I DELIVERY

ROOM
Directions: Selectthe besl answer tor each of the following questions. -l-
\t. '
Situation 1: A nurse is caring for severalclients in the delivery room who are in the tifst stage of labor.

1. A client'svaginalexaminationrevealscervicaldilationof 3 cm, 1oo%effacement, and positiveferning.Based

on theselindings,the nurseconcludesthat this clientis in whichphaseof the firststageo{ labor?
a. Latentphase phase
c. Transitional
b. Activephase d: Expulsivephase

2. Assessmentof a primigravid
clientrevealsthat her cervixis 4 cm dilatedand 100%effacedwithcontractions
occurringevery4 minutes.What phaseol laboris she in?
a, Latentphase c. Transitionalphase
b. Activephase d. Expulsivephase
'
3. When caringlor anotherclient,the nursedocumentscervicaldilationof I cm and intensecontractions
lasting
45 to 60 secondsand occurringaboutevery2 minutes.Basedon theselindings,the nurseshouldrecognize
that this clientis in whichphaseof labor?
a. Lalentphase c. Transitional phase
b. Activephase d. Expulsivephase

4. A multipara'sinitialexaminationrevealsher cervixto be at 8 cm, completelyetfaced(1OO%),

and at Ostation.
What ohaseot laboris she in?
a. Latentphase phase
c. Transitional
b, Activephase d. Expulsivephase

5. What is the shortestbut mosl difficultpartof this stage?

a. Latentphase phase
c. Transitional
b. Activephase d. Expulsivephase

Situation 2: The nurse knows that labor is the series of eventsby which uterinecontractionsand abdominat
pressure expel the fetus and placentafrom the woman,s body.

6. Laboris dividedintohow manystages?

a. Five b. Three c. Two , d. Four

. 7. The firststageof laborendswith whichof the following?

a. Whenthe clientis transferred to her postpartumbed c. Whenthe clientis fullydilated
b. Afterthe birthof the placenta d. The birthof the baby

8. What marksthe beginningof the secondstage,and what marksthe end?

a. Cervicaldilationof 7 to I cm; completecervicaldilation
b. Completecervicaldilation;deliveryof the neonate
c. Cervicaldilationof 7 to I cm; deliveryof the placenta
d. Completecervicaldilation;deliveryol the placenta

9. The thirdstageof laborbeginswithwhichof the tollowing'/

a. Whenthe clientis transferred to her oostpartumoeq
. b. Afterthe birthof the placenta
c. Whenthe clientis fullydilated
d. The birthof the babv

10. The nursecheckslor fetaldescent,flexion,internalrotation,extension,externalrotation,and expulsion.What

do thesetermsdescribe?
a. Factorsthat determinefetalposition c. Cardinalmovementsof labor
b. Factorsaffectinglabor d. Phases.ofthe firststageof'labor

Situation 3: Before going to the DeliveryBoom Area tor their clinical duty, a clinical instructor gives the
students a short quiz pertainingto the care of clients in labor.

1 1. A nulliparousclienthas been in the latentphaseof the firststageof labgrfor severalhours.Her latentphase

may be consideredprolongedafter:
a. 6 hours. b . 1 0h o u r s . c. 14hours. d, 20 hours.

12. A primigravidclientis in earlylabor.The client'scervicalexaminationwouldrevealwhichof the following?

a. 2 cm dilated;1OO%effacedat O station c. 2 cm dilated;50% effacedat +'1station
 b 4 to 5 cm dilated; 80% effaced at -1 station d. 3 cm dilated; 50% effaced at O station

13. For a client who's a primigravida,the nurse would expect that the second stage would normally last how long?
a. Approximately 2 hours c. 4 hours
tt. Lsss than t hour d. 3 hours

14. Durjnglhe secondstage,how frequentlyshouldthe nurseassessthe clienfs uterinecontractions?

a. Every5 minutes c, Every30 minutes
b. Every15 minutes d. Every60 minutes
.15.
How can the nursemostelfectivelydeterminethe durationof the client,scontractions?
a By timingthe periodbetweenone contractionand the beginningof the next contraction
b. By timingthe periodfromthe onsetof uterinetighteningto uterjnerelaxation
c. By timingthe periodfrom the increment(building-up)phaseto the acme (peak)phase
Q. By timingthe periodfromthe acme (peak)phaseto the decrement(letting:down) phase

Situation 4: A nurse is discussing Leopold's maneuversto a group of students.

16. When performingLeopold'smaneuvers,whichof the followingwouldthe nurseask the clientto do to ensure

optimalcomfortand accuracy?
a. Lie on her leftside c. Emptyher bladder
b . D r i n ka f u l lg l a s so t w a t e r d . B r e a t h ed e e p l v
'17. The
nurseperformsthe tirstmaneuverto do whichof the following?
a. ldentifythe degreeof letal descentand flexion
b. Determjnewhetherthe fetalheadis at the pelvicintet
c. Determinewhat is in the fundus
d. Locatethe tetalbackand spine

18. Whenperforming thesecondmaneuver, the nurseexplajnsthatthismaneuveris donefor whjchof the followinq

reasons?
a. To locatethe backof the fetus
b. To distinguishbetweena breechand a ceohalicoresentation
e. To locatethe fetalcephalicprominence
d. To determinewhetherthe fetalpresentingpart is engaged

19. The nurseperformsthe thirdmaneuverto do whjchof the following?

a. Determinewhetherthe fetalpresentingpart is engaged
b. Locatethe fetalcephalicprominence
c. Distinguishbetweena breechand a cephalicpresentation
d. Locatethe positionof the fetalarmsand legs

20. When performingthe fdurthmaneuver,the nurseexplainsthatthismaneuveris donefor whichof the followinq

reasons?
a. To identifythe degreeof {etaidescentand flexion
b. To determinewhetherthe fetalhead is at the pelvicinlet
c. To determinewhat is in the f undus
d. To locatethe fetalbackand spine

Situation 5: A nurse is caring for severalclientswho have preexistlngor newly acquiredillnessesand have
developedcomplicationsof pregnancy.

21. What is the primarynursingdiagnosisfor a clientwith a rupturedectopjcpregnancy?

a. Anticipatory grieving c. pain
b. Deficientfluidvolume d. Anxiety

22. The nurseis assessinga pregnantwoman.Whichsignsor symptomsindicatea hydatidiform

mole?
a. Rapidtetalhearttones
b. Abnormallyhigh humanchorionicgonadotropin(HCG)levels
c. Slow uterinegrowth
d. Lackof symptomsof pregnancy

29. A multiparousclienthas painlessvaginalbleeding.Ultrasonography showsthatan edgeof her placentameets

but doesn'toccludethe rim of the cervicalos. Thisfindingsuggests:
a. abruptioplacentae. c. a low * lyingplacenta.
b. marginalplacentaprevia. d. partialplacentaprevia.
 24. A clientis admittedto the facilityin pretermlabor.To halt her uterinecontractions,
the nurse expectsthe
physicianto prescribe:
a, betamethasone(Celestone). c. ergonovine(ErgotrateMaleate).
b. dinoprostone(Prepidil). d. ritodrine(yutopar).

25. A clienthas activegenitalherpes.Whichtype of birthshouldthe nurseanticipatefor thisclient?

a, [,4idforceps c. Induction
b. Low forceps d. Cesarean

Situation 6: A l7 - year - old primigravidis admittedto the labor unit at 39 weeks, She tells the nurse that
her physician said that she neededto be treatedtor high blood pressure.

26. Whichassessmentfindingwouldsupportthe diagnosisof pregnancy- inducedhypertension (plH)?

a. Pink- tingesputum c. Weightlossof 2 pounds
b , P r o t e i ni n t h e u r i n e d . D e p e n d e natn k l ee d e m a

27. when preparingthe roomfor admission,whichof the followingwouldthe nurseobtain?

a. Oxytocininfusionsolution c. Portableultrasoundmachine
b. Disposabletongueblades d. Paddingfor the side rails

28. Which laborroomassignmentwouldthe nursegiveto the client?

a. Closeto the nurseryso she,llmaintainhopeof a posiflveoutcome
b. In a back hallwaywherethereis a quiet,privateroom
c. Acrossfromthe nurses'stationso that she can be observedclosely
d. Nearthe elevatorso thatshe can bs transportedquickly

29 Whichof the followlngwouldalertthe nursethatthe clientmay be aboutto experiencea seizure?

a. Hyporeflexia c. Hypothermja
b. Epigastricpain d. Decreasedcontractionintensiry

30 The clientbeginsto havea seizure.The firstnursingactionby the nurseshouldbe to:

a. Insertan airway c. pad the side railsof the bed
b. callfor immediateassistance d. turn the clientto her leftside

Situation 7: MagnesiumSulfate is the drug of choice to preventeclampsia.

3'1. This drugacts as whichof the following?

a. Sedative/Hypnotic c . Antihypertensive
b. CentralNervousSystemDepressant d . PeripheralVasodilator
32. This drug is givento do whichof the following?
a. Increasediuresis c. Reducebloodpressure
b. Slowthe processof labor d. Preventseizures

33. lts actionoccursat whichof the tollowingsites?

a . N e u r a-l m u s c u l aj ru n c t i o n s c. Centralnervoussystem(CNS)
b . D i s t arl e n a tl u b u l e s d. Myocardialfibers

34. What is the therapeuticrangeof thisdrug?

a . 1 t o 4 m g / 1 0 0m L c , 9 t o 1 2 m g / 1 0 0m L
b . 5 t o 8 m g / 1 0 0m L d , 1 3 t o 1 6 m g / 1 0 0m L

35. What is the antidotefor magnesiumtoxicity?

a. Diazepam c. Calclumgluconate
b, Nifedipine d. Phenytoin

Situation 8t A client is to have a lumbar epidural block to relieve labor pain.

36 Beforeanesthesiaadministration,
the nurseinstructsthe clientto assumewhichof the followinooositions?
a. Prone c. Side_ lvino
b. Knee- to * chest d. Lithotomy

37 The nurseanticipatesthatthe anesthesiologist

will injectthe anestheticagentintothe:
a. subarachnoid space.
tr. area betweenthe subarachnoid spaceand the dura mater.
c. area betweenthe dura materand the liqamentumflavum.
d. ligamentum flavum.
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38. Whichvitalsign is mostlikelyto reflectan adverseeffectof this anesthesia?
a. Temperature c. Respiratory rate
b. Bloodpressure d. Heartrale

39. After administration

of the epiduralblock,for which of the followingwouldthe nursefrequentlyassessthe
client?
a. Relaxationof the uterus c. Hypotension i.
b. Hypeneflexia d. Spinalheadache ..\
40. Whichot the followingwouldthe nurseanticipatethat the physicianwill orderif the clientdevelopsthe most
commonadverseeffectto this anesthesia?
a. Atropinesulfate c. Epinephrine
b. I\4ethylergonovine d. Ephedrinesullate

Situatiori g: A nurse is providing care for a prihigravid client with insulin -.dependent diabetesmellitus.

41. The nurseshouldinstructthe clientthatfor mostpregnantclientswith insulin- dependentdiabetesmellitusj

a. nonstresstestingis pedormedweeklyuntil32 weeks'gestation.
b. inductionof laboris begunat 34 weeks'gestation.
c. contractionstresstestingis performedweekly.
d. weeklyfetalmovementcounlsare madeby the mother.

42. duringpregnancy.Which guidelineshouldthe nurse

The nurseis teachingher about insulinrequirements
provide?
a. "lnsulinrequirementsdon'tchangeduringpregnancy.Continueyour currentregimen."
b. "lnsulinrequirementsusuallydecreaseduringthe lasttwo trimesters."
c. "lnsulinrequirementsusuallydecreaseduringthe firsttrimester."
. d. "lnsulinrequirementsincreasegreatlyduringlabor."

43. The clientasksthe nurseif her insulin- dependentdiabetesmellituswillaffecther delivery.The nurseshould

knowthat:
a. it's too earlyto tell. c. the deliverymustbe by cesarean.
b. the motherwillcarryto termsafely. d. the deliverymay needto be inducedearly.

44. The nurseshouldexplainto the clientthat laboris usuallyinducedto preventneonatal:

a. ketoacidosis. c. stillbirth.
b. asphyxia. d. hyperglycem ia.

45. When developinga teachingplanfor the clientaboutmonitoringbloodglucosecontroland insulindosages

at home,whichof the followingwouldthe nurseexpectto includeas a desiredtargetrangefor bloodglucose
levels?
a. 140to 160 mg/dLone houraftermeals.
b. 110 to 140 mg/dl beforemealsand bedtimesnacks.
c. 60 to 100 mg/dLbeforemealsand bedtimesnacks.
d. 40 to 60 mo/dLbetween2:00 and 4:00 pM.

Situation 10: Hemorrhage is one of the most important causes of maternal mortality associated with
childbearing.

46. What is the maximumbloodlossconsideredwithinnormallimits?

a. 300mL b . 5 0 0m L c . 8 0 0m L d . 1 , 0 0 0m L

47. How much bloodis lostduringa vaginalbirth?

a. between100 mL and 300 mL c. between600 mL and 800 mL
b . b e t w e e n3 0 0m L a n d5 0 0 m L d . b e t w e e n8 0 0 m L a n d 1 , 0 0 0 m L

48. How much bloodis lostdurrnga cesareanbirth?

a . l e s st h a n5 0 0m L c . b e t w e e n1 0 0 0m L a n d 1 , 5 0 0 m L
b. between500 mL and 1, 000 mL d. gleaterthan 1, 500 mL

49. AII but whichof the followingare associatedwith earlypostpartumhemorrhage?

a. UterineAtony c. VaginalLacerations
b. CervicalLacerations d. RetainedPlacentalFragments

50. What is the most likelycauseof delayedpostpartumhemorrhage?

a. UterineAtony c. VaginalLacerations
b. CervicalLacerations d. RetainedPlacentalFraqments