Labor and Birth

During labor, nurses provide continuous support to clients. Which are the outcomes seen from this support? Select all that apply. A. Decrease in operative births B. Decreased chance of a low Apgar score at 5 minutes C. Decrease in childbirth satisfaction D. Decrease in pharmacological pain management E. Increase in labor length

A. Decrease in operative births B. Decreased chance of a low Apgar score at 5 minutes D. Decrease in pharmacological pain management

A group of pregnant women in the third trimester of pregnancy are attending a childbirth education class. When teaching about the differences between true labor and false labor, what would the nurse note about false labor? A. The cervix does not dilate. B. The contractions get stronger. C. The cervix becomes thinner. D. The contractions get closer together.

A. The cervix does not dilate.

The nurse is caring for a client in the first stage of labor. To assist the progression of labor, the nurse recommends which of the following? A. Changing positions and sitting upright B. Maintaining a side-lying position only C. Receiving an epidural as early as possible so she can relax and rest D. Limiting visitors at the bedside to promote rest

A. Changing positions and sitting upright

The nurse is caring for a term gestation client in active labor when her membranes rupture spontaneously. Prioritize the following nursing interventions. 1. Document the assessment findings along with time of rupture. 2. Assess the color, odor, and amount of fluid. 3. Assess the fetal heart rate (FHR). 4. Update the physician on spontaneous rupture of membranes (SROM) and labor progress.

3. Assess the fetal heart rate (FHR). 2. Assess the color, odor, and amount of fluid. 1. Document the assessment findings along with time of rupture. 4. Update the physician on spontaneous rupture of membranes (SROM) and labor progress.

The nurse knows there are five factors that are essential to a successful labor and birth. Which of the following are included in those factors? Select all that apply. A. Contractions B. Maternal response C. Provider response D. Fetal lie E. Squatting

A. Contractions B. Maternal response D. Fetal lie E. Squatting

The nurse is assisting a client who is in early labor and experiencing intense back pain with nonpharmacological pain management. Which technique can the nurse implement for this client? A. Counterpressure over the sacral area B. Effleurage over the abdomen C. Use of an ice pack over the forehead D. Playing music that is upbeat

A. Counterpressure over the sacral area

During labor and delivery (L&D), the fetus passes through the birth canal and must make several movements to allow for successful delivery. Place the following cardinal movements for birth into the correct order. 1. Descent 2. Expulsion 3. Extension 4. Flexion 5. External rotation 6. Engagement 7. Internal rotation

6. Engagement 1. Descent 4. Flexion 7. Internal rotation 3. Extension 5. External rotation 2. Expulsion

The nurse is assessing a client who has just delivered a baby and calculates the initial blood loss from delivery to be 338 g. Over the next couple of assessments, the nurse changes the chux pads under the client due to bleeding. The chux pads weigh 128 and 242 g, respectively. The nurse knows that the client has had an estimated blood loss of how many milliliters? Report your answer in mL. Enter only the numerical value.

708

The nurse is instructing a woman and her partner on nonpharmacological pain relief interventions such as effleurage and using heat and cold. The client asks how these techniques work to manage pain. Which is the best statement by the nurse? A. "Only a certain number of sensations can travel to the brain at once. We replace pain signals with pleasure signals to reduce discomfort." B. "Massage and heat reduce blood flow to tissues, and temporarily numb the nerve fibers." C. "The placebo effect makes the client believe their pain is less, even though there is no physiological benefit of the techniques." D. "The effects are only useful in latent phase labor. As active labor starts, she will likely need opioid pain medication."

A. "Only a certain number of sensations can travel to the brain at once. We replace pain signals with pleasure signals to reduce discomfort."

Following a precipitous labor, the obstetrician did not arrive to the hospital in time for the delivery. The nurse is monitoring for the delivery of the placenta. Which indications would result in the nurse asking the client to push to deliver the placenta? Select all that apply. A. A sudden gush of blood from the vagina occurs. B. The client starts to feel very nauseous. C. Umbilical cord lengthens at the vaginal introitus. D. Uterus rises upward in a ball shape. E. Blood pressure and pulse rate decrease.

A. A sudden gush of blood from the vagina occurs. C. Umbilical cord lengthens at the vaginal introitus. D. Uterus rises upward in a ball shape.

The nurse-midwife performs Leopold's maneuvers to determine fetal positioning in the womb. Which of the following does the midwife determine by palpating the fundus during the first maneuver? A. If the fetus is breech or vertex B. The location of the back and fetal small parts C. The fetal presenting part D. The location of the cephalic prominence

A. If the fetus is breech or vertex

Following the delivery of a term newborn, the mother experiences a moderate urge to push and a gush of blood emerges from the vagina. The nurse recognizes this as which of the following? A. Indicating the placenta is about to deliver B. The formation of a vaginal hematoma C. Perform a cervical examination D. Signs of a postpartum hemorrhage

A. Indicating the placenta is about to deliver

A pregnant woman is admitted to triage and states her contractions are "really strong." The nurse palpates her contractions and finds her uterus is resistant to indentation. The nurse would chart her contractions as which of the following? A. Weak B. Moderate C. Strong D. Intractable

B. Moderate

The nurse is preparing a group session for childbirth preparation. The topic will include signs of impending labor. The nurse will include which topics? Select all that apply. A. Lightening B. Decreased fetal movement C. Nesting D. Bloody show E. Weight gain

A. Lightening C. Nesting D. Bloody show

Upon admission, the nurse instructed a 39-week gestation client to lie on her back in bed for assessment and placement of the fetal monitor. After going through the medical history, the nurse assesses the client's blood pressure at 76/42. Which is the appropriate intervention? A. Retake the blood pressure with a manual cuff. B. Move the client onto her left side. C. Call the provider to obtain an order for IV fluids. D. Continue to monitor blood pressure every 30 minutes.

B. Move the client onto her left side.

While assisting a provider who is placing epidural anesthesia with a laboring woman, the RN is responsible for all of the following except which one? A. Administer an IV fluid bolus as ordered. B. Obtaining informed consent. C. Stop the epidural infusion after delivery. D. Replace empty infusion bags or syringes and restart the infusion.

B. Obtaining informed consent.

A client was recently admitted to the labor and delivery (L&D) unit in active labor. The nurse performs Leopold's maneuvers during the assessment. During the third maneuver, the nurse notes a firm and fixed fetal part. Which position correlates with this assessment finding? A. Occiput B. Acromion C. Sacrum D. Transverse

A. Occiput

Upon vaginal examination, the nurse notes that the infant's anterior fontanel is to the back left side of the maternal pelvis. How does the nurse chart this position? A. ROA B. LOA C. ROP D. LOP

A. ROA

A client is admitted to the labor and delivery (L&D) unit in active labor. There has been no prenatal care for the current pregnancy, and the on-call provider estimates the pregnancy to be around 35 weeks' gestation. Which medication will the nurse anticipate being ordered for this client? A. Oxytocin B. Penicillin C. Magnesium sulfate D. Metoclopramide

B. Penicillin

The provider and nurse are performing routine care immediately after a delivery, including assessing maternal bleeding along with inspecting the placenta and umbilical cord. Which findings require further assessment? Select all that apply. A. The umbilical cord contains one vein and one artery. B. The client has passed several large clots from her vagina. C. All of the membranes are not present. D. The maternal side of the placenta appears to have all parts. E. A gush of blood occurred just before the delivery of the placenta.

A. The umbilical cord contains one vein and one artery. B. The client has passed several large clots from her vagina. C. All of the membranes are not present.

The nurse initiates a fluid bolus before epidural administration. Which is the purpose of this action? A. To stabilize post-epidural blood pressure B. To prevent hypovolemia following blood loss after delivery C. To increase amniotic fluid volume and cushion the umbilical cord D. To flush fentanyl metabolites from maternal circulation

A. To stabilize post-epidural blood pressure

Which nursing interventions would support a normal, physiological birth? Select all that apply. A. Waiting until 40 weeks' gestation to induce labor B. Assisting the mother to change positions frequently C. Collaborating with a doula or other support person to manage discomfort D. Encouraging the mother to lie on her back and place her feet in stirrups for delivery E. Allowing the bag of waters to rupture spontaneously

A. Waiting until 40 weeks' gestation to induce labor B. Assisting the mother to change positions frequently C. Collaborating with a doula or other support person to manage discomfort E. Allowing the bag of waters to rupture spontaneously

The nurse is assisting a pregnant client who is placing her infant up for adoption, with the development of a birth plan. Which questions would the nurse consider when planning the birth plan? Select all that apply. A. Will the mother spend some time alone with the infant? B. How involved will the adoptive parents be in the labor and birth? C. Does the mother plan to leave the hospital immediately after delivery? D. Where are the closest support groups for birth parents? E. Who will be present at the hospital to support the client?

A. Will the mother spend some time alone with the infant? B. How involved will the adoptive parents be in the labor and birth? D. Where are the closest support groups for birth parents? E. Who will be present at the hospital to support the client?

The nurse is assessing a laboring client. Which signs and symptoms does the nurse recognize indicate movement into the second stage of labor? Select all that apply. A. Intense contractions every 4 to 5 minutes B. Significant bloody show C. Stated claim by client of needing a bowel movement D. Noted trembling of client E. Vomiting

B. Significant bloody show C. Stated claim by client of needing a bowel movement D. Noted trembling of client E. Vomiting

The nurse is admitting a 16-year-old client for induction. She expresses fear about the pain of labor and delivery. Which is the best response by the nurse? A. "Because you are under 18, your mom will decide what type of pain management is best for you." B. "You should get an epidural. You won't feel any labor, but pushing may be more difficult." C. "There are many options for pharmacological and nonpharmacological pain relief. I'll discuss the pros and cons with you." D. "Childbirth classes are a great way to learn about pain relief options. Did you attend any?"

C. "There are many options for pharmacological and nonpharmacological pain relief. I'll discuss the pros and cons with you."

Immediately following the delivery of the placenta, the nurse prepares to administer IV oxytocin. The client asks, "What is this medication for?" Which is the nurse's best response? A. "To augment labor contractions" B. "To improve the let-down reflex for your breast milk" C. "To prevent hemorrhage after delivery" D. "To prevent uterine cramping and pain following delivery"

C. "To prevent hemorrhage after delivery"

While caring for a client, which interventions would the nurse include in the nursing care plan to provide culturally competent care? Select all that apply. A. Describe hospital protocols that will be followed during the delivery. B. Provide teaching on nonpharmacological pain management options as they are preferred by women of the client's culture. C. Ask the client if they have any religious or cultural preferences they would like followed during their labor. D. Ask the client what gender pronouns they prefer and use them. E. Determine who the client's support person is and how they will participate in their care.

C. Ask the client if they have any religious or cultural preferences they would like followed during their labor. D. Ask the client what gender pronouns they prefer and use them. E. Determine who the client's support person is and how they will participate in their care.

During a childbirth education class, the nurse educator describes signs of impending labor. Which statement made by a class participant requires further teaching? A. "I may experience a sudden surge of energy, or a 'nesting' instinct, as labor approaches." B. "It may be more difficult to breathe as the baby gets larger toward my due date." C. "It's normal to experience warm-up contractions that aren't painful before the real thing." D. "I could feel some increasing lower back and hip discomfort."

B. "It may be more difficult to breathe as the baby gets larger toward my due date."

The grandmother of a newly delivered infant was in the room for the delivery. The newborn is placed skin-to-skin with the mother and covered with a warm blanket while waiting for the placenta to deliver. The grandmother expresses concern that the newborn is too cold with no clothes on. Which is the best response by the nurse? A. "I will check the temperature when I have time." B. "Skin-to-skin contact helps newborns to regulate temperature." C. "Please just stand out of the way of the provider." D. "The warm blanket will stop all cold air from reaching the baby."

B. "Skin-to-skin contact helps newborns to regulate temperature."

The nurse is caring for a client who has been dilated to 10 cm for about 1 hour. When assessing the client, her mother asks why the nurse has not started telling her daughter to push. Which is the appropriate response from the nurse? A. "Times are different now; we do not make women push if they do not want to." B. "There are better outcomes for the mom and baby if the mother waits to push once she feels the urge and pushes nondirected." C. "It is best to start pushing 1 hour after reaching full dilation. It will start soon." D. "The provider is not here yet, so pushing must be delayed."

B. "There are better outcomes for the mom and baby if the mother waits to push once she feels the urge and pushes nondirected."

The nurse is assessing the Apgar score on an infant at 1 minute of age. The infant has a lusty and vigorous cry with active motion of the extremities. The heart rate is 98 beats per minute. The respirations are 55 per minute, and the oxygen saturation is 98%. Acrocyanosis is noted on the hands and feet. Which does the nurse record for the Apgar score? A. Apgar 10 B. Apgar 8 C. Apgar 9 D. Apgar 7

B. Apgar 8

The nurse is caring for a client using a labor doula. While collaborating for the client's care, which activity would not be delegated to the doula? A. Assisting the woman to ambulate in the hall B. Assessing maternal vital signs before receiving regional anesthesia administration C. Applying heat and cold to the woman's lower back D. Advocating for the woman's birth plan to be followed

B. Assessing maternal vital signs before receiving regional anesthesia administration

The nurse is caring for a newly delivered multiparous client on labor and delivery. Reviewing the assessment data gathered, what medication would the nurse anticipate the provider ordering for this client? A. Methergine 0.2 mg IM B. Cytotec 1,000 mcg rectally C. Hemabate 0.25 mg IM D. Inhaled nitrous oxide

B. Cytotec 1,000 mcg rectally

The charge nurse is observing a new nurse on the labor and delivery (L&D) floor caring for a client in active labor and recognizes the need for additional training. Which of the following care provided demonstrates a need for further orientation? Select all that apply. A. The new nurse encourages the client to use the restroom every hour. B. The new nurse recommends the client stay in bed and rest until it is time to push. C. The new nurse explains all procedures to the client throughout the shift. D. The new nurse suggests that all family members leave the room. E. The new nurse assists the client with breathing techniques to help with relaxation.

B. The new nurse recommends the client stay in bed and rest until it is time to push. D. The new nurse suggests that all family members leave the room.

A 39-week gestation client calls the office to report increased vaginal mucus discharge and urinary frequency. She states there is good fetal movement. Which would the nurse explain to the client? A. This is likely a urinary infection. B. These are signs of impending labor. C. She should use a vaginal douche to clear the mucus discharge. D. The baby will have a drastic decrease in movement as labor approaches.

B. These are signs of impending labor.

The nurse admits a primiparous, laboring client to the labor/delivery/recovery/postpartum (LDRP) unit. Reviewing the history and assessment of this client, what interventions and actions should the nurse begin taking next? Select all that apply. A. Request an order for oxytocin. B. Take vital signs every 4 hours. C. Encourage the client to void and stool as needed. D. Inform the client an IV with maintenance fluid running at 125 mL/hour is required to be placed. E. Perform intermittent fetal monitoring. F. Request an order for a food tray. G. Encourage the client's mother to provide physical support in the form of back rubs and cool cloths. H. Check infant resuscitation and delivery equipment and supplies needed for immediate postpartum care. I. Encourage the client to rest and relax in bed between contractions.

C. Encourage the client to void and stool as needed. E. Perform intermittent fetal monitoring. F. Request an order for a food tray. G. Encourage the client's mother to provide physical support in the form of back rubs and cool cloths. H. Check infant resuscitation and delivery equipment and supplies needed for immediate postpartum care.

Following the assessment of a newly admitted laboring client, the nurse documents the client to be 4-cm dilated, 30% effaced, and at -3 station. She's having contractions every 9 to 10 minutes that are lasting 45 seconds. Which phase of labor does the nurse assess the client to be in? A. Second stage B. Third stage C. Latent phase D. Transition phase

C. Latent phase

The student nurse is watching the preceptor coach a client through the second stage of labor. During this stage, the nurse assesses the client for the urge to push and encourages the client to delay pushing until she feels the urge to. The student nurse recognizes this type of second-stage care as which of the following? A. Directed pushing B. Spontaneous pushing C. Nondirected pushing D. Valsalva pushing

C. Nondirected pushing

With regard to a pregnant woman's anxiety about her labor experience, which does the nurse recognize? A. Anxiety may increase the perception of pain, but it does not affect the process of labor. B. Women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity. C. Severe anxiety can increase pain and stress, which renders uterine contractions less effective. D. Continuous labor support decreases anxiety, but has no effect on pain perception or use of pain medication during labor.

C. Severe anxiety can increase pain and stress, which renders uterine contractions less effective.

A client and her partner who have recently immigrated to the United States request that no one speak at delivery so the first voice the infant hears will be their native language. How would the nurse respond to this request? A. "We do not allow that in this hospital. It is against all regulations." B. "We'll let you know when the baby's head is out so you can talk loudly in case we're talking too." C. "The infant won't understand words anyway, but I suppose we could try." D. "I understand that this is very important to you. I will inform the rest of the delivery team of your request and we will honor it if at all possible."

D. "I understand that this is very important to you. I will inform the rest of the delivery team of your request and we will honor it if at all possible."

A client calls the nurses station to report that she thinks her water has broken. Which of the following statements by the nurse explains the reason for the need for a vaginal examination to the client? A. "The vaginal examination allows for the assessment of the fetal heart rate (FHR)." B. "Laboring women often urinate and think it was their water breaking; let me check." C. "In order for us to confirm your water has broken, we'll need to place an internal monitor." D. "The laboratory test that confirms your amniotic fluid has ruptured requires a vaginal examination."

D. "The laboratory test that confirms your amniotic fluid has ruptured requires a vaginal examination."

A full-term infant girl was born 1 minute ago. She is centrally pink with blue hands, her heart rate is noted at 148 bpm, her arms and legs are flexed closely to her body, and she is crying vigorously. Using the table, calculate the Apgar score. A. 6 B. 7 C. 8 D. 9

D. 9

The nurse receives a call from the partner of a nulliparous woman in labor. The partner asks when they should come to the birthing facility. During which part of labor would a pregnant client be told to come to the birthing facility? A. Transition phase B. Fourth stage C. Second stage D. Active phase

D. Active phase

During the active phase, the client states that she feels a strong urge to push. The nurse explains that which reflex triggers this urge? A. Deep tendon reflex B. Moro reflex C. Naegele's rule D. Ferguson's reflex

D. Ferguson's reflex

Based on the image, which degree perineal laceration did this client experience? A. First degree B. Second degree C. Third degree D. Fourth degree

D. Fourth degree

While caring for a pregnant client, which of the following can the nurse provide to decrease fear and anxiety throughout labor and delivery? A. Ambulation B. Confidence C. Pain medication D. Labor support

D. Labor support

Upon starting a shift in the labor and delivery (L&D) unit, the nurse is assigned to care for a 15-year-old client in active labor. When entering the room to assess the client, the nurse finds a room full of visitors and notes the client appears uncomfortable. Which is the appropriate nursing intervention at this time? A. Insist that all visitors leave the room so that it can be a quiet labor environment. B. Tell the client you will come back to check her blood pressure after everyone leaves. C. Determine who the visitors are, so the nurse can focus her assessment questions toward the parents of the client. D. Request that everyone step out during the assessment and ask the client whom she would like in the room for the birth.

D. Request that everyone step out during the assessment and ask the client whom she would like in the room for the birth.

A woman has been using nonpharmacological pain relief methods during labor, but now requests IV pain medication. Which finding would cause the nurse to withhold a narcotic medication dose? A. Blood pressure 138/76 B. Moderate variability on the fetal heart tracing C. Client rating the pain 8/10 D. Respiratory rate of 11

D. Respiratory rate of 11

The nurse is assessing a low-risk pregnant client and documenting fetal heart tones (FHTs) every 5 minutes. Which stage of labor is this client in, based on the frequency of assessments being performed? A. Latent phase B. Early phase C. First stage D. Second stage

D. Second stage

To improve fetal oxygenation and decrease maternal exhaustion during second-stage labor, what would the nurse instruct the client to do? A. Take deep breaths from the nitrous oxide mask before pushing. B. Perform pant-blow breathing during the peak of a contraction. C. Use the Valsalva maneuver as the nurse directs pushing. D. Wait until there is a strong urge to push to begin bearing down efforts.

D. Wait until there is a strong urge to push to begin bearing down efforts.