The 4 P's: powers, passage, passenger and psyche

Two powers of labor are: uterine contractions and mother's pushing efforts
The amount of cervical dilation is expressed in: cm. Closed at 10
The nurse should promptly report contraction durations longer than 90s or intervals
shorter than 45-50s and a frequency closer than every 2m because: reduce fetal oxygen
supply
sutures and fontanels: allows the fetal head to change shape as it passes through the
pelvis, landmarks in determining how the fetus is ariented within the mother's pelvis
during birth
The thinning of the cervix during labor is called: effacement
A woman phones the birth center and says, I think my water broke and my baby is due,
but I'm not having any contractions." The most appropriate nursing response is to tell her
that: she should come to the birth center for evaluation
Frequency: time from the beginning of one contraction until the beginning of the next
Increment: period of increasing strength of a labor contraction
False: upper flaring part of the mother's pelvis
Outlet: part of the true pelvis that is nearest the perineum
Anterior: frontal that has four suture lines leading to it
Decrement: period of decreasing strength of a labor contraction
Dilation: opening of the cervix
Lie: orientation of the fetus in relation to the mother's spine
Posterior: fontanel that has three suture lines leading into it
Inlet: upper part of the true pelvis
Presentation: fetal part that enters pelvis first
Attitude: fetal flexion or extension
True: lower portion of pelvis
Interval: relaxation period between two labor contraction
peak: period of greatest strength of a labor contraction
Lower limit fetal heart rate: 110-120
Upper limit fetal heart rate: 150-160
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During normal labor, contractions become: more frequent and of longer duration
Extension: pivoting of fetal head under the mother's symphysis pubis during labor
Internal: fetal rotation as the head turns within the mother's pelvis
Expulsion: birth of fetal shoulders and body
External: fetal rotation as the head turns to face one of the mother's thighs
Engagement: descent of the fetal presenting part to a zero station or lower
Three phases of the first stage of labor: latent, active and transition

Latent Phase: cervix dilated to 1-4 cm. Duration of 15-40 seconds

Active Phase: cervix dilated to 4-7 cm. Duration of 40-60 seconds
Transition Phase: cervix dilated to 7-10cm. Duration is 60-90 seconds
Maternal behaviors during latent phase: cooperative, alert, talkative, welcomes
diversions, urinary frequency
Maternal behaviros during active phase: apprehensive, anxious, intraverted, less
social
Maternal behaviors during transition phase: irritable, rejects support person,
introverted
Three characteristics of abnormal amniotic fluid: green-stained fluid, cloudy or yellow
fluid and offensive odor
Early decelerations: rate decreases during contractions
Variable decelerations: begin and end abruptly
Late decelerations: do not return to baseline FHR until contractions end
Which maternal position should be avoided during labor: supine
Amniotic fluid usually turns Nitrazine paper: dark blue
First: stage of labor from its onset to complete cervical dilation
Second: maternal pushing occurs during this stage of labor
Third: stage of labor from the baby's birth until delivery of the placenta
Signs of impending labor: braxton-hicks contractions, increased vaginal discharge,
bloody show, rupture of the membranes, energy spurt, weight loss
False Labor: contractions irregular, walking releives contractions, blood shou usually not
present, no change in effacement/dilation of cervix
True Labor: contractions gradually develop a regular pattern, contractiosn become
stronger and more effective with walking, discomfot in lower back/abdomen, blood show
often present, pregressive effacement and dilation of cervix

Effleurage: stroking of the abdomen, thighs or other body parts

Pain Threshold: least amount of stimulation that aperson perceives as painful
Pain Tolerance: maximum amount of pain one is willing to bear
The prepared childbirth technique that is most likely to relieve back pain during labor is:
sacral pressure
A woman is using prepared childbirth breathing techniques and complains of dizziness
and tingling. the nurse should: tell her to exhale slowly into her cupped hands
Signs and symptoms of hyperventilation: dizziness, tingling of hands and feet, cramps
and muscle spasms of hands, numbness around nose and mouth, blurring of vision
Ways to correct hyperventilation: breathe slowly, breathe into cupped hands, place a
moist washcloth over the mouth and nose while breathing, hold breath for a few seconds
before exhaling
The nurse should observe the woman who received epidural opioid narcotics for: late
respiratory depression
Signs and symptoms of hyperventilation: dizziness, tingling of hands and feet, cramps
and muscle spasms of hands, numbness around nose and mouth, blurring of vision
Factors that influence labor pain: dilation, decrease in blood, pressure from fetus,
stretching of vagina
The nurse measures the frequency of a laboring woman's contractions by noting: the time
between the beginning of one contraction and the beginning of the next.
The relaxation phase between contractions is important because the contractions can
interfere with fetal oxygenation.
The nurse recognizes the contraction duration and interval that could result in fetal
compromise is duration longer than 90 seconds, interval shorter than 60 seconds.
Vaginal examination reveals the presenting part is the infant's head, which is well flexed
on the chest. This presentation is referred to as: vertex.
When the infant is in a vertex presentation, meconium-stained amniotic fluid indicates:
fetal distress.
It is determined that the presenting part of the fetus is the buttocks. At delivery the fetus's
hips are flexed and the knees are extended. The nurse would record this presentation as:
frank breech.
At a prenatal visit, a primigravida asks the nurse how she will know her labor has started.
The nurse instructs the woman that the beginning of true labor is indicated by: regular
contractions becoming more frequent and intense.

While discussing labor and delivery during a prenatal visit, a primigravida asks the nurse
when she should go to the hospital. The nurse's most informative response would be that
the woman should come when she: thinks her membranes have ruptured.
The nurse caring for a woman in the first stage of labor reminds the patient that
contractions during this stage of labor: dilate and efface the cervix.
A woman is 7 cm dilated, and her contractions are 3 minutes apart. When she begins
cursing at her birthing coach and the nurse, the nurse assesses the most likely explanation
for the woman's change in behavior is that: labor has progressed to the transition phase.
The nurse explains that the function of contractions during the second stage of labor is to:
push the infant out of the mother's body.
The nurse explains that the third stage of labor ends with: expulsion of the placenta and
membranes.
During the fourth stage of labor, the nurse encourages the mother to void, because a full
bladder may: predispose the mother to uterine hemorrhage.
When the nurse observes the patient bearing down with contractions and crying out, "The
baby is coming!" The nurse should: stay with the woman and use the call bell to get help.
The nurse observes on the fetal monitor a pattern of a 15-beat increase in the fetal heart
rate that lasts 15 to 20 seconds. The nurse knows that this pattern is indicative of: a welloxygenated fetus.
The nurse would coach the laboring woman with a fully dilated cervix to push by saying:
"At the beginning of a contraction, take two deep breaths and push with the second
exhalation."
The most important nursing activity during the fourth stage of labor is to: assess for
hemorrhage.
One hour postdelivery the nurse notes the new mother has saturated three perineal pads.
The nurse should: check the fundus for position and firmness.
While caring for a laboring woman, the nurse notices a pattern of variable decelerations
in fetal heart rate with uterine contractions. The nurse's initial action is to: reposition the
woman to her side.
To relieve perineal bruising and edema following delivery the nurse should: place an ice
pack on the area for 12 hours.
At 1 and 5 minutes of life, a newborn's Apgar score is 9. The nurse understands that a
score of 9 indicates this newborn: is in stable condition.
The husband of a woman in labor asks, "What does it mean when the baby is at minus 1
station?" After giving an explanation, the nurse determines that teaching was effective
when the husband states the fetal head is: above the ischial spines.

The nurse caring for a patient who is not certain if she is in true labor will attempt to
stimulate cervical effacement and intensify contractions in the patient by: helping the
patient to ambulate in room.
When late decelerations occur, the nurse should: increase oxygen.
The nurse takes into consideration that the primary concern in the initial care of the
newborn is maintaining: thermoregulation.
While caring for an Arab woman in labor, the nurse should provide cultural sensitivity
through which intervention(s)? Provide for extreme modesty, Provide adequate pain
control and Respect protective amulets.
What do late decelerations indicate? A nonreassuring pattern, Uteroplacental
insufficiency and Fetal heart depression
Deliver baby within 18h after water break
Chemical substances produced in the body that act as natural pain relievers are:
endorphins.
Sacral pressure refers to firm pressure against the lower back to relieve some of the pain
of back labor.
A woman who is 6 cm dilated has the urge to push. The nurse would instruct the woman
to blow in short breaths during the contraction.
The appropriate nursing action to take when a laboring woman hyperventilates is to: help
her breathe into her cupped hands.
The risk of narcotic analgesics is that they cross the placenta and can cause fetal
respiratory depression.
Panting relaxes the abdominal wall and distracts the patient. It would not be helpful to
offer fluids or to attempt conversation during contractions. Walking intensifies
contractions.
A side effect of an epidural block is urine retention because the anesthesia interferes with
the woman's ability to have an urge to void. The patient may have to be catheterized.
Naloxone (Narcan) is used to reverse respiratory depression caused by narcotics.
A woman received a subarachnoid block before delivery. In order to prevent the
associated side effect of this type of anesthesia, the nurse would include in the teaching
plan that the patient should: lie flat for several hours.
The pudendal block does not block pain from contractions and is given just before birth.
The nurse coaches the primigravida not to bear down until the cervix is completely
dilated because premature bearing down can cause: cervical laceration.

The nurse explains that the Dick-Read method of childbirth preparation is based on:
relaxation techniques.
The nurse defines the least amount of sensation that one perceives as pain as: threshold.
A sign to alert the nurse to the need of pain relief in an uncomplaining labor patient
would be: facial grimacing.
Which are nonpharmacological forms of pain relief? Skin stimulation, Diversion and
distraction and Breathing techniques
Which position(s) and exercise(s) will the nurse teach as beneficial in combating
discomfort in the later stages of pregnancy? Pelvic rock, Tailor sitting and Shoulder
curling
major advantages of nonpharmacological pain control methods. They do not slow labor.,
They do not dull the excitement of the birth experience, They do not have the potential to
cause allergic reactions and They do not have to be delayed until labor is well
established.