NUR 4132 Chapter 16: Giving Birth McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition

MULTIPLE CHOICE 1. The maternity nurse understands that as the uterus contracts during labor, maternal-fetal exchange of oxygen and waste products a. continues except when placental functions are reduced. b. increases as blood pressure decreases. c. diminishes as the spiral arteries are compressed. d. is not significantly affected. ANS: C During labor contractions, the maternal blood supply to the placenta gradually stops as the spiral arteries supplying the intervillous space are compressed by the contracting uterine muscle. The maternal blood supply to the placenta gradually stops with contractions and the exchange of oxygen and waste products decreases. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 290 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 2. A student nurse is trying to assess vital signs on a laboring woman. Which statement by the registered nurse is the best rationale for assessing maternal vital signs between contractions? a. During a contraction, assessing fetal heart rates is the priority. b. Maternal circulating blood volume increases temporarily during contractions. c. Maternal blood flow to the heart is reduced during contractions. d. Vital signs taken during contractions are not accurate. ANS: B During uterine contractions, blood flow to the placenta temporarily stops, causing a relative increase in the mother’s blood volume, which in turn temporarily increases blood pressure and slows pulse. It is important to monitor fetal response to contractions, but the question is concerned with the maternal vital signs so assessing the fetal heart rate is not the priority. Vital signs are altered by contractions but are considered accurate for that period of time. However, they do not reflect the woman’s baseline. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 289 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 3. Which mechanism of labor occurs when the largest diameter of the fetal presenting part passes the pelvic inlet? a. Engagement b. Extension c. Internal rotation d. External rotation ANS: A Engagement occurs when the presenting part fully enters the pelvic inlet. Extension occurs when the fetal head meets resistance from the tissues of the pelvic floor and the fetal neck stops under the symphysis. This causes the fetal head to extend. Internal rotation occurs when the fetus enters the pelvic inlet. The rotation allows the longest fetal head diameter to conform to the longest diameter of the maternal pelvis. External rotation occurs after the birth of the head. The head then turns to the side so the shoulders can internally rotate and are positioned with their transverse diameter in the anteroposterior diameter of the pelvic outlet. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 299 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 4. To adequately care for patients, the nurse understands that labor contractions facilitate cervical dilation by a. contracting the lower uterine segment. b. enlarging the internal size of the uterus. c. promoting blood flow to the cervix. d. pulling the cervix over the fetus and amniotic sac. ANS: D Effective uterine contractions pull the cervix upward at the same time that the fetus and amniotic sac are pushed downward. The contractions are stronger at the fundus. The internal size becomes smaller with the contractions; this helps to push the fetus down. Blood flow decreases to the uterus during a contraction. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 290 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 5. A student asks how pregnant women can usually tolerate the normal blood loss associated with childbirth. Which response by the nurse is best? “It is because they have a. a higher hematocrit.” b. increased blood volume.” c. a lower fibrinogen level.” d. increased leukocytes.” ANS: B Women have a significant increase in blood volume during pregnancy, which allows them to tolerate the normal blood loss seen in delivery. The hematocrit decreases with pregnancy due to the high fluid volume. Fibrinogen levels increase with pregnancy. Leukocyte levels increase during labor, but that is not the reason for the toleration of blood loss. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 290 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity 6. To assess the duration of labor contractions, the nurse determines the time a. from the beginning of one contraction to the beginning of the next. b. from the beginning to the end of each contraction. c. of the strongest intensity of each contraction. d. of uterine relaxation between two contractions. ANS: B Duration of labor contractions is the average length of contractions from beginning to end. Assessing from the beginning of one contraction to the beginning of the next is the frequency. The strongest intensity of each contraction is the strength or intensity. The interval of the contraction phase is the time of uterine relaxation between two contractions. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 314 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 7. The nurse teaching a prenatal class explains that which is the best indicator of true labor? a. Bloody show b. Cervical dilation and effacement c. Fetal descent into the pelvic inlet d. Uterine contractions every 7 minutes ANS: B The conclusive distinction between true and false labor is that contractions of true labor cause progressive change in the cervix. Bloody show can occur before true labor. Fetal descent can occur before true labor. False labor may have contractions that occur this frequently, but it is usually inconsistent. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 298 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 8. The student nurse learns that which factor ensures that the smallest anterior-posterior diameter of the fetal head enters the pelvis? a. Descent b. Engagement c. Flexion d. Station ANS: C Flexion of the fetal head allows the smallest head diameters to pass through the pelvis. Descent is the moving of the fetus through the birth canal. Engagement occurs when the largest diameter of the fetal presenting part has passed the pelvic inlet. Station is the relationship of the fetal presenting part to the level of the ischial spines.