Stages of labor & Postpartum Care

1. A client had a cesarean birth and is postpartum day 1. Shes asking for pain medication
when the nurse enters the room to do her shift assessment. She states that her pain level is
an 8 on a scale of 1 to 10. What should be the nurses priority of care?

a) Have the client get up to wash so that the bed can be made and the medication orders checked.
b) Start the postpartum assessment.
c) Check the orders for a pain medication and return for the assessment after the medication has
relieved her discomfort.
d) Tell the client to relax and the pain will subside

2. A client is dilated to 4 cm. Shes asking for an epidural; however, her mother states that
because of their culture, she has to bite the bullet as she did. What should the nurse do to
make sure her clients request is honored?
a) Ask the client in a non-threatening way if its her wish to have an epidural and then speak with
the physician.
b) Honor the clients mothers request for no epidural.
c) Knowing the clients culture, have the family call a meeting to make the decision.
d) Call the anesthesiologist and request that he perform the epidural because the client is
uncomfortable.

3. A client in the active phase of labor has a reactive fetal monitor strip and has been
encouraged to walk. When she returns to bed for a monitor check, she complains of an urge
to push. The nurse notes that the amniotic membranes have ruptured and that she can
visualize the umbilical cord. What should the nurse do next?
a) Put the client in a knee-to-chest position.
b) Call the physician or midwife.
c) Push down on the uterine fundus.
d) Arrange for fetal blood sampling to assess for fetal acidosis

4. A baby girl delivered at 38 weeks gestation weighs 2,325 g (5 lb, 2 oz) and is having
difficulty maintaining body temperature. Which nursing action would best prevent cold
stress?
a) Immediately after birth, dry the neonate and place her under a radiant warmer for 2 hours.
b) Administer oxygen for the first 30 minutes after birth.
c) Decrease integumentary stimulation after birth.
d) Maintain the environmental temperature at a constant level.
5. A client with gravida 3 para 2 at 40 weeks' gestation is admitted with spontaneous
contractions. The physician performs an amniotomy to augment her labor. The PRIORITY
nursing action is to: Client's needs category
a) Explain the rationale for the amniotomy to the patient
b) Monitor fetal heart tones after the amniotomy
c) Ambulate the client to strengthen the contraction pattern
d) Position the client in a lithotomy position to administer perineal care

6. The first stage of labor :

a) Separation of the placenta
b) Effacement of the cervix
c) Expulsion of the placenta
d) Ends with fully Dilation of the cervix
e) Expulsion of the fetus

7. A client is receiving magnesium sulfate to help suppress preterm labor. The nurse should
watch for which sign of magnesium toxicity?
a) Headache
b) Loss of deep tendon reflexes
c) Palpitations
d) Dyspepsia

8. A client in the second stage of labor experiences rupture of the membranes. The most
appropriate intervention by the nurse is to:
a) assess the clients vital signs immediately.
b) observe for a prolapsed cord and monitor fetal heart rate (FHR).
c) administer oxygen through a face mask at 6 to 10 L/minute.
d) position the client on her left side.

9. A client delivered a neonate with spina bifida. She had been informed during the pregnancy
that this was a potential risk. The nurse giving report states that this woman's decision to
continue with the pregnancy was selfish, and now the neonate will suffer. In spite of the
nurse's opinion, what ethical position should the nurse take when caring for this client and
neonate?
a. Ask the client why she didn't have an abortion.
b. Accept the client's decision and care for the family as with any other patient.
c. Ask for another assignment because she doesn't agree with the decision the client
made to continue the pregnancy.
d. Avoid going into the client's room if not necessary.

10. A nurse is doing a neurologic assessment on a 1-day-old neonate in the nursery. Which
findings indicate possible asphyxia in utero?
a) The neonates toes dont curl downward when the soles of his feet are stroked.
b) The neonate grasps the nurses finger when she puts it in the palm of his hand.
c) The neonate doesnt respond when the nurse claps her hands above him.
d) The neonate displays weak, ineffective sucking.
 11. This is the client's 1st pregnancy. Her blood type is A-Ve and her baby's type is A+Ve.
Before discharge the client is schedule to have a Rho (D) immunoglobulin (RhoGAM)
vaccine. What is the most important action the nurse should take before administering the
medication?
a) Insure that the client understands and signs a consent form for the vaccination
b) Choose a site for the injection that is not tender
c) Instruct the client that she won't need another vaccination after her next pregnancy
d) Document that the injection was given in the chart

12. During the 3rd postpartum day which finding is a nurse most likely to find in a client?
a) She's interested in learning more about neonate care.
b) She talks a lot about her birth experience
c) She sleeps whenever the baby isn't present.
d) She requests to help in choosing a name for the baby.

13. A client is 3 day postpartum. She states that she hasn't has a bowl movement since before
delivery and is experiencing discomfort. She has had a forth degree laceration. The nurse knows
that the best remedy is:
a) A suppository
b) An enema to alleviate gas pains quickly
c) Stool softeners and fluids
d) Pain medication for the discomfort

14. A neonate was delivered 1 hour ago. He is pink with acrocyanosis and exhibit occasional
shivering movements of his upper extremities. Which nursing action should take priority?
a) Obtain vital signs
b) Provide warmth with swaddling
c) Perform a neurological assessment
d) Evaluate blood glucose level

15. Hyperextension of the fetal head is found in:

a) Vertex presentation
b) Face presentation
c) Shoulder presentation
d) Breach presentation
e) Hydrocephalic baby

16. In performing a routine fundal assessment, a nurse finds that a client's fundus is boggy. That
should the nurse do first?
a) Call the physician
b) Massage the fundus
c) Assess lochia flow
d) Obtain an order for methyergonovine (Methergine)
 17. Early discharge from the postpartum unit have safety issues that need to be discussed with the
client during discharge education. What is the most important instruction that the nurse should
give the new mom?
a) "Sleep when the neonate sleeps to avoid exhaustion."
b) "Don't sleep with the neonate in deb with you".
c) if you have excessive vaginal bleeding, massage your fundus and call the physician."
d) "Don't worry; women have been having babies for years without postpartum problems."

18. A nurse is assessing a 4-hour old neonate. Which finding should be a cause of concern?
a) Anterior fontanel is 3/4" (1.9cm) wide, head is molded, sutures are overriding
b) Hands and feet are cyanotic, abdomen is rounded, neonate has not voided or passed meconium
c) Color is dusky, axillary temp is 97 F (36.1 C), and the neonate is spitting up excessive mucus.
d) The neonate exhibits irregular abdominal respiration and intermittent tremors in the extremities

19. The second stage of labor involves:

a) Separation of the placenta
b) Effacement of the cervix
c) Expulsion of the placenta
d) Dilation of the cervix
e) Expulsion of the fetus
20. On a client's 2nd postpartum visit, the physician reviews the chart note here regarding the
client's lochia. What is the best term of lochia described?
a) Alba
b) Thrombis
c) Rubra
d) Serosa

21. Engagement is strictly defined as:

a) When the presenting part goes through the pelvic inlet
b) When the presenting part is level with the ischial spines
c) When the greatest Biparietal diameter of the fetal head passes the pelvic inlet
d) When the greatest Biparietal diameter of the fetal head is at the level of ischial spines
e) None of the above
22. Which one is true about stages of labor:
a) The first stage commences at the time of membrane rupture
b) The cervix dilates at consistent rate of 3 cm per hour in the first stage
c) The third stage end with the delivery of the placenta and membranes
d) Forceps or ventose may be useful in slow progress of the late 1st stage
e) Syntometrine is a combination of oxytocin and Ergometrine which is used in the treatment of
secondary postpartum hemorrhage (PPH)

23. A nurse assesses a neonate's respiratory rate at 46b/m 6 hours after birth. Respirations are
shallow, with periods of apnea lasting up to 5 seconds. Which action should the nurse take next?
 a) Attach an apnea monitor
b) Continue routine monitoring
c) Follow respiratory arrest protocol
d) Call the pediatrician immediately to report findings

24. The fetal head may undergo changes in shape during normal delivery. The most common
etiology listed is:
a) Cephalohematoma
b) Molding
c) Subdural hematoma
d) Hydrocephalus
e) None of the above.

25. A prim Para is in labor and an episiotomy to be cut. Compared with a mid-line episiotomy, an
advantage of Medio-lateral episiotomy is:
a) Ease of repair
b) Fewer break downs
c) Lower blood loss
d) Less dyspareunia
e) Less extension of the incision

26. Which of the following statements about episiotomy is incorrect:?

a) Median (midline) episiotomy is generally considered to be less painful the medio-lateral
episiotomy.
b) Medio-lateral or lateral episiotomy may be associated with more blood loss than median one.
c) Indications for episiotomy include avoiding an imminent perineal tear, the use of forceps, breech
delivery, & the delivery of premature infants.
d) The earlier the episiotomy is done during delivery, generally the more beneficial it will be
speeding ---delivery.
e) Episiotomy incisions are repaired anatomically in layers.

27. The following are always indications for Caesarean Section:

a) Hydrocephalus
b) Abruptio placenta
c) Preterm Labor
d) active primary genital herpes
e) Sever pre-eclampsia

28. APGAR's score includes all the followings EXCEPT:

a) Skin color
b) Muscle tone
c) Blood PH
d) Heart rate
e) Respiration
29. A second degree perineal trauma is defined as:
a) Injury to the premium involving the perinea' muscles and anal sphincter
b) Injury to the perineal skin only
c) Injury to the premium involving the perineal muscles but not anal sphincter
d) Injury to the perineum where rectal mucosa is torn but the anal sphincter are intact
e) Both a and b options
30. ONE to one care in labor:
a) Means a doula is present
b) Reduce the need for analgesia
c) Require the woman's partner to stay with her
d) Require the same midwife to be present throughout labor
e) One nurse and one doctor should be present all the time of labor with the woman
31. The inclusion of the cervical canal into the lower uterine segment is called:
a) Replacement
b) Effacement
c) Infusion
d) Displacement
e) Leakage

32. When is active labor distinguished from the latent phase?

a) When the membranes rupture
b) when cervix is 3-4 cm dilated with regular rhythmic contractions
c) when contractions become regular
d) When the woman requests analgesia
e) When there are false contractions
33. The main risk to the fetus of pre-labor rupture of membranes is:
a) Precipitate birth
b) Pre-term birth
c) Neonatal infection
d) Hypoxia
e) All of the above

34. What is the traditional definition of the second stage of labor?

a) period during which the woman feels a strong pushing urge
b) The phase when the fetus enters the pelvic cavity .
c) The phase between the full dilatation of the cervical os and the birth of the baby
d) The period of labor when the woman is working the hardest

35. During the birth the woman and baby are both particularly vulnerable to?
a) Infection
b) Dehydration
c) Bladder damage
d) Asphyxia
e) Jaundice