B 101Chapter 8- Intrapartum Assessment and Interventions.
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. Passenger
b. Passage
c. Powers
d. 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.
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 interventions
b. Increased epidural rates
c. Earlier admission to the hospital
d. 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.
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.
,B 101Chapter 8- Intrapartum Assessment and Interventions.
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.
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 ED FIr ExExEx
Feedback
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
,B 101Chapter 8- Intrapartum Assessment and Interventions.
shoulders and remainder of the body are delivered.
5. A woman is considered in active labor when:
, B 101Chapter 8- Intrapartum Assessment and Interventions.
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 Latent 0-3cm, Active 4-8cm, Transition 8-10cm
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 continuously
b. Monitored every 15 minutes
c. Monitored every 30 minutes
d. Monitored every 60 minutes
ANS: c
Feedback
a.b.d. Assessment of fetal heart rate (FHR) during the active phase of labor
with a reassuring FHR is not indicated continuously nor every 15 minutes nor
60 minutes.
c. Assessment of fetal heart rate (FHR) during the active phase of labor with a
reassuring FHR is indicated every 30 minutes.
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:
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. Passenger
b. Passage
c. Powers
d. 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.
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 interventions
b. Increased epidural rates
c. Earlier admission to the hospital
d. 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.
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.
,B 101Chapter 8- Intrapartum Assessment and Interventions.
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.
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 ED FIr ExExEx
Feedback
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
,B 101Chapter 8- Intrapartum Assessment and Interventions.
shoulders and remainder of the body are delivered.
5. A woman is considered in active labor when:
, B 101Chapter 8- Intrapartum Assessment and Interventions.
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 Latent 0-3cm, Active 4-8cm, Transition 8-10cm
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 continuously
b. Monitored every 15 minutes
c. Monitored every 30 minutes
d. Monitored every 60 minutes
ANS: c
Feedback
a.b.d. Assessment of fetal heart rate (FHR) during the active phase of labor
with a reassuring FHR is not indicated continuously nor every 15 minutes nor
60 minutes.
c. Assessment of fetal heart rate (FHR) during the active phase of labor with a
reassuring FHR is indicated every 30 minutes.
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:
