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Chapter 8: Intrapartum Assessment and Interventions
Multiple Choice
1. In caring for a primiparous woman in labor, one of the factors to evaluate is uterine activity.
This is referred to as the __________ of labor.a. Passengerb. Passagec. Powersd. Psyche
ANS: c
Feedback
a. The passenger refers to the fetus.
b. The passage refers to the pelvis and birth canal.
c. Powers refer to the contractions.
d. Psyche refers to the response of a woman to
labor.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content
Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Easy
2. The provision of support during labor has demonstrated that women experience a decrease in
anxiety and a feeling of being in more control. In clinical situations, this has resulted in:a. A
decrease in interventionsb. Increased epidural ratesc. Earlier admission to the hospitald.
Improved gestational age
ANS: a
Feedback
a. Studies have shown that with a support person,
be it a family member, friend, or professional
such as a Doula or nurse, the patient
experiences a decrease in anxiety and has a
feeling of being in more control. This, in turn,
results in a decrease in interventions, a
significantly lower level of pain, and an
enhanced overall maternal satisfaction.
b. There is decreased use of pain medication with
continuous labor support.
c. There is no evidence that continuous labor
support results in earlier admission to the
hospital.
d. There is no evidence that continuous labor
support results in improved gestational age for
the fetus.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Comprehension | Content
Area: Maternity | Client Need: PSI, Psychosocial Integrity | Difficulty Level: Moderate
3. When caring for a primiparous woman being evaluated for admission for labor, a key
distinction between true versus false labor is:a. True labor contractions result in rupture of
membranes, and with false labor, the membranes remain intact.b. True labor contractions result
in increasing anxiety and discomfort, and false labor does not.c. True labor contractions are
accompanied by loss of the mucus plug and bloody show, and with false labor there is no vaginal
discharge. d. True labor contractions bring about changes in cervical effacement and dilation,
and with false labor there are irregular contractions with little or no cervical changes.
ANS: d
Feedback
a. Rupture of membranes can occur prior to labor
or during labor.
b. A woman’s response to labor may not be
reflective of her status in labor but is
influenced by expectations and emotional
status.
c. Loss of the mucus plug can occur prior to the
onset of labor.
d. True labor contractions bring about changes in
cervical effacement and dilation, and with false
labor there are irregular contractions with little
or no cervical changes.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area:
Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate
4. The mechanism of labor known as cardinal movements of labor are the positional changes
that the fetus goes through to best navigate the birth process. These cardinal movements are:a.
Engagement, Descent, Flexion, Extension, Internal rotation, External rotation, Expulsion b.
Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion c.
Engagement, Flexion, Internal rotation, Extension, External rotation, Descent, Expulsion d.
Engagement, Flexion, Internal rotation, Extension, External rotation, Flexion, Expulsion
ANS: b
Feedback
a. The order of the cardinal movements is
incorrect.
b. Engagement occurs when the greatest diameter
of the fetal head passes through the pelvic
inlet. Engagement can occur late in pregnancy
or early in labor. Descent is the movement of
the fetus through the birth canal during the first
and second stages of labor. Flexion is when the
chin of the fetus moves toward the fetal chest.
Flexion occurs when the descending head
meets resistance from maternal tissues. This
movement results in the smallest fetal diameter
to the maternal pelvic dimensions. It typically
occurs early in labor. Internal rotation is the
movement, the rotation of the fetal head, that
aligns the long axis of the fetal head with the
long axis of the maternal pelvis. It occurs
mainly during the second stage of labor.
Extension is the movement facilitated by
resistance of the pelvic floor, causing the
presenting part to pivot beneath the pubic
symphysis and the head to be delivered. This
occurs during the second stage of labor.
External rotation is when the sagittal suture
moves to a transverse diameter and the
shoulders align in the anteroposterior diameter.
The sagittal suture maintains alignment with
the fetal trunk as the trunk navigates through
the pelvis. Expulsion is the movement that
occurs when the shoulders and remainder of
the body are delivered.
c. The order of the cardinal movements is
incorrect.
d. The order of the cardinal movements is
incorrect.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Comprehension | Content
Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate
5. A woman is considered in active labor when:a. Cervical dilation progresses from 4 to 7 cm

with effacement of 40% to 80%, contractions become more intense, occurring every 2 to 5
minutes with duration of 45 to 60 seconds.b. Cervical dilation progresses to 3 cm with
effacement of 30, contractions become more intense, occurring every 2 to 5 minutes with
duration of 45 to 60 seconds.c. Cervical dilation progresses to 8 cm with effacement of 80%,
contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60
seconds.d. Cervical dilation progresses to 10 cm with effacement of 90%, contractions become
more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.
ANS: a
Feedback
a. Characteristics of this phase are the cervix
dilates, on an average, 1.2 cm/hr for
primiparous women and 1.5 cm/hr for
multiparous women. Cervical dilation
progresses from 4 to 7 cm with effacement of
40% to 80%. Fetal descent continues and
contractions become more intense, occurring
every 2 to 5 minutes with duration of 45 to 60
seconds, and discomfort increases.
b. Cervical dilation progresses to 3 cm with
effacement of 30, indicating the early or latent
phase of labor.
c. Cervical dilation progresses to 8 cm with
effacement of 80%, indicating the transition
phase of labor.
d. Cervical dilation of 10 cm with effacement is
the end of the first stage of labor.
6. You are caring for a woman in labor who is 6 cm dilated with a reassuring FHT pattern and
regular strong UCs. The fetal heart rate (FHR) should be:a. Monitored continuouslyb. Monitored
every 15 minutesc. Monitored every 30 minutesd. Monitored every 60 minutes
ANS: c
Feedback
a. Assessment of fetal heart rate (FHR) during the
active phase of labor with a reassuring FHR is
not indicated continuously.
b. Assessment of fetal heart rate (FHR) during the
not indicated every 15 minutes.
c. Assessment of fetal heart rate (FHR) during the
indicated every 30 minutes.
d. Assessment of fetal heart rate (FHR) during the
indicated every 30 minutes, not every 60
minutes.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content
7. A woman you are caring for in labor requests an epidural for pain relief in labor. Included in
your preparation for epidural placement is a baseline set of vital signs. The most common vital
sign to change after epidural placement:a. Blood pressure, hypotension
b. Blood pressure, hypertension
c. Pulse, tachycardia
d. Pulse, bradycardia
ANS: a
Feedback
a. Blood pressure, hypotension, as up to 40% of
women may experience hypotension.
Hypotension is defined as systolic BP <100
mm Hg or 20% decrease in BP from
preanesthesia levels. Intravenous bolus is
typically given to decrease the incidence of
hypotension.
b. Blood pressure, hypertension is incorrect
because hypotension is the common
complication after epidural placement.
c. Pulse, tachycardia is incorrect because
hypotension is the common complication after
epidural placement.
d. Pulse, bradycardia is incorrect because
hypotension is the common complication after
epidural placement.
8. The labor patient you are caring for is ambulating in the hall. Her vaginal exam 1 hour ago
indicated she was 4/70/–1 station. She tells you she has fluid running down her leg. Your priority
nursing intervention is to:a. Assess the color, odor, and amount of fluid.b. Assist your patient to
the bathroom.c. Assess the fetal heart rate.d. Call the care provider.
ANS: c
Feedback
a. Although assessing the color, odor, and
amount of fluid is appropriate, the priority
nursing action is to assess the FHR because of
the risk of umbilical cord prolapse with rupture
of membranes.
b. The fluid is probably related to rupture of
membranes rather than the patient needing to
go to the bathroom to urinate.
c. Assessing the fetal heart rate is the first priority
because of the risk of umbilical cord prolapse
with rupture of membranes.
d. Although you may call the care provider, the
priority nursing action is to assess the FHR
because of the risk of umbilical cord prolapse
with rupture of membranes.
Area: Maternity | Client Need: Reduction of Risk Potential | Difficulty Level: Moderate
9. You are in the process of admitting a multiparous woman to labor and delivery from the triage
area. One hour ago her vaginal exam was 4/70/0. While completing your review of her prenatal
record and completing the admission questionnaire, she tells you she has an urge to have a bowel
movement and feels like pushing. Your priority nursing intervention is to:a. Reassure the patient
and rapidly complete the admission.b. Assist your patient to the bathroom to have a bowel
movement.c. Assess the fetal heart rate and uterine contractions.d. Perform a vaginal exam.
ANS: d
Feedback
a. Completing the admission paperwork is not a
priority when birth may be imminent.
b. The urge to have a bowel movement is
probably related to fetal descent and complete
dilation rather than the patient needing to have
a bowel movement.
c. Doing a vaginal exam is the first priority as
birth may be imminent.
d. Perform a vaginal exam to assess the progress
of labor. The urge to have a bowel movement
and feeling like pushing indicate that birth may
be imminent.
10. The Apgar score consists of a rapid assessment of five physiological signs that indicate the
physiological status of the newborn and includes:a. Apical pulse strength, respiratory rate,
muscle flexion, reflex irritability, and colorb. Heart rate, clarity of lungs, muscle tone, reflexes,
and colorc. Apical pulse strength, respiratory rate, muscle tone, reflex irritability, and color of
extremitiesd. Heart rate, respiratory rate, muscle tone, reflex irritability, and color
ANS: d
Feedback
a. Heart rate, not apical pulse strength, is the
criterion for Apgar scoring; muscle tone, not
flexion, is assessed.
b. Clarity of lungs and reflexes are not assessed
as part of Apgar scoring. Neonatal lungs can be
congested normally at birth, and reflexes are
not assessed. Rather, reflex irritability is
assessed, based on response to tactile
stimulation.
c. Heart rate, not apical pulse strength, is assessed
along with respiratory rate, muscle tone, reflex
irritability, and color of extremities.
d. The Apgar score includes assessment of heart
rate based on auscultation, respiratory rate
based on observed movement of chest, muscle
tone based on degree of flexion and movement
of extremities, reflex irritability based on
response to tactile stimulation, and color based
on observation.
11. The perinatal nurse is assessing a woman in triage who is 34 + 3 weeks’ gestation in her first
pregnancy. She is worried about having her baby “too soon,” and she is experiencing uterine
contractions every 10 to 15 minutes. The fetal heart rate is 136 beats per minute. A vaginal
examination performed by the health-care provider reveals that the cervix is closed, long, and
posterior. The most likely diagnosis would be:
a. Preterm labor
b. Term labor
c. Back labor
d. Braxton-Hicks contractions
ANS: d
Feedback
a. Preterm labor (PTL) is defined as regular
uterine contractions and cervical dilation
before the end of the 36th week of gestation.
Many patients present with preterm
contractions, but only those who demonstrate
changes in the cervix are diagnosed with
preterm labor.
b. Term labor occurs after 37 weeks’ gestation.
c. There is no indication in this scenario that this
is back labor.
d. Braxton-Hicks contractions are regular
contractions occurring after the third month of
pregnancy. They may be mistaken for regular
labor, but unlike true labor, the contractions do
not grow consistently longer, stronger, and
closer together, and the cervix is not dilated.
Some patients present with preterm
contractions, but only those who demonstrate
changes in the cervix are diagnosed with
preterm labor.
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Difficult
12. The perinatal nurse knows that the term to describe a woman at 26 weeks’ gestation with a
history of elevated blood pressure who presents with a urine showing 2+ protein (by dipstick) is:
a. Preeclampsia
b. Chronic hypertension
c. Gestational hypertension
d. Chronic hypertension with superimposed preeclampsia
ANS: d
Feedback
a. Preeclampsia is a multisystem, vasopressive
disease process that targets the cardiovascular,
hematologic, hepatic, and renal and central
nervous systems.
b. Chronic hypertension is hypertension that is
present and observable prior to pregnancy or
hypertension that is diagnosed before the 20th
week of gestation.
c. Gestational hypertension is a nonspecific term
used to describe the woman who has a blood
pressure elevation detected for the first time
during pregnancy, without proteinuria.
d. The following criteria are necessary to
establish a diagnosis of superimposed
preeclampsia: hypertension and no proteinuria
early in pregnancy (prior to 20 weeks’
gestation) and new-onset proteinuria, a sudden
increase in protein—urinary excretion of 0.3 g
protein or more in a 24-hour specimen, or two
dipstick test results of 2+ (100 mg/dL), with
the values recorded at least 4 hours apart, with
no evidence of urinary tract infection; a sudden
increase in blood pressure in a woman whose
blood pressure has been well controlled;
thrombocytopenia (platelet count lower than
100,000/mmC); and an increase in the liver
enzymes alanine transaminase (ALT) or
aspartate transaminase (AST) to abnormal
levels.
Area: Peds/Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level:
Moderate
13. A patient is receiving magnesium sulfate for severe preeclampsia. The nurse must notify the
attending physician immediately of which of the following findings?
a. Patellar and biceps reflexes of +4
b. Urinary output of 50 mL/hr
c. Respiratory rate of 10 rpm
d. Serum magnesium level of 5 mg/dL
ANS: c
Feedback
a. Magnesium sulfate has been ordered because
the patient has severe pregnancy-induced
hypertension. Patellar and biceps reflexes of +4
are symptoms of the disease.
b. The urinary output must be above 25 mL/hr.
c. The drop in respiratory rate may indicate that
the patient is suffering from magnesium
toxicity. The nurse should report the finding to
the physician.
d. The therapeutic range of magnesium is 4 to 7
mg/dL.
KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Implementation |

Cognitive Level: Application | Content Area: Adverse Effects/Contraindications; Antepartum
Care; Potential for Alterations in Body Systems; Reduction of Risk Potential: Diagnostic Tests |
Client Need: Health Promotion and Maintenance; Pharmacological and Parenteral Therapies;
Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Difficult
14. A woman in labor and delivery is being given subcutaneous terbutaline for preterm labor.
Which of the following common medication effects would the nurse expect to see in the mother?
a. Serum potassium level increases
b. Diarrhea
c. Urticaria
d. Complaints of nervousness
ANS: d
Feedback
a. The nurse would not expect to see a rise in the
mother’s serum potassium levels.
b. The beta agonists are not associated with
diarrhea.
c. The beta agonists are not associated with
urticaria.
d. Complaints of nervousness are commonly
made by women receiving subcutaneous beta
agonists.
KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application | Content
Area: Intrapartum Care; Pharmacological and Parenteral Therapies: Adverse
Effects/Contraindications and Side Effects | Client Need: Health Promotion and Maintenance;
Physiological Integrity: Pharmacological and Parenteral Therapies | Difficulty Level: Moderate
15. Which of the following signs or symptoms would the nurse expect to see in a woman with
concealed abruptio placentae?
a. Increasing abdominal girth measurements
b. Profuse vaginal bleeding
c. Bradycardia with an aortic thrill
d. Hypothermia with chills
ANS: a
Feedback
a. The nurse would expect to see increasing
abdominal girth measurements.
b. Profuse vaginal bleeding is rarely seen in
placental abruption and is never seen when the
abruption is concealed.
c. With excessive blood loss, the nurse would
expect to see tachycardia.
d. The nurse would expect to see a stable
temperature.
KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content
Area: Antepartum Care; Reduction of Risk Potential: Potential for Alterations in Body Systems |
Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk
Potential | Difficulty Level: Moderate
16. A woman who has had no prenatal care was assessed and found to have hydramnios on
admission to the labor unit and has since delivered a baby weighing 4500 grams. Which of the
following complications of pregnancy likely contributed to these findings?
a. Pyelonephritis
b. Pregnancy-induced hypertension
c. Gestational diabetes
d. Abruptio placentae
ANS: c
Feedback
a. Pyelonephritis does not lead to the
development of hydramnios or macrosomia.
b. Pregnancy-induced hypertension does not lead
to the development of hydramnios or
macrosomia.
c. Untreated gestational diabetics often have
hydramnios and often deliver macrosomic
babies.
d. Abruptio placentae does not lead to the
development of hydramnios or macrosomia.
Area: Antepartum Care; Physiological Adaptation: Alterations in Body Systems | Client Need:
Health Promotion and Maintenance; Physiological Integrity: Physiological Adaptation |
Difficulty Level: Difficult
17. For the patient with which of the following medical problems should the nurse question a
physician’s order for beta agonist tocolytics?
a. Type 1 diabetes mellitus
b. Cerebral palsy
c. Myelomeningocele
d. Positive group B streptococci culture
ANS: a
Feedback
a. Beta agonists often elevate serum glucose
levels. The nurse should question the order.
b. Beta agonists are not contraindicated for
patients with cerebral palsy.
c. Beta agonists are not contraindicated for
patients with myelomeningocele.
d. Beta agonists are not contraindicated for
patients with group B streptococci.

Cognitive Level: Application | Content Area: Intrapartum Care; Reduction of Risk Potential:
Potential for Alterations in Body Systems | Client Need: Health Promotion and Maintenance;
18. The nurse is caring for two laboring women. Which of the patients should be monitored most
carefully for signs of placental abruption?
a. The patient with placenta previa
b. The patient whose vagina is colonized with group B streptococci
c. The patient who is hepatitis B surface antigen positive
d. The patient with eclampsia
ANS: d
Feedback
a. Patients with placenta previa are not especially
high risk for placental abruption.
b. Patients colonized with group B streptococci
are not especially high risk for placental
abruption.
c. Patients who are hepatitis B surface antigen
positive are not especially high risk for
placental abruption.
d. Patients with eclampsia are high risk for
placental abruption.
KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application |

Content Area: Intrapartum Care; Reduction of Risk Potential: Potential for Complications |
Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk
Potential | Difficulty Level: Difficult
19. The nurse is caring for a woman at 28 weeks’ gestation with a history of preterm delivery.
Which of the following laboratory data should the nurse carefully assess in relation to this
diagnosis?
a. Human relaxin levels
b. Amniotic fluid levels
c. Alpha-fetoprotein levels
d. Fetal fibronectin levels
ANS: d
Feedback
a. Relaxin levels are rarely assessed. In addition,
they are unrelated to the incidence of preterm
labor.
b. Amniotic fluid levels are not directly related to
the incidence of preterm labor.
c. Alpha-fetoprotein levels are not related to the
incidence of preterm labor.
d. A rise in the fetal fibronectin levels in cervical
secretions has been associated with preterm
labor.
Area: Antepartum Care; Reduction of Risk Potential: Laboratory Values | Client Need: Health
Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty
Level: Moderate
20. Which of the following statements is most appropriate for the nurse to say to a patient with a
complete placenta previa?
a. “During the second stage of labor you will need to bear down.”
b. “You should ambulate in the halls at least twice each day.”
c. “The doctor will likely induce your labor with oxytocin.”
d. “Please promptly report if you experience any bleeding or feel any back discomfort.”
ANS: d
Feedback
a. This response is inappropriate. This patient
will be delivered by cesarean section.
b. This response is inappropriate. Patients with
placenta previa are usually on bed rest.
c. This response is inappropriate. This patient
will be delivered by cesarean section.
d. Labor often begins with back pain. Labor is
contraindicated for a patient with complete
placenta previa.

Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty
Level: Easy
21. A woman at 32 weeks’ gestation is diagnosed with severe preeclampsia with HELLP
syndrome. The nurse will identify which of the following as a positive patient care outcome?
a. Rise in serum creatinine
b. Drop in serum protein
c. Resolution of thrombocytopenia
d. Resolution of polycythemia
ANS: c
Feedback
a. A rise in serum creatinine indicates that the
kidneys are not effectively excreting creatinine.
It is a negative outcome.
b. A drop in serum protein indicates that the
kidneys are allowing protein to be excreted.
This is a negative outcome.
c. Resolution of thrombocytopenia is a positive
sign. It indicates that the platelet count is
returning to normal.
d. Polycythemia is not related to HELLP
syndrome. Rather one sees a drop in red cell
and platelet counts with HELLP. A positive
sign, therefore, would be a rise in the RBC
count.
KEY: Integrated Process: Nursing Process: Evaluation | Cognitive Level: Application | Content
Area: Antepartum Care; Physiological Adaptation: Illness Management | Client Need: Health
Promotion and Maintenance; Physiological Integrity: Physiological Adaptation | Difficulty
Level: Difficult
22. A 16-year-old patient is admitted to the hospital with a diagnosis of severe preeclampsia. The
nurse must closely monitor the woman for which of the following?
a. High leukocyte count
b. Explosive diarrhea
c. Fractured pelvis
d. Low platelet count
ANS: d
Feedback
a. High leukocyte count is not associated with
severe pregnancy-induced hypertension (PIH)
or HELLP (hemolysis, elevated liver enzymes,
and low platelets) syndrome.
b. Explosive diarrhea is not associated with
severe PIH or HELLP syndrome.
c. A fractured pelvis is not associated with severe
PIH or HELLP syndrome.
d. Low platelet count is one of the signs
associated with HELLP (hemolysis, elevated
liver enzymes, and low platelets) syndrome.
Area: Antepartum Care; Diagnostic Tests; Reduction of Risk Potential: Laboratory Data | Client
Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential |
23. A woman at 10 weeks’ gestation is diagnosed with gestational trophoblastic disease

(hydatidiform mole). Which of the following findings would the nurse expect to see?
a. Platelet count of 550,000/mm3
b. Dark brown vaginal bleeding
c. White blood cell count 17,000/mm3
d. Macular papular rash
ANS: b
Feedback
a. The nurse would not expect to see an elevated
platelet count.
b. The nurse would expect to see dark brown
vaginal discharge.
c. The nurse would not expect to see an elevated
white blood cell count.
d. The nurse would not expect to see a rash.
24. After an education class, the nurse overhears an adolescent woman discussing safe sex
practices. Which of the following comments by the young woman indicates that additional
teaching about sexually transmitted infection (STI) control issues is needed?
a. “I could get an STI even if I just have oral sex.”
b. “Girls over 16 are less likely to get STDs than younger girls.”
c. “The best way to prevent an STI is to use a diaphragm.”
d. “Girls get human immunodeficiency virus (HIV) easier than boys do.”
ANS: c
Feedback
a. This statement is true. Organisms that cause
sexually transmitted infections can invade the
respiratory and gastrointestinal tracts.
b. This statement is true. Young women are
especially high risk for becoming infected with
sexually transmitted diseases.
c. This statement is untrue. The young woman
needs further teaching. Condoms protect
against STDs and pregnancy. In addition,
condoms can be kept in readiness for whenever
sex may occur spontaneously. Using condoms
does not require the teen to plan to have sex. A
diaphragm is not an effective infection-control
method. Plus, it would require the teen to plan
for intercourse.
d. This statement is true. Young women are
higher risk for becoming infected with HIV
than are young men.
KEY: Integrated Process: Nursing Process: Evaluation; Teaching and Learning | Cognitive
Level: Application | Content Area: Disease Prevention; High Risk Behaviors; Human Sexuality |
Client Need: Health Promotion and Maintenance: High Risk Behaviors; Human Sexuality |
Difficulty Level: Moderate
25. A woman who is admitted to labor and delivery at 30 weeks’ gestation, is 1 cm dilated, and is
contracting q 5 minutes. She is receiving magnesium sulfate IV piggyback. Which of the
following maternal vital signs is most important for the nurse to assess each hour?
a. Temperature
b. Pulse
c. Respiratory rate
d. Blood pressure
ANS: c
Feedback
a. The temperature should be monitored, but it is
not the most important vital sign.
b. The pulse rate should be monitored, but it is
not the most important vital sign.
c. The respiratory rate is the most important vital
sign. Respiratory depression is a sign of
magnesium toxicity.
d. The blood pressure should be monitored, but it
is not the most important vital sign.
Area: Intrapartum Care; Potential for Complications from Pharmacological Therapies: Adverse
Effects/Contraindications | Client Need: Health Promotion and Maintenance; Physiological
Integrity: Pharmacological and Parenteral Therapies | Difficulty Level: Moderate
26. A primiparous woman has been admitted at 35 weeks’ gestation and diagnosed with HELLP
syndrome. Which of the following laboratory changes is consistent with this diagnosis?
a. Hematocrit dropped to 28%.
b. Platelets increased to 300,000 cells/mm3.
c. Red blood cells increased to 5.1 million cells/mm3.
d. Sodium dropped to 132 mEq/dL.
ANS: a
Feedback
a. The nurse would expect to see a drop in the
hematocrit: The H in HELLP stands for
hemolysis.
b. The nurse would expect to see low platelets.
c. The nurse would expect to see hemolysis.
d. The sodium is usually unaffected in HELLP
syndrome.
Area: Intrapartum Care; Physiological Adaptation: Alterations in Body Systems | Client Need:
Difficulty Level: Moderate
27. A labor nurse is caring for a patient, 39 weeks’ gestation, who has been diagnosed with
placenta previa. Which of the following physician orders should the nurse question?
a. Type and cross-match her blood.
b. Insert an internal fetal monitor electrode.
c. Administer an oral stool softener.
d. Assess her complete blood count.
ANS: b
Feedback
a. It would be appropriate to type and cross-
match the patient for a blood transfusion.
b. This action is inappropriate. When a patient
has a placenta previa, nothing should be
inserted into the vagina.
c. To prevent constipation, it is appropriate for a
patient to take a stool softener.
d. It is appropriate to monitor the patient for signs
of anemia.
KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application

Content Area: Antepartum Care; Patient Advocacy; Potential for Alterations in Body Systems |
Client Need: Health Promotion and Maintenance; Physiological Integrity—Reduction of Risk
Potential; Safe and Effective Care Environment—Management of Care | Difficulty Level:
Moderate
28. A type 1 diabetic patient has repeatedly experienced elevated serum glucose levels
throughout her pregnancy. Which of the following complications of pregnancy would the nurse
expect to see?
a. Postpartum hemorrhage
b. Neonatal hyperglycemia
c. Postpartum oliguria
d. Neonatal macrosomia
ANS: d
Feedback
a. The patient is not especially high risk for a
postpartum hemorrhage.
b. The nurse would expect to see neonatal
hypoglycemia, not hyperglycemia.
c. The nurse would expect to see postpartum
polyuria.
d. The nurse would expect to see neonatal
macrosomia.
Health Promotion and Maintenance; Physiological Integrity—Physiological Adaptation |
29. According to agency policy, the perinatal nurse provides the following intrapartal nursing
care for the patient with preeclampsia:
a. Take the patient’s blood pressure every 6 hours
b. Encourage the patient to rest on her back
c. Notify the physician of urine output greater than 30 mL/hr
d. Administer magnesium sulfate according to agency policy
ANS: d
Feedback
a. The nurse is the manager of care for the
woman with preeclampsia during the
intrapartal period. Careful assessments are
critical. The blood pressure is taken every 1
hour or more frequently according to physician
orders or institutional protocol.
b. The nurse is the manager of care for the
critical. The patient should be encouraged to
assume a side-lying position to enhance uterine
perfusion.
c. The nurse is the manager of care for the
critical. A urine output less than 30 mL/hr is
indicative of oliguria, and the physician must
be notified.
d. The nurse is the manager of care for the
critical. The nurse administers medications as
ordered and should adhere to hospital protocol
for a magnesium sulfate infusion.
Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
30. A woman who is 36 weeks pregnant presents to the labor and delivery unit with a history of
congestive heart disease. Which of the following findings should the nurse report to the primary
health-care practitioner?
a. Presence of chloasma
b. Presence of severe heartburn
c. 10-pound weight gain in a month
d. Patellar reflexes +1
ANS: c
Feedback
a. Chloasma is a normal pregnancy finding.
b. Heartburn is an expected finding during the
third trimester.
c. The weight gain may be due to fluid retention.
Fluid retention may occur in patients with
pregnancy-induced hypertension and in
patients with congestive heart failure. The
physician should be notified.
d. Although slightly hyporeflexic, patellar
reflexes of +1 are within normal limits.

Cognitive Level: Application | Content Area: Antepartum Care; Reduction of Risk Potential:
Potential for Alterations in Body Systems | Client Need: Health Promotion and Maintenance;
31. Ms. M is 38 weeks’ gestation and is a G1 P0. At 10 pm Ms. M has just been informed by the
nurse that she is 3 to 4 cm dilated, cervix is 100% effaced, and contractions are every 4 to 5
minutes. When the nurse tells her the findings from the SVE, Ms. M states that she had been
contracting since early that morning and she becomes extremely frustrated stating “I should have
had this baby by now.” What is the best response by the nurse?
a. Remind her that length of labor for the first child can be 18 to 24 hours
b. Promote relaxation techniques
c. Discuss various analgesic options
d. Tell Ms. M that the provider will be contacted immediately about the slow progress of labor
ANS: b
Women in the latent phase of labor may be frustrated with lack of progress or slow progress of
labor and desire companionship and encouragement. The other responses are inappropriate. The
nurse should first encourage breathing and relaxation methods as well as provide reassurance,
and then contact the provider.
KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Analysis | Content
Area: Intrapartum Care | Client Need: Health Promotion and Maintenance—Intrapartum Care |
32. Ms. P has delivered her first baby 30 minutes ago and the placenta delivered 15 minutes ago.
She is attempting to breastfeed her newborn daughter for the first time. Which action by the
nurse would NOT be appropriate?
a. The nurse is checking the BP every 15 minutes
b. The nurse is massaging the fundus vigorously
c. The nurse is auscultating the infant’s heart and lungs while on the mother’s chest
d. The nurse is leaving the patient unattended for 30 minutes to bond with her newborn
ANS: d
During the fourth stage of labor the mothers should not be left unattended as maternal bleeding
needs to be closely monitored.
KEY: Integrated Process: Safe and Effective Care Environment | Cognitive Level: Application |
Content Area: Postpartum Care | Client Need: Safe and Effective Care Environment | Difficulty
Level: Moderate
33. It would be most important for a nurse caring for a mother and the infant in the fourth stage
of labor to do which of the following?
a. Assess and massage the fundus every 15 minutes or more often if needed
b. Massage the uterus continuously
c. Administer oxytocin per protocol
d. Assess the patient for a distended bladder
a.A, c
b.A, c, d
c.C, d
d.all of the above
ANS: b A, C, D
The fourth stage of labor immediately follows the delivery of the placenta. The nurse should be
assessing the fundus every 15 minutes for position, tone, and location. The provider may order
oxytocin at this stage, and the nurse should assist the woman to the bathroom if she has a
distended bladder which could interfere with the contraction of the uterus.

Content Area: Postpartum Care | Client Need: Health Promotion and Maintenance | Difficulty
Level: Difficult
34. Mrs. H is telling you she feels the urge to push. This is most likely caused by what?
a. Low fetal station triggering the Ferguson reflex
b. A fetal position of occiput posterior (OP)
c. The second stage of labor
d. Transition phase
ANS: a
Once the cervix is fully dilated and the vertex is low in the pelvis and the woman feels the urge
to push, she will involuntarily bear down. This is activated when the presenting part as it
descends stretches the pelvic floor muscles and triggers the Ferguson reflex.
KEY: Integrated Process: Knowledge | Cognitive Level: Analysis | Content Area: Intrapartum
Care | Client Need: Health Promotion and Maintenance: Intrapartum Care | Difficulty Level:
Difficult
35. A low-risk patient calls the labor unit and says “I need to come in to be checked right now,
there were pink streaks on the toilet paper when I went to the bathroom. I think I’m bleeding.”
What response should the nurse say first?
a. “How much blood is there?”
b. “You sound concerned, what other labor symptoms do you have?
c. “Don’t worry that sounds like a mucus plug.”
d. “Does it burn when you urinate?”
ANS: b
The nurse is using reflection to acknowledge the woman’s concerns and asks for further
assessment. The woman’s fear must first be acknowledged and then other questions or comments
can be made.
KEY: Integrated Process: Nursing Process | Cognitive Level: Analysis | Content Area: Maternity
| Client Need: Psychological Integrity | Difficulty Level: Moderate
Multiple Response
36. The perinatal nurse describes risk factors for placenta previa to the student nurse. Placenta
previa risk factors include (select all that apply):
a. Cocaine use
b. Tobacco use
c. Previous caesarean birth
d. Previous use of medroxyprogesterone (Depo-Provera)
ANS: a, b, c
Feedback
a. Placenta previa may be associated with risk
factors including smoking, cocaine use, a prior
history of placenta previa, closely spaced
pregnancies, African or Asian ethnicity, and
maternal age greater than 35 years.
b. Placenta previa may be associated with risk
factors including smoking, cocaine use, a prior
history of placenta previa, closely spaced
pregnancies, African or Asian ethnicity, and
maternal age greater than 35 years.
c. Placenta previa may be associated with
conditions that cause scarring of the uterus
such as a prior cesarean section, multiparity, or
increased maternal age.
d. Previous use of medroxyprogesterone (Depo-
Provera) is not a risk factor for placenta previa.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy
37. Kerry, a 30-year-old G3 TPAL 0110 woman presents to the labor unit triage with complaints
of lower abdominal cramping and urinary frequency at 30 weeks’ gestation. An appropriate
nursing action would be to (select all that apply):
a. Assess the fetal heart rate
b. Obtain urine for culture and sensitivity
c. Assess Kerry’s blood pressure and pulse
d. Palpate Kerry’s abdomen for contractions
ANS: a, b, d
Feedback
a. Women experiencing preterm labor may
complain of backache, pelvic aching,
menstrual-like cramps, increased vaginal
discharge, pelvic pressure, urinary frequency,
and intestinal cramping with or without
diarrhea. The patient’s abdomen should be
palpated to assess for contractions, and the
fetus’s heart rate should be monitored.
b. Women experiencing preterm labor may
diarrhea. A urinalysis and urine culture and
sensitivity (C & S) should be obtained on all
patients who present with signs of preterm
labor, and the nurse must remember that signs
of UTI often mimic normal pregnancy
complaints (i.e., urgency, frequency). The
patient’s abdomen should be palpated to assess
for contractions, and the fetus’s heart rate
should be monitored.
c. Assessment of blood pressure and pulse is not
an important nursing action in this scenario.
d. Women experiencing preterm labor may
diarrhea. The patient’s abdomen should be
palpated to assess for contractions, and the
fetus’s heart rate should be monitored.
Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
38. The perinatal nurse knows that tocolytic agents are most often used to (select all that apply):
a. Prevent maternal infection
b. Prolong pregnancy to 40 weeks’ gestation
c. Prolong pregnancy to facilitate administration of antenatal corticosteroids
d. Allow for transport of the woman to a tertiary care facility
ANS: c, d
Feedback
a. Tocolytics are not used to treat maternal
infection.
b. Tocolytics are generally only effective in
delaying delivery for several days.
c. Presently, it is believed that the best reason to
use tocolytic drugs is to allow an opportunity
to begin the administration of antenatal
corticosteroids to accelerate fetal lung
maturity.
d. Delaying the birth provides time for maternal
transport to a facility equipped with a neonatal
intensive care unit.
Area: Peds/Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level:
Easy
39. The perinatal nurse provides a hospital tour for couples and families preparing for labor and
birth in the future. Teaching is an important component of the tour. Information provided about
preterm labor and birth prevention includes (select all that apply):
a. Encouraging regular, ongoing prenatal care
b. Reporting symptoms of urinary frequency and burning to the health-care provider
c. Coming to the labor triage unit if back pain or cramping persist or become regular
d. Lying on the right side, withholding fluids, and counting fetal movements if contractions
occur every 5 minutes
ANS: a, b, c
Feedback
a. The nurse should encourage all pregnant
women to obtain prenatal care and screen for
vaginal and urogenital infections and treat
appropriately, and remind pregnant women to
call their provider repeatedly if symptoms of
preterm labor occur.
b. Educating all women of childbearing age about
preterm labor is a crucial component of
prevention. The nurse should encourage all
pregnant women to obtain prenatal care and
screen for vaginal and urogenital infections and
treat appropriately, and remind pregnant
women to call their provider repeatedly if
symptoms of preterm labor occur.
c. Educating all women of childbearing age about
preterm labor is a crucial component of
prevention. The nurse should encourage all
pregnant women to obtain prenatal care and
screen for vaginal and urogenital infections and
treat appropriately, and remind pregnant
women to call their provider if symptoms of
preterm labor occur.
d. Lying on the right side; drinking fluids, not
withholding fluids; and counting fetal
movements if contractions occur every 5
minutes are recommended if a woman thinks
she is contracting.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
40. The perinatal nurse describes for the new nurse the various risks associated with prolonged
premature preterm rupture of membranes. These risks include (select all that apply):
a. Chorioamnionitis
b. Abruptio placentae
c. Operative birth
d. Cord prolapse
ANS: a, b, d
Even though maintaining the pregnancy to gain further fetal maturity can be beneficial,
prolonged PPROM has been correlated with an increased risk of chorioamnionitis, placental
abruption, and cord prolapse.
Short Answer
41. A condition where the placenta attaches to the lower uterine segment of the uterus
ANS: Placenta previa

Refer To: Maternity Nursing Terms and Definitions
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
42. A pregnancy that ends before 20 weeks’ gestation
ANS: Miscarriage
43. Specks or spots in the vision where the patient cannot see; “blind spots”
ANS: Scotoma
44. A disease characterized by an abnormal placental development that results in the production
of fluid-filled grapelike clusters and a vast proliferation of trophoblastic tissue
ANS: Hydatidiform mole/Gestational trophoblastic disease

Refer To: Perinatal Nursing Terms and Definitions
Peds/Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
45. No expulsion of the products of conception, but bleeding and dilation of the cervix such that
a pregnancy is unlikely
ANS: Inevitable abortion

46. Placement of suture to mechanically close a weak cervix
ANS: Cervical cerclage

True/False
47. The perinatal nurse observes the placental inspection by the health-care provider after birth.
This examination may help to determine whether an abruption has occurred prior to or during
labor.
ANS: True
Fifty percent of abruptions occur before labor and after the 30th week, 15% occur during labor,
and 30% are identified only upon inspection of the placenta after delivery.
Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate
48. It is critical for the perinatal nurse to learn, as part of the facility’s policies and procedures, to
immediately perform a vaginal examination on a woman who presents with vaginal bleeding
after 24 weeks’ gestation.
ANS: False
Placenta previa should be suspected in all patients who present with bleeding after 24 completed
weeks of gestation. Because of the risk of placental perforation, vaginal examinations are not
performed.
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate
49. The perinatal nurse knows that the survival rate for infants born at or greater than 28 to 29
gestational weeks is greater than 90%.
ANS: True
With appropriate medical care, neonatal survival dramatically improves as the gestational age
increases, with over 50% of neonates surviving at 25 weeks’ gestation, and over 90% surviving
at 28 to 29 weeks of gestation.
Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
Fill-in-the-Blank
50. The perinatal nurse knows that an early pregnancy loss occurs before __________ weeks,
and a late pregnancy loss is one that occurs between 12 and __________ weeks.
ANS: 12; 20
Not all conceptions result in a live-born infant. Of all clinically recognized pregnancies, 10% to
20% are lost, and approximately 22% of pregnancies detected on the basis of hCG assays are lost
before the appearance of any clinical signs or symptoms. By definition, an early pregnancy loss
occurs before 12 weeks of gestation; a late pregnancy loss is one that occurs between 12 and 20
weeks of gestation.
Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy
51. Mary, a G3 TPAL 0020 woman at 20 weeks’ gestation, has had a transvaginal ultrasound.
Mary has been informed that she has cervical incompetence. The perinatal nurse explains that
this diagnosis means that her cervix has __________ without __________ contractions.
ANS: dilated; regular

Patients with cervical incompetence usually present with painless dilation and effacement of the
cervix, often during the second trimester of pregnancy. The patient frequently gives a history of
repeated second trimester losses with no apparent etiology. Incompetent cervix is estimated to
cause approximately 15% of all second trimester losses.
52. The perinatal nurse knows that nausea and vomiting are common in pregnancy and usually
resolve by __________ weeks’ gestation. The severe form of this condition is __________.
ANS: 16; hyperemesis gravidarum

Feedback 1: Nausea and vomiting are a common condition of pregnancy which affect 70% to
85% of pregnant women and usually resolve by the 16th week of gestation.
Feedback 2: Hyperemesis gravidarum represents the extreme end of the nausea/vomiting
spectrum in terms of severity. Criteria for the diagnosis of hyperemesis gravidarum include
persistent vomiting unrelated to other causes, a measure of acute starvation (usually large
ketonuria), and some discrete weight loss, most often 5% of the prepregnancy weight.
Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
53. The perinatal nurse explains to the student nurse who is assessing the abdomen of a 32-week
pregnant woman with placenta previa that it would not be unusual to find the fetus in a
__________ or __________ position.
ANS: breech; transverse

Placenta previa is an implantation of the placenta in the lower uterine segment, near or over the
internal cervical os. This condition accounts for 20% of all antepartal hemorrhages. Leopold
maneuvers often reveal the fetus to be in a breech or oblique position or transverse lie because of
the abnormal location of the placenta.
54. The perinatal nurse knows that a __________ hemorrhage is limited to the uterus, and a
__________ hemorrhage moves blood toward and through the cervix.
ANS: concealed; revealed

Feedback 1: A concealed hemorrhage occurs in 20% of cases and describes an abruption in
which the bleeding is confined within the uterine cavity. The most common abruption is
associated with a revealed or external hemorrhage, where the blood dissects downward toward
the cervix.
Feedback 2: The most common abruption is associated with a revealed or external hemorrhage,
where the blood dissects downward toward the cervix.
Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy
55. The perinatal nurse encourages Colleen, who has just been discharged from the hospital for
intravenous therapy for severe nausea and vomiting, to ensure that she __________ often, eats
frequent, __________ meals, and avoids __________ odors.
ANS: rests; small; cooking

The nurse should counsel the woman with nausea and vomiting to avoid foods and sensory
stimuli that provoke symptoms (i.e., some women become nauseous when they smell certain
foods being prepared) and also to eat small, frequent meals of dry, bland foods and include high-
protein snacks in their diet.
Matching
Match the term with the definition
56. Third stage of labor

57. Transition phase
58. False labor
59. Latent phase
a. Early and slow labor. Can last up to 9 hours. Many women choose to stay home.
b. Irregular contractions, with no increase in frequency, intensity, and duration, cause little or no
cervical change
c. Cervical dilation from 8 to 10 cm, contractions every 1 to 2 minutes. Woman may be panicky
and irritable.
d. Occurs immediately after the delivery of the fetus. Involves the separation and delivery of the
placenta. Can last up to 20 minutes.
ANS:
56. d
57. c
58. b
59. a
Third stage of labor: Begins immediately after the delivery of the fetus and involves separation
and expulsion of the placenta and membranes
Transition phase: Third phase of labor; dilation to 10 cm
False labor: Irregular contractions with little or no cervical changes
Latent phase: First phase of labor; the early and slower part of labor with cervical dilation from 0
to 3 cm
KEY: Integrated Process: Knowledge | Cognitive Level: Knowledge | Content Area: Intrapartum
Care | Client Need: Health Promotion and Maintenance—Intrapartum Care | Difficulty Level:
Moderate
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American Credo,” and “Heliogabalus.”
Walter Pach was born in New York in 1883, and was graduated from the
College of the City of New York in 19013. He studied art under Leigh Hunt, William
M. Chase, and Robert Henri, and worked during most of the eleven years before
the War in Paris and other European art-centres, exhibiting both here and abroad.
He was associated with the work of the International Exhibition of 1913, as well as
other exhibitions of the modern masters in America, and with the founding and
carrying on of the Society of Independent Artists. He is represented by paintings
and etchings in various public and private collections, has lectured at the
Metropolitan Museum of Art, New York, University of California, Wellesley College,
and other institutions, has contributed articles on art subjects to the Gazette des
Beaux-Arts, L’Arts et les Artistes, Scribner’s, the Century, the Freeman, etc., and is
the translator of Elie Faure’s “History of Art.”
Elsie Clews Parsons was graduated from Barnard College in 1896, and
received the degree of Ph.D. from Columbia University in 1899. She has been
Fellow and Lecturer in Sociology at Barnard College, Lecturer in Anthropology in
the New School of Social Research, assistant editor of the Journal of American
Folk-Lore, treasurer of the American Ethnological Society, and president of the
American Folk-Lore Society. She is married and the mother of three sons and one
daughter. Among her books are “The Family,” “The Old-Fashioned Woman,” “Fear
and Conventionality,” “Social Freedom,” and “Social Rule.”
Raffaello Piccoli, who has written the article on “American Civilization from an
Italian Point of View,” was born in Naples in 1886, and was educated at the
Universities of Padua, Florence, and Oxford. In 1913 he was appointed Lecturer in
Italian Literature in the University of Cambridge, and in 1916 was elected Foreign
Correspondent of the Royal Society of Literature. During the War he was an officer
in the First Regiment of Italian Grenadiers, was wounded and taken prisoner while
defending a bridge-head on the Tagliamento, and spent a year of captivity in
Hungary. After the Armistice he was appointed to the chair of English Literature in
the University of Pisa. During the years 1919–21 he has acted as exchange
professor at various American universities. He has published a number of books,
including Italian translations of Oscar Wilde and of several Elizabethan dramatists.
Louis Raymond Reid was born in Warsaw, N. Y., and was graduated from
Rutgers College in 1911. Since then he has been engaged in newspaper and
magazine work in New York City. He was for three years the editor of the Dramatic
Mirror.
Geroid Tanquary Robinson was born in Chase City, Virginia, in 1892, and
studied at Stanford, the University of California, and Columbia. He was a member
of the editorial board of the Dial at the time when it was appearing as a fortnightly,
and is now a member of the editorial staff of the Freeman, and a lecturer in
Modern European History at Columbia University. He served for sixteen months
during the War as a First Lieutenant (Adjutant) in the American Air Service.
Residence in Virginia, North Carolina, Colorado, Arizona, and California has given
him the opportunity to observe at first hand some of the modes and manners of
race-prejudice.
J. Thorne Smith, Jr., was born in Annapolis, Md., in 1892, and was graduated
from Dartmouth College in 1914. He was Chief Boatswain’s Mate in the U. S.
Naval Reserve during the War, and editor of the navy paper, The Broadside. He is
the author of “Haunts and By-Paths and Other Poems,” “Biltmore Oswald,” and
“Out-O’-Luck.”
George Soule was born in Stamford, Conn., in 1887, and was graduated from
Yale in 1908. He was a member of the editorial staff of the New Republic from
1914 to 1918, and during 1919 editorial writer for the New York Evening Post. He
drafted a report on the labour policy of the Industrial Service Sections, Ordnance
Department and Air Service, for the War Department, and was commissioned a
Second Lieutenant in the Coast Artillery Corps. He is a director of the Labour
Bureau, Inc., which engages in economic research for labour organizations, and is
co-author with J. M. Budish of “The New Unionism in the Clothing Industry.”
J. E. Spingarn was born in New York in 1875, was educated at Columbia and
Harvard, and was Professor of Comparative Literature in Columbia University until
1911. Among his other activities he has been a candidate for Congress, a delegate
to state and national conventions, chairman of the board of directors of the
National Association for the Advancement of Coloured People, vice-president of a
publishing firm, and editor of the “European Library.” During the War he was a
Major of Infantry in the A. E. F. His first book, “Literary Criticism in the
Renaissance,” was translated into Italian in 1905, with an introduction by
Benedetto Croce; he has edited three volumes of “Critical Essays of the 17th
Century” for the Clarendon Press of Oxford, and contributed a chapter to the
“Cambridge History of English Literature;” his selection of Goethe’s “Literary
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include “The New Hesperides and Other Poems” and “Creative Criticism.”
Harold E. Stearns was born in Barre, Mass., in 1891, and was graduated from
Harvard in 1913. Since then he has been engaged in journalism in New York, and
has been a contributor to the New Republic, the Freeman, the Bookman, and other
magazines and newspapers. He was associate editor of the Dial during the last six
months of its appearance as a fortnightly in Chicago. Among his books are
“Liberalism in America” and “America and the Young Intellectual.”
Henry Longan Stuart is an English author and journalist who has spent a
considerable part of his life since 1901 in the United States. He served through the
War as a Captain in the Royal Field Artillery, was attached to the Italian Third Army
after Caporetto, and was press censor in Paris after the Armistice and during the
Peace Conference. He is the author of “Weeping Cross,” a study of Puritan New
England, “Fenella,” and a quantity of fugitive poetry and essays.
Deems Taylor was born in New York in 1885, and was graduated from New
York University in 1906. He studied music with Oscar Coon from 1908 to 1911. He
has been connected with the editorial staff of the “Encyclopedia Britannica,” and
has been assistant Sunday editor of the New York Tribune and associate editor of
Collier’s Weekly, and at present is a critic of the New York World. He has
composed numerous musical works, including “The Siren Song” (symphonic
poem, awarded the orchestral prize of the National Federation of Music Clubs in
1912), “The Chambered Nautilus” (cantata), “The Highwaymen” (cantata written
for the MacDowell festival), and “Through the Looking Glass” (suite for symphonic
orchestra).
Hendrik Willem Van Loon was born in Holland in 1882, and received his
education in Dutch schools, at Cornell and Harvard, and at the University of
Munich, from which he received his Ph.D., magna cum laude, in 1911. He was a
correspondent of the Associated Press in various European capitals, and for some
time was a lecturer on modern European history in Cornell University. He is at
present Professor of the Social Sciences in Antioch College, and is the author of
“The Fall of the Dutch Republic,” “A Short History of Discovery,” “Ancient Man,”
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INDEX
Abbott, Lyman, 497

Abolitionists, 58
Absolute, 166
Academic life, 95
Accident lawyers, 59
Acoustics, 159
Adams, Henry, 11, 77, 303, 547;
quoted on a school of literature, 196
Ade, George, 249
Administrative officers, 32, 33
Adolescence, 436
Adulteration, 406
Advertising, 381–395;
appeal, 383;
bibliography, 551;
effects on the writers, 384;
efficacy, 389;
honest, 387;
justification, 388;
newspaper, 44;
newspaper control, 46, 47;
objectionable, 395;
outdoor, 395;
over-production and, 390;
pro and con, 391;
signs, 293, 395;
solicitor and writer, 387;
value, 391, 392;
writers, 387
Æsthetic emotion, 204, 214, 480
Æsthetics, vii, 14, 100, 105, 108, 492, 497
Africa, association of negroes to establish empire, 369
“Age of Innocence, The,” 179
Agnosticism, 171
Agricultural implements, 402
Aiken, Conrad, on poetry, 215–226
Akins, Zoë, 248, 253
Alcohol, 451
Alcoholics, children of, 452, 453
Alien Land Laws, 364
Aliens, 337–350;
economics and, 339;
legislative attitude to, 343;
protection, 349
Alfieri, Vittorio, 104
Alimony, 331
Alleghany mountains, 4, 30, 399
Allied troops, 469
Alphabetical order, 469
Amalgamated Clothing Workers, 346
America, as economic support for Europe, 475;
feminization, 135, 143;
germinal energy, 148, 150;
original culture, 512;
provincialism, 286;
“real America,” 138
“America First” Publicity Association, 47
“American ideals,” 104
American infantry in Paris, 470
American Legion, 88
American literature. See Literature, American
American Philosophical Association, 177
American Revolution, 300, 399, 417, 515
Americanism, 133, 519
Americanization, 337, 344, 346, 347, 442, 528;
spirit, 88, 89
Americans, uniformity, 36, 109
Ames, Winthrop, 245
Amusements, 8, 13, 440;
music, 204, 205
Anæmia, intellectual, 491, 492, 495, 501
Ancestor worship, 506
Anderson, Sherwood, 137
Anglin, Margaret, 251
Anglo-American relations, 471, 473, 474, 476
Anglo-Saxonism, 320, 341, 442, 471, 504
Anthony, Katharine, on the family, 319–336
Anthropological groups, 353
Anthropology, 154
Anti-Saloon League, 29
Anti-Semitism, 356, 364
Appleseed, Johnny, 4
Applied science, 146, 155–156
Architecture, 238;
city, debasement, 10;
industrial city, 11
Aridity of American life, 480
Aristocracy, 193
Aristocrats, 441, 442
Armageddon, 440
Armory Show, 239
Art, 100, 204, 207, 227–241;
bibliography, 542;
colonial, 230, 231;
conditions and opportunities, 228;
definition, 107;
feminization, 229;
morals and, 101;
poetry, 225;
tariff on works of art, 230
Art for art’s sake, 102
Artists, advertising as a benefit, 391;
definition, 107;
respect for, 208
Asiatics. See Orientals
Associated Press, 47
Asylums, 334, 451
Athletics, 526, 527;
college, 117
Atlantic City, 9
Atlantic Monthly, 243
Attorney-General, 66
Austin, Mrs. Mary, 144
Australia, farm policy, 347, 348
Australian Courts of Conciliation, 73
Authority, 160;
educational, 85
Automobile industry, 400
Back to the land, 285

Backgrounds, historical, 308;
intellectual, 146
Bacteriologists, 454
Baking industry, 400
Ballot, 281
Bar Associations, 65–66
Bargaining, collective, 264;
see also Contract
Barnum, P. T., 292
Barrie’s “Peter Pan,” 246
Barrymore, John, 250
Baseball, 458
Baseball fans, 457
Beard, C. A., 532, 547
Beard, G. M., 430, 431, 432, 438
Beautiful necessity, 165, 168
Beauty, 14, 204, 238, 492, 535
Beer-garden, 10
Behaviour, 173;
crowd, 312
Behaviourism, 169
Belief, 171
Bell, Sanford, 436
Bergson, Henri, 167, 172
Bett, Miss Lulu, 320
Beyer, O. S., Jr., on engineering, 417–425
“Beyond the Horizon,” 243, 244, 248
Bibliographical notes, 531
Big business, 406, 407, 409
Bigness, contrary effect on English and Americans, 477, 478
Billboards, 293, 395
Billiards, 460
Billings, Frank, 449
Biochemistry, 456
Biographical notes on contributors to this volume, 559–564
Biographies, 96;
political, 532
Biology, 456;
experimental, 153
Birth control, 320, 321, 322, 323;
artificial, 321
Birth-rate, 321, 336
Black Star Line, 369
Blackburn, J. B., 231
Blashfield, E. H., 236
Blind Tom, 207–208
Board of Health, 304
Boas, Franz, 154
Bodenheim, Maxwell, 218, 221, 222, 223
“Book of Daniel Drew, The,” 72
Boosters, 293
Bosses, political, 24
Boston, 4, 15;
dramatic taste, 245;
marriage age, 328;
Public Library, 11, 235;
Trinity Church, 11
Boxing, 459
Boyd, Ernest, on American civilization, 489–507
Brady, W. A., 244
Brandeis, L. D., brief on Oregon law, 73
Branford, V. V., 531
“Brass Check, The,” 41
Breasted, J. H., 547
Brewer, Justice P. J., 73–74
Brill, A. A., 434
British Institution of Civil Engineers, 418, 419
Britten, Clarence, on school and college life, 109–133
Broadway, 8
Brokers, 405
Bronson-Howard, George, 249
Brooke, Rupert, 503
Brookline, Mass., 15
Brooks, Van Wyck, iii;
on the literary life, 179–197
Brown, H. C., on philosophy, 163–177
Brown University, 125
Brunetière, Ferdinand, 498, 503
Bryan, W. J., 25, 429, 440, 451, 497
Bryce, James, 196, 490, 532, 536
Buddhism, 373
Bundling, 315
Bush Terminal Tower, 12
Business, 397–415;
American conception, 482;
bibliography, 551;
blind sequence, 414;
government and, 48;
honour, 405, 409, 410, 430;
individual and corporate, 409, 410;
revolution of methods, 405;
State and, 264
Business education, 80
Business life, 186
Business man’s chivalry, 324
Business world, 143
Butler, Samuel, 188, 547
California, early law, 54;

gold discovery, 403;
Land Laws, 365;
race-prejudice, 357, 364
Calvinism, 164, 168
Cambridge, Mass., 4, 6
Canals, 403
Canning industry, 401
Capital, 404, 405
Capital and labour, engineers and, 420
Capitalism, 544;
case for, 257, 261
Captains of industry, 517
Carnegie, Andrew, 18
Carnegie Institution, 158
Case-system, 68, 69
Castberg, Johan, 332
Caste system in college, 121
Catechism, Negro, 370
Catholic Church, 193
Cattell, J. Nick, 538
Cavalier and Puritan, 512, 513, 514
Celibacy, 321, 328
Cézanne, Paul, 239, 240
Chafee, Zechariah, Jr., on the law, 53–75
City, bibliography, 531
Chain-store, 407
Chambers, R. W., 192
Character in business, 409
Charm, personal, 112
Chase, W. M., 234, 235
Chastity, 454
Chautauqua, 6, 83, 142
Chekhov, A. P., 190
Chemistry of proteins, 456
Chesterton, G. K., 477;
on American genius, 183
Chicago, 8, 10, 403;
dramatic taste, 245
Chickens, alcoholic, 452
Chief Justice, 67
Child labour, 275, 329
Childhood, family influence, 335;
shortness, 185
Children, fewer and better, 452;
on farms, 321;
sexuality, 436;
spoiling, 334
Children’s Bureau, 320
Chinese, 373;
Californians and, 364;
in America, 357
Chiropractors, 444
Chivalry of the business man, 324
Christian Science, 438, 443
Christianity, 166, 167
Church, 35, 77, 85, 146
Church-college, 163, 168
Cincinnati, 4, 8
Circus parade, 292
Cirrhosis of the liver, 452
Cities, 3–20;
architectural debasement, 10;
civic equipment, 16;
civic life, 16;
country versus, 17;
drama, outside New York, 245;
future, 19;
growth and improvement, 15;
improvements, 14;
industrial, 9, 10;
provincial, 3;
shifts of population and institutions, 7;
spiritual failure, 9;
State legislatures and, 24;
three periods, 3
Citizenship, good, 175
City Beautiful movement, 14
Civil engineers, 417
Civil War, 139
Civilization, human, 508;
Roman, 509
Civilization, American, as seen by an Englishman, 469–488;
as seen by an Irishman, 489–507;
as seen by an Italian, 508–528
Clark University, 434
Classics, 79, 81, 94, 146
Cleanliness, 392
Clients and lawyers, 59
Clouston, T. S., 452
Clubs, college, 121, 128
Coeducational forms, 129
Cohan, G. M., 249, 457
Cohen, M. R., 168
Colby, F. M., on humour, 463–466
Cole, R., 444
Collective bargaining, 264
College “Bible,” 118
College life, 109–133;
athletics, 117;
avocations, 128;
bibliography, 536;
caste system, 121;
clubs, 121, 128;
course system, 126;
democracy, 118;
examination and passing, 126;
extra-collegiate social regimen, 129;
fellowship, 123;
moral crusades, 124–125;
political management of affairs, 124;
recreation, 130;
sex lines and forms, 129;
social life, 117–118;
study, 125;
traditions, 118
College professors, 491;
see also Professors
College stories, 536
Colleges, early church-college, 163, 168;
see also Education
Colonial culture, 138
Colonial law, 54
Colonialism, 97
Colonies, 301, 493
Colonists, 398
Colour of God, 370
Commercial city, 5
Commercial God, 480, 481, 483
Commercialism, 484
Common Law, American conditions and, 56;
New England and, 54
Communist parties, 279, 280
Community, New England, 5
Compensation acts, 72
Competition, 259, 260, 406, 482
Composers, 199, 208, 210
Compromise, 284
Compulsions, 439, 440
Concord, Mass., 4
Coney Island, 13
Conformity, 439, 520;
college, 118
Congress, 31
Congressional Record, 27, 532, 544
Congressmen, character, 22, 27, 33
Conjugal fidelity, 309
Connecticut, early land act, 55
Conservatives, 273
Constitution, U. S., 140, 506, 515
Contingent fee, 60
Contract, 275;
right of, 259, 262, 264
Contract labour law, 343
Contributors to this volume, brief biographies, 559–564
Control of industry, 257, 263, 419
Conventions, 291;
“iron hand of convention,” 182
Conventionalities, 252, 491;
college, 129
Co-operative movement, 284
Copley, J. S., 231, 232, 233, 237
Cornell University, tradition, 120
Corporation lawyers, 59
Corporations, 406, 411, 412;
State and, 412
Corrective Eating Society, 444
Correspondence schools, 385
Country, 287, 288;
envy of the city, 17;
social life, 294;
see also Small town
County fair, 295
Crisis-emotion, 315
Courage in journalism, 40
Courts, diversity, 71
Craftsmanship, 413
Crane, Frank, 44
Cranks, 147
Craven, Frank, 248
Credit, 405, 410, 413
Credulity, 454;
medical, 444
Criminal law, 60, 70
Criminals and lawyers, 60
Criticism, 497, 503;
American, 99;
bibliography, 535;
definition, 100, 108;
dogmatic or intellectual, 100, 108;
music, 209;
need, 105;
scholarship and, 93–108;
scholarship the basis, 99;
schools of, 100
Cross of Gold, 440
Crowd behaviour, 312
Culture, 93, 106, 175, 508;
original American, 512
Curiosity, 130, 131, 175
Daly, Arnold, 251

Dancing, 526
Dante, scholarship, 96
Darwin, Charles, 163
Days of grace, 64
Declaration of independence, 132, 133, 140, 506
Decorators, 236
De Leon, Daniel, 545
Demand and supply, 261
Dementia præcox, 434
Democracy, college, 118
Denmark, farmers, 347
Department stores, 8;
advertising in the newspapers, 389;
newspapers and, 46;
private tribunals, 70
Dependence, habits of, 401
Deportation, 342, 344, 348
Devil, 439, 440
Dewey, John, 168, 540;
on education, 175;
psychology, 173;
weakness of his philosophy, 176
Dickinson, Emily, 218
Differentiations, regional, 111
Diphtheria, 450
Diplomacy, shirt-sleeve, 489
Discipline, 471, 480, 482, 488
Disease, 443, 445, 449, 455;
prevention, 449
Dishonesty in business, 405, 409, 410, 430
Divorce, attitude to, 309, 310;
growing prevalence, 330
Doctors, 443;
see also Disease; Physicians
Dogmatic criticism, 100, 108
Domestic Relations Courts, 72, 331, 332
Double personality, 433
Dowden, Edward, 504
Drachsler, Julius, 375, 376, 377
Drama. See Theatre
Drama League, 247
Dreadnought Hams, 386
Dreiser, Theodore, 181, 182, 189, 196, 286
East, the, 112

Economic democracy, 339
Economic liberty, 276
Economic opinion, 255–270;
basis and value, 270;
opportunities, 346;
bibliography, 543;
radicalism, 276, 277, 278;
volume, 269–270
Economics, classical, 259;
facts and statistics, 268;
“fundamental,” 273;
immigration and, 338;
newer, 544;
protest, 263;
system, 517;
waste, 284
Eddy, Mrs. Mary Baker, 443, 498
Edison, T. A., 436
Editors, 36
Education, 77–92, 524, 525;
bibliography, 534;
corrupt practices, 90;
Dewey’s philosophy, 175;
engineering, 423, 424;
enthusiasm for, 109;
feminization, 317;
general and special, 81;
medical, 455;
State and, 89;
superficial, 82;
superstitious mood toward, 77, 78
Edwards, Jonathan, 164, 165
Efficiency, 471, 478, 481, 482, 484;
social, 175
Egoism, 197
Eight-hour day, 275
Elderton-Pearson report, 453
Election machinery, 281
Elections, 281
Elective system in education, 79, 119
Electric lighting, 14
Electrical engineers, 417
Eliot, C. W., 79
Eliot, T. S., 218, 221, 222, 223, 224
Elizabethan literature, 220
Ellis Island, 341
Emerson, R. W., 138, 164, 165, 184, 195, 494
Emotion, 203, 209;
crisis, 315;
lack, vii;
mother-love, 437, 438;
sex, 310, 317
Emotionality, 176
“Emperor Jones,” 360
Empiricism, 172
Employer and employé, 483
Employés’ welfare, 484
Employment, 482
Engineering, 417–425;
bibliography, 552;
bulwark and inspiration, 424;
new problems, 418
Engineers, capital and labour, relation to, 420;
educational background, 423, 424;
formulating a policy, 420;
intellectual limitations, 423;
intelligence, 455;
larger function, 418;
original function, 418;
position, 432;
symbolic speculations, 423;
typical, 417
England, 512;
bond with America, 473;
competition with America, and courses open, 474;
proletariat, 485, 487;
war and post-war conditions, 487
English language professors, 96
Englishman’s view of American civilization, 469–488
Englishmen, as immigrants, 472;
character, 476, 477, 478
Erie Railroad, 72, 409
Ethics, 174
Ettinger, W. L., 87, 88
Eucken, R. C., 167
Europe, American attitude to, 486;
attraction, 238, 239;
civilization and culture, 511;
history, 510;
impoverishment, 473;
problem, 511
Evangelical literature, 496, 497
Evening Sun, 250
Exchange, 413
Exercise, 458, 461

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Maternal Newborn Nursing The Critical

Components of Nursing Care 2nd

Contemporary Maternal Newborn Nursing Care 8th Edition

Contemporary Maternal Newborn Nursing Care 9th edition

Understanding the Essentials of Critical Care Nursing

Maternal Child Nursing Care 2nd Edition Ward Test Bank

Understanding the Essentials of Critical Care Nursing

Foundations of Maternal Newborn and Womens Health

Foundations of Maternal Newborn and Womens Health

Foundations of Maternal Newborn and Womens Health

5. A woman is considered in active labor when:a. Cervical dilation progresses from 4 to 7 cm

KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Implementation |

KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Implementation |

KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application |

KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application |

23. A woman at 10 weeks’ gestation is diagnosed with gestational trophoblastic disease

KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application

KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Implementation |

KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application |

ANS: Placenta previa

42. A pregnancy that ends before 20 weeks’ gestation

ANS: Hydatidiform mole/Gestational trophoblastic disease

ANS: Inevitable abortion

46. Placement of suture to mechanically close a weak cervix

ANS: Cervical cerclage

ANS: dilated; regular

ANS: 16; hyperemesis gravidarum

ANS: breech; transverse

ANS: concealed; revealed

ANS: rests; small; cooking

Match the term with the definition

56. Third stage of labor

Abbott, Lyman, 497

Back to the land, 285

California, early law, 54;

Daly, Arnold, 251

East, the, 112

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