A nurse is reviewing the progress her client has made in labor.  The fetal head engaged in a transverse position, fetal descent has been slow, and the nurse anticipates a forceps delivery.  Which pelvic types are common for such clients?  Select all that apply.

1. Android

2. Anthropoid

3. Gynecoid

4. Platypelloid

1. Android

4. Platypelloid

Rationale:  Android and platypelloid pelvis types are not favorable for labor or delivery, where gynecoid and anthropoid are.  With both android and platypelloid pelvises the fetal head is likely to engage in transverse position, and descent into the pelvis can be slow.  In the platypelloid type, there is frequent delay of progress at the outlet.

A client at 39 weeks' gestation calls the clinic nurse with complaints of pelvic pressure, urinary frequency, and vaginal secretions. The nurse would correctly interpret these as signs and symptoms of:

1. urinary tract infection

2. impending labor

3. rupture of membranes

4. vaginal infection

2. impending labor

Rationale:  Pelvic pressure, urinary frequency, and vaginal secretions are symptoms of impending labor.  Vaginal infection can be recognized by an odor to the vaginal secretions, along with back or abdominal pain and fever.  Urinary tract infection will present with a strong odor to the urine, along with pain and/or burning upon urination, with possible fever.  Although rupture of membranes precedes labor in 12% of cases, it likely would be accompanied by the expulsion of large amounts of amniotic fluid.

A nurse is caring for a client admitted to the birthing unit with rupture of membranes for 2 hours.  A pelvic exam reveals a dilatation of 4cm, and the presenting part is not engaged.  The patient asks if she can walk in the hallway.  The nurse's response that bedrest is required is based on the risk of:

1. prolapsed cord

2. amniotic infection

3. abruptio placentae

4. placenta previa

1. prolapsed cord

Rationale:  When a pelvic exam reveals a dilatation of 4cm and the presenting part is not engaged, the nurse should anticipate a prolapsed cord.  With placenta previa, the placenta is implanted in the lower uterine segment rather than the upper portion of the uterus, and it is not a complication of ruptured membranes or cervical dilatation.  Amniotic infection is a potential complication after the membranes have been ruptured for more than 12 hours, especially if uterine contractions are present.  Abruptio placentae is the premature separation of a normally implanted placenta from the uterine wall, and is not a complication of ruptured membranes or cervical dilatation.

A client in the transition phase of labor asks the nurse, "How much longer will it be before I have my baby?"  What factors should the nurse consider before she provides an answer?  Select all that apply.

1. Maternal age

2. Number of previous pregnancy

3. Station

4. Fetal position

2. Number of previous pregnancy

3. Station

4. Fetal position

A laboring client complains of nausea, vomiting, and increasing rectal pressure.  She states, "I can't take this anymore."  The nurse correctly assesses that this client is in which phase of labor?

1. Active

2. Transition

3. Second stage

4. Latent

2. Transition

Rationale:  Transition is the phase of labor where clients usually complain of nausea, vomiting, and increasing rectal pressure and state "I can't take this anymore."  A laboring client usually is able to cope in the latent and active phases of labor.  Nausea, vomiting and rectal pressure decrease during the second stage with the birth of the baby.

A nurse assesses a rise in the fundal height and a sudden gush of blood from the vagina of a postpartum client 5 minutes after birth.  the nurse appropriately interprets these findings as:

1. separation of the placenta

2. delivery of the placenta

3. immediate postpartum hemorrhage

4. late postpartum hemorrhage

1. separation of the placenta

Rationale:  Separation of the placenta is characterized by a rise in fundal height and sudden gush of blood 5 minutes after birth.  Immediate postpartum hemorrhage is not characterized by a rise in fundal height.  Late postpartum hemorrhage occurs 24-48 hours or more after birth.  Delivery of the placenta is characterized by a decrease in fundal height.

A nurse is caring for a client during the fourth stage of labor.  What are the expected assessment findings at this time?

1. decreased blood pressure and decreased pulse

2. decreased blood pressure and increased pulse

3. increased blood pressure and decreased pulse

4. increased blood pressure and increased pulse

2. decreased blood pressure and increased pulse

Rationale:  Decreased blood pressure and increased pulse are the expected assessment findings during the fourth stage of labor.

A laboring client is lying supine with a blood pressure of 88/60.  What should be the initial nursing action?

1. increase the IV drip rate

2. Notify the physician or nurse-midwife

3. Position the client to a lateral (side-lying) position

4. Administer oxygen at 5L

3. Position the client to a lateral (side-lying) position

Rationale:  Maternal position affects cardiac output.  In the supine position, cardiac output lowers, heart rate increases, and stroke volume decreases.  When the woman turns to a lateral position, cardiac output increases.  Position the client to a lateral position to correct the supine hypotension due to aortocaval compression.

A pregnant client at term calls to report she has been having regular contractions radiating from the back to the front that intensify with walking.  The nurse advises her:

1. Lie on her side to promote fetal rotation, as these are signs of posterior fetal position.

2. Stay at home, as these are signs of false labor.

3. Come to the birthing unit for accurate assessment.

4. Take a warm shower or tub bath to relieve discomfort.

3. Come to the birthing unit for accurate assessment

Rationale:  The contractions of true labor produce progressive dilatation and effacement of the cervix.  They occur regularly and increase in frequency, duration, and intensity.  The discomfort of true labor contractions usually starts in the back and radiates around to the abdomen.  The pain is not relieved by ambulation, in fact, walking may intensify the pain.  False labor cannot be distinguished from true labor except by vaginal examination.  A warm shower or tub bath will not relieve the discomfort of true labor and should not be advised unless the status of membranes is known.  Labor status, as well as fetal position, cannot be evaluated without an exam.  

The fetal heart rate of a laboring client in active labor shows early decelerations.  The nurse's response is based on the knowledge that:

1. This indicates an occiput-posterior position

2. This is a sign of fetal distress

3. This indicates fetal acidosis

4. This is a normal response to fetal head compression

4. This is a normal response to fetal head compression

Rationale:  Early fetal heart rate decelerations can occur with intracranial pressures of 40-55 mm Hg, as the head pushes against the cervix.  This early deceleration is believed to be due to hypoxic depression of the central nervous system, which is under vagal control.  These early decelerations are harmless in a normal fetus. 

Left-occiput-anterior

Right-occiput-anterior

Which pelvic shape is most adequate for a vaginal delivery?

1. Android

2. Gynecoid

3. Anthropoid

4. Platypelloid

2. Gynecoid

3. Anthropoid

What is the clinical purpose of the fontanelle?

1. Identifying fetal position in the maternal pelvis

2. to allow for molding of the fetal head during vaginal delivery

3. to relieve pressure caused by cerebral hemorrhage

4. to provide a reference of newborn's status during assessment

The relationship of the spinal column of the fetus to the spinal column of the mother.

Longitudinal:  cephalocaudal axis parallel to mom's spine

Transverse:  cephalocaudal axis at a right angle to mom's spine.  Associated with a shoulder presentation and complications later in labor.

Which of the following are cephalic presentations?

Select all that apply.

1. Vertex

2. Sinciput

3. Frank

4. Single footling

5. Brow

6. Double footling

7. Face

1. Vertex

2. Sinciput

5. Brow

7. Face

Which presentation is optimum?

1. Frank

2. Brow

3. Sinciput

4. Vertex

When does engagement occure?

1. When the largest diameter of the presenting part reaches or passes through the pelvic inlet.

2. When the smallest diameter of the presenting part reaches or passes through the pelvic inlet.

3. When the fetus is crowning

4. None of the above

The fetus is presenting LOA.  Where would you place the fetal heart monitor?

What is the primary force of labor?

1. uterine contractions

2. fetal presentation

3. fetal station

4. maternal pushing

What are the three phases of contractions?

1. increment, acme, decrement

2. frequency, duration, intensity

3. resting, breathing, pushing

4. increment, duration, resting

Which of the following would the fundus feel like during strong contractions?

1. Chin

2. Nose

3. Forehead

4. Cheek

Which of the following psychosocial factors would cause the uterus not to dilate and labor to last longer?

1. good preparedness

2. anxiety about the birth experience

3. Pitocin

4.previous episiotomy 

Which phase of labor lasts 8.6 hours on average, has cervical dilation of 0 to 3cm, and averages 25 to 55 mm Hg at acme?

1. active

2. latent

3. third

4. second

The acme of the contraction is the:

1. frequency

2. duration

3. peak

4. resting time

How much should the mother dilate during the active phase of labor?

1. 0 to 3cm

2. 4 to 7cm

3. 7 to 10cm

4. The mother should not dilate during active labor

During what stage does the fetus crown?

1. First

2. Third

3. Second

4. Latent

In what order do the cardinal movements occur?

1. Descent, internal rotation, flexion, restitution, extension, expulsion, external rotation

2. Internal rotation, external rotation, flexion, extension, descent, restitution, expulsion

3. Expulsion, internal rotation, flexion, descent, external rotation, restitution, extension

4. Descent, flexion, internal rotation, extension, restitution, external rotation, expulsion

During what stage do the cardinal movements occur?

1. Third

2. Second

3. First

4. Active

What separates during the third stage of labor?

1. baby from mother

2. baby from placenta

3. placenta from mother

4. all of the above

What happens during the fourth stage of labor?

1. fundus begins to return to normal position

2. baby is born

3. placenta separates

4. mother dilates from 8 to 10cm

Which is not a sign of true labor?

1. contractions have regular intervals

2. intervals gradually shorten

3. discomfort begins in the back and radiates to the front

4. walking has no effect on or lessens the contractions

Which is a sign of false labor?

1. cervical dilation and effacement are progressive

2. contractions don't decrease with rest

3. intensity increases with walking

4. contractions are irregular

Why shouldn't the mother push before she is fully dilated?

1. she could tear her uterus

2. the baby could get stuck

3. The cervix can swell, delaying or arresting full dilation

4. there is no reason the mother shouldn't push before complete dilation is reached.

False

Rationale:  one or two late decelerations are okay, but many decelerations are a big problem because it means that something is putting pressure on the cord.  The mother's position should be changed immediately.  If this does not help, a C-section is most likely imminent.

Are variable decelerations a concern?

1. Always

2. Never

3. Only when the fetal HR is less than 70bpm and last longer than 1 min

4. Only when fetal HR is greater than 120bpm and last longer than 30 seconds