Exam 2 - Chapter 16

Question 1

A new mother asks the nurse when the “soft spot” 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:
a.
2 months
b.
8 months
c.
12 months
d.
18 months

Answer 1

D - The larger of the two fontanels, the anterior fontanel closes by 18 months after birth.
The posterior fontanel closes at 6 to 8 weeks.
Eight months is much too early for the anterior fontanel to close. It closes by 18 months after birth.
Twelve months is too soon. The anterior fontanel closes by 18 months.

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

C - Attitude is the relation of the fetal body parts to each other.
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

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

C - Fetal position is denoted with a three-letter abbreviation. 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. This 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

Question 4

What position is least effective when gravity is desired to assist in fetal descent?
a.
Lithotomy
b.
Kneeling
c.
Sitting
d.
Walking

Answer 4

A - The predominant position in the United States for physician-attended births is the lithotomy position, which requires a woman to be in a reclined position with her legs in stirrups. Gravity has little effect in this position.

Question 5

The nurse recognizes that a woman is in true labor when she states:
a.
“I passed some thick, pink mucus when I urinated this morning.”
b.
“My bag of waters just broke.”
c.
“The contractions in my uterus are getting stronger and closer together.”
d.
“My baby dropped, and I have to urinate more frequently now.”

Answer 5

C - Regular, strong contractions with the presence of cervical change indicate that the woman is experiencing true labor.
Loss of the mucous plug (operculum) often occurs during the first stage of labor or before the onset of labor, but it is not the indicator of true labor.
Spontaneous rupture of membranes often occurs during the first stage of labor, but it is not the indicator of true labor.
The presenting part of the fetus typically becomes engaged in the pelvis at the onset of labor, but this is not the indicator of true labor.

Question 6

The nurse has received a report about a woman 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 6

B - 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). For this woman, the cervix is dilated 3 cm and effaced 30%, and the presenting part is 2 cm above the ischial spines.

Question 7

A pregnant woman is at 38 weeks of gestation. She wants to know if any signs indicate “labor is getting closer to starting.” The nurse informs the woman that which of the following is a sign that labor may begin soon?
a.
Weight gain of 1.5 to 2 kg (3 to 4 lb)
b.
Increase in fundal height
c.
Urinary retention
d.
Surge of energy

Answer 7

D - Women speak of having a burst of energy before labor.
The woman may lose 0.5 to 1.5 kg, the result of water loss caused by electrolyte shifts, which in turn are caused by changes in the estrogen and progesterone levels.
When the fetus descends into the true pelvis (called lightening), the fundal height may decrease.
Urinary frequency may return before labor.

Question 8

To adequately care for a laboring woman, the nurse should know which stage of labor varies the most in length?
a.
First
b.
Second
c.
Third
d.
Fourth

Answer 8

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 9

The nurse expects 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 9

A - During each contraction, 400 ml of blood is emptied from the uterus into the maternal vascular system. This increases cardiac output by about 10% to 15% in the first stage of labor and by about 30% to 50% in the second stage.

Question 10

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 10

D - The five Ps are passenger (fetus and placenta), passageway (birth canal), powers (contractions), position of the mother, and psychologic response. Pressure is not one of the five Ps.
The passenger (fetus and placenta) is one of the five Ps.
The passageway (birth canal) is also one of the five Ps.
Powers (contractions) are a necessary component of the five Ps.

Question 11

To provide the necessary assessment of parent education, the nurse must know which bone is not a bone in the fetal skull?
a.
Parietal
b.
Temporal
c.
Fontanel
d.
Occipital

Answer 11

C - The fetal skull has two parietal bones, two temporal bones, an occipital bone, and a frontal bone. The fontanels are membrane-filled spaces.
The fetal skull has two parietal bones.
The fetal skull has two temporal bones.
The fetal skull has an occipital bone and a frontal bone.

Question 12

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 12

B - 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 13

Which presentation is described accurately in terms of both presenting part and frequency of occurrence?
a.
Cephalic: occiput; at least 96%
b.
Breech: sacrum; 10% to 15%
c.
Shoulder: scapula; 10% to 15%
d.
Cephalic: cranial; 80% to 85%

Answer 13

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.
In a cephalic presentation the part of the head or cranium that emerges first is the occiput; cephalic presentations occur in 96% of births.

Question 14

Regarding 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 14

C - The normal attitude of the fetus is general flexion.
The fetal attitude is the relation of fetal body parts to each other. The normal attitude is called general flexion.
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 15

A woman’s position is very important in the progress of labor. While discussing optimal positioning, maternity nurses should be able to tell the client that:
a.
The supine position commonly used in the United States increases blood flow
b.
The “all fours” position, on her hands and knees, is hard on her back
c.
Frequent changes in position help relieve her fatigue and increase her comfort
d.
In a sitting or squatting position her abdominal muscles will have to work harder

Answer 15

C - Frequent position changes relieve fatigue, increase comfort, and improve circulation.
Blood flow can be compromised in the supine position; any upright position benefits cardiac output.
The “all fours” position is used to relieve backache in certain situations.
In a sitting or squatting position, the abdominal muscles work in greater harmony with uterine contractions.

Question 16

Certain changes stimulate chemoreceptors in the aorta and carotid bodies to prepare the fetus for initiating respirations immediately after birth. These changes occur naturally during labor and include all except:
a.
Fetal lung fluid is cleared from the air passages during labor and vaginal birth
b.
Fetal oxygen pressure decreases (PO2)
c.
Fetal arterial carbon dioxide increases (PCO2)
d.
Fetal respiratory movements increase during labor

Answer 16

D - Fetal respiratory movements actually decrease during labor.
Fetal lung fluid is cleared from the air passages during labor and vaginal birth.
Fetal oxygen pressure decreases (PO2).
Fetal arterial carbon dioxide increases (PCO2)

Question 17

Which description of the four stages of labor is correct for both definition and duration?
a.
First stage: onset of regular uterine contractions to full dilation; less than 1 hour to 20 hours
b.
Second stage: full effacement to 4 to 5 cm; visible presenting part; 1 to 2 hours
c.
Third stage: active pushing to birth; 20 minutes (multiparous women), 50 minutes (first-timer)
d.
Fourth stage: delivery of the placenta to recovery; 30 minutes to 1 hour

Answer 17

A - Full dilation may occur in less than 1 hour, but in first-time pregnancies it can take up to 20 hours.
The second stage extends from full dilation to birth and takes an average of 20 to 50 minutes, although 2 hours is still considered normal.
The third stage extends from birth to expulsion of the placenta and usually takes a few minutes.
The fourth stage begins after expulsion of the placenta and lasts until homeostasis is reestablished (about 2 hours).

Question 18

With regard to the turns and other adjustments of the fetus during the birth process, known as the mechanism of labor, nurses should be aware that:
a.
The seven critical movements must progress in a more or less orderly sequence
b.
Asynclitism sometimes is achieved by means of the Leopold maneuver
c.
The effects of the forces determining descent are modified by the shape of the woman’s pelvis and the size of the fetal head
d.
At birth the baby is said to achieve “restitution”; that is, a return to the C-shape of the womb

Answer 18

C - The size of the maternal pelvis and the ability of the fetal head to mold also affect the process.
The seven identifiable movements of the mechanism of labor occur in combinations simultaneously, not in precise sequences.
Asynclitism is the deflection of the baby’s head; the Leopold maneuver is a means of judging descent by palpating the mother’s abdomen.

Question 19

Signs that precede labor include (choose all that apply):
a.
Lightening
b.
Exhaustion
c.
Bloody show
d.
Rupture of membranes
e.
Decreased fetal movement

Answer 19

A,C,D - Signs that precede labor may include lightening, urinary frequency, backache, weight loss, surge of energy, bloody show, and rupture of membranes.
Many women experience a burst of energy before labor. A decrease in fetal movement is an ominous sign that does not always correlate with labor.

Question 20

Which factors influence cervical dilation? Choose all that apply.
a.
Strong uterine contractions
b.
The force of the presenting fetal part against the cervix
c.
The size of the female
d.
The pressure applied by the amniotic sac
e.
Scarring of the cervix

Answer 20

A,B,D,E - Dilation of the cervix occurs by the drawing upward of the musculofibrous components of the cervix, which is caused by strong uterine contractions. Pressure exerted by the amniotic fluid while the membranes are intact or by the force applied by the presenting part also can promote cervical dilation. Scarring of the cervix as a result of a previous infection or surgery may slow cervical dilation.

Question 21

Which pelvic shape is ideal for a vaginal birth? __________________

Answer 21

Gynecoid

Question 22

The woman in labor should be encouraged to use the Valsalva maneuver (holding one’s breath and tightening abdominal muscles) for pushing during the second stage. Is this statement true or false?

Answer 22

False

Question 23

The nurse has received a report regarding a client in labor. The womans last vaginal
examination was recorded as 3 cm, 30%, and 2. What is the nurses interpretation of this
assessment?
a. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm above the ischial
spines.
b. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial
spines.
c. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm below the ischial
spines.
d. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm below the ischial
spines.

Answer 23

B - 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). For this woman, the cervix is dilated 3 cm and effaced 30%, and the presenting part is 2
cm above the ischial spines. The first interpretation of this vaginal examination is incorrect; the
cervix is dilated 3 cm and is 30% effaced. However, the presenting part is correct at 2 cm above
the ischial spines. The remaining two interpretations of this vaginal examination are incorrect.
Although the dilation and effacement are correct at 3 cm and 30%, the presenting part is actually
2 cm above the ischial spines

Question 24

What is the correct term describing the slight overlapping of cranial bones or shaping of 
the fetal head during labor?
a. Lightening
b. Molding
c. Ferguson reflex
d. Valsalva maneuver

Answer 24

B - Molding also permits adaptation to various diameters of the maternal pelvis. Lightening is the
mothers sensation of decreased abdominal distention, which usually occurs the week before
labor. The Ferguson reflex is the contraction urge of the uterus after the stimulation of the cervix.
The Valsalva maneuver describes conscious pushing during the second stage of labor.

Question 25

A womans position is an important component of the labor progress. Which guidance is
important for the nurse to provide to the laboring client?
a. The supine position, which is commonly used in the United States, increases blood flow.
b. The laboring client positioned on her hands and knees (all fours position) is hard on the
womans back.
c. Frequent changes in position help relieve fatigue and increase the comfort of the laboring
client.
d. In a sitting or squatting position, abdominal muscles of the laboring client will have to
work harder

Answer 25

c - Frequent position changes relieve fatigue, increase comfort, and improve circulation. Blood flow
can be compromised in the supine position; any upright position benefits cardiac output. The all
fours position is used to relieve backache in certain situations. In a sitting or squatting position,
the abdominal muscles work in greater harmony with uterine contractions.

Question 26

Nurses should be cognizant of what regarding the mechanism of labor?
a. Seven critical movements must progress in a more or less orderly sequence.
b. Asynclitism is sometimes achieved by means of the Leopolds maneuver.
c. Effects of the forces determining descent are modified by the shape of the womans pelvis
and the size of the fetal head.
d. At birth, the baby is said to achieve restitution; that is, a return to the C-shape of the
womb

Answer 26

C - The size of the maternal pelvis and the ability of the fetal head to mold also affect the process.
The seven identifiable movements of the mechanism of labor simultaneously occur in
combinations, not in precise sequences. Asynclitism is the deflection of the babys head; the
Leopolds maneuver is a means of judging descent by palpating the mothers abdomen. Restitution
is the rotation of the babys head after the infant is born.

Question 27

Which statement related to fetal positioning during labor is correct for the
nurse to understand?
a. Position is a measure of the degree of descent of the presenting part of the fetus through
the birth canal.
b. Birth is imminent when the presenting part is at +4 to +5 cm below the spine.
c. The largest transverse diameter of the presenting part is the suboccipitobregmatic
diameter.
d. Engagement is the term used to describe the beginning of labor.

Answer 27

b - The station of the presenting part should be noted at the beginning of labor to determine the rate
of descent. Position is the relationship of the presenting part of the fetus to the four quadrants of
the mothers pelvis; station is the measure of degree of descent. The largest diameter is usually
the biparietal diameter. The suboccipitobregmatic diameter is the smallest, although one of the

Question 28

Which basic type of pelvis includes the correct description and percentage of occurrence
in women?
a. Gynecoid: classic female pelvis; heart shaped; 75%
b. Android: resembling the male pelvis; wide oval; 15%
c. Anthropoid: resembling the pelvis of the ape; narrow; 10%
d. Platypelloid: flattened, wide, and shallow pelvis; 3%

Answer 28

D - A platypelloid pelvis is flattened, wide, and shallow; approximately 3% of women have this
shape. The gynecoid pelvis is the classic female shape, slightly ovoid and rounded;
approximately 50% of women have this shape. An android or malelike pelvis is heart shaped;
approximately 23% of women have this shape. An anthropoid or apelike pelvis is oval and wide;
approximately 24% of women have this shape.

Question 29

Fuck this shit

Answer 29

i’m out

Question 30

Which statement regarding the care of a client in labor is correct and important to the
nurse as he or she formulates the plan of care?
a. The womans blood pressure will increase during contractions and fall back to prelabor
normal levels between contractions.
b. The use of the Valsalva maneuver is encouraged during the second stage of labor to
relieve fetal hypoxia.
c. Having the woman point her toes will reduce leg cramps.
d. Endogenous endorphins released during labor will raise the womans pain threshold and
produce sedation.

Answer 30

D - The endogenous endorphins released during labor will raise the womans pain threshold and
produce sedation. In addition, physiologic anesthesia of the perineal tissues, caused by the
pressure of the presenting part, decreases the mothers perception of pain. Blood pressure levels
increase during contractions but remain somewhat elevated between them. The use of the
Valsalva maneuver is discouraged during the second stage labor because of a number of
unhealthy outcomes, including fetal hypoxia. Pointing the toes can cause leg cramps, as can the
process of labor itself

Question 31

Which adaptation of the maternal-fetal exchange of oxygen occurs in response to uterine
contraction?
a. The maternal-fetal exchange of oxygen and waste products continues except when
placental functions are reduced.
b. This maternal-fetal exchange increases as the blood pressure decreases.
c. It diminishes as the spiral arteries are compressed.
d. This exchange of oxygen and waste products is not significantly affected by contractions.

Answer 31

C - Uterine contractions during labor tend to decrease circulation through the spiral electrodes and
subsequent perfusion through the intervillous space. The maternal blood supply to the placenta
gradually stops with contractions. The exchange of oxygen and waste products decreases. The
exchange of oxygen and waste products is affected by contractions.

Question 32

Which statement is the best rationale for assessing the maternal vital signs between
uterine contractions?
a. During a contraction, assessing the fetal heart rate is the priority.
b. Maternal circulating blood volume temporarily increases during contractions.
c. Maternal blood flow to the heart is reduced during contractions.
d. Vital signs taken during contractions are not accurate.

Answer 32

B - During uterine contractions, blood flow to the placenta temporarily stops, causing a relative
increase in the mothers blood volume, which, in turn, temporarily increases blood pressure and
slows the pulse. Monitoring fetal responses to the contractions is important; however, this
question concerns the maternal vital signs. Maternal blood flow is increased during a contraction.
Vital signs are altered by contractions but are considered accurate for that period.

Question 33

What is the primary difference between the labor of a nullipara and that of a multipara?

a. Amount of cervical dilation
b. Total duration of labor
c. Level of pain experienced
d. Sequence of labor mechanisms

Answer 33

B - In a first-time pregnancy, the descent is usually slow but steady; in subsequent pregnancies, the
descent is more rapid, resulting in a shorter duration of labor. 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 is the same with all labors.

Question 34

Which nursing assessment indicates that a woman who is in second-stage labor is almost
ready to give birth?
a. Fetal head is felt at 0 station during the vaginal examination.
b. Bloody mucous discharge increases.
c. Vulva bulges and encircles the fetal head.
d. Membranes rupture during a contraction.

Answer 34

C - During the active pushing (descent) phase, the woman has strong urges to bear down as the
presenting part of the fetus descends and presses on the stretch receptors of the pelvic floor. The
vulva stretches and begins to bulge, encircling the fetal head. Birth of the head occurs when the
station is +4. A 0 station indicates engagement. Bloody show occurs throughout the labor process
and is not an indication of an imminent birth. Rupture of membranes can occur at any time
during the labor process and does not indicate an imminent birth.

Question 35

Nurses can help their clients by keeping them informed about the distinctive stages of
labor. Which description of the phases of the first stage of labor is accurate?
a. Latent: Mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours
b. Active: Moderate, regular contractions; 4- to 7-cm dilation; duration of 3 to 6 hours
c. Lull: No contractions; dilation stable; duration of 20 to 60 minutes
d. Transition: Very strong but irregular contractions; 8- to 10-cm dilation; duration of 1 to 2
hours

Answer 35

B - The active phase is characterized by moderate, regular contractions; 4- to 7-cm dilation; and a
duration of 3 to 6 hours. The latent phase is characterized by mild-to-moderate and irregular
contractions; dilation up to 3 cm; brownish-to-pale pink mucus, and a duration of 6 to 8 hours.
No official lull phase exists in the first stage. The transition phase is characterized by strong- tovery strong and regular contractions; 8- to 10-cm dilation; and a duration of 20 to 40 minutes

Question 36

At least five factors affect the process of labor and birth. These are easily remembered as
the five Ps. Which factors are included in this process? (Select all that apply.)
a. Passenger
b. Passageway
c. Powers
d. Pressure
e. Psychologic response

Answer 36

A,B,C,E

Question 37

Because of its size and rigidity, the fetal head has a major effect on the birth process.
Which bones comprise the structure of the fetal skull? (Select all that apply.)
a. Parietal
b. Temporal
c. Fontanel
d. Occipital
e. Femoral

Answer 37

A,B,D - The fetal skull has two parietal bones, two temporal bones, an occipital bone, and a frontal bone.
The fontanels are membrane-filled spaces.