A nurse is caring for the following four laboring patients.

Which client should the nurse be

prepared to monitor closely for signs of postpartum hemorrhage (PPH)? Select all that apply.
1. G1 P0000, delivered a fetal demise at 29 weeks' gestation.
2. G2 P1001, prolonged first stage of labor.
3. G2 P0010, delivered by cesarean section for failure to progress.
4. G3 P0200, delivered vaginally a 42-week, 2,200-gram neonate.
5. G4 P3003, with a succenturiate placenta.
ANS: 2 and 5 are correct.
1. Preterm labor clients are not especially at high risk for postpartum hemorrhage.
2. Clients who have had a prolonged first stage of labor are at high risk for postpartum
hemorrhage (PPH).
3. Cesarean section clients are not especially at high risk for PPH.
4. Postdates clients who deliver small babies are not especially at high risk for PPH. 5. Clients
with a succenturiate placenta are at high risk for PPH.

Fetal presentation refers to which of the following descriptions?

Part of the fetus that is overlying the maternal pelvic inlet
Which of the following fetal positions is most favorable for birth?
a) Vertex presentation
b) Transverse lie
c) Frank breech presentation
d) Posterior position of the fetal head

Which occurrence is associated with cervical dilation and effacement?Select one:

a. Bladder distention b. Bloody show c. False labor d. Lightening

When the baby’s head can be seen at the vaginal opening and the baby is ready to be born it is
called:
cephalic presentation
The nurse has been working with a laboring client and notes that she has been pushing
effectively for 1 hour. What is the client's primary physiological need at this time?
1. Ambulation
2. Rest between contractions
3. Change positions frequently
4. Consume oral food and fluids

Which of the following situations is considered a vaginal delivery emergency?

1. Third stage of labor lasting 20 minutes.
2. Fetal heart dropping during contractions.
3. Three-vessel cord.
4. Shoulder dystocia.
4
Shoulder dystocia is an obstetric emergency.
Dystocia means difficult delivery. A shoulder dystocia, therefore, refers to difficulty in
delivering a baby's shoulders. This is an obstetric emer- gency since the dystocia occurs in the
middle of the delivery when the head has been delivered but the shoulders remain wedged in the
pelvis. The most common complications are related to nerve palsies from traction placed on the
baby's head in attempts to deliver the shoulder. In addition, the baby's life is threatened since the
baby is unable to breathe and umbilical cord flow is often dramatically reduced during this phase
of the delivery.

McRoberts maneuver, used in the management of shoulder dystocia, consists of

This procedure involves flexing and abducting the maternal hips, positioning the maternal thighs
up onto the maternal abdomen.

To correctly assess the duration of a contraction, the nurse counts the time between which
intervals?
A. The beginning of one contraction and the end of the same contraction

Which method represents the most accurate technique to use when assessing the client's
contractions?
Place the hand over the fundus of the uterus, which is located just above the umbilicus

A primigravida at 40 weeks of gestation is having uterine contractions every to 2 minutes and

states 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 precipitous labor.
ANS: C
The contraction pattern observed 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. Women
who experience hypertonic uterine dysfunction, or primary dysfunctional labor, are often 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. Precipitous labor is one that lasts less than 3
hours from the onset of contractions until time of birth.

The primary power involved in labor and delivery is

Bearing down ability of mother
Cervical effacement and dilatation
Uterine contraction
Valsalva technique
Answer: (C) Uterine contraction. Uterine contraction is the primary force that will expel the fetus
out through the birth canal Maternal bearing down is considered the secondary power/force that
will help push the fetus out.

The nurse is monitoring a client who is in the active phase of labor. The client has been
experiencing contractions that are short, irregular, and weak. Which type of labor dystocia
should the nurse document that the client is experiencing?
1. Hypotonic
Choose the abbreviation that represents the fetal presentation and position that is most favorable
for vaginal birth.
A) LOA
B) RMP
C)LST
D) ROP

A woman's membranes rupture during a contraction. The priority nursing action is to...
Assess the fetal heart rate.
A high probability of successful induction is associated with a Bishop score of:
A. Greater than 4
B. Greater than 6
C. Less than 4
D. Less than 6

A woman has shoulder dystocia when giving birth. they nurse should expect:
a. immediate forceps delivery
b. application of suprapubic pressure
c. oxytocin labor augmentation
d. turning to a hands and knees position

choose the primary nursing measure to promote fetal descent

a. remind the woman to empty her bladder every 1 to 2 hours
b. assist fetal head rotation while doing a vaginal examination
c. have the woman push at least 3 times with each contraction
d. promote intake of glucose-containing fluids during labor

When reviewing the medical record of a client, the nurse notes that the woman has a condition in
which the fetus cannot physically pass through the maternal pelvis. The nurse interprets this as:
A. Cervical insuffiency
B. Contracted pelvis
C. Maternal disproportion
D. Fetopelvic disproportion
Fetopelvic disproportion occurs when fetus is too large to pass through the maternal pelvis.
Cervical insufficiency would lead to an abortion, typically in the second trimester, when the
heavy gravid uterus would cause pressure on the weakened cervix.
Contracted pelvis might cause passageway problems, but if the fetus was small, no problem
might occur.
Maternal disproportion doesn't indicate where the disproportion is located

After a vaginal examination, the nurse determines that the client's fetus is in an occiput posterior
position. The nurse would anticipate that the client will have:
a. Intense back pain
b. Frequent leg cramps
c. Nausea and vomiting
d. A precipitous birth

A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of a slowing
labor. The nurse is reviewing the physician's orders and would expect to note which of the
following prescribed treatments for this condition?
1.Medication that will provide sedation
2.Increased hydration
3.Oxytocin (Pitocin) infusion
4.Administration of a tocolytic medication
3. Therapeutic management for hypotonic uterine dysfunction includes oxytocin augmentation
and amniotomy to stimulate a labor that slows.

A nurse in the labor room is preparing to care for a client with hypertonic uterine dysfunction.
The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their
frequency, duration, and intensity. The priority nursing intervention would be to:
1.Monitor the Pitocin infusion closely
2.Provide pain relief measures
3.Prepare the client for an amniotomy
4.Promote ambulation every 30 minutes
2. Management of hypertonic labor depends on the cause. Relief of pain is the primary
intervention to promote a normal labor pattern.

A nurse is developing a plan of care for a client experiencing dystocia, and includes several
nursing interventions in the plan. The nurse prioritizes the plan and selects which nursing
intervention as the highest priority?
The priority in the plan of care would include the intervention that addresses the physiological
integrity of the fetus. Although providing comfort measures, changing the client's position
frequently, and keeping the significant other informed of the progress of the labor are
components of the plan of care, fetal status is the priority.

What complication would you expect if the infant’s head at delivery is held back, does not fall
forward on the perineum, and does not undergo the normal rotation?
Fetal death
A congenital abnormality of the infant’s neck and shoulders
Impacted shoulders (i.e. shoulder dystocia)
The birth of a preterm infant because the small shoulders prevent normal rotation during delivery

A woman who has given birth to a healthy baby is being discharged. As a part of the discharge
teaching, the nurse should instruct the client to observe vaginal discharge for postpartum
hemorrhage and notify the healthcare provider (HCP) about:
saturating a pad in an hour

A mother, G6 P6006, is 15 minutes postpartum. Her baby weighed 4,595 grams at birth. For
which of the following complications should the nurse monitor this client?
1. Seizures.
2. Hemorrhage.
3. Infection.
4. Thrombosis.

1. This client is not especially at high risk for seizures.

2. The client should be monitored carefully for signs of postpartum hemorrhage.
3. This client is not especially at high risk for infection.
4. This client is not especially at high risk for thrombosis.

A nurse is caring for the following four laboring patients. Which client should the nurse be
prepared to monitor closely for signs of postpartum hemorrhage (PPH)? Select all that apply.
1. G1 P0000, delivered a fetal demise at 29 weeks' gestation.
2. G2 P1001, prolonged first stage of labor.
3. G2 P0010, delivered by cesarean section for failure to progress.
4. G3 P0200, delivered vaginally a 42-week, 2,200-gram neonate.
5. G4 P3003, with a succenturiate placenta.
ANS: 2 and 5 are correct.
1. Preterm labor clients are not especially at high risk for postpartum hemorrhage.
2. Clients who have had a prolonged first stage of labor are at high risk for postpartum
hemorrhage (PPH).
3. Cesarean section clients are not especially at high risk for PPH.
4. Postdates clients who deliver small babies are not especially at high risk for PPH. 5. Clients
with a succenturiate placenta are at high risk for PPH.

A client, 1 day postpartum (PP), is being monitored carefully after a significant postpartum
hemorrhage. Which of the following should the nurse report to the obstetrician?
1. Urine output 200 mL for last 8 hours.
2. Weight decrease of 2 pounds since delivery.
3. Drop in hematocrit of 2% since admission.
4. Pulse rate of 68 beats per minute.
1. This output is below the accepted minimum for 8 hours.
The nurse is caring for a patient recovering from a postpartum hemorrhage. The patient's
bleeding is under control, and vital signs are stable. Which action should the nurse take?
Discourage the patient from eating seafood.
Leave the room while the patient feeds her newborn to allow for privacy.
Perform shift assessments and medication administration at the same time.
Reassure the patient that a blood transfusion will most likely not be necessary at this point in her
care.

A woman with a firm fundus who presents with excessive vaginal bleeding may be at risk for
which complication?
Laceration
Hematoma
Uterine atony
Retained placental fragments

Which woman is at greatest risk for late postpartum hemorrhage?

A 17-year-old nullipara
A woman with preeclampsia
A 38-year-old woman with placenta accreta
A woman whose labor was induced and who delivered twins naturally

Which of the following is the best strategy to prevent a postpartum hemorrhage?

The most effective strategy to prevent postpartum hemorrhage is active management of the third
stage of labor (AMTSL). AMTSL also reduces the risk of a postpartum maternal hemoglobin
level lower than 9 g per dL (90 g per L) and the need for manual removal of the placenta.

In discussing obstetric emergencies with a new registered nurse on Labor and Delivery, you
initiate a conversation reviewing the common risk factors for postpartum hemorrhage. Which of
the following is considered a risk factor?
a. Age > 25
b. Induction or augmentation of labor
c. Drug induced analgesia
d. Fetal intrauterine growth restriction

Atonic bleeding is due to a lack of tone in the uterus

The word 'atonic' means 'loss of muscular tone or strength to contract'. Atonic postpartum
haemorrhage is characterised by excessive bleeding when the uterus is not well contracted after
the delivery, and is soft, distended and lacking muscular tone.

To be considered a PPH, what would the estimated blood loss have to be for a C-section?
Postpartum Hemorrhage (PPH) is defined by the WHO as blood loss of 500 ml or more within
24 h after birth [1]. Another, less commonly used definition distinguishes vaginal deliveries
(blood loss > 500 ml) from cesarean sections (> 1000 ml)

In the maternal attachment process, which statement best describes the anticipated actions in the
taking-hold phase?
Kissing, embracing, and caring for the neonate

A nurse coming onto the night shift assesses a client who gave birth vaginally that morning. The
nurse finds that the client's vaginal bleeding has saturated two perineal pads within 30 minutes.
What is the first action the nurse should take?
Assess the fundus and massage it if it's boggy

A postpartum client has a nursing diagnosis of risk for impaired urinary elimination related to
loss of bladder sensation after childbirth. Which of the following priorities outcome criteria
should the client achieve?
Client voids more than 30 mL/hour without urinary retention beginning 1 hour after birth

A client has just given birth to her first child, a healthy, full-term girl. The client is Rho(D)-
negative and her neonate is Rh-positive. What intervention will be performed to reduce the risk
of Rh incompatibility?
Administration of Rho(D) immune globulin I.M. to the mother within 72 hours
A nurse is teaching a group of clients about birth control methods. When providing instruction
about subdermal contraceptive implants, the nurse should cite which feature as the main
advantage of this method?
The implants provide effective, continuous contraception that isn't user dependent.

Twelve hours after a vaginal birth with epidural anesthesia, the nurse palpates the fundus of a
primiparous client and finds it to be firm, above the umbilicus, and deviated to the right. What
should the nurse do next?
Encourage the client to ambulate to the bathroom and void

A mother, G1 P1, who delivered a 2,800 gram baby vaginally 30 minutes earlier, is transferred to
the postpartum unit. She pushed for 45 minutes and the placenta was delivered 10 minutes later.
She is receiving an intravenous with 20 units oxytocin added. The postpartum nurse questions
why the oxytocin was added to the IV bag. Which of the following responses by the transferring
nurse is most likely?
1. "The medication was added 10 minutes ago to prevent excess bleeding during her transfer."
2. "The medication was added immediately after the baby's birth to promote placental delivery."
3. "The medication was added after the placenta was delivered because of its rapid separation."
4. "The medication was added while she was pushing to speed up the baby's birth.
1. Patient transfer from labor and delivery to postpartum does not stimulate excess bleeding. It is
unlikely that this is the rationale for the medication administration.
2. It is likely that the medication was added during the 3rd stage of labor to promote placental
delivery.
3. Placental delivery usually occurs between 5 minutes and 30 minutes after the birth. This is an
unlikely rationale for the medication administration.
4. The client's 2nd stage of labor lasted 45 minutes. That is a relatively short period of time for a
primipara. As important, 20 units of oxytocin is an unsafe dosage to be administered before the
fetus is birthed.

Which of the following is a priority nursing diagnosis for a woman, G10 P6226, who is PP1
from a spontaneous vaginal delivery with a significant postpartum hemorrhage?
1. Alteration in comfort related to afterbirth pains.
2. Risk for altered parenting related to grand multiparity.
3. Fluid volume deficit related to blood loss.
4. Risk for sleep deprivation related to mothering role.
1. This is an important nursing diagnosis, but it is not the priority diagnosis.
2. This is an important nursing diagnosis, but it is not the priority diagnosis.
3. Fluid volume deficit related to blood loss is the priority nursing diagnosis.
4. This is an important nursing diagnosis, but it is not the priority diagnosis.

A breastfeeding woman has been diagnosed with retained placental fragments 4 days
postdelivery. Which of the following breastfeeding complications would the nurse expect to see?
1. Engorgement.
2. Mastitis.
3. Blocked milk duct.
4. Low milk supply.

1. The nurse would not expect to see engorgement.

2. The nurse would not expect to see mastitis.
3. The nurse would not expect to see a blocked milk duct.
4. The nurse would expect that the woman would have a low milk supply.

Postpartum hemorrhage is a common maternal morbidity in high resource countries and is on the
rise. Which one of the following is the most common cause of postpartum hemorrhage?
a. Retained placental tissue
b. Atonic uterus
c. Coagulopathy
d. Vaginal laceration

Which of the following is not a part of the active management of the third stage of labor?
a. Oxytocin soon after delivery
b. Continuous controlled cord traction
c. Transabdominal uterine massage after placenta delivers
d. Delayed cord clamping

____ literally means difficult labor but often is abnormally slow progress of labor
c. labor dystocia

What should be performed if placenta is not delivered within 30 minutes of delivery of the baby?
a. manual sweep

An epidural is best performed when the client is how many centimeters dilated?
b.) 5 to 6

he nurse is working with a patient in labor. She is happy and cheerful, and states she is "ready to
see her baby." What stage or phase of labor would she anticipate the patient to be in right now?
C)Latent Phase

The client informs the nurse about a previous admission to the unit 3 days ago with "false labor.
" Which statement made by the client indicates a characteristic of Braxton Hicks contractions?
"The contractions are less strong when I walk."

A 25 yr old primigravid client in the last trimester of pregnancy calls the physician's office and
tells the nurse "I think I'm in labor." Which findings warrant instructing the client to notify the
physician and report to the hospital's labor and delivery unit immediately?
the client is having contractions very 5 minutes. the client experiences a sudden gush of fluid
from her vagina.

During the latent phase, which findings can the nurse expect to notice when assessing the client?
Contractions occurring every 10-15 minutes. Fetal heart rate of 120-160 beats/minute.
The registered nurse performs a vaginal examination of the client. The nurse determines that the
labor is progressing and the cervix is dilated 6 cm. When assessing the freq. and duration of the
client's contractions during this phase of labor, the nurse expects to find the contractions are
occurring every 3 to 5 minutes and lasting up to how many seconds?
90 seconds

The nurse is assisting in monitoring a client who is receiving oxytocin to induce labor. The nurse
should be alert to which maternal adverse reactions?
Hypertension, Fluid overload, Uterine tetany

Which response by the nurse is most accurate regarding a vaginal birth after a cesarean birth
(VBAC)?
It may be possible to have a VBAC if the previous cesarean was done with a low transverse
incision and wishes to attempt to have a vaginal birth.

While the client is receiving an epidural of morphine sulfate, the nurse closely monitors the
client for which adverse reaction?
Respiratory depression

Which response by the nurse regarding the placement of the indwelling catheter is most
accurate?
It keeps the bladder empty during the surgical procedure

A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her labor is
being controlled with tocolytic medications. She asks when she might be able to go home. Which
response by the nurse is most accurate?
a."After the baby is born."
b."When we can stabilize your preterm labor and arrange home health visits."
c."Whenever your physician says that it is okay."
d."It depends on what kind of insurance coverage you have."
This client's preterm labor is being controlled with tocolytics. Once she is stable, home care may
be a viable option for this type of client. Care of a client with preterm labor is multidisciplinary
and multifactorial; the goal is to prevent delivery. In many cases, this goal may be achieved at
home. Managed care may dictate an earlier hospital discharge or a shift from hospital to home
care. Insurance coverage may be one factor in client care, but ultimately, client safety remains
the most important factor.

he obstetric provider has informed the nurse that she will be performing an amniotomy on the
client to induce labor. What is the nurse's highest priority intervention after the amniotomy is
performed?

a.Applying clean linens under the woman

b.Taking the client's vital signs
c.Performing a vaginal examination
d.Assessing the fetal heart rate (FHR)
The FHR is assessed before and immediately after the amniotomy to detect any changes that
might indicate cord compression or prolapse. Providing comfort measures, such as clean linens,
for the client is important but not the priority immediately after an amniotomy. The woman's
temperature should be checked every 2 hours after the rupture of membranes but not the priority
immediately after an amniotomy. The woman would have had a vaginal examination during the
procedure. Unless cord prolapse is suspected, another vaginal examination is not warranted.
Additionally, FHR assessment provides clinical cues to a prolapsed cord.

The nurse is performing an assessment on a client who thinks she may be experiencing preterm
labor. Which information is the most important for the nurse to understand and share with the
client?

a.Because all women must be considered at risk for preterm labor and prediction is so variable,
teaching pregnant women the symptoms of preterm labor probably causes more harm through
false alarms.
b.Braxton Hicks contractions often signal the onset of preterm labor.
c.Because preterm labor is likely to be the start of an extended labor, a woman with symptoms
can wait several hours before contacting the primary caregiver.
d.Diagnosis of preterm labor is based on gestational age, uterine activity, and progressive
cervical change.
Gestational age of 20 to 37 weeks, uterine contractions, and a cervix that is 80% effaced or
dilated 2 cm indicates preterm labor. It is essential that nurses teach women how to detect the
early symptoms of preterm labor. Braxton Hicks contractions resemble preterm labor
contractions, but they are not true labor. Waiting too long to see a health care provider could
result in essential medications failing to be administered. Preterm labor is not necessarily long-
term labor.

Which statement related to cephalopelvic disproportion (CPD) is the least accurate?

a.CPD can be related to either fetal size or fetal position.
b.The fetus cannot be born vaginally.
c.CPD can be accurately predicted.
d.Causes of CPD may have maternal or fetal origins.
Unfortunately, accurately predicting CPD is not possible. Although CPD is often related to
excessive fetal size (macrosomia), malposition of the fetal presenting part is the problem in many
cases, not true CPD. When CPD is present, the fetus cannot fit through the maternal pelvis to be
born vaginally. CPD may be related to either fetal origins such as macrosomia or malposition or
maternal origins such as a too small or malformed pelvis.

The nurse is teaching a client with preterm premature rupture of membranes (PPROM) regarding
self-care activities. Which activities should the nurse include in her teaching?

a.Report a temperature higher than 40° C.

b.Tampons are safe to use to absorb the leaking amniotic fluid.
c.Do not engage in sexual activity.
d.Taking frequent tub baths is safe.
Sexual activity should be avoided because it may induce preterm labor. A temperature higher
than 38° C should be reported. To prevent the risk of infection, tub baths should be avoided and
nothing should be inserted into the vagina. Further, foul-smelling vaginal fluid, which may be a
sign of infection, should be reported.

Braxton Hicks, false

12. _______ are intermittent, physiological uterine contractions that may occur during the second
and third trimester and do not cause cervical change. They are associated with _____ labor.
A nurse is observing the electronic fetal heart rate monitor for a client who is at 40 weeks of
gestation and is in labor. The nurse should suspect cord compression when she observes which of
the following patterns?
A) Early decelerations
B) Accelerations
C) Late decelerations
D) Variable decelerations

laboring client station is complaining of severe back pain. The nurse knows that which of the
following positions is associated with lower back pain in laboring women.
A) RSA
B) LOA
C) ROP
D) ROA

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) Position.
C) Presentation.
D) Attitude

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the
fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction,
with the nadir of the decelerations occurring after the peak of the contraction. The nurse's first
priority is to:
A) Notify the care provider.
B) Assist with amnioinfusion
C) Change the woman's position
D) Insert a scalp electrode.
The nurse providing care for the laboring woman should understand that variable fetal heart rate
(FHR) decelerations are caused by:
A) Umbilical cord compression.
B) Altered fetal cerebral blood flow
C) Fetal hypoxemia.
D) Uteroplacental insufficiency

he nurse caring for the woman in labor should understand that maternal hypotension can result
in:
A) Uteroplacental insufficiency.
B) Spontaneous rupture of membranes
C) Fetal dysrhythmias.
D) Early decelerations.

A woman in labor has just received an epidural block. The most important nursing intervention is
to:
A) Limit parenteral fluids.
B) Monitor the fetus for possible tachycardia
C) Monitor the maternal blood pressure for possible hypotension.
D) Monitor the maternal pulse for possible bradycardia