Chapter 16 Processes and Stages of Labor and Birth

Chapter 16   Processes and Stages of Labor and Birth

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1) The nurse is caring for laboring patients. Which women are experiencing problems related to a critical factor of labor? Select all that apply.

1. Primipara at 7 cm, fetus in military attitude
2. Multipara at 3 cm, fetus in longitudinal lie
3. Primipara at 4 cm, fetus with macrocephaly due to hydrocephalus
4. Multipara at 6 cm, fetus at −2 station, mild contractions
5. Primipara at 5 cm, fetal presenting part is right shoulder

Answer:  1, 3, 4, 5

Explanation:  1. Attitude refers to the relationship of the fetal parts to one another. Military attitude is an extended neck; normal fetal attitude is flexion of the neck. Military attitude creates a larger diameter of the head fitting through the pelvis. This patient is experiencing a problem between the maternal pelvis and the presenting part.

2. Lie refers to the relationship between the cephalocaudal axis of the mother to the cephalocaudal axis of the fetal body; longitudinal lie is normal.
3. Hydrocephalus can lead to macrocephaly, or an abnormally large head. Macrocephalic babies might not fit through the bony pelvis and could require birth by cesarean. This patient is experiencing a problem between the maternal pelvis and the presenting part.
4. Station refers to how low in the pelvis the baby’s presenting part is; −2 station is high in the pelvis. Contractions should be strong to cause fetal descent and cervical dilation. Mild contractions will not move the baby down or open the cervix. This patient is experiencing a problem between the maternal pelvis and the presenting part.
5. The presenting part is the fetal part coming through the cervix. The occiput or back of the baby’s head is the most common and most effective presenting part. A shoulder presentation cannot deliver vaginally and will require a cesarean birth. This patient is experiencing a problem between the maternal pelvis and the presenting part.

Page Ref: 312-317

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 16.2-Describe the five critical factors that influence labor in the assessment of an expectant woman and fetus’s progress in labor and birth.

MNL LO:  Discuss the phases and stages of labor including factors that affect labor progress.

 

2) The charge nurse has received a shift change report. Which patient requires immediate intervention?

1. Multipara at 6 cm undergoing induction of labor, strong contractions every three minutes
2. Primipara at 4 cm whose fetus is in a longitudinal lie with a cephalic presentation
3. Multipara at 10 cm and fetus at +2 station experiencing a strong expulsion urge
4. Primipara at 3 cm screaming in fear because her mother died during childbirth

Answer:  4

Explanation:  1. Strong contractions every three minutes are an adequate labor pattern during induction of labor. This client is experiencing no complications.

2. Longitudinal lie with cephalic presentation is a head-down position. This is expected.
3. 10 cm is fully dilated; a +2 station is low in the pelvis. A strong expulsion urge is the urge to push, which will facilitate the birth of the child. These are expected.
4. This client is most likely fearful that she will die during labor if her mother died during childbirth. It is very rare to die during childbirth in developing countries. The extreme fear this client is experiencing could stimulate the fight-or-flight mechanism and hormone cascade, which can significantly slow the progress of her labor; screaming and muscle tension increase the body’s oxygen consumption, and in extreme cases can lead to fetal hypoxia. This client requires education and a great deal of support and is therefore the top priority.

Page Ref: 319

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 16.3-Summarize the implications of abnormalities present in each of the five critical factors on the outcome of labor and the health of the expectant woman and the fetus.

MNL LO:  Apply appropriate nursing care for the childbearing family during the first stage of labor.

 

3) The primiparous patient has asked the nurse why her cervix has only changed from 1 to 2 cm in 3 hours of contractions occurring every 5 minutes. The best response by the nurse is:

1. “Your cervix has also effaced, or thinned out, and that change in the cervix is also labor progress.”
2. “When your perineal body thins out, your cervix will begin to dilate much faster than it is now.”
3. “What did you expect? You’ve only had contractions for a few hours. Labor takes time.”
4. “The hormones that cause labor to begin are just getting to be at levels that will change your cervix.”

Answer:  1

Explanation:  1. Cervical effacement must be nearly complete before cervical dilation takes place in primiparas. This is why the labor and birth of a first baby usually take much less time than for subsequent labor and births.

2. The perineal body thinning primarily occurs during the second stage of labor; it is not expected now.
3. This reply is not therapeutic. Although it is true that this patient has only been in early labor for a short time, and it is true that labor for a primipara averages 12 to 24 hours, the nurse must always be therapeutic in all communication.
4. The hormones that cause labor contractions do not directly cause cervical change; the contractions cause the cervix to change.

Page Ref: 320

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 16.4-Examine an expectant woman’s and fetus’s response to labor based on the physiological processes that occur during labor.

MNL LO:  Apply appropriate nursing care for the childbearing family during the first stage of labor.

 

4) The primiparous patient 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?

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

Answer:  2

Explanation:  1. Increased pelvic pressure and urinary frequency are premonitory signs of labor. These are not signs of a urinary tract infection.

2. This is the best response because it most directly addresses what the client has reported. Increased pelvic pressure and urinary frequency are premonitory signs of labor.
3. There is no need for an additional appointment, as increased pelvic pressure and urinary frequency are premonitory signs of labor.
4. The client is experiencing premonitory signs of labor; the fetus changing to a breech presentation would be experienced as fetal movement that was formerly felt in the upper abdomen but now is down in the pelvis.

Page Ref: 321

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 16.5-Assess for the premonitory signs of labor when caring for an expectant woman.

MNL LO:  Discuss the phases and stages of labor including factors that affect labor progress.