Chapter 16

**Which of the following findings would be a cause for concern for a nurse who is monitoring an obstetric patient who is in early labor? (Select all that apply.) A. Biparietal diameter of less than 9.25 cm B. Vertex presenting part C. Transverse lie D. General flexion attitude E. Android pelvis

A, C, E Rationale: A biparietal diameter at term is typically noted as 9.25 cm, and the finding of a smaller measurement would cause a concern related to the mode of delivery. A transverse lie would also cause a concern relative to the mode of delivery because a cesarean section would be indicated. An android pelvis would cause a concern related to the mode of delivery. A vertex presenting part and a general flexion attitude are normal findings and would not cause concern.

A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure is to use: A. Counterpressure against the sacrum. B. Pant-blow (breaths and puffs) breathing techniques. C. Effleurage. D. Biofeedback.

A. Rationale: Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back. Pant-blow breathing techniques are usually helpful during contractions per the gate-control theory. Effleurage is light stroking, usually of the abdomen, in rhythm with breathing during contractions. It is used as a distraction from contraction pain but it is unlikely to be effective for back labor. Biofeedback-assisted relaxation techniques are not always successful in reducing labor pain. Using this technique effectively requires strong caregiver support.

The nurse providing care for the laboring woman understands that accelerations with fetal movement: A. Are reassuring. B. Are caused by umbilical cord compression. C. Warrant close observation. D. Are caused by uteroplacental insufficiency.

A. Rationale: Episodic accelerations in the fetal heart rate (FHR) occur during fetal movement and are indications of fetal well-being; they do not warrant close observation. Umbilical cord compression results in variable decelerations in the FHR. Uteroplacental insufficiency would result in late decelerations in the FHR.

Fetal well-being during labor is assessed by: A. The response of the fetal heart rate (FHR) to uterine contractions (UCs). B. Maternal pain control. C. Accelerations in the FHR. D. An FHR greater than 110 beats/min.

A. Rationale: Fetal well-being during labor can be measured by the response of the FHR to UCs. In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/min with no periodic changes, a moderate baseline variability, and accelerations with fetal movement. Although FHR accelerations and an FHR greater than 110 beats/min may be reassuring, they are only two components of the criteria by which fetal well-being is assessed. More information is needed to determine fetal well-being.

With regard to breathing techniques during labor, maternity nurses should be aware that: A. Breathing techniques in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction. B. By the time labor has begun, it is too late for instruction in breathing and relaxation. C. Controlled breathing techniques are most difficult near the end of the second stage of labor. D. The patterned-paced breathing technique can help prevent hyperventilation.

A. Rationale: First-stage techniques promote relaxation of abdominal muscles, thereby increasing the size of the abdominal cavity. Instruction in simple breathing and relaxation techniques early in labor is possible and effective. Controlled breathing techniques are most difficult in the transition phase at the end of the first stage of labor, when the cervix is dilated 8 to 10 cm. Patterned-paced breathing can sometimes lead to hyperventilation.

Fetal circulation can be affected by many factors during labor. Accurate assessment of the laboring woman and fetus requires knowledge of these expected adaptations. Which factor will not affect fetal circulation during labor? A. Fetal position B. Uterine contractions C. Blood pressure D. Umbilical cord blood flow

A. Rationale: Maternal position may affect fetal circulation; however, fetal position is unlikely to disturb umbilical blood flow. Uterine contractions during labor tend to decrease circulation and subsequent perfusion. Most healthy fetuses are well able to compensate for this stress and exposure to increased pressure while moving passively through the birth canal during labor. Maternal blood pressure is likely to have a significant effect on fetal circulation. Compression of the cord and reduction of umbilical blood flow do affect fetal circulation.

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. 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. Rationale: Placental separation is indicated by a firmly contracting uterus, a change in the uterus from a discoid to a globular ovoid shape, a sudden gush of dark red blood from the introitus, an apparent lengthening of the umbilical cord, and a finding of vaginal fullness. Cervical tears that do not extend to the vagina result in minimal blood loss. Signs of hemorrhage are a boggy uterus, bright red vaginal bleeding, alterations in vital signs, pallor, lightheadedness, restlessness, decreased urinary output, and alteration in the level of consciousness. If clots have formed in the upper uterine segment, the nurse would expect to find the uterus boggy and displaced to the side.

Nurses should be aware of the difference that experience can make in labor pain, such as: A. Sensory pain for nulliparous women often is greater than for multiparous women during early labor. B. Affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor. C. Women with a history of substance abuse experience more pain during labor. D. Multiparous women have more fatigue from labor and therefore experience more pain.

A. Rationale: Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous women during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue.

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? A. Place the woman in the knee-chest position. B. Cover the cord in a sterile towel saturated with warm normal saline. C. Prepare the woman for a cesarean birth. D. Start oxygen by face mask.

A. Rationale: The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or knee-chest position) in which gravity keeps the pressure of the presenting part off the cord. Relieving pressure on the cord is the nursing priority. The nurse may also use her gloved hand or two fingers to lift the presenting part off the cord. If the cord is protruding from the vagina it may be covered with a sterile towel soaked in saline. The nurse should administer O2 by facial mask at 8 to 10 L/min until delivery is complete. If the cervix is fully dilated, the nurse should prepare for immediate vaginal delivery. Cesarean birth is indicated only if cervical dilation is not complete.

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include: A. Encouraging the woman to try various upright positions, including squatting and standing. B. Telling the woman to start pushing as soon as her cervix is fully dilated. C. Continuing an epidural anesthetic so that pain is reduced and the woman can relax. D. Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction.

A. Rationale: Upright positions and squatting may enhance the progress of fetal descent. Many factors dictate when a woman will begin pushing. Complete cervical dilation is necessary, but it is only one factor. If the fetal head is still in a higher pelvic station, the physician or midwife may allow the woman to "labor down" (allowing more time for fetal descent, thereby reducing the amount of pushing needed) if she is able. An epidural may mask the sensations and muscle control needed for the woman to push effectively. Closed-glottic breathing may trigger the Valsalva maneuver, which increases intrathoracic and cardiovascular pressures, reducing cardiac output and inhibiting perfusion of the uterus and placenta. In addition, holding the breath for longer than 5 to 7 seconds diminishes the perfusion of oxygen across the placenta, resulting in fetal hypoxia.

When performing vaginal examinations on a laboring woman, the nurse should be guided by what principle? 1. Cleanse the vulva and perineum before and after the examination as needed. 2. Wear a clean glove lubricated with tap water to reduce discomfort. 3. Perform the examination every hour during the active phase of the first stage of labor. 4. Perform an examination immediately if active bleeding is present.

A. Rationale: Cleansing will reduce the possibility that secretions and microorganisms will ascend into the vagina to the cervix. Maternal comfort will also be enhanced. Sterile gloves and lubricant must be used to prevent infection. Vaginal examinations should be performed only as indicated to limit maternal discomfort and reduce the risk for transmission of infection, especially when rupture of membranes occurs. Examinations are never done by the nurse if vaginal bleeding is present, because the bleeding could be a sign of placenta previa and a vaginal examination could result in further separation of the low-lying placenta.

The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by: A. Change in position. B. Oxytocin administration. C. Regional anesthesia. D. Intravenous analgesic.

A. Rationale: Maternal supine hypotension syndrome is caused by the weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. This pressure reduces venous return to the woman's heart, as well as cardiac output, and subsequently lowers her blood pressure. The nurse can encourage the woman to change positions and avoid the supine position. Oxytocin administration, regional anesthesia, and intravenous analgesic may all reduce maternal cardiac output.

A woman in active labor receives an opioid agonist analgesic. Which medication relieves severe, persistent, or recurrent pain, creates a sense of well-being, overcomes inhibitory factors, and may even relax the cervix but should be used cautiously in women with cardiac disease? A. Meperidine (Demerol) B. Promethazine (Phenergan) C. Butorphanol tartrate (Stadol) D. Nalbuphine (Nubain)

A. Rationale: Meperidine is the most commonly used opioid agonist analgesic for women in labor throughout the world. It overcomes inhibitory factors in labor and may even relax the cervix. Because tachycardia is a possible adverse reaction, meperidine is used cautiously in women with cardiac disease. Phenergan is an ataractic (tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but has few of those drugs' undesirable effects. Stadol and Nubain are opioid agonist-antagonist analgesics.

When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that: A. The examiner's hand should be placed over the fundus before, during, and after contractions. B. The frequency and duration of contractions are measured in seconds for consistency. C. Contraction intensity is given a judgment number of 1 to 7 by the nurse and client together. D. The resting tone between contractions is described as either placid or turbulent.

A. Rationale: The assessment is done by palpation; duration, frequency, intensity, and resting tone must be assessed. The duration of contractions is measured in seconds; the frequency is measured in minutes. The intensity of contractions usually is described as mild, moderate, or strong. The resting tone usually is characterized as soft or relaxed.

With regard to primary and secondary powers, the maternity nurse should understand that: A.Primary powers are responsible for effacement and dilation of the cervix. B. Effacement generally is well ahead of dilation in women giving birth for the first time; they are more together in subsequent pregnancies. C. Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation. D. Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs.

A. Rationale: The primary powers are responsible for dilation and effacement; secondary powers are concerned with expulsion of the fetus. Effacement is generally well ahead of dilation in first-timers; the two are more concurrent in subsequent pregnancies. Scarring of the cervix may slow dilation. Pushing is more effective and less fatiguing when the woman begins to push only after she has the urge to do so.

The nurse expects which maternal cardiovascular finding during labor? a.Increased cardiac output b.Decreased pulse rate c.Decreased white blood cell (WBC) count d.Decreased blood pressure

ANS: A During each contraction, 400 ml of blood is emptied from the uterus into the maternal vascular system, which increases cardiac output by approximately 10% to 15% during the first stage of labor and by approximately 30% to 50% in the second stage of labor. The heart rate increases slightly during labor. The WBC count can increase during labor. During the first stage of labor, uterine contractions cause systolic readings to increase by approximately 10 mm Hg. During the second stage, contractions may cause systolic pressures to increase by 30 mm Hg and diastolic readings to increase by 25 mm Hg.

Which description of the four stages of labor is correct for both the definition and the duration? a.First stage: onset of regular uterine contractions to full dilation; less than 1 hour to 20 hours b.Second stage: full effacement to 4 to 5 cm; visible presenting part; 1 to 2 hours c.Third stage: active pushing to birth; 20 minutes (multiparous woman), 50 minutes (nulliparous woman) d.Fourth stage: delivery of the placenta to recovery; 30 minutes to 1 hour

ANS: A Full dilation may occur in less than 1 hour, but in first-time pregnancies full dilation can take up to 20 hours. The second stage of labor extends from full dilation to birth and takes an average of 20 to 50 minutes, although 2 hours is still considered normal. The third stage of labor extends from birth to the expulsion of the placenta and usually takes a few minutes. The fourth stage begins after the expulsion of the placenta and lasts until homeostasis is reestablished (approximately 2 hours).

**Which presentation is accurately described in terms of both the presenting part and the frequency of occurrence? a.Cephalic: occiput, at least 96% b.Breech: sacrum, 10% to 15% c.Shoulder: scapula, 10% to 15% d.Cephalic: cranial, 80% to 85%

ANS: A In cephalic presentations (head first), the presenting part is the occiput; this presentation occurs in 96% of births. In a breech birth, the sacrum emerges first; this presentation occurs in approximately 3% of births. In shoulder presentations, the scapula emerges first; this presentation occurs in only 1% of births. In a cephalic presentation, the part of the head or cranium that emerges first is the occiput; cephalic presentations occur in 96% of births.

Which stage of labor varies the most in length? a.First b.Second c.Third d.Fourth

ANS: A The first stage of labor is considered to last from the onset of regular uterine contractions to the full dilation of the cervix. The first stage is significantly longer than the second and third stages combined. In a first-time pregnancy, the first stage of labor can take up to 20 hours. The second stage of labor lasts from the time the cervix is fully dilated to the birth of the fetus. The average length is 20 minutes for a multiparous woman and 50 minutes for a nulliparous woman. The third stage of labor lasts from the birth of the fetus until the placenta is delivered. This stage may be as short as 3 minutes or as long as 1 hour. The fourth stage of labor, recovery, lasts approximately 2 hours after the delivery of the placenta.

At least five factors affect the process of labor and birth. These are easily remembered as the five Ps. Which factors are included in this process? (Select all that apply.) a.Passenger b.Passageway c.Powers d.Pressure e.Psychologic response

ANS: A, B, C, E The five Ps are passenger (fetus and placenta), passageway (birth canal), powers (contractions), position of the mother, and psychologic response. Pressure is not one of the five Ps.

Because of its size and rigidity, the fetal head has a major effect on the birth process. Which bones comprise the structure of the fetal skull? (Select all that apply.) a.Parietal b.Temporal c.Fontanel d.Occipital e.Femoral

ANS: A, B, D The fetal skull has two parietal bones, two temporal bones, an occipital bone, and a frontal bone. The fontanels are membrane-filled spaces.

**Which factors influence cervical dilation? (Select all that apply.) a.Strong uterine contractions b.Force of the presenting fetal part against the cervix c.Size of the woman d.Pressure applied by the amniotic sac e.Scarring of the cervix

ANS: A, B, D, E Dilation of the cervix occurs by the drawing upward of the musculofibrous components of the cervix, which is caused by strong uterine contractions. Pressure exerted by the amniotic fluid while the membranes are intact or by the force applied by the presenting part can also promote cervical dilation. Scarring of the cervix as a result of a previous infection or surgery may slow cervical dilation. Pelvic size or the size of the woman does not affect cervical dilation.

**Which changes take place in the woman's reproductive system, days or even weeks before the commencement of labor? (Select all that apply.) a.Lightening b.Exhaustion c.Bloody show d.Rupture of membranes e.Decreased fetal movement

ANS: A, C, D Signs that precede labor may include lightening, urinary frequency, backache, weight loss, surge of energy, bloody show, and rupture of membranes. Many women experience a burst of energy before labor. A decrease in fetal movement is an ominous sign that does not always correlate with labor.

Which statement is the best rationale for assessing the maternal vital signs between uterine contractions? a.During a contraction, assessing the fetal heart rate is the priority. b.Maternal circulating blood volume temporarily increases during contractions. c.Maternal blood flow to the heart is reduced during contractions. d.Vital signs taken during contractions are not accurate.

ANS: B During uterine contractions, blood flow to the placenta temporarily stops, causing a relative increase in the mother's blood volume, which, in turn, temporarily increases blood pressure and slows the pulse. Monitoring fetal responses to the contractions is important; however, this question concerns the maternal vital signs. Maternal blood flow is increased during a contraction. Vital signs are altered by contractions but are considered accurate for that period.

What is the primary difference between the labor of a nullipara and that of a multipara? a.Amount of cervical dilation b.Total duration of labor c.Level of pain experienced d.Sequence of labor mechanisms

ANS: B In a first-time pregnancy, the descent is usually slow but steady; in subsequent pregnancies, the descent is more rapid, resulting in a shorter duration of labor. Cervical dilation is the same for all labors. The level of pain is individual to the woman, not to the number of labors she has experienced. The sequence of labor mechanisms is the same with all labors.

What is the correct term describing the slight overlapping of cranial bones or shaping of the fetal head during labor? a.Lightening b.Molding c.Ferguson reflex d.Valsalva maneuver

ANS: B Molding also permits adaptation to various diameters of the maternal pelvis. Lightening is the mother's sensation of decreased abdominal distention, which usually occurs the week before labor. The Ferguson reflex is the contraction urge of the uterus after the stimulation of the cervix. The Valsalva maneuver describes conscious pushing during the second stage of labor.

Which statement related to fetal positioning during labor is correct and important for the nurse to understand? a.Position is a measure of the degree of descent of the presenting part of the fetus through the birth canal. b.Birth is imminent when the presenting part is at +4 to +5 cm below the spine. c.The largest transverse diameter of the presenting part is the suboccipitobregmatic diameter. d.Engagement is the term used to describe the beginning of labor.

ANS: B The station of the presenting part should be noted at the beginning of labor to determine the rate of descent. Position is the relationship of the presenting part of the fetus to the four quadrants of the mother's pelvis; station is the measure of degree of descent. The largest diameter is usually the biparietal diameter. The suboccipitobregmatic diameter is the smallest, although one of the most critical. Engagement often occurs in the weeks just before labor in nulliparous women and before or during labor in multiparous women.

**The nurse has received a report regarding a client in labor. The woman's last vaginal examination was recorded as 3 cm, 30%, and -2. What is the nurse's interpretation of this assessment? a.Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm above the ischial spines. b.Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines. c.Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm below the ischial spines. d.Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm below the ischial spines.

ANS: B The sterile vaginal examination is recorded as centimeters of cervical dilation, percentage of cervical dilation, and the relationship of the presenting part to the ischial spines (either above or below). For this woman, the cervix is dilated 3 cm and effaced 30%, and the presenting part is 2 cm above the ischial spines. The first interpretation of this vaginal examination is incorrect; the cervix is dilated 3 cm and is 30% effaced. However, the presenting part is correct at 2 cm above the ischial spines. The remaining two interpretations of this vaginal examination are incorrect. Although the dilation and effacement are correct at 3 cm and 30%, the presenting part is actually 2 cm above the ischial spines.

The nurse is performing an initial assessment of a client in labor. What is the appropriate terminology for the relationship of the fetal body parts to one another? a.Lie b.Presentation c.Attitude d.Position

ANS: C Attitude is the relationship of the fetal body parts to one another. Lie is the relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother. Presentation refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor at term. Position is the relationship of the presenting part of the fetus to the four quadrants of the mother's pelvis.

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth? a.Fetal head is felt at 0 station during the vaginal examination. b.Bloody mucous discharge increases. c.Vulva bulges and encircles the fetal head. d.Membranes rupture during a contraction.

ANS: C During the active pushing (descent) phase, the woman has strong urges to bear down as the presenting part of the fetus descends and presses on the stretch receptors of the pelvic floor. The vulva stretches and begins to bulge, encircling the fetal head. Birth of the head occurs when the station is +4. A 0 station indicates engagement. Bloody show occurs throughout the labor process and is not an indication of an imminent birth. Rupture of membranes can occur at any time during the labor process and does not indicate an imminent birth.

**When assessing the fetus using Leopold's maneuvers, the nurse feels a round, firm, and movable fetal part in the fundal portion of the uterus and a long, smooth surface in the mother's right side close to midline. What is the position of the fetus? a.ROA b.LSP c.RSA d.LOA

ANS: C Fetal position is denoted with a three-letter abbreviation. The first letter indicates the presenting part in either the right or the left side of the maternal pelvis. The second letter indicates the anatomic presenting part of the fetus. The third letter stands for the location of the presenting part in relationship to the anterior, posterior, or transverse portion of the maternal pelvis. Palpation of a round, firm fetal part in the fundal portion of the uterus would be the fetal head, indicating that the fetus is in a breech position with the sacrum as the presenting part in the maternal pelvis. Palpation of the fetal spine along the mother's right side denotes the location of the presenting part in the mother's pelvis. The ability to palpate the fetal spine indicates that the fetus is anteriorly positioned in the maternal pelvis. This fetus is anteriorly positioned in the right side of the maternal pelvis with the sacrum as the presenting part. RSA is the correct three-letter abbreviation to indicate this fetal position. ROA denotes a fetus that is anteriorly positioned in the right side of the maternal pelvis with the occiput as the presenting part. LSP describes a fetus that is posteriorly positioned in the left side of the pelvis with the sacrum as the presenting part. A fetus that is LOA would be anteriorly positioned in the left side of the pelvis with the occiput as the presenting part.

A woman's position is an important component of the labor progress. Which guidance is important for the nurse to provide to the laboring client? a.The supine position, which is commonly used in the United States, increases blood flow. b.The laboring client positioned on her hands and knees ("all fours" position) is hard on the woman's back. c.Frequent changes in position help relieve fatigue and increase the comfort of the laboring client. d.In a sitting or squatting position, abdominal muscles of the laboring client will have to work harder.

ANS: C Frequent position changes relieve fatigue, increase comfort, and improve circulation. Blood flow can be compromised in the supine position; any upright position benefits cardiac output. The "all fours" position is used to relieve backache in certain situations. In a sitting or squatting position, the abdominal muscles work in greater harmony with uterine contractions.

**Which statement by the client would lead the nurse to believe that labor has been established? a."I passed some thick, pink mucus when I urinated this morning." b."My bag of waters just broke." c."The contractions in my uterus are getting stronger and closer together." d."My baby dropped, and I have to urinate more frequently now."

ANS: C Regular, strong contractions with the presence of cervical change indicate that the woman is experiencing true labor. Although the loss of the mucous plug (operculum) often occurs during the first stage of labor or before the onset of labor, it is not the indicator of true labor. Spontaneous rupture of membranes often occurs during the first stage of labor; however, it is not an indicator of true labor. The presenting part of the fetus typically becomes engaged in the pelvis at the onset of labor but is not the indicator of true labor.

A labor and delivery nurse should be cognizant of which information regarding how the fetus moves through the birth canal? a.Fetal attitude describes the angle at which the fetus exits the uterus. b.Of the two primary fetal lies, the horizontal lie is that in which the long axis of the fetus is parallel to the long axis of the mother. c.Normal attitude of the fetus is called general flexion. d.Transverse lie is preferred for vaginal birth.

ANS: C The normal attitude of the fetus is called general flexion. The fetal attitude is the relationship of the fetal body parts to each one another. The horizontal lie is perpendicular to the mother; in the longitudinal (or vertical) lie, the long axes of the fetus and the mother are parallel. Vaginal birth cannot occur if the fetus stays in a transverse lie.

Nurses should be cognizant of what regarding the mechanism of labor? a.Seven critical movements must progress in a more or less orderly sequence. b.Asynclitism is sometimes achieved by means of the Leopold's maneuver. c.Effects of the forces determining descent are modified by the shape of the woman's pelvis and the size of the fetal head. d.At birth, the baby is said to achieve "restitution"; that is, a return to the C-shape of the womb.

ANS: C The size of the maternal pelvis and the ability of the fetal head to mold also affect the process. The seven identifiable movements of the mechanism of labor simultaneously occur in combinations, not in precise sequences. Asynclitism is the deflection of the baby's head; the Leopold's maneuver is a means of judging descent by palpating the mother's abdomen. Restitution is the rotation of the baby's head after the infant is born.

Which adaptation of the maternal-fetal exchange of oxygen occurs in response to uterine contraction? a.The maternal-fetal exchange of oxygen and waste products continues except when placental functions are reduced. b.This maternal-fetal exchange increases as the blood pressure decreases. c.It diminishes as the spiral arteries are compressed. d.This exchange of oxygen and waste products is not significantly affected by contractions.

ANS: C Uterine contractions during labor tend to decrease circulation through the spiral electrodes and subsequent perfusion through the intervillous space. The maternal blood supply to the placenta gradually stops with contractions. The exchange of oxygen and waste products decreases. The exchange of oxygen and waste products is affected by contractions.

**Which basic type of pelvis includes the correct description and percentage of occurrence in women? a.Gynecoid: classic female pelvis; heart shaped; 75% b.Android: resembling the male pelvis; wide oval; 15% c.Anthropoid: resembling the pelvis of the ape; narrow; 10% d.Platypelloid: flattened, wide, and shallow pelvis; 3%

ANS: D A platypelloid pelvis is flattened, wide, and shallow; approximately 3% of women have this shape. The gynecoid pelvis is the classic female shape, slightly ovoid and rounded; approximately 50% of women have this shape. An android or malelike pelvis is heart shaped; approximately 23% of women have this shape. An anthropoid or apelike pelvis is oval and wide; approximately 24% of women have this shape.

Certain changes stimulate chemoreceptors in the aorta and carotid bodies to prepare the fetus for initiating respirations immediately after birth. Which change in fetal physiologic activity is not part of this process? a.Fetal lung fluid is cleared from the air passages during labor and vaginal birth. b.Fetal partial pressure of oxygen (PO2) decreases. c.Fetal partial pressure of carbon dioxide in arterial blood (PaCO2) increases. d.Fetal respiratory movements increase during labor.

ANS: D Fetal respiratory movements actually decrease during labor. Fetal lung fluid is cleared from the air passages during labor and vaginal birth. Fetal PO2 decreases, and fetal PaCO2 increases.

Which statement regarding the care of a client in labor is correct and important to the nurse as he or she formulates the plan of care? a.The woman's blood pressure will increase during contractions and fall back to prelabor normal levels between contractions. b.The use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia. c.Having the woman point her toes will reduce leg cramps. d.Endogenous endorphins released during labor will raise the woman's pain threshold and produce sedation.

ANS: D The endogenous endorphins released during labor will raise the woman's pain threshold and produce sedation. In addition, physiologic anesthesia of the perineal tissues, caused by the pressure of the presenting part, decreases the mother's perception of pain. Blood pressure levels increase during contractions but remain somewhat elevated between them. The use of the Valsalva maneuver is discouraged during the second stage labor because of a number of unhealthy outcomes, including fetal hypoxia. Pointing the toes can cause leg cramps, as can the process of labor itself.

A new mother asks the nurse when the "soft spot" on her son's head will go away. What is the nurse's best response, based upon her understanding of when the anterior frontal closes? a.2 months b.8 months c.12 months d.18 months

ANS: D The larger of the two fontanels, the anterior fontanel, closes by 18 months after birth. The posterior fontanel closes at 6 to 8 weeks. The remaining three options are too early for the anterior fontanel to close.

A pregnant woman is at 38 weeks of gestation. She wants to know whether there are any signs that "labor is getting close to starting." Which finding is an indication that labor may begin soon? a.Weight gain of 1.5 to 2 kg (3 to 4 lb) b.Increase in fundal height c.Urinary retention d.Surge of energy

ANS: D Women speak of having a burst of energy before labor. The woman may lose 0.5 to 1.5 kg, as a result of water loss caused by electrolyte shifts that, in turn, are caused by changes in the estrogen and progesterone levels. When the fetus descends into the true pelvis (called lightening), the fundal height may decrease. Urinary frequency may return before labor.

A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: A. Uterine contractions occurring every 8 to 10 minutes. B. A fetal heart rate (FHR) of 180 with absence of variability. C. The client needing to void. D. Rupture of the client's amniotic membranes.

B. Rationale: A fetal heart rate (FHR) of 180 with absence of variability is nonreassuring; the oxytocin should be immediately discontinued and the physician should be notified. The oxytocin should also be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. The client needing to void is not an indication to discontinue the oxytocin induction immediately or to call the physician. The oxytocin does not need to be discontinued when the membranes rupture, but the physician should be notified.

Which statement is inaccurate with regard to normal labor? A. A single fetus presents by vertex. B. It is completed within 8 hours. C. A regular progression of contractions, effacement, dilation, and descent occurs. D. No complications are involved.

B. Rationale: Although the amount of time varies with each woman, a normal uncomplicated labor is usually completed within 18 hours. In normal labor, a single fetus presents by vertex. A regular progression of contractions, effacement, dilation, and descent is the trajectory that the nurse expects for a woman experiencing a normal labor, which usually occurs with no complications.

Under which circumstance would a nurse not perform a vaginal examination on a patient in labor? A. An admission to the hospital at the start of labor B. When accelerations of the fetal heart rate (FHR) are noted C. On maternal perception of perineal pressure or the urge to bear down D.When membranes rupture

B. Rationale: An accelerated FHR is a positive sign not requiring vaginal examination; variable decelerations, however, merit a vaginal examination. Vaginal examination should be performed when the woman is admitted to the hospital or birthing center at the start of labor. When the woman perceives perineal pressure or the urge to bear down is another appropriate time to perform a vaginal examination, as is after rupture of membranes (ROM). The nurse must be aware that there is an increased risk of prolapsed cord immediately after ROM.

After change of shift report, the nurse assumes care of a multiparous client in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, and buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is: A. Visceral B. Referred C. Somatic D. Afterpain

B. Rationale: As labor progresses the woman often experiences referred pain. It occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and the thighs. The woman usually has pain only during a contraction and is free from pain between contractions. Visceral pain predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen. Somatic pain is described as intense, sharp, burning, and well localized. It results from stretching of the perineal tissues and the pelvic floor and occurs during the second stage of labor. Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor.

With regard to systemic analgesics administered during labor, nurses should be aware that: A. Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. B. Effects on the fetus and newborn can include decreased alertness and delayed sucking. C. IM administration is preferred over IV administration. D. IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

B. Rationale: Effects depend on the specific drug given, the dosage, and the timing. Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCAs result in decreased use of an analgesic.

With regard to dysfunctional labor, nurses should be aware that: A. Women who are underweight are more at risk. B. Women experiencing precipitous labor are about the only women experiencing dysfunctional labor who are not exhausted. C. Hypertonic uterine dysfunction is more common than hypotonic dysfunction. D. Abnormal labor patterns are most common in older women.

B. Rationale: Precipitous labor lasts less than 3 hours. Short women more than 30 pounds overweight are more at risk for dysfunctional labor. Hypotonic uterine dysfunction, in which the contractions become weaker, is more common. Abnormal labor patterns are more common in women younger than 20 years.

With regard to spinal and epidural (block) anesthesia, nurses should know that: A. This type of anesthesia is commonly used for cesarean births but is not suitable for vaginal births. B. A high incidence of postbirth headache is seen with spinal blocks. C. Epidural blocks allow the woman to move freely. D. Spinal and epidural blocks are never used together.

B. Rationale: The headaches may be prevented or mitigated to some degree by a number of methods. An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for a spinal headache. Spinal blocks may be used for vaginal births, but the woman must be assisted through labor. Epidural blocks limit the woman's ability to move freely. Combined use of spinal and epidural blocks is becoming increasingly popular.

The nurse knows that the second stage of labor, the descent phase, has begun when: A. The amniotic membranes rupture. B. The cervix cannot be felt during a vaginal examination. C. The woman experiences a strong urge to bear down. D. The presenting part is below the ischial spines.

B. Rationale: The second stage of labor begins with full cervical dilation. During the active pushing phase of the second stage of labor, the woman may experience an increase in the urge to bear down. Rupture of membranes has no significance in determining the stage of labor. Many women may have an urge to bear down when the presenting part is below the level of the ischial spines. This can occur during the first stage of labor, as early as at 5 cm dilation.

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is: A. "Don't worry about it. You'll do fine." B. "It's normal to be anxious about labor. Let's discuss what makes you afraid." C. "Labor is scary to think about, but the actual experience isn't." D. "You may have an epidural. You won't feel anything."

B. Rationale: This statement allows the woman to share her concerns with the nurse and is a therapeutic communication tool. The statement in A negates the woman's fears and is not therapeutic. The statement in C also negates the woman's fears and offers a false sense of security. The statement in D is not true. A number of criteria must be met for use of an epidural. Furthermore, many women still experience the feeling of pressure with an epidural.

A group of fetal monitoring experts (National Institute of Child Health and Human Development, 2008) recommends that fetal heart rate (FHR) tracings demonstrate certain characteristics to be described as reassuring or normal (category I). These characteristics include: A. Bradycardia not accompanied by baseline variability. B. Early decelerations, either present or absent. C. Sinusoidal pattern. D. Tachycardia.

B. Rationale: Early decelerations, the absence of late decelerations, and the presence of accelerations indicate a normal category I tracing. Bradycardia not accompanied by variability is a category II tracing, as is fetal tachycardia. A sinusoidal pattern is considered an ominous sign and is definitely an abnormal category III tracing.

Which test is performed to determine whether membranes are ruptured? A. Urine analysis B. Fern test C. Leopold maneuvers D. AROM

B. Rationale: In many instances a sterile speculum examination and a Nitrazine (pH) and fern test are performed to confirm that fluid seepage is indeed amniotic fluid. A urine analysis should be performed on admission to labor and delivery to determine the presence or absence of glucose and protein. The nurse performs Leopold maneuvers to identify fetal lie, presenting part, and attitude. AROM is the procedure of artificially rupturing membranes, usually with a device known as an amnihook.

**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 1 to 2 hours

B. Rationale: The latent phase is characterized by mild to moderate, irregular contractions; dilation up to 3 cm; brownish to pale pink mucus; and a duration of 6 to 8 hours. No official lull phase exists in the first stage. The transition phase is characterized by strong to very strong, regular contractions; 8 to 10 cm dilation; and a duration of 20 to 40 minutes.

In planning for an expected cesarean birth for a woman who has given birth by cesarean section previously and who has a fetus in the transverse presentation, the nurse includes which information? A. "Because this is a repeat procedure, you are at the lowest risk for complications." B. "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." C. "Because this is your second cesarean birth, you will recover faster." D. "You will not need preoperative teaching because this is your second cesarean birth."

B. Rationale: The statement in B is most appropriate. The statements in A, C, and D are not accurate. Maternal and fetal risks are associated with every cesarean section. Physiologic and psychologic recovery from a cesarean section is multifactorial and individual to each client each time. Preoperative teaching should always be performed regardless of whether the client has already had this procedure.

**Concerning the third stage of labor, nurses should be aware that: A. The placenta eventually detaches itself from a flaccid uterus. B. The duration of the third stage may be as short as 3 to 5 minutes. 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. Rationale: The third stage of labor lasts from birth of the fetus until the placenta is delivered. The duration may be as short as 3 to 5 minutes, although up to 1 hour is considered within normal limits. The placenta cannot detach itself from a flaccid (relaxed) uterus. Which surface of the placenta comes out first is not clinically important. The major risk for women during the third stage of labor is postpartum hemorrhage; the risk of hemorrhage increases as the length of the third stage increases.

Which factors would lead to an increased likelihood of uterine rupture? (Select all that apply.) A. Preterm singleton pregnancy B. G3P3 with all vaginal deliveries C. Short interval between pregnancies D. Patient receiving a trial of labor (TOL) following a VBAC delivery E. Patient who had a primary caesarean section with a classic incision

C, D, E. Rationale: The shorter the interval between pregnancies/deliveries, the higher the risk of uterine rupture. A patient who is having a TOL following a VBAC and a patient who has had a C section with a classic incision into the uterus are at increased risk for uterine rupture. A pregnant woman with a singleton pregnancy (one fetus), even if preterm, is not considered to be at increased risk for uterine rupture; nor is a multipara who has delivered all her infants vaginally.

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: A. The drugs can be given efficaciously up to the designated beginning of term at 37 weeks. B. There are no important maternal (as opposed to fetal) contraindications. C. Its most important function is to afford the opportunity to administer antenatal glucocorticoids. D. If pulmonary edema develops while the client is receiving tocolytics, IV fluids should be given.

C. Rationale: Buying time for antenatal glucocorticoids to accelerate fetal lung development might be the best reason to use tocolytics. Once the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. There are important maternal contraindications to tocolytic therapy. Tocolytic-induced edema can be caused by IV fluids.

Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased? A. Semirecumbent B. Sitting C. Squatting D. Side-lying

C. Rationale: Kneeling or squatting moves the uterus forward and aligns the fetus with the pelvic inlet; this can facilitate the second stage of labor by increasing the pelvic outlet. Sitting may assist with fetal descent, but like a semirecumbent or side-lying position, it does not increase the size of the pelvic outlet.

Which description of the phases of the second stage of labor is accurate? A. Latent phase: feels sleepy, fetal station is 2+ to 4+, duration is 30 to 45 minutes B. Active phase: overwhelmingly strong contractions, Ferguson reflux activated, duration is 5 to 15 minutes C. Descent phase: significant increase in contractions, Ferguson reflux activated, average duration varies D. Transitional phase: woman "laboring down," fetal station is 0, duration is 15 minutes

C. Rationale: The descent phase begins with a significant increase in contractions, the Ferguson reflex is activated, and the duration varies, depending on a number of factors. The latent phase is the lull, or "laboring down" period, at the beginning of the second stage. It lasts 10 to 30 minutes on average. The second stage of labor has no active phase. The transition phase is the final phase in the second stage of labor; contractions are strong and painful.

Evidence-based care practices designed to support normal labor and birth recommend which practice during the immediate newborn period? A. The healthy newborn should be taken to the nursery for a complete assessment. B. After drying, the infant should be given to the mother wrapped in a receiving blanket. C. Skin-to-skin contact of mother and baby should be encouraged. D. The father or support person should be encouraged to hold the infant while awaiting delivery of the placenta.

C. Rationale: The unwrapped infant should be placed on the woman's bare chest or abdomen, then covered with a warm blanket. Skin-to-skin contact keeps the newborn warm, prevents neonatal infection, enhances physiologic adjustment to extrauterine life, and fosters early breastfeeding. Although complete assessment in the nursery is the practice in many facilities, it is neither evidence-based nor supportive of family-centered care. Handing the mother the blanket-wrapped baby is a common practice and more family friendly than separating mother and baby; however, ideally the baby should be placed on the mother skin to skin. The father or support person is likely also anxious to hold and admire the newborn. This can happen after the infant has been placed skin to skin with the mother and breastfeeding has been initiated.

With regard to what might be called the tactile approaches to comfort management, nurses should be aware that: A. Either hot or cold applications may provide relief, but they should never be used together in the same treatment. B. Acupuncture can be performed by a skilled nurse with just a little training. C. Hand and foot massage may be especially relaxing in advanced labor, when a woman's tolerance for touch is limited. D. Therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations.

C. Rationale: The woman and her partner should experiment with massage before labor to see what might work best. Heat and cold may be applied in an alternating fashion for greater effect. Unlike acupressure, acupuncture, which involves the insertion of thin needles, should be done only by a certified therapist. Therapeutic touch is a laying-on of hands technique that claims to redirect energy fields in the body.

Fetal bradycardia is most common during: A. Maternal hyperthyroidism. B. Fetal anemia. C. Viral infection. D. Tocolytic treatment using ritodrine.

C. Rationale: Fetal bradycardia can be considered a later sign of fetal hypoxia and is known to occur before fetal death. Bradycardia can result from placental transfer of drugs, viral infections such as cytomegalovirus (CMV), maternal hypothermia, and maternal hypothermia. Maternal hyperthyroidism, fetal anemia, and tocolytic treatment using ritodrine will most likely result in fetal tachycardia.

A nurse providing care to a woman in labor should be aware that cesarean birth: A. Is declining in frequency in the United States. B. Is more likely to be performed in the poor in public hospitals who do not receive the nurse counseling that wealthier clients do. C. Is performed primarily for the benefit of the fetus. D. Can be either elected or refused by women as their absolute legal right.

C. Rationale: The most common indications for cesarean birth are danger to the fetus related to labor and birth complications. Cesarean births are increasing in the United States. Wealthier women who have health insurance and who give birth in a private hospital are more likely to experience cesarean birth. A woman's right to elect cesarean surgery is in dispute, as is her right to refuse it if in doing so she endangers the fetus. Legal issues are not absolutely clear.

A nurse caring for a woman in labor understands that increased variability of the fetal heart rate might be caused by: A. Narcotics. B. Barbiturates. C. Methamphetamines. D. Tranquilizers.

C. Rationale: The use of illicit drugs such as cocaine or methamphetamines might cause increased variability. Maternal ingestion of narcotics and tranquilizer use may be the causes of decreased variability. The use of barbiturates may also result in a significant decrease in variability as these drugs are known to cross the placental barrier.

A nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates her understanding of the instructions when the woman states: A. "True labor contractions will subside when I walk around." B. "True labor contractions will cause discomfort over the top of my uterus." C. "True labor contractions will continue and get stronger even if I relax and take a shower." D. "True labor contractions will remain irregular but become stronger."

C. Rationale: True labor contractions occur regularly, become stronger, last longer, and occur closer together. They may become intense during walking and continue despite comfort measures. Typically, true labor contractions are felt in the lower back, radiating to the lower portion of the abdomen. During false labor, contractions tend to be irregular and felt in the abdomen above the navel. Typically the contractions stop with walking or a change of position.

Which statement is most likely to be associated with a breech presentation? A. Least common malpresentation B. Descent rapid C. Diagnosis by ultrasound only D. High rate of neuromuscular disorders

D. Rationale: Fetuses with neuromuscular disorders have a higher rate of breech presentation, perhaps because they are less capable of movement within the uterus. Breech is the most common malpresentation, affecting 3% to 4% of all labors. Descent is often slow because the breech is not as good a dilating wedge as the fetal head. Diagnosis is made by abdominal palpation and vaginal examination, and is confirmed by ultrasound.

Which of the following would not be included in a labor nurse's plan of care for an expectant mother? A. The onset of progressive, regular contractions B. The bloody, or pink, show C. The spontaneous rupture of membranes D. Formulation of the woman's plan of care for labor

D. Rationale: Labor care begins when progressive, regular contractions begin, the blood-tinged mucoid vaginal discharge appears, or fluid is discharged from the vagina. The woman and the nurse can formulate their plan of care before labor or during treatment.

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? A. Fetal heart rate of 116 beats/min B. Cervix dilated 2 cm and 50% effaced C. Score of 8 on the biophysical profile D. One fetal movement noted in 1 hour of assessment by the mother

D. Rationale: Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If she feels fewer than four movements, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation. The findings described in the other choices are normal at 42 weeks of gestation.

If a woman complains of back labor pain, the nurse might best suggest that she: A. Lie on her back for a while with her knees bent. B. Do less walking around. C. Take some deep, cleansing breaths. D. Lean over a birth ball with her knees on the floor.

D. Rationale: The hands-and-knees position, with or without the aid of a birth ball, should help with the back pain. The supine position should be discouraged. Walking generally is encouraged. Deep cleansing breaths will assist with any labor pain; however, it is very important that this woman's position is changed so that she is not on her back.

**Which sign does not precede the onset of labor? A. A return of urinary frequency as a result of increased bladder pressure B. Persistent low backache from relaxed pelvic joints C. Stronger and more frequent uterine (Braxton Hicks) contractions D. A decline in energy, as the body stores up for labor

D. Rationale: A surge of energy is a phenomenon that is common in the days preceding labor. After lightening, a return of the frequent need to urinate occurs as the fetal position causes increased pressure on the bladder. In the run-up to labor, women often experience persistent low backache and sacroiliac distress as a result of relaxation of the pelvic joints. Prior to the onset of labor, it is common for Braxton Hicks contractions to increase in both frequency and strength; bloody show may be passed.

The most common cause of decreased variability in the FHR that lasts 30 minutes or less is: A. Altered cerebral blood flow. B. Fetal hypoxemia. C. Umbilical cord compression. D. Fetal sleep cycles.

D. Rationale: A temporary decrease in variability can occur when the fetus is in a sleep state. These sleep states do not usually last longer than 30 minutes. Altered fetal cerebral blood flow results in early decelerations in the FHR, and umbilical cord compression in variable decelerations. Fetal hypoxemia is evidenced by tachycardia initially and then bradycardia. A persistent decrease or loss of FHR variability may be seen.

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? A. Estriol is not found in maternal saliva. B. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. C. Fetal fibronectin is present in vaginal secretions. D. The cervix is effacing and dilated to 2 cm.

D. Rationale: Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Irregular, mild contractions that do not cause cervical change are not considered a threat. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor, such as cervical changes.

In the current practice of childbirth preparation, emphasis is placed on: A. The Dick-Read (natural) childbirth method. B. The Lamaze (psychoprophylactic) method. C. The Bradley (husband-coached) method. D. Encouraging expectant parents to attend childbirth preparation in any or no specific method.

D. Rationale: Encouraging expectant parents to attend class is most important, because preparation increases a woman's confidence and thus her ability to cope with labor and birth. The goal is to encourage new parents to attend any one of the acceptable childbirth education programs. Gaining in popularity are Birthing from Within and Hypnobirthing. The Dick-Read method is historically popular and is still in use. The Lamaze method is less focused on a method approach and more concerned with psychologic preparation for labor. Attendance at any available class should be encouraged, however. Bradley as well as other methods encourage women to choose the techniques that work best for them. Women are helped to develop their own birth philosophy and then choose from a variety of skills to help cope with the labor process.

In a variation of rooming-in called couplet care, the mother and infant share a room and the mother shares the care of the infant with: A. The father of the infant. B. Her mother (the infant's grandmother). C. Her eldest daughter (the infant's sister). D. The nurse.

D. Rationale: In couplet care the mother shares a room with the newborn and shares infant care with a nurse educated in maternity and infant care. This may also be known as mother-baby care or single-room maternity care. The father is included in instruction regarding infant care whenever he is present. The grandmother is welcome to stay and take part in the woman's postpartum care, but she is not part of the couplet. An older sibling may stay with the client and her baby but is also not part of the couplet.

A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is about twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. The nurse should: A. Notify the woman's physician. B. Tell the woman to slow the pace of her breathing. C. Administer oxygen via a mask or nasal cannula. D. Help her breathe into a paper bag.

D. Rationale: This client is experiencing the side effects of hyperventilation, which include the symptoms of lightheadedness, dizziness, tingling of the fingers, and circumoral numbness. Notification of the physician is not necessary. The best approach is to have the client breathe into a paper bag held tightly around the nose and mouth to eliminate respiratory alkalosis. The woman can also breathe into her cupped hands if no paper bag is available. Slowing the pace of her breathing will not correct the problem, nor will administration of oxygen. Once the pattern of breathing is corrected, her partner can help the woman maintain her breathing rate with visual, tactile, or auditory cues.

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 IV fluid, and perform a vaginal exam. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should you take? A. Call for help. B. Insert a Foley catheter. C. Start oxytocin (Pitocin). D. Notify the primary health care provider immediately.

D. Rationale: To relieve an FHR deceleration the nurse can reposition the mother, increase IV fluid, and provide oxygen. Also, if oxytocin is being infused, it should be discontinued. If the FHR does not resolve, the primary health care provider should be notified immediately. Although it is always a good idea to have extra help during any unanticipated obstetric event, calling for help is not the most important nursing measure at this time. If the FHR were to continue in an abnormal or nonreassuring pattern, a cesarean section might be warranted. This would require the insertion of a Foley catheter; however, the physician must make that determination. Oxytocin may put additional stress on the fetus.

Which of the following statements is not used to describe a characteristic of a uterine contraction? A. Frequency (how often contractions occur) B. Intensity (the strength of the contraction at its peak) C. Resting tone (the tension in the uterine muscle) D. Appearance (shape and height)

D. Rationale: Uterine contractions are described in terms of frequency, intensity, duration, and resting tone.

What position is least effective when gravity is desired to assist in fetal descent?

Lithotomy The predominant position in the United States for physician-attended births is the lithotomy position which is least effective to work with gravity.

What is the 4th stage of labor and how long does it last?

The fourth stage of labor, recovery, lasts about 2 hours after delivery of the placenta.

How long does the second stage of labor last?

The second stage of labor lasts from a fully dilated cervix to the birth of fetus. Average length is 20 minutes for a multiparous woman and 50 minutes for a nulliparous woman.

How long does the third stage of labor last?

The third stage of labor lasts from the birth of the fetus until the placenta is delivered. This stage may be as short as 3 minutes or as long as 1 hour.

Which patient is likely to have a cesarean birth? a. a client with a fetus in a transverse lie b. a client with a fetus in a cephalic presention c. a client with the fetal biparietal diameter of 9.25 cm at term d. a client in whom the presenting part is 4cm below the spines

a. a client with a fetus in a transverse lie

Which assessment finding in the client increases the risk of forceps assisted birth? a. android pelvis b. effacement of the cervix c. biparietal diameter of 9.25 d. involuntary unterine contractions

a. android pelvis

The nursing instructor is teachin a group of students about the structure of the fetal head during labor and birth. Which statement indicates effective learning? a. "The fetal skull bones are firmly united during labor" b. "the fetal skulls are united by membranous sutures" c. "the two important fontanels are parietal and temporal" d. "the sutures and fontanels restrict brain growth"

b. "the fetal skulls are united by membranous sutures"

Which pelvic shape is the most classic female shape and most conductive to vaginal labor and birth? a. Android b. gynecoid c. platypelloid d. anthropoid

b. gynecoid

In which stage of labor does the nurse expect the placenta to be expelled? a. first b. second c. third d. fourth

c. third

What term describes a flat pelvis? a. gynecoid b. android c. anthropoid d. platypelloid

d. platypelloid

**What complication of cervical scarring might a nurse predict in a client during labor? a. ferguson reflex b. slow fetal descent c. supine hypotension d. slow cervical dilation

d. slow cervical dilation