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Stages and Mechanisms of Labor and Delivery, Exams of Nursing

Washington University in St. Louis (WUSTL)Nursing

Detailed information about the stages and mechanisms of labor and delivery, including the frequency and duration of contractions, the importance of the relaxation phase, indicators of fetal compromise, presentation and position of the fetus, the progression of labor, and nursing interventions during each stage. It covers topics such as the four ps of labor (powers, passenger, passage, and psyche), fetal heart rate monitoring, cultural considerations, and the advantages and disadvantages of different birthing settings. Likely to be useful for healthcare professionals, particularly nurses and midwives, who are involved in the care of women during labor and delivery.

Typology: Exams

2023/2024

Available from 08/13/2024

clevelsky
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LEIFER: L&D NURSING CARE OF MOTHER AND INFANT DURING
LABOR AND BIRTH EXAM 2 2024/2025
1. What does the nurse note when measuring the frequency of a laboring woman's contractions?
a. How long the patient states the contractions last
b. The time between the end of one contraction and the beginning of the next
c. The time between the beginning and the end of one contraction
d. The time between the beginning of one contraction and the beginning of the next - Precise Answer
✔✔ANS: D
The frequency of contractions is the elapsed time from the beginning of one contraction to the
beginning of the next contraction.
2. Why is the relaxation phase between contractions important?
a. The laboring woman needs to rest.
b. The uterine muscles fatigue without relaxation.
c. The contractions can interfere with fetal oxygenation.
d. The infant progresses toward delivery at these times. - Precise Answer ✔✔ANS: C
Blood flow from the mother into the placenta gradually decreases during contractions. During the
interval between contractions, the placenta refills with oxygenated blood for the fetus.
3. What contraction duration and interval does the nurse recognize could result in fetal compromise?
a. Duration shorter than 30 seconds, interval longer than 75 seconds
b. Duration shorter than 90 seconds, interval longer than 120 seconds
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LEIFER: L&D NURSING CARE OF MOTHER AND INFANT DURING

LABOR AND BIRTH EXAM 2 2024/

  1. What does the nurse note when measuring the frequency of a laboring woman's contractions? a. How long the patient states the contractions last b. The time between the end of one contraction and the beginning of the next c. The time between the beginning and the end of one contraction d. The time between the beginning of one contraction and the beginning of the next - Precise Answer ✔✔ANS: D The frequency of contractions is the elapsed time from the beginning of one contraction to the beginning of the next contraction.
  2. Why is the relaxation phase between contractions important? a. The laboring woman needs to rest. b. The uterine muscles fatigue without relaxation. c. The contractions can interfere with fetal oxygenation. d. The infant progresses toward delivery at these times. - Precise Answer ✔✔ANS: C Blood flow from the mother into the placenta gradually decreases during contractions. During the interval between contractions, the placenta refills with oxygenated blood for the fetus.
  3. What contraction duration and interval does the nurse recognize could result in fetal compromise? a. Duration shorter than 30 seconds, interval longer than 75 seconds b. Duration shorter than 90 seconds, interval longer than 120 seconds

c. Duration longer than 90 seconds, interval shorter than 60 seconds d. Duration longer than 60 seconds, interval shorter than 90 seconds - Precise Answer ✔✔ANS: C Persistent contraction durations longer than 90 seconds or contraction intervals less than 60 seconds may reduce fetal oxygen supply.

  1. Vaginal examination reveals the presenting part is the infants head, which is well flexed on the chest. What is this presentation? a. Vertex b. Military c. Brow d. Face - Precise Answer ✔✔ANS: A In the vertex presentation, the fetal head is the presenting part. The head is fully flexed on the chest.
  2. What does meconium-stained amniotic fluid indicate when the infant is in a vertex presentation? a. Fetal distress b. Fetal maturity c. Intact gastrointestinal tract d. Dehydration in the mother - Precise Answer ✔✔ANS: A Green-stained amniotic fluid means that the fetus passed the first stool before birth, and it is an indicator of fetal compromise.
  3. It is determined that the presenting part of the fetus is the buttocks. At delivery the fetus's hips are flexed and the knees are extended. How would the nurse record this presentation? a. Complete breech

a. They get the infant positioned for delivery. b. They push the infant into the vagina. c. They dilate and efface the cervix. d. They get the mother prepared for true labor. - Precise Answer ✔✔ANS: C The first stage of labor describes the time from the onset of labor until full dilation of the cervix.

  1. A woman is 7 cm dilated, and her contractions are 3 minutes apart. When she begins cursing at her birthing coach and the nurse, what does the nurse assess as the most likely explanation for the women's change in behavior? a. Labor has progressed to the transition phase. b. She lacked adequate preparation for the labor experience. c. The woman would benefit from a different form of analgesia. d. The contractions have increased from mild to moderate intensity. - Precise Answer ✔✔ANS: A If a woman suddenly loses control and becomes irritable, suspect that she has progressed to the transition stage of labor.
  2. What is the function of contractions during the second stage of labor? a. Align the infant into the proper position for delivery b. Dilate and efface the cervix c. Push the infant out of the mothers body d. Separate the placenta from the uterine wall - Precise Answer ✔✔ANS: C The contractions push the infant out of the mothers body as the second stage of labor ends with the birth of the infant.
  1. What marks the end of the third stage of labor? a. Full cervical dilation b. Expulsion of the placenta and membranes c. Birth of the infant d. Engagement of the head - Precise Answer ✔✔ANS: B The third stage of labor extends from the birth of the infant until the placenta is detached and expelled.
  2. Why should the nurse encourage the mother to void during the fourth stage of labor? a. A full bladder could interfere with cervical dilation. b. A full bladder could obstruct progress of the infant through the birth canal. c. A full bladder could obstruct the passage of the placenta. d. A full bladder could predispose the mother to uterine hemorrhage. - Precise Answer ✔✔ANS: D A full bladder immediately after birth can cause excessive bleeding because it pushes the uterus upward and interferes with contractions.
  3. The nurse observes the patient bearing down with contractions and crying out, The baby is coming! What is the best nursing intervention? a. Find the physician. b. Stay with the woman and use the call bell to get help. c. Send the womans partner to locate a registered nurse. d. Assist with deep breathing to slow the labor process. - Precise Answer ✔✔ANS: B If birth appears to be imminent, the nurse should not leave the woman and should summon help with the call bell.
  1. One hour postdelivery the nurse notes the new mother has saturated three perineal pads. What is the most appropriate nursing action? a. Check the fundus for position and firmness. b. Report to the doctor immediately. c. Change the pads and chart the time. d. Time how long it takes to soak one pad. - Precise Answer ✔✔ANS: A Increase d lochia may indicate hemorrhage. The fundus should be assessed for firmness. One pad an hour is an acceptable rate for immediate post delivery.
  2. While caring for a laboring woman, the nurse notices a pattern of variable decelerations in fetal heart rate with uterine contractions. What is the nurses initial action? a. Stop the oxytocin infusion. b. Increase the intravenous flow rate. c. Reposition the woman on her side. d. Start oxygen via nasal cannula. - Precise Answer ✔✔ANS: C Repositioning the woman is the first response to a pattern of variable decelerations. If the decelerations continue, then oxygen should be administered and/or the flow rate of oxygen should be increased.
  3. How should the nurse intervene to relieve perineal bruising and edema following delivery? a. Place an ice pack on the area for 12 hours. b. Place a warm pack on the perineal area for 24 hours. c. Administer aspirin to relieve inflammation. d. Change the perineal pad frequently. - Precise Answer ✔✔ANS: A

An ice pack can be placed on the mothers perineum to reduce bruising and edema for 12 hours followed by a warm pack after the first 12 to 24 hours after delivery.

  1. At 1 and 5 minutes of life, a newborns Apgar score is 9. What does the nurse understand that a score of 9 indicates? a. The newborn will require resuscitation. b. The newborn may have physical disabilities. c. The newborn will have above average intelligence. d. The newborn is in stable condition. - Precise Answer ✔✔ANS: D Apgar scoring is a system for evaluating the infants need for resuscitation at birth. Five categories are evaluated on a scale from 0 to 2, with the highest score being 10. A score of 9 indicates that the newborn is stable.
  2. The husband of a woman in labor asks, What does it mean when the baby is at minus 1 station? After giving an explanation, what statement by the husband indicates that teaching was effective? a. Fetal head is above the ischial spines. b. Fetal head is below the ischial spines. c. Fetal head is engaged in the mothers pelvis. d. Fetal head is visible at the perineum. - Precise Answer ✔✔ANS: A Station describes the level of the presenting part in the pelvis. It is estimated in centimeters from the level of the ischial spines. Minus stations are above the ischial spines.
  3. The nurse formulates a nursing diagnosis for a woman in the fourth stage of labor. What is the most appropriate nursing diagnosis? a. Pain related to increasing frequency and intensity of contractions. b. Fear related to the probable need for cesarean delivery.

d. Parental bonding - Precise Answer ✔✔ANS: C Thermoregulation is necessary to keep heat loss minimal and oxygen consumption low. Hypothermia can cause cold stress, which leads to hypoxia.

  1. A pregnant woman, gravida 2, para 1, tells the nurse she desires a VBAC (vaginal birth after cesarean section) with this pregnancy. What is the primary concern regarding complications for this patient during labor and birth? a. Eclampsia b. Placental abruption c. Congestive heart failure d. Uterine rupture - Precise Answer ✔✔ANS: D Nursing care for women who plan to have a VBAC is similar to that for women who have had no cesarean births. The main concern is that the uterine scar will rupture, which can disrupt the placental blood flow and cause hemorrhage. Observation for signs of uterine rupture should be part of the nursing care for all laboring women, regardless of whether they have had a previous cesarean birth.
  2. The physician performs an amniotomy on a laboring woman. What will be the nurse's priority assessment immediately following this procedure? a. Fetal heart rate b. Fluid amount c. Maternal blood pressure d. Deep tendon reflexes - Precise Answer ✔✔ANS: A The FHR should be assessed for at least 1 full minute after the membranes rupture and must be recorded and reported. Marked slowing of the rate or variable decelerations suggests that the fetal umbilical cord may have descended with the fluid gush and is being compressed. Fluid amount should be assessed and recorded but is not the top priority. Maternal blood pressure and deep tendon reflexes are not appropriate assessments following rupture of membranes.
  1. While caring for an Arab woman in labor, the nurse should provide cultural sensitivity through which interventions? (Select all that apply.) a. Provide for extreme modesty. b. Assign a male caregiver. c. Arrange for the husband/partner to participate in labor. d. Provide adequate pain control. e. Respect protective amulets. - Precise Answer ✔✔ANS: A, D, E Arab women are extremely modest, usually have a low pain tolerance, and wear various protective and religious amulets. The husband is in attendance but not as a participant. Arabs prefer female caregivers. If a male is in attendance, then the husband will remain in the room as long as the male is there.
  2. What are the advantages of a freestanding birth center? (Select all that apply.) a. Home-like setting b. Designed for high-risk pregnancies c. Lower costs d. Attended by certified obstetricians e. Immediate emergency access - Precise Answer ✔✔ANS: A, C Advantages of a freestanding birth center include a homelike setting and lower costs because the center does not require expensive departments such as emergency or critical care. Freestanding birth centers are not designed for high-risk patients, are not attended by certified obstetricians, and do not have immediate emergency access.
  3. What do late decelerations indicate? (Select all that apply.) a. A nonreassuring pattern b. Uteroplacental insufficiency c. Fetal heart depression

The four interrelated components of the process of labor and birth, called the four Ps, are powers, passenger, passage, and psyche.

  1. After the membranes have ruptured, the nurse should assess the fetal heart rate (FHR) for ________ minute(s). - Precise Answer ✔✔ANS: 1 The FHR is checked for 1 full minute to ensure that the infant is not in distress from cord compression resultant from the lost buoyancy.
  2. The nurse may assist the health care provider in determining the fetal position and presentation by abdominal palpations called _____________________________ _____________________________. - Precise Answer ✔✔ANS: Leopolds maneuver The nurse may assist the health care provider in determining the fetal position and presentation by abdominal palpations called Leopolds maneuver.
  3. A nursing student is observing prenatal exams in the office setting. The health care provider informs the student that the fetal position is LSA. The student interprets this as a ____________________ presentation. - Precise Answer ✔✔ANS: breech LSA is the abbreviation for Left Sacrum Anterior. This is a breech presentation
  4. Using a diagram, the nurse demonstrates the sequence of the mechanisms of labor. Place the seven mechanisms of labor in sequential order. Put a comma and space between each answer choice (a, b, c, d, etc.) a. Extension b. Engagement

c. Descent d. Flexion e. Expulsion f. Internal rotation g. External rotation - Precise Answer ✔✔ANS: C, B, D, F, A, G, E The process by which a normal vaginal delivery is accomplished requires the infant to make the descent into the birth canal, engage, flex and internally rotate, and extend and externally rotate to be expelled.