OB Ch. 13
List the following cardinal movements of labor in the correct order. Extension Expulsion Engagement Internal Rotation Flexion
Engagement Flexion Internal Rotation Extension Expulsion The cardinal movements of labor describe the positional changes the fetus goes through as it travels through the passageway. They are deliberate, specific, and very precise that allow the smallest diameter of the fetal head to pass through a corresponding diameter of the mother's pelvic structure. They are engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.
A nurse is documenting fetal lie of a woman in labor. Which term would the nurse most likely use? A) Flexion B) Extension C) Longitudinal D) Cephalic
C
A nurse is describing how the fetus moves through the birth canal. Which of the following would the nurse identify as being most important in allowing the fetal head to move through the pelvis? A) Sutures B) Fontanelles C) Frontal bones D) Biparietal diameter
A
Assessment of a fetus identifies the buttocks as the presenting part, with the legs extended upward. The nurse identifies this as which type of breech presentation? A) Frank B) Full C) Complete D) Footling
A
Assessment of a woman in labor reveals cervical dilation of 3 cm, cervical effacement of 30%, and contractions occurring every 7 to 8 minutes, lasting about 40 seconds. The nurse determines that this client is in: A) Latent phase of the first stage B) Active phase of the first stage C) Transition phase of the first stage D) Perineal phase of the second stage
A
During a follow-up prenatal visit, a pregnant woman asks the nurse, "How long do you think I will be in labor?" Which response by the nurse would be most appropriate? A) "It's difficult to predict how your labor will progress, but we'll be there for you the entire time." B) "Since this is your first pregnancy, you can estimate it will be about 10 hours." C) "It will depend on how big the baby is when you go into labor." D) "Time isn't important; your health and the baby's health are key."
A
The fetus of a nulliparous woman is in a shoulder presentation. The nurse would most likely prepare the client for which type of birth? A) Cesarean B) Vaginal C) Forceps-assisted D) Vacuum extraction
A
The nurse is reviewing the monitoring strip of a woman in labor who is experiencing a contraction. The nurse notes the time the contraction takes from its onset to reach its highest intensity. The nurse interprets this time as which of the following? A) Increment B) Acme C) Peak D) Decrement
A
Which of the following would indicate to the nurse that the placenta is separating? A) Uterus becomes globular B) Fetal head is at vaginal opening C) Umbilical cord shortens D) Mucous plug is expelled
A
A client calls the clinic asking to come in to be evaluated. She states that when she went to bed last night, the fetus was high in the abdomen, but this morning the fetus feels like it has dropped down. After asking several questions, you explain this is probably due to: A)Lightening B)Placenta previa C)Start of labor D) Rupture of the membranes
A Lightening occurs when the fetal presenting part begins to descend into the maternal pelvis. The uterus lowers and moves into a more anterior position. In primiparas, lightening can occur two weeks or more before labor begins; among multiparas, it may not occur until labor.
When explaining to a class why labor begins, the nurse will include the fact that there are several theories that have been proposed to explain why labor begins, although none have been proven scientifically. Which of the following is one of those theories? A}Change in estrogen-to-progesterone ratio B)The level of estrogen decreases. C)Number of oxytocin receptors decrease. D)Prostaglandins decrease, leading to myometrium contractions.
A One of the theories suggests that labor is initiated by a change in the estrogen-to-progesterone ratio. The number of oxytocin receptors have been noted to increase. Estrogen levels also increase, which in turn increases myometrial sensitivity to oxytocin. Prostaglandin levels also increase, which in turn leads to myometrial contractions.
As the nurse working in labor and delivery, you understand that the client who is well prepared and has good labor support demonstrates all except which of the following? A)Need someone to control the situation B)Less likely to need anesthesia C)Unlikely to require cesarean birth D) Less likely to need analgesia
A Prenatal education teaches the woman about the childbirth experience and increases her sense of control. An increasing body of evidence indicates that the well-prepared woman, with good labor support, is less likely to need analgesia or anesthesia and is unlikely to require cesarean birth.
A client is in the transitional phase of labor. Which of the following would the nurse most likely find? (Select all that apply.) A)Strong desire to push B)Contractions occurring every 3 minutes C)Irritability with restlessness D)Cervical dilation of 6 cm E)Apprehension mixed with excitement
A,C A strong desire to push occurs most often in the transitional phase of the first stage of labor. During this phase the woman commonly experiences increased apprehension and irritability with restless movements and feelings of loss of control and being overwhelmed. Cervical dilation from 4 to 7 cm characterizes the active phase of the first stage of labor. Contractions occurring every 2 to 5 minutes are associated with the active phase of the first stage of labor. The woman in the early or latent phase of the first stage of labor often is filled with apprehension but is excited about the start of labor. During the active phase of the first stage of labor, cervical effacement of 40% to 80% occurs.
After teaching a group of students about the factors affecting the labor process, the instructor determines that the teaching was successful when the group identifies which of the following as a component of the true pelvis? (Select all that apply.) A) Pelvic inlet B) Cervix C) Mid pelvis D) Pelvic outlet E) Vagina F) Pelvic floor muscles
A,C,D
A nurse is preparing a class for pregnant women about labor and birth. When describing the typical movements that the fetus goes through as it travels through the passageway, which of the following would the nurse most likely include? (Select all that apply.) A) Internal rotation B) Abduction C) Descent D) Pronation E) Flexion
A,C,E
A nurse is preparing a presentation for a group of pregnant women about the labor experience. Which of the following would the nurse most likely include when discussing measures to promote coping for a positive labor experience? (Select all that apply.) A) Presence of a support partner B) View of birth as a stressor C) Low anxiety level D) Fear of loss of control E) Participation in a pregnancy exercise program
A,C,E
A client is admitted to the labor and birthing suite in early labor. On review of her medical record, the nurse determines that the client's pelvic shape as identified in the antepartal progress notes is the most favorable one for a vaginal delivery. Which pelvic shape would the nurse have noted? A) Platypelloid B) Gynecoid C) Android D) Anthropoid
B
A woman calls the health care facility stating that she is in labor. The nurse would urge the client to come to the facility if the client reports which of the following? A) Increased energy level with alternating strong and weak contractions B) Moderately strong contractions every 4 minutes, lasting about 1 minute C) Contractions noted in the front of abdomen that stop when she walks D) Pink-tinged vaginal secretions and irregular contractions lasting about 30 seconds
B
A woman in her third trimester comes to the clinic for a prenatal visit. During assessment the woman reports that her breathing has become much easier in the last week but she has noticed increased pelvic pressure , cramping and lower back pain. The nurse determines that which of the following has most likely occurred? A) Cervical dilation B) Lightening C) Bloody show D) Braxton-Hicks contractions
B
A woman telephones her health care provider and reports that her "water just broke." Which suggestion by the nurse would be most appropriate? A) "Call us back when you start having contractions." B) "Come to the clinic or emergency department for an evaluation." C) "Drink 3 to 4 glasses of water and lie down." D) "Come in as soon as you feel the urge to push."
B
After teaching a group of students about the maternal bony pelvis, which statement by the group indicates that the teaching was successful? A) The bony pelvis plays a lesser role during labor than soft tissue. B) The pelvic outlet is associated with the true pelvis. C) The false pelvis lies below the imaginary linea terminalis. D) The false pelvis is the passageway through which the fetus travels.
B
When assessing cervical effacement of a client in labor, the nurse assesses which of the following characteristics? A) Extent of opening to its widest diameter B) Degree of thinning C) Passage of the mucous plug D) Fetal presenting part
B
When describing the stages of labor to a pregnant woman, which of the following would the nurse identify as the major change occurring during the first stage? A) Regular contractions B) Cervical dilation C) Fetal movement through the birth canal D) Placental separation
B
Assessment reveals that a woman's cervix is approximately 1 cm in length. The nurse would document this as: A)100% effaced B)50% effaced C)0% effaced D) 75% effaced
B A cervix 1 cm in length is described as 50% effaced. A cervix that measures approximately 2 cm in length is described as 0% effaced. A cervix 1/2 cm in length would be described as 75% effaced. A cervix 0 cm in length would be described as 100% effaced.
Within the first hour after birth, the nurse would expect to find the woman's fundus: A)Between the umbilicus and symphysis pubis B)At the level of the umbilicus C)2 cm above the umbilicus D)One fingerbreadth below the umbilicus
B After birth, the fundus is located midline between the umbilicus and symphysis pubis but then slowly rises to the level of the umbilicus during the first hour after birth. Then the uterus contracts, approximately 1 cm (or fingerbreadth) each day after birth.
When monitoring a woman in labor, which of the following is not expected to occur? A)Heart rate increase by 10 to 20 beats per minute B)Cardiac output increase by 50% during the first stage C)Blood pressure to increase up to 35 mmHg D) Respiratory rate to increase
B As the woman progresses through childbirth, numerous physiologic responses occur that assist her to adapt to the laboring process. Some of these changes include heart rate increasing by 10 to 20 beats per minute; cardiac output increasing by 12% to 31% during the first state and by 50% by the second stage; blood pressure increases by up to 35 mmHg; and respiratory rate increases as more oxygen is consumed.
A young couple are anxious for the birth of their child. When discussing the options, you explain that elective induction of labor in nulliparas is associated with all of the following except: A)Postpartum hemorrhage B)Shorter hospitalizations C)Neonatal resuscitation D) Increased rates of cesarean sections
B Elective induction of labor in nulliparas is associated with increased rates o cesarean, postpartum hemorrhage, neonatal resuscitation and longer hospitalizations without improvement in neonatal outcomes.
While discussing labor with your client and her partner, they ask what the best position is for delivering the baby. You provide them with information that indicates research has shown which of the following to be the best? A)Lying on her back with feet in stirrups B)Position of comfort for the mother C)Semi-Fowler's position D)Squatting
B Maternal positioning during labor has only recently been the subject of well-controlled research. Scientific evidence has shown that nonmoving, back-lying positions during labor are not healthy. Women should be encouraged to assume any position of comfort for them.
On examination, the nurse determines the fetus is at :1 station. He explains this means the fetus is: A)1 cm below the pubic bone B)1 cm above the ischial spines C)1 cm below the ischial spines D)1 cm above the pubic bone
B Station refers to the relationship of the presenting part to the level of the maternal pelvic ischial spines. Fetal station is measured in centimeters and referred to as a minus or plus, depending on its location above or below the ischial spines. When the presenting part is above the ischial spines, the distance is recorded as minus stations. When the presenting part is below the ischial spine, it is recorded as plus stations. Therefore this fetus is 1 cm above the ischial spines.
A new dad is alarmed at the shape of his newborn's head. You remind him this is due to: A)Extreme pressure in the vaginal vault B) Cranial bones overlapping at the suture lines C)Prolonged labor D) A congenital defect
B This is due to molding, which is the result of overlapping of the cranial bones at the suture lines. It is a temporary situation that will correct itself. It is due to the fetus passing through the pelvis.
After conducting a childbirth class, you recognize that students understand what was presented after correctly choosing which of the following factors that can affect the labor process? (Select all that apply.) A)Participation B)Patience C)Powers D)Place E)Passenger
B,C,E There are "five P's" that affect the labor process. They are passageway, passenger, powers, position, and psychological response. There are an additional five that can also have an effect on the labor process. They include philosophy, partners, patience, client preparation, and pain control.
A client has not received any medication during her labor. She is having frequent contractions every 1 to 2 minutes and has become irritable with her coach and no longer will allow the nurse to palpate her fundus during contractions. Her cervix is 8 cm dilated and 90% effaced. The nurse interprets these findings as indicating: A) Latent phase of the first stage of labor B) Active phase of the first stage of labor C) Transition phase of the first stage of labor D) Pelvic phase of the second stage of labor
C
A woman in her 40th week of pregnancy calls the nurse at the clinic and says she's not sure whether she is in true or false labor. Which statement by the client would lead the nurse to suspect that the woman is experiencing false labor? A) "I'm feeling contractions mostly in my back." B) "My contractions are about 6 minutes apart and regular." C) "The contractions slow down when I walk around." D) "If I try to talk to my partner during a contraction, I can't."
C
A woman is in the first stage of labor. The nurse would encourage her to assume which position to facilitate the progress of labor? A) Supine B) Lithotomy C) Upright D) Knee-chest
C
Assessment of a pregnant woman reveals that the presenting part of the fetus is at the level of the maternal ischial spines. The nurse documents this as which station? A) -2 B) -1 C) 0 D) +1
C
the nurse is reviewing the medical record of a woman in labor and notes that the fetal position is documented as LSA. The nurse interprets this information as indicating which of the following is the presenting part? A) Occiput B) Face C) Buttocks D) Shoulder
C
Which of the following hormones would the nurse expect to cause the pelvic connective tissue to become more relaxed and elastic in preparation for labor? A)Oxytocin B)Progesterone C)Relaxin D)Prolactin
C As the pregnancy progresses, the hormones relaxin and estrogen cause the connective tissues to become more relaxed and elastic and cause the joints to become more flexible to prepare the mother's pelvis for birth.
A pregnant woman comes to the emergency department because she thinks she is in labor. The nurse determines that the client is in true labor when assessment of contractions reveals which of the following? A)Contractions occur in an irregular pattern. B)Contractions slow when the woman changes position. C)Contractions radiate to the front of the abdomen from the back. D)Contractions last about 20 to 30 seconds.
C Contractions that begin in the back and then radiate to the front are typical of true labor. Contractions that slow when a woman walks or changes position suggest false labor, as do irregular contractions. Contractions lasting 30 seconds or less commonly suggest Braxton-Hicks contractions and are associated with false labor.
During the examination, the health care provider mentions the fetus has a good attitude. You explain to the parents that this means which of the following? A)The fetus is cooperating with the labor. B)Posture of the fetus is with arms at its side and legs straight. C)Posture of the fetus with all joints flexed for delivery D) The fetus is presenting head first.
C The attitude refers to the posturing of the joints, either flexion or extension, and the relationship of fetal parts to one another. The most common fetal attitude when labor begins is with all joints flexed. This normal fetal position is most favorable for vaginal brith, presenting the smallest fetal skull diameters to the pelvis.
A fetus is assessed at 2 cm above the ischial spines. The nurse would document fetal station as: A) +4 B) +2 C) 0 D) -2
D
A nurse is assessing a woman in labor. Which finding would the nurse identify as a cause for concern during a contraction? A) Heart rate increase from 76 bpm to 90 bpm B) Blood pressure rise from 110/60 mm Hg to 120/74 C) White blood cell count of 12,000 cells/mm3 D) Respiratory rate of 10 breaths /minute
D
A nurse is caring for several women in labor. The nurse determines that which woman is in the transition phase of labor? A) Contractions every 5 minutes, cervical dilation 3 cm B) Contractions every 3 minutes, cervical dilation 5 cm C) Contractions every 2½ minutes, cervical dilation 7 cm D) Contractions every 1 minute, cervical dilation 9 cm
D
As the client gets closer to her due date, it is important to stress that the woman seek assessment after spontaneous rupture of the membranes due to: A)Increased risk of breech presentation B)Potential rapid delivery of fetus C)Potential placenta previa D) Increased risk of infection
D After the amniotic sac has ruptured, the barrier to infection is gone and an ascending infection is possible. In addition, there is a danger of cord prolapse. The spontaneous rupture does not hasten labor, although it might signal the beginning of labor. The client may have placenta previa with the membranes intact.
The nurse notes that the fetal head is at the vaginal opening and does not regress between contractions. The nurse interprets this finding as which of the following? A)Engagement B)Descent C)Restitution D) Crowning
D Crowning occurs when the top of the fetal head appears at the vaginal orifice and no longer regresses between contractions. Engagement occurs when the greatest transverse diameter of the head passes through the pelvic inlet. Descent is the downward movement of the fetal head until it is within the pelvic inlet. Restitution or external rotation occurs after the head is born and free of resistance. It untwists, causing the occiput to move about 45 degrees back to its original left or right position.
The nurse is measuring a contraction from the beginning of the increment to the end of the decrement for the same contraction, documenting this as which of the following? A)Frequency B)Peak C)Intensity D)Duration
D Duration refers to how long a contraction lasts and is measured from the beginning of the increment to the end of the decrement for the same contraction. Intensity refers to the strength of the contraction determined by manual palpation or measured by an internal intrauterine catheter. Frequency refers to how often contractions occur and is measured from the increment of one contraction to the increment of the next contraction. The peak or acme of a contraction is the highest intensity of a contraction.
You have been asked to present information to a group of civic leaders concerning women's health issues. In preparing your information, you include what goals from Healthy People 2020? A)Ensure all couples receive preconceptional counseling B)Encourage women with previous cesareans to always have a cesarean C)Ensure prenatal care includes immunizations D) Reduce the rate of cesarean births among low-risk births
D Healthy People 2020 has two goals related to cesarean births in the United States. They are to reduce the rate of cesarean births among low-risk women and reduce the rate of cesarean births among women who have had a prior cesarean birth.
A 19-year-old female presents in advanced labor. Examination reveals the fetus is in frank breech position. You explain to the client this means which of the following? A)One leg is presenting. B)Fetus is sitting cross-legged above the cervix. C)One arm is presenting. D) Buttocks are presenting first with both legs extended up toward the face.
D In a frank breech position, the buttocks present first with both legs extended up toward the face. The full or complete breech occurs when the fetus sits crossed-legged above the cervix. In a footling or incomplete breech, one or both legs are presenting.
Which of the following would be least effective in promoting a positive birth outcome for a woman in labor? A)Promoting the woman's feelings of control B)Providing clear information about procedures C)Encouraging the woman to use relaxation techniques D)Allowing the woman time to be alone
D Positive support, not being alone, promotes a positive birth experience. Being alone can increase anxiety and fear, decreasing the woman's ability to cope. Feelings of control promote self-confidence and self-esteem, which in turn help the woman to cope with the challenges of labor. Information about procedures reduces anxiety about the unknown and fosters cooperation and self-confidence in her abilities to deal with labor. Catecholamines are secreted in response to anxiety and fear and can inhibit uterine blood flow and placental perfusion. Relaxation techniques can help to reduce anxiety and fear, in turn decreasing the secretion of catecholamines and ultimately improving the woman's ability to cope with labor.
When reviewing the history of a woman in labor, the nurse notes that the client has a funnel-shaped pelvis. The nurse would identify this pelvic shape as which of the following? A)Anthropoid B)Platypelloid C)Gynecoid D) Android
D The android pelvis is considered the male-shaped pelvis and is characterized by a funnel shape. The gynecoid pelvis is considered the true female pelvis and offers the optimal diameters in all three planes of the pelvic. An anthropoid pelvis has an oval pelvic inlet and long sacrum, producing a deep pelvis that is wider front to back than side to side. The platypelloid or flat pelvis has a shallow pelvic cavity that widens at the pelvic outlet.
When teaching a group of students about the structures of the fetal skull, the nurse describes the anterior fontanelle. Which of the following would the nurse include? A)Located at the back of the fetal head B)Triangular shape C)Closes 8 to 12 weeks after birth D)Approximately 2 to 3 cm in size
D The anterior fontanelle measures about 2 to 3 cm in size, is diamond-shaped, and closes 12 to 18 months after birth. The posterior fontanelle is triangular and located at the back of the fetal head. The posterior fontanelle closes about 8 to 12 weeks after birth.
A fetus is in the LST position. The nurse interprets this as indicating which of the following as the presenting part? A)Fetal head B)Shoulder C)Chin D) Buttocks
D The letter "S" indicates the sacrum or buttocks as the presenting part. The fetal head would be noted by the letter "O," indicating occiput. The fetal chin would be noted by the letter "M," indicating mentum. The fetal shoulder would be noted by the letter "A," indicating the acromion process.
