Question 1

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:

Accepted Answer

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

Question 2

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

Accepted Answer

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 3

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:

Accepted Answer

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

Question 4

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?

Accepted Answer

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 5

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.

Accepted Answer

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

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?

Accepted Answer

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

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

Accepted Answer

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 8

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?

Accepted Answer

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 9

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

Accepted Answer

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.

Question 10

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?

Accepted Answer

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

Question 11

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?

Accepted Answer

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 12

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

Accepted Answer

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 13

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?

Accepted Answer

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 14

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?

Accepted Answer

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 15

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

Accepted Answer

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 16

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

Accepted Answer

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 17

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?

Accepted Answer

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

Question 18

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.

Accepted Answer

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

Question 19

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?

Accepted Answer

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 20

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?

Accepted Answer

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

Exam 3: Intrapartum