Test #2 Fetal Assess, Labor & Birth 2

If the labor period lasts only for 3 hours, the nurse should suspect that the following conditions may occur. Select all that apply. A. Laceration of cervix B. Laceration of perineum C. Cranial hematoma in the fetus D. Fetal anoxia

Correct Answer: A, B, C, & D All the above conditions can occur following precipitate labor and delivery of the fetus because there was little time for the baby to adapt to the passageway. If the presentation is cephalic, the fetal head serves as the main part of the fetus that pushes through the birth canal which can lead to cranial hematoma, and possible compression of the cord may occur which can lead to less blood and oxygen to the fetus (hypoxia). Option A: The maternal passageway (cervix, vaginal canal, and perineum) did not have enough time to stretch which can lead to a laceration. Option B: Fetal anoxia may occur from inadequate oxygenation of the mother, low maternal blood pressure, or abnormalities in the uterus, placenta, or umbilical cord that result in inadequate blood flow to the fetus. After birth, anoxia may result from blood loss, shock, or inadequate respiration. Option C: Fetal intracranial hemorrhage is generally diagnosed in the late second trimester as an asymmetric echogenic mass within the ventricles, mostly associated with some degree of ventriculomegaly. Causes to be considered include drug use (warfarin, cocaine), alloimmune thrombocytopenia, coagulation disorders, or trauma. Option D: Anoxia occurs when the infant undergoes a total lack of oxygen. If the brain is deprived of oxygen for even a brief period of time, the infant's brain is not getting enough oxygen to function smoothly and will begin to malfunction.

The normal dilatation of the cervix during the first stage of labor in a nullipara is A. 1.2 cm./hr B. 1.5 cm./hr. C. 1.8 cm./hr D. 2.0 cm./hr

Correct Answer: A. 1.2 cm./hr For nullipara, the normal cervical dilatation should be 1.2 cm/hr. If it is less than that, it is considered a protracted active phase of the first stage. For multipara, the normal cervical dilatation is 1.5 cm/hr. Option B: For nulliparous women, Friedman (Friedman Studies) reported that the active phase of labor approximates the time from 2.5 cm cervical dilatation through complete dilatation, approximated at 10 cm. Use of 2.5 cm dilatation as the onset of active labor was an aggregate estimate and was, therefore, not strictly applicable to any individual woman. Option C: Active phase labor was further divided into three sub-phases, i.e., an acceleration phase, a phase of maximum slope, and a deceleration phase. Friedman described the acceleration phase as a rapid change in the slope of cervical dilation approximating the time needed for the cervix to dilate from 2.5 cm to 4 cm, and the phase of maximum slope as a period of rapid cervical dilation progressing linearly from approximately 4 cm to 9 cm cervical dilatation. Friedman reported the mean and slowest-yet-normal (i.e., mean - 2 standard deviations) cervical dilation rates in the phase of maximum slope to be 3.0 and 1.2 cm/hr, respectively. Option D: The deceleration phase was identified when the rate of dilation once again slowed as full dilatation was reached. For the aggregate of all labors, this phase approximated the time needed for the cervix to dilate from 9 cm to 10 cm. Friedman included data from some women without a spontaneous labor onset and some who were not low-risk by modern standards.

The anterior fontanelle is characterized as: A. 3-4 cm anteroposterior diameter and 2-3 cm transverse diameter, diamond shape. B. 2-3 cm anteroposterior diameter and 3-4 cm transverse diameter and diamond shape. C. 2-3 cm in both anteroposterior and transverse diameter and diamond shape. D. None of the above.

Correct Answer: A. 3-4 cm anteroposterior diameter and 2-3 cm transverse diameter, diamond shape. The anterior fontanelle is a diamond shape with the anteroposterior diameter being longer than the transverse diameter. The posterior fontanelle is a triangular shape. Option B: The anterior fontanelle is the largest of the six fontanelles, and it resembles a diamond-shape ranging in size from 0.6 cm to 3.6 cm with a mean of 2.1 cm. Option C: It forms through the juxtaposition of the frontal bones and parietal bones with the superior sagittal sinus coursing beneath it. Two frontal bones join to form one-half the anterior fontanelle with the metopic suture serving as the parallel divider between the paired bones. Option D: Next, the parietal bones are positioned against each other to complete the fontanelle. The positioning of the two parietal bones against each other gives rise to the sagittal suture. Finally, the alignment of the frontal bones against the parietal bones establishes the coronal suture.

When the bag of water ruptures, the nurse should check the characteristic of the amniotic fluid. The normal color of amniotic fluid is: A. Clear as water B. Bluish C. Greenish D. Yellowish

Correct Answer: A. Clear as water The normal color of the amniotic fluid is clear like water. If it is yellowish, there is probably Rh incompatibility. If the color is greenish, it is probably meconium stained. Option B: A color change from yellow to blue (nitrazine indicator) indicates the possible presence of amniotic fluid. Option C: Fluid that looks green or brown usually means that the baby has passed his first bowel movement (meconium) while in the womb. Option D: Amniotic fluid is usually clear to pale yellow in color.

The nurse should anticipate that hemorrhage related to uterine atony may occur postnatally if this condition was present during the delivery: A. Excessive analgesia was given to the mother. B. Placental delivery occurred within thirty minutes after the baby was born. C. An episiotomy had to be done to facilitate delivery of the head. D. The labor and delivery lasted for 12 hours.

Correct Answer: A. Excessive analgesia was given to the mother. Excessive analgesia can lead to uterine relaxation thus lead to hemorrhage postpartally. Both B and D are normal and C is at the vaginal introitus thus will not affect the uterus. Option B: The absolute time limit for delivery of the placenta, without evidence of significant bleeding, remains unclear. Periods ranging from 30-60 minutes have been suggested. Option C: An episiotomy is a minor incision made during childbirth to widen the opening of the vagina. A perineal tear or laceration often forms on its own during a vaginal birth. Rarely, this tear will also involve the muscle around the anus or the rectum. Both episiotomies and perineal lacerations require stitches to repair and ensure the best healing. Both are similar in recovery time and discomfort during healing. Option D: Normal labor usually begins within 2 weeks (before or after) the estimated delivery date. In a first pregnancy, labor usually lasts 12 to 18 hours on average; subsequent labors are often shorter, averaging 6 to 8 hours.

At what stage of labor and delivery does a primigravida differ mainly from a multigravida? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4

Correct Answer: A. Stage 1 In stage 1 during normal vaginal delivery of a vertex presentation, the multigravida may have about 8 hours of labor while the primigravida may have up to 12 hours labor. Option B: The second stage of labor commences with complete cervical dilation to 10 centimeters and ends with the delivery of the neonate. In women who have delivered vaginally previously, whose bodies have acclimated to delivering a fetus, the second stage may only require a brief trial, whereas a longer duration may be required for a nulliparous female. Option C: The third stage of labor commences when the fetus is delivered and concludes with the delivery of the placenta. Separation of the placenta from the uterine interface is hallmarked by three cardinal signs including a gush of blood at the vagina, lengthening of the umbilical cord, and a globular shaped uterine fundus on palpation. Option D: During the fourth stage of labor, the baby is born, the placenta has delivered, and the woman and her partner will probably feel joy, relief, and fatigue. Most babies are ready to nurse within a short period after birth. Others wait a little longer. If the woman is planning to breastfeed, it is strongly encouraged to try to nurse as soon as possible after the baby is born. Nursing right after birth will help the uterus to contract and will decrease the amount of bleeding.

When determining the duration of a uterine contraction the right technique is to time it from: A. The beginning of one contraction to the end of the same contraction. B. The end of one contraction to the beginning of another contraction. C. The acme point of one contraction to the acme point of another contraction. D. The beginning of one contraction to the end of another contraction.

Correct Answer: A. The beginning of one contraction to the end of the same contraction. Duration of a uterine contraction refers to one contraction. Thus it is correctly measured from the beginning of one contraction to the end of the same contraction and not of another contraction. Option B: The time between contractions includes the length or duration of the contraction and the minutes in between the contractions (called the interval). Mild contractions generally begin 15 to 20 minutes apart and last 60 to 90 seconds. The contractions become more regular until they are less than 5 minutes apart. Option C: Acme is the technical term for the highest point of intensity of a uterine contraction. Option D: The frequency of the uterine contraction is defined as from the beginning of one contraction to the beginning of another contraction.

The fetal heartbeat should be monitored every 15 minutes during the 2nd stage of labor. The characteristic of a normal fetal heart rate is: A. The heart rate will decelerate during a contraction and then go back to its pre-contraction rate after the contraction. B. The heart rate will accelerate during a contraction and remain slightly above the pre-contraction rate at the end of the contraction. C. The rate should not be affected by the uterine contraction. D. The heart rate will decelerate at the middle of a contraction and remain so for about a minute after the contraction.

Correct Answer: A. The heart rate will decelerate during a contraction and then go back to its pre-contraction rate after the contraction. The normal fetal heart rate will decelerate (go down) slightly during a contraction because of the compression on the fetal head. However, the heart rate should go back to the pre-contraction rate as soon as the contraction is over since the compression on the head has also ended. Option B: The presence of accelerations is considered a reassuring sign of fetal well-being. An acceleration pattern preceding or following a variable deceleration (the "shoulders" of the deceleration) is seen only when the fetus is not hypoxic. Option C: Uterine contractions can compress the blood vessels in the uterus, potentially interfering in the transfer of oxygen to the placenta and the baby. Contractions can also compress the umbilical cord, which may affect the flow of oxygenated blood to the baby. Option D: Early decelerations are caused by fetal head compression during uterine contraction, resulting in vagal stimulation and slowing of the heart rate. This type of deceleration has a uniform shape, with a slow onset that coincides with the start of the contraction and a slow return to the baseline that coincides with the end of the contraction.

The peak point of a uterine contraction is called the: A. Acceleration B. Acme C. Deceleration D. Axiom

Correct Answer: B. Acme Acme is the technical term for the highest point of intensity of a uterine contraction. Option A: An acceleration is an abrupt increase in FHR above baseline with onset to peak of the acceleration less than < 30 seconds and less than 2 minutes in duration. The duration of the acceleration is defined as the time from the initial change in heart rate from the baseline to the time of return to the FHR to baseline. Option C: A deceleration is a decrease in the fetal heart rate below the fetal baseline heart rate. Early deceleration is defined as a waveform with a gradual decrease and returns to baseline with time from onset of the deceleration to the lowest point of the deceleration (nadir) >30 seconds. Option D: Axiom is not a part of labor and delivery.

A nurse is beginning to care for a client in labor. The physician has prescribed an IV infusion of Pitocin. The nurse ensures that which of the following is implemented before initiating the infusion? A. Placing the client on complete bed rest B. Continuous electronic fetal monitoring C. An IV infusion of antibiotics D. Placing a code cart at the client's bedside

Correct Answer: B. Continuous electronic fetal monitoring Continuous electronic fetal monitoring should be implemented during an IV infusion of Pitocin. Continuous electronic fetal monitoring should be performed for a minimum of 20 minutes before starting oxytocin and should be continued until the baby is delivered. Option A: Complete bed rest is not a necessity before initiating Pitocin infusion. Pitocin is indicated for the initiation or improvement of uterine contractions, where this is desirable and considered suitable for reasons of fetal or maternal concern, in order to achieve vaginal delivery. Option C: It is unnecessary to administer IV antibiotics before Pitocin infusion. Immediately administer broad-spectrum antibiotics only to patients with severe postabortion infection. Option D: A code cart may be placed beside the client but in case of overdose, contact the Poison Control Center.

The fetal heart rate is checked following rupture of the bag of waters in order to: A. Check if the fetus is suffering from head compression. B. Determine if cord compression followed the rupture. C. Determine if there is uteroplacental insufficiency. D. Check if the fetal presenting part has adequately descended following the rupture.

Correct Answer: B. Determine if cord compression followed the rupture. After the rupture of the bag of waters, the cord may also go with the water because of the pressure of the rupture and flow. If the cord goes out of the cervical opening, before the head is delivered (cephalic presentation), the head can compress on the cord causing fetal distress. Fetal distress can be detected through the fetal heart tone. Thus, it is essential to check the FHB right after rupture of the bag to ensure that the cord is not being compressed by the fetal head. Option A: Head compression during normal uterine contractions may also result in early decelerations, but usually does not harm the fetus. Early decelerations are caused by head compression. Head compression results in fetal vagal stimulation which slows the fetal heart rate during contractions. Option C: Placental insufficiency is a process whereby there is a progressive deterioration in placental functioning such that oxygen and nutrient transfer to the fetus via the placenta is decreased, culminating in a decompensated hypoxia and acidosis. This process leads to fetal hypoxemia that then stimulates a downregulation of fetal metabolic demands to preserve what nutrients are already accessible, thus resulting in intrauterine fetal growth restriction. Option D: The downward passage of the presenting part through the pelvis is called descent. This occurs intermittently with contractions. The rate is greatest during the second stage of labor.

At what stage of labor is the mother advised to bear down? A. When the mother feels the pressure at the rectal area. B. During a uterine contraction. C. In between uterine contraction to prevent uterine rupture. D. Anytime the mother feels like bearing down.

Correct Answer: B. During a uterine contraction The primary power of labor and delivery is the uterine contraction. This should be augmented by the mother's bearing down during a contraction. Option A: During the second stage of labor, the fetal presentation comes down and compression occurs in both the bladder and rectum, generating a reflex that causes a strong urge to bear down, or 'push'. Therefore, the combination of involuntary intrauterine contractions and voluntary expulsive effort, through the abdominal and respiratory muscles, will help fetus delivery. Option C: Maternal pushing during the second stage of labor is an important and indispensable contributor to the involuntary expulsive force developed by uterine contraction. Option D: Waiting for the urge to push with an epidural does shorten the duration of pushing and increases spontaneous vaginal delivery, but lengthens the second stage and doubles the risk of low umbilical cord pH (based on data from one study).

The partograph is a tool used to monitor labor. The maternal parameters measured/monitored are the following, except? A. Vital signs B. Fluid intake and output C. Uterine contraction D. Cervical dilatation

Correct Answer: B. Fluid intake and output Partograph is a monitoring tool designed by the World Health Organization for use by health workers when attending to mothers in labor, especially the high risk ones. For maternal parameters all of the above is placed in the partograph except the fluid intake since this is placed in a separate monitoring sheet. WHO further modified the partograph for the third time. This simplified partograph is color-coded. The area to the left of the alert line is colored green representing the normal progress. The area to the right of the action line is colored red indicating dangerously slow progress. The area between the alert and action line is colored amber indicating the need for greater vigilance Option A: WHO has recommended use of the partograph, a low-tech paper form that has been hailed as an effective tool for the early detection of maternal and fetal complications during childbirth. All the recordings for the maternal condition are entered at the foot of the partograph below the recording of uterine contraction. Maternal vital signs such as temperature, pulse, BP, urine output and urine for protein and acetone are monitored. Option C: Below the cervical dilatation, there is a space for recording uterine contractions per 10 min and the scale is numbered from 1 to 5. Each square represents one contraction. So if two contractions are felt in 10 min, two squares are shaded. Option D: The central feature of the partogram is a graph where cervical dilatation is plotted. Along the left side, there are squares from 0 to 10, each representing 1-cm dilatation. Along the bottom of graph are numbers 0-24 each presenting 1 h. The first stage of labor is divided into latent and active phases. The latent phase is from 0 to 3 cm, and it lasts up to 8 h. The active phase is from 3 to 10 cm (full cervical dilatation). The dilatation of the cervix is plotted with "x."

To monitor the frequency of the uterine contraction during labor, the right technique is to time the contraction is: A. From the beginning of one contraction to the end of the same contraction. B. From the beginning of one contraction to the beginning of the next contraction. C. From the end of one contraction to the beginning of the next contraction. D. From the deceleration of one contraction to the acme of the next contraction.

Correct Answer: B. From the beginning of one contraction to the beginning of the next contraction. The frequency of the uterine contraction is defined as from the beginning of one contraction to the beginning of another contraction. Option A: Duration is timed from when the contraction is first felt until it is over. This time is usually measured in seconds. Option C: The time between contractions includes the length or duration of the contraction and the minutes in between the contractions (called the interval). Mild contractions generally begin 15 to 20 minutes apart and last 60 to 90 seconds. The contractions become more regular until they are less than 5 minutes apart. Option D: Acme is the highest point or peak of a contraction. It is the period during which the contraction is most intense.

The following are common causes of dysfunctional labor. Which of these can a nurse, on her own manage? A. Pelvic bone contraction B. Full bladder C. Extension rather than flexion of the head D. Cervical rigidity

Correct Answer: B. Full bladder A full bladder can impede the descent of the fetal head. The nurse can readily manage this problem by doing a simple catheterization of the mother. Option A: The narrower shape of the android pelvis can make labor difficult because the baby might move more slowly through the birth canal. Some pregnant women with an android pelvis may require a C-section. Option C: Abnormal labor could also be secondary to the passenger, the size of the infant, and/or the presentation of the infant. In addition to problems caused by the differential in size between the fetal head and the maternal bony pelvis, the fetal presentation may include asynclitism or head extension. Asynclitism is malposition of the fetal head within the pelvis, which compromises the narrowest diameter through the pelvis. Option D: According to the most recent evidence, arrest of labor in the first stage should be defined as more than or equal to 6cm dilation with ruptured membranes and one of the following: 4 hours or more of adequate contractions (>200 MVU) or 6 hours or more of inadequate contractions and no cervical change.

The first thing that a nurse must ensure when the baby's head comes out is A. The cord is intact B. No part of the cord is encircling the baby's neck C. The cord is still attached to the placenta D. The cord is still pulsating

Correct Answer: B. No part of the cord is encircling the baby's neck The nurse should check right away for possible cord coil around the neck because if it is present, the baby can be strangled by it and the fetal head will have difficulty being delivered. Option A: In a newborn who was born a few hours ago, the cord may look plump and pale yellow. One of the umbilical arteries may be visible and protruding from the cut edge. A normal cord has two arteries and one vein. Option C: The cord is expelled from the mother within a half-hour after birth. It is still attached to the placenta, which is commonly called "the afterbirth." With its function completed, it is no longer needed and so is discarded by the mother's body. Option D: Some cords may pulsate (the pulsation assists the transfer of your baby's blood back into their body) for as long as 30 minutes or more, where others may stop pulsating at 5 minutes or less after the baby is born.

This drug is usually given parenterally to enhance uterine contraction: A. Terbutaline B. Pitocin C. Magnesium sulfate D. Lidocaine

Correct Answer: B. Pitocin The common oxytocin given to enhance uterine contraction is Pitocin. This is also the drug given to induce labor. Option A: Terbutaline, sold under the brand name Bricanyl among others, is a ?2 adrenergic receptor agonist, used as a "reliever" inhaler in the management of asthma symptoms and as a tocolytic (anti-contraction medication) to delay preterm labor for up to 48 hours. Option C: Magnesium sulfate is often quite effective in slowing contractions, although this effect and how long it lasts varies from woman to woman. Like all tocolytic medications, however, magnesium sulfate does not consistently prevent or delay preterm delivery for a significant period of time. The most common explanation is that magnesium lowers calcium levels in uterine muscle cells. Since calcium is necessary for muscle cells to contract, this is thought to relax the uterine muscle. Option D: The local anesthetic is transferred to the fetus slowly, and its margin of safety is also increased. Considering how local anesthetics have small direct effects on the fetus even at submaximal doses, lidocaine may be considered relatively safe for use in pregnant women.

When delivering the baby's head the nurse supports the mother's perineum to prevent a tear. This technique is called A. Marmet's technique B. Ritgen's technique C. Duncan maneuver D. Schultze maneuver

Correct Answer: B. Ritgen's technique Ritgen's technique is done to prevent the perineal tear. This is done by the nurse by supporting the perineum with a sterile towel and pushing the perineum downward with one hand while the other hand is supporting the baby's head as it goes out of the vaginal opening. Option A: Developed by a mother who needed to express her milk over a long period of time for medical reasons, the Marmet technique mimics the actions of a breastfeeding baby and is the most recommended method of expressing breastmilk by hand. Option C: Duncan's mechanism is the expulsion of the placenta with the presentation of the maternal rough side first, rather than the usual fetal side of the placenta. Option D: There are 2 mechanisms possible during the delivery of the placenta. If the shiny portion comes out first, it is called the Schultze mechanism; while if the meaty portion comes out first, it is called the Duncan mechanism.

When the fetal head is at the level of the ischial spine, it is said that the station of the head is A. Station -1 B. Station "0" C. Station +1 D. Station +2

Correct Answer: B. Station "0" Determining is defined as the relationship of the fetal head and the level of the ischial spine. At the level of the ischial spine, the station is "0". Above the ischial spine it is considered (-) station and below the ischial spine it is (+) station. Option A: By 6 cm of dilation, the median station was 0 (95% CI ?2 to 1) for nulliparous and ?1 (95% CI ?3 to 0) for multiparous women. At 8 cm, 95% of nulliparous women were at ?1 station or lower. Option C: The fetal head is already engaged in station +1. The difference between numbers in the score is equivalent to the length in centimeters. Moving from +1 to +2 is a movement of about 1 centimeter. Option D: +2 to +3 station is crowning and beginning to emerge from the birth canal.

Which of the following techniques during labor and delivery can lead to uterine inversion? A. Fundal pressure applied to assist the mother in bearing down during delivery of the fetal head. B. Strongly tugging on the umbilical cord to deliver the placenta and hasten placental separation. C. Massaging the fundus to encourage the uterus to contract. D. Applying light traction when delivering the placenta that has already detached from the uterine wall.

Correct Answer: B. Strongly tugging on the umbilical cord to deliver the placenta and hasten placental separation. When the placenta is still attached to the uterine wall, tugging on the cord while the uterus is relaxed can lead to inversion of the uterus. Light tugging on the cord when placenta has detached is alright in order to help deliver the placenta that is already detached. Option A: The purpose of fundal pressure is to shorten the second stage of labor. The clinical indications for this maneuver can be fetal distress, failure to progress in the second stage of labor, and/or maternal exhaustion, or medical conditions whereby (prolonged) pushing is contraindicated, for example, maternal heart disease. Option C: Fundal massage, also called uterine massage, is a technique used to reduce bleeding and cramping of the uterus after childbirth or after an abortion. As the uterus returns to its nonpregnant size, its muscles contract strongly, which can cause pain. Option D: Controlled cord traction (CCT) is traction applied to the umbilical cord once the woman's uterus has contracted after the birth of her baby, and her placenta is felt to have separated from the uterine wall, whilst counter-pressure is applied to her uterus beneath her pubic bone until her placenta delivers.

The second stage of labor begins with ___ and ends with __? A. Begins with full dilatation of cervix and ends with delivery of placenta. B. Begins with true labor pains and ends with delivery of the baby. C. Begins with complete dilatation and effacement of cervix and ends with delivery of the baby. D. Begins with passage of show and ends with full dilatation and effacement of cervix.

Correct Answer: C. Begins with complete dilatation and effacement of cervix and ends with delivery of baby Stage 2 of labor and delivery process begins with full dilatation of the cervix and ends with the delivery of the baby. Stage 1 begins with true labor pains and ends with full dilatation and effacement of the cervix. Option A: The second stage of labor commences with complete cervical dilation to 10 centimeters and ends with the delivery of the neonate. This was also defined as the pelvic division phase by Friedman. After cervical dilation is complete, the fetus descends into the vaginal canal with or without maternal pushing efforts. The fetus passes through the birth canal via 7 movements known as the cardinal movements. Option B: The first stage of labor begins when labor starts and ends with full cervical dilation to 10 centimeters. Labor often begins spontaneously or may be induced medically for a variety of maternal or fetal indications. Option D: During the latent phase, the cervix dilates slowly to approximately 6 centimeters. The latent phase is generally considerably longer and less predictable with regard to the rate of cervical change than is observed in the active phase. Active labor with more rapid cervical dilation generally starts around 6 centimeters of dilation. During the active phase, the cervix typically dilated at a rate of 1.2 to 1.5 centimeters per hour. Multiparas, or women with a history of prior vaginal delivery, tend to demonstrate more rapid cervical dilation.

When the baby's head is out, the immediate action of the nurse is A. Cut the umbilical cord B. Wipe the baby's face and suction mouth first C. Check if there is a cord coiled around the neck D. Deliver the anterior shoulder

Correct Answer: C. Check if there is a cord coiled around the neck. The nurse should check if there is a cord coil because the baby will not be delivered safely if the cord is coiled around its neck. Normally the umbilical cord coils to the left. Regardless of its origin, umbilical coiling appears to confer turgor to the umbilical unit, producing a cord that is strong but flexible. The role of umbilical cord coiling is not clear; nonetheless, it is thought to play a role in protecting the umbilical cord from external forces such as tension, pressure, stretching or entanglement. Option A: The World Health Organization currently recommends clamping the umbilical cord between one and three minutes after birth, "for improved maternal and infant health and nutrition outcomes," while the American College of Obstetricians and Gynecologists recommends clamping within 30 to 60 seconds. Option B: Wiping off the face should be done seconds after you have ensured that there is no cord coil but suctioning of the nose should be done after the mouth because the baby is a "nasal obligate" breather. If the nose is suctioned first before the mouth, the mucus plugging the mouth can be aspirated by the baby. Option D: Anterior shoulder in obstetrics refers to that shoulder of the fetus that faces the pubic symphysis of the mother during delivery. Depending upon the original position of the fetus, either the left or the right shoulder can be the anterior shoulder.

When the bag of waters ruptures spontaneously, the nurse should inspect the vaginal introitus for possible cord prolapse. If there is part of the cord that has prolapsed into the vaginal opening the correct nursing intervention is: A. Push back the prolapsed cord into the vaginal canal. B. Place the mother in a semi fowlers position to improve circulation. C. Cover the prolapsed cord with sterile gauze wet with sterile NSS and place the woman in Trendelenburg position. D. Push back the cord into the vagina and place the woman in Sim's position.

Correct Answer: C. Cover the prolapsed cord with sterile gauze wet with sterile NSS and place the woman in Trendelenburg position. The correct action of the nurse is to cover the cord with sterile gauze wet with sterile NSS. Observe strict asepsis in the care of the cord to prevent infection. The cord has to be kept moist to prevent it from drying. Don't attempt to put back the cord into the vagina but relieve pressure on the cord by positioning the mother either on Trendelenburg or Sims position Option A: Avoid handling the cord to reduce vasospasm. Manually elevate the presenting part by lifting the presenting part of the cord by vaginal digital examination. Alternatively, if in the community, fill the maternal bladder with 500ml of normal saline (warmed if possible) via a urinary catheter and arrange immediate hospital transfer. Option B: Encourage into left lateral position with head down and a pillow placed under left hip OR knee-chest position. This will relieve pressure off the cord from the presenting part. Option D: Umbilical cord prolapse is an acute obstetric emergency that requires immediate delivery of the baby. The route of delivery is usually by cesarean section. The doctor will relieve cord compression by manually elevating the fetal presentation part until a cesarean section is performed.

When the nurse palpates the suprapubic area of the mother and found that the presenting part is still movable, the right term for this observation that the fetus is A. Engaged B. Descended C. Floating D. Internal Rotation

Correct Answer: C. Floating The term floating means the fetal presenting part has not entered/descended into the pelvic inlet. If the fetal head has entered the pelvic inlet, it is said to be engaged. Option A: If the fetal head accommodates two fingerbreadths above pelvic brim, it is said to be engaged. Option B: Using the rule of fifths, the distance between the base and vertex of the fetal head is divided into five equal parts. Each fifth corresponds to 2 cm or approximately one transverse fingerbreadth. Option D: As the head descends, the presenting part, usually in the transverse position, is rotated about 45° to anteroposterior (AP) position under the symphysis. Internal rotation brings the AP diameter of the head in line with the AP diameter of the pelvic outlet.

The proper technique to monitor the intensity of a uterine contraction is: A. Place the palm of the hands-on the abdomen and time the contraction. B. Place the fingertips lightly on the suprapubic area and time the contraction. C. Put the tip of the fingers lightly on the fundal area and try to indent the abdominal wall at the height of the contraction. D. Put the palm of the hands-on the fundal area and feel the contraction at the fundal area.

Correct Answer: C. Put the tip of the fingers lightly on the fundal area and try to indent the abdominal wall at the height of the contraction. In monitoring the intensity of the contraction the best place is to place the fingertips at the fundal area. The fundus is the contractile part of the uterus and the fingertips are more sensitive than the palm of the hand. Option A: Using the fingertips rather than the palm of the hands yields more accurate results. Fingertips are more sensitive than the palm of the hand. Option B: Place the fingertips on the fundal area because this area is the most contractile part of the uterus. Option D: Use the fingertips instead of the palms of the hand because it is more sensitive.

The following are signs and symptoms of fetal distress EXCEPT: A. Fetal heart rate (FHR) decreases during a contraction and persists even after the uterine contraction ends. B. The FHR is less than 120 bpm or over 160 bpm. C. The pre-contraction FHR is 130 bpm, FHR during contraction is 118 bpm, and FHR after uterine contraction is 126 bpm. D. FHR is 160 bpm, weak and irregular.

Correct Answer: C. The pre-contraction FHR is 130 bpm, FHR during contraction is 118 bpm, and FHR after uterine contraction is 126 bpm. The normal range of FHR is 120-160 bpm, strong and regular. During a contraction, the FHR usually goes down but must return to its pre-contraction rate after the contraction ends. Option A: Usually, doctors identify fetal distress based on an abnormal heart rate pattern in the fetus. Throughout labor, the fetus's heart rate is monitored. It is usually monitored continuously with electronic fetal heart monitoring. Or a handheld Doppler ultrasound device may be used to check the heart rate every 15 minutes during early labor and after each contraction during late labor. Option B: Contractions that are too strong and/or too close together may cause fetal distress. If oxytocin was used to stimulate contractions, it is stopped immediately. The woman may be repositioned and given analgesics. If no drug was used to stimulate contractions, the woman may be given a drug that can slow labor (such as terbutaline, given by injection) to stop or slow the contractions. Option D: Fetal rhythm abnormalities, which include fetal heart rates that are irregular, too fast or too slow, occur in up to 2% of pregnancies and account for 10-20% of the referrals to fetal cardiologists.

The primary power involved in labor and delivery is: A. Bearing down ability of a mother. B. Cervical effacement and dilatation. C. Uterine contraction. D. Valsalva technique.

Correct Answer: C. Uterine contraction Uterine contraction is the primary force that will expel the fetus out through the birth canal Maternal bearing down is considered the secondary power/force that will help push the fetus out. Option A: During the second stage of labor a common technique is to encourage women to take a deep breath at the beginning of a contraction then hold it and bear down throughout the contraction (this is known as directed pushing). Maternal pushing during the second stage of labor is an important and indispensable contributor to the involuntary expulsive force developed by uterine contraction. Option B: During the first stage of labor, the cervix opens (dilates) and thins out (effaces) to allow the baby to move into the birth canal. The cervix must be 100 percent effaced and 10 centimeters dilated before a vaginal delivery. Option D: When a person forcefully expires against a closed glottis, changes occur in intrathoracic pressure that dramatically affects venous return, cardiac output, arterial pressure, and heart rate. This forced expiratory effort is called a Valsalva maneuver.

A nurse is caring for a client in labor who is receiving Pitocin by IV infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued? A. Three contractions occurring within a 10-minute period B. Increased urinary output C. Adequate resting tone of the uterus palpated between contractions D. A fetal heart rate of 90 beats per minute

Correct Answer: D. A fetal heart rate of 90 beats per minute A normal fetal heart rate is 120-160 BPM. Bradycardia or late or variable decelerations indicate fetal distress and the need to discontinue to Pitocin. The goal of labor augmentation is to achieve three good-quality contractions in a 10-minute period. Option A: Pitocin (oxytocin injection) is a natural hormone that causes the uterus to contract used to induce labor, strengthen labor contractions during childbirth, control bleeding after childbirth, or induce an abortion. Option B: Oxytocin has an antidiuretic effect and increases the urinary excretion of AQP2 in humans whose urinary concentration mechanism is preserved. Urine volume and free water clearance were decreased, and urine osmolality was increased by the administration of oxytocin or dDAVP in the normal volunteers and CDI patients. Option C: In a normal labor, one contraction every two to three minutes or less than five contractions in a 10 minute period is ideal. A uterus must rest between contractions, having sufficient uterine resting tone (soft to the touch), and uterine resting time (about one minute).

What would be the appropriate first nursing action when caring for a 20-year old G1P0 woman at 39 weeks gestation who is in active labor and for whom an assessment reveals mild variable fetal heart rate deceleration A. Notify the physician B. Prepare the client for immediate delivery C. Readjust the fetal monitor D. Change the maternal position

Correct Answer: D. Change the maternal position The cause of variable fetal heart decelerations is umbilical cord compression, which can usually be corrected by changing the maternal position. Option A: Before informing the physician, the nurse must first intervene. Common causes of variable decelerations include vagal reflex triggered by head compression during pushing and cord compression such as that caused by short cord, nuchal cord, body entanglement, prolapsed cord, decreased amniotic fluid, and fetal descent. Option B: Perform a cervical exam to rule out prolapsed cord and funic presentation and check for imminent delivery only if appropriate. Option C: Variable decelerations occur when the fetal heart rate decrease is greater than or equal to 15 beats per minute and last for longer than or equal to 15 seconds but less than 2 minutes from onset to return to baseline.

The passageway in labor and delivery of the fetus include the following, except? A. Distensibility of lower uterine segment B. Cervical dilatation and effacement C. Distensibility of vaginal canal and introitus D. Flexibility of the pelvis

Correct Answer: D. Flexibility of the pelvis The pelvis is a bony structure that is part of the passageway but is not flexible. The lower uterine segment including the cervix as well as the vaginal canal and introitus are all part of the passageway in the delivery of the fetus. Option A: As uterine contractions cause pressure on the membranes, the hydrostatic action of the amniotic sac in turn dilates the cervical canal like a wedge. In the absence of intact membranes, the pressure of the presenting fetal part against the cervix and lower uterine segment is similarly effective. Option B: Effacement may be compared to a funneling process in which the whole length of a narrow cylinder is converted into a very obtuse, flaring funnel with a small circular opening. Because of increased myometrial activity during uterine preparedness for labor, appreciable effacement of a softened cervix sometimes is accomplished before active labor begins. Effacement causes expulsion of the mucous plug as the cervical canal is shortened. Because the lower segment and cervix have lesser resistance during a contraction, a centrifugal pull is exerted on the cervix and creates cervical dilatation. Option C: The tailbone (sacrum or coccyx) needs to be sufficiently mobile to be gently pressed back out of the way when the baby moves through. The sacroiliac joint allows this nutation or counter-nutation of the sacrum. The symphysis pubis is a cartilaginous joint in the front of the pelvis. It also needs to be properly mobile to help the pelvis flex to allow the baby to pass through. The relaxin hormone in your body helps both the tailbone and the symphysis pubis become more mobile to facilitate birth.

A nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes that last 45 seconds. The nurse notes that the fetal heart rate between contractions is 100 BPM. Which of the following nursing actions is most appropriate? A. Encourage the client's coach to continue to encourage breathing exercises. B. Encourage the client to continue pushing with each contraction. C. Continue monitoring the fetal heart rate. D. Notify the physician or nurse-midwife.

Correct Answer: D. Notify the physician or nurse-midwife. A normal fetal heart rate is 120-160 beats per minute. Fetal bradycardia between contractions may indicate the need for immediate medical management, and the physician or nurse-midwife needs to be notified. Option A: Steps can be taken to help the fetus get more oxygen, such as having the mother change position. If these procedures do not work, or if further test results suggest the fetus has a problem, the ob-gyn or other health care professional may decide to deliver right away. Option B: Uterine contractions also may be monitored with a special tube called an intrauterine pressure catheter that is inserted through the vagina into the uterus. Internal monitoring can be used only after the membranes of the amniotic sac have ruptured. Option C: Fetal heart rate monitoring may help detect changes in the normal heart rate pattern during labor. If certain changes are detected, steps can be taken to help treat the underlying problem. Fetal heart rate monitoring also can help prevent treatments that are not needed.

The following are nursing interventions to relieve episiotomy wound pain, except: A. Giving analgesic as ordered B. Sitz bath C. Perineal heat D. Perineal care

Correct Answer: D. Perineal care Perineal care is primarily done for personal hygiene regardless of whether there is pain or not; episiotomy wound or not. Option A: Analgesics such as ibuprofen may be taken as prescribed by the physician to relieve pain. Option B: Use sitz baths (sit in water that covers the vulvar area) a few times a day. Wait until 24 hours after giving birth to take a sitz bath as well. The woman can buy tubs in any drug store that will fit on the rim of the toilet. If she prefers, she can sit in this kind of tub instead of climbing into the bathtub. Option C: Take warm baths but wait until 24 hours after giving birth. Make sure that the bathtub is cleaned with a disinfectant before every bath.

The basic delivery set for normal vaginal delivery includes the following instruments/articles, except? A. 2 clamps B. Pair of scissors C. Kidney Basin D. Retractor

Correct Answer: D. Retractor For normal vaginal delivery, the nurse needs only the instruments for cutting the umbilical cord such as 2 clamps (straight or curve) and a pair of scissors as well as the kidney basin to receive the placenta. The retractor is not part of the basic set. In the hospital setting, needle holders and tissue forceps are added especially if the woman delivering the baby is a primigravida wherein episiotomy is generally done. Option A: The clamps are used for clamping the umbilical cord. After the cord has stopped pulsating, or after at least 1-3 minutes after birth, the first clamp is placed near the neonate's umbilicus, then the other one just farther down the cord. Option B: Using sterile scissors, cut between the two clamps. Keep in mind that the cord is thick and hard to cut. One pair will be used to cut the baby's umbilical cord. Another will be used if there is a need for an episiotomy. In that case, the doctor will have to cut into the perineum (the skin between the vagina and anus) to help the baby fit through. Option C: The kidney basin is used to receive the placenta. Inspect the placenta for completeness before disposing it properly.

Mechanism of labor, also known as the cardinal movements, refers to the sequencing of events involved in posturing and positioning that allows the baby to find the easiest to come out of the birth canal. Arrange the following mechanisms of labor in the order during the course of labor and fetal delivery. A Extension B Engagement C Internal rotation D External rotation E Flexion F Expulsion G Descent

B G E C A D F The mechanism of fetal delivery begins with descent into the pelvic inlet which may occur several days before true labor sets in the primigravida. Flexion, internal rotation, and extension are mechanisms that the fetus must perform as it accommodates through the passageway/birth canal. Eternal rotation is done after the head is delivered so that the shoulders will be easily delivered through the vaginal introitus.

The following are types of breech presentation, except: A. Footling B. Frank C. Complete D. Incomplete

Correct Answer: D. Incomplete Breech presentation means the buttocks of the fetus is the presenting part. If it is only the foot/feet, it is considered footling. If only the buttocks, it is a frank breech. If both the feet and the buttocks are presenting it is called complete breech. Option A: The footling breech can have any combination of one or both hips extended, also known as footling (one leg extended) breech, or double footling breech (both legs extended). Option B: In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. Option C: The complete breech has the fetus sitting with flexion of both hips and both legs in a tuck position.