Antepartum quiz

Question 1

A new mother asks the nurse when the soft spot 1d on her son’s head will go away. The nurse’s answer is based on the knowledge that the anterior fontanel closes after birth by _____ months.

Answer 1

1. ANS: D

The larger of the two fontanels, the anterior fontanel, closes by 18 months after birth.

Question 2

When assessing a woman in labor, the nurse is aware that the relationship of the fetal body parts to one another is called fetal:

a. lie.
b. presentation.
c. attitude.
d. position.

Answer 2

ANS: C
Attitude is the relation of the fetal body parts to one another. Lie is the relation 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 relation of the presenting part to the four quadrants of the mother’s pelvis.

Question 3

____ 3. When assessing the fetus using Leopold maneuvers, the nurse feels a round, firm, 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 likely position of the fetus?

a. ROA
b. LSP
c. RSA
d. LOA

Answer 3

ANS: C
The fetus is positioned anteriorly 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. The first letter indicates the presenting part in either the right or 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 relation 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.

Question 4

4. The nurse has received report regarding her patient in labor. The woman’s last vaginal examination was recorded as 3 cm, 30%, and –2. The nurse’s interpretation of this assessment is that:
   a. the cervix is effaced 3 cm, it is dilated 30%, and the presenting part is 2 cm above the ischial spines.
   b. the cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines.
   c. the cervix is effaced 3 cm, it is dilated 30%, and the presenting part is 2 cm below the ischial spines.
   d. the cervix is dilated 3 cm, it is effaced 30%, and the presenting part is 2 cm below the ischial spines.

Answer 4

ANS: B
The correct description of the vaginal examination for this woman in labor is the cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines. 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).

Question 5

5. To care for a laboring woman adequately, the nurse understands that the __________ stage of labor varies the most in length?
   a. first
   b. second
   c. third
   d. fourth

Answer 5

ANS: A
The first stage of labor is considered to last from the onset of regular uterine contractions to full dilation of the cervix. The first stage is much 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 about 2 hours after delivery of the placenta.

Question 6

6. The nurse would expect 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

Answer 6

ANS: A
During each contraction, 400 mL of blood is emptied from the uterus into the maternal vascular system. This increases cardiac output by about 51% above baseline pregnancy values at term. 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 about 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.

Question 7

7. The factors that affect the process of labor and birth, known commonly as the five Ps, include all except:
   a. passenger.
   b. passageway.
   c. powers.
   d. pressure.

Answer 7

ANS: D
The five Ps are passenger (fetus and placenta), passageway (birth canal), powers (contractions), position of the mother, and psychologic response.

Question 8

8. The slight overlapping of cranial bones or shaping of the fetal head during labor is called:
   a. lightening.
   b. molding.
   c. Ferguson reflex.
   d. Valsalva maneuver.

Answer 8

8. ANS: B
   Fetal head formation is called molding. 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 stimulation of the cervix. The Valsalva maneuver describes conscious pushing during the second stage of labor.

Question 9

9. Which presentation is described accurately in terms of both presenting part and frequency of occurrence?
   a. Cephalic: occiput; at least 95%
   b. Breech: sacrum; 10% to 15%
   c. Shoulder: scapula; 10% to 15%
   d. Cephalic: cranial; 80% to 85%

Answer 9

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

Question 10

10. Regarding factors that affect how the fetus moves through the birth canal, nurses should be aware that:
    a. the 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. the normal attitude of the fetus is called general flexion.
    d. the transverse lie is preferred for vaginal birth.

Answer 10

10. ANS: C
    The normal attitude of the fetus is general flexion. The fetal attitude is the relation of fetal body parts to 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.

Question 11

11. Which occurrence is associated with cervical dilation and effacement?
    a. Bloody show
    b. False labor
    c. Lightening
    d. Bladder distention

Answer 11

11. ANS: A
    As the cervix begins to soften, dilate, and efface, expulsion of the mucous plug that sealed the cervix during pregnancy occurs. This causes rupture of small cervical capillaries. Cervical dilation and effacement do not occur with false labor. Lightening is the descent of the fetus toward the pelvic inlet before labor. Bladder distention occurs when the bladder is not emptied frequently. It may slow down the descent of the fetus during labor.

Question 12

12. A primigravida at 39 weeks of gestation is observed for 2 hours in the intrapartum unit. The fetal heart rate has been normal. Contractions are 5 to 9 minutes apart, 20 to 30 seconds in duration, and of mild intensity. Cervical dilation is 1 to 2 cm and uneffaced (unchanged from admission). Membranes are intact. The nurse should expect the woman to be:
    a. admitted and prepared for a cesarean birth.
    b. admitted for extended observation.
    c. discharged home with a sedative.
    d. discharged home to await the onset of true labor.

Answer 12

12. ANS: D
    This situation describes a woman with normal assessments who is probably in false labor and will probably not deliver rapidly once true labor begins. These are all indications of false labor without fetal distress. There is no indication that further assessment or cesarean birth is indicated. The patient will likely be discharged; however, there is no indication that a sedative is needed.

Question 13

13. Regarding breathing techniques during labor, maternity nurses should understand 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.

Answer 13

13. ANS: A
    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 sometimes can lead to hyperventilation.

Question 14

14. Regarding 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. intramuscular (IM) administration is preferred over intravenous (IV) administration.
    d. IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

Answer 14

ANS: B
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. PCA results in decreased use of an analgesic.

Question 15

15. While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate at the onset of several contractions and returns to baseline before each contraction ends. The nurse should:
    a. change the woman’s position.
    b. discontinue the oxytocin infusion.
    c. insert an internal monitor.
    d. document the finding in the patient’s record.

Answer 15

ANS: D
The FHR indicates early decelerations, which are not an ominous sign and do not require any intervention. The nurse should simply document these findings.

Question 16

16. A normal uterine activity pattern in labor is characterized by:
    a. contractions every 2 to 5 minutes.
    b. contractions lasting about 2 minutes.
    c. contractions about 1 minute apart.
    d. a contraction intensity of about 1000 mm Hg with relaxation at 50 mm Hg.

Answer 16

16. ANS: A
    Contractions normally occur every 2 to 5 minutes and last less than 90 seconds (intensity 800 mm Hg) with about 30 seconds in between (20 mm Hg or less).

Question 17

17. Which maternal condition is considered a contraindication for the application of internal monitoring devices?
    a. Unruptured membranes
    b. Cervix dilated to 4 cm
    c. External monitors in current use
    d. Fetus with a known heart defect

Answer 17

17. ANS: A
    To apply internal monitoring devices, the membranes must be ruptured. Cervical dilation of 4 cm permits the insertion of fetal scalp electrodes and intrauterine catheter. The external monitor can be discontinued after the internal ones are applied. A compromised fetus should be monitored with the most accurate monitoring devices.

Question 18

18. The nurse knows that proper placement of the tocotransducer/tocometer for electronic fetal monitoring is located:
    a. over the uterine fundus.
    b. on the fetal scalp.
    c. inside the uterus.
    d. over the mother’s lower abdomen.

Answer 18

18. ANS: A
    The tocotransducer monitors uterine activity and should be placed over the fundus, where the most intensive uterine contractions occur. The tocotransducer is for external use.

Question 19

19. The most critical nursing action in caring for the newborn immediately after birth is:
    a. keeping the newborn’s airway clear.
    b. fostering parent-newborn attachment.
    c. drying the newborn and wrapping the infant in a blanket.
    d. administering eyedrops and vitamin K.

Answer 19

19. ANS: A
    The care given immediately after the birth focuses on assessing and stabilizing the newborn. Although fostering parent-infant attachment is an important task for the nurse, it is not the most critical nursing action in caring for the newborn immediately after birth. The nursing activities would be (in order of importance) to maintain a patent airway, support respiratory effort, and prevent cold stress by drying the newborn and covering the infant with a warmed blanket or placing the newborn under a radiant warmer. After the newborn has been stabilized, the nurse assesses the newborn’s physical condition, weighs and measures the newborn, administers prophylactic eye ointment and a vitamin K injection, affixes an identification bracelet, wraps the newborn in warm blankets, and then gives the infant to the partner or mother when he or she is ready.

Question 20

20. A patient whose cervix is dilated to 5 cm is in which phase of labor?
    a. Latent phase
    b. Active phase
    c. Second stage
    d. Third stage

Answer 20

20. ANS: B
    The latent phase is from the beginning of true labor until 3 cm of cervical dilation. The active phase of labor is characterized by cervical dilation of 4 to 7 cm. The second stage of labor begins when the cervix is completely dilated until the birth of the baby. The third stage of labor is from the birth of the baby until the expulsion of the placenta. This patient is in the active phase of labor.

Question 21

21. The primary difference between the labor of a nullipara and that of a multipara is the:
    a. amount of cervical dilation.
    b. total duration of labor.
    c. level of pain experienced.
    d. sequence of labor mechanisms.

Answer 21

21. ANS: B
    Multiparas usually labor more quickly than nulliparas, thus making the total duration of their labor shorter. 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 remains the same with all labors.

Question 22

22. A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and says that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman’s labor?
    a. She is exhibiting hypotonic uterine dysfunction.
    b. She is experiencing a normal latent stage.
    c. She is exhibiting hypertonic uterine dysfunction.
    d. She is experiencing pelvic dystocia.

Answer 22

22. ANS: C
    Women who experience hypertonic uterine dysfunction, or primary dysfunctional labor, often are anxious first-time mothers who are having painful and frequent contractions that are ineffective at causing cervical dilation or effacement to progress. With hypotonic uterine dysfunction, the woman initially makes normal progress into the active stage of labor; then the contractions become weak and inefficient or stop altogether. The contraction pattern seen in this woman signifies hypertonic uterine activity. Typically uterine activity in this phase occurs at 4- to 5-minute intervals lasting 30 to 45 seconds. Pelvic dystocia can occur whenever contractures of the pelvic diameters reduce the capacity of the bony pelvis, including the inlet, midpelvis, outlet, or any combination of these planes.

Question 23

23. The least common cause of long, difficult, or abnormal labor (dystocia) is:
    a. midplane contracture of the pelvis.
    b. compromised bearing-down efforts as a result of pain medication.
    c. disproportion of the pelvis.
    d. low-lying placenta.

Answer 23

23. ANS: C

The least common cause of dystocia is disproportion of the pelvis.

Question 24

24. A maternal indication for the use of forceps is:
    a. a wide pelvic outlet.
    b. maternal exhaustion.
    c. a history of rapid deliveries.
    d. failure to progress past 0 station.

Answer 24

24. ANS: B
    A mother who is exhausted may be unable to assist with the expulsion of the fetus.
    The patient with a wide pelvic outlet will likely not require vacuum extraction. With a rapid delivery, vacuum extraction is not necessary. A station of 0 is too high for a vacuum extraction.

Question 25

25. Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could you use to raise the patient’s blood pressure? (Select all that apply.)
    a. Place the woman in a supine position.
    b. Place the woman in a lateral position.
    c. Increase intravenous (IV) fluids.
    d. Administer oxygen.
    e. Perform a vaginal examination.

Answer 25

25 ANS: B, C, D
Nursing interventions for maternal hypotension arising from analgesia or anesthesia include turning the woman to a lateral position, increasing IV fluids, administering oxygen via face mask, elevating the woman’s legs, notifying the physician, administering an IV vasopressor, and monitoring the maternal and fetal status at least every 5 minutes until these are stable. Placing the patient in a supine position would cause venous compression, thereby limiting blood flow to and oxygenation of the placenta and fetus. A sterile vaginal examination has no bearing on maternal blood pressure.

Question 26

The vaginal examination is an essential component of labor assessment. It reveals whether the patient is in true labor and enables the examiner to determine whether membranes have ruptured. This examination is often stressful and uncomfortable for the patient and should be performed only when indicated. Please match the correct step number, from 1 to 7, with each component of a vaginal examination of the laboring woman.

a. After obtaining permission, gently insert the index and middle fingers into the vagina.
b. Explain findings to the patient.
c. Position the woman to prevent supine hypotension.
d. Use sterile gloves and soluble gel for lubrication.
e. Document findings and report to the provider.
f. Cleanse the perineum and vulva if necessary.
g. Determine dilation, presenting part, status of membranes, and characteristics of amniotic fluid.

Answer 26

26. ANS: D (same rationale for questions 26 to 32)
    The vaginal examination should be performed on admission, before administering analgesics, when a significant change in uterine activity has occurred, on maternal perception of perineal pressure, when membranes rupture, or when you note variable decelerations of the fetal heart rate. A full explanation of the examination and support of the woman are important in reducing the level of stress and discomfort.