Lesson 02: Self-Test - Obstetric and Newborn Care II

INSTRUCTIONS: Answer the following exercises by marking the lettered response that best answers the exercise, by completing the incomplete statement, or by writing the answer in the space(s) provided.

After you have completed all of these exercises, scroll to the end of this page and check your answers. For each exercise answered incorrectly, reread the material referenced with the solution.

1. What are the main factors involved in distinguishing between true and false labor?

______________________________ ________________________

2. Complete dilatation of the cervix is considered _________ cm.

3. There are forces involved when the cervix is dilating. These forces are called:

_______________________________________________________________

4. There are four stages involved in the labor process. Each stage is referred to with different events. Fill in the blanks identifying each event.

First stage – _____________________________________________________

Second stage – __________________________________________________

Third stage – ____________________________________________________

Fourth stage – ___________________________________________________

5. The first stage of labor is categorized with three phases. They are:

_______________________________

Special Instructions for exercises 6 through 18. Indicate whether the following statements/phrases are true or false by circling the “T” for true and “F” for false.

6. A cleansing enema is always given to the patient when she is in labor. T F

7. Normal fetal heart rate ranges from 120 to 160 beats per minute. T F

8. Rupture of the membranes is performed by the physician to induce or hasten labor. T F

9. The primigravida patient is transferred to the delivery room when her cervix is completely effaced and dilated and the head or presenting part is crowning. T F

10. The multipara patient is transferred to the delivery room when her cervix is completely effaced and dilated. T F

11. A patient who has been transferred to the delivery room can be left alone for 2 minutes. T F

12. APGAR is a method used for evaluating the condition of a newborn baby. T F

13. Oxytocin can be administered prior to delivery of the placenta. T F

14. A boggy uterus may indicate uterine atony or retained placental fragments. T F

15. The contractions of true labor produce progressive dilation and effacement of the cervix. T F

16. Show is present in false labor. T F

17. The fetus heart may increase or decrease by

40 BPM during a contraction. T F

18. A high risk patient is a candidate for continuous fetal monitoring. T F

19. Complete the chart below to indicate what happens during each factor to identify true and false labor.

FACTOR	TRUE LABOR	FALSE LABOR
Contractions
Show
Cervix
Fetal Movement

20. In which phase of the first stage of labor does the contractions become stronger and last longer, usually 45 to 60 seconds?

________________________________________________________________

21. In which phase of the first stage of labor does contractions become sharp, are more intensified, and last from 60 to 90 seconds?

________________________________________________________________

22. What are the reasons some physicians consider giving fleets?

________________________________________________________________

23. Where should you, the practical nurse, place your hands when you are palpating the patient’s contractions?

________________________________________________________________

24. Why is fetal monitoring performed?

________________________________________________________________

25. The patient being nauseated and retching, irritable and uncooperative, complains of severe discomfort, and pleas for relief are all impending signs of labor during which stage of labor?

________________________________________________________________

26. What nursing care is performed in the delivery room?

________________________________________________________________

27. The activity of the normal birthing process includes:

________________________________________________________________

28. Information to be recorded about the delivery includes:

________________________________________________________________

29. What are the characteristics of a full bladder after delivery?

________________________________________________________________

30. What nursing care is performed to the patient after delivery? List 8 of the 16 tasks.

________________________________________________________________

31. List the five factors that may extend or influence the duration of labor.

________________________________________________________________

32. If the patient’s uterus should relax after delivery, what nursing care should be given?

________________________________________________________________

33. ________ is the maternal discharge of blood, mucus, and tissue from the uterus.

34. What are the signs of placental separation?

________________________________________________________________

35. The onset of rhythmic contractions, the relaxation of the uterine smooth muscles which results in effacement or progressive thinning of the cervix, and dilation or widening of the cervix is known as:

________________________________________________________________

Lesson 02: Self-Test Answers

1. Contractions.

Show.

Cervix.

Fetal movement. (para 2-2)

2. 10 (para 2-3a)

3. Uterine contractions. (para 2-3a)

4. Dilating stage.

Delivery or expulsive stage.

Placental stage.

Recovery or stabilization stage. (para 2-3)

5. Latent (early) or prodromal.

Active or accelerated.

Transient or transitional. (para 2-3a)

6. F (para 2-5c(1))

7. T (para 2-5f(1))

8. T (para 2-5m(1))

9. T (para 2-7a)

10. T (para 2-7b)

11. F (para 2-8a)

12. T (para 2-10c)

13. F (para 2-13c)

14. T (para 2-14e(5)NOTE)

15. T (para 2-2a(1))

16. F (para 2-2b(2))

17. F (para 2-5f(1))

18. T (para 2-5f(5))

19. See chart. (para 2-2a)

FACTOR	TRUE LABOR	FALSE LABOR
Contractions	Produce progressive dilation and effacement of the cervix. Occur regularly and increase in frequency, duration, and intensity.	Do not produce progressive dilatation and effacement. Are irregular and do not increase in frequency, duration, and intensity.
Show	Is present.	Not present. May have brownish discharge which may be from vaginal exam if within the last 48 hours.
Cervix	Becomes effaced and dilates progressively.	Usually uneffaced and closed.
Fetal Movement	No significant change, even though fetus continues to move.	May intensify for a short period or it may remain the same.

20. Active or accelerated phase. (para 2-4b)

21. Transient or transitional phase. (para 2-4c)

22. Prevent fecal contamination of the perineum during delivery. Cleanse the bowel, providing more room for fetal passage. Stimulate uterine contractions. (para 2-5c(4))

23. Over the fundal area of the patient’s uterus. (para 2-5d(3))

24. To detect presence of fetal life at time of admission and to detect development of fetal distress during labor. (para 2-5f)

25. Second phase. (para 2-6a(2))

26. Never leave a patient alone nor turn your back on the perineum.

Encourage the patient to rest between contractions and to push with contractions.

Position patient’s legs in stirrups.

Prep the patient’s perineum.

Monitor the patient’s blood pressure and the fetal heart tones every 5 minutes and after each contraction. (para 2-8)

27. Crowning.

Delivery of the head.

Delivery of the anterior shoulder.

Delivery of the posterior shoulder.

Delivery of the trunk and lower body.

Clamping and cutting of the umbilical cord. (para 2-9).

28. Exact date and time of delivery.

Sex of the infant.

Condition of the infant after birth.

Position of the infant at delivery.

Type of episiotomy, lacerations.

Spontaneous or forceps delivery.

Use of oxygen and suction on the infant.

Number of vessels in the cord.

Mother’s name.

Any other pertinent facts about the delivery. (para 2-10)

29. Bulging of the lower abdomen.

Spongy feeling mass between the fundus and the pubis.

Displaced uterus from the midline, usually to the right.

Increase of lochia flow. (para 2-15i(1))

30. Any 8 of the sixteen listed. (para 2-15)

Transfer the patient from the delivery table.

Provide care of the perineum.

Transfer the patient to the recovery room.

Ensure emergency is available in the RR for possible complications.

Check fundus.

Monitor lochia flow.

Observe the mother for chills.

Monitor the mother’s vital signs and general condition.

Observe patient’s urinary bladder for distention.

Evaluate the perineal area for signs of developing edema/hematoma.

Observe for signs of hemorrhage.

Assess for ambulatory stability.

Observe C-section patients.

Instruct the patient in the proper perineal care.

Discontinue I.V.

Complete notes and transfer patient (if stable) to the ward.

31. Passenger (fetus).

Passage (birth canal).

Powers (contractions).

Placenta.

Psychology (psychological state of the woman). (para 2-16)

32. Massage the fundus until it is firm. (para 2-15e(2))

33. Lochia. (para 2-15f)

34. The uterus becomes globular in shape and firmer.

The uterus rises in the abdomen.

The umbilical cord descends three inches or more further out of the vagina.

Sudden gush of blood. (para 2-11f)

35. Labor. (para 2-1b)

Distance Learning for Medical and Nursing Professionals