Question 1

A nurse midwife is reviewing the laboratory tests of a client who is in labor. The laboratory findings include a hemoglobin level of 10 g/dL and a hematocrit concentration of 34%. The nurse midwife is correct if she determines that the client is at risk for which of the following during the postpartum period?

Accepted Answer

The client is at risk for postpartum infection. Research reveals that clients in labor who have anemia, which is demonstrated by low hemoglobin and hematocrit levels, have increased risk for postpartum infection, cardiac decompensation and poor wound healing. Decreased hemoglobin or hematocrit does not increase a client's risk of hemorrhage.

Question 2

A nurse midwife may administer meperidine to which of the following clients?

Accepted Answer

A nurse midwife may administer meperidine to the client who is 39 at weeks' gestation and is expected to give birth in 3 hours. Meperidine is not administered in early labor because it may slow the labor process. It is also not administered when labor is expected within one hour because it may enter the fetal circulation and cause respiratory depression. Meperidine is not usually administered to clients in preterm labor. Premature infants have immature lungs, and administering meperidine may further increase their risk for respiratory distress.

Question 3

A client in labor is given oxytocin as an artificial way to induce labor. The nurse midwife reviews the fetal heart monitor tracing and notes that the contractions occur every 3 minutes, lasting about 60 seconds per contraction. Which of the following is the next action of the nurse?

Accepted Answer

The next action of the nurse is to document that the ideal contraction pattern is achieved. Oxytocin may be discontinued if the frequency of contraction occurs in less than 2 minutes or if the duration of each contraction is more than 90 seconds. If fetal distress is suspected, the oxytocin must be discontinued.

Question 4

Meperidine is administered to a client who is in labor. Which of the following actions by the nurse midwife is the most effective when caring for a client who is administered with meperidine?

Accepted Answer

The most effective action of the nurse midwife is to prepare naloxone. Meperidine may cause respiratory depression. If the client's respiratory rate falls below 12 breaths per minute, naloxone, its antidote, may be administered. The client is maintained in dorsal recumbent. Meperidine is most likely to cause hypotension.

Question 5

Which of the following fetal attitudes is the most advantageous for birth?

Accepted Answer

A fetus in full flexion is exhibiting the most advantageous fetal attitude for birth. The fetal attitude refers to the relation of the fetal parts to each other. It also refers to the degree of flexion the fetus assumes during labor. Full flexion presents the smallest anteroposterior diameter of the skull. Option B refers to military position, where the fetus is in moderate flexion. Option C refers to brow presentation. Option D is the least advantageous for birth. This position presents the occipitomental diameter of the head, the widest skull diameter, to the birth canal.

Question 6

A client in labor is administered with an anesthetic through the spinal subarachnoid space. Which of the following actions by the nurse is the least appropriate when managing the client?

Accepted Answer

The nurse midwife should monitor the client for hypotension, not hypertension Subarachnoid or spinal block relieves uterine and perineal pain and numbs the lower extremities, vagina and perineum. The anesthetic may cause headaches. The client should be flat on the bed for 8 to 12 hours. Administration of IV fluids is also appropriate.

Question 7

Induction of labor is ordered for a G2P1 client at 43 weeks' gestation. Induction of labor has begun if the following conditions are present except:

Accepted Answer

A Bishop score of less than 8 indicates that the cervix is not ripe and that induction of labor is must not be initiated. The other conditions for induction of labor include absence of cephalic disproportion, engagement of the presenting part, fetal lung maturity or L/S score greater than 2 and longitudinal fetal lie.

Question 8

A client in labor, who is administered with epidural anesthesia, develops hypotension. Which of the following is the immediate action of the nurse midwife?

Accepted Answer

The immediate action of the nurse midwife is to raise the client's legs. The other options include interventions that may help elevate blood pressure and stabilize the client's cardiovascular status.

Question 9

A nurse midwife is monitoring a client in labor. Assessment findings determine that the fetus is in cephalic presentation. The descent of _________________ to the level of the ischial spines indicates that engagement has started.

Accepted Answer

The descent of biparietal diameter, the widest part of the fetus in cephalic presentation, to the level of the ischial spines indicates that engagement has started. The intertrochanteric diameter is the widest part of the fetus in breech presentation.

Question 10

An epidural block is ordered for a client in labor. The nurse midwife maintains the client in which of the following positions after the anesthetic is administered?

Accepted Answer

After an epidural block is administered, the client is maintained in side lying position to keep the pressure off the vena cava and improve circulation to the uterus. The client may be positioned in supine position with a rolled blanket beneath the right hip. A client who is administered a subarachnoid or spinal block is maintained flat on bed for 8 to 12 hours.

Question 11

Which of the following clients in labor is most likely considered for artificial induction of labor?

Accepted Answer

A client who gave birth to an Rh-positive baby and failed to get a RhoGAM after birth is most likely considered for induction of labor. The indications for induction of labor include: Rh-sensitization, pregnancies at more than 42 weeks' gestation, prolonged rupture of membrane (longer than 24 hours), eclampsia, pre-eclampsia, intrauterine growth retardation and severe hypertension.

Question 12

A G2P1 client at 39 weeks' gestation is admitted to the labor and delivery unit. A pudendal block is ordered. Which of the following statements about pudendal block is the most accurate?

Accepted Answer

A pudendal block does not have an effect on the contractions or the fetus. It is usually administered before the birth of the baby and is used to block the perineal area for episiotomy. The effect may lasts for up to 30 minutes. Option A refers to lumbar epidural block. Options B and D refer to spinal block.

Question 13

A nurse midwife notes that presenting part of the fetus is at the +2 station. This finding indicates that that the fetal presenting part is:

Accepted Answer

A +2 station indicates that the fetal presenting part is 2 cm below the ischial spine. A 0 station indicates that the fetal presenting part is at the level of the ischial spine and that engagement has occurred. A -2 station indicates that the fetal presenting part is above the ischial spine.

Question 14

A nullipara has been in the latent phase of labor for over 20 hours. Prolonged latent phase is diagnosed. Which of the following findings would be expected for this client?

Accepted Answer

Uterine contractions with intensities below 15 mm Hg are usually noted in clients with prolonged latent phase. Other findings may include inadequate uterine relaxation between contractions and uterus in the hypertonic state. A Bishop score of 8 indicates a ripe cervix, an assessment finding that is not usually seen in clients diagnosed with prolonged latent phase.

Question 15

A multiparous client at 38 weeks' gestation has been in the latent phase of labor for over 15 hours. Which of the following are likely causes of the dysfunctional labor?
I.Cephalopelvic disproportion
II.Analgesia is given too early in labor
III.Abnormal fetal head position
IV.Hypertonic contractions

Accepted Answer

Cephalopelvic disproportion and analgesia given too early in labor are the most likely causes of prolonged latent phase of labor. Abnormal fetal head position causes prolonged deceleration phase. Hypertonic contractions are the usual cause of prolonged descent.

Question 16

A nurse midwife is monitoring a client who is in labor. Assessment findings reveal that the fetus is in LOA position. The nurse midwife notes that the presenting part of the fetus is at 0 station. This finding indicates that:

Accepted Answer

A 0 station indicates that the presenting part, the head of the fetus, is at the level of the ischial spines and that engagement has occurred. Option A indicates a +4 station. Option C indicates a negative station. Option D describes descent, the first cardinal movement of labor. Station refers to the relationship of the presenting part of the fetus to the level of the ischial spines.

Question 17

A nurse midwife is creating a care plan for a client who has been diagnosed with hypertonic uterine dysfunction. Which of the following interventions is included in the plan of care?

Accepted Answer

The nurse midwife should instruct the client to perform breathing exercises to relieve discomforts and pain. Through alleviation of pain, normal labor pattern may be achieved. The client must be encouraged to conserve energy. Amniotomy is considered for clients with hypotonic uterine dysfunction. The nurse midwife should assess for signs of dehydration.

Question 18

A nurse midwife is assessing whether or not induction of labor can be initiated for a client at 41 weeks' gestation. The nurse midwife specifically assesses for cervical ripening using the Bishop criteria. Assessment findings include the following: cervical dilatation = 2 cm; effacement = 70%; station = -2; consistency = medium; position = mid-position. Is the client's cervix ripe enough for induction of labor?

Accepted Answer

The client has a Bishop score of 5, so cervix is not ripe enough for induction of labor. Based on the Bishop criteria, a client's cervix is ripe for induction of labor if she scores 8 or greater. The Bishop criteria score cervical dilatation, effacement, station, consistency and position. Each component is scored from 0 to 2. For a score of 10, the highest score, a client must have the following: at least 3 to 4 cm cervical dilatation, at least 80% of cervical effacement, station of +1 or +2, soft consistency of the cervix and anterior tilting of the cervix.

Question 19

A client says she has a feeling that something is coming through her vagina. On examination, the nurse midwife notes that the umbilical cord is visible. Which of the following interventions is the least appropriate for the client?

Accepted Answer

The client must be administered with oxygen at a rate of 10 L/min. The immediate goal of the nurse midwife is to relieve the cord pressure. Placing the client in the knee chest position or Trendelenburg position may help relieve the pressure. Manually elevating the fetal head off the cord is essential. Gentle support is applied until the fetus is delivered by cesarean section.

Question 20

A client at 40 weeks' gestation comes to the facility after having a gush of clear of vaginal discharge, which occurs with contractions. The client is admitted to the unit after true labor is determined and the interventions have started. Which of the following is the priority action of the nurse midwife?

Accepted Answer

The priority action of the nurse midwife is to attach an external electronic fetal monitor. The client's amnion membranes have ruptured, which require assessment of the fetal heart tone. An L/S ratio is not necessary because it is not a priority action when managing a client who is in labor at 40 weeks' gestation. An L/S ratio test may be ordered if the labor needs to be augmented. Amniotomy is not necessary because the membranes have ruptured. The frequency of the contractions should be monitored, but it is not a priority action for the nurse midwife.

Quiz 3: Intrapartum