Maternal Newborn Success - Intrapartum

25. The nurse auscultates a fetal heart rate of 152 on a client in early labor. Which of the following actions by the nurse is appropriate? 1. Inform the mother that the rate is normal. 2. Reassess in 5 minutes to verify the results. 3. Immediately report the rate to the health care practitioner. 4. Place the client on her left side and apply oxygen by face mask.

25. 1. This is the correct response. A fetal heart rate of 152 is normal.

82. A nurse is caring for women from four different countries. Which of the women is most likely to request that her head be kept covered throughout her hospitalization? 1. Arabic woman. 2. Chinese woman. 3. Russian woman. 4. Greek woman.

82. 1. Muslim women, who are often from Arabic countries, are expected to keep their heads covered at all times.

13. On examination, it is noted that a full-term primipara in active labor is right occipi toanterior (ROA), 7 cm dilated, and 3 station. Which of the following should the nurse report to the physician? 1. Descent is progressing well. 2. Fetal head is not yet engaged. 3. Vaginal delivery is imminent. 4. External rotation is complete.

13. 1. Descent is progressing well. The pre senting part is 3 centimeters below the ischial spines.

78. A client, G2P1001, 5 cm dilated and 40% effaced, has just received an epidural. Which of the following actions is important for the nurse to make at this time? 1. Assess the woman's temperature. 2. Place a wedge under the woman's side. 3. Place a blanket roll under the woman's feet. 4. Assess the woman's pedal pulses.

2. A wedge should be placed under one side of the woman.

53. The nurse wishes to assess the variability of the fetal heart rate. Which of the following actions must precede this assessment? 1. Place the client in the lateral recumbent position. 2. Insert an internal fetal monitor electrode. 3. Administer oxygen to the mother via face mask. 4. Ask the mother to indicate when she feels fetal movement.

2. Before the variability can be accu rately assessed, an internal fetal heart electrode must be applied.

22. In addition to breathing with contractions, which of the following actions can help a woman in labor to work with the pain of the first stage of labor? 1. Lying in the lithotomy position. 2. Performing effleurage. 3. Practicing Kegel exercises. 4. Pushing with each contraction.

2. Effleurage is a light massage that can soothe the mother during labor.

73. A G1P0, 8 cm dilated, is to receive pain medication. The health care practitioner has decided to order an opiate analgesic with an analgesic-potentiating medication. Which of the following medications would the nurse expect to be ordered as the analgesic-potentiating medication? 1. Seconal (secobarbital). 2. Phenergan (promethazine). 3. Benadryl (diphenhydramine). 4. Tylenol (acetaminophen).

2. Phenergan is often used as an anal gesic potentiator.

71. A woman, G1 P0000, 40 weeks' gestation, entered the labor suite stating that she is in labor. Upon examination it is noted that the woman is 2 cm dilated, 30% effaced, contracting every 12 min 30 sec. Fetal heart rate is in the 140s with good vari ability and spontaneous accelerations. What should the nurse conclude when re porting the findings to the primary health care practitioner? 1. The woman is high risk and should be placed on tocolytics. 2. The woman is in early labor and could be sent home. 3. The woman is high risk and could be induced. 4. The woman is in active labor and should be admitted to the unit.

2. The woman is in early labor. There is no need for her to be hospitalized at this time.

3. A client in labor, G2 P1001, was admitted 1 hour ago at 2 cm dilated and 50% effaced. She was talkative and excited at that time. During the past 10 minutes she has become serious, closing her eyes and breathing rapidly with each contraction. Which of the following is an accurate nursing assessment of the situation? 1. The client had poor childbirth education prior to labor. 2. The client is exhibiting an expected behavior for labor. 3. The client is becoming hypoxic and hypercapnic. 4. The client needs her alpha-fetoprotein levels checked.

2. The woman is showing expected signs of the active phase of labor.

60. A woman is in the second stage of labor with a strong urge to push. Which of the following actions by the nurse is appropriate at this time? 1. Assess the fetal heart rate between contractions every 60 minutes. 2. Encourage the woman to grunt during contractions. 3. Assess the pulse and respirations of the mother every 5 minutes. 4. Position the woman on her back with her knees on her chest.

2. The woman should be encouraged to grunt during contractions.

27. While caring for a client in the transition phase of labor, the nurse notes that the fetal monitor tracing shows average short-term and long-term variability with a baseline of 142 beats per minute (bpm). What should the nurse do? 1. Provide caring labor support. 2. Administer oxygen via face mask. 3. Change the client's position. 4. Speed up the client's intravenous.

27. 1. The tracing is showing a normal fetal heart tracing. No intervention is needed.

28. While evaluating the fetal heart monitor tracing on a client in labor, the nurse notes that there are fetal heart decelerations present. Which of the following assess ments must the nurse make at this time? 1. The relationship between the decelerations and the labor contractions. 2. The maternal blood pressure. 3. The gestational age of the fetus. 4. The placement of the fetal heart electrode in relation to the fetal position.

28. 1. The relationship between the deceler ations and the contractions will deter mine the type of deceleration pattern.

30. An obstetrician is performing an amniotomy on a gravid woman in transition. Which of the following assessments must the nurse make immediately following the procedure? 1. Maternal blood pressure. 2. Maternal pulse. 3. Fetal heart rate. 4. Fetal fibronectin level.

3. It is essential to assess the fetal heart rate immediately after an amniotomy.

12. When performing Leopold's maneuvers, the nurse notes that the fetus is in the left occiput anterior position. Where should the nurse place a fetoscope best to hear the fetal heart beat? 1. Left upper quadrant. 2. Right upper quadrant. 3. Left lower quadrant. 4. Right lower quadrant.

3. The fetoscope should be placed in the left lower quadrant for a fetus positioned in the LOA position as described in the question.

51. Which of the following pictures depicts a fetus in the frank breech position? 1. 3. 2. 4.

3. This is a picture of a fetus in the frank breech position.

33. A woman has decided to hire a doula to work with her during labor and delivery. Which of the following actions would be appropriate for the doula to perform? 1. Give the mother a back rub. 2. Assess the fetal heart rate. 3. Check the blood pressure. 4. Regulate the intravenous.

33. 1. An appropriate action by the doula is giving the woman a back massage.

40. A nurse determines that a client is carrying a fetus in the vertical lie. The nurse's judgment should be questioned if the fetal presenting part is which of the following? 1. Sacrum. 2. Occiput. 3. Mentum. 4. Scapula.

4. A fetus in a scapular presentation is in a horizontal lie.

2. A woman who states that she "thinks" she is in labor enters the labor suite. Whic of the following assessments will provide the nurse with the most valuable inform tion regarding the client's labor status? 1. Leopold's maneuvers. 2. Fundal contractility. 3. Fetal heart assessment. 4. Vaginal examination.

4. A vaginal examination will provide the nurse with the best information about the status of labor.

42. The nurse sees the fetal head through the vaginal introitus when a woman pushes. The nurse, interpreting this finding, tells the client, "You are pushing very well." In addition, the nurse could also state which of the following? 1. "The baby's head is engaged." 2. "The baby is floating." 3. "The baby is at the ischial spines." 4. "The baby is almost crowning."

4. The baby's head is almost crowning.

14. One hour ago, a multipara was examined with the following results: 8 cm, 50% effaced, and 1 station. She is now pushing with contractions and the fetal head seen at the vaginal introitus. The nurse concludes that the client is now 1. 9 cm dilated, 70% effaced, and 2 station. 2. 9 cm dilated, 80% effaced, and 3 station. 3. 10 cm dilated, 90% effaced, and 4 station. 4. 10 cm dilated, 100% effaced, and 5 station.

4. The cervix is fully dilated and fully ef faced and the baby is low enough to be seen through the vaginal introitus.

46. Which of the following frequency and duration assessments are consistent with the pattern shown below? 1. q 2 min 60 sec. 2. q 2 min 90 sec. 3. q 3 min 60 sec. 4. q 3 min 90 sec.

4. The contraction pattern is q 3 min 90 sec

41. Which of the following choices includes the correct order of the cardinal moves of labor? 1. Internal rotation, extension, external rotation. 2. External rotation, descent, extension. 3. Extension, flexion, internal rotation. 4. External rotation, internal rotation, expulsion.

41. 1. Internal rotation, extension, external rotation is the correct sequence of the cardinal moves of labor.

44. The frequency of the contractions seen on the monitor tracing below is q __________ 1050

44. q 3 minutes

1. A client enters the labor and delivery suite stating that she thinks she is in labor. Which of the following information about the woman should the nurse note from the woman's prenatal record before proceeding with the physical assessment? Select all that apply. 1. Weight gain. 2. Ethnicity and religion. 3. Age. 4. Type of insurance. 5. Gravidity and parity.

1. 1, 2, 3, and 5 are correct. 1. Before proceeding with a physical as sessment, the nurse should check the client's weight gain reported in her prenatal record. 2. The client's ethnicity and religion should be noted before physical assess ment. This allows the nurse to pro ceed in a culturally sensitive manner. 3. The client's age should also be noted before the physical assessment is begun. 4. The type of insurance the woman has is not relevant to the nurse. 5. The client's gravidity and parity—how many times she has been pregnant and how many times she has given birth—should also be noted before a physical assessment is begun.

59. The nurse is assessing an internal fetal heart monitor tracing of an unmedicated, full-term gravida who is in transition. Which of the following heart rate patterns would the nurse interpret as normal? 1. Variable baseline of 140 with V-shaped decelerations to 120 unrelated to contractions. 2. Variable baseline of 140 with decelerations to 100 that mirror each of the contractions. 3. Flat baseline of 140 with decelerations to 120 that return to baseline after the end of the contractions. 4. Flat baseline of 140 with no obvious decelerations or accelerations.

2. Decelerations that mirror contrac tions are early decelerations. These are related to head compression and are expected during transition and second stage labor.

77. Immediately following administration of an epidural anesthesia, the nurse must monitor the mother for which of the following? 1. Paresthesias in her feet and legs. 2. Drop in blood pressure. 3. Increase in central venous pressure. 4. Fetal heart accelerations.

2. Hypotension is a very common side effect of regional anesthesia.

81. Which of the following actions is appropriate for the nurse to perform when caring for a Chinese-speaking woman in active labor? 1. Apply heat to the woman's back. 2. Inquire regarding the woman's pain level. 3. Make sure that the woman's head is covered. 4. Accept the woman's loud verbalizations.

2. It is important to inquire about the pain level of all women in labor, but especially those from the Asian culture.

34. The nurse is assessing a client who states, "I think I'm in labor." Which of the fol lowing findings would positively confirm the client's belief? 1. She is contracting q 5 min 60 sec. 2. Her cervix has dilated from 2 to 4 cm. 3. Her membranes have ruptured. 4. The fetal head is engaged.

2. Once the cervix begins to dilate, a client is in true labor.

7. The nurse is assessing the fetal station during a vaginal examination. Which of the following structures should the nurse palpate? 1. Sacral promontory. 2. Ischial spines. 3. Cervix. 4. Symphysis pubis.

2. Station is assessed by palpating the ischial spines.

10. During a vaginal examination, the nurse palpates fetal buttocks that are facing the left posterior and are 1 cm above the ischial spines. Which of the following is consistent with this assessment? 1. LOA 1 station. 2. LSP 1 station. 3. LMP 1 station. 4. LSA 1 station.

2. The LSP position is the correct answer. The fetal buttocks (S or sacrum) are facing toward the mother's left posterior (LP) and but tocks at 1 station are 1 cm above the ischial spines.

70. A nurse is assessing the vital signs of a client in labor at the peak of a contraction. Which of the following findings would the nurse expect to see? 1. Decreased pulse rate. 2. Hypertension. 3. Hyperthermia 4. Decreased respiratory rate.

2. The blood pressure rises dramatically.

79. The practitioner is performing a fetal scalp stimulation test. Which of the following fetal responses would the nurse expect to see? 1. Spontaneous fetal movement. 2. Fetal heart acceleration. 3. Increase in fetal heart variability. 4. Resolution of late decelerations.

2. The fetal heart should accelerate in response to scalp stimulation.

48. An ultrasound report states, "The fetal head has entered the pelvic inlet." What does the nurse interpret this statement to mean? 1. The fetus has become engaged. 2. The fetal head has entered the true pelvis. 3. The fetal lie is horizontal. 4. The fetus is in an extended attitude.

2. The inlet's boundaries are: the sacral promontory and the upper margins of the ilia, ischia, and the symphysis pubis. This is the entry into the true pelvis.

37. A low-risk 38-week-gestation woman calls the labor unit and says, "I have to come to the hospital right now. I just saw pink streaks on the toilet tissue when I went to the bathroom. I'm bleeding." Which of the following responses should the nurse make first? 1. "Does it burn when you void?" 2. "You sound frightened." 3. "That is just the mucus plug." 4. "How much blood is there?"

2. The nurse is using reflection to ac knowledge the client's concerns.

24. A gravid client, G3 P2002, was examined 5 minutes ago. Her cervix was 8 cm dilated and 90% effaced. She now states that she needs to move her bowels. Which of the following actions should the nurse perform first? 1. Offer the client the bedpan. 2. Evaluate the progress of labor. 3. Notify the physician. 4. Encourage the patient to push.

2. The nurse should first assess the progress of labor to see if the client has moved into the second stage of labor.

66. A woman had a baby by normal spontaneous delivery 10 minutes ago. The nurse notes that a gush of blood was just expelled from the vagina and the umbilical cord lengthened. What should the nurse conclude? 1. The woman has an internal laceration. 2. The woman is about to deliver the placenta. 3. The woman has an atonic uterus. 4. The woman is ready to expel the cord bloods.

2. These are signs of placental delivery.

19. A client, who is 7 cm dilated and 100% effaced, is breathing at a rate of 30 breaths per minute during contractions. Immediately after a contraction, she complains of tingling in her fingers with some lightheadedness. Which of the following actions should the nurse take at this time? 1. Assess the blood pressure. 2. Have the woman breathe into a bag. 3. Turn the woman onto her side. 4. Check the fetal heart rate.

2. This client is showing signs of hyperventilation. The symptoms will likely subside if she rebreathes her exhalations.

68. A woman is in the transition phase of labor. Which of the following comments should the nurse expect to hear? 1. "I am so excited to be in labor." 2. "I can't stand this pain any longer!" 3. "I need ice chips because I'm so hot." 4. "I have to push the baby out right now!"

2. This comment is consistent with a woman in the transition phase of stage 1.

67. A client is in the third stage of labor. Which of the following assessments should the nurse make/observe for? 1. Fetal heart assessment after each contraction. 2. Uterus rising in the abdomen and feeling globular. 3. Rapid cervical dilation to ten centimeters. 4. Maternal complaints of intense rectal pressure.

2. This is a sign of placental separation.

35. The childbirth education nurse is evaluating the learning of four women, 38 to 40 weeks' gestation, regarding when they should go to the hospital. The nurse determines that the client who makes which of the following statements needs additional teaching? 1. The client who says, "If I feel a pain in my back and lower abdomen every 5 minutes." 2. The client who says, "When I feel a gush of clear fluid from my vagina." 3. The client who says, "When I go to the bathroom and see the mucus plug on the toilet tissue." 4. The client who says, "If I ever notice a greenish discharge from my vagina."

3. Expelling the mucus plug is not suffi cient reason to go to the hospital to be assessed.

83. The nurse is caring for an Orthodox Jewish woman in labor. It would be appropri ate for the nurse to include which of the following in the plan of care? 1. Encourage the father to hold his partner's hand during labor. 2. Ask the woman if she would like to speak with her priest. 3. Provide the woman with a long-sleeved hospital gown. 4. Place an order for the woman's postpartum vegetarian diet.

3. Observant Jewish women are ex pected to have their elbows covered at all times. A long-sleeved gown, there fore, should be provided for them.

74. On vaginal examination, it is noted that a woman with a well-functioning epidural is in the second stage of labor. The station is 2 and the baseline fetal heart rate is 130 with no decelerations. Which of the following nursing actions is appropriate at this time? 1. Coach the woman to hold her breath while pushing 3 to 4 times with each contraction. 2. Administer oxygen via face mask at 8 to 10 liters per minute. 3. Delay pushing until the baby descends further and the mother has a strong urge to push. 4. Place the woman on her side and assess her oxygen saturation.

3. Once the woman has a strong urge to push, then she should be encouraged to push against an open glottis in or der to birth the baby.

17. The childbirth educator is teaching a class of pregnant couples the breathing tech nique that is most appropriate during the second stage of labor. Which of the fol lowing techniques did the nurse teach the women to do? 1. Alternately pant and blow. 2. Take rhythmic, shallow breaths. 3. Push down with an open glottis. 4. Do slow chest breathing.

3. Open glottal pushing is used during stage 2 of labor.

63. A multipara, LOA, station 3, who has had no pain medication during her labor, is now in stage 2. She states that her pain is 6 on a 10-point scale and that she wants an epidural. Which of the following responses by the nurse is appropriate? 1. "Epidurals do not work well when the pain level is above level 5." 2. "I will contact the doctor to get an order for an epidural right away." 3. "The baby is going to be born very soon. It is really too late for an epidural." 4. "I will check the fetal heart rate. You can have an epidural if it is over 120."

3. Since this woman is a multipara, the position is LOA and the station is 3, this is an accurate statement.

16. Which of the following responses is the primary rationale for providing general information as well as breathing and relaxation exercises in childbirth education classes? 1. Mothers who are doing breathing exercises during labor will refrain from yelling. 2. Breathing and relaxation exercises are less exhausting than crying and moaning. 3. Knowledge learned at childbirth education classes helps to break the fear tension-pain cycle. 4. Childbirth education classes help to promote positive maternal-newborn bonding.

3. Some of the techniques learned at childbirth education classes are meant to break the fear-tension-pain cycle.

85. The nurse is providing acupressure to provide pain relief to a woman in labor. Where is the best location for the acupressure to be applied? 1. On the malleolus of the wrist. 2. Above the patella of the knee. 3. On the medial aspect of the lower leg. 4. Below the medial epicondyle of the elbow.

3. The medial surface of the lower leg has been shown to lessen the pain of labor.

38. A gravid client at term called the labor suite at 7:00 p.m. questioning whether she was in labor. The nurse determined that the client was likely in labor after the client stated: 1. "At 5:00 p.m., the contractions were about 5 minutes apart. Now they're about 7 minutes apart." 2. "I took a walk at 5:00 p.m., and now I talk through my contractions easier than I could then." 3. "I took a shower about a half hour ago. The contractions seem to hurt more since I finished." 4. "I had some tightening in my belly late this afternoon, and I still feel it after waking up from my 2-hour nap."

3. This response indicates that the labor contractions are increasing in intensity.

18. A nurse is teaching childbirth education classes to a group of pregnant teens. Which of the following strategies would promote learning by the young women? 1. Avoiding the discussion of uncomfortable procedures like vaginal exams and blood tests. 2. Focusing the discussion on baby care rather than labor and delivery. 3. Utilizing visual aids like movies and posters during the classes. 4. Having the classes at a location other than high school to reduce their embarrassment.

3. Using visual aids can help to foster learning in teens as well as adults.

11. The nurse enters a laboring client's room. The client is complaining of intense back pain with each contraction. The nurse concludes that the fetus is likely in which of the following positions? 1. Mentum anterior. 2. Sacrum posterior. 3. Occiput posterior. 4. Scapula anterior.

3. When a fetus is in the occiput poste rior position, mothers frequently complain of severe back pain.

29. A client is complaining of severe back labor. Which of the following nursing inter ventions would be most effective? 1. Assist mother with childbirth breathing. 2. Encourage mother to have an epidural. 3. Provide direct sacral pressure. 4. Use a hydrotherapy tub.

3. When direct sacral pressure is applied, the nurse is providing a counteraction to the pressure being exerted by the fetal head.

5. While performing Leopold's maneuvers on a woman in labor, the nurse palpates a hard round mass in the fundal area, a flat surface on the left side, small objects on the right side, and a soft round mass just above the symphysis. Which of the fol lowing is a reasonable conclusion by the nurse? 1. The fetal position is transverse. 2. The fetal presentation is vertex. 3. The fetal lie is vertical. 4. The fetal attitude is flexed.

3. With the findings of a hard round mass in the fundal area and soft round mass above the symphysis, the nurse can conclude that the fetal lie is vertical.

32. Upon examination, a nurse notes that a woman is 10 cm dilated, 100% effaced, and 3 station. Which of the following actions should the nurse perform during the next contraction? 1. Encourage the woman to push. 2. Provide firm fundal pressure. 3. Move the client into a squat. 4. Assess for signs of rectal pressure.

4. Assessing for rectal pressure is appropriate at this time.

61. A nurse is coaching a woman who is in the second stage of labor. Which of the following should the nurse encourage the woman to do? 1. Hold her breath for twenty seconds during every contraction. 2. Blow out forcefully during every contraction. 3. Push between contractions until the fetal head is visible. 4. Take a slow cleansing breath before bearing down.

4. By taking a slow, cleansing breath before pushing, the woman is waiting until the contraction builds to its peak. Her pushes will be more effec tive at this point in the contraction.

26. The nurse documents in a laboring woman's chart that the fetal heart is being "assessed via intermittent auscultation." To be consistent with this statement, the nurse, using a Doppler electrode, should assess the fetal heart at which of the fol lowing times? 1. After every contraction. 2. For 10 minutes every half hour. 3. Periodically during the peak of contractions. 4. For 1 minute immediately after contractions.

4. Intermittent auscultation should be performed for 1 full minute after con tractions end.

86. To decrease the possibility of a perineal laceration during delivery, the nurse performs which of the following interventions prior to the delivery? 1. Assists the woman into a squatting position. 2. Advises the woman to push only when she feels the urge. 3. Encourages the woman to push slowly and steadily. 4. Massages the perineum with mineral oil.

4. Massaging of the perineum with min eral oil does help to reduce perineal tearing.

55. After analyzing an internal fetal monitor tracing, the nurse concludes that there is moderate short-term variability. Which of the following interpretations should the nurse make in relation to this finding? 1. The fetus is becoming hypoxic. 2. The fetus is becoming alkalotic. 3. The fetus is in the middle of a sleep cycle. 4. The fetus has a healthy nervous system.

4. Moderate variability is indicative of fetal health.

20. A nurse is teaching a class of pregnant couples the most therapeutic breathing technique for the latent phase of labor. Which of the following techniques did the nurse teach? 1. Alternately panting and blowing. 2. Rapid, deep breathing. 3. Grunting and pushing with contractions. 4. Slow chest breathing.

4. Most women find slow chest breath ing effective during the latent phase.

39. A nurse describes a client's contraction pattern as: frequency every 3 min and dura tion 60 sec. Which of the following responses corresponds to this description? 1. Contractions lasting 60 seconds followed by a 1-minute rest period. 2. Contractions lasting 120 seconds followed by a 2-minute rest period. 3. Contractions lasting 2 minutes followed by a 60-second rest period. 4. Contractions lasting 1 minute followed by a 120-second rest period.

4. The frequency and duration of this contraction pattern is every 3 minutes lasting 60 seconds.

50. Which of the following pictures depicts a fetus in the LSA position? 1. 3. 2. 4.

4. This is a picture of a fetus in the LSA (left sacral anterior) position.

90. It is 4 p.m. A client, G1P0000, 3 cm dilated, asks the nurse when the dinner tray will be served. The nurse replies 1. "Laboring clients are never allowed to eat." 2. "Believe me, you will not want to eat by the time it is the dinner hour. Most women throw up, you know." 3. "The dinner tray should arrive in an hour or two." 4. "A heavy meal is discouraged. I can get clear fluids for you whenever you would like them, though."

4. This is the best response.

21. A woman, G2 P0101, 5 cm dilated and 30% effaced, is doing first-level Lamaze breathing with contractions. The nurse detects that the woman's shoulder and face muscles are beginning to tense during the contractions. Which of the following in terventions should the nurse perform first? 1. Encourage the woman to have an epidural. 2. Encourage the woman to accept intravenous analgesia. 3. Assist the woman in changing position. 4. Urge the woman to perform the next level breathing.

4. This woman is in the active phase of labor. The first phase breathing is probably no longer effective. Encouraging her to shift to the next level of breathing is appropriate at this time.

47. A woman, who is in active labor, is told by her obstetrician, "Your baby is in the flexed attitude." When she asks the nurse what that means, what should the nurse say? 1. The baby is in the breech position. 2. The baby is in the horizontal lie. 3. The baby's presenting part is engaged. 4. The baby's chin is resting on its chest.

4. When the baby's chin is on his or her chest, the baby is in the flexed attitude.

43. A midwife advises a mother that her obstetric conjugate is of average size. How should the nurse interpret that information for the mother? 1. The anterior to posterior diameter of the pelvis will accommodate a fetus with an average-sized head. 2. The fetal head is flexed so that it is of average diameter. 3. The mother's cervix is of average dilation for the start of labor. 4. The distance between the mother's physiological retraction ring and the fetal head is of average dimensions.

43. 1. The obstetric conjugate is the short est anterior to posterior diameter of the pelvis. When it is of average size, it will accommodate an average-sized fetal head.

45. The duration of the contractions seen on the monitor tracing below is: q ______________ 100 12 100 12 100 12 1050

45. 90 seconds

49. Which of the following pictures depicts a fetus in the ROP position? 1. 3. 2. 4.

49. 1. This is a picture of a fetus in the ROP (right occiput posterior) position.

54. The nurse is interpreting the fetal monitor tracing below. Which of the following actions should the nurse take at this time? 1. Provide caring labor support. 2. Administer oxygen via tight fitting facemask. 3. Turn the woman on her side. 4. Apply the oxygen saturation electrode to the mother.

54. 1. Because the variability is moderate (6 to 25 bpm wide), the nurse can conclude that the baby is well and that caring labor support is indicated.

57. When would the nurse expect to see the fetal heart changes noted on the monitor tracing shown below? 1. During fetal movement. 2. After the administration of analgesics. 3. When the fetus is acidotic. 4. With poor placental perfusion.

57. 1. The fetal heart rate normally acceler ates during fetal movement.

69. A client in labor is talkative and happy. How many centimeters dilated would a maternity nurse suspect that the client is at this time? 1. 2 cm. 2. 4 cm. 3. 8 cm. 4. 10 cm.

69. 1. The nurse would expect the woman to be 2 cm dilated.

87. The physician writes the following order for a newly admitted client in labor: Begin a 1000 cc IV of D5 1/2 NS at 150 cc/hr. The IV tubing states that the drop factor is 10 gtt/cc. Calculate the drip rate. _______ gtt/min

87. 25 gtt/min

58. A woman is in active labor and is being monitored electronically. She has just re ceived Stadol 2 mg IM for pain. Which of the following fetal heart responses would the nurse expect to see on the internal monitor tracing? 1. Variable decelerations. 2. Late decelerations. 3. Decreased variability. 4. Transient accelerations.

3. Analgesics are CNS depressants. The variability of the fetal heart rate, therefore, will be decreased.

52. During delivery, the nurse notes that the baby's head has just been delivered. The nurse concludes that the baby has just gone through which of the following cardinal moves of labor? 1. Flexion. 2. Internal rotation. 3. Extension. 4. External rotation.

3. During extension, the baby's head is birthed.

56. When would the nurse expect to see the monitor tracing shown below? 1. During latent phase of labor. 2. During an epidural insertion. 3. During second stage of labor. 4. During delivery of the placenta.

3. Early decelerations are frequently seen during the second stage of labor.

31. A nurse has just performed a vaginal examination on a client in labor. The nurse palpates the baby's buttocks as facing the mother's right side. Where should the nurse place the external fetal monitor electrode? 1. Left upper quadrant (LUQ). 2. Left lower quadrant (LLQ). 3. Right upper quadrant (RUQ). 4. Right lower quadrant (RLQ).

3. Since the baby's back is facing the mother's right side and the sacrum is presenting, the fetal monitor should be placed in her RUQ.

4. A woman has just arrived at the labor and delivery suite. In order to report the client's status to her primary health care practitioner, which of the following assess ments should the nurse perform? Select all that apply. 1. Fetal heart rate. 2. Contraction pattern. 3. Contraction stress test. 4. Vital signs. 5. Biophysical profile.

4. 1, 2, and 4 are correct. 1. The nurse should assess the fetal heart before reporting the client's status to the health care provider. 2. The nurse should assess the contrac tion pattern before reporting the client's status. 3. A contraction stress test is only performed if ordered by a health care practitioner. 4. The nurse should assess the woman's vital signs before reporting her status. 5. A biophysical profile is only performed if ordered by a health care practitioner.

36. A woman, 40 weeks' gestation, calls the labor unit to see whether or not she should go to hospital to be evaluated. Which of the following statements by the woman in dicates that she is probably in labor and should proceed to the hospital? 1. "The contractions are 5 to 20 minutes apart." 2. "I saw a pink discharge on the toilet tissue when I went to the bathroom." 3. "I have had cramping for the past 3 or 4 hours." 4. "The contractions are about a minute long and I am unable to talk through them."

4. This client is exhibiting clear signs of true labor. Not only are the contrac tions lasting a full minute but she is stating that they are so uncomfortable that she is unable to speak through them. She should be seen.

80. The nurse is interpreting the results of a fetal blood sampling test. Which of the following reports would the nurse expect to see? 1. Oxygen saturation of 99%. 2. Hgb of 11 gm/dL. 3. Serum glucose of 140 mg/dL. 4. pH of 7.30.

4. This fetal pH value is within normal limits.

15. The nurse is caring for a nulliparous client who attended Lamaze childbirth educa tion classes. Which of the following techniques should the nurse include in her plan of care? Select all that apply. 1. Hypnotic suggestion. 2. Rhythmic chanting. 3. Muscle relaxation. 4. Pelvic rocking. 5. Abdominal massage.

15. 3, 4, and 5 are correct. 1. Hypnotic suggestion is usually not in cluded in childbirth education based on the Lamaze method. 2. Rhythmic chanting is usually not in cluded in childbirth education based on the Lamaze method. 3. Muscle relaxation is an integral part of Lamaze childbirth education. 4. Pelvic rocking is taught in Lamaze classes as a way of easing back pain during pregnancy and labor. 5. Abdominal massage, called effleurage, is also an integral part of Lamaze childbirth education.

76. Which of the following actions would the nurse expect to perform immediately be fore a woman is to have regional anesthesia? Select all that apply. 1. Assess fetal heart rate. 2. Infuse 1000 cc of Ringer's lactate. 3. Place woman in Trendelenburg position. 4. Monitor blood pressure every 5 minutes for 15 minutes. 5. Have woman empty her bladder.

76. 1, 2, and 5 are correct. 1. Before a woman is given regional anesthesia, the nurse should assess the fetal heart rate. 2. The nurse should infuse Ringer's lac tate before the woman is given re gional anesthesia. 3. It is not necessary to place the woman in the Trendelenburg position. 4. The blood pressure will need to be mon itored every 5 minutes for 15 minutes af ter administration of the anesthesia, but not before. 5. The nurse should ask the woman to empty her bladder.

6. When during the latent phase of labor should the nurse assess the fetal heart pattern of a low-risk woman, G1 P0000? Select all that apply. 1. After vaginal exams. 2. Before administration of analgesics. 3. Periodically at the end of a contraction. 4. Every ten minutes. 5. Before ambulating.

6. 1, 2, 3, and 5 are correct. 1. The nurse should assess the fetal heart after all vaginal exams. 2. The nurse should assess the fetal heart before giving the mother any analgesics. 3. The fetal heart should be assessed pe riodically at the end of a contraction. 4. The fetal heart pattern should be as sessed every 1 hour during the latent phase of a low-risk labor. It is not stan dard protocol to assess every 10 minutes. 5. The nurse should assess the fetal heart before the woman ambulates.

65. During the third stage, the following physiological changes occur. Please place the changes in chronological order. 1. Hematoma forms behind the placenta. 2. Membranes separate from the uterine wall. 3. The uterus contracts firmly. 4. The uterine surface area dramatically decreases.

65. The order of change during the third stage of labor is: 3, 4, 1, 2 3. The contraction of the uterus after deliv ery of the baby is the first step in the third stage of labor. 4. As the uterus contracts, its surface area decreases more and more. 1. A hematoma forms behind the placenta as the placenta separates from the uterine wall after the uterus has contracted and its surface area has decreased. 2. The membranes separate from the uter ine wall after the placenta separates and begins to be born.

72. A nurse concludes that a woman is in the latent phase of labor. Which of the fol lowing signs/symptoms would lead a nurse to that conclusion? 1. The woman talks and laughs during contractions. 2. The woman complains about severe back labor. 3. The woman performs effleurage during a contraction. 4. The woman asks to go to the bathroom to defecate.

72. 1. Talking and laughing are characteris tic behaviors of the latent phase.

75. A nurse is assisting an anesthesiologist who is inserting an epidural catheter. Which of the following positions should the nurse assist the woman into? 1. Fetal position. 2. Lithotomy position. 3. Trendelenburg position. 4. Lateral recumbent position.

75. 1. The woman should be helped into the fetal position.

64. A pregnant woman is discussing positioning and the use of leg stirrups for delivery with a labor nurse. In which of the following instances should the nurse provide further information to the client? 1. When the client states, "I am glad that deliveries can take place in a variety of places, including a Jacuzzi bathtub." 2. When the client says, "I heard that for doctors to deliver babies safely, it is essential to have the mother's legs up in stirrups." 3. When the client says, "During difficult deliveries it is sometimes necessary to put a woman's legs up in stirrups." 4. When the client states, "I heard that midwives often deliver their patients either in the side-lying or squatting position."

2. The nurse should provide additional information to this client. Many deliv eries are performed safely without stirrups.

23. A client is in the second stage of labor. She falls asleep immediately after a contrac tion. Which of the following actions should the nurse perform as a result? 1. Awaken the woman and remind her to push. 2. Cover the woman's perineum with a sheet. 3. Assess the woman's blood pressure and pulse. 4. Administer oxygen to the woman via face mask.

2. The woman's privacy should be main tained while she is resting.

62. A primigravida is pushing with contractions. The nurse notes that the woman's per ineum is beginning to bulge and that there is an increase in bloody show. Which of the following actions by the nurse is appropriate at this time? 1. Report the findings to the woman's health care practitioner. 2. Immediately assess the woman's pulse and blood pressure. 3. Provide encouragement during each contraction. 4. Place the client on her side with oxygen via face mask.

3. Since this is a normal finding, the nurse should continue to provide la bor support and encouragement.

8. The labor and delivery nurse performs Leopold's maneuvers. A soft round mass is felt in the fundal region. A flat object is noted on the left and small objects are noted on the right of the uterus. A hard round mass is noted above the symphysis. Which of the following positions is consistent with these findings? 1. Left occipital anterior (LOA) 2. Left sacral posterior (LSP) 3. Right mentum anterior (RMA) 4. Right sacral posterior (RSP)

8. 1. The nurse's findings upon performing Leopold's maneuvers indicate that the fetus is in the left occiput anterior po sition (LOA)—that is, the fetal back is felt on the mother's left side, the small parts are felt on her right side, the buttocks are felt in the fundal re gion, and the head is felt above her symphysis.

84. Which of the following nonpharmacological interventions recommended by nurse midwives may help a client at full term to go into labor? Select all that apply. 1. Engage in sexual intercourse. 2. Ingest evening primrose oil. 3. Perform yoga exercises. 4. Eat raw spinach. 5. Massage the breast and nipples.

84. 1, 2, and 5 are correct. 1. Nurse midwives sometimes recom mend that women at full term engage in sexual intercourse to stimulate labor. 2. Ingesting primrose oil is also some times recommended. Primrose oil is believed to help ripen the cervix. 3. Exercise should be encouraged through out pregnancy, but it is not used for induction. 4. Raw spinach is an excellent source of iron as well as a source of calcium and fiber. It is, however, not used for induction. 5. Nipple and breast massage is some times recommended to help induce labor.

88. The health care practitioner orders the following medication for a laboring client: Stadol 0.5 mg IV stat for pain. The drug is on hand in the following concentration: Stadol 2 mg/mL. How many mL of medication will the nurse administer? _____ mL

88. 0.25 mL

89. The nurse is performing a vaginal examination on a client in labor. The client is found to be 5 cm dilated, 90% effaced, and station 2. Which of the following has the nurse palpated? 1. Thin cervix. 2. Bulging fetal membranes. 3. Head at the pelvic outlet. 4. Closed cervix.

89. 1. The cervix is thin.

9. A nurse is caring for a laboring woman who is in transition. Which of the following signs/symptoms would indicate that the woman is progressing into the second stage of labor? Select all that apply. 1. Bulging perineum. 2. Increased bloody show. 3. Spontaneous rupture of the membranes. 4. Uncontrollable urge to push. 5. Inability to breathe through contractions.

9. 1, 2, and 4 are correct. As the fetal head descends through a fully dilated cervix, the perineum begins to bulge, the bloody show increases, and the laboring woman usually feels a strong urge to push. 1. A bulging perineum indicates pro gression to the second stage of labor. 2. The bloody show increases as a woman enters the second stage of labor. 3. The amniotic sac can rupture at any time. 4. With a fully dilated cervix and bulging perineum, laboring women usually feel a strong urge to push. 5. The gravida's ability to work with her la bor is more dependent on her level of pain and her preparation for labor than on the phases and/or stages of labor.