Question 1

A nurse midwife is creating a care plan for a client who is in early labor. Which of the following guidelines is least important?

Accepted Answer

The nurse midwife should avoid projecting a definite time limit for labor to be completed. The length of labor can vary from client to client and still be within the normal limits. The outcomes should be realistic. Labors usually occur over a short period of time, and the nurse midwife should ensure that the outcomes are met within this time period. The female client and her support person should be incorporated so that the labor experience is a shared one. Comfort promotion is essential.

Question 2

A nurse midwife is about to perform amniotomy on a client who is in her 39th week of gestation. Which of the following actions of the nurse midwife is the least appropriate before starting the procedure?

Accepted Answer

The least appropriate action of the nurse is to place the client in the lithotomy position. The client must be positioned in the dorsal recumbent position. The nurse midwife should examine the cervix and measure cervical dilatation. In most cases, a cervical dilatation of 3 cm is needed before amniotomy. The fetal heart tone is assessed before and after the procedure. Aseptic technique is maintained throughout the procedure.

Question 3

A client is admitted to the labor and delivery unit. A nurse midwife is assessing the fetal heart tone monitor tracing and notes late decelerations. Which of the following is the most effective intervention?

Accepted Answer

The most effective action for the nurse midwife to take is to administer oxygen through a face mask. The client is most likely experiencing uteroplacental insufficiency, which usually results from decreased flow of oxygenated blood to the fetus during contractions. The client should be placed in the left side lying position to improve fetal circulation and oxygenation. Oxytocin increases uteroplacental insufficiency and should not be administered; it can aggravate or worsen fetal hypoxemia.

Question 4

A nurse midwife induces labor through amniotomy. The amniotic fluid is assessed and the nurse midwife notes that the amniotic fluid is red in color. This finding most likely suggests:

Accepted Answer

Red amniotic fluid most likely suggests fetal trauma. The characteristics of the amniotic fluid, such as color, odor and quantity of fluid, should be noted after amniotomy. A foul odor suggests infection. Excessive or too little amniotic fluid suggests fetal congenital disorder. Fetal distress may be manifested with green-colored amniotic fluid.

Question 5

A nurse midwife is reviewing the fetal heart rate monitor tracing obtained from a G2P1 client who is in labor. The nurse midwife notes decelerations at unpredictable times in relation to contractions. The nurse midwife suspects which of the following conditions?

Accepted Answer

The nurse midwife suspects cord compression. Variable deceleration is manifested by decelerations occurring at unpredictable times in relation to contractions. This type of variability usually occurs after rupture of the membranes or in cases of oligohydramnios. Cephalopelvic disproportion is manifested by early decelerations before the head is fully descended. Early decelerations normally occur during the final stages of labor. Uteroplacental insufficiency is manifested by late decelerations.

Question 6

A nurse midwife assesses a client who is in her 35th week of gestation. After conducting abdominal inspection and palpation, the nurse midwife notes that the fetus is in the transverse lie. This finding is verified by a sonogram. Which of the following actions by the nurse midwife is the most appropriate before an external version?

Accepted Answer

The most appropriate action by the nurse midwife before an external version is to administer a tocolytic agent. Tocolytics, such as tertbutaline, may be administered through the subcutaneous route to relax the uterus and to allow easier manipulation. External version is the manipulation of the fetus from an abnormal position to a good presentation. This is done after the 34th week of gestation. A non-stress test is ordered to determine fetal well-being. The blood pressure is monitored for vena cava compression. The nurse midwife ensures that the client had a RhoGAM during the 28th week.

Question 7

A client at 39 weeks' gestation is admitted to the labor and delivery unit. An external fetal heart rate monitor is attached to the client. Physical examination and laboratory test results reveal that the fetus is in breech position, and a cesarean delivery is recommended. Physical examination is conducted and laboratory tests are ordered. Before the pregnancy, the client's average heart rate was 80 beats per minute. Which of the following assessment findings necessitates immediate physician notification?

Accepted Answer

A fetal heart rate of 180 beats per minute requires immediate notification of the physician. The normal fetal heart rate is between 120 and 160 beats per minute. A fetal heart rate of 180 beats per minute suggests that the fetus is in respiratory distress. The client's hematocrit concentration is within the normal limits. The WBC increases above the normal range during the third trimester, and it may increase to 18,000 cells/mm3 during labor. The maternal heart rate may increase by 10 to 15 beats per minute during pregnancy.

Question 8

A nurse midwife conducts an amniotomy on a client to induce labor. Which of the following interventions is the priority of the nurse midwife after the procedure?

Accepted Answer

The priority action of the nurse after an amniotomy is to assess the fetal heart tone. After the escape of the amniotic fluid, the fetus is at risk of cord prolapse, which may result in brain damage. A decrease in the fetal heart tone suggests cord prolapse. Oxygen is administered and the client is placed in knee-chest position if cord prolapse is present.

Question 9

A few weeks before labor, the client may experience subtle signs that indicate the onset of labor. One of these signs is lightening. The nurse midwife teaches the client to recognize the signs of lightening. Which of the following is not a sign of lightening?

Accepted Answer

Increased amounts of vaginal discharge are commonly reported when lightening has occurred. Lightening may occur 10 to 14 days before labor. The client may report relief from diaphragmatic pressure and shortness of breath as the uterus becomes lower and more anterior. Although the client may report relief, the abdominal pressure increases, resulting in increased urinary frequency, shooting leg pains and increased amounts of vaginal discharge.

Question 10

A nurse midwife is caring for a client who is in the first stage of labor. The client's amniotic membranes have not ruptured. Which of the following interventions is the most effective during this stage of labor?

Accepted Answer

The most effective intervention during the first stage of labor is to instruct the client to void at least every two hours. Bladder fullness may be misinterpreted as sensations of labor by the client. The nurse midwife must learn not to interrupt the client during contraction time. If the amniotic membranes have not ruptured, the client must be encouraged to ambulate. Therapeutic touch is recommended.

Question 11

A nurse midwife is about to perform an amniotomy on a client who is in the active phase of labor. Before performing the procedure, the nurse midwife informs the client that after the amniotomy, she can expect:

Accepted Answer

The nurse midwife should inform the client that after amniotomy, she can expect increased efficiency of uterine contractions. Amniotomy is an artificial method of rupturing the membrane to induce labor. Rupturing of the membranes allows direct contact of the fetal head with the cervix, increasing the efficiency of the contractions. Fluttery feeling in the chest is expected after the administration of tertbutaline.

Question 12

A nurse midwife is managing the care of a G3P2 client. The birthing room is converted into a birth room when the cervix is dilated to:

Accepted Answer

The birthing room is converted into a birth room when the client's cervix is dilated to 7 to 9 cm. The second stage of labor is usually shorter for multipara clients. For primipara clients, this action may be delayed until the head of the fetus has crowned to the size of a quarter, or when the cervix is fully dilated and descent has occurred.

Question 13

A client with a multiple pregnancy is scheduled for cesarean delivery and is transported to the delivery operating room. The nurse midwife reminds the staff nurse to position the client in which of the following positions in the operating room?

Accepted Answer

The nurse midwife reminds the staff nurse to position the client in supine position, with a wedge placed under the right hip, in the operating room. The enlarging uterus compresses the vena cava and the descending aorta of the client, which impedes blood flow to the lower extremities and uterus. The side-lying position is the most ideal position during pregnancy, as it displaces the uterus off the compressed structures. In an abdominal surgery, the client should be positioned in supine position. To displace the uterus and to prevent decreased blood flow to the uterus, a wedge should be placed under the right hip.

Question 14

A nurse midwife is managing the care of a G1P0 client who is about to be placed in the lithotomy position. A registered nurse is positioning the client correctly and safely if which of the following nursing actions is observed by the nurse midwife?

Accepted Answer

The registered nurse is correctly and safely positioning the client in lithotomy position only when the nurse midwife is scrubbing. Lying longer for more than an hour in the lithotomy position may cause pelvic congestion and hemorrhage, so it is important that the client is placed in this position only when the procedure is about start. To prevent constriction, the strap holding the leg should not be secured too tightly . Once the client is in lithotomy, the top portion of the table is raised to 30 to 60 degrees for more effective pushing. The legs must be raised at the same time to prevent straining the client's back and abdominals.

Question 15

A client comes to the facility and tells the nurse midwife that she is in labor and is having some contractions. The client is at 37 weeks' gestation. Which of the following signs indicates that the client is in true labor?

Accepted Answer

Contractions that are initially felt in the lower back and then sweep around to the abdomen in a wave are a sign of true labor. Other signs of true labor include irregular contractions becoming regular, continuous contractions independent of activity level, increase in the duration, frequency and intensity of the contractions and occurrence of cervical dilatation. The other options are signs of false labor.

Question 16

After the placental delivery, which of the following is the next action of the nurse midwife?

Accepted Answer

After the placental delivery, the next action of the nurse is to inspect the placenta. Before administering oxytocics, the nurse midwife should ensure that the placenta is intact and without abnormalities. Inspection allows the nurse midwife to determine if any of the cotyledons are left inside the uterus. The baseline blood pressure is obtained before administering oxytocin, since oxytocin may cause hypertension.

Question 17

A client gives birth to a baby girl through vaginal birth. After placental delivery, which of the following assessment findings indicates that further evaluation of the client is necessary?

Accepted Answer

A fundus located at the level of the umbilicus after the delivery of the placenta indicates that further evaluation of the client is necessary. After placental delivery, the uterine fundus is usually firm, and the fundus is usually located about two fingerbreadths below the umbilicus. In vaginal births, about 300 to 500 mL of blood is lost. The specific gravity increases due to decreased fluid intake during labor.

Question 18

A client has just given vaginal birth to an eight-pound baby boy. A few minutes after the delivery, the nurse midwife observes lengthening of the umbilical cord and a gush of vaginal blood. The nurse midwife interprets these observations as:

Accepted Answer

The nurse midwife interprets these as signs of placental separation. Placenta separation occurs minutes after birth as the uterus resumes contractions. The signs of placental separation include lengthening of the umbilical cord, a gush of vaginal blood and change in the shape of the uterus.

Question 19

A nurse midwife notes that the separation of placenta from the uterus via the Schultze mechanism. This means that:

Accepted Answer

The Schultze mechanism indicates that the placenta's center portion separated first from the uterus and that the fetal surface emerges first from the vagina. The fetal surface is smooth and shiny, whereas the maternal surface appears dull red and feels rough. The placenta separates from the uterus via one of two mechanisms: the Schultze mechanism and the Duncan mechanism. The Duncan mechanism indicates that the margin of the placenta separated first from the lining of the uterus and that the maternal surface emerges from the vagina first.

Question 20

Which of the following factors contribute(s) to a successful labor?
I. The client's pelvis is of adequate size and contour.
II. The fetus is in an advantageous position and presentation and is of appropriate size.
III. The uterine contractions are adequate.
IV. The client has a strong sense of self-esteem.

Accepted Answer

A successful labor depends on the 4 Ps: the passage, the passenger, the power of labor and the client's psyche. The passage is the route the fetus has to travel from the uterus, through the cervix and vagina and into the external perineum. The passenger is the fetus. Power refers to adequate uterine contractions without which full dilatation may not be possible. Clients who have a strong sense of self-esteem manage labor the best.

Quiz 3: Intrapartum