Question 1

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:

Accepted Answer

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 2

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?

Accepted Answer

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

Question 3

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?

Accepted Answer

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 4

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?

Accepted Answer

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

Question 5

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

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

Question 6

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

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

Question 7

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?

Accepted Answer

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 8

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

Accepted Answer

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 9

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

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 10

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?

Accepted Answer

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 11

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:

Accepted Answer

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

Question 12

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

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

Question 13

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

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 14

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?

Accepted Answer

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."

Exam 22: Processes and Stages of Labor and Birth