Test #3 Study Guide
Chapter 19: Processes and Stages of Labor and Birth
1) How would the nurse best analyze the results from a client's sonogram that shows the fetal
shoulder as the presenting part?
A) Breech, transverse
B) Breech, longitudinal
C) Breech, frank
D) Vertex, transverse
Explanation:
A) A shoulder presentation is one type of breech presentation, and is also called a transverse lie.
2) A clinic nurse is preparing diagrams of pelvic shapes. Which pelvic shapes are considered
least adequate for vaginal childbirth? Select all that apply.
A) Android
B) Anthropoid
C) Gynecoid
D) Platypelloid
E) Lambdoidal suture
Explanation:
A) In the android and platypelloid types, the pelvic diameters are diminished. Labor is more
likely to be difficult (longer) and a cesarean birth is more likely.
D) In the android and platypelloid types, the pelvic diameters are diminished. Labor is more
likely to be difficult (longer) and a cesarean birth is more likely.
3) The nurse is caring for laboring clients. Which women are experiencing problems related to a
critical factor of labor? Select all that apply.
A) Woman at 7 cm, fetus in general flexion
B) Woman at 3 cm, fetus in longitudinal lie
C) Woman at 4 cm, fetus with transverse lie
D) Woman at 6 cm, fetus at -2 station, mild contractions
E) Woman at 5 cm, fetal presenting part is right shoulder
Explanation:
,C) A transverse lie occurs when the cephalocaudal axis of the fetal spine is at a right angle to the
woman's spine and is associated with a shoulder presentation and can lead to complications in
the later stages of labor.
D) Station refers to the relationship of the presenting part to an imaginary line drawn between the
ischial spines of the maternal pelvis. If the presenting part is higher than the ischial spines, a
negative number is assigned, noting centimeters above zero station. A -2 station is high in the
pelvis. Contractions should be strong to cause fetal descent. Mild contractions will not move the
baby down or open the cervix. This client is experiencing a problem between the maternal pelvis
and the presenting part.
E) When the fetal shoulder is the presenting part, the fetus is in a transverse lie and the acromion
process of the scapula is the landmark. This type of presentation occurs less than 1% of the time.
This client is experiencing a problem between the maternal pelvis and the presenting part.
4) The charge nurse has received the shift change report. Which client requires immediate
intervention?
A) Woman at 6 cm undergoing induction of labor, strong contractions every 3 minutes
B) Woman at 4 cm whose fetus is in a longitudinal lie with a cephalic presentation
C) Woman at 10 cm and fetus at +2 station experiencing a strong expulsion urge
D) Woman at 3 cm screaming in fear because her mother died during childbirth
Explanation:
D) This client is most likely fearful that she will die during labor because her mother died during
childbirth. This client requires education and a great deal of support, and is therefore the top
priority.
5) Premonitory signs of labor include which of the following? Select all that apply.
A) Braxton Hicks contractions
B) Cervical softening and effacement
C) Weight gain
D) Rupture of membranes
E) Sudden loss of energy
Explanation:
A) A premonitory sign of labor includes Braxton Hicks contractions.
B) A premonitory sign of labor includes cervical softening and effacement.
D) A premonitory sign of labor includes rupture of membranes.
,6) A client arrives in the labor and delivery unit and describes her contractions as occurring every
10-12 minutes, lasting 30 seconds. She is smiling and very excited about the possibility of
being in labor. On exam, her cervix is dilated 2 cm, 100% effaced, and -2 station. What best
describes this labor?
A) Second phase
B) Latent phase
C) Active phase
D) Transition phase
Explanation:
B) In the early or latent phase of the first stage of labor, contractions are usually mild. The
woman feels able to cope with the discomfort. The woman is often talkative and smiling and is
eager to talk about herself and answer questions.
7) The client has asked the nurse why her cervix has only changed from 1 to 2 cm in 3 hours of
contractions occurring every 5 minutes. What is the nurse's best response to the client?
A) "Your cervix has also effaced, or thinned out, and that change in the cervix is also labor
progress."
B) "When your perineal body thins out, your cervix will begin to dilate much faster than it is
now."
C) "What did you expect? You've only had contractions for a few hours. Labor takes time."
D) "The hormones that cause labor to begin are just getting to be at levels that will change your
cervix."
Explanation:
A) With each contraction, the muscles of the upper uterine segment shorten and exert a
longitudinal traction on the cervix, causing effacement. Effacement is the taking up (or drawing
up) of the internal os and the cervical canal into the uterine side walls.
8) To identify the duration of a contraction, the nurse would do which of the following?
A) Start timing from the beginning of one contraction to the completion of the same contraction.
B) Time between the beginning of one contraction and the beginning of the next contraction.
C) Palpate for the strength of the contraction at its peak.
D) Time from the beginning of the contraction to the peak of the same contraction.
Explanation:
, A) The duration of each contraction is measured from the beginning of the contraction to the
completion of the contraction.
9) The client at 40 weeks' gestation reports to the nurse that she has had increased pelvic pressure
and increased urinary frequency. Which response by the nurse is best?
A) "Unless you have pain with urination, we don't need to worry about it."
B) "These symptoms usually mean the baby's head has descended further."
C) "Come in for an appointment today and we'll check everything out."
D) "This might indicate that the baby is no longer in a head-down position."
Explanation:
B) This is the best response because it most directly addresses what the client has reported.
10) The client at 39 weeks' gestation calls the clinic and reports increased bladder pressure but
easier breathing and irregular, mild contractions. She also states that she just cleaned the entire
house. Which statement should the nurse make?
A) "You shouldn't work so much at this point in pregnancy."
B) "What you are describing is not commonly experienced in the last weeks."
C) "Your body may be telling you it is going into labor soon."
D) "If the bladder pressure continues, come in to the clinic tomorrow."
Explanation:
C) One of the premonitory signs of labor is lightening: The fetus begins to settle into the pelvic
inlet (engagement). With fetal descent, the uterus moves downward, and the fundus no longer
presses on the diaphragm, which eases breathing.
11) A client calls the labor and delivery unit and tells the nurse that she is 39 weeks pregnant and
over the last 4 or 5 days, she has noticed that although her breathing has become easier, she is
having leg cramps, a slight amount of edema in her lower legs, and an increased amount of
vaginal secretions. The nurse tells the client that she has experienced which of the following?
A) Engagement
B) Lightening
C) Molding
D) Braxton Hicks contractions
Explanation:
B) Lightening describes the effect occurring when the fetus begins to settle into the pelvic inlet.
Chapter 19: Processes and Stages of Labor and Birth
1) How would the nurse best analyze the results from a client's sonogram that shows the fetal
shoulder as the presenting part?
A) Breech, transverse
B) Breech, longitudinal
C) Breech, frank
D) Vertex, transverse
Explanation:
A) A shoulder presentation is one type of breech presentation, and is also called a transverse lie.
2) A clinic nurse is preparing diagrams of pelvic shapes. Which pelvic shapes are considered
least adequate for vaginal childbirth? Select all that apply.
A) Android
B) Anthropoid
C) Gynecoid
D) Platypelloid
E) Lambdoidal suture
Explanation:
A) In the android and platypelloid types, the pelvic diameters are diminished. Labor is more
likely to be difficult (longer) and a cesarean birth is more likely.
D) In the android and platypelloid types, the pelvic diameters are diminished. Labor is more
likely to be difficult (longer) and a cesarean birth is more likely.
3) The nurse is caring for laboring clients. Which women are experiencing problems related to a
critical factor of labor? Select all that apply.
A) Woman at 7 cm, fetus in general flexion
B) Woman at 3 cm, fetus in longitudinal lie
C) Woman at 4 cm, fetus with transverse lie
D) Woman at 6 cm, fetus at -2 station, mild contractions
E) Woman at 5 cm, fetal presenting part is right shoulder
Explanation:
,C) A transverse lie occurs when the cephalocaudal axis of the fetal spine is at a right angle to the
woman's spine and is associated with a shoulder presentation and can lead to complications in
the later stages of labor.
D) Station refers to the relationship of the presenting part to an imaginary line drawn between the
ischial spines of the maternal pelvis. If the presenting part is higher than the ischial spines, a
negative number is assigned, noting centimeters above zero station. A -2 station is high in the
pelvis. Contractions should be strong to cause fetal descent. Mild contractions will not move the
baby down or open the cervix. This client is experiencing a problem between the maternal pelvis
and the presenting part.
E) When the fetal shoulder is the presenting part, the fetus is in a transverse lie and the acromion
process of the scapula is the landmark. This type of presentation occurs less than 1% of the time.
This client is experiencing a problem between the maternal pelvis and the presenting part.
4) The charge nurse has received the shift change report. Which client requires immediate
intervention?
A) Woman at 6 cm undergoing induction of labor, strong contractions every 3 minutes
B) Woman at 4 cm whose fetus is in a longitudinal lie with a cephalic presentation
C) Woman at 10 cm and fetus at +2 station experiencing a strong expulsion urge
D) Woman at 3 cm screaming in fear because her mother died during childbirth
Explanation:
D) This client is most likely fearful that she will die during labor because her mother died during
childbirth. This client requires education and a great deal of support, and is therefore the top
priority.
5) Premonitory signs of labor include which of the following? Select all that apply.
A) Braxton Hicks contractions
B) Cervical softening and effacement
C) Weight gain
D) Rupture of membranes
E) Sudden loss of energy
Explanation:
A) A premonitory sign of labor includes Braxton Hicks contractions.
B) A premonitory sign of labor includes cervical softening and effacement.
D) A premonitory sign of labor includes rupture of membranes.
,6) A client arrives in the labor and delivery unit and describes her contractions as occurring every
10-12 minutes, lasting 30 seconds. She is smiling and very excited about the possibility of
being in labor. On exam, her cervix is dilated 2 cm, 100% effaced, and -2 station. What best
describes this labor?
A) Second phase
B) Latent phase
C) Active phase
D) Transition phase
Explanation:
B) In the early or latent phase of the first stage of labor, contractions are usually mild. The
woman feels able to cope with the discomfort. The woman is often talkative and smiling and is
eager to talk about herself and answer questions.
7) The client has asked the nurse why her cervix has only changed from 1 to 2 cm in 3 hours of
contractions occurring every 5 minutes. What is the nurse's best response to the client?
A) "Your cervix has also effaced, or thinned out, and that change in the cervix is also labor
progress."
B) "When your perineal body thins out, your cervix will begin to dilate much faster than it is
now."
C) "What did you expect? You've only had contractions for a few hours. Labor takes time."
D) "The hormones that cause labor to begin are just getting to be at levels that will change your
cervix."
Explanation:
A) With each contraction, the muscles of the upper uterine segment shorten and exert a
longitudinal traction on the cervix, causing effacement. Effacement is the taking up (or drawing
up) of the internal os and the cervical canal into the uterine side walls.
8) To identify the duration of a contraction, the nurse would do which of the following?
A) Start timing from the beginning of one contraction to the completion of the same contraction.
B) Time between the beginning of one contraction and the beginning of the next contraction.
C) Palpate for the strength of the contraction at its peak.
D) Time from the beginning of the contraction to the peak of the same contraction.
Explanation:
, A) The duration of each contraction is measured from the beginning of the contraction to the
completion of the contraction.
9) The client at 40 weeks' gestation reports to the nurse that she has had increased pelvic pressure
and increased urinary frequency. Which response by the nurse is best?
A) "Unless you have pain with urination, we don't need to worry about it."
B) "These symptoms usually mean the baby's head has descended further."
C) "Come in for an appointment today and we'll check everything out."
D) "This might indicate that the baby is no longer in a head-down position."
Explanation:
B) This is the best response because it most directly addresses what the client has reported.
10) The client at 39 weeks' gestation calls the clinic and reports increased bladder pressure but
easier breathing and irregular, mild contractions. She also states that she just cleaned the entire
house. Which statement should the nurse make?
A) "You shouldn't work so much at this point in pregnancy."
B) "What you are describing is not commonly experienced in the last weeks."
C) "Your body may be telling you it is going into labor soon."
D) "If the bladder pressure continues, come in to the clinic tomorrow."
Explanation:
C) One of the premonitory signs of labor is lightening: The fetus begins to settle into the pelvic
inlet (engagement). With fetal descent, the uterus moves downward, and the fundus no longer
presses on the diaphragm, which eases breathing.
11) A client calls the labor and delivery unit and tells the nurse that she is 39 weeks pregnant and
over the last 4 or 5 days, she has noticed that although her breathing has become easier, she is
having leg cramps, a slight amount of edema in her lower legs, and an increased amount of
vaginal secretions. The nurse tells the client that she has experienced which of the following?
A) Engagement
B) Lightening
C) Molding
D) Braxton Hicks contractions
Explanation:
B) Lightening describes the effect occurring when the fetus begins to settle into the pelvic inlet.
