Deck 16: Labor and Birth Processes

Question 1

The nurse is performing an initial assessment of a client in labor.What is the appropriate terminology for the relationship of the fetal body parts to one another?

A) Lie
B) Presentation
C) Attitude
D) Position

Answer 1

Attitude

Question 2

Which statement related to fetal positioning during labor is correct and important for the nurse to understand?

A) Position is a measure of the degree of descent of the presenting part of the fetus through the birth canal.
B) Birth is imminent when the presenting part is at +4 to +5 cm below the spine.
C) The largest transverse diameter of the presenting part is the suboccipitobregmatic diameter.
D) Engagement is the term used to describe the beginning of labor.

Answer 2

Birth is imminent when the presenting part is at +4 to +5 cm below the spine.

Question 3

The nurse has received a report regarding a client in labor.The woman's last vaginal examination was recorded as 3 cm,30%,and -2.What is the nurse's interpretation of this assessment?

A) Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm above the ischial spines.
B) Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines.
C) Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm below the ischial spines.
D) Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm below the ischial spines.

Answer 3

Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines.

Question 4

When assessing the fetus using Leopold's maneuvers,the nurse feels a round,firm,and 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 position of the fetus?

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

Question 5

A woman's position is an important component of the labor progress.Which guidance is important for the nurse to provide to the laboring client?

A) The supine position, which is commonly used in the United States, increases blood flow.
B) The laboring client positioned on her hands and knees ("all fours" position) is hard on the woman's back.
C) Frequent changes in position help relieve fatigue and increase the comfort of the laboring client.
D) In a sitting or squatting position, abdominal muscles of the laboring client will have to work harder.

Question 6

Which basic type of pelvis includes the correct description and percentage of occurrence in women?

A) Gynecoid: classic female pelvis; heart shaped; 75%
B) Android: resembling the male pelvis; wide oval; 15%
C) Anthropoid: resembling the pelvis of the ape; narrow; 10%
D) Platypelloid: flattened, wide, and shallow pelvis; 3%

Question 7

Nurses should be cognizant of what regarding the mechanism of labor?

A) Seven critical movements must progress in a more or less orderly sequence.
B) Asynclitism is sometimes achieved by means of the Leopold's maneuver.
C) Effects of the forces determining descent are modified by the shape of the woman's pelvis and the size of the fetal head.
D) At birth, the baby is said to achieve "restitution"; that is, a return to the C-shape of the womb.

Question 8

Which stage of labor varies the most in length?

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

Question 9

Which adaptation of the maternal-fetal exchange of oxygen occurs in response to uterine contraction?

A) The maternal-fetal exchange of oxygen and waste products continues except when placental functions are reduced.
B) This maternal-fetal exchange increases as the blood pressure decreases.
C) It diminishes as the spiral arteries are compressed.
D) This exchange of oxygen and waste products is not significantly affected by contractions.

Question 10

A new mother asks the nurse when the "soft spot" on her son's head will go away.What is the nurse's best response,based upon her understanding of when the anterior frontal closes?

A) 2 months
B) 8 months
C) 12 months
D) 18 months

Question 11

What is the nurse's understanding of the appropriate role of primary and secondary powers?

A) Primary powers are responsible for the effacement and dilation of the cervix.
B) Effacement is generally well ahead of dilation in women giving birth for the first time; they are closer together in subsequent pregnancies.
C) Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation.
D) Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs.

Question 12

A pregnant woman is at 38 weeks of gestation.She wants to know whether there are any signs that "labor is getting close to starting." Which finding is an indication 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 13

Which statement regarding the care of a client in labor is correct and important to the nurse as he or she formulates the plan of care?

A) The woman's blood pressure will increase during contractions and fall back to prelabor normal levels between contractions.
B) The use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia.
C) Having the woman point her toes will reduce leg cramps.
D) Endogenous endorphins released during labor will raise the woman's pain threshold and produce sedation.

Question 14

Certain changes stimulate chemoreceptors in the aorta and carotid bodies to prepare the fetus for initiating respirations immediately after birth.Which change in fetal physiologic activity is not part of this process?

A) Fetal lung fluid is cleared from the air passages during labor and vaginal birth.
B) Fetal partial pressure of oxygen (PO₂) decreases.
C) Fetal partial pressure of carbon dioxide in arterial blood (PaCO₂) increases.
D) Fetal respiratory movements increase during labor.

Question 15

The nurse expects which maternal cardiovascular finding during labor?

A) Increased cardiac output
B) Decreased pulse rate
C) Decreased white blood cell (WBC) count
D) Decreased blood pressure

Question 16

A labor and delivery nurse should be cognizant of which information regarding how the fetus moves through the birth canal?

A) Fetal attitude describes the angle at which the fetus exits the uterus.
B) Of the two primary fetal lies, the horizontal lie is that in which the long axis of the fetus is parallel to the long axis of the mother.
C) Normal attitude of the fetus is called general flexion.
D) Transverse lie is preferred for vaginal birth.

Question 17

Which statement by the client would lead the nurse to believe that labor has been established?

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 18

What is the correct term describing the slight overlapping of cranial bones or shaping of the fetal head during labor?

A) Lightening
B) Molding
C) Ferguson reflex
D) Valsalva maneuver

Question 19

Which presentation is accurately described in terms of both the resenting part and the frequency of occurrence?

A) Cephalic: occiput, at least 96%
B) Breech: sacrum, 10% to 15%
C) Shoulder: scapula, 10% to 15%
D) Cephalic: cranial, 80% to 85%

Question 20

Which description of the four stages of labor is correct for both the definition and the duration?

A) First stage: onset of regular uterine contractions to full dilation; less than 1 hour to 20 hours
B) Second stage: full effacement to 4 to 5 cm; visible presenting part; 1 to 2 hours
C) Third stage: active pushing to birth; 20 minutes (multiparous woman), 50 minutes (nulliparous woman)
D) Fourth stage: delivery of the placenta to recovery; 30 minutes to 1 hour

Question 21

Because of its size and rigidity,the fetal head has a major effect on the birth process.Which bones comprise the structure of the fetal skull?

A) Parietal
B) Temporal
C) Fontanel
D) Occipital
E) Femoral

Question 22

Which statement is the best rationale for assessing the maternal vital signs between uterine contractions?

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

Question 23

Which factors influence cervical dilation?

A) Strong uterine contractions
B) Force of the presenting fetal part against the cervix
C) Size of the woman
D) Pressure applied by the amniotic sac
E) Scarring of the cervix

Question 24

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

A) Amount of cervical dilation
B) Total duration of labor
C) Level of pain experienced
D) Sequence of labor mechanisms

Question 25

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

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

Question 26

At least five factors affect the process of labor and birth.These are easily remembered as the five Ps.Which factors are included in this process?

A) Passenger
B) Passageway
C) Powers
D) Pressure
E) Psychologic response

Question 27

Nurses can help their clients by keeping them informed about the distinctive stages of labor.Which 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 28

Which changes take place in the woman's reproductive system,days or even weeks before the commencement of labor?

A) Lightening
B) Exhaustion
C) Bloody show
D) Rupture of membranes
E) Decreased fetal movement