Deck 19: Nursing Care of the Family During Labor and Birth

Question 1

The nurse should assist the laboring woman into a hands-and-knees position when:

A)The occiput of the fetus is in a posterior position
B)The fetus is at or above the ischial spines
C)The fetus is in a vertex presentation
D)The membranes rupture

Answer 1

The occiput of the fetus is in a posterior position

Question 2

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.Based on 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

Answer 2

Document the findings because they reflect the expected contraction pattern for the active phase of labor

Question 3

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

A)Experiences a strong urge to bear down
B)Shows perineal bulging
C)Feels tired yet relieved that the worst is over
D)Shows an increase in bright red bloody show

Answer 3

Feels tired yet relieved that the worst is over

Question 4

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 5

Nurses alert to signs of the onset of the second stage of labor can be certain that 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 6

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 7

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 8

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

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

Question 9

A multiparous woman has been in labor for 8 hours.Her membranes have just ruptured.The nurse's initial response is 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 10

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 11

Through vaginal examination,the nurse determines that a woman is 4 cm dilated,and the external fetal monitor shows uterine contractions every 3 1/2 to 4 minutes.The nurse reports this as:

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

Question 12

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)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 13

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

A)Keeping the 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 14

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

A)The gender of the fetus
B)The number of fetuses
C)The fetal lie and attitude
D)The degree of the presenting part's descent into the pelvis

Question 15

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
B)Active: moderate,regular contractions;4 to 7 cm dilation
C)Lull: no contractions;dilation stable
D)Transition: very strong but irregular contractions;8 to 10 cm dilation

Question 16

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 17

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 18

Because the risk for childbirth complications may be revealed,nurses should know that the point of maximal intensity (PMI)of the fetal heart rate (FHR)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

Question 19

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 20

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 complications
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 21

A woman from out of state is visiting her relatives for the holidays.She presents at your facility in labor but does not have a copy of her prenatal records.The nurse would like to contact the woman's health care provider to obtain these records.Because the woman is in active labor it is not necessary for the nurse to obtain written consent for the transfer of these records.Is this statement true or false?

Question 22

Which collection of risk factors will most likely 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 23

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 appears before the shiny fetal surface
D)The major risk for women during the third stage is a rapid heart rate

Question 24

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

Question 25

The Valsalva maneuver can be described as the process of making a forceful bearing-down attempt while holding one's breath with a closed glottis and tightening the abdominal muscles.During the second stage of labor,when the woman is ready to push,this is considered the optimal method to enhance movement of the fetus down the birth canal.Is this statement true or false?

Question 26

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

Question 27

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 28

In the recovery room,if a woman is asked either to raise her legs (knees extended)off the bed or to flex her knees,place her feet flat on the bed,and raise her buttocks well off the bed,most likely she is being tested to see whether she:

A)Has recovered from epidural or spinal anesthesia
B)Has hidden bleeding underneath her
C)Has regained some flexibility
D)Is a candidate to go home after 6 hours

Question 29

The progress of labor can be verified effectively through use of a chart that plots cervical dilation and station.This chart is called a(n)____________________.

Question 30

Emergency conditions during labor that require immediate nursing intervention can arise with startling speed.Examples of such emergencies include (choose all that apply):

A)Nonreassuring or abnormal fetal heart rate (FHR)pattern
B)Inadequate uterine relaxation
C)Vaginal bleeding
D)Infection
E)Prolapse of the cord

Question 31

A 25-year-old gravida 2,para 2-0-0-2 gave birth 4 hours ago to a 9-lb,7-oz boy after augmentation of labor with oxytocin (Pitocin).She puts on her call light and asks for her nurse right away,stating "I'm bleeding a lot." The most likely cause of postpartum hemorrhage in this woman is:

A)Retained placental fragments
B)Unrepaired vaginal lacerations
C)Uterine atony
D)Puerperal infection

Question 32

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 33

The period encompassing the first 1 to 2 hours after birth often is referred to as the ____________________ stage of labor.

Question 34

A woman who has a history of sexual abuse may have a number of traumatic memories triggered during labor.She 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 is key for the nurse to use while providing care?

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

Question 35

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 practices and learn to incorporate them into a mutually agreed-upon 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 should anticipate that a woman from which country will have the baby's father in attendance?

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