and para, and her support person
D) Last food intake, when labor began, and cultural practices the couple desires

Question 24

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

A) 15 minutes
B) 30 minutes
C) 45 minutes
D) 1 hour

Question 25

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 26

The nurse who elects to practice in the area of obstetrics often hears discussion regarding the "four Ps." These are the four major factors that interact during normal childbirth.What are the "four Ps"?

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

Question 27

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) Determine if fetal tachycardia is present.

Question 28

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

A) Inform the mother that the rate is normal.
B) Reassess the FHR in 5 minutes because the rate is too high.
C) Report the FHR to the physician or nurse-midwife immediately.
D) Tell the mother that she is going to have a boy because the heart rate is fast.

Question 29

If a woman's fundus is soft 30 minutes after birth,the nurse's first response should be to

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

Question 30

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 uneffaced (unchanged from admission).Membranes are intact.The nurse should expect the woman to be

A) Admitted and prepared for a cesarean birth
B) Admitted for extended observation
C) Discharged home with a sedative
D) Discharged home to await the onset of true labor

Question 31

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 32

To adequately care for a laboring woman,the nurse should know that the _____ stage of labor varies the most in length.

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

Question 33

Inquiring about past pregnancies is an important part of the nursing assessment.Women who have had a previous cesarean birth may request a trial of labor and a ______ delivery.

Question 34

Occasionally a woman arrives at the intrapartum unit ready to give birth.Bearing down,grunting,or stating something like "the baby's coming" should direct the nurse to advise the client,"Do not push,pant,and blow until the physician arrives." Is this statement true or false?

Question 35

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 36

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 37

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 38

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!" This behavior is most likely

A) Normal and related to hyperventilation
B) Common during the transition phase of labor
C) A sign that she needs analgesia
D) Indicative of abnormal labor

Question 39

Which patient at term should go to the hospital or birth center the 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 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 mucus discharge increases.
C) The vulva bulges and encircles the fetal head.
D) The membranes rupture during a contraction.

Question 41

The woman in labor should be encouraged to use the Valsalva maneuver (holding one's breath and tightening abdominal muscles)for pushing during the second stage.Is this statement true or false?