Labor and Delivery questions
With regard to fetal positioning during labor, nurses should be aware that: A) Birth is imminent when the presenting part is at +4 to +5 cm, below the spine. B) Engagement is the term used to describe the beginning of labor. C) The largest transverse diameter of the presenting part is the suboccipitobregmatic diameter. D) Position is a measure of the degree of descent of the presenting part of the fetus through the birth canal.
A) Birth is imminent when the presenting part is at +4 to +5 cm, below the spine. • Primary Powers (involuntary uterine contractions) = term used to describe the beginning of labor. • The largest transverse diameter of the presenting part is the biparietal or occipitomental diameter. • Station = measure of the degree of descent of the presenting part of the fetus through the birth canal.
You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take? A) Call for help and Notify the care provider immediately B) Start pitocin C) Have her empty her bladder D) Insert a Foley catheter
A) Call for help and Notify the care provider immediately
Which presentation is described accurately in terms of both presenting part and frequency of occurrence? A) Cephalic: occiput; at least 95% B) Cephalic: cranial; 80% to 85% C) Shoulder: scapula; 10% to 15% D) Breech: sacrum; 10% to 15%
A) Cephalic: occiput; at least 95%
A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure would be to use: A) Counterpressure against the sacrum B) Pant-blow (breaths and puffs) breathing techniques C) Effleurage. D) Conscious relaxation or guided imagery.
A) Counterpressure against the sacrum
To adequately care for a laboring woman, the nurse knows that which stage of labor varies the most in length? A) First B) Fourth C) Third D) Second
A) First
When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman's risk for _____ has increased. A) Intrauterine infection B) Hemorrhage C) Precipitous labor D) Supine hypotension
A) Intrauterine infection
What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken. A) Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask. B) Perform a vaginal examination, reposition the mother, and provide oxygen via face mask. C) Administer oxygen to the mother, increase IV fluid, and notify the care provider. D) Call the provider, reposition the mother, and perform a vaginal examination
A) Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask.
A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to: A) Stay with the client and call for help. B) Insert an oral airway. C) Administer oxygen by mask. D) Suction the mouth to prevent aspiration.
A) Stay with the client and call for help.
When assessing a multiparous woman who has just given birth to an 8-pound boy, the nurse notes that the woman's fundus is firm and has become globular in shape. A gush of dark red blood comes from her vagina. The nurse concludes that: A) The placenta has separated. B) A cervical tear occurred during the birth C) The woman is beginning to hemorrhage. D) Clots have formed in the upper uterine segment.
A) The placenta has separated.
The nurse providing care for the laboring woman should understand that variable fetal heart rate (FHR) decelerations are caused by: A) Umbilical cord compression. B) Altered fetal cerebral blood flow C) Fetal hypoxemia. D) Uteroplacental insufficiency
A) Umbilical cord compression.
The nurse caring for the woman in labor should understand that maternal hypotension can result in: A) Uteroplacental insufficiency. B) Spontaneous rupture of membranes C) Fetal dysrhythmias. D) Early decelerations.
A) Uteroplacental insufficiency.
A laboring woman's amniotic membranes have just ruptured. The immediate action of the nurse would be to: A. Assess the fetal heart rate (FHR) pattern. B. Perform a vaginal examination. C. Inspect the characteristics of the fluid. D. Assess maternal temperature.
A. Assess the fetal heart rate (FHR) pattern. RATIONAL: The first nursing action after the membranes are ruptured is to check the FHR. Compression of the cord could occur after rupture leading to fetal hypoxia as reflected in an alteration in FHR pattern, characteristically variable decelerations. The same initial action should follow artificial rupture of the membranes (amniotomy).
On review of a fetal monitor tracing, the nurse notes that for several contractions the fetal heart rate decelerates as a contraction begins and returns to baseline just before it ends. The nurse should: A. Describe the finding in the nurse's notes. B. Reposition the woman onto her side. C. Call the physician for instructions. D. Administer oxygen at 8 to 10 L/min with a tight face mask.
A. Describe the finding in the nurse's notes. RATIONAL: An early deceleration pattern from head compression is described. No action other than documentation of the finding is required since this is an expected reaction to compression of the fetal head as it passes through the cervix.
The nurse should tell a primigravida that the definitive sign indicating that labor has begun would be: A. Progressive uterine contractions. B. Lightening. C. Rupture of membranes. D. Passage of the mucous plug (operculum).
A. Progressive uterine contractions.
On completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6 cm, -1. What is a correct interpretation of the data? A. The fetal presenting part is 1 cm above the ischial spines. B. Effacement is 4 cm from completion. C. Dilation is 50% completed. D. The fetus has achieved passage through the ischial spines.
A. The fetal presenting part is 1 cm above the ischial spines.
Through vaginal examination the nurse determines that a woman is 4 cm dilated, and the external fetal monitor shows uterine contractions every 3.5 to 4 minutes. The nurse would report this as: A) First stage, latent phase B) First stage, active phase C) First stage, transition phase D) Second stage, latent phase
B) First stage, active phase
What is an expected characteristic of amniotic fluid? A) Deep yellow color B) Pale, straw color with small white particles C) Acidic result on a Nitrazine test D) Absence of ferning
B) Pale, straw color with small white particles
The most common cause of decreased variability in the fetal heart rate (FHR) that lasts 30 minutes or less is: A) Fetal hypoxemia B) Fetal sleep cycles C) Altered cerebral blood flow. D) Umbilical cord compression.
B) Fetal sleep cycles
A client is admitted to the labor and delivery unit with contractions that are 3-5 minutes apart, lasting 60-70 seconds. She reports that she is leaking fluid. A vaginal exam reveals that her cervix is 80 percent effaced and 4 cm dilated and a -1 station. The nurse knows that the client is in which phase and stage of labor? A) Latent phase, First Stage B) Active Phase of First Stage C) Latent phase of Second Stage D) Transition
B) Active Phase of First Stage Second stage = full dilation until birth
Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate? A) Latent: Mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours B) Active: Moderate, regular contractions; 4- to 7-cm dilation; duration of 3 to 6 hours C) Lull: No contractions; dilation stable; duration of 20 to 60 minutes D) Transition: Very strong but irregular contractions; 8- to 10-cm dilation; duration of 3-4 hours
B) Active: Moderate, regular contractions; 4- to 7-cm dilation; duration of 3 to 6 hours
Concerning the third stage of labor, nurses should be aware that: A) The placenta eventually detaches itself from a flaccid uterus B) An active approach to managing this stage of labor reduces the risk of excessive bleeding C) It is important that the dark, roughened maternal surface of the placenta appear before the shiny fetal surface. D) The major risk for women during the third stage is a rapid heart rate.
B) An active approach to managing this stage of labor reduces the risk of excessive bleeding
While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate in a slow curve at the onset of several contractions and returns to baseline before each contraction ends. The nurse should: A) Insert an internal monitor B) Document the finding in the client's record. C) Discontinue the oxytocin infusion D) Change the woman's position
B) Document the finding in the client's record.
Which characteristic is associated with false labor contractions? A. Painless B. Decrease in intensity with ambulation C. Regular pattern of frequency established D. Progressive in terms of intensity and duration
B. Decrease in intensity with ambulation RATIONAL: Although false labor contractions decrease with activity, true labor contractions are enhanced or stimulated with activity such as ambulation.
Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of Pitocin. The woman is in a side-lying position, and her vital signs are stable and fall within a normal range. Contractions are intense, last 90 seconds, and occur every 1½ to 2 minutes. The nurse's immediate action would be to: A. Change the woman's position. B. Stop the Pitocin. C. Elevate the woman's legs. D. Administer oxygen via a tight mask at 8 to 10 L/min.
B. Stop the Pitocin. RATIONAL: Late deceleration patterns noted are most likely related to alteration in uteroplacental perfusion associated with the strong contractions described. The immediate action would be to stop the Pitocin infusion since Pitocin is an oxytocic that stimulates the uterus to contract. Elevation of her legs would be appropriate if hypotension were present.
While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurse's first priority is to: A) Notify the care provider. B) Assist with amnioinfusion C) Change the woman's position D) Insert a scalp electrode.
C) Change the woman's position
As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations with loss of variability is nonreassuring and is associated with A) Cord compression B) Hypotension C) Hypoxemia/acidemia D) Maternal drug use.
C) Hypoxemia/acidemia
A laboring woman received meperidine (Demerol) intravenously 90 minutes before she gave birth. Which medication should be available to reduce the postnatal effects of Demerol on the neonate? A) Fentanyl (Sublimaze) B) Promethazine (Phenergan) C) Naloxone (Narcan) D) Nalbuphine (Nubain)
C) Naloxone (Narcan)
What is an advantage of external electronic fetal monitoring? A) Once correctly applied by the nurse, the transducer need not be repositioned even when the woman changes positions. B) The tocotransducer can measure and record the frequency, regularity, intensity, and approximate duration of uterine contractions (UCs). C) The external EFM does not require rupture of membranes or introduction of scalp electrode or IUPC which may introduce risk of infection or fetal scarring. D) The external EFM can accurately record FHR all the time.
C) The external EFM does not require rupture of membranes or introduction of scalp electrode or IUPC which may introduce risk of infection or fetal scarring.
Which of the following is NOT a reason to come to labor and birth. A) The patient is 39 weeks with second baby. She has been having contractions for 2 hours. Contractions are getting longer and stronger and closer together. B) The patients says she has noticed greenish fluid leaking from her vagina. She is 41.5 weeks pregnant and not having contractions. C) The patient is 40 weeks and has contractions that are 8-10 minutes apart, 30 seconds long and been that way for 8 hours. D) The patient has not felt the baby move for 8 hours, despite drinking cold fluids, and nudging the baby with her hand.
C) The patient is 40 weeks and has contractions that are 8-10 minutes apart, 30 seconds long and been that way for 8 hours.
The nurse providing care for the laboring woman should understand that late fetal heart rate (FHR) decelerations are caused by: A) Altered cerebral blood flow B) Spontaneous rupture of membranes C) Uteroplacental insufficiency D) Umbilical cord compression
C) Uteroplacental insufficiency
The nurse has received a report about a woman in labor. The woman's last vaginal examination was recorded as 4, 80%, and -2. The nurse's interpretation of this assessment is that: A) The cervix is dilated 4 cm, it is effaced 80%, and the presenting part is 2 cm below the ischial spines B) The cervix is effaced 4 cm, it is dilated 80%, and the presenting part is 2 cm below the ischial spines. C) The cervix is effaced 4 cm, it is dilated 80%, and the presenting part is 2 cm above the ischial spines D) The cervix is 4 cm dilated, it is effaced 80%, and the presenting part is 2 cm above the ischial spines
D) The cervix is 4 cm dilated, it is effaced 80%, and the presenting part is 2 cm above the ischial spines
Which of the following is NOT a reassuring component of the fetal heart rate A) FHR of 114 B) Accelerations of the FHR C) Moderate Variability D) Absent FHR Variability
D) Absent FHR Variability
The nurse providing care for the laboring woman should understand that accelerations with fetal movement: A) Are caused by umbilical cord compression B) Are caused by uteroplacental insufficiency C) Warrant close observation D) Are reassuring.
D) Are reassuring.
To assess uterine contractions the nurse would A) Asses duration from the beginning of the contraction to the peak of the same contraction, frequency by measuring the time between the beginning of one contraction to the beginning of the next contraction. B) Assess frequency as the time between the end of one contraction and the beginning of the next contraction, duration as the length of time from the beginning to the end of contractions, and palpate the uterus for strength C) Assess duration from beginning to end of each contraction. Assess the strength of the contraction by the external fetal monitor reading. Measure frequency by measuring the beginning of one contraction to another. D) Assess duration from beginning to end of each contraction., frequency by measuring the time between the beginnings of contractions, and palpate the fundus of the uterus for strength.
D) Assess duration from beginning to end of each contraction., frequency by measuring the time between the beginnings of contractions, and palpate the fundus of the uterus for strength.
A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. The nurse's initial response would be to: A) Prepare the woman for imminent birth B) Notify the woman's primary health care provider. C) Document the characteristics of the fluid. D) Assess the fetal heart rate and pattern.
D) Assess the fetal heart rate and pattern.
When assessing a woman in labor, the nurse is aware that the relationship of the fetal body parts to one another is called fetal: A) Lie. B) Position. C) Presentation. D) Attitude.
D) Attitude. • Lie = relationship between the longitudinal axis of fetus and mother • Position = relationship of the presenting part to the 4 quadrants of the mother's pelvis, ie 3 letter abr: 1.) R or L 2.) O, S, M or Sc (Occiput, Sacrum, Mentum, SCapula) 3.) A, P, or T (Anterior, Posterior, Transverse) • Presentation = presenting part that overlies pelvic inlet
The factors that affect the process of labor and birth, known commonly as the five Ps, include all EXCEPT: A) Passageway. B) Powers. C) Passenger. D) Pressure.
D) Pressure. :: The 5 P's are: 1. Powers (contractions) 2. Passengers (fetus & placenta) 3. Passageway (birth canal) 4. Position (of the mother) 5. Psychological Response
During labor a fetus with an average heart rate of 175 beats/min over a 15-minute period would be considered to have: A) A normal baseline heart rate. B) Bradycardia. C) Hypoxia. D) Tachycardia.
D) Tachycardia.
A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent's class. Which aspect of their birth plan would be considered unrealistic and require further discussion with the nurse? A. "My husband and I have agreed that my sister will be my coach since he becomes anxious with regard to medical procedures and blood. He will be nearby and check on me every so often to make sure everything is OK." B. "We plan to use the techniques taught in the Lamaze classes to reduce the pain experienced during labor." C. "We want the labor and birth to take place in a birthing room. My husband will come in the minute the baby is born." D. "We do not want the fetal monitor used during labor since it will interfere with movement and doing effleurage."
D. "We do not want the fetal monitor used during labor since it will interfere with movement and doing effleurage." RATIONAL: Since monitoring is essential to assess fetal well-being, it is not a factor that can be determined by the couple. The nurse should fully explain its importance. The option for intermittent electronic monitoring could be explored if this is a low risk pregnancy and as long as labor is progressing normally.
A primigravida asks the nurse about signs she can look for that would indicate that the onset of labor is getting closer. The nurse should describe: A. Weight gain of 1 to 3 pounds. B. Quickening. C. Fatigue and lethargy. D. Bloody show.
D. Bloody show. RATIONAL: Passage of the mucous plug (operculum) also termed pink/bloody show occurs as the cervix ripens.
Which finding meets the criteria of a reassuring fetal heart rate (FHR) pattern? A. FHR does not change as a result of fetal activity. B. Average baseline rate ranges between 100 and 140 beats/min. C. Mild late deceleration patterns occur with some contractions. D. Variability averages between 6 to 10 beats/min.
D. Variability averages between 6 to 10 beats/min. RATIONAL: Variability indicates a well-oxygenated fetus with a functioning autonomic nervous system. Late deceleration patterns are never reassuring, although early and mild variable decelerations are expected, reassuring findings.
