The exact mechanism that initiates labor is:

A. uterine stretching

B. oxytocin stimulation

C. cervical pressure

D. unknown

E. placental age

F. progesterone withdrawal

D. unknown

-all of the other choices are suspected causes or thought to work in combination to cause labor but the true initial cause remains unknown

Which of the following is not one of the 4 Ps of pregnancy?

A. passage

B. pain

C. power

D. psyche

E. passenger

B. pain

-passage refers to the route the fetus must travel when leaving the uterus, ending at the external perineal area

-passenger refers to the fetus and its ability to move through the passage

-power refers to the force of uterine ctx

-psyche refers to the feelings the pt brings to labor

Apnea is considered a sign of respiratory distress in the newborn when the apnea last longer than:

A. 10 sec

B. 15 sec

C. 20 sec

D. 25 sec

C. 20 sec

-all newborns have brief periods of apnea that usually last a few seconds.  Rule of thumb is by the time you notice it the baby will start breathing again.  If it lasts longer than 20 secs (you should have done tactile stimulation by then) than it is true apnea and a sign of RD

Which crosses the placenta?

A. glucose, not insulin

B. insulin, not glucose

C. both insulin and glucose

D. neither insulin or glucose

A. glucose not insulin

-this abundance of glucose causes macrosomia (birth weight greater than 4000g)

-macrosomia can cause birth trauma but also the newborn will be born hyperglycemic which quickly turns to hypoglycemia

A diabetic mother gives birth to a 4500g newborn.  The initial serum glucose is high.  What interventions are the RN anticipating?  Select all that apply

A. feed the baby early

B. admin insulin

C. assess for birth trauma

D. assess respiratory function

E. maintain thermoregulation

A,C,D,E

-FEED THE BABY EARLY, the serum glucose is going to drop as a result of being cut off from mom's supply.  Feeding early will ward off hypoglycemia, this baby will need frequent serum glucose checks

-birth trauma caused by large size

-when the infant becomes hypoglycemic he has less glucose to use for energy and can become hypothermic.  Hypothermia will raise the metabolic rate which increases oxygen need, decreases surfactant production, and causes hypoxia

What is the major difference between true labor and false labor?

A. when it occurs

B. cervical change

C. hCG level

D. location and amount of pain

B. cervical change

-False labor: NO CERVICAL CHANGE, feels like the baby is "balling up", pain in low abd/groin, ambulation alleviates pain

-True labor: CERVICAL CHANGE OCCURS, pain increases in intensity and frequency, ambulation speeds up the process

-thinning of the cervix, 0-100%,

-100% is completely effaced

-felt during manual exam

-opening of the cervical canal during the first stage of labor

-0-10 cm, 10 cm is fully dialated

-location of the fetus in relation to the maternal pelvis

-rated (-)5 - 5, (-)5 still floating, 0 is level with the ischial spine, 5 you can see the head

-positive numbers indicate the fetus has entered the birth canal

-the head has entered the pelvis

-as the baby engages pressure is created on the cervix forcing effacement and dialation

-relationship of the fetal spinal column to the mother's

-longitudinal is a vertical lie (99% of all babies at labor)

-transverse is a horizontal lie

-oblique is where the fetal spine and maternal spine are at a 45^o angle, midway between longitudinal and transverse

-relationship of the fetal parts to one another

-rated in degrees of flexion, extension

1. complete flexion (most common) fetal position
2. moderate flexion (2nd most common)
3. partial extension (uncommon) brow presentation
4. complete extension (rare) face presentation, usually associated with a neurological or fetal abnormality, commonly requires a C/S

Which of these is NOT one of the 3 typical descriptions of presentation?

A. cephalic

B. breech

C. occiput

D. shoulder

Which of the 4 cephalic presentations occurs when the chin presents first?

A. face

B. vertex

C. brow

D. mentum

D. mentum

-vertex occurs when the head is flexed sharply and the fontanels is the presenting part

-brow occurs when the head is moderately flexed and the brow presents first

-face occurs when the head is  extended causing the face to present

-mentum occurs when the head is hyperextended causing the chin to present first

-my lecture notes say no vaginal delivery with brow, face, or mentum presentation but my NCLEX book says those would make a vaginal delivery difficult

Which of the 3 breech presentations occurs when the hips are flexed but the legs are extended resting on the chest?

A. complete

B. frank

C. footling

B. frank

-complete occurs when the thighs are tightly flexed to the abdomen causing the buttocks and flexed feet to present first

-footling occurs in the absence of hip or thigh flexion of one or both extremities so that one or both feet are the presenting part

-footling is the most difficult of breech deliveries

-cord prolapse is common with footling presentation and C/S MAY BE necessary

Which presentation is a result of a transverse lie?

A. cephalic

B. breech

C. brow

D. shoulder

D. shoulder

-the shoulder, iliac crest, hand, or elbow present

-can be caused by relaxation of the abd walls, pelvic ctx, or placenta previa

-the fetus must be turned before delivery however this is usually unsuccessful unless the fetus is SGA or preterm

-ALMOST ALWAYS requires a C/S delivery

Which is the most desireable lie for a vaginal delivery?

A. transverse

B. oblique

C. longitudinal

C. longitudinal

-this is the lie that accompanies cephalic vertex presentation

At what station does engagement occur?

A. longitudinal

B. zero

C. LOA

D. vertex

B. zero

-zero station is where the presenting part is level with the maternal ischial spine and is entering the birth canal

-vertex and longitudinal are presentations

-LOA is a postion

relationship of the presenting part of the fetus to a specific section of the mother's pelvis

-LOA, ROA, LOP, ROP (p347 textbook)

those are the only 4 we had to learn

For each of the following say whether they are r/t true labor or false labor:

A. braxton-hicks ctx

B. back discomfort that spreads to abd

C. ctx relieved by ambulation

D. decreased resting phase of ctx

E. increased intensity of ctx

A. false, are irregular and cause no cervical change

B. true, in false it is localized to the abd/groin

C. false, in true ambulation speeds labor

D. true, means ctx are closer together

E. true, sign of impending labor

What is the correct order of the 3 phases of the first stage of labor?

A. active, transitional, latent

B. transitional, active, latent

C. latent, transitional, active

D. latent, active, transitional

The latent phase of labor (Stage 1) is considered cervical dialation of what?

A. 0-2 cm

B. 1-4 cm

C. 0-3 cm

D. 1-3 cm

C. 0-3 cm

-ctx are irregular and short usually lasting 20-40 secs

-duration usually lasts 6-18 hrs in a primipara and 2-10 hrs in a multipara

The active phase of labor (stage 1) is considered when the cervix is dialated what?

A. 8-10 cm

B. 3-6 cm

C. 3-7 cm

D. 4-7 cm

D. 4-7 cm

-ctx are 5-8 mins apart and last 45-60 secs

-ctx are moderate to strong in intensity

-ROM usually occurs during this phase, if they haven't already done so

-generally lasts 3 hrs for primipara and 2 hr for multipara

The transitional phase of labor (stage 1) is considered when the cervix is dialated what?

A. 0-3 cm

B. 4-7 cm

C. 8-10 cm

D. 5-8 cm

C. 8-10 cm

-ctx are 1-2 mins apart, last 60-90 secs, and are strong in intensity

-moms feel a loss of control at this phase

-at the end of this phase moms feel the urge to push

-begins with complete cervical dialation and ends with delivery of the neonate

-usually lasts 40 mins (20 ctx) for a primipara

-usually lasts 20 mins (10 ctx) for a multipara

Name the seven cardinal movements of labor in order.

*ED FIRE ERE*

engagement, descent,

flexion, internal rotation, extension,

external rotation, expulsion

*I couldn't figure out an acronym so that's the best I could do

Which cardinal movement of labor is characterized by the fetal head moving into the pelvic inlet?  At the end of this movement the head contacts the posterior vaginal floor.

A. flexion

B. descent

C. internal rotation

D. engagment

B. descent

-the head has passed the ischial spine and continues down into the pelvic inlet

-progresses intermittently with ctx

This cardinal movement of labor occurs when the fetal head moves forward so that the chin is pressed against the chest.

A. flexion

B. extension

C. engagement

D. external rotation

A. flexion

-occurs during descent and is caused by resistance of the fetal head against the pelvic floor

-allows the smallest diameter of the fetal head to descend through the pelvis

This cardinal movement of labor is the rotation that allows the fetal head to pass through the ischial spines.

A. internal rotation

B. external rotation

C. transverse rotation

D. oblique rotation

A. internal rotation

-the head rotates about 45^o as it meets resistance of the pelvic floor

-this places the widest part of the shoulders in line with the widest part of the pelvis

-this also places the widest part of the fetal head in line with the widest part of the pelvic outlet

The cardinal movement of labor that delivers the head, face, and chin.

A. expulsion

B. external rotation

C. extension

D. flexion

C. extension

-descent is temporarily halted as the shoulders are too wide to pass through the pelvis

-upward resistance from the pelvic floor causes the fetal head to extend, presenting the brow, nose, mouth, and chin

The cardinal movement of labor where the head rotates back to the original position seen at the beginning of descent.

A. internal rotation

B. extension

C. flexion

D. external rotation

D. external rotation

-descent is halted during extension because the shoulders are too wide to pass, at this point the head and shoulders externally rotate the 45^o they earlier had internally rotated

-this allows the shoulders to pass the pelvic outlet

During which cardinal movement of labor do we typically have shoulder dystocia occur in macrosomia neonates?

A. extension

B. expulsion

C. internal rotation

D. external rotation

D. external rotation

-this is when the shoulders are passing the pelvic outlet and with a larger baby there may not be enough room

The final cardinal movement of labor where the remainder of the baby is delivered.

A. expulsion

B. delivery

C. extension

D. external rotation

A. expulsion

-this signifies the end of the 2nd stage of labor

The 3rd stage of labor is:

A. delivery of the neonate

B. recovery phase

C. delivery of the placenta

D. cardinal movements of labor

C. delivery of the placenta

-takes 5-30 mins

-immediately following delivery of the neonate the uterus stops contracting for several minutes, then it resumes contractions until the placenta is birthed

What keeps the placenta from separating prematurely in the first two stages of labor?

A. increased blood flow from ctx

B. pressure from the fetus

C. no known reason

D. continued blood flow, the cord hasn't been cut

B. pressure from the fetus

-during the first 2 stages the fetus is exerting pressure on the placenta preveting it from separating early

-after expulsion the uterus is contracting on relatively empty space leaving nothing to apply reverse pressure on the placenta

-the placenta folds and begins to separate which causes bleeding and further pushes the placenta away

What is the term when the fetal side of the placenta is showing upon delivery?

A. Duncan placenta

B. Crede's placenta

C. Truman's placenta

D. Schultze's placenta

D. Schultze's placenta

-Schultzes is shiny

-the fetal side is shiny and shows when the placenta separates in the middle first and folds onto itself

What is the name for a placenta with the maternal side showing?

A. Duncan placenta

B. Schultze's placenta

C. Crede's placenta

D. Heurshe placenta

A. Duncan placenta

-in this instance the presenting side is raw, red, and irregular

-this occurs when the placenta separates from the edges first

What is most important to note before applying pressure to the uterus to expel the placenta or placental fragments?

A. that the abdomenal muscles haven't separated

B. that the mother is adequately hydrated

C. that the uterus is contracted

D. that you have magnesium sulfate at bedside

C. that the uterus is contracted

-applying pressure to an uncontracted uterus can cause eversion (the uterus to turn inside out) which causes massive bleeding

What is the priority action of the 4th stage of labor?

A. stabilizing the newborn

B. administer Vitamin K

C. maternal-newborn bonding

D. promote breastfeeding

A. stabilizing the newborn

-bonding and breastfeeding are part of 4th stage of labor the priority is to establish stability with the newborn and get him acclimated to extrauterine life

-Vitamin K will be done later

Version is used to correct what?

A. early hemorrhage

B. post term labor

C. ABO incompatibility

D. shoulder presentation

D. shoulder presentation

-version is externally rotating the baby into a cephalic presentation

-also corrects breech presentation

Which are expected nursing interventions throughout all stages of labor? Select all that apply

A. record I&Os

B. maintain clean technique

C. offer ice chips

D. assess need for pain meds and effect

A,C,D

-you will need to maintain sterile technique

-also offer emotional support, explain procedures, and monitor and record VS

What is the priority intervention during the transition phase of labor?

A. monitor the patient

B. encourage ambulation

C. encourage proper breathing techniques

D. perform perineal care

A. monitor the patient

-at this point you should stay with the patient at all times because birth may be imminent

-at this point the mother will be on bed rest

-breathing and perineal care will be performed but are not the priority

What are appropriate interventions for a mother in labor who has a drop in BP?  Select all that apply

A. administer Apresoline

B. place pt on left side

C. increase primary IV flow rate

D. administer oxygen 8-10L via mask

B,C,D

-Apresoline is an antihypertensive

When ROM occurs what needs to be documented?

A. time

B. color

C. odor

D. amount

E. consistency

Which of these is not an expected intervention during the 3rd stage of labor?

A. administer or increase oxytocin rate

B. allow mother to breast feed

C. administer erythromycin eye ointment

D. assess for hypotensive supine syndrome

D. assess for hypotensive supine syndrome

-this occurs due to pressure of the fetus on the inferior vena cava

Which of these is not an expected intervention during the fourth stage of labor?

A. promote breathing techniques

B. assess lochia

C. Apgar scoring

D. assess fundus

E. perineal care

F. promote maternal-neonate bonding

The first manuever of Leopold's manuevers is used to:

A. palpate the abd to identify the location of the fetus's back

B. palpate the fundus to identify the occupying fetal part

C. grasping the lower portion of the abd above the symphysis pubis to identify the fetal part presenting over the inlet

D. moving the fingers down both sides of the uterus to assess the descent of the presenting part into the pelvis

B. palpate the fundus to identify the occupying fetal part

-when palpating the fundus a vertex presentatoin is noted by feeling the irregularly shaped, firm buttocks; breech presentation is noted if the hard, round, movable head is felt at the fundus

-A. is the second step, moving your hands down the side of the abd the back will feel firm, smooth, and convex; the front will feel soft, irregular, and concave

-C. is the third step, if the head is unengaged you'll feel it and can rock it from side to side; if it is engaged you'll feel a less distinct mass

-D. is the fourth step, you can determine which way the baby is facing because as you run your fingers downward one hand will be stopped by the brow

Why are Leopold's manuevers performed just prior to placement of the ultrasound transducer?

A. to ensure proper presentatoin

B. to assess the fetal lie

C. to find the baby's back

D. to locate the fundal height

C. to find the baby's back

-the ultrasound transducer is used for external monitoring of the fetal heart rate

-fetal heart sounds resound most audibly through the back and that is where the ultrasound transducer needs to be placed

Where is the TOCO-transducer placed?

A. over the fetal heart

B. directly to the fetal scalp

C. over the fundus

D. 2 cm inferior the umbilicus

C. over the fundus

-TOCO is external monitoring of frequency and intensity of ctx

-the monitor is placed over the fundus because it is the area of greatest muscle density in the uterus

Select the three criteria for placement of internal electronic fetal monitoring.

A. ROM

B. fetal descent

C. 2 cm dialation

D. active phase labor

Intrauterine Pressure Catheter

-a fluid filled catheter inserted into the uterine cavity alongside the fetus

-usually removed during the 2nd stage of labor

Where is the internal spiral electrode placed?

A. inside the uterine cavity

B. attached to the fetal scalp

C. at the level of the fundus

D. to the interior abdominal wall

B. attached to the fetal scalp

-the ISE is internal monitoring of the fetal heart

-accurately monitors baseline, variability, and reactivity to ctx

Contraction duration is measured from:

A. beginning of ctx to the end

B. beginning of ctx to beginning of the next ctx

C. the amount of resting phase between ctx

D. peak of ctx minus the average resting tone

A. beginning of ctx to the end of the same ctx

-measured over 10 minute strip, document as a time

Frequency of contracitions is measured by:

A. beginning of ctx to the end

B. the peak minus the resting tone

C. beginning of one ctx to the beginning of the next ctx

D. the total resting phase over 10 mins

C. beginning of one ctx to the beginning of the next ctx

-given as a range shortest to longest over 10 mins

Intensity of contractions is measured by:

A. peak minus baseline resting tone

B. beginning of one ctx to the beginning of the next ctx

C. beginning of one ctx to the end

D. total resting tone over 10 min strip

A. peak minus baseline resting tone

-IUPC gives the exact measure of intensity, given as MVU

-document total MVU over 10 min strip, also document average (total MVU divided by number of ctx)

Early decelerations are a sign of:

A. cord compression

B. prolonged hypoxia

C. uteroplacental insufficiency

D. head compression

D. head compression

-is a SUBTLE, SMOOTH deceleration that begins after the start of a ctx and returns to baseline before the ctx ends

-is a reassuring sign, no intervention required

Which alteration in FHR is associated with low Apgar scores?

A. late decels

B. early decels

C. accelerations

D. variable decels

A. late decels

-lates decels are associated with low Apgar scores, fetal hypoxia, and acidosis

Late decelerations are caused by?

A. head compression

B. nuchal cord

C. uteroplacental insufficiency

D. trauma

C. uteroplacental insufficiency

-SMOOTH, SUBTLE decels that begin after the peak of a ctx and return to baseline after the end of the ctx

-late decels may drop below 100 BPM if severe

-late decels are a nonreassuring sign

The RN on the L&D floor notices persistent late decels of the FHR.  What can be expected interventions? Select all

A. place pt in high Fowler's position

B. increase primary IV flow rate

C. administer oxygen 4-6 L

D. discontinue oxytocin

B,D

-pt should be placed in left-lateral position

-oxygen should be administered 8-10 L

-oxytocin should be discontinued if being used to induce or augment labor

Variable decelerations are signs of what?

A. cord compression

B. uteroplacental insufficiency

C. head compression

D. trauma

A. cord compression

-appear as a "V" shape with a SHARP drop and rise from the baseline

-may or may not indicate fetal distress

-interventions include left-lateral position, 8-10 L oxygen

Accelerations of the FHR are caused by:

A. head compression

B. fetal movement

C. uteroplacental insufficiency

D. trauma

B. fetal movement, also contractions

-increase of 15 BPM for at least 15 secs

-are a reassuring pattern that indicate fetal well-being and that the fetus is not acidotic

FHR variability is a reassuring sign of fetal CNS function.

True or False?

True

-short term variability is the jaggedness of the line, changes beat-to-beat

-long term variability is the hills and valleys occuring 3-10 times per minute

An increase in variability is caused by:

A. maternal stress

B. fetal sleep pattern

C. mild hypoxia

D. acidosis

C. mild hypoxia, also fetal stimulation

-increase in variability is the earliest sign of hypoxia and require careful evaluation of the FHR tracing for signs of fetal distress

Which of these is NOT a cause of decreased variability?

A. hypoxia

B. acidosis

C. contractions

D. CNS depressants

C. contractions

-benign when associated with drugs

-is a nonreassuring sign when associated with hypoxia or late decels

-interventions include: maternal left-lateral position, administer IV fluids and oxygen, possible fetal blood sampling

A fetus is considered acidotic with a ph of ___ or less.

A. 7.16

B. 7.20

C. 7.22

D. 7.25

B. 7.20

-preacidotic is considered between 7.20 and 7.24

-blood is usually drawn from the fetal scalp making vacuum extraction contraindicated afterward due to risk of bleeding from the puncture site

Oxytocin should always be administered:

A. as an IM injection

B. as a piggyback using a pump

C. undiluted via IV on a pump

D. PO if tolerated

B. as a piggyback to the primary IV line using a pump

-recommended dose for induction of labor is 0.5-1 mU/min

When using oxytocin to induce labor which of these need to be assessed before each increase to the dose?

A. contractions

B. maternal VS

C. fetal heart rhythm

D. FHR

If fetal distress is seen, what should the RN do with the infusing oxytocin?

A. reduce rate to before last increase

B. reduce rate to original starting dose

C. increase the infusion 2 mU/min

D. stop the infusion

What causes uterine pain during a contraction?

A. the stretching of the muscles

B. hypoxia of the uterine muscles

C. pressure of the fetus against the uterus

D. separation of the placenta

A patient is having the urge to push but hasn't yet reach full dialation.  What should the nurse do?

A. encourage deep, slow breathing

B. encourage the patient to squeeze her hand

C. remove the clients leg from the stirrups

D. encourage rapid, shallow breathing

D. encourage rapid, shallow breathing

-rapid, shallow breathing through the mouth only can help the mother resist the urge to push

When delivering a baby at what position should the umbilical cord be cut?

A. while the newborn is resting on the mother

B. below the level of the uterus

C. above the level of the uterus

D. most comfortable position

B. below the level of the uterus

-this prevents blood from the umbilical cord from draining into the placenta

What type of breathing would the RN instruct the patient to do during latent phase labor?

A. slow

B. accelerated

C. pant-blow

D. TENS

A. slow

-inhale through the nose and exhale through the mouth 6-9 times per minute; this is encouraged in early labor to conserve energy and prevent fatigue

-accelerated breathing: inhale through the nose and exhale through the mouth as ctx become more intense, active phase

-pant-blow: rapid, shallow breathing through the mouth only throughout ctx, particularly during transitional phase

Common opioids given during labor and delivery include:

Select all that apply

A. Demerol

B. fentanyl

C. Stadol

D. morphine

E. Nubain

A,B,C,E

-side effects may include: respiratory depression (maternal and neonatal), maternal NV, drowsiness (maternal/neonatal)

Terbutaline is a beta-adrenergic blocker used as a tocolytic to:

A. treat preeclampsia

B. treat hypotension

C. suppress preterm labor

D. cause uterine ctx

C. suppress preterm labor

-contraindicated in cases of severe gestational hypertension and cardiac disease

-antidote is propranolol (Inderal)

Tocolytics are contraindicated in general under all of the following circumstances except:

A. gestation less than 20 wks

B. cervical dialation >4 cm

C. cervical effacement >50%

D. maternal age <20 yrs

What is the drug typically used first to halt uterine ctx in preterm labor?

A. magnesium sulfate

B. Terbutaline

C. propanolol

D. Indocin

A. magnesium sulfate

-is a CNS depressant that prevents reflux of calcium into the myometrial cells, thereby keeping the uterus relaxed

Indomethacin (Indocin) is used with preterm labor because it decreases the production of:

A. estrogen

B. hCG

C. calcium

D. prostaglandins

D. prostaglandins

-Indocin is a prostaglandin synthesis inhibitor, typically not used after 32 wks gestation because it may prematurely close the ductus areteriosus

-decreases production of prostaglandins which are associated with the initiation of labor

-no antidote, discontinue use

Nifedipine (Procardia) is used with preterm labor because it decreases the production of _________ which is associated with the initiation of labor.

A. prostaglandins

B. progesterone

C. estrogen

D. calcium

D. calcium

-Procardia is a calcium-channel blocker

TABLE 7
Technique for Intravaginal Application of Misoprostol (Cytotec) Tablets

Technique for Placement of Dinoprostone Gel (Prepidil)