Chapter 20 Processes and Stages of Labor and Birth

Chapter 20   Processes and Stages of Labor and Birth

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

1) How would the nurse best analyze the results from a client’s sonogram that shows the fetal shoulder as the presenting part?

1. Breech, transverse
2. Breech, longitudinal
3. Breech, frank
4. Vertex, transverse

Answer:  1

Explanation:  1. A shoulder presentation is one type of breech presentation, and is also called a transverse lie.

Page Ref: 449, 450

Cognitive Level:  Applying

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

Standards:  QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN 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.

MNL LO:  3.3.1 Describe the five processes of labor.

2) 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 for all correct choices and no incorrect choices.

Select all that apply.

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

Answer:  1, 4

Explanation:  1. 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.

4. 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.

Page Ref: 446, 466

Cognitive Level:  Understanding

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

Standards:  QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN 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.

MNL LO:  3.3.1 Describe the five processes of labor.

3) 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 for all correct choices and no incorrect choices.

Select all that apply.

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

Answer:  3, 4, 5

Explanation:  3. 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.

4. 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.
5. 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.

Page Ref: 448, 449, 450, 451

Cognitive Level:  Understanding

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

Standards:  QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN 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.

MNL LO:  3.3.1 Describe the five processes of labor.

4) The charge nurse has received the shift change report. Which client requires immediate intervention?

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

Answer:  4

Explanation:  4. 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.

Page Ref: 453, 454

Cognitive Level:  Applying

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

Standards:  QSEN Competencies: V. C. 6. Value vigilance and monitoring (even of own performance of care activities) by patients, families, and other members of the health care team. | AACN Essentials Competencies: IX. 12. Create a safe environment that reflects high quality patient outcomes. | NLN 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.

MNL LO:  3.1.4 Examine the nursing assessments associated with each stage/phase of labor.

5) Premonitory signs of labor include which of the following?

Note: Credit will be given only for all correct choices and no incorrect choices.

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

Answer:  1, 2, 4

Explanation:  1. A premonitory sign of labor includes Braxton Hicks contractions.

2. A premonitory sign of labor includes cervical softening and effacement.
3. A premonitory sign of labor includes rupture of membranes.

Page Ref: 456

Cognitive Level:  Understanding

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

Standards:  QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN 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. | NLN 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.

MNL LO:  3.1.2 Compare and contrast the theories of labor onset and the physiology of labor.