Chapter 8: Intrapartum Assessment and Interventions Nursing School Test Banks

Chapter 8: Intrapartum Assessment and Interventions

Multiple Choice

1. In caring for a primiparous woman in labor, one of the factors to evaluate is uterine activity. This is referred to as the __________ of labor.a. Passengerb. Passagec. Powersd. Psyche

ANS: c
Feedback
a. The passenger refers to the fetus.
b. The passage refers to the pelvis and birth canal.
c. Powers refer to the contractions.
d. Psyche refers to the response of a woman to labor.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Easy
2. The provision of support during labor has demonstrated that women experience a decrease in anxiety and a feeling of being in more control. In clinical situations, this has resulted in:a. A decrease in interventionsb. Increased epidural ratesc. Earlier admission to the hospitald. Improved gestational age

ANS: a
Feedback
a. Studies have shown that with a support person, be it a family member, friend, or professional such as a Doula or nurse, the patient experiences a decrease in anxiety and has a feeling of being in more control. This, in turn, results in a decrease in interventions, a significantly lower level of pain, and an enhanced overall maternal satisfaction.
b. There is decreased use of pain medication with continuous labor support.
c. There is no evidence that continuous labor support results in earlier admission to the hospital.
d. There is no evidence that continuous labor support results in improved gestational age for the fetus.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: PSI, Psychosocial Integrity | Difficulty Level: Moderate
3. When caring for a primiparous woman being evaluated for admission for labor, a key distinction between true versus false labor is:a. True labor contractions result in rupture of membranes, and with false labor, the membranes remain intact.b. True labor contractions result in increasing anxiety and discomfort, and false labor does not.c. True labor contractions are accompanied by loss of the mucus plug and bloody show, and with false labor there is no vaginal discharge. d. True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.

ANS: d
Feedback
a. Rupture of membranes can occur prior to labor or during labor.
b. A womans response to labor may not be reflective of her status in labor but is influenced by expectations and emotional status.
c. Loss of the mucus plug can occur prior to the onset of labor.
d. True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate
4. The mechanism of labor known as cardinal movements of labor are the positional changes that the fetus goes through to best navigate the birth process. These cardinal movements are:a. Engagement, Descent, Flexion, Extension, Internal rotation, External rotation, Expulsion b. Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion c. Engagement, Flexion, Internal rotation, Extension, External rotation, Descent, Expulsion d. Engagement, Flexion, Internal rotation, Extension, External rotation, Flexion, Expulsion

ANS: b
Feedback
a. The order of the cardinal movements is incorrect.
b. Engagement occurs when the greatest diameter of the fetal head passes through the pelvic inlet. Engagement can occur late in pregnancy or early in labor. Descent is the movement of the fetus through the birth canal during the first and second stages of labor. Flexion is when the chin of the fetus moves toward the fetal chest. Flexion occurs when the descending head meets resistance from maternal tissues. This movement results in the smallest fetal diameter to the maternal pelvic dimensions. It typically occurs early in labor. Internal rotation is the movement, the rotation of the fetal head, that aligns the long axis of the fetal head with the long axis of the maternal pelvis. It occurs mainly during the second stage of labor. Extension is the movement facilitated by resistance of the pelvic floor, causing the presenting part to pivot beneath the pubic symphysis and the head to be delivered. This occurs during the second stage of labor. External rotation is when the sagittal suture moves to a transverse diameter and the shoulders align in the anteroposterior diameter. The sagittal suture maintains alignment with the fetal trunk as the trunk navigates through the pelvis. Expulsion is the movement that occurs when the shoulders and remainder of the body are delivered.
c. The order of the cardinal movements is incorrect.
d. The order of the cardinal movements is incorrect.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate
5. A woman is considered in active labor when:a. Cervical dilation progresses from 4 to 7 cm with effacement of 40% to 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.b. Cervical dilation progresses to 3 cm with effacement of 30, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.c. Cervical dilation progresses to 8 cm with effacement of 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.d. Cervical dilation progresses to 10 cm with effacement of 90%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.

ANS: a
Feedback
a. Characteristics of this phase are the cervix dilates, on an average, 1.2 cm/hr for primiparous women and 1.5 cm/hr for multiparous women. Cervical dilation progresses from 4 to 7 cm with effacement of 40% to 80%. Fetal descent continues and contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds, and discomfort increases.
b. Cervical dilation progresses to 3 cm with effacement of 30, indicating the early or latent phase of labor.
c. Cervical dilation progresses to 8 cm with effacement of 80%, indicating the transition phase of labor.
d. Cervical dilation of 10 cm with effacement is the end of the first stage of labor.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate
6. You are caring for a woman in labor who is 6 cm dilated with a reassuring FHT pattern and regular strong UCs. The fetal heart rate (FHR) should be:a. Monitored continuouslyb. Monitored every 15 minutesc. Monitored every 30 minutesd. Monitored every 60 minutes

ANS: c
Feedback
a. Assessment of fetal heart rate (FHR) during the active phase of labor with a reassuring FHR is not indicated continuously.
b. Assessment of fetal heart rate (FHR) during the active phase of labor with a reassuring FHR is not indicated every 15 minutes.
c. Assessment of fetal heart rate (FHR) during the active phase of labor with a reassuring FHR is indicated every 30 minutes.
d. Assessment of fetal heart rate (FHR) during the active phase of labor with a reassuring FHR is indicated every 30 minutes, not every 60 minutes.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate

7. A woman you are caring for in labor requests an epidural for pain relief in labor. Included in your preparation for epidural placement is a baseline set of vital signs. The most common vital sign to change after epidural placement:a. Blood pressure, hypotension
b. Blood pressure, hypertension
c. Pulse, tachycardia
d. Pulse, bradycardia

ANS: a
Feedback
a. Blood pressure, hypotension, as up to 40% of women may experience hypotension. Hypotension is defined as systolic BP <100 mm Hg or 20% decrease in BP from preanesthesia levels. Intravenous bolus is typically given to decrease the incidence of hypotension.
b. Blood pressure, hypertension is incorrect because hypotension is the common complication after epidural placement.
c. Pulse, tachycardia is incorrect because hypotension is the common complication after epidural placement.
d. Pulse, bradycardia is incorrect because hypotension is the common complication after epidural placement.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate

8. The labor patient you are caring for is ambulating in the hall. Her vaginal exam 1 hour ago indicated she was 4/70/1 station. She tells you she has fluid running down her leg. Your priority nursing intervention is to:a. Assess the color, odor, and amount of fluid.b. Assist your patient to the bathroom.c. Assess the fetal heart rate.d. Call the care provider.
ANS: c
Feedback
a. Although assessing the color, odor, and amount of fluid is appropriate, the priority nursing action is to assess the FHR because of the risk of umbilical cord prolapse with rupture of membranes.
b. The fluid is probably related to rupture of membranes rather than the patient needing to go to the bathroom to urinate.
c. Assessing the fetal heart rate is the first priority because of the risk of umbilical cord prolapse with rupture of membranes.
d. Although you may call the care provider, the priority nursing action is to assess the FHR because of the risk of umbilical cord prolapse with rupture of membranes.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Reduction of Risk Potential | Difficulty Level: Moderate

9. You are in the process of admitting a multiparous woman to labor and delivery from the triage area. One hour ago her vaginal exam was 4/70/0. While completing your review of her prenatal record and completing the admission questionnaire, she tells you she has an urge to have a bowel movement and feels like pushing. Your priority nursing intervention is to:a. Reassure the patient and rapidly complete the admission.b. Assist your patient to the bathroom to have a bowel movement.c. Assess the fetal heart rate and uterine contractions.d. Perform a vaginal exam.

ANS: d
Feedback
a. Completing the admission paperwork is not a priority when birth may be imminent.
b. The urge to have a bowel movement is probably related to fetal descent and complete dilation rather than the patient needing to have a bowel movement.
c. Doing a vaginal exam is the first priority as birth may be imminent.
d. Perform a vaginal exam to assess the progress of labor. The urge to have a bowel movement and feeling like pushing indicate that birth may be imminent.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate

10. The Apgar score consists of a rapid assessment of five physiological signs that indicate the physiological status of the newborn and includes:a. Apical pulse strength, respiratory rate, muscle flexion, reflex irritability, and colorb. Heart rate, clarity of lungs, muscle tone, reflexes, and colorc. Apical pulse strength, respiratory rate, muscle tone, reflex irritability, and color of extremitiesd. Heart rate, respiratory rate, muscle tone, reflex irritability, and color

ANS: d
Feedback
a. Heart rate, not apical pulse strength, is the criterion for Apgar scoring; muscle tone, not flexion, is assessed.
b. Clarity of lungs and reflexes are not assessed as part of Apgar scoring. Neonatal lungs can be congested normally at birth, and reflexes are not assessed. Rather, reflex irritability is assessed, based on response to tactile stimulation.
c. Heart rate, not apical pulse strength, is assessed along with respiratory rate, muscle tone, reflex irritability, and color of extremities.
d. The Apgar score includes assessment of heart rate based on auscultation, respiratory rate based on observed movement of chest, muscle tone based on degree of flexion and movement of extremities, reflex irritability based on response to tactile stimulation, and color based on observation.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate

11. The perinatal nurse is assessing a woman in triage who is 34 + 3 weeks gestation in her first pregnancy. She is worried about having her baby too soon, and she is experiencing uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats per minute. A vaginal examination performed by the health-care provider reveals that the cervix is closed, long, and posterior. The most likely diagnosis would be:
a. Preterm labor
b. Term labor
c. Back labor
d. Braxton-Hicks contractions

ANS: d
Feedback
a. Preterm labor (PTL) is defined as regular uterine contractions and cervical dilation before the end of the 36th week of gestation. Many patients present with preterm contractions, but only those who demonstrate changes in the cervix are diagnosed with preterm labor.
b. Term labor occurs after 37 weeks gestation.
c. There is no indication in this scenario that this is back labor.
d. Braxton-Hicks contractions are regular contractions occurring after the third month of pregnancy. They may be mistaken for regular labor, but unlike true labor, the contractions do not grow consistently longer, stronger, and closer together, and the cervix is not dilated. Some patients present with preterm contractions, but only those who demonstrate changes in the cervix are diagnosed with preterm labor.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Difficult

12. The perinatal nurse knows that the term to describe a woman at 26 weeks gestation with a history of elevated blood pressure who presents with a urine showing 2+ protein (by dipstick) is:
a. Preeclampsia
b. Chronic hypertension
c. Gestational hypertension
d. Chronic hypertension with superimposed preeclampsia

ANS: d
Feedback
a. Preeclampsia is a multisystem, vasopressive disease process that targets the cardiovascular, hematologic, hepatic, and renal and central nervous systems.
b. Chronic hypertension is hypertension that is present and observable prior to pregnancy or hypertension that is diagnosed before the 20th week of gestation.
c. Gestational hypertension is a nonspecific term used to describe the woman who has a blood pressure elevation detected for the first time during pregnancy, without proteinuria.
d. The following criteria are necessary to establish a diagnosis of superimposed preeclampsia: hypertension and no proteinuria early in pregnancy (prior to 20 weeks gestation) and new-onset proteinuria, a sudden increase in proteinurinary excretion of 0.3 g protein or more in a 24-hour specimen, or two dipstick test results of 2+ (100 mg/dL), with the values recorded at least 4 hours apart, with no evidence of urinary tract infection; a sudden increase in blood pressure in a woman whose blood pressure has been well controlled; thrombocytopenia (platelet count lower than 100,000/mmC); and an increase in the liver enzymes alanine transaminase (ALT) or aspartate transaminase (AST) to abnormal levels.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

13. A patient is receiving magnesium sulfate for severe preeclampsia. The nurse must notify the attending physician immediately of which of the following findings?
a. Patellar and biceps reflexes of +4
b. Urinary output of 50 mL/hr
c. Respiratory rate of 10 rpm
d. Serum magnesium level of 5 mg/dL

ANS: c
Feedback
a. Magnesium sulfate has been ordered because the patient has severe pregnancy-induced hypertension. Patellar and biceps reflexes of +4 are symptoms of the disease.
b. The urinary output must be above 25 mL/hr.
c. The drop in respiratory rate may indicate that the patient is suffering from magnesium toxicity. The nurse should report the finding to the physician.
d. The therapeutic range of magnesium is 4 to 7 mg/dL.

KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Implementation | Cognitive Level: Application | Content Area: Adverse Effects/Contraindications; Antepartum Care; Potential for Alterations in Body Systems; Reduction of Risk Potential: Diagnostic Tests | Client Need: Health Promotion and Maintenance; Pharmacological and Parenteral Therapies; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Difficult

14. A woman in labor and delivery is being given subcutaneous terbutaline for preterm labor. Which of the following common medication effects would the nurse expect to see in the mother?
a. Serum potassium level increases
b. Diarrhea
c. Urticaria
d. Complaints of nervousness

ANS: d
Feedback
a. The nurse would not expect to see a rise in the mothers serum potassium levels.
b. The beta agonists are not associated with diarrhea.
c. The beta agonists are not associated with urticaria.
d. Complaints of nervousness are commonly made by women receiving subcutaneous beta agonists.

KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application | Content Area: Intrapartum Care; Pharmacological and Parenteral Therapies: Adverse Effects/Contraindications and Side Effects | Client Need: Health Promotion and Maintenance; Physiological Integrity: Pharmacological and Parenteral Therapies | Difficulty Level: Moderate

15. Which of the following signs or symptoms would the nurse expect to see in a woman with concealed abruptio placentae?
a. Increasing abdominal girth measurements
b. Profuse vaginal bleeding
c. Bradycardia with an aortic thrill
d. Hypothermia with chills

ANS: a
Feedback
a. The nurse would expect to see increasing abdominal girth measurements.
b. Profuse vaginal bleeding is rarely seen in placental abruption and is never seen when the abruption is concealed.
c. With excessive blood loss, the nurse would expect to see tachycardia.
d. The nurse would expect to see a stable temperature.

KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care; Reduction of Risk Potential: Potential for Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Moderate

16. A woman who has had no prenatal care was assessed and found to have hydramnios on admission to the labor unit and has since delivered a baby weighing 4500 grams. Which of the following complications of pregnancy likely contributed to these findings?
a. Pyelonephritis
b. Pregnancy-induced hypertension
c. Gestational diabetes
d. Abruptio placentae

ANS: c
Feedback
a. Pyelonephritis does not lead to the development of hydramnios or macrosomia.
b. Pregnancy-induced hypertension does not lead to the development of hydramnios or macrosomia.
c. Untreated gestational diabetics often have hydramnios and often deliver macrosomic babies.
d. Abruptio placentae does not lead to the development of hydramnios or macrosomia.

KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application | Content Area: Antepartum Care; Physiological Adaptation: Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Physiological Adaptation | Difficulty Level: Difficult

17. For the patient with which of the following medical problems should the nurse question a physicians order for beta agonist tocolytics?
a. Type 1 diabetes mellitus
b. Cerebral palsy
c. Myelomeningocele
d. Positive group B streptococci culture

ANS: a
Feedback
a. Beta agonists often elevate serum glucose levels. The nurse should question the order.
b. Beta agonists are not contraindicated for patients with cerebral palsy.
c. Beta agonists are not contraindicated for patients with myelomeningocele.
d. Beta agonists are not contraindicated for patients with group B streptococci.

KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Implementation | Cognitive Level: Application | Content Area: Intrapartum Care; Reduction of Risk Potential: Potential for Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Difficult

18. The nurse is caring for two laboring women. Which of the patients should be monitored most carefully for signs of placental abruption?
a. The patient with placenta previa
b. The patient whose vagina is colonized with group B streptococci
c. The patient who is hepatitis B surface antigen positive
d. The patient with eclampsia

ANS: d
Feedback
a. Patients with placenta previa are not especially high risk for placental abruption.
b. Patients colonized with group B streptococci are not especially high risk for placental abruption.
c. Patients who are hepatitis B surface antigen positive are not especially high risk for placental abruption.
d. Patients with eclampsia are high risk for placental abruption.

KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application | Content Area: Intrapartum Care; Reduction of Risk Potential: Potential for Complications | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Difficult

19. The nurse is caring for a woman at 28 weeks gestation with a history of preterm delivery. Which of the following laboratory data should the nurse carefully assess in relation to this diagnosis?
a. Human relaxin levels
b. Amniotic fluid levels
c. Alpha-fetoprotein levels
d. Fetal fibronectin levels

ANS: d
Feedback
a. Relaxin levels are rarely assessed. In addition, they are unrelated to the incidence of preterm labor.
b. Amniotic fluid levels are not directly related to the incidence of preterm labor.
c. Alpha-fetoprotein levels are not related to the incidence of preterm labor.
d. A rise in the fetal fibronectin levels in cervical secretions has been associated with preterm labor.

KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care; Reduction of Risk Potential: Laboratory Values | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Moderate

20. Which of the following statements is most appropriate for the nurse to say to a patient with a complete placenta previa?
a. During the second stage of labor you will need to bear down.
b. You should ambulate in the halls at least twice each day.
c. The doctor will likely induce your labor with oxytocin.
d. Please promptly report if you experience any bleeding or feel any back discomfort.

ANS: d
Feedback
a. This response is inappropriate. This patient will be delivered by cesarean section.
b. This response is inappropriate. Patients with placenta previa are usually on bed rest.
c. This response is inappropriate. This patient will be delivered by cesarean section.
d. Labor often begins with back pain. Labor is contraindicated for a patient with complete placenta previa.

KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

21. A woman at 32 weeks gestation is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will identify which of the following as a positive patient care outcome?
a. Rise in serum creatinine
b. Drop in serum protein
c. Resolution of thrombocytopenia
d. Resolution of polycythemia

ANS: c
Feedback
a. A rise in serum creatinine indicates that the kidneys are not effectively excreting creatinine. It is a negative outcome.
b. A drop in serum protein indicates that the kidneys are allowing protein to be excreted. This is a negative outcome.
c. Resolution of thrombocytopenia is a positive sign. It indicates that the platelet count is returning to normal.
d. Polycythemia is not related to HELLP syndrome. Rather one sees a drop in red cell and platelet counts with HELLP. A positive sign, therefore, would be a rise in the RBC count.

KEY: Integrated Process: Nursing Process: Evaluation | Cognitive Level: Application | Content Area: Antepartum Care; Physiological Adaptation: Illness Management | Client Need: Health Promotion and Maintenance; Physiological Integrity: Physiological Adaptation | Difficulty Level: Difficult

22. A 16-year-old patient is admitted to the hospital with a diagnosis of severe preeclampsia. The nurse must closely monitor the woman for which of the following?
a. High leukocyte count
b. Explosive diarrhea
c. Fractured pelvis
d. Low platelet count

ANS: d
Feedback
a. High leukocyte count is not associated with severe pregnancy-induced hypertension (PIH) or HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.
b. Explosive diarrhea is not associated with severe PIH or HELLP syndrome.
c. A fractured pelvis is not associated with severe PIH or HELLP syndrome.
d. Low platelet count is one of the signs associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.

KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care; Diagnostic Tests; Reduction of Risk Potential: Laboratory Data | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Difficult

23. A woman at 10 weeks gestation is diagnosed with gestational trophoblastic disease (hydatidiform mole). Which of the following findings would the nurse expect to see?
a. Platelet count of 550,000/mm3
b. Dark brown vaginal bleeding
c. White blood cell count 17,000/mm3
d. Macular papular rash

ANS: b
Feedback
a. The nurse would not expect to see an elevated platelet count.
b. The nurse would expect to see dark brown vaginal discharge.
c. The nurse would not expect to see an elevated white blood cell count.
d. The nurse would not expect to see a rash.

KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care; Physiological Adaptation: Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Physiological Adaptation | Difficulty Level: Difficult

24. After an education class, the nurse overhears an adolescent woman discussing safe sex practices. Which of the following comments by the young woman indicates that additional teaching about sexually transmitted infection (STI) control issues is needed?
a. I could get an STI even if I just have oral sex.
b. Girls over 16 are less likely to get STDs than younger girls.
c. The best way to prevent an STI is to use a diaphragm.
d. Girls get human immunodeficiency virus (HIV) easier than boys do.

ANS: c
Feedback
a. This statement is true. Organisms that cause sexually transmitted infections can invade the respiratory and gastrointestinal tracts.
b. This statement is true. Young women are especially high risk for becoming infected with sexually transmitted diseases.
c. This statement is untrue. The young woman needs further teaching. Condoms protect against STDs and pregnancy. In addition, condoms can be kept in readiness for whenever sex may occur spontaneously. Using condoms does not require the teen to plan to have sex. A diaphragm is not an effective infection-control method. Plus, it would require the teen to plan for intercourse.
d. This statement is true. Young women are higher risk for becoming infected with HIV than are young men.

KEY: Integrated Process: Nursing Process: Evaluation; Teaching and Learning | Cognitive Level: Application | Content Area: Disease Prevention; High Risk Behaviors; Human Sexuality | Client Need: Health Promotion and Maintenance: High Risk Behaviors; Human Sexuality | Difficulty Level: Moderate

25. A woman who is admitted to labor and delivery at 30 weeks gestation, is 1 cm dilated, and is contracting q 5 minutes. She is receiving magnesium sulfate IV piggyback. Which of the following maternal vital signs is most important for the nurse to assess each hour?
a. Temperature
b. Pulse
c. Respiratory rate
d. Blood pressure

ANS: c
Feedback
a. The temperature should be monitored, but it is not the most important vital sign.
b. The pulse rate should be monitored, but it is not the most important vital sign.
c. The respiratory rate is the most important vital sign. Respiratory depression is a sign of magnesium toxicity.
d. The blood pressure should be monitored, but it is not the most important vital sign.

KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content Area: Intrapartum Care; Potential for Complications from Pharmacological Therapies: Adverse Effects/Contraindications | Client Need: Health Promotion and Maintenance; Physiological Integrity: Pharmacological and Parenteral Therapies | Difficulty Level: Moderate

26. A primiparous woman has been admitted at 35 weeks gestation and diagnosed with HELLP syndrome. Which of the following laboratory changes is consistent with this diagnosis?
a. Hematocrit dropped to 28%.
b. Platelets increased to 300,000 cells/mm3.
c. Red blood cells increased to 5.1 million cells/mm3.
d. Sodium dropped to 132 mEq/dL.

ANS: a
Feedback
a. The nurse would expect to see a drop in the hematocrit: The H in HELLP stands for hemolysis.
b. The nurse would expect to see low platelets.
c. The nurse would expect to see hemolysis.
d. The sodium is usually unaffected in HELLP syndrome.

KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application | Content Area: Intrapartum Care; Physiological Adaptation: Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Physiological Adaptation | Difficulty Level: Moderate

27. A labor nurse is caring for a patient, 39 weeks gestation, who has been diagnosed with placenta previa. Which of the following physician orders should the nurse question?
a. Type and cross-match her blood.
b. Insert an internal fetal monitor electrode.
c. Administer an oral stool softener.
d. Assess her complete blood count.

ANS: b
Feedback
a. It would be appropriate to type and cross-match the patient for a blood transfusion.
b. This action is inappropriate. When a patient has a placenta previa, nothing should be inserted into the vagina.
c. To prevent constipation, it is appropriate for a patient to take a stool softener.
d. It is appropriate to monitor the patient for signs of anemia.

KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application
Content Area: Antepartum Care; Patient Advocacy; Potential for Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological IntegrityReduction of Risk Potential; Safe and Effective Care EnvironmentManagement of Care | Difficulty Level: Moderate

28. A type 1 diabetic patient has repeatedly experienced elevated serum glucose levels throughout her pregnancy. Which of the following complications of pregnancy would the nurse expect to see?
a. Postpartum hemorrhage
b. Neonatal hyperglycemia
c. Postpartum oliguria
d. Neonatal macrosomia

ANS: d
Feedback
a. The patient is not especially high risk for a postpartum hemorrhage.
b. The nurse would expect to see neonatal hypoglycemia, not hyperglycemia.
c. The nurse would expect to see postpartum polyuria.
d. The nurse would expect to see neonatal macrosomia.

KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application | Content Area: Antepartum Care; Physiological Adaptation: Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological IntegrityPhysiological Adaptation | Difficulty Level: Difficult

29. According to agency policy, the perinatal nurse provides the following intrapartal nursing care for the patient with preeclampsia:
a. Take the patients blood pressure every 6 hours
b. Encourage the patient to rest on her back
c. Notify the physician of urine output greater than 30 mL/hr
d. Administer magnesium sulfate according to agency policy

ANS: d
Feedback
a. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The blood pressure is taken every 1 hour or more frequently according to physician orders or institutional protocol.
b. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The patient should be encouraged to assume a side-lying position to enhance uterine perfusion.
c. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. A urine output less than 30 mL/hr is indicative of oliguria, and the physician must be notified.
d. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The nurse administers medications as ordered and should adhere to hospital protocol for a magnesium sulfate infusion.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

30. A woman who is 36 weeks pregnant presents to the labor and delivery unit with a history of congestive heart disease. Which of the following findings should the nurse report to the primary health-care practitioner?
a. Presence of chloasma
b. Presence of severe heartburn
c. 10-pound weight gain in a month
d. Patellar reflexes +1

ANS: c
Feedback
a. Chloasma is a normal pregnancy finding.
b. Heartburn is an expected finding during the third trimester.
c. The weight gain may be due to fluid retention. Fluid retention may occur in patients with pregnancy-induced hypertension and in patients with congestive heart failure. The physician should be notified.
d. Although slightly hyporeflexic, patellar reflexes of +1 are within normal limits.

KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Implementation | Cognitive Level: Application | Content Area: Antepartum Care; Reduction of Risk Potential: Potential for Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Difficult

31. Ms. M is 38 weeks gestation and is a G1 P0. At 10 pm Ms. M has just been informed by the nurse that she is 3 to 4 cm dilated, cervix is 100% effaced, and contractions are every 4 to 5 minutes. When the nurse tells her the findings from the SVE, Ms. M states that she had been contracting since early that morning and she becomes extremely frustrated stating I should have had this baby by now. What is the best response by the nurse?
a. Remind her that length of labor for the first child can be 18 to 24 hours
b. Promote relaxation techniques
c. Discuss various analgesic options
d. Tell Ms. M that the provider will be contacted immediately about the slow progress of labor

ANS: b
Women in the latent phase of labor may be frustrated with lack of progress or slow progress of labor and desire companionship and encouragement. The other responses are inappropriate. The nurse should first encourage breathing and relaxation methods as well as provide reassurance, and then contact the provider.

KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Analysis | Content Area: Intrapartum Care | Client Need: Health Promotion and MaintenanceIntrapartum Care | Difficulty Level: Difficult

32. Ms. P has delivered her first baby 30 minutes ago and the placenta delivered 15 minutes ago. She is attempting to breastfeed her newborn daughter for the first time. Which action by the nurse would NOT be appropriate?
a. The nurse is checking the BP every 15 minutes
b. The nurse is massaging the fundus vigorously
c. The nurse is auscultating the infants heart and lungs while on the mothers chest
d. The nurse is leaving the patient unattended for 30 minutes to bond with her newborn

ANS: d
During the fourth stage of labor the mothers should not be left unattended as maternal bleeding needs to be closely monitored.

KEY: Integrated Process: Safe and Effective Care Environment | Cognitive Level: Application |
Content Area: Postpartum Care | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

33. It would be most important for a nurse caring for a mother and the infant in the fourth stage of labor to do which of the following?
a. Assess and massage the fundus every 15 minutes or more often if needed
b. Massage the uterus continuously
c. Administer oxytocin per protocol
d. Assess the patient for a distended bladder
a.A, c
b.A, c, d
c.C, d
d.all of the above

ANS: b A, C, D
The fourth stage of labor immediately follows the delivery of the placenta. The nurse should be assessing the fundus every 15 minutes for position, tone, and location. The provider may order oxytocin at this stage, and the nurse should assist the woman to the bathroom if she has a distended bladder which could interfere with the contraction of the uterus.

KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application | Content Area: Postpartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Difficult

34. Mrs. H is telling you she feels the urge to push. This is most likely caused by what?
a. Low fetal station triggering the Ferguson reflex
b. A fetal position of occiput posterior (OP)
c. The second stage of labor
d. Transition phase

ANS: a
Once the cervix is fully dilated and the vertex is low in the pelvis and the woman feels the urge to push, she will involuntarily bear down. This is activated when the presenting part as it descends stretches the pelvic floor muscles and triggers the Ferguson reflex.

KEY: Integrated Process: Knowledge | Cognitive Level: Analysis | Content Area: Intrapartum Care | Client Need: Health Promotion and Maintenance: Intrapartum Care | Difficulty Level: Difficult

35. A low-risk patient calls the labor unit and says I need to come in to be checked right now, there were pink streaks on the toilet paper when I went to the bathroom. I think Im bleeding. What response should the nurse say first?
a. How much blood is there?
b. You sound concerned, what other labor symptoms do you have?
c. Dont worry that sounds like a mucus plug.
d. Does it burn when you urinate?

ANS: b
The nurse is using reflection to acknowledge the womans concerns and asks for further assessment. The womans fear must first be acknowledged and then other questions or comments can be made.

KEY: Integrated Process: Nursing Process | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Psychological Integrity | Difficulty Level: Moderate

Multiple Response

36. The perinatal nurse describes risk factors for placenta previa to the student nurse. Placenta previa risk factors include (select all that apply):
a. Cocaine use
b. Tobacco use
c. Previous caesarean birth
d. Previous use of medroxyprogesterone (Depo-Provera)

ANS: a, b, c
Feedback
a. Placenta previa may be associated with risk factors including smoking, cocaine use, a prior history of placenta previa, closely spaced pregnancies, African or Asian ethnicity, and maternal age greater than 35 years.
b. Placenta previa may be associated with risk factors including smoking, cocaine use, a prior history of placenta previa, closely spaced pregnancies, African or Asian ethnicity, and maternal age greater than 35 years.
c. Placenta previa may be associated with conditions that cause scarring of the uterus such as a prior cesarean section, multiparity, or increased maternal age.
d. Previous use of medroxyprogesterone (Depo-Provera) is not a risk factor for placenta previa.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy

37. Kerry, a 30-year-old G3 TPAL 0110 woman presents to the labor unit triage with complaints of lower abdominal cramping and urinary frequency at 30 weeks gestation. An appropriate nursing action would be to (select all that apply):
a. Assess the fetal heart rate
b. Obtain urine for culture and sensitivity
c. Assess Kerrys blood pressure and pulse
d. Palpate Kerrys abdomen for contractions

ANS: a, b, d
Feedback
a. Women experiencing preterm labor may complain of backache, pelvic aching, menstrual-like cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. The patients abdomen should be palpated to assess for contractions, and the fetuss heart rate should be monitored.
b. Women experiencing preterm labor may complain of backache, pelvic aching, menstrual-like cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. A urinalysis and urine culture and sensitivity (C & S) should be obtained on all patients who present with signs of preterm labor, and the nurse must remember that signs of UTI often mimic normal pregnancy complaints (i.e., urgency, frequency). The patients abdomen should be palpated to assess for contractions, and the fetuss heart rate should be monitored.
c. Assessment of blood pressure and pulse is not an important nursing action in this scenario.
d. Women experiencing preterm labor may complain of backache, pelvic aching, menstrual-like cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. The patients abdomen should be palpated to assess for contractions, and the fetuss heart rate should be monitored.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

38. The perinatal nurse knows that tocolytic agents are most often used to (select all that apply):
a. Prevent maternal infection
b. Prolong pregnancy to 40 weeks gestation
c. Prolong pregnancy to facilitate administration of antenatal corticosteroids
d. Allow for transport of the woman to a tertiary care facility

ANS: c, d
Feedback
a. Tocolytics are not used to treat maternal infection.
b. Tocolytics are generally only effective in delaying delivery for several days.
c. Presently, it is believed that the best reason to use tocolytic drugs is to allow an opportunity to begin the administration of antenatal corticosteroids to accelerate fetal lung maturity.
d. Delaying the birth provides time for maternal transport to a facility equipped with a neonatal intensive care unit.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy

39. The perinatal nurse provides a hospital tour for couples and families preparing for labor and birth in the future. Teaching is an important component of the tour. Information provided about preterm labor and birth prevention includes (select all that apply):
a. Encouraging regular, ongoing prenatal care
b. Reporting symptoms of urinary frequency and burning to the health-care provider
c. Coming to the labor triage unit if back pain or cramping persist or become regular
d. Lying on the right side, withholding fluids, and counting fetal movements if contractions occur every 5 minutes

ANS: a, b, c
Feedback
a. The nurse should encourage all pregnant women to obtain prenatal care and screen for vaginal and urogenital infections and treat appropriately, and remind pregnant women to call their provider repeatedly if symptoms of preterm labor occur.
b. Educating all women of childbearing age about preterm labor is a crucial component of prevention. The nurse should encourage all pregnant women to obtain prenatal care and screen for vaginal and urogenital infections and treat appropriately, and remind pregnant women to call their provider repeatedly if symptoms of preterm labor occur.
c. Educating all women of childbearing age about preterm labor is a crucial component of prevention. The nurse should encourage all pregnant women to obtain prenatal care and screen for vaginal and urogenital infections and treat appropriately, and remind pregnant women to call their provider if symptoms of preterm labor occur.
d. Lying on the right side; drinking fluids, not withholding fluids; and counting fetal movements if contractions occur every 5 minutes are recommended if a woman thinks she is contracting.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

40. The perinatal nurse describes for the new nurse the various risks associated with prolonged premature preterm rupture of membranes. These risks include (select all that apply):
a. Chorioamnionitis
b. Abruptio placentae
c. Operative birth
d. Cord prolapse

ANS: a, b, d
Even though maintaining the pregnancy to gain further fetal maturity can be beneficial, prolonged PPROM has been correlated with an increased risk of chorioamnionitis, placental abruption, and cord prolapse.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

Short Answer

41. A condition where the placenta attaches to the lower uterine segment of the uterus

ANS: Placenta previa
Refer To: Maternity Nursing Terms and Definitions

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

42. A pregnancy that ends before 20 weeks gestation

ANS: Miscarriage
Refer To: Maternity Nursing Terms and Definitions

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

43. Specks or spots in the vision where the patient cannot see; blind spots

ANS: Scotoma
Refer To: Maternity Nursing Terms and Definitions

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

44. A disease characterized by an abnormal placental development that results in the production of fluid-filled grapelike clusters and a vast proliferation of trophoblastic tissue

ANS: Hydatidiform mole/Gestational trophoblastic disease
Refer To: Perinatal Nursing Terms and Definitions

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Peds/Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

45. No expulsion of the products of conception, but bleeding and dilation of the cervix such that a pregnancy is unlikely

ANS: Inevitable abortion
Refer To: Maternity Nursing Terms and Definitions

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

46. Placement of suture to mechanically close a weak cervix

ANS: Cervical cerclage
Refer To: Maternity Nursing Terms and Definitions

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

True/False

47. The perinatal nurse observes the placental inspection by the health-care provider after birth. This examination may help to determine whether an abruption has occurred prior to or during labor.

ANS: True
Fifty percent of abruptions occur before labor and after the 30th week, 15% occur during labor, and 30% are identified only upon inspection of the placenta after delivery.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

48. It is critical for the perinatal nurse to learn, as part of the facilitys policies and procedures, to immediately perform a vaginal examination on a woman who presents with vaginal bleeding after 24 weeks gestation.

ANS: False
Placenta previa should be suspected in all patients who present with bleeding after 24 completed weeks of gestation. Because of the risk of placental perforation, vaginal examinations are not performed.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

49. The perinatal nurse knows that the survival rate for infants born at or greater than 28 to 29 gestational weeks is greater than 90%.

ANS: True
With appropriate medical care, neonatal survival dramatically improves as the gestational age increases, with over 50% of neonates surviving at 25 weeks gestation, and over 90% surviving at 28 to 29 weeks of gestation.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

Fill-in-the-Blank

50. The perinatal nurse knows that an early pregnancy loss occurs before __________ weeks, and a late pregnancy loss is one that occurs between 12 and __________ weeks.

ANS: 12; 20
Not all conceptions result in a live-born infant. Of all clinically recognized pregnancies, 10% to 20% are lost, and approximately 22% of pregnancies detected on the basis of hCG assays are lost before the appearance of any clinical signs or symptoms. By definition, an early pregnancy loss occurs before 12 weeks of gestation; a late pregnancy loss is one that occurs between 12 and 20 weeks of gestation.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy

51. Mary, a G3 TPAL 0020 woman at 20 weeks gestation, has had a transvaginal ultrasound. Mary has been informed that she has cervical incompetence. The perinatal nurse explains that this diagnosis means that her cervix has __________ without __________ contractions.

ANS: dilated; regular
Patients with cervical incompetence usually present with painless dilation and effacement of the cervix, often during the second trimester of pregnancy. The patient frequently gives a history of repeated second trimester losses with no apparent etiology. Incompetent cervix is estimated to cause approximately 15% of all second trimester losses.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

52. The perinatal nurse knows that nausea and vomiting are common in pregnancy and usually resolve by __________ weeks gestation. The severe form of this condition is __________.

ANS: 16; hyperemesis gravidarum
Feedback 1: Nausea and vomiting are a common condition of pregnancy which affect 70% to 85% of pregnant women and usually resolve by the 16th week of gestation.
Feedback 2: Hyperemesis gravidarum represents the extreme end of the nausea/vomiting spectrum in terms of severity. Criteria for the diagnosis of hyperemesis gravidarum include persistent vomiting unrelated to other causes, a measure of acute starvation (usually large ketonuria), and some discrete weight loss, most often 5% of the prepregnancy weight.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

53. The perinatal nurse explains to the student nurse who is assessing the abdomen of a 32-week pregnant woman with placenta previa that it would not be unusual to find the fetus in a __________ or __________ position.

ANS: breech; transverse
Placenta previa is an implantation of the placenta in the lower uterine segment, near or over the internal cervical os. This condition accounts for 20% of all antepartal hemorrhages. Leopold maneuvers often reveal the fetus to be in a breech or oblique position or transverse lie because of the abnormal location of the placenta.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

54. The perinatal nurse knows that a __________ hemorrhage is limited to the uterus, and a __________ hemorrhage moves blood toward and through the cervix.

ANS: concealed; revealed
Feedback 1: A concealed hemorrhage occurs in 20% of cases and describes an abruption in which the bleeding is confined within the uterine cavity. The most common abruption is associated with a revealed or external hemorrhage, where the blood dissects downward toward the cervix.
Feedback 2: The most common abruption is associated with a revealed or external hemorrhage, where the blood dissects downward toward the cervix.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy

55. The perinatal nurse encourages Colleen, who has just been discharged from the hospital for intravenous therapy for severe nausea and vomiting, to ensure that she __________ often, eats frequent, __________ meals, and avoids __________ odors.

ANS: rests; small; cooking
The nurse should counsel the woman with nausea and vomiting to avoid foods and sensory stimuli that provoke symptoms (i.e., some women become nauseous when they smell certain foods being prepared) and also to eat small, frequent meals of dry, bland foods and include high-protein snacks in their diet.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

Matching

Match the term with the definition

56. Third stage of labor
57. Transition phase
58. False labor
59. Latent phase
a. Early and slow labor. Can last up to 9 hours. Many women choose to stay home.
b. Irregular contractions, with no increase in frequency, intensity, and duration, cause little or no cervical change
c. Cervical dilation from 8 to 10 cm, contractions every 1 to 2 minutes. Woman may be panicky and irritable.
d. Occurs immediately after the delivery of the fetus. Involves the separation and delivery of the placenta. Can last up to 20 minutes.

ANS:
56. d
57. c
58. b
59. a
Third stage of labor: Begins immediately after the delivery of the fetus and involves separation and expulsion of the placenta and membranes
Transition phase: Third phase of labor; dilation to 10 cm
False labor: Irregular contractions with little or no cervical changes
Latent phase: First phase of labor; the early and slower part of labor with cervical dilation from 0 to 3 cm

KEY: Integrated Process: Knowledge | Cognitive Level: Knowledge | Content Area: Intrapartum Care | Client Need: Health Promotion and MaintenanceIntrapartum Care | Difficulty Level: Moderate

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