Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

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?
2. Breech, transverse
3. Breech, longitudinal
4. Breech, frank
5. Vertex, transverse

Page Ref: 435

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Examine the five critical factors that affect the labor process.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. A clinic nurse is preparing diagrams of pelvic shapes. Which pelvic shapes are considered least adequate for vaginal childbirth?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Android
2. Anthropoid
3. Gynecoid
4. Platypelloid
5. Lambdoidal suture

Page Ref: 431

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Examine the five critical factors that affect the labor process.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The nurse is caring for laboring clients. Which women are experiencing problems related to a critical factor of labor?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Woman at 7 c m, fetus in general flexion
2. Woman at 3 c m, fetus in longitudinal lie
3. Woman at 4 c m, fetus with transverse lie
4. Woman at 6 c m, fetus at -2 station, mild contractions
5. Woman at 5 c m, fetal presenting part is right shoulder

Page Ref: 432

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Examine the five critical factors that affect the labor process.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The charge nurse has received the shift change report. Which client requires immediate intervention?
2. Woman at 6 c m undergoing induction of labor, strong contractions every 3 minutes
3. Woman at 4 c m whose fetus is in a longitudinal lie with a cephalic presentation
4. Woman at 10 c m and fetus at +2 station experiencing a strong expulsion urge
5. Woman at 3 c m screaming in fear because her mother died during childbirth

Page Ref: 443

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. C. 6. Value vigilance and monitoring (even of own performance of care activities) by patients, families, and other members of the healthcare team. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that reflects high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 7 Describe the physiologic and psychosocial changes that are indicative of the maternal progress during each of the stages of labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. Premonitory signs of labor include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Braxton Hicks contractions
2. Cervical softening and effacement
3. Weight gain
4. Rupture of membranes
5. Sudden loss of energy

Page Ref: 440

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 4 Discuss premonitory signs of labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. 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 c m, 100% effaced, and -2 station. What best describes this labor?
2. Second phase
3. Latent phase
4. Active phase
5. Transition phase

Page Ref: 443

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Describe the characteristics of the four stages of labor and their accompanying phases.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The client has asked the nurse why her cervix has only changed from 1 to 2 c m in 3 hours of contractions occurring every 5 minutes. What is the nurse's best response to the client?
2. "Your cervix has also effaced, or thinned out, and that change in the cervix is also labor progress."
3. "When your perineal body thins out, your cervix will begin to dilate much faster than it is now."
4. "What did you expect? You've only had contractions for a few hours. Labor takes time."
5. "The hormones that cause labor to begin are just getting to be at levels that will change your cervix."

Page Ref: 440

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 15. Communicate care provided and needed at each transition in care. | A A C N Essentials Competencies: Ⅸ. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | N L N Competencies: Quality and Safety: Encourage patients and families to communicate their observations and concerns regarding safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Describe the characteristics of the four stages of labor and their accompanying phases.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. To identify the duration of a contraction, the nurse would do which of the following?
2. Start timing from the beginning of one contraction to the completion of the same contraction.
3. Time between the beginning of one contraction and the beginning of the next contraction.
4. Palpate for the strength of the contraction at its peak.
5. Time from the beginning of the contraction to the peak of the same contraction.

Page Ref: 437

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and excellence in nursing. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Describe the physiology of labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. 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?
2. "Unless you have pain with urination, we don't need to worry about it."
3. "These symptoms usually mean the baby's head has descended further."
4. "Come in for an appointment today and we'll check everything out."
5. "This might indicate that the baby is no longer in a head-down position."

Page Ref: 440

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. C. 10. Value active partnership with patients or designated surrogates in planning, implementation, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Discuss premonitory signs of labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. 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?
2. "You shouldn't work so much at this point in pregnancy."
3. "What you are describing is not commonly experienced in the last weeks."
4. "Your body may be telling you it is going into labor soon."
5. "If the bladder pressure continues, come in to the clinic tomorrow."

Page Ref: 440

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Discuss premonitory signs of labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. 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?
2. Engagement
3. Lightening
4. Molding
5. Braxton Hicks contractions

Page Ref: 440

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 4 Discuss premonitory signs of labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. A client who is having false labor most likely would have which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Contractions that do not intensify while walking
2. An increase in the intensity and frequency of contractions
3. Progressive cervical effacement and dilation
4. Pain in the abdomen that does not radiate
5. Contractions that lessen with rest and warm tub baths

Page Ref: 440

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 5 Differentiate between false and true labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The nurse is preparing a client education handout on the differences between false labor and true labor. What information is most important for the nurse to include?
2. True labor contractions begin in the back and sweep toward the front.
3. False labor often feels like abdominal tightening, or "balling up."
4. True labor can be diagnosed only if cervical change occurs.
5. False labor contractions do not increase in intensity or duration.

Page Ref: 440

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 5 Differentiate between false and true labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The nurse is teaching a prenatal class about false labor. The nurse should teach clients that false labor will most likely include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Contractions that do not intensify while walking
2. An increase in the intensity and frequency of contractions
3. Progressive cervical effacement and dilation
4. Pain in the abdomen that does not radiate
5. Contractions are at regular intervals

Page Ref: 440

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 5 Differentiate between false and true labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. A client is admitted to the labor and delivery unit with contractions that are 2 minutes apart, lasting 60 seconds. She reports that she had bloody show earlier that morning. A vaginal exam reveals that her cervix is 100 percent effaced and 8 c m dilated. The nurse knows that the client is in which phase of labor?
2. Active
3. Latent
4. Transition
5. Fourth

Page Ref: 444

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and excellence in nursing. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Describe the characteristics of the four stages of labor and their accompanying phases.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. A client is admitted to the labor unit with contractions 1-2 minutes apart lasting 60-90 seconds. The client is apprehensive and irritable. This client is most likely in what phase of labor?
2. Active
3. Transition
4. Latent
5. Second

Page Ref: 444

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and excellence in nursing. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Describe the characteristics of the four stages of labor and their accompanying phases.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The client in early labor asks the nurse what the contractions are like as labor progresses. What would the nurse respond?
2. "In normal labor, as the uterine contractions become stronger, they usually also become less frequent."
3. "In normal labor, as the uterine contractions become stronger, they usually also become less painful."
4. "In normal labor, as the uterine contractions become stronger, they usually also become longer in duration."
5. "In normal labor, as the uterine contractions become stronger, they usually also become shorter in duration."

Page Ref: 444

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly or cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Describe the characteristics of the four stages of labor and their accompanying phases.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. Four minutes after the birth of a baby, there is a sudden gush of blood from the mother's vagina, and about 8 inches of umbilical cord slides out. What action should the nurse take first?
2. Place the client in McRoberts position.
3. Watch for the emergence of the placenta.
4. Prepare for the delivery of an undiagnosed twin.
5. Place the client in a supine position.

Page Ref: 445

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Describe the characteristics of the four stages of labor and their accompanying phases.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. A nurse needs to evaluate the progress of a woman's labor. The nurse obtains the following data: cervical dilation 6 c m; contractions mild in intensity, occurring every 5 minutes, with a duration of 30-40 seconds. Which clue in this data does not fit the pattern suggested by the rest of the clues?
2. Cervical dilation 6 c m
3. Mild contraction intensity
4. Contraction frequency every 5 minutes
5. Contraction duration 30-40 seconds

Page Ref: 444

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Describe the characteristics of the four stages of labor and their accompanying phases.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The labor nurse would not encourage a mother to bear down until the cervix is completely dilated, to prevent which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Maternal exhaustion
2. Cervical edema
3. Tearing and bruising of the cervix
4. Enhanced perineal thinning
5. Having to perform an episiotomy

Page Ref: 437

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 7 Describe the physiologic and psychosocial changes that are indicative of the maternal progress during each of the stages of labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The nurse is caring for a laboring client. A cervical exam indicates 8 c m dilation. The client is restless, frequently changing position in an attempt to get comfortable. Which nursing action is most important?
2. Leave the client alone so she can rest.
3. Ask the family to take a coffee-and-snack break.
4. Encourage the client to have an epidural for pain.
5. Reassure the client that she will not be left alone.

Page Ref: 444

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Therapeutic Environment

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Describe the characteristics of the four stages of labor and their accompanying phases.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. During the fourth stage of labor, the client's assessment includes a B P of 110/60, pulse 90, and the fundus is firm midline and halfway between the symphysis pubis and the umbilicus.

What is the priority action of the nurse?

1. Turn the client onto her left side.
2. Place the bed in Trendelenburg position.
3. Massage the fundus.
4. Continue to monitor.

Page Ref: 449

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Quality and Safety: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Describe the characteristics of the four stages of labor and their accompanying phases.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The nurse has just palpated a laboring woman's contractions. The uterus cannot be indented during a contraction. What would the intensity of these contractions best be characterized as?
2. Weak
3. Mild
4. Moderate
5. Strong

Page Ref: 437

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Quality and Safety: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Describe the physiology of labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The labor and delivery nurse is reviewing charts. The nurse should inform the supervisor about which client?
2. Client at 5 c m requesting labor epidural analgesia
3. Client whose cervix remains at 6 c m for 4 hours
4. Client who has developed nausea and vomiting
5. Client requesting her partner to stay with her

Page Ref: 444

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: I I. B. 9. Communicate with team members, adapting own style of communicating to needs of the team and situation. | A A C N Essentials Competencies: Ⅸ. 13. Revise the plan of care based on an ongoing evaluation of patient outcomes | N L N Competencies: Quality and Safety: Communicate effectively with different individuals (team members, other care providers, patients, families, etc.) so as to minimize risks associated with handoffs among providers and across transitions in care. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Describe the characteristics of the four stages of labor and their accompanying phases.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. Which client requires immediate intervention by the labor and delivery nurse?
2. Client at 8 c m, systolic blood pressure has increased 35 m m H g
3. Client who delivered 1 hour ago with W B C of 50,000/m m3
4. Client at 5 c m with a respiratory rate of 22 between contractions
5. Client in active labor with polyuria

Page Ref: 450

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate effectively with different individuals (team members, other care providers, patients, families, etc.) so as to minimize risks associated with handoffs among providers and across transitions in care. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 8 Summarize maternal systemic responses to labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The labor and delivery nurse is preparing a prenatal class about facilitating the progress of labor. Which of the following frequent responses to pain should the nurse indicate is most likely to impede progress in labor?
2. Increased pulse
3. Elevated blood pressure
4. Muscle tension
5. Increased respirations

Page Ref: 428

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 8 Summarize maternal systemic responses to labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. While caring for a client in labor, the nurse notices during a vaginal exam that the fetus's head has rotated internally. What would the nurse expect the next set of cardinal movements for a fetus in a vertex presentation to be?
2. Flexion, extension, restitution, external rotation, and expulsion
3. Expulsion, external rotation, and restitution
4. Restitution, flexion, external rotation, and expulsion
5. Extension, restitution, external rotation, and expulsion

Page Ref: 445

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Describe the characteristics of the four stages of labor and their accompanying phases.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. When comparing the anterior and posterior fontanelles of a newborn, the nurse knows that both are what?
2. Both are approximately the same size.
3. Both close within 12 months of birth.
4. Both are used in labor to identify station.
5. Both allow for assessing the status of the newborn after birth.

Page Ref: 432

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Examine the five critical factors that affect the labor process.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The nurse is aware that labor and birth will most likely proceed normally when the fetus is in what position?
2. Right-acromion-dorsal-anterior
3. Right-sacrum-transverse
4. Occiput anterior
5. Posterior position

Page Ref: 436

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Examine the five critical factors that affect the labor process.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The midwife performs a vaginal exam and determines that the fetal head is at a -2 station. What does this indicate to the nurse about the birth?
2. The birth is imminent.
3. The birth is likely to occur in 1-2 hours.
4. The birth will occur later in the shift.
5. The birth is difficult to predict.

Page Ref: 436

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Examine the five critical factors that affect the labor process.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. Childbirth preparation offers several advantages including which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. It helps a pregnant woman and her support person understand the choices in the birth setting.
2. It promotes awareness of available options.
3. It provides tools for a pregnant woman and her support person to use during labor and birth.
4. Women who receive continuous support during labor require more analgesia, and have more cesarean and instrument births.
5. Each method has been shown to shorten labor.

Page Ref: 428

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 1 Compare methods of childbirth preparation.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The nurse is reviewing educational material on newborn care with a patient in the 3rd trimester of pregnancy. Which area on the following diagram should the nurse point out as being the anterior fontanelle?

1. A
2. B
3. C
4. D

Page Ref: 432

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 1 Compare methods of childbirth preparation.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The fetus of a patient in labor is determined to be in the brow presentation. Which diagram should the nurse provide to the patient to explain this position?

Page Ref: 435

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 2 Examine the five critical factors that affect the labor process.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. A pregnant patient's fetus is in the left-occiput-transverse position. Which diagram should the nurse use to explain this position to the patient?

Page Ref: 436

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 9 Describe fetal adaptations to labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The cervix of a laboring patient is measured as being 50% effaced. Which diagram should the nurse use to explain this finding to the patient?

Page Ref: 441

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 9 Describe fetal adaptations to labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.

1. The nurse is assisting in the delivery of a pregnant patient's placenta post-delivery. The placenta appears as follows. What term should the nurse use to document this placental delivery?

1. Schultz mechanism of delivery
2. Duncan mechanism of delivery
3. Complete mechanism of delivery
4. Incomplete mechanism of delivery

Page Ref: 448

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network. | N L N Competencies: Relationship-Centered Care: Knowledge; effective communication. | Nursing/Integrated Concepts: Implementation: Communication and Documentation.

Learning Outcome: 7 Describe the physiologic and psychosocial changes that are indicative of the maternal progress during each of the stages of labor.

M N L L O: Demonstrate use of the nursing process in the care of a laboring patient.