Deck 22: Processes and Stages of Labor and Birth

Question 1

To identify the duration of a contraction, the nurse would:

A) Start timing from the beginning of one contraction to the completion of the same contraction.
B) Time between the beginning of one contraction and the beginning of the next contraction.
C) Palpate for the strength of the contraction at its peak.
D) Time from the beginning of the contraction to the peak of the same contraction.

Answer 1

Start timing from the beginning of one contraction to the completion of the same contraction.

Question 2

A primigravida patient arrives in the labor and delivery unit and describes her contractions as occurring every 10-12 minutes, lasting 30 seconds. She is smiling and very excited about the possibility of being in labor. On exam, her cervix is dilated 2 cm, 100% effaced, and -2 station. What best describes this labor?

A) Second phase
B) Latent phase
C) Active phase
D) Transition phase

Answer 2

Latent phase

Question 3

A clinic nurse is preparing diagrams of pelvic shapes. Which pelvic shapes are considered least adequate for vaginal childbirth?

A) Android
B) Anthropoid
C) Gynecoid
D) Platypelloid
E) Lambdoidal suture

Answer 3

Android
Platypelloid

Question 4

A patient is admitted to the labor and delivery unit with contractions that are 2 minutes apart, lasting 60 seconds. She reports that she had bloody show earlier that morning. A vaginal exam reveals that her cervix is 100 percent effaced and 8 cm dilated. The nurse knows that the patient is in which phase of labor?

A) Active
B) Latent
C) Transition
D) Fourth

Question 5

The primiparous patient in early labor asks the nurse what the contractions are like as labor progresses. The nurse responds, "In normal labor, as the uterine contractions become stronger, they usually also become:

A) "Less frequent."
B) "Less painful."
C) "Longer in duration."
D) "Shorter in duration."

Question 6

A woman who is 40 weeks pregnant calls the labor suite to ask whether she should be evaluated. Which statements by the patient indicate she is likely in labor?

A) "The contractions are 5-20 minutes apart."
B) "I had pink discharge on the toilet paper."
C) "I have had cramping for the past 3-4 hours."
D) "The contractions are about a minute long and I am unable to talk through them."
E) "The contractions hurt more when I walk."

Question 7

A patient is admitted to the labor unit with contractions 1-2 minutes apart lasting 60-90 seconds. The patient is apprehensive and irritable. This patient is most likely in what phase of labor?

A) Active
B) Transition
C) Latent
D) Second

Question 8

The primiparous patient at 40 weeks' gestation reports to the nurse that she has had increased pelvic pressure and increased urinary frequency. Which response by the nurse is best?

A) "Unless you have pain with urination, we don't need to worry about it."
B) "These symptoms usually mean the baby's head has descended further."
C) "Come in for an appointment today and we'll check everything out."
D) "This might indicate that the baby is no longer in a head-down position."

Question 9

A nurse needs to evaluate the progress of a woman's labor. The nurse obtains the following data: cervical dilatation 6 cm; contractions mild in intensity, occurring every 5 minutes, with a duration of 30-40 seconds. Which clue in this data does not fit the pattern suggested by the rest of the clues?

A) Cervical dilatation 6 cm
B) Mild contraction intensity
C) Contraction frequency every 5 minutes
D) Contraction duration 30-40 seconds

Question 10

The charge nurse has received the shift change report. Which patient requires immediate intervention?

A) Multip at 6 cm undergoing induction of labor, strong contractions every 3 minutes
B) Primip at 4 cm whose fetus is in a longitudinal lie with a cephalic presentation
C) Multip at 10 cm and fetus at +2 station experiencing a strong expulsion urge
D) Primip at 3 cm screaming in fear because her mother died during childbirth

Question 11

The primiparous patient has asked the nurse why her cervix has only changed from 1 to 2 cm in 3 hours of contractions occurring every 5 minutes. The best response by the nurse is:

A) "Your cervix has also effaced, or thinned out, and that change in the cervix is also labor progress."
B) "When your perineal body thins out, your cervix will begin to dilate much faster than it is now."
C) "What did you expect? You've only had contractions for a few hours. Labor takes time."
D) "The hormones that cause labor to begin are just getting to be at levels that will change your cervix."

Question 12

A patient who is having false labor most likely would have:

A) Contractions that do not intensify while walking.
B) An increase in the intensity and frequency of contractions.
C) Progressive cervical effacement and dilatation.
D) Pain in the abdomen that does not radiate.
E) Contractions that lessen with rest and warm tub baths.

Question 13

A patient is being admitted to the labor and delivery suite. The nurse will need to report the patient's progress to the primary healthcare practitioner. Which findings should the nurse report?

A) Fetal heart rate
B) Contraction pattern
C) Contraction stress test
D) Vital signs
E) Biophysical profile

Question 14

The nurse is preparing a patient education handout on the differences between false labor and true labor. What information is most important for the nurse to include?

A) True labor contractions begin in the back and sweep toward the front.
B) False labor often feels like abdominal tightening, or "balling up."
C) True labor can be diagnosed only if cervical change occurs.
D) False labor contractions do not increase in intensity or duration.

Question 15

How would the nurse best analyze the results from a patient's sonogram that shows the fetal shoulder as the presenting part?

A) Breech, transverse
B) Breech, longitudinal
C) Breech, frank
D) Vertex, transverse

Question 16

The nurse is teaching a prenatal class about false labor. The nurse should teach patients that false labor most likely will include which of the following?

A) Contractions that do not intensify while walking
B) An increase in the intensity and frequency of contractions
C) Progressive cervical effacement and dilatation
D) Pain in the abdomen that does not radiate
E) Increased thin vaginal secretions

Question 17

The primiparous patient at 39 weeks' gestation calls the clinic and reports increased bladder pressure but easier breathing and irregular, mild contractions. She also states that she just cleaned the entire house. Which statement should the nurse make?

A) "You shouldn't work so much at this point in pregnancy."
B) "What you are describing is not commonly experienced in the last weeks."
C) "Your body may be telling you it is going into labor soon."
D) "If the bladder pressure continues, come in to the clinic tomorrow."

Question 18

Four minutes after the birth of a baby, there is a sudden gush of blood from the mother's vagina and about 8 inches of umbilical cord slides out. What action should the nurse take first?

A) Place the bed in Trendelenburg position.
B) Watch for the emergence of the placenta.
C) Prepare for the delivery of an undiagnosed twin.
D) Roll her onto her left side.

Question 19

A primigravida calls the labor and delivery unit and tells the nurse that she is 39 weeks pregnant and that over the last 4 or 5 days, she has noticed that although her breathing has become easier, she is having leg cramps, a slight amount of edema in her lower legs, and an increased amount of vaginal secretions. The nurse tells the patient that she has experienced what is commonly called:

A) Quickening.
B) Lightening.
C) Dilation.
D) Braxton Hicks contractions.

Question 20

The nurse is caring for laboring patients. Which women are experiencing problems related to a critical factor of labor?

A) Primip at 7 cm, fetus in military attitude
B) Multip at 3 cm, fetus in longitudinal lie
C) Primip at 4 cm, fetus with macrocephaly due to hydrocephalus
D) Multip at 6 cm, fetus at -2 station, mild contractions
E) Primip at 5 cm, fetal presenting part is right shoulder.

Question 21

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

A) Multip at 5 cm requesting labor epidural analgesia
B) Primip whose cervix remains at 6 cm for 4 hours
C) Multip who has developed nausea and vomiting
D) Primip requesting her partner to stay with her

Question 22

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

A) After a vaginal exam
B) Before administration of analgesics
C) Periodically at the end of a contraction
D) Every 10 minutes
E) Before ambulating

Question 23

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:

A) Sacrum.
B) Left arm.
C) Mentum.
D) Left scapula.
E) Right scapula.

Question 24

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?

A) Flexion, extension, restitution, external rotation, and expulsion
B) Expulsion, external rotation, and restitution
C) Restitution, flexion, external rotation, and expulsion
D) Extension, restitution, external rotation, and expulsion

Question 25

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

A) Is imminent.
B) Is likely to occur in 1-2 hours.
C) Will occur later in the shift.
D) Is difficult to predict.

Question 26

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

A) Maternal exhaustion.
B) Cervical edema.
C) Tearing and bruising of the cervix.
D) Enhanced perineal thinning.
E) Having to perform an episiotomy.

Question 27

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?

A) Leave the patient alone so she can rest.
B) Ask the family to take a coffee-and-snack break.
C) Encourage the patient to have an epidural for pain.
D) Reassure the patient that she will not be left alone.

Question 28

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

A) Multip at 8 cm, systolic blood pressure has increased 35 mm Hg.
B) Primip who delivered 1 hour ago with WBC of 50,000
C) Multip at 5 cm with a respiratory rate of 22 between contractions
D) Primip in active labor with urine output of 100 ml/hour

Question 29

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?

A) Bulging perineum
B) Increased bloody show
C) Spontaneous rupture of the membranes
D) Uncontrollable urge to push
E) Inability to breathe through contractions

Question 30

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:

A) Turn the patient onto her left side.
B) Place the bed in Trendelenburg position.
C) Massage the fundus.
D) Continue to monitor.

Question 31

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

A) Are approximately the same size.
B) Close within 12 months of birth.
C) Are used in labor to identify station.
D) Allow for molding of the head.

Question 32

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

A) Occiput posterior.
B) Mentum anterior.
C) Occiput anterior.
D) Mentum posterior.

Question 33

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?

A) Increased pulse
B) Elevated blood pressure
C) Muscle tension
D) Increased respirations

Question 34

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:

A) Weak.
B) Mild.
C) Moderate.
D) Strong.