Question 1

The perinatal nurse knows that a cephalic presentation has which of the following advantages to the woman in labor? (Select all that apply.)
A)Fetal skull bones have the ability to mold during birth.
B)The largest part of the fetus is presenting first.
C)The presenting part may not totally cover the cervix.
D)The shape of the fetal head is optimal for cervical dilatation.
E)The top of the fetal head assists with cervical effacement.

Accepted Answer

The following advantages are associated with a cephalic presentation: the fetal head is usually the largest part of the infant and after the fetal head is born,the rest of the body usually delivers without complications;the fetal head is capable of molding and there is sufficient time during labor and descent for molding of the fetal head to occur;molding helps the fetus to maneuver through the maternal birth passage;and the fetal head is smooth and round,which is the optimal shape to apply pressure to the cervix and to aid in dilation.Breech or malpresentations can lead to umbilical cord prolapse because the presenting part (e.g.,a foot)may not totally cover the cervix.The presenting part does not influence effacement.

Question 2

The nurse in the birthing unit is aware that according to the Emergency Medical Treatment and Active Labor Act (EMTALA),pregnant women should receive care for problems such as which of the following? (Select all that apply.)
A)A history of recent trauma
B)Contractions that occur 20 minutes apart
C)Decreased fetal movement
D)Rupture of the membranes
E)Sexually transmitted infections

Accepted Answer

The federal regulation known as the Emergency Medical Treatment and Active Labor Act (EMTALA)was created to ensure that all women receive emergency treatment or active labor care whenever such treatment is sought.The nurse who is working in a birthing unit must be familiar with the full range of responsibilities included in the EMTALA regulations: (1)provide services to pregnant women when an urgent pregnancy problem such as labor,rupture of the membranes,decreased fetal movement,or recent trauma is experienced;and (2)fully document all relevant information to include assessment findings,interventions implemented,and the patient's response to the care provided.Treatment would not be required for women whose contractions are 20 minutes apart or who may have sexually transmitted infections.

Question 3

The nurse assessing a woman in the third stage of labor would expect which of the following findings? (Select all that apply.)
A)Cramping as the placenta delivers
B)Mother crying or feeling relieved
C)Presence of lochia rubra with small clots possible
D)Uterus rises upward
E)Vital signs returning to prelabor values

Accepted Answer

During the third stage of labor,the mother may experience cramping as the placenta is expelled,after which the uterus will rise upward.The mother may cry or express relief that labor is over.Lochia rubra and prelabor vital signs are seen in the fourth stage of labor.

Question 4

The faculty member teaching a class of students explains several theories regarding the onset of labor.Which of the following does the faculty member include? (Select all that apply.)
A)Closure of ductus arteriosus
B)Molding of the fetal head
C)Placental aging
D)Pressure on the cervix
E)Uterine muscle stretching

Accepted Answer

Several theories regarding the onset of labor exist and include (among others)placental aging,
pressure on the cervix,and uterine muscle stretching.

Question 5

A nursing instructor explains to the class of nursing students that the critical factors affecting the progress of labor include which of the following? (Select all that apply.)
A)Passageway
B)Passageway + Passenger
C)Passenger
D)Productivity
E)Psychosocial factors

Accepted Answer

The 5 P's of labor are Powers,Passageway,Passenger,Passageway + Passenger,and Psychosocial influences.Productivity is not included.

Question 6

When calling the primary health-care provider regarding a woman's admission,the perinatal nurse includes which of the following information? (Select all that apply.)
A)Gestational age and estimated date of birth
B)Maternal and fetal vital signs
C)Presence of support person(s)
D)Status of other children
E)Status of the fetal membranes

Accepted Answer

Critical information to relay to the physician or nurse-midwife includes the patient's name and age;gravidity and parity;gestational age and estimated date of delivery;labor status,pattern of contractions,cervical dilatation and effacement;fetal presentation and station;status of the fetal membranes;fetal heart rate and response to contractions;patient's vital signs,especially blood pressure and temperature;any identified risk to maternal or fetal well-being;and the patient's coping ability in response to labor.Presence of support persons and status of other children would not be critical information at this point.

Question 7

A nurse is caring for a new mother during the fourth stage of labor and assesses the following: patient has soaked two peri-pads in 45 minutes,pulse is 118 beats/minute,and blood pressure is 90/62 mm Hg.Which action by the nurse is most important?
A)Assess the firmness of the patient's uterus.
B)Document the findings and reassess in 15 minutes.
C)Encourage the woman to attempt breastfeeding.
D)Escort the woman to the bathroom to void.

Accepted Answer

Hypotension,tachycardia,excessive bleeding (more than one peri-pad in the first hour),and a boggy,noncontracting uterus are all danger signs of postpartum hemorrhage.Based on this woman's signs and symptoms,the nurse should assess her uterus and,if necessary,begin uterine massage.Documentation needs to be thorough,but further action is needed.Breastfeeding does stimulate the uterus,but this action is not the priority in a possible emergent situation.A hypotensive woman should not be ambulated.

Question 8

A woman who is 37 weeks pregnant calls the birthing center to report a gush of clear fluid from her vagina.What response by the nurse is best?
A)"Are you having any pain?"
B)"Come in now to be evaluated."
C)"Did you have any trauma?"
D)"It is too early for membrane rupture."

Accepted Answer

Any gush of fluid from a pregnant woman's vagina needs to be evaluated,even if there are no contractions.The other responses are not appropriate for this situation.

Question 9

A woman is admitted in labor.The perinatal nurse would demonstrate cultural sensitivity by assessing the patient for which of the following? (Select all that apply.)
A)Need for an interpreter
B)Pain management and coping techniques
C)Preference for food during labor
D)Preferences for touch during labor
E)Support person during labor
F)None of the above

Accepted Answer

Culturally oriented views of childbirth help to shape the woman's expectations and ongoing perceptions of the birth experience.The nurse's understanding of the cultural values and expectations attached to childbirth provide a meaningful framework on which to plan and deliver sensitive,appropriate care.Cultural considerations for the laboring woman encompass many elements of the birth experience,including choice of a birth support person,strategies for coping with contractions,pain expression and relief,language preference,use of touch,and food preferences.

Question 10

The nurse instructs the pregnant woman to report any rupture of the membranes along with a description of the fluid.Which of the following would the nurse evaluate as normal amniotic fluid? (Select all that apply.)
A)Clear liquid
B)Contains white specks
C)Presence of lanugo
D)Slight ammonia odor
E)Yellow-greenish color

Accepted Answer

Amniotic fluid should be clear and odorless.It may contain white specks and/or fetal hair (lanugo).Yellowish-green tinged fluid may indicate infection or the presence of meconium.

Question 11

The perinatal nurse describes normal maternal signs and symptoms associated with lightening to the prenatal class attendants.These signs and symptoms include which of the following? (Select all that apply.)
A)Difficulty breathing
B)Increased urinary frequency
C)Increased vaginal secretions
D)Leg cramps
E)Nausea and vomiting

Accepted Answer

The downward settling that occurs during lightening may also lead to the following maternal symptoms: leg cramps or pains,increased pelvic pressure,increased urinary frequency,increased venous stasis that may cause edema in the lower extremities,and increased vaginal secretions related to congestion in the vaginal mucosa.The downward movement of the fetus actually may make breathing easier.Nausea and vomiting are not associated symptoms.

Question 12

A nurse is assisting with an amnioinfusion.What critical nursing actions are included in this procedure? (Select all that apply.)
A)Assessing the maternal temperature
B)Assembling equipment
C)Documenting fluid exiting the vagina
D)Maintaining sterile technique
E)Monitoring the fetal heart rate

Accepted Answer

The critical nursing actions during this procedure are assembling the equipment;monitoring the fetal heart rate,contraction status,and maternal temperature;and verifying and documenting that the infused fluid exits the vagina.The nurse is not performing the procedure;it is up to the provider to maintain sterile technique.Of course the nurse should be vigilant that sterile technique is not breached.

Question 13

A nurse assesses a newborn as follows: heart rate is 112 beats/minute;respiratory effort: slow,irregular,with a weak cry;muscle tone: some flexion of the extremities;reflex irritability: grimace;color: pink.What Apgar score does the nurse give this infant?
____________________

Accepted Answer

The answer of A nurse assesses a newborn as follows:...

Question 14

The perinatal nurse obtains valuable information from a vaginal examination.Which of the following assessments from this examination should the nurse document? (Select all that apply.)
A)Extent of cervical dilation
B)Fetal presentation
C)Presence of cervical effacement
D)Status of the amniotic membranes
E)Strength of uterine contractions

Accepted Answer

The vaginal examination provides important information regarding the diameter of the opening of the cervix,which ranges from 1 cm (not dilated)to 10 cm (fully dilated);the status of the amniotic membranes (ruptured or intact);and the fetal presentation and the station or the extent of the fetal descent through the maternal pelvis.A trained examiner can also assess effacement of the cervix during a vaginal exam.

Question 15

The nurse is assessing a woman in labor.What techniques are vital for the nurse to use during this assessment? (Select all that apply.)
A)Auscultation
B)Inspection
C)Interviewing
D)Percussion
E)Palpation

Accepted Answer

The nurse uses the skills of interviewing,inspection (observation),palpation,and auscultation to assess the woman in labor.Percussion is not generally used in this assessment.

Question 16

A nurse notes variable decelerations on the fetal heart monitor and is explaining them to the laboring woman and her partner.What information about these patterns does the nurse share? (Select all that apply.)
A)Last at least 15 seconds
B)Least common type of deceleration pattern
C)May be a result of cord compression
D)Occur at any time during a contraction
E)Return to baseline within 4 minutes

Accepted Answer

Variable decelerations are inconsistent in the onset,peak,duration,and intensity.They are the most common type of deceleration pattern seen in labor.They last at least 15 seconds,occur any time during a contraction,and may be the result of cord compression.They return to baseline within 2 minutes.

Question 17

The perinatal nurse knows that changes in the pelvic floor musculature that normally occur in labor include which of the following? (Select all that apply.)
A)Eversion of the anus
B)Exposure of the internal rectal wall
C)Pulling downward on the levator ani muscles
D)Rectum drawn upward and backward
E)Thinning of the perineal body

Accepted Answer

Uterine contractions bring about changes in the pelvic floor musculature.The forces of labor cause the levator ani muscles and fascia of the pelvic floor to draw the rectum and vagina upward and forward.During descent,the fetal head exerts increasing pressure and causes thinning of the perineal body from 5 cm to less than 1 cm in thickness.Continued pressure causes the maternal anus to evert,and the interior rectal wall is exposed as the fetal head descends forward.

Question 18

The perinatal nurse describes prelabor or Braxton Hicks contractions to the prenatal class attendants as which of the following? (Select all that apply.)
A)Contributing to cervical effacement and dilation
B)Felt in the abdomen or groin
C)Intensely painful
D)Irregular
E)Regular and progressive

Accepted Answer

As the pregnancy approaches term,most women become more aware of irregular contractions called Braxton Hicks contractions.As the contractions increase in frequency (they may occur as often as every 10 to 20 minutes),they may be associated with increased discomfort.Braxton Hicks contractions are usually felt in the abdomen or groin region,and patients may mistake them for True labor.It is believed that these contractions contribute to the preparation of the cervix and uterus for the advent of True labor.However,Braxton Hicks contractions do not lead to dilation or effacement of the cervix,and therefore are often termed "False labor."

Question 19

Place the following cardinal movements in the order in which they occur as a fetus passes through the birth canal during a vertex-presentation birth.
A. _____ Flexion
B. _____ External rotation
C. _____ Descent
D. ____ Extension
E. _____ Restitution
F. _____ Internal rotation
G. ____ Expulsion

Accepted Answer

The answer of Place the following cardinal movements in the...

Question 20

A young girl in active labor arrives at the hospital without having had any prenatal care.She is extremely anxious and crying out in pain.What would the nurse assess to best determine that goals for the diagnosis of knowledge deficit have been met? (Select all that apply.)
A)Begs her mother to stay with her while giving birth
B)Can describe expected labor progress and states she is in less pain
C)Is able to cooperate with breathing instructions during contractions
D)Is able to give a history of this pregnancy to the admitting nurse
E)States that after this birth,she wants to learn about birth control

Accepted Answer

A lack of knowledge can lead to anxiety and increased perceived pain.When the patient understands labor progression and the events surrounding childbirth,she will be better able to cooperate with breathing instructions and hopefully will feel less pain as she feels more in control.The other actions do not show the benefit of an educated patient.

Quiz 12: The Process of Labor and Birth

The perinatal nurse knows that a cephalic presentation has which of the following advantages to the woman in labor? (Select all that apply.)

The nurse in the birthing unit is aware that according to the Emergency Medical Treatment and Active Labor Act (EMTALA) ,pregnant women should receive care for problems such as which of the following? (Select all that apply.)

The nurse assessing a woman in the third stage of labor would expect which of the following findings? (Select all that apply.)

The faculty member teaching a class of students explains several theories regarding the onset of labor.Which of the following does the faculty member include? (Select all that apply.)

A nursing instructor explains to the class of nursing students that the critical factors affecting the progress of labor include which of the following? (Select all that apply.)

When calling the primary health-care provider regarding a woman's admission,the perinatal nurse includes which of the following information? (Select all that apply.)

A nurse is caring for a new mother during the fourth stage of labor and assesses the following: patient has soaked two peri-pads in 45 minutes,pulse is 118 beats/minute,and blood pressure is 90/62 mm Hg.Which action by the nurse is most important?

A woman who is 37 weeks pregnant calls the birthing center to report a gush of clear fluid from her vagina.What response by the nurse is best?

A woman is admitted in labor.The perinatal nurse would demonstrate cultural sensitivity by assessing the patient for which of the following? (Select all that apply.)

The nurse instructs the pregnant woman to report any rupture of the membranes along with a description of the fluid.Which of the following would the nurse evaluate as normal amniotic fluid? (Select all that apply.)

The perinatal nurse describes normal maternal signs and symptoms associated with lightening to the prenatal class attendants.These signs and symptoms include which of the following? (Select all that apply.)

A nurse is assisting with an amnioinfusion.What critical nursing actions are included in this procedure? (Select all that apply.)

A nurse assesses a newborn as follows: heart rate is 112 beats/minute;respiratory effort: slow,irregular,with a weak cry;muscle tone: some flexion of the extremities;reflex irritability: grimace;color: pink.What Apgar score does the nurse give this infant? ____________________

The perinatal nurse obtains valuable information from a vaginal examination.Which of the following assessments from this examination should the nurse document? (Select all that apply.)

The nurse is assessing a woman in labor.What techniques are vital for the nurse to use during this assessment? (Select all that apply.)

A nurse notes variable decelerations on the fetal heart monitor and is explaining them to the laboring woman and her partner.What information about these patterns does the nurse share? (Select all that apply.)

The perinatal nurse knows that changes in the pelvic floor musculature that normally occur in labor include which of the following? (Select all that apply.)

The perinatal nurse describes prelabor or Braxton Hicks contractions to the prenatal class attendants as which of the following? (Select all that apply.)

Place the following cardinal movements in the order in which they occur as a fetus passes through the birth canal during a vertex-presentation birth. A. ___ Flexion B. _ External rotation C. _ Descent D. Extension E. _ Restitution F. _ Internal rotation G. __ Expulsion

A young girl in active labor arrives at the hospital without having had any prenatal care.She is extremely anxious and crying out in pain.What would the nurse assess to best determine that goals for the diagnosis of knowledge deficit have been met? (Select all that apply.)