Deck 12: Processes of Birth

Question 1

A client 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 1

umbilical cord compression.

Question 2

Which event is the best indicator of true labor?

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

Answer 2

Cervical dilation and effacement

Question 3

The nurse is assessing the duration of a client's labor contractions. Which action 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.

Answer 3

Assess from the beginning to the end of each contraction.

Question 4

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

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

Question 5

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 6

Which maternal factor may inhibit fetal descent?

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

Question 7

The nurse is explaining to a group of nursing students what occurs during active labor as the uterus contracts. Which statement explains the maternal-fetal exchange of oxygen and waste products during a contraction?

A) Is not significantly affected
B) Increases as blood pressure decreases
C) Diminishes as the spiral arteries are compressed
D) Continues except when placental functions are reduced

Question 8

The nurse is directing an unlicensed assistive personnel (UAP) to take maternal vital signs between contractions. Which statement is the best rationale for assessing maternal vital signs between contractions?

A) Vital signs taken during contractions are not accurate.
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 9

Uncontrolled maternal hyperventilation during labor results in:

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

Question 10

An increase in urinary frequency and leg cramps after the 36th week of pregnancy most likely indicates:

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

Question 11

A client whose cervix is dilated to 5 cm is considered to be in which phase of labor?

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

Question 12

A laboring client 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 13

Which assessment finding would cause a concern for a client 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) Client complains of fingers tingling
D) Client complains of thirst

Question 14

The laboring client asks the nurse how the labor contractions work to dilate the cervix. The best response by the nurse is 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 15

Pregnant clients can usually tolerate the normal blood loss associated with childbirth because they have:

A) a higher hematocrit.
B) increased leukocytes.
C) increased blood volume.
D) a lower fibrinogen level.

Question 16

A client just delivered a baby by the vaginal route. The client asks the nurse why the baby's head is not round, but oval. Which explanation should the nurse give to the client?

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 17

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 18

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 19

A nullipara client has progressed to the active phase of labor. The nurse understands that this phase of labor, on the average, for a nullipara will last how long?

A) 50 minutes
B) 3 1/2 hours
C) 6 to 7 hours
D) 8 to 10 hours

Question 20

The husband of a laboring woman asks the nurse how he can help his wife throughout the first stage of labor. The nurse informs him that in addition to all that he's doing now, he could tell her when the contractions are:

A) 2 minutes apart.
B) at their acme.
C) at their increment.
D) at their decrement.

Question 21

To determine if the client 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 22

Match each term with the correct definition.

Fetal lie

A)The fetal part that enters the pelvic inlet first
B)The orientation of the long axis of the fetus to the long axis of the woman
C)Relation of a fixed reference point on the fetus to the quadrants of the maternal pelvis

Question 23

Match each term with the correct definition.

Presentation

A)The fetal part that enters the pelvic inlet first
B)The orientation of the long axis of the fetus to the long axis of the woman
C)Relation of a fixed reference point on the fetus to the quadrants of the maternal pelvis

Question 24

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/min.

Question 25

The nurse assess a laboring patient's contraction pattern and notes the frequency at every 3 to 4 minutes, duration 50 to 60 sections, 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 26

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

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

Question 27

After birth of the placenta the patient states, "All of a sudden I feel very cold." What is the best nursing action in response to this statement?

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 28

The nurse is teaching a group of nursing students about factors that have a role in starting labor. Which should the nurse include in the 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 29

The assessment finding which indicates that the client is in the active phase of the first stage of labor is:

A) 80% effacement.
B) dilation of 5 cm.
C) presence of bloody show.
D) regular contraction every 3 to 4 minutes.

Question 30

A client asks the nurse how she can tell if labor is real? What should the nurse give as an explanation? (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 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 32

Which clinical findings would be considered to be normal for a preterm fetus during the labor period?

A) Baseline tachycardia
B) Baseline bradycardia
C) Fetal anemia
D) Acidosis

Question 33

If a notation on the client's health record states that the fetal position is LSP, this means 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.

Question 34

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 35

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 36

A 28-year-old gravida 1, para 0 client 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 but it is not bloody in nature. She relates a contraction pattern that is irregular, ranging from 5 to 7 minutes and lasting 30 seconds. What questions would be used during the process of phone triage by the nurse? (Select all that apply.)

A) Ask her if her if she thinks that her membranes have ruptured.
B) Ask her if she has any evidence of bloody show.
C) Have her keep monitoring her contraction pattern and call you back if they become more regular.
D) Ask her when her she has her next scheduled visit with her health care provider.
E) Tell her to come into the hospital for evaluation.

Question 37

Match each term with the correct definition.

Position

A)The fetal part that enters the pelvic inlet first
B)The orientation of the long axis of the fetus to the long axis of the woman
C)Relation of a fixed reference point on the fetus to the quadrants of the maternal pelvis

Question 38

Which 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 39

An assessment finding that would indicate to the nurse that cervical dilation and/or effacement has occurred is:

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 40

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