Deck 3: Intrapartum

Question 1

A nurse midwife is creating a care plan for a client who is in early labor. Which of the following guidelines is least important?

A)Be certain that the outcomes are realistic.
B)Incorporate both the client and her support person.
C)Project a definite time limit for labor to be completed.
D)Address the discomforts of labor.

Answer 1

Project a definite time limit for labor to be completed.

Question 2

A nurse midwife is about to perform amniotomy on a client who is in her 39th week of gestation. Which of the following actions of the nurse midwife is the least appropriate before starting the procedure?

A)Examine the cervix and measure cervical dilatation.
B)Assess the fetal heart tone.
C)Maintain aseptic technique.
D)Position the client in lithotomy position.

Answer 2

Position the client in lithotomy position.

Question 3

A client is admitted to the labor and delivery unit. A nurse midwife is assessing the fetal heart tone monitor tracing and notes late decelerations. Which of the following is the most effective intervention?

A)Administer oxygen through a face mask.
B)Position the client in knee-chest position.
C)Administer oxytocin.
D)Document the findings and continue monitoring the client.

Answer 3

Administer oxygen through a face mask.

Question 4

A nurse midwife induces labor through amniotomy. The amniotic fluid is assessed and the nurse midwife notes that the amniotic fluid is red in color. This finding most likely suggests:

A)Fetal trauma.
B)Infection.
C)A fetal congenital disorder.
D)Fetal distress.

Question 5

A nurse midwife is reviewing the fetal heart rate monitor tracing obtained from a G2P1 client who is in labor. The nurse midwife notes decelerations at unpredictable times in relation to contractions. The nurse midwife suspects which of the following conditions?

A)Cephalopelvic disproportion
B)Good fetal-well being
C)Uteroplacental insufficiency
D)Cord compression

Question 6

A nurse midwife assesses a client who is in her 35th week of gestation. After conducting abdominal inspection and palpation, the nurse midwife notes that the fetus is in the transverse lie. This finding is verified by a sonogram. Which of the following actions by the nurse midwife is the most appropriate before an external version?

A)Initially order a contraction stress test.
B)Administer a tocolytic agent.
C)Monitor the heart rate for vena cava compression.
D)Withhold RhoGAM administration.

Question 7

A client at 39 weeks' gestation is admitted to the labor and delivery unit. An external fetal heart rate monitor is attached to the client. Physical examination and laboratory test results reveal that the fetus is in breech position, and a cesarean delivery is recommended. Physical examination is conducted and laboratory tests are ordered. Before the pregnancy, the client's average heart rate was 80 beats per minute. Which of the following assessment findings necessitates immediate physician notification?

A)Hematrocrit = 38%
B)WBC = 18,000 cells/mm3
C)Maternal heart rate = 95 beats per minute
D)Fetal heart rate = 180 beats per minute

Question 8

A nurse midwife conducts an amniotomy on a client to induce labor. Which of the following interventions is the priority of the nurse midwife after the procedure?

A)Administer oxygen.
B)Obtain the client's blood pressure.
C)Assess the fetal heart tone.
D)Position the client in knee-chest position.

Question 9

A few weeks before labor, the client may experience subtle signs that indicate the onset of labor. One of these signs is lightening. The nurse midwife teaches the client to recognize the signs of lightening. Which of the following is not a sign of lightening?

A)Relief from diaphragmatic pressure and shortness of breath.
B)Abdominal contour changes.
C)Increased urinary frequency.
D)Decreased amounts of vaginal discharge.

Question 10

A nurse midwife is caring for a client who is in the first stage of labor. The client's amniotic membranes have not ruptured. Which of the following interventions is the most effective during this stage of labor?

A)Apply distraction techniques during contractions.
B)Instruct the client to lie on her left side and to avoid frequent change of positions.
C)Instruct the client to void at least every two hours.
D)Limit therapeutic touch.

Question 11

A nurse midwife is about to perform an amniotomy on a client who is in the active phase of labor. Before performing the procedure, the nurse midwife informs the client that after the amniotomy, she can expect:

A)Increased efficiency of uterine contractions.
B)Increased number of uterine contractions.
C)Fluttery feeling in the chest.
D)Decreased number of uterine contractions.

Question 12

A nurse midwife is managing the care of a G3P2 client. The birthing room is converted into a birth room when the cervix is dilated to:

A)5 cm
B)5 to 7 cm
C)7 to 9 cm
D)10 cm

Question 13

A client with a multiple pregnancy is scheduled for cesarean delivery and is transported to the delivery operating room. The nurse midwife reminds the staff nurse to position the client in which of the following positions in the operating room?

A)Left side-lying position
B)Semi-Fowler position
C)Supine position, with a wedge placed under the right hip.
D)Supine position, with a wedge placed under the left hip.

Question 14

A nurse midwife is managing the care of a G1P0 client who is about to be placed in the lithotomy position. A registered nurse is positioning the client correctly and safely if which of the following nursing actions is observed by the nurse midwife?

A)The strap holding the leg in the stirrups is secured tightly.
B)The top portion of the table is raised to 15 to 20 degrees for effective pushing once the client is in the lithotomy position.
C)The legs are raised one at a time.
D)The registered nurse places the client's legs in the stirrups only when the nurse midwife is scrubbing.

Question 15

A client comes to the facility and tells the nurse midwife that she is in labor and is having some contractions. The client is at 37 weeks' gestation. Which of the following signs indicates that the client is in true labor?

A)Contractions are initially felt in lower back and then sweep around to the abdomen in a wave.
B)The contractions are relieved with ambulation and sleep.
C)The contractions do not achieve cervical dilatation.
D)The contractions remain irregular.

Question 16

After the placental delivery, which of the following is the next action of the nurse midwife?

A)Inspect the placenta.
B)Obtain a baseline blood pressure.
C)Administer oxytocin.
D)Administer an antihypertensive.

Question 17

A client gives birth to a baby girl through vaginal birth. After placental delivery, which of the following assessment findings indicates that further evaluation of the client is necessary?

A)Uterine fundus is firm.
B)The fundus is located at the level of the umbilicus.
C)About 300 mL of blood is lost.
D)Specific gravity increases.

Question 18

A client has just given vaginal birth to an eight-pound baby boy. A few minutes after the delivery, the nurse midwife observes lengthening of the umbilical cord and a gush of vaginal blood. The nurse midwife interprets these observations as:

A)Signs of hemorrhage.
B)Signs of placenta previa.
C)Signs of placental separation.
D)Signs of retained placental fragment.

Question 19

A nurse midwife notes that the separation of placenta from the uterus via the Schultze mechanism. This means that:

A)The margin of the placenta separated first; the red, dull and rough surface emerges from the vagina first.
B)The margin of the placenta separated first; the shiny surface emerges from the vagina first.
C)The center portion of the placenta separated first; the maternal surface emerges from the vagina first.
D)The center portion of the placenta separated first; the fetal surface emerges first from the vagina.

Question 20

Which of the following factors contribute(s) to a successful labor?
I. The client's pelvis is of adequate size and contour.
II. The fetus is in an advantageous position and presentation and is of appropriate size.
III. The uterine contractions are adequate.
IV. The client has a strong sense of self-esteem.

A)I and II
B)I and III
C)I, II and III
D)Successful labor depends of all of the above factors.

Question 21

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?

A)Anemia
B)Increased cardiac output
C)Postpartum infection
D)Hemorrhage

Question 22

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

A)A client at 39 weeks' gestation who is expected to give birth in 3 hours.
B)A client at 41 weeks' gestation in the latent phase of labor.
C)A client at 32 weeks' gestation who is expected to give birth in 2 hours.
D)A client at 38 weeks' gestation who is expected to give birth in 1 hour.

Question 23

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?

A)Discontinue oxytocin.
B)Increase oxytocin's rate of infusion.
C)Administer oxygen through face mask.
D)Document that the ideal contraction pattern is achieved.

Question 24

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?

A)Closely monitor the client's temperature.
B)Prepare naloxone.
C)Maintain the client in semi-Fowler's position.
D)Closely monitor for hypertension.

Question 25

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

A)The spine is bowed forward; the head is flexed with the chin touching the sternum; the arms and legs are flexed and folded on the chest; thighs are flexed into the abdomen; calves are pressed against the back of the thighs.
B)The chin is not touching the chest; occipital frontal diameter is the presenting part.
C)The brow of the head is the presenting part; fetus is in partial extension.
D)The back is arched; the neck is extended; occipitomental diameter of the head is the presenting part; fetus is in full extension.

Question 26

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?

A)The nurse midwife maintains the client flat on bed for 8 to 12 hours.
B)Inform the client that headaches may occur.
C)Monitor the client for hypertension.
D)Administer IV fluids.

Question 27

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:

A)Cephalic disproportion is not present.
B)The presenting part is engaged.
C)The L/S ratio is 2.5
D)The Bishop score is 7.

Question 28

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

A)Raise the client's legs.
B)Administer oxygen.
C)Administer IV fluids.
D)Administer ephedrine.

Question 29

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.

A)Biparietal diameter
B)Intertrochanteric diameter
C)Hips
D)Biacromial diameter

Question 30

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?

A)Dorsal recumbent
B)Side-lying position
C)Flat on bed for 12 hours
D)Supine with a rolled blanket beneath left hip

Question 31

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

A)A client who gave birth to an Rh-positive baby and failed to get a RhoGAM after birth.
B)A client at 43 weeks' gestation who has been in the second stage of labor for one hour.
C)A client who ruptured her membranes 18 hours ago.
D)A client with severe hypertension.

Question 32

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?

A)It is administered after labor is established.
B)It blocks uterine and perineal pain and numbs the lower extremities, vagina and perineum.
C)It has no effects on contractions or the fetus.
D)It may cause postpartum headache.

Question 33

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:

A)At the level of the ischial spine.
B)2 cm below the ischial spine.
C)2 cm above the ischial spine.
D)2 inches above the ischial spine.

Question 34

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?

A)Uterine contractions at 12 mm Hg
B)Bishop score - 8
C)Uterine relaxation between contractions is adequate.
D)The uterus is in the hypotonic state.

Question 35

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

A)I and II
B)I and III
C)I, II and III
D)All of the above are likely causes.

Question 36

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:

A)The presenting part is at the perineum, and the fetal head is crowning.
B)The presenting part is at the level of the ischial spines, and the fetal head is engaged.
C)The presenting part is above the level of the ischial spines, and the fetal head is floating.
D)The presenting part has descended to within the pelvic inlet.

Question 37

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?

A)Encourage the client to ambulate and change positions frequently.
B)Perform amniotomy.
C)Instruct the client to perform breathing exercises.
D)Assess for signs of fluid retention.

Question 38

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?

A)Yes. The Bishop score is 8.
B)No. The Bishop score is 7.
C)No. The Bishop score is 6.
D)No. The Bishop score is 5.

Question 39

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?

A)Assist the client in knee-chest position.
B)Position the client in Trendelenburg position.
C)Manually elevate the fetal head off the cord.
D)Administer oxygen 2 to 3 L/min

Question 40

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?

A)Order L/S ratio.
B)Perform amniotomy.
C)Attach an external electronic fetal monitor.
D)Determine the frequency of the contractions.

Question 41

A nurse midwife is caring for a client who is scheduled for a cesarean section. The multiparous client is pregnant with twins. The nurse midwife assesses the fetal heart tones through an external fetal monitor. Which of the following actions of the nurse is the most appropriate when assessing the client?

A)Place the monitor over the fetus that is more anterior to the client's abdomen.
B)Monitor each fetal heart rate with a separate fetal monitor.
C)Monitor the twin that is more anterior to the client's abdomen for 15 minutes and then monitor the other in the next 15 minutes.
D)Place the monitor over the umbilical level.

Question 42

A client is given oxytocin for the induction of labor. The nurse midwife should monitor the client for which of the following side effects of oxytocin?

A)Vomiting
B)Increased urine outflow
C)Hypertension
D)Bradycardia

Question 43

A nurse midwife is monitoring a client who is about to deliver the placenta. The client begins to complain of severe pain in the abdominal area. On assessment, the nurse midwife notes that there is a depression in the fundal area of the uterus. Increased flow of vaginal blood is also noted. The client is demonstrating signs of shock. The nurse suspects that the client is mostly experiencing:

A)Rupture of uterus.
B)Uterine inversion.
C)Placenta previa.
D)Abruptio placenta.

Question 44

A nurse midwife performs combined abdominal inspection and palpation on a client who is in labor and determines that the fetal position is ROA. Which of the following statements about the ROA fetal position is false?

A)The fetal landmark is pointing the client's right.
B)The occiput is the fetal landmark.
C)The fetus is in a transverse lie.
D)The back of the fetal head is pointing toward the client's anterior side.

Question 45

A client in labor is expected to give birth less than three hours after the onset of contractions. Which of the following actions by the nurse midwife is the most effective during the labor process?

A)Encourage the client to pant with each contraction.
B)Keep the fetus from being delivered
C)Deliver the infant between contractions.
D)Apply gentle, downward pressure to the fetal head, toward the rectum.

Question 46

A nurse midwife is monitoring a client who was admitted to the labor and delivery unit about 5 hours ago. The nurse midwife notes a cervical dilatation of 5 cm. The contractions occurring every 5 minutes usually last between 50 and 55 seconds. The client is in which phase of labor?

A)Latent phase
B)Active phase
C)Transition phase
D)Second stage of labor

Question 47

A client in labor begins to complain of severe abdominal pain and chest pain. On assessment, the nurse midwife notes that uterine contractions have stopped and that the abdomen is rigid. Fetal heart tone is not noted. The client's blood pressure decreases, and her heart rate increases to over 100 beats per minute. Which of the following is the next action of the nurse midwife?

A)Maintain bed rest in a side-lying position.
B)Prepare the client for cesarean delivery.
C)Administer oxytocin.
D)Initiate intubation and mechanical ventilation.

Question 48

A nurse midwife is caring for a client in labor and is about to determine the fetal position and presentation. Which of the following methods can be used to obtain the needed assessments?
I.Vaginal examination
II.Sonography
III.Combined abdominal inspection and palpation.
IV.Auscultation of fetal heart tones

A)I, III and IV
B)I, II and IV
C)II, III and IV
D)All of the above can be used to determine fetal position and presentation.

Question 49

After an ultrasound, a client in labor is informed that she has a low-lying placenta. Which of the following statements accurately describes the client's diagnosis?

A)The placenta is improperly implanted in the upper uterine segment.
B)The placenta attaches in the lower uterine segment but it does not reach the cervical os.
C)Only the edge of the placenta extends to the os.
D)The internal os is covered entirely by the placenta.

Question 50

A nurse midwife assesses a client in labor. Combined abdominal inspection and palpation and sonography indicate that the occiput of the fetus is the presenting part. The nurse midwife also finds out that there is a disproportion between the fetus and the client's pelvis. The history of the client's pregnancy is not remarkable. Routine screening tests suggested good fetal well-being. Which of the following statements made by the nurse midwife is the most appropriate when informing the client about the findings?

A)"Your pelvis is too small for the baby's head. Your baby cannot be born vaginally."
B)"Your baby's head is too large for your pelvis. You should consider a cesarean birth."
C)"We're considering a cesarean birth. Tell me how you feel about that."
D)"Your baby cannot be born vaginally. Do not worry much about it. We'll do everything to keep you and your baby safe."

Question 51

A client in her third trimester is admitted to the unit after complaining of painless, bright red vaginal bleeding. Placenta previa is suspected. Which of the following actions of the nurse midwife is not appropriate during the admission?

A)Prepare the patient for an ultrasound.
B)Prepare equipment for bi-manual pelvic examination.
C)Attach an external electronic fetal heart rate monitor.
D)Order blood tests, including hemoglobin and hematocrit counts.

Question 52

A nurse midwife is monitoring a client with a cervical dilatation of 3 cm. The nurse midwife determines that the client has contractions occurring every 3 minutes. Each contraction lasts for 50 seconds. The fetal heart rate is determined at 100 beats per minute. Which of the following is the priority action of the nurse midwife?

A)Encourage the client to push with every contraction and to rest in between contractions.
B)Administer oxygen via face mask.
C)Document the findings as normal.
D)Encourage frequent change of position.

Question 53

A primiparous client at 38 weeks' gestation is admitted to the labor and delivery room after showing signs of true labor. The client asks how long she should expect to be in labor before she gives birth to her baby. The nurse midwife informs the client that, on the average, the length of labor for primiparous clients is:

A)13 to 15 hours.
B)8 to 9 hours.
C)18 to 24 hours.
D)5 to 7 hours.

Question 54

A client at 38 weeks' gestation is admitted to the unit after complaining of painful, moderate vaginal bleeding of dark, clotted blood. A series of diagnostic and laboratory tests verify that the client is experiencing abruptio placenta. The fetal heart rate is 180 beats per minute. Which of the following actions is the priority action of the nurse midwife?

A)Order bed rest for the remainder of the pregnancy.
B)Prepare the client for cesarean delivery.
C)Prepare the client for platelet transfusion.
D)Instruct the client to avoid sexual intercourse throughout the pregnancy.

Question 55

A nurse midwife is assessing a client in labor by auscultating the fetal heart tone using the Doppler ultrasound. The fetal position is LOA. The nurse midwife should not:

A)Place the Doppler probe on the left side of the client's abdomen, just below the belly button.
B)Apply generous amounts of ultrasound gel to the client's abdomen and to the face of the probe.
C)Palpate the client's carotid pulse before auscultating the fetal heart tone.
D)Simultaneously palpate the client's radial pulse and auscultate the fetal heart tone.

Question 56

A nurse midwife is assessing a client at 34 weeks' gestation. An external fetal heart monitor is attached. Which of the following assessment findings suggest fetal distress?
I. Fetal heart rate decreases at the onset of contractions and returns to baseline after the contraction
II. Fetal heart rate of 130 beats per minute
III. Greenish amniotic fluid
IV. Continuous decrease in baseline variability

A)I and II
B)I and III
C)III and IV
D)I, III, and IV

Question 57

A client at 38 weeks' gestation is admitted to the facility after a nurse midwife suspects that she has a case of premature rupture of the amniotic membranes. Which of the following information given by the client supports this diagnosis?

A)Fewer than 5 fetal movements per hour for the past 24 hours.
B)Uterine contractions with leakage of clear fluid from the vagina.
C)Contractions are not alleviated with ambulation.
D)Leakage of clear fluid from the vagina without contractions.

Question 58

A nurse midwife suspects that a client at 39 weeks' gestation has hypertonic uterine activity. The client is in the early stages of labor. Which of the following findings support the diagnosis?
I.Uterine intensity is about 120 mm Hg.
II.Uterus relaxes between contractions for 90 seconds.
III.Uterine resting tone is 3 mm Hg.
IV.Uterine resting tone is 20 mm Hg.

A)I and IV
B)III and IV
C)I, II and III
D)All of the findings support a diagnosis of hypertonic uterine activity.

Question 59

A nurse midwife is monitoring a G3P2 client who is in labor. Cervical changes are assessed, and the findings are noted. Which of the following cervical changes would the nurse midwife expect when caring for the client?

A)Cervical effacement is accomplished before dilatation begins.
B)Cervical effacement and dilatation occur at the same time.
C)Cervical dilatation proceeds before full effacement.
D)Cervical dilatation is the only cervical change determined during labor

Question 60

A client at 38 weeks' gestation comes to the facility after experiencing leakage of clear fluid from the vagina without contractions. Premature rupture of membranes is suspected. Which of the following actions by the nurse midwife would be inappropriate for a client with this condition?

A)Perform digital vaginal examination.
B)Administer ampicillin IV.
C)Assess the client's cervix and vaginal cavity through sterile speculum vaginal examination.
D)Order L/S ratio.

Question 61

A nurse midwife is monitoring a client at 38 weeks' gestation who is in labor. The most recent findings include full dilatation and cervical effacement. The client says, "I feel this uncontrollable urge to push." The client is in which stage of labor?

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

Question 62

A G3P2 client at 41 weeks' gestation is in labor. The nurse midwife determines that the client has a cervical dilatation of 10 cm. At this time, the nurse would auscultate for the fetal heart tone:

A)Every 5 to 15 minutes.
B)Every 30 minutes.
C)Every 30 to 60 minutes.
D)At the start of each contraction.

Question 63

Each uterine contraction consists of three phases. The contraction is at strongest during which phase?

A)Increment
B)Acme
C)Climax
D)Decrement

Question 64

A client is in the second stage of labor and has been pushing for almost an hour. Which of the following interventions is the most appropriate for the client at this stage?

A)Offer clear fluids in between contractions.
B)Encourage ambulation.
C)Instruct the client to push with each contraction.
D)Encourage frequent changes in position.

Question 65

A client in labor is receiving oxytocin. The nurse midwife assesses the client and notes after uterine palpation that the contractions are uncoordinated and that only a portion of the uterus is involved. Which of the following is the priority action of the nurse midwife?

A)Administer oxygen by face mask at 8 to 10 L/min.
B)Position the client in the side-lying position.
C)Stop the infusion of oxytocin.
D)Check for a prolapsed cord.

Question 66

A nurse midwife reviews a fetal heart rate monitor tracing and notes decelerations occurring until 35 seconds after the onset of each contraction. The nurse midwife further notes that the decelerations are continuous past the end of each contraction. The fetal head is fully descended. The nurse midwife suspects which of the following conditions?

A)Fetal head compression
B)Cephalopelvic disproportion
C)Cord compression
D)Uteroplacental insufficiency

Question 67

A nurse midwife is monitoring a client in labor who is receiving intravenous oxytocin. The fetal heart rate monitor tracing reveals decelerations occurring 35 seconds after the onset of each contraction and continuously past the end of the each contraction. Which of the following is the priority action of the nurse midwife?

A)Change the client's position to side-lying position.
B)Position the client to Trendelenburg position.
C)Stop the administration of oxytocin.
D)Administer oxygen.