Deck 12: Processes of Birth

Question 1

Pregnant patients can usually tolerate the normal blood loss associated with childbirth because of which physiologic adaptation to pregnancy?

A) A higher hematocrit
B) Increased leukocytes
C) Increased blood volume
D) A lower fibrinogen level

Answer 1

Increased blood volume

Question 2

A patient in labor presents with a breech presentation. The nurse understands that a breech presentation is associated with

A) more rapid labor.
B) a high risk of infection.
C) maternal perineal trauma.
D) umbilical cord compression.

Answer 2

umbilical cord compression.

Question 3

Uncontrolled maternal hyperventilation during labor results in

A) metabolic acidosis.
B) metabolic alkalosis.
C) respiratory acidosis.
D) respiratory alkalosis.

Answer 3

respiratory alkalosis.

Question 4

The laboring patient asks the nurse how the labor contractions cause the cervix to dilate. The nurse responds that labor contractions facilitate cervical dilation by

A) promoting blood flow to the cervix.
B) contracting the lower uterine segment.
C) enlarging the internal size of the uterus.
D) pulling the cervix over the fetus and amniotic sac.

Question 5

The nurse is assessing a patient in the active phase of labor. What should the nurse expect during this phase?

A) The patient is sociable and excited.
B) The patient is requesting pain medication.
C) The patient begins to experience the urge to push.
D) The patient experiences loss of control and irritability.

Question 6

Which physiologic event is the key indicator of the commencement of true labor?

A) Bloody show
B) Cervical dilation and effacement
C) Fetal descent into the pelvic inlet
D) Uterine contractions every 7 minutes

Question 7

Which assessment finding indicates that cervical dilation and/or effacement has occurred?

A) Onset of irregular contractions
B) Cephalic presentation at 0 station
C) Bloody mucus drainage from vagina
D) Fetal heart tones (FHTs) present in the lower right quadrant

Question 8

Which mechanism of labor occurs when the largest diameter of the fetal presenting part passes the pelvic inlet?

A) Extension
B) Engagement
C) Internal rotation
D) External rotation

Question 9

A patient just delivered her baby via the vaginal route. The patient asks the nurse why the baby's head is not round, but oval. Which explanation should the nurse provide the patient?

A) This results from molding.
B) This results from lightening.
C) This results from the fetal lie.
D) This results from the fetal presentation.

Question 10

The nurse is directing an unlicensed assistive personnel (UAP) to obtain maternal vital signs between contractions. Which statement is the appropriate rationale for assessing maternal vital signs between contractions rather than at another interval?

A) Vital signs taken during contractions are inaccurate.
B) During a contraction, assessing fetal heart rate is the priority.
C) Maternal blood flow to the heart is reduced during contractions.
D) Maternal circulating blood volume increases temporarily during contractions.

Question 11

The nurse is assessing the duration of a patient's labor contractions. Which method does the nurse implement to assess the duration of labor contractions?

A) Assess the strongest intensity of each contraction.
B) Assess uterine relaxation between two contractions.
C) Assess from the beginning to the end of each contraction.
D) Assess from the beginning of one contraction to the beginning of the next.

Question 12

A patient whose cervix is dilated to 6 cm is considered to be in which phase of labor?

A) Latent phase
B) Active phase
C) Second stage
D) Third stage

Question 13

Which maternal factor may inhibit fetal descent during labor?

A) A full bladder
B) Decreased peristalsis
C) Rupture of membranes
D) Reduction in internal uterine size

Question 14

Which assessment finding would cause a concern for a patient who had delivered vaginally?

A) Estimated blood loss (EBL) of 500 mL during the birth process
B) White blood cell count of 28,000 mm3 postbirth
C) Patient complains of fingers tingling
D) Patient complains of thirst

Question 15

An increase in urinary frequency and leg cramps after the 36th week of pregnancy are an indication of

A) lightening.
B) breech presentation.
C) urinary tract infection.
D) onset of Braxton-Hicks contractions.

Question 16

The nurse is explaining the physiology of uterine contractions to a group of nursing students. Which statement best explains the maternal-fetal exchange of oxygen and waste products during a contraction?

A) Little to no affect
B) Increases as blood pressure decreases
C) Diminishes as the spiral arteries are compressed
D) Continues except when placental functions are reduced

Question 17

On admission to the labor and birth unit, a 38-year-old female, gravida 4, para 3, at term in early labor is found to have a transverse lie on vaginal examination. What is the priority intervention at this time?

A) Perform a vaginal exam to denote progress.
B) Notify the health care provider.
C) Initiate parenteral therapy.
D) Apply oxygen via nasal cannula at 8 L/minute.

Question 18

A laboring patient asks the nurse how she will know that the contraction is at its peak. The nurse explains that the contraction peaks during which stage of measurement?

A) The acme
B) The interval
C) The increment
D) The decrement

Question 19

Which factor ensures that the smallest anterior-posterior diameter of the fetal head enters the pelvis?

A) Station
B) Flexion
C) Descent
D) Engagement

Question 20

The primary difference between the labor of a nullipara and that of a multipara is

A) total duration of labor.
B) level of pain experienced.
C) amount of cervical dilation.
D) sequence of labor mechanisms.

Question 21

The examiner indicates to the labor nurse that the fetus is in the left occiput anterior (LOA) position. To facilitate the labor process, how will the nurse position the laboring patient?

A) On her back
B) On her left side
C) On her right side
D) On her hands and knees

Question 22

To determine if the patient is in true labor, the nurse would assess for changes in

A) cervical dilation.
B) amount of bloody show.
C) fetal position and station.
D) pattern of uterine contractions.

Question 23

Which clinical finding should the nurse expect to assess in the third stage of labor that indicates the placenta has separated from the uterine wall? (Select all that apply.)

A) A gush of blood appears.
B) The uterus rises upward in the abdomen.
C) The fundus descends below the umbilicus.
D) The cord descends further from the vagina.
E) The uterus becomes boggy and soft, with an elongated shape.

Question 24

A 28-year-old gravida 1, para 0 patient who is at term calls the labor and birth unit stating that she thinks she is in labor. She states that she does have some vaginal discharge and feels wet; however, it is not bloody in nature. She relates a contraction pattern that is irregular, ranging from 5 to 7 minutes and lasting 30 seconds. Which questions should the nurse pose to the patient during this telephone triage? (Select all that apply.)

A) Does she think that her membranes have ruptured?
B) Is there any evidence of bloody show?
C) Instruct the patient to keep monitoring her contraction pattern and call you back if they become more regular.
D) When is her next scheduled visit with her health care provider?
E) Tell her to come into the hospital for evaluation.

Question 25

The clinical nurse educator is providing instruction to a group of new nurses during labor orientation. Which information regarding the factors that have a role in the initiation of labor should the educator include in this teaching session? (Select all that apply.)

A) Progesterone levels become higher than estrogen levels.
B) Natural oxytocin in conjunction with other substances plays a role.
C) Stretching, pressure, and irritation of the uterus and cervix increase.
D) The secretion of prostaglandins from the fetal membranes decreases.

Question 26

After birth of the placenta the patient states, "All of a sudden I feel very cold." What is the most appropriate nursing action at this time?

A) Place a warm blanket over the patient.
B) Place the baby on the patient's abdomen.
C) Tell the patient that chills are expected after birth.
D) "What do you mean by your words 'very cold'?"

Question 27

The nurse assesses a laboring patient's contraction pattern and notes the frequency at every 3 to 4 minutes, duration 50 to 60 seconds, and the intensity is moderate by palpation. What is the most accurate documentation for this contraction pattern?

A) Stage 1, latent phase
B) Stage 2, latent phase
C) Stage 1, active phase
D) Stage 2, active phase

Question 28

The nurse who elects to practice in the area of obstetrics often hears discussion regarding the four Ps. What are the four Ps that interact during childbirth? (Select all that apply.)

A) Powers
B) Passage
C) Position
D) Passenger
E) Psyche

Question 29

The health care provider for a laboring patient makes the following entry into the patient's record: 3/50%/+1. What instruction will the nurse implement with the patient?

A) "You will need to remain in bed attached to the electronic fetal monitor."
B) "Breathe with me slowly, in through your nose and out through your mouth."
C) "I will begin the administration of 1000 mL of IV fluid so you can have an epidural."
D) "Your partner will need to change into scrub attire to attend the imminent birth."

Question 30

A patient asks the nurse how she can tell if labor is real. Which information should the nurse provide to this patient? (Select all that apply.)

A) In true labor, the cervix begins to dilate.
B) In true labor, the contractions are felt in the abdomen and groin.
C) In true labor, contractions often resemble menstrual cramps during early labor.
D) In true labor, contractions are inconsistent in frequency, duration, and intensity in the early stages.
E) In true labor your contractions tend to increase in frequency, duration, and intensity with walking.

Question 31

The nurse is planning care for a patient during the fourth stage of labor. Which interventions should the nurse plan to implement? (Select all that apply.)

A) Offer the patient a warm blanket.
B) Place an ice pack on the perineum.
C) Massage the uterus if it is boggy.
D) Delay breastfeeding until the patient is rested.
E) Explain to the patient that the lochia will be light pink in color.

Question 32

The primiparous patient at 39 weeks' gestation states to the nurse, "I can breathe easier now." What is the nurse's most appropriate response?

A) "Your labor will start any day now since the baby has dropped."
B) "That process is called lightening. Do you have to urinate more frequently?"
C) "Contact your health care provider when your contractions are every 5 minutes for 1 hour."
D) "You will likely not feel you baby's movements as much now, so do not be concerned."

Question 33

A laboring patient states to the nurse, "I have to push!" What is the next nursing action?

A) Contact the health care provider.
B) Examine the patient's cervix for dilation.
C) Review with her how to bear down with contractions.
D) Ask her partner to support her head with each push.

Question 34

If a notation on the patient's health record states that the fetal position is LSP, this indicates that the

A) head is in the right posterior quadrant of the pelvis.
B) head is in the left anterior quadrant of the pelvis.
C) buttocks are in the left posterior quadrant of the pelvis.
D) buttocks are in the right upper quadrant of the abdomen.