Labor and Delivery

LABOR AND DELIVERY
VAGINAL BIRTH
Questions To Think About
1. During Lisa's admission/initial interview, can you assess her stage of labor and predict what her cervical
dilation might be? Support your answer with evidence from the video.
2. Assess the different physical and emotional change, as Lisa progresses through each stage of labor.
3. How did the nurse establish a bond with Lisa and her husband? Describe the methods used.
4. What role did Lisa's husband appear to assume throughout the video? How do you think he provided support
to Lisa? Explain how he did or didn't.
5. During labor what comfort measures did the nurse initiate to facilitate relaxation and the progression of labor?
How involved was Lisa in decision-making?
6. What methods worked best for Lisa?
7. Why wouldn't the nurse midwife initially allow Janet to push?
8. What was the purpose of a warm compress on the perineal area during labor?
9. Who was the primary support person for Janet during labor? Explain your answer.
EFFECTIVE POSITIONING DURING LABOR CAN:
Reduce uterine pressure and speed up the delivery
Speed up cervical dilation
Reduce the amount of muscular effort needed during delivery
Speed up the labor process and reduce discomfort
DURING LABOR CONTRACTIONS, DOING ALL OF THE FOLLOWING MAY HELP REDUCE PAIN, EXCEPT:
Breathing properly
Lying flat on the back
Kneeling down
Relaxing the shoulders
WHEN A CLIENT IN LABOR ARRIVES AT THE HOSPITAL, THE NURSE SHOULD FIRST;
Perform an ultrasound to assess the fetus
Assess the health status of the client and connect her to the fetal monitor
Administer the proper medications immediately
Acquire the medical and health history of the client
TO HELP REDUCE THE PAIN DURING LABOR, THE NURSE MAY:
Give the client a hand massage

Promote ambulation
Massage the abdomen of the client in between contractions
Give the client soft foods and plenty of fluids
ALL OF THE FOLLOWING ARE PAIN MANAGEMENT TECHNIQUES DURING LABOR CONTRACTIONS,
EXCEPT:
Soaking in a tub of water
Breathing deeply and slowly
Sitting upright with the legs stretched apart
Rocking the hips from side to side
DURING LABOR, SOAKING IN A TUB OF WATER MAY:

Prevent contractions from occurring
Result in an easy and fast delivery
Cause the body to become numb
Make the contractions more manageable
ACCORDING TO THE LESSON, SUCTIONING THE NOSE AND THE MOUTH OF THE BABY IS DONE AS
SOON AS:
The placenta is expelled
The head emerges from the perineum
The head and shoulders emerge from perineum
The baby completely emerges
THE APGAR SCORE GRADES ALL OF THE FOLLOWING, EXCEPT:
Heart rate
Weight
Respiration
Muscle tone
AFTER GIVING BIRTH, THE NURSE SHOULD CHECK THE CLIENT'S BLOOD PRESSURE EVERY:
30 minutes
10 minutes
20 minutes
15 minutes
WHEN THE BABY’S HEAD CROWNS, THE CLIENT SHOULD BE ADVISED TO:
Stop pushing
Breathe rapidly
Push strongly
Push gently
THE CLIENT IN LABOR MAY BR ADVISED TO USE AN OXYGEN MASJ DURING RAPID BREATHING TO
PREVENT:
Apnea and muscle cramps
Dizziness and numbing of the feet and hands
Dizziness and muscle cramps
Apnea and numbing of the feet and hands
TO HELP THE CLIENT PARTICIPATE DURING THE LABOR AND DELIVERY PROCESS, THE NURSES:
Provided the client with birthing information
Allowed as many people as possible into the delivery room
Coached the client to push, pant, and blow
Allowed the husband of the client to watch
THE PURPOSE OF ASKING THE CLIENT TO FEEL THE HEAD OF HER BABY DURING LABOR IS:
To reassure the client that the birthing process is progressing
To support the baby as it emerges from the birth canal
To allow an early connection between the mother and the infant
To allow the client to gauge her progress and to connect her to the birthing
THE GI TRACT OF JANET'S BABY WAS SUCTIONED BY THE NURSE TO DRAIN:
Melena from the infant's stomach

Meconium from the infant's stomach
Lanugo from the infant's stomach
Fluid from the infant's stomach
DURING LABOR, THE CLIENT SHOULD NOT PUSH UNTIL:
Blood spots appear
The cervix is fully dilated
Contractions have become long and strong
Contractions last for 30 seconds each
THE FIRST VITAMIN A NEWBORN USUALLY RECEIVES IS
Vitamin K
Vitamin C
Vitamin E
Vitamin B
NEWBORNS HAVE BLUE HANDS AND FEET BECAUSE
Newboms initially lack oxygen
These body parts are most distal from the brain
These body parts are most distal from the near
Newborns are still adapting to the temperature outside the uterus
CERVIX DILATION IS ASSESSED TO
Calculate the duration of the labor process and delivery
Determine the fetal heart rate
Determine if labor is progressing to the next stage
Determine the presences of any fetal complications

Labor and Delivery
Components of Labor
A. Power (Uterine Contractions)

1. Frequency: from the beginning of one contraction to the beginning of the next
contraction
2. Duration: from the beginning of one contraction to the end of that same
contraction
3. Intensity: strength of contraction, measured with fingertips lightly on the fundus
(mild, moderate. and strong); accurate measurement can only be made with an internal
monitor
4. Regularity: establish a pattern that increases in frequency and duration
5. Effacement: thinning of cervix, 0-100%
6. Dilatation: opening of cervix, 0-10 cms
B. Passenger (Fetus)
1. Lie: relationship of the cephalocaudal axis of the infant to the cephalocaudal axis of the mother
1. Transverse lie
2. Longitudinal lie
2. Presentation: body part of the passenger that enters. The pelvic passageway first is called the
“presenting part”
1. Cephalic
1. Vertex: occiput (most common)
2. Brow: sinciput
3. Face: mentum
2. Breech
1. Complete: sacrum
2. Frank
3. Footling
3. Shoulder
3. Position: relationship of the landmark on the presenting fetal part to the front sides, and back
of the maternal pelvis
1. Pelvis is divided into six areas anterior, transverse, or posterior; left or right side
2. Fetal landmarks are: occiput (O), mentum (M), sacrum (S), and scapula (Sc)
3. Most common is left occiput anterior (LOA)
4. Attitude or habitus: to the relationship of the fetal parts to one another, usual is "fetal posh
ion"
5. Station: the relationship between the presenting part and the ischial spines; O-station is
engagement
6. Cardinal movements of descent
1. Descent
2. Flexion
3. Internal rotation
4. Extension
5. External rotation or restitution
C. Passageway (Maternal Pelvis)

1. False pelvis helps support pregnant uterus
2. True pelvis forms bony canal; inlet, pelvic cavity, outlet
3. Types
1. Gynecoid: normal female (50%), best for delivery
2. Android: normal male (20%), not favorable
3. Platypelloid: flat female pelvis (5%), not favorable
4. Anthropoid: apelike (25%), favorable
4. Cephalo-pelvic disproportion (CPD)
D. Psyche
1. Physical preparation for childbirth
2. Cultural heritage
3. Previous experience
4. Support systems
5. Self-esteem
IN LABOR, DILATION REFERS TO THE:
Thickening of the cervix from 0 to 100 percent
Thinning of the cervix from 0 to 100 percent
Opening of the cervix from 5 to 15 cm
Opening of the cervix from 0 to 10 cm
IN LABOR, EFFACEMENT REFERS TO THE:
Thickening of the cervix, measured from 0 to 100 percent
Opening of the cervix, measured from 0 to 10 cm
Thinning of the cervix, measured from 0 to 100 percent
Opening of the cervix, measured from 5 to 15 cm

ACCORDING TO THE LESSON, THE STRENGTH OF UTERINE CONTRACTION DURING LABOR IS
MEASURED:
With fingertips lightly on the fundus
With fingertips deeply in the apex
With fingertips lightly on the apex
With fingertips deeply in the fundus
Fetal Assessment
1. Sonogram
1. Purpose
1. Locate placenta
2. Diagnose multiple pregnancy
3. Identify some congenital anomalies
4. Determine gestational age
2. Nursing Interventions
1. Assure that client has a full bladder
2. Provide client education
2. Fetal Monitoring
1. Purpose
1. Determine fetal heart rate (FHR): normal is 110-160BPM
2. Recognize periodic changes in FHR
3. Determine frequency and duration of contractions
1. Types
1. Auscultation with fetoscope; palpation
2. External electronic monitoring
3. Internal electronic monitoring
1. Provides actual intrauterine pressures
2. Provides beat-to-beat variability of the FHR, which is an indication of the
sympathetic and parasympathetic nervous system status
2. Periodic changes
1. Early decelerations: head compression
2. Variable decelerations: cord compression
3. Late decelerations: uteroplacental insufficiency
4. Accelerations: usually a sign of fetal well-being
DURING LABOR, EARLY DECELERATIONS IN FETAL HEART RATE ARE USUALLY ASSOCIATED WITH:
Fetal well-being
Cord compression
Uteroplacental insufficiency
Head compression
ACCORDING TO THE VIDEO, ALL OF THE FOLLOWING ARE VALID MEDICAL USES OF SONOGRAM,
EXCEPT:
To locate the placenta
To diagnose multiple pregnancy
To determine the sex
To identify congenital anomalies
DURING LABOR, VARIABLE DECELERATIONS IN FETAL HEART RATE ARE USUALLY ASSOCIATED
WITH:
Head compression
Cord compression
Fetal well-being
C. Non-Stress Test (NST)

1. Purpose
1. Assess fetal well-being
2. Look for increase in FHR (accelerations) with fetal activity (reactive NST)
2. A non-reactive, non-stress test is NOT reassuring
D. Contraction Stress Test
1. Types
1. Oxytocin challenge test (OCT)
2. Nipple stimulation test
2. Purpose
1. Look for three contractions in 10 minutes
2. No late decelerations determines fetal well-being
3. A negative CST is reassuring
E. Biophysical Profile
1. Purpose
1. Determine fetal well-being after questionable NST
2. Determine amount of amniotic fluid
2. Nursing Interventions
1. Provide client education
2. Provide emotional support
THESE ARE THE TYPES OF CONTRACTION STRESS TESTS:
Nipple and vaginal stimulation tests
Oxytocin challenge test and nipple stimulation test
Nipple stimulation and ultrasound modulation tests
Oxytocin challenge test and vaginal stimulation test
IN REGARD TO FETAL ASSESSMENT, A NON-STRESS TEST INCLUDES ALL OF THE FOLLOWING

FEATURES, EXCEPT:
Not given during labor
Looks for increase in the fetal heart rate
A non-reactive, non-stress test is reassuring
Not given during inducement of contractions
A CONTRACTION STRESS TEST LOOKS FOR:
6 contractions in 10 minutes and no late decelerations
6 contractions in 10 minutes and no late accelerations
3 contractions in 10 minutes and no late accelerations
3 contractions in 10 minutes and no late decelerations
1.
Amniocentesis (performed after 16th week)
2.
1.
Purpose
2.
1.
Determine fetal anomalies, sex, fetal maturity
2.
3.
Determine lecithin-sphingomyelin (L/S) ratio, bilirubin levels, creatine levels
4.
3.
Nursing Interventions
4.
1.
Provide client education
2.
3.
Assess for premature labor, hemorrhaging
4.
5.
Provide RhoGAM for Rh negative client
6.
7.
Empty bladder
8.
3.
Chorionic Villi Sampling
4.
1.
Purpose
2.
1.
Determine fetal anomalies, genetic defects

2.
3.
Early test: 8-10 weeks
4.
3.
4.
1.
Provide client education
2.
3.
Provide RhoGAM for Rh negative client
4.
IN REGARD TO CHORIONIC VILLI SAMPLING, RHOGAM SHOULD BE PROVIDED TO AN RH NEGATIVE

CLIENT:
Before and after the procedure
Before the procedure:
After the procedure
During the procedure
2. IN REGARD TO AMNIOCENTESIS, RHOGAM SHOULD BE GIVEN TO AN RH NEGATIVE CLIENT

BECAUSE:
There is a risk for low creatinine level
There is a risk for partial paralysis
There is a risk for micro blood transfer and sensitization
There is a risk for abnormal uterine contractions
3. ALL OF THE FOLLOWING STATEMENTS ABOUT AMNIOCENTESIS ARE TRUE, EXCEPT:
It should be performed before and after the 16th week

It can be used to help determine fetal anomalies and sex
It can be used to determine the lecithin-sphingomyelin ratio
It can be used to adjust bilirubin and creatinine levels
Signs of Impending Labor
1.
Lightening - engaged
2.
3.
Braxton-Hicks Contractions
4.
5.
Weight Loss (one to three pounds)
6.
7.
Cervical Changes
8.
9.
Increase in Back Discomfort
10.
11.
Bloody Show
12.
13.
Rupture of Membranes
14.
1.
Client should contact primary care provider
2.
3.
4.
1.
Monitor FHR
2.
3.
Check for prolapsed cord
4.
5.
Test vaginal secretions for alkalinity with Nitrazine paper
6.
7.
Watch for signs of infection/meconium
8.
15.
Sudden Burst of Energy
16.
IN AN IMPENDING LABOR, LIGHTENING IS COMMONLY EXPERIENCES WHEN:
The baby’s head ascends into the pelvis
The baby’s head ascends into the cervix
The baby’s head descends into the pelvis
The baby’s head descends into the cervix
ALL OF THE FOLLOWING ARE STATED SIGNS OF IMPENDING LABOR, EXCEPT:
Braxton-hicks contractions
Cervical changes
Weight gain
Lightening
NITRAZINE PAPER DRIPPED WITH AMNIOTIC FLUID WILL TURN:

Green
Red
Blue
Yellow
STAGES OF LABOR
A.
STAGE OF DILATATION
B.
1.
LATENT PHASE -0-4 CM
2.
3.
ACTIVE PHASE -5-7 CM
4.
5.
TRANSITIONAL -8-10CM
6.
B. STAGE OF DELIVERY- complete dilatation and 10cm

C. EXPULSION OF PLACENTA
D. STAGE OF RECOVERY
STAGES OF LABOR
STAGES CHARACTERISTICS INTERVENTIONS
- First Stage: - Duration: - Admission; assessment: medical and
("stage of OB history, vital signs, FHRs, signs of
dilatation") -primigravida 3.3-19.7 hours; labor, weight, vaginal exam (if no
begins true labor, active vaginal bleeding)
ends with -multigravida 0.1-14.3hours
complete cervical - Diversional activities; time
dilatation; - 0-4 cm dilatation; mild to contractions; assess maternal-fetal
composed of moderate contractions q 15-20 status; pelvic rock: promote
three phases min, lasting 10-30 seconds; hydration; use breathing patterns;
backache, cramping, bloody evaluate labor progress
- Latent phase show; mother talkative,
cheerful, anxious - Assess maternal-fetal status;
- Active phase backrubs; comfort measures; mother
- 5-7 cm dilatation; strong may feel apprehensive; provide
- Transitional contractions 3-5 minutes, encouragement; provide analgesia or
phase lasting 30-60 seconds anesthesia if requested and is
appropriate: promote hydration and
- 8-10 cm dilatation; strong elimination; keep perineum clean;
contractions of 2-3 min, promote rest between contractions;
lasting 50-90 seconds; legs evaluate labor progress
may cramp; nausea/vomiting,
perspiration on forehead and - Assess maternal-fetal status; provide
upper lip; dark, profuse bloody much reassurance; provide comfort
show; mother may have measures; pant/blow with pushing
amnesia between contractions, urges; be supportive and help mother
is irritable, anxious, and self- maintain control with breathing;
oriented evaluate labor progress
- Second stage: - Duration; primigravida .3-1.9 - Assess maternal-fetal status; coach

("stage of hrs; multigravida .9-.69 hours; pushing; promote comfort; record
delivery") begins contractions 2-3 minutes, time of delivery,
with complete lasting 50- 90 seconds; client episiotomy/lacerations, medications,
dilatation of the has urge to push and is or anesthetics; evaluate labor progress
cervix and ends exhausted
with delivery
- Third stage: - Mild contractions; continue - Assess maternal status, blood loss;
("placental until placenta is expelled, note time of placenta delivery;
stage") begins normally within 30 minutes; administer an oxytocic after placental
with delivery of client may have to push to separation, if ordered; promote
infant; ends with help expel placenta bonding
delivery of
placenta
- Fourth stage: - Cramping uterine - Assess vital signs (BR, P and R)
("stage of discomfort; rubra vaginal fundus, lochia, bladder and perineum
recovery") the discharge with small clots; q 15 mm. for 1st hr., q 30 min., second
first hour after discomfort if episiotomy done; hr.; temp, xl; encourage hydration and
delivery or until client feels happy, relieved, elimination; promote comfort; ice to
stable excited perineum if painful; promote bonding
THE FOURTH STAGE OF LABOR IS CHARACTERIZED BY ALL OF THE FOLLOWING, EXCEPT:
Rubra vaginal discharge
Lasts for at least 3 hours after delivery
Cramping
Uterine discomfort
THE THIRD STAGE OF LABOR IS CHARACTERIZED BY ALL OF THE FOLLOWING, EXCEPT:
Ends with delivery of the placenta
Begins with delivery of the infant
Client may have to push to help expel placenta
Ends with delivery of the infant
THE FIRST STAGE OF LABOR INCLUDES ALL OF THE FOLLOWING PHASES, EXCEPT:
Latent
Transitional
Active
Placental
ANALGESIA/ANESTHESIA FOR LABOR AND DELIVERY
A. Analgesics: butorphanol tartrate (Stadol), nalbuphine hydrochloride (Nubain), meperidine

hydrochloride (Demerol); often mixed with hydroxyzine HCI (Vistaril) or promethazine HCI
(Phenergan) to potentiate; do not give if within 2 hours of delivery— infant may be depressed and
require naloxone HCI (Narcan)
B. Local anesthetic: given locally into perineal tissue during second stage just prior to delivery
C. Paracervical: numbs cervix; good for 1st stage of labor; should not be given after dilation of 8 cms
(danger of injecting fetal head); can cause fetal bradycardia
D. Pudendal: numbs vagina and perineum; good for 2nd stage, large episiotomy, or if anterior posterior
repair is to follow delivery
E. Epidural: numbs from the waist down
1) Nursing interventions: take BP q 5 minutes until stable; assess bladder; assist in turning and
pushing; hydrate client; assess fetal heart rate
2) Complications: hypotension and fetal distress; turn client on side, increase IV rate, give
oxygen
F. Saddle (spinal): numbs from waist down
1) Complications; headaches, may need blood patch
2) Nursing interventions: use good body mechanics when moving client
G. General: used primarily for emergency cesarean section
IN REGARD TO LABOR AND DELIVERY, AN EPIDURAL PLACEMENT INCREASES THE CHANCES

OF:
Hypotension
Hypertension
Stillbirth
Electrolyte imbalance
ACCORDING TO THE VIDEO, IV ANALGESICS SHOULD BE AVOIDED FOR AT LEAST:
3 hours before labor
1 hour before labor
AFTER THE ADMINISTRATION OF AN EPIDURAL DURING LABOR OR DELIVERY, THE NURSE

SHOULD DO ALL OF THE FOLLOWING, EXCEPT:
Assess the bladder
Monitor blood pressure
Assess the kidneys
Maintain hydration
Complications During Labor and Delivery
1.
Fetal Distress
2.
1.
Etiology
2.
1.
2.
1.
Acute uteroplacental insufficiency
2.
1.
Excessive uterine activity associated with oxytocin

(Pitocin)
2.
3.
Maternal hypotension: epidural, venacaval compression,

supine position, internal hemorrhage
4.
5.
Placental separation: abruptio, previa
6.
3.
Chronic uteroplacental insufficiency
4.
1.
PIH
2.
3.
Diabetes
4.
5.
Postmaturity
6.
3.
4.
1.
Position client on left side
2.
3.
Start IV or increase rate
4.
5.
Administer oxygen
6.
7.
Notify primary care provider
8.
9.
Monitor FHR continuously
10.
1.
PROM (Premature Rupture of Membrane)
2.
1.
Etiology
2.
1.
Infection
2.
3.
Trauma
4.
3.
4.
1.
Assess FHR
2.
3.
Assess for infection
4.
5.
Assess for prolapsed cord
6.
3.
Umbilical Cord Compression
4.
1.
Etiology
2.
1.
Prolapsed cord
2.
1.
Causes: abnormal presentation, inadequate pelvis, presenting

part at high station, multiple gestation, prematurity, PROM,
polyhydramnios
2.
3.
Complications: fetal asphyxia
4.
5.
6.
1.
Keep hand in vagina; push presenting part away from

cord
2.
3.
Continuously assess fetal welfare by pulsation of the cord
4.
5.
Place client in Trendelenburg or knee-chest position
6.
7.
Prepare for c-section; type and cross match blood; start

IV; obtain consent
8.
3.
Nuchal cord (cord around neck)
4.
ALL OF THE FOLLOWING ARE POSSIBLE CAUSES OF CHRONIC UTEROPLACENTAL

INSUFFICIENCY, EXCEPT:
Insufficient calcium uptake
PIH
Diabetes
Postmaturity
IN REGARD TO LABOR AND DELIVERY, ALL OF THE FOLLOWING ARE STATED

NURSING INTERVENTIONS FOR PREMATURE RUPTURE OF MEMBRANES, EXCEPT:
Assess fetal heart rate
Assess for prolapsed cord
Assess for infection.
Assess for maternal diabetes
ALL OF THE FOLLOWING ARE POTENTIAL COMPLICATIONS DURING LABOR OR

DELIVERY, EXCEPT:
Premature rupture of membranes
Dysplasia
Fetal distress
Umbilical cord compression
1.
Premature Labor
2.
1.
Etiology
2.
1.
Chronic pyelonephritis
2.
3.
Incompetent cervix
4.
5.
Multiple pregnancy
6.
7.
History of premature births
8.
9.
Sepsis
10.
11.
Placental disorders
12.
3.
4.
1.
Place client on bed rest
2.
3.
Assess for signs of infection; monitor vital signs; FHR
4.
5.
Administer ritodrine HCI (Yutopar), terbutaline, (Brethine) or

magnesium sulfate as ordered to stop premature labor.
6.
7.
Provide emotional support
8.
9.
Administer betamethasone (Celestone) to promote fetal lung

development.
10.
11.
Delivery if near term
12.
1.
Amniotic Fluid Emboli
2.
1.
Definition: amniotic fluid in blood stream
2.
3.
Often happens at delivery
4.
5.
Emergency situation, often fatal
6.
3.
Dystocia
4.
1.
Definition: prolonged, difficult labor
2.
3.
Etiology
4.
1.
Dysfunction of uterine contractions
2.
3.
Abnormal position
4.
5.
Cephalopelvic disproportion (CPD)
6.
7.
Maternal exhaustion
8.
5.
6.
1.
Depends upon cause
2.
3.
Can vary from rest to c-section
4.
ALL OF THE FOLLOWING ARE CHARACTERISTICS OR AMNIOTIC FLUID EMBOLISM,

EXCEPT
Can be treated by administering betamethasone
Involves amniotic fluid in the bloodstream

Is often fatal
Usually occurs during delivery
ACCORDING TO THE LESSON, ALL OF THE FOLLOWING ARE POTENTIAL CAUSES OF

DYSTOCIA, EXCEPT:
Dysfunction of uterine contractions
Maternal anxiety
Cephalopelvic disproportion
Abnormal fetus position
IN LABOR AND DELIVERY, THIS MEDICATION IS USED TO STIMULATE LUNG

DEVELOPMENT IN PREMATURE INFANTS:
Calcium Gluconate
Ritodrine hydrochloride
Betamethasone
Oxytocin
Operative Obstetrics
1.
Episiotomy
2.
1.
Definition: incision made into the perineum during delivery
2.
3.
Purpose:
4.
1.
To spare muscles from overstretching/lacerations; to avoid

difficulty holding urine in later life
2.
3.
Limit pressure on infant's head
4.
5.
6.
1.
Assess for healing, infection, laceration of the anal sphincter

(4th degree tear), hemorrhage
2.
3.
Teach Kegel exercises
4.
1.
Forceps
2.
1.
Definition: obstetric instrument used to aid in delivery
2.
3.
Indications
4.
1.
Poor progress
2.
3.
Fetal distress
4.
5.
Persistent occiput posterior position
6.
7.
Exhaustion (maternal)
8.
5.
6.
1.
Assess infant for intracranial hemorrhage, facial bruising, facial

palsy
2.
3.
Assist with delivery as needed
4.
5.
Check FHR before traction is applied
6.
7.
Complications
8.
1.
Lacerations to cervix or vagina

2.
3.
Rupture of the uterus
4.
5.
Compression of cord
6.
1.
Vacuum Extraction
2.
1.
Definition: an OB procedure using a suction cup to aid in delivery
2.
3.
Indications
4.
1.
Poor progress
2.
3.
Fetal distress
4.
5.
Occiput posterior/occiput transverse position
6.
7.
Exhaustion (maternal)
8.
5.
6.
1.
Assess FHR every 5 minutes
2.
3.
Assess for cerebral trauma
4.
5.
Inform parents that caput will disappear in a few hours
6.
IN OPERATIVE OBSTETRICS, EPISIOTOMY IS COMMONLY DONE BY:
Incising the perineum during delivery
Incising the perineum before labor
Incising the perineum during labor
Incising the perineum after delivery
2. ALL OF THE FOLLOWING ARE EXAMPLES OF OPERATIVE OBSTETRICS, EXCEPT:
Umbilical cord decompression
Forceps Delivery
Vacuum extraction
Episiotomy
All Of The Following Are Stated Indications For Forceps Delivery, Except:
Maternal exhaustion
Fetal distress
Poor Progress
Prolapsed cord
1.
Cesarean Section (c-section)
2.
1.
Definitions: incision into abdominal wall and uterus to deliver fetus
2.
3.
Types
4.
1.
Low transverse: decrease chance of uterine rupture with future

pregnancies; less bleeding after delivery
2.
3.
Classical: good for emergency delivery; provides more room
4.
5.
Indications
6.
1.
Fetal distress
2.
3.
Cephalo-pelvic disproportion (CPD)
4.
5.
Placenta previa, abruptio
6.
7.
Uterine dysfunction
8.
9.
Prolapsed cord
10.
11.
Diabetes
12.
13.
Toxemia
14.
15.
Malpresentation
16.
7.
8.
1.
Postoperative assessment
2.
3.
Postpartum assessment
4.
9.
Vaginal birth after c-section (VBAC): current accepted standard of care
10.
1.
Induction of Labor
2.
1.
Definition: process of initiating labor
2.
3.
Indications
4.
1.
Maternal disease: cardiac, PIH
2.
3.
Placental malfunctions (example: partial previa)
4.
5.
Fetal conditions (for example: anomaly, death)
6.
7.
Post maturity
8.
5.
Methods used to soften cervix
6.
1.
Prostaglandin E2 gel
2.
3.
Laminaria (natural cervical dilation, made from seaweed; left in place
for 6-12 hours): be alert for contraindications such as asthma,
nonreassuring FHR, pelvic infection, ROM, vaginal bleeding
4.
7.
Methods used to initiate induction
8.
1.
Oxytocin (Pitocin)
2.
3.
Rupture of membranes (ROM) (amniotomy)
4.
9.
10.
1.
Assessment of FHR
2.
3.
Assess for prolapsed cord, ruptured uterus
4.
5.
Stop oxytocin (Pitocin) if contraction lasts longer than 90 seconds or

at signs of fetal distress
6.
LABOR AND DELIVERY POST-QUIZ

THIS TYPE OF CESAREAN SECTION INVOLVES LESS POSTOPERATIVE
BLEEDING:
Low transverse
High transverse
Modern
Classical
THIS TYPE OF CESAREAN SECTION PROVIDES MORE ROOM FOR THE

SURGEON TO WIRK IN:
Low transverse
High transverse
Modern
Classical
THIS TYPE OF CESAREAN SECTION IS GOOD FOR EMERGENCY DELIVERY:

Low transverse
High transverse
Modern
Classical
ACCORDING TO THE LESSON, IN REGARD TO DELIVERY, LOCAL

ANESTHETICS ARE USUALLY INJECTED INTO:
Perineal tissue
Uterine tissue
Abdominal tissue
Vaginal tissue
ACCORDING TO THE VIDEO, CHORIONIC VILLI SAMPLING IS BEST

PERFORMED IN THIS PERIOD:
8-10 weeks of pregnancy
ACCORDING TO THE LESSON, THE STRENGTH OF UTERINE CONTRACTION

DURING LABOR IS MEASURED: A
With fingertips deeply in the apex Å
With fingertips lightly on the fundus A
With fingertips deeply in the fundus A
With fingertips lightly on the apex
This type of Cesarean section decreases the chance of uterine rupture with future
pregnancies:
Modern
Low transverse
High transverse
Classical
According to the video, all of the following are potential causes of premature labor,
except: A
Incompetent cervix Å
Sepsis A
Primigravid pregnancy A
Multiple pregnancy
According to the video, fetal monitoring is used for all of the following purposes,
except:
To determine fetal heart rate Å
To determine the frequency of contractions
To determine the location of contractions A
To recognize changes in fetal heart rate
According to the lesson, after forceps delivery, the nurse should assess the baby for
all of the following, except:
Facial palsy
Intracranial hemorrhage
Facial bruising
Cerebral trauma
All of the following are stated appropriate nursing interventions for fetal distress,
except:
Start or increase the rate of an IV Â
Continuously monitor fetal heart rate Å
Place the client in semi-Fowler's position
Administer oxygen Â
ACCORDING TO THE VIDEO, A NEGATIVE CONTRACTION STRESS TEST IS:

Serious
Not reassuring
Reassuring
Inconclusive
ACCORDING TO THE VIDEO, THE FREQUENCY OF UTERINE CONTRACTION

DURING LABOR IS BEST MEASURED:
From the end of one contraction to the end of the next Â
From the beginning of one contraction to the end of the next Â
From the beginning of one contraction to the beginning of the next A
From the end of one contraction to the beginning of the next Â
EMERGENCY C-SECTION: PART I

Prior to administering cytotec to a pregnant client, the nurse should do all of the
following.except
Make sure that the client's blood pressure is lower than 112/70 mmHg
Make sure that the client is not experiencing too many contractions
Make sure that the fetus exhibits good variability and accelerations
Make sure that the fetus exhibits a reassuring tracing on the fetal monitor
After administering cytotec to a pregnant client, the nurse should advise the client to:
Lie flat on her back
Lie on her side
Lie flat with her legs slightly raised
Sit up
Cytotec is a synthetic analogue of:

Adrenosterone
Prostaglandin (breaks down collagen in the cervix)
Condotrophin
Epinephrine
EMERGENCY C-SECTION: PART II

ACCORDING TO THE LESSON, DURING LABOR, IT IS NORMAL FOR THE
CLIENT TO:
Lose consciousness
Vomit
Have elevated temperature
Shiver
ACCORDING TO THE LESSON, A GOOD LABOR PATTERN IS CHARACTERIZED

BY
Contractions every 4 to 5 minutes
ACCORDING TO THE LESSON, A CLIENT IN BACK LABOR MAY BENEFIT

FROM:
The client sitting upright
The client lying in a supine position
Light abdominal masage
Light lower back massage
EMERGENCY C-SECTION: PART III

A FETAL MONITOR IS USED TO:
Determine the fetus' heart rate and the frequency of contractions
Determine the size and position of the fetus in the womb
Measure a client's cervical dilation
Determine the fetus' respiration and the strength of each contraction
THIS MEDICATION MAY BE ADMINISTERED TO MANAGE NAUSEA DURING

LABOR:
Zofran
Catala
Atarax
Ativan
TO DETERMINE THE FREQUENCY OF CONTRACTIONS, THE NURSE SHOULD

COUNT FROM:
The end of one contraction to the beginning of the next contraction
The end of one contraction to the end of the next contraction
The beginning of one contraction to the end of the next contraction
The beginning of one contraction to the beginning of the next contraction
EMERGENCY C-SECTION: PART IV

This statement about the uterus is most true:
The uterus is also known as the oviduct
The uterus is directly connected to the vagina
The uterus is located in the lateral wall of the pelvic region
The uterus is a muscle
All of the following are pain management techniques to help alleviate labor pain,
except:
Hot showers
Rocking the hips from side to side
Soaking in a hot tub
Applying pressure to the pelvic area
If labor progresses too slowly, health care providers should consider all of the
following. except:
The size of the fetus' head
The position of the baby in the womb
The shape and size of the mother's pelvis
The age of the fetus
PLANNED C-SECTION PART I

AS SOON AS A CLIENT FOR A PLANNED C-SECTION ARRIVES, ALL OF THE
FOLLOWING INTERVENTIONS SHOULD BE PERFORMED, EXCEPT:
Assessment of the status of the fetus
Insertion of an IV line
Inquiry about recent food intake
Insertion of a Foley catheter into the bladder
THIS SHOULD BE PERFORMED PRIOR TO ADMINISTERING SPINAL

ANESTHESIA:
Mediastinoscopy
Blood test
Chest X-ray
ABG analysis
ONE OF THE SIDE EFFECTS OF SPINAL ANESTHESIA IS:

Itching
Fever
Excessive bleeding
Blood clots
PLANNED C-SECTION PART II

When assisting a client during a C-section, all of the following are appropriate nursing
responsibilities, except:
Help the client be as comfortable as possible
Administer the epidural anesthesia
Guide the client through the process
Reassure the client that she is doing a great job
During a C-section, when the surgeon removes the infant from the uterus, it is normal
for the mother to feel
Pressure in the abdomen
A tingling sensation in the pelvis
A burning sensation in the pelvis
Pain in the abdomen
During the administration of spinal anesthesia for C-section, the client may feel:
A tinging sensation
A cold sensation
A prickling sensation
A burning sensation
PLANNED C-SECTION PART III

Vitamin K is usually injected into the newborn's:
Thigh
Calf
Arms
Buttocks
A white cheese-like protective material that covers a newborn's skin is called:

Caseosa
Vernix
Collagen
Proteoglycan
According to the lesson, before bathing a newborn, his/her temperature should be:
99 degrees Fahrenheit and up
90 degrees Fahrenheit and up
Less than 90 degrees Fahrenheit
Less than 99 degrees Fahrenheit
PLANNED C-SECTION PART IV

The cord stump of a newborn is usually:
Brownish
Pinkish
Greenish
Yellowish
The normal respiration rate of a newborn is around:

40 breaths/minute
60 breaths/minute
20 breaths/minute
30 breaths/minute
A newborn should receive a sponge bath:

For the first 3 to 5 days
Until the cord stump falls off
Until all the vernix has been washed off
For the first 5 to 7 days
PLANNED C-SECTION PART V

To normalize the intestinal functions of a client who has recently had a C-section, the
nurse
should:
Promote early ambulation
Encourage the client to drink more fluids
Promote a low calorie and low sodium diet
Administer an antacid.
2. The nurse should auscultate the abdomen of a C-section client postoperatively to:
Determine if the bladder is functioning normally
Assess the position of the client's uterus
Assess the client's bowel sounds
Assess the fundus of the uterus
3. Postoperative care for C-section usually includes all of the following, except:
Lung auscultation
Abdominal auscultation
Chest percussion
Pain assessment
CESAREAN DELIVERY POST-QUIZ

This is performed to ensure that the newborn does not have any genetic
disorders:
PKU test
Coombs test
Reflex assessment test
Apgar score
To prepare a client for C-section, the nurse should do all of the following, except:
Educate the client about what to expect after the surgery
Explain the disadvantages of having a C-section to the baby's well-being
Administer a drug that will reduce acid in the stomach
Administer a drug that will prevent nausea
This is inserted after administering spinal anesthesia for a C- section:

Foley catheter
CVC
Chest tube
IV catheter
All of the following are nursing responsibilities during labor, except:

Assess the health status of the client and the fetus
Help the client be as comfortable as possible
Explain the labor process to the client to alleviate her anxiety
Speed up the labor process by administering pitocin
All of the following are responsibilities of the nurse after a C- section, except:
Make the client as comfortable as possible
Promote a low-calorie and low-sodium diet
Teach the client about infant care
Teach the client about wound care
Newborns receive vitamin K to:

Promote growth
Increase RNA production
Increase blood coagulation
Build up the immune system
This is given to pregnant clients to induce labor:

Cytotec
Edecrin
Clomiphene
Pitocin
THIS IS THE PROPER WAY OF BREATHING DURING LABOR

CONTRACTIONS:
Inhaling through the mouth and exhaling through the nose as rapidly as possible
Inhaling through the nose and exhaling through the mouth asnormally as possible
Inhaling through the mouth and exhaling through the nose asnormally as possible
Inhaling through the nose and exhaling through the mouth as rapidly as
possible
WHEN PERFORMING A VAGINAL EXAM ON A PREGNANT CLIENT, THE

NURSE SHOULD WEAR:
A gown
Sterile gloves
A mask
Eye protection
TYPE OF ANESTHESIA FOR CLIENTS UNDERGOING C-SECTION

Spinal Anesthesia
Nursing Care of the Neonate
1.
Initial Care of Newborn
2.
1.
Maintain patent airway by suction, position
2.
3.
Maintain temperature: dry, place baby on mother or under radiant

heat source
4.
5.
APGAR score: performed at one and five minutes after birth
6.
1.
Five areas scored: heart rate, respiratory effort, muscle tone,

reflex irritability, color
2.
1.
7-10: good
2.
3.
3-6: moderately depressed
4.
5.
0-2: severely depressed
6.
7.
Eye prophylaxis: silver nitrate (AgNO3), erythromycin or tetracycline

(protects against infections caused by chlamydia & gonorrhea)
8.
9.
Identification
10.
11.
Vitamin K (AquaMEPHYTON)
12.
1.
Vital Signs
2.
1.
Temperature range is 97-99°F: if too high: dehydration, sepsis, brain

damage, overheated; if too low: infection, brain stem injury, cold
2.
3.
Heart rate range is 120-150 beats /minute, dependent upon state;

murmur is common at first from transient patent ductus arteriosus
4.
5.
Respirations
6.
1.
30-50/minute
2.
3.
Distress: nasal flaring, intercostal or xiphoid retractions,

expiratory grunt, tachypnea
4.
7.
BP is 80/40 at birth. 100/50 by the 10th day
8.
1.
Head
2.
1.
Measure head circumference
2.
3.
Assess fontanels
4.
1.
Posterior: triangular shaped, closes at 8-12 weeks
2.
3.
Anterior: diamond shaped, closes at 18 months
4.
5.
Bulging: increased intracranial pressure; depressed:

dehydration
6.
5.
Molding
6.
7.
Caput succedaneum (edema of soft scalp tissue)
8.
9.
Cephalohematoma (hematoma between periosteum and skull bone)
10.
1.
Eyes
2.
1.
Blue-gray color
2.
3.
Strabismus is common ("cross-eye")

4.
5.
Small hemorrhage (clears in a few weeks)
6.
7.
Cataracts
8.
3.
Ears
4.
1.
Low-set ears are associated with anomalies
2.
3.
Infants hear acutely as mucous is absorbed
4.
5.
Nose
6.
1.
Patency: infants are obligatory nose breathers; can smell
2.
3.
Symmetry
4.
CEPHALOHEMATOMA IN A NEONATE IS:
Edema of soft scalp tissue

Ahematoma between the periosteum and the dura
Edema of brain tissue.
Ahematoma between the periosteum and the skull bone
CAPUT SUCCEDANEUM IN A NEONATE IS:
A hematoma between the periosteum and the dura

Edema of brain tissue
A hematoma between the periosteum and the skull bone
Edema of soft scalp tissue
THE TOP SCORE OF AN APGAR IS:

5
20
10
6
1.
Mouth
2.
1.
Sucking reflex
2.
3.
Epstein pearls (small white epithelial cysts along midline of hard

palate)
4.
5.
Thrush (white patches that adhere to tongue, palate, and Buccal

mucosa)
6.
7.
Palate intact
8.
3.
Breast
4.
1.
Engorgement
2.
3.
Amount of breast tissue
4.
5.
Abdomen
6.
1.
Measure abdominal circumference
2.
3.
Palpate for masses
4.
5.
Umbilical cord
6.
1.
Three vessels (one vein, two arteries) "AVA"
2.
3.
Will fall off in 10 days; assess for infection
4.
1.
Skin
2.
1.
Normal variations
2.
1.
Acrocyanosis: immature circulation (cyanosis of hands and

feet)
2.
3.
Milia (tiny white papules on face, distended sebaceous

glands)
4.
5.
Toxic erythema (pink papular rash on trunk)
6.
7.
Vernix (white, cheese-like substance)
8.
9.
Mongolian spots: birth marks (irregular areas of pigmentation)
10.
11.
Lanugo (fine, downy hair on forehead, shoulders, back)

12.
3.
Color
4.
3.
Skeletal
4.
1.
Clavicles
2.
3.
Hips (Check for congenital hip dysplasia; feel for "Ortolani click")
4.
1.
Genitals
2.
1.
Female
2.
1.
Swollen
2.
3.
Pseudo menstruation
4.
5.
Vaginal tag
6.
3.
Male
4.
1.
Swollen
2.
3.
Hypospadias (opening on underside of penis)
4.
5.
Phimosis (stenosis that prevents foreskin from being retracted

back; leads to problems with urination; treatment:
circumcision)
6.
7.
Testicles
8.
3.
Elimination
4.
1.
Void in first 24 hours: pink stains from urates
2.
3.
Patent rectum: meconium during first 24 hours
4.
A neonate should void:

Urine in the first hour and meconium in the first 6 hours
Urine in the first 24 hours and meconium in the first 24 hours
Urine in the first 6 hours and meconium in the first hour
Urine in the first 12 hours and meconium in the first 12 hours
2. Vernix in a neonate
Acts as a protective skin coating
Consists of fine hairs covering parts of the body
Is a birthmark that look like bruising
Is a rash that does not need to be treated
3. Lanugo in a neonate:
Acts as a protective skin coating
Is a rash that does not need to be treated
a birthmark that look like bruising
Consists of fine hairs covering parts of the body
Assessment for Gestational Age
1.
Physical Assessment (first 24 hours): for full-term infant
2.
1.
Resting posture
2.
3.
Vernix distribution (very little)
4.
5.
Skin
6.
7.
Nails
8.
9.
Lanugo (very sparse)
10.
11.
Sole creases (present at full term)
12.
13.
Skull firmness
14.
15.
Breast tissue
16.
17.
Ear formation and cartilage (firm; springs back)
18.
19.
Genitalia
20.
21.
Recoil
22.
1.
Neurological Exam (after 24 hours)
2.
1.
Ankle dorsiflexion
2.
3.
Square window sign
4.
5.
Popliteal angle
6.
7.
Heel-to-ear maneuver
8.
9.
Scarf sign (contraindicated if fractured clavicle is suspected)
10.
11.
Neck extensors
12.
13.
Neck flexors
14.
15.
Horizontal position
16.
17.
Major reflexes
18.
1.
Sucking: response to nipple
2.
3.
Rooting: touch cheek and neonate will turn head to that side
4.
5.
Grasping: touch palm, fingers curl
6.
7.
Moro: "startle" reflex
8.
9.
Tonic neck: turn head to one side in supine position: arm and
leg on that side will extend, but flex on opposite side
10.
Physical assessment of a neonate should occur.

Within the first 48 hours
Within the first hour
2. During a neurological exam to determine the gestational age of a neonate, this

exam is contraindicated if the neonate has a fractured clavicle:
Neck flexors
Ankle dorsiflexion
Scarf sign
Square window sign
3. All of the following are neonate major reflexes, except:

Grasping
Grounding
Rooting
Moro
Care of Newborn
1.
Weigh daily: initial loss of 10% is normal; newborns should regain

birthweight by the two-week visit
2.
3.
Nutrition: record daily intake and number of wet and dry diapers
4.
5.
Regulate temperature
6.
7.
Circumcision: discuss options with parents
8.
1.
Permit signed
2.
3.
Assess for hemorrhage, infection
4.
5.
Required or forbidden by some cultures, religions or ethnic

groups
6.
9.
Tests
10.
1.
Phenylketonuria (PKU): lack of enzyme to convert phenylalanine

to tyrosine, Guthrie test: 24 hours after first milk feeding, again
in 4-6 weeks
2.
3.
Dextrostix: assess blood sugar level

4.
5.
Cultures: if possible infection
6.
11.
Parent education: general care such as feeding, bathing, dressing,

cord, and circumcision care
12.
13.
Promote attachment
14.
15.
Assess need for parental support after discharge
16.
A NEWBORN IS EXPECTED:
To lose 10% of its birth weight in the first week
To gain 10% of its birth weight in the first week
To gain 10% of its birth weight in the first month
To lose 10% of its birth weight in the first month
2. IN REGARD TO CARE OF A NEWBORN, THE PKU TEST SHOULD BE

CONDUCTED:
24 hours after the first reading
24 hours after the first milk feeding
24 hours after the first blood draw
24 hours after birth
3. ALL OF THE FOLLOWING ARE COMMON TESTS FOR NEWBORNS, EXCEPT:

Dextrostix
Cultures
PKU
HIV
In regard to umbilical cord care, the nurse should teach the parents all of the
following, except:
Not to immerse it in bath water until it falls off
How to assess it for infection
To wipe the area with alcohol after each diaper change
It should fall off in about two weeks
The nursing priorities for initial care of a neonate can be remembered by using
the mnemonic ABCT. "B" stands for:
Blood pressure
Blood type
Bolus
Breathing
In regard to the abdomen of a neonate, the nurse should do all of the following,
except:
Palpate for masses
Measure abdominal circumference
Listen for bowel sounds
Assess the umbilical cord
In regard to initial care of a newborn, for eye prophylaxis, the nurse may use all of
the following, except:
Tetracycline
Silver nitrate
Acyclovir
Erythromycin
The nursing priorities for initial care of a neonate can be remembered by using the
mnemonic ABCT. "A" stands for:
Access
Attention
Airway
Adenosine
The nursing priorities for initial care of a neonate can be remembered by using
the mnemonic ABCT. "C" stands for:
Caution
Circulation
Clamp
Creatinine
All of the following are signs and symptoms in a newborn that may need to be
reported to a physician, except:
Baby cries at night
Baby is listless
Fever
Baby is not eating well
A physical assessment to determine the gestational age of a neonate should

include all of the following, except:
Presence of lanugo and vernix
Genitalia and recoil
Muscle tissue and skull firmness
Skin and nails
In regard to initial care of a newborn, the nurse should assess the mouth for all of the
following, except:
Presence of sucking reflex
Whether the palate is intact
Whether respiration is occurring through the mouth
Presence of thrush
In regard to initial care of a newborn, a normal blood pressure for the infant is:
100/60
90/60
120/70
80/40
LESSON 11: PRENATAL CARE

FIRST TRIMESTER
PART 1
PRENATAL VITAMINS SHOULD BE TAKEN DURING PREGNANCY TO:
Provide essential nutrition in case a proper diet is not being eaten
Eliminate the possibility of health complications
Ensure that the fetus is firmly attached to the uterus
Prevent the mother from experiencing excessive discomfort
HEALTHY WEIGHT GAIN DURING THE FIRST TRIMESTER OF PREGNANCY IS

GENERALLY BETWEEN:
35 to 45 lbs
25 to 35 lbs
45 to 55 lbs
55 to 65 lbs
THE FIRST TRIMESTER OF PREGNANCY IS CHARACTERIZED BY:

Braxton Hick's contractions
Excessive back ache
Strong fetal movements
Nausea and vomiting
PART II
Screening for Down syndrome and other neonatal complications can begin by:
The 8th week of pregnancy
2. All of the following are considered normal during the first trimester of pregnancy,
except
Weak bladder control
Breast tenderness
Sleepless nights
Feeling bloated
3. All of the following are considered normal during the first trimester of pregnancy,
except:
PMS-like symptoms
Swollen ankles.
Fatigue
Irritability
PART III
SUBCHORIONIC HEMATOMA IS USUALLY MONITORED THROUGH:
Ultrasound
Abdominal palpation
Blood test
Urine test
2. All of the following should be monitored throughout the period of pregnancy,

except:
Weight
Height
Blood pressure
Heart rate
3. Subchorionic hematoma is characterized by:

Bleeding of varying degrees, from light spotting to heavy gushing with clots
Painless contractions that occur 6 to 10 times per day
Disproportionate enlargement of the uterus and abdominal tenderness
Increased venous stasis and IVC compression
SECOND TRIMESTER
PART I
During the second trimester of pregnancy, the nurse should promote all of the
following. except:
Bed rest
Nutrition
Proper diet
Exercise
2. Women in the second trimester of pregnancy should exercise to most specifically

prevent:
Blood clots
Dizziness
Chills
Hypertension
3. During the second trimester of pregnancy, women usually experience increased:

Nausea and vomiting
Morning sickness
Fetal movements
Defecation
PART II
According to the lesson, for pregnant women, a good source of calcium is:
Cashew nuts
Potatoes
Pork
Totu
2. During the second trimester of pregnancy clients should drink at least

6 glasses of
12 glasses of fluid
8 glasses of fluid
10 glasses of fluid
3. A pregnant women in her second trimester should get at least this much calcium
per day:
2 servings
8 servings
6 servings
4 servings
PART III
During the second trimester of pregnancy, the heartbeat of the infant should range
between:
80-110 beats per minute
2. During an oral glucose tolerance test fly gestational diabetes, a blood sample is
taken:
60 minutes after drinking the sweetened liquid
30 minutes after drinking the sweetened liquid
2 hours after drinking the sweetened liquid
1 day after drinking the sweetened liquid
Assessment of a client in the second trimester of pregnancy should include all of the
following except:
Fundal height
Edema
Baby's heartbeat
Diabetes screening
THIRD TRIMESTER
PART I
1, Clients in their third trimester are usually assessed for all of the following, except:
High blood pressure
Swelling
Tachypnea
Headaches
2. All of the following are red flags during pregnancy except

Toxemia
Chloasma
Proteinuria
Hypertension
3. During the third trimester of pregnancy, the urine of the client should be tested for:
Calcium and sodium
Glucose and protein
Sodium and protein
Glucose and Sodium
PART II
All of the following are signs of impending labor, except:
Water break
Nausea and vomiting
Severe back pain
Strong uterine contraction
2. A pregnant client in her third trimester is most uncomfortable when

Lying on one side
Lying supine
Sitting upright
Standing
3. All of the following may help minimize discomfort during the third trimester of
pregnancy. except
Placing pillows in between the
Placing pillows under the belly
Hot and cold compresses
Sleeping on one side
PART III
Breastfeeding should begin to become comfortable for both the mother and baby
after:
2 to 3 weeks
4 to 5 weeks
8 to 9 weeks
6 to 7 weeks
2. To prevent pre-eclampsia, the health care provider should look for signs of:
Respiratory distress
Candidiants
Hypertension
Endometriosis
3. A client in her third trimester should immediately inform her health care provider if
she experiences any of the following, except
Blurred vision
Fetal movement in the left part of the abdomen
Excessive swelling
Headaches that do not go away with rest
PRETERM LABOR AND DELIVERY

PART I
1. In preterm labor, magnesium sulfate is usually effective for about:
72 hours
36 hours
12 hours
48 hours
2. During pregnancy, a client should contact her physician if she experiences this
many contractions per hour:
5 contractions
6 contractions
4 contractions
3 contractions
3. This may be administered to treat preterm labor by delaying contractions:
Magnesium sulfate
Ritodrine or terbutaline
Pitoan
Nifedipine
PART II
1. A preterm infant on intermediate care is usually placed in:
An incubator
An Invasive BP unit
An open crib
A closed isolette
2. To avoid some possible complications of prematurity, a preterm neonate should

receive this type of therapy:
Enzyme replacement therapyElectrotherapy
Moist heat therapy
Phototherapy
3. Kangaroo care can be best defined as:

A method of care for preterm infants herein the infant is held in close skin-to-
skin contact with a parent
A care technique for preterm infants which decreases the risk of cranial distortion and
plagiocephaly
A practice of wrapping infants in swaddling cloths or blankets to develop proper
posture
A practice of carrying a baby in a sling to promote attachment parenting
GESTATIONAL DIABETES
PART I
1. This test confirms gestational diabetes:
Western blot test
ABG
Glucose tolerance test
Urinalysis
2. The sugar level of a pregnant client is usually monitored through:
Urine testing
Vaginal smear
Western blot test
Sputum culture
3. Client teaching for gestational diabetes usually covers all of the following topics,
except:
Various types of treatment
Psychoshal effects of experiencing the disease
Nature of the disease
Diet regimens appropriate for the cilent's needs
PART II
A client with gestational diabetes is likely to develop diabetes mellitus within:
5 to 8 years
2 to 8 months
6 to 12 months
1 to 7 years
2. A client with gestational diabetes may meet with a nutritionist to most specifically:
Monitor the fetus condition during insulin therapy
Plan the appropriate combinations of food for the client's condition
Accurately monitor her blood sugar level
Design an appropriate exercise regimen for the client
3. A client with gestational diabetes should eat a diet that is mostly composed of all of
the following, except
Vegetables
Grains
Fruit
Fat
FETAL LOSS
PART I
1. In the lesson, the cause of the client's fetal loss was:
Chorioamnionitis
Huntington's chorea
Cystic fibrosis
Blighted ovum
2. This is used to detect and trace the heart rate of the fetus:
Heart-lung machine
Pulse oximeter
Fetal monitor
Ultrasound
3. To measure the cervix dilation of a pregnant client, the care provider should
perform a/an:
Fetoscopy
Amniocentesis
Vaginal examination
Ultrasound
PART II
1. In regard to fetal loss, all of the following are appropriate nursing interventions,
except:
Encourage the family to hold the baby
Encourage the family to talk to other people who have undergone the same
experience
Transport the baby to the morgue immediately after delivery
Exhibit a professional yet caring approach
2. All of the following statements about grief due to fetal loss are true, except:
Support people are crucial and significant during the grieving process
Sharing experiences with others may help in coping with grief and loss
Experiencing grief and sadness after a significant loss is normal
Suppressing emotions may speed up the grieving process
3. In regard to fetal loss, all of the following are appropriate nursing interventions,
except:
Be sensitive to the family's needs
Help the family with the grieving process
Encourage the family to trust God's plan
Let the family spend time with the baby,
7/10
A client of advanced maternal age may be required to undergo all of the following
additional assessments, except:
Amniocentesis
Genetic testing
Reflex testing
Placenta testing
During the third trimester of pregnancy, clients are commonly assessed for all of the
following, except:
Discharge or bleeding
Vaginal itching or burning
Fetal position and movement
Nausea and vomiting.
Nursing care for women in the third trimester of pregnancy should focus on all of the
following, except:
Client teaching about the discomforts of late pregnancy
Client and fetal health assessments
Physical and psychological preparation for the birth process
The importance of monthly check-ups until the ninth month of pregnancy
A true contraction during the third trimester of pregnancy causes:

Pain in the leftmost portion of the abdomen
The upper portion of the abdomen to harden
The upper portion of the abdomen to soften
Pain in the rightmost portion of the abdomen
Women in the second trimester of pregnancy should exercise to most specifically

improve:
Respiration
Muscle tone
Circulation
Stamina
Protein in urine during pregnancy could be a sign of:

Bacterial infection
Problems in blood pressure
Pancreatic disease
Gestational diabetes
During the first trimester of pregnancy, the health care provider should focus on all of
Providing client education
Obtaining baseline information for the client's care
Determining potential problems that may occur throughout the pregnancy
Establishing an atmosphere of care and empathy
This pregnant client is most at increased risk for developing gestational diabetes:
An obese 26-year old
A 28-year old multigravida with gonorrhea
A 24-year old primigravida with genital herpes
A malnourished 23-year old
Pre-eclampsia is characterized by:

Oliguria
Facial edema
Blood pressure elevation
Decreased cardiac output
A good physical exercise for pregnant women during the second trimester is:
Walking
Weight lifting
Jogging
Passive ROM exercises
LESSON 12
INITIAL CARE: PART I
1. TO AVOID CIRCULATION PROBLEMS AFTER A C-SECTION, THE NURSE
SHOULD:
Assess the client's pain every hour
Have the client walk as soon as she is able to
Obtain the client's hemodynamic values
Have the client take vitamin K to increase coagulation
2. AFTER A C-SECTION, THE NURSE SHOULD ADVISE THE CLIENT TO:

Drink more than 8 glasses of fluid per day
Splint when moving in bed
Avoid applying pressure on the abdomen
Palpate the abdomen to locate the uterus
3. AFTER A C-SECTION, THE NURSE SHOULD ENCOURAGE THE CLIENT TO:

Avoid eating anything cold
Move while in bed
Avoid massaging her breasts
Sit up straight most of the time
PART II
1. The first stool of a newborn is normally:
Dark and tarry
Yellow and soft
Blood tinged and hard
Light brown and watery
2. To prepare for breastfeeding, the mother can:

Massage her breast in a circular motion towards the nipple
Massage her breast in a circular motion away from the nipple
Massage her breast in an up and down motion towards the nipple
Massage her breast in an up and down motion away from the nipple
3. When sleeping, a newborn should be:
Laid on his/her right side
Laid on his/her left side
Laid on his/her back
Laid on his/her stomach
PART III
1. A newborn baby should be breastfed at least:
10 to 16 times a day
8 to 12 times a day
12 to 18 times a day
6 to 10 times a day
2. All of the following tests and/or procedures are routinely performed in a

newborn, except
Hearing test
Newborn screening test
Chromosomal screening
Hepatitis vaccination
3. After a C-section, vaginal bleeding may occur until:

The 6th week after delivery
The 5th week after delivery
The uterus returns to its normal shape
The incision is totally healed
PREPARATION FOR DISCHARGE

PART I
1. POSTPARTUM BLEEDING MAY OCCUR FOR:
1 to 3 weeks
6 to 8 weeks
2 to 6 weeks
3 to 4 weeks
2. THE CORD STUMP OF A NEWBORN SHEDS OFF WITHIN:

2 days 2 weeks
5 days 1 week
10 days 2 weeks
12 days 3 weeks
3. IF A POSTPARTUM CLIENT EXPERIENCES ABDOMINAL CRAMPS, THE

NURSE SHOULD ENCOURAGE HER TO:
Urinate often
Lie on her back
Walk around
Use the peri bottle
PART II
1. During the first few weeks, the postpartum client should try to increase her:
Caloric intake
Fat intake
Sodium intake
Iron intake
2. All of the following are ways to prevent postpartum depression, except:

Get sufficient rest
Spend more time with the infant
Eat a proper diet
Seek and receive help in infant care
1. All of the following are signs that the body is not responding well to the hormonal
changes that occur after pregnancy, except
Cannot eat
Unable to get out of bed
Feels unattractive
Unable to sleep
1. All of the following are appropriate nursing instructions for clients with mastitis,
except:
Take antibiotics
Take lots of fluid
Rest
Stop breastfeeding
2. Symptoms of mastitis may include all of the following, except:

Milkstasis
Breast engorgement
Fever
Breast pain
This part of the uterus is the last to heal after giving birth:
Isthmus of the uterus
The cervix
Fundus of the uterus
Area where the placenta was deepest
2. The healing process of the uterus after giving birth may continue for up to:
2 to 3 weeks
4 to 5 weeks
3 to 4 weeks
5 to 6 weeks
3. If a postpartum client experiences some bleeding during an activity, one way to

attempt to stop the bleeding is to:
Drink cold water
Breast feed
Wash her genitals
Rest
Mababa ako dito

All of the following are normal findings in a female newborn, except:
Swelling in the labia
Pseudo-period
Mongolian spot
Low-set ears
Postpartum abdominal cramps are often worse in a client who:

Is over 25 years old
Does not breastfeed
Is under 25 years old
Breastfeeds
To prepare a newborn for breastfeeding, the mother should be advised to do all of

Play with the baby's tongue
Bring the baby close to her
Massage the baby's back
Talk to the baby
A peri bottle is used by postpartum clients to:

Relieve perineal and vaginal pain
Check the amount and color of the vaginal discharge
Prevent hemorrhoids from forming
Cleanse the area of an episiotomy after urinating
To prepare for breastfeeding, the mother can:

Massage her breast in a circular motion towards the nipple
Massage her breast in a circular motion away from the nipple
Massage her breast in an up and down motion towards the nipple
Massage her breast in an up and down motion away from the nipple
This can help ease postpartum abdominal cramps:

Light meals
Cold compress
Hot compress
Light exercise
An episiotomy normally causes:

Itching and burning over the area
Rectal swelling and local pain
Discomfort and low-grade fever
Vaginal bleeding and mucus discharge
After a C-section, the nurse should encourage the client to:

Sit up straight most of the time
Move while in bed
Avoid eating anything cold
Avoid massaging her breasts
Massaging the breast prior to feeding will help prevent:

Ductal carcinomas
Engorgement
Atypical hyperplasia
Mastitis
The uterus returns to its normal shape approximately:

1 to 4 weeks after delivery
Postpartal Adaptations and Nursing Assessment
Physical Assessment
BUBBLE HE
1.
Breasts
2.
1.
Engorgement
2.
1.
Non breast feeding: don't stimulate
2.
1.
Ice
2.
3.
Supportive bra
4.
5.
Pain meds
6.
3.
Breast feeding
4.
1.
Frequent hot showers

2.
3.
Frequent feedings
4.
5.
Massage
6.
3.
Uterus (involution)
4.
1.
Fundus is at umbilicus after delivery; 1 fingerbreadth above umbilicus

12 hours after delivery; decreases 1 fingerbreadth a day; by 10th day,
is at symphysis pubis
2.
3.
Fundus involutes faster if client breast feeds infant
4.
5.
Gastrointestinal
6.
1.
Sluggish bowels
2.
3.
Increased appetite
4.
5.
Hemorrhoids
6.
7.
8.
1.
Administer stool softeners
2.
3.
Instruct client to increase dietary fiber and fluids
4.
5.
Suggest sitz baths, witch hazel pads for comfort
6.
1.
Urinary tract
2.
1.
Lessened sensation of bladder fullness
2.
3.
Urinary retention
4.
5.
Difficulty urinating
6.
3.
Lochia
4.
1.
Definition: vaginal discharge following delivery
2.
3.
Color
4.
1.
Rubra (1-3 days)
2.
3.
Serosa (3-10 days)
4.
5.
Alba (3-6 weeks)
6.
5.
Odor: if foul smelling, may indicate infection
6.
7.
Amount: moderate at first, will increase with activity
8.
9.
Afterpains: due to involution of uterus; more severe with multiple births

(example: twins), polyhydramnios; administration of oxytocin,
breastfeeding
10.
11.
Menstruation: resumes in about 6-8 weeks in non-nursing mothers;

and can vary with nursing mothers
12.
5.
Perineum
6.
1.
Episiotomy or laceration
2.
1.
Edema
2.
3.
Pain
4.
3.
4.
1.
Sitz baths
2.
3.
Sprays or ointments
4.
5.
Kegel exercises
6.
1. A substance discharged from the vagina after delivery best describes:

Lochia
Ichor
Amniotic fluid
Succus
2. The color of lochia within 3 to 10 days post-delivery is called:

Mebara
Rubra
Serosa
Alba
3. Appropriate treatments for engorged breasts in non-nursing mothers, include all of

the following.except:
Use of a supportive bra
Frequent hot showers
Avoidance of use of a breast pump
Application of ice
1. According to the video, mood swings and depression after delivery may be related
to all of the following, except:
Postpartum medications
Major life adjustments
Hormonal changes
Fatigue
2. Postpartum depression:
Usually peaks on the 5th day and should ompt notification of the primary care
provider if it lasts more than 10 days
Usually peaks on the 14th day and should prompt notification of the primary care
provider if lasts more than 90 days.
Usually peaks on the 10th day and should prompt notification of the primary care
Usually peaks on the 3rd day and should prompt notification of the primary care
3. Postpartum hemorrhage may be caused by all of the following, except:

Infection
Lacerations
Retained placenta
Atony

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LABOR AND DELIVERY

EFFECTIVE POSITIONING DURING LABOR CAN:

Reduce uterine pressure and speed up the delivery

Speed up cervical dilation

Reduce the amount of muscular effort needed during delivery

Speed up the labor process and reduce discomfort

Lying flat on the back

Relaxing the shoulders

Perform an ultrasound to assess the fetus

Administer the proper medications immediately

Acquire the medical and health history of the client

TO HELP REDUCE THE PAIN DURING LABOR, THE NURSE MAY:

Give the client a hand massage

Massage the abdomen of the client in between contractions

Give the client soft foods and plenty of fluids

DURING LABOR, SOAKING IN A TUB OF WATER MAY:

Result in an easy and fast delivery

Cause the body to become numb

Make the contractions more manageable

The placenta is expelled

The head emerges from the perineum

The head and shoulders emerge from perineum

The baby completely emerges

THE APGAR SCORE GRADES ALL OF THE FOLLOWING, EXCEPT:

Apnea and muscle cramps

Dizziness and numbing of the feet and hands

Dizziness and muscle cramps

Apnea and numbing of the feet and hands

Provided the client with birthing information

Allowed as many people as possible into the delivery room

Coached the client to push, pant, and blow

Allowed the husband of the client to watch

To reassure the client that the birthing process is progressing

To support the baby as it emerges from the birth canal

To allow an early connection between the mother and the infant

THE GI TRACT OF JANET'S BABY WAS SUCTIONED BY THE NURSE TO DRAIN:

Melena from the infant's stomach

Lanugo from the infant's stomach

Fluid from the infant's stomach

DURING LABOR, THE CLIENT SHOULD NOT PUSH UNTIL:

Blood spots appear

The cervix is fully dilated

Contractions have become long and strong

Contractions last for 30 seconds each

THE FIRST VITAMIN A NEWBORN USUALLY RECEIVES IS

NEWBORNS HAVE BLUE HANDS AND FEET BECAUSE

Newboms initially lack oxygen

These body parts are most distal from the brain

These body parts are most distal from the near

Newborns are still adapting to the temperature outside the uterus

CERVIX DILATION IS ASSESSED TO

Calculate the duration of the labor process and delivery

Determine the fetal heart rate

Determine if labor is progressing to the next stage

Determine the presences of any fetal complications

A. Power (Uterine Contractions)

C. Passageway (Maternal Pelvis)

IN LABOR, DILATION REFERS TO THE: