Developmental Concepts - OB Module 3

The nurse is monitoring a client in the first stage of labor. The nurse determines the client's uterine contractions are effective and progressing well based on which finding? A) Engagement of fetus B) Dilation of cervix C) Rupture of amniotic membranes D) Bloody show

B) Dilation of cervix

Which nursing action has a negative effect on fetal descent? A) Laying the client on the left side B) Using a tap water enema C) Administering narcotic pain medication D) Walking the client in the hall

C) Administering narcotic pain medication

Place the following stages of labor in order from what occurs first to last. All options must be used. 1) third stage 2) latent stage 3) second stage 4) active stage 5) transition stage

2) latent stage 4) active stage 5) transition stage 3) second stage 1) third stage

A primagravida has an office appointment in her 39th week of pregnancy. Which assessment data is most definitive of the onset of labor? A) The mother reports frequent urination. B) The fetal head is engaged in the pelvis. C) Cervical ripening is noted on examination. D) Expulsion of the mucous plug.

C) Cervical ripening is noted on examination.

During the fourth stage of labor, which mother typically experiences the strongest afterpains? A) The primigravid who delivers a 6 lb (2,688 g) newborn B) A multipara who is breast-feeding C) A primigravid whose breast milk has not come in D) A multigravid with twins who decided to formula feed

B) A multipara who is breast-feeding

A client gave birth to a child 3 hours ago and noticed a triangular-shaped gap in the bones at the back of the head of her newborn. The attending nurse informs the client that it is the posterior fontanelle. The client is anxious to know when the posterior fontanelle will close. Which time span is the normal duration for the closure of the posterior fontanelle? A) 4 to 6 weeks B) 8 to 12 weeks C) 12 to 14 weeks D) 14 to 8 weeks

B) 8 to 12 weeks

The nurse is documenting the length of time in the second stage of labor. Which data will the nurse use to complete the documentation? A) Admission time and time of fetal birth B) Complete cervical dilation and time of fetal birth C) Effacement time and time when contractions are regular D) Time of mucous plug expulsion and full cervical dilation

B) Complete cervical dilation and time of fetal birth

The nurse is appraising the post birth laboratory results of a client and discovers the WBC is 22,000 cells/mcL. The nurse predicts which action should be prioritized in response? A) None, a normal variation due to labor B) An abnormal finding, needs antibiotics C) Occurs in clients after a cesarean birth D) Further testing is required to determine source.

A) None, a normal variation due to labor

As a woman enters the second stage of labor, which would the nurse expect to assess? A) feelings of being frightened by the change in contractions B) reports of feeling hungry and unsatisfied C) falling asleep from exhaustion D) expressions of satisfaction with her labor progress

A) feelings of being frightened by the change in contractions

An OB/GYN care provider has just finished evaluating the 100th client. If the nurse could review all the documentation from each client thus far, which types of pelvis would the nurse predict the care provider has seen the most and the least? A) gynecoid and android, respectively B) gynecoid and platypelloid, respectively C) anthropoid and gynecoid, respectively D) android and platypelloid, respectively

B) gynecoid and platypelloid, respectively

A nurse is educating a group of nursing students about the molding of the fetal skull during the birth process. What would the nurse include as the usual cause of molding? A) tight membranous attachments B) poorly ossified bones of the cranial vault C) rigid bones at the base of the skull D) well-ossified bones of the face

B) poorly ossified bones of the cranial vault

The nurse instructs the client about skin massage and the gate control theory of pain. Which statement would be appropriate for the nurse to include for client understanding of the nonpharmacologic pain relief methods? A) The gating mechanism is located at the pain site. B) Pain perception is decreased if anxiety is present. C) The gating mechanism opens so all the stimuli pass through to the brain. D) These methods are a technique to prevent the painful stimuli from entering the brain.

D) These methods are a technique to prevent the painful stimuli from entering the brain.

During the second stage of labor, a woman is generally: A) very aware of activities immediately around her. B) anxious to have people around her. C) no longer in need of a support person. D) turning inward to concentrate on body sensations.

D) turning inward to concentrate on body sensations.

In providing culturally competent care to a laboring woman, which is a priority? A) Identify the decision maker within the family. B) Identify any cultural foods used prior to labor. C) Identify who is the support person during the labor. D) Identify how the client expresses labor pain.

D) Identify how the client expresses labor pain.

A pregnant client is admitted to a maternity clinic for birth. The client wishes to adopt the kneeling position during labor. The nurse knows that which to be an advantage of adopting a kneeling position during labor? A) It helps the woman in labor to save energy. B) It facilitates vaginal examinations. C) It facilitates external belt adjustment. D) It helps to rotate fetus in a posterior position.

D) It helps to rotate fetus in a posterior position.

The nurse is admitting a client who is in early labor. After determining that the birth is not imminent, which assessment should the nurse perform next? A) Risk factors B) Maternal status C) Fetal status D) Maternal obstetrical history

C) Fetal status

The coach of a client in labor is holding the client's hand and appears to be intentionally applying pressure to the space between the first finger and thumb on the back of the hand. The nurse recognizes this as which form of therapy? A) acupressure B) acupuncture C) effleurage D) biofeedback

A) acupressure

The pain of labor is influenced by many factors. What is one of these factors? A) The woman is prepared for labor and birth. B) The woman has a high tolerance for pain. C) The woman has a high threshold for pain. D) The woman has lots of visitors during labor.

A) The woman is prepared for labor and birth.

A nurse is preparing a patient for rhythm strip testing. She places the woman into a semi-Fowler's position. What is the appropriate rationale for this measure? A) To prevent supine hypotension syndrome B) To decrease the heart rate of the fetus C) To aid the woman as she pushes during labor D) To prevent the woman from falling out of bed

A) To prevent supine hypotension syndrome

To assess the frequency of a woman's labor contractions, the nurse would time: A) the beginning of one contraction to the beginning of the next. B) the end of one contraction to the beginning of the next. C) the interval between the acme of two consecutive contractions. D) how many contractions occur in 5 minutes.

A) the beginning of one contraction to the beginning of the next.

The student nurse is learning about normal labor. The teacher reviews the cardinal movements of labor and determines the instruction has been effective when the student correctly states the order of the cardinal movements as follows: A) internal rotation, flexion, descent, extension, external rotation, expulsion. B) descent, flexion, external rotation, extension, internal rotation, expulsion. C) descent, flexion, internal rotation, extension, external rotation, expulsion. D) internal rotation, flexion, descent, extension, external rotation, expulsion.

C) descent, flexion, internal rotation, extension, external rotation, expulsion.

The client is being rushed into the labor and delivery unit. At which station would the nurse document the fetus immediately prior to birth? A) -5 B) 0 C) +1 D) +4

D) +4

A client experiencing contractions presents at a health care facility. Assessment conducted by the nurse reveals that the client has been experiencing Braxton Hicks contractions. The nurse has to educate the client on the usefulness of Braxton Hicks contractions. Which role do Braxton Hicks contractions play in aiding labor? A) These contractions help in softening and ripening the cervix. B) These contractions increase the release of prostaglandins. C) These contractions increase oxytocin sensitivity. D) These contractions make maternal breathing easier.

A) These contractions help in softening and ripening the cervix.

While assessing the progress of the labor, the nurse explains that the fetal heart rate variability is moderate. Which explanation is best to use with the parents? A) FHR fluctuates from 6 to 25 beats per minute. B) FHR fluctuation range is undetectable. C) FHR fluctuates less than 5 beats per minute. D) FHR fluctuates over 25 beats per minute.

A) FHR fluctuates from 6 to 25 beats per minute.

The nurse is admitting a primigravida client who has just presented to the unit in early labor. Which response should the nurse prioritize to assist the client in remaining calm and cooperative during birth? A) "The baby is coming. Relax and everything will turn out fine." B) "Do you want me to call in your family?" C) "Even though the baby is coming, the health care provider will be here soon." D) "The baby is coming. I'll explain what's happening and guide you."

D) "The baby is coming. I'll explain what's happening and guide you."

The nurse is caring for a client who has an irregular pattern of uterine contraction. As a result, the nurse anticipates a problem with which? A) The passenger B) The passageway C) The psyche D) The powers

D) The powers

A nurse is teaching a couple about patterned breathing during their birth education. Which technique should the nurse suggest for slow-paced breathing? A) Inhale and exhale through the mouth at a rate of 4 breaths every 5 seconds. B) Inhale slowly through nose and exhale through pursed lips. C) Punctuated breathing by a forceful exhalation through pursed lips every few breaths. D) Hold breath for 5 seconds after every 3 breaths.

B) Inhale slowly through nose and exhale through pursed lips.

A nurse recommends to a client in labor to try concentrating intently on a photo of her family as a means of managing pain. The woman looks skeptical and asks, "How would that stop my pain?" Which explanation should the nurse give? A) "It distracts your brain from the sensations of pain." B) "It causes the release of endorphins." C) "It blocks the transmission of nerve messages of pain at the receptors." D) "It disrupts the nerve signal of pain via mechanical irritation of the nerves."

A) "It distracts your brain from the sensations of pain."

The nurse is providing care to a client in labor. On examination, the nurse determines the fetus is at -1 station. The nurse interprets this as indicating that the fetus is: A) 1 cm above the ischial spines. B) 1 cm below the ischial spines. C) 1 cm below the pubic bone. D) 1 cm above the pubic bone.

A) 1 cm above the ischial spines.

The nurse is preparing an educational event for pregnant women on the topic of labor pain and birth. The nurse understands the need to include the origin of labor pain for each stage of labor. What information will the nurse present for the first stage of labor? A) Pain originates from the cervix and lower uterine segment. B) It is reported as the worst pain a woman will ever feel. C) Pain is focal in nature. D) Diffuse abdominal pain signals a complication with progression of labor.

A) Pain originates from the cervix and lower uterine segment.

The nurse has been asked to present information to a group of civic leaders concerning women's health issues. In preparing the information, the nurse includes what goal from Healthy People 2020 related to women in labor? A) Reduce the rate of cesarean births among low-risk births. B) Encourage women with previous cesareans to always have a cesarean. C) Ensure care during labor includes immunizations. D) Ensure all couples receive preconceptional genetic counseling.

A) Reduce the rate of cesarean births among low-risk births.

The nurse identifies from a client's prenatal record that she has a documented gynecoid pelvis. Upon the client entering the labor and delivery department, which nursing action is best? A) Take no extra measures; prepare for a standard labor. B) Anticipate this client is a one-to-one registered nursing assignment. C) Notify the client's support person that the labor is typically long. D) Prepare for vital signs and fetal monitoring hourly.

A) Take no extra measures; prepare for a standard labor.

During a prenatal visit a pregnant client asks the nurse how to tell whether the contractions she is having are true contractions or Braxton Hicks contractions. Which description should the nurse mention as characteristic of true contractions? A) begin irregularly but become regular and predictable B) felt first in lower back and sweep around to the abdomen in a wave C) increase in duration, frequency, and intensity D) begin and remain irregular E) felt first abdominally and remain confined to the abdomen and groin F) often disappear with ambulation or sleep

A) begin irregularly but become regular and predictable B) felt first in lower back and sweep around to the abdomen in a wave C) increase in duration, frequency, and intensity

A nurse is caring for woman in labor. The woman's membranes just ruptured. The nurse assesses the characteristics of the fluid. Which finding would the nurse identify as normal? A) clear B) cloudy C) green D) malodorous

A) clear

The nurse is assessing the laboring client to determine fetal oxygenation status. What indirect assessment method will the nurse likely use? A) external electronic fetal monitoring B) fetal blood pH C) fetal oxygen saturation D) fetal position

A) external electronic fetal monitoring

A nurse sees a pregnant client at the clinic. The client is close to her due date. During the visit the nurse would emphasize that the client get evaluated quickly should her membranes rupture spontaneously based on the understanding of which possibility? A) increased risk of infection B) potential rapid birth of fetus C) potential placenta previa D) increased risk of breech presentation

A) increased risk of infection

A woman is told she has an anthropoid pelvis. This means her pelvis: A) is narrow transversely. B) is ideal for birth. C) has weaker bones than normal. D) is "male" shaped.

A) is narrow transversely.

A nurse is conducting a presentation for a group of pregnant women about labor and the importance of being well prepared and having good labor support. The nurse determines that additional discussion is needed when the group identifies which possible outcome as the result of being prepared? A) need for someone to control the situation B) less likely to need analgesia C) less likely to need anesthesia D) unlikely to require cesarean birth

A) need for someone to control the situation

A client is in the first stage of labor and asks the nurse what type of pain she should expect at this stage. What is the nurse's most appropriate response? A) pain from the dilation or stretching of the cervix B) hypoxia of the contracting uterine muscles C) distention of the vagina and perineum D) pressure on the lower back, buttocks, and thighs

A) pain from the dilation or stretching of the cervix

The assessment of a pregnant client who is toward the end of her third trimester reveals that she has increased prostaglandin levels. For which factors should the nurse assess the client? Select all that apply. A) reduction in cervical resistance B) myometrial contractions C) boggy appearance of the uterus D) softening and thinning of the cervix E) hypotonic character of the bladder

A) reduction in cervical resistance B) myometrial contractions D) softening and thinning of the cervix

A client asks her nurse what effleurage means. After instruction is given, the nurse determines learning has taken place when the client states: A) "Effleurage is the pattern for cleaning the perineum before birth." B) "Effleurage is light abdominal massage used to displace pain." C) "Effleurage is the effect of a full bladder on fetal descent." D) "Effleurage is massaging the perineum as the fetal enlarges the vaginal opening."

B) "Effleurage is light abdominal massage used to displace pain."

A labor nurse is caring for a client who is 7 cm dilated, 100% effaced, at a +1 station, and has a face presentation on examination. The nurse knows that teaching was understood when the birth partner makes which statement? A) "Our baby will come out facing the hip." B) "Our baby will come out face first." C) "Our baby will come out with the back of the head first." D) "Our baby will come out with the buttocks first."

B) "Our baby will come out face first."

The nurse is teaching a non-English speaking primigravida about the most common type of fetal presentation. Which presentation will the nurse prepare? A) Breech presentation using a picture of the type B) Cephalic presentation using preprinted materials in her language C) Occiput presentation using a PowerPoint presentation D) Footling presentation drawing a hand-prepared diagram

B) Cephalic presentation using preprinted materials in her language

The nursing instructor is illustrating the various positions the fetus may utilize during the passage through the vaginal canal at birth. The instructor determines the session is successful when the students correctly identify the ROA position, indicating which presentation by the fetus? A) In a longitudinal lie facing the left posterior B) Facing the right anterior pelvic quadrant C) In a common breech birth position D) Presenting with the face as the presenting part

B) Facing the right anterior pelvic quadrant

The client in labor at 3 cm dilation and 25% effaced is asking the nurse for analgesia. Which explanation should the nurse provide when explaining why it is too early to administer an analgesic? A) This would cause fetal depression in utero. B) This may prolong labor and increase complications. C) The effects would wear off before delivery. D) This can lead to maternal hypertension.

B) This may prolong labor and increase complications.

A client in labor is agitated and nervous about the birth of her child. The nurse explains to the client that fear and anxiety cause the release of certain compounds which can prolong labor. Which compounds is the nurse referring to in the explanation? A) prostaglandins B) catecholamines C) oxytocin D) relaxin

B) catecholamines Fear and anxiety cause the release of catecholamines, such as norepinephrine and epinephrine, which stimulate the adrenergic receptors of the myometrium. This in turn interferes with effective uterine contractions and results in prolonged labor.

A client who requested "no drugs" in labor asks the nurse what other options are available for pain relief. The nurse reviews several options for nonpharmacologic pain relief, and the client thinks effleurage may help her manage the pain. This indicates that the nurse will: A) lead the client through a series of visualizations to aid in relaxation. B) instruct the client or her partner to perform light fingertip repetitive abdominal massage. C) instruct the client to perform controlled chest breathing with a slow inhale and a quick exhale. D) press down firmly with her index finger and forefinger on key trigger points on the client's ankle or wrist.

B) instruct the client or her partner to perform light fingertip repetitive abdominal massage.

When assessing fetal heart rate patterns, which finding would alert the nurse to a possible problem? A) variable decelerations B) prolonged decelerations C) early decelerations D) accelerations

B) prolonged decelerations Prolonged decelerations are associated with prolonged cord compression, abruptio placentae, cord prolapse, supine maternal position, maternal seizures, regional anesthesia, or uterine rupture.

A woman states that she does not want any medication for pain relief during labor. Her primary care provider has approved this for her. What the nurse's best response to her concerning this choice? A) "That's wonderful. Medication during labor is not good for the baby." B) "Your health care provider is a man and has never been in labor; he may be underestimating the pain you will have." C) "I respect your preference whether it is to have medication or not." D) "Let me get you something for relaxation if you don't want anything for pain."

C) "I respect your preference whether it is to have medication or not."

The nurse is assessing a woman at 37 weeks' gestation who has presented with possible signs of labor. The nurse determines the membranes have ruptured based on which color of the Nitrazine paper? A) Pink B) Yellow C) Blue D) White

C) Blue

effaced and dilated at 3 cm. What nourishment can the nurse provide if the client mentions she hasn't eaten since 5 p.m. yesterday and is hungry? A) Solid food and fluids B) Nothing except for intravenous fluids C) Clear liquids but no solid food D) Cannot assess with the information given

C) Clear liquids but no solid food

A client has moved into the active phase of labor and is now at 6 cm dilated and +1 station. The nurse is prepared to monitor the contraction pattern how often? A) Every 10 minutes B) Every 15 minutes C) Every 30 minutes D) Every hour

C) Every 30 minutes

The nurse is monitoring a client who is in labor and notes the client is happy, cheerful, and "ready to see the baby." The nurse interprets this to mean the client is in which stage or phase of labor? A) Transition phase B) Stage two C) Latent phase D) Stage three

C) Latent phase

Which intervention would be least effective in caring for a woman who is in the transition phase of labor? A) having the client breathe with contractions B) providing one-to-one support C) encouraging the woman to ambulate D) urging her to focus on one contraction at a time

C) encouraging the woman to ambulate

A nurse performs an initial assessment of a laboring woman and reports the following findings to the primary care provider: fetal heart rate is 152 bpm, cervix is 100% effaced and 5 cm dilated, membranes are intact, and presenting part is well applied to the cervix and at -1 station. The nurse recognizes that the client is in which stage of labor? A) second B) first, latent C) first, active D) third

C) first, active

Which nursing action would the nurse anticipate doing more often for a cesarean section newborn than a vaginal birth newborn? A) Monitor the temperature B) Assess voiding C) Note number of stools D) Upper airway suctioning

D) Upper airway suctioning

A woman is lightly stroking her abdomen in rhythm with her breathing during contractions. The nurse identifies this technique as: A) acupressure. B) patterned breathing. C) therapeutic touch. D) effleurage.

D) effleurage.

The nurse is reviewing the laboratory test results of a client in labor. Which finding would the nurse consider normal? A) decreased plasma fibrinogen levels B) increased blood coagulation time C) increased blood glucose levels D) increased white blood cell count

D) increased white blood cell count

The student nurse is preparing to assess the fetal heart rate (FHR). She has determined that the fetal back is located toward the client's left side, the small parts toward the right side, and there is a vertex (occiput) presentation. The nurse should initially begin auscultation of the fetal heart rate in the mother's: A) right upper quadrant. B) right lower quadrant. C) left upper quadrant. D) left lower quadrant.

D) left lower quadrant.