Test Prep for Nursing Exam about Obstetric Nursing (1-5)

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Situation: Julia, primagravida is brought to the labor room with the following PE findings: Cervical dilation 8cm, fully effaced +1, AOG: 39-40 weeks.

1. When is the first stage of labor considered to be achieved?

a) presenting part is at station +1
b) cervix is 10 cm dilated
c) uterine contractions occur every 2-3 min. interval
d) cervix is gully effaced

2. Upon admission to the labor room, which of the following is not a routine procedure considering her cervical dilation

a) mini prep. of the perineal area
b) keep on NPO
c) monitor vital signs and FHT
d) cleansing enema

3. Which of the following observation requires the nurse to refer stat to the obstetricians?

a) frequent urination
b) blood-streak mucus in the vaginal discharge
c) sudden gush of amniotic fluid from the vagina
d) FHT is 110 during uterine contractions but returns to 130 after 10 seconds following contract

4. Which of the following signs indicate that delivery is near?

1. Julie verbalized her desire to defecate
2. uterine contractions increased in frequency duration and intensity
3. the perineum is bulging
4. bloody show is increased

a) 1,2,3,4
b) 1,2,3
c) 1,2,4

5. After the delivery of the baby, which of the following indicate placental separation?

1. protrusion of three or more inches of the umbilical cord
2. gradual descent of the uterus further into the pelvis
3. uterus becomes more firm and rounded
4. sudden spurt of blood from the vagina

a) 1,3,4
b) 1,2,4
c) 2,3,4
d) 1,2,3


ANSWERS AND RATIONALE

1) B
- First Stage/Cervical Stage - the period from onset of true labor contractions until full cervical dilation and effacement is achieved. The most important events during this time are cervical dilatation and effacement.

  • Cervical Effacement is the shortening of the cervical canal from a length of about 1 to 2 cm until it is paper thin. In primiparas, dilatation begins when cervix is completely effaced. In multiparas, dilatation and effacement takes place at the same time. Effacement is expressed in percentage.
  • Cervical dilatation refers to the enlargement or widening of cervical os. The cervix is completely dilated when its diameter is already 10 cm
Second Stage/Expulsive Stage - the stage from full cervical dilatation until the birth of the baby. The main event of this period is the birth of the baby.

Third Stage/Placental Stage - the period from delivery of the baby to the expulsion of placenta. The main event in this period is the delivery of the placenta

Fourth Stage/Immediate Postpartum Period - the period from delivery of placenta until the condition of the woman has stabilized.

2) D
- Enema - is not a routine procedure in the preparation of woman in labor. Commonly used enemas are tap water enema, fleet enema and prepacked disposable type enema. Soap suds enema is not recommended because they have been associated with several complications. Suppositories are also included.

Enema is a procedure of emptying the colon of fecal matter to:
prevent infection - expulsion of feces during the second stage predispose mother and infant infection
facilitate descent of fetus
stimulate uterine contractions

Contraindication to Enema
  • not given during active phase
  • vaginal bleeding
  • ruptured bag of water
  • abnormal fetal presentation and position
  • fetus not yet engaged
  • premature labor because of the danger of cord prolapse
  • abnormal fetal heart rate pattern
3) C
- when the bag of water has ruptured, the nurse should call the physician. Remember, the first action to take when the bag of water has ruptured is to check the FHT as the danger at this time is cord prolapse and compression.

The abnormal signs that should be reported to the physician are:
  1. Signs of fetal distress (tachycardia, bradycardia)
  2. Red stained amniotic fluid (abruptio placenta)
  3. cord prolapse
  4. Maternal tachy cardia, hypertension and hypotension (PIH)
  5. Pallor, cold clammy skin
  6. Elevated temperature, foul smelling vaginal discharge (chrioamnionitis)
  7. bleeding
Blood streaked mucus is show and it is a normal signs of labor. It is normal for a woman to have frequency of urination. It is expected for the FHT to decrease during uterine contraction. This is an effect of fetal head compression when the uterus contracts.

4) A
- all signs that delivery is near. The desire to defecate is due to the stimulation of the sacral nerves as the fecal head presses against the sacrum. Uterine contractions reach its maximum intensity during the transition and second stage of labor. The bulging of perineum is due to the fetal pushing behind it. Show is increased as the remaining operculum is dislodged by the complete dilatation of the cervix.

5) D
- the signs of placental separation usually appear within 5 minutes after baby's birth:
  • Calkin's Sign - usually the first sign of placental separation
  • the uterus becomes firm and globular rising to the level of umbilicus
  • sudden gush of blood from the vagina
  • lengthening of the cord

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