Pediatric/OB Exam 2 CH; 13,14,21
CORRECT ANSWERS 100%
GRADE A +
1. A woman in her 40th week of pregnancy calls the nurse at the clinic and says she is not sure
whether she is in true or false labor. Which statement by the client would lead the nurse to
suspect that the woman is experiencing false labor?
A. "I'm feeling contractions mostly in my back."
B. "My contractions are about 6 minutes apart and regular." C. "The contractions slow down
when I walk around."
D. "If I try to talk to my partner during a contraction, I can't." Answer: C
Rationale: False labor is characterized by contractions that are irregular and weak, often slowing
down with walking or a position change. True labor contractions begin in the back and radiate
around toward the front of the abdomen. They are regular and become stronger over time; the
woman may find it extremely difficult if not impossible to have a conversation during a
contraction.
2. A client is in the third stage of labor. Which finding would alert the nurse that the placenta is
separating?
A. uterus becomes globular
B. fetal head at vaginal opening
C. umbilical cord shortens
D. mucous plug is expelled Answer: A
Rationale: Placental separation is indicated by the uterus changing shape to globular and upward
rising of the uterus. Additional signs include a sudden trickle of blood from the vaginal opening,
and lengthening (not shortening) of the umbilical cord. The fetal head at the vaginal opening is
termed crowning and occurs before birth of the head. Expulsion of the mucous plug is a
premonitory sign of labor.
3. When assessing cervical effacement of a client in labor, the nurse assesses which
characteristic?
A. extent of opening to its widest diameter
B. degree of thinning
C. passage of the mucous plug
D. fetal presenting part Answer: B
Rationale: Effacement refers to the degree of thinning of the cervix. Cervical dilation refers to
the extent of opening at the widest diameter. Passage of the mucous plug occurs with bloody
show as a premonitory sign of labor. The fetal presenting part is determined by vaginal
examination and is commonly the head (cephalic), pelvis (breech), or shoulder.
4. A woman calls the health care facility stating that she is in labor. The nurse would urge the
client to come to the facility if the client reports which symptom?
A. increased energy level with alternating strong and weak contractions
B. moderately strong contractions every 4 minutes, lasting about 1 minute
C. contractions noted in the front of abdomen that stop when she walks
,D. pink-tinged vaginal secretions and irregular contractions lasting about 30 seconds
Answer: B
Rationale: Moderately strong regular contractions 60 seconds in duration indicate that the client
is probably in the active phase of the first stage of labor. Alternating strong and weak
contractions, contractions in the front of the abdomen that change with activity, and pink-tinged
secretions with irregular contractions suggest false labor.
5. A woman is in the first stage of labor. The nurse would encourage her to assume which
position to facilitate the progress of labor?
A. supine
B. lithotomy
C. upright
D. knee-chest Answer: C
Rationale: The use of any upright position helps to reduce the length of labor. Research shows
that women who assumed the upright position during the first stage of labor experienced
significant improvement in the progress of labor, faster fetal head descent, significant reduction
of pain, and a good Apgar score. Additionally, studies show that recumbent positions result in
supine hypotension, diminishing uterine activity and reducing the dimensions of the pelvic
outlet. The knee-chest position would assist in rotating the fetus in a posterior position. Question
format: Multiple Choice
Chapter 13: Labor and Birth Process
6. A client has not received any medication during her labor. She is having frequent contractions
about every 1 to 2 minutes and has become irritable with her coach and no longer will allow the
nurse to palpate her fundus during contractions. Her cervix is 8 cm dilated and 90% effaced. The
nurse interprets these findings as indicating:
A. latent phase of the first stage of labor.
B. perineal phase of the first stage of labor. C. late active phase of the first stage of labor. D.
early phase of the third stage of labor. Answer: C
Rationale: Late in the active phase of labor, contractions become more frequent (every 2 to 5
minutes) and increase in duration (45 to 60 seconds). The woman's discomfort intensifies
(moderate to strong by palpation). She becomes more intense and inwardly focused, absorbed in
the serious work of her labor. She limits interactions with those in the room. The latent phase is
characterized by mild contractions every 5 to 10 minutes, cervical dilation of 0 to 3 cm and
effacement of 0% to 40%, and excitement and frequent talking by the mother. The pelvic phase
of the second stage of labor is characterized by complete cervical dilation and effacement, with
strong contractions every 2 to 3 minutes; the mother focuses on pushing. The perineal phase of
the second stage is the period of active pushing. The third stage, placental expulsion, starts after
the newborn is born and ends with the separation and birth of the placenta
7. The fetus of a nulliparous woman is in a shoulder presentation. The nurse would prepare the
client for which type of birth?
A. cesarean
B. vaginal
C. forceps-assisted
D. vacuum extraction Answer: A
Rationale: The fetus is in a transverse lie with the shoulder as the presenting part, necessitating a
cesarean birth. Vaginal birth, forceps-assisted, and vacuum extraction births are not appropriate.
, 8. Assessment of a woman in labor reveals cervical dilation of 3 cm, cervical effacement of 30%,
and contractions occurring every 7 to 8 minutes, lasting about 40 seconds. The nurse determines
that this client is in:
A. latent phase of the first stage.
B. active phase of the first stage.
C. pelvic phase of the second stage. D. early phase of the third stage. Answer: A
Rationale: The latent phase of the first stage of labor involves cervical dilation of 0 to 3 cm,
cervical effacement of 0% to 40%, and contractions every 5 to 10 minutes lasting 30 to 45
seconds. The active phase is characterized by cervical dilation of 4 to 7 cm, effacement of 40%
to 80%, and contractions occurring every 2 to 5 minutes lasting 45 to 60 seconds. The perineal
phase of the second stage occurs with complete cervical dilation and effacement, contractions
occurring every 2 to 3 minutes and lasting 60 to 90 seconds, and a tremendous urge to push by
the mother. The third stage, placental expulsion, starts after the newborn is born and ends with
the separation and birth of the placenta.
9. A client is admitted to the labor and birthing suite in early labor. On review of her prenatal
history, the nurse determines that the client's pelvic shape as identified in the antepartal progress
notes is the most favorable one for a vaginal birth. Which pelvic shape would the nurse have
noted?
A. platypelloid
B. gynecoid
C. android
D. anthropoid Answer: B
Rationale: The most favorable pelvic shape for vaginal birth is the gynecoid shape. The
anthropoid pelvis is favorable for vaginal birth, but it is not the most favorable shape. The
android pelvis is not considered favorable for a vaginal birth because descent of the fetal head is
slow and failure of the fetus to rotate is common. Women with a platypelloid pelvis usually
require cesarean birth.
10. A woman telephones the prenatal clinic and reports that her water just broke. Which
suggestion by the nurse would be most appropriate?
A. "Call us back when you start having contractions."
B. "Come to the clinic or emergency department for an evaluation."
C. "Drink 3 to 4 glasses of water and lie down."
D. "Come in as soon as you feel the urge to push." Answer: B
Rationale: When the amniotic sac ruptures, the barrier to infection is gone, and there is the
danger of cord prolapse if engagement has not occurred. Therefore, the nurse should suggest that
the woman come in for an evaluation. Calling back when contractions start, drinking water, and
lying down are inappropriate because of the increased risk for infection and cord prolapse.
Telling the client to wait until she feels the urge to push is inappropriate because this occurs
during the second stage of labor.
11. A nurse is conducting a continuing education program for a group of nurses working in the
perinatal unit. After reviewing information about the maternal bony pelvis with the group, the
nurse determines that the teaching was successful based on which statement by the group?
A. The bony pelvis plays a lesser role during labor than soft tissue.
B. The pelvic outlet is associated with the true pelvis.
C. The false pelvis lies below the imaginary linea terminalis.
D. The false pelvis is the passageway through which the fetus travels. Answer: B
CORRECT ANSWERS 100%
GRADE A +
1. A woman in her 40th week of pregnancy calls the nurse at the clinic and says she is not sure
whether she is in true or false labor. Which statement by the client would lead the nurse to
suspect that the woman is experiencing false labor?
A. "I'm feeling contractions mostly in my back."
B. "My contractions are about 6 minutes apart and regular." C. "The contractions slow down
when I walk around."
D. "If I try to talk to my partner during a contraction, I can't." Answer: C
Rationale: False labor is characterized by contractions that are irregular and weak, often slowing
down with walking or a position change. True labor contractions begin in the back and radiate
around toward the front of the abdomen. They are regular and become stronger over time; the
woman may find it extremely difficult if not impossible to have a conversation during a
contraction.
2. A client is in the third stage of labor. Which finding would alert the nurse that the placenta is
separating?
A. uterus becomes globular
B. fetal head at vaginal opening
C. umbilical cord shortens
D. mucous plug is expelled Answer: A
Rationale: Placental separation is indicated by the uterus changing shape to globular and upward
rising of the uterus. Additional signs include a sudden trickle of blood from the vaginal opening,
and lengthening (not shortening) of the umbilical cord. The fetal head at the vaginal opening is
termed crowning and occurs before birth of the head. Expulsion of the mucous plug is a
premonitory sign of labor.
3. When assessing cervical effacement of a client in labor, the nurse assesses which
characteristic?
A. extent of opening to its widest diameter
B. degree of thinning
C. passage of the mucous plug
D. fetal presenting part Answer: B
Rationale: Effacement refers to the degree of thinning of the cervix. Cervical dilation refers to
the extent of opening at the widest diameter. Passage of the mucous plug occurs with bloody
show as a premonitory sign of labor. The fetal presenting part is determined by vaginal
examination and is commonly the head (cephalic), pelvis (breech), or shoulder.
4. A woman calls the health care facility stating that she is in labor. The nurse would urge the
client to come to the facility if the client reports which symptom?
A. increased energy level with alternating strong and weak contractions
B. moderately strong contractions every 4 minutes, lasting about 1 minute
C. contractions noted in the front of abdomen that stop when she walks
,D. pink-tinged vaginal secretions and irregular contractions lasting about 30 seconds
Answer: B
Rationale: Moderately strong regular contractions 60 seconds in duration indicate that the client
is probably in the active phase of the first stage of labor. Alternating strong and weak
contractions, contractions in the front of the abdomen that change with activity, and pink-tinged
secretions with irregular contractions suggest false labor.
5. A woman is in the first stage of labor. The nurse would encourage her to assume which
position to facilitate the progress of labor?
A. supine
B. lithotomy
C. upright
D. knee-chest Answer: C
Rationale: The use of any upright position helps to reduce the length of labor. Research shows
that women who assumed the upright position during the first stage of labor experienced
significant improvement in the progress of labor, faster fetal head descent, significant reduction
of pain, and a good Apgar score. Additionally, studies show that recumbent positions result in
supine hypotension, diminishing uterine activity and reducing the dimensions of the pelvic
outlet. The knee-chest position would assist in rotating the fetus in a posterior position. Question
format: Multiple Choice
Chapter 13: Labor and Birth Process
6. A client has not received any medication during her labor. She is having frequent contractions
about every 1 to 2 minutes and has become irritable with her coach and no longer will allow the
nurse to palpate her fundus during contractions. Her cervix is 8 cm dilated and 90% effaced. The
nurse interprets these findings as indicating:
A. latent phase of the first stage of labor.
B. perineal phase of the first stage of labor. C. late active phase of the first stage of labor. D.
early phase of the third stage of labor. Answer: C
Rationale: Late in the active phase of labor, contractions become more frequent (every 2 to 5
minutes) and increase in duration (45 to 60 seconds). The woman's discomfort intensifies
(moderate to strong by palpation). She becomes more intense and inwardly focused, absorbed in
the serious work of her labor. She limits interactions with those in the room. The latent phase is
characterized by mild contractions every 5 to 10 minutes, cervical dilation of 0 to 3 cm and
effacement of 0% to 40%, and excitement and frequent talking by the mother. The pelvic phase
of the second stage of labor is characterized by complete cervical dilation and effacement, with
strong contractions every 2 to 3 minutes; the mother focuses on pushing. The perineal phase of
the second stage is the period of active pushing. The third stage, placental expulsion, starts after
the newborn is born and ends with the separation and birth of the placenta
7. The fetus of a nulliparous woman is in a shoulder presentation. The nurse would prepare the
client for which type of birth?
A. cesarean
B. vaginal
C. forceps-assisted
D. vacuum extraction Answer: A
Rationale: The fetus is in a transverse lie with the shoulder as the presenting part, necessitating a
cesarean birth. Vaginal birth, forceps-assisted, and vacuum extraction births are not appropriate.
, 8. Assessment of a woman in labor reveals cervical dilation of 3 cm, cervical effacement of 30%,
and contractions occurring every 7 to 8 minutes, lasting about 40 seconds. The nurse determines
that this client is in:
A. latent phase of the first stage.
B. active phase of the first stage.
C. pelvic phase of the second stage. D. early phase of the third stage. Answer: A
Rationale: The latent phase of the first stage of labor involves cervical dilation of 0 to 3 cm,
cervical effacement of 0% to 40%, and contractions every 5 to 10 minutes lasting 30 to 45
seconds. The active phase is characterized by cervical dilation of 4 to 7 cm, effacement of 40%
to 80%, and contractions occurring every 2 to 5 minutes lasting 45 to 60 seconds. The perineal
phase of the second stage occurs with complete cervical dilation and effacement, contractions
occurring every 2 to 3 minutes and lasting 60 to 90 seconds, and a tremendous urge to push by
the mother. The third stage, placental expulsion, starts after the newborn is born and ends with
the separation and birth of the placenta.
9. A client is admitted to the labor and birthing suite in early labor. On review of her prenatal
history, the nurse determines that the client's pelvic shape as identified in the antepartal progress
notes is the most favorable one for a vaginal birth. Which pelvic shape would the nurse have
noted?
A. platypelloid
B. gynecoid
C. android
D. anthropoid Answer: B
Rationale: The most favorable pelvic shape for vaginal birth is the gynecoid shape. The
anthropoid pelvis is favorable for vaginal birth, but it is not the most favorable shape. The
android pelvis is not considered favorable for a vaginal birth because descent of the fetal head is
slow and failure of the fetus to rotate is common. Women with a platypelloid pelvis usually
require cesarean birth.
10. A woman telephones the prenatal clinic and reports that her water just broke. Which
suggestion by the nurse would be most appropriate?
A. "Call us back when you start having contractions."
B. "Come to the clinic or emergency department for an evaluation."
C. "Drink 3 to 4 glasses of water and lie down."
D. "Come in as soon as you feel the urge to push." Answer: B
Rationale: When the amniotic sac ruptures, the barrier to infection is gone, and there is the
danger of cord prolapse if engagement has not occurred. Therefore, the nurse should suggest that
the woman come in for an evaluation. Calling back when contractions start, drinking water, and
lying down are inappropriate because of the increased risk for infection and cord prolapse.
Telling the client to wait until she feels the urge to push is inappropriate because this occurs
during the second stage of labor.
11. A nurse is conducting a continuing education program for a group of nurses working in the
perinatal unit. After reviewing information about the maternal bony pelvis with the group, the
nurse determines that the teaching was successful based on which statement by the group?
A. The bony pelvis plays a lesser role during labor than soft tissue.
B. The pelvic outlet is associated with the true pelvis.
C. The false pelvis lies below the imaginary linea terminalis.
D. The false pelvis is the passageway through which the fetus travels. Answer: B
