Chapter 19: Processes and Stages of Labor & Birth

Childbirth preparation offers several advantages including which of the following? Select all that apply. A. It helps a pregnant woman and her support person understand the choices in the birth setting. B. It promotes awareness of available options. C. It provides tools for a pregnant woman and her support person to use during labor and birth. D. Women who receive continuous support during labor require more analgesia, and have more cesarean and instrument births. E. Each method has been shown to shorten labor.

A. It helps a pregnant woman and her support person understand the choices in the birth setting. B. It promotes awareness of available options. C. It provides tools for a pregnant woman and her support person to use during labor and birth. E. Each method has been shown to shorten labor.

The labor nurse would not encourage a mother to bear down until the cervix is completely dilated, to prevent which of the following? Select all that apply. A. Maternal exhaustion B. Cervical edema C. Tearing and bruising of the cervix D. Enhanced perineal thinning E. Having to perform an episiotomy

A. Maternal exhaustion B. Cervical edema C. Tearing and bruising of the cervix

To identify the duration of a contraction, the nurse would do which of the following? 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.

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

The client has asked the nurse why her cervix has only changed from 1 to 2 c m in 3 hours of contractions occurring every 5 minutes. What is the nurse's best response to the client? 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."

A. "Your cervix has also effaced, or thinned out, and that change in the cervix is also labor progress."

A clinic nurse is preparing diagrams of pelvic shapes. Which pelvic shapes are considered least adequate for vaginal childbirth? Select all that apply. A. Android B. Anthropoid C. Gynecoid D. Platypelloid E. Lambdoidal suture

A. Android D. Platypelloid

Premonitory signs of labor include which of the following? Select all that apply. A. Braxton Hicks contractions B. Cervical softening and effacement C. Weight gain D. Rupture of membranes E. Sudden loss of energy

A. Braxton Hicks contractions B. Cervical softening and effacement D. Rupture of membranes

How would the nurse best analyze the results from a client's sonogram that shows the fetal shoulder as the presenting part? A. Breech, transverse B. Breech, longitudinal C. Breech, frank D. Vertex, transverse

A. Breech, transverse

A nurse needs to evaluate the progress of a woman's labor. The nurse obtains the following data: cervical dilation 6 c m; 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 dilation 6 c m B. Mild contraction intensity C. Contraction frequency every 5 minutes D. Contraction duration 30-40 seconds

A. Cervical dilation 6 cm

The nurse is teaching a prenatal class about false labor. The nurse should teach clients that false labor will most likely include which of the following? Select all that apply. A. Contractions that do not intensify while walking B. An increase in the intensity and frequency of contractions C. Progressive cervical effacement and dilation D. Pain in the abdomen that does not radiate E. Contractions are at regular intervals

A. Contractions that do not intensify while walking D. Pain in the abdomen that does not radiate With false labor, contractions are irregular.

A client who is having false labor most likely would have which of the following? Select all that apply. A. Contractions that do not intensify while walking B. An increase in the intensity and frequency of contractions C. Progressive cervical effacement and dilation D. Pain in the abdomen that does not radiate E. Contractions that lessen with rest and warm tub baths

A. Contractions that do not intensify while walking D. Pain in the abdomen that does not radiate E. Contractions that lessen with rest and warm tub baths

What are the signs of placental separation?

(1) a globular-shaped uterus (2) a rise of the fundus in the abdomen (3) a sudden gush or trickle of blood (4) further protrusion of the umbilical cord out of the vagina

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 client in McRoberts position. B. Watch for the emergence of the placenta. C. Prepare for the delivery of an undiagnosed twin. D. Place the client in a supine position.

B. Watch for the emergence of the placenta.

The client 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."

B. "These symptoms usually mean the baby's head has descended further."

Which client requires immediate intervention by the labor and delivery nurse? A. Client at 8 c m, systolic blood pressure has increased 35 m m H g B. Client who delivered 1 hour ago with W B C of 50,000/m m3 C. Client at 5 c m with a respiratory rate of 22 between contractions D. Client in active labor with polyuria

B. Client who delivered 1 hour ago with W B C of 50,000/m m3 The white blood cell (WBC) count increases to between 25,000/mm3 to 30,000/mm3 during labor and early postpartum. This count is abnormally high, and requires further assessment and provider notification.

The labor and delivery nurse is reviewing charts. The nurse should inform the supervisor about which client? A. Client at 5 c m requesting labor epidural analgesia B. Client whose cervix remains at 6 c m for 4 hours C. Client who has developed nausea and vomiting D. Client requesting her partner to stay with her

B. Client whose cervix remains at 6 c m for 4 hours

A client 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 c m, 100% effaced, and -2 station. What best describes this labor? A. Second phase B. Latent phase C. Active phase D. Transition phase

B. Latent phase

A client calls the labor and delivery unit and tells the nurse that she is 39 weeks pregnant and 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 client that she has experienced which of the following? A. Engagement B. Lightening C. Molding D. Braxton Hicks contractions

B. Lightening

A client is admitted to the labor unit with contractions 1-2 minutes apart lasting 60-90 seconds. The client is apprehensive and irritable. This client is most likely in what phase of labor? A. Active B. Transition C. Latent D. Second

B. Transition

The client in early labor asks the nurse what the contractions are like as labor progresses. What would the nurse respond? A. "In normal labor, as the uterine contractions become stronger, they usually also become less frequent." B. "In normal labor, as the uterine contractions become stronger, they usually also become less painful." C. "In normal labor, as the uterine contractions become stronger, they usually also become longer in duration." D. "In normal labor, as the uterine contractions become stronger, they usually also become shorter in duration."

C. "In normal labor, as the uterine contractions become stronger, they usually also become longer in duration."

The client 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."

C. "Your body may be telling you it is going into labor soon."

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

C. Muscle tension It is important for the woman to relax each part of her body. Be alert for signs of muscle tension and tightening. Dissociative relaxation, controlled muscle relaxation, and specified breathing patterns are used to promote birth as a normal process.

The nurse is aware that labor and birth will most likely proceed normally when the fetus is in what position? A. Right-acromion-dorsal-anterior B. Right-sacrum-transverse C. Occiput anterior D. Posterior position

C. Occiput anterior

A client 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 c m dilated. The nurse knows that the client is in which phase of labor? A. Active B. Latent C. Transition D. Fourth

C. Transition

The nurse is preparing a client 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.

C. True labor can be diagnosed only if cervical change occurs.

The nurse is caring for laboring clients. Which women are experiencing problems related to a critical factor of labor? Select all that apply. A. Woman at 7 c m, fetus in general flexion B. Woman at 3 c m, fetus in longitudinal lie C. Woman at 4 c m, fetus with transverse lie D. Woman at 6 c m, fetus at -2 station, mild contractions E. Woman at 5 c m, fetal presenting part is right shoulder

C. Woman at 4 c m, fetus with transverse lie D. Woman at 6 c m, fetus at -2 station, mild contractions E. Woman at 5 c m, fetal presenting part is right shoulder

When comparing the anterior and posterior fontanelles of a newborn, the nurse knows that both are what? A. Both are approximately the same size. B. Both close within 12 months of birth. C. Both are used in labor to identify station. D. Both allow for assessing the status of the newborn after birth.

D. Both allow for assessing the status of the newborn after birth.

During the fourth stage of labor, the client's assessment includes a B P of 110/60, pulse 90, and the fundus is firm midline and halfway between the symphysis pubis and the umbilicus. What's the priority action of the nurse? A. Turn the client onto her left side. B. Place the bed in Trendelenburg position. C. Massage the fundus. D. Continue to monitor.

D. Continue to monitor.

The nurse is caring for a laboring client. A cervical exam indicates 8 c m dilation. The client is restless, frequently changing position in an attempt to get comfortable. Which nursing action is most important? A. Leave the client alone so she can rest. B. Ask the family to take a coffee-and-snack break. C. Encourage the client to have an epidural for pain. D. Reassure the client that she will not be left alone.

D. Reassure the client that she will not be left alone

The nurse has just palpated a laboring woman's contractions. The uterus cannot be indented during a contraction. What would the intensity of these contractions best be characterized as? A. Weak B. Mild C. Moderate D. Strong

D. Strong Rationales: - Weak contractions are not identified. - If the uterine wall can be indented easily, the contraction is considered mild. - Moderate intensity falls between these two ranges. When intensity is measured with an intrauterine catheter, the normal resting tonus (between contractions) is about 10 to 12 m m H g of pressure. During acme the intensity ranges from 25 to 40 m m H g in early labor, 50 to 70 m m H g in active labor, 80 to 100 m m H g during transition, and greater than 100 m m H g while the woman is pushing in the second stage. - Strong intensity exists when the uterine wall cannot be indented.-

The midwife performs a vaginal exam and determines that the fetal head is at a -2 station. What does this indicate to the nurse about the birth? A. The birth is imminent. B. The birth is likely to occur in 1-2 hours. C. The birth will occur later in the shift. D. The birth is difficult to predict.

D. The birth is difficult to predict.

The charge nurse has received the shift change report. Which client requires immediate intervention? A. Woman at 6 c m undergoing induction of labor, strong contractions every 3 minutes B. Woman at 4 c m whose fetus is in a longitudinal lie with a cephalic presentation C. Woman at 10 c m and fetus at +2 station experiencing a strong expulsion urge D. Woman at 3 c m screaming in fear because her mother died during childbirth

D. Woman at 3 c m screaming in fear because her mother died during childbirth

While caring for a client in labor, the nurse notices during a vaginal exam that the fetus's head has rotated internally. What would the nurse expect the next set of cardinal movements for a fetus 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

D.Extension, restitution, external rotation, and expulsion