Question 1

The labor and delivery nurse is reviewing charts. The nurse should inform the supervisor about which patient?

Accepted Answer

A cervix that remains at 6 cm for 4 hours could indicate a failure to progress, which may require intervention. The other patients' situations are common and do not necessarily require immediate supervisor notification.

Question 2

During the latent phase of labor, when should the nurse assess the fetal heart pattern of a low-risk woman?

Accepted Answer

The answer of During the latent phase of labor, when...

Question 3

The nurse determines that a patient is carrying her fetus in the vertical lie. The nurse's judgment should be questioned if the fetal presenting part is the:

Accepted Answer

The answer of The nurse determines that a patient is...

Question 4

While caring for a patient in labor, the nurse notices during a vaginal exam that the baby's head has rotated internally. What would the nurse expect the next set of cardinal movements for a baby in a vertex presentation to be?

Accepted Answer

After the baby's head rotates internally, the next steps in the cardinal movements for a baby in a vertex presentation include extension as the head passes under the pubic symphysis, followed by restitution and external rotation to align the head with the body, and finally expulsion as the baby is delivered.

Question 5

The midwife performs a vaginal exam and determines that the fetal head is at a -2 station. The nurse knows that birth:

Accepted Answer

The fetal station of -2 indicates that the fetal head is 2 centimeters above the ischial spines, which means labor could progress in various ways depending on multiple factors such as the mother's labor pattern, whether it's her first baby, and other variables. Therefore, the timing of birth is difficult to predict based on station alone.

Question 6

The labor nurse would not encourage a mother to bear down until the cervix is completely dilated, to prevent:

Accepted Answer

The answer of The labor nurse would not encourage a...

Question 7

The nurse is caring for a laboring patient. A cervical exam indicates 8 cm dilation. The patient is restless, frequently changing position in an attempt to get comfortable. Which nursing action is most important?

Accepted Answer

It is important to reassure the patient that she will not be left alone during labor. This helps to alleviate anxiety and provides a sense of support for the patient. Leaving the patient alone (Option A) may cause her to feel unsupported and increase her anxiety. Asking the family to take a coffee-and-snack break (Option B) may be appropriate in some situations, but not when the patient is actively laboring. Encouraging the patient to have an epidural (Option C) is a personal decision and should not be imposed on the patient.

Question 8

Which patient requires immediate intervention by the labor and delivery nurse?

Accepted Answer

A WBC count of 50,000 indicates infection and requires immediate intervention to prevent further complications. The other scenarios may require monitoring and further assessment, but not immediate intervention.

Question 9

The nurse is caring for a patient in labor. Which signs and symptoms would indicate the patient is progressing into the second stage of labor?

Accepted Answer

The answer of The nurse is caring for a patient...

Question 10

During the fourth stage of labor, the patient's assessment includes a BP of 110/60, pulse 90, and the fundus is firm midline and halfway between the symphysis pubis and the umbilicus. The priority action of the nurse is to:

Accepted Answer

The patient's vital signs and fundal assessment are within normal limits during the fourth stage of labor, and no immediate action is necessary. However, continued monitoring is important to ensure that there are no changes in the patient's condition. Choices A and B are not indicated as there is no indication of hypotension or potential for supine hypotensive syndrome. Massage of the fundus may be necessary if it becomes boggy or deviates from midline, but it is not a priority action at this time.

Question 11

When comparing the anterior and posterior fontanelles of a newborn, the nurse knows that both:

Accepted Answer

The anterior and posterior fontanelles allow for molding of the newborn's head during birth, accommodating passage through the birth canal. The anterior fontanelle is larger and closes later (around 18-24 months) compared to the posterior fontanelle, which typically closes by 1-2 months after birth. Fontanelles are not used to identify station in labor, which refers to the baby's position relative to the ischial spines of the mother's pelvis.

Question 12

The nurse is aware that labor and birth will most likely proceed normally when the fetal position is:

Accepted Answer

Occiput anterior position, also known as the "head-down" position or vertex presentation, is the most common and favorable fetal position for labor and birth because the baby's head can easily fit through the mother's pelvis. Occiput posterior position, in which the baby's head is facing towards the mother's back, can cause a longer and more difficult labor. Mentum anterior (also known as "face-first" or brow presentation) and mentum posterior positions are both rare and can result in complications during labor and delivery.

Question 13

The labor and delivery nurse is preparing a prenatal class about facilitating the progress of labor. Which of the following frequent responses to pain should the nurse indicate is most likely to impede progress in labor?

Accepted Answer

Muscle tension can impede progress in labor by causing the uterus to work harder against the resistance of tense pelvic muscles. Increased pulse, elevated blood pressure, and increased respirations are all expected responses to pain in labor and do not necessarily impede progress.

Question 14

The nurse has just palpated a laboring woman's contractions. The uterus cannot be indented during a contraction. The nurse compares the consistency of the uterus during a contraction with that of the forehead. The intensity of these contractions would best be characterized as:

Accepted Answer

When the uterus cannot be indented during a contraction and its consistency is compared to the forehead, it indicates strong contractions. Weak contractions would allow the uterus to be easily indented, while moderate contractions would allow for some indentation but with resistance. Mild contractions would only cause slight tightening of the uterus. Therefore, the best choice is D.

Quiz 22: Processes and Stages of Labor and Birth